ELECTROCARDIOGRAPHY RHYTHM

1. SINUS RYTHM

Rhythm

Regular

Rate

Normal (60-100 bpm)

P Wave

Normal (positive & precedes each QRS)

PR Interval Normal (0.12-0.20 sec)

QRS

Normal (0.06-0.10 sec)

2. ASYSTOLE

Rhythm

Not present

Rate

Absent

P Wave

Absent

PR Interval Absent
QRS

Absent

Notes

Confirm with multiple leads

3. ATRIAL FLUTTER

Atrial flutter is an abnormally fast heart rate where the atria contract rapidly do not
adequately pump blood to the ventricles. These fluttering atrial contractions are out
of sync with the ventricles. As a result, the heart does not pump blood effectively.
Atrial flutter is a common arrhythmia. It is a type of supra-ventricular tachycardia
(SVT) and is similar to atrial fibrillation.
Sawtooth patterns in baseline

Rhythm

Regular or irregular

Rate

Fast (250-350 bpm) for Atrial, but

ventricular rate is often slower

P Wave

Not observable, but saw-toothed flutter

waves are present

PR Interval Not measureable

QRS

Normal (0.06-0.10 sec)

4. MULTIFOCAL ATRIAL TACHYCARDIA

Multifocal atrial tachycardia is caused by electrical signals being sent from multiple
(ectopic) locations in the atria rather than from the sinoatrial (SA) node. These
multiple signals cause a rapid, inefficient heartbeat. This arrhythmia is more
commonly found in patients over 50 years of age, particular in patients with lung
disorders. Also see Wandering Atrial Pacemaker, a related abnormality.

Rhythm

Irregular

Rate

Fast (> 100 bpm)

P Wave

Often changing shape and size from beat to

beat (at least three differing forms)

PR Interval Variable
QRS

Normal (0.06-0.10 sec)

Notes

T wave is often distorted Also review

wandering atrial pacemaker lesson

5. ATRIAL FIBRILLATION
Atrial fibrillation is a common type of supraventricular tachycardia (SVT) arrhythmia,
characterized by chaotic, quivering atria. These atrial fibrillations result in atrial
contractions that are ineffective and out of coordination with the ventricles.
P wave missing, replaced by a fine wavy wave

Rhythm

Irregular

Rate

Very fast (> 350 bpm) for Atrial, but

ventricular rate may be slow, normal or fast

P Wave

Absent - erratic waves are present

PR Interval Absent
QRS

Normal but may be widened if there are

conduction delays

6. SUPRAVENTRIKULAR TACHYCARDIA
Supraventricular tachycardia (SVT) is a rapid heart rhythm originating at or above
the AV node. SVT rates are above 100 beats per minute and are typically 150-250
bpm. SVT is the most common pediatric rhythm problem. SVTs rapid heart rate
does not allow the ventricles to completely fill with blood, decreasing cardiac
output.

Rhythm

Regular

Rate

Fast (150-250 bpm)

P Wave

Merged with T wave

PR Interval Normal (0.12 sec)

QRS

Normal (.10 sec)

Notes

PR interval can be difficult to measure

7. VENTRICULAR TACHYCARDIA
Ventricular tachycardia (VT) is a rapid heartbeat over 100 bpm that originates in the
ventricles. The EKG will show three or more irregular heartbeats in a row. Ventricular
tachycardia can be classified by type. Several types of VT, including Monomorphic,

Polymorphic and Torsade de Pointes are available for review on this website.
Ventricular tachycardia requires immediate medical attention.

Rhythm

Regular

Rate

Fast (100-250 bpm)

P Wave

Absent

PR Interval Not measurable

QRS

Wide (>0.10 sec), bizarre appearance

7.1.

VT MONOMORPHIC

Monomorphic ventricular tachycardia is a form of ventricular tachycardia where the

shape of each beat on an ECG match each other. A common cause is tissue scarring
from a previous heart attack.

Rhythm

Regular

Rate

Fast (100-250 bpm)

P Wave

Absent

PR Interval Not measurable

QRS

Wide (>0.10 sec), bizarre looking

7.2.

VT POLYMORPHIC

Polymorphic ventricular tachycardia has changing ECG shapes from beat to beat.

Rhythm

Regular or irregular

Rate

Fast (100-300 bpm)

P Wave

Absent

PR Interval Not measurable

QRS

Normal or wide (>0.10 sec), bizarre looking

7.3.

TORSADE DE POINTES

Torsade de pointes ventricular tachycardia is a particular type of polymorphic VT. An

ECG characterizes it by the QRS complexes twisting around the isoelectric line.

