经导管射频消融治疗阵发性室上性心动过速78例

目的:探讨经导管射频消融治疗阵发性室上性心动过速的临床疗效.方法:78例阵发性室上性心动过速患者均行心内电生理检查和经导管射频消融治疗.结果:消融成功率为97.4%(76/78),复发率为3.8%(3/78),并发症发生率为2.56%(2/78).结论:经导管射频消融是治疗阵发性室上性心动过速的一种有效方法.     

Occurrence of Atrial Fibrillation in Patients With Paroxysmal Supraventricular Tachycardia Due to Atrioventricular Nodal Reentry

The occurrence of atrial fibrillation in patients with paroxysmal supraventricular tachycardia (PSVT) has been well documented when PSVT is secondary to atrioventricular reentry, but not when PSVT is secondary to atrioventricular nodal reentry (AVNRT). Seventeen patients with AVNRT were followed using transtelephonic electrocardiogram monitoring to document symptomatic tachycardias. The median length of telephone monitor surveillance was 357 days. Fifteen of 17 patients transmitted electrocardiograms that showed PSVT. Three of 17 patients (18%) transmitted electrocardiograms that showed atrial fibrillation. A transition from PSVT into atrial fibrillation was not recorded, but all three did have PSVT recorded on other days of follow-up. We report the occurrence of atrial fibrillation in patients with AVNRT and that its incidence is higher than expected for the general population.     

Adenosine use in pregnancy: Lack of effect on fetal heart rate

The treatment for supraventricular tachycardia in pregnancy is somewhat controversial. Although a variety of medications have been used to terminate this rhythm during pregnancy, all have actual or theoretical drawbacks. Adenosine is a relatively new medication with an extremely short half-life and is effective in the treatment of supraventricular tachycardia. We report a case in which this medication was used successfully during pregnancy. In addition, we found that adenosine had no effect on fetal heart rate in this case.     

新生儿阵发性室上性心动过速的治疗

目的：探讨新生儿阵发性窒上性心动过速（PSVT）的治疗方法。方法：对15例阵发性室上性心动过速患儿的临床资料进行分析。结果：15例患儿中，除1例无效自动出院外。其余患儿均恢复窦性节律。心衰纠正、血清心肌酶恢复正常、肌钙蛋白转阴，于终止发作后4～10d出院．出院后继续服地高辛酏剂3-6个月。结论：（1）PSVT首先采用地高辛静脉注射治疗，若无效则按序分别加用“ATP、心律平、盐酸胺碘酮”；（2）该治疗方法列序安全可靠，值得临床应用。     

静脉注射胺碘酮或普罗帕酮治疗阵发性室上性心动过速的对比研究

目的:观察静脉注射胺碘酮或普罗帕酮治疗阵发性室上性心动过速(PSVT)的疗效及副作用。方法:静脉注射胺碘酮治疗44例PSVT,并与普罗帕酮静脉注射治疗46例PSVT对比观察。结果:胺碘酮组和普罗帕酮组总终止率分别为82%和85%,无显著差异(P>0.05);复律时间:胺碘酮组的20±5min明显慢于普罗帕酮组的8.5±2.5min(P<0.05);副作用发生率二者无显著差异性,但普罗帕酮组的副作用较重。结论:胺碘酮治疗PSVT疗效确切、安全,可作为治疗PSVT的一线药物之一。     

Pseudoephedrine-induced paroxysmal supraventricular tachycardia: a case report

Palpitation is a common chief complaint among emergency department patients, and is often associated with a tachydysrhythmia. Tachydysrhythmia is classified as supraventricular tachycardia or ventricular tachycardia. Reentry in a normal or accessory pathway is one of the most frequently seen mechanisms explaining the tachydysrhythmia. In the present case, we report an unusual cause of atrioventricular paroxysmal supraventricular tachycardia due to pseudoephedrine intake.     

