(Disclaimer: This article is for scientific use only, and relevant information in the following content has been processed to protect patient privacy)
Abstract: The common cause of paroxysmal supraventricular tachycardia is atrioventricular node folding due to atrioventricular node double path. This patient was diagnosed with atrioventricular node folding tachycardia after perfecting electrocardiogram and electrophysiological examination. .
Basic information】Female, 70 years old
Disease Type】Atrioventricular node regurgitation tachycardia
Hospital】Wuhan University People’s Hospital
Date of Consultation】May 2022
Treatment plan】Surgical treatment (radiofrequency ablation)
Treatment Period】5 days of hospitalization, followed by 3 weeks of outpatient treatment
Effectiveness】Heart panic disappeared and no more attacks
I. Initial consultation
The 70-year-old patient complained that her partner was admitted to the ICU a week ago after a serious illness. The monitor showed that her heart rate was 180 beats per minute, while the normal heart rate should be 60-100 beats per minute. The doctor immediately sent the patient to the emergency department for further treatment. However, she was very uncomfortable and scared afterwards, so she came to the outpatient clinic for consultation. Through careful questioning, we learned that the patient had been suffering from brief panic attacks for decades, but each attack was only short and not as severe as this one, so she did not see a doctor. Based on the patient’s symptoms and the heart rate recorded in the ECG monitor, the patient was considered to be suffering from paroxysmal supraventricular tachycardia and was recommended to be hospitalized for further treatment.
II. Treatment history
Since the ECG of the patient’s tachycardia was not captured, in order to further clarify the target, I arranged for the patient to undergo an esophageal electrophysiological examination soon after her admission, which showed that the patient had an AV node double pathway and that AV node folding tachycardia could be induced after stimulation. The patient and family were informed of the diagnosis and it was explained to them that this disease is due to an extra abnormal electrical conduction pathway in the atrioventricular node area of the heart, resulting in a short-circuit-like condition (foldback) between the normal and abnormal electrical conduction pathways, causing the heart to beat too fast.
The cure can be achieved through a minimally invasive interventional procedure, transcatheter cardiac radiofrequency ablation, which ablates the dual pathway of the AV node and interrupts the abnormal electrical conduction pathway. The procedure is performed by puncturing the blood vessel in the thigh and delivering the ablation catheter through the blood vessel into the heart, which is minimally invasive and risky, with a quick recovery and the patient can get out of bed and take care of himself on the 2nd day. The patient and family understood that surgical treatment was a good option, and the patient was scheduled for surgery. Intraoperative cardiac electrophysiological examination reconfirmed the AV node double pathway and induced tachycardia by electrical stimulation, and ablation of the slow pathway discharge in the AV node. After ablation, the phenomenon of AV node double pathway disappeared, and tachycardia could not be induced when electrical stimulation was performed again, showing that the operation was successfully completed.
III. Treatment effect
After the operation, the patient was advised to rest in bed for 12 hours, and the surgical puncture site was compressed with salt bags to stop bleeding, and the affected limb should not be moved casually. After 5 days of hospitalization, the patient was discharged from the hospital and continued to be followed up. Now it has been 3 weeks, the patient said that he did not have any more panic or discomfort, and he did not worry about the sudden onset of tachycardia which he did not know when, and he felt that a stone had fallen from his heart.
IV. Precautions
Radiofrequency ablation is a radical treatment option for atrioventricular node folding tachycardia, so after the patient was treated with radiofrequency ablation, no special medication was needed. We are sincerely happy that her disease was cured, and we are also glad that she is in a good mental state now. Due to the presence of a small puncture wound, patients still need to be reminded to keep the wound site clean and dry and to avoid excessive force on the lower extremities to prevent infection or bleeding if the wound is not fully healed. In addition, it is important to keep the mood happy and relaxed, not to be too nervous and worried, not to be overjoyed and sad, and to pay attention to a light diet with balanced nutrition and avoid eating too spicy and stimulating food.
V. Personal insight
Atrioventricular nodal tachycardia is a relatively common arrhythmia, with the characteristics of sudden onset and sudden stop, the heartbeat during the attack is often 150-200 beats per minute, the main manifestation is panic, may also be combined with chest tightness, chest pain, dizziness, blackness and even fainting symptoms. When tachycardia occurs, you can try to terminate the attack by deep breathing, stimulating the pharynx and other excitatory vagus nerve actions. It is the preferred treatment option because of the small trauma and quick recovery. As in this patient, the condition was effectively controlled after the surgery.