SVT vs SVT w/ abberancy

[pinipig523]

Question - what do you guys do for your SVT vs SVT w/ aberrancy?

My understanding is that an SVT w/ aberrancy means that it could be SVT + a BBB or an SVT w/ WPW....

Do you guys give adenosine for both without a second thought?

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[RustedFox]

Sure. Adenosine lasts only a hot second anyways.

By the way - I'm all settled down here in FL. I'll PM you with my address so I can mail you that stuff that we talked about.

 

[kat82]

I think adenosine is ok to give for any regular tachycardia (wide or narrow). Even for v-tach. The time to avoid adenosine (or any nodal blocker) is when you have an IRREGULAR wide complex tachycardia (specifically afib with WPW). Here, the key point is you want to avoid blocking the AV node, forcing a rapidly conducted beat (ie, rapid impulses from the atrium) down the accessory pathway.

This blog points out that afib with conduction delay is very different from afib with accessory path. Its only in the accessory path where nodal blockers are contraindicated. A subtle but important point. The two can be differentiated by the rate and the varied QRS morphologies found on the EKG.

http://hqmeded-ecg.blogspot.com/2011/05/wide-complex-tachycardias-2-cases-what.html

Correct me if I'm wrong- this topic is confusing.

 

[adenocard]

just passing through...

 

[Arcan57]

Question - what do you guys do for your SVT vs SVT w/ aberrancy?

My understanding is that an SVT w/ aberrancy means that it could be SVT + a BBB or an SVT w/ WPW....

Do you guys give adenosine for both without a second thought?

According to Amal Mattu, SVT w/aberrancy shouldn't exist for you as an EP. Wide-complex tachycardia is VT until proven otherwise (usually in the EP lab). This matters somewhat because adenosine sensitive VT is a thing, and the dispo is very different then for SVT.

 

[pinipig523]

According to Amal Mattu, SVT w/aberrancy shouldn't exist for you as an EP. Wide-complex tachycardia is VT until proven otherwise (usually in the EP lab). This matters somewhat because adenosine sensitive VT is a thing, and the dispo is very different then for SVT.

Thanks for the input folks. I have read that VT does not do well with adenosine, I have to rack my memory banks as to where I encountered that info.

But I see what you are saying with Afib with wpw...

 

[Arcan57]

Thanks for the input folks. I have read that VT does not do well with adenosine, I have to rack my memory banks as to where I encountered that info.

But I see what you are saying with Afib with wpw...

VT can convert with adenosine, the problem is that the level of work-up and closeness of outpatient f/u for SVT /= VT. And if you thought it was SVT and converted it with adenosine, it's unlikely you're going to catch that it was really VT until the patient collapses and dies some time in the future. When in doubt, etomidate + electricity works really well. And is probably more comfortable for the patient then the adenosine.

 

[Cerberus]

According to Amal Mattu, SVT w/aberrancy shouldn't exist for you as an EP. Wide-complex tachycardia is VT until proven otherwise (usually in the EP lab). This matters somewhat because adenosine sensitive VT is a thing, and the dispo is very different then for SVT.

This is what I go by as well.