The presence of multiple P wave morphologies indicates multiple ectopic pacemakers within the atria and/or AV junction. If ≥ 3 different P wave morphologies are seen, then multifocal atrial rhythm is diagnosed:

The presence of multiple P wave morphologies indicates multiple ectopic pacemakers within the atria and/or AV junction. If ≥ 3 different P wave morphologies are seen, then multifocal atrial rhythm is diagnosed:

Atrial abnormalities are most easily seen in the inferior leads (II, III and aVF) and lead V1, as the P waves are most prominent in these leads.

Atrial abnormalities are most easily seen in the inferior leads (II, III and aVF) and lead V1, as the P waves are most prominent in these leads.

If ≥ 3 different P wave morphologies are seen and the rate is ≥ 100, then multifocal atrial tachycardia (MAT) is diagnosed:

If ≥ 3 different P wave morphologies are seen and the rate is ≥ 100, then multifocal atrial tachycardia (MAT) is diagnosed:

We therefore interpret this tracing as showing “AV dissociation” – since at least some P waves are unrelated to the QRS complexes that follow them. The term AV dissociation should never be used as a “diagnosis” per se.  Instead – it is the result of the underlying rhythm on the tracing.  In this case – the underlying rhythm is sinus bradycardia at a rate of 50/minute (the P-P interval is precisely 6 large boxes in duration for each of the P waves on this tracing). AV dissociation occurs by…

We therefore interpret this tracing as showing “AV dissociation” – since at least some P waves are unrelated to the QRS complexes that follow them. The term AV dissociation should never be used as a “diagnosis” per se. Instead – it is the result of the underlying rhythm on the tracing. In this case – the underlying rhythm is sinus bradycardia at a rate of 50/minute (the P-P interval is precisely 6 large boxes in duration for each of the P waves on this tracing). AV dissociation occurs by…

Special+Investigations+In+Cardiology:+Radiology+And+Electrocardiography+(ECG)

Special Investigations In Cardiology: Radiology And Electrocardiography (ECG)

Special+Investigations+In+Cardiology:+Radiology+And+Electrocardiography+(ECG)

[What are those funny looking beats????]{Frank G. Yanowitz, M.D.}The differential diagnosis of funny-looking-beats, or FLB's, primarily considers beats of supraventricular origin with aberrant conduction and ventricular ectopic beats. In this example the two FLB's have an easily seen ectopic P wave before them; therefore these are PAC's with RBBB aberration.

[What are those funny looking beats????]{Frank G. Yanowitz, M.D.}The differential diagnosis of funny-looking-beats, or FLB's, primarily considers beats of supraventricular origin with aberrant conduction and ventricular ectopic beats. In this example the two FLB's have an easily seen ectopic P wave before them; therefore these are PAC's with RBBB aberration.

Junctional Rhythms: P wave might be present, absent, buried in QRS or present after the QRS (RETROGRADE CONDUCTION)

Junctional Rhythms: P wave might be present, absent, buried in QRS or present after the QRS (RETROGRADE CONDUCTION)

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