This night shift was very unstable. Just after a patient with heart failure, a patient with paroxysmal atrial fibrillation started crying, palpitations, and chest tightness. The doctor who took my shift today happens to be an ECG machines chaperone. I asked him to give me an EKG to see if the atrial fibrillation had returned. The first time I saw it, I was able to look at it. The heart rate was slightly faster, about 120-130 beats/min, but the P waves in each lead were not visible. Is this a sinus heart rate or frequent atrial fibrillation?

The rhythm of the heart is sometimes relatively uniform in frequent atrial fibrillation, and it is not always possible to determine whether the rhythm system is performing a rule to determine sinus rhythm or atrial fibrillation rhythm. It seems unlikely that this ECG P-wave can be easily distinguished from sinus rhythm or atrial fibrillation rhythm, which in turn involves the choice of the next analysis and processing technique.

This time, we tried a new wire connection method, the Fontaine wire connection method, in which the red wire is placed at the sternal stalk, the yellow wire is placed under the saber, the green wire is placed at v4 of the thoracic wire, and the i, ii, and iii wires are recorded by the ECG machine, i.e., the fii and fiii wires. The p-wave amplitude recorded by this method is higher than that of conventional ECG, especially in five leads.

After tracing with the Fontaine leads, the patient was found to have significant P waves and a clear correspondence between P waves and QRS waves, and was therefore considered to be in sinus rhythm. In other words, the patient did not have atrial fibrillation, but only a rapid heartbeat due to stress during the resuscitation of heart failure, and consciously experienced palpitations and chest tightness. The mystery is solved. We did not intervene with specialized drugs and gave the patient psychological comfort. The patient gradually calmed down and his heart rate returned to normal.

Thoughts and Experiences

There are many problems that require us in China to be both ECG readers and ECG collectors, and we need to fully develop this competitive advantage of our students. Sometimes arrhythmias are fleeting, and rather than analyzing and guessing afterwards, it is better to use some special tracing skills to capture these traces during the examination.

A clear P-wave display is very important for arrhythmia analysis.

Interestingly, when using the Fontaine conduction method, I have found that single-lead ECG machines have difficulty tracing patterns, whereas 12-lead simultaneous ECG machines are much easier, probably due to the automatic baseline correction feature.

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