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Abstract: Atrioventricular folding tachycardia can be induced when an abnormal bypass conduction pathway is congenitally formed in the normal cardiac conduction system and forms a folding loop with the atrioventricular node of the heart, as in the case of the patient in this article, who had intermittent sudden and abrupt panic attacks for 5 years and was diagnosed with atrioventricular folding tachycardia after coming to our hospital for electrocardiographic examination. The patient was given medication + radiofrequency ablation + vagus nerve stimulation after consultation, and was followed up for 1 year after discharge.
Basic information】Male, 14 years old
Disease Type】Pre-excitation syndrome, atrioventricular folding tachycardia
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of Consultation】April 2021
Treatment plan】Vagus nerve stimulation + pharmacological resuscitation (adenosine triphosphate) + radiofrequency ablation
Treatment Period】5 days of hospitalization and telephone follow-up
Effectiveness】Electrocardiogram was normal, the symptoms of panic disappeared, and the tachycardia was cured.
I. Initial consultation
The patient is a 14-year-old male, a school student, who reported that he started to have sudden onset and cessation of panic attacks 5 years ago, accompanied by profuse sweating and weakness, often occurring during exertion or emotional excitement, and improving on his own after 5-30 minutes of rest. One hour ago, the patient came to our hospital with sudden onset of panic again, and the symptoms did not subside. Examination of the electrocardiogram showed supraventricular tachycardia with a heart rate of 160 beats per minute. Combined with the boy’s previous ECG and current heart rate in an outside hospital, the possibility of preexcitation syndrome combined with atrioventricular folding tachycardia was considered.
II. Treatment history
Based on the patient’s condition, prehospital and admission examinations, he was admitted to the hospital for treatment. We instructed the patient to hold his breath after deep inspiration (Valsalva maneuver), induce nausea by sticking his finger into his throat, and press his unilateral carotid sinus and eye in sequence to stimulate the patient’s vagus nerve, and repeat the above actions 3-4 times. After discussion with the patient and his family, pharmacological diversion was performed. After giving the patient oxygen, emotional reassurance and a bullet injection of adenosine triphosphate (ATP), the patient’s heart rate turned to a normal heart rate. During this time, the patient complained of chest tightness and breath-holding discomfort, which lasted for 3-5 minutes and gradually relieved. The electrocardiogram was checked again and showed type A preexcitation, and the electrocardiogram was as follows (Figure 1: the red box shows the preexcitation wave). Oral medications such as metoprolol were given to prevent the recurrence of tachycardia, and catheter ablation for radical treatment was also possible. Three days after admission, the patient was given an intracardiac electrophysiological examination, which showed a left-sided bypass, and radiofrequency ablation was performed. The postoperative electrocardiogram was checked and showed a normal electrocardiogram, and the electrocardiogram was as follows (Figure 2: the pre-excitation wave in the red box disappeared).
Admission recheck ECG (Figure 1)
The ECG was reviewed 3 days after admission (Figure 2)
III. Treatment effect
The patient underwent radiofrequency ablation 3 days after admission, and the symptoms of tachycardia were significantly relieved after the procedure, and he was discharged from the hospital in 5 days. At present, the patient has been discharged from the hospital for 1 year. During the telephone follow-up 1 year after the operation, both the patient and his family indicated that there was no recurrence of panic, sweating and weakness after the radiofrequency ablation, and the general electrocardiogram and dynamic electrocardiogram outside the hospital were normal. The patient was also instructed to review the ECG regularly and to visit our hospital promptly if the symptoms of panic recur.
IV. Notes
After active in-hospital treatment, the patient’s sudden tachycardia symptoms basically disappeared, and we were truly happy for him. After the patient was discharged from the hospital, during the consolidation period, it is recommended to give the medication regularly and in full, and avoid stopping the medication on your own; and to follow up regularly and communicate with the doctor about the recovery. In daily life, especially in this case, the patient is a school student with high academic pressure, so he should pay attention to appropriately reduce mental stress, and learn to eliminate nervousness and anxiety during the examination period; participate in more social activities to adjust his state; on diet, advocate a light and nutritious diet, small and frequent meals, regular rationing; you can exercise appropriately, such as jogging, walking, etc., to enhance your physical fitness.
V. Personal insight
Clinically, many patients only find ventricular preexcitation waves during routine physical examination of electrocardiogram, ventricular preexcitation does not cause symptoms, only about 1.8% of such patients will have preexcitation syndrome combined with atrioventricular fold tachycardia, so there is no need to be overly nervous. If a patient experiences tachycardia, simple methods such as holding the breath after a deep inhalation or picking the throat to induce nausea are recommended to stop the onset of tachycardia; for patients who understand their situation, oral medications such as metoprolol and verapamil can be taken to prevent the onset of tachycardia under the guidance of a doctor. If a patient has tachycardia that becomes prolonged and cannot be reversed, or has frequent episodes of tachycardia, it is recommended to seek immediate medical attention and undergo surgery under the guidance of a doctor.