1/41. Junctional ectopic tachycardia evolving into complete heart block.Transition from congenital junctional ectopic tachycardia to complete AV block was observed in an 8 month old girl, over a 36 hour period, during initial hospital admission. Two years later she had evidence of a rapidly increasing left ventricular end diastolic diameter, associated with lowest heart rates during sleep of < 30 beats/min. A transvenous permanent pacemaker was therefore implanted. This finding supports the idea that a pathological process in the area of the AV junction, initially presenting as junctional ectopic tachycardia may later extend to sudden complete atrioventricular block.- - - - - - - - - - ranking = 1keywords = tachycardia (Clic here for more details about this article) |
2/41. Paired ventricular pacing: an alternative therapy for postoperative junctional ectopic tachycardia in congenital heart disease.Junctional ectopic tachycardia (JET) is one of the most life-threatening postoperative arrhythmias in children with congenital heart disease, and medical management is difficult. Paired ventricular pacing (PVP) may provide a safe alternative mode of management. We evaluated the safety and efficacy of PVP for the management of postoperative JET in patients with congenital heart disease. A retrospective collection of data was done from 1981-1995. PVP was successfully tried in five postoperative patients (age range: 37 days to 22 years, median: 10 months). Onset of JET was 3-60 hours (mean /- SD, 19 /- 23 hours) postoperatively. The maximal JET rate was 261 /- 39 beats/min. PVP was used as the first line of management in three patients and was successful in all patients. It resulted in an instantaneous increase in blood pressure from 66 /- 9 to 94 /- 15 mmHg (42% increase) and was required for 12 /- 14 hours (range 2-36 hours). No complications were noted. Therefore, in our experience, this is a safe alternative modality for the control of postoperative JET.- - - - - - - - - - ranking = 0.83333333333333keywords = tachycardia (Clic here for more details about this article) |
3/41. Radiofrequency catheter ablation of junctional ectopic tachycardia in adults.Junctional ectopic tachycardia is an arrhythmia seen principally in infants and children, in adults it is even more rare and is difficult to treat with antiarrhythmic drugs and is associated with a poor prognosis. To our knowledge, there is not information about treatment with nonpharmacological methods in adults. We report two adult patients with junctional ectopic tachycardia who underwent successful radiofrequency catheter ablation of the automatic focus located in the His bundle region. The tachycardia was eliminated in both patients with AV block in one and the AV conduction was preserved in the other. After six and 48 months of follow-up both patients are asymptomatic and free of recurrences.- - - - - - - - - - ranking = 1.1666666666667keywords = tachycardia (Clic here for more details about this article) |
4/41. prenatal diagnosis of a familial form of junctional ectopic tachycardia.Junctional ectopic tachycardia (JET) is a rare cardiac arrhythmia characterized by atrio-ventricular dissociation, a high rate junctional escape rhythm and poor clinical tolerance in neonates and infants. sudden infant death has been reported. The intra-uterine presentation of this arrhythmia is unknown. We report a familial form of JET with antenatal diagnosis. A sustained tachycardia at a rate of 170 beats/min with a 1:1 conduction was diagnosed in a hydropic fetus at a gestational age of 32 weeks. The older brother had presented with prenatal hydrops and junctional ectopic tachycardia was diagnosed at birth. Assuming that this arrhythmia was a JET, amiodarone was given to the mother in order to control the fetal tachycardia. The arrhythmia persisted with a 1/1 pattern but at a slower ventricular rate (140 beats/min). The ECG performed at birth revealed a narrow QRS tachycardia with a ventricular rate of 180 beats/min and a 1/1 retrograde conduction. amiodarone therapy was continued with the addition of propanolol. Postnatal echocardiography revealed normal chambers and left ventricular dysfunction with a left ventricular shortening fraction of 17 per cent. Subsequent ECGs and Holter monitoring demonstrated typical electrocardiographic features of JET. Both parents had a normal ECG and Holter monitoring. A fetal tachycardia of moderately high rate with a 1/1 retrograde conduction and poor cardiac tolerance can be due to JET. In such cases, the use of amiodarone can be considered as a first line drug.- - - - - - - - - - ranking = 1.6666666666667keywords = tachycardia (Clic here for more details about this article) |
5/41. Successful radiofrequency ablation in an infant with drug-resistant permanent junctional reciprocating tachycardia.Over the past decade, the technique of radiofrequency ablation has evolved substantially. Currently, most forms of cardiac arrhythmias seen in children can be treated with good long-term results and low risk of adverse outcome. Curative arrhythmia treatment with this technique, however, is still uncommon in neonates and infants. Reported here is our experience in the management of an 8-week-old with drug-resistant permanent junctional reciprocating tachycardia.- - - - - - - - - - ranking = 0.83333333333333keywords = tachycardia (Clic here for more details about this article) |
