Second degree AV block differential diagnosis: Difference between revisions

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{{CMG}}; {{AE}} {{CZ}}
{{CMG}}; {{AE}} {{CZ}}


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==Overview==
Second degree [[AV block ]] must be differentiated from different abnormal and irregular cardiac [[rhythms]] as [[atrial fibrillation]] with slow [[ventricular ]] response, [[atrial flutter]], [[atrial tachycardia]] with block.


==Differentiating Second degree AV block from other Diseases==
==Differentiating Second degree AV block from other Diseases==
* Second degree AV Block may be simulated by blocked [[PAC]]s. Must be very careful to assure that the P to P intervals are constant.
* Second degree AV Block may be simulated by blocked [[PAC]]s. Must be very careful to assure that the P to P intervals are constant.
* 2:1 conduction may simulate [[sinus bradycardia]] as the blocked [[P wave]]s may fall on the preceding [[T wave]]s.
* 2:1 conduction may simulate [[sinus bradycardia]] as the blocked [[P wave]]s may fall on the preceding [[T wave]]s.
==Differentiating Second degree heart block From Other Diseases==
==Differentiating Second degree heart block From Other Diseases==
<br />
<br />
{| class="wikitable"
{| class="wikitable"
|+
|+
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arrhythmia
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Arrhythmia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rhythm
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rhythm
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rate
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rate
Line 22: Line 24:
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Co-existing Conditions
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Co-existing Conditions
|-
|-
!'''Atrial Fibrillation (AFib)<ref name="pmid24837984">{{cite journal |vauthors=Lankveld TA, Zeemering S, Crijns HJ, Schotten U |title=The ECG as a tool to determine atrial fibrillation complexity |journal=Heart |volume=100 |issue=14 |pages=1077–84 |date=July 2014 |pmid=24837984 |doi=10.1136/heartjnl-2013-305149 |url=}}</ref><ref name="pmid22518390">{{cite journal |vauthors=Harris K, Edwards D, Mant J |title=How can we best detect atrial fibrillation? |journal=J R Coll Physicians Edinb |volume=42 Suppl 18 |issue= |pages=5–22 |date=2012 |pmid=22518390 |doi=10.4997/JRCPE.2012.S02 |url=}}</ref>'''
! rowspan="3" |Atrioventricular block<ref name="pmid311250962">{{cite journal| author=Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ et al.| title=Risk Factors Associated With Atrioventricular Block. | journal=JAMA Netw Open | year= 2019 | volume= 2 | issue= 5 | pages= e194176 | pmid=31125096 | doi=10.1001/jamanetworkopen.2019.4176 | pmc=6632153 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31125096  }}</ref>
![[First degree AV block|First degree]] <ref name="pmid8734740">{{cite journal| author=Barold SS| title=Indications for permanent cardiac pacing in first-degree AV block: class I, II, or III? | journal=Pacing Clin Electrophysiol | year= 1996 | volume= 19 | issue= 5 | pages= 747-51 | pmid=8734740 | doi=10.1111/j.1540-8159.1996.tb03355.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8734740  }}</ref><ref name="pmid15233485">{{cite journal| author=Upshaw CB| title=Comparison of the prevalence of first-degree atrioventricular block in African-American and in Caucasian patients: an electrocardiographic study III. | journal=J Natl Med Assoc | year= 2004 | volume= 96 | issue= 6 | pages= 756-60 | pmid=15233485 | doi= | pmc=2568382 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15233485  }}</ref>
|
* Regular
|
|
* Normal
|
* Prolonged PR interval (>200 msec)
|
* Less than 0.12 seconds, consistent, and normal in morphology.
|
* No treatment required
 
<br />
|
* Prevalence: 650 to 1600 per 100,000 individuals in the united states.
| rowspan="3" |<br />
 
*[[Heart failure]]
*[[Coronary heart disease]]
*[[Cardiomyopathy]]
*[[Sarcoidosis]]
*[[Lyme disease]]
* Defenerative muscle disorders as [[Lev's disease]] and [[Lenegre's disease]].
* Overly active [[vagus nerve]].
|-
![[Second degree AV block|Second degree]]<ref name="pmid2191578">{{cite journal| author=Zehender M, Meinertz T, Keul J, Just H| title=ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance. | journal=Am Heart J | year= 1990 | volume= 119 | issue= 6 | pages= 1378-91 | pmid=2191578 | doi=10.1016/s0002-8703(05)80189-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2191578  }}</ref><ref name="pmid1176840">{{cite journal| author=Friedman HS, Gomes JA, Haft JI| title=An analysis of Wenckebach periodicity. | journal=J Electrocardiol | year= 1975 | volume= 8 | issue= 4 | pages= 307-15 | pmid=1176840 | doi=10.1016/s0022-0736(75)80003-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1176840  }}</ref>
|
* Regular irregular
|
|
* Normal
|
* Mobtiz I: Progressive PR prolongation
*Mobitz II: Normal PR interval
|QRS is normal but dropped as the following:
 
