TAQUICARDIA

SUPRAVENTRICULAR
PAROXÍSTICA.

DR IVAN MORENO DIMAS

Aristóteles (siglo IV a.C.)
fue el filósofo del corazón
en la antigüedad. Creyó que
el corazón era el origen de
la sangre y de la vida, y que
todos los órganos se
formaban a partir del
corazón. Según su doctrina,
en él residían el alma y la
inteligencia, y el alma
gobernaba el cuerpo desde
el corazón.
 ORDEN DEL DIA
• Definición
• Epidemiologia
• Etiología
• Fisiopatología
• Diagnóstico clínico
• Diagnóstico gabinete
• Tratamiento
 Taquiarritmias supraventriculares
son los ritmos rápidos en que
alguna estructura por encima de
la bifurcación del haz de His es
necesaria para su mantenimiento
Taquicardias paroxísticas supraventriculares y síndromes de preexcitación. Jesús Almendral revista españla de
cardiología. Vol 65. DOI: 10.1016/j.recesp.2011.11.026
 • En la población general, la prevalencia de la TSV es de 2,25/1.000
personas y la incidencia, 35/100.000 personas-años.
• 2:1 M:H
• 30 y 50 años
• >65 años 5 veces mas riesgo

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
• El aumento en la frecuencia de generación del impulso eléctrico
• La presencia de un circuito de reentrada
A. Taquicardia reentrante nodal B. Taquicardia con participación de una vía accesoria
1. Taquicardia de origen sinusal.
a. Taquicardia sinusal fisiológica.
b. Taquicardia sinusal inapropiada.
c. Síndrome de taquicardia postural ortostática.
d. Taquicardia por reentrada en el nodo sinusal.
2. Taquicardia con participación del nodo auriculoventricular.
a. Taquicardia por rentrada en el nodo auriculoventricular
b. Taquicardia por rentrada auriculoventricular reciprocante (vía accesoria oculta).
3. Taquicardia de origen en el tejido de la unión por foco ectópico.
4. Taquicardia auricular
a. Unifocal
b. Multifocal
5. Fibrilación y flúter auricular.
 Etiología

• Ejercicio
• Momentos de estrés
• Bebidas energéticas
• Fármacos

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
 Síntomas
• Asintomáticos
• Palpitaciones
• Secundarios a estrés físico
• Poliuria
• Sincope
• Disnea

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
Algoritmo ECG para el diagnóstico de las taquicardias con complejo estrecho. tAM, taquicardia auricular multifocal; tAVNR, taquicardia auriculoventricular nodular reciprocante; tAVR, taquicardia auriculoventricular reciprocante; tURp, forma
permanente de taquicardia de la unión reciprocante. (tomado de blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary. Circulation.

2003;108:1871-1909.)
Algoritmo ECG para el diagnóstico de las taquicardias con complejo ancho. AV, auriculoventricular; bR, bloqueo de rama; bRD, bloqueo de rama derecha; bRI, bloqueo de rama izquierda; FV, fibrilación ventricular; RS, ritmo sinusal; tA, taquicardia
auricular; tAR, taquicardia auriculoventricular con reciprocidad; tSV, taquicardia supraventricular; tV, taquicardia ventricular. (tomado de blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of

patients with supraventricular arrhythmias— executive summary. Circulation. 2003;108:1871-1909.)

 Criterios de Brugada de taquicardia ventricular
Este algoritmo tiene una sensibilidad del 99% y una especificidad del
96,5% en pacientes sin bloqueo de rama preexistente.
Es una taquicardia ventricular si existe:
• Ausencia de complejos RS en las derivaciones precordiales.
• Algún intervalo RS mayor de 100 ms en alguna derivación precordial.
• Presencia de disociación auriculoventricular.
• Si cumplen los criterios morfológicos de taquicardia ventricular en las
derivaciones precordiales tanto en V1-V2 como en V6.

