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Curtis TM, Sady KM, Randall JT, Kervin P, Mosher DM, Dailey MW. 18-Month-Old with Lethargy and Accelerated Idioventricular Rhythm in Prehospital Setting: A Case Report. PREHOSP EMERG CARE 2024:1-4. [PMID: 38551813 DOI: 10.1080/10903127.2024.2337755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION We report a case of accelerated idioventricular rhythm (AIVR) identified by Emergency Medical Services (EMS) monitoring of an infant presenting with lethargy and respiratory distress. Accelerated idioventricular rhythms are rare ventricular rhythms originating from the His-Purkinje system or ventricular myocytes, consisting of >3 monomorphic beats with gradual onset and termination.1 An AIVR is usually well-tolerated and does not require treatment, though sustained arrythmia may induce syncope, and the rhythm has been seen in newborn infants with congenital heart diseases.1 Monitoring ill children with ECG can identify such dysrhythmias in the prehospital setting. CASE REPORT An 18-month-old male presented to their pediatrician with lethargy and respiratory distress, prompting activation of EMS. The patient was placed on a 4-lead ECG initially revealing monomorphic QRS complexes at a rate of 170 beats per minute (BPM). A 12-lead ECG was interpreted as sinus tachycardia by the paramedics who noted the QRS complexes were "getting taller and shorter" with a stable rapid heart rate. The clinician then noted a consistently wide tachycardia which spontaneously converted to a narrow complex tachycardia. The QRS pattern remained variable, with notation of variable R-wave height. After arrival to the emergency department, pediatric cardiology was consulted and interpreted the prehospital ECG findings as accelerated idioventricular rhythm. The patient experienced multiple occurrences of accelerated idioventricular rhythm during hospitalization without associated hypoxia or decreased perfusion. DISCUSSION Accelerated idioventricular rhythm is relatively rare entity without underlying cardiac disease and most cases are asymptomatic or benign. In the pediatric population, AIVR is generally related to congenital heart defects, cardiac tumors, and cardiomyopathies. In the prehospital setting, continuous ECG monitoring should be a part of care by Advanced Life Support personnel in children with altered mental status, respiratory distress, unexplained syncope, or suspected arrhythmias and 12 lead ECG should be considered if there is any abnormality noted. While this patient did not experience persisting morbidity from AIVR, the potentially hazardous rhythm would not have been recognized without the astute observation, clinical management and persistent follow up of the prehospital clinicians.
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Affiliation(s)
| | - Kaden M Sady
- Family Nurse Practitioner Program, SUNY Polytechnic Institute, Utica, New York
| | | | - Patrick Kervin
- EMS Division, Albany County Sheriff's Office EMS Division, Albany, New York
| | - Dawn M Mosher
- EMS Division, Albany County Sheriff's Office EMS Division, Albany, New York
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Silva RRP, Magalhães CJ, Silva RSVD, Tavares de Albuquerque AL, Montenegro ST, Alencar Neto JND. Accelerated idioventricular rhythm as anginous substrate in elderly: Report of an unprecedented case. HeartRhythm Case Rep 2024; 10:217-221. [PMID: 38496744 PMCID: PMC10943551 DOI: 10.1016/j.hrcr.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Rodrigo Rufino Pereira Silva
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Carolina Jerônimo Magalhães
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Rafael Silvestre Vieira da Silva
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Afonso Luiz Tavares de Albuquerque
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Sérgio Tavares Montenegro
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
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Knoll K, Fuchs P, Weidmann I, Altunkas F, Voss S, Lennerz C, Kolb C, Kessler T, Schunkert H, Reinhard W, Groß S, Trenkwalder T. Incidence and Predictors of Ventricular Arrhythmias in Transthyretin Amyloid Cardiomyopathy. J Clin Med 2023; 12:4624. [PMID: 37510739 PMCID: PMC10380522 DOI: 10.3390/jcm12144624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is characterized by heart failure, conduction abnormalities and arrhythmias. The incidence of ventricular arrhythmias, particularly ventricular tachycardias (VTs), in wtATTR-CM is unclear. With the development of targeted therapies and improved overall prognosis, there is an unmet need to identify patients at high risk for VTs who might benefit from ICD therapy. METHODS Between 2017 and 2022, 72 patients diagnosed with wtATTR-CM were prospectively evaluated for the presence of ventricular arrhythmias using a Holter ECG. VTs were defined as >3 consecutive beats with a heart rate > 100 beats per minute originating from a ventricle. RESULTS The incidence of VTs was 44% (n = 32/72) in unselected wtATTR-CM patients. Patients with VT showed significantly more severe left ventricular (LV) hypertrophy (septum diameter 21 ± 2.6 vs. 19 ± 3.0 mm, p = 0.006), reduced LV ejection fraction (47 ± 8 vs. 52 ± 8%, p = 0.014) and larger left atria (32 ± 7 vs. 28 ± 6 mm2, p = 0.020), but no differences in cardiac markers such as NTproBNP and troponin. In a multivariable model, LV hypertrophy (LV mass indexed, OR = 1.02 [1.00-1.03], p = 0.031), LV end-diastolic diameter (OR = 0.85 [0.74-0.98], p = 0.021) and LV end-systolic diameter (OR = 1.19 [1.03-1.349], p = 0.092) were predictive for VT occurrence with an area under the receiver operating characteristic of 0.76 [0.65-0.87]. CONCLUSIONS The incidence of ventricular arrhythmia in wtATTR-CM is high and is associated with an advanced stage of left ventricular disease. Further studies are needed evaluating the role of VTs in predicting sudden cardiac death and the benefit of ICD therapy in wtATTR-CM.
