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Sample records for supraventricular tachycardia psvt

  1. Paroxysmal supraventricular tachycardia: physiopathology and management

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    Paola Neroni

    2014-06-01

    Full Text Available Paroxysmal supraventricular tachycardia (PSVT is the most frequent arrhythmia in newborns and infants. Most supraventricular tachycardias affect structurally healthy hearts. Apart from occasional detection by parents, most tachycardias in this age group are revealed by heart failure signs, such as poor feeding, sweating and shortness of breath. The main symptom reported by school-age children is palpitations. The chronic tachycardia causes a secondary form of dilative cardiomyopathy. Treatment of acute episode usually has an excellent outcome. Vagal manoeuvres are effective in patients with atrioventricular reentrant tachycardia. Adenosine is the drug of choice at all ages for tachycardias involving the atrioventricular node. Its key advantage is its short half life and minimum or no negative inotropic effects. Verapamil is not indicated in newborns and children as it poses a high risk of electromechanical dissociation. Antiarrhythmic prophylaxis of PSVT recurrence is usually recommended in the first year of life, because the diagnosis of tachycardia may be delayed up to the appearance of symptoms. Digoxin can be administered in all forms of PSVT involving the atrioventricular node, except for patients with Wolff-Parkinson-White syndrome below one year of age. Patients with atrioventricular reentrant PSVT can be treated effectively by class Ic drugs, such as propaphenone and flecainide. Amiodarone has the greatest antiarrhythmic effect, but should be used with caution owing to the high incidence of side effects. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  2. Postexertional Supraventricular Tachycardia in Children with Catecholaminergic Polymorphic Ventricular Tachycardia

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    Scott D. N. Else

    2012-01-01

    Full Text Available Catecholaminergic polymorphic ventricular tachycardia (CPVT is a severe arrhythmia associated with sudden death in the young. It is caused by defective calcium handling in ventricular myocytes. The association of supraventricular tachycardia (SVT with CPVT is described in the literature, occurring in the lead-up to ventricular tachycardia during exercise testing. We describe three cases of SVT that were initiated in the recovery period of exercise testing in children with CPVT.

  3. Paroxysmal supraventricular tachycardia in pregnant women and birth outcomes of their children: a population-based study.

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    Bánhidy, Ferenc; Ács, Nándor; Puhó, Erzsébet H; Czeizel, Andrew E

    2015-08-01

    The aim of the study was to estimate the possible association of pregnant women with paroxysmal supraventricular tachycardia (PSVT) with the possible risk for adverse birth outcomes, particularly different congenital abnormalities (CAs) in their children. Prospectively and medically recorded PSVT was evaluated in 103 pregnant women who later had offspring with CA (case group) and 149 pregnant women who later delivered newborn infants without CA (control group) and matched to cases in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. Of 252 pregnant women with PSVT, 115 (45.6%) had the onset of this condition before the study pregnancy, that is, their PSVT was a chronic condition, while the rest (N = 137) of PSVT was considered as new onset in the study pregnancy. The comparison of occurrence of PSVT in pregnant women who had offspring with different CA groups and in control mothers showed a higher risk for cardiovascular CAs (adjusted OR with 95% CI: 2.1, 1.1-3.8) explained mainly by secundum atrial septal defect. This association was confirmed in pregnant women with PSVT in the second and/or third gestational month, that is, critical period of cardiovascular CAs. In conclusion PSVT in pregnant women associates with a higher risk of secundum atrial septal defect in their children. © 2015 Wiley Periodicals, Inc.

  4. Occurrence of atrioventricular block during supraventricular tachycardia: What is its possible mechanism?

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    Ho-Shun Cheng

    2014-02-01

    Full Text Available A female patient was admitted to our hospital for catheter ablation arising from paroxysmal supraventricular tachycardia (PSVT. In the laboratory, PSVT (the earliest retrograde atrial activation at the coronary sinus ostium with intermittent atrioventricular (AV block could be induced repeatedly. The tachycardia could be terminated during ventricular pacing without retrograde conduction to the atria. Therefore, orthodromic AV reciprocating tachycardia (AVRT and atrial tachycardia (AT could be ruled out and AV nodal re-entrant tachycardia (AVNRT was subsequently considered. Initial attempts using slow or intermediate AV nodal ablation failed to cure the tachycardia. We considered the possibility of orthodromic AV reciprocating tachycardia (AVRT with AV block occurring during the tachycardia. The tachycardia was successfully terminated during the ablation of the right posteroseptal pathway at the coronary sinus ostium. We hypothesized about the possible explanation that might help to clarify the phenomenon of AV block during SVT in order to provide some guidance to other clinicians confronted with similar patient challenges in the future.

  5. Practice makes perfect: relationship between hospital procedure volume and permanent pacemaker implantation after paroxysmal supraventricular tachycardia ablation.

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    Agarwal, Vratika; Shah, Neeraj; Mehta, Kathan; Agarwal, Anand; Willner, Jonathan; Lafferty, James

    2017-11-01

    Paroxysmal supraventricular tachycardia (PSVT) ablation can result in injury to the atrioventricular (AV) node causing complete heart block requiring permanent pacemaker (PPM) implantation. Few studies have examined the impact of hospital PSVT ablation volume and PPM implantation rates post ablation. We included adult patients from the Nationwide Inpatient Sample (NIS) database, from 1998 to 2011, using ICD-9 diagnoses codes 427.0 and 427.89 for PSVT and ICD-9 procedure code 37.34 for ablation. Patients with concomitant arrhythmias, prior pacemaker/defibrillator implants, or pre-existing sinus node dysfunction were excluded. Multivariate logistic regression analysis was performed to identify predictors of PPM implantation. There were 119,938 PSVT ablations from 1998 to 2011 with a mean age of 54.6 ± 17.5 years and 64.1% females. The overall PPM implantation rate was 3.2%. PPM implantation rates in the first (1-14 ablations/year), second (15-32 ablations/year), and third (> 32/ablations/year) tertiles of annual PSVT ablation volume were respectively 4.4, 3.3, and 1.9% (p  32 PSVT ablations/year compared to hospitals performing ≤ 14 PSVT ablations/year was 0.54 (95% confidence interval 0.3-0.9, p = 0.026). PPM implantation rates are significantly lower in hospitals performing > 32 PSVT ablations/year, indicating that hospital experience is an important determinant of outcomes after PSVT ablation.

  6. Evaluation and Management of Neonatal Supraventricular Tachycardia

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    Malekian

    2016-07-01

    Full Text Available Background Supraventricular Tachycardia (SVT is the most frequent arrhythmia requiring a medical treatment in neonates. Objectives The aim of our study was to evaluate and manage neonatal supraventricular tachycardia. Methods This study was performed on 22 newborns that were diagnosed with SVT at two neonatal intensive care units (NICU in south west of Iran from October 2012 to October 2015. Data on gender, age, weight, maternal age, gestational age, presence of congenital heart disease, blood pressure in admission, duration of hospitalization period, duration of SVT, medicine for the control of SVT, list of medicine administered at releasing time were collected. Echocardiography was performed for all patients. Data was analyzed by the SPSS version 18 software. Results Twelve neonates were male (54.5% and ten (45.5% were female. The mean age was 11.68 ± 8.17 days. Three neonates (13.6% had congenital heart disease. The mean duration of hospitalization was 6.54 ± 3.98 days. Nine patients (41% only had responded adenosine. One patient had hypotensive that received D/C shock. Conclusions We concluded that in most SVT patients, conventional treatment can be helpful and an only minor percentage of patients need to receive flecainide as the last line of treatment.

  7. SUCCESSFUL TREATMENT OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA IN A LOW-BIRTH-WEIGHT NEWBORN BY INJECTION OF ADENOSINE-5'-TRIPHOSPHATE

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    古市, 康子; 吉田, 裕慈; 川口, 千晴; 桑原, 勲; 箕輪, 秀樹; 江國, 豊; 吉岡, 章; 高橋, 幸博; 松村, 正彦

    2002-01-01

    We report a case in which paroxysmal supraventricular tachycardia (PSVT) in a low-birth-weight newborn, due to atrioventricular nodal re-entry, wassuccessfully treated by intravenous bolus injection of adenosine-5'-triphosphate (ATP). The newborn was a male, born after 36 weeks and 1 day of gestation, weighing 2,204g. One hour after birth, he exhibited tachycardia, at 250 to 270 beats/min. A chest radiogragh revealed cardiomegaly, with a cardiothoracic ratio of 71%. Injection of ATP at a dose...

  8. A male infant had subdural effusion and paroxysmal supraventricular tachycardia during the febrile episode of Kawasaki disease: a case report and literature review.

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    Chou, Chia-Pei; Lin, I-Chun; Kuo, Kuang-Che

    2016-05-28

    Kawasaki disease is an acute, febrile, self-limiting, inflammatory systemic vasculitis seen in early childhood, most commonly in those below 5 years of age. In Kawasaki disease, the coronary arteries are most commonly affected, which may lead to asymptomatic coronary artery ectasia or formation of an aneurysm. Paroxysmal supraventricular tachycardia(PSVT) is a severe and rare cardiovascular complication of Kawasaki disease. A case of Kawasaki disease presenting with unusual findings, including subdural effusion and PSVT is reported. This is a 4-month-10-day-old boy presents with anterior fontanelle bulging and moderate bilateral subdural effusion at the acute stage of Kawasaki disease and PSVT at the subacute stage of Kawasaki disease. The subdural effusion was resolution after intravenous immunoglobulin(IVIG) administration. And the PSVT was subsided after administered 3 doses of adenosine, 1 dose of amiodarone loading and Propranolol twice per day use. At 1-year follow-up has made a complete recovery with no arrhythmia episodes, developmental effects or abnormal neurologic findings. Subdural effusion in the acute stage of Kawasaki disease may be an inflammatory response. It may resolves spontaneously after anti-inflammatory treatment such as IVIG infusion. PSVT is a severe cardiovascular complication of Kawasaki disease. In those who taking aspirin, we need to carefully observe the heart rhythm and PSVT side effects, especially in the first month.

  9. Assessment of the neutrophil/lymphocyte ratio in patients with supraventricular tachycardia.

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    Aydın, Mesut; Yıldız, Abdülkadir; Yüksel, Murat; Polat, Nihat; Aktan, Adem; İslamoğlu, Yahya

    2016-01-01

    The neutrophil/lymphocyte ratio (NLR) has been evaluated as a new predictor of cardiovascular risk. Inflammation has been shown to be associated with various arrhythmias including supraventricular tachycardias (SVTs). In this study, we aimed to investigate the relation between NLR and SVT in patients with a documented atrial tachyarrhythmia. The study used a retrospective cross-sectional design. Patients who had SVT but were otherwise healthy were included. The exclusion criteria included drug use (except antiarrhythmic agents), morbid obesity, acute or chronic infection, inflammatory diseases, systemic diseases, and cancer. Total and differential leukocyte counts and routine biochemical tests were performed before the ablation procedure. The study included 150 patients with SVT and 98 healthy controls. The biochemical and hematological parameters were comparable between the groups, except neutrophil and lymphocyte counts. The neutrophil count was significantly higher (4.7±1.5x103/µL versus 4.1±1.0x103/µL; pSVT group than in the control group. As a result, the SVT group had significantly higher NLR values than the control group (2.2±0.9 versus 1.7±0.5; pSVT remained significant after multivariate analysis (odds ratio: 1.5, 95% confidence interval: 1.001-2.263, p=0.049). Our study indicated that NLR values were significantly higher in patients with documented SVT than in control subjects. Inducibility of SVT during EPS was associated with higher NLR values.

  10. Supraventricular tachycardia following insertion of a central venous catheter

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    Yavascan Onder

    2009-01-01

    Full Text Available Placement of central venous catheters (CVCs in patients is associated with several risks including endocardial injury and dysrhythmias. In addition, CVC extending into intracardiac chambers can provoke premature atrial and ventricular complexes, which have been reported to initiate supraventricular tachycardia (SVT. A 15-year-old boy with end-stage renal failure developed SVT after insertion of a CVC.

  11. Inappropriate Detection of a Supraventricular Tachycardia as Dual Tachycardia by the PR Logic™ Algorithm

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    Ajit Thachil, MD, DM, CCDS

    2014-05-01

    Full Text Available Tachycardia detection and therapy algorithms in Implantable Cardioverter-Defibrillators (ICD reduce, but do not eliminate inappropriate ICD shocks. Awareness of the pros and cons of a particular algorithm helps to predict its utility in specific situations. We report a case where PR logic™, an algorithm commonly used in currently implanted ICDs to differentiate supraventricular tachycardia (SVT from ventricular tachycardia resulted in inappropriate detection and shock for an SVT, and discuss several solutions to the problem.

  12. Intrauterine management of fetal supraventricular tachycardia (SVT) with cardiac failure.

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    Muniswaran, G; Japaraj, R P; Asri Ranga, A R; Cheong, H K

    2015-12-01

    Fetal arrhythmias are not uncommon in pregnancy. The diagnosis can be established on routine ultrasound scan. Fetal supraventricular tachycardia (SVT) is the most common cause of fetal tachycardia. If left undiagnosed and untreated, these fetuses may develop cardiac failure, hydrops fetalis and eventually death. We report two fetuses diagnosed antenatally to have fetal SVT. Both fetuses were in cardiac failure and were successfully treated with maternal administration of antiarrhythmic medications. Digoxin, and in severe instances, a combination with flecanaide significantly improved fetal outcomes and prevented fetal mortality. The long term prognosis of such patients are good.

  13. Treatment of supraventricular tachycardia in infants: Analysis of a large multicenter database.

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    Chu, Patricia Y; Hill, Kevin D; Clark, Reese H; Smith, P Brian; Hornik, Christoph P

    2015-06-01

    Supraventricular tachycardia (SVT) is the most common arrhythmia in infants. Infants are typically treated with antiarrhythmic medications, but there is a lack of evidence guiding management, thus exposing infants to risks of both inadequate therapy and medication adverse events. We used data from a large clinical database to better understand current practices in SVT management, safety of commonly used medications, and outcomes of hospitalized infants treated for SVT. This retrospective data analysis included all infants discharged from Pediatrix Medical Group neonatal intensive care units between 1998 and 2012 with a diagnosis of SVT who were treated with antiarrhythmic medications. We categorized infants by the presence of congenital heart disease other than patent ductus arteriosus. Medications were categorized as abortive, acute, or secondary prevention therapies. We used descriptive statistics to describe medication use, adverse events, and outcomes including SVT recurrence and mortality. A total of 2848 infants with SVT were identified, of whom 367 (13%) had congenital heart disease. Overall, SVT in-hospital recurrence was high (13%), and almost one fifth of our cohort (18%) experienced an adverse event. Mortality was 2% in the overall cohort and 6% in the congenital heart disease group (pSVT. Significant variation in SVT treatment and suboptimal outcomes warrant future clinical trials to determine best practices in treating SVT in infants. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Follow-up of children or teenagers with paroxysmal supraventricular tachycardia, but without pre-excitation syndrome.

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    Brembilla-Perrot, Béatrice; Olivier, Arnaud; Villemin, Thibaut; Manenti, Vladimir; Vincent, Julie; Moulin-Zinsch, Anne; Lethor, Jean-Paul; Tisserant, Anne; Marçon, François; Jean Marc, Sellal

    2017-11-01

    Paroxysmal supraventricular tachycardia (SVT) is considered benign in children if the electrocardiogram in sinus rhythm is normal, but causes anxiety in parents, children and doctors. To report on the clinical and electrophysiological data from children with SVT, their follow-up and management. Overall, 188 children/teenagers (mean age 15±2.8 years) with a normal electrocardiogram in sinus rhythm were studied for SVT, and followed for 2.3±4 years. SVT was poorly tolerated in 30/188 children (16.0%). SVT was related to atrioventricular nodal reentrant tachycardia (AVNRT) (n=133) or atrioventricular reentrant tachycardia (AVRT) over a concealed accessory pathway (n=55; 29.3%). Ablation of the slow pathway (n=66) or the accessory pathway (n=43) was performed without general anaesthesia, 2±3 years after initial evaluation. Failure or refusal to continue occurred in 18/109 (16.5%) children: 7/66 with AVNRT (10.6%), 11/43 with AVRT (25.6%) (PSVT recurred in 20/91 children (22.0%) with apparently successful ablation: 6/91 (6.6%) had real SVT recurrence; 14/91 (15.4%) had only a sinus tachycardia, more frequent in AVNRT (11/59; 18.6%) than AVRT (3/32; 9.4%) (PSVT recurred in four; two presented AAD-related syncope. In 66 untreated children, one death was noted after excessive AAD infusion to stop SVT; the others remained asymptomatic or had well-tolerated SVT. At the time of ablation, SVT management remains difficult in children. Indications for ablation are more common in AVRT than in AVNRT, but failures are frequent; 22.0% remained symptomatic after successful ablation, but false recurrences were frequent (15.4%). Without ablation, one third had a spontaneous favourable evolution. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. Radiofrequency ablation in an infant with recurrent supraventricular tachycardia and cyanosis

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    Vora Amit

    2009-01-01

    Full Text Available We report an unusual presentation of supraventricular tachycardia, in an infant, with cyanosis. The child had atrial septal defect with hypoplastic right ventricle. Radiofrequency ablation was performed in view of drug resistant SVT

  16. Postnatal Outcomes of Fetal Supraventricular Tachycardia: a Multicenter Study.

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    Hinkle, Kevin A; Peyvandi, Shabnam; Stiver, Corey; Killen, Stacy A S; Weng, Hsin Yi; Etheridge, Susan P; Puchalski, Michael D

    2017-10-01

    Supraventricular tachycardia (SVT), the most common fetal tachycardia, can be difficult to manage in utero. We sought to better understand predictors of the postnatal clinical course in neonates who experienced fetal SVT. We hypothesized that fetuses with hydrops or those with refractory SVT (failure of first-line SVT therapy) are more likely to experience postnatal SVT. This was a retrospective multicenter cohort study of subjects diagnosed with fetal SVT between 2006 and 2014. Fetuses with structural heart disease were excluded. Descriptive comparative statistics and univariate analysis with logistic regression were utilized to determine factors that most strongly predicted postnatal SVT and preterm delivery. The cohort consisted of 103 subjects. Refractory SVT was found in 37% (N = 38) of the cohort with this group more likely to be delivered prematurely (median = 36 vs. 37.5 weeks, p = 0.04). Refractory SVT did not increase the risk of postnatal SVT (p = 0.09). Postnatal SVT was seen in 61% (N = 63). Of those, 68% (N = 43) had postnatal SVT at ≤2 days of age. Postnatal SVT was associated with a later fetal SVT diagnosis (median = 30 vs. 27.5 weeks, p = 0.006). We found a strong correlation between postnatal SVT and later gestational age at fetal SVT diagnosis. Subjects with refractory SVT or hydrops did not have a higher risk of postnatal SVT. We propose strong consideration for term delivery in the absence of significant clinical compromise. Further studies to assess whether outcomes vary for preterm delivery versus expectant management in those with refractory SVT should be performed.

  17. Flecainide as first-line treatment for fetal supraventricular tachycardia.

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    Ekiz, Ali; Kaya, Basak; Bornaun, Helen; Acar, Deniz Kanber; Avci, Muhittin Eftal; Bestel, Aysegul; Yildirim, Gokhan

    2018-02-01

    The aim of this study was to evaluate utilization, efficacy, and side effects of flecainide treatment as first-line agent in patients with fetal supraventricular tachycardia (SVT). This retrospective review was conducted on 23 consecutive fetal tachyarrhythmia cases that met inclusion criteria. If the treatment was necessary, then flecainide was used as first-line treatment in all cases. Among the study group, there were 21 (91.3%) cases of SVT and 2 (8.6%) cases of Atrial Flutter (AF). Sixteen fetuses had persistent SVT and five fetuses had intermittent SVT. We treated 17 fetuses with flecainide monotherapy and 15 of them converted to sinus rhythm and remaining two fetuses were refractory to monotherapy. The median time to conversion to sinus rhythm was 3.8 ± 1.6 days. Only one fetus (20%) among the intermittent SVT cases required anti-arrhythmic treatment. Our study has demonstrated that flecainide is an effective first-line treatment for fetal SVT with high success rate (88.2%), low side effect profile and relatively easy utilization. Based on the current study and recently published article results, flecainide can be recommended as the drug of first choice for treatment of fetal SVT cases.

  18. Low-energy radiofrequency catheter ablation as therapy for supraventricular tachycardia in a premature neonate

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    Kolditz, Denise P.; Blom, Nico A.; Bökenkamp, Regina; Schalij, Martin J.

    2005-01-01

    A premature neonate with hydrops was born at 32 weeks of gestation after successful direct fetal amiodarone therapy via cordocentesis for incessant supraventricular tachycardia. After birth the tachycardia could not be controlled despite high doses of amiodarone and flecainide and the patient

  19. Studies in a newborn infant with supraventricular tachycardia and Wolff-Parkinson-White syndrome.

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    Kaye, H H; Reid, D S; Tynan, M

    1975-01-01

    A neonatal patient with Wolff-Parkinson-White type A and supraventricular tachycardia is described. Demonstration of the mechanism of the tachycardia and its termination were achieved using intracardiac electrography and cardiac pacing. Quantitative left ventricular angiography and echocardiography showed impaired left ventricular function following the arrhythmia. Serial echocardiograms demonstrated the subsequent return to normal left ventricular performance. Images PMID:1138737

  20. [Systematic assessment of the paediatrician's performance during simulated supraventricular tachycardia].

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    Oulego Erroz, I; Rodríguez Núñez, A; Alonso Quintela, P; Mora Matilla, M; Iglesias Vázquez, A; Fernández Sanmartín, M; Civantos Fuentes, E; Sánchez Santos, L

    2012-09-01

    The aims of this study are to: a) assess the quality in clinical management during a simulated scenario of acute supraventricular tachycardia (SVT) by means of a structured task-based checklist and to b) detect pitfalls and grey areas where reinforcement in training may be needed. We systematically reviewed SVT simulated scenarios during simulation courses between June 2008 and April 2010. Three scenarios were programmed using SimBaby® simulation system, and included stable SVT (S-SVT), stable progressing to unstable SVT (SU-SVT) and unstable SVT (U-SVT). Scenarios were evaluated by means of an 18-task checklist based on ILCOR international recommendations. A total of 45 scenarios were assessed with the participation of 167 paediatricians, including 15 S-SVT, 25 SU-SVT and 5 U-SVT scenarios. Out of a total of 551 possible tasks, 328 (59.5%) were completed correctly. The mean percentage of correct tasks per scenario was 63.4 (16.7) for S-SVT, 47.8 (20.3) for SU-ST and 38.6 (31) for U-SVT (p=0.028). There were no significant differences between primary care paediatricians and hospital paediatricians. Most of the participants correctly identified non-sinus rhythm as SVT. However, important pitfalls were observed, including failure to identify haemodynamic instability in 20 out of 43 (48%) cases, an incorrect dose of adenosine in 18 out of 39 (48%), incorrect adenosine administration in 23 out of 39 (59%), and non-recognition of indication to emergent cardioversion in 15 out of 31 (48%). Paediatricians are able to diagnose SVT correctly, but need to improve their skills in treatment. Systematic analysis of clinical performance in a simulated scenario allows the identification of strengths, as well as weak points, where reinforcement is needed. Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  1. Changes in hemodynamic parameters and cerebral saturation during supraventricular tachycardia.

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    Hershenson, Jared A; Ro, Pamela S; Miao, Yongjie; Tobias, Joseph D; Olshove, Vincent; Naguib, Aymen N

    2012-02-01

    Induced supraventricular tachycardia (SVT) during electrophysiology studies (EPS) can be associated with hemodynamic changes. Traditionally, invasive arterial blood pressure has been used for continuous monitoring of these changes. This prospective study evaluated the efficacy of near-infrared spectroscopy (NIRS) monitoring during SVT. The use of NIRS has expanded with evidence of its accuracy and benefit in detecting cerebral hypoperfusion. This study aimed first to determine the hemodynamic changes associated with electrophysiology testing for SVT and second to determine whether the hemodynamic changes are associated with similar changes in the cerebral saturation as determined by NIRS. The study enrolled 30 patients 5-20 years of age with a history of SVT who underwent an EPS. The demographic data included age, gender, weight, height, and type of SVT. Hemodynamic data (invasive blood pressure and heart rate), NIRS, bispectral index (BIS), end-tidal carbon dioxide, and pulse oximetry were collected before and during three episodes of induced SVT. The linear correlation coefficient (r) was measured to calculate the relationship of the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) to the changes in NIRS values during the SVT episodes. Data from 22 patients were collected. The induction of SVT was associated mainly with a change in SBP and a less prominent change in DBP and MAP from baseline. The changes in hemodynamic status were associated with minimal changes in cerebral saturations, as evidenced by an average absolute change in NIRS of SVT during electrophysiology testing is associated with hemodynamic changes, mainly in SBP. In this study, these hemodynamic changes resulted in a minimal decrease in cerebral perfusion, as evidenced by minimal changes in the cerebral saturation measured by NIRS (0.7% from baseline). Although the changes in the cerebral saturation were minimal, these changes were

  2. Adenosine versus intravenous calcium channel antagonists for supraventricular tachycardia.

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    Alabed, Samer; Sabouni, Ammar; Providencia, Rui; Atallah, Edmond; Qintar, Mohammed; Chico, Timothy Ja

    2017-10-12

    People with supraventricular tachycardia (SVT) frequently are symptomatic and present to the emergency department for treatment. Although vagal manoeuvres may terminate SVT, they often fail, and subsequently adenosine or calcium channel antagonists (CCAs) are administered. Both are known to be effective, but both have a significant side effect profile. This is an update of a Cochrane review previously published in 2006. To review all randomised controlled trials (RCTs) that compare effects of adenosine versus CCAs in terminating SVT. We identified studies by searching CENTRAL, MEDLINE, Embase, and two trial registers in July 2017. We checked bibliographies of identified studies and applied no language restrictions. We planned to include all RCTs that compare adenosine versus a CCA for patients of any age presenting with SVT. We used standard methodological procedures as expected by Cochrane. Two review authors independently checked results of searches to identify relevant studies and resolved differences by discussion with a third review author. At least two review authors independently assessed each included study and extracted study data. We entered extracted data into Review Manager 5. Primary outcomes were rate of reversion to sinus rhythm and major adverse effects of adenosine and CCAs. Secondary outcomes were rate of recurrence, time to reversion, and minor adverse outcomes. We measured outcomes by calculating odds ratios (ORs) and assessed the quality of primary outcomes using the GRADE approach through the GRADEproGDT website. We identified two new studies for inclusion in the review update; the review now includes seven trials with 622 participants who presented to an emergency department with SVT. All included studies were RCTs, but only three described the randomisation process, and none had blinded participants, personnel, or outcome assessors to the intervention given. Moderate-quality evidence shows no differences in the number of people reverting to

  3. Efficacy of Antiarrhythmic Drugs in Adults With Congenital Heart Disease and Supraventricular Tachycardias

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    Koyak, Zeliha; Kroon, Bart; de Groot, Joris R.; Wagenaar, Lodewijk J.; van Dijk, Arie P.; Mulder, Bart A.; van Gelder, Isabelle C.; Post, Marco C.; Mulder, Barbara J. M.; Bouma, Berto J.

    2013-01-01

    Supraventricular tachycardias (SVTs) are a major cause of morbidity in adults with congenital heart disease (CHD). Few data exist on safety and efficacy of antiarrhythmic drugs in this population. Our aim was to determine the efficacy of antiarrhythmic drugs in adults with CHD and first-onset SVT on

  4. Efficacy of antiarrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias

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    Koyak, Z.; Kroon, B.; Groot, J.R. de; Wagenaar, L.J.; Dijk, A.P.J. van; Mulder, B.A.; Gelder, I.C.; Post, M.C.; Mulder, B.J.; Bouma, B.J.

    2013-01-01

    Supraventricular tachycardias (SVTs) are a major cause of morbidity in adults with congenital heart disease (CHD). Few data exist on safety and efficacy of antiarrhythmic drugs in this population. Our aim was to determine the efficacy of antiarrhythmic drugs in adults with CHD and first-onset SVT on

  5. Management of resistant supraventricular tachycardia in the immediate postpartum period: A case report

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    Gangadharaiah Narasimhaiah

    2013-01-01

    Full Text Available Supraventricular tachycardia (SVT during pregnancy or immediate postpartum is the commonest arrhythmia during pregnancy. Usually, the clinical symptoms are mild or go unrecognized. Rarely as in our case, can patient present with severe symptoms of agitation and restlessness which can mimic puerperal psychosis. A 12 lead electrocardiogram (ECG and an echocardiogram usually are sufficient to diagnose SVT. Amiodarone, even though is not the drug recommended to be used during pregnancy, in resistant types of SVT it is an useful drug.

  6. Cardiovascular collapse during amiodarone infusion in a hemodynamically compromised child with refractory supraventricular tachycardia

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    Sunil Saharan

    2015-01-01

    Full Text Available We describe a 7-week-old female infant who presented with refractory supraventricular tachycardia (SVT. During amiodarone infusion, she developed hypotension and cardiac arrest requiring extracorporeal membrane oxygenation (ECMO support. After successful control of SVT using procainamide infusion, she was weaned from ECMO and discharged home on oral flecainide. We conclude that infants with acidosis, ventricular dysfunction, and prolonged refractory SVT may poorly tolerate intravenous amiodarone.

  7. Recurrent supraventricular tachycardia in a newborn treated with amiodarone: is hyperkalemia the apparent cause?

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    Yildirim, S V; Tiker, F; Cengiz, N; Kiliçdağ, H

    2005-01-01

    Supraventricular tachycardia (SVT) is the most common type of arrhythmia observed in children, especially in newborns. Infants with severe SVT must be treated immediately with first-line drugs such as amiodarone. There are some minor and major side effects of amiodarone in this patient group, but no associated electrolyte disorders have been observed. This report describes a newborn whose recurrent SVT attacks during amiodarone treatment were suspected to have been caused by hyperkalemia.

  8. Reentrant Supraventricular Tachycardia in a Pediatric Trauma Patient Masquerading as a Cardiac Contusion

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    Bradbum, Christopher

    2005-01-01

    Full Text Available Establishing the etiology of tachycardia in a trauma patient is often difficult. Pediatric trauma patients present an even tougher challenge. Cardiac contusion should be suspected when other more common traumatic injuries that produce hypoxia and blood loss are excluded. The diagnosis of cardiac contusion is notoriously difficult to make largely due to the controversy over the definition of the disease, and the lack of a true gold standard confirmatory test. Atrioventricular nodal reentrant tachycardia (AVNRT is a common form of supraventricular tachycardia (SVT that can also present a diagnostic challenge to emergency physicians. While electrophysiologic studies are the gold standard for confirming the diagnosis, there are certain aspects of the history, electrocardiogram (ECG, and responses to cardiac maneuvers that strongly suggest the diagnosis. We present the case of a pediatric trauma patient that presented with new onset AVNRT masquerading as cardiac contusion.

  9. New insights into the clinical signs of supraventricular tachycardia: The "sign of lace-tying".

    Science.gov (United States)

    Blommaert, Dominique; Dormal, Fabien; Deceuninck, Olivier; Xhaet, Olivier; Ballant, Elisabeth; De Roy, Luc

    2018-01-01

    Supraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy. This prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the "sign of lace-tying" that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay. Our series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the "sign of lace-tying." Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT. Overall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the "sign of lace-tying" or body position change before SVT, implying a diagnosis of SVT. © 2017 Wiley Periodicals, Inc.

  10. Utility of 12-lead electrocardiogram for differentiating paroxysmal supraventricular tachycardias in dogs.

    Science.gov (United States)

    Santilli, R A; Perego, M; Crosara, S; Gardini, F; Bellino, C; Moretti, P; Spadacini, G

    2008-01-01

    The 12-lead surface ECG is validated for differentiating supraventricular tachycardias (SVT) in humans. Despite the description of SVT in veterinary medicine, no studies have analyzed the electrocardiographic features of this type of arrhythmias in dogs. To describe the specific electrocardiographic criteria used to differentiate the most common SVT in dogs. Twenty-three dogs examined at Clinica Veterinaria Malpensa for SVT with the mechanism documented by electrophysiologic studies (EPS). Twelve-lead electrocardiographic variables obtained from 14 dogs with orthodromic atrioventricular reciprocating tachycardia (OAVRT) and 9 dogs with focal atrial tachycardia (FAT) were compared. Dogs with FAT had faster heart rates (278 +/- 62 versus 229 +/- 42 bpm; P= .049) and less QRS alternans (33 versus 86%; P= .022). P waves appeared during tachycardia in 22 dogs, with a superior axis in 100% of OAVRT and 22% of FAT (P < .001). OAVRT was characterized by a shorter RP interval (85.0 +/- 16.8 versus 157.1 +/- 37.3 ms; P < .001) and smaller RP/PR ratio (0.60 +/- 0.18 versus 1.45 +/- 0.52; P < .001). Repolarization anomalies were present in 64% of OAVRT and no FAT (P < .001). Multivariate analysis identified QRS alternans and a positive P wave in aVR during tachycardia as independent predictors of arrhythmia type. Electrocardiographic criteria used in people for differentiating SVT can also be applied in dogs.

  11. Neonatal supraventricular tachycardia: outcomes over a 27-year period at a single institution.

    Science.gov (United States)

    Gilljam, Thomas; Jaeggi, Edgar; Gow, Robert M

    2008-08-01

    To establish prognosis in neonatal supraventricular tachycardia. All 109 patients arrhythmia. Freedom from arrhythmia, antiarrhythmic medication or late recurrence of arrhythmia was 52% at 1 year, 82% at 5 years and 83% at 10 years. At 10 years 31% of patients with ventricular preexcitation on electrocardiogram had symptoms or medication compared to 6% in those with concealed pathways (p arrhythmia control, 50% had arrhythmias at 10 years, compared to 10% of more easily treated cases (p = 0.001). Ventricular preexcitation and initial treatment difficulties, but not foetal presentation, were significant risk factors for prolonged arrhythmia, as confirmed by multivariate analysis. In the remainder, arrhythmia resolved in approximately 90%.

  12. Subcutaneous fat necrosis in a newborn following icebag application for treatment of supraventricular tachycardia.

    Science.gov (United States)

    Diamantis, S; Bastek, T; Groben, P; Morrell, D

    2006-08-01

    Cases of subcutaneous fat necrosis of the newborn (SCFN) and neonatal cold panniculitis have been reported most often secondary to perinatal distress or hypothermia. We present a case of a newborn infant who developed erythematous, indurated plaques on both cheeks and right shoulder following ice pack application for supraventricular tachycardia. The distinction between SCFN and cold panniculitis is important as SCFN may have complications such as hypercalcemia, whereas cold panniculitis is not associated with such sequelae. Clinicians should be aware of the diagnostic similarities and differences between these two conditions because of differences in potential serious sequelae.

  13. [Successful treatment of fetal supraventricular tachycardia with a combination of digoxin and amiodarone].

    Science.gov (United States)

    Hajdú, J; Szabó, I; Német, J

    1996-10-06

    The supraventricular tachycardia is a life threatening state in the intrauterine life. It can cause non-immune hydrops fetalis, intrauterine death or complications during the delivery. The unexplained tachycardia can cause fetal distress and premature delivery. Usually the digoxin is the first drug of choice for transplacental cardioversion. If digitalisation does not achieve cardioversion, the second line antiarrhythmic drugs should be instituted. Amiodarone has been suggested as a therapeutic alternative after failure of digoxin-verapamil combination. We give a drug in standard therapeutic doses for four-five days and after it we determine whether it is effective or not. We should determine the newer therapy or termination of pregnancy. The transplacental administration of amiodarone may be dangerous because of fetal cretinism. Our case is the first in Hungary-in our best knowledge- and we suggest the amiodarone for transplacental therapy.

  14. Neonatal thyrotoxicosis with severe supraventricular tachycardia: case report and review of the literature.

    Science.gov (United States)

    Abbasoğlu, Aslıhan; Ecevit, Ayşe; Tuğcu, Ali Ulaş; Erdoğan, Lkay; Kınık, Sibel Tulgar; Tarcan, Aylin

    2015-03-01

    Neonatal thyrotoxicosis is a rare condition caused by the transplacental passage of thyroid stimulating immunoglobulins from mothers with Graves' disease. We report a case of neonatal thyrotoxicosis with concurrent supraventricular tachycardia (SVT). The female infant, who was born by section due to breech delivery and meconium in the amniotic fluid at 36 weeks of gestation, presented with tachycardia on day 7. Her heart rate was between 260 and 300 beats/min, and an electrocardiogram revealed ongoing SVT. Sotalol was effective after two cardioversions in maintaining sinus rhythm. Thyroid function studies revealed hyperthyroidism in the infant, and her mother was found to have Graves' disease. Since symptoms and signs can vary, especially in preterm infants with neonatal hyperthyroidism, we want to emphasize the importance of prenatal care and follow-ups of Graves' disease associated pregnancies and management of newborns after birth.

  15. Coronary Vasospasm While Treating Supraventricular Tachycardia: Is Adenosine Really to Blame?

    Science.gov (United States)

    Quevedo, Henry C.; Pinto Miranda, Veronica; Sequeira, Rafael F.

    2013-01-01

    Coronary artery spasm has been reported during adenosine stress testing. Herein, we describe a transient ST-segment elevation following adenosine therapy for supraventricular tachycardia. A 38-year-old male presented to the emergency department with palpitations. Electrocardiogram showed supraventricular tachycardia with short RP interval. Vagal maneuvers were unsuccessful. Adenosine was then administered in two successive injections of 6 and 12 mg dosages, respectively. A subsequent 12-lead electrocardiogram revealed ST-segment elevation in inferior leads with reciprocal changes. Coronary angiography disclosed nonobstructive coronary disease. A postprocedure electrocardiogram exhibited normal sinus rhythm with nonspecific T wave abnormalities. Cardiac biomarkers were elevated with a peak troponin I of 0.32. Echocardiogram depicted bicuspid aortic valve and normal systolic function. Electrophysiological study revealed a concealed left accessory pathway and successful radiofrequency ablation was performed. Given the dynamic changes in the electrocardiogram, we hypothesize that this event was most likely a coronary vasospasm. The mechanism of coronary spasm following adenosine injection remains uncertain. Potential mediators include KATP channels and adenosine-2 receptors. PMID:24826297

  16. Atrioventricular Nodal Re-entry Tachycardia in Identical Twins: A Case Report and Literature Review

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    Walid Barake, MD MBBCh

    2013-01-01

    Full Text Available This report details the case of 17 year old identical twins who both presented with paroxysmal supraventricular tachycardia (PSVT. Electrophysiological studies revealed atrioventricular nodal reentry tachycardia (AVNRT in both twins. Successful but technically challenging slow pathway ablation was performed in both twins. This is the first reported case of confirmed AVNRT in identical twins which adds strong evidence to heritability of the dual AV node physiology and AVNRT. A review of the current literature regarding PSVT in monozygotic twins is provided.

  17. Long-term outcome of ablative therapy of postoperative supraventricular tachycardias in patients with univentricular heart: a European multicenter study

    NARCIS (Netherlands)

    de Groot, Natasja M. S.; Lukac, Peter; Blom, Nico A.; van Kuijk, Jan Peter; Pedersen, Anders K.; Hansen, Peter S.; Delacretaz, Etienne; Schalij, Martin J.

    2009-01-01

    BACKGROUND: Catheter ablation has evolved as a possible curative treatment modality for supraventricular tachycardias (SVT) in patients with univentricular heart. However, the long-term outcome of ablation procedures is unknown. We evaluated the procedural and long-term outcome of ablative therapy

  18. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of inducible paroxysmal supraventricular tachycardia without pre-excitation syndromes: A cohort study of 1960 patients included over 25 years

    Science.gov (United States)

    Brembilla-Perrot, Béatrice; Sellal, Jean Marc; Olivier, Arnaud; Villemin, Thibaut; Beurrier, Daniel; Vincent, Julie; Manenti, Vladimir; de Chillou, Christian; Bozec, Erwan

    2018-01-01

    Aim To investigate the influence of increasing age on clinical presentation, treatment and long-term outcome in patients with inducible paroxysmal supraventricular tachycardia (SVT) without pre-excitation syndromes. Methods Clinical and electrophysiological study (EPS) data, as well as long-term clinical outcome (mean follow-up 2.4±4.0 years) were collected in patients referred for regular tachycardia with inducible SVT during EPS without pre-excitation. Results Among 1960 referred patients, 301 patients (15.4%) were aged ≥70 (70–97). In this subset, anticoagulants were prescribed in 49 patients following an erroneous diagnosis of atrial tachycardia and 14 were previously erroneously diagnosed with ventricular tachycardia because of wide QRS. Ablation was performed more frequently in patients ≥70 despite more frequent failure and complications. During follow-up, higher risks of AF, stroke, pacemaker implantation and death were observed in patients ≥70 whereas SVT recurrences were similar in both age groups. In multivariable analysis, age ≥70 was independently associated with higher risks of SVT-related adverse events prior to ablation (OR = 1.93, 1.41–2.62, pSVT without pre-excitation syndromes are elderly. These patients exhibit higher risks of erroneous tachycardia diagnosis prior to EPS as well as failure and/or complication of ablation, but similar risk of SVT recurrence. These results support performing transesophageal EPS in most patients and intracardiac EPS in selected patients. EPS may furthermore prove useful in elderly patients with regular tachycardia, mainly by avoiding treatment based on an erroneous diagnosis. PMID:29304037

  19. Neurocardiogenic Syncope and Supraventricular Tachycardia in Association with a Rare Congenital Aortic Valve Abnormality

    Directory of Open Access Journals (Sweden)

    Yashwant Agrawal

    2016-01-01

    Full Text Available We report a case of a 26-year-old woman who presented with multiple episodes of syncope over a five-months period of time. Transthoracic echocardiogram had shown a normal functioning quadricuspid aortic valve (QAV which was also confirmed on a transesophageal echocardiogram. Computed tomographic angiography of heart and coronary arteries showed the QAV with equal size of all aortic cusps and normal coronary arteries. Intermittent chest pain and palpitations warranted an exercise stress test. The stress test revealed normal aerobic exertion, with achievement of 101% of maximal peak heart rate. However, during peak stress, we noted a drop in her blood pressure significantly resulting in dizziness. No arrhythmias were noted during the stress test. With recurrent syncope episodes and palpitations, Holter monitoring was done, revealing supraventricular tachycardia (SVT. We discuss current available literature and coassociations with QAV. New association of QAV with SVT needs further analysis.

  20. Blocked Atrial Bi/Trigeminy In Utero Evolving in Supraventricular Tachycardia after Birth

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    V. Martucci

    2012-01-01

    Full Text Available Transient episodes of fetal bradycardia (heart rate less than 110 bpm are usually benign and typically result from increased vagal stimulation in the fetus. Causes of sustained fetal bradycardia include sinus bradycardia, blocked atrial bigeminy/trigeminy, high-degree atrioventricular block, and long QT syndrome. We present the case of a 34-year-old Caucasian patient referred to our department for “blocked atrial bigeminy with pseudobradycardia” detected elsewhere at 33 weeks of gestation. A fetal echocardiography showed during all the examination a blocked atrial trigeminy with a mean fetal heart rate of 100 bpm. After birth three subsequent ECGs until day 3 showed no evidence of atrial extrasystoles, confirming the well-known frequent regression of this kind of fetal benign arrhythmia, but on day 11 recurrence of supraventricular trigeminy and development of episodes of paroxystic supraventricular tachycardia were observed. On the basis of this observation, we recommend that fetuses with complex atrial ectopic beats should be closely monitored before and after birth for evidence of new arrhythmias.

  1. Clinical characteristics of the patients presented with supraventricular tachycardia in southeast Anatolian region of Turkey

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    Mesut Aydın

    2014-12-01

    Full Text Available Objective: In this study, we aimed to evaluate the characteristic of patients with supraventricular tachycardia for proper diagnosis and treatment in Southeast Anatolian region. Methods: The study was has a retrospective cross-sectional design. One hundred eighty-seven consecutive patients who underwent catheter ablation of SVT between June 2012 and April 2014 at the Dicle University Heart Hospital were included in the study. In those patients, in whom the arrhythmia substrate was identified, ablation therapy was carried out using radiofrequency (RF energy. Results: Among SVTs 119 (63.6% patients had atrioventricular nodal re-entry tachycardia (AVNRT, 20 (10.7% patients had concealed atrioventricular re-entry tachycardia (AVRT, 40 (21.4% patients had Wolf Parkinson White (WPW syndrome, and 8 (4.3% patients had atrial tachycardia. RF ablation was applied on 184 patients. Overall RF ablation success rate was 96.2%. Overall recurrence was 8 (4% of 187 patients during the follow-up period 12 ± 6 (1-23 months. The recurrence was 4 (3.4% of 119 patients in AVNRT, 2(5% of 40 patients in WPW syndrome and 2 (10% of 20 patients in concealed AVRT. There was no statistically significant difference between groups in terms of recurrence. Two patients having AVNRT ablation died due to acute coronary syndrome in clinical follow-up. Conclusion: The acute and long-term success rates of SVT ablation were in accordance with literature. The other characteristics of SVT were similar with the current data.

  2. Are patients admitted to emergency departments with regular supraventricular tachycardia (SVT) treated appropriately?

    Science.gov (United States)

    Sawhney, Vinit; Corden, Benjamin; Abdul-Mukith, Kibria; Harris, Tim; Schilling, Richard John

    2013-04-01

    Regular supraventricular tachycardia (SVT) is frequently encountered in clinical practice. Guidelines are available from the National Service Framework (NSF) for the treatment of patients attending emergency departments (ED) with SVT. These recommend a thyroid-function test (TFT) and arrhythmia electrocardiography (ECG), and referral to a heart-rhythm specialist on discharge. Hospital admission is rarely required. In our multicentre study, we examined the implementation of these guidelines among patients attending the ED with SVT. Only 34% of patients had specialist referrals, with an average wait of 50.3 days (the majority of delays resulted from referral requests from general practitioners). A history of previous SVT, the mode of tachycardia termination, patient age and/or comorbidities were similar for the 27 (23.5%) patients who were admitted overnight. Of these, 15 (13%) of the total 115 patients who attended ED with regular SVT were referred for Holter monitoring despite having ECGs demonstrating arrhythmia. Low referral rates, unnecessary investigations and admissions indicate a need for improvement for better patient care and to minimise healthcare costs. We have formulated a standard operating procedure, which will be available via the College of Emergency Medicine website.

  3. Supraventricular tachycardia during the first year of life: is subclinical inflammation the trigger?

    Science.gov (United States)

    Bassareo, Pier Paolo; Fanos, Vassilios; Pala, Mario; Antonucci, Luca; Neroni, Paola; Antonucci, Roberto; Mercuro, Guseppe

    2018-01-01

    Neutrophil/lymphocyte ratio (NLR) and red cell distribution width (RDW) may be associated with the onset of arrhythmias in adults, thus underlining a possible inflammatory etiology. Paroxysmal supraventricular tachycardia (SVT) is the most frequent pathological tachycardia in childhood. To verify NLR and RDW levels in a group of children (SVT with a structurally normal heart and without fever or inflammatory diseases; to compare NLR and RDW before and after SVT resolution, to verify whether the latter was related with the reduction in inflammatory state; to identify - in SVT subtypes caused by a reentry mechanism - an NLR and RDW cutoff point beyond which adenosine was ineffective in preventing SVT recurrence. Eighteen SVT patients were recruited (mean age 18.9 ± 3.2 days; 50% males) and compared with 18 healthy peers. NLR was higher in SVT group than in controls (p SVT recurrence. However, all patients featuring SVT recurrence following adenosine injection presented with a lymphocyte count >6000/mm 3 . Elevated NLR is associated with an increased risk of SVT during the first year of life, while its decline looks like to lead the SVT resolution. A subclinical inflammatory status, as assessed by lymphocytes count, influences SVT recurrence. These results provide further support for an inflammatory etiology of SVT in babies.

  4. Management of supraventricular tachycardia using the Valsalva manoeuvre: a historical review and summary of published evidence.

    Science.gov (United States)

    Smith, Gavin

    2012-12-01

    Use of the Valsalva manoeuvre (VM) as a first-line management tool for the reversion of supraventricular tachycardia (SVT) in both emergency medicine and prehospital emergency-care settings has presented challenges, requiring continuous examination and refinement to define both its appropriateness and effectiveness. This report details the evolution of knowledge related to SVT and the historical evolution and controversies associated with VM; it also highlights the ongoing development of an evidence-based model of practice for the management of SVT in the emergency medicine and prehospital emergency-care settings. A two-part review of the literature using electronic medical databases was conducted. Other relevant texts or articles unavailable within the electronic search were also identified. Part 1 of the search criteria identified the historical evolution of the pathophysiology of SVT, whereas part 2 identified the use of VM for the clinical management of SVT. Part 1 of the review identified a total of 38 articles with eight meeting the inclusion criteria, and part 2 of the review identified a total of 44 articles with 17 meeting the inclusion criteria. An evidence-based model of practice requires clarification. The differentiation of nodal re-entrant tachycardias may, with further research, lead to identification of the specificity of VM in reversion of SVT during the early stages of arrhythmia. There is a need for further prehospital and emergency department research to quantify an evidence-based approach to VM.

  5. [Supraventricular tachycardia in newborns and its association with gastroesophageal reflux disease].

    Science.gov (United States)

    Fuertes, Ángeles; Alshweki, Ayham; Pérez-Muñuzuri, Alejandro; Couce, María-Luz

    2017-10-01

    Supraventricular tachycardia (SVT) is the most common arrhythmia in the neonatal period, but its association with other triggering processes is not well established. The aim of the study was to analyse the possible relationship between neonatal SVT and gastroesophageal reflux disease (GERD), a condition which was recently linked to atrial arrhythmias. A retrospective longitudinal descriptive study was conducted over a period of 5years on newborns who were diagnosed with SVT in a level III neonatal unit, assessing morphological aspects, associated symptoms, and treatments received. Its association with GERD and the impact of this on SVT was studied. Eighteen patients (1.2 per 1000 newborns) were diagnosed with SVT. Fifty percent of them were combined with clinically significant GERD (P=.01), and all of them received drug treatment. The average time of control of SVT without GERD since diagnosis was 6 days (95% CI: 2.16-9.84, with a median of 3) and 7.6 days when both pathologies were present (95% CI: 4.14-10.9, with a median of 7) (P=.024). Patients with SVT in the neonatal period frequently have GERD, and this combination leads to more difficulty in controlling the tachycardia. The reflux could act as a trigger or perpetuator of arrhythmia, therefore it is important to find and treat GERD in infants with SVT. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Transesophageal electrophysiological evaluation of children with a history of supraventricular tachycardia in infancy.

    Science.gov (United States)

    Blaufox, Andrew D; Warsy, Irfan; D'Souza, Marise; Kanter, Ronald

    2011-12-01

    Supraventricular tachycardia (SVT) presenting in the neonatal period may resolve by 1 year of age. Predicting which patients require therapy beyond 1 year of age is desirable. Pediatric electrophysiology databases from two institutions were reviewed for patients with a history of infant SVT who underwent transesophageal electrophysiology study (TEEPS) after initial SVT and before 2 years of age. All patients were tested off medications and followed for clinical recurrence. Forty-two patients presented with SVT at median age of 4 days (0-300 days). Initial control was achieved with one drug in 31 patients and multiple drugs in 11 patients. Prior to TEEPS, nine patients had clinical recurrence in the first year of life after initial control had been previously achieved. For all patients, TEEPS was performed, without complications, at median 13 months (9-22 months) of age and at median of 13 months (6-22 months) following the initial SVT episode. SVT was inducible in 27/42: 8 atrio-ventricular nodal reentry tachycardia (AVNRT) and 19 atrio-ventricular reciprocating tachycardia (AVRT). Inducibility was not associated with age at presentation, age at TEEPS, ventricular dysfunction at presentation, presence of structural congenital heart disease, number of drugs required to initially control SVT, or SVT recurrence after initial control. Of 15 not inducible at TEEPS, none had known SVT recurrence off medications at median follow-up of 27 months (6-37 months). In conclusion, among patients having SVT in early infancy, (1) TEEPS results are not associated with clinical variables, (2) non-inducibility is a good indicator of lack of clinical recurrence at intermediate follow-up, and (3) AVNRT may be more prevalent in infancy than previously reported.

  7. Identifying an evidence-based model of therapy for the pre-hospital emergency management of supraventricular tachycardia

    OpenAIRE

    Smith, Gavin

    2017-01-01

    This thesis provides a comprehensive reporting of the work undertaken to identify evidence supporting pre-hospital management of supraventricular tachycardia (SVT), delivering an evidence base for paramedic treatment of these patients. The literature search identified absences in evidence supporting therapies used within existing clinical guidelines. The vagal manoeuvres, the simplest and least invasive therapy to employ in the stable patient, were insufficiently evidenced regarding technique...

  8. The value of adrenaline in the induction of supraventricular tachycardia in the electrophysiological laboratory.

    Science.gov (United States)

    Cismaru, Gabriel; Rosu, Radu; Muresan, Lucian; Puiu, Mihai; Andronache, Marius; Hengan, Erika; Ispas, Daniel; Gusetu, Gabriel; Pop, Dana; Mircea, Petru Adrian; Zdrenghea, Dumitru

    2014-11-01

    The most commonly used drug for the facilitation of supraventricular tachycardia (SVT) induction in the electrophysiological (EP) laboratory is isoprenaline. Despite isoprenaline's apparent indispensability, availability has been problematic in some European countries. Alternative sympatomimethic drugs such as adrenaline have therefore been tried. However, no studies have determined the sensitivity and specificity of adrenaline for the induction of SVT. The objective of this study was to determine the sensitivity and specificity of adrenaline for the induction of SVT. Between February 2010 and July 2013, 336 patients underwent an EP study for prior documented SVT. In 66 patients, adrenaline was infused because tachycardia was not induced under basal conditions. This group was compared with 30 control subjects with no history of SVT. Programmed atrial stimulation was carried out during baseline state and repeated after an infusion of adrenaline (dose ranging from 0.05 mcg/kgc to 0.3 mcg/kgc). The endpoint was the induction of SVT. Among 66 patients with a history of SVT but no induction under basal conditions, adrenaline facilitated induction in 54 patients (82%, P Adrenaline was generally well tolerated, except for two patients (3.0%), where it had to be discontinued due to headache and high blood pressure or lumbar pain. Adrenaline infusion has a high sensitivity (82%) and specificity (100%) for the induction of SVT in patients with prior documented SVT. Therefore, it could serve as an acceptable alternative to isoprenaline, when the latter is not available. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  9. Efficacy of Adenosine for Acute Treatment of Supraventricular Tachycardia in Infants and Children

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    Seyed Mohammad Dalili

    2008-10-01

    Full Text Available Background: This study was done to assess the efficacy and adverse effects of the different doses of adenosine in the pediatric age group with respect to multiple patient variables. Methods: Over a period of 1 year, 86 occasions of supraventricular tachycardia (SVT were treated with adenosine in 81 infants and children aged between 18 days and 12 years (median of 1.3 years, SD=3. Adenosine efficacy was evaluated in terms of the patients’ demographics, SVT rate, electrocardiogram characteristics, and route of drug administration.Results: The dose of 50μg/kg was effective only in 24% of the SVT cases, and the additional doses of 100μg/kg, 150μg/kg, and 200μg/kg were effective in another 29% of the cases. The drug efficacy was higher in the infants than that in the older children. There were no predictors other than age for the estimation of the efficacy of the drug. Conclusion: Our findings showed that the current recommended doses of adenosine are ineffective in the vast majority of children and infants with SVT. No patient-related factor other than age seems to affect the efficacy of the drug

  10. [Supraventricular tachycardia in utero. Apropos of a personal case, review of the literature].

    Science.gov (United States)

    Pelletier, P; Delarue, T; Souplet, J P; Foissey, A; Oudry, B; Lefrançois, C

    1983-01-01

    After describing a case of early hydrops fetalis in a fetus demonstrating supraventricular tachycardia (TSVF) the authors review the literature: First they note the increase in the number of cases of TSVF published in the last few years, thanks to better means of monitoring pregnancies and to the place taken by TSVF among the different other troubles of fetal heart rhythm than can occur. The second section enumerates and analyses the pathological associations and the complications that have been observed in cases of TSVF that have been indexed. All have a poor prognosis: as far as those cases where there are faults in the rhythm which are associated with or alternate with TSVF, congestive heart failure occurs in 50% of cases, and organic heart pathological conditions in 20% of cases. 19.1% die. The third section analyses the means available for diagnosis and prognosis and the value of these means. Diagnosis rests on screening by clinical observation (careful auscultation in every pregnancy, observation of the raised height of the uterine fundus and a lessening in active fetal movements) and by monitoring. Only the ECG can confirm the diagnosis. Congestive heart failure is diagnosed by using ultrasound. A cardiac malformation should be searched for thoroughly by ultrasound. Monitoring in labour has no use as a prognostic indicator. Only repeated measurements of pH can demonstrate fetal distress in labour. The last section is concerned with management: digitalisation is strongly to be recommended before the fetus is mature. Propranolol should be reserved for resistant and severe cases: when there is no congestive heart failure a wait and see policy under strict observation can be followed. If there is congestive heart failure, caesarean section must be carried out. After delivery resuscitation with vagal stimulation is often sufficient, but when it is not digitalisation can be used and very rarely electric cardioversion is needed. Relapses are frequent and treatment

  11. Prehospital management of supraventricular tachycardia in Victoria, Australia: epidemiology and effectiveness of therapies.

    Science.gov (United States)

    Smith, Gavin; McD Taylor, David; Morgans, Amee; Cameron, Peter

    2014-08-01

    The present study examined patient demographics, characteristics and the effectiveness of current prehospital supraventricular tachycardia (SVT) management by ambulance paramedics in Victoria, Australia. We conducted a retrospective study of all Victorian patients attended by paramedics between 14 February 2012 and 13 February 2013, where SVT was the initial or final diagnosis. Patients were excluded if SVT was not captured on ECG, incomplete data were recorded, or SVT began after initial assessment. Data were extracted from the VACIS(®) clinical data warehouse. Accuracy of paramedic SVT diagnosis was examined. Nine hundred and thirty-three patients were enrolled, including 882 (94.5%) adults and 564 (60.5%) women. Mean adult and paediatric (SVT in 119/123 (96.7%, 95% CI: 91.5, 99.0) of adult ECG strips examined. There were 273/882 (31.0%) patients who spontaneously reverted while in paramedic care. Valsalva manoeuvre was undertaken by 212/882 (24.0%) patients and reverted the SVT in 99/358 (27.7%) attempts. Verapamil was administered to 38/882 (4.3%) patients and reverted 33 (86.8%). Aramine was administered to 43/882 (4.9%) patients and 35 reverted following administration (81.4%). Synchronised cardioversion (70 J) reverted four patients at first attempt. Ultimately, 438 (49.7%) patients remained in SVT on arrival at hospital. Patient characteristics associated with SVT are more likely to be middle-aged women with a history of hypertension and hypercholesterolaemia. Therapies were underutilised leading to reduced clinical guideline effectiveness. Where therapies were instigated, reversion rates are greater than previously reported. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Health care utilization among adenosine-sensitive supraventricular tachycardia patients presenting to the emergency department.

    Science.gov (United States)

    Dewland, Thomas A; Oesterle, Adam; Stein, John; Marcus, Gregory M

    2017-08-01

    Although adenosine-sensitive supraventricular tachycardia (SVT) is generally curable, it remains an important cause of healthcare utilization. We sought to determine predictors of health care utilization among SVT patients presenting to the emergency department (ED). We studied consecutive patients evaluated in an urban, academic ED for adenosine-sensitive SVT. The primary study outcomes were (1) ambulance transportation to the index ED visit, (2) hospital admission from the index ED encounter, and (3) recurrent SVT-associated ED encounters. Among 100 patients with adenosine-sensitive SVT, 35 were transported to the ED by ambulance. Prior electrophysiologist evaluation was associated with a significant 87% reduced odds of ambulance utilization (OR 0.13, 95% CI 0.03-0.67, p = 0.015). A total of 62 patients were subsequently admitted to the hospital. All patients with coronary artery disease, diabetes, syncope, and wide complex SVT were admitted. Similarly, individuals with an elevated troponin had a significantly greater odds of hospital admission (OR 16.8, 95% CI 1.9-148.4, p = 0.011). After the index ED visit, 60 patients were seen by an electrophysiologist, and 47 underwent catheter ablation. Individuals treated with catheter ablation had a significant 75% reduction in the risk of a recurrent ED visit for SVT (HR 0.25, 95% CI 0.10-0.62, p = 0.003). Readily modifiable clinical factors, including a previous visit to an electrophysiologist and treatment with catheter ablation, are associated with reduced health care utilization among patients presenting to the ED with SVT.

  13. Usefulness of laboratory and radiological investigations in the management of supraventricular tachycardia.

    Science.gov (United States)

    Ashok, Aadith; Cabalag, Miguel; Taylor, David McD

    2017-08-01

    Although ED patients presenting with supraventricular tachycardia (SVT) are commonly investigated, the value of these investigations has been questioned. We aimed to determine the frequency and utility of investigations in patients with SVT. We undertook an explicit retrospective medical record audit of patients with SVT who presented to a single ED (January 2004 to June 2014). Data on demographics, presenting complaints, investigations and outcomes were extracted. The outcomes were nature and utility of investigations. A total of 633 patients were enrolled (mean [SD] age 55.4 [17.7] years, 62% female). Laboratory investigations were common: electrolytes (83.7% of patients), full blood count (81.2%), magnesium (57.5%), calcium (39.3%) and thyroid function (30.3%). These investigations revealed many mildly abnormal results but resulted in electrolyte supplementation in only 19 patients: eight with mild hypokalaemia (potassium 3.0-3.5 mmol/L) and 11 with mild hypomagnesia (magnesium 0.49-1.1 mmol/L). Troponin was ordered for 302 (47.7%) patients, many of whom had no history or risk factors for cardiac disease, or ischaemic symptoms associated with their SVT. The troponin was normal, mildly and moderately elevated in 65.2, 24.5 and 10.2% of cases, respectively. Only seven (1.1%) patients were diagnosed with acute myocardial ischemia. Although 190 (30.0%) patients had a chest X-ray (CXR), it was normal in 78.4% of cases. All CXR abnormalities were incidental and not relevant to the immediate ED management. Patients with uncomplicated SVT are over-investigated. Guidelines for ED SVT investigation are recommended. Further research is recommended to determine the indications for each investigation in the setting of SVT. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  14. Supraventricular tachycardia during pediatric anesthesia: a case series and qualitative analysis.

    Science.gov (United States)

    Cripe, Chad C; Patel, Akash R; Markowitz, Scott D; Behringer, Tiffany S; Litman, Ronald S

    2014-06-01

    To perform a qualitative analysis of noncardiac patients who developed suspected intraoperative supraventricular tachycardia (SVT) during general anesthesia. Retrospective database analysis and chart review. Operating room of a university-affiliated children's hospital. The records of children without cardiac disease who received general anesthesia at The Children's Hospital of Philadelphia from July 1998 through June 2011 were reviewed. Patients with heart rate values above 180 beats per minute were identified, as were specific medications or key words in the free-text fields of the anesthesia records that would be indicative of a tachyarrhythmia. Each case was reviewed by at least two authors; each patient was assigned a diagnosis classification of "highly suspicious" or "unlikely" SVT. The highly suspicious SVT cases were examined in detail to determine the specific aims. 36 subjects out of a total of 285,353 anesthetics administered during the study period were suspected by the anesthesia care team to have had an episode of intraoperative SVT: 22 were "highly suspicious" events, and 14 were "unlikely" events. The highly suspicious SVT events occurred in all phases of anesthesia, and none led to any hemodynamic instability. Effective treatments included vagal maneuvers, pharmacologic antiarrhythmics, or no treatment if the event resolved spontaneously before treatment. Six patients had outpatient follow-up and three received antiarrhythmic medications to control ongoing SVT. SVT during the intraoperative period in noncardiac pediatric patients was uncommon. When it occurred, it was not associated with clinically significant patient morbidity. For some patients, the anesthesia unmasked a predisposition for re-entrant SVT and those patients remained on maintenance antiarrhythmic therapy following discharge home. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. The retrograde P-wave theory: explaining ST segment depression in supraventricular tachycardia by retrograde AV node conduction.

    Science.gov (United States)

    Rivera, Santiago; De La Paz Ricapito, Maria; Conde, Diego; Verdu, Mariano Badra; Roux, Jean François; Paredes, Félix Ayala

    2014-09-01

    Pseudo ischemic ST segment changes during supraventricular tachycardia (SVT) are not yet fully understood. Our aim was to determine whether venticulo-atrial (VA) conduction during SVT may be a possible mechanism for ST depression (STd) in SVT. Patients undergoing SVT ablation (2010-2012) were analyzed (n = 72).Typical atrioventricular node reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) were included. Those with STd were compared to those without STd. VA interval length, tachycardia cycle length (TCL), and retrograde P-wave activation during SVT were assessed. Retrograde P waves arriving simultaneously with the ST segment (PWST) during SVT were considered, whenever an atrial electrogram (measured from the high right atrium) was "on time" with the ST segment. Patients with STd during SVT presented longer VA intervals than those without STd (VA 100 ± 37 ms vs VA 69 ± 22 ms; P = 0.006). No differences in TCL were observed (TCL 333 ± 35 ms vs TCL 360 ± 22 ms; P = 0.1). PWST was observed in 38.5% of patients with AVNRT and STd versus 0% in those without STd. The TCL was similar in both groups (355 ± 25 ms vs 334 ± 18 ms; P = 0.1). In patients with AVRT and STd, PWST was present in 81% of cases versus 0% in those without STd. The TCL was also similar (330 ± 29 ms vs 346 ± 17 ms; P = 0.1). STd during SVT is observed at long VA intervals when the retrograde P wave matches the ST segment, without dependence on the TCL. This suggests that STd is not necessarily rate dependent but a result of a fusion between the ST segment and the P wave. ©2014 Wiley Periodicals, Inc.

  16. [An analysis of clinical characteristics and acute treatment of supraventricular tachycardia in children from a multicenter study].

    Science.gov (United States)

    Li, X M; Ge, H Y; Liu, X Q; Shi, L; Guo, B J; Li, M T; Jiang, H; Zhang, Y; Liu, H J; Zheng, X C; Li, A J; Zhang, Y Y

    2018-01-02

    Objective: The study assessed the clinical characteristics and response to acute intravenous antiarrhythmic drug therapy of supraventricular tachycardia (SVT) in children. Methods: This was a multicenter prospective descriptive study including 257 children from First Hospital of Tsinghua University, Peking University First Hospital, Children's Hospital Affiliated to Capital Institute of Pediatrics and Beijing Anzhen Hospital who received intravenous antiarrhythmic drug therapy for SVT from July 2014 to February 2017. The clinical and tachycardia features, response to intravenous antiarrhythmic drug therapy of these children were characterized. Statistical analyses were performed using t test, Mann-Whitney U test, χ(2) test and H test. Results: The onset of SVT occurred at any age with a distribution with positive skewness, 57.6% ( n =148) childrenSVT types were 49.4% ( n =127) for atrioventricular reentry tachycardia (AVRT), 4.3% ( n =11) for atrioventricular nodal reentry tachycardia (AVNRT), 26.8% ( n =69) for unclassified paroxysmal SVT and 19.5% ( n =50) for atrial tachycardia (AT), respectively. Tachycardia-induced cardionyopathy (TIC) secondary to SVT developed in 30 of 225 (13.3%). Left ventricular ejection fraction (LVEF) of the 27 children attacked by TIC returned to normal after successful control of SVT (41.1%±6.3% vs. 60.3%±9.2%, t =-10.397, P =0.000). Complete termination of SVT by antiarrhythmic drugs was achieved in 164 of 257 (63.8%), partial termination rate was 18.7% (48 of 257) and failure to terminate rate was 17.5% (45 of 257). Propafenone (complete cardioversion in 98 (73.1%) of 134) and amiodarone (complete cardioversion in 23 (76.7%) of 30) showed better efficacy for SVT termination than adenosine (complete cardioversion in 26 (44.1%) 59) (χ(2)=20.524, P =0.000). Paroxysmal SVT had a higher termination rate on pharmacological therapy than AT (67.1% vs. 50.0%, χ(2)=6.337, P =0.042). Patients of different age groups had significantly

  17. Cardioversion of a supraventricular tachycardia (SVT) in a 7-year-old using a postural modification of the Valsalva manoeuvre.

    Science.gov (United States)

    Morley-Smith, Edward John; Gagg, James; Appelboam, Andrew

    2017-05-04

    A boy aged 7 years presented with his parents to the emergency department (ED). He had a known diagnosis of paroxysmal supraventricular tachycardia (SVT) and was under the care of paediatricians. He had been suffering episodes of palpitations and chest pain for over a year and had been prescribed atenolol 25 mg ON, though the side effects meant he had not taken it for a month prior to presentation. He had 2 previous confirmed episodes of SVT, one that reverted with Valsalva manoeuvres, and the other with intravenous adenosine. In the ED, an ECG was recorded showing SVT at 180 bpm. Aside from his tachycardia, he was haemodynamically stable. The postural modification of the Valsalva technique was performed within 5 min of arrival, with reversion to sinus rhythm occurring during the leg-lift phase on the first attempt. After 30 min of observation, the child remained stable and was discharged home. 2017 BMJ Publishing Group Ltd.

  18. Accessory atrioventricular myocardial connections in the developing human heart: relevance for perinatal supraventricular tachycardias

    NARCIS (Netherlands)

    Hahurij, Nathan D.; Gittenberger-de Groot, Adriana C.; Kolditz, Denise P.; Bökenkamp, Regina; Schalij, Martin J.; Poelmann, Robert E.; Blom, Nico A.

    2008-01-01

    BACKGROUND: Fetal and neonatal atrioventricular (AV) reentrant tachycardias can be life-threatening but resolve in most cases during the first year of life. The transient presence of accessory AV myocardial connections during annulus fibrosus development may explain this phenomenon. METHODS AND

  19. Propanolol: una alternativa cercana para el tratamiento de la taquicardia supraventricular del feto Propanolol: a close alternative for the treatment of fetal supraventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Juan F Jaramillo

    -arrhythmogenic phenomenon and the secondary effects involve also the pregnant women. Hypotension and arrhythmias such as auricular flutter demand a compromised vigilance. It is important to consider a safer drug that may be useful in the simpler and more common forms of fetal tachyarrhythmias. Objetivo: to show by means of a clinical case and by revision of relevant articles, that propanolol can be part of the group of drugs for the treatment of fetal supraventricular tachycardia. A series of alternatives have been imposed with adequate results; nevertheless, these are exigent in its knowledge and control and definitely not exempt of risks. Our objective is to show that propanolol is still an alternative for specific cases of tachyarrhythmias in fetuses, isolated or combined with other drugs.

  20. Factors associated with the occurrence and treatment of supraventricular tachycardia in a pediatric congenital heart disease cohort.

    Science.gov (United States)

    Tripathi, Avnish; Black, George B; Park, Yong-Moon Mark; Jerrell, Jeanette M

    2014-02-01

    In patients with congenital heart disease (CHD), the association between supraventricular tachycardia (SVT), type of pathophysiology, and therapeutic interventions in a population-based cohort warrants further examination. A retrospective, longitudinal 15-year data set (1996-2010) was analyzed. Inclusion criteria included age ≤17 years, enrolled in South Carolina State Medicaid, and diagnosed as having one or more CHDs as well as SVT. SVT was diagnosed in 6.5 % of CHD patients (N = 1,169) during the 15-year epoch investigated. SVT was less likely to occur in African-American (hazard ratio [HR] = 0.76) or male patients (HR = 0.88), but it was significantly more likely to occur in patients age ≤12 months or in adolescents ≥13 years in those undergoing multiple surgeries/medical interventions for their CHD (HR = 1.14), those receiving antiarrhythmic/diuretic/preload-/afterload-reducing medications (HR = 5.46), and those with severe/cyanotic CHDs (HR = 1.52) or chromosomal abnormalities (HR = 1.64). Children who had an atrial septal defect secundum (adjusted odds ratio [aOR] = 3.03) and those treated with diuretic or antiarrhythmic medication (aOR = 1.80) were significantly more likely to undergo SVT ablation, whereas those with late-onset pulmonary hypertension (ages 6-12 years old) were significantly less likely to undergo SVT ablation. SVT recurred in only 14 of 166 patients who underwent SVT ablation. Multiple medical interventions at an early age may increase the risk of SVT occurrence in young CHD patients regardless of the severity/complexity of the CHD.

  1. Tachycardia

    Science.gov (United States)

    ... rate to rise during exercise or as a physiological response to stress, trauma or illness (sinus tachycardia). ... increase the risk of tachycardia include: Older age. Aging-related wear on the heart makes you more ...