• Si no se cumplen ninguno de los enunciados previos: es una

taquicardia supraventricular.
 Tratamiento
• TA < 90/50 mm Hg
• Disnea
• Insuficiencia cardiaca/EAP
• Ángor
• Shock
• Disminución del nivel de conciencia

Guía ESC 2019 sobre el tratamiento de pacientes con taquicardia supraventricular

Guía ESC 2019 sobre el tratamiento de pacientes con taquicardia supraventricular
 Tratamiento

• Masaje carotideo 19-54% : ejercer presión digital sobre la bifurcación de la arteria carotídea
• Contraindicado:
• IAM 3 meses
• Soplos
• Evc

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
 Adenosina
• 6-18 mg en bolo
• 6  12  18 mg

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
 AMIODARONA
• 5mg/kg en 250 mg solución glucosa 5%. En
20 min
• Dosis de mantenimiento: de 10 a 20 mg/kg
de peso / 24 horas (generalmente de 600 a
800 mg/24 horas, límite 1.200 mg/24 horas)
en 250 ml de dextrosa al 5% durante varios
días.

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
VERAPAMILO
• Dosis inicial: 5 a 10 mg (0.075 a 0.15 mg/kg de peso corporal)
administrados como un bolo intravenoso durante al menos 2 minutos.

• Repetición de dosis: 10 mg (0.15 mg/kg de peso corporal) 30 minutos

después de la primera dosis, si la respuesta inicial no es adecuada.
DILTIAZEM
• Diltiazem i.v. (0,25 mg/kg [media, 20 mg] en 2 min) terminan la TSV
en el 64- 98% de los pacientes.
Alabed, S. orcid.org/0000-0002-9960-7587, Providência, R. and Chico, T.J.A. orcid.org/0000-0002-7458-5481 (2018) Cochrane corner: adenosine versus intravenous calcium channel antagonists for supraventricular
tachycardia. Heart, 104 (24). pp. 1993-1994. ISSN 1355-6037 https://doi.org/10.1136/heartjnl-2017-312909
Alabed, S. orcid.org/0000-0002-9960-7587, Providência, R. and Chico, T.J.A. orcid.org/0000-0002-7458-5481 (2018) Cochrane corner: adenosine versus intravenous calcium channel antagonists for supraventricular
tachycardia. Heart, 104 (24). pp. 1993-1994. ISSN 1355-6037 https://doi.org/10.1136/heartjnl-2017-312909
 Eur Heart J, Volume 43, Issue 40, 21 October 2022,
Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Pages
3997–4126,
Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262 https://doi.org/10.1093/eurheartj/ehac262
 Los bloqueadores beta intravenosos están
contraindicados en presencia de IC
descompensada.

El verapamilo y el diltiazem intravenosos están

contraindicados en presencia de hipotensión o IC-

FEr.

Guía ESC 2019 sobre el tratamiento de pacientes con taquicardia supraventricular

 En el ensayo PROCAMIO. en pacientes con taquicardia
de complejo QRS ancho bien tolerada, con y sin FEVI
reducida, la procainamida se asocio´ con menos eventos
adversos cardiacos mayores y una mayor proporcio´ n de
fin de la taquicardia en 40 min en comparacio´ n con la
amiodarona.

Guía ESC 2019 sobre el tratamiento de pacientes con taquicardia supraventricular

Guía ESC 2019 sobre el tratamiento de pacientes con taquicardia supraventricular
 Contraindication
Indications Oral dose per
Anti-arrhythmic s, precautions,
Effects on ECG (specific day Side effects
drug other
indication) (i.v. dose)
considerations
Amiodarone Decreases sinus PVC, VT, VF 200–400 mg Cardiac: Precautions:
node frequency, Loading dose: Bradycardia, TdP Sinus node
prolongs QT 600–1200 mg/24 (infrequent) dysfunction,
intervala h 8–10 days. Extracardiac: severe AV
(Loading dose: 5 Photosensitivity, conduction
mg/kg in 20 min– corneal deposits, disturbances,
2 h, 2–3 times in hypothyroidism, hyperthyroidism
24 h, then 600– hyperthyroidism, Other
1200 mg/24 h 8– pulmonary considerations:
10 days) toxicity, Can be used in
hepatotoxicity, patients with heart
polyneuropathy, failure. Increases
skin discoloration the risk of
myopathy when
used with statins

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
 Contraindication
Indications Oral dose per
Anti-arrhythmic s, precautions,
Effects on ECG (specific day Side effects
drug other
indication) (i.v. dose)
considerations

Adenosine Transitory AV Regular wide No oral use Chest pain, Contraindication

block complex (6–18 mg bolus) flushing, s:
tachycardia of bronchoconstrict Severe asthma,
unknown origin ion pre-excited AF
(outflow tract Other
VT) considerations:
Antagonist:
theophylline

