Diagnosis

Atrial electrodes (in situ after cardiac surgery) may aid diagnosis in broad complex tachycardia. Each of the two upper limb leads of a four-lead ECG monitor are connected to the atrial wires, the two lower limb leads are left in situ, and recordings are made at 25 mm/s. Lead I records a bipolar electrogram (across the two atrial leads), while leads II and III record unipolar (atrial to lower limb) electrograms. An independent P-wave activity rate lower than the ventricular rate confirms ventricular tachycardia. A higher atrial dissociated rate suggests supraventricular tachyarrhythmia with aberrant conduction; this is confirmed by comparison of the timing of the atrial and ventricular recordings.

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