6/41. Transient QT prolongation with torsades de pointes tachycardia after ablation of permanent junctional reciprocating tachycardia.INTRODUCTION: catheter ablation with radiofrequency energy is a curative therapy in patients with permanent junctional reciprocating tachycardia (PJRT). methods AND RESULTS: For the first time, we report a case of transient QT prolongation with torsades de pointes tachycardia 18 hours after successful radiofrequency energy ablation of PJRT in a 25-year-old woman with tachycardia-induced cardiomyopathy. Of note, the torsades de pointes occurred in the absence of bradycardia, electrolyte disturbances, or QT-prolonging drugs. This patient initially was thought to have a hereditary long qt syndrome that was unmasked by PJRT ablation. Therefore, the patient received an implantable defibrillator in addition to beta-blocker therapy, which was discontinued 6 months later. Surprisingly, the QT interval completely normalized within 1 week after PJRT ablation, and the patient remained free of arrhythmias during a follow-up period of 4.5 years. CONCLUSION: patients with incessant tachyarrhythmias should undergo ECG monitoring for at least 24 hours following successful radiofrequency catheter ablation because transient QT prolongation with torsades de pointes may occur even in the absence of bradycardia, QT-prolonging drugs, or electrolyte disturbances.- - - - - - - - - - ranking = 1.8333333333333keywords = tachycardia (Clic here for more details about this article) |
7/41. prenatal diagnosis of junctional ectopic tachycardia.The congenital form of junctional ectopic tachycardia has never been reported during the prenatal period. We describe a case in which the diagnosis could be ascertained in utero with the superior vena cava/ascending aorta Doppler approach. The diagnosis was based on the evidence of ventricular tachycardia with atrioventricular (AV) dissociation and the simultaneous occurrence of atrial and ventricular contractions during an episode of tachycardia with 1:1 AV relationship.- - - - - - - - - - ranking = 1.1666666666667keywords = tachycardia (Clic here for more details about this article) |
8/41. Atrial pacing during radiofrequency ablation of junctional ectopic tachycardia--a useful technique for avoiding atrioventricular bloc.Radiofrequency catheter ablation (RFCA) was performed on a 5-year-old boy with congenital junctional ectopic tachycardia (JET) that was refractory to medical management. Because of the lack of retrograde atrial depolarization during tachycardia, radiofrequency energy was delivered during atrial overdrive pacing to confirm the presence of preserved atrioventricular (AV) conduction. Although the procedure was complicated by complete right bundle branch block after ablation of the para-Hissian region, the patient regained sinus rhythm accompanied by normal AV conduction. Rapid atrial pacing during RFCA of JET may be safely used to avoid AV block.- - - - - - - - - - ranking = 1keywords = tachycardia (Clic here for more details about this article) |
9/41. amiodarone in the treatment of junctional ectopic tachycardia after cardiac surgery in children: report of two cases and review of the literature.Junctional ectopic tachycardia (JET) occurs most frequently after operative repair of congenital heart defects. The mechanism is thought to involve direct trauma to the atrioventricular node and His bundle resulting in an ectopic focus. Several therapeutic methods have been described in the pediatric literature with varying degrees of success and complication rates. Because heart rates may exceed 200 to 300 beats per minute, there may be inadequate time for ventricular filling. Ventricular filling can be further compromised because of the asynchrony between the atria and the ventricles. These factors can lead to significant compromise of cardiovascular function in the postoperative patient. We describe our experience with amiodarone in two patients who developed postoperative JET after repair of congenital heart defects. Dosing regimens and previous experience with amiodarone in patients with JET are reviewed.- - - - - - - - - - ranking = 0.83333333333333keywords = tachycardia (Clic here for more details about this article) |
10/41. catheter ablation of an epicardial accessory pathway via the middle cardiac vein guided by monophasic action potential recordings.This report describes a case of permanent junctional reciprocating tachycardia (PJRT) that was ablated via the middle cardiac vein, guided by monophasic action potential recording. The patient was a 63-year-old woman who had been suffering from palpitation for 10 years. ECG during palpitation showed a narrow QRS tachycardia with a long RP interval. Electrophysiological study revealed that this tachycardia was an orthodromic reciprocating tachycardia, via an accessory pathway with a decremental property and a long ventriculoatrial interval (130 ms): PJRT. The earliest atrial activation during tachycardia was detected at the junction of the middle cardiac vein with the coronary sinus. Monophasic action potentials were recorded to confirm that the ablation catheter was in contact with the epicardium.- - - - - - - - - - ranking = 0.83333333333333keywords = tachycardia (Clic here for more details about this article) |
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