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Heart, Lung & Circulation Nov 2018Sotalol is a non-selective beta-adrenergic blocking agent without intrinsic sympathomimetic activity. It has the additional unique property of producing pronounced... (Review)
Review
Sotalol is a non-selective beta-adrenergic blocking agent without intrinsic sympathomimetic activity. It has the additional unique property of producing pronounced prolongation of the cardiac action potential duration. Sotalol therapy has been indicated for the management of supraventricular arrhythmias, refractory life threatening ventricular arrhythmias and atrial fibrillation/flutter. Until recently, sotalol was only available in the oral form, however, it was approved for intravenous administration by the US Food & Drug Administration (FDA). The current recommendations are for sotalol 75-150mg to be administered intravenously over 5hours. This rate of administration does not reflect the majority of the research that has been performed with regards to intravenous sotalol. Also, the safety of intravenous bolus dosing of 100mg over 1 and 5minutes has previously been demonstrated. The antiarrhythmic action of sotalol depends on its ability to prolong refractoriness in the nodal and extra nodal tissue. Hence, by giving a lower dose over a long duration, patients may not necessarily benefit from its anti-arrhythmic potential. The purpose of this article is to review the research that has been conducted with regards to dosage and safety of intravenous sotalol, its electrophysiological effects and finally the spectrum of arrhythmias in which it has been used to date.
Topics: Adrenergic beta-Antagonists; Arrhythmias, Cardiac; Dose-Response Relationship, Drug; Humans; Injections, Intravenous; Sotalol
PubMed: 29853342
DOI: 10.1016/j.hlc.2018.03.017 -
Journal of the Neurological Sciences Feb 2019Takotsubo syndrome(TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate... (Review)
Review
Takotsubo syndrome(TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate and delayed detection of seizure-induced TTS differ. We screened the literature and compared clinical and electrocardiographic (ECG) findings. In 48 cases with seizure-associated TTS, the time between seizure and TTS-detection was reported. Troponin levels were elevated in 37/40. ECG abnormalities were negative T-waves(40%), ST-elevations(33%) and ventricular fibrillation/flutter(10%). Immediate detection was reported in 23 patients, in the remaining 25 patients, TTS was detected 5-288 h postictally. Patients did not differ in gender, age or symptoms. Negative T-waves were more frequent in patients with delayed detection(64 vs. 13%, p = .0009), whereas ECG-abnormalities suggesting acute myocardial infarction tended to be more prevalent in patients with immediate detection. Due to lack of typical symptoms, seizure-induced TTS can be overlooked. Postictally, an ECG should be recorded and troponin levels measured. New T-wave inversions might indicate seizure-induced TTS.
Topics: Electrocardiography; Humans; Seizures; Takotsubo Cardiomyopathy; Time Factors; Ventricular Dysfunction, Left
PubMed: 30583237
DOI: 10.1016/j.jns.2018.12.005 -
International Heart Journal Jan 2019Emery-Dreifuss muscular dystrophy (EDMD) is a group of hereditary muscular dystrophy syndrome caused by deficiency of genes encoding nuclear envelope proteins. Patients... (Review)
Review
Emery-Dreifuss muscular dystrophy (EDMD) is a group of hereditary muscular dystrophy syndrome caused by deficiency of genes encoding nuclear envelope proteins. Patients having EDMD show the triad of muscle dystrophy, joint contracture, and cardiac disease. In almost all patients, cardiac involvement is prevalent and is the most severe aspect of EDMD. Cardiac disease is predominantly shown by conduction defects, atrial fibrillation/flutter, and atrial standstill. Sudden death and heart failure because of left ventricular dysfunction are important causes of mortality, particularly in those patients that have the LMNA mutation. Medical treatment of EDMD is limited to addressing symptoms and ambulation support; moreover, pacemaker implantation is necessary when there are severe conduction defects and bradycardia occurs. Note that automated defibrillation devices may be considered for those patients who have a high risk of sudden death, rate, or rhythm control. Also, anticoagulation should be initiated in those patients who have atrial fibrillation/flutter. Thus, for optimal management, a multidisciplinary approach is required.
