Ectopic Paroxysmal Atrial Tachycardia
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A 45-year-old female presented with progressive palpitations over the past year. Holter monitoring showed frequent atrial premature complexes and runs of atrial tachycardia. An electrophysiology study identified a focal source of ectopic beats in the right atrium above the appendage. Radiofrequency catheter ablation was performed at this site, which eliminated the arrhythmia based on follow up Holter monitoring two months later.
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Atrial tachycardia_lecture
Atrial tachycardias are an uncommon cause of supraventricular tachycardia, accounting for around 5-15% of cases depending on whether the patient has congenital heart defects. Atrial tachycardias can be focal, originating from a single site, or macroreentrant utilizing existing anatomical barriers; 3D mapping systems have improved localization of focal atrial tachycardia origins by providing better atrial anatomy visualization. Successful focal atrial tachycardia ablation is identified by termination of tachycardia within 10 seconds of beginning radiofrequency delivery and inability to reinduce tachycardia with drug provocation.
Atrial tachycardia
Atrial tachycardias can originate from different sites in the atria and have various mechanisms. Common sites include the right atrial appendage, coronary sinus ostium, and crista terminalis. Mechanisms include focal automaticity, triggered activity, microreentry, and macroreentry. Macroreentry is the most common mechanism and can involve single or double loop circuits around anatomical barriers or scar tissue. Diagnosis involves electrocardiographic localization of the origin and electrophysiological testing including pacing maneuvers to evaluate for entrainment. Catheter ablation is often curative by targeting the arrhythmia origin site or critical portions of reentrant circuits.
Atrial Tachycardia
Atrial tachycardia can originate from focal sites in the atria through mechanisms like automaticity, triggered activity, or microreentry, or can involve macroreentrant circuits circulating around anatomical barriers; focal atrial tachycardias are identified by characteristics like initiation with pacing or termination with adenosine while macroreentrant atrial tachycardias involve larger reentry circuits; the site of origin of atrial tachycardia can be localized using electrocardiographic criteria like the morphology and polarity of P-waves.
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A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.Ablation of atypical flutter
This document discusses ablation of atypical flutter. It begins with a case presentation and surface ECG of a patient with incessant tachycardia. It then provides an overview of typical and atypical flutter mechanisms, including CTI-dependent typical flutter and various non-CTI dependent circuits. It describes challenges ablating non-CTI dependent flutters and mapping algorithms. The document concludes with examples of ablation of different atypical flutter circuits, including incisional flutters.
interesting ECG,CXR,ECHO, EP
1. A case of Ebstein's anomaly is presented with ECG findings including tall P waves and right bundle branch block.
2. A 50-year-old male with palpitations shows wide complex tachycardia that is irregularly irregular, concerning for atrial fibrillation with aberrancy or SVT due to preexcitation.
3. Two devices for occluding the left atrial appendage to reduce risk of emboli, the Watchman device and Amplatzer cardiac plug, are identified based on their designs and implantation procedures.
interesting ECG,CXR,ECHO
The document provides information about various cardiac conditions that can be identified on ECGs, echocardiograms, chest x-rays and other cardiac tests. It describes the findings and diagnoses for 12 different clinical cases, including polymorphic atrial tachycardia, preexcited atrial fibrillation, AV nodal reentrant tachycardia, Brugada syndrome, R-on-T phenomenon, hypokalemia, catecholaminergic polymorphic ventricular tachycardia, atrial lead dislodgment, atrial flutter, pulmonary and aortic pressures in ventricular septal defect, and intra-aortic balloon pump positioning.
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Atrial tachycardias are an uncommon cause of supraventricular tachycardia, accounting for around 5-15% of cases depending on whether the patient has congenital heart defects. Atrial tachycardias can be focal, originating from a single site, or macroreentrant utilizing existing anatomical barriers; 3D mapping systems have improved localization of focal atrial tachycardia origins by providing better atrial anatomy visualization. Successful focal atrial tachycardia ablation is identified by termination of tachycardia within 10 seconds of beginning radiofrequency delivery and inability to reinduce tachycardia with drug provocation.
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Atrial tachycardias can originate from different sites in the atria and have various mechanisms. Common sites include the right atrial appendage, coronary sinus ostium, and crista terminalis. Mechanisms include focal automaticity, triggered activity, microreentry, and macroreentry. Macroreentry is the most common mechanism and can involve single or double loop circuits around anatomical barriers or scar tissue. Diagnosis involves electrocardiographic localization of the origin and electrophysiological testing including pacing maneuvers to evaluate for entrainment. Catheter ablation is often curative by targeting the arrhythmia origin site or critical portions of reentrant circuits.
