• Ventricular Rhythm
• Ventricular Rhythm - Most Common Causes
• Accelerated Ventricular Rhythm
• ECG and Accelerated Ventricular Rhythm
• Frequency and Ventricular Rhythm

Ventricular Rhythm

• The heart beats according to ventricular rhythm when impulses originate in the ventricles
• In the Purkinje fibers, occasionally in the myocardium
• Each impulse then activates the ventricles through the myocardium
• Through the myocardium, impulses spread slowly
• Therefore, QRS complexes will be wide (>0.12s)
• Ventricular rhythm is very rare, and it activates
• In case of dysfunction of the SA node and AV junction
• Ventricular rhythm has a frequency of 20-40/min.
• Sometimes referred to as
• Idioventricular rhythm
• Ventricular escape rhythm

Accelerated Ventricular Rhythm

• Accelerated ventricular rhythm is a ventricular rhythm with a frequency of 40-100/min.
• Some sources cite a frequency of 50-110/min.
• Sometimes referred to as slow ventricular tachycardia
• There is no academic consensus on the frequency that separates these two arrhythmias (100 to 120/min.?)
• Often occurs with parasympathetic dominance (vagus nerve), leading to suppression of the SA node and AV node
• Protectively (to prevent asystole), an ectopic ventricular focus with a frequency of 40-100/min. is activated
• The mechanism of the ectopic focus is most often increased automaticity
• In ischemia and digoxin toxicity, the mechanism is: triggered activity
• Accelerated ventricular rhythm (as well as ventricular tachycardia) is
• Marker of successful reperfusion in myocardial infarction
• Accelerated ventricular rhythm is a "good sign" of reperfusion therapy for infarction

Accelerated Ventricular Rhythm

• Frequency: 80/min.
• Accelerated ventricular rhythm has a frequency of 40-100/min.
• Wide QRS complexes (> 0.12s)
• P waves are absent
• Most commonly occurs as a marker after successful reperfusion in myocardial infarction
• Often does not require treatment and terminates spontaneously

Ventricular Rhythm

• Frequency: 27/min.
• Ventricular rhythm has a frequency of 20-40/min.
• Wide QRS Complexes (> 0.12s)
• P Waves Are Absent
• This indicates SA Block IIIrd Degree
• A secondary pacemaker often activates - Junctional Rhythm
• In this case, ventricular rhythm - tertiary pacemaker was activated

Ventricular Tachycardia

• Frequency: 160/min.
• Ventricular tachycardia has a frequency of > 100/min.
• Wide QRS Complexes (> 0.12s)
• P Waves Are Absent
• Patients with ventricular tachycardia are often hemodynamically unstable, at risk of ventricular fibrillation
• The heart stops functioning as a pump
• Require urgent treatment (medication or defibrillation)

Sinus Rhythm and Ventricular Extrasystoles

• This is an ECG from the aforementioned healthy 36-year-old athlete
• Increased vagal tone inhibits the SA node and AV node
• The heart rhythm is alternately controlled by the SA node and an ectopic ventricular focus
• On the ECG we see:
• Sinus rhythm with a frequency of 75/min.
• Ventricular beats (Ventricular couplet) with a frequency of 60/min.
• Fusion beats (Capture beats)
• Sinus rhythm is intermittently interrupted by ventricular extrasystoles
• The ectopic ventricular focus is in the right ventricle (resembles LAFB pattern)

Accelerated Ventricular Rhythm

• Frequency 90/min.
• Wide QRS complexes (>0.12s)
• QRS complexes are not distorted by P waves
• Ectopic focus is between the ventricles, but more in the right ventricle
• Marked positive QRS (V6)
• Negative QRS (V1)
• Patient after reperfusion of an anterior wall infarction
• Accelerated ventricular rhythm is a marker of successful reperfusion of the infarct
• Later, there was a spontaneous conversion to sinus rhythm