Incessant Supraventricular Tachycardia Research Articles

The nightmare of catheter ablation in a young male with incessant supraventricular tachycardia.

A case report involving incessant multi-types of supraventricular tachycardia and acute decompensated heart failure required a rescuing electrophysiology study and ablation. Ventricular fibrillation occurred due to coronary spasm, complicating the deteriorating heart. However, aggressive therapies, including extracorporeal support and the timely elimination of the culprit accessory pathway, successfully resolved the patient's condition.

Nearly incessant supraventricular tachycardia in a child diagnosed without pacing maneuvers: What's the mechanism?

Nearly incessant supraventricular tachycardia in a child diagnosed without pacing maneuvers: What's the mechanism?

Emerging concepts in heart failure management and treatment: focus on tachycardia-induced cardiomyopathy.

Tachycardia-induced cardiomyopathy is an entity characterized by reversible dysfunction of the left ventricle, which can be induced by different types of arrhythmia such as atrial fibrillation, atrial flutter, incessant supraventricular tachycardia and ventricular arrhythmia (more frequent causes). Correct identification of the causative arrhythmia and normalization of the heart rate (e.g through medical treatment, electrical cardioversion, ablation) can lead to recovery of left ventricular function. Tachycardia-induced cardiomyopathy should be suspected in patients with tachycardia and left ventricular dysfunction (heart failure setting), especially when there is no history of previous heart disease. Its usual phenotype is that of non-ischaemic/non-valvular dilated cardiomyopathy and it can occur in both children (main cause: permanent junctional reciprocating tachycardia) and adults (main cause: atrial fibrillation). With proper treatment, most cases recover within a few months, though there is a risk of relapse, especially when the causal arrhythmia reappears or its control is lost. This is a narrative review that comprehensively addresses the pathophysiology, clinical manifestations, and therapeutic management of tachycardia-induced cardiomyopathy. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.

An unusual cause of heart failure in a young man

A 21year old gentleman was admitted with shortness of breath and heart failure. He was noted to have incessant supraventricular tachycardia which was refractory to pharmacological and electrical cardioversion. Electrophysiology study revealed focal atrial tachycardia from an unusual location which was successfully ablated.

Rate Control by Transoesophageal Atrial Overdrive Pacing for Refractory Supraventricular Tachycardia with Severe Ventricular Dysfunction: A Bridge to Recovery.

Tachyarrhythmia-induced cardiomyopathy (TIC) is a rare, yet life-threatening phenomenon in children. TIC has been defined as myocardial dysfunction that is entirely or partially reversible after control of the responsible tachyarrhythmia and is typically caused by an incessant supraventricular tachycardia. In cases of unsuccessful termination of the tachycardia, cardiogenic shock may occur. Several authors favour the use of mechanical circulatory support in such cases. Particularly with regard to these partly severe cases, the authors would like to present the option of transoesophageal overdrive pacing (TOP) as a tool for initial heart rate control and hemodynamic stabilization of patients with TIC refractory to conventional strategies of tachycardia termination. Chart review for patients receiving TOP during the last 5years in two centres was performed. A case series of successful TOP including technique and outcomes is depicted. Rate control through TOP is a safe and effective option to restore acceptable hemodynamics in infants with refractory supraventricular tachycardia and severe impairment of ventricular function. It presents the possibility of immediate heart rate control and offers time for myocardial recovery and safe implementation of antiarrhythmic drug therapy.

Clinical and Electrophysiological Characteristics of Incessant Atrioventricular Nodal Re-Entrant Tachycardia

This study investigated clinical and electrophysiological findings in patients with incessant atrioventricular nodal reentrant tachycardia (AVNRT). AVNRT is the most frequent cause of paroxysmal supraventricular tachycardia (SVT) and, rarely, incessant SVT. There are a few case reports describing incessant AVNRT. Among 342 patients treated using ablation for AVNRT, we identified 8 patients with incessant AVNRT (2.3%). We describe the clinical and electrophysiological features of patients with incessant AVNRT and compare them with those of patients with paroxysmal AVNRT (n= 334). This study population consisted of 5 men and 3 women with incessant AVNRT. Patients with incessant AVNRT presented more frequently with the fast-slow form than those with paroxysmal AVNRT (63% vs. 14%, respectively, p<0.001). The ejection fraction in patients with incessant AVNRT was significantly lower than that in patients with paroxysmal AVNRT (49 ± 12% vs. 60 ± 8%, p= 0.03). The H-V interval in patients with incessant AVNRT was significantly longer than that in patients with paroxysmal AVNRT. A large circuit path length is inferred by spontaneous tachycardia induction in response to slight changes in sinus rate or random premature beats, suggesting that slight changes in rate produce changes in atrial or nodal refractoriness and provoke SVT. Catheter ablation in the conventional slow pathway region was successful in eliminating SVT. AVNRT can rarely present as incessant SVT, mimicking permanent junctional reciprocating tachycardia, and can be associated with tachycardia-associated cardiomyopathy. Catheter ablation in the slow pathway region leads to long-term success.

