Classification of supraventricular tachyarrhythmias

Supraventricular tachyarrhythmias are classified taking into account the localization and characteristics of the electrophysiological mechanism and clinical and electrocardiographic manifestations.

• Supraventricular extrasystole is divided into typical extrasystole and parasystole.
• Extrasystole is divided into atrial (left and right) and nodal.
• A distinction is made between monomorphic (one morphology of the ventricular complex) and polymorphic (polytopic) extrasystole.
• According to their severity, they are divided into single, paired (two consecutive extrasystoles), interpolated or intercalated (an extrasystole occurs in the middle between two sinus contractions in the absence of a compensatory pause), allorhythmia (an extrasystole occurs after a certain number of sinus complexes) - bigeminy (every second contraction is an extrasystole) and trihymeny (every third contraction is an extrasystole), etc.
• According to the clinical classification, frequent extrasystole is distinguished (it accounts for more than 10% of all registered complexes on a standard ECG or more than 5000 in 24 hours with Holter monitoring).
• Taking into account the circadian representation, extrasystole is divided into daytime, nighttime and mixed.
• Supraventricular contractions and rhythms: atrial escape rhythms, accelerated atrial rhythms, rhythms from the AV junction (junctional rhythms).
• Sinus tachycardia - typical sinus tachycardia, chronic sinus tachycardia and paroxysmal sinus tachycardia (sinoatrial re-entry tachycardia). According to the nature of the course, reactive and chronic forms of sinus tachycardia are distinguished.
• Supraventricular heterotopic tachycardia is divided into re-entry and automatic.
• Re-entry supraventricular tachycardia:
  • AV reciprocal supraventricular tachycardia is caused by the presence of at least two electrical connections between the atria and ventricles via the AV node and via an additional atrioventricular junction - manifest Wolff-Parkinson-White syndrome with antegrade conduction via an additional atrioventricular junction (antidromic), latent pre-excitation syndrome with retrograde conduction via an additional atrioventricular junction (orthodromic), nodoventricular tachycardia;
  • AV nodal reciprocal supraventricular tachycardia with excitation circulation within the AV junction (typical “slow-fast”, atypical “fast-slow”, atypical “slow-slow”);
  • atrial flutter, atrial fibrillation;
  • atrial re-entry tachycardia.
• Automatic supraventricular tachycardia can be atrial ectopic; AV nodal; chaotic or multifocal. Paroxysmal and non-paroxysmal forms of supraventricular tachycardia are distinguished.
• Paroxysmal occurs with pronounced clinical symptoms and is characterized by a sudden onset and termination of an attack of palpitations lasting from several seconds to several hours (less often a day).
• Non-paroxysmal supraventricular tachycardia is characterized by the constant existence of an abnormal high-frequency rhythm. It is characterized by a long course (often more than 10 years), the absence of typical clinical symptoms, the difficulty of drug relief and the development of such a severe complication as arrhythmogenic cardiomyopathy. The identification of two electrocardiographic forms of non-paroxysmal supraventricular tachycardia is clinically substantiated: constant (with it, the tachycardia is practically not interrupted by any sinus contraction) and recurrent (characterized by a change in sinus and heterotopic rhythm). The ratio of recurrent and constant forms of non-paroxysmal supraventricular tachycardia in children is 2.5:1.

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