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Related Concept Videos

Dysrhythmias IV: Characteristics of Bradyarrhythmias01:18

Dysrhythmias IV: Characteristics of Bradyarrhythmias

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Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
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ECG Interpretation of Arrhythmias I: Sinus Arrhythmias01:16

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Arrhythmias are disturbances in the heart's rhythm that lead to abnormal heartbeats. These irregularities can originate from different parts of the heart and are classified based on their origin and nature.
Types of Arrhythmias
Sinus Node Arrhythmias
Sinus Bradycardia: Originating from the sinoatrial (SA) node, sinus bradycardia involves slower impulses, resulting in a heart rate of less than 60 beats per minute (bpm). Causes include sleep, vagal stimulation, beta-blockers, hypothyroidism,...
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Correlation between ECG and Cardiac Cycle01:25

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The electrical signals recorded on an electrocardiogram (ECG) occur before the mechanical processes of contraction and relaxation during the cardiac cycle.
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...
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ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Dysrhythmias III: Characteristics of Dysrhythmias01:29

Dysrhythmias III: Characteristics of Dysrhythmias

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Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per...
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Electrophysiology of Normal Cardiac Rhythm01:19

Electrophysiology of Normal Cardiac Rhythm

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The normal cardiac rhythm is a synchronized electrical activity that facilitates the regular and coordinated contraction of the heart muscle. This process is essential for efficient blood circulation throughout the body. The fundamental elements involved in establishing and maintaining this rhythm include the unique electrical properties of cardiac muscle cells, the sinoatrial (SA) node's pacemaker function, the specialized conducting system, and the ionic mechanisms underlying each phase...
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P-wave pseudonormalization after iatrogenic coronary sinus isolation.

Fariha Sadiq Ali1, Andres Enriquez1, Damian Redfearn1

  • 1Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston ON, Canada.

Journal of Electrocardiology
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Summary

A patient with persistent atrial fibrillation (AF) experienced an iatrogenic coronary sinus (CS) isolation during a redo ablation. This led to significant changes in his P-wave morphology on the ECG.

Keywords:
ECGInteratrial blockLeft atrial ablation

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • A 58-year-old gentleman with a history of catheter ablation for persistent atrial fibrillation (AF) presented with recurrence.
  • Baseline ECG revealed advanced interatrial block, characterized by specific P-wave abnormalities.

Observation:

  • During a repeat ablation procedure for AF, an unintended isolation of the coronary sinus (CS) occurred.
  • This iatrogenic complication was identified through electrophysiological monitoring and surface ECG changes.

Findings:

  • The coronary sinus isolation resulted in a marked narrowing of the P-wave on the surface ECG.
  • Specifically, the terminal negative component of the P-wave, previously noted, was lost post-procedure.

Implications:

  • This case highlights a potential complication of catheter ablation procedures, specifically iatrogenic CS isolation.
  • It underscores the importance of careful monitoring of ECG morphology during ablation to detect such events.
  • Understanding these ECG changes can aid in diagnosing and managing complications following cardiac ablation for atrial fibrillation.