Pay Bill

Resources Library

Clinical case studies

Is this artefact?

This week MD Assoc Prof H Mond examines the similarities between the characteristics of artefact vs non-atrioventricular Wenckebach blocks and the importance of recognising footprints for correct diagnosis.

Read more
Clinical case studies

Rate dependent bundle branch block

Exploring another ventricular aberration this week, we look at rate dependent bundle branch block, its defining characteristics, a number of important differential diagnoses and how to avoid serious misdiagnosis.

Read more
Clinical case studies

Sino-atrial Wenckebach

With a pause about twice the cycle length of the R to R intervals and no P, QRS or T waves, this case tackles one of the most difficult explanations in ECG interpretation and demands a revisit to the fundamentals or “footprints” of Wenckebach AV...

Read more
Clinical case studies

The bizarre atrioventricular (AV) delay

In this first of his Fun With ECG series, our MD Assoc Prof Harry Mond looks at this bizarre atrioventricular (AV) delay. Look closely at the ECG. The AV delay timings don’t make sense. The AV delay for atrial sensing/ventricular pacing (As Vp) is always...

Read more
Clinical case studies

Interpreting the Holter monitor rate histogram

In this rare case, we see two very unusual and critical factors that together lead to atrial oversensing and “apparent” violation of the lower rate limit; a very narrow zone of open atrial sensing and far-field R wave sensing. While the first time MD Assoc...

Read more
Clinical case studies

Non-physiologic atrial pacing

First thoughts on this Holter tracing was artefact, but the native rhythm showed a regular pattern of irregularity! Taking a close look at overnight tracings when the rhythm would be slow and the “artefact” less likely, revealed what was really going on. In this case...

Read more
Medical Papers

The electrocardiographic interpretation of pacemaker algorithms enabling...

Cardiac pacing from the apex of the right ventricle has been shown to result in left ventricular dysfunction, atrial fibrillation and increased mortality. To counter this, one of the strategies developed, is to avoid ventricular pacing when not necessary, using programmable algorithms to minimize ventricular...

Read more
Clinical case studies

Vagal hypertonia in 44-year old male

The Holter monitor tracings of a 44-year old male caused a lot of excitement at Cardiac Monitoring Service this week. With 12 bradycardia episodes overnight, it was initially considered Wenckebach AV block. While clinically, rather than visually, correct, it nevertheless, did not fulfil the footprints...

Read more
Clinical case studies

Mode switching: Fast and slow pacing

Seen for the first time, the pattern in this 24hr histogram gives instantly recognisable clues about what is happening, even without looking at the tracings. Normally, we see a diurnal pattern of rate changes during the day with lower rates at night, but rarely a...

Read more