Onset Of Tachycardia Research Articles

Impact of Ethanol Infusion to the Vein of Marshall in Atrial Fibrillation and Atrial Tachycardia.

The ligament of Marshall is an epicardial structure characterized by its composition of fat, fibrous tissue, blood vessels, muscle bundles, nerve fibers, and ganglia. Its intricate network forms muscular connections with the coronary sinus and left atrium, alongside adjacent autonomic nerves and ganglion cells. This complexity plays a pivotal role in initiating focal electrical activities and sustaining micro- and macro-reentrant circuits, thereby contributing to the onset of atrial fibrillation and atrial tachycardia. However, endocardial ablation in this area may encounter challenges due to anatomical variations and insulation by fibrofatty tissue. Combining ethanol infusion into the vein of Marshall with radiofrequency ablation presents a promising strategy for effectively and safely eliminating this arrhythmogenic structure and terminating associated tachycardias.

Impact of genotype on clinical course in biventricular arrhythmogenic cardiomyopathy

Aim. To analyze the correlation between genotype and phenotype in patients with biventricular arrhythmogenic right ventricular cardiomyopathy (ARVC).Methods. The clinical phenotype of 9 unrelated probands (89 % men, median age 35 [34; 37]) with biventricular ARVC were observed. The clinical and instrumental examination included a 12-lead ECG, 24-hour Holter ECG monitoring, transthoracic echocardiography and cardiac magnetic resonance imaging with late gadolinium enhancement. Biventricular variant of ARVC was diagnosed according to the 2020 Padua criteria for both right and left ventricles involvement. High-throughput sequencing was utilized to search for mutations in genes linked to the onset of cardiomyopathies and other inherited rhythm disorders. Statistical analysis procedures were performed using the STATISTICA-12 program.Results. In all patients with biventricular ARVC, according to late gadolinium enchansment magnetic resonance imaging, left ventricular involvement of varying degrees was detected, characterized by fibrous or fibrofatty infiltration of the myocardium, as well as regional or global systolic dysfunction. Genotyping in 9 patients with biventricular ARVC revealed 10 variants of the nucleotide sequence of III-V classes of pathogenicity according to the criteria of ACMG (2015) in 4 genes associated with ARVC (PKP2, DSP, DSC2, DSG2). Of these, 7 variants belonged to classes IV and V (PKP2 - 4 mutations, DSP - 2 mutations, DSG2 - 1 mutation); 3 nucleotide substitutions were variants with uncertain significance (VUS, class III) - 2 in DSC2 gene and 1 in DSP gene. A combination of nucleotide variants in two genes (DSP and DSC2) was detected in 1 patient. The findings highlight that mutations in DSP gene were associated with more severe systolic dysfunction and left ventricle dilation compared to carriers of mutations in PKP2 gene. In patients with variants of class III pathogenicity in DSC2 gene the most adverse clinical course of the disease was observed with the early onset of the first sustained ventricular tachycardia and the development of severe dysfunction and dilation of both ventricles requiring heart transplantation in comparison with carriers of mutations in other genes.Conclusion. The results obtained in a cohort of patients with biventricular ARVC demonstrate a specific correlation between genotype and clinical course and disease severity as well.

The great mimic: A rare clinical presentation of myocarditis and multi-organ failure secondary to phaeochromocytoma

Phaeochromocytomas are catecholamine-producing tumours derived from the sympathetic or parasympathetic nervous system. The clinical presentation is variable, ranging from adrenal incidentalomas to patients with hypertensive crisis or, rarely, with myocarditis and multiple organ failure. We present the case of a 54-year-old patient admitted to the emergency room due to sudden onset of dyspnoea and tachycardia; after a few minutes, due to the onset of oxygen desaturation and loss of consciousness, he was intubated; a coronary angiography was performed which revealed no significant stenosis; the diagnostic hypothesis therefore led us to think of a genesis of the clinical presentation due to a myocarditis which was then confirmed by cardiac MRI. The aetiology was also clarified by performing abdominal CT and urinary and serum dosage of catecholamines. Phaeochromocytoma confirms itself as an excellent simulator, which is why it is defined as the "great mimic" and is one of the diagnostic hypotheses to think about in young patients with acute multiorgan failure not explained by other causes. Contributions: VN and MUS helped in conception and design of the study, MUS, VN and PV did data collection, VN and MUS did analysis and interpretation of data; MUS and VN contributed to drafting the work and revising it critically for important intellectual content. All authors approved the final version for publication and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Conflict of interest: The authors declare they have no competing interests, and all authors confirm accuracy. Grant support & financial disclosures: None Ethical Consideration, informed consent, and Consent for publication: Informed consent was signed by patient. All mentioned ethical aspects and related consents were taken into consideration during the conduct of this study.

