Heart Conduction System,Sinus Rhythm,Narrow-Wide QRS Complex Arrhythmias

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ARRHYTHMIAS

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Arrythmias with Normal Heart Rate and Bradycardia and Tachycardia

Supraventricular Tachycardia and EP Study in Arrhythmias

Dr N.C.Joshi
Consultant Pediatrician,
Consultant at Nanavati Hospital,
Ex Dean:-B.J.Wadia Children's Hospital.

CONDUCTION SYSTEM.

Figure1. Conduction System

SINUS RHYTHM

Definition: Rhythm originating in the sinus node.

QRS COMPLEX :

Consider the following when looking at the QRS complex

Regular or irregular
How fast?
P-waves
Narrow or wide
P-wave axis
Association of P-waves to QRS

Narrow QRS

Definition :

Infant < 80 msec
Child < 85 msec
It is generally supraventricular in origin

Generally requires activation through bundle of His

Wide QRS

It is often of ventricular origin
Also seen with Aberrant conduction (Rate-related versus present in sinus)
There may be presence of accessory connection
Associated with Drug effects
Seen with electrolyte imbalance
Wide QRS of Ventricular origin

The following is supportive of ventricular origin:
- Positive concordance (If no RVH)
- AV dissociation
Wide QRS of Aberrancy

Fixed bundle branch block
- Common in post-op hearts
- Reflects conduction system disease in unoperated hearts
Rate-related
- Ashman phenomenon
- Failure of bundle to consistently conduct at higher rates
- Usually refractory period of right bundle is more than left bundle
Wide QRS of Accessory connection
- Bundle Branch morphology: opposite location of accessory connection
- May be present intermittently in sinus rhythm
Wide QRS of Drug effects
- Type IA antiarrythmics prolong
- Tricyclic antidepressants may prolon
Wide QRS of Electrolytes
- Hyperkalemia prolongs
- Hypoxia and acidosis prolong

Next : Arrythmias with Normal Heart Rate and Bradycardia and Tachycardia

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