ECG-ARRHYTHMIA CLASSIFICATION
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SUMMARY ARTICLE
1. SINUS ARRHYTHMIA: variation of the HR during respiration, particularly in young people
- Increases with inspiration due to vagal inhibition of the cardio-inhibitory area of the medulla (note: double negative) due to stretch receptors in the lungs
- Decreases in expiration
2. SICK SINUS SYNDROME: pathologies related to SA node
3. HEART BLOCK (AV nodal vs infranodal block):
a. First degree: PR interval > 0.2s
b. Second degree: Mobitz I (progressively lengthening PR interval until a QRS complex is dropped) & II (2:1, 3:1, 4:1 P waves consistently not being followed by QRS complexes)
c. Third degree: none of the P waves are conducted to the ventricles
4. SUPRAVENTRICULAR ARRHYTHMIAS:
a. Atrial flutter: circus rhythm running b/w IVC and TV causing atrial rate ~300/min commonly with 2:1 AV block
b. Atrial fibrillation: most common sustained arrhythmia, irregularly irregular ventricular response with rate 120-180/min in the absence of treatment
c. Multifocal atrial tachycardia: ECG shows atrial rate > 100/min & P waves of 3 or more distinct morphologies
d. Supraventricular tachycardia: narrow QRS complex tachycardias arising above the ventricles (key is to recognize the P wave in relation to QRS complexes)
e. Wolff-Parkinson-White syndrome: a/w an accessory/aberrant pathway (bundle of Kent) b/w atria & ventricles which bypasses the AV node & 'pre-exciting' the ventricle
5. VENTRICULAR ARRHYTHMIAS:
a. Premature ventricular contractions: premature ventricular beats with a compensatory pause
b. Ventricular tachycardia: defined as 3 or more sequential QRS complexes of ventricular origin at rate > 100/min, divided into monomorphic vs. polymorphic VT and sustained vs. non-sustained VT
- Increases with inspiration due to vagal inhibition of the cardio-inhibitory area of the medulla (note: double negative) due to stretch receptors in the lungs
- Decreases in expiration
2. SICK SINUS SYNDROME: pathologies related to SA node
3. HEART BLOCK (AV nodal vs infranodal block):
a. First degree: PR interval > 0.2s
b. Second degree: Mobitz I (progressively lengthening PR interval until a QRS complex is dropped) & II (2:1, 3:1, 4:1 P waves consistently not being followed by QRS complexes)
c. Third degree: none of the P waves are conducted to the ventricles
4. SUPRAVENTRICULAR ARRHYTHMIAS:
a. Atrial flutter: circus rhythm running b/w IVC and TV causing atrial rate ~300/min commonly with 2:1 AV block
b. Atrial fibrillation: most common sustained arrhythmia, irregularly irregular ventricular response with rate 120-180/min in the absence of treatment
c. Multifocal atrial tachycardia: ECG shows atrial rate > 100/min & P waves of 3 or more distinct morphologies
d. Supraventricular tachycardia: narrow QRS complex tachycardias arising above the ventricles (key is to recognize the P wave in relation to QRS complexes)
e. Wolff-Parkinson-White syndrome: a/w an accessory/aberrant pathway (bundle of Kent) b/w atria & ventricles which bypasses the AV node & 'pre-exciting' the ventricle
5. VENTRICULAR ARRHYTHMIAS:
a. Premature ventricular contractions: premature ventricular beats with a compensatory pause
b. Ventricular tachycardia: defined as 3 or more sequential QRS complexes of ventricular origin at rate > 100/min, divided into monomorphic vs. polymorphic VT and sustained vs. non-sustained VT
Reference(s)
Gale, M., Grantham, H., Morley, P. and Parr, M. (2016). Advanced Life Support Level 1: 3rd Australian Edition. Australian Resuscitation Council.
American College Of Surgeons. Committee On Trauma (2012). ATLS : student course manual. Chicago, Ill.: American College Of Surgeons.
