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Deutsches Arzteblatt International May 2018Heart failure affects 1–2% of the population and is associated with elevated morbidity and mortality. Cardiac arrhythmias are often a result of heart failure, but they... (Review)
Review
BACKGROUND
Heart failure affects 1–2% of the population and is associated with elevated morbidity and mortality. Cardiac arrhythmias are often a result of heart failure, but they can cause left-ventricular systolic dysfunction (LVSD) as an arrhythmia-induced cardiomyopathy (AIC). This causal relationship should be borne in mind by the physician treating a patient with systolic heart failure in association with cardiac arrhythmia.
METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed (1987–2017) and on the recommendations in current guidelines.
RESULTS
The key criterion for the diagnosis of an AIC is the demonstration of a persistent arrhythmia (including pathological tachycardia) together with an LVSD whose origin cannot be explained on any other basis. Nearly any type of tachyarrhythmia or frequent ventricular extrasystoles can lead, if persistent, to a progressively severe LVSD. The underlying pathophysiologic mechanisms are incompletely understood; the increased ventricular rate, asynchronous cardiac contractions, and neurohumoral activation all seem to play a role. The most common precipitating factors are supraventricular tachycardias in children and atrial fibrillation in adults. Recent studies have shown that the causal significance of atrial fibrillation in otherwise unexplained LVSD is underappreciated. The treatment of AIC consists primarily of the treatment of the underlying arrhythmia, generally with drugs such as beta-blockers and amiodarone. Depending on the type of arrhythmia, catheter ablation for long-term treatment should also be considered where appropriate. The diagnosis of AIC is considered to be well established when the LVSD normalizes or improves within a few weeks or months of the start of targeted treatment of the arrhythmia.
CONCLUSION
An AIC is potentially reversible. The timely recognition of this condition and the appropriate treatment of the underlying arrhythmia can substantially improve patient outcomes.
Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiomyopathies; Humans; Prognosis; Tachycardia, Supraventricular; Ventricular Dysfunction, Left
PubMed: 29875055
DOI: 10.3238/arztebl.2018.0335 -
Deutsche Medizinische Wochenschrift... Apr 2020
Topics: Arrhythmias, Cardiac; Humans
PubMed: 32294776
DOI: 10.1055/a-0952-9549 -
Texas Heart Institute Journal Sep 2021
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Humans; Long QT Syndrome; Syndrome; Tachycardia, Ventricular
PubMed: 34669951
DOI: 10.14503/THIJ-20-7482 -
Journal of Cardiovascular... Apr 2021
Topics: Arrhythmias, Cardiac; Cardiomyopathies; Heart Failure; Humans; Myocardium
PubMed: 33625774
DOI: 10.1111/jce.14962 -
Cell Biochemistry and Biophysics Nov 2015The cardiac arrhythmia is characterized by irregular rhythm of heartbeat which could be either too slow (<60 beats/min) or too fast (>100 beats/min) and can happen at...
The cardiac arrhythmia is characterized by irregular rhythm of heartbeat which could be either too slow (<60 beats/min) or too fast (>100 beats/min) and can happen at any age. The use of pacemaker and defibrillators devices has been suggested for heart arrhythmias patients. The antiarrhythmic medications have been reported for the treatment of cardiac arrhythmias or irregular heartbeats. The diagnosis, symptoms, and treatments of cardiac arrhythmias as well as the radiofrequency ablation, tachycardia, Brugada syndrome, arterial fibrillation, and recent research on the genetics of cardiac arrhythmias have been described here.
Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Brugada Syndrome; Catheter Ablation; Defibrillators; Electrocardiography; Heart; Humans; Pacemaker, Artificial
PubMed: 25737133
DOI: 10.1007/s12013-015-0626-4 -
Circulation Journal : Official Journal... 2007Inherited cardiac arrhythmia syndromes have received a lot of attention in recent years, particularly the molecular genetic basis, which has been unraveled to a great... (Review)
Review
Inherited cardiac arrhythmia syndromes have received a lot of attention in recent years, particularly the molecular genetic basis, which has been unraveled to a great extent in the past years. Disease entities have been subdivided based on their causal gene defect, which, indeed, has been shown to impact on disease expression, clinical characteristics, prognosis and treatment. This particularly holds for the long QT syndrome. Studies in other, more recently described, disease entities, such as Brugada syndrome, catecholaminergic polymorphic ventricular arrhythmias and the short QT syndrome, are ongoing. For some of them the heterogenetic nature has just very recently been established. For these reasons, genetic testing has been introduced to clinical practice in several countries, which enables timely treatment of affected individuals and reassurance of those not inheriting the causal gene defect. Presymptomatic testing, however, is not without drawbacks. Psychosocial studies are needed in this field and should be promoted. It is likely that this development will further increase the knowledge of the (patho-) physiology of these disease entities, but also of more common arrhythmia syndromes.
