scholarly journals Recurrence of palpitations following electrophysiological study and ablation in suspected but undocumented paroxysmal supraventricular tachycardias: follow-up results of the BELIEVE-SVT registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Marco Del Castillo ◽  
J Ramos Jimenez ◽  
VC Lozano Granero ◽  
M Rodriguez Manero ◽  
P Ramos Fernandez ◽  
...  
Keyword(s):  
Electrophysiological Study ◽  
Clinical Suspicion ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Early Referral ◽  
Clinical Recurrence ◽  
Funding Sources ◽  
High Clinical Suspicion ◽  
Pr Interval ◽  
Supraventricular Tachycardias

Abstract Funding Acknowledgements Type of funding sources: None. Introduction ECG documentation of paroxysmal supraventricular tachycardias (PSVT) may be challenging due to their short duration and usually abrupt end.  As ablation represents first-line treatment of this pathologies, it is not uncommon that physicians refer patients to electrophysiological study (EPS) when symptoms are suggestive of PSVT even though no ECG documentation has been obtained. Our objective was to evaluate the results of ablation performed in patients with induced arrhythmias in EPS but no previous ECG documentation. Methods Retrospective and observational multicenter registry of consecutive patients undergoing EPS, followed or not by ablation, referred because of undocumented clinical suspicion of PSVT. We collected clinical, EPS and clinical follow-up data, along with data regarding ablation, when performed. Descriptive statistical analysis was carried out using Stata. Results 427 patients of 12 centers were included. Mean age was 46.3 ± 16.1 and 297 (69.6%) were females. Sustained arrhythmias were induced in most patients (n = 255; 59.7%) and ablation was performed in 274 (64.2%). 10 complications (2.3% of procedures) were reported: 3 transient AV block, 2 PR interval prolongation, 2 puncture-related hematoma, 2 painful sites of puncture and 1 catheter entrapment in mitral chordae. During a mean follow-up of 3.1 ± 2.0 years, 111 patients experienced recurrence of palpitations, mostly (n = 77; 69.4%) without ECG documentation. Clinical recurrence was more frequent in subjects who had not been ablated (41.8% vs 17.2% in ablated patients; risk ratio 2.44 (CI 95% 1.77-3.36); p < 0.001). Table 1 shows types of clinical recurrences. Conclusions EPS in patients with high clinical suspicion of PSVT, followed by ablation when tachycardia is induced is effective in preventing future recurrences of palpitations. Early referral for EPS can, therefore, reduce visits to the emergency room, admissions and healthcare burden due to other low-yield, unnecessary tests. Type of recurrence ECG documentation 34(8.0%) ·Sinus rhythm 12(2.8%) ·Atrial tachycardia 6(1.4%) ·Typical atrioventricular nodal reentrant tachycardia 5(1.2%) ·Atrial fibrillation 5(1.2%) ·Premature ventricular beats 3(0.7%) ·Orthodromic atriventricular tachycardia 2(0.5%) Non documented recurrence 77(18.0%)

Clinical recurrence of palpitations following slow pathway ablation in patients with suspected paroxysmal supraventricular tachycardias but non-documented, non-inducible tachycardias

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Ramos Jimenez ◽  
A Marco Del Castillo ◽  
VC Lozano Granero ◽  
C Lazaro Rivera ◽  
R Salgado ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Clinical Suspicion ◽  
Therapeutic Modality ◽  
P Value ◽  
Slow Pathway ◽  
Clinical Recurrence ◽  
Slow Pathway Ablation ◽  
Supraventricular Tachycardias

