Sinus Rhythm with Wide QRS

Kardia flagged my most recent ekg as Sinus Rhythm with Wide QRS. I've attached it here. It's the first time I've seen the Kardia say this. I've had tachycardia, unclassified and afib over the last couple of weeks but this is the first Sinus Rhythm with Wide QRS.

Is there any reason to be concerned about this? My rate was 99 during this ekg, so I'm wondering if it were 1 or so beats higher at 100+ if it would of just said Tachycardia? I don't think there is a tachycardia With wide QRS? I don't know if Amiodarone can cause a wide QRS? I am 3 weeks out of surgery and I've had the Kardia tell me just about everything except Bradycardia. I know the heart can do erratic things in the blanking period but being this is the first time I've seen NSR with Wide QRS I figured it can't hurt to ask If this should be a concern.

I don't have the experience here, although I was on Amiodarone for eight weeks two years ago. However, it seems that a wide QRS is often associated with right bundle branch block. This might not be a compelling issue, particularly if the results show NSR consistently, but it's definitely worth a fly-past of your cardiologist.

I did read a wide QRS can be from a bundle branch block. The thing is in my case unless a bundle branch block can develop immediately I don't think that would be the case as I've had multiple Echos in the last few weeks and none mentioned a bundle branch block. If a bundle branch block can come out of nowhere within hours or days then that may be a possibility here. I guess this is one more thing to discuss with my EP among many. Definitely getting lots of different EKGs the last few weeks that's for sure.

That's not wide enough to be of concern. An echo can't see BBB, and I don't think there's any here. Show it to your EP but I think you can safely ignore it in the meantime.

I've noticed, if I'm not pristine about my form holding the Kardia for the reading, that I can get a wide QRS reading. On repeat, it is usually normal if I pay close attention to not moving & etc while doing the reading.

Thanks again for all the responses. I'm glad to hear that doesn't appear wide enough to be of concern. I do 1 to 3 EKGs a day and that's the first time I've seen that classification.

I will see what Kardia says later tonight and over the next few weeks but even if I were in NSR my rate is much higher then it was the first week post surgery and I'm essentially on the same medications. My rate in NSR was right at 60bpm and now it's almost always in the mid 80s to low 100s no matter what. I haven't seen a rate in the 60s in two solid weeks regardless of what classification the Kardia has so something changed from week 1 to the last two weeks to increase my rate over 20bpm. For the first full week post surgery I was in NSR every time I checked and my rate was right around 60bpm. The last 2 weeks whether it's flutter or NSR or afib or tachycardia or Sinus rhythm with wide QRS the rate hasn't been under 80 once and averages 85bpm.

85bpm is still alright but as mentioned, something changed from week 1 to week 3 to increase my rate 20-30+bpm regardless of what classification Kardia gives.



Edited 2 time(s). Last edit at 03/23/2024 10:16PM by cornerbax.

I can’t read an ECG to comment but there was a period when I got a lot of Sinus Rhythm with wide QRS and it was when Flecainide was giving me heart block. So, yes, just another topic to discuss with your EP. And George is right, keep an eye on your form when holding the Kardia.

Quote

Does amiodarone affect QRS duration?
Amiodarone's effect on QRS duration is between that of the IB and IA agents consistent with its tau rec of 1.5 seconds. Moricizine's effects on QRS duration are more marked than would be expected from its tau rec of 2.6 seconds but may be explained by the slow onset of inactivation block.

@ Daisy,

In this case I was sitting at a table very still and didn't move at all. I don't think there is much or any noise/static in the EKG?
Being that flecainide caused a wide QRS for you I wonder If amiodarone is doing the same. Carey mentioned it isn't wide enough to be of concern and I'll see what the EKGs over the next few weeks look like.

@Joe,

Thank you for your response I'm not sure what any of that means though.



Edited 1 time(s). Last edit at 03/23/2024 10:59PM by cornerbax.

Taking a Kardia reading 3 times a day would just cause me a lot of stress! I do not mean to be ignorant. I have a Kardia and have not used it for 2 months now and I can feel my AFib without taking a reading. I used it in the beginning to send to my EP but he said he has seen enough and I am scheduled for an Ablation.

Why are you checking your Kardia 3 times a day? I think Calvin's right that that's just going to create stress. Do you feel okay? Pulse feels normal? Then why check your Kardia? I think you're getting kind of obsessive about it and I've seen a lot of that here. It just creates stress and anxiety. You've posted a whole lot of recordings and almost all of them have been unremarkable and not anything for you to be worrying about. Ease up on yourself, buddy, and put the Kardia away until you feel symptoms of some sort.

@Calvin/Carey

I've had my kardia for over a year and probably took a hand full of ekgs when I was in afib 100% of the time. Over a year and prior to my surgery I almost never took an ekg and never posted one here or anywhere. I had robotic mitral valve repair surgery and a CryoMaze procedure 3 weeks ago so I am intentionally trying to get an idea of what my ekgs look like during the blanking period.

The first week I was in NSR 100% of the time. The second week I had some arrythmias and a much higher heart rate. My metoprolol was increased to 100mg total at 50mg twice a day and since the increase my average resting heart rate is around 85bpm. However, I am typically in tachycardia or possible flutter most of the time.

No matter whether it's afib, flutter, tachycardia or sinus rhythm I have no symptoms at all. No dizziness or fatigue or shortness of breath. I don't even feel my heart beat AT ALL. I feel very fortunate to be asymptomatic. I can't tell flutter from NSR from tachycardia at all. I have no symptoms with any of it. I just know to get my EF increased I likely need to be in NSR more often than not so I have been much more focused on my ekgs during this blanking period.

With that said though I agree at this point over three weeks as crazy as all the different ekgs have been it's to be expected during the healing process so I'll wait until the 60 day plus window and just hope I'm in NSR routinely.



Edited 2 time(s). Last edit at 03/24/2024 03:44AM by cornerbax.

I've had Sinus Rythum Wide QRS for about 4 years now, no clinical significance!

Did you get the wide QRS one time or more often? I got that message numerous times over several weeks. Each time the ECG was sent in for evaluation, and on three occasions, the person agreed with the Kardia, and recommended a 10 lead for evaluation. I got two ECG from my local urgent care, both showing IVCD because of my LAFB. Both said to check for ischemia, and one said a probable septal infarction.

My cardiologist ordered a cardiac PET scan, where the ECG showed an abnormal QRS-T angle. Possible primary T wave abnormality. PET shows one area of probable infarction. R wave axis has changed from -45 to +5 degrees (50 degrees from previous ECG in December). Changes to other timing as well.

It can be insignificant as others have stated, but not always so.