三维电生理导航系统指导下导管射频消融术治疗阵发性室上性心动过速的效果及安全性

目的分析三维电生理导航系统(Carto3)指导下导管射频消融术(RFA)治疗阵发性室上性心动过速(PSVT)的效果及安全性。方法将我院收治的64例PSVT患者按手术方案不同分为研究组与参照组,各32例。研究组给予Carto3指导下导管RFA,参照组给予X线透视下常规消融法。比较两组的消融成功率、临床相关指标及并发症发生率。结果研究组消融成功率为96.88%,高于参照组的81.25%(P<0.05);研究组的肺静脉定口时间、环肺静脉消融时间、X线辐射时间均短于参照组(P<0.05)。两组的并发症总发生率比较,差异无统计学意义(P>0.05)。结论Carto3指导下导管RFA治疗PSVT患者可提高消融成功率,缩短肺静脉定口时间、环肺静脉消融时间、X线辐射时间。     

胺碘酮治疗阵发性室上性心动过速30例临床分析

目的：探讨胺碘酮治疗阵发性室上性心动过速的临床效果及安全性。方法：回顾性分析2011年1月至2012年12月收治的应用胺碘酮治疗阵发性室上性心动过速30例的临床资料。结果：本组30例中,3小时内恢复窦性心律25例（83．3％）,5小时内恢复窦性心律2例（6．7％）,8小时内恢复窦性心律2例（6．7％）,24小时内恢复窦性心律1例（3-3％）;治疗过程中未见严重副作用。结论：胺碘酮治疗快速性室上性心动过速安全有效。     

老年阵发性室上性心动过速药物治疗的回顾性研究

目的:采用回顾性研究方法比较两种不同类型抗心律失常药物Ⅰc类药物普罗帕酮和Ⅳ类药物维拉帕米治疗老年阵发性室上性心动过速的疗效及相关的不良反应。方法:对我院急诊医学科2008-2012年68例老年阵发性室上性心动过速患者应用不同类型的抗心律失常药物普罗帕酮和维拉帕米进行治疗。普罗帕酮组:普罗帕酮35～140mg在心脏监护的情况下缓慢静脉注射。维拉帕米组:维拉帕米5～10mg在心脏监护的情况下缓慢静脉注射。心脏监护持续到转复后2h。结果:普罗帕酮和维拉帕米治疗老年阵发性室上性的疗效无差异,严重不良反应维拉帕米较普罗帕酮发生率高。结论:对老年阵发性室上性心动过速患者进行药物治疗时,一定要遵循个体化,权衡疾病的进展以及药物的反应。     

Hospitalization rate of paroxysmal supraventricular tachycardia in Sweden

Abstract

Introduction: The hospitalization rate of paroxysmal supraventricular tachycardia (PSVT) in a nationwide study is not established. We determined age- and sex-specific hospitalization rates and time trends for hospitalized PSVT in the Swedish population between 1987 and 2010.

Methods: This nationwide study is based on the Swedish Hospital Discharge Register. The patients with first PSVT diagnoses between January 1987 and December 2010 were identified.

Results: A total of 42,765 individuals with PSVT were diagnosed (mean age 60 years; 44% males). The overall age- and sex-adjusted hospitalization rate was 20 per 100,000 person-years. The hospitalization rate increased with advancing age with highest hospitalization rates in individuals aged 80–84 years (67.12 per 100,000 person-years) and did not change significantly over time. A total of 20,011 (46.8%) patients had “lone” PSVT without any comorbidities. Lone PSVT patients were younger than PSVT patients with comorbidities (mean age 54 vs. 67 years, p?=?.0002).

Conclusions: This study showed a slight preponderance for females and stable hospitalization rate of PSVT over time; the hospitalization rate increased with age. A high proportion of PSVT patients had no comorbidities. They were affected at a younger age than patients with comorbidities, which suggests an inherent predisposition.

• Key messages

• This study represents the first extensive and nationwide hospitalization study of PSVT. Hospitalization is highest in old age but a bimodal pattern was observed with a small peak in the first years of life. Patients with lone PSVT are younger than those with comorbidities; which suggests an inherent predisposition.

     

Reproducible induction of atrioventricular nodal reentrant tachycardia with adenosine triphosphate

A 29-year-old woman was referred for electrophysiological testing and radiofrequency ablation because of repeated episodes of palpitation of a 8-year duration. The 12-lead ECG during palpitations showed narrow QRS tachycardia at a rate of 160 beats/min. Dual AVN physiology according to electrophysiological criteria was not shown by single atrial extrastimulation and the tachycardia could not be induced. Slow/fast atrioventricular nodal reentrant tachycardia (AVNRT) was induced once by double atrial extrastimuli, but it was not reproducible. However, intravenous bolus injection of adenosine triphosphate (12.5 mg) during sinus rhythm led to reproducible initiation of slow/fast AVNRT.     

Self-conversion of supraventricular tachycardia by rapid atrial pacing.

