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Padda I, Sebastian SA, Khehra N, Mahtani A, Sethi Y, Panthangi V, Fulton M, Bandyopadhyay D, Johal G. Tachy-brady syndrome: Electrophysiology and evolving principles of management. Dis Mon 2024; 70:101637. [PMID: 37690863 DOI: 10.1016/j.disamonth.2023.101637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Sudden alterations in the heart rate may be associated with diverse symptoms. Sinus node dysfunction (SND), also known as sick sinus syndrome, is a sinoatrial (SA) node disorder. SND is primarily caused by the dysfunction of the pacemaker, as well as impaired impulse transmission resulting in a multitude of abnormalities in the heart rhythms, such as bradycardia-tachycardia, atrial bradyarrhythmias, and atrial tachyarrhythmias. The transition from bradycardia to tachycardia is generally referred to as "tachy-brady syndrome" (TBS). Although TBS is etiologically variable, the manifestations remain consistent throughout. Abnormal heart rhythms have the propensity to limit tissue perfusion resulting in palpitations, fatigue, lightheadedness, presyncope, and syncope. In this review, we examine the physiology of tachy-brady syndrome, the practical approach to its diagnosis and management, and the role of adenosine in treating SND.
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Affiliation(s)
- Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA.
| | | | - Nimrat Khehra
- Saint James School of Medicine, Arnos Vale, Saint Vincent and the Grenadines
| | - Arun Mahtani
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Yashendra Sethi
- Department of Internal Medicine, Government Doon Medical College, Dehradun, India
| | | | - Matthew Fulton
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | | | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, WA, USA
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Morishima I, Kanzaki Y, Morita Y, Inoue K, Kobori A, Kaitani K, Kurotobi T, Yamaji H, Matsui Y, Nakazawa Y, Kusano K, Tomomatsu T, Ikai Y, Furui K, Yamauchi R, Miyazawa H, Tanaka N, Morimoto T, Kimura T, Shizuta S. Catheter Ablation for Paroxysmal Atrial Fibrillation With Sick Sinus Syndrome: Insights From the Kansai Plus Atrial Fibrillation Registry. Heart Lung Circ 2023; 32:205-214. [PMID: 36274004 DOI: 10.1016/j.hlc.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/13/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Coexisting sick sinus syndrome (SSS) is associated with both electrical and structural atrial remodelling in patients with atrial fibrillation (AF). Limited data are available concerning catheter ablation (CA) for AF in this condition. This study investigated the efficacy of CA as a curative therapy for AF and SSS in a large-scale prospective multicentre registry. METHODS The Kansai Plus Atrial Fibrillation (KPAF) registry enrolled 5,010 consecutive patients who underwent CA for AF; this included 3,133 patients with paroxysmal AF (mean age, 66 years; male, 69.3%; mean CHA2DS2-VASc score, 2.05±1.50; SSS, n=315 [tachy-brady syndrome, n=285]). The endpoints included the recurrence of AF with a blanking period of 90 days after CA, and de novo pacemaker implantation during the follow-up period (median duration, 2.93 years). RESULTS The AF-free survival did not significantly differ between patients with and those without SSS (n=2,818) after the initial (log-rank p=0.864) and final sessions (log-rank p=0.268). Pacemakers were implanted in 48 patients with SSS, and implantation in this group was significantly associated with AF recurrence, including early recurrence (adjusted odds ratio, 3.57; 95% confidence interval, 1.67-7.64; p=0.002). The remaining 85.3% of patients with SSS did not require pacemaker implantation at 3 years after CA. CONCLUSIONS Coexisting SSS did not adversely affect recurrence-free survival after CA for paroxysmal AF. Pacemaker implantation was not required in most patients with SSS, with AF recurrence serving as a strong predictor for this.
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Affiliation(s)
- Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuaki Kaitani
- Division of Cardiology, Otsu Red Cross Hospital, Otsu, Japan
| | - Toshiya Kurotobi
- Cardiovascular Center, Nanba Kurotobi Heart Clinic, Osaka, Japan
| | | | - Yumie Matsui
- Department of Cardiology, Saiseikai Izuo Hospital, Osaka, Japan
| | - Yuko Nakazawa
- Department of Cardiovascular Medicine, Heart Rhythm Center, Shiga University of Medical Science, Shiga, Japan
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Yoshihiro Ikai
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Han Q, Wang L, Jiang L, Feng Y, Chen Y, Chen S, Gao Q. Tachy-brady syndrome induced by a transversus thoracis muscle plane block. J Clin Anesth 2021; 73:110327. [PMID: 33962335 DOI: 10.1016/j.jclinane.2021.110327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Qiaoyu Han
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
| | - Lu Wang
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
| | - Luyang Jiang
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China.
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
| | - Yu Chen
- Department of Cardiac Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Shenglong Chen
- Department of Cardiac Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Qing Gao
- Department of Cardiac Surgery, Peking University People's Hospital, Beijing 100044, China
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Korantzopoulos P, Kyrlas K, Liu T, Li G, Goudevenos JA. Red blood cell distribution width and atrial fibrillation in patients with sick sinus syndrome. J Cardiol 2015; 67:551-4. [PMID: 26321105 DOI: 10.1016/j.jjcc.2015.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/03/2015] [Accepted: 07/11/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sick sinus syndrome (SSS) is associated with atrial fibrillation (AF). Red blood cell distribution width (RDW) is a marker of anisocytosis of erythrocytes and is related to inflammatory stress. Recently, RDW has been associated with AF. The aim of the present study was to evaluate the potential association of RDW with AF history in patients with SSS. METHODS Consecutive patients with symptomatic SSS undergoing dual-chamber pacemaker implantation were screened. Baseline clinical, laboratory, echocardiographic, and electrocardiographic parameters were recorded. Conventional inflammatory indexes were also assessed. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis for parameters associated with AF were performed. RESULTS The final study population consisted of 101 patients (47 men); median age: 77 [73-82] years. The demographic and clinical characteristics were comparable between tachy-brady (AF history) patients (n=32) and patients with other forms of SSS (n=69). Left atrial diameter was increased in tachy-brady patients [44 (39-48)mm vs. 39 (36-44)mm; p=0.05]. Also, the RDW was greater in these patients [14.7 (13.6-15.4)% vs. 13.7 (13.4-14.3)%; p=0.02]. Multivariate analysis showed that RDW is independently associated with AF (OR: 1.58; 95% CI: 1.06-2.85; p=0.04). The ROC curve analysis showed that the area under the curve was 0.69 (p=0.028). A RDW cut-off point of 14 was related to AF with a sensitivity of 70% and a specificity of 69%. CONCLUSION RDW is associated with AF history in patients with SSS. The prognostic value of RDW in terms of future AF development and arrhythmia perpetuation in these patients should be further examined.
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Affiliation(s)
| | - Konstantinos Kyrlas
- First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Guangping Li
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - John A Goudevenos
- First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
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