Repetitive, incessant supraventricular tachycardia: Noninvasive determination of the electrophysiologic mechanism

Repetitive, incessant supraventricular tachycardia: Noninvasive determination of the electrophysiologic mechanism

The use of flecainide in critical neonates and infants with incessant supraventricular tachycardias.

This study aimed to evaluate the efficacy of flecainide therapy in neonates and infants with drug resistant incessant supraventricular tachycardia. The study included 11 neonates and infants who received medical and/or ablation therapy between January 2010 and December 2013. Mean patient age and weight were 101.6 ± 96 days and 5.3 ± 1.9 kg respectively. Of the 12 patients, 5 underwent ablation between January 2010 and December 2011, and 6 were treated medically between January 2012 and December 2013. Mean follow-up time was 18 months (6 months-4 years). The antiarrhythmic agent flecainide only became available in Turkey in 2012, and the most noteworthy point was its addition to the therapy administered prior to ablation (adenosine, esmolol-propranolol, propafenone, amiodarone and cardioversion). In all 6 patients admitted between January 2012 and December 2013, refractory SVT was successfully treated with the administration of a triple therapy regimen of esmolol-propranolol, amiodarone and flecainide. One patient with myocarditis developed an atrial flutter complicated by a concealed accessory pathway and was put on extracorporeal membrane oxygenation (ECMO) support due to cardiopulmonary failure. The SVT was terminated, but the patient died on the fifteenth day of ECMO support. One patient with recurrent tachycardia, who had previously undergone ablation for a complex cardiac anomaly and Wolf-Parkinson-White syndrome, was treated with ablation again. No recurrence of tachycardia was observed in any of the other 9 patients. It appears that the use of propranolol-esmolol and amiodarone combined with flecainide in the medical treatment of drug-resistant SVT may reduce the need for ablation in critical neonates and infants.

PP-206 Focal Tachycardia with an Unusual Origin 5 cm Above the Atriocaval Junction Within the Superior Vena Cava

Previous studies showed that tachycardias arising from superior vena cava (SVC) are located generally within 2-3 cm above the atriocaval junction. We present a male with an incessant supraventricular tachycardia (SVT) that was ablated at a target site 5.0 cm above the atriocaval junction in the SVC.

Radiofrequency catheter ablation of atypical atrial flutter in dogs

Five dogs were presented to our institution for fatigue caused by an incessant supraventricular tachycardia. In all dogs, an ECG on admission showed a narrow QRS complex tachycardia with a median ventricular cycle length of 220 ms (range 180–360 ms), and a positive atrial depolarization identifiable in the ST segment following the previous QRS complex. There was a 1:1 atrioventricular conduction ratio in all but one dog, which presented with 2:1 atrioventricular block. Electrophysiologic studies identified the underlying arrhythmogenic mechanism as a right atrial macro-reentrant tachycardia with two distinct isthmic areas: right septal (RS) in three dogs and right atrial free wall (RAFW) in two dogs. Linear radiofrequency catheter ablation was performed during tachycardia in all dogs at the identified isthmic area, which acutely blocked the macroreentrant circuit. At 18-month follow-up, 3 dogs (1 with RAFW isthmus and 2 with RS isthmus) showed no recurrence of the arrhythmia on Holter monitoring. One dog with RS isthmus showed recurrence of the supraventricular tachycardia 15 days post-ablation, and 1 dog with RAFW isthmus presented with persistent atrial fibrillation 2 months post-ablation.

Right atrial appendage tachycardia: A rare cause of tachycardia induced cardiomyopathy with successful radiofrequency ablation using the 3D mapping system

We report the case of a 40-year-old patient with incessant supraventricular tachycardia (SVT). As this SVT was resistant to medical therapy and was complicated by severe LV dysfunction and cardiogenic shock, the patient was referred for EPS (electrophysiologic study) and ablation. EPS and successful ablation of the right atrial appendage (RAA) tachycardia were performed by means of a 3D mapping system NavX (St. Jude Medical, St. Paul, MN, USA) with complete resolution of symptoms and normalization of LV function, as evaluated at three-month follow-up examination.

