RESUMEN
INTRODUCTION: An early repolarization (ER) pattern on electrocardiogram (ECG) sometimes has the risk of polymorphic ventricular tachycardia (PVT) or ventricular fibrillation (VF). An abnormal ER pattern can develop in various experimental or clinical situations. We experienced 4 cases of abnormal ER pattern with or without PVT during the radiofrequency (RF) ablation of the left accessory pathway. METHODS AND RESULTS: An electrophysiologic study and RF ablation were performed in 4 patients. Four patients had atrioventricular reentrant tachycardia. During RF ablation of the left accessory pathway, severe chest pain developed and was followed by abnormal J-point elevation. During the ongoing chest pain and J-point elevation, coronary angiograms showed normal findings. The chest pain and J-point elevation were followed by PVT or VF that was unresponsive to defibrillation. The PVT was spontaneously terminated and repeated. After 0.5 mg atropin was given, chest pain and ECG change disappeared. CONCLUSION: The mechanisms of ER syndrome during RF ablation might be increased vagal tone due to chest pain or direct vagal stimulation.
Asunto(s)
Fascículo Atrioventricular Accesorio/cirugía , Ablación por Catéter/efectos adversos , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia Ventricular/etiología , Fascículo Atrioventricular Accesorio/diagnóstico , Fascículo Atrioventricular Accesorio/fisiopatología , Adulto , Anciano , Antiarrítmicos/uso terapéutico , Atropina/uso terapéutico , Angiografía Coronaria , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Femenino , Humanos , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/tratamiento farmacológico , Taquicardia Ventricular/fisiopatología , Resultado del Tratamiento , Nervio Vago/efectos de los fármacos , Nervio Vago/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Although high-dose statin therapy has been reported to improve outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), patterns of statin usage for such patients have not been reported in real-world clinical practice. HYPOTHESIS: Some clinical factors would affect the pattern of statin usage in patients with ACS. METHODS: In the multicenter prospective registry, 3362 patients with ACS who underwent PCI were analyzed. High-dose statin treatment was defined as atorvastatin ≥40 mg or rosuvastatin ≥20 mg per day. The patterns of statin usage were investigated for 30 days after the index PCI. RESULTS: High-dose statins were administered prior to PCI to 13.7% and 19.6% of patients with unstable angina/non-ST-elevated myocardial infarction (UA/NSTEMI) and ST-elevated myocardial infarction (STEMI), respectively (P < 0.001). After PCI, 476 (14.2%) patients were maintained on high-dose statins, and 550 (16.4%) patients received no statins. Independent factors associated with high-dose statin usage after PCI were STEMI (odds ratio [OR]: 1.704, 95% confidence interval [CI]: 1.321-2.197, P < 0.001), high total cholesterol level (OR: 1.445, 95% CI: 1.136-1.837, P = 0.003), and current smoker (OR: 1.556, 95% CI: 1.206-2.008, P < 0.011). The absence of hypercholesterolemia was an independent factor determining the nonuse of statins (OR: 0.229, 95% CI: 0.148-0.353, P < 0.001). CONCLUSIONS: In real-world clinical practice, high-dose statin treatment is being underused despite extensive evidence for patients with ACS undergoing PCI, particularly in UA/NSTEMI. Efforts are needed to ensure that clinical practice complies with evidence-based guidelines.