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SupravetricularTachyarrhythmias
Part 1
Rey Vivo, MDAssistant Professor of Medicine
Texas Tech University Health Sciences Center
Objectives
• Define the mechanisms of arrhythmias
• Understand the relevance of the site of origin to the arrhythmia
• Recognize and differentiate the Supraventricular Arrhythmias
“You see only what you look for,
you recognize only what you know.”
Basics
• Two most important aspects of arrhythmias:
1. Their mechanism
2. Their site of origin
The two mechanisms that produce arrhythmias are:
1. Automaticity (problems of impulse formation)
2. Block or Reentry(problems of impulse
conduction)
The two mechanisms that produce arrhythmias are:
1. Automaticity (problems of impulse formation)
2. Block or Reentry(problems of impulse
conduction)
SVTs
• Accelerated Automaticity
• Reentrant Atrial Tachyarrhythmias
• Reentrant Junctional Tachyarrhythmias- The Atrioventricular Nodal and Bypass Tachycardias
Accelerated Automaticity
1. Sinus Tachycardia
2. Atrial Tachyarrhythmias
e.g. PAT with Block, MAT
3. Accelerated Junctional Rhythm
Reentrant Atrial Tachs
1. Atrial Flutter
2. Atrial Fibrillation
Accelerated Automaticity
Accelerated Automaticity
• May originate from any of the pacemaker cells
• “Ectopic” – any rhythm that comes from any other site than the SA node
Site Term Rate Range
SA node Sinus tachycardia 100-200 bpm
Atria Atrial tachycardia 100-200 bpm
Common bundle AJR 60-130
Bundle branches AVR 50-110
Sinus Tachycardia
Tips:1. Max. rate: 220 – age2. Discrete, antegrade P waves3. Short PR interval4. Normal QRS duration
Sinus Tachycardia
Atrial Tachycardias
1. Accelerated atrial rhythm
2. Paroxysmal Atrial Tachycardia with Block
3. Multifocal Atrial Tachycardia
Accelerated Atrial Rhythm
Accelerated Atrial Rhythm
PAT with Block
PAT with Block
Wandering Atrial Pacemaker-Multifocal Atrial Tachycardia Spectrum
MAT
Acelerated Junctional Rhythm
Acelerated Junctional Rhythm
Reentrant Atrial Tachyarrhythmias
Reentrant Atrial Tachs
• Atrial flutter • Atrial fibrillation
Single circuit,Uniform F waves
Multiple circuits,Multiform f waves
Atrial Flutter
Flutter waves best seen oninferior leads (II, III, aVF) and V1
Atrial Flutter
Atrial Flutter
Atrial Flutter
Atrial Fibrillation
Fibrillatory waves best seen ininferior waves and V1
Atrial Fibrillation
Atrial Fibrillation
Let’s practice!
We make most mistakes because of
failure to apply reason and logic,
not because of ignorance.
Barney Marriott, MD
EKG expert
Author, Practical Electrocardiography
EKG 1
EKG 2
EKG 3
EKG 4
EKG 5
EKG 6
EKG 7
EKG 8
EKG 9
The End(Part 2 next Tuesday)