Refractory swallowing-induced paroxysmal supraventricular tachycardia

A 51-year-old female with a two-year history of palpitations associated with swallowing was evaluated by intracardiac electrophysiologic studies. Intracardiac recordings documented the presence of an ectopic left atrial focus induced by swallowing with no evidence of accessory pathway conduction. Gastrointestinal evaluation did not demonstrate any significant disorder. The tachycardia was refractory to all pharmacologic therapy including investigational therapy with mexiletine and amiodarone.     

Orthostatic paroxysmal ventricular tachycardia

An unusual instance of orthostatic paroxysmal ventricular tachycardia in a young woman with no other evidence of heart disease is reported. The relation to autonomic imbalance is discussed.     

Refractory paroxysmal supraventricular tachycardia incited by multiple mechanisms

A patient with refractory paroxysmal supraventricular tachycardia post acute myocardial infarction is presented. His bundle recordings and atrial stimulation studies suggest atrioventricular nodal reentry precipitated by three different mechanisms. Therapy required permanent coronary vein pacing and drugs.     

aVR导联与阵发性室上性心动过速相关性研究

目的研究aVR导联中ST段抬高对阵发性室上性心动过速(PSVT)的诊断价值。方法分析PSVT发作时在aVR导联中ST段抬高情况,同时结合心电生理检查结果对其进行对比分析。结果 259例PSVT者按折返部位不同分为两组:①A组:房室折返性心动过速者158例,占61.00%;②B组:房室结折返性心动过速者101例,占39.00%。A组中PSVT发作时aVR导联ST段抬高者59例,占37.34%;B组中PSVT发作时aVR导联ST段抬高者79例,占78.22%。B组显著高于A组。A组中有左侧旁道参与的PVST者有75例(A1组),其中PSVT发作时aVR导联ST段抬高者64例,占85.33%。结论 aVR导联ST段抬高对有旁道参与的PVST有诊断价值,特别是左侧旁道参与者有十分明显的鉴别诊断意义。     

Familial paroxysmal ventricular tachycardia in two sisters

Two sisters, aged 13 and 17 years, who presented with paroxysmal ventricular tachycardia and intermittent left axis deviation are described. They had otherwise normal hearts with normal Q-T intervals; hearing was also clinically normal. Satisfactory therapeutic control of paroxysms of ventricular tachycardia was achieved, using a combination of practolol and quinidine, although isolated multiform ventricular extrasystoles persisted.     

The clinical recognition of paroxysmal ventricular tachycardia

There are clinical criteria that enable one to make a bedside diagnosis of paroxysmal ventricular tachycardia. These are slight irregularities in the rapid heart rhythm which otherwise appears quite regular, a changing quality and intensity of the first heart sound as heard at the apex, and the failure to slow the heart by vagal stimulation. This condition previously has been considered unrecognizable except by the use of electrocardiograms. There are instances where the differentiation between this condition and paroxysmal auricular tachycardia is of great importance.     

Refractory ventricular tachycardia terminated by electric countershock

A case of persistent ventricular tachycardia terminated by alternating current countershock is presented. The importance of electric countershock as a means of controlling refractory ventricular tachycardia in dire situations is discussed.     

A case of paroxysmal ventricular tachycardia during pregnancy

We report a case of a 37-year-old woman who had paroxysmal ventricular tachycardia (VT) during early pregnancy. She had severe hyperemesis, palpitation at 6 weeks of gestation and many episodes of paroxysmal VT, but no apparent organic heart disease. At that time she had a transient increase of thyroid hormone levels. With bed rest and without medication, her symptoms and episodes of VT disappeared in accordance with the improvement of hyperemesis and thyrotoxicosis. She demonstrated a rare course of arrhythmias in which the deterioration of VT was observed at transient thyrotoxicosis and hyperemesis.     

Conservative treatment of paroxysmal ventricular tachycardia during pregnancy

Paroxysmal ventricular tachycardia during pregnancy presents a therapeutic dilemma for the treating physician. The clinical course of two otherwise healthy pregnant patients with this arrhythmia in whom treatment was withheld is outlined. The indications and guidelines for treatment in relatively asymptomatic patients is discussed.