Radiofrequency catheter ablation Case Study Example | Topics and Well Written Essays - 3250 words

Radiofrequency catheter ablation - Case Study Example His medication history suggested that he was initially placed on amiodarone for his problems; however, it led to significant side effects of hypothyroidism and gastrointestinal upset. These could have implications on his baseline cardiac disease, and hence it was decided that he be weaned off the medicine, and about 3 months back, he was placed on bisoprolol 2.5 mg in case of tachycardia. He continued to drive for another half an hour and at 1300 hours, when he came back home, he took a 2.5 mg tablet of bisoprolol. From his experience of similar attacks, he found that at this time, the heart beats were taking a longer time to normalise, and in fact, they did not normalise at all, although were slowing. He had previous episodes of atrial fibrillation and had been cardioverted for three occasions in the past. He could recognise that this time, he was not feeling like he had an atrial fibrillation. Thus he was brought in an ambulance to the emergency department. His past medical history is significant for having had rheumatic fever at his age of 12 which was complicated by questionable mild aortic valve incompetence. He was diagnosed with atrial fibrillation for which he was cardioverted in three occasions. In the year 1984, he was diagnosed with Wolf-Parkinson-White syndrome. ... He is on thyroxine 120 mg once daily and warfarin 8 mg daily as a prophylactic. His family history is positive strongly for stroke. He is a company director for sales; he is a teetotaler and does not smoke cigarettes. On examination, he looks well with vitals as charted, The mechanical heart click is audible on cardiac auscultation. His chest is clear. Abdomen is soft and nontender. ECG appears to have p waves, demonstrated short PR interval and appearance of delta waves. The treatment plan as decided was to have a Cardiology review. He would be placed on a cardiac monitor. Routine blood needs to be done with a chest X-ray. IV access would be established. This approach has been supported by studies and reports. The impression at this point in time was Wolf-Parkinson-White syndrome (WPW) with now slowing tachycardia. The best course of events would be to repeat an electrophysiological study (EPS) followed by a cardio ablation of the accessory pathway. In this assignment, the underlying basic sciences linking his WPW syndrome, EPS, and ablation will be discussed based on the available evidence from literature. Discussion Cardiac Conduction In all striated muscle cells, muscle contraction is triggered by a phenomenon of rapid voltage change. This is called an action potential. Action potentials occur on the cell membrane. However, action potentials on cardiac muscle cells differ considerably from those arising from the skeletal muscle cells. These differences are important since cardiac contraction has autonomous rhythmic excitation demanded by the physiology, and in normal circumstances this is involuntary. There are three important pathways that promote such synchronous rhythmic