Paroxysmal Supraventricular Tachycardia Patients Research Articles

Comparing the effects of pulsed and radiofrequency catheter ablation on quality of life, anxiety, and depression of patients with paroxysmal supraventricular tachycardia: a single-center, randomized, single-blind, standard-controlled trial

BackgroundRadiofrequency catheter ablation (RFCA) may lead to decreased quality of life (QOL) and increased anxiety and depression in patients with paroxysmal supraventricular tachycardia (PSVT), possibly due to the lack of selectivity of the ablation tissue and the long ablation time. In recent years, pulsed field ablation (PFA) has been used for the first time in China to treat PSVT patients because of its ability to ablate abnormal tissue sites in a precise and transient manner. This study was conducted to compare the effects of PFA and RFCA on QOL and psychological symptoms of PSVT patients.MethodsWe have designed a single-center, randomized, single-blind, standard-controlled trial. A total of 50 participants who met the eligibility criteria would be randomly allocated into the PFA group or RFCA group in a 1:1 ratio. All participants were assessed using the 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS) at pre-procedure (T0), post-procedure (T1), and 3 months post-procedure (T2). The SPSS 21.0 software was used to analyze the data through Wilcoxon and Fisher’s exact tests and repeated measures ANOVA.ResultsTwenty-five in the PFA group and 24 in the RFCA group completed the trial. SF-36: (1) Between-group comparison: At T1, PFA group had significantly higher SF-36 scores on physiological function (PF) and general health (GH) than RFCA group, with a treatment difference of 5.61 points and 18.51 points(P < 0.05). (2) Within-group comparison: We found that in the PFA and RFCA groups, T2 showed significant improvement in the remaining 6 subscales of the SF-36 scale compared to T1 and T0 (P < 0.05), except for body pain (BP) and social function (SF) scores. HADS: (1) Between-group comparison: no significant difference (P > 0.05). (2) Within-group comparison: The HADS scores of the PFA and RFCA groups were statistically significant at T2 compared to T0 and T1 (P < 0.05).ConclusionsOur study provided new and meaningful evidence that PFA was effective in significantly improving QOL and decreasing anxiety and depression in PFA patients.Trial registrationChinese Clinical Trial Registry, ChiCTR2200060272.

Catheter ablation for supraventricular tachycardia and health resource utilization and expenditures: A propensity-matched cohort study

BackgroundFew data are available regarding temporal patterns of health resource utilization (HRU) and expenditures among patients undergoing catheter ablation for paroxysmal supraventricular tachycardia (PSVT). This study aimed to describe expenditures and HRU in patients with PSVT who underwent catheter ablation compared to a matched cohort of patients on medical therapy alone. MethodsUsing a large US administrative database, we identified adult patients (age 18 to 65 years) with a new PSVT diagnosis between 2008 and 2016. Propensity-score matching was used to assemble a PSVT cohort treated with ablation or medical therapy alone (N = 2556). Longitudinal trends in HRU and expenditures in the 3-years preceding and following PSVT diagnosis were compared. ResultsThere were no significant differences in expenditures between groups except within the first year after PSVT diagnosis: $48,004 ablation vs. $17,560 medical therapy (p < 0.001). This difference was driven by procedural expenditures, where the mean cost of catheter ablation was $32,057 ± SD 26,737. In Years 2 and 3 post-ablation, HRU and expenditures decreased to the levels associated with the medical therapy group, although fewer ablation patients required any prescription for beta-blockers, calcium channel blockers, or anti-arrhythmic drugs (32% ablation vs. 42% medical therapy group, p < 0.001). ConclusionCatheter ablation reduces medication burden in PSVT, yet health resource use and expenditures were similar beyond 2 years post-ablation when compared to PSVT patients on medical therapy alone. Additional studies are required to better understand drivers of these sustained health expenditures, and barriers to achieving cost-savings for a potentially curative procedure.

