All rights reserved. This article explains bradycardia symptoms and their causes. 4,319. A typical example is a 100 Hz background distortion from fluorescent lights. You will note that the artifact is most pronounced in leads I, II, and aVR. It occurs when the upper chambers of your heart beat too fast. Table adapted from Baranchul et al's work[3]: Crit Care Nurse 2009;29:67-73 doi: 10.4037/ccn2009607. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. The patients rhythm is regular. It was cold in the fire station and he was shivering. Paroxysmal Supraventricular Tachycardia (PSVT) Heart and Vascular Arrhythmias. Ischemia, or lack of blood flow, may also cause an abnormal ECG. . [8] It is important to differentiate these, as misdiagnosis can lead to inadvertent use of medications and procedures in such a patient[9][10]. Whats Causing Me to Wake Up with a Racing Heart, and How Do I Treat It? The fourth beat (purpose circle) is a PVC. While similar, sinus rhythm is a little different from heart rate. Sinus bradycardia is a heart rate between 50 to 60 beats per minute. Sinus rhythm . Sinus Arrest or Sinus block is commonly referred to as a Pause. The manual goes on to state that the AliveCor normal detector has been designed to be conservative with what it detects as normal. [1] As a result of artifacts, normal components of the EKG can be distorted. At ACLS Medical Training, we pride ourselves on the quality, research, and transparency we put into our content. Your heart rate is the number of times your heart beats in a minute. Its quite uncertain why they cant solve the PVC issue. 480 b. Confirmed Atrial Fibrillation patient for 2 years. The term "anteroseptal" refers to a location of the heart in front of the septum the wall of tissue that separates the left and right sides of the heart. Sinus bradycardia is a resting heart rate of under 60 beats per minute that arises from the sinus node, which sets heart rhythm. In electrocardiography, left axis deviation is a condition where the mean electrical axis of ventricular contraction of the heart lies in a frontal plane direction between 30 and 90. Sinus rhythm with marked sinus arrhythmia Possible blocked premature atrial complexes versus artifact. There are times when your patient is acutely short of breath and its simply impossible to capture a 12-lead ECG with excellent data quality. If symptoms are present, they can include dizziness, palpitations, tiredness, feeling your heart miss a beat, fainting (syncope) or almost fainting (pre-syncope). While it is common to have sinus tachycardia as a compensatory response to exercise or stress, it becomes concerning when it occurs at rest. Also Ive had a couple that came back as unclassified as my heart rate was 110 bpm. Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. Recovery from pacemaker implantation often means limiting your physical activity. Right atrial abnormality signifies an enlargement of the right side of the heart. The local cardiologist confirmed PACS on full ECG. People with sleep apnea are also more likely to experience arrhythmias, including respiratory sinus arrhythmia. Slow heart rates without symptoms usually are no cause for concern. Sinus bradycardia is the opposite of sinus tachycardia and happens when your sinus node sends slower pulses, resulting in a heart rate of fewer than 60 bpm. In this patients case, every other beat was a PVC (red circles). American Heart Association. Early assessment of ventricular synchronization and function after left bundle-branch-area pacing with right bundle-branch block. This can lead to life-threatening cardiac arrest. There are many types of arrhythmia that originate in other electrical pathways of the heart. Institute for Quality and Efficiency in Health Care (IQWiG). It occurs when a short circuit rhythm develops in the upper chamber of the heart. Learn about causes and outlook here. Muscle tremor (or tension) artifact is a type of motion artifact. The sinus node is the hearts natural pacemaker, which means it is responsible for setting the rhythm of a persons heartbeats. Last year, to much fanfare, Apple announced two new additions to the Apple Watch. Echo distortion causes a pseudo-QRS complex after the pacing spike which is sometimes referred to as false capture.. These tracings from a woman with paroxysmal atrial fibrillation are typical: all the Normal readings are truly normal and all the atrial fibrillation readings are truly atrial fibrillation with heart rates above 100. Slow heart rates due to infection or inflammation can be treated. Clockwise rotation ECG meaning: Sinus rhythm in an ECG If you see a clockwise rotation on your electrocardiogram (ecg), it can mean a few different things. While technically outside of the normal range, these values can be entirely normal for some people. 