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Paludan-Müller C, Stampe NK, Monfort LM, Andreasen L, Vad OB, Ahlberg G, Johansen JB, Winkel BG, Torp-Pedersen C, Køber L, Fosbøl EL, Svendsen JH, Olesen MS. Presence of Atrioventricular Nodal Reentrant Tachycardia Is Associated With Cardiomyopathy, Heart Failure, and Death. J Am Heart Assoc 2024; 13:e034439. [PMID: 38686897 PMCID: PMC11179896 DOI: 10.1161/jaha.123.034439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Christian Paludan-Müller
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
| | - Niels K Stampe
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
| | - Laia M Monfort
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Laura Andreasen
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
| | - Oliver B Vad
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Gustav Ahlberg
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Jens B Johansen
- The Danish Pacemaker and ICD Registry Odense University Hospital Odense Denmark
| | - Bo G Winkel
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Copenhagen University Hospital - North Zealand Hospital Hillerød Denmark
- Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Jesper H Svendsen
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Morten S Olesen
- Department of Cardiology, The Heart Center Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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2
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Peng G, Zei PC. Diagnosis and Management of Paroxysmal Supraventricular Tachycardia. JAMA 2024; 331:601-610. [PMID: 38497695 DOI: 10.1001/jama.2024.0076] [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] [Indexed: 03/19/2024]
Abstract
Importance Paroxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy. Observations Approximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options. Conclusion and Relevance Paroxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.
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Affiliation(s)
- Gary Peng
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C Zei
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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3
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Blacker SN, Kang M, Chakraborty I, Chowdhury T, Williams J, Lewis C, Zimmer M, Wilson B, Lele AV. Utilizing Artificial Intelligence and Chat Generative Pretrained Transformer to Answer Questions About Clinical Scenarios in Neuroanesthesiology. J Neurosurg Anesthesiol 2023:00008506-990000000-00090. [PMID: 38124357 DOI: 10.1097/ana.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE We tested the ability of chat generative pretrained transformer (ChatGPT), an artificial intelligence chatbot, to answer questions relevant to scenarios covered in 3 clinical guidelines, published by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), which has published management guidelines: endovascular treatment of stroke, perioperative stroke (Stroke), and care of patients undergoing complex spine surgery (Spine). METHODS Four neuroanesthesiologists independently assessed whether ChatGPT could apply 52 high-quality recommendations (HQRs) included in the 3 SNACC guidelines. HQRs were deemed present in the ChatGPT responses if noted by at least 3 of the 4 reviewers. Reviewers also identified incorrect references, potentially harmful recommendations, and whether ChatGPT cited the SNACC guidelines. RESULTS The overall reviewer agreement for the presence of HQRs in the ChatGPT answers ranged from 0% to 100%. Only 4 of 52 (8%) HQRs were deemed present by at least 3 of the 4 reviewers after 5 generic questions, and 23 (44%) HQRs were deemed present after at least 1 additional targeted question. Potentially harmful recommendations were identified for each of the 3 clinical scenarios and ChatGPT failed to cite the SNACC guidelines. CONCLUSIONS The ChatGPT answers were open to human interpretation regarding whether the responses included the HQRs. Though targeted questions resulted in the inclusion of more HQRs than generic questions, fewer than 50% of HQRs were noted even after targeted questions. This suggests that ChatGPT should not currently be considered a reliable source of information for clinical decision-making. Future iterations of ChatGPT may refine algorithms to improve its reliability as a source of clinical information.
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Affiliation(s)
- Samuel N Blacker
- Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Mia Kang
- Department of Anesthesiology, University of North Carolina at Chapel Hill
| | | | | | - James Williams
- Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Carol Lewis
- Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Michael Zimmer
- Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Brad Wilson
- Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Abhijit V Lele
- Department of Anesthesiology, University of Washington, Seattle, WA
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4
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Omodara AB, Areo O, Kintu J, Thornton M. Sudden Onset of Broad Complex Tachycardia in a Fit Young Man: A Case Report. Cureus 2023; 15:e50425. [PMID: 38222204 PMCID: PMC10784759 DOI: 10.7759/cureus.50425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Wolff-Parkinson-White (WPW) syndrome is a clinical pre-excitation syndrome often strongly associated with tachyarrhythmias that are predominantly atrioventricular re-entrant tachycardia (AVRT). It is generally considered to be a relatively benign arrhythmogenic condition associated with a slightly higher risk of sudden cardiac death (SCD) in comparison to the general population. Epidemiological data suggests that 0.1%-0.3% of the general population have electrocardiographic (ECG) findings suggesting that during sinus rhythm, in addition to atrioventricular (AV) conduction over the AV node-His bundle pathway, there is an additional atrioventricular conduction across an accessory pathway. Whilst in most cases, such phenomenon is associated with WPW syndrome, other similar conditions, including Lown-Ganong-Levine (LGL) syndrome and Mahaim-type pre-excitation, have also been documented. Our patient is a young man in his late twenties admitted with broad complex tachycardia at 252 beats per minute associated with diaphoresis and pre-syncope. In our case report, we describe how we managed this emergency, eventually unveiling the underlying aetiology as well as a stepwise approach to dealing with adult broad-complex tachycardia.
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Affiliation(s)
- Ayobami B Omodara
- General Internal Medicine, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Olusegun Areo
- Cardiology, Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, GBR
| | | | - Mia Thornton
- General Internal Medicine, Manchester University NHS Foundation Trust, Manchester, GBR
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5
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Hernández-Romero I, Molero R, Fambuena-Santos C, Herrero-Martín C, Climent AM, Guillem MS. Electrocardiographic imaging in the atria. Med Biol Eng Comput 2023; 61:879-896. [PMID: 36370321 PMCID: PMC9988819 DOI: 10.1007/s11517-022-02709-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
The inverse problem of electrocardiography or electrocardiographic imaging (ECGI) is a technique for reconstructing electrical information about cardiac surfaces from noninvasive or non-contact recordings. ECGI has been used to characterize atrial and ventricular arrhythmias. Although it is a technology with years of progress, its development to characterize atrial arrhythmias is challenging. Complications can arise when trying to describe the atrial mechanisms that lead to abnormal propagation patterns, premature or tachycardic beats, and reentrant arrhythmias. This review addresses the various ECGI methodologies, regularization methods, and post-processing techniques used in the atria, as well as the context in which they are used. The current advantages and limitations of ECGI in the fields of research and clinical diagnosis of atrial arrhythmias are outlined. In addition, areas where ECGI efforts should be concentrated to address the associated unsatisfied needs from the atrial perspective are discussed.
