Anyone have a sample ecg strip of a crt patient with a fib?

I can't seem to find any examples online. Thanks!


7 Comments

AF ECG strips

by AgentX86 - 2021-03-08 19:13:28

Tons of them are available online.  Sometimes they're hard to read because of our pacemakers but AF is really easy to identify.  AF is a chaotic process so the timing of the heartbeats can't be predicted and completely random.

Any CRT patients out there with AF who can share an ECG strip with Asully?

by Gemita - 2021-03-09 05:31:57

Asully I have had a look online for ECGs of patients with both AF and CRT (you do like to challenge us, don’t you) and as you say it will probably require a lot of time and effort to find what you want for any further study.  I would be inclined to choose one or two of your Kardia 6L prints and either take or send to your EP for analysis.  You are quite right, EPs in the UK also are pressed for time but if I take any ECG prints in to them, they are always interested to have a quick look to rule out anything significant.  It doesn't take a good EP too long to analyse the report, does it.  Take a few in with you but only show him one or two and if he needs to see more, you can offer him more.  That is what I do.

When I was searching I came across the attached link and it seemed to suggest, if my interpretation is correct, that at 12-month follow-up, an AV node ablation for AF (atrial fibrillation) seemed to enhance any CRT response and improve overall survival of patients with HF (heart failure).  Because of the frequent co-occurrence of AF and HF, AF is often present in CRT patients and can have a significant negative impact on the CRT response. This occurs for two reasons: 1) the negative effects that AF has on HF in general; and 2) when conducted to the ventricles with an R-R interval similar or shorter than the lower pacing rate, AF completely or partially prevents biventricular pacing.  

I am not sure what your exact atrial tachyarrhythmia is (flutter, fibrillation, SVT/AT?) but I think we have mentioned previously this final, possible option of an AV node ablation to treat your fast atrial tachyarrhythmias.  I wouldn’t necessarily wish an AV node ablation on anyone but in view of your worsening EF (ejection fraction), I wonder if it would be worth considering an AV node ablation as another tool in the toolbox to prevent worsening HF, to try to help enhance CRT response and to prevent your atrial tachyarrhythmias from ever reaching/affecting your ventricles ?  The article suggests, AV node ablation remains the most practical method to achieve maximal BiV pacing in a significant proportion of patients with severe HF.  It may be a dated article Asully but one perhaps worth reading and discussing with your EP for future treatment if your EF doesn't improve quickly?  It might be worth trying before going down the route of Left Ventricular Assist Device or a Heart Transplant which I know you have been asking about.

I wish I could do more to help.  I only have dual lead ECG Reveal Linq downloads showing a variety of atrial tachyarrhythmias for myself and single (ventricular) lead ECG reports/strips for hubby who has AF, but you are asking specifically for ECGs of CRT patients with AF. 

https://www.innovationsincrm.com/cardiac-rhythm-management/2011/december-2011/165-maximizing-cardiac-resynchronization-therapy-af-patientss

 

 

Thanks Gemita

by asully - 2021-03-10 11:04:15

I have spent hours scouring for crt readings and they are difficult to find.  I wouldn't need an AV node ablation (I have complete heart block) so as I understand it none of my impulses are being sent down to the ventricles.  To put it in a humerus description I had an "accidental" av node ablation during my tricuspid replacement 5 years ago.  I already know I have SA node dysfunction, a because of my prior ablation for SVT (not-a fib).  The last two weeks I had increased palpitations and dizziness so I started taking recordings and on the beats I feel the palpitations my p waves just vanish.  It started out being around ever 5th-6th beat now (as of last night I am having runs where there is no (visible) p wave and palpitations for 8-12 beats in a row. Granted they are kardia 6L recordings so maybe there are p waves it's just not visible?  If they are there they are minuscule compared to the regular ones (which are extremely large).  Strange thing is if I hit the enhance feature I can clearly see my atrial pacing artifacts prior to where the p wave should be...but no p wave follows, then my ventricular pacemaker artifact and my QRS.  My new EP is going to have his work cut out for him I think.  I do know that somewhere around 40percent of crt patients end up developing a fib (depending on which study) after implant, so that may be what is happening.

Also.

by asully - 2021-03-10 11:05:54

I did read somewhere that in 100percent paced patients that the r-r interval does not get irregular as it does in normal patients with a fib? Curious if anyone can confirm that?

Are you sure your heart block is permanent, not "transiently" permanent?

by Gemita - 2021-03-10 14:39:34

and therefore are you absolutely confident that no atrial tachyarrhythmia like SVT, Flutter, Afib is getting through the AV node to affect your ventricles?  I would question whether a total block is 100% present at all times and would want to make absolutely sure with heart failure that this was the case.  I have seen a lot of members here who thought they were in total block only to discover that their block situation can change.

I would rather think that any arrhythmia like AF or a ventricular arrhythmia is more likely to develop because of a worsening heart or other health condition rather than be triggered by CRT pacing.  I think too after any recent heart procedure, arrhythmias can be very common until the heart settles.  I remember it was for me Asully.  I presume you have had electrolytes, thyroid and checks for other conditions done for your increased palpitations.  I note your NSVT episodes which I also get when my arrhythmias are super active.

I hope you like your new EP and that he/she answers all your questions and can help you improve your situation.   By the way did you see Atiras' post above.  I noticed he is being assessed for a Heart Transplant since I know you were wanting to get in touch with any members being considered for this procedure?

Gemita

by asully - 2021-03-10 15:13:48

Yeah I saw his post! Thanks for mentioning it.  I am positive it is CHB, during the surgery my av node was completely destroyed.  I have no underlying rhythm whenever they turn off the pacemaker which they like to do at almost every check (or at least turn it down to 30-40 and see if there is anything).  My ventricles are 100percent paced.  If any electrical stimulation is getting to them it's not through my AV node.  After surgery they had me externally paced for 3 months (well internal leads connected to external box) in hopes I might get a rhythm back but I never did.  Plus with all my recent monitoring including the 30 day mcot patch last summer I think they would have noticed if I had any natural rhythm poking through.  It is actually a good thing depending on how you look at it because my SVTs won't pass through, unless of course my pacemaker reads them and paces them (which is what was happening with the SVT I had ablated).  I just seem to be getting worse, which is what happens.  Newest item to add is >5 PVCs/min at rest.  We will see what the new EP says tomorrow.

Oh and bloodwork...

by asully - 2021-03-10 15:17:30

It's all good, they do bloodwork at least once a month sometimes more lmao!

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