What does this ecg look like to you? I know there are some highly knowledgeable members here. I'm just curious what the thoughts are on what this ecg looks like? The heart rate was 115bpm it cut off on the screenshot. https://www.afibbers.org/forum/read.php?9,191422,191422#msg-191422 Sat, 19 Sep 2026 23:26:08 +0000 Phorum 5.2.23 https://www.afibbers.org/forum/read.php?9,191422,191511#msg-191511 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191511#msg-191511
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P.S. I send you a PM—link is in the line with your username at the top.

I just saw it and responded. Thanks, Daisy.]]> cornerbax AFIBBERS FORUM Thu, 06 Jul 2023 00:09:35 +0000 https://www.afibbers.org/forum/read.php?9,191422,191509#msg-191509 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191509#msg-191509
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cornerbax
Between this and the Starship Enterprise state of art facility/technology, I almost want to go even if I didn't have Heart Arrythmias...lol

On my second visit (for a Watchman) I had the presence of mind to ask about different pieces of equipment and what role each of the many who were busily prepping me played in the procedure. Too bad we don’t get to stay awake and watch! I you are interested, there are videos of Natale performing ablations on YouTube and also a tour when the new labs opened.

P.S. I send you a PM—link is in the line with your username at the top.]]> Daisy AFIBBERS FORUM Wed, 05 Jul 2023 21:46:58 +0000 https://www.afibbers.org/forum/read.php?9,191422,191508#msg-191508 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191508#msg-191508
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They have 6 of those incredible labs! And, everything is on one floor so Dr. Natale just has to walk a few hundred steps to visit patients in their rooms—which he does do. I never waited for more than a few seconds when I pressed the call button for a nurse—really excellent care.


Between this and the Starship Enterprise state of art facility/technology, I almost want to go even if I didn't have Heart Arrythmias...lol]]> cornerbax AFIBBERS FORUM Wed, 05 Jul 2023 20:52:24 +0000 https://www.afibbers.org/forum/read.php?9,191422,191507#msg-191507 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191507#msg-191507
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cornerbax
Those pictures look incredible and I'm sold. I'm going with PFA and in Austin only. I don't care about convenience, it isn't like i'm buying a pair of shoes. From everything i've read I have to go with PFA.

They have 6 of those incredible labs! And, everything is on one floor so Dr. Natale just has to walk a few hundred steps to visit patients in their rooms—which he does do. I never waited for more than a few seconds when I pressed the call button for a nurse—really excellent care.]]> Daisy AFIBBERS FORUM Wed, 05 Jul 2023 20:43:09 +0000 https://www.afibbers.org/forum/read.php?9,191422,191506#msg-191506 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191506#msg-191506 Carey AFIBBERS FORUM Wed, 05 Jul 2023 20:20:15 +0000 https://www.afibbers.org/forum/read.php?9,191422,191505#msg-191505 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191505#msg-191505 cornerbax AFIBBERS FORUM Wed, 05 Jul 2023 19:46:16 +0000 https://www.afibbers.org/forum/read.php?9,191422,191504#msg-191504 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191504#msg-191504
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cornerbax
One question Carey, do you think the Texas location over the Thousand Oaks location is better for a PFA ABLATION? I'm actually very close to Thousand Oaks but i've read that the Imaging equipment may be better in Texas? I've worked 6 days a week for the last 10 years, sometimes 7, so it may actually be nice to get away for a few days anyway. Just curious your thoughts on Thousand Oaks vs. Texas for a PFA ablation with Dr. Natale?

I would go to Austin. Not only is the imaging better, pretty much everything is better. They built an entirely new EP lab in 2019 and got all the latest whiz bang toys and gadgets. Everything is new. The place looks like the bridge of the Starship Enterprise. I got a tour when they were almost finished with construction, which you can view here.

