Supraventricular Tachycardia

Minimal Risk ◽

Reentrant Tachycardia ◽

Av Node ◽

Inappropriate Sinus Tachycardia ◽

Adults And Children ◽

Antiarrhythmic Medications

Supraventricular tachycardias (SVTs) comprise a group of arrhythmias for which the atria and/or atrioventricular (AV) node are integral to sustaining the rhythm. These arrhythmias typically have a benign natural history but account for a considerable proportion of patients presenting with symptoms including palpitations, shortness of breath, chest discomfort, dizziness, and, on occasion, syncope. They affect a broad range of patients, from young, otherwise healthy adults and children to elderly patients with multiple comorbidities. Although medical management with AV nodal blocking medications or antiarrhythmic medications is a reasonable first-line approach, catheter ablation is a definitive, most often curable option that has minimal risk and offers the chance of avoiding long-term medications. This chapter covers the epidemiology, diagnosis, and management of SVTs, which include atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial tachycardia (AT), and others (atrial flutter, inappropriate sinus tachycardia, and junctional tachycardia). Atrial fibrillation, which is more prevalent than all other SVTs combined, are discussed elsewhere. Figures describe the differential diagnosis of tachycardia with narrow and wide QRS complexes, the relationship between the response to intravenous adenosine and the cause of tachycardia, the mechanism of tachycardia induction in patients with dual AV node conduction pathways, and the management of atrial flutter. Electrocardiograms illustrate features of various forms of SVT. This review contains 11 highly rendered figures (included 6 twelve-lead ECGs), 1 table, and 69 references.

Supraventricular Tachycardia

10.2310/im.1013 ◽

2020 ◽

Author(s):

Laurence M. Epstein ◽

Saurabh Kumar

Keyword(s):

Atrial Flutter ◽

Supraventricular Tachycardia ◽

Cardiac Tissue ◽

Accessory Pathway ◽

Maze Procedure ◽

Reentrant Tachycardia ◽

Inappropriate Sinus Tachycardia ◽

Supraventricular Tachycardias

Supraventricular tachycardias (SVTs) comprise a group of usually benign arrhythmias that originate from cardiac tissue at or above the His bundle. SVTs include inappropriate sinus tachycardia, atrial tachycardias (ATs), atrial flutter (AFL), junctional tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), and forms of accessory pathway–mediated reentrant tachycardias (atrioventricular reentrant tachycardia [AVRT]). Although mostly benign, symptoms can be debilitating, in the form of palpitations, shortness of breath, chest discomfort, dizziness, and/or syncope; rarely, SVTs can result in cardiomyopathy due to incessant arrhythmia. This review covers the epidemiology, diagnosis, management, and classification of SVTs. This review contains 14 figures, 17 tables, and 61 references. Keywords: Supraventricular tachycardia, cardioversion, arrhythmia, atrial flutter, atrial fibrillation, Wolff-Parkinson-White syndrome, MAZE procedure, catheter ablation

A novel diagnostic algorithm for the identification of different supraventircular tachycardias

European Heart Journal ◽

10.1093/ehjci/ehaa946.0371 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Solis Cancino ◽

A.D Pacheco Bouthillier ◽

L.A Moreno Ruiz

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Sensitivity And Specificity ◽

