RESUMEN
Catecholaminergic polymorphic ventricular tachycardia (CPVT), a rare inheritable fatal arrhythmogenic disorder, is difficult to diagnose and is a challenge to manage. A 21-years-old man presented with recurrent exertional syncope and complex multifocal ventricular ectopy. CPVT was diagnosed based on the clinical criteria, despite the absence of some classical findings. The patient underwent cardiac sympathetic denervation (CSD) after lifestyle modification and pharmacological management were ineffective. CSD proved to be effective. The patient did not have any exertional symptoms or recurrence of syncope at follow-up period of 1 year. The present case report adds to the growing evidence in favour of CSD for CPVT.
Asunto(s)
Taquicardia Ventricular , Adulto , Humanos , Masculino , Simpatectomía , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/cirugía , Adulto JovenAsunto(s)
Fibrilación Atrial , Seno Coronario , Divertículo , Síndrome de Wolff-Parkinson-White , Fibrilación Atrial/complicaciones , Seno Coronario/diagnóstico por imagen , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Electrocardiografía , Humanos , Vena Cava Inferior/diagnóstico por imagen , Síndrome de Wolff-Parkinson-White/complicacionesRESUMEN
AIM: A national atrial fibrillation (AF) registry was conducted under the aegis of the Indian Heart Rhythm Society (IHRS), to capture epidemiological data-type of AF, clinical presentation and comorbidities, current treatment practices, and 1-year follow-up outcomes. METHODS: A total of 1537 patients were enrolled from 24 sites in India in the IHRS-AF registry from July 2011 to August 2012. Their baseline characteristics and follow-up data were recorded in case report forms and subsequently analyzed. RESULTS: The average age of Indian AF patients was 54.7 years. There was a marginal female preponderance - 51.5% females and 48.5% males. At baseline, 20.4% had paroxysmal AF; 33% had persistent AF; 35.1% had permanent AF and 11% had first AF episode. At one-year follow-up, 45.6% patients had permanent AF. Rheumatic valvular heart disease (RHD) was present in 47.6% of patients. Hypertension, heart failure, coronary artery disease, and diabetes were seen in 31.4%, 18.7%, 16.2%, and 16.1%, respectively. Rate control was the strategy used in 75.2% patients, digoxin and beta-blockers being the most frequently prescribed rate-control drugs. Oral anticoagulation (OAC) drugs were used in 70% of patients. The annual mortality was 6.5%, hospitalization 8%, and incidence of stroke 1%. CONCLUSIONS: In India, AF patients are younger and RHD is still the most frequent etiology. Almost two-third of the patients have persistent/permanent AF. At one-year follow-up, there is a significant mortality and morbidity in AF patients in India.
Asunto(s)
Antiarrítmicos/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Cardiología , Manejo de la Enfermedad , Frecuencia Cardíaca/fisiología , Sistema de Registros , Sociedades Médicas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/epidemiología , Fibrilación Atrial/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Pronóstico , Estudios Prospectivos , Tasa de Supervivencia/tendencias , Adulto JovenRESUMEN
The range of implantable cardiac pacing devices has expanded, with the advances in available technology. Indications for cardiac pacing devices, that is pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy devices (CRTs), have expanded for the treatment, diagnosis and monitoring of bradycardia, tachycardia and heart failure. While the need for pacemakers is increasing, not all patients who require pacemakers are receiving them, especially in the Asia-Pacific region. There is a need to be more critical in advising the use of more expensive devices like ICDs and CRT/CRT-D devices, since most patients in the Asia-Pacific region pay out of pocket for these therapies. The AHA-ACC guidelines need not be blindly followed, since they are too wide-sweeping and are often based on the intention-to-treat basis of trials rather than on the parameters of the patients actually enrolled.