The efficacy and safety of pulsed-field ablation in para-Hisian paroxysmal supraventricular tachycardia: first-in-human pilot trial

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Key Research and Development Program of China Background Para-Hisian paroxysmal supraventricular tachycardia (PSVT) is associated with a higher risk of atrioventricular block due to proximity of the His bundle during catheter ablation. Pulsed-field ablation (PFA) with high tissue selectivity may be a promising technique for catheter ablation in patients with para-Hisian PSVT. Purpose This study aimed to evaluate the efficacy and safety of PFA for para-Hisian PSVT. Methods This investigator-initiated, single-center, single-arm, prospective study was the first in-human pilot phase to evaluate the efficacy and safety of a novel PFA system in patients with PSVT. Patients diagnosed with para-Hisian PSVT via electrophysiological examination were included and treated with PFA. The primary outcome was the ability to achieve acute ablation success. The secondary outcome was ablation success and safety after 3 months. Results A total of seven patients with a mean age of 49.4±13.1 years were included and underwent PFA. Acute ablation success was achieved in all seven patients. The skin-to-skin procedure time was 135.0±17.7 minutes, fluoroscopy time was 4.3±1.6 minutes, and the number of PFA applications was 7±1.6. No adverse events occurred in any patient during the ablation or during the 3-month follow-up. Conclusion PFA had favorable efficacy and safety in para-Hisian PSVT patients and can help minimize the risk of inadvertent atrioventricular block during ablation. PFA may be a favorable treatment choice for patients with para-Hisian PSVT.

Deep-Learning-Based Detection of Paroxysmal Supraventricular Tachycardia Using Sinus-Rhythm Electrocardiograms.

Background: Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia associated with palpitation and a decline in quality of life. However, it is undetectable with sinus-rhythmic ECGs when patients are not in the symptomatic onset stage. Methods: In the current study, a convolution neural network (CNN) was trained with normal-sinus-rhythm standard 12-lead electrocardiographs (ECGs) of negative control patients and PSVT patients to identify patients with unrecognized PSVT. PSVT refers to atrioventricular nodal reentry tachycardia or atrioventricular reentry tachycardia based on a concealed accessory pathway as confirmed by electrophysiological procedure. Negative control group data were obtained from 5107 patients with at least one normal sinus-rhythmic ECG without any palpitation symptoms. All ECGs were randomly allocated to the training, validation and testing datasets in a 7:1:2 ratio. Model performance was evaluated on the testing dataset through F1 score, overall accuracy, area under the curve, sensitivity, specificity and precision. Results: We retrospectively enrolled 407 sinus-rhythm ECGs of PSVT procedural patients and 1794 ECGs of control patients. A total of 2201 ECGs were randomly divided into training (n = 1541), validation (n = 220) and testing (n = 440) datasets. In the testing dataset, the CNN algorithm showed an overall accuracy of 95.5%, sensitivity of 90.2%, specificity of 96.6% and precision of 86.0%. Conclusion: Our study reveals that a well-trained CNN algorithm may be a rapid, effective, inexpensive and reliable method to contribute to the detection of PSVT.

Troponin Testing in Adult Patients Presenting to the Emergency Department for Paroxysmal Supraventricular Tachycardia: A Review.

International guidelines define paroxysmal supraventricular tachycardia (PSVT) as all supraventricular tachyarrhythmias other than atrial flutter and atrial fibrillation. Associate symptoms, such as chest pain and dyspnea, and possible ECG changes during arrhythmia, such as ST depression, may suggest to the emergency physician a diagnosis of acute coronary syndrome (ACS), and thus lead to a request for troponin (cTn) level. Here, we provide a comprehensive synthesis covering published literature on the diagnostic and prognostic role of cTn in patients admitted to Emergency Department (ED) for an episode of PSVT. We performed an extensive evaluation article written in English and available in PubMed and Web of Science by using the following Medical Subject Headings (MeSH): "paroxysmal supraventricular tachycardia" AND/OR "supraventricular tachycardia" AND "Troponin" AND "Emergency Department" AND/OR "coronary artery disease". We also performed hand searching of reference lists of selected articles. A total of 17 articles were finally included. There was great variability about study design, setting and criteria for the definition of PSVT and/or type of troponin. Troponin levels were measured frequently (up to 79%) in patients admitted to ED for PSVT. About 30% of them showed cTn elevation. This elevation appears not to be associated with the presence of CAD. However, c-Tn measurements could retain utility in stratifying those with poorer prognosis among PSVT patients with an elevated cardiovascular risk profile.

