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ECG Atrial and Junctional rhythms Dr Sarfaraz
This document discusses various types of atrial and junctional dysrhythmias seen on electrocardiograms (ECGs), including atrial fibrillation, flutter, tachycardia, and premature atrial contractions as well as junctional rhythms, accelerated junctional rhythms, tachycardias, and premature junctional contractions. Mechanisms and treatments for supraventricular tachycardia are explained, including catheter ablation procedures to treat conditions like Wolff-Parkinson-White syndrome.
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ECG Atrial and Junctional rhythms Dr Sarfaraz
- 1. ATRIAL AND JUNCTIONAL DYSRHYTHMIAS ATRIALAND JUNCTIONAL DYSRHYTHMIAS DR SARFARAZ AHMAD ER PHYSICIAN AFH--KANB DR SARFARAZ AHMAD ER PHYSICIAN AFH--KANB ECG Interpretation ECG Interpretation
- 2. Factors that affectsECGFactors that affects ECG
- 3.
- 4. Electrophysiologic studyElectrophysiologic study Cardiaccatheter laboratory
- 5. ATRIAL DYSRHYTHMIASATRIAL DYSRHYTHMIAS •AtrialFlutter •Atrial Fibrillation •Premature Atrial Contraction (PAC) •Atrial Tachycardia •Atrial Flutter •Atrial Fibrillation •Premature Atrial Contraction (PAC) •Atrial Tachycardia
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- 7. Atrial FlutterAtrial Flutter Regularor irregular
- 8. Atrial flutter- regularAtrialflutter- regular
- 9. Old saw DDFlutter Atrial fibrillationAtrial fibrillation
- 11.
- 12.
- 13.
- 14. Premature Atrial Contraction(PAC)PrematureAtrial Contraction(PAC) Normally conducted Abnormally conducted No conduction Normally conducted Abnormally conducted No conduction
- 16. PAC Normal conduction PAC Normal conduction SAnodeSA node focusfocus P
- 17. PAC Conducted with aberration PAC Conductedwith aberration PAC WITH RBBB ABERRATION Wide QRS called ASHMAN BEATWide QRS called ASHMAN BEAT PAC makes it into the ventricles but finds a bundle branch or fascicle asleepPAC makes it into the ventricles but finds a bundle branch or fascicle asleep
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- 22. Junctional DysrhythmiasJunctional Dysrhythmias JunctionalRhythm(escape) Accelerated Junctional Junctional Tachycardia Premature Junctional Contraction (PJC) Junctional Rhythm(escape) Accelerated Junctional Junctional Tachycardia Premature Junctional Contraction (PJC) P wave inverted before or after QRS or hidden under QRS.P wave inverted before or after QRS or hidden under QRS.
- 23.
- 24. Junctional RhythmJunctional Rhythm40--6040--60 It is a normal response that may result from ---- •Excessive vagal tone on the SA node, • A pathological slowing of the SA discharge, • or a complete AV block.
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- 28. Enhanced automaticity ofthe AV node that supersedes the SA node rate. Enhanced automaticity of the AV node that supersedes the SA node rate. Accelerated JunctionalAccelerated Junctional 60--10060--100
- 29. Accelerated JunctionalAccelerated Junctional60--10060--100
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- 31.
- 32.
- 33. PSVTPSVT Paroxysmal Supraventricular (atrial) tachycardiais a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles. Paroxysmal Supraventricular (atrial) tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles.
- 34. P.S.V.T.P.S.V.T. A narrow complextachycardia/ atrial tachycardia Originates in the 'atria‘ Not under direct control from the SA node. SVT can occur in all age groups • Types: depend on the location of reentry circuit--- 1)atrioventricular nodal reentrant tachycardia (AVNRT) 2)atrioventricular reentrant tachycardia (AVRT). 3) Sino-Atrial Reentrant Tachycardia.
- 35. SUMMARY Mechanisms of SVT AtrialTachycardia AVNRT AVRT FPSP
- 36.
- 37. Atrioventricular nodal re-entranttachycardiaAtrioventricular nodal re-entrant tachycardia
- 38. Atrio ventricular re-entrant Tachycardia Atrioventricular re-entrant Tachycardia
- 41. WPW is atype of AVRT
- 42. WPW SHORT PR WITHDELTA WAVE
- 43. Orthodromic atrioventricular reentranttachycardia. This patient has Wolff-Parkinson-White syndrome.
- 44. Successful conversion withadenosine Supraventricular ; chemical conversion
- 46. ELECTROPHYSIOLOGYELECTROPHYSIOLOGY CATHETER ABLATIONCATHETERABLATION by burning or freezing the tissues. by burning or freezing the tissues.
