Although each arrhythmia is different there is a common guideline that one should use in approaching an arrhythmia. Once the heart rate has been determined, the following steps will help you to begin an analysis of the ECG.
1. Is the QRS complex rhythm regular or irregular?
2. If the QRS complex rhythm is irregular, is there any
regularity or repetition to this irregularity?
3. What is the P-wave/QRS complex relationship? Is there a
P-wave prior to each QRS complex?
4. Are the P-waves that precede the QRS complexes related
to them or are they independent?
5. If the P-waves are related to the QRS complex, is the
P-R interval fixed? Is there a progressive increase in the P-R
intervals with a decrease in the R-R intervals?
6. If the QRS complexes are without a P-wave, are the QRS
complexes ectopic or are the P-waves hidden?
7. If the QRS complexes are ectopic, where is the focus? A
narrow QRS complex is of supraventricular origin. A widened QRS
complex may be ventricular or supraventricular with aberrancy in
etiology.
8. If the P-waves are absent, is the atrial rhythm
fibrillation or flutter?
9. Are there any premature events?
10. Are there any pauses or late events?
11. Are there any unexpected events?