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Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1-2% of the general population. AF confers a fivefold increased risk of stroke. One in five of all strokes is attributed to this arrhythmia. Effective treatment strategies exist which have shown to significantly reduce thromboembolic events. 1 There is only scant published evidence demonstrating the importance of diagnosing AF in patients with a ventricularly paced rhythm. This potential pitfall to recognise AF 2 3 has the implication of devastating outcomes.
Method
A short survey was undertaken in order to gauge the ability of doctors of all grades to recognise AF in the patient with chronic right ventricular pacing (RVp), based on ECG interpretation. Doctors were given an ECG ( figure 1 ) showing AF and RVp, and were given a brief clinical history stating, 'A 75-year-old asymptomatic, independent lady with a background history of ischemic heart disease and transient ischemic attacks had an ECG performed as a part of routine health check-up. Kindly answer the following questions based on the history and ECG findings'. They were then asked to identify the rate, axis, underlying rhythm and whether they would consider any further intervention. The patient has a CHA 2