Atrioventricular block

FIRST DEGREE ATRIOVENTRICULAR BLOCK Fir!t "e#ree atrioventricular $AV%

no"al block& "e'ine" a! a (rolon#e" )R interval $*+,-+ !econ"!%& .o!t o'ten occur! /0en
t0ere i! a (rolon#ation or "ela1 in i.(ul!e con"uction t0rou#0 t0e AV no"e,
T0i! "ela1 .a1 re!ult 'ro. t0e 'ollo/in#2
Un"erl1in# !tructural abnor.alitie! o' t0e no"e
An increa!e in va#al tone t0at cau!e! a re"uction in t0e rate o' i.(ul!e con"uction
Dru#! t0at i.(air or !lo/ no"al con"uction inclu"in# "i#o3in& beta blocker!& an"
t0e calciu. c0annel blockin# a#ent!
A (rolon#e" )R interval .a1 al!o be "ue to a "ela1 or !lo/in# in intraatrial con"uction&
or 'ro. uni'or. "ela1 o' con"uction /it0in t0e 4i!5)urkin6e !1!te.,
T0e )R interval #enerall1 varie! /it0 t0e 0eart rate7 in t0e (re!ence o' !inu! bra"1car"ia
$u!uall1 t0e re!ult o' en0ance" va#al tone%& t0e )R interval len#t0en!, In contra!t& t0e )R
interval beco.e! !0orter "urin# !inu! tac01car"ia,
SECOND DEGREE ATRIOVENTRICULAR BLOCK Secon" "e#ree AV block .a1
eit0er be 8obit9 t1(e I $:enckebac0% or 8obit9 t1(e II,
Mobitz type I 8obit9 t1(e I or :enckebac0 !econ" "e#ree AV block i! a re!ult o' an
inter.ittent block o' t0e i.(ul!e /it0in t0e AV no"e& /it0 !ub!e;uent 'ailure to con"uct
an atrial i.(ul!e 'ro. t0e atria to t0e ventricle!,
I.(aire" AV no"al con"uction i! o'ten "ue to a (rolon#ation in t0e no"al re'ractor1
(erio" t0at occur! /0en t0ere i! an increa!e in va#al tone, Eac0 !ucce!!ive atrial i.(ul!e
reac0e! t0e AV no"e /0ile it i! !till (artiall1 re'ractor1, T0ere i! a (ro#re!!ive !lo/in# o'
eac0 !ub!e;uent i.(ul!e "ue to "ecre.ental AV no"al con"uction& until t0e no"e 'inall1
'ail! to con"uct t0e i.(ul!e becau!e it 0a! arrive" at a ti.e /0en it i! ab!olutel1
re'ractor17 t0e re!ult i! no activation o' t0e ventricle an" no <RS i.(ul!e on t0e ECG,
T0e ECG correlate! o' t0e!e electrical event! inclu"e t0e 'ollo/in#2
T0ere i! a (ro#re!!ive len#t0enin# o' t0e )R interval until a nor.all1 occurrin# )
/ave i! not 'ollo/e" b1 a <RS co.(le3 becau!e o' 'ailure o' t0e no"e to con"uct
t0e i.(ul!e to t0e ventricle,
An1 (attern o' block $e#& -2=& >2-& ?2>& etc% .a1 occur "e(en"in# u(on t0e AV
no"al electro(01!iolo#ic (ro(ertie! an" t0e "e#ree o' va#al tone,
T0e co.(letel1 blocke" ) /ave i! on ti.e7
t0e !urroun"in# RR interval i! (rolon#e",
T0e i.(ul!e t0at arrive! at t0e no"e 'ollo/in# t0e co.(letel1 blocke" beat i!
con"ucte" nor.all1 a#ain becau!e t0e no"e 0a! 0a" ti.e to beco.e totall1
=
re(olari9e", T0u!& t0e )R interval a'ter t0e lon# RR interval or (au!e i! le!! t0an
t0e )R interval i..e"iatel1 (rece"in# t0e (au!e,
T0i! !e;uence o' event! .a1 be re(eate" 'or a variable (erio" o' ti.e, T0e r01t0. i!
