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ABSTRACT Adenosine is an antiarrhythmic drug that slows conduction through the atrioventricular node and acts as a coronary blood vessel dilator. This case report highlights two unusual life-threatening events following the use of adenosine to revert supraventricular tachycardia in a structurally normal heart: non-sustained polymorphic ventricular tachycardia and myocardial infarction. A 46-year-old woman presented to the emergency department with a two-hour history of palpitations and was diagnosed with supraventricular tachycardia. Vagal maneuvers were ineffective, and after intravenous adenosine administration, the patient presented with chest pain and hypotension. The rhythm degenerated into non-sustained polymorphic ventricular tachycardia and spontaneously reverted to sinus rhythm with ST elevation in lead aVR and ST depression in the inferior and anterolateral leads. The patient spontaneously recovered within a few minutes. Despite successful arrhythmia reversal, the patient was admitted to the intensive care unit because of an infarction without obstructive atherosclerosis. This report aims to alert emergency physicians about the potential complications associated with supraventricular tachycardia and its reversal with adenosine.
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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.
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RESUMEN Antecedentes : El diagnóstico diferencial entre la taquicardia reentrante ortodrómica (TRO) y la taquicardia por reentrada nodal atípica (TRNa) puede ser dificultoso. Nuestra hipótesis es que las TRNa tienen más variabilidad en el tiempo de con ducción retrógrada al comienzo de la taquicardia que las TRO. Nuestros objetivos fueron evaluar la variabilidad en el tiempo de conducción retrógrada al inicio de la taquicardia en TRNa y TRO, y proponer una nueva herramienta diagnóstica para diferenciar estas dos arritmias. Métodos : Se midió el intervalo ventrículo-auricular (VA) de los primeros latidos tras la inducción de la taquicardia, hasta su estabilización. La diferencia entre el intervalo VA máximo y el mínimo se definió como delta VA (ΔVA). También contamos el número de latidos necesarios para que se estabilice el intervalo VA. Se excluyeron las taquicardias auriculares. Resultados : Se incluyeron 101 pacientes. Se diagnosticó TRO en 64 pacientes y TRNa en 37. El ΔVA fue 0 (rango intercuartílico, RIC, 0-5) milisegundos (ms) en la TRO frente a 40 (21-55) ms en la TRNa (p < 0,001). El intervalo VA se estabilizó significativamente antes en la TRO (1,5 [1-3] latidos) que en la TRNa (5 [4-7] latidos; p < 0,001). Un ΔVA < 10 ms diagnosticó TRO con 100% de sensibilidad, especificidad y valores predictivos positivo y negativo. La estabilización del intervalo VA en menos de 3 latidos predijo TRO con buena precisión diagnóstica. Los resultados fueron similares considerando sólo vías accesorias septales. Las TRN típicas tuvieron una variación intermedia. Conclusión : Un ΔVA < 10 ms es un criterio simple, que distingue con precisión la TRO de la TRNa, independientemente de la localización de la vía accesoria.
ABSTRACT Background : Differential diagnosis between orthodromic reentrant tachycardia (ORT) and atypical nodal reentrant tachy cardia (ANRT) can be challenging. Our hypothesis was that ANRT presents more variability in retrograde conduction time at tachycardia onset than ORT. Objectives : The objectives of this study were to assess retrograde conduction time variability at the start of tachycardia in ANRT and ORT, and postulate a new diagnostic tool to differentiate these two types of arrhythmias. Methods : The ventriculoatrial (VA) interval of the first beats after tachycardia induction was measured until stabilization. The difference between the maximum and minimum VA interval was defined as delta VA (ΔVA), and the number of beats needed for VA interval stabilization was also assessed. Atrial tachycardias were excluded. Results : In a total of 101 patients included in the study, ORT was diagnosed in 64 patients and ANRT in 37. ΔVA interval was 0 (interquartile range [IQR] 0-5) milliseconds (ms) in ORT vs. 40 (21-55) ms in ANRT (p <0.001). The VA interval significantly stabilized earlier in ORT (1.5 [1-3] beats) than in ANRT (5 [4-7] beats) (p<0.001). A ΔVA <10 ms diagnosed ORT with 100% sensitivity, specificity, and positive and negative predictive values. Ventriculoatrial interval stabilization in less than 3 beats predicted ORT with good diagnostic accuracy. The results were similar considering only accessory septal pathways. Typical NRTs presented an intermediate variation. Conclusion : Presence of DVA <10 ms is a simple criterion that accurately differentiates ORT from ANRT, independently of the accessory pathway localization.
