Chest Thump Research Articles

PO-03-049 SUBACUTE MIGRATION OF LEFT BUNDLE BRANCH PACING LEAD INTO THE LEFT VENTRICLE

RV pacing is associated with increased risk for systolic dysfunction. Conduction system pacing has emerged as an alternative. His bundle pacing is limited by higher capture threshold, reducing battery life, and concerns of increasing thresholds over time. LBBP is a promising alternative, however limited data exist on associated complications. We report a case of LBBP complicated by subacute migration into the LV presenting with increasing threshold. A 78 yoM with symptomatic bradycardia and chronotropic incompetence referred for PPM underwent implantation of DC-PPM with left bundle lead. A Medtronic SelectSecure 3830 lead was advanced into a C315 sheath and positioned at the LV septum. Pace mapping defined a candidate site for LBBP (W in V1). Lead was screwed into the septum. Unipolar impedance prior to deployment was 820Ω. After 5 turns paced QRSd 140ms with qR morphology in lead V1, R waves 12.4mV, unipolar impedance 760Ω, threshold 0.75V at 0.4ms. This was accepted as nonselective LBBP. He began to have chest thumping on POD 3. Device showed elevated ventricular threshold, decreasing impedance, and stable sensing. ECG showed broad notched R wave in V1 consistent with LV pacing. CT revealed migration of the lead, coursing through the IVS into the LV myocardium with tip terminating along the inferior LV wall. Lead tip was possibly puncturing through the myocardium and within the epicardial fat. There was no effusion Lead was removed with manual traction in the EP suite. Heart border remained unchanged on fluoroscopy. Transthoracic echo showed no effusion. New lead was positioned with active fixation in the RV apical septum away from the prior position. Lead showed suitable parameters without diaphragmatic stimulation. LBBP can be an alternative to HB, RV, and CRT pacing. LBBP involves placing the lead deep within the IVS and close to the LV subendocardium. Septal perforation is often recognized during the procedure, however, the risk of late perforation must be considered. In our case, timing of lead migration is unclear as parameters during implant suggested adequate LB capture but reported diaphragmatic capture at day 3, before threshold increase. It demonstrates important findings:1.Acute decrease in unipolar impedance may not be a sensitive marker for septal perforation as it did not change appreciably in our case; 2.ECG/CXR in follow up can help identify lead migration; 3.Migrated leads can be safely removed in the EP suite without need for surgical backup

UNLEASHING SOUTH CHINA SEA CONFLICT: MULTIPLEX ANALYSIS OF DIPLOMATIC CHAOS

The South China Sea, one of the busiest trade routes around the world consisting of an area of 3.5 million square kilometers, is subject to several overlapping territorial disputes involving China, Vietnam, the Philippines, Taiwan, Malaysia, and Brunei as its stakeholders. The South China Sea connects Asia to Europe and Africa. Political rivals have tried amicable settlement of the contemporary disputes but instead, the tensions have increased over the course of recent years. Multiple Confidence Building Measures (CBMs) and Treaties of Amity and Cooperation (TAC) have been signed by the contending states but all have proven to be in vain. Mechanisms like Freedom of Navigation Operations (FONOPs) are used for chest thumping and hard power display. Numerous other factors are there that eventuate in weakening of diplomatic ties between the contending states. One of such factors is involved is the presence of alien powers like the United States for maintenance of a World Order favouring her on interests under the guise of providing security to the region. Adopting multiplex methodology, this research paper adopts an approach aiming at giving a synopsis of the inherent disputes between the stakeholders, the reasons for failure of efforts for amicable settlement, the role of the stakeholders with special reference to the major contending forces i.e., United States and China, the subsequent implications arising therefrom and some possible solutions to the issue. Keywords: SCS, FONOS, CBM, Multiplex methodology.

An Unusual Case of Diaphragmatic Stimulation Following Single Chamber ICD Implantation

A 54-year-old female with a history of nonischemic cardiomyopathy presented to the outpatient cardiology clinic with intermittent chest pain and “chest thumping.” She had a single-chamber implantable cardioverter defibrillator (ICD) implanted 4 weeks previously.

