Comentarios a la guía ESC 2019 sobre taquicardia supraventricular / Comments on the 2019 ESC guidelines on supraventricular tachycardia

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Guía ESC 2019 sobre el tratamiento de pacientes con taquicardia supraventricular / No disponible

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Respuesta al ECG de agosto de 2019 / Response to ECG, August 2019

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Prolonged Tachycardia with Higher Heart Rate Is Associated with Higher ICU and In-hospital Mortality.

Tachycardia is common in intensive care units (ICUs). It is unknown whether tachycardia or prolonged tachycardia affects patient outcomes. We investigated the association between tachycardia and mortality in critically ill patients. This retrospective cohort study's primary outcome was patient mortality in the ICU and the hospital. We stratified the patients (n=476) by heart rate (HR) as LowHR, MediumHR, and HighHR groups. We also stratified them by their durations of HR >100 (prolonged HR; tachycardia): MildT, ModerateT, and SevereT groups. We determined the six groups' mortality. The ICU mortality rates of the LowHR, MediumHR, and HighHR groups were 1.0%, 1.5%, and 7.9%, respectively; significantly higher in the HighHR vs. LowHR group. The in-hospital mortality rates of these groups were 1%, 4.5%, and 14.6%, respectively; significantly higher in the HighHR vs. LowHR group. The ICU mortality rates of the MildT, ModerateT, and SevereT groups were 0.9%, 5.6%, and 57.1%, respectively. The mortality of the HRT=0 (i.e., all HR ≤ 100) patients was 0%. The in-hospital mortality rates of the MildT, ModerateT, and SevereT groups were 1.8%, 16.7%, and 85.7%, respectively; that of the HRT=0 patients was 0.5%. Both higher HR and prolonged tachycardia were associated with poor outcomes.

Diagnosis and management of phantom tachycardias based on an electrophysiologically guided approach.

BACKGROUND: Non-documented palpitations, or phantom tachycardias, are palpitations deemed to be of unknown origin after evaluation with conventional diagnostic tools, such as 12-lead electrocardiogram and Holter recordings. Our aim was to determine the diagnostic value of an electrophysiologic study (EPS) and its role in the management of patients presenting with non-documented palpitations. METHODS: We performed EPS in 78 consecutive patients with repeatable, poorly tolerated symptoms of paroxysmal, non-documented tachycardia, the absence of structural heart disease and at least one 24-h Holter recording. The duration and frequency of palpitations was registered in each patient. RESULTS: Long-lasting palpitations (>1 hour) were present in 15.4% of patients. Half of patients reported symptoms less often than once per week. Only 13/78 patients (16.6%) had normal EPS findings, while dual pathways at the AV node ± echo beats were identified in another 13 patients without inducible tachycardia. At least one tachycardia event was induced in 52 patients (66.6%). AVNRT was provoked in 32 patients (41.2%). Ablation was performed in 14/52 patients with inducible tachycardia (26.9%). Slow pathway ablation was also performed in three patients with dual AV pathways and atrial echo-beats but without provoked tachycardia. Follow-up data were available in 52 patients, and 84.6% had fewer or no clinical recurrences. CONCLUSIONS: EPS is safe and of enhanced diagnostic value in patients with unexplained palpitations because only 1/6 had negative results. EPS also provided an explanation about the mechanism of arrhythmia and successfully guided the management of these patients, as well as enhanced improvement in the quality of life.

Respuesta al ECG de diciembre de 2014 / Response to ECG, December 2014

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Registro Español de Ablación con Catéter. XIII Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2013) / Spanish Catheter Ablation Registry. 13th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2013)

Introducción y objetivos: Se detallan los resultados del Registro Español de Ablación con Catéter del año 2013. Métodos: La recogida de datos se llevó a cabo mediante dos sistemas. De forma retrospectiva con la cumplimentación de un formulario y de forma prospectiva a través de una base de datos común. La elección de una u otra fue voluntaria para cada uno de los centros. Resultados: Se recogieron datos de 80 centros. El número total de procedimientos de ablación fue 11.987, con una media de 149±105 procedimientos. Los tres sustratos abordados con más frecuencia fueron la taquicardia intranodular (n=2.959; 24,6%), la ablación del istmo cavotricuspídeo (n=2.700; 22,5%) y la fibrilación auricular (n=2.201; 18,4%). La ablación de arritmias ventriculares ha permanecido estable, pero han aumentado discretamente los procedimientos sobre las asociadas a cicatriz tras infarto. La tasa total de éxito fue del 94,4%; la de complicaciones mayores, del 1,8% y la de mortalidad, del 0,03%. Conclusiones: En el registro del año 2013 se mantiene una línea de continuidad ascendente en el número de ablaciones realizadas y muestran, en líneas generales, una elevada tasa de éxito y bajo número de complicaciones. Continúa el aumento del abordaje de sustratos más complejos

Introduction and objectives: This report presents the results of the 2013 Spanish Catheter Ablation Registry. Methods: Data were collected using 2 systems: retrospectively by completing a dedicated form and prospectively by reporting to a central database. Each participating center chose 1 of the 2 data collection methods. Results: Eighty centers voluntarily contributed data to the registry. A total of 11 987 ablation procedures were performed, with a mean (standard deviation) of 149 (105) procedures per center. The 3 main arrhythmic substrates treated were atrioventricular nodal reentrant tachycardia (n=2959; 24.6%), cavotricuspid isthmus ablation (n=2700; 22.5%), and atrial fibrillation (n=2201; 18.4%). The number of ventricular ablation procedures was similar to the 2012 activity, but there was a slight increase in procedures for scar-related postmyocardial infarction ventricular tachycardia. The success rate was 94.4%, major complications occurred in 1.8%, and the mortality rate was 0.03%. Conclusions: In line with previous reports, the data from the 2013 registry show a continuing increase in the number of ablations performed. Overall, there was a high success rate and few complications. Ablation of complex substrates has continued to increase

Permanent junctional reciprocating tachycardia in a dog.

