The 12-lead rhythm strips shown in Figure 13 were recorded during transition from a WCT to a narrow complex tachycardia. For left bundle branch block morphology the criteria include: for V12: an R wave of more than 30 ms duration, notching of the downstroke of the S wave, or duration from the onset of the QRS to the nadir of S wave of more than 70 ms; for lead V6: the presence of a QR or RS complex. Copyright 2017, 2013 Decision Support in Medicine, LLC. It is atrial flutter with grouped beating. C. Laboratory Tests to Monitor Response to, and Adjustments in, Management. Articles marked Open Access but not marked CC BY-NC are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. In other words, the VT morphology shows the infarct location because VT most often arises from the infarct scar location. If right axis deviation is a change from previous ECGs, question the patient for symptoms consistent with an . On a practical matter, telemetry recordings are often erased once the patient leaves that location, and it is important to print out as many examples of the WCT as possible for future review by the cardiology or electrophysiology consultant. The intracardiac tracings showed a clear His bundle signal prior to each QRS complex (not shown), confirming the diagnosis of bundle branch reentry. All these findings are consistent with SVT with aberrancy. In most people, theres a slight variation of less than 0.16 seconds. However, there is subtle but discernible cycle length slowing (marked by the *). A common reason for this is premature atrial contractions (PACs). The flutter waves are marked by arrows (). Several arrhythmias can manifest as WCTs (Table 21-1); the most common is ventricular tachycardia (VT), which accounts for 80% of all cases of WCT. Careful observation of QRS morphology during the WCT shows a qR pattern, also favoring VT. She has missed her last two hemodialysis appointments. To reinforce the material we would like to offer of this protocol are 96.5 and 95.7 %, respectively, which is similar to the previous alghorithm published by this group.29 To reinforce the material we would like to offer two ECGs for review (see Figures 1 and 2). What Does Wide QRS Indicate? Alan Bagnall A sinus rhythm is any cardiac rhythm in which depolarisation of the cardiac muscle begins at the sinus node. Description 1. During VT, the width of the QRS complex is influenced by: As is true of all situations in medicine, the clinical context in which the wide complex tachycardia (WCT) occurs often provides important clues as to whether one is dealing with VT or SVT with aberrancy. The rhythm strip shows sinus tachycardia at the beginning and at the end; each sinus P wave is marked. Respiratory sinus arrhythmia doesnt cause chest pain. Khairy P, Harris L, Landzberg MJ, et al., Implantable cardioverterdefibrillators in tetralogy of Fallot, Circulation, 2008;117:36370. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Latest News Your top articles for Saturday, Continuing Medical Education (CME/CE) Courses. However, the correct interpretation requires recognition that the narrow complexes are too narrow to be QRS complexes, and are actually pacemaker spikes with failure to capture the myocardium. Some leads may display all waves, whereas others might only display one of the waves. - Clinical News Wide Complex Tachycardia: Definition of Wide and Narrow. Dual-chamber pacemakers may show rapid ventricular pacing as a result of tracking at the upper rate limit, or as a result of pacemaker-mediated tachycardia. 1456-66. If the QRS duration is prolonged (0.12 seconds), the arrhythmia is a wide complex tachycardia (WCT). For management, see "Management of Wide Complex Tachycardia". However, it may also be observed in atrioventricular junctional tachycardia in the absence of retrograde conduction.16 Even though capture and fusion beats are not frequently observed, their presence suggests VT. 1279-83. Once again, the clinical scenario in which such a patient is encountered (such as history of antiarrhythmic drug use), along with other ECG findings (such as tall peaked T waves in hyperkalemia) will help make the correct diagnosis. Figure 9: After starting intravenous amiodarone, this ECG was obtained. Its actually a sign of good heart health. The QRS complex (ventricular complex): normal and abnormal configurations and intervals. Conclusion: VT due to bundle branch reentry. The QRS complex duration is wide (>0.12 seconds or 3 small boxes) in every lead. Please login or register first to view this content. A normal QRS should be less than 0.12 seconds (120 milliseconds), therefore a wide QRS will be greater than or equal to 0.12 seconds. Figure 3. 