accelerated atrial escape rhythm
Introduction
Introduction to accelerated atrial escape rhythm Accelerated atrial escaping rhythm (acceleratedatrialescaperhytym), also known as nonparoxysmalatrial tachycardia (nonparoxysmalatrialtachycardia), accelerated atrial autonomic rhythm, accelerated atrial rhythm and so on. Less common in clinical practice. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: atrial fibrillation
Cause
Accelerated atrial escape rhythm
Causes:
Accelerated atrial escape rhythm is common in organic heart disease involving the atria, such as rheumatic heart disease, chronic pulmonary heart disease, pulmonary infection, emphysema, coronary heart disease, myocardial infarction, myocarditis, after cardiac surgery , digitalis poisoning and systemic infections, individual cases can be seen in patients with no structural heart disease, rarely seen in normal people, the emergence of accelerated atrial escape rhythm suggests a certain damage to the atrial muscle, but generally the blood flow Learning has no obvious influence, and it is not easy to develop into atrial fibrillation.
Pathogenesis:
Because the ectopic pacemaker in the atrium is affected by certain factors, its self-discipline is significantly increased. When the frequency exceeds the sinus rhythm and/or the autonomicity of the sinus node decreases, the law governs the self-discipline advantage. Accelerated escape rhythm occurs, the frequency is generally 60 ~ 140 times / min, rarely more than 140 times / min, because its frequency is close to the frequency of sinus rhythm, so the two are often prone to competition, and sometimes sinus rhythm, Sometimes it is accelerated escape rhythm, which can form atrioventricular separation, atrial fusion wave. When the frequency of sinus is equal to the frequency of accelerated atrial escape rhythm, the atrium can be controlled by sinus node, and the ventricle is atrial pulsation. Point control, if this phenomenon occurs temporarily, it is called temporary synchronization phenomenon. If it is persistent, it is called long-lasting synchronization phenomenon. At this time, the equal room separation is also formed. The above phenomenon also exists in the accelerated interventricular communication. Heart rhythm and accelerated ventricular escape rhythm.
Accelerated atrial escape rhythm is an active ectopic arrhythmia between escape rhythm and paroxysmal atrial tachycardia, which is pathological, and escape and escape rhythm are passive arrhythmias It belongs to the physiological protection mechanism, and the nature of the two is different.
Prevention
Accelerated atrial escape rhythm prevention
This kind of arrhythmia is an active heterotopic arrhythmia between escape rhythm and atrial tachycardia. It is pathological and is common in organic heart disease. It is caused by certain damage to the atrial muscle. Because of its ventricular rate is not fast, it has little effect on hemodynamics. When such arrhythmia occurs, the cause should be identified, and active treatment for the cause is a fundamental measure to prevent accelerated atrial escape.
Complication
Accelerated atrial escape rhythm complications Complications, atrial fibrillation
Accelerated atrial escape rhythm is pathological, but generally has no significant effect on hemodynamics, and is not easy to develop into atrial fibrillation.
Symptom
Accelerated atrial escape rhythm symptoms common symptoms chest tightness heart rate increased heart palpitations heartbeat after meals heart rate
Usually no obvious symptoms, such as increased heart rate can have heart palpitations, palpitation, chest tightness and other symptoms, other symptoms of the primary disease, ventricular rate of 60 ~ 140 times / min, mostly around 100 times / min.
Examine
Accelerated atrial escape rhythm
Mainly rely on ECG diagnosis.
1. Typical ECG characteristics of accelerated atrial escape rhythm
(1) Three or more P' waves in succession.
(2) The shape of the P' wave is different from the sinus P wave: the P' wave frequency is 60 to 140 times/min, and the rhythm is neat (Fig. 1).
(3) P'-R interval > 0.12 s.
(4) The QRS complex is the same as the sinus.
(5) Not accompanied or accompanied by sinus competition.
2. Detailed description of the characteristics of accelerated atrial escape rhythm ECG
(1) Frequency of accelerated atrial escape rhythm: Some people think that it should be 70-140 times/min.
(2) Accelerated atrial escape rhythm rules: gradually increase in the onset, and the termination usually stops slowly, so the rhythm of the P' wave can be irregular in the short time before the onset and before the termination.
(3) There is no fixed inter-trial interval between accelerated atrial escape rhythm and sinus beat, so its mechanism is not related to reentry.
(4) Accelerated atrial escape rhythm contraction before the onset of seizure.
(5) There is no protective afferent block around the ectopic pacemaker of accelerated atrial escape rhythm. When the frequency of sinus rhythm exceeds the frequency of ectopic pacemaker, the heart is controlled by sinus rhythm.
(6) Accelerated atrial escape rhythm without sinus node competition, there is no sinus P wave on the electrocardiogram, only atrial P' wave is seen, the shape of P' wave is different from sinus P wave, such as ectopic The pacing point in the lower part of the atrium may be retrograde. It may also be left atrial, and accelerated atrial escape rhythm without sinus node competition is more common than sinus node competition.
(7) Accelerated atrial escape rhythm with sinus node competition can have the following two manifestations:
1 Sinus heart rate and accelerated atrial escape heart rate are close: only a few times per minute, and the atrial heart rate is faster than the sinus heart rate, but sometimes almost equal or completely equal, this is equal to the phenomenon, often easy to form a house Sexual fusion waves appear in a series of two heart rhythm alternations. The atrial fusion wave morphology is between the sinus P wave and the accelerated P' wave of the atrial escape rhythm.
2 When the frequency of sinus exceeds the frequency of accelerated atrial escape rhythm, only a single sinus rhythm is formed; when the frequency of accelerated atrial escape rhythm exceeds the sinus frequency, only a single accelerated atriality is formed. Escape rhythm, at this time, the two rhythms compete with each other. In the process of alternation, the rhythm of the other side can be reorganized, because there is no protective afferent block in both, and the atrial rhythm and sinus rhythm can compete with each other on the electrocardiogram. Mutual growth and decline, when the time is hidden, one after another.
Diagnosis
Accelerated atrial escape rhythm diagnosis
According to the medical history, symptoms, signs and electrocardiogram performance can be clearly diagnosed.
Differential diagnosis
1. Accidental atrial escape rhythm and atrial parallel heart rhythm tachycardia
In the case of atrial rhythm tachycardia, the external impulse cannot invade the ectopic pacemaker and re-regulate the rhythm. This is due to the protective afferent block around the ectopic pacemaker. In addition, the adjacent ectopic beat The interval is a multiple of the atrial rhythm tachycardia cycle; and the accelerated atrial escape rhythm has no protective afferent block around the ectopic pacemaker, which is easily invaded by external impulses to rectify the rhythm. Once the frequency of sinus rhythm exceeds the atrial frequency, it causes atrial rhythm reforming, making the atrial pacing point temporarily become an ineffective pacemaker, sinus rhythm occurs, in addition, two different before and after sinus rhythm capture The pulsation is not a multiple of the accelerated atrial escape rhythm cycle.
2. Accelerated right atrial escape rhythm and accelerated intersection area escape rhythm
Both have retrograde P-waves, mainly identifying the P--R interval, accelerating the right atrial lower escape rhythm with a PR interval >0.12 s, and accelerating the transitional escape rhythm, P--R The period <0.12s, if the accelerated transition zone escape rhythm with a degree of atrioventricular block, P--R interval can be greater than 0.12s, the two can not be identified.
