Assessment of the hemogram parameters in patients with paroxysmal supraventricular tachycardia: a retrospective study

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.

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.

Enfoque en el diagnóstico diferencial de las taquicardias paroxísticas supraventriculares en el Laboratorio de electrofisiología / Differential diagnosis of paroxysmal supraventricular tachycardia at the electrophysiology laboratory

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.

Um conto de duas ttaquicardias / A tale of two tachycardias

Relato de caso de um paciente de 78 anos de idade, portador de marcapasso dupla-câmara há mais de 10 anos por doença do nó sinusal, bloqueio atrioventricular de primeiro grau e bloqueio de ramo direito, que se apresentou com taquicardia de QRS largo incessante e alternância de morfologia do QRS entre deflagração e inibição do canal ventricular

We describe the case of a 78-year-old patient who received a dual-chamber pacemaker implant ten years ago due to sick sinus syndrome, first degree heart block and right bundle branch block and now presents with an incessant wide QRS tachycardia with alternating morphology between deflagration and inhibition of the pacemaker's ventricular channel

Spontaneous Transition of Double Tachycardias with Atrial Fusion in a Patient with Wolff-Parkinson-White Syndrome

Among patients with Wolff-Parkinson-White syndrome, atrioventricular reciprocating tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) can coexist in a single patient. Direct transition of both tachycardias is rare; however, it can occur after premature atrial or ventricular activity if the cycle lengths of the two tachycardias are similar. Furthermore, persistent atrial activation by an accessory pathway (AP) located outside of the AV node during ongoing AVNRT is also rare. This article describes a case of uncommon atrial activation by an AP during AVNRT and gradual transition of the two supraventricular tachycardias without any preceding atrial or ventricular activity in a patient with preexcitation syndrome.

Dos décadas de seguimiento exitoso de la primera ablación de arritmias por catéter de radiofrecuencia realizado en la historia de la medicina del Paraguay / Two decades of succesful follow-up of the first radiofrequency catheter arrhythmia ablation done in the history of medicine in Paraguay

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.

Long-term Prognosis of Paroxysmal Atrial Fibrillation and Predictors for Progression to Persistnt or Chronic Atrial Fibrillation in the Korean Population

Little is known about the long-term prognosis of or predictors for the different clinical types of atrial fibrillation (AF) in Korean populations. The aim of this study was to validate a risk stratification to assess the probability of AF progression from paroxysmal AF (PAF) to persistent AF (PeAF) or permanent AF. A total of 434 patients with PAF were consecutively enrolled (mean age; 71.7 +/- 10.7 yr, 60.6% male). PeAF was defined as episodes that are sustained > 7 days and not self-terminating, while permanent AF was defined as an ongoing long-term episode. Atrial arrhythmia during follow-up was defined as atrial premature complex, atrial tachycardia, and atrial flutter. During a mean follow-up of 72.7 +/- 58.3 months, 168 patients (38.7%) with PAF progressed to PeAF or permanent AF. The mean annual AF progression was 10.7% per year. In univariate analysis, age at diagnosis, body mass index, atrial arrhythmia during follow-up, left ventricular ejection fraction, concentric left ventricular hypertrophy, left atrial diameter (LAD), and severe mitral regurgitation (MR) were significantly associated with AF progression. In multivariate analysis, age at diagnosis (P = 0.009), atrial arrhythmia during follow-up (P = 0.015), LAD (P = 0.002) and MR grade (P = 0.026) were independent risk factors for AF progression. Patients with younger age at diagnosis, atrial arrhythmia during follow-up, larger left atrial chamber size, and severe MR grade are more likely to progress to PeAF or permanent AF, suggesting more intensive medical therapy with close clinical follow-up would be required in those patients.

