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Hon KL, Tan YW, Leung KKY, Fung GPG, Kwok KH, Ho AY, Chan BH. Respiratory versus Cardiac Algorithm for Pediatric and Neonatal Resuscitation. Curr Pediatr Rev 2024; 20:278-282. [PMID: 36803743 DOI: 10.2174/1573396319666230220130016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/10/2022] [Accepted: 01/11/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Hong Kong
- Department of Paediatrics, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Yok Weng Tan
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Hong Kong
| | - Karen Ka Yan Leung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Hong Kong
| | - Genevieve P G Fung
- Department of Paediatrics, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Ka Hang Kwok
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Hong Kong
| | - Alice Yan Ho
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Hong Kong
| | - Bill H Chan
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Hong Kong
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2
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Ray L, Geier C, DeWitt KM. Pathophysiology and treatment of adults with arrhythmias in the emergency department, part 1: Atrial arrhythmias. Am J Health Syst Pharm 2023; 80:1039-1055. [PMID: 37227130 DOI: 10.1093/ajhp/zxad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Indexed: 05/26/2023] Open
Abstract
PURPOSE This article, the first in a 2-part review, aims to reinforce current literature on the pathophysiology of cardiac arrhythmias and various evidence-based treatment approaches and clinical considerations in the acute care setting. Part 1 of this series focuses on atrial arrhythmias. SUMMARY Arrhythmias are prevalent throughout the world and a common presenting condition in the emergency department (ED) setting. Atrial fibrillation (AF) is the most common arrhythmia worldwide and expected to increase in prevalence. Treatment approaches have evolved over time with advances in catheter-directed ablation. Based on historic trials, heart rate control has been the long-standing accepted outpatient treatment modality for AF, but the use of antiarrhythmics is often still indicated for AF in the acute setting, and ED pharmacists should be prepared and poised to help in AF management. Other atrial arrhythmias include atrial flutter (AFL), atrioventricular nodal reentry tachycardia (AVNRT), and atrioventricular reentrant tachycardia (AVRT), which warrant distinction due to their unique pathophysiology and because each requires a different approach to utilization of antiarrhythmics. Atrial arrhythmias are typically associated with greater hemodynamic stability than ventricular arrhythmias but still require nuanced management according to patient subset and risk factors. Since antiarrhythmics can also be proarrhythmic, they may destabilize the patient due to adverse effects, many of which are the focus of black-box label warnings that can be overreaching and limit treatment options. Electrical cardioversion for atrial arrhythmias is generally successful and, depending on the setting and/or hemodynamics, often indicated. CONCLUSION Atrial arrhythmias arise from a variety of mechanisms, and appropriate treatment depends on various factors. A firm understanding of physiological and pharmacological concepts serves as a foundation for exploring evidence supporting agents, indications, and adverse effects in order to provide appropriate care for patients.
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Affiliation(s)
- Lance Ray
- Denver Health and Hospital Authority, Denver, CO
- Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Curtis Geier
- San Francisco General Hospital, San Francisco, CA, USA
| | - Kyle M DeWitt
- University of Vermont Medical Center, Burlington, VT, USA
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3
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Lim YT, Kim YH, Kwon JE. Effective Control of Supraventricular Tachycardia in Neonates May Requires Combination Pharmacologic Therapy. J Clin Med 2022; 11:3279. [PMID: 35743350 DOI: 10.3390/jcm11123279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Supraventricular tachycardia (SVT) is one of the arrhythmias that can occur in newborns. Most SVT incidents in the neonatal period are spontaneously resolved around the first year of life, but since tachycardia can frequently occur before complete resolution, appropriate medication use is required. However, no clear guidelines or consensus on the treatment of neonatal SVT have been established yet. METHODS From January 2011 to December 2021, demographic data and antiarrhythmic medications used were retrospectively analyzed for 18 newborns diagnosed with SVT at a single center. RESULTS A total of four medications (propranolol, amiodarone, flecainide, and atenolol) were used as maintenance therapy to prevent tachycardia recurrence, and propranolol was the most used, followed by amiodarone. Thirty-nine percent of the patients were controlled with monotherapy, but the remainder required two or more medications. The median period from medication initiation after diagnosis to the last tachycardia event was 15.5 days, and the median total duration of medication use was 362 days. None of the patients experienced any side effects of antiarrhythmic medications. The total duration of medication use was statistically significant according to the mechanism of SVT, and the usage time of the increased automaticity group was shorter than that of the re-entry group. CONCLUSION Since most neonatal SVT resolves within 1 year, it is significant to provide prophylactic medication to prevent tachycardia recurrence at least until 1 year of age, and depending on the patient, the appropriate combination of medications should be identified.
