Types Of Supraventricular Tachycardia Research Articles

Implementation of near zero fluoroscopy in supraventricular tachycardia ablation procedures: a single center experience

Abstract Background Supraventricular tachycardia (SVT) are common cardiac arrhythmias, and catheter ablation has proven to be a very effective treatment, but exposes patients and healthcare providers to radiation. "Near Zero Fluoroscopy" (NZF) techniques, utilizing advanced imaging, aim to reduce radiation exposure while maintaining efficacy. Purpose To present an analysis of near-zero fluoroscopy in SVT ablation procedures, in a tertiary center, since its implementation. Methods We prospectively enrolled 446 SVT-diagnosed patients for this study. All of them underwent NZF procedures using the same specific 3D mapping system, between January/19 and December/22. Patients with atrial fibrillation or macroreentrant atrial tachycardias or when a different mapping system was used, were excluded. All patients provided informed consent. Results Our population had 266 (60%) females and a median age of 39 (IQR 24-51) years. AVNRT was the most frequent arrhythmia documented (229 cases, 51%), followed by Accessory Pathways (AP) (201 cases, 45%) and focal atrial tachycardia (AT) (16 cases, 4%). The ablation success rate was high (405/418, 97%). There was no ablation attempt in 12 patients (9 APs and 3 ATs) and the unsuccessful ablations (7/418 cases, 1,67%) were APs. Overall, fluoroscopy time was 1.1 minutes (IQR 0-2.6). There was no statistically significant difference in the distribution of fluoroscopy time among the types of SVT based on the Kruskal-Wallis test (p 0.14). Observing trends of fluoroscopy use through time, we acknowledge the presence of a learning curve, leading towards shorter times of X-ray during procedures along the first 3 years of implementation of a near-zero strategy. Median times (IQR) of fluoroscopy were as follows: 2019 – 2.25 (0.45-3.4) min; 2020 – 1 (0-2.5) min; 2021 – 0 (0-1.9) min; 2022 – 0.55 (03.05) min. (see BoxPlot) Pairwise comparisons using the Wilcoxon rank-sum test with continuity correction revealed statistically significant differences in medians between all pairs of years, with p-values adjusted for multiple comparisons using the Bonferroni method (p<0.01). In 2022, fluoroscopy time increased, when compared to 2021. We believe this finding can be explained by the fact that in 2022, our department received a new fellow and a young EP consultant (coming from a center where NZF was not the standard for SVT ablation), both being in the lab on a daily basis, explaining this upward trend in fluoroscopy time. There were no acute complications requiring hospital admission or active treatment. Conclusion Our results emphasize the potential of near-zero fluoroscopy techniques to enhance safety and reduce radiation exposure while maintaining a high level of procedural efficacy in the treatment of SVT cases. Absence of acute complications highlighted the safety of these approaches.

Characteristics of Patients Undergoing Electrophysiologic Procedures in a Tertiary Hospital in Saudi Arabia.

The electrophysiology field has progressed rapidly over the last 2 decades. No study has examined the characteristics of patients and types of electrophysiology procedures performed in the Kingdom of Saudi Arabia. This is important given our distinctly different demographic composition and health system. As such, we sought to describe the characteristics of consecutive patients presenting for electrophysiology procedures in our tertiary care hospital. Data was collected from the electrophysiology database at King Khalid University Hospital for procedures performed between April 2016 and November 2022. Patients' characteristics were retrieved from the electronic medical record. Procedures were categorized into supraventricular tachycardia, premature ventricular contraction and "complex ablations", which included atrial fibrillation and scar-mediated ventricular tachycardia ablation. If no abnormality was found, the procedure was labeled as "normal EP study". Multivariate regression analysis was performed to assess predictors of atrioventricular nodal reentry tachycardia among patients presenting with undifferentiated supraventricular tachycardia. A total of 459 patients were included in the study. The mean age was 42.06 years (±14.89 years), and 256 (55.77 %) were females. The most common procedure was supraventricular tachycardia (n = 289/459, 63.24 %), and only 5 % had complex ablations. The most common type of supraventricular tachycardia ablated was found to be atrioventricular nodal reentry tachycardia (n = 157/289, 54 %). Multivariate logistic regression revealed female sex and age to be independently associated with atrioventricular nodal reentry tachycardia (OR = 2.27 95 % CI [1.40-3.67]) for female sex and (OR = 1.02 95 % CI [1.01-1.04]) for every increase in age by 1-year. We reported a younger average age than other countries and less complex ablations. In addition, we reported 2 independent predictors of atrioventricular nodal reentry tachycardia in patients presenting with undifferentiated supraventricular tachycardia. Larger studies including multiple centers should be performed to confirm our findings.

Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population.

Catheter ablation (CA) of supraventricular tachycardias (SVTs) is conventionally performed with the aid of X-ray fluoroscopy. Usage of a three-dimensional (3D) electro-anatomical mapping (EAM) system and intracardiac echocardiography (ICE) enables zero-fluoroscopy ablation, eliminating the harmful effects of radiation. We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients. Overall, in 171 consecutive patients (12.5 ± 3.9 years), 175 SVTs were diagnosed and 201 procedures were performed. The procedural success rate was 98% (193/197), or more precisely, 100% (86/86) for AVNRT, 95.8% (91/95) for AVRT, 94.1% (16/17) for AT and 100% (2/2) for AFL. No complications were recorded. Follow-up was complete in 100% (171/171) of patients. During the mean follow-up period of 488.4 ± 409.5 days, 98.2% of patients were arrhythmia-free with long-term success rates of 98.7% (78/79), 97.5% (78/80), 100% (13/13) and 100% (2/2) for AVNRT, AVRT, AT and AFL, respectively. Zero-fluoroscopy CA of various types of SVTs in the pediatric population is a feasible, effective and safe treatment option.

Quality of life among patients with supraventricular tachycardia post radiofrequency cardiac ablation in Jordan.

Supraventricular tachycardia (SVT) is a common arrhythmia with associated symptoms such as palpitation, dizziness, and fatigue. It significantly affects patients' quality of life (QoL). Radiofrequency cardiac ablation (RFCA) is a highly effective treatment to eliminate arrhythmia and improve patients' QoL. The purpose of this study was to assess the level of QoL among patients with SVT and examine the difference in QoL before and after RFCA. One group pre-posttest design with a convenience sample of 112 patients was used. QoL was assessed by 36-Item Short Form (SF-36). Data were collected at admission through face-to-face interviews and 1-month post-discharge through phone interviews. There was a significant difference between QoL before (33.7±17.0) and 1 month after (62.5±18.5) the RFCA. Post-RFCA patients diagnosed with atrioventricular nodal reentrant tachycardia had higher QoL than other types of SVT. Moreover, there were significant negative relationships between QoL and the number and duration of episodes pre- and post-RFCA. There were no significant differences in QoL based on: age, sex, working status, marital status, smoking, coronary artery disease, diabetes mellitus, and hypertension. After RFCA, the QoL of patients with ST improved for both physical and mental component subscales.

Atrial Arrhythmias in Adults with Fontan Palliation.

Single ventricle physiology is a rare form of congenital heart disease and was, historically, a uniformly lethal condition. However, the atriopulmonary Fontan operation, and its successive iterations, the lateral tunnel and extracardiac conduit Fontan, became the fundamental approach to treating single ventricle heart disease. Over time, dysrhythmias are some of the most common complications with Fontan physiology, compounding morbidity and mortality. Atrial arrhythmias are prevalent in the Fontan population and occur in about 15-60% of patients with Fontan palliation, increasingly with age. Diagnosing atrial arrhythmias in patients with Fontan palliation may be challenging because of low voltage amplitudes arising from myopathic atrial tissue making it difficult to clearly assess atrial depolarization on surface electrocardiograms (ECG), vague symptoms not suggestive of tachyarrhythmia, or atrial arrhythmia with ventricular rates below 100beats per minute. Intra-atrial reentrant tachycardia (IART) is the most common type of supraventricular tachycardia in adults with Fontan palliation. Acute management of atrial arrhythmias in patients with Fontan palliation involves prompt assessment of a patient's hemodynamic stability, anticoagulation and thrombosis risk, systemic ventricular function, and risk of sedation or anesthesia if needed. Long-term management of atrial arrhythmias is often multifactorial and may include long-term anti-arrhythmic therapy, permanent pacing, and ablation. The best approach for the management of atrial arrhythmias in adults with Fontan palliation is patient-specific and involves collaboration between congenital electrophysiologists, adult congenital cardiologists, and the patient.

