Taking the mystery out of rhythm interpretation: atrial electrograms.

OBJECTIVE

To verify cardiac rhythms in which diagnosis from conventional surface recordings was unclear.

DESIGN

Approximately five electrograms were recorded each week from randomly selected patients who had undergone cardiac surgery in a two-year period from 1989 to 1991.

SETTING

A 1000 bed acute care medical facility that provides care to more than 1300 patients per year after open heart surgery.

PATIENTS: Adult patients in the surgical intensive care unit or stepdown units who were recovering from coronary artery bypass grafting, valve replacement or repair, aneurysm resection, and/or atrial and ventricular septal defect repairs.

RESULTS

The atrial electrogram was used to diagnose various dysrhythmias. The most frequent application was the verification of atrial flutter, atrial fibrillation, and junctional rhythm. Another use was to differentiate between ventricular tachycardia and supraventricular tachycardia with aberrant conduction.

CONCLUSION

Critical care clinicians caring for patients who have undergone cardiac surgery must be proficient at rapid, accurate rhythm interpretation to give appropriate treatment. The use of atrial electrograms can be extremely helpful in rhythm interpretation and clarification for this population of patients.