Subject(s)
Catheter Ablation/methods , Tachycardia, Paroxysmal/surgery , Tachycardia, Supraventricular/surgery , Adult , Echocardiography , Electrocardiography , Electrophysiologic Techniques, Cardiac , Humans , Male , Recurrence , Reoperation , Tachycardia, Paroxysmal/complications , Tachycardia, Paroxysmal/diagnosis , Tachycardia, Supraventricular/complications , Tachycardia, Supraventricular/diagnosis , Transposition of Great Vessels/complications , Transposition of Great Vessels/diagnostic imaging , Treatment Outcome , Tricuspid Valve Insufficiency/complications , Tricuspid Valve Insufficiency/diagnostic imagingABSTRACT
Although persistent left superior vena cava (PLSVC) is the most common major venous anomaly of the heart, associated absence of the right superior vena cava with normal visceral situs is exceedingly rare. Such a patient presented with complete heart block requiring permanent pacing. This was achieved successful using a single lead VDD system via the PLSVC with atrial sensing in the coronary sinus.
Subject(s)
Cardiac Pacing, Artificial/methods , Heart Block/therapy , Pacemaker, Artificial , Vena Cava, Superior/abnormalities , Heart Block/etiology , Humans , Male , Middle AgedABSTRACT
The slow AV nodal pathway was ablated selectively in a 62-year-old man with uncontrolled rapid atrial fibrillation. This resulted in a much slower ventricular response without the need for permanent pacing. The pathophysiology is discussed.
Subject(s)
Atrial Fibrillation/surgery , Atrioventricular Node/surgery , Catheter Ablation , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/physiopathology , Flecainide/therapeutic use , Humans , Male , Middle Aged , Ventricular Function/physiologyABSTRACT
Intravenous verapamil was given to two haemodynamically stable patients with persistent atrial tachycardia, resulting in circulatory arrest requiring CPR in one and collapse with unrecordable blood pressure in the other. Both responded to resuscitation and tachycardia was subsequently controlled with propranolol in one and sotalol in the other. Factors contributing to the cardiovascular collapse included: (i) left ventricular dysfunction; and (ii) failure to convert the tachycardia to sinus rhythm. It was concluded that verapamil may be dangerous in supraventricular tachycardia not due to atrioventricular (AV) junctional re-entry, despite normal blood pressure and perfusion, particularly if left ventricular dysfunction were present. If the diagnosis of AV junctional re-entry is in doubt, adenosine is preferable as it is less likely to cause haemodynamic collapse and will assist in making the diagnosis.
