scholarly journals Cardiac Arrhythmias – Part III Narrow Complex Tachycardia

2005 ◽  
Vol 4 (2) ◽  
pp. 51-57
Author(s):  
DW Davies ◽  
◽  
MD O’Neill ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrhythmias ◽  
Sinus Tachycardia ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Supraventricular Arrhythmia ◽  
Common Causes ◽  
Atrioventricular Reciprocating Tachycardia ◽  
Narrow Complex Tachycardia ◽  
Wolff Parkinson White Syndrome

Narrow complex tachycardia usually refers to an abnormality of cardiac rhythm involving the tissues of the sinus node, atrial tissue, the atrioventricular node or an accessory atrioventricular communication. Although atrial fibrillation is the most common supraventricular arrhythmia, the term “supraventricular tachycardia” conventionally refers to the group of rhythm disturbances encompassing sinus tachycardia (appropriate and inappropriate), atrial tachycardia, atrial flutter, atrioventricular nodal reciprocating tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT) including the Wolff Parkinson White syndrome (WPW). Atrial fibrillation is beyond the scope of this article which focuses on the diagnosis and acute management of the patient presenting with one of these common causes of a regular, narrow complex tachycardia.

Sevoflurane Has No Effect on Sinoatrial Node Function or on Normal Atrioventricular and Accessory Pathway Conduction in Wolff-Parkinson-White Syndrome during Alfentanil/Midazolam Anesthesia 

1999 ◽  
Vol 90 (1) ◽  
pp. 60-65 ◽  
Author(s):  
Michael D. Sharpe ◽  
Daniel J. Cuillerier ◽  
John K. Lee ◽  
Magdi Basta ◽  
Andrew D. Krahn ◽  
...  
Keyword(s):  
Cycle Length ◽  
Sinoatrial Node ◽  
Sinus Node ◽  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Conduction Time ◽  
White Syndrome ◽  
The Right ◽  
Ablative Procedures ◽  
Wolff Parkinson White Syndrome

Background The effects of sevoflurane on the electrophysiologic properties of the human heart are unknown. This study evaluated the effects of sevoflurane on the electrophysiologic properties of the normal atrioventricular conduction system, and on the accessory pathways in patients with Wolff-Parkinson-White syndrome, to determine its suitability as an anesthetic agent for patients undergoing ablative procedures. Methods Fifteen patients with Wolff-Parkinson-White syndrome undergoing elective radiofrequency catheter ablation were studied. Anesthesia was induced with alfentanil (20-50 microg/kg) and midazolam (0.15 mg/kg), and vecuronium (20 mg) and maintained with alfentanil (0.5 to 2 microg x kg(-1) x min(-1)) and midazolam (1 or 2 mg every 10-15 min, as required). An electrophysiologic study measured the effective refractory period of the right atrium, atrioventricular node, and accessory pathway; the shortest conducted cycle length of the atrioventricular node and accessory pathway during atrial pacing; the effective refractory period of the right ventricle and accessory pathway; and the shortest retrograde conducted cycle length of the accessory pathway during ventricular pacing. Parameters of sinoatrial node function included sinus node recovery time, corrected sinus node recovery time, and sinoatrial conduction time. Intraatrial conduction time and the atrial-His interval were also measured. Characteristics of induced reciprocating tachycardia, including cycle length, atrial-His, His-ventricular, and ventriculoatrial intervals, also were measured. Sevoflurane was administered to achieve an end-tidal concentration of 2% (1 minimum alveolar concentration), and the study measurements were repeated. Results Sevoflurane had no effect on the electrophysiologic parameters of conduction in the normal atrioventricular conduction system or accessory pathway, or during reciprocating tachycardia. However, sevoflurane caused a statistically significant reduction in the sinoatrial conduction time and atrial-His interval but these changes were not clinically important. All accessory pathways were successfully identified and ablated. Conclusions Sevoflurane had no effect on the electrophysiologic nature of the normal atrioventricular or accessory pathway and no clinically important effect on sinoatrial node activity. It is therefore a suitable anesthetic agent for patients undergoing ablative procedures.