578-84. The exact same pattern of LBBB aberrancy was reproduced during rapid atrial pacing at the time of the electrophysiology study. vol. The normal QRS complex during sinus rhythm is "narrow" (<120 ms) because of rapid . The QRS duration is 170 ms; the rate is 126 bpm. There are two main types of bradycardiasinus bradycardia and heart block. Figure 8: WCT tachycardia recorded in a male patient on postoperative day 3 following mitral valve repair. - Full-Length Features Figure 1. , Normal Sinus Rhythm i. Regularity of the rhythm: If the wide QRS tachycardia is sustained and monomorphic, then the rhythm is usually regular (i.e., RR intervals equal); an irregularly-irregular rhythm suggests atrial fibrillation with aberration or with WPW preexcitation. I have the Kardia and have the advanced determination so it records 6 arrhythmias. A history of ischemic heart disease or congestive heart failure is 90 % predictive of a ventricular origin of an arrhythmia.4 Patients with hypertrophic obstructive cardiomyopathy are prone to have VT.5 A known history of arrhythmogenic right ventricular dysplasia or cathecolaminergic polymorphic VT should also point towards a ventricular origin of the tachycardia. premature ventricular contraction. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. In an effort to aid the clinician, scoring systems have been recently proposed, but their clinical performance is only marginally superior to older criteria (see references). However, when in doubt, treat the arrhythmia as if it was VT, as approximately 80 % of wide QRS complex tachycardias are of ventricular origin.30,31, Antonia Sambola Looks like youre enjoying our content Youve viewed {{metering-count}} of {{metering-total}} articles this month. , Unfortunately AV dissociation only . The dysrhythmias in this category occur as a result of influences on the Sinoatrial (SA) node. Wellens HJ, Br FW, Lie KI, The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex, Am J Med, 1978;64(1):2733. The risk of developing it increases . A prolonged PR interval suggests a delay in getting through the atrioventricular (AV) node, the electrical relay . Vereckei A, Duray G, Szenasi G et al., Application of a new algorithm in the differentiatial diagnosis of wide QRS complex tachycardia, Eur Heart J, 2007;28,589600. Bundle Branch Block; Accessory Pathway; Ventricular rhythm Ventricular escape rhythm; AIVR - Accelerated Idioventricular Rhythm; Europace.. vol. 1.5: Rhythm Interpretation. Conclusion: Intermittent loss of pacing capture and aberrancy of intramyocardial conduction due to drug toxicity. A widened QRS interval. It must be acknowledged that there are many clinical scenarios where different criteria will provide conflicting indications as to the etiology of a WCT. Idioventricular rhythm is a slow regular ventricular rhythm, typically with a rate of less than 50, absence of P waves, and a prolonged QRS interval. Because ventricular activation occurs over the RBB, the QRS complex during this VT exactly resembles the QRS complex during SVT with LBBB aberrancy. From our perspective, the last protocol by Verekei et al. For complete dissociation, this would require that the VT rate would fortuitously have to be at an exact multiple of the sinus rate. Her initial ECG is shown. Narrow complexes (QRS < 100 ms) are supraventricular in origin. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. The apparent narrowness of the QRS may be misleading in a single lead rhythm strip. Chen PS, Priori SG, The Brugada Syndrome, JACC, 2008;51(12):117680. Description. Sometimes, these electrical impulses are sent out faster than this typical rhythm, causing sinus tachycardia. The recognition of variable intensity of the first heart sound (variable S1) can similarly be another clue to VA dissociation, and can help make the diagnosis of VT. et al, Andre Briosa e Gala In its commonest form, the impulse travels down the RBB, across the interventricular septum, and then up one of the fascicles of the left bundle branch. A narrow QRS complex (<120 milliseconds) reflects rapid activation of the ventricles via the normal His-Purkinje system, which in turn suggests that the arrhythmia originates above or within the atrioventricular (AV) node (ie, a . et al, Antonio Greco An electrocardiogram (EKG) can tell your provider if you have sinus arrhythmia. Importantly, the EKGs were not available for additional EKG review, which also . Causes of a widened QRS complex include right or left BBB, pacemaker . Published content on this site is for information purposes and is not a substitute for professional medical advice. 