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Chapter 4. Atrial Rhythms. Atrial Dysrhythmias : Mechanisms. Altered automaticity and triggered activity are disorders in impulse formation. Reentry is a disorder in impulse conduction. Altered Automaticity.
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Chapter 4 Atrial Rhythms
Atrial Dysrhythmias: Mechanisms • Altered automaticity and triggered activity are disorders in impulse formation. Reentry is a disorder in impulse conduction.
Altered Automaticity • Altered Automaticity occurs in normal pacemaker cells and in myocardial working cells that do not normally function as pacemaker sites.
Triggered Activity • Triggered Activity results from abnormal electrical impulses that sometimes occur during repolarization, when cells are normally quiet.
Reentry • Reentry (reactivation) is a condition in which an impulse returns to stimulate tissue that was previously depolarized. • Reentry requires: • A potential condition circuit or circular conduction pathway • A block within part of the circuit • Delayed conduction within the remainder of the circuit
Premature Atrial Complexes (PACs) • A premature atrial complex (PAC) occurs when an irritable site within the atria fires before the next SA node impulse is due to fire. 2 PAC’s
Aberrantly Conducted PACs • PACs associated with a wide QRS complex are called aberrantly conducted PACs. Aberrantly conducted PACs
Wandering Atrial Pacemaker • With this rhythm, the size, shape and direction of the P waves vary, sometimes from beat to beat. Notice all of the P waves are different even in the slightest bit.
Multifocal Atrial Tachycardia • When the wandering atrial pacemaker is associated with a ventricular rate greater than 100 bpm, the rhythm is called multifocal atrial tachycardia (MAT).
Atrial Tachycardia • An irritable site in the atria fires at a rate of 150-250 bpm.
Atrial Tachycardia • Atrial tachycardia that starts or ends suddenly is called paroxysmal atrial tachycardia (PAT).
Synchronized Cardioversion • Synchronized cardioversion is the delivery of shock to the heart by means of a defibrillator to terminate rapid dysrhythmia.
AV Nodal Reentrant Tachycardia (AVNRT) • AVNRT is caused by reentry in the area of the AV node.
AVNRT • A regular, narrow-QRS tachycardia that starts or ends suddenly is called paroxysmal supraventricular tachycardia (PSVT).
AV Reentrant Tachycardia (AVRT) • Preexcitation is a term used to describe rhythms that originate from above the ventricles but in which the impulse travels via a pathway other than the AV node & bundle of His • The most common type of preexcitation syndrome is called Wolff-Parkinson-White (WPW) Syndrome. Delta Wave
Atrial Flutter • Atrial Flutter is an ectopic rhythm in which an irritable site fires regularly at a very rapid rate.
Atrial Fibrillation • Atrial Fibrillation occurs because of altered automaticity in one of several rapidly firing sites in the atria or reentry involving one or more circuits in the atria. • These rapid impulses cause the muscles of the atria to quiver (fibrillate).