ARRHYTHMIA

Eko Antono
Division of Cardiovascular
Department of Internal Medicine
Dr. Hasan Sadikin Hospital

Diagrammatic representation of mechanism of reentry

Blood supply of the AV conduction system

The resting membrane potential and the action potential of an ordinary

working cell from the ventricular myocardium

Schematic representation of pacemaker cell action potential

Schematic representation of ventricular myocardial working cell

action potential

Action potentials recorded from isolated pacemaker cells immersed in a

saline bath and firing at their own inherent discharge rates

Action potentials from different myocardial cells

 TERMINOLOGY
ETIOLOGY
SIGNS

AND SYMPTOMS

SINUS RHYTHM

Relation of an electrocardiogram to the anatomy of the cardiac conduction system

Sinus bradycardia.

Sinus tachycardia

SUPRAVENTRICULAR
ARRHYTHMIAS

Non-compensatory
postextrasystolic
pause

Short coupling
interval in supraventricular extrasystole

Supraventricular
extrasystole

Atrial flutter with high-grade AV block.

Atrial flutter. The atrial rate is 250 beats per minute, and the rhythm is
regular. Every other flutter wave is conducted to ventricles (2:1 block),
resulting in regular ventricular rhythm at a rate of 125 beats per minute

Atrial flutter with variable AV block.

The different appearances of the flutter line in atrial flutter

Atrial flutter with an AV

conduction ratio (AV-CR) at
sleep and rest of 6 : 1 or 4 :
1 decreasing to 1 : 1 with
slight exercise

Fig 5.21

(hal 141 & 142)

Atrial fibrillation with controlled ventricular response.

Atrial fibrillation with rapid ventricular response

Atrial fibrillation (A) untreated and (B) after digitalis

VENTRICULAR
ARRHYTHMIAS

Premature ventricular complex

Unifocal premature ventricular complexes. Note occurrence of

wide, premature QRS complexes. Interval between preceding
normal QRS and PVC (coupling interval) remains constant, and
morphology remains the same

Multiformed premature ventricular complexes. Note variation in

morphology and in coupling interval of PVCs

Premature ventricular complex with fully compensatory pause

Ventricular bigeminy. Note that every other betas is PVC. Both

coupling interval and morphology remain constant; hence they
are unifocal

Pairs of premature ventricular complexes

R-on-T phenomenon. Multiple PVCs are present. Mulitple PVCs

are present. On right, a PVC falls on downslope of T wave,
precipitating ventricular fibrillation

The QRST complex

in ventricular
arrhythmia

The
apprearance of
the QRST
complex in
ventricular
extrasystole

Regular
appearance
of
extrasystole

Lowns criteria
(1975) for a
grading system of
warning
arrhythmias in AMI

Precipitation of ventricular tachycardia by late-cycle PVC. Note

brief salvo of ventricular tachycardia that is initiated by PVC
occurring well beyond T wave

Ventricular tachycardia

Ventricular tachycardia and the diagnostic significance of ventricular

extrasystole

Toardes de pointes

Torsade de pontes ventricular tachycrdial in third degree AV block

Coarse ventricular fibrillation

Fine ventricular fibrillation (coarse asystole)

Onset of ventricular fibrillation in the first hours of an acute

myocardial infarction

Arrhythmogenic
right ventricular
dysplasia. A 6year-old boy
with fainting
spells

Ventricular asystole

CONDUCTION
DISTURBANCES

First-degree AV block. The PR interval is prolonged to 0.31 second

Second-degree AV block type I

Second-degree AV block type II.

Third-degree AV block occuring at level of AV node.

Third-degree AV block occuring at ventricular level

Review of
cardiac
arrhythmias
(1) :
Arrhythmias
with extopic
impulse
formation

Review of
cardiac
arrhythmias (2) :
Arrhythmias with
disturbances in
impulse
conduction

BATAS AKHIR
SLIDE

P wave polarity and

pacemaker site in
atrial and AV
junctional
arrhythmia

Extra-systole
in singles (A)
and in pairs
of couplets
(B) and brief
attacks of
tachycardial
(C)

third-degree AV block with ventricular asystole

Premature junctional complexes

Junctional excape complexes

Paroxysmal supraventricular tachycardial (PSVT)

Atrial tachycardia with block

Survival rates are estimates of probability of survival to

hospital discharge for patients with witnessed collapse
and with ventricular fibrillation as initial rhythm