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LVNC (left ventricular non-compaction) is a rare congenital cardiomyopathy with a reported incidence of 0.05% in adults. It can occur in isolation or affect both ventricles. It’s characterized by prominent LV trabeculae and deep intertrabecular recesses which are filled with blood from the ventricular cavity without evidence of communication to the epicardial coronary artery system. Frequent premature supra ventricular tachycardia as unique finding in LVNC cardiomyopathy is rare manifestation of this disease. We report a case of a frequent persistent supraventricular tachycardia as first manifestation of a patient with LVNC cardiomyopathy in a young healthy woman who despite radio frequency ablation therapy of the supraventricular tachycardia remains symptomatic. The patient was later placed on medical therapy based on a non-cardio selective beta-blocker with a good clinical outcome without recurrent of supra-ventricular arrythmias.
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Objective:To investigate the effect of drug therapy on heart failure caused by supraventricular tachycardia(SVT) in infants.Methods:Fifty-five infants with heart failure caused by SVT, including 24 boys and 31 girls, were treated at Beijing Children′s Hospital of Capital Medical University from January 2014 to December 2021.The drug treatment effects of heart failure caused by SVT were analyzed.Results:The average age of 55 infants at the first diagnosis was 5.8 months(1-11 months). All of them had heart failure, including three cases of atrial flutter, 23 cases of atrial tachycardia(13 cases of disordered atrial tachycardia and ten cases of monomorphic atrial tachycardia), and 29 cases of paroxysmal supraventricular tachycardia.Ultrasonic cardiogram showed that the left ventricular diameter increased and/or left ventricular systolic function decreased.Anti-heart failure therapy was effective in 55 cases(100.0%). Anti-arrhythmic drug therapy: atrial flutter and atrial tachycardia were mainly treated by controlling ventricular rate, digitalis combined with metoprolol was effective in 21 cases(80.8%, 21/26), digitalis alone was effective in four cases(15.4%, 4/26), and sotalol was effective in one case(3.8%, 1/26); paroxysmal supraventricular tachycardia was mainly treated with sinus rhythm conversion.The success rates of conversion were: ATP 20.7%(6/29), ATP combined with digitalis 26.1%(6/23), propafenone combined with digitalis 42.9%(3/7), amiodarone combined with digitalis 60.0%(3/5), and sotalol 92.9%(12/13). During follow-up period for 1 to 12 months, heart failure symptoms of all 55 cases(100.0%) improved, and ultrasonic cardiogram of 53 cases(96.3%)returned to normal.Conclusion:Anti-heart failure and anti-arrhythmic drugs for infants with heart failure caused by SVT need to be selected individually.Atrial tachycardia, especially disordered atrial tachycardia, is sensitive to digitalis.Sotalol can be used to treat refractory SVT.
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Abstract Background: Coumel tachycardia is an infrequent form of supraventricular tachycardia (SVT) that usually occurs in infants and children. It is a tachycardia mediated by an accessory pathway with retrograde slow conduction that explains the classic ECG pattern with long RP' interval and negative P waves in leads II, III, and aVF. In this study, we describe the clinical course and management of Coumel tachycardia in children. Case report: We conducted a retrospective review of five consecutive pediatric patients, mean age 11 ± 3 years (range 6 to 14). The first episode of SVT was at a mean age of 10.4 ± 4.8 years (range 2 to 14) with a mean evolution of 7.4 ± 9.4 months (range 1 to 24). Pharmacological therapy was unsuccessful despite the combination of antiarrhythmic drugs. The tachycardia was incessant with a density > 85% by 24-hour Holter monitoring; one patient developed tachycardia-induced cardiomyopathy. All children underwent successful radiofrequency catheter ablation, mean 5 ± 3 applications (range 1 to 8) with a single session and with no complications. After a mean follow-up of 24 ± 16 months, all patients were asymptomatic and recurrence-free without antiarrhythmic treatment. Conclusions: Coumel tachycardia is clinically persistent and usually refractory to antiarrhythmic treatment with substantial risk of tachycardia-mediated cardiomyopathy. Catheter ablation is effective and safe in children; thus, it should be indicated promptly and based on individual selection.