* Mobitz I: QRS complex is dropped after a progressive lengthening of PR
* Mobitz II: QRS complex is dropped after a normal PR
|
* Can be reversed by using a pacemaker.
|
* Prevalence: 3 per 100,000 individuals in the united states.
|-
![[Third degree AV block|Third degree]]<ref name="pmid14297523">{{cite journal |vauthors=OSTRANDER LD, BRANDT RL, KJELSBERG MO, EPSTEIN FH |title=ELECTROCARDIOGRAPHIC FINDINGS AMONG THE ADULT POPULATION OF A TOTAL NATURAL COMMUNITY, TECUMSEH, MICHIGAN |journal=Circulation |volume=31 |issue= |pages=888–98 |date=June 1965 |pmid=14297523 |doi=10.1161/01.cir.31.6.888 |url=}}</ref><ref name="pmid16236932">{{cite journal |vauthors=Movahed MR, Hashemzadeh M, Jamal MM |title=Increased prevalence of third-degree atrioventricular block in patients with type II diabetes mellitus |journal=Chest |volume=128 |issue=4 |pages=2611–4 |date=October 2005 |pmid=16236932 |doi=10.1378/chest.128.4.2611 |url=}}</ref>
|
* Regular
|
|
* Normal but no relationship between P wave and the QRS.
* More P waves than the QRS complexes. 
|
* Varies
|
* Normal QRS
|
* Can be reversed by using a pacemaker.
|
* The prevalence: 20 per 100,000 individuals worldwide.
|-
! colspan="2" |'''Atrial Fibrillation (AFib)<ref name="pmid24837984">{{cite journal |vauthors=Lankveld TA, Zeemering S, Crijns HJ, Schotten U |title=The ECG as a tool to determine atrial fibrillation complexity |journal=Heart |volume=100 |issue=14 |pages=1077–84 |date=July 2014 |pmid=24837984 |doi=10.1136/heartjnl-2013-305149 |url=}}</ref><ref name="pmid22518390">{{cite journal |vauthors=Harris K, Edwards D, Mant J |title=How can we best detect atrial fibrillation? |journal=J R Coll Physicians Edinb |volume=42 Suppl 18 |issue= |pages=5–22 |date=2012 |pmid=22518390 |doi=10.4997/JRCPE.2012.S02 |url=}}</ref>'''
|
|
* Irregularly irregular
* Irregularly irregular
Line 51: Line 114:
* Left chamber enlargement
* Left chamber enlargement
|-
|-
!'''[[Atrial Flutter]]'''<ref name="pmid28835836">{{cite journal |vauthors=Cosío FG |title=Atrial Flutter, Typical and Atypical: A Review |journal=Arrhythm Electrophysiol Rev |volume=6 |issue=2 |pages=55–62 |date=June 2017 |pmid=28835836 |pmc=5522718 |doi=10.15420/aer.2017.5.2 |url=}}</ref>
! colspan="2" |'''[[Atrial Flutter]]'''<ref name="pmid28835836">{{cite journal |vauthors=Cosío FG |title=Atrial Flutter, Typical and Atypical: A Review |journal=Arrhythm Electrophysiol Rev |volume=6 |issue=2 |pages=55–62 |date=June 2017 |pmid=28835836 |pmc=5522718 |doi=10.15420/aer.2017.5.2 |url=}}</ref>
|
|
* Regular or Irregular
* Regular or Irregular
Line 71: Line 134:
*[[Alcohol]]
*[[Alcohol]]
|-
|-
!'''[[Atrioventricular nodal reentry tachycardia]] ([[AV nodal reentrant tachycardia|AVNRT]])<ref name="pmid27617092">{{cite journal |vauthors=Katritsis DG, Josephson ME |title=Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia |journal=Arrhythm Electrophysiol Rev |volume=5 |issue=2 |pages=130–5 |date=August 2016 |pmid=27617092 |pmc=5013176 |doi=10.15420/AER.2016.18.2 |url=}}</ref><ref name="pmid20458824">{{cite journal |vauthors=Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, Kalusche D, Arentz T |title=Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway |journal=Acta Cardiol |volume=65 |issue=2 |pages=171–6 |date=April 2010 |pmid=20458824 |doi=10.2143/AC.65.2.2047050 |url=}}</ref>'''<ref name="urlAtrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK499936/ |title=Atrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid25196716">{{cite journal |vauthors=Schernthaner C, Danmayr F, Strohmer B |title=Coexistence of atrioventricular nodal reentrant tachycardia with other forms of arrhythmias |journal=Med Princ Pract |volume=23 |issue=6 |pages=543–50 |date=2014 |pmid=25196716 |pmc=5586929 |doi=10.1159/000365418 |url=}}</ref>
! colspan="2" |'''[[Atrioventricular nodal reentry tachycardia]] ([[AV nodal reentrant tachycardia|AVNRT]])<ref name="pmid27617092">{{cite journal |vauthors=Katritsis DG, Josephson ME |title=Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia |journal=Arrhythm Electrophysiol Rev |volume=5 |issue=2 |pages=130–5 |date=August 2016 |pmid=27617092 |pmc=5013176 |doi=10.15420/AER.2016.18.2 |url=}}</ref><ref name="pmid20458824">{{cite journal |vauthors=Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, Kalusche D, Arentz T |title=Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway |journal=Acta Cardiol |volume=65 |issue=2 |pages=171–6 |date=April 2010 |pmid=20458824 |doi=10.2143/AC.65.2.2047050 |url=}}</ref>'''<ref name="urlAtrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK499936/ |title=Atrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid25196716">{{cite journal |vauthors=Schernthaner C, Danmayr F, Strohmer B |title=Coexistence of atrioventricular nodal reentrant tachycardia with other forms of arrhythmias |journal=Med Princ Pract |volume=23 |issue=6 |pages=543–50 |date=2014 |pmid=25196716 |pmc=5586929 |doi=10.1159/000365418 |url=}}</ref>
