In this paper we highlight the presence of tachycardia in post-acute COVID-19 syndrome by introducing a new label for this phenomenon—post-COVID-19 tachycardia syndrome—and argue that this ...constitutes a phenotype or sub-syndrome in post-acute COVID-19 syndrome. We also discuss epidemiology, putative mechanisms, treatment options, and future research directions in this novel clinical syndrome.
Differentiating between atypical atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic reciprocating tachycardia utilizing a septal accessory pathway is a complex challenge.
The ...purpose of this study was to describe the "local VA index," a straightforward method based on signals from the coronary sinus catheter, to distinguish between these arrhythmias during tachycardia and entrainment. The ventriculoatrial (VA) interval on the coronary sinus catheter is measured during tachycardia and entrainment, at the site of earliest atrial activity. The difference between these 2 situations defines the "local VA index." We also propose a mechanism to clarify the limitations of historical pacing maneuvers, such as postpacing interval minus tachycardia cycle length (PPI-TCL) and stimulus-atrial interval minus ventriculoatrial interval (SA-VA), by examining nodal decrement and intraventricular conduction delay.
In a retrospective study of 75 patients referred for supraventricular tachycardia evaluation, 37 were diagnosed with atrioventricular reentrant tachycardia (AVRT) with orthodromic reciprocating tachycardia, and 38 with AVNRT (27 typical, 11 atypical).
In comparison to AVRT patients, AVNRT patients exhibited longer PPI-TCL (176 ± 47 ms vs 113 ± 42 ms; P <.01) and SA-VA (138 ± 47 ms vs 64 ± 28 ms; P <.01). The AVRT group had mean local VA index of -1 ± 13 ms, whereas the AVNRT group had a significantly longer index of 91 ± 46 ms (P <.01). An optimal threshold for differentiation was a local VA index of 40 ms. Importantly, there was no significant correlation between pacing cycle length and nodal decrement as well as intraventricular delay related to pathway location. This interindividual variability might explain misleading interpretations of PPI-TCL and SA-VA.
This novel approach is advantageous because of its simplicity and effectiveness, requiring only 2 diagnostic catheters. A local VA interval difference <40 ms provides a clear distinction for AVRT.
Tachycardia-induced tachycardia, or so-called double tachycardia, appears to be a relatively rare condition. This article is protected by copyright. All rights reserved.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
ACC/AHA Task Force Members Jonathan L. Halperin, MD, FACC, FAHA, Chair Glenn N. Levine, MD, FACC, FAHA, Chair-Elect Jeffrey L. Anderson, MD, FACC, FAHA, Immediate Past Chair¶ Nancy M. Albert, PhD, ...RN, FAHA¶ Sana M. Al-Khatib, MD, MHS, FACC, FAHA Kim K. Birtcher, PharmD, AACC Biykem Bozkurt, MD, PhD, FACC, FAHA Ralph G. Brindis, MD, MPH, MACC Joaquin E. Cigarroa, MD, FACC Lesley H. Curtis, PhD, FAHA Lee A. Fleisher, MD, FACC, FAHA Federico Gentile, MD, FACC Samuel Gidding, MD, FAHA Mark A. Hlatky, MD, FACC John Ikonomidis, MD, PhD, FAHA Jose Joglar, MD, FACC, FAHA Richard J. Kovacs, MD, FACC, FAHA¶ E. Magnus Ohman, MD, FACC¶ Susan J. Pressler, PhD, RN, FAHA Frank W. Sellke, MD, FACC, FAHA¶ Win-Kuang Shen, MD, FACC, FAHA¶ Duminda N. Wijeysundera, MD, PhD Table of Contents Preamblee29 Introductione31 Methodology and Evidence Reviewe31 Organization of the GWCe31 Document Review and Approvale31 Scope of the Guidelinee31 General Principlese32 Mechanisms and Definitionse32 Epidemiology, Demographics, and Public Health Impacte32 Evaluation of the Patient With Suspected or Documented SVTe34 Clinical Presentation and Differential Diagnosis on the Basis of Symptomse34 Evaluation of the ECGe36 Principles of Medical Therapye40 Acute Treatment: Recommendationse41 Ongoing Management: Recommendationse43 Basic Principles of Electrophysiological Study, Mapping, and Ablatione45 Mapping With Multiple and Roving Electrodese45 Tools to Facilitate Ablation, Including 3-Dimensional Electroanatomic Mappinge45 Mapping and Ablation With No or Minimal Radiatione45 Ablation Energy Sourcese46 Sinus Tachyarrhythmiase46 Physiological Sinus Tachycardiae46 Inappropriate Sinus Tachycardiae46 Acute Treatmente46 Ongoing Management: Recommendationse53 Nonsinus Focal Atrial Tachycardia and MATe54 Focal Atrial Tachycardiae54 Acute Treatment: Recommendationse56 Ongoing Management: Recommendationse58 Multifocal Atrial Tachycardiae58 Acute Treatment: Recommendatione59 Ongoing Management: Recommendationse59 Atrioventricular Nodal Reentrant Tachycardiae60 Acute Treatment: Recommendationse61 Ongoing Management: Recommendationse63 Manifest and Concealed Accessory Pathwayse64 Management of Patients With Symptomatic Manifest or Concealed Accessory Pathwayse66 Acute Treatment: Recommendationse66 Ongoing Management: Recommendationse68 Management of Asymptomatic Pre-Excitatione69 PICOTS Critical Questionse69 Asymptomatic Patients With Pre-Excitation: Recommendationse71 Risk Stratification of Symptomatic Patients With Manifest Accessory Pathways: Recommendationse72 Atrial Fluttere72 Cavotricuspid Isthmus-Dependent Atrial Fluttere72 Non-Isthmus-Dependent Atrial Flutterse74 Acute Treatment: Recommendationse76 Ongoing Management: Recommendationse78 Junctional Tachycardiae80 Acute Treatment: Recommendationse81 Ongoing Management: Recommendationse81 Special Populationse82 Pediatricse82 Patients With Adult Congenital Heart Diseasee83 Clinical Featurese83 Acute Treatment: Recommendationse85 Ongoing Management: Recommendationse87 Pregnancye90 Acute Treatment: Recommendationse90 Ongoing Management: Recommendationse91 