ABSTRACT
La tormenta tiroidea es un estado crítico y poco frecuente que condiciona la disfunción de múltiples órganos por el efecto del exceso de las hormonas tiroideas, esta disfunción endócrina tiene una elevada mortalidad y genera manifestaciones típicas como la taquicardia, fiebre, alteraciones gastrointestinales, cardiovasculares y del sistema nervioso central. El embarazo se ha asociado con un incremento en la incidencia de arritmias. Necesitan un tratamiento inmediato con drogas antiarrítmicas, cardioversión eléctrica o cesárea de urgencia. El WPW es una anormalidad cardiaca congénita que consiste en la presencia de un haz anómalo (Haz de Kent) que evita el sistema normal de conducción uniendo directamente aurículas y ventrículos. Veremos el caso de una gestante de 32 semanas que presenta un cuadro de tormenta tiroidea y múltiples episodios de taquicardia paroxística supraventricular (TPS), de tórpida y sombría evolución clínica mediada por un haz anómalo de Kent intermitente. Es evidente que la tormenta tiroidea en el contexto de la gestación produjo cambios en las propiedades electrofisiológicas del haz anómalo de Kent intermitente lo cual propició el desarrollo de múltiples taquicardias paroxísticas supraventriculares refractarias a la cardioversión eléctrica y farmacológica. Tampoco mejoró con la tiroidectomía total, solamente cedió por completo con la ablación por catéter de radiofrecuencia del haz anómalo de Kent.
Thyroid storm is a critical and infrequent state that conditions the dysfunction of multiple organs due to the effect of excess thyroid hormones. This endocrine dysfunction has a high mortality and generates typical manifestations such as tachycardia, fever, gastrointestinal, cardiovascular and heart disorders, and the central nervous system. Pregnancy has been associated with an increased incidence of arrhythmias. They need immediate treatment with antiarrhythmic drugs, electrical cardioversion, or emergency caesarean section. WPW is a congenital cardiac abnormality that consists of the presence of an abnormal bundle (Kent bundle) that prevents the normal conduction system, directly joining the atria and ventricles. We will see the case of a 32-week pregnant woman who presented symptoms of thyroid storm and multiple episodes of paroxysmal supraventricular tachycardia (PST), with a torpid clinical course mediated by an abnormal intermittent Kent bundle. It is evident that the thyroid storm in the context of pregnancy produced changes in the electrophysiological properties of the intermittent Kent bundle, which led to the development of multiple PST refractory to electrical and pharmacological cardioversion. Moreover, it also did not improve with total thyroidectomy, only resolved completely with radiofrequency catheter ablation of the Kent bundle.
ABSTRACT
Objective:To explore the safety and efficacy of Propafenone in terminating paroxysmal supraventricular tachycardia (PSVT) in children and analyze the factors influencing the effectiveness.Methods:A retrospective study was conducted on 169 PSVT children treated with Propafenone in the Department of Pediatric Cardiology, Heart Center, the First Hospital of Tsinghua University from September 2014 to October 2021.There were 118 boys and 51 girls with an average age of (2.84±2.91) years (age range: 14 days-13 years). According to age, they were divided into ≤ 1-year-old group, >1-3-year-old group, >3-7-year-old group, and >7-year-old group.Mea-surement data were compared between groups using t-test and Mann- Whitney U test.Counting data were analyzed by χ2 test. Results:Among the 169 children with PSVT, 65 cases (38.5%) were below 1 year old, 47 cases (27.8%) were >1-3 years old, 40 cases (23.7%) were >3-7 years old, 17 cases (10.1%) were above 7 years old.About 24 cases (14.2%) were combined with congenital heart disease.A total of 153 cases (90.5%) had nonspecific symptoms at the first visit.A total of 4.1% (7/169 cases) were complicated with tachycardia-induced cardiomyopathy, and their left ventricular ejection fraction increased from (44.0±4.0)% to (53.7±6.9)% after successful control of PSVT ( t=-4.700, P=0.003). The complete termination of PSVT by intravenous Propafenone was achieved in 125 of 169 cases (74.0%, 125/169 cases). The complete termination rate after multiple times of administration (74.0%) was significantly higher than that after the first intravenous injection (53.3%, 90/169 cases) ( χ2=15.657, P<0.001). There was a significant difference regarding the complete termination rate between children ≤1 year old (60.0%, 39/65 cases) and those >1 year old (82.7%, 86/104 cases) ( χ2=10.696, P=0.001). For children ≤1 year old, 1.5 mg/kg Propafenone (51.1%, 23/45 cases) showed better efficacy for PSVT termination than 1.0 mg/kg Propafenone (20.0%, 4/20 cases) ( χ2=5.519, P=0.019). For children >1 year old, there was no significant diffe-rence between 1.5 mg/kg and 1.0 mg/kg Propafenone groups (57.9% vs.62.1%) ( χ2=0.180, P=0.671). The adverse reaction rate of intravenous Propafenone was 9.5% (16/169 cases). One case presented with severe hypotension, which occurred in a child with right cardiac insufficiency with tricuspid valve depression; 15 cases showed abnormal cardiac conduction and recovered spontaneously in a short time.There was no deterioration of cardiac function in children with mildly to moderately reduced cardiac function. Conclusions:It is relatively safe and effective to terminate PSVT in children with intravenous Propafenone.The complete termination rate is 74.0%, which is related to age, dose and times of administration.Despite of low incidence of side effects, Propafenone should not be used to treat PSVT with cardiac function which is significantly impaired or unclear secondary to persistent tachycardia.Special attention should be paid to cardiac function deterioration in these patients.
ABSTRACT
Objective:To explore the safety and efficacy of adenosine triphosphate (ATP) in terminating paro-xysmal supraventricular tachycardia (PSVT) in children and the correlation between its efficacy, age and dose.Methods:A retrospective analysis was performed on the clinical data, efficacy and adverse effects of intravenous ATP in 120 children who had received ATP emergency cardioversion among 1 488 children with PSVT hospitalized in the Department of Pediatric Cardiology, Heart Center, First Hospital of Tsinghua University from September 2014 to November 2019.There were 80 boys and 40 girls with the age of (3.50±3.66) years (25 d-15 years). As for the group comparison, the measurement data was subject to the independent samples t test and Mann- Whitney U test; the enumeration data was subject to χ2 test. Results:Among the 120 children with PSVT, there were 42 cases (35.0%) <1 year old, and 24 cases(20.0%) combined with congenital heart disease.There were 8.3% of them (10/120 cases) suffering from tachycardiomyopathy (TCM) secondary to PSVT, whose LVEF increased from (32.70±11.69)% to (40.50±11.63)% after successful control of PSVT ( t=-3.647, P=0.005). The complete termination of PSVT by intravenous ATP was achieved in 53 of 120 cases (44.2%). ATP was given at 0.3 mg/kg, 0.2 mg/kg and 0.1 mg/kg in dose, and the significant effective rate was 56.5%(13/23 cases), 36.4%(32/88 cases) and 0, respectively, which showed that there was a significant difference in the therapeutic effect between different dose groups ( χ2=10.058, P=0.007). There was a significant difference regarding the complete termination rate between children <1 year old and those ≥1 year old [31.0%(13/42 cases) vs.51.3%(40/78 cases), χ2=4.575, P=0.032]. For refractory PSVT, the intravenous ATP was performed based on the absence of cardioversion with continuous pumping of other antiarrhythmic drugs, which achieved a significantly complete termination rate of 55.6% (10/18 cases). The rate of ATP adverse reactions was 2.5%(3/120 cases), presented with sinus arrest in children >1 year old with the dose of 0.2-0.3 mg/kg. Conclusions:It was relatively safe and effective to terminate PSVT in children with ATP, which was related to dose and age.For refractory PSVT, ATP can be intravenously pushed on the basis of continuous pumping of other antiarrhythmic drugs, which can achieve a higher complete termination rate.
