Ablación de reentrada nodal en vena cava superior izquierda persistente y ausencia de vena cava superior derecha / Nodal re-entry in patient with persistent left superior vena cava and absent right superior vena cava

Resumen La taquicardia por reentrada nodal es la arritmia más frecuente entre las taquicardias supraventriculares paroxísticas; la variedad lenta-rápida es la más común. En muchos casos la ablación de la vía lenta es el tratamiento definitivo y puede llegar a tener alta tasa de éxito y baja frecuencia de complicaciones. La presencia de una vena cava superior izquierda y la ausencia de vena cava superior derecha con drenaje venoso sistémico superior al seno coronario es una malformación congénita poco frecuente, la cual genera alteraciones anatómicas que dificultan el abordaje tradicional para la ablación de esta arritmia. Se presenta el caso de una paciente con esta condición en la que fue exitosa la ablación mediante ecocardiografía intracardiaca y reconstrucción tridimensional.

Abstract Nodal re-entrant tachycardia is the most common arrhythmia among the paroxysmal atrioventricular tachycardias, with the slow-fast variant being the most common. In many cases, the ablation of the slow pathway is the definitive treatment in many cases, often with a high rate of success and low frequency of complications. The presence of a left superior vena cava and the absence of a right superior vena cava with systematic venous drainage above the coronary sinus is a rare congenital malformation that leads to anatomical anomalies. These make it difficult to use the traditional approach for the ablation of this arrhythmia. The case is presented of a patient with this condition in which the ablation was successful using intracardiac echocardiography and three-dimensional reconstruction.

Atrial Fibrillation during General Anesthesia Induction and Paroxysmal Supraventricular Tachycardia on Emergence / 이화의대지

A healthy 35-year-old man who was scheduled for closed reduction of nasal bone fracture developed atrial fibrillation during induction of general anesthesia after intravenous glycopyrrolate injection. During emergence of general anesthesia, atrial fibrillation was suddenly changed to paroxysmal supraventricular tachycardia with 200 beat per minute and lasted for about 10 seconds. Because blood pressure was stable, esmolol was used to reduce ventricular response. At recovery room, ventricular response reduction about 55 beat per minute was observed after intravenous injection of verapamil 5 mg. Thereafter, the rhythm was returned to normal sinus rhythm with bradycardia.

Short-term Result of Radiofrequency Catheter Ablation in Pediatirc Patients with Paroxysmal Tachycardia

PURPOSE: To find out the efficacy, safety and early complication of radiofrequency catheter ablation(RFCA) in pediatric patients with paroxysmal tachycardia, we compared short-term results of RFCA in pediatric patients to adult patients. METHODS: We studied 25 patients(11 pediatric patients, 14 adult patients), who underwent RFCA due to paroxysmal supraventricular tachycardia(PSVT) or idiopathic ventricular tachycardia(VT) from November 1997 to August 1998. We evaluated PSVT or idiopathic VT mechanism and compared total procedure times, total energy durations and complication rates between pediatric patients and adult patients. RESULTS: Among the 25 patients, the mechanisms of tachycardia were atrioventricular reentrant tachycardias in 14 patients, atrioventricular nodal reentrant in 10 patients and idiopathic left ventricular in 1 patient. Among the 11 pediatric patients, atrioventricular reentrant was found in 9 patients, atrioventricular nodal reentrant in 1 patient and idiopathic left ventricular in 1 patient. while among the 14 adult patients, atrioventricular reentrant was found in 5 patients and atrioventricular nodal reentrant in 9 patients. Total procedure time was 190+/-52 minutes in pediatric patients and 161+/-49 minutes in adult patients(P=0.17). Total energy duration was 244+/-223 seconds in pediatric patients and 187+/-122 seconds in adult patients(P=0.45). There were no major complications related to RFCA except minor hematomas at puncture sites. CONCLUSION: Considering the total procedure time, total energy duration and complication rates, there were no significant differences between pediatric patients and adult patients. RFCA showed relatively high success rate and one recurrence after initial success. Thus, we consider RFCA is as a good therapeutic modality which can cure tachycardia, especially PSVT.

Uso de marcapasso implantável no tratamento da taquicardia supraventricular paroxística refratária a terapeutica farmacológica / Treatment of refractory paroxysmal supraventricular tachycardia with an implantable pacemaker

Objetivo - Avaliar o uso de marcapasso antitaquicardia em portadores de taquicardia supraventricular paroxística refratária à farmacoterapia. Casuística e Métodos - Oito casos com implante em posiçäo atrial e um em ventricular. As idades variaram de 32 a 63 anos e a duraçäo dos sintomas de 2 a mais de 40 anos. O tratamento com até seis drogas antiarrítmicas foi ineficaz em todos os casos; a freqüência de crises variou de mensal até 3 vezes ao dia. Quatro pacientes necessitaram cardioversäo das taquicardias, demonstrando em estudo eletrofisiológico, foi a reentrada nodal atrioventricular (AV) em 6 casos e a reentrada AV por via acessória AV em 4 (em 1 paciente contribuíram ambos mecanismos). O acompanhamento pós-implante variou de 2 a 18 meses. Resultados - Todos os pacientes experimentaram significativa melhora. Dois episódios näo interrompidos ocorreram em 2 pacientes; foi observada, em um deles, taquicardia supra ventricular paroxística induzida pelo marcapasso, como conseqüência de taquicardia sinusal. Estes eventos foram resolvidos pela reprogramaçäo. O tratamento farmacológico foi suspenso em 7 pacientes. Conclusäo - A utilizaçäo de marcapasso antitaquicardia demonstrou ser efetiva no tratamento da taquicardia supraventricular paroxística, refratária à farmacoterapia