AV reentrant tachycardia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

Synonyms and Keywords: AVRT; AV-reciprocating tachycardia; atrioventricular reentrant tachycardia; circus movement tachycardia

Overview

AVRT results from an anatomically distinct atrioventricular connection. The causes, which usually are congenital or genetic, include: Ebstein anomaly, Lown-Ganong-Levine syndrome, Mahaim fiber tachycardia, Wolff-Parkinson-White syndrome.

Classification

Two types of tachycardia fall under this category:

Orthodromic Atrioventricular Reentrant Tachycardia

In orthodromic AVRT, the antegrade conduction (from the atria to the ventricles) occurs through the AV node, whereas the retrograde conduction (from the ventricle to the atrium) occurs through the accessory pathway. In this case, the ECG will reveal narrow QRS and retrograde P wave following the QRS complex.

Orthodromic AVRT.png

Antidromic Atrioventricular Reentrant Tachycardia

In antidromic AVRT, the antegrade conduction (from the atrium to the ventricle) occurs through the accessory pathway, whereas the retrograde conduction (from the ventricles to the atria) occurs through the AV node. In this case, the ECG will reveal wide QRS similar to those found in ventricular tachycardia.

Antidromic AVRT.png

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

AV nodal reentrant tachycardia is usually not life-threatening.

Common Causes

Causes by Organ Systems

Cardiovascular Ebstein anomaly, Lown-Ganong-Levine syndrome, Mahaim fiber tachycardia, Wolff-Parkinson-White syndrome
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Ebstein anomaly
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Pathophysiology

Electrical activity of the heart is rerouted through an accessory pathway that connects the atria with the ventricles.

Diagnosis

Electrocardiogram

QRS Atlernans

The appearance of QRS alternans as part of a narrow complex tachycardia suggests the diagnosis of orthodromic atrioventricular (AV) reentrant tachycardia which conducts retrograde over an accessory pathway.

Video

Below is a video explaining the mechanism of AV re-entrant tachycardia

References

See Also

Wolff-Parkinson-White syndrome Lown-Ganong-Levine syndrome


Cardiology


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