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.