Attacks Of Supraventricular Tachycardia Research Articles

Managing SVT attacks in NICU: A single tertiary center experience

Aim: This study aimed to assess the efficiency of adenosine and amiodarone in ceasing supraventricular tachycardia (SVT) attacks and enduring 1-hour attack-free period in neonates. Materials and Methods: We included all SVT attacks detected in our NICU and recorded adenosine success in enduring 1-hour attack-free period, postnatal day, birth week, and clinical status. All patients underwent vagal maneuvers as the initial intervention; then, they were administered intravenous adenosine via a central line, the dose of which was increased from 0,05 mg/kg/dose up to 0.2 mg/kg/dose if the SVT attack persisted. We included each SVT attack separately. Results: We observed 21 SVT attacks (gestational age 39.8+/-2.3 weeks) in 10 patients. There was a significant correlation between adenosine success and the postnatal day for SVT attacks (Kendall’s tau b: 0.584, p=0.002). Multivariate analysis showed that the most effective confounder for adenosine success was the postnatal day [odds ratio 1.9 (%95 CI: 1.03-3.5) per day]. Intravenous amiodarone loading therapy aborted SVT attack in all adenosine-resistant patients. Conclusion: Amiodarone infusion may be considered earlier in cases where there is a need for repeated adenosine, especially in the early neonatal period.

The Effectiveness of Adenosine in Treating the Acute Attacks of Supra-ventricular Tachycardia

Background: Adenosine is a natural adenine nucleoside available endogenously that decreases heart beat by blocking atrioventricular (AV) node transiently so that extend the duration of conduction in (AV) node when injected intravenously. It has a curative value in the conversion of majority of supraventricular tachycardia (SVT) to sinus rhythm. In order to evaluate the adenosine in the management of arrhythmias we conduct this study. Objective: This study was conducted to evaluate the safety and efficacy of intravenous adenosine therapy for treatment of (SVT), to determine the optimal adenosine dose effective in (SVT), and to determine the underlying conditions affecting the effective dose. And to evaluate the effectiveness of vagal maneuvers in terminating of spontaneous SVT patients and methods: A cross-sectional study conducts in a group consist of 69 patients ranged from 23-70 years old admitted to the Coronary care unit in Azadi Teaching Hospital ,in Kirkuk city, from July 2014 to June 2016. The diagnosis of (SVT) was made by present of tachycardia which is of narrow complex with a heart beat rate greater than 140 beats/ min by 12 leads chest electrocardiography (ECG). In patients who are hemodynamically stable, vagal maneuvers were carried out initially in the form of carotid sinus massage, gag reflex and Valsalva maneuver, if this failed intravenous administration of adenosine as recommended doses were preformed. If three doses of adenosine boluses were unsuccessful to convert the arrhythmia, patients were managed with other available antiarrythmias or managed with direct electrical cardio version (DC). In unstable patients were managed with (DC). Results: Of 69 included patients, diagnosed as (SVT), M: F ratio was 1:2.1. Their age ranged from 23 years to 70 years with mean age of 57 years. Vagal maneuvers (VM) resulted in restoration of sinus rhythm (SR) in 8patients (7.6%). Out of 57 episodes of (SVT), Adenosine was effective in reverting 51 episodes of SVT to sinus rhythm (89.5%). Of those converted, 18 required a single dose (6mg) (31.6%), fifteen required one additional (12mg) dose (26.3%), and another 18 required two additional doses (81mg) (31.6%).four patients were hemo-dynamically unstable (systolic blood pressure <90 mm Hg) which required (DC). Six patients (10.5%) not responding to full adenosine dose(81mg), started treatment with other medication, 1 with verapamil, 4 with amiodarone, and1 with digoxin. All of them were successfully treated. Conclusions: Adenosine is an effective medicine in treating (SVT) in those patients in whom vagal maneuvers has unsuccessful. It demonstrates a high rate of success in terminating acute attack of SVT. A higher dose may be required in majority of patients specially

Supraventricular Tachycardia Induced by Nasal Continuous Positive Airway Pressure

The use of noninvasive ventilation in the treatment of respiratory failure has increased in recent years. Nasal continuous positive airway pressure, a noninvasive method of ventilation, is thought to decrease the incidence of arrhythmias, but this case report presents supraventricular tachycardia attacks secondary to nasal continuous positive airway pressure. A 15-month-old boy was admitted to the intensive care unit with diagnoses of sepsis, disseminated intravascular coagulopathy, acute renal failure, and myocarditis. Supraventricular tachycardia attacks started after nasal continuous positive airway pressure but became regular after switching to invasive mechanical ventilation.

