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Journal of Electrocardiology 2018Differentiating between atrial fibrillation (AF) and atrial tachycardia (AT) or atrial flutter (AFL) on surface ECG can be challenging. The same problem arises in animal...
BACKGROUND
Differentiating between atrial fibrillation (AF) and atrial tachycardia (AT) or atrial flutter (AFL) on surface ECG can be challenging. The same problem arises in animal models of AF, in which atrial arrhythmias are induced by pacing or pharmacological intervention with the goal of making mechanistic determinations. Some of these induced arrhythmias can be AFL or AT, even though it might appear as AF on the body-surface ECG based on irregular R-R intervals. We hypothesize that a dominant frequency (DF) analysis of the ECG can differentiate between the two distinct arrhythmias, even when it is not evident by the presence of flutter waves or beat-to-beat regularity when looking at brief recordings.
METHODS
Canine model (n = 15, 10 controls and 5 Persistent AF animals with >6 months of AF) was used to test the hypothesis. Atrial arrhythmia was induced by rapid atrial pacing. Five blinded observers evaluated the 3‑lead surface ECGs recorded during atrial arrhythmia and classified the rhythm as AFL/AT or AF. The 64-electrode Constellation (Boston Scientific) catheter was used to acquire left (entire group) and right (7 of 10 controls) atrial intracardiac electrograms. For the surface ECG and the intracardiac electrograms, Welch method with a hamming window and 50% overlap was used to calculate DF of two-minute segments. Mean of standard deviations of the DF values were calculated for both ECGs and intracardiac EGMs. Ground truth came from activations maps and DF analysis derived from the intracardiac electrograms recorded in the two chambers.
RESULTS
Rapid pacing induced atrial arrhythmias in all the control animals. The ECG in 8 of the 10 control cases was read as AF by at least 80% percent of observers even though the EGMs from the Constellation showed organized activation and consistent DF (STD of DF < 0.001) in all the electrodes confirming the arrhythmia as AFL in 10/10 cases. In the persistent AF group, the DF from the three lead ECGs were significantly different (Mean of STDs = 2.65 ± 0.99) whereas the DF in the control animals with AFL was consistent across all ECG channels (Mean of STDs < 0.001), and the DF in the control animals ECGs was in agreement with the DF of the intracardiac electrograms.
CONCLUSION
Surface ECG recordings can mimic AF even when the underlying atrial arrhythmia is AFL in control canine models. DF variation of the signals from multiple surface ECG leads can help differentiate between the AF and AFL.
Topics: Animals; Atrial Fibrillation; Atrial Flutter; Diagnosis, Differential; Disease Models, Animal; Dogs; Electrocardiography
PubMed: 30029778
DOI: 10.1016/j.jelectrocard.2018.07.010 -
JACC. Clinical Electrophysiology Oct 2017
Topics: Atrial Flutter; Catheter Ablation; Electrodes; Humans; Radiofrequency Ablation; Saline Solution
PubMed: 29759493
DOI: 10.1016/j.jacep.2017.06.002 -
International Heart Journal 2019Severe ventricular arrhythmias such as high-grade atrioventricular block and ventricular tachycardia may cause lethal conditions or sudden death in patients with cardiac...
Severe ventricular arrhythmias such as high-grade atrioventricular block and ventricular tachycardia may cause lethal conditions or sudden death in patients with cardiac sarcoidosis (CS). Physicians should examine patients carefully for these conditions and treat them appropriately. As arrhythmias are being better diagnosed and treated, physicians are increasingly aware of atrial arrhythmias, which have not been focused upon as CS-related conditions, in patients with CS. This article reports a case of atrial flutter in sarcoidosis, and discusses literature findings on atrial arrhythmias and atrial involvement of CS. It is highly likely that atrial arrhythmia and supraventricular conduction disorder associated with or caused by CS are more common than previously thought. Physicians should pay careful attention for these conditions in the diagnosis and treatment of CS.
Topics: Atrial Fibrillation; Atrial Flutter; Cardiomyopathies; Catheter Ablation; Echocardiography; Electrocardiography, Ambulatory; Heart Atria; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Sarcoidosis
PubMed: 31353344
DOI: 10.1536/ihj.19-265 -
The Journal of Cardiovascular NursingDepression and anxiety in patients with atrial fibrillation (AF) and/or atrial flutter may influence the effectiveness of cardioversion and ablation. There is a lack of...
BACKGROUND
Depression and anxiety in patients with atrial fibrillation (AF) and/or atrial flutter may influence the effectiveness of cardioversion and ablation. There is a lack of knowledge related to depressive symptoms and anxiety at the time of these procedures.
