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Ismail H, Gabriels JK, Chang D, Donnelly J, Kim BS, Epstein LM, Hentz R, Fishbein J, Huang X, Kowalski M, Dasrat P, Rahyab AS, Goldner B. Site-specific effects of dobutamine on cardiac conduction and refractoriness. J Interv Card Electrophysiol 2024; 67:71-82. [PMID: 37227538 DOI: 10.1007/s10840-023-01573-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Isoproterenol, a non-specific beta agonist, is commonly used during electrophysiology studies (EPS). However, with the significant increase in the price of isoproterenol in 2015 and the increasing number of catheter ablations performed, the cost implications cannot be ignored. Dobutamine is a less expensive synthetic compound developed from isoproterenol with a similar mechanism to enhance cardiac conduction and shorten refractoriness, thus making it a feasible substitute with a lower cost. However, the use of dobutamine for EPS has not been well-reported in the literature. OBJECTIVE To determine the site-specific effects of various doses of dobutamine on cardiac conduction and refractoriness and assess its safety during EPS. METHODS From February 2020 to October 2020, 40 non-consecutive patients scheduled for elective EPS, supraventricular tachycardia, atrial fibrillation, and premature ventricular contraction ablations at a single center were consented and prospectively enrolled to assess the effect of dobutamine on the cardiac conduction system. At the end of each ablation procedure, measures of cardiac conduction and refractoriness were recorded at baseline and with incremental doses of dobutamine at 5, 10, 15, and 20 mcg/kg/min. For the primary analysis, the change per dose of dobutamine from baseline to each dosing level of dobutamine received by the patients, comparing atrioventricular node block cycle length (AVNBCL), ventricular atrial block cycle length (VABCL) and sinus cycle length (SCL), was tested using mixed-effect regression. For the secondary analysis, dobutamine dose level was tested for association with relative changes from baseline of each electrophysiologic parameter (SCL, AVNBCL, VABCL, atrioventricular node effective refractory period (AVNERP), AH, QRS, QT, QTc, atrial effective refractory period (AERP), ventricular effective refractory period (VERP), using mixed-effect regression. Changes in systolic and diastolic blood pressures were also assessed. The Holm-Bonferroni method was used to adjust for multiple testing. RESULTS For the primary analysis there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to each dose level of dobutamine. The SCL, AVNBCL, VABCL, AVNERP, AERP, VERP and the AH, and QT intervals all demonstrated a statistically significant decrease from baseline to at least one dose level with incremental dobutamine dosing. Two patients (5%) developed hypotension during the study and one patient (2.5%) received a vasopressor. Two patients (5%) had induced arrhythmias but otherwise no major adverse events were noted. CONCLUSION In this study, there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to any dose level of dobutamine. As expected, the AH and QT intervals, and the VABCL, VERP, AERP and AVNERP all significantly decreased from baseline to at least one dose level with an escalation in dobutamine dose. Dobutamine was well-tolerated and safe to use during EPS.
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Affiliation(s)
- Haisam Ismail
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - James K Gabriels
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - David Chang
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Joseph Donnelly
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Beom Soo Kim
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Laurence M Epstein
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Roland Hentz
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Joanna Fishbein
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Xueqi Huang
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Marcin Kowalski
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Parmanand Dasrat
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Ali Seyar Rahyab
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Bruce Goldner
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA.
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2
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Van Matre ET, Rice PJ, Wempe MF, Lyda C, Kiser TH. Extended Stability of Isoproterenol Hydrochloride Injection in Polyvinyl Chloride Bags Stored in Amber Ultraviolet Light Blocking Bags. Hosp Pharm 2023; 58:183-187. [PMID: 36890952 PMCID: PMC9986575 DOI: 10.1177/00185787221125722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose:Evaluate the stability of isoproterenol hydrochloride injection in 0.9% sodium chloride in polyvinyl chloride bags for up to 90 days. Methods: Dilutions of isoproterenol hydrochloride injection to a concentration of 4 μg/mL were performed under aseptic conditions. The bags were stored in amber ultraviolet light blocking bags at room temperature (23°C-25°C) or under refrigeration (3°C-5°C). Three samples of each preparation and storage environment were analyzed on days 0, 2, 14, 30, 45, 60, and 90. Physical stability was performed by visual examination. The pH was assessed at baseline, each analysis day, and upon final degradation evaluation. Sterility of the samples was not assessed. Chemical stability of isoproterenol hydrochloride was evaluated using liquid chromatography with tandem mass spectrometry. Samples were considered stable if there was <10% degradation of the initial concentration. Results: Isoproterenol hydrochloride diluted to 4 μg/mL with 0.9% sodium chloride injection was physically stable throughout the study. No precipitation was observed. At days 2, 14, 30, 45, 60, and 90 all bags diluted to 4 μg/mL had <10% degradation when stored under refrigeration (3°C-5°C) or stored at room temperature (23°C-25°C). Conclusion: Isoproterenol hydrochloride diluted to a concentration of 4 μg/mL with 0.9% sodium chloride for injection in ultraviolet light blocking bags was stable for 90 days at room temperature and under refrigeration.
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Affiliation(s)
| | - Peter J. Rice
- University of Colorado Skaggs School of
Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Michael F. Wempe
- University of Colorado Skaggs School of
Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
- University of Colorado Cancer Center,
Aurora, CO, USA
| | - Clark Lyda
- University of Colorado Hospital,
Aurora, CO, USA
| | - Tyree H. Kiser
- University of Colorado Skaggs School of
Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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3
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Sager S, Bernhardt F, Kehrle F, Merkert M, Potschka A, Meder B, Katus H, Scholz E. Expert-enhanced machine learning for cardiac arrhythmia classification. PLoS One 2021; 16:e0261571. [PMID: 34941897 PMCID: PMC8699667 DOI: 10.1371/journal.pone.0261571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/05/2021] [Indexed: 12/12/2022] Open
Abstract
We propose a new method for the classification task of distinguishing atrial fibrillation (AFib) from regular atrial tachycardias including atrial flutter (AFlu) based on a surface electrocardiogram (ECG). Recently, many approaches for an automatic classification of cardiac arrhythmia were proposed and to our knowledge none of them can distinguish between these two. We discuss reasons why deep learning may not yield satisfactory results for this task. We generate new and clinically interpretable features using mathematical optimization for subsequent use within a machine learning (ML) model. These features are generated from the same input data by solving an additional regression problem with complicated combinatorial substructures. The resultant can be seen as a novel machine learning model that incorporates expert knowledge on the pathophysiology of atrial flutter. Our approach achieves an unprecedented accuracy of 82.84% and an area under the receiver operating characteristic (ROC) curve of 0.9, which classifies as "excellent" according to the classification indicator of diagnostic tests. One additional advantage of our approach is the inherent interpretability of the classification results. Our features give insight into a possibly occurring multilevel atrioventricular blocking mechanism, which may improve treatment decisions beyond the classification itself. Our research ideally complements existing textbook cardiac arrhythmia classification methods, which cannot provide a classification for the important case of AFib↔AFlu. The main contribution is the successful use of a novel mathematical model for multilevel atrioventricular block and optimization-driven inverse simulation to enhance machine learning for classification of the arguably most difficult cases in cardiac arrhythmia. A tailored Branch-and-Bound algorithm was implemented for the domain knowledge part, while standard algorithms such as Adam could be used for training.
