Summary
Definition
History and exam
Key diagnostic factors
- atrioventricular re-entrant tachycardia (AVRT)
Other diagnostic factors
- palpitations
- dizziness
- shortness of breath
- chest pain
- atrial fibrillation
- atrial flutter
- congenital cardiac abnormalities
- sudden cardiac death
- syncope and presyncope
- tachycardia in pregnancy
Risk factors
- Ebstein anomaly
- hypertrophic cardiomyopathy
- mitral valve prolapse
- atrial septal defect
- ventricular septal defect
- transposition of great vessels
- coarctation of aorta
- dextrocardia
- coronary sinus diverticula
- right and left atrial aneurysms
- cardiac rhabdomyomas
- Marfan syndrome
- Friedreich ataxia
- family history
Diagnostic tests
1st tests to order
- 12-lead ECG
Tests to consider
- echocardiogram
- treadmill exercise test
- electrophysiology study
Treatment algorithm
unstable: BP <90/60 mmHg, signs of systemic hypoperfusion or unstable atrial fibrillation
stable: narrow complex (orthodromic atrioventricular reciprocating) tachycardia
stable: wide complex (antidromic atrioventricular reciprocating) tachycardia
stable: pre-excited tachycardia due to atrial fibrillation or atrial flutter
stable: pre-excited tachycardia due to atrial tachycardia
following acute treatment: asymptomatic
following acute treatment: symptomatic
Contributors
Authors
Hugh Calkins, MD
Professor of Medicine
Director of Electrophysiology
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
HC declares that he is a consultant for Medtronic, Biosense Webster, Abbott, and Boston Scientific.
Acknowledgements
We would like to acknowledge our cardiology expert panel member, Dr Fred Kusumoto, for his contribution to this topic.
Professor Hugh Calkins would like to gratefully acknowledge Dr David Frankel, Dr Mithilesh K. Das, and Dr Douglas P. Zipes, previous contributors to this topic.
Disclosures
DF, MKD, and DPZ declare that they have no competing interests.
Peer reviewers
Nicolas Palaskas, MD, FACC
Assistant Professor
University of Texas MD Anderson Cancer Center
Houston
TX
Disclosures
NP declares that he has no competing interests.
Joseph E. Marine, MD
Associate Professor of Medicine
Director of Electrophysiology
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
JEM declares that he has no competing interests.
Suneet Mittal, MD
Director
Electrophysiology Laboratory
The St. Luke's-Roosevelt Hospital Center
New York
NY
Disclosures
SM declares that he has no competing interests.
Andrew Turley, MB ChB
Cardiology Specialist Registrar
The James Cook University Hospital
Middlesbrough
UK
Disclosures
AT declares that he has no competing interests.
Steve Hsu, MD
Associate Professor
Department of Medicine
Division of Cardiology
University of Florida College of Medicine
Jacksonville
FL
Disclosures
SH declares that he has no competing interests.
Differentials
- Atriofascicular pathway
- Lown-Ganong-Levine syndrome
- Nodofascicular pathway
More DifferentialsGuidelines
- 2023 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation
- 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
More GuidelinesPatient information
Atrial fibrillation
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