Cardiology In Critical Care

Arrhythmia Recognition

Atrial Fib.

Impulses originate in multifocal atrial pacemaker at a rate 300-600/min but only some of them are conducted to the ventricles.  The atrial activity is represented by numerous, irregularly spaced small deflections of varying configuration (f waves) best seen in L2, L3 AVF and V1.  Occasionally, f waves may be prominent ("coarse" fibrillation) resembling atrial flutter or no atrial activity is discernible ("fine" fibrillation).  Only some f waves pass through the AV junction and activate ventricles in a completely irregular fashion.  Vagal stimulation may have no effect or may slow the ventricular rate by increasing the AV block.


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