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A 12-lead ECG of a woman with Ebstein's anomaly: The ECG shows signs of right atrial enlargement, best seen in V1. Other P waves are broad and tall, these are termed "Himalayan" P waves. Also, a right bundle-branch block pattern and a first-degree atrioventricular block (prolonged PR-interval) due to intra-atrial conduction delay are seen.
The conduction system consists of specialized heart muscle cells, situated within the myocardium. [3] There is a skeleton of fibrous tissue that surrounds the conduction system which can be seen on an ECG. Dysfunction of the conduction system can cause irregular heart rhythms including rhythms that are too fast or too slow.
Intraventricular conduction delay seen in precordial/chest leads with QRS duration 100 ms. An EKG of a 25-year-old male. Intraventricular conduction delays (IVCD) are conduction disorders seen in intraventricular propagation of supraventricular impulses resulting in changes in the QRS complex duration or morphology, or both.
Common causes include ischemia (lack of blood flow and oxygen to the heart muscle) or progressive fibrosis (excessive scarring) of the heart. [9] It is also possible that a high degree block can result after cardiac surgery during which the surgeon was in close proximity to the electrical conduction system and accidentally injured it.
Lev’s disease, or Lenegre-lev syndrome, is used to describe the large proportion of cases that are idiopathic, and described as progressive cardiac conduction defects. Meaning it’s not clear exactly what causes it, but over time, fibrosis, or scarring, develops in the conduction system which can delay or stop electrical conduction.
A major cause of AV dyssynchrony is VA conduction. VA conduction, sometimes referred to as retrograde conduction, leads to delayed, nonphysiologic timing of atrial contraction in relation to ventricular contraction. Nevertheless, many conditions other than VA conduction promote AV dyssynchrony. [1] [2] [4] [8] [10]
In comparison to second-degree atrioventricular block, in first-degree block there is an absence of non-conduction or "dropped beats." In an electrophysiology study, this corresponds to a prolonged A-H interval that shows the time between atrial depolarization and His bundle depolarization near the AV node.
Delayed afterdepolarizations (DADs) begin during phase 4, after repolarization is completed but before another action potential would normally occur via the normal conduction systems of the heart. They are due to elevated cytosolic calcium concentrations, classically seen with digoxin toxicity.
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