Intraventricular dissociation due to complete intraventricular block

Intraventricular dissociation due to complete intraventricular block. A Castellanos, R J Sung and R J Myerburg Chest 1975;68;833-834 DOI 10.1378/chest.68.6.833 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/68/6/833

Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1975by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692

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lntraventricular

Dissociation

Complete

due

lntraventricular

to

1TI:IT!;f

Block*

- 9

Agustin

Ca,ctellanos,

M.D.,

Robert

I. Myerburg,

M.D.

F.C.C.P.;

hemorrhage.

complete

atrioventricular

of accelerated not

an area

of complete

impulse

formation

phenomenon isolated

rectly

D

size

rather

the

lion

due

been

is,

to

between Although

‘

of

plete

any

of the

be seen

of

two

process

5

=

quately part

first

but dis-

heart

is

irreversible

are

cardiac

cerebral

block

has

case

pre-

reported

had

specific

ST-T

unstable

shown

by

ectopic

between

50/mm

Complete 72/mm

with

recorded

sinus

rhythm

rhythm

) is

Reprint Miami

requests:

of

Cardiology, University

( with seen

an

Dr.

Castellanos,

1 700

NW

days

patients A

stimulate

parts

of

the

of

the

effective

true

fusion

TT

the

=iTiiF+ !

with

non-

block

with

cycle

beats

that

impulses.1

The

of the

1.

the bottom

coexist

with

These

wide

complexes C )

and

60/mm

For

Medicine, FL.

Tenth

on

Avenue,

.

75/mm. do

.

JI

not

the

effective

impulses

from

I

:_

#{182}\

FIGuii.s

1. Intraventricular complexes which

refractory

period.

CHEST, 68: 6, DECEMBER, 1975

Tracings

a function collision

at

parts

different

as

not

activated

of

terminal

a specific

type

of

of two

interfere block

Figure

with

each

( pre-

occurring

1, type

in

the

B ventricular

ventricular occur

at

other

between

strip, even

This

unable

rhythm

rates

middle

each

period.

were

of the

( ectopic)

with

of

physiologic

the

when

indicates

to reach

by the other

the

QRS falling

that

part

the

of the

beats.

I I -1

t-ri

I

U

occurrence

I

&

1 ia_I

I I LI

I

HTI

_LI _LLL1_L_L!

Q RS

Again,

area

their

Hence,

.

superimposition

complexes

refractory

muscle

of

a third rS

leads

foci.

strip

interfere

one

3 )

1 ) shows

corresponding

) to

( Fig

3 ( a magnification

do

the

surface

conduction

to

on

the

place

which

able

other

by

ECG

what

ventricular

although

to the

pre-

to

falling

because

in Figure

complexes

the

a

the

are

when

( in

take

of pathologic in

ectopic

of each present,

due

) around

adeof

contrast

complexes

B even

can

strip

be

from

in

double

is extinguished

beats”6 QRS

But

activation,

Figure

second

because

( type

not

latter

as the

(1

can

dissociated

type

periods

ventricles. On the contrary,

to

because

is a magnification

corresponding

rhythms,

referred

standardization

JILLLJIL

U-HH

yen-

1, these type A complexes with another ectopic at a rate of 75/mm. These M-

ventricles

were

be

at half which

with

ventricular

ectopic

Finally,

ranging

i

I

1 show-

A ectopic

seen,

beats.

and

refractory

ventricular Ti

in Figure

deflections

are

A

in

sumably

33136

U

.

) coexist

type type

other

massive

Figure of Miami,

?#{149}

1.

of Figure

the

the

three

rates

in

Department Miami,

of

2,

87/mm

occurs

complexes #{176}From the Division School of Medicine,

of

rhythms,

of

corn-

during

atrioventricular

ventricular and

obtained

ECG

regular

strip

pseudofusion

in a patient

12-lead

only

changes.

strips

#{149} #{149}

-i

hardly

atrial

Figure

a

rate

the

in Figure

second

usually

both

exam-

produced

occurring

A

in

mentioned

implies

ELECTROCARDIOGRAMS

selected

arrest

hemorrhage.

previously an

3

.

type

will

were

recorded

strip

viously

portion

block.

to

strip

and

complexes

waves

) . However,

top

at

different 1

QRS

P

identified

part

Figures

i

,

.a..

