RESUMO
AIMS AND OBJECTIVES: Atrial fibrillation (AF) with preexcitation can be life threatening. Our study evaluated the incidence, clinical features, electrophysiologic characteristics and outcomes of patients presenting with AF and fast ventricular rates associated with an antegrade conducting accessory pathway. METHODS: Hospital data of patients who had undergone electrophysiology study and radiofrequency ablation for AF and Wolff-Parkinson-White (WPW) syndrome was retrospectively evaluated over 10 years and prospective data was further collected over 1 year. Out of 2876 patients undergoing electrophysiology study, 320 patients had manifest preexcitation on ECG. Forty one patients who had presented with AF and fast ventricular rates were included in the study. RESULTS: Forty one (12.8%) patients out of 320 patients of WPW syndrome patients presented with AF and fast ventricular rates. Mean age of presentation was 38.5 ± 12.3 yrs. Twenty nine (72.5%) were male. Most common presenting features were palpitations, presyncope and syncope. Twenty eight (71.1%) patients were electrically cardioverted on presentation, of which two patients having narrow complex tachycardia, when given adenosine, developed AF and fast ventricular rates and had to be electrically cardioverted. Intravenous amiodarone converted AF to sinus rhythm in 11 (28.9%) patients. Right postero-septal pathway (33.3%) followed by coronary sinus epicardial pathway (22.9%) were the most commonly located pathways associated with AF. Five (12.2%) patients had multiple pathways. CS diverticulum was seen in 6 (14.7%) patients. Ablation was done during AF in 6 (14.7%) patients. All except one had immediate successful ablation. One patient had a recurrence of preexcitation on follow up and successfully ablated during redo procedure. CONCLUSION: AF with WPW syndrome is not uncommon. AF is commonly associated with posteriorly located accessory pathways, CS diverticulum and multiple pathways. Radiofrequency ablation has good outcomes.
RESUMO
A 57-year old woman who had pericardial patch closure of ostium secundum atrial septal defect (ASD) at the age of 23 years presented with shortness of breath. Her echocardiogram showed no residual ASD, good biventricular function and normal pulmonary artery pressures.
Assuntos
Potenciais de Ação , Flutter Atrial/diagnóstico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Comunicação Interatrial/cirurgia , Pericárdio/transplante , Taquicardia Supraventricular/diagnóstico , Flutter Atrial/etiologia , Flutter Atrial/fisiopatologia , Ablação por Cateter , Eletrocardiografia , Feminino , Comunicação Interatrial/fisiopatologia , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
A 34-year-old gentleman, who had undergone pericardial patch closure of ostium secundum atrial septal defect (ASD) at 8 years of age, was evaluated for shortness of breath. Electrocardiogram revealed typical atrial flutter with varying atrioventricular conduction. Echocardiogram showed no residual ASD or pulmonary hypertension and good biventricular function. He was taken for an electrophysiological study with the intention of radiofrequency ablation of the typical flutter.
Assuntos
Flutter Atrial/diagnóstico , Procedimentos Cirúrgicos Cardíacos , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Comunicação Interatrial/cirurgia , Pericárdio/transplante , Taquicardia Supraventricular/diagnóstico , Potenciais de Ação , Adulto , Flutter Atrial/fisiopatologia , Ablação por Cateter , Humanos , Masculino , Valor Preditivo dos Testes , Taquicardia Supraventricular/fisiopatologia , Resultado do TratamentoRESUMO
A 25â¯year old lady presented with palpitation to the emergency department. Her pulse rate was 210 beats per minute. She was hemodynamically stable with a blood pressure of 100/60â¯mmâ¯Hg. 12 lead surface electrocardiogram (ECG) was recorded during the presentation (Fig. 1) and rhythm strip (Fig. 2A) during administration of IV adenosine. What is the likely diagnosis?
