II. Definitions
- Atrioventricular Reciprocating Tachycardia (AVRT)
- Form of Paroxysmal Supraventricular Tachycardia (30% of cases) with an accessory pathway (outside the AV Node)
III. Epidemiology
- Overall, second most common cause of PSVT (30% of cases)
- Most common in children (represents 60% of SVT cases in first decade of life)
- Decreasing Prevalence with age (represents 9% of SVT cases over age 70 years)
IV. Pathophysiology
V. Findings: EKG
- Heart Rate 160 to 240 (up to 256)
- Images
VI. Types: General
- Orthodromic, narrow complex (87% of cases)
- Signal passes anterograde down the AV Node, through the ventricles and retrograde up the accesory path
- Represents up to 87% of AVRT cases
- Narrow Complex Tachycardia at 150 to 250 bpm
- RP interval is <50% of the tachycardic RR interval
- Retrograde P Waves appear after the QRS in I, II, III, aVF, V1 (may be obscured by T Wave)
- Antidromic, wide complex
- Signal passes retrograde up the AV Node and anterograde down the accessory path
- Wide Complex Tachycardia at 150 to 200 bpm
- RP interval is >50% of the tachycardic RR interval (<100 msec)
- Short PR Interval
VII. Types: Variants
-
Wolff-Parkinson-White Syndrome (WPW Syndrome)
- Orthodromic variant
- Anterograde conduction down the accessory path reaches the ventricle before the AV Nodal signal
- Results in preexcitation of the ventricle, forming a slurred upstroke of the QRS (delta wave)
- Permanent (or persistent) Junctional Reciprocating Tachycardia
- Slow retrograde conduction via the accessory pathway
- Results in sustained Supraventricular Tachycardia
- Risk of Tachycardia induced Cardiomyopathy and Congestive Heart Failure
VIII. Management
- Catheter Ablation (preferred)
- First-Line Management for recurrent AVNRT
- Medical Management (alternative)
- See Paroxysmal Supraventricular Tachycardia
- See Supraventricular Tachycardia
- Orthodromic AVRT
- Contraindications to AV Nodal and Rate Control Agents
- Preexcitation such as WPW Syndrome (refer for ablation)
- Heart Failure with Reduced Ejection Fraction (HFrEF)
- Medications
- Beta Blocker (e.g. Metoprolol)
- Nondihydropyridine Calcium Channel Blocker (e.g. Diltiazem)
- Contraindications to AV Nodal and Rate Control Agents
- Antidromic AVRT
- Contraindications to Antiarrhythmic Agents
- Ischemic or structural heart disease
- Medications
- Contraindications to Antiarrhythmic Agents
IX. Course
- May degenerate into Atrial Fibrillation
X. References
- Joshi and Dermark (2016) Crit Dec Emerg Med 30(8):3-12
- Colucci (2010) Am Fam Physician 82(8): 942-52 [PubMed]
- Delacretaz (2006) N Engl J Med 354(10): 1039-51 [PubMed]
- Helton (2015) Am Fam Physician 92(9): 793-800 [PubMed]
- Kumar (2006) Cardiol Clin 24(3): 427-37 [PubMed]
- Nasir (2023) Am Fam Physician 107(6): 631-41 [PubMed]
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Related Studies
| Definition (NCI_CDISC) | An electrocardiographic finding of a regular supraventricular tachycardia which utilizes an atrioventricular bypass tract as its retrograde limb (orthodromic tachycardia) or as its antegrade limb (antidromic tachycardia). QRS complexes during sinus rhythm may show preexcitation. During orthodromic tachycardia the preexcitation is not present and a retrograde P wave may appear after the QRS complex. During antidromic tachycardia the QRS complex is preexcited. |
| Definition (NCI) | An electrocardiographic finding of a regular supraventricular tachycardia which utilizes an atrioventricular bypass tract as its retrograde limb (orthodromic tachycardia) or as its antegrade limb (antidromic tachycardia). QRS complexes during sinus rhythm may show preexcitation. During orthodromic tachycardia the preexcitation is not present and a retrograde P wave may appear after the QRS complex. During antidromic tachycardia the QRS complex is preexcited. (CDISC) |
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 233897008 |
| English | AVRT- AV re-entrant tachy, Re-entrant AV tachycardia, AV Reentrant Tachycardia, AV reentrant tachycardia, Atrioventricular Reentrant Tachycardia, Atrioventricular Reentrant Tachycardia by EKG Finding, AV re-entrant tachycardia, AV RE-ENTRANT TACHYCARDIA, Atrioventricular Reentrant Tachycardia by ECG Finding, AVRT - Atrioventricular re-entrant tachycardia, Re-entrant atrioventricular tachycardia, Re-entrant atrioventricular tachycardia (disorder) |
| Dutch | AV-re-entry-tachycardie |
| French | Tachycardie par réentrée AV |
| German | AV Reentry-Tachykardie |
| Italian | Tachicardia da rientro atrioventricolare |
| Portuguese | Taquicardia AV reentrante |
| Spanish | Taquicardia por reentrada AV, taquicardia auriculoventricular por reentrada (trastorno), taquicardia auriculoventricular por reentrada |
| Japanese | 房室リエントリー性頻脈, ﾎﾞｳｼﾂﾘｴﾝﾄﾘｰｾｲﾋﾝﾐｬｸ |
| Czech | AV reentry tachykardie |
| Hungarian | AV reentry tachycardia |
Ontology: Orthodromic atrioventricular re-entrant tachycardia (C0340478)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 233898003 |
| English | Orthodrom a/v re-entrant tachy, Orthodromic atrioventricular re-entrant tachycardia, Orthodromic atrioventricular re-entrant tachycardia (disorder) |
| Spanish | taquicardia reentrante auriculoventricular ortodrómica (trastorno), taquicardia reentrante auriculoventricular ortodrómica |
Ontology: Antidromic atrioventricular re-entrant tachycardia (C0340479)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 233899006 |
| English | Antidromic a/v re-ent tachy, Antidromic atrioventricular re-entrant tachycardia, Antidromic atrioventricular re-entrant tachycardia (disorder) |
| Spanish | taquicardia auriculoventricular reentrante antidrómica (trastorno), taquicardia auriculoventricular reentrante antidrómica |
