Atrioventricular reentrant tachycardia

Not to be confused with AV nodal reentrant tachycardia.
Atrioventricular reentrant tachycardia

Conduction pathway in atrioventricular reentrant tachycardia, a form of supraventricular tachycardia
Classification and external resources
Specialty cardiology
ICD-10 I47.1
ICD-9-CM 427.89, 427.0
MeSH D013617

Atrioventricular reentrant tachycardia, atrioventricular reciprocating tachycardia or AVRT, is a supraventricular tachycardia (SVT) most commonly associated with Wolff-Parkinson-White syndrome, in which an accessory pathway allows electrical signal from the ventricles to enter the atria and cause premature contraction and repeat stimulation of the atrioventricular node.[1]

Video explanation

Signs and symptoms

12 lead electrocardiogram of an individual with Wolff–Parkinson–White syndrome exhibiting 'slurred upstrokes' or 'delta waves' before the QRS complexes

An episode of SVT may present with palpitations, dizziness, shortness of breath, or syncope. The electrocardiogram would appear as a narrow-complex SVT. Between episodes of tachycardia the patient is likely to be asymptomatic, however the electrocardiogram would demonstrate the classic delta wave in Wolff–Parkinson–White syndrome.[2]

Pathophysiology

Two distinct pathways are involved: the normal atrioventricular conduction system, and an accessory pathway. During AVRT, electrical signal passes in the normal manner from the AV node into the ventricles. It then, pathologically, passes back into the atria via the accessory pathway, causing atrial contraction, and returns to the AV node to complete the reentrant circuit; see figure. Once initiated, the cycle may continue causing an episode of tachycardia.

Initiation of the tachycardia may be through a premature impulse of atrial, junctional, or ventricular origin.[3]

Treatment

Acute management is as for SVT in general. The aim is to interrupt the circuit. In the shocked patient, DC cardioversion may be necessary. In the absence of shock, inhibition at the AV node is attempted. This is achieved first by a trial of vagal maneuvers, then if this fails using intravenous adenosine;[4] the latter causes complete electrical blockade at the AV node. Long-term management includes beta blocker therapy and radiofrequency ablation of the accessory pathway.

See also

References

  1. ↑ Josephson ME. Preexcitation syndromes. In: Clinical Cardiac Electrophysiology, 4th, Lippincot Williams & Wilkins, Philadelphia 2008. p.339
  2. ↑ Hampton J. The ECG Made Easy. Elsevier 2008
  3. ↑ UpToDate: Atrioventricular reentrant tachycardia (AVRT) associated with an accessory pathway
  4. ↑ UK Resuscitation Council. Adult tachycardia algorithm. 2010.
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