Supraventricular Tachycardia (SVT)

Brandon Fainstad, MD
Zachary Goldberger, MD (University of Wisconsin, Department of Cardiology) – Expert review


OBJECTIVES
1. Characterize the electrophysiology of the seven supraventricular tachycardias.
2. Differentiate the supraventricular tachycardias based on regularity and  P wave morphology.
3. Identify the best acute management for each rhythm.


TEACHING INSTRUCTIONS


PRINTOUTS
1. Learner Handout
2. Practice ECGS


INTERACTIVE BOARD FOR PREPARING A TALK OR SELF-DIRECTED LEARNING
*Teachers: Use this interactive board to become familiar with the material and framework for the talk.


INTERACTIVE BOARD FOR PRESENTING
*Teachers: This interactive board expands to full-screen by clicking the “expand” icon on the bottom right of the frame. It is designed to be projected on a large monitor or screen.  Alternatively, you can reproduce this talk on a whiteboard.


PRACTICE CASES
*See “Print outs” above for printable version


TAKE HOME POINTS

  1. Tachycardia is due to either increased automaticity of a pacemaker (nodal or ectopic) or a re-entry circuit. Re-entry circuits are generally faster.
  2. There are only 7 SVTs that are distinguished by regular vs. irregular rhythm and the presence or morphology of the p wave.
  3. Hemodynamically stable SVTs are acutely managed one of 3 ways:
    1. Address underlying disease (for sinus tach, atrial tach, and multi-atrial tach)
    2. Resolve the re-entry circuit by interrupting AV conduction with vagal maneuvers or adenosine (for AVnRT and AVRT)
    3. Rate control with AV nodal blockers (for afib and aflutter)

REFERENCES

Goldberger, Ary Louis, Zachary D. Goldberger, and Alexei Shvilkin. Goldberger’s Clinical Electrocardiography: a Simplified Approach. Philadelphia: Elsevier, 2018

Nelson, William Paul, Henry J. L. Marriott, and Douglas D. Schocken. Concepts and Cautions in Electrocardiography. Northglenn, CO: MedInfo Inc., 2007.