Premature Beats -- Atrial with Aberrancy or Ventricular... How to Tell FOR SURE!

This ChalkTalk is for beginners and expert ECG readers alike! I discuss how you can tell whether these premature beats are PVCs or PACs with aberrancy. Understanding the physiology is the key to learning the BETTER WAY to Read ECGs. You can find other great video lessons at ECGAcademy.com
Make sure to watch for my NEW ANNOUNCEMENT soon!! ECG Academy will be breaking new ground in the world of Online ECG Training... we'll be providing the one thing missing from all other internet courses... stay tuned!!
Nicholas Tullo, MD, FACC, FHRS
ECG Academy

[@ECGDoc]

Don't forget to watch for my BIG ANNOUNCEMENT next week!

[@spacefed101]

Awesome. stuff!!!

[@ahmeddaoud9901]

Interesting. Thanks alot 😊👍

[@ECGDoc]

Glad you liked it!

[@ahmeddaoud9901]

Excellent

[@5omethingsBetterThanNothing]

FANTASTIC

[@ECGDoc]

Thank you! I'm glad you enjoyed my video!

[@weebleapplesmooooo]

at around 4:10, are you suggesting that the right bundle branch naturally repolarizes later than the left branches?

[@harshkumar1078]

What if you don't have APC interval to compare with that wide complex in question...

[@healtheducation2257]

Well thanks doc..but we can expect PAC with that long pause ?

[@xxrobodave]

Also, the QRS vector for the PVC begins in completely the opposite direction. To have this happen it would almost certainly be because the overall vector of deplorarisation is in the opposite direction. With an aberrant PAC you would expect the initial deflection to be in the same direction as the intrinsic as begins to travel for HIS before it hits a refractory bundle.

[@ECGDoc]

That can be a very useful clue, but doesn't always apply. In some leads, the aberrant beat might not have the same initial deflection. For example, in V1 there is usually a small R-wave, but in LBBB aberrancy the R-wave disappears and you have a QS pattern.

[@xxrobodave]

@@ECGDoc fair point and thanks for the prompt reply. What about lead II? Looking at 12 lead ECG's, if there is RBBB or LBBB it would appear there is the same general initial inflection in that lead compared to sinus QRS. I only ask, as single lead holters sometimes use only a lead II set up as the only lead and unless I'm mistaken, for this lead, a complete opposite QRS initial deflection can assist in differentiating aberancy vs VE (if VE is opposite to start with of course.

[@ECGDoc]

@@xxrobodave My point is that looking at morphology differences can be very helpful but there are many other finer points of physiology that can help distinguish ventricular ectopy from aberrant conduction and you should use all the information you can.

[@audiokees4045]

Could this be caused by Lyme? I have supraventricular extrasystoles with aberrant ventricular conduction, sometimes the case is ridiculously upset and that is scary, according to the doctor this is benign. I have late lyme, but that was treated last year, I don't think it's gone yet.

[@ECGDoc]

It may not be from Lyme. Chronic Lyme infections do cause systemic inflammation. Theoretically if the heart muscle is inflamed it may be more likely to develop extra beats. But classically acute Lyme infections cause AV Block, not extra beats. And there is no definite association between chronic Lyme and other arrhythmias, but who knows? You can never say never. However, that doesn't help you, since I imagine you are being treated for your Lyme. Although PACs and PVCs are "Benign," nevertheless they can be very annoying and can interfere with your quality of life. If you can't just live with them, see an electrophysiologist, who may be more comfortable treating highly symptomatic extra beats than your other doctor. Good luck!

[@audiokees4045]

@@ECGDoc Hi. Thanks for message. I have now start reduce stomach acid with pills to check, this is because I do have discomfort there al for some years, feel like it is a mass, stress do have a impact, old stress from past, but it will be with me a long time, stress do lessenen very slowly. I have today for first time no ectopics, have a slow 58 beats sinusoidal feeling beat. But the chest still feel tight, I think I have a stressrelated problem, not solved in one day, the fact that I had ectopics special when walk stairs or hills did me think of stomach. I had lyme ACA inflammation on the left leg, above the feet, it was purle coloured, and the doctor has done a biopt for test en bloodwork, I have a kind of lime bacteria who do infect the skin not the nerves in the body, I have done a antibiotics regime for 4 weeks, doxycycline. and the ACA did dissapair, until now 1.5 year later it is still gone about a rest damage left there, I am not tyred or so, I can do things normally like walk far distances and bicycle rides, sometimes I get ectopics when on bike, then I get when I stop abd go rest on couche, then I have them when I stand up, and vica versa, it change a lot, so I think stomach needs to be checked, I am only not a fan for een camera into mine throat, still scared because long ago i did get a bleeding when it was done, it did hit a ulcur, I had the stomach bacteria that time and was treated. Still, stomach can be a cause. now I have pills to limit acid I have from yesterday to now no ectopics, so I wait because it can also be a pause and will coming back. Lyme is I think gone, but I do not now for shure, I have not the symtoms what it cause like compleet done and tyred. Sometimes I feel so energetic I am suprised of myself, can take the world with mine 67 year. Talking to other people about this is quite helpfull thanks the internet. But read it with wisdom, it can also make you scared. regards

[@tabascocat5102]

Is Aberrancy dangerous?

[@ntullomd]

No, not at all. It just makes the ECG look funny.

[@SwaggerBoyJayOfficial]

@@ntullomdwhat if they’re frequent?

[@Ahdree23]

Talks too damn much and all over the place