Ashman Phenomenon Clinical Presentation
- Author: Roger Freedman, MD; Chief Editor: Jeffrey N Rottman, MD more...
History
- The diagnosis of Ashman phenomenon is made using ECG evaluation findings. Patients may be asymptomatic or may have symptoms of the underlying cardiac condition.
- Ashman phenomenon, per se, causes no symptoms. Symptoms, if present, are related to the premature complexes and are not related to whether the complexes are conducted aberrantly.
Physical
- No specific physical examination findings are described for Ashman phenomenon.
- Pulse findings may include an irregular pulse, tachycardia, and/or pulse deficit in atrial fibrillation.
Causes
Conditions causing an altered duration of the refractory period of the bundle branch or the ventricular tissue cause Ashman phenomenon. These conditions are commonly observed in atrial fibrillation, atrial tachycardia, and atrial ectopy.
Gouaux JL, Ashman R. Auricular fibrillation with aberration stimulating ventricular paroxysmal tachycardia. Am Heart J. 1947;34:366.
Fisch C. Electrocardiography of arrhythmias: from deductive analysis to laboratory confirmation--twenty-five years of progress. J Am Coll Cardiol. Jan 1983;1(1):306-16. [Medline].
Marriott HJL, Sandler JA. Criteria, old and new, for differentiating between ectopic ventricular beats and aberrant ventricular conduction in the presence of atrial fibrillation. Prog Cardiovasc Dis. 1966;9:18.
Gulamhusein S, Yee R, Ko PT, Klein GJ. Electrocardiographic criteria for differentiating aberrancy and ventricular extrasystole in chronic atrial fibrillation: validation by intracardiac recordings. J Electrocardiol. Jan 1985;18(1):41-50. [Medline].
Adelstein EC, Saba S. Usefulness of baseline electrocardiographic QRS complex pattern to predict response to cardiac resynchronization. Am J Cardiol. Jan 15 2009;103(2):238-42. [Medline].
Antunes E, Brugada J, Steurer G, et al. The differential diagnosis of a regular tachycardia with a wide QRS complex on the 12-lead ECG: ventricular tachycardia, supraventricular tachycardia with aberrant intraventricular conduction, and supraventricular tachycardia with anterograde conducti. Pacing Clin Electrophysiol. Sep 1994;17(9):1515-24. [Medline].
Chaudry II, Ramsaran EK, Spodick DH. Observations on the reliability of the Ashman phenomenon. Am Heart J. Jul 1994;128(1):205-9. [Medline].
Strabuzynska-Migaj E, Szyszka A, Cieslinski A. Prolonged QRS duration in patients with heart failure: relation to exercise tolerance, diastolic function and aetiology. Kardiol Pol. Dec 2008;66(12):1251-7. [Medline].
Wagner GS. Ashman phenomenon. In: Wagner GS, Marriott HJ, eds. Marriott's Practical Electrocardiography. 9th ed. Baltimore, Md: Williams & Wilkins; 1994:340.
Wellens HJ. The QRS configuration during bundle branch block. What has rate got to do with it?. Eur Heart J. Oct 2008;29(19):2319-20. [Medline].

