Atrial or Ventricular Fibrillation?

Report:

Top:

Atrial fibrillation with third degree AV block, or ventricular fibrillation

Ventricular standstill

Middle:

Atrial fibrillation

Third degree AV block

Junctional rhythm 68/min

Bottom:

Sinus rhythm 98/min

Third degree AV block

Junctional rhythm 37/min

Comment:

It has been said - I cannot recall the reference - that only two rhythms can be diagnosed as certainly ventricular in origin: ventricular fibrillation and the electrical pacemaker rhythm. This case leaves the paced rhythm as the only one140. What happened in Casualty was lead 2 monitoring where the QRS complexes were beyond recognition and she was given adrenaline and shocked. VF was never there, AF persisted, but a new lead told the staff they were “successful”. In a sense, they were – but it’s the adrenaline that’s done it, making her pulses palpable.

The 12-lead ECG of this patient and her unhealthy conduction system, taken upon arrival to ICU, is shown below (Fig 204a).

204a. On a monitor lead 2 one can easily imagine the QRS complex swamped. That is what happened, in a profoundly hypotensive patient.

205. 42 year old man with congestive cardiomyopathy following myocarditis three months previously. Treatment included frusemide 200 mg, spironolactone 150 mg and captopril 75 mg daily; upon admission, he was started on dobutamine infusion. He was not digitalised.