1/12. Laboratory confirmation of scopolamine co-intoxication in patients using tainted heroin.BACKGROUND: First described in 1995, at least 325 patients with a history of heroin use have since required emergency medical evaluation in several eastern US cities, because of an anticholinergic toxidrome following use of heroin. This co-intoxication has been alleged to result from an atropine-like compound. We report the clinical findings and laboratory analysis of one of several individuals who presented to our Emergency Department during this epidemic. CASE REPORT: A 23-year-old male was one of 3 patients brought to the Emergency Department due to agitated behavior after insufflating heroin. Following physical and chemical restraint, vital signs were pulse 134 bpm, BP 160/90 mm Hg, RR 24/min, and T 37.3 degrees C. physical examination was remarkable for dilated pupils 8-9 mm without nystagmus, along with dry mouth, decreased bowel sounds, and flushed dry skin. A bladder catheter was placed and 500 mL of urine was obtained. Electrocardiogram revealed sinus tachycardia only. Additional sedation was required for 12 hours until normal mental status returned. A small sample of the "heroin" used was obtained and analyzed. Scopolamine was confirmed by gas chromatography-mass spectrometry. Further evidence of scopolamine intoxication was supported by identifying scopolamine in the urine of this patient. CONCLUSION: gas chromatography-mass spectrometry revealed scopolamine to be the cause of anticholinergic findings in a patient following use of tainted heroin. It is unclear whether scopolamine is an adulterant or contaminant in this heroin. patients with anticholinergic findings following use of heroin may be co-intoxicated with scopolamine.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/12. Basket catheter localization of the origin of atrial tachycardia with atypical morphology after atrial flutter ablation.Atrial activation from a site in the low lateral right atrium will typically proceed in a superior direction. We present a case of a low lateral right atrial tachycardia with a surface electrocardiographic P wave morphology that appeared to have an inferiorly directed axis. The tachycardia occurred 2 years after successful atrial flutter ablation. The use of a multipolar basket catheter allowed confirmation of the focal origin of the tachycardia, permitted its rapid localization, facilitated catheter ablation, and provided clues to atrial activation that helped describe the appearance of the P wave.- - - - - - - - - - ranking = 6keywords = catheter (Clic here for more details about this article) |
3/12. Electrophysiologic findings of a patient with inappropriate sinus tachycardia cured by selective radiofrequency catheter ablation.Radiofrequency catheter ablation (RFCA) for inappropriate sinus tachycardia (IST) is associated with a high recurrence rate and sometimes requires pacemaker implantation, especially after extensive ablation. We report a patient with drug-refractory IST who was successfully treated by selective RFCA to the 2 earliest activation sites. During tachycardia, the earliest atrial activation preceded the surface P wave by 50 ms or more, whereas it was only 27 ms for the rest of the right atrium after ablation. Our patient had the longest activation period during tachycardia among the reported patients. In IST patients, a longer activation time at the site of the earliest atrial activation may imply that the abnormality is confined to a small area within the sinus node and may predict the efficacy of selective RFCA.- - - - - - - - - - ranking = 5keywords = catheter (Clic here for more details about this article) |
4/12. Right diaphragm paralysis following cardiac radiofrequency catheter ablation for inappropriate sinus tachycardia.We describe a case of permanent right diaphragm paralysis following a radiofrequency cardiac ablation procedure. The relationship between the procedure and the phrenic nerve lesion is discussed with respect to the possible pathogenetic mechanisms. Radiofrequency current used in cardiac electrophysiology may cause serious thoracic nerve injuries. Means to avoid this complication are pointed out.- - - - - - - - - - ranking = 4keywords = catheter (Clic here for more details about this article) |
5/12. Radiofrequency catheter ablation using non-contact mapping for inappropriate sinus tachycardia.INTRODUCTION: In this report we describe our experience using non-contact mapping for radiofrequency ablation in patients with inappropriate sinus tachycardia. methods AND RESULTS: Two female patients with persistent complaints of palpitations and documented inappropriate sinus tachycardia with failed medical management underwent radiofrequency ablation using non-contact mapping. Non-contact mapping provided a continuous determination of the site of earliest breakthrough, facilitating the delivery and the assessment of the results of each radiofrequency application. CONCLUSION: Non-contact mapping is an effective mapping modality in the interventional treatment of inappropriate sinus tachycardia.- - - - - - - - - - ranking = 4keywords = catheter (Clic here for more details about this article) |
