Table of ContentsView AllTable of ContentsNormal vs. ArrhythmiaTypesHow It WorksDiagnosis and SymptomsTreatmentMaintaining Heart Health
Table of ContentsView All
View All
Table of Contents
Normal vs. Arrhythmia
Types
How It Works
Diagnosis and Symptoms
Treatment
Maintaining Heart Health
This article explores sinus arrhythmia, including its cause, types, and whether treatment is warranted.
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Normal Sinus Rhythm vs. Sinus Arrhythmia
Role of ECG
The heart’s electrical activity appears as a series of wavy, spiky lines. These lines are comprised of three main parts:
Innormal sinus rhythm, the P-P interval (the time between consecutive P waves) is the same throughout the ECG. Also, the heart rate (how fast the heart is beating) is between 60 and 100 beats per minute, and the P waves are the same shape throughout.
Sinus Arrhythmia Is “Regularly Irregular"Even though the P-P intervals are slightly different in sinus arrhythmia versus normal sinus rhythm, the irregularity has a pattern associated with the natural breathing process.
Sinus Arrhythmia Is “Regularly Irregular”
Even though the P-P intervals are slightly different in sinus arrhythmia versus normal sinus rhythm, the irregularity has a pattern associated with the natural breathing process.
Types of Sinus Arrhythmia
The three types of sinus arrhythmia are:
Understanding Idioventricular Rhythm
How Sinus Arrhythmia Works
Respiratory sinus arrhythmiaoccurs when the heart rate increases with inspiration and decreases with expiration.
Thevagus nerve—a vital component of the parasympathetic nervous system—mediates this patterned change in heart rate during the breathing cycle.
What Is the Parasympathetic Nervous System?The parasympathetic nervous system is part of theautonomic nervous system, and the sympathetic nervous system is the other part.
What Is the Parasympathetic Nervous System?
The parasympathetic nervous system is part of theautonomic nervous system, and the sympathetic nervous system is the other part.
Unlike the sympathetic nervous system, which is responsible for the flight-or-fight response, the parasympathetic nervous system controls the body’s ability to relax—what’s known as the “rest and digest” response.
Interestingly, due to the vagus nerve connection, research suggests that respiratory sinus arrhythmia may be a marker of parasympathetic regulation, specifically emotional regulation and stress response.
Diagnosis and Symptoms of Sinus Arrhythmia
In most cases, sinus arrhythmia is harmless and not problematic. However, if a person is experiencing symptoms or is taking certain medications—for example, digoxin forheart failureoratrial fibrillation—further testing is necessary.
Symptoms
Respiratory sinus arrhythmiais usually an incidental finding on ECG and does not cause symptoms.
Non-respiratory sinus arrhythmiamay be associated with symptoms if heart problems or digoxin toxicity are present.
Possible symptoms of heart problems include:
Possible symptoms of digoxin toxicity include:
Nearly everyone withventriculophasic sinus arrhythmia related to complete heart blockhas symptoms. They may include:
Diagnosis
Respiratory and non-respiratory sinus arrhythmiaappears on an ECG as the following:
The critical distinction between these two types of sinus arrhythmia is that in non-respiratory sinus arrhythmia, the variation in the P-P intervals is unrelated to a person’s breathing.
Other diagnostic tests potentially used to assess for heart problems or digoxin toxicity include:
Ventriculophasic sinus arrhythmiafrom complete heart blockmeans no electrical impulses from the heart’s atria reach the ventricles. So, an ECG will reveal the following:
A complete heart block has many possible causes, so several diagnostic tests (including many of those mentioned above) are used.
Possible causes of complete heart block include:
Treating Sinus Arrhythmia With Other CVD Risk Factors
Sinus arrhythmiais a normal phenomenon when associated with the breathing cycle. No further evaluation is needed.
If the sinus arrhythmia is unrelated to the breathing cycle, an investigation into underlying causes may be performed, such as if a person has symptoms or is suspected of having a diseased heart.
Finally,ventriculophasic sinus arrhythmia from a complete heart blockrequires immediate attention in a hospital setting.
Depending on the person’s stability and whether the cause is reversible, treatment may involve intravenous (IV) medicine, temporary heart pacing, and/or the placement of a permanentpacemaker.
Heart Health to Lower Arrhythmia Complications
Adopting the following lifestyle behaviors can help optimize your heart’s functioning and prevent the development of a diseased heart or dangerousarrhythmiaslike heart block:
Summary
Respiratory sinus arrhythmia is common in children and young individuals with a healthy and well-functioning heart. It’s a normal, often incidental finding that is not associated with symptoms and does not require further evaluation.
Conversely, two other types of sinus arrhythmia—non-respiratory or ventriculophasic sinus arrhythmia—require a careful and thorough work-up and evaluation, as heart or other medical conditions may be present.
