RESUMEN
BACKGROUND: Coumel tachycardia is an infrequent form of supraventricular tachycardia (SVT) that usually occurs in infants and children. It is a tachycardia mediated by an accessory pathway with retrograde slow conduction that explains the classic ECG pattern with long RP' interval and negative P waves in leads II, III, and aVF. In this study, we describe the clinical course and management of Coumel tachycardia in children. CASE REPORT: We conducted a retrospective review of five consecutive pediatric patients, mean age 11 ± 3 years (range 6 to 14). The first episode of SVT was at a mean age of 10.4 ± 4.8 years (range 2 to 14) with a mean evolution of 7.4 ± 9.4 months (range 1 to 24). Pharmacological therapy was unsuccessful despite the combination of antiarrhythmic drugs. The tachycardia was incessant with a density > 85% by 24-hour Holter monitoring; one patient developed tachycardia-induced cardiomyopathy. All children underwent successful radiofrequency catheter ablation, mean 5 ± 3 applications (range 1 to 8) with a single session and with no complications. After a mean follow-up of 24 ± 16 months, all patients were asymptomatic and recurrence-free without antiarrhythmic treatment. CONCLUSIONS: Coumel tachycardia is clinically persistent and usually refractory to antiarrhythmic treatment with substantial risk of tachycardia-mediated cardiomyopathy. Catheter ablation is effective and safe in children; thus, it should be indicated promptly and based on individual selection.
INTRODUCCIÓN: La taquicardia de Coumel es una forma poco frecuente de taquicardia supraventricular que suele presentarse en lactantes. Es una taquicardia mediada por una vía accesoria de conducción lenta retrógrada que explica el patrón ECG clásico con intervalo RP' largo y ondas P negativas en las derivaciones II, III y aVF. En este trabajo se describe el curso clínico y el manejo de la taquicardia de Coumel en niños. CASO CLÍNICO: Se llevó a cabo una revisión retrospectiva de cinco pacientes pediátricos consecutivos, con una media de edad de 11 ± 3 años (intervalos 6 a 14). El primer episodio de taquicardia 10.4 ± 4.8 años con evolución de 7.4 ± 9.4 meses. El tratamiento farmacológico fue ineficaz a pesar de la combinación de antiarrítmicos. La taquicardia era incesante con una densidad > 85% por Holter-24h; un paciente desarrolló miocardiopatía inducida por taquicardia. Todos los niños fueron sometidos a ablación con catéter y radiofrecuencia con éxito, y un promedio de 5 ± 3 aplicaciones en una sola sesión y sin complicaciones. Después de un seguimiento de 24 ± 16 meses, todos los pacientes fueron asintomáticos y libres de recurrencia sin tratamiento antiarrítmico. CONCLUSIONES: La taquicardia de Coumel es clínicamente persistente y generalmente refractaria al tratamiento antiarrítmico con un riesgo sustancial de miocardiopatía mediada por taquicardia. La ablación con catéter es eficaz y segura en niños, por lo que debe indicarse de forma temprana y en lactantes de una selección individual.
Asunto(s)
Ablación por Catéter , Taquicardia Supraventricular , Lactante , Niño , Humanos , Adolescente , Electrocardiografía , Taquicardia/cirugía , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
OBJECTIVE: The objective of this study was to evaluate the agreement of smartwatch-derived single-lead electrocardiogram (ECG) recordings with 12-lead ECGs for diagnosing electrocardiographic abnormalities. STUDY DESIGN: A 12-lead ECG and an ECG using Apple Watch were obtained in 110 children (aged 1 week to 16 years) with normal (n = 75) or abnormal (n = 35) 12-lead ECGs (atrioventricular block [7], supraventricular tachycardia [SVT] {5}, bundle branch block [12], ventricular preexcitation [6], long QT [5]). In children aged <6 years, the ECG recording was performed with the active participation of an adult who applied the neonate or child's finger to the crown of the watch. In older children, tracings were obtained after brief teaching without adult guidance. All 12-lead ECGs were independently evaluated by 2 blinded cardiologists. Apple Watch ECGs were independently evaluated by another blinded cardiologist. RESULTS: In 109 children (99.1%), the smartwatch tracing was of sufficient quality for evaluation. Smartwatch tracings were 84% sensitive and 100% specific for the detection of an abnormal ECG. All 75 normal tracings were correctly identified. Of the 35 children with abnormalities on 12-lead ECGs, 5 (14%) were missed, most often because of baseline wander and artifacts. Rhythm disorders (atrioventricular block or SVT) and bundle branch blocks were correctly detected in most cases (11 of 12 and 11 of 12, respectively); preexcitation and long QT was detected in 4 of 6 and 4 of 5, respectively. CONCLUSION: Smartwatch ECGs recorded with parental assistance in children aged up to 6 years and independently in older children have the potential to detect clinically relevant conditions.
