Atrial fib. with PVC's?

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    Hello, to all! Can someone explain why a person in A. fib with ventricular response of 120 beat/min cannot have PVC's. I had a patient last night in this situation and they had what appeared to be a 6 beat run of V-tach; however, I was told that a person in A. Fib can not have PVC's.
    Thanks in advance!
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  5. 0
    Quote from MrsSandman
    Hello, to all! Can someone explain why a person in A. fib with ventricular response of 120 beat/min cannot have PVC's. I had a patient last night in this situation and they had what appeared to be a 6 beat run of V-tach; however, I was told that a person in A. Fib can not have PVC's.
    Thanks in advance!
    That's a new one for me too...I'd like to hear more.
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    Whoever told you that didnt know what they were talking about.
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    Should've added...

    In a-fib, you'll occaisionally see runs of abberant beats that mimic pvc's/vt (wide, bizarre, different qrs-complex morphology, etc.). I think the term is Ashman's phenomena. (because this abberant conduction does not have a ventricular origin, it's a more-or-less benign finding)
    There're certain ways to distinguish this from v-tach (easier to do if 12-lead captures it). However, it's not very common and until this can be confirmed, it's best to assume they're pvc's.

    BUT, ashmans phenomena is the exception, and if you're unsure, call it v-tach.

    AND, it would be ****-poor practice to assume that all pvc's in a-fib are ashmans beats. ...

    Am i off track? I guess the point is:---- Yes, PVC's definitely can occur while a heart is in a-fib-------.
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    Gosh, this gives me good memories of working cardiac. There is an argument amongst the cardiac folks about this. Not so much can there be V-tach in the middle of A-Fib (most of the docs I worked with agreed there can be though they recognized that it could also be Ashman's phenomenon). There were those who said there cannot however be any PVC's in A-fib because by definition they are premature and there is no way of determining if a beat is premature in A-fib since it is irregular. Their argument was that there was no way of determining if the abberrant beat was a premature vent. contraction or an vent. escape beat. On the tele floors where they were sticklers about this we called such a rhythm "A-fib with V.E. (ventricular ectopy)".

    Gosh, I used to love that aspect of cardiac nursing.
  9. 0
    Quote from TiffyRN
    Gosh, this gives me good memories of working cardiac. There is an argument amongst the cardiac folks about this. Not so much can there be V-tach in the middle of A-Fib (most of the docs I worked with agreed there can be though they recognized that it could also be Ashman's phenomenon). There were those who said there cannot however be any PVC's in A-fib because by definition they are premature and there is no way of determining if a beat is premature in A-fib since it is irregular. Their argument was that there was no way of determining if the abberrant beat was a premature vent. contraction or an vent. escape beat. On the tele floors where they were sticklers about this we called such a rhythm "A-fib with V.E. (ventricular ectopy)".

    Gosh, I used to love that aspect of cardiac nursing.
    THats a good point tiffy. But dont you think It's kinda splitting hairs? Obviously, it cant be called 'premature' if the atria arent in a sinus rhythm...however, these beats have the same etiology and are as 'significant' in a-fib as they are in any other rhythm. And you stated that 'most' of the doc's you worked with agreed that v-tach can occur in a-fib...i'd be VERY afraid of the doc's who werent in agreement with these guys...hopefully they not cardiologists
    Anyway, i think 'a-fib with ventricular ectopy' is a good way of 'naming' such a rhythm...but i would also warn newer nurses not to jump to conclusions regarding ashmans. If it looks like VT...consider it just that until proven otherwise.

    Good Post Tiffy!
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    Obviously in A-Fib all the stimuli are not getting through the His pathway, (thank goodness), but if you really want to catch hell from a cardiologist, try to define anything without a 12 lead. It's either A-fib or flutter, SVT, or ventricular origin. Period, with a lot of docs, anyhow. (Just report 'it appears to be x, y or z, Sir.')
    There can be unknown abnormal pathways, BBB at a given millisecond interval which mimics VT. Antiarrythmics can of course be proarrythmic given the right circumstances, and you never know what those little action potentials are going to do. Wide QRS can be retrograde depolarization, blah,blah....you know all of this. I'm just throwing in my 2 cents worth from one who has been yelled at a time or two for being 'Dr. Nurse'.
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    Just was re-reading my prior posts and wanted to clarify what i mean by pvc's being possible with a-fib....
    PVC's happen when the ventricle/ventricles become irritated, etc. When a PVC happens, it does so irregardless of what the atria are doing. The atria could be sinus, a-fib, pat, etc... the ventricles dont care. Now, if it happens during sinus, it is called 'premature' because it happens withought 'listening' to the atria, and thus contracting out of synch.

