11/40. Combined epicardial-endocardial approach to ablation of inappropriate sinus tachycardia.A combined epicardial-endocardial approach to ablation of inappropriate sinus tachycardia in a highly symptomatic patient who failed to respond to medical therapy and endocardial ablation is described. The anatomy and physiology of the sinus node is discussed, providing a basis for performing this procedure. This case provides an additional therapeutic option for a condition that often is difficult to manage.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
12/40. hypoglycemia after albuterol overdose in a pediatric patient.albuterol overdose can lead to tachycardia, hypotension, tremor, hypokalemia, and hyperglycemia in children. hypoglycemia had been previously reported in only one child. We describe a 3-year-old boy who ingested high-dose albuterol in this report. On arrival to the emergency department, the child was agitated and had noticeable restlessness, sinus tachycardia, mild hypokalemia (3.2 mEq/L), and hyperglycemia (187 mg/dL). Activated charcoal and intravenous hydration were given, and electrocardiogram monitoring was performed. Sinus tachycardia resolved within 4 to 6 hours. hypoglycemia (45 mg/dL) was identified 4 hours after admission. The child recovered uneventfully within 24 hours with glucose replacement. This case suggests that hypoglycemia could be a late complication of acute albuterol overdose; thus, the period of observation should be extended in these cases.- - - - - - - - - - ranking = 0.16666666666667keywords = sinus (Clic here for more details about this article) |
13/40. Recurrent syncope triggered by inappropriate sinus tachycardia.A 25-year-old woman with daily episodes of syncope and several related traumatic injuries was referred for electrophysiological study. Structural heart disease was excluded. Electrophysiological study revealed inappropriate sinus tachycardia with heart rates up to 190 beats/min. A sinus node modulation was performed. However, 5 days later the patient again developed syncope during sinus tachycardia at rates of 140 beats/min with systolic blood pressure of 60 mmHg. The patient subsequently underwent AVN ablation and implantation of a dual chamber pacemaker. The patient has remained asymptomatic during a 12-month follow-up. This article reports on the first case of a moderate sinus tachycardia in a structurally normal heart as an underlying mechanism of recurrent episodes of syncope. While moderate supraventricular tachycardia in a structurally normal heart alone is unlikely to explain the severe symptoms, additional sympathovagal or humoral mechanisms induced by sinus tachycardia may contribute to syncopal events in this patient.- - - - - - - - - - ranking = 1.5keywords = sinus (Clic here for more details about this article) |
14/40. Cardiac wall motion abnormalities observed in a patient with transient hyperthyroidism.A 74-year-old woman, with a history of hypertension and hyperlipidemia, was admitted to our hospital. She was found to have a sinus tachycardia with ST-segment elevations in leads II, III, (a)V(F), and V(3) through V(6) in electrocardiography, hypokinesis of the left ventricular apex by echocardiography, and normal findings on coronary angiography. Blood analysis revealed an increase in the creatine kinase MB fraction, a significant positive detection in troponin t, and transient elevations in the concentrations of free triiodothyronine, free thyroxine, thyroid globulin antibody, and thyroid peroxidase antibody. Defects in myocardial perfusion and fatty acid metabolism in the apical area were also demonstrated by myocardial scintigraphy. These data suggest that tako-tsubo syndrome or myocardial infarction may be induced in patients with mild and transient hyperthyroidism.- - - - - - - - - - ranking = 0.16666666666667keywords = sinus (Clic here for more details about this article) |
15/40. Superior vena cava rupture caused during balloon dilation for treatment of SVC syndrome due to repetitive catheter ablation--a case report.A 29-year-old woman with an implanted AAI mode permanent pacemaker, who had undergone catheter ablation for inappropriate sinus tachycardia 4 times, experienced complications of superior vena cava (SVC) syndrome. Severe stenosis of the SVC wall was observed in computed tomograms. During balloon dilation for the treatment of SVC syndrome, the SVC was ruptured, resulting in cardiac tamponade. An emergency operation was performed using percutaneous cardiopulmonary support (PCPS). A longitudinal tear 1 cm in length was identified at the junction of the right atrium and the SVC, requiring a patch plasty using an autologous pericardium 2.5 cm x 3 cm in size. SVC rupture is a complication to be completely avoided when we perform balloon dilation for the treatment of SVC syndrome. Therefore, the indication of balloon dilation for the treatment of SVC syndrome requires critical examination and attention.- - - - - - - - - - ranking = 0.16666666666667keywords = sinus (Clic here for more details about this article) |
16/40. 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.- - - - - - - - - - ranking = 1.1666666666667keywords = sinus (Clic here for more details about this article) |
17/40. Pseudosinus tachycardias originating from left pulmonary veins.The case of a 55-year-old man with LV dysfunction in whom the baseline cardiac rhythm falsely mimicked a sinus rhythm (SR) but actually originated from the left superior and inferior pulmonary vein (PV) is reported. The P waves before ablation were flat in leads I and V1, negative in lead aVL, and positive in leads II, III, aVF. After the left superior PV was isolated from the left atrium, another ectopic rhythm newly appeared from the left inferior PV. Interestingly, the LV systolic function improved after the resumption of the SR, thus suggesting that tachycardia-induced cardiomyopathy might be involved in the mechanism of LV systolic disturbance.- - - - - - - - - - ranking = 0.83333333333333keywords = sinus (Clic here for more details about this article) |
18/40. Electrocardiographical case. A man found unconscious.A 25-year-old man was brought to the emergency room after being found unconscious. electrocardiography (ECG) showed changes classical of tricyclic antidepressant (TCA) poisoning. These included sinus tachycardia, QTc prolongation, QRS complex widening, right axis deviation and positive R waves in lead aVR. This unique ECG highlights the importance of lead aVR, which often tends to be ignored. Treatment is started based on ECG findings.- - - - - - - - - - ranking = 0.16666666666667keywords = sinus (Clic here for more details about this article) |
19/40. 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.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
20/40. 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.- - - - - - - - - - ranking = 1.1666666666667keywords = sinus (Clic here for more details about this article) |
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