Asunto(s)
Bloqueo Atrioventricular , Taquicardia Supraventricular , Adulto , Recién Nacido , Humanos , Niño , Estudios de Factibilidad , Arritmias Cardíacas/diagnóstico , Electrocardiografía , Taquicardia Supraventricular/diagnósticoRESUMEN
La taquicardia supraventricular (TSV) es la principal taquiarritmia en el recién nacido (RN) que requiere una resolución urgente. Por su parte, la enterocolitis necrosante (ECN) es la emergencia gastrointestinal más común que afecta principalmente a RN prematuros. Aunque estas se reconocen como patologías distintas, la bibliografía sugiere que los episodios de TSV pueden predisponer a los pacientes a la ECN a través de alteraciones en el flujo sanguíneo mesentérico y una disminución de la perfusión tisular. Se presenta aquí el caso clínico de un neonato prematuro que desarrolló un cuadro de ECN luego de un evento aislado de TSV con bajo gasto cardíaco
Supraventricular tachycardia (SVT) is the main tachyarrhythmia in the newborn (NB) that requires urgent resolution. Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency that mainly affects premature infants. Although these conditions are recognized as distinct pathologies, literature reports suggest that episodes of SVT may predispose patients to NEC secondary to disturbances in mesenteric blood flow and a decrease in tissue perfusion. We present here the clinical case of a premature neonate who developed NEC after an isolated SVT event with low cardiac output
Asunto(s)
Humanos , Masculino , Recién Nacido , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiología , Enterocolitis Necrotizante/complicaciones , Enterocolitis Necrotizante/diagnóstico , Enfermedades del Recién Nacido , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/etiología , Enfermedades FetalesRESUMEN
Supraventricular tachycardia (SVT) is the main tachyarrhythmia in the newborn (NB) that requires urgent resolution. Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency that mainly affects premature infants. Although these conditions are recognized as distinct pathologies, literature reports suggest that episodes of SVT may predispose patients to NEC secondary to disturbances in mesenteric blood flow and a decrease in tissue perfusion. We present here the clinical case of a premature neonate who developed NEC after an isolated SVT event with low cardiac output.
La taquicardia supraventricular (TSV) es la principal taquiarritmia en el recién nacido (RN) que requiere una resolución urgente. Por su parte, la enterocolitis necrosante (ECN) es la emergencia gastrointestinal más común que afecta principalmente a RN prematuros. Aunque estas se reconocen como patologías distintas, la bibliografía sugiere que los episodios de TSV pueden predisponer a los pacientes a la ECN a través de alteraciones en el flujo sanguíneo mesentérico y una disminución de la perfusión tisular. Se presenta aquí el caso clínico de un neonato prematuro que desarrolló un cuadro de ECN luego de un evento aislado de TSV con bajo gasto cardíaco.
