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Dysrhythmias III: Characteristics of Dysrhythmias

Dysrhythmias III: Characteristics of Dysrhythmias

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 minute.

Disturbances in Heart Rhythm

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...

Dysrhythmias II: Classification of Tachyarrhythmias

Dysrhythmias II: Classification of Tachyarrhythmias

Tachyarrhythmias are a type of dysrhythmia where the heart rate exceeds 100 beats per minute. Here are some common types of tachyarrhythmias:Sinus TachycardiaSinus tachycardia originates from increased impulses from the sinus node, leading to an elevated heart rate. It is often triggered by stress, fever, or exercise.Patients may experience palpitations, a sensation of a racing heart, dizziness, and chest discomfort.Causes and Risk Factors: Common causes include physical exertion, emotional...

Dysrhythmias IV: Characteristics of Bradyarrhythmias

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...

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

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...

Pulse rhythm

Pulse rhythm

Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac muscle...

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Irregularly Irregular Wide Complex Tachycardia: Look Beyond the Atrium.

Gaurav Lakhani¹, Daljeet Kaur Saggu¹, Muthiah Subramanian¹

¹AIG Hospitals, Hyderabad, India.

JACC. Case Reports

|June 23, 2026

Summary

This summary is machine-generated.

Irregularly irregular wide complex tachycardia can mimic atrial fibrillation but may indicate ventricular tachycardia (VT) in patients with structural heart disease. Using algorithms like the Basel algorithm aids VT diagnosis, guiding appropriate treatment strategies.

Keywords:

atrial fibrillation electrocardiogram electrophysiology ventricular tachycardia

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Area of Science:

Cardiology
Electrophysiology
Medical Diagnostics

Background:

Structural heart disease, such as ischemic cardiomyopathy, presents diagnostic challenges for wide complex tachycardias.
Distinguishing ventricular tachycardia (VT) from supraventricular tachycardias (SVT) is critical for patient management.

Purpose of the Study:

To highlight the diagnostic considerations for irregularly irregular wide complex tachycardia in patients with structural heart disease.
To emphasize the utility of integrated diagnostic algorithms for VT identification.

Main Methods:

Case presentation of a 69-year-old gentleman with ischemic cardiomyopathy and an implantable cardioverter-defibrillator.
Electrocardiogram analysis using the Basel algorithm, morphology criteria, and assessment for atrioventricular dissociation.
Electrophysiology study to confirm inducible ventricular tachycardia and subsequent substrate-based catheter ablation.

Main Results:

The patient presented with palpitations and an irregularly irregular wide complex rhythm suggestive of VT.
Electrophysiology study confirmed inducible irregular VTs.
Successful substrate-based catheter ablation was performed.

Conclusions:

Irregularly irregular wide complex tachycardia in structural heart disease necessitates considering VT, even with irregularity.
Integrated algorithms, including the Basel algorithm and morphology criteria, are crucial for VT discrimination.
In single-chamber implantable cardioverter-defibrillator patients with documented irregular VT, disabling the stability criterion and relying on onset/morphology criteria for SVT discrimination is recommended.