2020;30(5):265-272. doi:10.1016/j.tcm.2019.07.001, Chalmers JA, Quintana DS, Abbott MJ, Kemp AH. There are also some situations where sinus tachycardia can happen at rest. Pauses can also be caused by a blocked PAC. These devices are working as intended as warning signals to seek further advice. 39 cycle interference. Pacemaker therapy is more likely with partial and complete blocks. Learn about the different types, including their causes and treatments. If it did not, the signal would go right off the ECG paper! 2011;44(6):810-811. doi:10.1016/j.jelectrocard.2011.04.001. There may be times when CPR artifact makes it difficult to determine the underlying rhythm. As long as the low frequency / high pass filter (the lower number) is set to 0.05 Hz you should get accurate ST-segments. Learn more about it, including its types. When this happens, some potential complications can include: Similar to sinus tachycardia, many people with sinus bradycardia have no symptoms. Sinus bradycardia is a resting heart rate of under 60 beats per minute that arises from the sinus node, which sets heart rhythm. Medications such as digoxin, beta-blockers, and calcium channel blockers can make SSS worse. Heart block occurs when the heart's electrical impulses are wholly or partially blocked as they travel from the heart's atria to the ventricles. American Heart Association. 3. Sinus Rhythm: What's Normal and What's Not, The Heart's Electrical System: Anatomy and Function, How to Treat Wide and Narrow Tachycardia in the Field. She became quite frustrated because AliveCor kept reading her heart rate at 42 BPM and giving her an unclassified reading. The other form of sinus arrhythmia is less common and known as non-respiratory sinus arrhythmia. Persistent reasons are more likely to require treatment. Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute. Junctional rhythm describes a heart-pacing fault where the electrical activity that initiates heart muscle contraction starts in the wrong region. For the most common type of sinus arrhythmia, the time between heartbeats can be slightly shorter or longer depending on whether you're breathing in or out. In cases of respiratory sinus arrhythmia, the P-P interval will often be longer than 0.12 seconds when the person breathes out. 2. The phenomenon was first reported in 2005 by zhan et al. Consider these two ECGs which were recorded from the same patient less than 1 minute apart. "Spike" sign: Presence of regular or irregular tiny spikes among wide-QRS complexes. When your heart rhythm or heart rate is abnormal, its called arrhythmia. Once when I was a cardiac monitoring technician the alarm sounded and it appeared as though ventricular tachycardia was on the monitor. Because of this, sinus rhythm often aligns with your heart rate. You can read more about the problem of false capture here. Atrial fibrillation and sinus rhythm connection, nhlbi.nih.gov/health-topics/atrial-fibrillation, heart.org/en/health-topics/arrhythmia/about-arrhythmia/bradycardia--slow-heart-rate, nhlbi.nih.gov/health-topics/how-heart-works, ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.018011, sciencedirect.com/topics/medicine-and-dentistry/sinus-rhythm, heart.org/en/health-topics/arrhythmia/about-arrhythmia/tachycardia--fast-heart-rate, heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates, Atrial Fibrillation: How the Maze Procedure Works. The first signal of PACS was a wiggly heart symbol, both on the old Omron and the new Bluetooth Qardia. all of which were called normal. (2021). Then it's time to consult a physician to determine the underlying cause. There's an ECG app exclusive to the Series 4 that can indicate whether your heart rhythm shows . Submitted by Maria on 04/23/2015 If there remains some question, an echocardiogram can distinguish between an old MI and a normal heart. Can diet help improve depression symptoms? In the United States this is sometimes referred to as 60 cycle interference (or 60 Hz pickup). Im wondering if the false positives/negatives can be ignored if you understand how to read and interpret an EKG? There are several arrhythmias associated with SSS: SSS more commonly affects older people. I am a user of Kardia. However, symptoms may also be present when the body is at rest if bradycardia is severe. However, the difference is that NRSA does not affect a persons breathing. Among people who have itincluding healthy young people and older people in good physical conditiontheir resting heart rate may hover in the 40s or 50s. Sometimes (rarely) it mistakes the premature beats for atrial fibrillation and sometimes it calls the recording unclassified. Factors that increase the risk of arrhythmia include: Sick sinus syndrome (SSS) is when the sinus node causes abnormalities in the heart rhythm. In reality, sinus tachycardia is a form of SVT, and the rate can easily exceed 150. Curious in this product. Persistent heart block, primarily symptomatic or complete, also is more likely to require permanent treatment. I dont know who was reading these but I have a recent trace with 5 consecutive PVCs that was deemed no problem. b.) Sinus bradycardia that produces symptoms is a sign you should seek medical care. An infarct is an obstruction of . An older person with severe arrhythmia may require a pacemaker. