A Dotty Plot with Irregular Behaviour
Senior Cardiac Physiologist, Kingston Hospital NHS Foundation Trust
Disclosure: The author has no conflict of interests to declare.
A 58-year-old patient with an implantable loop recorder, implanted to investigate episodes of unexplained syncope was admitted to A&E, following a pre-syncopal episode post dermatological surgery. Known arrhythmia history included a high ventricular ectopic burden and previously documented nocturnal bradycardia down to 35 bpm.
At the time of the episode the patient reported that they had suddenly felt dizzy and they had activated a symptom recording. They denied losing consciousness and were unaware of palpitations preceding or during the episode.
A remote monitoring transmission was received and reviewed by the remote monitoring team. The symptom episode displayed a 30 second ECG trace (30 seconds back from the activation time) and a heart rate interval dot plot displaying heart rate intervals in the eight minutes prior to the activation time. The full 8-minute ECG trace was not available to view.
Figure 1: The heart rate dot plot for the event summary, time in seconds along the x axis, heart rate in beats per minute on the y axis. A single channel 30 second ECG trace displaying the heart rhythm in a 30 second window immediately prior to the symptom activation time.