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Chew DS, Sacks NC, Emden MR, Cyr PL, Sherwood R, Pokorney SD. Catheter ablation for supraventricular tachycardia and health resource utilization and expenditures: A propensity-matched cohort study. Int J Cardiol 2024; 403:131831. [PMID: 38331201 DOI: 10.1016/j.ijcard.2024.131831] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Few data are available regarding temporal patterns of health resource utilization (HRU) and expenditures among patients undergoing catheter ablation for paroxysmal supraventricular tachycardia (PSVT). This study aimed to describe expenditures and HRU in patients with PSVT who underwent catheter ablation compared to a matched cohort of patients on medical therapy alone. METHODS Using a large US administrative database, we identified adult patients (age 18 to 65 years) with a new PSVT diagnosis between 2008 and 2016. Propensity-score matching was used to assemble a PSVT cohort treated with ablation or medical therapy alone (N = 2556). Longitudinal trends in HRU and expenditures in the 3-years preceding and following PSVT diagnosis were compared. RESULTS There were no significant differences in expenditures between groups except within the first year after PSVT diagnosis: $48,004 ablation vs. $17,560 medical therapy (p < 0.001). This difference was driven by procedural expenditures, where the mean cost of catheter ablation was $32,057 ± SD 26,737. In Years 2 and 3 post-ablation, HRU and expenditures decreased to the levels associated with the medical therapy group, although fewer ablation patients required any prescription for beta-blockers, calcium channel blockers, or anti-arrhythmic drugs (32% ablation vs. 42% medical therapy group, p < 0.001). CONCLUSION Catheter ablation reduces medication burden in PSVT, yet health resource use and expenditures were similar beyond 2 years post-ablation when compared to PSVT patients on medical therapy alone. Additional studies are required to better understand drivers of these sustained health expenditures, and barriers to achieving cost-savings for a potentially curative procedure.
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Affiliation(s)
- Derek S Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Naomi C Sacks
- Precision Health Economics and Outcomes Research, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Maia R Emden
- Precision Health Economics and Outcomes Research, Boston, MA, USA
| | - Philip L Cyr
- Precision Health Economics and Outcomes Research, Boston, MA, USA; College of Health and Human Services, University of North Carolina, Charlotte, NC, USA
| | | | - Sean D Pokorney
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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Chen W, Li S, Huang D, Su Y. Drugs associated with a risk of supraventricular tachycardia: analysis using the OpenVigil database. J Int Med Res 2024; 52:3000605241238993. [PMID: 38530149 DOI: 10.1177/03000605241238077] [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: 03/27/2024] Open
Abstract
OBJECTIVE The OpenVigil database can be used to assess medications that may cause supraventricular tachycardia (SVT) and to produce a reference for their safe use in clinical settings. METHODS We analyzed first-quarter data from 2004 to 2023, obtained by searching the OpenVigil database using the keyword "supraventricular tachycardia." Trade names and generic names were obtained by querying the RxNav database, and the proportions were summarized. The proportionate reporting ratio (PRR), reporting odds ratio, and chi-square values were also summarized. We created Asahi diagrams and set the screening criteria to drug events ≥30, PRR >2, and chi-square >4. Outcomes were evaluated using the Side Effect Resource database, several scientific literature databases, and the Hangzhou Yiyao Rational Medication System. RESULTS A total of 2435 distinct medications were found to induce SVT between the first quarter of 2004 and 2023, leading to 22,375 documented adverse events related to SVT. Further investigation revealed that salbutamol, paroxetine, formoterol, paclitaxel, venlafaxine, and theophylline were most likely to cause SVT. CONCLUSION We conducted signal mining of adverse drug events using the OpenVigil database and evaluated the six drugs most likely to cause SVT. The results of this research can serve as a drug safety reference in the clinic.
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Affiliation(s)
- Weihong Chen
- Department of Anxi County Hospital, Quanzhou, China
| | - Shaobin Li
- Department of Anxi County Hospital, Quanzhou, China
| | | | - Yuchao Su
- Department of Anxi County Hospital, Quanzhou, China
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Jalali R, Romaszko J, Dragańska E, Gromadziński L, Cymes I, Sokołowski JB, Poterała M, Markuszewski L, Romaszko-Wojtowicz AM, Jeznach-Steinhagen A, Glińska-Lewczuk K. Heat and cold stress increases the risk of paroxysmal supraventricular tachycardia. PLoS One 2024; 19:e0296412. [PMID: 38165960 PMCID: PMC10760728 DOI: 10.1371/journal.pone.0296412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia in adults. Its occurrence depends on the presence of the reentry circuit and the trigger of the paroxysm. Stress, emotional factors, and comorbidities favour the occurrence of such an episode. We hypothesized that the occurrence of PSVT follows extreme thermal episodes. The retrospective analysis was based on the data collected from three hospital emergency departments in Poland (Olsztyn, Radom, and Wroclaw) involving 816 admissions for PSVT in the period of 2016-2021. To test the hypothesis, we applied the Universal Climate Thermal Index (UTCI) to objectively determine exposure to cold or heat stress. The risk (RR) for PSVT increased to 1.37 (p = 0.006) in cold stress and 1.24 (p = 0.05) in heat stress when compared to thermoneutral conditions. The likelihood of PSVT during cold/heat stress is higher in women (RR = 1.59, p< 0.001 and RR = 1.36, p = 0.024, respectively) than in men (RR = 0.64 at p = 0.088 and RR = 0.78, p = 0.083, respectively). The susceptibility for PSVT was even higher in all groups of women after exclusion of perimenopausal group of women, in thermal stress (RR = 1.74, p< 0.001, RR = 1.56, p = 0.029, respectively). Females, particularly at the perimenopausal stage and men irrespective of age were less likely to develop PSVT under thermal stress as compared to thermoneutral conditions. Progress in climate change requires searching for universal methods and tools to monitor relationships between humans and climate. Our paper confirms that the UTCI is the universal tool describing the impact of thermal stress on the human body and its high usefulness in medical researches.
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Affiliation(s)
- Rakesh Jalali
- Department of Emergency Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Jerzy Romaszko
- Department of Family Medicine and Infectious Diseases, School of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Ewa Dragańska
- Department of Water Management and Climatology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Iwona Cymes
- Department of Water Management and Climatology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | | | - Magdalena Poterała
- Department of Medicine, Faculty of Medical Sciences and Health Science, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom, Poland
| | - Leszek Markuszewski
- Department of Medicine, Faculty of Medical Sciences and Health Science, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom, Poland
| | - Anna Maria Romaszko-Wojtowicz
- Department of Pulmonology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | | | - Katarzyna Glińska-Lewczuk
- Department of Water Management and Climatology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Peng X, Wang S, Ju W, Yang G, Gu K, Liu H, Li M, Chen H, Wang J, Chen M. Right atrial tachycardia after atrial fibrillation ablation: prevalence, clinical characteristics, electrophysiological mechanisms, and long-term outcomes. J Interv Card Electrophysiol 2023; 66:1641-1650. [PMID: 36692686 DOI: 10.1007/s10840-023-01482-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/14/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND This study aims to evaluate the prevalence, clinical characteristics, electrophysiological mechanisms, and long-term outcomes of right atrial tachycardia (AT) in patients who underwent ablation for atrial fibrillation (AF). METHODS From March 2010 to December 2020, 220 consecutive patients undergoing index AF ablation were referred for post-ablation AT recurrence. Thirty-five patients (35/220, 15.9%) with right AT recurrence (25 men; mean age 59.3 ± 10.2 years) were enrolled. These patients were divided into groups with right ATs exclusively (group 1) and right combined with left ATs (group 2). RESULTS Fifty-three ATs were mapped in all patients, with thirty-nine ATs originating from the right atrium. The detailed distribution of all right ATs was 22 in the cavo-tricuspid isthmus (CTI), 6 in the ostium of superior vein cava (SVC), 4 in the right free wall, 4 in the right anterior atrial septum, 2 in coronary sinus ostium, and 1 in crista terminalis. Group 2 had a significantly higher incidence of typical atrial flutter (AFL) than group 1 (11/12, 90.9% vs. 12/24, 50.0%, P = 0.03). During the mean follow-up of 43.6 ± 25.2 months after the index AT ablation, the recurrence rate of AT/AF was 22.9% (8/35), and it was lower in group 1 than in group 2 (8.3% vs. 54.5%, P = 0.01). CONCLUSION Right AT is relatively less common post-AF ablation. The CTI-dependent AFL and the ostium of SVC-derived focal AT constituted the major components of right ATs, suggesting the importance of ablation- and anatomy-related arrhythmogenic effects in the right atrium.
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Affiliation(s)
- Xiafeng Peng
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Shixin Wang
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Weizhu Ju
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Gang Yang
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Kai Gu
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hailei Liu
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Mingfang Li
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hongwu Chen
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| | - Jing Wang
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| | - Minglong Chen
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
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Venkatesh P, Lin JP, Nguyen A, Rezkalla J, Moore JP. Predictors of arrhythmia during pregnancy in adults with congenital heart disease. Int J Cardiol 2023; 386:37-44. [PMID: 37178799 DOI: 10.1016/j.ijcard.2023.05.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Risk prediction of arrhythmia during pregnancy in adult congenital heart disease (ACHD) patients is currently lacking, and the impact of preconception catheter ablation on future antepartum arrhythmia has not been studied. METHODS We conducted a single-center, retrospective cohort study of pregnancies in ACHD patients. Clinically significant arrhythmia events during pregnancy were described, predictors of arrhythmia were analyzed, and a risk score devised. The impact of preconception catheter ablation on antepartum arrhythmia was assessed. RESULTS The study included 172 pregnancies in 137 patients. Arrhythmia events occurred in 25 (15%) of pregnancies, with 64% of events occurring in the second trimester and sustained supraventricular tachycardia being the most common rhythm. Univariate predictors of arrhythmia were history of tachyarrhythmia (OR 20.33, 95% CI 6.95-59.47, p < 0.001, Fontan circulation (OR 11.90, 95% CI 2.60-53.70, p < 0.001), baseline physiologic class C/D (OR 3.72, 95% CI 1.54-9.01, p = 0.002) and history of multiple valve interventions (OR 3.10, 95% CI 1.20-8.20, p = 0.017). Three risk factors (excluding multiple valve interventions) were used to formulate a risk score, with a cutoff of ≥2 points predicting antepartum arrhythmia with sensitivity and specificity of 84%. While recurrence of the index arrhythmia was not observed following successful catheter ablation, preconception ablation did not impact odds of antepartum arrhythmia. CONCLUSIONS We provide a novel risk stratification scheme for predicting antepartum arrhythmia in ACHD patients. The role of contemporary preconception catheter ablation in risk reduction needs further refinement with multicenter investigation.
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Affiliation(s)
- Prashanth Venkatesh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Jeannette P Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; UCLA Cardio-Obstetrics Program, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Amanda Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Joshua Rezkalla
- Department of Cardiology, Mayo Clinic, Rochester, MN, United States of America
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; UCLA Cardiac Arrhythmia Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
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6
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Dung BT, Nhut NM, Son LC, An BG, Duc NM, Van Phuoc D. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children: Insights on its safety and efficacy from a lower middle-income country. Int J Med Sci 2023; 20:1293-1299. [PMID: 37786440 PMCID: PMC10542029 DOI: 10.7150/ijms.86594] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/01/2023] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVE: Radiofrequency catheter ablation (RFCA) is a safe and effective treatment for paroxysmal supraventricular tachycardia in adults. However, data on its use in children, particularly from low- and middle-income countries, are limited. This study aimed to evaluate the safety and efficacy of RFCA in children with paroxysmal supraventricular tachycardia from Vietnam. METHODS: A prospective study was conducted from January 2009 to July 2016 at the University Medical Center, Ho Chi Minh City, Vietnam. Ninety-five children diagnosed with paroxysmal supraventricular tachycardia were enrolled; 90 patients underwent cardiac electrophysiology and RFCA. The patients were followed up for 3-12 months, with a mean follow-up period of 7.5 ± 2.3 months. RESULTS: The average age of the patients was 10.5 ± 3 years, with the youngest patient being 4 years old; 46.3% of the patients were female and 53.7% were male. The patients' average weight was 35.2 ± 9.6 kg. Atrioventricular reentrant tachycardia accounted for 72.6% of the cases and atrioventricular nodal reentrant tachycardia for 27.4% of the cases; no patients had atrial tachycardia. The success rate of RFCA was 98.9% (89/90 patients). During the 12-month follow-up, 5.6% of the patients experienced recurrence but were successfully treated with a second ablation. No severe complications were reported during the procedure and follow-up. CONCLUSIONS: This study found RFCA to be a safe and effective treatment for paroxysmal supraventricular tachycardia in children. It demonstrated a high success rate and low recurrence and complication rates for RFCA in children, thereby highlighting the potential advantages of the procedure as a treatment option.
