Ventricular

Arrhythmias
FENDY DWIMARTYONO
Ventricular arrhythmias
conduct more slowly so
the QRS is wide (greater
than .12 seconds)
They are usually caused by an ectopic focus in the ventricles that
has become “irritable” due to ischemia. They may also originate
from complete pacemaker failure
 Premature Ventricular Contractions (PVCs)

 Irritable focus causes ventricles to depolarize before the SA

node fires
 Premature beat that has a wide QRS
 QRS and T wave of a PVC usually point in opposite direction from
one another
 “Bad PVCs” – more than 6/minute, coupled, multifocal, and on
or near the T wave of the previous sinus beat
 Suppressed by lidocaine.
Coupled PVCs
Multifocal PVCs
R-on-T Phenomenon: May cause a
run of PVCs or Vfib
Vtach: 3 or more PVCs in a row

 Wide QRS with a regular pattern and a rate of 150-200

 Patient will usually lose consciousness
 Treated with lidocaine; may help to have patient cough if they
are still conscious
 May require DC shock
Vtach
 Vtach

Remember, 3 or more PVCs in a row is a run of Vtach

 Vfib

 Many ectopic foci firing at the same time

 There is no regular pattern as in Vtach
 No effective cardiac output!
 Requires CPR and DC shock, ie, Defibrillation
 Vfib

This is “coarse” vfib

 Vfib

This is “fine” vfib

 Idioventricular Rhythm

 Ventricles depolarizing on their own because of no

conduction from above
 Rate will be between 20-40
 A rate of 60-120 (all PVCs) is sometimes called “Slow
Vtach”
Agonal Rhythm Leading to Ventricular
Standstill (Asystole)
 External Cardiac Pacing : Pacemakers

 Electrodes most commonly placed in ventricles

 Most pacemakers are “demand” type
 Used for symptomatic bradycardia or heart blocks
 EKG shows a “spike” when pacer fires
Demand Pacemaker
Laboratory Exercises # 6
Numbers 9-12
Laboratory Exercises #7
Numbers 1-8
TERIMA KASIH