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Patient
75-year-old man with episodes of paroxysmal atrial fibrillation was referred because of bradycardia (measurement of a heartbeat by radial measurement by his attending physician) and possible pacemaker implantation;
Trace
This ECG shows a bradycardia; there is sinus activity with left atrial enlargement (wide P wave > 120 ms, bifid in V5, V6 and widened negative component > 40 ms in V1); repeated succession of 2 sinus beats followed by a premature atrial complexe (atrial beat in the T wave with marked modification of the pattern of this T wave); there is an atrial trigeminy; the atrial complexes are very premature and blocked (not conducted to the ventricle) explaining the bradycardia measured by radial measurement;
Exergue
Premature atrial complexes can be isolated, in pairs or in bursts with a fixed or variable coupling interval. An atrial bigeminy corresponds to the alternation between a complex of sinus origin and a premature atrial complex. There is trigeminy when a premature atrial complex repeatedly occurs after two complexes of sinus origin.
This patient presented blocked premature atrial complexes leading to a bradycardia diagnosed by pulse measurement. It is thus an elevated automaticity disorder and not a conduction disorder.