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Affiliation(s)
| | - Rubén Molero
- ITACA, Universitat Politècnica de València, Valencia, Spain
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6
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COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review. Cureus 2023; 15:e36955. [PMID: 37009342 PMCID: PMC10065129 DOI: 10.7759/cureus.36955] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
POTS (Postural Orthostatic Tachycardia Syndrome) is a multisystem disorder characterized by the abnormal autonomic response to an upright posture, causing orthostatic intolerance and excessive tachycardia without hypotension. Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Prominent symptoms of POTS include fatigue, orthostatic intolerance, tachycardia, and cognitive impairment. The exact mechanisms of post-COVID-19 POTS are unclear. Still, different hypotheses have been given, including autoantibody production against autonomic nerve fibers, direct toxic effects of SARS-CoV-2, or sympathetic nervous system stimulation secondary to infection. Physicians should have a high suspicion of POTS in COVID-19 survival when presented with symptoms of autonomic dysfunction and should conduct diagnostic tests like the Tilt table and others to confirm it. The management of COVID-19-related POTS requires a comprehensive approach. Most patients respond to initial non-pharmacological options, but when the symptoms become more severe and they do not respond to the non-pharmacological approach, pharmacological options are considered. We have limited understanding and knowledge of post-COVID-19 POTS, and further research is warranted to improve our understanding and formulate a better management plan.
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7
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Wołowiec Ł, Grześk G, Osiak J, Wijata A, Mędlewska M, Gaborek P, Banach J, Wołowiec A, Głowacka M. Beta-blockers in cardiac arrhythmias-Clinical pharmacologist's point of view. Front Pharmacol 2023; 13:1043714. [PMID: 36699057 PMCID: PMC9868422 DOI: 10.3389/fphar.2022.1043714] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
β-blockers is a vast group of antiarrhythmic drugs which differ in their pharmacokinetic and chemical properties. Some of them block β-adrenergic receptors selectively while the others work non-selectively. Consequently, they reduce the influence of the sympathetic nervous system on the heart, acting negatively inotropic, chronotropic, bathmotropic and dromotropic. Although they have been present in medicine since the beginning of the 1960s, they still play a crucial role in the treatment of cardiac arrhythmias. They are also first-line group of drugs used to control the ventricular rate in patients with the most common arrhythmia-atrial fibrillation. Previous reports indicate that infection with SARS-CoV-2 virus may constitute an additional risk factor for arrhythmia. Due to the aging of the population in developed countries and the increase in the number of patients with cardiac burden, the number of people suffering from cardiac arrhythmias will increase in the upcoming years. As a result the role of above-mentioned beta-blockers will remain significant. Particularly noteworthy is propranolol-the oldest beta adrenergic antagonist, which in recent years has found additional applications due to its unique properties. In this article, we reviewed the accessible literature and summarized the current guidelines on the use of beta-blockers in the treatment of cardiac arrhythmias.
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Affiliation(s)
- Łukasz Wołowiec
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland,*Correspondence: Łukasz Wołowiec,
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Joanna Osiak
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Aleksandra Wijata
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Martyna Mędlewska
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Patryk Gaborek
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Joanna Banach
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Anna Wołowiec
- Department of Geriatrics, Division of Biochemistry and Biogerontology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
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8
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Lapalme C, Kaw S, Drennan I, Cheskes S. Non-Sustained Polymorphic Ventricular Tachycardia Induced by Modified Valsalva in a Pregnant Patient with Supraventricular Tachycardia. PREHOSP EMERG CARE 2023; 27:54-58. [PMID: 34709116 DOI: 10.1080/10903127.2021.1999543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The modified Valsalva maneuver has been promoted as a safe and effective method for the treatment of supraventricular tachycardia. Serious adverse events associated with the modified Valsalva maneuver are not well documented. Here we report a case of non-sustained polymorphic ventricular tachycardia in a pregnant patient associated with the use of the modified Valsalva maneuver by paramedics in the prehospital setting.
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Affiliation(s)
- Corey Lapalme
- Paramedic Operations, Peel Regional Paramedic Services, Brampton, Ontario, Canada.,Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sean Kaw
- Paramedic Operations, Peel Regional Paramedic Services, Brampton, Ontario, Canada
| | - Ian Drennan
- Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheldon Cheskes
- Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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9
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Velayutham R, Parale C, Bootla D. A Patient With Palpitations-Exceptions Prove the Rule. JAMA Intern Med 2022; 182:1210-1211. [PMID: 36121678 DOI: 10.1001/jamainternmed.2022.3813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This case report describes a patient with sudden-onset, intermittent episodes of palpitations for the past year and no associated syncopal episodes or giddiness.
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Affiliation(s)
- Ramanathan Velayutham
- Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER Campus Road, Dhanvantari Nagar, Puducherry, India
| | - Chinmay Parale
- Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER Campus Road, Dhanvantari Nagar, Puducherry, India
| | - Dinakar Bootla
- Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER Campus Road, Dhanvantari Nagar, Puducherry, India
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10
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Doshchitsin VL, Tarzimanova AI. Historical Aspects of the Use of Antiarrhythmic Drugs in Clinical Practice. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-06-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heart rhythm disorders are one of the most urgent problems in cardiology. The first reports on the possibility of using drugs in the treatment of cardiac arrhythmias began to appear in the scientific literature from the middle of the 18th century. This pharmacotherapeutic direction has been developed since the second half of the 20th century, when new antiarrhythmic drugs began to be used in clinical practice. The introduction of new drugs and modern methods of treating arrhythmias into clinical practice has significantly improved the prognosis and quality of life of patients. Combination antiarrhythmic therapy, including antiarrhythmic drugs and radiofrequency ablation, seems to be the most promising and successful tactic for treating patients in the future. A historical review of the literature on the clinical use of antiarrhythmic drugs both in past years and at present is presented in the article.
