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Clinical case studies

The Wandering Atrial Pacemaker

As a rare find Wandering Atrial Pacemaker can be mistaken for marked sinus arrhythmia with unifocal atrial ectopics. Here, we look at the tell-tale characteristics that set them apart in another interesting case study by Medical Director Dr Harry Mond.

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Medical Papers

Underutilization of Ambulatory ECG Monitoring After Stroke and Transient Ischemic Attack

Atrial fibrillation (AF) is the leading cardiac cause of stroke. and its identification after a stroke or transient ischemic attack (TIA) is important for guiding secondary prevention management. However, paroxysmal AF frequently goes undetected and untreated if sufficient ECG monitoring is not performed. This study underscores the need for clinicians and policymakers to address the gap between recent evidence regarding the effectiveness of ECG monitoring for AF detection and real-world practices.

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Clinical case studies

Isorhythmic AV dissociation with idioventricular rhythm

A recent ECG was reported as sinus rhythm with intermittent bundle branch block – but this diagnosis was incorrect. CardioScan’s Medical Director Dr Harry Mond discusses the identifying factors in the ECG, and how he reached his diagnosis of an idioventricular rhythm with isorhythmic AV dissociation.

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Medical Papers

The Electrocardiographic Footprints of Atrial Ectopy

The term ectopic means ‘‘out of place” or ‘‘abnormal position” and, in relation to the heart, refers to an early heartbeat, whose origin is from a focus other than the sinus node. They increase in frequency with age and are generally innocent, unless there is an underlying cause. The ECG footprints of atrial ectopy are prematurity and a non-sinus P wave morphology. Additionally, variable AV conduction, post-ectopic compensatory (or otherwise) pauses and QRS widening due to aberrant conduction may all be observed and all should be considered, when interpreting this common electrophysiology phenomenon.

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Medical Papers

The Electrocardiographic Footprints of Ventricular Ectopy

The term ectopic means “out of place” or “abnormal position” and, in relation to the heart, refers to an early or premature heartbeat, whose origin is from a focus other than the sinus node. Ventricular ectopics originate from an irritable focus within the ventricles and clinically they may be asymptomatic or described by the patient as an “extra” beat, “missed” beat or irregular pulse. Ventricular ectopics may occur in groups including bigeminy, trigeminy, couplets and triplets. Very frequent ventricular ectopics may result in a potentially reversible ectopy-mediated cardiomyopathy.

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Clinical case studies

The atrial compensatory pause

Compensatory pauses often follow atrial ectopics, but they can cause some confusion. In his latest case study, our Medical Director Dr Harry Mond clarifies the different types of compensatory pauses that can occur, as well as the typical characteristics of each compensatory pause as they present on an ECG.

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Medical Papers

One vs three channels – Ambulatory ECG Holter Monitor results

As the technology surrounding Holter monitors continues to evolve, more options becomes available – including Holters with multi-channels, versus one channel patch Holter monitors. Our Medical Director, Dr Harry Mond, looks at the differences between one channel and multi-channel Holter monitors, and which is better for improving confidence in the diagnosis of arrhythmia.

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Medical Papers

Arrhythmic indications for ambulatory ECG monitoring

A cardiac arrhythmia is a rhythm disturbance of the heart which may require investigation using ambulatory electrocardiographic (ECG) monitoring. This may be a 24 hour or greater (Holter) or medium term (events and telemetry) recording which can be up to 30 days. Longer term recording is available as an implantable loop recorder which may last for up to two years. Access the full resource via the link.

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Medical Papers

Non-arrhythmic indications for ambulatory Holter ECG monitoring

There are a number of computerized packages that can measure Holter ECG recordings over a 24 or shorter period. They require high quality tracings and despite being available in a Holter monitor report, none have been found to be useful in routine medical management. Access the full resource via the link.

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