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation is recommended as first-line treatment in patients with atrioventricular nodal reentry tachycardias (AVNRT). However, the best therapeutic modality in patients with dual AV nodal physiology but non-inducible tachycardias in electrophysiological study (EPS) remains controversial, especially when no tachycardias have been documented. Our objective was to evaluate the results of empirical slow pathway ablation in patients showing dual AV nodal physiology but non-inducible AVNRT. Methods Multicenter, retrospective, observational registry of consecutive patients undergoing EPS due to clinical suspicion of paroxysmal supraventricular tachycardias (PSVT), but with no prior ECG documentation. Clinical, EPS and ablation (when performed) data were collected and andalyzed.  Results 427 patients of 12 centers were included. Mean age was 46.3 ±16.1 and 297 (69.6%) were females. AVNRT was induced in 188 patients (typical in 181 cases, atypical in 7). Dual AV nodal physiology with or without single nodal echo beats, but with no sustained tachycardia and without evidence of accessory pathway was present in 68 patients. Ablation of the slow pathway was performed in 187/188 patients with AVNRT and in 30/68 patients with dual physiology. Among subjects with non-inducible tachycardia, ablation reduced significantly recurrences (39.5% in non-ablated vs. 16.7%; p = 0.04), with a level equivalent to those with ablated AVNRT(14.4% vs. 16.7%; p = 0.75). Procedure-related complications were similar in both groups: empirical ablation n = 1; 3.3% vs. induced tachycardia n = 6; 3.2% (p = 0.98). Conclusions In patients with high clinical suspicion of PSVT but non-documented and non-inducible arrhythmias, the presence of dual AV nodal physiology makes AVNRT a likely mechanism of the clinical tachycardia. Catheter ablation of slow pathway reduces the risk of recurrence to a level equivalent to those with inducible and ablated AVNRT. AVNRT (n = 188) Dual nodal physiology (n = 68) p value Age (years) 48.6 ± 16.3 41.9 ± 14.0 <0.01 Female 71.8% 67.7% 0.52 Years symptomatic 9.3 ± 11.3 3.6 ± 8.1 <0.01 Sudden onset 83.9% 88.0% 0.54 Abrupt end 73.4% 74.6% 0.96 Previous rate-slowing drugs 30.9% 25.0% 0.36 Previous antiarrhythmic drugs 5.9% 2.9% 0.35 Isoproterenol in EPS 70.0% 89.7% <0.01

Result of electrophysiological study in patients with undocumented suspected paroxysmal supraventricular tachycardia: the BELIEVE-SVT registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Ramos Jimenez ◽  
A Marco Del Castillo ◽  
VC Lozano Granero ◽  
P Ramos Fernandez ◽  
D Jimenez Sanchez ◽  
...  
Keyword(s):  
Electrophysiological Study ◽  
Sudden Onset ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Atrioventricular Reentrant Tachycardia ◽  
Funding Sources ◽  
Painful Site ◽  
First Choice ◽  
Study Results ◽  
Pr Interval ◽  
Supraventricular Tachycardias

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Paroxysmal supraventricular tachycardias (PSVT) are common arrhythmias and catheter ablation is considered its first-line treatment. However, the duration of the episodes frequently precludes ECG documentation. Thus, patients may not be referred for ablation until the tachycardia is documented, leading to recurrences, emergency room visits and often unnecessary tests or treatments. Our objective was to evaluate the results of electrophysiological study (EPS) followed or not by ablation in patients with suspected but not documented PSVT. Methods Multicenter, retrospective, observational registry of consecutive patients undergoing EPS due to clinical suspicion of PSVT, but with no prior ECG documentation. Collection of clinical and EPS data, along with data regarding ablation, when performed. Results 427 patients of 12 centers were included. Mean age was 46.3 ±16.1 and 297 (69.6%) were females. Most frequent symptoms consisted on sudden onset (n = 360; 84.9%) and abrupt end (n = 304; 72.0%), with median episode duration of 10 minutes (interquartile range 5-20 min). Sustained arrhythmias were induced in most patients (n = 255; 59.7%). Specific types are summarized in Table 1. Ablation was performed in 274 (64.2%) patients. A total of 10 complications (2.3% of procedures) were reported: 3 transient AV block, 2 PR interval prolongation, 2 puncture-related hematoma, 2 painful site of puncture and 1 catheter entrapment in mitral chordae. Conclusions Electrophysiological study in patients with palpitations highly suggestive of PSVT is an effective and safe diagnostic and therapeutic tool that may be considered as a first-choice even in the absence of documented tachycardia. Results of EP study Results of electrophysiological study Typical AVNRT 183 (42.9%) Orthodromic AVRT 38 (8.9%) Dual AV nodal physiology 30 (7.0%) 1 nodal echo beat 21 (4.9%) Atrial tachycardia 19 (4.5%) >1 nodal echo beat 17 (4.0%) Atrial fibrillation 7 (1.6%) Atypical AVNRT 7 (1.6%) Atrial flutter 1 (0.2%) No abnormal findings 104 (24.4%) AVNRT atrioventricular nodal reentran tachycardia AVRT atrioventricular reentrant tachycardia

scholarly journals Post-cardiac injury syndrome triggered by radiofrequency ablation for AVNRT

