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ECG library

Atrial fibrillation with slow ventricular response

core

An 81-year-old on three AV-nodal agents, brought in after a fall.

25 mm/s · 10 mm/mV · synthetic tracing
100%
IIIIIIaVRaVLaVFV1V2V3V4V5V6
II (rhythm)
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.

Key findings

  • Irregular bradycardia without P waves
  • Pauses on the strip

Learning points

  • The first intervention is usually the medication list, not a pacemaker.
  • A perfectly regular slow rhythm in known AF is different and worse: suspect complete block with a junctional escape.

Connected