Different Types Of Supraventricular Tachycardias Research Articles

A novel diagnostic algorithm for the identification of different supraventircular tachycardias

Abstract Background Supraventricular arrhythmias represent a diagnostic challenge. Its prevalence and causes are not well established, given the impossibility to differentiate between all different types of supraventricular tachycardias (SVT). There are several supraventricular arrhythmias, but we focus on: 1) Atrial tachycardia (AT) 2) Junctional tachycardia (JT) 3) Atrial fibrillation (AF) 4) Atrial flutter (AA) 5) Atrioventricular nodal reentrant tachycardia (AVNRT), and 6) Atrioventricular reentrant tachycardia (AVRT). The electrocardiographic diagnosis is based on the presence of P-waves, its morphology and relationship with the QRS complex, and the relationship between the atrial and ventricular frequency. Purpose The purpose of this study was to create a helpful clinical tool that could serve the physician as a guide to determine a diagnosis and initial treatment. Additionally, we wanted to establish the sensitivity and specificity of the algorithm. Methods It is a diagnostic test study. We include 190 electrocardiograms of different SVT of patients undergoing electrophysiological studies. The data consists of 760 observations from two different readings of the electrocardiograms. Results 104 of 112 AF, were correctly identified using the algorithm, with a sensitivity and specificity of 92.9% and 99.1%, respectively (95% CI: 0.86–0.96). 76 of 760 were AA, and 62 were correctly diagnosed, with a sensitivity and specificity of 81.6% and 95.5%, respectively (95% CI 0.71–0.88). 50 of the 72 AT were correctly classified, with a sensitivity of 69.4% and specificity of 97.4% (95% CI 0.58–0.78). 99 of 152 AVNRT were identified with a sensitivity and specificity of 64.5% and 87%, respectively (95% CI 0.84–0.89). 254 of 344 AVRT were diagnosed correctly with a sensitivity of 73.8% and specificity of 88.2% (95% CI 0.68–0.78). Finally, 1 of 4 JT were identified, with a sensitivity and specificity of 25% and 99.1% respectively (95% CI 0.04–0.69). Conclusion The algorithm is an excellent diagnostic tool to identify atrial flutter, atrial fibrillation and atrioventricular reentrant tachycardia. SVT algorithm Funding Acknowledgement Type of funding source: None

The Symptom Checklist: Frequency and Severity Scale – translation and psychometric properties of the Swedish version

The Symptom Checklist: Frequency and Severity Scale (SCL) is a symptom-specific questionnaire that measures the patient’s perception of the frequency and severity of arrhythmia-related symptoms. Worldwide, the SCL is one of the most used symptom-specific questionnaires for this purpose. Until now, there has not been a valid Swedish translation of the SCL. This study aimed to translate the SCL into Swedish and test the face, content and construct validity of the translated version. The questionnaire was translated using the WHO’s recommendations for translation. Using the ‘think aloud method’, we gathered data from 12 patients regarding the intelligibility of the questions. Using exploratory factor analysis (EFA), we evaluated the face validity, construct validity and internal consistency properties of the questionnaire. The study included 646 patients with different types of supraventricular tachycardia, atrial fibrillation (AF) atrial flutter (AFL), atrioventricular reentrant tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), and ectopic atrial tachycardia (EAT). Translation and face validity were found to be acceptable. Construct validity evaluated using EFA and principal component analysis with varimax rotation identified four factors with eigenvalues greater than 1 and factor loading equal to or greater than 0.364, accounting for 58% and 53% of the variance in the frequency scale and the severity scale, respectively. Reliability evaluation revealed high internal consistency. For both the frequency and severity scale, the Cronbach’s alpha coefficient was 0.88. Our results show evidence that the Swedish version of the SCL has good psychometric properties according to face and construct validity and internal consistency for patients with AF, AFL, AVRT, AVNRT and EAT, and is reproducible and valid.

Change in Atrial Activation Pattern during Ablation of Atrial Flutter

Different types of supraventricular tachycardia have been reported in patients with history of surgical repair of Tetralogy of Fallot. This report presents appearance of focal atrial tachycardia during radiofrequency ablation of the cavotricuspid isthmus

Carotid sinus hypersensitivity in an elderly patient with recurrent syncope and two different types of supraventricular tachycardias

Carotid sinus hypersensivity syndrome also known as Bishop's syndrome is an uncommon cause of syncope. Carotid sinus hypersensitivity may be an important cause of syncope even in patients thought to have other causes of syncope. We report a patient who presented with syncope and had supraventricular tachycardia documented on Holter monitor. Patient subsequently underwent diagnostic EP study and was inducible for two different types of tachycardias that obviously were not the cause of syncope. He finally had long hemodynamically significant pauses on carotid sinus massage.