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Ramlakhan KP, Kauling RM, Schenkelaars N, Segers D, Yap SC, Post MC, Cornette J, Roos-Hesselink JW. Supraventricular arrhythmia in pregnancy. Heart 2022; 108:1674-1681. [PMID: 35086889 PMCID: PMC9606519 DOI: 10.1136/heartjnl-2021-320451] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
The physiological changes during pregnancy predispose a woman for the development of new-onset or recurrent arrhythmia. Supraventricular arrhythmia is the most common form of arrhythmia during pregnancy and, although often benign in nature, can be concerning. We describe three complex cases of supraventricular arrhythmia during pregnancy and review the currently available literature on the subject. In pregnancies complicated by arrhythmia, a plan for follow-up and both maternal and fetal monitoring during pregnancy, delivery and post partum should be made in a multidisciplinary team. Diagnostic modalities should be used as in non-pregnant women if there is an indication. All antiarrhythmic drugs cross the placenta, but when necessary, medical treatment should be used with consideration to the fetus and the mother’s altered pharmacodynamics and kinetics. Electrical cardioversion is safe during pregnancy, and electrophysiological study and catheter ablation can be performed in selected patients, preferably with zero-fluoroscopy technique. Sometimes, delivering the fetus (if viable) is the best therapeutic option. In this review, we provide a framework for the workup and clinical management of supraventricular arrhythmias in pregnant women, including cardiac, obstetric and neonatal perspectives.
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Affiliation(s)
- Karishma P Ramlakhan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Fetal Medicine, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole Schenkelaars
- Department of Obstetrics and Fetal Medicine, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dolf Segers
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martijn C Post
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jérôme Cornette
- Department of Obstetrics and Fetal Medicine, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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5
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Malagù M, Marchini F, Fiorio A, Sirugo P, Clò S, Mari E, Gamberini MR, Rapezzi C, Bertini M. Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management. Biology (Basel) 2022; 11:biology11010148. [PMID: 35053146 PMCID: PMC8772694 DOI: 10.3390/biology11010148] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 05/05/2023]
Abstract
Thalassemia is an inherited blood disorder with worldwide distribution. Transfusion and chelation therapy have radically improved the prognosis of β-thalassemic patients in the developed world, but this has led to the development of new chronic cardiac complications like atrial fibrillation (AF). Prevalence of AF in patients with β-thalassemia is higher than in the general population, ranging from 2 to 33%. Studies are lacking, and the little evidence available comes from a small number of observational studies. The pathophysiology is not well understood but, while iron overload seems to be the principal mechanism, AF could develop even in the absence of iron deposition. Furthermore, the clinical presentation is mainly paroxysmal, and patients are highly symptomatic. The underlying disease, the pathophysiology, and the clinical presentation require a different management of AF in β-thalassemia than in the general population. Rhythm control should be preferred over rate control, and the most important antiarrhythmic therapy is represented by chelation drugs. Thromboembolic risk is high, but the available risk scores are not validated in β-thalassemia, and the choice of anticoagulation therapy should be considered early. The main purpose of this review is to summarize the actual knowledge about AF in β-thalassemia, with a specific focus on the clinical management of these complex patients.