Asunto(s)
Enterocolitis Necrotizante , Enfermedades Fetales , Enfermedades del Recién Nacido , Enfermedades del Prematuro , Taquicardia Supraventricular , Enterocolitis Necrotizante/complicaciones , Enterocolitis Necrotizante/diagnóstico , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/etiología , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologíaRESUMEN
Scombroid poisoning is caused by the consumption of certain types of fish (from the Scombridae family), especially tuna. Due to inadequate refrigeration procedures, these fish have high levels of histamine which generate symptoms similar to those of a food allergy in their consumers, so it is frequently underdiagnosed. It is self-limited in a few hours and the symptoms are usually not serious, except for specific cases reported in the literature of hypotension, bronchospasm, respiratory distress, tachyarrhythmias, and even acute myocardial infarction. We report here the case of a woman admitted to the emergency department of a third level hospital in Medellín a few minutes after eating tuna with the typical symptoms of intoxication, as well as tachyarrhythmias, a serious and atypical manifestation.
La intoxicación escombroide es ocasionada por el consumo de ciertos tipos de pescado (de la familia Scombridae), comúnmente el atún, los cuales acumulan grandes concentraciones de histamina cuando los procedimientos de refrigeración son inadecuados, ocasionando en quienes los consumen síntomas muy similares a los de una alergia alimentaria, por lo que es frecuente que no se diagnostique correctamente. Generalmente, los síntomas desaparecen en pocas horas y no suelen ser graves, excepto algunos casos descritos en la literatura especializada, de hipotensión, broncoespasmo, dificultad respiratoria, taquicardia supraventricular e, incluso, infarto agudo de miocardio. Este fue, precisamente, el caso de una mujer que ingresó al servicio de urgencias de un hospital de tercer nivel de Medellín a los pocos minutos de haber ingerido atún con una sintomatología típica de la intoxicación, pero con taquicardia supraventricular, una de sus manifestaciones graves y atípicas.
Asunto(s)
Enfermedades Transmitidas por los Alimentos/complicaciones , Toxinas Marinas/envenenamiento , Taquicardia Supraventricular/etiología , Atún , Adulto , Animales , Electrocardiografía , Urgencias Médicas , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Taquicardia Supraventricular/diagnóstico , Factores de TiempoRESUMEN
Resumen: Las taquicardias paroxísticas supraventriculares son arritmias frecuentes y producen importante morbilidad. El estudio electrofisiológico permite hacer el diagnóstico su mecanismo para luego realizar la ablación. El diagnóstico no siempre es sencillo y se debe recurrir a múltiples observaciones y maniobras para alcanzarlo. En la siguiente revisión se discuten los principales criterios usados para el diagnóstico del mecanismo de estas taquicardias durante un estudio electrofisiológico.
Abstract: Paroxysmal supraventricular tachycardias are frequently observed arrhythmias associated to significant morbidity. Electrophysiological study allows the diagnosis of the mechanisms underlying the arrhythmia leading toblation. The diagnosis is not always easy and multiple observations and maneuvers are required to uncover it. In the following review, the main criteria used to diagnose the mechanisms of these tachycardias during an electrophysiological study are discussed.
Asunto(s)
Humanos , Taquicardia Paroxística/diagnóstico , Taquicardia Supraventricular/diagnóstico , Arritmias Cardíacas , Taquicardia Paroxística/fisiopatología , Taquicardia Supraventricular/fisiopatología , Diagnóstico Diferencial , Electrofisiología CardíacaRESUMEN
El diagnóstico electrocardiográfico correcto de la causa de una taquicardia de complejo QRS ancho (TCA) es fundamental, ya que tanto el manejo, como el pronóstico del paciente, es diferente según su etiología, y define el estudio que debemos realizar. Numerosos criterios y algoritmos han sido descritos para diferenciar el origen de estas taquicardias. Sin embargo, muchos de estos son complejos y difíciles de aplicar para el médico menos experimentado. Esto es particularmente importante en los servicios de emergencia, donde se necesita una definición rápida que permita un manejo agudo apropiado. En la presente revisión analizamos los diferentes mecanismos de las TCA y los principales criterios diagnósticos en el ECG, reforzando, especialmente, aquellos de aplicación rápida y de alto rendimiento diagnóstico.
