Atrial fibrillation and preexcitation - A licence to kill

Strategies for rate and rhythm control of atrial fibrillation in the ED

ABSTRACT

Atrial fibrillation (AF) is one of the most common dysrhythmias managed in the ED and accounts for more than half a million visits a year in the United States. More than 6 out of 10 of these visits result in admissions. As the prevalence of AF has continued to increase in recent years, so has the presentation of patients with AF to the ED. For these reasons, clinicians in emergency settings must be knowledgeable of evidence-based rate and rhythm control strategies for stabilizing patients and preventing complications. This article discusses options, indications, contraindications, and safe implementation of rate and rhythm control strategies for ED clinicians. Recent studies have suggested that early rhythm control may benefit newly diagnosed patients, reducing stroke risk, cardiovascular deaths, and disease progression.

Pre-excited atrial fibrillation revealed at a very delayed age: case report

BACKGROUND

Wolff-Parkinson-White (WPW) syndrome is a condition characterized by the persistence of an accessory pathway responsible for ventricular pre-excitation that can lead to symptomatic and potentially severe arrhythmias. Coexistence with atrial fibrillation is well known and not uncommon, exposing to potential degenerescence into ventricular fibrillation when atrial impulses are transmitted along the accessory pathway. WPW syndrome is most prevalent in younger patients and cases revealed after an advanced age have rarely been described in the literature.

CASE PRESENTATION

Here, we report a case of atrial pre-excitation first diagnosed at the age of 72 years that required external electrical cardioversion with a favorable outcome. The diagnosis was based on clinical and electrographic findings.

CONCLUSIONS

WPW syndrome is a relatively rare cardiac disorder that can be a cause of sudden death, especially when combined with atrial fibrillation. Therefore, cardiologists have to consider this diagnosis in patients presenting clinical signs of arrhythmia with an electrical pattern of WPW.

How Should We Approach Syncope in the Emergency Department? Current Perspectives

Syncope is a clinical picture that can affect all age groups and has an important place in admissions to the emergency department. There is an important diagnostic challenge in cases where there are different clinical presentations and patients cannot express the situation clearly. Although the emergency department facilities for the diagnosis of syncope are limited, the diagnosis of many patients can be differentiated from life-threatening conditions with a detailed history and physical examination. High-risk patients should be identified and directed for definitive treatment by emergency medicine physicians. This review contains information about the management of the syncope patient in the emergency department.

Electrophysiological and therapeutic effects of amiodarone in patients with preexcited atrial fibrillation

Background:

Atrial fibrillation (AF) with fast ventricular response over an overt accessory pathway (AP) (preexcited AF) with a short anterograde refractory period is a potentially malignant arrhythmia. This study aimed to evaluate the safety and efficacy of amiodarone for preexcited AF management.

Materials and Methods:

This study enrolled 103 patients with evidence of AP in electrocardiography. Patients with preexcited AF were included in the study. Intravenous amiodarone (300 mg) was infused for 30 min for all patients in the AF rhythm. Electrophysiological parameters were evaluated before amiodarone injection and 2 h after pharmacological or electrical cardioversion.

Results:

Antegrade and retrograde refractory periods of the atrioventricular node (AVN) and AP, as well as antegrade and retrograde Wenckebach points of AVN, were increased significantly after amiodarone infusion. Furthermore, the mean of the shortest preexcited RR interval was increased during the monitoring period. Comparing the preexcited index at the beginning of the study and before cardioversion (2 h later) revealed that the QRS complexes changed to a wider pattern as the preexcitation index changed from 80.61 to 92.26 (P < 0.001). Nineteen (18.4%) patients converted to the sinus rhythm with amiodarone infusion. No ventricular arrhythmia was detected during monitoring.

Conclusion:

Amiodarone could be considered a safe drug in patients with preexcited AF for rate control despite its relatively low efficacy in conversion to the sinus rhythm.