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Affiliation(s)
- Michele Malagù
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
- Correspondence: ; Tel.: +39-532-236269
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Alessio Fiorio
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Paolo Sirugo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Stefano Clò
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Elisa Mari
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (E.M.); (M.R.G.)
| | - Maria Rita Gamberini
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (E.M.); (M.R.G.)
| | - Claudio Rapezzi
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
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Sánchez-Quintana D, Anderson RH, Tretter JT, Cabrera JA, Sternick EB, Farré J. Anatomy of the conduction tissues 100 years on: what have we learned? Heart 2021; 108:1430-1437. [PMID: 34969873 DOI: 10.1136/heartjnl-2021-320304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
Abstract
Knowledge of the anatomy of the 'conduction tissues' of the heart is a 20th century phenomenon. Although controversies still continue on the topic, most could have been avoided had greater attention been paid to the original descriptions. All cardiomyocytes, of course, have the capacity to conduct the cardiac impulse. The tissues specifically described as 'conducting' first generate the cardiac impulse, and then deliver it in such a fashion that the ventricles contract in orderly fashion. The tissues cannot readily be distinguished by gross inspection. Robust definitions for their recognition had been provided by the end of the first decade of the 20th century. These definitions retain their currency. The sinus node lies as a cigar-shaped structure subepicardially within the terminal groove. There is evidence that it is associated with a paranodal area that may have functional significance. Suggestions of dual nodes, however, are without histological confirmation. The atrioventricular node is located within the triangle of Koch, with significant inferior extensions occupying the atrial vestibules and with septal connections. The conduction axis penetrates the insulating plane of the atrioventricular junctions to continue as the ventricular pathways. Remnants of a ring of cardiomyocytes observed during development are also to be found within the atrial vestibules, particularly a prominent retroaortic remnant, although that their role has still to be determined. Application of the initial criteria for nodes and tracts shows that there are no special 'conducting tissues' in the pulmonary venous sleeves that might underscore the abnormal rhythm of atrial fibrillation.
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Affiliation(s)
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - José Angel Cabrera
- Department of Cardiology, Hospital Universitario Quirón-Madrid, European University of Madrid, Madrid, Spain
| | | | - Jerónimo Farré
- Madrid Autonomous University, Fundación Jiménez Díaz Hospital, Madrid, Spain
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Ávila P, Calvo D, Tamargo M, Uribarri A, Datino T, Arenal A, Atienza F, Soto N, Fernández-Avilés F, González-Torrecilla E. Association of age with clinical features and ablation outcomes of paroxysmal supraventricular tachycardias. Heart 2021; 108:1107-1113. [PMID: 34635482 DOI: 10.1136/heartjnl-2021-319685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The role of age in clinical characteristics and catheter ablation outcomes of atrioventricular nodal re-entrant tachycardia (AVNRT) or orthodromic atrioventricular re-entrant tachycardia (AVRT) has been assessed in retrospective studies categorising age by arbitrary cut-offs, but contemporary analyses of age-related trends are lacking. We aimed to study the relationship of age with epidemiological, clinical features and catheter ablation outcomes of AVNRT and AVRT. METHODS We recruited 600 patients (median age 56 years, 60% female) with a confirmed diagnosis of AVNRT (n=455) or AVRT (n=145) by means of an electrophysiological study. They were interrogated for arrhythmia-related symptoms with a structured questionnaire and followed up to 1 year. We analysed age as a continuous variable using regression models and adjusting for relevant covariables. RESULTS Both typical and atypical forms of AVNRT upraised with age while AVRT decreased (p<0.001 by regression). Female sex predominance in AVNRT was not observed in older patients. Overall, these tachycardias became more symptomatic with ageing despite a longer tachycardia cycle length (p<0.001) and regardless of the presence of structural heart disease, with a higher proportion of dizziness, syncope, chest pain or dyspnoea (p<0.005 for all) and a lower presence of palpitations or neck pounding (p<0.001 for both). Age was not associated with catheter ablation acute success, periprocedural complications or 1-year recurrence rates (p>0.05 for all). CONCLUSIONS Age, evaluated as a continuous variable, had a significant association with the clinical profile of patients with AVNRT and AVRT. Nevertheless, catheter ablation outcomes and complications were not significantly related to patients' age.
