Episodes Of Palpitations Research Articles

Cyclic Rapid Fluctuation of Hypertension and Hypotension in Pheochromocytoma

Cyclic Rapid Fluctuation of Hypertension and Hypotension in Pheochromocytoma

Intermittent rate-dependent retrograde conduction over a concealed atrioventricular accessory pathway: what is the mechanism?

Intermittent retrograde conduction over an accessory pathway (AP) is quite an uncommon phenomenon. We describe the case of a 60-year-old woman with recurrent episodes of palpitations. Atrioventricular re-entry tachycardia was diagnosed at electrophysiological study. Interestingly, retrograde conduction over the AP was detectable only when ventricular pacing was performed at fast rate. Supernormal retrograde conduction over the AP was considered the most likely explanation of this unusual finding.

Does Stopping Amiodarone after Successfully Treating Atrial Fibrillation Occurring after Cardiac Surgery Increase the Risk of Recurrence?

Atrial fibrillation (AF) following cardiac surgery is common and can complicate postoperative recovery. Amiodarone is a drug frequently used for cardioversion. Some clinicians advocate only in-hospital use of amiodarone until cardioversion, whereas others continue its use for several weeks following cardiac surgery. Inadvertent long-term administration of the drug could be harmful. This study assessed the risk of AF recurrence under 2 different regimens of amiodarone treatment. From January 2005 to July 2007, we reviewed 296 patients who developed postoperative AF. Group A consisted of 198 patients who were discharged on amiodarone treatment, and group B consisted of 98 patients who were discharged without amiodarone treatment. The patients were followed for 8 weeks after cardiac surgery and were observed for the development of symptoms such as palpitations, transient ischemic attack (TIA), stroke, and recurrence of or readmission for AF. In addition, we evaluated a control group of 145 patients with similar characteristics and no postoperative AF for the incidence of stroke and AF and compared the results with their rates in the study groups. Patients discharged on amiodarone therapy were more likely to experience episodes of palpitations than those not on amiodarone (13% versus 10%); however, the rates of AF recurrence were almost the same for the 2 groups (8% and 9%, respectively). The 2 groups also showed no difference in the incidence of TIA and stroke (5% versus 4%). A low incidence of stroke and AF (1%-2%) was observed in patients with no perioperative AF. Long-term treatment of patients with amiodarone should be reconsidered, because it may not be as effective as previously thought in preventing symptoms and AF recurrence. The surprising incidence of neurologic events requires further investigation.

Triple myxoma (right and left atrial, left ventricular)

An 11-year-old boy presented to our hospital with episodes of palpitations of short duration. 2-Dimensional echocardiography revealed tumors originating in left atrium and left ventricle. During surgery one more tumor was detected in right atrium. All three tumors were excised successfully.

Ventricular Fibrillation in the EP Lab. What is the Atrial Rhythm?

An 81-year-old gentleman presented with recurrent episodes of syncope. He had no episodes of palpitations or angina. His echocardiography study was normal and stress test and head-up tilt test were negative. The baseline ECG showed incomplete right bundle branch block. He was taken up for an electrophysiology study under local anesthesia in conscious nonsedated state. A 6F diagnostic quadripolar catheter was placed in the high right atrium through the right

Radiofrequency Catheter Ablation of Atrial Fibrillation in Athletes Referred for Disabling Symptoms Preventing Usual Training Schedule and Sport Competition

Atrial fibrillation (AF) may occasionally affect athletes by impairing their ability to compete, and leading to noneligibility at prequalification screening. The impact of catheter ablation (CA) in restoring full competitive activity of athletes affected by AF is not known. The aim of our study was to investigate the effectiveness of CA of idiopathic AF in athletes with palpitations impairing physical performance and compromising eligibility for competitive activities. Twenty consecutive competitive athletes (all males; 44.4 +/- 13.0 years) with disabling palpitations on the basis of idiopathic drug-refractory AF underwent 46 procedures (2.3 +/- 0.4 per patient) according to a prospectively designed multiprocedural CA approach that consolidates pulmonary veins (PV) isolation through subsequent steps. Preablation, effort-induced AF could be documented in 13 patients (65%) during stress ECG and significantly reduced maximal effort capacity (176 +/- 21 W), as compared with patients with no AF during effort (207 +/- 43 W, P < 0.05). At the end of CA protocol, which also included ablation of atrial flutter (AFL) in 7 patients, 18 (90.0%) patients were free of AF and two (10.0%) reported short-lasting (minutes) episodes of palpitations during 36.1 +/- 12.7 months follow-up. Compared with preablation, postablation maximal exercise capacity significantly improved (from 183 +/- 32 to 218 +/- 20 W, P < 0.02). All baseline quality of life (QoL) parameters pertinent to physical activity significantly improved (P < 0.05) at the end of CA protocol. All athletes obtained reeligibility and could effectively reinitiate sport activity. AF, alone or in combination with AFL, may significantly impair maximal effort capacity thereby limiting competitive performance. Multiple PV isolation proved very effective in these patients to restore full competitive activity and allow reeligibility.

