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Treatment of underlying atrial fibrillation: paced rhythm obscures recognition

^a Department of Cardiac Electrophysiology, Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA

View larger version (31K): [in a new window]   Figure 1 Unrecognized atrial fibrillation underlying ventricular paced rhythm. No discernable atrial activity is seen in the lead II rhythm strip; however, clear fibrillatory waves are seen in precordial lead V1.

View larger version (136K): [in a new window]   Figure 2 Unrecognized atrial fibrillation underlying atrioventricular sequential paced rhythm. In the precordial leads there is the appearance of organized atrial activity followed by ventricular pacing. This was interpreted as sinus rhythm with premature atrial depolarization and DDD pacing. The pacemaker was reprogrammed to VVI revealing the underlying rhythm to be coarse atrial fibrillation.