Epidemiology, presentation, and therapy of supraventricular tachycardias

Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm

Supraventricular tachycardias (SVT) are traditionally considered as sinus nodal tachycardias, atrial tachycardia and flutter, AVNRT and other junctional arrhythmias, and AVRT. In this chapter, classification, epidemiology, and presentation of SVT in various clinical settings are presented.

2021 ◽  
Vol 11 (3) ◽  
pp. 520-524
Author(s):  
Khalid Sawalha ◽  
Vikram Baldini Gondhalekar ◽  
Nathan Klammer ◽  
Fuad Habash ◽  
Hakan Paydak

A 63-year-old male patient with a history of hypertension, diabetes mellitus type 2, prostate cancer and class two obesity was admitted for encephalopathy. During his hospital stay he developed narrow complex tachycardia and it was difficult to definitively diagnose the underlying arrhythmia. Observation of the cool down phenomenon on telemetry strip allowed us to make the diagnosis of atrial tachycardia and elegantly rule out other causes. We report this interesting case of narrow complex tachycardia.


2003 ◽  
Vol 8 (1_suppl) ◽  
pp. S5-S11 ◽  
Author(s):  
Stanley Nattel

Atrial fibrillation is the most common cardiac arrhythmia in clinical practice, and its management remains challenging. A solid understanding of the scientific basis for atrial fibrillation therapy requires insight into the mechanisms underlying the arrhythmia, about which an enormous amount has been learned over the past 10 years. The basic information presently available about atrial fibrillation mechanisms is reviewed. The particular properties of normal atrial electrophysiology are discussed, including salient ionic determinants of the atrial action potential and key anatomic features. Reviewed are three crucial arrhythmia mechanisms long held to be involved in atrial fibrillation: 1) rapid ectopic activity, 2) single-circuit reentry with fibrillatory conduction, and 3) multiple-circuit reentry. The determinants of each and the evidence for their involvement in clinical and/or experimental atrial fibrillation are noted. The physiological consequences, various contributing mechanisms, and clinical implications of the role of atrial-tachycardia remodeling are analyzed. Atrial-tachycardia remodeling links the potential mechanisms of atrial fibrillation, since atrial fibrillation beginning by any mechanism is likely to cause tachycardia-remodeling and thus promote the maintenance of atrial fibrillation by multiple-circuit reentry. Atrial structural remodeling is discussed as a paradigm of atrial fibrillation in which the classic features required for reentry (reduced refractory period and reentrant wavelength) may be lacking. Finally, the importance of recent insights into potential genetic determinants of atrial fibrillation is reviewed. The classic understanding of atrial fibrillation pathophysiology saw the different possible mechanisms as being alternative and opposing hypotheses. We now consider the multiple potential mechanisms as contributing to the pathophysiology of the arrhythmia to a different extent in different clinical settings and interacting with each other in a dynamic way at various stages of the natural history in many patients. It is hoped that this improved mechanistic understanding will lead to the development of improved therapeutic options.


2021 ◽  
Vol 7 (2) ◽  
pp. 243-246
Author(s):  
Nick Johannes Lorenz ◽  
Laura Anna Unger ◽  
Armin Luik ◽  
Olaf Dössel

Abstract The incidence of atrial tachycardia steadily increases in industrial nations. During invasive electrophysiological studies, a catheter measures electrograms within the atrium to assist detailed diagnosis and treatment planning. With unipolar and bipolar electrograms, two different acquisition modes are clinically available. Unipolar electrograms have several advantages over bipolar electrograms. However, unipolar electrograms are more affected by noise and the ventricular far field. Therefore, only bipolar electrograms are typically used in clinical settings. A recently published ventricular far field removal technique models the ventricular far field by a set of dipoles and yielded promising results in a simulation study. However, the method lacks quantitative clinical validation. Therefore, we adapted the technique to clinical needs and applied it to data sets of two patients using four different lengths of the removal window. Results were compared quantitatively by a tailored residual error measure. The used method resulted in a median reduction of the ventricular far field by approximately 89% using a removal window of optimal length for both patients. The results showed that the dipole method provides an alternative to other VFF removal techniques in clinical practice because it can reveal AA originally hidden by VFF without leading to a prolongation of the electrophysiological study.


2005 ◽  
Vol 15 (4) ◽  
pp. 427-430 ◽  
Author(s):  
Nikolaus A. Haas ◽  
Scott Fox ◽  
Jonathan R. Skinner

After repair of an atrioventricular septal defect with common atrioventricular junction in a 2-month-old girl, rapid atrial tachycardia, in combination with junctional ectopic tachycardia, led to severe postoperative cardiovascular compromise. Intercurrent runs of ectopic atrial tachycardia made atrial pacing impossible, despite high doses of intravenous amiodarone. Following the addition of flecainide to the infusion, we were able to control the rhythm, and when combined with atrial pacing, this led to an immediate haemodynamic improvement. Treatment of refractory supraventricular tachycardias with amiodarone combined with flecainide can be very effective in the setting of postoperative cardiac intensive care.


2008 ◽  
Vol 11 (2) ◽  
pp. 56-60 ◽  
Author(s):  
Jill K. Duthie

Abstract Clinical supervisors in university based clinical settings are challenged by numerous tasks to promote the development of self-analysis and problem-solving skills of the clinical student (American Speech-Language-Hearing Association, ASHA, 1985). The Clinician Directed Hierarchy is a clinical training tool that assists the clinical teaching process by directing the student clinician’s focus to a specific level of intervention. At each of five levels of intervention, the clinician develops an understanding of the client’s speech/language target behaviors and matches clinical support accordingly. Additionally, principles and activities of generalization are highlighted for each intervention level. Preliminary findings suggest this is a useful training tool for university clinical settings. An essential goal of effective clinical supervision is the provision of support and guidance in the student clinician’s development of independent clinical skills (Larson, 2007). The student clinician is challenged with identifying client behaviors in the therapeutic process and learning to match his or her instructions, models, prompts, reinforcement, and use of stimuli appropriately according to the client’s needs. In addition, the student clinician must be aware of techniques in the intervention process that will promote generalization of new communication behaviors. Throughout the intervention process, clinicians are charged with identifying appropriate target behaviors, quantifying the progress of the client’s acquisition of the targets, and making adjustments within and between sessions as necessary. Central to the development of clinical skills is the feedback provided by the clinical supervisor (Brasseur, 1989; Moss, 2007). Particularly in the early stages of clinical skills development, the supervisor is challenged with addressing numerous aspects of clinical performance and awareness, while ensuring the client’s welfare (Moss). To address the management of clinician and client behaviors while developing an understanding of the clinical intervention process, the University of the Pacific has developed and begun to implement the Clinician Directed Hierarchy.


2006 ◽  
Vol 5 (1) ◽  
pp. 156-156
Author(s):  
M SENNI ◽  
G SANTILLI ◽  
P PARRELLA ◽  
R DEMARIA ◽  
G ALARI ◽  
...  

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