Corticotropin-producing pheochromocytoma in multiple endocrine neoplasia type 1

A clinical case of a man 66 y.o. who was diagnosed with hormone-inactive pituitary macroadenoma complicated by corneal erosion and partial atrophy of the optic nerve of the left eye due to exophthalmos. The increase in prolactin level was regarded due to a «stalk-effect». The patient underwent a transnasal pituitary adenomectomy with subsequent regression of symptoms. After 4 years, against the background of a new coronavirus infection, increasing general weakness, headaches, a crisis increase in blood pressure and tachycardia attacks appeared. Computed tomography (CT) accidentally revealed an adrenal incidentaloma, in laboratory tests - hypercortisolism, elevated ACTH levels, hypokalemia, hyperglycemia, increased levels of metanephrine and normetanephrine. The patient developed acute steroid psychosis, after which an adrenalectomy with a tumor was performed, a pheochromocytoma was histologically confirmed. After surgery, there was a regression of symptoms, the development of adrenal insufficiency with reduced levels of ACTH and cortisol. Upon further examination, a polynodose euthyroid goiter was established, the biopsy of the nodes - Hashimoto's thyroiditis (Bethesda II). Meanwhile, primary hyperparathyroidism was detected. According to ultrasound, scintigraphy with Ts99m-Technetril and CT revealed an increase of left parathyroid gland. A bilateral revision of the neck, removal of the right upper and left upper parathyroid adenomas were performed. In the postoperative period, the levels of calcium and parathyroid hormone were normalized. Given the presence of a combination of multiple tumors of the endocrine system (primary hyperparathyroidism, corticotropin-producing pheochromocytoma, hormone-inactive pituitary macroadenoma, polynodose euthyroid goiter), the MEN1 syndrome was clinically established. The study of 2 and 10 exons of the MEN1 gene revealed no mutations, which does not exclude the presence of a hereditary syndrome. The patient continues observation. In the available literature in Russian and English languages the case of ACTH pheochromocytoma as part of the MEN type 1 syndrome have not been found. Therefore, we consider the presented case to be the first one.

A School Nurse's Experience With Supraventricular Tachycardia.

Students visit school health offices with a variety of complaints, and while some may be minor, others may be more pressing. The challenge for the school nurse is being able to differentiate between the two. This article features a case study of a fourth-grade elementary student who presented to the school nurse with a sudden onset of supraventricular tachycardia (SVT), a rapid cardiac arrhythmia that originates above the ventricles in the heart. The student's complaint was a "racing heart," and it was her first time experiencing a cardiac episode. It was also the school nurse's first time encountering this chief complaint. The article will describe the student's presentation to the health office, will discuss the school nurse's assessments along with SVT management techniques, and will conclude with the student's outcome and a sample individualized healthcare plan.

Analysis of factors associated with operative difficulty in thoracoscopic esophageal cancer surgery in the left-decubitus position: a single-center retrospective study.

The degree of difficulty in the overall procedure and forceps handling encountered by surgeons is greatly influenced by the positional relationship of intrathoracic organs in minimally invasive esophagectomy. This study aimed to identify the anatomical factors associated with the difficulty of minimally invasive esophagectomy assessed by intraoperative injuries and postoperative outcomes. Minimally invasive esophagectomy in the left-decubitus position was performed in 258 patients. We defined α (mm) as the anteroposterior distance between the front of the vertebral body and aorta, β (mm) as the distance between the center of the vertebral body and center of the aorta, and γ (degree) as the angle formed at surgeon's right-hand port site by insertion of lines from the front of aorta and from the front of vertebrae in the computed tomography slice at the operator's right-hand forceps hole level. We retrospectively analyzed the correlations among clinico-anatomical factors, surgeon- or assistant-caused intraoperative organ injuries, and postoperative complications. Intraoperative injuries significantly correlated with shorter α (0.2 vs. 3.9), longer β (33.0 vs. 30.5), smaller γ (3.0 vs. 4.3), R1 resection (18.5% vs. 8.3%), and the presence of intrathoracic adhesion (46% vs. 26%) compared with the non-injured group. Division of the median values into two groups showed that shorter α and smaller γ were significantly associated with organ injury. Longer β was significantly associated with postoperative tachycardia onset, respiratory complications, and mediastinal recurrence. Furthermore, the occurrence of intraoperative injuries was significantly associated with the onset of postoperative pulmonary complications. Intrathoracic anatomical features greatly affected the procedural difficulty of minimally invasive esophagectomy, suggesting that preoperative computed tomography simulation and appropriate port settings may improve surgical outcomes.