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Atrial tachycardia can originate from focal sites in the atria through mechanisms like automaticity, triggered activity, or microreentry, or can involve macroreentrant circuits circulating around anatomical barriers; focal atrial tachycardias are identified by characteristics like initiation with pacing or termination with adenosine while macroreentrant atrial tachycardias involve larger reentry circuits; the site of origin of atrial tachycardia can be localized using electrocardiographic criteria like the morphology and polarity of P-waves.
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3. Two devices for occluding the left atrial appendage to reduce risk of emboli, the Watchman device and Amplatzer cardiac plug, are identified based on their designs and implantation procedures.
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Caseof wide QRS tachycarfdia ablation
A 17-year-old male presented with recurrent episodes of rapid heart palpitations. During an episode, electrocardiography (ECG) showed a wide complex tachycardia. An electrophysiology study was performed, which induced the clinical tachycardia and identified it as an atrial flutter conducting with 2:1 block to the ventricles. Linear radiofrequency ablation of the cavo-tricuspid isthmus was performed to cut the reentry circuit, requiring 8 applications to achieve bidirectional block and render the tachycardia non-inducible.
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- Catheter ablation is an effective treatment for ventricular tachycardia (VT) in both structurally normal hearts and those with structural heart disease.
- For normal hearts, activation mapping and pace mapping are used to identify the origin of VT, with typical sites including the right ventricular outflow tract. Success rates are high with few complications.
- In structural heart disease, substrate mapping is used to identify scar tissue which hosts reentrant VT circuits. Entrainment mapping during VT can confirm circuits. Ablation targets abnormal potentials in scar or the scar border zone. Integration of cardiac imaging helps define substrate. Long-term outcomes after ablation are improved compared to antiarrhythmic drugs alone.
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3. Ablation techniques for AVNRT and AVRT are covered, including approaches for mapping the circuits and terminating arrhythmias. The importance of making an accurate diagnosis is emphasized.
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It reflects conduction through the AV node.
The normal PR interval is between 120 – 200 ms (0.12-0.20s) in duration (three to five small squares).
If the PR interval is > 200 ms, first degree heart block is said to be present.
PR interval < 120 ms suggests pre-excitation (the presence of an accessory pathway between the atria and ventricles) or AV nodal (junctional) rhythm.
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The document discusses several potential cardiac diagnoses:
1. AV block: 2nd degree Mobitz type I (Wenckebach phenomenon) characterized by progressive PR interval prolongation.
2. ARVD diagnosed based on major/minor echo criteria of RV abnormalities.
3. Brugada syndrome type 1 diagnosed by characteristic ECG pattern with clinical criteria like family history of sudden death.
4. Ashman phenomenon involving aberrant conduction following a short RR interval after a long one due to refractory period differences.
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1. Ventricular tachycardia (VT) is an important cause of sudden cardiac arrest and can manifest as premature ventricular contractions (PVCs) or sustained VT.
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3. Treatment depends on the type and cause of VT but may include medications, implantable cardioverter defibrillators (ICDs), and catheter ablation which can be curative for some idiopathic VT cases.DM cardiology Exam Spotter
In this ppt i am going to discuss various spotters, including ECG, X-ray, fluroscopy images and there answers. These spotter now days asked in various DM cardiology exam conducted all over India, so it will help you in your DM Cardiology exam preperationn.
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What is cardiac Electrophysiology?
This presentation will cover basics of EP. It is Part 1 of 4 lectures about EP.
Part 1 - basics of EP and Supraventricular Tachycardias (SVT)
Part 2 - Ventricular arrhythmias and Cardiac Devices
Part 3 - Afib
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This document provides an overview of tachyarrhythmias. It defines tachyarrhythmias as abnormal heart rhythms with a heart rate exceeding 100 beats per minute. The document classifies and describes various types of tachyarrhythmias including extrasystoles, sinus tachycardia, supraventricular tachycardias such as AV nodal reentrant tachycardia, atrial fibrillation, and ventricular tachycardias. It discusses the mechanisms, clinical presentations, diagnostic tools and management options for these arrhythmias.
