Irritation disorders

As early as 1845, J.E. Purkinje described the Purkinje fibres named after him and in 1893 W. His jr. described the so-called His bundle. In 1906 L. Aschoff and S. Tawara described the AV knot for the first time. One year later, the sinus node was discovered by A. Keith and M. W. Flack as the primary center of stimulation. The Wenckebach bundle was described in 1906 / 1907 by K. F. Wenckebach and the Mahaim fibers by I. Mahaim in 1932 (Lewalter 2010).

Together with conduction disorder and tachycardia, stimulation disorder (RBS) belongs to the group of cardiac arrhythmias (Herold 2020). In RBS there is a disturbance of the electrical impulses (Müller 2019).

RBS are divided into normotopic and heterotopic disorders depending on the origin of the disorder.

• Normotopic RBS: Normotopic RBS always originate from the sinus node (Herold 2020). They include, for example:
  • Sinus arrhythmia
  • Sinus bradycardia (< 60 beats / min.)
  • sinus tachycardia (> 100 beats / min.) (Herold 2020)
• Heterotopic RBS: Heterotopic RBS are those that do not originate from the sinus node. Depending on their origin, a differentiation is made between:
  • supraventricular RBS (these originate from secondary excitation formation center, the atrium or AV node)
  • ventricular RBS (ventricular RBS originate from the tertiary excitation generation center, the ventricle) (Herold 2020).

A further differentiation of heterotopic RBS consists of:

• passive heterotopia: When activity in the sinus node fails or slows down, or when conduction is blocked, there is a substitutional step-in of the secondary or tertiary excitation formation center. These manifest themselves in
  • Replacement systoles
  • replacementrhythms (secondary automaticity of the atrium or AV node or tertiary automaticity by the ventricle)
  • wandering pacemaker (Herold 2020)
• active heterotopy: In this case there are
  • extrasystoles
  • extrarhythms (a heterotopic rhythm is faster than sinus rhythm) such as accelerated junctional rhythm, accelerated idioventricular rhythm
• RBS originating from the sinus node, atrium, or AV node, respectively, are termed supraventricular. These include:
  • Sinus bradycardia (< 60 beats / min.)
  • Sinus tachycardia (> 100 beats / min.)
  • Sinus arrhythmia
  • supraventricular extrasystoles
• RBS originating from the His- bundle, Tawara- limbs and ventricles are termed ventricular. These include:
  • ventricular extrasystoles

The cause of cardiac arrhythmia can be:

• coronary heart disease
• Myocardial infarction
• Cardiomyopathy
• arterial hypertension
• Hypoxia
• and others (Buchta 2004)

First and foremost is the treatment of the underlying disease (see d.). Antiarrhythmic drugs such as beta blockers, calcium channel blockers etc. can be used medicinally (Buchta 2004).

1. Buchta M et al (2004) The second StEx: Basic knowledge of clinical medicine for exams and practice. Springer publishing house 7
2. Herold G et al (2020) Internal medicine. Herold Publishing House 273 - 277
3. Lewalter B et al (2010) Cardiac arrhythmias: Diagnosis and therapy. Springer Medicine Publishing House 2 - 5
4. Müller L (2019) Comparison: Short-term ECGs (Smartphone 3 min/short time 30 sec/holter 5 min) versus long-term ECG (Holter 24 h) in dogs with atrial fibrillation. Inaugural dissertation of the Faculty of Veterinary Medicine of the Ludwig-Maximilians-University Munich