VERIFIED CONTENTAuthor: lek. Maciej Grymuza, a graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań.

Supraventricular arrhythmia is not one thing, but many heart rhythm disturbances. Some of them can be dangerous and require immediate treatment, while others do not have a negative effect on he alth and appear in many everyday situations. It is worth finding out which groups of arrhythmias in this group, their symptoms and treatment methods.

Supraventricular arrhythmiasis a broad term that describes both states of the heart accelerating and slowing down. Some of these ailments are completely asymptomatic and do not require medical intervention, but some of these disorders can be life-threatening, so in the case of symptoms such as palpitations, fainting, fainting, which may indicate arrhythmia, it is necessary to contact a doctor. Some supraventricular arrhythmias can be interrupted temporarily with drugs or electrical cardioversion, but even in such a case, further diagnosis and long-term treatment under the supervision of a cardiologist is necessary.

The heart consists of two atria and two ventricles, the properly synchronized work of which ensures maximum effective blood flow. The conductive system is a complex structure built into the heart muscle that produces and conducts impulses to keep the heart working properly. It is he who is responsible for the so-called automatism, which consists in the autonomous stimulation of this organ to work.

The activity of the conducting system is subject to the supervision of the nervous system and biochemical influences: concentration of ions, hormones (e.g. adrenaline, thyroxine) or temperature.

The formation and spread of the pulse in the heart. After being produced in the sinus node, a stimulus runs through the atria, stimulating them to contract. Further, it is conducted through the atrioventricular node, the bundle of His and its branches, and Purkinje fibers to the ventricles, which are also activated when it arrives.

Proper operation of the conductive stimulus system ensures the proper work of the heart, both in terms of its frequency - e.g. acceleration of action during exercise, and proper spreadingincentives. Disturbances in the generation of impulses and their conduction can cause various diseases.

What is supraventricular arrhythmia and what are its types?

We talk about supraventricular arrhythmias when the above-mentioned impulses are not conducted properly or there is improper electrical activation above the His bundle. Therefore, it may concern the sinus node, atria and the atrioventricular node. The most common supraventricular arrhythmias are:

  • additional supraventricular stimulations
  • atrioventricular node recurrent tachycardia (AVNRT)
  • pre-excitation teams
  • atrial tachycardia
  • sinus tachyarrhythmias
  • atrial fibrillation
  • atrial flutter

Supraventricular tachycardia

Supraventricular tachycardia is any heart rate greater than 90 beats per minute that occurs in the conductive system above or within the His bundle. So they belong to him:

  • Recurrent tachycardia in the atrioventricular node
  • Recurrent atrioventricular tachycardia
  • atrial tachycardia

The first two result from the presence of the so-called accessory pathway, which improperly conducts stimuli from the atria to the ventricles - there is no delay in conduction in the atrioventricular node. This has two main effects: on the one hand, the chambers shrink too soon when they are not yet completely filled. Moreover, the ventricles can retrograde (via an additional pathway) re-activation of the atria, the cycle closes and the cavities of the heart continue to stimulate each other and develop tachyarrhythmias. Atrial tachycardia is a consequence of too fast electrical activation of the atria.

Sinus tachyarrhythmias

They are usually the least serious group of supraventricular arrhythmias. Their essence is to accelerate the sending of impulses through the sinus node, which also causes the heart to work more than 90 beats per minute. This phenomenon occurs, for example, during physical exertion, but also during fever, emotional stress, it may also result from taking medications or other diseases, e.g. hyperthyroidism.

Supraventricular additional stimulations

Occasionally, the heart muscle excitation impulse is produced in the atrium tissue rather than in the sinus node. This activates the atria, their contraction, and after moving into the ventricles, they are also stimulated to work. Supraventricular additional stimulations are usually asymptomatic, they can occur in he althy people, and also intensify after drinking alcohol, coffee, in the case of electrolyte disorders or diseaseshearts.

Atrial Fibrillation

Atrial fibrillation is by far the most common arrhythmia, it is based on the very rapid electrical activity of the atria, which prevents them from relaxing and contracting. As a result, the atria of the heart in practice do not work at all, which negatively affects the efficiency of the whole heart by reducing the volume of blood ejected by the ventricles. Additionally, in the course of atrial fibrillation, the ventricles work irregularly. There are many causes of atrial fibrillation, including:

  • heart defects
  • cardiac surgery
  • hypertension
  • ischemic heart disease
  • myocarditis
  • diseases affecting the heart muscle, e.g. haemochromatosis, amyloidosis
  • heart failure

but also non-cardiac causes:

  • lung diseases
  • kidney failure
  • diabetes
  • drugs
  • hyperthyroidism

Atrial Flutter

This is an arrhythmia similar to atrial fibrillation, in which case it is also inappropriately activated electrically. The contraction is effective, but the heart is not optimal because the atria contract much faster than the ventricles.

