Supraventricular extrasystole
Author Ольга Кияница
2019-02-03
Supraventricular extrasystoles (SES), also known as premature atrial fibrillation (PACs), atrial premature complexes (APCs) or atrial contractions (APBs), is a common cardiac arrhythmia. It is characterized by the appearance of a sensation of premature heartbeat, originating from the atrium. Although the sinusoidal node usually regulates the palpitation during normal sinus rhythm, SES occurs when the other region of the atrium is depolarized (activated) in front of the sinoatrial node and thus causes a premature heartbeat.
The exact cause of SES is unclear; while there are several predisposing conditions, in particular, SES is usually found in healthy young and elderly people.
Supraventricular extrasystoles are often absolutely asymptomatic and can only be observed during Holter monitoring.Sometimes this form of arrhythmia can be perceived as a missed hit or a thrust in the chest. In most cases, no treatment is required, except for adherence to the rules of a healthy lifestyle. In extreme cases, prescribe medications such as beta-blockers that can reduce the incidence of symptomatic SES.
Video: Premature Atrial Contraction
Normal electrical conductivity of the heart
Each time the heart is compressed, an electrical impulse is generated. With normal electrical conductivity, pulses come from the region in the upper right corner of the heart, known as a sinusoatrial node (CA-node). Then the signal spreads through the two upper chambers of the heart (atrium). After it passes into two lower chambers (the ventricles) on a special conducting path known as the atrioventricular (AV) node.
Normally, each cardiomyocyte in the heart is electrically active. In addition, all areas of the heart tissue can generate electricity, but in normal condition, the normal rhythm is sinusoidal. However, extraordinary impulses are sometimes generated, resulting in premature contraction of the atrium or ventricles.
Description of the rare supraventricular extrasystole
Supraventricular extrasystole is a type of cardiac arrhythmia with premature contractions of the atrium or beats caused by signals originating from ectopic atrial portions. Ectopic signals may or may not lead to heart ventricles.
Atrial premature complexes are characterized by premature P-teeth on ECG, which differ in configuration from the teeth P generated by the normal rhythm driver, that is, the sinus node.
Synonyms of supraventricular extrasystoles: supraventricular extrasystole, extraordinary rhythms of the atrium, premature atrial contractions, atrial extrasystole, extrasystole supraventricular, atrial extrasystole.
Supraventricular extrasystole can only be a premature contraction of the atrium or expressed as a premature pulse coming from the atrial-ventricular node (AV node). In the second case, an electrical impulse, which begins at the sinoatrial (CA) node and propagates into an atrioventricular node, is directed both to the ventricles and back to the CA node, where the signal has started.
The main risk factor
Hypertension or abnormally high blood pressure often leads to an increase in the level of psychological and physiological stress. Often, hypertension is accompanied by various atrial fibrillations, including premature atrial contractions.
Additional factors that can contribute to spontaneous premature atrial cuts include:
- Old age
- Abnormal physical development
- Family predisposition to cardiovascular diseases
- Endocrine diseases by type of diabetes mellitus and hypothyroidism
- Elevated cholesterol levels
- Infectious diseases
- Hypokalemia
- Hypomagnesaemia
There are drugs whose misuse may lead to supraventricular extrasystoles
| Preparations with side effect in the form of SES | Frequency of occurrence of SES |
| L-Dmp | rarely |
| Adenosine | |
| Atropine | |
| Bupivacaine | |
| Citalopram | rarely |
| Donepezil | not often |
| Esmolol | |
| Famotidine | |
| Fluvoxamine | rarely |
| Gabapentin | rarely |
| Ibutylid 0.9% | |
| Ivabradin | |
| Paroxetine | rarely |
| Pregabalin | rarely |
| Risperidone | rarely |
| Rivastigmine | not often |
| Sumatriptan | rarely |
| Voriconazole |
Symptoms of supraventricular extrasystoles
Most patients with SES complain about heartbeat . However, instead of reporting a constant rhythm of the heart, they usually describe a "missed" or "extraordinary" heart attack. Some patients even feel that the heart "has stopped," while others describe the feeling of "acceleration".
The feeling of wrong or extraordinary stroke in SES is due to the fact that the contraction occurs too early (prematurely).This disrupts the normal heart cycle and results in an ineffective pulse or heart rate reduction.