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Affiliation(s)
- Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain .,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - David Calvo
- Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - María Tamargo
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Aitor Uribarri
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Tomas Datino
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Angel Arenal
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Nina Soto
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban González-Torrecilla
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 485] [Impact Index Per Article: 161.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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9
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Yeo C, Wang Y, Tan VH. Wide complex tachycardia captured on smartwatch. Heart 2021; 107:626-684. [PMID: 33766853 DOI: 10.1136/heartjnl-2020-318621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Colin Yeo
- Cardiology, Changi General Hospital, Singapore
| | - Yue Wang
- Cardiology, Changi General Hospital, Singapore
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10
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Kumar S, Mogalapalli A, Srinivasamurthy R, Hussain ST, Mar PL. Supraventricular tachycardia with the use of phentermine: case report and review of literature. Postgrad Med 2021; 133:454-457. [PMID: 33686912 DOI: 10.1080/00325481.2021.1901476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Case: A 34-year-old woman with no significant past medical history presented to the hospital with sudden onset of palpitations with associated dyspnea and chest discomfort. She denied any similar previous episodes. Initial electrocardiogram (EKG) was consistent with a short R-P interval supraventricular tachycardia (SVT). Her transthoracic echocardiogram (TTE) revealed no structural abnormalities, TSH levels were normal, and urine drug screen was negative for any recreational drugs. However, the patient had been taking phentermine for weight loss.Discussion: The exact mechanism is not clear; however, we postulate that the sympathomimetic effects of phentermine likely contribute to SVT induction through enhanced AV nodal conduction or increased atrial ectopy. Conclusions: The only medication she was taking at home was phentermine, and the palpitations did not recur after discontinuation of the drug during follow-up. It is important to collect a thorough medication history when patients present with AV nodal reentrant tachycardia (AVNRT) or other SVT.
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Affiliation(s)
- Sundeep Kumar
- Department of Cardiovascular Medicine, Saint Louis University, St Louis, MO, USA.,Department of Cardiovascular Medicine, Internal Medicine, Kissimmee, FL, USA
| | - Akhil Mogalapalli
- DepartmentofCardiovascular Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Sayed T Hussain
- DepartmentofCardiovascular Medicine, UCF, Ocoee, FL, USA.,DepartmentofCardiovascular Medicine, Osceola Regional Medical Center, Kissimmee, FL, USA
| | - Philip L Mar
- Department of Cardiovascular Medicine, Saint Louis University, St Louis, MO, USA
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Hale ZD, Greet BD, Burkland DA, Greenberg S, Razavi M, Rasekh A, Molina Razavi JE, Saeed M. Slow-pathway visualization by using voltage-time relationship: A novel technique for identification and fluoroless ablation of atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2020; 31:1430-1435. [PMID: 32270564 DOI: 10.1111/jce.14481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) is treatable by catheter ablation. Advances in mapping-system technology permit fluoroless workflow during ablations. As national practice trends toward fluoroless approaches, easily obtained, reproducible methods of slow-pathway identification, and ablation become increasingly important. We present a novel method of slow-pathway identification and initial ablation results from this method. METHODS AND RESULTS We examined AVNRT ablations performed at our institution over a 12-month period. In these cases, the site of the slow pathway was predicted by latest activation in the inferior triangle of Koch during sinus rhythm. Ablation was performed in this region. Proximity of the predicted site to the successful ablation location, complication rates, and patient outcomes were recorded. Junctional rhythm was seen in 40/41 ablations (98%) at the predicted site (mean, 1.3 lesions and median, 1 lesion per case). One lesion was defined as 5 mm of ablation. The initial ablation was successful in 39/41 cases (95%); in two cases, greater or equal to 2 echo beats were detected after the initial ablation, necessitating further lesion expansion. In 8/41 cases (20%), greater than one lesion was placed during initial ablation before attempted reinduction. Complications included one transient heart block and one transient PR prolongation. During follow-up (median, day 51), one patient had lower-extremity deep-vein thrombosis and pulmonary embolus, and one had a lower-extremity superficial venous thrombosis. There was one tachycardia recurrence, which prompted a redo ablation. CONCLUSIONS Mapping-system detection of late-activation, low-amplitude voltage during sinus rhythm provides an objective, and fluoroless means of identifying the slow pathway in typical AVNRT.
