A. Third degree heart block
No. This EKG is not showing any characteristics of complete heart block. These are bradycardia with a regular ventricular rhythm and independent activity of the atria (P waves) and ventricles (QRS complexes).
B. Atrial flutter
No. Atrial flutter is characterized by saw-toothed flutter waves often best seen in lead II. Also the ventricular rate will often be regular, but may however be irregular due to Wenckebach phenomenon or variabel conduction of the flutter waves.
C. AV nodal re-entry tachycardia (AVNRT)
No. In AVNRT the rate is regular and faster (150-250 beats per minute).
D. Atrial fibrillation
Yes! Atrial fibrillation is seen on the EKG as an irregular ventricular rhythm and an oscillating baseline with absent P waves. Keeping the mechanism of the arrhythmia in mind will make this clear. Atrial fibrillation is caused by multiple re-entrant circles in the myocardium of the two upper chambers (hence the irregular baseline) and some of these will actually conduct to the ventricles (hence the irregular ventricular rhythm). The ventricular rate may be between 60 and 180 depending on the medication of a given individual. In this EKG the rate is acceptable low. The fibrillation waves are often more pronounced in lead V1 and are sometimes mistanken for flutter waves. See more on atrial fibrillation in the library.
E. Pre-mature ventricular contractions
No. Pre-mature ventricular contractions may however give rise to an irregular rhythm. They are recognized as sudden large QRS complexes of different appearance and width followed by a compensatory pause. These complexes are not present in this EKG.
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Atrial fibrillation