Topics: Abnormalities, Multiple; Anticoagulants; Atrial Fibrillation; Cardiomyopathies; Cleft Palate; Contracture; Death, Sudden; Female; Genetic Diseases, Inborn; Heart Atria; Heart Block; Heart Diseases; Humans; Hydrocephalus; Interdisciplinary Communication; Limb Deformities, Congenital; Male; Muscular Dystrophies; Muscular Dystrophy, Emery-Dreifuss; Pacemaker, Artificial; Ventricular Dysfunction, Left
PubMed: 30518714
DOI: 10.1536/ihj.17-604 -
Arquivos Brasileiros de Cardiologia Sep 2022PRKAG2 syndrome is a rare autosomal dominant disease, a phenocopy of hypertrophic cardiomyopathy characterized by intracellular glycogen accumulation. Clinical...
BACKGROUND
PRKAG2 syndrome is a rare autosomal dominant disease, a phenocopy of hypertrophic cardiomyopathy characterized by intracellular glycogen accumulation. Clinical manifestations include ventricular preexcitation, cardiac conduction disorder, ventricular hypertrophy, and atrial arrhythmias.
OBJECTIVE
To compare the clinical and electrophysiological characteristics observed in patients with atrial flutter, with and without PRKAG2 syndrome.
METHODS
An observational study comparing patients with atrial flutter: group A consisted of five patients with PRKAG2 syndrome from a family, and group B consisted of 25 patients without phenotype of PRKAG2 syndrome. The level of significance was 5%.
RESULTS
All patients in group A had ventricular preexcitation and right branch block, and four had pacemakers (80%). Patients in group A were younger (39±5.4 vs 58.6±17.6 years, p=0.021), had greater interventricular septum (median=18 vs 10 mm; p<0.001) and posterior wall thickness (median=14 vs 10 mm; p=0.001). In group A, four patients were submitted to an electrophysiological study, showing a fasciculoventricular pathway, and atrial flutter ablation was performed in tree. All patients in group B were submitted to ablation of atrial flutter, with no evidence of accessory pathway. Group B had a higher prevalence of hypertension, diabetes mellitus, coronary artery disease and sleep apnea, with no statistically significant difference.
CONCLUSION
Patients with PRKAG2 syndrome presented atrial flutter at an earlier age and had fewer comorbidities when compared to patients with atrial flutter without mutation phenotype. The occurrence of atrial flutter in young individuals, especially in the presence of ventricular preexcitation and familial ventricular hypertrophy, should raise the suspicion of PRKAG2 syndrome.
PubMed: 36102422
DOI: 10.36660/abc.20210792 -
International Journal of Cardiology Jan 2016It has been almost a century since atrial infarction was first described, yet data describing its significance remain limited. To date, there are still no universally... (Review)
Review
It has been almost a century since atrial infarction was first described, yet data describing its significance remain limited. To date, there are still no universally accepted criteria for the diagnosis of atrial infarction. Atherosclerosis is the leading cause of atrial infarction but it has also been described in cor pulmonale and pulmonary hypertension. Atrial infarction almost always occurs concomitantly with ventricular infarction. Its clinical presentation depends largely on the extent and site of ventricular involvement. Atrial infarction can present with supraventricular tachyarrhythmias. Electrocardiographic (ECG) criteria for diagnosing atrial infarction have been described but none have yet to be validated by prospective studies. Atrial ECG patterns include abnormal P-wave morphologies, PR-segment deviations, as well as transient rhythm abnormalities, including atrial fibrillation, atrial flutter, atrial tachycardia, wandering atrial pacemaker (WAP) and atrioventricular (AV) blocks. Complications of atrial infarction include thromboembolic events and cardiogenic shock. There are no specific additional recommendations in the management of myocardial infarction with suspected involvement of the atria. The primary goal remains coronary reperfusion and maintenance of, or conversion to, sinus rhythm.
