Recently I had to analyze the Holter ECG blinded from 2 patients as an expert examination. It was only known that ECG №1 from female patient 36 years, ECG №2 - from patient 40 years, male.Two different atrial potential attended the entire period of HM. What could be clinically?
What these findings on an electrocardiogram can be?
Hi, Michael. Yes I agree with you: on ECG-1 there are signs of RBBB evidently? But for some reason there are two atrial rhythm? Why two P waves are present here? Тhink about it...
Hi,
Peace and blessings!
Thank you very much for sharing those interesting and challenging ECGs.
In both tracings, I see p-wave-like deflections that appear to be wandering on the ECG, whereas a p-wave with a regular PR-segment is clear.
In the upper tracing, the p-wave-like deflection has a regular interval, and almost coincides with the one preceding the ectopic beat, at the base of the T-wave. Additionally, the PR segment of the fixed p-wave preceding the QRS complex is stable and short (< 110 ms) and I do not see a clear sign of pre-excitation in any of the three leads.
In the lower tracing, the interval between the p-wave-like deflections seems to decay, and is virtually stable in the last three beats. The PR segment of the fixed p-wave preceding the QRS complex is stable and normal, although in the lower normal range (about 130 ms).
Well, I consider two possibilities: 1st) Most probably, those are tracings of receptors of orthotopic heart transplantation, in which part of the right atrium of the receptor was left in place during transplantation. Thus, a receptor originated (remaining right atrium) p-wave lives together on the same ECG with donor's heart originated p-wave. Clinical history will confirm or exclude.
2nd) Less probably, those could be cases of advanced interatrial block. I have seen one or two in the past, and, quite frankly, those on both tracings have not the presentation I would expect in this particular hypothesis.
Best regards.
Hi
ECG 1 clearly shows two independent sets of P waves. The conducted P waves have a short PR interval (no delta wave) with a compensatory pause post ectopic. The non-conducted P waves measure out as regular and are unaffected by the superventricular ectopic. The most likely explanation is orthotic heart transplant. Interatrial block seems unlikely.
ECG 2 is a bit of a puzzle. The varying appearance of the early "P" wave may be due to respiratory changes in electrical axis (the cycle time seems right for this) it could be that . Could these be atypical U waves?
Hi,
in my opinion, both of them could had been receptors of orthotopic heart transplantation.
greetings
in the 1th strip - first small deflexion is like to ectopic non-conducted P wave. It is visible too behind 2dn P-QRS-T, then it make "fusion" P wave than is like two-peaks P befor 5th QRS complex and last small deflexion in end of strip...
if it's an artifact or an ectopic P wave'm not sure
in the 2nd strip - U wave?
Dear colleagues, thank you all for your attention, interest and assistance. To be clear, both of these ECGs were performed in cardiac transplant patients (orthotopic heart transplantation, biatrial technique). Lower-Shumway technique (atrioatrial anastomosis) is the most frequently used technique for orthotopic heart transplantation and such a patient has two right atria and two sinus nodes. ECG interpretation link below
Best regards.
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