Atrial wandering rhythm

Introduction The pace of pacing in the heart may be called the migratory rhythm. The pacing point is indefinite in the atrium, called the arrhythmia in the atrium, and the migratory rhythm in the sinus node. It means that the pace of the sinus node is not in one part, but is transferred from a certain part to Another part. Often accompanied by sinus arrhythmia. It is a type of sinus arrhythmia. The migratory rhythm means that the position of the heart pacemaker is not fixed, but the position is constantly changing. It can swim back and forth in different parts of the sinus node, or swim in different parts of the atrioventricular node, or walk between the sinus node, the atrium and the atrioventricular node. Therefore, it is often divided into: (1) the rhythm of the sinus node. (2) The heart rhythm of the atrioventricular node. (3) The rhythm of the sinus node to the atrioventricular node connection area. Sinus rhythm includes sinus bradycardia, sinus rhythm, sinus arrhythmia, and sinus node migratory rhythm. The mechanism of migratory rhythm in the sinus node may be due to certain inhibitory factors (such as increased vagal tone or drug influence), which inhibits the faster frequency in the sinus node, and the slower frequency begins to work. . When these inhibitors are removed, the faster paced pacing site resumes its pacing function, and the slower frequency is suppressed. This cycle, the sinus rhythm is fast and slow, and the P wave morphology also mutates, forming a migratory rhythm within the sinus node. This type of heart rhythm is usually found in healthy people, but patients with digitalis poisoning are also common.

Cause

Cause classification

There are many reasons for inducing sinus arrhythmia, both pathological and non-pathological.

The first cause of sinus arrhythmia, that is, respiratory sinus arrhythmia, occurs because the tension of the vagus nerve and sympathetic nerve changes during the process of breathing, and the sinus node is also self-disciplined. Periodic and regular changes occur. When inhaling, the sympathetic tone is increased, the heart rate is increased, the vagus nerve tension is increased during exhalation, and the heart rate is slowed down. The cycle of heart rate changes is exactly equal to one breathing cycle, and the heart rhythm changes to regularity when the breathing is stopped. This kind of arrhythmia is usually more common in children, youth and the elderly, and it is a normal physiological phenomenon.

The second cause of sinus arrhythmia, which is the cause of non-respiratory arrhythmia, is not well understood. Some people think that it is angry, emotionally unstable, or use certain drugs (such as digitalis, morphine, etc.) )related.

The third cause of sinus arrhythmia is sinus arrhythmia associated with ventricular contraction and blood flow. It is due to abnormal blood supply to the sinus node due to abnormal ventricular contraction and blood flow, resulting in the spontaneous occurrence of sinoatrial node. Induced by the change.

The fourth type is ectopic heart rhythm-induced sinus arrhythmia. Due to ectopic agitation, especially from the atrial ectopic agitation, sometimes the sinus node sensation can occur early, followed by inhibition of the sinoatrial node, resulting in a sinus arrhythmia induced by transient ectopic agitation .

related analysis

The heartbeat of a normal person is commanded by a high-level command called the sinus node. The sinoatrial node sends a signal to stimulate the heartbeat. This heartbeat caused by the sinus node signal is called normal "sinus rhythm" and the frequency is about 60-100 times per minute. The number of heartbeats per minute, that is, the heart rate is the result. But this frequency may be affected by many factors, even the effects of breathing.

Under normal circumstances, the heartbeat rhythm is regular and neat, if the heart beats irregularly, we call it arrhythmia. From this point of view, "sinus arrhythmia" is the most common type of arrhythmia, because the signal from the sinus node is not completely regular. However, most of these "arrhythmia" belong to "respiratory sinus arrhythmia", which is a normal physiological phenomenon. It is characterized by changes in breathing. When inhaling, the heart rate can increase by several hops. When you are angry, you can slow down the number of hops. The fast and slow cycle is exactly equal to one breathing cycle. When you hold your breath, the heart rhythm turns into a regular rule. This "sinus arrhythmia" with changes in breathing is completely normal, no need to worry, no treatment.

Therefore, people diagnosed with "sinus arrhythmia" can notice whether there is any relationship between their own heart rate acceleration and deceleration and breathing. As long as there are no other symptoms, there is no need for treatment, and you can fully engage in normal study and life.

an examination

Related inspection

ECG chest CT examination

Basic symptoms

1. Sinus bradycardia, if the heart rate is not less than 50 beats per minute, generally asymptomatic.

2. If the heart rate is lower than 40 times per minute, it can often cause angina pectoris, cardiac insufficiency or syncope.

Diagnose based on

The electrocardiogram shows sinus P waves, the P wave rate is lower than 60 times per minute, and the PR interval is greater than 0.12 seconds.

Differential diagnosis

It should be identified with the following arrhythmias:

1. Atrial premature contraction: P wave morphology should be identical in sinus arrhythmia, or gradually change slightly. The P' wave of the atrial contraction is completely different from the sinus P wave shape. In the sinus rhythm, the PP interval is not completely the same, and the pre-atrial contraction rhythm changes suddenly aroused in advance, followed by incomplete compensation intermittent.

2. Second degree I sinus block: During the sinus arrhythmia, the PP interval is gradually shortened and then gradually extended, while the second degree I sinus block PP interval is gradually shortened, followed by a long interval. After this interval, the PP interval is gradually shortened, regardless of the respiratory cycle. The change of PP interval in sinus arrhythmia is related to the respiratory cycle, and the sinus arrhythmia disappears when the breathing is temporarily stopped.

3. Irregular second sinus block: During the sinus arrhythmia, the PP interval is gradually shortened and prolonged. The change is closely related to the respiratory cycle; while the second interval of sinus block is abruptly prolonged, which is independent of the respiratory cycle.

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