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. AliveCor is always going to call rhythms (other than afib) unclassified when it counts a heart rate less than 50 BPM or greater than 100 BPM. Symptoms of a third-degree heart block include chest pain, fatigue, and shortness of breath. I have had 27 PVCs in a row and the device states it is a normal reading. Anxiety also is shown to be a predictor of cardiovascular disease and sudden cardiac death. I have had the problem you are describing of AliveCor Kardia interpreting PVCs as possible afib. This sinus arrhythmia can be abolished during exercise and vagolytic therapy. Additionally, the upper and lower chambers of the heart arent coordinated. Steps may also be taken to normalize heart rhythm through the use of medications or procedures like electrical cardioversion, although AFib may sometimes recur after these interventions. Pacemaker Components 1. Over time, it also may cause high blood pressure. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. The hearts of adults at rest normally beat between 60 and 100 times per minute. In some cases, healthcare providers will do a trial of a temporary pacemaker. However, it can also happen when patients prop themselves up by their arms. Interpretation on ekg says 'sinus rhythm, Low Voltage in precordial leads - RSR (V1)-non diagnostic - Horizontal axis for age. The P wave may also be hidden within the QRS complex. c. Sinus rhythm with ventricular bigeminy d. 3:2 Wenckebach block e. Motion artifact You measure a QT interval of 480 msec while the sinus rate is 90 bpm. You dont want to use it for defibrillation pads. An ECG is used to measure the electrical signals generated by the heart as it contracts, notes MedicineNet. I have bigeminy and skipped every beat which I cant seem to find a name for, How are you feeling now ? Normal sinus rhythm is a regular rhythm that occurs in generally healthy people. Ventriculophasic sinus arrhythmia occurs mostly in patients with third-degree heart block, also called an AV block. Usually it's happening because your patient is cold and shivering. Electrical disruption. In cases of respiratory sinus arrhythmia, the heart rate per minute is usually normal. Sinus arrhythmia is a kind of arrhythmia (abnormal heart rhythm). The ventricles are the chambers that pump blood out of the heart. "*d^M"O9$h[,bpWnb ;E285-GO
r:V Generally, making an effort to maintain a healthy heart is helpful for people. Communicating concerns about nonspecific changes on ECG. In adults, normal sinus rhythm usually accompanies a heart rate of 60 to 100 bpm. https://www.wikidoc.org/index.php?title=EKG_artifacts&oldid=645512, Pages with citations using unsupported parameters, Creative Commons Attribution/Share-Alike License, Atrial or ventricular extrasystoles, pseudowaves (QRS), COBE Prisma System for continuous venovenous hemofiltration, Straight shot microdebrider (nasal endoscopy), Pseudowaves (P), premature atrial contraction, Somatosensory evoked potential monitoring units, Atrial flutter, atrial fibrillation, ventricular tachycardia, Ventricular tachycardia, ventricular fibrillation, non-specific, Transcutaneous electrical nerve stimulator, Spikes, runaway pacemaker, ventricular fibrillation, non-specific, R wave is positive in lead aVR (P wave also positive), Reversal of left arm and right arm electrodes, Very low (<0.1 mV) voltage in an isolated limb lead, Reversal of right leg and left arm or right arm electrodes, Exchanged amplitude of P waves (P wave in lead I > lead II), Reversal of left arm and left leg electrodes, R wave abnormal progression in precordial lead (pre-dominal R in V1 and S in V6), Reversal of precordial electrodes (V1 through V6), Suspect dextrocardia (negative P waves in lead I), Eliminate noise and interference (artifact mimicking tachycardias or ST-T changes. These were the last to items on an EKG and lipid test. On the other hand if you are experiencing palpitations and make a recording with Alivecor that comes back as normal do not assume that your heart rhythm was totally normal. This means that if the interval between two beats (R-R) is 5 large squares, the HR is 60 beat/min. Prematurity induced sinus arrhythmia (SA) Respiratory sinus arrhythmia (RSA) has slow component -0.12 sec, Fast component -0.16 sec. The Normal Detector in the AliveECG app notifies you when a recording is normal. 2012;45(1):15-17. doi:10.1016/j.jelectrocard.2010.12.162. PMID: 30563728 DOI: 10.1016/j . %PDF-1.7
