Recurrent Episodes Of Supraventricular Tachycardia Research Articles

Inferior Tricuspid Annular Atrial Tachycardia

A 60-year-old male with recurrent episodes of supraventricular tachycardia on regular medications had another episode. Was taken up for electrophysiological study and radiofrequency ablation (EPS and RFA) under 3-D electro-anatomical mapping (EAM). The challenges in the case were need for isoprenaline infusion for sustenance of tachycardia and relatively wider area of ablation requirement for success.

Neonatal supraventricular tachycardia and necrotizing enterocolitis: case report and literature review

BackgroundNecrotizing enterocolitis (NEC) and supraventricular tachycardia (SVT) are serious emergencies in the neonatal period. Although these conditions are recognized as distinct pathologies, literature reports suggest that recurrent episodes of SVT may predispose patients to NEC via disturbances in mesenteric blood flow and a decrease in tissue perfusion.Case presentationWe present a case of a preterm infant affected by recurrent episodes of SVT who developed the initial stage of NEC on the 17th day of life. Moreover, a detailed description of all the cases described in the literature is reported.Materials and methodsAn integrative review of the updated literature in the Medline database and PubMed and scientific books and articles was conducted. The research from October 2019 to December 2019 was searched for with MeSH and free terms (necrotizing enterocolitis, supraventricular tachycardia) and was linked by Boolean operators.ConclusionsSVT can be considered a risk factor for the development of NEC. Therefore, clinicians should have a high level of suspicion for NEC in infants affected by SVT. This article is the first structured literature review analysing the association between SVT and NEC.

SUCCESSFUL PERFORMANCE OF CARDIAC ELECTROPHYSIOLOGICAL PROCEDURES VIA A CONGENITAL INFERIOR VENA CAVA ANOMALY- REPORT OF 2 CASES

Background: Femoral vein access is the preferred approach for advancing multiple catheters via the inferior vena cava (IVC) to the heart during routine cardiac electrophysiology study and catheter ablation. Compared to acquired venous abnormalities, congenital inferior vena cava anomalies are encountered rather infrequently in adult electrophysiology procedures and their presence may pose technical procedural challenges. Presentation: We describe 2 cases in which we were able to successfully perform cardiac electrophysiological procedures in the presence of a complex congenital venous anomaly, the left sided IVC. First case was 30 year old gentleman presented with history of recurrent episodes of supraventricular tachycardia terminated with AV nodal blocking agents. Second case was 21 year old boy with WPW syndrome and recurrent supra-ventricular tachycardia. Diagnosis and Management: We managed to pass the EP catheters in both cases with a bit difficulty and angulation, while given I/V heparin to reduce the risk of thrombosis and confirmed the position of catheters via subclavian venous placement of a guidewire. In first case, typical AV node reentry tachycardia was induced which was mapped and ablated in the slow pathway region. In second case, right posterior accessory pathway was ablated at 6 0’clock. CT angiography of the abdominal veins was performed which confirmed the finding of left sided IVC. Follow-up and Outcomes: Abnormalities of the IVC are relatively uncommon. But it is an important condition that may be encountered by electrophysiologist. Catheter ablation of the slow AV nodal pathway and right posterior accessory pathway was safely and successfully performed with this unusual venous anomaly. Keywords: SVT, LEFT IVC, RFA

Recurrent Supraventricular Tachycardia and Necrotizing Enterocolitis: A Causative Role or a Simple Association? A Case Report and Literature Review

Insufficiency in mesenteric flow is a risk factor for the development of necrotizing enterocolitis (NEC). Recurrent episodes of supraventricular tachycardia (SVT) can lead to gut ischemia, with subsequent reperfusion injury. We present a term infant who developed NEC at 37 days of life after refractory SVT and reverted to sinus rhythm on day 23 and 25 of life. Resected stenotic ileum and transverse colon demonstrated inflammation with ischemia. This is the first case of NEC following SVT in a term infant without a congenital morphologic abnormality. In view of the temporal sequence of events, and in the absence of other risk factors for NEC, the SVT and NEC were likely causally related.

Wolff-Parkinson White syndrome in a parturient with rheumatic heart disease for caesarean section - Anaesthesia management.

Wolff-Parkinson White syndrome in a parturient with rheumatic heart disease for caesarean section - Anaesthesia management.