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Affiliation(s)
- Sebastian Sager
- Department of Mathematics, Otto-von-Guericke University, Magdeburg, Germany
- Informatics for Life, Heidelberg, Germany
| | - Felix Bernhardt
- Department of Mathematics, Otto-von-Guericke University, Magdeburg, Germany
| | - Florian Kehrle
- Informatics for Life, Heidelberg, Germany
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Merkert
- Institute of Optimization, Technical University Braunschweig, Braunschweig, Germany
| | - Andreas Potschka
- Institute of Mathematics, Clausthal University of Technology, Clausthal-Zellerfeld, Germany
| | - Benjamin Meder
- Informatics for Life, Heidelberg, Germany
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
| | - Hugo Katus
- Informatics for Life, Heidelberg, Germany
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research, Heidelberg, Germany
| | - Eberhard Scholz
- Informatics for Life, Heidelberg, Germany
- GRN Gesundheitszentren Rhein-Neckar gGmbH, Schwetzingen, Germany
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4
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Duman D, Ertuğrul İ, Yıldırım Baştuhan I, Aykan HH, Karagöz T. Empiric slow-pathway ablation results for presumed atrioventricular nodal reentrant tachycardia in pediatric patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1200-1206. [PMID: 34080209 DOI: 10.1111/pace.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/29/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In pediatric patients with documented narrow QRS tachycardia that is suggestive of atrioventricular nodal reentrant tachycardia (AVNRT) and not inducible in electrophysiological study (EPS), empiric slowpathway ablation (ESPA) may be considered. There is limited data in children about this topic. METHODS Seventy-nine patients who underwent cryoablation and/or radiofrequency ablation (RFA) for presumed AVNRT between January 2010 and January 2020, with no inducible tachycardia and no other tachycardia mechanisms during EPS, were included in this study. RESULTS The age was between 6 and 18 years. All patients had no structural heart disease. Preablation exhibited sustained SP conduction for all patients. In all cases, the ablation end points were prolongation in wenckebach cycle length (WBCL) with loss of cross and/or jump, and/or echo beat. The end points were not achieved in two patients. Overall, the mean basal WBCL increased to 351 ms (240-500 ms) from 301.3 ms (180-420 ms), evident in the non-recurrence group. Nine patients had a transient AV block that improved. We followed the patients without medication for about 46.9 months (8 months to 10 years). Palpitations occurred again in 9 of 77 patients (clinical recurrence rate 9/79 - 11.3%). The documented ECG recurrence rate was 1.2% (1/79). In the non-recurrence group, WBCL prolongation was higher and mean age was lower than in the recurrence group (13.075 vs. 15.33 years). CONCLUSION In cases with presumed AVNRT, ESPA seems to be a reasonable and safe way. In our study, we found our procedural success rate as 97.4% and follow-up recurrence rate as 12.6% (9+1/79).
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Affiliation(s)
- Derya Duman
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - İlker Ertuğrul
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - Işıl Yıldırım Baştuhan
- Division of Pediatric Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Dalian
| | - Hayrettin Hakan Aykan
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - Tevfik Karagöz
- Department of Pediatrics, University of Hacettepe, Ankara, Turkey
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5
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Chin CG, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Vicera JJB, Chen CC, Chuang CM, Cheng WH, Liu SH, Hsieh MH, Chen SA. Extremely late recurrences (≥3 years) of atrioventricular nodal reentrant tachycardia: Electrophysiological characteristics of the index and repeat ablation procedures. Int J Cardiol 2020; 305:70-75. [PMID: 32059994 DOI: 10.1016/j.ijcard.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/26/2020] [Accepted: 02/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catheter ablation is an effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). However, the characteristics of extremely late (>3 years) recurrences of AVNRT after a successful initial ablation are not fully elucidated. We aimed to explore the electrophysiological characteristics of extremely late recurrences of AVNRT after a successful ablation. METHODS From 1991 to 2018, 3311 patients (mean age: 48.7 ± 17.4 years; men: 1328 [40.1%]) who underwent catheter ablation for AVNRT were investigated. Baseline characteristics of the patients, recurrence status, and detailed electrophysiological parameters of the index and repeat ablation procedures were obtained for analysis. RESULTS After a mean follow-up period of 129.5 ± 58.0 months, 65 (2.0%) patients underwent repeat ablation for recurrences of AVNRT, of whom 17 (0.5%) presented with extremely late recurrences. The incidence of transient AV block was significantly higher in patients with extremely late recurrences (5.9%) than in those without recurrences (1.9%) but lower than that in patients with recurrences within <3 years (12.5%, P < .001). In addition, among patients with extremely late recurrences of AVNRT, the atrial-His bundle interval was significantly longer (99.1 ± 23.4 vs. 76.5 ± 13.1 ms, P < .01) and the need for intravenous isoproterenol and/or atropine for the induction of AVNRT (88.2% vs. 47.1%, P = .03) was higher in the repeat ablation procedure than in the index ablation procedure. CONCLUSION Recurrences of AVNRT can occur 3 years after a successful initial ablation. The electrophysiological features of the index and repeat ablation procedures differed between patients with extremely late recurrences of AVNRT and those with recurrences within <3 years.