SVT in Older Populationse92 Acute Treatment and Ongoing Management: Recommendatione92 Quality-of-Life Considerationse93 Cost-Effectivenesse93 Shared Decision Makinge93 Evidence Gaps and Future Research Needse94 Referencese95 Appendix 1 Author Relationships With Industry and Other Entities (Relevant)e108 Appendix 2 Reviewer Relationships With Industry and Other Entities (Relevant)e110 Appendix 3 Abbreviationse115 Preamble Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder characterized by an excessive heart rate increase on standing and orthostatic intolerance. POTS ...affects younger individuals 15–45 years old with a distinct female predominance (≈80%). The prevalence ranges between 0.2% and 1.0% in developed countries. The onset of POTS is typically precipitated by immunological stressors such as viral infection, vaccination, trauma, pregnancy, surgery or psychosocial stress. The most common complaints are dizziness, weakness, rapid heartbeat and palpitation on standing. Moreover, patients often report physical deconditioning and reduced exercise capacity as well as headache, ‘brain fog’, dyspnoea, gastrointestinal disorders and musculoskeletal pain. The aetiology of POTS is largely unknown and three main hypotheses include an autoimmune disorder, abnormally increased sympathetic activity and catecholamine excess, and sympathetic denervation leading to central hypovolaemia and reflex tachycardia. The golden standard for POTS diagnosis is head‐up tilt test with a non‐invasive beat‐to‐beat haemodynamic monitoring. Although long‐term prognosis of POTS is poorly explored, around 50% of patients spontaneously recover within 1–3 years. After the diagnosis has been established, patient should be thoroughly educated about non‐pharmacological measures alleviating the symptoms. Exercise training may be very effective and counteract deconditioning. In more symptomatic patients, different drugs directed at controlling heart rate, increasing peripheral vasoconstriction and intravascular volume can be tested. However, the overall effects of pharmacological therapy are modest and the most affected patients remain handicapped. Future efforts should focus on better understanding of POTS pathophysiology and designing randomized controlled trials for selection of more effective therapy.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Coumel tachycardia in children Velázquez-Rodríguez, Enrique; García-Hernández, Norberto; Martínez-Sánchez, Arturo ...
Boletin medico del Hospital Infantil de Mexico,
2023, Volume:
80, Issue:
Supl 1
Journal Article
Peer reviewed
Open access
Coumel tachycardia is an infrequent form of supraventricular tachycardia (SVT) that usually occurs in infants and children. It is a tachycardia mediated by an accessory pathway with retrograde slow ...conduction that explains the classic ECG pattern with long RP' interval and negative P waves in leads II, III, and aVF. In this study, we describe the clinical course and management of Coumel tachycardia in children.
We conducted a retrospective review of five consecutive pediatric patients, mean age 11 ± 3 years (range 6 to 14). The first episode of SVT was at a mean age of 10.4 ± 4.8 years (range 2 to 14) with a mean evolution of 7.4 ± 9.4 months (range 1 to 24). Pharmacological therapy was unsuccessful despite the combination of antiarrhythmic drugs. The tachycardia was incessant with a density > 85% by 24-hour Holter monitoring; one patient developed tachycardia-induced cardiomyopathy. All children underwent successful radiofrequency catheter ablation, mean 5 ± 3 applications (range 1 to 8) with a single session and with no complications. After a mean follow-up of 24 ± 16 months, all patients were asymptomatic and recurrence-free without antiarrhythmic treatment.
Coumel tachycardia is clinically persistent and usually refractory to antiarrhythmic treatment with substantial risk of tachycardia-mediated cardiomyopathy. Catheter ablation is effective and safe in children; thus, it should be indicated promptly and based on individual selection.
Background: With advancements in fetal echocardiography, the diagnosis of supraventricular tachycardia (SVT) is now made antenatally. There is wide variability in practice in the post-natal ...management and the indications for initiation of therapy have not been clearly defined. Esophageal recording and pacing is a useful and minimally invasive tool in the assessment and management of SVT. The proximity of the esophagus to the atria in an anatomically normal individual allows for excellent recording of atrial signals as well as noninvasive-programmed stimulation to elicit or terminate reentrant SVT. Objectives: To validate our current protocol using transesophageal-pacing study (TEPS) and to assess its negative predicting value. Methods: A retrospective review of all cases of fetal SVT from 2004 to 2015 was performed. A total of 61 patients were included. 41% had spontaneous SVT during the observation period. Of the 59% remaining, half had inducible SVT during the TEPS. Overall, 70% of patients with a fetal diagnosis of SVT will have post-natal recurrence, either spontaneous or inducible. Therefore, a significant number of patients would receive unnecessary treatment if all cases of fetal SVT were treated after birth. None of the %non-inducible patients% had long-term recurrence. Conclusions: TEPS is a valid tool to evaluate the need for postnatal therapy in fetal SVT. Futures studies should be done to evaluate long-term spontaneous recurrence of SVT in inducible patients without initiation of treatment.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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