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Affiliation(s)
- Bui The Dung
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Nhut
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Luong Cao Son
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Bui Gio An
- Department of Cardiology, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Dang Van Phuoc
- School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
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7
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Pærregaard MM, Hartmann J, Sillesen AS, Pihl C, Dannesbo S, Kock TO, Pietersen A, Raja AA, Iversen KK, Bundgaard H, Christensen AH. The Wolff-Parkinson-White pattern in neonates: results from a large population-based cohort study. Europace 2023; 25:euad165. [PMID: 37465966 PMCID: PMC10354624 DOI: 10.1093/europace/euad165] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/17/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Wolff-Parkinson-White (WPW) syndrome is a conduction disorder characterized by an accessory electrical pathway between the atria and ventricles, which may predispose to supraventricular tachycardia (SVT) and sudden cardiac death. It can be seen as an isolated finding or associated with structural heart disease. Our aims were to determine the prevalence of a WPW pattern in a large and unselected cohort of neonates and to describe the electro- and echocardiographic characteristics as well as the natural history during early childhood. METHODS AND RESULTS Electrocardiograms and echocardiograms of neonates (aged 0-30 days) from a large, prospective, population-based cohort study were included. Neonates with a WPW pattern were identified and matched 1:4 to controls. Localization of the accessory pathway was assessed by different algorithms. Among 17 489 neonates, we identified 17 (76% boys) with a WPW pattern consistent with a prevalence of 0.1%. One neonate had moderate mitral regurgitation while other echocardiographic parameters were similar between cases and controls (all P > 0.05). The accessory pathways were primarily predicted to be left-sided. At follow-up (available in 14/17 children; mean age 3.2 years) the pre-excitation pattern persisted in only four of the children and none of the children had experienced any episodes of SVT. CONCLUSION The prevalence of a WPW pattern in our cohort of unselected neonates was 0.1%. The WPW pattern was more frequent in boys and generally not associated with structural heart disease, and the accessory pathways were primarily left-sided. At follow-up, the WPW pattern had disappeared in most of the children suggesting either an intermittent nature or that normalization occurs. CLINICAL TRIAL REGISTRATION Copenhagen Baby Heart, NCT02753348.
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Affiliation(s)
- Maria Munk Pærregaard
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Joachim Hartmann
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Christian Pihl
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Sofie Dannesbo
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
- Department of Cardiology, The Capital Regions Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100 Copenhagen, Denmark
| | - Thilde Olivia Kock
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Adrian Pietersen
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Capital Regions Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100 Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Capital Regions Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
- Department of Cardiology, The Capital Regions Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
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8
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Dionne A, Friedman KG, Young CC, Newhams MM, Kucukak S, Jackson AM, Fitzgerald JC, Smallcomb LS, Heidemann S, McLaughlin GE, Irby K, Bradford TT, Horwitz SM, Loftis LL, Soma VL, Rowan CM, Kong M, Halasa NB, Tarquinio KM, Schwarz AJ, Hume JR, Gertz SJ, Clouser KN, Carroll CL, Wellnitz K, Cullimore ML, Doymaz S, Levy ER, Typpo KV, Lansell AN, Butler AD, Kuebler JD, Zambrano LD, Campbell AP, Patel MM, Randolph AG, Newburger JW. Tachyarrhythmias During Hospitalization for COVID-19 or Multisystem Inflammatory Syndrome in Children and Adolescents. J Am Heart Assoc 2022; 11:e025915. [PMID: 36250670 PMCID: PMC9673680 DOI: 10.1161/jaha.122.025915] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022]
Abstract
Background Cardiac complications related to COVID-19 in children and adolescents include ventricular dysfunction, myocarditis, coronary artery aneurysm, and bradyarrhythmias, but tachyarrhythmias are less understood. The goal of this study was to evaluate the frequency, characteristics, and outcomes of children and adolescents experiencing tachyarrhythmias while hospitalized for acute severe COVID-19 or multisystem inflammatory syndrome in children. Methods and Results This study involved a case series of 63 patients with tachyarrhythmias reported in a public health surveillance registry of patients aged <21 years hospitalized from March 15, 2020, to December 31, 2021, at 63 US hospitals. Patients with tachyarrhythmias were compared with patients with severe COVID-19-related complications without tachyarrhythmias. Tachyarrhythmias were reported in 22 of 1257 patients (1.8%) with acute COVID-19 and 41 of 2343 (1.7%) patients with multisystem inflammatory syndrome in children. They included supraventricular tachycardia in 28 (44%), accelerated junctional rhythm in 9 (14%), and ventricular tachycardia in 38 (60%); >1 type was reported in 12 (19%). Registry patients with versus without tachyarrhythmia were older (median age, 15.4 [range, 10.4-17.4] versus 10.0 [range, 5.4-14.8] years) and had higher illness severity on hospital admission. Intervention for treatment of tachyarrhythmia was required in 37 (59%) patients and included antiarrhythmic medication (n=31, 49%), electrical cardioversion (n=11, 17%), cardiopulmonary resuscitation (n=8, 13%), and extracorporeal membrane oxygenation (n=9, 14%). Patients with tachyarrhythmias had longer hospital length of stay than those who did not, and 9 (14%) versus 77 (2%) died. Conclusions Tachyarrhythmias were a rare complication of acute severe COVID-19 and multisystem inflammatory syndrome in children and adolescents and were associated with worse clinical outcomes, highlighting the importance of close monitoring, aggressive treatment, and postdischarge care.
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Affiliation(s)
- Audrey Dionne
- Department of CardiologyBoston Children’s HospitalDepartment of PediatricsHarvard Medical SchoolBostonMA
| | - Kevin G. Friedman
- Department of CardiologyBoston Children’s HospitalDepartment of PediatricsHarvard Medical SchoolBostonMA
| | - Cameron C. Young
- Department of Anesthesiology, Critical Care, and Pain MedicineBoston Children’s HospitalBostonMA
| | - Margaret M. Newhams
- Department of Anesthesiology, Critical Care, and Pain MedicineBoston Children’s HospitalBostonMA
| | - Suden Kucukak
- Department of Anesthesiology, Critical Care, and Pain MedicineBoston Children’s HospitalBostonMA
| | - Ashley M. Jackson
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Julie C. Fitzgerald
- Division of Critical CareDepartment of Anesthesiology and Critical CareUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Laura S. Smallcomb
- Department of PediatricsMedical University of South CarolinaCharlestonSC
| | - Sabrina Heidemann
- Division of Pediatric Critical Care Medicine, Department of PediatricsCentral Michigan UniversityDetroitMI
| | - Gwenn E. McLaughlin
- Division of Pediatric Critical Care MedicineDepartment of PediatricsUniversity of Miami Miller School of MedicineMiamiFL
| | - Katherine Irby
- Section of Pediatric Critical CareDepartment of PediatricsArkansas Children’s HospitalLittle RockAR
| | - Tamara T. Bradford
- Division of Cardiology, Department of PediatricsLouisiana State University Health Sciences Center and Children’s Hospital of New OrleansNew OrleansLA
| | - Steven M. Horwitz
- Division of Pediatric Critical Care Medicine, Department of PediatricsRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJ
| | - Laura L. Loftis
- Section of Critical Care MedicineDepartment of PediatricsTexas Children’s HospitalHoustonTX
| | - Vijaya L. Soma
- Division of Infectious Diseases, Department of PediatricsNew York University Grossman School of Medicine and Hassenfeld Children’s HospitalNew YorkNY
| | - Courtney M. Rowan
- Division of Pediatric Critical Care MedicineDepartment of PediatricsIndiana University School of MedicineRiley Hospital for ChildrenIndianapolisIN
| | - Michele Kong
- Division of Pediatric Critical Care MedicineDepartment of PediatricsUniversity of Alabama at BirminghamBirminghamAL
| | - Natasha B. Halasa
- Division of Pediatric Infectious DiseasesDepartment of PediatricsVanderbilt University Medical CenterNashvilleTN
| | - Keiko M. Tarquinio
- Division of Critical Care MedicineDepartment of PediatricsEmory University School of MedicineChildren’s Healthcare of AtlantaAtlantaGA
| | - Adam J. Schwarz
- Division of Critical Care MedicineCHOC Children’s HospitalOrangeCA
| | - Janet R. Hume
- Division of Pediatric Critical CareUniversity of Minnesota Masonic Children’s HospitalMinneapolisMN
| | - Shira J. Gertz
- Division of Pediatric Critical CareDepartment of PediatricsCooperman Barnabas Medical CenterLivingstonNJ
| | | | | | - Kari Wellnitz
- Division of Pediatric Critical CareStead Family Department of PediatricsUniversity of Iowa Carver College of MedicineIowa CityIA
| | - Melissa L. Cullimore
- Division of Pediatric Critical CareDepartment of Pediatrics, Children’s Hospital and Medical CenterOmahaNE
| | - Sule Doymaz
- Division of Pediatric Critical CareDepartment of PediatricsSUNY Downstate Health Sciences UniversityBrooklynNY
| | - Emily R. Levy
- Divisions of Pediatric Infectious Diseases and Pediatric Critical Care MedicineDepartment of Pediatric and Adolescent Medicine, Mayo ClinicRochesterMN
| | - Katri V. Typpo
- Division of Pediatric Critical CareDepartment of PediatricsUniversity of ArizonaTucsonAZ
| | - Amanda N. Lansell
- Division of Pediatric Hospital MedicineRainbow Babies and Children’s HospitalClevelandOH
| | - Andrew D. Butler
- Division of Pediatric Critical CareSt. Christopher’s Hospital for ChildrenPhiladelphiaPA
| | - Joseph D. Kuebler
- Division of Pediatric Critical CareDepartment of PediatricsGolisano Children’s HospitalUniversity of RochesterRochesterNY
| | - Laura D. Zambrano
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | | | - Manish M. Patel
- COVID‐19 Response, Centers for Disease Control and PreventionAtlantaGA
| | - Adrienne G. Randolph
- Department of Anesthesiology, Critical Care, and Pain MedicineBoston Children’s HospitalBostonMA
- Departments of Anaesthesia and PediatricsHarvard Medical SchoolBostonMA
| | - Jane W. Newburger
- Department of CardiologyBoston Children’s HospitalDepartment of PediatricsHarvard Medical SchoolBostonMA
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9
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Wang W, Norby FL, Zhang MJ, Reyes JL, Shah AM, Soliman EZ, Lutsey PL, Alonso A, Solomon SD, Inciardi RM, Chen LY. Differences in Left Atrial Size and Function and Supraventricular Ectopy Between Black and White Participants in the ARIC Study. J Am Heart Assoc 2021; 10:e021723. [PMID: 34713724 PMCID: PMC8751819 DOI: 10.1161/jaha.121.021723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022]
Abstract
Background Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. Methods and Results We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2-week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%-47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. Conclusions Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial arrhythmias in Black individuals.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Faye L. Norby
- Center for Cardiac Arrest PreventionDepartment of CardiologyCedars‐Sinai Smidt Heart InstituteLos AngelesCA
| | - Michael J. Zhang
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Jorge L. Reyes
- Department of MedicineHennepin County Medical CenterMinneapolisMN
| | - Amil M. Shah
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMA
| | - Elsayed Z. Soliman
- Department of EpidemiologyDivision of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNC
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | | | - Riccardo M. Inciardi
- Institute of CardiologyDepartment of Medical and Surgical SpecialtiesRadiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Lin Y. Chen
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
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10
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Harding BN, Norby FL, Heckbert SR, McKnight B, Psaty BM, Soliman EZ, Floyd JS, Chen LY. Longitudinal Measures of Blood Pressure and Subclinical Atrial Arrhythmias: The MESA and the ARIC Study. J Am Heart Assoc 2021; 10:e020260. [PMID: 34014105 PMCID: PMC8483516 DOI: 10.1161/jaha.120.020260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022]
Abstract
Background High blood pressure (BP) is a well-known risk factor for atrial fibrillation (AF), but a single BP measurement may provide limited information about AF risk in older adults. Methods and Results This study included 1256 MESA (Multi-Ethnic Study of Atherosclerosis) and 1948 ARIC (Atherosclerosis Risk in Communities) study participants who underwent extended ambulatory electrocardiographic monitoring and who were free of clinically detected cardiovascular disease, including AF. Using BP measurements from 6 examinations (2000-2018 in MESA and 1987-2017 in ARIC study), we calculated individual long-term mean, trend, and detrended visit-to-visit variability in systolic BP and pulse pressure for each participant. Outcomes, assessed at examination 6, included subclinical AF and supraventricular ectopy. Results from each study were combined with inverse variance-weighted meta-analysis. At examination 6, the mean age was 73 years in MESA and 79 years in ARIC study, and 4% had subclinical AF. Higher visit-to-visit detrended variability in systolic BP was associated with a greater prevalence of subclinical AF (odds ratio [OR], 1.20; 95% CI, 1.02-1.38) and with more premature atrial contractions/hour (geometric mean ratio, 1.08; 95% CI, 1.01-1.15). For pulse pressure as well, higher visit-to-visit detrended variability was associated with a greater prevalence of AF (OR, 1.18; 95% CI, 1.00-1.37). In addition, higher long-term mean pulse pressure was associated with a greater prevalence of subclinical AF (OR, 1.36; 95% CI, 1.08-1.70). Conclusions Antecedent visit-to-visit variability in systolic BP and pulse pressure, but not current BP, is associated with a higher prevalence of subclinical atrial arrhythmias. Prior longitudinal BP assessment, rather than current BP, may be more helpful in identifying older adults who are at higher risk of atrial arrhythmias.