  2. Intrauterine supraventricular tachyarrhythmias and transplacental digitalisation.

    OpenAIRE

    Nagashima, M; Asai, T; Suzuki, C; Matsushima, M; Ogawa, A

    1986-01-01

    Six newborn infants with intrauterine supraventricular tachyarrhythmias (five cases of atrial flutter and one of supraventricular tachycardia) are described. Transplacental digitalisation was attempted in three cases. Supraventricular tachycardia associated with hydrops fetalis, detected in a fetus at a gestation of 31 weeks, was successfully converted to normal sinus rhythm eight days after the mother began treatment with digoxin. The serum concentration of digoxin in cord blood almost equal...

  3. Intrauterine supraventricular tachyarrhythmias and transplacental digitalisation.

    Science.gov (United States)

    Nagashima, M; Asai, T; Suzuki, C; Matsushima, M; Ogawa, A

    1986-10-01

    Six newborn infants with intrauterine supraventricular tachyarrhythmias (five cases of atrial flutter and one of supraventricular tachycardia) are described. Transplacental digitalisation was attempted in three cases. Supraventricular tachycardia associated with hydrops fetalis, detected in a fetus at a gestation of 31 weeks, was successfully converted to normal sinus rhythm eight days after the mother began treatment with digoxin. The serum concentration of digoxin in cord blood almost equalled the maternal concentration in three cases. In the remaining three cases treatment with digitalis was effective in converting tachyarrhythmias to sinus rhythm after delivery. With maintenance digoxin therapy, the prognosis of fetal tachyarrhythmias seems to be good, once conversion to sinus rhythm has been accomplished.

  4. Irregularity and lack of p-waves in short tachycardia episodes predict atrial fibrillation and ischemic stroke.

    Science.gov (United States)

    Johnson, Linda S B; Persson, Anders P; Wollmer, Per; Juul-Möller, Steen; Juhlin, Tord; Engström, Gunnar

    2018-02-12

    Atrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p-waves, with a duration >30s. It is not known whether AF characteristics in shorter SVT episodes predict AF and stroke. To determine if irregularity and lack of p-waves, alone or in combination, at short SVT episodes increased the risk of incident AF and ischemic stroke. The population-based Malmö Diet and Cancer study includes 24hECG screening of 377 AF-free individuals (mean age 64.5 years, 43% men) who were prospectively followed for >13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats were identified and the longest SVT episode was assessed for irregularity and lack of p-waves. The association between SVT classification and AF and stroke was assessed using multivariable adjusted Cox regression. Incidence of AF increased with increasing abnormality of the SVTs. The risk-factor adjusted hazards ratio (HR) for AF was 4.95 (95%CI 2.06-11.9, pSVT episodes without p-waves (HR 14.2 (95%CI 3.76-57.6, pSVT episodes at detected at 24hECG screening are associated with incident AF and ischemic stroke. Short irregular SVTs without p-waves likely represent early stages of AF or atrial myopathy. 24hECG could identify subjects suitable for primary prevention efforts. Copyright © 2018. Published by Elsevier Inc.

  5. Supraventricular microreentry in a newborn due to a giant atrial septum aneurysm

    OpenAIRE

    Wagner, Franziska; Gebauer, Roman; Wagner, Robert; Paech, Christian

    2017-01-01

    Key Clinical Message Supraventricular arrhythmias in neonates are rare and mostly not related to structural heart defects. We present the first case of a newborn with a supraventricular microreentrant tachycardia possibly associated with an atrial septum aneurysm and emphasize the importance of a thorough diagnostic workup allowing a fast and adequate therapy.

  6. Atrial tachycardia mimicking atrioventricular nodal reentry tachycardia.

    Science.gov (United States)

    Eilbert, Wesley P; Patel, Neal

    2013-07-01

    The term supraventricular tachycardia (SVT) is used to describe tachydysrhythmias that require atrial or atrioventricular nodal tissue for their initiation and maintenance. SVT can be used to describe atrioventricular nodal reentry tachycardia, atrioventricular reentry tachycardia, and atrial tachycardia (AT). AT is the least common of these SVT subtypes, accounting for only 10% of cases. Although the suggested initial management of each SVT subtype is different, they all can present with similar symptoms and electrocardiographic findings. Discuss the pathophysiology, diagnosis, and treatment of AT as compared with other types of SVT. We report a 56-year-old woman with symptoms and electrocardiographic findings consistent with SVT. Although standard treatment with intravenous adenosine failed to convert the SVT, it revealed AT as the cause of the tachydysrhythmia. The AT was successfully terminated with beta-blockade and the patient eventually underwent successful radioablation of three separate AT foci. AT frequently mimics other more common forms of SVT. AT might be recognized only when standard treatment of SVT has failed. Identification of AT in this setting is crucial to allow for more definitive therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Taquiarritmias supraventriculares fetales refractarias al tratamiento inicial Fetal supraventricular tachyarrhythmias refractory to initial therapy

    Directory of Open Access Journals (Sweden)

    Eduardo Malvino

    2005-04-01

    Full Text Available Las arritmias fetales representan un motivo infrecuente de ingreso a la unidad de cuidados intensivos. Se presenta tres casos de gestantes entre 27 y 32 semanas, con el diagnóstico de taquiarri-tmias supraventriculares fetales sostenidas, que exhibían fracaso en el intento inicial de reversión con digoxina. Dos casos con taquicardia supraventricular respondieron favorablemente cuando se asoció flecainida. Un feto hidrópico con aleteo auricular y bloqueo 2:1 no revirtió con la asociación de flecainida ni amiodarona a la digoxina y requirió la interrupción de la gestación en la 30ª semana. El neonato presentó disfunción tiroidea transitoria atribuida a la administración de amiodarona.Fetal arrhythmia is an unusual cause of admission in critical care unit. We report three cases of pregnant patients with gestational age of 27 to 32 weeks, with diagnosis of fetal sustained supraventricular tachyarrhymias; which were resistant to digoxin as first line therapy. Two fetuses had supraventricular tachycardia and were converted with flecainide in association with digoxin. A remaining hydropic fetus suffering atrial flutter with 2:1 auriculo-ventricular conduction, failed to restore sinus rhythm with digoxin alone or in association with flecainide nor amiodarone, and required premature c-section at 30ª week of gestation. Due to amiodarone administration the neonate suffered transient neonatal hypothyroidism.

  8. Management of paroxysmal ectopic atrial tachycardia with long sinus pauses in a teenager

    OpenAIRE

    Seshadri Balaji

    2015-01-01

    Sinus pauses in the setting of supraventricular tachycardia is rare in children. We describe an asymptomatic teen with irregular heart rate detected during an incidental exam who was found to have short runs of a slow ectopic atrial tachycardia on electrocardiogram and prolonged sinus pauses on routine ambulatory ECG. Successful catheter ablation of the ectopic atrial tachycardia led to resolution of the sinus pauses.

  9. Transjugular approach for radiofrequency ablation of permanent junctional reciprocal tachycardia in a newborn with bilateral femoral vein thrombosis.

    Science.gov (United States)

    Gülgün, Mustafa; Karagöz, Tevfik; Aykan, Hakan Hayrettin; Ertuğrul, İlker

    2015-03-01

    Although radiofrequency ablation is the first line therapy in some children with supraventricular tachycardia, its application in small children is still limited. Herein, we presented a premature newborn diagnosed as multidrug-resistant permanent junctional reciprocal tachycardia, and treated by radiofrequency ablation via the jugular vein approach because of bilateral femoral vein thrombosis. We think that when there is limited vascular access, the transjugular route for radiofrequency ablation might be considered as an alternative treatment in newborns with multidrug-resistant supraventricular tachycardia.

  10. Nonsustained Repetitive Upper Septal Idiopathic Fascicular Left Ventricular Tachycardia: Rare Type of VT

    Directory of Open Access Journals (Sweden)

    Gokhan Aksan

    2016-05-01

    Full Text Available Upper septal fascicular ventricular tachycardia is a very rare form of idiopathic fascicular ventricular tachycardia. Upper septal fascicular tachycardia uses the posterior fascicle as the anterograde limb and the septal fascicle as the retrograde limb. When evaluating the electrocardiography for this form of tachycardia, the presence of narrow QRS morphology and normal axis may be misinterpreted as supraventricular tachycardia. Here, we report a very rare subtype of fascicular tachycardia that originates more proximally in the His-Purkinje system at the base of the heart.

  11. Epicardial Ablation of Focal Atrial Tachycardia Arising From Left Atrial Appendage in Children

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    Abdhija Hanumandla

    2014-07-01

    Full Text Available Focal left atrial tachycardia (FLAT although a common cause of supraventricular tachycardia(SVT among children, the one's arising from left atrial appendage (LAA present a unique challenge for successful ablation because of anatomical location. We present two children with FLAT arising from the epicardial LAA, successfully mapped and ablated through percutaneuous epicardial approach.

  12. [Perinatal Presentation and Complicated Course of a Multifocal Atrial Tachycardia].

    Science.gov (United States)

    Braun, M; Siauw, C; Schirrmeister, J; Wirbelauer, J

    2016-12-01

    We report a male newborn who became symptomatic with supraventricular tachycardia on the first day of life. Neither adenosine nor electric cardioversion could terminate the tachycardia, therefore intravenous esmolol (β-receptor blocker) was initiated. Inspite of subsequent administration of various antiarrhythmic medications in increasingly higher doses, repeated supraventricular tachycardic episodes occurred. The electrocardiogram showed typical findings of a multifocal atrial tachycardia as the underlying cause. When tachycardic episodes occurred, they also presented as atrial flutter at 460 bpm and a 2:1 block. Finally, high dosage of amiodarone (10 mg/kgbw/d) led to continuous control of the heart rate without tachycardic episodes. To date our patient is mostly in sinus rhythm but without tachycardic episodes and doing well. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study

    NARCIS (Netherlands)

    Jaeggi, Edgar T.; Carvalho, Julene S.; de Groot, Ernestine; Api, Olus; Clur, Sally-Ann B.; Rammeloo, Lukas; McCrindle, Brian W.; Ryan, Greg; Manlhiot, Cedric; Blom, Nico A.

    2011-01-01

    Fetal tachyarrhythmia may result in low cardiac output and death. Consequently, antiarrhythmic treatment is offered in most affected pregnancies. We compared 3 drugs commonly used to control supraventricular tachycardia (SVT) and atrial flutter (AF). We reviewed 159 consecutive referrals with fetal

  14. Taquicardias supraventriculares. Estado del arte

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    Jairo Alfonso Gándara Ricardo

    2016-01-01

    El tratamiento de las taquicardias supraventriculares dependerá del estado hemodinámico del paciente, el cual definirá el requerimiento de terapia eléctrica o tratamiento médico. Se debe hacer una selección adecuada de los pacientes que requieren estudio electrofisiológico y ablación.

  15. A case of tacrolimus-induced supraventricular arrhythmia after kidney transplantation

    Directory of Open Access Journals (Sweden)

    Bo-Ra Kim

    Full Text Available CONTEXT Tacrolimus is a potent immunosuppressive drug often administered to transplant recipient patients and exhibits a variety of adverse cardiovascular effects. CASE REPORT We report a case of a 53-year-old Asian female who developed various arrhythmic phenomena including atrial premature complexes and supraventricular tachycardia after administration of tacrolimus. CONCLUSION Tacrolimus-associated arrhythmia after kidney transplantation may be life-threatening, and so patients undergoing this procedure should be carefully monitored.

  16. Familial occurrence of atrioventricular nodal reentrant tachycardia in a mother and her son.

    Science.gov (United States)

    Namgung, June; Kwak, Jae-Jin; Choe, Hyunmin; Kwon, Sung Uk; Doh, Joon Hyung; Lee, Sung Yun; Lee, Won Ro

    2012-10-01

    Atrioventricular nodal reentrant tachycardia (AVNRT), caused by a reentry circuit involving fast and slow atrioventricular nodal pathways, is one of the most common types of paroxysmal supraventricular tachycardias. While familial Wolff-Parkinson-White syndrome has been well recognized, familial AVNRT has been rarely reported. We report a familial occurrence of AVNRT in a mother and her son, who were symptomatic and successfully treated with radiofrequency catheter ablation of slow pathway.

  17. AV nodal reentrant tachycardia with a 2:1 right bundle branch block missed as bidirectional ventricular tachycardia in the first superficial evaluation

    Directory of Open Access Journals (Sweden)

    Akbarzadeh Mohammad Ali

    2017-06-01

    Full Text Available A 95-year old woman was admitted to our emergency unit because of acute abdominal pain. After urgent surgery according to the acute abdomen, she was referred to intensive care unit (ICU of the emergency unit as she was intubated. It was developed a run of new arrhythmia which was diagnosed by cardiology resident as bidirectional ventricular tachycardia due to beat to beat changing the axis of the QRS. However, a second and more precise evaluation of the abnormal ECG suggested a narrow supraventricular tachycardia, most probably AV nodal reentrant tachycardia with a 2:1 right bundle branch block.

  18. Chitinase-3-like protein-1 (YKL-40) before and after therapy in supraventricular arrhythmias.

    Science.gov (United States)

    Michelakakis, Nikolaos; Neroutsos, Georgios J; Perpinia, Anastasia S; Farmakis, Dimitrios; Voukouti, Eugenia G; Karavidas, Apostolos J; Parissis, John; Georgiakaki, Maria T; Pyrgakis, Vlassios N

    2017-09-01

    The inflammatory glycoprotein chitinase-3-like protein 1 or YKL-40 has emerged as a potential biomarker of cardiovascular diseases, including atrial fibrillation (AFib). We sought to assess YKL-40 in a wide spectrum of supraventricular arrhythmias besides AFib in comparison with other inflammatory markers. We determined serum levels of YKL-40, C-reactive protein (CRP) and IL-6 in 70 patients with AFib, atrial flutter, atrioventricular node reentry tachycardia or other supraventricular tachycardias before, immediately after therapy and 1 week after therapy; 20 healthy patients served as controls. Patients were subsequently followed for 6 months for arrhythmia recurrence. Baseline YKL-40 was significantly elevated in AFib patients [99.5 (65.5,194) ng/ml versus 47.2 (38.9,51.6) ng/ml in controls, P 40 levels correlated positively with left atrial volume index (Spearman's rho = 0.853, P 40 was independently associated with AFib recurrence (adjusted odds ratio = 1.02, 95% confidence interval = 1.00-1.04, P = 0.016). Neither CRP nor IL-6 was associated with AFib recurrence. Serum YKL-40 was elevated only in AFib and not in other supraventricular arrhythmias. In AFib, YKL-40 levels were responsive to therapy and predicted long-term recurrence.

  19. Are Gender Differences in Spatial Ability Real or an Artifact? Evaluation of Measurement Invariance on the Revised PSVT:R

    Science.gov (United States)

    Maeda, Yukiko; Yoon, So Yoon

    2016-01-01

    We investigated the extent to which the observed gender differences in mental rotation ability among the 2,468 freshmen studying engineering at a Midwest public university attributed to the gender bias of a test. The Revised Purdue Spatial Visualization Tests: Visualization of Rotations (Revised PSVT:R) is a spatial test frequently used to measure…

  20. Failed anti-tachycardia pacing can be used to differentiate atrial arrhythmias from ventricular tachycardia in implantable cardioverter-defibrillators.

    Science.gov (United States)

    Michael, Kevin A; Enriquez, Andres; Baranchuk, Adrian; Haley, Charlotte; Caldwell, Jane; Simpson, Christopher S; Abdollah, Hoshiar; Redfearn, Damian P

    2015-01-01

    Atrial fibrillation/tachycardia (AF/AT) may result in inappropriate therapies in implantable cardioverter-defibrillators (ICDs). The post-pacing interval (PPI) and tachycardia cycle length difference (PPI - TCL) has been previously demonstrated to indicate the proximity of the pacing site to a tachycardia origin. We postulated that the PPI and PPI - TCL would be greater in AT/AF vs. ventricular tachycardia (VT) after episodes of failed anti-tachycardia pacing (ATP). This was a single-centre, retrospective study evaluating consecutive patients implanted with dual (DR)/biventricular (BIV) ICDs. Stored electrograms were used to determine whether the ATP captured the arrhythmia and the arrhythmia did not present with primary or secondary termination. Measurements were done using manual calipers. A total of 155 patients were included. There were 79 BIV and 76 DR devices. In total, 39 episodes were identified in 20 patients over a 23-month follow-up period. A total of 76 sequences of ATP (burst/ramp) were delivered, 28 (37%) of them inappropriate. Fifty-one events (18 AT/AF and 33 VT) were compared. The mean PPI was 693 ± 96 vs. 512 ± 88 ms (P failed ATP differs significantly between AF/AT and VT and are therefore useful indices to discriminate between supraventricular tachycardia and VT in ICDs. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  1. DDD-ICD: discrimination of supraventricular tachyarrhythmias Discriminação de taquiarritmias supraventriculares

    Directory of Open Access Journals (Sweden)

    Amiran R. REVISHVILI

    1999-01-01

    Full Text Available Background: Dual Chamber Implantable Cardioverter Defibrillator (ICD in addition to providing hemodynamically improved bradycardia support can also reduce the incidence of inappropriate ventricular shocks owing to episodes of Supraventricular Tachycardia (SVT, with reported incidence of up to 41% of patients. An atrio-ventricular (AV discrimination algorithm is needed in dual chamber implantable cardioverter-defibrillators (ICD to avoid these inappropriate shocks. Methods: An AV discrimination algorithm, SMART DetectionTM, has been developed to differentiate between episodes of ventricular tachycardia (VT and SVT. It relies on the concept that the chamber with the higher rate is the origin of the tachycardia. The ventricular rate stability criterion is also used to detect concurrent VT during an episode of SVT. Other parameters used in the discrimination algorithm are: atrial and ventricular rhythm multiplicity, P-R regularity, sudden onset. The SMART DetectionTM algorithm has been implemented in the Biotronik Phylax® AV dual chamber ICD. The original SMART DetectionTM has been improved recently with the addition of active detection in the case of 1:1 AV conduction. Results: 10 patients were implanted with Phylax® AV's at the Bakoulev Institute. Analyses of stored dual chamber intracardiac electrogram (IEGM indicate that all episodes of VTs and Ventricular Fibrillations (VF were terminated following appropriate therapies. No episode of Atrial Flutter (Afl or Atrial Fibrillation (AF was treated even though the majority of patients have a history of SVTs. In one patient, an episode of Sinus Tachycardia (ST was inappropriately treated. Increasing the sudden onset criterion, which is used only in the case of stable 1:1 rhythms, was sufficient to prevent recurrence of inappropriate therapy. To avoid the necessity of setting the, not very reliable, sudden onset criterion an active detection procedure was developed. Isolated Premature Ventricular

  2. Autoimmune Basis for Postural Tachycardia Syndrome

    Science.gov (United States)

    2018-01-23

    Postural Orthostatic Tachycardia Syndrome; Postural Tachycardia Syndrome; Tachycardia; Arrhythmias, Cardiac; Autonomic Nervous System Diseases; Orthostatic Intolerance; Cardiovascular Diseases; Primary Dysautonomias

  3. Taquiarritmias supraventriculares no feto. Experiência de uma unidade de referência em cardiologia fetal Fetal supraventricular tachyarrhythmias. Experience of a fetal cardiology reference center

    Directory of Open Access Journals (Sweden)

    Paulo Zielinsky

    1998-05-01

    referred for fetal cardiac evaluation. RESULTS: There were 17 fetuses with the diagnosis of supraventricular tachycardia (SVT and 8 patients with atrial flutter (AF. Gestational age ranged from 26 to 40 weeks. Twelve patients were hydropic at presentation (6 with SVT and 6 AF. Four fetuses with SVT showed structural abnormalities (two with Ebsten's anomaly and two with VSD. All patients were admitted to the Fetal Cardiology Unit for monitoring and treatment. Among 17 fetuses with SVT, twelve showed good response to digoxin administration, but this drug was not useful in any of the patients with flutter. In two patients with SVT and in six with AF, the pregnancy was interrupted to perform post-natal cardioversion. The mortality rate was 3/17 in the SVT group (including 2 patients with ebstein's anomaly and 0/8 in the flutter group CONCLUSION: Fetal supraventricular tachyarrithmias are rare in the general population. Nevertheless, the fetus may present with severe heart failure and death. Considering the satisfactory therapeutic response, accurate diagnosis and early treatment of these conditions are extremely important.

  4. Adenosine Triphosphate-sensitive Micro-reentrant Atrial Tachycardia Originating from the Crista Terminalis in a Patient with Chronic Renal Failure due to Thrombotic Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Shinya Sugiura, MD

    2009-01-01

    Full Text Available A 57-year-old woman with chronic renal failure due to the thrombotic thrombocytopenic purpura complained of palpitation. A 12-lead ECG showed supraventricular tachycardia with a cycle length of 375 ms. During the electrophysiological study, a tachycardia with a cycle length of 375 ms was reproducibly induced and terminated by atrial extrastimulation. The tachycardia exhibited an inverse relationship between the coupling interval of extrastimulus initiating the tachycardia, and the first postpacing return cycle, as well as an increasing pattern of resetting the tachycardia with an atrial extrastimulus. Ventricular burst pacing during tachycardia produced AV dissociation. Intravenous injections of a low dose (4 mg of adenosine triphosphate (ATP terminated the tachycardia without a preceding atrio-His bundle block. The tachycardia was diagnosed as an ATP-sensitive micro-reentrant atrial tachycardia. Real-time endocardial activation mapping using an electroanatomical mapping system revealed that the earliest activation site of the tachycardia was located at the midlateral portion of the crista terminalis. The tachycardia was abolished by focal ablation targeting the earliest activation site during tachycardia. This is the first reported case of an ATP-sensitive micro-reentrant atrial tachycardia associated with thrombotic thrombocytopenic purpura.

  5. Auricular tachycardia: therapeutic and pathophysiologic news concepts: literature review and casuistic Service presentation

    International Nuclear Information System (INIS)

    Horta, J. de; Reyes, W.; Calleriza, F.; Pouso, J.; Besada, E.

    1998-01-01

    The auricular tachycardia are the supraventricular tachycardias whose origin mechanism and maintenance is located at level exclusively auricular. It show diagnostic and therapeutics difficulties.The inadequate handling can cause commitment of the ventricular function and to commit the predict vital.The pharmacological treatment, is more used is few effective.The ablation for catheter with radiofrequency is a new weapon transcendent therapy for the resolution of a significant group of these patients. A review of the concept of auricular tachycardias, it upgrades its classification and the mechanisms pathophysiologic.It describes the techniques of ablation for catheter in these arrhythmias and their results are revised in the literature. In the end it presents the casuistry of the Service in the treatment of the auricular tachycardias focal s,incision ales and atrial flutter by means of ablation for catheter with radiofrequency [es

  6. INTERMITTENT ANTIARYTHMIC THERAPY OF ARIOVENTICULAR NODAL REENTRY TACHYCARDIA IN CHILDREN

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    Boris Djindjic

    2008-04-01

    Full Text Available Until recent advances in pharmacology and clinical cardiology regarding farmacodynamics of antiarrhythmic drugs and their efficiency in patients with refractory paroxysmal supraventricular tachycardia, chronic prophylactic therapy was the only treatment option for patients refusing catheter ablation. Another treatment option, also known by eponym “pill in pocket” have been shown to be equally useful and efficacious.The aim of our study was prospective examination of children with refractory atrioventricular nodal reentry tachycardia (AVNRT who were withdrawn from chronic antiarrhythmic prophylactic therapy and started with intermittent oral beta blocker treatment (propranolol at dosage 1 mg/kg - max 80 mg.Twelve children (8 boys and 4 girls with AVNRT were included in the study. Four children did not have arrhythmia during first six months after withdrawal and 7 were successfully treated without complication.Intermittent antiarrhythmic therapy in children with AVNRT could be very efficacious and useful treatment option which significantly improves their quality of life.

  7. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

    OpenAIRE

    Amer, Aya; Broadbent, Roland S.; Edmonds, Liza; Wheeler, Benjamin J.

    2016-01-01

    Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC), who then developed a supraventricular tachycardia (SVT). This was initially treated with intravenous adenosine with transient reversion. Catheter migration w...

  8. Drug: D10932 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available oxysmal supraventricular tachycardia (PSVT) ... CAS: 1593673-23-4 PubChem: 342581789 ChEMBL: CHEMBL3707312 ... ... D10932 Drug Etripamil (USAN/INN) ... C27H36N2O4 D10932.gif ... Phenylalkylamine derivative Treatment of par

  9. Familial neonatal atrial tachycardia.

    OpenAIRE

    Balaji, S.; Sullivan, I. D.; Shinebourne, E. A.

    1996-01-01

    A father and his two sons each presented with atrial tachycardia in the newborn period. The father went on to develop dilated cardiomyopathy. The first son (who also had transposition of the great arteries) died from the arrhythmia after surgery. The second son is currently successfully managed pharmacologically.

  10. Familial neonatal atrial tachycardia.

    Science.gov (United States)

    Balaji, S.; Sullivan, I. D.; Shinebourne, E. A.

    1996-01-01

    A father and his two sons each presented with atrial tachycardia in the newborn period. The father went on to develop dilated cardiomyopathy. The first son (who also had transposition of the great arteries) died from the arrhythmia after surgery. The second son is currently successfully managed pharmacologically. PMID:8795484

  11. Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias

    Directory of Open Access Journals (Sweden)

    Kostas Polymeropoulos

    2011-01-01

     min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94% in the ibutilide arm and in all patients (100% in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA.

  12. Prenatal features of Costello syndrome: Ultrasonographic findings and atrial tachycardia

    Science.gov (United States)

    Lin, Angela E.; O’Brien, Barbara; Demmer, Laurie A.; Almeda, Kristina K.; Blanco, Cynthia L.; Glasow, Patrick F.; Berul, Charles I.; Hamilton, Robert; Innes, A. Micheil; Lauzon, Julie L.; Sol-Church, Katia; Gripp, Karen W.

    2015-01-01

    Objective Delineate prenatal features of Costello syndrome (caused by HRAS mutations) which consists of mental retardation, facial, cardiovascular, skin, and musculoskeletal anomalies, and tumor predisposition. Methods Literature and new cases classified as Group I (pre-HRAS), Group II (HRAS confirmed), and Group III (HRAS confirmed in natural history study, plus three contributed cases). Results Polyhydramnios occurred in most (mean 79%) pregnancies of cases in Groups I (98), II (107), and III (17), advanced paternal age and prematurity were noted in approximately half. Less frequent were nuchal thickening, ascites, shortened long bones, abnormal hand posture, ventriculomegaly, macrosomia, and macrocephaly. Fetal arrhythmia occurred in 9 cases (6 supraventricular or unspecified tachycardia, 1 unspecified arrhythmia, 2 premature atrial contractions, PACs); excluding 3 new cases and 2 with PACs, the estimated prenatal frequency is 4/222 (2%). Conclusion Costello syndrome can be suspected prenatally when polyhydramnios is accompanied by nuchal thickening, hydrops, shortened long bones, abnormal hand posture, ventriculomegaly, large size, and macrocephaly, and especially fetal atrial tachycardia. Consideration should be given for timely prenatal diagnostic studies for confirmative HRAS gene mutations, and for maternal treatment of serious fetal arrhythmia. PMID:19382114

  13. Troponin elevation in patients with various tachycardias and normal epicardial coronaries

    Directory of Open Access Journals (Sweden)

    Yousuf Kanjwal

    2008-08-01

    Full Text Available Troponin elevation is usually synonymous with acute coronary syndrome (ACS. Although sensitive for ACS, the elevation of serum troponin, in the absence of clinical evidence of ischemia, should prompt a search for other etiologies of myocardial necrosis. In fact, elevated values of troponin are correlated with myocardial necrosis even though it does not discriminate the mechanism involved. We report a series of seven patients (age range 18-67 years, who presented with complaints of chest discomfort and were found to have regular supraventricular tachycardia (5 patients and one patient each with atrial fibrillation and ventricular tachycardia. All these patients had elevated troponin I and underwent coronary angiography that revealed normal epicardial coronary arteries. This is first case series in which all patients underwent coronary angiography and none of the patients was hemodynamically unstable at the time of presentation. Patients with elevated troponin due to conditions other than ACS can receive inappropriate and delayed definitive diagnosis and treatment.

  14. Vagal Techniques for Terminating Paroxysmal Tachycardia in Children: Assessment of Clinical Electrophysiological Factors of Valsalva Test Effectiveness

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    T. K. Kruchina

    2015-01-01

    Full Text Available Background: Vagal techniques constitute the first line of medical care for terminating paroxysmal supraventricular tachycardia in children and adults due to ease of application, relative safety and possibility of avoiding injection of antiarrhythmic drugs. Effectiveness of vagal techniques depends on the method of execution, as well as a range of clinical and electrophysiological factors, which require study and specification. Objective: Our aim was to study effectiveness of the modified Valsalva test for terminating paroxysmal tachycardia in children. Methods: Effectiveness of the Valsalva test for terminating paroxysmal tachycardia induced in the course of a transesophageal electrophysiological examination in children aged 7–18 years was studied retrospectively. Results: Data of 306 children (mean age — 13.1 ± 3.2 years were analyzed; 130 of them (42.5% suffered from paroxysmal AV nodal reentrant tachycardia (PAVNRT, 176 — from paroxysmal AV reentrant tachycardia involving an additional AV connection (PAVRT. Valsalva test was effective in 88 children (28.8% — 44 children (33.8% with PAVNRT and 44 children (25.1% with PAVRT. In most cases, tachycardia was terminated by means of anterograde block: PAVRT — in 65.5% of the cases, PAVNRT — in 92.7% of the cases. Children with ineffective Valsalva test featured longer duration of the disorder (p = 0.035, higher rate of the initial sinus rhythm before a tachycardic paroxysm (p = 0.043 and higher rhythm rate during tachycardia (p = 0.019, as well as high level of AV node conduction (p = 0.038. Conclusion: Valsalva test terminates paroxysmal tachycardia in not more than 1/3 of children with paroxysmal AV reentrant tachycardia. Test effectiveness depends on duration of the disorder and electrophysiological characteristics of AV node conduction. Valsalva test is especially effective in the onset of tachycardic paroxysm and terminates it by means of anterograde AV node block in most cases. 

  15. Oxygen therapy reduces postoperative tachycardia

    DEFF Research Database (Denmark)

    Stausholm, K; Kehlet, H; Rosenberg, J

    1995-01-01

    Concomitant hypoxaemia and tachycardia in the postoperative period is unfavourable for the myocardium. Since hypoxaemia per se may be involved in the pathogenesis of postoperative tachycardia, we have studied the effect of oxygen therapy on tachycardia in 12 patients randomly allocated to blinded...... air or oxygen by facemask on the second or third day after major surgery. Inclusion criteria were arterial hypoxaemia (oxygen saturation 90 beat.min-1). Each patient responded similarly to oxygen therapy: an increase in arterial oxygen saturation and a decrease...... in heart rate (p oxygen has a positive effect on the cardiac oxygen delivery and demand balance....

  16. AV nodal reentrant tachycardia or AV reentrant tachycardia using a concealed bypass tract-related adverse events.

    Science.gov (United States)

    Brembilla-Perrot, Béatrice; Bénichou, Maxime; Brembilla, Alice; Bozec, Erwan; Dorlet, Sarah; Sellal, Jean Marc; Olivier, Arnaud; Manenti, Vladimir; Villemin, Thibaut; Beurrier, Daniel; Moulin-Zinsch, Anne; De Chillou, Christian; Girerd, Nicolas

    2015-11-15

    To jointly study paroxysmal supraventricular tachycardia (SVT)-related adverse events (AE) and ablation-related complications, with specific emphasis on the predictors of SVT-related AE as well as their significance by investigating their association with long-term mortality. 1770 patients were included, aged 6 to 97, with either atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic atrioventricular reciprocal tachycardia (AVRT) mediated by concealed accessory pathway, consecutively referred for SVT work-up in a tertiary care center. SVT-related AE were identified in 339 patients (19%). Major AEs were identified in 23 patients (1%; 15 cardiac arrests or ventricular arrhythmias requiring cardioversion and 8 hemodynamic collapses). Other AE were related to syncope (n=236), acute coronary syndrome (n=57) and heart failure/rhythmic cardiomyopathy (n=21). In multivariable analysis, higher age, heart disease and requirement of isoproterenol to induce SVT were independently associated with a higher risk for SVT-related AE. During follow-up (2.8±3.0years), death occurred more frequently in patients with SVT-related AE, especially in patients with major adverse events (pSVT-related AE remained significantly associated with occurrence of death (HR=6.72, IC=(2.58-17.52), pSVT-related AE in the whole population referred for SVT were more frequent than immediate major ablation complications in patients undergoing SVT ablation (5/1186 vs. 23/1770, p=0.02). SVT-related AE are independent predictors of mortality and are more frequent than immediate major ablation complications in patients undergoing SVT ablation. The present findings support systematically performing SVT ablation in patients with SVT-related adverse events. Copyright © 2015. Published by Elsevier Ireland Ltd.

  17. Taquicardia supraventricular en recién nacido: Un reto diagnóstico y terapéutico en la práctica médica / Supraventriculartachycardia in a newborn: A diagnostic and therapeuticchallenge in medical practice

    Directory of Open Access Journals (Sweden)

    Elibet Chávez González

    2015-10-01

    Full Text Available Supraventricular tachycardias in children are the fastest rhythms most frequently reported (70%. Orthodromic tachycardia is that which usually occurs in newborns, and its treatment with amiodarone together with beta blockers has an effectiveness of 63%. However, the combination of antiarrhythmic drugs in children and infants is not recommended because of the proarrhythmic effects. Electrophysiological study and radiofrequency ablation are reserved for older children, where there is less risk of procedures; besides little risk has been reported in children with accessory pathways. The case of an 11-day-old newborn who presented two electrocardiographically different episodes of tachycardia is reported. Those episodes suggested unequal production mechanisms of the arrhythmia, which was difficult to control and needed the combination of three antiarrhythmic drugs for maintaining sinus rhythm.

  18. Differential Diagnosis of Narrow QRS Tachycardia

    Directory of Open Access Journals (Sweden)

    Syamkumar Menon

    2017-04-01

    Full Text Available Differential diagnosis of short RP tachycardia include atrioventricualr nodal re entrant tachycardia, atrio ventricular re entrant tachycardia and less commonly atrial tachycardia with a long PR interval. Analysis of retrograde P waves in different leads is helpful in the differential diagnosis, with certain limitations.

  19. Treating critical supraventricular and ventricular arrhythmias

    Directory of Open Access Journals (Sweden)

    Trappe Hans-Joachim

    2010-01-01

    Full Text Available Atrial fibrillation (AF, atrial flutter, AV-nodal reentry tachycardia with rapid ventricular response, atrial ectopic tachycardia and preexcitation syndromes combined with AF or ventricular tachyarrhythmias (VTA are typical arrhythmias in intensive care patients (pts. Most frequently, the diagnosis of the underlying arrhythmia is possible from the physical examination (PE, the response to maneuvers or drugs and the 12-lead surface electrocardiogram. In unstable hemodynamics, immediate DC-cardioversion is indicated. Conversion of AF to sinus rhythm (SR is possible using antiarrhythmic drugs. Amiodarone has a conversion rate in AF of up to 80%. Ibutilide represents a class III antiarrhythmic agent that has been reported to have conversion rates of 50-70%. Acute therapy of atrial flutter (Aflut in intensive care pts depends on the clinical presentation. Atrial flutter can most often be successfully cardioverted to SR with DC-energies < 50 joules. Ibutilide trials showed efficacy rates of 38-76% for conversion of Aflut to SR compared to conversion rates of 5-13% when intravenous flecainide, propafenone or verapamil was administered. In addition, high dose (2 mg of ibutilide was more effective than sotalol (1.5 mg/kg in conversion of Aflut to SR (70 versus 19%. Drugs like procainamide, sotalol, amiodarone or magnesium were recommended for treatment of VTA in intensive care pts. However, only amiodarone is today the drug of choice in VTA pts and also highly effective even in pts with defibrillation-resistant out-of-hospital cardiac arrest (CA. There is a general agreement that bystander first aid, defibrillation and advanced life support is essential for neurologic outcome in pts after cardiac arrest due to VTA. Public access defibrillation in the hands of trained laypersons seems to be an ideal approach in the treatment of ventricular fibrillation (VF. The use of automatic external defibrillators (AEDs by basic life support ambulance providers or

  20. Treating critical supraventricular and ventricular arrhythmias

    Science.gov (United States)

    Trappe, Hans-Joachim

    2010-01-01

    Atrial fibrillation (AF), atrial flutter, AV-nodal reentry tachycardia with rapid ventricular response, atrial ectopic tachycardia and preexcitation syndromes combined with AF or ventricular tachyarrhythmias (VTA) are typical arrhythmias in intensive care patients (pts). Most frequently, the diagnosis of the underlying arrhythmia is possible from the physical examination (PE), the response to maneuvers or drugs and the 12-lead surface electrocardiogram. In unstable hemodynamics, immediate DC-cardioversion is indicated. Conversion of AF to sinus rhythm (SR) is possible using antiarrhythmic drugs. Amiodarone has a conversion rate in AF of up to 80%. Ibutilide represents a class III antiarrhythmic agent that has been reported to have conversion rates of 50-70%. Acute therapy of atrial flutter (Aflut) in intensive care pts depends on the clinical presentation. Atrial flutter can most often be successfully cardioverted to SR with DC-energies <50 joules. Ibutilide trials showed efficacy rates of 38-76% for conversion of Aflut to SR compared to conversion rates of 5-13% when intravenous flecainide, propafenone or verapamil was administered. In addition, high dose (2 mg) of ibutilide was more effective than sotalol (1.5 mg/kg) in conversion of Aflut to SR (70 versus 19%). Drugs like procainamide, sotalol, amiodarone or magnesium were recommended for treatment of VTA in intensive care pts. However, only amiodarone is today the drug of choice in VTA pts and also highly effective even in pts with defibrillation-resistant out-of-hospital cardiac arrest (CA). There is a general agreement that bystander first aid, defibrillation and advanced life support is essential for neurologic outcome in pts after cardiac arrest due to VTA. Public access defibrillation in the hands of trained laypersons seems to be an ideal approach in the treatment of ventricular fibrillation (VF). The use of automatic external defibrillators (AEDs) by basic life support ambulance providers or first

  1. Persistent junctional reciprocating tachycardia in the fetus

    NARCIS (Netherlands)

    Oudijk, M. A.; Stoutenbeek, P.; Sreeram, N.; Visser, G. H. A.; Meijboom, E. J.

    2003-01-01

    Persistent junctional reciprocating tachycardia (PJRT) tends to be a persistent arrhythmia and requires aggressive therapeutic management. Diagnosis and management of this infrequently occurring tachycardia in the fetus at an early stage is of importance for the prevention of congestive heart

  2. Is There a Difference in Tachycardia Cycle Length during SVT in Children with AVRT and AVNRT?

    Science.gov (United States)

    Mills, Marcos F; Motonaga, Kara S; Trela, Anthony; Dubin, Anne M; Avasarala, Kishor; Ceresnak, Scott R

    2016-11-01

    There are limited adult data suggesting the tachycardia cycle length (TCL) of atrioventricular reentry tachycardia (AVRT) is shorter than atrioventricular nodal reentry tachycardia (AVNRT), though little data exist in children. We sought to determine if there is a difference in TCL between AVRT and AVNRT in children. A single-center retrospective review of children with supraventricular tachycardia (SVT) from 2000 to 2015 was performed. Age ≤ 18 years, invasive electrophysiology study (EPS) confirming AVRT or AVNRT. Atypical AVNRT, congenital heart disease, antiarrhythmic medication use at time of EPS. Data were compared between patients with AVRT and AVNRT via t-test, χ 2 test, and linear regression. A total of 835 patients were included (12 ± 4 years, 52 ± 31 kg, TCL 321 ± 55 ms), 539 (65%) with AVRT (270 Wolff-Parkinson-White, 269 concealed pathways) and 296 (35%) with AVNRT. Patients with AVRT were younger (11.7 ± 4.1 years vs 13.0 ± 3.6 years, P SVT, there was no difference in TCL (290 ± 49 ms vs 297 ± 49 ms, P = 0.26). When controlling for age, there was no difference in TCL between AVRT and AVNRT at baseline or on isoproterenol. The regression equation for TCL in the baseline state was TCL = 290 + 4 (age), indicating the TCL will increase by 4 ms above a baseline of 290 ms for each year of life. When controlling for age, there is no difference in the TCL between AVRT and AVNRT in children. Age, not tachycardia mechanism, is the most significant factor in predicting TCL. © 2016 Wiley Periodicals, Inc.

  3. Ventricular tachycardia following tube thoracotomy.

    Science.gov (United States)

    Hibbert, Benjamin; Lim, Toon Wei; Hibbert, Rebecca; Green, Martin; Gollob, Michael H; Davis, Darryl R

    2010-10-01

    Arrhythmias provoked by tube thoracotomy are a rare complication. We report a ventricular tachycardia after chest tube insertion for a device-related pneumothorax. Sinus rhythm was restored only by removal of the chest tube and insertion of a pliable pleural drain. Identification of the chest tube as an arrhythmic trigger following tube thoracotomy is essential in definitive management of refractory arrhythmias.

  4. Drug treatment of fetal tachycardias

    NARCIS (Netherlands)

    Oudijk, Martijn A.; Ruskamp, Jopje M.; Ambachtsheer, Barbara E.; Ververs, Tessa F. F.; Stoutenbeek, Philip; Visser, Gerard H. A.; Meijboom, Erik J.

    2002-01-01

    The pharmacological treatment of fetal tachycardia (FT) has been described in various publications. We present a study reviewing the necessity for treatment of FT, the regimens of drugs used in the last two decades and their mode of administration. The absence of reliable predictors of fetal hydrops

  5. Bidirectional Ventricular Tachycardia: A Hallmark of Catecholaminergic Polymorphic Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Dr. Francisco Femenia, MD

    2012-03-01

    Full Text Available Catecholaminergic polymorphic ventricular tachycardia is a familial cardiac arrhythmia that is related to RYR2 or CASQ2 gene mutation. It occurs in patients with structurally normal heart and causes exercise-emotion triggered syncope and sudden cardiac death. We present a 13 year-old girl with recurrent episodes of exercise-related syncope and prior history of sudden death in a first degree relative.

  6. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Aya Amer

    2016-01-01

    Full Text Available Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC, who then developed a supraventricular tachycardia (SVT. This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management.

  7. Multifocal atrial tachycardia in two neonates.

    Science.gov (United States)

    Farooki, Z Q; Green, E W

    1977-01-01

    Two neonates with rapid and irregular pulse rate had an uncommon form of atrial tachycardia. The irregular heart rate was first detected during fetal monitoring. Postnatal electrocardiograms were compatible with the diagnosis of multifocal atrial tachycardia or chaotic atrial rhythm. Both patients were treated with digoxin and the rhythm gradually reverted to sinus. This may represent the first description of multifocal atrial tachycardia in the newborn. Images PMID:901681

  8. Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

    DEFF Research Database (Denmark)

    Mattsson, Nick; Kumarathurai, Preman; Larsen, Bjørn Strøier

    2017-01-01

    BACKGROUND AND PURPOSE: Stroke is independently associated with the common conditions of hypokalemia and supraventricular ectopy, and we hypothesize that the combination of excessive supraventricular ectopic activity and hypokalemia has a synergistic impact on the prognosis in terms of stroke in ...

  9. Multifocal atrial tachycardia: an unusual cause of cardiogenic shock in a newborn.

    Science.gov (United States)

    Bouziri, Asma; Khaldi, Ammar; Hamdi, Asma; Ben Massoud, Ines; Borgi, Aida; Menif, Khaled; Ben Jaballah, Nejla

    2011-01-01

    Chaotic or multifocal atrial tachycardia (MAT) is a rare tachyarrhythmia in children, accounting for less than 1% of supraventricular tachycardia seen in childhood. The majority of children with MAT are healthy; a few may exhibit mild to life threatening cardiorespiratory disease. To report a new case of MAT revealed by a severe respiratory distress and cardiogenic shock. We report a rare case of MAT revealed by a severe respiratory distress and cardiogenic shock in a 12-day-old newborn. The echocardiogram demonstrated an isolated secundum-type atrial septal defect with a decreased left ventricular function. He was successfully treated with intravenous amiodarone. A relay by oral amiodarone and digoxine was made. Four months later, he had no recurrence of arrhythmia and left ventricular function returned to normal. Our case is original by its association to an isolated ostium secondum-type atrial septal defect and by the occurrence of a congestive heart failure revealing the arrhythmia and the structural heart disease during the neonatal period.

  10. [Wide QRS tachycardia preceded by pacemaker spikes].

    Science.gov (United States)

    Romero, M; Aranda, A; Gómez, F J; Jurado, A

    2014-04-01

    The differential diagnosis and therapeutic management of wide QRS tachycardia preceded by pacemaker spike is presented. The pacemaker-mediated tachycardia, tachycardia fibrillo-flutter in patients with pacemakers, and runaway pacemakers, have a similar surface electrocardiogram, but respond to different therapeutic measures. The tachycardia response to the application of a magnet over the pacemaker could help in the differential diagnosis, and in some cases will be therapeutic, as in the case of a tachycardia-mediated pacemaker. Although these conditions are diagnosed and treated in hospitals with catheterization laboratories using the application programmer over the pacemaker, patients presenting in primary care clinic and emergency forced us to make a diagnosis and treat the haemodynamically unstable patient prior to referral. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  11. Cryoablation of junctional tachycardia at high risk of atrio-ventricular block.

    Science.gov (United States)

    Nadji, G; Hermida, J-S; Kubala, M; Quenum, S; Bakkour, H; Jarry, G

    2008-03-01

    Transcatheter cryoablation is an alternative option for the treatment of supraventricular tachycardia, due to its very low risk of permanent atrio-ventricular block. However, the overcost of cryocatheter and the high recurrence rate of this emerging technology braked its large use. This study reports the results of an approach using cryoablation for the treatment of junctional tachycardia (JT) in selected patients at high risk of atrio-ventricular (AV) block. Out of a series of 199 patients with JT treated by catheter ablation, 26 benefited from cryoablation (mean age 32.8+/-15 years, 15 males). The indications were the presence of an accessory pathway with a high risk of atrio-ventricular block (n=7), a slow pathway difficult to ablate, with a risk of atrio-ventricular block (n=7), a recurrence after a RF procedure, during which a transient atrio-ventricular block has occurred (n=4), and finally patients at young age (n=8). The primary success rate was 92%. No permanent AV block has been reported, neither with RF nor with cryoablation. The recurrence rate at 9+/-10 months was at 29% after cryoablation and 8.6% after RF. In case of AV nodal reentrant tachycardia, the additional cost of cryotherapy catheter has been avoided in 76.85% of cases. The use of a cryotherapy catheter and RF catheter has been necessary for the remaining cases. This study demonstrates that an approach, reserving cryoablation in selected patients at high risk of AV block is an alternative strategy to "the systematic use" of cryotherapy in the ablation of JT with a high efficacy, an excellent safety and a reduced cost.

  12. Confounders of vasovagal syncope: postural tachycardia syndrome.

    Science.gov (United States)

    Nwazue, Victor C; Raj, Satish R

    2013-02-01

    Most patients who present to a cardiologist with syncope have vasovagal (reflex) syncope. A busy syncope practice often also sees patients with postural tachycardia syndrome, often presenting with severe recurrent presyncope. Recognition of this syncope confounder might be difficult without adequate knowledge of their presentation, and this can adversely affect optimal management. Postural tachycardia syndrome can often be differentiated from vasovagal syncope by its hemodynamic pattern during tilt table test and differing clinical characteristics. This article reviews the presentation of postural tachycardia syndrome and its putative pathophysiology and presents an approach to nonpharmacologic and pharmacologic management. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Radiofrequency Catheter Ablation of Coexistent Idiopathic Left Ventricular Tachycardia and Atrioventricular Nodal Reentrant Tachycardia

    Directory of Open Access Journals (Sweden)

    Ken-Pen Weng

    2005-10-01

    Full Text Available A healthy 15-year-old male patient presented with a 6-month history of recurrent attacks of palpitations. On multiple emergency room visits, a sustained wide QRS complex tachycardia with a right bundle branch block and northwest axis deviation was documented. The tachycardia was not terminated by intravenous adenosine, but was suppressed with intravenous verapamil. There was no evidence of structural heart disease, myocarditis, long QT syndrome, or electrolyte imbalance after a series of standard examinations. Idiopathic left ventricular tachycardia (ILVT was suspected. Electrophysiologic studies revealed 2 inducible tachycardias, which were shown to represent atrioventricular nodal reentrant tachycardia (AVNRT and ILVT. Transformation from AVNRT to ILVT occurred spontaneously following atrial pacing. Successful ablation of ILVT and the slow atrioventricular nodal pathway resulted in cure of the double tachycardia.

  14. "Cristal tachycardias": origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography.

    Science.gov (United States)

    Kalman, J M; Olgin, J E; Karch, M R; Hamdan, M; Lee, R J; Lesh, M D

    1998-02-01

    We sought to use intracardiac echocardiography (ICE) to identify the anatomic origin of focal right atrial tachycardias and to define their relation with the crista terminalis (CT). Previous studies using ICE during mapping of atrial flutter and inappropriate sinus tachycardia have demonstrated an important relation between endocardial anatomy and electrophysiologic events. Recent studies have suggested that right atrial tachycardias may also have a characteristic anatomic distribution. Twenty-three consecutive patients with 27 right atrial tachycardias were included in the study. ICE was used to facilitate activation mapping in relation to endocardial structures. A 20-pole catheter was positioned along the CT under ICE guidance. ICE was also used to assist in guiding detailed mapping with the ablation catheter in the right atrium. Of 27 focal right atrial tachycardias, 18 (67%, 95% confidence interval [CI] 46% to 83%) were on the CT (2 high medial, 8 high lateral, 6 mid and 2 low). ICE identified the location of the tip of the ablation catheter in immediate relation to the CT in all 18 cases. The 20-pole mapping catheter together with echocardiographic visualization of the CT provided a guide to the site of tachycardia origin along this structure. Radiofrequency ablation was successful in 26 (96%) of 27 (95% CI 81% to 100%) right atrial tachycardias. This study demonstrates that approximately two thirds of focal right atrial tachycardias occurring in the absence of structural heart disease will arise along the CT. Recognition of this common distribution may potentially facilitate mapping and ablation of these tachycardias.

  15. Ventricular tachycardia induced by weight loss pills

    DEFF Research Database (Denmark)

    Pareek, Manan; Hansson, Nils Henrik; Grove, Erik Lerkevang

    2013-01-01

    A previously healthy 29-year-old man was admitted with palpitations, dizziness, and near-syncope after he had recently started taking weight loss pills purchased on the internet. The pills contained caffeine and ephedrine. An electrocardiogram and telemetry revealed multiple episodes of non......-sustained monomorphic ventricular tachycardia, which was successfully treated with amiodarone. In conclusion, unauthorized weight loss pills can be harmful. In particular, ephedrine-containing drugs carry a risk of ventricular tachycardia and should be discouraged....

  16. Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty: Secondary analysis of a J-PSVT cohort study on anesthesia.

    Science.gov (United States)

    Nakamura, Mashio; Kamei, Masataka; Bito, Seiji; Migita, Kiyoshi; Miyata, Shigeki; Kumagai, Kenji; Abe, Isao; Nakagawa, Yasuaki; Nakayama, Yuichiro; Saito, Masanobu; Tanaka, Takaaki; Motokawa, Satoru

    2017-05-01

    Clinical guidance on the choice of anesthetic modality vis-à-vis the risk of perioperative venous thromboembolism (VTE) is largely lacking because of a paucity of recent evidence. A comparative effect of general anesthesia and neuraxial blockade on the perioperative incidence of VTE has not been well-investigated.We compared the effects of different types of anesthetic modalities on the risk of VTE after total hip arthroplasty (THA) and total knee arthroplasty (TKA).This is a secondary analysis of the Japanese Study of Prevention and Actual Situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT). Data pertaining to a total of 2162 patients who underwent THA and TKA at 34 hospitals were included in this analysis. We compared the different anesthetic modalities with respect to the incidence of VTE. The composite end-point was asymptomatic/symptomatic deep vein thrombosis detected using scheduled bilateral ultrasonography up to postoperative day (POD) 10 and fatal/non-fatal pulmonary embolism up to POD 10.The study groups were as follows: general anesthesia (n = 646), combined epidural/general anesthesia (n = 1004), epidural anesthesia (n = 87), and spinal anesthesia (n = 425). On multivariate analysis, only spinal anesthesia was associated with a significant increase in the risk of VTE as compared with that associated with general anesthesia. Propensity score-matched analysis for "combined epidural/general anesthesia group" versus "spinal anesthesia group" demonstrated a 48% higher incidence of VTE (relative risk = 1.48, 95% confidence interval [CI] 1.18-1.85) in the latter.Spinal anesthesia was associated with a higher risk of postoperative VTE, as compared with that associated with combined epidural/general anesthesia, in patients undergoing total arthroplasty.

  17. Tachycardia in a newborn with enterovirus infection.

    Science.gov (United States)

    Banjac, Lidija; Nikcević, Drasko; Vujosević, Danijela; Raonić, Janja; Banjac, Goran

    2014-03-01

    Enterovirus infections are common in the neonatal period. Newborns are at a higher risk of severe disease including meningoencephalitis, sepsis syndrome, cardiovascular collapse, or hepatitis. The mechanism of heart failure in patients with enterovirus infection remains unknown. Early diagnosis may help clinicians predict complications in those infants initially presenting with severe disease. An 11-day-old male newborn was admitted to our neonatal intensive care unit because of tachycardia and crises of cyanosis. His elder brother had febrile illness. The newborn was cyanotic, in respiratory distress, with tachycardia, low blood pressure and prolonged capillary refilling time. Limb pulse oximeter was around 85%. During the first day of hospitalization, the newborn had one febrile episode. Laboratory data: elevated transaminases, markers of inflammation negative, all bacterial cultures negative. Enterovirus RNA was detected in blood sample. Other blood findings were without significant abnormalities. Electrocardiogram showed tachycardia, with narrow QRS complexes (atrial tachycardia) and heart rate up to 280/min. In order to convert the rhythm, the patient was administered adenosine and amiodarone. In the further course of hospitalization, the patient was in good general condition, eucardiac and eupneic. Newborns with tachycardia and a family history of febrile illness should be suspected to have enterovirus infection. Enterovirus infection is a highly contagious and potentially life-threatening infection if not detected early. The use of sensitive molecular-based amplification methods offers potential benefits for early diagnosis and timely treatment.

  18. A congenital form of junctional ectopic tachycardia.

    Science.gov (United States)

    Tulino, Domenico; Dattilo, Giuseppe; Tulino, Viviana; Marte, Filippo; Patanè, Salvatore

    2010-11-19

    Accessory pathways have been described as well as their Ecg identification criteria also in pediatric population. Radiofrequency ablation is a curative treatment but its application has been more limited in the paediatric population. The congenital form of junctional ectopic tachycardia was firstly described by Coumel et al. in 1976. It usually occurs in the first six months of life presenting as a persistent sustained form, lasting up to 90% of the time and it is hampered by high mortality. Its clinical presentation may be dramatic, being associated in up to 60% of cases with cardiomegaly and/or heart failure. Secondary dilated cardiomyopathy, ventricular fibrillation and sudden cardiac death have also been reported. We present a case of congenital form of junctional ectopic tachycardia in a 12-day-old newborn infant. Also this case is illustrative of the congenital form of junctional ectopic tachycardia. Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.

  19. Impact of Supraventricular Tachyarrhythmia in Patients With Inherited Cardiac Arrhythmia.

    Science.gov (United States)

    Ragab, Ahmed A Y; Houck, Charlotte A; van der Does, Lisette J M E; Lanters, Eva A H; Muskens, Agnes J Q M; de Groot, Natasja M S

    2017-12-01

    Supraventricular tachyarrhythmia (SVT), especially atrial fibrillation (AF), has been observed in patients with inherited cardiac arrhythmia (ICA). Data on the time course of SVT and the occurrence of SVT other than AF is limited. In this study, we examined the prevalence, co-existence, and the time course of different types of SVT in patients with various ICAs. In this retrospective study, we selected 393 patients (median 49 years, range 17 to 87, 57% male) from a cohort of patients visiting the outpatient clinic for cardiogenetic screening of ICA. Patients' medical records were examined for the occurrence of AF and other SVT. AF/SVT was found in 49 patients (12%, 31 male, 42 ± 17 years). Patients presenting with only AF (n = 12, 3%) were older than patients presenting with only SVT (n = 28, 7%), respectively 52 ± 18 versus 37 ± 14, p = 0.007. Nineteen patients (5%) had multiple episodes of either AF (n = 7, 2%) or SVT (n = 12, 3%). Alternating episodes of AF and SVT occurred in 9 patients (2%). Intervals between second and third AF episodes were significantly shorter than between first and second episodes (p = 0.02). An implantable cardioverter defibrillator (ICD) was implanted in 158 patients (40.2%) and 26 patients (16%) had inappropriate ICD shocks (SVT 25, AF 1), particularly those with multiple SVT episodes (p = 0.003). In patients with a variety of ICAs, episodes of AF/SVT occurred in 12%. In patients with multiple AF episodes, intervals between consecutive episodes became significantly shorter over time. AF/SVT episodes are associated with inappropriate ICD shocks and aggressive therapy of AF/SVT is therefore justified. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Slow pathway modification in patients presenting with only two consecutive AV nodal echo beats.

    Science.gov (United States)

    Wegner, Felix K; Silvano, Maria; Bögeholz, Nils; Leitz, Patrick R; Frommeyer, Gerrit; Dechering, Dirk G; Zellerhoff, Stephan; Kochhäuser, Simon; Lange, Philipp S; Köbe, Julia; Wasmer, Kristina; Mönnig, Gerold; Eckardt, Lars; Pott, Christian

    2017-02-01

    Slow pathway modification (SPM) is the therapy of choice for AV-nodal reentry tachycardia (AVNRT). When AVNRT is not inducible, empirical ablation can be considered, however, the outcome in patients with two AV nodal echo beats (AVNEBs) is unknown. Out of a population of 3003 patients who underwent slow pathway modification at our institution between 1993 and 2013, we retrospectively included 32 patients with a history of symptomatic tachycardia, lack of paroxysmal supraventricular tachycardia (pSVT) inducibility but occurrence of two AVNEBs. pSVT documentation by electrocardiography (ECG) was present in 20 patients. The procedural endpoint was inducibility of less than two AVNEBs. This was reached in 31 (97%) patients. Long-term success was assessed by a telephone questionnaire (follow-up time 63±9 months). A total 94% of the patients benefited from the procedure (59% freedom from symptoms; 34% improvement in symptoms). Among those patients in whom ECG documentation was not present, 100% benefited (58% freedom from symptoms, 42% improvement). This is the first collective analysis of a group of patients presenting with symptoms of pSVT and inducibility of only two AVNEBs. Procedural success and clinical long-term follow-up were in the range of the reported success rates of slow pathway modification of inducible AVNRT, independent of whether ECG documentation was present. Thus, SPM is a safe and effective therapy in patients with two AVNEBs. Copyright © 2016. Published by Elsevier Ltd.

  1. Bidirectional ventricular tachycardia of unusual etiology

    Directory of Open Access Journals (Sweden)

    Praloy Chakraborty

    2015-11-01

    Full Text Available Bidirectional ventricular tachycardia (BDVT is a rare form of ventricular arrhythmia, characterized by changing QRS axis of 180 degrees. Digitalis toxicity is considered as commonest cause of BDVT; other causes include aconite toxicity, myocarditis, myocardial infarction, metastatic cardiac tumour and cardiac channelopathies. We describe a case of BDVT in a patient with Anderson-Tawil syndrome.

  2. Tachycardia During Resistance Exercise: A Case Study.

    Science.gov (United States)

    Fry, Andrew C.; Parks, Michael J.

    2001-01-01

    This case study examined a weight-trained (WT) male who had an unusually high heart rate response to heavy resistance exercise and self-administered anabolic androgenic steroids as an ergogenic aid to training. The subject was compared to 18 other WT people. His tachycardia response occurred only in the presence of a pressure load and not with a…

  3. Lesional tachycardias related to mitral valve surgery.

    Science.gov (United States)

    Markowitz, Steven M; Brodman, Richard F; Stein, Kenneth M; Mittal, Suneet; Slotwiner, David J; Iwai, Sei; Das, Mithilesh K; Lerman, Bruce B

    2002-06-19

    The purpose of this study was to define the anatomic distribution of electrically abnormal atrial tissue and mechanisms of atrial tachycardia (AT) after mitral valve (MV) surgery. Atrial tachycardia is a well-recognized long-term complication of MV surgery. Because atrial incisions from repair of congenital heart defects provide a substrate for re-entrant arrhythmias in the late postoperative setting, we hypothesized that atriotomies or cannulation sites during MV surgery also contributed to postoperative arrhythmias. In 10 patients with prior MV surgery, electroanatomic maps were constructed of 11 tachycardias (6 right atrium [RA], 4 left atrium [LA] and 1 biatrial). Activation and voltage maps were used to identify areas of low voltage, double potentials and conduction block. Lesions were present in the lateral wall of the RA (six of seven maps) and in the LA along the septum adjacent to the right pulmonary veins (four of five maps). In 8 of 10 patients, these findings corresponded to atrial incisions or cannulation sites. Arrhythmia mechanisms were identified for 9 of 11 tachycardias. A macro-re-entrant circuit was mapped in six cases, three involving lesions in the lateral wall of the RA and three involving the LA septum and right pulmonary veins. In three of these cases figure-of-eight re-entry was demonstrated, and in the other three a single macro-re-entrant circuit was observed. In three other cases, a focal origin was identified adjacent to abnormal tissue in the RA (two cases) or within a pulmonary vein (one case). Surgical incisions for MV surgery provide a substrate for atrial arrhythmias. Both macro-re-entrant and focal mechanisms contribute to AT after MV surgery.

  4. A Simple Method to Differentiate Atrioventricular Node Reentrant Tachycardia from Orthodromic Reciprocating Tachycardia.

    Science.gov (United States)

    He, Quan; Lei, Sen; Jia, Feng-Peng; Gao, Ling-Yun; W X Zhu, Dennis

    2018-01-27

    Discrimination between atrioventricular node reentry tachycardia (AVNRT) and orthodromic reciprocating tachycardia (ORT) during an electrophysiological study is sometimes challenging. This study aimed to investigate if the difference in the local VA (ventricle-atrium) interval during ventricular entrainment pacing and during tachycardia (DVA, defined as the shortest local VA interval of coronary sinus [CS] during entrainment minus the shortest local VA interval of CS during tachycardia) was different in patients with AVNRT and patients with ORT.Diagnoses of AVNRT or ORT through a concealed accessory pathway (AP) were made according to conventional electrophysiological criteria and ablation results. Entrainment by right ventricular (RV) pacing was performed in each patient before ablation and patients with successful entrainment were included in the study. The DVA was compared between patients with AVNRT and patients with ORT. The DVA in patients with AVNRT was significantly longer than that in patients with ORT (120 ± 20 versus 5.7 ± 9; P DVA was more than 48 ms. In each patient with ORT using a left free wall accessory pathway (AP), right free wall AP, and septal AP, the DVA was less than 20 ms.DVA was found to be a rapid, useful test in distinguishing patients with AVNRT from those with ORT.

  5. Pseudo ventricular tachycardia: a case report.

    LENUS (Irish Health Repository)

    Riaz, A

    2012-02-01

    BACKGROUND: Dramatic artifacts of pseudo flutter have been reported in the past secondary to various factors including tremor (Handwerker and Raptopoulos in N Engl J Med 356:503, 2007) and dialysis machines (Kostis et al. in J Electrocardiol 40(4):316-318, 2007). METHODS: We present this unusual case where the artifact, produced by tremor, was so pronounced to be misdiagnosed and treated as ventricular tachycardia. CONCLUSION: This case highlights the importance of correlating ECG findings with history and clinical examination and of using 12 lead ECGs for rhythm interpretation especially to confirm consistence of arrhythmias in all leads.

  6. Catecholaminergic polymorphic ventricular tachycardia in 2012

    Directory of Open Access Journals (Sweden)

    Christian van der Werf

    2011-12-01

    Full Text Available Catecholaminergic polymorphic ventricular tachycardia (CPVT is a rare, potentially lethal inherited arrhythmia syndrome characterized by stress or emotion-induced ventricular arrhythmias. CPVT was first described in 1960, while the genetic basis underlying this syndrome was discovered in 2001. The past decade has seen substantial advances in understanding the pathophysiology of CPVT. In addition, significant advances have been made in elucidating clinical characteristics of CPVT patients and new treatment options have become available. Here, we review current literature on CPVT to present state-of-the-art knowledge on the subject of the genetic basis, pathophysiology, clinical presentation, diagnosis, treatment and prognosis.

  7. Ventricular tachycardia in ischemic heart disease substrates

    Directory of Open Access Journals (Sweden)

    Olujimi A. Ajijola

    2014-01-01

    This review will discuss the central role of the ischemic heart disease substrate in the development MMVT. Electrophysiologic characterization of the post-infarct myocardium using bipolar electrogram amplitudes to delineate scar border zones will be reviewed. Functional electrogram determinants of reentrant circuits such as isolated late potentials will be discussed. Strategies for catheter ablation of reentrant ventricular tachycardia, including structural and functional targets will also be examined, as will the role of the epicardial mapping and ablation in the management of recurrent MMVT.

  8. Ablation of supraventricular arrhythmias in adult congenital heart disease: A contemporary review.

    Science.gov (United States)

    Combes, Nicolas; Derval, Nicolas; Hascoët, Sebastien; Zhao, Alexandre; Amet, Denis; Le Bloa, Mathieu; Maltret, Alice; Heitz, François; Thambo, Jean-Benoit; Marijon, Eloi

    2017-05-01

    Supraventricular arrhythmias are an important and increasing cause of morbidity in adults with congenital heart disease, requiring specific management strategies. Pharmacological treatment has limited efficacy, and is often associated with some side-effects. Major improvements in catheter ablation techniques have opened new opportunities to better understand underlying mechanisms of supraventricular arrhythmias, offer better therapy, and eventually improve symptoms and quality of life in these patients. An array of tools and techniques are necessary to access relevant anatomical areas to address the arrhythmogenic substrate. The mechanism of these arrhythmias is mostly related to macroreentry around surgical scars or cavotricuspid isthmus-dependent flutter. The efficacy of catheter ablation is mainly dependent on the underlying congenital heart condition, with the most complex cases typically being associated with atrial switch and Fontan surgeries. Although relatively high rates of recurrence are seen after a single procedure, additional attempts are often helpful to decrease recurrences and improve symptoms. Catheter ablation in such patients continues to present many unique challenges that are best addressed by experienced multidisciplinary teams, at centres equipped with the proper catheters, imaging capabilities, mapping systems and support staff needed to maximize safety and success. Consensus indications have emerged that often support ablation as first-line therapy in these patients. In this comprehensive review, we aim to describe the specific issues associated with ablation of supraventricular arrhythmias in adult congenital heart disease, assess the results in contemporary practice and, finally, review the current indications. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Cardiac development : the posterior heart field and atrioventricular reentry tachycardia

    NARCIS (Netherlands)

    Hahurij, Nathan Dominggus

    2011-01-01

    This thesis is separated in two parts (Part I and Part II) in which normal and abnormal heart development are studied and related to congenital heart disease, in particular to the etiology of supraventricular arrhythmias in fetuses and neonates. Part I describes the development of the posterior

  10. Body-surface QRST integral mapping. Arrhythmogenic righ ventricular dysplasia versus idiopathic right ventricular tachycardia

    NARCIS (Netherlands)

    Peeters, H. A.; SippensGroenewegen, A.; Schoonderwoerd, B. A.; Wever, E. F.; Grimbergen, C. A.; Hauer, R. N.; Rohles de Medina, E. O.

    1997-01-01

    Ventricular tachycardia originating in the right ventricle may arise in the presence or absence of structural heart disease. The two main causes of right ventricular tachycardia are arrhythmogenic right ventricular dysplasia (ARVD) and idiopathic right ventricular tachycardia (IRVT) originating from

  11. Current topics in catecholaminergic polymorphic ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Naokata Sumitomo, MD, PhD

    2016-10-01

    Full Text Available Catecholaminergic polymorphic ventricular tachycardia (CPVT is induced by emotions or exercise in patients without organic heart disease and may be polymorphic or bidirectional in nature. The prognosis of CPVT is not good, and therefore prevention of sudden death is of utmost importance. Genetic variants of CPVT include RyR2, CASQ2, CALM2, TRD, and possibly KCNJ2 and ANK2 gene mutations. Hypotheses that suggest the causes of CPVT include weakened binding of FKBP12.6 and RyR2, a store overload-induced Ca2+ release (SOICR, unzipping of intramolecular domain interactions in RyR2, and molecular and functional abnormalities caused by mutations in the CASQ2 gene. The incidence of an RyR2 anomaly in CPVTs is about 35–79%, whereas anomalies in the CASQ2 gene account for 3–5% CPVTs. The ping-pong theory, suggesting that reciprocating delayed after depolarization induces bigeminy of the right and left bundle branches, may explain the pathogenesis of bidirectional ventricular tachycardia. Flecainide, carvedilol, left sympathetic nerve denervation, and catheter ablation of the PVC may serve as new therapeutic strategies for CPVT while gene-therapy may be applied to some types of CPVT in the future. Although, not all sudden cardiac deaths in CPVT patients are currently preventable, new medical and interventional therapies may improve CPVT prognosis.

  12. Torsade de pointes ventricular tachycardia in a newborn infant.

    Science.gov (United States)

    Finley, J P; Radford, D J; Freedom, R M

    1978-01-01

    A case of paroxysmal ventricular tachycardia of torsade de pointes variety occurring in a newborn infant is described. A rare problem in the newborn, ventricular tachycardia has been associated with congenital heart disease, electrolyte abnormality, and cardiac tumour. In this case, the association was with myocarditis. The arrhythmia was refractory to treatment, and the infant died. Images PMID:646910

  13. Test Characteristics of Neck Fullness and Witnessed Neck Pulsations in the Diagnosis of Typical AV Nodal Reentrant Tachycardia

    Science.gov (United States)

    Sakhuja, Rahul; Smith, Lisa M; Tseng, Zian H; Badhwar, Nitish; Lee, Byron K; Lee, Randall J; Scheinman, Melvin M; Olgin, Jeffrey E; Marcus, Gregory M

    2011-01-01

    Summary Background Claims in the medical literature suggest that neck fullness and witnessed neck pulsations are useful in the diagnosis of typical AV nodal reentrant tachycardia (AVNRT). Hypothesis Neck fullness and witnessed neck pulsations have a high positive predictive value in the diagnosis of typical AVNRT. Methods We performed a cross sectional study of consecutive patients with palpitations presenting to a single electrophysiology (EP) laboratory over a 1 year period. Each patient underwent a standard questionnaire regarding neck fullness and/or witnessed neck pulsations during their palpitations. The reference standard for diagnosis was determined by electrocardiogram and invasive EP studies. Results Comparing typical AVNRT to atrial fibrillation (AF) or atrial flutter (AFL) patients, the proportions with neck fullness and witnessed neck pulsations did not significantly differ: in the best case scenario (using the upper end of the 95% confidence interval [CI]), none of the positive or negative predictive values exceeded 79%. After restricting the population to those with supraventricular tachycardia other than AF or AFL (SVT), neck fullness again exhibited poor test characteristics; however, witnessed neck pulsations exhibited a specificity of 97% (95% CI 90–100%) and a positive predictive value of 83% (95% CI 52–98%). After adjustment for potential confounders, SVT patients with witnessed neck pulsations had a 7 fold greater odds of having typical AVNRT, p=0.029. Conclusions Although neither neck fullness nor witnessed neck pulsations are useful in distinguishing typical AVNRT from AF or AFL, witnessed neck pulsations are specific for the presence of typical AVNRT among those with SVT. PMID:19479968

  14. Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia: Success Rates and Complications during 14 Years of Experience

    Directory of Open Access Journals (Sweden)

    Mansour Moghaddam

    2010-05-01

    Full Text Available Background: Radiofrequency catheter ablation (RFCA has been introduced as the treatment of choice for supraventricular tachycardia. The aim of this study was to evaluate the success rate as well as procedural and in-hospital complications of RFCA for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT.Methods: Between March 1995 and February 2009, 544 patients (75.9% female, age: 48.89 ± 13.19 years underwent 548 RFCAs for AVNRT in two large university hospitals. Echocardiography was performed for all the patients before and after the procedure. Electrocardiograms were recorded on digital multichannel systems (EP-Med or Bard EP system. Anticoagulation was initiated during the procedure.Results: From the 548 patients, 36 had associated arrhythmias, atrial flutter (4%, atrial fibrillation (0.7%, concurrent atrial fibrillation and atrial flutter (0.7%, and concealed atrioventricular pathway (0.4%. The overall success rate was 99.6%. There were 21 (3.9% transient III-degree AV blocks (up to a few seconds and 4 (0.7% prolonged II- or III-degree AV blocks, 2 (0.25% of which required permanent pacemaker insertion, 3(0.5% deep vein thrombosis, and one (0.2% arteriovenous fistula following the procedure. No difference was observed in the echocardiography parameters before and after the ablation.Conclusion: RFCA had a high success rate. The complication rate was generally low and in the above-mentioned centers it was similar to those in other large centers worldwide. Echocardiography showed no difference before and after the ablation. The results from this study showed that the risk of permanent II or III-degree AV block in patients undergoing RFCA was low and deep vein thrombosis was the second important complication. There was no risk of life-threatening complications.