u!uall1 !inu!& an" t0ere i! a re#ular )) interval, T0e ba!eline )R interval .a1 be nor.al
or a 'ir!t "e#ree AV block .a1 be (re!ent, T0e incre.ental len#t0enin# o' eac0
!ucce!!ive )R interval beco.e! (ro#re!!ivel1 le!!ene" $e#& +,-+& t0en +,-@& t0en +,>+
!econ"!& etc%& re!ultin# in a (ro#re!!ive !0ortenin# o' !ucce!!ive RR interval!, T0u!&
t0ere .a1 a((ear to be #rou( beatin# on t0e ECG,
All o' t0e!e 'eature! .a1 not be !een in eac0 ca!e o' 8obit9 t1(e I !econ" "e#ree AV
block,
Mobitz type II 8obit9 t1(e II !econ" "e#ree AV block i! u!uall1 in"icative o'
un"erl1in# !tructural "i!ea!e involvin# t0e AV no"e t0at i! c0aracteri9e" b1 e(i!o"ic an"
un(re"ictable 'ailure o' t0e no"e to con"uct t0e i.(ul!e 'ro. t0e atria to t0e ventricle!,
T0e block occur! belo/ t0e AV no"e in !o.e ca!e!& /it0in t0e bun"le o' 4i!& or /it0in
bot0 bun"le branc0e!,
In contra!t to 8obit9 t1(e I& t0ere i! no c0an#e in t0e )R interval (rior to or a'ter t0e non5
con"ucte" ) /ave, T0ere .a1 be .ore t0an one !ucce!!ive non5con"ucte" ) /ave&
re!ultin# in !everal ) /ave! in a ro/ /it0out <RS co.(le3e!, An e!ca(e ventricular
'ocu! .a1 #enerate a <RS co.(le3 in !o.e ca!e! a'ter a variable "uration,
T4IRD DEGREE ATRIOVENTRICULAR BLOCK T0ir" "e#ree or co.(lete AV
block occur! /0en t0ere i! co.(lete 'ailure o' t0e AV no"e to con"uct an1 i.(ul!e! 'ro.
t0e atria to t0e ventricle!,
Ot0er cau!e! inclu"e2
Dru#! t0at "e(re!! an" block no"al con"uction !uc0 a! "i#o3in& beta blocker!& or
calciu. c0annel blocker!
En0ance" va#al tone& !uc0 a! t0at occurrin# "urin# !lee(
In're;uentl1 it i! con#enital,
In !o.e ca!e! it i! t0e re!ult o' in'rano"al block occurrin# /it0in t0e bun"le o'
4i! or in bot0 bun"le branc0e!,
T0e ) /ave! are co.(letel1 "i!!ociate" 'ro. t0e <RS co.(le3e! on t0e ECG , T0u!& t0e
)R interval! are irre#ularl1 variable, T0e atrial an" ventricular rate! are bot0 !table7 t0e
'or.er i! 'a!ter t0an t0e latter,
T0e "o.inant (ace.aker activatin# t0e ventricle! .a1 be locate" in t0e lo/er (ortion o'
t0e AV 6unction belo/ t0e block& re!ultin# in a 6unctional e!ca(e r01t0. t0at i! u!uall1 at
a rate bet/een ?+ to @+ beat!A.inute, T0e <RS co.(le3e! are narro/ in t0i!
