Ectopic supraventricular rhythm

It is about various rhythms emanating from supraventricular sources (usually atria). Many conditions are asymptomatic and do not require treatment.

Atrial extrasystole (PES), or premature atrial contraction, is a frequently occurring episodic extraordinary impulse. They are able to appear in a normal heart on the background of provoking factors or without them (for example, taking coffee, tea, alcohol, ephedrine analogues) or may be a sign of cardiopulmonary disorders. Sometimes they cause a heartbeat. The diagnosis is made according to ECG data. Atrial extrasystoles can be normal, aberrant or without conduction. Normally conducted atrial extrasystoles are usually accompanied by an uncompensated pause. Aberrantly conducting atrial extrasystole (usually with blockade of the right leg of the bundle of His) must be distinguished from ventricular extrasystoles.

Atrial slip cuts are ectopic atrial contractions following a prolonged pause of the sinus node or its stopping. They can be single and multiple. Slip cuts from one focus can create a continuous rhythm (called the ectopic atrial rhythm). The heart rate usually decreases, the shape of the P wave may be different, and the P-P interval is somewhat shorter than with the sinus rhythm.

Migration of the pacemaker in the atria (multifocal atrial rhythm) is an irregular rhythm that arises from the indiscriminate excitation of a large number of foci in the atria. By definition, the heart rate should be <100 per minute. This arrhythmia often occurs in patients with lung disease and who are in a state of hypoxia, acidosis, theophylline overdose or a combination of these causes. On the electrocardiogram, the shape of the teeth is different for each contraction: three or more different forms of the R wave are identified. The presence of the teeth distinguishes the migration of the pacemaker from atrial fibrillation.

Multifocal atrial tachycardia (chaotic atrial tachycardia) is an irregular rhythm that arises from the indiscriminate excitation of a large number of foci in the atria. By definition, the heart rate should be> 100 per minute. With the exception of this feature, all other characteristics are similar to the pacemaker migration. Symptoms, if they appear, are the same as with pronounced tachycardia. Treatment is directed to the primary pulmonary cause.

Atrial tachycardia is a regular rhythm that arises from the constant rapid activation of the atria from a single focus in the atria. The heart rate is usually 150-200 per minute. At the same time, with a very high incidence of atrial excitation, dysfunction of the nodes of the conduction system, intoxication with digitalis preparations, an AV blockade may occur, and the frequency of the ventricular rhythm will become smaller. Mechanisms include increased atrial automatism and an intra-atrial mechanism for re-entry. Atrial tachycardia is the least frequent (5%) of supraventricular tachycardia; it usually develops in patients with structural pathology of the heart. Other causes include atrial irritation (eg, pericarditis), medicinal effects (digoxin), alcohol intake and exposure to toxic gases. Symptoms are similar to those in other tachycardias. The diagnosis is made according to ECG data. The teeth R, which differ in shape from normal sinus teeth, precede the QRS complex, but may "hide" behind the previous T wave. To slow down the heart rate, it is possible to use vagal samples that help visualize the P teeth if they are "hidden", but these receptions usually do not stop the arrhythmia (which indicates that the AV node is not an obligatory part of the pulse circulation). Treatment consists of correcting the underlying cause and slowing the rate of ventricular contraction by using b-adrenoblockers or calcium channel blockers. The arrhythmia attack can be interrupted by direct cardioversion. The pharmacological approach to arresting and preventing atrial tachycardia includes antiarrhythmic drugs of la, lc, and III classes. With the ineffectiveness of non-invasive techniques, an alternative is overwhelming pacemaking and radiofrequency ablation of the foci of excitation.

Non-paroxysmal nodular tachycardia arises from abnormal automatism in the AV joint or other tissue (which often accompanies open heart surgery, acute anterior myocardial infarction, myocarditis, or intoxication with cardiac glycosides). The heart rate is usually in the range of 60-120 per minute, in connection with this symptomatology is most often absent. The ECG demonstrates a regular, normally formed QRS complex without well-visualized teeth or with retrograde denticles (inverted in the lower leads) that appear immediately before (<0.1 s) or after the ventricular complex. Rhythm differs from paroxysmal supraventricular tachycardia of lower heart rate and gradual onset and termination. Treatment depends on the cause.

[1], [2], [3], [4], [5], [6], [7], [8], [9]