Efficacy and economic benefits of a modified Valsalva maneuver in patients with paroxysmal supraventricular tachycardia

BACKGROUND A modified Valsalva maneuver(VM)has been suggested to be superior to the standard VM for conversion of paroxysmal supraventricular tachycardia(PSVT).AIM To evaluate the efficacy and economic benefits of a modified VM in Chinese patients.METHODS Patients with PSVT admitted to our center between October 2017 and September 2019 were randomly assigned to the modified and standard VM groups.Conversion via VM was performed up to three times.The primary outcome of the study was the success rate of PSVT conversion to sinus rhythm.The secondary outcomes included the incidence of adverse events,economic cost during the visit,and the degree of patient acceptance of the treatment.RESULTS Overall,361 patients were enrolled,with 180 allocated to the modified VM group and 181 to the standard VM group.Baseline characteristics were well matched in the groups.Overall,the modified VM group had higher success rates of PSVT conversion after single(47.78%vs 15.38%,P<0.001)and multiple(62.22%vs 19.78%,P<0.001)VM sessions.No significant differences in the incidences of adverse events and rates of patient acceptance were detected between the two groups(both P>0.05).Moreover,the economic cost of the clinic visit was significantly lower for the modified VM group than for the standard VM group(P<0.05).CONCLUSION The modified VM may confer both therapeutic and economic benefits as compared with the standard VM for conversion of PSVT.

Landiolol, an ultra-short-acting β1-blocker, is useful for managing supraventricular tachyarrhythmias in sepsis

AIM: To investigate whether landiolol, an ultra-shortacting β1-antagonist, can safely and effectively control heart rate in septic patients with supraventricular tachyarrhythmias.METHODS: We reviewed all patients with sepsis who admitted to our intensive care unit between January 2006 and December 2011. Sixty one septic patients suffered from supraventricular tachyarrhythmias(heart rate ≥ 120 bpm for > 1 h). Among 61 patients, 39 patients were treated with landiolol(landiolol group) and 22 patients were not treated with landiolol(control group). Arterial pressure, heart rate, cardiac rhythm, pulmonary arterial pressure and cardiac output(if a pulmonary arterial catheter was inserted) were compared between the 2 groups at 1, 8 and 24 h after the initiation of tachyarrhythmias. RESULTS: Mean age and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were similar between the 2 groups. Paroxysmal atrial fibrillation/flutter(87%), paroxysmal atrial tachycardia(10%), and paroxysmal supraventricular tachycardia(3%) were observed. The initial landiolol dose administered was 6.3 ± 5.8 g/kg per minute. Rapid and substantial reduction of heart rate was observed in the landiolol group without anydeterioration of hemodynamics. Landiolol significantly reduced heart rate(from 145 ± 14 bpm to 90 ± 20 bpm) compared to the control group(from 136 ± 21 bpm to 109 ± 18 bpm, P < 0.05). The conversion to sinus rhythm was observed more frequently in the landiolol group than in the control group at every point(P < 0.01 at 8 h; P < 0.05 at 1 and 24 h).CONCLUSION: Landiolol safely reduced heart rate and, in part, converted to sinus rhythm in septic patients with supraventricular tachyarrhythmias.

Effects of Isoproterenol and Metoprolol on the Suppression of Propafenone on with Supraventricular Tachycardia

This study was to determine whether isoproterenol (Iso) reverses the effects of propafenone(Pro) on the induction of supraventricular tarhycardia and whether the revergal during electrophysiologicstudy (EPS) is predictive of clinical recurrences of SVT during long-term treatment with Pro.Thirtypatients with inducible sustained SVT at baseline state were studied. Iso infusion at a rate necessary toachieve a 20%-40% increase in heart rate completely (16/28 cases,57%) or partially (5/28 case, 18%)revereed Pro's suppressant effects on the induction of SVT.There were clinical recurrcnces of SVT in fiveof 16 patients (31%) treated on a long-term basis (mean 4.5±3.6 months) with Pro,Iso completelyreveroed Pro's supprosant effect on the induction of SVT in four of these five patients (80%).These fivepatients then were treated with Pro and metoprolol and no further clincal recnrrences of SVT.These resultssuggested that reveroal by Iso ofpro's suppresaant effects on the induction of SVT may identify patients whoare likely to experience clinical recurrence of SVT and these patients may benefit from treatment with aB-blocker during longterm therapy with Pro.

