Chronobiology of Symptomatic Supraventricular Paroxysmal Tachycardia

The circadian, circaseptenal and circaannual occurrence of supraventricular paroxysmal tachycardias (SVPT) were examined in patients addressing an Emergency Department. Sixty-one patients, 22 men and 39 women aged 48.3+13.0 y, were eligible and investigated during a solar year. Cosinor method indicated a significant circadian SVPT variation, with an acrophase at about 6 p.m. A similar periodicity was also detected in supraventricular premature beat prevalence (acrophase at 3 h 31 min), concordant with heart rate peaking. Monday was the most frequently affected day, while the circa-annual analysis disclosed a peak in summer and autumn. Our findings provide further evidence that SVPT shows the highest occurrence during daytime, in possible connection with adrenergic influence. Moreover there are clues that cyclic stressors, e.g. the ones connected with working-activity resumption or climate influence, may partly condition SVPT appearance during the week or the year.     

Chronobiology of Symptomatic Supraventricular Paroxysmal Tachycardia

The circadian, circaseptenal and circaannual occurrence of supraventricular paroxysmal tachycardias (SVPT) were examined in patients addressing an Emergency Department. Sixty-one patients, 22 men and 39 women aged 48.3+13.0 y, were eligible and investigated during a solar year. Cosinor method indicated a significant circadian SVPT variation, with an acrophase at about 6 p.m. A similar periodicity was also detected in supraventricular premature beat prevalence (acrophase at 3 h 31 min), concordant with heart rate peaking. Monday was the most frequently affected day, while the circa-annual analysis disclosed a peak in summer and autumn. Our findings provide further evidence that SVPT shows the highest occurrence during daytime, in possible connection with adrenergic influence. Moreover there are clues that cyclic stressors, e.g. the ones connected with working-activity resumption or climate influence, may partly condition SVPT appearance during the week or the year.     

Atrioventricular Block Subsequent to Intraoperative Device Closure Atrial Septal Defect with Transthoracic Minimal Invasion; A Rare and Serious Complication

Objectives

Atrioventricular block (AVB) is a infrequent and serious complication after percutaneous ASD closure. In this study, we report on the incidence of AVB associated with intraoperative device closure of the ASD with transthoracic minimal invasion, and the outcomes of this complication in our center.

Methods

Between May 2006 and January 2011, a total of 213 secundum-type ASD patients were accepted in our hospital for intraoperative and transthoracic device closure with a domestic occluder. All patients were assessed by real-time transthoracic echocardiography (TTE) and electrocardiograph (ECG).

Results

All patients were occluded successfully under this approach. Immediate postprocedure third-degree AVB was observed in two patients. Since heart rates were in the range of about 50 to 55 beats per minute, no intervention was needed except for close observation for one patient. Another patient who recovered sinus rhythm intermittently during the operation was fitted with a temporary pacemaker. Approximately one week following glucocorticoid treatment, the AVB resolved spontaneously in these two patients. Mobitz type II AVB occurred in three patients during the procedure. Two patients developed post-operative cardiac arrest and were rescued successfully with cardiopulmonary resuscitation. One other patient changed to Mobitz type I AVB after three days. During the follow-up period, which ranged from six months to five years, no further occurrence of AVB was found.

Conclusions

Intraoperative and transthoracic device closure of secundum ASDs with domestic occluder resulted in excellent closure rate. AVB is an infrequent but serious complication during and after device closure of a secundum ASD. AVB is a complication that warrants greater attention and long-term follow-up.     

Differences in Quality of Life,Anxiety and Depression in Patients with Paroxysmal Atrial Fibrillation and Common Forms of Atrioventricular Reentry Supraventricular Tachycardias

Introduction

The aim of this study was to evaluate the differences in quality of life and psychosocial stress parameters among patients with paroxysmal atrial fibrillation (AF) and common forms of atrioventricular reentry supraventricular tachycardias (SVTs).

Methods and Results

The total study population included 106 patients, 54 patients with paroxysmal AF (32 males, age 56.64±12.50 years) and 52 with SVTs (25 males, age 40.46±14.96 years). General health (p<0.01), physical function (p=0.004), role emotion (p=0.002) and role physical (p<0.01) scores were lower in patients who suffered AF. SF-36 physical and mental health summary measures were also significantly lower in the AF group compared to those in SVT group (p<0.01 and p=0.001, respectively). Lower SF-36 total score was observed in patients with AF compared to those with SVTs (p<0.01). Comparing the anxiety and depression scores all the values were higher in patients with AF. Higher STAI-state scores (p<0.01), STAI-trait scores (p=0.039) and BDI scores (p=0.077) were seen in patients who suffered AF comparing to those with SVTs.

Conclusions

Quality of life is significantly impaired and the level of anxiety is significantly higher in patients with AF comparing to those with common forms of SVTs.     

Navx-guided Cryoablation of Atrial Tachycardia Inside the Left Atrial Appendage

Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavX-guided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.