Narrow complex tachycardia resident survival guide: Difference between revisions
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Patients with focal junctional tachycardia may mimic the pattern of slow-fast [[AVNRT]] and may show AV dissociation and/or marked irregularity in the junctional rate.<br>AV indicates atrioventricular; [[AVNRT]], [[atrioventricular nodal reciprocating tachycardia]]; [[MAT]], [[multifocal atrial tachycardia]]; ms, miliseconds; PJRT, permanent form of junctional reciprocating tachycardia; QRS, ventricular activation on ECG. | Patients with focal junctional tachycardia may mimic the pattern of slow-fast [[AVNRT]] and may show AV dissociation and/or marked irregularity in the junctional rate.<br>AV indicates atrioventricular; [[AVNRT]], [[atrioventricular nodal reciprocating tachycardia]]; [[MAT]], [[multifocal atrial tachycardia]]; ms, miliseconds; PJRT, permanent form of junctional reciprocating tachycardia; QRS, ventricular activation on ECG.<br> | ||
''Algorithm based on the 2003 | ''Algorithm based on the 2003 ACC/AHA/ESC guidelines for the management of tachycardia.''<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> | ||
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†Adenosine should be used with caution in patients with severe coronary artery disease and may produce | †Adenosine should be used with caution in patients with severe coronary artery disease and may produce | ||
AF, which may result in rapid ventricular rates for patients with pre-excitation. *Ibutilide is especially effective for patients with atrial flutter but should not be used in patients with EF less than 30% due to increased risk of polymorphic VT. AF indicates atrial fibrillation; AV, atrioventricular; BBB, bundle-branch block; DC, direct current; IV, intravenous; LV, left ventricle; QRS, ventricular activation on ECG; SVT, supraventricular tachycardia; VT, ventricular tachycardia. | AF, which may result in rapid ventricular rates for patients with pre-excitation. *Ibutilide is especially effective for patients with atrial flutter but should not be used in patients with EF less than 30% due to increased risk of polymorphic VT. AF indicates atrial fibrillation; AV, atrioventricular; BBB, bundle-branch block; DC, direct current; IV, intravenous; LV, left ventricle; QRS, ventricular activation on ECG; SVT, supraventricular tachycardia; VT, ventricular tachycardia.<br> | ||
''Algorithm based on the 2003 | ''Algorithm based on the 2003 ACC/AHA/ESC guidelines for the management of tachycardia.''<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> | ||
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AT indicates atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reciprocating tachycardia; AVRT, atrioventricular reciprocating tachycardia; IV, intravenous; QRS, ventricular activation on ECG; VT, ventricular tachycardia. | AT indicates atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reciprocating tachycardia; AVRT, atrioventricular reciprocating tachycardia; IV, intravenous; QRS, ventricular activation on ECG; VT, ventricular tachycardia.<br> | ||
''Algorithm based on the 2003 | ''Algorithm based on the 2003 ACC/AHA/ESC guidelines for the management of tachycardia.''<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> | ||
==References== | ==References== | ||
Revision as of 20:01, 19 August 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hilda Mahmoudi M.D., M.P.H.[2]
Definition
Heart rate > 100 with QRS complex width 0.12 seconds or less.
Causes
Life Threatening Causes
Life-threatening causes include conditions which result in death or permanent disability within 24 hours if left untreated.
Common Causes
Management
Figure 1: Differential diagnosis for narrow QRS tachycardia.[1]
| Narrow QRS tachycardia (QRS duration less than 120 ms) | |||||||||||||||||||||||||||||||||||||||||||
| Regular tachycardia? | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Visible P waves? | Atrial fibrillation Atrial tachycardia/flutter with variable AV conduction MAT | ||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||
| Atrial rate greater than ventricular rate? | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Atrial flutter or atrial tachycardia | Analyze RP interval | ||||||||||||||||||||||||||||||||||||||||||
| Short (RP shorter than PR) | Long (RP longer than PR) | ||||||||||||||||||||||||||||||||||||||||||
| RP shorter than 70 ms | RP longer than 70 ms | Atrial tachycardia PJRT Atypical AVNRT | |||||||||||||||||||||||||||||||||||||||||
| AVNRT | AVRT AVNRT Atrial tachycardia | ||||||||||||||||||||||||||||||||||||||||||
Patients with focal junctional tachycardia may mimic the pattern of slow-fast AVNRT and may show AV dissociation and/or marked irregularity in the junctional rate.
AV indicates atrioventricular; AVNRT, atrioventricular nodal reciprocating tachycardia; MAT, multifocal atrial tachycardia; ms, miliseconds; PJRT, permanent form of junctional reciprocating tachycardia; QRS, ventricular activation on ECG.
Algorithm based on the 2003 ACC/AHA/ESC guidelines for the management of tachycardia.[1]
Figure 2: Acute management of patients with hemodynamically stable and narrow QRS regular tachycadia:[1]
| Hemodynamically stable regular tachycardia | |||||||||||||||||||||||||||||||||||||||||||
| Narrow QRS | |||||||||||||||||||||||||||||||||||||||||||
| SVT | |||||||||||||||||||||||||||||||||||||||||||
| Vagal maneuvers IV adenosine† IV verapamil/diltiazem IV beta blocker | |||||||||||||||||||||||||||||||||||||||||||
| Termination | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No,persistent tachycardia with AV block | ||||||||||||||||||||||||||||||||||||||||||
| *IV ibutilide plus AV-nodal-blocking agent Overdrive pacing/DC cardioversion, and/or rate control | |||||||||||||||||||||||||||||||||||||||||||
†Adenosine should be used with caution in patients with severe coronary artery disease and may produce
AF, which may result in rapid ventricular rates for patients with pre-excitation. *Ibutilide is especially effective for patients with atrial flutter but should not be used in patients with EF less than 30% due to increased risk of polymorphic VT. AF indicates atrial fibrillation; AV, atrioventricular; BBB, bundle-branch block; DC, direct current; IV, intravenous; LV, left ventricle; QRS, ventricular activation on ECG; SVT, supraventricular tachycardia; VT, ventricular tachycardia.
Algorithm based on the 2003 ACC/AHA/ESC guidelines for the management of tachycardia.[1]
Figure 3: Responses of narrow complex tachycardias to adenosine.[1]
| Regular narrow QRS complex tachycardia | |||||||||||||||||||||||||||||||||||||||||||||||
| IV adenosine | |||||||||||||||||||||||||||||||||||||||||||||||
| No change in rate | Gradual slowing then reacceleration of rate | Sudden termination | Persisting atrial tachycardia with transient high-grade AV block | ||||||||||||||||||||||||||||||||||||||||||||
| Inadequate dose/delivery Condiser VT (fascicular or hight septal origin) | Sinus tachycardia Focal AT Nonparoxysmal junctional tachycardia | AVNRT AVRT Sinus node re-entry Focal AT | Atrial flutter AT | ||||||||||||||||||||||||||||||||||||||||||||
AT indicates atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reciprocating tachycardia; AVRT, atrioventricular reciprocating tachycardia; IV, intravenous; QRS, ventricular activation on ECG; VT, ventricular tachycardia.
Algorithm based on the 2003 ACC/AHA/ESC guidelines for the management of tachycardia.[1]