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Affiliation(s)
- Barbara N. Harding
- Barcelona Institute of Global HealthBarcelonaSpain
- Cardiovascular Health Research UnitSeattleWA
| | - Faye L. Norby
- University of Minnesota Division of Epidemiology and Community HealthSchool of Public HealthMinneapolisMN
| | - Susan R. Heckbert
- Cardiovascular Health Research UnitSeattleWA
- Department of EpidemiologyUniversity of WashingtonSeattleWA
| | - Barbara McKnight
- Cardiovascular Health Research UnitSeattleWA
- Department of BiostatisticsUniversity of WashingtonSeattleWA
| | - Bruce M. Psaty
- Cardiovascular Health Research UnitSeattleWA
- Department of EpidemiologyUniversity of WashingtonSeattleWA
- Department of Health ServicesUniversity of WashingtonSeattleWA
- Department of Medicine ServicesUniversity of WashingtonSeattleWA
| | - Elsayed Z. Soliman
- Department of Epidemiology and PreventionDepartment of Medicine, Cardiology SectionEpidemiological Cardiology Research CenterWake Forest School of MedicineWinston SalemNC
| | - James S. Floyd
- Cardiovascular Health Research UnitSeattleWA
- Department of EpidemiologyUniversity of WashingtonSeattleWA
- Department of Medicine ServicesUniversity of WashingtonSeattleWA
| | - Lin Yee Chen
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
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11
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Beinart R, Goldenberg I, Younis A, McNitt S, Huang D, Aktas MK, Spencer R, Kutyifa V, Nof E. Systolic Blood Pressure and Risk for Ventricular Arrhythmia in Patients With an Implantable Cardioverter Defibrillator. Am J Cardiol 2021; 143:74-79. [PMID: 33359194 DOI: 10.1016/j.amjcard.2020.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Low systolic blood pressure (SBP) was previously suggested to be a marker for heart failure and mortality in patients with low left ventricular ejection fraction. We aimed to explore the association of SBP on risk of ventricular tachyarrhythmias (VTA) and atrial arrhythmias as well as appropriate and inappropriate Implantable Cardioverter Defibrillator (ICD) therapy. The study population comprised 1,481 of 1,500 (99%) patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial - Reduce Inappropriate Therapy trial. Multivariate Cox proportional hazards regression modeling was used to identify the association of baseline SBP (recorded prior to ICD implantation) with the risk of VTA > 170 beats/min during follow-up (primary end point) and atrial arrhythmia, appropriate and inappropriate ICD therapy, hospitalization and death (secondary end points). SBP was dichotomized at 120 mm Hg (approximate mean and median) and was also assessed as a continuous measure. Multivariate analysis showed that each 10 mm Hg decrement in SBP was associated with corresponding 11% increased risk for VTA (p = 0.008). Low SBP (≤120 mm Hg) was associated with a significant 58% (p = 0.002) increased risk for VTA ≥170 beats/min; 53% (p = 0.019) increased risk for VTA ≥200 beats/min; and 65% (p = 0.001) increased risk for appropriate ICD therapy, as compared with SBP >120 mm Hg. Low SBP was not associated with increased risk of atrial arrhythmias, and inappropriate ICD therapy. In conclusion, in MADIT-RIT, SBP (≤120 mm Hg) predicted higher rates of VTA. These findings suggest that SBP may be utilized for VTA risk stratification in candidates for primary ICD therapy.
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MESH Headings
- Aged
- Atrial Fibrillation/epidemiology
- Blood Pressure
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/statistics & numerical data
- Female
- Heart Failure/complications
- Heart Failure/physiopathology
- Heart Failure/therapy
- Humans
- Male
- Middle Aged
- Multivariate Analysis
- Proportional Hazards Models
- Randomized Controlled Trials as Topic
- Risk Factors
- Stroke Volume
- Systole
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/therapy
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Fibrillation/epidemiology
- Ventricular Fibrillation/therapy
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Affiliation(s)
- Roy Beinart
- Leviev Heart Institute and Sackler School of Medicine Tel Aviv University, Israel
| | - Ilan Goldenberg
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester NY
| | - Arwa Younis
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester NY
| | - Scott McNitt
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester NY
| | - David Huang
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester NY
| | - Mehmet K Aktas
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester NY
| | - Rosero Spencer
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester NY
| | - Valentina Kutyifa
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester NY
| | - Eyal Nof
- Leviev Heart Institute and Sackler School of Medicine Tel Aviv University, Israel.
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12
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Thakkar S, Patel HP, Chowdhury M, Patel K, Kumar A, Arora S, Zahid S, Goel M, Barssoum K, Jain V, AbouEzzeddine OF, DeSimone CV, Baibhav B, Rao M, Deshmukh A. Impact of Arrhythmias on Hospitalizations in Patients With Cardiac Amyloidosis. Am J Cardiol 2021; 143:125-130. [PMID: 33352208 DOI: 10.1016/j.amjcard.2020.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 02/01/2023]
Abstract
Cardiac involvement in amyloidosis is associated with a poor prognosis. Data on the burden of arrhythmias in patients with cardiac amyloidosis (CA) during hospitalization are lacking. We identified the burden of arrhythmias using the National Inpatient Sample (NIS) database from January 2016 to December 2017. We compared patient characteristics, outcomes, and hospitalization costs between CA patients with and without documented arrhythmias. Out of 5,585 hospital admissions for CA, 2,020 (36.1%) had concurrent arrhythmias. Propensity-score matching for age, sex, income, and co-morbidities was performed with 1,405 CA patients with arrhythmias and 1,405 patients without. The primary outcome of all-cause mortality was significantly higher in CA patients with arrhythmia than without(13.9% vs 5.3%, p-value <0.001). Atrial fibrillation (AF) was the most common (72.2%) arrhythmia in CA patients with concurrent arrhythmia. The secondary outcomes of AF-related mortality (11.95% vs 9.16%, p-value = 0.02) and acute and acute on chronic as heart failure (HF) exacerbation (32.38% vs 24.91%, p-value <0.0001) were significantly higher in CA and concurrent arrhythmia compared with CA patients without. The total length of hospital stay (6[3 to 12] vs 5[3 to 10], p-value <0.001) and cost of hospitalization were ($ 15,086[7,813 to 30,373] vs $ 12,219[6,865 to 23,997], p-value = 0.001) were significantly greater among CA with arrhythmia compared with those without. These data suggest that the presence of arrhythmias in CA patients during hospital admission is associated with a poorer prognosis and may reflect patients with a higher risk of HF exacerbation and mortality.
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Affiliation(s)
- Samarthkumar Thakkar
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Harsh P Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, Illinois
| | - Medhat Chowdhury
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Kirtenkumar Patel
- Department of Cardiology, North Shore University Hospital, Manhasset, New York
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Shilpkumar Arora
- Department of Cardiology, Case Western University, Cleveland, Ohio
| | - Salman Zahid
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Mishita Goel
- Department of Internal Medicine, Wayne State University/APRH, Rochester, Michigan
| | - Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | | | | | | | - Bipul Baibhav
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York
| | - Mohan Rao
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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13
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Kim ED, Soliman EZ, Coresh J, Matsushita K, Chen LY. Two-Week Burden of Arrhythmias across CKD Severity in a Large Community-Based Cohort: The ARIC Study. J Am Soc Nephrol 2021; 32:629-638. [PMID: 33510037 PMCID: PMC7920167 DOI: 10.1681/asn.2020030301] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/19/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND CKD is associated with sudden cardiac death and atrial fibrillation (AF). However, other types of arrhythmia and different measures of the burden of arrhythmias, such as presence and frequency, have not been well characterized in CKD. METHODS To quantify the burden of arrhythmias across CKD severity in 2257 community-dwelling adults aged 71-94 years, we examined associations of major arrhythmias with CKD measures (eGFR and albuminuria) among individuals in the Atherosclerosis Risk in Communities study. Participants underwent 2 weeks of noninvasive, single-lead electrocardiogram monitoring. We examined types of arrhythmia burden: presence and frequency of arrhythmias and percent time in arrhythmias. RESULTS Of major arrhythmias, there was a higher prevalence of AF and nonsustained ventricular tachycardia among those with more severe CKD, followed by long pause (>30 seconds) and atrioventricular block. Nonsustained ventricular tachycardia was the most frequent major arrhythmia (with 4.2 episodes per person-month). Most participants had ventricular ectopy, supraventricular tachycardia, and supraventricular ectopy. Albuminuria consistently associated with higher AF prevalence and percent time in AF, and higher prevalence of nonsustained ventricular tachycardia. When other types of arrhythmic burden were examined, lower eGFR was associated with a lower frequency of atrioventricular block. Although CKD measures were not strongly associated with minor arrhythmias, higher albuminuria was associated with a higher frequency of ventricular ectopy. CONCLUSIONS CKD, especially as measured by albuminuria, is associated with a higher burden of AF and nonsustained ventricular tachycardia. Additionally, eGFR is associated with less frequent atrioventricular block, whereas albuminuria is associated with more frequent ventricular ectopy. Use of a novel, 2-week monitoring approach demonstrated a broader range of arrhythmias associated with CKD than previously reported.
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Affiliation(s)
- Esther D. Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Elsayed Z. Soliman
- Division of Public Health Sciences, Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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14
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Fingrova Z, Ambroz D, Jansa P, Kuchar J, Lindner J, Kunstyr J, Aschermann M, Linhart A, Havranek S. The prevalence and clinical outcome of supraventricular tachycardia in different etiologies of pulmonary hypertension. PLoS One 2021; 16:e0245752. [PMID: 33471824 PMCID: PMC7817034 DOI: 10.1371/journal.pone.0245752] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Patients with pulmonary hypertension (PH) frequently suffer from supraventricular tachycardias (SVT). The main purpose of our study was to identify the cumulative incidence of SVT in patients with different etiologies of PH. The secondary objective was to analyse the clinical impact of SVT. Methods We retrospectively studied the prevalence of SVT and the clinical outcome in 755 patients (41% males; 60 ± 15 years; mean follow-up 3.8 ± 2.8 years) with PH of different etiologies. The prevalence of SVT was analysed separately in isolated pre-capillary PH (Ipc-PH) and in patients with combined post- and pre-capillary PH (Cpc-PH). Results The prevalence of SVT in the Ipc-PH group (n = 641) was 25% (n = 162). The most prevalent arrhythmias were atrial fibrillation followed by a typical atrial flutter (17% and 4.4% of all Icp-PH patients). An excessive prevalence of SVT was found in patients with pulmonary arterial hypertension associated with congenital heart disease (35%, p = 0.01). Out of the overall study population, Cpc-PH was present in 114 (15%) patients. Patients with Cpc-PH manifested a higher prevalence of SVT than subjects with Ipc-PH (58; 51% vs. 162; 25%; p <0.0001) and were more likely to have persistent or permanent atrial fibrillation (38; 29% vs. 61; 10%; p <0.0001). Parameters significantly associated with mortality in a multivariate analysis included age, male gender, functional exercise capacity and right atrial diameter (p < 0.05). Neither diagnosis of SVT nor type of arrhythmia predicted mortality. Conclusions The study detected a significant prevalence of SVT in the population of PH of different origins. Different spectrum and prevalence of arrhythmia might be expected in different etiologies of PH. Patients with an elevated post-capillary pressure showed a higher arrhythmia prevalence, predominantly due to an excessive number of atrial fibrillations. The diagnosis of SVT was not associated with mortality.
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Affiliation(s)
- Zdenka Fingrova
- 1Faculty of Medicine, 2 Department of Medicine-Department of Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - David Ambroz
- 1Faculty of Medicine, 2 Department of Medicine-Department of Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Pavel Jansa
- 1Faculty of Medicine, 2 Department of Medicine-Department of Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Jan Kuchar
- 1Faculty of Medicine, 2 Department of Medicine-Department of Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
- Regional Hospital in Tabor, Tabor, Czech Republic
| | - Jaroslav Lindner
- 1 Faculty of Medicine, 2 Department of Surgery–Department of Cardiovascular Surgery, General University Hospital, Charles University, Prague, Czech Republic
| | - Jan Kunstyr
- 1 Faculty of Medicine, Department of Anaesthesiology, Resuscitation and Intensive Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Michael Aschermann
- 1Faculty of Medicine, 2 Department of Medicine-Department of Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Ales Linhart
- 1Faculty of Medicine, 2 Department of Medicine-Department of Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Stepan Havranek
- 1Faculty of Medicine, 2 Department of Medicine-Department of Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
- * E-mail:
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15
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Tseng WC, Huang CN, Chiu SN, Lu CW, Wang JK, Lin MT, Chen CA, Wu MH. Long-term outcomes of arrhythmia and distinct electrophysiological features in congenitally corrected transposition of the great arteries in an Asian cohort. Am Heart J 2021; 231:73-81. [PMID: 33098810 DOI: 10.1016/j.ahj.2020.10.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
Congenitally corrected transposition of the great arteries (ccTGA) is associated with various types of arrhythmia, including supraventricular tachycardia (SVT) and complete atrioventricular block (cAVB). Our study aims to characterize the arrhythmia burden, associated risk factors, arrhythmia mechanisms, and the long-term follow-up results in patients with ccTGA in a large Asian cohort. METHODS We enrolled 104 patients (43 women and 61 men) diagnosed with ccTGA at our institution. The mean age at last follow-up was 20.8 years. RESULTS For 40 patients (38%) with tachyarrhythmia, paroxysmal SVT (PSVT) and atrial arrhythmia were observed in 17 (16%) and 27 (26%) patients, respectively, with 4 patients (4%) having both types of SVT. The 20-year and 30-year SVT-free survival rates were 68% and 54%, respectively. Seven patients (7%) developed cAVB: 2 (2%) developed spontaneously, and the other 5 (5%) was surgically complicated (surgical risk of cAVB: 7%, all associated with ventricular septal defect repair surgery). PSVT was mostly associated with accessory pathways (5/9) but also related to twin atrioventricular nodal reentry tachycardia (3/9) and atrioventricular nodal reentry tachycardia (1/9). Most of the accessory pathways were located at tricuspid valve (9/10). Catheter ablation successfully eliminated all PSVT substrates (10/10) and most of the atrial arrhythmia substrates (3/5), with low recurrence rate. CONCLUSIONS The arrhythmia burden in patients with ccTGA is high and increases over time. However, cAVB incidence was relatively low and kept stationary in this Asian cohort. The mechanisms of SVT are complicated and can be controlled through catheter ablation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/surgery
- Atrioventricular Block/epidemiology
- Atrioventricular Block/mortality
- Atrioventricular Block/physiopathology
- Atrioventricular Block/surgery
- Child
- Child, Preschool
- Congenitally Corrected Transposition of the Great Arteries/epidemiology
- Congenitally Corrected Transposition of the Great Arteries/mortality
- Congenitally Corrected Transposition of the Great Arteries/physiopathology
- Congenitally Corrected Transposition of the Great Arteries/surgery
- Electrocardiography
- Female
- Follow-Up Studies
- Heart Septal Defects, Ventricular/surgery
- Humans
- Incidence
- Infant
- Male
- Middle Aged
- Risk Factors
- Survival Rate
- Tachycardia, Atrioventricular Nodal Reentry/epidemiology
- Tachycardia, Atrioventricular Nodal Reentry/mortality
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/mortality
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Taiwan
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No. 1 Jen Ai Rd Section 1, Taipei City, Taiwan
| | - Chi-Nan Huang
- Department of Pediatrics, Taipei, City Hospital Heping Fuyou Branch, No. 12, Fuzhou St, Zhongzheng District, Taipei City, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan.
