Paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia (PNT) - one of the types of arrhythmia, which is characterized by a sudden paroxysmal increase in the frequency of contractions of the heart muscle. Heart rate increases to 140 - 250 beats per minute, with the right rhythm of heartbeat remaining.

The emergence of PNT is associated with activation in the myocardium of a highly active ectopic foci of automatism or a focus of post-depolarization trigger activity. In the overwhelming majority of cases, the basis of PNT is the mechanism of pulse re-entry and the circular circulation of excitation through the myocardium (or, so-called reciprocal mechanism of re-entry). In any of these cases, the appearance of PRT is facilitated by the pre-emergence of extrasystole.

[1], [2], [3], [4]

Of all the types of arrhythmias, in 95% of cases, PIT appears in children. In patients under the age of 18, PNT is the most common cause, leading to arrhythmogenic collapse and heart failure. For every 1000 people in the population there are 2.29 patients with PNT. In women, this disease occurs twice as often as in men. The risk of developing tachycardia rises at the age of more than 65 years - a fivefold increase in patients who have crossed this age line is recorded.

[5], [6], [7], [8], [9], [10],

With any mechanism of the occurrence of paroxysmal supraventricular tachycardia, extrasystole develops beforehand. Extrasystolia is the most common form of arrhythmia, which manifests itself in the form of disturbance of the heart rhythm and is characterized by the occurrence of single or paired premature contractions of the heart (extrasystoles). Arrhythmic contractions of the cardiac muscle are caused by the excitation of the myocardium, which comes from a pathogenic focus of excitation. The disease is functional (neurogenic).

The causes of paroxysmal supraventricular tachycardia of an organic nature are as follows: 

1. Organic damage to the heart muscle and the conduction pathways of the heart, which are inflammatory, dystrophic, necrotic and sclerotic. Such damage occurs with acute myocardial infarction, chronic ischemic heart disease, heart disease, cardiopathy, myocarditis. 
2. The presence of additional abnormal ways of carrying out, for example, in the syndrome of Wolff-Parkinson-White.
3. The presence of additional viscero-cardinal reflexes and mechanical effects (for example, additional chords, mitral valve prolapse, adhesions). 
4. Occurrence of expressed vegetative-humoral disorders in the syndrome of neurocircular dystonia.

The above disorders are called intracardial factors of the onset of PNT.

Experts believe that the presence of certain features of the structure of the heart or damage is not enough for the occurrence of paroxysmal supraventricular tachycardia. Psychoemotional factors play an important role in the development of this disease. It is known that increased sympathoadrenal activity leads to the emergence of various forms of ectopic arrhythmias.

In childhood and adolescence, it is often difficult to diagnose the causes of paroxysmal tachycardia. In these cases, the presence of a violation of the contractions of the heart muscle is defined as essential (or idiopathic). Although, experts believe that the causes of paroxysmal supraventricular tachycardia in such patients are minimal, not diagnosed dystrophic damage to the myocardium.

Like ecstasy, PTH can also appear in healthy people due to pathogenic factors. With intense physical or mental stress, with strong and long-term stress. These reasons are called extracardiac. These factors also include smoking and alcohol abuse, strong tea, coffee and spicy food.

When tachycardia occurs, it is necessary to check the level of thyroid hormones in the blood. Although thyrotoxicosis is almost never the only reason for the appearance of PNT. But when choosing a therapy, difficulties may arise that are related to the need to stabilize the hormonal level.

The disease of some other organs can cause paroxysmal tachycardia. For example, omission of the kidney and other kidney diseases, lung diseases (acute, and, in particular, chronic), impaired function and diseases of the gastrointestinal tract. The above diseases of the internal organs are related to extracardiac factors; as a result of the transfer of such diseases, paroxysmal supraventricular tachycardia arises as a complication.

