Arrhythmia Recognition
Cardiac Conduction System
ECG Components
LEFT
ATRIUM
Sinoatrial
Node
HIS Bundle
RIGHT ATRIUM
Left Bundle
Branch
Right Bundle
Branch
LEFT
VENTRICLE
RIGHT
VENTRICLE
VERTICAL
AXIS
2 Large Squares = 1 mV
Sinus Rhythms
Mid
Diastole
Atrial
Contraction
Isovolumic
Ventricular
Contraction
Supraventricular Rhythms
Atrial Tachycardia
Heart Rate
Rhythm
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Heart Rate
Rhythm
P Wave
PR Interval
60 100 bpm
Regular
0.12 to 0.20
< 0.12
(in seconds)
(in seconds)
Regular
Abnormal P before
each QRS
(difcult to see)
0.12 to 0.20
< 0.12
Rhythm
P Wave
PR Interval
(in seconds)
(in seconds)
N/A
Irregular
Premature and
abnormal.
May be hidden
0.12 to 0.20
< 0.12
Sinus Arrhythmia
QRS
Isovolumic
Ventricular
Relaxation
Conduction Defects
Heart Rate
Ventricular
Ejection
QRS
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Characteristics
0.12 to 0.20
0.12
RSR in V1
Atrial Flutter
Premature Atrial Complex Isolated PAC
Heart Rate
Usually
60 100 bpm
Rhythm
Irregular
P Wave
Before each QRS,
identical
PR Interval
(in seconds)
0.12 to 0.20
QRS
(in seconds)
< 0.12
Heart Rate
Rhythm
P Wave
PR Interval
QRS
(in seconds)
(in seconds)
N/A
Irregular
Premature and
abnormal.
May be hidden
0.12 to 0.20
< 0.12
Heart Rate
Rhythm
P Wave
PR Interval
(in seconds)
(in seconds)
A: Regular
V: Regular,
group beating
or variable
N/A
< 0.12
Sinus Tachycardia
Premature Atrial Complexes (Atrial Bigeminy)
Every other beat is a PAC
Heart Rate
Rhythm
P Wave
PR Interval
Regular
0.12 to 0.20
(in seconds)
< 0.12
Sinus Bradycardia
P Wave
PR Interval
(in seconds)
(in seconds)
N/A
Irregular
Premature and
abnormal.
May be hidden
0.12 to 0.20
< 0.12
(in seconds)
(in seconds)
QRS
Characteristics
0.12 to 0.20
0.12
QS or rS in V1 and V2
ST elevation
Pre-excitation Syndrome
Atrial Fibrillation
QRS
Rhythm
PR Interval
QRS
(in seconds)
Heart Rate
P Wave
QRS
Heart Rate
Rhythm
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Irregular
Absent
Fibrillatory (f) waves
N/A
< 0.12
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Characteristics
< 0.12
Delta wave
distorts initial QRS
First-Degree AV Block
Junctional Rhythm
Heart Rate
Rhythm
P Wave
PR Interval
< 60 bpm
Regular
0.12 to 0.20
(in seconds)
QRS
(in seconds)
< 0.12
Heart Rate
Rhythm
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
40 60 bpm
Regular
Inverted in inferior
leads; before, during
or after the QRS;
may be absent
< 0.12
< 0.12
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Characteristics
> 0.20
< 0.12
Regular rhythm
Heart Rate
Rhythm
P Wave
PR Interval
40 100 bpm
Irregular
Identical before
each QRS.
P to P interval
may be xed before
and after the pause
0.12 to 0.20
(in seconds)
Heart Rate
Rhythm
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
N/A
Irregular
Premature and
abnormal.
May be hidden
0.12 to 0.20
< 0.12
Abnormal shape
QRS
(in seconds)
< 0.12
Heart Rate
60 100 bpm
Rhythm
P Wave
PR Interval
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Characteristics
Conduction
intermittent
Increasingly
prolonged
< 0.12
QRS dropped in a
repeating pattern
QRS
(in seconds)
(in seconds)
< 0.12
< 0.12
Heart Rate
Rhythm
P Wave
PR Interval
(in seconds)
(in seconds)
N/A
Irregular
Premature and
abnormal.
May be hidden
None
Absent
Junctional Tachycardia
QRS
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Characteristics
Sinus
Usually normal
and identical
(before and after a
blocked impulse)
Broad
0.12
Some P waves
are not conducted
Heart Rate
Rhythm
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Usually
<140 bpm
Regular
Inverted, absent or
after QRS
< 0.12
< 0.12
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Characteristics
Sinus
Normal or prolonged
Narrow or broad
2:1 AV conduction
01d
13d
37d
7 30 d
1 3 mo
3 6 mo
6 12 mo
13 y
35y
58y
8 12 y
12 16 y
94 -155
(122)
91 - 158
(122)
90 - 166
(128)
106 - 182
(149)
120 - 179
(149)
105 - 185
(141)
108 - 169
(131)
89 - 152
(119)
73 - 137
(109)
65 - 133
(100)
62 - 130
(91)
60 - 120
(80)
PR Interval
Lead II
(Seconds)
0.08 - 0.16 0.08 - 0.14 0.07 - 0.15 0.07 - 0.14 0.07 - 0.13 0.07 - 0.15 0.07 - 0.16 0.08 - 0.15 0.08 - 0.16 0.09 - 0.16 0.09 - 0.17 0.09 - 0.18
(0.107)
(0.108)
(0.102)
(0.100)
(0.098)
(0.105)
(0.106)
(0.113)
(0.119)
(0.123)
(0.128)
(0.135)
QRS Interval
Lead V5
(Seconds)
0.02 - 0.07 0.02 - 0.07 0.02 - 0.07 0.02 - 0.08 0.02 - 0.08 0.02 - 0.08 0.03 - 0.08 0.03 - 0.08 0.03 - 0.07 0.03 - 0.08 0.04 - 0.09 0.04 - 0.09
(0.05)
(0.05)
(0.05)
(0.05)
(0.05)
(0.05)
(0.05)
(0.06)
(0.06)
(0.06)
(0.06)
(0.07)
All values 2nd 98th percentile; numbers in parentheses, means. Adapted from Pediatr Cardiol. 1979;1:123.
P Wave
PR Interval
(in seconds)
(in seconds)
QRS
Characteristics
N/A
Narrow or broad
AV dissociation
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