AVNRT
Jason Ryan, MD, MPH
PSVT
Paroxysmal Supraventricular Tachycardia
• Intermittent tachycardia (HR > 100bpm)
• Sudden onset/offset
• Contrast with sinus tachycardia
• Electrical activity originates above ventricle
• “Supraventricular”
• Contrast with ventricular tachycardia
• Produces narrow QRS complex (<120ms)
PSVT
Paroxysmal Supraventricular Tachycardia
• Often causes sudden-onset palpitations
• Chest discomfort
• Rarely syncope
AVNRT
Atrioventricular nodal reentrant tachycardia
• Most common cause of PSVT
• More common in young women
• Mean age onset: 32 years old
• Requires dual AV nodal pathways
Normal Conduction
SA
AV LBB
His
Purkinje
RBB Fibers
Dual Pathways
Sinus Rhythm
Slow Fast
Conduction Conduction
Short RP Long RP
HIS
Dual Pathways
PAC
Slow Fast
Conduction Conduction
Short RP Long RP
HIS
Retrograde P Waves
AVNRT
• Recurrent episodes of palpitations
• Many episodes spontaneously resolve
• ↓ conduction in AV node breaks arrhythmia
• Will halt conduction in slow pathway
• Carotid massage
• Vagal maneuvers
• Adenosine
Carotid Massage
• Examiner presses on neck near carotid sinus
• Stretch of baroreceptors
• CNS response as if high blood pressure
• Increased vagal tone
• ↓ AV node conduction
Wikipedia/Public Domain
Vagal Maneuvers
• Valsalva
• Patient bears down as if moving bowels
• Increased thoracic pressure
• Aortic pressure rises → ↓ heart rate and AV conduction
• Breath holding
• Coughing
• Deep respirations
• Gagging
• Swallowing
AVNRT
Chronic Treatment
• Many patients need no therapy
• Beta blockers, Verapamil/Diltiazem
• Slow conduction in slow pathway
• Surgical ablation of slow pathway