[11], [12], [13], [14], [15], [16]

In the clinical picture of paroxysmal supraventricular tachycardia is characterized by the presence of the following symptoms: 

1. Increased palpitation begins with a "push" or "injection" in the heart, a sense of stopping or turning over. 
2. The heart rate is increased to 250 beats per minute. 
3. There are interruptions in the heartbeat.
4. Pulse has a weak filling, it is often impossible to probe it. 
5. There is an unmotivated anxiety, shortness of breath, weakness, dizziness, noise in the head, sweating. 
6. There is pain in the sternum or angina occurs. 
7. With a pronounced tachycardia, blood pressure decreases. 
8. With an attack, the pulse has a constant stable frequency, which does not change with time. 
9. There is frequent and profuse urination; manifestations of flatulence are possible.

The minimum duration of paroxysmal supraventricular tachycardia is three cardiac cycles. Such manifestations were called "runs" of tachycardia. Usually, seizures of paroxysmal supraventricular tachycardia last from several hours to several days. Perhaps a longer manifestation of tachycardia, up to several months,

Symptoms of supraventricular paroxysmal tachycardia often disappear spontaneously and independently. In some cases, with prolonged seizures for several days, a fatal outcome is possible, if no treatment measures are applied.

[17], [18]

There are two main types of paroxysmal tachycardia: 

• ventricular (ventricular).
• supraventricular (supranventicular).

This classification arose due to the locus of localization of pathological excitation. PNT in comparison with the gastrointestinal tract proceeds more gently and favorably, and a greater number of cases of positive dynamics in the treatment of PNT are also recorded. Because paroxysmal supraventricular tachycardia is less associated with organic heart disease and left ventricular dysfunction. And yet, PNT potentially poses a threat to life, because they are characterized by sudden manifestations that can lead to disability of the patient or his death (in 2-5% of cases).

Paroxysmal supraventricular tachycardia has two subspecies: 

• atrial paroxysmal tachycardia - in 15-20% of cases.
• atrial-ventricular (atrioventicular) paroxysmal tachycardia - in 80-85% of patients.
• The division into subsets of PNT is due to the localization of the pathological zone or the circulating excitation wave.

According to the nature of the course of the disease, three forms are distinguished: 

• acute (paroxysmal).
• constantly recurrent (chronic).
• continuously recurrent, which has been developing continuously for several years.

Considering the mechanism of the development of the disease, three types of PNT are distinguished: 

• reciprocal (associated with the mechanism of re-entry in the sinus node).
• ectopic (or focal).
• multifocal (or multi-focus).

The diagnosis of "paroxysmal supraventricular tachycardia" is established if the patient complains of suddenly occurring attacks of rapid heartbeat. Confirmation can be obtained using the following methods: physical examination and instrumental diagnostics.

At the initial stage, it may be sufficient to collect an anamnesis. A characteristic feature for PNT is the appearance of a heartbeat, "as by the click of a switch". It is important, when examining a patient, to find out how abruptly a heart rhythm disturbance occurs. At the beginning of the collection of data on the manifestations of symptoms, patients can assert that a failure in the heartbeat occurs suddenly. But with a detailed and thorough questioning of patients it sometimes turns out that the change in the rhythm of heartbeats occurs gradually, within a few minutes. These symptoms are characteristic of another disease called sinus tachycardia.

PNT is diagnosed by external signs and vegetative manifestations of the disease. For this type of tachycardia is characterized by excessive sweating, frequent urination, nausea, dizziness, noise in the head and so on.

Physical examination

If at auscultation heart rate exceeds 150 beats per minute, then this excludes the diagnosis of "sinus tachycardia". The heart rate more than 200 beats per minute refutes the diagnosis of "gastric tachycardia". But auscultation does not allow to reveal the source of tachycardia, and also does not always distinguish sinus tachycardia from paroxysmal.

When measuring the pulse, it is almost impossible to count, it is so frequent. In this case, the pulse is soft and weakly filled.

In the physical examination, vagal samples are used. They are mechanical stimulation of the vagus nerve receptors, which is carried out in the form of pressure. This procedure causes a rapid and reflex increase in the tone of the above nerve. With vagal tests, the method of pressing on the carotid sinus, the Valsalva test, pressure on the eyeball and other methods is used.

