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Ectopic Atrial Rhythm

Image 2 of 2 in Series "Intermittent Ectopic Atrial Rhythm"

Description

The patient’s second ECG shows that sinus rhythm has spontaneously restored, as evidenced by upright p-waves in both inferior (II, III, aVF) and lateral leads (V4-V6). This indicates that electrical activity is originating superiorly in the right atrium and moving right to left, which creates positive deflections in the inferior and lateral leads and is consistent with an origin in the sinus node. The self-resolving nature of these findings suggests that the patient may be experiencing paroxysmal, self-limited, focal ectopic atrial rhythm.

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This image is part of the series "Intermittent Ectopic Atrial Rhythm"

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Ectopic Atrial Rhythm

by: Charlotte M. Greenway; Joe B. Calkins, Jr., M.D.

The patient’s first ECG demonstrates a normal heart rate of ~80 bpm as well as p-waves that precede narrow QRS complexes at intervals consistently <210 ms, indicating that the cardiac electrical rhythm is originating from one focus within the atria and being conducted through an intact AV node and His-Purkinje system. However, the p-waves are noted to be inverted in inferior leads II, III and aVF, which reveals that this is not sinus rhythm but rather an ectopic atrial rhythm originating from a low focus within the atria, thereby causing negative deflections in inferior leads. Additionally, p-waves are inverted in lateral leads V4-V6, suggesting that depolarization is flowing left to right across the atria.