    So, if a ventricle becomes irritated and fires while someone's atria are fibrillating, you cant (obviously) call it 'premature'...
    However, a PVC is a PVC is a PVC no matter what the rhythm of the atria, and are just as significant (or not) regardless.

    As far as talk about Ashmans, retrograde this-and-that, blah blah, etc...thats all fluff.
    PVC's can and do occur in a-fib...
  12. 0
    Quote from Dinith88
    Just was re-reading my prior posts and wanted to clarify what i mean by pvc's being possible with a-fib....
    PVC's happen when the ventricle/ventricles become irritated, etc. When a PVC happens, it does so irregardless of what the atria are doing. The atria could be sinus, a-fib, pat, etc... the ventricles dont care. Now, if it happens during sinus, it is called 'premature' because it happens withought 'listening' to the atria, and thus contracting out of synch.

    So, if a ventricle becomes irritated and fires while someone's atria are fibrillating, you cant (obviously) call it 'premature'...
    However, a PVC is a PVC is a PVC no matter what the rhythm of the atria, and are just as significant (or not) regardless.

    As far as talk about Ashmans, retrograde this-and-that, blah blah, etc...thats all fluff.
    PVC's can and do occur in a-fib...
    Is 'fluff' a term for abnormal conduction pathways and alteration of the action potential? Meaning I agree to an extent. There are only 3 basic dysrhythmias; SV, A-fib/flutter, or ventricular. Cardiac tissue does not become 'irritable', and antiarrythmics are not anti-itch creams . It is refractory period alterations and involves active and passive transport of ions. All the respect in the world to you, check out a good book on E/P testing. I suggest Foguros (sp?). He's really good, and a joy to read. And it has to be simple for me....
  13. 0
    Quote from Crumbwannabe
    Is 'fluff' a term for abnormal conduction pathways and alteration of the action potential? Meaning I agree to an extent. There are only 3 basic dysrhythmias; SV, A-fib/flutter, or ventricular. Cardiac tissue does not become 'irritable', and antiarrythmics are not anti-itch creams . It is refractory period alterations and involves active and passive transport of ions. All the respect in the world to you, check out a good book on E/P testing. I suggest Foguros (sp?). He's really good, and a joy to read. And it has to be simple for me....

    I think, from reading this thread, that the term "fluff" was used in place of the word hogwash.......When one states that the artia or the ventricles are irritable, it is to say that they are recieveing stimulus from more than one place (ie: normal electrcal pathway) in the tissue, such as in A-fib.....the atria would look very much like a bag of worms because the electrical stimulus is causing the atria to usually beat in excess of 200, hense the squiggley looking base line where a nice P wave should be, which does not effectively empty the atria and hense puts a pt at risk for clots if not treated immediately or within 48. After 48 hours and you have to treat the rhythm and rate before you can even consider cardioversion (minimizes the risk of breaking off a potential clot). I also agree that nothing should be confirmed without a 12 lead (ICU and ER experience talking now and the memory of a doc or 2 yelling...lol), yes you can have ectopic beats in A-fib/flutter. Yes, depending on how frequently the ectopy is occuring, it can be quite significant and yes, anti arrhythmics can, under certain circumstances have the exact opposite effect and creat a proble rather than correct it. When I first started nursing, I thought the ectopics looked like PVCs and then I took ACLS and talked with the cardiologists and learned that based on what is happening in the heart with A-fib/flutter, it can not be called a PVC because you do not have an actual P-QRS-T complex because of the disrhythmia. Now that I have rambled on and more or less repeated in dofferent words what everyone else basically said....I'll shut up now....LOL (I really need to get better and go back to work....LOL LOL LOL)


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