Understanding SVT and Atrial Fibrillation Ramin Davoudi MD Medical Director Cardiac Arrhythmia Service
Understanding SVT and Atrial Fibrillation
Ramin Davoudi MD
Medical Director
Cardiac Arrhythmia Service
Disclosures
• Speaker’s Bureau: Boston Scientific, Biotronik, Boerhinger-Ingelheim
• Research: Biotronik, Boston Scientific, St Jude Medical
• Corporate Investments: None
Objectives
• Understand pathophysiology of SVT
• Identify different SVT’s
• Understand treatment options of a fib
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Mechanisms of SVT
• Automaticity
• Triggered Activity
• Re-entry
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Types of SVT
• AV nodal reentrant tachycardia (70%)
• AV reentrant tachycardia (20%)
• Atrial tachycardia (9%)
• Junctional tachycardia (1%)
• Atrial Flutter
• Atrial Fibrillation
SVT: Long RP vs Short RP
AVNRT
AVNRT
AVRT
Atrial Flutter
• Typical
• Counterclockwise/clockwise
• Atypical
Atrial Flutter
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Atrial Fibrillation
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Fire and ICE
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Kuck et al. NEJM 2016
22Kuck et al. NEJM 2016
23 Roy et al NEJM 2000
24 Pappone et al. JACC 2003
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Wyse et al. NEJM 2002
AFFIRM STUDY
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Treatment
• Beta blockers
• Calcium Channel blockers
• Antiarrhythmic Medications
• Atrial fibrillation – Amiodarone, Sotalol, Dofetilide, Flecainide, Propafenone
• AVRT – Flecainide, Propafenone, Amiodarone
Amiodarone
• Most potent
• CHF safe
• Torsades
• Liver metabolism
• Extracardiac
• Skin
• Pulmonary
• Thyroid
• Lung
• Nervous system
• GI
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Sotalol
• Kidney
• Little Drug - Drug interaction
• Not very potent
• Torsades
• ? CHF safe
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Tikosyn
• Kidney
• Drug interactions - Verapamil, Bactrim, HCTZ
• Slightly more potent than sotalol
• Torsades
• CHF safe
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Flecainide/Propafenone
• Not CHF safe
• Liver/kidney
• Drug interactions
• Not many side effects (metallic taste, tremor, headache)
• Rare Torsades - mostly conduction issues
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Conclusions
• SVT mechanisms are few
• Drugs are moderately effective
• Treating SVT is becoming increasingly catheter based
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QUESTIONS?
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