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Cardiac rhythms: the 5 families and how to tell them apart

It's easier to learn rhythms in families than as a long list. Most teaching sets group them five ways: sinus, supraventricular, conduction (the AV blocks plus the junctional escape rhythm), ventricular and paced, and arrest. Learn what each family shares, and the individual rhythms fall into place.

  • Sinus
  • Supraventricular
  • Conduction
  • Ventricular/Paced
  • Arrest
The Rhythm Lessons screen showing a 0 of 27 progress tracker, a foundation track, a 367-term glossary, and rhythm families with a lesson for each rhythm

Sinus rhythms

Normal architecture (an upright P before every QRS) with only the rate changing: normal sinus, sinus tachycardia (fast), and sinus bradycardia (slow).

Supraventricular rhythms

Rhythms from above the ventricles: atrial fibrillation (irregularly irregular, no organized P waves), atrial flutter (saw-tooth flutter waves), SVT, and related narrow-complex tachycardias. Afib vs flutter: flutter has regular saw-tooth waves and often a regular ventricular response; afib is chaotic and irregularly irregular.

Conduction rhythms

Where the signal is delayed or blocked between the atria and ventricles (the first-, second-, and third-degree AV blocks) plus the junctional escape rhythm that takes over when the normal pacemaker fails. See the heart blocks guide.

Ventricular and paced rhythms

Rhythms from the ventricles or an artificial pacemaker. A ventricular beat is wide because activation spreads cell to cell, while paced beats are flagged by a pacer spike (wide with ventricular pacing, narrow with atrial pacing). This family holds the slow idioventricular escape rhythm and the paced rhythms; the fast, dangerous ventricular tachycardias are taught with the arrest rhythms: see the dangerous rhythms guide.

Arrest rhythms

The rhythms of cardiac arrest: ventricular fibrillation, pulseless electrical activity, and asystole. A key teaching point: electrical activity on the monitor does not prove a pulse.

Learn all 27 in the app

VitalSim Rhythm teaches all 27 rhythms grouped into these five families (each with a live strip you can drive, a component breakdown, and a quiz) so the families become second nature.

FAQ

What are the main types of cardiac rhythms?

Teaching sets usually group them into five families: sinus, supraventricular, conduction (AV blocks and escape rhythms), ventricular/paced, and arrest.

What's the difference between atrial fibrillation and atrial flutter?

Flutter shows regular saw-tooth flutter waves and often a regular ventricular response; atrial fibrillation is chaotic, with no organized P waves and an irregularly irregular rhythm.

How many rhythms should I learn?

VitalSim Rhythm teaches 27, which covers the common rhythms across all five families: a solid foundation for reading a monitor.

VitalSim Rhythm