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Abstract: A patient came to the clinic complaining of frequent panic attacks, with the feeling that the heart is always beating and stopping, which is obvious after drinking and during fatigue. In the early stage of the disease, it is not harmful to the body, but in excessive numbers, it can lead to severe arrhythmias such as panic attacks and even atrial fibrillation. The patient was diagnosed and treated with a minimally invasive radiofrequency ablation procedure, after which the premature atrial beats disappeared and no further episodes of panic occurred.
Basic information】Male, 63 years old
Disease Type】Atrial premature beats
Hospital】Wuhan University People’s Hospital
Date of Consultation】May 2022
Treatment plan】Radiofrequency ablation of the heart
Treatment Period】5 days of inpatient treatment, 2 weeks of outpatient follow-up
Results】Premature beats disappeared, no more heart attacks
I. Initial consultation
The 63-year-old patient is usually in good health and has no chronic diseases such as hypertension or diabetes, but in the past two years, he has always felt panic attacks, and his heart has the discomfort of stopping every now and then. As I always feel that I am in good health, I have never seen a doctor. Recently, he came to the outpatient clinic for examination after feeling uncomfortable with heartburn all day long. After careful auscultation with a stethoscope in the patient’s heart area, there were obvious abnormalities in the heartbeat rhythm with characteristics of premature beats. The electrocardiogram showed atrial premature beats, a type of supraventricular arrhythmia, and the patient was recommended to be hospitalized for further treatment because of the obvious symptoms.
II. Treatment history
The patient’s electrocardiogram clearly showed the presence of atrial premature beats, and further 24-hour ambulatory electrocardiogram was required to assess the number of atrial premature beats, as well as cardiac ultrasound to check for the presence of organic heart disease. The cardiac ultrasound results showed that the patient’s heart structure and function were completely normal, but the number of premature beats in a 24-hour period reached more than 20,000, which is equivalent to 1 out of every 4-5 heartbeats, so it is no wonder that he always felt panicky and uncomfortable. After the condition was clarified, the patient and his family were further informed of the treatment plan. Due to the high number of premature beats and obvious symptoms, the patient was advised to choose minimally invasive radiofrequency ablation, and if he did not want to undergo surgery, he could consider taking medication to control it. After discussing with his family, the patient still wanted to get a better treatment result through surgery. The ablation catheter was sent through the blood vessel in the thigh to the heart to find the ectopic pacing point causing the premature atrial beats and ablate it. The premature beats disappeared immediately after the ablation treatment, and the procedure was successfully completed after a period of observation without abnormalities.
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 a salt bag to stop bleeding, and the affected limb should not be moved casually. The patient’s general condition was good, and his vital signs were stable, and he got out of bed normally on the second day after surgery without any special discomfort. After 2 days of observation, the patient was discharged on the 5th day, and follow-up was continued. The patient returned to the clinic 2 weeks later and when the stethoscope was placed in his heart area, he could not hear the frequent and irregular premature beats on palpation. The patient also reported that the symptoms of panic had improved after the surgery and returned to normal life.
IV. Precautions
The patient improved after the treatment, and I am happy for the patient. However, since there is a puncture wound in the radiofrequency ablation procedure, patients should be reminded to keep the wound site clean and dry and avoid excessive force on the lower limbs to prevent infection or bleeding if the wound is not completely healed. In addition, it is important to keep the mood happy and relaxed, pay attention to a light diet, balanced nutrition, avoid too spicy and stimulating food, as well as smoking, drinking and other bad habits. Especially in this case, the patient likes to drink alcohol, so I repeatedly emphasized that alcohol must be limited, otherwise it will have a negative effect on the heart and may stimulate the recurrence of premature beats.
V. Personal insight
Atrial premature beats are a kind of common supraventricular arrhythmia, due to the presence of an ectopic pacing point in a certain part of the atrium, which may give out abnormal electrical signals from time to time and make the heart beat prematurely, mainly manifesting as panic attacks and possibly combined with chest tightness, chest pain and dizziness. Therefore, if the number of premature beats is not large and the patient has no obvious symptoms, the patient can be temporarily observed without special treatment, mainly avoiding emotional tension, smoking, alcohol, strong tea, coffee and other behaviors or diet that are stimulating to premature beats. However, if the number of premature beats is too high, the patient may have obvious symptoms and be uncomfortable. In the long run, it may also lead to structural reconstruction of the atria and may lead to more serious arrhythmias such as atrial tachycardia and atrial fibrillation. The disease can be treated with drugs, but drugs usually need to be taken for a long time, while radiofrequency ablation through minimally invasive can achieve a better treatment effect on the disease with less trauma and faster recovery.