Sympathetic denervation — a promising method for treatment of ventricular tachyarrhythmia in children

Ventricular tachycardia is a rare but potentially life-threatening arrhythmia. Ventricular tachycardia in patients with structural pathology and cardiac channelopathies is associated with the highest risk of sudden cardiac death. The stratification of patients depending on the risk of developing a life-threatening arrhythmia determines the choice of treatment method. Left cardiac sympathetic denervation is a surgical method of treatment aimed at preventing attacks of ventricular tachycardia. The antiarrhythmic effect of sympathetic denervation has been proven in both experimental and clinical studies. Currently, the technique of left cardiac sympathetic denervation consists of a video-assisted sympathectomy by thoracoscopic access, which makes the procedure safe and effective. Left cardiac sympathectomy is used in the treatment of patients with recurrent ventricular tachycardia despite adequate medical therapy. The authors recommend the use of left cardiac sympathectomy in those types of channelopathies, in which stress is the main proven provoking factor of ventricular tachycardia.

Anesthesia in patients with Brugada syndrome: two case reports

BackgroundBrugada syndrome is a rare disease. It causes sudden cardiac arrest, which is a serious life-threatening event. Sudden cardiac death mostly results from coronary artery disease. However, patients with Brugada syndrome show normal cardiac anatomy and no evidence of ischemia or electrolyte imbalance. Anesthesia in patients with Brugada syndrome is challenging due to its unpredictable nature, and is worth our attention.Case presentationWe report two cases of Brugada syndrome during anesthesia. In case one, a 31-year-old Filipino laborer was scheduled for laparoscopic appendectomy. The patient denied any preexisting cardiac disease. The preoperative vital signs were stable, with mild fever of 37.9 °C. The operation was smooth. During the emergence period, the patient suffered from sudden onset of ventricular tachycardia. After resuscitation, the cardiac rhythm returned to normal. Later, he was confirmed to have a genetic trait of Brugada syndrome. In case two, a young Taiwanese patient with pre-diagnosed Brugada syndrome underwent an operation. The perioperative precautions were taken to prevent the occurrence of ventricular arrhythmia. The surgery was uneventful.ConclusionsBrugada syndrome, although rare, has the highest incidence in South East Asian healthy young males. It brings attention to possible fatal cardiac arrhythmia in this population. Careful preoperative evaluation and perioperative management can help reduce the harmful outcome of the disease and prevent any untoward events.

Cardiac magnetic resonance imaging T1 mapping and late gadolinium enhancement entropy: Prognostic value in patients with systemic sclerosis

BackgroundSystemic sclerosis (SSc) affects the myocardium, thereby resulting in a poor prognosis. Late gadolinium enhancement (LGE) entropy, derived from routine cardiac magnetic resonance (CMR) LGE images, is an index that reflects the complexity of the left ventricular myocardium. The aim of this study was to investigate whether LGE entropy can serve as a prognostic factor in patients with SSc. MethodsTwenty-four patients with SSc, who underwent CMR-T1 mapping and LGE to identify myocardial damage, were enrolled, and LGE entropy was measured. Extracellular volume (ECV) values were calculated using the same CMR-LGE images. The endpoint was major adverse cardiac events (MACEs), comprising all-cause death, hospitalization due to heart failure, and the onset of sustained ventricular tachycardia and ventricular fibrillation. The ability to predict MACE was assessed using receiver operating characteristic (ROC) analysis, and the predictability of LGE entropy was analyzed using Kaplan–Meier analysis. ResultsThe ROC curve analysis demonstrated a cut-off value of 7.39 for MACE with LGE entropy and had a sensitivity and specificity of 80 % and 79 %, respectively. Patients with LGE entropy ≥7.39 had a significantly higher MACE rate than those with LGE entropy <7.39 (p = 0.010). Moreover, LGE entropy ≥7.39 was a poor prognostic factor in patients without elevated ECV values. ConclusionsLGE entropy can be used to predict MACE and allows for further risk stratification in addition to ECV determination.

