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1.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32561613

RESUMO

Flecainide acetate is a Vaughan-Williams class IC antiarrhythmic drug prescribed for the treatment of supraventricular arrhythmias. It has a narrow therapeutic index and proarrhythmic effects even at therapeutic doses. Flecainide is metabolized by a CYP2D6 enzyme that exhibits polymorphism. In this case report, we present, to our best knowledge, the first case of toxicity contributed by genetic polymorphism in an infant. Our patient with recurrent supraventricular tachycardia was treated with a therapeutic dose of flecainide but developed heart block requiring extracorporeal membrane oxygenation support and subsequent treatment with lipid emulsion therapy. He was found to have supratherapeutic serum flecainide concentration, and gene testing revealed the patient to be an intermediate metabolizer. With this case report, we reinforce the importance of evaluating the CYP2D6 genotype before drug initiation in the neonatal population and recommend regular monitoring of serum flecainide levels and electrocardiograms in these patients.


Assuntos
Citocromo P-450 CYP2D6/genética , Eletrocardiografia , Flecainida/efeitos adversos , Bloqueio Cardíaco/induzido quimicamente , Polimorfismo Genético , Taquicardia Supraventricular/tratamento farmacológico , Citocromo P-450 CYP2D6/metabolismo , Genótipo , Bloqueio Cardíaco/genética , Bloqueio Cardíaco/metabolismo , Humanos , Recém-Nascido , Taquicardia Supraventricular/fisiopatologia , Bloqueadores do Canal de Sódio Disparado por Voltagem/efeitos adversos
2.
Am J Emerg Med ; 38(7): 1541.e3-1541.e4, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32278568

RESUMO

Paroxysmal supraventricular tachycardia (PSVT) is one of the more common arrhythmias requiring treatment in the emergency department. Intravenous adenosine is recommended as the initial medication of choice for treatment of PSVT, given in escalating doses up to a maximum of 12 mg. With a serum half-life of less than 10 s, adenosine must be given rapidly to allow for adequate time for it to reach the heart via venous return. In over 10% of adult patients, PSVT will not be terminated with maximum doses of adenosine. We report a case of a patient requiring a higher-than recommended dose of adenosine for termination of PSVT. The patient had a history of pulmonary hypertension with resultant right heart failure at the time of presentation. We believe the higher dose of adenosine was necessary in this patient because of the impaired venous return to her right heart. This case indicates that patients with impaired venous return to the right heart may require higher-than-recommended doses of adenosine for effective termination of PSVT.


Assuntos
Adenosina/administração & dosagem , Antiarrítmicos/administração & dosagem , Taquicardia Paroxística/tratamento farmacológico , Taquicardia Supraventricular/tratamento farmacológico , Relação Dose-Resposta a Droga , Eletrocardiografia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão Pulmonar/complicações , Pessoa de Meia-Idade
3.
Expert Opin Investig Drugs ; 29(1): 1-4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31825681

RESUMO

Introduction: Paroxysmal supraventricular tachycardia (SVT) can be very bothersome and may potentially lead to considerable health-care utilization. Non-parenteral medication is currently unavailable for the rapid termination of paroxysmal SVT. However, an intranasal spray formulation of etripamil, a short-acting calcium-channel blocker, is under investigation as a convenient, safe, and rapidly efficacious means to terminate paroxysmal SVT.Areas covered: This review summarizes the clinical rationale, potential benefit, and clinical trials safety and efficacy data for the use of etripamil nasal spray to terminate paroxysmal SVT.Expert opinion: Based on the efficacy and tolerability demonstrated in phase 1 and 2 clinical trials, etripamil nasal spray is a potential convenient, safe, and effective means for patients to terminate paroxysmal SVT. It has the potential to improve quality of life, reduce health-care burden, and alter the current management paradigm for many patients with SVT. Further ongoing evaluation in ambulatory patients will help to determine its real-life practicality, safety, and effectiveness.


