64 year old female patient monitored during cholecystectomy procedure. Patient has a history of acute cholecystitis.
Rhythm analysis indicates normal sinus rhythm (NSR) at 68 bpm. Premature atrial complexes (PACs), Premature junctional complexes (PJCs), and Premature ventricular contractions (PVCs) are present.
This encounter shows a normal sinus rhythm with a large amount of ectopy. This causes an irregular looking rhythm that can easily confuse beginner monitor techs. The presence of P waves indicates that this is a sinus initiated rhythm. Some P waves are inverted, indicating junctional ectopy. The P wave morphology changes also show that atria initiation is coming from different areas.
Source: PhysioNet MGH004