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.

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 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.

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.

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

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 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.

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.

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).

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.

Treatment of Supraventricular Arrhythmias by Transcatheter Radiofrequency Ablation： The Experience of the Electrophysiology Unit of the University Hospital

TC-RF （transcatheter radiofrequency） ablation has an important role in the treatment ofSVA （supraventricular arrhythmias）. The indication to TC-RF ablation is usually made to improve the patient＇s quality of life through the elimination of the arrhythmic substrate. The objective of this study is to make a brief review of the literature and to report the Electrophysiology Unit experience of the Cardiovascular Department of the University Hospital of Trieste. From the study, it can be found that about one thousand of patients are visited annually in the Cardiovascular Department of the University Hospital of Trieste （1,019 ± 71/year over the past five years）. The acute success rate of atrial fibrillation and flutter ablation procedures was respectively 93.9% and 97.9% with a relapse rate of 30% and 10% at 12 month. Accessory pathways and nodal atrio ventricular re-entry tachycardia ablation procedures had an acute success rate of respectively 91.1% and 96.6% with a relapse rate of 10% at 12 months. The overall complication rate was 5%. Catheter ablation is an effective therapy for SVA treatment. It can often be definitive, and it is generally superior to drug therapy, with a low complication rate. The improvement in patients＇ quality of life is associated with a reduced need for access to health services.

Electrophysiologic Mechanism and Radiofrequency Catheter Ablation of Incessent Atrioventricular Reentrant Tachycardia

Objective\ To study electrophysiologic mechanism and radiofrequency catheter ablation of incessent atrioventricular reentrant tachycardia. Methods\ In this report, 17 cases of incessant atrioventricular reentrant tachycardia (IAVRT) were presented. There were twelve men and five women. The average age was (46±17) years. Mean duration of persistent tachycardia was (36±76) days. Mean ventricular rate was (180±17) min\+\{-1\} during tachycardia. Five patients had cardiac dysfunction and four had tachycardia induced dilated cardiomyopathy. Results\ All the 17 patients underwent successful radiofrequency catheter ablation. There were eleven accessory pathways(APs) in the left side posteroseptal position, three in the left free wall, two in the right free wall and one in the right side posteroseptal position. Two Aps had decremental conduction characteristics. Four patients had longer than normal atrioventricular conduction time, mean AH interval being (161±6) ms. Six patients had posteroseptal AP with RP≥PR during tachycardia on the surface ECG. All patients were free of symptomatic tachycardia during follow up period of 1 38 months. Five patients with heart dysfunction ameliorated one week after tachycardia ablated. Four tachycardia induced dilated cardiomyopathies were followed for mean of 12 months, the size and function of the heart returned normal in three patients, and the heart size became smaller in one. Conclusion\ It was concluded that electrophysiologic mechanism of IAVRT could be related to the following factors: ①Position of the AP, posteroseptal AP had the highest incidence of IAVRT; ②Characteristics of AP, AP with RP≥PR during tachycardia on the surface ECG and the decremental conduction was liable to IAVRT; ③Longer atrioventricular conduction time. As previously described, one or more factors can lead to IAVRT. Radiofrequency catheter ablation could eradicate IAVRT and cure IAVRT induced dilated cardiomyopathy.

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.

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。

盐酸胺碘酮注射液结合盐酸普罗帕酮注射液对急诊阵发性室上性心动过速患者血压、心功能指标的影响

目的探讨在急诊阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)患者中应用盐酸胺碘酮注射液结合盐酸普罗帕酮注射液治疗的具体影响。方法回顾性选取淄博昌国医院于2020年4月—2023年8月收治的80例急诊PSVT患者的临床资料,按照治疗方法将患者分为观察组、对照组。对照组(40例)皮下注射盐酸普罗帕酮注射液,观察组(40例)在对照组基础上皮下注射盐酸胺碘酮注射液。比较两组的临床疗效、血压水平、心功能指标、不良反应发生情况。结果观察组治疗总有效率为92.50%(37/40),高于对照组的75.00%(30/40),差异有统计学意义(χ^(2)=4.501,P<0.05);治疗后观察组收缩压、左室收缩末期容积、舒张压、左室舒张末期内径、左室舒张末期容积均较对照组低,左心室射血分数较对照组高,差异有统计学意义(P均<0.05);两组的不良反应发生情况比较,差异无统计学意义(P>0.05)。结论盐酸胺碘酮注射液结合盐酸普罗帕酮注射液用于PSVT患者,具有明显治疗效果,可对患者血压进行有效调节,改善心功能水平,且用药安全性高。

经食管电生理检查在阵发性室上性心动过速诊治中的应用价值

目的探讨经食管电生理检查(transesophageal electrophysiologic study,TEEPS)在阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)诊治中的应用价值。方法回顾性分析因心悸怀疑PSVT而行TEEPS的371例患者的电生理资料。分析TEEPS对心动过速的检出情况,并统计TEEPS相对于心内电生理检查(intracardiac electrophysiologic study,IEPS)的敏感性、特异性及准确率。结果45.55%(169/371)的患者通过TEEPS检出心动过速,其中,81.07%(137/169)为房室结折返性心动过速(atrioventricular node reentrant tachycardia,AVNRT)和房室折返性心动过速(atrioventricular reentrant tachycardia,AVRT)。运动联合S1S1及S1S2刺激可显著提高PSVT的检出率。以IEPS为金标准,TEEPS诊断PSVT的准确率为95.54%(107/112)。TEEPS诊断AVNRT的敏感性、特异性分别为100%、92.31%;诊断AVRT的敏感性、特异性分别为93.18%、98.53%;诊断房性心动过速的敏感性、特异性分别为71.43%、100%。结论TEEPS安全且有效,能提高PSVT的诊断率,在多种心律失常的诊断中均有较高的敏感性和特异性。