臨床心電図解析の実際 − どこをどうみるか −

Takao Katoh

doi:10.5105/jse.46.251

October 31, 2026Japanese Journal of ElectrocardiologyOpen Access

臨床心電図解析の実際 − どこをどうみるか −

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Key Points

Illustrate the electrophysiological mechanisms and diagnostic interpretation of atrioventricular dissociation using detailed ladder diagrams and electrocardiographic tracings from clinical presentations.
Evaluated continuous 12-lead electrocardiograms from three clinical cases: a 31-year-old man undergoing health screening, a 61-year-old man with palpitations, and a 70-year-old man with palpitations.
Magnified waveform leads and constructed ladder diagrams to map sinus node firing, atrial depolarization, atrioventricular junctional conduction, and ventricular activation.
Demonstrated isofrequent atrioventricular dissociation in a 31-year-old man with sinus bradyarrhythmia (PP intervals 1200–1280 msec) and a passive junctional escape rhythm at ~48 beats/min (RR intervals ~1240 msec) without an intrinsic conduction block.
Identified complete atrioventricular dissociation in a 61-year-old man caused by an accelerated idioventricular rhythm (71 beats/min, RR interval 840 msec) overriding sinus rhythm (57 beats/min, PP interval ~1060 msec) via retrograde junctional refractoriness.
Observed intermittent narrow QRS ventricular captures (R4 and R10) interrupting accelerated idioventricular rhythm (71 beats/min, RR interval 840 msec) amidst sinus rhythm (PP intervals 920 msec) in a 70-year-old man, with potential electrical reflection.

Structured PICO

P

Population

3 male patients presenting with atrioventricular (AV) dissociation on 12-lead ECG (Case 1: 31-year-old male during routine company health checkup; Case 2: 61-year-old male presenting with palpitations; Case 3: 70-year-old male presenting with palpitations)

Implication

This educational review illustrates the step-by-step electrocardiographic interpretation of atrioventricular dissociation using ladder diagrams across three clinical cases, demonstrating mechanisms such as isofrequent AV dissociation, accelerated idioventricular rhythm, ventricular capture, and potential reflection.

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Cite This Study

Takao Katoh (2026) studied this question.

synapsesocial.com/papers/6ae8679ab29eedd186728784 https://doi.org/10.5105/jse.46.251

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臨床心電図解析の実際 − どこをどうみるか −

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

臨床心電図解析の実際 − どこをどうみるか −

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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