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Affiliation(s)
- Chye-Gen Chin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; University of Santo Tomas Hospital, Manila, Philippines
| | - Chun-Chao Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Mao Chuang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Pediatric Cardiology, Chinese Medical University Children's Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Hsiung Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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Iqbal AM, Mubarik A, Cheetirala VG, Mohammed SK, Muddassir S. Marijuana Induced Sick Sinus Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:882-885. [PMID: 31227686 PMCID: PMC6598785 DOI: 10.12659/ajcr.915943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 27 Final Diagnosis: Sick sinus syndrome Symptoms: Syncope Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
| | - Ateeq Mubarik
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
| | | | | | - Salman Muddassir
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
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7
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Abstract
Palpitations are among the most common symptoms that prompt patients to consult a physician. In the diagnostic workup of patients with palpitations, the initial evaluation involves history, physical examination, and 12-lead electrocardiogram. These investigations yield a prognostic stratification of the patients, and a definitive suspected diagnosis of the cause of symptoms in a good proportion of cases. When the initial evaluation results are negative and the patient is suffering from heart disease, or if the palpitations are frequent or poorly tolerated and with a high probability of an arrhythmic origin, ambulatory electrocardiogram monitoring and/or electrophysiological study should be undertaken.
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8
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Suryanarayana P, Garza HHK, Klewer J, Hutchinson MD. Electrophysiologic Considerations After Sudden Cardiac Arrest. Curr Cardiol Rev 2018; 14:102-108. [PMID: 29737257 PMCID: PMC6088441 DOI: 10.2174/1573403x14666180507164443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/31/2018] [Accepted: 04/25/2018] [Indexed: 01/18/2023] Open
Abstract
Background: Sudden Cardiac Death (SCD) remains a major public health concern, accounting for more than 50% of cardiac deaths. The majority of these deaths are related to ischemic heart disease, however increasingly recognized are non-ischemic causes such as cardiac channelopathies. Bradyarrhythmias and pulseless electrical activity comprise a larger proportion of out-of-hospital arrests than previously realized, particularly in patients with more advanced heart failure or noncardiac triggers such as pulmonary embolism. Patients surviving Sudden Cardiac Arrest (SCA) have a substantial risk of recurrence, particularly within 18 months post event. The timing of tachyarrhythmias complicating acute infarction has important implications regarding the likelihood of recurrence, with those occurring within 48 hours having a more favorable long-term outcome. In the absence of a clear reversible cause, implantable cardioverter defibrillators remain the mainstay in the secondary prevention of SCD. Post defibrillation electromechanical dissociation is common in patients with cardiomyopathy and can lead to SCD despite successful defibrillation of the primary tachyarrhythmia. Antiarrhythmic agents are highly effective in preventing recurrent arrhythmias in specific diseases such as the congenital long QT syndrome. Conclusion: Catheter ablation is used most commonly to prevent recurrent ICD therapies in patients with structural heart disease-related ventricular arrhythmias, however recent publications have shown substantial benefit in other entities such as idiopathic ventricular fibrillation.
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Affiliation(s)
- Prakash Suryanarayana
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Hyon-He K Garza
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Jacob Klewer
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Mathew D Hutchinson
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
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9
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Abstract
The hyperinflation of isoproterenol, a 75-year-old drug, in early 2015 was unbelievable. The attention of health-care professionals, health system administrators, legislators, and the general public was quickly focused on Valeant Pharmaceuticals, purchaser of several generics solely to raise their price. With isoproterenol easily launched toward the top of drug expenditures, pharmacists in many hospitals were forced to engage stakeholders in the investigation and implementation of alternatives, explore utilization and optimize inventory, reduce cost through sterile product preparation, where possible, restrict use to settings that were beneficial to their budget, and become legislative advocates. The alternatives drugs and strategies will be reviewed.
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Affiliation(s)
- Julie D'Ambrosi
- 1 Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT, USA
| | - Nilesh Amin
- 1 Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT, USA
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10
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Gerguri S, Jathanna N, Lin T, Müller P, Clasen L, Schmidt J, Kurt M, Shin DI, Blockhaus C, Kelm M, Fürnkranz A, Makimoto H. Clinical impact of "pure" empirical catheter ablation of slow-pathway in patients with non-ECG documented clinical on-off tachycardia. Eur J Med Res 2018; 23:16. [PMID: 29580297 PMCID: PMC5870342 DOI: 10.1186/s40001-018-0314-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background Catheter ablation of slow-pathway (CaSP) has been reported to be effective in patients with dual atrioventricular nodal conduction properties (dcp-AVN) and clinical ECG documentation but without the induction of tachycardia during electrophysiological studies (EPS). However, it is unknown whether CaSP is beneficial in the absence of pre-procedural ECG documentation and without the induction of tachycardia during EPS. The aim of this study was to evaluate long-term results after a “pure” empirical CaSP (peCaSP). Methods 334 consecutive patients who underwent CaSP (91 male, 47.5 ± 17.6 years) were included in this study. Sixty-three patients (19%) who had no pre-procedural ECG documentation, and demonstrated dcp-AVN with a maximum of one echo-beat were assigned to the peCaSP group. The remaining 271 patients (81%) were assigned to the standard CaSP group (stCaSP). Clinical outcomes of the two groups were compared, based on ECG documented recurrence or absence of tachycardia and patients’ recorded symptoms. Results CaSP was performed in all patients without any major complications including atrioventricular block. During follow-up (909 ± 435 days), 258 patients (77%) reported complete cessation of clinical symptoms. There was no statistically significant difference in the incidence of AVNRT recurrence between the peCaSP and stCaSP groups (1/63 [1.6%] vs 3/271 [1.1%], P = 0.75). Complete cessation of clinical symptoms was noted significantly less frequently in patients after peCaSP (39/63 [62%] vs 219/271 [81%], P = 0.0013). The incidence of non-AVNRT atrial tachyarrhythmias (AT) was significantly higher in patients after peCaSP (5/63 [7.9%] vs 1/271 [0.4%], P = 0.0011). Conclusion A higher incidence of other AT and subjective symptom persistence are demonstrated after peCaSP, while peCaSP improves clinical symptoms in 60% of patients with non-documented on–off tachycardia.
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Affiliation(s)
- Shqipe Gerguri
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Nikesh Jathanna
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Tina Lin
- Heart Care Victoria, Victoria, Australia
| | - Patrick Müller
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Lukas Clasen
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Jan Schmidt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Muhammed Kurt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Dong-In Shin
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Christian Blockhaus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Alexander Fürnkranz
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Hisaki Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. .,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany.
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Viu J, Armengou L, Decloedt A, Jose-Cunilleras E. Investigation of ventricular pre-excitation electrocardiographic pattern in two horses: clinical presentation and potential causes. J Vet Cardiol 2018; 20:213-221. [PMID: 29573995 DOI: 10.1016/j.jvc.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 01/02/2023]
Abstract
Two horses referred to the Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, for unrelated clinical problems, and with no previous history of cardiac disease exhibited an intermittent ventricular pre-excitation electrocardiographic pattern during hospitalization. Both animals showed decreased plasma total and ionized magnesium concentrations, but no other relevant electrolyte disturbances were detected. Altered interventricular septal motion associated with ventricular pre-excitation beats (VPBs) was detected on M-mode echocardiography in both horses. The likely localization of an accessory pathway (AP) was identified in case 2 using pulsed-wave tissue Doppler imaging in the left anterior paraseptal location. Decreased frequency of the VPB was observed with long-term magnesium supplementation and restoration of plasma magnesium concentrations. The presence of ventricular pre-excitation electrocardiographic pattern was attributed to higher sensitivity of the AP to hypomagnesemia in both cases.