Fetal Supraventricular Tachycardia: Histologic Evidence of Accessory Pathways Due to Incomplete Annulus Fibrosus Formation.

Atrioventricular (AV) reentrant tachycardia is a common type of supraventricular tachycardia (SVT) that occurs in the fetus and neonate. Although many tachycardias resolve within several weeks of birth or respond to medical management, disruptions in the cardiac annulus fibrosus and development of additional accessory pathways may lead to refractory dysrhythmia resulting in fetal hydrops and ultimately, fetal death. While accessory pathways have been well documented anatomically in adult and childhood tachyarrhythmias, there are no reports of the histology of these pathways in human fetuses with SVT. This is a small case series of 2 fetuses with a history of SVT that resulted in fetal hydrops. In both cases, examination of the cardiac conduction system was unremarkable and examination of the atrioventricular junction revealed a focally thinned and/or discontinuous annulus fibrosus with documented direct continuity between the atrial and ventricular myocardium in 1 case. This case series demonstrates that thinning or absence of the annulus fibrosus is a feature seen in fetal SVT, and the development of subsequent aberrant AV connections due to defective formation of the annulus fibrosus suggests a possible cause for these arrhythmias.

Abstract 14091: Severe Hypothyroidism Revealing Hidden Tracts

Discussion: Atrioventricular reciprocating tachycardia (AVRT) is a type of Supraventricular tachycardia (SVT) caused by an accessory pathway can result in symptomatic and also life-threatening arrhythmias. Supraventricular tachycardias are less commonly seen in hypothyroidism than hyperthyroidism. We present a case of a 41 year old gentleman who presented with chest pain and SVT was found to have severe hypothyroidism with pre-excitation pattern on his EKG. Case: 41-year-old Caucasian gentleman with history of untreated Hashimoto’s thyroiditis presented with palpitations and acute onset left-sided chest pain. His symptoms were aggravated with movement and improved with rest. When EMS found him, his vitals were significant for tachycardia with a heart rate (HR) of 200 beats per minute (bpm). EKG showed supraventricular tachycardia. Vagal maneuvers were attempted followed by adenosine. This resulted in conversion to sinus rhythm and improvement in HR to 88 bpm. His chest pain completely resolved. He was then brought to the emergency room where he had normal vitals. Examination revealed thyroid gland was palpable and noted to be diffusely enlarged. Laboratory data was significant for an elevated thyroid-stimulating hormone (TSH) of 373 mIU/ml and undetectable free thyroxine (fT4) levels. His creatinine kinase (CK) was high at 16260, and troponin was elevated at 0.220 ng/ml (reference:<0.04 ng/ml). TPO antibodies were >600 IU/ml. EKG demonstrated sinus rhythm with pre-excitation and incomplete left bundle-branch block. He had normal chest x-ray. An echocardiogram showed an ejection fraction of 55% with mild LV diastolic dysfunction. He later underwent a stress myocardial perfusion scan which showed no definite evidence of inducible ischemia. Follow up: He was started on thyroxine replacement therapy. He is due for an EP study to evaluate for an accessory pathway causing pre-excitation with repolarization pattern on his ECG. Conclusion: This case suggests that severe hypothyroidism can also cause supraventricular tachycardias (SVT) by metabolic and conduction derangements revealing concealed bypass tracts in patients with accessory pathways. In most cases these arrhythmias are reversible once the underlying thyroid disorder is treated.

