Supraventricular tachycardia overview

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Among the Different Types of Supraventricular Tachycardia

Differentiating Supraventricular Tachycardia from Ventricular Tachycardia

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

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Cardiac Catheterization

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Medical Therapy

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2015 ACC/AHA Guideline Recommendations

Acute Treatment of SVT of Unknown Mechanism
Ongoing Management of SVT of Unknown Mechanism
Ongoing Management of IST
Acute Treatment of Suspected Focal Atrial Tachycardia
Acute Treatment of Multifocal Atria Tachycardia
Ongoing Management of Multifocal Atrial Tachycardia
Acute Treatment of AVNRT
Ongoing Management of AVNRT
Acute Treatment of Orthodromic AVRT
Ongoing Management of Orthodromic AVRT
Asymptomatic Patients With Pre-Excitation
Management of Symptomatic Patients With Manifest Accessory Pathways
Acute Treatment of Atrial Flutter
Ongoing Management of Atrial Flutter
Acute Treatment of Junctional Tachycardia
Ongoing Management of Junctional Tachycardia
Acute Treatment of SVT in ACHD Patients
Ongoing Management of SVT in ACHD Patients
Acute Treatment of SVT in Pregnant Patients
Acute Treatment and Ongoing Management of SVT in Older Population

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD[2]

Overview

A supraventricular tachycardia (SVT) is a tachycardia or rapid rhythm of the heart in which the origin of the electrical signal is either the atria or the AV node. These rhythms, by definition, are either initiated or maintained by the atria or the AV node. This is in contrast to ventricular tachycardias, which are rapid rhythms that originate from the ventricles of the heart, that is, below the atria or AV node. The term SVT encompasses a large number of arrhythmias arising from the atria and the AV node, and the term SVT is often incorrectly applied only to the subgroup of AV nodal re-entrant tachycardias.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Supraventricular Tachycardia from Ventricular Tachycardia

Most supraventricular tachycardias have a narrow QRS complex on the EKG. It is not infrequent, however, for aberrant conduction to be be present, sometimes as a result of the more rapid rate of conduction. This widening of the QRS complex yields supraventricular tachycardia with aberrant conduction (SVTAC) which produces a wide-complex tachycardia that may mimic ventricular tachycardia (VT). In the clinical setting, it is important to determine whether a wide-complex tachycardia is an SVT or a ventricular tachycardia, since they are treated differently. Ventricular tachycardia has to be treated appropriately, since it can quickly degenerate to ventricular fibrillation and death. A number of different algorithms have been devised to determine whether a wide complex tachycardia is supraventricular or ventricular in origin.[1] In general, a history of structural heart disease, ischemic heart disease or congestive heart failure increases the likelihood that the tachycardia is ventricular in origin.

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Supraventricular tachycardias may start and stop abruptly. Patients may develop syncope. The prognosis of an SVT is generally good in absence of underlying heart disease.

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

The best method to diagnose supraventricular tachycardia is through electrocardiography. Presentation on EKG will vary depending on the subtype. In general, QRS complexes tend to be tall and narrow, P waves are absent, and rate is greater than 100 beats per minute. Asystole may occur due to tachycardia-mediated suppression of the sinus node when the rhythm is in AVNRT.

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CT scan

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Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

References

  1. Lau EW, Ng GA (2002). "Comparison of the performance of three diagnostic algorithms for regular broad complex tachycardia in practical application". Pacing and clinical electrophysiology : PACE. 25 (5): 822–7. PMID 12049375.


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