Arrhythmia
Arrhythmia is any abnormal pattern of electrical activity in the heart. Normally the waves of depolarization follow a specific sequence, starting in the S-A node and ending with the contraction of the ventricles. Sometimes another area of the myocardium or conducting system begins to depolarize out of sequence or more rapidly than the S-A node, disrupting the normal electric pattern.
Arrhythmias are divided into two general groups: those that result in an increased heart rate and those that result in a decreased heart rate.
Arrhythmias are further subdivided into groups according to the location of the ectopic foci or lesion causing arrhythmia.
A ‘supraventricular arrhythmia’ indicated that the cause of the problem is above the ventricle.
A ‘ventricular arrhythmia’ indicates that the problem originates in the ventricles.
The abnormal site of depolarization is called an ectopic focus. An ectopic focus in the ventricles may be indicated on the ECG as a single large bizarre wave. Multiple premature ventricular contractions cause flutter. If the conduction disturbance is severe, the heart has no coordinated contractions and the condition is referred to as ventricular fibrillation.
Types of arrhythmia
- Sinus bradycardia – low sinus rate <60 beats/min.
- Sinus tachycardia – high sinus rate of 100-180 beats/min as occurs during exercise or other conditions that lead to increased SA nodal firing rate.
- Atrial tachycardia – a series of 3 or more consecutive atrial premature beats occurring at a frequency >100/min; usually due to abnormal focus within the atria and paroxysmal in nature. This type of rhythm includes paroxysmal atrial tachycardia (PAT).
- Atrial flutter – sinus rate of 250-350 beats/min.
- Atrial fibrillation – uncoordinated atrial depolarizations.
- Junctional Escape Rhythm – SA node suppression can result in AV node-generated rhythm of 40-60 beats/min (not preceded by p-wave).
- AV blocks – a conduction block within the AV node (or occasionally in the bundle of his) that impairs impulse conduction from the atria to the ventricles.
- Supraventricular tachycardia (SVT)– usually caused by reentry currents within the atria or between ventricles and atria producing high heart rates of 140-250.
- Ventricular premature beats (VPBs)– caused by ectopic ventricular foci; characterized by widened QRS.
- Ventricular tachycardia (VT)– high ventricular rate caused by aberrant ventricular automaticity or by intraventricular reentry; can be sustained or non-sustained (paroxysmal); characterized by widened QRS; rates of 100 to 200 beats/min; life-threatening.
- Ventricular flutter – ventricular depolarizations >200/min.
- Ventricular fibrillation – uncoordinated ventricular depolarizations
- Ventricular fibril first-degree AV nodal block – the conduction velocity is slowed so that the P-R interval is increased to greater than 0.2 seconds. Can be caused by enhanced vagal tone, digitalis, beta-blockers, calcium channel blockers, or ischemic damage.
- Second-degree AV nodal block – the conduction velocity is slowed to the point where some impulses from the atria cannot pass through the AV node. this can result in P-waves that are not followed by ARS complexes. for example, 1 or 2 P-waves may occur alone before one is followed by a QRS. When the QRS follows the P-wave, the P-R interval is increased. In this type of block, the ventricular rhythm will be less than the sinus rhythm.
- Third-degree AV nodal block – conduction through the AV node is completely blocked so that no impulses are able to be transmitted from the atria to the ventricles. QRS complexes will still occur (escape rhythm), but they will originate from within the AV node, bundle of his, or other ventricular regions. Therefore, QRS complexes will not be preceded by P-waves. Furthermore, there will be complete asynchrony between the P-wave and QRS complexes. Atrial rhythm may be completely normal, but ventricular rhythm will be greatly reduced depending upon the location of the site generating the ventricular impulse. Ventricular rate typically range from 30 to 40 beats/min.
- Wolff Parkinson Syndrome – An accessory pathway (Bundle of Kent) that connects the atria and the ventricles, in addition to the AV node. This accessory pathway does not share the rate-slowing properties of the AV node, and may conduct electrical activity at a significantly higher rate than the AV node