Cases reported "Tachycardia, Sinus"

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1/16. baroreflex failure syndrome after bilateral excision of carotid body tumors: an underestimated problem.

    carotid body tumors (CBTs) are relatively rare paragangliomas that develop from neural crest cells at the bifurcation of the common carotid artery. They are generally slow growing and benign. Excision is currently considered the treatment of choice, although vascular and especially neural injuries are still relatively frequent in patients with large or bilaterally resected tumors. The baroreflex failure syndrome (BFS) has recently been identified as a severe, rarely recognized, and certainly underestimated complication after the bilateral excision of CBTs. The present report describes a case of a bilateral CBT followed by BFS and reviews the experiences reported in the literature. In light of the low incidence of malignancy of these tumors, their biologic behavior, their very high rate of cranial nerve palsy, and the occurrence of BFS in bilaterally resected paragangliomas, the current practice of bilaterally removing these tumors is questioned.
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keywords = nerve
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2/16. Evidence of sinoatrial block as a curative mechanism in radiofrequency current ablation of inappropriate sinus tachycardia.

    Inappropriate sinus tachycardia is a nonparoxysmal tachycardia characterized by high resting heart rates and a disproportionate response to activity. Sinus node modification with radiofrequency current has been used successfully as treatment for this arrhythmia. However, the electrophysiologic mechanisms leading to successful modification are not yet fully elucidated. We report a case of a patient with drug-resistant inappropriate sinus tachycardia in whom successful treatment of the arrhythmia was achieved by documented sinoatrial exit block induced by radiofrequency current applications.
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ranking = 356.80571177075
keywords = block
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3/16. Right diaphragm paralysis following cardiac radiofrequency catheter ablation for inappropriate sinus tachycardia.

    We describe a case of permanent right diaphragm paralysis following a radiofrequency cardiac ablation procedure. The relationship between the procedure and the phrenic nerve lesion is discussed with respect to the possible pathogenetic mechanisms. Radiofrequency current used in cardiac electrophysiology may cause serious thoracic nerve injuries. Means to avoid this complication are pointed out.
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ranking = 2
keywords = nerve
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4/16. Progression of first degree heart block to high-grade second degree block during spinal anaesthesia.

    A case is presented in which a patient with pre-existing first degree heart block developed high-grade second degree heart block during spinal anaesthesia. Progression of the block was associated with blockade of cardiac sympathetic neurons induced by spinal anaesthesia. This suggests that patients with pre-existing heart block may be at increased risk for development of higher grade block during spinal anaesthesia.
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ranking = 999.05599295809
keywords = block
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5/16. ECG of the month. hypotension, pulmonary edema, and an irregular cardiac rhythm in a 50-year-old woman. Sinus tachycardia, type I (Wenckebach) second degree atrioventricular block, acute inferoposterior myocardial infarct, and anterolateral myocardial infarct of indeterminate age (probably old).

    A 50-year-old woman came to the emergency department because of chest discomfort and dyspnea. She was found to have hypotension, oliguria, and pulmonary edema, i.e., full-blown cardiogenic shock, an irregular rhythm, and no cardiac murmur. The electrocardiogram (ECG) was recorded one lead at a time, and a lead II rhythm strip was mounted above the standard 12 leads (Figure 1).
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ranking = 285.4445694166
keywords = block
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6/16. Persistent inappropriate sinus tachycardia after radiofrequency ablation of left lateral accessory pathway.

    A patient with palpitations and narrow QRS tachycardia was evaluated. In the EP study an atrioventricular reentrant tachycardia mediated by a left lateral accessory pathway was identified and catheter ablation was performed with success. A week later she returned with palpitations and pre-syncope. The resting ECG showed a sinus tachycardia with 110 bpm. After unsuccessful clinical treatment with beta-blockers, diltiazem and digoxin she underwent sinus node modification using radiofrequency catheter ablation with success. We postulated that RF application to ablate the lateral accessory pathway damaged the parasympathetic innervation in the left atrioventricular groove, causing inappropriate sinus tachycardia.
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ranking = 71.361142354149
keywords = block
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7/16. Right diaphragmatic paralysis following endocardial cryothermal ablation of inappropriate sinus tachycardia.

    Inappropriate sinus tachycardia (IST) is a rare disorder amenable to catheter ablation when refractory to medical therapy. Radiofrequency (RF) catheter modification/ablation of the sinus node (SN) is the usual approach, although it can be complicated by right phrenic nerve paralysis. We describe a patient with IST, who had symptomatic recurrences despite previous acutely successful RF SN modifications, including the use of electroanatomical mapping/navigation system. We decided to try transvenous cryothermal modification of the SN. We used 2 min applications at -85 degrees C at sites of the earliest atrial activation guided by activation mapping during isoprenaline infusion. Every application was preceded by high output stimulation to reveal phrenic nerve proximity. During the last application, heart rate slowly and persistently fell below 85 bpm despite isoprenaline infusion, but right diaphragmatic paralysis developed. At 6 months follow-up, the patient was asymptomatic and the diaphragmatic paralysis had partially resolved. This is the first report, we believe, of successful SN modification for IST by endocardial cryoablation, although this case also demonstrates the considerable risk of right phrenic nerve paralysis even with this ablation energy.
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ranking = 3
keywords = nerve
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8/16. Thoracoscopic microwave epicardial ablation: feasibility for the treatment of idiopathic sinus node tachycardia.

    Inappropriate sinus tachycardia is a potentially debilitating condition with tachycardia emanating from the sinus node region. Endocardial radiofrequency energy ablation is the current preferred mode of treatment for symptomatic medication failures. phrenic nerve damage can result from this procedure. We report a case in which the potential for phrenic nerve damage was avoided by using a thoracoscopic approach to displace the phrenic nerve posteriorly and perform epicardial microwave ablation. This resulted in the successful treatment of a patient with highly symptomatic inappropriate sinus tachycardia.
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ranking = 3
keywords = nerve
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9/16. Sinus tachycardia masquerading as ventricular tachycardia.

    We describe here a 87-year-old male who came to the emergency room with the chief complaints of dyspnea and chest pain. His electrocardiogram showed a wide QRS tachycardia with a heart rate of 140 beats/min, a left bundle branch block pattern and low voltage in leads I, aVL, V5 and V6. A long strip showed a premature ventricular complex, and the sinus beat just after the extrasystole showed P waves which were positive in leads I, II, III and a VF similar in shape to those in sinus rhythm. Therefore, a diagnosis of sinus tachycardia with tachycardia dependent left bundle branch block was made. The low voltage in the left lateral leads was ascribed to pneumothorax of the left lung. When a wide QRS tachycardia is encountered in an emergency situation, marked sinus tachycardia with coexistent bundle branch block or aberrant ventricular conduction should be taken into consideration.
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ranking = 214.08342706245
keywords = block
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10/16. Alternate Wenckebach conduction through the right bundle branch.

    This case report describes a patient with chronic chagasic myocarditis who presented with a unique tachycardia-dependent or phase 3 aberrant ventricular conduction. The electrocardiogram showed sinus tachycardia with sequences of alternate and progressive right bundle branch block, that is, Wenckebach periods of alternate beats. We postulated the existence of functional longitudinal dissociation in atrioventricular conduction axis, responsible for the alternant normal and Wenckebach beats.
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ranking = 71.361142354149
keywords = block
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