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Affiliation(s)
- Zachary D Hale
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Brian D Greet
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Cardiology, University of Texas, Houston, Texas
| | - David A Burkland
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Texas Cardiac Arrhythmia, Houston, Texas
| | - Scott Greenberg
- Department of Cardiology, Baylor College of Medicine, The Woodlands, Texas
| | - Mehdi Razavi
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Abdi Rasekh
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Joanna E Molina Razavi
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Mohammad Saeed
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
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12
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Fernando H, Adams N, Mitra B. Review article: The utility of troponin and other investigations in patients presenting to the emergency department with supraventricular tachycardia. Emerg Med Australas 2018; 31:35-42. [PMID: 29752780 DOI: 10.1111/1742-6723.12971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
Patients with supraventricular tachycardia commonly present to the ED. There is a lack of consensus regarding assessment of these patients. Our aim was to determine the utility of troponin and four other investigations (full blood examination, electrolyte levels, thyroid function tests and chest X-rays) commonly requested for these patients. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (January 1992-March 2017) were searched for randomised controlled trials and observational studies (of sample size greater than 10). Our search strategy yielded no randomised controlled trials and seven observational studies with significant statistical heterogeneity among selected studies (I2 87.3%, P < 0.001). Included studies investigated a total of 1155 patients. All studies reported on the utility of troponin testing in this patient population. The pooled proportion of patients investigated with troponin was 0.66 (95% confidence interval 0.44-0.88). The pooled proportion of positive troponin tests was 0.32 (95% confidence interval 0.23-0.41). Only one study reported on the utility of the remaining four investigations with abnormal results as follows: thyroid stimulating hormone 14%, haemoglobin 6%, white cell count 19% and chest X-ray 22%. Investigations are commonly requested for patients presenting with supraventricular tachycardia. Troponin testing is commonly performed with a high proportion of positive findings although these results did not appear to be associated with major adverse cardiac events. Heterogeneity among studies and low levels of evidence precluded conclusions on full blood examinations, electrolyte levels, thyroid testing and utility of chest X-rays in this patient population.
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Affiliation(s)
- Harith Fernando
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Adams
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Althunayyan SM, Khan AA, Samarkandi OA. Emergency department visits for paroxysmal supraventricular tachycardia in Saudi Arabia. Saudi J Anaesth 2018; 12:521-528. [PMID: 30429731 PMCID: PMC6180673 DOI: 10.4103/sja.sja_35_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The present study aimed to compare the demographic, medical history, clinical features, and treatment management of paroxysmal supraventricular tachycardia (PSVT) in the emergency department of a teaching hospital in Riyadh, Saudi Arabia. A secondary purpose was to evaluate Adenosine response among numerous variables that might be used as predictors of the conversion. METHODS All PSVT cases presented to the Department of Emergency Medicine at King Khalid University Hospital, during the period from January 1, 2016, until December 31, 2016, were included in the study. Patients were assigned into two groups: adenosine sensitive (AS-group) and adenosine resistant (AR-group) according to adenosine conversion response. RESULTS A total of 38 patients were admitted during the study period. Fisher's exact test results showed that there were no significant (P > 0.05) differences among the AS-group and AR-group in the demographics, past medical history and clinical features, and post-ablation condition, except for the previous usage of the other anti-arrhythmic drugs to convert the last PSVT in the AR-group. The first bolus of adenosine had higher sensitivity and specificity, compared to the second bolus. Further, the second bolus of adenosine was not specific for short-term treatment of PSVT. CONCLUSIONS Differences in adenosine sensitivity among PSVT patients were independent of demographic, past medical history, and clinical features of PSVT patients. Thus, the difference in adenosine response among groups may be attributed to the heterozygosity in conducting pathways. The first bolus of adenosine had high sensitivity and specificity, compared to the second bolus, and their optimal levels were predictable by HR deceleration.
