Figure 1 ECG analysis:
sinus P disappears, replaced by f-waves of different size, morphology, and spacing. The QRS wave is significantly uneven, with an average ventricular rate of 89bpm, indicating atrial fibrillation . The 2.2s RR interval can be seen.
Figure 2 Electrocardiogram analysis:
R1-R8 is atrial fibrillation, and atrial fibrillation terminates after R8, and a long RR interval of up to 4.1s occurs, and there is no atrial or ventricular excitation wave during this period, which is manifested as full-cardiac arrest.
R11 and turned to atrial fibrillation.
Figure 3 is a 12-lead synchronization diagram of the length R8-R11 in Figure 2.
Figure 4 is a 12-lead synchronization diagram of the length R4-R6 in Figure 5.
Figure 5 ECG analysis:
R1-R4 is atrial fibrillation, and a long RR interval of up to 2.3s and 7.1s occurs after atrial fibrillation. There is no atrial or ventricular excitation during the interval of 7.1s, which is manifested as total heart arrest. After the suspension is terminated on its own, it turns into excessive atrial ejaculation (R5, R6). There is P' before R5 and R6, and the P'R interval is 0.2s, and P' is significantly different from the sinus P in Figure 2.
R6 and then turned to atrial fibrillation.
Figure 6 ECG analysis:
basal heart rhythm is atrial fibrillation. A long RR interval of up to 8.4 seconds occurred after atrial fibrillation. There is no atrial or ventricular excitation during intervals, which is manifested as total heart arrest. After the arrest is terminated on its own, it turns into an excessively prone border ejaculation (R4), and there is no P wave before R4.
studies show that symptoms of fainting are significantly related to the time limit of the long RR interval. Too long RR interval leads to hemodynamic disorders in patients, and are prone to symptoms such as fainting and black dysfunction. This case of total cardiac arrest lasts for 8 seconds but no junctional or ventricular escape occurs, indicating that the patient not only has abnormal sinus node impulse formation and conduction disorders, but also has different degrees of obstacles in the pacing and conduction function of the atrioventricular junction and ventricular conduction system. Long-term total heart arrest can lead to A-S comprehensive convulsion or even sudden death of .
Related knowledge points:
1. Atrial fibrillation
0 is more common than atrial flutter, and is a common rapid arrhythmia. Because of its rapid atrial excitation and disorderly tremor, it loses coordinated contraction, the atrium has lost its normal blood-extraction function, and the clavicle thrombus is easily formed.
ECG characteristics:
1, P wave disappears, replaced by f waves of different sizes, shapes and spacings. The frequency of f waves is 350-600/min. A typical F-wave is the key point in diagnosing atrial fibrillation and the only basis for diagnosing atrial fibrillation. However, various interferences and artifacts need to be eliminated.
2, significant arrhythmias in the ventricular rhythm of atrial fibrillation is caused by occult transmission within at the atrioventricular node. The R-R cycle of atrial fibrillation is extremely irregular. You can only measure several R-R cycles continuously and find the average value, which is the average ventricular rate of atrial fibrillation.
3. Indoor conduction can be normal during atrial fibrillation, or can be differentially transmitted in .
2. atrial fibrillation combined with ventricular long interval
For a considerable period, long ventricular intervals occurring in atrial fibrillation were regarded as the result of combined second-degree atrioventricular block, and the following standards were formulated:
1. Those who have not been transferred to the ventricles for 10 consecutive fs and have repeated more than three times.
2, the average ventricular rate is less than 50bpm.
3, the long R-R interval is 2500ms, and more than three times of junction or ventricular ejaculation occurs, the more conditions meet, the greater the reliability of diagnosis of combined second-degree atrioventricular block.
Dynamic ECG monitoring found that long ventricular intervals combined with atrial fibrillation are not necessarily secondary atrioventricular block.
Now it is believed that atrial fibrillation combined with second degree atrioventricular block does exist, but it is rare and there are certain difficulties in diagnosis.If one of the following conditions occurs, it is suggested that atrial fibrillation is combined with second-degree atrioventricular block:
1, sinus rhythm and persistent secondary atrioventricular block. When atrial fibrillation occurs, the ventricular rate is less than 50bpm.
2, and frequent long ventricular intermittent with ≥2500ms occurs.
3, junctional ejaculation, junctional bradycardia, ventricular ejaculation or ventricular rhythm with atrial fibrillation combined with hyperactivity.
Holer monitoring shows that occasional long ventricular intervals occur during night sleep are often related to increased vagus nerve tone and occult Atrioventricular conduction.
33. Hidden conduction caused by atrial fibrillation
Atrial fibrillation is accompanied by hidden conduction in the junction area, which is commonly manifested as ventricular rhythm disorder, which is also one of the important characteristics of atrial fibrillation. The generation mechanism is related to occult conduction.
The atrial rate during atrial fibrillation is as high as 350-600 times per minute. Although many atrial agitations enter the junction area and fail to pass the junction area "full process" (hidden conduction). The depths of these excitements enter the atrioventricular area are different, and the degree of subsequent agitation is also different. Some excitements can still be transmitted to the ventricle, but the conduction is delayed, and some excitements are completely blocked, which causes the ventricular rate to be rapid and slow, which seems absolutely uneven.
There are many opportunities for occult conduction in the atrioventricular junction during atrial fibrillation.
2. sinus arrest : The length of the long P-P interval is different, and there is no multiple relationship with the short P-P interval. The diagnosis reliability is higher when the long P-P interval is >2 times the basal sinus P-P interval.
3. Ventricular arrest : Long R-R interval ≥3.0s, during which atrial excitation waves (P wave, F wave or f wave) are not transmitted to the ventricle, which are mostly caused by paroxysmal height or third degree atrioventricular block with poor function at the lower pacing point (
Zhejiang Province Dynamic Electrocardiogram Examination Operation and Diagnosis Writing Specifications).
Ventricular arrest can be clearly diagnosed based on the following ECG characteristics:
1, sinus rhythm with third degree atrioventricular block, and QRS wave group disappears.
2, atrial ejaculation rhythm, atrial tachycardia , atrial flutter or ventricular fibrillation combined with three degrees of atrioventricular block, and the QRS wave group disappeared.
3, after the junctional heart rhythm disappears, the QRS wave group disappears.
4. Total heart arrest : Long R-R interval ≥3.0s, and there are no atrial excitation waves (P wave, F wave or f wave) during this period (Zhejiang Province Dynamic Electrocardiogram Examination Operation and Diagnosis Writing Specifications).
Total cardiac arrest and ventricular pacing are the two most serious fatal arrhythmias among all kinds of arrests. Once a total heart arrest occurs, quick and effective rescue measures should be taken immediately, otherwise the patient will die. The death of human beings is ultimately a one-time stop to the public.
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