ABSTRACT
Idiopathic ventricular tachycardia(IVT), which is a clinical entity without any structural heart disease or definite inducing factors, has a low incidence and a good overall prognosis in children, but long-term episode can lead to hemodynamic collapse or even be life-threatening.According to the origin of IVT, the response to drugs and the morphological characteristics of electrocardiogram, it can be divided into different subtypes whose electrophysiological mechanisms are also different.Besides, these is no guideline for the indications and treatment of IVT.This paper summarizes the electrophysiological mechanisms and progress of treatment of idiopathic ventricular tachycardia in children by reviewing the relevant literatures.
ABSTRACT
Objective To study the clinical characteristics and therapy of children with idiopathic ventricular tachycardia(IVT).Method Clinical features,laboratory examination,treatment and outcomes of cases involving 36 children with IVT were retrospectively and statistically analysed.Results IVT often happened in teenagers.The average age of selected patients was 7 years and 8 months,and the ratio of male and female was 1.11.Electrokardiogram(EKG)results showed 23 cases(63.8%)were VT that arised from the left ventricular tachycardia(ILVT)with right bundle branch block,and 13 cases(36%)were VT that arise from the right ventricular outflow tract(RVOT VT)with left bundle branch block.Among the 23 children with tachycardia,15 children had palpitation,2 children had syncope.Of the 13 children with right ventricular tachycardia,3 children had increased heartbeat,and 1 child suffered from weakness,others had no significant clinical symptoms.Cases with ILVT had more serious clinical symptoms than cases with right ventricular tachycardia.It was of marked significance to compare their differences(P
ABSTRACT
Objective To investigate the value of radiofrequency catheter ablation(RFCA) on idiopathic ventricular tachycardia(IVT) in children.Methods The treatment efficiency of 35 patients accepting RFCA from March 2000 to February 2006 was analyzed,which was divided into control group and study group,randomly.The target site of IVT was localized by routine mapping in control group,and study group was localized by routine mapping combining doppler tissue imaging(DTI) on the basic treatment.Results Numbers of discharge,X-ray exposure time in study group were shorter than that in control group.There were no significance of radiofrequency energy,achievement rates and relapse rates between two groups.Conclusions RFCA is a safe and effective method on IVT.Children are localized combined with DTI shall decrease numbers of discharge and X-ray exposure time.
ABSTRACT
Objective To investigate whether taking diastolic potential(DP)and earliest Purkinje potential(PP)as ablation targets together is superior to taking earliest PP alone in patients with left posterior fascicular ventricular tachycardia(VT).MethodsTotally 18 patients who were admitted in our department from May 2006 to May 2009 were enrolled,and the results of their electrophysiological examination were analyzed.According to radiofrequency(RF)ablation targets,patients were classified into 2 groups:DP+PP group(DP and PP as ablation targets together)and PP group(PP as the target alone).Successful RF ablation was established when the ventricular tachycardia was no longer inducible.The acute success rate,recurrent rate,number of ablation application,procedure time,X-ray exposure and complications were compared between DP+PP and PP groups.ResultsThere was 1 case receiving no ablation because of not being induced to clinical VT.Seventeen cases were induced to clinical VT and displayed right bundle branch block(RBBB)and left axis morphology(DP+PP group 7 cases,and PP group 10 cases).All cases were successfully ablated,their DP-Q interval and PP-Q interval were 60.17?8.16 and 30.64?7.19 ms,respectively.There was no significant difference between the 2 groups in the age,ventricular tachycardial cycle,procedure time and recurrent rate.Compared to the PP group,the number of RF application in DP+PP group was fewer(4.55?2.07 vs 7.50?1.64,P=0.04),and X-ray exposure time was a little longer(18.33?1.51 min vs 15.37?2.77 min,P=0.03).There was neither left posterior fascicular block nor other complications seen in the 2 groups.The follow-up period was 14.29?10.05 months,and during this there was 1 case recurrence in DP group(2 months after procedure)and 1 case in PP group(1 month after procedure)respectively.ConclusionThe 2 methods are effective and safe for successful ablation of left posterior fascicular VT.Compared to ablation of earliest PP site alone,ablation of DP+PP might need fewer times of RF application but longer X-ray exposure time.
