Overview

In this course, we will teach you how to identify the clinical syndrome of paroxysmal SVT (pSVT). We explain the pathogenesis of the two common arrhythmias underlying this clinical syndrome; AVNRT and AVRT. You will learn how the underlying pathogenic mechanisms in these conditions result in identifiable diagnostic findings on the ECG. You will learn the definition and significance of the terms AV node dependent tachycardia and AV node independent tachycardia. We explain the mechanism underlying the efficacy of adenosine in the management of AV node dependent tachycardia. You will learn how to identify the ‘Wolf Parkinson White (WPW) pattern’ on the ECG and how this relates to the ‘WPW syndrome’. We discuss the nature of pre-excitation due to accessory pathways and the findings produced by this phenomenon on the ECG readout.

Faculty

Planner and Author: Dr John Seery MB PhD

• Consultant Physician at St. Vincent's University Hospital, Dublin, Ireland
• Lecturer at the School of Medicine and Medical Science, University College Dublin, Ireland
• Studied medicine at the University of Cambridge, United Kingdom
• A Natural Sciences graduate of Trinity College Dublin, Ireland
• PhD in Cell Biology from University College London, United Kingdom

Planner: Dr Karen Strahan PhD (University of Cambridge), Head of Editorial
Planner: Tommy O'Sullivan, CME Manager
 

Estimated Time to Complete

2.0 hours

Target Audience

• Physicians
• Nurses
• Nurse Practitioners
• Physician Assistants
• Paramedics

Learning Objectives

Upon successful completion of this activity, you will be able to:

• Explain the re-entrant mechanisms of AVNRT and AVRT
• Explain the term ‘AV node dependent tachycardia’
• Define the Wolf Parkinson White Syndrome
• Identify the clinical syndrome of ‘paroxysmal SVT’ (pSVT)
• Identify AVNRT on the ECG
• Identify AVRT on the ECG
• Identify pre-excitation on the ECG 
• Avoid adenosine administration in atrial fibrillation and sinus tachycardia

Course Content

• Introduction
• Frontal Heart Schematic
• AVNRT - Two Routes into the AV Node
• AVNRT - The Re-entrant Mechanism
• AVNRT - An AV Node Dependent Tachycardia
• Pre-excitation – The WPW Pattern
• The WPW Syndrome – AVRT
• ECG features of AVRT
• Concealed Pathways
• AV Node Dependent Tachycardia
• Quiz
• Essential Reading

Release date

31-JUL-2023

Expiration date

30-JUL-2026

Instructions for Participation

Participants must complete the online activity during the valid period as noted above.
Follow these steps:

1. View videos in sequence
2. Read the papers on the essential reading list
3. Complete the quiz
4. Complete the activity evaluation form to provide feedback for continuing education purposes and for the development of future activities
5. Download the Certificate of Completion

Relevant Financial Disclosures

Acadoodle adheres to the ACCME's Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Planners and faculty for this activity have no relevant financial relationships with commercial interests to disclose.

Bibliography

Garcia T and Miller G. (2004) Arrhythmia Recognition: The Art of Interpretation. 1st Edition. Jones & Bartlett Learning. 

O’Rourke SF et al. Paroxysmal supraventricular tachycardia: improving diagnosis and management within the accident and emergency department. Emerg Med J. 2004;21:495-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726368/pdf/v021p00495.pdf

Mani BC and Pavri BB. Dual atrioventricular nodal pathways physiology: a review of relevant anatomy, electrophysiology, and electrocardiographic manifestations Indian Pacing and Electrophysiol J. 2014:14(1):12-25.
https://www.sciencedirect.com/science/article/pii/S0972629216307112

Katritsis DG and Camm AJ. Atrioventricular Nodal Reentrant Tachycardia. Circulation. 2010;122(8):831-40.
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.110.936591

Katritsis D and Josephson ME. Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Rentrant Tachycardia. Arrhythm Electrophysiol Rev. 2016;5(2):130-5.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013176/

Ali R et al. Antidromic Atrioventricular Reentry Tachycardia with Wolf Parkinson White Syndrome: A Rare Beast. Cureus. 2018;10(5):e2642.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050167/

Cakar MA et al. Atrial fibrillation induced by mad honey intoxication in a patient with Wolff-Parkinson-White Syndrome. Clinl Toxicol (Phila). 2011;49(5):438-9.
https://www.tandfonline.com/doi/full/10.3109/15563650.2011.586351

Kaya H et al. Wolff-Parkinson-White Syndrome Presenting after a Motorcycle Accident. J Med Cases. 2011;2(6):268-71.
https://www.journalmc.org/index.php/JMC/article/view/331/230

Chadha S et al. The delta wave in Wolff-Parkinson-White Syndrome. QJM. 2013;106(12):1147-8.
https://academic.oup.com/qjmed/article/106/12/1147/1632734

Additional Reading

Medi C et al. Supraventricular tachycardia. Med J Aust. 2009;190(5):255-60.
https://www.mja.com.au/system/files/issues/190_05_020309/med10727_fm.pdf

Nelson SD et al. Significance of ST segment depression during paroxysmal supraventricular tachycardia. J Am Coll Cardiol. 1988;12(2):383-7.
https://www.sciencedirect.com/science/article/pii/073510978890410X

ACCME Accreditation Statement

Acadoodle, Ltd is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

AMA Physician’s Recognition Award

Acadoodle, Ltd designates this enduring material activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.