A Cardiac cephalalgia attacks provoked by Prinzmetal angina - a case report

A 51-year-old man with no past medical history of headache or risk factors for vascular diseases was diagnosed with supraventricular tachycardia (SVT) in 2005. In 2014 SVT attacks were longer and always followed by severe headache attacks. Accompanying symptoms were dizziness, non-rotational vertigo, confusion, episodes of double vision and tinnitus; these symptoms would last one day, followed by severe tiredness for 2 days. Neurologic and cardiologic evaluation as well as extensive diagnostic test between the attacks was normal. Catheter coronarography showed no stenoses but did show spasms in distal left anterior descending artery. A remarkable effect on SVT and headaches was shown after the introducement of diltiazem. The diagnosis cardiac cephalalgia (CC) was established. As our case report is unique, we hope that our observations will help cardiologists and neurologists to better understand and treat patients with CC. CC should be distinguished from migraine, to avoid prescribing triptans and vasoconstrictors.

Pregnancy with pre-excitation syndrome influence on pregnancy outcomes

Objective: To investigate the characteristics of pregnancy with pre-excitation syndrome and its influence on pregnancy outcomes. Methods: A retrospective analysis was made on the clinical data of 62 cases of pregnancy complicated with pre-excitation syndrome in Beijing Anzhen Hospital from Jan. 2008 to Dec. 2008. According to whether there was a supraventricular tachycardia (SVT) in pregnancy, they were divided into two groups. There were 16 pregnant women in the SVT seizure group during pregnancy, and 46 pregnant women in no SVT seizure group, with a multi-disciplinary comprehensive diagnosis and treatment model. SPSS software was used to analyze the data and compare the gestational age, age and weight of the newborn, and then compare the pregnancy outcomes. Results: (1) The total number of deliveries in Beijing Anzhen Hospital during the study period was 21 786, and the patients with pregnancy combined with pre-excitation syndrome account for 0.28% (62/21 786). (2) Totally 44 patients (71%, 44/62) were diagnosed with pre-excitation syndrome before pregnancy, and 18 patients (29%, 18/62) were diagnosed for the first-time during pregnancy. Among patients diagnosed with pre-excitation syndrome before pregnancy, 16 patients (36%, 16/44) had seizures before pregnancy, 28 patients (64%, 28/44) had asymptomatic before pregnancy, and 4 of asymptomatic patients had SVT during pregnancy. (3) Of the 16 pregnant women in the SVT seizure group during pregnancy, 2 patients (2/16) had SVT episodes in the first trimester, 5 patients (5/16) had SVT episodes in the second trimester, 9 patients (9/16) had SVT episodes in the third trimester. In the SVT seizure group, 8 patients (8/16) had SVT episodes before pregnancy, and 8 patients (8/16) had no SVT episodes before pregnancy. There were 46 patients in the SVT seizure-free group during pregnancy, including 9 patients with SVT attacks before pregnancy and 37 patients without SVT before pregnancy. (4) Compared with the pregnant women in the SVT seizure group, the age, weight gained during pregnancy, delivery gestation week, newborn weight, and the time of the first and second labors were not statistically different between the two groups of pregnant women (all P>0.05). However, the total duration of labor in the SVT seizure group during pregnancy was shorter and pre-pregnancy weight was lower (all P<0.05). The rate of cesarean section in pregnant women with SVT attack was 12/16, and the rate of cesarean section in pregnant women without SVT was 50% (23/46; P=0.051). No pregnant woman had an arrhythmia during delivery. Conclusions: SVT episode in patients during pregnancy most occurs in the third trimester. Patients who are asymptomatic before pregnancy may also have SVT during pregnancy. Pre-excitation syndrome patients with SVT attacks during pregnancy increase adverse pregnancy outcomes. Multidisciplinary comprehensive management could effectively control pregnant women with pre-excitation syndrome, effectively reduce the occurrence of serious arrhythmia risk events during pregnancy, so that most patients could get good pregnancy outcomes.