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Transcatheter aortic valve replacement (TAVR) has come of age as a treatment for aortic stenosis. TAVR has been shown to have outcomes comparable to surgical aortic valve replacement (SAVR) with lower short-term mortality and stroke rates based on the PARTNER trials. Long-term concerns include patient-prosthesis mismatch, structural valve deterioration, and access issues for future procedures. Ongoing trials are exploring earlier intervention in asymptomatic or mildly symptomatic patients to prevent myocardial damage and decline. TAVR is now considered the standard of care for high-risk and intermediate-risk patients with aortic stenosis.
PCI & AimRadial 2018 | A Trans-Radial Approach of Cardiac Catheterization f...
PCI & AimRadial 2018 | A Trans-Radial Approach of Cardiac Catheterization f...International Chair on Interventional Cardiology and Transradial Approach
Bleeding avoidance strategies, such as a transradial approach (TRA), should be considered especially for patients with high bleeding risk.3) However, PCI operators hesitate to choose conventional TRA for patients on dialysis because of the increased risk of radial artery occlusion (RAO) and general tendency to preserve possible hemodialysis access points for the future. Tavi 2014
This document discusses transcatheter aortic valve implantation (TAVI) for treating severe aortic stenosis. It summarizes several key trials that demonstrated the safety and effectiveness of TAVI compared to surgical aortic valve replacement. The PARTNER trials showed TAVI to be non-inferior to surgery in reducing mortality, while being associated with lower risks of bleeding, stroke, and repeat hospitalization. Subsequent trials like the CoreValve US Pivotal Trial and CHOICE trial reinforced TAVI as a standard treatment for high-risk surgical patients with aortic stenosis.
Introduction to ecg
This document introduces a standardized method for electrocardiogram (ECG) interpretation. It begins by dedicating the document to Dr. Alan E. Lindsay, a master teacher of electrocardiography. It then outlines a 6 step method for ECG interpretation: 1) Measurements, 2) Rhythm analysis, 3) Conduction analysis, 4) Wave analysis, 5) Hypertrophy analysis, and 6) Miscellaneous abnormalities analysis. The document provides background information on the components of a 12-lead ECG and emphasizes following a systematic approach to avoid missing important abnormalities.
Ecg
This document provides an introduction to electrocardiogram (ECG) interpretation. It outlines a standardized 6-step method for analyzing ECGs, including measurements, rhythm analysis, conduction analysis, waveform description, interpretation, and comparison to previous ECGs. The method emphasizes a systematic approach to avoid missing abnormalities. The document also reviews ECG waves, intervals, lead placements, and how to measure the frontal plane QRS axis.
The expanding clinical applications of tevar
The document summarizes the expanding clinical applications of endovascular aneurysm repair (TEVAR) beyond its original use for descending thoracic aneurysms. It discusses how TEVAR is now being used to treat a wider range of thoracic aortic pathologies including dissections, ulcers, trauma, and various complex aneurysms. The document also explores new techniques like branched endografts and debranching procedures that are pushing the anatomic limits of TEVAR proximally and distally. While noting some limitations, it presents data showing TEVAR has led to reduced mortality, complications, and hospital stay compared to open surgery for many thoracic aortic conditions.
Fundación EPIC _ Tendencias actuales en TAVI y desafíos futuros.
This document summarizes a presentation on current trends in transcatheter aortic valve implantation (TAVI) and future challenges. It discusses the use of TAVI in intermediate surgical risk patients, new generation valve devices, post-implant outcomes like paravalvular regurgitation and pacemaker rates, and several large clinical trials investigating the use of TAVI in lower risk patients. It also reviews temporal trends in TAVI procedures in France and research on reducing cerebral embolism during the procedure.
In most cases evar substituted conventional repaire for ruptured aaa why
The document discusses the increasing use of endovascular aneurysm repair (EVAR) to treat ruptured abdominal aortic aneurysms (rAAA) instead of open repair. EVAR is considered less invasive, resulting in less blood loss, shorter hospital stays, and lower mortality compared to open repair. While evidence comes from heterogeneous studies and a single-arm trial of 34 patients treated with the Anaconda device showed 91% treatment success but 30-day mortality of 17%, EVAR is increasingly used for rAAA due to the potential advantages over open repair. Randomized controlled trials are still needed to provide higher quality evidence.
Ablación de FA ¿A quién y cómo?
