Ashman phenomenon

Other names| Ashman beats
Atrial fibrillation with rapid ventricular response; Ashman's phenomenon with RBBB aberrancy (13th beat)

Ashman phenomenon, also known as Ashman beats, describes a particular type of wide QRS complex, often seen isolated that is typically seen in atrial fibrillation. It is more often misinterpreted as a premature ventricular complex.

It is named for Richard Ashman (of New Orleans) (1890 –1969),[1] after first being described by Gouaux and Ashman in 1947.[2]

## Contents

* 1 Presentation
* 2 Cause
* 3 Prognosis
* 4 See also
* 5 References
* 6 Further reading

## Presentation

Ashman beats are described as wide complex QRS complexes that follow a short R-R interval preceded by a long R-R interval.[3] This short QRS complex typically has a right bundle branch block morphology and represents an aberrantly conducted complex that originates above the AV node, rather than a complex that originates in either the right or left ventricle.[citation needed]

## Cause

It occurs because the duration of the refractory period of the myocardium is proportional to the R-R interval of the preceding cycle. A short R-R interval is associated with a shorter duration of action potential and vice versa. A long R-R cycle will prolong the ensuing refractory period, and if a shorter cycle follows, the beat terminating the cycle is likely to be conducted aberrantly. Because the refractory period of the right bundle branch is longer than the left, the right bundle will still be in the refractory period when the supraventricular impulse reaches the His-Purkinje system, resulting in a complex with right bundle branch block morphology.[citation needed]

## Prognosis

Clinically, it is often asymptomatic by itself and considered benign in nature.[citation needed]

## See also

* Atrial fibrillation
* Electrocardiogram

## References

1. ↑ "The Ashman phenomenon". J la State Med Soc 156 (3): 159–62. 2004. PMID 15233390.
2. ↑ Gouaux, JL; Ashman, R (Sep 1947). "Auricular fibrillation with aberration simulating ventricular paroxysmal tachycardia.". American Heart Journal 34 (3): 366–73. doi:10.1016/0002-8703(47)90487-0. PMID 20262631.
3. ↑ "Review #1". http://www.amc.edu/Amr/archives/200301/review01.html.

## Further reading

* Kennedy, LB; Leefe, W; Leslie, BR (May–Jun 2004). "The Ashman phenomenon.". The Journal of the Louisiana State Medical Society 156 (3): 159–62. PMID 15233390.
* Chenevert, M; Lewis, RJ (Mar–Apr 1992). "Ashman's phenomenon--a source of nonsustained wide-complex tachycardia: case report and discussion.". The Journal of Emergency Medicine 10 (2): 179–83. doi:10.1016/0736-4679(92)90213-d. PMID 1376740.
* Tamburrini, LR; Fontanelli, A; Primossi, G (Feb 2001). "[Ventricular pre-excitation: electrophysiopathology, criteria for interpretation and clinical diagnosis. References for geriatrics]." (in it). Minerva Cardioangiologica 49 (1): 47–73. PMID 11279385.
* Oreto, G; Luzza, F; Satullo, G; Donato, A; Carbone, V; Calabrò, MP (Sep 2009). "[Wide QRS complex tachycardia: an old and new problem]." (in it). Giornale Italiano di Cardiologia (2006) 10 (9): 580–95. PMID 19891250.
* Harrigan, RA; Garg, M (Dec 2013). "An interesting cause of wide complex tachycardia: Ashman's phenomenon in atrial fibrillation.". The Journal of Emergency Medicine 45 (6): 835–41. doi:10.1016/j.jemermed.2013.08.018. PMID 24074525.

Classification|

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External resources|

* eMedicine: article/161028

* v
* t
* e

Cardiovascular disease (heart) (I00–I52, 390–429)

Ischaemic|

| Coronary disease|

* Coronary artery disease (CAD)
* Coronary artery aneurysm
* Spontaneous coronary artery dissection (SCAD)
* Coronary thrombosis
* Coronary vasospasm
* Myocardial bridge

|

Active ischemia|

* Angina pectoris
* Prinzmetal's angina
* Stable angina
* Acute coronary syndrome
* Myocardial infarction
* Unstable angina

Sequelae|

* hours
* Hibernating myocardium
* Myocardial stunning
* days
* Myocardial rupture
* weeks
* Aneurysm of heart / Ventricular aneurysm
* Dressler syndrome

Layers|

| Pericardium|

* Pericarditis
* Acute
* Chronic / Constrictive
* Pericardial effusion
* Cardiac tamponade
* Hemopericardium

|

Myocardium|

* Myocarditis
* Chagas disease
* Cardiomyopathy
* Dilated
* Alcoholic
* Hypertrophic
* Tachycardia-induced
* Restrictive
* Loeffler endocarditis
* Cardiac amyloidosis
* Endocardial fibroelastosis
* Arrhythmogenic right ventricular dysplasia

Endocardium /
valves|

| Endocarditis|

* infective endocarditis
* Subacute bacterial endocarditis
* non-infective endocarditis
* Libman–Sacks endocarditis
* Nonbacterial thrombotic endocarditis

|

Valves|

* mitral
* regurgitation
* prolapse
* stenosis
* aortic
* stenosis
* insufficiency
* tricuspid
* stenosis
* insufficiency
* pulmonary
* stenosis
* insufficiency

Conduction /
arrhythmia|

| Bradycardia|

* Sinus bradycardia
* Sick sinus syndrome
* Heart block: Sinoatrial
* AV
* 1°
* 2°
* 3°
* Intraventricular
* Bundle branch block
* Right
* Left
* Left anterior fascicle
* Left posterior fascicle
* Bifascicular
* Trifascicular
* Adams–Stokes syndrome

|

Tachycardia
(paroxysmal and sinus)|

| Supraventricular|

* Atrial
* Multifocal
* Junctional
* AV nodal reentrant
* Junctional ectopic

|

Ventricular|

* Accelerated idioventricular rhythm
* Catecholaminergic polymorphic
* Torsades de pointes

Premature contraction|

* Atrial
* Junctional
* Ventricular

Pre-excitation syndrome|

* Lown–Ganong–Levine
* Wolff–Parkinson–White

Flutter / fibrillation|

* Atrial flutter
* Ventricular flutter
* Atrial fibrillation
* Familial
* Ventricular fibrillation

Pacemaker|

* Ectopic pacemaker / Ectopic beat
* Multifocal atrial tachycardia
* Pacemaker syndrome
* Parasystole
* Wandering atrial pacemaker

Long QT syndrome|

* Andersen–Tawil
* Jervell and Lange-Nielsen
* Romano–Ward

Cardiac arrest|

* Sudden cardiac death
* Asystole
* Pulseless electrical activity
* Sinoatrial arrest

Other / ungrouped|

* hexaxial reference system
* Right axis deviation
* Left axis deviation
* QT
* Short QT syndrome
* T
* T wave alternans
* ST
* Osborn wave
* ST elevation
* ST depression
* Strain pattern

Cardiomegaly|

* Ventricular hypertrophy
* Left
* Right / Cor pulmonale
* Atrial enlargement
* Left
* Right
* Athletic heart syndrome

Other|

* Cardiac fibrosis
* Heart failure
* Diastolic heart failure
* Cardiac asthma
* Rheumatic fever

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