• PDF / 152,031 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 72 Downloads / 161 Views

DOWNLOAD

REPORT

---

1 S

Paroxysmal atrial fibrillation and supraventricular tachyarrhythmia: case report A 52-year-old man developed paroxysmal atrial fibrillation (AF) following administration of clomipramine for head-up tilt (HUT) test, and supraventricular tachyarrhythmia following administration of atropine for complete heart block. The man, who had a history of vasovagal syncope, was hospitalised for nonspecific syncopal episode. His physical examination, laboratory tests, ECG, stress test, heart ultrasound, 24-hour Holter monitoring and neurological examinations were normal. Therefore, HUT test was performed at an angle of 60°, and he was administered IV infusion of clomipramine 5mg over 5 minutes (1 mg/min). In supine position, his BP was 136/87mm Hg and HR was 87 beats/minute, indicating a sinus rhythm. After tilting and complete clomipramine infusion, he was clinically and haemodynamically stable until seven minutes after the tilting and completion of clomipramine infusion. At seventh minute, an ECG revealed initiation of paroxysmal AF with fast ventricular response (VR); however, he was still asymptomatic. The paroxysmal AF was attributed to clomipramine administration. At eighth minute, VR abruptly switched to bradycardia. He appeared pale, and was experiencing nausea and syncope tendency, followed by a prolonged ventricular asystole with a 17 seconds of cardiac pause. The prolonged ventricular asystole under AF, suggested complete heart block and was associated with convulsions. The man was was repositioned to supine position, and was treated with IV atropine 1mg. His condition recovered but his heart rhythm was still AF with rapidly accelerating VR (up to the extremely high rate of approximately 290 beats/minute) with narrow QRS complexes. He was in good mental state during tachycardia. The extremely high VR indicated supraventricular tachyarrhythmia secondary to atropine use. He was then treated with amiodarone, after which the VR decreased to 200 beats/minute. Subsequently, he was shifted to the ICU and received a conservative amiodarone dose. Two hours later, the sinus rhythm was restored. A diagnosis of vasovagal (neurocardiogenic) syncope was made, and after 6 hours, he was discharged. His CHA2DS2-VASc score was 0. He remained asymptomatic 1 year after the HUT test without clinical episodes of syncope or AF. Margos NP, et al. Extreme heart rhythm alteration during a head-up tilt test. Hellenic Journal of Cardiology 61: 224-225, No. 3, May-Jun 2020. Available from: URL: http:// 803517527 doi.org/10.1016/j.hjc.2019.11.003

0114-9954/20/1832-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 28 Nov 2020 No. 1832