Resumen Introducción: La taquicardia de Coumel es una forma poco frecuente de taquicardia supraventricular que suele presentarse en lactantes. Es una taquicardia mediada por una vía accesoria de conducción lenta retrógrada que explica el patrón ECG clásico con intervalo RP' largo y ondas P negativas en las derivaciones II, III y aVF. En este trabajo se describe el curso clínico y el manejo de la taquicardia de Coumel en niños. Caso clínico: Se llevó a cabo una revisión retrospectiva de cinco pacientes pediátricos consecutivos, con una media de edad de 11 ± 3 años (intervalos 6 a 14). El primer episodio de taquicardia 10.4 ± 4.8 años con evolución de 7.4 ± 9.4 meses. El tratamiento farmacológico fue ineficaz a pesar de la combinación de antiarrítmicos. La taquicardia era incesante con una densidad > 85% por Holter-24h; un paciente desarrolló miocardiopatía inducida por taquicardia. Todos los niños fueron sometidos a ablación con catéter y radiofrecuencia con éxito, y un promedio de 5 ± 3 aplicaciones en una sola sesión y sin complicaciones. Después de un seguimiento de 24 ± 16 meses, todos los pacientes fueron asintomáticos y libres de recurrencia sin tratamiento antiarrítmico. Conclusiones: La taquicardia de Coumel es clínicamente persistente y generalmente refractaria al tratamiento antiarrítmico con un riesgo sustancial de miocardiopatía mediada por taquicardia. La ablación con catéter es eficaz y segura en niños, por lo que debe indicarse de forma temprana y en lactantes de una selección individual.
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En la actualidad existen diferencias en la interpretación y cuantificación de los extrasístoles supraventriculares y ventriculares en el Holter de ritmo cardíaco y no existe siempre una misma definición e interpretación de lo que se denomina como "escaso", "ocasional", "frecuente" o "muy frecuente". El objetivo del presente trabajo ha sido revisar las evidencias actuales y sus fundamentos en relación a la cuantificación o carga de la extrasistolía supraventricular y ventricular en un Holter de ritmo cardíaco, lo que debiera contribuir a una mayor precisión y mejor interpretación de la información cuantitativa en la práctica clínica diaria con este examen. Se revisa en la literatura el concepto de carga de extrasístoles supraventriculares y ventriculares y su relación con eventos clínicos: fibrilación auricular y accidente cerebrovascular en el caso de la extrasistolía supraventricular y mortalidad post infarto y deterioro de la función ventricular en el caso de la extrasistolía ventricular. De esta manera se cuantifica en base a la evidencia la extrasistolía supraventricular y ventricular.
Considerable differences exist in the quantification and clinical significance of both supraventricular and ventricular extrasystoles found in Holter recordings. Usually extrasystoles were classified as rare, occasional, frequent and very frequent. Current publications were analyzed regarding the frequency and clinical significance or these arrhythmias, especially in in relation to prior myocardial infarction, ventricular dysfunction, atrial fibrillation and cerebro vascular events. Tables showing limits to define the severity of supraventricular and ventricular extrasystoles are included.
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Humans , Electrocardiography, Ambulatory/methods , Ventricular Premature Complexes/diagnosis , Monitoring, Physiologic/methods , Arrhythmias, Cardiac/diagnosis , Risk , Electrocardiography, Ambulatory/instrumentation , Monitoring, Physiologic/instrumentation , Myocardial InfarctionABSTRACT
Introducción: La fibrilación auricular o atrial fue considerada durante mucho tiempo como una alternativa al ritmo sinusal y es en la actualidad un serio problema de salud en muchos países del mundo, a la cual se le asocian muchos factores de riesgo como la insuficiencia cardiaca, la hipertensión arterial y la diabetes mellitus. Es la arritmia más prevalente en la práctica clínica. Objetivo: Caracterizar a la fibrilación auricular en cuanto a sus manifestaciones clínicas y tratamiento. Desarrollo: Se realizó una revisión bibliográfica de artículos publicados desde 2010 hasta 2020. Se consultaron las bases de datos SciELO, EBSCO, PubMed/Medline, Dialnet y revistas de acceso abierto, se emplearon los descriptores fibrilación auricular, arritmia supraventricular y mecanismos de reentrada, en idioma español e inglés. Se seleccionaron 25 referencias las cuales incluyen artículos científicos, anuario estadístico y guías de práctica clínica. En la literatura consultada se señaló que la fibrilación auricular es una arritmia supraventricular que se observa electrocardiográficamente como oscilaciones basales de baja amplitud con un ritmo ventricular irregular, que se produce por mecanismos de reentrada únicos o múltiples que generan una conducción eléctrica desordenada y generalmente se manifiesta por palpitaciones, fatiga y disnea, aunque pudiera ser asintomática. Conclusiones: Se constata que esta arritmia posee un cuadro clínico y electrocardiográfico reconocido y ampliamente estudiado. Se describen diversas clasificaciones y mecanismos fisiopatológicos, de acuerdo con sus etiologías. Los métodos diagnósticos y terapéuticos se encuentran en constante desarrollo y perfeccionamiento.