The wandering nerve is connected with the atrium and the atrioventicular node. Increased nerve tone slows the frequency of atrial contractions and atrioventicular conduction, which reduces the frequency of contractions of the ventricles of the heart. Thus, the interpretation of the supraventricular rhythm is facilitated, which makes it possible to correctly diagnose tachycardia. You can conduct a comprehensive diagnosis, which increases the value of vagal samples. In this case, prolonged ECG and auscultation of the heart are carried out together with the stimulation of the vagus nerve. Such diagnostics are carried out before, during and after vagal tests. With PNT there is a sudden stop of arrhythmic contractions and the sinus rhythm is restored. In a number of cases in the diagnosis there is no change in the frequency of contraction of the heart muscle. This is due to the "all or nothing" law, which is typical for the clinical picture of the course of this type of tachycardia.

In this case, it should be remembered that vagal tests can provoke unforeseen complications not only in patients, but also in healthy people. There are a number of cases that have resulted in fatalities. In rare cases, under pressure on the carotid sinus, elderly patients may experience thrombosis of cerebral vessels. Stimulation of the vagus nerve can lead to a decrease in the minute volume of the heart. And this, in turn, in some cases leads to a sudden drop in blood pressure. There may be an attack of acute left ventricular failure.

Instrumental diagnostics

Instrumental diagnosis of PNT is carried out using the following methods: 

1. The study of the work of the heart with the help of an electrocardiogram. 
2. Holter monitoring. 
3. Load ECG-tests or stress test. 
4. Echocardiography. 
5. Transesophageal stimulation of the heart. 
6. Intracardiac electrophysiological study. 
7. Magnetic resonance imaging (MRI) of the heart. 
8. Multislice CT cardiography (MSCT of the heart).

Nadzheludochkovaya paroxysmal tachycardia on the ECG

One of the main methods of diagnosing paroxysmal tachycardia is electrocardiography.

Carrying out an electrocardiogram is a non-invasive method of research, which has proved itself to be quick and painless. The essence of this method is in checking the electrical conductivity of the heart. On the patient's body - his chest, arms and legs - 12 electrodes are placed, thanks to which it is possible to obtain a schematic representation of the activity of the heart at different points. Using an electrocardiogram, it is possible to establish a diagnosis of PNT, as well as to identify its causes.

Nadzheludochkovaya paroxysmal tachycardia on the ECG has the following features that are clearly visible on the electrocardiogram tape: 

1. A sharp initial appearance of paroxysm and the same end of the attack. 
2. There is more than 140 beats per minute. 
3. Regular heartbeat rhythm. 
4. Usually, QRS complexes have a normal appearance. 
5. The teeth of P are different for visual diagnosis. With paroxysmal tachycardia of the atrioventicular shape, the P-waves are located after the QRS complexes or layered on them. At the PT of the atrial form, the P-waves are located in front of the QRS complexes, but they have a modified or deformed appearance.

Emergency care for paroxysmal supraventricular tachycardia

At some attacks of PNT urgent medical help is necessary, as the attack does not pass independently, and the patient's condition worsens. The treatment is on the spot arrived by the ambulance. If a paroxysmal attack occurs for the first time or there are suspicions for the hospitalization of the patient, an additional cardiac emergency team is called in addition. The following emergency methods are used for paroxysmal supraventricular tachycardia: 