  15. A review of postural orthostatic tachycardia syndrome.

    LENUS (Irish Health Repository)

    Carew, Sheila

    2012-01-31

    A 21-year-old female reports an 18-month history of light-headedness on standing. This is often associated with palpitations and a feeling of intense anxiety. She has had two black-outs in the past 12 months. She is not taking any regular medications. Her supine blood pressure was 126\\/84 mmHg with a heart rate of 76 bpm, and her upright blood pressure was 122\\/80 mmHg with a heart rate of 114 bpm. A full system examination was otherwise normal. She had a 12-lead electrocardiogram performed which was unremarkable. She was referred for head-up tilt testing. She was symptomatic during the test and lost consciousness at 16 min. Figure 1 summarizes her blood pressure and heart rate response to tilting. A diagnosis of postural orthostatic tachycardia syndrome with overlapping vasovagal syncope was made.

  16. [Poorly tolerated broad QRS complex tachycardia in a newborn].

    Science.gov (United States)

    Affangla, Désiré Alain; Leye, Mohamed; Simo, Angèle Wabo; D'Almeida, Franck; Sarr, Thérèse Yandé; Phiri, Adamson; Kane, Adama

    2017-01-01

    Poorly tolerated broad QRS complex tachycardia in a newborn poses problems with its diagnosis and emergency management. We report the case of a 35-day-old newborn with broad QRS complex tachycardia admitted because of cardiocirculatory distress. Doppler echocardiography showed morphologically normal heart. The patient received a loading dose of amiodarone but it didn't attenuate tachycardia. Normal sinus rhythm was restored after cardioversion through Lifeline semi-automatic external defibrillator. Maintenance therapy was based on oral amiodarone. The patient had normal sinus rhythm at 03 months of follow-up.

  17. Novel Mapping Strategies for Ventricular Tachycardia Ablation.

    Science.gov (United States)

    Aziz, Zaid; Tung, Roderick

    2018-03-23

    Despite advances in antiarrhythmic and device therapy, ventricular tachycardia (VT) continues to be a major cause of increased morbidity and mortality. During scar-mediated monomorphic ventricular tachycardia ablation, the search for critical isthmus sites continues to be the primary goal during successful ablative procedures. However, given the overwhelming hemodynamic instability of most ventricular arrhythmias (> 70%), VT ablation is increasingly performed during sinus rhythm. This technique requires either a greater reliance on isthmus surrogates, or more extensive ablation techniques and is a more probabilistic approach to substrate modification. We believe that a better understanding of scar physiology and activation during sinus rhythm has important implications for clinical workflow and mechanistic improvements with current ablation strategies. With advancements in high-density mapping and multi-electrode catheter technology, mapping of VT substrates is performed with higher resolution, with improved visualization of local abnormal ventricular activities (LAVA), and with a more nuanced functional understanding of late potentials. As a prerequisite, our practice for VT ablation starts with a high-density structural map to identify voltage abnormalities as well as an isochronal functional map of sinus rhythm activation to identify region of discontinuous wavefront propagation. As the era of increased automation has emerged, there continues to be vast array of customizable features, and we have adopted the use of multiple wavefront mapping to further elucidate possible arrhythmogenic substrate. Our emerging understanding of how scar propagation patterns relate to areas of abnormal signals and critical isthmuses may greatly improve the ability to identify surrogates during sinus rhythm and help localize the most arrhythmogenic regions within a given scar. In the hemodynamically unstable patients, we routinely integrate isochronal late activation mapping (ILAM

  18. [Idiopathic ventricular tachycardia, an arrhythmia with good prognosis].

    NARCIS (Netherlands)

    Camaro, C.; Bos, H.S.; Smeets, J.L.R.M.

    2010-01-01

    Three patients, one experiencing palpitations and two complaining of chest pain in stressful situations, appeared to have monomorphic wide complex tachycardia. After excluding channelopathy, structural abnormalities and ischaemia of the heart, this arrhythmia was classified as idiopathic. Symptoms

  19. Ventricular Tachycardia Triggered by Loperamide and Famotidine Abuse.

    Science.gov (United States)

    Larsen, Timothy R; McMunn, Jedediah; Ahmad, Hala; AlMahameed, Soufian T

    2018-02-17

    A 32-year-old male developed recurrent ventricular tachycardia after taking mega doses of loperamide and famotidine in order to experience an opiate-like euphoric effect. He was taking up to 200 mg of loperamide and multiple doses of famotidine each day. He developed palpitations and syncope. Electrocardiography demonstrated ventricular tachycardia and QT interval prolongation (corrected QT interval was 597 ms). He was diagnosed with loperamide-induced QT prolongation resulting in incessant ventricular tachycardia. Loperamide was discontinued, and he was treated with electrolyte replacement, supportive care, and monitoring. After 5 days, his electrocardiogram (ECG) normalized and he had no more ventricular tachycardia. A Naranjo assessment score of 8 was obtained, indicating a probable relationship between QT prolongation and his use of loperamide. Large doses of loperamide can cause QT interval prolongation and life-threatening arrhythmias. These effects may be accentuated when histamine-2 receptor blockers are also abused.

  20. Effect of Pregnancy on Postural Tachycardia Syndrome

    Science.gov (United States)

    Kimpinski, Kurt; Iodice, Valeria; Sandroni, Paola; Low, Phillip A.

    2010-01-01

    OBJECTIVES: To compare the clinical presentation, autonomic dysfunction, and pregnancy outcomes in parous and nulliparous women with postural tachycardia syndrome (POTS) and in women with POTS before and after pregnancy. PATIENTS AND METHODS: This study consists of women who had at least 1 pregnancy during which time they met criteria for POTS between May 1993 and July 2009. All patients underwent standard autonomic testing. POTS was defined as a heart rate (HR) increase of greater than 30 beats/min on head-up tilt (HUT) with symptoms of orthostatic intolerance. Patients' charts were reviewed retrospectively to determine pregnancy outcomes. RESULTS: Clinical characteristics related to POTS did not differ between parous and nulliparous women except for disease duration (parous, 3.7±2.6; nulliparous, 2.1±2.2; Pchange in HR on HUT: parous, 42.6±12.0 beats/min; nulliparous, 41.3±10.6 beats/min; P=.39). Of 116 total pregnancies, adverse pregnancy outcomes were reported in 9% and maternal complications in 1%. No complication was related to POTS. There was a trend toward modest improvement in autonomic dysfunction before and after pregnancy (change in HR on HUT: before pregnancy, 38.1±22.7 beats/min; after pregnancy, 21.9±14.9 beats/min; P=.07). CONCLUSION: The long-term impact of pregnancy on POTS does not appear to be clinically important. However, there does appear to be a trend toward improvement in the short-term postpartum period. Adverse pregnancy events were similar to those seen in the general public and do not present a barrier to women with POTS who want to have children. PMID:20516426

  1. Catheter ablation of epicardial ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Takumi Yamada, MD, PhD

    2014-08-01

    Full Text Available Ventricular tachycardias (VTs can usually be treated by endocardial catheter ablation. However, some VTs can arise from the epicardial surface, and their substrate can be altered only by epicardial catheter ablation. There are two approaches to epicardial catheter ablation: transvenous and transthoracic. The transvenous approach through the coronary venous system (CVS has been commonly used because it is easily accessible. However, this approach may be limited by the distribution of the CVS and insufficient radiofrequency energy delivery. Transthoracic epicardial catheter ablation has been developed to overcome these limitations of the transvenous approach. It is a useful supplemental or even preferred strategy to eliminate epicardial VTs in the electrophysiology laboratory. This technique has been applied for scar-related VTs secondary to often non-ischemic cardiomyopathy and sometimes ischemic cardiomyopathy, and idiopathic VTs as the epicardial substrates of these VTs have become increasingly recognized. When endocardial ablation and epicardial ablation through the CVS are unsuccessful, transthoracic epicardial ablation should be the next option. Intrapericardial access is usually obtained through a subxiphoidal pericardial puncture. This approach might not be possible in patients with pericardial adhesions caused by prior cardiac surgery or pericarditis. In such cases, a hybrid procedure involving surgical access with a subxiphoid pericardial window and a limited anterior or lateral thoracotomy might be a feasible and safe method of performing an epicardial catheter ablation in the electrophysiology laboratory. Potential complications associated with this technique include bleeding and collateral damage to the coronary arteries and phrenic nerve. Although the risk of these complications is low, electrophysiologists who attempt epicardial catheter ablation should know the complications associated with this technique, how to minimize their

  2. Cardiac Fibroma in a Neonate Presenting With Dyspnea and Tachycardia: A Very Rare Case Tachycardia

    Directory of Open Access Journals (Sweden)

    Anvari Shahriar

    2016-01-01

    Full Text Available Introduction: Cardiac tumors can be divided to primary and secondary and to benign and malignant tumors. One of the benign tumors of the heart is cardiac fibroma. More than 80% of this tumor occurs in children; however its occurrence in neonates is very rare. Fewer than 100 cases have been reported. Case Presentation: Our patient is a 10 day’s girl neonate with severe dyspnea, mild cyanosis, tachycardia (heart rate = 170- 180/min and obstruction of right ventricle (RV outlet with very large tumor. Conclusion: Cardiac tumors in neonate population must be considered in the diagnosis of arrhythmias, cardiac insufficiency, valvular disease, cardiomegaly or presence of murmurs. Early diagnosis before birth should be appropriate and accurate imaging devices must be used in detecting these tumors.

  3. Ventricular tachycardia associated with radiation-induced cardiac sarcoma.

    Science.gov (United States)

    Beaty, Elijah H; Ballany, Wassim; Trohman, Richard G; Madias, Christopher

    2014-12-01

    Cardiac tumors can lead to distinct electrocardiographic changes and ventricular arrhythmias. Benign and malignant cardiac tumors have been associated with ventricular tachycardia. When possible, benign tumors should be resected when ventricular arrhythmias are intractable. Chemotherapy can shrink malignant tumors and eliminate arrhythmias. We report the case of a 52-year-old woman with breast sarcoma whom we diagnosed with myocardial metastasis after she presented with palpitations. The initial electrocardiogram revealed sinus rhythm with new right bundle branch block and ST-segment elevation in the anterior precordial leads. During telemetry, hemodynamically stable, sustained ventricular tachycardia with right ventricular localization was detected. Images showed a myocardial mass in the right ventricular free wall. Amiodarone suppressed the arrhythmia. To our knowledge, this is the first report of ventricular tachycardia associated with radiation-induced undifferentiated sarcoma. We discuss the distinct electrocardiographic changes and ventricular arrhythmias that can be associated with cardiac tumors, and we review the relevant medical literature.

  4. Exploring postinfarction reentrant ventricular tachycardia with entrainment mapping.

    Science.gov (United States)

    Stevenson, W G; Friedman, P L; Sager, P T; Saxon, L A; Kocovic, D; Harada, T; Wiener, I; Khan, H

    1997-05-01

    Ventricular tachycardia late after myocardial infarction is usually due to reentry in the infarct region. These reentry circuits can be large, complex and difficult to define, impeding study in the electrophysiology laboratory and making catheter ablation difficult. Pacing through the electrodes of the mapping catheter provides a new approach to mapping. When pacing stimuli capture the effects on the tachycardia depend on the location of the pacing site relative to the reentry circuit. The effects observed allow identification of various portions of the reentry circuit, without the need for locating the entire circuit. Isthmuses where relatively small lesions produced by radiofrequency catheter ablation can interrupt reentry can often be identified. A classification that divides reentry circuits into one or more functional components helps to conceptualize the reentry circuit and predicts the likelihood that heating with radiofrequency current will terminate tachycardia. These methods are helping to define human reentry circuits.

  5. Vortex Flow in the Right Atrium Surrogates Supraventricular Arrhythmia and Thrombus After Atriopulmonary Connection-Type Fontan Operation: Vortex Flow Analysis Using Conventional Cine Magnetic Resonance Imaging.

    Science.gov (United States)

    Shiina, Yumi; Inai, Kei; Takahashi, Tatsunori; Shimomiya, Yamato; Ishizaki, Umiko; Fukushima, Kenji; Nagao, Michinobu

    2018-02-01

    We developed a novel imaging technique, designated as vortex flow (VF) mapping, which presents a vortex flow visually on conventional two-dimensional (2D) cine MRI. Using it, we assessed circumferential VF patterns and influences on RA thrombus and supraventricular tachycardia (SVT) in AP connection-type Fontan circulation. Retrospectively, we enrolled 27 consecutive patients (25.1 ± 9.2 years) and 7 age-matched controls who underwent cardiac MRI. Conventional cine images acquired using a 1.5-Tesla scanner were scanned for axial and coronal cross section of the RA. We developed "vortex flow mapping" to demonstrate the ratio of the circumferential voxel movement at each phase to the total movement throughout a cardiac cycle towards the RA center. The maximum ratio was used as a magnitude of vortex flow (MVF%) in RA cine imaging. We also measured percentages of strong and weak VF areas (VFA%). Furthermore, in 10 out of 27, we compared VF between previous CMR (3.8 ± 1.5 years ago) and latest CMR. Of the patients, 15 had cardiovascular complications (Group A); 12 did not (Group B). A transaxial image showed that strong VFA% in Group A was significantly smaller than that in Group B or controls. A coronal view revealed that strong VFA% was also smaller, and weak VFA% was larger in Group A than in Group B or controls (P < 0.05, and P < 0.05). Maximum MVF% in Group A was significantly smaller than in other groups (P < 0.001). Univariate logistic analyses revealed weak VFA% on a coronal image, and serum total bilirubin level as factors affecting cardiovascular complications (Odds ratio 1.14 and 66.1, 95% CI 1.004-1.30 and 1.59-2755.6, P values < 0.05 and < 0.05, respectively). Compared to the previous CMR, smaller maximum VMF%, smaller strong VFA%, and larger weak VFA% were identified in the latest CMR. Circumferentially weak VFA% on a coronal image can be one surrogate marker of SVT and thrombus in AP connection-type Fontan circulation. This simple VF

  6. Ventricular tachycardia reveals cardiac infiltration due to mediastinal lymphoma.

    Science.gov (United States)

    Algalarrondo, Vincent; Misra, Srimanta C; Bennani, Soumia L; Mabille, Mylene; Cavailloles, Françoise; Machover, David; Slama, Michel S

    2010-09-01

    A 61-year-old man was referred to us for palpitations and ventricular tachycardia. After being treated by chemotherapy for a mediastinum lymphoplasmocytic lymphoma, a ventricular tachycardia (VT) occurred. It was well tolerated. Several imaging techniques showed that this VT was related to a tumoural infiltration of the anterior part of the right ventricle by the lymphoma. Ventricular arrhythmias were controlled under antiarrhythmic drugs and chemotherapy was continued, with close cardiac follow-up. Complete remission was reached with restoration of a normal right ventricular function and resolution of the ventricular arrhythmias.

  7. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Kernan Scott

    2010-01-01

    Full Text Available Postural orthostatic tachycardia syndrome (POTS is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.

  8. Slow-fast Form of Atrioventricular Nodal Reentrant Tachycardia with Unusual Retrograde Activation in the Right Atrium —Possible Conduction Disturbance across the Tendon of Todaro Related to the Genesis of Positive Component of Biphasic Retrograde P Wave—

    Directory of Open Access Journals (Sweden)

    Kazuya Ishibashi, MD

    2006-01-01

    Full Text Available We report a rare case of slow-fast form of atrioventricular nodal reentrant tachycardia with delayed activation in the low septal right atrium (His bundle area. During supraventricular tachycardia (SVT, electrocardiogram showed “pseudo-positive P waves” in II, III, and aVF leads. SVT was induced by atrial extrastimulus with marked AH prolongation (i.e., jump phenomenon. Ventricular pacing showed a decremental retrograde conduction without jump phenomenon. Double atrial potentials were observed in the His bundle area during SVT and during ventricular pacing. The first electrogram of these split potentials, which was the earliest activation during SVT and during ventricular pacing, showed a dull and small deflection, whereas the second electrogram was sharp and clear. The interval of these discrete potentials was 70 msec during SVT. After a standard slow pathway ablation, SVT could never be induced by any programmed stimuli. It was concluded that in this case, the conduction disturbance across the tendon of Todaro was likely to cause the delayed atrial activation in the His bundle area, which created the pseudo-positive (biphasic. retrograde P wave.

  9. Brugada ECG Pattern Unmasked by IV Flecainide in an Individual with Idiopathic Fascicular Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Andrew R. Gavin, MBChB

    2013-01-01

    Full Text Available A 45-year old man presents with stable monomorphic ventricular tachycardia. He had previously been diagnosed with idiopathic fascicular ventricular tachycardia. Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG. We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

  10. An approach to the patient with a suspected tachycardia in the ...

    African Journals Online (AJOL)

    Either way, the tachycardia needs to be documented, preferably on a 12-lead electrocardiogram (ECG) for diagnosis and management. If a tachycardia is not documented, a careful history of the palpitations should be taken to see if further monitoring and investigations are required. If a tachycardia is confirmed on an ECG, ...

  11. Atrioventricular node reentrant tachycardia (AVNRT) after mitral valvuloplasty during cardiac rehabilitation.

    Science.gov (United States)

    Fallavollita, Luca; Santillo, Elpidio; Marini, Luciano; Balestrini, Fabrizio

    2012-12-01

    We descrive a patient who presents palpitations during cardiac rehabilitation after mitral valvuloplasty. ECG showed regular narrow QRS tachycardia compatible with Atrioventricular Node Reentrant Tachycardia. After slow pathway radiofrequency catheter ablation, the patient completed the rehabilitation program remained tachycardia and palpitations-free.

  12. [Catecholaminergic polymorphic ventricular tachycardia is a rare inherited heart disease.

    DEFF Research Database (Denmark)

    Holst, Anders Gaarsdal; Tfelt-Hansen, 1jacob; Olesen, Morten S

    2010-01-01

    Catecholaminergic polymorphic ventricular tachycardia is a rare inherited heart disease, which can lead to life-threatening ventricular arrhythmias in patients with a structurally normal heart. The age of onset is usually between two and 12 years and the initial symptom is frequently syncope...

  13. Sustained Ventricular Tachycardia and Cardiogenic Shock due to Scorpion Envenomation

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Miranda

    2014-01-01

    Full Text Available We describe a case of severe scorpion envenomation in an adult patient, with the presence of very rapid sustained ventricular tachycardia followed by cardiogenic shock, which was reversed by scorpion antivenom administration. Scorpion venom causes cardiac changes that can lead to an environment favoring arrhythmogenesis.

  14. Ventricular tachycardia in a patient with the "Chinese restaurant syndrome".

    Science.gov (United States)

    Gann, D

    1977-07-01

    A 36-year-old man developed severe weakness, palpitation, and diaphoresis 30 minutes after eating wonton soup. On admission to the hospital he was found to have ventricular tachycardia. He was given lidocaine intravenously and the rhythm converted to normal with the three minutes. It was concluded that monosodium L-glutamate might produce potentially serious arrhythmias in susceptible persons.

  15. Junctional ectopic tachycardia following repair of congenital heart ...

    African Journals Online (AJOL)

    Background: Postoperative junctional ectopic tachycardia (JET) is a rare and transient phenomenon occurring after repair of congenital heart defects. Report on this arrhythmia in the subregion is rare. We set out to determine the incidence of this arrhythmia and review the treatment and outcomes of treatment in our centre.

  16. Pharmacological treatment of young children with permanent junctional reciprocating tachycardia

    NARCIS (Netherlands)

    van Stuijvenberg, M; Beaufort-Krol, GCM; Haaksma, J; Bink-Boelkens, MTE

    2003-01-01

    Our objective was to assess the efficacy of pharmacological treatment in reducing the incidence of permanent junctional reciprocating tachycardia in young children, or to bring the mean heart rate over 24 h to a normal level. We included 21 children with a median age of 0.05 year seen with permanent

  17. Orthostatic intolerance without postural tachycardia: how much dysautonomia?

    Science.gov (United States)

    Parsaik, Ajay K; Singer, Wolfgang; Allison, Thomas G; Sletten, David M; Joyner, Michael J; Benarroch, Eduardo E; Low, Phillip A; Sandroni, Paola

    2013-08-01

    Chronic symptoms of orthostatic intolerance occur in postural tachycardia syndrome (POTS) and patients with orthostatic intolerance (OI) without tachycardia. We recently reported that deconditioning is almost universal in both patient groups. In this study, we focussed on the question of how much dysautonomia, besides orthostatic tachycardia, is there in POTS vs. OI, and how the two groups compare in regards to clinical, autonomic, laboratory, and exercise variables. We retrospectively studied all patients referred for orthostatic intolerance at Mayo Clinic between January 2006 and June 2011, who underwent standardized autonomic and exercise testing. Eighty-four POTS and 100 OI fulfilled inclusion criteria, 89 % were females. The mean age was 25 and 32 years, respectively. Clinical presentation, autonomic parameters, laboratory findings, and degree of deconditioning were overall similar between the two groups, except for the excessive orthostatic heart rate (HR) rise and mild vasomotor findings observed in POTS but not in OI (slightly larger Valsalva ratio and incomplete blood pressure recovery during Valsalva). Both groups responded poorly to various medications. Severely deconditioned patients were similar to non-deconditioned patients, except for 24 h urine volume (1,555 vs. 2,417 ml), sweat loss on thermoregulatory sweat test (1.5 vs. 0.5 %), and few respiratory parameters during exercise, which are likely clinically insignificant. Though similar in clinical presentation, POTS and OI are different entities with greater, albeit still mild, dysautonomia in POTS. The clinical and pathophysiological relevance of minimal dysautonomia in the absence of orthostatic tachycardia as seen in OI remain uncertain.

  18. Identifying sites for catheter ablation of ventricular tachycardia.

    Science.gov (United States)

    Stevenson, W G; Sager, P; Nademanee, K; Hassan, H; Middlekauff, H R; Saxon, L A; Wiener, I

    1992-06-01

    The approach to localizing sites for catheter ablation of ventricular tachycardia foci depends on the type of tachycardia. In large reentry circuits such as those arising from infarct scars, areas of slow conduction in and around the scar should be targeted. During sinus rhythm, these can be suspected from the presence of fractionated electrograms and, at some sites, long stimulus to QRS delays during pacing. Slow conduction areas can be classified as: 1. central slow conduction zone sites, 2. exits from the slow conduction zone, 3. entrances to the slow conduction zone, and 4. bystander areas which are not involved in the tachycardia circuit. In the central slow conduction zone stimulation entrains or resets tachycardia with a long stimulus to QRS (S-QRS) delay (40 to greater than 300 ms) without altering the QRS morphology (entrainment with concealed fusion). At slow conduction zone exits, presystolic electrograms are recorded during VT, the pacemap matches the VT QRS morphology, and with pacing during VT the S-QRS interval is relatively short and VT may or may not be entrained. At entrances to the slow conduction zone electrogram timing is variable but early diastolic electrograms are expected and the pace-map QRS may differ from the VT QRS morphology. Relatively late stimuli or slow trains of stimuli entrain VT with concealed fusion with a relatively longer S-QRS interval than observed in the central slow conduction zone. Early stimuli may entrain VT while altering the QRS morphology due to propagation of the stimulated antidromic wavefront out of the scar from a site other than the tachycardia exit. At bystander sites electrogram timing, pace-mapping, and the effects of programmed stimulation are variable but may occasionally mimic reentry circuit sites. Relatively late stimuli are likely to capture the site without altering the VT. If discrete electrograms are present, analysis of these during pacing may provide further evidence that the site is not in the

  19. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal

    2016-01-01

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar manage...

  20. [Non-invasive exploration methods of supraventricular arrhythmia in current practice].

    Science.gov (United States)

    Fauchier, J P; Fauchier, L; Babuty, D; Sirinelli, A; Cosnay, P

    1993-06-15

    In patients with supraventricular rhythm disorders ambulatory electro-cardiographic recording (Holter system) is an indispensable examination as it detects attacks that pass unrecorded by conventional ECG, being asymptomatic, too brief or too rare. It confirms the diagnosis, defines the factors triggering the attacks, detects the association of rhythm and conduction disorders, guides the treatment and monitors its effectiveness. Sequential ambulatory recording lends itself particularly well to this last objective. Biochemical examinations explain the cause of certain relapses (potassium depletion, high alcohol blood level) or detect the origin, clinically more or less obvious, of these disorders of rhythm (essays of thyroid hormones). Measuring blood levels of therapeutic drugs makes the handling of these various drugs safer. Finally, echocardiography detects an underlying heart disease, evaluates the size of the left atrium (a factor of relapse when it is dilated and of embolism when it harbours thrombi) and assesses the left ventricular function before administration of antiarrhythmics which, to varying extents, are all negative inotropic drugs.

  1. Role of ventricular tachycardia ablation in arrhythmogenic right ventricular cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Alberto Cipriani

    2017-11-01

    Full Text Available Arrhythmogenic right ventricular cardiomyopathy (ARVC is characterized by progressive fibro-fatty replacement of the myocardium that represents the substrate for recurrent sustained ventricular tachycardia (VT. These arrhythmias characterize the clinical course of a sizeable proportion of patients and have significant implications for their quality of life and long-term prognosis. Antiarrhythmic drugs are often poorly tolerated and usually provide incomplete control of arrhythmia relapses. Catheter ablation is a potentially effective strategy to treat frequent VT episodes and ICD shocks in ARVC patients. The aims of this review are to discuss the electrophysiological and electroanatomic substrates of ventricular tachycardia in patients with ARVC and to analyze the role of catheter ablation in their management with particular reference to selection of patients, technical issues, potential complications and outcomes.

  2. Cor triatriatum sinistrum: presentation of syncope and atrial tachycardia.

    Science.gov (United States)

    Avari, Malcolm; Nair, Sunil; Kozlowska, Zofia; Nashef, Samer

    2017-02-14

    We present a rather unusual cause for syncope associated with atrial tachycardia. A man aged 39 years presented with an episode of syncope and narrow complex tachycardia. Further investigations, including transoesophageal echocardiography, identified cor triatriatum sinistrum (CTS), a rare congenital abnormality characterised by the atrium being divided by a fibrous membrane. Although it is rare, there has been an increase in diagnosis due to developments in diagnostic imaging techniques. Symptoms are related to the size of fenestrations within the fibrous membrane. Presenting symptoms can mimic those seen in mitral stenosis. It is a condition that can occur in isolation, but it can also be associated with other cardiac abnormalities such as an atrial septal defect (ASD) (as in this case). Surgery is the definitive treatment (this man had surgical repair of CTS and closure of ASD) and should be considered at any age if there are any associated symptoms or complications. 2017 BMJ Publishing Group Ltd.

  3. Recurrent Ventricular Tachycardia in Sheehan’s Syndrome

    Directory of Open Access Journals (Sweden)

    Bashir Ahmad Laway

    2015-03-01

    Full Text Available Sheehan’s syndrome is one of the common causes of hypopituitarism in developing countries. Electrocardiographic (ECG abnormalities in Sheehan’s syndrome are not well documented. However, in hypopituitarism due to other causes, ECG findings include low-voltage QRS complex, ST segment depression, T-wave inversion and prolonged QT interval. We hereby describe a 45-year-old female who presented with a history of recurrent syncope for last three years. Electrocardiography revealed ventricular tachycardia, which reverted back with hormone replacement therapy. Since it is a common problem in our community, clinicians should consider Sheehan’s syndrome as an etiology of metabolic disturbances leading to ventricular tachycardia in women.

  4. Mutations in calmodulin cause ventricular tachycardia and sudden cardiac death

    DEFF Research Database (Denmark)

    Nyegaard, Mette; Overgaard, Michael Toft; Sondergaard, M.T.

    2012-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a devastating inherited disorder characterized by episodic syncope and/or sudden cardiac arrest during exercise or acute emotion in individuals without structural cardiac abnormalities. Although rare, CPVT is suspected to cause...... a substantial part of sudden cardiac deaths in young individuals. Mutations in RYR2, encoding the cardiac sarcoplasmic calcium channel, have been identified as causative in approximately half of all dominantly inherited CPVT cases. Applying a genome-wide linkage analysis in a large Swedish family with a severe...... calmodulin-binding-domain peptide at low calcium concentrations. We conclude that calmodulin mutations can cause severe cardiac arrhythmia and that the calmodulin genes are candidates for genetic screening of individual cases and families with idiopathic ventricular tachycardia and unexplained sudden cardiac...

  5. Postural Tachycardia Syndrome: A Heterogeneous and Multifactorial Disorder

    Science.gov (United States)

    Benarroch, Eduardo E.

    2012-01-01

    Postural tachycardia syndrome (POTS) is defined by a heart rate increment of 30 beats/min or more within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension; the standing heart rate is often 120 beats/min or higher. POTS manifests with symptoms of cerebral hypoperfusion and excessive sympathoexcitation. The pathophysiology of POTS is heterogeneous and includes impaired sympathetically mediated vasoconstriction, excessive sympathetic drive, volume dysregulation, and deconditioning. POTS is frequently included in the differential diagnosis of chronic unexplained symptoms, such as inappropriate sinus tachycardia, chronic fatigue, chronic dizziness, or unexplained spells in otherwise healthy young individuals. Many patients with POTS also report symptoms not attributable to orthostatic intolerance, including those of functional gastrointestinal or bladder disorders, chronic headache, fibromyalgia, and sleep disturbances. In many of these cases, cognitive and behavioral factors, somatic hypervigilance associated with anxiety, depression, and behavioral amplification contribute to symptom chronicity. The aims of evaluation in patients with POTS are to exclude cardiac causes of inappropriate tachycardia; elucidate, if possible, the most likely pathophysiologic basis of postural intolerance; assess for the presence of treatable autonomic neuropathies; exclude endocrine causes of a hyperadrenergic state; evaluate for cardiovascular deconditioning; and determine the contribution of emotional and behavioral factors to the patient's symptoms. Management of POTS includes avoidance of precipitating factors, volume expansion, physical countermaneuvers, exercise training, pharmacotherapy (fludrocortisone, midodrine, β-blockers, and/or pyridostigmine), and behavioral-cognitive therapy. A literature search of PubMed for articles published from January 1, 1990, to June 15, 2012, was performed using the following terms (or combination of terms): POTS

  6. Prognostic significance of nonsustained ventricular tachycardia after revascularization.

    Science.gov (United States)

    Mittal, Suneet; Lomnitz, David J; Mirchandani, Sunil; Stein, Kenneth M; Markowitz, Steven M; Slotwiner, David J; Iwai, Sei; Das, Mithilesh K; Lerman, Bruce B

    2002-04-01

    Two randomized trials (Multicenter Automatic Defibrillator Implantation Trial [MADIT] and Multicenter Unsustained Tachycardia Trial [MUSTT]) suggest that implantable cardioverter defibrillator (ICD) placement is associated with improved survival in patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia (VT) who also have inducible sustained VT. However, neither study directly addresses the management of such patients who develop nonsustained VT early after revascularization. We evaluated 109 consecutive patients who underwent electrophysiologic testing to evaluate nonsustained VT, which occurred 5 +/- 4 days following revascularization. Sustained monomorphic VT was inducible in 46 (42%) patients; these patients received an ICD. The remaining 63 (58%) noninducible patients received neither antiarrhythmic drug therapy nor an ICD. During 27 +/- 12 months of follow-up, 15 (33%) of 45 patients with an implanted ICD received at least one appropriate therapy from the device and 26 (24%) of the 109 study patients died. The 1- and 2-year freedom from ventricular tachycardia/fibrillation or sudden death in noninducible patients (97% and 93%) was significantly greater than that of inducible patients (84% and 71%; P = 0.001). However, no difference was observed in total mortality. Patients with nonsustained VT during the early postrevascularization period who have inducible VT have a high incidence of arrhythmic events. Although this study was not designed to assess the impact of ICD placement on the total mortality of inducible patients, the finding that one third of these patients received appropriate ICD therapy suggests that the device may have a protective effect in these patients.

  7. [The treatment of intranodal tachycardias with intracavitary fulguration].

    Science.gov (United States)

    Zayas, R; Dorticós, F; Dorantes, M; Nieto, C; Castro, J

    1992-01-01

    The electrical ablation of the His bundle with proximal intracardiac shocks of low energy was performed through an electrical catheter, to 14 patients with AV nodal reentry tachycardias refractory to pharmacological therapy, to whom at least 3 antiarrhythmic drugs were previously administered. The electrical energy applied oscillated between 10 to 150 Joules (114 average). 11 patients (72%) recovered the normal atrioventricular conduction and in the electrophysiological evaluation was found: 1--Increase in the duration of the AH interval. 2--No existence of two AV nodal pathways. 3--Absence of retrograde conduction. 4--Impossibility to induce tachycardia. The PR interval was prolonged (60 ms average) after the electrical shocks. These criteria defined the total effectiveness of the procedure. In the 3 remaining patients (28%) a permanent atrioventricular complete block was induced and the implantation of the permanent pacemaker was required. It was concluded that the electrical fulguration of the atrioventricular junction with low energy is an effective technique as curative treatment for intranodal reentry tachycardias, which can be applied without induction of permanent cardiac block.

  8. Familial orthostatic tachycardia due to norepinephrine transporter deficiency

    Science.gov (United States)

    Robertson, D.; Flattem, N.; Tellioglu, T.; Carson, R.; Garland, E.; Shannon, J. R.; Jordan, J.; Jacob, G.; Blakely, R. D.; Biaggioni, I.

    2001-01-01

    Orthostatic intolerance (OI) or postural tachycardia syndrome (POTS) is a syndrome primarily affecting young females, and is characterized by lightheadedness, palpitations, fatigue, altered mentation, and syncope primarily occurring with upright posture and being relieved by lying down. There is typically tachycardia and raised plasma norepinephrine levels on upright posture, but little or no orthostatic hypotension. The pathophysiology of OI is believed to be very heterogeneous. Most studies of the syndrome have focused on abnormalities in norepinephrine release. Here the hypothesis that abnormal norepinephrine transporter (NET) function might contribute to the pathophysiology in some patients with OI was tested. In a proband with significant orthostatic symptoms and tachycardia, disproportionately elevated plasma norepinephrine with standing, impaired systemic, and local clearance of infused tritiated norepinephrine, impaired tyramine responsiveness, and a dissociation between stimulated plasma norepinephrine and DHPG elevation were found. Studies of NET gene structure in the proband revealed a coding mutation that converts a highly conserved transmembrane domain Ala residue to Pro. Analysis of the protein produced by the mutant cDNA in transfected cells demonstrated greater than 98% reduction in activity relative to normal. NE, DHPG/NE, and heart rate correlated with the mutant allele in this family. CONCLUSION: These results represent the first identification of a specific genetic defect in OI and the first disease linked to a coding alteration in a Na+/Cl(-)-dependent neurotransmitter transporter. Identification of this mechanism may facilitate our understanding of genetic causes of OI and lead to the development of more effective therapeutic modalities.

  9. The relationship between ECG signs of atrial infarction and the development of supraventricular arrhythmias in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Andersen, H H; Gram-Hansen, P

    1992-01-01

    ECGs obtained on arrival at the hospital from 277 patients with acute myocardial infarction were analyzed retrospectively for PR displacements, which were classified as major or minor criteria for atrial infarction and related to the later occurrence of supraventricular arrhythmia in the hospital...... arrhythmias, giving odds ratios of 9.9 and 3.7, respectively. Enzyme-estimated infarct size, the occurrence of heart failure, and mortality rates did not differ in patients with or without major criteria for atrial infarction. We conclude that the occurrence of PR segment displacements on the admission ECG...

  10. Catheter ablation of atrial tachycardia after interatrial defect repair with patch apposition.

    Science.gov (United States)

    Nguyen, B L; Garante, C M; Tersigni, F; Sergiacomi, R; Petrassi, M; Di Matteo, A; Tufano, F; Alessandri, N

    2012-02-01

    A 54-year-old woman with history of septal atrial mixoma surgically treated and drug-refractory supraventricular tachyarrhythmia underwent catheter ablation of macro-reentry areas near the pericardial patch placed to repair an interatrial defect. The use of ablative therapy has been successful to cure this arrhythmia.

  11. Hydralazine tachycardia and sympathetic cardiovascular reactivity in normal subjects.

    Science.gov (United States)

    Vidrio, H; Tena, I

    1980-11-01

    The correlation between hydralazine-induced tachycardia and overall cardiovascular reactivity to sympathetic stimulation was explored in 50 normal subjects. Blood pressure and heart rate changes after standing, immersion of a hand in cold water, the Valsalva maneuver, and moderate exercise were compared with pressure and rate responses to 20 mg oral hydralazine. The drug did not modify blood pressure but increased heart rate, mainly in the standing position. Because plotting the magnitude of this response suggested a two-population distribution, subjects were divided into hyporeactor and hyperreactor groups. Reactivity did not appear to be related to acetylator phenotype. The magnitude of the cardiac response correlated with heart rate responses to standing and to the Valsalva maneuver; when analyzed separately from hyporeactors, correlation was greater among hyperreactors. Because the orthostatic and Valsalva responses are reflex in nature, these results suggest that hydralazine tachycardia is also reflexly induced, that its magnitude depends on individual baroreceptor sensitivity, which is distributed nonnormally, and that it can be predicted by suitable tests of sympathetic responsiveness.

  12. Catecholaminergic polymorphic ventricular tachycardia: An exciting new era

    Directory of Open Access Journals (Sweden)

    Shashank P Behere

    2016-01-01

    Full Text Available Catecholaminergic polymorphic ventricular tachycardia (CPVT is a highly malignant inheritable cardiac channelopathy. The past decade and a half has provided exciting new discoveries elucidating the genetic etiology and pathophysiology of CPVT. This review of the current literature on CPVT aims to summarize the state of the art in our understanding of the genetic etiology and the molecular pathogenesis of CPVT, and how these relate to our current approach to diagnosis and management. We will also shed light on groundbreaking new work that will continue to refine the management of CPVT in the future. As our knowledge of CPVT continues to grow, further studies will yield a better understanding of the efficacy and pitfalls of established diagnostic approaches and therapies as well as help shape newer diagnostic and treatment strategies. Two separate searches were run on the National Center for Biotechnology Information's (NCBI website. The first used the medical subject headings (MeSH database using the term “catecholaminergic polymorphic ventricular tachycardia” that was run on the PubMed database using the age filter (birth to 18 years, and it yielded 58 results. The second search using the MeSH database with the search term “catecholaminergic polymorphic ventricular tachycardia,” applying no filters yielded 178 results. The abstracts of all these articles were studied and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.

  13. Unresponsive ventricular tachycardia associated with aluminum phosphide poisoning.

    Science.gov (United States)

    Jadhav, Amar P; Nusair, Maein B; Ingole, Apekshe; Alpert, Martin A

    2012-05-01

    Inhalation or ingestion of aluminum phosphide (AP) generates phosphine gas on exposure to moisture, which, in turn, produces widespread organ toxicity primarily involving the lungs, heart, liver, and kidneys. Cardiac manifestations of AP poisoning include toxic myocarditis, refractory heart failure, bradyarrhythmias, and tachyarrhythmias including ventricular tachycardia (VT). A 19-year-old depressed male farm worker ingested ten 500-mg tablets of Celphos in a suicide attempt. Each Celphos tablet contains 56% AP. Over the course of 10 hours, the patient developed heart failure and respiratory failure associated with a rise in serum troponin level to 12.7 ng/mL. Serum electrolytes (including magnesium) and serum creatinine levels were normal throughout. His course was further complicated by acidemia and hypotension. These hemodynamic and metabolic abnormalities were initially corrected by assisted ventilation and continuous veno-venous hemofiltration. However, he developed hemodynamically stable sustained monomorphic VT, which proved unresponsive to treatment with intravenous magnesium sulfate and intravenous amiodarone therapy. After a decline in blood pressure, 6 attempts at electrocardioversion failed to restore sinus rhythm, and he died. Postmortem histologic examination of myocardium showed contraction band necrosis, early coagulation necrosis, edema, hemorrhage, and pyknosis of cardiac myocyte nuclei. Ventricular tachycardia associated with AP poisoning has been successfully treated with magnesium sulfate, amiodarone, and electrocardioversion. This case report documents failure of all 3 of these therapeutic modalities.

  14. Ventricular Tachycardia in the Absence of Structural Heart Disease

    Directory of Open Access Journals (Sweden)

    Luis R. P. Scott

    2005-04-01

    Full Text Available In up to 10% of patients who present with ventricular tachycardia (VT, obvious structural heart disease is not identified. In such patients, causes of ventricular arrhythmia include right ventricular outflow tract (RVOT VT, extrasystoles, idiopathic left ventricular tachycardia (ILVT, idiopathic propranolol-sensitive VT (IPVT, catecholaminergic polymorphic VT (CPVT, Brugada syndrome, and long QT syndrome (LQTS. RVOT VT, ILVT, and IPVT are referred to as idiopathic VT and generally do not have a familial basis. RVOT VT and ILVT are monomorphic, whereas IPVT may be monomorphic or polymorphic. The idiopathic VTs are classified by the ventricle of origin, the response to pharmacologic agents, catecholamine dependence, and the specific morphologic features of the arrhythmia. CPVT, Brugada syndrome, and LQTS are inherited ion channelopathies. CPVT may present as bidirectional VT, polymorphic VT, or catecholaminergic ventricular fibrillation. Syncope and sudden death in Brugada syndrome are usually due to polymorphic VT. The characteristic arrhythmia of LQTS is torsades de pointes. Overall, patients with idiopathic VT have a better prognosis than do patients with ventricular arrhythmias and structural heart disease. Initial treatment approach is pharmacologic and radiofrequency ablation is curative in most patients. However, radiofrequency ablation is not useful in the management of inherited ion channelopathies. Prognosis for patients with VT secondary to ion channelopathies is variable. High-risk patients (recurrent syncope and sudden cardiac death survivors with inherited ion channelopathies benefit from implantable cardioverter-defibrillator placement. This paper reviews the mechanism, clinical presentation, and management of VT in the absence of structural heart disease.

  15. 24. Entrainment of wide complex tachycardia by atrial stimulation is highly accurate and can rapidly elucidate the tachycardia mechanism through analysis of entrainment response

    Directory of Open Access Journals (Sweden)

    Abdulhakim Noman

    2015-10-01

    Conclusion: Response to atrial entrainment can be helpful in the majority of WCT patients, particularly those with 1:1 AV relationship to diagnose or rule out VT as a mechanism of tachycardia with high accuracy.

  16. Non-ventricular, Clinical, and Functional Features of the RyR2(R420Q) Mutation Causing Catecholaminergic Polymorphic Ventricular Tachycardia.

    Science.gov (United States)

    Domingo, Diana; Neco, Patricia; Fernández-Pons, Elena; Zissimopoulos, Spyros; Molina, Pilar; Olagüe, José; Suárez-Mier, M Paz; Lai, F Anthony; Gómez, Ana M; Zorio, Esther

    2015-05-01

    Catecholaminergic polymorphic ventricular tachycardia is a malignant disease, due to mutations in proteins controlling Ca(2+) homeostasis. While the phenotype is characterized by polymorphic ventricular arrhythmias under stress, supraventricular arrhythmias may occur and are not fully characterized. Twenty-five relatives from a Spanish family with several sudden deaths were evaluated with electrocardiogram, exercise testing, and optional epinephrine challenge. Selective RyR2 sequencing in an affected individual and cascade screening in the rest of the family was offered. The RyR2(R420Q) mutation was generated in HEK-293 cells using site-directed mutagenesis to conduct in vitro functional studies. The exercise testing unmasked catecholaminergic polymorphic ventricular tachycardia in 8 relatives (sensitivity = 89%; positive predictive value = 100%; negative predictive value = 93%), all of them carrying the heterozygous RyR2(R420Q) mutation, which was also present in the proband and a young girl without exercise testing, a 91% penetrance at the end of the follow-up. Remarkably, sinus bradycardia, atrial and junctional arrhythmias, and/or giant post-effort U-waves were identified in patients. Upon permeabilization and in intact cells, the RyR2(R420Q) expressing cells showed a smaller peak of Ca(2+) release than RyR2 wild-type cells. However, at physiologic intracellular Ca(2+) concentration, equivalent to the diastolic cytosolic concentration, the RyR2(R420Q) released more Ca(2+) and oscillated faster than RyR2 wild-type cells. The missense RyR2(R420Q) mutation was identified in the N-terminus of the RyR2 gene in this highly symptomatic family. Remarkably, this mutation is associated with sinus bradycardia, atrial and junctional arrhythmias, and giant U-waves. Collectively, functional heterologous expression studies suggest that the RyR2(R420Q) behaves as an aberrant channel, as a loss- or gain-of-function mutation depending on cytosolic intracellular Ca(2

  17. Clinical sustained uniform ventricular tachycardia in hypertrophic cardiomyopathy: association with left ventricular apical aneurysm.

    OpenAIRE

    Alfonso, F; Frenneaux, M P; McKenna, W J

    1989-01-01

    Of 51 patients with hypertrophic cardiomyopathy who had episodes of ventricular tachycardia detected during ambulatory electrocardiographic monitoring only two had clinical sustained uniform ventricular tachycardia that required medical treatment because of worsening symptoms. In both patients the arrhythmia was associated with the uncommon finding of an apical aneurysm with angiographically normal coronary arteries.

  18. Surgical correction of mitral valve prolapse : a cure for recurrent ventricular tachycardia in Marfan syndrome?

    Science.gov (United States)

    Beroukhim, Rebecca S; Reed, John H; Schaffer, Michael S; Yetman, Anji T

    2006-01-01

    We describe the case of a 3-year-old child with neonatal Marfan syndrome complicated by mitral valve prolapse with regurgitation, marked aortic root dilatation, and ventricular tachycardia. The patient had resolution of ventricular tachycardia following surgical intervention consisting of a valve-sparing aortic root replacement and mitral valve annuloplasty.

  19. Intolerable wide and narrow QRS complex tachycardia in the same patient: What is your diagnosis?

    Directory of Open Access Journals (Sweden)

    Tolga Aksu

    2016-06-01

    Full Text Available A 54-year-old female with recurrent syncope was referred to our institution for electrophysiological study. The patient had two documented intolerable tachycardia; one of them was a wide QRS, and the other one was a narrow QRS. As a clinical puzzle format, we aimed to present our basic electrophysiological approach of an intolerable and rare clinical tachycardia.

  20. Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Andreas Müssigbrodt

    2015-01-01

    Full Text Available Radiofrequency (RF ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.

  1. [Neonatal atrial tachycardia: suggestive clinical sign of Costello syndrome].

    Science.gov (United States)

    Laux, D; Bajolle, F; Maltret, A; Bonnet, D

    2011-10-01

    Costello syndrome is a rare association of symptoms caused by de novo germline mutations of the HRAS oncogene interfering in the RAS/mitogen-activated protein kinase (MAPK) signal transduction pathway. Mutations in this pathway are also responsible for Noonan syndrome and the related cardiofaciocutaneous syndrome (CFC) as well as LEOPARD syndrome. The 4 syndromes share phenotypic resemblances concerning patients' morphology but also regarding associated cardiac disease, namely hypertrophic cardiomyopathy, pulmonary stenosis, and atrial septal defect. The electrocardiogram often shows an upper deviation of the QRS axis. Arrhythmias are rare but, if present, are particularly typical of CS. We describe herein two newborn infants with Costello syndrome revealed by atrial tachycardia associated with characteristic morphological and cardiac features of syndromes related to mutations in the RAS/MAPK pathway. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  2. The relationship between ECG signs of atrial infarction and the development of supraventricular arrhythmias in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Andersen, H H; Gram-Hansen, P

    1992-01-01

    arrhythmias, giving odds ratios of 9.9 and 3.7, respectively. Enzyme-estimated infarct size, the occurrence of heart failure, and mortality rates did not differ in patients with or without major criteria for atrial infarction. We conclude that the occurrence of PR segment displacements on the admission ECG......ECGs obtained on arrival at the hospital from 277 patients with acute myocardial infarction were analyzed retrospectively for PR displacements, which were classified as major or minor criteria for atrial infarction and related to the later occurrence of supraventricular arrhythmia in the hospital....... Major criteria were (1) PR segment elevation greater than 0.5 mm in leads V5 and V6 with reciprocal PR segment depression in leads V1 and V2, (2) PR segment elevation greater than 0.5 mm in lead I with reciprocal PR segment depression in leads II and III, and (3) PR segment depression greater than 1...

  3. Contribution of body surface mapping to clinical outcome after surgical ablation of postinfarction ventricular tachycardia

    NARCIS (Netherlands)

    van Dessel, Pascal F.; van Hemel, Norbert M.; Groenewegen, Arne Sippens; de Bakker, Jacques M.; Linnebank, André C.; Defauw, Jo J.

    2002-01-01

    This article investigates the influence of body surface mapping on outcome of ventricular antiarrhythmic surgery. Preoperative mapping is advocated to optimize map-guided antiarrhythmic surgery of postinfarction ventricular tachycardia. We sequentially analyzed the results of catheter activation

  4. Simultaneous wide and narrow QRS complex tachycardia: what is the mechanism?

    NARCIS (Netherlands)

    Rodriguez-Manero, M.; Bayrak, F.; Namdar, M.; Casado-Arroyo, R.; Ricciardi, D.; Chierchia, G.B.; Sarkozy, A.; Asmundis, C. de; Brugada, P.

    2013-01-01

    We present the case of a 50-year-old patient with several episodes of syncope and documented simultaneous wide and narrow QRS complex tachycardia. We then review this tacharrhythmia, focusing on electrophysiological findings and pathophysiology, diagnosis and treatment.

  5. Catheter Ablation of Ectopic Atrial Tachycardia Originating from the Left Atrial Appendage using CARTOMERGE® System

    Directory of Open Access Journals (Sweden)

    Masahiko Goya, MD

    2008-01-01

    Full Text Available A 70-year-old woman was referred because of drug resistant and daily incessant palpitation attack. She had undergone two previous unsuccessful radiofrequency catheter ablations at another hospital. The physical examination, chest X-ray, and echocardiogram were all normal. The 12-lead ECG during tachycardia showed narrow QRS, short PR tachycardia and negative polarity of the P wave in leads I and aVL (Fig. 1A. The ECG monitor showed incessant tachycardia with warming-up phenomenon. Three dimensional electroanatomical map integrated with CT imaging (CARTOMERGE®, Biosense Webster Inc. clearly revealed the radial activation pattern originating from the basalo-postero-inferior aspect of the left atrial appendage. Radiofrequency energy application at this site eliminated tachycardia permanently.

  6. Incessant atrio-ventricular node reentrant tachycardia induced by unapparent dual atrio-ventricular node conduction.

    Science.gov (United States)

    Maury, Philippe; Detis, Nicolas; Duparc, Alexandre; Mondoly, Pierre; Rollin, Anne; Delay, Marc

    2013-04-01

    We present the case of a patient with incessant slow-fast atrio-ventricular (AV) node reentrant tachycardia induced by dual AV node conduction with aborted conduction to the ventricles. The unapparent conduction over the slow pathway was suspected here because of spontaneous nodal echoes without QRS complexes occurring during sinus rhythm, manifested as isolated premature atrial beats and which repetitively induced the tachycardia. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  7. His-Purkinje system-related incessant ventricular tachycardia arising from the left coronary cusp

    Directory of Open Access Journals (Sweden)

    Eiji Sato, MD

    2014-08-01

    Full Text Available We describe the case of a 23-year-old woman who had His-Purkinje system-related incessant ventricular tachycardia with a narrow QRS configuration. The ventricular tachycardia was ablated successfully in the left coronary cusp where the earliest endocardial activation had been recorded. We hypothesize that a remnant of the subaortic conducting tissue was the source of the ventricular arrhythmias.

  8. Tachycardia-Induced Cardiomyopathy in a 12-Year-Old Child With Long QT Syndrome

    Directory of Open Access Journals (Sweden)

    Ghandi

    2016-05-01

    Full Text Available Introduction Tachycardia-induced cardiomyopathy (TIC is a ventricular dysfunction secondary to chronic and persistent tachycardia that can regress partially or completely following heart rate normalization. Paroxysmal atrial tachycardia and permanent junctional reciprocating tachycardia are two types of frequent arrhythmias that can cause cardiomyopathy in children. Case Presentation A 12-year-old child with obesity (body mass index > 26.8 was admitted with fatigue, pallor and tachypnea to the clinic. He had palpitation for the past 24 hours. On the cardiac auscultation, holosystolic 2/6 murmur was heard in the apex as well as gallop rhythm. Electrocardiogram revealed heart rate of 150 - 160 bpm and negative P waves in II, III and AVF leads. The echocardiography revealed dilated cardiomyopathy with an ejection fraction of 30%. Conclusions Diagnosis of tachycardia-induced cardiomyopathy in children is important, since appropriate treatment improves the prognosis. Every child with recurrent and persistent palpitation with the first episode of congestive heart failure should be evaluated for tachycardia- induced cardiomyopathy.

  9. Relation of pace mapping QRS configuration and conduction delay to ventricular tachycardia reentry circuits in human infarct scars.

    Science.gov (United States)

    Stevenson, W G; Sager, P T; Natterson, P D; Saxon, L A; Middlekauff, H R; Wiener, I

    1995-08-01

    This study sought to determine the relation of the paced QRS configuration and conduction delay during pace mapping to reentry circuit sites in patients with ventricular tachycardia late after myocardial infarction. The QRS configuration produced by ventricular pacing during sinus rhythm (pace mapping) can locate focal idiopathic ventricular tachycardias during catheter mapping, but postinfarction reentry circuits may be relatively large and contain regions of slow conduction. We hypothesized that for postinfarction ventricular tachycardia, 1) pacing during sinus rhythm at reentry circuit sites distant from the exit from the scar would produce a QRS configuration different from the tachycardia; and 2) a stimulus to QRS delay during pace mapping may be a useful guide to reentry circuit slow conduction zones. Catheter mapping and ablation were performed in 18 consecutive patients with ventricular tachycardia after myocardial infarction. At 85 endocardial sites in 13 patients, 12-lead electrocardiograms (ECGs) were recorded during pace mapping, and participation of each site in a reentry circuit was then evaluated by entrainment techniques during induced ventricular tachycardia or by application of radiofrequency current. Pace maps resembled tachycardia at 40 ms was observed at > or = 70% of reentry circuit sites. At many sites in postinfarction ventricular reentry circuits, the QRS configuration during pace mapping does not resemble the ventricular tachycardia QRS complex, consistent with relatively large reentry circuits or regions of functional conduction block during ventricular tachycardia. A stimulus to QRS delay during pace mapping is consistent with slow conduction and may aid in targeting endocardial sites for further evaluation during tachycardia.

  10. Evaluation of medical and psychological parameters of quality of life in supraventricular tachyarrhythmia children. A comparison with healthy children.

    Science.gov (United States)

    Szafran, Emilia; Baszko, Artur; Bukowska-Posadzy, Anna; Moszura, Tomasz; Werner, Bożena; Siwińska, Aldona; Banach, Maciej; Walkowiak, Jarosław; Bobkowski, Waldemar

    2016-10-01

    There are only a few available studies evaluating quality of life (QoL) in pediatric patients with cardiac arrhythmia. The aim of the study was to evaluate medical and psychological parameters of the QoL in children with a diagnosed supraventricular tachyarrhythmia (SVT) and to compare the obtained data with a group of healthy children (HC). Inclusion criteria: children aged 7-18 with SVT, treated at Poznan University of Medical Sciences, Department of Pediatric Cardiology. The evaluation tools were the WHOQOL-BREF instrument and a questionnaire related to the patient's feelings and observations concerning arrhythmia (Pediatric Arrhythmia Related Score - PARS), developed by the authors and adjusted to the group of arrhythmia patients. The study included 180 SVT children and 83 HC. On the basis of WHOQOL-BREF the SVT group was found to have lower assessment values of QoL within the physical domain (Phd) (mean ± SD: 65.7 ±15.8 vs. 81.6 ±12.8; p psychological domain (Psd) (mean ± SD: 75.8 ±15.2 vs. 81.3 ±14.1; p psychological parameters of the QoL in SVT children are significantly lower in comparison with HC. A diagnosis of SVT has no influence on the social and environmental areas of QoL. The PARS appears to be a useful tool to supplement the generic questionnaire for QoL evaluation in SVT children.

  11. Cardiac responses to exercise distinguish postural orthostatic tachycardia syndrome variants.

    Science.gov (United States)

    Pianosi, Paolo T; Schroeder, Darrell R; Fischer, Philip R

    2016-11-01

    We previously showed that one-third of adolescents with postural orthostatic tachycardia syndrome (POTS) have hyperkinetic circulation. In a subsequent cohort, we compare participants with POTS grouped according to cardiac output (Q˙) versus oxygen uptake (V˙O2) function, whose circulatory response to exercise lay at the lower end of this distribution. We hypothesized that such grouping determines the circulatory response to incremental-protocol, upright, cycle ergometry by whatever blend of flow and resistance adjustments best maintains normal blood pressure. We reviewed data on 209 POTS participants aged 10-19 years (73% female) grouped as follows: Q˙-V˙O2 8 L·min -1 per L·min -1 (N = 32). Heart rate response to exercise was virtually identical in each group. Mean stroke volume (SV) rose normally in the hyperkinetic group (51 ± 38%); less in the normal Q˙ group (22 ± 27%); but was flat in the low Q˙ group (-7 ± 16%). Mean arterial pressure was similar at rest while systemic vascular conductance was flat from rest to exercise in the hypokinetic group, and by comparison rose more steeply in the normal Q˙ (P < 0.001) and in the hyperkinetic (P = 0.02) groups. In conclusion, we identified a variant of POTS with a hypokinetic circulation maintained by a vasoconstricted state. We speculate that they cannot muster preload to augment exercise SV due to profound thoracic hypovolemia, and must resort to vasoconstriction in order to maintain perfusion pressure within working muscle. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

  12. [Reversibility of cardiomyopathy after therapy of incessant left ventricular tachycardia with radiofrequency ablation in a newborn infant].

    Science.gov (United States)

    Benito Bartolomé F; Sánchez Fernández-Bernal C

    2000-08-01

    We present a 15-month-old infant with tachycardia-induced cardiomyopathy secondary to idiopathic left ventricular tachycardia, which was incessant despite medical treatment. In the electrocardiogram, the tachycardia showed right bundle branch morphology and left superior axis deviation and was successfully ablated with the application of radiofrequency in the inferior apical septal region of the left ventricle. One week after the procedure the shortening fraction increased from 12% to 30% and at 18 months of follow-up the patient is tachycardia-free.

  13. Characteristics and identification of sites of chagasic ventricular tachycardia by endocardial mapping

    Directory of Open Access Journals (Sweden)

    Távora Maria Zildany P.

    1999-01-01

    Full Text Available OBJECTIVE: To study electrophysiological characteristics that enable the identification and ablation of sites of chagasic tachycardia. METHODS: Thirty-one patients with chronic Chagas' heart disease and sustained ventricular tachycardia (SVT underwent electrophysiological study to map and ablate that arrhythmia. Fifteen patients had hemodinamically stable SVT reproducible by programmed ventricular stimulation, 9 men and 6 women with ages ranging from 37 to 67 years and ejection fraction varying from 0.17 to 0.64. Endocardial mapping was performed during SVT in all patients. Radiofrequency (RF current was applied to sites of presystolic activity of at least 30 ms. Entrainment was used to identify reentrant circuits. In both successful and unsuccessful sites of RF current application, electrogram and entrainment were analyzed. RESULTS: Entrainment was obtained during all mapped SVT. In 70.5% of the sites we observed concealed entrainment and ventricular tachycardia termination in the first 15 seconds of RF current application. In the unsuccessful sites, significantly earlier electrical activity was seen than in the successful ones. Concealed entrainment was significantly associated with ventricular tachycardia termination. Bystander areas were not observed. CONCLUSION: The reentrant mechanism was responsible for the genesis of all tachycardias. In 70.5% of the studied sites, the endocardial participation of the slow conducting zone of reentrant circuits was shown. Concealed entrainment was the main electrophysiological parameter associated with successful RF current application. There was no electrophysiological evidence of bystander regions in the mapped circuits of SVT.

  14. Comparative Effectiveness of Acupuncture and Antiarrhythmic Drugs for the Prevention of Cardiac Arrhythmias: A Systematic Review and Meta-analysis of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Yanda Li

    2017-06-01

    Full Text Available Introduction and Objectives: This study was designed to systematically evaluate the effectiveness of acupuncture treatment for arrhythmia compared to existing drug therapy.Methods: Randomized controlled trials (RCTs were identified through searches of the MEDLINE, CNKI, Embase, and Cochrane databases (1970 through 2016 and hand searches of cross-references from original articles and reviews. Clinical trials that randomized arrhythmia patients to acupuncture therapy vs. conventional drugs, sham acupuncture, or bed rest were included for analysis.Results: A total of 13 trials with 797 patients met the criteria for analysis. The results of the meta-analysis showed no statistically significant difference between acupuncture and conventional treatment for paroxysmal supraventricular tachycardia (PSVT (n = 203; RR, 1.18; 95% CI 0.78–1.79; I2 = 80%; P = 0.44. However, in the ventricular premature beat (VPB group, it showed a significant benefit of acupuncture plus oral administration of anti-arrhythmic drug (AAD on response rates compared with the oral administration of AAD (n = 286; RR, 1.15; 95% CI 1.05–1.27; I2 = 0%; P = 0.002. Finally, when compared with the sinus tachycardia (ST cases without any treatment, acupuncture has benefited these patients (n = 120; MD, 18.80, 95% CI 12.68–24.92; I2 = 81%; P < 0.00001.Conclusions: In summary, our meta-analysis demonstrates that clinical efficacy of acupuncture is not less than AAD for PSVT. Furthermore, in sub-group analysis, acupuncture with or without AAD, shows a clear benefit in treating VPB and ST. However, more definitive RCTs are warranted to guide clinical practice.

  15. Case report: an infant with congenital junctional ectopic tachycardia requiring extracorporeal mechanical oxygenation.

    Science.gov (United States)

    Darst, Jeffrey R; Kaufman, Jon

    2007-10-01

    A case report of an infant with hemodynamic compromise and impending collapse due to congenital junctional ectopic tachycardia. Medical therapy was maximized and he required the rapid initiation of extracorporeal life support, in order to achieve hemodynamic stability. This case report briefly reviews the presentation and treatment options for congenital junctional ectopic tachycardia, as well as the indications for initiation of mechanical support for this potentially lethal condition. Congenital junctional ectopic tachycardia is a rare though often fatal arrhythmia of the newborn or infant. Medical treatment options may be limited, or may require time to attain efficacy. Despite aggressive escalation of antiarrhythmic therapy, mechanical support in the form of extracorporeal mechanical oxygenation is a viable option, until the arrhythmia is well controlled and the myocardium recovers function.

  16. Catch 22: a case of incessant ventricular tachycardia post-left ventricular assist device resulting in right ventricular failure, left ventricular cavity obliteration and failure of endocardial ventricular tachycardia ablation.

    Science.gov (United States)

    Thosani, Amit J; Bailey, Stephen H; Raina, Amresh

    2017-06-01

    Ventricular tachycardia (VT) in the setting of left ventricular assist device (LVAD) therapy has been well described. We present a case of incessant ventricular tachycardia resulting in severe right ventricular (RV) failure and subsequent left ventricular (LV) cavity obliteration, which in turn diminished the feasibility of initial attempt at VT ablation.

  17. Efficacy of dexmedetomidine for the control of junctional ectopic tachycardia after repair of tetralogy of Fallot

    Directory of Open Access Journals (Sweden)

    Randhir S Rajput

    2014-01-01

    Full Text Available Background: Junctional ectopic tachycardia occurs frequently after congenital cardiac surgery and can be a cause of increased morbidity and mortality. Dexmedetomidine (DEX is an a2 adrenoreceptor agonist, has properties of controlling tachyarrhythmia by regulating the sympatho-adrenal system. Objective: To evaluate the efficacy of DEX for control of junctional ectopic tachycardia after repair of Tetralogy of Fallot (TOF. Materials and Methods: Two hundred and twenty pediatric cardiac patients with TOFs were enrolled in a prospective randomized control study. Patients underwent correction surgery. They were divided into two groups, i.e., Group 1 (DEX and Group 2 (control. Heart rate, rhythm, mean arterial pressure (MAP were recorded after the anesthetic induction (T1, after termination of bypass (T2, after 04 hours (T3, and 08 hours after transferring the patient to intensive care unit (ICU; T4. Results: Heart rate was comparable between two groups before starting the drug but statistically significant after bypass until 08 hours after transferring the patient to ICU. Junctional ectopic tachycardia occurred more in Group-2 (20% as compared to Group-1 (9.09%; P = 0.022. Junctional ectopic tachycardia occurs early in Group-2 (0.14 ± 0.527 hours as compared to Group 1 (0.31 ± 1.29 hours; P = 0.042. The duration of junctional ectopic tachycardia was more prolonged in Group-2 (1.63 ± 3.64 hours as compared to Group-1 (0.382 ± 1.60 hours; P = 0.012. The time to withdraw from mechanical ventilation and ICU stay of Group 1 patient was less than of Group 2 patients (P = <0.001. Conclusion: DEX had a therapeutic role in the prevention of junctional ectopic tachycardia in patients undergoing repair for TOF.

  18. Successful Non-fluoroscopic Radiofrequency Ablation of Incessant Atrial Tachycardia in a High Risk Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Dr Zia Zuberi, BSc PhD MRCP

    2014-01-01

    Full Text Available We describe a patient presenting with incessant ectopic atrial tachycardia during a high risk twin pregnancy. Tachycardia was resistant to escalating doses of beta-blockade with digoxin. Because of increasing left ventricular dysfunction early in the third trimester, catheter ablation was performed successfully at 30 weeks gestation. Electro-anatomic mapping permitted the entire procedure to be conducted without the use of ionizing radiation. The pregnancy proceeded to successful delivery near term and after three years the patient remains recurrence free with normal left ventricular function, off all medication.

  19. Electrocardiogram artifact caused by rigors mimicking narrow complex tachycardia: a case report.

    Science.gov (United States)

    Matthias, Anne Thushara; Indrakumar, Jegarajah

    2014-02-04

    The electrocardiogram (ECG) is useful in the diagnosis of cardiac and non-cardiac conditions. Rigors due to shivering can cause electrocardiogram artifacts mimicking various cardiac rhythm abnormalities. We describe an 80-year-old Sri Lankan man with an abnormal electrocardiogram mimicking narrow complex tachycardia during the immediate post-operative period. Electrocardiogram changes caused by muscle tremor during rigors could mimic a narrow complex tachycardia. Identification of muscle tremor as a cause of electrocardiogram artifact can avoid unnecessary pharmacological and non-pharmacological intervention to prevent arrhythmias.

  20. Inadvertent puncture of the aortic noncoronary cusp during postoperative left atrial tachycardia ablation

    Directory of Open Access Journals (Sweden)

    Dursun Aras, MD

    2015-08-01

    Full Text Available Transseptal catheterization has become part of the interventional electrophysiologist׳s technical armamentarium since the development of left atrial catheter ablation and percutaneous technologies for treating mitral and aortic valve disease. Although frequently performed, the procedure׳s most feared complication is aortic root penetration. Focal atrial tachycardia has been described as the most common late sequela of surgical valve replacements. We present a complicated case involving the inadvertent delivery of an 8 French sheath across the noncoronary cusp during radiofrequency catheter ablation for left atrial tachycardia originating from the mitral annulus in a patient with prior mitral valve replacement.

  1. Dual AV Nodal Nonreentrant Tachycardia Resulting in Inappropriate ICD Therapy in a Patient with Cardiac Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Ankur A. Karnik, MD

    2014-01-01

    Full Text Available Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT occurs due to concurrent antegrade conduction over fast and slow atrioventricular nodal pathways and is treated by slow pathway modification. We describe a unique case of a patient with cardiac sarcoidosis who received inappropriate ICD shocks for DAVNNT. Atrial and ventricular device electrograms satisfied both rate and V>A criteria for ventricular tachycardia. We postulate that alterations in refractoriness and conduction as is seen in cardiac sarcoidosis (CS may have contributed to occurrence of DAVNNT.

  2. Metabolite concentrations in supraventricular white matter from teenage to early old age: A short echo time 1H magnetic resonance spectroscopy (MRS) study

    International Nuclear Information System (INIS)

    Raininko, Raili; Mattsson, Peter

    2010-01-01

    Background: Age- and sex-related changes of metabolites in healthy adult brains have been examined with different 1 H magnetic resonance spectroscopy (MRS) methods in varying populations, and with differing results. A long repetition time and short echo time technique reduces quantification errors due to T1 and T2 relaxation effects and makes it possible to measure metabolites with short T2 relaxation times. Purpose: To examine the effect of age on the metabolite concentrations measured by 1H MRS in normal supraventricular white matter using a long repetition time (TR) and a short echo time (TE). Material and Methods: Supraventricular white matter of 57 healthy subjects (25 women, 32 men), aged 13 to 72 years, was examined with a single-voxel MRS at 1.5T using a TR of 6000 ms and a TE of 22 ms. Tissue water was used as a reference in quantification. Results: Myoinositol increased slightly and total N-acetyl aspartate (NAA) decreased slightly with increasing age. Glutamine/glutamate complex (Glx) showed U-shaped age dependence, with highest concentrations in the youngest and oldest subjects. No significant age dependence was found in total choline and total creatine. No gender differences were found. Macromolecule/ lipid (ML) fractions were reliably measurable only in 36/57 or even fewer subjects and showed very large deviations. Conclusion: The concentrations of several metabolites in cerebral supraventricular white matter are age dependent on 1H MRS, even in young and middle-aged people, and age dependency can be nonlinear. Each 1H MRS study of the brain should therefore take age into account, whereas sex does not appear to be so important. The use of macromolecule and lipid evaluations is compromised by less successful quantification and large variations in healthy people

  3. Comparison of P-wave dispersion in healthy dogs, dogs with chronic valvular disease and dogs with disturbances of supraventricular conduction

    Directory of Open Access Journals (Sweden)

    Nicpoń Józef

    2011-03-01

    Full Text Available Abstract Background P-wave dispersion (Pd is a new ECG index used in human cardiology and veterinary medicine. It is defined as the difference between the maximum and the minimum P-wave duration recorded from multiple different ECG leads. So far no studies were performed assessing the importance of P-wave dispersion in dogs. Methods The current study was aimed at determining proper value of Pd in healthy dogs (group I, dogs with chronic valvular disease (group II and dogs with disturbances of supraventricular conduction (group III. The tests were carried out in 53 healthy dogs, 23 dogs with chronic valvular disease and 12 dogs with disturbances of supraventricular conduction of various breeds, sexes and body weight from 1,5 to 80 kg, aged between 0,5 and 17 years, submitted to the ECG examination. ECG was acquired in dogs in a standing position with BTL SD-8 electrocardiographic device and analyzed once the recording was enlarged. P-wave duration was calculated in 9 ECG leads (I, II, III, aVR, aVL, aVF, V1, V2, V4 from 5 cardiac cycles. Results The proper P-wave dispersion in healthy dogs was determined at up to 24 ms. P-wave dispersion was statistically significant increased (p Conclusions The P-wave dispersion is a constant index in healthy dogs, that is why it can be used for evaluating P wave change in dogs with chronic valvular disease and in dogs with disturbances of supraventricular conduction.

  4. Metabolite concentrations in supraventricular white matter from teenage to early old age: A short echo time {sup 1}H magnetic resonance spectroscopy (MRS) study

    Energy Technology Data Exchange (ETDEWEB)

    Raininko, Raili [Dept. of Radiology, Uppsala Univ., Uppsala (Sweden)], e-mail: raili.raininko@radiol.uu.se; Mattsson, Peter [Dept. of Neuroscience, Neurology, Uppsala Univ., Uppsala (Sweden)

    2010-04-15

    Background: Age- and sex-related changes of metabolites in healthy adult brains have been examined with different {sup 1}H magnetic resonance spectroscopy (MRS) methods in varying populations, and with differing results. A long repetition time and short echo time technique reduces quantification errors due to T1 and T2 relaxation effects and makes it possible to measure metabolites with short T2 relaxation times. Purpose: To examine the effect of age on the metabolite concentrations measured by 1H MRS in normal supraventricular white matter using a long repetition time (TR) and a short echo time (TE). Material and Methods: Supraventricular white matter of 57 healthy subjects (25 women, 32 men), aged 13 to 72 years, was examined with a single-voxel MRS at 1.5T using a TR of 6000 ms and a TE of 22 ms. Tissue water was used as a reference in quantification. Results: Myoinositol increased slightly and total N-acetyl aspartate (NAA) decreased slightly with increasing age. Glutamine/glutamate complex (Glx) showed U-shaped age dependence, with highest concentrations in the youngest and oldest subjects. No significant age dependence was found in total choline and total creatine. No gender differences were found. Macromolecule/ lipid (ML) fractions were reliably measurable only in 36/57 or even fewer subjects and showed very large deviations. Conclusion: The concentrations of several metabolites in cerebral supraventricular white matter are age dependent on 1H MRS, even in young and middle-aged people, and age dependency can be nonlinear. Each 1H MRS study of the brain should therefore take age into account, whereas sex does not appear to be so important. The use of macromolecule and lipid evaluations is compromised by less successful quantification and large variations in healthy people.

