Narrow complex tachycardia (NCT)

1. NARROW COMPLEX
TACHYCARDIA
DR. DEBABRATA HALDER
NICVD, DHAKA

17. Accessory pathway localization in
WPW syndrome.

22. SOME DEFINITIONS
• SVT- include all tachyarrhymias that either
originate from or incorporate supraventricular
tissue in a reentrant circuit
• PSVT-refers to a clinical syndrome
characterized by rapid regular narrow complex
tachycardia with abrupt onset and termination

23. • AT-arise exclusively from atrial tissue it is 5%
of all PSVT.
• WPW Syndrome-include preexcitation
&tachyarrhythmia.

24. AVNRT-INCIDENCE
• 2/3 rd of PSVT
• About 10% of general population
• Women affected more(twice)
• Extremely uncommon prior to age 5years
• Usually onset -4th decade

25. TYPES OF NCT
• Sinus node origin
-sinus tachycardia
- inappropriate sinus tachycardia
-sinus node reentry tachycardia.
Atrial tissue origin
-AT (Ectopic,MAT)
- AFIB
-Atrial flutter

26. • AV node
-AVNRT(Typical /Atypical)
-JET
Accessory pathway-PJRT(decremental)

27. DIFFERIAL DIAGNOSIS FOR TYPES OF
SVT BASED ON ECG CRITERIA
• A)-short RP interval RP<PR
typical AVNRT
AVRT
B)-long RP interval RP>0r=PR
Atypical AVNRT
AT
AVRT with slowly conducting pathway-PJRT
Sinus node reentry
Sinus tachycardia

28. Types of Accessory Pathway
I. Based on site of origin and insertion:
a) Atrioventricular
i. Right-sided: anteroseptal, RV free wall, Posteroseptal
ii. Left-sided: anteroseptal, LV free wall, posteroseptal
b) Atriofasicular (Brechenmacher fibers)
c) Nodofasicular (Mahaim Fibers)
II. Based on direction of conduction:
a. Antegrade
b. Retrograde (Concealed)
c. Bidirectional

29. Types of Accessory PathwayCont…
III. Based on conduction property:
a. Slow, decremental
b. Fast, nondecremental
IV. Based on Number:
a. Single
b. Multiple

30. AVNRT

31. CLINICAL FEATURE
• Palpitation
• Dizziness
• Dyspnoea
• Weakness
• Angina
• Frank syncope
• Neck pounding-it is helpful for diagnosis of
AVNRT

32. • Episode may last from seconds to several
hours
• Sign –rapid rate
-cannon A wave

33. ECG CRITERIA
• Rapid regular narrow complex tachycardia.
Rate is 120-200b/min .rate varies episode to
episode
• P wave is obscured by QRS complex
• P wave may be seen slightly before or after
QRS(<80 ms)
• Pseudo r inVI
• Pseudo S in II III aVF

34. • Functional BBB
• In sinus rhythm sudden prolongation PR
interval PR alternans &two QRS complexes in
a response to single P
• ST depression in 25%-50%
• New t wave inversion immediate after or 6
hours after in anterior &inferior leads
• QRS alternans

35. WPW OR ACCESSORY PATHWAY

36. AVRT

40. •THANK YOU