Intraventricular dissociation due to complete intraventricular block
Descripción
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
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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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