Simultaneous antegrade dual AV node conduction initiates AV nodal re-entrant tachycardia [a rare initiation mechanism]

Typical atrioventricular nodal reentrant tachycardia [AVNRT] is the most common paroxysmal supraventricular tachycardia among adults. The concept of dual pathway physiology remains widely accepted, although this physiology likely results from the functional properties of anisotropic tissue within the triangle of Koch, rather than anatomically distinct tracts of conduction. AVNRT is typically induced with anterograde block over the fast pathway and conduction over the slow pathway, with subsequent retrograde conduction over the fast pathway. On rare occasions, anterograde AV node conduction occurs simultaneously through fast and slow pathways resulting in two ventricular beats in response to one atrial beat. We report a case of AVNRT where the tachycardia is always induced by the same mechanism described above. Successful ablation was achieved by slow pathway modification

Myocardial Ischemia Caused by Paroxysmal Supraventricular Tachycardia in a Patient with Anomalous Origin of Right Coronary Artery Arising from Left Sinus of Valsalva

Anomalous origin of a coronary artery is rare and does not generally lead to myocardial infarction and paroxysmal supraventricular tachycardia (PSVT). We report an uncommon case of anomalous origin of the right coronary artery (RCA) originating from the left sinus of Valsalva with PSVT and myocardial ischemia. A 58-year-old man presented with PSVT. After arrhythmia subsided, electrocardiogram showed ST and T wave abnormalities, and transient cardiac enzymes were found to be elevated. Coronary CT angiography confirmed that there was anomalous origin of the RCA originating from the left sinus of Valsalva and no intracoronary stenotic lesion. He was managed with conservative treatment, having no symptoms on clinical follow-up for 4 years.

Myocardial Ischemia Caused by Paroxysmal Supraventricular Tachycardia in a Patient with Anomalous Origin of Right Coronary Artery Arising from Left Sinus of Valsalva

Anomalous origin of a coronary artery is rare and does not generally lead to myocardial infarction and paroxysmal supraventricular tachycardia (PSVT). We report an uncommon case of anomalous origin of the right coronary artery (RCA) originating from the left sinus of Valsalva with PSVT and myocardial ischemia. A 58-year-old man presented with PSVT. After arrhythmia subsided, electrocardiogram showed ST and T wave abnormalities, and transient cardiac enzymes were found to be elevated. Coronary CT angiography confirmed that there was anomalous origin of the RCA originating from the left sinus of Valsalva and no intracoronary stenotic lesion. He was managed with conservative treatment, having no symptoms on clinical follow-up for 4 years.

Taquicardias supraventriculares na sala de emergência: uma revisão para o clínico / Supraventricular tachycardia in emergency room: a review for the clinician

JUSTIFICATIVA E OBJETIVOS: As taquicardias supraventriculares (TSV) são arritmias frequentes no setor de urgência e emergência. Este estudo teve como objetivo revisar a abordagem diagnóstica inicial e a terapêutica das TSV. CONTEÚDO: As taquicardias com complexo "QRS" estreito (< 120 ms) e frequência cardíaca superior a 150 bpm devem receber especial atenção do emergencista. Após avaliação clínica inicial, o médico deve identificar e tratar possíveis causas associadas e monitorizar o paciente. Na presença de instabilidade hemodinâmica, a cardioversão el¨¦trica sincronizada deve ser prontamente realizada.Caso contrário, um eletrocardiograma de 12 derivações fornecer subsídios para uma análise mais precisa do ritmo, guiando o tratamento mais adequado para cada tipo específico de taquicardia. Em algumas situações, a avaliação do especialista deve ser considerada. CONCLUSÃO: O conhecimento das recomendações na abordagem das TSV é essencial para o médico emergencista. Cardioversão elétrica deve ser realizada em todos os pacientes instáveis e medidas para o tratamento da causa e terapia elétrica e/ou farmacológica devem ser consideradas nas diferentes situações clinicas e eletrocardiográficas.

