Approach to diagnosis of an irregularly irregular supraventricular rhythm*

This graphic describes an approach to distinguishing atrial fibrillation (identified with a thick border) from other causes of an irregularly irregular supraventricular rhythm. While atrial fibrillation is the rhythm most commonly described as irregularly irregular, mimics of atrial fibrillation should be excluded when an irregularly irregular rhythm is identified. Of note, atrial fibrillation uncommonly occurs with a regular ventricular rhythm, as described in UpToDate content on the electrocardiogram in atrial fibrillation.

ECG: electrocardiogram; AV: atrioventricular; PVCs: premature ventricular complexes; PACs: premature atrial complexes.
* Refer to UpToDate content on distinguishing supraventricular from ventricular rhythms.
¶ If no atrial activity is detected or the morphology of atrial activity is unclear, use ECG amplification (digital magnification or increase in gain for the entire ECG signal).
Δ The ventricular rhythm associated with Mobitz I or II second-degree AV block is not irregularly irregular since there is a pattern to the variation in ventricular rate, but this pattern may not be immediately recognized.

Graphic 132103 Version 1.0

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Approach to diagnosis of an irregularly irregular supraventricular rhythm*