417

Size: px

Start display at page:

Download "417"

강희 예
7 years ago
Views:

1 Analysis of Factors Predicting Recurrence and the Result of Treatment in PSVT Patients at the Emergency Department Byeong Jo Chun, M.D., Jung Mi Moon, M.D., Joon Sun Wi, M.D., Kyoung Woon Jeoung, M.D., Hyun Chang Kim, M.D., Seung Tae Jeong, M.D., Tag Heo, M.D., Young Il Min, M.D. P u r p o s e: The purpose of this research was to evaluate the factors predicting recurrence and the characteristics of patients who recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with a d e n o s i n e. M e t h o d s: From January 1999 to December 2001, 62 patients with PSVT were enrolled in this study. The conversion group included patients who had had a therapeutic response, which was defined as the occurrence of a change in the sinus rhythm after adenosine administration. The recurred group consisted of all patients who had not had a therapeutic response. Clinical features, the results of treatment, ECG findings, and the hemodynamic statuses were analyzed. R e s u l t s: The treatments were vagal maneuver (5 pts, 7.5 ), adenosine 6 mg (37 pts, 55.2), adenosine 12 mg (14 pts, 20.9), verapamil 5 mg (9 pts, 13.4), and cardioversion (2 pts, 3.0). Twenty-five of the 62 patients failed to have a therapeutic response, yielding a recurrence rate of Atrioventricular reentrant tachycardia (AVRT) was more prevalent in the recurred group. The most common symptom at presentation was chest pain. The recurred group had increased heart rate, and increased blood pressure. When patients were monitered after adenosine, unifocal premature ventricular complex was the most common rhythm encountered in the conversion group, but atrial fibrillation, and multifocal premature ventricular complex was the most common rhythm encountered. C o n c l u s i o n: Age, heart rate, difference in systolic blood pressure from presentation to discharge, previous history of heart disease, and rhythms encountered after adenosine administration were factors predicting recurrence. Key Words: Paroxysmal supraventricular tachycardia (PSVT), Recurrence, Predicting factors Department of Emergency Medicine, Chonnam National University College of Medicine, Kwangju, Korea 416

recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with a d e n o s i n e.

2 417

3 418 /

4 419

5 420 /

6 421

7 422 / 11. Yealy DM, Delbridge TR: Rosen s Emergency Medicine. Concepts and Clinical Practice. 4th ed. p1617, St. Louis, MO, Mosby, Orejaurena LA, Vidaillaet H Jr, Destefano F: Paroxysmal 15. Nayebpour M, Billette J, Amellal F, Nattel S: Effects of supraventricular tachycardia in the general population. J of the Am Colleage of Cardiology 31(1): Akhtar MA, Jazayeri MR, Sra J: Atrioventricular nodal reentry. Clinical electrophysiology and therapeutic consid- Circulation 88:282-95, eration. 14. Kugler JD, Danford DA: Management of Infants, children, and adolescents with paroxysmal supraventricular tachycardia. J Pediatr 129:324-38, adenosine on rate dependent atrioventricular nodal function. Potential roles in tachycardia termination and physiological regulation. Circulation 88: , Luber S, Brady W, Joyce T, Perron: Paroxysmal sypraventricular tachycardia: outcome after ED care. Ame J of Emergency Medicine 19(1):40-2, Wen ZC, Chen SA, Tai CT, Chiang CE, Chiou CW, Chang MS: Electrophysiological mechanism and determinations of vagal maneuver for termination of Paroxysmal supraventricular tachycardia. Circulation 98 ( 24 ): , Metha S, Wafa DE, Ward AJ, Camm AJ: Relative efficacy of various physical maneuvers in the termination of junc-

Akhtar MA, Jazayeri MR, Sra J: Atrioventricular nodal reentry. Clinical electrophysiology and therapeutic consid- Circulation 88:282-95, 1993. eration. 14.

8 423 tional tachycardia. Lancet(1):1181-5, Shen W, Kurachi Y: Mechanism of Adenosine mediated Actions on Cellular and Clinical Cardiac Electro- physiology. Mayo Clinic Proceedings 70(3):274-91, Lerman BB, Belardinelli L: Cardiac electrophysiology of adenosine. Basic and clinical concepts. C i r c u l a t i o n. 83: , Camm AJ, Garratt C: Adenosine and supraventricular tachycardia. N Engl J Med. 325:1621-9, Belardinelli L, Curtis AB, Bertolet B. In: Jacobson KA, Jarvis MF, eds. Purinergic Approaches in Experimental Therapeutics. p , New York, NY: Wiley-Liss, Inc, Freilich A, Tepper D: Adenosine and its cardiovascular effects. Am Heart J. 123: , John M, Miller P, Douglas P: Heart disease. A textbook of cardiovascular medicine. 6th ed. p738, W.B. Saunders, Losek JD, Endom E, Dietrich A, et al.: Adenosine and Pediatric supraventricular tachycardia in the emergency department: Multicenter study and review. Ann Emerg Med 33:185, O Nunain S, Jennison S, Bashir Y, et al.: Effects of adenos i n e on atrial repolarization in the transplanted human heart. Am J Cardiol 71:248, Westfall DP, Fleming WW: Sensitivity changes in the dog heart to norepinephrine calclium and aminophylline resulting from preteatment with reserpine. J Pharmacol Exp Ther 159:98-105, Belardinelli L, Fenton RA, West A, Linden J, Althaus JS, Berne RM: Extracellular action of adenosine and the antagonism by aminophylline on the atrioventricular conduction of isolated perfused guinea pig and rat hearts. Circ Res 51:569-79, Ganz L, Friedman P: Supraventricular tachycardia. N Engl J Med 332:162-73, Podrid P, Kowey P: Cardiac Arrhythmia. p828-74, Baltimore, Williams and Wilkins, Lim SH, Anantharaman V, Teo WS, et al.: Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med 31: 30-5, Cairns CB, Niemann JT: Intravenous adenosine in the emergency department management of paroxysmal supraventricular tachycardia.. Ann emerg Med 20(7):717-21, Duriseti RS, vander Vlugt TM: 257 Cardiac enzymes, ischemia symptoms, and ST segment Depression in the Emergency Department presentation of paroxysmal supraventricular tachycardia. Ann Emerg Med 3 8 : 6 9, McManus BM, Wood SM: Key morphologic features of the normal and abnormal, modified and unmodified con - duction system. In singer 1st ed. Interventional Electrophysiology, Baltimore: Williams & Wilkins;133-77, Ooi SB, Cgua BK: Conversion Rhytms From Adenosine in Treating Supraventricular Tachycardia. Ann Emerg Med 35(3): S35, Lowenstein SR, Halperin BD, Reiter MJ: Paroxysmal tachycardias. J of Emerg Med 14, 39-51, Ho MT: Current Emergency Diagnosis and Treatment. 4th ed. p Norwalk, CT, Appleton & Lange, 1992.

Camm AJ, Garratt C: Adenosine and supraventricular tachycardia. N Engl J Med. 325:1621-9, 1991. 12. Belardinelli L, Curtis AB, Bertolet B. In: Jacobson KA, Jarvis MF, eds.

ºÎÁ¤¸ÆV10N³»Áö

ºÎÁ¤¸ÆV10N³»Áö A case of atrioventricular dissociation with interference ABSTRACT Interference dissociation is one of the most interesting arrhythmias. Once thought to be a rare arrhythmia, it is now considered a very