BACKGROUND AND OBJECTIVES: The supraventricular tachycardias (SVT) arrhythmias are common in the emergency room. This study aimed to review the initial diagnosis and treatmentof SVT. CONTENTS: The complex tachycardias with "QRS" narrow (< 120 ms) and heart rate ¡Ý 150 bpm should receive special attention of the emergency. After initial clinical evaluation, the clinician should identify and treat possible associated causes and monitor the patient. In the presence of hemodynamic instability, synchronized electrical cardioversion should be performed promptly. Otherwise, a 12-lead electrocardiogram provide subsidies to a more precise analysis of rhythm, guiding the most appropriate treatment for each specific type of tachycardia. In some situations, the expert assessment should be considered. CONCLUSION: Knowledge of the recommendations in addressing SVT is essential for the emergency physician. Electrical cardioversion should be performed in all patients and unstable measures to treat and cause electrical therapy and/or drugs hould be considered in different clinical situations and electrocardiographic.

Trastorno del ritmo poscierre del foramen oval con dispositivo Amplatzer PFO® / Rhythm disorder post-closure of the foramen ovale with Amplatzer PFO® device

Presentamos el caso clínico de una paciente de 53 años que consultó con síntomas neurológicos compatibles con un ataque isquémico transitorio. Se encontró un desorden protrombótico y un foramen oval permeable, sin otra explicación para la enfermedad. Se decidió cerrarlo por vía percutánea mediante un dispositivo Amplatzer PFO® y no hubo complicaciones durante el procedimiento. A los 15 días del alta comenzó con palpitaciones rápidas y se demostró una taquicardia auricular paroxística recurrente. Se inició tratamiento farmacológico con propafenona que logró controlar la arritmia y el síntoma. A los tres meses se suspendió la medicación. Transcurridos seis meses la paciente está asintomática, con electrocardiograma normal y un Holter sin la arritmia. Revisamos la literatura disponible sobre los trastornos del ritmo luego del cierre percutáneo del foramen oval y comunicación interauricular.

We report the case of a 53 years old woman who presents with neurologycal symptoms suggestive of a transient ischemic attack. A prothrombotic disorder and patent formen oval were found, with no other explantion for the disease. It was decided to closed the foramen with a percutaneously implanted Amplatzer PFO® device and there were no incidents during the procedure. Fiftheen days after hospital discharge she began to refere rapid palpitations and a paroxistic recurrent atrial tachycardia was documented. Pharmacological therapy with propafenone was initiated and it was able to control the arrhythmia and the symptoms. Three months later the drug was discontinued. After 6 months follow up the patient is asymptomatic, with a normal EKG and a Holter without arrhythmias. We review the available literature about rhythm disorders after the percutaneus closure of the foramen oval and interatrial comunication.

Ablação por cateter na população pediátrica: indicações, cuidados e resultados / Catheter ablation in the pediatric population: indications, results and care

A ablação percutânea com radiofrequência (RF) foi introduzida em 1987 para tratamento de adultos com taquicardias paroxísticas supraventriculares, tornando-se o tratamento de escolha para uma variedade de arritmias na população pediátrica já em 1989. Com os avanços tecnológicos na emissão controlada de RF e o desenvolvimento de cateteres deflectíveis de diâmetro pequeno, a ablação com cateter tornou-se o tratamento de primeira escolha para tratamento das taquicardias na população pediátrica evitando o uso prolongado de fármacos antiarrítmicos. Entretanto, a utilização de RF em crianças menores de 5 anos e em recém-nascidos com arritmias, ainda é controvertida. Sem dúvidas existem múltiplas variáveis que aumentam a complexidade deste procedimento na população pediátrica, tais como: menor superfície corporal, órgãos com menores dimensões maior dificuldade para obter os acessos vasculares, as possíveis variações anatômicas devido à presença de cardiopatia congênita, os potenciais efeitos deletérios da aplicação de RF sobre as células em desenvolvimento e a exposição à radiação em idade tão precoce aumenta o risco de doenças neoplásicas ao longo da vida quando comparados com a população adulta.

