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Supraventriculartachyarrhythmias
Václav DurdilKardiologická klinika UK 2.LF a FN Motol
Definition
Supraventricular tachyarrhythmia (=SVT)Different heart rhythm than sinus rhythm
Rate of contractions is more than 100 per minute
Atrial myocardium is needed to sustain the arrhythmia
Mechanism of origin
● Focal (ectopic) activity ○ trigerred activity○ enhanced automaticity
● Reentry○ macroreentry○ microreentry
● Sinoatrial node● Atrial myocardium● Atrioventricular node
Place of origin
Focal activityEarly afterdepolarizations Delayed afterdepolarizationsEnhanced automaticity
ReentryTwo requirements:
● anatomic barrier● zone of slow conduction
ClassificationSinoatrial node Focal Inappropriate sinus tachycardia
Reentry Sinus nodal reentrant tachycardia (SNRT)
Atrial myocardium
Focal Focal atrial tachycardia (FAT)
Reentry Atrial flutter (AFL)
Atrial fibrillation (AFib)
Atrioventricular node
Focal Junctional ectopic tachycardia (JET)
Reentry AV nodal reentrant tachycardia (AVNRT)
AV reentrant tachycardia (AVRT)
SymptomsPalpitations (feeling of irregular heart beats)
● Regularity○ Regular - AVNRT, AVRT, FAT○ Irregular - atrial fibrillation or flutter
● Beginning and end○ Sudden - reentry tachycardia○ Gradual - focal atrial tachycardia, sinus tachycardia
● Vagal maneuvers reaction○ Yes = reentry dependent on AV node
Dizziness, pre collapse state, exceptionally syncope
Atrial flutterTypical (cavotricuspid isthmus dependent)
Atypical (non-isthmus dependent)
Typical atrial flutter
Atypický flutter síní
AVNRTTypical = slow-fast
Atypical = fast-slow, slow-slow
AVNRTRP<100ms
AVNRT
AVNRT
AVRT = atrio-ventricular reentrant tachycardiaOrthodromic AVRT
Antidromic AVRT
Preexcitation
Preexcitation
AVRT RP>100ms
Atrial fibrillation
Atrial fibrillation
Therapy
● Pharmacological = antiarrhythmic drugs● Non-pharmacological = catheter ablation
, propafenon
blocks accessory pathway
blocks AV node
all above effects
blocks AV node
, metoprolol
, ajmalin, prajmalin
blocks ectopy
Catheter ablation of AVNRT
Catheter ablation of AVRT
Catheter ablation of typical atrial flutter
Recommended