Radiofrequency Catheter Ablation for Supraventricular Tachycardias: A Six-Year Single Centre Experience at NICVD

Pharmacological therapy is mostly employed in the management of supraventricular tachyarrhythmias in different part of the world including Bangladesh. However, Radiofrequency catheter ablation has been found to be highly effective and safe in the treatment of such tachyarrhythmias. Objective: The current study is aimed at sharing our experiences of 842 patients who presented with Supraventricular tachycardias and were diagnosed by EPS and treated with Radiofrequency catheter ablation. Methods: This descriptive study has been carried out in the cardiac electro physiology Department of NICVD, Dhaka, Bangladesh from 2nd January 2015 to 31st December, 2020. Electrophysiology study(EPS) was carried out to identity and diagnose the mechanism of different SVTs in 842 consecutive patients. RF catheter ablation was used to interrupt the tachycardia circuit. Results: Out of a total 842 patients who underwent Electrophysiology study, 435 were found to have atrioventricular nodal re-entry tachycardia (AVNRT) as underlying mechanism and 391 were having accessory pathway responsible for the reentry mechanism; of these accessory mediated tachycardia, 250 patients were manifested accessory pathway (WPWS); 141 were concealed accessory pathway (out of them 365 were presented with orthodromic and 26 as antidromic reciprocating tachycardia); moreover among the accessory pathway 231 patients were found having left sided accessory pathway whereas 155 having right sided pathway; 12 patients were having focal atrial tachycardia and 4 were found atrial flutter as the underlying cause for SVT. Radiofrequency catheter ablation was used with an overall success rate of 95%, recurrence rate of 2% without any significant complication. Complication: One patient developed pulmonary thrombo-embolism, 6 patients developed DVT of right lower limb, 4 patients developed complete heart block. Conclusion: RF catheter ablation is safe and highly effective mode of treatment of different types of supraventricular tachyarrhythmias which is emerging and becoming popular in our country. Bangladesh Heart Journal 2021; 36(2): 68-73

Older female relatives of Covid-19 patients have an unsatisfactory perception of emergency room performance by clinical staf

Flecainide is a class I antiarrhythmic used for supraventricular tachyarrhythmias with mild adverse reactions. We present a case report in a 78-year-old male that came to the emergency department with atrial fibrillation and was subsequently treated with flecainide. During the infusion, the patient went into cardiac arrest. Cardiopulmonary resuscitation was performed until the return of spontaneous circulation was achieved after 1min and 40 seconds. Conclusion. Some trials, like The Cardiac Arrhythmia Suppression Trial (CAST), consider flecainide to be safe, but our case report, together with several other published reports brings attention to the use of flecainide in pharmacologic cardioversion of atrial fibrillation as a cause of cardiac arrest. Keywords: Older man, atrial fibrillation, emergency department, cardiac arrest, flecainide

Cardiac arrest in an older male patient treated with flecainide for atrial fibrillation

Flecainide is a class I antiarrhythmic used for supraventricular tachyarrhythmias with mild adverse reactions.We present a case report in a 78-year-old male that came to the emergency department with atrial fibrillation and was subsequently treated with flecainide. During the infusion, the patient went into cardiac arrest. Cardiopulmonary resuscitation was performed until the return of spontaneous circulation was achieved after 1 min and 40 seconds. Conclusion. Some trials, like The Cardiac Arrhythmia Suppression Trial (CAST), consider flecainide to be safe, but our case report, together with several other published reports brings attention to the use of flecainide in pharmacologic cardioversion of atrial fibrillation as a cause of cardiac arrest. Keywords: Older man, atrial fibrillation, emergency department, cardiac arrest, flecainide

Atypical Amiodarone toxicity: Iatrogenic ataxia and dysarthria in an elderly female

Amiodarone is one of the most frequently used antiarrhythmic drugs on the market, treating both life-threatening ventricular arrhythmias as well as supraventricular tachyarrhythmias. Some of its most commonly known side effects include corneal deposits, cardiac toxicity, pneumonitis, thyroid hormone fluctuation, and dermatological reactions. Despite the frequency of occurrence of neurological complications secondary to Amiodarone they remain to be under-recognized by healthcare professionals. This casereport aims to increase awareness of the neurological complications of Amiodarone.

Atrial cardiomyopathy — a new concept with a long history

Atrial cardiomyopathy (ACM) is a relatively common but clinically underestimated disorder, which is characterized by an increased atrial size and dysfunction. Previously, ACM was considered a primary disorder, but in 2016 this concept was revised by European Heart Rhythm Association (EHRA) working group with inclusion of secondary atrial remodeling. The EHRA document details aspects of atrial anatomy and pathophysiology, proposes definitions of ACM, histological classification, outlines the molecular mechanisms of atrial arrhythmia and the problems of personalized treatment and optimization of indications for catheter ablation.Practical application of the proposed ACM classification system, the clinical significance of novel ACM concept and the potential role of this information for a practitioner are presented in this article. Two clinical cases of ACM with “primary” (familial form of ACM due to NPPA gene mutation with primary defect in atrial structure and function) and “secondary” atrial remodeling (ACM caused by a longterm supraventricular tachyarrhythmias due to SCN1B gene mutation).

Congenital left atrial appendage aneurysm with unexpected course of left anterior descending coronary artery

The left atrial appendage (LAA) aneurysm is a rare condition that can produce local compressive effects and complications including supraventricular tachyarrhythmias, thromboembolic events and myocardial ischaemia. We present a rare case of a neonate with a congenital LAA aneurysm which resulted in local compressive effects on the left ventricle, severe mitral regurgitation and malposition of the left anterior descending (LAD) coronary artery. Intraoperatively, the LAD was found to be within the aneurysmal wall exterior to the left ventricular epicardium and was inadvertently injured during LAA aneurysm resection. Retrospective review of the preoperative computed tomography and echocardiography scans demonstrated the LAD lying within the wall of the LAA aneurysm, although this had not been well appreciated at that time. This highlights the importance of thorough multimodal preoperative imaging and intraoperative assessment for recognition of this rare association between the LAA aneurysm and LAD malposition, and prevention of inadvertent LAD injury during aneurysm resection.