The correct electrocardiographic diagnosis of the cause of a wide QRS complex tachycardia (WCT) is essential since both management and prognosis of the patient. The correct electrocardiographic diagnosis of the cause of a wide QRS complex tachycardia (WCT) is essential since both management and prognosis is different according to its etiology and defines the study that we should perform. Numerous criteria and algorithms have been described to differentiate the origin of these tachycardias. However, many of these are complex and difficult to apply to the less experienced doctor. This is particularly important in emergency rooms, where a rapid definition is needed to allow proper therapy. In this review we analyze the different mechanisms of WCT and the main EKG diagnostic criteria, emphasizing those which can be applied rapidly and have high diagnostic value.
Asunto(s)
Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia/diagnóstico , Taquicardia/fisiopatología , Algoritmos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatología , Síndromes de Preexcitación , Bloqueo de Rama , Taquicardia Ventricular/fisiopatología , Diagnóstico Diferencial , ElectrocardiografíaRESUMEN
BACKGROUND: Ebstein anomaly (EA) is a heterogeneous congenital heart defect (CHD), frequently accompanied by diverse cardiac and extracardiac comorbidities, resulting in a wide range of clinical outcomes. HYPOTHESIS: Phenotypic characterization of EA patients has the potential to identify variables that influence prognosis and subgroups with distinct contributing factors. METHODS: A comprehensive cross-sectional phenotypic characterization of 147 EA patients from one of the main referral institutions for CHD in Colombia was carried out. The most prevalent comorbidities and distinct subgroups within the patient cohort were identified through cluster analysis. RESULTS: The most prevalent cardiac comorbidities identified were atrial septal defect (61%), Wolff-Parkinson-White syndrome (WPW; 27%), and right ventricular outflow tract obstruction (25%). Cluster analysis showed that patients can be classified into 2 distinct subgroups with defined phenotypes that determine disease severity and survival. Patients in cluster 1 represented a particularly homogeneous subgroup with a milder spectrum of disease, including only patients with WPW and/or supraventricular tachycardia (SVT). Cluster 2 included patients with more diverse cardiovascular comorbidities. CONCLUSIONS: This study represents one of the largest phenotypic characterizations of EA patients reported. The data show that EA is a heterogeneous disease, very frequently associated with cardiovascular and noncardiovascular comorbidities. Patients with WPW and SVT represent a homogeneous subgroup that presents with a less severe spectrum of disease and better survival when adequately managed. This should be considered when searching for genetic causes of EA and in the clinical setting.
Asunto(s)
Anomalía de Ebstein/epidemiología , Defectos del Tabique Interatrial/epidemiología , Taquicardia Supraventricular/epidemiología , Síndrome de Wolff-Parkinson-White/epidemiología , Adolescente , Adulto , Niño , Preescolar , Colombia/epidemiología , Comorbilidad/tendencias , Estudios Transversales , Anomalía de Ebstein/diagnóstico , Ecocardiografía , Electrocardiografía , Femenino , Defectos del Tabique Interatrial/diagnóstico , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Fenotipo , Tasa de Supervivencia/tendencias , Taquicardia Supraventricular/diagnóstico , Síndrome de Wolff-Parkinson-White/diagnóstico , Adulto JovenRESUMEN
Aims: The clinical characteristics of atrial tachycardias (AT) ablated from the non-coronary aortic sinus (NCS) are thus far described only in small series. We aimed to outline, in a large cohort of patients, the clinical, electrocardiographic, electrophysiological characteristics of this tachycardia. Methods and results: We analysed data pertaining to clinical, electrocardiographic, and electrophysiological characteristics of 43 consecutive patients from an overall cohort of 441 with AT who were successfully ablated from the NCS. The tachycardias ablated from the NCS were paroxysmal (98%) and adenosine sensitive (35/35). The patients were aged 54.6 ± 12.4 years, showing female preponderance (74%). No P wave pattern was predictive of the location of ablation. Electrophysiological findings suggested a possible micro-reentrant mechanism. During tachycardia, atrial electrograms recorded in the NCS preceded the A in the His region by 10.9 ± 7.4 ms. Fractionated atrial electrograms were noted at the site of ablation in 42 patients during the tachycardia. Radiofrequency ablation terminated the tachycardia within 5 s in 88%, with thermal automaticity seen only in 3 patients. The site of ablation at the base of the NCS was adjacent to the presumed site of the retroaortic node, a remnant of the initial atrio-ventricular canal musculature. Conclusions: AT ablated from the NCS is a paroxysmal arrhythmia in middle-aged women, with distinct electrocardiographic and electrophysiological characteristics. We suspect the retroaortic node to be involved in the tachycardia circuit.