RESUMEN
Idiopathic ventricular tachycardia is a defined set of tachycardias when structural or pathological cause has been ruled out for the same. This paper tries to define and classify these arrhythmias to organize a logical therapeutic approach to deal with them. 60-80% of the idiopathic tachycardias originate from the right ventricular outflow tract (RVOT) and in 10% from the left ventricular outflow tract (LVOT). Outflow tract tachycardias have either LBBB or RBBB morphology with early R wave transition in chest leads. Adenosine, beta blockers and calcium channel blockers is the common medical treatment. Radiofrequency ablation is however the treatment of choice. Verapamil sensitive left ventricular tachycardia (ILVT) and propranolol sensitive left ventricular tachycardia (IPVT) are the other two forms recognized. RF ablation seems ideal for long-term management of ILVT and implantable cardioverter defibrillator (ICD) for IPVT. Inherited channelopathies include catecholaminergic polymorphic ventricular tachycardia (CPVT), Brugada syndrome and long QT syndrome where there is an inherited disorder in the ion-exchange channels of the cell-membrane leading to tachycardia. Prognosis in these is variable; CPVT, in particular, has a malignant course when untreated. RF ablation and placement of an ICD are important in the overall management of specific arrhythmia.
Asunto(s)
Taquicardia Ventricular , Adenosina/uso terapéutico , Antagonistas Adrenérgicos beta/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Ablación por Catéter , Desfibriladores Implantables , Electrocardiografía , Humanos , Pronóstico , Taquicardia Ventricular/clasificación , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Taquicardia Ventricular/terapiaRESUMEN
An 82 year old man presented with multiple syncopal episodes. Since his ECG showed LBBB (left bundle branch block) with first degree AV block, he was advised permanent pacemaker implantation. However, a wide QRS tachycardia on the Holter raised the possibility of tachycardia-mediated syncope. EP (electrophysiological) studies revealed easily and repeatedly inducible short lasting slow-fast AVNRT (atrioventricular nodal reentry tachycardia) with severe hypotension. After RF ablation of the slow pathway, he is asymptomatic at six month follow-up.
Asunto(s)
Síncope/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Anciano , Anciano de 80 o más Años , Ablación por Catéter , Técnicas Electrofisiológicas Cardíacas , Humanos , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/terapiaAsunto(s)
Hipotensión Ortostática/diagnóstico , Hipotensión Ortostática/terapia , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/terapia , Sistema Nervioso Autónomo/fisiopatología , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Diagnóstico Diferencial , Humanos , Hipotensión Ortostática/complicaciones , Síncope Vasovagal/complicaciones , Taquicardia/diagnóstico , Taquicardia/etiología , Pruebas de Mesa InclinadaAsunto(s)
Pulso Arterial , Presión Sanguínea , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/fisiopatología , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/fisiopatología , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/fisiopatología , Sístole/fisiologíaRESUMEN
INTRODUCTION: Radiofrequency ablation (RFA) is currently being advocated as the first line of therapy for symptomatic and drug refractory arrhythmias mediated by accessory pathways (APs). However, a large database on RFA for APs from India is still lacking. METHODS: Four hundred thirty-four patients (298 males, (69%)), with APs who underwent RF ablation between January, 1998 and May, 2001 were included. The success and variants were evaluated retrospectively from the data. RESULTS: The mean age was 36 +/- 11 years. There were 314 (73%) patients with WPW syndrome while the other 120 (27%) had concealed APs. Documented tachycardia was noted in 406 (91%) patients. Forty-six (11%) patients had associated structural heart disease (Ebstein's anomaly in 18). The procedure was successful in 414 (97%) of 425 patients in whom it was attempted. Of those unsuccessful, five had epicardial APs, four had multiple APs and two had immediate recurrence of APs. RFA was not attempted in nine parahissian pathways. Additional mechanisms were seen in 48 (11%) patients with WPW syndrome (14 (4.4%) AV nodal reentrant tachycardias, 16 (5%) additional concealed APs and 18 (5.7%) multiple APs). Coronary sinus diverticulum were detected in 23 (7.3%) patients, and Mahaim-like APs were diagnosed in 24 (6\8%) patients. The procedural and fluoroscopy time was 96 +/- 41 and 19 +/- 13 minutes, respectively. There were no deaths; three patients developed pericardial tamponade, which was promptly treated by pericardiocentesis. CONCLUSION: Radiofrequency ablation is a safe and effective treatment for AP mediated tachycardia, especially for younger patients and children in whom life-long drug therapy may not be best option.