OBJECTIVE
We aimed to describe the prevalence and explore potential covariates of depressive symptoms and anxiety in patients with AF at the time of cardioversion or ablation. We further explored the influence of depressive symptoms and anxiety on quality of life at the time of procedure and 6-month AF recurrence.
METHODS
Depressive symptoms, anxiety, and quality of life were collected at the time of cardioversion or ablation using the Patient Health Questionnaire-9, State-Trait Anxiety Inventory, and Atrial Fibrillation Effect on Quality of Life questionnaire. Presence of AF recurrence within 6 months post procedure was evaluated.
RESULTS
Participants (N = 171) had a mean (SD) age of 61.20 (11.23) years and were primarily male (80.1%) and white, non-Hispanic (81.4%). Moderate to severe depressive symptoms (17.2%) and clinically significant state (30.2%) and trait (23.6%) anxiety were reported. Mood/anxiety disorder diagnosis was associated with all 3 symptoms. Atrial fibrillation symptom severity was associated with both depressive symptoms and trait anxiety. Heart failure diagnosis and digoxin use were also associated with depressive symptoms. Trends toward significance between state and trait anxiety and participant race/ethnicity as well as depressive symptoms and body mass index were observed. Study findings support associations between symptoms and quality of life, but not 6-month AF recurrence.
CONCLUSION
Depressive symptoms and anxiety are common in patients with AF. Healthcare providers should monitor patients with AF for depressive symptoms and anxiety at the time of procedures and intervene when indicated. Additional investigations on assessment, prediction, treatment, and outcome of depressive symptoms and anxiety in patients with AF are warranted.
Topics: Anxiety; Anxiety Disorders; Atrial Fibrillation; Atrial Flutter; Depression; Electric Countershock; Humans; Male; Middle Aged; Quality of Life; Recurrence; Treatment Outcome
PubMed: 32675627
DOI: 10.1097/JCN.0000000000000723 -
The Journal of Invasive Cardiology Jul 2019Atrial fibrillation (AF) and atrial flutter (AFL) are associated with increased risk of stroke and mortality after transcatheter aortic valve replacement (TAVR). Many...
BACKGROUND
Atrial fibrillation (AF) and atrial flutter (AFL) are associated with increased risk of stroke and mortality after transcatheter aortic valve replacement (TAVR). Many episodes of new-onset AF/AFL (NOAF) occur after hospital discharge and may not be clinically apparent. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented AF.
METHODS
From 2012 to 2017, patients who underwent pacemaker implantation after TAVR were reviewed, and pacemaker data from device checks were analyzed for detection of NOAF. Patients with prior AF/AFL were excluded. Secondary outcomes were mortality and ischemic stroke.
RESULTS
A total of 172 patients underwent TAVR and pacemaker implantation, and 95 were without pre-existent AF/AFL. Over a median follow-up of 15 months, a total of 24 patients had NOAF (25%), of which 10 patients (10.5%) had manifest NOAF detected on electrocardiography, and 14 patients (14.7%) had subclinical NOAF first identified on device interrogation. The cumulative incidence of mortality was 16.7% for NOAF and 15.5% for normal sinus rhythm (P=.83). The cumulative incidence of stroke was 12.5% for NOAF and 1.4% for normal sinus rhythm (P=.04). Subclinical NOAF patients were less likely to be started on anticoagulation compared with manifest NOAF patients (70% vs 15.3%, respectively; P=.02).
CONCLUSION
Subclinical NOAF is common after TAVR, usually occurs months after hospital discharge, and is associated with lack of anticoagulation therapy and increased risk of stroke. Prolonged surveillance of subclinical NOAF may be warranted after TAVR.
Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; Atrial Fibrillation; Atrial Flutter; Electrocardiography; Female; Follow-Up Studies; Humans; Incidence; Male; Minnesota; Pacemaker, Artificial; Postoperative Period; Retrospective Studies; Stroke; Survival Rate; Transcatheter Aortic Valve Replacement
PubMed: 31257211
DOI: No ID Found -
Clinical Cardiology Jan 2022In this post hoc analysis, we assessed patient characteristics as predictors of dronedarone trough concentrations and characterized the relationship of trough...
BACKGROUND
In this post hoc analysis, we assessed patient characteristics as predictors of dronedarone trough concentrations and characterized the relationship of trough concentrations of dronedarone with its efficacy and safety.
HYPOTHESIS
Dronedarone is recommended as a 400 mg twice daily dose taken orally with meals. We hypothesize that drug concentration/bioavailability of dronedarone, measured as above- and below-median trough concentrations, does not impact the efficacy outcomes.
