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Tachycardia: Difference between revisions
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It is a fast regular small complex tachycardia with a frequency of 180-250 bpm. It is more common in women than in men (3:1) and has a sudden onset. Palpitation are experienced due to the fast regular heartbeat. The Frog sign can be observed; neck vein pulsations which occur due to simultaneous contraction of the atria and ventricles. The atria cannot empty into the ventricles and therefore expulse their contents into the venous circulation. A typical AVNRT can be diagnosed on the ECG by a RP distance of 100ms. The P wave is sometimes hidden in the QRS complex or appears directly after the QRS complex. An atypical AVNRT has a retrograde P appearing far away from the QRS, as it has to travel through the slow pathway. A registration of the onset can often be quite helpful in establishing the diagnosis AVNRT. | It is a fast regular small complex tachycardia with a frequency of 180-250 bpm. It is more common in women than in men (3:1) and has a sudden onset. Palpitation are experienced due to the fast regular heartbeat. The Frog sign can be observed; neck vein pulsations which occur due to simultaneous contraction of the atria and ventricles. The atria cannot empty into the ventricles and therefore expulse their contents into the venous circulation. A typical AVNRT can be diagnosed on the ECG by a RP distance of 100ms. The P wave is sometimes hidden in the QRS complex or appears directly after the QRS complex. An atypical AVNRT has a retrograde P appearing far away from the QRS, as it has to travel through the slow pathway. A registration of the onset can often be quite helpful in establishing the diagnosis AVNRT. | ||
====Management:==== | ====Management:==== | ||
Termination of acute episodes is possible by vagal maneuvers (blowing on the wrist, carotid sinus massage) or medication (adenosine, verapamil, diltiazem). If vagal maneuvers or medication fail ECV can be performed. Catheter ablation can be the treatment of first choice in AVNRT. Electrophysiological studies can demonstrate dual AV-node physiology and evoke the arrhythmia in these patients. Selective ablation of the slow pathway has a high success rate (up to 98%) and the risk of inducing AV-block is low (<0,5%). Long term medical therapy can be initiated in patients not suitable for catheter ablation, or who do not desire a catheter ablation. Calcium channel blocker, beta-blockers and digoxin are used as first option or in a pill in the pocket approach.<cite>Alboni</cite> Other options are class IC or class III anti-arrhythmic drugs. | Termination of acute episodes is possible by vagal maneuvers (blowing on the wrist, carotid sinus massage) or medication (adenosine, verapamil, diltiazem).<cite>Akhtar</cite> If vagal maneuvers or medication fail ECV can be performed. Catheter ablation can be the treatment of first choice in AVNRT. Electrophysiological studies can demonstrate dual AV-node physiology and evoke the arrhythmia in these patients. Selective ablation of the slow pathway has a high success rate (up to 98%) and the risk of inducing AV-block is low (<0,5%).<cite>Clague</cite> Long term medical therapy can be initiated in patients not suitable for catheter ablation, or who do not desire a catheter ablation. Calcium channel blocker, beta-blockers and digoxin are used as first option or in a pill in the pocket approach.<cite>Alboni</cite> Other options are class IC or class III anti-arrhythmic drugs. | ||
===AV Re-entry Tachycardia (AVRT)=== | ===AV Re-entry Tachycardia (AVRT)=== | ||