1887
Volume 2021, Issue 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Dysrhythmias are commonly encountered in the Emergency Department (ED). Timely management and recognition of dysrhythmia in the ED is essential and crucial. Physicians working in the ED should be familiar with atypical presentation of common dysrhythmias. This case report illustrates atrioventricular nodal re-entrant tachycardia (AVNRT) with an unusually slow heart rate in an adolescent.

A 16-year-old male presented to the ED twice for palpitations. His electrocardiograms showed narrow complex tachycardia with absent P waves. Electrophysiology studies confirmed typical slow-fast AVNRT which was treated successfully with radiofrequency ablation of the slow pathway.

Diagnosing rare dysrhythmias or common dysrhythmias which manifest atypically can be challenging for non-cardiologists. Although AVNRT generally occurs with a heart rate of >130 bpm, emergency physicians should be aware that AVNRT can take place with a relatively slower rate in both the elderly and young.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2021.17
2021-10-08
2024-03-29
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2021/3/jemtac.2021.17.html?itemId=/content/journals/10.5339/jemtac.2021.17&mimeType=html&fmt=ahah

References

  1. Bobbo M, Amoroso S, Tamaro G et al. Retrospective study showed that palpitations with tachycardia on admission to a paediatric emergency department were related to cardiac arrhythmias. Acta Paediatr. 2019 Feb; 108:(2):328–332.
    [Google Scholar]
  2. Saccilotto RT, Nickel CH, Bucher HC et al. San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review. CMAJ. 2011 Oct 18; 183:(15):E1116–26.
    [Google Scholar]
  3. Steinman RT, Herrera C, Schuger CD et al. Wide QRS tachycardia in the conscious adult. Ventricular tachycardia is the most frequent cause. JAMA. 1989;261:1013–6.
    [Google Scholar]
  4. Al-Khatib SM, Stevenson WG, Ackerman MJ et al. 2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018 Oct 2; 72:(14):e91–e220.
    [Google Scholar]
  5. Panchal AR, Bartos JA, Cabañas JG et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20; 142:(16 suppl 2):S366–S468.
    [Google Scholar]
  6. Page RL, Joglar JA, Caldwell MA et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016 Apr 5; 133:(14):e506–74.
    [Google Scholar]
  7. Brugada J, Katritsis DG, Arbelo E et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020 Feb1; 41:(5):655–720.
    [Google Scholar]
  8. Probst MA, Mower WR, Kanzaria HK et al. Analysis of emergency department visits for palpitations (from the National Hospital Ambulatory Medical Care Survey). Am J Cardiol. 2014; 113:(10):1685–1690.
    [Google Scholar]
  9. Weber BE, Kapoor WN, . Evaluation and outcomes of patients with palpitations. Am J Med. 1996;100:138–148.
    [Google Scholar]
  10. Josephson ME. Josephson's Clinical Cardiac Electrophysiology: Techniques and Interpretations 5th Edition. Lippincott Williams & Wilkins; 2015.
    [Google Scholar]
  11. Walls RM, Hockberger RS, Gausche-Hill . Rosen's Emergency Medicine Concepts and Clinical Practice 9th Edition. Elsevier, Inc; 2018.
    [Google Scholar]
  12. Kylat RI, Samson RA, . Junctional ectopic tachycardia in infants and children. J Arrhythm. 2019 Dec 3; 36:(1):59–66.
    [Google Scholar]
  13. Wyndham CR, Dhingra RC, Smith T et al. Concealed nonparoxysmal junctional tachycardia. Circulation. 1979;60:707–10.
    [Google Scholar]
  14. Konecke LL, Knoebel SB, . Nonparoxysmal junctional tachycardia complicating acute myocardial infarction. Circulation. 1972;45:367–74.
    [Google Scholar]
  15. Fishenfeld J, Desser KB, Benchimol A, . Nonparoxysmal A-V junctional tachycardia associated with acute myocardial infarction. Am Heart J. 1973;86:754–8.
    [Google Scholar]
  16. Evrengul H, Alihanoglu YI, Kilic ID et al. Clinical and electrophysiological characteristics of the patients with relatively slow atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol. 2014 Aug; 40:(2):117–23.
    [Google Scholar]
  17. Vijayaraman P, Alaeddini J, Storm R et al. Slow atrioventricular nodal reentrant dysrhythmias: clinical recognition, electrophysiological characteristics, and response to radiofrequency ablation. J Cardiovasc Electrophysiol. 2007 Sep; 18:(9):950–3.
    [Google Scholar]
  18. Kanjwal K, Kanjwal S, Ruzieh M, . Atrioventricular Nodal Reentrant Tachycardia in Very Elderly Patients: A Single-center Experience. J Innov Card Rhythm Manag. 2020; 11:(2):3990–3995.
    [Google Scholar]
  19. Reddy CD, Silka MJ, Bar-Cohen Y. A Comparison of AV Nodal Reentrant Tachycardia in Young Children and Adolescents: Electrophysiology, Ablation, and Outcomes. Pacing Clin Electrophysiol. 2015 Nov; 38:(11):1325–32.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2021.17
Loading
/content/journals/10.5339/jemtac.2021.17
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error