Seek medical attention if you or a loved one is experiencing potentialsymptoms of an abnormal heart rhythm, such as light-headedness or palpitations (racing, pounding, or fluttering heart).
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Other heart rhythm disorders.Cascino T, Shea M.J. (2023).Electrocardiography. InMerck Manual Consumer Version. Merck & Co., Inc.Sauer WH.Normal sinus rhythm and sinus arrhythmia. In: UpToDate, Olshansky B (Ed), Wolters Kluwer.Manne JR.Paradoxical ventriculophasic arrhythmia in a patient with 2:1 atrioventricular block: a rare phenomenon.Ann Noninvasive Electrocardiol. 2016;21(3):325-327. doi:10.1111/anec.12340Fisher JP, Zera T, Paton JFR.Respiratory-cardiovascular interactions.Handb Clin Neurol.2022;188:279-308. doi:10.1016/B978-0-323-91534-2.00006-0Tonhajzerova I, Mestanik M, Mestanikova A, Jurko A.Respiratory sinus arrhythmia as a non-invasive index of ‘brain-heart’ interaction in stress.Indian J Med Res. 2016;144(6):815-822. doi:10.4103/ijmr.IJMR_1447_14Djohan AH, Sia CH, Singh D, Lin W, Kong WK, Poh KK.A myriad of electrocardiographic findings associated with digoxin use.Singapore Med J.2020;61(1):9-14. doi:10.11622/smedj.2020005Meloy P, Rutz D, Bhambri A.3rd-degree atrioventricular block.J Educ Teach Emerg Med. 2022;7(2):O1-O28. doi:10.21980/J8NP9SKuwahara K.The natriuretic peptide system in heart failure: diagnostic and therapeutic implications.Pharmacol Ther. 2021;227:107863. doi: 10.1016/j.pharmthera.2021.107863Centers for Disease Control and Prevention.Lyme carditis. February 24, 2022.Ata F.Atrioventricular block in patients with hyperthyroidism: a narrative review.Journal of International Medical Research. 2024;52(1). doi:10.1177/03000605231223040Tisdale JE, Chung MK, American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing, et al.Drug-induced arrhythmias: a scientific statement from the American Heart Association.Circulation. 2020;142(15):e214-e233. doi:10.1161/CIR.0000000000000905Rippe JM.Lifestyle strategies for risk factor reduction, prevention, and treatment of cardiovascular disease.Am J Lifestyle Med. 2018;13(2):204-212. doi:10.1177/1559827618812395
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Other heart rhythm disorders.Cascino T, Shea M.J. (2023).Electrocardiography. InMerck Manual Consumer Version. Merck & Co., Inc.Sauer WH.Normal sinus rhythm and sinus arrhythmia. In: UpToDate, Olshansky B (Ed), Wolters Kluwer.Manne JR.Paradoxical ventriculophasic arrhythmia in a patient with 2:1 atrioventricular block: a rare phenomenon.Ann Noninvasive Electrocardiol. 2016;21(3):325-327. doi:10.1111/anec.12340Fisher JP, Zera T, Paton JFR.Respiratory-cardiovascular interactions.Handb Clin Neurol.2022;188:279-308. doi:10.1016/B978-0-323-91534-2.00006-0Tonhajzerova I, Mestanik M, Mestanikova A, Jurko A.Respiratory sinus arrhythmia as a non-invasive index of ‘brain-heart’ interaction in stress.Indian J Med Res. 2016;144(6):815-822. doi:10.4103/ijmr.IJMR_1447_14Djohan AH, Sia CH, Singh D, Lin W, Kong WK, Poh KK.A myriad of electrocardiographic findings associated with digoxin use.Singapore Med J.2020;61(1):9-14. doi:10.11622/smedj.2020005Meloy P, Rutz D, Bhambri A.3rd-degree atrioventricular block.J Educ Teach Emerg Med. 2022;7(2):O1-O28. doi:10.21980/J8NP9SKuwahara K.The natriuretic peptide system in heart failure: diagnostic and therapeutic implications.Pharmacol Ther. 2021;227:107863. doi: 10.1016/j.pharmthera.2021.107863Centers for Disease Control and Prevention.Lyme carditis. February 24, 2022.Ata F.Atrioventricular block in patients with hyperthyroidism: a narrative review.Journal of International Medical Research. 2024;52(1). doi:10.1177/03000605231223040Tisdale JE, Chung MK, American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing, et al.Drug-induced arrhythmias: a scientific statement from the American Heart Association.Circulation. 2020;142(15):e214-e233. doi:10.1161/CIR.0000000000000905Rippe JM.Lifestyle strategies for risk factor reduction, prevention, and treatment of cardiovascular disease.Am J Lifestyle Med. 2018;13(2):204-212. doi:10.1177/1559827618812395