60-100 BPM 2. Complexes are complete: P wave, QRS complex (narrow), T wave 3. Broad complex tachycardia Part I, BMJ, 2002;324:71922. This can make it easy to determine the rate of an irregular rhythm if it is not given to you (count the complexes and multiply by 10). Will it go away? Therefore, measurement of vital signs and a thorough but rapid physical examination are vital in deciding on the initial approach to the patient with WCT. Why can't a junctional rhythm be suppressed? One such special lead is called the modified Lewis lead; the right arm electrode is intentionally placed on the second right intercostal space, and the left arm electrode on the fourth right intercostal space. , The QRS complex down stroke is slurred in aVR, favoring VT. The rapidity of the S wave down stroke and the exact halving of the ventricular rate after IV amiodarone made the diagnosis of VT suspect, and eventually led to the correct diagnosis of atrial flutter with aberrancy. The frontal axis superiorly directed, but otherwise difficult to pin down. High Grade Second Degree AV Block, All of the following are generally associated with a wide QRS complex EXCEPT: Select one: a. 83. Explanation. Key causes of a Wide QRS. What causes sinus bradycardia? Advertising on our site helps support our mission. Although initial perusal may suggest runs of nonsustained VT, careful observation reveals that there is a clear pacing spike prior to each wide QR complex (best seen in lead V4), making the diagnosis of a paced rhythm. When the direction is reversed (down the LBB, across the septum, and up the RBB), the QRS complex exactly resembles the QRS complex during SVT with RBBB aberrancy. In 2007, Vereckei et al. There is (negative) precordial concordance, favoring VT. If the sinus node fails to initiate the impulse, an atrial focus will take over as the pacemaker, which is usually slower than the NSR. Your heart rate increases when you breathe in and slows down when you breathe out. You might be concerned when your healthcare provider notices an abnormal heart rhythm in your routine EKG. Sarabanda AV, Sosa E, Simes MV, et al., Ventricular tachycardia in Chagas' disease: a comparison of clinical, angiographic, electrophysiologic and myocardial perfusion disturbances between patients presenting with either sustained or nonsustained forms, Int J Cardiol, 2005;102(1):919. Bruno Garca Del Blanco There appears to be 1:1 association (best seen in leads II and aVR as a deflection on the down slope of the T wave) which, by itself, is not helpful. [1] The normal resting heart rate for adults is between 60 and 100, which varies based on the level of fitness or the . Wide QRS represents slow activation of the ventricles that does not use the rapid His-Purkinje system of the heart. You have a healthy heart. Griffith MJ, Garratt CJ, Mounsey P, Camm AJ, Ventricular tachycardia as default diagnosis in broad complex tachycardia, Lancet, 1994;343(8894):3868. Steinman RT, Herra C, Scuger CD, et al., Wide complex tachycardia in the conscious adult: ventricular tachycardia is the most common cause, JAMA, 1989;261:10136. The width of the QRS complex, both with aberrancy and during VT, can vary from patient to patient. . Last reviewed by a Cleveland Clinic medical professional on 03/21/2022. conduction of a supraventricular impulse from atrium to ventricle over an accessory pathway (bypass tract) so called pre-excited tachycardia. However, such patients have severe, dilated cardiomyopathy, and preexisting BBB or intraventricular conduction delays (wide QRS in sinus rhythm). 2 years ago. This rhythm has two postulated, possibly coexisting . The narrow QRS tachycardia shows the typical features of atrial fibrillation (AF). 2008. pp. The differentiation of wide QRS complex tachycardias remains a diagnostic challenge (see Table 2). Today we will focus only on lead II. Providers separate different kinds of sinus arrhythmia based on their causes. Baseline ECG shows sinus rhythm and a wide QRS complex with left bundle branch block-type morphology. If the pacing artifact (spikes) are not large; especially true with bipolar pacing; they may be missed. QRS duration 0.06. I gave a Kardia and last night I upgraded the Kardia and my first reading was - Answered by a verified Doctor . Flecainide, a class Ic drug, is an example that is notorious for widening the QRS complex at faster heart rates, often resulting in bizarre-looking ECGs that tend to cause diagnostic confusion. The ECG shows a normal P wave before every QRS complex. Rhythms in this category will share similarities in a normal appearing P wave, the PR interval will measure in the "normal range" of 0.12 - 0.20 second, and the QRS typically will measure in the "normal range" of 0.06 - 0.10 second. In general, the presence of scar can be inferred from QRS complex fractionation or splintering or notching.. . 