Surviving COVID-19 Pneumonia At Home: COVID Case #1906

Surviving COVID-19 Pneumonia At Home: COVID Case #1906

Last Scene Underground: An Ethnographic Novel of Iran

Last Scene Underground: An Ethnographic Novel of Iran

Gangguan Emosional Anak Akibat Tayangan Misteri Televisi (Studi Kasus Pada Anak Usia 2-11 Tahun)

This study aims to: (1) understand the emotional disturbance experienced by children aged 2-10 years old because they often watch a mystery program an television, (2) understand the physical problems experienced by children aged 2-10 years old as a result of emotional disturbance because the frequently watch mystery television program.This research is a qualitative research with case study method with three children with different age classifications as research subject. Two children are from pre-operational phase and a child from the concrete operational phase. The data collection techniques used in this research are observation, interview and documentation.The results provide conclusion that the emotional distress experienced by children (2-10 years old) is whyny, often delirious, coward and always felt overshadowed, not independent, and fear of certain animals and thus affects his physical with the chest thumping, trembling and cold sweat and stamina of his body became weak, so vulnerable to disease. Emotional disturbances experienced by each child depend on the intensity of children watching mystery program in the mystique level contained in those program

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.

Is Surface ECG a Useful Surrogate for Subcutaneous ECG?

Surface electrocardiograms (ECGs) have been used as surrogates for subcutaneous ECGs to optimize and evaluate subcutaneous devices, but differences between surface and subcutaneous ECGs remain poorly understood. This study evaluated the correspondence between surface and subcutaneous ECGs in Reveal Plus (Medtronic Inc., Minneapolis, MN, USA) patients during various maneuvers. Surface electrodes were placed over the Reveal electrodes of 48 subjects (23 men, age 60 +/- 14.3 years, body mass index 27 +/- 4.9 kg/m(2), implant time 45 +/- 29 weeks). Surface and subcutaneous ECGs were recorded simultaneously for 30 seconds during rest, isometric myopotential noise (pushing palms together), and artifact-inducing maneuvers (repetitive displacement of device, chest thumping on device, arm flaps, handshake, hallwalk). During rest, subcutaneous and surface ECGs were highly correlated (R = 0.96), had similar R-wave amplitude (487 +/- 40 vs 507 +/- 49 microV, NS), and signal-to-noise ratio (SNR) (13.4 +/- 0.8 vs 13.5 +/- 0.7, NS). During myopotential noise, subcutaneous and surface ECGs were highly correlated (R = 0.91) and had similar SNR (10.0 +/- 0.6 vs 9.7 +/- 0.6, NS). During artifact-inducing maneuvers, subcutaneous and surface ECGs were less correlated (R = 0.82 displacement, 0.84 chest thumping, 0.93 arm flaps, 0.90 handshake, 0.92 hallwalk) with subcutaneous SNR significantly higher than surface (11.4 +/- 0.7 vs 9.9 +/- 0.7 displacement, 11.1 +/- 0.6 vs 8.4 +/- 0.6 chest thumping, 11.5 +/- 0.4 vs 10.3 +/- 0.5 arm flaps, 9.5 +/- 0.4 vs 8.4 +/- 0.4 handshake, 12.0 +/- 0.4 vs 10.0 +/- 0.4 hallwalk, P < 0.05). Surface ECGs are adequate surrogates for subcutaneous ECGs in situations free from motion artifacts but not in situations involving movement of the device, surface electrodes, or recording equipment. During artifact-inducing maneuvers, subcutaneous ECGs are of higher quality and less susceptible to artifacts than surface ECGs.

The antiarrhythmic blow to the sternum: Thumpversion

It has long been known that a blow to the chest can restore a heartbeat in patients with Adams-Stokes syncope. 1 Schott E. Über Ventrikelstillstand (Adams-Stokes'sche Anfälle) nebst Bemerkungen überLandersartige Arrhythmien passagerer Natur. Dtsch Arch Klin Med. 1920; 131: 211-229 Google Scholar , 2 Scherf D. Bornemann C. Thumping the precordium for ventricular standstill. Am J Cardiol. 1960; 5: 30-40 Abstract Full Text PDF PubMed Scopus (49) Google Scholar A chest thump can also terminate ventricular tachycardia (VT) or ventricular fibrillation (VF). Although counterintuitive, this simple maneuver has proved life saving. Few know when this maneuver was introduced, how its effectiveness was discovered, and what, if any, are its clinical possibilities. Like much in clinical medicine, the introduction of chest thumping resulted from an unplanned and serendipitous observation.