Ablation of incessant supraventricular tachycardia in pregnancy (RCD code: VIII-V-3A.O)

We present a case of a 40‑year‑old woman, 4‑months pregnant (in vitro fertilization), admitted to a hospital due to incessant supraventricular tachycardia with a rate of 187 beats/min. Attempts to stop the arrhythmia (3 × cardioversion, verapamil IV) were unsuccessful; after electrical cardioversion, tachycardia recurred after a few sinus beats. In the view of poor arrhythmia tolerance (hypotonia, dyspnea) and the risks associated with incessant tachycardia (placental hypoperfusion, development of tachyarrhythmic cardiomyopathy), it was decided to perform an electrophysiology study and ablation. The procedure was carried out with the use of a computer 3D mapping system (Ensite NavX), aiming to minimize standard fluoroscopy use. The electrophysiology study indicated the presence of focal right‑atrial tachycardia. In this situation, geometry reconstruction and activation mapping of the right atrium was carried out, localizing the arrhythmogenic focus in the inferolateral portion of the tricuspid ring. After several radiofrequency (RF) applications, arrhythmia subsided and sinus rhythm was restored. Total fluoroscopy time in the procedure was only 90 seconds; the total radiation exposure was 12mGy. In addition, the abdomen of the pregnant woman was shielded with lead gowns from both sides, thus nearly completely eliminating the fetal radiation exposure. Unfortunately, after 4 weeks, the arrhythmia returned. A repeated ablation was carried out in an identical fashion as the index procedure, again with only minimal fluoroscopy time (62 s, 10mGy). The rest of pregnancy and labour were uneventful, without recurrence of tachycardia and a healthy baby was delivered. Therapeutic options and literature are reviewed and discussed. JRCD 2013; 1 (4): 24–28

Response to Letter Regarding Article, “Comparison of Transplacental Treatment of Fetal Supraventricular Tachyarrhythmias With Digoxin, Flecainide, and Sotalol: Results of a Nonrandomized Multicenter Study”

We thank Drs Uzun, Sinha, and Beattie for taking interest in our study. We fully agree that sustained fetal supraventricular tachycardia and atrial flutter (AF) is a life-threatening situation, and maternal drug therapy is therefore offered in the majority of these cases. In 1980, the first report appeared of a hydropic fetus with incessant supraventricular tachycardia that was successfully treated with transplacental digoxin therapy.1 Since then numerous retrospective studies in fetal supraventricular arrhythmia (SVA) have looked at different maternal drug therapies showing variable results.2 Our study indicates that digoxin and flecainide controls fetal SVA more effectively than sotalol, although we were unable to find differences in survival among the 3 drug cohorts. Despite relatively low conversion rates, …

Remote Navigation Guided Ablation of Incessant Atrial Tachycardia in a Patient with Restricted Venous Access

We report a case of a 45-year-old man with incessant supraventricular tachycardia (SVT) in the setting of intrahepatic inferior vena cava thrombus and a left upper extremity arteriovenous fistula. A diagnostic electrophysiology study (EPS) was performed via the right internal jugular and right subclavian veins. After confirming the mechanism of SVT was atrial tachycardia (AT), mapping, and successful ablation was performed using remote catheter navigation. This case demonstrates that remote navigation can facilitate the therapy of complex arrhythmias in challenging clinical situations.

Non-Re-Entrant Atrioventricular Nodal Tachycardia

Supraventricular tachycardia caused by AV nodal dual conduction is usually re-entry tachycardia. We report a case of a 40-year-old man with incessant supraventricular tachycardia caused by simultaneous conduction via slow and fast AV nodal pathway. The patient was successfully treated with catheter ablation of slow AV nodal pathway, the treatment of choice of this form of tachycardia (when proper diagnosis is made). Analysis of previously published cases is discussed.

Recovery of systolic and diastolic function after ablation of incessant supraventricular tachycardia

We report a case of a 26-year-old woman who presented to our hospital with arrhythmia and heart failure. She had an incessant supraventricular tachycardia, which was not reversible with electrical cardioversion. Echocardiogram showed a severe LV systolic and diastolic dysfunction. After radiofrequency catheter ablation, LV function returned to normal. This article is intended to show a case with tachycardiomyopathy, which is considered the most frequently unrecognized curable cause of heart failure, and to demonstrate that early treatment allows the recovery to a normal LV systolic and diastolic function, preventing irreversible structural cardiac damage. It is very likely that some patients with idiopathic dilated cardiomyopathy and chronic atrial fibrillation or other chronic arrhythmia actually have a curable tachycardiomyopathy.