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Affiliation(s)
| | - A. I. Tarzimanova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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11
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He B, Li Y, Huang W, Yu W, Zhao F, Wu X, Yao S, Po SS, Lu Z. Mapping and Ablation of Isolated Frequent Symptomatic Premature Atrial Contractions in Patients With Structurally Normal Heart. Front Cardiovasc Med 2022; 9:862659. [PMID: 35497996 PMCID: PMC9041661 DOI: 10.3389/fcvm.2022.862659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background The present study investigated the safety and efficacy of mapping and ablating isolated premature atrial contractions (PACs) in patients with a structurally normal heart, as well as whether the elimination of PACs by radiofrequency catheter ablation (RFCA) improved symptoms and the quality of life. Methods Forty-three consecutive patients with frequent, symptomatic, and drug-refractory PACs, but without atrial tachyarrhythmias (≥5 beats), were enrolled. In all patients, we performed physical, laboratory, and imaging examinations to exclude structural heart disease. The quality of life questionnaire SF-36 before and 3 months after RFCA was performed in each patient. Results Twenty-three men and 20 women with an average age of 52.6 ± 17.6 years were finally enrolled. The mean number of PACs was 21,685 ± 9,596 per 24 h, and the mean PACs' burden was 28.9 ± 13.7%. Short runs of tachycardia (<5 atrial beats) were observed in 32 patients (74.4%). All patients underwent successful RFCA without complications. The activation time at the successful ablation sites preceded the onset of the P-wave by 36 ± 7.6 ms. During 15 ± 8 months of follow-up, the recurrence of PACs was observed in 2 patients. The 24-h PAC burden was significantly reduced 3 months after RFCA (mean 0.5%, p < 0.05). The quality of life scores were significantly increased 3 months after RFCA (all p < 0.05). Conclusions RFCA was feasible, safe, and effective to eliminate isolated frequent, symptomatic, and drug-refractory PACs in patients with a structurally normal heart. The elimination of PACs by RFCA significantly improved symptoms and the quality of life.
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Affiliation(s)
- Bo He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Yi Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Weiping Huang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Wenxi Yu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Fang Zhao
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Xiaoyan Wu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Shuyuan Yao
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Sunny S. Po
- Heart Rhythm Institute, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
- *Correspondence: Zhibing Lu
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12
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Wan-Tong Z, Bao-Chen Z, Zhao L, Xu-Jie W, Rui G, Ning X, Wei T, Yu-Fei W, Miles P, Wei-Liang W, Hao-Xiang L, Qiu-Yan L. Compassionate Use of Yuanjiang Decoction, a Traditional Chinese Medicinal Prescription, for Symptomatic Bradyarrhythmia. Front Pharmacol 2022; 13:764930. [PMID: 35479315 PMCID: PMC9035522 DOI: 10.3389/fphar.2022.764930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: No effective medication is available for symptomatic bradyarrhythmia, particularly in low socioeconomic status (SES) population. Objective: To explore the safety and efficacy of Yuanjiang decoction, a traditional Chinese medicinal prescription, for symptomatic bradyarrhythmia on a compassionate-use basis. Methods: This compassionate-use study was conducted in Beijing, China between January 2019 and January 2020. Eligible participants were recruited and treated with Yuanjiang decoction (composed of 6 Chinese herbal medicines), 200 ml twice daily for 16 weeks. Analyses were done with the intention-to-treat (ITT) approach. The primary outcome measure was the proportion of participants who achieved a favorable treatment outcome at 16 weeks. Results: As of January 2020, 184 patients were included. After 16-weeks treatment, 12 participants were lost to contact while 21 participants were terminated from this study, with a drop-out rate of 17.93%. The most common treatment-related adverse events were xerostomia (6.52%), constipation (6.45%) and sleepiness (3.26%). The proportion of participants with favorable treatment outcome was 65.22% at 4 weeks, 59.78% at 8 weeks (OR: 1.11, 95% CI: 0.71–1.73), 61.41% at 12 weeks (OR: 1.16, 95% CI: 0.92–1.45) and 60.87% at 16 weeks (OR: 1.15, 95% CI: 0.98–1.35). In the multifactor regression analysis, the favorable treatment outcome at 16 weeks was significantly associated with completing at least 8 weeks treatment (OR: 2.053, 95% CI: 1.064–3.560), while unfavorable treatment outcome was significantly associated with an atrioventricular block (OR: 0.255, 95% CI: 0.083–0.784), current smoking (OR: 0.343, 95% CI: 0.027–0.487), and syncope in the month before treatment (OR: 0.321, 95%CI: 0.114–0.904). Conclusion: This compassionate-use study showed encouraging outcomes of treatment with Yuanjiang decoction, without serious adverse events. This study identified several key factors that may affect outcomes. These findings helped inform the design and assess the feasibility of a large-scale randomized clinical trial.
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Affiliation(s)
- Zhang Wan-Tong
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
| | - Zhu Bao-Chen
- Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Liu Zhao
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China
| | - Wang Xu-Jie
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
| | - Gao Rui
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
| | - Xiao Ning
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Tang Wei
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
| | - Wu Yu-Fei
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
| | - Phoebe Miles
- Faculty of Humanities and Social Sciences, University of Nottingham, Ningbo, China
| | - Weng Wei-Liang
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
- *Correspondence: Weng Wei-Liang, ; Li Qiu-Yan,
| | - Lin Hao-Xiang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Li Qiu-Yan
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
- Stroke Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Weng Wei-Liang, ; Li Qiu-Yan,
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13
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Khan MT, Hameed A, Saeed Y. Interesting presentation of a broad complex tachycardia during the head up tilt table test. BMJ Case Rep 2021; 14:e245083. [PMID: 34607816 PMCID: PMC8491290 DOI: 10.1136/bcr-2021-245083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/04/2022] Open
Abstract
Broad complex tachycardia (BCT) during head up tilt test (HUTT) is infrequent. Electrophysiology Study (EPS) plays an important part in further differentiation of BCT. We present a case of BCT during HUTT in a patient presenting with presyncope which later on EPS with 3D mapping was diagnosed as ventricular tachycardia. This case highlights the unusual occurrence of BCT during HUTT, the differential diagnosis of BCT and the utility of EPS to reliably identify the type and origin of BCT.