Introduction: Atrial fibrillation was considered for decades as an alternative for sinus rhythm and nowadays it is a severe health problem in many countries of the world associated with some risks factors as cardiac insufficiency, hypertension and diabetes mellitus. It is the most common type of arrhythmia in clinic marks. Objective: Characterize atrial fibrillation in terms of its clinical manifestations and treatment. Development: A bibliographical review was made on published articles from 2010 to 2020. Data Bases like SciELO, EBSCO, PubMed/Medline, Dialnet and open-access magazines were consulted, using the descriptive words atrial fibrillation, supraventricular arrhythmia and reentrance mechanisms for English and Spanish languages. A total of 28 references were selected. In the literature was checked that atrial fibrillation is a supraventricular arrhythmia that can be identified on electrocardiogram by low-amplitude basalts oscillations with an irregular ventricular rhythm. It is produced by unique or multiple reentrance mechanisms that generate a disordered electrical conduction and usually it is accompanied with palpitations, fatigue and dyspnea, but it could also be asymptomatic. Conclusions: Atrial fibrillation has studied clinical signs and treatment is oriented in four directions; frequency controlling, rhythm controlling, thromboembolism prevention and risks factors management.
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La taquicardia supraventricular (TSV) es la principal taquiarritmia en el recién nacido (RN) que requiere una resolución urgente. Por su parte, la enterocolitis necrosante (ECN) es la emergencia gastrointestinal más común que afecta principalmente a RN prematuros. Aunque estas se reconocen como patologías distintas, la bibliografía sugiere que los episodios de TSV pueden predisponer a los pacientes a la ECN a través de alteraciones en el flujo sanguíneo mesentérico y una disminución de la perfusión tisular. Se presenta aquí el caso clínico de un neonato prematuro que desarrolló un cuadro de ECN luego de un evento aislado de TSV con bajo gasto cardíaco
Supraventricular tachycardia (SVT) is the main tachyarrhythmia in the newborn (NB) that requires urgent resolution. Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency that mainly affects premature infants. Although these conditions are recognized as distinct pathologies, literature reports suggest that episodes of SVT may predispose patients to NEC secondary to disturbances in mesenteric blood flow and a decrease in tissue perfusion. We present here the clinical case of a premature neonate who developed NEC after an isolated SVT event with low cardiac output
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Humans , Male , Infant, Newborn , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/etiology , Enterocolitis, Necrotizing/complications , Enterocolitis, Necrotizing/diagnosis , Infant, Newborn, Diseases , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/etiology , Fetal DiseasesABSTRACT
Background: Supraventricular tachycardia is a clinical syndrome characterized by a rapid tachycardia with an abrupt onset and termination.The objective ofour study was to determine andassess the clinical profile, electrocardiographic and echocardiographic of patients diagnosed with supraventricular tachycardia.Methods: This cross-sectional study was conducted in the department of general medicine, Dr DY Patil medical college and hospital, Navi Mumbai from April 2020 till October 2021, in which we included patients diagnosed with any type of supra-ventricular tachycardia and excluded hemodynamically unstable patients. Results:In the present study, of the 45 cases, atrial fibrillation was the most common mechanism of SVT, diagnosed in 47% of the patients. Next most common was AVNRT (22%) and AVRT (18%). In addition, atrial tachycardia was diagnosed in 9% of the patients and atrial flutter was diagnosed in 4%. Mean age of the patients was 34.5 years, ranging from 13 to 68 years and 56% were males. It was observed that palpitation was the most common symptoms (91%). On ECG, no abnormalities were detected in 64%, while left ventricular hypertrophy (18%) and prolonged corrected QT (18%) were the most common abnormalities.On echocardiography, no abnormality was detected in 78% of the patients. Furthermore, 49% of the patients achieved normal sinus rhythm with a single dose of adenosine infusion and 33% of the patients required another dose of adenosine infusion.Conclusions:Palpitation is common presentation symptom. Most of patients had good response to medication treatment especially adenosine therapy, additional treatment was required in few patients.