Precordial thump for cardiac arrest is effective for asystole but not for ventricular fibrillation

Precordial thump for cardiac arrest remains controversial. Although precordial blows can trigger ventricular fibrillation (VF) (i.e., commotio cordis), they paradoxically have been regarded as potential therapy for cardiac arrest. In commotio cordis, impact energy and resultant peak left ventricular (LV) pressure are important variables in VF initiation. The purpose of this study was to assess the relationship between LV pressures generated by thumps and their effectiveness in defibrillation of VF or resuscitation of asystole after defibrillation. After induction of VF, 10 swine each received 18 chest thumps; two sets of three thumps each with a clenched fist, a 30-mph lacrosse ball, and a 40-mph lacrosse ball. If asystole followed defibrillation, manual thumps were given to induce ventricular depolarizations until resumption of spontaneous rhythm. During VF, generated LV pressure (mmHg) was 263 +/- 52 with manual thumps, 392 +/- 179 with 30-mph ball thumps, and 616 +/- 182 with 40-mph ball thumps (P <.001). None of the 180 thumps terminated VF. All episodes required electrical defibrillation. During asystole, generated LV pressures were greater for thumps that induced ventricular depolarizations than for those that did not (111 +/- 27 mmHg vs 73 +/- 23 mmHg, P <.001). A significant association was observed between induction of ventricular depolarizations and thump-generated LV pressures (odds ratio 2.0 per 10 mmHg rise in LV pressure, 95% confidence interval 1.8-2.1). Despite generating high LV pressures, precordial thumps were not effective in terminating VF. Based on these data, precordial thump for VF in cardiac arrest victims cannot be recommended but for asystolic victims might be beneficial.

Abstract P112: Precordial Thump Ineffective in Terminating Ventricular Fibrillation but May Have a Role in Asystole

BACKGROUND. The efficacy of the chest thump in cardiac arrest is controversial. In an animal model of cardiac arrest we assess the efficacy of precordial thump in ventricular fibrillation (VF) and asystole. METHODS. Under general anesthesia, 10 swine were induced to VF using a RV pacing lead and an AC fibrillator. In random order, animals received chest thumps with a 30 or 40 mph lacrosse ball or a chest thump with a fist. If VF continued after 3 thumps, animals were externally defibrillated. All animals underwent 6 VF inductions and received a total of 18 chest thumps; 2 sets of 3 thumps each with a fist, 30 mph, and 40 mph lacrosse balls. If asystole followed defibrillation, chest thumps with a fist were given to induce premature ventricular contractions (PVCs) until resumption of sinus rhythm. LV pressures of all thumps were recorded. RESULTS. None of the 180 chest thumps terminated VF. The LV pressure generated by thumps during VF was 263 ± 52 mmHg for manual thumps, 392 ± 179 mmHg for 30 mph thumps, and 616 ± 182 mmHg for 40 mph thumps (p&lt;0.001). All VF episodes were terminated by a 200J shock. Defibrillation was followed by asystole after 46/60 (77%) of VF inductions. During asystole, 1533/1856 (83%) chest thumps induced PVCs. LV pressure was higher for thumps that induced PVCs than those that did not (113 ± 27 vs 75 ± 23 mmHg, p&lt;0.001). For each 10 mmHg rise in LV pressure, the OR of inducing a PVC was 1.9 (95% CI 1.8 –2.1; Figure ). CONCLUSIONS. Despite achieving high LV pressures, precordial thumps were not effective in terminating VF, but did produce PVCs in asystole. Based on this data, a precordial thump cannot be recommended for VF, but its use in asystole should be further explored.

