Supraventricular tachycardia (SVT) is one of the most common conditions in neonates that require emergency cardiac care. Its incidence in infancy is 0.06 and 0.25 per 1000 patients per year by the age of 1 month and one year respectively.The symptoms are usually nonspecific and include poor feeding, irritability, vomiting, cyanosis, and pallid spells. If the symptoms are unrecognized for hours to days, the infant can present with significant hemodynamic compromise or heart failure. Despite the success of conservative management in most cases, catheter ablation is required in cases of failure of medical treatment.We report a case of SVT ablation using a single catheter in a neonate who presented with tachycardia-induced cardiomyopathy (TIC).

Incessant focal atrial tachycardia (FAT) is the most common cause of tachycardia-induced cardiomyopathy in pediatric patients and is usually a reversible condition with effective management of tachycardia, either with medical treatment or ablation. These patients may be misdiagnosed, potentially leading to inappropriate treatment. Diagnosis is often late and should always be suspected in patients with congestive heart failure and unexplained persistent tachycardia. Para-Hisian atrial tachycardia is not an uncommon type of FATs; however, catheter ablation of anterior atrial septum-ATs has been a challenge because of its proximity to the AV node and the complex anatomy of its region.

Background Spinal cord injury (SCI) is a significant cause of morbidity and mortality with an incidence of 40-83/million/year. Sympathetic denervation in SCI leads to cardiovascular abnormalities including orthostatic hypotension, rhythm disturbance and repolarization changes. Electrocardiographic (ECG) findings include brady-arrhythmias, ectopic beats, long QT interval and ST-T changes that may be mistaken for myocardial ischemia. Case Summary A patient in their 40s with free past medical history was referred to our center with the diagnosis of non-ST elevation acute coronary syndrome. On presentation, chest pain was diffuse and radiating to the back. 12-lead Electrocardiogram (ECG) showed deep symmetrical T wave inversion. Echocardiography and cardiac troponin were normal. The patient was scheduled for multi-slice CT coronary angiography which was normal, however, a few hours after admission, the patient developed rapidly progressive motor weakness in both lower limbs with urine retention. Examination revealed motor power grade 1 in both lower limbs. All sensations were diminished with a sensory level at T6. Urgent MRI spine revealed neoplastic infiltration of the whole vertebrae with D5/D6 fracture exerting spinal cord compression. The patient was referred for urgent decompression surgery. Conclusion ECG changes could be the earliest sign for ongoing SCI. ST elevation is reported in higher levels of complete injury, while ST depression and inverted T waves can occur independent of lesion level or severity. Misinterpretation of these changes may cause a delay in reaching the correct diagnosis. We highlight the importance of considering neurological causes for ischemic-like ECG changes, as early recognition could prevent irreversible functional loss.