This page provides an introduction to ventricular rhythms and links to our EKG interpretation courses and drills.
When the ventricles handle the pacemaking role, they can be observed on EKG tracings. This website and related websites provide training, practice drills and quizzes related to ventricular rhythms.
There are several type of ventricular rhythms:
Accelerated idioventricular rhythm occurs when three or more ventricular escape beats appear in a sequence. Heart rate will be 50-100 bpm. The QRS complex will be wide (0.12 sec. or more).
Asystole is the state of no cardiac electrical activity and no cardiac output. Immediate action is required.
Idioventricular rhythm is a slow rhythm of under 50 bpm. It indicates that then ventricles are producing escape beats.
Premature ventricular complexes (PVCs) occur when a ventricular site generates an impulse. This happens before the next regular sinus beat. Look for a wide QRS complex, equal or greater than 0.12 sec. The QRS complex shape can be bizarre. The P wave will be absent.
Ventricular fibrillation originates in the ventricles, and it is chaotic. No normal EKG waves are present. No heart rate can be observed. Ventricular fibrillation is an emergency condition requiring immediate action.
A sequence of three PVCs in a row is ventricular tachycardia. The rate will be 120-200 bpm. Ventricular Tachycardia has two variations, monomorphic and polymorphic. These variations are discussed separately.
Monomorphic ventricular tachycardia occurs when the electrical impulse originates in one of the ventricles. The QRS complex is wide. Rate is above 100 bpm.
Polymorphic ventricular tachycardia has QRS complexes that vary in shape and size. If a polymorphic ventricular tachycardia has a long QT Interval, it could be Torsade de Pointes.
Torsade de Pointes is a special form of ventricular tachycardia. The QRS complexes vary in shape and amplitude and appear to wind around the baseline.
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Rhythm analysis using a 5 step method will be practiced in this section. Analyze tracings in the following order.
Rhythm | Rate |
Asystole | 0 |
Agonal | less than 20 bpm |
Idioventricular | 20-40 bpm |
Accelerated Idioventricular | 40-100 bpm |
*Ventricular Tachycardia | > 100 bpm |
*Ventricular Fibrillation | Electrical Chaos |
Regardless of rhythm category, morphology of waveforms and pattern of occurrence are important aspects to include in an accurate interpretation.
Unifocal – abnormal complexes are of the same shape
Multifocal – abnormal complexes are of two or more different shapes. This indicates the impulse causing the PVC’s are coming from different locations.
Bigeminy – abnormal complexes occur every second complex
Trigeminy– abnormal complexes occur every third complex
Regardless of rhythm category, morphology of waveforms and pattern of occurrence are important aspects to include in an accurate interpretation.
Quadrigeminy– abnormal complexes occur every fourth complex
Couplet – Two PVC’s together
Run of Ventricular Tachycardia
(V Tach) – Three or more PVC’s in a row at a rate of 100 bpm or greater. Also known as Triplet PVC’s or Salvo PVC’s
Analyze this tracing using the five steps of rhythm analysis.
Analyze this tracing using the five steps of rhythm analysis.
Analyze this tracing using the five steps of rhythm analysis.
Analyze this tracing using the five steps of rhythm analysis.
Analyze this tracing using the five steps of rhythm analysis.
Analyze this vfib rhythm strip using the five steps of rhythm analysis.
Analyze this tracing using the five steps of rhythm analysis.
Analyze this tracing using the five steps of rhythm analysis.
When analyzing a rhythm strip, it qualifies as being regular when
Which of the following steps is not one of the five-steps of rhythm analysis?
Which of the following is considered normal range of the QRS complex?
Which of the following is considered normal range of the PR interval?
A good starting point is our ventricular rhythms module, which focuses on the morphologic features and qualifying criteria of ventricular rhythms. The module includes interactive Q&A.
Hundreds heart rhythms in this practice test. Test can be tailored for specific learning needs.
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