Medicine · 2021
Frequent inappropriate implantable cardioverter defibrillator therapy was determined to be dual atrioventricular nodal non-reentrant tachycardia: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Ma Chengming, Yin Xiaomeng, Xia Yunlong, Li Wenwen, Gao Lianjun, Dai Shiyu, Yu Xiaohong
Аннотация
RATIONALE: Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia. We present a case of inappropriate implantable cardioverter defibrillator (ICD) therapy caused by DAVNNRT. DAVNNRT is easily misdiagnosed as atrial fibrillation and is often identified as ventricular tachycardia (VT) by the supraventricular tachycardia-ventricular tachycardia (SVT-VT) discriminator of the ICD.
PATIENT CONCERNS: A 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%.
DIAGNOSIS: He was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT.
INTERVENTIONS: : Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia.
OUTCOMES: No episode of inappropriate ICD therapy or tachycardia occurred during the follow-up.
LESSONS: In conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.
PATIENT CONCERNS: A 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%.
DIAGNOSIS: He was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT.
INTERVENTIONS: : Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia.
OUTCOMES: No episode of inappropriate ICD therapy or tachycardia occurred during the follow-up.
LESSONS: In conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.