MAT vs Afib

[LouisianaDoctor]

Hi all,

Can I get your interpretation of this EKG? I'm not asking for any clinical management. This was in our ER today. The first EKG was read by the machine as Afib with RVR. Pt was an elderly male with severe pulmonary fibrosis, and a history of prostate cancer supposedly in remission. 20 of Cardizem was given IV and the second EKG follows.

I believe this is MAT. While the initial EKG is messy with a lot of artifact, I believe I can see a lot of p waves in there that would discount this from being Afib. What do you think?

Totally just curious. No treatments will be modified based on your opinions.

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[DrAwesomo]

Afib

 

[desdinova]

MAT

 

[Instatewaiter]

MAT

 

[rockersoccer]

Looks like AFib.

 

[FreakofMeds]

This is MAT. The second EKG is clearly showing organized atrial activity in V1. If you compare to the first EKG, you can clearly see very similar P waves morphology between the second EKG and the first EKG in V1. If there is a clearly organized atrial activity, it just cannot be atrial fibrillation. Also your clinical picture, which is Pulmonary Fibrosis patient, who is likely hypoxic, lends to the diagnosis of MAT. I would not be surprised though if this patient ends up developing a.fib.