ABSTRACT
Objective To explore the value of transseptal puncture for left-sided accessory pathway in radio-frequency catheter ablation in children with paroxysmal supraventricular tachycardia(PSVT). Methods Thirty-three patients with PSVT who had underwent radiofrequency catheter ablation in the First Affiliated Hospital,Sun Yat-Sen University from January 2012 to December 2017 were retrospectively analyzed. All the cases were treated by transaortic approach(transaortic group)or transseptal approach(transseptal group). The immediate success rates,total fluoroscopy time and radiation exposure between 2 groups were compared,and the perioperative complications and recurrence rates were observed between 2 groups. Results Thirty-three cases of children were enrolled,22 cases were male and 11 cases were female. Nineteen cases were treated by transaortic approach(transaortic group),while 18 cases were treated by transseptal approach(transseptal group),including 4 recurrent cases in the transaortic group who were switched to transseptal approach because of previous treatment failure. The age was(10. 16 ± 3. 06)years and(10. 67 ± 2. 20) years,and the weight was(37. 68 ± 14. 28)kg and(37. 33 ± 8. 64)kg,respectively. There were no significant diffe-rences in age and weight statistics between 2 groups(all P>0. 05). The total fluoroscopy time was(20. 16 ± 11. 41) minutes and(12. 56 ± 5. 23)minutes,and the median dose of radiation exposure was 67. 0 mGy and 33. 5 mGy,re-spectively. The postoperative recurrence rate was 21%(4/19 cases)and 0(0/18 cases),respectively. There were sig-nificant differences in total fluoroscopy time,radiation exposure and recurrence rate statistics between 2 groups( t ＝2. 627,Z＝ -2. 31,χ2 ＝4. 249,all P<0. 05). No complications were found in both 2 groups. Conclusions It is safe and feasible by transseptal puncture for left-sided accessory pathway in radiofrequency catheter ablation in children with PSVT. Radiofrequency catheter ablation by transseptal approach could significantly reduce the postoperative recu-rrence rate,and should be the first choice for left-side accessory pathway in children.
ABSTRACT
Objective To analyze retrospectively the cardioversion for paroxysmal supraventricular tachycardia (PSVT) in emergency department in order to explore rational guidance for the diagnosis and treatment for PSVT.Methods A retrospective analysis of PSVT patients in the emergency department admitted from June 2015 to December 2015 was carried out.First,all the patients were divided into two groups according to the cardioversion achieved by Valsalva's maneuvre or not.Forty patients were enrolled in study.There were 11 patients got cardioversion successfully achieved by the Valsalva's maneuvre and 29 patients failed to get cardioversion.Then,comparisons of demographics,vital sign,serum CTNI,potassium and NTproBNP level were carried out between these groups of patients using statistical analysis.The categorical variable was expressed in percentage and the continuous variable was described by mean±standard deviation and the comparisons of parameters were conducted by group t-test and chi-square test.Results The success rate of PSVT maneuvre cardioversion was 27.5％.In addition,there were no significant differences in demographics vital sign,TNI and NTproBNP between the two groups while there were significant differences in serum potassium level between the two groups [(3.8±0.4)mmol/L vs.(3.5±0.35)mmol/L P＜0.05].There was no significant difference in successful rate of cardioversion between the standard Valsalva's maneuvre(n=6) the modified Valsalva's maneuvre(n=5).The second-line treatment mainly included propafenone,adenosine,electroversion,verapamil and amiodarone.The propafenone was the most common second-line agent used for PSVT cardioversion accounting for 58.6％.Conclusions The success rate of Valsalva's maneuver cardioversion was low.Keeping properly a higher level of serum potassium could increase the success rate of cardioversion by Valsalva's maneuvre.
ABSTRACT
Objective To explore the clinical characteristics and treatment of paroxysmal supraventricular tachycardia (PSVT) in children. Methods The clinical data of 67 children with PSVT were analyzed retrospectively, and the therapeutic effects of different treatments were compared. Results The clinical manifestations of infants were paleness, shortness of breath, irritability and sweating, and children showed chest tightness, palpitations, abdominal discomfort and fatigue. The curative effect of electric cardioversion, transesophageal atrial pacing, physical therapy, and drug therapy was statistically different (P<0.05), The different cardioversion rates of them were observed for the treatment of paroxysmal supraventricular tachycardia. The cardioversion rate of transesophageal atrial pacing, was the highest, and the rate of physical therapy was the lowest. There was no significant difference in the cardioversion rate between propafenone, digoxin and amiodarone. Conclusion The clinical manifestations of PSVT in infants are atypical and easily to be ignored. There are many methods for treatment of PSVT. The vagus nerve can be stimulated first, and, if no response, either drugs or electric cardioversion and transesophageal atrial pacing can be used. The cardioversion rate of transesophageal atrial pacing is higher. The drug effectiveness for the treatment of PSVT depends on many factors, and our choice of medication varies from person to person.
