Atrial Fibrillation??

Re: Atrial Fibrillation??

Anthony Todd — Thu, 29 Jan 2015 17:40:33 GMT

[quote user="alex gough"]I just don't think what we are seeing here so far proves it either way.[/quote]

As I said, look at other leads and/or change the leg position until you get a nice clear big P wave.

P waves occur in all leads after all.

Re: Atrial Fibrillation??

Anthony Todd — Thu, 29 Jan 2015 10:17:29 GMT

[quote user="Tom Ward"] I shall report back[/quote]

In the horse P waves can be very small but if you move the front legs they change completely.

Other leads, particularly the chest leads can give enormous P waves so other leads and moving the leads can give you larger definite P waves, in the dog too.

Probably be definitive in this trace. I used to do it to get a defined P-R interval if the P wave ending was vague.

Re: Atrial Fibrillation??

Tom Ward — Wed, 28 Jan 2015 18:24:07 GMT

thanks so much for your help! I've booked the dog in for another auscultation and repeat ecg (going to admit him this time so can do it in a more controlled environment than a consultation!). I shall report back!

Thanks again!

Re: Atrial Fibrillation??

Alex Gough — Sat, 24 Jan 2015 23:05:58 GMT

Yep I agree. Could be AF with a slow rate, see that sometimes, I just don't think what we are seeing here so far proves it either way. I've also seen a number of dogs that have been sent to me for ECG to investigate their arrhythmia and they simply have a sinus arrhythmia, (at least at the time I have ECGd them!) so normal dogs can sound like they have arrhythmias.

Re: Atrial Fibrillation??

Anonymous — Sat, 24 Jan 2015 22:00:26 GMT

If this lead was taken at 50mm/sec then the ventricular rate is ~140/minute.

I admit it would be unusual to see a dog with Afib with a normal HR (normal being 70-160 bpm in my book) but it is not unheard of (I actually saw an Irish Wolfhound with afib and a HR of 120 not so long ago, but I suppose they "suffer" from lone afib).

If you get a 6 (or at least 3) lead reading, you can compare these and see if there are really not any P waves.

What made me agree to the diagnosis of afib were the comments I made above and that the dog had an irregular HR on ausculation...

Re: Atrial Fibrillation??

Alex Gough — Sat, 24 Jan 2015 20:24:57 GMT

I'm afraid I'm not convinced. If the heart rate is 140 (I havent worked it out from your trace) then the rate seems a bit low for AF, and the bit you showed isn't particularly irregular. To me it looks like sinus arrhythmia with baseline artefact from tremor. These are the criteria for AF:

Electrocardiographic Diagnosis

l. The heart rate is usually rapid, exceeding 180 beats per minute in the dog and 240 beats per minute in the cat.

2. The rhythm is irregular, although at rapid rates it may appear to be more regular.

3. There are no P waves or P-R intervals. In atrial fibrillation small or fibrillatory (f) waves take the place of the P waves, and are seen as undulations in the baseline. They represent the chaotic electrical activity of the fibrillating atria. Occasionally these f waves may be large enough to resemble the sawtooth flutter waves of atrial flutter. The term " fibrillo-flutter" or "flutter-fibrillation" is then used.

4. The QRS complexes appear to be fairly normal, although they usually indicate ventricular enlargement. Frequently they will vary slightly in size and shape due to aberrant ventricular conduction, especially when the ventricular response rate exceeds 200 beats per minute. The QRS complexes can occasionally be wide and bizarre, associated with coexisting bundle branch block. S-T segment and T -wave changes are also frequently present.

Try getting a longer trace with 6 leads. I'm not saying this definitely isn't AF but I would need some more convincing than what you have shown here.

Sorry to be a pain!

Alex

Re: Atrial Fibrillation??

Tom Ward — Sat, 24 Jan 2015 19:50:16 GMT

Thank you both for your reply - It's always nice to know I'm not just making stuff up sometimes!

Re: Atrial Fibrillation??

Anonymous — Fri, 23 Jan 2015 21:12:10 GMT

I agree, you cannot see any P waves, the RR interval is irregular and at ~140bpm, the RR interval should be pretty much bang on time! I guess this dog should go for echocardiography....

Re: Atrial Fibrillation??

John Flynn — Fri, 23 Jan 2015 20:21:07 GMT

[quote user="Tom Ward"]atrial fibrillation[/quote]

you've convinced me :-)