AHA SVT 2015

Question 1

What is differential for Wide QRS tachycadia?

Answer 1

• VT
• SVT with BBB/NSICD pre-existing
• SVT with rate related aberrancy
• SVT with wide QRS related to electrolyte or metabolic disorder
• SVT with conduction over an accessory pathway
• Paced Rhythm
• Artifact

Question 2

What can be done when giving Diltiazem for SVT (Class 2a indication) ?

Answer 2

Can give it over 20 minutes

Question 3

What is more effective in terminating SVT, BB or CCB?

Answer 3

CCB

Question 4

Review SVT treatment algorithm

Answer 4

Question 5

Review chronic management of a Regular SVT

Answer 5

Question 6

What is acute dose of Metoprolol?

Answer 6

2.5-5mg IV over 2 minutes, repeat in 10 mins up to 3 doses

Question 7

What is acute dose of Propranolol in SVT?

Answer 7

1mg IV over 1 minute

Question 8

What is acute dose of Diltiazem?

Answer 8

0.25mg/kg/ IV bolus over 2 minutes

Question 9

What is dose of Verapamil for acute treatment of SVT?

Answer 9

5-10mg IV over 2 minutes, can give another 10mg 30 minutes after first dose

Question 10

How to dose Propranolol chronically?

Answer 10

40-160mg divided or single dose with long acting formulations

Question 11

How to dose Diltiazem chronically?

Answer 11

120-360 mg daily

Question 12

How to dose Verapamil chronically?

Answer 12

120-480mg daily

Question 13

What is starting and max dose of Flecainide?

Answer 13

50mg q12h, 150mg q12h

Question 14

What is Propafenone starting and max dose?

Answer 14

225mg BID XR , 425mg BID XR

Question 15

What is Sotalol starting and max dose?

Answer 15

40-80mg q12h, 160mg q12h

Question 16

What is overall complication rate in SVT ablation?

Answer 16

3%

Question 17

What 2 medications can be used in Innappropriate Sinus Tachycardia?

Answer 17

Ivabradine, Beta Blockers

Question 18

how to diagnose Inappropriate Sinus Tachycardia?

Answer 18

Mean HR > 90bpm over 24 hours

Question 19

What is recommended for Focal AT as First line form of therapy?

Answer 19

Catheter Ablation

Question 20

What is most common kind of SVT?

Answer 20

AVNRT (especially in young patients)

Question 21

What is risk of AV block in AVNRT ablation?

Answer 21

< 1%

Question 22

when can you use AV node blockers in management of AVRT?

Answer 22

when Pre excitation not present on baseline ECG

Question 23

When is Catheter ablation indicated in asymptomatic patients with WPW? (2)

Answer 23

• High risk pathway on EPS
  a) RR < 250 msec in induced Afib with preexcitation
  b) Antegrade RP < 240 msec
  c) Sustained AVRT
  d) AVRT precipitating Afib
  e) Multiple pathways

-If presence of pre-excitation precludes specific employment (pilots)

Question 24

What is the only 2 antiarrhythmics that is listed as class 1 for cardioversion of Atrial Flutter?

Answer 24

Dofetilide (oral)

Ibutilide (IV)

Question 25

What three drugs can be used to maintain sinus rhythm in Atrial Flutter chronically?

Answer 25

• Amiodarone
• Dofetilide
• Sotalol

Question 26

Is the fast or slow pathway of the AVNRT supposed to be ablated?

Answer 26

Slow pathway

Question 27

How does recommendations of AV node blockade change in Orthodromic AVRT if pre-excitation is present on resting ECG?

Answer 27

• if pre-excitation present it is a class IIb, (Class 1c is class 2a), ablation Class 1
• If pre-excitation not present, it is a class 1 alongside catheter ablation