The Artefact and Atrial Fibrillation: An Unholy Alliance

The most common error in ECG reporting we encounter is differentiating between sinus rhythm and atrial fibrillation particularly in poor quality tracings. Thankfully a confirmed report with this error is very rare. This is because the Techs putting the final stamp of approval on your reports are taught that:

“Atrial fibrillation with a regular ventricular response is actually sinus rhythm until proven otherwise.”— DR HARRY MOND

Such was the case with the accompanying ECG.

Our clever tech changed the rhythm strip and the diagnosis became obvious.

Sinus rhythm with first degree AV block.

We probably see at least one example each day.

Some examples:

This should be repeated but sometimes this is difficult to do.

The major footprint is QRS regularity.

The minor are the P waves.

However, this can sometimes fool you when there are atrial ectopics!!

Assoc Prof Harry Mond