Permanent Junctional Reciprocating Tachycardia in Infants from Myocarditis-like Presentation to Simple Tachycardia: A Case Series

Permanent Junctional Reciprocating Tachycardia (PJRT) is a rare type of supraventricular tachycardia. It can be misdiagnosed and hence under-treated in infants and children, leading to significant cardiac morbidities and mortalities. We describe four cases of young infants who presented with a wide range of clinical scenarios from neonatal tachycardia to overtly decompensated heart failure, all caused by PJRT. All cases showed complete recovery with appropriate medical treatment. In this case series, we aim to discuss the diversity of clinical presentations, and the challenges surrounding the diagnosis, management, and prognosis. To achieve this aim, we have also performed a detailed literature review and reflected on our cases presented to our center between 2016 to 2020. PJRT is rare; it is often missed or diagnosed late in the presentation. Hence, the key is to keep it in mind in infants presenting with acute cardiac problems from simple tachycardia to a myocarditis-like presentation. Anti-arrhythmic medications are safe and effective as first-line therapy for PJRT in neonates and infants. They can prevent or delay the need for invasive cardiac ablation, which is more challenging in these age groups and should be considered in cases refractory to medical treatment.

An Ayurvedic Management of Paroxysmal Supraventricular Tachycardia

Background: Paroxysmal Supraventricular Tachycardia is a type of Supraventricular tachycardia (SVT) and is defined as intermittent SVT and typically presents with a ventricular rhythm of 160 bpm. The patient morbidity with paroxysmal supraventricular tachycardia (PSVT) is directly proportional to the frequency of episodes, and it can be life-threatening in patients with atrial fibrillation and ventricular pre-excitation. Its management depends and varies according to severity of the symptoms which includes long-term treatment to surgical procedure like catheter ablation. Case Report: A 26-year Female patient, who was a known case PSVT, approached with complaints of recurrent palpitations, chest discomfort with breathing difficulty, palpitation, lightheadedness and exercise intolerance. Conclusion: the patient was diagnosed as vataja hridaroga and treated with ayurvedic medicine for the duration of 3-4 months. With the help of ayurvedic medicines, patient is free from symptoms and chronic drug therapy.

Common Supraventricular and Ventricular Arrhythmias in Children.

The most common pediatric arrhythmias are tachycardias, and the most common type is supraventricular tachycardia, originating from or above the atrioventricular node and HIS bundle. Ventricular tachycardias are less common but more dangerous. Supraventricular tachycardias usually cause a narrow complex tachycardia unless there is a basal bundle branch block or rate-dependent aberration. A wide QRS tachycardia should be treated as ventricular tachycardias unless proven to be an supraventricular tachycardia with aberration. Diagnosis of both tachyarrhythmia types depends mainly on 12-lead electrocardiography. The most common supraventricular tachycardia type in newborns and infants is atrioventricular reentry tachycardia, related to manifest or concealed accessory pathways and in adolescent atrioventricular nodal reentry tachycardia, whereas focal atrial tachycardias consist of 10%-15% of supraventricular tachycardias during all ages. Supraventricular tachycardias have a low risk of morbidity, and ablation therapy is successful in most types with success rates over 90%. Ventricular tachycardias can be monomorphic or polymorphic, nonsustained or sustained, and can cause more hemodynamic instability than supraventricular tachycardias, requiring more close monitoring and urgent therapies. If hemodynamically unstable, synchronized cardioversion must be performed. Polymorphic ventricular tachycardias are very dangerous and often associated with primary ion channel defects (channelopathies), which can cause sudden cardiac death.