ABSTRACT
Objective To evaluate the feasibility,effectiveness and safety of Carto3 three-dimensional electrophysiological mapping system in guiding radiofrequency ablation (RFA) for paroxysmal supraventricular tachycardia (PSVT).Methods The clinical data of a total of 28 patients with PSVT (Carto group),who received RFA guided by Carto3 three-dimensional electrophysiological mapping system during the period from March 2015 to February 2016,were retrospectively collected.Other 36 parents with PSVT,who received fluoroscopy-guided RFA during the period from March 2014 to February 2015,were collected as control group.The X-ray irradiation time,success rate of operation,operation time,complication and recurrence rate were calculated and the results were compared between the two groups.Results The mean fluoroscopy time in Carto group was (2.6±2.3) min,which was significantly less than (15.8±9.5) min in the control group (P＜0.001),and among them zero X-ray irradiation was obtained in 8 patients who had atrioventricular nodal reentrant tachycardia (AVNRT).The operation success rates of Carto group and the control group were 100％ (28/28) and 94.4％ (35/36) respectively (P＞0.05).The operation time in Carto group and the control group was (162.7±34.4) min and (149.4±46.2) min respectively (P＞0.05).In Carto group no any complications occurred,and in the control group one patient with AVNRT developed transient degree Ⅱ atrioventricular block during ablation process.All patients were followed up for 6 months,and no recurrence was observed in all patients of both groups.Conclusion For the treatment of PSVT,RFA guided by Carto3 three-dimensional electrophysiological mapping system is safe and effective,it can significantly reduce the X-ray irradiation time,even zero X-ray radiation in some AVNRT patients,meanwhile,this technique does not increase operation time and operation risk.
ABSTRACT
Objective To explore the function of autonomic nerves system in children with congenital heart disease (CHD) combined with paroxysmal supraventricular tachycardia (PSVT). Methods Fifty children having PSVT and no CHD (PSVT group), 30 children with both PSVT and CHD (CHD group), and 50 cases of healthy children (control group) were selected. The difference of 24-hour heart rate variability (HRV) among three groups was analyzed retrospectively. Results There were statistical differences in the long-range time domain HRV indexes, including SDNN, SDANN, SDNN Index, pNN 50 , and RMSSD among three groups (F=80.32-?263.18, P all??0.05). The SDNN, SDANN, SDNN Index, pNN50, and RMSSD were signiifcantly decreased in CHD group compared with PSVT group (P all?
ABSTRACT
Objective To explore the value of transesophageal atrial pacing (TEAP) in assessing the mechanism of paroxysmal supraventricular tachycardia (PSVT) in children. Methods The electrophysiological data of 50 children with PSVT who had undergone TEAP and, at a later stage, radio-frequency catheter ablation (RFCA) examination were retrospectively analyzed from January 2008 to December 2013. Results When using the intracardiac electrophysiological study (IEPS) as the diagnostic gold standard, the sensitivity of TEAP for atrioventricular nodal reentrant tachycardia (AVNRT), left accessory pathway (LAP) and right accessory pathway (RAP) was 92.9%, 83.1%and 90%respectively;the speciifcity was 86.4%, 100%and 95%respectively;the accuracy was 90%, 96%, and 94%respectively. The diagnostic accuracy of TEAP for AVNRT was 92.9%(26/28), the diagnosis accuracy for slow-fast AVNRT was 100%, but 2 cases of fast-slow AVNRT were both misdiagnosed as AVRT. The diagnostic accuracy of TEAP for AVRT was 86.4%(19/22) and 3 cases were misdiagnosed as slow-fast AVNRT. Conclusions TEAP has good clinical value in ifnding the mechanism of PSVT and its preliminarily location in children, but it has some limitations for some types of PSVT.
