Ashman Phenomenon Clinical Presentation

  • Author: Roger Freedman, MD; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Jan 4, 2012
 

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.
Next

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.
Previous
Next

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.

Previous
 
 
Contributor Information and Disclosures
Author

Roger Freedman, MD  Director of Clinical Cardiology, Professor, Department of Internal Medicine, Division of Cardiology, University of Utah School of Medicine

Roger Freedman, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, Heart Rhythm Society, Phi Beta Kappa, and Sigma Xi

Disclosure: St. Jude Medical Grant/research funds Other; St. Jude Medical Consulting fee Consulting; St. Jude Medical Ownership interest Other; Boston Scientific Grant/research funds Other; Boston Scientific Consulting fee Consulting; Medtronic Grant/research funds Other; Medtronic Consulting; Sorin Consulting fee Consulting

Coauthor(s)

Ram C Sharma, MD, MRCP  Assistant Professor of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville

Ram C Sharma, MD, MRCP is a member of the following medical societies: American Academy of Sleep Medicine, American College of Cardiology, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell F Kelly  MD, Assistant Professor, Department of Internal Medicine, Rush Medical College; Chairman of Adult Cardiology and Director of the Fellowship Program, Cook County Hospital

Russell F Kelly is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Brian Olshansky, MD  Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine

Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences

Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

References
  1. Gouaux JL, Ashman R. Auricular fibrillation with aberration stimulating ventricular paroxysmal tachycardia. Am Heart J. 1947;34:366.

  2. 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].

  3. 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.

  4. 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].

  5. 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].

  6. 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].

  7. Chaudry II, Ramsaran EK, Spodick DH. Observations on the reliability of the Ashman phenomenon. Am Heart J. Jul 1994;128(1):205-9. [Medline].

  8. 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].

  9. Wagner GS. Ashman phenomenon. In: Wagner GS, Marriott HJ, eds. Marriott's Practical Electrocardiography. 9th ed. Baltimore, Md: Williams & Wilkins; 1994:340.

  10. 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].

Previous
Next
 
Ashman phenomenon illustrated by 12th and 15th beats, which follow a premature ventricular complex and long R-R cycle respectively. The underlying rhythm is atrial fibrillation.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.