Behavior of Retrograde Conduction Time at Supraventricular Tachycardia Induction and its Role in Differential Diagnosis

Background: Differential diagnosis between orthodromic reentrant tachycardia (ORT) and atypical nodal reentrant tachycardia (ANRT) can be challenging. Our hypothesis was that ANRT presents more variability in retrograde conduction time at tachycardia onset than ORT. Objectives: The objectives of this study were to assess retrograde conduction time variability at the start of tachycardia in ANRT and ORT, and postulate a new diagnostic tool to differentiate these two types of arrhythmias. Methods: The ventriculoatrial (VA) interval of the first beats after tachycardia induction was measured until stabilization. The difference between the maximum and minimum VA interval was defined as delta VA (ΔVA), and the number of beats needed for VA interval stabilization was also assessed. Atrial tachycardias were excluded. Results: In a total of 101 patients included in the study, ORT was diagnosed in 64 patients and ANRT in 37. ΔVA interval was 0 (interquartile range [IQR] 0-5) milliseconds (ms) in ORT vs. 40 (21-55) ms in ANRT (p &lt;0.001). The VA interval significantly stabilized earlier in ORT (1.5 [1-3] beats) than in ANRT (5 [4-7] beats) (p&lt;0.001). A ΔVA &lt;10 ms diagnosed ORT with 100% sensitivity, specificity, and positive and negative predictive values. Ventriculoatrial interval stabilization in less than 3 beats predicted ORT with good diagnostic accuracy. The results were similar considering only accessory septal pathways. Typical NRTs presented an intermediate variation. Conclusion: Presence of ΔVA &lt;10 ms is a simple criterion that accurately differentiates ORT from ANRT, independently of the accessory pathway localization.

Pneumologie meets Kardiologie: Kardiale Sarkoidose

Cardiac sarcoidosis is variable in its clinical manifestations and is characterized by challenges in the diagnostics, treatment and prognosis assessment. Due to increased awareness and advances in diagnostic tools, a rising incidence of the disease has been observed. This article presents the developments and necessary background knowledge based on the current guidelines. A case report of a 50-year-old male patient with sudden onset of ventricular tachycardia serves as an illustrative case.

Managing SVT attacks in NICU: A single tertiary center experience

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

Abstract 10554: Major Cardiac Side Effects of BTK and BCR-ABL Kinase Inhibitor Therapy in Cancer Patients: A Global WHO Database Analysis

Introduction: Bruton’s tyrosine kinase (BTK) and BCR-ABL kinase inhibitors have transformed the treatment for hematological cancers, such as mantle cell lymphoma and chronic myelogenous leukemia. However, these therapies present unique cardiac events that remain underexplored. Hypothesis: We hypothesize that the two groups of targeted therapies commonly used to treat hematological cancers will differ in cardiac side-effect profiles. Methods: The World Health Organization database, VigiBase ®, contains over 20 million Individual Case Safety Reports and is maintained by the Uppsala Monitoring Centre. Reports for unique cardiac events associated with the use of BTK and BCR-ABL kinase inhibitors were analyzed. Reporting odds ratios (ROR), 95% confidence intervals (CI) and chi-squared tests were used to compare differences in cardiac side-effect profiles between the two groups of therapies. Results: A total of 24,385 adverse cardiac events from the use of BTK inhibitors (ibrutinib, acalabrutinib, zanubrutinib, tirabrutinib) and BCR-ABL kinase inhibitors (imatinib, dasatinib, nilotinib, bosutinib, ponatinib) have been observed based on records obtained to-date. Compared to BCR-ABL kinase inhibitors, BTK inhibitors have significantly increased reporting for atrial fibrillation (ROR: 6.995; 95% CI: 6.493-7.537; P &lt; 0.001) and ventricular tachycardia (ROR: 1.829; 95% CI: 1.342-2.493; P &lt; 0.001). However, BCR-ABL inhibitors have significantly increased reporting for myocardial infarction (ROR: 2.077; 95% CI: 1.863-2.316; P &lt; 0.001) but similar reporting for congestive cardiac failure (ROR: 0.949; 95% CI: 0.852-1.058; P = 0.343). The median onset of ventricular tachycardia from the use of BTK inhibitors is 176 days (interquartile range: 48-636 days). For BCR-ABL kinase inhibitors, the median onset of ventricular tachycardia is similar at 137 days (interquartile range: 92-396 days), P = 0.741 from nonparametric tests. Conclusion: We conclude that BTK inhibitors are associated with arrhythmic events, while BCR-ABL kinase inhibitors are associated with myocardial infarction. Both groups have similar reporting for congestive cardiac failure. Research is underway to study the mechanisms behind these novel side-effect profiles.

