Saturday, January 23, 2021

ECG Blog #188 (ECG MP-5) - How to Read (and Draw) Laddergrams

Learning to draw Laddergrams is challenging. I fully acknowledge that it took me significant time until I felt comfortable with this skill. That said — learning to read laddergrams is EASY — and important for enhancing your understanding of more complex arrhythmias.
  • I cover the basics of what a laddergram is in the 7-minute ECG Video below. With this as introduction — you should be able to understand the mechanism portrayed in most laddergrams you will see.
  • For those who are interested in drawing laddergrams — I walk you through a step-by-step approach in my ECG Blog #69 (followed by links at the BOTTOM of the page to more than 20 clinical examples of laddergrams that I've drawn to illustrate cases).
  • NOTE: You do not need to know how to draw laddergrams in order to attain excellence in arrhythmia interpretation. But becoming comfortable in reading laddergrams will be invaluable for taking you to your next level!


ECG Media Pearl #5: This 7-minute video reviews the basics of what a Laddergram is — with the laddergram that I illustrate (beginning at ~5 minutes in the video) excerpted from my ECG Blog #187 (which provides additional detail on this case).

How to Draw a Laddergram (Step-by-Step Demonstration) 
   — See ECG Blog #69 —

As a Summary of essential laddergram elements — I've added the following 2 figures (taken from my ACLS-2013-ePub book):


For Practice in Reading Laddergrams Please CHECK OUT the following ECG Blogs I've written in which I've added laddergram illustrations:
  • MOST Recently — My ECG Blog #189 (with an illustrative ECG video that traces construction of the laddergram in this challenging case)and — My ECG Blog #187 (which illustrates how sometimes more than a single laddergram explanation is possible)
  • A case with Group Beating (Step-by-Step demonstration) — See ECG Blog #164 —
  • A patient with syncope and hypotension (Step-by-Step demonstration) — See ECG Blog #168 —
  • Inferior STEMI + Wenckebach — See ECG Blog #154 —
  • Mobitz I + Acute MI — See ECG Blog #55 —
  • Mobitz I + Junctional Escapes — See ECG Blog #63 —
  • Group Beating + PACs — See ECG Blog #147 —
  • Escape-Capture — See ECG Blog #163 —
  • Fusion Beats — See ECG Blog #129 —
  • Interpolated PVCs — See ECG Blog #68 —
  • AIVR with Retrograde Conduction — See ECG Blog #107 —
  • Lots of AV Dissociation, but not 3rd-Degree — See ECG Blog #202
  • Challenging AV Block case ... — See ECG Blog #216

For Additional Practice in Reading Laddergrams Please CHECK OUT the following posts in Dr. Smith's ECG Blog (Please scroll down to the BOTTOM of the page for My Comment with laddergram illustration. Many of these will show step-by-step how I construct the laddergram).

NOTE: I'll continue to add links to this page of additional laddergrams I use to illustrate cases.
  • SEND ME cases of your interesting arrhythmias that you'd like to see published on my ECG Blog. I'm always happy to acknowledge your contribution on the blog post! THANKS for your interest!

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