Efficacy of Chest Thump Version for Ventricular Arrhythmias

Purpose Electrical cardioversion for ventricular arrhythmias (VAs) contained of ventricular tachycardia (VT), ventricular fibrillation (VF) and torsades de pointes (TdP), was established to be effective for VAs. Little is known about which case should have an effect on chest thump version (TV) in patients with VAs. Method Subjects were 18 patients (Male: Female = 9:9, mean age 61±20 years old). TV was done for 28 episodes in VT, 8 episodes in VF, and 5 episodes in TdP. TV was performed after onset of symptoms within one minutes, and electrocardiogram (ECG) monitor was analyzed. Heart beats were averaged with 10 beats of VF and TdP. The time from Q wave to TV was measured from ECG monitoring in VT patients. Result TV successfully terminated VT in 12 of 28 episodes, VF in 1 of 8 episodes, and 1 of 5 episodes. TV terminated VT in the range between -20ms and +60ms. The mean cycle length of VT was 284±30ms, VF was 238±21ms, and TdP was 270±25ms, respectively. The mean cycle length of successful TV was significantly longer than that of failed TV in VT (358±57ms vs 289±59ms, p<0.01). There was no acceleration of VT in this study. Conclusion TV was available for slower VT at the timing in the range between -20ms and +60ms, and not for TdP and VF.

Mechanical conversion of post-ischaemic ventricular fibrillation: effects on function and myocyte injury in isolated rat hearts

Ventricular fibrillation (VF) and ventricular tachycardia (VT) are common phenomena during reperfusion. In experimental research many hearts have to be excluded from haemodynamic evaluation because of severe arrhythmias. Theoretically, electroconversion or mechanical conversion (MC) might be used to convert VF or VT. MC induces a physical shock analogous to a chest thump. The aim of this study was to investigate the efficacy of MC in isolated, perfused rat hearts, and to see whether MC itself induced myocardial cell injury and functional impairment. Langendorff-perfused rat hearts (n=89) from several experimental series subjected to 30 min of global ischaemia and 60 min of reperfusion were retrospectively analysed. Left ventricular systolic (LVSP), end-diastolic (LVEDP), and developed (LVDP) pressures, coronary flow (CF), and heart rate (HR) were measured. If VF or VT continued for 1 min during reperfusion, MC was attempted by a flick of the forefinger to the right ventricle. If VF or VT still occurred, MC was repeated. Hearts that did not have regular beating after 20 min of reperfusion were excluded. Release of cardiac troponin T (cTnT) was measured before ischaemia and after 20 min of reperfusion. Forty-four out of 89 hearts had VF or VT during reperfusion. Thirty-five hearts were converted, 18 of which were converted by one or two MCs only. The higher the total number of MCs employed, the more cTnT was released. After 20 min of reperfusion, LVEDP, LVDP and CF were better in hearts with a higher number of MCs and with increased release of cTnT. After 60 min of reperfusion, LVEDP was still improved in hearts with more cTnT release, whereas LVSP was lower, and LVDP and CF were independent of the number of MCs. There was no consistent correlation between release of cTnT and heart dysfunction. In conclusion, MC effectively converted VF or VT. MCs increased post-ischaemic myocardial cell damage, as judged from increased cTnT release. Post-ischaemic dysfunction was partly attenuated in hearts with multiple MCs, and did not correlate with release of cTnT. We feel that MCs should not be used in isolated, perfused hearts.