The use of pacemakers in the treatment of tachycardias is one of the most exciting and rapidly expanding applications of cardiac pacing. One of the more recent developments in this field has been the use of patient-activated radio frequency transmitted rapid atrial stimulation (RAS) in the treatment of paroxysmal supraventricular tachycardia (PSVT). Based on the previously established ability of asynchronous atrial pacing to interrupt a variety of re-entrant supraventricular rhythm disturbances, this modality of treatment is gaining increasing applicability in patients with PSVT associated with debilitating symptoms or other severe cardiovascular consequences in whom standard pharmacological regimens have either failed or are impossible to maintain for indefinite periods. This report describes our experience with five patients who underwent implantation of RAS units. The detailed electrophysiological studies required to ensure success and avoid any possible future complications are described. Over a follow-up period of four months to four years (mean 16 months) very few problems arose in the use of these units which have immeasurably improved the quality of life of the recipients. Our experience with RAS units has led to a few suggestions for future improvement and these are outlined in this report. The excellent patient acceptance and the reliability of this technique in terminating episodes of PSVT should, in the future, render RAS the treatment of choice in certain selected patients suffering from this common disorder.     

Heart Rate During Spontaneous and Induced Paroxysmal Supraventricular Tachycardia

It is generally assumed that paroxysmal supraventricular tachycardia (PSVT) induced during invasive electrophysiological study reproduces the patient's spontaneous, clinical arrhythmia. Even in the absence of antiarrhythmic drugs, however, there may be significant differences in characteristics of the induced and spontaneous arrhythmias. We compared the heart rate of PSVT in 38 patients who had undergone electrophysiological study with induction of PSVT who also had a spontaneous episode of PSVT documented by transtelephonic ECG monitoring during a period when all antiarrhythmic drugs were withheld. The heart rate during spontaneous PSVT was faster than the heart rate of PSVT induced during electrophysiological study; the mean difference was 16 beats/min (P < 0.001). We conclude that heart rate of PSVT induced during electrophysiological study generally underestimates the heart rate of spontaneous PSVT in the antiarrhythmic drug-free state. This may be due to differences in the autonomic and hemodynamic states during spontaneous and induced arrhythmias.     

阵发性室上性心动过速急诊科不同治疗方法比较

目的：比较急诊科常用的4种治疗方法对阵发性室上性心动过速（PSVT）的疗效。方法：选择2007年8月-2009年3月急诊科诊断的236例PSVT患者,应用不同方法：迷走神经刺激法（对照组）,去乙酰毛花苷,普罗帕酮和胺碘酮进行治疗,对比不同方法的有效转复率、转复时间及不良反应。结果：有效转复率,迷走神经刺激法为17．86％,去乙酰毛花苷为56．45％,普罗帕酮为74．14％,胺碘酮为93．33％。三组药物复律与迷走神经刺激法复律存在明显差异（P〈0．05,P〈0．01）。胺碘酮复律高于去乙酰毛花苷（P〈0．01）和普罗帕酮（P〈0．01）。转复时间：迷走神经刺激法最短,胺碘酮最长,二者比较差异有显著性（P〈0．05）,但胺碘酮与普罗帕酮复律时间无明显差异。不良反应发生率：迷走神经刺激法3．57％,去乙酰毛花苷17．74％,普罗帕酮10．34％,胺碘酮13．33％。与迷走神经刺激方法比较：去乙酰毛花苷差异有显著性（0．01〈P〈0．05）,胺碘酮、普罗帕酮的不良反应差异无显著性。结论：复律,胺碘酮和普罗帕酮较高,去乙酰毛花苷次之,迷走神经刺激法最低。转复时间,迷走神经刺激法最短,胺碘酮最长。不良反应,短期应用普罗帕酮、胺碘酮的不良反应不明显,去乙酰毛花苷有明显的不良反应。     

胺碘酮治疗阵发性室上性心动过速56例临床分析

目的：总结胺碘酮治疗阵发性室上性心动过速的临床疗效及副作用.方法：回顾性分析2010年1月至2012年12月我科收治的阵发性室上性心动过速患者56例的临床资料,56例阵发性室上性心动过速患者均为临床诊断,胺碘酮采取静脉应用,负荷量（150 mg）加维持量（1 mg/min）,首次给药后15-20 min未复律者,再给予负荷量150 mg,负荷总量小于500 mg,2小时后进行疗效和副作用判断.结果：本组56例患者中,1小时内复律21例（37.5％）,2小时内复律49例（87.5％）,无效7例（12.5％）;出现低血压3例（5.4％）,恶心2例（3.6％）,浅静脉炎1例（1.8％）,均无需特殊处理.结论：胺碘酮静脉应用治疗阵发性室上性心动过速疗效显著,副作用少,值得临床推广应用.     