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Affiliation(s)
- Saqer M. Althunayyan
- Department of Trauma and Accident, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Anas A. Khan
- Department of Emergency Medicine, College of Medicine and University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Osama A. Samarkandi
- Department Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Dr. Osama A. Samarkandi, Department of Basic Science, Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia. E-mail:
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Abstract
Supraventricular tachycardia is the most common significant arrhythmia in children. If prolonged, it may cause heart failure and progress to cardiogenic shock warranting prompt treatment. The recommended interventions following vagal manoeuvres are intravenous adenosine and in the unstable patient electrical cardioversion. We present an infant with an unstable supraventricular tachycardia that was resistant to electrical cardioversion and recommended doses of adenosine. He reverted to sinus rhythm with a higher dose of adenosine, suggesting that such doses may be required in refractory supraventricular tachycardia.
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Abstract
A 64-year-old woman was referred to our hospital with palpitation and exertional dyspnea. An electrocardiogram showed sinus rhythm, but supraventricular tachycardia was recorded on Holter monitoring. Multidetector computed tomography revealed a small left ventricular outpouching in the apex, with a narrow connection to the ventricle and normal coronary arteries. Surgery for the left ventricular pouch was performed successfully. Histological examination demonstrated that the left ventricular diverticulum consisted of three layers of the ventricular wall, with the myocardial layer mostly replaced by fibrous tissue. The patient has been well after surgery.
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Affiliation(s)
- Nobuchika Ozaki
- Department of Cardiovascular Surgery, Kobe Rosai Hospital, Hyogo, Japan
| | - Masanobu Sato
- Department of Cardiovascular Surgery, Kobe Rosai Hospital, Hyogo, Japan
| | - Kyozo Inoue
- Department of Cardiovascular Surgery, Kobe Rosai Hospital, Hyogo, Japan
| | - Noboru Wakita
- Department of Cardiovascular Surgery, Kobe Rosai Hospital, Hyogo, Japan
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2015; 13:e92-135. [PMID: 26409097 DOI: 10.1016/j.hrthm.2015.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 10/23/2022]
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2015; 67:e27-e115. [PMID: 26409259 DOI: 10.1016/j.jacc.2015.08.856] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Affiliation(s)
- Samuel J Asirvatham
- From the Division of Cardiovascular Diseases, Department of Medicine (S.J.A.) and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.).
| | - William G Stevenson
- From the Division of Cardiovascular Diseases, Department of Medicine (S.J.A.) and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.)
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Çetin C, Akçabay Ç, Büyükkurt S, Özbarlas N. Successful medical treatment of fetal supraventricular tachycardia that cause hydrops fetalis. Turk J Obstet Gynecol 2014; 11:193-195. [PMID: 28913017 PMCID: PMC5558334 DOI: 10.4274/tjod.56578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 12/30/2013] [Indexed: 12/01/2022] Open
Abstract
Supraventricular tachycardia (SVT) is the most frequent fetal tachyarrhythmia. Diagnosis is established with M-mode ultrasound and/or Doppler investigation. Untreated cases may develop fetal heart failure and hydrops. Even these cases should not be left untreated - maternal administration of anti-arrhythmic drugs should be undertaken. In this manuscript, we describe a successful treatment with maternal administration of sotalol and digoxin in a fetus that developed hydrops because of SVT.