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Affiliation(s)
- Judit Viu
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lara Armengou
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annelies Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eduard Jose-Cunilleras
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Population-Based Evaluation of Major Adverse Events After Catheter Ablation for Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:1425-1433. [DOI: 10.1016/j.jacep.2017.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 11/17/2022]
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Prevention and Treatment of Lower Limb Deep Vein Thrombosis after Radiofrequency Catheter Ablation: Results of a Prospective active controlled Study. Sci Rep 2016; 6:28439. [PMID: 27329582 PMCID: PMC4916462 DOI: 10.1038/srep28439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/06/2016] [Indexed: 01/07/2023] Open
Abstract
We conducted a prospective, single-center, active controlled study from July 2013 to January 2015, in Chinese patients with rapid ventricular arrhythmia who had received radiofrequency catheter ablation (RFCA) treatment to determine formation of lower extremity deep vein thrombosis (LDVT) post RFCA procedure, and evaluated the effect of rivaroxaban on LDVT. Patients with asymptomatic pulmonary thromboembolism who had not received any other anticoagulant and had received no more than 36 hours of treatment with unfractionated heparin were included. Post RFCA procedure, patients received either rivaroxaban (10 mg/d for 14 days beginning 2–3 hours post-operation; n = 86) or aspirin (100 mg/d for 3 months beginning 2–3 hours post-operation; n = 90). The primary outcome was a composite of LDVT occurrence, change in diameter of femoral veins, and safety outcomes that were analyzed based on major or minor bleeding events. In addition, blood flow velocity was determined. No complete occlusive thrombus or bleeding events were reported with either of the group. The lower incidence rate of non-occluded thrombus in rivaroxaban (5.8%) compared to the aspirin group (16.7%) indicates rivaroxaban may be administered post-RFCA to prevent and treat femoral venous thrombosis in a secure and effective way with a faster inset of action than standard aspirin therapy.
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Zipes DP, Calkins H, Daubert JP, Ellenbogen KA, Field ME, Fisher JD, Fogel RI, Frankel DS, Gupta A, Indik JH, Kusumoto FM, Lindsay BD, Marine JE, Mehta LS, Mendes LA, Miller JM, Munger TM, Sauer WH, Shen WK, Stevenson WG, Su WW, Tracy CM, Tsiperfal A. 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). Heart Rhythm 2016; 13:e3-e37. [DOI: 10.1016/j.hrthm.2015.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Indexed: 12/20/2022]
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2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). J Am Coll Cardiol 2015; 66:2767-2802. [DOI: 10.1016/j.jacc.2015.08.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Li YC, Lin J, Wu L, Li J, Chen P, Guang XQ. Clinical Features of Acute Massive Pulmonary Embolism Complicated by Radiofrequency Ablation: An Observational Study. Medicine (Baltimore) 2015; 94:e1711. [PMID: 26448025 PMCID: PMC4616747 DOI: 10.1097/md.0000000000001711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although pulmonary embolism (PE) complicated by radiofrequency catheter ablation (RFCA) is rare, it can be life-threatening. Our goal was to elucidate the clinical features of acute massive PE after RFCA. Of 2386 patients who underwent RFCA for supraventricular tachycardia or idiopathic ventricular arrhythmia, 4 patients (0.16%) whose cases were complicated by acute massive PE were examined. These 4 patients were female and middle-aged (range 43-52 years), and 2 of the 4 patients had iron-deficiency anemia and reactive thrombocytosis. Ablation in all patients was performed in the left heart via the right femoral arterial approach. All of the patients had a long-duration hemostasis procedure and bed rest following femoral arterial sheath removal after RFCA. All of the patients collapsed and lost consciousness during their first attempt at walking after RFCA. The emergent electrocardiogram in 2 of the 4 patients revealed an S1Q3T3 pattern, 1 patient demonstrated new onset of right bundle-branch block (RBBB) and S1Q3 pattern and Qr pattern in V1, and the remaining patient had negative T waves in leads V1, V2, and III. The emergent echocardiogram revealed right ventricular hypokinesis and pulmonary hypertension in the 4 patients with acute PE after ablation. Although all of the patients initially experienced sinus tachycardia when they recovered consciousness, 2 of the 4 patients suddenly developed intense bradycardia and lost consciousness again, and these patients finally died (50% fatality rate). All of the patients were identified by CT pulmonary angiography or pulmonary angiography. Our report suggests that although acute massive PE is highly rare, there is a real and fatal risk in patients who experienced acute massive PE after RFCA. Particular attention should be paid to the first ambulation after RFCA. Acute PE should be strongly suspected when sudden loss of consciousness occurs upon mobilization after RFCA. The new onset of S1Q3T3 pattern, RBBB or T wave inversion in the right precordial leads, and early detection of echocardiographic right ventricular dysfunction may be useful for making an early diagnosis of acute PE after RFCA. Early ambulation after left-sided RFCA might be helpful to prevent the formation of deep venous thrombosis and subsequent PE.
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Affiliation(s)
- Yue-Chun Li
- From the Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Calkins H, Awtry EH, Bunch TJ, Kaul S, Miller JM, Tedrow UB. COCATS 4 Task Force 11: Training in Arrhythmia Diagnosis and Management, Cardiac Pacing, and Electrophysiology. J Am Coll Cardiol 2015; 65:1854-65. [DOI: 10.1016/j.jacc.2015.03.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Perlman O, Katz A, Weissman N, Amit G, Zigel Y. Atrial electrical activity detection using linear combination of 12-lead ECG signals. IEEE Trans Biomed Eng 2014; 61:1034-43. [PMID: 24658228 DOI: 10.1109/tbme.2013.2292930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
ECG analysis is the method for cardiac arrhythmia diagnosis. During the diagnostic process many features should be taken into consideration, such as regularity and atrial activity. Since in some arrhythmias, the atrial electrical activity (AEA) waves are hidden in other waves, and a precise classification from surface ECG is inapplicable, a confirmation diagnosis is usually performed during an invasive procedure. In this paper, we study a "semiautomatic" method for AEA-waves detection using a linear combination of 12-lead ECG signals. This method's objective is to be applicable to a variety of arrhythmias with emphasis given to detect concealed AEA waves. It includes two variations--using maximum energy ratio and a synthetic AEA signal. In the former variation, an energy ratio-based cost function is created and maximized using the gradient ascent method. The latter variation adapted the linear combiner method, when applied on a synthetic signal, combined with surface ECG leads. A study was performed evaluating the AEA-waves detection from 63 patients (nine training, 54 validation) presenting eight arrhythmia types. Averaged sensitivity of 92.21% and averaged precision of 92.08% were achieved compared to the definite diagnosis. In conclusion, the presented method may lead to early and accurate detection of arrhythmias, which will result in a better oriented treatment.
