Approach to Supraventricular Tachyarrhythmias

• Supraventricular tachycardias (SVTs) are the most common arrhythmias

with a narrow QRS complex tachycardia.
• Physiologic sinus tachycardia can be seen due to concurrent illness,
exertion, stress, and exogenous or endogenous stimulants.
• Pathologic Supraventricular Tachycardia (SVT) shows chaotic atrial
electrical activity with variable ventricular rate; the most commonly
observed arrhythmia in older adults.
• Multifocal atrial tachycardia is observed in pulmonary disease patients with
discrete P waves.
• Tachycardia originating from atrium may continue despite the failure to
conduct to the ventricles.
• Inappropriate sinus tachycardia results from dysfunctional autonomic
regulation.
• Atrial fibrillation is commonly seen in young adults, especially women, and
is a paroxysmal regular tachycardia.
• Orthodromic AV reciprocating tachycardia (AVRT) and preexcited
tachycardia are associated with accessory atrioventricular pathways.

Approach to Supraventricular Tachyarrhythmias

• Tachycardia subclasses based on mechanism and underlying heart
disease.
• SVT can be brief or sustained, and can require intervention.
• PSVT includes AVNRT, AV reciprocating tachycardia, and atrial tachycardia.
• Diagnostic possibilities can be derived from 12-lead ECG.
• Symptoms of supraventricular arrhythmia vary.
• ECG can help establish SVT diagnosis.
• Vagal maneuvers or carotid sinus massage are used to achieve AV block in
treatment.
• CSM should be used cautiously in patients with carotid atherosclerosis.
Approach to Supraventricular Tachyarrhythmias
• Adenosine administration is successful in terminating AV nodal-dependent
SVT or diagnosing non-AV nodal-dependent SVT like atrial tachycardia or
atrial flutter.
• Atrial tachycardias can be adenosine sensitive and thus not eliminated by
the drug.
• Increasing atrioventricular node block through vagal maneuvers, carotid
sinus massage, adenosine, verapamil, or beta blockers has a diagnostic
effect on atrial fibrillation.
• Some types of supraventricular tachycardia are AVRT, AVNRT, multifocal
atrial tachycardia, sinus tachycardia, and junctional tachycardia.
• Abdominal muscles, larynx, and lung vagal maneuvers, submerging the
face into cold water, and carotid sinus massage are useful vagal maneuvers.
• Ambulatory ECG recording devices are available for patients, allowing
them to access the ECG diagnosis before seeing a physician.
• Carotid sinus massage, which targets the cardiac plexus and the vagus
nerve, is a useful vagal maneuver.
Medical Texts on Internal Medicine and Supraventricular Tachyarrhythmias
• To increase venous return, legs should be raised abruptly according to
Harrison's Principles of Internal Medicine, 21e by J. Larry Jameson.
• Adenosine can be used in the treatment of supraventricular tachycardia, as
mentioned in two sources: Harrison's Principles of Internal Medicine, 21e by
J. Larry Jameson and Chapter 246: Approach to Supraventricular
Tachyarrhythmias by William H. Sauer and Paul C. Zei.
• The waveform pattern of a Lead I ECG can be seen in a signal with 25 mm,
10 mm, Lead 1, 511 Hz, IOS 12.1.4, watchOS 5.1.3, and Watch42. These
details are provided in Harrison's Principles of Internal Medicine, 21e by
Joseph Loscalzo, Anthony Fauci, Dennis Kasper, Stephen Hauser, Dan
Longo, and J. Larry Jameson.
• According to Harrison's Principles of Internal Medicine, 21e by Larry
Jameson, exercise testing can be useful to assess exercise-related
symptoms and evoking arrhythmia, which may require invasive
electrophysiology study for further evaluation. Paroxysmal supraventricular
tachycardia is common in patients without heart diseases, while other
supraventricular arrhythmias are often associated with various heart
problems. The type of treatment for specific types of SVT depends on the
diagnosis and clinical findings and is discussed in more detail in
subsequent chapters.

Management of Patients with Supraventricular Tachycardia

• The task force for the management of patients with supraventricular
tachycardia was developed by the European Society of Cardiology in
collaboration with the Association for European Paediatric and Congenital
Cardiology.
• The publication was made in the Eur Heart J in 2020.
• The reference number for the publication in PubMed is 31504425.
• Callans DJ's Josephson's Clinical Cardiac Electrophysiology: Techniques
and Interpretations, 6th ed. is a valuable resource on the subject.
• This book was published by Wolters Kluwer in 2021.