Atrial ectopic rhythm: signs and treatment

© Author: Sazykina Oksana Yuryevna, cardiologist, especially for SosudInfo.ru (about the authors)

If the human heart always worked correctly and contracted with the same regularity, there would be no diseases such as arrhythmias, and there would not be a vast subsection of cardiology called arrhythmology. Thousands of patients around the world experience one or another type of arrhythmia due to various reasons. Arrhythmias have not been spared in very young patients, in whom registration of an irregular heart rhythm on a cardiogram is also quite common. One of the common types of arrhythmias are disorders such as ectopic rhythms.

What is atrial rhythm

Myocardial contractions normally occur regularly and do not depend on consciousness: even when the brain dies, the heart still works for some time.
This process is very important for maintaining life. Failures occur due to serious damage to the cell structure or metabolic disorders. If the main pacemaker is affected, its function passes to the underlying sections located in the atria, atrioventricular zone, and bundle branches. In this case, the normal impulse becomes too weak or absent. If the generation of myocardial contractions comes from the atria, then in this case an atrial ectopic rhythm is recorded on the ECG.

Diagnosis of ectopic rhythm

The leading diagnostic method is the electrocardiogram. If an ectopic rhythm is detected on the ECG, the doctor should prescribe a further examination plan, which includes cardiac ultrasound (ECHO-CS) and daily ECG monitoring. In addition, patients with myocardial ischemia are prescribed coronary angiography (CAG), and patients with other arrhythmias are prescribed transesophageal electrophysiological examination (TEPE).

ECG signs for different types of ectopic rhythm differ:

• With an atrial rhythm, negative, high, or biphasic P waves appear, with a right atrial rhythm - in additional leads V1-V4, with a left atrial rhythm - in V5-V6, which may precede or overlap the QRST complexes.

accelerated ectopic atrial rhythm

• The rhythm from the AV junction is characterized by the presence of a negative P wave, superimposed on the QRST complexes, or present after them.

AV nodal rhythm

• Idioventricular rhythm is characterized by a low heart rate (30-40 per minute) and the presence of altered, deformed and widened QRST complexes. There is no P wave.

idioventricular (ventricular) ectopic rhythm

• With atrial extrasystole, premature, extraordinary, unchanged PQRST complexes appear, and with ventricular extrasystole, altered QRST complexes appear followed by a compensatory pause.

atrial and ventricular ectopia (extrasystoles) on the ECG

• Paroxysmal tachycardia is characterized by a regular rhythm with a high frequency of contractions (100-150 per minute), P waves are often quite difficult to determine.
• Atrial fibrillation and flutter on the ECG are characterized by an irregular rhythm, the P wave is absent, and fibrillation f waves or flutter waves F are characteristic.

Causes and types

The main causes of atrial, as well as any ectopic (displaced) rhythm, are:

1. Changes in the structure of the myocardium - as a result of inflammation, ischemia, cardiosclerosis, hypertrophy or dystrophy.
2. Valve defects and other congenital anomalies.
3. Violation of electrolyte and water levels. This happens with a sudden loss of fluid (vomiting, diarrhea, taking diuretics).
4. Metabolic changes in diseases of the endocrine organs.
5. Internal or external intoxication (impaired kidney and liver function, smoking, alcoholism, drug addiction, ingestion of heavy metal salts, etc.).
6. Overdose of cardiac glycosides.
7. Traumatic chest injury.

All these reasons are characteristic of ectopic atrial impulses in an adult. In children and adolescents, they most often occur against the background of impaired autonomic innervation.

Depending on the frequency of contractions, slow and accelerated atrial rhythms are distinguished. The lower the pacemaker is located in the conduction system, the rarer the pulse - up to 45–60 beats per minute. An increase of up to 130 or more occurs when, under the influence of inflammation or other pathology, hyperexcitation and excessive activity of the ectopic focus develop.

The displaced rhythm may be permanent or temporary. According to localization, it can be left or right atrial, but this division has no particular clinical significance and does not affect the prescribed treatment regimen.

Ectopic impulses can vary in frequency, regularity and strength. But in the absence of normal sinus rhythm, they allow the heart to continue pumping.

Treatment of arrhythmia

Should arrhythmia be treated? Some of the disorders, such as single supraventricular or ventricular extrasystoles in the absence of organic heart damage, are harmless and do not require treatment. In other cases, a person’s life depends on timely recognition and assistance.

Treatment of rhythm disturbances depends on the etiology, type of disorder, patient’s condition, and the presence of contraindications for certain methods of influence.

There are several approaches to treatment:

• impact on the cause;
• influence on factors that provoke arrhythmia;
• effect on the mechanisms of arrhythmogenesis;
• impact on patient tolerance to arrhythmia

All therapeutic effects for rhythm disturbances are divided into medicinal

and
non-medicinal
. The selection of pharmaceuticals is always carried out by a doctor and should be monitored by repeated ECG recordings. Based on the approach to treatment, medications of different directions of action are used; antiarrhythmics often come to the rescue. Amiodarone, sotalol, propafenone, verapamil, etc. show high effectiveness.

