Supraventricular Tachyarrhythmias
Supraventricular Tachyarrhythmias is a topic covered in the Washington Manual of Medical Therapeutics.
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General Principles
- SVTs—often recurrent, rarely persistent, and can result in visits to emergency departments and primary care physician offices.
- Always begin with prompt assessment of hemodynamic stability and clinical status.
- Diagnostic and therapeutic discussion that follows is aimed at hemodynamically stable patients. If a patient is clinically unstable based on signs and symptoms, immediately proceed to cardioversion per ACLS guidelines.
Definition
- Tachyarrhythmias that require atrial or AV nodal tissue or both for their initiation and maintenance are termed SVT.
- The QRS complex in most SVTs is narrow (QRS <120 ms).
- SVTs can present as a wide-complex tachycardia (QRS ≥120 ms) if they are aberrantly conducted.
Classification
- Initially classified by ECG to help understand likely underlying arrhythmia mechanism.
- Diagnostic approach, based on the ECG, is summarized in Figure 7-1.
- Narrow QRS complex tachyarrhythmias can be divided into those requiring only atrial tissue for initiation and maintenance (atrial tachycardia [AT], AF, and AFL) versus those that require the AV junction for perpetuation (JT, AVNRT, and AVRT).
- Paroxysmal SVT—intermittent SVT other than AF, AFL, and multifocal AT (MAT).
Figure 7-1 Diagnostic approach to tachyarrhythmias.
AF, atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; EAT, ectopic atrial tachycardia; MAT, multifocal atrial tachycardia; O-AVRT, orthodromic AVRT; PAC, premature atrial complex; SANRT, sinoatrial nodal reentrant tachycardia; ST, sinus tachycardia; SVT, supraventricular tachyarrhythmia; VT, ventricular tachycardia; WPW, Wolff–Parkinson–White.
Epidemiology
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General Principles
- SVTs—often recurrent, rarely persistent, and can result in visits to emergency departments and primary care physician offices.
- Always begin with prompt assessment of hemodynamic stability and clinical status.
- Diagnostic and therapeutic discussion that follows is aimed at hemodynamically stable patients. If a patient is clinically unstable based on signs and symptoms, immediately proceed to cardioversion per ACLS guidelines.
Definition
- Tachyarrhythmias that require atrial or AV nodal tissue or both for their initiation and maintenance are termed SVT.
- The QRS complex in most SVTs is narrow (QRS <120 ms).
- SVTs can present as a wide-complex tachycardia (QRS ≥120 ms) if they are aberrantly conducted.
Classification
- Initially classified by ECG to help understand likely underlying arrhythmia mechanism.
- Diagnostic approach, based on the ECG, is summarized in Figure 7-1.
- Narrow QRS complex tachyarrhythmias can be divided into those requiring only atrial tissue for initiation and maintenance (atrial tachycardia [AT], AF, and AFL) versus those that require the AV junction for perpetuation (JT, AVNRT, and AVRT).
- Paroxysmal SVT—intermittent SVT other than AF, AFL, and multifocal AT (MAT).
Figure 7-1 Diagnostic approach to tachyarrhythmias.
AF, atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; EAT, ectopic atrial tachycardia; MAT, multifocal atrial tachycardia; O-AVRT, orthodromic AVRT; PAC, premature atrial complex; SANRT, sinoatrial nodal reentrant tachycardia; ST, sinus tachycardia; SVT, supraventricular tachyarrhythmia; VT, ventricular tachycardia; WPW, Wolff–Parkinson–White.
Epidemiology
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Citation
Bhat, Pavat, et al., editors. "Supraventricular Tachyarrhythmias." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. The Washington Manual, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602411/all/Supraventricular_Tachyarrhythmias.
Supraventricular Tachyarrhythmias. In: Bhat PP, Dretler AA, Gdowski MM, et al, eds. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602411/all/Supraventricular_Tachyarrhythmias. Accessed February 8, 2023.
Supraventricular Tachyarrhythmias. (2016). In Bhat, P., Dretler, A., Gdowski, M., Ramgopal, R., & Williams, D. (Eds.), Washington Manual of Medical Therapeutics (35th ed.). Wolters Kluwer Health. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602411/all/Supraventricular_Tachyarrhythmias
Supraventricular Tachyarrhythmias [Internet]. In: Bhat PP, Dretler AA, Gdowski MM, Ramgopal RR, Williams DD, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2023 February 08]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602411/all/Supraventricular_Tachyarrhythmias.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Supraventricular Tachyarrhythmias
ID - 602411
ED - Williams,Dominique,
ED - Bhat,Pavat,
ED - Dretler,Alexandra,
ED - Gdowski,Mark,
ED - Ramgopal,Rajeev,
BT - Washington Manual of Medical Therapeutics
UR - https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602411/all/Supraventricular_Tachyarrhythmias
PB - Wolters Kluwer Health
ET - 35
DB - The Washington Manual
DP - Unbound Medicine
ER -