Slow pseudo sinus rhythm and atrial tachycardia of right superior venous pulmonary origin

ABSTRACT Paroxysmal atrial tachycardia usually presents as a sudden acceleration of the atrial rate combined with modifications of the P wave morphology. A 22-year-old patient presented with very fast and very slow atrial ectopic activity. He complained of repetitive episodes of fast tachycardia, some accompanied with dizziness. When the ectopic discharge was slow, no clear-cut difference between the sinus rate and the ectopic rate was seen and thus the atrial rhythm appeared quite regular. The ectopic focus was situated deep inside the right upper pulmonary vein (RSPV). After RSPV isolation a persistent sinus rhythm was established and since then the patient has been asymptomatic for 3 years. Thus, subtle changes in the P wave morphology without a significant change in the heart rate in patients presenting with palpitations can give a clue to the diagnosis of the tachycardia and the localization of the ectopic focus.

Abstract MP208: A Shared Fog2 / Tbx5-dependent Gene Regulatory Network Identified By Transcription Factor-dependent Non-coding RNA Profiling Modulates Cardiac Rhythm

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting over 33 million individuals throughout the world. AF is highly heritable and recent genome-wide association studies (GWAS) have cumulatively identified over 100 loci associated with AF risk. Genome-wide association studies (GWAS) often identify transcription factor (TF) loci in association with complex human diseases, implying that a significant transcriptional component underlies human disease risk and etiology. The transcription factors ZFPM2 (FOG2), GATA4, and TBX5 have all been implicated in human AF risk by genetic studies. We hypothesized that FOG2, GATA4, and TBX5 functionally interact to regulate a gene regulatory network essential for atrial rhythm control. We generated a novel mouse model of spontaneous AF based on FOG2 overexpression. FOG2 ChIP-seq identified FOG2 genomic localization at loci co-occupied by GATA4, a known FOG2 binding partner. However, we found that FOG2 OE caused gene expression alterations that correlated more highly with TBX5-dependent rather than GATA4-dependent gene expression, including a module of calcium handling genes required for atrial rhythm homeostasis. We applied TF-dependent non-coding transcriptional profiling to examine the FOG2 dependent atrial GRN, which identified 805 candidate regulatory regions with accessible chromatin and FOG2 dependent ncRNAs. TBX5 removal and FOG2 OE caused highly correlated dysregulation of ncRNA expression at open chromatin regions genome-wide, suggesting a functional interaction between TBX5 and FOG2. Furthermore, FOG2 OE only affected enhancer activity by altered ncRNA abundance at locations of TBX5 co-binding. The shared TBX5/FOG2 genomic interaction predicted a potential genetic interaction, and we found that cardiac rhythm abnormalities caused by Tbx5 haploinsufficiency were rescued by Fog2 haploinsufficiency. Taken together, TF-dependent ncRNA-profiling revealed an interconnected cardiac rhythm gene regulatory network (GRN) between FOG2, TBX5 and GATA4. These data nominate a specific model in which FOG2 is recruited by GATA4 to modulate a co-bound TBX5-dependent atrial gene regulatory network for calcium handling and atrial rhythm homeostasis.

The Safety of Cardioversion in Supra Ventricular Tachycardia Patient with Pregnancy

Backgrounds. Supraventricular tachycardia is a type of tachyarrhythmia characterized by sudden changes in heart rate and increases rapidly. In supraventricular tachycardia, the abnormalities that occur include components of the conduction system and occur in the upper part of the HIS bundle. This case report describes a case of supraventricular tachycardia suspected of AVNRT in a pregnant woman accompanied by hypokalemia, hypocalcemia and prolonged QT Interval along with cardioversion which was performed as the management of this case.Case presentation. A woman, Mrs Y, 24 years old, a housewife, having her address within the city of Palembang. The patient came to the emergency department of Moh. Hoesin Hospital Palembang with the chief complaint of chest palpitations. On physical examination, there was a grade 2/6 murmur, no shortness of breath, the patient was 7 months pregnant. He had a history of heart disease SVT 8 years ago. ECG examination showed sinus rhythm with low atrial rhythm in leads II, III, AVF. On laboratory examination, the blood calcium level was 8.3 mg/dL. Management of this patient includes pharmacological and non-pharmacological management. On the 14th day of hospitalization, 100 joules of cardioversion was performed and the patient responded well. The patient's condition improved on the 20th day of treatment.Conclusion. The patient experienced a good and effective response to 100 joules of cardioversion which was performed on the 14th day of treatment. Maintenance treatment in the form of drugs in the form of diltiazem due to the condition of the patient who is 27 weeks pregnant. The next management is planning the birth process according to the patient's hemodynamics and preventing the occurrence of SVT in subsequent pregnancies.

