A Rare Arrhythmia in a Child with Atrial Fibrillation: Ashman Phenomenon
Ashman phenomenon is an aberrant ventricular conduction seen in atrial fibrillation. It is due to a change in the length of QRS complex. It is most often mistaken for a premature ventricular contraction (PVC) or ventricular tachycardia. A 15-year-old male patient was admitted to the emergency depart...
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| Format: | Article |
| Language: | English |
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Galenos Yayinevi
2019-08-01
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| Series: | Journal of Pediatric Emergency and Intensive Care Medicine |
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http://www.caybdergi.com/archives/archive-detail/article-preview/a-rare-arrhythmia-in-a-child-with-atrial-fibrillat/27795
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| author | Gülhan Atakul Ferhat Sarı Rana İşgüder Gökhan Ceylan Özlem Saraç Sandal Yakup Ergül Murat M. Yılmazer Hasan Ağın |
| author_facet | Gülhan Atakul Ferhat Sarı Rana İşgüder Gökhan Ceylan Özlem Saraç Sandal Yakup Ergül Murat M. Yılmazer Hasan Ağın |
| author_sort | Gülhan Atakul |
| collection | DOAJ |
| description | Ashman phenomenon is an aberrant ventricular conduction seen in atrial fibrillation. It is due to a change in the length of QRS complex. It is most often mistaken for a premature ventricular contraction (PVC) or ventricular tachycardia. A 15-year-old male patient was admitted to the emergency department with the complaint of palpitation. He had a 3-year history of type 1 diabetes mellitus and he was using isotretinoin for nodular acne for 1 month. His heart rate was 195 beats/min and his electrocardiographic findings were compatible with supraventricular tachycardia (PVC). Adenosine was administered as an intravenous push twice, however, since atrial fibrillation did not return to normal sinus rhythm , he was transferred to our pediatric intensive care unit. After a transesophageal echocardiography showing no thrombus or structural defect, synchronized cardioversion was attempted at escalating doses of 0.5 J/kg, 1 j/kg and 1.5 j/kg dose, but the patient was unresponsive. After the cardioversion, the patient did not return to normal sinus rhythm hence re-evaluated with ECG again. Persisted tachycardia, absence of p waves, similar extra-ventricular beats and unequal R-R distances were observed. This rhythm was found to be compatible with atrial fibrillation and that the supraventricular pulses delivered with the accompanying aberration were Ashman’s phenomena. After infusion of 3 mg/kg, amiodarone was continued 6 mcg/kg/min as maintenance infusion. His rhythm went back to normal. Amiodarone infusion was discontinued at the 48th hour and the patient was transferred to pediatric cardiology service with oral propranolol treatment. The Ashman phenomenon is a very rare condition in childhood and should be distinguished from the series of PVC and sequentially identified supraventricular complexes, due to completely different treatment options. |
| first_indexed | 2024-04-10T11:38:10Z |
| format | Article |
| id | doaj.art-fd7fbd68c04042709c8d7b5612c93ce6 |
| institution | Directory Open Access Journal |
| issn | 2146-2399 2148-7332 |
| language | English |
| last_indexed | 2024-04-10T11:38:10Z |
| publishDate | 2019-08-01 |
| publisher | Galenos Yayinevi |
| record_format | Article |
| series | Journal of Pediatric Emergency and Intensive Care Medicine |
| spelling | doaj.art-fd7fbd68c04042709c8d7b5612c93ce62023-02-15T16:17:41ZengGalenos YayineviJournal of Pediatric Emergency and Intensive Care Medicine2146-23992148-73322019-08-016210510810.4274/cayd.galenos.2019.4041213049054A Rare Arrhythmia in a Child with Atrial Fibrillation: Ashman PhenomenonGülhan Atakul0Ferhat Sarı1Rana İşgüder2Gökhan Ceylan3Özlem Saraç Sandal4Yakup Ergül5Murat M. Yılmazer6Hasan Ağın7 Dr. Behçet Uz Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, İzmir, Türkiye Dr. Behçet Uz Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, İzmir, Türkiye Dr. Behçet Uz Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, İzmir, Türkiye Dr. Behçet Uz Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, İzmir, Türkiye Dr. Behçet Uz Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, İzmir, Türkiye Mehmet Akif Ersoy Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Çocuk Kardiyolojisi Kliniği, İstanbul, Türkiye Dr. Behçet Uz Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, İzmir, Türkiye Dr. Behçet Uz Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, İzmir, Türkiye Ashman phenomenon is an aberrant ventricular conduction seen in atrial fibrillation. It is due to a change in the length of QRS complex. It is most often mistaken for a premature ventricular contraction (PVC) or ventricular tachycardia. A 15-year-old male patient was admitted to the emergency department with the complaint of palpitation. He had a 3-year history of type 1 diabetes mellitus and he was using isotretinoin for nodular acne for 1 month. His heart rate was 195 beats/min and his electrocardiographic findings were compatible with supraventricular tachycardia (PVC). Adenosine was administered as an intravenous push twice, however, since atrial fibrillation did not return to normal sinus rhythm , he was transferred to our pediatric intensive care unit. After a transesophageal echocardiography showing no thrombus or structural defect, synchronized cardioversion was attempted at escalating doses of 0.5 J/kg, 1 j/kg and 1.5 j/kg dose, but the patient was unresponsive. After the cardioversion, the patient did not return to normal sinus rhythm hence re-evaluated with ECG again. Persisted tachycardia, absence of p waves, similar extra-ventricular beats and unequal R-R distances were observed. This rhythm was found to be compatible with atrial fibrillation and that the supraventricular pulses delivered with the accompanying aberration were Ashman’s phenomena. After infusion of 3 mg/kg, amiodarone was continued 6 mcg/kg/min as maintenance infusion. His rhythm went back to normal. Amiodarone infusion was discontinued at the 48th hour and the patient was transferred to pediatric cardiology service with oral propranolol treatment. The Ashman phenomenon is a very rare condition in childhood and should be distinguished from the series of PVC and sequentially identified supraventricular complexes, due to completely different treatment options. http://www.caybdergi.com/archives/archive-detail/article-preview/a-rare-arrhythmia-in-a-child-with-atrial-fibrillat/27795 Arrhythmiaatrial fibrillationAshman phenomenon |
| spellingShingle | Gülhan Atakul Ferhat Sarı Rana İşgüder Gökhan Ceylan Özlem Saraç Sandal Yakup Ergül Murat M. Yılmazer Hasan Ağın A Rare Arrhythmia in a Child with Atrial Fibrillation: Ashman Phenomenon Journal of Pediatric Emergency and Intensive Care Medicine Arrhythmia atrial fibrillation Ashman phenomenon |
| title | A Rare Arrhythmia in a Child with Atrial Fibrillation: Ashman Phenomenon |
| title_full | A Rare Arrhythmia in a Child with Atrial Fibrillation: Ashman Phenomenon |
| title_fullStr | A Rare Arrhythmia in a Child with Atrial Fibrillation: Ashman Phenomenon |
| title_full_unstemmed | A Rare Arrhythmia in a Child with Atrial Fibrillation: Ashman Phenomenon |
| title_short | A Rare Arrhythmia in a Child with Atrial Fibrillation: Ashman Phenomenon |
| title_sort | rare arrhythmia in a child with atrial fibrillation ashman phenomenon |
| topic | Arrhythmia atrial fibrillation Ashman phenomenon |
| url |
http://www.caybdergi.com/archives/archive-detail/article-preview/a-rare-arrhythmia-in-a-child-with-atrial-fibrillat/27795
|
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