Download - Understanding Supraventricular Tachycardias...Understanding Supraventricular Tachycardias Ramin Davoudi MD Medical Director Cardiac Arrhythmia Service. Understanding SVT • Disclosures:

Understanding SupraventricularTachycardias

Ramin Davoudi MD

Medical Director

Cardiac Arrhythmia Service

Understanding SVT

• Disclosures:

• Speakers Bureau – Boston Scientific, Biotronik, Boehringer Ingelheim

• Research – Boston Scientific, Biotronik

Understanding SVT

• Goals:

• Understand different mechanisms of SVT

• Differentiate SVT based on ECG clues

• Understand therapies for the various SVT’s

Types of SVT

• AV nodal reentrant tachycardia (70%)

• AV reentrant tachycardia (20%)

• Atrial tachycardia (9%)

• Junctional tachycardia (1%)

• Atrial Flutter

• Atrial Fibrillation

Long RP vs Short RP

AVRT

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCKWcu9W1-cgCFQdiJgod7WgN5Q&url=http://what-when-how.com/acp-medicine/supraventricular-tachycardia-part-1/&bvm=bv.106674449,d.eWE&psig=AFQjCNEg5WKqIui0DJeyrQI-qNubKKpvZA&ust=1446817533352798

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCKWcu9W1-cgCFQdiJgod7WgN5Q&url=http://what-when-how.com/acp-medicine/supraventricular-tachycardia-part-1/&bvm=bv.106674449,d.eWE&psig=AFQjCNEg5WKqIui0DJeyrQI-qNubKKpvZA&ust=1446817533352798

Atrial Tachycardia

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCJeO4au8-cgCFUhUPgodN0sA7g&url=https://ceufast.com/course/congestive-heart-failure-the-essence-of-heart-failure&bvm=bv.106674449,d.eWE&psig=AFQjCNHNUo8gFUGhLzmlt_y3Tk4rxg9YfQ&ust=1446819338699714

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCJeO4au8-cgCFUhUPgodN0sA7g&url=https://ceufast.com/course/congestive-heart-failure-the-essence-of-heart-failure&bvm=bv.106674449,d.eWE&psig=AFQjCNHNUo8gFUGhLzmlt_y3Tk4rxg9YfQ&ust=1446819338699714

Atrial Tachycardia

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMSRkoaz-cgCFcYzJgodrOgN3w&url=http://www.ipej.org/1001/namboodiri.htm&bvm=bv.106674449,d.eWE&psig=AFQjCNHurJ_zMS07-Mt_vHGj_aVTVZ9kNw&ust=1446816867583797

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMSRkoaz-cgCFcYzJgodrOgN3w&url=http://www.ipej.org/1001/namboodiri.htm&bvm=bv.106674449,d.eWE&psig=AFQjCNHurJ_zMS07-Mt_vHGj_aVTVZ9kNw&ust=1446816867583797

Understanding SVT

Understanding SVT - Linkage

Junctional Tachycardia

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCJCGmtC_-cgCFYjKPgodmPQC6Q&url=https://www.studyblue.com/notes/note/n/lab-31-intrinsic-conduction-system-pg458/deck/8829723&bvm=bv.106674449,d.eWE&psig=AFQjCNHUkyXLYNLLnPm-z_zOsO6aL0xBvw&ust=1446820207927769

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCJCGmtC_-cgCFYjKPgodmPQC6Q&url=https://www.studyblue.com/notes/note/n/lab-31-intrinsic-conduction-system-pg458/deck/8829723&bvm=bv.106674449,d.eWE&psig=AFQjCNHUkyXLYNLLnPm-z_zOsO6aL0xBvw&ust=1446820207927769

Long RP vs Short RP

AVNRTJunctional Tachycardia

AVRTAtrial Tachycardia

Atrial Flutter

• Typical

• Counterclockwise/clockwise

• Atypical

Atrial Flutter

• 140-160 bpm

Atrial Flutter - Typical

V1

II,III,AVF

Atrial Flutter - Typical

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCNqn6dy0-cgCFQHnJgodcXgFxg&url=http://www.hcplive.com/journals/family-practice-recertification/2015/february2015/palpatations-and-light-headedness-another-typical-day&bvm=bv.106674449,d.eWE&psig=AFQjCNHkBXDn8fR3UJRSO601eT7CsP6L4A&ust=1446817312008526

