Sinus arrhythmia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]; Mahmoud Sakr, M.D. [3]

Overview

Sinus arrhythmia is an irregularity of the sinus rhythm defined as a variation in the P-P interval by 0.16 sec (160 msec) or more in the presence of normal P waves. It is the most common type of arrhythmia and it is classified into respiratory sinus arrhythmia and non-respiratory sinus arrhythmia. While respiratory sinus arrhythmia is a normal variant that is mostly common in young, the non-respiratory sinus arrhythmia is most commonly present among elderly with heart disease. Respiratory sinus arrhythmia occurs with slower heart rates or after enhanced vagal tone, and tends to disappear with age or with increase in the heart rate.

Classification

Non-respiratory Sinus Arrhythmia

• In this type, the variation in the P-P interval is unrelated to the respiratory cycle. It can occur in the normal heart, the diseased heart or a side effect of some medications.

Ventriculophasic Sinus Arrhythmia

• A ventriculophasic sinus arrhythmia occurs most often in patients with third degree AV block, but it's also observed after a compensatory pause induced by a premature ventricular contraction.