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Importantly the reading cardiologist will go through the patient diary and see if any heart tracing abnormalities were seen at the time . When the sinus node produces electrical impulses at a relatively reduced rate, the heart rate becomes slow, resulting in sinus bradycardia. What does this mean from an EKG reading: Sinus rhythm with marked sinus arrhythmia Possible blocked premature atrial? Atrial fibrillation occurs when the normal, regular, synchronous action of the upper chambers of the heart becomes chaotic, rapid, and inefficient. Sinus arrhythmia is one type of arrhythmia. 60 cycle interference. Our website services, content, and products are for informational purposes only. It means the electrical pulse from your sinus node is being properly transmitted throughout the heart muscle. Treatment may involve correcting any underlying causes or implanting a pacemaker. A lower-than-normal heart rate poses no problem for many people unless certain symptoms appear. However, S1Q3T3 is also present along with anterior T-wave inversions. The SA node is called the heart's pacemaker because it adjusts your heart rate based on what you're doing.. SVT with Aberrancy or Ventricular Tachycardia. This often occurs right after lead connection and after electric cardioversion. Once again the exact cause is unknown. Skipping the doctor dashboard might have an impact on their regulatory compliance requirements Unclear why they dont solve that PVC issue and even add other arrythmia detection, as algorithms exist since decades. When the heart's ventricles can't get information from the sinus node about how fast to beat, they use information from another part of the heart between the atria and ventricles, called the AV node. I have many PVCs PA Cs and short bursts of afib I understand everything you are saying about the alivecor even though I do love mine as well I would be very interested in being able to send you an occasional reading to look at for me even for a fee what would I have to do to be one of your patientsand get this service. Sinus arrhythmia tends to decrease as a person gets older. Respiratory sinus arrhythmia is not harmful. Artifact is a common finding in the EKG of patients in hospital setting. References 2013;61:e6-e75. A good rule of thumb to estimate the maximum sinus rate is 220 minus age but that can vary by 10-15%, which is a lot. Epstein AE, DiMarco JP, Ellenbogen KA, et al. Both new Apple Watch 4 and the Kardia band on the old AW3 indicated irregularities. Can poor sleep impact your weight loss goals? [O]ne may expect that the leads not connected to the electrode affected by the source of disturbance would be free of distortion; but this is not the case. Sinus arrhythmia is an irregularity in the heart rhythm that originates at the sinus node. Your 10% OFF discount codehas been sent to your email. Learn the symptoms, causes, and treatments for junctional tachycardia, a type of abnormal heart rhythm that starts in the sinus node of your heart. The second ECG shows large, bizarre T-waves that were concerning to the paramedics on the call. In some cases he is having isolated PVCs:The first 3 beats in the lower strip are NSR. For patients who experience either PVCs or PACs the AliveCor device is frequently inaccurate. However, a case of symptomatic bradycardia may cause cardiac arrest if left untreated. Apart from the poor quality of EKG, artifacts can cause serious consequences particularly when they mimic genuine changes. Sinus arrhythmia in young people is usually not a cause for concern. This can be due to the sinus node not generating electrical pulses as it should. Epub 2015 Jan 19 doi: 10.1016/j.hrthm.2015.01.023. Sinus rhythm refers to the rhythm of your heartbeat, determined by the sinus node of your heart. Distinguishing PVCs from afib is not exactly rocket surgery. If ST segments are affected by artifacts, either ST segment depression or elevation can occur on the EKG. Simply email us through the contact us link displayed on every page of this website any time within 60 days of purchase. . Proc Natl Acad Sci USA. 184 0 obj
