Question 1 of 10

    Supraventricular Tachycardia with Aberrant Conduction

    Supraventricular Tachycardia with Aberrant Conduction originates from the following process: endocrine.

    Presentation

    Skin
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  • psychiatrical
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  • cardiovascular
    Tachycardia
    • […] supraventricular, supraventricular tachycardias, Supraventricular tachycardia (SVtach), Supraventricular tachycardia NOS (disorder), SVT - Supraventricular tachycardia, Supraventricular tachycardia (disorder), supraventricular; tachycardia, tachycardia[fpnotebook.com]
    • Treating supraventricular tachycardia with aberrancy as though it were ventricular tachycardia is not dangerous; however, treating ventricular tachycardia as though it were supraventricular tachycardia with aberrancy can make a bad situation worse. 1,3[patientcareonline.com]
    • It is always better to consider a wide QRS tachycardia as ventricular tachycardia until proved otherwise as 80% of wide QRS tachycardias are likely to of ventricular origin [2].[cardiophile.org]
    • Tachycardia AV Reentrant Tachycardia Accelerated Junctional Tachycardia Wide Complex Tachycardias: If the QRS is 120 msec, the vast majority of the time the rhythm is due to one of three possibilities: ventricular tachycardia (the most common - usually[clinicaladvisor.com]
    • Introduction In cases of tachycardia with a broad QRS complex, it is important to differentiate between supraventricular tachycardia (SVT) and ventricular tachycardia (VT).[e-arrhythmia.org]
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  • musculoskeletal
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  • neurologic
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  • Workup

    ECG

    Other ECG Findings
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  • QT, RR, ST Intervals
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  • QRS Wave
    Wide QRS Complex
    • If the impulse is too premature , it may find one of the bundle branches still refractory from the previous impulse and will be conducted with a wide QRS complex . these premature atrial impulses that are followed by wide QRS complexes are aberrantly[afghanheart.wordpress.com]
    • Aberration is seen as bundle branch block pattern (wide QRS complex).[metealpaslan.com]
    • Figure 20.5 illustrates several paroxysms of wide QRS complexes.[thoracickey.com]
    • New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia.[e-arrhythmia.org]
    • A wide QRS complex with a right BBB was noted in the baseline ECG (see Figure 1 ).[patientcareonline.com]
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  • PR Interval
    Prolonged PR Interval
    • The characteristic features of TCA toxicity are: Tachycardia — this is often a sinus tachycardia with a grossly prolonged PR interval, such that the P wave is hidden in the previous T wave or QRS complex; may be difficult to differentiate from junctional[lifeinthefastlane.com]
    • In typical AVNRT, if a PAC occurs while the fast pathway is still refractory, the impulse instead travels down the slow pathway, resulting in ventricular depolarization with prolonged PR interval.[ahcmedia.com]
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  • Treatment

    Prognosis

    Complications

    Supraventricular Tachycardia
    • […] supraventricular, supraventricular tachycardias, Supraventricular tachycardia (SVtach), Supraventricular tachycardia NOS (disorder), SVT - Supraventricular tachycardia, Supraventricular tachycardia (disorder), supraventricular; tachycardia, tachycardia[fpnotebook.com]
    • Treating supraventricular tachycardia with aberrancy as though it were ventricular tachycardia is not dangerous; however, treating ventricular tachycardia as though it were supraventricular tachycardia with aberrancy can make a bad situation worse. 1,3[patientcareonline.com]
    • Supraventricular tachycardia with RBBB pattern (Click on the image for an enlarged view) SVT with RBBB (supraventricular tachycardia with right bundle branch block) pattern as evidenced by the slurred S wave in lead I and aVL and rSR’ pattern in V1.[cardiophile.org]
    • All 8 episodes of supraventricular tachycardia with aberrant conduction were correctly diagnosed, whereas 15 of 38 episodes of ventricular tachycardia (39%) were misdiagnosed as supraventricular tachycardia at the time initial therapy was given.[annals.org]
    Ventricular Tachycardia
    • Ventricular tachycardia: tricks and traps.[patientcareonline.com]
    • Presence of AV dissociation, if visible on the ECG would point towards ventricular tachycardia.[cardiophile.org]
    • Yes: Dx is ventricular tachycardia![ecg.utah.edu]
    • Figure.1 Ventricular tachycardia (VT) with positive concordance across the chest leads[bromleyemergency.com]
    • Ventriculoatrial dissociation was evident in 11 (73%) of the electrocardiograms of misdiagnosed ventricular tachycardia.[annals.org]
    Bradycardia
    • The use of Amiodarone should be limited due to its delayed onset of action and its potential complications (hypotension and post conversion bradycardia).[bctg.bcas.ca]
    • Like bradycardia, tachycardia can be life-threatening if it compromises the heart’s ability to perfuse effectively.[nhcps.com]
    • Figure 14 - Concealed transeptal conduction Aberration caused by heart rate deceleration/bradycardia-dependent aberrancy(ECG case#4) ECG case # 4 is an example of bradycardia-dependent aberrancy.[learningecg.blogspot.com]
    • , bradycardia, fatigue, insomnia, and depression.[ahcmedia.com]
    • Verapamil, a negative inotrope, can result in relative bradycardia and vasodilation; care must be used if patients have a significant decrease in cardiac output. 27 Neither digoxin nor a calcium channel blocker should be used in patients with Wolff-Parkinson-White[aafp.org]
    Liver Disease
    • Perfusion computed tomography for diffuse liver diseases; Perfusions-CT bei diffusen Lebererkrankungen Energy Technology Data Exchange (ETDEWEB) Schmidt, S.A.; Juchems, M.S.[worldwidescience.org]
    Torsades De Pointes
    • Non-sustained ventricular dysrhythmias do not need treatment with the exception of magnesium for torsades de point.[bctg.bcas.ca]
    • Patients with congenital prolonged QT syndromes may present with recurrent episodes of Torsades de pointes.[rcemlearning.co.uk]
    • Polymorphic VT (eg, torsades de pointes): give magnesium 2 g over 10 minutes).[patient.info]
    • Polymorphic VT, Torsades de pointes, and unusual SVT (SVT with wide complexes due to aberrant conduction) may be reversible, e.g. magnesium for Torsades, but do not delay treatment for VT.[nhcps.com]
    • Torsade-de-pointes Torsade-de-pointes: a polymorphic ventricular tachycardia associated with the long-QT syndromes characterized by phasic variations in the polarity of the QRS complexes around the baseline.[ecg.utah.edu]