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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.
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Introducción: El 11 de marzo de 2020 se confirmaron los primeros casos de la enfermedad en Cuba. Objeto: Examinar una complicación de la infección por SARS-CoV-2 infrecuente en edad pediátrica y su tratamiento. Presentación del caso: Lactante de 2 meses de edad producto de un parto distócico por cesárea a las 41,5 semanas, procedente de la provincia de Guantánamo. Por condiciones maternas permaneció con su madre en el hospital durante 45 días. Egresa y a los 15 días en casa, consultan por fiebre de 38 ℃ durante tres días consecutivos. Se constata frecuencia cardiaca muy elevada y estado eutérmico. El test de antígeno y las pruebas de reacción en cadena de la polimerasa con transcriptasa inversa y PCR para SARS-CoV-2 fueron positivas, por lo que se ingresa en terapia intensiva pediátrica con impresión diagnóstica de taquicardia supraventricular que se define finalmente como flutter auricular. El tratamiento aplicado controló la arritmia cardiaca y contribuyó a su favorable evolución posterior. Conclusiones: Los hallazgos del examen físico y los datos en la anamnesis permiten realizar el diagnóstico del paciente en su etapa temprana. La fisiopatología de las complicaciones en niños está en la regulación local de la expresión de los receptores ACE2, aumento de la producción de catecolaminas y una mayor incidencia de toxicidad por medicamentos que producen lesión cardíaca aguda y arritmia, síntomas que pueden estar asociados con disfunción del sistema respiratorio y cambios hematológicos o no en la edad pediátrica.
Introduction: On March 11, 2020, the first cases of COVID-19 were confirmed in Cuba. Purpose: To examine a complication of SARS-CoV-2 infection uncommon in pediatric ages and its treatment. Case presentation: A 2-month-old infant from Guantánamo province was delivered by cesarean section at 41.5 weeks. Due to maternal conditions, the newborn remained with the mother in the hospital for 45 days. Then the newborn was discharged and after 15 days at home was evaluated due to fever of 38 ° C during three consecutive days. A very high heart rate and euthermic state were observed. The antigen test and reverse transcriptase polymerase chain reaction and PCR tests for SARS-CoV-2 were positive, so the newborn was admitted to the pediatric intensive care unit with diagnostic impression of supraventricular tachycardia that is finally defined as atrial flutter. The treatment applied controlled the cardiac arrhythmia and contributed to its subsequent favorable evolution. Conclusions: The findings of the physical examination and the data in the anamnesis allow the diagnosis of the patient in its early stage. The pathophysiology of complications in children is in the local regulation of ACE2 receptor expression, increased catecholamine production and an increased incidence of toxicity by drugs that produce acute cardiac injury and arrhythmia, symptoms that may be associated with dysfunction of the respiratory system and hematological changes or not in pediatric age.
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Abstract The atrioventricular (AV) reentrant tachycardia (AVRT) is the most common cause of supraventricular tachycardia (SVT) in the young pediatric population. Some newborns might present with congestive heart failure and require interventional treatment. Catheter ablation in small infants (<6 months and <5 kg) is still poorly performed and controversial due to high complications rate in this group of patients.1 We report a case of a 28 days old infant (3,5 kg) with a drug-refractory left accessory pathway mediated tachycardia and severe hemodynamic compromise, who underwent catheter ablation. Radiofrequency ablation should be part of the therapeutic arsenal in a context of drug-resistant supraventricular tachycardia with hemodynamic compromise, despite the greater risks of complications in this special population.