Assuntos
Benzoatos/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Sprays Nasais , Taquicardia Paroxística/tratamento farmacológico , Taquicardia Supraventricular/tratamento farmacológico , Benzoatos/efeitos adversos , Benzoatos/farmacologia , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/farmacologia , Humanos , Qualidade de Vida , Taquicardia Paroxística/fisiopatologia , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo
5.
J Am Coll Cardiol ; 74(7): 874-885, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31416531

RESUMO

BACKGROUND: Standardized treatment of fetal tachyarrhythmia has not been established. OBJECTIVES: This study sought to evaluate the safety and efficacy of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). METHODS: In this multicenter, single-arm trial, protocol-defined transplacental treatment using digoxin, sotalol, and flecainide was performed for singleton pregnancies from 22 to <37 weeks of gestation with sustained fetal SVT or AFL ≥180 beats/min. The primary endpoint was resolution of fetal tachyarrhythmia. Secondary endpoints were fetal death, pre-term birth, and neonatal arrhythmia. Adverse events (AEs) were also assessed. RESULTS: A total of 50 patients were enrolled at 15 institutions in Japan from 2010 to 2017; short ventriculoatrial (VA) SVT (n = 17), long VA SVT (n = 4), and AFL (n = 29). One patient with AFL was excluded because of withdrawal of consent. Fetal tachyarrhythmia resolved in 89.8% (44 of 49) of cases overall and in 75.0% (3 of 4) of cases of fetal hydrops. Pre-term births occurred in 20.4% (10 of 49) of patients. Maternal AEs were observed in 78.0% (39 of 50) of patients. Serious AEs occurred in 1 mother and 4 fetuses, thus resulting in discontinuation of protocol treatment in 4 patients. Two fetal deaths occurred, mainly caused by heart failure. Neonatal tachyarrhythmia was observed in 31.9% (15 of 47) of neonates within 2 weeks after birth. CONCLUSIONS: Protocol-defined transplacental treatment for fetal SVT and AFL was effective and tolerable in 90% of patients. However, it should be kept in mind that serious AEs may take place in fetuses and that tachyarrhythmias may recur within the first 2 weeks after birth.


Assuntos
Antiarrítmicos/uso terapêutico , Doenças Fetais/tratamento farmacológico , Cuidado Pré-Natal , Taquicardia Supraventricular/tratamento farmacológico , Administração Oral , Adulto , Flutter Atrial/tratamento farmacológico , Cesárea/estatística & dados numéricos , Digoxina/sangue , Digoxina/uso terapêutico , Feminino , Morte Fetal , Flecainida/sangue , Flecainida/uso terapêutico , Humanos , Recém-Nascido , Injeções Intravenosas , Japão/epidemiologia , Peptídeo Natriurético Encefálico/sangue , Gravidez , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Recidiva , Sotalol/sangue , Sotalol/uso terapêutico , Taquicardia/epidemiologia , Veias Umbilicais/química , Adulto Jovem
6.
Circ Arrhythm Electrophysiol ; 12(8): e007387, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31345093

RESUMO

BACKGROUND: Incessant focal atrial tachycardia (FAT), if untreated, can lead to ventricular dysfunction and heart failure (tachycardia-induced cardiomyopathy). Drug therapy of FAT is often difficult and ineffective. The efficacy of ivabradine has not been systematically evaluated in the treatment of FAT. METHODS: The study group consisted of patients with incessant FAT (lasting >24 hours) and structurally normal hearts. Patients with ventricular dysfunction as a consequence of FAT were not excluded. All antiarrhythmic drugs were discontinued at least 5 half-lives before the initiation of ivabradine. Oral ivabradine (adults, 10 mg twice 12 hours apart; pediatric patients: 0.28 mg/kg in 2 divided doses) was initiated in the intensive care unit under continuous electrocardiographic monitoring. A positive response was defined as the termination of tachycardia with the restoration of sinus rhythm or suppression of the tachycardia to <100 beats per minute without termination within 12 hours of initiating ivabradine. RESULTS: Twenty-eight patients (mean age, 34.6±21.5 years; women, 60.7%) were included in the study. The most common symptom was palpitation (85.7%) followed by shortness of breath (25%). The mean atrial rate during tachycardia was 170±21 beats per minute, and the mean left ventricular ejection fraction was 54.7±14.3%. Overall, 18 (64.3%) patients responded within 6 hours of the first dose of ivabradine. Thirteen of 18 ivabradine responders subsequently underwent successful catheter ablation. FAT originating in the atrial appendages was a predictor of ivabradine response compared with those arising from other atrial sites (P=0.046). CONCLUSIONS: Ivabradine-sensitive atrial tachycardia constitutes 64% of incessant FAT in patients without structural heart disease. Incessant FAT originating in the atrial appendages is more likely to respond to ivabradine than that arising from other atrial sites. Our findings implicate the funny current in the pathogenesis of FAT.


