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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024:S1547-5271(24)02560-8. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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Lacoste JL, Szymanski TW, Avalon JC, Kabulski G, Kohli U, Marrouche N, Singla A, Balla S, Jahangir A. Atrial Fibrillation Management: A Comprehensive Review with a Focus on Pharmacotherapy, Rate, and Rhythm Control Strategies. Am J Cardiovasc Drugs 2022; 22:475-496. [PMID: 35353353 DOI: 10.1007/s40256-022-00529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) is an increasingly common arrhythmia encountered in clinical practice that leads to a substantial increase in utilization of healthcare services and a decrease in the quality of life of patients. The prevalence of AF will continue to increase as the population ages and develops cardiac comorbidities; thus, prompt and effective treatment is important to help mitigate systemic resource utilization. Treatment of AF involves two tenets: prevention of stroke and systemic embolism and symptom control with either a rate or a rhythm control strategy. Historically, due to the safe nature of medications like beta-blockers and non-dihydropyridine calcium channel blockers, used in rate control, it has been the initial strategy used for symptom control in AF. Newer data suggest that a rhythm control strategy with antiarrhythmic medications with or without catheter ablation may lead to a reduction in major adverse cardiovascular events, particularly in patients newly diagnosed with AF. Modulation of factors that promote AF or its complications is another important aspect of the overall holistic management of AF. This review provides a comprehensive focus on the management of patients with AF and an in-depth review of pharmacotherapy of AF in the rate and rhythm control strategies.
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Affiliation(s)
- Jordan L Lacoste
- Department of Pharmacy, WVU Medicine, 1 Medical Center Drive, Morgantown, WV, 26505, USA.
| | - Thomas W Szymanski
- Department of Pharmacy, WVU Medicine, 1 Medical Center Drive, Morgantown, WV, 26505, USA
| | - Juan Carlo Avalon
- Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Galen Kabulski
- Department of Pharmacy, WVU Medicine, 1 Medical Center Drive, Morgantown, WV, 26505, USA
| | - Utkarsh Kohli
- Department of Pediatrics, WVU School of Medicine, Morgantown, WV, USA
| | - Nassir Marrouche
- Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Atul Singla
- Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sudarshan Balla
- Department of Cardiovascular and Thoracic Surgery, WVU School of Medicine, Morgantown, WV, USA
| | - Arshad Jahangir
- Center for Advanced Atrial Fibrillation Therapies at Aurora St. Luke's Medical Center, Milwaukee, WI, 53215, USA
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Liu JS, Fan EH. Toxic Effects of Flecainide in a Patient With Kidney Failure and Tachyarrhythmia. JAMA Intern Med 2021; 181:1516-1518. [PMID: 34515729 DOI: 10.1001/jamainternmed.2021.5030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jerry S Liu
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Eugene H Fan
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5009] [Impact Index Per Article: 1669.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Zorzi A, Cipriani A, Corrado D. Anti-arrhythmic therapy in athletes. Pharmacol Res 2019; 144:306-314. [PMID: 31028906 DOI: 10.1016/j.phrs.2019.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Abstract
The spectrum of arrhythmias that may be encountered in athletes ranges from isolated ectopic beats to ventricular tachycardia, usually in the context of a structurally normal heart. Anti-arrhythmic therapy in these individuals may be particularly challenging because of the young age, the hypervagotonic state, the desire to maintain a high physical performance, the reluctance to take medications and the need to avoid molecules included in the list of prohibited drugs of the World Anti-Doping Agency. Furthermore, the possible serious adverse effects of anti-arrhythmic drugs should be balanced against the benign nature of arrhythmias in patients with no underlying heart disease. The review summarizes the most common arrhythmias of athletes and the possible therapeutic options, including anti-arrhythmic drugs and non-pharmacological interventions. Eligibility criteria according to current guidelines are also addressed.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Italy.
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Italy
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Burkhart R, Gerasimon G. Atrial Flutter With Exercise-Induced 1:1 Atrioventricular Conduction. J Osteopath Med 2018; 118:337-340. [DOI: 10.7556/jaoa.2018.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Typical atrial flutter is a common atrial tachyarrhythmia. Symptoms are typically related to the rate of ventricular response. Although atrial flutter with 1:1 atrioventricular conduction is rare, it is important to recognize because it may precipitate rapid hemodynamic compromise. The authors present a case of exercise-induced 1:1 atrioventricular conduction in a patient with typical atrial flutter.
