SVT (Supra Ventricular Tachycardia)

R Hemalatha1, T.Jasmine Rajareegam Princely2, M.Ramunapriya3

1 Ward Supervisor, Kauvery Heartcity, Trichy, India

2Ward Incharge, Kauvery Heartcity, Trichy, India

3Ward Staff Nurse, Kauvery Heartcity, Trichy, India

*Correspondence: Tel: +918508698000; Email: [email protected]

Abstract

A 46 years old female, hypertensive and euglycemic and with mild Mitral Regurgitation (MR), got admitted in Kauvery Heartcity hospital as a  known patient of SVT, for Electro Physiology Study and Radio frequency ablation procedure.

Background

Patient had one episode of palpitation and giddiness for 6 month on & off no treatment was taken again she develop palpitation and giddiness in the month of January – 2023 and she went to nearby hospital, reverted with Inj.Adenocin. The past 6 months she was unknown of these signs and symptom and it was auto reverted within 5minutes. She was referred to Kauvery Hospital – Heartcity, for Radio frequency and ablation procedure.

Supraventricular tachycardia (SVT) is an arrhythmia that originates in the upper chambers of the heart and causes an unusually fast or chaotic heartbeat. Paroxysmal Supraventricular tachycardia is another name for SVT.

The average heart beats between 60 and 100 times every minute. Tachycardia is the medical term for a heart rate of greater than 100 beats per. The heart typically beats 150 to 220 times per minute during an episode of SVT, but it can occasionally beat faster or slower.

A narrow complex (QRS 120 ms) with a pace of more than 100 beats per minute characterizes Supraventricular tachycardia (SVT), a dysrhythmia that originates at or above the Atrio Ventricular (AV) node (bpm).

Types of SVT

  1. Sinus tachycardia
  2. Sinus nodal reentrant tachycardia (SNRT)
  3. Inappropriate sinus tachycardia (IST)
  4. Multifocal atrial tachycardia (MAT)
  5. Junctional ectopic tachycardia (JET)
  6. Nonparoxysmal junctional tachycardia (NPJT

Symptoms

  1. Palpitation for 6 months
  2. Giddiness for 6 months

Examination

CVS: S1 S2+ BP – 120/80 mmhg

RS : BAE(+) HR – 84/min

P/A: Soft RR – 20/mt

CNS: Within normal limits T – Normal

GCS – 15/15

GRBS – 100 mg/dl

Procedure Details

Surface ECG details

PR interval – 112 msec QRS interval – 86 msec

RR interval – 800msec QT interval – 390 msec

Under local anesthesia, catheters were placed in the above said location. Using 3D ENSITE NAVIX mapping, RA geometry was created

Baseline measurements are as below.

V. Pacing : Concentric & Decremental,

VAW – < 200 msec

VERP – 600 / 250 msec

A Pacing : No pre – Excitation

AV cross over at 320 msec

Easily inducible clinical Tachycardia at burst pacing at 310 msec after AV crossover

AVNERP – 500 / 220 msec

Tachycardia: (TCL – 240 msec

1:1 AV ratio, concentric VA

Septal VA 10 msec

VOP – VAV response

CPPI – 150 msec

Diagnosis: Typical slow- fast AVNRT

Ablation details: with medium curve therapy ablation catheter in sinus rhythm, slow pathway region was mapped with 3D mapping. Ablation at that spot revealed stable functional rhythm for 60 seconds

Energy settings: 30w, 50oC

Post Radio Frequency Ablation:

Baseline: PR – 110/msec HV – 42 msec, AH – 60 msec

Easily inducible AVNRT was not inducible with burst and extra atrial Stimulus (Double Extras). AH jump was present. No AV nodal Echoes.

Final Diagnosis: SVT- Typical AVNRT (Drug refractory) using 3D ENSITE NAVX mapping

Successful slow pathway modification done

ECG:

1. Before Ablation:

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2. After Ablation:

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ECHO Report:

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Nursing Management:

  1. Inserted and maintained IV access in a sterile method.
  2. Every four hours, blood pressure was monitored
  3. Physicians gave attendees an explanation of the patient’s situation.
  4. After thorough counselling, nurses were able to secure consent for the clinical procedures.
  5. Whole body preparation done for the procedure.
  6. Povidone bath given prior to the procedure.
  7. When speaking with patients and visitors, nurses employed the AIDET strategy (Acknowledge, Introduce, Duration, Explanation and Thank you) to build trust and raise satisfaction levels.
  8. The patient was moved to the cath lab on 11/2/2023 for an electrophysiological investigation and radio frequency ablation.
  9. The 3D ablation procedure was completed successfully.
  10. Nurses monitored for any hematomas or active bleeding at the femoral site
  11. Vital signs were closely checked both throughout the procedure and following it to avoid stasis and embolism formation.
  12. Following the surgery, effective hydration and I/O chart maintenance optimised renal function.
  13. We provided a quiet and calm environment.
  14. Demonstrated and encouraged the use of stress management behaviors, relaxation techniques and slow/deep breathing.
  15. Diversional therapy was supplied with newspapers, television and active listening to patient voice by nurses.
  1. Instructed to avoid heavy lifting and vigorous walking for 2 to 3 days after procedure.
  2. Patient was advised to continue the normal life pattern after 1 week.
  3. If palpitation occurs again, advised to immediately consult the doctor and do follow up accordingly.

Discharge Medication:

  1. Tab. Rantac 150mg BD
  2. Tab. Ecosprin 75mg OD

Outcome

On discharge: she was asymptomatic. Heart rate was 86/Min. She went to home with full of happiness. Now she is leading a happy life without any problem.

 

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Ms. R. Hemalatha

Ward Supervisor

Ka3-5

Ms. T. Jasmine Rajareegam Princely

Ward Incharge

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Ms. M. Ramunapriya

Nursing Staff Nurse

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