Assuntos
Função do Átrio Esquerdo/fisiologia , Eletrocardiografia/métodos , Átrios do Coração/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Ivabradina/administração & dosagem , Taquicardia Supraventricular/fisiopatologia , Administração Oral , Adulto , Fármacos Cardiovasculares/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Taquicardia Supraventricular/tratamento farmacológico , Resultado do Tratamento
7.
Am J Emerg Med ; 37(8): 1604.e1-1604.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31155170

RESUMO

Supraventricular Tachycardias are the most common cardiac rhythm disturbances in pregnant patients. Adenosine is the recommended medication to treat these arrhythmias in part because the medication is projected to be metabolized prior to crossing the placenta and producing any fetal effects. Reported here is a case of a pregnant patient treated with adenosine in which the fetal heart activity was monitored through point of care ultrasonography with documentation of no fetal impact from this medication. This is the first documentation of a lack of fetal effect from adenosine.


Assuntos
Adenosina/administração & dosagem , Antiarrítmicos/administração & dosagem , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Taquicardia Supraventricular/tratamento farmacológico , Administração Intravenosa , Adulto , Eletrocardiografia , Feminino , Monitorização Fetal/métodos , Frequência Cardíaca Fetal , Humanos , Testes Imediatos , Gravidez , Ultrassonografia Pré-Natal
8.
J Vet Emerg Crit Care (San Antonio) ; 29(3): 326-330, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31044499

RESUMO

OBJECTIVE: To describe the successful management of 2 dogs with septic shock and persistent tachycardia using norepinephrine and esmolol, a short-acting beta receptor antagonist. SERIES SUMMARY: Two cases are reviewed. In the first case, septic shock with ventricular tachycardia was diagnosed in a 4-year-old neutered female Great Dane that underwent jejunoileal resection and anastomosis for a partial mesenteric torsion. The patient's tachyarrhythmias failed to respond to lidocaine, and an esmolol infusion was used for heart rate control. The condition of the dog improved and she was discharged after 4 days of hospitalization. The second case was a 7-year-old neutered female Cavalier King Charles Spaniel with septic peritonitis. Following surgery for intestinal resection and anastomosis, supraventricular tachycardia developed that was not responsive to volume resuscitation and was treated with an esmolol infusion. The condition of the dog improved and she was discharged after 6 days of hospitalization. Both patients were doing well at the time of long-term follow-up. NEW OR UNIQUE INFORMATION PROVIDED: This case series highlights a novel method of managing dogs in septic shock with persistent tachycardia based on recently published data in the human literature. The use of esmolol may be considered in certain veterinary patients with septic shock to improve persistent tachycardia not related to hypovolemia.


Assuntos
Doenças do Cão/tratamento farmacológico , Choque Séptico/veterinária , Taquicardia Supraventricular/veterinária , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Animais , Procedimentos Cirúrgicos do Sistema Digestório/veterinária , Cães , Quimioterapia Combinada/veterinária , Feminino , Norepinefrina/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/veterinária , Propanolaminas/administração & dosagem , Choque Séptico/complicações , Choque Séptico/tratamento farmacológico , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/tratamento farmacológico , Vasoconstritores/administração & dosagem
10.
Prehosp Disaster Med ; 34(3): 297-302, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31043186

