Paradoxical atrial capture during a wide complex tachycardia

518 Evaluation of a rate overdrive algorithm for reliable automatic atrial capture threshold measurement

EP Europace ◽

10.1016/s1099-5129(05)80465-9 ◽

2005 ◽

Vol 7 ◽

pp. 157-158

Keyword(s):

Atrial Capture ◽

Threshold Measurement

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Wide Complex Tachycardia

Electrocardiogram in Clinical Medicine ◽

10.1002/9781118754511.ch44 ◽

2020 ◽

pp. 461-471

Author(s):

Scott Young ◽

Rachel Villacorta Lyew

Keyword(s):

Wide Complex Tachycardia

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Presence of low voltage area predicts atrial tachyarrhythmia inducibility with atrial burst pacing after pulmonary vein isolation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0595 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Kawai ◽

K Nagaoka ◽

S Takase ◽

K Sakamoto ◽

H Ikuta ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Low Voltage ◽

Past History ◽

Univariate Analysis ◽

Atrial Tachyarrhythmia ◽

Chads2 Score ◽

Atrial Capture ◽

History Of

Abstract Background Induction of atrial fibrillation (AF)/atrial tachycardia (AT) by atrial burst pacing following ablation procedure may reflect the presence of residual substrates in the atria that maintain AF. However, the relation between the inducibility and left atrial low voltage area (LVA) has not been established. Methods Fifty-nine patients (65 years old, 43 males) with persistent AF who underwent pulmonary vein isolation (PVI)-based ablation were studied. All patients underwent left atrial voltage mapping during sinus rhythm and atrial burst pacing after PVI. Atrial burst pacing was performed with 30-beat at an amplitude of 10V from the ostium of the coronary sinus; increasing from 240 to 320 ppm in steps of 20 ppm or failure to 1:1 atrial capture. Inducibility was defined as AF/AT lasting more than 5 minutes following burst pacing. Left atrial LVA and other co-variates were analyzed with regard to burst pacing positivity. Results AF/AT was induced by burst pacing in 23 patients (39%). Univariate analysis revealed that past history of stroke, CHADS2 score and presence of left atrial LVA were significantly associated with the inducibility of AF/AT. Multivariate analysis revealed that only the presence of LVA was associated with the inducibility (OR 1.5: per 10% increase; p=0.04). We focused on the relationship between the extent of LVA and burst positivity. AF/AT inducibility increased as low voltage area increased, and it was as high as 72.7% when low voltage area was more than 20% (P<0.05). Interestingly, induced arrhythmia type was AT rather than AF when low voltage area was more than 20%. Conclusions Presence of left atrial LVA is an independent predictor of atrial tachyarrhythmia inducibility after PVI in patients with persistent AF. A large amount of low voltage area is related to AT inducibility rather than AF. Extent of LVA and burst positivity Funding Acknowledgement Type of funding source: None

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Wide Complex Tachycardia in a Pediatric Diphenhydramine Overdose Treated With Sodium Bicarbonate

Pediatric Emergency Care ◽

10.1097/pec.0b013e31823b0e47 ◽

2011 ◽

Vol 27 (12) ◽

pp. 1175-1177 ◽

Cited By ~ 20

Author(s):

Jon B. Cole ◽

Samuel J. Stellpflug ◽

Eric A. Gross ◽

Stephen W. Smith

Keyword(s):

Sodium Bicarbonate ◽

Wide Complex Tachycardia ◽

Diphenhydramine Overdose

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What Caused This Wide-Complex Tachycardia?

Progress in Cardiovascular Nursing ◽

10.1111/j.0889-7204.2003.02890.x ◽

2003 ◽

Vol 18 (4) ◽

pp. 201-202

Author(s):

Angela Tsiperfal ◽

Christine Thompson

Keyword(s):

Wide Complex Tachycardia

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Lipid therapy for the treatment of a refractory amitriptyline overdose

CJEM ◽

10.2310/8000.2011.110486 ◽

2012 ◽

Vol 14 (03) ◽

pp. 193-197 ◽

Cited By ~ 15

Author(s):

Mathew B. Kiberd ◽

Samuel F. Minor

Keyword(s):

Lipid Emulsion ◽

Case Reports ◽

Hemodynamic Instability ◽

Tricyclic Antidepressant ◽

Intentional Ingestion ◽

Wide Complex Tachycardia ◽

Whole Bowel Irrigation ◽

Level Of Consciousness ◽

Amitriptyline Overdose ◽

Multiple Episodes

ABSTRACT Tricyclic antidepressant (TCA) overdose is a leading cause of death among intentional overdoses. Intravenous lipid emulsion therapy is an emerging antidote for local anesthetic toxicity, and there is animal evidence that lipid therapy may be efficacious in TCA overdose. Furthermore, case reports in humans have described the use of lipid therapy to reverse the toxicity of other lipophilic drugs. Here we report a 25-year-old female presenting with coma and hemodynamic instability following intentional ingestion of amitriptyline. She had multiple episodes of pulseless wide-complex tachycardia despite conventional treatment with chest compressions, cardioversion, lidocaine, epinephrine, norepinephrine, magnesium sulphate, sodium bicarbonate, activated charcoal, and whole bowel irrigation. Twenty percent lipid emulsion was administered intravenously (an initial 150 mL bolus, followed by an infusion at 16 mL/h and a second bolus of 40 mL) over 39 hours (total dose 814 mL) yet resulted in no dramatic changes in hemodynamics or level of consciousness. However, there was a decrease in the frequency of wide-complex tachycardia during the lipid emulsion infusion and a recurrence of wide-complex tachycardia shortly after the infusion was stopped. The patient was discharged from the intensive care unit 11 days later with no lasting physiologic sequelae.

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