circu.!tance an" re!e.ble t0o!e o' !inu! r01t0., 4o/ever& i' t0ere i! coe3i!tent "i!ea!e
in t0e ri#0t or le't bun"le& t0e <RS co.(le3e! o' t0e e!ca(e 6unctional r01t0. .a1 be
-
/i"ene"& re!e.blin# a ventricular co.(le3 /it0 a ri#0t or le't bun"le branc0 block
con'i#uration,
T0e "o.inant (ace.aker i! /it0in t0e ventricular .1ocar"iu. i' t0e block i! belo/ t0e
6unction or in t0e 4i! )urkin6e !1!te., T0i! re!ult! in a ventricular e!ca(e r01t0. /it0 a
/i"e bi9arre <RS co.(le3 occurrin# at a rate /0ic0 i! u!uall1 le!! t0an ?+ beat!A.inute ,
VARIABLE ATRIOVENTRICULAR BLOCK A"vance" or 0i#0 #ra"e AV block
re'er! to an AV con"uction ratio t0at varie! bet/een -2=& >2=& an" 0i#0er, T0i! !ituation
co..onl1 occur! in t0e !ettin# o' an increa!e" atrial rate& !uc0 a! occur! /it0 atrial
'lutter, It can al!o occur /it0 nor.al atrial rate! /0en t0ere i! 0i#0 va#al tone $e#& /it0
an acute in'erior .1ocar"ial in'arction%, In t0e la!t !ituation& con"ucte" !inu! beat! are
.ore likel1 to 0ave a nor.al rat0er t0an (rolon#e" )R interval,
Intraventricular block
LEFT ANTERIOR FASCICULAR BLOCK A le't anterior 0e.iblock or 'a!cicular
block i! c0aracteri9e" b1 a (at0olo#ic le't a3i! in t0e 'rontal li.b lea"!& "e'ine" a! an
a3i! *5>+B or *5@+B& "e(en"in# u(on t0e aut0or,
T0i! .a1 be t0e re!ult o' con"uction !1!te. "i!ea!e involvin# t0e anterior 'a!cicle o' t0e
le't bun"le& or .a1 occur /0en t0ere i! "i!ea!e or 'ibro!i! aroun" t0e le't anterior 'a!cicle
$e#& /it0 a .1ocar"ial in'arction%,
T0e <RS co.(le3e! in lea" I are u(ri#0t7 in t0e in'erior lea"! -&>& an" aVF t0e1 are
ne#ative $!.all R /ave& "ee( S /ave%, T0ere i! o'ten a tall R /ave in aVR& an" (oor R
/ave (ro#re!!ion in lea"! V=5V>, T0e <RS "uration i! u!uall1 nor.al,
An in'erior /all .1ocar"ial in'arction al!o 0a! a le't a3i! a! t0e re!ult o' <S or ne#ative
co.(le3e! in t0e in'erior lea"!, T0i! i! "ue to 'ibrotic ti!!ue rat0er t0an con"uction
!1!te. "i!ea!e7 it 0a! been calle" a (eriin'arction block,
LEFT )OSTERIOR FASCICULAR BLOCK A le't (o!terior 0e.iblock occur! /0en
t0ere i! con"uction !1!te. "i!ea!e involvin# t0e (o!terior 'a!cicle o' t0e le't bun"le
branc0, It i! "e'ine" a! a (at0olo#ic ri#0t a3i!& *CD+B& /0en t0ere i! no ot0er etiolo#1
!uc0 a! ri#0t ventricular 01(ertro(01, T0e <RS co.(le3 i! ne#ative $!.all R an" "ee( S%
in lea" I an" aVL& an" (o!itive $tall R /ave% in lea"! II an" aVF,
T0e ri#0t a3i! .a1 be t0e re!ult o' a lateral /all .1ocar"ial in'arction in !o.e ca!e!
$(eriin'arction block%, In t0i! circu.!tance t0ere i! an initial "ee( < /ave an" !.all R
/ave in lea"! I an" aVL,
RIG4T BUNDLE BRANC4 BLOCK A ri#0t bun"le branc0 block $RBBB% .a1 be
inco.(lete or co.(lete,
>
Incomplete RBBB An inco.(lete RBBB i! (re!ent /0en t0ere i! a !lo/in# o' or
"ela1e" con"uction t0rou#0 t0e ri#0t bun"le branc0 or /it0in t0e ri#0t ventricular
.1ocar"iu.& t0ereb1 "ela1in# activation o' t0e ri#0t ventricle, Activation o' t0e !e(tu.
an" le't ventricular .1ocar"iu. i! una''ecte"7 t0u!& t0e initial (art o' t0e <RS co.(le3 i!
nor.al $e#& !e(tal < /ave! 'ollo/e" b1 a R /ave%, 4o/ever& t0e "ela1 in ri#0t
ventricular .1ocar"ial activation cau!e! it to occur a'ter le't ventricular activation rat0er
t0an !i.ultaneou!l1& t0ereb1 alterin# t0e ter.inal (ortion o' t0e <RS co.(le3,
T0e "ela1e" ri#0t ventricular 'orce! are "irecte" 'ro. le't to ri#0t& lea"in# to a tall
!econ"ar1 R /ave $RE% in t0e ri#0t !i"e" lea"!& an" a "ee( ter.inal S /ave in t0e le't
!i"e" lea"! $!0o/ ECG >%, T0u!& t0ere i! a r!RE in lea"! aVR an" V=5V-& an" a ;R!
