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SVT Case

This document discusses different types of narrow complex tachycardias based on QRS width and regularity of rhythm. It describes AV nodal reentrant tachycardia (AVNRT) which can occur due to dual AV node pathways, and accessory pathway mediated AV reentrant tachycardia (AVRT). It notes the importance of looking for retrograde P waves and assessing the RP interval to help differentiate between different types of regular narrow complex tachycardias.

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Zakiy Azzuhdi
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© © All Rights Reserved
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Download as PPT, PDF, TXT or read online on Scribd
73 views

SVT Case

This document discusses different types of narrow complex tachycardias based on QRS width and regularity of rhythm. It describes AV nodal reentrant tachycardia (AVNRT) which can occur due to dual AV node pathways, and accessory pathway mediated AV reentrant tachycardia (AVRT). It notes the importance of looking for retrograde P waves and assessing the RP interval to help differentiate between different types of regular narrow complex tachycardias.

Uploaded by

Zakiy Azzuhdi
Copyright
© © All Rights Reserved
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Morning report ECG

Elias B Hanna, MD
LSU New Orleans, Cardiology
What is the diagnosis?
QRS width

Narrow complex
tachycardia
QRS<120 ms
=SVT
QRS width

Narrow complex
tachycardia
QRS<120 ms
=SVT

Irregularly
irregular

1.Afib
2.MAT
(P waves of
≥3 different
morphologies)
QRS width

Narrow complex
tachycardia
QRS<120 ms
=SVT

Irregularly Regular or regularly irregular


irregular

1.Afib
2.MAT
(P waves of
≥3 different
morphologies)
QRS width

Narrow complex
tachycardia
QRS<120 ms
=SVT

Irregularly Regular or regularly irregular


irregular Beside sinus tachy

1.AVNRT
1.Afib
2.AVRT
2.MAT
3.Atrial tachycardia
(P waves of
≥3 different 4.Atrial flutter
morphologies)
Dual AV node pathways and AVNRT

Some individuals have dual AV node


pathways (up to 20% of individuals).
Normally, conduction spreads through the
fast pathway and gets blocked in the slow
pathway. However, after a PAC, the
electrical activity cannot spread through the
fast pathway (which is still in a refractory
period), but can get conducted through the
slow pathway which then conducts both
down to the ventricle and up to the atrium,
through the recovered “fast pathway”, thus
creating a tachycardia with retrograde P
waves
AV
AV node
node

Accessory
pathway

AVRT (after PAC or PVC)


AV node

Accessory
pathway

Similar process happens in case of accessory pathway that is conducting


retrogradely. We have 2 pathways that create a reentrant circuit after a PAC
or PVC.
Arrows point to the retrograde P that is
superimposed on ST segment and looks as
a notch on ST segment

Retrograde P wave

Pseudo-r’ in V1 + Pseudo S in inf leads


ECG of the previous pt in sinus rhythm after adenosine. Note the
difference (no “pseudo-r’ “ or “pseudo S”)
QRS width

Narrow complex
tachycardia
QRS<120 ms
=SVT

Irregularly Regular or regularly irregular


irregular
Look for P waves
1.Afib
2.MAT Assess RP interval
(P waves of
≥3 different
morphologies)
Sawtooth P, Short RP (<1/2 RR) Long RP (>1/2 RR)
esp. rate~150

-Atrial flutter -AVNRT -Atrial tachycardia


-AVRT
-Atrial tachycardia -Atypical AVNRT

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