Supraventricular

Arrhythmias

Johny Abboud, MD.

 Atrial premature beats

• P’ occurs earlier than expected

• Variation of the morphology and
the duration of the subsequent P’R
 Atrial Premature Beats

• Anxiety. • Hypokalemia
• Sympathomimetics. • Hypomagnesaemia
• Beta-agonists. • Digoxin toxicity .
• Excess caffeine. • Myocardial ischemia
 Atrial Premature Beats
• Bigeminy — every other beat is a PAC.
• Trigeminy — every third beat is a PAC.
• Quadrigeminy — every fourth beat is a PAC.
• Couplet – two consecutive PACs.
• Triplet — three consecutive PACs
Atrial bigeminy
Atrial bigeminy, trigeminy and couplet
•AV Conduction
depends on
the degree of
prematurity.
 Focal Atrial tachycardia

• P’ occurs earlier than expected

• Sustained or non sustained
• High ventricular rate and response
 Multifocal atrial tachycardia

• rapid firing of atrial foci from more than two

locations
• multiple shapes of P waves
• irregular rhythm
• High ventricular rate
• Usually it is a complication in COPD patients
and elderly patients
Multifocal atrial tachycardia
 Atrial Flutter (A-Flutter)
• Rapid and regular form of atrial tachycardia
• Usually paroxysmal
• Sustained by a macro-reentrant circuit
• Circuit is confined to the right atrium
• Episodes can last from seconds to years
• Chronic atrial flutter usually progresses to
atrial fibrillation
 Atrial Flutter

• Atrial rapid rate and regular

• Ventricular rate depends on AV
conduction
• Ventricular rate usually is regular but
it could be irregular
• Identified on surface ECG and usually
in the inferior leads
Atrial Flutter
 Atrial fibrillation

• The most frequent arrhythmia

• Chaotic, irregular, very rapid disordered
pattern of atrial excitation
• Irregular ventricular rate
• Symptoms related to ventricular rate and
cardiac disorders
 AF Pathophysiology
• The hallmark of AF is chaotic atrial impulses leading to irregularly irregular
ventricular contraction, usually with incessant tachycardia
Atrial Fibrillation
 Classification

• Paroxysmal atrial fibrillation

• Persistent atrial fibrillation

• Permanent atrial fibrillation

Cardiac Left Atrial Appendage
AVNRT
AVNRT
Accessory
Pathway
Wolf Parkinson White ( Concealed Bypass in sinus
WPW) in SR = delta wave rhythm = Normal ECG
 Wolf Parkinson White
(WPW) in SR = delta wave
Concealed Bypass in sinus
rhythm = Normal ECG
Orthodromic Supra Ventricular Tachycardia
SVT

Usually narrow QRS

Orthodromic Supra Ventricular Tachycardia
SVT
Antidromic Supra Ventricular Tachycardia
SVT

Almost wide QRS

Antidromic Supra Ventricular Tachycardia
SVT
 Tachycardia by WPW

Orthodromic avrt Antidromic avrt

Usually narrow QRS Almost wide QRS

 Tachycardia by Concealed byspass

Only Orthodromic

Usually narrow QRS

 Accessory Pathway
WPW Concealed bypass

• Delta wave during sinus rhythm • Normal sinus rhythm . No delta wave
• Orthodromic tachycardia • Orthodromic tachycardia
• Antidromic tachycardia • No antidromic tachycardia
WPW + A fibrillation

Atrial fibrillation with

WPW