1. Supravetricular Tachyarrhythmias Part 2
Rey Vivo, MD
Assistant Professor of Medicine
Texas Tech University Health Sciences Center

2. Objectives Describe the AVNRT
Recognize and differentiate the Supraventricular Tachyarrhythmias
PRACTICE, PRACTICE, PRACTICE!!!

3. Review of last week Two most important aspects of arrhythmias:
The two mechanisms that
produce arrhythmias are:
Automaticity
(problems of impulse
formation)
2. Block or Reentry
conduction)
Two most important aspects of arrhythmias:
1. Their mechanism
2. Their site of origin

4. SVTs Accelerated Automaticity Reentrant Atrial Tachyarrhythmias
Sinus Tachycardia
Atrial Tachyarrhythmias
e.g. PAT with Block, MAT
3. Accelerated Junctional Rhythm
Reentrant Atrial Tachyarrhythmias
Atrial Flutter
Atrial Fibrillation
Reentrant Junctional Tachyarrhythmias
- The Atrioventricular Nodal and Bypass Tachycardias

5. RJT Reentrant Junctional Tachyarrhythmias
AVNRT – Atrioventricular Nodal Reentrant Tachycardia
Atrioventricular Bypass Tachycardia

6. AVNRT • Rate: 140 – 220 beats/minute
• Usually 1:1 atrial-ventricular association
• Every QRS has a P (concealed, fused or retrograde)

7. AVNRT

8. AVNRT

9. SVT Differentials SVT Rate Rhythm P wave Adenosine effect Sinus tach
100 - (220-age)
Regular
Discrete anterograde
P waves
Gradual slowing, then reaccelerates
AAR
“Not sinus”
antegrade P
Gradual slowing to reveal atrial activity
MAT
> 100
Irregular
> 3 different forms in 1 lead NA
AJR
Inverted, absent or after QRS
Flutter A:
V: <300
Regular or Reg. Irreg.
F waves
Fibrillation A:
V: slow to rapid
Irreg. Irreg.
f waves
AVNRT
(A:V 1:1)
Absent or discrete retrograde P waves
“Breaks” abruptly, converts to sinus

10. Narrow Complex Tachs Regular Irregular “Normal” ante Ps..ST
Abnormal Ps
Rate < 140……….AJR
Rate > 140
Ante P…………AAR
No or Retro P...AVNRT
F waves………….Flut
Irregular
Polymorphic Ps…..MAT
f waves…………….Fib
(Reg. irreg, F……...Flut)

11. Let’s practice! Bix rule
Whenever the P of an SVT is halfway between QRS complexes always suspect that an extra P is hiding within the QRS

12. EKG 1

13. EKG 2

14. EKG 3

15. EKG 4

16. EKG 5

17. EKG 6

18. EKG 7

19. EKG 8

20. EKG 9

21. EKG 10

22. The End