-
JACC. Clinical Electrophysiology Jan 2022Increasing maternal mortality and incidence of arrhythmias in pregnancy have been noted over the past 2 decades in the United States. Pregnancy is associated with a... (Review)
Review
Increasing maternal mortality and incidence of arrhythmias in pregnancy have been noted over the past 2 decades in the United States. Pregnancy is associated with a greater risk of arrhythmias, and patients with a history of arrhythmias are at significant risk of arrhythmia recurrence during pregnancy. The incidence of atrial fibrillation in pregnancy is rising. This review discusses the management of tachyarrhythmias and bradyarrhythmias in pregnancy, including management of cardiac arrest. Management of fetal arrhythmias are also reviewed. For patients without structural heart disease, β-blocker therapy, especially propranolol and metoprolol, and antiarrhythmic drugs, such as flecainide and sotalol, can be safely used to treat tachyarrhythmias. As a last resort, catheter ablation with minimal fluoroscopy can be performed. Device implantation can be safely performed with minimal fluoroscopy and under echocardiographic or ultrasound guidance in patients with clear indications for devices during pregnancy. Because of rising maternal mortality in the United States, which is partly driven by increasing maternal age and comorbidities, a multidisciplinary and/or integrative approach to arrhythmia management from the prepartum to the postpartum period is needed.
Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Female; Flecainide; Humans; Pregnancy; Sotalol; Tachycardia
PubMed: 35057977
DOI: 10.1016/j.jacep.2021.10.004 -
European Heart Journal May 2023Cardiac sarcoidosis (CS) results from epithelioid cell granulomas infiltrating the myocardium and predisposing to conduction disturbances, ventricular tachyarrhythmias,...
Cardiac sarcoidosis (CS) results from epithelioid cell granulomas infiltrating the myocardium and predisposing to conduction disturbances, ventricular tachyarrhythmias, and heart failure. Manifest CS, however, constitutes only the top of an iceberg as advanced imaging uncovers cardiac involvement 4 to 5 times more commonly than what is clinically detectable. Definite diagnosis of CS requires myocardial biopsy and histopathology, but a sufficient diagnostic likelihood can be achieved by combining extracardiac histology of sarcoidosis with clinical manifestations and findings on cardiac imaging. CS can appear as the first or only organ manifestation of sarcoidosis or on top of pre-existing extracardiac disease. Due to the lack of controlled trials, the care of CS is based on observational evidence of low quality. Currently, the treatment involves corticosteroid-based, tiered immunosuppression to control myocardial inflammation with medical and device-based therapy for symptomatic atrioventricular block, ventricular tachyarrhythmias, and heart failure. Recent outcome data indicate 90% to 96% 5-year survival in manifest CS with the 10-year figures ranging from 80% to 90%. Major progress in the care of CS awaits the key to its molecular-genetic pathogenesis and large-scale controlled clinical trials.
Topics: Humans; Cardiomyopathies; Prognosis; Sarcoidosis; Heart Failure; Myocarditis; Tachycardia, Ventricular; Phenotype
PubMed: 36924191
DOI: 10.1093/eurheartj/ehad067 -
JAMA Internal Medicine Sep 2021The notion that caffeine increases the risk of cardiac arrhythmias is common. However, evidence that the consumption of caffeinated products increases the risk of...
IMPORTANCE
The notion that caffeine increases the risk of cardiac arrhythmias is common. However, evidence that the consumption of caffeinated products increases the risk of arrhythmias remains poorly substantiated.
OBJECTIVE
To assess the association between consumption of common caffeinated products and the risk of arrhythmias.
DESIGN, SETTING, AND PARTICIPANTS
This prospective cohort study analyzed longitudinal data from the UK Biobank between January 1, 2006, and December 31, 2018. After exclusion criteria were applied, 386 258 individuals were available for analyses.
EXPOSURES
Daily coffee intake and genetic polymorphisms that affect caffeine metabolism.
MAIN OUTCOMES AND MEASURES
Any cardiac arrhythmia, including atrial fibrillation or flutter, supraventricular tachycardia, ventricular tachycardia, premature atrial complexes, and premature ventricular complexes.