Introduction

ESC CardioMed ◽  
2018 ◽  
pp. 2049-2050
Author(s):  
Carina Blomström-Lundqvist
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Atrioventricular Node ◽  
Supraventricular Arrhythmia ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Atrioventricular 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.

scholarly journals Catheter Cryoablation of the Atrioventricular Node in Patients with Atrial Fibrillation: A Novel Technology for Ablation of Cardiac Arrhythmias

2001 ◽  
Vol 12 (4) ◽  
pp. 439-444 ◽  
Author(s):  
MARC DUBUC ◽  
PAUL KHAIRY ◽  
ANGEL RODRIGUEZ-SANTIAGO ◽  
MARIO TALAJIC ◽  
JEAN-CLAUDE TARDIF ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrhythmias ◽  
Atrioventricular Node ◽  
Novel Technology

scholarly journals Drug correction of cardiac arrhythmias in patients with сoronary heart disease combined with mitral valve prolapse syndrome

2013 ◽  
Vol 17 (2 (66)) ◽  
pp. 94-96
Author(s):  
T. V. Naluzhna
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Mitral Valve ◽  
Cardiac Arrhythmias ◽  
Mitral Valve Prolapse ◽  
Prognostic Value ◽  
Sinus Tachycardia ◽  
Positive Impact ◽  
Paroxysmal Tachycardia

The paper presents data of cardiac arrhythmias in patients with coronary heart disease combined with the mitral valve prolapse syndrome. In these patients were dominated Sinus tachycardia, atrioventricular extrasystole, atrial fibrillation, paroxysmal tachycardia predominated in such patients. It has been proposed to include to the basic therapy these patients such preparations of magnesium, in particular, a domestic preparation – Rythmocor, taking into account the principal mechanisms of the development of arrhythmias. The antiarrhythmic, antiischemic, membranostabilizing action of the drug has been corroborated. A positive impact of Rhythmocor on the magnesium levels in the blood and a reduction of the duration of the interval QT has also been noteds correction of the arrhythmic syndrome has an important prognostic value in terms of reducing the risk of the onset of cardiac arrhythmias dangerous to life in patients with coronary heart disease, which occurs with the mitral valve prolapse syndrome.

Augmented Ventricular Rate Following Verapamil Treatment for Atrial Fibrillation with Wolff-Parkinson-White Syndrome

PEDIATRICS ◽  
1983 ◽  
Vol 72 (2) ◽  
pp. 245-246
Author(s):  
Thomas W. Rowland
Keyword(s):  
Atrial Fibrillation ◽  
Supraventricular Tachycardia ◽  
Refractory Period ◽  
Atrioventricular Node ◽  
Ventricular Rate ◽  
Paroxysmal Supraventricular Tachycardia ◽  
First Line ◽  
Ventricular Preexcitation ◽  
Line Drug ◽  
Wolff Parkinson White Syndrome

Verapamil has gained increasing acceptance as a first-line drug in the treatment of paroxysmal supraventricular tachycardia in both adults1 and children.2-4 Conversion to sinus rhythm in more than 90% of cases has been reported, an effect related to the drug's prolongation of refractory period and conduction through the atrioventricular node. The electrophysiologic effects of verapamil on accessory atrioventricular conduction pathways are more variable, and in some patients the drug will cause a decrease in refractory period.5-7 In individuals with reentrant paroxysmal supraventricular tachycardia this action is inconsequential, but in those with ventricular preexcitation accompanied by atrial fibrillation or flutter the effect may be catastrophic.

scholarly journals Atrial Tachyarrhythmias and Atrial Flutter: the Basics of Diagnostics and Modern Opportunities of Therapy

2019 ◽  
Vol 15 (1) ◽  
pp. 115-124 ◽  
Author(s):  
Yu. A. Bunin ◽  
S. A. Miklishanskaya ◽  
E. A. Zolozova ◽  
V. V. Chigineva
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Flutter ◽  
Sinus Tachycardia ◽  
Sinus Node ◽  
Preventive Therapy ◽  
Interventional Treatment ◽  
Inappropriate Sinus Tachycardia ◽  
Atrial Tachyarrhythmias ◽  
The Usa