ABSTRACT
Objective To investigate the comparison of the clinical treatment efficacy of propafenone and amiodarone in patients with paroxysmal supraventricular tachycardia ( PSVT ) .Methods Retrospective a total of 89 patients with PSVT from June 2013 to June 2015 in our hospital were selected.According to the different administration methods, the patients were divided into the propafenone group of 46 cases and the amiodarone group of 43 cases.The changes of left ventricular end-systolic volume, left ventricular end-diastolic volume, ejection fraction, cardioversion success rate, mean cardioversion time, heart rate and side effects were compared.Results After treatment, the left ventricular end-systolic volume (52.31 ±8.34) mL/m2 , (54.28 ±7.23) mL/m2, left ventricular end-diastolic volume (47.31 ±8.56) mL/m2, (45.28 ±7.16) mL/m2 and ejection fraction (61.57 ± 0.76)%, (61.39 ±0.69)% were without significant differences.After treatment, the heart rates of the two groups were significantly decreased, the propafenone group ( 85.31 ±12.84 ) times/min, amiodarone group ( 87.26 ±11.95 ) times/min, and there were not significant differences.The recovery time of propafenone group was ( 19.34 ±4.76 ) , higher than the amiodarone group ( 25.69 ±6.09 ) ( P <0.05 ).But the success rate of cardioversion (52.17%) was lower than the amiodarone group (88.37%) (P<0.05).The side effect rates in the propafenone group (21.74%) was significantly higher than that in the amiodarone group ( 4.65%) ( P <0.05 ) .Conclusion Propafenone and amiodarone cardioversion PSVT have achieved good results, but propafenone rapid onset, the average cardioversion time is short, which is only suitable for acute tachycardia and without serious organic heart disease patients.Amiodarone onset is slower,but the cardioversion success rate is higher.
ABSTRACT
La técnica de mapeo endocárdico durante el estudio electrofisiológico ha sido extensamente empleada en el análisis de las taquicardias paroxísticas supraventriculares (TPS). Mediante este mapeo endocárdico y el análisis meticuloso de los electrogramas endocárdicos y los respectivos intervalos de conducción, es posible localizar el sitio de origen de las arritmias y así facilitar su tratamiento ablativo por medio de catéteres de radiofrecuencia. Se describe el caso de un hombre de 29 años con síndrome de Wolff-Parkinson-White (WPW) que manifiestó que presentaba varios episodios documentados de TPS con serio compromiso hemodinámico que motivaba su frecuente internación en terapia intensiva. El mapeo electrofisiológico endocárdico meticuloso demostró la presencia de un haz anómalo de Kent auriculoventricular izquierdo en posición posteroseptal. El período refractario absoluto del haz anómalo de Kent fue de 240 ms. La primera emisión de radiofrecuencia a través de un catéter adecuadamente posicionado previo terminó la taquicardia. La taquicardia permaneció no inducible a partir de entonces. En estas dos décadas de seguimiento clínico, el paciente no ha presentado ni un solo episodio de taquicardia. La curación definitiva generada por la ablación del haz anómalo de Kent ha proporcionado un cambio drástico, total y beneficioso en la calidad de vida al paciente. Los beneficios clínicos y socioeconómicos son mayores cuanto más temprano en la evolución se realice el procedimiento de ablación de arritmias.
Endocardial mapping has been widely used for the analysis of supraventriculartachycardias during electrophysiological study. This mapping and the detailed analysis ofendocardial electrograms and conduction intervals allow for the localization of the site oforigin of the arrhythmias thus facilitating curative treatment with radiofrequency catheterablation. The case describes our 29 years old patient with manifested Wolff-ParkinsonWhitesyndrome that presented frequent, documented episodes of paroxysmal supraventricular tachycardia with serious hemodynamic alteration that needed frequentadmissions to intensive care units despite the use of 2-3 antiarrhythmic agents per day. Adetailed endocardial mapping showed a left posteroseptal accessory pathway. Theaccessory pathway effective refractory period is 240 ms. The first radiofrequency emissionthrough an adequately positioned radiofrequency catheter terminated the tachycardia. Thetachycardia was rendered non-inducible thereafter. In two decades of follow-up, the patienthas not presented a single episode of tachycardia. The definite cure provided by theradiofrequency ablation produced a total, dramatic, and beneficial change in the quality oflife of the patient. The clinical and socio-economical benefits are greater the earlier thearrhythmia ablation procedure is performed.