RESULTS
A total of 386 258 individuals (mean [SD] age, 56 [8] years; 52.3% female) were assessed. During a mean (SD) follow-up of 4.5 (3.1) years, 16 979 participants developed an incident arrhythmia. After adjustment for demographic characteristics, comorbid conditions, and lifestyle habits, each additional cup of habitual coffee consumed was associated with a 3% lower risk of incident arrhythmia (hazard ratio [HR], 0.97; 95% CI, 0.96-0.98; P < .001). In analyses of each arrhythmia alone, statistically significant associations exhibiting a similar magnitude were observed for atrial fibrillation and/or flutter (HR, 0.97; 95% CI, 0.96-0.98; P < .001) and supraventricular tachycardia (HR, 0.96; 95% CI, 0.94-0.99; P = .002). Two distinct interaction analyses, one using a caffeine metabolism-related polygenic score of 7 genetic polymorphisms and another restricted to CYP1A2 rs762551 alone, did not reveal any evidence of effect modification. A mendelian randomization study that used these same genetic variants revealed no significant association between underlying propensities to differing caffeine metabolism and the risk of incident arrhythmia.
CONCLUSIONS AND RELEVANCE
In this prospective cohort study, greater amounts of habitual coffee consumption were associated with a lower risk of arrhythmia, with no evidence that genetically mediated caffeine metabolism affected that association. Mendelian randomization failed to provide evidence that caffeine consumption was associated with arrhythmias.
Topics: Adult; Aged; Caffeine; Coffee; Cytochrome P-450 CYP1A2; Female; Follow-Up Studies; Humans; Incidence; Life Style; Male; Mendelian Randomization Analysis; Middle Aged; Polymorphism, Genetic; Prospective Studies; Risk Factors; Tachycardia; Time Factors; United States
PubMed: 34279564
DOI: 10.1001/jamainternmed.2021.3616 -
Circulation Sep 2021Polymorphic ventricular tachyarrhythmias are highly lethal arrhythmias. Several types of polymorphic ventricular tachycardia have similar electrocardiographic... (Review)
Review
Polymorphic ventricular tachyarrhythmias are highly lethal arrhythmias. Several types of polymorphic ventricular tachycardia have similar electrocardiographic characteristics but have different modes of therapy. In fact, medications considered the treatment of choice for one form of polymorphic ventricular tachycardia, are contraindicated for the other. Yet confusion about terminology, and thus diagnosis and therapy, continues. We present an in-depth review of the different forms of polymorphic ventricular tachycardia and propose a practical step-by-step approach for distinguishing these malignant arrhythmias.
Topics: Arrhythmias, Cardiac; Electrocardiography; Emergency Treatment; Humans; Long QT Syndrome; Tachycardia, Ventricular
PubMed: 34491774
DOI: 10.1161/CIRCULATIONAHA.121.055783 -
Future Cardiology Jul 2010
Topics: Adenosine; Cardiovascular Agents; Heart Arrest; Humans; Tachycardia
PubMed: 20608813
DOI: 10.2217/fca.10.66 -
BMJ Case Reports Sep 2012Tachycardia-induced cardiomyopathy (TIC) is an important cause of heart failure as it is potentially reversible after ventricular rate control. A 66-year-old...
Tachycardia-induced cardiomyopathy (TIC) is an important cause of heart failure as it is potentially reversible after ventricular rate control. A 66-year-old hypertensive woman presented with a 15-day history of tachycardia, dyspnoea and oedema. ECG revealed atrial fibrillation with ventricular frequency of 130 beats per minute (bpm). Echocardiogram showed dilated left ventricle (LV) with 0.39 ejection fraction. Angiography revealed non-obstructed coronary arteries. Heart rate and cardiac failure were controlled with amiodarone, digoxine, captopril, metoprolol and furosemide. During follow-up, despite drug dose optimisation, the patient kept complaining of tachycardia and dyspnoea with a ventricular rate between 108 and 120 bpm. Medical staff suspected she was not taking her medicines properly. Two months later, the patient was asymptomatic and had converted to sinus rhythm (heart rate of 76 bpm). Echocardiogram showed normal LV size and function. Patient's diagnosis was TIC. Although rare, TIC should be considered in all cases of systolic dysfunction associated with tachyarrhythmia.