ODP023 Adrenal medullary hyperplasia as a differential diagnosis of paroxysmal hypertension: case report

Abstract Background Sporadic Adrenal Medullary hyperplasia (AMH) has been little described in the literature, being most often diagnosed during a genetic syndrome screening or the evaluation of an adrenal incidentaloma. Case report A 51-year-old female patient presented with progressive attacks of tachycardia, headache, nausea and mild paroxysmal hypertension, which started in December 2020. She had a history of smoking and she also presented Takotsubo syndrome in 2018. She denied other comorbidities. In March 2021, she was submitted to laboratorial testing which demonstrated indeterminate plasma fractionated metanephrines by HPLC/MS: metanephrines 0.3 nmol/L (n&amp;lt; 0.5) and normetanephrines 1.2 nmol/L (n&amp;lt; 0.9) and normal serum chromogranin A level: 82 ng/mL (n&amp;lt;93) by Directed Proteomic. Urinary metanephrines were collected in a spot sample after an adrenergic crisis episode, confirming the biochemical diagnosis: metanephrines 255 mcg/g creatinine (n 30-165), normetanephrine 824 mcg/g creatinine (n 105-375), total 1119 mcg/g creatinine (n 150- 510) by HPLC. She was submitted to an abdominal MRI, which showed bilateral adrenal thickening with medullary predominance with hyperintense sign on T2-weighted images. It was also performed a mIBG I 131 spect and a PET-CT DOTATATO-Galium 68 without abnormal uptakes. A genetic panel by NextGeneration Sequence (NGS) was also carried out for pheochromocytoma/paraganglioma (PHEO/PGL) without pathological findings. The patient underwent laparoscopic left adrenalectomy after the use of alpha and beta blockade for one month, with pathological findings suggestive of adrenal medullary hyperplasia. However, she remained symptomatic after surgery. Once again, new urinary metanephrines in a spot sample were collected after an adrenergic crisis: metanephrines 188 mcg/g creatinine (n 30-165), normetanephrines 1229 mcg/g creatinine (n 105-375), total 1417 mcg/g creatinine (n 150-510) by HPLC, which demonstrated remaining cathecolamine excess. She underwent a contralateral laparoscopic adrenalectomy without surgical complications. An anatomopathological analysis was performed in both adrenals, which confirmed bilateral adrenal medullary hyperplasia without associated PHEO. The patient showed improvement in adrenergic symptoms and normalization of plasma fractionated metanephrines levels postoperatively, currently using hydrocortisone and fludrocortisone for the treatment of adrenal insufficiency. Conclusion Adrenal Medullary hyperplasia is a rare condition, which usually presents in a milder form and is often associated with pheochromocytoma or genetic syndromes. However it should be considered in symptomatic patients without a personal or family history of PHEO/PGL, allowing an early diagnosis and treatment. Presentation: No date and time listed

Cardio-protective effect of Cocculus hirsutus in experimental hypertension in rats

