Ectopic Complexes

Ectopic beats

The pacemakercells in the sinusnode are not the only cells in the heart that can depolarize spontaneously. Actually all cardiomyoctyes have this capacity. The only reason why the sinusnode 'rules' is that it is the fastest pacemaker of the heart. From sinusnode to ventricle all healthy cardiomyocytes can function as a ectopic pacemaker. Ectopic pacemaker activity can originate from the atria (60-80 bpm), AV-node (40-60 bpm) and the ventricles (20-40 bpm). So, as the sinus rate drops (e.g. during atrial infarction), other cells can take over. The configuration of ectopic beats or extrasystoles, as seen on the ECG, reveals its origin, whether they are atrial, nodal or ventrical.

Ectopic pacemakers

• Atrial ectopic pacemaker: frequency 50-60bpm
• Nodal ectopic pacemaker frequency 50bpm
• Ventricular ectopic pacemaker frequency 30-40bpm

Atrial rhythm

Atrial Rhythm
{{{locatieafbeelding}}}
Atrial rate	50-100 bpm
Ventricular rate	1:1
Regularity	regular
Origin	atrial
P-wave	present, but different from sinus rhythm
Effect of adenosine	slows down
Example ECG:
Example ECG2: {{{example2}}}

Atrial rhythm resembles sinusrhythm, but origins from a different atrial focus. It can be recognised by the abnormal configuration of the p-wave. Often the p-wave is negative in AVF, as is seen in the example.

Wandering Pacemaker

Wandering pacemaker. Every p-wave is different and thus has a different origin.

When several pacemakers are competing, p-waves with different origins and thus configurations occur. The rhythm is slightly different from beat to beat.

note If the heart rate increases to above 100bpm, it is called Multifocal Atrial Tachycardia. Possible causes are hypoxia, COPD and medication such as digoxin.

Premature atrial complex / atrial extrasystole

Premature Atrial Complexes

AV-nodal complexes

Originate from the AV node. The AV node fires before the sinusnode. The ECG shows a QRS complex with a comparable morphology as during sinus rhythm as these extra beats are conducted further through the normal conduction system. When the extra follows very soon after the earlier one, aberrant conduction can occur. The extra beat does not have a p-wave in front of it. Sometimes an inverted p-wave can be seen in or at the end of the QRS complex.

Ventricular premature beat (VPB) / Ventricular extrasystole (VES)

Ventricular Premature beats

Bigemini

Bigemini: every sinus beat is followed by a ventricular extrasystole

Every sinus beat is followed by a ventricular extrasystole.

Trigemini

Every second sinus beat is follow by a ventricular extrasystole.