Supravetricular Tachyarrhythmias Part 1 Rey Vivo, MD Assistant 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

May originate from any of the pacemaker cells “Ectopic” – any rhythm that comes from any other site than the SA node SiteTermRate Range SA nodeSinus tachycardia bpm AtriaAtrial tachycardia bpm Common bundleAJR Bundle branchesAVR50-110

Sinus Tachycardia Tips: 1.Max. rate: 220 – age 2.Discrete, antegrade P waves 3.Short PR interval 4.Normal QRS duration

Sinus Tachycardia

Atrial Tachycardias 1.Accelerated atrial rhythm 2.Paroxysmal Atrial Tachycardia with Block 3.Multifocal Atrial Tachycardia

Accelerated Atrial Rhythm

PAT with Block

Wandering Atrial Pacemaker- Multifocal Atrial Tachycardia Spectrum

MAT

Acelerated Junctional Rhythm

Reentrant Atrial Tachyarrhythmias

Reentrant Atrial Tachs Atrial flutterAtrial fibrillation Single circuit, Uniform F waves Multiple circuits, Multiform f waves

Atrial Flutter Flutter waves best seen on inferior leads (II, III, aVF) and V1

Atrial Flutter

Atrial Fibrillation Fibrillatory waves best seen in inferior waves and V1

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

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The End (Part 2 next Tuesday)