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Florian A. Wenzl ◽  
Martin Manninger ◽  
Stefanie Wunsch ◽  
Daniel Scherr ◽  
Egbert H. Bisping
Keyword(s):  
Pericardial Effusion ◽  
Electrophysiological Study ◽  
Cardiac Injury ◽  
Myocardial Damage ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Rf Ablation ◽  
Close Proximity ◽  
History Of

Abstract Background Post-cardiac injury syndrome (PCIS) is an inflammatory condition following myocardial or pericardial damage. In response to catheter ablation, PCIS most frequently occurs after extensive radiofrequency (RF) ablation of large areas of atrial myocardium. Minor myocardial injury from right septal slow pathway ablation for atrioventricular nodal reentrant tachycardia (AVNRT) is not an established cause of the syndrome. Case presentation A 62-year-old women with a 6-year history of symptomatic narrow-complex tachycardia was referred to perform an electrophysiological study. During the procedure AVNRT was recorded and a total of two RF burns were applied to the region between the coronary sinus and the tricuspid annulus. Pericardial effusion was routinely ruled out by focused cardiac ultrasound. In the following days, the patient developed fever, elevated inflammatory and cardiac markers, new-onset pericardial effusion, characteristic ECG changes, and complained of pleuritic chest pain. An extensive workup for infectious, metabolic, rheumatologic, neoplastic, and toxic causes of pericarditis and myocarditis was unremarkable. Cardiac magnetic resonance imaging showed no signs of ischemia, infiltrative disease or structural abnormalities. The patient was diagnosed with PCIS and initiated on aspirin and low-dose colchicine. At a 1-month follow-up visit the patient was free of symptoms but still had a small pericardial effusion. After three  months of treatment the pericardial effusion had resolved completely. Conclusions Inflammatory pericardial reactions can occur after minor myocardial damage from RF ablation without involvement of structures in close proximity to the pericardium.

Atrial fibrillation in the young: clinical characteristics, predictors of new onset and outcomes

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Segev ◽  
E Maor ◽  
M Goldenfeld ◽  
E Grossman ◽  
R Beinart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
P Value ◽  
Bundle Branch Block ◽  
Total N ◽  
Funding Sources ◽  
Conduction Disorders ◽  
Tertiary Center ◽  
Pr Interval ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) onset in the young (≤45 years) is uncommon and not well studied. Purpose Identifying the determinants of AF in this population in order to help direct timely diagnosis, appropriate follow up and management. Methods We retrospectively evaluated all patients aged ≤45, admitted to the internal and cardiology wards between January 2009 and December 2019 at a large tertiary center. Clinical, electrocardiographic and echocardiographic data were collected and compared among patients with and without AF at baseline. A subgroup of patients with no AF at baseline and a subsequent hospital visit were followed for development of new onset AF (NOAF). Results A total of 16,432 patients (55.5% male, 33 ±8.3 years old) were analyzed. At baseline, patients with AF (n = 366) tended to be older, more often male, and had a higher proportion of comorbidities and ECG conduction disorders, compared with the patients without AF (n = 16,066). Male sex, increased age, obesity, heart failure (HF) and the presence of left or right bundle branch block (LBBB and RBBB, respectively) were all strongly and independently associated with young-onset AF. A total of 10,691 patients were followed for a median of 41.5 (16.6-78.6) months, during which 85 patients developed NOAF (equivalent to 0.5%/year). Increased age, hypertension, HF, RBBB and LBBB were independent predictors of NOAF. CHARGE-AF score outperformed CHA2DS2-VASc score in NOAF prediction [AUC of ROC 0.75 (0.7-0.8) vs. 0.56 (0.48-0.65)]. Conclusions The annual risk of NOAF among young adults admitted to the hospital is noteworthy. NOAF may be predicted by clinical risk factors and the CHARGE-AF score. Characteristic No AF (N = 16066) AF (N = 366) Total (N = 16432) P value Age- yr. 33.06 ± 8.3 36.8 ± 7.3 33.1 ±8.3 <0.0001 Male gender 8914 (55.5) 240 (65.6) 9154 (55.7) <0.0001 BMI- kg/m2 25.5 ± 5.75 27.48 ± 6.36 25.2 ± 5.8 <0.0001 HTN 2679 (16.7) 73 (19.9) 2752 (16.7) 0.098 CHF 124 (0.8) 13 (3.6) 137 (0.8) <0.0001 PR interval > 200ms 117 (1.3) 15 (9.1) 132 (1.5) <0.0001 QRS interval > 120ms 220 (2.4) 25 (8.4) 245 (2.6) <0.001 LBBB 29 (0.2) 6 (1.6) 35 (0.2) <0.0001 LVEF < 40 323 (10.1) 35 (16.9) 358 (10.5) 0.002 CHA2DS2-VASc 0.75 ±0.75 0.73 ±0.84 0.74 ±0.76 0.647 CHARGE AF 6.3 ±1.1 6.8 ±0.9 6.32 ±1.06 <0.001

