Cases Of Paroxysmal Supraventricular Tachycardia Research Articles

Patent foramen ovale occlusion with the Cocoon PFO Occluder. The PROS-IT collaborative project.

The Cocoon patent foramen ovale (PFO) Occluder is a new generation nitinol alloy double-disk device coated with nanoplatinum, likely useful in patients with nickel hypersensitivity. Early results and mid-term outcomes of this device in percutaneous PFO closure are missing. To assess the preliminary efficacy and safety profile of PFO closure with Cocoon device in an Italian multi-center registry. This is a prospective registry of 189 consecutive adult patients treated with the Cocoon PFO Occluder at 15 Italian centers from May 2017 till May 2020. Patients were followed up for 2 years. Closure of the PFO with Cocoon Occluder was carried out successfully in all patients, with complete closure without residual shunt in 94.7% of the patients and minimal shunt in 5.3%. Except from a case of paroxysmal supraventricular tachycardia and a major vascular bleeding, no procedural and in-hospital device-related complications occurred. No patient developed cardiac erosions, allergic reactions to nickel, or any other major complications during the follow-up. During the follow-up period, 2 cases of new-onset atrial fibrillation occurred within thirty-day. Percutaneous closure of PFO with Cocoon Occluder provided satisfactory procedural and mid-term clinical follow-up results in a real-world registry.

Abstract 392: Incidence Of Paroxysmal Supraventricular Tachycardia In The United States

Background: Paroxysmal supraventricular tachycardia (PSVT) encompasses a range of heart rhythm disorders that lead to abrupt increases in heart rate. Given its episodic nature, PSVT can be difficult to capture in a clinical setting. Therefore, estimating incidence of PSVT is challenging and thus limited data is available on the incidence of this disease. Objective: Estimate the incidence of PSVT within the United States in contemporary practice. Methods: Using claims, enrollment, and demographic data from the IBM Marketscan® Commercial Research Database (<65y) and the Medicare Limited Dataset (≥65y), individuals enrolled in health plans for at least 5 continuous years from 2008-2016 were identified. Patients having claims with a PSVT diagnosis (ICD-9: 427.0; ICD-10 I47.1) on 2+ outpatient visits, 1+ ED visit, or 1+ inpatient admission were included in the analysis. Only patients receiving an initial diagnosis of PSVT in year 5 of continuous enrollment were included in the incidence calculation in order to avoid including prevalent cases. Incidence was projected to the US population based on the 2018 US census data. Results: Among 18,057,297 patients, 86,614 met PSVT criteria. Incidence rates were higher in female and older patients. Within the 18-44y group, the incidence rate was 1.9-fold higher for females as compared to males. Overall incidence rate per 100,000 was 79.1 and 107.2 for males and females respectively (Table). Projected to the 2018 US Census, there were 305,548 incident PSVT cases in 2018. Conclusion: There were over 305,000 incident cases of PSVT in 2018 with higher rates in female and older patients. Further studies are needed to understand practice patterns in management of PSVT, given the high incidence of this disease.

A Case of Paroxysmal Supraventricular Tachycardia Caused by Caffeine Overdose Successfully Treated with Dexmedetomidine

A Case of Paroxysmal Supraventricular Tachycardia Caused by Caffeine Overdose Successfully Treated with Dexmedetomidine

Paroxysmal Supraventricular Tachycardia with Wolff-Parkinson-White Syndrome in a Neonate

A case of paroxysmal supraventricular tachycardia with Wolff-Parkinson-White syndrome in an Indonesian neonate born in the Departement of Obstetrics, Dr. Hasan Sadikin General Hospital, Bandung, is reported. Tachycardia in the neonate was first noted at the age of 6 days, but the heart rate gradually decreased in 8 hours after oxygen was administered. Electrocardiographic examination revealed a Wolff-Parkinson-White syndrome. A second attack of tachycardia occurred at the age of 2 months and the infant was immediately hospitalized and treated with lanoxin. Serial electrocardiographic examination still revealed the same syndrome. The management and prognosis of supraventricular tachycardia in the neonate is also discussed.

Paroxysmal Supraventricular Tachycardia: A Complex Dilemma during Pregnancy

ABSTRACT The acute and chronic management of paroxysmal supraventricular tachycardia (PSVT) during pregnancy presents a challenging clinical situation as there are no evidence-based guidelines despite being the commonest arrhythmia found in pregnancy. We report a case of paroxysmal supraventricular tachycardia in a 25 years old antenatal woman with no organic heart disease, where she received verapamil followed by diltiazem as antiarrhythmics instead of adenosine for conversion into sinus rhythm. Since she had recurrent episodes in third trimester she received verapamil and metoprolol as prophylaxis with good fetal and maternal outcome. This case highlights the need to understand the complexities in diagnosis and management of paroxysmal supraventricular tachycardia during pregnancy. How to cite this article Kumare BD, Kawathalkar A, Vijay NR. Paroxysmal Supraventricular Tachycardia: A Complex Dilemma during Pregnancy. J South Asian Feder Obst Gynae 2015;7(1):44-47.