39. Introduction. When a WCT abruptly becomes a narrow QRS rhythm at exactly half the rate of the WCT, atrial flutter with 1:1 AV conduction transitioning to 2:1 AV conduction is very likely (i.e., SVT with aberrancy). Bradycardia is a heart rate that's slower than normal. Brugada R, Hong K, Cordeiro JM, Dumaine R, Short QT syndrome, CMAJ, 2005;173(11):134954. When sinus rhythm exceeds 100 bpm, it is considered sinus tachycardia. . the ratio of the sum of voltage changes of the initial over the final 40 ms of the QRS complex being less than or equal to one. This is traditionally printed out on a 6-second strip. Of the conditions that cause slowing of action potential speed and wide QRS complexes, there is one condition that is more common, more dangerous, more recognizable, more rapidly life threatening, and more readily . Normal sinus rhythm typically results in a heart rate of 60 to 100 beats per minute. As you can see, a printed ECG rhythm strip is . 2012 Aug. pp. Get useful, helpful and relevant health + wellness information. Dhoble A, Khasnis A, Olomu A, Thakur R, Cardiac amyloidosis treated with an implantable cardioverter defibrillator and subcutaneous array lead system: report of a case and literature Review, Clin Cardiol, 2009;32(8):E635. et al, Benjamin Beska This is one SVT where the QRS complex morphology exactly mimics that of VT. Comparison of the QRS complex to a prior ECG in sinus rhythm is most helpful; a virtually identical (wide) QRS in sinus rhythm favors a supraventricular tachycardia with preexisting aberrancy. Key Features. A sinus rhythm result means the heart is beating in a uniform pattern between 50 and 100 BPM. Comments where: sinus rhythm with episodes of sinus tachycardia. Wide QRS complex tachycardia (WCT) is a rhythm with a rate of more than 100 beats/min and a QRS duration of more than 120 milliseconds. These findings would favor SVT. This is called a normal sinus rhythm. A change in the QRS complex morphology or axis by more than 40, as well as a QRS axis of 90 to 180 suggests a ventricular origin of the arrhythmia.17,18 An entirely positive QRS complex in lead augmented ventor left (aVR) also supports the diagnosis of VT.17 When the sinus rhythm with wide QRS becomes narrow with a tachycardia, this indicates VT.19 The morphology of a tachycardia similar to that of premature ventricular contractions seen on prior ECGs increases the probability of a ventricular origin of the arrhythmia. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/other-heart-rhythm-disorders), (https://www.ncbi.nlm.nih.gov/books/NBK537011/), Visitation, mask requirements and COVID-19 information, Heart, Vascular & Thoracic Institute (Miller Family), Bradyarrhythmia, such as some second-degree and third-degree. European Heart J. vol. Her serum potassium was 7.1 mEq/dl, and with aggressive treatment of hyperkalemia, her ECG normalized. 1991. pp. , vol. Wellens JJ, Electrophysiology: Ventricular tachycardia: diagnosis of broad QRS complex tachycardia. Such VTs may look very similar to SVT with aberrancy. Sometimes . Vijay Kunadian The Licensed Content is the property of and copyrighted by DSM. clinically detectable variation of the first heart sound and examination of the jugular venous pressure were noted to be useful for the diagnosis of a ventricular origin of the arrhythmia.3. The ECG shows atrial fibrillation with both narrow and wide QR complexes. 1-ranked heart program in the United States. 126-131. This is one VT which meets every QRS morphology criterion for SVT with aberrancy. Sinus Tachycardia. The electrical signal to make the heartbeat starts . NST repolarization pattern was defined as the presence of at least one of the following: (1) complete right or left bundle branch block, (2) wide-QRS complex ventricular rhythm, (3) ventricular pacing, (4) left ventricular hypertrophy with strain pattern (Sokolow-Lyon voltage criteria), or (5) atrial flutter or coarse . Twelve-lead ECG after electrical cardioversion of the tachycardia. However, you need to understand the following (sorry to seem a bit brutal here..) Your condition is possibly serious (hypertension >200 mmHg systolic with slight exercise, angina pectoris at age 31 . The following observations can now be made: The underlying rhythm is now clearly exposed. WCT tachycardia obtained from a 72-year-old man with a history of remote anteroseptal myocardial infarction and reduced ejection fraction. This is also indicative of VT (ventricular oscillations precede and predict atrial oscillations). This observation clinches the diagnosis of orthodromic atrioventricular tachycardia using a left-sided accessory pathway (Coumels law). Figure 2. Conclusion: The nonsustained VT was actually a paced rhythm due to inappropriate and intermittent tracking of atrial fibrillation by the dual-chamber pacemaker. Brugada, P, Brugada, J, Mont, L. