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  Theory: AVNRT is a supraventricular tachycardia, which means that the arrythmia originates from either the atria or AV-node. A premature atrial complex (PAC) often luxates the arrythmia, as the consequential depolarisation wave can induce a re-entry circuit inside the AV-node (1). The AV-node contains two bundles: a slow pathway (alpha cells) and a fast pathway (beta cells). Almost always (~ 90%) the circle tachycardia arises within the slow pathway, resulting in retrograde activation of the atria through the fast pathway. Therefore, the typical AVNRT (or “slow-fast AVNRT”), the atrial contraction follows shortly after the ventricular contraction. This results in the P-wave showing during (invisible) or just shortly after the QRS-complex (short RP interval)! --------- Clinic: Typically, AVNRT has a sudden onset of rapid regular palpitations which end just as sudden. The heartrate varies from 100-250 bpm – typically 180 bpm. The high frequency and therefore consequential release o...

. ATRIAL FIBRILLATION: On your rhythm strip, the two most important characteristics are: . 1) A rhythm that’s IRREGULARLY irregular (meaning there’s no way to predict the next beat) 2) No discernible P waves . In fact, if you notice an irregularly irregular rhythm and you’re having to convince yourself that you see P waves... it’s probably A-fib (multifocal atrial arrhythmias like WAP/MAT could fit the differential) . *In my opinion: Don’t get caught up in using fibrillation waves as an absolute criteria. Very fine A-fib can sometimes produce a near isoelectric line between beats. . JUNCTIONAL RHYTHMS: The pacemaker cells surrounding the AV junction are capable of initiating regular impulses but at a slightly slower natural rate than their sinus and atrial superiors. The heart is built this way so that when the pacemaker cells with the fastest intrinsic rates are in action, those below are suppressed and function primarily to pass along the impulse from above. . For these reasons, we s...

In a healthy heart, the rate and rhythm of the heartbeat are controlled by an electrical system. A series of coordinated electrical signals start in a part of the heart called the Sinus Node. The electrical impulse then spreads across the heart and tells it when and where to contract, or squeeze. This synchronized heartbeat continuously circulates blood from the lungs, through the heart, and out to the rest of the body to deliver oxygen. In people with atrial fibrillation--also called AFib--the electrical signals are abnormal, and largely chaotic, and cause the heart's chambers to beat irregularly, and often rapidly. If you have been diagnosed with AFib, you are not alone. AFib is the most common type of irregular heartbeat and an estimated  Over 1 million people in the UK have atrial fibrillation  . Some people with AFib never experience symptoms and are diagnosed when a healthcare professional detects an irregular heartbeat. It's estimated that one-third of Americans who hav...