Celiac disease presenting as abnormal atrial rhythm resolving after gluten-free diet

We describe a case of a teenager who presented with palpitations and abnormal low atrial rhythm. Celiac Disease (CD) serology, sent due to low ferritin, was positive and gastroscopy confirmed CD diagnosis. Both palpitations and abnormal rhythm resolved after gluten-free diet with normalization of CD serology.

The different surgical impact of the superior cavoatrial incision in children and adults

Introduction: The single- and double-patch repairs are undoubtedly the most commonly used techniques for the surgical management of partial anomalous pulmonary venous connection associated with sinus venosus atrial septal defect. The aim of this study was to retrospectively compare early and long-term surgical outcomes in paediatric and adult patients, focusing in particular on the occurrence of ectopic atrial rhythm. Material and methods: Seventy patients (male: 38, 54.2%) underwent surgical repair for partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. Forty-nine patients (70%) underwent surgical repair in paediatric age (<16 years old), while 21 of (30%) patients were operated in adulthood. Thirty patients (42.8%) underwent single-patch repair and 39 patients (55.7%) underwent double-patch repair. In only one patient, the Warden procedure was performed (1.4%). Median follow-up time was 52 months (IQ 15.1–113). Results: The type of surgical technique didn’t affect the incidence of ectopic atrial rhythm (26.6% in single-patch group and 25.6% in double-patch groups, p = 0.9). At long-term follow-up, ectopic atrial rhythm, as an expression of sinoatrial node disturbance, was however significantly more frequent in the paediatric population (28.8% paediatric group and 4.7% adult group, p = 0.02). Conclusions: The higher incidence of ectopic atrial rhythm in children is probably related to the closer position of the sinus node to the superior cavoatrial incision, which makes irreversible iatrogenic traumatism more likely to occur. Surgical techniques that avoid any manipulation on the superior cavoatrial junction should, therefore, be preferred for children undergoing partial anomalous pulmonary venous connection repair.

Clinical case of borreliosis myocarditis

Annotation. The purpose of the work is to demonstrate the peculiarities of its course, modern methods of diagnosis and treatment on the example of a clinical case of borreliosis myocarditis. According to the results of the patient's ECG, a transient atrio-ventricular block of the first degree was established. The results of general clinical methods of examination of the patient generally corresponded to the reference values. According to the results of Holter ECG monitoring, a diagnosis of mild myocarditis, heart failure I, functional class I, with preserved ejection fraction (50 %) of the left ventricle was made. Ventricular arrhythmia – 4th grade according to Laun. Competitive atrial rhythm, transient atrioventricular block. Because specific cardiovascular lesions occurred for no apparent reason and symptoms occurred during peak tick activity, the patient was re-interviewed for migratory erythema and tick bites. The patient confirmed being in the forest during the disease season and sucking the mite without specific skin lesions. To further search for the etiological factor that led to the identified changes, the patient was tested for antibodies to Burrelia burgdorferi by ELISA. The obtained positive result (Ig G – 3.89 IU/ml, Ig M – 33.74 IU/ml) indicated an acute period of Lyme disease. Thus, the final diagnosis was: Lyme disease, stage II (early disseminal). Subacute infectious (borreliosis) myocarditis, mild course, heart failure I, functional class I, with preserved ejection fraction (50 %) of the left ventricle. Ventricular arrhythmia – 4th grade according to Laun. Competitive atrial rhythm, transient atrioventricular block of the I degree. Treatment is prescribed: doxycycline 100 mg x 2 times/day, metoprolol 25 mg x 2 times/day, metabolic therapy and serological tests are recommended after 3, 6, 12 months and 2 years. Thus, the clinical case shows the difficulties of diagnosing “borreliosis myocarditis”, emphasizes the prospects for the development of algorithms for the diagnosis and treatment of borreliosis myocarditis.