Figure 1 and Figure 2 are the starting points and end points of arrhythmia in a wide QRS wave group.
ECG analysis:
basal heart rhythm is sinus rhythm .
In Figure 1, R2-R10: Deformity begins from R2, and the degree of deformity gradually increases. R7-R10 is a stable wide QRS wave with a ventricular rate of 58 bpm, and the PR interval gradually decreases. It can be seen that P wave gradually separates from the QRS wave group, and finally P wave overlaps with the QRS wave group, considering accelerated ventricular ejaculation rhythm (accelerated ventricular autonomic rhythm) with interfering atrioventricular disconnection (atrioventricular separation phenomenon).
R2-R6 morphology is between sinus QRS and ventricular QRS, and there is a sinus P wave before it. The PR interval is smaller than the sinus PR interval, which is indicated as sinus-ventricular ventricular fusion wave , which is a fusion pulse caused by ventricular depole of ventricular dysfunction.
In Figure 2, R1-R7: is a wide QRS wave with a ventricular rate of 58 bpm, and the P wave overlaps with the QRS wave group. It can sometimes be seen that the P wave gradually separates from the QRS wave group and gradually increases during the PR interval. When the PR interval approaches 0.2s, the QRS wave group becomes narrower, and accelerated ventricular autonomic rhythm with interfering atrioventricular disconnection is considered.
R5-R7 is sinus-ventricular ventricular fusion wave .
Interference atrioventricular disconnection mechanism occurs in two rhythm points that exist at the same time in the atrium and ventricle. When the impulses emitted by each encounter their respective refractory periods, the cells in the refractory period do not react to other impulses, which affects the conduction of the other's rhythms and causes the phenomenon that each of the atrioventricular is independent. Under normal circumstances, the self-discipline of sinoatrial nodes is significantly higher than that of the atria and ventricles, which can effectively inhibit the urge to be released at low pacing points. When the self-discipline of the sinoatrial node is reduced, once it is lower than the self-discipline of the junction and below pacing points, the low-level pacing points have the opportunity to emit a rhythm of ejaculation; or when the self-discipline of the low-level pacing points increases, it can interfere at the junction, forming interfering atrioventricular separation.
usually interfering atrioventricular separation lasts for a short time. As long as the P wave does not fall into the refractory period of the atrioventricular conduction system, it can be transmitted and captured. With the different relationship between P wave and QRS wave group, retrograde P wave, atrial fusion wave, and ventricular fusion wave may appear, and ventricular rhythm and ventricular capture. As long as the sinus heart rate is faster than the ventricular heart rate, normal sinus rhythm can be restored.
Figures 3 and 4 are the 12-lead synchronization diagrams of Figure 5. It can be seen that accelerated ventricular autonomic rhythm is accompanied by interfering atrioventricular disconnection and ventricular fusion wave, and related knowledge points of
:
1. Ventricular fusion wave
6 The excitation of the two pacing points causes fusion pulses generated by the ventricular depole at the same time or almost at the same time, which is called ventricular fusion wave. Ventricular fusion waves often occur when ventricular premature beats, ventricular tachycardia , ventricular parallel rhythm, ventricular pacing rhythm, accelerated ventricular ejaculation and accelerated ventricular ejaculation rhythm .
(I) Sinus-compartmental fusion wave
Among all types of ventricular fusion waves, sinus-compartmental fusion wave is the most common. One pacing point is located in the sinoatrial node; the other pacing point is located in the ventricle. The excitement at the two pacing points is absolutely disturbed in the ventricle, resulting in sinus-ventricular fusion waves.
ECG has pure sinus QRS-T wave group, pure ventricular QRS wave group and ventricular fusion wave between the two.
Characteristics of sinus-compartmental fusion wave:
(1) There must be sinus P wave before the QRS of the fusion wave.
(2) PR interval is shortened, sometimes it can be normal. The QRS time of the fusion wave of
(3) is narrower than the ventricular QRS time, but wider than the sinus QRS time (except for bundle branch block).
2. Accelerated ventricular heart rhythm
Accelerated ventricular escape three or more consecutive times active ventricular arrhythmia is called accelerated ventricular heart rhythm, which is an active ventricular arrhythmia between ventricular heart rhythm and ventricular tachycardia.
ECG diagnosis
1, a series of large deformities QRS wave groups originated from the ventricle, the QRS time limit is ≥120ms
2, the ventricular rate is 40-100bpm, and the rhythm is very irregular.
3 occurs when sinus rhythm and sinus bradycardia . After the sinus frequency accelerates, the accelerated ventricular rhythm disappears.
4, often has ventricular fusion waves.
5, interfering atrioventricular separation. Accelerated ventricular rhythm coexist with sinus rhythm. When the frequencies of the two rhythms are similar or the same, ventricular agitation occurs within a specific time after the P wave, which can form interfering atrioventricular separation.
