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Xiao L, Ou X, Liu W, Lin X, Peng L, Qiu S, Zhang Q. Combined modified Valsalva maneuver with adenosine supraventricular tachycardia: A comparative study. Am J Emerg Med 2024; 78:157-162. [PMID: 38281376 DOI: 10.1016/j.ajem.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/11/2024] [Accepted: 01/20/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND IMPORTANCE Paroxysmal supraventricular tachycardia (PSVT) is an arrhythmia commonly seen in the emergency department. Both modified Valsalva maneuver (MVM) and intravenous adenosine are the first line treatment, of which the former has e lower success rate while the latter has a higher success rate but some risks and adverse effects. Given both of these reverse rhythms quickly, combining them may achieve a better effect. OBJECTIVE The objective of this study is to evaluate the success rate and potential risk of combining the use of intravenous adenosine while patients were doing MVM as a treatment for paroxysmal supraventricular tachycardia(pSVT). DESIGN, SETTINGS AND PARTICIPANTS We recruited patients with pSVT from 2017 to 2022, and randomly assigned them into 3 groups, MVM group, intravenous adenosine group, and combination therapy group, in which MVM was allowed to be performed twice, while intravenous adenosine was given in a titration manner to repeat three times, recorded the success rate and side effects in each group. MAIN RESULTS The success rate of the MVM group, adenosine group, and combination group are 42.11%, 75.00 and 86.11%, respectively. The success rate of the adenosine group and combination group is significantly higher than the n MVSM group (p < 0.01, p < 0.001), while the success rate of the combination group is higher than the adenosine group, it has no significant difference (p = 0.340). In terms of safety, the longest RR durations (asystole period) are 1.61 s, 1.60s, and 2.27 s, there is a statistical difference among the three groups (p < 0.01) and between the adenosine and combination group (0.018). CONCLUSION Therefore, we can conclude that combination therapy has a relatively high success rate and good safety profile, but the current study failed to show its superiority to adenosine.
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Affiliation(s)
- Lifeng Xiao
- Emergency Department, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaomin Ou
- Emergency Department, Shantou Central Hospital, Shantou, Guangdong, China
| | - Wanshang Liu
- Emergency Department, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaorong Lin
- Emergency Department, The Second Affiliated Hospital of Shantou University Medical College, Guangdong, China
| | - Lin Peng
- Central Laboratory, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shuyi Qiu
- School of Public Health, Shantou University, Shantou, Guangdong, China
| | - Qishuo Zhang
- General Internal Medicine, Department of Medicine, Medical College of Wisconsin, USA.
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Ao CV, Ho MP. Valsalva maneuvers with or without adenosine for supraventricular tachycardiac. Am J Emerg Med 2024; 78:218. [PMID: 38423936 DOI: 10.1016/j.ajem.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Chi-Va Ao
- Cardiovascular Intensive Care Unit, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Gan Y, Ma L, Fang P. Perioperative management of a patient with haemophilia B and PSVT undergoing radiofrequency ablation: A case report. J Int Med Res 2023; 51:3000605231208599. [PMID: 37890144 PMCID: PMC10612451 DOI: 10.1177/03000605231208599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Haemophilia B is a rare inherited bleeding disorder in which patients have impaired coagulation. This study describes a patient with Haemophilia B and paroxysmal supraventricular tachycardia (PSVT) who underwent radio frequency catheter ablation (RFCA). The perioperative replacement therapy with coagulation factor IX (FIX) was agreed upon after an interdisciplinary consultation involving a team of specialists in haematology, cardiovascular medicine and cardiothoracic surgery. There were no obvious bleeding points or complications during the perioperative period following the treatment, nor recurrence of PSVT within a three-year follow-up period. In summary, RFCA can be performed safely in patients with haemophilia B on the premise of developing an individualized perioperative exogenous coagulation factor supplementation regimen based upon an adequate preoperative evaluation and clinical monitoring and management by an interdisciplinary team.
