Arrhythmogenic right ventricular dysplasia: a rare case report from tribal zone of Central India.

Arrhythmogenic Right Ventricular Dysplasia (ARVD) is under diagnosed cardiomyopathy which commonly presents in young adults with ventricular tachycardia or sudden death. It is characterized pathologically by progressive fibrofatty replacement of the myocardium, primarily of the right ventricular free wall. Clinically, it presents with life-threatening malignant ventricular arrhythmias which may lead to sudden death, most often in young people and athletes. ARVD/C is difficult to diagnose, although standardized diagnostic criteria have been proposed, based on the presence of major and minor criteria encompassing electrocardiographic, arrhythmic, morphofunctional, histopathologic, and genetic factors.

Taquicardia supraventricular en pediatría: Presentación clínica y manejo. Experiencia del servicio de cardiología hospital de Niños JM de los Ríos. Caracas, Venezuela. 2001-2011

Introducción: La taquicardia paroxística supraventricular (TPSV) representa la segunda causa más frecuente de arritmias en pediatría (1). Objetivos 1. Determinar las características clínicas y el tratamiento en la emergencia. 2. Evaluar la respuesta al tratamiento y los fármacos utilizados. Metodología: Estudio retrospectivo de 69 casos con ingreso en el Servicio de Cardiología del Hospital de niños JM de los Ríos de 2001-2011. Criterio de Ingreso: pacientes con Diagnóstico de TPSV que ingresaron a la emergencia. Resultados: Se seleccionaron 69 pacientes. Edad promedio: 5,9 años (DE ± 3,5). Dos con antecedentes de Cardiopatía Congénita (2,9 %). La frecuencia cardíaca media fue de 284 lat./min (DE ± 30,66). El diagnóstico más frecuente fue TPSV por reentrada, en 35 pacientes (51%); el resto de los pacientes presentaron Wolff Parkinson White (WPW). Cinco pacientes respondieron a maniobras vagales. El tratamiento de elección en la crisis aguda fue Adenosina, y en casos de fallar el tratamiento inicial y de inestabilidad hemodinámica se utilizó la cardioversión eléctrica (16 pacientes). Para mantenimiento se indicó: Betabloqueantes y Amiodarona siendo efectivos (60,8%). Cuatro pacientes necesitaron ablación por radiofrecuencia (1 paciente presentó recaída posterior al tratamiento). Conclusiones: La presentación clínica de la TPSV varía con la edad. La mayoría de pacientes respondieron al tratamiento con adenosina. El tratamiento de mantenimiento con Betabloqueantes y Amiodarona es efectivo.

Paroxysmal supraventricular tachycardia (PSVT) is the most common pediatric arrhythmia. The objectives of this study were to determine the clinical features and treatment of PSVT in the emergency room and to evaluate the response to treatment and drugs employed. Methods: This is a retrospective study of 69 children admitted to the cardiology department of the Children's Hospital JM de los Rios from 2001 to 2011. Inclusion criteria: patients diagnosed with PSVT who were admitted to the emergency room. Results: 69 patients. Mean age: 5.9 years (SD ± 3.5). Two had a history of congenital heart disease (2.9%). The average heart rate was 284 beats / min (SD ± 30.66). The most frequent diagnosis was reentrant SVT, 35 patients (51%); the rest corresponded to Wolf Parkinson White syndrome. Five patients responded to vagal maneuvers. The treatment of choice in the acute crisis was adenosine. Electrical cardioversion was utilized in cases of initial treatment failure and hemodynamic inestability (16 patients). Maintenance treatment with beta-blockers and amiodarone was indicated in most cases (60.8%) with an effective response. Four patients required ablation, one of them relapsed. Conclusions: 1. clinical presentation of PSVT varies with age. 2. most patients responded to treatment with adenosine. 3. maintenance therapy with beta blockers and amiodarone is effective.

A Convenient Method of Adenosine Administration for Paroxysmal Supraventricular Tachycardia

PURPOSE: The purpose of this study was to observe the success rate, the average of total admininstration doses and the complications associated with a convenient method of adenosine administration for paroxysmal supraventricular tachycardia (PSVT). METHODS: A non-blind, randomized, prospective study was conducted during the 30 months from January 1999 to June 2001. We enrolled 65 cases during this period. The number of cases in the standard method group was 35, and that in the mixed method group was 30. In the standard method group, 6 mg of adenosine was administered intravenously; therefore, 15~20 ml of normal saline was immediately flushed. This method is usually used and recommended. In the mixed method group, 6 mg of adenosine had been previously mixed with 15 ml of normal saline was administered intravenously without any additional manipulation. We evaluated the success rate, the average successful doses, and the complications of each group. RESULTS: The success rate was 80% in the standard method group and 85.7 % in the mixed method group, but this difference was not statistically significant (Chi square test, p=0.39). The average of total admininstration doses were 10.3+/-6.3 mg in the standard method group and 11.0+/-6.5 mg in the mixed method group, but this difference is not statistically significant (student t-test, p=0.07). There was no remarkable complication in the mixed method group. CONCLUSION: The mixed method was effective and more convenient than the standard method. A further, larger study is required.

