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Abstract: A 36-year-old female patient, Ms. Liu, came to the clinic with paroxysmal panic attacks for more than 1 year, which were aggravated for 3 days again. Transesophageal electrophysiological examination was performed on admission, suggesting atrioventricular fold tachycardia, and the patient was given transcatheter cardiac radiofrequency ablation. Intraoperative electrophysiological examination revealed the presence of a left septal bypass, and the retrograde function of the bypass was blocked by surgical ablation, while medication was given. The patient’s related symptoms improved, the stenosed and occluded vessel was opened, and all indicators improved, and she was discharged successfully.
Basic information】Female, 36 years old
Disease Type】Atrial fold tachycardia
Hospital】Wuhan University People’s Hospital
Date of consultation】April 2021
Treatment plan】Surgery (radiofrequency ablation surgery) + medication (metoprolol succinate extended-release tablets + coenzyme Q10 tablets + ginseng heart capsule)
Treatment period】4 days of hospitalization and 1 month of follow-up
Treatment effect]: The symptoms improved, the stenosed and occluded blood vessels were opened, and all indicators improved, and the patient was discharged successfully.
I. Initial consultation
On a day in April 2021, a female patient came to the clinic with paroxysmal panic attacks for more than 1 year, which worsened for 3 days. The patient reported that six months ago, she developed panic attacks and chest tightness without any obvious triggering factors, with blackness in front of her eyes, but no sweating, nausea, vomiting or stomach distension. 3 days ago, the patient felt that her panic attacks and chest tightness had worsened, and she had an electrocardiogram at a local hospital, which indicated sinus tachycardia, without any other treatment, so she came to the hospital. The patient was carefully asked about his previous physical condition and learned that the patient had previously had a fracture in his right leg, which was fixed with a steel nail. He had no underlying diseases such as hypertension, diabetes, or coronary heart disease, and his parents and siblings had no history of these diseases. On physical examination, the heart rate was found to be increased to 103 beats/min; the blood pressure was normal at 135/82 mmHg. The patient was considered to have unexplained tachycardia, and it was not yet known whether it was supraventricular tachycardia or ventricular tachycardia, so the patient was admitted to the cardiology department to further clarify the diagnosis.
II. Treatment history
At the time of hospitalization, the patient underwent blood sampling, and ultrasensitive troponin was 0.03 ng/mL. There were no significant abnormalities in blood routine, liver and kidney function, and electrolytes, while urine routine revealed occult blood (+). . After discussion in the department, the patient was given cardiac radiofrequency ablation, so the patient underwent transcatheter cardiac radiofrequency ablation on the 5th day after admission. The intraoperative electrophysiological examination showed the presence of left septal bypass, which had retrograde conduction, and the retrograde function of the bypass was blocked after surgical ablation, and no further tachycardia was induced. Through radiofrequency ablation, the occurrence of tachycardia was prevented from the root cause, and Ms. Liu’s heart rate was within the normal range after the operation. In addition, the patient was admitted to the hospital with metoprolol succinate extended-release tablets to control the ventricular rate, supplemented with coenzyme Q10 tablets and ginseng heart capsules to combat the arrhythmia, and the patient was discharged the day after the operation.
III. Treatment effect
The treatment effect of Ms. Liu was remarkable. Firstly, Ms. Liu’s symptoms such as heart panic, chest pain and chest tightness were significantly relieved. Secondly, through transesophageal electrophysiological examination, the cause of the panic was identified as atrioventricular fold tachycardia among the arrhythmias. Furthermore, the root cause of atrioventricular fold tachycardia was resolved by radiofrequency ablation procedure, and the use of ventricular rate control drugs and cardioprotective drugs prevented the occurrence of tachycardia leading to ischemia, syncope, blackout, sudden death, and other acute nausea events. In summary, the patient’s stenosed and occluded vessels were opened, all indicators improved, and he was discharged successfully after 4 days of hospitalization. At the time of discharge, the patient was advised to follow up with the clinic after 1 month.
IV. Notes
The patient in this case was discharged successfully after active and effective treatment, and we are sincerely glad for his good disease regression. After discharge, patients should still not take it lightly. When there is persistent unrelieved chest pain or shortness of breath, dizziness, or syncope, they should seek follow-up medical care promptly; if there is no abnormality, they should also be followed up 1 month after discharge. In addition, it is necessary to pay attention to the daily lifestyle and diet regulation, eat nutritious and light diet, eat less and more meals, and drink less strong tea or coffee-based beverages to avoid inducing tachycardia. Daily exercise can be appropriate, mainly low-intensity, such as jogging, walking, etc.; pay attention to keep enough sleep and maintain mental health, pay attention to emotions, should not be anxious.
V. Personal insight
There are many causes of atrial folding tachycardia, such as smoking, alcoholism, large intake of caffeine, drug abuse, etc. If there is organic heart disease, prolonged tachycardia will increase the risk of morbidity and mortality. Tachycardia should be terminated as soon as a relatively long period of tachycardia occurs. For people with atrioventricular folding tachycardia who have good cardiac function and blood pressure, they can first out try to stimulate the vagus nerve; if repeated attempts fail, they should choose drug therapy or perform transcatheter radiofrequency ablation therapy, which has a higher success rate and can prevent recurrence. catheter ablation technology is very mature and can safely and effectively treat tachycardia. this patient was treated with radiofrequency ablation and drug therapy, and the condition The patient’s condition was effectively relieved by radiofrequency ablation and medication.