• The use of vagal samples helps to stop the attack. First of all, the Valsalva test is used, when you need to strain and hold your breath for 20 or 30 seconds. This is the most effective trial. Also, deep and rhythmic breathing can help. Also used is Ashner's test, which is a pressure on the eyeballs for five seconds. You can also crouch down. The use of vagal tests is contraindicated in the following diseases: conduction disorder, severe heart failure, sinus node weakness syndrome, stroke, dyscirculatory encephalopathy, glaucoma. 
• If the face in cold water is 10 -20 - 30 seconds, this will help to stop the attack of PNT. 
• Mass one of the carotid sinuses. Massage is contraindicated if there is a sharp decrease in the pulse and there is a noise over the carotid artery. 
• If all of the above actions did not produce a result, then you need to stop the attack with the help of transesophageal heart stimulation (CHPSS) or electropulse therapy (EIT). ChPSS is also used in case of inability to use arrhythmic drugs due to intolerance. It shows the use of CHPSS with available data on conduction disturbances during the withdrawal from an attack. 
• To most effectively stop the attack of PNT, you need to determine its shape - PNT with narrow or wide QRS complexes. 
• With PNT with narrow QRS complexes, the following drugs must be administered intravenously: adenosine phosphate, verapamil, procainamide, and others. Without electrocardiographic examination, the use of medications is possible only in extreme, critical cases. Or when there is evidence that the drug was applied to the patient during previous seizures, and the procedure did not bring any complications. A constant monitoring of the patient's condition with the help of ECG is necessary. If the effect of the administration of drugs is not available, then it is necessary to apply the tablets in a chewed manner, namely, propranolol, atenolol, verapamil and others. In any case, these procedures are carried out only by an ambulance team, which came to the patient. 
• With an attack of PNT with wide QRS complexes, there is a suspicion of a ventricular paroxysmal tachycardia. Therefore, the tactics of arresting an attack in this case are somewhat different. Electropulse therapy is effective, as is transesophageal stimulation of the heart. Medicinal preparations are used, which stop both attacks of supraventricular and ventricular PT. The most frequent medications are procainamide and / or amiodarone. In cases of unspecified tachycardia with wide complexes, adenosine, aymalin, lidocaine, and sotalol are used.

Indications for hospitalization of the patient are as follows: 

• The attack of PNT can not be stopped on the spot. 
• The attack of PNT is accompanied by acute cardiac or cardiovascular insufficiency.

Patients who have attacks of PNT occur at least twice a month are subject to compulsory planned hospitalization. In the hospital, the patient undergoes an in-depth diagnostic examination, during which he is prescribed treatment.

[19], [20], [21],

Treatment of paroxysmal supraventricular tachycardia

Diet and diet

• If you develop a tachycardia, you should lead a certain lifestyle. 
• First of all, you must stop smoking and drinking alcohol. 
• We need to monitor the maintenance of an even psycho-emotional state during the day and avoid stress. To strengthen the psyche is useful to do autogenic training and other types of self-regulation. It is also possible to use sedatives prescribed by a doctor. 
• It is necessary to adhere to a stable schedule of the day, get enough sleep and do not stay up late watching TV or social networking. During the day there should be enough time for rest or daytime sleep, if it is necessary for the patient. 
• Include in the daily routine of the feasible physical load, namely, morning exercises, every night walks in the fresh air, swimming in the pool or open water. 
• Be sure to monitor the level of cholesterol and sugar in the blood. 
• It is necessary to maintain the optimal body weight. 
• Food should be taken in small portions 4-5 times a day. Because the overfilled stomach begins to irritate the receptors of the nerves responsible for the work of the heart, which can lead to an attack of tachycardia. 
• To avoid overeating, you need to exclude reading books, watching TV and working at the computer while eating. When concentration only occurs on the process of absorbing food, it is much easier to feel the saturation in time to stop. 
• Do not eat at night; it is advisable to hold the last meal two to three hours before bedtime.

From the use it is necessary to exclude products that provoke the appearance of tachycardia: 

• tea and coffee.
• products containing starch and sugar, high-calorie foods - baked goods, chips, crackers, chocolate bars, sweets and so on.
• fatty foods - fatty meat, mayonnaise, sour cream, fat, margarine; it is necessary to limit the consumption of butter.

Most of these products contain "bad" cholesterol, which adversely affects the condition of the heart muscle.

It is necessary to minimize the consumption of salt, if necessary, replacing it with spices (for example, dried sea kale). Add salt only in ready meals.

Also should be excluded from the diet: 

• canned and refined food, because it contains a lot of fat, salt and other products that are dangerous for the work of the heart.
• fried food.

Diet for patients with paroxysmal supraventricular tachycardia should include a large amount of lean and plant foods.