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Front Psychiatry. This is because underlying conditions such as heart diseases and diabetes can aggravate the arrhythmia. GATA6 is a regulator of sinus node development and heart rhythm. If left untreated, SSS can have serious consequences for a persons health. This is when the electrical rhythms of the heart are disrupted or blocked, causing the heart to beat slowly. Sinus tachycardia refers to a faster-than-usual heart rhythm. I have been having chest pain, a cough and a fast heart rate. Ive discussed premature ventricular contractions (PVCs) here and here. AFib can have potentially serious health effects. This is because a heart thats beating too slowly can mean that blood isnt flowing effectively to the organs and tissues of the body. It can mimic a number of arrhythmias causing patients to be subjected to unnecessary and potentially dangerous therapeutic interventions ().Consistency of parkinsonian tremor closely mimics that of AF as seen in our case, making this an uncommon but potentially misleading associated phenomenon. In atrial pacing, the stimulation artifact precedes the P-wave. Such palpitations can mimic the feeling patients get when they go into atrial fibrillation. We avoid using tertiary references. Subsequent work by Aslanger solved the issue in favor of arterial pulse tapping (which explains why the artifact occurs synchronously with the cardiac cycle on the ECG.). In many cases, the underlying cause cannot be identified. This section looks at the different types of sinus arrhythmia. I have also noticed that stopping or accelerating the ambulance can cause wandering baseline. Thomas James, Director of Customer Experience. Overview. Some of the triggers for irregularity include: caffeine, tobacco, alcohol, cough and cold medicine, high blood pressure, anxiety, stress, sleep apnea, lung disease, and heart disease. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. hYko6+;)I8k#YJ9eK;yZ1L:14 The medical term means that a person's resting heart rate is below 60 beats per minute. Until recently only had a few episodes, but recently had one lasting 3 months per Kardia and professional halter monitor that found me constantly in AF. What is clear is that premature beats significantly confuse the AliveCor algorithm. Most causes for waking up with a racing heart aren't serious. I weigh 148 lbs and do not smoke or drink alcohol. #2. stuart. The heart is functioning normally and there is no indication of any cardiac issues. When you have tachycardia, your heart rate is faster than 100 beats per minute. It does not identify the PVCS or PACS. However, other arrhythmias can sometimes indicate heart disease. However, if youre performing CPR at a 30:2 compression to ventilation ratio you can see the underlying rhythm during ventilations! An infarct is. You can think of the sinus node as a natural pacemaker. The sinoatrial or sinus node is in the upper chamber on the right side of the heart, which is the right atrium. You can learn more about how we ensure our content is accurate and current by reading our. As these pulses travel through the heart muscle, they cause it to beat (heart rate). My monitors were really sensitive to movement, just walking or changing positions would affect my strip. It can cause heart failure or loss of consciousness. This results in a regular but rapid heartbeat that starts and stops abruptly. Show More. 2 years ago. Discussion. SA nodal rhythm (normal sinus rhythm) (NSR) (Figure 2) The sinus node is located at the SVC/right atrial junction. Keep in mind that in some cases, sinus bradycardia is actually a sign of a well-conditioned heart. In some cases, this is normal, such as sinus tachycardia during exercise or sinus bradycardia in athletes. This is because a childs heart is still growing, and changes to the heart can lead to respiratory sinus arrhythmia. Heart block, an abnormal type of bradycardia, may lead to serious symptoms and outcomes. 5 years ago. In patients with left ventricular hypertrophy, QRS axis may be within normal (but between 0 and -30) or deviated to the left 2.. That basically means the heart is beating in a uniform pattern, and the Apple Watch hasn't detected . In fact, AFib frequently, but not always happens along with sick sinus syndrome. This broken communication results in potentially dangerous bradycardia. answer. In some cases, yes, but it will depend on the cause. The sinus node, or sinoatrial node, is a bundle of specialized electrical cells in the right upper chamber of the heart. When this happens, it can increase your risk of serious complications, including: Its possible to have sinus tachycardia and have no symptoms. The maze procedure is a surgical intervention used to treat atrial fibrillation when medications can't adequately control frequent arrhythmias. Ask your doctor. J Am Coll Cardiol. It is more common in the elderly where it may occur in association with heart disease . The function of the sinus node is to generate the electrical impulse . This can often be determined by simply taking a careful medical history. While highly unlikely to be afib, your palpitations could still be due to PACs or PVCs. Whilst the cardiologist was complacent about PACS some lifestyle changes seem to be helping, as I am mindful that PACS may be a harbinger of further problems. Sinus tachycardia occurs when your sinus node sends more rapid electrical pulses, leading to a heart rate thats higher than 100 bpm. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. My department has been doing this for so long that I dont have any good examples of 60 cycle interference! This ECG shows normal sinus rhythm, and this does not rule out the presence of a pacemaker. bypeep The question I have is: Did the artifact occur during times that you were experiencing palpitations and if so, might it have masked some events that they needed to look at more closely. It corresponds to the rate at which electrical pulses are sent out from the sinus node. deep brain stimulator) in the body and includes the following[3]: The table includes data from references[5][7]. Sinus bradycardia. Types include bradyarrhythmia or supraventricular arrhythmia. Interpretive Statements: SINUS RHYTHM BORDERLINE LEFT AXIS DEVIATION CONSIDER ANTEROSEPTAL INFARCT. Normal sinus rhythm is defined as the rhythm of a healthy heart. An arrhythmia is an instance when there is a problem with the hearts rhythm or it beats irregularly. Kardia Advanced Determination "Sinus Rhythm with Premature Ventricular Contractions" indicates sinus rhythm with occasional premature ventricular contractions. By using our services, you agree to our use of cookies. But the beat is slow (less than 60 beats per minute). Learn more about instructions for recovery after this procedure. Thank you for your really helpful posts! This is reflected by a QRS complex positive in lead I and negative in leads aVF and II. A reader sent me a series of recordings he had made when feeling his typical palpitations. I happen to know something about electrocardiography and they are classic examples. Journal of Electrocardiology. J Am Coll Cardiol. Look at the EKG/ECG to see if the rate is regular and how fast the heart is beating; both are important for rhythm interpretation. The rate (95-to-100/minute), apparently normal QRS duration, and near regularity of the rhythm suggest a sinus etiology.That said - from this tracing alone, one could not rule out the possibility of either accelerated junctional rhythm (since no definite P waves are seen) or atrial fibrillation (since there is a . Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist. Normal sinus rhythm is the gold standard. Sick sinus syndrome. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Medications can be changed if they lead to slow heart rates. It works great for diaphoretic patients. Sinus tachycardia is a regular cardiac rhythm in which the heart beats faster than normal and results in an increase in cardiac output. Cookies help us deliver our services. Atrioventricular block. I am seeing a cardiologist as I just dont fee well as it is happening so often. Lendell Richardson, MD. Heart rhythm is the result of electrical impulses sent from the pacemaker cells of the sinoatrial node (SAN) at the top of the right atrium. An ECG measures several aspects of the heart, including the rate, rhythm, and intervals between beats. These devices are used to treat a variety of symptoms including tremors, seizures, chronic pain, nausea and vomiting related to gastroparesis, problems with bladder or bowel control, visual impairment, and hypertension. This strip shows 10 QRS complexes. An ectopic rhythm is an irregular heart rhythm due to a premature heartbeat. This ECG was automatically recorded during a cardiac arrest. Thank you. A normal heartbeat is referred to as normal sinus rhythm (NSR). It's generally. Healthline Media does not provide medical advice, diagnosis, or treatment. Anelectrocardiogram (ECG)will show that the slow heart rate is present. Read our, When a Pacemaker Is Needed for a Heart Block. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. The treatment of AFib typically involves medications to lower heart rate, such as beta-blockers or calcium channel blockers. A left axis is a measurement made from a 12-lead ECG. Now been in NSR for two months. The inaccuracies worry me but if the ekg strip is accurate, but the findings are not, I dont think I should be too worried. Nonrespiratory sinus arrhythmia (NRSA) more commonly occurs in adults. Contact your healthcare provider if you are concerned about stress and anxiety affecting your health. Sinus arrhythmia is an irregularity of the heartbeat. However, when the heart rate becomes too slow to pump enough blood, it needs treatment.