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Circulation Journal : Official Journal... Jul 2016Atrial standstill is one of the important clinical consequences on the heart in severe hyperkalemia, but it occurs even at modest potassium ion elevation. The extent to... (Clinical Trial)
Clinical Trial
BACKGROUND
Atrial standstill is one of the important clinical consequences on the heart in severe hyperkalemia, but it occurs even at modest potassium ion elevation. The extent to which other factors might potentiate the electrocardiographic changes induced by hyperkalemia remains unclear.
METHODS AND RESULTS
This was a retrospective review of the data on 12,639 hospital admissions over a 15-year period. A total of 778 patients with hyperkalemia were identified, 28 of whom had atrial standstill, and had several parameters measured prior to any treatment of hyperkalemia. Patients with atrial standstill were older (P=0.036), had lower diastolic blood pressure (DBP; P<0.0001) and serum sodium concentration (P<0.0001), higher serum potassium (P<0.0001), and high prevalence of angiotensin converting-enzyme inhibitor (ACEI; P=0.009) or mineral corticoid receptor (MR)-blocker (P=0.006), compared with those without atrial standstill. On multivariate logistic regression, DBP <67 mmHg (P=0.006), serum sodium ion <135 mmol/L (P=0.006) and serum potassium ion >6.1 mmol/L (P=0.018) were identified as independent indicators of atrial standstill, after adjusting for sex, age, chronic maintenance hemodialysis, diuretics use or ACEI/angiotensin receptor blocker and MR blocker.
CONCLUSIONS
Hyponatremia and decline in DBP are associated with atrial standstill in patients with hyperkalemia. (Circ J 2016; 80: 1781-1786).
Topics: Aged; Aged, 80 and over; Arrhythmias, Cardiac; Blood Pressure; Female; Humans; Hyperkalemia; Hyponatremia; Male; Middle Aged; Retrospective Studies
PubMed: 27301330
DOI: 10.1253/circj.CJ-16-0283 -
Nucleus (Austin, Tex.) 2018Lamin A/C gene mutations can be associated with cardiac diseases, usually referred to as 'cardiolaminopathies' characterized by arrhythmic disorders and/or left... (Review)
Review
Lamin A/C gene mutations can be associated with cardiac diseases, usually referred to as 'cardiolaminopathies' characterized by arrhythmic disorders and/or left ventricular or biventricular dysfunction up to an overt picture of heart failure. The phenotypic cardiac manifestations of laminopathies are frequently mixed in complex clinical patterns and specifically may include bradyarrhythmias (sinus node disease or atrioventricular blocks), atrial arrhythmias (atrial fibrillation, atrial flutter, atrial standstill), ventricular tachyarrhythmias and heart failure of variable degrees of severity. Family history, physical examination, laboratory findings (specifically serum creatine phosphokinase values) and ECG findings are often important 'red flags' in diagnosing a 'cardiolaminopathy'. Sudden arrhythmic death, thromboembolic events or stroke and severe heart failure requiring heart transplantation are the most dramatic complications of the evolution of cardiolaminopathies and appropriate risk stratification is clinically needed combined with clinical follow-up. Treatment with cardiac electrical implantable devices is indicated in case of bradyarrhythmias (implant of a device with pacemaker functions), risk of life-threatening ventricular tachyarrhythmias (implant of an ICD) or in case of heart failure with wide QRS interval (implant of a device for cardiac resynchronization). New technologies introduced in the last 5 years can help physicians to reduce device-related complications, thanks to the extension of device longevity and availability of leadless pacemakers or defibrillators, to be implanted in appropriately selected patients. An improved knowledge of the complex pathophysiological pathways involved in cardiolaminopathies and in the determinants of their progression to more severe forms will help to improve clinical management and to better target pharmacological and non-pharmacological treatments.
Topics: Arrhythmias, Cardiac; Clinical Decision-Making; Heart Diseases; Humans; Lamin Type A; Musculoskeletal Diseases
PubMed: 30130999
DOI: 10.1080/19491034.2018.1506680 -
Cardiovascular Journal of Africa 2021Atrial standstill is an uncommon but serious clinical entity that is often unrecognised in the clinical setting. Its diagnosis and treatment should be swift as malignant...
Atrial standstill is an uncommon but serious clinical entity that is often unrecognised in the clinical setting. Its diagnosis and treatment should be swift as malignant arrhythmias and thromboembolic complications can arise. We present a 79-year-old man brought to our emergency department with acute confusion, heart failure and severe bradycardia in the context of diabetic ketoacidosis, and discuss the diagnosis and management of this arrhythmic condition.
