ARRHYTHMIA
Eko AntonoDivision of Cardiovascular
Department of Internal MedicineDr. Hasan Sadikin Hospital
Diagrammatic representation of mechanism of reentry
Blood supply of the AV conduction system
The resting membrane potential and the action potential of an ordinary working cell from the ventricular myocardium
Schematic representation of pacemaker cell action potential
Schematic representation of ventricular myocardial working cell action potential
Action potentials recorded from isolated pacemaker cells immersed in a saline bath and firing at their own inherent
discharge rates
Action potentials from different myocardial cells
TERMINOLOGY
ETIOLOGY
SIGNS AND SYMPTOMS
SINUS RHYTHM
Relation of an electrocardiogram to the anatomy of the cardiac conduction system
Sinus bradycardia.
Sinus tachycardia
SUPRAVENTRICULAR ARRHYTHMIAS
Non-compen-satory
postextrasystolic pause
Short coupling interval in
supra-ventricular
extra-systole
Supraven-tricular
extrasystole
Atrial flutter with high-grade AV block.
Atrial flutter. The atrial rate is 250 beats per minute, and the rhythm is regular. Every other flutter wave is conducted to
ventricles (2:1 block), resulting in regular ventricular rhythm at a rate of 125 beats per minute
Atrial flutter with variable AV block.
The different appearances of the flutter line in atrial flutter
Fig 5.21 (hal 141 & 142)
Atrial flutter with an AV conduction ratio (AV-CR) at sleep and rest of 6 : 1
or 4 : 1 decreasing to 1 : 1 with slight exercise
Atrial fibrillation with controlled ventricular response.
Atrial fibrillation with rapid ventricular response
Atrial fibrillation (A) untreated and (B) after digitalis
VENTRICULAR ARRHYTHMIAS
Premature ventricular complex
Unifocal premature ventricular complexes. Note occurrence of wide, premature QRS complexes. Interval
between preceding normal QRS and PVC (coupling interval) remains constant, and morphology remains the
same
Multiformed premature ventricular complexes. Note variation in morphology and in coupling interval of PVCs
Premature ventricular complex with fully compensatory pause
Ventricular bigeminy. Note that every other betas is PVC. Both coupling interval and morphology remain constant;
hence they are unifocal
Pairs of premature ventricular complexes
R-on-T phenomenon. Multiple PVCs are present. Mulitple PVCs are present. On right, a PVC falls on downslope of T
wave, precipitating ventricular fibrillation
The QRST complex in ventricular arrhythmia
The apprearance of the QRST complex in ventricular
extrasystole
Regular appearanc
e of extrasystol
e
Lown’s criteria (1975) for a
grading system of “warning
arrhythmias” in AMI
Precipitation of ventricular tachycardia by late-cycle PVC. Note brief salvo of ventricular tachycardia that is initiated
by PVC occurring well beyond T wave
Ventricular tachycardia
Ventricular tachycardia and the diagnostic significance of ventricular extrasystole
Toardes de pointes
Torsade de pontes ventricular tachycrdial in third degree AV block
Coarse ventricular fibrillation
Fine ventricular fibrillation (“coarse” asystole)
Onset of ventricular fibrillation in the first hours of an acute myocardial infarction
Arrhythmogenic right
ventricular dysplasia. A 6-
year-old boy with fainting
spells
Ventricular asystole
CONDUCTION DISTURBANCES
First-degree AV block. The PR interval is prolonged to 0.31 second
Second-degree AV block type I
Second-degree AV block type II.
Third-degree AV block occuring at level of AV node.
Third-degree AV block occuring at ventricular level
Review of cardiac
arrhythmias (1) :
Arrhythmias with extopic
impulse formation
Review of cardiac
arrhythmias (2) :
Arrhythmias with
disturbances in impulse
conduction
BATAS AKHIR SLIDE
P wave polarity and pacemaker
site in atrial and AV junctional
arrhythmia
Extra-systole in
singles (A) and in pairs of couplets
(B) and brief
attacks of tachycardia
l (C)
third-degree AV block with ventricular asystole
Premature junctional complexes
Junctional excape complexes
Paroxysmal supraventricular tachycardial (PSVT)
Atrial tachycardia with block
Survival rates are estimates of probability of survival to hospital discharge for patients with witnessed collapse and with ventricular fibrillation as initial rhythm
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