  5. Metabolite concentrations in supraventricular white matter from teenage to early old age: A short echo time 1H magnetic resonance spectroscopy (MRS) study.

    Science.gov (United States)

    Raininko, Raili; Mattsson, Peter

    2010-04-01

    Age- and sex-related changes of metabolites in healthy adult brains have been examined with different (1)H magnetic resonance spectroscopy (MRS) methods in varying populations, and with differing results. A long repetition time and short echo time technique reduces quantification errors due to T(1) and T(2) relaxation effects and makes it possible to measure metabolites with short T(2) relaxation times. To examine the effect of age on the metabolite concentrations measured by (1)H MRS in normal supraventricular white matter using a long repetition time (TR) and a short echo time (TE). Supraventricular white matter of 57 healthy subjects (25 women, 32 men), aged 13 to 72 years, was examined with a single-voxel MRS at 1.5T using a TR of 6000 ms and a TE of 22 ms. Tissue water was used as a reference in quantification. Myoinositol increased slightly and total N-acetyl aspartate (NAA) decreased slightly with increasing age. Glutamine/glutamate complex (Glx) showed U-shaped age dependence, with highest concentrations in the youngest and oldest subjects. No significant age dependence was found in total choline and total creatine. No gender differences were found. Macromolecule/ lipid (ML) fractions were reliably measurable only in 36/57 or even fewer subjects and showed very large deviations. The concentrations of several metabolites in cerebral supraventricular white matter are age dependent on (1)H MRS, even in young and middle-aged people, and age dependency can be nonlinear. Each (1)H MRS study of the brain should therefore take age into account, whereas sex does not appear to be so important. The use of macromolecule and lipid evaluations is compromised by less successful quantification and large variations in healthy people.

  6. Metabolite concentrations in supraventricular white matter from teenage to early old age: A short echo time 1H magnetic resonance spectroscopy (MRS) study

    Energy Technology Data Exchange (ETDEWEB)

    Raininko, Raili (Dept. of Radiology, Uppsala Univ., Uppsala (Sweden)), e-mail: raili.raininko@radiol.uu.se; Mattsson, Peter (Dept. of Neuroscience, Neurology, Uppsala Univ., Uppsala (Sweden))

    2010-04-15

    Background: Age- and sex-related changes of metabolites in healthy adult brains have been examined with different 1H magnetic resonance spectroscopy (MRS) methods in varying populations, and with differing results. A long repetition time and short echo time technique reduces quantification errors due to T1 and T2 relaxation effects and makes it possible to measure metabolites with short T2 relaxation times. Purpose: To examine the effect of age on the metabolite concentrations measured by 1H MRS in normal supraventricular white matter using a long repetition time (TR) and a short echo time (TE). Material and Methods: Supraventricular white matter of 57 healthy subjects (25 women, 32 men), aged 13 to 72 years, was examined with a single-voxel MRS at 1.5T using a TR of 6000 ms and a TE of 22 ms. Tissue water was used as a reference in quantification. Results: Myoinositol increased slightly and total N-acetyl aspartate (NAA) decreased slightly with increasing age. Glutamine/glutamate complex (Glx) showed U-shaped age dependence, with highest concentrations in the youngest and oldest subjects. No significant age dependence was found in total choline and total creatine. No gender differences were found. Macromolecule/ lipid (ML) fractions were reliably measurable only in 36/57 or even fewer subjects and showed very large deviations. Conclusion: The concentrations of several metabolites in cerebral supraventricular white matter are age dependent on 1H MRS, even in young and middle-aged people, and age dependency can be nonlinear. Each 1H MRS study of the brain should therefore take age into account, whereas sex does not appear to be so important. The use of macromolecule and lipid evaluations is compromised by less successful quantification and large variations in healthy people

  7. Digoxin delays recovery from tachycardia-induced electrical remodeling of the atria

    NARCIS (Netherlands)

    Tieleman, RG; Blaauw, Y; Van Gelder, IC; De Langen, CDJ; de Kam, PJ; Grandjean, JG; Patberg, KW; Bel, KJ; Allessie, MA; Crijns, JGM

    1999-01-01

    Background-Atrial fibrillation (AF) induces electrical remodeling, which is thought to be responsible for the low success rate of antiarrhythmic treatment in AF of longer duration. Electrical remodeling seems to be related to tachycardia-induced intracellular calcium overload. Due to its vagomimetic

  8. Cardiac Metastasis of Leiomyosarcoma Complicated with Complete Atrio-Ventricular Block and Ventricular Tachycardia.

    Science.gov (United States)

    Park, Yae Min; Shin, Jae Ouk; Kim, Minsu; Kang, Woong Chol; Moon, Jeonggeun; Chung, Wook-Jin; Sung, Yon Mi

    2016-03-01

    We described a case of a 54-year-old male who presented with dizziness and dyspnea due to cardiac metastasis of leiomyosarcoma. Cardiac metastasis of leiomyosarcoma caused both bradyarrhythmia and tachyarrhythmia in the patient. He was treated with implantation of a permanent pacemaker for management of complete atrio-ventricular block and anti-arrhythmic drug that suppressed ventricular tachycardia successfully.

  9. Overview of the management of postural tachycardia syndrome in pregnant patients.

    Science.gov (United States)

    Ruzieh, Mohammed; Grubb, Blair P

    2018-02-16

    Postural tachycardia syndrome (POTS) is a chronic condition characterized by symptoms of orthostatic intolerance. Pregnancy can cause different physiological changes in cardiovascular parameters, that could have greater impact on POTS patients. In this review, we discuss the management of POTS in the pregnant and obstetric settings. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. Fatal monomorphic ventricular tachycardia in a semi-urban setting in Cameroon : A case report

    NARCIS (Netherlands)

    Nkoke, Clovis; Luchuo, Engelbert Bain; Dikoume, Laetitia

    2017-01-01

    Background: Ventricular tachycardia is a life threatening cardiac arrhythmia. It needs management with defibrillation, without which, immediate death may occur. Case presentation: A 66 year old black African patient with a 2 year history of hypertension was admitted to the emergency department of

  11. Atrial activation during atrioventricular nodal reentrant tachycardia: studies on retrograde fast pathway conduction

    NARCIS (Netherlands)

    Katritsis, Demosthenes G.; Ellenbogen, Kenneth A.; Becker, Anton E.

    2006-01-01

    Detailed right and left septal mapping of retrograde atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) has not been undertaken and may provide insight into the complex physiology of AVNRT, especially the anatomic localization of the fast and slow pathways. The

  12. Molecular diagnostics of catecholaminergic polymorphic ventricular tachycardia using denaturing high-performance liquid chromatography and sequencing

    NARCIS (Netherlands)

    Postma, Alex V.; Bhuiyan, Zahurul A.; Bikker, Hennie

    2006-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an arrhythmogenic disease characterized by adrenergic-induced arrhythmias in the form of bidirectional and PVT. CPVT is a distinct clinical entity associated with a high mortality rate of up to 50% by the age of 30 yr. Recently, the

  13. Right Atrial Dual-loop Reentry Tachycardia after Cardiac Surgery: Prevalence, Electrophysiologic Characteristics and Ablation Outcomes.

    Science.gov (United States)

    Yang, Jian-du; Sun, Qi; Guo, Xiao-Gang; Zhou, Gong-Bu; Liu, Xu; Luo, Bin; Wei, Hui-Qiang; Santangeli, Pasquale; Liang, Jackson J; Ma, Jian

    2018-04-03

    Right atrial dual-loop reentry tachycardia has been described in patients with open-heart surgery. However, the prevalence, electrophysiologic substrate and ablation outcomes have been poorly characterized. We aimed to investigate the prevalence, electrophysiologic substrate and ablation outcomes for RA dual-loop reentry tachycardia following cardiac surgery. We identified all patients with atrial tachycardia after cardiac surgery. We compared electrophysiologic findings and outcomes of those with RA dual-loop reentry tachycardia versus a control group of patients with RA macro-reentrant arrhythmias in the setting of linear RA free wall (FW) scar. Out of 127 patients with 152 post-surgical atrial tachycardias (ATs), 28 (18.4%) had diagnosis of RA dual-loop reentry and 24/28 (85.7%) had tricuspid annular (TA) reentry combined with FW incisional reentry. An incision length > 51.5mm along the FW predicted the substrate for a second loop. In 22/23 patients (95.7%) with initial ablation in the cavo-tricuspid isthmus, a change in the interval between Halo d to CS p could be recorded, while 15/23 patients (65.2%) had CS activation pattern change. Complete success was achieved in 25/28 (89.3%) and 64/69 (92.8%) in the dual-loop reentry and control groups, respectively. After mean follow-up of 33.9±24.2 months, 24/28 (85.7%) and 60/69 (86.95%) were free of arrhythmias after initial procedure in two groups. The prevalence of RA dual-loop reentry is 18.4% among ATs with prior atriotomy scar. A long incision should alert physician the possibility of the second loop at the FW. Halo and CS activation pattern are important clues for circuit transformation. Copyright © 2018. Published by Elsevier Inc.

  14. Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction.

    Science.gov (United States)

    Stevenson, W G; Khan, H; Sager, P; Saxon, L A; Middlekauff, H R; Natterson, P D; Wiener, I

    1993-10-01

    Ventricular tachycardia reentry circuits in chronic infarct scars can contain slow conduction zones, which are difficult to distinguish from bystander areas adjacent to the circuit during catheter mapping. This study developed criteria for identifying reentry circuit sites using computer simulations. These criteria then were tested during catheter mapping in humans to predict sites at which radiofrequency current application terminated ventricular tachycardia. In computer simulations, effects of single stimuli and stimulus trains at sites in and adjacent to reentry circuits were analyzed. Entrainment with concealed fusion, defined as ventricular tachycardia entrainment with no change in QRS morphology, could occur during stimulation in reentry circuit common pathways and adjacent bystander sites. Pacing at reentry circuit common pathway sites, the stimulus to QRS (S-QRS) interval equals the electrogram to QRS interval (EG-QRS) during tachycardia. The postpacing interval from the last stimulus to the following electrogram equals the tachycardia cycle length. Pacing at bystander sites the S-QRS exceeds the EG-QRS interval when the conduction time from the bystander site to the circuit is short but may be less than or equal to the EG-QRS interval when the conduction time to the circuit is long. The postpacing interval, however, always exceeds the tachycardia cycle length. When conduction in the circuit slows during pacing, the S-QRS and postpacing intervals increase and the slowest stimulus train most closely reflects conduction times during tachycardia. Endocardial catheter mapping and radiofrequency ablation were performed during 31 monomorphic ventricular tachycardias in 15 patients with drug refractory ventricular tachycardia late after myocardial infarction. During ventricular tachycardia, trains of electrical stimuli or scanning single stimuli were evaluated before application of radiofrequency current at the same site. Radiofrequency current terminated

  15. An unusual cause of ventricular tachycardia: Port-A-Cath fracture and embolization into the pulmonary artery

    Directory of Open Access Journals (Sweden)

    Anthony W.A. Wassef

    2014-08-01

    Full Text Available We describe the case of a patient with a previously placed Port-A-Cath who was admitted to hospital for new onset of non-flushing catheter and palpitations with ventricular tachycardia. A chest X-ray and a linogram showed a Port-A-Cath fracture and distal embolization into the right ventricle resulting in ventricular tachycardia. The catheter was removed percutaneously using a Goose Neck snare with no complications and resolution of the ventricular tachycardia. The removed segment demonstrated thrombus. Prompt removal of the embolized catheter fragments should be undertaken given the subtle nature of the embolization and the potential complications.

  16. Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with orthotopic heart transplantation by bicaval anastomosis.

    Science.gov (United States)

    Rodríguez de Armas, Lissette; Dorantes, Margarita; Castro, Jesús; Tornés, Francisco José; Rodríguez, Julio César; Fayad, Yanela; Almeida, Javier

    2006-04-01

    Patients with orthotopic heart transplantation may have a variety of arrhythmias. There are reports of successful radiofrequency catheter ablation of some of them. Two months after orthotopic cardiac transplantation by bicaval anastomosis, a 49-year-old man developed episodes of tachycardia. The patient developed with dyspnoea and hypotension during typical atrioventricular nodal reentrant tachycardia (AVNRT) revealed by electrocardiogram. During programmed atrial stimulation with progressively increasing prematurity, dual auriculoventricular nodal physiology was observed and AVNRT was induced. This tachycardia was successfully eliminated without complications by radiofrequency catheter ablation of the slow pathway. The patient remained asymptomatic at 4-month follow-up.

  17. Resolution of Postural Orthostatic Tachycardia Syndrome After CT-Guided, Percutaneous T2 Ethanol Ablation for Hyperhidrosis

    Energy Technology Data Exchange (ETDEWEB)

    Brock, Malcolm, E-mail: mabrock@jhmni.edu [Johns Hopkins University, Department of Thoracic Surgery, Center for Sweat Disorders (United States); Chung, Tae Hwan, E-mail: Tchang7@jhmi.edu [Johns Hopkins University, Physical Medicine and Rehabilitation (United States); Gaddam, Sathvika Reddy, E-mail: drsathvikareddy@yahoo.com; Kathait, Anjaneya Singh, E-mail: askathait@gmail.com [Johns Hopkins University, Vascular & Interventional Radiology (United States); Ober, Cecily, E-mail: ceober21@gmail.com [Johns Hopkins University, Department of Thoracic Surgery (United States); Georgiades, Christos, E-mail: cgeorgi@jhmi.edu [Johns Hopkins University, Vascular & Interventional Radiology (United States)

    2016-12-15

    Postural orthostatic tachycardia syndrome is characterized by orthostatic intolerance. Orthostasis (or other mild physical stress) triggers a cascade of inappropriate tachycardia, lightheadedness, palpitations, and often fainting. The underlying defect is sympathetic dysregulation of the heart, which receives its sympathetic tone from the cervical and upper thoracic sympathetic ganglia. Primary hyperhidrosis is also thought to be the result of sympathetic dysregulation. We present the case of a patient treated with CT-guided, percutaneous T2 EtOH sympatholysis for craniofacial hyperhidrosis. The patient also suffered from postural orthostatic tachycardia syndrome for many years and was unresponsive to treatment. Immediately after sympatholysis, the patient experienced resolution of both craniofacial hyperhidrosis and postural orthostatic tachycardia syndrome.

  18. Resolution of Postural Orthostatic Tachycardia Syndrome After CT-Guided, Percutaneous T2 Ethanol Ablation for Hyperhidrosis.

    Science.gov (United States)

    Brock, Malcolm; Chung, Tae Hwan; Gaddam, Sathvika Reddy; Kathait, Anjaneya Singh; Ober, Cecily; Georgiades, Christos

    2016-12-01

    Postural orthostatic tachycardia syndrome is characterized by orthostatic intolerance. Orthostasis (or other mild physical stress) triggers a cascade of inappropriate tachycardia, lightheadedness, palpitations, and often fainting. The underlying defect is sympathetic dysregulation of the heart, which receives its sympathetic tone from the cervical and upper thoracic sympathetic ganglia. Primary hyperhidrosis is also thought to be the result of sympathetic dysregulation. We present the case of a patient treated with CT-guided, percutaneous T2 EtOH sympatholysis for craniofacial hyperhidrosis. The patient also suffered from postural orthostatic tachycardia syndrome for many years and was unresponsive to treatment. Immediately after sympatholysis, the patient experienced resolution of both craniofacial hyperhidrosis and postural orthostatic tachycardia syndrome.

  19. Histamine induces postprandian tachycardia through a direct effect on cardiac H2-receptors in pythons

    DEFF Research Database (Denmark)

    Jensen, Nini Skovgaard; Møller, Kate; Gesser, Hans

    2009-01-01

    The intrinsic heart rate of most vertebrates studied, including humans, is elevated during digestion, suggesting that a non-adrenergic-non-cholinergic factor contributes to the postprandial tachycardia. The regulating factor, however, remains elusive and difficult to identify. Pythons can ingest...... very large meals and digestion is associated with a marked rise in metabolism that is sustained for several days. The metabolic rise causes more than a doubling of heart rate and a four-fold rise in cardiac output. This makes the python an interesting model to investigate the postprandial tachycardia....... We measured blood pressure and heart rate in fasting Python regius, and at 24 and 48h after ingestion of a meal amounting to 25% of body weight. Digestion caused heart rate to increase from 25 to 56 min-1 while blood pressure was unchanged. The postprandial rise in heart rate was partially due...

  20. Early experiences with tachycardia-triggered vagus nerve stimulation using the AspireSR stimulator.

    Science.gov (United States)

    El Tahry, Riëm; Hirsch, Martin; Van Rijckevorsel, Kenou; Santos, Susana Ferrao; de Tourtchaninoff, Marianne; Rooijakkers, Herbert; Coenen, Volker; Schulze-Bonhage, Andreas

    2016-06-01

    Many epilepsy patients treated with vagus nerve stimulation additionally use an "on-demand" function, triggering an extra stimulation to terminate a seizure or diminish its severity. Nevertheless, a substantial number of patients are not able to actively trigger stimulations by use of a magnet, due to the absence of an aura or inability for voluntary actions in the early phase of a seizure. To address this need, a novel implantable pulse generator, the AspireSR VNS system, was developed to provide automated ictal stimulation triggered by a seizure-detecting algorithm. We report our experience with three patients in assessing the functionality of ictal stimulation, illustrating the detection system in practice. Detection of ictal tachycardia and variable additional detections of physiological tachycardia depended on the individual seizure-detecting algorithm settings.

  1. Unexplored relationship of sleep disturbances linked to suicidal ideation and behavior in postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Shafqat MN

    2017-07-01

    Full Text Available Muhammad Nabeel Shafqat,1 Muhammad Aadil,2 Maria Shoaib31Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC, Villa Clara, Cuba; 2Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA; 3Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PakistanWe read with great interest the currently published article written by Pederson and Brook1 entitled “Sleep disturbance linked to suicidal ideation in postural orthostatic tachycardia syndrome”. Awareness of postural orthostatic tachycardia syndrome (POTS has increased in recent years. However, sleep disturbance has not been thoroughly investigated as a cause of increased suicidal risk in patients with POTS. We would like to applaud the authors on conducting this novel cross-sectional study to understand and highlight the potential relationship between sleep disturbances and increased risk of suicide in patients suffering from POTS.1View the original paper by Pederson and Brook.

  2. Ventricular tachycardia after infarction: sources of coronary blood flow to the infarct zone.

    Science.gov (United States)

    Saxon, L A; Sherman, C T; Stevenson, W G; Yeatman, L A; Wiener, I

    1992-07-01

    The purpose of this study was to determine the sources of coronary blood flow to infarct scars in patients with sustained ventricular tachycardia occurring late after myocardial infarction, which is necessary for transcoronary sclerosis or embolization. Angiograms of 32 consecutive patients (age 63 +/- 8 years, ejection fraction 0.30 +/- 0.10) were reviewed. Sources of blood flow to the infarct zone were identified as coming from a recanalized infarct-related artery, side branch, collateral, or coronary bypass graft. Eighty-four percent of patients in the study had an identifiable blood supply to the area of previous infarction. More than one source of blood flow to anterior infarct locations were observed more often than to inferior infarct locations (53% vs 17%, p = 0.03). Transcoronary mapping for possible chemical ablation should be technically feasible in the majority of patients with ventricular tachycardia. Infarct zone blood flow arises from any of several sources and varies somewhat depending on infarct location.

  3. A Novel Low-Energy Electrotherapy That Terminates Ventricular Tachycardia With Lower Energy than a Biphasic Shock When Anti-Tachycardia Pacing Fails

    Science.gov (United States)

    Janardhan, Ajit H.; Li, Wenwen; Fedorov, Vadim V.; Yeung, Michael; Wallendorf, Michael J.; Schuessler, Richard B.; Efimov, Igor R.

    2015-01-01

    Objectives To develop a low-energy electrotherapy that terminates ventricular tachycardia (VT) when anti-tachycardia pacing (ATP) fails. Background High-energy ICD shocks are associated with device failure, significant morbidity and increased mortality. A low-energy alternative to ICD shocks is desirable. Methods Myocardial infarction (MI) was created in 25 dogs. Sustained, monomorphic VT was induced by programmed stimulation. Defibrillation electrodes were placed in the RV apex, and coronary sinus (CS) and LV epicardium (LVP). If ATP failed to terminate sustained VT, the defibrillation thresholds (DFTs) of standard versus experimental electrotherapies were measured. Results Sustained VT ranged from 276–438 bpm (mean 339 bpm). The RV-CS shock vector had lower impedance than RV-LVP (54.4±18.1 Ω versus 109.8±16.9, Ω pelectrotherapy (MSE) achieved significantly lower DFT compared to a single biphasic shock (0.03±0.05 J versus 2.37±1.20 J, respectively, pelectrotherapy to reduce high-energy ICD shocks. PMID:23141483

  4. Mitral valve m-mode echo in complete heart block with atrial tachycardia

    Directory of Open Access Journals (Sweden)

    Kalathingathodika Sajeer

    2013-01-01

    Full Text Available We report a 48-year-old man who presented with history of syncope. Electrocardiogram on admission showed infrahisian complete heart block with a ventricular rate of 36 beats per min with wide QRS junctional escape and atrial rate was 188 beats per min. Transthoracic echocardiogram showed fine vibratory movement of both mitral leaflet tips. M-mode evaluation of mitral leaflets showed multiple ′a′ waves corresponding to atrial tachycardia rate.

  5. Ventricular Tachycardia Storm in Cardiac Sarcoidosis: A 76-Day-ICU-Nightmare

    Directory of Open Access Journals (Sweden)

    Dr. Ajay M. Naik, MD, DM, DNB, FACC, FHRS

    2012-11-01

    Full Text Available Ventricular Tachycardia (VT is a life threatening complication in a patient with Cardiac Sarcoidosis. The management becomes extremely challenging when it is refractory to traditional anti-arrhythmic drugs. Herein, we describe a case where a 33-year-old patient with VT storm, with an implantable cardioverter defibrillator (ICD, was managed by medications, sedation, ventilator support and multiple Radio-Frequency (RF ablation procedures over 76- days ICU stay period.

  6. Cardiovascular profile in postural orthostatic tachycardia syndrome and Ehlers-Danlos syndrome type III.

    Science.gov (United States)

    Cheng, Jem L; Au, Jason S; Guzman, Juan C; Morillo, Carlos A; MacDonald, Maureen J

    2017-04-01

    The cardiovascular profile of postural orthostatic tachycardia syndrome + Ehlers-Danlos syndrome hypermobility type (POTS + EDSIII) has not been described, despite suggestions that it plays a role in orthostatic intolerance. We studied nine individuals diagnosed with POTS + EDSIII and found that the arterial stiffness and cardiac profiles of patients with POTS + EDSIII were comparable to those of age- and sex-matched controls, suggesting an alternate explanation for orthostatic intolerance.

  7. The world's largest family with familial atrio-ventricular nodal reentry tachycardia.

    Science.gov (United States)

    Stec, Sebastian; Deutsch, Karol; Zienciuk-Krajka, Agnieszka

    2015-01-01

    We report a three-generation family coming from southeastern region of Poland (Podkarpackie voivodship) with 6 women having normal hearts and presenting with a history of paroxysmal tachycardia with onset of symptoms in the adulthood. Recordings of clinical SVT, dual AVN electrophysiology, induction of typical AVNRT and results of RFCA are available. The history of this family shows the significance of a careful and detailed collection of medical history, and point towards the importance of family screening in AVNRT patients.

  8. A Case Report and Review of Postural Orthostatic Tachycardia Syndrome in Pregnancy

    OpenAIRE

    Lide, Brianna; Haeri, Sina

    2015-01-01

    Purpose - Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal ...

  9. Clinical and genetic profile of catecholaminergic polymorphic ventricular tachycardia in Hong Kong Chinese children.

    Science.gov (United States)

    Yu, T C; Liu, A Py; Lun, K S; Chung, B Hy; Yung, T C

    2016-08-01

    To report our experience in the management of catecholaminergic polymorphic ventricular tachycardia in Hong Kong Chinese children. This case series study was conducted in a tertiary paediatric cardiology centre in Hong Kong. All paediatric patients diagnosed at our centre with catecholaminergic polymorphic ventricular tachycardia from January 2008 to October 2014 were included. Ten patients (five females and five males) were identified. The mean age at presentation and at diagnosis were 11.0 (standard deviation, 2.9) years and 12.5 (2.8) years, respectively. The mean delay time from first presentation to diagnosis was 1.5 (standard deviation, 1.3) years. They presented with recurrent syncope and six patients had a history of aborted cardiac arrest. Four patients were initially misdiagnosed to have epilepsy. Catecholaminergic polymorphic ventricular tachycardia was diagnosed by electrocardiogram at cardiac arrest (n=2), or provocation test, either by catecholamine infusion test (n=6) or exercise test (n=2). Mutations of the RyR2 gene were confirmed in six patients. Nine patients were commenced on beta-blockers after diagnosis. Despite medications, three patients developed aborted or resuscitated cardiac arrest (n=2) and syncope (n=1). Left cardiac sympathetic denervation was performed in five patients and an implantable cardioverter defibrillator was implanted in another. There was no mortality during follow-up. Catecholaminergic polymorphic ventricular tachycardia should be considered in children who present with recurrent syncope during exercise or emotional stress. Despite beta-blocker treatment, recurrent ventricular arrhythmias occur and may result in cardiac arrest.

  10. Heart rate variability analysis in postural orthostatic tachycardia syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Raffaele Calabrò

    2006-09-01

    Full Text Available The authors present a case of 36 year old male patient with idiopathic postural orthostatic tachycardia syndrome (POTS diagnosed during head-up tilt testing. Power spectral analysis of heart rate variability (HRV during the tilt test revealed that the ratio of low and high frequency powers (LF/HF increased with the onset of orthostatic intolerance. This analysis confirmed in our patient a strong activation in sympathetic tone.

  11. Contribution of arousal from sleep to postevent tachycardia in patients with obstructive sleep apnea.

    Science.gov (United States)

    Azarbarzin, Ali; Ostrowski, Michele; Moussavi, Zahra; Hanly, Patrick; Younes, Magdy

    2013-06-01

    Heart rate increases after obstructive events in patients with obstructive sleep apnea (OSA). This response is generally attributed to arousal from sleep. Opening of the obstructed airway, however, is associated with ventilatory and hemodynamic changes that could result in physiologic responses unrelated to arousal. Our objective was to determine the contribution of these physiologic responses to postevent tachycardia. Analysis of data obtained during previous research protocols. Academic sleep laboratory. Twenty patients with severe OSA. Patients were placed on a continuous positive airway pressure (CPAP) device. CPAP was reduced during sleep to different levels (dial-downs), producing obstructive events of varying severity. Some dial-downs with severe obstruction were maintained until spontaneous airway opening. In others, CPAP was increased after three obstructed breaths, terminating the events approximately 10 sec before spontaneous termination in long dial-downs. Beat-by-beat heart rate (HR) was measured for 20 sec following airway opening. Spontaneous opening during sustained dial-downs occurred 21.9 ± 8.4 sec after dial-down, was associated with arousal, and resulted in the greatest postevent tachycardia (7.8 ± 4.0 min(-1)). However, deliberate termination of events (12.2 ± 2.6 sec after dial-down) was also followed by tachycardia that, in the absence of cortical arousal, showed a dose-response behavior, increasing with severity of obstruction and without apparent threshold. ΔHR following deliberately brief, severe obstruction (3.8 ± 3.0 min(-1)) was approximately half the ΔHR that followed spontaneous opening of equally severe obstructions despite the shorter duration and absence of cortical arousal. Postevent tachycardia is due in large part to physiologic (arousal-unrelated) responses that occur upon relief of obstruction.

  12. Successful Right Ventricular Tachycardia Ablation in a Patient with Left Ventricular Non-compaction Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Shohreh Honarbakhsh, MBBS, BSc, MRCP

    2013-09-01

    Full Text Available We report a case of a 67-year old male with a recent diagnosis of left ventricular noncompaction (LVNC, initially presenting with symptomatic ventricular ectopy and runs of non-sustained ventricular tachycardia (VT. This ventricular arrhythmia originated in a structurally normal right ventricle (RV and was successfully localized and ablated with the aid of the three-dimensional mapping and remote magnetic navigation.

  13. Asymmetry of cardiac [123I] meta-iodobenzyl-guanidine scans in patients with ventricular tachycardia and a "clinically normal" heart.

    OpenAIRE

    Gill, J S; Hunter, G J; Gane, J; Ward, D E; Camm, A J

    1993-01-01

    OBJECTIVE--Patients with exercise induced ventricular tachycardia associated with a "clinically normal" heart may have an abnormality of the regional distribution of the cardiac sympathetic nerve supply. In this study the regional distribution of the myocardial nerve supply in patients with ventricular tachycardia (VT) and control subjects was examined by [123] meta-iodobenzylguanidine (MIBG) scanning. PATIENTS AND DESIGN--Eight patients with exercise induced VT and seven patients with VT unr...

  14. Atrioventricular reciprocal rhythm and chronic reciprocating tachycardia in a newborn infant with concealed Wolff-Parkinson-White syndrome.

    Science.gov (United States)

    Sung, R J; Ferrer, P; Garcia, O L; Castellanos, A; Gelband, H

    1977-01-01

    A case of atrioventricular reciprocal rhythm and chronic reciprocating tachycardia in a newborn infant is presented. Electrophysiological studies suggest that these rhythm disturbances are related to the presence of a right-sided atrioventricular accessory pathway capable only of retrograde conduction (concealed Wolff-Parkinson-White syndrome). The technique of recording the sequence of atrial activation during the tachycardia is described and its clinical importance emphasised. PMID:884032

  15. Ablación de taquicardia supraventricular resistente a terapia médica y a cardioversión eléctrica en una gestante

    Directory of Open Access Journals (Sweden)

    Edison Muñoz Ortiz

    2018-01-01

    Full Text Available Las arritmias cardiacas son complicaciones frecuentes durante el embarazo, y de hecho se ha considerado que este estado incrementa la incidencia de arritmias en pacientes con y sin enfermedad cardiaca estructural. El manejo de las arritmias en la paciente embarazada debe tener en cuenta no solo el bienestar materno sino el fetal, característica que restringe muchas de las terapias usadas en población no embarazada; sin embargo, es poco frecuente la falta de respuesta a terapia médica y cardioversión eléctrica. Se presenta el caso de una paciente gestante con taquicardia supraventricular por reentrada por vía accesoria sin respuesta a diferentes medidas farmacológicas y a varios intentos de cardioversión eléctrica, que requirió estudio electrofisiológico y ablación emergentes. Adicionalmente, se listan algunos aspectos claves sobre el tema.

  16. The impact of supraventricular ectopic complexes in different age groups and risk of recurrent atrial fibrillation after antiarrhythmic medication or catheter ablation

    DEFF Research Database (Denmark)

    Alhede, Christina; Lauridsen, Trine K; Johannessen, Arne

    2018-01-01

    INTRODUCTION: Supraventricular ectopic complexes (SVEC) are known risk factors of recurrent atrial fibrillation (AF). However, the impact of SVEC in different age groups is unknown. We aimed to investigate the risk of AF recurrence with higher SVEC burden in patients ±57years, respectively, after....... RESULTS: Age >57years were significantly associated with higher AF recurrence rate after CA (58% vs 36%, p=0.02). After CA, we observed a higher SVEC burden during follow-up in patients >57years which was not observed in the younger age group treated with CA (p=0.006). High SVEC burden at 3months after CA...... treatment with antiarrhythmic medication (AAD) or catheter ablation (CA). METHODS: In total, 260 patients with LVEF >40% and age ≤70 years were randomized to AAD (N=132) or CA (N=128) as first-line treatment for paroxysmal AF. All patients underwent 7-day Holter monitoring at baseline, and after 3, 6, 12...

  17. Bidirectional Tachycardia after an Acute Intravenous Administration of Digitalis for a Suicidal Gesture

    Directory of Open Access Journals (Sweden)

    Diletta Sabatini

    2014-01-01

    Full Text Available Acute digoxin intoxication is a life-threating condition associated with severe cardiotoxicity. Female gender, age, low lean body mass, hypertension, and renal insufficiency may worsen the prognosis. Arrhythmias caused by digitalis glycosides are characterized by an increased automaticity coupled with concomitant conduction delay. Bidirectional tachycardia is pathognomonic of digoxin intoxication, but it is rarely observed. An 83-year-old woman was admitted to the Emergency Department after self-administration of 5 mg of digoxin i.v. for suicidal purpose. Her digoxin serum concentration was 17.4 ng/mL. The patient developed a bidirectional tachycardia and the Poison Control Center of the hospital provided digoxin immune fab. Bidirectional tachycardia quickly reversed and the patient remained stable throughout the hospital stay. This case shows that a multiple disciplinary approach, involving cardiologists and toxicologists, is essential for the management of digoxin intoxication. The optimal treatment of this rare event depends on the clinical conditions and on the serum drug concentration of the patient. Digoxin immune fab represents a safe, effective, and specific method for rapidly reversing digitalis cardiotoxicity and should be started as soon as the diagnosis is defined.

  18. Effect of novel mucoadhesive buccal patches of carvedilol on isoprenaline-induced tachycardia

    Directory of Open Access Journals (Sweden)

    Navneet Verma

    2014-01-01

    Full Text Available The main aim of the study was designed to develop bioadhesive buccal patches of carvedilol (CR and evaluate for isoprenaline-induced tachycardia. Buccal patches of carvedilol were prepared by using chitosan (CH, sodium salt of carboxy methyl cellulose (NaCMC, and polyvinyl alcohol (PVA as mucoadhesive polymers. The solvent evaporation method was used for the preparation of buccal patches. The patches were evaluated for their physical characteristics like patch thickness, weight variation, content uniformity, folding endurance, surface pH, residence time, in vitro drug release, and in vivo pharmacodynamic study. The swelling index of the patches was found to be proportional to the polymer concentration, whereas surface pH of all the formulated bioadhesive patches was found to lie between neutral ranges. In-vitro release study shows that 94.75% drug was release in 8 hours from the patch, which containing 2% w/v chitosan. The folding endurance result shows good elasticity in all the patches.Application of buccal patches on buccal mucosa of rabbit shows a significant result in % inhibition of isoprenaline-induced tachycardia. Prepared buccal patches of chitosan, NaCMC, and PVA containing Carvedilol meet the ideal requirement for the delivery of cardiovascular drugs and inhibit the isoprenaline tachycardia.

  19. Reversal by hypothermia of vasodilator-induced tachycardia in anesthetized rats.

    Science.gov (United States)

    Vidrio, H; García-Márquez, F

    1987-08-01

    The normal cardiovascular response to hydralazine in urethane-anesthetized rats, i.e. hypotension and tachycardia, was changed to hypotension and bradycardia if the body temperature of the animals was not maintained constant by external heating, but was allowed to decrease spontaneously throughout the experiment. A similar phenomenon was observed with diazoxide. In rats maintained at a rectal temperature of 31 degrees C, hydralazine bradycardia was partially blocked by a low dose of atropine and was reversed to tachycardia by a high dose of this agent; mecamylamine failed to influence heart rate lowering in this condition. Heart rate responses in unheated animals to acetylcholine and isopropylarterenol were respectively potentiated and depressed when compared to responses in heated rats. These findings suggest that cold-induced reciprocal changes in reactivity of cardiac muscarinic and beta-adrenoceptors may be responsible for reversal of hydralazine or diazoxide tachycardia in urethane-anesthetized hypothermic rats. As a result, cardiac stimulation by the sympatho-adrenal discharge induced by hypotension is inhibited, while cardiac depression which is apparently also induced by hypotension, is facilitated. It is speculated that vasopressin, released as a consequence of the blood pressure fall, could be this negative chronotropic factor.

  20. Postural tachycardia syndrome (POTS) and other autonomic disorders in antiphospholipid (Hughes) syndrome (APS).

    Science.gov (United States)

    Schofield, J R; Blitshteyn, S; Shoenfeld, Y; Hughes, G R V

    2014-06-01

    Antiphospholipid syndrome (APS) is an autoimmune hypercoagulable disorder that has been shown to cause a large number of cardiac and neurological manifestations. Two recent studies have demonstrated abnormalities in cardiovascular autonomic function testing in APS patients without other cardiovascular or autoimmune disease. However, an association between autonomic disorders such as postural tachycardia syndrome and APS has not previously been described. Data were obtained by retrospective chart review. We identified 15 patients who have been diagnosed with APS and an autonomic disorder. The median age of the patients at the time of data analysis was 39 years. The autonomic disorders seen in these patients included postural tachycardia syndrome, neurocardiogenic syncope and orthostatic hypotension. The majority of patients (14/15) were female and the majority (14/15) had non-thrombotic neurological manifestations of APS, most commonly migraine, memory loss and balance disorder. Many also had livedo reticularis (11/15) and Raynaud's phenomenon (nine of 15). In some patients, the autonomic manifestations improved with anticoagulation and/or anti-platelet therapy; in others they did not. Two patients with postural tachycardia syndrome who failed to improve with the usual treatment of APS have been treated with intravenous immunoglobulin with significant improvement in their autonomic symptoms. We believe that autonomic disorders in APS may represent an important clinical association with significant implications for treatment. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle

    Directory of Open Access Journals (Sweden)

    Tadashi Wada

    2012-06-01

    Full Text Available A 54-year-old man with a surgically repaired double-outlet right ventricle (DORV presented with palpitations and worsening right heart failure. His 12-lead ECG showed atrial tachycardia (AT with an atrial cycle length (CL of 300 ms and an inverted saw-tooth F-wave pattern in the inferior leads II, III, and aVF typical of atrial flutter. Electrophysiological study and radiofrequency catheter ablation were performed. A total of 3 sustained ATs (AT1–AT3 were induced. Using the electroanatomical mapping system, CARTO3, and conventional mapping techniques, the ATs were identified as macroreentrant tachycardias circling around an incisional line on the free wall of the right atrium (AT1, the tricuspid annulus (AT2, and low voltage area in the lateral wall including the right septum (AT3. Accuracy of CARTO3 in three-dimensional reconstruction was sufficient to elucidate anatomical features (including catheter sites, incision, and low voltage areas and macroreentrant circuits. However, conventional mapping techniques were also necessary to identify the mechanism of the tachycardias, and therefore to eliminate all of them successfully. This case demonstrates that the use of combined conventional and electroanatomical mapping techniques, such as CARTO3, can be helpful in identifying the critical isthmus for catheter ablation of macroreentrant AT in patients with surgically corrected congenital heart disease (CHD.

  2. Role of the sympatho-adrenal system in the reflex tachycardia produced by hydralazine in the anesthetized rat.

    Science.gov (United States)

    Vidrio, H; García-Márquez, F

    1986-09-01

    The role of the sympatho-adrenal system in the production of tachycardia accompanying the hypotensive response to hydralazine was studied in urethane-anesthetized rats subjected to previous bilateral adrenal demedullation or to pretreatment with 6-hydroxydopamine and compared with intact control animals. The prolonged hypotension induced by the vasodilator was not affected by these maneuvers, but the slowly developing tachycardia was reversed to bradycardia, which in the demedullated group was followed after 60 min by a moderate increase in heart rate. In the chemically sympathectomized rats, the cardiac depressant response was completely blocked by pretreatment with atropine. In additional experiments, previous administration of methylatropine enhanced hydralazine tachycardia, but atropine partially inhibited this response and changed its time course to mirror that of the hypotension. These results indicate that in urethane-anesthetized rats, hydralazine tachycardia is mediated by sympatho-adrenal activation and that it is accompanied by a simultaneous heart rate-lowering parasympathetic discharge normally masked by the predominant tachycardia. They further suggest that the tachycardia is facilitated by a muscarinic mechanism which modulates central sympathetic influences on cardiovascular function.

  3. A Practical ECG Criterion to Unmask Left Accessory AV Connections in Patients With Subtle Preexcitation.

    Science.gov (United States)

    Thompson, J Jenkins; Shah, Jignesh; Charnigo, Richard; Tackett, Andrea; Darrat, Yousef H; Bailey, Alison; Delisle, Brian; Kakavand, Bahram; DI Biase, Luigi; Natale, Andrea; Morales, Gustavo; Elayi, Claude S

    2015-05-20

    Accessory AV-connections capable of antegrade conduction need to be recognized because of the potential for life-threatening arrhythmias. However, the preexcited ECG pattern may be subtle, especially among left-sided AV-connections. We explored whether additional ECG criteria might help identify left-sided AV-connections. We analyzed 156 patients who underwent an electrophysiology study (EPS) and ablation for paroxysmal supraventricular tachycardias (PSVT). Patients were divided into 2 groups: those with left-sided AV-connections (Group 1) and all other PSVT (Group 2). Various ECG parameters were compared before and after ablation in both groups. The EPS identified left-sided AV-connections among 43 patients (Group 1) and excluded it among 113 (Group 2). Baseline ECG in Group 1 demonstrated obvious preexcitation among 24/43 patients (55.8%), the remaining 19/43 missing obvious preexcitation. R/S ratio > 0.5 in V1 was noted in 38/43 (88.4%) patients in Group 1 before ablation (median 1.00; IQR 0.58-2.20), including 16/19 (84.2%) patients lacking obvious left-sided AVconnections. Conversely, only 10/113 (8.8%) patients in Group 2 had R/S ratios in V1 ≥ 0.5 (0.20; 0.10-0.31), P AV-connections (sensitivity 93.0%). The negative predictive value of this combined criterion was 103/106 (97.2%). In symptomatic patients, combining the R/S ratio (≥ 0.5) in lead V1 with the classic preexcitation pattern on ECG markedly improved the sensitivity to diagnose left-sided AV-connections. This ratio may be particularly useful among patients lacking obvious preexcitation. © 2015 Wiley Periodicals, Inc.

  4. [Indications for implantable loop recorders in patients with channelopathies and ventricular tachycardias].

    Science.gov (United States)

    Köbe, Julia; Wasmer, Kristina; Reinke, Florian; Eckardt, Lars

    2016-12-01

    Implantable loop recorders (ILR) do not play a pivotal role in the current guidelines on ventricular arrhythmias except in identifying rhythm-symptom correlations if ventricular arrhythmias are assumed. Before a decision for a pure diagnostic implantable device is made, a thorough arrhythmic risk assessment is of major importance due to the potential lethal outcome of ventricular arrhythmias. Nevertheless, some clinical circumstances exist where long-term monitoring by an ILR may add significant information in electrical heart diseases, in patients with ventricular arrhythmias, or structural heart diseases and a potential risk of ventricular arrhythmias. As medical therapy (β-blocker therapy) plays an important role in long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardias (cpVT), the ILR can be used to control therapy in patients at risk. In electrical diseases without pharmacologic therapeutic options (e. g., Brugada syndrome), the ILR may be used in low-risk patients with atypical syncope as benign faints may occur without association to the underlying disease. Evidence on cardiomyopathies with preserved left ventricular function and nonsustained VT or premature ventricular complexes is scarce. The ILR may also add long-term information on the individual risk in these circumstances. In very rare diseases like infiltrative disease or muscular dystrophies, the ILR may also provide evidence on risk stratification. In summary, ILR in electrical heart diseases and in patients with ventricular tachycardia remains a very individual decision taking into account various clinical, electrocardiographic, and genetic parameters. The following review aims at highlighting possible indications and clinical scenarios for ILR in ventricular tachycardias and electrical heart diseases with-probably debatable-case presentations.

  5. Associations among left ventricular systolic function, tachycardia, and cardiac preload in septic patients.

    Science.gov (United States)

    Lanspa, Michael J; Shahul, Sajid; Hersh, Andrew; Wilson, Emily L; Olsen, Troy D; Hirshberg, Eliotte L; Grissom, Colin K; Brown, Samuel M

    2017-12-01

    In sepsis, tachycardia may indicate low preload, adrenergic stimulation, or both. Adrenergic overstimulation is associated with septic cardiomyopathy. We sought to determine whether tachycardia was associated with left ventricular longitudinal strain, a measure of cardiac dysfunction. We hypothesized an association would primarily exist in patients with high preload. We prospectively observed septic patients admitted to three study ICUs, who underwent early transthoracic echocardiography. We measured longitudinal strain using speckle tracking echocardiography and estimated preload status with an echocardiographic surrogate (E/e'). We assessed correlation between strain and heart rate in patients with low preload (E/e' intermediate preload (E/e' 8-14), and high preload (E/e' > 14), adjusting for disease severity and vasopressor dependence. We studied 452 patients, of whom 298 had both measurable strain and preload. Abnormal strain (defined as >-17%) was present in 54%. Patients with abnormal strain had higher heart rates (100 vs. 93 beat/min, p = 0.001). After adjusting for vasopressor dependence, disease severity, and cardiac preload, we observed an association between heart rate and longitudinal strain (β = 0.05, p = 0.003). This association persisted among patients with high preload (β = 0.07, p = 0.016) and in patients with shock (β = 0.07, p = 0.01), but was absent in patients with low or intermediate preload and those not in shock. Tachycardia is associated with abnormal left ventricular strain in septic patients with high preload. This association was not apparent in patients with low or intermediate preload.

  6. Understanding the placebo effect in clinical trials for postural tachycardia syndrome.

    Science.gov (United States)

    Nwazue, Victor C; Arnold, Amy C; Raj, Vidya; Black, Bonnie K; Biaggioni, Italo; Paranjape, Sachin Y; Orozco, Carlos; Dupont, William D; Robertson, David; Raj, Satish R

    2014-05-01

    Postural tachycardia syndrome (POTS) is characterized by excessive increases in heart rate (HR) upon standing. Previous studies have shown that standing HR decreases over time in POTS patients given placebo. We hypothesized that this reduction is due to cardiovascular physiological alteration, as opposed to psychological benefit from perceived therapy. To prospectively test this hypothesis, we examined the effects of an open-label 'no treatment' intervention (NoRx) compared with a patient-blinded placebo on standing HR in POTS patients. Twenty-one POTS patients participated in a randomized cross-over trial with oral placebo versus NoRx administered at 0900 h. Seated blood pressure (BP) and HR were measured at baseline and every hour for 4 h. Similarly, BP and HR were measured while patients stood for 10 min at these time points. Standing HR decreased significantly over time with both NoRx (112±13 and 103±16 b.p.m. at baseline and 4 h, respectively) and placebo (112±14 and 102±16 b.p.m. at baseline and 4 h, respectively; Ptimeeffect was not different between interventions (Pdrug=0.771). Postural tachycardia syndrome patients have exaggerated orthostatic tachycardia in the morning that decreases over time with either placebo or NoRx interventions, suggesting this phenomenon is due to cardiovascular physiological variation. These data highlight the need for a placebo arm in haemodynamic clinical trials in POTS and may have important implications for the diagnosis of these patients. © 2014 Wiley Publishing Asia Pty Ltd.

  7. Treatment of Refractory Postural Tachycardia Syndrome with Subcutaneous Octreotide Delivered Using an Insulin Pump

    Directory of Open Access Journals (Sweden)

    Muhammad Khan

    2015-01-01

    Full Text Available Postural Tachycardia Syndrome (PoTS represents a disorder of the autonomic nervous system that results in symptoms of orthostatic intolerance. Despite having a severe impact on the patient’s quality of life, the current treatment options for PoTS are based on limited evidence. Subsequently, this results in clinicians having to utilise a variety of treatment regimens in the hope of successfully providing symptomatic relief. However, the options available for PoTS are not without significant side effects that can worsen an already debilitating condition. Our cases provide a further novel treatment option for clinicians to consider in PoTS refractory to established treatments.

  8. Effect of oxygen on tachycardia and arterial oxygen saturation during colonoscopy

    DEFF Research Database (Denmark)

    Holm, C; Christensen, M; Schulze, S

    1999-01-01

    OBJECTIVE: To evaluate the effect of supplementary oxygen on heart rate and arterial oxygen saturation during colonoscopy. DESIGN: Controlled study. SETTING: Two university hospitals, Denmark. SUBJECTS: 40 patients having colonoscopy. INTERVENTIONS: 20 patients were given supplementary oxygen...... colonoscopy. RESULTS: There were no differences in the incidence of tachycardia or mean heart rate during endoscopy between the two groups, and no patient developed symptomatic cardiac arrhythmias or hypotensive episodes. 10 patients in the room air compared with none in the oxygen treatment group (p = 0...

  9. Severe infundibular pulmonary stenosis and coronary artery stenosis with ventricular tachycardia 24 years after mediastinal irradiation

    International Nuclear Information System (INIS)

    Ichinose, Tetsuo; Miyano, Hiroshi; Kimura, Toru; Yamashita, Haruyo; Takizawa, Kei; Nakazato, Yuji; Kawai, Sachio; Daida, Hiroyuki; Kawasaki, Shiori; Amano, Atushi

    2005-01-01

    A 28-year-old man developed severe infundibular pulmonary stenosis (PS), coronary artery stenosis with sustained ventricular tachycardia (VT) 24 years after mediastinal irradiation (total amount of 40 Gray) for non-Hodgkin's lymphoma. Repair of right ventricular outflow tract and coronary artery bypass graft procedure were performed. Infundibular PS was successfully relieved after operation and VT was also controlled by medication. Mediastinal irradiation often causes various cardiac complications after a latent period. Therefore, continuous careful observation is mandatory in patients with the history of mediastinal irradiation. (author)

  10. An unusual case of sustained ventricular tachycardia following a wasp bite

    Directory of Open Access Journals (Sweden)

    Tarun Sharma

    2016-01-01

    Full Text Available Sustained ventricular tachycardia (VT is a life-threatening condition which requires immediate intervention. We report a case of unusual etiology of sustained VT in a 42-year-old male after a wasp bite in the absence of anaphylaxis. The patient was treated with amiodarone and improved within 48 h. Thus, wasp stings can lead to serious tachyarrhythmias which can be life-threatening. Emergency care physicians should be aware of such arrhythmias in the setting of wasp bites which can be fatal.

  11. Nationwide experience of catecholaminergic polymorphic ventricular tachycardia caused by RyR2 mutations

    DEFF Research Database (Denmark)

    Broendberg, Anders Krogh; Nielsen, Jens Cosedis; Bjerre, Jesper

    2017-01-01

    probands, 18 symptomatic and 10 asymptomatic relatives with a RyR2 mutation. Twenty (87%) probands and 10 (36%) relatives had severe presenting symptoms (sudden cardiac death (SCD), aborted SCD (ASCD) or syncope).As compared with symptomatic relatives, probands had lower age at onset of symptoms (16 years...... of the 28 ICD treated patients (7%). No patients receiving treatment died during follow-up (57 months (IQR, 32-139)). Multifocal atrial tachycardia was the predominant symptom in five patients. CONCLUSIONS: In a national cohort of RyR2 mutation-positive CPVT patients, SCD, ASCD and syncope were presenting...

  12. Catecholaminergic polymorphic ventricular tachycardia in a 3-year-old with occult myocarditis.

    Science.gov (United States)

    Bryant, Randall M; Redfearn, Sharon P; Marangi, Don; Davenport, Joseph P; Kuntz, Sean T; Schowengerdt, Kenneth O

    2002-10-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare clinical entity in children. Occult myocarditis has not been previously implicated as an etiologic agent. A 3-year-old female presents with a presumed breath-holding spell and is found to have ventricular fibrillation requiring DC cardioversion. An invasive electrophysiological study was performed demonstrating the absence of inducible ventricular arrhythmias. Low dose epinephrine confirmed the presence CPVT. Right ventricular endomyocardial biopsies sent for polymerase chain reaction (PCR) analysis demonstrated the presence of adenoviral DNA. The authors hypothesize that occult myocarditis may be the inciting agent for CPVT in children.

  13. Ventricular tachycardia in a Brugada syndrome patient caused by a novel deletion in SCN5A

    DEFF Research Database (Denmark)

    Tfelt-Hansen, J; Jespersen, T; Hofman-Bang, J

    2009-01-01

    -cell patch clamp experiments using human embryonic kidney 293 cells transfected with the mutated SCN5A, no current could be recorded. Hence, the results suggest that the patient suffered from haploinsufficiency of Na(v)1.5, and that this mutation was the cause of his Brugada syndrome.......The aim of the present study was to identify the molecular mechanism behind ventricular tachycardia in a patient with Brugada syndrome. Arrhythmias in patients with Brugada syndrome often occur during sleep. However, a 28-year-old man with no previously documented arrhythmia or syncope who...

  14. Executive Summary: European Heart Rhythm Association Consensus Document on the Management of Supraventricular Arrhythmias: Endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE).

    Science.gov (United States)

    Katritsis, Demosthenes G; Boriani, Giuseppe; Cosio, Francisco G; Jais, Pierre; Hindricks, Gerhard; Josephson, Mark E; Keegan, Roberto; Knight, Bradley P; Kuck, Karl-Heinz; Lane, Deirdre A; Lip, Gregory Yh; Malmborg, Helena; Oral, Hakan; Pappone, Carlo; Themistoclakis, Sakis; Wood, Kathryn A; Young-Hoon, Kim; Lundqvist, Carina Blomström

    2016-01-01

    This paper is an executive summary of the full European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, published in Europace . It summarises developments in the field and provides recommendations for patient management, with particular emphasis on new advances since the previous European Society of Cardiology guidelines. The EHRA consensus document is available to read in full at http://europace.oxfordjournals.org.

  15. Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

    Directory of Open Access Journals (Sweden)

    Perković-Vukčević Nataša

    2012-01-01

    Full Text Available Introduction. Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient with acute iatrogenic caffeine poisoning. Case report. A 51-year-old woman, with preexisting hypertension and hypertensive cardiomyopathy was subjected to cosmetic treatment in order to remove fat by intradermal caffeine injections. During the treatment the patient felt sickness, an urge to vomit, and a pronounced deterioration of general condition. Upon examination, the patient exhibited somnolence, hypotension and nonsustained ventricular tachycardia, which was sufficient enough evidence for further hospitalization. On admission to the intensive care unit the patient was anxious with increased heart rate, normotensive, with cold, damp skin, and visible traces of injection sites with surrounding hematomas on the anterior abdominal wall. Paroxysmal supraventricular tachycardia (PSVT on electrocardiographic monitoring was found. The laboratory analysis determined a lowered potassium level of 2.1 mmol/L (normal range 3,5 - 5.2 mmol/L, and a toxicological analysis (liquid chromatography with ultraviolet detection proved a toxic concentration of caffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L. On application of intensive therapy, antiarrhythmics, and substitution of potassium, as well as both symptomatic and supportive therapy, there was a significant recovery. The patient was discharged without any sequele within four days. Conclusion. A presented rare iatrogenic acute caffeine poisoning occured due to massive absorption of caffeine from the

  16. Guidelines for the diagnosis and management of Catecholaminergic Polymorphic Ventricular Tachycardia.

    Science.gov (United States)

    Pflaumer, Andreas; Davis, Andrew M

    2012-02-01

    Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is an inherited arrhythmia syndrome, characterised by polymorphic ventricular tachycardia induced by adrenergic stress. CPVT can be caused by mutations the cardiac ryanodine receptor gene (RYR2) or mutations in the cardiac calsequestrin gene CASQ2. Structural heart disease is usually absent and the baseline ECG is usually normal. Patients with CPVT often present with exercise- or emotion induced syncope, the first presentation can also be sudden cardiac death. Besides removal of triggers treatment with beta blockers is currently a class I indication in clinically diagnosed patients. Beta blockage should be titrated up to an effective level. The addition of flecainide seems to be a promising approach in patients where arrhythmias are not completely suppressed by beta blockers. A cardioverter-defibrillator (ICD) or left cervical sympathetic denervation might be considered under special circumstances. Genetic counselling is recommended and all first degree relatives should be properly evaluated. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

  17. Objective Sleep Assessments in Patients with Postural Tachycardia Syndrome using Overnight Polysomnograms

    Science.gov (United States)

    Bagai, Kanika; Peltier, Amanda C.; Malow, Beth A.; Diedrich, André; Shibao, Cyndya A.; Black, Bonnie K.; Paranjape, Sachin Y.; Orozco, Carlos; Biaggioni, Italo; Robertson, David; Raj, Satish R.

    2016-01-01

    Study Objectives: Patients with postural tachycardia syndrome (POTS) commonly complain of fatigue, unrefreshing sleep, daytime sleepiness, and diminished quality of life. The study objective was to assess objective sleep quality in POTS patients using overnight polysomnography. Methods: We studied 16 patients with POTS and 15 healthy control subjects performing daytime autonomic functions tests and overnight polysomnography at the Vanderbilt Clinical Research Center. Results: There were no significant differences in the objective sleep parameters including sleep efficiency, sleep onset latency, wake time after sleep onset, REM latency, percentage of time spent in N1, N2, N3, and REM sleep, arousal index, apnea-hypopnea index, or periodic leg movement index in POTS patients as compared with healthy control subjects. There were significant negative correlations between sleep efficiency and the change in HR from supine to stand (rs = −0.527; p = 0.036) Conclusions: POTS patients do not have significant differences in objective sleep parameters as compared to control subjects based on overnight polysomnograms. Activation of the sympathetic nervous system may contribute significantly to the hyper arousal state and worsening of subjective estimates of sleep quality as previously reported in POTS patients. Citation: Bagai K, Peltier AC, Malow BA, Diedrich A, Shibao CA, Black BK, Paranjape SY, Orozco C, Biaggioni I, Robertson D, Raj SR. Objective sleep assessments in patients with postural tachycardia syndrome using overnight polysomnograms. J Clin Sleep Med 2016;12(5):727–733. PMID:26951415

  18. Effects of volume loading and pressor agents in idiopathic orthostatic tachycardia

    Science.gov (United States)

    Jacob, G.; Shannon, J. R.; Black, B.; Biaggioni, I.; Mosqueda-Garcia, R.; Robertson, R. M.; Robertson, D.

    1997-01-01

    BACKGROUND: Idiopathic orthostatic tachycardia (IOT) is characterized by an increase in heart rate (HR) with standing of > or = 30 bpm that is associated with elevated catecholamine levels and orthostatic symptoms. A dynamic orthostatic hypovolemia and alpha1-adrenoreceptor hypersensitivity have been demonstrated in IOT patients. There is evidence of an autonomic neuropathy affecting the lower-extremity blood vessels. METHODS AND RESULTS: We studied the effects of placebo, the alpha1-adrenoreceptor agonist midodrine (5 to 10 mg), the alpha2-adrenoreceptor agonist clonidine (0.1 mg), and I.V. saline (1 L) in 13 patients with IOT. Supine and upright blood pressure (BP) and HR were measured before and at 1 and 2 hours after intervention. Midodrine decreased both supine and upright HR (all HR values are given as bpm) at 2 hours (from 78+/-2 supine to 108+/-5 upright before treatment and from 69+/-2 supine to 95+/-5 upright after treatment, Pdysautonomia and indicates that the use of alpha1-agonists to pharmacologically replace lower-extremity postganglionic sympathetics is an appropriate overall goal of therapy. These findings are consistent with our hypothesis that the tachycardia and elevated catecholamine levels associated with IOT are principally due to hypovolemia and loss of adequate lower-extremity vascular tone.

  19. Benign joint hypermobility syndrome with postural orthostatic tachycardia syndrome and acrocyanosis

    Directory of Open Access Journals (Sweden)

    Navjyot Kaur

    2017-01-01

    Full Text Available Benign joint hypermobility syndrome (BJHS and postural orthostatic tachycardia syndrome (POTS are two common conditions which are frequently overlooked. While patients with BJHS are known to attend rheumatology, orthopedic, and medical outpatient departments for years with polyarthralgia; POTS is commonly misdiagnosed as anxiety neurosis or panic attack. Described first in 1940, POTS is one of the common causes of orthostatic symptoms in females. POTS is defined as orthostatic intolerance associated with tachycardia exceeding 120 beats/min (bpm or an increase in the heart rate (HR of 30 bpm from baseline within 10 min of changing the posture from a lying to standing position, in the absence of long-term chronic diseases and medications that affect the autonomic or vascular tone. Classified as primary and secondary, the underlying pathophysiological mechanism is assumed to be a failure of peripheral vascular resistance to increase sufficiently in response to orthostatic stress, and consequently, venous pooling occurs in the legs resulting in decreased venous return to the heart. This is compensated by an increase in HR and inotropy. We present a case of BJHS, who reported to us with recurrent episodes of syncope and presyncope and was diagnosed to have POTS secondary to his hypermobility syndrome. Although the tilt-table test is the gold standard for diagnosis of POTS, this case highlights the importance of bedside tests in evaluation of orthostatic symptoms and in diagnosis of relatively common but frequently overlooked syndrome.

  20. Delayed Onset of Atrial Fibrillation and Ventricular Tachycardia after an Automobile Lightning Strike.

    Science.gov (United States)

    Drigalla, Dorian; Essler, Shannon E; Stone, C Keith

    2017-11-01

    Lightning strike is a rare medical emergency. The primary cause of death in lightning strike victims is immediate cardiac arrest. The mortality rate from lightning exposure can be as high as 30%, with up to 70% of patients left with significant morbidity. An 86-year-old male was struck by lightning while driving his vehicle and crashed. On initial emergency medical services evaluation, he was asymptomatic with normal vital signs. During his transport, he lost consciousness several times and was found to be in atrial fibrillation with intermittent runs of ventricular tachycardia during the unconscious periods. In the emergency department, atrial fibrillation persisted and he experienced additional episodes of ventricular tachycardia. He was treated with i.v. amiodarone and admitted to cardiovascular intensive care unit, where he converted to a normal sinus rhythm on the amiodarone drip. He was discharged home without rhythm-control medications and did not have further episodes of dysrhythmias on follow-up visits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Lightning strikes are one of the most common injuries suffered from natural phenomenon, and short-term mortality ordinarily depends on the cardiac effects. This case demonstrates that the cardiac effects can be multiple, delayed, and recurrent, which compels the emergency physician to be vigilant in the initial evaluation and ongoing observation of patients with lightning injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Automatic Supporting System for Regionalization of Ventricular Tachycardia Exit Site in Implantable Defibrillators

    Science.gov (United States)

    Sanromán-Junquera, Margarita; Mora-Jiménez, Inmaculada; Almendral, Jesús; García-Alberola, Arcadio; Rojo-Álvarez, José Luis

    2015-01-01

    Electrograms stored in Implantable Cardioverter Defibrillators (ICD-EGM) have been proven to convey useful information for roughly determining the anatomical location of the Left Ventricular Tachycardia exit site (LVTES). Our aim here was to evaluate the possibilities from a machine learning system intended to provide an estimation of the LVTES anatomical region with the use of ICD-EGM in the situation where 12-lead electrocardiogram of ventricular tachycardia are not available. Several machine learning techniques were specifically designed and benchmarked, both from classification (such as Neural Networks (NN), and Support Vector Machines (SVM)) and regression (Kernel Ridge Regression) problem statements. Classifiers were evaluated by using accuracy rates for LVTES identification in a controlled number of anatomical regions, and the regression approach quality was studied in terms of the spatial resolution. We analyzed the ICD-EGM of 23 patients (18±10 EGM per patient) during left ventricular pacing and simultaneous recording of the spatial coordinates of the pacing electrode with a navigation system. Several feature sets extracted from ICD-EGM (consisting of times and voltages) were shown to convey more discriminative information than the raw waveform. Among classifiers, the SVM performed slightly better than NN. In accordance with previous clinical works, the average spatial resolution for the LVTES was about 3 cm, as in our system, which allows it to support the faster determination of the LVTES in ablation procedures. The proposed approach also provides with a framework suitable for driving the design of improved performance future systems. PMID:25910170

  2. Automatic supporting system for regionalization of ventricular tachycardia exit site in implantable defibrillators.

    Directory of Open Access Journals (Sweden)

    Margarita Sanromán-Junquera

    Full Text Available Electrograms stored in Implantable Cardioverter Defibrillators (ICD-EGM have been proven to convey useful information for roughly determining the anatomical location of the Left Ventricular Tachycardia exit site (LVTES. Our aim here was to evaluate the possibilities from a machine learning system intended to provide an estimation of the LVTES anatomical region with the use of ICD-EGM in the situation where 12-lead electrocardiogram of ventricular tachycardia are not available. Several machine learning techniques were specifically designed and benchmarked, both from classification (such as Neural Networks (NN, and Support Vector Machines (SVM and regression (Kernel Ridge Regression problem statements. Classifiers were evaluated by using accuracy rates for LVTES identification in a controlled number of anatomical regions, and the regression approach quality was studied in terms of the spatial resolution. We analyzed the ICD-EGM of 23 patients (18±10 EGM per patient during left ventricular pacing and simultaneous recording of the spatial coordinates of the pacing electrode with a navigation system. Several feature sets extracted from ICD-EGM (consisting of times and voltages were shown to convey more discriminative information than the raw waveform. Among classifiers, the SVM performed slightly better than NN. In accordance with previous clinical works, the average spatial resolution for the LVTES was about 3 cm, as in our system, which allows it to support the faster determination of the LVTES in ablation procedures. The proposed approach also provides with a framework suitable for driving the design of improved performance future systems.

  3. Treatment of postural tachycardia syndrome: a comparison of octreotide and midodrine.

    Science.gov (United States)

    Hoeldtke, Robert D; Bryner, Kimberly D; Hoeldtke, Martin E; Hobbs, Gerald

    2006-12-01

    We assessed the potency of octreotide and midodrine, and their combination, in the treatment of the postural tachycardia syndrome (POTS) and orthostatic intolerance (OI). Nine patients with POTS and six patients with OI stood for up to 1 hour while their HR and BP were monitored. Patients received on separate days, midodrine 10 mg 1 hour before testing, octreotide 0.9 micro g/kg 8 minutes before testing or combination therapy. Standing time in the patients with POTS was 41.2 +/- 8.4 minutes and not improved by midodrine or octreotide, but increased to 56.3 +/- 2.7 (P midodrine 92.8 +/- 0.7 (P midodrine, octreotide and combination therapy (55.5 +/- 3.1, 56.5 +/- 3.5, and 56.6 +/- 3.3, respectively, P midodrine it was 80.3 +/- .69 (P midodrine it was 41.4 +/- 3.5 (P Midodrine and octreotide suppressed tachycardia in POTS and improved standing times in OI. The two drugs had similar potencies; combination therapy was not significantly better than monotherapy.

  4. Phrenic nerve protection via packing of gauze into the pericardial space during ablation of cristal atrial tachycardia in a child.

    Science.gov (United States)

    Takahashi, Kazuhiro; Fuchigami, Tai; Nabeshima, Taisuke; Sashinami, Arata; Nakayashiro, Mami

    2016-03-01

    The success of catheter ablation of focal atrial tachycardia is limited by possible collateral damage to the phrenic nerve. Protection of the phrenic nerve is required. Here we present a case of a 9-year-old girl having a history of an unsuccessful catheter ablation of a focal atrial tachycardia near the crista terminalis (because of proximity of the phrenic nerve) who underwent a successful ablation by means of a novel technique for phrenic nerve protection: packing of gauze into the pericardial space. This method is a viable approach for patients with a failed endocardial ablation due to the proximity of the phrenic nerve.

  5. A double-blind placebo-controlled cross-over study of the vascular effects of midodrine in neuropathic compared with hyperadrenergic postural tachycardia syndrome

    OpenAIRE

    ROSS, Amanda J.; OCON, Anthony J.; MEDOW, Marvin S.; STEWART, Julian M.

    2014-01-01

    POTS (postural tachycardia syndrome) is a chronic form of OI (orthostatic intolerance). Neuropathic POTS is characterized by decreased adrenergic vasoconstriction, whereas hyperadrenergic POTS exhibits increased adrenergic vasoconstriction. We hypothesized that midodrine, an α1-adrenergic receptor agonist, would increase CVR (calf vascular resistance), decrease Cv (calf venous capacitance) and decrease orthostatic tachycardia in neuropathic POTS, but not alter haemodynamics in hyperadrenergic...

  6. Evaluation of highly accelerated real-time cardiac cine MRI in tachycardia.

    Science.gov (United States)

    Bassett, Elwin C; Kholmovski, Eugene G; Wilson, Brent D; DiBella, Edward V R; Dosdall, Derek J; Ranjan, Ravi; McGann, Christopher J; Kim, Daniel

    2014-02-01

    Electrocardiogram (ECG)-gated breath-hold cine MRI is considered to be the gold standard test for the assessment of cardiac function. However, it may fail in patients with arrhythmia, impaired breath-hold capacity and poor ECG gating. Although ungated real-time cine MRI may mitigate these problems, commercially available real-time cine MRI pulse sequences using parallel imaging typically yield relatively poor spatiotemporal resolution because of their low image acquisition efficiency. As an extension of our previous work, the purpose of this study was to evaluate the diagnostic quality and accuracy of eight-fold-accelerated real-time cine MRI with compressed sensing (CS) for the quantification of cardiac function in tachycardia, where it is challenging for real-time cine MRI to provide sufficient spatiotemporal resolution. We evaluated the performances of eight-fold-accelerated cine MRI with CS, three-fold-accelerated real-time cine MRI with temporal generalized autocalibrating partially parallel acquisitions (TGRAPPA) and ECG-gated breath-hold cine MRI in 21 large animals with tachycardia (mean heart rate, 104 beats per minute) at 3T. For each cine MRI method, two expert readers evaluated the diagnostic quality in four categories (image quality, temporal fidelity of wall motion, artifacts and apparent noise) using a Likert scale (1-5, worst to best). One reader evaluated the left ventricular functional parameters. The diagnostic quality scores were significantly different between the three cine pulse sequences, except for the artifact level between CS and TGRAPPA real-time cine MRI. Both ECG-gated breath-hold cine MRI and eight-fold accelerated real-time cine MRI yielded all four scores of ≥ 3.0 (acceptable), whereas three-fold-accelerated real-time cine MRI yielded all scores below 3.0, except for artifact (3.0). The left ventricular ejection fraction (LVEF) measurements agreed better between ECG-gated cine MRI and eight-fold-accelerated real-time cine MRI

  7. Local activation time sampling density for atrial tachycardia contact mapping: how much is enough?

    Science.gov (United States)

    Williams, Steven E; Harrison, James L; Chubb, Henry; Whitaker, John; Kiedrowicz, Radek; Rinaldi, Christopher A; Cooklin, Michael; Wright, Matthew; Niederer, Steven; O'Neill, Mark D

    2018-02-01

    Local activation time (LAT) mapping forms the cornerstone of atrial tachycardia diagnosis. Although anatomic and positional accuracy of electroanatomic mapping (EAM) systems have been validated, the effect of electrode sampling density on LAT map reconstruction is not known. Here, we study the effect of chamber geometry and activation complexity on optimal LAT sampling density using a combined in silico and in vivo approach. In vivo 21 atrial tachycardia maps were studied in three groups: (1) focal activation, (2) macro-re-entry, and (3) localized re-entry. In silico activation was simulated on a 4×4cm atrial monolayer, sampled randomly at 0.25-10 points/cm2 and used to re-interpolate LAT maps. Activation patterns were studied in the geometrically simple porcine right atrium (RA) and complex human left atrium (LA). Activation complexity was introduced into the porcine RA by incomplete inter-caval linear ablation. In all cases, optimal sampling density was defined as the highest density resulting in minimal further error reduction in the re-interpolated maps. Optimal sampling densities for LA tachycardias were 0.67 ± 0.17 points/cm2 (focal activation), 1.05 ± 0.32 points/cm2 (macro-re-entry) and 1.23 ± 0.26 points/cm2 (localized re-entry), P = 0.0031. Increasing activation complexity was associated with increased optimal sampling density both in silico (focal activation 1.09 ± 0.14 points/cm2; re-entry 1.44 ± 0.49 points/cm2; spiral-wave 1.50 ± 0.34 points/cm2, P sampling density (0.61 ± 0.22 points/cm2 vs. 1.0 ± 0.34 points/cm2, P = 0.0015). Optimal sampling densities can be identified to maximize diagnostic yield of LAT maps. Greater sampling density is required to correctly reveal complex activation and represent activation across complex geometries. Overall, the optimal sampling density for LAT map interpolation defined in this study was ∼1.0-1.5 points/cm2. Published on behalf of the European Society

  8. Failure in short-term prediction of ventricular tachycardia and ventricular fibrillation from continuous electrocardiogram in intensive care unit patients.

