Supraventricular Tachycardia

Abstract

Supraventricular tachycardias (SVTs) comprise a group of arrhythmias for which the atria and/or atrioventricular (AV) node are integral to sustaining the rhythm. These arrhythmias typically have a benign natural history but account for a considerable proportion of patients presenting with symptoms including palpitations, shortness of breath, chest discomfort, dizziness, and, on occasion, syncope. They affect a broad range of patients, from young, otherwise healthy adults and children to elderly patients with multiple comorbidities. Although medical management with AV nodal blocking medications or antiarrhythmic medications is a reasonable first-line approach, catheter ablation is a definitive, most often curable option that has minimal risk and offers the chance of avoiding long-term medications. This chapter covers the epidemiology, diagnosis, and management of SVTs, which include atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial tachycardia (AT), and others (atrial flutter, inappropriate sinus tachycardia, and junctional tachycardia). Atrial fibrillation, which is more prevalent than all other SVTs combined, are discussed elsewhere. Figures describe the differential diagnosis of tachycardia with narrow and wide QRS complexes, the relationship between the response to intravenous adenosine and the cause of tachycardia, the mechanism of tachycardia induction in patients with dual AV node conduction pathways, and the management of atrial flutter. Electrocardiograms illustrate features of various forms of SVT. This review contains 11 highly rendered figures (included 6 twelve-lead ECGs), 1 table, and 69 references.