Thanks! If you want to learn more, check out ECGAcademy.com 😃

It's unlikely that this arrhythmia would directly cause hypotension. Even with a sinus rate of only 60 or so, the slowest pulse you'd see is maybe 40 bpm. When the heart slows down and cardiac output decreases, the sympathetic nervous system will often cause the bp to increase in order to compensate for the slower pulse. This arrhythmia generally does not require treatment, unless the sudden slowing of the HR causes the patient to feel lightheaded. That usually won't occur unless the BP is already quite low. If it's an incessant arrhythmia, ideally you could map the focus and eliminate it with catheter ablation. Otherwise, antiarrhythmic therapy might be tried, but the choice of antiarrhythmic drug would be tricky.

Hi, Swerte -- No one can learn to read complex tracings like that from free videos on KZfaq or on a Google search. If you want to truly understand ECGs and learn what it takes to analyze difficult tracings like you describe, you need to go through an advanced course like I offer on ECGAcademy.com

ECGDoc hello Doc, I have a question, when ventricle still not repelarazed how p wave can appear on top of T wave?

That would not be correct... the T-wave is not just notched -- the proof is that the p-wave actually occurs slightly later on the 2nd beat than on the rest of the beats, proving that it is not part of the T-wave but rather a superimposed PAC. It's subtle but it was clear to me, which is why I turned it into this lesson.