Supraventricular Rhythms

Supraventricular Rhythms originate from the atria. Examples of supraventricular rhythms are:

• Sinustachycardia
• Atrial Rhythm
• Atrial Flutter
• Atrial Fibrillation
• Atrial Tachycardia
• AVNRT
• Atrio-ventricular Reentry Tachycardia AVRT
• AV junctional tachycardia
• Nodal Rhythm
• Idioventricular Rhythm
• Ventriculophasic Reflex

Supraventricular ectopic beats can result in:

• Atrial Premature Complexes
• Wandering Pacemaker
• AV-nodal complexes

Also read:

• Flowchart: Approach to the Narrow Complex Tachycardia Adapted from [1].
• Mechanisms of Arrhythmias
• Ventricular Arrhythmias
• Sinus node rhythms and arrhythmias

An overview of supraventricular tachycardias

	regularity	atrial frequency	ventricular frequency	origin (SVT/VT)	p-wave	effect of adenosine
Narrow complex (QRS<0.12)
Sinustachycardia	regular	100-180 bpm	100-180 bpm	sinusnode (SVT)	precedes every QRS complex	gradual slowing
Atrial Fibrillation	grossly irregular	400-600 bpm	75-175 bpm	atria (SVT)	absent	slows down rate; irregularity remains
Atrial Flutter	regular (sometimes alternating block)	250-350 bpm	75-150 bpm (3:1 or 2:1 block is most common)	atria (SVT)	negative sawtooth in lead II	temporary reduced conduction (e.g. 4:1)
AVNRT	regular	180-250 bpm	180-250 bpm	AV-node (SVT)	in QRS complex (R')	stops
Atrial Tachycardia	regular	120-250 bpm	75-200 bpm	atria	precedes QRS, p wave differs from sinus-p	temporary AV-block
Atrio-Ventricular Reentry Tachycardia (AVRT)- orthodromic	regular	150-250 bpm	150-250 bpm	circle: av-node - ventricles - bypass - atria	RP < PR	stops
AV junctional tachycardia	regular	60-100 bpm	70-130 bpm	AV node	RP < PR	reduces rate
Wide complex (QRS>0.12)
Supraventricular tachycardia with block	(ir)regular depending on SVT	150-250 bpm	75-200 bpm	atria (SVT)	absent	temporary increased AV-block (eg 4:1)
Atrio-ventricular Reentry Tachycardia (AVRT) - antidrome	regular	150-250 bpm	150-250 bpm	circular: bypass - atria - av-node - ventricles	RP < PR	stops

References

1. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW, Stevenson WG, Tomaselli GF, Antman EM, Smith SC Jr, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO Jr, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JC, Oto A, Smiseth O, Trappe HJ, and European Society of Cardiology Committee, NASPE-Heart Rhythm Society. 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) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol. 2003 Oct 15;42(8):1493-531. DOI:10.1016/j.jacc.2003.08.013 |