American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2019, 7(9), 210-213
DOI: 10.12691/ajmcr-7-9-7
Open AccessCase Report

Profound Hypotension in Supraventricular Tachycardia with Intermittent Wolff-Parkinson-White Syndrome Refractory to Cardioversion

Dennis Miraglia1, and Orlando Marini2

1Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR

2Division of Cardiovascular Disease, Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR

Pub. Date: July 21, 2019

Cite this paper:
Dennis Miraglia and Orlando Marini. Profound Hypotension in Supraventricular Tachycardia with Intermittent Wolff-Parkinson-White Syndrome Refractory to Cardioversion. American Journal of Medical Case Reports. 2019; 7(9):210-213. doi: 10.12691/ajmcr-7-9-7

Abstract

We report a case of an 87-year-old man with unstable supraventricular tachycardia (SVT) with intermittent Wolff-Parkinson-White (WPW) syndrome refractory to biphasic synchronized electrical cardioversion terminated by adding intravenous amiodarone. We conclude that the unique properties of intravenous amiodarone might make it especially effective in emergency situations when urgent intervention is needed to terminate life-threatening wide-complex tachycardias (WCTs) with evidence of hemodynamic instability refractory to synchronized electrical cardioversion.

Keywords:
supraventricular tachycardia (SVT) Wolff-Parkinson-White (WPW) syndrome amiodarone synchronized electrical cardioversion

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Wellens HJ, Bär FW, Lie K. The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med. 1978; 64: 27-33.
 
[2]  Hollowell H, Mattu A, Perron AD, et al. Wide-complex tachycardia: Beyond the traditional differential diagnosis of ventricular tachycardia vs supraventricular tachycardia with aberrant conduction. Am J Emerg Med. 2005; 23: 876-889.
 
[3]  Brady WJ, Mattu A, Tabas J, et al. The differential diagnosis of wide QRS complex tachycardia. Am J Emerg Med. 2017; 35: 1525-1529.
 
[4]  Lobo SM, Salgado PF, Castillo VG, et al. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med. 2000; 28: 3396-3404.
 
[5]  Maccannell KL, Mcnay JL, Meyer MB, et al. Dopamine in the Treatment of Hypotension and Shock. N Engl J Med. 1966; 275: 1389-1398.
 
[6]  Backer DD, Biston P, Devriendt J, et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. N Engl J Med. 2010; 362: 779-789.
 
[7]  Polanczyk CA, Goldman L, Marcantonio ER, et al. Supraventricular Arrhythmia in Patients Having Noncardiac Surgery: Clinical Correlates and Effect on Length of Stay. Ann of Intern Med. 1998; 129: 279-285.
 
[8]  Neumar RW, Otto CW, Link MS, et al. Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122: 729-767
 
[9]  Link MS. Evaluation and Initial Treatment of Supraventricular Tachycardia. N Engl J Med. 2012; 367: 1438-1448.
 
[10]  Tijunelis MA, Herbert ME. Myth: Intravenous amiodarone is safe in patients with atrial fibrillation and Wolff–Parkinson–White syndrome in the emergency department. CJEM. 2005; 7: 262-265.
 
[11]  Duffens K. Intravenous amiodarone in the treatment of refractory arrhythmias. Ann Emerg Med. 1986; 15: 867.
 
[12]  Hoch DH, Batsford WP, Greenberg SM, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994; 23: 1141-1145.
 
[13]  Cortez E, Krebs W, Davis J, et al. Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest. Resuscitation. 2016; 108: 82-86.
 
[14]  Bjerregaard P, El-Shafei A, Janosik DL, et al. Double external direct-current shocks for refractory atrial fibrillation. Am J Cardiol. 2000; 83: 972-974.
 
[15]  Saliba W, Juratli N, Chung MK, et al. Higher energy synchronized external direct current cardioversion for refractory atrial fibrillation. J Am Coll Cardiol. 1999; 34: 2031-2034.
 
[16]  Cabañas JG, Myers JB, Williams JG, et al. Double sequential external defibrillation in out-of-hospital refractory ventricular fibrillation: a report of ten cases. Prehosp Emerg Care. 2015; 19: 126-30.
 
[17]  Leacock BW. Double simultaneous defibrillators for refractory ventricular fibrillation. J Emerg Med. 2014; 46: 472-4.
 
[18]  Gerstein NS, Shah MB, Jorgensen KM. Simultaneous use of two defibrillators for the conversion of refractory ventricular fibrillation. J Cardiothorac Vasc Anesth. 2015; 29: 421-4.