Download - ECG: Atrial Dissociation
![Page 1: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/1.jpg)
ECG OF THE WEEK
DR.Prof.K.H.Noorul Ameen’s unit(M4)
Dr.S.Dhileepan
![Page 2: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/2.jpg)
![Page 3: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/3.jpg)
History
• 70 yr old male,• k/c HT,CAD for 20 years,• Had cardiac transplantation 6 months back.
![Page 4: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/4.jpg)
ECG shows
• HR-140/min,• Rhythm –regular,• PR interval -0.28 sec,• Axis +60-90 degree,• Incomplete RBBB• Two sets of P waves, independent to each
other and one being always conducted.
![Page 5: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/5.jpg)
DIAGNOSIS
ATRIAL DISSOCIATION
![Page 6: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/6.jpg)
Atrial dissociation
• First reported by Wenkeback in 1906. It has been suggested that inatrial dissociation each atrium beats separatelyand independently as a result of blockage orinterruption of an interatrial pathway (Bachmann'sbundle). The sinus pacemaker controlsone atrium and the ectopic pacemaker controlsthe other atrium. The two pacemakers donot interfere with each other as a result of interatrial block or presence of preferential exit block
![Page 7: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/7.jpg)
Differential diagnosis
1)Atrial parasystole-conducted, - normal P wave.2)Artefact –rhythmic muscular twitchings, electrical disturbance from adjacent person.
![Page 8: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/8.jpg)
causes
• RHD• SHT• CCF• Sudden neurogenic stimuli• Uremia• Diphtheria
![Page 9: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/9.jpg)
Atrial dissociation in transplanted heart
• Heart transplantation- orthotropic, - heterotropic . • In orthotropic transplantation posterior wall
of recipient heart is retained but denervated.• It produces impulse but not conducted as it is
blocked by suture line.• In heterotrophic transplantation 2 sets of
complexes are produced.
![Page 10: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/10.jpg)
Orthotropic transplantation
![Page 11: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/11.jpg)
Heterotropic transplantation
![Page 12: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/12.jpg)
Heterotrophic transplantation
![Page 13: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/13.jpg)
![Page 14: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/14.jpg)
![Page 15: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/15.jpg)
ECG shows
• Varying PP,PR,RR interval,• P wave inverted and gradually become normal
when heart rate speeds up.
![Page 16: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/16.jpg)
Wandering pacemaker
![Page 17: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/17.jpg)
causes
• Phyisiologic-deep sleep• Young adults with high vagal tone• Digitalis • Sick sinus syndrome
![Page 18: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/18.jpg)
WANDERING PACEMAKER.
• This variant of sinus arrhythmia involves passive transfer of the dominant pacemaker focus from the sinus node to latent pacemakers that have the next highest degree of automaticity located in other atrial sites (usually lower in the crista terminalis) or in AV junctional tissue. The change occurs in a gradual fashion over the duration of several beats; thus, only one pacemaker at a time controls the rhythm, in sharp contrast to AV dissociation.
• Precursor of MAT
![Page 19: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/19.jpg)
![Page 20: ECG: Atrial Dissociation](https://reader036.vdocuments.site/reader036/viewer/2022081504/554b5ca7b4c9051b458b4e6b/html5/thumbnails/20.jpg)
THANK YOU