atrio ventricular nodal dependent tachycardias and pre excitation
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Atrio Ventricular Nodal – Dependent Tachycardias And Pre- excitation. Textbook Eric J. Topol Cardiology Updated December 2008 ROBERT A. SCHWEIKERT AND DOUGLAS L. PACKER . Curso Bá sico ECG VII Parte. Dr . Juan Herrera Salazar .

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atrio ventricular nodal dependent tachycardias and pre excitation

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.

advertencia al lector
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.

agradecimientos a
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.

slide17

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).

slide19
Supraventricular tachycardia. P wave is not visible in this example, suggesting AV nodal reentry tachycardia.
slide20

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.

slide24
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.

slide25
Electrocardiogram showing transition from left-bundle-branch block to normal QRS supraventricular tachycardia.
slide27
Left free wall accessory pathway mediating orthodromic AVRT –Earliest Atrial Activation Occurs in the Distal Coronary Sinus at CS .
send patients to electro physiologic studies
Variable ventricular preexcitation dependent on relative conduction through the atrioventricular node (AVN) and accessory pathway (AP).SendPatientsto Electro PhysiologicStudies….
slide30
Mechanisms of preexcitedatrioventricular (AV) nodal–dependent tachycardias
risk stratification in wolff parkinson white patients
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
electrocardiographic criteria for the diagnosis of ventricular tachycardia
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.
priorities in the treatment of frequent ventricular tachycardia episodes
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
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