AV reentrant tachycardia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

Synonyms and keywords: AVRT; AV-reciprocating tachycardia; atrioventricular reentrant tachycardia; circus movement tachycardia

Overview

AVRT results from an anatomically distinct atrioventricular connection. The causes, which usually are congenital or genetic, include: Ebstein anomaly, Lown-Ganong-Levine syndrome, Mahaim fiber tachycardia, Wolff-Parkinson-White syndrome.

Classification

Two types of tachycardia fall under this category:

Orthodromic Atrioventricular Reentrant Tachycardia

In orthodromic AVRT, the antegrade conduction (from the atria to the ventricles) occurs through the AV node, whereas the retrograde conduction (from the ventricle to the atrium) occurs through the accessory pathway. In this case, the ECG will reveal narrow QRS and retrograde P wave following the QRS complex.

Antidromic Atrioventricular Reentrant Tachycardia

In antidromic AVRT, the antegrade conduction (from the atrium to the ventricle) occurs through the accessory pathway, whereas the retrograde conduction (from the ventricles to the atria) occurs through the AV node. In this case, the ECG will reveal wide QRS similar to those found in ventricular tachycardia.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

AV nodal reentrant tachycardia is usually not life-threatening.

Common Causes

• Mitral valve prolapse

Causes by Organ Systems

Cardiovascular	Ebstein anomaly, Lown-Ganong-Levine syndrome, Mahaim fiber tachycardia, Wolff-Parkinson-White syndrome
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	Ebstein anomaly
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Ebstein anomaly
• Lown-Ganong-Levine syndrome
• Mahaim fiber tachycardia
• Wolff-Parkinson-White syndrome

Pathophysiology

Electrical activity of the heart is rerouted through an accessory pathway that connects the atria with the ventricles.

Diagnosis

Electrocardiogram

QRS Atlernans

The appearance of QRS alternans as part of a narrow complex tachycardia suggests the diagnosis of orthodromic atrioventricular (AV) reentrant tachycardia which conducts retrograde over an accessory pathway.

Video

Below is a video explaining the mechanism of AV re-entrant tachycardia

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See Also

Wolff-Parkinson-White syndrome Lown-Ganong-Levine syndrome

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