Atrial Rhythms
Junctional Rhythms
AVBs
Ventricular Rhythms
Pacemakers
100
What is Atrial Fibrillation.
100
What is Accelerated Junctional Rhythm.
100
What is Third Degree AV Block.
100
What is Ventricular Fibrillation.
100
What is Ventricular Paced Rhythm.
200
What is Multifocal Atrial Tachycardia.
200
What is Junctional Tachycardia.
200
What is Second Degree AV Block, Mobitz 1 (Wenckebach)
200
What is Monomorphic Non-sustained Ventricular Tachycardia.
200
What is AAI paced rhythm.
300
What is Atrial Flutter with 2:1 Atrioventricular (AV) block.
300
What is Atrial fibrillation with 3rd degree AV block and a junctional escape rhythm
300
What is FIRST DEGREE AV Block.
300
What is Ventricular Bigeminy.
300
What is Biventricular Paced Rhythm.
400
What is Atrioventricular Nodal Reentrant Tachycardia.
400
What is Junction Rhythm (bradycardia).
400
PRI is...
What is Third Degree AV Block with Ventricular pacing
400
What is Accelerated Idioventricular Rhythm (Slow VT).
400
What is Atrial Paced rhythm, First Degree AV Block
Atrial pacing spikes precede most of the QRS complexes.
Prolonged PR interval
500
What is ATRIAL Flutter with variable (2:1 and 4:1) Atrioventricular bock.
500
What is JUNCTIONAL TACHYCARDIA with Left Bundle Branch Block
500
What is Second Degree AVB, Mobitz II
500
What is Monomorphic Ventricular Tachycardia with Right Bundle Branch Block.
500
What is Atrial Fibrillation with DDD pacing and occasional ventricular ectopic beats.
- There is an irregularly irregular rhythm with multiple atrial and ventricular pacing spikes.
- The majority of the QRS complexes are broad (120ms) and preceded by ventricular pacing spikes.
- The LBBB morphology is consistent with a ventricular pacing electrode located in the right ventricle.
The varying relationship between the atrial and ventricular pacing spikes is best understood by examining the lead II rhythm strip (below):
- Beat 1 is narrow — this appears to be a native ventricular complex triggered by an atrial pacing spike. This indicates that AV conduction is intact to some degree (i.e. 3rd degree AV block cannot be present).
- Beat 9 is broad with a completely different morphology and axis to the rest of the strip — this is a ventricular ectopic beat.
- Beats 3, 6, 8, 10 and 12 are preceded by both atrial and ventricular pacing spikes — sequential A-V pacing.
- Beats 2, 4, 5, 7 and 11 are preceded by ventricular pacing spikes only. The absence of atrial pacing spikes suggests that the pacemaker is responding to native supraventriclar impulses.
- Given the absence of discernible P waves and the very irregular rhythm, it is likely that the underlying native rhythm is atrial fibrillation.