RESUMO

INTRODUCTION: Atrial fibrillation (AFIB) with rapid ventricular response (RVR) is a common tachydysrhythmia encountered by Emergency Medical Services (EMS). Current guidelines suggest rate control in stable, symptomatic patients. PROBLEM: Little is known about the safety or efficacy of rate-controlling medications given by prehospital providers. This study assessed a protocol for prehospital administration of diltiazem in the setting of AFIB with RVR for provider protocol compliance, patient clinical improvement, and associated adverse events. METHODS: This was a retrospective, cohort study of patients who were administered diltiazem by providers in the Orange County EMS System (Florida USA) over a two-year period. The protocol directed a 0.25mg/kg dose of diltiazem (maximum of 20mg) for stable, symptomatic patients in AFIB with RVR at a rate of >150 beats per minute (bpm) with a narrow complex. Data collected included patient characteristics, vital signs, electrocardiogram (ECG) rhythm before and after diltiazem, and need for rescue or additional medications. Adverse events were defined as systolic blood pressure <90mmHg or administration of intravenous fluid after diltiazem administration. Clinical improvement was defined as a heart rate decreased by 20% or less than 100bmp. Original prehospital ECG rhythm interpretations were compared to physician interpretations performed retrospectively. RESULTS: Over the study period, 197 patients received diltiazem, with 131 adhering to the protocol. The initial rhythm was AFIB with RVR in 93% of the patients (five percent atrial flutter, two percent supraventricular tachycardia, and one percent sinus tachycardia). The agreement between prehospital and physician rhythm interpretation was 92%, with a Kappa value of 0.454 (P <.001). Overall, there were 22 (11%) adverse events, and 112 (57%) patients showed clinical improvement. When diltiazem was given outside of the existing protocol, the patients had higher rates of adverse events (18% versus eight percent; P = .033). Patients who received diltiazem in adherence with protocols were more likely to show clinical improvement (63% versus 46%; P = .031). CONCLUSION: This study suggests that prehospital diltiazem administration for AFIB with RVR is safe and effective when strict protocols are followed.Rodriguez A, Hunter CL, Premuroso C, Silvestri S, Stone A, Miller S, Zuver C, Papa L. Safety and efficacy of prehospital diltiazem for atrial fibrillation with rapid ventricular response. Prehosp Disaster Med. 2019;34(3):297-302.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Diltiazem/uso terapêutico , Serviços Médicos de Emergência/métodos , Taquicardia Supraventricular/tratamento farmacológico , Adulto , Fatores Etários , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Distribuição de Qui-Quadrado , Estudos de Coortes , Eletrocardiografia/métodos , Feminino , Florida , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Taxa de Sobrevida , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/diagnóstico por imagem , Resultado do Tratamento
11.
Int Heart J ; 60(3): 756-760, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105156

RESUMO

We report a case of atypical fast-slow atrioventricular nodal reentrant tachycardia (AVNRT) using a slow pathway variant extending to the superoanterior right atrium. The AVNRT diagnosis was confirmed by using standard electrophysiological criteria that exclude a diagnosis of atrial tachycardia and atrioventricular reentrant tachycardia. The earliest atrial activation during tachycardia was found in the superoanterior right atrium adjacent to the tricuspid annulus, where the first delivery of radiofrequency energy terminated and eliminated the inducibility of the tachycardia.


Assuntos
Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Trifosfato de Adenosina/administração & dosagem , Trifosfato de Adenosina/uso terapêutico , Assistência ao Convalescente , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/terapia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/tratamento farmacológico , Resultado do Tratamento
12.
Arch Dis Child ; 104(8): 789-792, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31005896

RESUMO

OBJECTIVE: Guidelines state that verapamil is contraindicated in infants. This is based on reports of cardiovascular collapse and even death after rapid intravenous administration of verapamil in infants with supraventricular tachycardia (SVT). We wish to challenge this contraindication for the specific indication of verapamil sensitive ventricular tachycardia (VSVT) in infants. DESIGN: Retrospective case series and critical literature review. SETTING: Hospitals within New Zealand. PATIENTS: We present a series of three infants/young children with VSVT or 'fascicular VT'. RESULTS: Three children aged between 8 days and 2 years presented with tachycardia 200-220 beats per minute with right bundle brunch block and superior axis. Adenosine failed to cardiovert and specialist review diagnosed VSVT. There were no features of cardiovascular shock. Verapamil was given as a slow infusion over 10-30 min (rather than as a push) and each successfully cardioverted without incident. Critical review of the literature reveals that cardiovascular collapses were associated with a rapid intravenous push in cardiovascularly compromised infants and/or infants given other long-acting antiarrhythmics prior to verapamil. CONCLUSIONS: Verapamil is specifically indicated for the treatment of fascicular VT, and for this indication should be used in infancy, as well as in older children, as first-line treatment or after failure of adenosine raises suspicion of the diagnosis. We outline how to distinguish this tachycardia from SVT and propose a strategy for the safe intravenous slow infusion of verapamil in children, noting that extreme caution is necessary with pre-existing ventricular dysfunction.


