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http://en.wikipedia.org/wiki/AV_nodal_reentrant_tachycardia
I47.1 (http://apps.who.int
/classifications/icd10/browse
/2010/en#/I47.1)
ICD-9
427.89 (http://www.icd9data.com
/getICD9Code.ashx?icd9=427.89)
eMedicine med/2955
(http://www.emedicine.com
/med/topic2955.htm) ped/2535
(http://www.emedicine.com
/ped/topic2535.htm#)
MeSH
Contents
D013611 (https://www.nlm.nih.gov
/cgi/mesh/2014/MB_cgi?field=uid&
term=D013611)
Diagnosis
If the symptoms are present while the patient is attending medical care (e.g. emergency department), an electrocardiogram (ECG/EKG) may show
typical changes that confirm the diagnosis. If the palpitations are recurrent, a doctor may request a Holter monitor (24 hour or longer portable ECG)
recording. Again, this will show the diagnosis if the recorder is attached at the time of the symptoms. Rarely, disabling but infrequent episodes of
palpitations may require the insertion of a small microchip-based device (e.g. Reveal Plus) under the skin that continuously record heart activity, and
can be read through the skin after an episode. All these ECG-based technologies also enable the distinction between AVNRT and other tachycardias
such as atrial fibrillation, atrial flutter, sinus tachycardia, ventricular tachycardia and tachyarrhythmias related to Wolff-Parkinson-White syndrome,
all of which may have symptoms that are similar to AVNRT.
Blood tests commonly performed in people with palpitations are:
thyroid function tests (TFTs) - an overactive thyroid increases the risk of AVNRT
electrolytes - disturbances in potassium, calcium and magnesium may predispose to AVNRT
cardiac markers - if there is a concern that myocardial infarction (heart attack) has occurred either as a cause or as a result of the AVNRT; this
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is usually only the case if the patient has experienced chest pain
Classification
There are several types of AVNRT. The "common form" or "usual" AVNRT utilizes the slow AV nodal pathway as the anterograde limb of the circuit
and the fast AV nodal pathway as the retrograde limb. The reentry circuit can be reversed such that the fast AV nodal pathway is the anterograde limb
and the slow AV nodal pathway is the retrograde limb. This, not surprisingly, is referred to as the "uncommon form" of AVNRT. However, there is
also a third type of AVNRT that utilizes the slow AV nodal pathway as the anterograde limb and left atrial fibers that approach the AV node from the
left side of the inter-atrial septum as the retrograde limb. This is known as atypical, or Slow-Slow AVNRT. [1]
Common AVNRT
In common AVNRT, the anterograde conduction is via the slow pathway and the retrograde conduction is via the fast pathway ("slow-fast" AVNRT).
Because the retrograde conduction is via the fast pathway, stimulation of the atria (which produces the inverted P wave) will occur at the same time
as stimulation of the ventricles (which causes the QRS complex). As a result, the inverted P waves may not be seen on the surface ECG since they
are buried with the QRS complexes. Often the retrograde p-wave is visible, but also in continuity with the QRS complex, appearing as a "pseudo R
prime" wave in lead V1 or a "pseudo S" wave in the inferior leads.
Uncommon AVNRT
In uncommon AVNRT, the anterograde conduction is via the fast pathway and the retrograde conduction is via the slow pathway ("fast-slow"
AVNRT).
Multiple slow pathways can exist so that both anterograde and retrograde conduction are over slow pathways. ("slow-slow" AVNRT).
Because the retrograde conduction is via the slow pathway, stimulation of the atria will be delayed by the slow conduction tissue and will typically
produce an inverted P wave that falls after the QRS complex on the surface ECG.
Treatment
An episode of supraventricular tachycardia (SVT) due to AVNRT can be terminated by any action that transiently blocks the AV node. Various
methods are possible.
Vagal maneuvers
Some people with known AVNRT may be able to stop their attack by using various tricks to activate the vagus nerve. This includes carotid sinus
massage (pressure on the carotid sinus in the neck) or the Valsalva maneuver (increasing the pressure in the chest by attempting to exhale against a
closed airway).
Medication
Medical therapy can be initiated with AV nodal slowing drugs such as adenosine (which is a pharmacologic cardioversion), beta blockers or
non-dihydropyridine calcium channel blockers (such as verapamil). Numerous other antiarrhythmic drugs may be effective if the more commonly
used medications have not worked; these include flecainide or amiodarone. Both adenosine and beta blockers may cause tightening of the airways,
and are therefore used with caution in people who are known to have asthma.
Cardioversion
In very rare instances, cardioversion (the electrical restoration of a normal heart rhythm) is needed in the treatment of AVNRT. This would normally
only happen if all other treatments have been ineffective, or if the fast heart rate is poorly tolerated (e.g. the development of heart failure symptoms,
low blood pressure or coma).
Electrophysiology
After being diagnosed with AVNRT, patients can also undergo an Electrophysiology (EP) study to confirm the diagnosis. Catheter ablation of the
slow pathway, if successfully carried out, can potentially cure the patient of AVNRT.
Pacemaker-mediated tachycardia
A separate form of AV nodal reentrant tachycardia is pacemaker-mediated tachycardia (PMT), a possible complication of dual-chamber artificial
pacemakers. In PMT, the artificial pacemaker forms the anterograde (atrium to ventricle) limb of the circuit and the atrioventricular (AV) node forms
the retrograde limb (ventricle to atrium) of the circuit.[2] Treatment of PMT typically involves reprogramming the pacemaker.[2]
See also
List of circulatory system conditions
Wolff-Parkinson-White syndrome
Supraventricular tachycardia
Cardiac electrophysiology
Clinical cardiac electrophysiology
References
1. ^ http://lifeinthefastlane.com/2009/09/avnrt-ecg/
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2. ^ a b eMedicine > Pacemaker-Mediated Tachycardia (http://emedicine.medscape.com/article/159645-overview) Author: Brian Olshansky, MD. Coauthor(s):
Chirag M Sandesara, MD; Noel G Boyle, MB, BCh, MD, PhD. Updated: Jun 17, 2008
External links
AVNRT Clinical Cases (http://lifeinthefastlane.com/2009/09/avnrt-ecg/) from Life in the Fast Lane Medical Blog
Supraventricular Tachycardia: Diagnosis and Management (http://www.mayoclinicproceedings.com/content/83/12/1400.full) from Mayo
Clinic Proceedings
Retrieved from "http://en.wikipedia.org/w/index.php?title=AV_nodal_reentrant_tachycardia&oldid=617432791"
Categories: Cardiac dysrhythmia
This page was last modified on 18 July 2014 at 09:39.
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