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Heart Association.Other heart rhythm disorders.Cascino T, Shea M.J. (2023).Electrocardiography. InMerck Manual Consumer Version. Merck & Co., Inc.Sauer WH.Normal sinus rhythm and sinus arrhythmia. In: UpToDate, Olshansky B (Ed), Wolters Kluwer.Manne JR.Paradoxical ventriculophasic arrhythmia in a patient with 2:1 atrioventricular block: a rare phenomenon.Ann Noninvasive Electrocardiol. 2016;21(3):325-327. doi:10.1111/anec.12340Fisher JP, Zera T, Paton JFR.Respiratory-cardiovascular interactions.Handb Clin Neurol.2022;188:279-308. doi:10.1016/B978-0-323-91534-2.00006-0Tonhajzerova I, Mestanik M, Mestanikova A, Jurko A.Respiratory sinus arrhythmia as a non-invasive index of ‘brain-heart’ interaction in stress.Indian J Med Res. 2016;144(6):815-822. doi:10.4103/ijmr.IJMR_1447_14Djohan AH, Sia CH, Singh D, Lin W, Kong WK, Poh KK.A myriad of electrocardiographic findings associated with digoxin use.Singapore Med J.2020;61(1):9-14. doi:10.11622/smedj.2020005Meloy P, Rutz D, Bhambri A.3rd-degree atrioventricular block.J Educ Teach Emerg Med. 2022;7(2):O1-O28. doi:10.21980/J8NP9SKuwahara K.The natriuretic peptide system in heart failure: diagnostic and therapeutic implications.Pharmacol Ther. 2021;227:107863. doi: 10.1016/j.pharmthera.2021.107863Centers for Disease Control and Prevention.Lyme carditis. February 24, 2022.Ata F.Atrioventricular block in patients with hyperthyroidism: a narrative review.Journal of International Medical Research. 2024;52(1). doi:10.1177/03000605231223040Tisdale JE, Chung MK, American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing, et al.Drug-induced arrhythmias: a scientific statement from the American Heart Association.Circulation. 2020;142(15):e214-e233. doi:10.1161/CIR.0000000000000905Rippe JM.Lifestyle strategies for risk factor reduction, prevention, and treatment of cardiovascular disease.Am J Lifestyle Med. 2018;13(2):204-212. doi:10.1177/1559827618812395
American Heart Association.Other heart rhythm disorders.
Cascino T, Shea M.J. (2023).Electrocardiography. InMerck Manual Consumer Version. Merck & Co., Inc.
Sauer WH.Normal sinus rhythm and sinus arrhythmia. In: UpToDate, Olshansky B (Ed), Wolters Kluwer.
Manne JR.Paradoxical ventriculophasic arrhythmia in a patient with 2:1 atrioventricular block: a rare phenomenon.Ann Noninvasive Electrocardiol. 2016;21(3):325-327. doi:10.1111/anec.12340
Fisher JP, Zera T, Paton JFR.Respiratory-cardiovascular interactions.Handb Clin Neurol.2022;188:279-308. doi:10.1016/B978-0-323-91534-2.00006-0
Tonhajzerova I, Mestanik M, Mestanikova A, Jurko A.Respiratory sinus arrhythmia as a non-invasive index of ‘brain-heart’ interaction in stress.Indian J Med Res. 2016;144(6):815-822. doi:10.4103/ijmr.IJMR_1447_14
Djohan AH, Sia CH, Singh D, Lin W, Kong WK, Poh KK.A myriad of electrocardiographic findings associated with digoxin use.Singapore Med J.2020;61(1):9-14. doi:10.11622/smedj.2020005
Meloy P, Rutz D, Bhambri A.3rd-degree atrioventricular block.J Educ Teach Emerg Med. 2022;7(2):O1-O28. doi:10.21980/J8NP9S
Kuwahara K.The natriuretic peptide system in heart failure: diagnostic and therapeutic implications.Pharmacol Ther. 2021;227:107863. doi: 10.1016/j.pharmthera.2021.107863
Centers for Disease Control and Prevention.Lyme carditis. February 24, 2022.
Ata F.Atrioventricular block in patients with hyperthyroidism: a narrative review.Journal of International Medical Research. 2024;52(1). doi:10.1177/03000605231223040
Tisdale JE, Chung MK, American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing, et al.Drug-induced arrhythmias: a scientific statement from the American Heart Association.Circulation. 2020;142(15):e214-e233. doi:10.1161/CIR.0000000000000905
Rippe JM.Lifestyle strategies for risk factor reduction, prevention, and treatment of cardiovascular disease.Am J Lifestyle Med. 2018;13(2):204-212. doi:10.1177/1559827618812395
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