The relationship between blood glucose and nocturnal supraventricular tachycardia attacks in non-diabetic patients.

Decrease in the blood glucose level may trigger the tachycardia or bradycardia because it has an arrhythmogenic effect on the heart. Our purpose in this study was to investigate whether the blood glucose level has an effect on patients who attended to the hospital with nocturnal supraventricular tachycardia (SVT). We included 151 patients in our study who have SVT history. Plasma glucose levels which were taken during night hours, electrolytes, and 12 lead electrocardiography were evaluated. There were 105 patients without nocturnal SVT attack and 46 patients with nocturnal SVT attack. Patients with nocturnal SVT attack, blood glucose level, potassium, calcium, and hemoglobin levels were significantly lower, hs-CRP was significantly higher, basal cycle length (BCL) was significantly short, and QT interval was significantly longer. It was found that blood glucose (O.R. = 0.904, 95% GA 0.828-0.986, p = 0.023) and potassium levels (O.R. = 0.128, 95% GA 0.029-0.561, p = 0.006) and basal cycle length (BCL) (O.R. 0.988, 95% GA, 0.980-0.996, p = 0.005) values were in independently correlated with nocturnal SVT attacks. The decrease in blood glucose level of the patients who are being followed with SVT diagnosis might trigger the nocturnal SVT attacks.

Antenatally diagnosed fetal cardiac tumor associated with tuberous sclerosis

Term male baby was born by normal vaginal delivery. The mother was followed-up in fetomaternal unit. Ultrasound report showed a huge mass arising externally from left ventricle free wall with multiple intracardiac masses with moderate pericardial effusion. A possibility of rhabdomyoma was considered. Baby was born with poor respiratory effort needed resuscitation and mechanical ventilation. Immediate postnatal echocardiography confirmed the presence of the extra and intra cardiac masses. Baby remained hemodynamically stable, developed one attack of supraventricular tachycardia and heart failure for which medical treatment given. Investigations confirmed the presence of tuberous sclerosis complex in this baby including magnetic resonance imaging and computed tomography (CT) scan that showed multiple subcortical and periventricular tubers'. CT abdomen showed angiomyolipoma of the left kidney, which disappeared completely after that. Baby remained free from neurological symptoms, discharged home on oral propranolol with multidisciplinary outpatient follow-up. His cardiac masses regressed significantly over his 2 years of life

A Rare Rhythm Abnormality in Acute Rheumatic Fever: Supraventricular Tachycardia

Different kinds of rhythm and conduction disturbances may be seen during the course of acute rheumatic fever (ARF), one of the most frequently seen disorder being the first degree atrioventricular block. These disturbances, mostly bradycardias, are seen independent of the valvular involvement and they are limited to the acute phase. This case reportb is about a 14 year-old-female patient diagnosed as ARF based on migratory polyarthritis and carditis who also developed supraventricular tachycardia (SVT) on the second day of admission,. The SVT attack was treated with intravenous adenosine successfully a which did not recur during and after anti-inflammatory treatment.

Recognising supraventricular tachycardia in children: An arrhythmia not to miss

Supraventricular tachycardia (SVT) is the most common symptomatic arrhythmia in children that demands urgent medical attention. This article describes the caveats in diagnosing and managing children with SVT in the pre-hospital setting. It is important that the paramedic team arranges urgent transfer of a child with SVT to the emergency department. The prehospital management should include obtaining an electrocardiogram (ECG), administering oxygen and attempting vagal manoeuvres such as carotid sinus massage while en route to hospital. It is also important that the paramedic team should actively look for clues for the sudden onset of SVT in a child such as the presence of illegal drugs at home, a history of accidental ingestion of parents’ medicines, and a family history of arrhythmias. The clinical presentation of SVT varies with the child’s age, and can be difficult to diagnose in infants and young children. It is important that paramedic teams consider a diagnosis of SVT in young children with histories of poor feeding, lethargy, irritability, excessive sweating or pallor and in older children with a history of palpitations, dizziness, chest pain, syncope or shortness of breath. Tachycardia is a common symptom, encountered in children presenting to the emergency services. In the majority of cases, tachycardia can occur in response to pain, emotional distress (crying), hypovolaemia (fluid loss) and fever. It can, however, also be a primary tachyarrhythmia with potentially serious consequences. It is therefore important that the paramedic team remains aware of the commonly encountered types of arrhythmia and institute appropriate management when faced with these cases (Karpas, 2006). SVT is defined as an abnormally rapid heart rhythm originating above the ventricles often, although not exclusively, with a narrow QRS complex. It is important that health professionals remain aware of the normal ranges of heart rates in children as this varies with age unlike in adults (Table 1). In this article we present a case of a two-year-old boy who was diagnosed with SVT followed by a discussion of the condition itself. Some practical points are provided which will be helpful in managing children with SVT in the prehospital setting.

