Download Acute Management of Wide QRS

IN THE NAME OFGOD
SVT
S.SAYAH

All cardiac tachyarrhythmias are
produced by:
1/disorders of impulse initiation
:automatic
2/abnormalities of impulse
conduction:
re-entrant.
Clinical History and Physical
Examination

Patients with paroxysmal
arrhythmias are most often
asymptomatic at the time of
evaluation. Arrhythmia-related
symptoms include palpitations;
fatigue; lightheadedness; chest
discomfort; dyspnea; presyncope; or,
more rarely, syncope.

With SVT, syncope is observed in approximately 15% of
patients, usually just after initiation of rapid SVT or with a
prolonged pause after abrupt termination of the
tachycardia

Symptoms vary with the ventricular rate, underlying
heart disease, duration of SVT, and individual patient
perceptions.

Supraventricular tachycardia that is persistent for
weeks to months and associated with a fast ventricular
response may lead to a tachycardia-mediated
cardiomyopathy
Diagnostic Investigations

A resting 12-lead ECG

An ambulatory 24-hour Holter recording

Implantable loop recorders may be helpful in
selected cases

Exercise testing

Transesophageal atrial recordings
 Invasive electrophysiological
investigation with subsequent catheter
ablation may be used for diagnoses and
therapy
SPECIFIC ARRHYTHMIAS

A. Sinus Tachyarrhythmias

1. Physiological Sinus Tachycardia

2. Inappropriate Sinus Tachycardia

3. Postural Orthostatic Tachycardia
Syndrome(autonomic dysfunction)

4. Sinus Node Re-entry Tachycardia
S.TAC.
B. Atrioventricular Nodal
Reciprocating Tachycardia

is the most common form of
PSVT.

It is more prevalent in females
AVNRT
C. Focal and Nonparoxysmal Junctional
Tachycardia

1. Focal Junctional Tachycar

2. Nonparoxysmal Junctional Tachycardia
J.TAC.
D. Atrioventicular Reciprocating
Tachycardia
(Extra Nodal Accessory Pathways)

1. Sudden Death in WPW Syndrome and Risk

Stratification: The incidence of sudden cardiac death
in patients with WPW syndrome: range from 0.15 to
0.39% , over 3- to 10-year follow-up
WPW
WPW
AVRT
E. Focal Atrial Tachycardias

F. Macro–Re-entrant Atrial Tachycardia:

1. Isthmus-Dependent Atrial Flutter

2. Non–Cavotricuspid Isthmus-Dependent
Atrial Flutter

G.ATRIAL FIBRILATION
AT
AFL
AF
Acute Management of Narrow QRS-Complex
Tachycardia
 vagal maneuvers
 IV antiarrhythmic drugs
 DC SHOCK
Wide-QRS tachycardias

1. preexisting bundle branch block;

2. functional bundle branch block (tachycardiadependent phase 3 block);

3. ventricular pre-excitation;

4. aberrancy due to sodium channel-blocking
antiarrhythmic drugs.

5.VT
WQT
Acute Management of Wide QRSComplex Tachycardia

Immediate DC cardioversion is the treatment for
hemodynamically unstable tachycardias

For pharmacologic termination of a stable
wide QRS-complex tachycardia, IV procainamide
and/or sotalol are recommended

Amiodarone is preferred, compared to procainamide
and sotalol, in patients with impaired left ventricular
(LV) function
IRREGULAR WIDE QRS

For termination of an irregular wide QRS-complex
tachycardia (ie, pre-excited AF), DC cardioversion is
recommended.

If the patient is hemodynamically stable,
pharmacologic conversion using IV ibutilide,
flecainide, or procainamide is appropriate.
AF + LBBB
First degree avb
Second degree avb
CHB
PVC
VT
VF
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