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.

CHANGES OF PLASMA ENDOTHELIN AND ATRIAL NATRIURETIC PEPTIDE DURING THE ONSET AND AFTER TERMINATION OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

Radioimmunoassays were used to measure the concentration changes of plasma endothelin(ET) and atrial natriuretic peptide(ANP) during the onset and after termination of paroxysmal supraventricular tachycardia(SVT). 30 cases were reviewed and compansons with 42 normal subjects were made. There are very significant differences(P<0.0001) in the concentration changes of both plasma ET and ANP during the onset and 30 minutes after the termination of SVT. During the onset period of SVT. the plasma ET and ANP were markedly elevated and 30 minutes after its termination they were lowered significantly, but their concentrations were still 2-fold higher than ihose of the control group. As the biological effects of ANP and ET are antagonistic to each other. their parallel elevation and lowering of plasma concentrations during and.after the termination of SVT reveal that these 2 hormones parucipate in the pathophysiological process of SVT. This phenomenon is possibly one of the homeostatic regulatory functions in the organism.

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

Seventy patients with left atrioventricular accessory pathways and paroxysmal supraventricular tachycardia(PSVT) underwent radiofrequency catheter ablation(RFCA). The success rate was 94. 3%. Among these patients,26 had manifest preexcitation syndrome, and 44 had concealed preexcitation. Eighteen patients with concealed preexcitation underwent coronary sinus (CS) pacing, and delta wave appeared in 15. The keys to successful RFCA were correct positioning of the radiofrequency(RF) catheter tip, A/V amplitude ratio, AV interval (in sinus rhythm) and VA interval(during SVT or ventricular pacing). After 1～14 months of follow-up. two patients had supraventricular tachycardia(SVT) recurrence.

Transient severe mitral regurgitation after paroxysmal supraventricular tachycardia in patient with WPW syndrome

A 65-year-old woman was presented with acute ab- dominal pain. The initial heart rate was 170 beats/min and the ECG showed supraventricular tachycardia （Figure IA）. After intra-venous adenosine administered, it recovered to sinus rhythm and the follow-up ECG showed WPW pattern （Figure 1B）. The echocardiography revealed mitral valve prolapse of mid portion of anteromedial valve leaflet （A2） with severe mitral regurgitation （MR） （Figure 2）.

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.

RADIOFREQUENCY CATHETER ABLATION IN 66 CASES WITH REENTRANT PAROXYSMAL SUPERVENTRICULAR TACHYCARDIA

Sixty-six cases with reentrant supraventricular tachycardias were treatedby radiofrequency current cather ablation(RFCA).Forty one patients withatrioventricular reentrant tachycardia(male 30,femal 11,Group Ⅰ),Twenty fivepatients with atrloventricular nodal reentrant tachycaria(male 8,femal 17,Group Ⅱ).Group 1.41 patients had 43 accessory pathways(APs)of which23 located at left free wall(53.5),6 at left posteroseptal region(13.9%),14 atright free wall(32.6%).Successful RFCA were 26 in 27 cases with leftAPs(96.3%),14 in 14 cases with right APs(100%).In group 11.13 patientswith slow pathway were ablated,success rate is 92.3.The characteristics of local electrocardlogram at the ablation target sitewere:(1)A/V ratlo【1.(2)AV or VA Interval【40ms.(3)V-delta Interval】20ms.the 95%ablation target sites were slmler to this characteristics in oursuccessful RFCA.During a follow up of 1-7months,no Patients hadexparienced recurrence of arrhythmia.

Unexplained fetal tachycardia:A case report

BACKGROUND This study aimed to explore the possible etiology and treatment of severe fetal tachycardia in the absence of organic disease and provide a reference for clinical management of severe fetal tachycardia.CASE SUMMARY A 29-year-old pregnant woman,with a gravidity 1 parity 0,presented with a fetal heart rate(FHR)of 243 beats per minute during a routine antenatal examination at 31+2 wk of gestation.Before termination of pregnancy at 38 wk of gestation,the FHR repeatedly showed serious abnormalities,lasting more than 30 min.However,the pregnant woman and the fetus had no clinical symptoms,and repeated examination revealed no organic lesions.The mother and the baby were regularly followed up.CONCLUSION This was a case of severe fetal tachycardia with no organic lesions and management based on clinical experience.

