isorhythmic Av disassociation

VFlutter

Flight Nurse
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Anyone ever heard of "isorhythmic Av disassociation"?

Today was the first time I have heard the term. It was a patient who I was charting as advanced / 3rd degree with junctional escape. The atrial and ventricular rate was about the same at 40 but the P-P and R-R clearly marched out as two separate rhythms however at times would start to line up and appear conducted but then would continue to disassociate and eventually fuse together and repeat the cycle. Per MD, since it was a 1:1 conduction with the same atrial and ventricular rate it was isorhythmic Av disassociation as opposed to a 3rd degree. Which kind of makes sense but I am confused how it is different than a 3rd degree in regards to the patho of it.

I have a strip but it looks like junk when I scan it so I will try to get another one.
 
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