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Affiliation(s)
- Muhammad Taha Khan
- Cardiac Electrophysiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Aamir Hameed
- Medicine, Section of Cardiology, Agha Khan University Hospital, Karachi, Sindh, Pakistan
| | - Yawer Saeed
- Medicine, Section of Cardiology, Agha Khan University Hospital, Karachi, Sindh, Pakistan
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14
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Phillips D, O’Callaghan P, Zaidi A. Arrhythmia in an athlete diagnosed by smartphone electrocardiogram: a case report. Eur Heart J Case Rep 2021; 5:ytab186. [PMID: 34056525 PMCID: PMC8142154 DOI: 10.1093/ehjcr/ytab186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/13/2020] [Accepted: 04/16/2021] [Indexed: 11/14/2022]
Abstract
Background This is the first case report demonstrating the use of a smartphone device, enabling the diagnosis of an arrhythmia in the sports cardiology literature. Case summary A 17-year-old semi-professional rugby player presented with recurrent episodes of palpitations terminated by vagal manoeuvres. The rugby player’s resting 12-lead electrocardiogram (ECG), echocardiogram, and exercise stress test were normal. Due to his suggestive history and an ECG trace from a smartphone device, demonstrating a narrow complex tachycardia, an electrophysiological study was arranged. The study demonstrated a slow-fast atrioventricular nodal re-entrant tachycardia which was successfully ablated. Discussion The ambulatory use of a smartphone ECG device assisted in the timely diagnosis and management of an undiagnosed paroxysmal arrhythmia in a rugby player. This resulted in an expedited return to play.
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Affiliation(s)
- Daniel Phillips
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | - Peter O’Callaghan
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | - Abbas Zaidi
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
- Corresponding author. Tel: +442920744988,
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15
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Relationship of Catheter Contact Angle and Contact Force with Contact Area on the Surface of Heart Muscle Tissue in Cardiac Catheter Ablation. Cardiovasc Eng Technol 2021; 12:407-417. [PMID: 33723738 PMCID: PMC8354874 DOI: 10.1007/s13239-021-00529-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
Purpose The aims of this study were to develop an experimental procedure for setting the catheter angle with respect to the surface of the heart muscle and the catheter contact force and to investigate the catheter contact area on the heart muscle as a function of catheter contact angle and force. Methods Visualization tests were performed for 5 contact angles (0°, 30°, 45°, 60°, and 90°) and 8 contact forces (2, 4, 6, 10, 15, 20, 30, and 40 gf). Each experiment was repeated 6 times with 2 different commercially available catheter tips. Results The morphology of the contact area was classified into rectangular, circular, ellipsoidal, and semi-ellipsoidal. The correlation between contact force and contact area was a logarithmic function; increasing contact force was associated with increased contact area. At the same contact force, the correlation between contact angle and contact area was inverse; decreasing contact angle was associated with a corresponding increase in contact area. Conclusion Both the catheter contact angle and contact force substantially impact the contact area and morphology in catheter ablation procedures.
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16
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Nesheiwat Z, Towheed A, Eid J, Tomcho J, Shastri P, Oostra C, Karabin B, Grubb B. Supraventricular Tachycardia and Postural Orthostatic Tachycardia Syndrome Overlap: A Retrospective Study. J Innov Card Rhythm Manag 2021; 12:4385-4389. [PMID: 33654569 PMCID: PMC7906564 DOI: 10.19102/icrm.2021.120201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022] Open
Abstract
Postural orthostatic tachycardia syndrome (POTS) and supraventricular tachycardia (SVT) are disease states with distinctive features but overlapping clinical manifestations. Currently, studies on the presence of underlying SVT in patients with POTS are lacking. This retrospective study analyzed 64 patients [mean age: 43 years; 41 (61%) women] who had a POTS diagnosis and were found to have concomitant SVT during rhythm monitoring from September 1, 2013 to September 30, 2019 at our Syncope and Autonomic Disorders Clinic. The outcomes assessed were changes in disease severity, frequency of symptoms, heart rate, and blood pressure between before and after SVT ablation. The most frequent types of SVT noted on the electrophysiologic study were atrioventricular nodal reentrant tachycardia (57.81%), atrial flutter (29.68%), atrioventricular reentrant tachycardia (9.37%), atrial tachycardia (1.56%), and junctional tachycardia (1.56%). After SVT ablation, all 64 patients experienced an improvement in symptoms. Palpitations and lightheadedness experienced the most improvement after the procedure (72% vs. 31%; p < 0.001 and 63% vs. 22%; p < 0.001, respectively). There was a significant improvement in the resting heart rate (81.1 ± 12.8 vs. 75.8 ± 15.6 bpm; p < 0.002), but the orthostatic tachycardia on standing persisted (93.6 ± 16.5 vs. 77.3 ± 19.8 bpm; p = 0.14). Underlying SVT in patients with POTS can be missed easily. A strong suspicion and long-term ambulatory cardiac rhythm monitoring can help in diagnosing the condition.
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Affiliation(s)
- Zeid Nesheiwat
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Arooge Towheed
- Department of Cardiac Electrophysiology, The Georgetown University/Medstar Washington Hospital Center, Washington DC, USA
| | - Joseph Eid
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Jeremy Tomcho
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Pinang Shastri
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Carson Oostra
- Division of Cardiovascular Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Beverly Karabin
- Division of Cardiovascular Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Blair Grubb
- Division of Cardiovascular Medicine, The University of Toledo Medical Center, Toledo, OH, USA
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17
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Jani C, Arora S, Zuzek Z, Jaswaney R, Thakkar S, Patel HP, Lahewala S, Arora N, Josephson R, Deshmukh A, Viles-Gonzalez J, Osman MN, Sahadevan J, Hoit BD, Mackall JA. Impact of catheter ablation in patients with atrial flutter and concurrent heart failure. Heart Rhythm O2 2020; 2:53-63. [PMID: 34113905 PMCID: PMC8183960 DOI: 10.1016/j.hroo.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background No studies assessed impact of atrial flutter (AFL) ablation on outcomes in patients with AFL and concurrent heart failure (HF). Objectives To assess the effect of AFL ablation on mortality and HF readmissions in patients with AFL and HF. Methods This retrospective cohort study identified 15,952 patients with AFL and HF from the 2016–17 Nationwide Readmissions Database. The primary outcome was a composite of all-cause mortality and/or HF readmission at 1 year. Secondary outcomes included HF readmission, all-cause mortality, and atrial fibrillation (AF) readmission at 1 year. Propensity score match (1:2) algorithm was used to adjust for confounders. Cox proportional hazard regression was used to generate hazard ratios. Results Of the 15,952 patients, 9889 had heart failure with reduced ejection fraction (HFrEF) and 6063 had heart failure with preserved ejection fraction (HFpEF). In the matched HFrEF cohort (n = 5421), the primary outcome was significantly lower in patients undergoing ablation (HR 0.72, 95% CI 0.61–0.85, P < .001). HF readmission (HR 0.73, 95% CI 0.61–0.89, P = .001), all-cause mortality (HR 0.62, 95% CI 0.46–0.85, P = .003), and AF readmission (HR 0.63, 95% CI 0.48–0.82, P = .001) were also significantly reduced. In the matched HFpEF cohort (n = 2439), the primary outcome was lower in the group receiving ablation but was not statistically significant (HR 0.80, 95% CI 0.63–1.01, P = .065). Conclusion In patients with AFL and HFrEF, AFL ablation was associated with lower mortality and HF readmissions at 1 year. Patients with AFL and HFpEF did not show a similar significant reduction in the primary outcome.
