Ventricular paired pacing to control rapid ventricular heart rate following open heart surgery. Observations on ectopic automaticity. Report of a case in a four-month-old patient.
An unusual case is presented in which an atrioventricular (A-V) junctional tachycardia at a rate of 285 beats/min developed in the immediate postoperative period following surgical repair (a Mustard procedure) of transposition of the great vessels in a four-month-old infant. With that heart rate the systolic blood pressure bacame 35-40 mm Hg and urinary output ceased. Ventricular paired pacing was employed successfully to halve the mechanically effective ventricular rate. This resulted in a clinically effective blood pressure and return of normal urinary output. The clinical course of the A-V junctional tachycardia, plus its response to several interventions, suggested that the mechanism of the A-V junctional tachycardia was automatic rather than re-entrant. The study demonstrates that ventricular paired pacing for the control of cardiac arrhythmias is a useful clinical technique in selected cases.
D001283:Atrioventricular Node / Q000503:physiopathology; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002315:Cardiopulmonary Bypass; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000628:therapy*; D013610:Tachycardia / Q000503:physiopathology / Q000628:therapy*; D014188:Transposition of Great Vessels / Q000601:surgery