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Supraventricular Arrhythmias
Diagnosis/Definition
Symptoms: palpitations, chest discomfort, dizziness, and syncope. Electrocardiogram (EKG): Narrow QRS complex tachycardia, rate > 100 bpm.
Initial Diagnosis and Management
- History and physical exam: onset, resolution, duration, frequency and associated symptoms (hemodynamic significance of event, e.g., syncope, congestive heart failure, cardioversion or treatment with adenosine or verapamil).
12 lead EKG. - PA and LAT CXR.
- Thyroid function.
- Evaluate for structural heart disease (echocardiogram or other studies as needed).
- Document rhythm during symptoms: 24-hour holter monitor for frequent symptoms. For infrequent symptoms, an event recorder is preferred (arranged through cardiology).
- Nonsustained atrial rhythms, structurally normal hearts – treat symptoms only. Consider beta-blocker or digoxin.
- Limit caffeine, tobacco, or other stimulant use.
- Wolf-Parkinson-White (WPW) syndrome and atrial fibrillation: cardioversion or intravenous procainamide.
- Digoxin, beta blockers or calcium channel blockers may favor accessory pathway conduction and may rarely lead to ventricular fibrillation in patients with WPW syndrome.
Ongoing Management and Objectives
- Medical management should reduce symptoms of atrial ectopy.
- In paroxysmal supraventricular tachycardia (PSVT), medical management may reduce episodes.
Indications for Specialty Care Referral
WPW syndrome with arrhythmia symptoms, syncope or documented narrow or wide complex tachycardias to include atrial fibrillation.
WPW patients without tachycardias generally do not need a referral.
History consistent with or documented symptomatic PSVT.
Criteria for Return to Primary Care
Patients who have undergone successful radio frequency catheter ablation.
Patients on stable antiarrhythmic regimens with control of their arrhythmias.