I don't know if Thousand Oaks is a teaching hospital, but St. David's isn't, so you're guaranteed there won't be any fellows doing any of the procedure because there aren't any fellows. Also, all rooms are private, the food is the best hospital food I've ever had (and I've had a lot since getting food from hospital cafeterias is common practice for EMS personnel). And I must say the staff is the nicest, most competent I've ever encountered.

That said, if you can get PFA in one location but not the other, I would choose the PFA.]]> Carey AFIBBERS FORUM Wed, 05 Jul 2023 18:41:08 +0000 https://www.afibbers.org/forum/read.php?9,191422,191501#msg-191501 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191501#msg-191501
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Without doing something more than what you're doing now? No, probably not.

I've been where you are now with the NSR + bigeminal PACs. It would last for weeks, and then just as my brain was adjusting and beginning to filter out the PACs and not notice them, they would stop. But then a few days later they would start again but my brain had reset and I was noticing every single one of them again.

Sounds to me like you're on the right track with your thinking and planning, so keep doing what you're doing

I figured there wasn't a great chance to get into NSR but at least my heart rate is down much better than it was. I feel absolutely no fluttering/skipped beats in this NSR with PACS so I definitely prefer this over AFIB/AFLUTTER. Either way, I need to get into NSR sooner vs. later so I'll await Dr. Natale's review of my medical records and the MVP.

One question Carey, do you think the Texas location over the Thousand Oaks location is better for a PFA ABLATION? I'm actually very close to Thousand Oaks but i've read that the Imaging equipment may be better in Texas? I've worked 6 days a week for the last 10 years, sometimes 7, so it may actually be nice to get away for a few days anyway. Just curious your thoughts on Thousand Oaks vs. Texas for a PFA ablation with Dr. Natale?]]> cornerbax AFIBBERS FORUM Wed, 05 Jul 2023 17:21:44 +0000 https://www.afibbers.org/forum/read.php?9,191422,191498#msg-191498 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191498#msg-191498 Pompon AFIBBERS FORUM Wed, 05 Jul 2023 12:52:41 +0000 https://www.afibbers.org/forum/read.php?9,191422,191496#msg-191496 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191496#msg-191496
NSR this morning- right hand thumb to left V4. Good p wave:


This is the tachogram of the above, provided by Kardia. It is an unusual presentation. The heart rate y axis is on the right side. Increasing going down. The scaling is unusual as it is based on the RR time in seconds, a linear scale on the left side, increasing going up.


This is afib. No p waves.


This is the tachogram. The variability is very apparent, especially when you look at the right y scale. Note as the rate goes higher, the scale is compressed.
]]> GeorgeN AFIBBERS FORUM Wed, 05 Jul 2023 12:26:37 +0000 https://www.afibbers.org/forum/read.php?9,191422,191494#msg-191494 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191494#msg-191494
I agree with the comments saying those are bigeminal PACs. I'm used to this kind of disorder: those PACs are often annoying, but mostly harmless. And they usually don't lead to AFib. Depending on the way you feel them, you may think your heart is beating half as slowly as it is really beating. I mean you may feel "heavy" normal beats and barely feel the discrete PACs (except if you take your pulses with your fingers).
I've lots of ECG tracings like this.

The device I make use of is not a Kardia, but a HealForce Prince; but it can be used the same way (between hands - between right hand and left leg - between right hand and torso). I guess the built in hardware and software may give better or worse printings, the processing (filtering) being different.
I can't see clear "P" waves on the tracing you got from V4 position; but I've pretty good results that way. As my ectopics are PACs as well as PVCs (don't ask why they come and go, I'm searching for years and still don't know), the V4 location allows the PACs to be displayed "positive" (QRS pointing upwards - no P wave) and the PVCs mostly "negative" (wider QRS pointing downwards - no P wave). There may be ectopics somewhere "in between", often hard to say of what kind they are, but sure they're ectopics (no P waves).
Normal beats have clear P waves displayed.]]> Pompon AFIBBERS FORUM Wed, 05 Jul 2023 07:47:16 +0000 https://www.afibbers.org/forum/read.php?9,191422,191493#msg-191493 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191493#msg-191493
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cornerbax
I'm the meantime, do you think there's a chance I'll get into normal sinus rhythm without Pacs?