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Ogawa E, Ito A, Arai T. Detailed in vitro study of the photosensitization reaction of extracellular talaporfin sodium in rat myocardial cells. Lasers Surg Med 2013; 45:660-7. [DOI: 10.1002/lsm.22192] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Emiyu Ogawa
- School of Fundamental Science and Technology; Graduate School of Science and Technology; Keio University; Kohoku-ku Yokohama Japan
| | - Arisa Ito
- School of Fundamental Science and Technology; Graduate School of Science and Technology; Keio University; Kohoku-ku Yokohama Japan
| | - Tsunenori Arai
- School of Fundamental Science and Technology; Graduate School of Science and Technology; Keio University; Kohoku-ku Yokohama Japan
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MÜSSIGBRODT ANDREAS, RICHTER SERGIO, WETZEL ULRIKE, VAN BELLE YVES, BOLLMANN ANDREAS, HINDRICKS GERHARD. Diagnosis of Arrhythmias in Athletes Using Leadless, Ambulatory HR Monitors. Med Sci Sports Exerc 2013; 45:1431-5. [DOI: 10.1249/mss.0b013e31828ca1bf] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Laish-Farkash A, Shurrab M, Singh S, Tiong I, Verma A, Amit G, Kiss A, Morriello F, Birnie D, Healey J, Lashevsky I, Newman D, Crystal E. Approaches to empiric ablation of slow pathway: results from the Canadian EP web survey. J Interv Card Electrophysiol 2012; 35:183-7. [PMID: 22833011 DOI: 10.1007/s10840-012-9696-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 05/20/2012] [Indexed: 10/28/2022]
Abstract
AIM Dual atrioventricular nodal physiology (DAVNP) is a frequent finding in patients with suspected or documented supraventricular tachycardia (SVT). Empiric slow pathway ablation (ESPA) is sometimes performed in patients with DAVNP without inducible SVT at the time of electrophysiological study. Evidence to guide this practice in the adult population is limited. This study was aimed to assess the practice of ESPA by adult electrophysiologists in Canada. METHODS All Canadian interventional electrophysiologists (n = 81) were invited to complete a web-based questionnaire assessing their practice of ESPA in patients with suspected and documented SVT. Operator experience, reimbursement models, diagnostic, and treatment decisions regarding ESPA were assessed with case scenarios. RESULTS Forty-one responses (50 %) were obtained. Ninety-five percent of the responders stated that the evidence for ESPA is lacking or limited. Responders were more likely to perform ESPA in the setting of non-inducible SVT when there was documentation of the clinical arrhythmia (64 vs. 31 % (p = 0.017)). The threshold to perform ESPA was highly variable. Longer time in practice (r = 0.38, p = 0.017) and less perceived complications with ESPA (r = 0.31, p = 0.05) were correlated with the practice of ESPA, whereas length of ablation waiting lists (r = -0.15, p = 0.38), number of procedures performed per day (r = 0.11, p = 0.51) and type of reimbursement (p = 0.24) were not associated with the practice of ESPA. The perceived complication rate with ESPA was <1 %. CONCLUSION Variability in the practice of ESPA in cases of non-inducible SVT exists. Documentation of the clinical arrhythmia, operator experience, and perceived low complication rates positively influence this practice.
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Affiliation(s)
- Avishag Laish-Farkash
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite D-377, Toronto, ON, M4N 3M5, Canada
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Hoyt WJ, Thomas PE, DeSena HC, Steinberg JS, Harmon DE, Snyder CS. Atrial fibrillation induction by transesophageal electrophysiology studies in patients with asymptomatic ventricular preexcitation. CONGENIT HEART DIS 2012; 8:57-61. [PMID: 22716259 DOI: 10.1111/j.1747-0803.2012.00689.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Ventricular preexcitation is a conduction abnormality caused by an accessory pathway bridging the atria and ventricles. If the accessory pathway conducts rapidly during atrial fibrillation (AFib), sudden death may result. The purpose of this study was to determine the ability of transesophageal electrophysiology studies (TEEPS) to induce AFib in pediatric patients with asymptomatic ventricular preexcitation (aVPE). DESIGN A retrospective review of patients with aVPE who had a TEEPS was conducted. Inclusion criteria were evidence of ventricular preexcitation on electrocardiogram; age <18 years; and no history of tachycardia, palpitations, or syncope. Data gathered included age, weight, height, form of sedation, and TEEPS results. If AFib was induced, patients were classified as at risk of sudden death if the shortest preexcited RR interval during AFib was <250 ms or no risk if ≥ 250 ms. RESULTS A total of 26 patients met the inclusion criteria, with average age of 11.9 years, weight of 48.9 kg, and height of 149.2 cm. During the procedure, nine patients underwent conscious sedation (34.6%), and 17 underwent general anesthesia (65.4%). AFib was induced in 23 patients (88.5%), of whom 17 (73.9%) had no risk and six (26.1%) had risk. No statistical differences were noted in age, weight, height, or form of sedation when comparisons were made between AFib induction and no AFib induction. CONCLUSIONS TEEPS induced AFib in 88.5% of patients. Age, weight, height, and form of sedation had no effect upon AFib inducibility. TEEPS is an effective modality to induce AFib in pediatric patients with aVPE.
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Affiliation(s)
- Walter J Hoyt
- Department of Pediatrics, Tulane University, New Orleans, LA, USA
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Alsayegh Y, Abdallah C. Unusual diagnosis of a persistent third-degree atrioventricular block during anesthesia in a "healthy" pediatric patient. Saudi J Anaesth 2012; 6:61-4. [PMID: 22412781 PMCID: PMC3299120 DOI: 10.4103/1658-354x.93070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We present an unusual diagnosis of a permanent third-degree atrioventricular block under general anesthesia in an otherwise healthy and asymptomatic child. This diagnosis of unclear causality represented a serious rare finding, requiring judicious management and resulting in the placement of a permanent pacemaker.
