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EP 101 > SVTs > Flashcards

SVTs Flashcards

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1
Q

abnormally fast rhythm that originates above the bifurcation of bundle of His

A

Supraventricular tachyarrhythmias (SVTs)

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2
Q

SVT originators (4)

A

SA node
Atria
AV node
anatomic structures

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3
Q

majority of SVT caused by

A

reentry

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4
Q

abnormally of conduction in which the same electrical impulse reenters and re-excites an area of the heart

A

reentry

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5
Q

reentrant circuit is established around an

A

inexcitable obstacle

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6
Q

inexcitable objects

A

valve, vessel opening, scar tissue

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7
Q

cardiac tissue that forms the reentrant circuit

A

substrate

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8
Q

connected proximally and distally to normal conduction tissue

A

two pathways

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9
Q

one pathway is blocked so the reentrants dies out in one direction, but propogates in the other direction

A

unidirectional block

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10
Q

Pathway Fast (B) blocked pathways has a ____ effective refractory period so it recovers ____

A

Longer

slowly

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11
Q

unblocked pathway, which gives the conductive cells in the rest of the circuit time to repolarize before the reentrant wavefront arrives

A

slow conduction

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12
Q

slow pathway has ___ ERP so it recovers ____

A

shorter

quicker

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13
Q

area of repolarized tissue just ahead of a reentrant wavefront is

A

excitable gap

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14
Q

reentry only occurs if there is a

A

premature impulse

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15
Q

premature impulse can get in if

A

fast pathway is refractory and slow pathway has recovered

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16
Q

trigger for reentry may be (4)

A

PAV, PVC, PJC, pacing stimilus

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17
Q

premature impulse first travels through the unblocked pathway (which is the ___)

A

slow pathway

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18
Q

EP studies reentry mechanisms (4)

A

mode of initation
activation sequence
tachycardia zone
antegrade/retrograde conduction patterns

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19
Q

find site from which tachycardia can be most easily induced

A

mode of initiation

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20
Q

id any conduction delay zones, reentrant pathways, or activation of normal tissue

A

activation sequence

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21
Q

id the range of coupling intervals taht initiate reentry.

A

tachycardia zone

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22
Q

help localize reentrant circuit and determine if the atrial or ventricular myocardium are part of the reentrant circuit

A

antegrade or retrograde conduction patterns

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23
Q

precisely timed stiumuli are delivered into an acative reentrant circuit to create wavefronts that collide and extinguish reentrant wavefront

A

terminant an SVT

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24
Q

synchronized to the sensed tachycardia rate but delivered at a slightly faster rate

A

first paced stimulus

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25
Q

first paced stimulus is to create refractory in

A

excitable gap

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26
Q

originates in a microreentrant circuit enclosed within the SA node

A

SA nodal reentrant tachycardia (SANRT)

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27
Q

sinus node reentry atrial activation is

A

normal

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28
Q

originates in a microreentrant circuit in teh right or left atrium.

A

intraatrial reentry tachycardia

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29
Q

if earliest atrial signal is recorded by the HIS EGM

A

the origin of AT is most likely the anteroseptal RA

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30
Q

if earliest atrial signal is recorded by the PROXIMAL CS EGM

A

the origin of AT is most likely the posteroseptal RA

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31
Q

if earliest atrial signal is recorded by the LOW OR HIGH RA EGM

A

the origin of AT is most likely the somewhere in the RA

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32
Q

if earliest atrial signal is recorded by the DISTAL CS EGM

A

the origin of AT is most likely the lateral LA

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33
Q

if earliest atrial signal is recorded by the HRA EGM

A

right superior pulmonary vein

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34
Q

confined to macroreentrant circuit in the RA

A

typical atrial flutter

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35
Q

travels SA - pectinate muscles - right atrial floor - interatrial septum -

A

counterclockwise atrial flutter

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36
Q

confined to its conduction pathway by the crista terminalis, eustachian ridge, triscupid valve

A

counterclockwise atrial flutter

37
Q

area of slow conduction

A

triscupid isthmus

38
Q

counterclockwise atrial flutter signal is detected by

A

proximal CS or HIS catheter

39
Q

counterclockwise atrial flutter signal travels in sequence down what catheter

A

proximal to distal HRA Catheter

40
Q

P wave morphology counterclockwise atrial flutter

A

P waves are positive in Lead V

negative in leads II, III and AVF

41
Q

P wave morphology clockwise atrial flutterECG postitive and negative (p waves)

A

Upright P waves in inferior leads II, III and AVF and inverted P waves in Leads V

42
Q

variations of A FLutter (2)

A

atypical flutter

scar related atrial flutter (from Congential ehart defect)

43
Q

shorter cycle length and is less stable. transition from/to AF is common. may rotate around anatomic structures