Recalcitrant Supraventricular Tachycardia: Occult Albuterol Toxicity Due to a Factitious Disorder

BackgroundWe report a case of a factitious disorder presenting with recurrent episodes of supraventricular tachycardia (SVT). Case ReportA 26-year-old woman presented with recurrent episodes of SVT. Medical history included SVT, asthma, anxiety, depression, type 2 diabetes, and migraine headaches. The patient had frequent emergency department (ED) visits with complaints of chest pain, palpitations, and heart rates typically between 130 and 150 beats/min. Electrocardiograms revealed sinus tachycardia; laboratory studies were consistently normal except for periodic episodes of hypokalemia. Over the 3 years, the patient had more than 50 visits for health care and underwent multiple diagnostic evaluations, including comprehensive laboratory testing, echocardiography, Holter monitoring, and event monitoring. Given the constellation of clinical features, a plasma albuterol concentration was obtained during an ED visit for SVT, which was 17 ng/mL (reference range for peak plasma concentration after 0.04–0.1-mg inhaler dose = 0.6–1.4 ng/mL). A subsequent ED visit with a similar presentation revealed a plasma albuterol level of 11 ng/mL. The patient adamantly denied using this medication. Due to concerns about a factitious disorder, a multidisciplinary hospital discussion was planned for subsequent interventions; however, the patient was lost to follow-up. Why Should an Emergency Physician Be Aware of This?This is a compelling case report of a factitious disorder and occult albuterol abuse resulting in recalcitrant SVT with numerous ED visits and interventions. Patients with factitious disorders can have multiple visits for emergency care and are challenging to evaluate and treat. Albuterol toxicity can present with pronounced sinus tachycardia, fine tremor, and often with transient hypokalemia.

Necrotizing enterocolitis after recurrent supraventricular tachycardia

Necrotizing enterocolitis (NEC) is the most common gastrointestinal (GI) emergency that primarily affects premature infants. In the last decade, there have been significant advances to our understanding of neonatal NEC. The exact etiology of NEC remains unclear, but it is widely considered a multifactorial disease; prematurity, enteral feeding, intestinal hypoxia-ischemia, and bacterial colonization are considered major risk factors. We report a case of a 35 week preterm infant with recurrent episodes of supraventricular tachycardia who developed NEC in the second week of life. This case underscores the importance of being appropriately cautious in the feeding of these high-risk premature infants.

Automaticity with anterograde conduction of a concealed accessory pathway due to radiofrequency energy application

We report a case of a patient with recurrent episodes of supraventricular tachycardia in which a concealed left-posterior accessory pathway-mediated orthodromic tachycardia was reproducibly induced during the EP study. Two interesting and very unusual electrophysiological phenomenon were observed at the same time during the ablation procedure of the accessory pathway: 1— Automaticity of the regular accessory atrioventricular pathway; 2— Emergence of manifest preexcitation following radiofrequency application exclusively during the automatic accessory pathway-mediated rhythm.

Successful catheter ablation of a slow AV-nodal pathway from the left posteroseptal region

We present the case of a 44 year old woman with recurrent episodes of supraventricular tachycardia due to AV-nodal reentry (AVNRT). She was refractory to conventional medical treatment and referred to our hospital with the view to catheter ablation of the slow AV-nodal pathway. AVNRT of the common type was easily induced performing stimulation from the high right atrium and proximal coronary sinus. Other forms of supraventricular tachycardia were definitely ruled out during further electrophysiologic study. Repetitive RF applications around the right posteroseptal region failed to cure the tachycardia which remained inducible with a typical jump in the AH interval. Extensive RF applications from posteroinferior to the midseptum including the area of the proximal coronary sinus and its os were ineffective as well.AVNRT was transiently but reproducibly eliminated while burns were applied to the high midseptum but AVNRT reoccured within 20 minutes. Finally after retrograde passage of the aortic valve with a 4 mm tip ablation catheter, RF was applied to the left postero to midseptal region. An accelerated junctional rhythm was immediately observed and AVNRT remained non-inducible from that time onwards. It is concluded that an atypical posterior extension of the AV node with predominant leftatrial course might be responsible for this unusual success of slow pathway elimination from left posteroseptal.

