IN THE NAME OFGODIN THE NAME OFGOD SVTS.SAYAH

 All cardiac tachyarrhythmias are produced by: 1/disorders of impulse initiation :automatic 2/abnormalities of impulse conduction: re-entrant.

Clinical History and Physical Examination  Patients with paroxysmal arrhythmias are most often asymptomatic at the time of evaluation. Arrhythmia-related symptoms include palpitations; fatigue; lightheadedness; chest discomfort; dyspnea; presyncope; or, more rarely, syncope.

 With SVT, syncope is observed in approximately 15% of patients, usually just after initiation of rapid SVT or with a prolonged pause after abrupt termination of the tachycardia  Symptoms vary with the ventricular rate, underlying heart disease, duration of SVT, and individual patient perceptions.  Supraventricular tachycardia that is persistent for weeks to months and associated with a fast ventricular response may lead to a tachycardia-mediated cardiomyopathy

Diagnostic InvestigationsDiagnostic Investigations  A resting 12-lead ECG  An ambulatory 24-hour Holter recording  Implantable loop recorders may be helpful in selected cases  Exercise testing  Transesophageal atrial recordings

 Invasive electrophysiological investigation with subsequent catheter ablation may be used for diagnoses and therapy

SPECIFIC ARRHYTHMIASSPECIFIC ARRHYTHMIAS  A. Sinus Tachyarrhythmias  1. Physiological Sinus Tachycardia  2. Inappropriate Sinus Tachycardia  3. Postural Orthostatic Tachycardia Syndrome(autonomic dysfunction)  4. Sinus Node Re-entry Tachycardia

S.TAC.

B. Atrioventricular Nodal Reciprocating Tachycardia  is the most common form of PSVT.  It is more prevalent in females

AVNRT

C. Focal and Nonparoxysmal Junctional Tachycardia  1. Focal Junctional Tachycar  2. Nonparoxysmal Junctional Tachycardia

J.TAC.

D. Atrioventicular Reciprocating Tachycardia (Extra Nodal Accessory Pathways)  1. Sudden Death in WPW Syndrome and Risk  Stratification: The incidence of sudden cardiac death in patients with WPW syndrome: range from 0.15 to 0.39%, over 3- to 10-year follow-up

WPW

WPW

AVRT

E. Focal Atrial TachycardiasE. Focal Atrial Tachycardias  F. Macro–Re-entrant Atrial Tachycardia:  1. Isthmus-Dependent Atrial Flutter  2. Non–Cavotricuspid Isthmus-Dependent Atrial Flutter  G.ATRIAL FIBRILATION

AT

AFL

AF

Acute Management of Narrow QRS-Complex Tachycardia  vagal maneuvers  IV antiarrhythmic drugs  DC SHOCK

Wide-QRS tachycardiasWide-QRS tachycardias  1. preexisting bundle branch block;  2. functional bundle branch block (tachycardia- dependent phase 3 block);  3. ventricular pre-excitation;  4. aberrancy due to sodium channel-blocking antiarrhythmic drugs.  5.VT

WQT

Acute Management of Wide QRS- Complex Tachycardia  Immediate DC cardioversion is the treatment for hemodynamically unstable tachycardias  For pharmacologic termination of a stable wide QRS-complex tachycardia, IV procainamide and/or sotalol are recommended  Amiodarone is preferred, compared to procainamide and sotalol, in patients with impaired left ventricular (LV) function

IRREGULAR WIDE QRSIRREGULAR WIDE QRS  For termination of an irregular wide QRS-complex tachycardia (ie, pre-excited AF), DC cardioversion is recommended.  If the patient is hemodynamically stable, pharmacologic conversion using IV ibutilide, flecainide, or procainamide is appropriate.

AF + LBBBAF + LBBB

First degree avbFirst degree avb

Second degree avbSecond degree avb

CHB

PVC

VT

VF

THANKS FOR YOUR ATTENTIONTHANKS FOR YOUR ATTENTION