In the diet should include the following foods that support the healthy work of the heart: 

• products rich in magnesium and potassium - dried apricots, buckwheat porridge, honey, pumpkin, zucchini.
• products containing Omega 3 unsaturated fatty acids - marine fish, flax seed, walnuts, canola oil.
• products containing Omega 6 unsaturated fatty acids - vegetable oils, various seeds and soy.
• monounsaturated fats - they are in sufficient quantities contained in cashew, almonds, peanuts, avocados and oils from various types of nuts.
• products with low fat content - skim milk, yogurt and cottage cheese.
• various kinds of porridge, which contain a large number of nutrients, as well as fresh and stewed vegetables.
• it is necessary to introduce in the diet a certain amount of freshly squeezed juices, since they are rich in vitamins and minerals.
• There are several useful recipes that should be included in the diet of patients with tachycardia. 
• Take 200 grams of dried apricots, walnuts, raisins, lemon and honey of May. All grind and mix in a blender, pour into a jar and store in a refrigerator. Take twice a day for one tablespoon. 
• A good remedy for tachycardia is the root of celery. With it you need to prepare salads: grate it on a large grater and add greens - celery, dill and parsley. Salad should be salted and dressed with low-fat yogurt (or put a small amount of low-value sour cream).

[22], [23]

Medication for paroxysmal supraventricular tachycardia

It must be remembered that the doctor prescribes the administration of medications, as well as their dosage.

When treating PONT, sedatives are used: tranquilizers, bromine, barbiturates.

Begins drug therapy with the use of beta-blockers: 

• Atenolol - a daily dose of 50-100 mg for 4 doses or propranolol (anaprilin, obzidan) - a daily dose of 40-120 mg for 3 doses. 
• Metoprolol (vasocardine, egilok) - 50-100 mg 4 times a day.

Patients who do not suffer from myocardial damage and heart failure are prescribed quinidine. The average dose is 0.2 - 0.3 grams 3-4 times a day. The course of treatment is several weeks or months.

Quinidine bisulfate (quinidine dreeter, quinidine durilez), as the last generation drugs, cause fewer side effects from the gastrointestinal tract, and also have a higher concentration in the patient's blood. Quinidine dreuter is used for 0.6 grams 2 times a day.

In the treatment of patients with affected myocardium and heart failure, as well as pregnant women, it is recommended to use preparations of the fusiform-isoptin. The daily dose of the drug is from 120 to 480 mg per day and is used for 4 receptions. It is good to apply and the preparation digoxin - 0, 25 grams per day.

The best results are combined with the use of medicines of the foxglove and quinidine.

The drug procainamide is prescribed for use as follows: 1 or 2 dragees, 0.25 grams, 4 times a day.

The following drugs are also prescribed: 

• Aimalin - 50 mg 4-6 times a day.
• Verapamil - 120 mg 3-4 times a day.
• Sotalol - 20 to 80 mg 3-4 times.
• Propafenone - 90 - 250 mg, 3-4 times a day.
• Allapinin - 15 - 30 mg, 3-4 times a day.
• Etatsizin - 50 mg, 3 times a day.

Experts recommend a long course of treatment with potassium preparations; potassium chloride, panangin, thromcareine are used. These drugs are prescribed in combination with some of the main anti-arrhythmic drugs. Potassium chloride in a 10% solution is used in a dosage of 20 ml 3 or 4 times a day for a prolonged course of treatment. 

Physiotherapy with paroxysmal supraventricular tachycardia 

In the treatment of paroxysmal supraventricular tachycardia, water procedures are actively used: 

• medical baths.
• bath with hydromassage.
• dousing.
• rubbing.
• circular shower.

Treatment of paroxysmal supraventricular tachycardia with alternative methods

It happens that patients suffering from paroxysmal supraventricular tachycardia are contraindicated in some drugs prescribed by a doctor. To help patients come alternative medicine. Here are a few recipes that can easily be used by patients to ease their condition. 