Subject(s)
Humans , Male , Adult , Catheter Ablation/history , Arrhythmias, Cardiac , Wolff-Parkinson-White Syndrome/diagnosis , Tachycardia, Paroxysmal , Electrophysiologic Techniques, CardiacABSTRACT
Objective To investigate the efficacy and safety of catheter radiofrequency ablation of paroxysmal supraventricular tachycardia.Methods From Jul 2003 to Jan 2011,1106 cases with narrow QRS complex tachycardia who were treated by catheter radiofrequency ablation were recruited from our center and followed up for the rates of successful treatment,rcurrence and complications.Results There were in total 1106 patients (atrioventricular reentrant tachycardia:588 ; atrioventricular nodal reentrant tachycardia:477; atrial tachycardia:41 ),with a sex proportion of 1∶1.Successful ablation rate was 98.3 ％ (1087/1106).Of the 1087 successful ablation cases,43 (3.9％ )were warranted repeated ablation.The recurrent rates for trioventricular nodal reentrant tachycardia,atrioventricular reentrant tachycardia,left accessory pathway and right accessory pathway were 1.5％,5.6％,3.9％,and 9.1％ respectively.Complication rate was 1.5％.The major complications included pheumothorax ( 6 cases ),pulmonary embolism ( 1 case ),transient third-degree atrioventricular block ( 2 cases ),first-degree atrioventricular block ( 3 cases ),and persistent third-degree atrioventricular block(2 cases)with pacemaker implantation.There was one case of cardiogenic sudden death 5 days after the treatment procedure.The cause of his death was chronic stroke-related but not related to the operation procedure.Conclusion Catheter ablation has high efficacy and low complication rate in long-term follow-up,and is a promising treatment for paroxysmal supraventricular tachycardia.
ABSTRACT
An 11-month-old male infant was admitted to our hospital with fever, fussiness, poor feeding, vomiting, and tachypnea for two days prior. Physical examination revealed sporadic papules and vesicles occurring on his hands, feet, face, and perianal mucosa. Enterovirus 71 was identified from both throat swab and vesicle fluid using virus isolation techniques. The patient's heart rate fluctuated in a very narrow range from 180~210/beats/min regardless of his physiologic state. An electrocardiogram showed P-waves buried within or occurring just after regular, narrow, QRS complexes. The patient was diagnosed as having hand, foot, and mouth disease in combination with paroxysmal supraventricular tachycardia (PSVT). The child recovered well with symptomatic treatment, including intravenous administration of acyclovir, glucocorticoids, immunoglobulin, adenosine, and sotalol. PSVT was terminated within 36 hours of hospitalization. The skin lesions became crusted on the third day, and then proceeded to heal spontaneously. Here we report on this unusual case and review the associated literature.
Subject(s)
Animals , Child , Humans , Infant , Male , Acyclovir , Adenosine , Administration, Intravenous , Electrocardiography , Enterovirus , Fever , Foot , Foot-and-Mouth Disease , Glucocorticoids , Hand , Heart Rate , Hospitalization , Immunoglobulins , Mouth , Mouth Diseases , Mucous Membrane , Pharynx , Physical Examination , Skin , Sotalol , Tachycardia, Supraventricular , Tachypnea , Viruses , VomitingABSTRACT
Supraventricular arrhythmias during and after thoracotomy for pulmonary resections are well documented, and risk factors of post-pulmonary resection arrhythmias are old age, magnitude of surgery, and coexisting cardiopulmonary disease etc. Among of supraventricular arrhythmias, atrial fibrillation is the most common rhythm disturbance that may be associated with increased morbidity and mortality. We experienced a case of paroxysmal supraventricular tachycardia with severe hypotension which was escalated from atrial fibrillation during pulmonary bilobectomy for tuberculosis in a 44-year old male patient. Instead of usual electrical cardioversion or common antiarrhythmic agents, we selected phenylephrine bolus injection which induced normal sinus rhythm successfully from paroxysmal supraventricular tachycardia of the patient.
Subject(s)
Adult , Humans , Male , Arrhythmias, Cardiac , Atrial Fibrillation , Electric Countershock , Hypotension , Lung , Mortality , Phenylephrine , Risk Factors , Tachycardia, Supraventricular , Thoracotomy , TuberculosisABSTRACT
A 54-year-old male patient with squamous cell carcinoma of lung was scheduled for right lower lobectomy. He had suffered from diabetes mellitus during 8 years, but his preoperative electrocardiogram was normal sinus rhythm. During right thoracotomy, 2 times of unstable paroxysmal supraventricular tachycardia (PSVT) appeared but returned to normal sinus rhythm by carotid sinus massage. But, third unstable PSVT was not controlled by adenosine and anterior-lateral paddle positioned biphasic cardioversion. We changed anterior-lateral paddle position to anterior-posterior paddle position. And PSVT terminated abruptly and changed to sinus rhythm. So we present a case of unstable PSVT during right thoracotomy and treated with anterior-posterior paddle positioned biphasic cardioversion.