A case report of an infant after episodes of paroxysmal supraventricular tachycardia with left ventricular thrombosis and cerebral infarction

Left ventricular thrombosis and cerebral infarction caused by recurrent episodes of paroxysmal supraventricular tachycardia (PSVT) are uncommon in infants. We present the case of a 23-month-old girl whose echocardiography revealed a left ventricular thrombus, which resolved after sinus rhythm was restored. The girl had experienced repeated systemic convulsions and high muscular tension of the left limb accompanied by movement disorder. Soon afterward, cranial magnetic resonance imaging (MRI) revealed scattered lacunar cerebral infarctions in the right lateral ventricle. The symptoms, signs, and laboratory examination satisfied the diagnosis of left ventricular thrombosis and cerebral infarction caused by recurrent episodes of PSVT. The girl was given antiarrhythmic drugs, including propranolol, esmolol, and amiodarone, intracranial pressure decreasing treatment (mannitol), heart and brain cell nutritional therapy, anticoagulant therapy, and her condition gradually improved. This case report highlights the importance of pediatric PSVT patients' clinical management and that more emphasis should be placed on early recognition and prevention of severe complications. Pediatricians should be trained early recognition of the nonspecific clinical manifestations of PSVT, make effectively and quickly diagnosis by electrocardiogram, evaluation of cardiac function and thrombosis by echocardiography, and termination PSVT as rapidly as possible. Thromboprophylaxis therapy might be considered for recurrent episodes of PSVT.

Trends in health care resource use and expenditures in patients with newly diagnosed paroxysmal supraventricular tachycardia in the United States

Few data are available on the temporal patterns of health resource utilization (HRU) and expenditures around paroxysmal supraventricular tachycardia (PSVT) diagnosis. This study assessed the longitudinal trends in HRU and expenditures in the 3 years preceding and subsequent to PSVT diagnosis. Adult patients (age 18-65 years) with newly diagnosed PSVT were identified using administrative claims from the IBM MarketScan Research Database between January 1, 2008 and December 31, 2016 and propensity-score matched (1:1) with non-PSVT controls. Among the 12,305 PSVT patients compared with matched controls, PSVT was associated with statistically significant higher annual rates of emergency department visits, physician office visits, inpatient hospitalizations, and diagnostic testing. HRU increased in the years preceding PSVT diagnosis, reaching its peak in the year following PSVT diagnosis. Over the 6-year follow-up period, PSVT was associated with higher mean annual per patient expenditures ($12,665) compared to matched controls ($6,004; P < .001). Upon diagnosis of PSVT, the mean expenditures per PSVT patient doubled from $11,714 in the year immediately preceding index diagnosis to $23,335 in the first postdiagnosis year. Inpatient services, diagnostic testing, and ablation procedures were the principle drivers of higher mean expenditures in the first year post-PSVT diagnosis versus the year prior to PSVT diagnosis. PSVT presents a substantial economic burden to health care systems. The annual expenditure per PSVT patient is within the range previously reported for atrial fibrillation. The increased HRU and expenditures in the year following diagnosis, which do not return to baseline, suggest a potential gap in non-interventional, long-term PSVT management.

PCV22 Trends in Diagnostic Testing Utilization and Expenditures in Patients with NEWLY Diagnosed Paroxysmal Supraventricular Tachycardia in the United States

Few data are available on longitudinal trends in health resource utilization and expenditures for paroxysmal supraventricular tachycardia (PSVT). We sought to assess the trends in diagnostic testing and expenditures around the time of PSVT diagnosis in a large, nationwide cohort. Adults (age 18 to 65 years) with newly diagnosed PSVT were identified in IBM MarketScan between 1/1/08 and 12/31/16. Patients were observable for three years before and after PSVT diagnosis. PSVT patients were propensity-score matched (1:1) with non-PSVT controls. Over the 6-year period around PSVT diagnosis, trends in the variation in diagnostic testing use and expenditures were evaluated. Among 24,624 matched patients, PSVT was associated with a higher rate of diagnostic testing (1292 tests per 1000 patient-years [PYs] vs. 313 per 1000 PYs; p<0.001). Diagnostic testing increased leading up to PSVT diagnosis, peaking in the year preceding and the year following PSVT diagnosis and remaining elevated after PSVT diagnosis, relative to matched controls. Among PSVT patients, the most common diagnostic tests were electrocardiograms (878 per 1000 PYs), echocardiograms (205 per 1000 PYs), event monitoring (205 per 1000 PYs), and stress testing (108 per 1000 PYs). Diagnostic testing accounted for 10% of the $12,675 mean annual expenditures for PSVT patients. Diagnostic testing was more common in PSVT than non-PSVT patients in both the pre- and post-diagnosis periods. A diagnosis of PSVT is resource intensive and expensive, and further research is required to determine the appropriate frequency of diagnostic testing and optimal patient care pathway.

