This Lead II rhythm strip is from a nine-year-old girl being monitored for an outpatient surgical procedure. She has no known heart disease. Her heart rate is 110 per minute. The PR interval is .12 seconds (120 ms), the QRS is upright and narrow at .06 seconds (60 ms), and the rhythm is regular.
This ECG rhythm strip has all the hallmarks of atrial fibrillation: the rhythm is irregularly irregular and there are no P waves. The rate is about 150 beats per minute. There is no P wave because the atria are being irregularly depolarized by many ectopic pacemakers at once, causing the atria to "quiver". This patient has new-onset atrial fib, and has been medicated with a calcium channel blocker. The rate shows signs of slowing, but has not reached the target rate for this patient of less than 80 bpm.
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