Rob Scott Millar

Rhythms of the heart: The history of electrophysiology and its current status in South Africa

The foundations of cardiac electrophysiology were laid in the 19th and 20th century by the elucidation of the anatomy and physiology of the conduction system and cardiac muscle. The development of the ECG by Einthoven in the early 1900s has been the basis for its clinical application and remains the most important tool for diagnosis of arrhythmias. Invasive electrophysiological studies have refi ned and added to this understanding and led to the development of catheter ablation of cardiac arrhythmias. The invention of pacemakers and implantable cardioverter defi brillators (ICDs) has revolutionised the treatment of patients with brady and tachyarrhythmias. Despite these advances, catheter ablation, pacemakers and ICDs are unavailable to the majority of patients living in sub-Saharan Africa. In South Africa, there is a paucity of electrophysiologists in the academic/public sector as almost all electrophysiologists serve patients with private health insurance.

ECG Quiz 38 - Answer

There is a regular bradycardia, around 54bpm. The most striking feature is deep T-wave inversion in leads V1 to V4. There are many possible causes for this pattern.

ECG Quiz 41 Answer

The ECG shows a wide complex, regular QRS tachycardia. The rate of the tachycardia is 264bpm. The QRS complexes are wide (140ms). The QRS axis of the tachycardia is +90 degrees. There is positive concordance in the chest leads.

ECG Quizz 37 - Answer

The ECG shows a regular, narrow complex (80ms) tachycardia with a ventricular rate of 180bpm. The rhythm is supraventricular in origin.

Is computer-assisted instruction more effective than other educational methods in achieving ECG competence among medical students and residents? Protocol for a systematic review and meta-analysis

Introduction Although ECG interpretation is an essential skill in clinical medicine, medical students and residents often lack ECG competence. Novel teaching methods are increasingly being implemented and investigated to improve ECG training. Computer-assisted instruction is one such method under investigation; however, its efficacy in achieving better ECG competence among medical students and residents remains uncertain. Methods and analysis This article describes the protocol for a systematic review and meta-analysis that will compare the effectiveness of computer-assisted instruction with other teaching methods used for the ECG training of medical students and residents. Only studies with a comparative research design will be considered. Articles will be searched for in electronic databases (PubMed, Scopus, Web of Science, Academic Search Premier, CINAHL, PsycINFO, Education Resources Information Center, Africa-Wide Information and Teacher Reference Center). In addition, we will review citation indexes and conduct a grey literature search. Data extraction will be done on articles that met the predefined eligibility criteria. A descriptive analysis of the different teaching modalities will be provided and their educational impact will be assessed in terms of effect size and the modified version of Kirkpatrick framework for the evaluation of educational interventions. This systematic review aims to provide evidence as to whether computer-assisted instruction is an effective teaching modality for ECG training. It is hoped that the information garnered from this systematic review will assist in future curricular development and improve ECG training. Ethics and dissemination As this research is a systematic review of published literature, ethical approval is not required. The results will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement and will be submitted to a peer-reviewed journal. The protocol and systematic review will be included in a PhD dissertation. PROSPERO registration number CRD42017067054; Pre-results.

Letter by Millar and Makanjee Regarding Article, “Masking Inferior Infarction by Anterior Myocardial Injury”

To the Editor: Drs Deng and Das1 have provided ECGs showing the apparent disappearance and reappearance of signs of old inferior myocardial infarction during transient ischemia of the anterolateral left ventricle. They ascribe this to electrical forces in …