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Affiliation(s)
- Yu Gan
- The Second School of Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Zhejiang Shuren University Shulan International Medical College, Department of Cardiovascular Medicine, Hangzhou, Zhejiang, CN
| | - Liping Ma
- Department of Cardiovascular Medicine, Shu Lan (Hangzhou) Hospital, Hangzhou, China
| | - Pihua Fang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Zhejiang Shuren University Shulan International Medical College, Department of Cardiovascular Medicine, Hangzhou, Zhejiang, CN
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Endres KM, Kierys K, Shang Y, Zhou S, Ceneviva GD, Thomas NJ, Krawiec C. A Multicenter Retrospective Evaluation of Specialized Laboratory Investigations in the Workup of Pediatric Patients With New-Onset Supraventricular Tachycardia. J Emerg Nurs 2022; 48:678-687.e1. [PMID: 35989191 PMCID: PMC9669098 DOI: 10.1016/j.jen.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Specialized laboratory evaluation of supraventricular tachycardia in children may occur, but the utility is unknown. The study objectives are to assess the type, frequency, and results of specialized laboratory testing performed in pediatric patients presenting with new-onset supraventricular tachycardia. We hypothesized that when specialized laboratory testing occurs (particularly for cardiac failure, toxicologic, inflammatory, and thyroid diseases), the results are generally within normal limits. METHODS This is a retrospective descriptive study using an electronic health record database (TriNetX, Inc). We collected and evaluated the following data of subjects aged younger than 18 years with a first-time supraventricular tachycardia diagnosis: demographics, diagnostic codes, deaths, and laboratory codes/results (natriuretic peptide B, natriuretic peptide B prohormone N-terminal, troponin I, toxicology testing, inflammatory markers, and thyroid studies). RESULTS A total of 621 subjects (524 [84.4%] without laboratory testing, 97 [15.6%] with laboratory testing) were included. Thyroid studies (65 [10.5%]) were the most frequent laboratory study performed followed by cardiovascular specific studies (35 [5.6%]), inflammatory markers (21 [3.4%]), and toxicology tests (10 [1.6%]) (P = .002). Obtained laboratory testing was more frequent with older subjects, females, and need for emergency, hospital, and critical care services. DISCUSSION Cardiac-specific and noncardiac laboratory testing is frequently ordered for pediatric patients who present with supraventricular tachycardia. Thyroid studies were the most common laboratory testing ordered, but abnormal results only occurred in less than a quarter of subjects. These findings may highlight a quality improvement opportunity for emergency nurses and practitioners in the practice of obtaining laboratory tests to better reflect high-value evidence-based care for this vulnerable population.
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Affiliation(s)
- Kodi M. Endres
- Penn State College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA, USA 17033-0850
| | - Krista Kierys
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, 500 University Drive, P.O. Box 850, Hershey, PA, USA 17033-0850
| | - Yimeng Shang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, Pennsylvania, USA 17033-0850
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, Pennsylvania, USA 17033-0850
| | - Shouhao Zhou
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, Pennsylvania, USA 17033-0850
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, Pennsylvania, USA 17033-0850
| | - Gary D. Ceneviva
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, 500 University Drive, P.O. Box 850, Hershey, PA, USA 17033-0850
| | - Neal J. Thomas
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, 500 University Drive, P.O. Box 850, Hershey, PA, USA 17033-0850
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, Pennsylvania, USA 17033-0850
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, Pennsylvania, USA 17033-0850
| | - Conrad Krawiec
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, 500 University Drive, P.O. Box 850, Hershey, PA, USA 17033-0850
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Baptista R, Maricoto T, Monteiro S, Dias J, Gonçalves S, Febra H, Gil V. Practical approach to referral from primary health care to a cardiology hospital consultation in 2021. Rev Port Cardiol 2022. [DOI: 10.1016/j.repc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Murray K, Wahid M, Alagiakrishnan K, Senaratne J. Clinical electrophysiology of the aging heart. Expert Rev Cardiovasc Ther 2022; 20:123-139. [PMID: 35282746 DOI: 10.1080/14779072.2022.2045196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Advancements in medical and consumer-grade technologies have made it easier than ever to monitor a patient's heart rhythm and to diagnose arrhythmias. Octogenarians with symptomatic arrhythmias have unique management challenges due to their frailty, complex drug interactions, cognitive impairment, and competing comorbidities. The management decisions are further complicated by the lack of randomized evidence to guide treatment. AREAS COVERED A comprehensive literature review was undertaken to outline various tachyarrhythmias and bradyarrhythmias and their management, the role of cardiac implantable electronic devices, cardiac ablations, and specific geriatric arrhythmia considerations as recommended in international guidelines. EXPERT OPINION Atrial fibrillation (AF) is arguably the most important arrhythmia in the elderly and is associated with significant morbidity and mortality. Early diagnosis of AF, potentially with smart devices (wearables), has the potential to reduce the incidence of stroke, systemic emboli, and the risk of dementia. Bradyarrhythmias have a high incidence in the elderly as well, often requiring implantation of a permanent pacemaker. Leadless pacemakers implanted directly into the right ventricle are great options for gaining traction in elderly patients.