Topics: Aged; Arrhythmias, Cardiac; Bradycardia; Diabetic Ketoacidosis; Electrocardiography; Heart Atria; Humans; Male
PubMed: 34143176
DOI: 10.5830/CVJA-2020-026 -
Cureus May 2022Atrial standstill is a rare condition in which the atrium loses its mechanical contraction with or without losing the electrical conduction. In this report, we discuss...
Atrial standstill is a rare condition in which the atrium loses its mechanical contraction with or without losing the electrical conduction. In this report, we discuss a case of a 64-year-old male patient with a history of hypertrophic cardiomyopathy (HCM) and persistent refractory atrial fibrillation (AF). He underwent ablation therapy with a successful return to sinus rhythm. However, post-procedure echocardiography imaging showed the absence of left atrium mechanical activity. We aim to highlight the importance of assessing atrial mechanical activity by imaging after sinus cardioversion in order to treat any preventable complications promptly.
PubMed: 35755564
DOI: 10.7759/cureus.25293 -
Frontiers in Cardiovascular Medicine 2023To characterize the cardiac phenotype associated with the novel pathogenic variant (c.1526del) of gene, which we identified in a large, six-generation family.
OBJECTIVE
To characterize the cardiac phenotype associated with the novel pathogenic variant (c.1526del) of gene, which we identified in a large, six-generation family.
METHODS AND RESULTS
A family tree was constructed. The clinical data of living and deceased family members were collected. DNA samples from 7 family members were analyzed for mutations using whole-exome high-throughput sequencing technology. The clinical presentation of pathogenic variant carriers was evaluated. In this six-generation family ( = 67), one member experienced sudden death at the age of 40-years-old. Three pathogenic variant carriers were identified to possess a novel heterozygous deletion mutation in gene (HGVS: NM_170707.4, c.1526del) located at exon 9 of chr1:156137145, which creates a premature translational stop signal (p.Pro509Leufs*39) in the LMNA gene and results in an mutant lamin A protein product. The main symptoms of the pathogenic variant carriers were palpitation, fatigue, and syncope, which typically occurred around 20-years-old. AV-conduction block and non-sustained ventricular tachycardia were the first signs of disease and would rapidly progress to atrial standstill around 30-years-old. Significant right atrial enlargement and bicuspid aortic valve malformation was also commonly seen in patients who carried this pathogenic variant.
CONCLUSION
The pathogenic variant of c.1526del p.P509Lfs*39 was a frameshift deletion located at exon 9 of chr1:156137145 and causes severe right atrial enlargement, sick sinus syndrome, atrial standstill, ventricular tachycardia, and bicuspid aortic valve malformation. Our findings expand the phenotypic spectrum of novel gene mutations.
PubMed: 37465451
DOI: 10.3389/fcvm.2023.1109008 -
The Journal of Innovations in Cardiac... Jan 2024
PubMed: 38304085
DOI: 10.19102/icrm.2024.15016 -
SAGE Open Medical Case Reports 2023The case report shares evidence for a better understanding of atrial standstill. This being a rare arrhythmogenic condition. This is a 46-year-old woman presented with...
The case report shares evidence for a better understanding of atrial standstill. This being a rare arrhythmogenic condition. This is a 46-year-old woman presented with multiple sites of arterial embolism, including lower extremity arteries, coronary artery, and cerebral artery. Unexpectedly, multiple arterial embolization in the patient was due to atrial standstill by transthoracic echocardiography and cardiac electrophysiological study. An additional family investigation revealed that the patient's brother and sister also suffered from this disease. In search of further understanding the case, we carried out the genetic testing of the family and a frame shift double-G insertion mutation at c.1567 in the gene was found in all the three individuals. The patient recovered well after anticoagulation therapy and left bundle branch area pacing. This report remarks on the importance of multiple sites of arterial embolism which should be wary of family atrial standstill.
PubMed: 37425136
DOI: 10.1177/2050313X231179810 -
Research in Cardiovascular Medicine Nov 2014Atrial standstill is a rare condition, characterized by absence of atrial electrical and mechanical activity evident in surface electrocardiography echocardiography, or...