Studies on the Prevalence of Complicated Atrial Arrhythmias, Flutter, and Fibrillation in Patients with Reciprocating Supraventricular Tachycardia Before and After Successful Catheter Ablation

Atrial flutter and AF are complications in approximately 30% of cases of paroxysmal supraventricular tachycardia (PSVT)-indicated catheter ablation, and it is of interest to determine if therapeutic modification for PSVT would eliminate combined atrial tachyarrhythmia like atrial flutter and AF. The aim of this study was to determine the incidence and the risk of atrial tachyarrhythmias after catheter ablation of PSVT. A total of 152 patients (age range 12-74, mean 41 +/- 17 years) with accessory pathway (n = 106) and/or dual atrioventricular nodal conduction (n = 46) were enrolled in a 2-year follow-up program after successful catheter ablation. Possible risks on clinical background (age, sex, PSVT duration, hemodynamic instability during attacks), premature atrial contraction (PACs) on Holter monitoring, echocardiographic left atrial size, and electrophysiological property (insertion site, conduction type, effective refractory period) were evaluated. Atrial flutter and AF were complications in 53 (35%) of the subjects, who were elderly and had a longer PSVT history with a larger left atrial dimension and frequent PACs; however, the electrophysiological properties were similar. After a 2-year follow-up period 36 (24%) of the patients still exhibited PAC runs, including 13 (9%) with atrial flutter and AF, each one of whom were complicated with nonlethal cerebral thromboembolism and congestive heart failure. Multiplelogistic-regression analysis revealed that advanced age (> or = 41 years, P = 0.0152) and frequent PACs (> or = 1% of total daily QRS counts, P = 0.0426) on Holter monitoring are the risk factors of PAC runs and/or atrial flutter and AF. In conclusion, successful ablation for PSVT is thought to be beneficial for preventing atrial flutter and AF. However, careful follow-up to monitor for the recurrence and atrial flutter and AF related complications, especially in patients of solitary atrial flutter and AF without reciprocating tachycardia and with frequent PAC.     

Tachycardias Initiated by Automatic Antitachycardia Pacemakers

Available automatic tachycardia-terminating pacemaker cannot distinguish between physiological and pathological tachycardia and, consequently, electrical stimulation during sinus tachycardia can occur. In order to evaluate whether this might be an arrhythmogenic problem or not the cardiac response in eight patients having paroxysmal supraventricular tachycardia treated with tachycardia-terminating pacemakers was studied during exercise. After tachycardia recognition, the implanted pulse generator automatically emits single or double critically timed premature stimuli for termination of the arrhythmia. Post-implantation examination revealed successful tachycardia termination by the pacemaker at rest, without the addition of any antiarrhythmic drugs, in all eight patients. During exercise tests, the sinus rate in seven patients exceeded the programmed tachycardia trigger rate resulting in triggered pacemaker stimulation. The native supraventricular tachycardia was initialed in four cases. In one of these patients, two short episodes of probable ventricular tachycardia were also recorded. This study demonstrates the clinical value of post-implantation assessments with exercise tests concerning the problem of pacemaker-initiated tachyarrhythmias. Tachycardia-terminating devices can induce tachycardias, and individual precautions must be taken in order to prevent or minimize the risk of pacemaker reversion of sinus rhythm to paroxysmal tachycardia or hazardous arrhythmias.     

Mechanisms of Spontaneous Tachycardia Termination in a Patient with the Wolff-Parkinson-White Syndrome and Dual Atrioventricular Nodal Pathways

A patient with the Wolff-Parkinson-White syndrome and recurrent bouts of paroxysmal supraventricular tachycardia underwent electrophysiologic studies. These studies revealed evidence of dual atrioventricular nodal pathways and a septal accessory pathway. The tachycardia circuit involved anterograde conduction over a slow atrioventricular nodal pathway and retrograde conduction over the accessory pathway. Spontaneous tachycardia termination was frequently observed, was almost always abrupt, and was associated with a beat-to-beat decrease in the A-H interval, In this patient, the mechanism for spontaneous tachycardia termination appeared to be an abrupt shift in anterograde conduction from the slow to the fast pathway, advancing the tachycardia so that the block occurred in the accessory pathway (or atrium). To our knowledge, this mechanism of spontaneous tachycardia termination has not been described previously. Use of agents to facilitate fast atrioventricular nodal conduction (i.e., atro-pine) may be effective in tachycardia termination for these patients.