Association between Supraventricular Tachycardia and Necrotizing Enterocolitis: A Case-Control Study

Background: Necrotizing enterocolitis (NEC) is the most common and fatal gastrointestinal disease encountered in the Neonatal Intensive Care Unit. Several case reports have shown an association between supraventricular tachycardia and necrotizing enterocolitis. This study aimed to determine the association between supraventricular tachycardia and necrotizing enterocolitis. Methods: This study was conducted from April 1st, 2016 to March 31st, 2022, at the Department of Pediatrics, Zhongnan Hospital of Wuhan University, Hubei, China. The records of 74 subjects with the diagnosis of necrotizing enterocolitis (NEC) were obtained from the hospital’s medical data records. Consequently, 74 gender, gestational age, and birth weight-matched controls (babies without NEC) were recruited as controls. Results: Of the 74 cases, 47.3% of the cases were males, and 52.7% were females. Regarding the birth weight and gestational age, 77% of the cases had low birth weight (LBW) and 86.5% were premature. In terms of Apgar score, 93.2% of NEC cases had an Apgar score of >7 at five minutes. The median values of white blood cells, platelets, and hemoglobin of cases were 10.90 (8.09, 13.80), 227 (169.75, 295.50), and 155.6 (130.53, 170.95), respectively. No Association between supraventricular tachycardia and necrotizing enterocolitis (P = 1.00). Conclusion: No association between necrotizing enterocolitis and supraventricular tachycardia was found. Further multicenter-based studies examining whether there is a potential relationship exists between supraventricular tachycardia and the development of necrotizing enterocolitis are required.

RADIOFREQUENCY CURRENT ABLATION TREATMENT IN 56 PATIENTS WITH INTRACTABLE SUPRAVENTRICULAR TACHYCARDIA

Fifty six patients with intractable supraventricular tachycardiainduced by 57 accessory pathways were treated by radiofrequencycurrent catheter ablatio(RFCA)from October,1993 to January,1998.34 sales and 22 females,aged from 16-63 years.They had no organiccardia disease and treated with antiarrhythemia agents in all casesbut failed before RFCA therapy,the electrophysiological examinaionwas done for dsterming the location of acceesory pathway andevaluating the results before and after the treatment,34 dominantpathways and 23 latent pathways,and 42 on the left side and 15 onthe right side were found in examination.We used 12±11 time ofmean pulses,29±2.6 watts of radiofrequency energy,8105±6059J ofcumulative electro-energy and 1.1±0.5 hours in each patient,allpatient had no arrhythemia even antiarrhythemia agents was withdrewafter the therapy and during 2-62 months follow-up.They had no arerecurrence.Tne results suggested as follows:1.The accurate location of the accessory pathway was a importantfactor in the successful ablation therapy and the standardlocation of ablation target was the shortest A-V or V-A interval;the accessory pathway potential wasn’t a marker in the location inour study.2.The procedure time and consumption of ablation energy on theright side was wore and higher than that on the left(1h and 1.3h.5418J and 12864J respectlvely)which was due to the cathetercouldn’t touch wih endocardia closely so result to the accessorypathway wasn’t blocked properly.

Atypical Intrapartum Maternal Heart Rate Pattern in a Woman with Paroxysmal Supraventricular Tachycardia

Pregnant women show characteristic hemodynamics, and their heart rates ordinarily increase with uterine contractions during labor. Conversely, uterine contraction-associated decelerations of maternal heart rate (MHR) are rare. We present a pregnant woman with paroxysmal supraventricular tachycardia (PSVT) who exhibited intrapartum MHR deceleration pattern. We performed simultaneous fetal heart rate monitoring with an external ultrasound transducer and MHR monitoring with a tocogram during her parturition. She developed a PSVT exacerbation in the second stage of parturition. As revealed by cardiotocography, the MHR baseline abruptly declined at onset of uterine contractions during the active phase of labor. Recovery followed, and the contraction resolved. The tachycardia got prolonged as the labor advanced. Our patient exhibited the unusual, up-and-down changes of the MHR pattern associated with labor contractions. The etiology of the occurrence of uterine contraction-associated MHR decelerations was unclear in the present case. Continuous tracing to visually inspect MHR patterns during parturition is a simple method for examining real-time MHR status of patients treated within obstetric practice settings.

Peripheral Central Venous Catheter Induced Supraventricular Tachycardia in a Patient of Acute Lymphoblastic Leukemia

Central venous catheters (CVCs) are used in intensive care units (and, increasingly, in other locations) to administer intravenous fluids and blood products, drugs, parenteral nutrition, and to monitor haemodynamic status. The risk of complication during the insertion or exchange of central venous catheters has been well documented. The majority of complications involve mechanical problems, although rarely it may induce arrhythmias as well [1]. Herein we present a case of peripheral central venous catheter induced supraventricular tachycardia in a young patient of acute lymphoblastic leukemia.

