An Irregular Heart Beat

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Author(s) A.A.M. Wilde
NHJ edition: 2009:04,172
These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.
The ECG can be enlarged twice by clicking on the image and it's first enlargement
Puzzle2009 04.jpg

A 71-year-old female patient presents to your outpatients clinic with an irregular heart rhythm. The complaints started a few weeks ago and seem to worsen. Her cardiac history reveals the use of digoxin prescribed by her general physician for an irregular, much faster, heart beat a few years ago. The present symptoms are different from those. Physical examination did not reveal any abnormalities except the irregular heart rhythm. Additional cardiological examinations (X-ray, echo) were without abnormalities. Part of the ECG is shown in figure 1. Only the extremity leads are shown (standard calibration).

What is your diagnosis?

Answer