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| {{CMG}}; {{AE}}{{Noha}} | | {{CMG}}; {{AE}}{{Noha}} |
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| {{SK}}[[PSVT]], [[Narrow complex tachycardia|Narrow QRS complex tachycardia]], [[AV nodal reentrant tachycardia|Atrioventricular nodal reentrant tachycardia]], [[AV nodal reentrant tachycardia|AVNRT]], [[Supraventricular arrhythmias|Supraventricular arrhythmia]], [[Supraventricular tachycardia]], [[Tachyarrhythmia]], [[Arrhythmia]]. | | {{SK}}[[PSVT]], [[Paroxysmal supraventricular arrythmia|Paroxysmal supraventricular arrhythmia]] |
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| ==[[Paroxysmal supraventricular tachycardia overview|Overview]]== | | ==[[Paroxysmal supraventricular tachycardia overview|Overview]]== |
| Paroxysmal Supraventricular tachycardia (PSVT) is a subset of supraventricular tachycardia (SVT), characterized by its episodic nature with sudden onset, sudden offset, regular, rapid rhythm and narrow QRS complex on Electrocardiogram (ECG), usually the patient is normal in between attacks and except for patients with preexisting heart disease, the prognosis is usually good.
| | == [[Paroxysmal supraventricular tachycardia historical perspective|Historical Perspective]] == |
| ==[[Paroxysmal supraventricular tachycardia historical perspective|Historical Perspective]]== | | == [[Paroxysmal supraventricular tachycardia classification|Classification]] == |
| Catheter-based radiofrequency ablation has improved the treatment of PSVT by precise ablation of the abnormal accessory pathway. First catheter ablations were in the early to mid-1980s, since then it has improved progressively especially in terms of safety and specificity.
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| ==[[Paroxysmal supraventricular tachycardia classification|Classification]]== | | == [[Paroxysmal supraventricular tachycardia causes|Causes]] == |
| SVTs are classified based on the origin and the regularity of the rhythm:
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| === Atrial in origin: === | | == [[Paroxysmal supraventricular tachycardia differential diagnosis|Differentiating Paroxysmal supraventricular tachycardia from other Diseases]] == |
| | == [[Paroxysmal supraventricular tachycardia epidemiology and demographics|Epidemiology and Demographics]] == |
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| * Sinus tachycardia
| | == [[Paroxysmal supraventricular tachycardia risk factors|Risk Factors]] == |
| * Inappropriate sinus tachycardia
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| * Sinoatrial nodal reentrant tachycardia
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| * Atrial flutter
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| * Atrial fibrillation
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| * Multi atrial focal tachycardia
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| === AV nodal in origin: === | | == [[Paroxysmal supraventricular tachycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| * Junctional tachycardia
| | == [[Paroxysmal supraventricular tachycardia diagnosis|Diagnosis]] == |
| * Atrioventricular nodal reentrant tachycardia
| | [[Paroxysmal supraventricular tachycardia history and symptoms|History and Symptoms]] | [[Paroxysmal supraventricular tachycardiaphysical examination|Physical Examination]] | [[Paroxysmal supraventricular tachycardia laboratory findings|Laboratory Findings]] | [[Paroxysmal supraventricular tachycardia electrocardiogram|Electrocardiogram]] | [[Paroxysmal supraventricular tachycardia other diagnostic studies|Other Diagnostic Studies]] |
| * Atrioventricular reentrant tachycardia
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| === Regular SVT: ===
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| * All tachycardia originating from the AV node
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| * Sinus tachycardia
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| * Inappropriate sinus tachycardia
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| * Sinoatrial nodal reentrant tachycardia
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| * Atrial flutter
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| === Irregular SVT'':'' ===
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| * Multifocal atrial tachycardia
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| * Atrial flutter with variable block
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| * Atrial fibrillation
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| ==[[Paroxysmal supraventricular tachycardia pathophysiology|Pathophysiology]]==
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| PSVTs are due to abnormalities in impulse formation and conduction pathways. Often due to different reentry circuits in the heart, less frequent causes include enhanced or abnormal automaticity and triggered activity.
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| ==[[Paroxysmal supraventricular tachycardia causes|Causes]]==
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| Reentry circuits are the most common cause
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| a. About 60% are due to AVNRT either within
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| * AV node
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| * Perinodal atrial tissue.
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| b. 30% are due to Atrioventricular reciprocating tachycardia (AVRT)
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| * Extranodal accessory pathway connecting the atrium and ventricle, e.g. Wolff-Parkinson-White syndrome (WPW).