Subject(s)
Humans , Female , Infant, Newborn , Tachycardia, Atrioventricular Nodal Reentry/surgery , Tachycardia, Supraventricular/surgery , Catheter Ablation/methods , Tachycardia, Atrioventricular Nodal Reentry/drug therapy , Tachycardia, Supraventricular/drug therapy , Catheter Ablation/adverse effects , Catheter Ablation/mortalityABSTRACT
Resumo Fundamento O diagnóstico diferencial de taquicardia de QRS largo, entre taquicardia ventricular (TV) ou taquicardia supraventricular com condução aberrante (TSV-A) é algumas vezes difícil de ser feito na sala de emergência. Objetivo Avaliar a acurácia de um algoritmo novo e simples para a detecção de TV no eletrocardiograma (ECG) em pacientes com taquicardia de QRS largo. Métodos ECGs de 12 derivações para detecção de taquicardia de QRS largo foram obtidos prospectivamente de 120 pacientes durante estudo eletrofisiológico. Seis médicos com diferentes experiências analisaram os ECGs, e fizeram o diagnóstico com base no algoritmo D12V16, que envolve a análise da polaridade predominante do complexo QRS nas derivações I, II, V1 e V6. O diagnóstico foi comparado com os obtidos pelo algoritmo tradicional de Brugada e pelo estudo eletrofisiológico, o qual é considerado padrão ouro. Adotou-se um nível de significância de 5% (p<0,05) nas análises estatísticas. Resultados De acordo com o estudo eletrofisiológico, 82 ECGs eram de TV e 38 de TSV-A. Doenças cardíacas estruturais estavam presentes em 71 (86,6%) dos pacientes com TV e em oito (21,1%) com TSV-A. O algoritmo de Brugada teve uma maior sensibilidade global (87,2%), enquanto o algoritmo D12V16 apresentou maior especificidade global (85,1%) para TV. Tanto o algoritmo D12V16 como o de Brugada apresentou um alto valor preditivo positivo (90,9% vs. 85,8%, respectivamente) e acurácia similar (73,8% vs. 81,4%, respectivamente) para o diagnóstico de TV. Nos avaliadores experientes, a acurácia foi maior utilizando o algoritmo de Brugada que o algoritmo D12V16, mas a acurácia dos dois algoritmos foi similar segundo os avaliadores menos experientes. Conclusão O algoritmo simplificado pode ser um método útil para reconhecer TV no ECG, principalmente para médicos menos experientes. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)
Abstract Background The differential diagnosis of wide QRS complex tachycardia (WCT) between ventricular tachycardia (VT) or supraventricular tachycardia with aberrant conduction (SVT-A) is sometimes difficult in the emergency room. Objective The aim of this study was to evaluate the accuracy of a new simple electrocardiographic algorithm to recognize VT in patients with wide complex tachycardia. Methods The 12-lead electrocardiograms (ECG) for WCT were prospectively obtained from 120 patients during electrophysiological study. Six physicians with different expertise analyzed the electrocardiographic recordings, and made the diagnosis based on the D12V16 algorithm, that involves the analysis of the predominant polarity of QRS in leads I, II, V1 and V6. The diagnosis was compared with that made using the traditional Brugada algorithm and the "gold-standard" electrophysiological study. Statistical analyses were performed with a significance level of 5% (p<0.05). Results According to the EPS study, 82 ECG recordings were VT and 38 SVT-A. Structural heart diseases were present in 71 (86.6%) patients with VT and in 8 (21.1%) with SVT-A. The Brugada algorithm had higher global sensitivity (87.2%), and the D12V16 algorithm had higher global specificity (85.1%) for VT. Both D12V16 and Brugada's algorithms presented a high positive predictive value (90.9% vs 85.8%, respectively) and similar accuracy (73.8% vs 81.4%, respectively) for the diagnosis of VT. Experienced evaluators were more accurate using Brugada algorithm than the D12V16 algorithm, but the accuracy of both algorithms was similar according to less experienced examiners. Conclusion The simplified algorithm may be a useful method to recognize VT in the ECG, especially for less experienced doctors. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)
Subject(s)
Humans , Tachycardia, Supraventricular , Tachycardia, Ventricular/diagnosis , Algorithms , Sensitivity and Specificity , Diagnosis, Differential , Electrocardiography , Heart RateABSTRACT
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
Resumen La disfunción ventricular secundaria a disincronía eléctrica y mecánica es una complicación de la estimulación ventricular desde el ápex del ventrículo derecho. No existen informes de disincronía secundaria a los efectos de fármacos antiarrítmicos. Se presenta el caso de una niña de 10 días de vida con taquicardia supraventricular incesante que se internó en terapia intensiva neonatal. Se inició tratamiento con propranolol por vía oral y ante la persistencia de la taquicardia se agregó amiodarona endovenosa. La paciente estuvo predominantemente en taquicardia con frecuencias cardíacas entre 200 y 290 latidos por minuto durante una semana a pesar del tratamiento instaurado. La función ventricular fue normal en los ecocardiogramas realizados. Se agregó flecainida por vía oral al esquema de tratamiento y luego de 24 horas presentó una taquicardia más lenta con QRS ancho e imagen de bloqueo completo de rama izquierda. Un nuevo ecocardiograma evidenció deterioro de la función ventricular izquierda e insuficiencia mitral moderada lo que motivó la suspensión de la flecainida y el propranolol. A las 24 horas de la suspensión se observó la normalización de la función ventricular a pesar de la persistencia de episodios intermitentes de taquicardia. Se reinició el propranolol logrando el control de la taquicardia. La presencia de disincronía ventricular generada por el bloqueo de rama izquierda secundario al tratamiento farmacológico con flecainida constituye una novedosa explicación posible para el desarrollo de disfunción ventricular.
