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Ventricular Premature Complexes

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Question: EKG: can you have an atrial fibrillation with a premature ventricular complex (pvc)? can you have an atrial fibrillation with a premature ventricular complex (pvc)?

Answer: How certain are you that it was a PVC? Yes it can occurr but frequently in atrial fibrillation it could be aberrant ventricular conduction.Aberrant ventricular conduction occurs when a supraventricular impulse reaches the His-Purkinje system when one of the bundle branches (BB) is in the absolute refractory period resulting in slow or blocked conduction through the BB and delayed repolarization through the ventricular muscles causing a BBB (wide Qrs) on the surface ecg in the absence of bundle branch block (BBB) pathology. A right BBB pattern is more common than left BBB. If there is a change in QRS cycle length it is called Ashmans phenonemen. There is a long cycle followed by a short cycle and the beat with the short cycle has a RBBB morphology which causes alot of diagnostic confusion. There is a sudden lengthening of the QRS cycle the subsequent impulse with a shorter cycle or even normal cycle length may be conducted aberrantly . In short aberrant venricular is an abnormal conduction of a supraventricular impulse resulting in a wide QRS complex that can be missed diagnosed as a PVC, but PVC's can occur in atrial fibrillation, you just need to know how to interpret the ecg correctly, clear as mud??? take care, Donna

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