Once your students have mastered the basic rhythms and their criteria, many of them will want to try more challenging rhythms.  Non-conducted premature beats, retrograde conduction, AV blocks, and concealed conduction can be easily explained using LADDERGRAMS.  A laddergram is a diagram of a rhythm strip showing the timing and conduction of the electrical impulses.  There is a line drawn for the atrial activity, one for ventricular activity, and one for AV activity.  Blocks and retrograde conduction can be easily shown.  The rhythm strip with laddergram here is provided by one of our Experts, Jason Roediger.  It shows an ECG with PACs, some of them non-conducted, a ventricular escape beat and a PVC. (Thanks for sharing, Jason!)  To see the entire 12-Lead, check our ECG Archives.

Another of the ECG Guru's Experts, Dr. Ken Grauer, has allowed us to reprint an excellent explanation of laddergrams from his free ECG blog. He uses an ECG with AV block and explains the rhythm using a laddergram.  For a link to Dr. Grauer's ECG Consult, click here.  

  You can see the entire page on our Ask the Expert page, also.

For more laddergram practice, you might like to take a look at Dr. Bill Nelson's site, or any book written by Dr. Henry J.L. Marriott or Mary Boudreau Connover.

Just be careful:  If you are an ECG geek (or ECG Guru), laddergrams can be addicting!