Reentrant tachycardias can often be terminated by discrete pacing stimuli that penetrate the reentrant circuit. Antitachycardia pacemaker PASAR 4172 (Programmable Automatic Scanning Arrhythmia Reversion, Model 4172, Telectronics) is designed to detect tachycardia automatically and subsequently to deliver programmed one or two extrastimuli to revert to sinus rhythm. We experienced two patients, one paroxysmal supraventricular tachycardia and one paroxysmal ventricular tachycardia, who had had frequent and often prolonged episodes of tachycardia that responded poorly to pharmacologic antiarrhythmic therapy. Each patient underwent a detailed preimplantation clinical electrophysiological study in order to determine the number of stimuli required for termination of tachycardia, the most satisfactory site for electrode placement, and the tachycardia termination zone. During the follow-up period of 7 to 11 months after implantation of PASAR 4172, no patient complained of an episode of sustained tachycardia although they experienced symptoms of an impending attack. We conclude that antitachycardia pacemaker PASAR 4172 is a safe, effective, and well tolerated method for the therapy of drug resistant paroxysmal supraventricular tachycardia and paroxysmal ventricular tachycardia.
Arrhythmias, Cardiac ; Electrodes ; Follow-Up Studies ; Humans ; Tachycardia ; Tachycardia, Paroxysmal* ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

PURPOSE: To find out the efficacy, safety and early complication of radiofrequency catheter ablation(RFCA) in pediatric patients with paroxysmal tachycardia, we compared short-term results of RFCA in pediatric patients to adult patients. METHODS: We studied 25 patients(11 pediatric patients, 14 adult patients), who underwent RFCA due to paroxysmal supraventricular tachycardia(PSVT) or idiopathic ventricular tachycardia(VT) from November 1997 to August 1998. We evaluated PSVT or idiopathic VT mechanism and compared total procedure times, total energy durations and complication rates between pediatric patients and adult patients. RESULTS: Among the 25 patients, the mechanisms of tachycardia were atrioventricular reentrant tachycardias in 14 patients, atrioventricular nodal reentrant in 10 patients and idiopathic left ventricular in 1 patient. Among the 11 pediatric patients, atrioventricular reentrant was found in 9 patients, atrioventricular nodal reentrant in 1 patient and idiopathic left ventricular in 1 patient. while among the 14 adult patients, atrioventricular reentrant was found in 5 patients and atrioventricular nodal reentrant in 9 patients. Total procedure time was 190+/-52 minutes in pediatric patients and 161+/-49 minutes in adult patients(P=0.17). Total energy duration was 244+/-223 seconds in pediatric patients and 187+/-122 seconds in adult patients(P=0.45). There were no major complications related to RFCA except minor hematomas at puncture sites. CONCLUSION: Considering the total procedure time, total energy duration and complication rates, there were no significant differences between pediatric patients and adult patients. RFCA showed relatively high success rate and one recurrence after initial success. Thus, we consider RFCA is as a good therapeutic modality which can cure tachycardia, especially PSVT.
Adult ; Catheter Ablation* ; Catheters ; Hematoma ; Humans ; Punctures ; Recurrence ; Tachycardia ; Tachycardia, Paroxysmal*

One case of cerebral embolism developed during cessation of supraventricular tachycardia in Wolff-Parkinson-White syndrome is reported with brief review. Twenty five years old, male was admitted to Seoul National University hospital with palpitation. He had numerous episodes of paroxysmal tachycardia for 3 years. He was diagnosed as Wolff-Parkinson-White syndrome at this hospital, ca 6 months prior to admission. Wolff-Parkinson-White syndrome was improved with atropine test at that time. The electrocardiogram on admission revealed Wolff-Parkinson-White synd rome associated with supraventricular tachycardia. He developed cerebral embolism after paroxysmal tachycardia of 22 days.
Atropine ; Electrocardiography ; Humans ; Intracranial Embolism* ; Male ; Seoul ; Tachycardia, Paroxysmal* ; Tachycardia, Supraventricular ; Wolff-Parkinson-White Syndrome*

In recent 10 years, using radiofrequency catheter ablation, our medical center has treated 4865 cases of paroxysmal supraventricular tachycardia (PSVT). To improve clinical practice, a retrospective analysis of this group was made. In this group, 2092 cases were atrioventricular reentry tachycardia (AVRT), including 1415 left accesory pathway and 677 right accesory pathway, and 2773 cases were atrioventricular nodal reentry tachycardia (AVNRT). The total success rate of radiofrequency treatment is 99.71%; the recurrence rate after half a year 1.73%; the total complication rate 1.25%. In conclusion, radiofrequency ablation is a safe and effective treatment for tachycardia with high rate of success and low rate of complication.
Adult ; Catheter Ablation ; Female ; Humans ; Male ; Retrospective Studies ; Tachycardia, Paroxysmal ; surgery ; Tachycardia, Supraventricular ; surgery ; Young Adult

