Skip to main content
SpringerLink
Log in

Cardiac Arrhythmias: Premature Beats and Paroxysmal Tachycardias

  • Chapter
Diagnosis of Heart Disease

  • 197 Accesses

Abstract

Normal cardiac rhythm is called sinus rhythm. Sinus rhythm is controlled by the sinoatrial (SA) node, located in the right atrial wall near its junction with the superior vena cava. With sinus rhythm, the P wave due to atrial depolarization is upright in ECG leads I and II, AVF, and leads V3-V6. It is negative in lead AVR, and may be upright or negative in leads III and AVL. In the healthy resting adult, sinus rhythm is usually stated to range between 60 and 100 beats/minute. Cardiac rates above 100/minute are referred to as sinus tachycardia when they originate in the SA node. Cardiac rates below 60/minute are considered to be sinus bradycardia when they originate within the sinoatrial node. However, healthy resting adults often have heart rates in the 50s and even in the 40s. Occasional healthy young adults have heart rates in the 30s during sleep (Brodsky et al, 1977). On the other hand, healthy resting adults seldom have heart rates above 80/minute or so.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Akhtar M, Shenasa M, Jazayeri M, et al. Wide QRS complex tachycardia. Reappraisal of a common clinical problem. Ann Intern Med. 1988; 109: 905.

    PubMed  CAS  Google Scholar 

  • Benchimol A, Liggett MS. Cardiac hemodynamics during stimulation of the right atrium, right ventricle, and left ventricle in normal and abnormal hearts. Circulation. 1966; 33: 933.

    PubMed  CAS  Google Scholar 

  • Benditt DG, Pritchett ELC, Smith WM, et al. Characteristics of atrioventricular conduction and the spectrum of arrhythmias in Lown-Ganong-Levine syndrome. Circulation. 1978; 57: 454.

    PubMed  CAS  Google Scholar 

  • Braunwald E, ed. Heart Disease. A Textbook of Cardiovascular Medicine. 3rd ed. Philadelphia, PA: WB Saunders; 1988.

    Google Scholar 

  • Braunwald E, Sobel BE, Braunwald NS. Treatment of paroxysmal suprventricular tachycardia by electrical stimulation of the carotid sinus nerves. N Engl J Med. 1969; 281: 885.

    Article  PubMed  CAS  Google Scholar 

  • Brechenmacher C. Atrio-His bundle tracts. Br Heart J. 1975; 37: 853.

    Article  PubMed  CAS  Google Scholar 

  • Brodsky M, Wu D, Denes P, et al. Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol. 1977; 39: 390.

    Article  PubMed  CAS  Google Scholar 

  • Caracta AR, Damato AN, Gallagher JJ, et al. Electrophysiologic studies in the syndrome of short P-R interval, normal QRS complex. Am J Cardiol. 1973; 31: 245.

    Article  PubMed  CAS  Google Scholar 

  • Castellanos A, Sung RJ, Myerburg RJ. His bundle electrocardiography in digitalis-induced “atrioventricular junctional” Wenckebach periods with irregular H-H intervals. Am J Cardiol. 1979; 43: 653.

    Article  PubMed  CAS  Google Scholar 

  • Chung EK. Wolff-Parkinson-White syndrome — Current views. Am J Med. 1977; 62: 252.

    Article  PubMed  CAS  Google Scholar 

  • Chung EKY. Parasystole. Prog Cardiovasc Dis. 1968; 11: 64.

    Article  PubMed  CAS  Google Scholar 

  • Dessertenne F. La tachycardie ventriculaire a deux foyers opposés variables. Arch Mal Coeur. 1966; 59: 263.

    PubMed  CAS  Google Scholar 

  • Ekblom B, Hartley LH, Day WC. Occurrence and reproducibility of exercise-induced ventricular ectopy in normal subjects. Am J Cardiol. 1979; 43: 35.

    Article  PubMed  CAS  Google Scholar 

  • Gallagher JJ, Damato AN, Lau SH. Electrophysiologic studies during accelerated idioventricular rhythms. Circulation. 1971; 44: 671.

    PubMed  CAS  Google Scholar 

  • Gallagher JJ, Smith WM, Kasell JH, et al. Role of Mahaim fibers in cardiac arrhythmias in man. Circulation. 1981; 64: 176.

    Article  PubMed  CAS  Google Scholar 

  • Garon H, Horowitz SA. Case records of the Massachusetts General Hospital. A 60-year-old man with a large right atrial mass. N Engl J Med. 1989; 320: 652 (654).