Assuntos
Antiarrítmicos/administração & dosagem , Taquicardia Supraventricular/diagnóstico , Verapamil/administração & dosagem , Serviços de Saúde da Criança , Diagnóstico Diferencial , Esquema de Medicação , Eletrocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Infusões Intravenosas , Masculino , Nova Zelândia , Estudos Retrospectivos , Taquicardia Supraventricular/tratamento farmacológico
13.
J Vet Med Sci ; 81(5): 717-722, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-30956271

RESUMO

Maintaining a good ventricular systolic function is important in the long-term therapy of dogs with supraventricular tachyarrhythmia (SVTA). The objective of this study was to evaluate the inhibitory effect of telmisartan on myocardial injury and the resulting ventricular systolic dysfunction in a canine model of SVTA. A total of 14 dogs were randomly assigned to a Telmisartan (oral telmisartan, 1.0 mg/kg daily, n=7) or a Control (no drug administration, n=7) group; the duration of rapid atrial pacing (RAP) was 3 weeks for both groups. The cardiac troponin I (cTnI) concentration in the Control group was significantly increased after 3 weeks compared to that before RAP initiation (baseline), but no significant difference was observed in the Telmisartan group. Moreover, the cTnI concentration at 3 weeks was significantly lower in the Telmisartan group than in the Control group. The left ventricular fractional shortening was significantly decreased at 3 weeks compared to that at baseline in both groups. However, fractional shortening at 3 weeks was significantly higher in the Telmisartan group than in the Control group. The cardiac output values in the Control group were significantly decreased at 3 weeks compared with those at baseline, but no significant difference was observed in the Telmisartan group. This study demonstrates that telmisartan inhibits the reduction in ventricular systolic function and prevents myocardial injury in a canine model of SVTA. Therefore, telmisartan is suggested as a novel treatment for canine SVTA.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Taquicardia Supraventricular/veterinária , Telmisartan/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Animais , Débito Cardíaco/efeitos dos fármacos , Estimulação Cardíaca Artificial/veterinária , Doenças do Cão/tratamento farmacológico , Cães , Feminino , Frequência Cardíaca/efeitos dos fármacos , Masculino , Miocárdio/patologia , Taquicardia Supraventricular/tratamento farmacológico , Telmisartan/administração & dosagem , Troponina I/sangue , Troponina I/efeitos dos fármacos , Função Ventricular/efeitos dos fármacos
14.
J Emerg Med ; 56(6): e111-e114, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30879847

RESUMO

BACKGROUND: Diabetic ketoacidosis (DKA) is a common complication affecting patients with type 1 diabetes, and DKA is associated with dehydration and electrolyte abnormalities. Supraventricular tachycardia (SVT), although a common tachydysrhythmia in the pediatric population, remains a rare entity in patients presenting with DKA. CASE REPORT: We describe a case of first-time SVT in an adolescent patient with DKA and recent methamphetamine abuse, with both factors likely predisposing him to develop a tachydysrhythmia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: SVT can be present in a patient who has concomitant recent stimulant intake and DKA. A trial of abortive therapy, such as adenosine, should be considered upon diagnosis.