- 47. CATHETER ABLATION WPW SVT ATRIAL FLUTTER ATRIALFIBRILLATION CATHETER ABLATION WPW SVT ATRIAL FLUTTER ATRIAL FIBRILLATION
- 48. Wolff-Parkinson-White syndrome Radiofrequencycatheter ablation BUNDLE OF KENT
- 49. CATHETER ABLATION OFATRIAL FLUTTER A line is drAwn in the right Atrium to block the flutter circuit. Atrial flutter circuit in the right atria Atrial flutter circuit in the right atria Ablation lesionsAblation lesions Ablation catheterAblation catheter
- 50.
- 51. Atrial PAC MAT EAT Atrial flutter Atrialfibrillation Junctional PJC Junctional Escape beat Accelerated Junctional rhythm Nonparoxysmal Junctional tachycardia PSVT AV Nodal Reentrant Tachycardia AV Reciprocal tachycardia/ Extranodal bypass Sino-atrial Reentrant tachycardia
- 52. The achievement ofthe electrocardiogram by the physician and nurses, in period of crisis, is the primordial element. The achievement of the electrocardiogram by the physician and nurses, in period of crisis, is the primordial element.
Editor's Notes
- #22 Discrete, multifocal P' waves occurring at rates of 100-250/min and with varying P'R intervals (should see at least 3 different P wave morphologies in a given lead). Ventricular response is irregularly irregular (i.e., often confused with A-fib). May be intermittent, alternating with periods of normal sinus rhythm. Seen most often in elderly patients with chronic or acute medical problems such as exacerbation of chronic obstructive pulmonary disease. If atrial rate is <100 bpm, call it multifocal atrial rhythm
- #29 Accelerated Junctional Rhythm: This is an active junctional pacemaker rhythm caused by events that perturb pacemaker cells (e.g., ischemia, drugs, and electrolyte abnormalities). The rate is 60-100 bpm).
- #32 Ischemia (usually from right coronary artery occlusion) and digitalis intoxication are the two most common causes. It can appear similar to atrioventricular nodal reentrant tachycardia.
- #33 Rate: Underlying rhythmRhythm: Irregular with PJC'sPacemaker: Ectopic junctional pacemakerP wave: If present, negative in Lead 2PRI: .12 seconds or lessQRS: .08-.12 seconds, unless prolonged by aberrant conduction
- #35 Supraventricular tachycardia can be broadly defined as any tachycardia requiring the atrium or the atrioventricular (AV) node, either in whole or in part, for its perpetuation. Sino-Atrial Reentrant Tachycardia: This is a rare form of PSVT where the reentrant circuit is between the sinus node and the right atria. The ECG looks like sinus tachycardia, but the tachycardia is paroxysmal; i.e., it starts and ends abruptly.
- #36 Predictions about V:A time for DDX Circuits require two pathways with different conduction vel and different refractory periods
- #38 Onset of AVNRT is triggered by a premature atrial impulse. The most frequent mechanism of SVT, usually a regular narrow QRS tachycardia . May occur in healthy, young individuals, and it most commonly occurs in women. Most patients do not have structural heart disease.
- #39 The AP conduction varies extensively from patient to patient.3 It can conduct antegradely during sinus rhythm (manifest Wolff-Parkinson-White (WPW) syndrome). Or it may conduct retrogradely from ventricle to atrium during tachycardia (concealed WPW syndrome). In manifest WPW syndrome the antegradely conducting AP excites the ventricle before the AV node, resulting in a delta wave on the surface electrocardiogram
- #42 Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the bundle of Kent. This accessory pathway is an abnormal electrical communication from the atria to the ventricles. WPW is a type of atrioventricular reentrant tachycardia.
- #47 the abnormal electrical connection in the heart can be indentified and blocked either by burning or freezing the tissues.
- #48 Ablation can also be carried out for atrial flutter, where a line is drawn in the right atrium to block the flutter circuit. In recent years we have also learnt how to carry out ablation in atrial fibrillation.
- #49 Wolff-Parkinson-White syndrome is the name for episodes of fast heart rate caused by an extra electrical pathway between the atria and the ventricles. Electrical impulses can go down the normal pathway from the atria to the ventricles and then return to the atria through the extra pathway. Radiofrequency catheter ablation is the treatment of choice for Wolff-Parkinson-White syndrome. In this procedure, catheters are threaded through the blood vessels to the inside of the heart, and electrodes at the catheter tips are heated to destroy (ablate) a small spot of heart tissue, which blocks the extra electrical pathway.
- #50 Radiofrequency ablationIn most patients, atrial flutter is a macroreentrant circuit around the right atrium with a critical isthmus of tissue (right posteroseptal atria between inferior vena cava, tricuspid valve, and coronary sinus ostium) necessary for propagation of the flutter. This type of ablation is successful in over 90% of patients with very low complication rates. Therefore, ablation is the preferred method of treatment. This figure shows an atrial flutter circuit in the right atria (black arrow head) with the ablation lesions (red lines) delivered to terminate and prevent the atrial flutter.
- #52 All junctional tachycardia are Supraventricular tachycardia but all Supraventricular are not junctional.