By Francis Morris; William Brady; A John Camm
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Additional resources for ABC of clinical electrocardiography
During the tachycardia the rhythm is regular, with narrow QRS complexes and a rate of 130-250 beats/min. Atrial conduction proceeds in a retrograde fashion producing inverted P waves in leads II, III, and aVF. However, since atrial and ventricular depolarisation often occurs simultaneously, the P waves are frequently buried in the QRS complex and may be totally obscured. A P wave may be seen distorting the last part of the QRS complex giving rise to a “pseudo” S wave in the inferior leads and a “pseudo” R wave in V1.
It results from a failure of complete separation of the atria and ventricles during fetal development. The pathway can be situated anywhere around the groove between the atria and ventricles, and in 10% of cases more than one accessory pathway exists. The accessory pathway allows the formation of a re-entry circuit, which may give rise to either a narrow or a broad complex tachycardia, depending on whether the atrioventricular node or the accessory pathway is used for antegrade conduction. Electrocardiographic features In sinus rhythm the atrial impulse conducts over the accessory pathway without the delay encountered with atrioventricular nodal conduction.
Indd 30 2/7/2008 12:00:28 PM Broad Complex Tachycardia—Part II captured beats. 14 s generally indicate a ventricular origin. Concordance throughout the chest leads also indicates ventricular tachycardia. A previous electrocardiogram may give valuable information. Evidence of a myocardial infarction increases the likelihood of ventricular tachycardia, and if the mean frontal plane axis changes during the tachycardia (especially if the change is > 40° to the left or right) this points to a ventricular origin.
ABC of clinical electrocardiography by Francis Morris; William Brady; A John Camm