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
 Contraindication
Indications Oral dose per
Anti-arrhythmic s, precautions,
Effects on ECG (specific day Side effects
drug other
indication) (i.v. dose)
considerations

Beta-blocker Decreases sinus PVC, VT Various Cardiac: Contraindication

node frequency, (LQTS, CPVT) (various) Bradycardia, AV s:
prolongs PR block, Severe sinus
interval, shortens hypotension, node
QT interval negative dysfunction,
inotrope severe AV
Extracardiac: conduction
Fatigue, disturbances,
bronchospasm, decompensated
sexual heart failure,
disturbances, coronary
depression, cold vasospasm,
extremities severe asthma,
BrS

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
 Contraindication
Indications Oral dose per
Anti-arrhythmic s, precautions,
Effects on ECG (specific day Side effects
drug other
indication) (i.v. dose)
considerations

Verapamil Prolongs PR (LV fascicular 120–480 mg Cardiac: Contraindication

interval tachycardia) (5–10 mg in Sinus s:
slow bolus. If bradycardia in Heart failure
necessary, can sinus node with reduced
be repeated in dysfunction, AV LVEF, severe
30 min) block, negative sinus node
inotrope, dysfunction,
hypotension and severe AV
Extracardiac: conduction
Gastrointestinal disturbances, VT
disturbances, of unknown
peripheral origin, ACS,
oedema, WPW syndrome
flushing Other
considerations:
Increase the risk
ofDeveloped
Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: myopathy by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262 when used with
 • Implante cardiovertos desfribilador
• <mortalidad 25% (HR 0.72; 95% CI 0.6–0.87; P = 0.0006)
• < riesgo de arritmia letales (HR 0.5; 95% CI 0.37–0.67; P < 0.0001)

Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the
management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital
Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–4126, https://doi.org/10.1093/eurheartj/ehac262
 RECUERDA
• La diferenciación entre arritmia supraventricular o
ventricular es importante tanto desde el punto de vista
pronóstico como terapéutico. Las arritmias
supraventriculares acontecen muy frecuentemente en
personas sanas, sin cardiopatía, mientras que las
ventriculares traducen en general la existencia de una
alteración cardíaca (valvulopatía, miocardiopatía, etc.).
Además, el tratamiento de ambos tipos de arritmias es muy
diferente.
•NO HAY MEJOR
MEDICINA QUE
PENSAMIENTOS
ALEGRES
BIBLIOGRAFIA
• Smith GD, Fry MM, Taylor D, Morgans A, Cantwell K. Effectiveness of the Valsalva Manoeuvre for reversion of
supraventricular tachycardia. Cochrane Database Syst Rev. 2015 Feb 18;2015(2):CD009502. doi:
10.1002/14651858.CD009502.pub3. PMID: 25922864; PMCID: PMC7104204
• Katja Zeppenfeld, et.ESC Scientific Document Group, 2022 ESC Guidelines for the management of patients
with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for
the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of
the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and
Congenital Cardiology (AEPC), European Heart Journal, Volume 43, Issue 40, 21 October 2022, Pages 3997–
4126, https://doi.org/10.1093/eurheartj/ehac262
• Alabed, S. orcid.org/0000-0002-9960-7587, Providência, R. and Chico, T.J.A. orcid.org/0000-0002-7458-5481
(2018) Cochrane corner: adenosine versus intravenous calcium channel antagonists for supraventricular
tachycardia. Heart, 104 (24). pp. 1993-1994. ISSN 1355-6037 https://doi.org/10.1136/heartjnl-2017-312909
• Taquicardias paroxísticas supraventriculares y síndromes de preexcitación. Jesús Almendral revista españla de
cardiología. Vol 65. DOI: 10.1016/j.recesp.2011.11.026
• Algoritmo ECG para el diagnóstico de las taquicardias con complejo estrecho. tAM, taquicardia auricular multifocal; tAVNR,
taquicardia auriculoventricular nodular reciprocante; tAVR, taquicardia auriculoventricular reciprocante; tURp, forma
permanente de taquicardia de la unión reciprocante. (tomado de blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al.
ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary.
Circulation. 2003;108:1871-1909.)