Asunto(s)
Ablación por Catéter/métodos , Seno Aórtico/cirugía , Taquicardia Supraventricular/cirugía , Potenciales de Acción , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Ablación por Catéter/efectos adversos , Supervivencia sin Enfermedad , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Europa (Continente) , Femenino , Frecuencia Cardíaca , Humanos , India , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Seno Aórtico/fisiopatología , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: We hypothesize that routine daily transtelephonic monitoring (TTM) transmissions can accurately detect supraventricular tachycardia (SVT) in asymptomatic infants and/or assuage parental concerns rather than being used solely to diagnose arrhythmias. STUDY DESIGN: Single center, retrospective chart review of 60 patients with fetal or infant SVT prescribed TTM for at least 30 days, January 2010-September 2016. Patients were excluded if initial SVT was not documented, was perioperative, was atrial flutter/fibrillation, or chaotic atrial tachycardia. Categorical variables expressed as mean ± SD. Mann-Whitney, Spearman correlation, and Fisher exact tests were used for continuous and categorical variables respectively. RESULTS: Sixty patients were included. There were 2688 TTM transmissions received from 55 of 60 patients over 61.1 ± 66.7 days (0.73 ± 0.65 TTM/patient/days). Routine asymptomatic TTM transmissions revealed actionable findings in 5 of 2801 TTM transmissions sent by 5 patients (8.3%). No patient presented in shock or died. Forty-five of 2688 TTM transmissions were sent for parental concerns/symptoms in 16 patients (25.8%) with findings of normal sinus rhythm in 37 of 45 TTM transmissions and SVT in 8 of 45 TTM transmissions. Symptomatic actionable findings were more likely sent by patients discharged on class I or III antiarrhythmics (95% CI = 11.5%-68.3%, P = .004) and patients with prolonged initial hospitalizations (95% CI = 6.98%-59.7%, P = .01). Flecainide was discontinued in 1 patient after widened QRS was noted on routine TTM. CONCLUSIONS: TTM accurately diagnose asymptomatic recurrent SVT in neonates and infants before they develop signs of congestive heart failure or shock and is helpful for recurrent SVT management.
Asunto(s)
Taquicardia Supraventricular/diagnóstico , Telemetría/métodos , Antiarrítmicos/uso terapéutico , Electrocardiografía , Femenino , Humanos , Lactante , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Taquicardia Supraventricular/tratamiento farmacológico , Telemetría/estadística & datos numéricos , TeléfonoAsunto(s)
Electrocardiografía Ambulatoria , Sistema de Conducción Cardíaco/fisiopatología , Taquicardia Supraventricular/diagnóstico , Técnicas de Ablación , Fascículo Atrioventricular Accesorio , Potenciales de Acción , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/fisiopatología , Bloqueo de Rama/diagnóstico , Bloqueo de Rama/fisiopatología , Técnicas Electrofisiológicas Cardíacas , Sistema de Conducción Cardíaco/cirugía , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Taquicardia Supraventricular/fisiopatología , Taquicardia Supraventricular/cirugíaRESUMEN
Introdução: Alguns estudos têm demonstrado a utilidade do mapa de ativação para guiar a ablação de taquicardias atriais reentrantes atípicas em populações pequenas e heterogêneas. Este estudo teve como objetivo avaliar a utilidade do mapeamento eletroanatômico em caracterizar e auxiliar a ablação de taquicardias atriais reentrantes pela localização do istmo protegido. Método: O estudo incluiu 9 pacientes consecutivos portadores de taquicardias atriais encaminhados a nossa instituição para ablação por cateter. Em todos, usou-se o mapeamento eletroanatômico (CARTO-3). Cicatrizes foram consideradas áreas com voltagem bipolar < 0,5 mV. De acordo com o mapa de ativação, reentrada foi definida pelo critério early-meet-late e focal, pela ativação centrífuga.Embora não tenha sido usado para guiar a ablação, o encarrilhamento foi usado em taquicardias