|example (lead II)||regularity||atrial frequency||ventricular frequency||origin (SVT/VT)||p-wave||effect of adenosine|
|Narrow complex (QRS<0.12)|
|Sinus tachycardia||regular||100-180 bpm||100-180 bpm||sinus node (SVT)||precedes every QRS complex||gradual slowing|
|Atrial Fibrillation||grossly irregular||400-600 bpm||75-175 bpm||atria (SVT)||absent||slows down rate; irregularity remains|
|Atrial Flutter||regular (sometimes alternating block)||250-350 bpm||75-150 bpm (3:1 or 2:1 block is most common)||atria (SVT)||negative sawtooth in lead II||temporary reduced conduction (e.g. 4:1)|
|AVNRT||regular||180-250 bpm||180-250 bpm||AV-node (SVT)||in QRS complex (R')||stops|
|Atrial tachycardia||regular||120-250 bpm||75-200 bpm||atria||precedes QRS, p wave differs from sinus-p||temporary AV-block|
|Atrio-Ventricular Reentry Tachycardia (AVRT)- orthodromic||regular||150-250 bpm||150-250 bpm||circle: av-node - ventricles - bypass - atria||RP < PR||stops|
|AV junctional tachycardia||regular||60-100 bpm||70-130 bpm||AV node||RP < PR||reduces rate|
|Wide complex (QRS>0.12)|
|Supraventricular tachycardia with block||(ir)regular depending on SVT||100-250 bpm||75-200 bpm||atria (SVT)||absent||temporary increased AV-block (eg 4:1)|
|Atrio-ventricular Reentry Tachycardia (AVRT) - antidrome||regular||150-250 bpm||150-250 bpm||circular: bypass - atria - av-node - ventricles||RP < PR||stops|
Supraventricular ectopic beats
- Flowchart: Approach to the Narrow Complex Tachycardia Adapted from ESCnarrowQRS.
- Introduction to Arrhythmias
- Mechanisms of Arrhythmias
- Sinus node rhythms and arrhythmias
- Junctional Tachycardias
- Ventricular Arrhythmias
This is an electrocardiogram from a woman in her forties who had several operations for congenital heart disease. At the time of the electrocardiogram the patient was taking flecainide and metoprolol .
This patient was being treated for ventricular tachycardia. She was initially treated with amiodarone and then was switched to a combination of flecainide and metoprolol. She was doing well. The underlying congenital heart disease was Tetralogy of Fallot. The electrocardiogram shows a supraventricular rhythm which is probably not sinus as indicated by the negative P waves in the inferior leads. The cardiogram also shows 1 PVC and a right Branch block with a left anterior hemi-block.
Drug Side Effect
- ESCnarrowQRS pmid=14563598