AVNRT natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ramyar Ghandriz MD [2]

Overview

AVNRT starts and stops abruptly. Patients may develop syncope. The prognosis is good.

Natural History, Complications and Prognosis

Natural History

The rhythm often ceases abruptly and spontaneously. An episode generally last seconds to hours.

Complications

Some patients will develop syncope during episodes of AVRNT. ^[1]The mechanism of syncope may be due to a reduction of cardiac output and hemodynamic compromise as a result of the short ventricular filling time or alternatively it may be due to transient asystole due to tachycardia-mediated suppression of the sinus node when the rhythm terminates.^[2] Those patients who do become symptomatic during episodes of AVNRT (i.e. have syncope) should avoid activities where the occurrence of hemodynamic compromise would endanger their safety or that of others (like driving).
In patients with underlying ischemic heart disease, demand-related myocardial ischemia, angina and even myocardial infarction and/or congestive heart failure can occur.
Tachycardia mediated cardiomyopathy may develop if the AVNRT is chronic and does not terminate.

Prognosis

AVNRT is rarely life threatening and in the absence of underlying structural heart disease, the prognosis is good. Radiofrequency ablation is curative in 95% of cases.^[3]

References

↑ Leitch, J W; Klein, G J; Yee, R; Leather, R A; Kim, Y H (1992). “Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?”. Circulation. 85 (3): 1064–1071. doi:10.1161/01.CIR.85.3.1064. ISSN 0009-7322.
↑ Moya, A.; Sutton, R.; Ammirati, F.; Blanc, J.-J.; Brignole, M.; Dahm, J. B.; Deharo, J.-C.; Gajek, J.; Gjesdal, K.; Krahn, A.; Massin, M.; Pepi, M.; Pezawas, T.; Granell, R. R.; Sarasin, F.; Ungar, A.; van Dijk, J. G.; Walma, E. P.; Wieling, W.; Abe, H.; Benditt, D. G.; Decker, W. W.; Grubb, B. P.; Kaufmann, H.; Morillo, C.; Olshansky, B.; Parry, S. W.; Sheldon, R.; Shen, W. K.; Vahanian, A.; Auricchio, A.; Bax, J.; Ceconi, C.; Dean, V.; Filippatos, G.; Funck-Brentano, C.; Hobbs, R.; Kearney, P.; McDonagh, T.; McGregor, K.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Tendera, M.; Vardas, P.; Widimsky, P.; Auricchio, A.; Acarturk, E.; Andreotti, F.; Asteggiano, R.; Bauersfeld, U.; Bellou, A.; Benetos, A.; Brandt, J.; Chung, M. K.; Cortelli, P.; Da Costa, A.; Extramiana, F.; Ferro, J.; Gorenek, B.; Hedman, A.; Hirsch, R.; Kaliska, G.; Kenny, R. A.; Kjeldsen, K. P.; Lampert, R.; Molgard, H.; Paju, R.; Puodziukynas, A.; Raviele, A.; Roman, P.; Scherer, M.; Schondorf, R.; Sicari, R.; Vanbrabant, P.; Wolpert, C.; Zamorano, J. L. (2009). “Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)”. European Heart Journal. 30 (21): 2631–2671. doi:10.1093/eurheartj/ehp298. ISSN 0195-668X.
↑ O’Hara, Gilles E.; Philippon, François; Champagne, Jean; Blier, Louis; Molin, Franck; Côté, Jean-Marc; Nault, Isabelle; Sarrazin, Jean-François; Gilbert, Marcel (2007). “Catheter ablation for cardiac arrhythmias: A 14-year experience with 5330 consecutive patients at the Quebec Heart Institute, Laval Hospital”. Canadian Journal of Cardiology. 23: 67B–70B. doi:10.1016/S0828-282X(07)71013-9. ISSN 0828-282X.

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[LeitchKlein1992-1] Leitch, J W; Klein, G J; Yee, R; Leather, R A; Kim, Y H (1992). “Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?”. Circulation. 85 (3): 1064–1071. doi:10.1161/01.CIR.85.3.1064. ISSN 0009-7322.

[MoyaSutton2009-2] Moya, A.; Sutton, R.; Ammirati, F.; Blanc, J.-J.; Brignole, M.; Dahm, J. B.; Deharo, J.-C.; Gajek, J.; Gjesdal, K.; Krahn, A.; Massin, M.; Pepi, M.; Pezawas, T.; Granell, R. R.; Sarasin, F.; Ungar, A.; van Dijk, J. G.; Walma, E. P.; Wieling, W.; Abe, H.; Benditt, D. G.; Decker, W. W.; Grubb, B. P.; Kaufmann, H.; Morillo, C.; Olshansky, B.; Parry, S. W.; Sheldon, R.; Shen, W. K.; Vahanian, A.; Auricchio, A.; Bax, J.; Ceconi, C.; Dean, V.; Filippatos, G.; Funck-Brentano, C.; Hobbs, R.; Kearney, P.; McDonagh, T.; McGregor, K.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Tendera, M.; Vardas, P.; Widimsky, P.; Auricchio, A.; Acarturk, E.; Andreotti, F.; Asteggiano, R.; Bauersfeld, U.; Bellou, A.; Benetos, A.; Brandt, J.; Chung, M. K.; Cortelli, P.; Da Costa, A.; Extramiana, F.; Ferro, J.; Gorenek, B.; Hedman, A.; Hirsch, R.; Kaliska, G.; Kenny, R. A.; Kjeldsen, K. P.; Lampert, R.; Molgard, H.; Paju, R.; Puodziukynas, A.; Raviele, A.; Roman, P.; Scherer, M.; Schondorf, R.; Sicari, R.; Vanbrabant, P.; Wolpert, C.; Zamorano, J. L. (2009). “Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)”. European Heart Journal. 30 (21): 2631–2671. doi:10.1093/eurheartj/ehp298. ISSN 0195-668X.

[O’HaraPhilippon2007-3] O’Hara, Gilles E.; Philippon, François; Champagne, Jean; Blier, Louis; Molin, Franck; Côté, Jean-Marc; Nault, Isabelle; Sarrazin, Jean-François; Gilbert, Marcel (2007). “Catheter ablation for cardiac arrhythmias: A 14-year experience with 5330 consecutive patients at the Quebec Heart Institute, Laval Hospital”. Canadian Journal of Cardiology. 23: 67B–70B. doi:10.1016/S0828-282X(07)71013-9. ISSN 0828-282X.

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