atriais com ciclo > 250 ms para correlação com istmo crítico do mapa de ativação. O alvo para ablação foi o istmo ou foco crítico encontrado no mapa de ativação, com o objetivo imediato de reversão da taquicardia e não de indução ao final do procedimento. Os pacientes foram acompanhados a cada 6 meses e as recorrências foram definidas por taquicardias atriais sustentadas sintomáticas. Resultados: No total, 14 taquicardias atriais foram induzidas e todas foram revertidas pela ablação guiada pelo mapa de ativação. O átrio esquerdo foi envolvido em 8 taquicardias e o direito, em 6. Em todos os pacientes encontrou-se cicatriz no átrio envolvido com o local crítico da arritmia. No acompanhamento médio de 12 meses, 2 pacientes apresentaram recorrência. Conclusão: A ablação por cateter guiada pelo mapeamento eletroanatômico foi efetiva no controle de taquicardias atriais reentrantes, constituindo ferramenta útil para o tratamento dessas arritmias complexas. A definição do mecanismo da taquicardia e dos componentes de seu circuito, em especial o istmo protegido, confere maior sucesso terapêutico.
Background: Some studies have demonstrated the value of activation maps to guide ablation in atypical reentry atrial tachycardias in small and heterogeneous populations. This study was aimed at evaluating the ability of electroanatomic mapping to characterize and guide the ablation of reentrant atrial tachycardia locating the protected isthmus. Method: Nine consecutive patients with atrial tachycardia were consecutively referred to catheter ablation. Electroanatomic mapping (CARTO-3) was used in all patients. Scars were defined by areas with bipolar voltage < 0.5 mV. According to the activation map, reentry was defined by the early-meet-late criteria and focal was defined by centrifugal activation. Although entrainment was not used to guide the ablation, it was used in atrial tachycardia with cycle length > 250 ms for correlation with critical isthmus in the activation map. Ablation target was defined as critical isthmus or focus in the activation map. The immediate objective was to revert, and not induce, tachycardia at the end of the procedure. The patients were followed every 6 months and recurrences were defined by symptomatic sustained atrial tachycardia. Results: Fourteen atrial tachycardias were induced and all were reversed by ablation guided by the activation map. The left atrium was involved in 8 atrial tachycardias and the right atrium in 6. In all patients, a scar was identified in the atrium involved with the critical isthmus. In the mean follow-up of 12 months, 2 patients had recurrences. Conclusion: Catheter ablation guided by electroanatomic mapping was effective in controlling reentrant atrial tachycardia and is a useful tool for the treatment of complex arrhythmias. The definition of the mechanism of atrial tachycardia and its arrhythmogenic circuit components, in particular the protected isthmus, provides greater therapeutic success.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Ablación por Catéter/métodos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/terapia , Taquicardia/diagnóstico , Taquicardia/terapia , Aleteo Atrial/complicaciones , Aleteo Atrial/diagnóstico , Ecocardiografía/métodos , Electrocardiografía/métodos , Atrios Cardíacos , Estudio Observacional , Resultado del TratamientoRESUMEN
Supraventricular arrhythmias are one of the main causes of medical consultation. They may also be the clinical presentation of various cardiovascular diseases and a marker of sudden death. The correct diagnosis of these arrhythmias could be a challenge. The purpose of this narrative review is to update succinctly on the topic.
Las arritmias supraventriculares son una de las principales causas de consulta médica y de presentación clínica de varias enfermedades cardiovasculares y un marcador de muerte súbita. El diagnóstico adecuado de estas arritmias puede ser un reto. El objetivo de esta revisión narrativa es actualizar sucintamente sobre el tópico.