The role of magnesium in cardiac arrhythmias

Magnesium plays an essential role in many fundamental biological reactions, as it is involved in more than 300 metabolic reactions. Deficiency of magnesium may result in many disorders, including cardiac arrhythmias. As intravenous magnesium has a high therapeutic to toxic ratio and a minimal negative inotropic effect, it has long been used in treatment and prevention of cardiac arrhythmias. Several studies have shown the beneficial effect of intravenous infusion of Mg during an attack of supraventricular tachycardia, indicating that the effectiveness of magnesium depends on the type of tachycardia. Magnesium has also an advantageous effect in the case of atrial fibrillation, considered a criterion of the effectiveness of atrial fibrillation acute treatment at the ventricular rate ≤ 100 min–1. As intravenous magnesium seems to be useful in prevention and treatment of various cardiac arrhythmias, it is a common component of a complex antiarrhythmic therapy.

Electrocardiographic Findings at Initial Diagnosis in Children with Isolated Left Ventricular Noncompaction

The aim of this study was to comprehensively evaluate electrocardiographic (ECG) findings of isolated left ventricular noncompaction (IVNC) patients at initial diagnosis and to explore the correlation between them and the clinical, echocardiographic, and magnetic resonance imaging (MRI) findings. Twenty-three patients diagnosed with IVNC by echocardiography and cardiac MRI between January 2006 and June 2010 were enrolled in this study. The patients were examined with standard ECG and 24-hour Holter ECG. For comparison purpose, ECGs of 50 healthy children of similar ages and demographic characteristics were taken. In 87% of patients, ECG abnormalities were found. The most frequently seen ECG findings were left ventricular hypertrophy, ST-segment depression, and negative T wave related to abnormal repolarization particularly in DII, DIII, and V(4-6) leads, as well as prolonged PR and QTc intervals. No ECG features or patterns were found that were specific to the disease. In contrast to adult patients, while no intraventricular conduction defects (particularly in the left bundle brach) were found in any of our patients, 13% had considerable bradycardia and one required a pacemaker. The Holter ECG recordings showed supraventricular tachycardia attacks in two patients and a short ventricular tachycardia attack in one. Patients whose echocardiograms and MRI showed left ventricular systolic dysfunction and left ventricular dilatation had signs of left ventricular hypertrophy and repolarization abnormality on their ECGs, but there was no significant difference in PR, QRS, and QTc intervals. Regardless of how frequently left ventricular hypertrophy and repolarization abnormalities are found on IVNC patients' initial ECGs, we think that they are not unique to the disease but are related to the severity of the cardiomyopathy.

A Case of Carbon Monoxide Poisoning Presenting with Supraventricular Tachycardia

Carbon monoxide intoxication is one of the most common types of poisoning in the world. Cardiac manifestations after exposure to carbon monoxide including myocardial ischemia, heart failure and arrhythmias have been reported. A 17-year-old woman was admitted to the emergency service with the complaints of palpitation, headache and nausea. Electrocardiogram revealed supraventricular tachycardia. The arterial blood gas analysis was normal. Her carboxyhemoglobin level was 19% and oxygen treatment was started promptly. Echocardiographic examination demonstrated normal cardiac function. To the best of our knowledge, this case report is the first carbon monoxide intoxication case in the literature presenting with supraventricular tachycardia attack.