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Affiliation(s)
- Yasser Alsayegh
- Department of Pediatric Anesthesiology, Dhahran Health Center, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia
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Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart: role of cardiac electroanatomical mapping and biopsy. Heart Rhythm 2011; 8:1915-22. [DOI: 10.1016/j.hrthm.2011.07.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 07/14/2011] [Indexed: 02/06/2023]
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Yamini Sharif A, Vasheghani Farahani A, Reza Davoodi G, Kazemisaeid A, Fakhrzadeh H, Ghazanchai F. A new method for induction of atrioventricular nodal reentrant tachycardia in non-inducible cases. Europace 2011; 13:1789-92. [DOI: 10.1093/europace/eur234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Saoudi N, Latcu DG. Que reste-t-il des explorations électrophysiologiques en 2011 ? ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2010. [DOI: 10.1016/s1878-6480(10)70367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol 2009; 54:e13-e118. [PMID: 19926002 DOI: 10.1016/j.jacc.2009.07.010] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Circulation 2009; 120:e169-276. [PMID: 19884473 DOI: 10.1161/circulationaha.109.192690] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Priester R, Bunting T, Usher B, Chiaramida S, Taylor MH, Gregg D, Sturdivant JL, Leman RB, Wharton JM, Gold MR. Role of transesophageal echocardiography among patients with atrial fibrillation undergoing electrophysiology testing. Am J Cardiol 2009; 104:1256-8. [PMID: 19840572 DOI: 10.1016/j.amjcard.2009.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/04/2009] [Accepted: 06/04/2009] [Indexed: 10/20/2022]
Abstract
External or internal shocks administered to terminate ventricular arrhythmias as a part of electrophysiology or implantable cardioverter-defibrillator testing, can inadvertently cardiovert atrial fibrillation (AF). Moreover, anticoagulation therapy is often withheld in these patients in anticipation of an invasive procedure. The risk of embolic events during these procedures has not been well described. Accordingly, the present study was a prospective evaluation of the incidence of left atrial (LA) thrombus and AF cardioversion among patients undergoing ventricular arrhythmia assessment. Transesophageal echocardiography was routinely performed on 44 consecutive patients in AF with subtherapeutic anticoagulation undergoing electrophysiology or implantable cardioverter-defibrillator testing. Arrhythmia induction was not performed when LA thrombus was present. The incidence and clinical predictors of thrombus, the inadvertent cardioversion of AF, and adverse events related to the procedure were assessed during the subsequent 4 to 6 weeks. Left atrial thrombus was observed in 12 patients (27%). Sinus rhythm was restored in 29 patients (91%), at least transiently, who underwent testing with a shock delivered. No adverse neurologic or hemorrhagic complications were observed. Univariate analysis identified no predictors of LA thrombus or cardioversion to sinus rhythm. In conclusion, LA thrombus and cardioversion to sinus rhythm are common among patients with AF undergoing an evaluation of ventricular arrhythmias. Transesophageal echocardiography performed before the procedure in patients with subtherapeutic anticoagulation is warranted to minimize embolic complications. This strategy appears to be a safe method to guide diagnostic testing in this patient population.
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Casella M, Perna F, Dello Russo A, Pelargonio G, Bartoletti S, Ricco A, Sanna T, Pieroni M, Forleo G, Pappalardo A, Di Biase L, Natale L, Bellocci F, Zecchi P, Natale A, Tondo C. Right ventricular substrate mapping using the Ensite Navx system: Accuracy of high-density voltage map obtained by automatic point acquisition during geometry reconstruction. Heart Rhythm 2009; 6:1598-605. [PMID: 19786371 DOI: 10.1016/j.hrthm.2009.07.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 07/19/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND Contact point-to-point electroanatomic mapping (Pt-Map) is a validated tool to evaluate right ventricular (RV) substrate. When using the EnSite NavX system (St. Jude Medical, St Paul, Minnesota), geometry reconstruction by dragging the mapping catheter (Geo-Map) allows for quicker acquisition of a large number of points and better definition of anatomy, but it is not validated for substrate mapping. OBJECTIVE This study evaluates the feasibility and accuracy of Geo-Map. METHODS Thirteen patients (mean age 38 +/- 12 years) with RV arrhythmias and an apparently normal heart underwent cardiac magnetic resonance imaging (MRI), Pt-Map, and Geo-Map. The 2 maps were compared in terms of mapping procedural time, radiation time, and total number of points acquired. We finally compared the number and characteristics of low-potential areas on each patient's Pt-Map, Geo-Map, and cardiac MRI. RESULTS Geo-Map required significantly shorter mapping and radiation times in comparison to Pt-Map (12.4 +/- 4.6 vs. 31.9 +/- 10.1 and 5.8 +/- 2.1 vs. 12.1 +/- 3.9, P <.001). Furthermore, Geo-Map was based on a significantly higher density of points in comparison to Pt-Map (802 +/- 205 vs. 194 +/- 38, P <.001). Taking into consideration the total number of RV regions analyzed, the Pt-Map and Geo-Map disagreed in 2 of 65 (3%) regions (P = NS), which only Geo-Map identified as low-potential areas and indeed corresponded to wall motion abnormalities on MRI. CONCLUSION Voltage maps obtained through RV geometry acquisition have accuracy comparable to that of conventional point-by-point mapping in detecting low-voltage areas, have a good correlation with MRI wall motion abnormalities, and allow a significant reduction in procedural time and x-ray exposure.
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Affiliation(s)
- Michela Casella
- Cardiac Arrhythmia and Heart Failure Research Center, Catholic University of the Sacred Heart, San Camillo-Forlanini Hospital, Rome, Italy.