Supraventricular tachycardia induced by chocolate: is chocolate too sweet for the heart?

Conflicting studies have been published concerning the association between chocolate and cardiovascular diseases. Fewer articles have described the potential arrhythmogenic risk related to chocolate intake. We present a case of paroxysmal supraventricular tachycardia in a woman after consumption of large quantity of chocolate. A 53-year-old woman with no significant medical history presented to us with complaints of palpitations and shortness of breath after consuming large amounts of chocolate. Electrocardiogram showed supraventricular tachycardia at 165 beats per minute, which was restored to sinus rhythm after adenosine bolus injection. Electrophysiology studies showed atrioventricular nodal reentry tachycardia, which was treated with radiofrequency ablation. Chocolate contains caffeine and theobromine, which are methylxanthines and are competitive antagonists of adenosine and can have arrhythmogenic potential. Our case very well describes an episode of tachycardia precipitated by large amount of chocolate consumption in a patient with underlying substrate. There are occasional case reports describing association between chocolate, caffeine, and arrhythmias. A large Danish study, however, did not find any association between amount of daily caffeine consumption and risk of arrhythmia.

How to explain the reduced cardiovascular mortality in the ticagrelor arm of the PLATO trial?

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Doubling of the Ventricular Rate by Interpolated Junctional Extrasystoles Resembling Supraventricular Tachycardia

In a study of seven cases of paroxysmal supraventricular tachycardia, it was noted that the fast rate was not caused by the mechanism of rapid firing, reentry, or dual atrioventricular nodal conduction but by an abrupt doubling of the rate by interpolation of junctional extrasystoles between adjacent sinus beats while the sinus mechanism remained undisturbed. Dual ventricular response to a single atrial depolarization was seriously considered in each case. The intervals separating the junctional extrasystoles tended to be quite fixed, thus conforming to the pattern of junctional parasystole with an intrinsic rate very close to the rate of the dominant sinus rhythm. The paroxysms of tachycardia were transient, lasting a few seconds to 3.5 minutes. The onset and termination of the paroxysms were completely unpredictable and appeared unrelated to any change in the basic sinus rate or other identifiable mechanism. In only one case, case 7, the concept of dual ventricular response appeared tenable. However, as will be discussed later, the mechanism of junctional parasystole was found to be physiologically more acceptable.

Studies on the Prevalence of Complicated Atrial Arrhythmias, Flutter, and Fibrillation in Patients with Reciprocating Supraventricular Tachycardia Before and After Successful Catheter Ablation

Atrial flutter and AF are complications in approximately 30% of cases of paroxysmal supraventricular tachycardia (PSVT)-indicated catheter ablation, and it is of interest to determine if therapeutic modification for PSVT would eliminate combined atrial tachyarrhythmia like atrial flutter and AF. The aim of this study was to determine the incidence and the risk of atrial tachyarrhythmias after catheter ablation of PSVT. A total of 152 patients (age range 12-74, mean 41 +/- 17 years) with accessory pathway (n = 106) and/or dual atrioventricular nodal conduction (n = 46) were enrolled in a 2-year follow-up program after successful catheter ablation. Possible risks on clinical background (age, sex, PSVT duration, hemodynamic instability during attacks), premature atrial contraction (PACs) on Holter monitoring, echocardiographic left atrial size, and electrophysiological property (insertion site, conduction type, effective refractory period) were evaluated. Atrial flutter and AF were complications in 53 (35%) of the subjects, who were elderly and had a longer PSVT history with a larger left atrial dimension and frequent PACs; however, the electrophysiological properties were similar. After a 2-year follow-up period 36 (24%) of the patients still exhibited PAC runs, including 13 (9%) with atrial flutter and AF, each one of whom were complicated with nonlethal cerebral thromboembolism and congestive heart failure. Multiplelogistic-regression analysis revealed that advanced age (> or = 41 years, P = 0.0152) and frequent PACs (> or = 1% of total daily QRS counts, P = 0.0426) on Holter monitoring are the risk factors of PAC runs and/or atrial flutter and AF. In conclusion, successful ablation for PSVT is thought to be beneficial for preventing atrial flutter and AF. However, careful follow-up to monitor for the recurrence and atrial flutter and AF related complications, especially in patients of solitary atrial flutter and AF without reciprocating tachycardia and with frequent PAC.

