Supraventricular tachycardia differentiating SVT from VT
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Supraventricular tachycardia Microchapters |
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Differentiating Among the Different Types of Supraventricular Tachycardia |
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Differentiating Supraventricular Tachycardia from Ventricular Tachycardia |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
See also: Wide complex tachycardia
Overview
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.
Differentiating SVT from VT
- Rate: More than 100 bpm and usually 150-200 bpm
- Rhythm: Generally regular
- P waves: Normal morphology, upright, but dissociated from the QRS complex (i.e. "march through" the QRS complex)
- PR interval: Variable PR interval
- QRS complex: Wide and greater than 0.12 seconds
- Response to Maneuvers: Does not terminate in response to adenosine or vagal maneuvers
- Epidemiology and Demographics: Ventricular tachycardia is a major cause of sudden cardiac death. Common in elderly men compared to wpmen.
- Risk Factors: Occurs in the context of myocardial ischemia, myocardial infarction, congestive heart failure, drug toxicity, and inhereted channelopathies