METHODS
Average trough concentrations (C ) across multiple timepoints were calculated for each patient, and patient C values were categorized as below-median or above-median concentrations. The effect of patient baseline characteristics on dronedarone C was assessed in the below-median versus above-median groups. The effect of dronedarone in each C group versus placebo on risk of first atrial fibrillation/atrial flutter (AF/AFL) recurrence and safety was also evaluated.
RESULTS
Overall, 1795 plasma samples were available from 507 dronedarone-treated patients. An above-median C was associated with age ≥75 years, female sex, lower weight, higher pacemaker use, and higher oral anticoagulant use. The risk of adjudicated first AF/AFL recurrence was significantly lower with dronedarone versus placebo in the below-median (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.56-0.91; p = .0054) and above-median groups (HR: 0.63; 95% CI: 0.50-0.81; p = .0002). No difference in risk of AF/AFL recurrence was observed between the above- and below-median groups. Safety and tolerability of dronedarone were similar between groups.
CONCLUSION
Significant reduction in AF/AFL recurrence was observed in patients treated with dronedarone versus placebo, regardless of dronedarone concentrations above or below the median value.
Topics: Adonis; Aged; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Dronedarone; Female; Humans; Pharmaceutical Preparations
PubMed: 35032136
DOI: 10.1002/clc.23768 -
Open Heart Jan 2021The clinical outcome and threshold of oral anticoagulation differs between patients with solitary atrial flutter (AFL) and those with AFL developing atrial fibrillation...
AIMS
The clinical outcome and threshold of oral anticoagulation differs between patients with solitary atrial flutter (AFL) and those with AFL developing atrial fibrillation (AF) (AFL-DAF). We therefore investigated previously unevaluated predictors of AF development in patients with AFL, and also the predictive values of risk scores in predicting the occurrence of AF and ischaemic stroke.
METHODS AND RESULTS
Participants were those diagnosed with AFL between 1 January 2001 and 31 December 2013. Patients were classified into solitary AFL and AFL-DAF groups during follow-up. Finally, 4101 patients with solitary AFL and 4101 patients with AFL-DAF were included after 1:1 propensity score matching with CHADS-VASc scores and their components, AFL diagnosis year and other comorbidities. The group difference in the prevalence of ischaemic stroke/transient ischaemic attack (TIA) and congestive heart failure (CHF) was substantial, that of vascular disease was moderate, and that of diabetes and hypertension was negligible. Therefore, we reweighted the component of heart failure as 2 (the same with stroke/TIA) and vascular disease as 1 in the proposed ACS-VASc score. The proposed ACS-VASc and CHADS-VAS scores showed patients with AFL who had higher delta scores and follow-up scores had higher risk of AF development. The delta score outperformed the follow-up score in both scoring systems in predicting ischaemic stroke.
CONCLUSION
This study showed that new-onset CHF, stroke/TIA and vascular disease were predictors of AF development in patients with AFL. The dynamic score and changes in both CHADS-VAS and the proposed ACS-VASc score could predict the development of AF and ischaemic stroke.
Topics: Age Factors; Aged; Atrial Fibrillation; Atrial Flutter; Female; Follow-Up Studies; Heart Rate; Humans; Male; Prognosis; Propensity Score; Retrospective Studies; Risk Assessment
PubMed: 33514633
DOI: 10.1136/openhrt-2020-001478 -
International Journal of Cardiology Jul 2020Atrial arrhythmias after heart transplantation have rarely been investigated. The aim of this study is to assess incidence, type and predictors of atrial arrhythmias...
OBJECTIVES
Atrial arrhythmias after heart transplantation have rarely been investigated. The aim of this study is to assess incidence, type and predictors of atrial arrhythmias during a long-term follow-up in a large population of heart-transplanted patients.
METHODS
Consecutive patients undergone to heart transplantation at our Centre from 1990 to 2017 were enrolled. All documented atrial arrhythmias were systematically reviewed during a long-term follow-up after heart transplantation. Atrial fibrillation (AF), atrial flutter and tachycardias were defined according to current guidelines.
RESULTS
Overall, 364 patients were included and followed for 120 ± 70 months. During the follow-up period 108 (29.7%) patients died and 3 (0.8%) underwent re-transplantation. Sinus rhythm was present in 355 (97.5%) patients. Nine patients had persistent atrial arrhythmias: 8 (2.2%) presented atypical flutter and one (0.3%) patient AF. Paroxysmal sustained arrhythmias were detected in 42 (11.5%) patients, always atrial flutters. At univariate analysis several echocardiographic (left ventricular end-diastolic diameter, TEI index, mitral and tricuspid regurgitation grade) hemodynamic (systolic and diastolic pulmonary pressure, capillary wedge pressure) and clinical (dyslipidaemia, weight, pacemaker implantation) parameters related to higher incidence of atrial arrhythmias.
