COVID-19 primarily presents as a pulmonary problem, ranging from mild respiratory illness to fatal acute respiratory distress syndrome. Most common manifestations are fever (89%) and cough (72%), while headache and arrhythmia are found in 28% and 17%, respectively. We aim to present a confirmed COVID-19 case presenting with both neurologic and cardiac manifestations. A 33-year-old Filipino male nurse initially consulted at the emergency room due to progressive diffuse headache, with associated localized seizures progressing to generalized tonic clonic seizure and arrhythmia. He had no coryza, cough, sore throat, and diarrhea. He was previously well and had no known co-morbidities or direct exposure to confirmed COVID-19 patients. Physical examination showed elevated blood pressure, tachycardia, and sensory and motor deficits in the left upper and lower extremities. Pertinent diagnostic test results included the detection of SARS-CoV-2 viral RNA via RT-PCR. Imaging studies demonstrated cortical venous thrombosis with hemorrhagic venous infarction in the right parietal lobe. Ground glass appearance on the middle lobe of the left lung was also evident. ECG showed supraventricular tachycardia. Prothrombin time, activated partial thromboplastin time, and D-dimer were all within the normal limits. Carotid massage was done. He was treated with anti-epileptics, anticoagulants, antiarrhythmics, antivirals, antibiotics, and supportive management. During the hospital stay, his symptoms resolved; he was discharged after 21 days. Follow-up done after 3 weeks revealed no recurrence of severe headache, seizure, or tachycardia. It is theorized that an interplay exists between ACE-2 tropism, systemic inflammation, cytokine storm, and hypoxemia in the background of COVID-19 infection. These mechanisms may lead to thrombosis and arrhythmia resulting to neurologic derangements and myocardial injury. Underlying mechanisms make the cerebro-cardiovascular systems vulnerable to the coronavirus disease 2019 infection. COVID-19 should therefore be part of the differential diagnoses in patients presenting with headache, seizures, and arrhythmias.
COVID-19 ; headache ; seizure ; supraventricular tachycardia

INTRODUCTION: Radiofrequency catheter ablation (RFA) is an interventional cardiac electrophysiologic procedure that uses heat energy for definitive management of supraventricular tachycardias. It is a class I recommendation for chronic management of most supraventricular arrhythmias. No local data exist in the incidence hospitalization for SVT and utilization of RFA for this condition. The study aimed to obtain the prevalence of hospitalization of patients with supraventricular tachycardias where RFA is utilized, including the patients’ demographic profile, length of hospitalization, and mortality rate. METHODOLOGY: Philippine Health Insurance Corporation claims for hospitalization from January 1, 2017, to December 31, 2018, were reviewed. Data analysis was done using median and interquartile range for continuous data, and frequency and percentage distribution for categorical data. RESULTS: There were 1121 and 1149 claims for hospitalization for SVTs (atrial paroxysmal tachycardia, atrioventricular paroxysmal tachycardia, nodal paroxysmal tachycardia, and junctional tachycardia) in 2017 and 2018, respectively. This represents four hospitalization claims for SVT per 10,000 of the total PHIC claims. The majority of patients were female with median age of 52 years. Only 25 and 19 patients underwent radiofrequency ablation in 2017 and 2018, respectively. The majority of these patients were male and younger with a median age of 31 years. No mortality was recorded among patients admitted for catheter ablation. CONCLUSION In 2017 and 2018, hospitalization claims for SVT requiring catheter ablation were 0.04% (four hospitalization claims for SVT per 10,000 of the total claims) in both years. The majority of patients were admitted with pharmacologic therapy on discharge with very low utilization of radiofrequency ablation for long-term management.
Arrhythmias, Cardiac ; Tachycardia, Supraventricular ; Radiofrequency Ablation ; prevalence ; Hospitalization

Atrial fibrillation is the most common persistent arrhythmia in the clinic. It affects a wide range of populations with high incidence, morbidity and mortality. Clinical studies have shown that ablation is one of the best means for the treatment of atrial fibrillation. However, after receiving ablation, some patients may experience atrial tachycardia and thus feel even deteriorated feelings. Understanding the predicting factors, electrophysiological mechanisms, and differential diagnosis and treatment strategies for post-ablation atrial tachycardia is essential for reducing the incidence and for the management of post-ablation atrial tachycardia. Therefore, we summarize the research progress of the above-mentioned aspects, and correspondingly proposes further research directions.
Atrial Fibrillation ; Catheter Ablation ; Humans ; Tachycardia, Supraventricular/surgery* ; Treatment Outcome

Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Electrocardiography ; Humans ; Tachycardia, Supraventricular