The document discusses guidelines for selecting candidates for catheter ablation to treat atrial fibrillation (AF). It notes that ablation is recommended for symptomatic patients with recurrent AF despite medication. Ablation success depends on properly selecting patients with high likelihood of symptom improvement and success but low risk of complications. Long-standing and persistent AF as well as certain medical conditions like obstructive sleep apnea predict lower success rates.
Pejkov H - AIMRADIAL 2014 - Anatomical variations
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Anatomical variations of the radial artery and aorta can impact the success of transradial procedures. The study analyzed 10,504 patients and found 10.6% had radial artery anomalies, most commonly a high bifurcation of the radial artery (7%). Patients with anomalies had higher rates of spasm (15% vs 2.7%) and bleeding complications (13% vs 7.5%). Pre-procedural imaging of radial artery anatomy allows operators to plan for anomalies and achieve a 95.3% procedural success rate with only a 4.7% crossover rate. Experience and technique can help operators overcome challenges from anatomical variations.Valutazione e.m.g. dell'innervazione dello sfintere anale post parto riva
This document summarizes preliminary results from the TASI-2 study, which analyzed changes in innervation zones of the external anal sphincter before and after childbirth using surface electromyography. It found that episiotomies were associated with significant changes in innervation zone distribution postpartum, particularly in the right ventral quadrant. A total of 126 women were studied across 20 hospitals as part of this ongoing investigation into the effects of childbirth on pelvic floor muscles.
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This document discusses acute traumatic aortic rupture, summarizing that it is a life-threatening surgical emergency caused by blunt trauma from motor vehicle accidents or falls. It can be diagnosed using CT scans or TEE ultrasound and treated either through open surgical repair requiring bypass and clamping, or endovascular stent grafting which avoids thoracotomy. While endovascular repair has advantages of less invasiveness and shorter procedure time, open repair may be necessary for injuries of the ascending aorta and there is limited long-term data on endovascular techniques. Complication and mortality rates were found to be lower for endovascular repair compared to open surgery in studies of patients at the Deutsches Herzzentrum Berlin.
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How accurate electrocardiogram predict LV diastolic dysfunction?
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Arrhythmia news no.40
1) The digital ESC Congress 2020 attracted over 116,000 healthcare professionals from 211 countries, focusing on new knowledge in arrhythmias and device therapy.
2) New guidelines and studies provided updates on atrial fibrillation screening and management, showing benefits of early rhythm control and new anticoagulants.
3) Studies explored new pacing approaches like His bundle and left bundle pacing to improve effectiveness and reduce fluoroscopy time.
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THRS allied professional training course
A meeting was held on August 10, 2019 (Saturday) in room 803 of the Taipei Chang Yung-fa International Convention Center. The meeting location and date are provided.
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Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
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Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
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**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
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- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
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- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
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- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
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1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
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Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
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1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
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Pharmacological actions-
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- 1. Ectopic Paroxysmal Atrial Tachycardia Cardiovascular Division, Departments of Internal National Taiwan University Hospital, Taipei, Taiwan CASE PRESENTATION Fellow 廖敏村 / VS 游治節
- 2. A 45-year-old female presented with progressive palpitation in recent one year
- 3. Brief history 2010/10 OPD for palpitation Holter:total 3738 SVEs (3.5%), atrial pairs: 881 No medical control Free T4 0.999 ng/dL 2011/10 ER for palpitation ECG: multiple APCs Holter Total32282 SVEs (30.1%) 424 atrial runs, longest 7 beats, fastest 136bpm 5393 atrial pairs
- 4. ECG Multiple APCs
- 5. Holter Atrial bigeminy
- 6. Holter Atrial run
- 7. Holter Atrial run with group
- 8. Holter Long-pause 3.6 sec
- 9. UCG report 2011/10/13 Ao 24 mm (20-37) IVS 7 mm (7-10) AV 16 mm (16-26) LVPW 8 mm (8-13) LA 36 mm (19-40) LVEDD 43 mm (35-53) RV 16 mm (5-21) LVESD 26 mm (20-35) LVEF: 70.6%(M-mode) Mitral valve prolapse, anterior leaflet Mild MR Mild to moderate TR
- 10. UCG
- 11. CXR
- 14. CARTO mapping RAO LAO
- 15. RFCA Anterior lateral site of RA ( above the roof of appendage)
- 16. Repeat Holter 2 months later
- 17. Thank you for your attention