Atrial Rhythm

Presented by-
Dr. Mashhoora Jahan
 I. Introduction
Definition of Atrial Rhythm
• Atrial rhythm refers to the pattern of electrical impulses generated in the atria (the
upper chambers of the heart) that control the heartbeat. Normally, the electrical
impulses are generated by the sinoatrial (SA) node, the heart's natural pacemaker,
and travel through the atria, causing them to contract and pump blood into the
ventricles (the lower chambers of the heart). An atrial rhythm can refer to any
deviation from this normal pattern of electrical impulses, such as an irregular or rapid
heartbeat caused by abnormalities in the SA node or other parts of the heart's
electrical system.
 II. Types of Atrial Rhythm
 Atrial Ectopics
 Atrial Flutter
 Atrial Fibrillation
 Supraventricular Tachycardia
 Atrial tachycardia
III. Symptoms
Common symptoms of Atrial Rhythm
        Supraventicular
At. Tachycardia At. Ectopics At.Flutter At. Fibrillation Tachycardia
 Palpitations  Palpitations  Palpitations  Palpitation  Palpitations
 Shortness of  Fluttering or Shortness of  Breathlessness  Shortness of
 Breath pounding in Breath  Fatigue breath
 Dizziness the chest Dizziness  lightheadnes  Fatigue
 Chest Pain  Shortness of Chest  Chest pain Dizziness
breath Discomfort  Panic or anxiety
 Fatigue  Fatigue  Chest pain or
Dizziness  Anxiety discomfort
 panic or  Syncope  
anxiety  Nausea
 chest pain or Sweating Etc.
discomfort
 
 Investigation findings used to identify Atrial Rhythm
Atrial ectopics

 Premature P wave
 Abnormal P wave morphology
 PP interval irregular
 Shortened or prolonged PR
interval
 Normal QRS complex
 Atrial flutter
 Saw-tooth flutter waves
 Normal QRS complex
 Prolonged PR interval: if
the flutter waves are
conducted through the
AV node with delay.
 Atrial Fibrillation
 The normal P wave is absent
and replaced by fibrillatory
waves
 Irregularly irregular RR
interval.
 There may be rapid or slow
ventricular rate.
 ST segment and T wave may
appear abnormal due to the
effects of rapid and irregular
atrial activity on the
ventricular repolarization.

Others
• i) Thyroid function test
ii)Echocardiogram
Supraventricular tachycardia
 Absent P wave
 Narrow QRS complex
 Regular rhythm
 High heart rate
Atrial Tachycardia
 P small & abnormal
shape
 Atrial rate – 140-220/min
 QRS normal
 Rhythm normal
(there may be 2:1, 3:1 or
variable AV block. Atrial
TAchycardia with AV
block is common in
digoxin toxicity)

Atrial Tachycardia
 If digoxin toxicity, stop
Digoxin
 To control HR- digoxin, β-  rhythm control: DC
blocker, verapamil,
amiodarone, flecainide.
 DC cardioversion
General Approach
Patient
ECG
Atrial flutter Atrial fibrillation
 Rate control: B blocker,  Restoration of sinus Rhythm by  Treatment is rarely
verapamil, digoxin. DC cardioversion or
pharmacological cardioversion,
cardioversion, catheter intravenous flecainide
ablation  Rate control by Beta-blockers,
 Anticoagulant rate-limiting calcium
prophylaxis antagonists, such as verapamil
or diltiazem
 To prevent thromboembolism
and stroke anticoagulation
should be started.
MANAGEMENT
Atrial ectopics SVT
 AVNRT: Carotid sinus
necessary but β-blockers pressure or by the Valsalva
can be used if symptoms manoeuvre. Adenosine,
are intrusive. verapamil, Intravenous β-
blocker or flecainide
 AVRT: Catheter ablation is
first-line treatment. Carotid
sinus pressure or
intravenous adenosine. If
AF then DC cardioversion.
 prophylactic anti-
arrhythmic drugs, such as
flecainide or propafenone
can be used.
References :

1.Davidson's Principles and Practice of Medicine

24th Edition

2.ECG in Medical Practice;5th Edition 2022 by ABM

Abdullah
Thank You