|
|
* Regular
* Regular
Line 99: Line 162:
*[[Atrial tachyarrhythmias]]
*[[Atrial tachyarrhythmias]]
|-
|-
!'''[[Multifocal atrial tachycardia|Multifocal Atrial Tachycardia]]<ref name="pmid2570520">{{cite journal |vauthors=Scher DL, Arsura EL |title=Multifocal atrial tachycardia: mechanisms, clinical correlates, and treatment |journal=Am. Heart J. |volume=118 |issue=3 |pages=574–80 |date=September 1989 |pmid=2570520 |doi=10.1016/0002-8703(89)90275-5 |url=}}</ref><ref name="pmid11884328">{{cite journal |vauthors=Goodacre S, Irons R |title=ABC of clinical electrocardiography: Atrial arrhythmias |journal=BMJ |volume=324 |issue=7337 |pages=594–7 |date=March 2002 |pmid=11884328 |pmc=1122515 |doi=10.1136/bmj.324.7337.594 |url=}}</ref>'''
! colspan="2" |'''[[Multifocal atrial tachycardia|Multifocal Atrial Tachycardia]]<ref name="pmid2570520">{{cite journal |vauthors=Scher DL, Arsura EL |title=Multifocal atrial tachycardia: mechanisms, clinical correlates, and treatment |journal=Am. Heart J. |volume=118 |issue=3 |pages=574–80 |date=September 1989 |pmid=2570520 |doi=10.1016/0002-8703(89)90275-5 |url=}}</ref><ref name="pmid11884328">{{cite journal |vauthors=Goodacre S, Irons R |title=ABC of clinical electrocardiography: Atrial arrhythmias |journal=BMJ |volume=324 |issue=7337 |pages=594–7 |date=March 2002 |pmid=11884328 |pmc=1122515 |doi=10.1136/bmj.324.7337.594 |url=}}</ref>'''
|
|
* Irregular
* Irregular
Line 119: Line 182:
*[[Chronic obstructive pulmonary disease]] ([[Chronic obstructive pulmonary disease|COPD]])
*[[Chronic obstructive pulmonary disease]] ([[Chronic obstructive pulmonary disease|COPD]])
|-
|-
!'''Paroxysmal Supraventricular Tachycardia'''
! colspan="2" |'''Paroxysmal Supraventricular Tachycardia'''
|
|
* Regular
* Regular
Line 142: Line 205:
*[[Wolff-Parkinson-White syndrome]]
*[[Wolff-Parkinson-White syndrome]]
|-
|-
!'''[[Premature atrial contraction|Premature Atrial Contractrions]] ([[Premature atrial contraction|PAC]])'''<ref name="pmid26316525">{{cite journal |vauthors=Lin CY, Lin YJ, Chen YY, Chang SL, Lo LW, Chao TF, Chung FP, Hu YF, Chong E, Cheng HM, Tuan TC, Liao JN, Chiou CW, Huang JL, Chen SA |title=Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome |journal=J Am Heart Assoc |volume=4 |issue=9 |pages=e002192 |date=August 2015 |pmid=26316525 |pmc=4599506 |doi=10.1161/JAHA.115.002192 |url=}}</ref><ref name="pmid18063110">{{cite journal |vauthors=Strasburger JF, Cheulkar B, Wichman HJ |title=Perinatal arrhythmias: diagnosis and management |journal=Clin Perinatol |volume=34 |issue=4 |pages=627–52, vii–viii |date=December 2007 |pmid=18063110 |pmc=3310372 |doi=10.1016/j.clp.2007.10.002 |url=}}</ref>
! colspan="2" |'''[[Premature atrial contraction|Premature Atrial Contractrions]] ([[Premature atrial contraction|PAC]])'''<ref name="pmid26316525">{{cite journal |vauthors=Lin CY, Lin YJ, Chen YY, Chang SL, Lo LW, Chao TF, Chung FP, Hu YF, Chong E, Cheng HM, Tuan TC, Liao JN, Chiou CW, Huang JL, Chen SA |title=Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome |journal=J Am Heart Assoc |volume=4 |issue=9 |pages=e002192 |date=August 2015 |pmid=26316525 |pmc=4599506 |doi=10.1161/JAHA.115.002192 |url=}}</ref><ref name="pmid18063110">{{cite journal |vauthors=Strasburger JF, Cheulkar B, Wichman HJ |title=Perinatal arrhythmias: diagnosis and management |journal=Clin Perinatol |volume=34 |issue=4 |pages=627–52, vii–viii |date=December 2007 |pmid=18063110 |pmc=3310372 |doi=10.1016/j.clp.2007.10.002 |url=}}</ref>
|
|
* Regular except when disturbed by premature beat(s)
* Regular except when disturbed by premature beat(s)
Line 150: Line 213:
* Upright
* Upright
|
|
* > 0.12 second  
* > 0.12 second
* May be shorter than that in normal sinus rhythm (NSR) if the origin of PAC is located closer to the AV node
* May be shorter than that in normal sinus rhythm (NSR) if the origin of PAC is located closer to the AV node
*Ashman’s Phenomenon:
*Ashman’s Phenomenon:
Line 169: Line 232:
*[[Hypercholesterolemia]]
*[[Hypercholesterolemia]]
|-
|-
!'''[[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White Syndrome]]<ref name="pmid24982705">{{cite journal |vauthors=Rao AL, Salerno JC, Asif IM, Drezner JA |title=Evaluation and management of wolff-Parkinson-white in athletes |journal=Sports Health |volume=6 |issue=4 |pages=326–32 |date=July 2014 |pmid=24982705 |pmc=4065555 |doi=10.1177/1941738113509059 |url=}}</ref><ref name="pmid10597097">{{cite journal |vauthors=Rosner MH, Brady WJ, Kefer MP, Martin ML |title=Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues |journal=Am J Emerg Med |volume=17 |issue=7 |pages=705–14 |date=November 1999 |pmid=10597097 |doi=10.1016/s0735-6757(99)90167-5 |url=}}</ref>'''
