Copyright © 2008 by F. A. Davis.

Chapter 3

Sinoatrial Node
Arrhythmias

Sinus rhythms all originate in the sinoatrial (SA)
node. The ECG features common to all of them are
upright P waves, all similar in appearance; normal-
duration PR intervals; and normal-duration QRS com-
plexes if no ventricular conduction disturbances are
present. Sinus rhythms described here, in addition to
normal sinus rhythm, are sinus bradycardia, sinus
tachycardia, sinus arrhythmia, sinus pause (sinus
arrest), and SA block. All ECG strips, including the
practice strips, were recorded in lead II.

NORMAL SINUS RHYTHM (NSR) ■

Rate: Normal (60–100 bpm) Rhythm: Regular

P Waves: Normal (upright and PR Interval: Normal (0.12–0.20 sec) QRS: Normal (0.06–0.10 sec)
uniform)

Clinical Tip:
A normal ECG does not exclude heart disease.

Clinical Tip:
This rhythm is generated by the sinus node and its rate is within normal limits (60–100 bpm).

20
Copyright © 2008 by F. A. Davis.

Chapter 3 Sinoatrial Node Arrhythmias 21

SINUS BRADYCARDIA ■
• The SA node discharges more slowly than in NSR.

Rate: Slow (60 bpm) Rhythm: Regular

P Waves: Normal (upright and PR Interval: Normal (0.12–0.20 sec) QRS: Normal (0.06–0.10 sec)
uniform)

Clinical Tip:
Sinus bradycardia is normal in athletes and during sleep. In acute MI, it may be protective and beneficial or the
slow rate may compromise cardiac output. Certain medications, such as beta blockers, may also cause sinus
bradycardia.

SINUS TACHYCARDIA ■
• The SA node discharges more frequently than in NSR.

Rate: Fast (100 bpm) Rhythm: Regular

P Waves: Normal (upright and PR Interval: Normal (0.12–0.20 sec) QRS: Normal (0.06–0.10 sec)
uniform)

Clinical Tip:
Sinus tachycardia may be caused by exercise, anxiety, fever, hypoxemia, hypovolemia, or cardiac failure.
Copyright © 2008 by F. A. Davis.

22 ECG Success

SINUS ARRHYTHMIA ■
• The SA node discharges irregularly.
• The R-R interval is irregular.

Rate: Usually normal (60–100 bpm); frequently Rhythm: Irregular; varies with respiration;
increases with inspiration and decreases with difference between shortest R-R and longest
expiration; may be  60 bpm R-R intervals is  0.12 sec
P Waves: Normal (upright and PR Interval: Normal (0.12–0.20 sec) QRS: Normal (0.06–0.10 sec)
uniform)

Clinical Tip:
The pacing rate of the SA node varies with respiration, especially in children and elderly people.

SINUS PAUSE (SINUS ARREST) ■

• The SA node fails to discharge and then resumes.
• Electrical activity resumes either when the SA node resets itself or when a lower latent pacemaker begins to
discharge.
• The pause (arrest) time interval is not a multiple of the normal P-P interval.

3.96–sec pause/arrest

Rate: Normal to slow; determined by duration Rhythm: Irregular whenever a pause (arrest) occurs
and frequency of sinus pause (arrest)
P Waves: Normal (upright and PR Interval: Normal (0.12–0.20 sec) QRS: Normal (0.06–0.10 sec)
uniform) except in areas of pause
(arrest)

Clinical Tip:
Cardiac output may decrease, causing syncope or dizziness.
Copyright © 2008 by F. A. Davis.

Chapter 3 Sinoatrial Node Arrhythmias 23

SINOATRIAL (SA) BLOCK ■

• The block occurs in some multiple of the P-P interval.
• After the dropped beat, cycles continue on time.

Rate: Normal to slow; determined by Rhythm: Irregular whenever an SA block occurs

duration and frequency of SA block
P Waves: Normal (upright and PR Interval: Normal (0.12–0.20 sec) QRS: Normal (0.06–0.10 sec)
uniform) except in areas of
dropped beats

Clinical Tip:
Cardiac output may decrease, causing syncope or dizziness.

ECG PRACTICE STRIPS ■

For instructions on analyzing these practice strips, please see the guidelines given at the end of Chapter 2.

ECG 3•1

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:
Copyright © 2008 by F. A. Davis.

24 ECG Success

ECG 3•2

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:

ECG 3•3

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:

ECG 3•4

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:
Copyright © 2008 by F. A. Davis.

Chapter 3 Sinoatrial Node Arrhythmias 25

ECG 3•5

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:

ECG 3•6

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:

ECG 3•7

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:
Copyright © 2008 by F. A. Davis.

26 ECG Success

ECG 3•8

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:

ECG 3•9

Rate: Rhythm:
P Waves: PR Interval: QRS:
Interpretation:

Answers to Chapter 3 ■ ECG 3•3

ECG PRACTICE STRIPS ■ Rate: 136 bpm
Rhythm: Regular
■ ECG 3•1 P Waves: Normal
Rate: 35 bpm PR Interval: 0.16 sec
Rhythm: Regular QRS: 0.10 sec
P Waves: Normal Interpretation: Sinus tachycardia
PR Interval: 0.16 sec
QRS: 0.08 sec ■ ECG 3•4
Interpretation: Sinus bradycardia Rate: 80 bpm
Rhythm: Irregular
■ ECG 3•2 P Waves: Normal
Rate: 63 bpm PR Interval: 0.16 sec
Rhythm: Regular QRS: 0.10 sec
P Waves: Normal Interpretation: Sinus rhythm with
PR Interval: 0.20 sec ST segment depression and one
QRS: 0.10 sec PVC at beat 6
Interpretation: Normal sinus rhythm with U wave