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCNqn6dy0-cgCFQHnJgodcXgFxg&url=http://www.hcplive.com/journals/family-practice-recertification/2015/february2015/palpatations-and-light-headedness-another-typical-day&bvm=bv.106674449,d.eWE&psig=AFQjCNHkBXDn8fR3UJRSO601eT7CsP6L4A&ust=1446817312008526

Atrial Flutter

Atrial Fibrillation

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMTs5d-z-cgCFYzvJgodAL0BvQ&url=http://www.nature.com/nrcardio/journal/v7/n3/fig_tab/nrcardio.2009.232_F1.html&bvm=bv.106674449,d.eWE&psig=AFQjCNGNSDjkezWMg8xebWJfSWN1bKb1tA&ust=1446817067412433

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMTs5d-z-cgCFYzvJgodAL0BvQ&url=http://www.nature.com/nrcardio/journal/v7/n3/fig_tab/nrcardio.2009.232_F1.html&bvm=bv.106674449,d.eWE&psig=AFQjCNGNSDjkezWMg8xebWJfSWN1bKb1tA&ust=1446817067412433

Atrial Fibrillation

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMChxPSz-cgCFQY6Jgodn34AUg&url=http://www.azheartrhythmcenter.com/resources/procedure-instructions/atrial-fibrillation-ablation/&bvm=bv.106674449,d.eWE&psig=AFQjCNGNSDjkezWMg8xebWJfSWN1bKb1tA&ust=1446817067412433

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMChxPSz-cgCFQY6Jgodn34AUg&url=http://www.azheartrhythmcenter.com/resources/procedure-instructions/atrial-fibrillation-ablation/&bvm=bv.106674449,d.eWE&psig=AFQjCNGNSDjkezWMg8xebWJfSWN1bKb1tA&ust=1446817067412433

Atrial fibrillation

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCIeQuoW0-cgCFcfhJgodxYcL5Q&url=https://www.youtube.com/watch?v=MYLhyhHAecE&bvm=bv.106674449,d.eWE&psig=AFQjCNGNSDjkezWMg8xebWJfSWN1bKb1tA&ust=1446817067412433

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCIeQuoW0-cgCFcfhJgodxYcL5Q&url=https://www.youtube.com/watch?v=MYLhyhHAecE&bvm=bv.106674449,d.eWE&psig=AFQjCNGNSDjkezWMg8xebWJfSWN1bKb1tA&ust=1446817067412433

Treatment

• Beta blockers

• Calcium Channel blockers

• Antiarrhythmic Medications

• Atrial fibrillation – Amiodarone, Sotalol, Dofetilide, Flecainide, Propafenone

• AVRT – Flecainide, Propafenone, Amiodarone

Antiarrhythmics

• Sodium Channel Blockers

• IA – Disopyramide, Quinidine, Procainamide

• IB – Mexiletine, Lidocaine

• IC – Flecainide, Propafenone

Na

K

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCK_H7qPR-cgCFYFAPgodAeAA7A&url=http://lifeinthefastlane.com/toxicology-conundrum-044/&bvm=bv.106674449,d.eWE&psig=AFQjCNHUBAdeWcTTTJ98VaYAoOQbvt9uRA&ust=1446825000634091


Antiarrhythmics

• Potassium Channel Blockers

• Amiodarone

• Sotalol

• Tikosyn(Dofetilide)

• Dronaderone

Na

K



Conclusion

• Mechanisms of SVT are few and simple

• Look for Clues with Long RP – Short RP

• Treatment is similar

• Know what is easy to ablate

• Thanks!

Download - Understanding Supraventricular Tachycardias...Understanding Supraventricular Tachycardias Ramin Davoudi MD Medical Director Cardiac Arrhythmia Service. Understanding SVT • Disclosures:

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