n Cardiovascular Journal of South Africa - The William Nelson ECG Quiz

Volume 15, Issue 1
  • ISSN : 1680-0745



Extracted from text ... The answer is provided on page 37. This is the ECG of a 17-year-old male. ? Post-op repair ASD ? No Rx The ladder diagram depicts the problem: The sinus node is frequently 'sluggish' after ASD surgery and the junction has taken over. Its stimuli are conducted retrogradely to the atria, turn around and 'echo' back to the ventricles - this is called 'reciprocal rhythm'. On its return, the impulse encounters refractoriness in the left anterior fascicle and right bundle branch and is aberrantly conducted with a pattern of RBBB and LAFB. Therapy with IV atropine resulted in an increase in ..

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