Bethann's death

Last summer, my sister-in-law Bethann died. She was thirty-nine years old. She had had cardiac arrhythmias for many years. Nobody knew why. Maybe congenital; maybe she'd had rheumatic fever as a child that had never been diagnosed. Growing up on a farm, they'd never gone to doctors. They took care of themselves. And they had no money. Now to keep her heart beating regularly, she had to take three different drugs daily. Some were quite new and expensive, and her husband Ed, a construction worker, didn't have health insurance. I managed to get her the medications at cost from the pharmacy of the hospital where I work. Even so, they cost $150 per month. She died in her own backyard, just after preparing a picnic for a family reunion. About twenty-five of us were feasting on freshly picked corn-on-the-cob, fried chicken, enchiladas, salad right out of the garden. The kids were playing tag, the dogs were begging for handouts, the sun was setting over the rolling hills of northeastern Pennsylvania. Her mother, my mother-in-law, Evelyn, had been diagnosed with breast cancer two years earlier, had a lumpectomy, and two years of chemotherapy and radiation. Her hair had turned white and she'd lost some weight but come through it OK, largely because Bethann had been there to help with the driving, some housework, the loose ends. The picnic was a family reunion called, in part, to celebrate Evelyn's cure. We loved to visit Bethann and Ed. They were not farmers, but they lived what seemed to us an idyllic rural life. They lived in the house that Bethann's grandparents had built, on a hill overlooking a farm that had been in the family for generations. She nurtured a huge perennial garden, and dried flowers in the attic to make into wreaths and wall hangings. They kept goats, honeybees, and chickens, heated their house with wood, canned tomatoes, lived simply. We had moved to the south side of Chicago, and put our kids to bed each night to the sound of sirens and, occasionally, of distant gunfire. When the kids got to the farm, it was as if they started breathing again. After supper, Bethann stood up, grabbed her chest, and collapsed. My wife and I are both doctors. We ran over, felt for a pulse. Nothing. Bethann's eyes were rolled back in her head. She was gasping. Her color was terrible, pale, bluish-gray. We looked at her, at each other. This is it. I told somebody to call 911. We were way out in the country. Miles from nowhere. Better start chest compressions. 1-2-3-4-5. Nancy couldn't do mouth-to-mouth on her own sister. We switched. She did the chest compressions. I started mouth-to-mouth. I had never done CPR in the field before. In the hospital, CPR is, weirdly enough, a friendly, communal activity. When a code is called, the team comes running, just like on TV. There is familiar equipment. People work together. Anesthesia intubates. Respiratory therapy has the ambubag. Residents start intravenous lines. Nursing, poised by the wellstocked crash cart, hands me the meds. Monitors beep. In the hospital, you never have to do mouth-to-mouth resuscitation, so I had never actually done it on anybody except on the plastic Resusci-Annie dolls in CPR class. It was a little like that. Head tilt. Watch the chest. Puff. Count it out. 1-2-3-4-5. Breathe. 1-2-3-4-5. In another sense, it was nothing at all like CPR class or anything else. It was gruesome. The sun was going down. We could hardly see what we were doing. Mosquitoes were buzzing by my ears. Kids were screaming and crying, but I only heard them like a distant sound track, and I hardly noticed when they were gone. Bethann vomited the supper she had just cooked and enjoyed. We had no suction equipment, so it got harder and harder to breathe for her. I cut my lip pressing it against her teeth and my blood began to drip onto her lips and chin. Suddenly, I remembered that we should have given her a chest thump. We stopped CPR. I raised my fist above my head and smashed it down upon her chest. …