Asunto(s)
Arritmias Cardíacas/diagnóstico , Electrocardiografía , Taquicardia Supraventricular/diagnóstico , Arritmias Cardíacas/fisiopatología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Muerte Súbita Cardíaca/etiología , Humanos , Taquicardia Supraventricular/fisiopatologíaRESUMEN
Na taquicardia por reentrada nodal atrioventricular, a necessidade do átrio para a manutenção da taquicardia é controverso. Descrevemos um caso de fibrilação atrial ocorrendo durante taquicardia por reentrada nodal atrioventricular sem afetar o ciclo da arritmia, e discutimos as evidências favorecendo a presença de umavia comum superior.
In Atrioventricular Nodal Reentry Tachycardia the requirement of the atrium for the maintenance oftachycardia is controversial. We describe a case of atrial fibrillation that occurred during Atrioventricular Nodal Reentry Tachycardia without affecting the arrhythmia cycle, and discuss the evidences favoring the presence ofan upper common pathway.
Asunto(s)
Humanos , Masculino , Adulto , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Taquicardia Supraventricular/complicaciones , Taquicardia Supraventricular/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/complicaciones , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Catéteres , Atrios Cardíacos , Ventrículos CardíacosRESUMEN
During pregnancy, a number of physiological changes occur which can predispose to arrhythmias. Symptoms can range from asymptomatic states to shortage of breath or palpitations, as also found in non-pregnant patients. Treatment is currently subject of scientific studies and there are different recommendations proposed by the main scientific societies. Hence, doubts and disputes raise when facing each case, firstly due to the concern about maternal and fetal well-being, and secondly to the possible complications inherent in the management of each drug. Clinical case: A case of a pregnant woman with 37 weeks of pregnancy, who presented supraventricular tachycardia without hemodynamic instability, is presented. According to the Spanish Society of Cardiology, guidelines an intravenous adenosine treatment was applied in a first instance. Since no reversion of the arrhythmic state was observed, the conduction of an electric countershock and termination of pregnancy by elective caesarean section was performed in agreement among Obstetrics, Intensive Care, Emergency Care and Pediatric Services.
Asunto(s)
Complicaciones Cardiovasculares del Embarazo , Taquicardia Supraventricular , Adulto , Algoritmos , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/terapia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/terapiaRESUMEN
AIMS: This study's aim is to compare the ability of two ECG criteria to differentiate ventricular (VT) from supraventricular tachycardia (SVT): Brugada et al. [horizontal plane (HP) leads] and Vereckei et al. [frontal plane (FP), specifically aVR lead], having electrophysiological study (EPS) as gold standard. After comparing, suggestions for better diagnosis of wide QRS-complex tachycardia (WCT) in emergency situations were made. METHODS AND RESULTS: Fifty-one consecutive patients with 12-lead ECG registered during EPS-induced regular WCT were selected. Each ECG was split into two parts: HP (V1-V6) and FP (D1-D3, aVR, aVL, and aVF), randomly distributed to three observers, blinded for EPS diagnosis and complementary ECG plane, resulting in total 306 ECG analyses. Observers followed the four steps of both algorithms, counting time-to-diagnosis. Global sensitivity, specificity, percentage of incorrect diagnoses, and step-by-step positive/negative likelihood ratios (+LR and -LR) were calculated. Kaplan-Meier curve was plotted for final time-to-diagnosis. Inter-observer agreement was assessed with kappa-statistic. Global sensitivity was similarly high in FP and HP algorithms (89.2 vs. 90.1%), and incorrect classifications were 27.4 vs. 24.7%. Forty-eight correct analyses by Vereckei criteria took 9.13 s to diagnose VT in the first step, showing that first step was fast, with high +LR, generating nearly conclusive pre- (72.6%) to post-test (98.0%) changes for VT probability. CONCLUSION: Both algorithms as a whole are similar for diagnosis of WTC; however, the first step of Vereckei (initial R in aVR) is a simple, reproducible, accurate, and fast tool to use. The negativity of this step requires a 'holistic' approach to distinguish VT from SVT.