Intravenous calcium chloride in the conversion of paroxysmal supraventricular tachycardia to normal sinus rhythm

This brief report describes several cases of paroxysmal supraventricular tachycardia that converted promptly to normal sinus rhythm within 1 to 2 minutes of receiving intravenous calcium salts as pretreatment in anticipation of verapamil therapy. A review of calcium's hemodynamic and dromotropic effects suggests that this probably was due to electrophysiological effects rather than mere coincidence. Calcium raises blood pressure, which may reflexively increase cardiac parasympathetic tone, and also has a direct slowing effect on atrioventricular conduction. Adenosine remains the drug of choice in the treatment of paroxysmal supraventricular tachycardia. However, in addition to preventing hypotension when used as pretreatment to overapamil, intravenous calcium itself may terminate supraventricular tachycardia.

Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia

Two cases of paroxysmal supraventricular tachycardia are reported in which the administration of adenosine produced sustained elevation of the rate of paroxysmal supraventricular tachycardia. In each case, sinus rhythm was restored readily through the use of intravenous verapamil. This adverse reaction to adenosine has not been previously described.

The use of the diving reflex to terminate supraventricular tachycardia in a 2-week-old infant

The use of the diving reflex to terminate a case of paroxysmal supraventricular tachycardia (PST) is described in a 2-week-old infant who presented in severe congestive heart failure with supraventricular tachycardia at a rate of 300. The infant's face was placed in a basin of ice water at 5°C. for 5 seconds with manual occlusion of the infant's nostrils to prevent aspiration. The PST converted to a sinus rhythm of 120 within 3 seconds of facial immersion. The physiology of the diving reflex is reviewed and the uses and hazards of this reflex in terminating attacks of PST in infants is discussed.

A case of paroxysmal supraventricular tachycardia which developed transient ventricular tachycardia induced by eye ball pressure

A case of paroxysmal supraventricular tachycardia which developed transient ventricular tachycardia induced by eye ball pressure

Reciprocating supraventricular tachycardia initiated by paired premature beats.

Two cases of paroxysmal supraventricular tachycardia were documented, and its underlying mechanism was discussed. 1) An antegrade A-V conduction pathway was found to be more refractory than a retrograde A-S conduction pathway because an antegrade A-V block was usually accompanied by a retrograde A-S conduction, resetting the sinus cycle. 2) A single supraventricular premature beat did not initiate paroxysmal tachcardia. 3) Paroxysmal tachycardia consisting of an alternate appearance of a retrograde P wave and a QRS complex of normal configuration (reciprocation) always followed a pair of two premature beats. 4) The first premature beat showed an aberrant ventricular conduction, indicating that the impulse spread the same way as that of the preceding sinus impulse. 5) The second premature impulse with an antegrade P wave showed a QRS complex of normal configuration similar to those appearing during paroxysmal tachycardia with a shorter coupling interval, indicating that the second premature impulse spread the pathway which had not been discharged by the preceding premature impulse. 6) Even when the reciprocating supraventricular tachycardia was suppressed by oculovagal reflex, these two premature beats appeared as a pair, indicating that the second premature impulse is causally linked to the first, i.e., an atrial echo via the S-A node. 7) It was inferred that this echo impulse via the S-A node spreads the pathway which has not been discharged by the first premature impulse and turns back to the atria through the pathway which has been discharged by the first premature impulse but has then recovered, thus initiating a sustained reciprocation of an impulse.

Assessment of electrical conversion of supraventricular arrhythmiasPresented at Symposium of the Royal College of Physicians of Ireland and the American College of Physicians in Dublin, Eire, on 18 September, 1971.

Summary Direct current shock therapy in 244 cases of atrial fibrillation, fifty cases of paroxysmal supraventricular tachycardia, and eighteen cases of atrial flutter has been assessed. The administration of intravenous diazepam (Valium) allowed direct current shock therapy without general anaesthesia and tracheal intubation. Seventy percent of cases of atrial fibrillation, 96% of cases of paroxysmal supraventricular tachycardia, and 94% of cases of atrial flutter reverted to sinus rhythm. The 190 patients first treated were followed up after the attempt at conversion until relapse of the arrhythmia or for a minimum of 2 years. The best results were obtained in arrhythmia of thyrotoxic aetiology. In patients with ischaemic/hypertensive heart disease and rheumatic heart disease the results were disappointing. The success rate with direct current shock therapy is inversely related to the cardiothoracic index, and with increase in heart size there is also deterioration in the long-term results. Only one of the patients who had a cardiothoracic index of more than 55% remained in sinus rhythm at the end of 2 years. The success rate decreases with increasing duration of the preceding arrhythmia, particularly when it had been present for more than 1 year, and the stability of the attained sinus rhythm also decreases with increasing duration of the preceding arrhythmia. Direct current shock therapy is the method of choice in most cases of atrial flutter. Direct current shock therapy is seldom indicated in paroxysmal supraventricular tachycardia except in cases with underlying serious heart disease. Direct current shock therapy is contra-indicated in digitalis-induced arrhythmias.