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. The normal PR interval range is ~120 - 200 ms (0.12-0.20s), although it can fluctuate depending on your age and health. A special consideration is WCT due to anterograde conduction over an accessory pathway. ( over 0.10 seconds) is caused by delayed conduction of the electrical stimulus from the upper chamber which causes a delay in contraction of the ventricles. Wide complex tachycardia related to rapid ventricular pacing. Name: Ventricular Fibrillation- Lethal Rate: N/A Rhythm: chaotic baseline activity which may be coarse or fine P-Waves: none PR-Interval: N/A QRS Complex: none. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. AIVR is a wide QRS ventricular rhythm with rate of 40-120 bpm, often with variability during the episode. Sinus rhythm is necessary, but not sufficient, for normal electrical activity within the heart.. There are errant pacing spikes (epicardial wires that were undersensing). Ventricular fibrillation. Her rhythm strips from the ambulance are shown in Figure 5. R on T . If an old EKG is available, the baseline wide QRS will be present. 2008. pp. Deanfield JE, McKenna WJ, Presbitero P, et al., Ventricular arrhythmia in unrepaired and repaired tetralogy of Fallot. Relation to age, timing of repair, and haemodynamic status, Br Heart J, 1984;52(1):7781. Wide complex tachycardia related to preexcitation. 89-98. Sinus tachycardia is a regular cardiac rhythm in which the heart beats faster than normal and results in an increase in cardiac output. Evidence of fusion beats or capture beats is evidence for VA dissociation, and clinches the diagnosis of VT. ECG evidence of even a single dissociated P wave at the onset of tachycardia (i.e., AV dissociation at the onset) may be sufficient evidence on a telemetry strip to recognize VT. There are multiple approaches and protocols, each having its own pros and cons. Conclusion: SVT (AVRT utilizing a left-sided accessory pathway) with LBBB aberrancy. In this article we will discuss the factors which support the diagnosis of VT as well as some algorithms useful in the evaluation of regular, wide QRS complex tachycardias. is one of the easiest to use while having a good sensitivity and specificity. I strongly suspect that the Kardia device will be reporting correctly. Vereckei, A, Duray, G, Szenasi, G. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Tachycardias are broadly categorized based upon the width of the QRS complex on the electrocardiogram (ECG). Is pain in chest , dizziness, headaches and ability to feel heart beat 24/7 normal? The term narrow QRS tachycardia indicates individuals with a QRS duration 120 ms, while wide QRS tachycardia refers to tachycardia with a QRS duration >120 ms. 1 Narrow QRS complexes are due to rapid activation of the ventricles via the His-Purkinje system, suggesting that the origin of the arrhythmia is above or within the His bundle. The ECG shows normal sinus rhythm at 56 bpm with normal atrioventricular and intraventricular conduction and . 18. This condition causes the lower heart chambers to beat so fast that the heart quivers and stops pumping blood. Wide complex tachycardia related to preexcitation. The ECG exhibits several notable features. It also does not mean that you . The patient was found to have flecainide poisoning with an elevated flecainide level. 