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.



16 years old male wpw
16 yearsoldmale WPW





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).


58 yr old female with supraventricular tachycardia avnrt diagnosed with eps
58 yr. old female with supraventricular tachycardia. AVNRT diagnosedwith EPS


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


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.


57 yr old female with supraventricular tachycardia avrt diagnosed with eps
57 yr. old female with supraventricular tachycardia. AVRT diagnosed with EPS.




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.


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


Preexcitation variants

The most common of these are PJRT and block to normal QRS preexcited tachycardia related to atriofascicular fibers

Preexcitation Variants  


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


Wolff parkinson white syndrome2
Wolff block to normal QRS Parkinson-White Syndrome


Send patients to electro physiologic studies

Variable ventricular block to normal QRS preexcitation dependent on relative conduction through the atrioventricular node (AVN) and accessory pathway (AP).

SendPatientsto Electro PhysiologicStudies….


Mechanisms of block to normal QRS preexcitedatrioventricular (AV) nodal–dependent tachycardias


Risk stratification in wolff parkinson white patients

Atrial block to normal QRS 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


Rhythm strip showing intermittent preexcitation in a patient with wolff parkinson white syndrome
Rhythm strip showing intermittent block to normal QRS preexcitation in a patient with Wolff-Parkinson-White syndrome


Reciprocating tachycardia
Reciprocating block to normal QRS Tachycardia


Mechanism of atriofascicular af mahaim reentrant tachycardias
Mechanism block to normal QRS of atriofascicular (AF) (Mahaim) reentranttachycardias.


Microanatomy of atrioventricular av nodal reentrant tachycardia
Microanatomy of block to normal QRS atrioventricular(AV) nodal reentrant tachycardia


Mechanism of atrioventricular av reentrant and av nodal reentrant tachycardias
Mechanism of block to normal QRS atrioventricular (AV) reentrant and AV nodal reentrant tachycardias.


Polymorphic ventricular tachycardia with the features of torsade de pointes
. block to normal QRS Polymorphic ventricular tachycardia with the features of torsade de pointes


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.


Sarcoidosis
Sarcoidosis VENTRICULAR TACHYCARDIA


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


Giant cell myocarditis
Giant cell TACHYCARDIA EPISODESmyocarditis.


Myocarditis sarcoidosis
Myocarditis-sarcoidosis TACHYCARDIA EPISODES


Myocarditis sarcoidosis1
Myocarditis TACHYCARDIA EPISODES - sarcoidosis


Myocarditis giant cell
Myocarditis TACHYCARDIA EPISODES-giant cell


Myocarditis eosinophilic
Myocarditis TACHYCARDIA EPISODES- eosinophilic


Wide complex tachycardia with atrio ventricular dissociation
Wide TACHYCARDIA EPISODEScomplextachycardiawith atrio-ventricular dissociation.


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