Ashman Phenomenon Clinical Presentation

Updated: Nov 21, 2014
  • Author: Roger Freedman, MD; Chief Editor: Jeffrey N Rottman, MD  more...
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Presentation

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.

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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.

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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.

A study by Sardar et al indicated that dofetilide, a delayed rectifier potassium current (IKr) blocker used to treat atrial fibrillation, can promote the development of Ashman phenomenon, possibly through a reverse use-dependence effect associated with prolongation of the ventricular refractory period. The study involved 10 patients with atrial fibrillation who underwent dofetilide loading, receiving 250-500 micrograms of the drug every 12 hours. The investigators found that the total number of Ashman beats rose from 42±24 prior to the administration dofetilide to 93±79 after the first dose of the drug and 133±101 after the second dose. [2]

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