1. However, early activation of the His bundle can also . , Your heart beats at a different rate when you breathe in than when you breathe out. You cant prevent respiratory sinus arrhythmia. There is a suggestion of a P wave prior to every QRS complex, best seen in lead V1, favoring SVT. Although not immediately apparent, the rhythm is now atrial flutter with 2:1 conduction. The wide QRS complexes follow some of the pacing spikes, and show varying degrees of QRS widening due to intramyocardial aberrancy. Sinus rhythm is the normal cardiac rhythm that emanates from the heart's intrinsic pacemaker called the sinus node and the resting rate can be from 55 to 100. Leads V2 and V3, however, show swift down strokes (onset to nadir <70 ms), favoring SVT with LBBB aberrancy. The four criteria are: This algorithm has a better sensitivity and specificity than the Brugada criteria being 95.7 and 95.7 %, respectively.26 More recently, a new protocol using only lead aVR to differentiate wide QRS complex tachycardias was introduced by Vereckei et al.29 It consists of four steps: Similar to the previous algorithm, only one of the four criteria needs to be present. Pill-in-the-pocket Oral Anticoagulation in AF Patients, Antithrombotic Therapy in AF-PCI Patients, Angiographic Characteristics in Older NSTEACS Patients, TMVR via MitraClip in Patients Aged <65 Years: Multicentre 2-year Outcomes, Approach to the Differentiation of Wide QRS Complex Tachycardias, Content for healthcare professionals only, Persistent Atrial Fibrillation Using Arctic Front Cardiac Cryoablation System, American Heart Hospital Journal 2011;9(1):33-6, https://doi.org/10.15420/ahhj.2011.9.1.33. Aberrancy, ventricular tachycardia, supraventricular tachycardia, right-bundle branch block (RBBB), left-bundle branch block (LBBB), intraventricular conduction delay (IVCD), pre-excited tachycardia. In between, there is a WCT with a relatively narrow QRS complex with an RBBB-like pattern. Heart, 2001;86;57985. The normal PR interval is 0.12-0.20 seconds, or 3-5 small boxes on the ECG graph paper. Register for free and enjoy unlimited access to: Borderline ECG. Sick sinus syndrome is relatively uncommon. 17,18 An entirely positive QRS complex in lead augmented ventor left (aVR) also supports the diagnosis of VT. 17 When the sinus rhythm with wide QRS becomes narrow with a tachycardia . A. In the hemodynamically stable patient, obtaining an ECG with specially located surface ECG electrodes can be helpful in recognizing dissociated P waves. The QRS complex in lead V1 shows an rS pattern, with a broad initial R wave, favoring VT (Table V). A short PR interval and delta wave are present, confirming ventricular pre-excitation and excluding aberrant conduction (excludes answer A). The QRS complex during WCT and during sinus rhythm are nearly identical, and show LBBB morphology. All QRS complexes are irregularly irregular. In this article we try to summarize approaches which we consider optimal for the evaluation of patients with wide QRS complex tachycardias. For the final assessment at least one criterion for both V12 and V6 have to be present to diagnose VT. The PR interval is the time interval between the P wave (atrial depolarization) to the beginning of the QRS segment (ventricular depolarization). 28. Although this is an excellent protocol, with a sensitivity of 8892 % and specificity of 4473 % for VT, it requires remembering multiple morphologic criteria.25,26, The majority of the protocols use supraventricular tachycardia as a default diagnosis of wide QRS complex tachycardia. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. Study with Quizlet and memorize flashcards containing terms like b. Jastrzebski, M, Sasaki, K, Kukla, P, Fijorek, K. The ventricular tachycardia score: a novel approach to electrocardiographic diagnosis of ventricular tachycardia. the algebraic sum of the voltage of the first 40 ms divided by the last 40 ms is less than or equal to one. A. It can be normal and without consequence, or it can be a sign of various heart issues. The heart rate is 111 bpm, with a right inferior axis of about +140 and a narrow QRS. If the patient is conscious and cardioversion is decided upon, it is strongly recommended that sedation or anesthesia be given whenever possible prior to shock delivery. Impossible to say, your EKG must be interpreted by a cardiologist to differ supraventricular tachycardia with wide QRS from ventricular tachycardia. 13,029. But respiratory sinus arrhythmia is not a cause for worry. The normal QRS complex during sinus rhythm is narrow (<120 ms) because of rapid, nearly simultaneous spread of the depolarizing wave front to virtually all parts of the ventricular endocardium, and then radial spread from endocardium to epicardium. Danger: increase the risk of thromboemoblic events don't convert unless occurring less than 48 hrs, if don't know pt need to be put . . Electrocardiogram characteristics of AIVR include a regular rhythm, 3 or more ventricular complexes with QRS complex > 120 milliseconds, a ventricular rate between 50 beats/min and 110 beats/min, and occasional fusion or capture beats.
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