! colspan="2" |'''[[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White Syndrome]]<ref name="pmid24982705">{{cite journal |vauthors=Rao AL, Salerno JC, Asif IM, Drezner JA |title=Evaluation and management of wolff-Parkinson-white in athletes |journal=Sports Health |volume=6 |issue=4 |pages=326–32 |date=July 2014 |pmid=24982705 |pmc=4065555 |doi=10.1177/1941738113509059 |url=}}</ref><ref name="pmid10597097">{{cite journal |vauthors=Rosner MH, Brady WJ, Kefer MP, Martin ML |title=Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues |journal=Am J Emerg Med |volume=17 |issue=7 |pages=705–14 |date=November 1999 |pmid=10597097 |doi=10.1016/s0735-6757(99)90167-5 |url=}}</ref>'''
|
|
* Regular
* Regular
Line 193: Line 256:
*[[Tuberous sclerosis]]
*[[Tuberous sclerosis]]
|-
|-
!'''[[Ventricular fibrillation|Ventricular Fibrillation]] (VF)'''<ref name="pmid27899944">{{cite journal |vauthors=Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J |title=Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction |journal=J Geriatr Cardiol |volume=13 |issue=9 |pages=789–797 |date=September 2016 |pmid=27899944 |pmc=5122505 |doi=10.11909/j.issn.1671-5411.2016.09.006 |url=}}</ref><ref name="pmid11334828">{{cite journal |vauthors=Samie FH, Jalife J |title=Mechanisms underlying ventricular tachycardia and its transition to ventricular fibrillation in the structurally normal heart |journal=Cardiovasc. Res. |volume=50 |issue=2 |pages=242–50 |date=May 2001 |pmid=11334828 |doi=10.1016/s0008-6363(00)00289-3 |url=}}</ref><ref name="pmid20142817">{{cite journal |vauthors=Adabag AS, Luepker RV, Roger VL, Gersh BJ |title=Sudden cardiac death: epidemiology and risk factors |journal=Nat Rev Cardiol |volume=7 |issue=4 |pages=216–25 |date=April 2010 |pmid=20142817 |pmc=5014372 |doi=10.1038/nrcardio.2010.3 |url=}}</ref>
! colspan="2" |'''[[Ventricular fibrillation|Ventricular Fibrillation]] (VF)'''<ref name="pmid27899944">{{cite journal |vauthors=Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J |title=Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction |journal=J Geriatr Cardiol |volume=13 |issue=9 |pages=789–797 |date=September 2016 |pmid=27899944 |pmc=5122505 |doi=10.11909/j.issn.1671-5411.2016.09.006 |url=}}</ref><ref name="pmid11334828">{{cite journal |vauthors=Samie FH, Jalife J |title=Mechanisms underlying ventricular tachycardia and its transition to ventricular fibrillation in the structurally normal heart |journal=Cardiovasc. Res. |volume=50 |issue=2 |pages=242–50 |date=May 2001 |pmid=11334828 |doi=10.1016/s0008-6363(00)00289-3 |url=}}</ref><ref name="pmid20142817">{{cite journal |vauthors=Adabag AS, Luepker RV, Roger VL, Gersh BJ |title=Sudden cardiac death: epidemiology and risk factors |journal=Nat Rev Cardiol |volume=7 |issue=4 |pages=216–25 |date=April 2010 |pmid=20142817 |pmc=5014372 |doi=10.1038/nrcardio.2010.3 |url=}}</ref>
|
|
* Irregular
* Irregular
Line 225: Line 288:
*[[Stroke]]
*[[Stroke]]
|-
|-
!'''[[Ventricular tachycardia|Ventricular Tachycardia]]'''<ref name="pmid19252119">{{cite journal |vauthors=Koplan BA, Stevenson WG |title=Ventricular tachycardia and sudden cardiac death |journal=Mayo Clin. Proc. |volume=84 |issue=3 |pages=289–97 |date=March 2009 |pmid=19252119 |pmc=2664600 |doi=10.1016/S0025-6196(11)61149-X |url=}}</ref><ref name="pmid21505622">{{cite journal |vauthors=Levis JT |title=ECG Diagnosis: Monomorphic Ventricular Tachycardia |journal=Perm J |volume=15 |issue=1 |pages=65 |date=2011 |pmid=21505622 |pmc=3048638 |doi=10.7812/tpp/10-130 |url=}}</ref>
! colspan="2" |'''[[Ventricular tachycardia|Ventricular Tachycardia]]'''<ref name="pmid19252119">{{cite journal |vauthors=Koplan BA, Stevenson WG |title=Ventricular tachycardia and sudden cardiac death |journal=Mayo Clin. Proc. |volume=84 |issue=3 |pages=289–97 |date=March 2009 |pmid=19252119 |pmc=2664600 |doi=10.1016/S0025-6196(11)61149-X |url=}}</ref><ref name="pmid21505622">{{cite journal |vauthors=Levis JT |title=ECG Diagnosis: Monomorphic Ventricular Tachycardia |journal=Perm J |volume=15 |issue=1 |pages=65 |date=2011 |pmid=21505622 |pmc=3048638 |doi=10.7812/tpp/10-130 |url=}}</ref>
|
|
* Regular
* Regular
Line 252: Line 315:
*[[Myocardial infarction]]
*[[Myocardial infarction]]
*[[Torsades de pointes]] is a form of polymorphic VT that is often associated with a prolonged [[QT interval]]
*[[Torsades de pointes]] is a form of polymorphic VT that is often associated with a prolonged [[QT interval]]
|}
The table below provides information on the [[differential diagnosis]] of ventricular tachycardia in terms of [[ECG]] appearance:
{| border="3"
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Disease Name}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Causes}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| ECG Characteristics}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| ECG view}}