High Altitude Arrhythmias

Objective: To investigate the cause and nature of palpitations occurring at high altitude. Methods: Implantable loop recorders were inserted subcutaneously in the left pectoral region of 9 healthy male volunteers. Subjects flew to Kathmandu (1,250 m) and then Lukla (2,800 m) before immediately commencing an identical ascent and descent profile to high altitude. The loop recorders were activated with any episode of palpitations and during exercise, rest and sleep. Arterial oxygen saturation was assessed concomitant with device activation. Results: Above 5,000 m all subjects reported palpitations during exercise. All subjects demonstrated sinus tachycardia and marked sinus arrhythmia; one subject demonstrated atrial flutter; one subject had non-conducted p waves, and a further subject had marked ST segment depression. Conclusions: Significant arrhythmias occur at high altitude. In view of the increased risk of sudden cardiac death at high altitude, and considering that the elderly account for 15% of the 100 million visitors to altitude annually, further investigation is required.

Prospective comparison of the diagnostic utility of a standard event monitor versus a “leadless” portable ECG monitor in the evaluation of patients with palpitations

Current ambulatory ECG monitoring systems are limited in their ability to diagnose patients with palpitations. The aim of this prospective study was to compare a new "leadless" ambulatory monitor with a standard event monitor in the evaluation of patients with palpitations. Eighteen consecutive patients (11 female, 56 +/- 16 years) referred for evaluation of palpitations were provided with both a standard event monitor and a "leadless" monitor for 30 days. They were asked to record episodes of palpitations with both monitoring devices. All 18 individuals were compliant with the "leadless" monitor for the 30-day period while only 14 (78%) patients were compliant with the standard event monitor (p = 0.10). During a combined monitoring period of 563 days, 159 symptomatic episodes were recorded with the "leadless" ECG monitor (8.8 +/- 9.7 per patient, range 1-35) and 169 symptomatic episodes were recorded with the event monitor (12 +/- 8.3 per patient, range 1-33) (p = NS). The "leadless" ECG monitor recorded arrhythmias in 13 of 18 patients (72%) and the standard event monitor recorded arrhythmias in 8 of 14 patients (57%) (p = NS). The "leadless" ECG monitor is associated with high patient compliance and results in high quality ECG recordings. The diagnostic yield of this monitoring system is equivalent to a standard event monitor.

Unusual Appearance of Clot in the Left Atrium

A 73-year-old man had experienced episodes of palpitations for more than 1 year. The palpitations occurred when the patient was in a supine position and they were not related to exertion. They were not associated with syncope or chest pain. The cardiac workup included a Holter monitor that showed a predominantly sinus rhythm with premature atrial contractions and several episodes of nonsustained atrial tachycardia. A transthoracic echocardiogram demonstrated a left atrial mass. A transesophageal echocardiogram confirmed the presence of an echodensity attached to the posterior aspect of the left atrium that measured 1.4 × 1.5 cm with calcium in the mass (Fig 1).

Real-time representation of multielectrode ablation catheters by integration of computed tomographic geometry with three-dimensional electroanatomic mapping of left atrium and pulmonary veins

t B f s t P l s a S t v A m c t f w t R l A 36-year-old man without apparent structural heart disase was referred for catheter ablation of atrial fibrillation. e had weekly episodes of palpitations that were resistant to iltiazem, propranolol, and flecainide. Short bursts of atrial achycardia and fibrillation were demonstrated on ECGs and 4-hour ambulatory ECG Holter monitoring recorded on ifferent days. The patient underwent 64-detector multislice omputed tomography (CT) of the left atrium and pulmoary veins before the ablation procedure. A 24-pole ring-shaped catheter (yellow in Figure 1) and custom octapolar ablation catheter (white in Figure 1) ere introduced into the left atrium for mapping and abla-

A 19-year-old male with palpitations

A 19-year-old male presented to the emergency department (ED) following intermittent episodes of palpitations. Classical “epsilon waves” noted on his initial electrocardiogram prompted an evaluation for arrhythmogenic right ventricular dysplasia (ARVD). The diagnosis was confirmed with magnetic resonance imaging of the heart and stress test. A prompt recognition and management of this condition in the ED helped prevent significant mortality that may be associated with ARVD.

