Understanding Types of Arrhythmias on ECG

Introduction

Arrhythmias are disturbances in the heart's rhythm that can be detected using an electrocardiogram (ECG). These irregularities can range from harmless to life-threatening. Understanding the different types of arrhythmias can help in early diagnosis and management.

Main Types of Arrhythmias on ECG

1. Bradyarrhythmias (Slow Heart Rhythms)

  • Sinus Bradycardia: A heart rate below 60 bpm. Often seen in athletes or during sleep. Can be benign or due to a pathological cause.
  • Sick Sinus Syndrome: Dysfunction of the sinus node causing alternating bradycardia and tachycardia.
  • Heart Block (AV Block):
    • 1st-degree AV block: Prolonged PR interval (>200 ms) but consistent conduction.
    • 2nd-degree AV block:
      • Mobitz Type I (Wenckebach): Progressively lengthening PR interval until a beat is dropped.
      • Mobitz Type II: Sudden dropped beats without PR interval prolongation.
    • 3rd-degree AV block (Complete Heart Block): No connection between atrial and ventricular activity, requiring a pacemaker.

2. Tachyarrhythmias (Fast Heart Rhythms)

  • Supraventricular Tachycardia (SVT): Narrow QRS complexes with fast heart rate (>150 bpm), often caused by reentrant circuits.
  • Atrial Fibrillation (AFib): Irregular and rapid atrial activity with absent P waves.
  • Atrial Flutter: Sawtooth pattern of atrial activity, typically around 300 bpm, with a regular ventricular response.
  • Ventricular Tachycardia (VT): Wide QRS complexes, fast ventricular rate (>100 bpm), which can be life-threatening.
  • Ventricular Fibrillation (VFib): Chaotic ventricular activity leading to no effective cardiac output; requires immediate defibrillation.
  • Torsades de Pointes: Polymorphic VT associated with prolonged QT interval, can progress to VFib.

Diagnosis and Treatment

  • ECG remains the primary tool to diagnose arrhythmias.
  • Holter monitoring may be required for intermittent arrhythmias.
  • Treatment depends on the specific arrhythmia but may include medications (e.g., beta-blockers, antiarrhythmics), electrical interventions (pacemakers, defibrillators), or catheter ablation.

Conclusion

Recognizing arrhythmias on ECG is crucial for early intervention. Understanding their characteristics helps in selecting the appropriate treatment.

Source recommendations

1. American Heart Association Guidelines on Arrhythmias

  1. https://www.heart.org/en/health-topics/arrhythmia
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
  3. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  5. https://pubmed.ncbi.nlm.nih.gov/29084733/

2. European Society of Cardiology Guidelines on Arrhythmias

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia
  4. https://pubmed.ncbi.nlm.nih.gov/36017572/
  5. https://www.ahajournals.org/doi/10.1161/01.cir.0000091380.04100.84

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