ARRHYTHMIA

Surya Dharma, MD, FIHA

Division of Cardiac Emergency
Department of Cardiology and Vascular Medicine
Faculty of Medicine, University of Indonesia
National Cardiovascular Center Harapan Kita
Jakarta, Indonesia

Aritmia
Gangguan irama jantung berupa segala jenis
irama jantung selain IRAMA SINUS
Supraventrikular
QRS sempit seperti normal
(kecuali beberapa hal:
BBB, WPW,aberans)
Ventrikular
QRS lebar > 0,12 dt


Conduction System
SA Node
Internodal branch

AV Node

Hiss Bundle

Purkinje Fiber

Contraction


Normal Sinus Rhythm
Rhythm : Reular
Rate : !" # $""
P %a&e : Normal in con'iuration( )recede each *RS
PR : Normal + ", $- # ",-" seconds .
*RS : Normal + less than ",$- seconds .
SINUS ARRYTMIA
SINUS BRADYCARDIA
SINUS TACHYCARDIA

Sinus ritme

Sinus Ritme

Sinus Aritmia

Sinus Takikardi

Sinus bradikardi

Aritmia Supraventrikular
Premature beat
/ ekstra sistolik
Takikardi aritmia
Atrial Flutter
Atrial fibrilasi
Supra Ventrikel Takikardi/
Paroksismal Atrial Takikardi
150 - 250 x/mnt

Diagramatic of the mechanisms of SVT and VT
Atrial fibrillation
Atrial flutter
AVRT
AVNRT
V Tach
V Fibrillation
SNRT
AT
JT
TACHYCARDIA

SVT

Treatment strategies of SVT
Pharmacological
Acute Tx (Adenosine iv, Verapamil iv)
Chronic Tx (Verapamil, Betablocker, Digoxin)
Non-pharmacology
1980s sharp dissection or cryosurgical modification
His bundle ablation using DC shock
Radiofrequency catheter ablation

Atrial Fibrilasi

I
II
III
V1
V2
V6
ATRIAL FLUTTER

Approaches to Treatment
Any or all may apply

Anticoagulation (acute and

chronic)

Ventricular rate control

Maintenance of sinus rhythm

Wolff-Parkinson-White syndrome

Aritmia Ventrikular
Premature beat
/ ekstra sistolik
Takikardi aritmia
Ventrikel Fibrilasi

> 350 x/mnt

Ventrikel Takikardi

100-250 x/mnt



Torsade de pointes

Management of Malignant
Ventricular arrhythmia

Pharmacological

Class I

Class III

Class II, Beta blocker

Non-pharmacological

Surgical arrhythmias

Catheter ablation

Device : AICD

Bradycardia

Gangguan AV node

Derajat satu

Derajat dua

Derajat tiga

Gangguan SA node

SA block

SA arrest

Interventrikel blok: Bundle branch block

Fasicular block

Gangguan SA node

First-degree AV block
Rhythm : Reular
Rate : /sually normal
P %a&e : P %a&e )resent( one P %a&e to each *RS
PR : Proloned + reater than ",-" seconds .
*RS : Normal

Second -degree AV block, Mobitz I
Rhythm : Irreular
Rate : /sually slo% but can be normal
P %a&e : Sinus P %a&e )resent(
some not 'ollo%ed by *RS com)le0es
PR : Proressi&ely lenthens
*RS : Normal

Second-degree AV block, Mobitz II
Rhythm : Reular usually(
can be irreuler i' conduction ratios &ary
Rate : /sually slo%
P %a&e : 1%o2 three2 or 'our P %a&es be'ore each
*RS
PR : PR inter&al o' beat %ith *RS is constant(
PR inter&al may be normal or )roloned
*RS : Normal i' block o&er His bundle(
%ide i' block in&ol&es bundle branches

Third-degree AV block
Rhythm : Reular
Rate : 3" # !" i' block in His bundle(
4" # 3" i' block in&ol&es bundle branches
P %a&e : Sinus P %a&e )resent( bear no relationshi) to
*RS(
can be 'ound hidden in *RS com)le0es and 1
%a&es
PR : Varies reatly
*RS : Normal i' block in His bundle(
%ide i' block in&ol&es bundle branches

Third-degree AV block




RBBB,1
st
degree AVBLOCK ,LPHB
RBBB, 1
st
degree AVB,LPHB,MCI

ACUT MCI

Kesimpulan

EKG pemeriksaan yang sangat

sederhana, sangat mobile, segera
didapatkan hasil dan sangat bermanfaat di
bidang kardiologi

EKG hanya sebagai alat bantu diagnosis

Sebagian besar aritmia dapat didiagnosis

berdasarkan EKG

Semua dokter umum seyogyanya

menguasai EKG

1 H A N 5 6 7 /

VES

VES R on T
VT
VF


Torsade de pointes

Ventricular fibrillation

Gangguan SA node

Blok AV derajat 1

Blok AV derajat 2

Blok AV derajat 3