• Using lovage: you need to take 40 grams of roots of the plant and pour 1 liter of hot water (but not with boiling water). Infusion should be kept for 8 hours, and then drain. Take a drink during the day in small portions until the health improves. 
• Three glasses of berries of a Kalina to fall asleep in a three-liter jar and to fill in with two liters of boiled water. After this, carefully close the jar, wrap it and leave it for six hours. Then it is necessary to filter the infusion into the enamelware and also to squeeze the berries there. Then add 0.5 liters of quality honey to the infusion and place in the refrigerator for storage. Take an infusion before meals three times a day for one-third of the glass. The course of treatment is one month, then you need to take a break in ten days and repeat the infusion. Thus, it is necessary to conduct three courses of treatment. 
• He also recommended a method of treating hawthorn. In the pharmacy you should buy alcohol tinctures of hawthorn, motherwort and valerian (one bottle). Next, you must carefully mix the tinctures and leave for one day in the fridge. Take the medicine three times a day on a teaspoon for half an hour before eating. 
• It is good to use hips infusion in the treatment of tachycardia. It is necessary to take 2 tablespoons of dog rose, put them in a thermos bottle and pour half a liter of boiling water. Leave to stand for one hour and then add 2 tablespoons of hawthorn. The resulting infusion should be drunk in small portions throughout the day and brew a fresh drink daily. For three months you need to drink the infusion, and then take a break for one year.

Treatment of paroxysmal supraventricular tachycardia at home

With an attack of paroxysmal tachycardia, one must resort to self-help and self-help means: 

• First of all, we must calm down, the most important thing at this moment is to acquire physical and emotional rest. 
• With severe weakness, nausea and dizziness, you must sit in a comfortable position or lie down in a horizontal position. 
• It is necessary to ensure the penetration of fresh air to the patient. To do this, it is necessary to unbutton clothes that hold your breath, and also open the window. 
• The paroxysmal tachycardia attack can be removed by irritating the vagus nerve, using reflex methods. To do this, you need to perform the following exercises: straining to squeeze the abdominal press; press on the eyeballs; hold your breath for 15-20 seconds; cause vomiting. 
• If the attending physician has shown how the vagal tests are performed, it will be useful to carry them out. 
• It is necessary to take those drugs that the doctor prescribed and in no case independently change the dosage of taking the medicine. 
• If the state of health and well-being worsens, you need to call an ambulance urgently. When there are pains in the heart, sudden weakness, suffocation, loss of consciousness and other signs of deterioration, medical care should be called forth immediately.

Treatment of paroxysmal supraventricular tachycardia requires the restoration in the blood of the required concentration, the so-called electrolyte substances. These include potassium, calcium and chlorine. If you choose the right therapy with medicinal herbs, then the body will receive in sufficient quantities the necessary substances, as well as plant glycosides.

In paroxysmal tachycardia, plants containing cardiac glycosides and having sedative (soothing) effect are widely used. These include hawthorn, motherwort, valerian, mint, lemon balm. They should be used for a long time with courses with certain interruptions in the form of broths and infusions. There are also alcohol analogues of medicinal tinctures, but because of the presence of alcohol in the preparation they can not be used by all patients. In any case, before taking any medicinal herbs, consult your doctor. Because there are contraindications to the use of various alternative medicine, as well as their incompatibility with pharmaceuticals prescribed by a doctor.

At attacks of a paroxysmal tachycardia it is necessary to apply respiratory technicians. For example, "yogic breathing" is good for arresting attacks of accelerated heartbeat. The breathing exercise is performed as follows: inhale through one nostril (with the other nostril covered with a finger) - exhale through another nostril.

A different modification of the respiratory technique is possible, in which the inhalation and exhalation are performed rhythmically, with a delay in breathing. For example, inhale - 3 counts, delay - 2 scores, exhalation - 3 counts, delay 2 scores.

It is good to learn respiratory gymnastics according to the Strelnikova method or breathing through Buteyko. These methods do not eliminate the cause of the disease, but can help alleviate the condition of the patient, and also promote the training of the heart muscle, which greatly reduces the number and duration of seizures.

Surgical treatment of paroxysmal supraventricular tachycardia 

This method is used in case the conservative treatment has shown its inefficiency. Also, with irreversible sclerotic changes in the heart and in the detection of cardiac malformation, surgery is recommended.

There are two types of surgical treatment - partial and radical. With a radical method of treatment, the patient permanently gets rid of the symptoms of the disease. With a partial method of treatment, tachycardia attacks lose their power and occur much less frequently; also increases the effectiveness of the use of antiarrhythmic drugs.