Analysis of Factors Predicting Recurrence and the Result of Treatment in PSVT Patients at the Emergency Department

PURPOSE: The purpose of this research was to evaluate the factors predicting recurrence and the characteristics of patients who recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with adenosine. METHODS: From January 1999 to December 2001, 62 patients with PSVT were enrolled in this study. The conversion group included patients who had had a therapeutic response, which was defined as the occurrence of a change in the sinus rhythm after adenosine administration. The recurred group consisted of all patients who had not had a therapeutic response. Clinical features, the results of treatment, ECG findings, and the hemodynamic statuses were analyzed. RESULTS: The treatments were vagal maneuver (5 pts, 7.5 %), adenosine 6 mg (37 pts, 55.2 %), adenosine 12 mg (14 pts, 20.9 %), verapamil 5 mg (9 pts, 13.4 %), and cardioversion (2 pts, 3.0 %). Twenty-five of the 62 patients failed to have a therapeutic response, yielding a recurrence rate of 40.3 %. Atrioventricular reentrant tachycardia (AVRT) was more prevalent in the recurred group. The most common symptom at presentation was chest pain. The recurred group had increased heart rate, and increased blood pressure. When patients were monitered after adenosine, unifocal premature ventricular complex was the most common rhythm encountered in the conversion group, but atrial fibrillation, and multifocal premature ventricular complex was the most common rhythm encountered. CONCLUSION: Age, heart rate, difference in systolic blood pressure from presentation to discharge, previous history of heart disease, and rhythms encountered after adenosine administration were factors predicting recurrence.

A Study on Electrophysiologic Mechanism and Clinical Characteristics of Paroxysmal Supraventricular Tachycardia / 대한내과학회지

OBJECTIVES: Accurate diagnosis of the mechanism and origin site of paroxysmal supraventricular tachycardia(PSVT) can be made using electrophysiologic study(EPS). Recently, radiofrequency catheter ablation technique has been introduced and widely used for the definitive treatment of various forms of PSVT, thereby precise determination of the mechanism of PSVT can be possible. It has been known that atrioventricular reentry tachycardia (AVRT) using concealed bypass tract is more frequent than atrioventricular nodal reentry tachycardia (AVNRT) in Korea. But it is not certain that those studies represent actual distribution of PSVT in Korea. This study was designed to determine the mechanism and clinical characteristics of PSVT in Korea. METHODS: We investigated 136patients in whom electrophysiolosic study was performed from October 1992 through October 1994 at the Chonnam National University Hospital, the only tertiary referral center of the Kwangju-Chonnam area of Korea. RESULTS: 1) The electrophysiologic mechanism of PSVT was AVNRT in 44patients(32.4%), WPW syndrome in 46(33.8%), AVRT using concealed bypass tract in 40(29.4%), sinoatrial nodal reentry tachycardia (SANRT) in 4(2.9%), and automatic atrial tachycardia(AAT) in 2(1.5%), ensuing that AVNRT is most common mechanism of PSVT with no preexcitation during sinus rhythm. 2) Male is more frequent than female in AVNRT, WPW syndrome, and AVRT, which was most prominent in WPW syndrome. 3) The first episode of symptom occured at the age of 34.9 +/- 17.3 years in AVNRT, 25.5 +/- 13.3 years in WPW and 26.3 +/- 15.0 years in AVRT(p<0.05). There was no significant difference in the duration of symptom. The tachycardia rate in WPW syndrome was 183.6 +/- 23.9 per minute and AVRT was 186.7 +/- 38.0 per minute, which were faster than that of AVNRT(161.7 +/- 28.6/min)(p<0.05). 4) There was no significant difference in the presenting symptoms and in the provocation factors between AVNRT and AVRT. CONCLUSION: AVNIlT is most common mechanism of PSVT with no preexcitation during sinus rhythm, developed at older age than WPW syndorme and AVRT, and had lower tachycardia rate than WPW syndrome and AVRT.

Combination Therapy of Verapamil and Esmolol for the Paroxysmal Supraventricular Tachycardia Recurred during the Central Venous Catheterization: A case report / 대한구급학회지

Combination therapy of beta-blocker and a calcium channel blocker is not recommened because their additive effect on the myocardium and the atrioventricular node may precipitate heart block in susceptible patients. We experienced a 68 years old female patient who had paroxysmal supraventricular tachycardia that was treated with verapamil and esmolol. She had been taking verapamil for 2 years because of her paroxysmal supraventricular tachycardia. She was planned for left ureteronephrectomy due to left ureteral tumor. After epidural catheterization for the postoperative pain control, she was anesthetized with isoflurane and vecuronium. During central venous catheterization, SVT (H.R. from 98 beats per minute to 190 BPM) was suddenly developed with hypotension (B.P. from 120/65 mmHg to 75/42 mmHg) when guide wire was introduced. We treated her with combination therapy of verapamil 7.5 mg and esmolol 18 mg under the monitoring of blood pressure, electrocardiogram, end-tidal CO2 tension, central venous pressure and pulse oximeter. After 20 minutes of vigorous treatment, her heart rate and blood pressure returned to a normal range.