Without doing something more than what you're doing now? No, probably not.

I've been where you are now with the NSR + bigeminal PACs. It would last for weeks, and then just as my brain was adjusting and beginning to filter out the PACs and not notice them, they would stop. But then a few days later they would start again but my brain had reset and I was noticing every single one of them again.

Sounds to me like you're on the right track with your thinking and planning, so keep doing what you're doing.]]> Carey AFIBBERS FORUM Wed, 05 Jul 2023 05:28:16 +0000 https://www.afibbers.org/forum/read.php?9,191422,191492#msg-191492 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191492#msg-191492
In the meantime I'll continue to monitor my resting and daily heart rates on the increased Diltiazem. As of a week in I've had zero side effects and a much lower overall heart rate, in addition to potentially being in NSR with PACS. If there's a better chance to revert to NSR from where I am not vs Aflutter or AFIB hopefully I will.]]> cornerbax AFIBBERS FORUM Wed, 05 Jul 2023 03:41:06 +0000 https://www.afibbers.org/forum/read.php?9,191422,191491#msg-191491 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191491#msg-191491
All the while ALL of them were MASSIVELY pushing ablation. I read people pretty well and I can genuinely say these "doctors" were more salesmen than doctor. I do understand the importance of ablation but these doctors were not wanting to even see if I ever got back in sinus rhythm on my own or with medication. I'm sure ablations pay much more than writing prescriptions but it's very unfortunate there are people who may of gotten ablations and who with time WOULD of gotten into sinus rhythm on their own if they were given the opportunity.

Regardless, I am working with Dr. Natalie's office as of last week and he will review all of my medical records when he is back next week. I did want to say to you that it may be no coincidence after many months on sotalol and diltiazem where I seemed to be in aflutter most of the time and where my resting heart rate was almost always over 100-115.

If you remember my post regarding those medications I did lots of research and didn't even consult my EP. I just increased Diltiazem 120mg on my own. I didn't do this blindly but I figured if 240mg of sotalol and 240mg of diltiazem wasn't slowing my heart and where I read up to 540mg diltiazem can be taken daily I couldn't see how another 120mg of diltiazem to 360mg a day would do any harm in my case. It seems Bradycardia is the biggest concern with sotalol and diltiazem and I was closer to tachycardia even with 480mg combined between the two.

Within a week of continuing 240mg of sotalol at 120mg twice a day and going to 360mg of diltiazem extended release once a day my resting heart rate has dropped at least 25-30bpm on average. I will consult my EP or even Dr Natale when he gets back next week via Norma who has been exceptional. I will inform them of the change and see their thoughts.

I'm the meantime, do you think there's a chance I'll get into normal sinus rhythm without Pacs?]]> cornerbax AFIBBERS FORUM Wed, 05 Jul 2023 03:16:47 +0000 https://www.afibbers.org/forum/read.php?9,191422,191490#msg-191490 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191490#msg-191490
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cornerbax
With that said, does that change anything I should discuss with my EP on medication or potential ablation?

No, not really. All that's relevant here is you're experiencing a lot of PACs. It will be kind of a "duly noted" thing for your EP and it doesn't change decisions. The conversation needs to be continue drug therapy or go for an ablation, and currently the guidelines say choose ablation. Drug therapy will not work forever and ablations get harder the longer you wait. But, on the other hand, it might be worth waiting for PFA to become widely available if you can.