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Affiliation(s)
- Chinmay Jani
- Mount Auburn Hospital-Harvard Medical School, Cambridge, Massachusetts
| | - Shilpkumar Arora
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Zachary Zuzek
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Rahul Jaswaney
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | - Richard Josephson
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | | | - Juan Viles-Gonzalez
- Miami Cardiac and Vascular Institute/ Baptist Health South Florida, Miami, Florida
| | - Mohammed Najeeb Osman
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Jayakumar Sahadevan
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Brian D Hoit
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Judith A Mackall
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
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18
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Sayseng V, Grondin J, Salgaonkar VA, Grubb CS, Basij M, Mehrmohammadi M, Iyer V, Wang D, Garan H, Wan EY, Konofagou EE. Catheter Ablation Lesion Visualization With Intracardiac Strain Imaging in Canines and Humans. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:1800-1810. [PMID: 32305909 PMCID: PMC7483419 DOI: 10.1109/tuffc.2020.2987480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Catheter ablation is a common treatment for arrhythmia, but can fail if lesion lines are noncontiguous. Identification of gaps and nontransmural lesions can reduce the likelihood of treatment failure and recurrent arrhythmia. Intracardiac myocardial elastography (IME) is a strain imaging technique that provides visualization of the lesion line. Estimation of lesion size and gap resolution were evaluated in an open-chest canine model ( n = 3 ), and clinical feasibility was investigated in patients undergoing ablation to treat typical cavotricuspid isthmus (CTI) atrial flutter ( n = 5 ). A lesion line consisting of three lesions and two gaps was generated on the canine left ventricle via epicardial ablation. One lesion was generated in one canine right ventricle. Average lesion and gap areas were measured with high agreement (33 ± 14 and 30 ± 15 mm2, respectively) when compared against gross pathology (34 ± 19 and 26 ± 11 mm2, respectively). Gaps as small as 11 mm2 (3.6 mm on epicardial surface) were identifiable. Absolute error and relative error in estimated lesion area were 9.3 ± 8.4 mm2 and 31% ± 34%; error in estimated gap area was 11 ± 9.0 mm2 and 40% ± 29%. Flutter patients were imaged throughout the procedure. Strain was shown to be capable of differentiating between baseline and after ablation completion as confirmed by conduction block. In all patients, strain decreased in the CTI after ablation (mean paired difference of -17% ± 11%, ). IME could potentially become a useful ablation monitoring tool in health facilities.
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19
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Long-term outcomes of sinus node modification in patients with severely symptomatic drug-refractory inappropriate sinus tachycardia: a single-center experience. J Interv Card Electrophysiol 2020; 61:511-516. [PMID: 32761537 DOI: 10.1007/s10840-020-00846-3] [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: 06/20/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate the long-term outcomes of sinus node modification (SNM) in treating patients with severely symptomatic drug-refractory inappropriate sinus tachycardia (IST). METHODS The study included 39 patients with symptomatic drug-refractory IST who have undergone SNM at Saint Louis University Hospital. Data was reviewed retrospectively. Recurrence of symptoms was assessed at 3-6-month follow-up intervals. RESULTS The mean age of our cohort was 31.5 ± 11. The mean HR at diagnosis was 135 ± 25.4 beats per minute (BPM). Thirty-seven of 39 (94.8%) patients had complete resolution of symptoms. Of these 37 patients, 16 required 1 SNM, 17 patients required 2 SNM, and 4 patients required 3 SNM in order to achieve complete symptom resolution. Mean HR post-procedure was 78.6 ± 12.3 BPM. Thirteen of 39 patients required rate control medication post-procedure, all of whom were prescribed beta-blockers. Patients were followed every 3 to 6 months with a mean follow-up duration of 62.3 ± 42.9 months from the patient's last SNM procedure. Thirteen of those 37 patients (35.1%) developed intermittent symptomatic bradycardia requiring permanent pacemaker implantation. Two of the 39 patients had phrenic nerve injury, and 6 patients had post-procedure pericarditis. CONCLUSIONS This study provides additional information to the limited dataset available in the literature and shows that SNM might provide patients with long-term symptomatic relief bearing in mind the potential increased risk for the need for permanent pacing.
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20
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Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P. SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. Heart Lung Circ 2020; 29:973-987. [PMID: 32601020 PMCID: PMC7274628 DOI: 10.1016/j.hlc.2020.05.101] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease (COVID-19) is a serious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The symptoms of the disease range from asymptomatic to mild respiratory symptoms and even potentially life-threatening cardiovascular and pulmonary complications. Cardiac complications include acute myocardial injury, arrhythmias, cardiogenic shock and even sudden death. Furthermore, drug interactions with COVID-19 therapies may place the patient at risk for arrhythmias, cardiomyopathy and sudden death. In this review, we summarise the cardiac manifestations of COVID-19 infection and propose a simplified algorithm for patient management during the COVID-19 pandemic.
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Affiliation(s)
| | | | - Julia H Indik
- Sarver Heart Center, University of Arizona, Tucson, AZ, USA
| | - Deepak Acharya
- Sarver Heart Center, University of Arizona, Tucson, AZ, USA
| | - Preethi William
- Sarver Heart Center, University of Arizona, Tucson, AZ, USA.
