From the Guidelines
Aberrancy in the heart refers to abnormal electrical conduction, primarily occurring in three main types: functional aberrancy, fixed aberrancy, and pre-excitation syndromes, as noted in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Types of Aberrancy
The main types of aberrancy include:
- Functional aberrancy: temporary and commonly appears as rate-related bundle branch block when heart rates increase rapidly, causing one ventricle to activate later than the other.
- Fixed aberrancy: results from permanent damage to the conduction system, often due to heart attacks or fibrosis, creating consistent conduction delays.
- Pre-excitation syndromes: like Wolff-Parkinson-White syndrome, involve accessory pathways that bypass the normal conduction system, allowing electrical signals to reach the ventricles prematurely.
Diagnosis and Treatment
These aberrancies are diagnosed through ECG patterns showing widened QRS complexes and specific morphology changes, as described in the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1. Treatment depends on the type and severity, ranging from observation for benign functional aberrancy to antiarrhythmic medications like beta-blockers or calcium channel blockers for symptomatic cases, and catheter ablation for accessory pathways in pre-excitation syndromes.
Key Considerations
Understanding these distinctions helps clinicians properly interpret ECG findings and determine appropriate management strategies, particularly in differentiating between supraventricular and ventricular rhythms, as most wide-complex tachycardias are ventricular in origin 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Types of Aberancy
- Aberrant ventricular conduction is a common electrocardiographic manifestation that occurs when the supraventricular electrical impulse is conducted abnormally through the ventricular conducting system 2
- This results in a wide QRS complex that may be confused with a ventricular ectopic beat
- The mechanisms of aberrant ventricular conduction are discussed in the context of supraventricular tachycardia (SVT) 2
Supraventricular Tachycardia (SVT)
- SVT is an abnormal rapid cardiac rhythm that involves atrial or atrioventricular node tissue from the His bundle or above 3, 4, 5, 6
- Common types of SVT include:
- Atrioventricular nodal reentrant tachycardia
- Atrioventricular reentrant tachycardia
- Atrial tachycardia
- Presenting symptoms may include altered consciousness, chest pressure or discomfort, dyspnea, fatigue, lightheadedness, or palpitations 3, 4, 5, 6
Diagnosis and Management
- Diagnostic evaluation may be performed in the outpatient setting and includes a comprehensive history and physical examination, electrocardiography, and laboratory workup 3, 4, 5, 6
- Extended cardiac monitoring with a Holter monitor or event recorder may be needed to confirm the diagnosis 3, 4
- Acute management of paroxysmal SVT is similar across the various types and is best completed in the emergency department or hospital setting 3, 4, 5, 6
- First-line management for hemodynamically stable patients includes vagal maneuvers and adenosine, while synchronized cardioversion is first-line management for hemodynamically unstable patients 3, 4, 5, 6