Scenario: This is a dual lead (leads V1 and V6) ECG strip of a 52-year-old man hospitalized on the cardiac telemetry unit for management of acute coronary syndromes. Upon comparison, the nurse concludes that this ECG strip is similar to the 12-lead ECG obtained after the patient’s admission to the emergency department. The patient denies having pain or symptoms, and his vital signs are stable.

Interpretation: Atrial fibrillation with developing right bundle branch block (RBBB).

Atrial fibrillation is one of the most common arrhythmias seen in clinical practice. It is characterized by disorganized electrical activity of the atrium and is recognized by irregular undulations of the baseline. In this strip, there are barely recognizable deflections in the baseline (fine fibrillation); however, atrial fibrillation may be inferred from the irregularly irregular ventricular response rate.

In the first...

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