Arrhythmia

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§ The origin of electrocardiogram
activity, frequency, rhythm,
conduction sequence and
speed, any link produced
abnormal.

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 Classification
Abnormal origin
----sinus arrhythmia
----ectopic rhythm: passivity—escape beat
Activity ---Premature contraction
Ectopic Tachycardia
Flutter and fibrillation
Abnormal conduction
----Physiological block:
----Pathological block: S-AB; A-VB; LBBB; RBBB
----Accessory pathway: pre-excitation syndrome
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 Sinus Rhythm
and
Sinus Arrhythmias

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§ Sinus rhythm
§ Sinus Tachycardia
§ Sinus Bradycardia
§ Sinus arrhythmia
§ Sinus arrest
§ Sick Sinus Syndrome　

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 Sinus Rhythm
§ The cardiac rhythm originated
from the sinus node is
defined as sinus rhythm.
§ P vave is positive in lead Ⅰ,
Ⅱ,aVF,V4～V6,negative in lead
aVR.

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 Normal Sinus Rhythm

§ Every P wave is following by

a QRS complex;
§ P-R interval: 0.12-0.20sec
§ Heart rate is between 60～100
beats per minute.
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*Normal Sinus Rhythm*

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 Sinus Tachycardia

Sinus rhythm
Rate :more than 100 beats per minute
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*Sinus Tachycardia*

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 Sinus Bradycardia

Sinus rhythm
Rate less than 60 beats per minute 11
 Sinus Arrhythmia

Sinus rhythm
The variation of the P-P
interval is greaterr than 0. 12
seconds in the same lead. 12
*Sinus arrhythmia*

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 Sinus Arrest

§ The sinus node fails to produce

impulses in regular sinus rhythm.
§ A prolonged P-P interval suddenly
appears.

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*Sinus arrest*

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 Sick Sinus Syndrome
§ Characterized by a collection of symptoms and ECG
findings due to chronic dysfunction of the sinoatrial
(SA) node:
Ø Chronic and severe sinus bradycardia
Ø sinus arrest or sinoatrial block;
Ø alternate with periods of quick supraventricular
tachycardia (bradycardia-tachycardia syndrome）

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Sick Sinus Syndrome

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Premature contractions

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 Definition

§ The ectopic pacemaker outside

the sinoatrial node emits
electrical signals in advance。

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 Premature Contractions

§ Premature Ventricular Contraction

§ Premature Atrial Contraction
§ Premature AV Junctional
Contraction

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 Common Terms

§ Coupling interval:
It is the interval between a
normal sinus beat and the ensuing
premature beat.

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22
Ventricular Premature Contraction

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 Compensatory Pause

The pause between the extra beat and the

next normal beat is slightly longer than the
usual beat interval, which is called
compensatory pause. 24
Interpolated Premature
Contraction

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 Unifocal Premature Contraction

§ The premature contractions

originate from the same ectopic
pacemaker.

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Multifocal Premature Contraction

§ Premature contractions
originate from more than one
location.

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Multifocal Premature Contraction

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§ Frequent Premature Contraction
§ Accidental Premature Contraction

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Bigeminy

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 Trigeminy

Two normal beats are followed by

a premature beat.
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 Basic Features
§ Arrhythmia
§ An early wave group
§ Compensatory pause

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Premature Atrial Contraction

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 Premature Atrial Contraction

The premature P' wave differs in contour

from the normal P wave in the same lead.

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Premature Atrial Contraction
 PACs with No Conduction

§ PACs with Aberrant intra-

Ventricular Conduction

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Premature Atrial Contraction

PACs with aberrant

intra-ventricular conduction.

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*Premature Atrial Contraction*

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Normal sinus rhythm with atrial bigeminy

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Premature Atrial Contraction

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Premature Ventricular Contraction

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 Premature Ventricular Contraction

①PVCs are not preceded by a P wave.

②The QRS complex is obviously wide
( Duration of QRS﹥0.12s) .
T wave in direction is opposite to QRS complex
③Complete compensatory pause .

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 Premature Ventricular Contraction

Compensatory Pause:The interval between the

normal complexes surrounding the extrasystole is
twice the interval between the normal complexes.
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Normal Sinus Rhythm with
Ventricular Bigeminy

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bigeminy

trigeminy

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*Bigeminy*

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*Bigeminy*

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*Premature VentricularContraction*

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Premature AV Junctional Contraction

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Premature AV Junctional Contraction

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Premature AV Junctional Contraction

Close to atrial Close to ventricular Equal

In
Before After

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Premature AV Junctional Contraction

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Premature AV Junctional Contraction

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 Differential Diagnosis
PAC PJC PVC
different from
P’ that of sinus P
antidromic No associated P’

normal P`-R<0.12s
P’-R ——
R-P`<0.20s

wide and
QRS normal normal bizarre
opposite
T normal normal
to QRS
pause. noncompensatory compensatory compensatory55