Abstract Ventricular dysfunction secondary to electrical and mechanical dyssynchrony in chronic right ventricular apical pacing is a well-recognized complication. There are no previous reports of pharmacologically induced dyssynchrony. A 10-day old infant with incessant supraventricular tachycardia was admitted to the neonatal intensive care unit. Therapy with oral propranolol was initiated and due to persistence of tachycardia intravenous amiodarone was administered. The patient remained predominantly in tachycardia with heart rates between 200-290 beats per minute for a week with serial echocardiograms showing preserved ventricular function. Oral flecainide was started. After 24 hours of treatment the patient developed a slower incessant wide QRS with a left bundle branch block pattern. The echocardiogram showed deterioration of left ventricular systolic function and moderate mitral regurgitation. Flecainide and propranolol were discontinued. The QRS complex narrowed and despite intermittent breakthroughs of supraventricular tachycardia, ventricular function normalized. Propranolol was restarted to achieve definitive control of the tachycardia. The presence of ventricular dyssynchrony generated by the left bundle branch block pattern secondary to pharmacological treatment with flecainide is a novel possible explanation for the development of ventricular dysfunction.
Subject(s)
Humans , Infant, Newborn , Infant , Tachycardia, Supraventricular/chemically induced , Tachycardia, Supraventricular/drug therapy , Pharmaceutical Preparations , Bundle-Branch Block , Electrocardiography , Heart VentriclesABSTRACT
SUMMARY OBJECTIVE: Inflammation has been suggested as a potential mechanism in the pathogenesis of arrhythmia. Hemogram parameters such as monocyte count to high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) have been considered to be markers of inflammation and new cardiovascular risk predictors. This retrospective study aimed to investigate the relationship between MHR, NLR, and MLR in patients with paroxysmal supraventricular tachycardia (PSVT). METHODS: A retrospective study conducted at a university hospital in Bolu, Turkey, between 2017 and 2019. Our study included 196 patients who underwent electrophysiological study (EPS) due to palpitation or documented PSVT on electrocardiography (ECG). Patients having documented atrioventricular nodal re-entrant tachycardia (AVNRT) on ECG or inducible AVNRT on EPS were included in the PSVT group (n=130), and patients with palpitation but without inducible arrhythmia on EPS (n=66) were included in the control group. Routine biochemical and hemogram tests were performed before the EPS procedure. RESULTS: When hemogram parameters were compared, there was no statistically significant difference in MHR values [0.010 (0.001-0.030) vs 0.010 (0.001-0.020) p =0.67]. Additionally, both NLR [2.21(0.74-11.36) vs 1.98(0.72-24.87) p=0.13] and MLR [0.25 (0.03-1.05) vs 0.24(0.07-1.39) p=0.41] were not statistically significant between the two groups. CONCLUSION: There is no significant difference in PSVT patients regarding hemogram parameters including white blood cell subtypes, MLR, NLR, and MHR. Therefore the evaluation of hemogram parameters may not be clinically relevant for PSVT patients.
