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Review
. 2014 Winter;14(4):586-95.

Current trends in supraventricular tachycardia management

Daniel Sohinki  1 , Owen A Obel  2
Affiliations
Review

Current trends in supraventricular tachycardia management

Daniel Sohinki et al. Ochsner J. 2014 Winter.

Abstract

Background: Supraventricular tachycardia (SVT) is a general term describing a group of arrhythmias whose mechanism involves or is above the atrioventricular node. The mechanisms of most forms of SVT have been elucidated, and pharmacologic and invasive therapies have evolved simultaneously.

Methods: We provide a brief overview of the mechanisms, classifications, and electrocardiographic characteristics of different SVTs and describe current trends in noninvasive and invasive therapies.

Results: The term SVT encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each SVT is important in determining management at the bedside and in the electrophysiology laboratory.

Conclusion: In the acute setting, vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter-based radiofrequency ablation has revolutionized therapy for many SVTs, and newer techniques have significantly improved ablation efficacy and reduced periprocedural complications and procedure times. Cryoablation is currently being investigated as an alternative form of energy delivery, although the long-term effectiveness of this procedure currently limits its use for many SVTs.

Keywords: Ablation–catheter; ablation techniques; arrhythmias–cardiac; electric countershock; tachycardia–supraventricular.

PubMed Disclaimer

Conflict of interest statement

Disclaimer: Owen A. Obel, MD, is a consultant for Medtronic and is on the speaker bureau for Medtronic and Biotronik. Otherwise the authors have no financial or proprietary interest in the subject matter of this article.

Figures

Figure 1.
Figure 1.
Subtypes of supraventricular tachycardia. The figures demonstrate the mechanisms of arrhythmia. Atrioventricular nodal reentrant tachycardia (far left) and atrioventricular reciprocating tachycardia (middle) are exclusively reentrant in mechanism. Atrial arrhythmias include atrial tachycardia, atrial flutter, and fibrillation and may be because of reentry, automaticity (star), or triggered activity (T) (far right). Enhanced automaticity and triggered activity may cause the initiation of reentry.
Figure 2.
Figure 2.
A 12-lead electrocardiogram (ECG) showing a short PR interval and slurred R wave upstroke (delta wave) characteristic of the Wolff-Parkinson-White pattern. The pattern of preexcitation on this particular ECG is suggestive of a left lateral accessory pathway.
Figure 3.
Figure 3.
A 12-lead electrocardiogram showing a long RP tachycardia. The RP interval (A) is longer than the PR interval, with inverted P waves in the inferior leads. The differential diagnosis for this rhythm includes atypical (fast-slow) atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia with a slowly conducting accessory pathway, and certain forms of atrial tachycardia.
Figure 4.
Figure 4.
A 12-lead electrocardiogram of atrioventricular nodal reentrant tachycardia (AVNRT). The presence of the pseudo S wave in lead II (A) is highly suggestive of AVNRT as the mechanism of supraventricular tachycardia, particularly if the rhythm terminates with adenosine.
Figure 5.
Figure 5.
A 12-lead electrocardiogram (ECG) showing preexcited atrial fibrillation. The ECG shows an irregular, wide complex tachycardia with QRS complexes that are similar but with varying morphologies.
Figure 6.
Figure 6.
Three-dimensional electroanatomical map (ESI system, St. Jude Medical) demonstrating a diverticulum of the coronary sinus containing a posteroseptal accessory pathway. A: ablation catheter electrograms. B: coronary sinus electrograms. The electrograms show 2 leads of the surface electrocardiogram with disappearance of the delta wave on the third beat and corresponding intracardiac electrograms below.
Figure 7.
Figure 7.
Fluoroscopic catheter positions during typical atrial flutter ablation. A: around the tricuspid annulus (Halo catheter). B: in the coronary sinus. C: tip of the ablation catheter positioned on the cavotricuspid isthmus. Catheters A and B measure isthmus block. Ablation is performed with the catheter looping back on itself as in this example or with the catheter flat against the isthmus.
See this image and copyright information in PMC

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