EKG

Ectopic Atrial Rhythm

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Ectopic Atrial Rhythm

  • Findings
  1. Supraventricular rhythm (narrow complex) similar to sinus rhythm
    1. Regular rhythm typically at 50 to 100 bpm
  2. Unlike sinus rhythm
    1. Focus external from the Sinoatrial Node (SA)
    2. Although P Waves are present, they are a different configuration from typical P Waves
      1. Often inverted in I, II, III, aVF (if focus is lower in the atrium than the SA Node)
    3. Short PR Interval may be present (<0.12 sec)
  • Causes
  1. Common
    1. Increased vagal tone (e.g. young, athlete)
    2. During sleep
    3. Acute significant pain
    4. Emesis
  2. Medications
    1. Beta Blockers
    2. Calcium Channel Blockers
    3. Digoxin
  3. Other
    1. Hyperkalemia
    2. Hypoxia
    3. Myocarditis
    4. Sick Sinus Syndrome or other underlying chronic conduction abnormality
  • Management
  1. Benign in most young patients, athletes, acute pain or Emesis
  2. Stable and asymptomatic patients require no intervention
  3. Manage Electrolyte abnormalities (e.g. Potassium, Magnesium)
  4. Caution, telemetry and consider Consultation in symptomatic patients (e.g. Syncope) with risk factors
    1. Older patients (esp. with known heart disease)
    2. Suspected ingestion
  • References
  1. Smith, Brady and Vendersteenhoven (2026) Crit Dec Emerg Med 40(1): 13-4