There is an underlying sinus bradycardia (atrial rate 55/min) but with a simultaneous accelerated junctional rhythm (discharge rate 80/min). Most beats are junctional but there are also sinus capture beats (‘C’), producing incomplete AV dissociation. There is no AV block.

Not particularly difficult but good for practising rigorous, systematic analysis. What is the rhythm? #ECG

What are the two main findings present here?

I have never seen these two uncommon findings, co-exist on the same ECG.

#epeeps

Note the deterioration in P wave morphology.

ECGs are 2.5 years apart and represent a worsening delay of atrial conduction (inter-atrial block - IAB).

Elderly female complaining of palpitations and fainting. IAB often predisposes patients to AF, symptoms may correlate with PAF.

A case where a PAC triggers a short run of WAP 🤔

Middle-aged female with palpitations and chest tightness (but asymptomatic during ECG)

Lead reversals and electrode misplacement can cause alterations in morphology, leading to erroneous interpretation.

This is the first time that I have seen it obscure rhythm analysis.

LA ↔️ RL hiding atrial activity, but if you look carefully, you can still see 2:1 conduction

x.com/Arron_Pearce_/…

Here is a fascinating EKG of a 70 years male who was gasping and was intubated I! What’s your take? #CardioTwitter #ECG #FOAMed Sam Ghali, M.D. Amal Mattu Stephen W. Smith Dr Razi 🫀EcgOxford ECGs Andreas Roeschl, MD Nanashī 🫀 Pendell Meyers the EMCrit Crew Faheem Younus, MD