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Supraventricular Tachycardias: How to Diagnose the Mechanism

  • Giulia Enea
  • Alessio Menditto
  • Francesca Patani
  • Francesca Troiano
Chapter

Abstract

Supraventricular tachycardias are a very common clinical condition. In this chapter, we analyze few supraventricular tachydardia 12-lead EKGs to discover their underlying mechanism.

At first, we have to observe the rhythm regular pattern. If regular, we have to check for P (or F) waves. If a P wave is visible, we have to assess the P/QRS ratio. When atrial activity is faster than the ventricular, we may consider the atrial flutter or atrial tachycardia hypothesis.

When P/QRS ratio is 1:1, we have to consider a possible reentrant circuit between atria and ventricles. Then, assessing RP and PR intervals, we can identify the mechanism of the tachycardia and make the correct diagnosis.

References

  1. 1.
    Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias). Circulation. 2003;108:1871–909.CrossRefGoogle Scholar
  2. 2.
    Lee KW, Badhwar N, Scheinman MM. Supraventricular tachycardia – part I. Curr Probl Cardiol. 2008;33:467–546.CrossRefGoogle Scholar
  3. 3.
    Lee KW, Badhwar N, Scheinman MM. Supraventricular tachycardia – part II. Curr Probl Cardiol. 2008;33:557–622.CrossRefGoogle Scholar
  4. 4.
    Contadini D, Menditto A. Supraventricular reentrant tachycardias. In: Capucci A, editor. Clinical cases in cardiology. Cham: Springer; 2015. p. 213–26.CrossRefGoogle Scholar
  5. 5.
    Surawicz B, Knilans T. Chou’s electrocardiography in clinical practice. 6th ed. Philadelphia: Saunders Elsevier; 2008. p. 384–402.Google Scholar
  6. 6.
    Bagliani G, Leonelli F, Padeletti L. P wave and the substrates of arrhythmias originating in the atria. Card Electrophysiol Clin. 2017;9(3):365–82.CrossRefGoogle Scholar
  7. 7.
    Oreto G. I disordini del ritmo cardiaco. 2nd ed. Torino: Centro Scientifico Editore; 1997. p. 35–7.Google Scholar
  8. 8.
    Green M, Heddle B, Dassen W, et al. The value of QRS alternation in diagnosing the site of origin of narrow QRS supraventricular tachycardia. Circulation. 1983;68:368–73.CrossRefGoogle Scholar
  9. 9.
    Reddy GV, Schamroth L. The localization of by-pass tracts in the Wolff-Parkinson-White syndrome from the surface electrocardiogram. Am Heart J. 1987;113:984–95.CrossRefGoogle Scholar
  10. 10.
    Saoudi N, Cosio F, Waldo A, et al. Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic bases: a statement from a joint expert group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. J Cardiovasc Electrophysiol. 2001;12:852–66.CrossRefGoogle Scholar
  11. 11.
    Issa ZF, Miller JM, Zipes DP. Clinical arrhythmology and electrophysiology: a companion to Braunwald’s heart disease. 2nd ed. Philadelphia: Saunders Elsevier; 2009. p. 239–59.Google Scholar
  12. 12.
    Buttà C, Tuttolomondo A, Giarrusso L, et al. Electrocardiographic diagnosis of atrial tachycardia: classification, P-wave morphology, and differential diagnosis with other supraventricular tachycardias. Ann Noninvasive Electrocardiol. 2014;20(4):314–27.CrossRefGoogle Scholar
  13. 13.
    Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P-wave morphology in focal atrial tachycardia. Development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol. 2006;48(5):1010–7.CrossRefGoogle Scholar
  14. 14.
    Leonelli F, Bagliani G, Boriani G, et al. Arrhythmias originating in the atria. Card Electrophysiol Clin. 2017;9:383–409.CrossRefGoogle Scholar
  15. 15.
    Cosio F. Atrial flutter, typical and atypical: a review. Arrhythm Electrophysiol Rev. 2017;6(2):55–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Giulia Enea
    • 1
  • Alessio Menditto
    • 1
  • Francesca Patani
    • 1
  • Francesca Troiano
    • 1
  1. 1.Clinica di Cardiologia e AritmologiaUniversità Politecnica delle MarcheAnconaItaly

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