History

Atrioventricular nodal reentry tachycardia (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 the following:

Palpitations
Nervousness
Anxiety
Lightheadedness
Neck pounding^[7]
Neck and chest discomfort
Dyspnea
Polyuria - Can occur after termination of an episode (due to the release of atrial natriuretic factor)

AVNRT may cause angina or myocardial infarction in patients with coronary artery disease and may cause or worsen heart failure in patients with poor left ventricular function.

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.

Physical Examination

The heart rate is usually rapid, ranging from 150-250 beats per minute (bpm). It is usually 180-200 bpm in adults; in children, the rate may exceed 250 bpm.

Cannon A waves can be seen in the neck due to simultaneous atrial and ventricular contraction.

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.

Rarely, signs of left heart failure may develop or worsen in patients with poor left ventricular function.

Differential Diagnoses

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Media Gallery

Atrioventricular Nodal Reentry Tachycardia. Electrophysiologic mechanism of atrioventricular nodal reentry tachycardia (AVNRT).
Atrioventricular Nodal Reentry Tachycardia. Atypical atrioventricular nodal (AV) reentry tachycardia. Often, an inverted P wave is seen just before the QRS complex in leads II, III, aVF. This represents activation of the posterior septum due to antegrade conduction via the fast pathway and retrograde conduction via the slow pathway of the AV node.
Atrioventricular Nodal Reentry Tachycardia. Typical atrioventricular nodal (AV) reentry tachycardia. In this electrocardiogram, the P wave appears immediately after or just within the QRS complex. Often a “pseudo R wave" is seen in lead V1 and a “pseudo S wave" in leads II, III, aVF. The retrograde P wave represents retrograde activation via the fast pathway, which is anterior septal and superior to the AV node.

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Author

Brian Olshansky, MD, FESC, FAHA, FACC, FHRS Professor Emeritus of Medicine, Department of Internal Medicine, University of Iowa College of Medicine

Brian Olshansky, MD, FESC, FAHA, FACC, FHRS is a member of the following medical societies: American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, European Society of Cardiology, Heart Rhythm Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Astra Zeneca, Artivion<br/>DSMB.

Coauthor(s)

Renee M Sullivan, MD, FACC Assistant Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Missouri Health System; Staff Physician, Electrophysiology, Harry S Truman Veterans Affairs Medical Center

Renee M Sullivan, MD, FACC is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, Heart Rhythm Society, European Cardiac Arrhythmia Society, Group on Women in Medicine and Science

Disclosure: Nothing to disclose.

Chief Editor

Jose M Dizon, MD Professor of Clinical Medicine, Clinical Electrophysiology Laboratory, Division of Cardiology, Columbia University College of Physicians and Surgeons; Attending Physician, Department of Medicine, New York-Presbyterian/Columbia University Medical Center

Jose M Dizon, MD is a member of the following medical societies: American College of Cardiology, Heart Rhythm Society

Disclosure: Nothing to disclose.

Acknowledgements

Marco A Barzallo, MD Consulting Staff, HeartCare Midwest, SC