Spontaneous transition of a regular narrow complex tachycardia to a wide complex tachycardia: What is the mechanism?

Bharatraj Banavalikar; Sanjai Pattu Valappil; Deepak Padmanabhan; Milan Ghadei; Anju Kottayan; Jayaprakash Shenthar

doi:10.1111/pace.13963

Incessant Automatic Atrial Tachycardia in a Neonate Successfully Treated with Nadolol and Closely Spaced Doses of Flecainide: A Case Report

Pediatric Reports ◽

10.3390/pediatric12030024 ◽

2020 ◽

Vol 12 (3) ◽

pp. 108-113

Author(s):

Gilda Belli ◽

Mattia Giovannini ◽

Giulio Porcedda ◽

Marco Moroni ◽

Giancarlo la Marca ◽

...

Keyword(s):

Case Report ◽

Sinus Rhythm ◽

Atrial Tachycardia ◽

Electrophysiological Study ◽

Common Type ◽

Supraventricular Tachyarrhythmia ◽

Risk Of Mortality ◽

Wide Complex Tachycardia ◽

Stable Sinus Rhythm ◽

Narrow Complex Tachycardia

Supraventricular tachyarrhythmia (SVT) is the most common type of arrhythmia in childhood. Management can be challenging with an associated risk of mortality. A female neonate was diagnosed with episodes of SVT, controlled antenatally with digoxin. Flecainide was commenced prophylactically at birth. Despite treatment, the infant developed a narrow complex tachycardia at 5 days of age. The electrocardiogram features were suggestive of either re-entry tachycardia or of automatic atrial tachycardia (AAT). Following several unsuccessful treatments, a wide complex tachycardia developed. A transesophageal electrophysiological study led to a diagnosis of AAT. Stable sinus rhythm was finally achieved through increasing daily administrations of flecainide up to six times a day, in association with nadolol. The shortening of intervals to this extent has never been reported before and supports the evidence of a personal, age-specific variability in pharmacokinetics of flecainide. Larger studies are needed to better define the appropriate dose and timing of administration.

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Incessant Automatic Atrial Tachycardia in a Neonate Successfully Treated with Nadolol and Closely Spaced Doses of Flecainide: A Case Report

Pediatric Reports ◽

10.3390/pediatrrep12030001 ◽

2020 ◽

Vol 12 (3) ◽

pp. 1-6

Author(s):

Gilda Belli ◽

Mattia Giovannini ◽

Giulio Porcedda ◽

Marco Moroni ◽

Giancarlo la Marca ◽

...

Keyword(s):

Case Report ◽

Sinus Rhythm ◽

Atrial Tachycardia ◽

Electrophysiological Study ◽

Common Type ◽

Supraventricular Tachyarrhythmia ◽

Risk Of Mortality ◽

Wide Complex Tachycardia ◽

Stable Sinus Rhythm ◽

Narrow Complex Tachycardia

Supraventricular tachyarrhythmia (SVT) is the most common type of arrhythmia in childhood. Management can be challenging with an associated risk of mortality. A female neonate was diagnosed with episodes of SVT, controlled antenatally with digoxin. Flecainide was commenced prophylactically at birth. Despite treatment, the infant developed a narrow complex tachycardia at 5 days of age. The electrocardiogram features were suggestive of either re-entry tachycardia or of automatic atrial tachycardia (AAT). Following several unsuccessful treatments, a wide complex tachycardia developed. A transesophageal electrophysiological study led to a diagnosis of AAT. Stable sinus rhythm was finally achieved through increasing daily administrations of flecainide up to six times a day, in association with nadolol. The shortening of intervals to this extent has never been reported before and supports the evidence of a personal, age-specific variability in pharmacokinetics of flecainide. Larger studies are needed to better define the appropriate dose and timing of administration.

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Wide complex tachycardia cycle length shorter than the narrow complex tachycardia. What is the mechanism?

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2020.02.002 ◽

2020 ◽

Vol 59 ◽

pp. 171-173

Author(s):

Vern Hsen Tan ◽

Colin Yeo ◽

Kelvin Wong

Keyword(s):

Cycle Length ◽

Wide Complex Tachycardia ◽

Narrow Complex Tachycardia

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Indications for and Complications of Temporary Transvenous Cardiac Pacing

Anaesthesia and Intensive Care ◽

10.1177/0310057x8501300109 ◽

1985 ◽

Vol 13 (1) ◽

pp. 63-70 ◽

Cited By ~ 15

Author(s):

Karl D. Donovan ◽

K. Y. Lee

Keyword(s):

Cardiac Pacing ◽

Paroxysmal Supraventricular Tachycardia ◽

Prospective Survey ◽

Group Iii ◽

Group I ◽

Wide Complex Tachycardia ◽

Pacing Lead ◽

Supraventricular Tachyarrhythmias ◽

Group Ii ◽

Narrow Complex Tachycardia

A prospective survey was conducted of the indications for and complications of 153 temporary transvenous cardiac pacing lead insertions in 148 patients. Pacing for bradyarrhythmias or potential bradyarrhythmias (Group I) accounted for 105 insertions, wide complex tachycardia (Group II) 17, and narrow complex tachycardia (Group III) 31 pacing electrode insertions respectively. The infraclavicular subclavian vein approach was used in 73%. The median insertion time was 20 minutes. Group I: 77% were undertaken because of severe symptoms. On 64 occasions (61 %) the patient had complete heart block or ventricular asystole. Group II: The lead was inserted to treat and often assist in the diagnosis of the wide complex tachycardia. Ventricular‘burst’ pacing reverted ventricular tachycardia in 13 (76%). Group III: Rapid atrial‘burst’ pacing was used to treat supraventricular tachyarrhythmias (paroxysmal supraventricular tachycardia and atrial flutter) resistant to medical therapy. Pacing was successful in reverting 28 (90%). A complication occurred in 27 (18%) of 153 lead insertions, 11 (7%) were serious. No complication resulted in the death of a patient. Temporary transvenous pacing is safe and effective for the treatment of bradyarrhythmias and certain tachyarrhythmias.

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