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.

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.

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.

STUDIES ON TILT TABLE TESTING IN SYNCOPAL PATIENTS WITH PAROXYMAL SUPRAVENTRICULAR TACHYCARDIA

The commonly proposed mechamism of syncope in patients(pts)withparoxymal supraventricular tachycardia(PSVT)is a more rapid tachycardiarate.Nevertheless,the probability of a coesxistent vasovagal syncope(VS)component has not bees adequatelly investigated in these patients.Westudied 3 groups:group 1(G1):20 syucopal patients(age:37±9 years,M/F:11/9)with supraventricular tachycardia,group 2(G2):40 Syncopalpatients(age:37±13 year,M/F:19/21)without supraventriculartachycardia,these syncopal patients with syncope of unknown etiology andgroup 3(G3):22 healthy controls(age:39±10 years,M/F:10/12).Thesame tilt table test(TTT)protocol was used(25min in 80 degreesUpright followed by two 10 min stages in the same postion undergraded isoproternol(iso)intravebiys infusion at 2ug/min and 5ug/min).The tilt table test was considered positive(pos)if induced syncope dueto hypocension with of without bradycardia.Results:A positive tilttable test result was observed in 13 patients of G1(65%)and 30 patientsof group 2(75%)(pNS).In contrast,only 5 of the healthy controls group(22.7%)developed syncope(p【0.05).We conclude that syncopalsupraventricular tachycardia patients commonly demonstrate a positivetilt table test.Tilt table test is a useful test for investigatingsyncope in patients with supraventricular tachycardia.Tilt table testis also a safe,simple and effective test for nonivasive identifyingvasovagal syncope.Tilt table test shoule be used widely.

CLINICAL STUDY OF THE ELECTROPHYSIOLOGICAL CHARACTERISTICS AND RADIOFREQUENCY ABLTION OF SUPRAVENTRICULAR TACHYCARDIA

Radiofrequancy ablation is a popular and effective approach to cure arrhythmia.The present study is an analysis of the electrophysiological mechanism,charateristics and the best treatment of supraventricular tachycardia.Therecords of arrhythmia radiofrequancy ablation regestry were reviewed betweenDecember,1996 and July,1997.33 patients with supraventricular tachycardiawere examine by programmed electrial stimulation(PES,esophagus andintracardia PES),cured by radiofrequency ablation and its electrophysiologicalmechanism and characteristics was analyzed.Of all the patients,the rate ofAVNRT is 24.3%,that of AVRT is 75.7%,in which 68% were left pathways,32% right pathways.All the 33 patients were radiofrequency ablated,31patients were cured,the other two recurred within one month,and ablated again,no recurrence again,So we concluded that most supraventricular tachycardiawere caused by reentrant,catheter ablation is a safe and cured treatmant forsupraventricular tachycardia caused by reentrant.

CLINICAL SIGNIFICANCE OF TRANSESOPHAGUS Pv1-Pe ON DIAGNOSIS OF VARLDUS TYPES OF SUPRAVENTRICULAR TACHYCARDIA

Radiofrequency catheter ablation(RFCA)were performed in 142 patients with paroxysmal supraventricular reentranltechycardia(PSVT),including 67 patients of left side accessory pathway,20 patients of right side accessory pathway,48 patients with slow-fast type atrioventricular nodal reentrent tachyardia(AVNRT),and 7 patients with strialreetrant tachycardia(ART),The average of age was 40.9±13.8 years old(14-72ys).Transesophagus and intracardiacelectrophysiologic studies were carried out in all patients,and the Pv1-Pe,R-Pe were compared in these two methods.In order to assess the clinical significant of Pvl-Pe.R-Pe in diagnosis of various types of supratachycardia anddifferent accessory pathway.ResultsConclusionsThis article analysed the relations of the Pvl-Pe,R-Pe and the Δ A,V-A in all 142 patients with SVT.It is suggestthat AVRT with anterograde,Pvl-Pe was more than 25 ms,R-Pe more than 75ms,with the exception of RSAP Pvl-Pewas 0,R-Pe more than 75ms.In petients with ART,Pvl-Pe more than 25ms,R-Pe more than 150ms and R-Pe morethan Pe-R.AVNRT group Pvl-Pe less than 25ms,R-Pe less than 70ms.These are very sensitive and specific in makingthe diagnosis of SVT,It is also useful that conceled assessory pathway site can be decided,according to the trend ofchange of Pvl-Pe and R-Pe.We concluded that tranesophagus Pvl-Pe and R-Pe hold great value on diagnsis ofvarious types of supraventricular

Plasma natriuretic peptides during supraventricular tachycardia: A study in patients with atrioventricular nodal reentry tachycardia

Aims: To characterize the plasma levels of the atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in patients with atrioventricular nodal reentry tachycardia (AVNRT), we measured the plasma levels of these peptides before and during tachycardia. Methods: We included 10 consecutive patients scheduled for ablation of typical AVNRT without structural heart disease. Catheters were inserted in the femoral artery, femoral vein, and coronary sinus (CS) prior to the ablation procedure. Blood samples were drawn before and after 3 min of tachycardia to measure plasma levels of ANP and BNP. Right atrial pressure (RAP) was measured at baseline. Results: Of the 10 patients, in three patients it was not possible to induce tachycardia leaving a total of 7 patients available for analysis. Mean age of the seven included patients was 40 ± 12 years (mean ± SD), five were female. ANP levels increased significantly during tachycardia in the artery (p = 0.0009) and vein (p = 0.003), but only borderline in CS (p = 0.09). BNP levels did not change during tachycardia in any location. Conclusion: ANP levels measured in the peripheral circulation increased acutely during tachycardia due to AVNRT. BNP levels did not increase.

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.

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.

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.

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.

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.

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.