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21
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Potapova KV, Nosov VP, Koroleva LY, Amineva NV. [Atrial Flutter: up-to-date Problem Evaluation with Clinical Positions]. ACTA ACUST UNITED AC 2020; 60:70-80. [PMID: 32245357 DOI: 10.18087/cardio.2020.1.n693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/29/2019] [Indexed: 11/18/2022]
Abstract
The review provides current ideas about the etiology and prevalence of atrial flutter (AF), mechanism and substrate of arrhythmogenesis, and principles of clinical and electrophysiological classification of this arrhythmia. Methods for conservative and surgical treatments of AF, including their comparative aspect, are described in detail. The review presented recent data on efficacy and potential risks of different approaches to reversing the arrhythmia. The authors indicated a need for early diagnosis and strict control of the sinus rhythm in AF, which would help a successful intervention not only to completely cure the existing arrhythmia but also to prevent other heart rhythm disorders, primarily atrial fibrillation.
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Affiliation(s)
| | - V P Nosov
- Privolzhsky Research Medical University
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22
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Gopinathannair R, Cornwell WK, Dukes JW, Ellis CR, Hickey KT, Joglar JA, Pagani FD, Roukoz H, Slaughter MS, Patton KK. Device Therapy and Arrhythmia Management in Left Ventricular Assist Device Recipients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e967-e989. [DOI: 10.1161/cir.0000000000000673] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure with reduced ejection fraction. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common, predispose these patients to additional risk, and complicate patient management. However, there is no consensus on best practices for the medical management of these arrhythmias or on the optimal timing for procedural interventions in patients with refractory arrhythmias. Although the vast majority of these patients have preexisting cardiovascular implantable electronic devices or cardiac resynchronization therapy, given the natural history of heart failure, it is common practice to maintain cardiovascular implantable electronic device detection and therapies after LVAD implantation. Available data, however, are conflicting on the efficacy of and optimal device programming after LVAD implantation. Therefore, the primary objective of this scientific statement is to review the available evidence and to provide guidance on the management of atrial and ventricular arrhythmias in this unique patient population, as well as procedural interventions and cardiovascular implantable electronic device and cardiac resynchronization therapy programming strategies, on the basis of a comprehensive literature review by electrophysiologists, heart failure cardiologists, cardiac surgeons, and cardiovascular nurse specialists with expertise in managing these patients. The structure and design of commercially available LVADs are briefly reviewed, as well as clinical indications for device implantation. The relevant physiological effects of long-term exposure to continuous-flow circulatory support are highlighted, as well as the mechanisms and clinical significance of arrhythmias in the setting of LVAD support.
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23
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The relationship between blood glucose and nocturnal supraventricular tachycardia attacks in non-diabetic patients. J Interv Card Electrophysiol 2019; 55:115-120. [PMID: 31041584 DOI: 10.1007/s10840-019-00549-4] [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: 09/04/2018] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Decrease in the blood glucose level may trigger the tachycardia or bradycardia because it has an arrhythmogenic effect on the heart. Our purpose in this study was to investigate whether the blood glucose level has an effect on patients who attended to the hospital with nocturnal supraventricular tachycardia (SVT). METHODS We included 151 patients in our study who have SVT history. Plasma glucose levels which were taken during night hours, electrolytes, and 12 lead electrocardiography were evaluated. RESULTS There were 105 patients without nocturnal SVT attack and 46 patients with nocturnal SVT attack. Patients with nocturnal SVT attack, blood glucose level, potassium, calcium, and hemoglobin levels were significantly lower, hs-CRP was significantly higher, basal cycle length (BCL) was significantly short, and QT interval was significantly longer. It was found that blood glucose (O.R. = 0.904, 95% GA 0.828-0.986, p = 0.023) and potassium levels (O.R. = 0.128, 95% GA 0.029-0.561, p = 0.006) and basal cycle length (BCL) (O.R. 0.988, 95% GA, 0.980-0.996, p = 0.005) values were in independently correlated with nocturnal SVT attacks. CONCLUSION The decrease in blood glucose level of the patients who are being followed with SVT diagnosis might trigger the nocturnal SVT attacks.
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Ernst S, Cazzoli I, Guarguagli S. An initial experience of high-density mapping-guided ablation in a cohort of patients with adult congenital heart disease. Europace 2019; 21:i43-i53. [PMID: 30801127 PMCID: PMC6388091 DOI: 10.1093/europace/euy188] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/31/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS In the management of both ventricular and supraventricular tachycardia in patients with congenital heart disease (CHD) catheter ablation has now been recognized as one of the mainstays. METHODS AND RESULTS We review our initial experience of using the Rhythmia mapping system in a cohort of 12 adult CHD patients presenting with multiple arrhythmia substrates. A total of 78 arrhythmia maps were attempted in a total of 15 procedures, but possible due to the dilatation of the target chamber only 44% of maps were able to reconstruct the entire arrhythmia. All patients underwent pre-procedure 3D imaging (either cardiac magnetic resonance or computed tomography), but image integration was suboptimal. A median of two maps per patient were finally analysed and acquisition took in median 22 min with a median number of 12 574 (8230-18 167) mapping points. Procedural data with a total duration amounting to in median 285 (194-403) min, with a median total fluoroscopy exposure of 7.5 (5.2-10.7) min. After a median of 1.5 procedures [median of 12 (8-16 months)], nine patients remained in stable sinus rhythm or atrial paced rhythm, while three patients had further sustained recurrences. One of these passed away in end-staged heart failure. CONCLUSION This initial experience of using high-density mapping for arrhythmia management in patients with CHD allowed rapid acquisition of multiple maps with high accuracy to identify surgical scars and fibrosis, however, it was limited by large atrial volumes and a high percentage of incomplete maps resulting in modest clinical success.
