A case series: On patients with arrhythmias

S. Bhuvaneswari

Duty Medical Officer, Department of Cardiology, Kauvery Hospital, Heart City, Trichy

Case Presentation

Patient no – 1

38 years aged female patient, known patient of supraventricular tachycardia, had complaints of recurrent palpitations for two years. Patient was found to have Short RP- Tachycardia, refractory to drugs, and admitted for Electrophysiology (EP) study + Radiofrequency ablation.

On electrophysiological study, patient was found to have inducible, typical, slow AVNRT (Atrioventricular Nodal Re-entrant Tachycardia). Using 3D guided EAM, slow pathway region was mapped and ablation was done at that spot.

Final diagnosis: SVT – typical AVNRT (drug refractory). Using 3D ensite NAVX mapping, successful slow pathway modification was done.

Patient was discharged with advice of tab. Ecospirin 0-1-0 & Tab. Rantac 150 mg BD and review after one month.

Fig (1): ECG of the patient -1

Patient no: 2

A 44 years aged female, knownto have Diabetes and Hypertension, with supraventricular tachycardia, had complaints of recurrent palpitations since past 3 months. She arrived with palpitations lasting for one hour since previous 3 days. Patient was diagnosed to have recurrent SVT, short RP-tachycardia, refractory to drugs.

On EP study, patient was found to have inducible typical slow – fast AVNRT, using 3D mapping, slow pathway region was noted and ablation was done at that spot.

Final diagnosis: SVT – typical AVNRT (drug refractory) using 3D ensite NAVX mapping, successful slow pathway modification done.

Patient was discharged with advice of Tab. Ecospirin 75 mg 0-1-0, Tab. Concor 1.25 mg OD (morning) & Tab. Rantac 150 mg BD along with OHA and review after one month.

Patient no: 3

A 28 years aged female complained of recurrent palpitations since past 10 years, she was diagnosed to have recurrent AVT, short RP-tachycardia, refractory to drugs.

On EP study, patient was found to have inducible typical slow- AVNRT, using 3D mapping, slow pathway region was noted and ablation was done at that spot.

Final diagnosis: SVT – typical AVNRT (drug refractory) using 3D ensite NAVX mapping, successful slow pathway modification done.

Patient was discharged with advice of Tab. Ecospirin 75 mg 0-1-0, Tab. Rantac 150 mg OD and review after one month.

Fig (2): ECG of the patient -3Patient

Patient no: 4

35 years aged male patient came with complaints of syncope × 4 episodes 5 days back. No history of any previous similar episodes. He initially went to an outside hospital, where neuroimaging (EEG – Electro Encephalogram) was done which showed normal study and referred here for further evaluation and management.

Patient was admitted to rule out cardiogenic syncope. EP study and coronary angiogram were done.

Blood investigations showed dyslipidaemia and tab. Idetor (Atorvastatin) 20 mg 0-0-1 was added.

Coronary angiogram showed normal coronaries.

On EP study, only runs of sinus tachycardia was induced with and without isoprenaline, no arrhythmia was induced, sinus node modification was not tried.

Final diagnosis: Inappropriate sinus tachycardia, sinus node modification if refractory.

Plan: Long term holter with smart watch.

Patient was discharged with advice of Tab. Idetor 20 mg 0-0-1 and review after one month.

ECG on admission

Fig (3): ECG of the patient -4

Post CAG/EP Study ECG

Fig (4): Post CAG ECG of the patient -4

Inference

On doing ep study in patients with SVT, typical AVNRT (slow/slow- fast/slow t) was easily inducible. The slow pathway was noted using 3d mapping and radiofrequency ablation (RFA) was done at that spot. Post RFA, easily inducible AVNRT was not inducible.
On doing ep study in syncope patient, only runs of tachycardia were inducible with and without isoprenaline, no arrhythmia was inducible. The patient might need sinus node modification for inappropriate tachycardia if patient has persistent symptoms. Patient was also advised long term holter with smart watch.

Kauverian Bookshelf

Applied Medical Statistics

A case series: On patients with arrhythmias