Supraventricular Tachycardia - 02/09/11

Doi : 10.1016/S0025-7125(05)70313-8

Vijay S. Chauhan, MD, FRCPC ^{^{*
Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada}}, Andrew D. Krahn, MD, FRCPC, FACC ^{^{*
Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada}}, George J. Klein, MD, FRCPC, FACC ^{^{*
Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada}}, Allan C. Skanes, MD, FRCPC ^{^{*
Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada}}, Raymond Yee, MD, FRCPC, FACC ^{^{*
Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada}}

Résumé

Supraventricular tachycardias (SVTs) affect more than 1% of the population, making them a relatively common clinical problem.^{48 Ostrander L., Brandt R.L., Kjelsberg M.D. , et al. Electrocardiographic findings among the adult population of a total natural community, Tecumseh, Michigan Circulation 1965 ; 31 : 888-898

Cliquez ici pour aller à la section Références} SVTs encompass a large group of arrhythmias that originate above the bifurcation of the bundle of His. An antiquated term, paroxysmal atrial tachycardia, previously was used to describe SVTs that began and ended abruptly. This term has become obsolete because many such arrhythmias arise from not only the atria, but also the atrioventricular (AV) node, bundle of His, and accessory pathway tissue. Most SVTs have normal narrow-complex morphology,^{31 Kalbfleisc S.J., el-Atass R., Calkins H. , et al. Differentiation of paroxysmal narrow QRS complex tachycardias using the 12-lead electrocardiogram J Am Coll Cardiol 1993 ; 21 : 85-89

Cliquez ici pour aller à la section Références} but they also may have wide QRS complexes resulting from aberrant conduction or, less commonly, preexcitation. This article discusses SVTs with respect to their classification, mechanisms, electrocardiogram (ECG) manifestations, and medical management. Catheter ablation is available for patients who fail medical therapy or who do not wish to take medications. A detailed discussion of catheter ablation is found in the article by Calkins elsewhere in this issue.

Le texte complet de cet article est disponible en PDF.

Plan

CLASSIFICATION

MECHANISMS OF SUPRAVENTRICULAR TACHYCARDIA

Atrioventricular Node Reentrant Tachycardia

Atrioventricular Reentrant Tachycardia Mediated by Accessory Pathways

Atrial Tachycardia

Multifocal Atrial Tachycardia

Junctional Tachycardia

Tachycardias Arising From the Sinus Node Region

CLINICAL PRESENTATION

DIFFERENTIAL DIAGNOSIS

THERAPY

Acute Medical Therapy

Long-Term Medical Therapy

Catheter Ablation

Recommendation for Management

Address reprint requests to Andrew D. Krahn, MD, Division of Cardiology, University of Western Ontario, 339 Windermere Road, London, Ontario, N6A 5A5, Canada. e-mail: akrahn@julian.uwo.ca