Decremental Atriofascicular Accessory Pathway with Bidirectional Conduction: Delineation of Atrial and Ventricular Insertion by Radiofrequency Current Application

A 17-year-old girl with a corrected complex congenital heart disease and recurrent episodes of supraventricular tachycardia was referred for catheter ablation. Electrophysiologic studies revealed the presence of an accessory pathway (AP) with bidirectional conduction and decremental properties. We demonstrated a course parallel to the node-His AV conduction system. Transient abolition of the bidirectional conduction through the AP was obtained by radiofrequency application to the ventricular insertion located in the distal right bundle branch and to the atrial insertion, located in the mid-anterior atrial septum. Radiofrequency application at the low anterior atrial septum, above the His bundle, successfully abolished AP conduction without affecting AV nodal conduction. Demonstration of the course and insertions of the AP, its bidirectional decremental conduction properties, and the association with a complex congenital heart disease are exceptional and interesting findings and raise the possibility of an accessory AV node with a parallel conduction pathway to the right bundle branch.

Complications of chest thump for termination of supraventricular tachycardia in children

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

Automatic Implantable Scanning Burst Pacemakers for Recurrent Tachyarrhythmias

Ninety patients (13 patients with supraventricular tachycardia and 72 patients with ventricular tachycardia) underwent electrophysiological study. Six out of 18 patients with supraventricular tachycardia (33%) and one out of 72 patients with ventricular tachycardia (1.4%) were considered suitable candidates for the scanning pacemaker. However, only six of the seven patients underwent implantation. The seventh patient decided not to undergo implantation and continued to have recurrent episodes of supraventricular tachycardia. The scanning pacemaker delivers extrastimuli at preset initial and coupled delay after four cycles of tachycardia. If tachycardia is not terminated, another set of extrastimuli are delivered with a decrement in the coupling cycle. During the follow-up period of 7-25 months (mean, 14.3 months), tachycardia cycle lengths and termination windows changed in four patients. The pacemakers in these patients were reprogrammed multiple times (2 to 6 times with a mean of 3.5) as the previous number of extrastimuli and intervals were ineffective in the termination of tachycardias. The major limitations of the extrastimulus pacemaker were: 1) only a small percentage of patients were suitable candidates for its use; (2) the initially selected termination window in the majority of patients was ineffective during the follow-up period due mainly to the changes in tachycardia cycle length and subsequent termination windows; and (3) the majority (five out of six patients in this series) of patients needed additional pharmacologic therapy to modify their tachycardia rates. However, despite these limitations, the scanning pacemaker may be an additional tool in the management of recurrent tachyarrhythmias in selected patients.

The R-on-T phenomenon during supraventricular tachycardia in childhood

The electrocardiographic R-on-T phenomenon was observed in the absence of Wolff-Parkinson-White syndrome during recurrent episodes of supraventricular tachycardia (SVT) with rates between 240 to 275 per minute in a 5 year old boy. The rapid ventricular response during SVT corroborates the recent finding of a short refractory period of the A-V node in children. The demonstration of the R-on-T phenomenon in this child may be important in attempting to understand the pathogenesis of sudden death in children.

Prevention of Paroxysmal Tachycardia of Wolff Parkinson-White Syndrome With Combined Propranolol and Quinidine Therapy

• The prevention of frequent episodes of the tachyarrhythmias associated with Wolff­ Parkinson-White syndrome may pose a diffi­ cult therapeutic problem. The usual prophy­ lactic regimens that have been used include digitalis, quinidine, procainamide, and reser­ pine; frequently, they have been unsuccessful. The beta adrenergic blocking agent proprano­ lol has been shown to be of value in prevent­ ing recurrent supraventricular tachycardias in patients with the Wolff-Parkinson-White syn­ drome. Recently the synergistic action of propranolol with quinidine has been proposed for the treatment of chronic atrial fibrillation. We have utilized this combined therapy in a patient with the Wolff-Parkinson-White syn­ drome for the prevention of recurrent episodes of supraventricular tachycardia. The patient is a 29-year-old man with the Wolff-Parkinson-White syndrome who has ex­ perienced frequent episodes of su;>raventri­ cular tachycardia since early childhood. These

A Case of Idiopathic Cardiomegaly

A case of 64-year-old male, with recurrent episodes of supraventricular tachycardia and progressive congestive heart failure of unknown origin was presented and discussed.Markedly dilated heart showed diffuse irregular myocardial degeneration and fibrosis, without arteriosclerosis or valvular lesions, and patchy fibro-elastosis of the parietal endocardium at autopsy. The pathogenesis has been discussed and it was assumed that it might be a certain degenerative process of muscle fibres themselves.