Radiofrequency Catheter Ablation of Ventricular Tachycardia Originating in the Left Posterior and Left Anterior Fascicles in a Patient With Prior Myocardial Infarction

A 61-year-old man with prior anteroseptal myocardial infarction (ejection fraction: 40%) presented with recurrent episodes of palpitations. Twelve-lead ECG during palpitations showed an incessant ventricular tachycardia (VT1) with right bundle branch block (RBBB) morphology and inferior axis. Electrophysiologic study revealed that the clinical VT originated from the anterolateral left ventricle. A Purkinje potential preceded onset of the QRS complex by 34 ms. Radiofrequency ablation guided by the Purkinje potential terminated the VT1. Another ventricular tachycardia (VT2) showing RBBB morphology with superior axis and originating from the posteroseptal left ventricle, was induced by programmed ventricular stimulation. A Purkinje potential preceded onset of the local ventricular potential by 120-130 ms in this VT. Radiofrequency ablation guided by the Purkinje potential terminated the VT2.

Supraventricular tachycardia: What is the mechanism?

A 32-year-old woman presented with recurrent episodes of palpitations and documented supraventricular tachycardia (SVT). Five years earlier, she had had similar symptoms and reportedly underwent successful ablation of a manifest left lateral accessory pathway. An electrophysiology study was performed. Quadripolar electrophysiology catheters were placed in the high right atrium, His bundle, and right ventricular (RV) apex. A decapolar catheter (2-8-2 mm spacing) was placed in the coronary sinus with the proximal bipole at the coronary sinus ostium, and the distal bipole was located posterolaterally.

Anestesia para cesariana em paciente portadora de cardiomiopatia hipertrófica familiar: relato de caso

Familiar Hypertrophic cardiomyopathy (FHC) is a rare hereditary cardiac disorder characterized by hypertrophy of the ventricular septum and variable degrees of subvalvular aortic stenosis. In this disease, the increase in myocardial contractility and reduction in peripheral vascular resistance can aggravate left ventricular outlet obstruction, leading to arrhythmias and cardiac ischemia. The objective of this report was to discuss the anesthetic management of cesarean section in a patient with FHC. A patient in the 33rd week of pregnancy and prior diagnosis of FHC presented, on the 24-hour Holter monitor, 22 episodes of non-sustained ventricular tachycardia (NSVT) and 2 episodes of sustained ventricular tachycardia (SVT). She complained of episodes of palpitation, dyspnea, and chest pain of short duration. The patient was medicated with atenolol, with control of symptoms and cardiac arrhythmias. Within 38 weeks and 5 days of gestation, the patient underwent elective cesarean section. Besides the usual monitoring, analysis of the ST segment and invasive blood pressure were also instituted. Anesthesia consisted of combined spinal-epidural technique with subarachnoidal administration of 5 microg of sufentanil followed by the administration of increasing doses of 0.375% bupivacaine until it reached the level of T6 (total of 16 mL). Metaraminol was used as a vasopressor. Perioperative maternal hypotension or other complications were not observed. General anesthesia is often used for cesarean sections in patients with FHC. Spinal-epidural anesthesia with slow installation of the blockade was a safe alternative. In those patients, one should avoid an increase in myocardial contractility and, if necessary, a a-agonist should be used to treat maternal hypotension.

Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia

Summary A 34-year-old male patient with situs inversus and recurrent sustained episodes of palpitations due to atrioventricular nodal reentrant tachycardia underwent successful radiofrequency catheter ablation of the slow pathway without complication. The procedure was performed using single plane fluoroscopy in the antero-posterior projection with simple leftright fluoroscopic image reversal. Radiofrequency ablation of atrioventricular nodal reentrant tachycardia in dextrocardia appears to be feasible and as safe as in normal patients.

