Assoc Prof Harry Mond
February 23, 2026
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32 year-old one legged ballerina with acute gout in the amputated leg.
Overnight tracings from Holter monitor recording. There is a pause (red highlight).
What do you think?
The top tracing is Wenckebach second degree AV block.
There is an increasing PR interval (red horizontal arrows) and 2:1 AV block. Such findings are common in the young overnight and are the result of vagal hypertonia.
What is the significance of the two non-conducted P waves?
The first non-conducted P wave (red highlight) times out as a sinus P wave. The second is a non-conducted atrial ectopic, structurally different from the sinus P waves
The timing of the non-conducted atrial ectopic (yellow highlight) can be before or after the non-conducted sinus P wave (red highlight), even in the same patient.
It’s all in the timing.
September 11, 2026
Fusion beats are an amalgam of two competing rhythms within the same chamber, atrial or ventricular. They are not “abnormal” beats and are a lesson in timing. For fusion beats to occur, two foci must commence propagation at or near the same time and both contribute to chamber depolarization. Both must be either atrial or ventricular and depending on the contribution of each, the resultant progeny have similarities to one or both parents.Â
August 26, 2026
Is this the impossible pacemaker ECG? It took me a while to work out what was going on. Is it pacemaker malfunction?‍ What do you think?
July 24, 2026
I came upon these ECG tracings of ventricular tachycardia from a Holter study in a 79-year old asymptomatic female. What do you think?
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