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"| '''[[Ventricular tachycardia]]''' <ref name="AjijolaTung2014">{{cite journal|last1=Ajijola|first1=Olujimi A.|last2=Tung|first2=Roderick|last3=Shivkumar|first3=Kalyanam|title=Ventricular tachycardia in ischemic heart disease substrates|journal=Indian Heart Journal|volume=66|year=2014|pages=S24–S34|issn=00194832|doi=10.1016/j.ihj.2013.12.039}}</ref><ref name="Meja LopezMalhotra2019">{{cite journal|last1=Meja Lopez|first1=Eliany|last2=Malhotra|first2=Rohit|title=Ventricular Tachycardia in Structural Heart Disease|journal=Journal of Innovations in Cardiac Rhythm Management|volume=10|issue=8|year=2019|pages=3762–3773|issn=21563977|doi=10.19102/icrm.2019.100801}}</ref><ref name="CoughtrieBehr2017">{{cite journal|last1=Coughtrie|first1=Abigail L|last2=Behr|first2=Elijah R|last3=Layton|first3=Deborah|last4=Marshall|first4=Vanessa|last5=Camm|first5=A John|last6=Shakir|first6=Saad A W|title=Drugs and life-threatening ventricular arrhythmia risk: results from the DARE study cohort|journal=BMJ Open|volume=7|issue=10|year=2017|pages=e016627|issn=2044-6055|doi=10.1136/bmjopen-2017-016627}}</ref><ref name="El-Sherif2001">{{cite journal|last1=El-Sherif|first1=Nabil|title=Mechanism of Ventricular Arrhythmias in the Long QT Syndrome: On Hermeneutics|journal=Journal of Cardiovascular Electrophysiology|volume=12|issue=8|year=2001|pages=973–976|issn=1045-3873|doi=10.1046/j.1540-8167.2001.00973.x}}</ref><ref name="de RivaWatanabe2015">{{cite journal|last1=de Riva|first1=Marta|last2=Watanabe|first2=Masaya|last3=Zeppenfeld|first3=Katja|title=Twelve-Lead ECG of Ventricular Tachycardia in Structural Heart Disease|journal=Circulation: Arrhythmia and Electrophysiology|volume=8|issue=4|year=2015|pages=951–962|issn=1941-3149|doi=10.1161/CIRCEP.115.002847}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Ischemic heart disease]]
*Illicit drug use such as [[cocaine]] and [[methamphetamine]]
*[[Structural heart diseases]]
*[[Electrolyte disturbances]]
*[[Congestive heart failure]]
*[[Myocarditis]]
*[[Obstructive sleep apnea]]
*[[Pulmonary artery catheter]]
*[[Long QT syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ventricular tachycardia originates from a [[ventricular]] focus.
* Lasts more than 30 seconds.
* [[Broad QRS complex]]es: rate of >90 BPM.
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture V tach.PNG|center|300px]]<ref> ECG found in of https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"| '''[[Ventricular fibrillation]]''' <ref name="pmid19252119">{{cite journal |vauthors=Koplan BA, Stevenson WG |title=Ventricular tachycardia and sudden cardiac death |journal=Mayo Clin. Proc. |volume=84 |issue=3 |pages=289–97 |date=March 2009 |pmid=19252119 |pmc=2664600 |doi=10.1016/S0025-6196(11)61149-X |url=}}</ref><ref name="pmid28222965">{{cite journal |vauthors=Maury P, Sacher F, Rollin A, Mondoly P, Duparc A, Zeppenfeld K, Hascoet S |title=Ventricular arrhythmias and sudden death in tetralogy of Fallot |journal=Arch Cardiovasc Dis |volume=110 |issue=5 |pages=354–362 |date=May 2017 |pmid=28222965 |doi=10.1016/j.acvd.2016.12.006 |url=}}</ref><ref name="pmid1638716">{{cite journal |vauthors=Saumarez RC, Camm AJ, Panagos A, Gill JS, Stewart JT, de Belder MA, Simpson IA, McKenna WJ |title=Ventricular fibrillation in hypertrophic cardiomyopathy is associated with increased fractionation of paced right ventricular electrograms |journal=Circulation |volume=86 |issue=2 |pages=467–74 |date=August 1992 |pmid=1638716 |doi=10.1161/01.cir.86.2.467 |url=}}</ref><ref name="BektasSoyuncu2012">{{cite journal|last1=Bektas|first1=Firat|last2=Soyuncu|first2=Secgin|title=Hypokalemia-induced Ventricular Fibrillation|journal=The Journal of Emergency Medicine|volume=42|issue=2|year=2012|pages=184–185|issn=07364679|doi=10.1016/j.jemermed.2010.05.079}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Coronary ischemia|Acute coronary ischemia]]
*[[cardiomyopathy|Cardiomyopathies]]
*[[Congenital heart disease]]
*[[Myocardial infarction]]
*[[Heart surgery]]
*[[Electrolyte abnormalities]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Poorly identifiable [[QRS complexes]] and absent [[P waves]]
* The [[heart rate]] is >300 BPM
*[[Rhythm]] is irregular
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture VF.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"| '''[[Ventricular flutter]]''' <ref name="ThiesBoos2000">{{cite journal|last1=Thies|first1=Karl-Christian|last2=Boos|first2=Karin|last3=Müller-Deile|first3=Kai|last4=Ohrdorf|first4=Wolfgang|last5=Beushausen|first5=Thomas|last6=Townsend|first6=Peter|title=Ventricular flutter in a neonate—severe electrolyte imbalance caused by urinary tract infection in the presence of urinary tract malformation|journal=The Journal of Emergency Medicine|volume=18|issue=1|year=2000|pages=47–50|issn=07364679|doi=10.1016/S0736-4679(99)00161-4}}</ref><ref name="KosterWellens1976">{{cite journal|last1=Koster|first1=Rudolph W.|last2=Wellens|first2=Hein J.J.|title=Quinidine-induced ventricular flutter and fibrillation without digitalis therapy|journal=The American Journal of Cardiology|volume=38|issue=4|year=1976|pages=519–523|issn=00029149|doi=10.1016/0002-9149(76)90471-9}}</ref><ref name="pmid250503">{{cite journal |vauthors=Dhurandhar RW, Nademanee K, Goldman AM |title=Ventricular tachycardia-flutter associated with disopyramide therapy: a report of three cases |journal=Heart Lung |volume=7 |issue=5 |pages=783–7 |date=1978 |pmid=250503 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Electrolyte disturbances]]
