ECG (Rythm Interpretation)

ARRHYTHMIA
MEDT June 2011

Rhythms:
Sinus rhythm
Atrial rhythm
Junctional rhythm
Ventricular rhythm ( Idioventricular
rhythm )
Premature beat ( extrasystole )
Blocks
About ECG :
Sinus rhythm
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Sinus arrhythmia
Sinus arrest
Sinus block
Sinus rhythm
Criteria :
P wave : normal, each P always followed by
QRS and T ( 1:1 )
PR interval : normal ( 0,12 - 0,20 s )
QRS wave : normal ( 0,06 0,12 s )
Sinus rhythm
Normal sinus rhythm
plus .
Rhythm : regular ( RR interval constant )
Frequency : 60-100x/min
Sinus rhythm
Sinus tachycardia
plus .
Frequency : >100-150x/min
Sinus rhythm
Sinus bradycardia
plus .
Frequency : < 60x/min
Sinus rhythm
Sinus arrhythmia
plus .
Rhythm : irregular ( RR interval not constant )
To differentiate between normal variant and sinus arrhythmia, use this rule:
if the longest minus shortest of RR interval in 1 minute > 0,12 s sinus

arrhythmia.
Frequency : usually 60-100x/min
Sinus rhythm
Sinus arrest
plus .
There are one or more episodes of nil P, QRS, and T
Ratio of RR to RR is not complete number
Frequency : usually < 60x/min
Sinus rhythm
Sinus block
plus .
Ratio of RR to RR is a complete number
Junctional rhythm
Criteria :
Frequency : 40-60x/min ( if 60-100x/min, called : accelerated junctional
rhythm )
P wave : negative, occur before or after QRS or not seen
PR interval : shortened ( < 0,12 s ) or not seen
Junctional tachycardia
Included in Supraventricular tachycardia ( SVT )

Criteria :
Frequency : > 100x/min, usually 150-250x/min
P wave : negative, occur before or after QRS or not seen
Atrial rhythm
Criteria :
P wave : normal, each P always followed by QRS and T (
1:1 )
PR interval : shortened ( < 0,12 s )
Atrial tachycardia
Included in Supraventricular tachycardia ( SVT )

Criteria :
Frequency : > 100x/min, usually 150-250x/min
P wave : normal or not seen
Atrial flutter
Criteria :
Rhythm : usually regular ( RR interval constant )
Frequency : variable - slow ventricular response ( < 60x/min )
- normal ventricular response ( 60-100x/min )
- rapid ventricular response ( >100x/min )
P wave : saw teeth pattern which P waves occur in regular pattern and have a good ratio
( e.g., P : QRS = 2:1, 3:1, 4:1 )
PR interval : cannot be evaluated
Atrial fibrillation
Criteria :
Rhythm : irregular ( RR interval not constant )
Frequency : variable and irregular - slow ventricular response ( < 60x/min )
- normal ventricular response ( 60-100x/min )
- rapid ventricular response ( >100x/min )
P wave : cannot be identified
PR interval : cannot be evaluated
Ventricular rhythm
( Idioventricular rhythm )
Criteria :
P wave : not seen
PR interval : none
QRS wave : prolonged ( > 0,12 s )
Ventricular tachycardia
Criteria :
Frequency : > 100x/min
P wave : not seen
PR interval : none
Ventricular fibrillation
Criteria :
Rhythm : irregular
Frequency : cannot be evaluated
P wave : none
PR interval : none
QRS wave : uncounted, irregular, wavy
Ventricular fibrillation
There are 2 kinds of Ventricular fibrillation :
Coarse VF
Fine VF ( should be DD : Asystole )

Premature beat
( extrasystole )
Premature beat ( extrasystole )
Mention first the base rhythm then name the
type of premature rhythm
Occurs paroxysmally
The RR interval after premature beat always
longer than RR of base rhythm (compensatory
phase)
Premature atrial beat
( Atrial extrasystole )
Criteria :
Rhythm : irregular, because of the occurrence of premature
complexes
Frequency : depend on base rhythms frequency
P wave : abnormal, depend on the origin of impuls
PR interval : normal or shortened ( < 0,12 s )
Premature junctional beat
( Junctional extrasystole )
Criteria :
complexes
P wave : abnormal, depend on the origin of impuls
PR interval : shortened ( < 0,12 s ) or none
Premature ventricular beat
( Ventricular extrasystole )
Criteria :
complexes
P wave : none
PR interval : none
Premature ventricular beat
( Ventricular extrasystole )
Life threatening Premature ventricular beats :
Occur more than 6x/min
Bigemini ( normal : premature = 1:1 )
Multifocal ( more than one type pattern )
Salvo/consecutive ( 2 or 3 beats; note : if 4 or more
beats, is called as Ventricular tachycardia )

R on T
Life threatening because can become ventricular

tachycardia.
Life threatening Premature Ventricular beats
Bigemini
Multifocal
Salvo / consecutive / couplet
R on T
Blocks in heart rhythm
Sinoatrial block ( SA Block ) /
Sinus block

Ratio of RR to RR is a complete number
DD : AV block grade II type Mobitz 2
Criteria :
Frequency : usually <60x/min
P wave : normal, each P always followed by QRS and T ( 1:1 )
PR interval : normal ( 0,12 - 0,20 s )
Atrioventricular block ( AV block )
Grade I
Criteria :
Frequency : usually 60-100x/min

P wave : normal, each P always followed by QRS and T ( 1:1 )
PR interval : prolonged ( > 0,20 s )

Grade II - type Mobitz 1 ( Wenchebach )
Criteria :
Rhythm : irregular
Frequency : 60-100x/min or < 60x/min
P wave : normal, but there is one P that not followed by QRS in a cycle
( e.g., 3:2, 4:3, 5:4 )
PR interval : prolonged ( > 0,20 s ) gradually unto there is a P that not followed by
QRS, then the cycle repeated
Grade II - type Mobitz 2
Criteria :
Rhythm : irregular
P wave : normal, but there are one or more Ps that not followed by QRS in a cycle
( e.g., 2:1, 3:1, 4:1 )
PR interval : normal ( 0,12 - 0,20 s ) or prolonged constantly then the block occurs
Grade III
DD : Junctional ryhthm
Ventricular rhythm
Criteria :
P wave : normal, but the P and QRS stand independently, thus the P waves sometimes
followed by QRS, sometimes not
PR interval : variable or none
QRS wave : normal ( 0,06 0,12 s ) or prolonged
.thank you

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ARRHYTHMIA

MEDT June 2011

Normal sinus rhythm

if the longest minus shortest of RR interval in 1 minute > 0,12 s sinus

Included in Supraventricular tachycardia ( SVT )

Included in Supraventricular tachycardia ( SVT )

Fine VF ( should be DD : Asystole )

Bigemini ( normal : premature = 1:1 )

Multifocal ( more than one type pattern )

Salvo/consecutive ( 2 or 3 beats; note : if 4 or more

beats, is called as Ventricular tachycardia )

Life threatening because can become ventricular

There are one or more episodes of nil P, QRS, and T

Frequency : usually 60-100x/min

PR interval : prolonged ( > 0,20 s )

QRS wave : normal ( 0,06 0,12 s )

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