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Ziskind AA, Lauer MA, Bishop G, Vogel RA. Assessing the appropriateness of coronary revascularization: the University of Maryland Revascularization Appropriateness Score (RAS) and its comparison to RAND expert panel ratings and American College of Cardiology/American Heart Association guidelines with regard to assigned appropriateness rating and ability to predict outcome. Clin Cardiol 2009; 22:67-76. [PMID: 10068842 PMCID: PMC6655816 DOI: 10.1002/clc.4960220204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Significant regional variation in procedural frequencies has led to the development of the RAND and American College of Cardiology/American Heart Association (ACC/AHA) guidelines; however, they may be difficult to apply in clinical practice. The University of Maryland Revascularization Appropriateness Score (RAS) was created to address the need for a simplified point scoring system. HYPOTHESIS The study was undertaken to compare revascularization appropriateness ratings yielded by the RAND Expert Panel Ratings, ACC/AHA guidelines, and the University of Maryland RAS. METHODS We applied these three revascularization appropriateness scoring systems to 153 catheterization laboratory patients with a variety of cardiac diagnoses and treatments. For each patient, appropriateness scores assigned by each of the three systems were compared with each other and with the actual treatment delivered. Concordance of care with appropriateness score was then correlated with outcome. RESULTS There were significant differences among all three scoring systems in their ratings and in the concordance of treatment with appropriateness rating. When treatment provided was concordant with RAND ratings, there was a lower occurrence of subsequent coronary artery bypass grafting (CABG), the composite end point of either CABG or percutaneous transluminal coronary angioplasty (PTCA), and the composite end point of death, myocardial infarction (MI), or revascularization. When treatment was concordant with the ACC/AHA guidelines, there was lower occurrence of all-cause mortality, PTCA, the composite end point of either CABG or PTCA, and the composite end point of death, MI, or revascularization. When treatment provided was concordant with the RAS, there was lower occurrence of cardiac death, all-cause death, CABG, the composite end point of either CABG or PTCA, and the composite end point of death, MI, or revascularization. CONCLUSIONS The RAS is a simple scoring system to assess revascularization appropriateness. When the RAND, ACC/AHA, and RAS systems are compared in a catheterization laboratory population, they rate the same patient differently and vary in their correlation of appropriateness rating with outcome.
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Affiliation(s)
- A A Ziskind
- Department of Medicine, University of Maryland, Baltimore, USA
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Pires LA, Ravi S, Lal VR, Kahlon JP. Safety and potential cost savings of same-setting electrophysiologic testing and placement of transvenous implantable cardioverter-defibrillators. Clin Cardiol 2009; 24:592-6. [PMID: 11558840 PMCID: PMC6654776 DOI: 10.1002/clc.4960240905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Separately, electrophysiologic study (EPS) and placement of a transvenous implantable cardioverter-defibrillator (ICD) can be performed safely in the majority of patients. The safety and potential cost savings of same-setting procedures have not been evaluated. HYPOTHESIS Electrophysiologic study and placement of transvenous ICDs can be performed safely in the same setting at reduced cost. METHODS In all. 160 (mean age 65 +/- 10 years, 75% men) and 41 (mean age 66 +/- 11 years, 73% men) consecutive patients who underwent same- versus separate-setting procedures, respectively, were prospectively evaluated. RESULTS The two groups had similar clinical characteristics and indications for EPS and ICD therapy. Complications occurred in eight patients (5.0%, 95% confidence interval [CI] 2.3-10.3) who had same-setting procedures (one hypotension during ICD testing, one pocket hematoma, two lead dislodgments, two pneumothoraces, one stroke, and one infection) and in two (4.9%, CI 0.60-16.5) who had separate-setting procedures (one pocket hematoma and one infection). There were no procedure-related deaths or long-term ICD-related complications in either group. The mean time from ICD implantation to hospital discharge was similar in the two groups (2.5 +/- 2.4 vs. 2.7 +/- 2.2 days, p = NS). The combined procedure cost was higher in patients who had separate-setting procedures ($12,403 +/- 1,386 vs. $10,242 +/- 2.256, p = < 0.001). who incurred an additional hospital cost of $2,121 +/- $2,125 for the waiting period (1.7 +/- 1.6 days) between EPS and ICD implantation. CONCLUSIONS In patients deemed candidates for ICD therapy based on EPS results, placement of transvenous defibrillators in the same setting as EPS is as safe as separate-setting procedures and, if adopted, could further reduce the cost of providing ICD therapy.
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Affiliation(s)
- L A Pires
- St John Hospital Cardiovascular Institute and Wayne State University School of Medicine, Detroit, Michigan, USA
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51:e1-62. [PMID: 18498951 DOI: 10.1016/j.jacc.2008.02.032] [Citation(s) in RCA: 1098] [Impact Index Per Article: 68.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 2008; 5:e1-62. [PMID: 18534360 DOI: 10.1016/j.hrthm.2008.04.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 01/27/2023]
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Niwano S, Fukaya H, Yuge M, Imaki R, Hirasawa S, Sasaki T, Yumoto Y, Inomata T, Izumi T. Role of electrophysiologic study (EPS)-guided preventive therapy for the management of ventricular tachyarrhythmias in patients with heart failure. Circ J 2008; 72:268-73. [PMID: 18219165 DOI: 10.1253/circj.72.268] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ventricular tachyarrhythmias (VT/VF) are 1 of the most important factors determining the prognosis of patients with heart failure (HF). Although priority is given to implantable cardioverter defibrillator (ICD) therapy for the prevention of sudden cardiac death, electrophysiologic-study (EPS)-guided preventive therapy could be important for reducing the number of cardiac events. METHODS AND RESULTS Of 864 patients with a history of HF, an EPS was performed in 168 and 121 had inducible VT/VF. Under the basic therapy of an ICD, additional catheter ablation was attempted for 95 of 124 monomorphic VT foci in 74 patients, and 78 of the VT were successfully ablated. The prognoses were compared among 5 patient groups with different results for the EPS and catheter ablation: (1) success group (n=43), (2) failure group (n=15), (3) not attempted group (n=16), (4) VF group (n=47), and (5) no inducible VT/VF group. During a follow-up period of 31+/-22 months, the incidence of VT/VF was lower in the success and no inducible VT/VF groups than in the other groups (p=0.0018), although a significant difference was not observed for the total deaths. CONCLUSION EPS-guided preventive therapy using an ICD and catheter ablation can be useful, at least for the reduction of arrhythmic events in patients with HF.
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Affiliation(s)
- Shinichi Niwano
- Department of Cardio-angiology, Kitasato University School of Medicine, 1-15-1 Kitasato,Sagamihara 228-8555, Japan.