Low-energy radiofrequency catheter ablation as therapy for supraventricular tachycardia in a premature neonate

A premature neonate with hydrops was born at 32 weeks of gestation after successful direct fetal amiodarone therapy via cordocentesis for incessant supraventricular tachycardia. After birth the tachycardia could not be controlled despite high doses of amiodarone and flecainide and the patient developed severe respiratory and circulatory failure. After 3 weeks, weighing 2 kg, he underwent successful and uncomplicated catheter ablation of a left free-wall accessory pathway using low-energy radiofrequency. radiofrequency catheter ablation is rarely used in neonates, but when used with caution may provide the optimal treatment.

A permanent junctional reciprocating tachycardia with atypical location, treated with radiofrequency catheter ablation

Permanent junctional reciprocating tachycardia (PJRT) is an incessant or almost incessant supraventricular tachycardia with a long RP interval, usually occurring in children and young adults. The differential diagnosis of PJRT includes an atrial tachycardia and atypical atrioventricular nodal reentrant tachycardia (AVNRT). The accessory pathways in PJRT are typically located in the posteroseptal region.We report a case of successful radiofrequency catheter ablation in a 28-year-old male patient with PJRT due to a left posterolateral accessory pathway.

Radiofrequency Catheter Ablation of Atrioventricular Accessory Pathways in 3 Dogs with Subsequent Resolution of Tachycardia‐Induced Cardiomyopathy

Incessant supraventricular tachyarrhythmias are known to result in myocardial dysfunction indistinguishable from idiopathic dilated cardiomyopathy by current testing methods. This tachycardia‐induced cardiomyopathy (TICM), however, is uniquely reversible with adequate rhythm control. Two dogs were presented to The Ohio State University for incessant supraventricular tachycardia (SVT) and echocardiographic signs of dilated cardiomyopathy, later proven to be TICM. A 3rd dog presented for frequent paroxysms of SVT and syncope had echocardiographic signs of mild myocardial systolic dysfunction. All 3 dogs had inadequate rhythm control with multiple antiarrhythmic agents, and 1 dog suffered from recurrent left‐sided congestive heart failure. Generalized cardiomegaly was found in 1 dog and left‐sided dilatation without concurrent right‐sided enlargement in 1 dog. Mild‐tosevere left ventricular systolic dysfunction was confirmed echocardiographically in all dogs. A total of 4 atrioventricular accessory pathways (APs) were found during invasive electrophysiologic studies in these 3 dogs. All APs were successfully ablated with radiofrequency energy delivered through a thermistor‐tipped catheter. Elimination of AP conduction, and thus orthodromic atrioventricular reciprocating tachycardia, resulted in resolution of all clinical and echocardiographic evidence of TICM in these dogs. This result confirms that the cardiomyopathy was, in fact, reversible TICM. All cardiovascular medications were discontinued, and no complications occurred during a 15–25‐month follow‐up period.

Radiofrequency catheter ablation of atrioventricular accessory pathways in 3 dogs with subsequent resolution of tachycardia-induced cardiomyopathy.

Incessant supraventricular tachyarrhythmias are known to result in myocardial dysfunction indistinguishable from idiopathic dilated cardiomyopathy by current testing methods. This tachycardia-induced cardiomyopathy (TICM), however, is uniquely reversible with adequate rhythm control. Two dogs were presented to The Ohio State University for incessant supraventricular tachycardia (SVT) and echocardiographic signs of dilated cardiomyopathy, later proven to be TICM. A 3rd dog presented for frequent paroxysms of SVT and syncope had echocardiographic signs of mild myocardial systolic dysfunction. All 3 dogs had inadequate rhythm control with multiple antiarrhythmic agents, and 1 dog suffered from recurrent left-sided congestive heart failure. Generalized cardiomegaly was found in 1 dog and left-sided dilatation without concurrent right-sided enlargement in 1 dog. Mild-to-severe left ventricular systolic dysfunction was confirmed echocardiographically in all dogs. A total of 4 atrioventricular accessory pathways (APs) were found during invasive electrophysiologic studies in these 3 dogs. All APs were successfully ablated with radiofrequency energy delivered through a thermistor-tipped catheter. Elimination of AP conduction, and thus orthodromic atrioventricular reciprocating tachycardia, resulted in resolution of all clinical and echocardiographic evidence of TICM in these dogs. This result confirms that the cardiomyopathy was, in fact, reversible TICM. All cardiovascular medications were discontinued, and no complications occurred during a 15-25-month follow-up period.