Zero-fluoroscopy catheter ablation of supraventricular tachycardias in pediatric population

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation (CA) of supraventricular tachycardias (SVTs) in pediatric patients is conventionally performed with the aid of X-ray fluoroscopy. Usage of the three-dimensional (3D) electro-anatomical mapping (EAM) system and the intracardiac echocardiography (ICE) enables zero-fluorscopy ablation, eliminating the harmful effects of the radiation (1-3). Purpose We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients. Methods In this retrospective study, we analyzed consecutive pediatric patients who underwent CA procedure due to SVT in our institution from April 2014 to October 2021. All procedures were performed completely without the use of fluoroscopy. A 3D EAM system and ICE were used as the principal modes of catheter visualisation. Left-sided procedures were done with ICE guided transseptal approach. Radiofrequency was the principal energy source, while cryoablation was used for arrhythmia substrates in the proximity of the conduction system. Results The study included 174 consecutive patients (69/174 (66%) female; 12.5 ± 3.9 years; 19.2 ± 3.6 kg/m2). Altogether 176 SVTs were diagnosed and treated. Atrio-ventricular nodal reentry tachycardia (AVNRT) was diagnosed in 45% of cases (80/176), atrio-ventricular reentry tachycardia (AVRT) in 47% (82/176), focal atrial tachycardia (AT) in 7% (13/176), typical atrial flutter (AFL) was treated in only one patient, while 2 patients had multiple arrhythmias (AVNRT and AVRT). In total, 202 procedures were performed. Radiofrequency ablation was performed in 76% (154/202), cryoablation in 20% (40/202) and both in 4% (8/202) of procedures. The acute procedural success rate was 96% (195/202). Procedural success rate was 99% (79/80) for AVNRT, 94% (77/82) for AVRT, 92% (12/13) for AT, and 100% (1/1) for AFL, respectively. There were no major complications in our study group. Follow-up was complete in 99% (172/174) of patients. During the follow-up period of a median of 316 days (181 - 747), 98% of patients were arrhythmia free. On average, 1.16 procedures per patient were performed with the long-term success rate of 99% (79/80), 98% (80/82), 100% (13/13) and 100% (1) for AVNRT, AVRT, AT, and AFL, respectively. Conclusion Zero-fluoroscopy CA of various types of SVTs in pediatric population is a feasible, effective, and safe treatment option.

Negative SA-VA difference during entrainment of a supraventricular tachycardia: a new criterion for the diagnosis of focal atrial tachycardia

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Ventricular overdrive pacing during tachycardia is one of the most common and useful maneuvers to assess de differential diagnosis of supraventricular tachycardia (SVT). Focal atrial tachycardia (FAT) usually presents long ventriculo-atrial (VA) interval, which is a passive interval since FAT is not an atrio-ventricular reentry. Therefore, during ventricular entrainment of a FAT, the stimulus-atrial (SA) interval will depend solely on the retrograde VA conduction time, if retrograde conduction exists. This retrograde conduction time is usually shorter than the VA Interval during tachycardia, thus being able to cause a negative SA-VA difference. This does not occur in other types of SVT, where the SA-VA difference helps to differential diagnosis, but positive values have been described. Purpose Our aim was to analyze whether the SA-VA value discriminates FAT from the other types of SVT, in patients with SVT and VA conduction when stimulating the ventricle during tachycardia. Methods Multicenter data of SVT entrainment were collected retrospectively, including FAT, atrioventricular nodal reentry tachycardia (AVNRT), and atrioventricular reciprocating tachycardia (AVRT). The numeric value of SA-VA difference was calculated for each case. The best SA-VA cut-off point for the diagnosis of TAF was determined, evaluating the sensitivity and specificity of this value for the diagnosis of TAF with respect to the gold standard (classical criteria). Results Continuous ventricular pacing during tachycardia succeeded in accelerating the atrium to the pacing rate in 80 cases out of the total studied cases: 32 (40%) AVNRT, 28 (35%) AVRT and 20 (25%) FAT. All FAT cases had a negative SA-VA value and all AVNRT and AVRT cases obtained positive SA-VA (Figure 1). SA-VA value lower than 0 ms was the best cut-off point (using ROC curve, Figure 2) with an area under the curve of 1. SA-VA difference lower than 0 ms (or negative SA-VA difference) showed 100% sensitivity and specificity for the diagnosis of FAT. Conclusions Negative SA-VA difference is a new and accurate criterion for the diagnosis of focal atrial tachycardia.

