E.C.G.

Course – V
Ventricular
rhythms
Dr. Michael Kassirer

”Dept. Internal Medicine ”D

Tel-Aviv Medical center
 Objective
By the end of lesson 5 the student will:
 Know how to differentiate between APCs and VPCs,
and ECG criteria for each.
 Be familiar with different forms of ectopic activity
 Be able to diagnose the following rhythms:
Ventricular tachycardia (mono and polymorphic, V.
Fibrillation, Accelerated idio-ventricular rhythms,
and asystole.
 Know how to differentiate wide complex
tachycardia – between ventricular rhythms and
 Ventricular premature
beat

 Wide, Bizzare-shaped QRS complex (Uni or

Multifocal)
 Prematurity (Unlike escape beat)
 No P before QRS
 Compensatory Pause – complete
Escape beat
Compensatory Pause
 APBs Vs VPBs
APBs = PACs VPBs = PVCs
 Normal, narrow  Wide, Bizzare QRS
QRS  No P / Retrograde P
 No P / different P  Compensatory
 Partial- period
Compensatory
period
 Reasons for Ventricular
complexes
 Normal – (↑ in Anxiety, stress, coffee
and more…)
 Metabolic disturbances
 Myocardial Ischemia
 Ventricular aneurism, CMP, CHF
 Drug intoxication

 Escape rhythm in Severe bradycardia

Couplets
Bigeminy
Trigeminy
Ventricular Tachycardia
Ventricular tachycardia

A-V
160-250 Regular sec 12. >
dissociation
 Accelerated Idio-
Ventricular rhythm (AIVR =
(“Slow” VT

Normal Ventricular ”escape" rhythm = 30-40bpm*

Ventricular Fibrillation
Asystole
 Wide complex
Tachycardia
+90%

• Ventricular Tachycardia
• AF/AVNRT (SVT)
• AIVR With aberrant conduction
• WPW
• Tachycardia + RBBB / LBB
 Wide Complex
tachycardia
Aberrant Ventricular
conduction tachycardia
 Normal axis  Abnormal Cardiac Axis
 Known WPW/BBB (NML).
 P:R Wave ratio =  All Complexes same
1:1 direction in V1-6
(Concordance)
 AV dissociation
 Very wide QRS (> .16)
 In V1 (Brugada criteria):
RBBB morphology - Rsr’
pattern