Tachycardia: Difference between revisions

===AV Nodal Re-entry Tachycardia (AVNRT)===

====Pathophysiology:====  

AVNRT is a regular arrhythmia relying only on the dual AV-physiology for its maintenance. The AV-node has two pathways; a fast pathway with fast conduction times and a slow pathway with exhibits slow conduction. The fast pathway has a longer refractory period than the slow pathway. Due to these characteristics re-entry formation is possible. Normally the impulse from the atria is conducted through the fast pathway to the ventricle. The impulse also travels through the slow pathway, but reaches a refractory ending of the AV-node (as the fast pathway already has conducted the impulse and activated this part of the AV-node). When an extra premature atrial contraction occurs it encounters a refractory fast-pathway (which has a longer refractory period). It enters the slow pathway and when it reaches the end of this pathway it can conduct to the (now restored) end of the AV-node to the ventricles and back into the fast pathway. The result is a ventricular activation with a retrograde P-wave. If the slow pathway is restored when the impulse reaches the end (atrial side) of the fast pathway, the impulse can re-enter the slow-pathway and a re-entry mechanism is established. This is usually the mechanism of an AVNRT and is called a typical AVNRT and is found in 90% of the patient with an AVNRT. There exists two other form of AVNRT that take a different route through the AV-node. Firstly there is an atypical AVNRT in which the impulse travels through the fast pathway and returns through the slow pathway. The result of this AVNRT is a retrograde P-wave which appears far from the QRS complex. Finally there is a rare AVNRT which in patients with two slow pathways. The impulse enters en re-enters through a slow pathway.