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Affiliation(s)
- Kyle Murray
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Muizz Wahid
- Department of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kanna Alagiakrishnan
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janek Senaratne
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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Huang EPC, Chen CH, Fan CY, Sung CW, Lai PC, Huang YT. Comparison of Various Vagal Maneuvers for Supraventricular Tachycardia by Network Meta-Analysis. Front Med (Lausanne) 2022; 8:769437. [PMID: 35186966 PMCID: PMC8850969 DOI: 10.3389/fmed.2021.769437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vagal maneuvers (VagMs) are recommended as the first-line treatment of supraventricular tachycardia (SVT). However, the optimal type of VagMs remains unproven. AIM This study aims to compare the effectiveness and adverse events amongst VagMs on SVT via network meta-analyses (NMAs). METHODS We systematically searched randomized controlled trials (RCTs) that involved adults with SVT and compared VagMs without language restrictions. We determined the initial and final responses of conversion rate to sinus rhythm and adverse events. Risk of bias (RoB) was appraised by Cochrane revised tool, and contribution matrix was calculated. NMAs were synthesized using frequentist random-effects model and presented as relative risk (RR) with 95% CI. The order of probability was presented as surface under the cumulative ranking curve analysis (SUCRA). Sensitivity analysis was performed using both Bayesian and frequentist approach with fixed- or random-effects models. Certainty of evidence (CoE) was rated by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology. RESULTS Fourteen RCTs with 2,180 patients were enrolled. Small portion of mixed estimates was contributed from high overall RoB studies. Compared with carotid sinus massage (CSM), the modified Valsalva maneuver (MVM) was the most effective VagM after initial performance [SUCRA: 0.9992, RR: 5.47 (1.77-16.93)] and at the end of study [SUCRA: 1.0000, RR: 3.62 (2.04-6.39), CoE: high]. The standard VM did not elicit better conversion rate to the sinus rhythm than CSM at the initial response [SUCRA: 0.4395, RR: 1.97 (0.63-6.15)] and at the end of the study [SUCRA: 0.4795, RR: 1.64 (0.94-2.87), CoE: moderate]. The SUCRA value of CSM at the initial and final responses was the least one amongst three VagMs (0.0613 and 0.0205, respectively). Adverse events amongst three VagMs were similar (CoE: low). Sensitivity analyses yielded consistent results. CONCLUSION We recommended MVM as the first choice of VagM for rhythm conversion before the pharmacological management of SVT.
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Affiliation(s)
- Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei City, Taiwan
| | - Chi-Hsin Chen
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Cheng-Yi Fan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Pei Chun Lai
- Education Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yen Ta Huang
- Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
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Kim S, Kim CG. Effects of an Electrocardiography Training Program: Team-Based Learning for Early-Stage Intensive Care Unit Nurses. J Contin Educ Nurs 2021; 51:174-180. [PMID: 32232493 DOI: 10.3928/00220124-20200317-07] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Team-based learning (TBL) can be one way of improving professional and practical skills for nurses. This study explored the effectiveness of an electrocardiography training program using TBL for early-stage nurses in intensive care units. METHOD This study used a pretest-posttest nonequivalent control group. A total of 65 participants were enrolled in the study (36 in the experimental group and 29 in the control group). Participants in the experimental group were trained with TBL, and participants in the control group had lecture-based learning on electrocardiography education. RESULTS There was no statistically significant difference between the team-based and lecture-based learning groups after the training in participants' knowledge of electrocardiography and reading ability of bedside (lead II rhythm) electrocardiography monitoring (p > .05). However, there was a statistically significant difference between the two groups in the reading ability of the 12-lead electrocardiography (p < .001). CONCLUSION TBL was more effective in improving nurses' reading ability of the 12-lead electrocardiography. [J Contin Educ Nurs. 2020;51(4):174-180.].
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Hassett CE, Cho SM, Suarez JI. Tachyarrhythmias and neurologic complications. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:151-162. [PMID: 33632434 DOI: 10.1016/b978-0-12-819814-8.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tachyarrhythmias are abnormal heart rhythms with a ventricular rate of 100 or more beats per minute. These rhythms are classified as either narrow or wide-complex tachycardia with further subdivision into regular or irregular rhythm. Patients are frequently symptomatic presenting with palpitations, diaphoresis, dyspnea, chest pain, dizziness, and syncope. Sudden cardiac death may occur with certain arrhythmias. Recognizing tachyarrhythmia and understanding its management is important as a wide spectrum of neurologic complications have been associated with such arrhythmias. The purpose of this chapter is to provide a comprehensive overview on the neurologic complications of tachyarrhythmias, neurologic adverse events of antiarrhythmic interventions, and neurologic conditions that can precipitate tachyarrhythmia.
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Affiliation(s)
- Catherine E Hassett
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Sung-Min Cho
- Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jose I Suarez
- Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Subhani F, Ahmed I, Manji AA, Saeed Y. Atrial Tachycardia Associated With a Tachycardia-Induced Cardiomyopathy in a Patient With Systemic Lupus Erythematosus. Cureus 2020; 12:e11626. [PMID: 33376640 PMCID: PMC7755648 DOI: 10.7759/cureus.11626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organ systems. Cardiovascular involvement in SLE is well described in the literature. Cardiac arrhythmias associated with SLE include sinus tachycardia, atrial fibrillation, and atrial ectopy or atrial tachycardia. In this report, we present the case of a patient with SLE who was found to have focal atrial tachycardia that mimicked sinus tachycardia on a 12-lead electrocardiogram (ECG). She was inappropriately treated as a case of sinus tachycardia initially. But she did not respond to the treatment and developed tachycardia-induced cardiomyopathy despite being on antiarrhythmic medications. She subsequently underwent successful radiofrequency catheter ablation and her left ventricular ejection fraction (LVEF) recovered within three months after the ablation.
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Affiliation(s)
| | | | | | - Yawer Saeed
- Medicine/Cardiology/Electrophysiology, Aga Khan University, Karachi, PAK
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