    Science.gov (United States)

    Sachdev, Molly; Fetics, Barry J; Lai, Shenghan; Dalal, Darshan; Insel, Jerald; Berger, Ronald D

    2010-01-01

    Patients in the intensive care unit (ICU) setting are prone to malignant ventricular arrhythmias. We sought to test whether electrocardiographic (ECG) markers of autonomic tone, ventricular irritability, and repolarization lability could be used in short-term prediction of ventricular arrhythmias in this patient population. We studied 38 patients with sustained (>30 seconds) monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, or ventricular fibrillation while monitored in the ICU and 30 patients without arrhythmia in the ICU who served as controls. All patients had at least 12 hours of continuously recorded multilead ECG before arrhythmic event. Mean heart rate and measures of heart rate variability, QT variability, and ventricular ectopy were quantified in 1-hour epochs for the 12 hours before the arrhythmic event and in 5-minute epochs for the last hour preevent (and using a random termination time point in controls). A modest downward trend in QT variability and a rise in heart rate were observed hours before polymorphic ventricular tachycardia and ventricular fibrillation events, although no significant changes heralded monomorphic ventricular tachycardia and no changes in any parameter predicted imminent ventricular arrhythmia of any type. There were no significant differences in ECG parameters between arrhythmia patients and controls. In ICU patients, sustained ventricular arrhythmias are not preceded by change in ECG measures of autonomic tone, repolarization variability, and ventricular ectopy. Short-term arrhythmia prediction may be difficult or impossible in this patient population based on ECG measures alone. Copyright 2010 Elsevier Inc. All rights reserved.

  9. Catecholaminergic polymorphic ventricular tachycardia. An important diagnosis in children with syncope and normal heart

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Leite

    2001-01-01

    Full Text Available Syncope in children is primarily related to vagal hyperreactivity, but ventricular tachycardia (VT way rarely be seen. Catecholaminergic polymorphic VT is a rare entity that can occur in children without heart disease and with a normal QT interval, which may cause syncope and sudden cardiac death. In this report, we describe the clinical features, treatment, and clinical follow-up of three children with syncope associated with physical effort or emotion and cathecolaminergic polymorphic VT. Symptoms were controlled with beta-blockers, but one patient died suddenly in the fourth year of follow-up. Despite the rare occurrence, catecholaminergic polymorphic VT is an important cause of syncope and sudden death in children with no identified heart disease and normal QT interval.

  10. Female preponderance in atrioventricular node reentrant tachycardia, but no sex related electrophysiological differences

    Directory of Open Access Journals (Sweden)

    Claes Williamsson

    2014-01-01

    Full Text Available The mechanism behind the female preponderance for atrio-ventricular node reentrant tachycardia (AVNRT is not clear. We compared baseline electrophysiological measurements and clinical data in 141 consecutive patients (96 women who underwent successful AVNRT ablation at their fi rst therapeutic procedure. Women had on average 9% higher resting heart rate than men (p<0.05, but were similar in all measures of AV node function. Isoproterenol infusion was required for AVNRT induction in 69 cases (49%, and the need for isoproterenol was associated with lower resting heart rate and longer anterograde and retrograde AV node refractory periods (p<0.05 for comparisons, but not with sex. We conclude that the spectrum of baseline AV node physiology in AVNRT patients is wide, and is similar in men and women. The female preponderance for AVNRT cannot be explained from comparisons of baseline AV node electrophysiological properties.

  11. Recurrent Pulseless Ventricular Tachycardia Induced by Commotio Cordis Treated with Therapeutic Hypothermia

    Directory of Open Access Journals (Sweden)

    Sanghyun Lee

    2015-11-01

    Full Text Available The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT, and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33°C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.

  12. Postural orthostatic tachycardia syndrome with increased erythrocytic hydrogen sulfide and response to midodrine hydrochloride.

    Science.gov (United States)

    Yang, Jinyan; Zhao, Juan; Du, Shuxu; Liu, Die; Fu, Chunhin; Li, Xueying; Chen, Stella; Tang, Chaoshu; Du, Junbao; Jin, Hongfang

    2013-10-01

    To evaluate the use of erythrocytic hydrogen sulfide (H2S) in predicting the therapeutic efficacy of midodrine hydrochloride for children with postural orthostatic tachycardia syndrome (POTS). Fifty-five children were included in this study, involving 28 children with POTS (POTS group) and 27 healthy children (control group). Children in the POTS group received midodrine hydrochloride treatment. Erythrocytic H2S production was measured; a receiver operating characteristic curve was used to assess if erythrocytic H2S could predict the therapeutic response to midodrine hydrochloride treatment. H2S production from erythrocytes was significantly higher in the POTS group than in the control group (P midodrine hydrochloride than in non-responders (P midodrine hydrochloride therapy for children with POTS. Erythrocytic H2S could serve as a useful predictor of therapeutic response to midodrine hydrochloride in children with POTS. Copyright © 2013 Mosby, Inc. All rights reserved.

  13. Surgery of Hypertrophic Obstructive Cardiomyopathy in Patients With Severe Hypertrophy, Myocardial Fibrosis and Ventricular Tachycardia.

    Science.gov (United States)

    Borisov, Konstantin V

    2018-03-10

    In patients with hypertrophic obstructive cardiomyopathy myocardial fibrosis is an independent predictor of adverse outcome. A new technique of HOCM surgical correction in patients with severe hypertrophy and septal myocardial fibrosis has been proposed. The excision of the asymmetrical hypertrophied area of the interventricular septum causing obstruction was performed from the conal part of the right ventricle corresponding to the zone of obstruction of the left ventricle (LV). The areas of septal myocardial fibrosis were removed corresponding to the zone of delayed enhancement imaging. Myocardial fibrosis was detected by cardiovascular magnetic resonance. Eleven HOCM patients with severe hypertrophy, myocardial fibrosis and episodes of ventricular tachycardia underwent this procedure. Five patients had biventricular obstruction. The follow-up period was 39±9 months. Ten patients were free of symptoms (NYHA class 1) and one patient had only mild limitations. The mean echocardiographic gradient in LV decreased from 88.9±10.0 to 9.7±2.1 mmHg, the mean value of gradient in right ventricular outflow tract (RVOT) was reduced from 45.2±4.7 to 3.8±1.3 mmHg. Echocardiographically determined septal thickness was reduced from 34.5±3.8 to 15.5±1.6 mm. Sinus rhythm without block of His bundle right branch was noted in all patients after surgery. Ventricular tachycardia was not registered. The benefits of applying our technique include effective surgical treatment of HOCM patients with severe hypertrophy and biventricular obstruction. It may be an appropriate choice for HOCM patients with septal myocardial fibrosis. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Postural tachycardia in hypermobile Ehlers-Danlos syndrome: A distinct subtype?

    Science.gov (United States)

    Miglis, Mitchell G; Schultz, Brittany; Muppidi, Srikanth

    2017-12-01

    It is not clear if patients with postural tachycardia syndrome (POTS) and Ehlers-Danlos syndrome (hEDS) differ from patients with POTS due to other etiologies. We compared the results of autonomic testing and healthcare utilization in POTS patients with and without hEDS. Patients with POTS+hEDS (n=20) and POTS controls without hypermobility (n=20) were included in the study. All patients underwent autonomic testing, and the electronic medical records were reviewed to determine the number and types of medications patients were taking, as well as the number of outpatient, emergency department, and inpatient visits over the prior year. Patients with hEDS had twice as many outpatient visits (21 v. 10, p=0.012), were taking more prescription medications (8 vs. 5.5, p=0.030), and were more likely to see a pain physician (70% vs 25%, p=0.005). Autonomic testing demonstrated a slight reduction in heart rate variability and slightly lower blood pressures on tilt table testing in hEDS patients, however for most patients these variables remained within the range of normal. Orthostatic tachycardia on tilt table testing was greater in POTS controls (46bpm vs 39bpm, p=0.018). Abnormal QSweat responses were common in both groups (38% of POTS+hEDS and 36% of POTS controls). While autonomic testing results were not significantly different between groups, patients with POTS+hEDS took more medications and had greater markers of healthcare utilization, with chronic pain likely playing a prominent role. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Effects of volume loading and pressor agents in idiopathic orthostatic tachycardia

    Science.gov (United States)

    Jacob, G.; Shannon, J. R.; Black, B.; Biaggioni, I.; Mosqueda-Garcia, R.; Robertson, R. M.; Robertson, D.

    1997-01-01

    BACKGROUND: Idiopathic orthostatic tachycardia (IOT) is characterized by an increase in heart rate (HR) with standing of > or = 30 bpm that is associated with elevated catecholamine levels and orthostatic symptoms. A dynamic orthostatic hypovolemia and alpha1-adrenoreceptor hypersensitivity have been demonstrated in IOT patients. There is evidence of an autonomic neuropathy affecting the lower-extremity blood vessels. METHODS AND RESULTS: We studied the effects of placebo, the alpha1-adrenoreceptor agonist midodrine (5 to 10 mg), the alpha2-adrenoreceptor agonist clonidine (0.1 mg), and I.V. saline (1 L) in 13 patients with IOT. Supine and upright blood pressure (BP) and HR were measured before and at 1 and 2 hours after intervention. Midodrine decreased both supine and upright HR (all HR values are given as bpm) at 2 hours (from 78+/-2 supine to 108+/-5 upright before treatment and from 69+/-2 supine to 95+/-5 upright after treatment, Pmidodrine decreased supine systolic BP mildly. CONCLUSIONS: IOT responds best acutely to saline infusion to correct the underlying hypovolemia. Chronically, this can be accomplished with increased salt and water intake in conjunction with fludrocortisone. The response of patients to the alpha1-agonist midodrine supports the hypothesis of partial dysautonomia and indicates that the use of alpha1-agonists to pharmacologically replace lower-extremity postganglionic sympathetics is an appropriate overall goal of therapy. These findings are consistent with our hypothesis that the tachycardia and elevated catecholamine levels associated with IOT are principally due to hypovolemia and loss of adequate lower-extremity vascular tone.

  16. Identification and Radiofrequency Catheter Ablation of a Nonsustained Atrial Tachycardia at the Septal Mitral Annulus with the Use of a Noncontact Mapping System: A Case Report

    Directory of Open Access Journals (Sweden)

    Sumito Narita, MD

    2008-01-01

    Full Text Available Here we report a case of a 16-year old female with symptomatic nonsustained atrial tachycardia (NSAT originating from the septal mitral annulus. NSAT was induced by atrial burst pacing after an intravenous isoproterenol (ISP injection. The array mode of the noncontact mapping system (NCM allowed us to quickly identify the tachycardia focus at the septal mitral annulus, where the contact bipolar voltage map revealed no low voltage area (<0.5 mV. The NSAT was eliminated by a radiofrequency energy application to the identified tachycardia focus during sinus rhythm, and the patient has been free from any symptoms during 10 months of follow-up.

  17. Cardiac rhythm abnormalities during intravenous immunoglobulin G(IVIG) infusion in two newborn infants: coincidence or association?

    OpenAIRE

    Tufekci, Sinan; Coban, Asuman; Bor, Meltem; Yasa, Beril; Nisli, Kemal; Ince, Zeynep

    2015-01-01

    Key Clinical Message We report the occurrence of supraventricular tachycardia during intravenous immunoglobulin (IVIG) infusion. Supraventricular tachycardia was observed in two newborn patients during IVIG infusion. Both of the babies responded to adenosine treatment. Cardiorespiratory monitoring during IVIG infusion can be recommended because of the possibility of this potentially lifethreatening adverse effect.

  18. Ten-year outcomes of monomorphic ventricular tachycardia catheter ablation in repaired tetralogy of Fallot.

    Science.gov (United States)

    Laredo, Mikaël; Frank, Robert; Waintraub, Xavier; Gandjbakhch, Estelle; Iserin, Laurence; Hascoët, Sebastien; Himbert, Caroline; Gallais, Yves; Hidden-Lucet, Françoise; Duthoit, Guillaume

    2017-05-01

    Monomorphic ventricular tachycardia (MVT) is common in adults with repaired tetralogy of Fallot (TOF), and is associated with sudden cardiac death. Management of MVT is not defined, and results of catheter ablation (CA) are limited. To evaluate long-term outcomes of MVT CA in repaired TOF. Thirty-four patients (mean age 32±10.3 years; 59% male) with repaired TOF underwent CA for symptomatic MVT between 1990 and 2012 in our centre; direct-current ablation (DCA) was used in 6%, radiofrequency followed by DCA in 29% and radiofrequency alone in 65%. Right ventricular (RV) dysfunction was present in 35% and left ventricular (LV) dysfunction in 21%. Mean numbers of clinical and induced MVTs were 1 and 2, respectively. Mean VT rate was 225±95bpm. Ablation targeted a single site (range 1-2), which was RV outflow tract in 85%. Primary success, defined as ventricular tachycardia (VT) termination during CA and final non-inducibility, was obtained in 82%. Seven patients (21%) required redo ablation in the first 3 months (before 2004; DCA). No death related to CA occurred. Mean follow-up time was 9.5±5.2 years. Antiarrhythmic therapy was discontinued in 71%. There were two cases of sudden cardiac death and four VT recurrences. Freedom from death and arrhythmia recurrence was 94% at 5 years, 81% at 10 years and 70% at 20 years. Global survival was 91% at 20 years. Baseline LV ejection fraction<60% was significantly associated with ventricular arrhythmia recurrence (hazard ratio 16.4, 95% confidence interval 1.8-147; P=0.01). CA can safely address macroreentrant MVT in repaired TOF patients with an acceptable long-term rate of recurrence in this high-risk population. Anatomical classification of isthmuses with electroanatomical mapping provides reproducible endpoints for CA. Attention should be given to LV systolic function in risk assessment and selection of candidates for implantable cardioverter-defibrillator. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Ventricular Tachycardia with ICD Shocks: When to Medicate and When to Ablate.

    Science.gov (United States)

    AbdelWahab, Amir; Sapp, John

    2017-09-13

    Ventricular tachycardia occurrence in implantable cardioverter defibrillator (ICD) patients may result in shock delivery and is associated with increased morbidity and mortality. In addition, shocks may have deleterious mechanical and psychological effects. Prevention of ventricular tachycardia (VT) recurrence with the use of antiarrhythmic drugs or catheter ablation may be warranted. Antiarrhythmic drugs are limited by incomplete efficacy and an unfavorable adverse effect profile. Catheter ablation can be effective but acute complications and long-term VT recurrence risk necessitating repeat ablation should be recognized. A shared clinical decision process accounting for patients' cardiac status, comorbidities, and goals of care is often required. There are four published randomized trials of catheter ablation for sustained monomorphic VT (SMVT) in the setting of ischemic heart disease; there are no randomized studies for non-ischemic ventricular substrates. The most recent trial is the VANISH trial which randomly allocated patients with ICD, prior infarction, and SMVT despite first-line antiarrhythmic drug therapy to catheter ablation or more aggressive antiarrhythmic drug therapy. During 28 months of follow-up, catheter ablation resulted in a 28% relative risk reduction in the composite endpoint of death, VT storm, and appropriate ICD shock (p = 0.04). In a subgroup analysis, patients having VT despite amiodarone had better outcomes with ablation as compared to increasing amiodarone dose or adding mexiletine. There is evidence for the effectiveness of both catheter ablation and antiarrhythmic drug therapy for patients with myocardial infarction, an implantable defibrillator, and VT. If sotalol is ineffective in suppressing VT, either catheter ablation or initiation of amiodarone is a reasonable option. If VT occurs despite amiodarone therapy, there is evidence that catheter ablation is superior to administration of more aggressive antiarrhythmic drug therapy

  20. Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation or sustained ventricular tachycardia.

    LENUS (Irish Health Repository)

    Corrado, Domenico

    2010-09-21

    The role of implantable cardioverter-defibrillator (ICD) in patients with arrhythmogenic right ventricular cardiomyopathy\\/dysplasia and no prior ventricular fibrillation (VF) or sustained ventricular tachycardia is an unsolved issue.

  1. Totally Leadless Dual-Device Implantation for Combined Spontaneous Ventricular Tachycardia Defibrillation and Pacemaker Function: A First Report.

    Science.gov (United States)

    Ahmed, Fozia Zahir; Cunnington, Colin; Motwani, Manish; Zaidi, Amir Masood

    2017-08-01

    Subcutaneous implantable cardioverter defibrillators (S-ICDs) provide effective defibrillation, while also reducing the risk of long-term lead problems. However, S-ICDs do not offer bradycardia or antitachycardia pacing and therefore use has been limited. Combined implantation of an S-ICD with a leadless pacemaker (LP) has been proposed to overcome this limitation. Although a handful of combined S-ICD/LP implantations have been reported for Nanostim (St Jude Medical, St Paul, MN) as well as Micra LP (Medtronic, Minneapolis, MN) systems, none have documented delivery of appropriate shock therapies for spontaneous ventricular tachycardia. We report the first case of effective defibrillation for spontaneous ventricular tachycardia in a patient with combined Micra LP and S-ICD. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  2. A giant cardiac hydatid cyst presenting with chest pain and ventricular tachycardia in a pregnant woman undergoing cesarean section

    Directory of Open Access Journals (Sweden)

    Mehmet Yaman

    2016-09-01

    Full Text Available Cyst hydatid disease is an infectious disease caused by development of the larval form of Echinococcus granulosus in humans. Cardiac involvement of this disease is a rare condition, and if present, it is most commonly located in the left ventricle. Interventricular septal involvement is observed only in 4% of these cases. Herein, we report a case of cyst hydatid located at interventricular septum causing chest pain and ventricular tachycardia during cesarean section.

  3. P-Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism.

    Science.gov (United States)

    Field, Michael E; Donateo, Paolo; Bottoni, Nicola; Iori, Matteo; Brignole, Michele; Kipp, Ryan T; Kopp, Douglas E; Leal, Miguel A; Eckhardt, Lee L; Wright, Jennifer M; Walsh, Kathleen E; Page, Richard L; Hamdan, Mohamed H

    2018-04-19

    The mechanism of inappropriate sinus tachycardia (IST) remains incompletely understood. We prospectively compared 3 patient groups: 11 patients with IST (IST Group), 9 control patients administered isoproterenol (Isuprel Group), and 15 patients with cristae terminalis atrial tachycardia (AT Group). P-wave amplitude in lead II and PR interval were measured at a lower and higher heart rate (HR1 and HR2, respectively). P-wave amplitude increased significantly with the increase in HR in the IST Group (0.16±0.07 mV at HR1=97±12 beats per minute versus 0.21±0.08 mV at HR2=135±21 beats per minute, P =0.001). The average increase in P-wave amplitude in the IST Group was similar to the Isuprel Group ( P =0.26). PR interval significantly shortened with the increases in HR in the IST Group (146±15 ms at HR1 versus 128±16 ms at HR2, P PR interval was noted in the Isuprel Group ( P =0.6). In contrast, patients in the atrial tachycardia Group experienced PR lengthening during atrial tachycardia when compared with baseline normal sinus rhythm (153±25 ms at HR1=78±17 beats per minute versus 179±29 ms at HR2=140±28 beats per minute, P PR shortening similar to what is seen in healthy controls following isoproterenol infusion. The increase in P-wave amplitude and absence of PR lengthening in IST support an extrinsic mechanism consistent with a state of sympatho-excitation with cephalic shift in sinus node activation and enhanced atrioventricular nodal conduction. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  4. Unmappable ventricular tachycardia after an old myocardial infarction. Long-term results of substrate modification in patients with an implantable cardioverter defibrillator

    OpenAIRE

    Alzand, B. S. N.; Timmermans, C. C. M. M.; Wellens, H. J. J.; Dennert, R.; Philippens, S. A. M.; Portegijs, P. J. M.; Rodriguez, LM.

    2011-01-01

    Purpose The frequent occurrence of ventricular tachycardia can create a serious problem in patients with an implantable cardioverter defibrillator. We assessed the long-term efficacy of catheter-based substrate modification using the voltage mapping technique of infarct-related ventricular tachycardia and recurrent device therapy. Methods The study population consisted of 27 consecutive patients (age 68 ± 8 years, 25 men, mean left ventricular ejection fraction 31 ± 9%) with an old myocardial...

  5. Postural Orthostatic Tachycardia With Chronic Fatigue After HPV Vaccination as Part of the “Autoimmune/Auto-inflammatory Syndrome Induced by Adjuvants”

    OpenAIRE

    Lucija Tomljenovic PhD; Serena Colafrancesco MD; Carlo Perricone MD; Yehuda Shoenfeld MD, FRCP (Hon), MaACR

    2014-01-01

    We report the case of a 14-year-old girl who developed postural orthostatic tachycardia syndrome (POTS) with chronic fatigue 2 months following Gardasil vaccination. The patient suffered from persistent headaches, dizziness, recurrent syncope, poor motor coordination, weakness, fatigue, myalgias, numbness, tachycardia, dyspnea, visual disturbances, phonophobia, cognitive impairment, insomnia, gastrointestinal disturbances, and a weight loss of 20 pounds. The psychiatric evaluation ruled out t...

  6. Wide QRS tachycardia in a patient with pre excitation; what are the pathways involved? Pacing manoeuvres to characterize a unique pathway

    Directory of Open Access Journals (Sweden)

    Krishna Kumar Mohanan Nair

    2017-03-01

    Full Text Available A 30year old patient presented to us with recurrent episodes of palpitation and documented tachycardia. In all his presentations a wide QRS tachycardia was recorded. The baseline ECG showed pre excitation. The 12 lead ECG of the tachycardia and the baseline ECG is shown in Fig. 1A. During EP study the patient had baseline pre excitation and the HV interval was 16 ms. A duo-decapolar halo (HL catheter was used to map right atrium and a decapolar coronary sinus (CS catheter was used to map coronary sinus. In addition a His bundle and right ventricular (RV quadripolar catheters were used. The delta wave morphology was suggestive of a posteroseptal pathway. Ventricular pacing from RV apex showing central decremental conduction with ventriculo-atrial Wenkebach at 290 ms. Ventricular extrastimulation also showed decremental conduction and VA block at S1 S2 of 400,240. The intra cardiac recording of tachycardia and its initiation is shown in Fig. 1B. Pacing from lateral RA (HL 5, 6 electrodes showed progressive pre excitation with extrastimulation and induction of tachycardia. The QRS morphology was same as the patient's clinical tachycardia and the tachycardia cycle length (TCL was 304 ms. An atrial entrainment protocol showed entrainment with the same QRS morphology while pacing from right atrium. The VA interval of the first return cycle was the same as the subsequent VA intervals. A ventricular entrainment protocol showed V-A-V response and post pacing interval of 414 ms. An atrial extra systole was given from the mid CS electrodes (CS 5, 6 – the effect is shown in Fig. 3. In sinus rhythm a parahisian pacing manoeuvre was done as shown in Fig. 4A. What is the mechanism of the tachycardia and what are the pathways involved?

  7. Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome: a randomized, placebo-controlled trial.

    Science.gov (United States)

    Kpaeyeh, John; Mar, Philip L; Raj, Vidya; Black, Bonnie K; Arnold, Amy C; Biaggioni, Italo; Shibao, Cyndya A; Paranjape, Sachin Y; Dupont, William D; Robertson, David; Raj, Satish R

    2014-12-01

    Postural tachycardia syndrome (POTS) is characterized clinically not only by an exaggerated increase in heart rate (HR), but an associated cognitive impairment that disables many patients. Modafinil might be effective in improving the cognitive symptoms, but modafinil may stimulate the sympathetic nervous system and worsen tachycardia in POTS. We tested the hypothesis that modafinil would worsen tachycardia and orthostatic symptoms in POTS. Patients with POTS (n = 54) underwent a randomized crossover trial with modafinil 100 mg versus placebo. Heart rate and systolic blood pressure (SBP) were measured seated and standing before modafinil or placebo administration and then hourly for 4 hours. Over 4 hours, standing HR was not significantly different between the modafinil and placebo groups (analysis of variance [ANOVA] Pdrug = 0.328), but seated SBP was significantly higher in the modafinil group (mean [SD], 109 [12] mm Hg vs 104 [10] mm Hg; P = 0.004). Modafinil also significantly increased both the seated SBP (ANOVA Pdrug = 0.004) and the standing SBP (ANOVA Pdrug = 0.041) over time. There was no significant difference between modafinil and placebo over the 4-hour period with regard to POTS symptom burden scores (14 [12] vs 14 [12]; P = 0.962). Modafinil did not significantly worsen standing HR or acute orthostatic symptoms in patients with POTS compared with the placebo group and improved upright blood pressure. Therefore, modafinil could be tested as a potential treatment for the cognitive impairment in POTS.

  8. Autonomic control of heart rate during orthostasis and the importance of orthostatic-tachycardia in the snake Python molurus.

    Science.gov (United States)

    Armelin, Vinicius Araújo; da Silva Braga, Victor Hugo; Abe, Augusto Shinya; Rantin, Francisco Tadeu; Florindo, Luiz Henrique

    2014-10-01

    Orthostasis dramatically influences the hemodynamics of terrestrial vertebrates, especially large and elongated animals such as snakes. When these animals assume a vertical orientation, gravity tends to reduce venous return, cardiac filling, cardiac output and blood pressure to the anterior regions of the body. The hypotension triggers physiological responses, which generally include vasomotor adjustments and tachycardia to normalize blood pressure. While some studies have focused on understanding the regulation of these vasomotor adjustments in ectothermic vertebrates, little is known about regulation and the importance of heart rate in these animals during orthostasis. We acquired heart rate and carotid pulse pressure (P PC) in pythons in their horizontal position, and during 30 and 60° inclinations while the animals were either untreated (control) or upon muscarinic cholinoceptor blockade and a double autonomic blockade. Double autonomic blockade completely eradicated the orthostatic-tachycardia, and without this adjustment, the P PC reduction caused by the tilts became higher than that which was observed in untreated animals. On the other hand, post-inclinatory vasomotor adjustments appeared to be of negligible importance in counterbalancing the hemodynamic effects of gravity. Finally, calculations of cardiac autonomic tones at each position revealed that the orthostatic-tachycardia is almost completely elicited by a withdrawal of vagal drive.

  9. Symptoms predictive of postural tachycardia syndrome (POTS) in the adolescent headache patient.

    Science.gov (United States)

    Heyer, Geoffrey L; Fedak, Erin M; LeGros, Aggie L

    2013-06-01

    To identify symptoms that may predict postural tachycardia syndrome (POTS) among adolescent patients with headache and lightheadedness referred for tilt table testing. Individuals with POTS can have a variety of symptoms that impair quality of life. The specific symptoms that help to distinguish the POTS patient in an adolescent headache population have not been determined. A group of symptoms was compared among 70 adolescent patients with headache and lightheadedness referred to a pediatric headache clinic for tilt table testing. Every patient completed a symptom questionnaire prior to the tilt table test. The chi-square test was used to compare questionnaire responses between patients found to have POTS and those who did not have POTS. Thirteen symptoms were analyzed. Symptoms that differed statistically between groups were further assessed for sensitivity, specificity, and diagnostic predictive values. Thirty-seven (53%) patients met diagnostic criteria for POTS. Several symptoms differed between the patients found to have POTS and those without POTS. Headache type was not predictive. Vertigo and evening exacerbation of headaches had P values headache trigger, and orthostatic headaches had P values headache type reliably establishes the POTS diagnosis, several symptoms can help to distinguish the POTS patient in an adolescent headache population. © 2013 American Headache Society.

  10. Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy

    Directory of Open Access Journals (Sweden)

    Kenneth A. Mayuga

    2018-01-01

    Full Text Available A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.

  11. Four faces of baroreflex failure: hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia

    Science.gov (United States)

    Ketch, Terry; Biaggioni, Italo; Robertson, RoseMarie; Robertson, David

    2002-01-01

    BACKGROUND: The baroreflex normally serves to buffer blood pressure against excessive rise or fall. Baroreflex failure occurs when afferent baroreceptive nerves or their central connections become impaired. In baroreflex failure, there is loss of buffering ability, and wide excursions of pressure and heart rate occur. Such excursions may derive from endogenous factors such as stress or drowsiness, which result in quite high and quite low pressures, respectively. They may also derive from exogenous factors such as drugs or environmental influences. METHODS AND RESULTS: Impairment of the baroreflex may produce an unusually broad spectrum of clinical presentations; with acute baroreflex failure, a hypertensive crisis is the most common presentation. Over succeeding days to weeks, or in the absence of an acute event, volatile hypertension with periods of hypotension occurs and may continue for many years, usually with some attenuation of pressor surges and greater prominence of depressor valleys during long-term follow-up. With incomplete loss of baroreflex afferents, a mild syndrome of orthostatic tachycardia or orthostatic intolerance may appear. Finally, if the baroreflex failure occurs without concomitant destruction of the parasympathetic efferent vagal fibers, a resting state may lead to malignant vagotonia with severe bradycardia and hypotension and episodes of sinus arrest. CONCLUSIONS: Although baroreflex failure is not the most common cause of the above conditions, correct differentiation from other cardiovascular disorders is important, because therapy of baroreflex failure requires specific strategies, which may lead to successful control.

  12. Patient-specific detection of ventricular tachycardia in remote continuous health devices.

    Science.gov (United States)

    Juneja, Amit; Marefat, Michael

    2016-08-01

    Ventricular Tachycardia (VT) is a dangerous arrhythmic event which can lead to sudden cardiac death if not detected and taken care of in time. This work uses non-linear features derived from Recurrence Quantification Analysis (RQA) along with Kolmogorov complexity, by analyzing the ECG signals, to train a classifier which can predict VT prior to their onset in remote continuous health devices. Compressed ECG signal along with amplitude ranges extracted from the ECG signal are used as features to strengthen the classifier. Stacked Denoising Autoencoders (SDAE) are used for the purpose of feature extraction and compression of signals, and their performance is compared with other works that detect VT for different window sizes. Softmax Regression is used as the classifier in this work. The proposed method is tested against MIT-BIH Arrhythmia database, MIT-BIH Malignant Ventricular Arrhythmia Database (VFDB) and Creighton University Ventricular Tachyarrhythmia Database (CUDB). A total of 96.52% accuracy with 96.18% sensitivity is obtained after testing the proposed method on all test records.

  13. Amiodarone for the treatment and prevention of ventricular fibrillation and ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Hugo Van Herendael

    2010-06-01

    Full Text Available Hugo Van Herendael, Paul DorianDivision of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, CanadaAbstract: Amiodarone has emerged as the leading antiarrhythmic therapy for termination and prevention of ventricular arrhythmia in different clinical settings because of its proven efficacy and safety. In patients with shock refractory out-of-hospital cardiac arrest and hemodynamically destabilizing ventricular arrhythmia, amiodarone is the most effective drug available to assist in resuscitation. Although the superiority of the transvenous implantable cardioverter defibrillator (ICD over amiodarone has been well established in the preventive treatment of patients at high risk of life-threatening ventricular arrhythmias, amiodarone (if used with a beta-blocker is the most effective antiarrhythmic drug to prevent ICD shocks and treat electrical storm. Both the pharmacokinetics and the electrophysiologic profile of amiodarone are complex, and its optimal and safe use requires careful patient surveillance with respect to potential adverse effects.Keywords: amiodarone, ventricular fibrillation, unstable ventricular tachycardia

  14. Association of temporary complete AV block and junctional ectopic tachycardia after surgery for congenital heart disease.

    Science.gov (United States)

    Paech, Christian; Dähnert, Ingo; Kostelka, Martin; Mende, Meinhardt; Gebauer, Roman

    2015-01-01

    Junctional ectopic tachycardia (JET) is a postoperative complication with a mortality rate of up to 14% after surgery for congenital heart disease. This study evaluated the risk factors of JET and explored the association of postoperative temporary third degree atrioventricular (AV) block and the occurrence of JET. Data were collected retrospectively from 1158 patients who underwent surgery for congenital heart disease. The overall incidence of JET was 2.8%. Temporary third degree AV block occurred in 1.6% of cases. Permanent third degree AV block requiring pacemaker implantation occurred in 1% of cases. In all, 56% of patients with JET had temporary AV block (P AV block (P = 0.56). temporary third degree AV block did not suffer from JET. A correlation between temporary third degree AV block and postoperative JET could be observed. The risk factors identified for JET include younger age groups at the time of surgery, longer aortic cross clamping time and surgical procedures in proximity to the AV node.

  15. Atrio-ventricular conduction following radiofrequency ablation for atrio-ventricular node reentry tachycardia in children.

    Science.gov (United States)

    Kantoch, Michal J; Atallah, Joseph; Soni, Reeni N

    2010-07-01

    The study was designed to assess atrio-ventricular (AV) conduction with non-invasive methods at least 1 year after radiofrequency ablation (RFA) of the slow pathway for AV node reentry tachycardia. Medical records of all patients who underwent RFA before their 18th birthday were reviewed. Patients were brought back for clinical evaluation, an electrocardiogram, an exercise stress test, and ambulatory Holter monitoring. Radiofrequency ablation of the slow pathway above the ostium of the coronary sinus was done in 106 children. No procedure resulted in high degree AV block. Follow-up evaluation was possible in 67 patients (63% of the total cohort) who were brought back to the clinic 1-13.7 years, mean 4.7+/-3.0 years after the procedure. Dizzy spells were reported by 36% of examined patients and 2 patients reported syncope. PR intervals were normal in all but two patients when compared with published normal values. One patient presented with persistent, post-procedural first-degree AV block and another developed new onset, symptomatic second degree AV block 2 years after the procedure and required pacemaker implantation. Non-invasive testing showed normal PR intervals in a cohort of patients who underwent RFA of the slow pathway in childhood or adolescence. Late AV block occurred in one child. Clinical evaluation more than a year after the procedure is warranted in symptomatic patients.

  16. A Case Report and Review of Postural Orthostatic Tachycardia Syndrome in Pregnancy

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    Brianna Lide

    2015-04-01

    Full Text Available Purpose - Postural orthostatic tachycardia syndrome (POTS is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal symptoms. Management includes volume expansion, physical counter maneuvers, and pharmacological agents such as fludrocortisone, midodrine, propranolol, and pyridostigmine. The course of POTS in pregnancy is variable and POTS has not been directly implicated in any adverse outcomes for the mother or fetus. Methods - Two cases of POTS in pregnancy are presented, along with a review of the literature for reports of POTS in pregnancy. Results - Along with our 2 cases, 10 other case reports were identified and included. Conclusion - The course of POTS in pregnancy is variable, and not directly linked to increase perinatal morbidity or mortality. Women can safely undergo regional anesthesia, and vaginal delivery with close monitoring of hemodynamic changes.

  17. A Case Report and Review of Postural Orthostatic Tachycardia Syndrome in Pregnancy.

    Science.gov (United States)

    Lide, Brianna; Haeri, Sina

    2015-04-01

    Purpose Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal symptoms. Management includes volume expansion, physical counter maneuvers, and pharmacological agents such as fludrocortisone, midodrine, propranolol, and pyridostigmine. The course of POTS in pregnancy is variable and POTS has not been directly implicated in any adverse outcomes for the mother or fetus. Methods Two cases of POTS in pregnancy are presented, along with a review of the literature for reports of POTS in pregnancy. Results Along with our 2 cases, 10 other case reports were identified and included. Conclusion The course of POTS in pregnancy is variable, and not directly linked to increase perinatal morbidity or mortality. Women can safely undergo regional anesthesia, and vaginal delivery with close monitoring of hemodynamic changes.

  18. Structural brain abnormalities in postural tachycardia syndrome: A VBM-DARTEL study

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    Satoshi eUmeda

    2015-03-01

    Full Text Available Postural tachycardia syndrome (PoTS, a form of dysautonomia, is characterized by orthostatic intolerance, and is frequently accompanied by a range of symptoms including palpitations, lightheadedness, clouding of thought, blurred vision, fatigue, anxiety and depression. Although the estimated prevalence of PoTS is approximately 5-10 times ascommon as the better-known condition orthostatic hypotension, the neural substrates of the syndrome are poorly characterized. In the present study, we used magnetic resonance imaging (MRI with voxel-based morphometry (VBM applying the diffeomorphic anatomical registration through exponentiated lie algebra (DARTEL procedure to examine variation in regional brain structure associated with PoTS. We recruited eleven patients with established PoTS and twenty-three age-matched normal controls. Group comparison of grey matter volume revealed diminished grey matter volume within the left anterior insula, right middle frontal gyrus and right cingulate gyrus in the PoTS group. We also observed lower white matter volume beneath the precentral gyrus and paracentral lobule, right pre- and post-central gyrus, paracentral lobule and superior frontal gyrus in PoTS patients. Subsequent ROI analyses revealed significant negative correlations between left insula volume and trait anxiety and depression scores. Together, these findings of structural differences, particularly within insular and cingulate components of the salience network, suggest a link between dysregulated physiological reactions arising from compromised central autonomic control (and interoceptive representation and increased vulnerability to psychiatric symptoms in PoTS patients.

  19. Anatomic characterization of endocardial substrate for hemodynamically stable reentrant ventricular tachycardia: identification of endocardial conducting channels.

    Science.gov (United States)

    Hsia, Henry H; Lin, David; Sauer, William H; Callans, David J; Marchlinski, Francis E

    2006-05-01

    Detailed anatomic characterization of endocardial substrate of ventricular tachycardia (VT) is limited. The purpose of this study was to determine the endocardial dimensions and local electrogram voltage characteristics of the reentrant circuit. VT-related conducting channels corresponding to zones of slow conduction may be identified. Electroanatomic mapping was performed in 26 patients with uniform VT. Entrainment mapping was performed in 53 VTs, of which 19 entrance, 37 isthmus, 48 exit, and 32 outer loop sites were identified. The color display of voltage maps was adjusted to identify conducting channels associated with VT circuits. A conducting channel was defined as a path of multiple orthodromically activated sites within the VT circuit that demonstrated an electrogram amplitude higher than that of surrounding areas as evidenced by voltage color differences. Forty-seven (84%) of 56 entrance or isthmus sites were located within dense scar (channels was identified in 18 of 32 VTs with detailed mapping (average length 32 +/- 22 mm). The voltage threshold in the conducting channels ranges from 0.1 to 0.7 mV (mean 0.33 +/- 0.15 mV). (1) Most entrance and isthmus sites of hemodynamically stable VT are located in dense scar, whereas exits are located in the border zone. (2) VT-related conducting channels may be identified by careful voltage threshold adjustment. These findings have important implications regarding strategies for substrate-based VT ablation.

  20. 3H-digoxin distribution in the nervous system in ventricular tachycardia

    International Nuclear Information System (INIS)

    Frazer, G.; Binnion, P.

    1981-01-01

    The distribution of 3H-digoxin has been measured in a large number of tissues from the central, autonomic, and peripheral nervous system after the induction of ventricular tachycardia by infusing digoxin into anesthetized dogs. In most parts of the nervous system the tissue digoxin concentration was close to that in the cerebrospinal fluid. Digoxin accumulation in the choroid plexus probably represented a labeling of adenosine triphosphatase. There was a markedly higher concentration of digoxin in the neurohypophysis than in the adenohypophysis, and the very high levels in the neurohypophysis are hard to explain. There may be a relationship between the pituitary and the hypothalamic digoxin levels, although the concentration in the latter was unimpressive. The fornix showed a modest increase in 3H-digoxin concentration and may play a role, as its efferent discharge goes to the hypothalamus. The high concentration of digoxin in the area postrema suggests that this central nervous system structure is responsible, at least in part, for producing digoxin-induced cardiac arrhythmias. It may act as a sensing organ sensitive to blood digoxin concentration. Either it is the only central nervous structure implicated, or it is involved together with the fornix-hypothalamus-hypophysis pathways. Further proof is given for the importance of the autonomic nervous system in cardiac arrhythmias by the high digoxin levels in the superior cervical sympathetic ganglion and adrenal medulla

  1. 3H-digoxin distribution in the nervous system in ventricular tachycardia. [Dogs

    Energy Technology Data Exchange (ETDEWEB)

    Frazer, G.; Binnion, P.

    The distribution of 3H-digoxin has been measured in a large number of tissues from the central, autonomic, and peripheral nervous system after the induction of ventricular tachycardia by infusing digoxin into anesthetized dogs. In most parts of the nervous system the tissue digoxin concentration was close to that in the cerebrospinal fluid. Digoxin accumulation in the choroid plexus probably represented a labeling of adenosine triphosphatase. There was a markedly higher concentration of digoxin in the neurohypophysis than in the adenohypophysis, and the very high levels in the neurohypophysis are hard to explain. There may be a relationship between the pituitary and the hypothalamic digoxin levels, although the concentration in the latter was unimpressive. The fornix showed a modest increase in 3H-digoxin concentration and may play a role, as its efferent discharge goes to the hypothalamus. The high concentration of digoxin in the area postrema suggests that this central nervous system structure is responsible, at least in part, for producing digoxin-induced cardiac arrhythmias. It may act as a sensing organ sensitive to blood digoxin concentration. Either it is the only central nervous structure implicated, or it is involved together with the fornix-hypothalamus-hypophysis pathways. Further proof is given for the importance of the autonomic nervous system in cardiac arrhythmias by the high digoxin levels in the superior cervical sympathetic ganglion and adrenal medulla.

  2. Dexmedetomidine controls junctional ectopic tachycardia during Tetralogy of Fallot repair in an infant

    Directory of Open Access Journals (Sweden)

    Michelle LeRiger

    2012-01-01

    Full Text Available Dexmedetomidine is a highly selective α2 -adrenergic agonist approved for short-term sedation and monitored anesthesia care in adults. Although not approved for use in the pediatric population, an increasing number of reports describe its use in pediatric patients during the intraoperative period and in the intensive care unit. Dexmedetomidine can potentially have an adverse impact on the cardiovascular system secondary to its negative chronotropic and dromotropic effects. However, it is these cardiac effects that are currently being explored as a therapeutic option for the treatment of perioperative tachyarrhythmias in pediatric patients with congenital heart disease (CHD. We report the use of dexmedetomidine to treat junctional ectopic tachycardia (JET, which developed following cardiopulmonary bypass for surgical correction of Tetralogy of Fallot in a 6-week-old infant. Within 15 min of increasing the dexmedetomidine infusion from 0.5 to 3 μg/kg/h, JET converted to normal sinus rhythm. This case report provides additional anecdotal evidence that dexmedetomidine may have a therapeutic role in the treatment of perioperative tachyarrhythmias in pediatric patients with CHD. The specific effects of dexmedetomidine on the cardiac conduction system are reviewed followed by a summary of previous reports describing its use as a therapeutic agent to treat perioperative arrhythmias.

  3. Outcomes in adolescents with postural orthostatic tachycardia syndrome treated with midodrine and beta-blockers.

    Science.gov (United States)

    Lai, Cindy C; Fischer, Philip R; Brands, Chad K; Fisher, Jennifer L; Porter, Co-Burn J; Driscoll, Sherilyn W; Graner, Kevin K

    2009-02-01

    Postural orthostatic tachycardia syndrome (POTS) is associated with debilitating fatigue, dizziness, and discomfort in previously healthy adolescents. The effects of medical therapy have not been well studied in this patient population. This study assessed the relative efficacy and impact of drug therapy on the functioning and quality of life in adolescents with POTS. A retrospective, single center, chart review analysis with a follow-up written survey was conducted on a group of 121 adolescents who had undergone autonomic reflex screening at the Mayo Clinic from 2002 to 2005 as part of an evaluation for possible POTS. Of 121 surveys sent, 47 adolescents returned a completed survey. In this cohort of patients, the two most commonly prescribed drug therapies were midodrine (n = 13) and beta-blockers (n = 14). Patients in the midodrine group were comparable to patients in the beta-blocker group in gender, age, pretreatment postural heart rate changes, and months from initial evaluation to survey completion. More patients treated with a beta-blocker reported improvement after visiting Mayo Clinic (100% vs 62%, P = 0.016) and more attributed their progress to medication (63.6% vs 36.4%, P = 0.011) than did those treated with midodrine. Treatment with both midodrine and beta-blockers was associated with overall improvement in POTS patients' general health; however, adolescents taking beta-blockers were more likely than those taking midodrine to credit the role of medications in their improvement.

  4. Hemodynamic and symptomatic effects of acute interventions on tilt in patients with postural tachycardia syndrome

    Science.gov (United States)

    Gordon, V. M.; Opfer-Gehrking, T. L.; Novak, V.; Low, P. A.

    2000-01-01

    A variety of approaches have been used to alleviate symptoms in postural tachycardia syndrome (POTS). Drugs reported to be of benefit include midodrine, propranolol, clonidine, and phenobarbital. Other measures used include volume expansion and physical countermaneuvers. These treatments may influence pathophysiologic mechanisms of POTS such as alpha-receptor dysfunction, beta-receptor supersensitivity, venous pooling, and brainstem center dysfunction. The authors prospectively studied hemodynamic indices and symptom scores in patients with POTS who were acutely treated with a variety of interventions. Twenty-one subjects who met the criteria for POTS were studied (20 women, 1 man; mean age, 28.7 +/- 6.8 y; age range, 14-39 y). Patients were studied with a 5-minute head-up tilt protocol, ECG monitoring, and noninvasive beat-to-beat blood pressure monitoring, all before and after the administration of an intervention (intravenous saline, midodrine, propranolol, clonidine, or phenobarbital). The hemodynamic indices studied were heart rate (ECG) and systolic, mean, and diastolic blood pressure. Patients used a balanced verbal scale to record any change in their symptoms between the tilts. Symptom scores improved significantly after the patients received midodrine and saline. Midodrine and propranolol reduced the resting heart rate response to tilt (p midodrine and intravenous saline are effective in decreasing symptoms on tilt in patients with POTS when given acutely. Effects of treatments on heart rate and blood pressure responses generally reflected the known pharmacologic mechanisms of the agents.

  5. Midodrine hydrochloride is effective in the treatment of children with postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Chen, Li; Wang, Li; Sun, Jinghui; Qin, Jiong; Tang, Chaoshu; Jin, Hongfang; Du, Junbao

    2011-01-01

    The study was carried out to examine the effect of selective α1 adrenoceptor agonist midodrine hydrochloride vs. β-adrenergic blockade metoprolol in the treatment of children with postural orthostatic tachycardia syndrome (POTS). Fifty-three children with POTS were divided into group I (midodrine hydrochloride plus conventional therapy), group II (metoprolol plus conventional therapy) and group III (conventional therapy). Standing test was conducted for all participants. The cure rate, improvement rate, effective rate and score of symptoms were compared among the 3 groups. A Kaplan-Meier survivorship curve was used to describe the proportion of symptom-free cases during a long term follow-up. The cure rate and effective rate at the end of short term follow-up in group I were significantly higher than those of group II and group III (68.42% vs. 42.11% vs. 20.00%, P0.05). Midodrine hydrochloride is effective in the treatment of children with POTS. All rights are reserved to the Japanese Circulation Society.

  6. Changes in I K, ACh single-channel activity with atrial tachycardia remodelling in canine atrial cardiomyocytes.

    Science.gov (United States)

    Voigt, Niels; Maguy, Ange; Yeh, Yung-Hsin; Qi, Xiaoyan; Ravens, Ursula; Dobrev, Dobromir; Nattel, Stanley

    2008-01-01

    Although atrial tachycardia (AT) remodelling promotes agonist-independent, constitutively active, acetylcholine-regulated K+-current (I K,ACh) that increases susceptibility to atrial fibrillation (AF), the underlying changes in I K,Ach channel function are unknown. This study aimed to establish how AT remodelling affects I K,ACh single-channel function. I K,ACh single-channel activity was studied via cell-attached patch-clamp in isolated left atrial cardiomyocytes of control and AT (7 days, 400 min(-1)) dogs. Atrial tachycardia prolonged the mean duration of induced AF from 44 +/- 22 to 413 +/- 167 s, and reduced atrial effective refractory period at a 360 ms cycle length from 126 +/- 3 to 74 +/- 5 ms (n = 9/group, P ACh conductance and rectification properties were sparse under control conditions. Atrial tachycardia induced prominent agonist-independent I K,ACh activity because of increased opening frequency (fo) and open probability (Po: approximately seven- and 10-fold, respectively, vs. control), but did not alter open time-constant, single-channel conductance, and membrane density. With maximum I K,ACh activation (10 micromol/L carbachol), channel Po was enhanced much more in control cells ( approximately 42-fold) than in AT-remodelled myocytes (approximately five-fold). The selective Kir3 current blocker tertiapin-Q (100 nmol/L) reduced fo and Po at -100 mV by 48 and 51%, respectively (P ACh. Atrial tachycardia had no significant effect on mRNA or protein expression of either of the subunits (Kir3.1, Kir3.4) underlying I K,ACh. Atrial tachycardia increases agonist-independent constitutive I K,ACh single-channel activity by enhancing spontaneous channel opening, providing a molecular basis for AT effects on macroscopic I K,ACh observed in previous studies, as well as associated refractoriness abbreviation and tertiapin-suppressible AF promotion. These results suggest an important role for constitutive I K,Ach channel opening in AT remodelling and support its

  7. Electrocardiography-Derived Predictors for Therapeutic Response to Treatment in Children with Postural Tachycardia Syndrome.

    Science.gov (United States)

    Lu, Wenxin; Yan, Hui; Wu, Shu; Chen, Selena; Xu, Wenrui; Jin, Hongfang; Du, Junbao

    2016-09-01

    To explore whether electrocardiography (ECG) variables could be used to predict responses to physical treatment in children with postural tachycardia syndrome (POTS). Forty children with POTS and 32 healthy controls were enrolled in this study. General information and hemodynamic and supine ECG variables, including QT interval dispersion (QTd), were collected. The children with POTS received physical treatment and 3 months of follow-up. A receiver-operating characteristic curve was used to evaluate the value of ECG variables for predicting the effectiveness of physical treatment. Compared with the healthy children, the children with POTS had longer baseline QTd and heart rate (HR)-corrected QTd (QTcd), but shorter minimum QT intervals (QTmin) and minimum HR-corrected QT intervals (P < .05). In children with POTS, responders to physical treatment had a longer baseline time between QRS complexes (RR) interval of minimum QT interval and a longer QTcd compared with nonresponders. A longer QTcd was a significant risk factor for the presence of POTS (OR, 1.022; P = .02) and for undesirable responses to physical treatment in children with POTS (OR, 1.044; P = .03). Baseline QTcd was positively correlated with the HR elevation from supine to upright seen in children with POTS (r = 0.348; P = .003). Receiver operating characteristic curve analysis demonstrated an area under the curve of 0.73, and using 43.0 msec as a cutoff of QTcd yielded a sensitivity of 90% and a specificity of 60%. QTcd might be useful for predicting the effectiveness of physical treatment for POTS in children. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Catheter ablation of pediatric AV nodal reentrant tachycardia: results in small children.

    Science.gov (United States)

    Krause, Ulrich; Backhoff, David; Klehs, Sophia; Kriebel, Thomas; Paul, Thomas; Schneider, Heike E

    2015-11-01

    AV nodal reentrant tachycardia (AVNRT) is commonly encountered in pediatric patients. Definite treatment can be achieved by catheter ablation. The purpose of the study was to evaluate the efficacy and safety of AVNRT ablation focusing on children with a body weight ≤25 kg. Catheter ablation of AVNRT was attempted in 253 patients. Median age was 12.5 years; median body weight was 48.7 kg. 25 (9.9 %) children had a body weight ≤25 kg. Congenital heart disease was present in 6 patients (2.4 %). Procedural success was achieved in 98 % using radiofrequency, in 100 % using cryoenergy alone, and in 94 % using both energy sources. In patients with a body weight ≤25 kg, success was achieved in 96 %. In patients ≤25 kg, fluoroscopy and procedure duration did not differ from those >25 kg. The rate of major complications was significantly higher in the patients ≤25 kg (12 vs. 2.2 %, p = 0.04). Permanent AV block after RF ablation occurred in 2 patients with congenital heart disease and one infant with a body weight of 8.7 kg. Catheter ablation of AVNRT in children and adolescents was safe and effective. Infants and small children with a body weight ≤25 kg had a higher prevalence of serious complications. This should alert physicians in decision making toward catheter ablation in these patients. In patients with congenital heart disease and different anatomy of the cardiac conduction system, operators must be aware of an increased risk for AV block.

  9. Characteristics of ventricular tachycardia arising from the inflow region of the right ventricle.

    Science.gov (United States)

    Ceresnak, Scott R; Pass, Robert H; Krumerman, Andrew K; Kim, Soo G; Nappo, Lynn; Fisher, John D

    2012-01-01

    Ventricular tachycardia (VT) arising from the right ventricular inflow (RVI) region is uncommon. There is minimal literature on the clinical and electrocardiographic characteristics of RVI VT. A retrospective analysis of patients with RVI VT who underwent electrophysiology study between 2006 and 2011 was performed. Patients with structural heart disease (including arrhythmogenic right ventricular dysplasia) were excluded. Seventy patients underwent an electrophysiology study for VT arising from the right ventricle during the study period. Nine patients (13%) met the inclusion criteria for RVI VT and were the subject of this analysis. The median age was 46 years (range, 14-71), and VT cycle length was 295 milliseconds (range, 279-400 milliseconds). All VTs had an left bundle-branch block morphology. An inferiorly directed QRS axis was noted in 7 (78%) of 9 patients and a left superior axis in 2 (22%) of 9 patients. A QS or rS pattern was noted in all patients in aVR and V(1). A transition from S to R wave occurred in V(3) to V(5) in all patients, with 78% of the patients transitioning in V(4) or V(5). Ablation was attempted in 8 (89%) of 9 patients and was successful in 6 (67%) of 9 patients. Ablation was limited in all unsuccessful patients due to the proximity to the His and risk of complete heart block. Electrocardiographic findings of a left bundle-branch block with a normal QRS axis, QS or rS patterns in aVR and V(1), and late S to R transition (V(4)/V(5)) are commonly found in RVI VT. Because of the proximity to the His, ablation of RVI VT may be more challenging than that of right ventricular outflow tract VT. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Atrial tachycardias: Cause or effect with ablation of persistent atrial fibrillation?

    Science.gov (United States)

    Yamashita, Seigo; Hooks, Darren A; Shah, Ashok; Relan, Jatin; Cheniti, Ghassen; Kitamura, Takeshi; Berte, Benjamin; Mahida, Saagar; Sellal, Jean-Marc; Jefairi, Nora Al; Frontera, Antonio; Amraoui, Sana; Collotand, Florent; Denis, Arnaud; Derval, Nicolas; Sacher, Frédéric; Cochet, Hubert; Dubois, Rémi; Hocini, Mélèze; Haïssaguerre, Michel; Klein, George; Jaïs, Pierre

    2018-02-01

    It is largely believed that atrial tachycardias (ATs) encountered during ablation of persistent atrial fibrillation (PsAF) are a byproduct of ablative lesions. We aimed to explore the alternative hypothesis that they may be a priori drivers of AF remaining masked until other AF sources are reduced or eliminated. Radiofrequency ablation of fibrillatory drivers mapped by electrocardiographic imaging (ECGI; ECVUE™, Cardioinsight Technologies, Cleveland, OH, USA) terminated PsAF in 198 (73%) out of 270 patients (61 ± 10 years, 9 ± 9 m). Two hundred and six ATs in 158 patients were subsequently mapped. Their anatomic relationship to the fibrillatory drivers prospectively identified by ECGI was then established. There were 26 (13%), 52 (25%), and 128 (62%) focal, localized, and macrore-entrant ATs, respectively. In focal/localized re-entrant ATs, 64 (82%) were terminated within an AF-driver region, in which 26 (81%) among 32 focal/localized ATs analyzed with 3-D-mapping system merged to driver map occurred from AF-driver regions in 1.0 ± 1.0 cm distance from the driver core. Importantly, there was no attempt at ablation of the associated AF-driver region in 25 of 64 (39%) of focal/localized re-entrant ATs. The sites of ATs origin generally had low-voltage, fractionated, and long-duration electrograms in AF. All but two focal/localized re-entrant ATs were successfully ablated. The majority of post-AF-ablation focal and localized re-entrant ATs originate from the region of prospectively established AF-driver regions. A third of these are localized to regions not subsequently submitted to ablation. These data suggest that many ATs exist, although not necessarily manifest independently, prior to ablation. They may have a role in the maintenance of PsAF in these individuals. © 2017 Wiley Periodicals, Inc.

  11. Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation.

    Science.gov (United States)

    Mukherjee, Rahul K; Whitaker, John; Williams, Steven E; Razavi, Reza; O'Neill, Mark D

    2018-03-23

    Catheter ablation has an important role in the management of patients with ventricular tachycardia (VT) but is limited by modest long-term success rates. Magnetic resonance imaging (MRI) can provide valuable anatomic and functional information as well as potentially improve identification of target sites for ablation. A major limitation of current MRI protocols is the spatial resolution required to identify the areas of tissue responsible for VT but recent developments have led to new strategies which may improve substrate assessment. Potential ways in which detailed information gained from MRI may be utilized during electrophysiology procedures include image integration or performing a procedure under real-time MRI guidance. Image integration allows pre-procedural magnetic resonance (MR) images to be registered with electroanatomical maps to help guide VT ablation and has shown promise in preliminary studies. However, multiple errors can arise during this process due to the registration technique used, changes in ventricular geometry between the time of MRI and the ablation procedure, respiratory and cardiac motion. As isthmus sites may only be a few millimetres wide, reducing these errors may be critical to improve outcomes in VT ablation. Real-time MR-guided intervention has emerged as an alternative solution to address the limitations of pre-acquired imaging to guide ablation. There is now a growing body of literature describing the feasibility, techniques, and potential applications of real-time MR-guided electrophysiology. We review whether real-time MR-guided intervention could be applied in the setting of VT ablation and the potential challenges that need to be overcome.

  12. Validation of a novel mapping system and utility for mapping complex atrial tachycardias.

    Science.gov (United States)

    Honarbakhsh, S; Hunter, R J; Dhillon, G; Ullah, W; Keating, E; Providencia, R; Chow, A; Earley, M J; Schilling, R J

    2018-03-01

    This study sought to validate a novel wavefront mapping system utilizing whole-chamber basket catheters (CARTOFINDER, Biosense Webster). The system was validated in terms of (1) mapping atrial-paced beats and (2) mapping complex wavefront patterns in atrial tachycardia (AT). Patients undergoing catheter ablation for AT and persistent AF were included. A 64-pole-basket catheter was used to acquire unipolar signals that were processed by CARTOFINDER mapping system to generate dynamic wavefront propagation maps. The left atrium was paced from four sites to demonstrate focal activation. ATs were mapped with the mechanism confirmed by conventional mapping, entrainment, and response to ablation. Twenty-two patients were included in the study (16 with AT and 6 with AF initially who terminated to AT during ablation). In total, 172 maps were created with the mapping system. It correctly identified atrial-pacing sites in all paced maps. It accurately mapped 9 focal/microreentrant and 18 macroreentrant ATs both in the left and right atrium. A third and fourth observer independently identified the sites of atrial pacing and the AT mechanism from the CARTOFINDER maps, while being blinded to the conventional activation maps. This novel mapping system was effectively validated by mapping focal activation patterns from atrial-paced beats. The system was also effective in mapping complex wavefront patterns in a range of ATs in patients with scarred atria. The system may therefore be of practical use in the mapping and ablation of AT and could have potential for mapping wavefront activations in AF. © 2018 Wiley Periodicals, Inc.

  13. Plasma copeptin and therapeutic effectiveness of midodrine hydrochloride on postural tachycardia syndrome in children.

    Science.gov (United States)

    Zhao, Juan; Tang, Chaoshu; Jin, Hongfang; Du, Junbao

    2014-08-01

    Midodrine hydrochloride is used clinically to treat children with postural tachycardia syndrome (POTS), but it is not effective in all patients. This study was designed to explore the changes in plasma copeptin and its predictive value in assessing the therapeutic efficacy of midodrine hydrochloride in children with POTS. The study included 33 children with POTS and 26 healthy children. The group with POTS received midodrine hydrochloride treatment for 1.5-3 months. The plasma copeptin was measured using a sandwich immunoluminometric assay. A receiver operating characteristic curve was used to explore the predictive value of plasma copeptin. The plasma copeptin in the group with POTS was significantly higher than that of the control group (10.827±2.459 pmol/L vs 8.845±1.471 pmol/L, Pmidodrine hydrochloride was significantly higher than that of nonresponders (12.082±1.998 pmol/L vs 9.646±2.301 pmol/L, P=.003). Receiver operating characteristic analysis on the predictive value of plasma copeptin showed that the area under the curve was 0.800 with a 95% CI of 0.640-0.959. Using a plasma copeptin level of 10.482 pmol/L as the cutoff point produced both favorite sensitivity (81.3%) and specificity (76.5%) in predicting the efficacy of midodrine hydrochloride therapy in children with POTS. Plasma copeptin may be considered as a predictive biomarker for the likelihood of successful treatment of children with POTS with midodrine hydrochloride. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Night-time heart rate cut-off point definition by resting office tachycardia in untreated hypertensive patients: data of the Spanish ABPM registry.

    Science.gov (United States)

    Vinyoles, Ernest; de la Sierra, Alejandro; Roso, Albert; de la Cruz, Juan J; Gorostidi, Manuel; Segura, Julián; Banegas, José R; Martell-Claros, Nieves; Ruilope, Luís M

    2014-05-01

    Epidemiological studies have shown that an elevated resting heart rate (HR) is a risk factor for both total and cardiovascular mortality. Our aim was to estimate the night-time HR cut-off point that best predicts cardiovascular risk office tachycardia in hypertensive patients. Untreated hypertensive patients without concomitant cardiovascular diseases were included. Office and ambulatory HRs were measured. Cardiovascular risk office tachycardia was defined by office HR at least 85 beats per minute (bpm). Different night-time HR cut-offs were estimated by receiver operating characteristic curve analyses to predict cardiovascular risk office tachycardia. The best cut-off was selected on the basis of its combined sensitivity and specificity. A total of 32 569 hypertensive patients were included: 46.5% women, mean age (SD) 52 (14) years, office blood pressure 146 (16)/89 (11) mmHg, diabetes 10.3%, smoking 19.2%, BMI 29 (6.8) kg/m, office HR 77 (11.2) bpm, and night-time HR 64.9 (9.3) bpm. A total of 7070 (21.7%) patients were found to have cardiovascular risk office tachycardia. The night-time HR value that better predicted cardiovascular risk office tachycardia was more than 66 bpm. In comparison with patients with night HR below this value, those with night-time tachycardia were predominantly women, younger, with higher ambulatory blood pressure, greater BMI, and higher prevalence of diabetes and smoking. All comparisons were statistically significant (P less than 0.001). A mean night-time HR more than 66 bpm is a good predictor of cardiovascular risk office tachycardia in untreated hypertensive patients and could be considered a variable associated with an increased cardiovascular risk.

  15. Central estrogenic pathways protect against the depressant action of acute nicotine on reflex tachycardia in female rats

    International Nuclear Information System (INIS)

    El-Mas, Mahmoud M.; Fouda, Mohamed A.; El-gowilly, Sahar M.; Saad, Evan I.

    2012-01-01

    We have previously shown that acute exposure of male rats to nicotine preferentially attenuates baroreceptor-mediated control of reflex tachycardia in contrast to no effect on reflex bradycardia. Here, we investigated whether female rats are as sensitive as their male counterparts to the baroreflex depressant effect of nicotine and whether this interaction is modulated by estrogen. Baroreflex curves relating reflex chronotropic responses evoked by i.v. doses (1–16 μg/kg) of phenylephrine (PE) or sodium nitroprusside (SNP), were constructed in conscious freely moving proestrus, ovariectomized (OVX), and estrogen (50 μg/kg/day s.c., 5 days)-replaced OVX (OVXE 2 ) rats. Slopes of the curves were taken as a measure of baroreflex sensitivity (BRS PE and BRS SNP ). Nicotine (100 μg/kg i.v.) reduced BRS SNP in OVX rats but not in proestrus or OVXE 2 rats. The attenuation of reflex tachycardia by nicotine was also evident in diestrus rats, which exhibited plasma estrogen levels similar to those of OVX rats. BRS PE was not affected by nicotine in all rat preparations. Experiments were then extended to determine whether central estrogenic receptors modulate the nicotine–BRS SNP interaction. Intracisteral (i.c.) treatment of OVX rats with estrogen sulfate (0.2 μg/rat) abolished the BRS SNP attenuating effect of i.v. nicotine. This protective effect of estrogen disappeared when OVX rats were pretreated with i.c. ICI 182,780 (50 μg/rat, selective estrogen receptor antagonist). Together, these findings suggest that central neural pools of estrogen receptors underlie the protection offered by E 2 against nicotine-induced baroreceptor dysfunction in female rats. -- Highlights: ► Estrogen protects against the depressant effect of nicotine on reflex tachycardia. ► The baroreflex response and estrogen status affect the nicotine–BRS interaction. ► The protection offered by estrogen is mediated via central estrogen receptors.

  16. An electrocardiography algorithm combined with clinical features could localize the origins of focal atrial tachycardias in adjacent structures.

    Science.gov (United States)

    Uhm, Jae-Sun; Shim, Jaemin; Wi, Jin; Mun, Hee-Sun; Pak, Hui-Nam; Lee, Moon-Hyoung; Joung, Boyoung

    2014-07-01

    It is difficult to differentiate the origins of focal atrial tachycardias (ATs) in adjacent structures by electrocardiography (ECG) alone. The aim of this study was to evaluate whether the clinical features of these ATs may help differentiate their origins. One hundred and ninety-four patients (mean age, 43.5 ± 17.9 years; male, 53.6%) who underwent electrophysiological study for focal AT were included. We evaluated accuracy in differentiating the origin of AT by using ECG alone as well as with the addition of the clinical features. Electrocardiographs of ATs originating from the left superior pulmonary vein (LSPV, n = 24) vs. the left atrial appendage (LAA, n = 6), and from the right superior pulmonary vein (RSPV, n = 14) vs. the superior vena cava (SVC, n = 8) showed similar patterns. However, while no ATs from the LAA were found to be related to paroxysmal atrial fibrillation, 22 out of 24 ATs from the LSPV were associated with this condition. After localizing AT by using ECG, this clinical feature helped differentiate the ATs from the LSPV vs. the LAA with 93% accuracy. Moreover, while an on-and-off tachycardia (initiated and terminated more than 10 times per day) was observed in 4 of 8 ATs from the SVC, this pattern was observed in 13 of 14 ATs from the RSPV. After localizing the ATs by using ECG, on-and-off tachycardia helped differentiate the ATs from the RSPV vs. the SVC with 82% accuracy. The clinical features and Holter monitoring can give additional information for differentiating the focal ATs originating from the adjacent structures. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.

  17. Orthostatic symptoms does not always manifest during tilt-table test in pediatric postural orthostatic tachycardia syndrome patients

    Directory of Open Access Journals (Sweden)

    Tae-Eon Huh

    2013-01-01

    Full Text Available &lt;b&gt;Purpose:&lt;/b&gt; Chronic day-to-day symptoms of orthostatic intolerance are the most notable features of postural orthostatic tachycardia syndrome (POTS. However, we have encountered patients with such symptoms and excessive tachycardia but with no symptoms during the tilt-table test (TTT. We aimed to investigate whether POTS patients with chronic orthostatic intolerance always present orthostatic symptoms during the TTT and analyze the factors underlying symptom manifestation during this test. &lt;b&gt;Methods:&lt;/b&gt; We retrospectively examined patients who presented with POTS at the Gyeongsang Na tional University Hospital between 2008 and 2011. Diagnosis of POTS was based on chronic day-to-day orthostatic intolerance symptoms as well as excessive tachycardia during the TTT. The patients were divided two groups depending on the presentation of orthostatic symptoms during the TTT. Clinical data and the results of the TTT were compared between these groups. &lt;b&gt;Results:&lt;/b&gt; In 22 patients, 7 patients (31.8% did not present orthostatic symptoms during the test. Diastolic blood pressure (BP was significantly lower in the symptom-positive group. The head-up tilt resulted in a significant increase in diastolic BP in the symptom-negative group (&lt;i&gt;P&lt;/i&gt; =0.04, while systolic BP had a tendency to decrease in the symptom-positive group (&lt;i&gt;P&lt;/i&gt; =0.06. &lt;b&gt;Conclusion:&lt;/b&gt; Significant patients with POTS did not present orthostatic symptoms during the TTT despite having chronic daily symptoms. This finding may be important for establishing definitive diagnostic criteria for pediatric POTS. Development of symptoms during TTT might be related to low diastolic BP and abnormal compensatory responses to orthostasis.

  18. Radiofrequency Ablation of an Atrial Tachycardia Emanating From the Non-coronary Aortic Cusp Guided by an Electroanatomic Navigation System

    Directory of Open Access Journals (Sweden)

    Agustin Bortone

    2010-02-01

    Full Text Available We report on an atrial tachycardia (AT, emanating from the non-coronary (NC aortic cusp, ablated with the aid of an electro-anatomical navigation system. In this setting, the electrocardiographic, electrophysiologic (EP, anatomical, and ablative considerations are discussed.Although NC aortic cusp focal ATs are an uncommon EP finding, their ablation is effective and safe, especially from an atrio-ventricular (AV conductive point of view. This origin of AT must be invoked and systematically disclosed when a peri-AV nodal AT origin is suspected, in order to avoid a potentially harmful energy application at the vicinity of the AV conductive tissue.

  19. Substrate Ablation of Ventricular Tachycardia: Late Potentials, Scar Dechanneling, Local Abnormal Ventricular Activities, Core Isolation, and Homogenization.

    Science.gov (United States)

    Briceño, David F; Romero, Jorge; Gianni, Carola; Mohanty, Sanghamitra; Villablanca, Pedro A; Natale, Andrea; Di Biase, Luigi

    2017-03-01

    Ventricular arrhythmias are a frequent cause of mortality in patients with ischemic cardiomyopathy and nonischemic cardiomyopathy. Scar-related reentry represents the most common arrhythmia substrate in patients with recurrent episodes of sustained ventricular tachycardia (VT). Initial mapping of scar-related VT circuits is focused on identifying arrhythmogenic tissue. The substrate-based strategies include targeting late potentials, scar dechanneling, local abnormal ventricular activities, core isolation, and homogenization of the scar. Even though substrate-based strategies for VT ablation have shown promising outcomes for patients with structural heart disease related to ischemic cardiomyopathy, the data are scarce for patients with nonischemic substrates. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Sick sinus syndrome, progressive cardiac conduction disease, atrial flutter and ventricular tachycardia caused by a novel SCN5A mutation

    DEFF Research Database (Denmark)

    Holst, Anders G; Liang, Bo; Jespersen, Thomas

    2010-01-01

    Mutations in the cardiac sodium channel encoded by the gene SCN5A can result in a wide array of phenotypes. We report a case of a young male with a novel SCN5A mutation (R121W) afflicted by sick sinus syndrome, progressive cardiac conduction disorder, atrial flutter and ventricular tachycardia. His...... father carried the same mutation, but had a milder phenotype, presenting with progressive cardiac conduction later in life. The mutation was found to result in a loss-of-function in the sodium current. In conclusion, the same SCN5A mutation can result in a wide array of clinical phenotypes and perhaps...

  1. A Case of Cough-induced Ventricular Tachycardia in a Patient with a Left Ventricular Assist Device.

    Science.gov (United States)

    Ruckdeschel, Emily Sue; Wolfel, Eugene; Nguyen, Duy Thai

    2016-03-01

    In this case, the patient's ventricular tachycardia (VT) was specifically induced by coughing, which has not previously been described. Decreasing the rotational speed of the left ventricular assist device (LVAD) and increasing preload by stopping the patient's nitrates and reducing diuretic dose allowed improved filling of the left ventricle (LV) and increased LV volumes. When coughing recurred, the effects on the LV cavity were less pronounced and thus VT was reduced. Although ventricular arrhythmias are common after LVAD placement, this is a unique case in which VT was caused by coughing, which is ordinarily not considered arrhythmogenic. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Overactive bladder and autonomic dysfunction: Lower urinary tract symptoms in females with postural tachycardia syndrome.

    Science.gov (United States)

    Kaufman, Melissa R; Chang-Kit, Laura; Raj, Satish R; Black, Bonnie K; Milam, Douglas F; Reynolds, W Stuart; Biaggioni, Italo; Robertson, David; Dmochowski, Roger R

    2017-03-01

    Postural Tachycardia Syndrome (POTS) represents an autonomic disorder predominantly affecting females between 15 and 50 years of age. POTS is a chronic disorder (>6 months) characterized by an excessive heart rate increment on standing (>30 beats/min) in the presence of characteristic symptoms of cerebral hypoperfusion or sympathetic activation. Patients have clinically been noted to describe lower urinary tract symptoms (LUTS), although urologic symptoms have not been methodically assessed in the POTS population. Herein, we present data from a pilot study designed to identify and quantitate overactive bladder (OAB) in patients diagnosed with POTS. Patients admitted to the Vanderbilt Autonomic Dysfunction Center between June 2009 and October 2010 for evaluation for the potential diagnosis of POTS completed a validated, standardized questionnaire for OAB (OAB-q) at presentation. Symptom score and subscale analyses were conducted. Subscale health related quality of life (HRQL) scores were transformed into a 0-100 scale, with higher scores reflecting superior HRQL. Data are presented as mean ± SD. Thirty-two females presented for evaluation of symptoms consistent with POTS. Twenty-nine women were subsequently diagnosed with POTS with 19 of these patients completing the OAB-q questionnaire (65.5% response rate). Average age was 33.5 ± 8.3 years. Symptom severity transformed score was 26.0 ± 16.4, with 13 of 19 patients (68.4%) meeting clinical criteria for diagnosis of probable clinically significant OAB. Nocturia was the most bothersome symptom, followed by increased daytime frequency and urgency. This pilot study describes bothersome lower urinary tract dysfunction in patients presenting with POTS as assessed by patient-reported questionnaire data. Nocturia demonstrated the greatest negative impact on health-related quality of life (HRQL), while social interaction was the least affected HRQL domain. In patients with dysautonomia, this data provides a

  3. Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm.