Evaluation of pacemaker dependence in patients on ablate and pace therapy for atrial fibrillation

In patients with atrial fibrillation (AF) and uncontrolled ventricular rate, radiofrequency (RF) ablation of the atrioventricular (AV) node and pacemaker (PM) implantation (ablate and pace) is a valid therapeutic approach, especially in elderly patients. The aim of our study was to evaluate the PM dependence and the incidence of correlated clinical phenomena in a patients population with AV block induced by RF ablation of the AV junction. One-hundred and sixty-three patients (71 men; mean age 71 +/- 8 years) who had undergone ablate and pace therapy were evaluated. The patients underwent assessment of quality of life, impairment of consciousness, stroke/transient ischaemic attack (TIA), hospitalizations for heart failure, episodes of palpitations, and instrumental evaluation of PM dependence during PM inhibition (absence of escape rhythm; asystolic pause >5 s; escape rhythm <30 bpm after rhythm stabilization). Correlation between instrumentally evaluated PM dependence and clinical history was analysed. Hundred and thirty-two patients were evaluated after a mean follow-up period of 36 months [31 subjects (19%) died before the evaluation]; 55 patients (42%) were classified as PM-dependent: 38 (69%) complained of disturbances (19 dizziness, 15 pre-syncope, 4 syncope); 77 patients (58%) were considered non-PM-dependent: symptoms (dizziness, flush) were reported by only 3 (4%). No significant differences emerged between PM-dependent and non-PM-dependent patients with regard to episodes of pre-syncope, syncope, stroke/TIA, hospitalizations for heart failure, and quality of life. This study confirms that ablate and pace is an effective and safe approach in subjects with chronic or recurrent AF and uncontrolled ventricular rate.

Left main coronary artery aneurysm revealed by syncopal ventricular tachycardia in a 28-year-old woman

A 28-year-old woman was referred to our department with a syncopal sustained ventricular tachycardia with right bundle branch morphology. She was diagnosed with a pericarditis when she was 2 years old, and related an episode of palpitations five years ago. After electrical cardioversion of ventricular tachycardia, her 12-lead electrocardiogram revealed a normal sinus rhythm at 70 beats/min without any sign of myocardial ischaemia, no sign for arrhythmogenic right ventricular dysplasia or Brugada disease, or …

Left Atrial Appendage Aneurysm: A Rare Cause of Paroxysmal Supraventricular Tachycardia

Left atrial appendage aneurysm is a rare abnormality and a diagnostic dilemma in patients with cardiomegaly. Patients most commonly present with atrial tachyarrhythmias and thromboembolic events. Resection of the aneurysm is usually curative. We report herein the case of a 27-year-old man with massive left atrial appendage aneurysm diagnosed incidentally in the course of pre-operative evaluation for a non-cardiac surgery. The marked cardiomegaly detected in a routinely ordered pre-operative chest X-ray and the history of previous episodes of palpitation accompanied by chest discomfort guided us to the diagnosis. The diagnosis was made by transthoracic echocardiography and confirmed by angiography and then surgery.

Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED

Estimated to occur in 0.1% to 0.3% of the population, Wolff-Parkinson-White syndrome (WPW) is a condition where atrial impulses bypass the atrioventricular node and activate the ventricular myocardium directly via an accessory pathway. Clinical clues to the diagnosis include a young patient with previous episodes of palpitations, rapid heart rate, or syncope. Although several different rhythm presentations are possible, atrial fibrillation is a not infrequent dysrhythmia seen in the WPW patient. Electrocardiographic features suggestive of WPW atrial fibrillation include irregularity of the rhythm; a very rapid ventricular response; presence of a delta wave; and a wide, bizarre QRS complex. Stable patients suspected of having this condition should not receive agents that predominantly block atrioventricular conduction, but they may be treated with procainamide or ibutilide. If instability is present, electrical cardioversion is required.

Huge Pericardial Hemangioma Imaging

A 37-year-old healthy woman presented to our emergency department because of episodes of palpitation and syncope. Her general physical examination was unremarkable. The x-ray of her chest was normal except for bulging near the left border of her heart (Figure 1). Her ECG exhibited sinus tachycardia and short runs of monomorphic ventricular tachycardia. Consequently, the patient was admitted to the cardiology intensive care unit for further investigation. Transthoracic echocardiogram and transesophageal echocardiogram showed a large, rounded, extracardiac hypoechogenic mass within the posterosuperior portion of the heart (Figure 2A). Further evaluation of the mass was performed by cardiac computed tomography angiography using 64-row multidetector computed tomography. Cardiac computed tomography angiography revealed a large, hypodense, epicardial solid mass (9×6×6 cm) with small central areas of enhancement. The mass was located posteriorly to the right ventricle outflow tract and ascending aorta, at the level of the left coronary sinus of Valsalva, causing compression and displacement of the left atrium and the left superior pulmonary vein. In addition, …