    Google Scholar 

  • Gaum WE, Biancaniello T, Kaplan S. Accelerated ventricular rhythm in childhood. Am J Cardiol. 1979; 43: 162.

    Article  PubMed  CAS  Google Scholar 

  • Glasser SP, Clark PI, Applebaum HJ. Occurrence of frequent complex arrhythmias detected by ambulatory monitoring. Chest. 1979; 75: 565.

    Article  PubMed  CAS  Google Scholar 

  • Goldreyer BN, Kastor JA, Kershbaum KL. The hemodynamic effects of induced supraventricular tachycardia in man. Circulation. 1976; 54: 783.

    PubMed  CAS  Google Scholar 

  • Guise L, Sovia R, Chaouat JC, et al. Prévalence et evolution du syndrome de Wolff-Parkinson-White dans une population de 138048 sujets. Ann Med Interne. 1985; 136: 474.

    Google Scholar 

  • Gunn J, Wilson J, Mackintosh AF. Butane sniffing causing ventricular fibrillation. Lancet. 1989; Mar 18: 617.

    Article  Google Scholar 

  • Hiss RG, Lamb LE. Electrocardiographic findings in 122,043 individuals. Circulation. 1962; 25: 947.

    PubMed  CAS  Google Scholar 

  • Isner JM, Estes NAM III, Thompson PD, et al. Acute cardiac events temporally related to cocaine abuse. N Engl J Med. 1986; 315: 1438.

    Article  PubMed  CAS  Google Scholar 

  • Josephson ME. Antiarrhythmic agents and the danger of proarrhythmic events. Ann Int Med. 1989; 111: 101.

    PubMed  CAS  Google Scholar 

  • Kay GN, Plumb VJ, Arciniegas JG, et al. Torsade de pointes: The long-short initiating sequence and other clinical features: observation in 32 patients. J Am Coll Cardiol. 1983; 2: 806.

    Article  PubMed  CAS  Google Scholar 

  • Kennedy HL. Comparison of ambulatory electrocardiography and exercise testing. Am J Cardiol. 1981; 47: 1359.

    Article  PubMed  CAS  Google Scholar 

  • Klein GJ, Yee R, Sharma AD. Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern. N Engl J Med. 1989; 320: 1229.

    Article  PubMed  CAS  Google Scholar 

  • Lemery R, Brugada P, Dalla Bella P, et al. Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease. Circulation. 1989; 79: 990.

    Article  PubMed  CAS  Google Scholar 

  • Lesch M, Lewis E, Humphries JO, et al. Paroxysmal ventricular tachycardia in the absence of organic heart disease: report of a case and review of the literature. Ann Intern Med. 1967; 66: 950.

    PubMed  CAS  Google Scholar 

  • Lown B, Ganong WF, Levine SA. The syndrome of short P-R interval, normal QRS complex and paroxysmal rapid heart action. Circulation. 1952; 5: 693.

    PubMed  CAS  Google Scholar 

  • Luria MH, Adelson EI, Lochaya S. Paroxysmal tachycardia with polyuria. Ann Intern Med. 1966; 65: 461.

    PubMed  CAS  Google Scholar 

  • McHenry PL, Morris SN, Kavalier M, et al. Comparative study of exercise-induced ventricular arrhythmias in normal subjects and patients with documented coronary artery disease. Am J Cardiol. 1976; 37: 609.

    Article  PubMed  CAS  Google Scholar 

  • Michelson EL . Clinical perspectives in management of Wolff-Parkinson-White syndrome Parts 1 and 2. Mod Concepts of Cardiovasc Dis.1989; 58:43,49.

    Google Scholar 

  • Montague TJ, Bewick DJ, Spencer CA, et al. Clinical utility of a single 24-hour electrocardiogram in the investigation of patients with suspected cardiac dysrhythm. Am J Noninvas Card. 1989; 3: 193.

    Google Scholar 

  • Morris SN, Zipes DP. His bundle electrocardiography during bidirectional tachycardia. Circulation. 1973; 48: 32.

    PubMed  CAS  Google Scholar 

  • Nava A, Thiene G, Canciani B, et al. Familial occurrence of right ventricular dysplasia: a study involving nine families. J Am Coll Cardiol. 1988; 12: 1222.

    Article  PubMed  CAS  Google Scholar 

  • Nora JJ, Nora AH. The evolution of specific genetic and environmental counseling in congenital heart diseases. Circulation. 1978; 57: 205.

