Isorhythmic A-V dissociation: Difference between revisions

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Revision as of 21:05, 3 September 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Synonyms and keywords: Isorhythmic AV dissociation

Overview

Isorhythmic AV dissociation is a AV dissociation initiated by slowing of SA node due to sinus arrhythmia, sinus bradycardia, sinus arrest, or sinoatrial exit block due to bradycardia. This allows an independent ventricular pacemaker response like either junctional (giving a normal or near normal QRS appearance and duration) or idioventricular (with a more bizarre, wide QRS) rhythm to take over the ventricles. In the presence of some degree of antegrade and retrograde atrioventricular block, there is a synchronization of independently beating sinus or atrial pacemaker with the junctional or ventricular pacemaker such that each discharges in the absolute refractory period of the other.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular	Acute coronary syndrome, acute rheumatic fever, amyloidosis, Andersen cardiodysrhythmic periodic paralysis, Brugada syndrome, cardiac lymphoma, cardiac transplantation, cardioinhibitory syncope, complete heart block, congenital heart disease, congestive heart failure, coronary reperfusion therapy, dilated cardiomyopathy, hypertensive heart disease, hypertrophic cardiomyopathy, ischemic heart disease, Jervell and Lange-Nielsen syndrome, Lev's disease, long QT syndrome, myocardial bridging, myocardial contusion, myocardial infarction, myocardial rupture, myocarditis, NSTEMI, pericarditis, Romano-Ward syndrome, sick sinus syndrome, sinoatrial block, sinus arrest, sinus bradycardia, sinus node fibrosis, STEMI, tachycardia-bradycardia syndrome, Timothy syndrome, valvular heart disease
Chemical/Poisoning	Berberine, carbamate poisoning, grayanotoxin, organophosphorus poisoning, parathion poisoning, poisonous spider bites, pyrethroid poisoning, scorpion toxin
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetylcholine, all-trans retinoic acid, amiodarone, anthracyclines, antiarrhythmic drugs, barbiturate, beta-blockers, bupivacaine, calcium channel blockers, carbamazepine, cholinesterase inhibitors, cimetidine, citalopram, clonidine, daunorubicin, digoxin, diltiazem, diphenhydramine, donepezil, doxorubicin, edrophonium, epirubicin, granisetron, guanethidine, halothane, idarubicin, isoprenaline, lithium, mepivacaine, mesalamine, methyldopa, methylprednisolone, nelfinavir, neostigmine, nicorandil, phenothiazine, phenytoin, procainamide, propafenone, propanolol, propofol, pyridostigmine, quinidine, remifentanil, reserpine, ropivacaine, tacrine, thiamylal, timolol, tramadol, tricyclic antidepressants, urapidil, verapamil
Ear Nose Throat	No underlying causes
Endocrine	Diabetic ketoacidosis, Hashimoto's thyroiditis, hyperthyroidism, hypothyroidism, pheochromocytoma
Environmental	Hypothermia
Gastroenterologic	Amyloidosis
Genetic	Brugada syndrome, Emery-Dreifuss muscular dystrophy, Jervell and Lange-Nielsen syndrome, Kearns-Sayre syndrome, limb-girdle muscular dystrophy type 1b, long QT syndrome, muscular dystrophy, myotonic dystrophy, Romano-Ward syndrome, Timothy syndrome
Hematologic	No underlying causes
Iatrogenic	Cardiac catheterization, cardiac resynchronization therapy, cardiac transplantation, coronary artery bypass grafting, Fontan procedure, heart surgery, infraclavicular brachial plexus block, post lung transplantation
Infectious Disease	Acute rheumatic fever, Chagas disease, diptheria, Lyme disease, septic shock
Musculoskeletal/Orthopedic	Muscular dystrophy, myotonic dystrophy, Timothy syndrome
Neurologic	Severe brain injury
Nutritional/Metabolic	Diabetic ketoacidosis, hyperkalemia, hypermagnesemia, hypocalcemia, metabolic acidosis
Obstetric/Gynecologic	No underlying causes
Oncologic	Cardiac lymphoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Severe anorexia nervosa, Takotsubo cardiomyopathy
Pulmonary	Hypoxia
Renal/Electrolyte	Acute renal failure, amyloidosis
Rheumatology/Immunology/Allergy	Neonatal lupus erythematosus, scleroderma, Sjogren's syndrome
Sexual	No underlying causes
Trauma	Myocardial contusion
Urologic	No underlying causes
Miscellaneous	Idiopathic

Causes in Alphabetical Order

References

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+__NOTOC__
+{{SI}}
+{{CMG}}; {{AE}} {{VR}}
+{{SK}} Isorhythmic AV dissociation
 ==Overview==
+Isorhythmic AV dissociation is a AV dissociation initiated by slowing of SA node due to sinus arrhythmia, sinus bradycardia, sinus arrest, or sinoatrial exit block due to bradycardia.  This allows an independent ventricular pacemaker response like either junctional (giving a normal or near normal QRS appearance and duration) or idioventricular (with a more bizarre, wide QRS) rhythm to take over the ventricles.  In the presence of some degree of antegrade and retrograde atrioventricular block, there is a synchronization of independently beating sinus or atrial pacemaker with the junctional or ventricular pacemaker such that each discharges in the absolute refractory period of the other.
 ==Causes==