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
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16
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Alonso A, Rooney MR, Chen LY, Norby FL, Saenger AK, Soliman EZ, O'Neal WT, Hootman KC, Selvin E, Lutsey PL. Circulating electrolytes and the prevalence of atrial fibrillation and supraventricular ectopy: The Atherosclerosis Risk in Communities (ARIC) study. Nutr Metab Cardiovasc Dis 2020; 30:1121-1129. [PMID: 32451276 PMCID: PMC7302995 DOI: 10.1016/j.numecd.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/01/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Evaluating associations of circulating electrolytes with atrial fibrillation (AF) and burden of supraventricular arrhythmias can give insights into arrhythmia pathogenesis. METHODS AND RESULTS We conducted a cross-sectional analysis of 6398 participants of the Atherosclerosis Risk in Communities (ARIC) study, ages 71-90, with data on serum electrolytes (magnesium, calcium, potassium, phosphorus, chloride, sodium). Prevalence of AF was determined from electrocardiograms and history of AF hospitalizations. A subset of 317 participants also underwent electrocardiographic recordings for up to 14 days using the Zio® patch. Burden of other supraventricular arrhythmias [premature atrial contractions (PACs), supraventricular tachycardia] was determined with the Zio® patch. We used logistic and linear regression adjusting for potential confounders to determine associations of electrolytes with arrhythmia prevalence and burden. Among 6394 eligible participants, 614 (10%) had AF. Participants in the top quintiles of magnesium [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.62, 1.08], potassium (OR 0.82, 95%CI 0.68, 1.00), and phosphorus (OR 0.73, 95%CI 0.59, 0.89) had lower AF prevalence compared to those in the bottom quintiles. No clear association was found for circulating chloride, calcium or sodium. Higher concentrations of circulating calcium were associated with lower prevalence of PACs in the 12-lead electrocardiogram, while higher concentrations of potassium, chloride and sodium were associated with higher PAC prevalence. Circulating electrolytes were not significantly associated with burden of PACs or supraventricular tachycardia among 317 participants with extended electrocardiographic monitoring. CONCLUSION Concentrations of circulating electrolytes present complex associations with selected supraventricular arrhythmias. Future studies should evaluate underlying mechanisms.
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Affiliation(s)
- Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Mary R Rooney
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Amy K Saenger
- Chemistry Laboratory, Hennepin Healthcare, Minneapolis, MN, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wesley T O'Neal
- Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Katie C Hootman
- Metabolic Research Unit, Clinical and Translational Science Center, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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17
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Rujirachun P, Wattanachayakul P, Charoenngam N, Winijkul A, Ungprasert P. Prevalence of atrial arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 21:368-376. [PMID: 32243340 DOI: 10.2459/jcm.0000000000000962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND/OBJECTIVES Little is known about atrial involvement in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Recent studies have suggested that atrial arrhythmia, including atrial fibrillation, atrial flutter (AFL), and atrial tachycardia, was common among these patients although the reported prevalence varied considerably across the studies. The current systematic review and meta-analysis was conducted with the aim of comprehensively investigating the prevalence of overall atrial arrhythmia and each atrial arrhythmia subtype in the setting of ARVC by identifying all relevant studies and combining their results together. METHODS A comprehensive literature review was conducted by searching for published articles indexed in MEDLINE and EMBASE databases from inception through to 22 September 2019 to identify cohort studies of patients with ARVC that described the prevalence of atrial arrhythmia among the participants. The pooled prevalence across studies was calculated using a random-effect, generic inverse variance method of DerSimonian and Laird with a double arcsine transformation. RESULTS A total of 16 cohort studies with 1986 patients with ARVC were included in this meta-analysis. The pooled prevalence of overall atrial arrhythmia among patients with ARVC was 17.9% [95% confidence interval (CI), 13.0-24.0%; I 88%], the pooled prevalence of atrial fibrillation of 12.9% (95% CI, 9.6-17.0%; I 78%), the pooled prevalence of AFL of 5.9% (95% CI, 3.7-9.2%; I 70%), and the pooled prevalence of atrial tachycardia of 7.1% (95% CI, 3.7-13.0%; I 49%). CONCLUSION Atrial arrhythmia is common among patients with ARVC with the pooled prevalence of approximately 18%, which is substantially higher than the reported prevalence of atrial arrhythmia in the general population.
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Affiliation(s)
| | | | | | | | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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18
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Shaikh SA, Jamal SZ, Qadir F, Mumtaz Z, Ullah Z, Mueed A, Karim M, Irfan G. Cardiac electrophysiologic procedures - A ten years' experience at National Institute of Cardiovascular Diseases, Karachi. J PAK MED ASSOC 2019; 69:68-71. [PMID: 30623915] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To review 10 years of clinical practice of cardiac electrophysiology study and radiofrequency catheter ablation in the treatment of supraventricular tachycardia. METHODS The retrospective chart review was conducted at the National Institute of Cardiovascular Diseases, Karachi, and comprised records of all patients who underwent electrophysiological study and / or radiofrequency catheter ablation from January2007 to December 2016. SPSS 21 was used for data analysis. RESULTS Of the 627 patients, 335(53.4%) were females. The overall mean age was 40.99}13.59 years. The major indication for procedure was supraventricular tachycardia 376(59.97%). Final electrophysiological study diagnosis was typical slow fast atrioventricular nodal re-entrant tachycardia in 303(48.3%) patients. The overall success rate was 472(75.3%). Procedure-related complications were reported in 25(4%) patients, and there was 1(0.15%) mortality. CONCLUSIONS Cardiac electrophysiology studies and radiofrequency catheter ablation were found to be an effective and safe method for diagnosis and treatment of supraventricular tachycardia.
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MESH Headings
- Adult
- Catheter Ablation/adverse effects
- Catheter Ablation/methods
- Catheter Ablation/statistics & numerical data
- Diagnosis, Differential
- Electrophysiologic Techniques, Cardiac/adverse effects
- Electrophysiologic Techniques, Cardiac/methods
- Electrophysiologic Techniques, Cardiac/statistics & numerical data
- Female
- Humans
- Male
- Middle Aged
- Outcome and Process Assessment, Health Care
- Pakistan/epidemiology
- Tachycardia, Sinoatrial Nodal Reentry/diagnosis
- Tachycardia, Sinoatrial Nodal Reentry/epidemiology
- Tachycardia, Sinoatrial Nodal Reentry/therapy
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/therapy
- Wolff-Parkinson-White Syndrome/diagnosis
- Wolff-Parkinson-White Syndrome/epidemiology
- Wolff-Parkinson-White Syndrome/therapy
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Affiliation(s)
| | | | - Faisal Qadir
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Zubair Mumtaz
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Zia Ullah
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Abdul Mueed
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Ghazala Irfan
- National Institute of Cardiovascular Diseases (NICVD), Karachi
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19
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Lee JH, Nam GB, Go TH, Hwang J, Kim M, Hwang YM, Kim J, Choi KJ, Kim YH. Alternative strategies to improve success rate of mitral isthmus block. Medicine (Baltimore) 2018; 97:e13060. [PMID: 30508886 PMCID: PMC6283218 DOI: 10.1097/md.0000000000013060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022] Open
Abstract
Achieving bidirectional conduction block (BDB) across the mitral isthmus (MI) is technically challenging. We describe our experience using different ablation strategies for achieving successful MI block.We reviewed the records of patients who had undergone MI ablation for peri-mitral (PM) flutter at our institution from January 2010 to May 2015. We investigated ablation strategies for achieving MI block and their long-term outcomes in terms of recurrence of atrial tachyarrhythmia.Single endocardial MI ablation with or without distal coronary sinus (CS) ablation achieved MI block in 129 out of 236 (54.7%) patients. After failure of MI block, a new MI line ablation, ablation targeting the vein of Marshall (VOM), or anterior line ablation was performed in selected patients. The MI block was achieved in 13 (52.0%) out of 25 patients with new MI line ablation and in 13 (68.4%) out of 19 patients with VOM ablation. Anterior line ablation was tried in 23 patients and the line of block was achieved in 12 (52.2%) patients. Finally, overall PM BDB (PMB, MI block or anterior line block) was achieved in 167 (70.8%) of 236 patients. The incidence atrial tachyarrhythmia was similar between the patients with successful PMB and those with failed PMB (32.9% vs 42.0%, P = .18). In multivariable Cox regression analysis, the PMB was not associated with recurrence of atrial tachyarrhythmia (hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.43-1.12).In conclusion, single endocardial MI line with or without distal CS ablation showed limited success for achieving MI block. Additional substrate modifications such as a new MI line ablation, anterior line ablation, or ablation targeting the VOM may improve the success rate of PMB block. However, the benefits of PMB were not clear in this study.
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Affiliation(s)
- Ji Hyun Lee
- Department of Cardiology, Wonju Severance Christian Hospital, Wonju
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Tae-Hwa Go
- Center of Biomedical Data Science, Wonju College of Medicine, Yonsei University, Wonju
| | - Jongmin Hwang
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Minsu Kim
- Department of Cardiology, Chungnam National University Hospital, Daejeon
| | - You Mi Hwang
- Department of Cardiology, St. Vincent Hospital, Suwon, Korea
| | - Jun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Kee-Joon Choi
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - You-Ho Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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20
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Go AS, Hlatky MA, Liu TI, Fan D, Garcia EA, Sung SH, Solomon MD. Contemporary Burden and Correlates of Symptomatic Paroxysmal Supraventricular Tachycardia. J Am Heart Assoc 2018; 7:e008759. [PMID: 29982228 PMCID: PMC6064827 DOI: 10.1161/jaha.118.008759] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Contemporary data about symptomatic paroxysmal supraventricular tachycardia (PSVT) epidemiology are limited. We characterized prevalence and correlates of symptomatic PSVT within a large healthcare delivery system and estimated national PSVT burden. METHODS AND RESULTS We identified adults with an encounter for potential PSVT between 2010 and 2015 in Kaiser Permanente Northern California, excluding those with prior known atrial fibrillation or atrial flutter. We adjudicated medical records, ECGs, and other monitoring data to estimate positive predictive values for targeted International Classification of Diseases (ICD), 9th and 10th Revisions codes in inpatient, emergency department, and outpatient settings. Combinations of diagnosis codes and settings were used to calculate PSVT prevalence, and PSVT correlates were identified using multivariable regression. We estimated national rates by applying prevalence estimates in Kaiser Permanente to 2010 US Census data. The highest positive predictive values included codes for "PSVT" in the emergency department (82%), "unspecified cardiac dysrhythmia" in the emergency department (27%), "anomalous atrioventricular excitation" as a primary inpatient diagnosis (33%), and "unspecified paroxysmal tachycardia" as a primary inpatient diagnosis (23%). Prevalence of symptomatic PSVT was 140 per 100 000 (95% confidence interval, 100-179) and was higher for individuals who were older, women, white or black, or who had valvular heart disease, heart failure, diabetes mellitus, lung disease, or prior bleeding. We estimate the national prevalence of symptomatic PSVT to be 168 per 100 000 (95% confidence interval, 120-215). CONCLUSIONS Selected diagnostic codes in inpatient and emergency department settings may be useful to identify symptomatic PSVT episodes. We project that at least 0.168% of US adults experience symptomatic PSVT, and certain characteristics can identify people at higher risk.
