Supraventricular Tachydysrhythmias in the Emergency Department | Digest
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Supraventricular Tachydysrhythmias in the Emergency Department

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Points & Pearls Excerpt

  • Supraventricular tachycardias (SVTs) arise at or above the atrioventricular (AV) node due either to abnormal automaticity or abnormal conduction.
  • AV nodal re-entry tachycardia (AVNRT) makes up 60%-70% of SVT cases due to a functional obstruction with 2 conduction systems within the node.
  • Ventricular pre-excitation (VPE) occurs when circus movements rely on anatomical accessory pathways from the atria to the ventricle. This is the mechanism of AV re-entry tachycardia (AVRT).
  • Wolff-Parkinson-White syndrome (WPW) involves conduction through a congenital accessory pathway, leading to pre-excitation to the ventricle. An ECG will reveal a shortened PR wave and up-swerving initiation of the R wave, called a delta wave.
  • Orthodromic (antegrade) conduction depolarizes through the bundle, resulting in a narrow QRS.
  • Antidromic (retrograde) conduction causes depolarization through the accessory pathway and retrograde progression through the AV node, leading to a wide QRS.

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Publication Information
Authors

Delbert D. Clark, DO, FAAEM; Morgan McGuire, MD; Mary Jones, MD; Heather Bruner, MD, FAAEM; David Bruner, MD, FAAEM

Peer Reviewed By

James E. Morris, MD, MPH; Jennifer White, MD

Publication Date

August 1, 2020

CME Expiration Date

August 2, 2023

CME Credits

4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits

Pub Med ID: 32678566

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CME Information

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