Topics: Electrocardiography; Heart Atria; Humans; Myocardial Infarction; Prospective Studies
PubMed: 26485186
DOI: 10.1016/j.ijcard.2015.10.070 -
Journal of Community Hospital Internal... 2018The term 'flutter' and 'fibrillation' were first coined to differentiate the differences between fast, regular contractions in Atrial Flutter (AFLUT) with irregular,... (Review)
Review
The term 'flutter' and 'fibrillation' were first coined to differentiate the differences between fast, regular contractions in Atrial Flutter (AFLUT) with irregular, vermiform contractions of Atrial Fibrillation (AFIB). Management of these two diseases has been a challenge for physicians. Rate control (along with rhythm control) is the first line of management for symptomatic AFIB/AFLUT with Rapid Ventricular Rate (RVR). In some situations, atrial rhythms may not be well controlled by these anti-arrhythmic drugs, making cardioversion to sinus rhythm necessary. Anti-coagulation therapy in both the disease population is essential. Catheter ablation is an effective treatment option in certain patients that have AFIB/AFLUT refractory to medical management. Newer techniques like left atrial appendage (LAA) has been developed and is a highly attractive concept for the future in the management of AFIB/AFLUT. Newer novel drugs targeting specific ion channels are approaching the stages of clinical investigation. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain. This literature review serves as one of the guideline papers for current up-to-date management on both AFIB and AFLUT.
PubMed: 30357020
DOI: 10.1080/20009666.2018.1514932 -
Europace : European Pacing,... Dec 2023In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of...
AIMS
In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of administrative data.
METHODS AND RESULTS
We determined the incidences of in-hospital mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German tertiary centres between 2005 and 2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all complications were individually reviewed based on patient-level source records. Overall, 43 031 ablations were analysed (30 361 AF; 9364 AFL; 3306 VT). The number of ablations/year more than doubled from 2005 (n = 1569) to 2020 (n = 3317) with 3 times and 2.5 times more AF and VT ablations in 2020 (n = 2404 and n = 301, respectively) as compared to 2005 (n = 817 and n = 120, respectively), but a rather stable number of AFL ablations (n = 554 vs. n = 612). Major peri-procedural complications occurred in 594 (1.4%) patients. Complication rates were 1.1% (n = 325) for AF, 1.0% (n = 95) for AFL, and 5.3% (n = 175) for VT. With an increase in complex AF/VT procedures, the overall complication rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; P = 0.004); but remained low over time. Following patient-adjudication, all in-hospital cardiac tamponades (0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications requiring surgical intervention occurred in 0.4% of all patients. The in-hospital mortality rate adjudicated to be ablation-related was lower than the coded mortality rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%.
CONCLUSION
Major adverse events are low and comparable after catheter ablation for AFL and AF (∼1.0%), whereas they are five times higher for VT ablations. In the presence of an increase in complex ablation procedures, a moderate but significant increase in overall complications from 2005-20 was observed. Individual case analysis demonstrated a lower than coded ablation-related in-hospital mortality. This highlights the importance of individual case adjudication when analysing administrative data.
Topics: Humans; Hospital Mortality; Atrial Fibrillation; Atrial Flutter; Tachycardia, Ventricular; Hospitals; Stroke; Catheter Ablation; Treatment Outcome
PubMed: 38102318
DOI: 10.1093/europace/euad361 -
Anatolian Journal of Cardiology Mar 2023Over the past few years, smartwatches have become increasingly popular in the monitoring of arrhythmias. Although the detection of atrial fibrillation with smartwatches... (Review)
Review
BACKGROUND
Over the past few years, smartwatches have become increasingly popular in the monitoring of arrhythmias. Although the detection of atrial fibrillation with smartwatches has been the subject of various articles, there is no comprehensive research on the detection of arrhythmias other than atrial fibrillation. In this study, we included individual cases from the literature to identify the characteristics of patients with smartwatch-detected arrhythmias other than atrial fibrillation.
