Supraventricular Arrhythmias
Carina Blomström-Lundqvist and Melvin Scheinman
16
Organization of committee and evidence review
General evaluation and management of SVA
Patients without documented arrhythmia
Diagnostic investigations
Additional evaluation
Patients with documented arrhythmia
Differential diagnosis for narrow QRS complex
tachycardia (QRS duration <120 ms).
Differential diagnosis for wide QRS-complex
tachycardia (QRS duration ≥120 ms)
Management
Specifi c arrhythmias
Sinus tachyarrhythmias
Physiological sinus tachycardia
Inappropriate sinus tachycardia
Sinus node re-entry tachycardia
Atrioventricular nodal reciprocating tachycardia
(AVNRT)
Focal and nonparoxysmal junctional tachycardia
Focal junctional tachycardia
Nonparoxysmal junction tachycardia
AV re-entrant tachycardia
Focal atrial tachycardias
Atrial fl utter
Special circumstances
Pregnancy
Future directions
Organization of committee and
evidence review
In order to facilitate and optimize the management
of patients with supraventricular arrhythmias, the
American Heart Association (AHA), American
College of Cardiology Foundation (ACCF), and the
European Society of Cardiology (ESC) created a
committee to establish guidelines for the manage-
ment and treatment of patients with supraventricu-
lar arrhythmias (SVA), written in collaboration with
the Heart Rhythm Society (HRS). The term supra-
ventricular arrhythmias refers to rhythms emanat-
ing from the sinus node, from atrial tissue (focal
atrial tachycardias, atrial fl utter), from the atrioven-
tricular (AV) node, as well as accessory pathway-
mediated tachycardia. The document summarized
recommendations for diagnostic procedures as well
as indications for anti-arrhythmic drugs and/or
nonpharmacological treatments. For the purpose of
this handbook, a comprehensive review of relevant
literature from 2003 to 2006 using the PubMed/
MEDLINE and Cochrane Library databases was
conducted, using English language sources and
including studies in human subjects only. Anti-
arrhythmic drug dosages are outlined in detail in the
Atrial Fibrillation section, and are therefore not
repeated.General evaluation and management
of SVA
Patients without documented arrhythmia
A clinical history of arrhythmia-related symptoms
may give clues to the type of arrhythmia. Arrhythmia-
related symptoms include palpitations, fatigue, light-
headedness, chest discomfort, dyspnea, presyncope
or syncope. The clinician should distinguish whether
the palpitations are regular or irregular:- Irregular palpitations may be due to premature
extra beats, atrial fi brillation (AF) or multifocal
atrial tachycardia.
The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978 -1-405-18463-2