Assuntos
Eletrocardiografia , Situs Inversus/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Adenosina/farmacologia , Adulto , Antiarrítmicos/farmacologia , Dextrocardia/diagnóstico por imagem , Eletrocardiografia/efeitos dos fármacos , Feminino , Coração/diagnóstico por imagem , Frequência Cardíaca , Humanos , Radiografia Torácica , Situs Inversus/complicações , Taquicardia/etiologia , Taquicardia por Reentrada no Nó Atrioventricular/complicaçõesAssuntos
Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/fisiopatologia , Potenciais de Ação , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Humanos , Masculino , Marca-Passo Artificial , Fatores de Tempo , Resultado do TratamentoAssuntos
Feixe Acessório Atrioventricular/fisiopatologia , Bloqueio de Ramo/fisiopatologia , Frequência Cardíaca , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Técnicas de Ablação , Feixe Acessório Atrioventricular/cirurgia , Potenciais de Ação , Bloqueio de Ramo/diagnóstico , Estimulação Cardíaca Artificial , Técnicas Eletrofisiológicas Cardíacas , Humanos , Masculino , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Fatores de Tempo , Adulto JovemAssuntos
Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/prevenção & controle , Estimulação Cardíaca Artificial/métodos , Taquicardia/diagnóstico , Taquicardia/prevenção & controle , Adulto , Bloqueio de Ramo/fisiopatologia , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Taquicardia/fisiopatologiaAssuntos
Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Adulto , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Ablação por Radiofrequência , Síndrome de Wolff-Parkinson-White/fisiopatologia , Síndrome de Wolff-Parkinson-White/cirurgiaRESUMO
Aims: To study the respiratory variation of right atrial (RA) pressures at baseline and during atrioventricular nodal reentry tachycardia (AVNRT). Methods: Of the 23 patients screened, 16 participants with typical AVNRT were included in the study. After ensuring adequate hydration, baseline RA pressures were measured as the height of 'a' and 'v' waves. The patients were asked to take deep breaths, and the measurements were taken in both inspiration and expiration. Results: Of the 16 participants, 14(87.5%) showed a normal fall in the height of 'a' and 'v' waves with inspiration, 1(6.25%) showed no change and 1(6.25%) showed a rise in height at baseline, p <0.01. During induced AVNRT, the 'a' and 'v' wave heights increased in 8(50%), remained same in 6(37.5%) and showed a normal fall in 2(12.5%), p = 0.07 for 'a' waves and p = 0.09 for 'v' waves. When the magnitude and direction of change in 'a' and 'v' wave height at baseline was compared with AVNRT, it showed a significant difference with 13(81.25%) participants demonstrating positive Pseudo-Kussmaul's sign, p <0.01. Mean age was numerically higher in those with a more considerable inspiratory rise in RA pressures but was not statistically significant, χ2(2) = 3.1, p = 0.21. Conclusions: Pseudo-Kussmaul's sign does occur in a substantial number of patients during AVNRT. Clinical appreciation of this phenomenon is possible in half to three-fourth of patients, provided the mean RA pressures are low enough for the variation to be visible in the neck.
RESUMO
A 30-year-old man with no structural heart disease has been evaluated for paroxysmal palpitation with documented regular narrow QRS tachycardia that has not responded to intravenous adenosine. Surface electrocardiogram has not shown any pre-excitation. He has been taken for an electrophysiology study after informed consent. Diagnostic catheters were placed at the coronary sinus, His bundle region, and right ventricle. During catheter manipulation a regular narrow QRS tachycardia with incomplete right bundle branch block morphology and normal QRS axis similar to the clinical tachycardia got induced. No other tachycardia was induced. What is the mechanism of tachycardia?
Assuntos
Bloqueio de Ramo/complicações , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Taquicardia Ventricular/complicações , Adulto , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/cirurgia , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/cirurgia , Humanos , Masculino , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgiaAssuntos
Nó Atrioventricular/fisiopatologia , Ablação por Cateter/métodos , Eletrocardiografia , Frequência Cardíaca/fisiologia , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Idoso , Nó Atrioventricular/cirurgia , Feminino , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgiaRESUMO
Objective: To study the predictive power of noninvasive investigative parameters (clinical, biochemical, radiological) for detection of esophageal varices in patients with portal hypertension (PHT) as compared to invasive parameters (upper gastrointestinal endoscopy). Materials and methods: Fifty patients with PHT, between May 2008 to September 2010, were studied. Those who had decompensated liver diseases, HIV, hepatocellular carcinoma, metastasis in liver, parentral drug addiction, chronic febrile illness, H/O treatment taken for PHT in the form of surgery or endoscopic bending or sclerotherapy were excluded. Detailed clinical history was taken and physical examination was done. All patients underwent the required hematological, biochemical, radiological, endoscopic and histopathological investigations. Results: Platelet count/splenic size showed a significant correlation between presence or absence and grade of esophageal varices (p < 0.00015). If a cut-off value of 1,000/cu mm is taken, then 87.5% (35/40) patients with esophageal varices have ratio <1,000 while 20% (2/10) of patients with ratio <1,000 did not have any varices. It was also observed that lower the ratio, higher the grade of varices. Conclusion: Asymptomatic esophageal varices, which is quite common, can be easily diagnosed with invasive endoscopy or otherwise can be suspected with noninvasive predictors like platelet/spleen size ratio in our country, where financial constraint is a major problem for investigations like endoscopy.