Stable vs. Unstable Tachycardia
Rules for Sinus Tachycardia
Regularity | R-R intervals are regular, overall rhythm is regular. |
Rate | The rate is over 100 bpm but usually less than 150 bpm. |
P Wave | There is one P wave in front of every QRS. The P waves appear uniform. |
PR Interval | Measures between 0.12 and 0.20 seconds in duration. PR interval is consistent. |
QRS Complex | Measures less than 0.12 seconds. |
Rules for Atrial Flutter
Regularity | The atrial rate is regular. The ventricular rate will usually be regular, but only if the AV node conducts the impulses in a consistent manner. Otherwise, the ventricular rate will be irregular. |
Rate | The atrial rate is normally between 250 to 350. Ventricular rate depends on conduction through the AV node to the ventricles. |
P Wave | The P waves will be well defined and have a “sawtooth” pattern to them. |
PR Interval | Due to the unusual configuration of P waves, the interval is not measured with atrial flutter. |
QRS Complex | QRS measures less than 0.12 seconds. |
Rules for Atrial Fibrillation (A-Fib) Irregular Narrow Complex Tachycardia
Regularity | The R-R intervals are irregular; therefore, overall rhythm is irregularly irregular. The ventricles conduct from different atrial foci causing the irregularity. |
Rate | Atrial rate usually exceeds 350. If the ventricular rate is between 60 and 100 bpm, this is known as “controlled” A-Fib. If the ventricular rate is more than 100, it is considered A-Fib with Rapid Ventricular Response (RVR), also known as uncontrolled A-Fib. |
P Wave | Due to the atria firing so rapidly from multiple foci, there are no obvious P waves in the rhythm. The baseline appears chaotic because the atria are fibrillating, therefore no P waves are produced. |
PR Interval | Because there are no P waves, PR interval cannot be measured. |
QRS Complex | QRS measures less than 0.12 seconds. |