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Gepubliceerd in: Netherlands Heart Journal 9/2014

Open Access 01-09-2014 | Rhythm Puzzle - Answer

A Particular Bigeminy During Atrial Tachycardia

Auteurs: C. Buttà, A. Tuttolomondo, L. Giarrusso, A. Pinto

Gepubliceerd in: Netherlands Heart Journal | Uitgave 9/2014

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ZOEKEN
The ECG shows clearly visible P waves only in lead V1 (Fig. 1). Regular PP intervals and an isoelectric baseline are present between the P waves, so the diagnosis is atrial tachycardia [1]. During the ECG recording, lead V1 shows 12 P waves but some of these are not visible because they are concealed by the QRS complex (Fig. 2). In lead V1, the beats following the long RR intervals are conducted by the first and the seventh P wave and the premature QRS complexes are conducted by the third and the ninth P wave because the fourth and the tenth P wave are too close to the following QRS complex to conduct the impulse. Consequently, the atrial tachycardia presents an alternating 2:1 and 4:1 conduction. However, the long RR interval is less than twice the short RR interval and the PR intervals of the premature QRS complex are longer than other PR intervals. In order to understand this mechanism, it should be considered that not just one but two constant blocks are present in the atrioventricular node: one proximal and one distal. In our case, there is a 2:1 proximal block and a 3:2 distal Wenckebach block. The distal Wenckebach block explains why the PR intervals progressively increase until a P wave is blocked causing an alternating 2:1 and 4:1 conduction; this is a rare phenomenon and it is recorded as alternating Wenckebach [2].
Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
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Literatuur
1.
go back to reference Buttà C, Tuttolomondo A, Di Raimondo D, et al. The supraventricular tachycardias: proposal of a diagnostic algorithm for the narrow complex tachycardias. J Cardiol. 2013;61(4):247–55. PubMedCrossRef Buttà C, Tuttolomondo A, Di Raimondo D, et al. The supraventricular tachycardias: proposal of a diagnostic algorithm for the narrow complex tachycardias. J Cardiol. 2013;61(4):247–55. PubMedCrossRef
2.
go back to reference Oreto G. I disordini del ritmo cardiaco. Torino: Centro Scientifico Editore; 1997. p. 242–3. Oreto G. I disordini del ritmo cardiaco. Torino: Centro Scientifico Editore; 1997. p. 242–3.
Metagegevens
Titel
A Particular Bigeminy During Atrial Tachycardia
Auteurs
C. Buttà
A. Tuttolomondo
L. Giarrusso
A. Pinto
Publicatiedatum
01-09-2014
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 9/2014
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-014-0571-7

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