264.4 📌 章末速蚘

264.4.0.0.1 SVT Types
  • AVNRT (60%, slow + fast pathway in AV node)
  • AVRT (WPW, accessory pathway; orthodromic narrow / antidromic wide)
  • Atrial flutter (saw-tooth, 2:1 → rate 150)
  • Atrial tachycardia (focal; multifocal AT in COPD)
  • Junctional tachycardia
264.4.0.0.2 Acute Stable Management
  1. Modified Valsalva (REVERT)
  2. Adenosine 6 → 12 mg IV
  3. IV CCB / β-blocker
  4. Synchronized cardioversion if unstable
264.4.0.0.3 Adenosine
  • 6 mg IV rapid push + flush
  • Brief AV node block
  • Avoid: WPW + AF, severe asthma, 2°/3° AV block
264.4.0.0.4 WPW + AF (Pre-Excited)
  • AVOID AV nodal blockers (BB, CCB, digoxin, adenosine)
  • Procainamide IV or cardioversion preferred
264.4.0.0.5 Antidromic AVRT (Wide QRS)
  • Treat as VT until proven otherwise
  • Procainamide IV or cardioversion
264.4.0.0.6 Catheter Ablation
  • Curative for AVNRT, AVRT, typical AFL, AT (> 95%)
  • First-line for symptomatic recurrent
264.4.0.0.7 MAT
  • ≥ 3 P morphologies; COPD + hypoxia
  • Magnesium + β-blocker (CCB if asthma)
264.4.0.0.8 Catheter Ablation Pearls
  • AVNRT slow pathway (< 1% AV block)
  • AVRT accessory pathway
  • AFL cavotricuspid isthmus
264.4.0.0.9 盧醫垫 hint
  • Stable SVT: modified Valsalva → adenosine → CCB / β-blocker → cardioversion
  • WPW + AF: procainamide or cardioversion (NO AV nodal blockers)
  • Wide complex tachycardia: treat as VT until proven otherwise
  • Recurrent SVT: refer for catheter ablation (curative)
  • MAT in COPD: oxygen + treat COPD + Mg + electrolytes