The document discusses 5 types of supraventricular arrhythmia: 1) Atrial flutter which involves a reentrant circuit, 2) Atrial fibrillation which involves multiple electrical foci, 3) Multifocal atrial tachycardia which involves at least 3 distinct atrial impulses, 4) Atrioventricular nodal reentrant tachycardia which involves an aberrant reentry loop through two conduction pathways, and 5) Preexcitation accessory pathway (Wolff-Parkinson-White) which involves ventricular preexcitation through an accessory pathway. Treatment options discussed include drugs, cardioversion, catheter ablation, and treating underlying causes.
The document discusses 5 types of supraventricular arrhythmia: 1) Atrial flutter which involves a reentrant circuit, 2) Atrial fibrillation which involves multiple electrical foci, 3) Multifocal atrial tachycardia which involves at least 3 distinct atrial impulses, 4) Atrioventricular nodal reentrant tachycardia which involves an aberrant reentry loop through two conduction pathways, and 5) Preexcitation accessory pathway (Wolff-Parkinson-White) which involves ventricular preexcitation through an accessory pathway. Treatment options discussed include drugs, cardioversion, catheter ablation, and treating underlying causes.
The document discusses 5 types of supraventricular arrhythmia: 1) Atrial flutter which involves a reentrant circuit, 2) Atrial fibrillation which involves multiple electrical foci, 3) Multifocal atrial tachycardia which involves at least 3 distinct atrial impulses, 4) Atrioventricular nodal reentrant tachycardia which involves an aberrant reentry loop through two conduction pathways, and 5) Preexcitation accessory pathway (Wolff-Parkinson-White) which involves ventricular preexcitation through an accessory pathway. Treatment options discussed include drugs, cardioversion, catheter ablation, and treating underlying causes.
The document discusses 5 types of supraventricular arrhythmia: 1) Atrial flutter which involves a reentrant circuit, 2) Atrial fibrillation which involves multiple electrical foci, 3) Multifocal atrial tachycardia which involves at least 3 distinct atrial impulses, 4) Atrioventricular nodal reentrant tachycardia which involves an aberrant reentry loop through two conduction pathways, and 5) Preexcitation accessory pathway (Wolff-Parkinson-White) which involves ventricular preexcitation through an accessory pathway. Treatment options discussed include drugs, cardioversion, catheter ablation, and treating underlying causes.
1. Atrial flutter Mechanism : AFL is a “re-entrant” tachyarrhythmia, which means that an electrical impulse is traveling around and around an electrical circuit other than the normal conduction system (the electricity re-enters the circuit). Cause : pulmonary causes (eg, antiarrhythmic drug initiation, chronic pulmonary disease, pulmonary embolism) cardiac causes (eg, pericarditis, myocardial infarction) systemic causes (thyrotoxicosis) other miscellaneous causes (eg, obesity, obstructive sleep apnea, post-cardiac surgery). Signs and symptoms : palpitations, tachycardia, fatigue, weakness, dizziness, and lightheadedness. ECG: “saw-tooth” pattern that is most distinctly seen in leads II, III, and aVF Irregular P waves
Drugs - verapamil, diltiazem, β-blockers, or digitalis Tissue burning or freezing can be done if medications fail 2. Atrial fibrillation Mechanism : The atrial pathology disrupts the conduction pathway which causes formation of multiple electrical foci .Each electrical focus is capable of emitting impulses independently and at different rates. Cause :AF is associated with a whole spectrum of diseases. Signs and symptoms : palpitations, tachycardia, fatigue, weakness, dizziness, and lightheadedness. Formation of mural thrombus due to blood stain in the left appendage . ECG : classic buzz phrase for describing AF is “irregularly irregular.” This describes both the abnormal length and frequency of R-R intervals Treatment : due to risk of blood clots and stroke treatment can be of two method rate vs rhythm control and which anticoagulant to use Patient should first start with anticoagulant rate control, the patient is allowed to stay in AF, but the rate is slowed to reduce symptoms and complications.β-blocker, but diltiazem and verapamil. Used in older patients Rhythm control is the conversion of AF to sinus rhythm via either synchronized cardioversion or medications like class III (amiodarone, ibutilide) or class Ic (flecainide) antiarrhythmic drugs. Used in younger patients . 3. Multifocal atrial tachycardia Mechanism : MAT occurs when there are three or more distinct impulses in the atria that travel to the AV node and cause depolarization. Cause: Causes of MAT include pulmonary causes (eg, COPD, pneumonia), cardiac causes (eg, coronary artery disease, valvular heart disease), and miscellaneous causes (eg, hypokalemia, hypomagnesemia, chronic kidney disease, and drugs). ECG : There are at least three different morphologies of p-waves
Treatment : treating the underlying pulmonary disease will restore normal sinus rhythm. If not, verapamil or diltiazem can be used to do so 4. Atrioventricular nodal reentrant tachycardia Mechanism :AVNRT is caused by an aberrant re-entry loop with two distinct conduction pathways that become sequentially linked. Slow pathway + fast pathway Cause : Triggers for AVNRT include alcohol, smoking, caffeine and other stimulants, and exercise Signs and symptoms : palpitations, lightheadedness, diaphoresis, chest pain, presyncope or syncope, and dyspnea ECG: AVNRT shows a sudden onset of narrow QRS complexes P wave retrograde
Treatment : (1) carotid sinus massage, which increases vagal tone and slows the AV nodal transmission rates (effective in 25% of cases); (2) adenosine (effective in >90% of cases); and (3) synchronized cardioversion (electric shock) if the patient is unstable or drugs can be used beta blockers or verampil 5. Pre - excitation accessory pathway ( wolff parkinson white syndrome ) Mechanism : Ventricular pre-excitation is exactly what it sounds like: a ventricle that gets excited (depolarized) before (pre) the normal timing through the AV node. Cause : WPW is a congenital disorder Signs and symptoms : palpitations, lightheadedness, presyncope or syncope, chest pain, and even sudden cardiac death. ECG: sinus rhythm show a shortened PR interval (often <120 ms) and characteristic delta wave
Treatment : catheter radio-ablation of abnormal pathways in the electrophysiology lab.