scholarly journals Peripheral Facial Palsy in the Setting of Melkersson-Rosenthal Syndrome

2001 ◽  
Vol 20 (2) ◽  
pp. 233-235
Author(s):  
Sabrina Pimentel ◽  
Amélia Mendes ◽  
Maria José Rosas
Keyword(s):  
Case Report ◽  
Facial Palsy ◽  
Clinical Suspicion ◽  
Peripheral Facial Palsy ◽  
High Clinical Suspicion ◽  
Clinical Triad ◽  
Suspicion Index ◽  
Fissured Tongue

Melkersson-Rosenthal syndrome is characterized by recurrent periph­eral facial palsy, recurrent or persistent orofacial edema and a fissured tongue. However, this clinical triad occurs only in a minority of cases; mono or oligosymptomatic forms are much more common. The au­thors describe a case report of a 39-year-old woman with Melkersson- Rosenthal syndrome, discuss the evolution of the disease and treat­ment, highlighting the need of a high clinical suspicion index and a regular follow-up to reduce progression of deficits

scholarly journals Radiofrequency Catheter Ablation in Children with Supraventricular Tachycardias: Intermediate Term Follow up Results

2012 ◽  
Vol 6 ◽  
pp. CMC.S8578 ◽  
Author(s):  
Mm. Hafez ◽  
Mm. Abu-Elkheir ◽  
M. Shokier ◽  
Hf. Al-Marsafawy ◽  
Hm. Abo-Haded ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Electrophysiologic Study ◽  
Atrioventricular Reentrant Tachycardia ◽  
Pediatric Age Group ◽  
Line Of Therapy ◽  
Supraventricular Tachycardias

The Purpose of the Study Radiofrequency (RF) catheter ablation represents an important advance in the management of children with cardiac arrhythmias and has rapidly become the standard and effective line of therapy for supraventricular tachycardias (SVTs) in pediatrics. The purpose of this study was to evaluate the intermediate term follow up results of radiofrequency catheter ablation in treatment of SVT in pediatric age group. Methods A total of 60 pediatric patients (mean age = 12.4 ± 5.3 years, ranged from 3 years to 18 years; male: female = 37:23; mean body weight was 32.02 ± 12.3 kg, ranged from 14 kg to 60 kg) with clinically documented SVT underwent an electrophysiologic study (EPS) and RF catheter ablation at Children's Hospital Mansoura University, Mansoura, Egypt during the period from January 2008 to December 2009 and they were followed up until October 2011. Results The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 45, 75%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 6, 10%), and atrial tachycardia (AT; n = 9, 15%). The success rate of the RF catheter ablation was 93.3% for AVRT, 66.7% for AVNRT, and 77.8% for AT, respectively. Procedure-related complications were infrequent (7/60, 11.7%), (atrial flutter during RF catheter ablation (4/60, 6.6%); ventricular fibrillation during RF catheter ablation (1/60, 1.6%); transient complete heart block during RF catheter ablation (2/60, 3.3%)). The recurrence rate was 8.3% (5/60) during a follow-up period of 34 ± 12 months. Conclusion RF catheter ablation is an effective and safe method to manage children with SVT.