In surgical intervention, two types of treatment are used: 

• Destruction of additional conducting paths or foci of heterotopic automatism. Surgical intervention is performed with the help of minimally invasive methods with the use of mechanical, electrical, laser, chemical, cryogenic agents. This is a so-called closed surgery, in which two types of catheters are used - diagnostic and therapeutic. They are introduced into the patient through the femoral or subclavian vein. Diagnostic catheter using a computer allows you to determine the exact zone of tachycardia. A medical catheter is used to conduct the procedure for exposure to the PNT zone.
• The most common is radiofrequency ablation. The term "ablation" means removal, but this treatment procedure uses the cauterization of the zone that caused the tachycardia. 
• Implantation of pacemakers of two types - an artificial pacemaker (pacemaker) and an implantable cardioverter-defibrillator. Pacemakers should function in preset modes - paired stimulation, "exciting" stimulation and so on. The devices are set to automatically turn on after the onset of an attack.

Operation with paroxysmal supraventricular tachycardia

If the drug therapy is ineffective in paroxysmal supraventricular tachycardia, an operation is prescribed. Also, with congenital defects in the structure of the heart muscle and violation of cardiac conduction (for example, with the syndrome of Wolff-Parkinson-White), surgical intervention is used.

The classical method is an open heart operation, the purpose of which is to interrupt the conduct of an impulse along additional paths. Cessation of symptoms of tachycardia is achieved by cutting or removing pathological sections of the conducting system. Surgical intervention is performed with the use of artificial circulation.

So, surgery for paroximal supraventricular tachycardia is indicated with the following signs: 

1. The occurrence of ventricular fibrillation, even in a single case. 
2. Paroxysms of atrial fibrillation, which are repeated many times. 
3. Steady attacks of tachycardia that can not be quenched with the use of antiarrhythmic therapy. 
4. Presence of congenital malformations and anomalies in the development of the heart. 
5. Intolerance to drugs that block the attack of tachycardia and maintain a satisfactory state of the patient between attacks. 
6. The emergence of attacks of PNT in children and adolescents, which greatly hamper their physical, psycho-emotional and social development.

Prevention of paroxysmal supraventricular tachycardia is carried out with the help of a healthy lifestyle, the correct regime of the day and diet, which have been described in detail in the section "Treatment of paroxysmal supraventricular tachycardia." Patient PNT should avoid strong psycho-emotional and physical exertion, keep a sparing lifestyle, in which the movement and rest are evenly combined. It is also necessary to exclude the triggers of tachycardia factors - smoking, drinking alcohol, coffee, strong tea and so on.

Timely diagnosis and use of antiarrhythmic drugs also apply to methods of primary prevention of PNT. As well as treatment of the underlying disease that causes seizures of the paroxysms of the heart. Taking sedatives is also a preventive measure in the occurrence of paroxysmal supraventricular tachycardia. One of the means of preventing attacks of PNT is timely surgical intervention.

There are forms of paroxysmal supraventricular tachycardia that can not be prevented. The essential form of PNT refers to this case, since the reasons for its occurrence are still not known.

[24], [25], [26], [27], [28], [29], [30]

When making forecasts, it is necessary to take into account the causes and form of PNT. It takes into account the incidence and duration of paroxysmal seizures, available or missing complications, and the state of the myocardium. For example, with severe damage to the heart muscle, acute cardiac or cardiovascular insufficiency may occur. There is a high risk of ventricular fibrillation and ischemia in the affected myocardium; Cases of unexpected death were also recorded in case of an attack of PNT.

The effectiveness of treatment of the underlying disease, as well as the rate of its progression, affect the condition of the patient with PNT.

The prognosis of the course of the disease with the essential form of paroxysmal supraventricular tachycardia is favorable, although its prevention is difficult due to the absence of the identified causes of the disease. Patients with PNT can be able to work and maintain an active lifestyle for several years or decades. Cases of sudden cure of PNT are rare.

Paroxysmal supraventricular tachycardia is able to slow its course with timely diagnosis and prevention of this disease.

[31], [32], [33], [34], [35], [36],