1. Supravetricular Tachyarrhythmias Part 1 Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center

2. Objectives Define the mechanisms of arrhythmias Understand the relevance of the site of origin to the arrhythmia Recognize and differentiate the Supraventricular Arrhythmias

3. “You see only what you look for, you recognize only what you know.”

4. Basics Two most important aspects of arrhythmias: 1. Their mechanism 2. Their site of origin The two mechanisms that produce arrhythmias are: 1.Automaticity (problems of impulse formation) 2. Block or Reentry (problems of impulse conduction) The two mechanisms that produce arrhythmias are: 1.Automaticity (problems of impulse formation) 2. Block or Reentry (problems of impulse conduction)

5. SVTs Accelerated Automaticity Reentrant Atrial Tachyarrhythmias Reentrant Junctional Tachyarrhythmias - The Atrioventricular Nodal and Bypass Tachycardias

6. Accelerated Automaticity 1.Sinus Tachycardia 2.Atrial Tachyarrhythmias e.g. PAT with Block, MAT 3. Accelerated Junctional Rhythm

7. Reentrant Atrial Tachs 1. Atrial Flutter 2. Atrial Fibrillation

8. Accelerated Automaticity

9. May originate from any of the pacemaker cells “Ectopic” – any rhythm that comes from any other site than the SA node SiteTermRate Range SA nodeSinus tachycardia100-200 bpm AtriaAtrial tachycardia100-200 bpm Common bundleAJR60-130 Bundle branchesAVR50-110

10. Sinus Tachycardia Tips: 1.Max. rate: 220 – age 2.Discrete, antegrade P waves 3.Short PR interval 4.Normal QRS duration

11. Sinus Tachycardia

12. Atrial Tachycardias 1.Accelerated atrial rhythm 2.Paroxysmal Atrial Tachycardia with Block 3.Multifocal Atrial Tachycardia

13. Accelerated Atrial Rhythm

15. PAT with Block

17. Wandering Atrial Pacemaker- Multifocal Atrial Tachycardia Spectrum

18. MAT

19. Acelerated Junctional Rhythm

21. Reentrant Atrial Tachyarrhythmias

22. Reentrant Atrial Tachs Atrial flutterAtrial fibrillation Single circuit, Uniform F waves Multiple circuits, Multiform f waves

23. Atrial Flutter Flutter waves best seen on inferior leads (II, III, aVF) and V1

24. Atrial Flutter

27. Atrial Fibrillation Fibrillatory waves best seen in inferior waves and V1

28. Atrial Fibrillation

30. Let’s practice! We make most mistakes because of failure to apply reason and logic, not because of ignorance. Barney Marriott, MD EKG expert Author, Practical Electrocardiography

31. EKG 1

32. EKG 2

33. EKG 3

34. EKG 4

35. EKG 5

36. EKG 6

37. EKG 7

38. EKG 8

39. EKG 9

40. The End (Part 2 next Tuesday)