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| c. 10% are due to pathways within or around the sinus node:
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| * Focal atrial tachycardia
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| * Intra atrial reentrant tachycardia (IART)
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| * Sinoatrial nodal reentrant tachycardia (SANRT)
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| d. Other rare causes (Rare in adults, but can represent a larger portion of PSVTs in children) are due to
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| * Junctional ectopic tachycardia
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| * Non-paroxysmal junctional tachycardia
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| ==[[Paroxysmal supraventricular tachycardia differential diagnosis|Differentiating Paroxysmal supraventricular tachycardia from other Diseases]]== | |
| <br />Symptoms due to PSVT are often misdiagnosed as psychological disease e.g. panic attacks, stress, anxiety, or depression delaying referral for ablation.
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| ==[[Paroxysmal supraventricular tachycardia epidemiology and demographics|Epidemiology and Demographics]] ==
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| * In the United States, 1.1 to 1.4 million individuals before the age of 65 are affected annually
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| * Sporadic and unpredictable
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| * Slightly higher in males than females
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| * Positively correlated with age<br />
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| ==[[Paroxysmal supraventricular tachycardia risk factors|Risk Factors]]==
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| Any condition or drug that increases automaticity or triggers activity including:
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| * Abnormal thyroid hormone level
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| * Caffeine, nicotine, alcohol toxicity and Illicit drugs
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| * Digoxin and electrolyte abnormalities
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| * Sympathomimetic drugs
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| * Stress and anxiety
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| * Preexisting heart condition, e.g. Congenital heart disease, rheumatic heart disease, cardiomyopathy and previous myocardial infarction
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| * Lung disease and hypoxia e.g. Chronic lung disease and infection
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| ==[[Paroxysmal supraventricular tachycardia screening|Screening]]==
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| ==[[Paroxysmal supraventricular tachycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
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| * In Absence of underlying heard disease, the PSVT prognosis is favorable.
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| * Rarely PSVT can cause myocardial infarction, congestive heart failure and even death.
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| ==Diagnosis==
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| [[Paroxysmal supraventricular tachycardia diagnostic study of choice|Diagnostic study of choice]] | [[Paroxysmal supraventricular tachycardia history and symptoms|History and Symptoms]] | [[Paroxysmal supraventricular tachycardiaphysical examination|Physical Examination]] | [[Paroxysmal supraventricular tachycardia laboratory findings|Laboratory Findings]] | [[Paroxysmal supraventricular tachycardia electrocardiogram|Electrocardiogram]] | [[Paroxysmal supraventricular tachycardia x ray|X-Ray Findings]] | [[Paroxysmal supraventricular tachycardia echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Paroxysmal supraventricular tachycardia CT scan|CT-Scan Findings]] | [[Paroxysmal supraventricular tachycardia MRI|MRI Findings]] | [[Paroxysmal supraventricular tachycardia other imaging findings|Other Imaging Findings]] | [[Paroxysmal supraventricular tachycardia other diagnostic studies|Other Diagnostic Studies]]
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| The clinical presentation is variable, ranging from asymptomatic to complicated palpitation.
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| === History: ===
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| * If present, history of previous self-limiting attacks.
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| * In some patients there is a past history of preexisting heart disease
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| === Symptoms: ===
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| * Asymptomatic
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| * Some experience episodes palpitations that starts and ends suddenly, may be associated with
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| * Presyncope, syncope,
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| * Lightheadedness, dizziness
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| * Dyspnea, Shortness of breath
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| * Diaphoresis and/or chest pain.
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| === Physical examination: ===
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| * In patients with no underlying disease, the patient is clinically free: If terminated episode of PSVT or in between attacks.
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| * Tachycardia: Regular, Rapid, abrupt onset, with or without abrupt termination.
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| * If present Hemodynamic instability and/or lung congestion. Both varies According to the presence of preexisting heart disease
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| ==Treatment== | | ==Treatment== |
| [[Paroxysmal supraventricular tachycardia medical therapy|Medical Therapy]] | [[Paroxysmal supraventricular tachycardia interventions|Interventions]] | [[Paroxysmal supraventricular tachycardia surgery|Surgery]] | [[Paroxysmal supraventricular tachycardia primary prevention|Primary Prevention]] | [[Paroxysmal supraventricular tachycardia secondary prevention|Secondary Prevention]] | [[Paroxysmal supraventricular tachycardia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Paroxysmal supraventricular tachycardia future or investigational therapies|Future or Investigational Therapies]] | | [[Paroxysmal supraventricular tachycardia medical therapy|Acute treatment]] | [[Paroxysmal supraventricular tachycardia surgery|Long term treatme]][[Psvt|nt]] [[Paroxysmal supraventricular tachycardia primary prevention|<nowiki>| Prevention</nowiki>]] |
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| PSVTs are managed according to underlying mechanisms and the clinical stability and frequency of episodes.
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| Hemodynamic unstability or resistance to other treatment modalities: Direct-current cardioversion
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| ==Case Studies== | | ==Case Studies== |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| | <references /> |