Subject(s)
Humans , Male , Middle Aged , Adenosine , Carcinoma, Squamous Cell , Carotid Sinus , Diabetes Mellitus , Electric Countershock , Electrocardiography , Lung , Massage , Tachycardia, Supraventricular , ThoracotomyABSTRACT
Wolff-Parkinson-White (WPW) syndrome is a cardiac conduction disorder that presents potentially life-threatening consequences, and it is important that anesthesiologists recognize this syndrome because the sudden development of tachyarrhythmias may result in deleterious hemodynamic changes. We report an episode of severe hemodynamic changes induced by the insertion of a guide wire during central venous cannulation and operation in a 62-yr-old female patient with WPW syndrome. Initially, unstable paroxysmal supraventricular tachycardia was developed during central venous cannulation, which was disappeared immediately upon removing the guide wire. Subsequently, paroxysmal supraventricular tachycardia with severe hemodynamic changes developed 2 hours after operation, and this was successfully treated with an intravenous injection of adenosine, deep anesthesia with sevoflurane and fentanyl, and dopamine infusion. The patient recovered uneventfully after the operation.
Subject(s)
Female , Humans , Adenosine , Anesthesia , Catheterization , Dopamine , Fentanyl , Hemodynamics , Injections, Intravenous , Tachycardia , Tachycardia, Supraventricular , Wolff-Parkinson-White SyndromeABSTRACT
Wolff-Parkinson-White (WPW) syndrome is characterized by classical electrocardiographic findings resulting from preexcitation of a part of the ventricular myocardium due to anomalous atrioventricular conduction via a accessory pathway. Anesthetic management with this syndrome is aimed at avoiding tachycardia and cardiac arrhythmia by using the techniques to avoid hypoxia, hypercarbia, acidosis and sympathetic stimulation. We experienced a case of severe hypotension and paroxysmal supraventricular tachycardia (PSVT) during insertion of subclavian vein catheter on a patient with this syndrome prior to operation, in spite of adequate anesthetic management. The patient's condition was recovered after infusion of adenosine and removal of catheter. Operation was postponed for further evaluation of WPW syndrome. After 3 days, electrophysiologic study was done and accessory pathway was ablated by radiofrequency catheter. After 6 days, the patient was operated uneventfully and discharged 2 weeks later. We report that minor stimulation such as central venous catheterization on a patient with WPW syndrome can cause life-threatening severe hypotension and PSVT.
Subject(s)
Humans , Acidosis , Adenosine , Hypoxia , Arrhythmias, Cardiac , Catheterization, Central Venous , Catheters , Central Venous Catheters , Electrocardiography , Hypotension , Myocardium , Subclavian Vein , Tachycardia , Tachycardia, Supraventricular , Wolff-Parkinson-White SyndromeABSTRACT
62 patients with paroxysmal supraventricular tachycardia were treated at the 103 Hospital and the 175 Hospital between 2000-2002, who were diagnosed due to clinical and ECG before and after treatment. The effects obtened by methods: pressing eyeball (15.3%); direct current cardioversion (100%); verapamil (92.9%); other drugs (83.3-85.7%); rapid atrial pacing (66.7%).
Subject(s)
Therapeutics , Tachycardia, Supraventricular , DiagnosisABSTRACT
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.
Subject(s)
Humans , Adenosine , Atrial Fibrillation , Blood Pressure , Chest Pain , Electric Countershock , Electrocardiography , Emergencies , Emergency Service, Hospital , Heart Diseases , Heart Rate , Hemodynamics , Recurrence , Tachycardia , Tachycardia, Supraventricular , Ventricular Premature Complexes , VerapamilABSTRACT
Objective To investigate the result of RFCA and electrophysiologic characteristics in pediatric PSVT. Methods Electrophysiologic study and RFCA were performed in 25 patients(age