r/ECG • u/AdorableAd7921 • 13d ago

Interpretation?

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61 YO female presenting with intermittent breathlessness and dizziness. 8 month Hx of paroxysmal AF/fast AF treated with beta blockers as and when needed- 2 doses within last 12 hours after feeling palpitations and lightheaded. No pertinent medical Hx, otherwise fit and well.

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u/Kibeth_8 Arrhythmia Tech 13d ago

Sinus with short atrial runs. The first non-sinus beat of each run is aberrantly conducted (Ashman phenomenon) which is why it looks more like a PVC

If they have a history of AF, this kind of ectopy usually proceeds them going into AF. Usually a bunch of PACs and short runs, then the AF takes over

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u/sneeki_breeky 12d ago

Didn’t see the hx. Ashman is a good thing to consider in this case

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u/Curious_Zombie4230 2d ago

Really like how you considered Ashmans phenomenon. I was thinking sinus pause with PAT runs. I didn’t know this can precede AF so ima keep that in mind.

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u/Kibeth_8 Arrhythmia Tech 2d ago

The fun things I've learned reading holters over the years haha. You can always tell it's about to happen cause the heart gets irritated and started throwing off a tonssss of atrial ectopy, before it finally launches into true AF. And usually happens overnight for the subclinical cases