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Affiliation(s)
- Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA
- Department of Health Research and Policy, Stanford University, Stanford, CA
| | - Mark A Hlatky
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Health Research and Policy, Stanford University, Stanford, CA
- Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, CA
| | - Taylor I Liu
- Department of Cardiac Electrophysiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA
| | - Dongjie Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Elisha A Garcia
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Matthew D Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, CA
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21
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Baykaner T, Zaman JAB, Rogers AJ, Navara R, AlHusseini M, Borne RT, Park S, Wang PJ, Krummen DE, Sauer WH, Narayan SM. Spatial relationship of sites for atrial fibrillation drivers and atrial tachycardia in patients with both arrhythmias. Int J Cardiol 2017; 248:188-195. [PMID: 28733070 PMCID: PMC5865446 DOI: 10.1016/j.ijcard.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) often converts to and from atrial tachycardia (AT), but it is undefined if these rhythms are mechanistically related in such patients. We tested the hypothesis that critical sites for AT may be related to regional AF sources in patients with both rhythms, by mapping their locations and response to ablation on transitions to and from AF. METHODS From 219 patients undergoing spatial mapping of AF prior to ablation at 3 centers, we enrolled 26 patients in whom AF converted to AT by ablation (n=19) or spontaneously (n=7; left atrial size 42±6cm, 38% persistent AF). Both atria were mapped in both rhythms by 64-electrode baskets, traditional activation maps and entrainment. RESULTS Each patient had a single mapped AT (17 reentrant, 9 focal) and 3.7±1.7 AF sources. The mapped AT spatially overlapped one AF source in 88% (23/26) of patients, in left (15/23) or right (8/23) atria. AF transitioned to AT by 3 mechanisms: (a) ablation anchoring AF rotor to AT (n=13); (b) residual, unablated AF source producing AT (n=6); (c) spontaneous slowing of AF rotor leaving reentrant AT at this site without any ablation (n=7). Electrogram analysis revealed a lower peak-to-peak voltage at overlapping sites (0.36±0.2mV vs 0.49±0.2mV p=0.03). CONCLUSIONS Mechanisms responsible for AT and AF may arise in overlapping atrial regions. This mechanistic inter-relationship may reflect structural and/or functional properties in either atrium. Future work should delineate how acceleration of an organized AT may produce AF, and whether such regions can be targeted a priori to prevent AT recurrence post AF ablation.
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Affiliation(s)
- Tina Baykaner
- Stanford University Medical Center, Palo Alto, CA, United States.
| | - Junaid A B Zaman
- Stanford University Medical Center, Palo Alto, CA, United States
| | - Albert J Rogers
- Stanford University Medical Center, Palo Alto, CA, United States
| | - Rachita Navara
- Stanford University Medical Center, Palo Alto, CA, United States
| | | | - Ryan T Borne
- University of Colorado School of Medicine, Denver, CO, United States
| | - Shirley Park
- Stanford University Medical Center, Palo Alto, CA, United States
| | - Paul J Wang
- Stanford University Medical Center, Palo Alto, CA, United States
| | - David E Krummen
- University of California San Diego and Veterans Affairs Medical Center, La Jolla, CA, United States
| | - William H Sauer
- University of Colorado School of Medicine, Denver, CO, United States
| | - Sanjiv M Narayan
- Stanford University Medical Center, Palo Alto, CA, United States
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22
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Aman R, Qureshi AU, Sadiq M. Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms. J PAK MED ASSOC 2017; 67:975-979. [PMID: 28770871] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the yield of 48-hour Holter monitoring in children with unexplained palpitations and the significance of associated symptoms. METHODS This descriptive study was conducted at the Children's Hospital and Institute of Child Health, Lahore, Pakistan, from January 1 to December 31, 2015. All children above 5 years of age with history of intermittent palpitations and normal basic cardiovascular workup were enrolled. A 48-hour Holter study was performed using Motara Holter Monitoring System. Frequency of various symptoms and abnormal Holter findings were analysed. SPSS 21 was used for data analysis. RESULTS Of the 107 patients, 69(64.5%) were males and 38(34.5%) females. The median age was 10 years (interquartile range: 5-18 years). Most common concomitant symptoms with palpitation included syncope/pre-syncope in 35(32.7%) patients, chest pain 22(20.5%), shortness of breath 21(19.6%) and colour change/pallor 11(10.3%). Holter recording was positive in 40(37%) patients. Frequent premature ventricular contractions 12(11.2%) and atrial ectopic beats 9(8.4%) were the most common findings. Holter findings were significantly more common in patients with history of shortness of breath and colour change/pallor during palpitations (p=0.002). CONCLUSIONS Extended 24-hour Holter monitoring in children with palpitations was an inexpensive, non-invasive investigation with a reasonably high diagnostic yield in detecting arrhythmias.
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MESH Headings
- Adolescent
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/epidemiology
- Atrial Premature Complexes/diagnosis
- Atrial Premature Complexes/epidemiology
- Chest Pain/epidemiology
- Child
- Child, Preschool
- Dyspnea/epidemiology
- Electrocardiography, Ambulatory/methods
- Female
- Humans
- Male
- Pakistan/epidemiology
- Pallor/epidemiology
- Syncope/epidemiology
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/epidemiology
- Tachycardia, Ectopic Atrial/diagnosis
- Tachycardia, Ectopic Atrial/epidemiology
- Tachycardia, Reciprocating/diagnosis
- Tachycardia, Reciprocating/epidemiology
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/epidemiology
- Time Factors
- Ventricular Premature Complexes/diagnosis
- Ventricular Premature Complexes/epidemiology
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Maeda T, Sakamoto T, Nagashima M, Hiramatsu T, Yamazaki K. Long-Term Outcome of Arterial Switch Operation Conversion After Failed Senning/Mustard Procedure. Ann Thorac Surg 2016; 102:1573-1579. [PMID: 27262914 DOI: 10.1016/j.athoracsur.2016.03.114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/25/2016] [Accepted: 03/31/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Takuya Maeda
- Division of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiko Sakamoto
- Division of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
| | - Mitsugi Nagashima
- Division of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeshi Hiramatsu
- Division of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
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25
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Cannillo M, Grosso Marra W, Gili S, D'Ascenzo F, Morello M, Mercante L, Mistretta E, Salera D, Zema D, Bissolino A, Fusaro E, Marra S, Libertucci D, Gaita F. Supraventricular Arrhythmias in Patients With Pulmonary Arterial Hypertension. Am J Cardiol 2015; 116:1883-9. [PMID: 26522342 DOI: 10.1016/j.amjcard.2015.09.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022]
Abstract
The onset of supraventricular arrhythmias (SVA) may be associated with clinical worsening in patients with pulmonary arterial hypertension (PAH). However, limited data have been reported, especially at long-term follow-up. Aim of this study was to investigate the incidence of SVA in our patients with PAH, the risk factors correlated to their onset and the prognostic impact. All consecutive patients with PAH without history of SVA were enrolled. Incidence of new SVA was investigated and also the risk factors for SVA. Primary end point of the study was the impact of SVA on a composite of all-cause mortality and re-hospitalization, whereas mortality was the secondary end point. Seventy-seven patients were enrolled. No significant differences in the clinical or instrumental baseline characteristics between the 2 study groups were reported. During a median follow-up of 35 months (interquartile range 21.5 to 53.5), 17 (22%) patients experienced SVA. Development of SVA was associated with worsening of prognostic parameters at the follow-up: increasing of World Health Organization (WHO) functional class (p = 0.005) and N-terminal-pro-brain natriuretic peptide (NT-proBNP) (p = 0.018) and reduction of 6-minute walking distance (p = 0.048), tricuspid annular plane systolic excursion (TAPSE) (p = 0.041), and diffusing capacity of the lung for carbon monoxide (p = 0.025). The primary end point occurred in 13 patients (76%) in the SVA group and in 22 patients (37%) in the group without SVA (p = 0.004), whereas 9 patients (53%) among those with SVA died during the follow-up compared with 8 (13%) among those without (p = 0.001). At multivariate analysis, development of SVA was independently associated with an increased risk to meet the both primary (hazard ratio 2.13; 95% confidence interval 1.07 to 4.34; p = 0.031) and secondary (hazard ratio 4.1; 95% confidence interval 1.6 to 10.6; p = 0.004) end points. In conclusion, during the 3-year follow-up period, 1/3 of patients with PAH developed SVA, which was related to worsening of hemodynamic and functional parameter and independently predicted adverse prognosis.
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Affiliation(s)
- Margherita Cannillo
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
| | - Walter Grosso Marra
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Sebastiano Gili
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Mara Morello
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Lorena Mercante
- Division of Pneumology, Città Della Salute e Della Scienza, Turin, Italy
| | - Elisa Mistretta
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Davide Salera
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Domenica Zema
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Arianna Bissolino
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Enrico Fusaro
- Division of Rheumatology, Città Della Salute e Della Scienza, Turin, Italy
| | - Sebastiano Marra
- Division of Rheumatology, Città Della Salute e Della Scienza, Turin, Italy; Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Daniela Libertucci
- Division of Pneumology, Città Della Salute e Della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
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Chu PY, Hill KD, Clark RH, Smith PB, Hornik CP. Treatment of supraventricular tachycardia in infants: Analysis of a large multicenter database. Early Hum Dev 2015; 91:345-50. [PMID: 25933212 PMCID: PMC4433846 DOI: 10.1016/j.earlhumdev.2015.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/27/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Supraventricular tachycardia (SVT) is the most common arrhythmia in infants. Infants are typically treated with antiarrhythmic medications, but there is a lack of evidence guiding management, thus exposing infants to risks of both inadequate therapy and medication adverse events. We used data from a large clinical database to better understand current practices in SVT management, safety of commonly used medications, and outcomes of hospitalized infants treated for SVT. METHODS This retrospective data analysis included all infants discharged from Pediatrix Medical Group neonatal intensive care units between 1998 and 2012 with a diagnosis of SVT who were treated with antiarrhythmic medications. We categorized infants by the presence of congenital heart disease other than patent ductus arteriosus. Medications were categorized as abortive, acute, or secondary prevention therapies. We used descriptive statistics to describe medication use, adverse events, and outcomes including SVT recurrence and mortality. RESULTS A total of 2848 infants with SVT were identified, of whom 367 (13%) had congenital heart disease. Overall, SVT in-hospital recurrence was high (13%), and almost one fifth of our cohort (18%) experienced an adverse event. Mortality was 2% in the overall cohort and 6% in the congenital heart disease group (p<0.001). Adenosine was the most commonly used abortive therapy, but there was significant practice variation in therapies used for acute treatment and secondary prevention of SVT. CONCLUSION AND PRACTICE IMPLICATION Significant variation in SVT treatment and suboptimal outcomes warrant future clinical trials to determine best practices in treating SVT in infants.
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Affiliation(s)
- Patricia Y Chu
- Duke Clinical Research Institute, Durham, NC, United States
| | - Kevin D Hill
- Duke Clinical Research Institute, Durham, NC, United States; Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, United States
| | - P Brian Smith
- Duke Clinical Research Institute, Durham, NC, United States; Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Christoph P Hornik
- Duke Clinical Research Institute, Durham, NC, United States; Department of Pediatrics, Duke University Medical Center, Durham, NC, United States.
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Wen L, Sun ML, An P, Jiang X, Sun K, Zheng L, Liu QQ, Wang L, Zhao QH, He J, Jing ZC. Frequency of supraventricular arrhythmias in patients with idiopathic pulmonary arterial hypertension. Am J Cardiol 2014; 114:1420-5. [PMID: 25217453 DOI: 10.1016/j.amjcard.2014.07.079] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 11/18/2022]
Abstract
Supraventricular arrhythmias (SVA) may be risk factors of prognosis in patients with pulmonary arterial hypertension. SVA are increasingly reported in patients with pulmonary hypertension, but little is known about their incidence and outcomes for patients with idiopathic pulmonary arterial hypertension (IPAH) in a large cohort. In this 6-year prospective multicenter study, 280 patients with IPAH were enrolled to investigate the incidence of SVA and assess risk factors, clinical manifestation, management, and impact on survival. The cumulative 6-year incidence of SVA was 15.8%. The most common types of SVA were atrial fibrillation (n = 16) and atrial flutter (n = 13), followed by atrial tachycardia (n = 11). Most episodes of SVA were associated with significant clinical deterioration and right-sided cardiac failure. Sinus rhythm was successfully restored in most patients, resulting in clinical recovery. Increased right ventricular diameter, left atrial area, and higher right atrial pressure and pulmonary vascular resistance were associated with increased risk for experiencing SVA. SVA predicted a greater risk for mortality in a stepwise forward Cox analysis (hazard ratio 4.757, 95% confidence interval 2.695 to 8.397, p <0.001). Kaplan-Meier survival curves showed that patients with SVA, mainly permanent SVA, had a lower survival rate than those who did not develop SVA (p = 0.008). In conclusion, SVA often lead to clinical deterioration and may be associated with an increased risk for death in a large cohort of patients with IPAH. Restoration and maintenance of sinus rhythm are important treatment goals in patients with IPAH.