Clinical profile of patients diagnosed with supraventricular tachycardia: a descriptive study at a tertiary care hospital

Background: Supraventricular tachycardia is a clinical syndrome characterized by a rapid tachycardia with an abrupt onset and termination. The objective of our study was to determine and assess the clinical profile, electrocardiographic and echocardiographic of patients diagnosed with supraventricular tachycardia.Methods: This cross-sectional study was conducted in the department of general medicine, Dr DY Patil medical college and hospital, Navi Mumbai from April 2020 till October 2021, in which we included patients diagnosed with any type of supra-ventricular tachycardia and excluded hemodynamically unstable patients.Results: In the present study, of the 45 cases, atrial fibrillation was the most common mechanism of SVT, diagnosed in 47% of the patients. Next most common was AVNRT (22%) and AVRT (18%). In addition, atrial tachycardia was diagnosed in 9% of the patients and atrial flutter was diagnosed in 4%. Mean age of the patients was 34.5 years, ranging from 13 to 68 years and 56% were males. It was observed that palpitation was the most common symptoms (91%). On ECG, no abnormalities were detected in 64%, while left ventricular hypertrophy (18%) and prolonged corrected QT (18%) were the most common abnormalities. On echocardiography, no abnormality was detected in 78% of the patients. Furthermore, 49% of the patients achieved normal sinus rhythm with a single dose of adenosine infusion and 33% of the patients required another dose of adenosine infusion.Conclusions: Palpitation is common presentation symptom. Most of patients had good response to medication treatment especially adenosine therapy, additional treatment was required in few patients.

Assessment of cardiac arrhythmias using long-term continuous monitoring in patients with pulmonary hypertension

BackgroundCardiac arrhythmias are considered a prominent phenomenon in patients with pulmonary hypertension (PH). Older studies reported that 8% to 35% of patients with PH had supraventricular tachycardia (SVT), associated with adverse outcomes. Still, these arrhythmias have only been investigated via short-term monitoring or limited electrocardiogram recordings. MethodsPatients without previous arrhythmias diagnosed with PH at a tertiary facility received an insertable cardiac monitor as part of a prospective cohort study. Baseline assessments included World Health Organization functional class, six-minute walk test, echocardiography, and cardiac magnetic resonance imaging. ResultsThirty-four patients with PH were included. Twenty-four patients had pulmonary arterial hypertension (PAH) and 10 had chronic thromboembolic PH (CTEPH). During 46 patient-years of continuous monitoring (median: 594 (range: 334–654) days per patient), 70 arrhythmia episodes were recorded in 13 patients (38%), with a median of two (range: 1–3) episodes and an arrhythmic burden median of 1.6 (range: 0.1–228) minutes per patient. SVTs were the most common arrhythmias, with 16% of episodes being atrial fibrillation and 84% being other types of SVTs. Additionally, three patients experienced bradycardias, including one resulting in syncope and subsequent pacemaker implantation. None of the patients had sustained ventricular arrhythmias. ConclusionsArrhythmias were seen in 38% of contemporary patients with PH during long-term continuous monitoring; however, the vast majority of episodes were short and self-limiting. Modern therapy may alleviate the development of arrhythmias in stable patients with PH. This study is the first study to deploy long-term continuous monitoring in patients with PH.