Assessment of the hemogram parameters in patients with paroxysmal supraventricular tachycardia: a retrospective study.

Inflammation has been suggested as a potential mechanism in the pathogenesis of arrhythmia. Hemogram parameters such as monocyte count to high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) have been considered to be markers of inflammation and new cardiovascular risk predictors. This retrospective study aimed to investigate the relationship between MHR, NLR, and MLR in patients with paroxysmal supraventricular tachycardia (PSVT). A retrospective study conducted at a university hospital in Bolu, Turkey, between 2017 and 2019. Our study included 196 patients who underwent electrophysiological study (EPS) due to palpitation or documented PSVT on electrocardiography (ECG). Patients having documented atrioventricular nodal re-entrant tachycardia (AVNRT) on ECG or inducible AVNRT on EPS were included in the PSVT group (n=130), and patients with palpitation but without inducible arrhythmia on EPS (n=66) were included in the control group. Routine biochemical and hemogram tests were performed before the EPS procedure. When hemogram parameters were compared, there was no statistically significant difference in MHR values [0.010 (0.001-0.030) vs 0.010 (0.001-0.020) p =0.67]. Additionally, both NLR [2.21(0.74-11.36) vs 1.98(0.72-24.87) p=0.13] and MLR [0.25 (0.03-1.05) vs 0.24(0.07-1.39) p=0.41] were not statistically significant between the two groups. There is no significant difference in PSVT patients regarding hemogram parameters including white blood cell subtypes, MLR, NLR, and MHR. Therefore the evaluation of hemogram parameters may not be clinically relevant for PSVT patients.

Advances in the Value of Cardiac Troponin and ST Segment Depression in Predicting Coronary Artery Disease in Patients with Paroxysmal Supraventricular Tachycardia

Paroxysmal supraventricular tachycardia (PSVT) is similar to coronary artery disease (CAD) in that it is often accompanied by chest pain, ST segment depression or elevated cardiac troponin in the electrocardiogram (ECG). Studies have shown that only 20%-40% of these patients are diagnosed with CAD by coronary angiography and even lower in foreign countries. Therefore, a noninvasive and simple method is urgently needed in practice to determine the high-risk population of PSVT patients with CAD, so as to avoid excessive examination and waste of medical resources. Cardiac troponin and ECG are favored in clinic because of their simple, economical and non-invasive detection methods. By analyzing the mechanism, it is concluded that elevated troponin and ST segment depression are of low predictive value for CAD diagnosis in PSVT patients, and it is necessary to further evaluate the risk factors for cardiovascular disease in these patients to determine whether coronary angiography is required. However, it is worth noting that ST segment depression in PSVT patients may be associated with coronary microcirculation lesions. Future research should also start from the pathogenesis, symptoms and characteristics of coronary microcirculation lesions to find more similarities and differences with PSVT combined with ST segment depression. This paper may contribute to a better understanding of troponin elevation and ST segment depression in PSVT patients.

Healthcare Resource Use and Expenditures in Patients Newly Diagnosed With Paroxysmal Supraventricular Tachycardia

Information on paroxysmal supraventricular tachycardia (PSVT) patient characteristics and the associated economic burden of the disease is limited. Therefore, we sought to characterize newly diagnosed PSVT patients and quantify their healthcare resource use and expenditures. We used enrollment, demographic, and claims data from IBM MarketScan Research Database and Medicare Limited Data Set (LDS) to identify patients newly diagnosed with PSVT (ICD-9: 427.0; ICD-10: I47.1) from 10/1/2012 to 9/30/2016. Patients were required to be observable 1-year before and after index diagnosis. Patients were stratified by age (<65 years and ≥65 years), and propensity-matched to patients without PSVT. Expenditures and healthcare resource use were analyzed 1 year before and 1-year following index diagnosis. Among 49,316 patients <65 years and 23,954 patients ≥65 years, most were female (64% and 63%, respectively). Compared with matched controls, all PSVT patients had significantly more emergency department visits pre- and postdiagnosis, and more hospitalizations following diagnosis. Mean annual per patient expenditures paid by insurers were significantly higher in the year post-PSVT diagnosis, tripling for patients <65 years ($9,028 to $29,867) and nearly doubling for patients ≥65 years ($10,867 to $20,143). Spending for PSVT services accounted for 43% and 33% of the increase in expenditures in these patient-groups, respectively. Few patients had an ablation within 1 year of diagnosis, although ablations were more frequent in patients age <65 years (13% vs 3%). In conclusion, PSVT imposes a substantial economic burden, with increases in expenditures following initial diagnosis in both younger (<65 years) and older (≥65 years) patients who are not accounted for by cardiac ablation spending alone.