Diagnostic Algorithm ◽

Atrioventricular Reentrant Tachycardia

Supraventricular Arrhythmias ◽

Reentrant Tachycardia ◽

Clinical Tool ◽

Diagnostic Challenge ◽

Abstract Background Supraventricular arrhythmias represent a diagnostic challenge. Its prevalence and causes are not well established, given the impossibility to differentiate between all different types of supraventricular tachycardias (SVT). There are several supraventricular arrhythmias, but we focus on: 1) Atrial tachycardia (AT) 2) Junctional tachycardia (JT) 3) Atrial fibrillation (AF) 4) Atrial flutter (AA) 5) Atrioventricular nodal reentrant tachycardia (AVNRT), and 6) Atrioventricular reentrant tachycardia (AVRT). The electrocardiographic diagnosis is based on the presence of P-waves, its morphology and relationship with the QRS complex, and the relationship between the atrial and ventricular frequency. Purpose The purpose of this study was to create a helpful clinical tool that could serve the physician as a guide to determine a diagnosis and initial treatment. Additionally, we wanted to establish the sensitivity and specificity of the algorithm. Methods It is a diagnostic test study. We include 190 electrocardiograms of different SVT of patients undergoing electrophysiological studies. The data consists of 760 observations from two different readings of the electrocardiograms. Results 104 of 112 AF, were correctly identified using the algorithm, with a sensitivity and specificity of 92.9% and 99.1%, respectively (95% CI: 0.86–0.96). 76 of 760 were AA, and 62 were correctly diagnosed, with a sensitivity and specificity of 81.6% and 95.5%, respectively (95% CI 0.71–0.88). 50 of the 72 AT were correctly classified, with a sensitivity of 69.4% and specificity of 97.4% (95% CI 0.58–0.78). 99 of 152 AVNRT were identified with a sensitivity and specificity of 64.5% and 87%, respectively (95% CI 0.84–0.89). 254 of 344 AVRT were diagnosed correctly with a sensitivity of 73.8% and specificity of 88.2% (95% CI 0.68–0.78). Finally, 1 of 4 JT were identified, with a sensitivity and specificity of 25% and 99.1% respectively (95% CI 0.04–0.69). Conclusion The algorithm is an excellent diagnostic tool to identify atrial flutter, atrial fibrillation and atrioventricular reentrant tachycardia. SVT algorithm Funding Acknowledgement Type of funding source: None

589 Differentiating atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia via concealed accessory pathway

EP Europace ◽

10.1016/s1099-5129(05)80390-3 ◽

2005 ◽

Vol 7 ◽

pp. 132-132

Keyword(s):

Accessory Pathway ◽

Reentrant Tachycardia ◽

Concealed Accessory Pathway

Introduction

ESC CardioMed ◽

10.1093/med/9780198784906.003.0475 ◽

2018 ◽

pp. 2049-2050

Author(s):

Carina Blomström-Lundqvist

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Tachycardia ◽

Atrioventricular Node ◽

Supraventricular Arrhythmia ◽

Reentrant Tachycardia ◽

Dc Cardioversion ◽

Premature Beats

Supraventricular arrhythmias encompass atrial premature beats, supraventricular tachycardias (SVTs), and atrial fibrillation. SVT is used to describe tachycardias in which the mechanism involves tissue from the His bundle or above, thus including atrial tachycardias, atrioventricular nodal reentrant tachycardia, and atrioventricular reentrant tachycardia due to accessory pathways. Atrial fibrillation is not included among the SVTs and is described elsewhere. The term tachycardia refers to atrial and/or ventricular rates greater than 100 beats per minute at rest. Atrial premature beats, the most common supraventricular arrhythmia, can be seen in Holter recordings in the majority of healthy individuals, and increase in frequency with age and presence of structural heart disease. Paroxysmal SVTs that can be terminated by vagal manoeuvres are usually reentrant tachycardias involving the atrioventricular node, such as atrioventricular nodal reentrant tachycardia or atrioventricular reentrant tachycardia. Symptoms may result in a poor quality of life. Rarely, patients with the Wolff–Parkinson–White syndrome develop atrial fibrillation that may degenerate into ventricular fibrillation in case the anterograde refractory period of the accessory pathway is very short and permanent forms of SVTs result in tachycardiomyopathy with left ventricular dysfunction. Paroxysmal SVT can be terminated by vagal manoeuvres, adenosine, overdrive pacing, and DC cardioversion. Atrial flutter, the most common atrial tachycardia, is a macro-reentrant atrial tachycardia that can be terminated by drugs, overdrive atrial pacing, and DC cardioversion. Most SVTs can be successfully treated by catheter ablation facilitated by modern electroanatomical mapping systems. Long-term antiarrhythmic drug therapy may be required for patients who are not suitable for or cured by catheter ablation.

Electrophysiological Studies in Patients with Pulmonary Hypertension: A Retrospective Investigation

BioMed Research International ◽

10.1155/2014/617565 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Dirk Bandorski ◽

