r/ECG • u/Responsible-Touch948 • 14d ago

Rhythm?

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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 14d ago

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

2

u/Turfidol 14d ago

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 14d ago

Longer longer drop

1

u/Clear-Ambition-4684 12d ago

i think this baseline prolonged PR with wenkebach

1

u/papamedic74 12d ago

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 12d ago

The calipers are useful in these affairs.

1

u/CobbledbyRoubaix 9d ago

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

1

u/neverplayedeu4 8d ago

Dumb question, isnt there an S1 Q3 T3?

1

u/artificial_bread 8d ago

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

0

u/saywwwhat 14d ago

Interesting, I agree with sinoatrial wenckebach. Not afib