Peripartum Cardiomyopathy Complicated by Ventricular Tachycardia during Labor: A Case Report and Literature Review

Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventricular tachycardia (VT) is a major complication and contributor to sudden death. Available data on VT in patients with PPCM are limited. Aim: This case report demonstrates the clinical presentation, antenatal care, and management of labor and delivery in a patient with PPCM complicated by VT. Case report: 36-year old patient G4P3 presents at 27 weeks gestation to the emergency department complaining of chest tightness, palpitations, and profuse sweating. Peripartum cardiomyopathy was diagnosed after her last pregnancy a few years prior. Ventricular tachycardia was diagnosed at this visit and treated successfully. The remainder of the pregnancy was uneventful until she had another episode of ventricular tachycardia during labor. Treatment using antiarrhythmics (diltiazem, amiodarone, adenosine) highlights the importance of prompt intervention and the need for a range of therapeutic options. Results: This case demonstrated successful VT management during pregnancy and labor, emphasizing multidisciplinary collaboration, influencing maternal and fetal outcomes positively, providing insights into optimal care strategies. Conclusion: Peripartum cardiomyopathy complicated by ventricular tachycardia is a life-threatening combination. This case highlights the importance of timely diagnosis and management with combined care between cardiologists, maternal fetal medicine specialists and anesthesiologists to prevent morbidities and sudden maternal death.

Massive inferior wall aneurysm presenting with ventricular tachycardia and refractory cardiomyopathy requiring multiple interventions:A case report

BACKGROUND Inferior wall left ventricular aneurysms are rare,they develop after transmural myocardial infarction(MI)and may be associated with poorer prognosis.We present a unique case of a large aneurysm of the inferior wall complicated by ventricular tachycardia(VT)and requiring surgical resection and mitral valve replacement.CASE SUMMARY A 59-year-old male was admitted for VT one month after he had a delayed presentation for an inferior ST-segment elevation MI and was discovered to have a large true inferior wall aneurysm on echocardiography and confirmed on coronary computed tomography(CT)angiography.Due to the sustained VT,concern for aneurysm expansion,and persistent heart failure symptoms,the patient was referred for surgical resection of the aneurysm with patch repair,mitral valve replacement,and automated implantable cardioverter defibrillator insertion with significant improvement in functional and clinical status.CONCLUSION Inferior wall aneurysms are rare and require close monitoring to identify electrical or contractile sequelae.Coronary CT angiography can outline anatomic details and guide surgical intervention to ameliorate life-threatening complications and improve performance status.

Wide QRS complex tachycardia in a patient with wide QRS complex sinus rhythm due to left bundle branch block pattern

A 58-year-old man with hypertension and half a year ago documented left bundle branch block(LBBB)in his past history presented with progressive dyspnea.A pre-admission echocardiography showed severely depressed systolic left ventricular function[ejection fraction(EF)=27%],diffuse hypokinesis and dilated heart chambers consistent with dilated cardiomyopathy(DCM).

Antitachycardia pacing programming in implantable cardioverter defibrillator:A systematic review

Implantable cardioverter defibrillator(ICD) programminginvolves several parameters. In recent years antitachycardia pacing(ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias(188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation(VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.

Acute paroxysmal cold hemoglobinuria upon dengue fever:A case report

Rationale:Dengue fever is capable of inciting the formation of transient polyclonal antibodies directed at red blood cell antigens,resulting in complement-mediated hemolysis,leading to intravascular hemolysis and hemoglobinuria.Patient’s concern:A 12-year-old male patient who recovered from dengue fever a week ago had red blood cell agglutination,spherocytes,and engulfment of red blood cells(erythrophagocytosis)by monocytes and neutrophils on routine hematological peripheral blood smear.The unexpected blood smear results prompted the lab physicians to investigate autoimmune hemolytic anemia,which revealed a monospecific positive direct antiglobulin test for complement(C3d,C3b)and the presence of Donath-Landsteiner antibody.Diagnosis:Paroxysmal cold hemoglobinuria(PCH),secondary to dengue fever.Interventions:Oxygen supplements,antibiotics,intravenous immunoglobulins,steroid therapy,and packed cell transfusions were administered.Outcomes:The patient’s condition was improved following the therapy.Lessons:Post-dengue PCH is a rare complication that requires a thorough peripheral smear examination for erythrophagocytosis,as advanced hematology analyzers fail to detect such findings.

Diagnosis and management of postural orthostatic tachycardia syndrome：A brief review

Postural orthostatic tachycardia syndrome （POTS） has been recognized since at least 1940.A review of the literature identifies differences in the definition for this condition and wide variations in treatment and outcomes.This syndrome appears to describe a group of conditions with differing pathophysiology,which requires treatment tailored to the true underlying disorder.Patients need to be fully evaluated to guide treatment.Further research is required to effectively classify the range of underlying pathophysioiogy that can produce this syndrome and to guide optimal management.

Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations

A 61-year-old female patient suffering from recent onset palpitations and dyspnea on exertion with hypertension and mitral valve prolapse in her past history came to our outpatient department. Echocardiography revealed a mild mitral valve prolapse, slightly decreased left ventricular （LV） function （LV ejection fraction： 51%） and a mild mitral regurgitation.

Ventricular tachycardia ablation and substrate modification in ICD patients with electrical storm

The electrical storm （ES） is defined as a state of electrical instability with three or more sustained ventricular arrhythmias （VAs） occurring within twenty-four hours, which needs intravenous antiarrhythmic medications and frequent defibrillation. Recently, radiofrequency catheter ablation evolved as a sole therapy to terminate ES in patients with ICD, and the survival has been reported to be improved with successful ablation during follow-up. In this review, we briefly summarize substrate mapping and substrate ablation strategy in patients with ES, and discuss the reason of recurrence after ablation.

Climatic variations and benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo(BPPV) is probably the most common diagnosis at vertigo clinics.Seasonal cycles of several human illnesses could be attributed variously to changes in atmospheric or weather conditions.In this retrospective study,patients with BPPV from January 2010 to December 2012 were studied,and their charts were reviewed.Statistical analysis revealed a statistically significant difference in patients’ numbers among different months of the year.Also there is a significant statistical correlation between the numbers of patients with climatic variations especially the temperature.The present paper discusses the possible explanations for these results which confirms the seasonal variations in BPPV,together with a review of literature to view the possible associations with other disorders that causes such seasonality.

Discrimination of ventricular tachycardia and localization of its exit site using surface electrocardiography

Differential diagnosis of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) is of paramount importance for appropriate patient management. Several diagnostic algorithms for discrimination of VT and SVT based on surface electrocardiogram (ECG) analysis have been proposed. Following established diagnosis of VT,a specific origination tachycardia site can be supposed according to QRS complex characteristics. This review aims to cover comprehensive and comparative description of the main VT diagnostic algorithms and to present ECG characteristics which permit to suggest the most common VT origination sites.

Rare presentation of intralobar pulmonary sequestration associated with repeated episodes of ventricular tachycardia

Arterial supply of an intralobar pulmonary sequestration(IPS) from the coronary circulation is extremely rare. A significant coronary steal does not occur because of dual or triple sources of blood supply to sequestrated lung tissue. We present a 60-year-old woman who presented to us with repeated episodes of monomorphic ventricular tachycardia(VT) in last 3 mo. Radio frequency ablation was ineffective. On evaluation, she had right lower lobe IPS with dual arterial blood supply, i.e., right pulmonary artery and the systemic arterial supply from the right coronary artery(RCA). Stress myocardial perfusion scan revealed significant inducible ischemia in the RCA territory. Coronary angiogram revealed critical stenosis of proximal RCA just after the origin of the systemic artery supplying IPS. The critical stenosis in the RCA was stented. At 12 mo follow-up, she had no further episodes of VT or angina.

Low doses of intravenous epinephrine for refractory sustained monomorphic ventricular tachycardia

We report three cases of sustained monomorphic ventricular tachycardia(VT) in the setting of coronary artery disease,resistant to beta-blockers in two patients and to amiodarone in all,successfully terminated by low doses of intravenous(IV) epinephrine.VT was the first manifestation of coronary artery disease in one patient,whereas the other two patients had a previous history of myocardial infarction and were recipients of an implantable cardioverter-defibrillator(ICD).One of these two patients experienced an arrhythmic storm.All had hemodynamic instability at the time of epinephrine administration.A single slow administration of IV epinephrine(0.5 to 1 mg administered over 30 to 60 s) restored sinus rhythm after 30-90 s with only minor side effects.In the ICD patient with recurrent VT and several cardioversions due to transformation of VT to ventricular fibrillation,epinephrine injection led to the avoidance of further shocks.Although potentially harmful,low doses of IV epinephrine used alone or in combination with beta-blocker treatment and electrical cardioversion may be an alternative effective therapy for sustained monomorphic VT refractory to amiodarone.The role of epinephrine in the termination of VT should be studied further,especially in patients pre-treated with amiodarone in combination with beta-blockers.

Investigations for the assessment of adult patients presenting to the emergency department with supraventricular tachycardia

Dear editor,Patients with supraventricular tachycardia(SVT)commonly present to the emergency department(ED).Current guidelines[1,2]do not recommend routine pathology testing and a report on the topic has questioned their role.A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings,but these results were not associated with major adverse cardiac events.[3]The conclusions of this review were limited by paucity of data and heterogeneity among studies.