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Affiliation(s)
- Li Wen
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming-Li Sun
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Pei An
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Jiang
- Thrombosis and Vascular Medicine Center, State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kai Sun
- Thrombosis and Vascular Medicine Center, State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lu Zheng
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qian-Qian Liu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qin-Hua Zhao
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing He
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhi-Cheng Jing
- Thrombosis and Vascular Medicine Center, State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Vereczkey A, Gerencsér B, Czeizel AE, Szabó I. Association of certain chronic maternal diseases with the risk of specific congenital heart defects: a population-based study. Eur J Obstet Gynecol Reprod Biol 2014; 182:1-6. [PMID: 25216447 DOI: 10.1016/j.ejogrb.2014.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Received: 03/30/2014] [Revised: 06/18/2014] [Accepted: 08/16/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Previous epidemiological studies have evaluated cases with all congenital heart defects (CHDs), rather than analysing different types of CHD. The objective of this study was to evaluate the possible association of certain chronic maternal diseases with the risk of different types of CHD, because the role of possible environmental factors in the origin of CHDs is unclear in the vast majority of patients. STUDY DESIGN Different types of CHD, diagnosed after lethal outcome (autopsy report) or after surgical intervention (catheter or correction), were evaluated in order to estimate the possible role of chronic maternal diseases in their origin. This analysis was based on the rates of medically recorded chronic maternal diseases in 3562 live-born cases with CHDs, 38,151 population controls without any birth defects, and 16,602 malformed controls with other isolated congenital abnormalities, using the data set of the population-based Hungarian Case-Control Surveillance of Congenital Abnormalities (1980-1996). RESULTS Maternal epilepsy treated with carbamazepine and migraine were found to be associated with higher risk of ventricular septal defect; panic disorders were associated with higher risk of hypoplastic left heart; type I diabetes mellitus was associated with higher risk of coarctation of the aorta; chronic hypertension was associated with higher risk of ventricular septal defect, common atrioventricular canal and common truncus; and paroxysmal supraventricular tachycardia was associated with higher risk of atrial septal defect secundum, common atrioventricular canal and ventricular septal defect. CONCLUSION In conclusion, certain chronic maternal diseases were found to be associated with higher risk of specific CHDs. Appropriate treatment of these diseases may help to prevent these CHDs.
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Affiliation(s)
- A Vereczkey
- Versys Clinics, Human Reproduction Institute, Budapest, Hungary.
| | - B Gerencsér
- Alfréd Rényi Institute of Mathematics, Hungarian Academy of Sciences, Budapest, Hungary
| | - A E Czeizel
- Foundation for the Community Control of Hereditary Diseases, Budapest, Hungary
| | - I Szabó
- Department of Obstetrics and Gynaecology, University of Pécs, Pécs, Hungary
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Janion M, Janion-Sadowska A. [Ventricular and supraventricular arrhythmias in women]. Przegl Lek 2014; 71:142-146. [PMID: 25154210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There are few gender-related differences in electrophysiology regarding occurrence, clinical symptoms and prognosis of arrhythmias. Women tend to have higher incidence of sinus tachycardia and atrio-ventricular nodal re-entry tachycardia. Atrial fibrillation is more frequent among men, but women have worse prognosis as their mortality is higher, "rhythm control" strategy is less favorable and the thromboembolic risk is greater. Ventricular arrhythmias are less common in women and their significance is smaller. As women have longer QTc interval and torsade de pointes is typical women's arrhythmia, physicians must be very careful ordering QT-elongating drugs. Coronary heart disease (CHD) is seldom background for ventricular tachycardia and women with CHD and arrhythmias have better prognosis than men. Sex hormones play important role in women's electrophysiology. Pregnancy increase risk of supraventricular tachycardia and decrease occurrence of torsade de pointes.
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Piyanuttapull S, Patarananakul P. Recurrence rate of PSVT (paroxysmal supraventricular tachycardia) in Rajavithi emergency department. J Med Assoc Thai 2013; 96 Suppl 3:S47-S53. [PMID: 23682522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND PSVT (Paroxysmal Supraventricular Tachycardia) is a common heart disease, especially in young people. Although PSVT is not a life-threatening illness, its symptoms occur in a sudden onset and with increasing frequency. Because of the severity of its symptoms, it can interfere with patients' quality of life and lead to an increase in anxiety levels. The authors found that patients with PSVT tended to have recurrence of symptoms; however, there has been no previous study in Thailand of the rate of recurrent PSVT in adults. Moreover, there has been no study of the factors which precipitate PSVT cause recurrence, and result in hospitalization. OBJECTIVE To study the rate of recurrence of PSVT within 90 days, the precipitating factors that cause PSVT and the relationship between the factors that affect recurrence of symptoms and result in admission to hospital. MATERIAL AND METHOD This was a cross-sectional study of patients who had been diagnosed with PSVT and were treated in the emergency room at Rajavithi Hospital from 1st August 2008-31st August 2011. The primary outcome was recurrence of PSVT within 90 days and its impact on hospital admission. RESULTS The 55 patients in the present study visited the hospital 94 times. The authors found that: 20.0% of patients had recurrence of PSVT within 90 days; 45.7% of patients had no precipitating factors; 33.0% of patients had emotional stress; and 20.0% of patients had stopped taking their medication. Patients who presented at their first visit with a heart rate of more than 200 beats per minute were more likely to have recurrence (statistically significant, HR 2.43, p = 0.017). Patients presenting with low systolic blood pressure (SBP < 90 mmHg), long duration of symptoms, structural heart disease, low serum Hematocrit concentration (Hct < 30%), serum sodium < 135 milligram, and serum potassium < 3.5 milligram were more likely to be admitted to hospital (statistically significant at p = 0.013, 0.012, 0.004, 0.001, 0.001, and 0.004 respectively). CONCLUSION There was a high rate of recurrence of PSVT in patients in the emergency department at Rajavithi Hospital. Significant factors affecting recurrence were patients presenting with initial heart rate of over 200 beats per minute. Low systolic blood pressure, long duration of symptoms, structural heart disease, low serum Hematocrit, low serum sodium and serum potassium were associated with hospitalization.
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Affiliation(s)
- Sumitra Piyanuttapull
- Department of Emergency, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
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Wasmer K, Mönnig G, Bittner A, Dechering D, Zellerhoff S, Milberg P, Köbe J, Eckardt L. Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation. Heart Rhythm 2012; 9:1660-6. [PMID: 22683745 DOI: 10.1016/j.hrthm.2012.06.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antral pulmonary vein isolation (PVI) for treatment of atrial fibrillation may induce left atrial tachycardias (ATs). OBJECTIVE To determine the prevalence, time course of occurrence, mechanisms, and correlation with the electrocardiogram as well as the outcome of ablation of these tachycardias. METHODS AND RESULTS Out of the 839 patients who underwent circumferential antral radiofrequency PVI guided by a circumferential pulmonary vein catheter at our institution between February 2005 and April 2011, 35 patients (4%) developed AT during follow-up. Six patients with left AT and a previous PVI at other institutions were also included. Of these 41 patients (26 men, 63%; age 59 ± 10 years), 26 (63%) had underlying paroxysmal atrial fibrillation and 15 (37%) had persistent atrial fibrillation. AT ablation was performed 47 ± 60 weeks after initial PVI, within the first 3 months in 16 patients (39%). The tachycardia mechanism was focal in 15 patients (37%), macroreentry in 25 patients (61%), and undetermined in 1 (2%). Focal tachycardias had an isoelectric line between distinct P waves in 13 of the 15 patients (87%), while only 4 (16%) with a macroreentrant mechanism had an isoelectric line (P <.001). Although difficult to measure, a P-wave width of >140 ms had the highest sensitivity and specificity to identify macroreentrant mechanism. Ablation was acutely successful in 32 patients (78%) and not successful in 4 (10%). In 5 patients, success could not be determined as the tachycardia terminated or degenerated during mapping. During a mean follow-up of 31 ± 17 months, 11 patients (27%; n = 9 [82%] with macroreentry) underwent repeat ablation procedure for AT. Eight patients had true recurrence, for example, the same AT, and 3 patients had a second mechanism of AT. CONCLUSIONS With the use of an identical ablation protocol, it was found that approximately 4% of the patients developed AT after mere circumferential antral PVI. The majority of ATs developed within a few months after ablation but occurred as late as several years after the initial PVI. Macroreentry was more frequent than a focal mechanism. Broad P waves and isoelectric lines between P waves help to distinguish a focal mechanism from a macroreentrant mechanism. Ablation has a high acute success rate, and AT recurrence occurs predominantly in macroreentrant AT.
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Affiliation(s)
- Kristina Wasmer
- Division of Experimental and Clinical Electrophysiology, Department of Cardiology and Angiology, University Hospital, Muenster, Germany
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Shamszad P, Cabrera AG, Kim JJ, Moffett BS, Graves DE, Heinle JS, Rossano JW. Perioperative atrial tachycardia is associated with increased mortality in infants undergoing cardiac surgery. J Thorac Cardiovasc Surg 2012; 144:396-401. [PMID: 22306216 DOI: 10.1016/j.jtcvs.2012.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 12/19/2011] [Accepted: 01/04/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Few data are available on the frequency or importance of perioperative atrial tachycardia in infants. We hypothesized that atrial tachycardia in infants undergoing cardiac surgery is not rare and is associated with increased morbidity and mortality. METHODS From 2007 through 2010, 777 infants (median age, 1.8 months; interquartile range, 0.33-5.73) underwent cardiac surgery. Their medical records were reviewed for atrial tachycardia during the perioperative period. RESULTS Of the 777 patients, 64 (8.2%) developed atrial tachycardia. The independent risk factors for developing atrial tachycardia included surgical age 6 months or younger (odds ratio, 4.4; 95% confidence interval, 1.1-19.15), use of 3 or more inotropes (odds ratio, 2.9; 95% confidence interval, 1.4-6.2), and heterotaxy syndrome (odds ratio, 2.9; 95% confidence interval, 1.1-7.4). All-cause mortality in the atrial tachycardia group was increased (21.9% vs 7.2%, P<.001) during a median follow-up period of 14.6 months (interquartile range, 6.8-24.6), and atrial tachycardia was independently associated with decreased survival (hazard ratio, 1.9; 95% confidence interval, 1.1-3.8). Infants with perioperative atrial tachycardia had a longer hospital length of stay (32 vs 17 days, P<.001) and duration of inotrope use (10.5 vs 3.0 days, P<.001). A total of 57 patients received antiarrhythmic therapy, with propranolol the most common (n=31). Among the survivors, 48 patients received outpatient antiarrhythmic therapy, which was successfully discontinued in 23 patients at a median duration of 14 months (interquartile range, 5.7-18.6) without recurrence. CONCLUSIONS Atrial tachycardia is common in infants undergoing cardiac surgery and is independently associated with decreased survival. Among survivors, antiarrhythmic agents successfully controlled atrial tachycardia in most patients with a low recurrence risk after discontinuation.
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Affiliation(s)
- Pirouz Shamszad
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, and Department of Pharmacy, Texas Children's Hospital, Houston, TX 77030, USA.
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Mainigi SK, Almuti K, Figueredo VM, Guttenplan NA, Aouthmany A, Smukler J, Sheeron B, Meldrum B, Saenz AD, Tran G, Greenspan AM. Usefulness of radiofrequency ablation of supraventricular tachycardia to decrease inappropriate shocks from implantable cardioverter-defibrillators. Am J Cardiol 2012; 109:231-7. [PMID: 22000775 DOI: 10.1016/j.amjcard.2011.08.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/18/2011] [Accepted: 08/18/2011] [Indexed: 11/30/2022]
Abstract
Inappropriate implantable cardioverter-defibrillator (ICD) therapies can lead to significant adverse events and increased mortality. These therapies are often the result of supraventricular tachycardias (SVTs). The objective of this study was to evaluate the incidence of SVT leading to inappropriate shocks in a large cohort of patients with ICDs and assess the efficacy of radiofrequency ablation (RFA) in decreasing these therapies. Patients with ICDs and recurrent SVTs were identified. A cohort of patients with ICD therapies subsequently underwent electrophysiologic study and RFA. Eighty-four patients (13%) were found to have SVT leading to 122 inappropriate ICD shocks and 130 episodes of antitachycardia pacing therapies. Median time to SVT onset after ICD implantation was 269 days. Electrophysiologic studies were performed in 30 patients. Successful RFA was performed for atrial tachycardia, atrial flutter, or atrioventricular nodal reentrant tachycardia in 22 patients. Ninety-five percent of patients who underwent successful SVT ablation had no further inappropriate ICD therapies compared to 63% of patients in whom ablation was not performed during a mean follow-up of 20.7 ± 11.9 months. In conclusion, SVT is responsible for a significant number of inappropriate ICD therapies. RFA is an effective strategy to substantially decrease subsequent inappropriate ICD therapies.
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Affiliation(s)
- Sumeet K Mainigi
- Section of Electrophysiology, Heart and Vascular Institute, Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
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Ryzhak GA, Zheltysheva ZA. [Metabolic syndrome impact on arrhythmias genesis in elderly women]. Adv Gerontol 2011; 24:658-662. [PMID: 22550875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The article discusses the data of a study aimed at the impact of the metabolic syndrome on arrhythmias in elderly women. Analysis of the data showed that supraventricular arrhythmias were detected in most part of elderly women, ventricular arrhythmias a few less. The share of prognostically unfavorable arrhythmias is small, but they develop linked to the metabolic changes, and dangerous ventricular arrhythmias and atrial fibrillation develop more often in patients with metabolic syndrome.
