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Multifocal PVCs



In this strip we see sinus rhythm with two non-sinus beats.  Beats five and seven are markedly different from the other beats on this strip, and are also different from each other.  Beats five and seven both have QRS widths greater than 0.14 seconds, the depolarization phase slurs into the repolarization phase, these phases are on opposite sides of the baseline, and they are both followed by compensatory pauses, so they are both of ventricular origin.  However, their different shapes tell us that these two beats have different point of origin: there are two irritable foci in these ventricles, giving rise to the two different PVCs.  Because of the differing points of origin, they are called multifocal PVCs.