ECG

JUNCTIONAL &
VENTRICULAR
ARRHYTHMIAS

MARYAM JAMILAH BINTI ABDUL HAMID

082013100002
IMS BANGALORE
INTRODUCTION

 Student should be able to understand what is

junctional and ventricular arrhythmias

 Students should be able to identify these two

arrhythmias through electrocardiograph

 Student should know the classification that

comes below these two arrhythmias
CLASSIFICATIONS

JUNCTIONAL VENTRICULAR
ARRHYTHMIA ARRHYTHMIA

AV Nodal Reentrant
Premature Ventricular
Tachycardia
Contraction

Junctional Rhythm Ventricular tachycardia

Ventricular fibrillation
 JUNCTIONAL ARRHYTHMIA
AV Nodal Reentrant Tachycardia
-A type of supraventricular tachycardia (SVT); above
the
bundle of His
-Reentry circuit forms within or just next to the AV node
-Slow pathway is located inferior and slightly posterior
to the
AV node, often following the anterior margin of
the coronary
sinus.
-common AVNRT; anterograde conduction is via the

slow pathway and the retrograde conduction is via the

fast pathway

-uncommon AVNRT; anterograde conduction is via the

fast pathway and the retrograde conduction is via the

slow pathway
ECG
- P wave that falls after the QRS complex
Junctional Rhythm
-Abnormal heart rhythm resulting from impulses

coming from a locus of tissue in the area of

the AV node

-AV node as the pacemaker

-Retrograde conduction

ECG

- Without a P wave or with an inverted P wave.

- Retrograde P waves refers to the depolarization from the AV node

back towards the SA node

VENTRICULAR ARRHYTHMIA
Cause:
1. Sudden electrical shock of the heart

2. Ischemia of the heart muscle, of its

specialized conducting system

3. Both
Normal person:
After electrical impulses reach the
ventricles, they die
off
 Because all the ventricular muscle is in

refractory phase
 Types of Ventricular
Arrhythmias
 Premature Ventricular Contraction
 Ventricular Tachycardia
 Up to 200 bpm

 Ventricular Flutter
 200-350 bpm

 Ventricular Fibrillation
 350-500 bpm
Premature Ventricular Contraction

 Heartbeat is initiated by Purkinje fibres in

the ventricles rather than by the SA node

 Ventricles contract first and before the atria

have optimally filled the ventricles with

blood, which means that circulation is

inefficient
ECG
 Ventricular Ventricular Flutter Ventricular
Tachycardia Fibrillation
-ventricular QRS ECG
complexes are highly -ECG shows large
-fast
polymorphic
analogous to the oscillation; main and -small potential
ventricular extra fluctuations in rate
systoles terminal deflections
-rhythm
-Retrograde can no longer be
-amplitude
conduction to the atria
is almost always differentiated -appearance
blocked; thus,
undisturbed atrial
activity is scattered *a fatal condition
with P waves without
any relation to QRS
complexes.
 CIRCUS MOVEMENTS AS THE
BASIS FOR VENTRICULAR
FIBRILLATION
 Define circus movements:
‘Re-entry’ of the impulse into muscle that has already
been excited
 Why?
 Pathway around the circle is too long; dilated heart
 Velocity of conduction becomes decreased; blockage of
Purkinje system, ischemia of the muscle or high blood
potassium levels
 Refractory period of the muscle might become greatly
shortened; drugs (epinephrine) or after repetitive electrical
CONCLUSION

Junctional arrhythmia;
 AV nodal reentrant tachycardia
 Junctional Rhythm

Ventricular arrhythmia;
 Premature Ventricular Contraction
 Ventricular Tachycardia
 Ventricular Flutter
 Ventricular Fibrillation
 REFERENCES
1. AK JAIN Medical Physiology, 3rd edition
2. Davidson's Principles and Practice of Medicine, 21st Edition
3. http://en.wikipedia.org/wiki/AV_nodal_reentrant_tachycardia
4. http://en.wikipedia.org/wiki/Premature_ventricular_contraction
5. American Heart Association. (2012, September 05).Ventricular fibrillation.
Retrieved from
http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/
Ventricular-Fibrillation_UCM_324063_Article.jsp
6. Mayo Clinic Staff. (2011, November 01). Diseases and conditions
ventricular fibrillation. Retrieved from http://www.mayoclinic.org/diseases-
conditions/ventricular-fibrillation/basics/definition/CON-20034473
7. American Heart Association. (n.d.). Arrhythmias (ventricular fibrillation).
Retrieved from
http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=arrhyt
8. http://www.drsegal.com/medstud/ecg/junction.htm
9. http://en.wikipedia.org/wiki/Junctional_rhythm