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Supraventricular Tachycardias 

Supraventricular Tachycardias
Chapter:
Supraventricular Tachycardias
Author(s):

Jerónimo Farré

, Hein J.J. Wellens

, José M. Rubio

, and Juan Benezet

DOI:
10.1093/med/9780199566990.003.028
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date: 22 August 2019

Supraventricular arrhythmias comprise atrial extrasystoles, supraventricular tachycardia (SVT), and atrial fibrillation (AF). SVT includes atrial tachycardia and atrioventricular junctional tachycardia. Atrial flutter is the most common form of macro-re-entrant atrial tachycardia. Atrial extrasystoles are the most prevalent supraventricular arrhythmias, followed by AF, and atrial flutter. While the life expectancy of patients with paroxysmal SVT is often normal, their quality of life may be poor. Patients with the Wolff–Parkinson–White syndrome frequently develop paroxysmal SVT or AF; exceptionally, they may die suddenly if AF supervenes and degenerates into ventricular fibrillation due to a very short anterograde refractory period of the accessory pathway. Non-paroxysmal forms of SVT are rare. Among the latter, permanent SVTs can result in a tachycardiomyopathy with systolic left ventricular dysfunction that is usually reversible after abolishing the arrhythmia. The 12-lead electrocardiogram (ECG), combined with vagal or pharmacological manoeuvres, is essential for establishing the type of SVT. Paroxysmal SVT can be terminated by vagal manoeuvres, antiarrhythmic drugs, DC-shock cardioversion, and pacing. Paroxysmal atrial flutter usually is terminated by DC-shock cardioversion or overdrive atrial pacing. Although paroxysmal and permanent SVTs have various sites of origin and mechanisms, they can usually be cured by catheter ablation techniques. Electro-anatomic mapping and navigation systems facilitate the ablation of complex forms of atrial tachycardia. Surgery has no role today in the treatment of SVT. Patients in whom ablation cannot be performed may require the use of chronic antiarrhythmic drug therapy to prevent recurrences of SVT....

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