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Colucci RA, Silver MJ, Shubrook J. Common types of supraventricular tachycardia: diagnosis and management. Am Fam Physician 2010; 82:942-952. [PMID: 20949888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The most common types of supraventricular tachycardia are caused by a reentry phenomenon producing accelerated heart rates. Symptoms may include palpitations (pulsation in the neck), chest pain, lightheadedness or dizziness, and dyspnea. It is unusual for supraventricular tachycardia to be caused by structurally abnormal hearts. Diagnosis is often delayed because of the misdiagnosis of anxiety or panic disorder. Patient history is important in uncovering the diagnosis, whereas the physical examination may or may not be helpful, and usually necessitates use of a Holter monitor or an event recorder to capture the arrhythmia and confirm a diagnosis. Treatment consists of short-term or as needed pharmacotherapy using calcium channel or beta blockers when vagal maneuvers fail to halt or slow the rhythm. In those who require long-term pharmacotherapy, atrioventricular nodal blocking agents or class IC or III antiarrhythmics can be used; however, these agents should generally be managed by a cardiologist. Catheter ablation is an option in patients with persistent or recurrent supraventricular tachycardia who are unable to tolerate long-term pharmacologic management. If Wolff-Parkinson-White syndrome is present, expedient referral to a cardiologist is warranted because ablation is a potentially curative option.
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Affiliation(s)
- Randall A Colucci
- Ohio University College of Osteopathic Medicine, Athens, 45701, USA.
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Lopriore E, Aziz MI, Nagel HT, Blom NA, Rozendaal L, Kanhai HHH, Vandenbussche FPHA. Long-term neurodevelopmental outcome after fetal arrhythmia. Am J Obstet Gynecol 2009; 201:46.e1-5. [PMID: 19344880 DOI: 10.1016/j.ajog.2009.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 11/14/2008] [Accepted: 02/11/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the long-term neurodevelopmental outcome in fetuses with severe tachy- or bradyarrhythmia. STUDY DESIGN This was a follow-up study to assess the neurologic, mental, and psychomotor development in cases with fetal cardiac arrhythmia. RESULTS A total of 44 fetuses were diagnosed with fetal tachy- or bradyarrhythmia: 28 fetuses had supraventricular tachycardia (SVT); 7 fetuses had atrial flutter (AF), and 9 fetuses had atrioventricular block (AVB). The mortality rate was low (6%; 2/35 fetuses) in the SVT and AF groups and high in the AVB group (78%; 7/9 fetuses). Six patients were lost to follow-up evaluation (14%). Neurodevelopmental outcome was normal in all survivors in the SVT and AF groups, except for 1 patient who experienced plexus brachialis injury because of shoulder dystocia. Two of the 3 survivors in the AVB group had severe developmental delay. CONCLUSION The mortality rate and neurodevelopmental impairment in infants with SVT and AF are low, but the mortality rate in infants with AVB is elevated.
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Affiliation(s)
- Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
BACKGROUND Amiodarone hydrochloride has been in use for two decades for the control of ventricular and supraventricular arrhythmias. Established and emerging evidence indicates that amiodarone has an antiarrhythmic efficacy superior to that of most other drugs. HYPOTHESIS The study was undertaken to evaluate the efficacy and acceptability of low-dose amiodarone therapy in the long-term management of supraventricular and ventricular tachyarrhythmias. METHODS A total of 124 patients with symptomatic drug-refractory or life-threatening arrhythmias managed with low-dose oral amiodarone therapy over a 10-year period was analyzed retrospectively. Of these, 45 patients (36%) had ventricular arrhythmias, 52 (42%) had atrial arrhythmias, and 27 (22%) had atrioventricular reentry tachycardia. Loading doses of amiodarone 600 mg daily for 1 week were administered for supraventricular arrhythmias and 600-1200 mg daily for 2 weeks for ventricular arrhythmias. Maintenance daily doses were 194 +/- 48 and 206 +/- 55 mg, respectively. Mean treatment duration was 32 +/- 28 months, with 326.3 patient years of therapy. RESULTS Of 39 patients with sustained ventricular tachyarrhythmias, the actuarial incidence of satisfactory arrhythmia control (absence of sudden cardiac death or nonfatal arrhythmia recurrence) was 78% at 1 year and 71% at 2 years. Satisfactory control of supraventricular arrhythmias (mean ventricular rate < 100/min with significant symptomatic improvement for sustained atrial arrhythmias and < 1 attack per year for paroxysmal atrial or atrioventricular arrhythmias) was achieved in 73, 65, and 62% of patients at 1, 2, and 3 years, respectively. The cumulative incidence of amiodarone-related adverse effects was 5.8 per 100 patient years, with drug withdrawal required in 12 patients (9.7%). Fifteen patients had thyroid dysfunction, 2 had hepatic toxicity, and 1 developed nonfatal pulmonary fibrosis. Overall, the incidence of successful use of amiodarone (satisfactory arrhythmia control and freedom from side effects) was 67, 59, and 53% at 1, 2, and 3 years, respectively. CONCLUSIONS The results of this study suggest that the efficacy of low-dose amiodarone therapy in the management of serious ventricular and supraventricular arrhythmias would be similar to those achieved with higher doses, but with a much more acceptable side effect profile.
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Affiliation(s)
- K L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong
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Fazio G, Corrado G, Pizzuto C, Zachara E, Rapezzi C, Sulafa AK, Sutera L, Stollberger C, Sormani L, Finsterer J, Benatar A, Di Gesaro G, Novo G, Cavusoglu Y, Baumhakel M, Drago F, Carerj S, Pipitone S, Novo S. Supraventricular arrhythmias in noncompaction of left ventricle: Is this a frequent complication? Int J Cardiol 2008; 127:255-6. [PMID: 17467827 DOI: 10.1016/j.ijcard.2007.02.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 02/17/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Isolated left ventricular noncompaction is the result of incomplete myocardial morphogenesis, leading to persistence of the embryonic myocardium. The condition is recognised by an excessively prominent trabecular meshwork and deep intertrabecular recesses of the left ventricle. Whether these intertrabecular recesses are a favorable substrate for supraventricular arrhythmias is unclear, even if the incidence of chronic heart failure seems to be high. RESULTS We evaluated a continuous series of 238 patients affected by noncompaction. In 4 cases the patients reported palpitations and in 4 an episode of syncope. Periodic holter monitoring was performed every 6 months for 4 years. Only 9 patients had documented atrial fibrillation. In no cases we observed supraventricular tachycardia. CONCLUSIONS Noncompaction alone does not seem to be a risk factor for supraventricular arrhythmias.
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Balaguer Gargallo M, Jordán García I, Caritg Bosch J, Cambra Lasaosa FJ, Prada Hermogenes F, Palomaque Rico A. [Supraventricular tachycardia in infants and children]. An Pediatr (Barc) 2007; 67:133-8. [PMID: 17692258 DOI: 10.1016/s1695-4033(07)70573-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Supraventricular tachycardia (SVT) is the second most frequent form of arrhythmia in pediatrics after extrasystole. OBJECTIVES 1. To determine the clinical characteristics and treatment of SVT in infants and children. 2. To determine treatment response and the drugs used. METHOD A retrospective review of 61 cases of SVT requiring PICU admission (1999-2004) was performed. PICU admission was due to persistent SVT after vagal maneuvers. RESULTS There were 61 patients and 39 were boys (63.9%). The mean age was 2.1 years (SD +/- 3.1). Twelve patients had congenital heart disease (19.7%); three (4.9%) were admitted after heart surgery, and the remaining patients had no antecedents (60.7%). The mean cardiac frequency was 238 beats/min (SD +/- 42.86). Heart failure (HF) was observed in 14 patients (23%). Statistically significant differences were found between the presence of HF and time since onset (p < 0.01) and younger age (p < 0.01). The most frequent diagnosis was SVT due to re-entry in 28 patients (45.9%). Medical treatment was required in 46 patients (75.4%) and response was achieved in 35 (57.4%). At crisis the first drug used was adenosine triphosphate (ATP) in 35 patients (61.4%) with good response in 21 (36.8%). As maintenance therapy digoxin was used in 29 patients (50.9%) without relapses in 22 (78.6%). Radiofrequency ablation was required in 17 patients (27.9%), and there were three relapses (17.6%). The ages of patients who underwent ablation ranged from 3.5 days to 13 years. CONCLUSIONS 1. HF was observed mainly in infants. 2. Most of the patients had good response to ATP therapy. 3. Radiofrequency ablation was mainly required in patients aged more than 1 year.
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MESH Headings
- Adenosine Triphosphate/therapeutic use
- Adolescent
- Age Factors
- Anti-Arrhythmia Agents/therapeutic use
- Cardiotonic Agents/therapeutic use
- Catheter Ablation
- Child
- Child, Preschool
- Data Interpretation, Statistical
- Digoxin/therapeutic use
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Failure/diagnosis
- Heart Rate
- Humans
- Infant
- Infant, Newborn
- Male
- Retrospective Studies
- Sex Factors
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/drug therapy
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Treatment Outcome
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Affiliation(s)
- M Balaguer Gargallo
- Servicio de Pediatría, Sección UCIP, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
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Abstract
BACKGROUND Supraventricular tachycardia (SVT) is often described as a recurrent condition that leads to emergency department (ED) visits. However, the epidemiology of ED visits for SVT is unknown. OBJECTIVES To define the frequency of SVT in U.S. EDs and to analyze patient characteristics, ED management, and disposition for such visits. METHODS The authors analyzed data from the National Hospital Ambulatory Medical Care Survey, 1993-2003. SVT cases were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes 426.7 or 427.0 in any of the three diagnostic fields. RESULTS Of the 1.1 billion ED visits over the 11-year study period, an estimated 555,000 (0.05%; 95% confidence interval [CI] = 0.04% to 0.06%) were related to SVT. The annual frequency and population rate appear stable between 1993 and 2003 (p for trend = 0.35). Compared with non-SVT visits, those with SVT were more likely to be older than 65 years of age (26% vs. 15%, p < 0.01) and female (70% vs. 53%, p < 0.01). Electrocardiograms were documented for most visits (91%; 95% CI = 85% to 96%). Approximately half of the patients (51%; 95% CI = 40% to 61%) received an atrioventricular nodal blocking medication, most frequently adenosine (26%; 95% CI = 17% to 36%). SVT visits ended in hospital admission for 24% (95% CI = 15% to 34%). At the other extreme, 44% (95% CI = 32% to 56%) were discharged without planned follow-up. CONCLUSIONS Supraventricular tachycardia accounts for approximately 50,000 ED visits each year. Higher visit rates in older adults and female patients are consistent with prior studies of SVT in the general population. This study provides an epidemiologic foundation that will enable future research to assess and improve clinical management strategies of SVT in the ED.
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Affiliation(s)
- David H Murman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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41
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Mravian SR, Petrukhin VA. [Supraventricular paroxysmal tachycardias during pregnancy: the therapeutic tactics and prognosis]. Klin Med (Mosk) 2007; 85:17-20. [PMID: 17564030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The paper contains recommendations on treatment of supraventricular paroxysmal tachycardias (SVPT) during pregnancy. The recommendations are based on contemporary literature data and authors" own data. SVPT in postural syndrome are shown to be benign and to demand no continuous antiarrhythmic therapy, while tachycardiac attacks are terminated by vagal tests and adenosine application. Relapsing and steady forms of SVPT with a high heart rate are accompanied by subjective symptoms and require preventive antiarrhythmic therapy, which should be conducted considering risk/benefit ratio. According to the authors, sotalol is the most effective and safe pharmaceutical.
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Tongers J, Schwerdtfeger B, Klein G, Kempf T, Schaefer A, Knapp JM, Niehaus M, Korte T, Hoeper MM. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. Am Heart J 2007; 153:127-32. [PMID: 17174650 DOI: 10.1016/j.ahj.2006.09.008] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2006] [Accepted: 09/26/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND In patients with severe pulmonary hypertension (PH), right ventricular function is a main determinant of clinical stability and outcome. Supraventricular tachyarrhythmias (SVTs) may compromise cardiac function and threaten prognosis in patients with PH, but the incidence and clinical relevance of SVTs in PH and chronic right ventricular failure have not been evaluated. METHODS In a 6-year retrospective single-center analysis, 231 consecutive patients followed for pulmonary arterial hypertension, or inoperable chronic thromboembolic PH were studied for SVTs. Analysis included incidence, clinical consequences, treatment, and outcome. RESULTS Thirty-one episodes of SVT were observed in 27 of 231 patients (cumulative incidence 11.7%, annual risk 2.8% per patient), including atrial flutter (n = 15), atrial fibrillation (n = 13), and AV nodal reentry tachycardia (n = 3). Supraventricular tachyarrhythmia onset was almost invariably associated with marked clinical deterioration and right ventricular failure (84% of SVT episodes). Outcome was strongly associated with the type of SVT and restoration of sinus rhythm. During follow-up, cumulative mortality was low (6.3%, follow-up 26 +/- 23 months) when sinus rhythm was restored (all cases of AV nodal reentry tachycardia and atrial flutter). In contrast, 9 of 11 patients with sustained atrial fibrillation died from right ventricular failure (cumulative mortality 82%, follow-up 11 +/- 8 months). CONCLUSIONS In patients with PH, SVTs constitute a relevant problem, often resulting in clinical deterioration. Sustained atrial fibrillation may be associated with a high risk of death from right ventricular failure.