BackgroundAyurdvedic derived medicines are most promising and effective in the treatment of several cardiovascular diseases. Cocculus hirsutus (CH) has been reported for broad spectrum of activities like anticancer, antidiabetic, antioxidant, cardiotonic and hypotensive etc. ObjectivesThe present study aimed to find the cardio-protective effect of CH in experimental hypertension in rats. Materials and methodsFor acute renal hypertension, CH animals were pre-treated with CH-1 (250 mg/kg) and CH-2 (500 mg/kg) p. o. for 14 days. On the 15th day, hypertension was induced by renal occlusion and the mean arterial blood pressure (MABP) was recorded. For CAL pretreatment of CH-1 and CH-2 was given for 7 days on the 8th day animals were operated on for ligation. The MABP and the time of onset of ventricular tachycardia (VT), premature ventricular systole (PVS) were recorded. For induction of hypercholesterolemia, animals were fed with a high cholesterol diet (CD) with CH-1 and CH-2 for 21 days. The antioxidant potential of CH was done using the assay of superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), and glutathione peroxidase (GPx). ResultsCH treatment significantly decreases the MABP, the onset of VT and PVS. The histology show intact cardiac muscle with minimum necrosis and inflammation. CH treatment shows significant decrease in cholesterol, triglycerides, and glucose while HDL levels are significantly increased. The aortic section of CH-treated animals shows the intact layers of the artery, normal thickness and restoration of antioxidant enzymatic activity. ConclusionThe study shows significant cardio protective effect of CH in experimental animals.

Acute ST-Elevation Myocardial Infarction in Patient with Severe Uncontrolled Hyperthyroidism Complicated by Thyroid Storm

Acute ST-elevation myocardial infarction is a life-threatening medical emergency that needs to be recognized early and treated properly to prevent deleterious complications, including death. A thyroid storm (TS) is a rare but severe manifestation of uncontrolled hyperthyroidism that might present with serious cardiovascular or neurological problems. We described a case of a 40-year-old male patient, known to have uncontrolled hyperthyroidism, who presented with acute onset of central chest pain, agitation, tachycardia, and pulmonary congestion. Fast atrial fibrillation with ST-segment elevation in anterior leads was detected on electrocardiogram. Thyroxin level (T4) was very high with undetectable thyroid stimulating hormone. Initially, the patient refused any type of coronary revascularization; therefore, he was admitted to the cardiology intensive care unit, and medical treatment was commenced for both TS and acute coronary syndrome. High-risk coronary angiography was done 2 h later because he had worsening persistent chest pain and started to develop signs of heart failure. It showed embolic occlusion of the distal left anterior descending artery that was treated medically with anti-coagulation. There were no complications. Chest pain and thyroid function tests settled down during his hospital stay with close cardiology and endocrinology follow-up.

Variability of the VA interval at tachycardia induction: a simple method to differentiate orthodromic reciprocating tachycardia from atypical atrioventricular nodal reentrant tachycardia.

The differential diagnosis between orthodromic atrioventricular reentry tachycardia (AVRT) and atypical AV nodal reentrant tachycardia (aAVNRT) is sometimes challenging. We hypothesize that aAVNRTs have more variability in the retrograde conduction time at tachycardia onset than AVRTs. We aimed to assess the variability in retrograde conduction time at tachycardia onset in AVRT and aAVNRT and to propose a new diagnostic tool to differentiate these two arrhythmia mechanisms. We measured the VA interval of the first beats after tachycardia induction until it stabilized. The difference between the maximum and minimum VA intervals (∆VA) and the number of beats needed for the VA interval to stabilize was analyzed. Atrial tachycardias were excluded. A total of 107 patients with aAVNRT (n = 37) or AVRT (n = 64) were included. Six additional patients with decremental accessory pathway-mediated tachycardia (DAPT) were analyzed separately. All aAVNRTs had VA interval variability. The median ∆VA was 0 (0 - 5) ms in AVRTs vs 40 (21 - 55) ms in aAVNRTs (p < 0.001). The VA interval stabilized significantly earlier in AVRTs (median 1.5 [1 - 3] beats) than in aAVNRTs (5 [4 - 7] beats; p < 0.001). A ∆VA < 10ms accurately differentiated AVRT from aAVNRT with 100% of sensitivity, specificity, and positive and negative predictive values. The stabilization of the VA interval at < 3 beats of the tachycardia onset identified AVRT with sensitivity, specificity, and positive and negative predictive values of 64.1%, 94.6%, 95.3%, and 60.3%, respectively. A ∆VA < 20ms yielded good diagnostic accuracy for DAPT. A ∆VA < 10ms is a simple and useful criterion that accurately distinguished AVRT from atypical AVNRT. Central panel: Scatter plot showing individual values of ∆VA in atypical AVNRT and AVRT. Left panel: induction of atypical AVNRT. The VA interval stabilizes at the 5th beat and the ∆VA is 62ms (maximum VA interval: 172ms - minimum VA interval: 110ms). Right panel: induction of AVRT. The tachycardia has a fixed VA interval from the first beat. ∆VA is 0ms.

