Public Safety Training Facility

Monroe Community College
Rochester, New York

MCC Paramedic Program Case of the Month 05/00

EKG Tracing

In some patients with atrial fibrillation the occurence of wide PVC-like beats is not always ventricular ectopy. Because the right bundle branch repolarizes slightly slower than the left, supraventricular impulses can come down through the AV node and bundle of his and then down the left bundle branch only. In effect giving the appearance of a one beat RBBB. The halmarks of Ashman's beats are that they are only found in Af, are proceded by a long-short RR interval and they are conducted in RBBB morphology. You should check for RBBB morphology in lead MCL1 or V1. These beats are harmless and require no treatment. The patient was admitted and his Atrial Fib was treated with IV Cardizem and a normal sinus returned.
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Updated: May 12, 2000