Atrial fibrillation and AV block II

[Arveno]

s it possible to have atrial fibrillation and AV block II? Cardiologist whom we visited yesterday say no it is not possible. But ecg with automatic evaluation say definitely pathologic ecg, AV block II. According to another by phone consulted cardiologist it indicate need of pacemaker. Your comments and opinion would be highly appreciated. Thank You.

[etheral]

Depends what your ventricular rate is. If it is consistantly above 60 I would question the need for a pacemaker.

[Arveno in reply to etheral]

Thank You etheral for Your answer. I googled on difference between heart rate and ventricular rate and how it can be calculated. On the copy of ecg performed yesterday at cadiologists clinic I can see following : RR 688 ms , P 0 ms, PQ 0 ms, QRS 86 ms,

QT 358 ms, QTcB 432 ms. P- axel 0, QRS-axel -36, T-axel 34, HF 87/min. Acording to Googled medicine article it is possible to count the ventricular rate. Does those numbers give you some information about ventricular rate? Cardiologist which we met yesterday was not very plesant, she did not like to answer our questions. So unfortunately I do not trust her.

[BobD Volunteer]

Computer generated ECG diagnosis is not to be trusted,. Go with what the human expert says.

[ijregner in reply to BobD]

Are you saying that a Kardia is not a good investment?

[BobD Volunteer in reply to ijregner]

That is not what I said. Computer generated ECG (12 leads) are a guide only. It takes a lot of training at a very high level to read an ECG and my experience is that the "diagnosis" written across the top of a trace is frequently erroneous. I am pretty sceptical of anybody below the rank of EP giving me a diagnosis from such.

[ijregner in reply to BobD]

I wasn't confronting, just questioning.

[Arveno in reply to BobD]

Thank You BobD. You are right and I would be happy if I could trust each MD whom I met during my life. Sometimes different MD have different opinions about diagnosis of the same problem as well as of treatment. Therefore I am always checking specially in such important matter as possibility of undiagnosed AV block II.

[SingingT]

Hi, I definitely have AF and during a severe episode will go into AV block and nearly pass out which is why I have a pacemaker that cuts in when I need it. Seems to work. I am much more confident and can ride out the AF without having to seek help.

[Arveno]

Singing, do I understand that answer to my question is that it is possible to have afib and AV block ?

[Palpman]

RR is 688ms and is pretty accurate. That means Ventricular beat to beat is 688ms apart.

Per minute or per 60 000 ms it would be 60 000 / 688 = 87.2 beats per minute.

Your P wave or atrium pulse is not absent due to being 0ms but it is hiding inside the QRS complex. So Atrials still pulsing.

Your QRS is perfect as is your QTc.

[Arveno]

Thank You Palpman for kompetent and calming answer. Do I understand right that my husband has ventricular rate 87.2 beats/min which means that he does ot have AV block II and therefore no need of pacemaker??

[Palpman]

Pacemakers are for heartblock where the pulse is too low typically under 45 bpm.

[Arveno]

Thank You Palpman. Before cardio conversion at 11.8. 2020, when he was using Sotalol Mylan 40 mg x2, he has mostly pulse between 40-49/min. Not ventricular pulse. After electrical conversion he has now sometimes pulse 47/min in the morning but up to 77 /min in the evening. His blood pressure which was always under low 111/72 (104/68)/ is now ometimes upp to 133/89. He is now using 1,25 mg Bisoprolol in the morning. Should not be better if he use antiarythmicum (Multaq?) instead of beta1 blocker? Thank You for Your patience with my question which should be answered by cardiologist whom we pay for.

[Palpman]

I cannot advise on medication and you should ask your GP.

What do you mean by "it's not his ventricular pulse"?

There is no other pulse other than waves such as the P and T waves.

[Arveno]

Thank You Palpman. I understand Your answer concerning medication. I dream about cardiologist willing to answer patients question. I do not understand ecg sufficiently. I just learnt that there is difference between heart rate and ventricular rate mentioned by Etheral. I need to study more.