.or(0olo#1 in lea"! =& aVL& an" VF5@, 4o/ever& t0e <RS co.(le3 /i"t0 i! onl1 !li#0tl1
(rolon#e"& bet/een +,=+ an" +,=- !econ"!& !ince t0ere i! onl1 a .inor "ela1 in ri#0t
ventricular activation /0ic0 !till occur! via t0e ri#0t bun"le branc0,
Complete RBBB A co.(lete ri#0t bun"le branc0 block i! t0e re!ult o' a total block o'
i.(ul!e con"uction alon# t0e ri#0t bun"le branc0& lea"in# to "ela1e" an" abnor.al
activation o' t0e ri#0t ventricular .1ocar"iu. occurrin# 'ro. t0e le't ventricular
.1ocar"iu., T0e le't bun"le branc0 i! not a''ecte"7 t0u!& activation o' t0e !e(tu. an"
le't ventricular .1ocar"iu. i! nor.al& occurrin# 'ir!t 'ro. le't to ri#0t $!e(tal
"e(olari9ation% an" t0en 'ro. ri#0t to le't $ventricular "e(olari9ation%, T0i! i! t0en
'ollo/e" b1 ri#0t ventricular activation,
T0ere i! a nor.al !e(tal ; /ave in lea"! =& aVL& an" VF5@ 'ollo/e" b1 a tall R /ave&
re'lectin# t0e nor.al le't ventricular activation !e;uence $!0o/ ECG ?%, Si.ilarl1& t0ere
i! a nor.al initial !e(tal R /ave 'ollo/e" b1 a "ee( S /ave in lea"! V=5-, 4o/ever&
!ince t0e abnor.al an" "ela1e" ri#0t ventricular activation occur! 'ro. le't to ri#0t an"
#oe! t0rou#0 t0e ventricular .1ocar"iu. an" not t0e 4i!5)urkin6e !1!te.& t0ere /ill be a
tall an" broa" !econ"ar1 R /ave $RE% in lea"! aVR an" V=5- $a RSRE co.(le3%& an" a
"ee( an" broa" S /ave in lea"! =& aVL& an" VF5@, T0e /i"t0 o' t0e <RS co.(le3 i!
*+,=- !ec, In'arction (attern! can be reco#ni9e" !ince le't ventricular activation i!
nor.al,
T0e RBBB al!o re!ult! in an abnor.alit1 o' ventricular re(olari9ation o' t0e ri#0t
ventricular .1ocar"iu., T0u!& t0ere are o'ten !econ"ar1 ST !e#.ent an" T /ave
c0an#e! (re!ent in t0e ri#0t (recor"ial lea"! V=5V>& inclu"in# ST "e(re!!ion an" T /ave
inver!ion!, T0e!e are !i.ilar to t0e c0an#e! ob!erve" /it0 01(ertro(01 o' t0e le't
ventricle,
A RBBB "oe! not alter t0e 'rontal (lane a3i!7 0o/ever& i' t0ere i! a ver1 "ee( S /ave in
lea" =& t0ere .a1 be an a((arent ri#0t a3i! "eviation, In t0e!e ca!e!& onl1 t0e
"e(olari9ation vector o' t0e le't ventricle $t0e R /ave% !0oul" be con!i"ere"& an" t0e
abnor.all1 broa" "ee( S /ave& /0ic0 re'lect! ri#0t ventricular 'orce!& i#nore",
LEFT BUNDLE BRANC4 BLOCK A le't bun"le branc0 block $LBBB% .a1 al!o be
eit0er inco.(lete or co.(lete,
Incomplete LBBB An inco.(lete LBBB occur! /0en t0ere i! a !lo/in# or "ela1 o'
con"uction t0rou#0 t0e le't bun"le& or "i''u!el1 t0rou#0 t0e )urkin6e !1!te. an" t0e
?
