AVNRT

• 2/3 of all Paroxysmal SVT cases

• Regular rhythm

• No discernible P wave or retrograde P wave (Short RP tachycardia)

• Pathophysiology: Dual AV nodal pathway

• PAC precipitates reentrant circuit.

ECG Concept Using Electrophysiologic Principle

Management of AVNRT

ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: a report of the American College of Cardiology/American Heart Association Task

Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee

to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). 2003

Acute setting

• Vagal Maneuver

• Adenosine 90% success rate

• Calcium channel blocker: terminate in 2 minutes

• DC cardioversion 10-50 J

V1

II

Long term management

• Severity of attack

• Medication– Digoxin– Beta blocker– Calcium channel blocker

Catheter Ablation

• 95% success rate, 1% chance of AV block

• Patient preference

• Fail pharmacologic therapy or side effect from medication

• Severely symptomatic eg syncope angina dyspnea