    Etiology

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

    Other symptoms

    Amiodarone
    • The use of Amiodarone should be limited due to its delayed onset of action and its potential complications (hypotension and post conversion bradycardia).[bctg.bcas.ca]
    • Amiodarone 300 mg IV over 10-20 minutes and repeat shock; followed by amiodarone 900 mg over 24 hours.[patient.info]
    • In such cases (or those in which drugs are ineffective), IV procainamide or amiodarone can be used.[merckmanuals.com]
    Intermittent
    • […] configuration with rSR pattern in V1 because the right bundle branch has a longer refractory period than the left bundle branch in most individual . please click here for more information Consider the case illustrated in Figure below (lead V1) with intermittent[afghanheart.wordpress.com]
    • . - AV-dissociation , visible P waves at sinus rate but with no relationship to the broad QRS complexes - capture beats , an impulse from the SA node transiently captures the ventricle and intermittent narrow complex QRS complexes are seen - fusion beats[bromleyemergency.com]
    • This buildup is known as a cannon wave, and can be seen in a patient's neck as an intermittent pulsation of the external jugular veins.[emsworld.com]
    • There is intermittent/transient LBBB as the heart rate increases but as the rate decreases the narrow QRS would appear.[learningecg.blogspot.com]
    • Intermittently, atypical atrial flutter waves with pointed appearances at cycle lengths of 160 ms were seen indenting the diastolic intervals between the regular RR intervals in V1 ( Fig. 1 ).[pubmedcentralcanada.ca]
    Lidocaine
    • Dose: Biphasic 100 – 200 Joules (Monophasic 200 – 360 Joules) Unless patient in extremis, consider sedation /analgesia for procedure Chemical Cardioversion Lidocaine Class 1B antidysrhythmic agent Dose Bolus: 1.0-1.5 mg/kg (repeat 0.5 – 0.75 mg/kg up[emdocs.net]
    • For refractory cases, consider additional pharmacological agents (eg, lidocaine or sotalol) or overdrive pacing.[patient.info]
    • Lidocaine IV dose: 0.5 to 0.75 mg/kg IV push; repeat every 5 to 10 minutes as needed.[clinicaladvisor.com]
    • […] quinidine, procainamide, disopyramide (Norpace) Ib Do not reduce maximum velocity Shorten action potential duration Kinetics of onset and offset in blocking the sodium channel are rapid (less than 500 msec) Examples include mexiletine, phenytoin (Dilantin), lidocaine[aafp.org]
    • In almost all other circumstances, it is recommended to treat wide-complex tachycardias as ventricular tachycardia with procainamide, ibutilide, lidocaine, amiodarone, or sotalol. 10 Because of its long history of use, procainamide is recommended, and[ahcmedia.com]
    Intermediate
    • Usually 120–140 ms Normal frontal plane axis No QRS concordance Changes according to the arrhythmia mechanism (differs from typical bundle branch block*) Fusion beats (intermediate between a normal beat and a VT beat).[ebmpracticenet.be]
    • Vaughan-Williams Classification of Antiarrhythmics Class Description Ia Reduce maximum velocity (rate of rise of action potential upstroke [phase 0]) Prolong action potential duration Kinetics of onset and offset in blocking the sodium channel are of intermediate[aafp.org]
    • Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT.[worldwidescience.org]
    No Obesity
    • Features new chapters on pediatric electrocardiography that explore rhythm problems associated with pediatric obesity, heart failure, and athletic activity.[books.google.com]
    • Obesity and the risk of new-onset atrial fibrillation.[ahcmedia.com]

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    References

    • : Ventricular Tachycardia, Supraventricular Tachycardia with Aberrant Intraventricular Conduction, and Supraventricular Tachycardia with Anterograde Conduction - E Antunes, J Brugada, G Steurer - Pacing and Clinical , 1994 - Wiley Online Library
    • : Ventricular Tachycardia, Supraventricular Tachycardia with Aberrant Intraventricular Conduction, and Supraventricular Tachycardia with Anterograde Conduction - E Antunes, J Brugada, G Steurer - Pacing and Clinical , 1994 - Wiley Online Library
    • Antegrade and retrograde conduction characteristics in three patterns of paroxysmal atrioventricular junctional reentrant tachycardia - M Akhtar, AN Damato, JN Ruskin, WP Batsford - American heart , 1978 - Elsevier
    • : Ventricular Tachycardia, Supraventricular Tachycardia with Aberrant Intraventricular Conduction, and Supraventricular Tachycardia with Anterograde Conduction - E Antunes, J Brugada, G Steurer - Pacing and Clinical , 1994 - Wiley Online Library
    • : Ventricular Tachycardia, Supraventricular Tachycardia with Aberrant Intraventricular Conduction, and Supraventricular Tachycardia with Anterograde Conduction - E Antunes, J Brugada, G Steurer - Pacing and Clinical , 1994 - Wiley Online Library

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