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

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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.

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。

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

Background 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 enrolled. 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 significantly 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 .

室上速射频消融术后患者N末端脑钠肽前体的变化

目的:探究室上性心动过速(简称室上速)射频消融术后患者N末端脑钠肽前体(NT-proBNP)水平变化。方法:选取确诊的40例室上性心动过速患者为室上速组,另选取40例同期正常体检者为对照组,比较两组个体血清NT-proBNP水平差异,记录室上速组患者术前10 min、术后即刻、术后2 h以及术后24 h时NT-proBNP水平,比较不同射频消融位置(左侧组和右侧组)患者不同观察点NT-proBNP水平差异。结果:室上速组患者血清NT-proBNP平均水平明显高于对照组(P<0.05);相较于术前10 min、术后即刻、术后2 h和术后24 h左侧组及右侧组患者血清NT-proBNP水平均出现了明显的升高,前后差异具有统计学意义(P<0.05);左侧组和右侧组射频消融术的刺激强度和刺激时间比较差异无统计学意义(P>0.05),左侧组和右侧组患者在围术期不同观察点上,血清NT-proBNP水平组间差异无统计学意义(P>0.05)。结论:室上性心动过速患者血清NT-proBNP水平会出现异常升高,而射频消融术会进一步导致此类患者NT-proBNP水平出现上升,分析其原因可能与射频能量导致心肌细胞损伤和死亡,最终导致了B型利钠肽合成分泌增加有关。

经食管心脏电生理检查与腔内电生理检查对室上性心动过速的诊断价值对比

目的探讨经食管心脏电生理检查(transesophageal electrophysiologic study,TEEPS)与腔内电生理检查(intracardiac electrophysiologic study,IEPS)对室上性心动过速(supraventricular tachycardia,SVT)的诊断价值。方法对197例采用TEEPS诱发、终止SVT的患者行IEPS,并对结果进行对比分析。结果将IEPS诊断结果作为SVT诊断的金标准,验证TEEPS诊断的准确性。TEEPS对房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)的诊断准确率为97.1%,房室折返性心动过速(atrioventricular reentrant tachycardia,AVRT)诊断准确率为94.1%,房性心动过速(简称房速)诊断准确率为100%。TEEPS和IEPS对AVNRT的检出率分别是73.2%、72.3%,对AVRT的检出率均为26.7%,二者比较差异无统计学意义(P>0.05)。除房速外,患者自发或TEEP检查过程中诱发出的心动过速均能经食管心房调搏终止。结论TEEPS在明确SVT机制、定位房室旁道以及终止心动过速方面有较高的应用价值。TEEPS作为射频消融术前的常规筛查手段,可缩短手术时间、减轻手术创伤及经济负担。

心脏三维电解剖标测在导管射频消融术治疗阵发性室上性心动过速患者中的应用

目的探讨心脏三维电解剖标测在导管射频消融术治疗阵发性室上性心动过速患者中的应用。方法选取2018年10月至2020年4月中国人民解放军联勤保障部队第九〇四医院诊治的阵发性室上性心动过速患者87例,根据治疗方法不同分为对照组41例和观察组46例。对照组在X线透视下完成导管射频消融术治疗,观察组在心脏三维电解剖标测系统下完成导管射频消融术治疗,术后完成6个月随访。比较两组消融成功率、手术时间、X线辐射量、并发症及复发率;对患者复发情况进行单因素分析及多因素Logistic分析。结果两组术后1、3个月复发率无统计学意义(P>0.05);观察组术后并发症发生率及术后6个月复发率均低于对照组(χ^(2)=5.002、5.002,P<0.05);观察组X线辐射剂量和辐射时间低于对照组(t=10.936、11.322,P<0.05)。87例患者6个月随访时未有患者死亡,将复发2例作为复发组,其余作为未复发组,进行单因素分析,结果显示两组手术方法差异有统计学意义(χ^(2)=7.297,P<0.05)。多因素Logistic回归分析结果显示,手术方式是患者复发的影响因素[OR(95%CI)=1.846(1.527~2.313),P<0.05]。结论在阵发性室上性心动过速患者导管射频消融术治疗中应用心脏三维电解剖标测能减少辐射剂量,术后并发症和复发率较低。

胺碘酮与普罗帕酮在阵发性室上性心动过速患者院前急救中的效果

目的分析胺碘酮与普罗帕酮在阵发性室上性心动过速患者院前急救中的效果。方法选择2019年6月至2021年6月连云港市急救中心收治的院前急救阵发性室上性心动过速患者100例作为研究对象,采用随机数表法分为观察组(n=50)和对照组(n=50)。院前急救,对照组患者采用胺碘酮治疗,观察组实施普罗帕酮治疗。比较两组心动过速转归率、血细胞指标、急救效果。结果急救后,两组患者血细胞比容、血浆比黏度、纤维蛋白原、红细胞沉降率均低于急救前,差异有统计学意义(P<0.05),急救后,两组血细胞参数比较,差异无统计学意义(P>0.05);观察组患者的转归率高于对照组,差异有统计学意义(P<0.05);观察组患者药物起效、复律时间低于对照组,差异有统计学意义(P<0.05);不良反应发生率高于对照组,差异有统计学意义(P<0.05)。结论院前急救,选择普罗帕酮、胺碘酮转复阵发性室上性心动过速均具有较好的疗效,各有优劣。普罗帕酮起效快,安全性相对较低,胺碘酮起效慢,安全性更高,适用范围广,临床上需要根据患者情况合理选择治疗药物。