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Understanding Supraventricular Tachycardia

This document summarizes different types of supraventricular tachycardia including their mechanisms, characteristics, and treatment options. It describes atrial flutter, atrial fibrillation, AV nodal reentrant tachycardia, AV reentrant tachycardia, and other rare types. For each type it provides details on electrocardiogram patterns, rates, presence or absence of P-waves, and whether adenosine can be used to treat them.

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Joseph Mensa
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4 views9 pages

Understanding Supraventricular Tachycardia

This document summarizes different types of supraventricular tachycardia including their mechanisms, characteristics, and treatment options. It describes atrial flutter, atrial fibrillation, AV nodal reentrant tachycardia, AV reentrant tachycardia, and other rare types. For each type it provides details on electrocardiogram patterns, rates, presence or absence of P-waves, and whether adenosine can be used to treat them.

Uploaded by

Joseph Mensa
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

SVT notes

Paris Lovett, MD July 2004

Classification
Mechanism AFlutter AFib AVNRT AVRT Sinus node re-entry Unifocal Atrial Tachy Multifocal Atrial Tachy Elderly, Pulmonary Two pathways within AVN: fast and slow Accessory pathway around AVN
Short bursts. Resembles Sinus Tach. Rate 100-150. No Sinus arrythmia. Normal p-waves

Comments Flutter 1:2 = rate 150 Irregular, No P

P-waves not same as in SR. Rate 100-250. 3+ foci (p-morphology) Irregular

Atrioventricular NODAL re-entry


90% Common Slow-Fast with antegrade conduction via slow pathway to ventricles No P-wave (buried in QRS)

AVNRT
10% Uncommon Fast-Slow with antegrade conduction via fast pathway to ventricles P-waves inverted, may be in normal location (before QRS)

ATRIOVENTRICULAR re-entry =
Accessory Pathway = WPW Concealed versus Visible in SR

Visible 75%. Ventricular pre-excitation (delta wave) during SR . None during orthodromic tachycardia

AVRT
Concealed 25%. Normal P-QRS in SR.

ATRIOVENTRICULAR re-entry
Orthodromic vs Antidromic Tachycardia
90% Orthodromic. Antegrade conduction is via AVN. Normal QRS (no delta). P-waves late and inverted

AVRT
10% Antidromic. Antegrade conduction is via accessory Wide QRS during tachy (accentuated delta; unless concealed)

Re-entry Strips: in SR
AVNRT Normal in SR

AVRT (WPW) visible : short PR and delta wave; QRS abnormal


AVRT (WPW) concealed Normal in SR

Morphologies in AVNRT + AVRT


AVNRT Common Slow-Fast AVNRT Uncommon Fast-Slow AVRT Orthodromic

AVRT Antidromic

Adenosine
Will terminate re-entry tachycardias: AVNRT, AVRT, SNRT Sometimes terminates UAT; rarely terminates MAT Will reveal AFib, Aflutter Beware: in WPW with AFib, adenosine may convert orthodromic to antidromic and thus increase HR Beware dipyridamole and heart transplant Ineffective with theophylline

References
SUPRAVENTRICULAR TACHYCARDIA. Ganz, Friedman. NEJM. 1995.

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