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MESH Headings
- Cardiac Imaging Techniques
- Catheter Ablation/methods
- Electrophysiologic Techniques, Cardiac
- Female
- Fluoroscopy
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Humans
- Male
- Middle Aged
- Recurrence
- Tachycardia, Supraventricular/diagnostic imaging
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Tachycardia, Ventricular/diagnostic imaging
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/surgery
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Affiliation(s)
- Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK
| | - Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK
- Division Of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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25
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Lin YS, Chen YL, Chen TH, Lin MS, Liu CH, Yang TY, Chung CM, Chen MC. Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA2DS2-VASc Score. JAMA Netw Open 2018; 1:e180941. [PMID: 30646091 PMCID: PMC6324304 DOI: 10.1001/jamanetworkopen.2018.0941] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022] Open
Abstract
Importance Current guidelines support treating atrial fibrillation (AF) and atrial flutter (AFL) as equivalent risk factors for ischemic stroke stratified by CHA2DS2-VASc scores, recommending anticoagulation therapy for patients with a CHA2DS2-VASc score of 2 or higher, but some studies found differences in clinical outcomes. Objective To investigate differences in clinical outcomes among AF, AFL, and matched control cohorts. Design, Setting, and Participants This nationwide cohort study analyzed data from the Taiwan National Health Insurance Research Database from January 1, 2001, through December 31, 2012. Follow-up and data analysis ended December 31, 2012. A total of 219 416 age- and sex-matched individuals participated in the study. Clinical outcomes were compared after stratification by CHA2DS2-VASc score (possible score range, 0-9; higher scores indicate greater risk of ischemic stroke). Main Outcomes and Measures Ischemic stroke, heart failure hospitalization, and all-cause mortality among the AF, AFL, and matched control cohorts were analyzed using Cox proportional hazards regression. Results This study comprised 188 811 patients in the AF cohort (mean [SD] age, 73.8 [13.4] years; 104 703 [55.5%] male), 6121 patients in the AFL cohort (mean [SD] age, 67.7 [15.8] years; 3735 [61.0%] male), and 24 484 patients in the matched control cohort (mean [SD] age, 67.3 [15.6] years; 14 940 [61.0%] male). The patients with AF were older, were more predominantly female, and had higher CHA2DS2-VASc scores than the patients with AFL and the control participants. After stratification by CHA2DS2-VASc score, the incidence densities (IDs; events per 100 person-years) of ischemic stroke (AF cohort: ID, 3.08; 95% CI, 3.03-3.13; AFL cohort: ID, 1.45; 95% CI, 1.28-1.62; controls: ID, 0.97; 95% CI, 0.92-1.03), heart failure hospitalization (AF cohort: ID, 3.39; 95% CI, 3.34-3.44; AFL cohort: ID, 1.57; 95% CI, 1.39-1.74; controls: ID, 0.32; 95% CI, 0.29-0.35), and all-cause mortality (AF cohort: ID, 17.8; 95% CI, 17.7-17.9; AFL cohort: ID, 13.9; 95% CI, 13.4-14.4; controls: ID, 4.2; 95% CI, 4.1-4.4) were significantly higher in the AF cohort than in the matched control cohort. For the AFL cohort vs the matched control cohort, the incidences of heart failure hospitalization and all-cause mortality were significantly higher across all levels, but the incidence of ischemic stroke was only significantly higher at CHA2DS2-VASc scores of 5 to 9. For the AF cohort vs the AFL cohort, the incidences of ischemic stroke and heart failure hospitalization were significantly higher at a CHA2DS2-VASc score of 1 or higher, but the incidence of all-cause mortality was significantly higher only at CHA2DS2-VASc scores of 1 to 3. Conclusions and Relevance This study found different clinical outcomes between patients with AFL and AF and those without AF and AFL. The current recommended level of the CHA2DS2-VASc score in preventing ischemic stroke in patients with AFL should be reevaluated.
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Affiliation(s)
- Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Hung Liu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Teng-Yao Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chang-Ming Chung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
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26
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Mesquita J, Bisla J, Lee A, Perez M. Video-assisted thoracoscopic surgery to displace the phrenic nerve during endocardial ablation of right atrial tachycardia. HeartRhythm Case Rep 2018; 4:304-306. [PMID: 30023277 PMCID: PMC6050457 DOI: 10.1016/j.hrcr.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- João Mesquita
- Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Anson Lee
- Stanford University Medical Center, Palo Alto, California
| | - Marco Perez
- Stanford University Medical Center, Palo Alto, California
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Abstract
PURPOSE OF REVIEWS In this review, the challenges of managing cardiac arrhythmias and syncope in the setting of pregnancy will be discussed. RECENT FINDINGS Arrhythmias in pregnancy are increasing, as diagnostic and therapeutic options have advanced and women are older at the time of gestation. Atrial fibrillation has become the most common arrhythmia in pregnancy. Inherited arrhythmia has become a more common entity, with advances in treatments and genetic testing, and require specialized treatments in pregnancy. The majority of arrhythmias in pregnancy are benign. The potential risk of increased cardiac morbidity and mortality exists for mother and fetus, especially in women with structural heart disease, which is becoming increasingly common. Early evaluation, diagnosis, and appropriate treatment are necessary to achieve optimal outcomes for both mother and fetus.
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Affiliation(s)
- Ciorsti MacIntyre
- Department of Medicine, Halifax, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Room 2501D, Halifax, NS, B3H 4S9, Canada
| | - Chinyere Iwuala
- Department of Medicine, Halifax, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Room 2501D, Halifax, NS, B3H 4S9, Canada
| | - Ratika Parkash
- Department of Medicine, Halifax, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Room 2501D, Halifax, NS, B3H 4S9, Canada.
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28
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Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, Lampert R, May JL, McDaniel GM, Perez MV, Sendelbach S, Sommargren CE, Wang PJ. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e273-e344. [DOI: 10.1161/cir.0000000000000527] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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29
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Wood KA, Barnes AH, Paul S, Hines KA, Jackson KP. Symptom challenges after atrial fibrillation ablation. Heart Lung 2017; 46:425-431. [PMID: 28923248 PMCID: PMC5811184 DOI: 10.1016/j.hrtlng.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unclear what symptom challenges occur during the recovery phase after atrial fibrillation (AF) ablation. OBJECTIVES This longitudinal pilot study explored the patient perspective of the first six months following an AF ablation. METHODS Telephone interviews and questionnaires were used with 20 patients at baseline, at 1, 3, and 6 months after AF ablation. Telephone interview data were analyzed using content analysis. Longitudinal outcomes were analyzed using repeated measures analysis of variance (ANOVA). RESULTS Mean age was 65 ± 7 years and the sample was 55% female. The severity and duration of fatigue was the most concerning symptom. Patient expectations differed from providers' expectations. Recovery was a much slower process than patients expected. CONCLUSIONS Patients struggled to manage symptoms after AF ablation. A more accurate understanding of the symptom challenges following AF ablation could lead to development of more realistic education to improve patient self-management.
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Affiliation(s)
| | | | | | | | - Kevin P Jackson
- Division of Clinical Cardiac Electrophysiology, Duke University Medical Center, USA.