*[[Medications]] such as:
**[[Disopyramide]]
**[[Quinidine]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*The [[ECG]] shows:
**A typical [[sinusoidal]] pattern
**Frequency of 300 bpm
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture Ven Flu.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="left" | '''[[Asystole]]''' <ref name="ACLS_2003_H_T">''ACLS: Principles and Practice''. p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.</ref><ref name="ACLS_2003_EP_HT">''ACLS for Experienced Providers''. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hypovolemia]]
*[[Hypoxia (medical)|Hypoxia]]
*[[Acidosis]]
*[[Hypothermia|Hypothermia]]
*[[Hyperkalemia|Hyperkalemia]] or [[Hypokalemia|Hypokalemia]]
*[[Hypoglycemia|Hypoglycemia]]
*[[Cardiac tamponade|Cardiac Tamponade]]
*[[Tension pneumothorax|Tension pneumothorax]]
*[[Thrombosis|Thrombosis]]
*[[Myocardial infarction]]
*[[Thrombosis|Thrombosis]]
*[[Pulmonary embolism]]
*[[Cardiogenic shock]]
*Degeneration of the [[sinoatrial]] or [[atrioventricular]] nodes
*[[Ischemic stroke]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* There is no electrical activity in the asystole
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[Image:Lead II rhythm generated asystole.JPG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="left" | '''[[Pulseless electrical activity]]''' <ref name="ECC_2005_7.2">"2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest." ''Circulation'' 2005; '''112''': IV-58 - IV-66.</ref><ref>Foster B, Twelve Lead Electrocardiography, 2nd edition, 2007</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hypovolemia]]
*[[Hypoxia]]
*Hydrogen ions ([[Acidosis]])
*[[Hypothermia]]
*[[Electrolyte disturbances]]
*[[Hypoglycemia]]
*Tablets or [[Toxins]] (Drug overdose) such as [[beta blockers]], [[tricyclic antidepressants]], or [[calcium channel blockers]]
*[[Tamponade]]
*[[Tension pneumothorax]]
*[[Thrombosis]] ([[Myocardial infarction]])
*[[Thrombosis]] ([[Pulmonary embolism]])
*[[Trauma]] ([[Hypovolemia]] from [[blood loss]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Several pattern are possible including:
**[[Normal sinus rhythm]]
**[[Sinus tachycardia]], with discernible [[P waves]] and [[QRS complexes]]
**[[Bradycardia]], with or without [[P waves]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture PEA.PNG|center|300px]]<ref> ECG found in wikimedia Commons </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="left" |'''[[Torsade de Pointes]]''' <ref name="pmid28674475">{{cite journal |vauthors=Li M, Ramos LG |title=Drug-Induced QT Prolongation And Torsades de Pointes |journal=P T |volume=42 |issue=7 |pages=473–477 |date=July 2017 |pmid=28674475 |pmc=5481298 |doi= |url=}}</ref><ref name="SharainMay2015">{{cite journal|last1=Sharain|first1=Korosh|last2=May|first2=Adam M.|last3=Gersh|first3=Bernard J.|title=Chronic Alcoholism and the Danger of Profound Hypomagnesemia|journal=The American Journal of Medicine|volume=128|issue=12|year=2015|pages=e17–e18|issn=00029343|doi=10.1016/j.amjmed.2015.06.051}}</ref><ref name="pmid11330748">{{cite journal |vauthors=Khan IA |title=Twelve-lead electrocardiogram of torsades de pointes |journal=Tex Heart Inst J |volume=28 |issue=1 |pages=69 |date=2001 |pmid=11330748 |pmc=101137 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* *[[Electrolyte disturbances]]
*[[Medications]] such as:
**[[Amiodarone]]
** [[Azithromycin ]]
** [[Clozapine ]]
**[[Famotidine]]
** [[Flecainide ]]
** [[Foscarnet ]]
** [[Levofloxacin ]]
** [[Lithium ]]
** [[Mirtazipine]]
** [[Quetiapine ]]
** [[Risperidone ]]
** [[Tacrolimus ]]
** [[Tamoxifen ]]
** [[Ziprasidone]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
# Paroxysms of [[VT]] with irregular RR intervals.
# A [[ventricular]] rate between 200 and 250 beats per minute.
# Two or more cycles of [[QRS complex]]es with alternating polarity.
# Changing amplitude of the [[QRS complexes]] in each cycle in a [[sinusoidal]] fashion.
# Prolongation of the [[QT interval]].
# Is often initiated by a [[PVC]] with a long coupling interval, R on T phenomenon.
# There are usually 5 to 20 complexes in each cycle.
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture Tors De P.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|}
|}