Arterio-venous malformations of the liver in hereditary hemorrhagic telangiectasia (Rendu–Osler–Weber disease) causing right heart failure—Successful treatment with transarterial coil embolization

The presented case is a 66-year-old man with known hereditary hemorrhagic telangiectasia who presented with recurrent attacks of supraventricular tachycardia and dyspnoea. Cardiac catheterization revealed high cardiac output with peripheral shunting of about 50%. Three sessions of subsequent transarterial selective coil embolization were performed within 25 days after which no more AVMs were observed angiographically. The patient did not face any complications. Finally, the patient was in very good condition and reported neither tachycardia nor dyspnoea. Over a follow-up period of 12 months there were no biliary complications or recurrence of shunting observed. In summary, transarterial coil embolization of large parts of the hepatic arteries is a potent therapy to reduce the amount of arterio-venous blood shunting causing right heart failure.

Does P-Wave Dispersion Predict the Atrial Fibrillation Occurrence After Direct-Current Shock Therapy?

Supraventricular tachycardia attacks, including atrial fibrillation (AF), occur after both external and internal cardioversions. These attacks of atrial fibrillation after direct-current (DC) shock may be related to hemodynamic impairment, thromboembolic events, or enhanced electrical instability of the ventricular and atrial myocardium, especially in predisposed patients. In this study, the authors aimed to show the importance of P-wave dispersion (PWD), which lead the atrium to fibrillate, in predicting post-DC shock AF after external cardioversion. Thus physicians may be able to choose the patients with high risk for AF occurrence and apply some other therapeutic modalities to those patients. The authors identified 18 patients in whom an AF attack was induced by urgent or elective cardioversion for a ventricular tachycardia attack and compared these patients with a control group composed of 40 patients without AF in regard to some clinical, echocardiographic, and electrocardiographic parameters. Left atrial diameters were greater (4.3+/-0.3 vs 3.5+/-0.5 cm, p = 0.001), left ventricular ejection fractions (LVEF) were lower (45.2+/-8.2 vs 54.9+/-7.5, p = 0.001), the energy needed for successful cardioversion was higher (166.6+/-59.4 vs 80.8+/-51.6 J, p = 0.001), and P max (135.2+/-7.4 vs 118.7+/-10.5 ms, p = 0.001) and PWD (53.8+/-12.2 vs 23.8+/-9.5 ms, p = 0.001) values were higher in patients with AF when compared to those without AF. Thus, the patients with higher PWD values had a greater risk for development of AF after a DC shock.

Recurrent Supraventricular Tachycardia in a Newborn Treated with Amiodarone: Is Hyperkalemia the Apparent Cause?

Supraventricular tachycardia (SVT) is the most common type of arrhythmia observed in children, especially in newborns. Infants with severe SVT must be treated immediately with first-line drugs such as amiodarone. There are some minor and major side effects of amiodarone in this patient group, but no associated electrolyte disorders have been observed. This report describes a newborn whose recurrent SVT attacks during amiodarone treatment were suspected to have been caused by hyperkalemia.

Flutter-Like P Waves in a Case of Atrioventricular Reciprocating Tachycardia

Typical atrial flutter is characterized by its sawtooth flutter wave in leads II, III, aVF, and V1. Atrioventricular reciprocating tachycardia is characterized by its small retrograde P wave after completion of QRS complex, where sawtooth flutter-like P waves are rarely seen in the electrocardiogram during atrioventricular reciprocating tachycardia. We report on a 62-year-old patient who presented the characteristic sawtooth flutter-like P waves in the electrocardiogram during attack of supraventricular tachycardia. By electrophysiologic study, the mechanism of his supraventricular tachycardia was atrioventricular reciprocating tachycardia using the left posterior lateral concealed accessory pathway for retrograde conduction. The accessory pathway was successfully ablated by radiofrequency ablation therapy.