COVID-19 primarily presents as a pulmonary problem, ranging from mild respiratory illness to fatal acute respiratory distress syndrome. Most common manifestations are fever (89%) and cough (72%), while headache and arrhythmia are found in 28% and 17%, respectively. We aim to present a confirmed COVID-19 case presenting with both neurologic and cardiac manifestations. A 33-year-old Filipino male nurse initially consulted at the emergency room due to progressive diffuse headache, with associated localized seizures progressing to generalized tonic clonic seizure and arrhythmia. He had no coryza, cough, sore throat, and diarrhea. He was previously well and had no known co-morbidities or direct exposure to confirmed COVID-19 patients. Physical examination showed elevated blood pressure, tachycardia, and sensory and motor deficits in the left upper and lower extremities. Pertinent diagnostic test results included the detection of SARS-CoV-2 viral RNA via RT-PCR. Imaging studies demonstrated cortical venous thrombosis with hemorrhagic venous infarction in the right parietal lobe. Ground glass appearance on the middle lobe of the left lung was also evident. ECG showed supraventricular tachycardia. Prothrombin time, activated partial thromboplastin time, and D-dimer were all within the normal limits. Carotid massage was done. He was treated with anti-epileptics, anticoagulants, antiarrhythmics, antivirals, antibiotics, and supportive management. During the hospital stay, his symptoms resolved; he was discharged after 21 days. Follow-up done after 3 weeks revealed no recurrence of severe headache, seizure, or tachycardia. It is theorized that an interplay exists between ACE-2 tropism, systemic inflammation, cytokine storm, and hypoxemia in the background of COVID-19 infection. These mechanisms may lead to thrombosis and arrhythmia resulting to neurologic derangements and myocardial injury. Underlying mechanisms make the cerebro-cardiovascular systems vulnerable to the coronavirus disease 2019 infection. COVID-19 should therefore be part of the differential diagnoses in patients presenting with headache, seizures, and arrhythmias.
COVID-19 ; Headache ; Seizures ; Tachycardia, Supraventricular

BACKGROUND AND OBJECTIVES: Wrist-worn wearable devices provide heart rate (HR) monitoring function via photoplethysmography technology. Recently, these devices have been used by patients to measure the HR when palpitation occurs, but few validation studies of these instruments have been conducted. We assessed the accuracy of these devices for measuring a HR. METHODS: This study enrolled 51 consecutive patients with a history of paroxysmal supraventricular tachyarrhythmia (SVT) or paroxysmal palpitations who were scheduled to undergo an electrophysiological study (EPS). Three devices were assessed: Apple Watch Series 2 (Apple), Samsung Galaxy Gear S3 (Galaxy), and Fitbit Charge 2 (Fitbit). Patients were randomly assigned to wear 2 different devices. The HR at baseline and induced SVT were measured during the EPS. After successful ablation of SVT, HR measurements was also done during atrial and ventricular pacing study. RESULTS: The mean patient age was 44.4±16.6 years and 27 patients were male (53%). The accuracy (within ±5 beats per minute [bpm] of an electrocardiogram [ECG] measurement) of the baseline HR measurements was 100%, 100%, and 94%, for Apple, Galaxy, and Fitbit, respectively. The HR during induced SVT ranged from 108 bpm to 228 bpm and the accuracy (within ±10 bpm of an ECG) was 100%, 90%, and 87% for the Apple, Galaxy, and Fitbit, respectively. During pacing study, accuracy of these devices was also acceptable but tended to decrease as the HR increased, and showed differences between the devices. CONCLUSIONS: Wrist-worn wearable devices accurately measure baseline and induced SVT HR. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0002282
Electrocardiography ; Galaxies ; Heart Rate ; Heart ; Humans ; Information Services ; Male ; Photoplethysmography ; Tachycardia ; Tachycardia, Supraventricular

To explore the safety and efficacy for radiofrequency ablation of paroxysmal supraventricular tachycardia (PSVT) guided by Carto Univu three-dimensional mapping system.
 Methods: A total of 99 patients with PSVT underwent radiofrequency catheter ablation (RFCA) were assigned to a Carto Univu group (51 patients) and a two-dimensional X-ray group (48 patients) according to the mapping method. The operation time, X-ray exposure time, X-ray exposure dose, dose area product (DAP), operation success rate and complication rate were compared between the two groups.
 Results: The Carto Univu group and the two-dimensional X-ray group were not significant difference in the operation time, the X-ray exposure time of placing catheter, the X-ray DAP of placing catheter, the number of discharge, the discharge power, and the total discharge time (P>0.05). The mapping and ablation time, total exposure time, mapping and ablation DAP and total DAP in the Carto Univu group were significantly lower than those in the two-dimensional X-ray group (P<0.01). In the right accessory pathway cases, the mapping and ablation DAP and the total DAP in the Carto Univu group decreased compared with X-ray group (P<0.05), but it decreased more profound (P<0.01) in the left accessory pathway cases and the dual atrioventricular nodal pathways cases. Seven cases in the Carto Univu group achieved "zero X-ray", including 5 cases of the dual atrioventricular nodal pathways and 2 cases of the left accessory pathway. The immediate success rate for the two groups was 100%. After 3-12 months of follow-up, there was no recurrence in the Carto Univu group but 3 suspected recurrences in the two-dimensional X-ray group. In addition, no complications occurred in the two groups. 
 Conclusion: Carto Univu electroanatomic mapping system can guide PSVT safely and effectively during radiofrequency ablation and reduce radiation exposure to both doctors and patients. It is especially suitable for dual atrioventricular nodal pathways, which may even achieve "zero X-ray". Perhaps Carto Univu will be the first choice for RFCA of dual atrioventricular nodal pathways.
Catheter Ablation ; instrumentation ; methods ; Humans ; Imaging, Three-Dimensional ; instrumentation ; methods ; Operative Time ; Radiation Exposure ; prevention & control ; statistics & numerical data ; Radiography ; statistics & numerical data ; Recurrence ; Tachycardia, Supraventricular ; diagnostic imaging ; surgery ; Treatment Outcome