RADIOFREQUENCY CURRENT CATHETER ABLATION OF THE LEFT ATRIOVENTRICULAR ACCESSORY PATHWAYS WITH PAROXYSMAL SUPRAVENTRICULAR TAC

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Current knowledge for the risk factors of early permanent pacemaker implantation following transcatheter aortic valve replacement and what is next for the primary prevention?

In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.

Evaluation of AVNRT & AVRT by Different Criteria: Old & New

The two most frequent causes of paroxysmal SVT are atrioventricular tachycardia (AVRT) and atrioventricular nodal re-entrant tachycardia (AVNRT). The purpose of this study was to assess the diagnostic efficacy of traditional and newly proposed ECG criteria in the identification of Avnrt and Avrt. Aim of the Study: The aim of this study was to evaluate Atrioventricular Nodal Reentrant Tachycardia (AVNRT) and Atrioventricular Re-entrant Tachycardia (AVRT) using both traditional and novel criteria. Methods: This prospective observational study was conducted at the Electrophysiology Unit, Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD) in Dhaka, from February 2019 to January 2020. A total of 62 patients with Supraventricular Tachycardia (SVT) undergoing electrophysiology study (EPS) were included. Standard ECG criteria were applied for the differential diagnosis, and electrophysiological diagnoses were made using established criteria. Statistical analysis, including descriptive statistics and appropriate tests, was performed using SPSS 23.0. Result: In our study of 62 patients with Supraventricular Tachycardia (SVT), we found that 66.1% had AVNRT and 33.9% had AVRT. The mean age in AVNRT was higher than AVRT (41.3 ± 9.7 vs. 38.5 ± 14.3, p = 0.36) with statistically no significant difference, with similar gender distribution between AVNRT and AVRT groups. Classical AVNRT criteria were present in 30.6% of patients, and 45.2% showed a Pseudo R' wave in aVR. Additionally, 30.6% had an RP interval ≥100ms, more prevalent in AVRT patients (66.7%). Conclusion: Integrating traditional and novel criteria, including lead aVR analysis, enhances the electrocardiographic diagnosis of AVNRT and AVRT, offering a pathway to refined patient care.

室上性心动过速机制的智能分类模型:基于十二导联穿戴式心电设备

目的基于十二导联穿戴式心电设备,探索室上性心动过速(SVT)机制鉴别的智能分类模型。方法选取356份SVT的穿戴式心电图,通过五折交叉验证的方式随机分为训练集、验证集建立智能分类模型,选取2021年10月~2023年3月诊断为SVT并行电生理检查及射频消融术的患者共101例作为测试集。对比心动过速诱发前后的心电图参数改变,基于多尺度深度神经网络,并加入窦性心律对比图增强训练,建立SVT机制分类的智能分类模型并验证诊断效能。进一步提取II,III,V1三导联心电信号建立分类模型,并对比其与十二导联智能分类模型的效能。结果101例测试集中68例为房室结折返性心动过速,33例为房室折返性心动过速。预训练模型在验证集中识别房室结折返性心动过速的最高精确率-召回率曲线下面积达到0.9492,F1评分为0.8195。最终II导联,III导联,V1导联,三导联与十二导联智能分类模型于测试集中的总F1评分分别为0.5597,0.6061,0.3419,0.6003与0.6136。对比十二导联,III导联的净重新分类指数与综合判别改善指数分别为-0.029(P=0.714)与-0.005(P=0.817)。结论基于多尺度深度神经网络,初步建立了穿戴式心电图对SVT机制分类的智能分类模型,并具有一定的准确性。

