Atrioventricular Nodal Reentry Tachycardia (AVNRT) Clinical Presentation

  • Author: Brian Olshansky, MD; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Feb 28, 2012
 

History

  • AVNRT is typically characterized by an abrupt onset and termination.
  • Episodes may last from seconds to minutes to days.
  • In the absence of structural heart disease, it is usually well tolerated.
  • Common symptoms include palpitations, nervousness, anxiety, lightheadedness, neck pounding, neck and chest discomfort, and/or dyspnea. Polyuria can occur after termination of the episode (due to the release of atrial natriuretic factor).
  • AVNRT may cause or worsen heart failure in patients with poor left ventricular function.
  • It may cause angina or myocardial infarction in patients with coronary artery disease.
  • Syncope may occur in patients with a rapid ventricular rate or prolonged tachycardia due to poor ventricular filling, decreased cardiac output, hypotension, and reduced cerebral perfusion. Syncope may also occur because of transient asystole when the tachycardia terminates, due to tachycardia-induced depression of the sinus node.
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Physical

  • The heart rate is usually rapid, ranging from 150-250 beats per minute (bpm). It is usually 180-200 bpm in adults and, in children, may exceed 250 bpm.
  • Hypotension may occur initially or with rapid ventricular rates and prolonged episodes.
  • Sometimes, initial hypotension evokes a sympathetic response that increases blood pressure and may terminate the tachycardia by an increase in vagal tone.
  • Signs of left heart failure may develop or worsen in patients with poor left ventricular function.
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Causes

The substrate for AVNRT is the presence of dual AV nodal pathways. Age of onset varies from childhood to the teenage years or adulthood. Some patients do not present until their seventh or eighth decade or older. In contrast to a bypass tract, dual AV nodal physiology is often an acquired abnormality.

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Contributor Information and Disclosures
Author

Brian Olshansky, MD  Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine

Brian Olshansky, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, and Heart Rhythm Society

Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting

Coauthor(s)

Renee M Sullivan, MD  Fellow, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics

Renee M Sullivan, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell F Kelly  MD, Assistant Professor, Department of Internal Medicine, Rush Medical College; Chairman of Adult Cardiology and Director of the Fellowship Program, Cook County Hospital

Russell F Kelly is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Marschall S Runge, MD, PhD  Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association

Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthors Shamila Garg, MD, and Marina Hannen, MD, Chirag M Sandesara, MD, Mukesh Garg, MD, MRCP, Annette Quick, MD, and Marco A Barzallo, MD to the development and writing of this article.

References

  1. Jackman WM, Beckman KJ, McClelland JH, et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. Jul 30 1992;327(5):313-8. [Medline].

  2. Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, Pa: WB Saunders; 2004.

  3. Fogoros RN. Electrophysiologic Testing (Practical Cardiac Diagnosis). 3rd ed. London, UK: Blackwell Science; 1999.

  4. Gursoy S, Steurer G, Brugada J, et al. Brief report: the hemodynamic mechanism of pounding in the neck in atrioventricular nodal reentrant tachycardia. N Engl J Med. Sep 10 1992;327(11):772-4. [Medline].

  5. Janse MJ, Anderson RH, McGuire MA, Ho SY. "AV nodal" reentry: Part I: "AV nodal" reentry revisited. J Cardiovasc Electrophysiol. Oct 1993;4(5):561-72. [Medline].

 
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Electrophysiological mechanism of atrioventricular nodal reentry tachycardia.
Atypical atrioventricular nodal reentry tachycardia.
Typical atrioventricular nodal reentry tachycardia.
 
 
 
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