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350-408. [PMID: 18483207 DOI: 10.1161/circualtionaha.108.189742] [Citation(s) in RCA: 935] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Naccarelli GV, Conti JB, DiMarco JP, Tracy CM. Task Force 6: Training in Specialized Electrophysiology, Cardiac Pacing, and Arrhythmia Management. J Am Coll Cardiol 2008; 51:374-80. [PMID: 18206755 DOI: 10.1016/j.jacc.2007.11.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 2007; 50:e159-241. [PMID: 17950159 DOI: 10.1016/j.jacc.2007.09.003] [Citation(s) in RCA: 257] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Tarkington LG, Yancy CW. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Circulation 2007; 116:e418-99. [PMID: 17901357 DOI: 10.1161/circulationaha.107.185699] [Citation(s) in RCA: 377] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Giada F, Gulizia M, Francese M, Croci F, Santangelo L, Santomauro M, Occhetta E, Menozzi C, Raviele A. Recurrent Unexplained Palpitations (RUP) Study. J Am Coll Cardiol 2007; 49:1951-6. [PMID: 17498580 DOI: 10.1016/j.jacc.2007.02.036] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 01/30/2007] [Accepted: 02/05/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of the study was to compare the diagnostic yield and the costs of implantable loop recorder (ILR) with those of the conventional strategy in patients with unexplained palpitations. BACKGROUND In patients with unexplained palpitations, especially in those with infrequent symptoms, the conventional strategy, including short-term ambulatory electrocardiogram (ECG) monitoring and electrophysiological study, sometimes fails to establish a diagnosis. METHODS We studied 50 patients with infrequent (< or =1 episode/month), sustained (>1 min) palpitations. Before enrollment, patients had a negative initial evaluation, including history, physical examination, and ECG. Patients were randomized either to conventional strategy (24-h Holter recording, a 4-week period of ambulatory ECG monitoring with an external recorder, and electrophysiological study) (n = 24) or to ILR implantation with 1-year monitoring (n = 26). Hospital costs of the 2 strategies were calculated. RESULTS A diagnosis was obtained in 5 patients in the conventional strategy group, and in 19 subjects in the ILR group (21% vs. 73%, p < 0.001). Despite the higher initial cost, the cost per diagnosis in the ILR group was lower than in the conventional strategy group (euro 3,056 +/- euro 363 vs. euro 6,768 +/- euro 6,672, p = 0.012). CONCLUSIONS In subjects without severe heart disease and with infrequent palpitations, ILR is a safe and more cost-effective diagnostic approach than conventional strategy.
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Affiliation(s)
- Franco Giada
- Cardiovascular Department, Ospedale Umberto I, Mestre-Venice, Venice, Italy
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Abstract
Knowledge about cardiac arrhythmias has significantly improved in the last 20 years, and the improvements in diagnosis and in therapy have also had important effects on the management of pediatric arrhythmias. In this paper, the most important developments in the field of management of pediatric arrhythmias (fetal arrhythmias, genetics, pharmacological strategies, radiofrequency ablation, new technologies) as well as the remaining problems (risk stratification of some arrhythmic forms as for example Wolff-Parkinson-White and ventricular arrhythmias) will be discussed.
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Affiliation(s)
- Gabriele Vignati
- Pediatric Cardiology, Niguarda Hospital, Piazza Ospedale Maggiore, Milan, Italy.
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Vukajlović D, Nesković AN. [Learning curve in performing radiofrequency ablation of accessory pathways in patients with Wolf-Parkinson-White syndrome]. MEDICINSKI PREGLED 2007; 59:468-71. [PMID: 17345824 DOI: 10.2298/mpns0610468v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study examines the effect of operator experience on radiofrequency ablation (RFA) of accessory pathways success rate in patients with Wolff-Parkinson-White (WPW) syndrome. MATERIAL AND METHODS The first 100 consecutive patients with WPW syndrome treated by radiofrequency ablation at our Clinic, were divided into group A (first 50 patients) and group B (the following 50 patients). Various parameters were compared between these 2 groups. RESULTS The success rate in group A was 69% and in group B 92%, p < 0.01. There were 6 patients with recurrent WPW syndrome, after 3 months of follow-up, 5 were from group A and 1 from group B, p < 0.05. Significantly more applications of radiofrequency energy were delivered in group A (10.0 +/- 4.8 in group A and 6.2 +/- 3.1 in group B, p < 0.05). Two patients from group A presented with complications: one had intermittent complete AV-block, and the other pericardial effusion. CONCLUSION This study shows a clear learning curve in performing RFA of accessory pathways in patients with WPW syndrome.
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Iravanian S, Arshad A, Steinberg JS. Role of Electrophysiologic Studies, Signal‐Averaged Electrocardiography, Heart Rate Variability, T‐Wave Alternans, and Loop Recorders for Risk Stratification of Ventricular Arrhythmias. ACTA ACUST UNITED AC 2007; 14:16-9. [PMID: 15654148 DOI: 10.1111/j.1076-7460.2005.03354.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ventricular tachycardia and fibrillation are major causes of morbidity and mortality after myocardial infarction. Frequently, sudden cardiac death is the first manifestation of such malignant rhythms. Optimal risk stratification strategies in this population are of utmost importance. In this review the authors discuss the background and clinical use of invasive tests, such as electrophysiologic study and implantable loop recorders, and noninvasive tests, such as signal-averaged electrocardiography, heart rate variability, and T-wave alternans. The utility, indications, and limitations of each test in clinical practice are discussed, especially for the purpose of postmyocardial infarction risk stratification in the elderly population.
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Affiliation(s)
- Shahriar Iravanian
- Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA
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Kennebäck G, Tabrizi F, Lindell P, Nordlander R. High-degree atrioventricular block during anti-arrhythmic drug treatment: use of a pacemaker with a bradycardia-detection algorithm to study the time course after drug withdrawal. ACTA ACUST UNITED AC 2007; 9:186-91. [PMID: 17255148 DOI: 10.1093/europace/eul185] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM This study examines the recurrence of high-degree atrioventricular block (AVB) during a follow-up period of 2 years in patients with restored AV node function after antiarrhythmic drug withdrawal at implantation of a pacemaker. METHODS Nine men and eight women (77 +/- 7 years) taking antiarrhythmic drugs (beta-receptor blockers in 15) and presenting with high-degree AVB were followed for 2 years after being taken off drugs upon receiving a permanent pacemaker with special bradycardia detection software. RESULTS At inclusion, surface ECG identified two subsets of patients: a QRS duration < 120 ms (n = 5) and those with a QRS duration > or =120 ms (n = 12). During the 2-year follow-up, progression to high-degree AVB occurred in these groups: 1/5 (20%) and 9/12 (75%) P < 0.05. Six patients had to be restarted on drugs, mostly beta-receptor blockers, due to atrial tachyarrhythmias: 3/5 and 3/12. In total, 16 patients (94%) either developed high-degree AVB needing pacing or atrial tachyarrhythmias requiring drug treatment. CONCLUSION Patients on beta-receptor blocking drugs and QRS width > or =120 ms developing high-degree AVB should be recommended a pacemaker without further investigation or observation.
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Affiliation(s)
- Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, Huddinge 14186 Stockholm, Sweden.
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