Since its initial description in 1930, the preexcitation or Wolff-Parkinson-White(W-P-W) syndrome is characterized by a special electrocardiographic pattern and various paroxysmal tachyarrhythmia, which was found to have reciprocating tachycardia frequently. The W-P-W syndrome develops when some part of a ventricle is activated earlier than normal conduction pathway, and described as one type of ventricular preexcitation syndromes by Durrer (1974). The diagnostic criteria of the W-P-W syndrome are 1) initial slurring (delta wave) of the QRS complex, 2) short P-R interval, 3) widened QRS complex and 4) secondary T wave change. The initial slurring of the QRS complex (delta wave) which is the most important finding of preexcitation syndrome results from a premature activation of a portion of the ventricle through an accessary pathway which bypasses the A-V node and bundle. These accessary conduction fiber includes Kent's bundle, Jame's fibers, Mahaim's fibers and its combination. Recent developments in the field of electrophysiology and surgical therapy became to support the concept of anomalous pathways and the possible determination of the re-entry circuit of paroxysmal tachycardia. Total 12 cases including 9 cases of classical W-P-W syndromes and 3 cases of L-G-L syndromes were followed with special interest of pre-excitation phenomenon and paroxysmal tachyarrhythmia at the National medical Center during the period of Jan. 1975 to Feb. 1979 and found to have paroxysmal tachyarrhythmia in 8 cases out of 12 cases. His bundle electrogram (HBE) and right atrial pacing were recoded in 2 cases of W-P-W type B to support the existance of an anomalous pathway. Treatment was instituted in accordance with recent advanced knowledge for the paroxysmal tachyarrhymia and pre-excitation and references were reviewed.
Atrioventricular Node ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Electrophysiology ; Pre-Excitation Syndromes ; Tachycardia ; Tachycardia, Paroxysmal ; Tachycardia, Reciprocating ; Wolff-Parkinson-White Syndrome*

Among patients with Wolff-Parkinson-White syndrome, atrioventricular reciprocating tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) can coexist in a single patient. Direct transition of both tachycardias is rare; however, it can occur after premature atrial or ventricular activity if the cycle lengths of the two tachycardias are similar. Furthermore, persistent atrial activation by an accessory pathway (AP) located outside of the AV node during ongoing AVNRT is also rare. This article describes a case of uncommon atrial activation by an AP during AVNRT and gradual transition of the two supraventricular tachycardias without any preceding atrial or ventricular activity in a patient with preexcitation syndrome.
Atrioventricular Node ; Humans ; Pre-Excitation Syndromes ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Paroxysmal ; Tachycardia, Reciprocating ; Tachycardia, Supraventricular ; Wolff-Parkinson-White Syndrome*

A healthy 35-year-old man who was scheduled for closed reduction of nasal bone fracture developed atrial fibrillation during induction of general anesthesia after intravenous glycopyrrolate injection. During emergence of general anesthesia, atrial fibrillation was suddenly changed to paroxysmal supraventricular tachycardia with 200 beat per minute and lasted for about 10 seconds. Because blood pressure was stable, esmolol was used to reduce ventricular response. At recovery room, ventricular response reduction about 55 beat per minute was observed after intravenous injection of verapamil 5 mg. Thereafter, the rhythm was returned to normal sinus rhythm with bradycardia.
Anesthesia, General ; Atrial Fibrillation ; Blood Pressure ; Bradycardia ; Glycopyrrolate ; Injections, Intravenous ; Nasal Bone ; Propanolamines ; Recovery Room ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular ; Verapamil

OBJECTIVETo observe the therapeutic effect and prognosis of wrist-ankle acupuncture for treatment of paroxysmal supraventricular tachycardia.

METHODSNinety-five cases of paroxysmal supraventricular tachycardia were randomly divided into a wrist-ankle acupuncture group (n = 55) and a control group (n = 40). The treatment group were treated with acupuncture at the points, Wanshang No. 1 and 2, and the control group with oral administration of diltiazem. After being treated for 3 courses, their therapeutic effects were evaluated.

RESULTSThe total effective rate was 81.8% in the treatment group and 54.0% in the control group with a significant difference between the two groups (P < 0. 05); the long-term therapeutic effect in the treatment group was better than that in the control group.

CONCLUSIONWrist-Ankle acupuncture has obvious therapeutic effect on paroxysmal supraventricular tachycardia.

Acupuncture Therapy ; methods ; Adult ; Aged ; Ankle ; Female ; Humans ; Male ; Middle Aged ; Tachycardia, Paroxysmal ; therapy ; Tachycardia, Supraventricular ; therapy ; Wrist

BACKGROUND: Cardiac troponin I (cTnI) is most recently described and has nearly absolute myocardial tissue specificity, as well as high sensitivity. But an increased value for cTnI that indicates myocardial injury is not always synonym of myocardial infarction or ischemia due to coronary artery disease. METHODS: Retrospective follow-up study for whom underwent coronary angiography for suspected coronary artery disease was done if they had an elevated cTnI value and angiographically normal or minimal disease. RESULTS: 33 patients were qualified. Cut-off value for elevated cTnI was 0.06 ng/mL. Increased cTnI values were attributed to severe congestive heart failure in 7 patients, variant angina in 7 patients, myocarditis in 5 patients, pericarditis in 1 patient, severe myocardial bridge in 1 patient, rhabdomyolysis in 1 patient and cerebral infarction in 1 patient. Tachycardia was precipitating cause in 4 patients (sinus tachycardia, paroxysmal supraventricular tachycardia, paroxysmal atrial fibrillation and sustained ventricular tachycardia for each), two of whom had hemodynamic compromise. 2 of 33 patients had no identifiable cause for a rise in cTnI value. There was no acute myocardial infarction at 42+/-34 weeks follow-up. CONCLUSIONS: Although cTnI is a sensitive and specific marker of myocardial injury, an elevation of cTnI value may have a cause other than myocardial infarction or ischemia and may occur without significant angiographic coronary artery disease.
Atrial Fibrillation ; Cerebral Infarction ; Coronary Angiography ; Coronary Artery Disease ; Follow-Up Studies ; Heart Failure ; Hemodynamics ; Humans ; Ischemia ; Myocardial Infarction ; Myocarditis ; Organ Specificity ; Pericarditis ; Retrospective Studies ; Rhabdomyolysis ; Tachycardia ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Troponin I* ; Troponin*

Electrocardiography ; Humans ; Lung Abscess ; complications ; Male ; Middle Aged ; Pulmonary Veins ; diagnostic imaging ; Radiography ; Tachycardia, Paroxysmal ; etiology ; surgery