Paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia Microchapters
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Epidemiology and Demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Noha Elzeiny, M.B.B.Ch, M.Sc.[2]

Synonyms and keywords:PSVT, Narrow QRS complex tachycardia, Atrioventricular nodal reentrant tachycardia, AVNRT, Supraventricular arrhythmia, Supraventricular tachycardia, Tachyarrhythmia, Arrhythmia.

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.

Historical Perspective

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.

Classification

SVTs are classified based on the origin and regularity of the rhythm. i

Atrial in origin

·        Sinus tachycardia

·        Inappropriate sinus tachycardia

·        Sinoatrial nodal reentrant tachycardia

·        Atrial flutter

·        Atrial fibrillation

·        Multi atrial focal tachycardia

AV nodal in origin:

·        Junctional tachycardia

·        Atrioventricular nodal reentrant tachycardia

·        Atrioventricular reentrant tachycardia

Regular SVT:

·        All tachycardia originating from the AV node

·        Sinus tachycardia

·        Inappropriate sinus tachycardia

·        Sinoatrial nodal reentrant tachycardia

·        Atrial flutter

Irregular SVT

·        Multifocal atrial tachycardia

·        Atrial flutter with variable block

·        Atrial fibrillation

Pathophysiology

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.

Causes

Reentry circuits  are the most common cause

a.    About 60% are due to  AVNRT either within

·        AV node

·        Perinodal atrial tissue.

b.    30% are due to Atrioventricular reciprocating tachycardia (AVRT)

Extranodal accessory pathway connecting the atrium and ventricle, e.g. Wolff-Parkinson-White syndrome (WPW).

c.    10% are due to pathways within or around the sinus node:

·        Focal atrial tachycardia

·        Intra atrial reentrant tachycardia (IART)

·        Sinoatrial nodal reentrant tachycardia (SANRT)

d.    Other rare causes (Rare in adults, but can represent a larger portion of PSVTs in children) are due to

·        Junctional ectopic tachycardia

·        Non-paroxysmal junctional tachycardia

Differentiating Paroxysmal supraventricular tachycardia from other Diseases

Symptoms due to PSVT are often misdiagnosed as psychological disease e.g. panic attacks, stress, anxiety, or depression delaying referral for ablation.

Epidemiology and Demographics

• In the United States, 1.1 to 1.4 million individuals before the age of 65 are affected annually

• Sporadic and unpredictable

• Slightly higher in males than females

• Positively correlated with age
  

Risk Factors

Any condition or drug that increases automaticity or triggers activity including:

• Abnormal thyroid hormone level
• Caffeine, nicotine, alcohol toxicity and Illicit drugs
• Digoxin and electrolyte abnormalities
• Sympathomimetic drugs
• Stress and anxiety
• Preexisting heart condition, e.g. Congenital heart disease, rheumatic heart disease, cardiomyopathy and previous myocardial infarction
• Lung disease and hypoxia e.g. Chronic lung disease and infection

Diagnosis

Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Interventions | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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