Assoc Prof Harry Mond
February 23, 2026
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ECG reported as ventricular pentageminy.
What do you think?
With ventricular pentageminy, there are unifocal ventricular ectopics with fixed coupling intervals every 5th beat with 4 sinus beats between. In this ECG the coupling intervals are not fixed.
The ventricular ectopics are late (end-diastolic) and lie within the PR intervals.
The earliest ventricular ectopic commences midway through the sinus P wave (red highlight). Another ventricular ectopic (yellow highlight) commences on the downslope of the sinus P wave, whereasa third ectopic is a fusion beat (blue highlight). The time between ventricular ectopics is fixed at 3.6 seconds.
This is most likely ventricular parasystole.
Ventricular parasystole:
ECG features:
The diagnosis is always difficult, controversial and this even applies to cases in the literature.
To be absolutely sure, we need long strips.
Let us look at another ECG example this time with atrial fibrillation.
The relationship or coupling intervals of the ventricular ectopic (red vertical arrow) to the previous sinus beat (red highlight) varies.
The inter-ectopic intervals are all 1600 ms apart with one in the refractory period (blue vertical arrow).
October 16, 2026
Retrograde conduction is defined as conduction from an ectopic site to the atrium via the AV node or accessory pathway and referred to as VA conduction. II results in a P wave configuration which differs from an anterograde P wave, and in most ECG leads is inverted. The site from where the impulse originates can be the AV node, Bundle of His, distal conducting system or the body of the ventricles including ventricular pacing. On the ECG, the QRS complex usually precedes the inverted retrograde P wave but on occasion may follow it.
October 1, 2026
In 1970, I commenced work as a “novice” cardiologist at The Royal Melbourne Hospital. Training at that time was learning how to recognise the diastolic murmur of mitral stenosis and making sure the ECG and chest x-rays were the correct way up. As this was prior to coronary artery surgery, stenting and echocardiography, the ECG was a highly respected tool for the diagnosis of many conditions. I was fortunate to befriend a number of the gurus of ECG interpretation who taught me to look into the soul of an ECG. Today, even though the ECG is the first investigation performed by a cardiologist, the art of ECG interpretation has been lost because we depend on the new tools for cardiac diagnosis.
September 18, 2026
Dr Thura Thant asked for an opinion on this confusing ECG. By using arrows and highlight, the ECG bared its soul and gave me an answer. See if you can work it out? What do you think?
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