Adult Cardiac Scoring Rules

Sinus heart rate >90 bpm AND stable rhythm lasting >30 seconds

Confirm sinus morphology rather than classifying every fast rhythm as sinus tachycardia.

Recognition: consistent sinus P waves precede the QRS complexes, with a generally regular rhythm.

The adult PSG sleep-scoring threshold differs from the general clinical definition commonly using >100 bpm.

Heart rate <40 bpm AND stable rhythm lasting >30 seconds

Brief slowing around respiratory events does not automatically meet this sustained scoring definition.

A rate of 50 bpm does not meet this particular PSG threshold, but symptoms or other abnormalities may still require assessment.

Cardiac pause >3 seconds

Confirm the apparent pause is genuine. Lead disconnection, poor contact, and signal dropout can mimic a pause.

Patient assessment and signal verification occur promptly together. Do not delay assessment while troubleshooting.

≥3 consecutive beats AND rate >100 bpm AND QRS duration ≥120 ms

Wide-complex tachycardia is a descriptive finding. It is not automatically proof of ventricular origin.

Do not apply the >30-second sinus-rate requirement to this definition. A shorter run can qualify.

≥3 consecutive beats AND rate >100 bpm AND QRS duration <120 ms

A single PSG lead may not identify the exact mechanism. Do not automatically label every narrow-complex run AVNRT or another specific SVT.

Measure QRS width using the software time scale. 120 ms = 0.12 seconds.

Recognition: irregularly irregular ventricular timing without consistent discrete P waves; variable fibrillatory baseline activity may be visible.

• Exclude artifact and frequent ectopy.
• Annotate onset, offset, and rate when measurable.
• Preserve a representative strip.
• Seek confirmation if the single-lead recording is uncertain.

There is no universal minimum PSG episode duration for AFib, and the sinus tachycardia >30-second rule does not apply to AFib.

Recognition: some atrial impulses are not followed by ventricular conduction.

Different patterns exist. A 2:1 pattern cannot always be reliably classified as Mobitz I or II from the available strip.

Score/report the finding when signal quality supports identification. Preserve the strip and escalate according to facility protocol.

Recognition: atrial and ventricular activity proceed independently, without consistent AV conduction.

Treat suspected complete heart block as a significant finding requiring prompt assessment and escalation.

Recognition: pacing activity may precede atrial or ventricular depolarization, depending on the device and pacing mode.

Pacing spikes may be difficult to see on a filtered PSG channel.

Document the known device history and score the presence of pacemaker rhythm when identifiable. Do not infer device malfunction from an unclear single lead.

AASM Version 3 added recommended scoring for second-/third-degree AV block and cardiac pacemaker rhythm.

• Organized repetitive atrial activity, often with a sawtooth appearance.
• Ventricular conduction can be fixed or variable.
• Do not assume flutter always has a ventricular rate of 150 bpm.

• An early ventricular beat, typically with a broad QRS and no associated preceding sinus P wave.
• A compensatory pause may follow, but is not obligatory.
• Document clinically significant ectopy and patterns according to laboratory protocol.

• An early atrial beat, often with a differently shaped P wave.
• The conducted QRS is often narrow, but conduction can vary.

• Describe the repeating ectopic pattern.
• Bigeminy: ectopy every other beat.
• Trigeminy: ectopy every third beat.
• These pattern names do not by themselves establish severity.

• Chaotic activity without organized QRS complexes.
• Promptly assess the patient and activate the facility emergency response when indicated.
• Follow current BLS training.
• Do not infer pulse or patient stability from the screen alone.

There is no universal “PVCs per hour” threshold or single emergency rate applicable to every patient.

60 ÷ R–R interval in seconds

Example: R–R interval 0.60 seconds → 100 bpm

For irregular rhythms: measure an appropriate strip and describe variability. A short-strip estimate may not represent the full episode.

Measure from the first QRS deflection to the end of the final QRS deflection—not across the P wave or T wave.

Use the software’s calibrated time axis.

Do not assume displayed grid squares equal standard EKG-paper intervals.