Bethann's Death

Last summer, my sister-in-law Bethann died. She was thirty-nine years old. She had had cardiac arrhythmias for many years. Nobody knew why. Maybe congenital; maybe she'd had rheumatic fever as a child that had never been diagnosed. Growing up on a farm, they'd never gone to doctors. They took care of themselves. And they had no money. Now to keep her heart beating regularly, she had to take three different drugs daily. Some were quite new and expensive, and her husband Ed, a construction worker, didn't have health insurance. I managed to get her the medications at cost from the pharmacy of the hospital where I work. Even so, they cost $150 per month. She died in her own backyard, just after preparing a picnic for a family reunion. About twenty-five of us were feasting on freshly picked corn-on-the-cob, fried chicken, enchiladas, salad right out of the garden. The kids were playing tag, the dogs were begging for handouts, the sun was setting over the rolling hills of northeastern Pennsylvania. Her mother, my mother-in-law, Evelyn, had been diagnosed with breast cancer two years earlier, had a lumpectomy, and two years of chemotherapy and radiation. Her hair had turned white and she'd lost some weight but come through it OK, largely because Bethann had been there to help with the driving, some housework, the loose ends. The picnic was a family reunion called, in part, to celebrate Evelyn's cure. We loved to visit Bethann and Ed. They were not farmers, but they lived what seemed to us an idyllic rural life. They lived in the house that Bethann's grandparents had built, on a hill overlooking a farm that had been in the family for generations. She nurtured a huge perennial garden, and dried flowers in the attic to make into wreaths and wall hangings. They kept goats, honeybees, and chickens, heated their house with wood, canned tomatoes, lived simply. We had moved to the south side of Chicago, and put our kids to bed each night to the sound of sirens and, occasionally, of distant gunfire. When the kids got to the farm, it was as if they started breathing again. After supper, Bethann stood up, grabbed her chest, and collapsed. My wife and I are both doctors. We ran over, felt for a pulse. Nothing. Bethann's eyes were rolled back in her head. She was gasping. Her color was terrible, pale, bluish-gray. We looked at her, at each other. This is it. I told somebody to call 911. We were way out in the country. Miles from nowhere. Better start chest compressions. 1-2-3-4-5. Nancy couldn't do mouth-to-mouth on her own sister. We switched. She did the chest compressions. I started mouth-to-mouth. I had never done CPR in the field before. In the hospital, CPR is, weirdly enough, a friendly, communal activity. When a code is called, the team comes running, just like on TV. There is familiar equipment. People work together. Anesthesia intubates. Respiratory therapy has the ambubag. Residents start intravenous lines. Nursing, poised by the wellstocked crash cart, hands me the meds. Monitors beep. In the hospital, you never have to do mouth-to-mouth resuscitation, so I had never actually done it on anybody except on the plastic Resusci-Annie dolls in CPR class. It was a little like that. Head tilt. Watch the chest. Puff. Count it out. 1-2-3-4-5. Breathe. 1-2-3-4-5. In another sense, it was nothing at all like CPR class or anything else. It was gruesome. The sun was going down. We could hardly see what we were doing. Mosquitoes were buzzing by my ears. Kids were screaming and crying, but I only heard them like a distant sound track, and I hardly noticed when they were gone. Bethann vomited the supper she had just cooked and enjoyed. We had no suction equipment, so it got harder and harder to breathe for her. I cut my lip pressing it against her teeth and my blood began to drip onto her lips and chin. Suddenly, I remembered that we should have given her a chest thump. We stopped CPR. I raised my fist above my head and smashed it down upon her chest. …

Serial chest thumps for the treatment of ventricular tachycardia in patients with coronary artery disease

Clinical CardiologyVolume 15, Issue 7 p. A28-A28 Letters to the EditorFree Access Serial chest thumps for the treatment of ventricular tachycardia in patients with coronary artery disease David Shander M.D., David Shander M.D. 4545 East 9th Street Suite 390 Denver, CO 80220Search for more papers by this authorM. Gertsch M.D., M. Gertsch M.D. Department of Cardiology Medical University Clinic Inselspital Bern 3010 Bern, SwitzerlandSearch for more papers by this author David Shander M.D., David Shander M.D. 4545 East 9th Street Suite 390 Denver, CO 80220Search for more papers by this authorM. Gertsch M.D., M. Gertsch M.D. Department of Cardiology Medical University Clinic Inselspital Bern 3010 Bern, SwitzerlandSearch for more papers by this author First published: July 1992 https://doi.org/10.1002/clc.4960150703Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Gertsch M, Hottinger S, Hess T: Conversion of ventricular tachycardia in patients with coronary artery disease by serial chest thumps. Clin Cardiol 15, 181 (1992) 2 Conner D, Shander D, Deegan C, Craddock D, Wolf PS, Baum RS: Self-administered chest thumps for cardioversion of recurrent ventricular tachycardia. Chest 73, 877 (1978) 3 Gertsch M, Hottinger S, Mettler D, Leupi F, Gurtner HP: Conversion of induced ventricular tachycardia by single and serial chest thumps: A study in domestic pigs 1 week after experimental myocardial infarction. Am Heart J 118, 248 (1989) 4 Rozanski JJ: Ventricular tachycardia and the chest thump (letter to the editor). Chest 74, 694 (1978) 5 Pennington JE, Taylor J, Lown B: Chest thump for reverting ventricular tachycardia. N Engl J Med 283, 1192 (1970) 6 Miller J, Tresch D, Horwitz L, Thompson BM, Aprahamian C, Darin JC: The precordial thump. Ann Emerg Med 13, 791 (1984) 7 Sclarovsky S, Kracoff OH, Agmon J: Acceleration of ventricular tachycardia induced by a chest thump. Chest 80, 596 (1981) 8 Krijne R: Rate acceleration of ventricular tachycardia after a precordial chest thump. Am J Cardiol 53, 964 (1984) 9 Yakaitis RW, Redding JS: Precordial thumping during cardiac resuscitation. Crit Care Med 1, 22 (1973) 10 Volkmann H, Klumbies A, Kuhnert H, Paliège R, Dannberg G, Siegert K: Terminierung von Kammertachykardien durch mechanische Herzstimulation mit Praekordialschlägen. Z Kardiol 79, 717 (1990) Citing Literature Volume15, Issue7July 1992Pages A28-A28 ReferencesRelatedInformation