Latest revision as of 05:12, 12 July 2021

Second degree AV block Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Second degree AV block must be differentiated from different abnormal and irregular cardiac rhythms as atrial fibrillation with slow ventricular response, atrial flutter, atrial tachycardia with block.

Differentiating Second degree AV block from other Diseases

  • Second degree AV Block may be simulated by blocked PACs. Must be very careful to assure that the P to P intervals are constant.
  • 2:1 conduction may simulate sinus bradycardia as the blocked P waves may fall on the preceding T waves.

Differentiating Second degree heart block From Other Diseases


Arrhythmia Rhythm Rate P wave PR Interval QRS Complex Response to Maneuvers Epidemiology Co-existing Conditions
Atrioventricular block[1] First degree [2][3]
  • Regular
  • Normal
  • Prolonged PR interval (>200 msec)
  • Less than 0.12 seconds, consistent, and normal in morphology.
  • No treatment required
  • Prevalence: 650 to 1600 per 100,000 individuals in the united states.
Second degree[4][5]
  • Regular irregular
  • Normal
  • Mobtiz I: Progressive PR prolongation
  • Mobitz II: Normal PR interval
 QRS is normal but dropped as the following:
  • Mobitz I: QRS complex is dropped after a progressive lengthening of PR
  • Mobitz II: QRS complex is dropped after a normal PR
  • Can be reversed by using a pacemaker.
  • Prevalence: 3 per 100,000 individuals in the united states.
Third degree[6][7]
  • Regular
  • Normal but no relationship between P wave and the QRS.
  • More P waves than the QRS complexes.
  • Varies
  • Normal QRS
  • Can be reversed by using a pacemaker.
  • The prevalence: 20 per 100,000 individuals worldwide.
Atrial Fibrillation (AFib)[8][9]
  • Irregularly irregular
  • Absent
  • Fibrillatory waves
  • Absent
  • Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction
  • 2.7–6.1 million people in the United States have AFib
  • 2% of people younger than age 65 have AFib, while about 9% of people aged 65 years or older have AFib
Atrial Flutter[10]
  • Regular or Irregular
  • 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) beats per minute (bpm), but 150 is more common
  • Sawtooth pattern of P waves at 250 to 350 bpm
  • Biphasic deflection in V1
  • Varies depending upon the magnitude of the block, but is short
  • Less than 0.12 seconds, consistent, and normal in morphology
  • Conduction may vary in response to drugs and maneuvers dropping the rate from 150 to 100 or to 75 bpm
Atrioventricular nodal reentry tachycardia (AVNRT)[11][12][13][14]
  • Regular
  • 140-280 bpm
  • Slow-Fast AVNRT:
    • Pseudo-S wave in leads II, III, and AVF
    • Pseudo-R' in lead V1.
  • Fast-Slow AVNRT
  • Slow-Slow AVNRT
  • Inverted, superimposed on or buried within the QRS complex (pseudo R prime in V1/pseudo S wave in inferior leads)
  • Absent (P wave can appear after the QRS complex and before the T wave, and in atypical AVNRT, the P wave can appear just before the QRS complex)
  • Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction
  • QRS alternans may be present
Multifocal Atrial Tachycardia[15][16]
  • Irregular
  • Atrial rate is > 100 beats per minute
  • Varying morphology from at least three different foci
  • Absence of one dominant atrial pacemaker, can be mistaken for atrial fibrillation if the P waves are of low amplitude
  • Less than 0.12 seconds, consistent, and normal in morphology
Paroxysmal Supraventricular Tachycardia
  • Regular
  • 150 and 240 bpm
  • Absent
  • Hidden in QRS
  • Absent
  • Narrow complexes (< 0.12 s)
Premature Atrial Contractrions (PAC)[17][18]
  • Regular except when disturbed by premature beat(s)
  • 80-120 bpm
  • Upright
  • > 0.12 second
  • May be shorter than that in normal sinus rhythm (NSR) if the origin of PAC is located closer to the AV node
  • Ashman’s Phenomenon:
  • Usually narrow (< 0.12 s)
Wolff-Parkinson-White Syndrome[19][20]
  • Regular
  • Atrial rate is nearly 300 bpm and ventricular rate is at 150 bpm
  • Less than 0.12 seconds
  • A delta wave and evidence of ventricular pre-excitation if there is conduction to the ventricle via ante-grade conduction down an accessory pathway
  • A delta wave and pre-excitation may not be present because bypass tracts do not conduct ante-grade.
Ventricular Fibrillation (VF)[21][22][23]
  • Irregular
  • 150 to 500 bpm
  • Absent
  • Absent
  • Absent (R on T phenomenon in the setting of ischemia)
Ventricular Tachycardia[24][25]
  • Regular
  • > 100 bpm (150-200 bpm common)
  • Absent
  • Absent
  • Initial R wave in V1, initial r > 40 ms in V1/V2, notched S in V1, initial R in aVR, lead II R wave peak time ≥50 ms, no RS in V1-V6, and atrioventricular dissociation
  • Wide complex, QRS duration > 120 milliseconds
  • 5-10% of patients presenting with AMI