Supraventricular arrhythmias - symptoms

Despite such a wide variety of causes and conditions, many symptoms are common, including:

  • palpitations
  • chest discomfort
  • shortness of breath
  • fatigue, exercise intolerance
  • fainting and fainting

The severity of symptoms depends on the cause of the arrhythmia, general he alth, ventricular rate, duration of the arrhythmia, and the presence of heart disease. For example, in older, more ill people, the onset of atrial fibrillation can cause severe breathlessness and chest pain, while young, he althy people may not experience this arrhythmia at all. It is worth remembering that in many cases supraventricular arrhythmias are completely asymptomatic.

Supraventricular arrhythmias - auxiliary research

The diagnosis of supraventricular arrhythmias is based on similar studies regardless of the underlying arrhythmia.

Basic diagnostic tools include the ECG, as well as the 24-hour Holter ECG monitoring for when arrhythmias cannot be obtained on a standard ECG. This test continuously records the electrical activity of the heart, which is then analyzed by the doctor. When assessing such a record, it is particularly important to take into account the times of arrhythmia andcorrelating them with the symptoms experienced by the patient.

The next tests are: exercise ECG if arrhythmia occurs during exercise, and for the diagnosis of ischemic heart disease. An invasive test that allows you to make a certain diagnosis in doubtful cases is an electrophysiological test, sometimes it allows you to induce arrhythmia, determine its nature and, if necessary, perform ablation.

Less common tests performed in the case of supraventricular arrhythmias include echocardiography, laboratory tests, and coronary angiography. They are performed not to diagnose arrhythmias, but to diagnose the cause and treat it appropriately.

Supraventricular arrhythmias - treatment

While the diagnosis is favorable for most supraventricular arrhythmias, the treatment is more specific. First of all, diagnosis and treatment of any known arrhythmic condition should be given: appropriate pharmacological treatment of thyroid disease, implantation of stents for ischemic heart disease, and treatment of valves if the arrhythmia is caused by a defect.

The management of supraventricular arrhythmias depends on the patient's condition. If supraventricular arrhythmia causes severe pain, dyspnoea, or a sharp drop in blood pressure, immediate action is required.

In the case of atrial fibrillation, appropriate drugs are given, and if they are not effective - electrical cardioversion is performed. Recurrent tachycardias can be stopped by performing procedures such as: provoking vomiting, immersing the face in cold water, or inflating a syringe, if this is not effective, pharmacological methods and cardioversion are used. Other supraventricular arrhythmias are generally not so sudden and do not require immediate treatment.

Treatments for supraventricular arrhythmias can be divided into several types:

  • Antiarrhythmic drugs

these include several groups of drugs, e.g. propafenone, amiodarone, or beta-blockers used, for example, in arterial hypertension

  • Electrotherapy

Cardioversion - a procedure performed under short general anesthesia, during which the current flows through the heart moderating its electrical work.

  • Electrophysiology treatments

Ablation - an invasive procedure involving the destruction of the sites responsible for the development of arrhythmias in the heart.

Bradyarytmie

The previously described supraventricular arrhythmias belong to the so-called tachyarrhythmias, i.e. they are characterized by an acceleration of the heart rate. A different group are bradyarrhythmias, they within turn, the heart beats too slowly, below 60 beats per minute.

Their causes include, among others:

  • thyroid disease
  • electrolyte disturbance
  • neurological diseases
  • medications used

and among cardiological diseases these are:

  • ischemic heart disease
  • myocarditis
  • congenital heart disease
  • atrioventricular blocks
  • the so-called sick sinus syndrome, i.e. a disease of the sinus node

Symptoms that most often occur in people with bradycardia are dizziness, fainting, less often easy fatigue, fainting, sometimes it is also completely asymptomatic.

The diagnosis of bradycardia and bradyarrhythmia is based on similar tests as in the case of tachyarrhythmia: ECG, Holter monitoring, event recorders, and electrophysiological testing is much less frequent in such cases.

Pharmacological treatment of bradycardia and pauses is not possible, first of all, it is necessary to exclude reversible causes - electrolyte disturbances, thyroid diseases or the influence of medications used, but if the bradycardia persists and causes symptoms, it is necessary to implant a pacemaker.

About the authorBow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).

Category:

Cardiology