A new algorithm for the initial evaluation and management of supraventricular tachycardia

Interpretations by physicians and those generated by electrocardiograph computer softwares have poor ability to recognize different types of supraventricular tachycardia (SVT). Therefore, we developed and tested a new SVT algorithm based on easily identifiable morphological characteristics and a simple dichotomous yes/no format regarding initial electrocardiographic manifestation and response pattern. The algorithm was then tested by medical house staff during the initial evaluation of 50 adult ED and cardiac intensive care unit patients suspected of having SVT. For a wide representation of SVTs, the new algorithm gave an overall diagnostic accuracy rate of 90%. Adenosine use was limited to 54% of the cases. No patient developed hemodynamic instability after algorithm-dictated interventions were carried out. Electrocardiograph computer-generated diagnoses correctly identified the specific type of SVT in 38% of the cases. This study shows the effectiveness of the proposed new algorithm in the rapid bedside evaluation and management of SVTs and confirms that computer-generated diagnoses are unreliable.

25 years of insights into the mechanisms of supraventricular arrhythmias

The introduction of programmed electrical stimulation of the heart and intracardiac activation mapping 35 years ago made it possible to study the site of origin or pathway of a supraventricular tachycardia and to gain insight into the tachycardic mechanism. Information from these studies has been the basis for the development of new therapies, like arrhythmia surgery, antitachycardia pacing, and catheter ablation. The correlation of intracardiac findings with the 12-lead ECG during the tachycardia resulted in the recognition of characteristic ECG patterns for the different types of supraventricular tachycardias. Currently, gross localization of the site of origin of the arrhythmia is based on the 12-lead ECG during the arrhythmia with fine tuning using intracardiac activation mapping and pacing. These developments during the past 3 decades make accurate arrhythmia diagnosis possible and allow us to offer curative therapies to many of patients suffering from a supraventricular tachycardia.

Twenty-five years of insights into the mechanisms of supraventricular arrhythmias.

The introduction of programmed electrical stimulation of the heart and intracardiac activation mapping 35 years ago made it possible to study the site of origin or the pathway of a supraventricular tachycardia and to obtain insight into the mechanism of the tachycardia. Information from these studies has been the basis for the development of new therapies, such as arrhythmia surgery, antitachycardia pacing, and catheter ablation. Correlation of intracardiac findings with the 12-lead ECG recorded during the tachycardia resulted in the recognition of ECG patterns characteristic of the different types of supraventricular tachycardias. Currently, gross localization of the site of origin of the arrhythmia is based on the 12-lead ECG recorded during the arrhythmia, with fine-tuning using intracardiac activation mapping and pacing. These developments during the past 3 decades have made accurate arrhythmia diagnosis possible and allow us to offer curative therapies to many of our patients with a supraventricular tachycardia.

25 years of insights into the mechanisms of supraventricular arrhythmias.

The introduction of programmed electrical stimulation of the heart and intracardiac activation mapping 35 years ago made it possible to study the site of origin or pathway of a supraventricular tachycardia and to gain insight into the tachycardic mechanism. Information from these studies has been the basis for the development of new therapies, like arrhythmia surgery, antitachycardia pacing, and catheter ablation. The correlation of intracardiac findings with the 12-lead ECG during the tachycardia resulted in the recognition of characteristic ECG patterns for the different types of supraventricular tachycardias. Currently, gross localization of the site of origin of the arrhythmia is based on the 12-lead ECG during the arrhythmia with fine tuning using intracardiac activation mapping and pacing. These developments during the past 3 decades make accurate arrhythmia diagnosis possible and allow us to offer curative therapies to many of patients suffering from a supraventricular tachycardia.

Acute results of transvenous cryoablation of supraventricular tachycardia (atrial fibrillation, atrial flutter, Wolff-Parkinson-White syndrome, atrioventricular nodal reentry tachycardia).

