Abstract | HISTORY AND CLINICAL FINDINGS: A 49-year-old man, an alcoholic for the past 7 years, complained of dizziness, palpitations and exertional dyspnoea (NYHA stage III). Physical examination revealed peripheral cyanosis, slightly raised jugular venous pressure, râles in the lung bases, a loud systolic murmur, maximal over the apex, and an enlarged palpable liver. INVESTIGATIONS: Results of biochemical tests were unremarkable. The ECG showed sinus rhythm, 1 degree AV block and signs of left ventricular hypertrophy. Chest radiogram demonstrated cardiac dilatation and probably absent right superior vena cava (SVC). Long-term ECG monitoring during episodes of dizziness and one syncope revealed self-limited periods of unifocal ventricular tachycardia. Echocardiography and angiography showed bilateral ventricular dilatation with an ejection fraction reduced to 20%, as well as mild mitral and moderate tricuspid regurgitation but normal cardiac valves, suggesting a dilated cardiomyopathy. Coronary angiography was normal. No myocarditis was revealed on myocardial biopsy. The patient declined electrophysiological investigation. TREATMENT AND COURSE:
Amiodarone caused higher degree AV block. A temporary pacemaker lead was inserted via the persistent left SVC, amiodarone discontinued and later a pacemaker- defibrillator system (ICD) implanted, previous digital subtraction angiography having demonstrated a left SVC and absent right SVC. The transvenous electrode had been placed via the left subclavian vein, left SVC ( anode), coronary sinus, right atrium into the right ventricle (cathode), and the pacemaker- defibrillator implanted subpectorally. Stable electrode position and correct ICD function has been documented over 2 years. 4 months after implantation bursts of ventricular tachycardia recurred every few minutes that responded to renewed amiodarone administration. CONCLUSION:
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Authors | W Peters, A Krein, P Kowallik, G Wittenberg, M Meesmann |
Journal | Deutsche medizinische Wochenschrift (1946)
(Dtsch Med Wochenschr)
Vol. 122
Issue 12
Pg. 366-70
(Mar 21 1997)
ISSN: 0012-0472 [Print] Germany |
Vernacular Title | Implantation eines transvenösen Defibrillationssystems bei isoliert persistierender linker oberer Hohlvene. |
PMID | 9118791
(Publication Type: Case Reports, English Abstract, Journal Article)
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Chemical References |
- Anti-Arrhythmia Agents
- Amiodarone
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Topics |
- Amiodarone
(adverse effects, therapeutic use)
- Anti-Arrhythmia Agents
(adverse effects, therapeutic use)
- Cardiomyopathy, Dilated
(diagnosis, etiology, therapy)
- Coronary Angiography
- Defibrillators, Implantable
- Echocardiography
- Electrocardiography
- Humans
- Male
- Middle Aged
- Tachycardia, Ventricular
(diagnosis, etiology, therapy)
- Vena Cava, Superior
(abnormalities)
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