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Supraventricular Tachycardia

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1 Paroxysmal supraventricular tachycardia (PSVT) A clinical syndrome characterized by the presence of a regular and rapid tachycardia of abrupt onset and termination. ese features are characteristic of AVNRT or AVRT, and, less frequently, AT. PSVT represents a subset of SVT. Atrial fibrillation (AF) A supraventricular arrhythmia with uncoordinated atrial activation and, consequently, ineffective atrial contraction. ECG characteristics include: 1) irregular atrial activity, 2) absence of distinct P waves, and 3) irregular R-R intervals (when AV conduction is present). AF is not addressed in this document. Sinus tachycardia Rhythm arising from the sinus node in which the rate of impulses exceeds 100 bpm. • Physiologic sinus tachycardia Appropriate increased sinus rate in response to exercise and other situations that increase sympathetic tone. • Inappropriate sinus tachycardia (IST) Sinus heart rate >100 bpm at rest, with a mean 24-h heart rate >90 bpm not due to appropriate physiological responses or primary causes such as hyperthyroidism or anemia. Atrial tachycardia (AT) • Focal AT An SVT arising from a localized atrial site, characterized by regular, organized atrial activity with discrete P waves and typically an isoelectric segment between P waves. At times, irregularity is seen, especially at onset ("warm-up") and termination ("warm-down"). Atrial mapping reveals a focal point of origin. • Sinus node reentry tachycardia A specific type of focal AT that is due to microreentry arising from the sinus node complex, characterized by abrupt onset and termination, resulting in a P-wave morpholog y that is indistinguishable from sinus rhythm. • Multifocal atrial tachycardia (MAT) An irregular SVT characterized by ≥3 distinct P-wave morphologies and/or patterns of atrial activation at different rates. e rhythm is always irregular. Atrial flutter • Cavotricuspid isthmus (CTI)– dependent atrial flutter: typical Macroreentrant AT propagating around the tricuspid annulus, proceeding superiorly along the atrial septum, inferiorly along the right atrial wall, and through the CTI between the tricuspid valve annulus and the Eustachian valve and ridge. is activation sequence produces predominantly negative "sawtooth" flutter waves on the ECG in leads 2, 3, and aVF and a late positive deflection in V1. e atrial rate can be slower than the typical 300 bpm (cycle length 200 ms) in the presence of antiarrhythmic drugs or scarring. It is also known as "typical atrial flutter" or "CTI– dependent atrial flutter" or "counterclockwise atrial flutter." Table 1. Relevant Terms and Definitions (cont'd) Arrhythmia/Term Definition

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