Simulation of Ectopic Ventricular Rhythms By Aberrant Conduction

To the Editor:— In a recent issue ofThe Journal, Marriott1has properly redirected attention to the similarities and differences between the electrocardiographic patterns of supraventricular and ventricular arrhythmias. We are in full agreement with the author's contention that accurate diagnosis of these arrhythmias has become increasingly important with recent advances in therapy. Unfortunately, neither Marriott1nor Sandler and Marriott,2have listed the diagnoses in the cases they studied. In our experience, diagnostic problems of the type discussed have involved primarily patients with ischemic heart disease and it is this same group which most frequently confronts the physician with arrhythmias of ventricular origin which have serious prognostic implications. Furthermore, Marriott has assumed that impairment of conduction is the mechanism involved. The possibility of accelerated conduction as an explanation is an alternate hypothesis and this seems to account better for some cases of paroxysmal supraventricular tachycardia observed in ischemic

Treatment of paroxysmal supraventricular tachycardia with methoxamine.

We wish to call attention to the use of methoxamine hydrochloride (Vasoxyl) 1 in the treatment of paroxysmal supraventricular tachycardia. Not only is this drug effective in arresting the tachycardia, but, because of its powerful pressor action, 2 it is especially useful in cases complicated by vascular collapse, a frequent occurrence. 3 The mechanism of action is believed to be a reflex vagal effect following carotid sinus pressure elevation. Two cases of paroxysmal supraventricular tachycardia complicated by vascular collapse, successfully treated by this agent, have been reported 4 and two more are now added. The first case is one of nodal tachycardia and the second, one of auricular tachycardia. REPORT OF CASES Case 1.— C. M., a 63-year-old man, was admitted to the New Britain General Hospital on July 6, 1952, complaining of tachycardia of sudden onset, accompanied by dyspnea. He had previously experienced two similar attacks of tachycardia; the

Wolff-Parkinson-White syndrome and paroxysmal tachycardia in infancy; report of a case.

The syndrome of anomalous atrioventricular excitation, more commonly known as the Wolff-Parkinson-White syndrome, is an electrocardiographic entity that has been the subject of much discussion in recent years. Up to the present, however, only a few cases have been reported of this condition in infants. This conduction defect seems to predispose the patient to attacks of paroxysmal tachycardia, which are of a more serious nature in infants than they usually are in adults. For these reasons, we wish to report a case of paroxysmal supraventricular tachycardia in a 4-month-old infant in whom the electrocardiogram made on cessation of the arrhythmia showed the presence of the Wolff-Parkinson-White syndrome. REPORT OF A CASE A 4-month-old baby girl, weighing 11 lb. 6 oz. (5.17 kg.), was brought to St. Vincent's Hospital at 10 a. m., May 2, by her parents, because of weakness, pallor, and failure to nurse. Until 24 hours earlier, she

Neosynephrine in treatment of paroxysmal supraventricular tachycardia

Neosynephrine restores the normal sinus rhythm within thirty-five to seventy seconds after rapid intravenous injection in most cases of paroxysmal supraventricular tachycardia. The reversion of the supraventricular tachycardia is attributable to reflex cardiac inhibition elicited by the rapid rise in pressure in the carotid sinuses and aortic arch. The rise in pressure occurs as a result of the vasoconstriction produced by Neosynephrine. Presumably, any vasoconstrictor compound which acts quickly and briefly, and which has little or no direct stimulating action on the cardiac conducting system, would revert paroxysmal supraventricular tachycardia. Neosynephrine reverted paroxysmal supraventricular tachycardia in most cases when the systolic pressure reached a level of 160 mm. Hg or less. Some of the attacks which were terminated were refractory to treatment by mechanical methods and by various drugs. In occasional cases reversion was produced with Neosynephrine only when the systolic pressure was elevated to levels which might be considered too high for safety. In the typical case the rise in systolic blood pressure is proportional to the dose of Neosynephrine, and the maximum dose to be used is determined by the maximum rise in pressure which is considered safe for the individual patient. The initial dose should not exceed 0.5 mg., and any subsequent dose is selected on the basis of the pressor response to the initial dose. Most attacks were reverted by 1.0 mg. or less. These studies suggest that intravenous injection of Neosynephrine, or some other rapid-acting vasopressor substance, will prove to be the treatment of choice in selected cases of paroxysmal supraventricular tachycardia.