Rhythm

Irregular

Rate

Fast (200-250 bpm)

P Wave

Absent

PR Interval Not measurable

QRS

Wide (>0.10 sec), bizarre looking

8. VENTRICULAR PREMATURE BEATS

8.1.
PREMATURE BEATS BIGEMINY
Premature ventricular contraction bigeminy are extra, abnormal heartbeats
originating in the Purkinje fibers of the ventricles. The PVC occurs with every other
heart beat. Patients may feel a PVC as a skipped beat or palpitation. Single beat
premature ventricular contractions are very common and can often be
asymptomatic in healthy patients. PVCs are also called premature ventricular
complexes.

Rhythm

Irregular

Rate

The underlying rate

P Wave

Absent

PR
Interval

Not measurable

QRS

Wide (> 0.10 sec), bizarre appearance

Notes

PVC appears every second beat

8.2.

PREMATURE BEATS TRIGEMINY

Premature ventricular contraction trigeminy are extra, abnormal heartbeats that

originate in the Purkinje fibers of the ventricles. The PVC occurs with every third
heart beat. Patients may feel a PVC as a skipped beat or palpitation. Single beat
premature ventricular contractions are very common and can often be
asymptomatic in healthy patients.

Rhythm

Irregular

Rate

The underlying rate

P Wave

Absent

PR
Interval

Not measurable

QRS

Wide (> 0.10 sec), bizarre appearance

Notes

PVC appears every third beat

8.3.

PREMATURE BEATS QUADRIGEMINY

Premature ventricular contraction quadrigeminy are extra, abnormal heartbeats

originating in the Purkinje fibers of the ventricles. The PVC occurs with every fourth
heart beat. Patients may feel a PVC as a skipped beat or palpitation. Single beat
premature ventricular contractions are very common and can often be
asymptomatic in healthy patients.

Rhythm

Irregular

Rate

The underlying rate

P Wave

Absent

PR
Interval

Not measurable

QRS

Wide (> 0.10 sec), bizarre appearance

Notes

PVC appears every fourth beat

8.4. PREMATURE BEATS COMPLEX

Premature ventricular contraction couplets are extra, abnormal heartbeats that
originating the Purkinje fibers of the ventricles. The PVC occur in pairs. Patients may
feel a PVC as a skipped beat or palpitation. Single beat premature ventricular
contractions are very common and can often be asymptomatic in healthy patients.
PVCs are also called premature ventricular complexes. Premature ventricular
contraction (PVCs) are extra, abnormal heartbeats that originating the Purkinje
fibers of the ventricles. Patients may feel a PVC as a skipped beat or palpitation.
Single beat premature ventricular contractions are very common and can often be
asymptomatic in healthy patients. PVCs are also called premature ventricular
complexes.

Rhythm

Irregular

Rate

The underlying rate

P Wave

Absent

PR
Interval

Not measurable

QRS

Wide (> 0.10 sec), bizarre appearance

Notes

Two PVCs together are termed a couplet

while three PVCs in a row with a fast rhythm
is ventricular tachycardia

9. BUNDLE BRANCH BLOCK

A bundle branch block is a partial or total interruption of the hearts electrical
impulse in either the right or left branch of the electrical pathway. This interruption,
or block, causes the electrical signals for one of the ventricles to detour, so that one

of the ventricles contracts slightly later than the other ventricle. As a result, cardiac
output can drop. This condition can be congenital or caused by heart disease.

Rhythm

Regular

Rate

The underlying rate

P Wave

Normal

PR
Interval

Normal (0.12-0.20 sec)

QRS

Wide (>0.12 sec)

10.AV Blok Derajat 1

Rhythm

Regular

Rate

The underlying rate

P Wave

Normal

PR Interval

Prolonged (>0.20 sec)

QRS

Normal (0.06-0.10 sec)

Notes

A first degree AV block occurs when electrical impulses moving through the
Atrioventricular (AV) node are delayed (but not blocked). First degree
indicates slowed conduction without missed beats.

11.AV Blok Derajat 2

11.1. AV Blok Derajat 2 tipe I

Rhythm

Irregular but with progressively longer PR interval lengthening

Rate

The underlying rate

P Wave

Normal

PR Interval

Progressively longer until a QRS complex is missed, then cycle repeats

QRS

Normal (0.06-0.10 sec)

11.2. AV Blok Derajat 2 tipe II

Rhythm

Regular (atrial) and irregular (ventricular)

Rate

Characterized by Atrial rate usually faster than ventricular rate (usually slow)

P Wave

Normal form, but more P waves than QRS complexes

PR Interval

Normal or prolonged

QRS

Normal or wide

12. AV Blok Derajat 3

Rhythm

Regular, but atrial and ventricular rhythms are independent

Rate

Characterized by Atrial rate usually normal and faster than ventricular rate

P Wave

Normal shape and size, may appear within QRS complexes

PR Interval

Absent: the atria and ventricles beat independently.

QRS

Normal, but wide if junctional escape focus