The Value of Ventriculoatrial Intervals in Determining the Mechanism of PSVT and the Sites of Accessory Pathways

The ventriculoatrial(VA) intervals during supraventricular tachycardia(VAsvt) and during pacing with same cycle length as tachycardia(VApace) were analysed in 48 patients to evaluate the usefullness in determining the mechanism of paroxysmal supraventricular tachycardia(PSVT) and the sites of accessory pathways. The results are as follows : 1)In differenciation AV nodal reentry from AV reentry mechanism, VAsvt(25.6+/-21.5 vs 148.0+/-27.7msec, p50msec(sensitivity 81%,specificity 100%) and VAsvt/VAace<0.7(sensitivity 71%, specificity 100%) suggested the high probability of left free wall accessory pathway. In Conclusion, VAsvt, VApace-VAsvt and VAsvt/VApace are useful parameters in determining the mechanism of PSVT and the sites of accessory pathways.

Radiofrequency Catheter Ablation in Patients with Paroxysmal Supraventricular Tachycardia : The Initial Experience and The Extent of Myocardial Damage

BACKGROUND: The catheter ablation usin radiofrequency(RF) energy in patients with atrioventricular nodal reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT) ahs been proved as a safe and effective nonpharmacologic therapeutic modality. The purpose of our study was to evaluate the success rate and complications of the initial experience and to determine the extent of myocardial damage of RF catheter ablation. METHODS: Electrophysiologic study was performed with the standard technique. Twenty five patinents(M:F=16:9, mean age:42 years old) underwent RF catheter ablation in St. May's Hospital from April to December in 1994. The RF generator in this study was RFG-3D model and catheters were 6F or 7F steerable catheters with 4mm kistal tip. In order to evaluate the extent of myocardial damage the WBC count, LDH, CK, and CK-MB fraction were checked before and after RF catheter ablation and the Tc99m myocardial scintigraphy was performed within 72 hours of the porcedure. RESULTS: Six of twenty five patients had AVNRT, in which the success rate of selective ablation of the slow pathway was 83.8%. Nineteen patients with AVRT had one accessory pathway. The ablation success rate of 14 accessory pathways in left free wall location was 85.7%, and that of 3 in left posteroseptal location was 66.6%. Two right sided accessory pathways were not ablated successfully. The level of CK-MB fraction after ablation was within normal limit. Only one case revealed grade 2 of hot spot in Tc99m myocardial scintigraphy. CONCLUSION: The RF catheter ablation in patients with AVNRT and AVRT is a safe and effective nonpharmacologic therapeutic modality. But right sided accessory pathways are more difficult to ablate than left sided accessory pathways, requiring more experiences and better technique. The extent of myocardial damage after RF catheter ablation reveals relatively minimal by cardiac enzyme study and Tc99mmyocardial scintigraphy.

Comparison of Clinical and Economic Effects between Catheter Radoifrequency Current Ablation and Openheart Operation for Chinese Patients with Paroxysmal Supraventricular Tachycardia / 中国介入心脏病学杂志

0. 05) in rate of success, recurrence and complication between RFCA and OHO for the patients with AVRT. Medical workers were fewer, operation, du-ration, hospital days (including days of pre-operation preparation and post-operation recovery) and days of looking after the patients in RFCA were shorter than those in OHO,p

A case of broad QRS paroxysmall supraventricular tachycardia that is difficult to differentiate from ventricular tachycardia

No abstract available.

Value of P Wave in Determining the Site of Accessory Pathway during Orthodromic Atrioventricular Reentry Tachycardia

The P wave during orthodromic atrioventricular reentry tachycardial were analysed in 19 patients to evaluate the usefulness in identifying the location of accessory pathways. The results were as follows; 1) Definitely inverted and upright P waves in lead I represented the left-sided and right-sided pathways respectively, but the converse is not necessarily true. 2) Dome and Dart appearance in lead VI(4 cases), upright P wave in inferior leads(3 cases), and negative P wave in aVL(3 cases) suggested the left-sided pathway and deeply inverted P waves in inferior leads suggested the posteroseptal or right-sided one. 3) In 17 cases(79%), inverted P wave appeared on more than one lead among the inferior leads, which were helpful to identify the position on P wave and mechanism of supraventricular tachycardia. Although the number of cases especially with right-sided pathway was small to conclude, P wave was useful for determining the location of accessory pathway noninvasively.