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KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Heart rate 100–160 bpm

  • Each QRS preceded by a P wave identical with the P wave of normal sinus rhythm

  • Abrupt onset and termination

  • Organic heart disease in many patients

GENERAL CONSIDERATIONS

  • Accounts for less than 5% of supraventricular tachycardia

  • Reentry uses the sinus node or perinodal tissue

  • Heart rate similar to that in sinus tachycardia

  • Longitudinal dissociation as seen in atrioventricular node may be substrate for reentry in the sinoatrial node

  • This tachycardia is not physiologic unlike sinus tachycardia

  • Tachycardia is precipitated by an ectopic beat and exhibits characteristics of a reentry circuit

  • The arrhythmia can be acutely terminated by adenosine, verapamil, or carotid sinus massage

  • The tachycardia may be induced in the electrophysiologic lab with premature atrial stimuli or burst pacing

  • May be an incidental arrhythmia during a study for another diagnosis

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Palpitations

  • Dyspnea

PHYSICAL EXAM FINDINGS

  • Depends on precipitating cause

  • Elevated jugular venous pressure

  • S3

DIFFERENTIAL DIAGNOSIS

  • Sinus tachycardia

  • Inappropriate sinus tachycardia

  • Atrial tachycardia

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • CBC

  • Thyroid-stimulating hormone

ELECTROCARDIOGRAPHY

  • ECG to document rhythm disorder

  • Holter monitoring to determine frequency

IMAGING STUDIES

  • None required

  • Echocardiogram for underlying myocardial disease

DIAGNOSTIC PROCEDURES

  • Electrophysiologic study to confirm mechanism and determine suitability for ablation

TREATMENT

CARDIOLOGY REFERRAL

  • If the tachycardia is precipitating recurrent heart failure, then electrophysiology referral recommended

HOSPITALIZATION CRITERIA

  • Symptomatic patients may require hospitalization for control with medications or ablation

MEDICATIONS

  • Digoxin and calcium channel blockers are the most useful drugs

  • Beta blockers may not be very useful

THERAPEUTIC PROCEDURES

  • Radiofrequency ablation is usually curative

SURGERY

  • Generally not required

MONITORING

  • ECG monitoring if hospitalized

DIET AND ACTIVITY

  • Depends on underlying heart disease

ONGOING MANAGEMENT

HOSPITAL DISCHARGE CRITERIA

  • Symptomatic stability

FOLLOW-UP

  • Depends on underlying heart disease

COMPLICATIONS

  • Exacerbations of heart failure

PROGNOSIS

  • Depends on underlying heart disease

RESOURCES

PRACTICE GUIDELINES

  • Indications for electrophysiologic study:

    • – Frequent and poorly tolerated tachycardia that does not adequately respond to medications and exact nature of the tachycardia is uncertain

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