    Directory of Open Access Journals (Sweden)

    Bashar Aldhoon

    Full Text Available To investigate predictors of long-term outcomes after catheter ablation (CA for ventricular tachycardia (VT and the impact of electrical storm (ES prior to index ablation procedures.We studied consecutive patients with structural heart disease and VT (n = 328; age: 63±12 years; 88% males; 72% ischaemic cardiomyopathy; LVEF: 32±12% who had undergone CA. According to presenting arrhythmia at baseline, they were divided into ES (n = 93, 28% and non-ES groups. Clinical predictors of all-cause mortality were investigated and a clinically useful risk score (SCORE was constructed.During a median follow-up of 927 days (IQR: 564-1626, 67% vs. 60% of patients (p = 0.05 experienced VT recurrence in the ES vs. the non-ES group, respectively; and 41% vs. 32% patients died (p = 0.02, respectively. Five factors were independently associated with mortality: age >70 years (hazard ratio (HR: 1.6, 95% confidence interval (CI: 1.1-2.4, p = 0.01, NYHA class ≥3 (HR: 1.9, 95% CI: 1.2-2.9, p = 0.005, a serum creatinine level >1.3 mg/dL (HR: 1.6, 95% CI: 1.1-2.3, p = 0.02, LVEF ≤25% (HR: 2.4, 95% CI: 1.6-3.5, p = 0.00004, and amiodarone therapy (HR: 1.5, 95% CI: 1.0-2.2, p = 0.03. A risk SCORE ranging from 0-4 (1 point for either high-risk age, NYHA, creatinine, or LVEF correlated with mortality. ES during index ablation independently predicted mortality only in patients with a SCORE ≤1.Advanced LV dysfunction, older age, higher NYHA class, renal dysfunction, and amiodarone therapy, but not ES, were predictors of poor outcomes after CA for VT in the total population. However, ES did predict mortality in a low-risk sub-group of patients.

  4. Major adverse events and atrial tachycardia in Ebstein’s anomaly predicted by cardiovascular magnetic resonance

    Science.gov (United States)

    Rydman, Riikka; Shiina, Yumi; Diller, Gerhard-Paul; Niwa, Koichiro; Li, Wei; Uemura, Hideki; Uebing, Anselm; Barbero, Umberto; Bouzas, Beatriz; Ernst, Sabine; Wong, Tom; Pennell, Dudley J; Gatzoulis, Michael A; Babu-Narayan, Sonya V

    2018-01-01

    Objectives Patients with Ebstein’s anomaly of the tricuspid valve (EA) are at risk of tachyarrhythmia, congestive heart failure and sudden cardiac death. We sought to determine the value of cardiovascular magnetic resonance (CMR) for predicting these outcomes. Methods Seventy-nine consecutive adult patients (aged 37±15 years) with unrepaired EA underwent CMR and were followed prospectively for a median 3.4 (range 0.4–10.9) years for clinical outcomes, namely major adverse cardiovascular events (MACEs: sustained ventricular tachycardia/heart failure hospital admission/cardiac transplantation/death) and first-onset atrial tachyarrhythmia (AT). Results CMR-derived variables associated with MACE (n=6) were right ventricular (RV) or left ventricular (LV) ejection fraction (EF) (HR 2.06, 95% CI 1.168 to 3.623, p=0.012 and HR 2.35, 95% CI 1.348 to 4.082, p=0.003, respectively), LV stroke volume index (HR 2.82, 95% CI 1.212 to 7.092, p=0.028) and cardiac index (HR 1.71, 95% CI 1.002 to 1.366, p=0.037); all remained significant when tested solely for mortality. History of AT (HR 11.16, 95% CI 1.30 to 95.81, p=0.028) and New York Heart Association class >2 (HR 7.66, 95% CI 1.54 to 38.20, p=0.013) were also associated with MACE; AT preceded all but one MACE, suggesting its potential role as an early marker of adverse outcome (p=0.011). CMR variables associated with first-onset AT (n=17; 21.5%) included RVEF (HR 1.55, 95% CI 1.103 to 2.160, p=0.011), total R/L volume index (HR 1.18, 95% CI 1.06 to 1.32, p=0.002), RV/LV end diastolic volume ratio (HR 1.55, 95% CI 1.14 to 2.10, p=0.005) and apical septal leaflet displacement/total LV septal length (HR 1.03, 95% CI 1.00 to 1.07, p=0.041); the latter two combined enhanced risk prediction (HR 6.12, 95% CI 1.67 to 22.56, p=0.007). Conclusion CMR-derived indices carry prognostic information regarding MACE and first-onset AT among adults with unrepaired EA. CMR may be included in the periodic surveillance of these patients

  5. Electrophysiologic features of protected channels in late postinfarction patients with and without spontaneous ventricular tachycardia.

    Science.gov (United States)

    Nayyar, Sachin; Wilson, Lauren; Ganesan, Anand; Sullivan, Thomas; Kuklik, Pawel; Young, Glenn; Sanders, Prashanthan; Roberts-Thomson, Kurt C

    2018-01-01

    Protected channels of surviving myocytes in late postinfarction ventricular scar predispose to ventricular tachycardia (VT). However, only a few patients develop VT spontaneously. We studied differences in electric remodeling and protected channels in late postinfarction patients with and without spontaneous VT. Patients with ischemic cardiomyopathy (ICM) with recurrent sustained monomorphic VT (n = 22) were compared with stable ICM patients without spontaneous VT (control group; n = 5). Left ventricular mapping was performed with a 20-pole catheter. Detailed pace mapping was used to identify channels of protected conduction, and confirmed, when feasible, by entrainment. Anatomical and electrophysiological properties of VT channels and non-VT channels in VT patients and channels in controls were evaluated. Seventy-three (median 3) VTs were inducible in VT patients compared to two (median 0) in controls. The VT channels in VT patients (n = 57, 3 ± 1 per patient) were lengthier (mean ± SEM 53 ± 5 vs. 33 ± 4 vs. 24 ± 8 mm), had longer S-QRS (73 ± 4 vs. 63 ± 3 vs. 44 ± 8 ms), longer conduction time (103 ± 13 vs. 33 ± 4 vs. 24 ± 8 ms), and slower conduction velocity (CV) (0.85 ± 0.21 vs. 1.39 ± 0.20 vs. 1.31 ± 0.41 m/s) than non-VT channels in VT patients (n = 183, 8 ± 6 per patient) (p ≤ 0.01) and channels in controls (n = 46, 9 ± 8 per patient) (p ≤ 0.01). Additionally, non-VT channels in VT patients had longer S-QRS (p = 0.02); however, they were similar in length, conduction time, and CV compared to channels in controls. Channels supporting VT are lengthier, with longer conduction times and slower CV compared to channels in patients without spontaneous VT. These observations may explain why some ICM patients have spontaneous VT and others do not.

  6. Cardiac FKBP12.6 overexpression protects against triggered ventricular tachycardia in pressure overloaded mouse hearts.

    Science.gov (United States)

    Vinet, Laurent; Pezet, Mylène; Bito, Virginie; Briec, François; Biesmans, Liesbeth; Rouet-Benzineb, Patricia; Gellen, Barnabas; Prévilon, Miresta; Chimenti, Stefano; Vilaine, Jean-Paul; Charpentier, Flavien; Sipido, Karin R; Mercadier, Jean-Jacques

    2012-03-01

    Alterations in RyR2 function have been proposed as a major pathophysiological mechanism of arrhythmias and heart failure (HF). Cardiac FKBP12.6 overexpression protects against myocardial infarction-induced HF and catecholamine-promoted ventricular arrhythmias. We tested the hypothesis that FKBP12.6 overexpression protects against maladaptive LVH and triggered ventricular arrhythmias following transverse aorta constriction (TAC) in the mouse. The TAC-associated mortality rate was significantly lower in male transgenic (DT) than in Ctr mice (p < 0.05). TAC-associated maladaptive hypertrophy was blunted in DT mice especially 1 month post-TAC and their SERCA2a/PLB ratio remained unchanged 1 and 2 months post-TAC. Two months after TAC, trains of 30 stimuli (burst pacing) performed following isoproterenol injection (0.2 mg/kg, ip), induced VT in 50% of the TAC-Ctr and in none of the TAC-DT mice (p = 0.022). The increase in myocyte shortening and Ca(2+) spark frequency observed in sham-operated Ctr mice in response to 50 nM isoproterenol was reduced in DT mice, and abolished in TAC-DT mice. NCX1 function was reduced in Sham-DT and TAC-DT compared with Sham-Ctr and TAC-Ctr mice, respectively (p < 0.05 for the 2 comparisons). In mice killed after isoproterenol injection and burst pacing, RyR2 S2814 phosphorylation was decreased by 50% in TAC-DT versus TAC-Ctr mice (p < 0.05), with no change in RyR2 S2808 and PLB S16 and T17 phosphorylation. Cardiac FKBP12.6 overexpression in the mouse blunts pressure overload-induced maladaptive LV remodelling and protects against catecholamine-promoted burst pacing-induced ventricular tachycardia by decreasing cardiac sensitivity to adrenergic stress and RyR2 S2814 phosphorylation, and decreasing NCX1 activity.

  7. What is the optimal duration of tilt testing for the assessment of patients with suspected postural tachycardia syndrome?

    LENUS (Irish Health Repository)

    Carew, Sheila

    2012-01-31

    AIMS: The aim of this study is to define the optimal duration of tilt testing for the assessment of patients with suspected postural tachycardia syndrome (POTS). METHODS AND RESULTS: This was a case-control study. Cases were identified retrospectively from a database of patients referred with orthostatic intolerance (OI). All met the diagnostic criteria for POTS. Controls were enrolled prospectively. All subjects underwent tilting to 70 degrees for 40 min if tolerated. Continuous monitoring was provided by a Finometer. Analysis of responses to tilting was performed on 28 cases and 28 controls. The mean age in the case group was 23.6 and in the control group was 26.2. The majority was female in both groups (cases = 4F:3M, controls = 2F:1M). All cases met the criteria for POTS within 7 min of orthostasis. No controls demonstrated a sustained tachycardia. The prevalence of vasovagal syncope (VVS) was 36% in cases vs. 7% in controls (P = 0.02) and 25% in the remaining patients (n = 233) on the OI database (P = 0.259). CONCLUSION: A 10 min tilt will diagnose POTS in the majority of patients. It will not, however, be sufficient to identify the overlap that exists between POTS and VVS. The optimal duration of tilt testing in patients suspected of POTS is 40 min.

  8. [Competitive sports and dilated cardiomyopathy: the case of a 32-year-old soccer player with ventricular tachycardia].

    Science.gov (United States)

    Scharhag, J; Meyer, T; Görge, G; Kindermann, W

    2003-01-24

    A 32-year-old competitive soccer player presented with palpitations he had felt for 4 weeks during maximal activity (soccer training and match). The physical examination and an exercise electrocardiogram were carried out by his general practitioner up to 19 s at 350 W and a heart rate of 147/min without showing any abnormalities. All blood parameters revealed no signs of illness. During treadmill exercise at a heart rate of 181/min, a non-sustained ventricular tachycardia was induced. Echocardiography showed a dilated left ventricle with an enddiastolic diameter of 70 mm and low fractional shortening (28 %). Cardiac catheterization demonstrated a diminished left ventricular ejection fraction (38 %) and an enlarged enddiastolic volume (199 ml) without signs of coronary artery disease. Electrophysiologic testing induced a non-sustained ventricular tachycardia. The echocardiographic and angiographic results indicated a dilated cardiomyopathy. Competitive sports activities were stopped and treatment with a beta-blocker (metoprolol) and an ACE-antagonist (ramipril) was started. In young male and female athletes, the possibility of severe cardiac abnormalities have to be considered even in the presence of good physical fitness and performance. To reach a high sensitivity for diagnostic ergometry, the work-load must reach the maximal capacity of the cardio-pulmonary system. Differences in the exercise performance of athletes and untrained subjects have to be considered.

  9. Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia due to unilateral pulmonary agenesis: a case report

    Directory of Open Access Journals (Sweden)

    Aksu T

    2015-02-01

    Full Text Available Tolga Aksu, Tumer Erdem Guler, Ebru Golcuk, Ismail Erden, Kazim Serhan Ozcan Department of Cardiology, Kocaeli Derince Education and Research Hospital, Derince, Kocaeli, Turkey Abstract: Radiofrequency catheter ablation of the slow pathway is considered to be the treatment of choice for patients with atrioventricular nodal reentrant tachycardia. We report a 34-year-old female with mirror image dextrocardia due to unilateral pulmonary agenesis who underwent successful slow pathway ablation for typical atrioventricular nodal reentrant tachycardia. Using contrast injection, cardiac anatomy was identified in a short time and successfully ablated. Keywords: dextrocardia, AVNRT, ablation, pulmonary agenesis

  10. Successful radiofrequency catheter ablation assisted by the CartoSound® system for outflow tract origin nonsustained ventricular tachycardia in a patient with a severely deformed thorax

    Directory of Open Access Journals (Sweden)

    Naoaki Onishi

    2014-02-01

    Full Text Available We report the case of a 72-year-old man with a nonsustained ventricular tachycardia and a history of palpitations. He had a severely deformed thorax since childhood due to spinal caries. An integrated computed tomography image of the outflow tract region from the CartoSound® system revealed the detailed anatomical information around the origin of the tachycardia and that the left anterior descending coronary artery was very close (<10 mm to the target site. We carefully ablated that site with a 3.5-mm cooled-tip catheter while confirming it in the sound view, and succeeded without any complications.

  11. Diagnostik og behandling af paroksystisk supraventrikulær takykardi

    DEFF Research Database (Denmark)

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal

    2016-01-01

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar...... management strategies. The probable mechanism of paroxysmal SVT can often be diagnosed from the clinical findings and a 12-lead ECG. This review describes the initial evaluation and treatment of patients with paroxysmal SVT, including distinctive features from the most important differential diagnoses....

  12. Central estrogenic pathways protect against the depressant action of acute nicotine on reflex tachycardia in female rats

    Energy Technology Data Exchange (ETDEWEB)

    El-Mas, Mahmoud M., E-mail: mahelm@hotmail.com; Fouda, Mohamed A.; El-gowilly, Sahar M.; Saad, Evan I.

    2012-02-01

    We have previously shown that acute exposure of male rats to nicotine preferentially attenuates baroreceptor-mediated control of reflex tachycardia in contrast to no effect on reflex bradycardia. Here, we investigated whether female rats are as sensitive as their male counterparts to the baroreflex depressant effect of nicotine and whether this interaction is modulated by estrogen. Baroreflex curves relating reflex chronotropic responses evoked by i.v. doses (1–16 μg/kg) of phenylephrine (PE) or sodium nitroprusside (SNP), were constructed in conscious freely moving proestrus, ovariectomized (OVX), and estrogen (50 μg/kg/day s.c., 5 days)-replaced OVX (OVXE{sub 2}) rats. Slopes of the curves were taken as a measure of baroreflex sensitivity (BRS{sub PE} and BRS{sub SNP}). Nicotine (100 μg/kg i.v.) reduced BRS{sub SNP} in OVX rats but not in proestrus or OVXE{sub 2} rats. The attenuation of reflex tachycardia by nicotine was also evident in diestrus rats, which exhibited plasma estrogen levels similar to those of OVX rats. BRS{sub PE} was not affected by nicotine in all rat preparations. Experiments were then extended to determine whether central estrogenic receptors modulate the nicotine–BRS{sub SNP} interaction. Intracisteral (i.c.) treatment of OVX rats with estrogen sulfate (0.2 μg/rat) abolished the BRS{sub SNP} attenuating effect of i.v. nicotine. This protective effect of estrogen disappeared when OVX rats were pretreated with i.c. ICI 182,780 (50 μg/rat, selective estrogen receptor antagonist). Together, these findings suggest that central neural pools of estrogen receptors underlie the protection offered by E{sub 2} against nicotine-induced baroreceptor dysfunction in female rats. -- Highlights: ► Estrogen protects against the depressant effect of nicotine on reflex tachycardia. ► The baroreflex response and estrogen status affect the nicotine–BRS interaction. ► The protection offered by estrogen is mediated via central estrogen receptors.

  13. Magnetic-guided catheter ablation of twin AV nodal reentrant tachycardia in a patient with left atrial isomerism, interrupted inferior vena cana, and Kawashima-Fontan procedure.

    Science.gov (United States)

    Bessière, Francis; Mongeon, François-Pierre; Therrien, Judith; Khairy, Paul

    2017-12-01

    Twin AV nodal reentrant tachycardia most commonly occurs in patients with complex congenital heart disease who have two distinct AV nodes, His bundles, and non-preexcited QRS morphologies. Catheter ablation of the weaker AV node may be hindered by anatomical complexities. In such cases, remote magnetic guidance offers a potentially effective solution.

  14. Prediction and prognosis of ventricular tachycardia recurrence after catheter ablation with remote magnetic navigation for electrical storm in patients with ischemic cardiomyopathy

    DEFF Research Database (Denmark)

    Jin, Qi; Jacobsen, Peter Karl; Pehrson, Steen

    2017-01-01

    BACKGROUND: Ventricular tachycardia (VT) recurrence after catheter ablation for electrical storm is commonly seen in patients with ischemic cardiomyopathy (ICM). HYPOTHESIS: We hypothesized that VT recurrence can be predicted and be related to the all-cause death after VT storm ablation guided by...

  15. Body surface mapping of atrial arrhythmias: atlas of paced P wave integral maps to localize the focal origin of right atrial tachycardia

    NARCIS (Netherlands)

    SippensGroenewegen, A.; Roithinger, F. X.; Peeters, H. A.; Linnenbank, A. C.; van Hemel, N. M.; Steiner, P. R.; Lesh, M. D.

    1998-01-01

    Successful curative treatment of right atrial tachycardia (AT) can be obtained provided detailed catheter activation mapping of the target site for radiofrequency energy application has been accomplished. However, right AT mapping may be difficult with a single roving catheter due to infrequent

  16. Focal ablation for atrial tachycardia from the double-exit of the Marshall bundle inducing atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Jung Yeon Chin, MD

    2017-08-01

    Full Text Available Atrial fibrillation (AF from the ligament/vein of Marshall (LOM/VOM has previously been described. We report the case of a 23-year-old woman with an antiarrhythmic drug-resistant AF induced by two distinct atrial tachycardias (ATs. Focal ablation of these ATs from the double-exit of the Marshall bundle using a three-dimensional map eliminated AF triggering, even though pulmonary vein electrical isolation is the cornerstone for paroxysmal AF. Such mechanisms are important as triggering factors to plan ablation for paroxysmal AF. Focal ablation for triggering and inducing AF, originating from the double-exit of the Marshall bundle may be effective in eliminating AF in young patients.

  17. Integration of 60 000 exomes and ACMG guidelines question the role of Catecholaminergic Polymorphic Ventricular Tachycardia associated variants

    DEFF Research Database (Denmark)

    Paludan-Müller, Christian; Ahlberg, Gustav; Ghouse, Jonas

    2017-01-01

    Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a highly lethal cardiac arrhythmia disease occurring during exercise or psychological stress. CPVT has an estimated prevalence of 1:10 000 and has mainly been associated with variants in calcium regulating genes. Identification...... of potential false-positive pathogenic variants was conducted by searching The Exome Aggregation Consortium (ExAC) database (n=60 706) for variants reported to be associated with CPVT. The pathogenicity of the interrogated variants was assessed using guidelines from the American College of Medical Genetics...... and Genomics (ACMG) and in silico prediction tools. Thirty-eight out of 246 variants (15%) previously associated with CPVT were identified in the ExAC database. We predicted the CPVT prevalence to be 1:132. The ACMG standards classified 29% of ExAC variants as pathogenic or likely pathogenic. The in silico...

  18. Lethal ventricular tachycardia triggered after femoral fracture repair in an obese man with insulin-resistant diabetes.

    Science.gov (United States)

    Maeda, Hideyuki; Uramatsu, Masashi; Nakajima, Susumu; Yoshida, Ken-Ichi

    2016-11-01

    An obese man (height, 178 cm; weight, 160 kg; body mass index, 50.5 kg/m 2 ) with a history of recurrent ventricular tachycardia (VT), cardiomyopathy, coronary sclerosis, and insulin-resistant diabetes suffered a right femur fracture in a vehicular accident. His fracture was repaired the following day, but shortly after surgery, his serum potassium (K + ) level increased, presumably due to K + leakage from the injured muscles, leading to persistent VT and death. An autopsy revealed severe cardiac hypertrophy, moderate coronary sclerosis, and histological findings of myocardial hypercontraction, but not myoglobin-related renal failure, pulmonary thrombosis, lipid emboli, or inflammation. The hyperkalemia was not corrected by glucose-insulin infusion and led to the death of the patient due to the preexisting cardiomyopathy, coronary sclerosis, and a predisposition to VT. In addition to the autopsy, the analysis of the clinical course was indispensable for determining the cause of death as hyperkalemia-related VT.

  19. Isolated persistent left-sided superior vena cava, giant coronary sinus, atrial tachycardia and heart failure in a child

    Directory of Open Access Journals (Sweden)

    Nagaraja Moorthy

    2013-09-01

    Full Text Available Persistence of a left-sided superior vena cava (PLSVC with absent right superior vena cava (isolated PLSVC is a very rare venous malformation and commonly associated with congenital heart disease or alterations of the cardiac situs. We describe an unusual case of a young boy presenting with persistent atrial tachycardia and congestive heart failure. He was detected to have unexplained grossly dilated right atrium, right ventricle with systolic dysfunction and a giant coronary sinus (CS. The dilated CS closely mimicked a pseudo cor-triatriatum on echocardiography. Contrast echocardiography from both arms revealed opacification of the CS before the right atrium. Bilateral upper limb venography confirmed the presence of absent right SVC and isolated persistent left SVC draining into the giant coronary sinus.

  20. Management of focal atrial tachycardias originating from the atrial appendage with the combination of radiofrequency catheter ablation and minimally invasive atrial appendectomy.

    Science.gov (United States)

    Guo, Xiao-gang; Zhang, Jin-lin; Ma, Jian; Jia, Yu-he; Zheng, Zhe; Wang, Hong-yue; Su, Xi; Zhang, Shu

    2014-01-01

    Focal atrial tachycardias (ATs) originating from the left and the right atrial appendage (AA) were the most difficult to eliminate. To evaluate the safety and long-term efficacy of minimally invasive surgical atrial appendectomy in combination with radiofrequency catheter ablation (RFCA) in the management of focal atrial appendage tachycardias (AATs). We included 42 consecutive patients with 42 AATs confirmed by activation mapping and contrast venography. Thirty of them were successfully managed with RFCA (RFCA-successful group), while the remaining 12 (28.6%) finally resorted to video-assisted thoracoscopic atrial appendectomy owing to RFCA failure (resort-to-surgery group). We searched for predictors of RFCA failure, and the need for surgery by using a binomial logistic regression model. In the RFCA-successful group, 6 (20.0%) patients experienced recurrence and re-do ablation and 11 (36.7%) AATs originated from distal AAs. In the resort-to-surgery group, the tachycardias involved exclusively distal AAs and required more RFCA attempts compared with those of the RFCA-successful group (1.58 ± 0.51 vs 1.20 ± 0.41; P = .0165). During atrial appendectomy, incessant ATs were terminated immediately after resection of the AA at the base. Long-term success was achieved in all 42 patients with a follow-up of 29.1 ± 17.5 months. No complications occurred. Fourteen patients with tachycardia-induced cardiomyopathy recovered fully. We identified origin at distal AATs and longer time to tachycardia termination by ablation as predictors of RFCA failure and the need for surgical intervention. ATs originating from the distal portion of AA were more refractory to RFCA. The combination of catheter ablation and video-assisted thoracoscopic atrial appendectomy was an effective strategy to manage AATs. © 2014 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

  1. Taquicardia supraventricular en recién nacido: Un reto diagnóstico y terapéutico en la práctica médica

    Directory of Open Access Journals (Sweden)

    Elibet Chávez González

    2016-01-01

    Full Text Available Las taquicardias supraventriculares en niños son los ritmos más rápidos que con mayor frecuencia se registran (70 %. La taquicardia ortodrómica es la que se presenta habitualmente en el recién nacido y su tratamiento con amiodarona, en combinación con betabloqueadores, presenta una efectividad de 63 %. Sin embargo, la combinación de fármacos antiarrítmicos en niños y en recién nacidos no es recomendada por los efectos proarrítmicos. El estudio electrofisiológico y la ablación por radiofrecuencia se reserva para niños mayores, donde el riesgo del estudio es menor; además, se ha informado bajo riesgo en niños con presencia de vías accesorias. Se presenta el caso de una recién nacida de 11 días que presentó dos episodios de taquicardias electrocardiográficamente diferentes, que sugieren desiguales mecanismos de producción del trastorno del ritmo, en la cual fue difícil el control de la arritmia y el mantenimiento en ritmo sinusal, para lo cual se necesitó la combinación de tres fármacos antiarrítmicos.

  2. Prevalence and predictive factors of left atrial tachycardia occurring after second-generation cryoballoon ablation of atrial fibrillation.

    Science.gov (United States)

    Hermida, Alexis; Kubala, Maciej; Traullé, Sarah; Buiciuc, Otilia; Quenum, Serge; Hermida, Jean-Sylvain

    2018-01-01

    Assess the prevalence and predictors of left atrial tachycardia (LAT) after cryoballoon ablation of pulmonary veins. Patients who underwent catheter ablation of pulmonary veins with a second-generation cryoballoon for symptomatic paroxysmal (151 of 270, 56%) or persistent (119 of 270, 44%) atrial fibrillation were entered in a single-center prospective registry. Patients who experienced postcryoballoon LAT (pcryo-LAT) were selected on the basis of 12-lead ECG characteristics. Left atrial origin was confirmed during conventional EP study and electroanatomical activation mapping, and patients were treated by RF catheter ablation. Pcryo-LAT was observed in 15 (5.6%) of 270 patients and was attributed to a reentrant mechanism in 11 patients (73%). The other four cases of pcryo-LAT were due to focal atrial tachycardia associated with reconnection of one pulmonary vein. In comparison with patients who remained in sinus rhythm, LA area (HR = 1.09; CI 1.01, 1.2; P = 0.02), LVEF (HR = 0.94; CI 0.90, 0.97; P < 0.001), and LVEF <50% (HR = 8.5; CI 3.1, 23.6; P < 0.001) were predictors of pcryo-LAT. After multivariate Cox analysis, only left ventricular ejection fraction < 50% remained predictive of pcryo-LAT, (HR = 7.8, CI 2.3 26.7, P = 0.002). With a mean survival of 23 months, 73% of patients who experienced pcryo-LAT were in sinus rhythm versus 78% of patients without pcryo-LAT (log rank P = 0.85). The prevalence of pcryo-LAT in patients with atrial fibrillation is low. Left ventricular ejection fraction < 50% is associated with an increased risk of pcryo-LAT. When treated by RF catheter ablation, the presence of pcryo-LAT is not a predictive factor of subsequent recurrence of atrial fibrillation during follow-up. © 2017 Wiley Periodicals, Inc.

  3. Degree Of Diminution In Vagal-Cardiac Activity Predicts Sudden Death In Familial Dysautonomia When Resting Tachycardia Is Absent

    Science.gov (United States)

    Schlegel, T. T.; Marthol, H.; Bucchner, S.; Tutaj, M.; Berlin, D.; Axelrod, F. B.; Hilz, M. J.

    2004-01-01

    Patients with familial dysautonomia (FD) have an increased risk of sudden death, but sensitive and specific predictors of sudden death in FD are lacking. Methods. We recorded 10-min resting high-fidelity 12-lead ECGs in 14 FD patients and in 14 age/gender-matched healthy subjects and studied 25+ different heart rate variability (HRV) indices for their ability to predict sudden death in the FD patients. Indices studied included those from 4 "nonlinear" HRV techniques (detrended fluctuation analysis, approximate entropy, correlation dimension, and PoincarC analyses). The predictive value of PR, QRS, QTc and JTc intervals, QT dispersion (QTd), beat-to-beat QT and PR interval variability indices (QTVI and PRVI) and 12- lead high frequency QRS ECG (150-250 Hz) were also studied. FD patients and controls (C) differed (Pless than 0.0l) with respect to 20+ of the HRV indices (FD less than C) and with respect to QTVI and PRVI (FDBC) and HF QRS- related root mean squared voltages (FDBC) and reduced amplitude zone counts (FD less than C). They differed less with respect to PR intervals (FD less than C) and JTc intervals (FD greater than C) (P less than 0.05 for both) and did not differ at all with respect to QRS and QTc intervals and to QTd. Within 12 months after study, 2 of the 14 patients succumbed to sudden cardiac arrest. The best predictor of sudden death was the degree of diminution in HRV vagal-cardiac (parasympathetic) parameters such as RMSSD, the SDl of Poincare plots, and HF spectral power. Excluding the two FD patients who had resting tachycardia (HR greater than 100, which confounds traditional HRV analyses), the following criteria were independently 100% sensitive and 100% specific for predicting sudden death in the remaining 12 FD patients during spontaneous breathing: RMSSD less than 13 ms and/or PoincarC SD1 less than 9 ms. In FD patients without supine tachycardia, the degree of diminution in parasympathetic HRV parameters (by high-fidelity ECG) predicts

  4. A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia

    OpenAIRE

    Berman, Adam E; Rivner, Harold; Chalkley, Robin; Heboyan, Vahé

    2017-01-01

    Adam E Berman,1–4 Harold Rivner,1 Robin Chalkley,1 Vahé Heboyan2 1Department of Medicine, Medical College of Georgia, 2Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, 3Division of Cardiology, 4Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA Background: Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data ...

  5. Ventricular Tachycardia from a Central Line Fracture Fragment Embolus: A Rare Complication of a Commonly Used Procedure—A Case Report and Review of the Relevant Literature

    Directory of Open Access Journals (Sweden)

    Saptarshi Biswas

    2015-01-01

    Full Text Available A 22-year-old male admitted with multiple gunshot wounds (GSW had central line placed initially for hemodynamic monitoring and later for long term antibiotics and total parenteral nutrition (TPN. On postoperative day 4 he presented with bouts of nonsustained ventricular tachycardia; the cause was unknown initially and later attributed to a catheter fragment accidentally severed and lodged in the right heart. Percutaneous retrieval technique was used to successfully extract the catheter fragment and complete recovery was achieved.

  6. The Use of Isoproterenol in Electrophysiologic Drug Testing in Patients with Sustained Ventricular Tachycardia : The Mechanism and Clinical Significance of Isoproterenol

    OpenAIRE

    Satoh, Masahito

    1992-01-01

    Isoproterenol has been used in electrophysiologic studies to facilitate the induction of ventricular tachycardia (VT) as well as in drug testing. However, the mechanism of the induction of VT and the clinical significance of the VT induced with isoproterenol have yet to be determined. The present study assessed the effects of isoproterenol in the induction of VT during drug testing in 23 patients (34 drug testings), and analyzed the patients' characteristics and electrophysiologic parameters....

  7. Catheter Ablation of a Complex Atrial Tachycardia after Surgical Repair of Tetralogy of Fallot Guided by Combined Noncontact and Contact Mapping

    Directory of Open Access Journals (Sweden)

    Eitaro Fujii, MD

    2010-01-01

    Full Text Available A 34-year-old man with a surgically repaired Tetralogy of Fallot complained of palpitation, fatigue, and presyncope. A 12-lead ECG showed atrial tachycardia with a cycle length of 250 ms and a P wave morphology positive in leads II, III and aVF, and negative in lead V1. Although the EnSite system (version 6.OJ made use of noncontact mapping to delineate the counterclockwise reentry around the crista tenninalis, it was difficult to rule out the incisional atrial reentry because the location of the surgical incision was far from the multi-electrode array. Since the bipolar contact mapping of the EnSite system revealed the location of the atriotomy incision, entrainment mapping during the tachycardia demonstrated the critical reentry circuit around the crista terminalis. Radiofrequency ablation targeting the critical isthmus from the lower position of the crista terminalis to the posterior dense scar which was continuous with the inferior vena cava, and to the atriotomy scar, eliminated the tachycardia.

  8. Plasma C-type natriuretic peptide as a predictor for therapeutic response to metoprolol in children with postural tachycardia syndrome.

    Directory of Open Access Journals (Sweden)

    Jing Lin

    Full Text Available POTS is a global public-health disease, but predictor for therapeutic response to metoprolol in children with POTS is lacking. This study was designed to investigate predictive value of plasma C-type natriuretic peptide (CNP in the therapeutic efficacy of metoprolol on postural tachycardia syndrome (POTS in children. Totally 34 children with POTS and 27 healthy children were included in the study. The head-up test or head-up tilt test was used to check heart rate and blood pressure from supine to upright in subjects. A double antibody (competitive sandwich immunoluminometric assay was used to detect plasma CNP. Metoprolol was used to treat children with POTS. The difference in plasma concentrations of CNP between responders and non-responders was compared. An ROC curve was used to analyze plasma CNP to predict efficacy of metoprolol on POTS in children. Plasma CNP in children with POTS was significantly higher than that of healthy children [(51.9 ± 31.4 vs. (25.1 ± 19.1 pg/ml, P 32.55 pg/ml yielded a sensitivity of 95.8% and specificity of 70% in predicting therapeutic efficacy of metoprolol on POTS children. Plasma CNP might serve as a useful predictor for the therapeutic efficacy of metoprolol on POTS in children.

  9. Prevalence of ischemia by quantitative thallium-201 scintigraphy in patients with ventricular tachycardia or fibrillation inducible by programmed stimulation

    International Nuclear Information System (INIS)

    Sellers, T.D.; Beller, G.A.; Gibson, R.S.; Watson, D.D.; DiMarco, J.P.

    1987-01-01

    The prevalence of exercise-induced ischemia was determined by thallium-201 (TI-201) scintigraphic criteria in patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) inducible by programmed electrical stimulation. Thirty-eight patients (age 57 +/- 19 years), of whom 87% had angiographic coronary artery disease, underwent quantitative TI-201 exercise scintigraphy within 14 days of invasive electrophysiologic testing. The mean rest ejection fraction was 38 +/- 9%. Eighty percent of patients had 1 or more regions with akinetic or dyskinetic wall motion. Thallium-201 scan segments were scored as normal or containing redistribution defects or mild or severe persistent defects. Only 4 patients (10%) had only redistribution defects and 9 (24%) had both redistribution defects and persistent defects; 32 of 38 patients (84%) had 1 or more persistent defects, of which 26 had at least 1 severe, persistent defect (more than 50% reduction in TI-201 activity). Patients with and without exercise-induced VT had a similar prevalence of redistribution. Redistribution defect prevalence was similar in patients with polymorphic VT (3 of 13) and monomorphic VT (10 of 25) during programmed electrical stimulation (difference not significant). Thus, patients with VT or VF induced by programmed ventricular stimulation have extensive TI-201 scintigraphic abnormalities on exercise scintigrams, predominantly those suggesting scar, with associated severe regional wall motion abnormalities at rest

  10. Short-term exercise training improves the cardiovascular response to exercise in the postural orthostatic tachycardia syndrome

    Science.gov (United States)

    Shibata, Shigeki; Fu, Qi; Bivens, Tiffany B; Hastings, Jeffrey L; Wang, Wade; Levine, Benjamin D

    2012-01-01

    Recent studies have suggested the presence of cardiac atrophy as a key component of the pathogenesis of the postural orthostatic tachycardia syndrome (POTS), similar to physical deconditioning. It has also been shown that exercise intolerance is associated with a reduced stroke volume (SV) in POTS, and that the high heart rate (HR) observed at rest and during exercise in these patients is due to this low SV. We tested the hypotheses that (a) circulatory control during exercise is normal in POTS; and (b) that physical ‘reconditioning’ with exercise training improves exercise performance in patients with POTS. Nineteen (18 women) POTS patients completed a 3 month training programme. Cardiovascular responses during maximal exercise testing were assessed in the upright position before and after training. Resting left ventricular diastolic function was evaluated by Doppler echocardiography. Results were compared with those of 10 well-matched healthy sedentary controls. A lower SV resulted in a higher HR in POTS at any given oxygen uptake () during exercise while the cardiac output ()– relationship was normal. was lower in POTS than controls (26.1 ± 1.0 (SEM) vs. 36.3 ± 0.9 ml kg−1 min−1; P physical fitness and cardiovascular responses during exercise in patients with POTS. PMID:22641777

  11. Outcome of slow pathway modulation for atrioventricular nodal reentrant tachycardia with 50 versus 30 watts-more power, more effect?

    Science.gov (United States)

    Dechering, Dirk G; Schleberger, Ruben; Greiser, Eva; Dickow, Jannis; Koebe, Julia; Frommeyer, Gerrit; Willems, Stephan; Eckardt, Lars; Hoffmann, Boris A; Wasmer, Kristina

    2018-03-19

    Slow pathway modulation is the treatment of choice in patients with atrioventricular nodal reentrant tachycardia (AVNRT). No comparative data on ablation strategies exist. Therefore, we sought to compare two common ablation approaches. We analyzed prospective ablation databases of two high-volume tertiary centers (> 1000 ablations/year) using either 30 or 50 W for slow pathway modulation from 2012 to 2013. We analyzed procedural characteristics as well as short- and long-term outcomes. Mean follow-up was 36 ± 9 months. Six hundred thirty-four patients (50 W center: n = 342, 30 W center: n = 292) were ablated. Slow pathway modulation was successful in 99% in both groups (p = ns). Periprocedural AV block occurred in nine patients (2.6%) in the 50 W and five patients (1.7%) in the 30 W group (p = 0.59), respectively. We documented no permanent higher-degree AV block. The number of RF lesions and seconds of RF delivery was significantly less in the 50 W group (p = 0.04 for number of lesions; p modulation are highly effective and safe. Significantly, fewer RF duration was necessary to modulate the slow pathway with higher power output (50 W). Our subgroup analysis suggests that males and females might benefit most from different modulation approaches.

  12. Source-Sink Mismatch Causing Functional Conduction Block in Re-Entrant Ventricular Tachycardia.

    Science.gov (United States)

    Ciaccio, Edward J; Coromilas, James; Wit, Andrew L; Peters, Nicholas S; Garan, Hasan

    2018-01-01

    Ventricular tachycardia (VT) caused by a re-entrant circuit is a life-threatening arrhythmia that at present cannot always be treated adequately. A realistic model of re-entry would be helpful to accurately guide catheter ablation for interruption of the circuit. In this review, models of electrical activation wavefront propagation during onset and maintenance of re-entrant VT are discussed. In particular, the relationship between activation mapping and maps of transition in infarct border zone thickness, which results in source-sink mismatch, is considered in detail and supplemented with additional data. Based on source-sink mismatch, the re-entry isthmus can be modeled from its boundary properties. Isthmus boundary segments with large transitions in infarct border zone thickness have large source-sink mismatch, and functional block forms there during VT. These alternate with segments having lesser thickness change and therefore lesser source-sink mismatch, which act as gaps, or entrance and exit points, to the isthmus during VT. Besides post-infarction substrates, the source-sink model is likely applicable to other types of volumetric changes in the myocardial conducting medium, such as when there is presence of fibrosis or dissociation of muscle fibers. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Unmappable ventricular tachycardia after an old myocardial infarction. Long-term results of substrate modification in patients with an implantable cardioverter defibrillator.

    Science.gov (United States)

    Alzand, B S N; Timmermans, C C M M; Wellens, H J J; Dennert, R; Philippens, S A M; Portegijs, P J M; Rodriguez, L M

    2011-08-01

    The frequent occurrence of ventricular tachycardia can create a serious problem in patients with an implantable cardioverter defibrillator. We assessed the long-term efficacy of catheter-based substrate modification using the voltage mapping technique of infarct-related ventricular tachycardia and recurrent device therapy. The study population consisted of 27 consecutive patients (age 68 ± 8 years, 25 men, mean left ventricular ejection fraction 31 ± 9%) with an old myocardial infarction and multiple and/or hemodynamically not tolerated ventricular tachycardia necessitating repeated device therapy. A total of 31 substrate modification procedures were performed using the three-dimensional electroanatomical mapping system. Patients were followed up for a median of 23.5 (interquartile range 6.5-53.2) months before and 37.8 (interquartile range 11.7-71.8) months after ablation. Antiarrhythmic drugs were not changed after the procedure, and were stopped 6 to 9 months after the procedure in patients who did not show ventricular tachycardia recurrence. Median ventricular tachycardias were 1.6 (interquartile range 0.7-6.7) per month before and 0.2 (interquartile range 0.00-1.3) per month after ablation (P = 0.006). Nine ventricular fibrillation episodes were registered in seven patients before and two after ablation (P = 0.025). Median antitachycardia pacing decreased from 1.6 (interquartile range 0.01-5.5) per month before to 0.18 (interquartile range 0.00-1.6) per month after ablation (P = 0.069). Median number of shocks decreased from 0.19 (interquartile range 0.04-0.81) per month before to 0.00 (interquartile range 0.00-0.09) per month after ablation (P = 0.001). One patient had a transient ischemic attack during the procedure, and another developed pericarditis. Nine patients died during follow-up, eight patients due to heart failure and one patient during valve surgery. Catheter-based substrate modification using voltage mapping results in a long-lasting reduction

  14. Inducible NO synthase is constitutively expressed in porcine myocardium and its level decreases along with tachycardia-induced heart failure.

    Science.gov (United States)

    Paslawska, Urszula; Kiczak, Liliana; Bania, Jacek; Paslawski, Robert; Janiszewski, Adrian; Dzięgiel, Piotr; Zacharski, Maciej; Tomaszek, Alicja; Michlik, Katarzyna

    2016-01-01

    The adverse effects of oxidative stress and the presence of proinflammatory factors in the heart have been widely demonstrated mainly on rodent models. However, larger clinical trials focusing on inflammation or oxidative stress in heart failure (HF) have not been carried out. This may be due to differences in the anatomy and physiology of the cardiovascular system between small rodents and large mammals. Thus, we investigated myocardial inflammatory factors, such as inducible NO synthase (iNOS) and oxidative stress indices in female pigs with chronic tachycardia-induced cardiomyopathy. Homogenous female siblings of Large White breed swine (n=15) underwent continuous right ventricular (RV) pacing at 170bpm, whereas five sham-operated subjects served as controls. In the course of RV pacing, animals developed a clinical picture of HF and were euthanized at subsequent stages of the disease: mild, moderate and severe HF. Left ventricle (LV) sections were examined with electron microscopy. The relative expression of iNOS in LV was determined by quantitative PCR. The protein level of iNOS was determined by Western blotting and immunohistochemistry. The level of the S-nitrosylated (S-NO) protein in LV was determined after S-NO moieties were substituted by biotin, followed by a colorimetrical detection with streptavidin. Malondialdehyde (MDA), a marker of lipid peroxidation, was evaluated in the LV and serum using thiobarbituric acid. The aconitase activity (based on measurement of the concomitant formation of NADPH from NADP(+)), a marker of oxidative stress, was analyzed in mitochondrial and cytosolic LV fractions. The concentration of interleukin-1β (IL-1β) was measured in LV homogenates using enzyme-linked immunosorbent assay. RV pacing resulted in an impairment of LV systolic function, LV dilatation and neurohormonal activation. The electron microscopy revealed abnormalities within the cardiomyocytes of failing hearts, i.e. swollen mitochondria and myofibril

  15. Catheter Ablation of Idiopathic Left Posterior Fascicular Ventricular Tachycardia: Predicting the Site of Origin via Mapping and Electrocardiography.

    Science.gov (United States)

    Ma, Wei; Lu, Fengmin; Shehata, Michael; Wang, Xunzhang; Zhang, Fan; Chen, Bingwei; Wu, Dongyan; He, Le; Sun, Shan; Cheng, Aijuan; Ding, Jun; Cong, Hongliang; Xu, Jing

    2017-11-01

    We report the 12-lead ECG morphology of left posterior fascicular ventricular tachycardia (LPF-VT) and the relationship between His-ventricular (HV) interval and site of origin in LPF-VT. We studied 41 patients who underwent successful catheter ablation of LPF-VT with HV interval >0 ms (n=8; proximal-LPF group), HV interval 0 to -15 ms (n=15; middle-LPF group), and HV interval <-15 ms (n=18; distal-LPF group). The earliest mapped presystolic potential (PP)-QRS interval was 34.1±4.2, 24.5±3.2, and 19.4±2.8 ms in proximal-, middle-, and distal-LPF groups. The earliest PP ratio (PP-QRS interval during VT/HV interval during sinus rhythm) was 0.59±0.05, 0.45±0.07, and 0.31±0.05 in the proximal-, middle-, and distal-LPF groups. There were statistically significant differences between the 3 groups in earliest PP ratio, and there was close correlation between the HV interval during LPF-VT and earliest PP ratio. The QRS duration in the proximal-LPF group (114±6 ms) was significantly narrower compared with the middle-LPF group (128±5 ms) and distal-LPF group (140±6 ms). In leads I and V6, the ratio of R/S tended to be greater in the proximal-LPF group compared with the other 2 groups. QRS duration, the ratio of R/S in leads V6, and lead I could predict a proximal or distal origin site of LPF-VT with high sensitivity and specificity. The HV interval and 12-lead ECG morphology of LPF-VT may help predict the successful site of origin and prove useful in guiding an effective ablation strategy. © 2017 American Heart Association, Inc.

  16. Fast nonclinical ventricular tachycardia inducible after ablation in patients with structural heart disease: Definition and clinical implications.

    Science.gov (United States)

    Watanabe, Masaya; de Riva, Marta; Piers, Sebastiaan R D; Dekkers, Olaf M; Ebert, Micaela; Venlet, Jeroen; Trines, Serge A; Schalij, Martin J; Pijnappels, Daniël A; Zeppenfeld, Katja

    2018-01-08

    Noninducibility of ventricular tachycardia (VT) with an equal or longer cycle length (CL) than that of the clinical VT is considered the minimum ablation endpoint in patients with structural heart disease. Because their clinical relevance remains unclear, fast nonclinical VTs are often not targeted. However, an accepted definition for fast VT is lacking. The shortest possible CL of a monomorphic reentrant VT is determined by the ventricular refractory period (VRP). The purpose of this study was to propose a patient-specific definition for fast VT based on the individual VRP (fVT VRP ) and assess the prognostic significance of persistent inducibility after ablation of fVT VRP for VT recurrence. Of 191 patients with previous myocardial infarction or with nonischemic cardiomyopathy undergoing VT ablation, 70 (age 63 ± 13 years; 64% ischemic) remained inducible for a nonclinical VT and composed the study population. FVT VRP was defined as any VT with CL ≤VRP 400 + 30 ms. Patients were followed for VT recurrence. After ablation, 30 patients (43%) remained inducible exclusively for fVT VRP and 40 (57%) for any slower VT. Patients with only fVT VRP had 3-year VT-free survival of 64% (95% confidence interval [CI] 46%-82%) compared to 27% (95% CI 14%-48%) for patients with any slower remaining VT (P = .013). Inducibility of only fVT VRP was independently associated with lower VT recurrence (hazard ratio 0.38; 95% CI 0.19-0.86; P = .019). Among 36 patients inducible for any fVT VRP , only 1 had recurrence with fVT VRP . In patients with structural heart disease, inducibility of exclusively fVT VRP after ablation is associated with low VT recurrence. Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  17. Real-time integration of 2D intracardiac echocardiography and 3D electroanatomical mapping to guide ventricular tachycardia ablation.

    Science.gov (United States)

    Khaykin, Yaariv; Skanes, Allan; Whaley, Bonnie; Hill, Carol; Beardsall, Marianne; Seabrook, Catherine; Wulffhart, Zaev; Oosthuizen, Richard; Gula, Lorne; Verma, Atul

    2008-10-01

    Ablation of left ventricular tachycardia (LV VT) involves point-by-point reconstruction of the three-dimensional (3D) virtual anatomy. It is time consuming and requires substantial fluoroscopy exposure. Two-dimensional (2D) intracardiac echocardiography (ICE) affords real-time imaging of the cardiac structures. This study sought to evaluate a mapping system integrating ICE with 3D mapping to guide VT ablation. Seventeen patients (16 men, 62 +/- 11 years, LV ejection fraction 40% +/- 15%) had ablation of nonidiopathic VT guided using a system integrating 3D mapping and ICE. ICE probe with a location sensor tracked by the mapping system was positioned in the right heart. Endocardial contours traced on gated images of the LV were used to generate a registered 3D map. Regional wall motion abnormalities (WMA) were tagged. 3D maps were created in 26 +/- 8 min, before entering the LV and without fluoroscopy. Maps were built from 23 +/- 7 contours. Regional WMA corresponded to low bipolar voltage (ICE was 172 +/- 119 cm(3) versus 164 +/- 112 cm(3) for the point-by-point maps (P = .5). Scar area by ICE was 33 +/- 32 cm(2) versus 36 +/- 33 cm(2) for voltage mapping (P = .4). At 5 +/- 4 months, 12 patients (71%) were free of VT. A system combining 2D ICE and 3D mapping can reconstruct a 3D shell of the LV, including a substrate map based on regional WMA without the need to enter the LV. VT ablation guided using this approach is safe and effective.

  18. Characterization of a novel mutation in the cardiac ryanodine receptor that results in catecholaminergic polymorphic ventricular tachycardia

    Science.gov (United States)

    Jiang, Dawei; Jones, Peter P; Davis, Darryl R; Gow, Robert; Green, Martin S; Birnie, David H; Chen, SR Wayne

    2010-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an arrhythmogenic disease that manifests as syncope or sudden death during high adrenergic tone in the absence of structural heart defects. It is primarily caused by mutations in the cardiac ryanodine receptor (RyR2). The mechanism by which these mutations cause arrhythmia remains controversial, with discrepant findings related to the role of the RyR2 binding protein FKBP12.6. The purpose of this study was to characterize a novel RyR2 mutation identified in a kindred with clinically diagnosed CPVT. Single-strand conformational polymorphism analysis and direct DNA sequencing were used to screen the RyR2 gene for mutations. Site-directed mutagenesis was employed to introduce the mutation into the mouse RyR2 cDNA. The impact of the mutation on the interaction between RyR2 and a 12.6 kDa FK506 binding protein (FKBP12.6) was determined by immunoprecipitation and immunoblotting and its effect on RyR2 function was characterized by single cell Ca2+ imaging and [3H]ryanodine binding. A novel CPVT mutation, E189D, was identified. The E189D mutation does not alter the affinity of the channel for FKBP12.6, but it increases the propensity for store-overload-induced Ca2+ release (SOICR). Furthermore, the E189D mutation enhances the basal channel activity of RyR2 and its sensitivity to activation by caffeine. The E189D RyR2 mutation is causative for CPVT and functionally increases the propensity for SOICR without altering the affinity for FKBP12.6. These observations strengthen the notion that enhanced SOICR, but not altered FKBP12.6 binding, is a common mechanism by which RyR2 mutations cause arrhythmias. PMID:20676041

  19. Reports of Postural Orthostatic Tachycardia Syndrome After Human Papillomavirus Vaccination in the Vaccine Adverse Event Reporting System.

    Science.gov (United States)

    Arana, Jorge; Mba-Jonas, Adamma; Jankosky, Christopher; Lewis, Paige; Moro, Pedro L; Shimabukuro, Tom T; Cano, Maria

    2017-11-01

    Human papillomavirus (HPV) vaccination prevents infections with HPV strains that cause certain cancers. Reports of postural orthostatic tachycardia syndrome (POTS) following HPV vaccination have raised safety concerns. We reviewed POTS reports submitted to the Vaccine Adverse Event Reporting System (VAERS). We searched the VAERS database for reports of POTS following any type of HPV vaccination (bivalent, quadrivalent, or nonavalent) from June 2006 to August 2015. We reviewed reports and applied established POTS diagnostic criteria. We calculated unadjusted POTS case reporting rates based on HPV vaccine doses distributed and conducted empirical Bayesian data mining to screen for disproportional reporting of POTS following HPV vaccination. Among 40,735 VAERS reports following HPV vaccination, we identified 29 POTS reports that fully met diagnostic criteria. Of these, 27 (93.1%) were in females and mean age was 14 years (range 12-32). Median time from vaccination to start of symptoms was 43 days (range 0-407); most (18, 75.0%) had onset between 0 and 90 days. Symptoms frequently reported concomitantly included headache (22, 75.9%) and dizziness (21, 72.4%). Twenty (68.9%) reports documented a history of pre-existing medical conditions, of which chronic fatigue (5, 17.2%), asthma (4, 13.8%), and chronic headache (3, 10.3%) were most common. Approximately one POTS case is reported for every 6.5 million HPV vaccine doses distributed in the United States. No empirical Bayesian data mining safety signals for POTS and HPV vaccination were detected. POTS is rarely reported following HPV vaccination. Our review did not detect any unusual or unexpected reporting patterns that would suggest a safety problem. Published by Elsevier Inc.

  20. Flecainide Reduces Ventricular Arrhythmias in Patients With Genotype RyR2-positive Catecholaminergic Polymorphic Ventricular Tachycardia.

    Science.gov (United States)

    Wangüemert Pérez, Fernando; Hernández Afonso, Julio Salvador; Groba Marco, María Del Val; Caballero Dorta, Eduardo; Álvarez Acosta, Luis; Campuzano Larrea, Oscar; Pérez, Guillermo; Brugada Terradellas, Josep; Brugada Terradellas, Ramón

    2018-03-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited disease characterized by polymorphic or bidirectional ventricular arrhythmias (VA) triggered by physical or emotional stress in young people with a structurally normal heart. Beta-blockers are the cornerstone of treatment, while flecainide has recently been incorporated into the therapeutic arsenal. The aim of this study was to report our experience with this drug. The cohort included 174 genotype-positive CPVT-patients from 7 families. We collected data from patients who were receiving flecainide and analyzed the indications, adverse effects and dosage, clinical events, VA and arrhythmic window during exercise testing, and implantable cardioverter-defibrillator (ICD) shocks during follow-up. Eighteen patients (10.4%) received flecainide; 17 patients in combination with beta-blockers, and 1 patient as monotherapy due to beta-blocker intolerance. None of the patients presented side effects. In 13 patients (72.2%) the indication was the persistence of exercise-induced VA and in 5 patients (27.7%) persistent ICD-shocks, despite on beta-blockers. After flecainide initiation, the exercise-induced VA quantitative score was reduced by more than 50% in 66.7% of the members of family 1 (32.76 ± 84.06 vs 74.38 ± 153.86; P = .018). The arrhythmic window was reduced (5.8 ± 11.9 bpm vs 19.69 ± 21.27 bpm; P = .007), and 4 of 5 patients with appropriate ICD shocks experienced no further shocks in the follow-up. In CPVT-patients flecainide reduces clinical events, exercise-induced VA, the arrhythmic window, and ICD shocks, with good tolerance. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Comparison of defibrillator therapy and other therapeutic modalities for sustained ventricular tachycardia or ventricular fibrillation associated with coronary artery disease.

    Science.gov (United States)

    Choue, C W; Kim, S G; Fisher, J D; Roth, J A; Ferrick, K J; Brodman, R; Frame, R; Gross, J; Furman, S

    1994-06-01

    Outcomes of 282 patients referred to the arrhythmia service at Montefiore Medical Center for sustained ventricular tachycardia (n = 214) or ventricular fibrillation (n = 68) associated with coronary artery disease were analyzed retrospectively. All patients underwent serial drug trials by electrophysiologic testing and Holter monitoring. Sixty-eight patients who did not respond to drug therapy were treated with implantable cardioverter-defibrillators (ICD group), and 214 patients were treated with other methods guided by electrophysiologic testing and Holter monitoring (non-ICD group). The non-ICD group included 49 patients who responded to drug therapy as judged by electrophysiologic testing, as well as patients who did not respond and were not treated with defibrillator therapy for various reasons. Ten patients died in the hospital (2 patients in the ICD group, 8 in the non-ICD group). Actuarial survival rates free of total cardiac death at 1, 2, and 3 years were, respectively, 94%, 87%, and 85% in the ICD group, and 82%, 78%, and 73% in the non-ICD group (p = NS). Survival rates free of total death at 1, 2, and 3 years were 90%, 82%, and 76% in the ICD group, and 82%, 76%, and 70% in the non-ICD group, respectively (p = NS). Survival rates free of total cardiac and total deaths of 49 patients treated with an effective regimen determined by electrophysiologic testing were not significantly different from those of the ICD group. This retrospective study suggests that outcomes of patients treated with ICDs may not be dramatically different from those of patients treated with other methods guided primarily by electrophysiologic testing.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Midregional pro-adrenomedullin as a predictor for therapeutic response to midodrine hydrochloride in children with postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Zhang, Fengwen; Li, Xueying; Ochs, Todd; Chen, Li; Liao, Ying; Tang, Chaoshu; Jin, Hongfang; Du, Junbao

    2012-07-24

    This study was designed to explore the predictive value of the midregional fragment of pro-adrenomedullin (MR-proADM) in assessing the therapeutic efficacy of midodrine hydrochloride for children with postural orthostatic tachycardia syndrome (POTS). Midodrine hydrochloride is an important therapeutic option for children with POTS. However, there has not been any method to predict response to the drug. The MR-proADM is produced in equimolar amounts to adrenomedullin (ADM), and directly reflects levels of the rapidly degraded active peptide, ADM. Fifty-seven children with POTS were designated as the POTS group. Twenty healthy children served as the control group. The children in the POTS group received midodrine hydrochloride treatment. The plasma concentration of MR-proADM was measured, using a sandwich immunoluminometric assay. A receiver-operating characteristic curve was used to explore the predictive value of MR-proADM. Plasma levels of MR-proADM were significantly higher in children with POTS (75.0 [62.5 to 96.0] pg/ml) than in the control group (58.5 [50.3 to 69.0] pg/ml). Plasma levels of MR-proADM in responders to midodrine hydrochloride was significantly higher than that of nonresponders (76.0 [66.0 to 91.0] pg/ml vs. 59.0 [54.0 to 65.5] pg/ml, p midodrine hydrochloride therapy for treating POTS. MR-proADM can help guide midodrine hydrochloride therapy in the management of POTS in children. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Flow-mediated vasodilation as a predictor of therapeutic response to midodrine hydrochloride in children with postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Liao, Ying; Yang, Jinyan; Zhang, Fengwen; Chen, Stella; Liu, Xueqin; Zhang, Qingyou; Ai, Yi; Wang, Yuli; Tang, Chaoshu; Du, Junbao; Jin, Hongfang

    2013-09-15

    This study was designed to explore the value of flow-mediated vasodilation (FMD) as a predictor of therapeutic response to midodrine hydrochloride (MD) in children with postural orthostatic tachycardia syndrome (POTS). One hundred and eight children diagnosed with POTS and 20 healthy control children were enrolled. All children with POTS received MD and were followed up for 3 months. FMD of brachial artery for each participant was measured by vascular ultrasound. Symptom scores, FMD values, and head-up test (HUT)/head-up tilt test (HUTT) outcomes were investigated before and after treatment. A receiver operating characteristic curve was used to explore the value of FMD as a predictor. Baseline FMD (%) and increased heart rate (beats per minute) during HUT/HUTT were significantly greater in children with POTS compared with control children (FMD: 11 ± 3% vs 6 ± 2%, p <0.001; increased heart rate: 38 ± 9 vs 7 ± 7 beats/min, p <0.001, respectively). Before treatment, MD responders had greater FMD values than MD nonresponders (p <0.05). Symptom scores, excessive increases in heart rate during HUT, and increased FMD values were all reduced significantly after treatment (all p <0.05). The receiver operating characteristic curve for the predictive value of FMD showed the area under the curve to be 0.790 (95% confidence interval: 0.679 to 0.902; p <0.001) at 1-month and 0.803 (95% confidence interval: 0.669 to 0.936; p <0.01) at 3-month therapy. FMD of 9.85% had a high sensitivity (1-month therapy: 71.6%; 3-month therapy: 74.4%) and specificity (1-month therapy 77.8%; 3-month therapy: 80%). In conclusion, FMD is a predictor of the efficacy of MD for treating children with POTS. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Cardiorespiratory adaptations induced by aerobic training in middle-aged men: the importance of a decrease in sympathetic stimulation for the contribution of dynamic exercise tachycardia

    Directory of Open Access Journals (Sweden)

    Chacon-Mikahil M.P.T.

    1998-01-01

    Full Text Available We investigated the effects of aerobic training on the efferent autonomic control of heart rate (HR during dynamic exercise in middle-aged men, eight of whom underwent exercise training (T while the other seven continued their sedentary (S life style. The training was conducted over 10 months (three 1-h sessions/week on a field track at 70-85% of the peak HR. The contribution of sympathetic and parasympathetic exercise tachycardia was determined in terms of differences in the time constant effects on the HR response obtained using a discontinuous protocol (4-min tests at 25, 50, 100 and 125 watts on a cycle ergometer, and a continuous protocol (25 watts/min until exhaustion allowed the quantification of the parameters (anaerobic threshold, VO2 AT; peak O2 uptake, VO2 peak; power peak that reflect oxygen transport. The results obtained for the S and the T groups were: 1 a smaller resting HR in T (66 beats/min when compared to S (84 beats/min; 2 during exercise, a small increase in the fast tachycardia (D0-10 s related to vagal withdrawal (P<0.05, only at 25 watts was observed in T at all powers; at middle and higher powers a significant decrease (P<0.05 at 50, 100 and 125 watts in the slow tachycardia (D1-4 min related to a sympathetic-dependent mechanism was observed in T; 3 the VO2 AT (S = 1.06 and T = 1.33 l/min and VO2 peak (S = 1.97 and T = 2.47 l/min were higher in T (P<0.05. These results demonstrate that aerobic training can induce significant physiological adaptations in middle-aged men, mainly expressed as a decrease in the sympathetic effects on heart rate associated with an increase in oxygen transport during dynamic exercise.

  5. Bilateral passive leg raising attenuates and delays tourniquet deflation-induced hypotension and tachycardia under spinal anaesthesia: a randomised controlled trial.

    Science.gov (United States)

    Huang, Go-Shine; Wang, Chih-Chien; Hu, Mei-Hua; Cherng, Chen-Hwan; Lee, Meei-Shyuan; Tsai, Chien-Sung; Chan, Wei-Hung; Hsieh, Xhang-Xian; Lin, Leou-Chyr

    2014-01-01

    The pneumatic tourniquet is frequently used in total knee arthroplasty. Tourniquet deflation may result in hypotension and tachycardia caused by the rapid shift of blood volume back to the ischaemic limb and a decrease in cardiac preload. Passive leg raising (PLR) represents a 'self-volume challenge' that can result in an increase in preload. Such a PLR-induced increase in preload was hypothesised to attenuate the decrease in preload resulting from tourniquet deflation. To evaluate the effect of PLR on hypotension and tachycardia following tourniquet deflation. A randomised controlled trial. Single medical centre. Seventy patients who underwent unilateral total knee arthroplasty were randomised into two groups: tourniquet deflation with PLR (n = 35) or without PLR (control group, n = 35). Patients in both groups were administered a single dose of plain bupivacaine for spinal anaesthesia. The pneumatic tourniquet was inflated on the thigh and the surgery was performed. The study composed of four steps: for the PLR group, step 1 - inflation of the tourniquet while the patient was supine; step 2 - the patient's legs were raised to a 45° angle; step 3 - the tourniquet was deflated while the patient's legs were still raised; and step 4 - the legs were returned to the supine position. In the control group, the same perioperative procedure was used, but PLR was not conducted. The patients' blood pressure and heart rate were measured before, during and after tourniquet deflation. After tourniquet deflation, the magnitude of the changes in blood pressure and heart rate was less in the PLR group than that in the control group. In addition, the blood pressure nadir also occurred later in the PLR group than in the controls. Bilateral PLR is a simple, reversible manoeuvre that mimics rapid fluid loading. Bilateral PLR attenuates the severity of, and delays the time to, hypotension and tachycardia following deflation of a lower limb tourniquet. ClinicalTrials.gov number

  6. A double-blind placebo-controlled cross-over study of the vascular effects of midodrine in neuropathic compared with hyperadrenergic postural tachycardia syndrome.

    Science.gov (United States)

    Ross, Amanda J; Ocon, Anthony J; Medow, Marvin S; Stewart, Julian M

    2014-02-01

    POTS (postural tachycardia syndrome) is a chronic form of OI (orthostatic intolerance). Neuropathic POTS is characterized by decreased adrenergic vasoconstriction, whereas hyperadrenergic POTS exhibits increased adrenergic vasoconstriction. We hypothesized that midodrine, an α1-adrenergic receptor agonist, would increase CVR (calf vascular resistance), decrease C(v) (calf venous capacitance) and decrease orthostatic tachycardia in neuropathic POTS, but not alter haemodynamics in hyperadrenergic POTS. A total of 20 POTS patients (12 neuropathic and eight hyperadrenergic), ages 12-20 years, participated in this randomized placebo-controlled double-blind cross-over study. Of these subjects, 15 were female. POTS subjects received 2 weeks of treatment with midodrine or placebo, with increased dosing from 2.5 to 10 mg three times daily. Following a 7-day drug-washout period, subjects received the cross-over treatment. HR (heart rate), MAP (mean arterial pressure), Q(calf) (calf blood flow) and CVR were measured supine and during 35° HUT (head-up tilt). C(v) was measured supine. In neuropathic POTS, midodrine decreased supine HR, Q(calf) and C(v), while increasing MAP and CVR compared with placebo. During HUT, in neuropathic POTS, midodrine decreased HR, Q(calf) and C(v), while increasing MAP and CVR. In hyperadrenergic POTS, placebo and midodrine both decreased upright HR and increased supine CVR. Placebo also increased supine C(v), compared with midodrine in hyperadrenergic POTS. Therefore midodrine improved postural tachycardia in neuropathic POTS by increasing CVR and decreasing Q(calf) and C(v), whereas these effects were not seen in hyperadrenergic POTS patients who experienced a placebo effect. This suggests that midodrine is probably an effective treatment for neuropathic POTS, but not for hyperadrenergic POTS.

  7. [Use of non-fluoroscopic mapping in recurrent atrioventricular nodal reentrant tachycardia in a patient with corrected transposition of the great arteries].

    Science.gov (United States)

    Aristizábal, Julián; Uribe, William; Duque, Mauricio; Marín, Jorge; Medina, Eduardo; Velásquez, Jorge; Femenía, Francisco; Baranchuk, Adrían

    2013-01-01

    The anatomy in congenital corrected transposition of the great arteries is complex and the conduction system may experience large degrees of variation. Invasive procedures should be done with the use of the highest possible technological sources to warrant success. We describe here, a patient with recurrent atrioventricular node reentry tachycardia where non-fluoroscopic navigation system helped in a complex ablation. Copyright © 2011 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  8. Prevalence and prognostic implications of non-sustained ventricular tachycardia in ST-segment elevation myocardial infarction after revascularization with either fibrinolysis or primary angioplasty

    DEFF Research Database (Denmark)

    Høfsten, Dan Eik; Wachtell, Kristian; Lund, Birgit

    2007-01-01

    AIMS: We compared the prevalence and prognostic implications of non-sustained ventricular tachycardia (nsVT) detected early after ST-segment elevation myocardial infarction (STEMI) in patients randomized to either fibrinolysis or primary angioplasty in the DANAMI-2 trial. METHODS AND RESULTS...... for STEMI does not affect the subsequent prevalence of nsVT when compared with fibrinolysis. After adjustment for other relevant risk factors, the prognostic value of nsVT detected early after STEMI is limited, regardless of the chosen reperfusion strategy....

  9. Postural Tachycardia Syndrome

    Science.gov (United States)

    ... Youth Network of America, Inc. 1301 Greengate Court Waldorf MD Waldorf, MD 20601 info@dynainc.org http://www.dynainc. ... Youth Network of America, Inc. 1301 Greengate Court Waldorf MD Waldorf, MD 20601 info@dynainc.org http:// ...

  10. Postural Orthostatic Tachycardia With Chronic Fatigue After HPV Vaccination as Part of the “Autoimmune/Auto-inflammatory Syndrome Induced by Adjuvants”

    Directory of Open Access Journals (Sweden)

    Lucija Tomljenovic PhD

    2014-03-01

    Full Text Available We report the case of a 14-year-old girl who developed postural orthostatic tachycardia syndrome (POTS with chronic fatigue 2 months following Gardasil vaccination. The patient suffered from persistent headaches, dizziness, recurrent syncope, poor motor coordination, weakness, fatigue, myalgias, numbness, tachycardia, dyspnea, visual disturbances, phonophobia, cognitive impairment, insomnia, gastrointestinal disturbances, and a weight loss of 20 pounds. The psychiatric evaluation ruled out the possibility that her symptoms were psychogenic or related to anxiety disorders. Furthermore, the patient tested positive for ANA (1:1280, lupus anticoagulant, and antiphospholipid. On clinical examination she presented livedo reticularis and was diagnosed with Raynaud’s syndrome. This case fulfills the criteria for the autoimmune/auto-inflammatory syndrome induced by adjuvants (ASIA. Because human papillomavirus vaccination is universally recommended to teenagers and because POTS frequently results in long-term disabilities (as was the case in our patient, a thorough follow-up of patients who present with relevant complaints after vaccination is strongly recommended.

  11. electrode catheter techniques for treattnent of supraventricular ...

    African Journals Online (AJOL)

    damaged by radiofrequency energy (RP) delivered via catheters insened percutaneously without general anaes- thesia. The technique and results of its use were the main topics of interest at the 9th World Symposium on. Cardiac Pacing and Electrophysiology held in. Washington, DC, in June 1991. Effective cure of WPW.

  12. Increased resting heart rate following radiofrequency catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Nilsson, Brian; Chen, Xu; Pehrson, Steen

    2005-01-01

    AIM: Sinus tachycardia has been observed following radiofrequency (RF) catheter ablation for various kinds of supraventricular tachycardia. This study is aimed at determining the occurrence of changes in sinus-rhythm heart rate (HR) after pulmonary vein (PV) isolation in patients with paroxysmal...

  13. Neonatal arrhythmias: diagnosis, treatment, and clinical outcome

    OpenAIRE

    Ban, Ji-Eun

    2017-01-01

    Arrhythmias in the neonatal period are not uncommon, and may occur in neonates with a normal heart or in those with structural heart disease. Neonatal arrhythmias are classified as either benign or nonbenign. Benign arrhythmias include sinus arrhythmia, premature atrial contraction, premature ventricular contraction, and junctional rhythm; these arrhythmias have no clinical significance and do not need therapy. Supraventricular tachycardia, ventricular tachycardia, atrioventricular conduction...

  14. Antiarrhythmic treatment with flecainide (Tambocor). Clinical experience from 107 patients

    DEFF Research Database (Denmark)

    Frandsen, F; Pless, P; Mickley, H

    1990-01-01

    The long-term clinical effect of oral flecainide treatment was evaluated in 107 pts (10-82 yrs). Indications for treatment were: atrial fibrillation 38%, atrial flutter 16%, ventricular tachycardia 24%, ventricular ectopic beats 10% and supraventricular tachycardia 12%. Daily flecainide dosage...... was 200 (100-400) mg. Follow-up period 3 mths (15 days-15 mths). Based on the history and ECG flecainide had been effective in 51 pts. The improvement was most pronounced in pts suffering from supraventricular tachycardia involving an accessory bypass tract (84-92%). Flecainide had been discontinued in 50...

  15. Application of neural classifier to risk recognition of sustained ventricular tachycardia and flicker in patients after myocardial infarction based on high-resolution electrocardiography

    Science.gov (United States)

    Wydrzyński, Jacek; Jankowski, Stanisław; Piątkowska-Janko, Ewa

    2008-01-01

    This paper presents the application of neural networks to the risk recognition of sustained ventricular tachycardia and flicker in patients after myocardial infarction based on high-resolution electrocardiography. This work is based on dataset obtained from the Medical University of Warsaw. The studies were performed on one multiclass classifier and on binary classifiers. For each case the optimal number of hidden neurons was found. The effect of data preparation: normalization and the proper selection of parameters was considered, as well as the influence of applied filters. The best neural classifier contains 5 hidden neurons, the input ECG signal is represented by 8 parameters. The neural network classifier had high rate of successful recognitions up to 90% performed on the test data set.

  16. Role of surface electrocardiogram precordial leads in localizing different anatomic sites of ectopic atrial tachycardia arising from lower right atrium in pediatric population.

