Assoc Prof Harry Mond
March 12, 2025
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36-year old scorpion breeder with “funny” beats in the chest when being stung.
What do you think?
Sinus rhythm, atrial trigeminy with aberration and interpolation
You all got that correct. There is a wonderland of atrial ectopy patterns, provided you keep your eyes open. Let us review some of these patterns.
Trigeminy (red highlight), but no interpolation. Ectopic P wave (red arrow).
A little more complicated.
Sinus arrest; junctional rhythm with bifascicular block and atrial bigeminy (red highlight). This is a pan-conduction defect. Because the ectopics are very premature, the effective heart rate is 30 bpm.
Sinus rhythm (red arrows) with atrial trigeminy (red highlight). A more shorter coupling interval with bigeminy is conducted with aberration (yellow highlight). Also think of long-short intervals.
Sinus rhythm (red arrows) with atrial bigeminy. There are varying coupling intervals resulting in a range of conduction patterns. Normal conduction (red highlight). Left (yellow highlight)and right (blue highlight) bundle branch block aberration.
A Wenckebach AV block sequence can also occur with atrial bigeminy.
It’s all in the timing.
July 9, 2026
No tricks. Just a selection of tracings from a Holter study.Look at each one carefully, use calipers, arrows and highlight and write down your conclusions.
July 2, 2026
I came across these two tracings from the same patient during Holter reporting. Do you agree with the reported diagnoses?
June 26, 2026
I was asked to review this Holter monitor, the report of which stated: “Sinus rhythm, ventricular rate ~ 90 bpm, Wenckebach AV block”. What do you think?