Assuntos
Cetoacidose Diabética/complicações , Metanfetamina/efeitos adversos , Taquicardia Supraventricular/etiologia , Adenosina/uso terapêutico , Antiarrítmicos/uso terapêutico , Cetoacidose Diabética/fisiopatologia , Hidratação , Humanos , Masculino , Taquicardia Supraventricular/tratamento farmacológico , Taquicardia Supraventricular/fisiopatologia , Adulto Jovem
15.
Pacing Clin Electrophysiol ; 42(6): 670-677, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30875081

RESUMO

BACKGROUND: Supraventricular tachycardia (SVT) in children can be difficult to treat when first-line therapies (beta-blockade or digoxin) are not effective. Both flecainide and amiodarone are used as second-line therapies. We sought to compare the efficacy and safety of flecainide and amiodarone in pediatric patients with recurrent SVT. METHODS: Pediatric patients treated with oral flecainide or oral amiodarone for SVT between 2006 and 2015 were studied. Tachycardia mechanisms included orthodromic reciprocating tachycardia (ORT), intra-atrial reentrant tachycardia (IART), and ectopic atrial tachycardia (EAT). Outcomes were classified as full success, partial success (requiring additional intervention), or failure. RESULTS: Seventy-four patients were included (median age 46 days, range 1 day to 19 years). Flecainide was used in 47 patients and amiodarone in 27 patients. Full success was achieved in 68% and 59%, respectively (P = 0.28). Partial success was achieved in 13% and 19%, respectively (P = 0.12). Treatment failed in 19% and 22%, respectively (P = 0.97). Ten crossover patients received the second medication after the first failed. Of five amiodarone-to-flecainide crossovers, four achieved success on flecainide alone. Of five flecainide-to-amiodarone crossovers, two achieved success. Minor adverse events occurred in 9% of flecainide and 22% of amiodarone patients (P = 0.16). No significant differences were seen by arrhythmia subtype (36 EAT, 28 ORT, 10 IART), congenital heart disease (n = 38), or age group (56 infants). CONCLUSIONS: Oral flecainide and amiodarone achieved meaningful arrhythmia control in 81% and 78% of pediatric patients with recurrent SVT, respectively. Those who failed amiodarone had encouraging outcomes when changed to flecainide.


Assuntos
Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Flecainida/administração & dosagem , Taquicardia Supraventricular/tratamento farmacológico , Administração Oral , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Adulto Jovem
17.
Med Ultrason ; 21(1): 93-95, 2019 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-30779838

RESUMO

This report describes a case of fetal supraventricular tachycardia (SVT) diagnosed at 12 weeks of gestation in a pregnant woman with diabetes mellitus. Transplacental digoxin therapy administered orally to the mother was unsuccessful. Subsequently, sotalol was added to digoxin to achieve fetal heart rate (HR) control and the conversion to sinus rhythm was achieved. The fetal HR remained stable until term, and a healthy male baby was born. The newborn electrocardiogram showed sinus rhythm with normal PR and QTc intervals. When the newborn was stable, he was discharged with propanolol. Sustained SVT is extremely rare during the first trimester. The goal of treatment in utero is the conversion to sinus rhythm or reduction of the ventricular rate to tolerable levels, preventing or even reversing fetal hydrops.


Assuntos
Coração Fetal/diagnóstico por imagem , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/embriologia , Ultrassonografia Pré-Natal/métodos , Adulto , Antiarrítmicos/uso terapêutico , Digoxina/uso terapêutico , Ecocardiografia , Feminino , Coração Fetal/embriologia , Seguimentos , Humanos , Recém-Nascido , Masculino , Gravidez , Propranolol/uso terapêutico , Sotalol/uso terapêutico , Taquicardia Supraventricular/tratamento farmacológico , Adulto Jovem
18.
Am J Ther ; 26(1): e161-e169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-27759583

RESUMO

Despite proven effectiveness in treating tachyarrhythmias, sotalol is proarrhythmic and can cause torsades de pointes. Given the emergence of studies that show no benefit from rhythm control strategies in managing atrial fibrillation, as well as the introduction of nonpharmacological approaches to treating arrhythmias, we felt it necessary to ascertain if there was any role for sotalol given its side effects. Review of the literature regarding sotalol use in the prevention and treatment of supraventricular and ventricular tachyarrhythmias seems to show that more effective and safer agents and nonpharmacological alternatives are currently available. However, sotalol still seems to be useful in preventing supraventricular tachyarrhythmias postcardiac surgery and in reverting hemodynamically stable sustained ventricular tachycardias in the setting of coronary artery disease. Its role in the prevention of tachyarrhythmias in the setting of arrhythmogenic right ventricular cardiomyopathy requires further investigation.


