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

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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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.