A novel diagnostic algorithm for the identification of different supraventircular tachycardias

Abstract Background Supraventricular arrhythmias represent a diagnostic challenge. Its prevalence and causes are not well established, given the impossibility to differentiate between all different types of supraventricular tachycardias (SVT). There are several supraventricular arrhythmias, but we focus on: 1) Atrial tachycardia (AT) 2) Junctional tachycardia (JT) 3) Atrial fibrillation (AF) 4) Atrial flutter (AA) 5) Atrioventricular nodal reentrant tachycardia (AVNRT), and 6) Atrioventricular reentrant tachycardia (AVRT). The electrocardiographic diagnosis is based on the presence of P-waves, its morphology and relationship with the QRS complex, and the relationship between the atrial and ventricular frequency. Purpose The purpose of this study was to create a helpful clinical tool that could serve the physician as a guide to determine a diagnosis and initial treatment. Additionally, we wanted to establish the sensitivity and specificity of the algorithm. Methods It is a diagnostic test study. We include 190 electrocardiograms of different SVT of patients undergoing electrophysiological studies. The data consists of 760 observations from two different readings of the electrocardiograms. Results 104 of 112 AF, were correctly identified using the algorithm, with a sensitivity and specificity of 92.9% and 99.1%, respectively (95% CI: 0.86–0.96). 76 of 760 were AA, and 62 were correctly diagnosed, with a sensitivity and specificity of 81.6% and 95.5%, respectively (95% CI 0.71–0.88). 50 of the 72 AT were correctly classified, with a sensitivity of 69.4% and specificity of 97.4% (95% CI 0.58–0.78). 99 of 152 AVNRT were identified with a sensitivity and specificity of 64.5% and 87%, respectively (95% CI 0.84–0.89). 254 of 344 AVRT were diagnosed correctly with a sensitivity of 73.8% and specificity of 88.2% (95% CI 0.68–0.78). Finally, 1 of 4 JT were identified, with a sensitivity and specificity of 25% and 99.1% respectively (95% CI 0.04–0.69). Conclusion The algorithm is an excellent diagnostic tool to identify atrial flutter, atrial fibrillation and atrioventricular reentrant tachycardia. SVT algorithm Funding Acknowledgement Type of funding source: None

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Response to the Time

Experience of using propafenone in newborns and young children with arrhythmias

Aim. To evaluate the efficacy and safety of propafenone therapy in newborns and young children, including children with congenital heart defects (CHD). Material and methods . The study included 65 children with initiation of propafenone therapy at the age of 0-5 years. For diagnosis of arrhythmias and treatment control, electrocardiography (ECG), 24-hour Holter monitoring and echocardiography were performed. The initial dose of propafenone was 5-7 mg/kg/ day; the maximum dose — 15 mg/kg/day. The dose was titrated to effective with clinical and ECG control. It was considered acceptable to increase the duration of PQ interval and QRS complex by no more than 25% of the baseline value. The adverse and arrhythmogenic effects of the drug were evaluated. Results. Indications for propafenone administration were atrial tachycardia in 29 (44,61%) children, frequent premature ventricular contractions and ventricular tachycardia in 13 (20%) children, Wolff-Parkinson-White syndrome in 13 (20%) children, and other types of supraventricular tachycardia in 10 (15,39%) children. Sixteen (24,62%) children had CHD. In 20 (30,77%) children, propafenone was administrated in the neonatal period. The duration of propafenone therapy was 17,3±15,16 months. The drug was effective in 39 (60%) children (81,25% with CHD and 53,06% without CHD), not effective enough in 14 (21,54%) children, ineffective in 12 (18,46%) children. There was no association of the effectiveness/inefficiency of propafenone depending on the age, sex and the type of arrhythmia. Five (7,69%) children had prolongation of PQ interval and/or QRS by more than 25%. Arrhythmogenic effect of propafenone was observed in 1 (1,54%) child, noncardiac adverse effects — in 3 (4,62%) children. There were no cases of sudden cardiac death. Conclusion. Propafenone is an effective antiarrhythmic drug in newborns and young children with supraventricular and ventricular arrhythmias, including children with CHD. Using propafenone may be accompanied with adverse and arrhythmogenic effects, which were observed in 6% of children and were not associated with CHD.