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.

Arritmias en el embarazo / Arrhythmias during pregnancy

Las arritmias durante el embarazo son eventos de aparición frecuente. Desde las extrasístoles aisladas hasta las taquiarritmias, capaces de poner en riesgo las vidas materna y fetal, constituyen el amplio espectro de presentación. Muchas de ellas exigen intervenciones de urgencia, tratamientos crónicos o ambos. La comunicación de este caso nos motivó a realizar una revisión de las indicaciones y posibilidades farmacológicas de las taquicardias paroxísticas supraventriculares en este período particular de la mujer. El fármaco de elección para el manejo agudo de las taquicardias paroxísticas supraventriculares es la adenosina. Este agente debería encontrarse siempre en el área de quirófano al alcance de los anestesiólogos, para un manejo terapéutico de urgencia. La conducta obstétrica estará marcada por el estado hemodinámico de la madre y del feto.

Arrhythmias during pregnancy are frequent events. There is a wide spectrum of presentations: from isolated extrasystoles to tachyarrhythmias with risk to mother and fetal life. Many of these arrhythmias need urgent interventions and/or chronic treatment. The communication of this clinical case motivated us to realize a review of the indications and pharmacological possibilities in paroxysmal tachyarrhythmias in this particular period in women. Adrenosine is the pharmacological treatment of choice to manage paroxysmal supraventricular tachyarrhythmias. This drug should always be at hand in the operating theater, to be used by the anesthesiologists for the therapeutic managing of the emergencies. Obstetric clinical conduct will depend on the haemodynamic condition of the mother and the fetus.

As arritmias durante a gravidez são eventos de ocorrência freqüente. Desde as extrassístoles isoladas até as taquiarritmias, que podem pôr em risco as vidas materna e fetal, constituem o amplo espectro de apresentação. Muitas delas exigem intervenções de urgência, tratamentos crônicos ou ambos. Este caso nos estimulou a fazer uma revisão das indicações e possibilidades farmacológicas das taquicardias paroxísticas supraventriculares nesse período da mulher. O fármaco de escolha para o manejo agudo das taquicardias paroxísticas supraventriculares é a adenosina. Este agente deveria estar sempre disponível na sala de operações, ao alcance da mão dos anestesiologistas, para um manejo terapêutico de urgência. A conduta obstétrica estará marcada pelo estado hemodinâmico da mãe e do feto.

A retrospective study of 4865 cases of paroxysmal supraventricular tachycardia treated with catheter ablation / 生物医学工程学杂志

In recent 10 years, using radiofrequency catheter ablation, our medical center has treated 4865 cases of paroxysmal supraventricular tachycardia (PSVT). To improve clinical practice, a retrospective analysis of this group was made. In this group, 2092 cases were atrioventricular reentry tachycardia (AVRT), including 1415 left accesory pathway and 677 right accesory pathway, and 2773 cases were atrioventricular nodal reentry tachycardia (AVNRT). The total success rate of radiofrequency treatment is 99.71%; the recurrence rate after half a year 1.73%; the total complication rate 1.25%. In conclusion, radiofrequency ablation is a safe and effective treatment for tachycardia with high rate of success and low rate of complication.

Ablación por radiofrecuencia de fibrilación auricular paroxística y persistente / Radiofrequency ablation of paroxysmal and persistent atrial fibrillation

La ablación por radiofrecuencia (ARF) es aceptada en la actualidad como tratamiento de la fibrilación auricular (FA) paroxística y persistente. El objetivo del presente trabajo es comparar los resultados de la ablación por radiofrecuencia con diferentes técnicas...

Radiofrequency catheter ablation (RFA) is one of the currently accepted treatments for paroxysmal and persistent atrial fibrillation (AF). Different approaches are currently used. To analyze the results of RFA in patients (pts.) with paroxysmal and persistent AF performing different techniques...