1. Atrial Rhythms MEHDI BAKHSHI MSN CCN ICNS

2. Wandering Pacemaker Pacemaker site wanders between sinus node, atria, and AV junction. Rate is usually normal; impulses are conducted normally to the ventricles.

3. Wandering Pacemaker  Regularity: Slightly irregular  Rate: Usually normal, 60–100 beats/minute  P Wave: Morphology changes from beat to beat  PRI: Less than.20 seconds; may vary  QRS: Less than.12 seconds

4. Wandering Pacemaker

5. Premature Atrial Contraction Pacemaker is an irritable focus within the atrium that fires prematurely and produces a single ectopic beat. Impulses are conducted normally to the ventricles.

6. Premature Atrial Contraction  Regularity: Depends on underlying rhythm; usually regular except for PAC  Rate: Usually normal; depends on underlying rhythm  P Wave: P wave of early beat differs from sinus P Waves; can be flattened or notched; may be lost in preceding T wave  PRI:.12–.20 seconds; can be greater than.20 seconds  QRS: Less than.12 seconds

7. Premature Atrial Contraction

8. Atrial Tachycardia Pacemaker is a single irritable site within the atria that fires repetitively at a very high rate. Impulses are then conducted normally to the ventricles.

9. Atrial Tachycardia  Regularity: Regular  Rate: 150–250 beats per minute  P Wave: Atrial P wave; differs from sinus P wave; can be lost in preceding T wave  PRI:.12–.20 seconds  QRS: Less than.12 seconds

10. Atrial Tachycardia

11. Atrial Flutter Single irritable focus within the atria initiates rapid, repetitive impulses. AV node protects the ventricles by blocking conduction of some impulses.

12. Atrial Flutter  Regularity: Atrial Rhythm regular; ventricular rhythm usually regular but can be irregular if there is variable block  Rate: Atrial rate 250–350 beats per minute; ventricular rate varies  P Wave: Characteristic sawtooth pattern (F waves)  PRI: Unable to determine  QRS: Less than.12 seconds

13. Atrial Flutter

14. Atrial Fibrillation Many irritable sites within atria fire repetitively, causing ineffective atrial depolarization. AV node blocks most impulses, so ventricular rate is usually slower than atrial.

15. Atrial Fibrillation  Regularity: Grossly irregular  Rate: Atrial greater than 350 beats per minute; ventricular rate varies greatly  P Wave: No discernible P waves; atrial activity is referred to as fibrillatory waves (f waves)  PRI: Unable to measure  QRS: Less than.12 seconds

16. Atrial Fibrillation

17. Chapter 5 Practice Strips

18. 5.1

19. 5.2

20. 5.3

21. 5.4

22. 5.5

23. 5.6

24. 5.7

25. 5.8

26. 5.9

27. 5.10

28. 5.11

29. 5.12

30. 5.13

31. 5.14

32. 5.15

33. 5.16

34. 5.17

35. 5.18

36. 5.19

37. 5.20

38. 5.21

39. 5.22

40. 5.23

41. 5.24

42. 5.25

43. 5.26

44. 5.27

45. 5.28

46. 5.29

47. 5.30

48. 5.31

49. 5.32

50. 5.33

51. 5.34

52. 5.35

53. 5.36

54. 5.37

55. 5.38

56. 5.39

57. 5.40

58. 5.41

59. 5.42

60. 5.43

61. 5.44

62. 5.45

63. 5.46

64. 5.47

65. 5.48

66. 5.49

67. 5.50

68. 5.51

69. 5.52

70. 5.53

71. 5.54

72. 5.55

73. 5.56

74. 5.57