P3767Progressive left atrial remodeling associates with cholesterol efflux capacity of HDL in atrial fibrillation patients

Abstract Background The clinical significance of high-density lipoprotein (HDL) function, represented by cholesterol efflux capacity (CEC), in addition to serum HDL cholesterol (HDL-C) levels, has been recognized in the pathogenesis and prognosis in patients with atherosclerotic cardiovascular diseases. However, the roles of HDL in the development and the progression of atrial fibrillation (AF), has been rarely evaluated. In this study, we thus hypothesized that the compromised HDL function may be associated with the progression of pathological structural remodeling in left atrium (LA). Objective We explored the association between CEC of HDL and the left atrial dimension (LAD), a maker of structural remodeling in the LA, in patients with AF and control. Methods This is a single center case-control study including consecutive 260 AF patients (AF group) and 34 paroxysmal supraventricular tachycardia (PSVT) patients (PSVT group, served as a control group), who underwent catheter ablation from July 2017 to December 2018. Blood samples were collected before catheter ablation procedure. CEC of HDL was measured by using ex vivo radiotracer system that involved incubation of [3H] cholesterol-loaded J774.1 murine macrophage-like cells with apoB-depleted serum. Results Serum HDL-C level was lower in AF group compared to those of PSVT group (55.3±15.3mg/dl vs 61.7±13.3mg/dl: p=0.024). As a marker of HDL function, CEC of HDL was significantly lower in patients with AF group compared to those in PSVT patients (4.74±0.84% vs 5.20±0.99%: p=0.005, Fig 1). In all patients including both groups, CEC of HDL was inversely correlated with LAD (r=−0.25; p&lt;0.001, Fig 2), indicating the inverse association between HDL function and the progression of structural remodeling in AF. Moreover, multivariate logistic regression analysis adjusted by age, gender, body mass index, ejection fraction, and HDL-C demonstrated that increase in CEC of HDL was associated with the lower risk to be highest quartiles of LAD (&gt;42mm), even adjusted by serum HDL-C levels (odds ratio of 1-SD elevation in CEC of HDL for LAD&gt;42mm: 0.63; 95% confidence interval: 0.40–0.97, p=0.037), which implicated the link between HDL function and progression of left atrial structural remodeling. Conclusion Findings in this study may suggest that compromised HDL functionality is associated with the pathogenesis of left atrial structural remodeling in AF patients.

Abdominal Pain as an Initial Manifestation of Paroxysmal Supraventricular Tachycardia in Children

Objectives: The aim of this study was to evaluate the importance of abdominal pain in children with paroxysmal supraventricular tachycardia (PSVT). Methods: The authors reviewed the medical records of patients aged between three and 18 years old, who were diagnosed and treated for PSVT between March, 2011 and February, 2016. According to the presence of abdominal pain, they were grouped and analyzed for the difference of patient’s age, gender, interval between symptom onset and diagnosis, response to adenosine infusion, and the relationship with levels of N-terminal fragments of pro-brain natriuretic peptide (NT-proBNP). Results: A total of 43 patients (24 males and 19 females) were registered and the mean age at diagnosis of PSVT was 10.65 ± 4.81 years old. Although palpitation was the most common symptom (n = 29, 67.4 %), abdominal pain was also common (n = 18, 41.9%) with more frequent symptoms under 10 years old (n = 15/16, 93.8% versus n = 3/27, 11.1% in older than 10 years old). The PSVT patients with abdominal pain (group 1) were younger, had more frequent vomiting, less palpitation, and longer time to diagnosis of PSVT than subjects without this complication (group 2). In group 1, the level of NT-proBNP was shown significantly higher than group 2 (776.07 ± 913.57 versus 93.72 ± 51.25 pg/mL, P < 0.001). Conclusions: Abdominal pain may be an initial presentation of PSVT in children, especially under 10 years old.