The only thing I would caution against is letting your EP do an ablation unless they're very highly experienced with thousands of afib ablations under their belt. Don't feel compelled to stay with them out of loyalty or whatever. It's way too important a choice to base on a misplaced sense of loyalty.]]> Carey AFIBBERS FORUM Wed, 05 Jul 2023 03:01:07 +0000 https://www.afibbers.org/forum/read.php?9,191422,191488#msg-191488 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191488#msg-191488
With that said, does that change anything I should discuss with my EP on medication or potential ablation?]]> cornerbax AFIBBERS FORUM Wed, 05 Jul 2023 02:14:51 +0000 https://www.afibbers.org/forum/read.php?9,191422,191487#msg-191487 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191487#msg-191487
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cornerbax
I don't know what I was thinking. I just used my right hand and right thumb on one contact and placed the other contact in the V4 location as shown on the diagram. I've attached a screenshot of the ecg. Any better idea now of what the ecg shows?

Still hard to tell. I think I'm seeing a P wave on some of the beats in the first line. & yes, your device works fine for this.

I think it still looks like NSR with bigeminal PACs. I'm guessing the easy thing is if the rate is low, you are likely in NSR (of course with PACs at the moment).]]> GeorgeN AFIBBERS FORUM Wed, 05 Jul 2023 02:07:03 +0000 https://www.afibbers.org/forum/read.php?9,191422,191482#msg-191482 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191482#msg-191482 cornerbax AFIBBERS FORUM Wed, 05 Jul 2023 01:09:26 +0000 https://www.afibbers.org/forum/read.php?9,191422,191480#msg-191480 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191480#msg-191480
Also, is it normal to alternate between NSR with Pacs and either Aflutter and Afib? If I am regularly in NSR with PACS would different medication be better and would am ablation still be beneficial assuming I never go into complete Normal sinus rhythm without any PACS?]]> cornerbax AFIBBERS FORUM Wed, 05 Jul 2023 00:48:12 +0000 https://www.afibbers.org/forum/read.php?9,191422,191479#msg-191479 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191479#msg-191479
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cornerbax
Is NSR with bigeminal PACs any relation to AFIB/AFLUTTER?
No

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Is it better or worse that I would have NSR with bigeminal PACs, VS. AFIB or AFLUTTER?

Better! It is NSR!! Note your heart rate. If you are in NSR then lots of things are better.

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@George, thank you. I can pay for a subscription but I don't want to get obsessive with ECG's. I was just curious after 4 months or so on Sotalol and Diltiazem what the ECG reflected. I don't have the 6L KARDIA, that is just the 1 lead Kardia and I put the first two fingers on each of the contacts to get the ECG.

Single lead is fine for looking at P waves


Per Pompom's comment
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Pompom
Did you try with the left contact on the V4 location ?
.

I decided to do a search on contact locations to maximize the P wave amplitude. Came up with this paper. One comment is that most ECG contact locations are set to maximize visualization of the ventricular data.

Figure 9 shows the V4 location (on p6 of the PDF).



So what you can try is holding the Kardia with your right thumb on the contact, then place the contact on the V4 location (doesn't have to be perfect!) as shown in the image and see what you get. I've not played with this yet.]]> GeorgeN AFIBBERS FORUM Wed, 05 Jul 2023 00:15:23 +0000 https://www.afibbers.org/forum/read.php?9,191422,191477#msg-191477 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191477#msg-191477
@George, thank you. I can pay for a subscription but I don't want to get obsessive with ECG's. I was just curious after 4 months or so on Sotalol and Diltiazem what the ECG reflected. I don't have the 6L KARDIA, that is just the 1 lead Kardia and I put the first two fingers on each of the contacts to get the ECG.

Anyone have any thoughts on NSR with bigeminal PACs vs. Afib/Aflutter?]]> cornerbax AFIBBERS FORUM Tue, 04 Jul 2023 23:49:36 +0000 https://www.afibbers.org/forum/read.php?9,191422,191473#msg-191473 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191473#msg-191473
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GeorgeN
I think I'm seeing "p" waves on the second ECG (the small waveform just before the QRS waveform). If you hold your Kardia with your right thumb on the contact, then place the left contact either around your left knee (or somewhere on your left leg) or to the left of and a bit below your navel on your belly. This will give you a Lead II presentation which gives a better representation of the p wave. Absence of a p wave is an indicator of afib.

