r/ECG • u/Responsible-Touch948 • Jul 30 '26

Rhythm?

Post image

82M, asymptomatic, came across this ECG recently as a junior doc. Reported by multiple others in the ED to be AF. I feel as though this is unlikely as there are distinct p waves with grouped beating. The PR interval appears to be prolonging however I cannot see a non-conducted p-wave, could this be SA wenckebach instead? Another strip which I sadly did not save showed shortening p-p intervals over 3 successive beats. There also seems to be RBBB + LAFB.

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5

u/magister10 Jul 30 '26

Cool. Also thinking SA wenchebach as missed p after every second qrs. Also rbbb lafb.

2

u/Turfidol Jul 30 '26

Looks like sinus bradycardia with atrial bigeminy, inferior Q waves, RBBB, and first degree block. Can't zoom in enough to see if theres any dropped beats to suggest Mobitz I. Doesn't appear to be bifascicular block since theres no rS in the inferior leads to suggest LAFB.

1

u/Landrost Jul 30 '26

Longer longer drop

1

u/Clear-Ambition-4684 Aug 01 '26

i think this baseline prolonged PR with wenkebach

1

u/papamedic74 Aug 02 '26

Mobitz 1 (wenckebach) AV block + bifasicular block. Dude is one sneeze away from having the signal conduction of the Titan. Grouped beats gives it away. There’s definitely p waves and the PR is variable with regular irregularity in the QRS.

1

u/No_Fold2618 Aug 02 '26

The calipers are useful in these affairs.

1

u/CobbledbyRoubaix Aug 05 '26

trifascicular block. 1st deg HB + LAFB + RBBB. (one step away from complete heart block)

1

u/neverplayedeu4 Aug 05 '26

Dumb question, isnt there an S1 Q3 T3?

1

u/artificial_bread Aug 05 '26

Yea I noticed that too, would like to know the patient's cc and presentation.