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Affiliation(s)
- Cihan Çetin
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Çiğdem Akçabay
- Elazığ Research and Education Hospital, Clinic of Obstetrics and Gynecology, Elazığ, Turkey
| | - Selim Büyükkurt
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Nazan Özbarlas
- Çukurova University Faculty of Medicine, Department of Pediatric Cardiology, Adana, Turkey
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Bagherzadeh A, Rezaee ME, Farahani MM. Prediction of Primary Slow-Pathway Ablation Success Rate according to the Characteristics of Junctional Rhythm Developed during the Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia. J Tehran Heart Cent 2011; 6:14-8. [PMID: 23074599 PMCID: PMC3466865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 11/20/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nowadays, developed junctional rhythm (JR) that occurs during slow-pathway radiofrequency (RF) catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) has been focused upon as a highly sensitive surrogate end point for successful radiofrequency ablation. This study was conducted to assess the relationship between the presence and pattern of developed JR during the RF ablation of AVNRT and a successful outcome. METHODS Seventy-five patients aged between 14 and 88 who underwent slow-pathway RF ablation due to symptomatic AVNRT were enrolled into the study and received a total of 162 RF energy applications. Combined anatomic and electrogram mapping approach was used for slow-pathway RF ablation. The ablation procedure consisted of 60-second, 60 °C temperature-controlled energy delivery. After each ablation pulse, successful ablation was assessed according to the loss of AVNRT inducibility via isoproterenol infusion. Four different patterns were considered for the developed JR, namely sparse, intermittent, continuous, and transient block. Success ablation rate was assessed with respect to the position, pattern, and number of junctional beats. RESULTS Successful RF ablation with a loss of AVNRT inducibility was achieved in 43 (57.3%) patients using 119 RF energy applications (73.5%). JR developed in 133 of the 162 (82.1%) applications with a given sensitivity of 90.8% and low specificity of 41.9% as an end point of successful RF ablation, with a negative predictive value of 62.1%. The mean number of the developed junctional beats was significantly higher in the successful ablations (p value < 0.001), and the ROC analysis revealed that the best cut-off point of the cumulative junctional beats for identifying accurate AVNRT ablation therapy is 14 beats with 90.76 % sensitivity and 90.70% specificity. There were no significant differences in terms of successful ablation rates according to the four different patterns of JR and its positions (p value=0.338, p value=0.105, respectively) in the univariate analyses. CONCLUSION JR is a sensitive but non-specific predictor of the successful RF ablation of AVNRT. Nevertheless, according to the results, its specificity could increase with the presence of more than 14 cumulative junctional beats. Although the development of JR during slow-pathway RF ablation seems not to be reliable as a success end point, its absences could be a marker of requiring more energy application to ablate the slow pathway.
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Affiliation(s)
- Ataallah Bagherzadeh
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Ataallah Bagherzadeh, Assistant Professor of Interventional Cardiac Electrophysiology, Tehran University of Medical Sciences, Department of Interventional Cardiac Electrophysiology, Imam Khomeini Hospital. 1419733141. Tehran, Iran. Tel: +98 21 66930041. Fax: +98 21 66930330 E-mail:
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Veenhuyzen GD, Quinn FR. Principles of entrainment: diagnostic utility for supraventricular tachycardia. Indian Pacing Electrophysiol J 2008; 8:51-65. [PMID: 18270602 PMCID: PMC2231607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Entrainment is an important pacing maneuver that can be used to identify reentry as a tachycardia mechanism and define components of the circuit. This review examines how principles of entrainment can be used to arrive at a firm supraventricular tachycardia diagnosis using a simple algorithm and builds a foundation for the application of entrainment to more complex or unknown circuits.
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Venugopalan P, Shakeel A, Al Amry A, Jaya S. Supraventricular tachycardia in children: a report of three cases, diagnosis and current management. J Sci Res Med Sci 2000; 2:59-64. [PMID: 24019708 PMCID: PMC3174697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The article presents three Omani children with supraventricular tachycardia and discusses the diagnosis and management. Clinical features along with ECG help diagnosis of this common paediatric arrhythmia. Acute management has been facilitated with the introduction of adenosine. However, longterm management continues to be a topic for debate.
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Affiliation(s)
- P Venugopalan
- Department of Child Health, Sultan Qaboos University Hospital, P.O.Box: 38, Postal Code: 123, Muscat, Sultanate of Oman
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