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  • Understanding Supraventricular Tachycardias

    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

  • AVNRT

  • AVNRT

  • 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

    AVNRT Junctional Tachycardia

    AVRT Atrial 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 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 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

    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 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

  • 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!

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