Hospitalization rate of paroxysmal supraventricular tachycardia in Sweden

Introduction: The hospitalization rate of paroxysmal supraventricular tachycardia (PSVT) in a nationwide study is not established. We determined age- and sex-specific hospitalization rates and time trends for hospitalized PSVT in the Swedish population between 1987 and 2010.Methods: This nationwide study is based on the Swedish Hospital Discharge Register. The patients with first PSVT diagnoses between January 1987 and December 2010 were identified.Results: A total of 42,765 individuals with PSVT were diagnosed (mean age 60 years; 44% males). The overall age- and sex-adjusted hospitalization rate was 20 per 100,000 person-years. The hospitalization rate increased with advancing age with highest hospitalization rates in individuals aged 80–84 years (67.12 per 100,000 person-years) and did not change significantly over time. A total of 20,011 (46.8%) patients had “lone” PSVT without any comorbidities. Lone PSVT patients were younger than PSVT patients with comorbidities (mean age 54 vs. 67 years, p = .0002).Conclusions: This study showed a slight preponderance for females and stable hospitalization rate of PSVT over time; the hospitalization rate increased with age. A high proportion of PSVT patients had no comorbidities. They were affected at a younger age than patients with comorbidities, which suggests an inherent predisposition.Key messagesThis study represents the first extensive and nationwide hospitalization study of PSVT. Hospitalization is highest in old age but a bimodal pattern was observed with a small peak in the first years of life. Patients with lone PSVT are younger than those with comorbidities; which suggests an inherent predisposition.

A retrospective analysis of cardioversion for paroxysmal supraventricular tachycardia in emergency department

Objective To analyze retrospectively the cardioversion for paroxysmal supraventricular tachycardia(PSVT) in emergency department in order to explore rational guidance for the diagnosis and treatment for PSVT. Methods A retrospective analysis of PSVT patients in the emergency department admitted from June 2015 to December 2015 was carried out. First, all the patients were divided into two groups according to the cardioversion achieved by Valsalva’s maneuvre or not. Forty patients were enrolled in study. There were 11 patients got cardioversion successfully achieved by the Valsalva’s maneuvre and 29 patients failed to get cardioversion. Then, comparisons of demographics, vital sign, serum CTNI, potassium and NTproBNP level were carried out between these groups of patients using statistical analysis. The categorical variable was expressed in percentage and the continuous variable was described by mean±standard deviation and the comparisons of parameters were conducted by group t-test and chi-square test. Results The success rate of PSVT maneuvre cardioversion was 27.5%. In addition, there were no significant differences in demographics vital sign, TNI and NTproBNP between the two groups while there were significant differences in serum potassium level between the two groups [(3.8±0.4)mmol/L vs. (3.5±0.35)mmol/L P<0.05]. There was no significant difference in successful rate of cardioversion between the standard Valsalva’s maneuvre(n=6) the modified Valsalva’s maneuvre(n=5). The second-line treatment mainly included propafenone, adenosine, electroversion, verapamil and amiodarone. The propafenone was the most common second-line agent used for PSVT cardioversion accounting for 58.6%. Conclusions The success rate of Valsalva’s maneuver cardioversion was low. Keeping properly a higher level of serum potassium could increase the success rate of cardioversion by Valsalva’s maneuvre. Key words: Paroxysmal supraventricular tachycardia; Manoeuvre cardioversion; Modified Valsalva Manoeuvre; Propafenone; Electroversion; CTNI; NTproBNP

Emergency department visits for paroxysmal supraventricular tachycardia in Saudi Arabia.

