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Abstract: A 21-year-old female patient presented with palpitations with no apparent cause 1 year ago, with sudden onset and stopping characteristics, lasting 1-2 minutes and relieving on its own. 1 day ago, the symptoms recurred with a more intense degree and persisted without relief, so she was admitted to the hospital. The patient was diagnosed with arrhythmia by electrophysiological examination, and was treated with cardiac radiofrequency ablation and medication.
Basic information】Female, 21 years old
Disease Type】Cardiac arrhythmia
Hospital】Central South University Xiangya Hospital
Date of consultation】January 2022
Treatment plan】Surgical treatment (cardiac radiofrequency ablation) + oral medication (aspirin enteric tablets)
Treatment period】3 days of hospitalization and long-term follow-up
Treatment effect] Palpitations disappeared and the condition was stable
I. Initial consultation
The patient reported that he had palpitations with no obvious cause 1 year ago, and they were sudden and stopping, lasting 1-2 minutes, and could be relieved by themselves. The patient was not treated systematically, and the palpitations occurred intermittently afterwards, each time lasting for a short time. 1 day ago, the symptoms recurred with a more intense degree and persisted without relief, so he was admitted to the hospital for treatment. On examination, the heart border was not enlarged, the heart rate was 84 beats per minute, the rhythm was uniform, and there were no pathological murmurs. Ultrasound examination of the heart showed no significant abnormalities in cardiac morphology, structure and valve activities, and normal left ventricular diastolic function. Combined with the clinical symptoms, the initial diagnosis was arrhythmia, and the patient was admitted to the hospital.
II. Treatment process
After comprehensive consideration, the patient was admitted to the hospital and decided to prepare for minimally invasive cardiac radiofrequency ablation immediately. The patient was placed in a supine position, and the right femoral vein was punctured and a vascular sheath was placed after local anesthesia. The right femoral vein was punctured again and ablation was performed. The discharge ablation showed alternating sinus rhythm and junctional rhythm, suggesting a valid target. The electrodes were withdrawn successfully. After the operation, oral aspirin enteric tablets were administered for anticoagulation therapy to prevent postoperative thrombosis.
III. Treatment results
The patient’s operation was successful, and the intracardiac electrophysiological examination showed typical AV nodal folded tachycardia in the dual pathway of the AV node. The patient did not complain of discomfort intraoperatively or postoperatively, and returned to the ward safely with a postoperative blood pressure of 118/76 mmHg and a heart rate of 83 beats/min. Three days after hospitalization, the patient felt no palpitations, no chest tightness, chest pain, or dyspnea. On examination, the heart rate was 82 beats/min, rhythmical, no pathological murmur, and generally in good condition. The patient was discharged from the hospital and continued to take medication at home.
IV. Notes
I was happy to see the patient happily discharged from the hospital, and I also advised the patient to pay attention after going home. After discharge, pay attention to rest, ensure enough sleep, and avoid staying up late and straining. It is recommended to choose low to moderate intensity exercise such as jogging and walking, and avoid strenuous exercise. Diet should be low in salt and fat, and avoid cold, strain and infection in daily life. Regular oral aspirin enteric tablets are also needed after returning home. If there is bleeding tendency such as hematuria and hematochezia, you should go to the hospital promptly. Regularly review liver and kidney function, electrolytes, ECG, monitor blood pressure as well as heart rate by yourself and follow up regularly.
V. Personal insight
Arrhythmias can occur at any age, with palpitations as an early manifestation. Therefore, when palpitations occur, they should also be given some attention. The patient in this case did not pay attention after the onset of the disease, which led to a re-occurrence of symptoms before he was seen in the hospital. Because of the patient’s relatively young age and good physical condition, the condition was relatively well controlled after treatment with minimally invasive cardiac radiofrequency ablation and oral anticoagulants. If left untreated, it may easily cause heart failure, myocardial ischemia, or even sudden death, so the presence of palpitations should be taken seriously.