What is Ashman phenomenon?

Ashman phenomenon, first reported in 1947 by Gouaux and Ashman,1 is a physiological aberrancy of conduction of the ventricle as a result of a change in the QRS cycle length. Ashman beat is typically seen in atrial fibrillation when a relatively long cycle is followed by a relatively short cycle.

What are the symptoms of Ashman?

Patients who feel palpitations, chest pain, shortness of breath, dizziness, or syncope should be promptly evaluated. As while not a common presentation of Ashman phenomenon, this could represent a more serious problem such as atrial fibrillation or other arrhythmias.

What is LBBB aberrancy?

LBBB is defined as a prolonged QRS duration (≥ 120 ms) with broad monophasic R waves in leads I, V5 and V6 that are usually notched or slurred. There is delayed onset of the intrinsicoid deflection (the beginning of the QRS to the peak of the R wave is > 50 ms) in leads I, V5 and V6.

What is atrial fibrillation with aberrant conduction?

Aberrancy, or aberrant conduction just means that the beats do not get conducted along the traditional conduction pathway. Atrial fibrillation with a right bundle branch block or left bundle branch blocks are good examples of atrial fibrillation with aberrancy.

What causes wide complex tachycardia?

Wide complex tachycardia is a dysrhythmia with a long list of potential causes that ranges from various arrhythmias, structural heart abnormalities, electrolyte disturbances, toxins, and many more.

What is a flutter in the heart?

Atrial flutter is a type of abnormal heart rhythm, or arrhythmia. It occurs when a short circuit in the heart causes the upper chambers (atria) to pump very rapidly. Atrial flutter is important not only because of its symptoms but because it can cause a stroke that may result in permanent disability or death.

What causes intermittent LBBB?

Intermittent left bundle branch block (LBBB) has been reported in the literature following certain conditions such as cardiac blunt trauma, myocardial infarction (MI) or exercise induced LBBB. In the majority of cases, the patients usually have underlying coronary arteries disease.

Does LBBB have ap wave?

If it were LBBB, there would have to be a supraventricular rhythm conducted down the Purkinje system, but blocked at the left bundle. It would have a P-wave (if not another supraventricular origin) and it would also have a monophasic R-wave in I and aVL, which it does not.

What causes aberrant conduction?

Aberrant conduction occurs simply because the right and left bundle branches have different lengths of refractory periods. In Figure 2, the shaded area is the refractory period of the left and right bundle branches. As can be seen, one bundle branch, usually the right, has a longer refractory period than the other.

What are two examples of aberrant conduction?

1) Atrial fibrillation( AF): Figure 2; 2) Atrial tachycardia; 3) Premature Atrial Contractions. In this case aberration occurs when a short cycle follows a long one.

What drugs should be avoided with wide complex tachycardia?

It is so very critical to choose the right kind of medication once the decision is made to treat a patient with wide complex tachycardia. Calcium channel blockers (Diltiazem and verapamil) are strongly advised not to be used for fear of hemodynamic collapse, hypotension and cardiac arrest [4].

Is wide complex tachycardia the same as V tach?

Regular wide-complex tachycardia can be either ventricular tachycardia or supraventricular tachycardia. Ventricular tachycardia originates from the left ventricle, the left ventricular outflow tract, the right ventricle or the right ventricular outflow tract.

Can you have intermittent LBBB?

Intermittent left bundle branch block (LBBB) is an uncommon conduction disturbance with only few cases reported in the literature, mainly following myocardial ischemia or cardiac blunt trauma. Coronary vasospasm as a leading cause of intermittent LBBB has not been reported before.

Can a bundle branch block be transient?

It may be divided into two types: temporary bundle branch block which persists for days or months and the transient type which persists only seconds or hours. Such findings may be functional in cases of tachycardia without underlying heart disease or they may occur in cases of organic heart disease.

Does LBBB cause ST elevation?

Imitation: left bundle branch block causes secondary ST-T changes, with ST-segment elevations in V1–V2 and ST-segment depressions and T-wave inversions in V5, V6, aVL and I.

Why is there left axis deviation in LBBB?

Left axis deviation in patients with left bundle branch block is a marker of myocardial disease associated with poor response to cardiac resynchronization therapy. J Electrocardiol.

What causes PACs with aberrant conduction?

The QRSs are wider than and different from other QRSs, raising a possibility of PVC. But they are clearly preceded by a prematurely occurring P wave and so are PAC with aberrant conduction. Aberrant conduction occurs simply because the right and left bundle branches have different lengths of refractory periods.

What does aberrant conduction mean in an ECG?

Aberrant ventricular conduction is a common electrocardiographic (EKG) manifestation that occurs when the supraventricular electrical impulse is conducted abnormally through the ventricular conducting system. This results in a wide QRS complex that may be confused with a ventricular ectopic beat.

What is the Ashman phenomenon?

Ashman phenomenon or Ashman beat is a physiological aberrancy of conduction of the ventricle as a result of a change in the QRS cycle length 1).

What is the morphology of Ashman phenomenon on ECG?

Most commonly Ashman phenomenon has right bundle branch block (RBBB) morphology but it can have left bundle branch block (LBBB) morphology also. Figure 1. Ashman phenomenon ECG Footnote: ECG showed atrial fibrillation with aberrant conduction suggestive of ‘Ashman’s phenomenon’ in sixth and 14th beat (blue arrows).

What are Ashman beats?

Ashman phenomenon, also known as Ashman beats, describes a particular type of wide QRS complex, often seen isolated that is typically seen in atrial fibrillation. It is more often misinterpreted as a premature ventricular complex .

Is the Ashman phenomenon associated with a wide QRS complex?

The presence of the long-short sequence that ended in a wide QRS complex and, above all, the short-long-short sequence favors the diagnosis of Ashman phenomenon. The absence of this sequence excludes Ashman phenomenon and therefore aberrancy.