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AVNRT
Jason Ryan, MD, MPH
PSVT
Paroxysmal Supraventricular Tachycardia

• Intermittent tachycardia (HR > 100bpm)

• Sudden onset/offset
• Contrast with sinus tachycardia
• Electrical activity originates above ventricle
• “Supraventricular” AfraTafreeh.com
• Contrast with ventricular tachycardia
• Produces narrow QRS complex (<120ms)
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PSVT
Paroxysmal Supraventricular Tachycardia

• Often causes sudden-onset palpitations

• Chest discomfort
• Rarely syncope
AVNRT
Atrioventricular nodal reentrant tachycardia

• Most common cause of PSVT

• More common in young women
• Mean age onset: 32 years old
• Requires dual AV nodal pathways
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Normal Conduction

SA

AV LBB

His
Purkinje
RBB Fibers
Dual Pathways
Sinus Rhythm

Slow Fast
Conduction Conduction
Short RP Long RP
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HIS
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Dual Pathways
PAC

Slow Fast
Conduction Conduction
Short RP Long RP

HIS
Retrograde P Waves

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AVNRT
• Recurrent episodes of palpitations
• Many episodes spontaneously resolve
• ↓ conduction in AV node breaks arrhythmia
• Will halt conduction in slow pathway
• Carotid massage
• Vagal maneuvers
• Adenosine
Carotid Massage
• Examiner presses on neck near carotid sinus
• Stretch of baroreceptors
• CNS response as if high blood pressure
• Increased vagal tone
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• ↓ AV node conduction

Wikipedia/Public Domain
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Vagal Maneuvers
• Valsalva
• Patient bears down as if moving bowels
• Increased thoracic pressure
• Aortic pressure rises → ↓ heart rate and AV conduction
• Breath holding
• Coughing
• Deep respirations
• Gagging
• Swallowing
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Chronic Treatment

• Many patients need no therapy

• Beta blockers, Verapamil/Diltiazem
• Slow conduction in slow pathway
• Surgical ablation of slow pathway
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