Department of Cardiology and Vascular MedicineFaculty of Medicine University of Indonesia

National Cardiovascular Center Harapan Kita

ARRHYTHMIA

Surya Dharma, MD, FIHA

AritmiaGangguan irama jantung berupa segala jenis

irama jantung selain IRAMA SINUS

SupraventrikularQRS sempit seperti normal

(kecuali beberapa hal:BBB, WPW,aberans)

VentrikularQRS lebar > 0,12 dt

Atrial fibrillation

Atrial flutter

AVRT AVNRT

V Tach

V Fibrillation

SNRT

AT

JT

TACHYCARDIA

Aritmia Supraventrikular

Premature beat/ ekstra sistolik

Takikardi aritmia

Atrial FlutterAtrial fibrilasi

Supra Ventrikel Takikardi/Paroksismal Atrial Takikardi

150 - 250 x/mnt

ARRHYTHMIAS (ATRIAL RHYTHMS)

Gambaran premature atrial complex (tanda panah).

Gambaran EKG atrial tachycardia/SVT.

SVT

Treatment strategies of SVT:

PharmacologicalAcute Tx (Adenosine iv, Verapamil iv)Chronic Tx (Verapamil, Betablocker, Digoxin)

Non-pharmacology1980’s sharp dissection or cryosurgical modificationHis bundle ablation using DC shockRadiofrequency catheter ablation

Gambaran delta wave pada sindroma WPW

Atrial flutter dengan gambaran gigi gergaji.

Wolff-Parkinson-White syndrome

Gambaran fibrilasi atrial dengan rapid ventricular response

Approaches to Treatment of atrial fibrillation

• Ventricular rate control• Maintenance of sinus rhythm• Anticoagulation (acute and

chronic)

Aritmia Ventrikular

Premature beat/ ekstra sistolik

Takikardi aritmia

Ventrikel Fibrilasi

> 350 x/mnt

Ventrikel Takikardi

100-250 x/mnt

VENTRICULAR RHYTHMS

Gambar A menunjukkan sinus takikardi dengan frequent uniform PVC dan B menunjukkan sinus takikardi dengan multiform PVC.

VES

Sinus ritme dengan dua R on T PVC’s

Sinus ritme dengan run VT dan satu episode couplets

Gambaran trigeminal PVC.

Gambaran accelerated idioventricular rhythm

Gambaran Ventricular Tachycardia (VT)

Gambaran Ventricular Fibrillation (VF)

Torsade de pointes

Management of Malignant Ventricular arrhythmias

• Pharmacological– Class I– Class III– Class II, Beta blocker

• Non-pharmacological– Surgical arrhythmias– Catheter ablation– Device : AICD

Gambaran asistol

Gambaran ”P wave” asystole.

• BRADYARRHYTHMIA AND CONDUCTION ABNORMALITIES

• SPECIFIC ECG CHANGES

GANGGUAN KONDUKSI DI SA NODE

Gambaran sinus ritme dengan episode sinoatrial block.

Gambaran sinus ritme dengan episode sinus arrest

First-degree AV block

Rhythm : RegularRate : Usually normalP wave : Sinus P wave present; one P wave to each QRSPR : Prolonged ( greater than 0.20 seconds )QRS : Normal

GANGGUAN KONDUKSI DI AV NODE

Second -degree AV block, Mobitz I

Rhythm : IrregularRate : Usually slow but can be normalP wave : Sinus P wave present; some not followed by QRS complexesPR : Progressively lengthensQRS : Normal

Second-degree AV block, Mobitz II

Rhythm : Regular usually; can be irreguler if conduction ratios varyRate : Usually slowP wave : Two, three, or four P waves before each QRSPR : PR interval of beat with QRS is constant; PR interval may be normal or prolongedQRS : Normal if block in His bundle; wide if block involves bundle branches

Third-degree AV block

Rhythm : RegularRate : 40 – 60 if block in His bundle; 30 – 40 if block involves bundle branchesP wave : Sinus P wave present; bear no relationship to QRS; can be found hidden in QRS complexes and T wavesPR : Varies greatlyQRS : Normal if block in His bundle; wide if block involves bundle branches

0.04

RBBB

LBBB

Gambaran atrial pacing (tanda panah menunjukkan pacer spikes).

Gambaran ventricular pacing (tanda panah menunjukkan pacer spikes).

Kesimpulan

• EKG pemeriksaan yang sangat sederhana, sangat mobile, segera didapatkan hasil dan sangat bermanfaat di bidang kardiologi

• EKG hanya sebagai alat bantu diagnosis• Sebagian besar aritmia dapat didiagnosis

berdasarkan EKG• Semua dokter umum seyogyanya

menguasai EKG

T H A N K Y O U

VES

SVT

VES R on T

VT

VF