Author + information
- Alexey Biryukov1,
- Ekaterina Leonidovna Zaslavskaya1,
- Kirill Alexeevich Smirnov1,
- Andrei Aleksandrovich Voronkov1 and
- Dmitriy Vladimirovich Ovcharenko1
Patient initials or identifier number
Relevant clinical history and physical exam
History: Hypertension>30 years, Bronchial asthma, DM-Type 2, COPD, Atrial Flutter-Fibrillation-Paroxysmal type since 2016. Current Medications: ACE inhibitors, Cardiac Glycosides, Statins, Xarelto, Symbicort, Berodual. In the Emergency the Patient had been taken tab Brilinta 180 mg, ASA 250 mg and UFH 60 u/kg and put on Temporary Pacemaker. Sytems Review: - CVS- Pulse-70 /min set at Temporary Pacemaker. B.P- 85/45 mm/hg. S1/S2-Soft, Murmurs-Absent. Killip IV. RS- RR-23 /min. Breath sounds-Harsh.
Relevant test results prior to catheterization
Complaints: Heaviness in chest without irradiation, palpitations, dyspnoea, Fatigue, Episodes of Syncope
ECG-ST segment: On isoline, Q-wave on 2, 3, AVF, Pause-3 second
Relevant catheterization findings
- LAD: Diffuse lesions (50%) in proximal and central part
- RCA: 100% occlusion in proximal part
- Other vessels without significant changes
SYNTAX SCORE 27
ECG-ST segment: on isoline, Q-wave on 2, 3, AVF, Pause-3 second.
Echocardiography Ejection fraction-55%, a Hypokinesiainferior wall of LV. Symptoms of Systolic/Diastolic dysfunction absent.
LA-48 mm, RA-57 x 50 mm, End Systolic Size of LV-37 mm.
Arrhythmia Atrial flutter-2:1, Rate-150.
Attempts to convert to Sinus Rhythm were not successful.
Due to increasing Cardiac insufficiency, need to optimize heart rate and blood pressure.
Electrophysiological studies were needed to verify atrial tachycardia: Typical Atrial flutter with a cycle of 195 msec. Radiofrequency isolation catheter destruction of a neck of the Right atrium (No.15-45 W till 48 C) with conversion to Sinus Rhythm. Post control 30 minutes of EPS induction typical nodal tachycardia with cycle 360 msec. Radiofrequency affected region of slow part of AV node with stopped functional slow tract AVnode (No.10, till 52 C, 40 W, 60 sec)
After that, the patient's hemodynamic was stable. The patient was discharged to outpatient treatment.
Conclusion: This case report shows that an early combination electrophysiology and endovascular interventions in one hospital significantly reduces a patient's risk of death.