Catheter ablation of atrial tachycardia originated from the left atrial epicardium.

A patient was referred with frequent atrial tachycardia (AT) attacks. Activation mapping showed that the left atrium (LA) roof was earlier activated with a broad region, and right atrial activation was delayed. The far-field A wave corresponding to the pulmonary artery area was advanced with failed ablation. Therefore, the AT could be left atrial epicardial origin, which was further confirmed by the successful ablation at earliest activated site at the epicardium.

Acute T-cell Lymphoblastic Leukemia Presenting with Cardiac Encasement and Pericardial Tamponade

A 52-year-old woman with a history of breast cancer treated previously with doxorubicin, cyclophosphamide, and radiation therapy presented with subacute onset of dyspnea and tachycardia. She was found to have T cell acute lymphoblastic leukemia (T-ALL) with a mediastinal mass encasing the heart and a large pericardial effusion with tamponade. We highlight how this rare hematologic malignancy may initially present as pericardial tamponade, and specifically discuss presenting symptoms of subacute pericardial tamponade. Further, we discuss presentation, prognosis and management of T-ALL.

Catheter ablation of atrioventricular nodal reentry tachycardia and quality of life

Abstract Funding Acknowledgements Type of funding sources: None. Objective To present the results of radiofrequency catheter ablation of patients with atrioventricular nodal reentry tachycardia (AVNRT). Materials and methods Catheter ablation was performed in 488 patients with AVNRT. The age of patients is from 14 to 66 (mean age 40.2±14.7 years). Comorbidities such as ischemic heart disease and hypertension were in 234 (48%) patients, in 83 (17%) patients chronic myocarditis was detected. No organic pathology from the cardiovascular system was detected in 171 (35%) patients. In the anamnesis, tachycardia attacks were observed from 2 to 29 years (on average, 18.7 ± 4.9 years). After confirming the diagnosis of typical "slow-fast" AVNRT on the intracardiac electrophysiological investigation, an ablation catheter was inserted into the heart of the patient. Then radiofrequency ablation of "slow paths" of AV-connection was performed. Traditionally, the quality of life associated with health is considered as an integral characteristic of a person’s physical, mental (emotional) and social well-being, based on his subjective perception of these attributes. We assessed the quality of life of patients with AVNRT using the SF-36 questionnaire and The Hospital Anxiety and Depression Scale (HADS) before and after performing of catheter radiofrequency ablation. Results In 488 patients, the criteria for the effectiveness of the destruction of the "slow pathways" were obtained and the effectiveness of the procedure was 99.38%. During the study of indicators of QOL according to the SF-36 questionnaire, wich was obtained 6 months after Radiofrequency Ablation (RFA), the most significant improvement was noted in terms of role functioning RF (by 48.6%), physical functioning PF (by 25.5%) and GH general health (19.7%). The BP bodily pain index, although increased (by 13.8%), but not reliably. After 12 months, we observed a significant improvement in QOL in all indicators of the physical component of health, which did not differ from those in the control group. Clinically manifested anxiety was observed in a reliably larger number of patients (63.6%). The total indicator of the anxiety level was 11.1±2.4 points and corresponded to clinically manifested anxiety. The majority (66.7%) of patients had a subclinical form of depression. The total value of the depression level was 9.8±1.8 points and corresponded to the indicator of subclinically manifested disorders. Testing on the hospital anxiety and depression assessment scale after 12 months showed that all patients had no significant symptoms of anxiety and depression. The total score of anxiety was -2.8±1.1 points (p&amp;lt;0.0001), depression - 2.4±1.4 (p&amp;lt;0.0001). Conclusions Radiofrequency catheter ablation is an effective, drastic and safe method of treating AVNRT, the effectiveness of the procedure reaches up to 100% and allows patients to improve their quality of life, get rid of the lifelong intake of antiarrhythmic drugs.