Purpose:The present study aimed to compare the demographic, medical history, clinical features, and treatment management of paroxysmal supraventricular tachycardia (PSVT) in the emergency department of a teaching hospital in Riyadh, Saudi Arabia. A secondary purpose was to evaluate Adenosine response among numerous variables that might be used as predictors of the conversion.Methods:All PSVT cases presented to the Department of Emergency Medicine at King Khalid University Hospital, during the period from January 1, 2016, until December 31, 2016, were included in the study. Patients were assigned into two groups: adenosine sensitive (AS-group) and adenosine resistant (AR-group) according to adenosine conversion response.Results:A total of 38 patients were admitted during the study period. Fisher's exact test results showed that there were no significant (P > 0.05) differences among the AS-group and AR-group in the demographics, past medical history and clinical features, and post-ablation condition, except for the previous usage of the other anti-arrhythmic drugs to convert the last PSVT in the AR-group. The first bolus of adenosine had higher sensitivity and specificity, compared to the second bolus. Further, the second bolus of adenosine was not specific for short-term treatment of PSVT.Conclusions:Differences in adenosine sensitivity among PSVT patients were independent of demographic, past medical history, and clinical features of PSVT patients. Thus, the difference in adenosine response among groups may be attributed to the heterozygosity in conducting pathways. The first bolus of adenosine had high sensitivity and specificity, compared to the second bolus, and their optimal levels were predictable by HR deceleration.

Atrial Conduction Delay Predicts Atrial Fibrillation in Paroxysmal Supraventricular Tachycardia Patients after Radiofrequency Catheter Ablation

This study aimed to assess whether intra- and inter-atrial conduction delay could predict atrial fibrillation (AF) for paroxysmal supraventricular tachycardia (PSVT) patients after successful treatment by radiofrequency catheter ablation (RFCA). Echocardiography examination was performed on 524 consecutive PSVT patients (15 patients were excluded). Left atrial dimension, right atrial diameter and intra- and inter-atrial conduction delay were measured before ablation. Patients were divided into group A (n = 32): occurrence of AF after the ablation and group B (n = 477): remained in sinus rhythm during follow-up. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive value of intra- and inter-atrial conduction delay. Both intra- and inter-atrial conduction delay were higher in group A than in group B (4.79 ± 0.30 msec vs. 4.56 ± 0.32 msec; 21.98 ± 1.32 msec vs. 20.01 ± 1.33; p < 0.05). Binary logistic regression analysis showed that intra- and inter-atrial conduction were significant influential factors for the occurrence of AF (odds ratio [OR] = 13.577, 95% confidence interval [CI], 3.469–48.914; OR = 2.569, 95% CI, 1.909−3.459, p < 0.05). The ROC cure analysis revealed that intra-atrial conduction delay ≥ 4.45 msec and inter-atrial conduction delay ≥ 20.65 were the most optimal cut-off value for predicting AF in PSVT patients after RFCA. In conclusion, this is the first study to show that the intra- and inter-atrial conduction delay could effectively predict AF in post-ablation PSVT patients.

The occasion and clinical efficacy of radiofrequency ablation in the treatment of elderly patients with paroxysmal supraventricular tachycardia

Objective To explore the clinical pathological data of the elderly patients with paroxysmal supraventricular tachycardia(PSVT) and the timing of the radiofrequency ablation treatment for PSVT and its clinical efficacy.Methods The clinical pathological data of 45 elderly patients with PSVT for radiofrequency ablation were retrospectivly analyzed,and the information of cardiovascular and cerebrovascular diseases,the duration of PSVT and frequency of attacks,the reason of patients had to accept radiofrequency catheter ablation,the treatment effective of electrophysiological study and radiofrequency ablation were recorded.Results The duration and frequency of attacks with PSVT were positively related with pathogenesis in the elderly patients.Elderly PSVT patients with severe cardiovascular disease accounted for 28.89％.The first radiofrequency ablation treatment success rate was 100％ in this research and the recurrence rate was 4.4％.Conclusion It is recommended that elderly PSVT patients early access to the radiofrequency ablation. Key words: Gatheter ablation; Tachycardia; Aged

Acupuncture treatment for cardiac arrhythmias: A systematic review of randomized controlled trials