References

  1. ↑ Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ; et al. (2019). "Risk Factors Associated With Atrioventricular Block". JAMA Netw Open. 2 (5): e194176. doi:10.1001/jamanetworkopen.2019.4176. PMC 6632153 Check |pmc= value (help). PMID 31125096.
  2. ↑ Barold SS (1996). "Indications for permanent cardiac pacing in first-degree AV block: class I, II, or III?". Pacing Clin Electrophysiol. 19 (5): 747–51. doi:10.1111/j.1540-8159.1996.tb03355.x. PMID 8734740.
  3. ↑ Upshaw CB (2004). "Comparison of the prevalence of first-degree atrioventricular block in African-American and in Caucasian patients: an electrocardiographic study III". J Natl Med Assoc. 96 (6): 756–60. PMC 2568382. PMID 15233485.
  4. ↑ Zehender M, Meinertz T, Keul J, Just H (1990). "ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance". Am Heart J. 119 (6): 1378–91. doi:10.1016/s0002-8703(05)80189-9. PMID 2191578.
  5. ↑ Friedman HS, Gomes JA, Haft JI (1975). "An analysis of Wenckebach periodicity". J Electrocardiol. 8 (4): 307–15. doi:10.1016/s0022-0736(75)80003-3. PMID 1176840.
  6. ↑ OSTRANDER LD, BRANDT RL, KJELSBERG MO, EPSTEIN FH (June 1965). "ELECTROCARDIOGRAPHIC FINDINGS AMONG THE ADULT POPULATION OF A TOTAL NATURAL COMMUNITY, TECUMSEH, MICHIGAN". Circulation. 31: 888–98. doi:10.1161/01.cir.31.6.888. PMID 14297523.
  7. ↑ Movahed MR, Hashemzadeh M, Jamal MM (October 2005). "Increased prevalence of third-degree atrioventricular block in patients with type II diabetes mellitus". Chest. 128 (4): 2611–4. doi:10.1378/chest.128.4.2611. PMID 16236932.
  8. ↑ Lankveld TA, Zeemering S, Crijns HJ, Schotten U (July 2014). "The ECG as a tool to determine atrial fibrillation complexity". Heart. 100 (14): 1077–84. doi:10.1136/heartjnl-2013-305149. PMID 24837984.
  9. ↑ Harris K, Edwards D, Mant J (2012). "How can we best detect atrial fibrillation?". J R Coll Physicians Edinb. 42 Suppl 18: 5–22. doi:10.4997/JRCPE.2012.S02. PMID 22518390.
  10. ↑ Cosío FG (June 2017). "Atrial Flutter, Typical and Atypical: A Review". Arrhythm Electrophysiol Rev. 6 (2): 55–62. doi:10.15420/aer.2017.5.2. PMC 5522718. PMID 28835836.
  11. ↑ Katritsis DG, Josephson ME (August 2016). "Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia". Arrhythm Electrophysiol Rev. 5 (2): 130–5. doi:10.15420/AER.2016.18.2. PMC 5013176. PMID 27617092.
  12. ↑ Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, Kalusche D, Arentz T (April 2010). "Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway". Acta Cardiol. 65 (2): 171–6. doi:10.2143/AC.65.2.2047050. PMID 20458824.
  13. ↑ "Atrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf".
  14. ↑ Schernthaner C, Danmayr F, Strohmer B (2014). "Coexistence of atrioventricular nodal reentrant tachycardia with other forms of arrhythmias". Med Princ Pract. 23 (6): 543–50. doi:10.1159/000365418. PMC 5586929. PMID 25196716.
  15. ↑ Scher DL, Arsura EL (September 1989). "Multifocal atrial tachycardia: mechanisms, clinical correlates, and treatment". Am. Heart J. 118 (3): 574–80. doi:10.1016/0002-8703(89)90275-5. PMID 2570520.
  16. ↑ Goodacre S, Irons R (March 2002). "ABC of clinical electrocardiography: Atrial arrhythmias". BMJ. 324 (7337): 594–7. doi:10.1136/bmj.324.7337.594. PMC 1122515. PMID 11884328.
  17. ↑ Lin CY, Lin YJ, Chen YY, Chang SL, Lo LW, Chao TF, Chung FP, Hu YF, Chong E, Cheng HM, Tuan TC, Liao JN, Chiou CW, Huang JL, Chen SA (August 2015). "Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome". J Am Heart Assoc. 4 (9): e002192. doi:10.1161/JAHA.115.002192. PMC 4599506. PMID 26316525.
  18. ↑ Strasburger JF, Cheulkar B, Wichman HJ (December 2007). "Perinatal arrhythmias: diagnosis and management". Clin Perinatol. 34 (4): 627–52, vii–viii. doi:10.1016/j.clp.2007.10.002. PMC 3310372. PMID 18063110.
  19. ↑ Rao AL, Salerno JC, Asif IM, Drezner JA (July 2014). "Evaluation and management of wolff-Parkinson-white in athletes". Sports Health. 6 (4): 326–32. doi:10.1177/1941738113509059. PMC 4065555. PMID 24982705.
  20. ↑ Rosner MH, Brady WJ, Kefer MP, Martin ML (November 1999). "Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues". Am J Emerg Med. 17 (7): 705–14. doi:10.1016/s0735-6757(99)90167-5. PMID 10597097.
  21. ↑ Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J (September 2016). "Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction". J Geriatr Cardiol. 13 (9): 789–797. doi:10.11909/j.issn.1671-5411.2016.09.006. PMC 5122505. PMID 27899944.
  22. ↑ Samie FH, Jalife J (May 2001). "Mechanisms underlying ventricular tachycardia and its transition to ventricular fibrillation in the structurally normal heart". Cardiovasc. Res. 50 (2): 242–50. doi:10.1016/s0008-6363(00)00289-3. PMID 11334828.
  23. ↑ Adabag AS, Luepker RV, Roger VL, Gersh BJ (April 2010). "Sudden cardiac death: epidemiology and risk factors". Nat Rev Cardiol. 7 (4): 216–25. doi:10.1038/nrcardio.2010.3. PMC 5014372. PMID 20142817.
  24. ↑ Koplan BA, Stevenson WG (March 2009). "Ventricular tachycardia and sudden cardiac death". Mayo Clin. Proc. 84 (3): 289–97. doi:10.1016/S0025-6196(11)61149-X. PMC 2664600. PMID 19252119.
  25. ↑ Levis JT (2011). "ECG Diagnosis: Monomorphic Ventricular Tachycardia". Perm J. 15 (1): 65. doi:10.7812/tpp/10-130. PMC 3048638. PMID 21505622.


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