Did you try with the left contact on the V4 location ?
That's the way I usually do. P waves are clear too.]]> Pompon AFIBBERS FORUM Tue, 04 Jul 2023 18:25:19 +0000 https://www.afibbers.org/forum/read.php?9,191422,191468#msg-191468 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191468#msg-191468 Carey AFIBBERS FORUM Tue, 04 Jul 2023 15:43:15 +0000 https://www.afibbers.org/forum/read.php?9,191422,191466#msg-191466 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191466#msg-191466 "p" waves on the second ECG (the small waveform just before the QRS waveform). If you hold your Kardia with your right thumb on the contact, then place the left contact either around your left knee (or somewhere on your left leg) or to the left of and a bit below your navel on your belly. This will give you a Lead II presentation which gives a better representation of the p wave. Absence of a p wave is an indicator of afib.]]> GeorgeN AFIBBERS FORUM Tue, 04 Jul 2023 11:27:11 +0000 https://www.afibbers.org/forum/read.php?9,191422,191464#msg-191464 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191464#msg-191464
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cornerbax
Interesting. Very often I get the tachycardia reading and it's always at a heart rate of 110-120 so I'm sure that's likely flutter. Any thoughts on the ecg I attached reflects?

This 2nd EGC you submitted looks to me like NSR with PAC's every other beat (Atrial Bigeminy).]]> The Anti-Fib AFIBBERS FORUM Tue, 04 Jul 2023 09:33:18 +0000 https://www.afibbers.org/forum/read.php?9,191422,191458#msg-191458 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191458#msg-191458
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cornerbax
What is interesting is that my heart rate is usually around 100 and between 115 at rest, but for some reason today it's lower on average. I just did an ECG with Kardia and it shows 67 BPM but it shows as "UNCLASSIFIED" which i'm guessing is because Kardia will only detect certain rhythm's.

I don't have the 6L, just the standard Kardia.

Do you happen to subscribe to their KardiaCare subscription plan? If so, their PDF report has a heart rate vs time graph. It is a little screwy as the primary Y axis is based on RR time in ms, which makes the heart rate side inverted and also has kind of a logarithmic look to it. The reason I ask is that sometimes it is easier to see patterns on a HR vs. time graph. NSR with PACs is pretty obvious in this format, as is afib. Whereas looking at the ECG, it just looks variable. If you don't have the subscription, I can describe how to do it manually, just takes a little effort.]]> GeorgeN AFIBBERS FORUM Tue, 04 Jul 2023 02:06:06 +0000 https://www.afibbers.org/forum/read.php?9,191422,191453#msg-191453 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191453#msg-191453 cornerbax AFIBBERS FORUM Tue, 04 Jul 2023 00:22:51 +0000 https://www.afibbers.org/forum/read.php?9,191422,191450#msg-191450 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191450#msg-191450
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cornerbax
What is interesting is that my heart rate is usually around 100 and between 115 at rest, but for some reason today it's lower on average. I just did an ECG with Kardia and it shows 67BPM but it shows as "UNCLASSIFIED" which i'm guessing is because Kardia will only detect certain rhythm's.

I don't have the 6L, just the standard Kardia.

Unclassified often means a mixture of an NSR and PACs, which confuses it. It does detect six arrhythmias but not flutter, which it usually tags as tachycardia.]]> Daisy AFIBBERS FORUM Tue, 04 Jul 2023 00:10:09 +0000 https://www.afibbers.org/forum/read.php?9,191422,191449#msg-191449 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191449#msg-191449
I don't have the 6L, just the standard Kardia.]]> cornerbax AFIBBERS FORUM Mon, 03 Jul 2023 23:51:54 +0000 https://www.afibbers.org/forum/read.php?9,191422,191439#msg-191439 Re: What does this ecg look like to you? https://www.afibbers.org/forum/read.php?9,191422,191439#msg-191439 mjamesone AFIBBERS FORUM Mon, 03 Jul 2023 21:51:40 +0000