tag:blogger.com,1999:blog-549949223388475481.post2841026316242635034..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: Beware Automated Interpretations of Atrial Fibrillation!Unknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-549949223388475481.post-32009750955574718862018-12-16T17:02:01.012-06:002018-12-16T17:02:01.012-06:00Thank you so much for all of this information! It ...Thank you so much for all of this information! It was very useful in defining atrial tachycardia! I used this blog for my health exam, so thank you very much for all of your hard work and effort!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-72267049331862004552017-08-14T08:12:22.083-05:002017-08-14T08:12:22.083-05:00Great points. Thanks, Ken!Great points. Thanks, Ken!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-78523521933780611732017-08-13T12:02:45.338-05:002017-08-13T12:02:45.338-05:00GREAT clinical example by Dr. Smith! I’d add the f...GREAT clinical example by Dr. Smith! I’d add the following points: i) There are some things that computerized interpretations are good, or even excellent with. However, there are other things for which computerized interpretations are less good (if not poor) for. In my experience — ANY rhythm other than sinus on a computerized report needs to be carefully checked by the treating clinician; ii) If the clinician sees that the computerized interpretation of a rhythm is erroneous — then it is his/her responsibility to CROSS OUT the computerized interpretation, and to write in his/her corrected rhythm interpretation. iii) One of the most underused concepts in rhythm interpretation — is appreciation of the information that simultaneously-recorded leads can provide. As per Dr. Smith, despite loss of the P wave for the 7th and 8th beats in this tracing — a quick glance at simultaneously recorded leads V1,V2 PROVES that there IS still ongoing atrial activity. iv) I’m not convinced that there is another atrial focus for the last 2 beats on this tracing — as the marked underlying baseline artifact undulations make me uncertain if P wave morphology really changes for these last 2 beats — and since the lead switch is after beat #8 — looking at simultaneously-recorded leads V4,5,6 does not really help. v) In addition to the difference in heart rate — another essential difference for making the distinction between MAT vs WAP (Wandering Atrial Pacemaker) — is that there is beat-to-beat variation in both P wave morphology AND the PR interval with MAT — whereas with WAP, there is gradual variation in which you’ll see similar shapes (and similar PR intervals) for several beats in a row — and then the P wave shape will change. vi) Technically, one needs to see at least 3 different P wave morphologies in order to ensure a diagnosis of “WAP”. As per point v), I’m not convinced we yet have this. This emphasizes the clinical reality that most of the time, a significantly longer period of monitoring is needed to make a verified diagnosis of wandering atrial pacemaker. vii) In my experience, the diagnosis of MAT vs sinus rhythm with either wandering pacemaker and/or multiple PACs are all points on a SPECTRUM. Many patients “fail to read the textbook” — and it is common to see rhythm strips that don’t completely fit all criteria for any of these 3 diagnoses … In such cases, clinical setting may help in distinguishing (ie, a longstanding history of pulmonary disease favors MAT). viii) Although true that most cases of WAP are benign — as with almost everything else in ECG interpretation, Clinical Correlation is the KEY. So, the above rhythm might not necessarily be benign if it was recorded from an older adults with a history of weakness and blackouts — in which case the initial sinus bradycardia and arrhythmia could be among the rhythms associated with sick sinus syndrome. Bottom Line — GREAT illustrative case of many important concepts in arrhythmia interpretation. Thanks to Dr. Smith for presenting this!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com