CONCLUSION
Persistent atrial arrhythmias, and most of all AF, are rare among heart transplantation carriers, despite substantial comorbidities resulting in significant mortality. It can be speculated that the lesion set provided by the surgical technique, a complete and transmural electrical isolation of the posterior left atrium wall, represents an effective lesion set to prevent persistent AF.
Topics: Atrial Fibrillation; Atrial Flutter; Catheter Ablation; Heart Atria; Heart Transplantation; Humans; Incidence; Treatment Outcome
PubMed: 32331908
DOI: 10.1016/j.ijcard.2020.04.019 -
European Heart Journal. Cardiovascular... Jun 2022Use of antiarrhythmic drugs (AADs) in patients with chronic kidney disease (CKD) is challenging owing to issues with renal clearance, drug accumulation, and increased... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS
Use of antiarrhythmic drugs (AADs) in patients with chronic kidney disease (CKD) is challenging owing to issues with renal clearance, drug accumulation, and increased proarrhythmic risks. Because CKD is a common comorbidity in patients with atrial fibrillation/atrial flutter (AF/AFL), it is important to establish the efficacy and safety of AAD treatment in patients with CKD.
METHODS AND RESULTS
Dronedarone efficacy and safety in individuals with AF/AFL and varying renal functionality [estimated glomerular filtration rate (eGFR): ≥60, ≥45 and <60, and <45 mL/min] was investigated in a post hoc analysis of ATHENA (NCT00174785), a randomized, double-blind trial of dronedarone vs. placebo in patients with paroxysmal or persistent AF/AFL plus additional cardiovascular (CV) risk factors. Log-rank testing and Cox regression were used to compare the incidence of endpoints between treatments. Overall, 4588 participants were enrolled from the trial. There was no interaction between treatment group and baseline eGFR assessed as a continuous variable (P = 0.743) for the first CV hospitalization or death from any cause (primary outcome). This outcome was lower with dronedarone vs. placebo across a wide range of renal function. First CV hospitalization and first AF/AFL recurrence were both lower in the two least renally impaired subgroups with dronedarone vs. placebo. Treatment emergent adverse events leading to treatment discontinuation were more frequent with dronedarone vs. placebo and occurred more often in patients with severe renal impairment.
CONCLUSION
Dronedarone is an effective AAD in patients with AF/AFL and CV risk factors across a wide range of renal function.
Topics: Amiodarone; Atrial Fibrillation; Atrial Flutter; Double-Blind Method; Dronedarone; Humans; Kidney; Renal Insufficiency, Chronic
PubMed: 34958366
DOI: 10.1093/ehjcvp/pvab090 -
Revista Espanola de Cardiologia Aug 2006Invasive electrophysiologic studies have changed the clinical outlook for patients with atrial flutter. Recognition of the reentrant circuit responsible for typical... (Review)
Review
Invasive electrophysiologic studies have changed the clinical outlook for patients with atrial flutter. Recognition of the reentrant circuit responsible for typical atrial flutter has led to the development of catheter ablation techniques that can prevent recurrence in >90% of cases. In addition, general understanding of atrial tachycardias has changed radically, such that ECG-based classifications are now obsolete. Atypical reentrant circuits associated with surgical scars or fibrotic areas in either atrium, which are indistinguishable from focal tachycardias on ECG, have been identified. These circuits also seem amenable to treatment by ablation. Recently, a new type of reentrant tachycardia that could be problematic in the future has emerged in patients who have undergone extensive left atrial ablation for the treatment of atrial fibrillation. These atypical circuits can be characterized using the mapping and entrainment techniques initially developed for typical flutter. In these cases, electroanatomical mapping, involving the construction of a virtual anatomical model of the atria, is extremely helpful. Despite the success of ablation, long-term prognosis is frequently overshadowed by the appearance of atrial fibrillation, which suggests that flutter and fibrillation share a common arrhythmogenic origin that is not modified by cavotricuspid isthmus ablation. In contrast with our clear electrophysiologic understanding of atrial flutter, little is known about the natural history of the condition because the literature has traditionally grouped patients with flutter and fibrillation together. Consequently, the complex relationship between the two arrhythmias has still to be clearly delineated. Primary prevention and preventing the development of atrial fibrillation after ablation remain outstanding clinical challenges.
Topics: Anisotropy; Atrial Flutter; Electrocardiography; Humans; Prognosis; Tachycardia
PubMed: 16938231
DOI: No ID Found