6/12. Superior vena cava rupture caused during balloon dilation for treatment of SVC syndrome due to repetitive catheter ablation--a case report.A 29-year-old woman with an implanted AAI mode permanent pacemaker, who had undergone catheter ablation for inappropriate sinus tachycardia 4 times, experienced complications of superior vena cava (SVC) syndrome. Severe stenosis of the SVC wall was observed in computed tomograms. During balloon dilation for the treatment of SVC syndrome, the SVC was ruptured, resulting in cardiac tamponade. An emergency operation was performed using percutaneous cardiopulmonary support (PCPS). A longitudinal tear 1 cm in length was identified at the junction of the right atrium and the SVC, requiring a patch plasty using an autologous pericardium 2.5 cm x 3 cm in size. SVC rupture is a complication to be completely avoided when we perform balloon dilation for the treatment of SVC syndrome. Therefore, the indication of balloon dilation for the treatment of SVC syndrome requires critical examination and attention.- - - - - - - - - - ranking = 5keywords = catheter (Clic here for more details about this article) |
7/12. Persistent inappropriate sinus tachycardia after radiofrequency ablation of left lateral accessory pathway.A patient with palpitations and narrow QRS tachycardia was evaluated. In the EP study an atrioventricular reentrant tachycardia mediated by a left lateral accessory pathway was identified and catheter ablation was performed with success. A week later she returned with palpitations and pre-syncope. The resting ECG showed a sinus tachycardia with 110 bpm. After unsuccessful clinical treatment with beta-blockers, diltiazem and digoxin she underwent sinus node modification using radiofrequency catheter ablation with success. We postulated that RF application to ablate the lateral accessory pathway damaged the parasympathetic innervation in the left atrioventricular groove, causing inappropriate sinus tachycardia.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
8/12. Right diaphragmatic paralysis following endocardial cryothermal ablation of inappropriate sinus tachycardia.Inappropriate sinus tachycardia (IST) is a rare disorder amenable to catheter ablation when refractory to medical therapy. Radiofrequency (RF) catheter modification/ablation of the sinus node (SN) is the usual approach, although it can be complicated by right phrenic nerve paralysis. We describe a patient with IST, who had symptomatic recurrences despite previous acutely successful RF SN modifications, including the use of electroanatomical mapping/navigation system. We decided to try transvenous cryothermal modification of the SN. We used 2 min applications at -85 degrees C at sites of the earliest atrial activation guided by activation mapping during isoprenaline infusion. Every application was preceded by high output stimulation to reveal phrenic nerve proximity. During the last application, heart rate slowly and persistently fell below 85 bpm despite isoprenaline infusion, but right diaphragmatic paralysis developed. At 6 months follow-up, the patient was asymptomatic and the diaphragmatic paralysis had partially resolved. This is the first report, we believe, of successful SN modification for IST by endocardial cryoablation, although this case also demonstrates the considerable risk of right phrenic nerve paralysis even with this ablation energy.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
9/12. lightning injury: report of a case.lightning injury can cause severe damage to many systems and often results in a high mortality. We report a case of sustained lightning injury in which a 54-year-old woman presented with heart failure, pulmonary edema and consciousness disturbance. The patient was found unconscious, lying face down on the ground of a trash dump on the day of a thunderstorm. No deformities were seen in the extremities, but scattered third degree burns (less than 1%) were found on her neck where her necklace had been. Ventilator and inotropic agents with an adequate fluid supply were used. A Swan-Ganz catheter was inserted for monitoring. The patient was discharged two weeks later with an uneventful clinical course, except for mild neurologic sequelae (amnesia, disorientation).- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
10/12. Sinus node modification using radiofrequency current in a patient with persistent inappropriate sinus tachycardia.Radiofrequency catheter modification of the sinus node for persistent inappropriate sinus tachycardia has not been previously reported. This article describes a patient in whom radiofrequency current was used to ablate an incessant automatic tachycardia focus mapped to the region of the sinus node, where a discrete multicomponent electrogram demonstrating earliest atrial activation was recorded. A transient junctional rhythm developed immediately after ablation, with rapid subsequent emergence of a stable rhythm having normal sinus nodal characteristics.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
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