ventricular .1ocar"iu., T0i! cau!e! a /i"enin# o' t0e <RS co.(le3 to *+,=+ !econ"!
an" u!uall1 G+,=- !econ"!& a !ituation t0at .a1 al!o be ter.e" an intraventricular
con"uction "ela1 /it0 a le't bun"le branc0 block .or(0olo#1, T0e <RS co.(le3e! are
/i"ene"& but re!e.ble nor.al <RS co.(le3e! $!0o/ ECG F%7 t0e1 !till 0ave !e(tal <
/ave! an" initial R /ave!& unlike a co.(lete le't bun"le branc0 block in /0ic0 initial
!e(tal activation i! abnor.al $"irecte" ri#0t to le't%,
Complete LBBB A co.(lete LBBB "evelo(! a! a re!ult o' con"uction "ela1 or block
/it0in t0e le't bun"le branc0, T0ere i! "ela1e" an" abnor.al activation o' t0e le't
ventricular .1ocar"iu.& an" a "i''u!e !lo/in# o' con"uction t0rou#0out t0e le't
ventricle, Le't ventricular activation ori#inate! 'ro. t0e ri#0t bun"le branc0 in a ri#0t to
le't "irection& in contra!t to t0e nor.al !ituation in /0ic0 t0e 'ir!t (art o' t0e le't
ventricular .1ocar"iu. to be activate" i! t0e !e(tu. via a !.all !e(tal branc0 o' t0e le't
bun"le& /it0 !ub!e;uent i.(ul!e !(rea" in a le't to ri#0t "irection,
T0e!e event! re!ult in t0e 'ollo/in# c0an#e! on t0e ECG2
T0ere i! no !e(tal < /ave in lea"! =& aVL& an" V?5V@7 in!tea" t0ere i! a tall
.ono(0a!ic broa"ene" an" abnor.al R /ave in t0e!e lea"!,
T0ere i! a <S co.(le3 /0ic0 i! abnor.al an" /i"ene" in lea"! V=5V-& in!tea" o'
t0e !.all initial R /ave "ue to !e(tal activation,
T0e <RS interval i! (rolon#e" *+,=- !econ"! !ince le't ventricular activation i!
abnor.al& "ela1e"& an" !lo/e" "ue to con"uction o' t0e i.(ul!e t0rou#0 t0e
ventricular .1ocar"iu. rat0er t0an t0e 4i!5)urkin6e !1!te.,
T0ere .a1 not be an1 c0an#e in t0e 'rontal (lane a3i!& alt0ou#0 a le't a3i!
"eviation i! o'ten (re!ent, It i! not clear i' t0e a3i! "eviation i! a re!ult o' t0e
bun"le branc0 block& or re(re!ent! an in"e(en"ent (roble. o' .ore e3ten!ive
.1ocar"ial "i!ea!e an" 'ibro!i!,
ST an" T /ave abnor.alitie! .a1 be (re!ent& inclu"in# T /ave inver!ion! an" ST
!e#.ent "e(re!!ion, T0e!e c0an#e! o' .1ocar"ial re(olari9ation are !econ"ar1 to
t0e abnor.al ventricular activation,
It i! o'ten not (o!!ible to "ia#no!e ot0er abnor.alitie! !uc0 a! an anterior /all
.1ocar"ial in'arction in t0e (re!ence o' a LBBB "ue to t0e abnor.al con"uction t0rou#0
t0e le't ventricle,
)ree3citation !1n"ro.e!

