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SUPRAVENTICULAR TACHYCARDY

Usually, paroxysmal supraventricular tachycardia (SVT) denotes arrhythmias other than atrial
fibrillation and ventricular tachycardias. This definition is inaccurate as discussed in Chapter 50
on classification of tachycarrhythmias but traditionally used. Figure 50.1 presents the
mechanisms of supraventricular tachycardias.

The prevalence of SVT is 2.25/1000 persons and the incidence 35/100 000 person-years (MESA
study). 1 Thus, there are approximately 89 000 new cases/year and 570 000 persons with SVT
in the United States. Mean age at presentation is 37 to 45 years, 1,2 and the incidence and
prevalence of SVTs increase with age, with a risk of arrhythmia more than five times greater in
persons >65 years than in those <65 years old. 1 Age of tachycardia onset is lower for
atrioventricular reentrant tachycardia (AVRT) due to accessory pathway than atrioventricular
nodal reentrant tachycardia (AVNRT). In a recent study on 1754 patients undergoing catheter
ablation, AVNRT was the main aetiology (56%), followed by AVRT (27%) and atrial tachycardia
(AT, 17%). 2 The proportion of AVRT in both sexes decreased with age whereas AVNRT and AT
increased. The majority of patients with AVRT were men (55%) whereas the majority of patients
with AVNRT and AT were women (70% and 62%, respectively). Atrial flutter has an incidence of
0.09%, and 58% of the patients have AF (MESA study). 3 Its incidence increases with age, from
5/100 000 for those less than 50 years to 587/100 000 over 80 years of age, and is 2.5 times
more common in men than in women. The risk of developing atrial flutter increases 3.5 times
in subjects with heart failure and 1.9 times (p <0.001) in subjects with chronic obstructive
pulmonary disease. Atrial flutter is usually associated with heart disease, such as heart failure
(16%) or chronic obstructive lung disease (12%) whereas an apparently normal heart is found
in <2% of patients.

Patients present due to paroxysms of regular or irregular palpitations with a characteristically


sudden onset and offset that occur mostly in daylight, which may be associated with fatigue,
light-headedness, dyspnoea, chest discomfort, and presyncope. Syncope and cardiac arrest are
rare (<15%), usually denote underlying structural heart disease or AF in the presence of a
conducting accessory pathway, and may be due to rapid heart rate or vasomotor factors. 4,5
Polyuria is due to release of atrial natriuretic peptide in response to increased atrial pressure,
and vagal manoeuvres usually interrupt the tachycardia. Patients may also present with AF that
has been initiated by the SVT and which usually, 6,7 but not invariably, 8 is eliminated by
ablation of the SVT itself.