.‘.

of top

block

inadvertently

of the

( now

dissociathe

is the

OF

small

mm

In the

di-

se,

the

intraventricular

dissociation

DESCRIPTION

of part

these

The

were

my

mul-

That of

‘y

-

.

reasons, A.

strips

indepenper

processes.’

two parts intraventricular

f

.1f.

#{149} ‘

- .‘-.4-

ventricular rhythm discharging shaped ( type B ) complexes

knowledge

communication

intraventricular

type

surface.

which

other

our

intraventricular

didactic

of all

hearts.

degree to

of

counterpart

coexistence

.

e

in which

body

may

.

‘

e s I j 4

2. Magnification

FicuRE

depolarization

a primary of

second

in this

pie

the

consequence

described,24

sented

clinical

-1.r---

-I-

!IL

4

lug complete atrioventricular tricular complexes.

corresponding

at the

I.,

#{149}

did

existence

.-

‘#{149}1Tt#{149}i- I..! :1:.14.j-ti: j44j: .Jj I iLi: ! i.i.I llItL1ii

but only of certain regions. to produce ventricular corn-

is not

sociation can occur well recognized.’

the

from

of dying

rhythms,

--j#{149}. t.._1

t#{149}I-l t’ 1-e b . -f-e4-$-

types

beats

the areas

Hence,

contractions

that

dent

of the

to be recorded

ventricles

ectopic

because

result

is the

issociation,

The

different

-

.. -

[Uf

JfflJ

1.TT

t[t.f

L

and

showed

three

surrounding

not

focal

in the

other

muscle mass large enough

of enough

tiple

rhythm.

block did

This

with

occurred.

the ventricular The latter were plexes

electrocardiogram

block

each

complexes

QRS

The

with

M.D.;

due to infraventricular block cardiac arrest due to massive

ventricular

interfere

J. Sung,

e_t.l

Intraventricular dissociation occurred in a patient with cerebral

Ruey

I.

.1

11

LLLJ...L1

IL

.‘FH dissociation do not interfere were

obtained

due to intraventricular with each other even at half

standardization

block. There when appearing

(

1 my

=

are

three during

types of effective

5 mm).

INTRAVENTRICULAR DISSOCIATION

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833

:

3. Magnification distortion

FlvunE

from

of part

ECG

of middle strip superimposition

produced

by

:::J:i:j:thA::::

;.:‘

in Figure 1 showing of type A and 3

Pick

4

sis to physiological Gay RJ, Brown

DIscussIoN It is a fundamental that

law

ventricular

refractory apex

beats

period.

The

of the T wave. a regular sinus

whom

by

the

has

I)y the

the

ventricular

muscle. an

However, complete enough

reflect

the

that

activity

of

were

tricles

to

failing

of

to areas

shown

counterpart

of

be

directly

304

of

attributed

of

isolated

in the

and

focal

to the

contractions

.

profound

hypoxia

and

vented

from

producing

refractory

affected)

myocardium.

the

duration

tole

( that

is,

totality

of the

local

In

of the

a

myocardial

.1

of fact,

refractory

propagated

ventricles)

the

of

the

impulses

period,

response

of

D

iffuse

classification 66:147, 2

Katz

LN,

rhythmias pp

834

105-108,

and

consistent

terminology.

( part

A: Clinical Electrocardiography: 1 ). Philadelphia, Lea and

522-523

FLEMING El AL

Slow

ventricular

A

source

activation of

Pacing

in

re-entrant

Circulation

acute

premature

48:702,

1973

of ventricular infarction

arrhythmias in the canine

Disease

of

of

Honeycomb

Lung

Jerome Kleinerman, and Eugene V. Perrin,

M.D.;

M.D.;

physiologic,

which

M.D.; M.D.

recorded.

out-

physiologic,

pulmonary

fibrosis in

We

recenfly

is

is

de-

manifesthtions

are

honeycombing

has

of

with

our

to

who

not

demon-

been

describe

features

of

chron-

honeycombing.

has

purpose

number

with

childhood

association

pathologic

a

a patient

fibrosis

this

and

of a case

with

studied

disease

It

with

association

interstitial

knowledge,

of

lung.

interstitial

diffuse

study childhood

pathologic

disease

the

granulomatous

our

and

described

states.

(un-

CASE

the

To previously

the

of this

clinical,

case.

patient,

an

Rainbow

Babies

six

of

years

and

18-year-old and

age

for

left

REPORT

black

Children’s evaluation

hilar

man,

Hospital of

chronic

adenopathy.