Twenty-five years' experience with the arterial switch operation

Objective: The arterial switch operation was introduced in 1976 to correct transposition of the great arteries and has since replaced atrial palliation. This study examines the long-term outcomes of the arterial switch operation. Methods: Included in the study were 195 patients who underwent the arterial switch operation from 1977 through June 2000. Patients were evaluated for functional class, pulmonary stenosis, left ventricular function, arrhythmias, aortic sequelae, and coronary disease. Results: Overall perioperative mortality was 15%, but rates dropped in the last 5 years to 4% for complex transposition and 0% for simple transposition. Of 151 survivors, 2 died late; 1 died of persisting pulmonary hypertension and 1 died of ventricular fibrillation after coronary pathologic changes. At last follow-up, a total of 145 patients were in New York Heart Association functional class I and 4 patients were in class II. The most frequent complication was pulmonary stenosis, necessitating 45 reinterventions in 26 patients. Left ventricular dysfunction was noted in 5 patients. Arrhythmias were seen in 5 patients: 2 patients had ventricular fibrillation (1 died and 1 required a defibrillator implantation), 1 had sick sinus syndrome, 1 had atrial flutter, and 1 had a single attack of supraventricular tachycardia. Aortic valve incompetence was absent or trivial in 146 patients, 3 had mild incompetence, 1 had moderate incompetence, and 1 had severe incompetence. Coronary sequelae were found in 5 of the 61 patients who underwent angiography. Conclusion: Long-term clinical outcome of the arterial switch operation is good, and perioperative mortality is now low. Morbidity is dominated by pulmonary stenosis and coronary artery disease, with the potential for lethal arrhythmias.J Thorac Cardiovasc Surg 2002;124:790-7

Recurrence Risk of Supraventricular Tachycardia in Pediatric Patients

We analyzed risk of recurrence of supraventricular tachycardia (SVT) in 70 pediatric patients using both Kaplan-Meier survival analysis and logistic regression of likelihood of recurrence, each with covariates: (1) age at onset of SVT; (2) presence of Wolff-Parkinson-White syndrome (WPW), and (3) gender. Among 38 patients who had onset of SVT <1 year, only 11 had a recurrence, while among 32 older patients, 30 had a recurrence of SVT (p < 0.00001, Fisher’s exact test). The survival analyses, stratified by age at onset <1 versus >1 year, were significantly different (p < 0.0001) as was stratification by presence of WPW (p < 0.01). Logistic regression analysis showed that the only significant predictor of recurrence was age at onset; the additional information provided by presence of WPW and gender did not significantly add to the prediction of recurrence. The odds ratio of recurrence for age at onset >1 versus <1 year was 34.6, with a 95% confidence interval of 6.98–172.

Pregnancy‐induced increase of supraventricular arrhythmias in wolff‐parkinson‐white syndrome

Six women suffering from Wolff-Parkinson-White syndrome and who were previously asymptomatic or nearly asymptomatic, were followed prospectively during and after their subsequent pregnancies. Three women experienced several attacks of supraventricular tachycardia (SVT) for the first time and the rest experienced an increase in their attacks. It seems that there is an increased tendency for SVT in pregnancy. Increased adrenergic sensitivity by estrogens, increased plasma volume, stress, and anxiety during pregnancy may be some of the causative factors.

Probability of supraventricular tachycardia recurrence in pediatric patients.

Supraventricular tachycardia (SVT) in pediatric patients is usually associated with a better prognosis than that in adults. However, late recurrence of SVT has been recently described. A total of 90 patients who had their initial SVT episode before 15 years of age were retrospectively studied (2-228 follow-up months; median, 215 months). Concomitantly congestive heart failure was present in 14 (16%) patients, and a cerebrovascular accident occurred in 1 patient. Intravenous verapamil was most frequently used to convert the initial SVT episodes without adverse effects, even in those younger than 1 year of age (9 patients). Older children could also be converted spontaneously or by vagal maneuvers. Patients with SVT recurrence were associated with an older age at initial SVT episodes (p < 0.001). By Kaplan-Meier actuarial analysis, the chance of remaining SVT-free during the follow-up was much lower in patients with initial SVT after 5 years of age than in patients with initial attacks before the age of 1 and between the age of 1 and 5 (p = 0.02 and 0.04, respectively). Even though, about 40% of the patients whose initial attacks occurred during infancy had recurrences 5 years later. Only those who had the initial attacks during the prenatal period remained free from SVT recurrences. Patients with initial SVT episodes during infancy have a longer period without SVT attacks and a lower chance of recurrences; nonetheless, a substantial number of them had recurrence at later childhood except those with initial SVT attacks during the prenatal period.(ABSTRACT TRUNCATED AT 250 WORDS)