Atrial fibrillation (AF), the most common chronic arrhythmia in adults, is rarely reported in children. Moreover, most of the previously reported children with AF have comorbidities, such as structural heart diseases, rheumatic diseases, and thyroid diseases. This case report is about a healthy 9-year-old boy who was diagnosed with AF without cardiac anomaly. He visited the emergency department with chest pain and palpitation, lasting 2 hours. His electrocardiogram showed narrow-complex tachycardia, which led to the diagnosis of supraventricular tachycardia. The administration of adenosine revealed rapid irregular P waves. After electrical cardioversion, cardiac rhythm was converted to normal sinus rhythm. This case report suggests that when children with narrow-complex tachycardia visit the emergency department, the possibility of AF, in addition to supraventricular tachycardia, should be considered if the RR intervals are markedly irregular.
Adenosine ; Adult ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Cardiovascular Diseases ; Chest Pain ; Child ; Comorbidity ; Diagnosis ; Electric Countershock ; Electrocardiography ; Emergency Service, Hospital ; Humans ; Male ; Pediatrics ; Rheumatic Heart Disease ; Tachycardia ; Tachycardia, Supraventricular ; Thyroid Diseases

BACKGROUND AND OBJECTIVES: Multifocal atrial tachycardia (MAT), in general, has a favorable outcome. However, there are insufficient data regarding MAT in a pediatric population. This study sought to determine the clinical course of MAT and identify potential prognostic factors. METHODS: The medical records of MAT patients from 1997–2015 were reviewed. The arrhythmia control rate and factors for unfavorable outcomes were assessed and compared to those in the literature. RESULTS: Of the 33 included patients (19 boys and 14 girls), 27 were infants less than 1 year of age. The median age at diagnosis was 1.7 months (range, 0 day to 14 years). Fourteen (42%) patients had structural heart disease. Eight (24%) patients had lung disease and 6 (18%) had a syndromic diagnosis belonging to RASopathy. Two patients developed polymorphic ventricular tachycardia, in whom genetic analysis confirmed the presence of the RyR2 mutation several years later. MAT was controlled in 26 patients (84%) within 3.9 months (median; range, 16 days–18.4 years) using an average of 2.4 medications. There were 3 cases of cardiopulmonary mortality. The arrhythmia control rate was higher in the infant group (85%) than in the non-infant group (67%), although this trend was not statistically significant. There was a significantly lower rate of unfavorable outcomes in the idiopathic infant group (n=11) than in the other groups (p=0.008). Considering the findings of previous studies, the mortality rate was significantly higher in patients with structural heart disease than in patients without (21% vs. 5%, p=0.01). CONCLUSIONS: MAT usually affects infants and has a favorable prognosis, particularly in the idiopathic infant group. However, in the presence of other comorbidities, MAT may have a variable clinical course.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrial Flutter ; Comorbidity ; Diagnosis ; Heart Diseases ; Humans ; Infant ; Lung Diseases ; Medical Records ; Mortality ; Prognosis ; Ryanodine Receptor Calcium Release Channel ; Tachycardia ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

In patients with Ebstein's anomaly, the localization of accessory pathways may be impeded by abnormal local electrograms recorded along the atrialized right ventricle and by the presence of multiple accessory pathways. We report a case of 50-year-old man diagnosed with Ebstein's anomaly with Wolff-Parkinson-White syndrome who presented with recurrent palpitations. He was referred to our institution for radiofrequency catheter ablation of paroxysmal supraventricular tachycardia. Transthoracic echocardiography revealed the tricuspid valve displaced into the right ventricle, consistent with Ebstein's anomaly. The electrophysiology study showed a right posterolateral accessory pathway. The optimal ablation site was located not in the atrioventricular line of the atrialized ventricular portion, but in the original atrioventricular line.
Accessory Atrioventricular Bundle ; Catheter Ablation ; Ebstein Anomaly* ; Echocardiography ; Electrophysiology ; Heart Ventricles ; Humans ; Middle Aged ; Tachycardia, Supraventricular ; Tricuspid Valve ; Wolff-Parkinson-White Syndrome