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30
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Roversi S, Fabbri LM, Sin DD, Hawkins NM, Agustí A. Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care. Am J Respir Crit Care Med 2017; 194:1319-1336. [PMID: 27589227 DOI: 10.1164/rccm.201604-0690so] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely owing to shared risk factors (e.g., aging, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of patients with COPD. The prevalence and incidence of cardiac comorbidities are higher in patients with COPD than in matched control subjects, although estimates of prevalence vary widely. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. The differential diagnosis may be challenging, especially in older and smoking subjects complaining of unspecific symptoms, such as dyspnea and fatigue. The therapeutic management of patients with cardiac and pulmonary comorbidities may be similarly challenging: bronchodilators may have cardiac side effects, and, vice versa, some cardiac medications should be used with caution in patients with lung disease. The aim of this review is to summarize the evidence of the relationship between COPD and the three most frequent and important cardiac comorbidities in patients with COPD: ischemic heart disease, heart failure, and atrial fibrillation. We have chosen a practical approach, first summarizing relevant epidemiological and clinical data, then discussing the diagnostic and screening procedures, and finally evaluating the impact of lung-heart comorbidities on the therapeutic management of patients with COPD and heart diseases.
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Affiliation(s)
- Sara Roversi
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | - Leonardo M Fabbri
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | | | - Nathaniel M Hawkins
- 3 Division of Cardiology, Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Alvar Agustí
- 4 Thorax Institute, Hospital Clinic in Barcelona, University of Barcelona, Barcelona, Spain
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31
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Kawakami H, Nagai T, Inoue K, Higaki J, Ikeda S. Abnormal atrial strain with speckle-tracking echocardiography predicts the arrhythmic substrate of atypical right atrial flutter. HeartRhythm Case Rep 2017; 3:251-254. [PMID: 28736707 PMCID: PMC5509953 DOI: 10.1016/j.hrcr.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Hiroshi Kawakami
- Address reprint requests and correspondence: Dr Hiroshi Kawakami, Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.Division of CardiologyDepartment of CardiologyPulmonology, Hypertension and NephrologyEhime University Graduate School of MedicineShitsukawaToonEhime791-0295Japan
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32
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Voss F, Eckardt L, Busch S, Estner HL, Steven D, Sommer P, von Bary C, Neuberger HR. [AV-reentrant tachycardia and Wolff-Parkinson-White syndrome : Diagnosis and treatment]. Herzschrittmacherther Elektrophysiol 2016; 27:381-389. [PMID: 27878364 DOI: 10.1007/s00399-016-0466-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/01/2022]
Abstract
The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/1000. The pathophysiological basis is an accessory atrioventricular pathway (AP). Patients with AVRT typically present with palpitations, an on-off characteristic, anxiety, dyspnea, and polyuria. This type of tachycardia may often be terminated by vagal maneuvers. Although the clinical presentation of AVRT is quite similar to AV-nodal reentrant tachycardias, the correct diagnosis is often facilitated by analyzing a standard 12-lead ECG at normal heart rate showing ventricular preexcitation. Curative catheter ablation of the AP represents the therapy of choice in symptomatic patients. This article is the fourth part of a series written to improve the professional education of young electrophysiologists. It explains pathophysiology, symptoms, and electrophysiological findings of an invasive EP study. It focusses on mapping and ablation of accessory pathways.
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Affiliation(s)
- Frederik Voss
- Innere Medizin III, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54290, Trier, Deutschland.
| | - Lars Eckardt
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Sonia Busch
- Medizinische Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Coburg, Coburg, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Universitätsklinikum München-Großhadern, München, Deutschland
| | - Daniel Steven
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Köln, Deutschland
| | - Philipp Sommer
- Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Deutschland
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Al-Zaiti SS, Magdic KS. Paroxysmal Supraventricular Tachycardia: Pathophysiology, Diagnosis, and Management. Crit Care Nurs Clin North Am 2016; 28:309-16. [PMID: 27484659 DOI: 10.1016/j.cnc.2016.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Paroxysmal supraventricular tachycardia (PSVT) is a well-known and thoroughly studied clinical syndrome, characterized by regular tachycardia rhythm with sudden onset and abrupt termination. Most patients present with palpitations and dizziness, and their electrocardiogram demonstrates a narrow QRS complex and regular tachycardia with hidden or inverted P waves. PSVT is caused by re-entry due to the presence of inhomogeneous, accessory, or concealed conducting pathways. Hemodynamically stable patients are treated by vagal maneuvers, intravenous adenosine, diltiazem, or verapamil, hemodynamically unstable patients are treated by cardioversion. Patients with symptomatic and recurrent PSVT can be treated with long-term drug treatment or catheter ablation.
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Affiliation(s)
- Salah S Al-Zaiti
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street, 336 VB, Pittsburgh, PA 15261, USA.
| | - Kathy S Magdic
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street, 336 VB, Pittsburgh, PA 15261, USA
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34
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Takata J, Haruyama N, Arashi T, Mae T. Alteration of fatal 1:1 conducted atrial flutter to less conducted ratio by landiolol infusion. J Anesth 2016; 30:716-9. [PMID: 27085543 DOI: 10.1007/s00540-016-2173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 04/03/2016] [Indexed: 11/30/2022]
Abstract
An 84-year-old male patient with a past history of atrial-flutter-fibrillation and dementia underwent an urgent femoral neck fracture surgery. Preoperative electrocardiography demonstrated atrial flutter (AFL) with ventricular conduction at a ratio of 2:1-4:1, and transthoracic echocardiography showed severe left ventricular dysfunction with Ejection Fraction of 14.6 %. Femoral nerve block and Lateral femoral cutaneous nerve block with sedation was planned for the surgery. Upon entry to the operating room, ECG showed 2:1 conducted AFL at the rate of 128 beats min(-1). Due to the stimulation of urethral catheter insertion, it has altered to 1:1 conducted AFL. Loading dose of landiolol hydrochloride 7.5 mg followed by 1.5-3 μg/kg/min continuous administration was given, which had decreased the conduction ratio to 2:1 without causing hypotension. A further episode of 1:1 conducted AFL occurred when the pin was inserted to the thighbone, which caused circulatory collapse. Additional bolus dose of landiolol immediately altered it to 2:1 before operating cardioversion and stabilized the hemodynamics. He maintained AFL with 2:1 conduction thereafter, and 1:1 conduction was never seen postoperatively even after discontinuation of landiolol.
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Affiliation(s)
- Junko Takata
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan.
| | - Naoko Haruyama
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Tomoko Arashi
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Tomoko Mae
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
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