Topics: Aged; Cardiomyopathy, Dilated; Diagnosis, Differential; Dyspnea; Electrocardiography; Female; Heart; Humans; Tachycardia
PubMed: 23001096
DOI: 10.1136/bcr-2012-006587 -
International Journal of Molecular... Feb 2023Left ventricular hypertrophy (LVH) refers to a complex rebuilding of the left ventricle that can gradually lead to serious complications-heart failure and... (Review)
Review
Left ventricular hypertrophy (LVH) refers to a complex rebuilding of the left ventricle that can gradually lead to serious complications-heart failure and life-threatening ventricular arrhythmias. LVH is defined as an increase in the size of the left ventricle (i.e., anatomically), therefore the basic diagnosis detecting the increase in the LV size is the domain of imaging methods such as echocardiography and cardiac magnetic resonance. However, to evaluate the functional status indicating the gradual deterioration of the left ventricular myocardium, additional methods are available approaching the complex process of hypertrophic remodeling. The novel molecular and genetic biomarkers provide insights on the underlying processes, representing a potential basis for targeted therapy. This review summarizes the spectrum of the main biomarkers employed in the LVH valuation.
Topics: Humans; Hypertrophy, Left Ventricular; Myocardium; Heart Failure; Biomarkers; Tachycardia, Ventricular
PubMed: 36835293
DOI: 10.3390/ijms24043881 -
Revista Portuguesa de Cardiologia Mar 2018We present the case of a previously healthy 42-year-old man who attended the emergency department due to a sudden onset of rapid and regular palpitations. The ECG showed...
We present the case of a previously healthy 42-year-old man who attended the emergency department due to a sudden onset of rapid and regular palpitations. The ECG showed 190 bpm, wide QRS with left bundle branch block tachycardia. He was started on amiodarone with progression to 230 bpm, wide QRS tachycardia with multiple morphologies, followed by spontaneous conversion to sinus rhythm, normal PR interval and rS pattern in LIII. The echocardiogram was negative for structural heart disease. The electrophysiological study demonstrated the presence of an accessory pathway with anterograde decremental conduction and no retrograde conduction. Both episodes of clinical tachycardia were induced. A diagnosis of Mahaim fiber-mediated antidromic atrioventricular reentrant tachycardia and pre-excited atrial fibrillation was made. Mapping was performed with detection of an M potential (His-like) at the lateral region of the tricuspid ring followed by radiofrequency ablation with immediate success criteria. Post-ablation there was a change to a qR pattern in LIII. At 12-months follow-up there was no recurrence of the tachycardia.
Topics: Accessory Atrioventricular Bundle; Adult; Electrocardiography; Humans; Male; Tachycardia
PubMed: 29622376
DOI: 10.1016/j.repc.2017.01.008 -
Journal of the American Heart... Jun 2020The primary goal of the initial ECG evaluation of every wide complex tachycardia is to determine whether the tachyarrhythmia has a ventricular or supraventricular... (Review)
Review
The primary goal of the initial ECG evaluation of every wide complex tachycardia is to determine whether the tachyarrhythmia has a ventricular or supraventricular origin. The answer to this question drives immediate patient care decisions, ensuing clinical workup, and long-term management strategies. Thus, the importance of arriving at the correct diagnosis cannot be understated and has naturally spurred rigorous research, which has brought forth an ever-expanding abundance of manually applied and automated methods to differentiate wide complex tachycardias. In this review, we provide an in-depth analysis of traditional and more contemporary methods to differentiate ventricular tachycardia and supraventricular wide complex tachycardia. In doing so, we: (1) review hallmark wide complex tachycardia differentiation criteria, (2) examine the conceptual and structural design of standard wide complex tachycardia differentiation methods, (3) discuss practical limitations of manually applied ECG interpretation approaches, and (4) highlight recently formulated methods designed to differentiate ventricular tachycardia and supraventricular wide complex tachycardia automatically.
Topics: Action Potentials; Animals; Diagnosis, Differential; Electrocardiography; Electrophysiologic Techniques, Cardiac; Heart Conduction System; Heart Rate; Humans; Predictive Value of Tests; Tachycardia, Supraventricular; Tachycardia, Ventricular; Time Factors
PubMed: 32427020
DOI: 10.1161/JAHA.120.016598 -
Heart (British Cardiac Society) Oct 2017
Review
Topics: Cardiomyopathies; Diagnostic Techniques, Cardiovascular; Disease Management; Humans; Tachycardia; Ventricular Function
PubMed: 28855272
DOI: 10.1136/heartjnl-2016-310391