Serial chest thumps for the treatment of ventricular tachycardia in patients with coronary artery disease

Based on excellent results of successive single chest thumping (CT) and serial chest thumping (SCT) for the interruption of ventricular tachycardia (VT) in experimental animals with subacute myocardial infarction, the SCT method was applied for the treatment of VT in patients with coronary artery disease (CAD). SCT was successful in terminating 13 of 19 episodes of VT (68%) in 8 of 14 patients (57%). Conversion of VT was immediate in 9 episodes in 6 patients and latent in 4 episodes in 2 patients. Complications were rare but significant. In one case, SCT resulted in a ventricular asystole and in another case SCT accelerated the rate of VT from 167/min to 242/min, requiring electroconversion. Neither a short duration of VT nor a preserved left ventricular function seemed to enhance conversion by SCT. For interruption of VT in patients with CAD, SCT is not as successful as in the experimental animal model and, therefore, should not be used as a routine method. It may be applied in selected patients under hospital conditions with a standby defibrillator.

Complications of chest thump for termination of supraventricular tachycardia in children

We report on two cases of mechanical termination of supraventricular tachycardia by chest thump which were followed by serious complications. In a 3-year-old boy with an otherwise normal heart, incessant supraventricular tachycardia was converted to sinus rhythm by a single precordial thump. This, however was followed by thrombo-embolic infarction of the left-sided middle cerebral artery. In another case of a 9-year-old girl, recurrent episodes of supraventricular tachycardia were associated with Ebstein anomaly of the tricuspid valve. Chest thump was successful in terminating supraventricular tachycardia but induced a short run of ventricular tachycardia which terminated itself and was then followed by sinus rhythm. It is concluded that even a slight precordial thump implies undetermined risks in the acute management of supraventricular tachycardia in children and should therefore be abandoned in favour of other methods.

Conversion of induced ventricular tachycardia by single and serial chest thumps: A study in domestic pigs 1 week after experimental myocardial infarction

A single chest thump (CT) is widely accepted in the emergency treatment of ventricular asystole, whereas there exists controversy about this method for the interruption of ventricular tachycardia (VT). Hitherto, delivering serial chest thumps (SCTs) has been described only once for the treatment of VT. A systematic analysis for interruption of VT by CT or SCTs (or both) is lacking. We have therefore investigated this subject in five domestic pigs after experimental myocardial infarction. Manual conversion was attempted in 20 induced VTs. Six VTs were converted by CT, seven VTs were converted by the first SCTs, and six VTs were converted by the last of multiple (two to seven) SCTs. The overall success was 95%. There were no serious complications. The rate of successful SCTs exceeded the rate of VT by 10% to 126%. The technique of SCTs, the mechanisms of manual conversion, and the controversial opinions regarding the value of precordial thumping in asystole, VT, and ventricular fibrillation are discussed. SCTs should be practiced only very cautiously in patients until further experience is available.

Transient complete atrioventricular block induced by a chest thump in a patient with ventricular tachycardia

We describe an unusual case of transient complete atrioventricular block induced by a chest thump during resuscitation in a patient with ventricular tachycardia.