Non-drug

the direction includes electrical methods: cardioversion and defibrillation, temporary and permanent electrical stimulation; radiofrequency destruction of the ectopic focus, surgical treatment of organic heart diseases (developmental anomalies, valve defects), which are the cause of arrhythmia.

It is important to note that diagnosis at all stages and treatment of rhythm disturbances is carried out only by a doctor. Often, with questioning and an objective examination of the patient (palpation of the pulse, auscultation of the heart), it is possible to suspect the nature of the arrhythmia, and additional studies make it possible to clarify the diagnosis, the cause of the disease and select the correct treatment.

If you feel symptoms

heart rhythm disturbances or are not receiving proper treatment for an already established diagnosis, cardiologists at AVENU medical centers will help solve the problem. You can sign up for a consultation on the website avenumed.ru and by calling the branch nearest to you.

What is the danger

Active generation of heart rhythm from an atypical focus is most often a symptom of pathology of the myocardium or other organs and systems. I recommend that you undergo additional examinations and identify the cause of ectopia.

Rhythm and hemodynamic disturbances, especially with a high frequency of contractions and concomitant diseases, can lead to the formation of blood clots, angina attacks, the development of a heart attack, flicker, flutter and the gradual formation of heart failure.

Why does ectopic rhythm appear?

Ectopic rhythm occurs due to a weakening of the rhythmic functioning of the sinus node, or a complete cessation of its activity.

In turn, complete or partial inhibition of the sinus node is the result of various diseases and conditions:

1. Inflammation. Inflammatory processes in the heart muscle can affect both the cells of the sinus node and the muscle fibers in the atria and ventricles. As a result, the ability of cells to produce impulses and transmit them to underlying sections is impaired. At the same time, the atrial tissue begins to intensively generate excitation, which is supplied to the atrioventricular node at a frequency higher or lower than usual. Such processes are caused mainly by viral myocarditis.
2. Ischemia. Acute and chronic myocardial ischemia also contributes to impaired activity of the sinus node, since cells deprived of sufficient oxygen cannot function normally. Therefore, myocardial ischemia occupies one of the leading places in the statistics of the occurrence of rhythm disturbances, including ectopic rhythms.
3. Cardiosclerosis. The replacement of normal myocardium with growing scar tissue due to previous myocarditis and infarctions interferes with the normal transmission of impulses. In this case, in persons with ischemia and post-infarction cardiosclerosis (PICS), for example, the risk of ectopic heart rhythm increases significantly.

In addition to pathology of the cardiovascular system, vegetative-vascular dystonia, as well as hormonal imbalances in the body - diabetes mellitus, pathology of the adrenal glands, thyroid gland, etc., can lead to ectopic rhythm.

Possible symptoms

Ectopic left and right atrial rhythms manifest themselves in the same way. A person often does not notice changes, and the symptoms of the underlying disease that caused the deviation come first. The only way to detect a violation is to take an electrocardiogram.

In other cases, the patient makes the following complaints:

• feeling of pulse unevenness and interruptions;
• heart sinking;
• dyspnea;
• weakness, decreased ability to work;
• pain or discomfort in the heart area.

In the presence of temporary jumping atrial complexes, symptoms usually either do not appear or are transient. According to my observations, they do not pose any particular danger and do not affect hemodynamics.

With prolonged attacks, the patient’s condition worsens, in addition to the main complaints, signs of circulatory disorders and cardialgia of ischemic origin appear.

Sometimes ectopic rhythm occurs due to dysfunction of the autonomic system:

1. If the influence of the sympathetic department predominates, a person’s pulse quickens, the skin becomes cool and pale, and hypertension is observed. This condition is characterized by chills, headache, and often a panic attack.
2. When vagotonia (parasympathetic) comes first, the frequency of contractions decreases, sweat is released, blood pressure decreases, and digestion is disrupted.

Symptoms of ectopic rhythm

The clinical picture of replacement heart rhythms can be clearly expressed or not manifested at all. Usually, the symptoms of the underlying disease come first in the clinical picture, for example, shortness of breath on exertion, attacks of burning pain in the chest, swelling of the lower extremities, etc. Depending on the nature of the ectopic rhythm, the symptoms may be different:

