[SCD-FORUM] 120S PSVT Dr. Rodriguez Martorell

[SCD Symposium]

Dear experts, mainly Dr. Perez Riera,
I apologize for replying the questions by our colleague. Nevertheless, I would like to learn about your concepts. 
Dr. Xiuling Tan, I think that in your case, it would be useful before starting any therapeutic management, to know what type of PSVT we are facing: (orthodromic tachycardia using concealed accessory pathway in its circuit, which in fact respond well to adenosine and verapamil, or antidromic tachycardia with anterograde conduction and maximal preexcitation, which due to its high rate and hemodynamic involvement, will need electrical cardioversion and/or drugs (class I-C or III), during the acute phase). This case seems to correspond to the first one, but you do not state whether there is poor hemodynamic tolerance. Nevertheless, you doubt about whether Diazepam was the cause of the reversion of symptoms. According to our modest experience, I don't think so, since the crisis was interrupted by the action of the drugs that were initially used, and not by the sedative. 
On the other hand, we do not advocate the use of more than one drug in the acute phase, by deleterious and proarrhythmogenic electrophysiological effects. We do use electric cardioversion, which is a harmless and rapid method, when clinical symptoms appear, or we do not have the appropriate drugs. 
Finally, I think that if he is a carrier of an accessory pathway, with any of the mentioned tachyarrhythmias and the patient has a risky profession, explanations should be given to him about the best therapeutic option that is radiofrequency ablation, which will improve his quality of life. 
Kind regards, 
Dr. Francisco Rodriguez Martorell.
(Cardiólogo Intensivista). Unidad de Cuidados Intensivos Coronarios. Hospital ``Calixto García¨. Habana. Cuba.