Supraventricular arrhythmias

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]


An overview of supraventricular tachycardias
example (lead II) regularity atrial frequency ventricular frequency origin (SVT/VT) p-wave effect of adenosine
Narrow complex (QRS<0.12)
Sinus tachycardia Sinustachycardia - a normal p wave precedes every QRS complex regular 100-180 bpm 100-180 bpm sinus node (SVT) precedes every QRS complex gradual slowing
Atrial Fibrillation Atrial fibrillation - irregular rate, no p waves grossly irregular 400-600 bpm 75-175 bpm atria (SVT) absent slows down rate; irregularity remains
Atrial Flutter Atrial flutter - sawtooth in lead II with 2:1 block regular (sometimes alternating block) 250-350 bpm 75-150 bpm (3:1 or 2:1 block is most common) atria (SVT) negative sawtooth in lead II temporary reduced conduction (e.g. 4:1)
AVNRT ANVRT - rSR' in lead V1 regular 180-250 bpm 180-250 bpm AV-node (SVT) in QRS complex (R') stops
Atrial tachycardia Atrial tachycardia - like sinustachycardia but the p wave has a different morphology regular 120-250 bpm 75-200 bpm atria precedes QRS, p wave differs from sinus-p temporary AV-block
Atrio-Ventricular Reentry Tachycardia (AVRT)- orthodromic AVRT - inverted p wave behind every QRS complex regular 150-250 bpm 150-250 bpm circle: av-node - ventricles - bypass - atria RP < PR stops
AV junctional tachycardia AV junctional tachycardia - no or inverted p-waves within QRS complex regular 60-100 bpm 70-130 bpm AV node RP < PR reduces rate
Wide complex (QRS>0.12)
Supraventricular tachycardia with block SVT with block - any SVT combined with LBBB or RBBB (ir)regular depending on SVT 100-250 bpm 75-200 bpm atria (SVT) absent temporary increased AV-block (eg 4:1)
Atrio-ventricular Reentry Tachycardia (AVRT) - antidrome regular 150-250 bpm 150-250 bpm circular: bypass - atria - av-node - ventricles RP < PR stops

Supraventricular ectopic beats

Also read

EKG Examples

This is an electrocardiogram from a woman in her forties who had several operations for congenital heart disease. At the time of the electrocardiogram the patient was taking flecainide and metoprolol .

This patient was being treated for ventricular tachycardia. She was initially treated with amiodarone and then was switched to a combination of flecainide and metoprolol. She was doing well. The underlying congenital heart disease was Tetralogy of Fallot. The electrocardiogram shows a supraventricular rhythm which is probably not sinus as indicated by the negative P waves in the inferior leads. The cardiogram also shows 1 PVC and a right Branch block with a left anterior hemi-block.

Supraventricular arrhythmia.jpg


Drug Side Effect



  1. ESCnarrowQRS pmid=14563598