LO:N5GANONG5LEVINE SHNDRO8E A !0ort )R interval& G+,=- !ec& 0a! been
ter.e" t0e Lo/n5Ganon#5Levine $LGL% !1n"ro.e& or t0e !0ort )R5nor.al <RS
!1n"ro.e, LGL i! a 'or. o' a (ree3citation t0at i! t0e re!ult o' en0ance" or ra(i"
atrioventricular $AV% con"uction, T0e u!ual cau!e i! an acce!!or1 (at0/a1 $Ia.e!
bun"le% /0ic0 link! t0e atriu. to t0e ventricle an" b1(a!!e! t0e nor.al AV no"e,
Con"uction t0rou#0 t0e acce!!or1 (at0/a1 i! 'a!ter t0an t0rou#0 t0e nor.al no"e7 t0u!&
t0e i.(ul!e reac0e! t0e 4i!5)urkin6e !1!te. an" ventricle! a'ter a !0ort "ela1 an" (rior to
F
activation via t0e AV no"e, T0e <RS co.(le3 i! nor.al !ince ventricular activation i! via
t0e nor.al con"uction (at0/a1,
In !o.e ca!e! t0ere i! accelerate" con"uction t0rou#0 t0e nor.al AV no"e rat0er t0an
alon# an acce!!or1 (at0/a1, I' an acce!!or1 (at0/a1 i! (re!ent& t0ere i! t0e (otential 'or
"evelo(in# a reentrant !u(raventricular tac01car"ia& kno/n a! an atrioventricular
reentrant tac01car"ia $t0e circuit involvin# t0e no"e an" t0e b1(a!! tract% or 'or 0avin#
ra(i" ventricular rate! "urin# atrial 'ibrillation or atrial 'lutter,
:OLFF5)ARKINSON5:4ITE SHNDRO8E :ol''5)arkin!on5:0ite $:):%
!1n"ro.e i! a (ree3citation !1n"ro.e t0at re!ult! 'ro. an acce!!or1 (at0/a1& t0e Kent
bun"le& /0ic0 "irectl1 link! t0e atria to t0e ventricle!& b1(a!!in# t0e AV no"e, T0e
ventricular .1ocar"iu. i! activate" earl1 a! a re!ult o' t0i! b1(a!! tract& (rior to
activation via t0e nor.al AV no"eA4i!5)urkin6e (at0/a1,
T0e ECG correlate! o' t0e!e electrical event! inclu"e a !0ort )R interval $u!uall1 G+,=-
!ec% an" a "elta /ave $!lurre" an" broa" u(!troke o' t0e <RS co.(le3%& re(re!entin#
earl1 ventricular activation via t0e abnor.al acce!!or1 (at0/a1, T0e <RS co.(le3 i!
/i"e $*+,=- !ec% an" bi9arre& on occa!ion re!e.blin# a .1ocar"ial in'arction7 t0i! i! "ue
to .1ocar"ial activation "irectl1 t0rou#0 t0e ventricular .1ocar"iu.& an" J'u!in#J /it0
.1ocar"ial activation u!in# t0e 4i!5)urkin6e !1!te., T0u!& t0e <RS co.(le3 in :):
re(re!ent! a 'u!ion beat7 t0e initial (art re!ult! 'ro. !lo/ ventricular activation via t0e
acce!!or1 (at0/a1& /0ile t0e ter.ination o' ventricular activation i! via t0e nor.al
con"uction !1!te. lea"in# to a 'airl1 nor.al ter.inal (ortion o' t0e <RS, O'ten t0ere are
a!!ociate" ST !e#.ent an" T /ave abnor.alitie! re'lectin# abnor.al ventricular
re(olari9ation,
T0e e3tent o' (ree3citation .a1 be labile "e(en"in# u(on t0e re'ractor1 (erio" an"
con"uction c0aracteri!tic! o' t0e acce!!or1 (at0/a17 t0e latter in turn "e(en"! u(on
!1.(at0etic tone, T0ere .a1 be e(i!o"ic& ran"o.& an" !(ora"ic c0an#e! in t0e /i"t0 o'
t0e "elta /ave, T0u!& t0e )R interval an" <RS "uration .a1 be variable& una!!ociate"
/it0 c0an#e! in 0eart rate7 t0i! 0a! been ter.e" a Jconcertina e''ectJ,
Ori#inall1 t0ere /ere t/o t1(e! o' <RS (attern! i"enti'ie" in (atient! /it0 :):2 T1(e A
"ue to a le't !i"e" b1(a!! tract& in /0ic0 t0ere i! a tall R /ave in lea"! V=5V> $e#& a
(o!itive or u(/ar" "elta /ave% T1(e B "ue to a ri#0t !i"e" b1(a!! tract in /0ic0 t0ere are
<S co.(le3e! in lea"! V=5V> $e#& a ne#ative or "o/n/ar" "elta /ave%
It i! no/ kno/n ba!e" u(on electro(01!iolo#ic !tu"ie! an" .a((in# t0at t0e b1(a!! tract
or bun"le o' Kent .a1 be locate" an1/0ere alon# t0e AV rin# $#roove% or in t0e !e(tu.,
T0e .o!t 're;uent location! are le't lateral $F+ (ercent%& (o!tero!e(tal $>+ (ercent%& ri#0t
antero!e(tal $=+ (ercent%& an" ri#0t lateral $=+ (ercent%,
Atrioventricular reentrant tac01car"ia A .acroreentrant circuit e3i!t! a! a re!ult o' t0e
acce!!or1 (at0/a1 in :):& involvin# t0e b1(a!! tract& nor.al AV no"e& an" 4i!