A

Atypical Atrial Flutter

44
Q

rotates around scar tissue

A

scar-related atrial flutter

45
Q

caused by multiple wavelet reentry or multiple automatic foci

A

atrial fibrillation

46
Q

adjacent myocardial cells have different refractory periods

A

multiple wavelet reentry

47
Q

AF may be caused by multiple wavelet

A

automatic foci

48
Q

this arises from venous structures such as musclar ridges that surround the pulmonary veins

A

automatic foci

49
Q

requires slow conduction and short refractory periods

A

multiple wavelet reentry

50
Q

originates in dual pathways of Koch’s triangle

A

AV nodal reentrant tachycardia (AVNRT)

51
Q

AVNRT type of reentrant arrhythmia

A

microentrant

52
Q

classic sign of AV nodal pathway is increase in AH interval

A

> = 50 ms

called AH jump

53
Q

AV nodal reentry, premature impulse travels down what pathway

A

slow then up fastway

54
Q

a second atrial beat that occurs at teh same time as teh ventricular beat

A

echo beat

55
Q

earliest activation in typical AVNRT is recorded by the ___ catheter.

A

HIS EGM

56
Q

AVNRT VA intervals are short (XX ms)

A

<70 ms

57
Q

3 variations of AV nodal reentry

A

slow-fast AV nodal reentry with posterior exit
fast-slow AV nodal reentry
SLow-slow AVNRT

58
Q

earliest signal in slow-fast AVNRT is recorded by the proximal

A

CS electrode

59
Q

ERP of fast pathway is shorter than that of the slow pathway - so reentry occurs in teh opposite direction

VA is longer
AH interval is short
HA interval is long

A

fast-slow AV nodal reentry

60
Q

two slow pathways AVNRT

A

slow-slow AVNRT

61
Q

atria is activated via posterior septum.

VA intervals are short

A

slow-fast AVNRT with posterior exit

62
Q

bands of conduction tissue that form an accessory pathway from the atria to ventricles

A

bypass tracts

63
Q

bypass tracts generally located in

A

left or right freewall

septal

64
Q

bypass tracts conduct

A

rapidly

65
Q

antegrade conduction along a bypass tract therefore causes

A

ventricular preexcitation

66
Q

bypass tract is localized by examining ____ activation pattern during preexcitation and the _____ activation pattern during _____ conduction

A

ventricular

atrial

67
Q

bypass tract is an accessory tract pathway between A and V. tract bypasses

A

AV node

68
Q

bypass tract in which the impulse conducts in an antegrade direction

A

wolf parkison white syndrome WPW

69
Q

classic sign of WPW is short or slurred PR interval called

A

delta wave

70
Q

delta wave indications that venticular activation occured right ____ atrial activation (preexcitation)

A

after

71
Q

direction - typically a reentrant impulse travels slow and up fast

A

orthodromic direction

72
Q

WPW impusle travels (direction)

A

antidromic direction

73
Q

direction - travel down fast byfast fibers and up slower AV conduction pathway (down fast, up slow)

A

antidromic

WPW

74
Q

in WPW, bypass tract goes down in order (6)

A 
RA,
right freewall
accessory pathway
right bundle branch
HIS bundle
AV node
75
Q

activation occurs antegrade over the AV node and retrlgrade over the bypass tract

A

orthodromic conduction

76
Q

activation occurs antegrade over the bypass tract and retrograde over the AV node
Wide QRS

A

antidromic (WPW)

77
Q

conducts only in a retrograde direction

A

concealed bypass tract

78
Q

concealed bypass tract conducts only in

A

retrograde direction

79
Q

concealed bypass tracs are revealed during

A

ventricular extrastimulus pacing

80
Q

during a concealed bypass tract ECG visualize

A

no delta wave

ECG appears normal during sinus rhythm

81
Q

bypass tract connections can involved (5)

A 
atrial myocardium
ventricular myocardium
AV node
HIS bundle
bundle branches
82
Q

muscle ridge that connects atrial myocardium to the ventricular myocardium

A

bundle of kent

83
Q

most common bypass tract

A

bundle of kent

84
Q

connect atrial myocardium to the HIS bundle and completely bypasses AV node

A

james fibers

85
Q

bypass tract connects the atrial myocardium to a fascile of a bundle branch

A

mahaim bypass tract

86
Q

bypass tracts connect the AV node directly to the ventricle or a fascile. connections are rare

A

nodoventricular

nodofascicular

87
Q

bypass tract connect the HIS bundle or Purkinje fibers to the ventricle

A

Fasciculoventricular

88
Q

suggested by delta waves that appear to shift axis over time. one bypass dominates and other tracts become significant post ablation

A

multiple bypass tracts

EP 101 (6 decks)

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