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Affiliation(s)
- Katharina Knoll
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Patrick Fuchs
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Isabel Weidmann
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
| | - Fatih Altunkas
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
| | - Stephanie Voss
- German Heart Centre Munich, Department of Cardiovascular Surgery, Technical University of Munich, 80636 Munich, Germany
| | - Carsten Lennerz
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Christof Kolb
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
| | - Thorsten Kessler
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Heribert Schunkert
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Wibke Reinhard
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
| | - Stefan Groß
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, 17475 Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Teresa Trenkwalder
- German Heart Centre Munich, Department of Cardiology, Technical University of Munich, 80333 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
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Ljubas Perčić D, Krmek N, Benko I, Kniewald H, Bitanga S, Katavić M, Perčić M. Frequent accelerated idioventricular rhythm in an otherwise healthy child: a case report and review of literature. BMC Cardiovasc Disord 2023; 23:37. [PMID: 36670379 PMCID: PMC9862554 DOI: 10.1186/s12872-023-03074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Accelerated idioventricular rhythm (AIVR) is a wide QRS complex dysrhythmia that, as far as pediatric population is concerned, occurs mostly in children with underlying systemic or heart disease. Its clinical course is thought to be typically benign in otherwise healthy children and treatment to be completely needless. Existing guidelines/recommendations are based entirely on cases that had low daily burden of AIVR, and those referring to treatment itself are very unspecific. Pharmacologic therapy has been mostly unsuccessful and catheter ablation as a way of treatment has been only sporadically reported. This article is a case report with a literature review that aims to practically separate the age groups into newborn and older children and to emphasize the different clinical outcomes of children with occasional and frequent AIVR. There are only a few cases so far describing undesirable outcomes of this condition, and most of these patients had high daily burden of AIVR. To be more specific, among 38 healthy children older than 1 year reported in total, 6 had undesirable outcomes, short-term in terms of developing malignant arrhythmia or long-term in terms of developing cardiomyopathy/heart failure. CASE PRESENTATION An 11-year-old boy had been referred to our center for a workup of incidentally discovered wide-complex arrhythmia. He was asymptomatic, with no underlying cardiac or systemic diseases. Continuous heart rate monitoring detected AIVR during most time of monitoring. In 24-h Holter-ECG, wide QRS complexes accounted for 73%. With parental consent, we conducted an electrophysiological study accompanied by radiofrequent ablation of ectopic focus, which lead to an instantaneous sinus rhythm that continued during the entire follow-up. CONCLUSION AIVR is a rare dysrhythmia in the pediatric population, typically considered benign. Nevertheless, more than a few cases evidence its harmful potential, short-term in terms of developing malignant arrhythmia or long-term in terms of developing cardiomyopathy. Gathering more knowledge and experience along with conducting further studies is essential for the enhancement of understanding this condition, and selecting potentially vulnerable patients as well as their treatment.
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Affiliation(s)
- Daria Ljubas Perčić
- grid.412688.10000 0004 0397 9648Department of Neonatology, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Nikola Krmek
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Ivica Benko
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Hrvoje Kniewald
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Suzana Bitanga
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Matej Katavić
- grid.412688.10000 0004 0397 9648Department of Pediatrics, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
| | - Marko Perčić
- grid.412688.10000 0004 0397 9648Department of Cardiology, University Hospital “Sveti Duh”, Zagreb, Croatia
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Bijsterveld NR, van der Crabben SN, Groenink M, Wilde A, Jørstad H. Accelerated Idioventricular Rhythm in a Young Athlete: Physiology or Pathology? JACC Case Rep 2022; 4:101657. [PMID: 36507292 PMCID: PMC9730148 DOI: 10.1016/j.jaccas.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
An accelerated idioventricular rhythm was seen on a routine preparticipation electrocardiogram of a 19-year-old healthy and symptom-free athlete. Family history was negative for cardiac disease. Additional investigations revealed a hypertrophic cardiomyopathy, confirmed with cardiac magnetic resonance imaging and genetic analysis. Accelerated idioventricular rhythm in young athletes warrants careful clinical evaluation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Nick R. Bijsterveld
- Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam, the Netherlands,Department of Cardiology, Flevoziekenhuis, Almere, the Netherlands,Address for correspondence: Dr Nick R. Bijsterveld, Department of Cardiology, Amsterdam UMC, Heart Centre, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | | | - Maarten Groenink
- Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam, the Netherlands
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam, the Netherlands
| | - Harald Jørstad
- Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam, the Netherlands
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