He

was

first

of

Cleveland

bilateral

had

suffered

seen

at at

nodular

from

a comprehensive Am

J

Heart

1963

Pick

of

Appleton-Century-Crofts,

an extrasys-

depolarizing

for

JL:

honeycomb

been

The

: A proposal

Circula-

Electrophysiology

York,

granulomatous

in

those

resulted.

dissociation

L:

Cause

clinical,

infiltrates A : A-V

and

pacemakers.

1*

chronic

strated

REFERENCES

1 Pick

77:619,

arrhythmias

of

Granulomatous

II

scribed,

was preby the

surrounding

when

Cox

Unusual

The

infarc-

response

J

may

( Fig been

metabolic

depolarization

a propagated period

effective

lived

experimental

JP,

contractions.

ic

in

experiments,

Arrhythmias

p 117

ventricular

ventricular

activation

al: Heart

Pacemaker

Waldo AL Kaiser GA : A study associated with acute myocardial heart. Circulation 47 : 1222, 1973

disease

these

Lemberg

infarction:

developing in the dying heart ( Fig 304 of Katz and Pick2). It is also in keeping with the experimental studies of Boineau and Cox’ and of Waldo and Kaiser,9 who observed the existence of local nonpropagated areas of

In

L:

New

Gerald Al. Fleming, Carl F. Doershuk,

alterations

tion.

et Am

1973

Cardioversion.

An

The

has

added

HC,

demand.

procaine

re-

clinical

animals

phenomenon

This

hypothe-

Lflll#{248}flOO#{248}

yen-

which

of dying

Gadboys on

recognition

myocardial

l

the

the

E,

Lemberg

A Jr.

Chronic

regions.

be

from

in

block.

1 to 3 may

arrhythmias

In

the

probably

A,

Boineau

but

ventricular

ventricular

8

not

so deranged

intraventricular

ventricles

Pick2)

will

of

Donoso

47:1382,

and

9

described

areas

of cardiac

pacemaker

Castellanos

7

area

mass

was

was

by

1969,

it is confined.

arrest

other

RC,

Castellanos

of

an

muscle

certain

Spitzer induced

tion

yen-

of all

to

resulting complexes.

fact. Am Heart J 86:249, 1973 DF: Pacemaker failure due to Am J Cardiol 34:728, 1974

electrocardiographic

presence

ectopic

in Figures

the

seen Katz

total

cardiac

reach

6

re-

which

to which

dissociation

multiple

arrhythmia

the

activate

intraventricular

sult

of the

complex

area

toxicity.

refractori-

confined

occurring

able

while

Thus,

The

beats

1969

effectively

conduction

simultaneously

5

in

whole

is a composite

be

a QRS

intraventricular

rhythms

the

response

the

because

block,

to produce

report,

to

Mechanisms

amide

an iatrogenic

rendered

leads

can,

only that of the particular the patient with irreversible this

up in patients

propagated

depolarization.

impulse

electric

a

surface

intraventricular

large

effective

extends seen with

) , because

been

previous

detected

the

The

produce

surface

mass

ness

during

ventricular

body

muscle

fractory

roughly

cannot

at the

tricular

latter

)

stimuli

( recorded

electrocardiography

arise

This is clearly rhythm coexists

( pacemaker-induced artificial

of clinical

cannot

A:

pseudofusion B ventricular

type

The Febiger,

Ar1956,

#{176}From the

Division

Hospital, and and Medicine,

of

Pathology

the Departments Case Western

Research,

Saint

Luke’s

of Pathology, Pediatrics, Reserve University, Cleve-

land. Reprint

land

requests:

Dr.

Kleinerunan,

St.

Luke’s

Hospital,

Cleve-

44104

CHEST, 68: 6, DECEMBER, 1975

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Intraventricular dissociation due to complete intraventricular block. A Castellanos, R J Sung and R J Myerburg Chest 1975;68; 833-834 DOI 10.1378/chest.68.6.833 This information is current as of October 13, 2011 Updated Information & Services Updated Information and services can be found at: http://chestjournal.chestpubs.org/content/68/6/833 Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.chestpubs.org/site/misc/reprints.xhtml Reprints Information about ordering reprints can be found online: http://www.chestpubs.org/site/misc/reprints.xhtml Citation Alerts Receive free e-mail alerts when new articles cite this article. To sign up, select the "Services" link to the right of the online article. Images in PowerPoint format Figures that appear in CHEST articles can be downloaded for teaching purposes in PowerPoint slide format. See any online figure for directions.

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