HRDx Case Studies

Case Study #1

Sinus Tachycardia vs. Supraventricular tachycardia

  • A 28-year-old lady with history of recurrent dizziness during activity. Ambulatory cardiac monitoring was obtained.
  • During once episode of dizziness, a rhythm strip showed narrow-complex tachycardia.
  • The patient was diagnosed with paroxysmal supraventricular tachycardia (SVT), and she underwent an EP study. Dual atrioventricular node (AVN) physiology was observed but SVT could not be induced. Ablation of the AVN slow pathway performed.
  • The patient continued having recurrent symptoms, and was treated with antiarrhythmic drug therapy, but with modest efficacy.
  • The patient remained anxious about her cardiac disease, presenting to ED on multiple occasions, and she lost her job
  • When the original ambulatory cardiac monitoring data were reviewed again by HRDx, the narrow-complex tachycardia found to represent sinus tachycardia, rather than paroxysmal SVT, based on the gradual onset and offset of the tachycardia.
  • Those data required trained technicians and EP physician’s expertise to obtain, as the onset and offset of tachycardia were 20 and 15 minutes before and after the time stamp of symptoms, respectively.
  • The patient was reassured regarding the benign nature of symptoms, and she elected to stop drug therapy as she could tolerate her symptoms now knowing that they were not dangerous.

Case Study #2

Sinus Tachycardia vs. Supraventricular Tachycardia

  • A 66-year-old lady with history of recurrent palpitations. Ambulatory cardiac monitoring was obtained.
  • During once episode of palpitation, narrow-complex tachycardia was observed, and was interpreted by the automated algorithm and cardiac technicians as sinus tachycardia.
  • The patient was told that her symptoms were benign and do not require treatment. She continued having frequent symptoms that were often interrupting her lifestyle.
  • When the original ambulatory cardiac monitoring data were reviewed again by HRDx, the narrow-complex tachycardia found to represent atrial tachycardia, rather than sinus tachycardia, based on the sudden onset and offset of the tachycardia.
  • Those data required trained technicians with EP physician’s expertise to review and analyze, as the onset and offset of tachycardia were 26 and 13 minutes before and after the time stamp of symptoms, respectively.
  • The patient underwent successful catheter ablation of the focus of the atrial tachycardia, with complete resolution of her symptoms.

Case Study #3

Syncope

  • A 66-year-old lady with history of recurrent dizziness and syncope underwent ambulatory cardiac monitoring.
  • During once episode of syncope, atrial fibrillation with mildly rapid ventricular rate was observed. The patient was told that her syncope was unlikely to be related to the arrhythmia.
  • The patient subsequently underwent neurologic evaluation with brain CT, MRI, MRA, carotid ultrasound, and EEG, which were negative.
  • She was subsequently treated empirically for seizure disorder, but without benefit.
  • When the original ambulatory cardiac monitoring data were reviewed again by HRDx, a long (9.6 second) ventricular pause was observed 12 minutes before the time of manual transmission.
  • HRDx called the patient and confirmed that the patient manually transmitted the recording several minutes after she recovered from the fainting episode and fall.
  • The patient underwent pacemaker implantation, which resulted in resolution of her symptoms. Anti-seizure medications were stopped.

Case Study #4

Wide-Complex Tachycardia

  • A 79-year-old man with moderate coronary artery disease and palpitations. Ambulatory cardiac monitoring was obtained.
  • A long run of sustained ventricular tachycardia (VT) was observed on cardiac monitor. The patient underwent ICD implantation and was started on antiarrhythmic drug therapy.
  • When cardiac monitoring data were reviewed by HRDx, supraventricular tachycardia (SVT) and intermittent bundle branch block, rather than ventricular tachycardia, was diagnosed. Those data required trained technician and EP physician’s expertise to analyze and interpret, as the onset and offset of aberrancy was 18 minutes apart.
  • The patient underwent successful ablation of the SVT. The ICD was explanted.

Case Study #5

Atrial Fibrillation vs.
Atrial Tachycardia

  • A 77-year-old woman with history of paroxysmal atrial fibrillation was referred for consideration of left atrial appendage closure using the Watchman device because of intolerance to oral anticoagulation due to gastrointestinal bleeding.
  • The diagnosis of atrial fibrillation was based on findings of ambulatory cardiac monitoring.
  • When the original cardiac monitoring data were reviewed by HRDx, focal atrial tachycardia, rather than atrial fibrillation, was diagnosed. Revising the diagnosis required the expertise of an EP physician.
  • The patient underwent successful ablation of atrial tachycardia.
  • Chronic anticoagulation was not indicated since focal atrial is not associated with an increased risk of stroke. Oral anticoagulants were discontinued to avoid recurrent GI bleeding, without the need for the Watchman procedure.
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