Typical Arrhythmia Waveforms
Premature Supraventricular Contractions
(Premature Atrial Contractions (PAC))
P’
Diagnostic ECG Electrode Placement
Atrial Fibrillation (AF)
IEC
R and L electrodes should be placed just below the right
and left clavicle.
N and F electrodes should be placed on the lower edge of
the rib cage, or at the level of the umbilicus at the
mid-clavicular line.
P’
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Premature Ventricular Contractions (PVC)
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Lead Electrode Placement
R
Ventricular Tachycardia (VT)
L
C1
C2
C3
C4
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Multi-focal PVC
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N
C5
C6
F
C1
Fourth intercostal space at the
right border of the sternum
C2
Fourth intercostal space at the
left border of the sternum
C3
Midway between locations C2
and C4
C4
At the mid-clavicular line in the
fifth intercostal space
C5
At the anterior axillary line on
the same horizontal level as C4
C6
At the mid-axillary line on the
same horizontal level as C4
and C5
Ventricular Fibrillation (VF)
Heart Anatomy
15
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
16 17
2
2
1
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7
7
8
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14
9
Short run PVC
Second-degree atrioventricular (AV) block, Mobitz type II
8
13
10
7
3
12
6
P
P
P
11
4
1
5
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R-on-T PVC
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Third-degree (complete) atrioventricular (AV) block
18
Cardiac Conduction System
SA node
His bundle
Atria
P
P
P
P
P
P
P
P
P
P
Left
bundle
branch
P
AV node
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Electrocardiographs
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Defibrillators
Right
bundle
branch
Purkinje
fibers
Purkinje
fibers
Ventricles
R
The sinoatrial (SA) node generates a
wave of electrical excitation.
The excitation travels through the
internodal pathways to the atria and
the atrial muscles contract. This is
recorded as the P-wave.
The excitation travels to the
atrioventricular (AV) node.
The excitation then travels through the
bundle of His and down through the
right and left bundle branches.
Bedside monitors
T
P
Nihon Kohden products
which detect arrhythmia
Inferior vena cava
Superior vena cava
Right atrium
Tricuspid valve
Right ventricle
Pulmonary valve
Pulmonary artery
Pulmonary vein
Left atrium
Mitral valve
Left ventricle
Aortic valve
Coronary artery
Aorta
Brachiocephalic artery
Left common carotid artery
Left subclavian artery
Descending aorta
Q
S
The excitation terminates at the
Purkinje fibers in the ventricles and
the ventricular muscles contract.
This is the depolarization and is
recorded as the QRS complex.
The ventricular muscles relax. This is
the repolarization and is recorded as
the T-wave.
6727
SP60-075 '11.11.SZ. A