Paroxysmal supraventricular tachycardia

The article was professionally consulted with Specialist Doctor II Nguyen Quoc Viet - Interventional Cardiologist - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.

Supraventricular tachycardia is a disease that includes all types of tachyarrhythmias from the bundle of His upwards but does not include atrial fibrillation. Paroxysmal supraventricular tachycardia is a disease that begins and ends very suddenly, including: atrioventricular node re-entry tachycardia, supraventricular tachycardia due to re-entry of the atrioventricular accessory pathway. More specifically, supraventricular tachycardia also includes other types of arrhythmias such as atrial fibrillation, atrial flutter, atrial tachycardia...
However, in clinical practice, when referring to paroxysmal supraventricular tachycardia, people usually immediately think of episodes of supraventricular tachycardia with re-entry at the atrioventricular node or supraventricular tachycardia that re-enter the atrioventricular via an accessory conduction pathway.
In the past, when there was a sudden sudden onset of a tachycardia with a narrow, regular QRS complex in a patient with no underlying structural heart disease, it was called Bouveret's disease. Today, medicine is more advanced with electrophysiological probes, doctors have understood the mechanism of the formation of tachycardias when they occur, thereby classifying supraventricular and ventricular tachycardias. offer treatments.

Paroxysmal supraventricular tachycardia is mostly seen in patients without structural heart disease, although some cases occur in patients with structural heart disease. Some symptoms recognize paroxysmal supraventricular tachycardia:
Patients can feel palpitations, anxiety, sudden heart palpitations and ending quite suddenly; Paroxysmal supraventricular tachycardia has little effect on hemodynamics and is almost not prolonged, however, there are a few exceptions of paroxysmal supraventricular tachycardia lasting daily, which is also possible. lead to a drop in blood pressure or heart failure ; The heart rate is very regular, the average beat rate is 180-200 beats/min; Paroxysmal supraventricular tachycardia may end abruptly, or supraventricular tachycardia will end when the patient takes a deep breath in and then exhales with glottis closed (also called straining), or when the patient The doctor rubs the carotid sinus or presses on the eyeball.

The QRS complex of paroxysmal supraventricular tachycardia is slender, regular, and has a frequency of 180 - 200 beats/min; The P wave is not visible because the P wave is mixed into the QRS complex or can sometimes be seen as a small r wave in V1; When the patient finishes paroxysmal supraventricular tachycardia, a brief pause in sinus rhythm or bradycardia may appear before reestablishing a new sinus rhythm.

Using measures to induce vagus to stop the supraventricular tachycardia for the patient:
Instruct the patient to take a deep breath in and then exhale but close the glottis tightly (similar to pushing when exhaling); Carotid sinus massage: The carotid sinus is located at a horizontal position with the thyroid cartilage, when the doctor rubs the carotid sinus, he needs to instruct the patient to tilt his head to one side, the doctor will use his thumb to press on the position of the carotid sinus and rub it there. . Note that before rubbing the patient's carotid sinus, the doctor needs to listen to determine that there is no carotid artery stenosis and perform the massage one by one; Pressing the eyeball: this is a measure to cut supraventricular tachycardia quite effectively, but this method is somewhat rough, in the worst case it can cause retinal detachment of the patient. Ask the patient to close both eyes, place 2 thumbs or 3 fingertips (index finger, middle finger, ring finger) on each eye socket, then press slowly and gradually, when pressing the monitoring lever Patient's heart rate on monitoring, if tachycardia stops, stop pressing immediately. When paroxysmal supraventricular tachycardia stops, there will be a brief pause, followed by junctional exit or sinus rhythm return. This procedure should not be used in patients with a history of retinopathy, glaucoma...

Adenosine injectable 6mg: this is considered a first-line option. Adenosine injection site should be injected locally in the basilar vein, must be pumped very quickly because the half-life of Adenosine is extremely fast. Initiate injection of Adenosine 6mg, if not effective, repeat injection of 6mg Adenosine, if still not give results, can continue to use 12mg Adenosine (2 ampoules). Calcium channel blockers, beta blockers: used when therapy with Adenosine fails. In clinical practice, doctors often use calcium channel blocker, Verapamil intravenously at a dose of 5-10 mg, injected in 2-3 minutes, contraindicated in patients with impaired left ventricular function. hypotension, should be used with caution in the elderly. The usual clinical beta-blockers are Propranolol or Esmolol intravenously, the dose of Propranolol is 0.15 mg/kg intravenously at a rate of 1 mg/min, should pay attention to the side effects and contraindications of beta-blockers. Digitalis: Digitalis should be used with caution in patients with Wolff - Parkinson - White Syndrome or when the physician is planning to massage the carotid sinus later, because Digitalis drugs can increase carotid sinus sensitivity; Amiodarone: this is a drug that can be considered when the above treatments fail; Shock abrupt electric shock: Shock ablation is indicated when paroxysmal supraventricular tachycardia persists, affecting hemodynamics (risk of heart failure, hypotension) or when using other the above drugs but still failed to stop paroxysmal supraventricular tachycardia. Shock ablation usually only needs to use a small amount of energy (50J) and synchronously to be able to stop the attack.

Electrophysiological exploration: This method can help doctors detect accessory pathways, thereby using energy from high-frequency radio waves to destroy these accessory pathways, resulting in a complete cure. for the patient. Electrophysiological exploration is the method of first choice for patients with recurrent episodes of paroxysmal supraventricular tachycardia and unresponsive to conventional medical therapies.
Patients diagnosed with paroxysmal supraventricular tachycardia should go to modern medical facilities that perform electrophysiological investigations to consider curative treatment of paroxysmal supraventricular tachycardia.
The drugs indicated for the prevention of paroxysmal supraventricular tachycardia with recirculation at the atrioventricular node are: beta-blockers, digitalis, Verapamil... However, long-term use of these drugs requires Pay attention to the side effects of the drug.
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