ABSTRACT
There are a few case reports describing conversion to normal sinus rhythm after a propofol injection in tachyarrhythmic patients. We managed two cases of 52 year old males complaining of chest pain and dyspnea. We diagnosed them with atrial flutter and idiopathic ventricular tachycardia respectively. Initially they were treated with antiarrhythmic drugs but conversion to normal sinus rhythm was not achieved. Therefore, we decided to use electrical cardioversion. For sedation during electrical cardioversion, we injected propofol 2 mg/kg and 2% lidocaine 1 mg/kg. A few seconds later, conversion to normal sinus rhythm was achieved without electrical cardioversion in both cases. Thereafter normal sinus rhythm continued on the ECG and they were discharged.
Subject(s)
Humans , Male , Middle Aged , Anti-Arrhythmia Agents , Atrial Flutter , Chest Pain , Dyspnea , Electric Countershock , Electrocardiography , Lidocaine , Propofol , Tachycardia, VentricularABSTRACT
A 31-year-old female patient suffering from hemoptysis was scheduled for a lobectomy. Her preoperative electrocardiogram was normal sinus rhythm and electrolytes were within normal range. During mask ventilaton a short run of ventricular tachycardia appeared, but she returned to normal sinus rhythm after lidocaine 60 mg was injected. However, after intubation, sustained ventricular tachycardia developed and did not respond to additional lidocaine immediately. Blood gases and electrolytes were in acceptable range and severe hypotension did not occur during the attack. Several minutes later, the rhythm changed spontaneously to sinus rhythm with intermittent premature ventricular contractions. However, stimuli such as position change and endotracheal suctioning caused another paroxysmal ventricular tachycardia. Idiopathic ventricular tachycardia was suspected and esmolol 30 mg was injected. Ventricular tachycardia terminated abruptly and changed to sinus rhythm so that the lobectomy was done successfully with a continuous infusion of esmolol. We are going to report this clinical experience with review of its mechanism, treatment, and long term prognosis.
Subject(s)
Adult , Female , Humans , Electrocardiography , Electrolytes , Gases , Hemoptysis , Hypotension , Intubation , Lidocaine , Masks , Prognosis , Reference Values , Suction , Tachycardia, Ventricular , Ventricular Premature ComplexesABSTRACT
Objective To study the role of ventricular responses(VR) in radiofrequency catheter ablation (RFCA) of idiopathic ventricular tachycardia(VT).Methods Thirteen patients underwent RFCA by using a combination of surface ECG,activition mapping and VR.The ablation targets were primarily selected by activition mapping and was determined by the VR in RFCA,and then,the final ablation target was determined and ablated where VR and VT had the same ECG results.Results Thirteen patients were successfully ablated.The VRs showed:the VR induced by RFCA in sinus rhythm was just the same as VT;intermittent sinus rhythm appeared between VT;two couple or couplets,or premature beats appeared intermittently in sinus rhythm,and finally sinus rhythm appeared;the VR induced by RFCA was not the same as VT.Conclusion The ablation target should be the site where the VR induced by RFCA is just the same as VT;the occurence of VR that is just the same as VT can be the predictor of successful ablation.
ABSTRACT
BACKGROUND: Radiofrequency catheter ablation therapy of idiopathic ventricular tachycardia in patients without obvious structural heart disease has been assessed in a few studies, but the clinical feasibility and efficacy are not certain. This study reports our results of catheter ablation with radiofrequency energy in thirteen patients. METHODS: Thirteen consecutive patients with idiopathic ventricular tachycardia underwent electrophysiologic study, pharmacological interventions and radiofrequency catheter ablation therapy. RESULTS: There were 7 men and 6 women with a mean age of 34+/-11years(13-55 years). The QRS configuration during tachycardia were left bundle branch block and inferior axis in 5 patients, right axis in 1 patient and right bundle branch block configuration with superior axis in 4 patients, right axis in 2 patients, left axis in 1 patients. Mean tachycardia cycle length was 361 +/-20 milliseconds. The focus of ventricular tachycardia were located in the right ventricular outflow tract(six patients) and the left ventricular inferior wall(four patients), posterobasal wall(one patients), anterolateral wall(one patients). Ventricular tachycardias were electrically induced in 9/13 patients. Mapping and radiofrequent catheter ablation was done with standard technique and ventricular tachycardia or VPCs were successfully eliminated in nine patients(69.2%). One patients complicated with transient pleural effusion. During mean follow-up period of 12+/-3months, one patients had a recurrence of symptomatic ventricular tachycardia. CONCLUSION: Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease is effective and safe and may be considered as primary choice of therapy in the patients.