Radiofrequency (RF) catheter ablation currently is used for treatment of cardiac arrhythmias. Although the success rate is high for almost all supraventricular tachycardias (SVT), this technique has some drawbacks, especially when pulmonary veins (PV) are targeted for treatment of atrial fibrillation (AF). Additionally, new techniques for isolation of the PVs have the drawback that they can be used only for PV isolation and not for routine treatment of other SVTs. The aim of this study was to report on the safety and efficacy of a new cryoablation system for treatment of all SVTs. Forty-nine patients with SVT (38 men; age 48 years, range 23-76) were enrolled in the study. Five patients were withdrawn from the study before they underwent cryoablation. The remaining 44 patients were treated with cryoablation (22 AF, 15 atrial flutter, 3 accessory pathway, 2 AV nodal reentrant tachycardia, 1 AV junction ablation for permanent AF, 1 atrial tachycardia). Cryoablation was performed with the CryoCor cryoablation system, which uses a precooling system and N2O as a refrigerant. The number of freezes applied varied according to the index arrhythmia treated. Successful isolation of PVs was performed in 20 of (96%) 21 AF patients and 53 of 55 veins. The overall acute success was 98% (43/44). Fifty-three PVs were isolated (2.5/patient). The success rate was 100% (23/23) for right-sided procedures. The average and nadir temperatures reached in right-sided and left-sided procedures were -77 degrees C and -80 degrees C and -75 degrees C and -78 degrees C, respectively. No acute PV stenosis was seen. This novel cryoablation system appears to be safe and can successfully treat different types of SVTs, including AF. Isolation of PVs is possible without producing stenosis. Despite the high blood flow in the right atrial isthmus and PVs, bidirectional conduction block can be achieved.

ROLE OF THE SURFACE ELECTROCARDIOGRAM IN THE DIAGNOSIS OF PATIENTS WITH SUPRAVENTRICULAR TACHYCARDIA

In this era of interventional electrophysiology, the accuracy of the electrocardiogram in diagnosis of supraventricular tachycardia could be improved by detailed endocardial mapping and confirmed by results of radiofrequency catheter ablation. This article describes the electrocardiographic characteristics for different types of supraventricular tachycardia: atrial fibrillation, atrial flutter, atrial tachycardia, atrioventricular reciprocating tachycardia using an accessory pathway, and atrioventricular node reentrant tachycardia. Several limitations, including the identification of P wave morphologies and polarities and separation between the terminal part of T wave and P wave during tachycardia, should be resolved before an accurate algorithm of the 12-lead surface electrocardiogram is developed for the diagnosis of supraventricular tachycardia.

Age at onset and gender of patients with different types of supraventricular tachycardias

Sex differences between certain types of arrhythmias have been reported. For example the Wolff-Parkinson- White syndrome is more frequent in male than female subjects. 1 Atrioventricular (AV) nodal tachycardia has been found to occur more frequently in female subjects. 2 Little is known about the age at onset of different types of supraventricular tachycardias. The purpose of this study was twofold: (1) to obtain insight into a possible relation between gender of patient and type of supraventricular tachycardia, and (2) to look for possible differences in age at the time of the first arrhythmic event in relation to the type of arrhythmia. The following 3 groups of patients were studied: those with atrial tachycardia, AV nodal tachycardia and tachycardias in the presence of an accessory AV pathway.

Evaluation and Treatment of Narrow Complex Tachycardias

Narrow complex supraventricular tachycardia can occur transiently related to an acute illness or recur intermittently on a chronic basis. These disturbances are frequently treated in the emergency room or in the intensive care unit. Clinical electrophysiology testing has resulted in a better understanding of the different types of supraventricular tachycardias. The acronym PAT and junctional tachycardia were previously used to describe a narrow complex tachycardia that had an abrupt onset and abrupt termination. These arrhythmias, now termed paroxysmal supraventricular tachycardias (PSVT) are known to arise by different electrophysiologic mechanisms. Terms such as PAT and junctional tachycardia should be discarded for more precise terminology when possible. The term PSVT is used to describe a general category of supraventricular tachycardias.

Automatic pacemaker termination of two different types of supraventricular tachycardia

A new antitachycardia pacemaker system was used in a 58 year old woman to terminate two different types of supraventricular tachycardia by a single automatic pacing mode. During the invasive electrophysiologic study before pacemaker implantation (in the absence of medication), sustained episodes of atrioventricular (AV) nodal reentrant tachycardia and two short-lasting episodes of nonsustained atrial tachycardia were induced. After implantation, sustained episodes of both AV nodal tachycardia and atrial tachycardia were initiated. Both arrhythmias could be terminated reproducibly by a single pacing mode.