    Science.gov (United States)

    Allam, Lamyaa Elsayed; Ahmed, Rania Samir; Ghanem, Mazen Tawfik

    2018-01-01

    The study was designed to examine P wave morphology (PWM) in precordial leads (V 1 -V 6 ) during ectopic atrial tachycardia (EAT) originating from low right atrium (RA) to identify the anatomic sites of these foci in children. Twenty-three consecutive pediatric patients (56% females, mean age 8.5 ± 2.5) with EAT originating from the low RA underwent detailed atrial endocardial activation mapping and radiofrequency ablation. PWM during EAT was analyzed using standard 12-lead ECG in relation to successful ablation sites in RA. Ectopic atrial tachycardia originated from coronary sinus ostium (CSo) in 12 patients, nonseptal tricuspid annulus (TA) in five, lower crista terminalis (CT) in three and lower free wall in three. In lead V 1 , PWM showed a positive pattern during EAT originating from CSo (8/12) [91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), 100% negative predictive value (NPV)]. A negative pattern was observed in EAT originating from lower free wall (1/3) and nonseptal TA (5/5) [50% sensitivity, 100% specificity, 100% PPV, 75% NPV], while isoelectric pattern was in EAT originating from lower CT (3/3) [100% sensitivity, 100% specificity, 100% PPV, 100% NPV]. In leads V 3 -V 6 , PWM showed a negative pattern in at least two consecutive leads during EAT from CSo (12/12), nonseptal TA (5/5) and lower free wall (3/3) while it was positive in EAT originating from lower CT (3/3) [100% sensitivity, 95% specificity, 75% PPV and 100% NPV]. P wave morphology in precordial leads can help differentiate the anatomic sites of EAT from lower RA with high PPVs and NPVs. © 2017 Wiley Periodicals, Inc.

  17. Influence of steroid therapy on the incidence of pericarditis and atrial fibrillation after percutaneous epicardial mapping and ablation for ventricular tachycardia.

    Science.gov (United States)

    Dyrda, Katia; Piers, Sebastiaan R D; van Huls van Taxis, Carine F; Schalij, Martin J; Zeppenfeld, Katja

    2014-08-01

    This study evaluates the influence of 3 therapeutic approaches on the incidence of pericarditis and atrial fibrillation (AF) after percutaneous epicardial mapping and ablation for ventricular tachycardia. Eighty-five consecutive procedures (2006-2011) were retrospectively reviewed. After the first 17 procedures (20.0%), no steroids were administered. For the subsequent 30 procedures (35.3%), systemic steroids were administered intravenously or orally, whereas the last 38 procedures (44.7%) were followed by intrapericardial steroid injection. Compared with no steroids, the incidence of pericarditic chest pain was significantly reduced by intrapericardial steroids (58.8% versus 21.1%; P=0.006) but not by intravenous or oral steroids (58.8% versus 43.4%; P=0.31). There was no significant difference in the incidence of pericarditic ECG with steroids (36.8%, 30.0%, and 41.2% for intrapericardial, intravenous or oral, and none, respectively). There was a nonsignificant reduced incidence of chest pain with ECG changes with steroids (13.2%, 10.0%, and 29.4% for intrapericardial, intravenous or oral, and none, respectively). Radiofrequency applications (65.9% of procedures) did not affect the incidence of pericarditic ECG changes, pericarditic chest pain, or pericarditis (all P>0.05). In 7 (8.3%) patients with no prior history of AF, AF was documented a median 36 hours after procedure. Patients with pericarditic ECG tended to be at greater risk of AF (16.7 versus 3.6%; P=0.091). There is a high incidence of pericarditic chest pain and ECG changes after epicardial ventricular tachycardia mapping and ablation. Pericarditic chest pain is significantly decreased by intrapericardial steroids. Procedure-related AF is relatively frequent and tends to occur more commonly with pericarditic ECG changes. © 2014 American Heart Association, Inc.

  18. Cardiac arrhythmias in the fetus and newborn.

    Science.gov (United States)

    Wren, Christopher

    2006-06-01

    Arrhythmias are potentially life-threatening problems in the fetus and newborn. Appropriate management depends on accurate diagnosis. Atrioventricular re-entry is the most common type of supraventricular tachycardia in both the fetus and newborn. It should be distinguished from other types of tachycardia - such as atrial flutter, atrial ectopic tachycardia, permanent junctional re-entry tachycardia, and ventricular tachycardia. Neonatal and fetal bradycardias are less common clinical problems. Sustained bradycardia is most often caused by complete atrioventricular block. It can be mimicked by the more common but benign occurrence of non-conducted atrial premature beats.

  19. Occurrence of primarily noninducible atrioventricular nodal reentry tachycardia after radiofrequency delivery in the slow pathway region during empirical slow pathway modulation.

    Science.gov (United States)

    Wegner, Felix Konrad; Bögeholz, Nils; Leitz, Patrick; Frommeyer, Gerrit; Dechering, Dirk Georg; Kochhäuser, Simon; Lange, Philipp Sebastian; Köbe, Julia; Wasmer, Kristina; Mönnig, Gerold; Eckardt, Lars; Pott, Christian

    2017-11-01

    The first-line therapy for atrioventricular nodal reentry tachycardia (AVNRT) is catheter-based slow pathway modulation. If AVNRT is not inducible during an electrophysiological study, an empirical slow pathway modulation (ESPM) may be considered in patients with dual atrioventricular nodal physiology and/or a typical electrocardiogram (ECG). We screened 149 symptomatic patients who underwent ESPM in our department between 1993 and 2013. All patients fulfilled the following criteria: (1) either dual atrioventricular nodal (AVN) physiology with up to 2 AVN echo beats or characteristic ECG documentation or both, (2) noninducibility of AVNRT by programmed stimulation, and (3) completion of a telephone questionnaire for long-term follow-up. Out of this population we retrospectively investigated 13 patients who were primarily noninducible but in whom an AVNRT occurred during or after radiofrequency (RF) delivery. When AVNRT occurred, the procedure lost its empirical character, and RF delivery was continued until the procedural endpoint of noninducibility of AVNRT. This endpoint was reached in all but one patient (92%). After a follow-up of 73 ± 15 months, this patient was the only one who reported no benefit from the procedure. Out of 149 initially noninducible patients, a considerable number (9%) exhibited AVNRT during or after RF delivery. These patients crossed over from empirical to controlled slow pathway modulation resulting in a good clinical outcome. Our observations should encourage electrophysiologists to repeat programmed stimulation even after initial empirical RF delivery to retest for inducibility. © 2017 Wiley Periodicals, Inc.

  20. Reversing dobutamine-induced tachycardia using ivabradine increases stroke volume with neutral effect on cardiac energetics in left ventricular post-ischaemia dysfunction.

    Science.gov (United States)

    Bakkehaug, J P; Naesheim, T; Torgersen Engstad, E; Kildal, A B; Myrmel, T; How, O-J

    2016-10-01

    Compensatory tachycardia can potentially be deleterious in acute heart failure. In this study, we tested a therapeutic strategy of combined inotropic support (dobutamine) and selective heart rate (HR) reduction through administration of ivabradine. In an open-chest pig model (n = 12) with left ventricular (LV) post-ischaemia dysfunction, cardiac function was assessed by LV pressure catheter and sonometric crystals. Coronary flow and blood samples from the coronary sinus were used to measure myocardial oxygen consumption (MVO2 ). LV energetics was assessed by comparing MVO2 with cardiac work at a wide range of workloads. In the post-ischaemia heart, dobutamine (5 μg kg(-1)  min(-1) ) increased cardiac output (CO) by increasing HR from 102 ± 21 to 131 ± 16 bpm (beats per min; P efficiency. Similar findings on efficiency and LV function were also seen using an ex vivo working mouse heart protocol. A combined infusion of dobutamine and ivabradine had a neutral effect on post-ischaemia LV efficiency and increased left ventricular output without an increase in HR. © 2016 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  1. A novel low-energy electrotherapy that terminates ventricular tachycardia with lower energy than a biphasic shock when antitachycardia pacing fails.

    Science.gov (United States)

    Janardhan, Ajit H; Li, Wenwen; Fedorov, Vadim V; Yeung, Michael; Wallendorf, Michael J; Schuessler, Richard B; Efimov, Igor R

    2012-12-11

    The authors sought to develop a low-energy electrotherapy that terminates ventricular tachycardia (VT) when antitachycardia pacing (ATP) fails. High-energy implantable cardioverter-defibrillator (ICD) shocks are associated with device failure, significant morbidity, and increased mortality. A low-energy alternative to ICD shocks is desirable. Myocardial infarction was created in 25 dogs. Sustained, monomorphic VT was induced by programmed stimulation. Defibrillation electrodes were placed in the right ventricular apex, and coronary sinus and left ventricular epicardium. If ATP failed to terminate sustained VT, the defibrillation thresholds (DFTs) of standard versus experimental electrotherapies were measured. Sustained VT ranged from 276 to 438 beats/min (mean 339 beats/min). The right ventricular-coronary sinus shock vector had lower impedance than the right ventricular-left ventricular patch (54.4 ± 18.1 Ω versus 109.8 ± 16.9 Ω; p electrotherapy (MSE) achieved significantly lower DFT compared with a single biphasic shock (0.03 ± 0.05 J versus 2.37 ± 1.20 J; respectively, p electrotherapy to reduce high-energy ICD shocks. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Effect of dexmeditomidine on postoperative junctional ectopic tachycardia after complete surgical repair of tetralogy of Fallot: A prospective randomized controlled study

    Directory of Open Access Journals (Sweden)

    Shankar V Kadam

    2015-01-01

    Full Text Available Introduction: Incidence of junctional ectopic tachycardia (JET after repair of tetralogy of Fallot (TOF is 5.6-14%. Dexmeditomidine is a a-2 adrenoceptor agonist modulates the release of catecholamine, resulting in bradycardia and hypotension. These effects are being explored as a therapeutic option for the prevention of perioperative tachyarrhythmia. We undertook this study to examine possible preventive effects of dexmedetomidine on postoperative JET and its impact on the duration of ventilation time and length of Intensive Care Unit stay. Methods: After obtaining approval from the hospitals ethics committee and written informed consent from parents, this quasi-randomized trial was initiated. Of 94 patients, 47 patients received dexmedetomidine (dexmedetomidine group and 47 patients did not receive the drug (control group. Results: Dexmedetomidine group had more number of complex variants like TOF with an absent pulmonary valve or pulmonary atresia (P = 0.041. Hematocrit on cardiopulmonary bypass (CPB, heart rate while coming off from CPB and inotrope score was significantly low in the dexmedetomidine group compared to control group. The incidence of JET was significantly low in dexmedetomidine group (P = 0.040 compared to control group. Conclusions: Dexmedetomidine may have a potential benefit of preventing perioperative JET.

  3. Utility of a novel risk score for prediction of ventricular tachycardia and cardiac death in chronic Chagas disease - the SEARCH-RIO study

    Directory of Open Access Journals (Sweden)

    P.R. Benchimol-Barbosa

    2013-10-01

    Full Text Available The SEARCH-RIO study prospectively investigated electrocardiogram (ECG-derived variables in chronic Chagas disease (CCD as predictors of cardiac death and new onset ventricular tachycardia (VT. Cardiac arrhythmia is a major cause of death in CCD, and electrical markers may play a significant role in risk stratification. One hundred clinically stable outpatients with CCD were enrolled in this study. They initially underwent a 12-lead resting ECG, signal-averaged ECG, and 24-h ambulatory ECG. Abnormal Q-waves, filtered QRS duration, intraventricular electrical transients (IVET, 24-h standard deviation of normal RR intervals (SDNN, and VT were assessed. Echocardiograms assessed left ventricular ejection fraction. Predictors of cardiac death and new onset VT were identified in a Cox proportional hazard model. During a mean follow-up of 95.3 months, 36 patients had adverse events: 22 new onset VT (mean±SD, 18.4±4‰/year and 20 deaths (26.4±1.8‰/year. In multivariate analysis, only Q-wave (hazard ratio, HR=6.7; P1. In 10,000 bootstraps, the C-statistic of this novel score was non-inferior to a previously validated (Rassi score (0.89±0.03 and 0.80±0.05, respectively; test for non-inferiority: P<0.001. In CCD, surface ECG-derived variables are predictors of cardiac death and new onset VT.

  4. Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?

    Directory of Open Access Journals (Sweden)

    Claudia Celletti

    2017-01-01

    Full Text Available Background. Joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT, is a hereditary connective tissue disorder mainly characterized by generalized joint hypermobility, skin texture abnormalities, and visceral and vascular dysfunctions, also comprising symptoms of autonomic dysfunction. This study aims to further evaluate cardiovascular autonomic involvement in JHS/EDS-HT by a battery of functional tests. Methods. The response to cardiovascular reflex tests comprising deep breathing, Valsalva maneuver, 30/15 ratio, handgrip test, and head-up tilt test was studied in 35 JHS/EDS-HT adults. Heart rate and blood pressure variability was also investigated by spectral analysis in comparison to age and sex healthy matched group. Results. Valsalva ratio was normal in all patients, but 37.2% of them were not able to finish the test. At tilt, 48.6% patients showed postural orthostatic tachycardia, 31.4% orthostatic intolerance, 20% normal results. Only one patient had orthostatic hypotension. Spectral analysis showed significant higher baroreflex sensitivity values at rest compared to controls. Conclusions. This study confirms the abnormal cardiovascular autonomic profile in adults with JHS/EDS-HT and found the higher baroreflex sensitivity as a potential disease marker and clue for future research.

  5. [Predictive value of baseline plasma midregional fragment of pro-adrenomedullin level on long-term outcome of postural tachycardia syndrome children treated with midodrine hydrochloride].

    Science.gov (United States)

    Li, Hongxia; Zhang, Fengwen; Wang, Yuli; Liu, Ping; Zhang, Chunyu; Feng, Xueli; Du, Junbao; Jin, Hongfang

    2015-06-01

    To explore the predictive value of baseline plasma midregional fragment of pro-adrenomedullin level (MR-proADM) on long-term survival of postural tachycardia syndrome (POTS) children treated with midodrine hydrochloride. Fifty-three children (male 26, mean age (14.5 ± 4.5) years old) with POTS were included in this study, and all of them were diagnosed as POTS in our department from December 2007 to January 2010. Fifty-three children with POTS were divided into two groups according to the baseline plasma content of MR-proADM. Group I consisted of 35 POTS children with plasma content of MR-proADM > 61.5 ng/L, and the group II consisted of 18 POTS children with plasma content of MR-proADM ≤ 61.5 ng/L. The mean follow-up time was (67 ± 7) months. The orthostatic intolerance symptom score and the symptom free survival were compared between the 2 groups. At the 60 months follow-up, the symptom score of children in group I was significantly lower than that in group II (χ(2) = 4.985, P 0.05) while the symptom free survival of group I was significantly higher than that in group II (χ(2) = 4.566, P midodrine hydrochloride.

  6. [Predictive value of upright blood pressure change for long-term prognosis of children with postural tachycardia syndrome treated with midodrine hydrochloride].

    Science.gov (United States)

    Li, H X; Deng, W J; Zhang, C Y; Jin, H F; Du, J B

    2016-07-01

    To explore the predictive value of upright blood pressure change for long-term prognosis of children with postural tachycardia syndrome (POTS) treated with midodrine hydrochloride. A total of 90 children (male 41, female 49) were enrolled in this study. Their mean age was (11.8±2.7) years. They were diagnosed as POTS in Peking University First Hospital from 2005 to 2011. According to the upright change of blood pressure at the first visit, they were divided into two groups, effective group (n=55) and ineffective group(n=35). The follow-up time was 53-130 months. The orthostatic intolerance symptom score and symptom free survival rate were compared between the two groups. The change of systolic blood pressure and of diastolic blood pressure was lower in effective group than those in ineffective group (0(-6, 0) mmHg (1 mmHg=0.133 kPa) vs. 9(6, 11) mmHg, Z=-8.303, Pmidodrine hydrochloride.

  7. Clinical Profile of Atypical Manifestations of Dengue Fever.

    Science.gov (United States)

    Pothapregada, Sriram; Kamalakannan, Banupriya; Thulasingam, Mahalakshmy

    2016-06-01

    To study the clinical profile and outcome of the atypical manifestations of dengue fever in children. All children (0-12 y of age) diagnosed and confirmed as dengue fever at a tertiary care hospital at Puducherry, between the 1st of August 2012 and January 31st 2015 were reviewed retrospectively from hospital case records as per the revised World Health Organization (WHO) guidelines 2011 for dengue fever. The diagnosis was confirmed by NS1 antigen-based ELISA test or dengue serology for IgM and IgG antibodies and the data was analyzed using SPSS 16.0 statistical software. Out of 254 children admitted with dengue fever, non-severe dengue and severe dengue were seen in 62.6 % and 37.4 % respectively. Atypical manifestations were seen in 106 cases (41.7 %). Mean age of presentation was 6.9(3.3) y. M: F ratio was 1.2:1. The common manifestations of severe dengue infection were shock (37.4 %), bleeding (20.1 %) and multi-organ dysfunction (2.4 %). The most common atypical manifestations of dengue fever were lymphadenopathy (41.7 %), splenomegaly (21.2 %), biphasic fever (18.1 %), hepatitis (11.4 %), febrile diarrhea (6.3 %), refractory shock (2.4 %) and impaired consciousness (1.9 %). The other atypical manifestations present were portal hypertension, acalculous cholecystitis, appendicitis, acute respiratory distress syndrome (ARDS), myocarditis, pericardial effusion, paroxysmal supraventricular tachycardia (PSVT), myositis, acute kidney injury (AKI), hemophagocytic syndrome and disseminated intravascular coagulopathy (DIC). Platelet count did not always correlate well with the severity of bleeding. There were six deaths (2.4 %) and out of them four presented with impaired consciousness (66.6 %). The common causes for poor outcome were multiorgan failure, encephalopathy and refractory shock. The atypical manifestations of dengue fever are no more a rare entity. Clinicians should have a high index of suspicion and vigilance for atypical manifestations of

  8. The significance of 201Tl/123I MIBG (metaiodobenzylguanidine) mismatched myocardial regions for predicting ventricular tachycardia in patients with idiopathic dilated cardiomyopathy

    International Nuclear Information System (INIS)

    Maeno, Masakazu; Ishida, Yoshio; Shimonagata, Tsuyoshi

    1993-01-01

    123 I-MIBG (MIBG) regional defects in myocardial regions with preserved 201 Tl (Tl) uptake have been observed in patients with idiopathic dilated cardiomyopathy (DCM). To evaluate whether the presence of Tl/MIBG mismatched regions is related to the occurrence of ventricular tachycardia (VT), we performed myocardial dual SPECT imaging with Tl (111 MBq) and MIBG (111 MBq) in 17 patients with DCM, 11 (Gp A) with and 6 (Gp B) without VT. Myocardial dual SPECT imaging was performed at 15 minutes after and 4 hours after the tracer injection. The regional tracer uptake was scored visually in 6 segments of the basal, middle, and apical short-axial images and in 2 apical segments of the midventricular vertical long-axial image by a four-point scoring system (0=normal, 1=moderate, 2=severe and 3=complete defect). Then, the severity of tracer maldistributions was assessed by the difference between total defect scores (TDSs) of Tl and MIBG (ΔTDS). TDS was not different between Gps A and B in both Tl and MIBG images. However, ΔTDS was larger in Gp A than in Gp B (13.5±6.5 vs. 5.8±3.0, p<0.05). Also, the number of segments with the mismatched tracer uptake was larger in Gp A than in Gp B (12.5±3.0 vs. 8.3±1.5, p<0.01). In the electrophysiologic study, we found that the fractionated area corresponded to the mismatched region in 3 of 5 patients in Gp A. These results suggest that regional sympathetic denervation is a possible factor which provocates VT, and myocardial dual SPECT imaging with Tl and MIBG is a useful method for predicting VT in patients with DCM. (author)

  9. Magnesium Lowers the Incidence of Postoperative Junctional Ectopic Tachycardia in Congenital Heart Surgical Patients: Is There a Relationship to Surgical Procedure Complexity?

    Science.gov (United States)

    He, Dingchao; Sznycer-Taub, Nathaniel; Cheng, Yao; McCarter, Robert; Jonas, Richard A.; Hanumanthaiah, Sridhar; Moak, Jeffrey P.

    2015-01-01

    Magnesium sulfate was given to pediatric cardiac surgical patients during cardiopulmonary bypass period in an attempt to reduce the occurrence of postoperative junctional ectopic tachycardia (PO JET). We reviewed our data to evaluate the effect of magnesium on the occurrence of JET and assess a possible relationship between PO JET and procedure complexity. A total of 1088 congenital heart surgeries (CHS), performed from 2005 to 2010, were reviewed. A total of 750 cases did not receive magnesium, and 338 cases received magnesium (25 mg/kg). All procedures were classified according to Aristotle score from 1 to 4. Overall, there was a statistically significant decrease in PO JET occurrence between the two groups regardless of the Aristotle score, 15.3 % (115/750) in non-magnesium group versus 7.1 % (24/338) in magnesium group, P Aristotle score, P = 0.01. Following magnesium administration and controlling for body weight, surgical and aortic cross-clamp times in the analyses, reduction in adjusted risk of JET was significantly greater with increasing Aristotle level of complexity (JET in non-magnesium vs. magnesium group, Aristotle level 1: 9.8 vs. 14.3 %, level 4: 11.5 vs. 3.2 %; odds ratio 0.54, 95 % CI 0.31–0.94, P = 0.028). Our data confirmed that intra-operative usage of magnesium reduced the occurrence of PO JET in a larger number and more diverse group of CHS patients than has previously been reported. Further, our data suggest that magnesium’s effect on PO JET occurrence seemed more effective in CHS with higher levels of Aristotle complexity. PMID:25762470

  10. Catheter ablation of ventricular tachycardia in nonischemic cardiomyopathy: A propensity score-matched analysis of in-hospital outcomes in the United States.

    Science.gov (United States)

    Briceño, David F; Gupta, Tanush; Romero, Jorge; Kolte, Dhaval; Khera, Sahil; Villablanca, Pedro A; Tran, An; Mohanty, Sanghamitra; Trivedi, Chintan; Mohanty, Prasant; Gianni, Carola; Kim, Soo G; Garcia, Mario; Fonarow, Gregg C; Bhatt, Deepak L; Natale, Andrea; Di Biase, Luigi

    2018-02-05

    Monomorphic ventricular tachycardia (VT) is an important cause of morbidity and mortality. Use and outcome data of catheter ablation for VT in nonischemic cardiomyopathy (NICM) are limited. We obtained data from the 2003-2014 National Inpatient Sample databases. We used propensity score matching to compare patients undergoing catheter ablation versus medical therapy of VT related to NICM, and described the temporal trends in utilization and in-hospital outcomes of catheter ablation of VT in patients with NICM in the United States. From 2003 to 2014, of 133,529 patients hospitalized with the principal diagnosis of VT in NICM, 14,651 (11.0%) underwent catheter ablation. In this period, there was an increasing trend in utilization of catheter ablation (9.3% in 2003-2004 to 12.1% in 2003-2014, adjusted OR [per year], 1.12; 95% CI, 1.08-1.16; P trend  < 0.001). After propensity score matching, in-hospital mortality occurred in 172 of 14,318 (1.2%) patients in the catheter ablation group, compared with 297 of 14,156 (2.1%) of patients undergoing medical therapy (47% lower; 43% relative difference [adjusted OR, 0.53; 95% CI, 0.43-0.66]). In patients with NICM, catheter ablation of VT is associated with lower in-hospital mortality compared with those managed medically. The utilization rates of CA for VT related to NICM have increased in the past decade. Adequately powered randomized trials will be necessary to confirm these findings. © 2018 Wiley Periodicals, Inc.

  11. Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: systematic review and meta-analysis.

    Science.gov (United States)

    Briceño, David F; Romero, Jorge; Villablanca, Pedro A; Londoño, Alejandra; Diaz, Juan C; Maraj, Ilir; Batul, Syeda Atiqa; Madan, Nidhi; Patel, Jignesh; Jagannath, Anand; Mohanty, Sanghamitra; Mohanty, Prasant; Gianni, Carola; Della Rocca, Domenico; Sabri, Ahlam; Kim, Soo G; Natale, Andrea; Di Biase, Luigi

    2018-01-01

    To compare the long-term outcomes of standard ablation of stable ventricular tachycardia (VT) vs. substrate modification, and of complete vs. incomplete substrate modification in patients with structural heart disease (SHD) presenting with VT. An electronic search was performed using major databases. The main outcomes were a composite of long-term ventricular arrhythmia (VA) recurrence and all-cause mortality of standard ablation of stable VT vs. substrate modification, and long-term VA recurrence in complete vs. incomplete substrate modification. Six studies were included for the comparison of standard ablation of stable VT vs. substrate modification, with a total of 396 patients (mean age 63 ± 10 years, 87% males), and seven studies were included to assess the impact of extensive substrate modification, with a total of 391 patients (mean age 64 ± years, 90% males). More than 70% of all the patients included had ischaemic cardiomyopathy. Substrate modification was associated with decreased composite VA recurrence/all-cause mortality compared to standard ablation of stable VTs [risk ratio (RR) 0.57, 95% confidence interval (CI) 0.40-0.81]. Complete substrate modification was associated with decreased VA recurrence as compared to incomplete substrate modification (RR 0.39, 95% CI 0.27-0.58). In patients with SHD who had VT related mainly to ischaemic substrates, there was a significantly lower risk of the composite primary outcome of long-term VA recurrence and all-cause mortality among those undergoing substrate modification compared to standard ablation. Long-term success is improved when performing complete substrate modification. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  12. Taquicardia ventricular del tracto de salida del ventrículo derecho durante el embarazo Right ventricular outflow tachycardia during pregnancy

    Directory of Open Access Journals (Sweden)

    Ariel K. Saad

    2012-06-01

    Full Text Available Durante el embarazo aumentan el metabolismo basal, el consumo de O2, la frecuencia cardíaca, el volumen sistólico, el volumen minuto y la volemia y disminuyen la tensión arterial y la resistencia periférica. Diferentes estudios han demostrado que durante este período la posibilidad de que ocurra una arritmia cardíaca o se produzca la exacerbación de una arritmia preexistente es mayor. No obstante, en su enorme mayoría carecen de importancia pronóstica tanto para la madre como para el feto. La taquicardia ventricular del tracto de salida del ventrículo derecho es una arritmia poco frecuente y su aparición se ha correlacionado con el aumento del tono adrenérgico. Se presentan los casos de dos pacientes que mostraron en el curso de la gestación reiterados episodios de taquicardia ventricular del tracto de salida del ventrículo derecho. Se analiza la asociación del embarazo con la ocurrencia de trastornos del ritmo cardíaco.During pregnancy, there is an increase in metabolism, oxygen consumption, heart rate, stroke volume, cardiac output, blood volume and a decrease in blood pressure and peripheral resistance. Studies have shown that during this period the occurrence of cardiac arrhythmias is not uncommon. Fortunately, malignant arrhythmias are rare. Herein we report two young patients who presented with symptomatic right ventricular outflow tachycardia during pregnancy that required antiarrhythmic therapy. Possible pathophysiologic mechanisms are discussed.

  13. Assessment of Remote Myocardium Heterogeneity in Patients with Ventricular Tachycardia Using Texture Analysis of Late Iodine Enhancement (LIE) Cardiac Computed Tomography (cCT) Images.

    Science.gov (United States)

    Esposito, Antonio; Palmisano, Anna; Antunes, Sofia; Colantoni, Caterina; Rancoita, Paola Maria Vittoria; Vignale, Davide; Baratto, Francesca; Della Bella, Paolo; Del Maschio, Alessandro; De Cobelli, Francesco

    2018-03-13

    Diffuse remodeling of myocardial extra-cellular matrix is largely responsible for left ventricle (LV) dysfunction and arrhythmias. Our hypothesis is that the texture analysis of late iodine enhancement (LIE) cardiac computed tomography (cCT) images may improve characterization of the diffuse extra-cellular matrix changes. Our aim was to extract volumetric extracellular volume (ECV) and LIE texture features of non-scarred (remote) myocardium from cCT of patients with recurrent ventricular tachycardia (rVT), and to compare these radiomic features with LV-function, LV-remodeling, and underlying cardiac disease. Forty-eight patients suffering from rVT were prospectively enrolled: 5/48 with idiopathic VT (IVT), 23/48 with post-ischemic dilated cardiomyopathy (ICM), 9/48 with idiopathic dilated cardiomyopathy (IDCM), and 11/48 with scars from a previous healed myocarditis (MYO). All patients underwent echocardiography to assess LV systolic and diastolic function and cCT with pre-contrast, angiographic, and LIE scan to obtain end-diastolic volume (EDV), ECV, and first-order texture parameters of Hounsfield Unit (HU) of remote myocardium in LIE [energy, entropy, HU-mean, HU-median, standard deviation (SD), and mean absolute deviation (MAD)]. Energy, HU mean, and HU median by cCT texture analysis correlated with ECV (rho = 0.5650, rho = 0.5741, rho = 0.5068; p LIE may expand cCT capability of myocardial characterization. Myocardial heterogeneity (SD and MAD) was associated with LV dilatation, systolic and diastolic function, and is able to potentially identify the different patterns of structural remodeling characterizing patients with rVT of different etiology.

  14. Conditional FKBP12.6 overexpression in mouse cardiac myocytes prevents triggered ventricular tachycardia through specific alterations in excitation-contraction coupling.

    Science.gov (United States)

    Gellen, Barnabas; Fernández-Velasco, María; Briec, François; Vinet, Laurent; LeQuang, Khai; Rouet-Benzineb, Patricia; Bénitah, Jean-Pierre; Pezet, Mylène; Palais, Gael; Pellegrin, Noémie; Zhang, Andy; Perrier, Romain; Escoubet, Brigitte; Marniquet, Xavier; Richard, Sylvain; Jaisser, Fréderic; Gómez, Ana María; Charpentier, Flavien; Mercadier, Jean-Jacques

    2008-04-08

    Ca(2+) release from the sarcoplasmic reticulum via the ryanodine receptor (RyR2) activates cardiac myocyte contraction. An important regulator of RyR2 function is FKBP12.6, which stabilizes RyR2 in the closed state during diastole. Beta-adrenergic stimulation has been suggested to dissociate FKBP12.6 from RyR2, leading to diastolic sarcoplasmic reticulum Ca(2+) leakage and ventricular tachycardia (VT). We tested the hypothesis that FKBP12.6 overexpression in cardiac myocytes can reduce susceptibility to VT in stress conditions. We developed a mouse model with conditional cardiac-specific overexpression of FKBP12.6. Transgenic mouse hearts showed a marked increase in FKBP12.6 binding to RyR2 compared with controls both at baseline and on isoproterenol stimulation (0.2 mg/kg i.p.). After pretreatment with isoproterenol, burst pacing induced VT in 10 of 23 control mice but in only 1 of 14 transgenic mice (P<0.05). In isolated transgenic myocytes, Ca(2+) spark frequency was reduced by 50% (P<0.01), a reduction that persisted under isoproterenol stimulation, whereas the sarcoplasmic reticulum Ca(2+) load remained unchanged. In parallel, peak I(Ca,L) density decreased by 15% (P<0.01), and the Ca(2+) transient peak amplitude decreased by 30% (P<0.001). A 33.5% prolongation of the caffeine-evoked Ca(2+) transient decay was associated with an 18% reduction in the Na(+)-Ca(2+) exchanger protein level (P<0.05). Increased FKBP12.6 binding to RyR2 prevents triggered VT in normal hearts in stress conditions, probably by reducing diastolic sarcoplasmic reticulum Ca(2+) leak. This indicates that the FKBP12.6-RyR2 complex is an important candidate target for pharmacological prevention of VT.

  15. [Initial experience of catheter ablation of ventricular tachycardia originate from endocardium via direct ventricle puncture access in patients underwent mechanical valve implantation].

    Science.gov (United States)

    Wu, L M; Bao, J R; Zheng, L H; Chen, G; Ding, L G; Yao, Y

    2018-03-24

    Objective: To evaluate the results of catheter ablation of ventricular tachycardia (VT) via direct ventricle puncture access in patients without traditional approach. Methods: Two idiopathic left fasicular VT patients with mechanical aortic and mitrial valve repalcement and 1 patient with right ventricular originated VT post mechanical tricuspid valve repalcement from March 2010 to July 2012 in Fuwai hospital were enrolled in this study. For left fasicular VT patients, catheter ablation was performed using transapical left ventricular access via minithoracotomy. For the patient with right ventricular originated VT, catheter ablation was performed via percutaneous right ventricle puncture at xiphoid. Abaltion was guided under EnSite NavX mapping system. The feasibility of VT ablation via direct ventricle puncture access and long-term VT recurrence were investigated. Results: Catheter ablation was successful in all patients, and all clinical VTs were eliminated. The procedure time was 53, 62 and 74 minutes respectively with radiation time 11, 16 and 20 minutes. The ablation time was 130, 170 and 240 seconds individually. No procedure related complication occurred. After a follow-up time of 76, 55 and 82 months respectively, no VT recurrence was found in patients with left fasicular VT. New-onset VT with different morphology with previous VT was recorded in the patient with right ventricular originated VT, subcutaneous implantable defibrillator was implanted finally in this patient. Conclusions: For patients with endocardial origined ventricular arrhythmias which could not be ablated via traditional approaches, direct ventricle puncture access with hybrid techniques provides a new approach foreliminating VTs in these patients.

  16. Difference between supine and upright blood pressure associates to the efficacy of midodrine on postural orthostatic tachycardia syndrome (POTS) in children.

    Science.gov (United States)

    Deng, Wenjun; Liu, Yanling; Liu, Angie Dong; Holmberg, Lukas; Ochs, Todd; Li, Xueying; Yang, Jinyan; Tang, Chaoshu; Du, Junbao; Jin, Hongfang

    2014-04-01

    Postural orthostatic tachycardia syndrome (POTS) is common, and has a serious impact on children's quality of life. Midodrine hydrochloride, an α1-adrenoreceptor agonist, is an effective treatment. The study was designed to examine the therapeutic efficacy of midodrine hydrochloride by quantifying changes in blood pressure during the head-up test (HUT), in children with POTS. Overall, 104 out of 110 children with POTS were treated with midodrine hydrochloride and successfully followed-up. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) changes were analyzed during the HUT. In a retrospective analysis, a receiver operating characteristic (ROC) curve was used to analyze the therapeutic predictive value of pre-treatment changes in SBP, DBP, and a combination of both, from the supine position to standing, in the subjects. The increase of SBP and DBP from the supine position to standing in responders were significantly lower than that of the non-responders. The ROC curve showed that midodrine hydrochloride for children with POTS would be predicted to be effective when the pre-treatment increase of SBP was ≤ 0 mmHg, or when the pre-treatment increase of DBP was ≤ 6.5 mmHg (from the supine position to standing), yielding a sensitivity of 72% and specificity of 88%. The area under the curve was 0.744 and 0.809, respectively. Hence, the results suggested that looking at the changes in blood pressure during the HUT was useful in predicting the response to midodrine hydrochloride in children with POTS.

  17. Postural Orthostatic Tachycardia Syndrome (POTS

    Directory of Open Access Journals (Sweden)

    Koichi Mizumaki, MD PhD

    2011-01-01

    Therapies are directed at relieving the central hypovolemia or at compensating for the circulatory dysfunctions. Treatments include use of water, saline infusion, α-agonists, β-antagonists, and other agents that may correct the central hypovolemia. These have resulted in varying degrees of success, and they are often used in combination.

  18. Catheter Ablation of Ventricular Tachycardia

    Science.gov (United States)

    ... Noel G. Boyle , Kalyanam Shivkumar Download PDF https://doi.org/10.1161/CIRCULATIONAHA.110.963371 Circulation. 2010; 122: ... e389-e391 , originally published July 19, 2010 https://doi.org/10.1161/CIRCULATIONAHA.110.963371 Citation Manager Formats ...

  19. ICD discrimination of SVT versus VT with 1:1 V-A conduction: A review of the literature.

    Science.gov (United States)

    Cardoso, Rhanderson N; Healy, Chris; Viles-Gonzalez, Juan; Coffey, James O

    2015-01-01

    Inappropriate ICD shocks are associated with increased mortality. They also impair patients' quality of life, increase hospitalizations, and raise health-care costs. Nearly 80% of inappropriate ICD shocks are caused by supraventricular tachycardia. Here we report the case of a patient who received a single-lead dual-chamber sensing ICD for primary prevention of sudden cardiac death and experienced inappropriate ICD shocks. V-A time, electrogram morphology, and response to antitachycardia pacing suggested atrioventricular nodal reentry tachycardia, which was confirmed in an electrophysiology study. Inspired by this case, we performed a literature review to discuss mechanisms for discrimination of supraventricular tachycardia with 1:1 A:V relationship from ventricular tachycardia with 1:1 retrograde conduction.

  20. PROPAFENONE, A NEW EFFECTIVE ANTIARRHYTHMIC DRUG. REPORT OF 2 YEARS CLINICAL EXPERIMENT WITH PROPAFENONE (WITH BRIEF REVIEW OF ARTICLES

    Directory of Open Access Journals (Sweden)

    IRAJ NAZERY

    1986-05-01

    Full Text Available Propafenone HCI (p, is a relatively new Class IC antiarrhythmic agent. It has been reported to be superior to conventional antiarrhythmics in the control of supraventricular, ventricular and WPW associated tachyarrhythmias. It has been also shown to be well tolerated. In our study protocol, which extends over 2~ years period , we used (p in 87 patients for management of various types of cardiac arrhythmias (most of whom were resistant to conventmonal antiarrhythmics . Intravenously administered, (P was effective in 85% of patients with paroxysmal reentrant supraventricular tachycardia (PRSVT, 75% of those with paroxysmal atrial fibrillation (PAF , 50% and 42% of those with refractory premature ventricular contractions (PVC and ventricular tachycardia (V. Tach, respectively. Orally administered, (P was effective in 73% of those with resistant PVCs and nonsustained ventricular tachycardia (NSV Tach, and 75% of those with resistant sustained ventricular tachycardia (RSVT •

  1. Implantation of automatic cardioverter-defibrillators via median sternotomy.

    Science.gov (United States)

    Brodman, R; Fisher, J D; Furman, S; Johnston, D R; Kim, S G; Matos, J A; Waspe, L E

    1984-11-01

    15 AICD (automatic implantable cardioverter-defibrillator) Model B units were implanted in 10 patients. The median sternotomy is our preferred surgical approach using a right atrial patch electrode, a left ventricular apex patch electrode, and two closely placed epicardial sensing electrodes. Follow-up is 109 patient months and all patients are alive. AICD units discharged for ventricular tachycardia, ventricular flutter, and ventricular fibrillation. Discharges also occurred for sinus tachycardia and atrial fibrillation above the rate limit in three units. Premature pulse generator depletion has occurred in four AICD-B units 3 to 18 months postimplant and appears due to a defect in original battery design. Discharge of the AICD for supraventricular tachycardia is a problem that will remain until a better means of differentiating supraventricular tachycardia from ventricular tachyarrhythmias is found. The AICD appears to prevent sudden death from ventricular tachyarrhythmias.

  2. Impact of chocolate on the cardiovascular health.

    Science.gov (United States)

    Gammone, Maria Alessandra; Efthymakis, Konstantinos; Pluchinotta, Francesca Romana; Bergante, Sonia; Tettamanti, Guido; Riccioni, Graziano; D'Orazio, Nicolantonio

    2018-01-01

    The antioxidants such as polyphenols, especially flavonols, present in large quantitites in cocoa, cause vasodilation, modulate inflammatory markers and cardiovascular health, and possess a range of protective cardiovascular effects. On the other hand, overconsumption of chocolate can lead to tachyarrhythmias, supraventricular tachycardia, atrial fibrillation, ventricular tachycardia and ventricular fibrillation due to its caffeine content. This review describes both the cardioprotective and adverse effects of chocolate and its constituents.

  3. Infant with multiple congenital anomalies and deletion (9) (q34.3)

    Energy Technology Data Exchange (ETDEWEB)

    Schimmenti, L.A.; Berry, S.A.; Tuchman, M.; Hirsch, B. [Univ. of Minnesota, Minneapolis, MN (United States)

    1994-06-01

    The authors report on a male infant with developmental delay, growth failure, hypotonia, dolichocephaly, hypoplastic midface, epicanthal folds, down-slanting palpebral fissures, foveal hypoplasia, tracheomalacia, pectus excavatum, supraventricular tachycardia, gut malrotation, hypospadias, talipes equinovarus, short third metatarsals, capillary hemangiomata, and a de novo terminal deletion at 9q34.3.

  4. Retrospective platelet values measurement assesment always ...

    African Journals Online (AJOL)

    supraventricular tachycardia. ” In our opinion, a critical point of this paper are not completely clear. In particular, the authors state in methods section “This retrospective study…..Age, gender, leukocyte and thrombocyte counts at the time of hospital admission, MPV values, and ECG were recorded. The MPV was determined ...

  5. Vellykket behandling af supraventrikulær takykardi med modificeret Valsalvas manøvre

    DEFF Research Database (Denmark)

    Wallentin, Johan; Sjøl, Anette

    2016-01-01

    Supraventricular tachycardia (SVT) is a frequent challenge in medical emergency units. Adenosine, the drug of choice, may cause severe discomfort. The Danish Society of Cardiology's National Treatment Guidelines for SVT recommend first aid treatment with ''vagus stimulation such as carotid massage...

  6. Carotismassage is geen onschuldige interventie

    NARCIS (Netherlands)

    van den Brink, R. B. A.; de Lange, F. J.

    2017-01-01

    Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the A&E department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially

  7. Wolf-Parkinson-White syndrome in young men presenting with palpitation: the pattern of delta waves in predicting location of accessory pathway

    Directory of Open Access Journals (Sweden)

    Miryanti Cahyaningtias

    2011-11-01

    Full Text Available Palpitation is a common presenting symptom in the emergency department. Wolf-Parkinson White (WPW syndrome is a cardiac conduction disorder that may present with palpitation and lead to sudden cardiac death. WPW could be detected by  electrocardiogram (ECG. In this case report, we present two young male patients with WPW syndrome admitted to our hospital with history of repeated and progressive palpitation. ECG of the first patient revealed supraventricular tachycardia which converted to sinus rhythm after propanolol treatment. ECG showed sinus rhythm with delta wave in lead II,III,aVF, V1 suggesting the presence of accessory pathway (AP in left lateral wall. Electrophysiology study confirmed the presence of AP and radio frequency catheter ablation was successfully done resulted in disappearance of delta on outpatient clinic ECG. Patient has no symptom and he do not have to take medication. ECG of the second patient revealed supraventricular tachycardia with abberancy. After amiodarone infusion, ECG showed sinus rhythm with delta wave in lead I,II,aVL suggesting the presence of accessory pathway in anteroseptal wall. Electrophysiology study and catheter ablation did not perform for this patient because of financial problem, however amidarone has to be taken regularly to prevent the recurrence of supraventricular tachycardia. (Med J Indones 2011; 20:298-301Keywords: ECG, palpitation, supraventricular tachycardia, Wolf- Parkinson White syndrome

  8. Right Atrial Diverticulosis and Early-onset Arrhythmia: Rare Cause of Incessant Neonatal Arrhythmia.

    Science.gov (United States)

    Aggarwal, Neeraj; Joshi, Raja; Joshi, Reena K; Agarwal, Mridul

    2017-06-15

    Atrial flutter not responding to medications could be secondary to structural malformations of heart. A 5-year-old child with resistant arrhythmia, with onset in neonatal period. Multiple right atrial diverticuli were detected on CT angiography and cardiac catheterization. Patient reverted to sinus rhythm following surgical excision of diverticuli. In cases of intractable supraventricular tachycardia, structural anomalies of atrium should be suspected.

  9. Pseudo SVT in the pacemaker patient.

    Science.gov (United States)

    Modi, Simon; Barker, Diane; Cooper, Robert; Patwala, Ash; Hall, Mark

    2012-07-01

    This is an interesting report of a supraventricular tachycardia in a paced patient with intermittent atrioventricular nodal block. Only electrophysiology testing revealed the correct diagnosis. Images explain how pacemaker timing cycles and refractory periods can confuse an otherwise straightforward diagnosis. ©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.

  10. Behandeling van foetale supraventriculaire tachycardie met antiaritmica via de navelstrengvene

    NARCIS (Netherlands)

    Roest, A. A. W.; Vandenbussche, F. P. H. A.; Klumper, F. J. C. M.; Oepkes, D.; Rijlaarsdam, M. E. B.; Blom, N. A.

    2008-01-01

    Foetal supraventricular tachycardia (SVT) with hydrops foetalis is associated with a high morbidity and mortality rate. If SVT with hydrops foetalis persists despite transplacental therapy, direct foetal treatment can be initiated. One foetus was found to have SVT with hydrops foetalis during the

  11. The importance of the mean platelet volume in the diagnosis of ...

    African Journals Online (AJOL)

    In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p > 0.05). ... Keywords: mean platelet volume, inflammation, palpitation, supraventricular tachycardia, diagnostic

  12. [Wide spectrum of arrhythmias, with inductions and terminations of atrio-ventricular replica-nodal tachycardia by automaticity during successful radiofrequency ablation of long anterogradely slow conducting atrio-fasciculo-ventricular accessory pathway].

    Science.gov (United States)

    Bodalski, Robert; Szumowski, Lukasz; Walczak, Franciszek

    2012-01-01

    Mahaim syndrome is still a challenge. The specific characteristics of the pathway, the fact that it seldom occurs, and ambiguities about the pathophysiology and nomenclature make it, for electrophysiologists, still difficult to ablate. We present a case of a patient with anterogradely slow conducting accessory pathway, which has been effectively ablated although M potential was not observed nor was a mechanical conducting block of the accessory pathway. The accessory pathway showed a wide spectrum of electrophysiological characteristics of the "AV node physiology" including inductions and terminations of atrio-ventricular replica-nodal tachycardia by local automaticity, not only during electrophysiological study, but during successful application. The accessory pathway presented signs of two types of pseudo Mahaim fibers: atrio-fascicular and slow conducting atrio-ventricular connection.

  13. Improving SVT discrimination in single-chamber ICDs: a new electrogram morphology-based algorithm.

    Science.gov (United States)

    Klein, George J; Gillberg, Jeffrey M; Tang, Anthony; Inbar, Shmuel; Sharma, Arjun; Unterberg-Buchwald, Christina; Dorian, Paul; Moore, Hans; Duru, Firat; Rooney, Ethan; Becker, Daniel; Schaaf, Katie; Benditt, David

    2006-12-01

    Wide-spread adoption of ICD therapy has focused efforts on improving the quality of life for patients by reducing "inappropriate" shock therapies. To this end, distinguishing supraventricular tachycardia from ventricular tachycardia remains a major challenge for ICDs. More sophisticated discrimination algorithms based on ventricular electrogram morphology have been made practicable by the increased computational ability of modern ICDs. We report results from a large prospective study (1,122 pts) of a new ventricular electrogram morphology tachycardia discrimination algorithm (Wavelet Dynamic Discrimination, Medtronic, Minneapolis, MN, USA) operating at minimal algorithm setting (RV coil-can electrogram, match threshold of 70%). This is a nonrandomized cohort study of ICD patients using the morphology discrimination of the Wavelet algorithm to distinguish SVT and VT/VF. The Wavelet criterion was required ON in all patients and all other supraventricular tachycardia discriminators were required to be OFF. Spontaneous episodes (N = 2,235) eligible for ICD therapy were adjudicated for detection algorithm performance. The generalized estimating equations method was used to remove bias introduced when an individual patient contributes multiple episodes. Inappropriate therapies for supraventricular tachycardia were reduced by 78% (90% CI: 72.8-82.9%) for episodes within the range of rates where Wavelet was programmed to discriminate. Sensitivity for sustained ventricular tachycardia was 98.6% (90% CI: 97-99.3%) without the use of high-rate time out. Results from this prospective study of the Wavelet electrogram morphology discrimination algorithm operating as the sole discriminator in the ON mode demonstrate that inappropriate therapy for supraventricular tachycardia in a single-chamber ICD can be dramatically reduced compared to rate detection alone.

  14. Association of Regional Epicardial Right Ventricular Electrogram Voltage Amplitude and Late Gadolinium Enhancement Distribution on Cardiac Magnetic Resonance in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy: Implications for Ventricular Tachycardia Ablation.

    Science.gov (United States)

    Xie, Shuanglun; Desjardins, Benoit; Kubala, Maciej; Liang, Jackson; Yang, Jiandu; van der Geest, Rob J; Schaller, Robert; Riley, Michael; Callans, David; Zado Pac, Erica; Marchlinski, Francis; Nazarian, Saman

    2018-03-01

    Criteria for identification of anatomic ventricular tachycardia (VT) substrates in arrhythmogenic right ventricular cardiomyopathy (ARVC) on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) are unclear. We sought to define a) the association of regional RV epicardial voltage amplitude with the distribution of LGE, and b) appropriate image signal intensity (SI) thresholds for VT substrate identification, in ARVC. Pre-procedural LGE-CMR and epicardial electrogram mapping were performed in 10 ARVC patients. The location of epicardial electrogram map points, obtained during sinus rhythm with intrinsic conduction or RV pacing, were retrospectively registered to the corresponding LGE image regions. Standardized SI z-scores (standard deviation distance from the mean) were calculated for each 10-mm region surrounding map points. In patient-clustered, generalized estimating equations models that included 3205 epicardial EAM points and corresponding SI measures, bipolar (-1.43 mV/ z-score, P 0.05 [95% confidence interval (CI), -0.05-0.15] and 1.0 mV, respectively. Increased RV gadolinium uptake is associated with lower epicardial bipolar and unipolar electrogram voltage amplitude. Standardized LGE-CMR SI z-scores may augment pre-procedural planning for identification of low voltage zones and abnormal myocardium in ARVC. Copyright © 2018. Published by Elsevier Inc.

  15. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR

    Energy Technology Data Exchange (ETDEWEB)

    Avanesov, Maxim; Weinrich, Julius; Well, Lennart; Tahir, Enver; Adam, Gerhard; Lund, Gunnar [University Hospital Hamburg Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Muench, Julia; Patten, Monica [University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg (Germany); DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg (Germany); Saering, Dennis [University of Applied Sciences, Information Technology and Image Processing, Wedel (Germany); Stehning, Christian [Philips Research, Hamburg (Germany); Bohnen, Sebastian; Radunski, Ulf K.; Muellerleile, Kai [University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg (Germany)

    2017-12-15

    To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT). A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT. Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT. Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators. (orig.)

  16. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR

    International Nuclear Information System (INIS)

    Avanesov, Maxim; Weinrich, Julius; Well, Lennart; Tahir, Enver; Adam, Gerhard; Lund, Gunnar; Muench, Julia; Patten, Monica; Saering, Dennis; Stehning, Christian; Bohnen, Sebastian; Radunski, Ulf K.; Muellerleile, Kai

    2017-01-01

    To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT). A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT. Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT. Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators. (orig.)

  17. Signal-Averaged Electrocardiography as a Noninvasive Tool for Evaluating the Outcomes After Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease: Reassessment of an Old Tool.

    Science.gov (United States)

    Dinov, Borislav; Bode, Kerstin; Koenig, Sebastian; Oebel, Sabrina; Sommer, Philipp; Bollmann, Andreas; Hindricks, Gerhard; Arya, Arash

    2016-09-01

    Inducibility of ventricular tachycardia (VT) has limited ability to predict recurrent VT after catheter ablation (CA). We sought to correlate the signal-averaged ECG (SAECG) with the endocardial scar characteristics in patients with ischemic VTs. We suggest that successful CA can result in normalization of the SAECG. Fifty patients (42 male; aged 67±10 years, ejection fraction 34±12%) with ischemic VTs were prospectively enrolled. SAECG was performed before and after CA. Patients with at least 2 abnormal criteria (filtered QRS ≥114 ms; root mean square 40 38 ms) were defined as having positive SAECG. There was a linear correlation between endocardial scar area (<1.5 mV) and filtered QRS (r=0.414; P=0.003). CA resulted in normalization of the SAECG in 6 patients. In patients with filtered QRS ≤120 ms, 13 (40.6%) patients had normal SAECG after CA compared with 7 (21.9%) before ablation (P=0.034). Patients with normal or normalized SAECG after CA had better VT-free survival compared with those whose SAECG remained abnormal. Abnormal SAECG after CA was a predictor for VT recurrence: hazard ratio=3.64; P=0.039 for the overall population, and hazard ratio=5.80; P=0.022 for patients having QRS ≤120 ms. There is a significant correlation between the surface SAECG and endocardial scar size in patients with ischemic VTs. A successful CA can result in normalization of SAECG that is associated with more favorable long-term outcomes. SAECG can be useful to assess the procedural success of VT ablation. © 2016 American Heart Association, Inc.

  18. New Substrate-Guided Method of Predicting Slow Conducting Isthmuses of Ventricular Tachycardia: Preliminary Analysis to the Combined Use of Voltage Limit Adjustment and Fast-Fourier Transform Analysis.

    Science.gov (United States)

    Kuroki, Kenji; Nogami, Akihiko; Igarashi, Miyako; Masuda, Keita; Kowase, Shinya; Kurosaki, Kenji; Komatsu, Yuki; Naruse, Yoshihisa; Machino, Takeshi; Yamasaki, Hiro; Xu, Dongzhu; Murakoshi, Nobuyuki; Sekiguchi, Yukio; Aonuma, Kazutaka

    2018-04-01

    Several conducting channels of ventricular tachycardia (VT) can be identified using voltage limit adjustment (VLA) of substrate mapping. However, the sensitivity or specificity to predict a VT isthmus is not high by using VLA alone. This study aimed to evaluate the efficacy of the combined use of VLA and fast-Fourier transform analysis to predict VT isthmuses. VLA and fast-Fourier transform analyses of local ventricular bipolar electrograms during sinus rhythm were performed in 9 postinfarction patients who underwent catheter ablation for a total of 13 monomorphic VTs. Relatively higher voltage areas on an electroanatomical map were defined as high voltage channels (HVCs), and relatively higher fast-Fourier transform areas were defined as high-frequency channels (HFCs). HVCs were classified into full or partial HVCs (the entire or >30% of HVC can be detectable, respectively). Twelve full HVCs were identified in 7 of 9 patients. HFCs were located on 7 of 12 full HVCs. Five VT isthmuses (71%) were included in the 7 full HVC+/HFC+ sites, whereas no VT isthmus was found in the 5 full HVC+/HFC- sites. HFCs were identical to 9 of 16 partial HVCs. Eight VT isthmuses (89%) were included in the 9 partial HVC+/HFC+ sites, whereas no VT isthmus was found in the 7 partial HVC+/HFC- sites. All HVC+/HFC+ sites predicted VT isthmus with a sensitivity of 100% and a specificity of 80%. Combined use of VLA and fast-Fourier transform analysis may be a useful method to detect VT isthmuses. © 2018 American Heart Association, Inc.

  19. Correlation between the sudden jump-like increases of the atrio-Hisian interval induced during burst atrial pacing and during programmed atrial stimulation in patients with atrioventricular nodal reentrant tachycardia.

    Science.gov (United States)

    Bayraktarova, Iskra H; Stoyanov, Milko K; Kunev, Boyan T; Shalganov, Tchavdar N

    2017-11-26

    To study the correlation between the sudden prolongations of the atrio-Hisian (AH) interval with ≥50 ms during burst and programmed atrial stimulation, and to define whether the AH jump during burst atrial pacing is a reliable diagnostic criterion for dual AV nodal physiology. Retrospective data on 304 patients with preliminary ECG diagnosis of AV nodal reentrant tachycardia (AVNRT), confirmed during electrophysiological study, was analyzed for the presence of AH jump during burst and programmed atrial stimulation, and for correlation between the pacing modes for inducing the jump. Wilcoxon signed-ranks test and Spearman's bivariate correlation coefficient were applied, significant was P-value <0.05. The population was aged 48.5 ± 15.7 (12-85) years; males were 38.5%. AH jump occurred during burst atrial pacing in 81% of the patients, and during programmed stimulation - in 78%, P = 0.366. In 63.2% AH jump was induced by both pacing modes; in 17.8% - only by burst pacing; in 14.8% - only by programmed pacing; in 4.2% there was no inducible jump. There was negative correlation between both pacing modes, ρ = -0.204, Р<0.001. Burst and programmed atrial stimulation separately prove the presence of dual AV nodal physiology in 81 and 78% of the patients with AVNRT, respectively. There is negative correlation between the two pacing modes, allowing the combination of the two methods to prove diagnostic in 95.8% of the patients. Copyright © 2017 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

  20. Troponina T positiva em paciente chagásico com taquicardia ventricular sustentada e cinecoronariografia sem lesões obstrutivas Positive troponin T in a chagasic patient with sustained ventricular tachycardia and no obstructive lesions on cine coronary angiography

    Directory of Open Access Journals (Sweden)

    Maurício de Nassau Machado

    2005-02-01

    Full Text Available A avaliação e estratificação de pacientes com dor torácica na sala de emergência pode nos direcionar a terapêutica adequada a cada paciente baseada na probabilidade da presença de doença coronariana aguda e no risco de eventos cardíacos maiores desta coronariopatia. Esta avaliação é baseada no tripé: quadro clínico, achados eletrocardiográficos e nos marcadores de lesão miocárdica. Relatamos o caso de um paciente chagásico de 58 anos de idade admitido na unidade de emergência por dor torácica e palpitações, com eletrocardiograma mostrando uma taquicardia ventricular sustentada e com dosagem de troponina positiva (0,99 ng/ml, submetido a cinecoronariografia, que não evidenciou doença coronariana obstrutiva.The assessment and stratification of patients with chest pain in the emergency unit may indicate the appropriate therapy for each patient based on the probability of the presence of acute coronary artery disease and on the risk of its major cardiac events. That assessment is based on the triplet: clinical setting, electrocardiographic findings, and markers of myocardial lesion. We report the case of a 58-year-old male chagasic patient admitted to the emergency unit due to chest pain and palpitations, with an electrocardiogram showing sustained ventricular tachycardia and positive troponin measurement (0.99 ng/mL. The patient underwent cine coronary angiography, which evidenced no obstructive coronary artery disease.

  1. Concept of the five ′A′s for treating emergency arrhythmias

    Directory of Open Access Journals (Sweden)

    Trappe Hans-Joachim

    2010-01-01

    Full Text Available Cardiac rhythm disturbances such as bradycardia (heart rate < 50/min and tachycardia (heart rate > 100/min require rapid therapeutic intervention. The supraventricular tachycardias (SVTs are sinus tachycardia, atrial tachycardia, AV-nodal reentrant tachycardia, and tachycardia due to accessory pathways. All SVTs are characterized by a ventricular heart rate > 100/min and small QRS complexes (QRS width < 0.12 ms during the tachycardia. It is essential to evaluate the arrhythmia history, to perform a good physical examination, and to accurately analyze the 12-lead electrocardiogram. A precise diagnosis of the SVT is then possible in more than 90% of patients. In ventricular tachycardia (VT there are broad QRS complexes (QRS width > 0.12 s. Ventricular flutter and ventricular fibrillation are associated with chaotic electrophysiologic findings. For acute therapy, we will present the new concept of the five ′A′s, which refers to adenosine, adrenaline, ajmaline, amiodarone, and atropine. Additionally, there are the ′B,′ ′C,′ and ′D′ strategies, which refer to beta-blockers, cardioversion, and defibrillation, respectively. The five ′A′ concept allows a safe and effective antiarrhythmic treatment of all bradycardias, tachycardias, SVTs, VT, ventricular flutter, and ventricular fibrillation, as well as of asystole.

  2. Patients treated with catheter ablation for ventricular tachycardia after an ICD shock have lower long-term rates of death and heart failure hospitalization than do patients treated with medical management only.

    Science.gov (United States)

    Bunch, T Jared; Weiss, J Peter; Crandall, Brian G; Day, John D; May, Heidi T; Bair, Tami L; Osborn, Jeffrey S; Mallender, Charles; Fischer, Avi; Brunner, Kyle J; Mahapatra, Srijoy

    2014-04-01

    Ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs) adversely affect outcomes. Antiarrhythmic approaches to ventricular tachycardia (VT) have variable efficacy and may increase risk of ventricular arrhythmias, worsening cardiomyopathy, and death. Comparatively, VT ablation is an alternative approach that may favorably affect outcomes. To further explore the effect on long-term outcomes after catheter ablation of VT, we compared patients with history of ICD shocks who did not undergo ablation, patients with a history of ICD shocks that underwent ablation, and patients with ICDs who had no history of ICD shocks. A total of 102 consecutive patients with structural heart disease who underwent VT ablation for recurrent ICD shocks were compared with 2088 patients with ICDs and no history of appropriate shocks and 817 patients with ICDs and a history of appropriate shocks for VT or ventricular fibrillation. Outcomes considered were mortality, heart failure hospitalization, atrial fibrillation, and stroke/transient ischemic attack. The mean age of 3007 patients was 65.4 ± 13.9 years. Over long-term follow-up, 866 (28.8%) died, 681 (22.7%) had a heart failure admission, 706 (23.5%) developed new-onset atrial fibrillation, and 224 (7.5%) had a stroke. The multivariate-adjusted risks of deaths and heart failure hospitalizations were higher in patients with history of ICD shocks who were treated medically than in patients with ICDs and no history of shock (hazard ratio [HR] 1.45; P hospitalization rates similar to those of patients with no shock (HR 0.89; P = .58 vs HR 1.38; P = .09, respectively). A similar nonsignificant trend was seen with stroke/transient ischemic attack. Patients treated with VT ablation after an ICD shock have a significantly lower risk of death and heart failure hospitalization than did patients managed medically only. The adverse event rates after VT ablation were similar to those of patients with ICDs but without

  3. Ablation Techniques for Mahaim Fiber Tachycardia

    Directory of Open Access Journals (Sweden)

    Shomu Bohora

    2009-03-01

    Full Text Available Mahaim fiber exhibits atrio-ventricular node like properties and generally is localized at the lateral aspect of the tricuspid annulus. Of the varying methods for localization, ablation at the site of Mahaim potential is the most accepted and successful method. Radiofrequency ablation of Mahaim fiber has high success rates.

  4. Pacemarker Limitation of Tachycardia in Hypovolemic Shock

    Directory of Open Access Journals (Sweden)

    Gregory Moore

    2011-05-01

    Full Text Available A 49-year-old white man was admitted to the emergency department with nausea and diarrhea of 11 hours duration. He had experienced crampy abdominal pain as well. He reported that his stools had been dark and malodorous. He had no prior history of gastrointestinal disorders, nor travel, unusual oral or liquid intake. There was a remote history of alcohol abuse, but no hepatitis or cirrhosis. Recent alcohol intake was denied by the patient. He had no medical allergies. His past medical history was pertinent for a history of hypertension, congestive heart failure, and a dual chamber pacemaker insertion. There was no history of diabetes mellitus, smoking, or myocardial infarction. Medications included lisinopril, a small dose of aspirin daily, and thyroid supplement. Family history was negative for cardiomyopathy, sudden cardiac death, gastric or duodenal ulcers, colon cancer, or any congenital abnormalities. [West J Emerg Med. 2011;12(4:565–566.

  5. Tachycardia and heart failure after ritual circumcision.

    OpenAIRE

    Mor, A; Eshel, G; Aladjem, M; Mundel, G

    1987-01-01

    Four newborn babies developed acute heart failure a few hours after circumcision at 8 days. During this procedure, a sponge soaked in epinephrine was applied to the circumcision site and left there for several hours. Treatment was with digoxin and diuretics and signs of heart failure disappeared within 24-72 hours.

  6. Ablação de taquicardia ventricular idiopática com morfologia de bloqueio de ramo esquerdo localizada no tronco da artéria pulmonar Ablation of idiopathic ventricular tachycardia with left bundle-branch block morphology located in the pulmonary trunk

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Leite

    2005-02-01

    Full Text Available Paciente de 26 anos, sem cardiopatia estrutural, apresentando palpitações e pré-síncopes devido à taquicardia ventricular não sustentada, foi submetida a estudo eletrofisiológico para tentativa de ablação do foco arritmogênico, usando-se como local, os critérios de mapeamento. Sem obter êxito com o mapeamento da via de saída do ventrículo direito, posicionou-se o cateter dentro da artéria pulmonar com mapeamento de foco satisfatório, eliminando a taquicardia tão logo iniciada a radiofreqüência. Durante seguimento de 14 meses, a paciente permanece assintomática, sem arritmia ao Holter e não nessecitando de drogas antiarrítmicas.We report the case of a 26-year-old female patient with palpitations and presyncopes due to nonsustained ventricular tachycardia, who had no structural heart disease. The patient underwent electrophysiological study in an attempt to ablate the arrhythmogenic focus, whose location was determined by using mapping criteria. Because mapping of the right ventricular outflow tract was not successful, the catheter was placed inside the pulmonary artery with satisfactory mapping of the arrhythmogenic focus, and tachycardia was eliminated as soon as radiofrequency was initiated. The patient has remained asymptomatic for 14 months, with no treatment with antiarrhythmic drugs, and no arrhythmias on serial 24-hour Holter.

  7. Fetal and Neonatal Arrhythmias.

    Science.gov (United States)

    Jaeggi, Edgar; Öhman, Annika

    2016-03-01

    Cardiac arrhythmias are an important aspect of fetal and neonatal medicine. Premature complexes of atrial or ventricular origin are the main cause of an irregular heart rhythm. The finding is typically unrelated to an identifiable cause and no treatment is required. Tachyarrhythmia most commonly relates to supraventricular reentrant tachycardia, atrial flutter, and sinus tachycardia. Several antiarrhythmic agents are available for the perinatal treatment of tachyarrhythmias. Enduring bradycardia may result from sinus node dysfunction, complete heart block and nonconducted atrial bigeminy as the main arrhythmia mechanisms. The management and outcome of bradycardia depend on the underlying mechanism. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Salbutamol Abuse is Associated with Ventricular Fibrillation

    Directory of Open Access Journals (Sweden)

    Emin UYSAL

    2015-06-01

    Full Text Available SUMMARY: Salbutamol-induced cardiac complications are well-established. Herein, we describe a case of a 24-year female who was admitted to the emergency department because of a suicide attempt with salbutamol (76 mg. Salbutamol abuse induced the development of supraventricular tachycardia and ventricular fibrillation. Regular sinus rhythm was restored with defibrillation. The hypokalemic patient who stayed in the intensive care unit was discharged after 48 hours of hospitalization. Key words: Salbutamol, suicide, ventricular fibrillation

  9. P Wave Dispersion in Children with Breath-holding Spells

    OpenAIRE

    Tahsin Gider; Bülent Koca; Mustafa Çalık; Ali Yıldırım; Savaş Demirpençe

    2016-01-01

    Objective: A breath-holding spell (BHS) is a clinical feature frequently seen in infancy and early childhood and generally bringing children to pediatric cardiology outpatient clinics with the suspicion of cardiac disease. In this study, P wave dispersion (PWD), which is a marker of regional differences in atrial depolarization in electrocardiography and has been demonstrated to be beneficial in defining the risk of supraventricular tachycardia in various patient groups, was studied in childr...

  10. Arrhythmias in the paediatric intensive care unit: a prospective study of the rates and predictors of arrhythmias in children without underlying cardiac disease.

    Science.gov (United States)

    Cassel-Choudhury, Gina N; Aydin, Scott I; Toedt-Pingel, Iris; Ushay, H Michael; Killinger, James S; Cohen, Hillel W; Ceresnak, Scott R

    2015-10-01

    Arrhythmias are common in patients admitted to the paediatric intensive care unit. We sought to identify the rates of occurrence and types of arrhythmias, and determine whether an arrhythmia was associated with illness severity and paediatric intensive care unit length of stay. This is a prospective, observational study of all patients admitted to the paediatric intensive care unit at the Children's Hospital at Montefiore from March to June 2012. Patients with cardiac disease or admitted for the treatment of primary arrhythmias were excluded. Clinical and laboratory data were collected and telemetry was reviewed daily. Tachyarrhythmias were identified as supraventricular tachycardia, ventricular tachycardia, and arrhythmias causing haemodynamic compromise or for which an intervention was performed. A total of 278 patients met the inclusion criteria and were analysed. There were 97 incidences of arrhythmia in 53 patients (19%) and six tachyarrhythmias (2%). The most common types of arrhythmias were junctional rhythm (38%), premature atrial contractions (24%), and premature ventricular contractions (22%). Tachyarrhythmias included three supraventricular tachycardia (50%) and three ventricular tachycardia (50%). Of the six tachyarrhythmias, four were related to placement or migration of central venous lines and two occurred during aminophylline infusion. Patients with an arrhythmia had longer duration of mechanical ventilation and paediatric intensive care unit stay (pintensive care unit patients (19%), although tachyarrhythmias occurred rarely (2%). Central venous lines and use of aminophylline were identified as two clinical factors that may be associated with development of an arrhythmia.

  11. Hypertrophic cardiomyopathy: prognostic factors and survival analysis in 128 Egyptian patients.

    Science.gov (United States)

    El-Saiedi, Sonia A; Seliem, Zeinab S; Esmail, Reem I

    2014-08-01

    Hypertrophic cardiomyopathy is an important cause of disability and death in patients of all ages. Egyptian children may differ from Western and Asian patients in the pattern of hypertrophy distribution, clinical manifestations, and risk factors. The aim of our study was to report the clinical characteristics and outcomes of Egyptian children with hypertrophic cardiomyopathy studied over a 7-year duration and to determine whether the reported adult risk factors for sudden cardiac death are predictive of the outcome in these affected children. This retrospective study included 128 hypertrophic cardiomyopathy children. The data included personal history, family history, physical examination, baseline laboratory measurements, electrocardiogram, and Holter and echocardiographic results. Logistic regression analysis was used for the detection of risk factors of death. Fifty-one out of 128 patients died during the period of the study. Of the 51 deaths, 36 (70.5%) occurred in patients presenting before 1 year of age. Only eight patients had surgical intervention. Extreme left ventricular hypertrophy, that is, interventricular septal wall thickness or posterior wall thickness Z-score >6, sinus tachycardia, and supraventricular tachycardia were found to be independent risk factors for prediction of death in patients with hypertrophic cardiomyopathy. At our Egyptian tertiary care centre, hypertrophic cardiomyopathy has a relatively worse prognosis when compared with reports from Western and Asian series. Infants have a worse outcome than children presenting after the age of 1 year. A poorer prognosis in childhood hypertrophic cardiomyopathy is predicted by an extreme left ventricular hypertrophy, the presence of sinus tachycardia, and supraventricular tachycardia.

  12. Prehospital synchronized electrical cardioversion of a poorly perfused SVT patient by paramedics.

    Science.gov (United States)

    Smith, Gavin; Taylor, David McD; Morgans, Amee; Cameron, Peter

    2013-06-01

    Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of supraventricular tachycardia (SVT - either atrio-ventricular nodal reentry tachycardia (AVNRT) or atrio-ventricular reentrant tachycardia (AVRT)) with poor perfusion. The evidence is extremely limited with regard to the safety and effectiveness of this therapy. In Australia, half of the eight ambulance services include SDC within their clinical practice guidelines for the management of poorly perfused SVT; however the degree of variation in the application of SDC across these guidelines suggests a need to quantify the practice. This case provides a previously unreported example of the safety and effectiveness of prehospital SDC for SVT (with poor perfusion precipitated by a Valsalva Maneuver) by Victorian paramedics, and discusses the available literature regarding the effectiveness and safety of this practice.

  13. Extracorporeal membrane oxygenation support for intractable primary arrhythmias and complete congenital heart block in newborns and infants: short-term and medium-term outcomes.

    Science.gov (United States)

    Dyamenahalli, Umesh; Tuzcu, Volkan; Fontenot, Eudice; Papagiannis, John; Jaquiss, R D B; Bhutta, Adnan; Morrow, William R; Erickson, Christopher C; Imamura, Michiaki; Prodhan, Parthak

    2012-01-01

    To describe the experience with extracorporeal membrane oxygenation support for intractable primary arrhythmias in newborns and infants. Retrospective study. A tertiary care pediatric hospital. Patients younger than 1 yr supported with extracorporeal membrane oxygenation for primary cardiac arrhythmias were identified from the institutional extracorporeal membrane oxygenation registry. Extracorporeal membrane oxygenation support. Clinical characteristics and outcomes were investigated for patients with primary cardiac arrhythmia supported with extracorporeal membrane oxygenation. Outcomes investigated were time from initiation of extracorporeal membrane oxygenation support to arrhythmia control, duration of extracorporeal membrane oxygenation support, and results of interventions performed while supported with extracorporeal membrane oxygenation. We summarized the independent categorical and continuous variables using frequencies, percentages, and medians and ranges, respectively. Extracorporeal membrane oxygenation support was used in nine patients for rescue therapy for primary tachyarrhythmia and bradycardia. The primary arrhythmias were: focal atrial tachycardia (n = 2); reentrant supraventricular tachycardia (n = 3); junctional ectopic tachycardia (n = 2); and congenital complete atrioventricular block (n = 2) patients. Seven patients presented with severe hemodynamic compromise, with six patients requiring extracorporeal cardiopulmonary resuscitation. All patients required extracorporeal membrane oxygenation within 24 hrs of initial presentation. Balloon atrial septostomy was performed in three patients and ablation was performed in two patients. Sinus rhythm was achieved in all reentrant supraventricular tachycardia and rate control was established in both patients with focal atrial tachycardia and in one patient with junctional ectopic tachycardia while using extracorporeal membrane oxygenation support. All patients survived to hospital discharge, and

  14. Supraventricular escape rhythms during transient episodes of bradycardia in preterm infants

    NARCIS (Netherlands)

    Andriessen, P.; Koolen, A.M.P.; Bastin, F.H.; Lafeber, H.N.; Meijler, F.L.