胺碘酮治疗急性心肌梗死并室上性心律失常的临床疗效

目的探讨胺碘酮治疗急性心肌梗死(AMI)并室上性心律失常的临床疗效。方法选取2021年6月—2022年6月乳山市人民医院收治的AMI并室上性心律失常患者90例作为研究对象,以双色球法分为利多卡因组(n=45)与胺碘酮组(n=45)。利多卡因组给予利多卡因治疗,胺碘酮组给予胺碘酮治疗,2组均于心率稳定后停药。比较2组临床疗效,治疗前与治疗结束后心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]、室上性心律失常发作次数及发作持续时间、心电图[心率、校正后QT间期(QTc)、QT间期离散度(QTd)]及不良反应。结果胺碘酮组总有效率高于利多卡因组(97.78%vs.82.22%,χ^(2)=4.444,P=0.035)。治疗结束后,2组LVEF高于治疗前,LVEDD、LVESD小于治疗前,且胺碘酮组升高/缩小幅度大于利多卡因组(P<0.01);2组室上性心律失常发作次数少于治疗前,室上性心律失常发作持续时间短于治疗前,且胺碘酮组变化幅度大于利多卡因组(P<0.01);2组心率、QTd低于治疗前,QTc高于治疗前,且胺碘酮组降低/升高幅度大于利多卡因组(P<0.05或P<0.01)。利多卡因组与胺碘酮组不良反应总发生率比较,差异无统计学意义(13.33%vs.4.44%,χ^(2)=1.235,P=0.266)。结论胺碘酮治疗AMI并室上性心律失常可较好地改善患者的心功能及心室肌复极离散程度,同时减少室上性心律失常发作次数,缩短发作持续时间,进而增强临床疗效,但不会增加不良反应发生风险,安全性较高。

酒石酸美托洛尔联合胺碘酮对急诊室上性心动过速的疗效分析

目的分析急诊室上性心动过速治疗中酒石酸美托洛尔和胺碘酮静脉给药的疗效、不良反应及复律效果。方法回顾性选取2020年2月至2023年2月邹平市人民医院急诊室上性心动过速患者100例,依据用药方法分为酒石酸美托洛尔和胺碘酮静脉给药组(联合用药组)、单独胺碘酮静脉给药组(单独用药组),每组各50例。比较两组患者动脉血压(平均动脉压、舒张压、收缩压)、血液流变学指标、不良反应发生情况、药物起效时间、复律时间以及疗效评定。结果联合用药组患者的平均动脉压、舒张压、收缩压、血细胞比容、红细胞沉降率、纤维蛋白原水平、不良反应发生率均低于单独用药组,总有效率高于单独用药组,药物起效时间、复律时间均短于单独用药组(P值均<0.05)。结论急诊室上性心动过速治疗中酒石酸美托洛尔和胺碘酮静脉给药的疗效较单独胺碘酮静脉给药显著,且不良反应更少,复律时间更短。

危重症专职护理模式在小儿室上性心动过速急救中的应用效果

目的 危重症专职护理模式在小儿室上性心动过速急救中的应用效果。方法 根据随机数字表法,将2019年1月-2023年12月之间南阳市第二人民医院收治的室上性心动过速患儿(75例)分为对照/观察组(37/38例)。对照组采用一般常规护理,观察组采用危重症专职护理模式护理。比较两组患儿转复时间、心率改善情况,护士核心能力及家属满意度。结果 对照组患儿转复时间为(12.23±2.16)min,观察组患儿转复时间为(10.11±2.04)min,观察组显著短于对照组(t=4.371,P<0.001)。观察组患儿心率改善情况优于对照组[92.11%(35/38)vs70.27%(26/37)],(P<0.05)。观察组护士各项核心技能均优于对照组(P<0.05)。观察组护理总满意度优于对照组[94.74%(36/38)vs75.68%(28/37)],(P<0.05)。结论 危重症专职护理模式在小儿室上性心动过速急救中的应用效果确切,可有效缩短患儿转复时间,提高心率改善情况与护理满意度。

Radiofrequency ablation for treating paroxysmal supraventricular tachycardia complicated by atrial fibrillation： A single-center retrospective analysis

The effect of selective radiofrequency ablation for treating paroxysmal supraventricular tachycardia （PSVT） and its associated paroxysmal atrial fibrillation （PAF） was assessed. Methods Data were collected retrospectively from patients diagnosed of PSVT and subsequently treated with radiofrequency ablation. Regular monthly follow-up by dynamic electrocardiography （ECG） was performed. Incident rates of atrial fibrillation before and after ablation were compared. Results 382 PSVT patients with 58 having atrial fibrillation were en- rolled. The order of complicated PAF from high to low in these patients was displayed as： atrial tachycardia （AT）, atrioventricular reentrant tachycardia （AVRT） and atrioventricular nodal reentrant tachycardia （AVNRT）. Among AVRT patients, PAF was more frequent in patients having accessory pathways. AVNRT patients had significant- ly lower PAF rate comparing to other patients. PAF incident rate was significantly reduced by radiofrequency ablation therapy. Conclusion We advise regular dynamic ECG for PSVT patients, especially those with atrial flutter, AT or pre-excitation syndrome. Selective radiofrequency ablation is a feasible approach for treating AF complicated PSVT patients.

