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Related Concept Videos

Mechanism of Cardiac Arrhythmias01:28

Mechanism of Cardiac Arrhythmias

Arrhythmias are irregular heart rhythms occurring when the heart's electrical impulses become abnormal. These disturbances can lead to various symptoms, depending on their severity and the underlying cause. Some common factors contributing to arrhythmias include hypoxia, ischemia, electrolyte imbalances, excessive catecholamine exposure, drug toxicity, and muscle overstretching. Arrhythmias can be classified into two main types based on the rate and site of origin of abnormal heart rhythms.
Disturbances in Heart Rhythm01:29

Disturbances in Heart Rhythm

Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
ECG Interpretation of Arrhythmias I: Sinus Arrhythmias01:16

ECG Interpretation of Arrhythmias I: Sinus Arrhythmias

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, and...
Dysrhythmias IV: Characteristics of Bradyarrhythmias01:18

Dysrhythmias IV: Characteristics of Bradyarrhythmias

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...
Dysrhythmias VI: Management of Dysrhythmias01:25

Dysrhythmias VI: Management of Dysrhythmias

Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

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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Related Experiment Video

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Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine
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Iatrogenic pacemaker-induced ventricular arrhythmia: a case report.

Vivetha Pooranachandran1,2, Tim Hodson3, Will Nicolson1,3

  • 1Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.

European Heart Journal. Case Reports
|May 20, 2022
PubMed
Summary

Minimizing right ventricular pacing reduces heart failure risk. However, activating algorithms like RYTHMIQ™ requires careful assessment of heart conduction to prevent dangerous R on T pacing and arrhythmias.

Keywords:
Case reportImplantable cardioverter-defibrillatorRYTHMIQVentricular arrhythmia

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Minimizing right ventricular (RV) pacing is crucial for preventing heart failure progression.
  • Advanced pacemaker and implantable cardioverter-defibrillator (ICD) devices feature proprietary algorithms to reduce unnecessary RV pacing.
  • These algorithms aim to mitigate risks of heart failure and arrhythmias associated with RV pacing.

Observation:

  • A 43-year-old male with hypertrophic cardiomyopathy and intact atrioventricular (AV) conduction received an ICD for primary prevention.
  • Following disease progression and symptoms of dyspnea, the minimal RV pacing algorithm (RYTHMIQ™) was activated.
  • A subsequent deterioration in AV conduction led to intrinsic ventricular beats falling within the atrial blanking period, triggering VVI backup pacing.

Findings:

  • RYTHMIQ™ activation in this patient resulted in R on T pacing due to VVI backup pacing during AV conduction deterioration.
  • This R on T pacing induced a life-threatening ventricular arrhythmia.
  • Deactivation of the RYTHMIQ™ algorithm immediately resolved the device-induced arrhythmias.

Implications:

  • This case highlights the critical need to assess underlying conduction abnormalities before activating RV pacing minimization algorithms.
  • Careful intracardiac electrogram interpretation is essential for safe device programming.
  • Individualized, case-based device programming is paramount to avoid potentially fatal device-induced complications.