RESUMO OBJETIVO: A inflamação tem sido sugerida como um mecanismo potencial na patogênese da arritmia. Parâmetros do hemograma, como contagem de monócitos e razão de colesterol lipoproteína de alta densidade (MHP), proporção de neutrófilos / linfócitos (NLP) e proporção de monócitos / linfócitos (MLR), foram considerados marcadores de inflamação e novos preditores de risco cardiovascular. Este estudo retrospectivo teve como objetivo investigar a relação entre MHP, NLP e MLP em pacientes com taquicardia paroxística supraventricular (PSVT). MÉTODOS: Estudo retrospectivo realizado em um hospital universitário em Bolu, Turquia, entre 2017 e 2019. Nosso estudo incluiu 196 pacientes submetidos a estudo eletrofisiológico (EPS) devido a palpitações ou PSVT documentada na eletrocardiografia (ECG). Os pacientes com taquicardia nodal atrioventricular reentrante (AVNRT) no ECG ou AVNRT indutível no EPS foram incluídos no grupo PSVT (n = 130) e os pacientes com palpitações sem arritmia induzível no EPS (n = 66) foram incluídos no grupo controle. Testes bioquímicos e de hemograma de rotina foram realizados antes do procedimento de EPS. RESULTADOS: Quando os parâmetros do hemograma foram comparados, não houve diferença estatisticamente significante nos valores de MHP (0,010 (0,001-0,030) vs 0,010 (0,001-0,020) p = 0,67). Além disso, tanto o NLP (2,21 (0,74-11,36) vs 1,98 (0,72-24,87) p = 0,13) quanto o MLP (0,25 (0,03-1,05) vs 0,24 (0,07-1,39) p = 0,41) não foram estatisticamente significantes entre os dois grupos. CONCLUSÃO: Não há diferença significativa nos pacientes com PSVT em relação aos parâmetros do hemograma, incluindo os subtipos de glóbulos brancos, MHP, NLP e MHP. Portanto, a avaliação dos parâmetros do hemograma pode não ser clinicamente relevante para pacientes com PSVT.
Subject(s)
Tachycardia, Paroxysmal , Tachycardia, Supraventricular , Tachycardia, Ventricular , Turkey , Retrospective Studies , ElectrocardiographyABSTRACT
Objetivo. Evaluar los resultados y efectos adversos de la terapia con propranolol en menores de un año con taquicardia supraventricular. Población y métodos. Menores de 1 año con taquicardia supraventricular documentada, que recibieron tratamiento y prevención con propranolol por vía oral. Se analizaron sexo y edad, cardiopatía congénita asociada, pre excitación ventricular en el electrocardiograma basal, recurrencia intratratamiento y efectos adversos. Resultados. Se identificaron 107 pacientes. El primer episodio de taquicardia supraventricular ocurrió a una edad mediana de 190 días. En 10 pacientes, se observó cardiopatía congénita asociada. El 23,3 % presentó pre excitación ventricular en el electrocardiograma basal. El rango de la dosis de propranolol fue de 2 a 5 mg/kg/día. En el 30,8 %, se observó recurrencia intratratamiento. En 2 pacientes, se suspendió la medicación por efectos adversos graves. Conclusión. El propranolol evitó la recurrencia en el 70 % de los casos. En 2 pacientes, fue necesario suspenderlo por efectos adversos graves
Objective. To assess the results and adverse events of propranolol therapy in infants younger than 1 year with supraventricular tachycardia. Population and methods. Infants younger than 1 year with documented supraventricular tachycardia who received oral treatment and prophylaxis with propranolol. Sex and age, associated congenital heart disease, ventricular preexcitation in the base line electrocardiogram, on-treatment recurrence, and adverse events were analyzed. Results. A total of 107 patients were identified. The first supraventricular tachycardia event occurred at a median age of 190 days. Associated congenital heart disease was observed in 10 patients. Ventricular preexcitation in the baseline electrocardiogram was detected in 23.3 %. Propranolol dose ranged from 2 to 5 mg/kg/day. On-treatment recurrence was observed in 30.8 %. Medication was discontinued in 2 patients due to severe adverse events. Conclusion. Propranolol prevented recurrence in 70 % of cases. It was discontinued in 2 patients due to severe adverse events.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Propranolol/therapeutic use , Tachycardia, Supraventricular , Propranolol/administration & dosage , Propranolol/adverse effects , Recurrence , Epidemiology, Descriptive , Heart DiseasesABSTRACT
Resumen: Las taquicardias paroxísticas supraventriculares son arritmias frecuentes y producen importante morbilidad. El estudio electrofisiológico permite hacer el diagnóstico su mecanismo para luego realizar la ablación. El diagnóstico no siempre es sencillo y se debe recurrir a múltiples observaciones y maniobras para alcanzarlo. En la siguiente revisión se discuten los principales criterios usados para el diagnóstico del mecanismo de estas taquicardias durante un estudio electrofisiológico.
Abstract: Paroxysmal supraventricular tachycardias are frequently observed arrhythmias associated to significant morbidity. Electrophysiological study allows the diagnosis of the mechanisms underlying the arrhythmia leading toblation. The diagnosis is not always easy and multiple observations and maneuvers are required to uncover it. In the following review, the main criteria used to diagnose the mechanisms of these tachycardias during an electrophysiological study are discussed.