Supraventricular Tachyarrhythmias
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.
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 April 28, 2024.
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 2024 April 28]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602411/all/Supraventricular_Tachyarrhythmias.
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