The article is devoted to the description of all types of atrial tachyarrhythmias, including inappropriate sinus tachycardia, which, as a rule, is not paid enough attention in the domestic literature, sinoatrial node reentrant tachycardia, focal and multifocal atrial tachycardia, atrial flutter, and atrial fibrillation. The electrophysiological mechanisms of development and electrocardiographic criteria for the diagnosis of these cardiac rhythm disturbances are presented. Along with this, the article discusses the modern view of the strategy and tactics of pharmacological cardioversion and preventive therapy in patients with the main types of atrial tachyarrhythmias and atrial flutter. It is noted that the prognosis for inappropriate sinus tachycardia, as a rule, is favorable, and therefore, aim of treatment is to reduce the symptoms, and in their absence medical treatment is not necessary. Much attention is paid to drug and interventional treatment of atrial flutter. It is emphasized that catheter ablation of isthmus-dependent atrial flutter in most cases is preferred over long-term pharmacotherapy. However, in prolonged observation (more than 3 years), nearly 1/3 of patients may develop paroxysmal atrial fibrillation. At the same time, catheter ablation of atypical atrial flutter is, in most cases, substantially less effective. The indications and side effects of catheter ablation of the sinus node are also discussed. The authors provide a critical analysis of traditional approaches to the treatment of atrial tachyarrhythmias and analyze new recommendations for the management of these patients presented in Europe and the USA. Based on these recommendations, clear algorithms for the management of patients with atrial tachyarrhythmias are given. The need to prevent thromboembolic complications in some types of atrial tachyarrhythmias is emphasized.

Anatomy of the conduction tissues 100 years on: what have we learned?

Heart ◽  
2021 ◽  
pp. heartjnl-2021-320304
Author(s):  
Damián Sánchez-Quintana ◽  
Robert H Anderson ◽  
Justin T Tretter ◽  
José Angel Cabrera ◽  
Eduardo Back Sternick ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
20Th Century ◽  
Functional Significance ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Cardiac Impulse ◽  
Orderly Fashion ◽  
Histological Confirmation ◽  
Conduction Tissues

Knowledge of the anatomy of the ‘conduction tissues’ of the heart is a 20th century phenomenon. Although controversies still continue on the topic, most could have been avoided had greater attention been paid to the original descriptions. All cardiomyocytes, of course, have the capacity to conduct the cardiac impulse. The tissues specifically described as ‘conducting’ first generate the cardiac impulse, and then deliver it in such a fashion that the ventricles contract in orderly fashion. The tissues cannot readily be distinguished by gross inspection. Robust definitions for their recognition had been provided by the end of the first decade of the 20th century. These definitions retain their currency. The sinus node lies as a cigar-shaped structure subepicardially within the terminal groove. There is evidence that it is associated with a paranodal area that may have functional significance. Suggestions of dual nodes, however, are without histological confirmation. The atrioventricular node is located within the triangle of Koch, with significant inferior extensions occupying the atrial vestibules and with septal connections. The conduction axis penetrates the insulating plane of the atrioventricular junctions to continue as the ventricular pathways. Remnants of a ring of cardiomyocytes observed during development are also to be found within the atrial vestibules, particularly a prominent retroaortic remnant, although that their role has still to be determined. Application of the initial criteria for nodes and tracts shows that there are no special ‘conducting tissues’ in the pulmonary venous sleeves that might underscore the abnormal rhythm of atrial fibrillation.

scholarly journals Electrophysiologic study in chronic Chagas' heart disease

1995 ◽  
Vol 113 (2) ◽  
pp. 841-850 ◽  
Author(s):  
Maurício Scanavacca ◽  
Eduardo Sosa
Keyword(s):  
Heart Disease ◽  
Cardiac Arrhythmias ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Invasive Procedure ◽  
Pharmacological Therapy ◽  
Diagnostic Methods ◽  
Electrophysiologic Study ◽  
Non Invasive ◽  
Chagas Heart Disease

Cardiac arrhythmias are common in chagasic patients. Electrophysiologic study is an invasive procedure for the investigation of sinus node function, atrioventricular node conduction and intraventricular (His-Purkinje) conduction and the mechanism of tachycardias. It is useful in elucidating syncope, dizziness and tachycardiac palpitations that remain unexplained by non-invasive diagnostic methods. It is fundamental in directing non-pharmacological therapy, especially in "sudden death" survivors. Chagasic patients may benefit from electrophysiologic study after a critical clinical evaluation.

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