A 5-year-old male English Bulldog was presented with a 1-year history of paroxysmal supraventricular tachycardia (SVT) partially responsive to amiodarone. At admission the surface ECG showed sustained runs of a narrow QRS complex tachycardia, with a ventricular cycle length (R-R interval) of 260 ms, alternating with periods of sinus rhythm. Endocardial mapping identified the electrogenic mechanism of the SVT as a circus movement tachycardia with retrograde and decremental conduction along a concealed postero-septal atrioventricular pathway (AP) and anterograde conduction along the atrioventricular node. These characteristics were indicative of a permanent junctional reciprocating tachycardia (PJRT). Radiofrequency catheter ablation of the AP successfully terminated the PJRT, with no recurrence of tachycardia on Holter monitoring at 12 months follow-up.

Orthodromic atrioventricular reciprocating tachycardia conducted with intraventricular conduction disturbance mimicking ventricular tachycardia in an English Bulldog.

Electrocardiographic tracings of an English Bulldog referred for cardiogenic shock due to an orthodromic atrioventricular reciprocating tachycardia conducted with intraventricular conduction disturbance and mimicking ventricular tachycardia (VT) are presented. At admission the surface ECG showed a wide QRS complex tachycardia (WCT) that was converted to sinus rhythm using manual cardioversion (chest thump). This change revealed pre-existing right bundle branch block, and a final diagnosis of supraventricular tachycardia (SVT) with intraventricular conduction disturbance was made. Electrophysiologic study defined the SVT mechanism as an atrioventricular macroreentrant tachycardia mediated by a single mid-septal accessory pathway. The differentiation between various types of WCT is essential when antiarrhythmic therapy is considered. The surface ECG should be systematically evaluated in order to recognize the characteristic features of SVT and VT. Moreover chest thump procedure can be very helpful in the attempt to convert the rhythm to sinus rhythm and to correctly recognize the underlying arrhythmia.

Tratamiento de las arritmias / Treatment of arrhythmias

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Assessing patients for catheter ablation during hospitalization for acute heart failure.

Heart rhythm problems are common among patients who are hospitalized with acute heart failure (HF). Although it is often difficult to determine whether a tachyarrhythmia is the major contributor to an acute HF decompensation or merely a consequence of the decompensation, both issues usually need to be addressed. There is also a subset of patients with HF who have a tachycardia-induced cardiomyopathy (TIC), where the sole cause of the ventricular dysfunction is the heart rhythm problem. In most cases, the management of a tachyarrhythmia in a patient with acute HF is not significantly different than the management of a heart rhythm problem in any patient, but there are several special clinical scenarios and important considerations. These considerations include the time urgency for an intervention, the usual need to be more aggressive and definitive, the need to stabilize a patient to allow for a heart rhythm intervention, such as catheter ablation to be performed safely, and the limitations of antiarrhythmic drugs in patients with ventricular dysfunction. Catheter ablation is a highly effective treatment option for many patients with supraventricular or ventricular tachycardias who are hospitalized with HF. This review will discuss the different types of tachyarrhythmias that can be associated with acute HF and are amenable to catheter ablation, and the assessment that needs to take place in potentially eligible patients to determine when catheter ablation is appropriate.

Arrhythmia discrimination in implantable cardioverter defibrillators using support vector machines applied to a new representation of electrograms.

Arrhythmia classification remains a major challenge for appropriate therapy delivery in implantable cardioverter defibrillators (ICDs). The purpose of this paper is to present a new algorithm for arrhythmia discrimination based on a statistical classification by support vector machines of a novel 2-D representation of electrograms (EGMs) named spatial projection of tachycardia (SPOT) EGMs. SPOT-based discrimination algorithm provided sensitivity and specificity of 98.8% and 91.3%, respectively, on a test database. A simplified version of the algorithm is also presented, which can be directly implemented in the ICD.

Infants and children with tachycardia: natural history and drug administration.

Tachyarrhythmias can occur at any age from the developing fetus through adulthood. However, in deference to adult-onset ischemic cardiac issues, abnormal heart rhythms occurring in the young are often due to developmental alterations of the cardiac conduction tissue, genetically-inherited changes of myocardial cellular ion membrane properties and both pre- and post-surgical repair of associated structural congenital heart anatomical defects. And different from adults, abnormal rhythms occurring in the young can spontaneously disappear with progressive patient growth. Both supra- and ventricular tachyarrhythmias occur in the young although atrial rhythm abnormalities far exceed those of the ventricle. In both, pharmacologic therapies to alter tissue conduction and refractoriness remain the mainstay for initial intervention in the infant and young child, reserving more invasive and potentially harmful ablation therapies for drug-refractory cases. The purpose of the review is to present common and uncommon tachyarrhythmias which can occur in the fetus and throughout infancy. Emphasis will be placed on their electrocardiographic identification, recognition of any associated structural congenital heart defects and recommended pharmacologic management. Drug therapies will be divided according to mechanism of action and discussions of which particular agent is potentially best-suited to treat which specific tachyarrhythmia. A listing of current pharmacologic agents used in the young with appropriate dosages is included.