A Review of Atrial Dissociation, With Illustrative Cases and Critical Discussion

Atrial dissociation in a boxer with a carcinoma of the middle ear

“…zusätzlich eine AD auftritt, ist dies als schlechter prognostischer Faktor zu werten. 4,6 Falls die AD aber nur transient auftritt, keine bedeutende Herzerkrankung vorliegt und keine Therapie nötig ist, gilt die Prognose als gut. 11,12 Schliesslich wird ein benigne AD auch bei pädiatrischen Patienten beobachtet und benötigt in diesen Fällen keine Therapie.…”

Benign nature of atrial dissociation in pediatric patients

“…Since then, sporadic cases have been documented electrocardiographically, mostly in older adult patients [2], in which atrial dissociation has serious implications . Atrial dissociation has been seen most commonly with myocardial infarction, hypertensive heart disease, rheumatic heart disease, uremia, and digitalis intoxication [1] .…”

“…The entrance block allows the ectopic focus to fire regularly, undisturbed by the basic sinus rhythm, whereas the exit block prohibits the ectopic impulses from conduction to the ventricles [2] . If dissociation between the atria occurs, each atrium could be separately autonomous, or a part of 1 atrium is totally independent from the rest of the atrial muscle mass but excites a large enough volume of atrial myocardium to generate a P wave on the electrocardiogram but not conduct to the ventricles .…”

Respiratory artifact: A second vital sign on the electrocardiogram

“…3 Pseudo-P waves, as in this 57-year-old patient, are less often observed; but if their origin is Recognizing rapid respiratory artifact can raise awareness of possible severe respiratory distress RESPIRATORY ARTIFACT not recognized, the interpretation of the ECG can become puzzling. [1][2][3]7,8 Respiratory artifact is a marker of increased work of breathing and a strong indicator of significant cardiopulmonary compromise. Improvement in the patient's cardiac or respiratory condition is typically associated with a decrease in the rate or complete elimination of respiratory artifact.…”

“…6 Most other cases of apparent atrial dissociation described in the old cardiology and critical care literature probably represented unrecognized respiratory artifact. 7,8 An ECG from a different patient ( Figure 2) demonstrates rapid respiratory artifact that raised awareness of severe respiratory failure. The respiratory rate calculated from spacing of the pseudo-P waves is 62/min, confirmed by simultaneous respirography.…”