{"id":9624,"date":"2021-12-28T17:54:54","date_gmt":"2021-12-28T15:54:54","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/supraventricular-arrhythmias-atrial-tachycardia-fluttern-avnrt-avrt\/"},"modified":"2022-01-03T00:27:19","modified_gmt":"2022-01-02T22:27:19","slug":"supraventricular-arrhythmias-atrial-tachycardia-flutter-avnrt-avrt","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/supraventricular-arrhythmias-atrial-tachycardia-flutter-avnrt-avrt\/","title":{"rendered":"Supraventricular arrhythmias (atrial tachycardia, flutter, AVNRT, AVRT)"},"content":{"rendered":"\n

Atrial tachycardia<\/h3>\n<\/span>\n\n\n
  • Presents as narrow-complex tachycardia (>100BPM), usually due to increased automaticity.<\/li>
  • It can arise from a single focus (focal atrial tachycardia<\/strong>) or multiple foci (multifocal atrial tachycardia<\/strong>).<\/li>
  • Focal atrial tachycardia<\/strong>
    • Can be paroxysmal<\/strong> (short) or sustained<\/strong> (long-term).<\/li><\/ul>
      • Appears in patients with digoxin toxicity, congenital abnormalities, alcohol or stimulant usage, and ischemia.<\/li>
      • P-waves are consistant in morphology.<\/li><\/ul><\/li>
      • Multifocal atrial tachycardia<\/strong>
        • Appears in patients with respiratory failure.<\/li>
        • P-waves show different morphologies. The rhythm is irregularly irregular (chaotic).<\/li><\/ul><\/li>
        • The AV node blocks rates higher than 200\/min, resembling 2nd degree AV block; however, this is a normal feature of the AV node and not a pathological AV block.<\/li><\/ul>\n\n\n<\/span>\n

          Atrial flutter<\/h3>\n<\/span>\n\n\n

          Atrial flutter is a type of atrial tachycardia in which there’s a macro-reentry circuit within the atrium, characterized by a regular “saw-tooth” pattern.<\/p>\n\n\n\n

          • Atrial rate is ~300\/min, and the ventricular rate is typically ~150\/min (2:1 block).<\/li>
          • The “saw-tooth” pattern is easily seen on leads II, III, and aVF.<\/li>
          • Classified into type I<\/strong> (typical) and type II<\/strong> (atypical) AF<\/strong>.
            • Type I involves the cavotricuspid isthmus; can be futher classified into anticlockwise <\/strong>(most common) and clockwise <\/strong>reentry.<\/li>
            • Type II does not involve the cavotricuspid isthmus; has the least favorable outcome.<\/li><\/ul><\/li>
            • Treatment<\/strong>
              • Carotid sinus massage or Valsalva maneuver<\/li>
              • Urgent DC cardioversion in unstable patients<\/li>
              • Metoprolol\/verapamil followed by elective DC cardioversion or antiarrhythmics (amiodarone)<\/li>
              • Catheter ablation<\/li><\/ul><\/li><\/ul>\n\n\n<\/span>\n

                AVRT and AVNRT<\/h3>\n<\/span>\n\n\n

                AVRT and AVNRT are supraventricular tachycardias originating in the AV node or close to it, caused by a loop-back of electrical impulses in the heart, resulting in rates as high as 200-300 BPM.<\/p>\n\n\n<\/span>\n

                AVRT<\/h4>\n<\/span>\n\n\n

                AVRT (atrioventricular reentry tachycardia<\/strong>) is characterized by an accessory pathway<\/strong> that leads the electrical impulse back into the atria after reaching the ventricle; this is considered an anatomical re-entry circuit<\/strong>.<\/p>\n\n\n\n

                • Usually triggered by a PAC or PVC. <\/li>
                • Classified as orthodromic <\/strong>and antidromic<\/strong>.
                  • Orthodromic (95% of cases) involves an anterograde re-entry through the AV node, producing a narrow-complex<\/strong> rhythm with retrograde P waves<\/strong>.<\/li>
                  • Antidromic (5% of cases) involves a retrograde re-entry through the AV node, producing a wide-complex<\/strong> rhythm due to delta waves, with no P waves<\/strong> and may be difficult to distinguish from ventricular tachycardia.<\/li><\/ul><\/li>
                  • Treatment<\/strong>
                    • Carotid sinus massage or Valsalva maneuver<\/li>
                    • Urgent DC cardioversion in unstable patients<\/li><\/ul>
                      • Antiarrhythmics
                        • In orthodromic, adenosine\/verapamil<\/li>
                        • In antidromic, procainamide (adenosine is contraindicated!)<\/li><\/ul><\/li>
                        • Ablation of the accessory pathway<\/li><\/ul><\/li><\/ul>\n\n\n<\/span>\n

                          AVNRT<\/h4>\n<\/span>\n\n\n

                          AVNRT <\/strong>(atrioventricular nodal reentry tachycardia) is characterized by a connection between the atria and AV node consisting of two pathways (alpha and beta); this is considered a functional re-entry circuit<\/strong>.<\/p>\n\n\n\n

                          • The alpha pathway has a slow conduction speed and a short refractory period.<\/li>
                          • The beta pathway has a fast conduction speed and a long refractory period.<\/li>
                          • It is typically triggered by exercise, warm drinks, and alcohol.<\/li>
                          • It is the most common<\/strong> cause for palpitations in patients with otherwise normal heart anatomy, more commonly appearing in women. May present with presyncope and chest pain in patients with CAD.<\/li>
                          • Classified as slow-fast<\/strong>, fast-slow<\/strong>, and slow-slow<\/strong> AVNRT<\/strong> by the order of which pathway is anterograde, and which pathway is retrograde (where re-entry occurs).
                            • The slow-fast AVNRT (typical) is the most common form. It means the re-entry occurs from the slow (alpha) pathway into the fast (beta) pathway. Additional P waves are hidden by the QRS complex<\/strong>.<\/li>
                            • In fast-slow form, additional P waves appear after the QRS complex<\/strong>.<\/li>
                            • In slow-slow form, additional <\/strong>P waves appear before the QRS complex<\/strong>, making it hard to distinguish from sinus tachycardia.<\/li><\/ul><\/li>
                            • Treatment<\/strong>
                              • Carotid sinus massage or Valsalva maneuver<\/li><\/ul>
                                • Antiarrhythmics (adenosine\/flecinide)<\/li><\/ul>
                                  • DC cardioversion is rarely needed<\/li>
                                  • Definite treatment is catheter ablation of the slow pathway<\/li><\/ul><\/li><\/ul>\n<\/span>

                                    Atrial tachycardia<\/h3>

                                    Atrial flutter<\/h3>

                                    AVRT and AVNRT<\/h3>

                                    AVRT<\/h4>

                                    AVNRT<\/h4><\/div>","protected":false},"excerpt":{"rendered":"

                                    Atrial tachycardia Presents as narrow-complex tachycardia (>100BPM), usually due to increased automaticity. It can arise from a single focus (focal atrial tachycardia) or multiple foci (multifocal atrial tachycardia). Focal atrial tachycardia Can be paroxysmal (short) or sustained (long-term). Appears in patients with digoxin toxicity, congenital abnormalities, alcohol or stimulant usage, and ischemia. P-waves are consistant […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":15,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9624","page","type-page","status-publish","hentry"],"yoast_head":"\nSupraventricular arrhythmias (atrial tachycardia, flutter, AVNRT, AVRT) – Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/supraventricular-arrhythmias-atrial-tachycardia-flutter-avnrt-avrt\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" 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