    2001-01-01

    Objective: To evaluate the origin of transient episodes of sinus bradycardia, atrial escape rhythm, and atrioventricular nodal escape rhythm in preterm infants. Material and methods: The study was observational, and was carried out in a third level neonatal intensive care unit. We srudied 19

  15. The R-wave deflection interval in lead V3 combining with R-wave amplitude index in lead V1: a new surface ECG algorithm for distinguishing left from right ventricular outflow tract tachycardia origin in patients with transitional lead at V3.

    Science.gov (United States)

    Cheng, Zhongwei; Cheng, Kang'an; Deng, Hua; Chen, Taibo; Gao, Peng; Zhu, Kongbo; Fang, Quan

    2013-09-30

    To distinguish left ventricular outflow tract (LVOT) from right ventricular outflow tract (RVOT) origin in idiopathic premature ventricular contractions or ventricular tachycardia (PVCs/VT) patients with transitional lead at V3 is still a challenge. We sought to develop a new electrocardiography (ECG) algorithm for distinguishing LVOT from RVOT origin in patients with idiopathic outflow tract PVCs/VT with precordial transitional lead at V3. We analyzed the surface ECG characteristics in a retrospective cohort of idiopathic PVCs/VT patients with transitional lead at V3 who underwent successful radiofrequency catheter ablation and developed a new surface ECG algorithm, then validated it in a prospective cohort. A total of 82 consecutive patients (47 ± 17 years, 39% male) underwent radiofrequency catheter ablation of idiopathic outflow tract PVCs/VT between January 2006 and August 2010. Among them, 31 patients (38%) with transitional lead at V3 constituted the retrospective cohort. Based on the areas under the receiver operating characteristic curves, R-wave deflection interval in lead V3>80 ms and R-wave amplitude index in lead V1>0.30 were selected to develop the new surface ECG algorithm. It correctly identified the origin sites of eleven from 12 patients in the prospective cohort, yielding the accuracy of 91.7%. We presented a new simple surface ECG algorithm, R-wave deflection interval in lead V3>80 ms combining with R-wave amplitude index in lead V1>0.30 which can reliably distinguish LVOT from RVOT origin in idiopathic outflow tract PVCs/VT in patients with transitional lead at V3. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  16. The Association between Nocturnal Cardiac Arrhythmias and Sleep-Disordered Breathing: The DREAM Study.

    Science.gov (United States)

    Selim, Bernardo J; Koo, Brian B; Qin, Li; Jeon, Sangchoon; Won, Christine; Redeker, Nancy S; Lampert, Rachel J; Concato, John P; Bravata, Dawn M; Ferguson, Jared; Strohl, Kingman; Bennett, Adam; Zinchuk, Andrey; Yaggi, Henry K

    2016-06-15

    To determine whether sleep-disordered breathing (SDB) is associated with cardiac arrhythmia in a clinic-based population with multiple cardiovascular comorbidities and severe SDB. This was a cross-sectional analysis of 697 veterans who underwent polysomnography for suspected SDB. SDB was categorized according to the apnea-hypopnea index (AHI): none (AHI < 5), mild (5 ≥ AHI < 15), and moderate-severe (AHI ≥ 15). Nocturnal cardiac arrhythmias consisted of: (1) complex ventricular ectopy, (CVE: non-sustained ventricular tachycardia, bigeminy, trigeminy, or quadrigeminy), (2) combined supraventricular tachycardia, (CST: atrial fibrillation or supraventricular tachycardia), (3) intraventricular conduction delay (ICD), (4) tachyarrhythmias (ventricular and supraventricular), and (5) any cardiac arrhythmia. Unadjusted, adjusted logistic regression, and Cochran-Armitage testing examined the association between SDB and cardiac arrhythmias. Linear regression models explored the association between hypoxia, arousals, and cardiac arrhythmias. Compared to those without SDB, patients with moderate-severe SDB had almost three-fold unadjusted odds of any cardiac arrhythmia (2.94; CI 95%, 2.01-4.30; p < 0.0001), two-fold odds of tachyarrhythmias (2.16; CI 95%,1.47-3.18; p = 0.0011), two-fold odds of CVE (2.01; 1.36-2.96; p = 0.003), and two-fold odds of ICD (2.50; 1.58-3.95; p = 0.001). A linear trend was identified between SDB severity and all cardiac arrhythmia subtypes (p value linear trend < 0.0001). After adjusting for age, BMI, gender, and cardiovascular diseases, moderate-severe SDB patients had twice the odds of having nocturnal cardiac arrhythmias (2.24; 1.48-3.39; p = 0.004). Frequency of obstructive respiratory events and hypoxia were strong predictors of arrhythmia risk. SDB is independently associated with nocturnal cardiac arrhythmias. Increasing severity of SDB was associated with an increasing risk for any cardiac arrhythmia. © 2016 American Academy of Sleep

  17. P Wave Signal-Averaged Electrocardiography in Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Buzea, C A; Dan, Anca Rodica; Delcea, Caterina; Balea, M I; Gologanu, Daniela; Dobranici, Mihaela; Popescu, Raluca Alexandra; Dan, G A

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is associated with higher incidence of supraventricular arrhythmias. Atrial late potentials (ALP) detected by P-wave signal-averaged electrocardiography (SAECG) could be useful in detecting the patients at risk for supraventricular arrhythmias. Our objective was to assess the role of P-wave SAECG and ALP detection for arrhythmic risk evaluation of the patients with exacerbated COPD. We prospectively included 45 patients with exacerbation of COPD and 58 age- matched patients with no history of pulmonary disease in a control group. We performed pulmonary function tests, arterial blood gases, echocardiography, 24-hour Holter monitoring and P-wave SAECG. We measured filtered P-wave duration (FPD), the root mean square (RMS) voltages in the last 40, 30 and 20 ms of the filtered P-wave (RMS 40, RMS 30 and RMS 20), the root mean square voltage of the filtered P-wave potentials (RMS-p), and the integral of the potentials during the filtered P-wave (Integral-p). ALP was defined as FPD > 132 ms and RMS 20 < 2.3 μV. Isolated atrial premature beats (APB) and supraventricular tachycardias (SVT) were more frequent in the COPD group. There were no significant differences between groups regarding the P wave SAECG parameters. In the COPD group none of the supraventricular arrhythmias was correlated with ALP or any P-wave SAECG parameters. The patients with acute exacerbation of COPD but no apparent cardiac disease have a higher incidence of supraventricular arrhythmias. P-wave SAECG analysis and ALP detection have little value in the arrhythmic risk evaluation of these patients.

  18. Caution for anabolic androgenic steroid use: a case report of multiple organ dysfunction syndrome.

    Science.gov (United States)

    Unai, Shinya; Miessau, Joseph; Karbowski, Pawel; Baram, Michael; Cavarocchi, Nicholas C; Hirose, Hitoshi

    2013-12-01

    We report a 42-year-old male amateur body builder and user of anabolic androgenic steroids, who developed ARDS, acute kidney injury, and refractory supraventricular tachycardia. He required extracorporeal membrane oxygenation, continuous veno-venous hemodialysis, and catheter ablation. We believe that long-term anabolic androgenic steroid abuse predisposed the patient to multiple organ dysfunction syndrome, from its immunomodulatory effects in an otherwise healthy patient. Anabolic androgenic steroid use should be part of the history taking process, since it may complicate diagnosis, disease progression, and prognosis.

  19. Atrio-hisian fibers anatomy and electrophysiology.

    Science.gov (United States)

    Brechenmacher, Claude J

    2013-02-01

    In this case, electrophysiology and histology could be studied in the same heart. Clinical investigation, clinical electrophysiology, and postmortem serial histological sections of the septum were analyzed. A patient with repeated seizures and a short PR interval with narrow QRS complex underwent electrophysiologic studies. The patient died while experiencing a very rapid supraventricular tachycardia and histologic examination showed a atrio-hisian bypass tract. In our study, the lack of lengthening of the PR interval in spite of progressively premature atrial stimulation connected with the presence of atrio-hisian bypass tract. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  20. [Catecholaminergic polymorphic ventricular tachycardia is a rare inherited heart disease.

    DEFF Research Database (Denmark)

    Holst, Anders Gaarsdal; Tfelt-Hansen, 1jacob; Olesen, Morten S

    2010-01-01

    or cardiac arrest. The arrhythmias are usually triggered by exercise or emotional affection. The diagnosis is often made using exercise electrocardiogram, which typically triggers arrhythmias. The treatment consists of beta blockers, frequently in combination with implantation of a cardioverter...

  1. Bidirectional superior vena cava: Right atrial conduction delay during tachycardia

    NARCIS (Netherlands)

    A.S. Thornton (Andrew); M. Rivero-Ayerza (Maximo); J.M. Mekel (Joris); L.J.L.M. Jordaens (Luc)

    2007-01-01

    textabstractThe superior vena cava, like all the thoracic veins, has myocardial sleeves and plays a role in initiation and perpetuation of atrial fibrillation. Conduction delay between it and the right atrium has been shown previously. This case study shows delay in both directions during different

  2. Catheter Ablation of Focal Atrial Tachycardia Using Remote Magnetic Navigation

    DEFF Research Database (Denmark)

    Liu, Xiao-Yu; Jacobsen, Peter Karl; Pehrson, Steen

    2018-01-01

    , a total of 56 atrial foci were found. Acute success of the primary ablation was obtained in 52 patients (98%). Mean procedure duration was 109 ± 35 min, ablation duration was 401 sec (interquartile range [IQR], 332 sec), and fluoroscopy time was 5.0 min (IQR, 3.0 min). After a mean follow-up of 31 ± 18...

  3. Junctional ectopic tachycardia following repair of congenital heart ...

    African Journals Online (AJOL)

    4 patients had amiodarone administration, 5 had magnesium sulphate infusion, 2 patients had direct current shock (DCS) whilst 3 patients had all three therapeutic modalities. All patients had control of the arrhythmia with conversion to sinus rhythm and no recurrence. Conclusion: We report a JET incidence of 1.37% among ...

  4. Catecholaminergic polymorphic ventricular tachycardia: important messages from case reports

    NARCIS (Netherlands)

    van der Werf, Christian; Wilde, Arthur A. M.

    2011-01-01

    This editorial refers to 'Germline and somatic mosaicism for a mutation of the ryanodine receptor type 2 gene: implication for genetic counselling and patient caring' by N. Roux-Buisson et al., on page 130 and 'Efficacy of flecainide in a patient with catecholaminergic polymorphic ventricular

  5. Feminizing Adrenal Carcinoma Presenting with Heart Failure and Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Anjana Harnoor

    2012-01-01

    Full Text Available We present a case of feminizing adrenal carcinoma with severe elevation in serum estradiol and otherwise unexplained congestive heart failure with ventricular arrhythmia and review the literature on feminizing adrenal tumors and the potential relationship between estrogen and cardiac problems. A 54-year-old man presented with congestive heart failure and ventricular arrhythmia. Imaging revealed a large adrenal mass. Hormonal evaluation revealed a very high serum level of estradiol, elevated DHEA-sulfate and androstenedione, and lack of cortisol suppression on a low-dose overnight dexamethasone suppression test. The patient underwent a left adrenalectomy with subsequent normalization of serum estradiol. Surgical pathology examination established adrenocortical carcinoma MacFarlane stage II. Upon 15-month followup, the patient continued to have a normal serum estradiol level, his cardiac function was significantly improved, and he had no further episodes of ventricular arrhythmia. To the best of our knowledge, the serum estradiol level that was detected in our case is the highest that has been reported. Further, we hypothesize that the very high serum concentration of estradiol in our case may have played a role in his cardiac presentation with congestive heart failure and arrhythmia, particularly as these problems resolved with normalization of his serum estradiol level.

  6. The management of arrhythmic sincope.

    Science.gov (United States)

    Brembilla-Perrot, B

    2009-06-01

    Arrhythmic syncope explains 5% to 20% of the causes of syncope and its incidence increases with age. In patients with arrhythmic syncope, a poor prognosis can be expected if syncope is misdiagnosed, particularly when arrhythmias occur in a patient with advanced heart disease. Arrhythmic causes are due either to bradycardia (diagnosed by surface electrocardiography, 24-hour Holter monitoring and electrophysiologic study in patients with bundle-branch block) or to supraventricular or ventricular tachycardia (diagnosed by electrophysiologic study and/or long-term event recording). Arrhythmic syncope can be easily prevented with antiarrhythmic drugs or, more frequently, with non-medical treatments such as radiofrequency ablation of tachycardia, and pacemaker or defibrillator implantation.

  7. Emergency diagnosis and management of pediatric arrhythmias

    Directory of Open Access Journals (Sweden)

    Hanash Carla

    2010-01-01

    Full Text Available True emergencies due to unstable arrhythmias in children are rare, as most rhythm disturbances in this age group are well-tolerated. However, presentation to an emergency department with symptoms of palpitations, fatigue and/or syncope is much more common. Sinus tachycardia is by far the most commonly reported arrhythmia, followed by supraventricular tachycardia. Emergency physicians should be prepared for diagnosis and to acutely manage various types of arrhythmias seen in children, to assess the need for further diagnostic testing, and to determine whether cardiology evaluation and follow-up are needed. This article is intended to provide diagnostic and management guidelines of the most common types of arrhythmias seen in children with structurally normal hearts as well as those associated with congenital heart disease and cardiomyopathies.

  8. Unusual presentation of thyrotoxicosis as complete heart block and renal failure: a case report

    Directory of Open Access Journals (Sweden)

    Narain Rajay

    2009-11-01

    Full Text Available Abstract Introduction Thyrotoxicosis is a clinical entity often very difficult to diagnose without biochemical confirmation as its clinical features can be highly varied. The most common cardiac manifestations of thyrotoxicosis are resting sinus tachycardia, supraventricular tachycardia including atrial fibrillation and atrial flutter with or without cardiac failure. Bradycardia and atrio-ventricular conduction defects are very uncommon in thyrotoxicosis. Case presentation We report the case of a 59-year-old Caucasian man presenting with progressive weight loss, abnormal liver function, acute renal failure and complete heart block due to thyrotoxicosis. Conclusion Thyrotoxicosis should be considered as a possible diagnosis in patients with bradycardia and heart blocks associated with abnormal symptoms like weight loss. Nevertheless, the clinical, electrophysiological and biochemical abnormalities associated with thyrotoxicosis may be completely reversible restoring euthyroid state.

  9. Exclusion of fluoroscopy use in catheter ablation procedures: six years of experience at a single center.

    Science.gov (United States)

    Fernández-Gómez, Juan M; Moriña-Vázquez, Pablo; Morales, Elena Del Rio; Venegas-Gamero, José; Barba-Pichardo, Rafael; Carranza, Manuel Herrera

    2014-06-01

    Nonfluoroscopic mapping systems have demonstrated significant reduction of radiation exposure in radiofrequency (RF) catheter ablation procedures. However, their use as only imaging guide is still limited. To evaluate the usefulness of a completely nonfluoroscopic approach to catheter ablation of supraventricular arrhythmias using the Ensite-NavX™ electroanatomical navigation system. During 6 years, all consecutive patients referred for RF catheter ablation of regular supraventricular tachycardia (SVT) were admitted for a "zero-fluoroscopy" approach and studied prospectively. The only exclusion criterion was the need to perform a transseptal puncture. A total of 340 procedures were performed on 328 patients (179 men, age 55.7 ± 18.6 years). One hundred fifty-three patients had typical atrial flutter (AFL), 146 had AV nodal reentrant tachycardia (AVNRT), 35 had AV reciprocating tachycardia (AVRT), 4 patients had incisional atrial flutter (IAF), and 2 had focal atrial tachycardia (AT). Procedural success was achieved in 337 of the cases (99.1%). In 322 (94.7%), the procedure was completed without any fluoroscopy use. Mean procedure time was 110.5 ± 51.8 minutes. Mean RF application time was 9.8 ± 12.8 minutes and the number of RF lesions was 16.43 ± 15.8. Only 1 major complication related to vascular access was recorded. During follow-up, there were 12 recurrences (3.5%) (8 patients from the AVNRT group, 4 patients from the AP group). RF catheter ablation of SVT with an approach completely guided by the NavX system and without use of fluoroscopy is feasible, safe, and effective. © 2014 Wiley Periodicals, Inc.

  10. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes.

    Science.gov (United States)

    Silversides, Candice K; Harris, Louise; Haberer, Kym; Sermer, Mathew; Colman, Jack M; Siu, Samuel C

    2006-04-15

    In women with heart disease, sustained arrhythmias can result in an increased risk to the mother and fetus. The purpose of this study was to determine the recurrence rates of arrhythmias during pregnancy in women with cardiac rhythm disorders and examine the impact on fetal and neonatal outcomes. Women with tachyarrhythmias before pregnancy who underwent obstetric care at the Toronto General and Mount Sinai Hospitals from 1990 to 2002 were included. The recurrence rates of arrhythmias were calculated. A multivariate logistic model was used to identify predictors of fetal complications. Seventy-three women had 87 pregnancies; 36 pregnancies were in women with a history of paroxysmal supraventricular tachycardia, 23 with paroxysmal atrial fibrillation or atrial flutter (AF/Afl), 6 with persistent AF/Afl, and 22 with ventricular tachycardia. In the women in sinus rhythm at baseline, 44% (36 of 81 pregnancies) developed recurrences of tachyarrhythmias during pregnancy or in the early postpartum period. The specific recurrence rates during pregnancy in women with a history of supraventricular tachycardia, paroxysmal AF/Afl, and ventricular tachycardia were 50%, 52%, and 27%, respectively. The 6 women in AF/Afl at baseline remained in this rhythm throughout their pregnancy. Adverse fetal events occurred in 17 of the 87 pregnancies (20%). Adverse fetal events occurred more commonly in women who developed antepartum arrhythmias (RR 3.4, 95% confidence interval 1.0 to 11.0, p = 0.045) compared with those who did not. In conclusion, in women with preexisting cardiac rhythm disorders, exacerbation of arrhythmia during pregnancy is common. Recurrence of arrhythmia during the antepartum period increases the risk of adverse fetal complications, independent of other maternal and fetal risk factors.

  11. Comparação entre a lidocaína e a acupuntura no tratamento da taquicardia ventricular induzida com dopamina em equinos anestesiados com halotano Comparative study between lidocaine and acupunture in the treatment of ventricular tachycardia induced by dopamine in horses anesthetized with halothane

    Directory of Open Access Journals (Sweden)

    J.J. Cárdenas

    2009-08-01

    Full Text Available Os efeitos da lidocaina e da acupuntura nos pontos bilaterais associados ao pericárdio 6 (Pc6-Neiguan e ao coração 7 (C7-Shenmen, no tratamento da taquicardia ventricular (TV induzida por dopamina em equinos anestesiados com halotano, foram avaliados e comparados. Seis equinos, distribuídos em três grupos: grupo-controle (GC, grupo tratado com acupuntura (GA e grupo tratado com lidocaína (GL, foram anestesiados três vezes cada, com intervalo de uma semana entre cada anestesia. Avaliaram-se os parâmetros cardiovasculares (frequência cardíaca, pressão arterial e eletrocardiografia, os respiratórios (frequência respiratória, capnografía, saturação de hemoglobina e hemogasometria e o escore de recuperação. A dose arritmogênica da dopamina (DAD foi determinada a partir da infusão de 70µg/kg/min IV durante 10 minutos, sem interrupção, preenchendo o critério arritmogênico: quatro ou mais complexos ventriculares prematuros seguidos, com duração de pelo menos 15 segundos ou TV sustentada. O tempo médio de aparecimento da DAD ou da TV foi de 6,05±0,45 minutos nos animais não tratados, e a TV se reverteu espontaneamente aos 2,7±0,2 minutos. O grupo tratado com acupuntura reverteu a TV no tempo médio de 1,8±0,2 (PThe effects of lidocaine and acupuncture in the associated bilateral points, i.e. pericardium 6 (Pc 6- Neiguan and heart 7 (H7 - Shenmen, on the ventricular tachycardia (VT induced by dopamine were evaluated in horses anesthetized with halothane. Six horses were distributed in three groups: control group (CG, acupuncture treated group (AG, and lidocaine treated group (LG. They were anesthetized three times each one using halothane with one week interval between each anesthesic procedure. Cardiovascular (heart rate, arterial pressure, and ECG and respiratory (respiratory rate, capnometry, hemoglobin saturation, and blood gas analysis parameters and recovery score were evaluated. The arrhythmogenic dose of dopamine

  12. [Clinical analysis of 19 cases of pregnant women with rapid arrhythmia in the treatment of radiofrequency catheter ablation].

    Science.gov (United States)

    Chu, L; Zhang, J; Li, Y N; Long, D Y

    2016-10-25

    Objective: To investigate the risk of radiofrequency catheter ablation and maternal and infant in pregnant women with rapid arrhythmia during pregnancy. Methods: The clinical data of the 19 cases of pregnancy complicated with rapid arrhythmia were retrospectively analyzed and followed up, including the gestational week, the type of arrhythmia, the treatment, and the outcome of the mother and child in Beijing Anzhen Hospital of Capital Medical University from January 2002 to March 2016. Results: (1)Clinical characteristics: the ages of the 19 cases were(31±4)years old(ranged from 26 to 35 years old), the onset gestational ages were(21±4)weeks(ranged from 15 to 32 weeks). paroxysmal palpitation, chest tightness, dizziness, and blurred vision. Arrhythmia types: 1 case of atrial flutter and atrial tachycardia, 1 case of atrial flutter and atrial fibrillation, 1 case of atrial fibrillation, 3 cases of supraventricular tachycardia, 1 case of atrial tachycardia and supraventricular tachycardia, 4 cases of ventricular tachycardia, 3 cases of ventricular premature beats and ventricular tachycardia, and 5 cases of atrial tachycardia. All cases were treated by drugs, but all failed 2 cases of them were performed esophageal pacing and cardioversion and also failed.(2)Treatment plan: 19 cases after treatment of arrhythmia, completely terminated, the first 7 patients(from 2002 to 2014)were operated in a small amount of radiation under the guidance, the other 12 patients(after 2015)were carried out in the Ensite NavX mapping system, whichwere operated with zero radiation. Complications and adverse reactions: 1 case of uterine contraction end operation and was gived magnesium sulfate 3 days intravenous inhibition of uterine contractions, 1 case occurred vagal reflex caused by reduced blood pressure and was gived fluid infusion utill normal blood pressure.(3)Maternal and neonatal outcomes: in addition 1 case of pregnancy to give up, the remaining 18 cases were full-term pregnant

  13. Diagnosis, treatment and follow up of neonatal arrhythmias.

    Science.gov (United States)

    Binnetoğlu, Fatih Köksal; Babaoğlu, Kadir; Türker, Gülcan; Altun, Gürkan

    2014-01-01

    This study aimed to evaluate the aetiology, spectrum, course and outcomes of neonates with arrhythmias observed in a tertiary neonatal intensive care unit from 2007 to 2012. Neonates with rhythm problems were included. The results of electrocardiography (ECG), Holter ECG, echocardiography and biochemical analysis were evaluated. The long-term results of follow up were reviewed. Forty-five patients were male (68%) and 21 (32%) were female. Fifty-five patients (83.3%) were term, 11 (16.6%) were preterm, and 34% were diagnosed in the prenatal period. Twenty cases (30.3%) had congenital heart disease. Twenty-three patients (34.8%) were diagnosed during the foetal period. The most common arrhythmias were supraventricular ectopic beats and supraventricular tachycardia (SVT) at 39.3 and 22.7%, respectively. SVT recurred in five patients after the neonatal period. Supraventricular ectopic beats and SVT were the most common arrhythmias during the neonatal period. Although the prognosis of arrhythmias in the neonatal period is relatively good, regular monitoring is required.

  14. [Clinical demonstrations: Heart rupture in acute myocardial infarct. Infectious endocarditis. Wolff-Parkinson-White syndrome].

    Science.gov (United States)

    Nager, F

    1984-12-08

    This clinical demonstration includes three topics of clinical cardiology: myocardial rupture in acute myocardial infarction, infective endocarditis, and WPW-syndrome with paroxysmal supraventricular tachycardia. In the first part three cases with septal perforation or papillary muscle rupture are demonstrated. Our experience with myocardial rupture (free wall, septum, papillary muscle) during the last six years is summarized with special reference to the significance and the differential diagnosis of systolic regurgitant murmurs after myocardial infarction. Special features of acute mitral incompetence (papillary muscle dysfunction) in myocardial infarction are outlined and diagnostic guidelines for differentiation between septal perforation and papillary muscle rupture are discussed. In the second part two patients with aortic (e.g. mitral) valve rupture in the course of infective endocarditis are presented. The synoptic comparison of these two patients is related to the results of our own clinical studies on the changing pattern of infective endocarditis (epidemiologically, clinically) during the last three decades. The clinical picture of acute aortic valve rupture is outlined and the bedside signs indicating catastrophic complications of infective endocarditis are summarized. In the third part the odyssey of a patient with WPW-syndrome and consecutive paroxysmal supraventricular tachycardia is described. Progress in electrophysiological analysis of the re-entry circles in preexcitation syndromes is outlined.

  15. Risk and protective factors in the origin of atrial septal defect secundum--national population-based case-control study.

    Science.gov (United States)

    Csáky-Szunyogh, Melinda; Vereczkey, Attila; Urbán, Róbert; Czeizel, Andrew E

    2014-03-01

    The aim of this study was to assess the risk factors in the origin of lethal or surgically corrected isolated atrial septal defect secundum. The population-based Hungarian Case-Control Surveillance of Congenital Abnormalities (conducted between 1980 and 1996) comprised 472 atrial septal defect secundum cases, 678 matched controls and 38,151 available controls without any defects; in addition, 21,022 malformed controls with other isolated defects. Medically recorded chronic disorders in the prenatal maternity logbook were evaluated, while acute maternal diseases, drug treatments and pregnancy supplements were analyzed on the basis of both prospective medically recorded data and retrospective maternal information. Acute pelvic inflammatory disease, paroxysmal supraventricular tachycardia and phenolphthalein treatment due to severe constipation of mothers were shown to contribute to the development of atrial septal defect secundum of their children. High doses of folic acid in early pregnancy had positively influenced a minor part of isolated atrial septal defect secundum in foetuses. In conclusion, the obvious genetic predisposition for atrial septal defect secundum is connected with maternal paroxysmal supraventricular tachycardia and triggered by acute pelvic inflammatory diseases and phenolphthalein treatment, while the manifestation of atrial septal defect secundum can be reduced by high doses of folic acid supplementation in early pregnancy.

  16. Catheter Ablation of Tachyarrhythmias in Small Children

    Directory of Open Access Journals (Sweden)

    Andrew D. Blaufox

    2005-01-01

    Full Text Available An estimated 80,000-100,000 radiofrequency ablation (RFA procedures are performed in the United States each year.1 Approximately 1% of these are performed on pediatric patients at centers that contribute data to the Pediatric Radiofrequency Registry.2 Previous reports from this registry have demonstrated that RFA can safely and effectively be performed in pediatric patients.3,4 However, patients weighing less than 15 kg have been identified as being at greater risk for complications.3,4 Consequently, there has been great reluctance to perform RFA in small children such that children weighing less than 15 kg only represent approximately 6% of the pediatric RFA experience2 despite the fact that this age group carries the highest incidence of tachycardia, particularly supraventricular tachycardia (SVT.5 Factors other than the risk of complications contribute to the lower incidence of RFA in this group, including the natural history of the most common tachycardias (SVT, technical issues with RFA in small hearts, and the potential unknown long-term effects of RF applications in the maturing myocardium. Conversely, there are several reasons why ablation may be desirable in small children, including greater difficulties with medical management,6,7,8 the higher risk for hemodynamic compromise during tachycardia in infants with congenital heart disease (CHD, and the inability of these small children to effectively communicate their symptoms thereby making it more likely that their symptoms may go unnoticed until the children become more seriously ill. Before ultimately deciding that catheter ablation is indicated in small children, one must consider which tachycardias are likely to be ablated, the clinical presentation of these tachycardias, alternatives to ablation, the relative potential for success or complications, and modifications of the procedure that might reduce the risk of ablation in this group.

  17. Antiarrhythmic medication is superior to catheter ablation in suppressing supraventricular ectopic complexes in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Alhede, Christina; Lauridsen, Trine K; Johannessen, Arne

    2017-01-01

    to antiarrhythmic medication (AAD) is unknown. Our aims were to compare the prevalence of SVEC after AAD and CA and to estimate the association between baseline SVEC burden and AF burden during 24months of follow-up. METHODS: Patients with paroxysmal AF (N=260) enrolled in the MANTRA PAF trial were treated with AAD...

  18. Spatial Visualization by Realistic 3D Views

    Science.gov (United States)

    Yue, Jianping

    2008-01-01

    In this study, the popular Purdue Spatial Visualization Test-Visualization by Rotations (PSVT-R) in isometric drawings was recreated with CAD software that allows 3D solid modeling and rendering to provide more realistic pictorial views. Both the original and the modified PSVT-R tests were given to students and their scores on the two tests were…

  19. [Routine screening of splenic or portal vein thrombosis after splenectomy].

    Science.gov (United States)

    Bouvier, A; Gout, M; Audia, S; Chalumeau, C; Rat, P; Deballon, O

    2017-01-01

    Portal and/or splenic vein thrombosis (PSVT) is common after splenectomy. It can be a life-threatening complication, with a risk of bowel ischemia and portal hypertension. An early diagnosis allows an effective medical treatment and prevents life-threatening complications. There is no consensus regarding the benefit of systematic screening of patients after splenectomy for PSVT. We started in January 2012 a routine screening of PSVT after elective splenectomy. The aim of this study was to assess this policy. Since January 2012, all patients undergoing an elective splenectomy had an abdominal CT-scan on postoperative-day 7. Demographic data, pathology, type of surgery, platelet counts before and after surgery, outcome, results of medical imaging, and management of PSVT and its results were recorded. Over 3 years, 52 patients underwent an elective splenectomy. All of them had a CT-scan at postoperative-day 7. A PSVT was found in 11 patients (21.2 %). They were all asymptomatic. Lymphoma and splenomegaly were the main factors associated with PSVT in the univariate analysis. All patients with PSVT were treated with anticoagulation and no complication of PSVT occurred. The follow-up CT confirmed the efficacy of anticoagulation therapy in all patients. Routine screening of PSVT after elective splenectomy is warranted because it allows to start anticoagulant therapy and avoid further life-threatening complications. The incidence of PSVT is particularly high among patients operated on for lymphoma or with splenomegaly. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  20. The "hidden" concealed left-sided accessory pathway: An uncommon cause of SVT in young people.

    Science.gov (United States)

    Pass, Robert H; Liberman, Leonardo; Silver, Eric S; Janson, Christopher M; Blaufox, Andrew D; Nappo, Lynn; Ceresnak, Scott R

    2018-01-12

    Concealed left-sided accessory pathways (CLAP) are a cause of supraventricular tachycardia (SVT) in the young. Most are mapped with right ventricular (RV) apical/outflow pacing. Rarely, alternative means of mapping are required. We review our experience from three pediatric electrophysiology (EP) centers with a rare form of "hidden" CLAP. All patients SVT and one AFIB (4%). APs were adenosine sensitive in 7/20 patients (35%) and VA conduction was decremental in six (26%). CLAP conduction was demonstrable with orthodromic reentrant tachycardia in all patients, with RV extrastimulus testing in seven (30%) and with rapid RV pacing (tachycardia (ORT; 3/4 ventricular entrained), and three (13%) with brief rapid RV pacing. There were no complications. At 18 months (range 3-96), there was one recurrence (4%). Some CLAPs are only demonstrable with LV pacing, entrained ORT, or rapid RV pacing. LV pacing facilitated preferential AP conduction, allowing for mapping while maintaining stable hemodynamics. © 2018 Wiley Periodicals, Inc.

  1. Morphological detection algorithms for the automatic implantable cardioverter/defibrillator (AICD).

    Science.gov (United States)

    Kaup, H J; Hexamer, M; Werner, J

    2004-11-01

    To prevent sudden cardiac death of patients who are at risk from long standing tachyarrhythmia the implantable cardioverter defibrillator (ICD) is the first choice therapy. ICDs use a range of electrostimuli up to defibrillation, which is a non synchronous high energy shock, whereas cardioversion is synchronous with the ECG. In order to know when and how to react, a detection algorithm, which analyses an intracardial electrocardiogram (ECG) and classifies the heart rhythm, is implemented in every ICD. All detection algorithms use the heart rate to classify the different heart rhythms roughly. If a tachycardia is detected, it is important to discriminate between a ventricular tachycardia, which is life threatening and a supraventricular tachycardia, which is much less threatening. To be able to make this distinction the detection algorithms analyse the behaviour of the heart cycle intervals, the ECG-morphology or in addition to the ventricular ECG, an atrial ECG. In this paper morphological algorithms will be evaluated and newly developed algorithms will be presented. Recent algorithms use the mathematical wavelet theory. The evaluation shows that these get better results than all but one of the simpler classical morphological algorithms. A new wavelet based algorithm, developed by the authors, exhibits the best detection results.

  2. Diagnosis, management, and outcomes of patients with syncope and bundle branch block.

    Science.gov (United States)

    Moya, Angel; García-Civera, Roberto; Croci, Francesco; Menozzi, Carlo; Brugada, Josep; Ammirati, Fabrizio; Del Rosso, Attilio; Bellver-Navarro, Alejandro; Garcia-Sacristán, Jesús; Bortnik, Miriam; Mont, Lluis; Ruiz-Granell, Ricardo; Navarro, Xavier

    2011-06-01

    Although patients with syncope and bundle branch block (BBB) are at high risk of developing atrio-ventricular block, syncope may be due to other aetiologies. We performed a prospective, observational study of the clinical outcomes of patients with syncope and BBB following a systematic diagnostic approach. Patients with ≥1 syncope in the last 6 months, with QRS duration ≥120 ms, were prospectively studied following a three-phase diagnostic strategy: Phase I, initial evaluation; Phase II, electrophysiological study (EPS); and Phase III, insertion of an implantable loop recorder (ILR). Overall, 323 patients (left ventricular ejection fraction 56 ± 12%) were studied. The aetiological diagnosis was established in 267 (82.7%) patients (102 at initial evaluation, 113 upon EPS, and 52 upon ILR) with the following aetiologies: bradyarrhythmia (202), carotid sinus syndrome (20), ventricular tachycardia (18), neurally mediated (9), orthostatic hypotension (4), drug-induced (3), secondary to cardiopulmonary disease (2), supraventricular tachycardia (1), bradycardia-tachycardia (1), and non-arrhythmic (7). A pacemaker was implanted in 220 (68.1%), an implantable cardioverter defibrillator in 19 (5.8%), and radiofrequency catheter ablation was performed in 3 patients. Twenty patients (6%) had died at an average follow-up of 19.2 ± 8.2 months. In patients with syncope, BBB, and mean left ventricular ejection fraction of 56 ± 12%, a systematic diagnostic approach achieves a high rate of aetiological diagnosis and allows to select specific treatment.

  3. Avaliação da atividade elétrica atrial em pacientes submetidos ao tratamento cirúrgico da valvopatia mitral Evaluation of atrial electrical activity in patients operated on mitral valve disease

    Directory of Open Access Journals (Sweden)

    Cesar Augusto Ferreira

    2002-01-01

    . The classical right lateral subseptal access may sometimes provide difficult exposure, so that alternative approaches are used whose effects on atrial electrical activity are contradictory. OBJECTIVE:To standardize an investigative method to evaluate heart electrical activity post-op. METHODS: Ten consecutive adult patients with mitral valve disease were operated on. Surface electrocardiogram and continuous electrocardiographic monitoring (Holter system pre and post-op., and epicardical cardioestimulation post-op. were used to study cardiac electric activity. RESULTS: There was no mortality. All patients with sinus rhythm presented supraventricular ectopia, with episodes of supraventricular tachycardia in 57%, atrial flutter in 10%, and junctional rhythm in 10%. All patients presented ventricular ectopia, with a low incidence in 70% of them and with unsustained ventricular tachycardia in 30%. During the postoperative period there was a 40% rate of new supraventricular arrhythmias (atrial fibrillation, junctional rhythm, low atrial rhythm, and paroxistic supraventricular tachycardia, with no ventricular arrhythmias. Post-op. sinus node function was preserved. There was a significant reduction of supraventricular ectopia, with reversal of atrial fibrillation to sinus rhythm in one patient. Although there was a significant reduction in left atrium size post-op, P wave duration, as well as ventricular ectopia rate remained unchanged. Interatrial conduction time correlated with left atrium size measured pre and post-op. CONCLUSION: The methods proved useful to evaluate atrial electric activity in patients operated upon by the classic subseptal access, thus permitting future comparisons with other surgical approaches to the mitral valve.

  4. The prevalence and characteristics of intra-atrial right coronary artery anomaly in 9,284 patients referred for coronary computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Opolski, Maksymilian P., E-mail: opolski.mp@gmail.com [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Pregowski, Jerzy, E-mail: jerzypregowski74@gmail.com [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Kruk, Mariusz, E-mail: mariuszkruk2000@yahoo.com [Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Staruch, Adam D., E-mail: adstarman@gmail.com [Medical University of Warsaw, Warsaw (Poland); Witkowski, Adam, E-mail: witkowski@hbz.pl [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Demkow, Marcin, E-mail: mdemkow@ikard.pl [Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Hryniewiecki, Tomasz, E-mail: t.hryniewiecki@ikard.pl [Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw (Poland); Michalek, Piotr, E-mail: p.michalek@ikard.pl [Department of Immediate Diagnostics, Institute of Cardiology, Warsaw (Poland); Ruzyllo, Witold, E-mail: w.ruzyllo@ikard.pl [Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Kepka, Cezary, E-mail: c.kepka@ikard.pl [Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland)

    2014-07-15

    Objective: To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population. Methods: We included 9,284 consecutive subjects who underwent CCTA at a single high-volume center. The presence of IARCA including the number, length and diameter of IARCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Additionally, clinical characteristics and midterm follow-up of IARCA patients were recorded. Results: The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53 mm, and the mean diameter proximal to the entry site was 3.3 ± 0.7 mm. IARCA was more often associated with intramuscular course of the left anterior descending coronary artery (29% vs. 4%, p = 0.001) and anomalous origin of the left circumflex artery from the right aortic sinus (14% vs. 0.3%, p = 0.001) compared with non-IARCA cases. The majority of IARCA patients were women (86%) presenting with supraventricular arrhythmia (71%). Compared with computed tomographic population without IARCA, IARCA subjects were younger (60 ± 12 vs. 54 ± 14 years, p = 0.037) and more often women (51% vs. 86%, p = 0.013). At a mean of 20 months follow-up of IARCA patients there were no adverse cardiac events except for supraventricular tachycardia episodes occurring in 36% of subjects. Conclusions: IARCA occurs rarely and is often associated with additional coronary anomalies. The clinical profile of IARCA patients is most often represented by middle-aged women with supraventricular arrhythmia showing favorable midterm prognosis.

  5. Medical image of the week: polysomnogram artifact

    Directory of Open Access Journals (Sweden)

    Bartell J

    2015-02-01

    Full Text Available A 54 year-old man with a past medical history of attention deficit hyperactivity disorder (ADHD, low back pain, and paroxysmal supraventricular tachycardia presented to the sleep laboratory for evaluation of sleep disordered breathing. Pertinent medications include fluoxetine, ambien, and clonazepam. His Epworth sleepiness score was 18. He had a total sleep time of 12 min. On the night of his sleep study, the patient was restless and repeatedly changed positions in bed. Figures 1 and 2 show the artifact determined to be lead displacement of O1M2 after the patient shifted in bed, inadvertently removing one of his scalp electrodes. The sine waves are 60 Hz in frequency. Once the problem was identified, the lead was quickly replaced to its proper position.

  6. Inappropriate shocks in the subcutaneous ICD

    DEFF Research Database (Denmark)

    Olde Nordkamp, Louise R A; Brouwer, Tom F; Barr, Craig

    2015-01-01

    shocks have been reported. METHODS: We analyzed the incidence, predictors and management of inappropriate shocks in the EFFORTLESS S-ICD Registry, which collects S-ICD implantation information and follow-up data from clinical centers in Europe and New Zealand. RESULTS: During a follow-up of 21 ± 13...... months, 48 out of 581 S-ICD patients (71% male, age 49 ± 18 years) experienced 101 inappropriate shocks (8.3%). The most common cause was cardiac signal oversensing (73%), such as T-wave oversensing. Eighteen shocks (18%) were due to supraventricular tachycardias (SVT), of which 15 occurred in the shock......-only zone. Cox-proportional hazard modeling using time-dependent covariates demonstrated that patients with a history of atrial fibrillation (HR 2.4) and patients with hypertrophic cardiomyopathy (HR 4.6) had an increased risk for inappropriate shocks, while programming the primary vector for sensing (from...

  7. Cardiac arrhythmias the first month after acute traumatic spinal cord injury

    DEFF Research Database (Denmark)

    Bartholdy, Kim; Biering-Sørensen, Tor; Malmqvist, Lasse

    2014-01-01

    of this prospective observational study was to investigate the occurrence of cardiac arrhythmias and cardiac arrests in patients with acute traumatic SCI. METHODS: As early as possible after SCI 24-hour Holter monitoring was performed. Additional Holter recordings were performed 1, 2, 3, and 4 weeks after SCI....... Furthermore, 12-lead electrocardiograms (ECGs) were obtained shortly after SCI and at 4 weeks. RESULTS: Thirty patients were included. Bradycardia (heart rate (HR) ... both on 12-lead ECGs obtained shortly after SCI (P = 0.030) and at 4 weeks (P = 0.041). CONCLUSION: Many patients with cervical SCI experience arrhythmias such as bradycardia, sinus node arrest, supraventricular tachycardia, and more rarely cardiac arrest the first month after SCI. Apart from sinus...

  8. Cardiac arrhythmias associated with umbilical venous catheterisation in neonates

    Science.gov (United States)

    Verheij, Gerdina; Smits-Wintjens, Vivianne; Rozendaal, Lieke; Blom, Nico; Walther, Frans; Lopriore, Enrico

    2009-01-01

    Umbilical venous catheters (UVCs) are commonly used in the management of severely ill neonates. Several life-threatening complications have been described, including catheter-related infections, myocardial perforation, pericardial effusion and cardiac arrhythmias. This report describe two neonates with cardiac arrhythmias due to umbilical venous catheterisation. One neonate had a supraventricular tachycardia requiring treatment with intravenous adenosine administration. Another neonate had an atrial flutter and was managed successfully with synchronised cardioversion. The primary cause of cardiac arrhythmias after umbilical venous catheterisation is inappropriate position of the UVC within the heart and the first step to treat them should be to pull back or even remove the catheter. Cardiac arrhythmia is a rare but potentially severe complication of umbilical venous catheterisation in neonates. PMID:21691401

  9. Efficacy and adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome

    Directory of Open Access Journals (Sweden)

    Treharne GJ

    2002-09-01

    Full Text Available Abstract Background To investigate the effects of intravenous lignocaine infusions (IV lignocaine in fibromyalgia. Methods Prospective study of the adverse effects of IV lignocaine in 106 patients with fibromyalgia; retrospective questionnaire study of the efficacy of IV lignocaine in 50 patients with fibromyalgia. Results Prospective study: Two major (pulmonary oedema and supraventricular tachycardia and 42 minor side-effects were reported. None had long-term sequelae. The commonest was hypotension (17 cases. Retrospective study: Pain and a range of psychosocial measures (on single 11-point scales improved significantly after treatment. There was no effect of the treatment on work status. The average duration of pain relief after the 6-day course of treatment was 11.5 ± 6.5 weeks. Conclusions Intravenous lignocaine appears to be both safe and of benefit in improving pain and quality of life for patients with fibromyalgia. This needs to be confirmed in prospective randomised controlled trials.

  10. Cardiac Arrhythmias and Sleep-Disordered Breathing in Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Wolfram Grimm

    2014-10-01

    Full Text Available The relationship between heart failure (HF, sleep-disordered breathing and cardiac arrhythmias is complex and poorly understood. Whereas the frequency of predominantly obstructive sleep apnea in HF patients is low and similar or moderately higher to that observed in the general population, central sleep apnea (CSA has been observed in approximately 50% of HF patients, depending on the methods used to detect CSA and patient selection. Despite this high prevalence, it is still unclear whether CSA is merely a marker or an independent risk factor for an adverse prognosis in HF patients and whether CSA is associated with an increased risk for supraventricular as well as ventricular arrhythmias in HF patients. The current review focuses on the relationship between CSA and atrial fibrillation as the most common atrial arrhythmia in HF patients, and on the relationship between CSA and ventricular tachycardia and ventricular fibrillation as the most frequent cause of sudden cardiac death in HF patients.

  11. Inappropriate shock for myopotential over-sensing in a patient with subcutaneous ICD

    Directory of Open Access Journals (Sweden)

    Alessandro Corzani

    2015-01-01

    Full Text Available Inappropriate ICD shocks are common adverse events; they are mainly due to supraventricular arrhythmias and secondly are related to noise, undersensing, oversensing, device malfunctions. We present a case of inappropriate device therapy due to myopotential oversensing in a patient with a subcutaneous ICD (s-ICD. A 58 years old male with an s-ICD during the device interrogation showed a previous episode of suspected sustained ventricular tachycardia at 210 bpm, which was effectively treated with ICD shock. The patient experienced the electrical shock while holding a big gas-cylinder in his arms. The EGM analysis revealed many irregular ventricular signals of low amplitude lasting for 24 s and interrupted by the shock. The device showed no malfunctions. This is the first case report of inappropriate S-ICD shock related to myopotential over-sensing. By recording intracardiac EGM, we demonstrated that the noise was created by the activity of the pectorals muscles.

  12. A case of suicide by self-injection of adrenaline.

    Science.gov (United States)

    Palmiere, Cristian; Bévalot, Fabien; Malicier, Daniel; Grouzmann, Eric; Fracasso, Tony; Fanton, Laurent

    2015-09-01

    Adrenaline (epinephrine) auto-injectors provide life-saving pre-hospital treatment for individuals experiencing anaphylaxis in a community setting. Errors in handling adrenaline auto-injectors, particularly by children and healthcare professionals, have been reported. Reports of adrenaline overdoses are limited in the medical literature. In most of these cases, accidental adrenaline administration results from medical error. Exogenous administration of catecholamine is responsible for cardiovascular and metabolic responses, which may cause supraventricular tachycardia, ventricular dysrhythmias and myocardial ischemia. The authors present a unique autopsy case involving a 34 year-old woman who intentionally self-injected adrenaline using an adrenaline auto-injector as part of a suicide plan. Catecholamines and metanephrines were measured in peripheral and cardiac blood as well as urine and vitreous humor. Based on the results of all postmortem investigations, the cause of death was determined to be cardiac dysrhythmia and cardiac arrest following adrenaline self-injection.

  13. [Arrhythmias in pediatric patients].

    Science.gov (United States)

    Bauersfeld, U; Pfammatter, J P

    2004-04-01

    Arrhythmias in children occur frequently as isolated phenomena, however, may also represent comorbidities of congenital heart disease. Therefore electrophysiologic assessments must include morphologic and hemodynamic evaluations. Besides the arrhythmias commonly seen in adults children present with arrhythmias unique to pediatric patients. Antiarrhythmic therapy depends on patient age, expected natural history of the arrhythmia and possible congenital heart disease. As in adult patients in addition to antiarrhythmic drug therapy radiofrequency catheter ablation is a preferred definitive treatment especially in patients with supraventricular tachycardias. Bradycardias can be successfully treated with pacing systems which can already be implanted in the newborn period. As antiarrhythmic treatment in pediatric patients may be very complex a referral to a pediatric cardiology center is recommended.

  14. [Cardiac symptoms due to pectus excavatum in a man over the age of 55].

    Science.gov (United States)

    Guldemond, F I; Höppener, P F H M; Kragten, J A; van Leeuwen, Y D; Siebenga, J

    2008-02-09

    A healthy 59-year-old man, a retired general practitioner, suffered from increasing palpitations, fatigue and postural dyspnoea: bending over led to a significant increase in his shortness of breath. Cardiological and pulmonological examination, performed at regular intervals, showed occasional supraventricular arrhythmia and nodal tachycardia but did not yield a satisfactory explanation for the symptoms. In the years that followed, the physical impairment became a considerable handicap. Finally, the patient himself suggested a possible explanation on the basis of an Internet search: his pectus excavatum. A literature search confirmed this hypothesis. A lateral chest X-ray in bending position and a CT-scan of the chest revealed compression of the heart by the sternum. Ten years after the onset of symptoms, a modified Ravitch operation finally brought nearly complete recovery.

  15. Changes in plasma atrial natriuretic factor in patients with idiopathic atrial fibrillation

    International Nuclear Information System (INIS)

    Du Tongxin; Xia Xiaojie; Qu Wei; Wang Shukui; Sun Junjiang

    2002-01-01

    To observe the changes in plasma atrial natriuretic factor (AFN) in patients with idiopathic atrial fibrillation and investigate its mechanism, plasma ANF, platelet count and hematocrit were detected in 21 cases with transient idiopathic atrial fibrillation (group A, A1 representing attack, while A2 termination), 28 with persistent idiopathic atrial fibrillation (group B), 27 suffered from rheumatic heart disease with mitral stenosis and persistent atrial fibrillation (group C), 32 with transient supraventricular tachycardia (group D) and 20 normal controls (group E). It was found that the level of ANF was significantly higher in patients with attacking transient idiopathic atrial fibrillation than that in group A2, D and E (P 0.05), while there was significant difference in hematocrit in group A1 compared with group A2, D, E (P < 0.01). It suggested that ANF and hematocrit play an important role in the attack of idiopathic atrial fibrillation

  16. [Analysis of the cardiac arrhythmias in premature infants throughout the 24 hours following birth using Holter method].

    Science.gov (United States)

    Kohut, Joanna; Durmała, Jacek; Rokicki, Władysław; Gołba, Ewa; Goc, Barbara; Petelenz, Jolanta

    2002-01-01

    The aim of the study was to determine the heart rhythm (the frequency and disturbances) in premature infants in satisfactory clinical condition throughout the 24 hours following birth using Holter method. The influence of some maternal parameters (number of previous pregnancies, delivery mode, usage of pregnancy maintaining drugs) on newborn's heart rhythm and the influence of child's parameters (sex, birthweight, gestational week, clinical state according to Apgar score) were studied. Digital Holter registration system with two channels real-time recording Silicon Beat 2000 version 3.2 by Medea (Poland) was used. Sixty two premature infants were studied. Cardiac arrhythmias were found in 38 cases. They were mainly benign disturbances. The most frequent ones were supraventricular extrasystolic beats. The analysis of the influence of definitive features of mothers and children on arrhythmias and the values of heart rate revealed, that in naturally born infants naturally born and in these ones with low Apgar score the supraventricular extrasystolic beats were significantly more common as compared with those born by Caesarean section and with higher Apgar score. In younger subjects (< 30 gestation weeks) and with lower birthweight (< 2000 g) the sinus tachycardia was significantly more frequent as compared with older and heavier ones.

  17. Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with "ALARA" principles profoundly lowers total dose.

    Science.gov (United States)

    Pass, Robert H; Gates, Gregory G; Gellis, Laura A; Nappo, Lynn; Ceresnak, Scott R

    2015-06-01

    "ALARA--As Low As Reasonably Achievable" protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose. From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2-3 frames/second), low fluoro dose/frame (6-18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with "fast anatomical mapping" (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols. A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical-fluoroscopy technique. Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.

  18. Cardiac arrhythmias and conduction disturbances in autoimmune rheumatic diseases.

    Science.gov (United States)

    Seferović, P M; Ristić, A D; Maksimović, R; Simeunović, D S; Ristić, G G; Radovanović, G; Seferović, D; Maisch, B; Matucci-Cerinic, M

    2006-10-01

    Rhythm and conduction disturbances and sudden cardiac death (SCD) are important manifestations of cardiac involvement in autoimmune rheumatic diseases (ARDs). In patients with rheumatoid arthritis (RA), a major cause of SCD is atherosclerotic coronary artery disease, leading to acute coronary syndrome and ventricular arrhythmias. In systemic lupus erythematosus (SLE), sinus tachycardia, atrial fibrillation and atrial ectopic beats are the major cardiac arrhythmias. In some cases, sinus tachycardia may be the only manifestation of cardiac involvement. The most frequent cardiac rhythm disturbances in systemic sclerosis (SSc) are premature ventricular contractions (PVCs), often appearing as monomorphic, single PVCs, or rarely as bigeminy, trigeminy or pairs. Transient atrial fibrillation, flutter or paroxysmal supraventricular tachycardia are also described in 20-30% of SSc patients. Non-sustained ventricular tachycardia was described in 7-13%, while SCD is reported in 5-21% of unselected patients with SSc. The conduction disorders are more frequent in ARD than the cardiac arrhythmias. In RA, infiltration of the atrioventricular (AV) node can cause right bundle branch block in 35% of patients. AV block is rare in RA, and is usually complete. In SLE small vessel vasculitis, the infiltration of the sinus or AV nodes, or active myocarditis can lead to first-degree AV block in 34-70% of patients. In contrast to RA, conduction abnormalities may regress when the underlying disease is controlled. In neonatal lupus, 3% of infants whose mothers are antibody positive develop complete heart block. Conduction disturbances in SSc are due to fibrosis of sinoatrial node, presenting as abnormal ECG, bundle and fascicular blocks and occur in 25-75% of patients.

  19. Reduction of the inappropriate ICD therapies by implementing a new fuzzy logic-based diagnostic algorithm.

    Science.gov (United States)

    Lewandowski, Michał; Przybylski, Andrzej; Kuźmicz, Wiesław; Szwed, Hanna

    2013-09-01

    The aim of the study was to analyze the value of a completely new fuzzy logic-based detection algorithm (FA) in comparison with arrhythmia classification algorithms used in existing ICDs in order to demonstrate whether the rate of inappropriate therapies can be reduced. On the basis of the RR intervals database containing arrhythmia events and controls recordings from the ICD memory a diagnostic algorithm was developed and tested by a computer program. This algorithm uses the same input signals as existing ICDs: RR interval as the primary input variable and two variables derived from it, onset and stability. However, it uses 15 fuzzy rules instead of fixed thresholds used in existing devices. The algorithm considers 6 diagnostic categories: (1) VF (ventricular fibrillation), (2) VT (ventricular tachycardia), (3) ST (sinus tachycardia), (4) DAI (artifacts and heart rhythm irregularities including extrasystoles and T-wave oversensing-TWOS), (5) ATF (atrial and supraventricular tachycardia or fibrillation), and 96) NT (sinus rhythm). This algorithm was tested on 172 RR recordings from different ICDs in the follow-up of 135 patients. All diagnostic categories of the algorithm were present in the analyzed recordings: VF (n = 35), VT (n = 48), ST (n = 14), DAI (n = 32), ATF (n = 18), NT (n = 25). Thirty-eight patients (31.4%) in the studied group received inappropriate ICD therapies. In all these cases the final diagnosis of the algorithm was correct (19 cases of artifacts, 11 of atrial fibrillation and 8 of ST) and fuzzy rules algorithm implementation would have withheld unnecessary therapies. Incidence of inappropriate therapies: 3 vs. 38 (the proposed algorithm vs. ICD diagnosis, respectively) differed significantly (p fuzzy logic based algorithm seems to be promising and its implementation could diminish ICDs inappropriate therapies. We found FA usefulness in correct diagnosis of sinus tachycardia, atrial fibrillation and artifacts in comparison with tested ICDs.

  20. Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus

    DEFF Research Database (Denmark)

    Brinth, Louise S; Pors, Kirsten; Theibel, Ann C

    2015-01-01

    intolerance, headache, fatigue, cognitive dysfunction, and neuropathic pain starting in close relation to HPV vaccination. METHODS: Patients were referred for orthostatic intolerance following HPV vaccination. Symptoms of autonomic dysfunction were quantified by standardised questionnaire. The diagnosis...... intolerance, 94% nausea, 82% chronic headache, 82% fatigue, 77% cognitive dysfunction, 72% segmental dystonia, 68% neuropathic pain. CONCLUSIONS: In a population referred for symptoms of orthostatic intolerance and other symptoms consistent with autonomic dysfunction that began in close temporal association...

  1. Unfolded Protein Response Is Activated in the Hearts of Catecholaminergic Polymorphic Ventricular Tachycardia (Cpvt Mice

    Directory of Open Access Journals (Sweden)

    Bakiu Rigers

    2014-10-01

    Full Text Available Izoforma 2 kalsekvestrina (CSQ2 je glavni kalcijum-vezujući protein sarkoplazmatskog retikuluma (SR i nalazi se kako u srčanom tako i u skeletnom mišiću. CSQ2 deluje kao kalcijumski receptor koji reguliše oslobađanje Ca2+ jona iz SR, putem interakcije sa triadinom, junktinom i rianodinskim receptorom. Različite mutacije csq2 gena mogu da izazovu poremećaje u oslobađanju Ca2+ i time kontraktilne funkcije, čime doprinose ravoju aritmija i iznenadnoj srčanoj smrti mladih osoba koje boluju od kateholaminergičke polimorfne ventrikularne tahikardije (CPVT. Razvojem transgenetskih miševa sa CSG2 point mutacijom (R33Q i CPVT-om, primećen je drastičan pad nivoa mutiranog proteina. Prateći biomolekularni pristup, nekoliko analiza je izvedeno, koristeći tretman različitim antitelima, sa ciljem da se otkrije kada počinje smanjenje nivoa CSQ2, rasvetli mehanizam uključen u redukciju CSQ2 i ispita da li prisustvo mutiranih proteina utiče i na druge proteine. Rezultati ove studije su pokazali da se nivoi mutiranih CSQ2 smanjuju ubrzo nakon rodjenja, što je udruženo sa smanjenim nivoom ostalih značajnih proteina SR, uključujući triadin (TD. Takođe je primećeno da odgovor nesavijenih proteina može biti povezan sa ushodnom regulacijom proteina i aktivacijom ATF-6 zavisnog signalnog puta. Prisustvo R33Q mutacije je izazvalo smanjenje nivoa CSQ2 putem aktivacije odgovora nesavijenih proteina i posledične proteozomalne degradacije.

  2. RYR2 sequencing reveals novel missense mutations in a Kazakh idiopathic ventricular tachycardia study cohort.

    Directory of Open Access Journals (Sweden)

    Ainur Akilzhanova

    Full Text Available Channelopathies, caused by disturbed potassium or calcium ion management in cardiac myocytes are a major cause of heart failure and sudden cardiac death worldwide. The human ryanodine receptor 2 (RYR2 is one of the key players tightly regulating calcium efflux from the sarcoplasmic reticulum to the cytosol and found frequently mutated (T; p.D4631V in a CPVT patient and a novel rare variant (c5428G>C; p.V1810L of uncertain significance in a patient with VT of idiopathic origin which we suggest represents a low-penetrance or susceptibility variant. In addition we identified a known variant previously associated with arrhythmogenic right ventricular dysplasia type2 (ARVD2. Combining sets of prediction scores and reference databases appeared fundamental to predict the pathogenic potential of novel and rare missense variants in populations where genotype data are rare.

  3. Tachycardia-Induced J-Wave Changes in Patients With and Without Idiopathic Ventricular Fibrillation.

    Science.gov (United States)

    Aizawa, Yoshiyasu; Takatsuki, Seiji; Nishiyama, Takahiko; Kimura, Takehiro; Kohsaka, Shun; Kaneko, Yoshiaki; Inden, Yasuya; Takahashi, Naohiko; Nagase, Satoshi; Aizawa, Yoshifusa; Fukuda, Keichi

    2017-07-01

    To know the underlying mechanisms of J waves, the response to atrial pacing was studied in patients with idiopathic ventricular fibrillation (IVF) and patients with non-IVF. In 8 patients with IVF, the J-wave amplitude was measured before, during, and after atrial pacing. All patients had episodes of ventricular fibrillation without structural heart disease. The responses of J waves were compared with those of the 17 non-IVF control subjects who revealed J waves but no history of cardiac arrest and underwent electrophysiological study. The IVF patients were younger than the non-IVF patients (28±10 versus 52±14 years, respectively; P =0.002) and had larger J waves with more extensive distribution. J waves decreased from 0.35±0.26 to 0.22±0.23 mV ( P =0.025) when the RR intervals were shortened from 782±88 to 573±162 ms ( P =0.001). A decrease (≥0.05 mV) in the J-wave amplitude was observed in 6 of the 8 patients. In addition, 1 patient showed a distinct reduction of J waves in the unipolar epicardial leads. In contrast, J waves were augmented in the 17 non-IVF subjects from 0.27±0.09 to 0.38±0.10 mV ( P J waves to rapid pacing suggest different mechanisms: early repolarization in IVF patients and conduction delay in non-IVF patients. The response to atrial pacing was different between the IVF and non-IVF patients, which suggests the presence of different mechanisms for the genesis of J waves. © 2017 American Heart Association, Inc.

  4. Dyspnea, Tachycardia, and New Onset Seizure as a Presentation of Wilms Tumor: A Case Report

    Directory of Open Access Journals (Sweden)

    Linda Li

    2014-01-01

    Full Text Available Wilms tumor is found in 1 in 10,000 children and most commonly presents in asymptomatic toddlers whose care givers notice a nontender abdominal mass in the right upper quadrant. This case of Wilms tumor presented as a critically ill eleven-year old with significant tachypnea, dyspnea, vague abdominal pain, intermittent emesis, new onset seizure, metabolic acidosis, and hypoxemia. This is the first case in the literature of Wilms Tumor with cavoatrial involvement and seizure and pulmonary embolism resulting in aggressive resuscitation and treatment. Treatment included anticoagulation, chemotherapy, nephrectomy, and surgical resection of thrombi, followed by adjunctive chemotherapy with pulmonary radiation.

  5. Ultrasound-guided probe-generated artifacts stimulating ventricular tachycardia: A rare phenomenon

    Directory of Open Access Journals (Sweden)

    Rafat Shamim

    2017-01-01

    Full Text Available Electrocardiographic (ECG artifacts may arise due to interference, faulty earthing, and current leakages in biomedical equipment which might create clinical dilemmas in the perioperative settings. Piezoelectric signals generated by ultrasonography probe are another uncommon source which might be sensed by the ECG electrodes and produce tracings similar to pathological arrhythmias triggering false alarms and avoidable therapies. Anesthesiologists should be familiar with these uncommon sources which might produce these artifacts and they should be identified swiftly.

  6. Tachycardia induced electrical remodeling of the atria and the autonomic nervous system in goats

    NARCIS (Netherlands)

    Blaauw, Yuri; Tieleman, RG; Brower, T; Van den Berg, MP; de Kam, PJ; de Langen, CDJ; Haaksma, J; Grandjean, JG; Patberg, KW; van Gelder, IC; Crijns, HJGM

    1999-01-01

    Atrial fibrillation (AF) shortens the atrial effective refractory period (AERP). To investigate the role of the autonomic nervous system during this so-called electrical remodeling of the atria (ERA) and during recovery from ERA we analyzed heart rate variability (HRV). In 12 goats atrioventricular

  7. Junctional rhythm occurring during AV nodal reentrant tachycardia ablation, is it different among Egyptians?

    Directory of Open Access Journals (Sweden)

    Ayman M. Abdel Moteleb

    2013-12-01

    Conclusion: Junctional rhythm is a sensitive predictor of successful ablation. The pattern of JR is a useful predictor of successful ablation. Egyptian population has distinctive patterns of JR during AVNRT ablation.

  8. Transmitral Approach to Monopolar Radiofrequency Ablation of Inferior Papillary Muscle for Refractory Ischemic Ventricular Tachycardia

    OpenAIRE

    Rubino, Antonino S.; Onorati, Francesco; Serraino, Giuseppe F.; Renzulli, Attilio

    2010-01-01

    Despite the proven effectiveness of antiarrhythmic drugs and automated implantable cardioverter-defibrillators for ischemic ventricular arrhythmias, ablative procedures still play a major role. Herein, we report the cases of 2 patients who had malignant ventricular arrhythmias secondary to ischemic heart disease. The arrhythmias were treated intraoperatively by means of surgical ablation through a transmitral approach.

  9. Radiofrequency catheter ablation of atrioventricular node reentrant tachycardia in children with limited fluoroscopy.

    Science.gov (United States)

    Swissa, Moshe; Birk, Einat; Dagan, Tamir; Naimer, Sody Abby; Fogelman, Michal; Einbinder, Tom; Bruckheimer, Elchanan; Fogelman, Rami

    2017-06-01

    Limited fluoroscopy cryo-ablation using a 3D electro-anatomical system (3DS) has been used for AVNRT in children. We aimed to facilitate a fluoroscopy limited approach of RF ablation of AVNRT in children. A retrospective study was performed of procedure parameters in children undergoing RF ablation of AVNRT in 75 consecutive children (June 2011 to November 2013 - Group A) using standard fluoroscopy techniques compared to those of 64 consecutive children (December 2013 to May 2015 - Group B), using a fluoroscopy limited approach with 3DS. The acute success rate was 98.7% (74/75) and 98.4% (63/64) for groups A and B, respectively. The recurrence rate was 2.7% (2/74) and 0% (0/63) with a mean follow-up period of 45.5±12.1 and 14.3±6.1months for group A and group B, respectively. The mean procedure and fluoroscopy times were significantly lower for group B compared to group A (119±37 (43-203) and 0.83±1.04 (0.05-3.83) minutes versus 146±53 (72-250) and 16.1±8.9 (4.39-55) minutes, pfluoroscopy limited approach for RF ablation of AVNRT in children using a 3DS is easily acquired and adapted, and significantly reduces the fluoroscopy and procedure time with excellent efficacy, safety and low recurrence rate. This study confirmed that a 3D mapping system (3DS) to guide ablations of AVNRT in children reduces radiation exposure. Combined, limited fluoroscopy and 3DS in a methodology that resembles the familiar conventional fluoroscopy approach for RF ablation of AVNRT in children is proposed. Combined limited fluoroscopy and RF-energy in children with AVNRT are associated with a shorter procedure time, minimal fluoroscopy time, a high success rate and a low recurrence rate. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Navx-guided Cryoablation of Atrial Tachycardia Inside the Left Atrial Appendage

    Science.gov (United States)

    Pandozi, Claudio; Galeazzi, Marco; Lavalle, Carlo; Ficili, Sabina; Russo, Maurizio; Santini, Massimo

    2010-01-01

    Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavX-guided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed. PMID:21346824

  11. Acute Perforated Appendicitis as a Cause of Fetal Tachycardia at Term Pregnancy

    Directory of Open Access Journals (Sweden)

    Sabri Cavkaytar

    2015-06-01

    Full Text Available During pregnancy, appendectomy is the most common non-obstetrical surgery. But diagnosis of appendicitis is difficult in term pregnancy due to low sensitivity of ultrasound and nonspecific symptoms that interferes with pregnancy itself. Due to the delay in diagnosis, perforation of appendicitis is high in pregnant patients which is associated with adverse maternal and fetal outcomes. In this report, we present a term pregnant patient who had appendicitis with ruptured phlegmon during labour. [Cukurova Med J 2015; 40(2.000: 336-339

  12. Acute Perforated Appendicitis as a Cause of Fetal Tachycardia at Term Pregnancy

    OpenAIRE

    Sabri Cavkaytar; Mahmut Kuntay Kokanali; Canan Uzun; Aylin Kalinbacoglu; Nafiye Karakas Yilmaz

    2015-01-01

    During pregnancy, appendectomy is the most common non-obstetrical surgery. But diagnosis of appendicitis is difficult in term pregnancy due to low sensitivity of ultrasound and nonspecific symptoms that interferes with pregnancy itself. Due to the delay in diagnosis, perforation of appendicitis is high in pregnant patients which is associated with adverse maternal and fetal outcomes. In this report, we present a term pregnant patient who had appendicitis with ruptured phlegmon during labour...

  13. Outpatient evaluation and management of patients with ventricular premature beats or non-sustained ventricular tachycardia

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Goette, Andreas; Dobreanu, Dan

    2012-01-01

    except for coronary angiography, which was considered by one in four physicians when dealing with NSVT but by almost none for VPBs. The majority of physicians believe that it is acceptable to abstain from pharmacological therapy in an asymptomatic patient with VPBs. When considering second-line therapy...

  14. The role of mutant protein level in autosomal recessive catecholamine dependent polymorphic ventricular tachycardia (CPVT2)

    OpenAIRE

    Katz, Guy; Shainberg, Asher; Hochhauser, Edith; Kurtzwald-Josefson, Efrat; Issac, Ahuva; El-Ani, Dalia; Aravot, Dan; Afek, Arnon; Seidman, Jonathan G.; Seidman, Christine E.; Eldar, Michael; Arad, Michael

    2013-01-01

    Humans and genetically engineered mice with recessively inherited CPVT develop arrhythmia which may arise due to malfunction or degradation of calsequestrin (CASQ2). We investigated the relation between protein level and arrhythmia severity in CASQ2D307H/D307H (D307H), compared to CASQ2Δ/Δ (KO) and wild type (WT) mice. CASQ2 expression and Ca2+ transients were recorded in cardiomyocytes from neonatal or adult mice. Arrhythmia was studied in vivo using heart rhythm telemetry at rest, exercise ...

  15. Clarithromycine-Induced Ventricular Tachycardia in a Geriatric Patient Using Multiple Drugs

    Directory of Open Access Journals (Sweden)

    Gulsah Karaoren

    2016-07-01

    Full Text Available Long QT syndrome is a cardiac repolarization disorder, which can be either idiopathic or congenital, and cause sudden cardiac death. The iatrogenic form is generally associated with drugs or electrolyte imbalance. Although prolonged QT interval is frequently seen due to antiarrhythmic agents, it can also be seen with antibiotics or anti-epileptics. Adverse drug interaction can manifest in several clinicopathological forms in elder individuals. In such cases, potential adverse effects of drugs used should be taken into consideration before prescribing additional drugs. Here, we present a case of clarithromycine-induced ventricular arrhythmia accompanied by QT prolongation on the third day of therapy, and the subsequent therapeutic approach, in a 91-year-old man. The patient was taking multiple drugs due to comorbid conditions and was prescribed clarithromycine therapy in the intensive care unit.

  16. Clinical case: paroxysmal tachycardia attack in a newborn with multiple heart rhabdomyomas

    Directory of Open Access Journals (Sweden)

    Chernenkov Yu.V.

    2016-03-01

    Full Text Available The purpose of the clinical observation is to study the early symptoms of multiple heart rhabdomiomas of a newborn; to draw the attention of specialists on one of the rarely occurred problems in the neonatal practice.

  17. Clinical case: paroxysmal tachycardia attack in a newborn with multiple heart rhabdomyomas

    OpenAIRE

    Chernenkov Yu.V.; Pozgaleva N.V.; Panina O.S.

    2016-01-01

    The purpose of the clinical observation is to study the early symptoms of multiple heart rhabdomiomas of a newborn; to draw the attention of specialists on one of the rarely occurred problems in the neonatal practice.

  18. 77 FR 74630 - Medical Waivers for Merchant Mariner Credential Applicants With Anti-Tachycardia Devices or...

    Science.gov (United States)

    2012-12-17

    ... the comment, if submitted on behalf of an association, business, labor union, etc.). You may review a... 9, 2012. Because of the complexity and importance of the issues involved, we are reopening the...

  19. Efficient and robust ventricular tachycardia and fibrillation detection method for wearable cardiac health monitoring devices.

    Science.gov (United States)

    Prabhakararao, Eedara; Manikandan, M Sabarimalai

    2016-09-01

    In this Letter, the authors propose an efficient and robust method for automatically determining the VT and VF events in the electrocardiogram (ECG) signal. The proposed method consists of: (i) discrete cosine transform (DCT)-based noise suppression; (ii) addition of bipolar sequence of amplitudes with alternating polarity; (iii) zero-crossing rate (ZCR) estimation-based VTVF detection; and (iv) peak-to-peak interval (PPI) feature based VT/VF discrimination. The proposed method is evaluated using 18,000 episodes of different ECG arrhythmias taken from 6 PhysioNet databases. The method achieves an average sensitivity (Se) of 99.61%, specificity (Sp) of 99.96%, and overall accuracy (OA) of 99.92% in detecting VTVF and non-VTVF episodes by using a ZCR feature. Results show that the method achieves a Se of 100%, Sp of 99.70% and OA of 99.85% for discriminating VT from VF episodes using PPI features extracted from the processed signal. The robustness of the method is tested using different kinds of ECG beats and various types of noises including the baseline wanders, powerline interference and muscle artefacts. Results demonstrate that the proposed method with the ZCR, PPI features can achieve significantly better detection rates as compared with the existing methods.

  20. An approach to the patient with a suspected tachycardia in the ...

    African Journals Online (AJOL)

    or inpatient telemetry, depend ing on the frequency of palpitations. In clinical practice, performing an ECG during an episode of future palpitations is likely to have the best yield. An implantable loop recorder can be considered if VT is strongly suspected. Physical examination. The physical examination is useful to identify.