ACC GUIDELINES Bundle (free trial)

Supraventricular Tachycardia

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Key Points 2 • CTI– dependent atrial flutter: reverse typical Macroreentrant AT that propagates around in the direction reverse that of typical atrial flutter. Flutter waves typically appear positive in the inferior leads and negative in V1. is type of atrial flutter is also referred to as "reverse typical" atrial flutter or "clockwise typical atrial flutter." • Atypical or non- CTI– dependent atrial flutter Macroreentrant ATs that do not involve the CTI. A variety of reentrant circuits may include reentry around the mitral valve annulus or scar tissue within the le or right atrium. A variety of terms have been applied to these arrhythmias according to the reentry circuit location, including particular forms, such as "LA flutter" and "LA macroreentrant tachycardia" or incisional atrial reentrant tachycardia due to reentry around surgical scars. Junctional tachycardia A nonreentrant SVT that arises from the AV junction (including the His bundle). Atrioventricular nodal reentrant tachycardia (AVNRT) A reentrant tachycardia involving 2 functionally distinct pathways, generally referred to as "fast" and "slow" pathways. Most commonly, the fast pathway is located near the apex of Koch's triangle, and the slow pathway inferoposterior to the compact AV node tissue. Variant pathways have been described, allowing for "slow-slow" AVNRT. • Typical AVNRT AVNRT in which a slow pathway serves as the anterograde limb of the circuit and the fast pathway serves as the retrograde limb (also called "slow-fast AVNRT"). • Atypical AVNRT AVNRT in which the fast pathway serves as the anterograde limb of the circuit and a slow pathway serves as the retrograde limb (also called "fast-slow AV node reentry") or a slow pathway serves as the anterograde limb and a second slow pathway serves as the retrograde limb (also called "slow-slow AVNRT"). Accessory pathway For the purpose of this guideline, an accessory pathway is defined as an extranodal AV pathway that connects the myocardium of the atrium to the ventricle across the AV groove. Accessory pathways can be classified by their location, type of conduction (decremental or nondecremental), and whether they are capable of conducting anterogradely, retrogradely, or in both directions. Of note, accessory pathways of other types (such as atriofascicular, nodo-fascicular, nodo-ventricular, and fasciculoventricular pathways) are uncommon. • Manifest accessory pathways A pathway that conducts anterogradely to cause ventricular pre-excitation pattern on the ECG. • Concealed accessory pathway A pathway that conducts only retrogradely and does not affect the ECG pattern during sinus rhythm. Table 1. Relevant Terms and Definitions (cont'd) Arrhythmia/Term Definition

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