It is important to know that with the frequent occurrence of supraventricular extrasystoles, there may be a risk of normal heart function in general.
After the extrasystole, the heartbeat is not felt until after the pause the following regular reduction occurs. As a result, the time at which, as it were, the "die" heart is called a compensatory pause . By the way, beating after SES usually occurs with a stronger contraction than usual, and may be due to the desire to cough.
Symptoms of supraventricular extrasystoles are practically indistinguishable from the signs of ventricular extrasystole, as the processes of occurrence of abnormal rhythms are identical.
Video: Najyludochkovye extrasystoles, the mechanism of development
Normal electrical conductivity of the heart
Each time the heart is compressed, an electrical impulse is generated. With normal electrical conductivity, pulses come from the region in the upper right corner of the heart, known as a sinusoatrial node (CA-node). Then the signal spreads through the two upper chambers of the heart (atrium). After it passes into two lower chambers (the ventricles) on a special conducting path known as the atrioventricular (AV) node.
Normally, each cardiomyocyte in the heart is electrically active. In addition, all areas of the heart tissue can generate electricity, but in normal condition, the normal rhythm is sinusoidal. However, extraordinary impulses are sometimes generated, resulting in premature contraction of the atrium or ventricles.
Description of the rare supraventricular extrasystole
Supraventricular extrasystole is a type of cardiac arrhythmia with premature contractions of the atrium or beats caused by signals originating from ectopic atrial portions. Ectopic signals may or may not lead to heart ventricles.
Atrial premature complexes are characterized by premature P-teeth on ECG, which differ in configuration from the teeth P generated by the normal rhythm driver, that is, the sinus node.
Synonyms of supraventricular extrasystoles: supraventricular extrasystole, extraordinary rhythms of the atrium, premature atrial contractions, atrial extrasystole, extrasystole supraventricular, atrial extrasystole.
Supraventricular extrasystole can only be a premature contraction of the atrium or expressed as a premature pulse coming from the atrial-ventricular node (AV node). In the second case, an electrical impulse, which begins at the sinoatrial (CA) node and propagates into an atrioventricular node, is directed both to the ventricles and back to the CA node, where the signal has started.
The main risk factor
Hypertension or abnormally high blood pressure often leads to an increase in the level of psychological and physiological stress. Often, hypertension is accompanied by various atrial fibrillations, including premature atrial contractions.
Additional factors that can contribute to spontaneous premature atrial cuts include:
- Old age
- Abnormal physical development
- Family predisposition to cardiovascular diseases
- Endocrine diseases by type of diabetes mellitus and hypothyroidism
- Elevated cholesterol levels
- Infectious diseases
- Hypokalemia
- Hypomagnesaemia
There are drugs whose misuse may lead to supraventricular extrasystoles
| Preparations with side effect in the form of SES | Frequency of occurrence of SES |
| L-Dmp | rarely |
| Adenosine | |
| Atropine | |
| Bupivacaine | |
| Citalopram | rarely |
| Donepezil | not often |
| Esmolol | |
| Famotidine | |
| Fluvoxamine | rarely |
| Gabapentin | rarely |
| Ibutylid 0.9% | |
| Ivabradin | |
| Paroxetine | rarely |
| Pregabalin | rarely |
| Risperidone | rarely |
| Rivastigmine | not often |
| Sumatriptan | rarely |
| Voriconazole |
Symptoms of supraventricular extrasystoles
Most patients with SES complain about heartbeat . However, instead of reporting a constant rhythm of the heart, they usually describe a "missed" or "extraordinary" heart attack. Some patients even feel that the heart "has stopped," while others describe the feeling of "acceleration".
The feeling of wrong or extraordinary stroke in SES is due to the fact that the contraction occurs too early (prematurely).This disrupts the normal heart cycle and results in an ineffective pulse or heart rate reduction.
It is important to know that with the frequent occurrence of supraventricular extrasystoles, there may be a risk of normal heart function in general.
After the extrasystole, the heartbeat is not felt until after the pause the following regular reduction occurs. As a result, the time at which, as it were, the "die" heart is called a compensatory pause . By the way, beating after SES usually occurs with a stronger contraction than usual, and may be due to the desire to cough.
Symptoms of supraventricular extrasystoles are practically indistinguishable from the signs of ventricular extrasystole, as the processes of occurrence of abnormal rhythms are identical.
