Classification of arrhythmias

Bradyarrhythmias are due to sinus nodal disease ( Box 1.1 ) or atrioventricular conduction block ( Box 1.2 ).

Box 1.1

Sinus Node Dysfunction (with accompanying symptoms)

  • Sinus bradycardia

  • Sinoatrial exit block

  • Sinus pauses (>3 s)

  • Sinus node arrest

  • Tachycardia-bradycardia syndrome

  • Chronotropic incompetence *

* Maximum predicted heart rate is calculated as 220 – age (y).

Box 1.2

AV. Atrioventricular.

Atrioventricular Block

  • First-degree AV block

  • Second-degree AV block

    • Type I AV block (Mobitz I or Wenckebach)

    • Type II AV block (Mobitz II)

  • Third-degree (complete) AV block.

Tachyarrhythmias are classified as ventricular or supraventricular . The term supraventricular literally indicates tachycardias (atrial rates > 100 beats per minute [bpm] at rest) arising from the His bundle or above. Traditionally, the term supraventricular tachycardia (SVT) has been used to describe all tachycardias that are not solely infra-Hisian in origin, including atrial fibrillation and tachycardias such as atrioventricular reentry as a result of an accessory connection that involves both the atrium and ventricle ( Box 1.3 ). The term narrow QRS tachycardia indicates tachycardia with a QRS duration ≤ 120 milliseconds (ms). A wide QRS tachycardia refers to one with a QRS duration > 120 ms.

Box 1.3

AV, Atrioventricular.

Classification of Tachyarrhythmias

Atrial tachycardias

  • Sinus tachycardia

  • Physiologic sinus tachycardia

  • Inappropriate sinus tachycardia

  • Sinus nodal reentrant tachycardia

  • Focal atrial tachycardia

    • Microreentry

    • Automatic

  • Multifocal atrial tachycardia

  • Macroreentrant atrial tachycardia

  • Cavotricuspid isthmus dependent

    • Typical atrial flutter, counterclockwise (common) or clockwise (reverse)

    • Other cavotricuspid isthmus dependent

  • Noncavotricuspid isthmus dependent

    • Right atrial

    • Left atrial

  • Atrial fibrillation

Atrioventricular junctional tachycardias

  • Atrioventricular nodal reentrant tachycardia

  • Typical

  • Atypical

  • Nonreentrant junctional tachycardia

  • Junctional ectopic tachycardia (focal or automatic junctional tachycardia)

  • Other nonreentrant variants

Atrioventricular tachycardias

  • Orthodromic

    • Concealed or manifest atrioventricular accessory pathway conducting in retrograde direction, with anterograde conduction through the atrioventricular node node/His-Purkinje system

    • Nodofascicular or nodoventricular bypass tract conducting in retrograde direction, with anterograde conduction through the atrioventricular node/His-Purkinje system

  • Antidromic

    • Atrioventricular accessory pathway conducting anterograde with retrograde conduction through the AV node or, rarely, over another pathway

    • Atriofascicular, atrioventricular, nodofascicular, or nodoventricular bypass tract conducting in the anterograde direction, with retrograde conduction through the AV node or rarely through another pathway

Ventricular tachycardias

  • Monomorphic ventricular tachycardia

    • Scar-related reentry

    • Bundle branch reentry

    • Idiopathic (automatic, reentrant, interfascicular)

  • Accelerated idioventricular rhythm

  • Polymorphic ventricular tachycardia

  • Pleomorphic ventricular tachycardia

  • Bidirectional ventricular tachycardia

  • Torsades de pointes

  • Ventricular flutter

  • Ventricular fibrillation

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Jun 26, 2021 | Posted by in CARDIOLOGY | Comments Off on Classification of arrhythmias
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