ABSTRACT
A 44-year-old man had persistent fever following a severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. Because of progressive sinus tachycardia, thyroid hormones were measured which showed hyperthyroidism. Thyroid sonography revealed enlargement of the thyroid gland with hypoechoic areas with blurred margins. We diagnosed subacute granulomatous thyroiditis associated with SARS-CoV2 infection and initiated therapy with prednisolone. This therapy resulted in rapid improvement of the patient's clinical condition and complete remission after three months.
Subject(s)
COVID-19 , Fever of Unknown Origin , Thyroiditis, Subacute , Adult , COVID-19/complications , Fever of Unknown Origin/complications , Humans , Male , SARS-CoV-2 , Thyroiditis, Subacute/complicationsABSTRACT
We report 3 adolescents with structurally normal heart who were referred to hospital due to long-lasting palpitations. Initial 12-lead-ECG showed sustained, monomorphic ventricular tachycardia, right bundle branch block QRS morphology and axis deviation. After failure of different anti-arrhythmic drugs finally the intravenous medication with verapamil led to termination of ventricular tachycardia in all three patients. All clinical findings and the responsiveness to verapamil are consistent with the diagnosis of idiopathic left ventricular tachycardia. In one patient an electrophysiological study was done and increased left ventricular vulnerability was shown. After inducing a tachycardia originating from the left ventricle radiofrequency catheter ablation of the left-posterior fascicle was successfully performed. The tachycardia was not inducible after this ablation. Since that investigation the patient has been asymptomatic without anti-arrhythmic treatment. Two of three patients have been on oral verapamil prophylactically and have been free of symptoms.
Subject(s)
Bundle-Branch Block/diagnosis , Electrocardiography , Tachycardia, Ventricular/diagnosis , Administration, Oral , Adolescent , Anti-Arrhythmia Agents/administration & dosage , Bundle-Branch Block/therapy , Cardiac Pacing, Artificial , Catheter Ablation , Follow-Up Studies , Humans , Infusions, Intravenous , Long-Term Care , Male , Tachycardia, Ventricular/therapy , Verapamil/administration & dosageABSTRACT
AIMS: We describe a new strategic stepwise mapping approach for fast and accurate identification and ablation of ectopic atrial foci using an electroanatomic mapping system. METHODS AND RESULTS: Mapping procedures started with the acquisition of four points at the superior/septal part of the tricuspid annulus. According to this activation sequence, maps were continued towards the right atrial free wall if relatively early activation was shown at the superior part of the initial map or towards the triangle of Koch and, if necessary, to the left atrium, in cases of relatively early activation at the septum. High density mapping and detailed electrogram analysis only of the target area allowed identification and ablation of 34 foci in 30 of the 32 studied consecutive patients. A small number of mapping points were sufficient within a procedure time of 90 +/- 41 min for right 148 +/- 68 min and for left sided foci and a total fluoroscopy time of 9.6 +/- 7.2 min and 24.8 +/- 16.4 min respectively. Sixteen foci were located at the right free wall, eight at the left free wall, and 10 at the right or left side of the septum. CONCLUSION: Strategic electroanatomic mapping with fast identification of the area of tachycardia origin and high density mapping only of this target area allowed fast and successful localization and ablation of right and left free wall and septal ectopic atrial foci.