Video: Premature atrial contractions causes, symptoms, diagnosis, treatment, pathology
Supraventricular extrasystole in children
When premature contractions of the atrium occur frequently, the question arises whether they are a normal option or not.Sometimes, frequent SES can be a marker of any heart disease. For example, SES can occur if the heart muscle is inflamed or irritated. They can also occur with any problem with the electrical conductivity system. In this case, the pathology can progress by causing supraventricular tachycardia (CVT) or atrial tachycardia.
The work of a children's cardiologist is to determine whether a child with frequent SES has any illness that causes them, or they are still normal, but they simply occur more often than most other children.
As a rule, the assessment of a child or infant with frequent SES is conducted using the following research methods:
- Electrocardiography (ECG)
- Echocardiography to assess the appearance and function of the heart muscle
- 24-hour heart rate recording (Holter monitoring).
Holter Monitor allows a physician to evaluate the frequency and nature of SES over a long period of time. Assuming that the research does not show any deviations, apart from isolated (single) SES, it can usually be assumed that arrhythmias are benign and reductions are more frequent than those observed in most children.
The prognosis for a baby, child or adolescent with benign premature atrial cuts tends to be favorable. No special medical treatment is required; no special restrictions or precautions are taken. It often happens that the frequency of SES spontaneously decreases with time, which leads to the resolution of the pathological process. As a result, the extrasystole passes completely.
Thus, premature contractions of the atrium in the form of supraventricular extrasystole in children occur quite often.Fortunately, it usually happens benignly.
Supraventricular Extrasystole: Treatment
SES usually do not need special treatment. If necessary, they can give a medication from a group of antiarrhythmic drugs to intensify or regulate the heartbeat.
Methods of preventing an increase in supraventricular extrasystole:
- Do not drink alcohol or caffeine . This can increase extraordinary cuts.
- Do not smoke Nicotine and other chemicals in cigarettes and other tobacco products can exacerbate heart problems. If necessary, you can ask the attending physician to provide information if there is currently a bad habit of smoking and need help. It's important to know that electronic cigarettes or smokeless tobacco still contain nicotine. So talk to your doctor before using these products.
- Exercises according to instructions . Physical activity helps to keep the heart healthy. You should ask your doctor about the best training options.
To seek emergency assistance is necessary if the following signs occur:
- There is a compressing, pressing or painful chest pain
- Concerned for discomfort or pain in the back, neck, jaw, abdomen or arm
- There is a sassy breath
- Nausea or vomiting is expressed
- Dizziness or sudden cold sweat is determined
It is important to know that you should contact your doctor immediately if the symptoms of supraventricular extrasystoles do not pass or they get worse. There may also be questions or doubts about the condition / care, and in such cases, medical advice should help.
Supraventricular extrasystole: ECG
At the electrocardiogram (ECG), premature atrial complexes (cited below) are identified by three distinct features:
- Premature P-wave of unusual shape (denoted by P ')
- The QRS complex resembles a normal sinus rhythm
- The next heart cycle is a compensatory pause, longer duration than normal
SES originates from an ectopic focal point, located outside the CA-node. Consequently, the wrong waveform P is determined, the irregular duration of the PP interval and the increased duration of the PR interval is greater than 0.12 second.
It is important to remember that if the SES is determined at the very beginning of the heart cycle, ventricular activation may not occur or recurring atrial tachycardia may develop.
The results of some studies indicate that a small 1% probability of development of atrial fibrillation in the following year was determined by frequent atrial extraordinary strokes (more than 100 in 24 hours) [1 - Suzuki S, Sagara K, Otsuka T, Kano H , Matsuno S, Takai H, Uejima T, Oikawa Y, Koike A, Nagashima K, Kirigaya H, Yajima J, Tanabe H, Sawada H, Aizawa T, and Yamashita T. Usefulness of frequent supraventricular extrasystoles and a high CHADS2 score to predict first-time appearance of atrial fibrillation. Am J Cardiol. 2013 Jun 1; 111 (11): 1602-7].
Video: ECG's abnormal rhythms: Extrasystoles
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Among all arrhythmias, extrasystoles are the most common. Other known names of pathology are ectopic strokes, premature strokes, premature atrium or ventricular complexes. Their occurrence is associated with premature contraction of the heart. Most often they do not pose a health hazard, but in some cases, the course of the underlying disease worsens.