Assuntos
Antiarrítmicos/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Sotalol/efeitos adversos , Taquicardia Supraventricular/tratamento farmacológico , Torsades de Pointes/induzido quimicamente , Antiarrítmicos/uso terapêutico , Displasia Arritmogênica Ventricular Direita/complicações , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Recidiva , Prevenção Secundária/métodos , Sotalol/uso terapêutico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/prevenção & controle , Resultado do Tratamento
19.
Am J Emerg Med ; 37(3): 562.e5-562.e10, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30514596

RESUMO

A 27-year-old man presented with an intentional overdose of concentrated caffeine powder that he bought over the internet. The patient received benzodiazepines and ondansetron for symptomatic treatment when he arrived in the Emergency Department (ED). Subsequently, he developed recurrent supraventricular tachycardia in the ED. The SVT was successfully treated with metoprolol. The patient's caffeine level was >90 mg/L. This is the first known report of treatment of caffeine-induced supraventricular tachycardia with metoprolol.


Assuntos
Antiarrítmicos/uso terapêutico , Cafeína/envenenamento , Overdose de Drogas/tratamento farmacológico , Metoprolol/uso terapêutico , Taquicardia Supraventricular/induzido quimicamente , Taquicardia Supraventricular/tratamento farmacológico , Adulto , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Masculino , Tentativa de Suicídio , Taquicardia Supraventricular/diagnóstico
20.
Biomed Res Int ; 2018: 3059478, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30402470

RESUMO

Objective: This study aims to (i) translate, culturally adapt, and preliminarily validate the arrhythmia-specific Umea22 (U22) questionnaire and (ii) assess the impact of radiofrequency (RF) ablation and medical treatment on the quality of life of patients with supraventricular tachycardias (SVTs). Methods: A total of 140 patients with atrioventricular nodal re-entry tachycardia (AVNRT) and atrioventricular re-entry tachycardia (AVRT) were enrolled in the study. Of these, 100 patients underwent RF ablation (group A) and 40 patients were managed with antiarrhythmic medications (group B). Health-related quality of life (HRQoL) was assessed for both groups using the Short Form-36 Health Survey (SF-36) and the arrhythmia-specific Umea22 (U22) questionnaire at baseline and 3-month follow-up. Exploratory and confirmatory factor analyses were performed to assess the validity of the U22 questionnaire. Univariate comparisons of HRQoL scores between study timepoints and multivariate regression analyses adjusting for baseline confounders were conducted. Results: The factor analysis of the U22 questionnaire yielded a six-factor model ("burden of spells"; "heart contractility"; "character of spells"; "general/non-specific feeling"; "other specific somatic symptoms"; "fear") with acceptable fit results. Patients of group A showed significant improvement in all SF-36 and U22 scores at 3 months' follow-up compared to baseline (all p<0.05). Patients of group B presented deterioration of the total SF-36 score (p=0.001) and improvement of certain U22 measures, namely, well-being (p=0.004), heartbeat speed, and intensity during arrhythmia spells (p<0.0001 for both measures) at 3 months' follow-up, compared to baseline. Employment status, male sex, and urban residence emerged as important predictors. Conclusion: The Greek version of the U22 questionnaire is a valid tool to assess SVT-related symptoms. RF ablation appears to exert more pronounced beneficial outcomes on HRQoL of patients with SVTs compared to medical treatment. Prompt referral of patients with SVTs to specialist centers may favorably affect their quality of life and should be encouraged.


Assuntos
Antiarrítmicos/uso terapêutico , Qualidade de Vida , Ablação por Radiofrequência , Inquéritos e Questionários , Taquicardia Supraventricular/tratamento farmacológico , Taquicardia Supraventricular/cirurgia , Adulto , Análise Fatorial , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Reprodutibilidade dos Testes
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