Right You Are

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Author(s) T.A. Simmers, A.A.M. Wilde
NHJ edition: 2005:12,466
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
Figure 1
Figure 2
Figure 3

A 63-year-old female was referred to our outpatient clinic with symptoms of palpitations. These had been occurring in paroxysms since 2002, and were highly drug refractory; she had undergone numerous DC cardioversions. Her ECG in sinus rhythm is shown in figure 1, during symptoms in figure 2, with a blowup in figure 3. Her prior history provides the solution to the following questions, which you might nonetheless try to answer without additional information.

  1. What diagnoses could the ECG in sinus rhythm suggest?
  2. What is your interpretation of figure 2 (aided by figure 3)?