阵发性室上性心动过速ST段压低患者冠脉造影结果分析

目的 探讨阵发性室上性心动过速(PSVT)发作时ST段压低患者冠状动脉造影结果的影响因素及与ST段压低形态的关系。方法 选取PSVT发作时伴ST段压低,且已行腔内电生理检查及冠状动脉造影术的患者74例,根据冠状动脉造影结果分为造影阴性组(n=47)与造影阳性组(n=27)。比较两组患者临床资料、血液生化指标、PSVT类型、10年动脉粥样硬化性心血管疾病(ASCVD)风险及ST段压低形态,分析冠状动脉造影结果的影响因素。结果 与冠状动脉造影阴性组相比较,造影阳性组患者年龄更大(63±10 vs. 55.2±9)岁, P<0.01,合并高血压的比例更高(48%vs. 15%),P<0.01,出现胸闷/胸痛症状的比例更高(96%vs. 66%), P<0.05,但出现心悸症状的比例显著降低(82%vs. 98%), P<0.05,而10年ASCVD风险显著增高(P<0.01)。两组患者ST段压低形态无显著差异。单因素分析中,年龄、心悸症状、胸闷/胸痛症状、高血压、10年ASCVD风险对冠状动脉造影结果有影响。多因素Logistic回归分析表明胸闷/胸痛症状(OR=11.437, 95%CI 1.315~99.488, P<0.05)、10年ASCVD风险(OR=2.570, 95%CI 1.205~5.481, P<0.05)是冠状动脉造影结果的独立影响因素。结论 PSVT发作时ST段压低形态对冠状动脉造影结果无显著预测价值。10年ASCVD风险越高,且伴有胸闷/胸痛症状的患者,对冠状动脉造影可能有一定预测价值。

Intraoperative sudden arrhythmias in cervical spine surgery adjacent to the stellate ganglion:A case report

BACKGROUND Atrial arrhythmias such as paroxysmal supraventricular tachycardia(PSVT)and atrial flutter(AF)are common in the perioperative setting.They commonly resolve spontaneously.However,occasionally,they may continually progress to fatal arrhythmias or cause complications.Therefore,prompt and appropriate management is important.CASE SUMMARY A 46-year-old female patient diagnosed with cervical C6-7 radiculopathy characterized by decreased sensation in the right third,fourth and fifth fingers underwent C6-7 anterior cervical disc fusion surgery.Electrocardiography showed PSVT and ventricular tachycardia during C6-7 disc retraction.However,the patient remained stable.Initial treatment with esmolol and lidocaine for ventricular tachycardia was ineffective.Carotid massage and Valsalva maneuver were attempted but PSVT did not resolve.The surgery was paused,and the patient’s fraction of inspired oxygen was set to 100%.Adenosine was administered for pharmacological management of PSVT.The arrhythmia temporarily resolved.However,it then transformed into AF.Diltiazem was administered,which briefly decreased blood pressure,which immediately recovered.Surgery resumed while the patient was in normal sinus rhythm.She was discharged safely on postoperative day 6 without complications or abnormalities.Currently,she is living a healthy life without arrhythmia recurrence.CONCLUSION Ganglia associated with cardiac arrhythmias in the surgical site should be identified during cervical spine surgery.

Prognostic Factors of Mortality in Post-Myocardial Infarction Patients: A 24-Hour Rhythmic Holter Observational Study

Background: Heart dysfunction and sudden death are common complications in post-myocardial infarction. Purpose: This study aims to contribute to improving patient’s management by determining the factors correlated to the occurrence of left ventricular dysfunction or post-infarction sudden death. Method: It was a transversal, descriptive and analytical study conducted from January to October 2021. Results: The variables studied covered epidemiological, therapeutic and electrocardiographic aspects. There were 102 patients admitted for a recent revascularized myocardial infarction or not who had received a 24-hour ECG Holter after the acute phase of coronary event. The study population was predominantly men 88% versus 12% women with a sex ratio of 0.15. The discharge prescription was 74% antiarrhythmic, 91% platelet antiaggregator and 14% anticoagulant. Electrical abnormalities consisted of supraventricular extrasystoles in 45% of cases, ventricular extrasystoles in 61%, atrial fibrillation in 19% and supraventricular tachycardias in 11% (p Conclusion: The prognostic factors associated with the onset of post-infarction complications were ventricular arrhythmias (p .