Atrio Ventricular Nodal – Dependent Tachycardias And Pre- excitation

1. Atrio Ventricular Nodal – DependentTachycardias And Pre-excitation • Textbook Eric J. Topol Cardiology • Updated December 2008 • ROBERT A. SCHWEIKERT AND DOUGLAS L. PACKER Curso Básico ECG VII Parte. Dr. Juan Herrera Salazar. Clínica de Asma y Alergia Seminarios Marzo2009.

2. Advertencia al Lector Este curso básico espero sea útil al estudiante, a la enfermera, a los médicos de la práctica general o internística. Los limites de espacio, los autoimpuestos y los propios son evidentes a lo largo del curso, favor señalar los que Uds. encuentren. Si el benévolo lector cree que la propuesta sea digna de consideración y quieren señalar como enriquecerla les agradeceré profundamente su atención.

3. Agradecimientos a Novartis por habernos facilitado su curso en CD , que desgraciadamente ya no ofrecen a sus médicos y que ahora proponemos al benévolo lector integrado con los comentarios del Textbook of Cardiovascular Medecine III edition 2007, de Eric J. Topol del cual tomamos los registros ECG y el texto. Usamos el permiso expreso en la licencia del libro de texto y su codigo WEB , para su divulgación no comercial.

9. Wolff-Parkinson-White syndrome.

10. 16 yearsoldmale WPW

11. Ventricular Fibrillation

12. 44 yr. old female with WPW

13. Wolff-Parkinson-White syndrome

17. AV nodal reentrant tachycardia (AVNRT) AV reciprocating tachycardia (AVRT) These arrhythmias occur as a component of Wolff-Parkinson-White (WPW) . Some patients with WPW syndrome are at potential risk for atrial fibrillation (AF) degenerating into ventricular fibrillation (VF).

18. 58 yr. old female with supraventricular tachycardia. AVNRT diagnosedwith EPS

19. Supraventricular tachycardia. P wave is not visible in this example, suggesting AV nodal reentry tachycardia.

20. Electrocardiogram tracing from atrioventricular (AV) nodal–dependent tachycardia. This is a narrow-QRS-complex tachycardia with a 1:1 AV relationship in a patient with an AV nodal reentrant tachycardia.

21. 57 yr. old female with supraventricular tachycardia. AVRT diagnosed with EPS.

22. Spontaneous conversion to NSR

23. Classification of short- and long-RP tachycardias.

24. Change in ventriculoatrial (VA) interval with development of bundle branch (BB) aberration during orthodromicatrioventricular reciprocating tachycardia using an accessory pathway (AP). During normal conduction (solid line), the interval from the onset of the surface QRS to the earliest retrograde atrial activation (VA interval) is at least 70 msec because of the component conduction properties. With BB block ipsilateral to the AP, the additional conduction time due to transseptal and intramyocardial propagation (dashed line) to the AP prolongs the VA conduction time. A, atrium; AVN, atrioventricular node; H, bundle of His; V, ventricle.

25. Electrocardiogram showing transition from left-bundle-branch block to normal QRS supraventricular tachycardia.

26. The most common of these are PJRT and preexcited tachycardia related to atriofascicular fibers Preexcitation Variants  

27. Left free wall accessory pathway mediating orthodromic AVRT –Earliest Atrial Activation Occurs in the Distal Coronary Sinus at CS .

28. Wolff Parkinson-White Syndrome

29. Variable ventricular preexcitation dependent on relative conduction through the atrioventricular node (AVN) and accessory pathway (AP). SendPatientsto Electro PhysiologicStudies….

30. Mechanisms of preexcitedatrioventricular (AV) nodal–dependent tachycardias

31. Atrial fibrillation with a rapid ventricular response rate during Wolff-Parkinson-White syndrome. Initial atrioventricular reentrant tachycardia degenerates into atrial fibrillation (arrow). The shortest RR interval in this case was 240 to 250 Risk Stratification in Wolff-Parkinson-White Patients

32. Rhythm strip showing intermittent preexcitation in a patient with Wolff-Parkinson-White syndrome

33. ReciprocatingTachycardia

34. Mechanism of atriofascicular (AF) (Mahaim) reentranttachycardias.

35. Microanatomy of atrioventricular(AV) nodal reentrant tachycardia

36. Mechanism of atrioventricular (AV) reentrant and AV nodal reentrant tachycardias.

40. .Polymorphic ventricular tachycardia with the features of torsade de pointes

42. ELECTROCARDIOGRAPHIC CRITERIA FOR THE DIAGNOSIS OF VENTRICULAR TACHYCARDIA Fusion and/or capture beats • Atrioventriculardissociation • QRS width (rightbundlebranch block pattern ≥140 milliseconds, leftbundlebranch block pattern ≥160 milliseconds) • Frontal plane axis between −90 and +180 degrees • Precordial R/S criterion (absent R/S, or RS interval >100 milliseconds) • In thepresence of baselinewide QRS, different QRS patternduringtachycardia • LBBB, leftbundlebranch block; RBBB, rightbundlebranch block.

46. Sarcoidosis

47. PRIORITIES IN THE TREATMENT OF FREQUENT VENTRICULAR TACHYCARDIA EPISODES • Treatment of triggering events (ischemia, heart failure, supraventricular tachycardia) • β-Adrenergicblockade • Antitachycardiapacing • Antiarrhythmic drugs (preferably class III) • Catheterablation

50. Giant cell myocarditis.