Topics: Arrhythmias, Cardiac; Electrocardiography; Genetic Predisposition to Disease; Genetic Testing; Heart Conduction System; Heart Rate; Heredity; Humans; Phenotype; Syndrome
PubMed: 17587734
DOI: 10.1253/circj.71.a12 -
JACC. Clinical Electrophysiology Mar 2019After the most common causes of sudden cardiac death including ischemic and structural heart disease have been ruled out, clinicians on the front lines of emergent... (Review)
Review
After the most common causes of sudden cardiac death including ischemic and structural heart disease have been ruled out, clinicians on the front lines of emergent medical care can be faced with unexplained and recurrent life-threatening arrhythmia episodes in children and adults. In these cases, an inherited arrhythmia syndrome should be suspected, and a departure from conventional advanced cardiac life support algorithms may be required. This review focuses on the electrocardiographic clues of an inherited arrhythmia syndrome that can be uncovered through a careful analysis of the baseline electrocardiogram (ECG) and classification of the presenting ventricular arrhythmia and its mode of onset. After presenting an informed working diagnosis and an explanation of the implied electrophysiologic mechanisms, discussion provides a protocol approach to acute and subacute management decisions. Careful attention to a patient's response to treatment and its ECG surrogates have the potential to facilitate tailored therapy based on the underlying arrhythmogenic substrate and pathophysiology.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Electrocardiography; Heart Arrest; Heart Ventricles; Humans
PubMed: 30898228
DOI: 10.1016/j.jacep.2019.02.001 -
Nature Reviews. Cardiology Feb 2017The cardiovascular benefits of physical activity are indisputable. Nevertheless, growing evidence suggests that both atrial fibrillation and right ventricular arrhythmia... (Review)
Review
The cardiovascular benefits of physical activity are indisputable. Nevertheless, growing evidence suggests that both atrial fibrillation and right ventricular arrhythmia can be caused by intense exercise in some individuals. Exercise-induced atrial fibrillation is most commonly diagnosed in middle-aged, otherwise healthy men who have been engaged in endurance training for >10 years, and is mediated by atrial dilatation, parasympathetic enhancement, and possibly atrial fibrosis. Cardiac ablation is evolving as a first-line tool for athletes with exercise-induced arrhythmia who are eager to remain active. The relationship between physical activity and right ventricular arrhythmia is complex and involves genetic and physical factors that, in a few athletes, eventually lead to right ventricular dilatation, followed by subsequent myocardial fibrosis and lethal ventricular arrhythmias. Sinus bradycardia and atrioventricular conduction blocks are common in athletes, most of whom remain asymptomatic, although incomplete reversibility has been shown after exercise cessation. In this Review, we summarize the evidence supporting the existence of exercise-induced arrhythmias and discuss the specific considerations for the clinical management of these patients.
Topics: Arrhythmias, Cardiac; Athletes; Atrial Fibrillation; Exercise; Humans; Risk Factors; Ventricular Fibrillation
PubMed: 27830772
DOI: 10.1038/nrcardio.2016.173 -
Ryoikibetsu Shokogun Shirizu 1996
Review
Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Catheter Ablation; Diagnosis, Differential; Electrocardiography; Electrophysiology; Humans; Myocardial Ischemia; Ventricular Fibrillation
PubMed: 9047491
DOI: No ID Found -
Nihon Rinsho. Japanese Journal of... 1980
Review
Topics: Action Potentials; Arrhythmias, Cardiac; Electrocardiography; Heart Conduction System; Humans; Pacemaker, Artificial
PubMed: 6997562
DOI: No ID Found