Cardiac arrhythmias are common [1]. The clinical manifestations range from self-limited benign discomfort, such as palpitations, to lifethreatening crisis [1]. Traditional Chinese medicine (TCM) advocate several treatment options for cardiac arrhythmias [2]. Recent scientific experimental studies suggest that acupuncture might be an effective intervention for cardiac arrhythmias through multiple mechanisms [3]. The aim of this systematic review is to critically evaluate the clinical evidence for or against the notion that acupuncture is an effective treatment for arrhythmias through the explicit searching regardless of language. The following electronic databases and registry of clinical trials were searched from their inception through October 2010: MEDLINE, CINAHL, AMED, the Cochrane library, CNKI, J-East, Korean Studies Information, DBPIA, KoreaMed, KISTI, KMbase, NDSL and WHO International Clinical Trials and clinicaltrials.gov registries. The searching strategy was as follows: acupuncture AND (cardiac arrhythmia OR sinus arrhythmia OR atrial fibrillation OR bradycardia OR atrial premature complexes OR ventricular premature complexes OR heart block OR sick sinus syndrome OR Wolff– Parkinson–White syndrome OR tachycardia OR ventricular fibrillation OR ventricular flutter). The bibliographies of the included articles were also searched for relevant studies. No restrictions were applied according to language or publication status. Only randomized and quasi-randomized controlled trials were included. Hard copies of all of the relevant articles were read, and the data were extracted by two of the authors (THK, TYC). The quality of the selected studies was assessed according to the Cochrane criteria [4]. The Cochrane collaboration's software was used for the metaanalysis (the Nordic Cochrane Centre). In total 571 potentially relevant articles were identified, 10 of which met the inclusion criteria (Fig. 1). Three studies assessed the effectiveness of the acupuncture for paroxysmal supraventricular tachycardia (PSVT) [5–7]. Two of three studies assessed the immediate effect on heart rate after one acupuncture treatment [5,6]. The results of meta-analysis did not demonstrate a statistically significant difference compared with conventional drug therapy (n=59; RR, 0.90, 95% CIs 0.73 to 1.11; I=0%) (Fig. 2A) [5,6]. The third study tested the long term treatment effect of acupuncture in PSVT patients and acupuncture generated a favorable effect on the conversion of a normal sinus rhythm (NSR) compared with medication for PSVT [7]. Three studies tested the effectiveness of acupuncture compared with the oral administration of anti-arrhythmics for the treatment of ventricular premature beat (VPB) [8–10]. The results of the metaanalysis of these three RCTs failed to reveal significant effects of acupuncture treatment on the response rate compared with antiarrhythmics (n=140; RR, 1.12, 95% CIs 0.94 to 1.35; I=42%) (Fig. 2B) [8–10]. Two RCTs tested the effects of acupuncture on atrial fibrillation (Af) [11,12]. There were significant differences in favor of acupuncture treatment in both studies [11,12]. One RCT [13] assessed the effect of a single acupuncture in patients with sinus tachycardia (ST) and showed significant effects for reducing heart rate. The other RCT [14] investigated the effects of acupuncture on patients with ventricular extrasytole (VE). The results showed significant effects of acupuncture on alleviating symptoms and reducing the number of premature beats. Adverse events (AEs) werementioned in only two of the trials and no AEs were noted in the acupuncture group [12,13] (Table 1). We explored the clinical evidence for or against acupuncture as a treatment of various types of cardiac arrhythmias. Several studies demonstrated that acupuncture may be an effective treatment of cardiac arrhythmias. However, the evidence associated with acupuncture treatment for cardiac arrhythmias is limited because the majority of the studies were of low methodological quality [15]. The paucity of rigorous RCTs and their small sample sizes is a serious limitation of the evidence.

Serum troponin testing in patients with paroxysmal supraventricular tachycardia: outcome after ED care

Paroxysmal supraventricular tachycardia (PSVT), a common dysrhythmia seen in the emergency department (ED), is usually managed without difficulty and with a favorable prognosis. Serum cardiac troponin I (cTnI) testing provides important risk stratification information in certain patients; its use in PSVT patients, however, has not been explored. A retrospective review of consecutive adult ED PSVT patients seen for 21 months was performed. Fifty-four PSVT patients were identified on the basis of International Classification of Disease, Ninth Edition codes and the ED patient log at a university hospital. Three patients were excluded for incorrect rhythm, leaving 51 who were included in data analysis. Thirty-eight patients had at least one serum cTnI value measured. Of those, 11 had a positive result, defined as serum cTnI of more than 0.02 ng/dL. Thirty-day outcomes for these patients were evaluated and showed one ED return, no PSVT recurrences, and no deaths at our regional hospital. In this sample, serum cTnI testing did not identify PSVT patients at risk for poor outcome. Further consideration of the use of this testing modality in the PSVT patient population is recommended.