By : dr Bobby Rianto

Bachmanns bundle
Sinus node

Internodal pathways
Left bundle branch
AV node

Bundle of His Posterior division

Anterior division

Right bundle branch Purkinje fibers

 All forms of tachycardia (rate > 100 bpm) that arise above the
bifurcation of the His bundle. Paroxysmal = sudden onset.
Require AVN or atrial tissue, or both, for initiation and
maintenance of the arrhythmia.
Typically (P)SVT has a narrow QRS complex, but the QRS
complex may be wide at baseline, or become wide due to rate
dependent BBB.
 Incidence (new cases): 35 cases per 100,000 persons
per year.
Prevalence (all affected): 2.25 per 1000 (excluding
atrial fibrillation, atrial flutter, and multifocal atrial
tachycardia).
Increases with age and the presence of CV disease.
Not usually associated with structural heart disease.
Delacrtaz E. Supraventricular Tachycardia. N Engl J Med. 2006
 Palpitations: A trigger is usually not identified
(96%).
Feeling of heart pounding in the chest and neck.
Anxiety, light-headedness(75%), dyspnea(47%).
Syncope(20%) and chest pain (35%), carefull to
another indicate CAD, especially in older patients.
Psychological stress is very common.
 Reentry- approx 90% of all SVT. Either reentry within the
AVN (60%) or using an accessory bypass tract (30%).
Almost all reentrant SVTs are started with a PAC.
Atrial focus- approx 10%. Automaticity or Triggered activity
Important concepts- conduction time and refractory period.
Fast conduction typically has a long refractory period.
Slow conduction typically has a sort refractory period.
Ferguson JD. Contemporary Management of Supraventricular Tachycardia. Circulation. 2003
 AV Node Dependent-
Reentry- approx 90% of all SVT. Either reentry within the
AVN (60%) or using an accessory bypass tract (30%).

AV Node Independent-
Atrial focus- approx 10%. Automaticity or Triggered
activity.

Thinking of SVT in this way can help with treatment.

Short RP interval
Slow pathway

Fast pathway
His bundle

Ablation area
Conduction down AVnode

Up
accessory
pathway
Conduction down AVnode

Up
accessory
pathway
Long RP interval
All arrhythmias that are
hemodynamically significant
require immediate
cardioversion, defibrillation, or
cardiac pacing
 AV Node Dependent-
Vagotonic maneuvers- CSM, facial emersion in water,
coughing, straining, etc.
Drugs- Adenosine: 6 or 12 mg., verapamil: 5 mg up to 15 mg
Diltiazem, beta blockers may also be used on the AVN.
Ibutilide, procainamide, and flecainide, affect the bypass tract

AV Node Independent-
Heart rate control is the goal. Beta Blockers- sotalol.

Catheter ablation considered a long term option.

AVNRT
PSUEDO S WAVES
AVRT
 Fox DJ, et al. Supraventricular Tachycardia: Diagnosis and Management.
Mayo Clin Proc. 2008;83(12):1400-11
Delacrtaz E. Supraventricular Tachycardia. N Engl J Med. 2006;354:1039-51
ACC/AHA/ESC guide-lines for the management of patients with supra-
ventricular arrhythmias. J Am Coll Cardiol. 2003 Oct 15;42(8):1493-531
Ferguson JD, et al. Contemporary Management of Paroxysmal Supraventricular
Tachycardia. Circulation 2003;107:1096-1099
Salerno JC, et al. Supraventricular Tachycardia. Arch Pediatr Adolesc Med.
2009;163(3):268-274
ACC/AHA/HRS guideline for the management of adult patients with
supraventricular tachycardia,Sana M. Al-Khatib, MD, Foundation.doi.org/10.1016/
j.hrthm.2015.09.019