2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia

Evaluation and Management of Neonatal Supraventricular Tachycardia

“…These SVTs include inappropriate sinus tachycardia, AT (including focal and multifocal AT), macro-reentrant AT (including typical atrial flutter), junctional tachycardia, AVNRT, and various forms of accessory pathway-mediated reentrant tachycardia (8). Although the frequency of arrhythmias in the newborn period is not high, supraventricular tachycardia is the most observed arrhythmias in this period (14).…”

“…Many different drugs are used in the management of neonatal tachycardias. Acute drug therapy for SVT (intravenous therapy) and ongoing drug therapy for SVT (oral administration) are shown (8) in Tables 1 and 2. The recommendation for acute treatment of SVT of unknown mechanism is shown in Table 3.…”

Understanding the ECG. Part 3: Arrhythmias

“…On the ECG, the characteristic features of atrial flutter are (Page et al, 2015)  P-waves are replaced by regular flutter waves. These look similar to P-waves in the right sided precordial leads (V1 to V3), but in the inferior leads (II, III and aVF) have a characteristic 'saw tooth' pattern.…”

“…This rhythm is fast, regular, has a narrow QRS complex, and shows no visible P-, flutter-or fibrillationwaves. The most common mechanism for this type of rhythm is re-entry (Page et al, 2015).…”

“…An accessory pathway is a strand of myocardium that crosses the fibrous barrier that electrically isolates the atria from the ventricles (Page et al, 2015). Re-entry over an accessory pathway is again initiated by an ectopic beat.…”