METHODS
PubMed, Embase, and SCOPUS were searched for case reports, case series, or cohort studies that reported individual participant-level data, until January 6, 2022. The following search string was used for each databases: ('Smart Watch' OR 'Apple Watch' OR 'Samsung Gear') AND ('Supraventricular Tachycardia' OR 'Cardiac Arrhythmia' OR 'Ventricular Tachycardia' OR 'Atrioventricular Nodal Reentry Tachycardia' OR 'Atrioventricular Reentrant Tachycardia' OR 'Heart Block' OR 'Atrial Flutter' OR 'Ectopic Atrial Tachycardia' OR 'Bradyarrhythmia').
RESULTS
A total of 52 studies from PubMed, 20 studies from Embase, and 200 studies from SCOPUS were identified. After screening, 18 articles were included. A total of 22 patients were obtained from 14 case reports or case series. Four cohort studies evaluating various arrhythmias were included. Arrhythmias, including ventricular tachycardia, atrial fibrillation, atrial flutter, atrioventricular nodal reentry tachycardia, atrioventricular reentrant tachycardia, second- or third-degree atrioventricular block, and sinus bradycardia, were detected with smartwatches.
CONCLUSIONS
Cardiac arrhythmias other than atrial fibrillation are also commonly detected with smartwatches. Smartwatches have an important potential besides traditional methods in the detection of arrhythmias and clinical practice.
Topics: Humans; Atrial Fibrillation; Bradycardia; Atrial Flutter; Tachycardia, Ventricular; Atrioventricular Block; Tachycardia, Atrioventricular Nodal Reentry
PubMed: 36856589
DOI: 10.14744/AnatolJCardiol.2023.2799 -
Expert Review of Medical Devices Jul 2015Manual radio frequency (RF) ablation to restore a normal cardiac rhythm requires significant skill, manual dexterity and experience. In response to this, ablation... (Review)
Review
Manual radio frequency (RF) ablation to restore a normal cardiac rhythm requires significant skill, manual dexterity and experience. In response to this, ablation methods and technologies have evolved rapidly in the past decade, including the development of remote navigation technologies. Today, two principal methods of remote navigation are available. One utilizes magnetic field vectors to navigate proprietary catheters, the other maneuvers standard catheters robotically. The main advantages of remote navigation include improved catheter stability, reduced fluoroscopy times and decreased total radiation exposure to both the patient and the operator. The main limitations include cost and longer procedure times. Remote magnetic navigation appears to have the best safety profile; however, its efficacy in creating lesions may be lower, which has been attributed to the soft-tip catheter used. Remote robotic navigation on the other hand, which uses regular catheter tips, is associated with a slightly higher overall complication rate, but higher efficacy. This article reviews the pros and cons of remote navigation for ablation of both atrial and ventricular substrates. Finally, it attempts to predict the direction of this field in the coming years.
Topics: Catheter Ablation; Humans; Robotic Surgical Procedures
PubMed: 26076371
DOI: 10.1586/17434440.2015.1052406 -
Herzschrittmachertherapie &... Dec 2019Catheter ablation is a well-recognized treatment for a number of cardiac arrhythmias. Initially used to treat supraventricular tachycardia, this technique is now also... (Review)
Review
Catheter ablation is a well-recognized treatment for a number of cardiac arrhythmias. Initially used to treat supraventricular tachycardia, this technique is now also widely used to treat ventricular arrhythmia and atrial fibrillation. This review aims to describe all the possible types of complication related to this invasive procedure. Definitions according to the current guidelines are provided, as are some details on the frequency of complications and how to diagnose and treat them appropriately. Finally, each section of the review provides guidance on how to prevent the complications associated with catheter ablation.
Topics: Atrial Flutter; Catheter Ablation; Humans; Incidence; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Supraventricular
PubMed: 31754784
DOI: 10.1007/s00399-019-00652-z