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MESH Headings
- Adult
- Atrial Flutter/epidemiology
- Cardiac Pacing, Artificial
- Catheter Ablation
- Comorbidity
- Electric Countershock
- Electrophysiologic Techniques, Cardiac
- Female
- Humans
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/physiopathology
- Incidence
- Male
- Middle Aged
- Retrospective Studies
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/therapy
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Affiliation(s)
- Joern Tongers
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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43
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Pedrote A, Arana E, García-Riesco L, Maya E, Errazquin F. Radiofrequency catheter ablation of an orthodromic tachycardia in a patient with single ventricle. Int J Cardiol 2006; 112:e38-9. [PMID: 16843551 DOI: 10.1016/j.ijcard.2006.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 02/24/2006] [Indexed: 11/15/2022]
Abstract
Radiofrequency catheter ablation of a recurrent orthodromic tachycardia was performed in a 10-year-old child with single ventricle and bidirectional Glenn procedure before a Fontan operation. Identification of a His bundle electrogram was achieved at the postero-inferior atrioventricular (AV) groove by the inferior vena cava route, and electrophysiological demonstration of a concealed accessory pathway-mediated tachycardia was possible when a ventricular extrastimuli given during the His bundle refractoriness showed advancement of the atrium. A single energy application during tachycardia in the right antero-superior region of the AV groove resulted in the definitive interruption of the accessory pathway.
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Khan M, Kalahasti V, Rajagopal V, Khaykin Y, Wazni O, Almahameed S, Zuzek R, Shah T, Lakkireddy D, Saliba W, Schweikert R, Cummings J, Martin DO, Natale A. Incidence of Atrial Fibrillation in Heart Transplant Patients: Long-Term Follow-Up. J Cardiovasc Electrophysiol 2006; 17:827-31. [PMID: 16903960 DOI: 10.1111/j.1540-8167.2006.00497.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The incidence of atrial fibrillation (AF) in heart transplant patients has not been well documented. METHODS To determine the incidence of AF in a cohort of patients undergoing cardiac transplantation, clinical data were obtained from a prospectively collected database for all consecutive orthotopic heart transplantation (OHT) patients and for all consecutive coronary artery bypass graft (CABG) surgery patients between January 1984 and March 2004 at our institution. A cohort of 1,714 OHT patients and low-risk CABG (normal ejection fraction [EF] and no left ventricular hypertrophy [LVH]) patients were age- and sex-matched. RESULTS The average age in the two groups was 56 +/- 7 years with 87% male and 81% white race and body mass index (BMI) of 26 +/- 4. There were 3 cases of AF (0.3%) in the OHT group and 757 cases of AF (21%) in the low-risk CABG group. The strongest independent predictor of freedom from postoperative AF was having had a transplant (odds ratio [OR] 96, 95% confidence interval [CI] 13-720). The incidence of AF, atrial flutter (AFL), and supraventricular tachycardia (SVT) in OHT was 0.33, 2.8%, and 1.3%, respectively. Given that incidence of AF, AFL, and SVT in historical post-CABG population is 25%, 17%, and 4.3%, transplanted patients appear to have lower incidence of AF, AFL, and SVT than the reference population. Consistent with this, transplanted patients underwent few ablation procedures for atrial arrhythmias. Additionally, the three patients with AF had bicaval anastomoses suggesting the possibility of PACs originating in the donor superior vena cava (SVC) or IVC (inferior vena cava) initiating AF in these patients. CONCLUSIONS In a cohort study of transplant and low-risk CABG patients, the strongest independent predictor of freedom from AF is having undergone transplant surgery. One potential explanation for the markedly lower incidence of AF may be effective isolation of thoracic veins with documented cases retaining the native SVC.
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Affiliation(s)
- Mohammed Khan
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Karamlou T, Silber I, Lao R, McCrindle BW, Harris L, Downar E, Webb GD, Colman JM, Van Arsdell GS, Williams WG. Outcomes After Late Reoperation in Patients With Repaired Tetralogy of Fallot: The Impact of Arrhythmia and Arrhythmia Surgery. Ann Thorac Surg 2006; 81:1786-93; discussion 1793. [PMID: 16631673 DOI: 10.1016/j.athoracsur.2005.12.039] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 12/08/2005] [Accepted: 12/09/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND We evaluated outcomes in patients requiring late reoperation after tetralogy of Fallot (ToF) repair to identify risk factors for arrhythmia and determine whether arrhythmia surgery decreased the risk of subsequent death or recurrent arrhythmia. METHODS Review was performed of all ToF patients from 1969 to 2005 undergoing reoperation late (> 1 year) after repair. Patients with associated lesions, except pulmonary atresia, were included. A total of 249 patients had 278 reoperations. Procedures at initial reoperation included pulmonary valve replacement (PVR) in 217, ablation in 63, and tricuspid valve repair/replacement in 46. Pre-reoperative arrhythmias were present in 75, including supraventricular tachycardia (SVT) in 31, ventricular tachycardia (VT) in 34, and SVT+VT in 10 patients. RESULTS Median age at reoperation was 23 years (range, 1 to 63). Ten-year survival after reoperation was 93%, and was independent of arrhythmia status (p = 0.86). Arrhythmia patients were characterized by older age at initial repair and at late reoperation, tricuspid and pulmonary regurgitation, and longer QRS duration (p < 0.001 for all). Risk factors for post-reoperative recurrent arrhythmia were longer QRS duration and not having PVR. Longer QRS duration, with a cut-point of more than 160 msec, was associated with recurrent SVT (p = 0.004). Supraventricular tachycardia ablation improved arrhythmia-free survival (75% versus 33%, p < 0.001) but VT ablation did not (96% versus 95%, p = 0.50). However, recurrent VT occurred in only 3 patients (10%). CONCLUSIONS Late mortality in patients undergoing reoperation after ToF repair is not impacted by pre-reoperative arrhythmia. Prolongation of QRS identifies patients at risk for recurrent VT and SVT, but recurrent VT is uncommon. Early PVR, and surgical ablation in patients with SVT, decreases arrhythmic risk.
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Affiliation(s)
- Tara Karamlou
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Brembilla-Perrot B, Blangy H. Prevalence of inducible paroxysmal supraventricular tachycardia during esophageal electrophysiologic study in patients with unexplained stroke. Int J Cardiol 2006; 109:344-50. [PMID: 16039731 DOI: 10.1016/j.ijcard.2005.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 06/06/2005] [Accepted: 06/11/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The relationships between stroke and atrial tachycardia or atrial fibrillation were previously reported. Electrophysiological study is one of the means, used to detect and evaluate these atrial tachyarrhythmias. But, some other arrhythmias as paroxysmal supraventricular tachycardia, can be induced during electrophysiologic study and their significance in stroke is unknown. The aim of the study was to assess the significance of inducible paroxysmal supraventricular tachycardia (PSVT) in stroke. METHODS One hundred thirty seven patients, aged 61+/-12 years had unexplained stroke (group I) and were compared to 60 subjects aged 45+/-18.5 years without stroke and history of tachycardia (group II); Holter monitoring (HM), echocardiogram and esophageal electrophysiologic study (EPS) in basal state and after isoproterenol were performed. RESULTS Heart disease was noted in 19 group I patients (14%) and 10 group II patients (17%). In group I, atrial fibrillation or tachycardia (AF-AT) was induced in 20 patients (15%) and PSVT was induced in 19 patients (14%) aged 66+/-12 years. In group II, AF/AT was induced in 3 patients (5%); no group II patient had induced PSVT. After 3+/-1 years, in group I, one of 98 patients without induced arrhythmias had new strokes and 2 had AF; 5 patients with induced AT/AF developed AF; 5 patients with induced PSVT had PSVT's, requiring ablation in 4 of them; 1 died from a new stroke; one had a second non-fatal stroke and 3 patients developed AF (16%). In group II, there were no events. CONCLUSION In 14% of patients with unexplained stroke, PSVT was inducible during esophageal electrophysiologic study. Further studies are warranted to assess the significance of this finding in patients with unexplained stroke.
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Zaballos García M, López Berlanga JL, Navia Roque J. [Perioperative management of cardiac arrhythmia: part II]. Rev Esp Anestesiol Reanim 2006; 53:163-83; quiz 183, 193. [PMID: 16671260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Cardiac arrhythmias are an important cause of complications throughout the perioperative period. Although our understanding of arrhythmias has increased considerably in recent years, they remain a source of concern for anesthesiologists. Our objective was to review steps to take when diagnosing arrhythmia. Although treatment is still largely influenced by therapies used in nonsurgical patients, we will review the approaches that are most applicable to practice situations in which anesthesiologists must manage patients with arrhythmias or at high risk of developing them.
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Affiliation(s)
- M Zaballos García
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Madrid.
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48
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Papagiannis JK. Postoperative arrhythmias in tetralogy of Fallot. Hellenic J Cardiol 2005; 46:402-7. [PMID: 16422127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Affiliation(s)
- John K Papagiannis
- Division of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece.
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Pelliccia A, Maron BJ, Di Paolo FM, Biffi A, Quattrini FM, Pisicchio C, Roselli A, Caselli S, Culasso F. Prevalence and Clinical Significance of Left Atrial Remodeling in Competitive Athletes. J Am Coll Cardiol 2005; 46:690-6. [PMID: 16098437 DOI: 10.1016/j.jacc.2005.04.052] [Citation(s) in RCA: 287] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 04/01/2005] [Accepted: 04/25/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In the present study we assessed the distribution and clinical significance of left atrial (LA) size in the context of athlete's heart and the differential diagnosis from structural heart disease, as well as the proclivity to supraventricular arrhythmias. BACKGROUND The prevalence, clinical significance, and long-term arrhythmic consequences of LA enlargement in competitive athletes are unresolved. METHODS We assessed LA dimension and the prevalence of supraventricular tachyarrhythmias in 1,777 competitive athletes (71% of whom were males), free of structural cardiovascular disease, that were participating in 38 different sports. RESULTS The LA dimension was 23 to 50 mm (mean, 37 +/- 4 mm) in men and 20 to 46 mm (mean, 32 +/- 4 mm) in women and was enlarged (i.e., transverse dimension > or = 40 mm) in 347 athletes (20%), including 38 (2%) with marked dilation (> or = 45 mm). Of the 1,777 athletes, only 14 (0.8%) had documented, symptomatic episodes of either paroxysmal atrial fibrillation (n = 5; 0.3%) or supraventricular tachycardia (n = 9; 0.5%), which together occurred in a similar proportion in athletes with (0.9%) or without (0.8%; p = NS) LA enlargement. Multivariate regression analysis showed LA enlargement in athletes was largely explained by left ventricular cavity enlargement (R2 = 0.53) and participation in dynamic sports (such as cycling, rowing/canoeing) but minimally by body size. CONCLUSIONS In a large population of highly trained athletes, enlarged LA dimension > or = 40 mm was relatively common (20%), with the upper limits of 45 mm in women and 50 mm in men distinguishing physiologic cardiac remodeling ("athlete's heart") from pathologic cardiac conditions. Atrial fibrillation and other supraventricular tachyarrhythmias proved to be uncommon (prevalence < 1%) and similar to that in the general population, despite the frequency of LA enlargement. Left atrial remodeling in competitive athletes may be regarded as a physiologic adaptation to exercise conditioning, largely without adverse clinical consequences.
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Affiliation(s)
- Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Rome, Italy.
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Sedrakyan A, Treasure T, Browne J, Krumholz H, Sharpin C, van der Meulen J. Pharmacologic prophylaxis for postoperative atrial tachyarrhythmia in general thoracic surgery: Evidence from randomized clinical trials. J Thorac Cardiovasc Surg 2005; 129:997-1005. [PMID: 15867772 DOI: 10.1016/j.jtcvs.2004.07.042] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrial tachyarrhythmia is the most common complication after general thoracic surgery and is associated with significant morbidity, longer hospital stay, and higher costs. We sought to determine whether the use of antiarrhythmic medications is associated with a reduced rate of postoperative atrial tachyarrhythmia. METHODS MEDLINE, EMBASE, Cochrane Database of clinical trials (1980-2003), and reference lists of relevant articles were searched for randomized controlled trials with placebo control, general thoracic patients, and noncombined and prophylactic use of the medications. Search, data abstraction, and analyses were performed and confirmed by at least 2 authors. A fixed-effects model was used to perform meta-analyses. RESULTS There were 11 unique trials (total n = 1294) that met the inclusion criteria. Calcium-channel blockers and beta-blockers reduced the risk of atrial tachyarrhythmia in 4 and 2 trials, respectively (relative risk of 0.50 and 95% confidence interval of 0.34-0.73; relative risk of 0.40 and 95% confidence interval of 0.17-0.95, respectively). However, beta-blockers tended to increase the risk of pulmonary edema (relative risk, 2.15; 95% confidence interval, 0.74-6.23). Magnesium tested in one unblinded trial also reduced the risk of atrial tachyarrhythmia (relative risk, 0.4; 95% confidence interval, 0.21-0.78). On the other hand, digitalis preparations were found to be harmful because they increased the risk of atrial tachyarrhythmia in 3 trials (relative risk, 1.51; 95% confidence interval, 1.00-2.28). Finally, 2 other medications, flecainide and amiodarone, were each tested in a single small trial, and their effects were associated with great uncertainty. CONCLUSIONS Calcium-channel blockers and beta-blockers are effective in reducing postoperative atrial tachyarrhythmia. The use of these medications should be individualized, and possible adverse events of beta-blockers should be taken into account. Randomized clinical trials do not support the use of digitalis in general thoracic surgery. The value of magnesium as a supplement to a main prophylactic regimen should be explored.
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Affiliation(s)
- Artyom Sedrakyan
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, 35-43 Lincoln's Inn Fields, London WC2A 3PE, England, UK.
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