INTRODUCTION
Atrial standstill is a rare condition, characterized by absence of atrial electrical and mechanical activity evident in surface electrocardiography echocardiography, or fluoroscopy, which is associated with unresponsiveness of atria to maximal output electrical stimulation. This condition can be present with thromboembolic complication, low cardiac output, and sometimes palpitation.
CASE PRESENTATION
Here we presented a woman with right atrial stand still and left atrial tachycardia. It was confirmed by electrocardiogram, echocardiography, and intracardiac electrogram in basal state and during maximal output electrical stimulation. We treated her by implanting pacemaker to control bradycardia, oral calcium channel blocker to control palpitation episodes, and anticoagulation.
CONCLUSIONS
Atrial standstill can be present partially that can be localized in one atrium and is associated with tachycardia in the other atrium.
PubMed: 25785252
DOI: 10.5812/cardiovascmed.25173 -
Circulation Jun 2016The arrhythmogenesis of ventricular myocardial ischemia has been extensively studied, but models of atrial ischemia in humans are lacking. This study aimed at describing...
BACKGROUND
The arrhythmogenesis of ventricular myocardial ischemia has been extensively studied, but models of atrial ischemia in humans are lacking. This study aimed at describing the electrophysiological alterations induced by acute atrial ischemia secondary to atrial coronary branch occlusion during elective coronary angioplasty.
METHODS AND RESULTS
Clinical data, 12-lead ECG, 12-hour Holter recordings, coronary angiography, and serial plasma levels of high-sensitivity troponin T and midregional proatrial natriuretic peptide were prospectively analyzed in 109 patients undergoing elective angioplasty of right or circumflex coronary arteries. Atrial coronary branches were identified and after the procedure patients were allocated into two groups: atrial branch occlusion (ABO, n=17) and atrial branch patency (non-ABO, n=92). In comparison with the non-ABO, patients with ABO showed: (1) higher incidence of periprocedural myocardial infarction (20% versus 53%, P=0.01); (2) more frequent intra-atrial conduction delay (19% versus 46%, P=0.03); (3) more marked PR segment deviation in the Holter recordings; and (4) higher incidence of atrial tachycardia (15% versus 41%, P=0.02) and atrial fibrillation (0% versus 12%, P=0.03). After adjustment by a propensity score, ABO was an independent predictor of periprocedural infarction (odds ratio, 3.4; 95% confidence interval, 1.01-11.6, P<0.05) and atrial arrhythmias (odds ratio, 5.1; 95% confidence interval, 1.2-20.5, P=0.02).
CONCLUSIONS
Selective atrial coronary artery occlusion during elective percutaneous transluminal coronary angioplasty is associated with myocardial ischemic damage, atrial arrhythmias, and intra-atrial conduction delay. Our data suggest that atrial ischemic episodes might be considered as a potential cause of atrial fibrillation in patients with chronic coronary artery disease.
Topics: Action Potentials; Aged; Angioplasty, Balloon, Coronary; Arrhythmias, Cardiac; Atrial Natriuretic Factor; Biomarkers; Chi-Square Distribution; Constriction, Pathologic; Coronary Angiography; Coronary Circulation; Coronary Occlusion; Coronary Vessels; Electrocardiography, Ambulatory; Female; Heart Atria; Heart Conduction System; Heart Rate; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Odds Ratio; Propensity Score; Prospective Studies; Risk Factors; Time Factors; Troponin T
PubMed: 27151531
DOI: 10.1161/CIRCULATIONAHA.116.021700 -
SAGE Open Medical Case Reports 2019Atrial standstill is a rare arrhythmia defined by the absence of mechanical and electrical activity in the atria. Few cases of atrial standstill have been described in...
Atrial standstill is a rare arrhythmia defined by the absence of mechanical and electrical activity in the atria. Few cases of atrial standstill have been described in children, none of which have presented with cerebral infarction confirmed by imaging. We report a unique case of a 7-year-old girl presenting with expressive aphasia, central facial palsy and irregular pulse with cerebral infarction secondary to atrial standstill. This case illustrates that cardiogenic cerebral embolism in children can be caused by rare conditions like atrial standstill and should be considered in paediatric patients undergoing evaluation for stroke. There are no established treatment guidelines for atrial standstill. We recommend that treatment be directed towards any potential underlying cause. All patients with atrial standstill should receive long-term oral anticoagulation treatment and a permanent cardiac pacemaker implant to reduce the risk of further strokes or other cardiac events.
PubMed: 30783526
DOI: 10.1177/2050313X19827735