The prevalence of short PR interval in adolescent athletes and non-athletes

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Abela ◽  
N Grech ◽  
S Degiorgio ◽  
R Xuereb ◽  
S Xuereb ◽  
...  
Keyword(s):  
Clinical Relevance ◽  
Screening Program ◽  
Adolescent Athletes ◽  
Funding Sources ◽  
Athletic Ability ◽  
Pr Interval ◽  
Long Term Follow Up ◽  
Heart Foundation

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Malta Heart Foundation and Beating Hearts Background Little is known about the prevalence and clinical relevance of an isolated short PR interval in young individuals. Objectives To explore the PR interval in adolescent athletes and non-athletes and determine possible association with sex, age, ethnicity, athletic ability and sporting discipline. Methods Between 2017-2018, school children aged 14-17 years were invited to participate in a National cardiac screening programme comprised of a health questionnaire and a resting 12-lead ECG. An athlete was defined as an individual participating in >4 hours/week of organised sports. Sport disciplines were categorised as skill, power, mixed and endurance. A short PR interval was defined as <120ms. Results A total of 1619 (61.0%) non-athletes and 1036 (39.0%) athletes  (median age 15 years, 50.5% females, 93.0% Caucasian) participated in the screening program. Most athletes participated in mixed sports (62.2%). The mean PR interval was shorter in non-athletes compared to athletes (136.65 ± 19.00ms vs 139.93 ± 19.86ms p < 0.001) and in females compared to males (135.98 ± 18.39ms vs 139.93 ± 20.20ms, p < 0.001). An isolated short PR interval was present in 405 (15.3%) individuals. Associated pre-excitation was present in an additional 5 cases (0.2%). A short PR interval was commoner in females (18.7% vs 11.7%, p < 0.001) and in non-athletes (16.6% vs 13.2%, p = 0.020). Age (p = 0.657) and ethnicity (p = 0.115) did not influence the presence of a short PR interval. The presence of a short PR interval in adolescent athletes was independent of the sporting discipline category (p = 0.071), in both males (p = 0.400) and females (p = 0.233).  The absolute PR interval did not differ significantly between sporting categories (p = 0.065),  in both genders (males, p = 0.202, females, p = 0.279). Symptoms that were suggestive of arrhythmias were present in similar proportions of individuals with short and normal PR intervals (18.8% vs 17.1%, p = 0.393).  Conclusion An isolated short PR interval was a frequent finding in this cohort, with a predilection for females and non-athletes. The high frequency of short PR in young individuals suggests that in the absence of pre-excitation or symptoms, further evaluation is not warranted. Long-term follow-up studies may further elucidate the clinical relevance of this phenomenon.

scholarly journals Fracture of the Body of the Hamate With Dorsal Dislocation of the 4th and 5th Metacarpals: A Case Report

2017 ◽  
Vol 11 (1) ◽  
pp. 447-451 ◽  
Author(s):  
Vasilis Athanasiou ◽  
Ilias D. Iliopoulos ◽  
Konstantinos Pantazis ◽  
Andreas Panagopoulos
Keyword(s):  
Case Report ◽  
Full Range ◽  
Clinical Suspicion ◽  
The Body ◽  
Dominant Hand ◽  
Intraarticular Fracture ◽  
Patient Morbidity ◽  
High Clinical Suspicion ◽  
With Screws

Background: Solitary fractures of the body of the hamate are rare. Their diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination. Case report: We present a case of a 36-year-old male patient who sustained an intraarticular fracture of the body of the hamate along with dorsal dislocation of the 4th and 5th metacarpals on his right dominant hand. Through a dorsal surgical approach, he underwent ORIF of the hamate with screws and stabilization of the dislocated 4th and 5th metacarpals with KW. At his last follow-up appointment, 18 months postoperatively, he had no pain, almost full range of motion on his fingers and a Mayo Wrist score of 90 points. Conclusions: Hamate fractures are rare entities that can cause significant patient morbidity if not recognized and treated appropriately.

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