Paroxysmal Atrial Fibrillation Induced by Ciprofloxacin: A Rare Adverse Effect

Despite their adverse effects, fluoroquinolones continue to be commonly prescribed antibiotics. Ciprofloxacin remains the safest with remarkably few adverse effects of all fluoroquinolones. Here, we present a rare case of paroxysmal atrial fibrillation induced by ciprofloxacin intake in a 72-year-old woman. She was treated with ciprofloxacin and ceftriaxone for urinary tract infection caused by Klebsiella pneumonia and complicated with liver abscess. On the fifth day of ciprofloxacin intake, she suddenly complained of heart palpitations and epigastric pain. An electrocardiogram revealed supraventricular tachycardia type atrial fibrillation at 130 beats per minute. No QT interval prolongation was noted. Ciprofloxacin was stopped as it was the most incriminated to induce arrhythmia. A control electrocardiogram showed normal sinus rhythm. We continued ceftriaxone use solely for 3 weeks until the resolution of the liver abscess. Although rare, early detection of atrial fibrillation induced by ciprofloxacin may decrease the severity of complications and prevent death.

Treatment outcome of percutaneous ablation in patients with supraventricular arrhythmias in Cuenca, April 2013- July 2018

BACKGROUND: Supraventricular tachycardia is commonly diagnosed in clinical practice, despite having a good prognosis, it can significantly affect the patient’s life quality. Pharmacological treatment does not result in the total absence of the arrhythmia, which is why ablation therapy has become the treatment of choice, due to its high success rate, and for offering a definitive solution. The aim of this study was to determine the frequency of each supraventricular tachycardia type, according to age and sex, the rate of success of percutaneous ablation and its related factors, and the frequency of complications due to the procedure. METHODS: A cross-sectional, descriptive, correlational study was conducted, including 156 patients diagnosed with supraventricular tachycardia and ablated, from five hospitals where the procedure was performed, based on their clinical records. RESULTS: From the 156 patients in this study, 51.9% were women and 48.1% men, the age ranged between 10 and 80 years. The most commonly reported arrhythmias were nodal reentrant tachycardia, atrioventricular reentrant tachycardia and atrial flutter, being the atrioventricular reentrant tachycardia the most frequent of all. The global success rate was 93.5%, no complications were reported, and none of the studied factors had significant statistical association with the success rate. CONCLUSION: Ablation treatment had a high success rate, with cero complications in this study, demonstrating the efficacy and safety of the procedure.

Supraventricular Tachycardia and Postural Orthostatic Tachycardia Syndrome Overlap: A Retrospective Study.

Postural orthostatic tachycardia syndrome (POTS) and supraventricular tachycardia (SVT) are disease states with distinctive features but overlapping clinical manifestations. Currently, studies on the presence of underlying SVT in patients with POTS are lacking. This retrospective study analyzed 64 patients [mean age: 43 years; 41 (61%) women] who had a POTS diagnosis and were found to have concomitant SVT during rhythm monitoring from September 1, 2013 to September 30, 2019 at our Syncope and Autonomic Disorders Clinic. The outcomes assessed were changes in disease severity, frequency of symptoms, heart rate, and blood pressure between before and after SVT ablation. The most frequent types of SVT noted on the electrophysiologic study were atrioventricular nodal reentrant tachycardia (57.81%), atrial flutter (29.68%), atrioventricular reentrant tachycardia (9.37%), atrial tachycardia (1.56%), and junctional tachycardia (1.56%). After SVT ablation, all 64 patients experienced an improvement in symptoms. Palpitations and lightheadedness experienced the most improvement after the procedure (72% vs. 31%; p < 0.001 and 63% vs. 22%; p < 0.001, respectively). There was a significant improvement in the resting heart rate (81.1 ± 12.8 vs. 75.8 ± 15.6 bpm; p < 0.002), but the orthostatic tachycardia on standing persisted (93.6 ± 16.5 vs. 77.3 ± 19.8 bpm; p = 0.14). Underlying SVT in patients with POTS can be missed easily. A strong suspicion and long-term ambulatory cardiac rhythm monitoring can help in diagnosing the condition.