)urkin6e !1!te.& linke" (ro3i.all1 /it0in t0e atrial .1ocar"iu. an" "i!tall1 /it0in t0e
@
ventricular .1ocar"iu., $See JReentr1 an" t0e "evelo(.ent o' car"iac arr01t0.ia!J%,
T0u!& :): i! a!!ociate" /it0 an atrioventricular reentrant tac01car"ia $AVRT%,
T0e <RS co.(le3e! "urin# t0e reentrant tac01car"ia .a1 be narro/& a (0eno.enon
ter.e" ort0o"ro.ic !u(raventricular tac01car"ia, T0i! occur! /0en ante#ra"e con"uction
'ro. t0e atria to t0e ventricle! i! via t0e nor.al con"uction !1!te. $becau!e o' a lon#
ante#ra"e re'ractor1 (erio" o' t0e acce!!or1 (at0/a1%& /0ile retro#ra"e con"uction 'ro.
ventricle! to atria i! via t0e acce!!or1 (at0/a1, In contra!t& t0e <RS co.(le3e! "urin#
t0e !u(raventricular tac01car"ia are /i"e an" aberrate"& re!e.blin# t0e <RS co.(le3e!
"urin# !inu! r01t0.& /0en t0e ante#ra"e con"uction 'ro. atria to ventricle! i! via t0e
acce!!or1 (at0/a1 $/0ic0 in t0i! ca!e 0a! a !0ort re'ractor1 (erio"% an" retro#ra"e
con"uction 'ro. t0e ventricle! to t0e atria i! via t0e nor.al no"al 4i! )urkin6e
con"uction !1!te.7 t0i! i! ter.e" an anti"ro.ic tac01car"ia,
Atrial 'ibrillation or 'lutter Atrial 'ibrillation or 'lutter .a1 al!o occur in (atient! /it0
:):, Ante#ra"e con"uction to t0e ventricle! i! via t0e nor.al (at0/a1 i' t0e re'ractor1
(erio" o' t0e acce!!or1 (at0/a1 i! relativel1 lon# $e#& *-?+ .!ec%& lea"in# to nor.al an"
narro/ <RS co.(le3e! in a""ition to co.(le3e! t0at are /i"ene" an" 0ave t0e :):
(attern, I' t0e acce!!or1 (at0/a1 re'ractor1 (erio" i! !0ort $G-?+ .!ec%& 0o/ever&
ante#ra"e con"uction to t0e ventricle! i! via t0e acce!!or1 (at0/a1& b1(a!!in# t0e AV
no"e, T0e <RS co.(le3e! are (ri.aril1 /i"e& aberrate"& an" bi9arre in t0e!e ca!e!&
re!e.blin# t0o!e !een "urin# !inu! r01t0., T0ere i! a (o!!ibilit1 t0at t0e ventricular rate
/ill be ver1 ra(i" $*>++ beat! (er .inute% "ue to =2= con"uction 'ro. t0e atriu. to t0e
ventricle!,
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