Asunto(s)
Arritmias Cardíacas/terapia , Ablación por Catéter , Vías Clínicas , Adulto , Arritmias Cardíacas/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Enfermedad de la Arteria Coronaria/enzimología , Homocisteína/metabolismo , Biomarcadores , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Homocisteína/análisis , Humanos , India/epidemiología , Masculino , Pronóstico , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To evaluate the efficacy of single dose intravenous adenosine in differentiating atrioventricular nodal re-entrant tachycardia (AVNRT) from concealed pathway mediated atrioventricular re-entrant tachycardia (AVRT) using surface ECG at the bedside. METHOD: 12 mg of adenosine was administered to 97 consecutive patients who had documented narrow QRS tachycardia without manifest pre-excitation. The test was labelled positive for AVNRT if surface ECG recordings showed signs of dual atrioventricular (AV) node physiology-namely, PR jump or AV nodal echo. The diagnostic value of this test was evaluated by electrophysiological study as the yardstick. RESULTS: The adenosine test was positive for AVNRT in 48 patients (adenosine induced PR jump in 48, AV nodal echo in 3) and negative in 49 patients. On electrophysiological study, 62 patients had AVNRT and 35 had concealed pathway mediated AVRT. Thus, the test had a sensitivity of 74% and specificity of 94%. The positive predictive value was 96% and the negative predictive value was 67%. CONCLUSION: Single dose (12 mg) intravenous adenosine administered during sinus rhythm can identify dual AV node physiology on surface ECG recording at the bedside. A positive adenosine test identified by a PR jump can differentiate AVNRT from AVRT with a high specificity and positive predictive accuracy.
Asunto(s)
Adenosina , Antiarrítmicos , Taquicardia/diagnóstico , Adolescente , Adulto , Niño , Electrocardiografía/efectos de los fármacos , Electrofisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Taquicardia/fisiopatologíaAsunto(s)
Estimulación Cardíaca Artificial , Síncope Vasovagal/prevención & control , Bradicardia/complicaciones , Bradicardia/terapia , Estimulación Cardíaca Artificial/tendencias , Técnicas Electrofisiológicas Cardíacas/tendencias , Predicción , Humanos , Contracción Miocárdica/fisiología , Distribución Aleatoria , Síncope Vasovagal/complicacionesAsunto(s)
Amiodarona/análogos & derivados , Amiodarona/uso terapéutico , Antiarrítmicos/uso terapéutico , Arritmias Cardíacas/tratamiento farmacológico , Imidazoles/uso terapéutico , Imidazolidinas , Fenetilaminas/uso terapéutico , Piperazinas/uso terapéutico , Sulfonamidas/uso terapéutico , Amiodarona/farmacología , Animales , Antiarrítmicos/farmacología , Arritmias Cardíacas/terapia , Fibrilación Atrial/tratamiento farmacológico , Aleteo Atrial/tratamiento farmacológico , Compuestos Bicíclicos Heterocíclicos con Puentes/uso terapéutico , Ciclopropanos/uso terapéutico , Dronedarona , Aprobación de Drogas , Humanos , Hidantoínas , Imidazoles/farmacología , Fenetilaminas/farmacología , Piperazinas/farmacología , Sulfonamidas/farmacologíaRESUMEN
A 21-year-old male presented with episodes of paroxysmal tachycardia mediated via a concealed posteroseptal accessory pathway. He was also found to have a diverticulum of the coronary sinus. However, successful radiofrequency ablation was achieved only endocardially under the mitral annulus and not within the diverticulum.
Asunto(s)
Ablación por Catéter , Divertículo/terapia , Sistema de Conducción Cardíaco/anomalías , Cardiopatías/terapia , Adulto , Angiografía Coronaria , Humanos , MasculinoRESUMEN
The use of adenosine has been suggested as a diagnostic tool in the evaluation of wide ORS complex tachycardia. However, adenosine shortens the antegrade refractoriness of accessory atrioventricular connections and may cause acceleration of the ventricular rate during atrial fibrillation. We observed ventricular fibrillation in 2 patients who presented to the emergency department with pre-excited atrial fibrillation and were given 12 mg of adenosine.