Jörn Schmitt ◽

Claudia Kurzlechner ◽

Damir Erkapic ◽

Christian W. Hamm ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Flutter ◽

Electrophysiological Study ◽

Reentrant Tachycardia ◽

Group 4 ◽

Electrophysiological Studies ◽

Group 5 ◽

Group 2 ◽

Ventricular Tachycardias

Few studies have investigated patients with pulmonary hypertension and arrhythmias. Data on electrophysiological studies in these patients are rare. In a retrospective dual-centre design, we analysed data from patients with indications for electrophysiological study. Fifty-five patients with pulmonary hypertension were included (Dana Point Classification: group 1: 14, group 2: 23, group 3: 4, group 4: 8, group 5: 2, and 4 patients with exercised-induced pulmonary hypertension). Clinical data, 6-minute walk distance, laboratory values, and echocardiography were collected/performed. Nonsustained ventricular tachycardia was the most frequent indication (n=15) for an electrophysiological study, followed by atrial flutter (n=14). In summary 36 ablations were performed and 25 of them were successful (atrial flutter 12 of 14 and atrioventricular nodal reentrant tachycardia 4 of 4). Fluoroscopy time was 16±14.4 minutes. Electrophysiological studies in patients with pulmonary hypertension are feasible and safe. Ablation procedures are as effective in these patients as in non-PAH patients with atrial flutter and atrioventricular nodal reentrant tachycardia and should be performed likewise. The prognostic relevance of ventricular stimulations and inducible ventricular tachycardias in these patients is still unclear and requires further investigation.

High-Detailed evaluation of the right atrial anatomy by three-dimensional rotational angiography during ablation procedures for atrioventricular nodal reentrant tachycardia and atrial flutter

Scandinavian Cardiovascular Journal ◽

10.1080/14017431.2018.1546893 ◽

2018 ◽

Vol 52 (5) ◽

pp. 268-274 ◽

Cited By ~ 1

Author(s):

Christophe Garweg ◽

Stijn De Buck ◽

Bert Vandenberk ◽

Rik Willems ◽

Joris Ector

Keyword(s):

Atrial Flutter ◽

Three Dimensional ◽

Right Atrial ◽

Rotational Angiography ◽

Reentrant Tachycardia ◽

Detailed Evaluation ◽

The Right

Inducibility of Atrial Flutter in Patients With Atrioventricular Nodal Reentrant Tachycardia

Circulation Journal ◽

10.1253/circj.70.1133 ◽

2006 ◽

Vol 70 (9) ◽

pp. 1133-1137 ◽

Cited By ~ 4

Author(s):

Yasuhiro Takagi ◽

Ichiro Watanabe ◽

Yasuo Okumura ◽

Kimie Okubo ◽

Sonoko Ashino ◽

...

Keyword(s):

Atrial Flutter ◽

Reentrant Tachycardia

The combined use of amiodarone and class 1-C antiarrhythmic agents in children with intractable supraventricular tachyarrhythmias

Cardiology in the Young ◽

10.1017/s1047951100011495 ◽

1995 ◽

Vol 5 (1) ◽

pp. 70-74 ◽

Cited By ~ 3

Author(s):

Seshadri Balaji ◽

Christopher L. Case ◽

Paul C. Gillette

Keyword(s):

Atrial Flutter ◽

Supraventricular Tachycardia ◽

Combined Therapy ◽

Antiarrhythmic Agents ◽

Reentrant Tachycardia ◽

Fontan Patient ◽

Combined Use ◽

Class 1 ◽

Atrial Ectopic Tachycardia

AbstractCombined antiarrhythmic drug therapy is an occasionally necessary but problematic approach to the child with recalcitrant supraventricular tachycardia. There is little experience with the combined use of amiodarone and class 1-C agents (flecainide, propafenone and encainide) in children. To judge the efficacy and safety of this combination, we reviewed the case notes and results of investigation in all nine children with supraventricular tachycardia who received such therapy between 1984 and 1993. These nine children received combined therapy on 12 occasions. Five were infants with either atrioventricular reentrant tachycardia (n=3) or atrial ectopic tachycardia (n=2), and four were older children with atrial flutter seen after a Fontan procedure. Amiodarone was combined with flecainide on eight occasions, with propafenone on three occasions, and with encainide on one occasion. Both infants with atrial ectopic tachycardia were successfully controlled, but only one of three infants with atrioventricular reentrant tachycardia had successful control on combination therapy. In three of the four patients with atrial flutter, the combination was useful in reducing the number of arrhythmic episodes. Three infants suffered side effects. At electrophysiologic study to judge efficacy, ventricular tachycardia was induced in two patients (one infant and one Fontan patient), necessitating a change in the 1-C agent. One patient had skin rash due to flecainide and was placed on propafenone with success. One Fontan patient died of complications after an elective surgical procedure. No deaths occurred attributable to proarrhythmia. Thus, combined therapy with amiodarone and 1-C agents was found to be safe and fairly effective in children with certain types of intractable supraventricular tachycardia.