artrial and ventricular ectopic ecg teaching

artrial and ventricular ectopic ecg teaching

1. Ectopics

2. Learning objective To learn how to recognize ectopics in ECG and how to differentiate atrial ectopics (PACs) from ventricular ectopics (PVCs) To understand the special types of atrial and ventricular ectopics

3. Ectopic Beats ? Any single beat or group of beats arising from a single focus or multiple foci outside the SA node either in the atrium or the ventricle

4. 2 types of ectopic beats in general: 1. Atrial (supraventricular) ectopics 2. Ventricular ectopics

5. PAC

6. Coupling interval : the time interval between the sinus beat and the ectopic beat Compensatory pause : The time interval between the ectopic beat and the following sinus beat

7. In Summary , Atrial Ectopic (PAC) is Premature beat Followed by a compensatory pause P wave of different morphology and/or axis from the sinus rhythm Same QRS complex morphology and axis as the sinus rhythm

8. Do PAC conduct with longer PR or Shorter PR interval ?

9. Longer PR interval Due to decremental properties of the AVN The earlier the PAC , the more the AVN delay and the more time it takes for the atrial impulse to cross the AVN to the ventricle

10. Non Conducted PAC The PAC was too early that it arrived at the absolute refractory period of the AVN resulting in non conduction to the ventricle P wave without a complex

11. Atrial Trigeminy

12. EMBRACE TRIAL PAC of >500/24 Hours predict high risk of developing AF

13. VENTRICULAR ECTOPIC

14. PVC is : Premature beat Followed by a compensatory pause Bizarre-shaped complex with different morphology and/or axis from the baseline rhythm No preceding P wave ( or may be followed by a retrograde P wave due to retrograde AVN conduction)

15. Take Home Messages An ectopic beat preceded by a P wave is mostly PAC even if it shows wide complex Don’t jump to a diagnosis of sinus pause before you exclude a non conducted PAC