264.3 🩺 內科專科考前版

264.3.0.1 1⃣ REVERT Trial (Modified Valsalva)

  • Lancet 2015
  • Modified Valsalva (40 mmHg pressure × 15 sec then supine + leg elevation) = 43% success
  • Standard Valsalva = 17% success
  • Now first-line vagal maneuver

264.3.0.2 2⃣ AVNRT Ablation Risk

  • < 1% AV block requiring pacemaker
  • Slow pathway modification preferred (preserves AV node)
  • Success > 95%
  • Outpatient

264.3.0.3 3⃣ WPW Sudden Death Risk Stratification

  • Accessory pathway refractory period < 250 ms
  • Symptomatic palpitations / syncope
  • AF history
  • Septal pathway location
  • Multiple pathways
  • Family history of sudden death
  • EP study can characterize pathway properties

264.3.0.4 4⃣ Asymptomatic WPW Management

  • Risk stratification with EP study
  • Pathway refractoriness < 250 ms → ablation considered
  • Asymptomatic older adults with normal hearts: observation often acceptable
  • Decision: shared with patient

264.3.0.5 5⃣ Atrial Flutter Anticoagulation

  • Same risk as AF
  • CHA2DS2-VASc score
  • Anticoagulation for moderate-high risk
  • Sometimes underestimated; require same vigilance

264.3.0.6 6⃣ Tachycardia-Induced Cardiomyopathy

  • Sustained tachycardia → LV dysfunction
  • Reversible with rate / rhythm control
  • Persistent SVT + LV dysfunction → urgent rhythm control
  • Ablation often curative

264.3.0.7 7⃣ Inappropriate Sinus Tachycardia (IST)

  • Resting HR > 90 bpm without cause
  • Often young women
  • Symptoms: palpitations, fatigue
  • Treatment: ivabradine (sinus node-specific β-blocker — works by If channel), beta-blockers, lifestyle
  • Severe / refractory: catheter modification of sinus node (rare)

264.3.0.8 8⃣ POTS (Postural Orthostatic Tachycardia Syndrome)

  • HR increases > 30 bpm with standing (or to > 120 bpm)
  • Symptoms with orthostasis
  • Multidisciplinary management
  • Lifestyle, fluid + salt, gradual exercise, ivabradine, midodrine, β-blocker
  • 2024 ongoing research

264.3.0.9 9⃣ 健保 / Taiwan

  • 健保 ablation widely available
  • Antiarrhythmics covered
  • EP centers in tertiary hospitals
  • Vagal maneuvers + cardioversion routine

264.3.0.10 10. AI in Arrhythmia Diagnosis

  • AI-ECG for AVNRT vs AVRT differentiation
  • Smartphone-based ECG (KardiaMobile, AliveCor)
  • Wearables for palpitation detection
  • Increasing role in remote monitoring