Cases reported "Tachycardia, Sinus"

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1/10. Basket catheter localization of the origin of atrial tachycardia with atypical morphology after atrial flutter ablation.

    Atrial activation from a site in the low lateral right atrium will typically proceed in a superior direction. We present a case of a low lateral right atrial tachycardia with a surface electrocardiographic P wave morphology that appeared to have an inferiorly directed axis. The tachycardia occurred 2 years after successful atrial flutter ablation. The use of a multipolar basket catheter allowed confirmation of the focal origin of the tachycardia, permitted its rapid localization, facilitated catheter ablation, and provided clues to atrial activation that helped describe the appearance of the P wave.
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2/10. Electrophysiologic findings of a patient with inappropriate sinus tachycardia cured by selective radiofrequency catheter ablation.

    Radiofrequency catheter ablation (RFCA) for inappropriate sinus tachycardia (IST) is associated with a high recurrence rate and sometimes requires pacemaker implantation, especially after extensive ablation. We report a patient with drug-refractory IST who was successfully treated by selective RFCA to the 2 earliest activation sites. During tachycardia, the earliest atrial activation preceded the surface P wave by 50 ms or more, whereas it was only 27 ms for the rest of the right atrium after ablation. Our patient had the longest activation period during tachycardia among the reported patients. In IST patients, a longer activation time at the site of the earliest atrial activation may imply that the abnormality is confined to a small area within the sinus node and may predict the efficacy of selective RFCA.
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3/10. Unusual Wenckebach upper rate response of an atrial-based DDD pacemaker.

    We describe in this report an unusual form of Wenckebach upper rate response produced by a DDD pulse generator with atrial-based lower rate timing. The pacemaker maintained the programmed upper and lower rate intervals at the expense of a prolonged atrial paced-ventricular paced AV interval. This form of upper rate behavior eliminated the longer cycle (containing the unsensed P wave) that occurs at the end of the pacemaker Wenckebach sequence during traditional DDD pacing with ventricular-based lower rate timing.
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4/10. 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.
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5/10. 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.
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6/10. 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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7/10. 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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8/10. Arrhythmia during extracorporeal shock wave lithotripsy.

    A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.
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9/10. Sinus tachycardia and J wave masquerading as atrial flutter.

    The admission electrocardiogram (ECG) from a patient with severe heart failure was considered diagnostic of atrial flutter with 2:1 atrioventricular conduction. Slowing of the heart rate revealed sinus tachycardia with prominent 'J' waves that had been previously thought to be 'F' waves.
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10/10. Electrical proarrhythmia: induction of inappropriate atrial therapies due to far-field R wave oversensing in a new dual chamber defibrillator.

    This case report describes delivery of atrial therapies during a sinus tachycardia in a new dual chamber implantable cardioverter defibrillator inappropriately caused by far-field oversensing of ventricular beats in the atrial channel. Upon classification of the PR interval pattern, the rate criterion for an atrial tachycardia was fulfilled, and the device initiated high-frequency burst pacing as the first stage of programmed tiered atrial therapies. atrial fibrillation subsequently was induced by high-frequency burst pacing, and eventually a programmed 10-J shock was delivered for successful termination of atrial fibrillation. The phenomenon of far-field oversensing of ventricular beats could be repeatedly observed during exercise testing and abolished by decreasing the atrial sensitivity.
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