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Gao X, Guha A, Buck B, Patel D, Snider MJ, Boyd M, Afzal M, Badin A, Godara H, Liu Z, Tyler J, Weiss R, Kalbfleisch S, Hummel J, Augostini R, Houmsse M, Daoud EG. Initiation and outcomes with Class Ic antiarrhythmic drug therapy. Indian Pacing Electrophysiol J 2017; 18:68-72. [PMID: 29225010 PMCID: PMC5998214 DOI: 10.1016/j.ipej.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/17/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Expert opinion recommends performing exercise testing with initiation of Class Ic antiarrhythmic medication. OBJECTIVE To evaluate the rate and reason for discontinuation of Ic agent within the first year of follow up, with particular attention to rate of proarrhythmia and the value of routine treadmill testing. METHODS This is a single center retrospective cohort study including consecutive patients with atrial arrhythmias who were initiated on a Class Ic agent from 2011 to 2016. Data was collated from chart review and pharmacy database. RESULTS The study population included 300 patients (55% male, mean age 61; mean ejection fraction, 56%) started on flecainide (n = 153; 51%) and propafenone (n = 147; 49%). Drug initiation was completed while hospitalized on telemetry and the staff electrophysiologists directed dosing. There was one proarrhythmic event during initiation (0.3%). The primary reason for not being discharged on Ic agent was due to detection of proarrhythmia (n = 15) or ischemia (n = 1) with treadmill testing (5.3%). Exercise testing was the single significant variable to affect the decision to discontinue Ic drug, p < 0.0001 (95% CI: 1.89-6.08%). During follow up, the primary reason for discontinuation of Ic agent was lack of efficacy, 32%. CONCLUSIONS With proper screening, initiation of Class Ic agent is associated with very low rate of proarrhythmia. Treadmill testing is of incremental value and should be completed in all patients after loading Class Ic antiarrhythmic.
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Affiliation(s)
- Xu Gao
- Ohio State University Wexner Medical Center, Department of Internal Medicine, USA
| | - Avirup Guha
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Benjamin Buck
- Ohio State University Wexner Medical Center, Department of Internal Medicine, USA
| | - Dilesh Patel
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Melissa J Snider
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Michael Boyd
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Muhammad Afzal
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Auroa Badin
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Hemant Godara
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Zhenguo Liu
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Jaret Tyler
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Raul Weiss
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Steven Kalbfleisch
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - John Hummel
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Ralph Augostini
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Mahmoud Houmsse
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA
| | - Emile G Daoud
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, USA.
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Chouchoulis K, Chiladakis J, Koutsogiannis N, Davlouros P, Kaza M, Alexopoulos D. Impact of QT interval prolongation following antiarrhythmic drug therapy on left ventricular function. Future Cardiol 2016; 13:13-22. [PMID: 27990843 DOI: 10.2217/fca-2016-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We assessed whether antiarrhythmic drug-induced QT interval prolongation affects left ventricular function. METHODS Study population included 54 patients with symptomatic recent onset atrial fibrillation spontaneously cardioverted to sinus rhythm. Electrocardiographic and echocardiographic studies were done before initiating and after achieving drug's steady state. RESULTS Significantly prolonged corrected QT interval (QTc) was noticed following only sotalol and amiodarone. The corrected precontraction time increased after sotalol (p = 0.005) and amiodarone (p = 0.017), not propafenone (p = 0.139). Analysis results between ΔEF and ΔQTc, ΔEF and ΔQTc(p), ΔE/e' and ΔQTc, ΔE/e' and ΔQTc(p) for amiodarone group were (p = 0.66, p = 0.20, p = 0.66, p = 0.33), for sotalol (p = 0.36, p = 0.51, p = 0.44, p = 0.33) and for propafenone (p = 0.38, p = 0.12, p = 0.89, p = 0.61), respectively. CONCLUSION QT interval prolongation following antiarrhythmic therapy does not affect significantly left ventricular function.
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Affiliation(s)
| | - John Chiladakis
- Cardiology Department, University Hospital of Patras, Rion, Patras, Greece
| | | | - Periklis Davlouros
- Cardiology Department, University Hospital of Patras, Rion, Patras, Greece
| | - Maria Kaza
- School of Medicine, University of Patras, Rion, Patras, Greece
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