understanding supraventricular tachycardias...understanding supraventricular tachycardias ramin...
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Understanding SupraventricularTachycardias
Ramin Davoudi MD
Medical Director
Cardiac Arrhythmia Service
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Understanding SVT
• Disclosures:
• Speakers Bureau – Boston Scientific, Biotronik, Boehringer Ingelheim
• Research – Boston Scientific, Biotronik
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Understanding SVT
• Goals:
• Understand different mechanisms of SVT
• Differentiate SVT based on ECG clues
• Understand therapies for the various SVT’s
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Types of SVT
• AV nodal reentrant tachycardia (70%)
• AV reentrant tachycardia (20%)
• Atrial tachycardia (9%)
• Junctional tachycardia (1%)
• Atrial Flutter
• Atrial Fibrillation
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Long RP vs Short RP
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AVNRT
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AVNRT
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AVRT
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Atrial Tachycardia
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Atrial Tachycardia
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Understanding SVT
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Understanding SVT - Linkage
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Junctional Tachycardia
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Long RP vs Short RP
AVNRTJunctional Tachycardia
AVRTAtrial Tachycardia
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Atrial Flutter
• Typical
• Counterclockwise/clockwise
• Atypical
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Atrial Flutter
• 140-160 bpm
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Atrial Flutter - Typical
V1
II,III,AVF
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Atrial Flutter - Typical
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Atrial Flutter
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Atrial Flutter
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Atrial Fibrillation
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Atrial Fibrillation
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Atrial fibrillation
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Treatment
• Beta blockers
• Calcium Channel blockers
• Antiarrhythmic Medications
• Atrial fibrillation – Amiodarone, Sotalol, Dofetilide, Flecainide, Propafenone
• AVRT – Flecainide, Propafenone, Amiodarone
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Antiarrhythmics
• Sodium Channel Blockers
• IA – Disopyramide, Quinidine, Procainamide
• IB – Mexiletine, Lidocaine
• IC – Flecainide, Propafenone
Na
K
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Antiarrhythmics
• Potassium Channel Blockers
• Amiodarone
• Sotalol
• Tikosyn(Dofetilide)
• Dronaderone
Na
K
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Conclusion
• Mechanisms of SVT are few and simple
• Look for Clues with Long RP – Short RP
• Treatment is similar
• Know what is easy to ablate
• Thanks!