• With ectopic atrial rhythm , when the source of impulse generation is located entirely in one of the atria, in most cases there are no symptoms, and disturbances are detected by the cardiogram.
• With a rhythm from the AV junction, a heart rate close to normal is observed - 60-80 beats per minute, or below normal. In the first case, no symptoms are observed, but in the second, attacks of dizziness, a feeling of lightheadedness and muscle weakness are noted.
• With extrasystole, the patient notes a feeling of fading, cardiac arrest, followed by a sharp jolt in the chest and a further absence of sensations in the chest. The more often or less often the extrasystoles, the more varied the symptoms in duration and intensity.
• With atrial bradycardia , as a rule, the heart rate is not much lower than normal, within 50-55 per minute, as a result of which the patient may not notice any complaints. Sometimes he is bothered by attacks of weakness and sudden fatigue, which is caused by a reduced flow of blood to the skeletal muscles and brain cells.
• Paroxysmal tachycardia manifests itself much more clearly. During paroxysm, the patient notes a sharp and sudden sensation of accelerated heartbeat. According to many patients, the heart flutters in the chest like a “hare’s tail.” The heart rate can reach 150 beats per minute. The pulse is rhythmic, and may remain around 100 per minute, due to the fact that not all heartbeats reach the peripheral arteries at the wrist. In addition, there is a feeling of lack of air and chest pain caused by insufficient oxygen supply to the heart muscle.
• Atrial fibrillation and flutter can be paroxysmal or permanent. The basis of atrial fibrillation is a chaotic, non-rhythmic contraction of different parts of the atrium tissue, and the heart rate in the paroxysmal form is more than 150 per minute. However, there are normo- and bradysystolic variants, in which the heart rate is within the normal range or less than 55 per minute. The symptoms of the paroxysmal form resemble an attack of tachycardia, only with an irregular pulse, as well as a feeling of irregular heartbeat and interruptions in heart function. The bradysystolic form may be accompanied by dizziness and lightheadedness. With a permanent form of arrhythmia, the symptoms of the underlying disease that led to it come to the fore.
• Idioventricular rhythm is almost always a sign of serious cardiac pathology, such as severe acute myocardial infarction. In most cases, symptoms are noted, since the myocardium in the ventricles is capable of generating electricity at a frequency of no more than 30-40 per minute. In this regard, the patient may experience Morgagni-Edams-Stokes (MES) episodes - attacks of loss of consciousness lasting several seconds, but no more than one or two minutes, since during this time the heart “turns on” compensatory mechanisms and begins to contract again. In such cases, they say that the patient is “massing.” Such conditions are very dangerous due to the possibility of complete cardiac arrest. Patients with idioventricular rhythm are at risk of developing sudden cardiac death.

How to make a diagnosis

At the moment, the only objective way to detect ectopic atrial rhythm is an ECG. In the case when the impulses are temporary and interspersed with full myocardial contractions, Holter monitoring is used for diagnosis.

An electrocardiogram will reveal not only rhythm disturbances, but also indicate the localization of pathological impulses based on the state of the P wave. For clarity, you can give a table that shows how different types of ectopia manifest themselves:

Atrial rhythm in its pure form is not accompanied by a change in the electrical axis of the heart (EOS), and it is also not characterized by the appearance of deformation of the ventricular complexes.

As additional research methods and to identify the cause, I usually recommend:

1. General and biochemical analysis of blood and urine. Laboratory results show the presence of inflammatory processes, problems in kidney function, and electrolyte imbalance.
2. EchoCG. Ultrasound examination of the myocardium will help detect dilation of the heart, valvular insufficiency, and the presence of structural changes.
3. In case of chest injury, an x-ray is taken.

Ectopic rhythms in children

In children, this type of arrhythmia can be congenital or acquired.

Thus, ectopic atrial rhythm occurs most often with vegetative-vascular dystonia, with hormonal changes during puberty (in adolescents), as well as with pathology of the thyroid gland.

In newborns and young children, a right atrial, left or lower atrial rhythm may be a consequence of prematurity, hypoxia or pathology during childbirth. In addition, the neurohumoral regulation of heart activity in very young children is immature, and as the baby grows, all heart rate indicators can return to normal.

If the child does not have any pathology of the heart or central nervous system, then the atrial rhythm should be considered a transient, functional disorder, but the baby should be regularly monitored by a cardiologist.

But the presence of more serious ectopic rhythms - paroxysmal tachycardia, atrial fibrillation, atrioventricular and ventricular rhythms - require more detailed diagnosis, as this may be due to congenital cardiomyopathy, congenital and acquired heart defects, rheumatic fever, viral myocarditis.

Treatment

If a problem occurs in a healthy person under the influence of external factors, then it is transient and is eliminated when their influence ceases. In this case, no treatment is required. In the presence of a pathological condition, the main therapy should be aimed at eliminating the cause. To directly stop ectopic rhythm from the atria, the following are used:

• beta blockers for frequent contractions (Anaprilin);
• stimulants for bradycardia (Atropine);
• if there is a lack of potassium and magnesium, Panangin is used;
• sedatives for autonomic disorder (Motherwort, Persen);
• soothing herbal infusions.

In case of severe disorders with a pronounced decrease in the frequency of contractions and a high probability of developing a heart attack and other acute conditions, the issue of installing an artificial pacemaker is decided.

Lifestyle restrictions

To prevent rhythm disturbances and the occurrence of ectopic atrial complexes, heart disease should be treated in time and the functioning of the autonomic nervous system should be restored. Following the usual rules will help improve the condition of existing deviations and prevent their development:

1. Nutrition plays an important role. It must be balanced and complete. It is necessary to drink 1.5–2 liters of liquid per day, exclude animal fat from the menu, and consume as many vegetables and fruits as possible. You should eat small portions 4-5 times a day.
2. Eliminate the possibility of overwork and normalize sleep.
3. Breathe fresh air, go hiking, walk in a public garden or park.
4. Exercise daily and go to the gym. Swimming, dancing, yoga will be beneficial.
5. Studying with a psychologist and meditative practices help to develop stress resistance.
6. Do not abuse alcohol, quit smoking.