    PubMed  CAS  Google Scholar 

  • Øie BK, Hoff PI, Skadberg B, et al. Atrial natriuretic peptide from the coronary sinus is acutely increased following induction of paroxysmal tachycardia. J Am Coll Cardiol.1989; 13, No.2:172A.

    Google Scholar 

  • Pratt CM, Slymen DJ, Wierman AM, et al. Asymptomatic telephone ECG transmissions as an outpatient surveillance system of ventricular arrhythmias: relationship to quantitative ambulatory ECG recordings. Am Heart J. 1987; 113: 1.

    Article  PubMed  CAS  Google Scholar 

  • Rothfeld EL, Zucker IR, Parsonnet V, et al. Idioventricular rhythm in acute myocardial infarction. Circulation. 1968; 37: 203.

    Google Scholar 

  • Samet P. Hemodynamic sequelae of cardiac arrhythmias. Circulation. 1973; 47: 399.

    PubMed  CAS  Google Scholar 

  • Schweitzer P, Teichholtz LE. Carotid sinus massage. Its diagnostic and therapeutic value in arrhythmias. Am J Med. 1985; 78: 645.

    Article  PubMed  CAS  Google Scholar 

  • Sheffield LT, Reeves TJ. Graded exercise in the diagnosis of angina pectoris. Mod Concepts Cardiovasc Dis. 1965; 34: 1.

    PubMed  CAS  Google Scholar 

  • Shine KI, Kastor JA, Yurchak PM. Multifocal atrial tachycardia: clinical and electrocardiographic features in 32 patients. N Engl J Med. 1968; 279: 344.

    Article  PubMed  CAS  Google Scholar 

  • Smith WM, Gallagher JJ, Kerr CR, et al. The electrophysiologic basis and management of symptomatic recurrent tachycardia in patients with Ebstein’s anomaly of the tricuspid valve. Am J Cardiol. 1982; 49: 1223.

    Article  PubMed  CAS  Google Scholar 

  • Surawicz B. Electrophysiologic substrate of torsade de pointes: dispersion of repolarization or early after-depolarizations? J Am Coll Cardiol. 1989; 14: 172.

    Article  PubMed  CAS  Google Scholar 

  • Wallace AG, Boineau JP, Davidson RM, et al. Wolff-Parkinson-White syndrome: a new look. Am J Cardiol. 1971; 28: 509.

    Article  PubMed  CAS  Google Scholar 

  • Waxman MB, Wald RW. Termination of ventricular tachycardia by an increase in cardiac vagal drive. Circulation. 1977; 56: 385.

    PubMed  CAS  Google Scholar 

  • Wellens HJJ, Bar FWHM, Lie KI. The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med. 1978; 64: 27.

    Article  PubMed  CAS  Google Scholar 

  • Wellens HJJ, Brugada P. Diagnosis of ventricular tachycardia from the 12-lead electrocardiogram. Cardiol Clin. 1987; 5: 511.

    PubMed  CAS  Google Scholar 

  • Wellens HJ, Schuilenburg RM, Durrer D. Electrical stimulation of the heart in patients with ventricular tachycardia. Circulation. 1972; 46: 216.

    PubMed  CAS  Google Scholar 

  • Wood P. Polyuria in paroxysmal tachycardia and paroxysmal atrial flutter and fibrillation. Br Heart J. 1963; 25: 273.

    Article  PubMed  CAS  Google Scholar 

  • Wood PH. Diseases of the Heart and Circulation. 3rd ed. Philadelphia, PA: JB Lippincott; 1968: 268

    Google Scholar 

  • Wu D, Denes P, Amat-y-Leon F, et al. Clinical, electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia. Am J Cardiol. 1978; 41: 1045.

    Article  PubMed  CAS  Google Scholar 

  • Zipes DP. Cardiac electrophysiology: promises and contributions. J Am Coll Cardiol. 1989; 13: 1329.

    Article  PubMed  CAS  Google Scholar 

  • Zipes DP, Ben-David J. Autonomic neural modulation of cardiac rhythm, Part 2. Mechanisms and examples. Mod Concepts Cardiovasc Dis. 1988; 57: 47.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, University of Cincinnati Medical Center, 45267-0542, Cincinnati, Ohio, USA

    Noble O. Fowler M.D.

Authors
  1. Noble O. Fowler M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 1991 Springer-Verlag New York Inc.

About this chapter

Cite this chapter

Fowler, N.O. (1991). Cardiac Arrhythmias: Premature Beats and Paroxysmal Tachycardias. In: Diagnosis of Heart Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-3068-7_26

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-3068-7_26

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7784-2

  • Online ISBN: 978-1-4612-3068-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation