What is the pattern of QRS complexes in rhythm strip of this ecg?
Main differential of such a rhythm would be sinus arrhythmia, Mobitz type II block, Atrial premature beats, Sinus arrhythmia is unlikely because, in sinus arrhythmia, the rate usually gradually slows and then gradually speeds up. There is no prolongation of PR interval as in mobitz type II block. Now have a look at p wave morphology of three beats in every group and the compensatory pause after it:
Are you thinking Atrial Trigeminy?
YES, you nailed it. If we notice the p wave morphology of every third beat its slightly different from the preceding p waves, and also its occurring earlier, compensatory pause after it and then restoration of sinus p wave in next cycle. So these are definitely Atrial Ectopics. Every third beat is atrial premature beat so pattern is Trigeminy.
These arise from ectopic pacemaking tissue within the atria. There is an abnormal P wave, usually followed by a normal QRS complex. PACs have the following features:
PACs may be either:
PACs often occur in repeating patterns:
Frequent or symptomatic PACs may occur due to:
J Electrocardiol. 1978 Apr;11(2):185-9. Concealed atrial bigeminy and trigeminy.Levy MN, Kerin N, Rubenfire M.
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