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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 -
Frontiers in Medicine 2019Pulmonary arterial hypertension (PAH) is a devastating, life-limiting disease driven by small vessel vascular remodeling leading to a rise in pulmonary vascular... (Review)
Review
Pulmonary arterial hypertension (PAH) is a devastating, life-limiting disease driven by small vessel vascular remodeling leading to a rise in pulmonary vascular resistance (PVR). Patients present with a range of symptoms including shortness of breath, exercise intolerance, palpitations or syncope. Symptoms may be related to vascular disease progression or arrhythmia secondary to the adaptation of the right heart to pressure overload. Arrhythmic burden is high in patients with left heart disease and guideline-based treatment of arrhythmias improves quality of life and prognosis. In PAH the incidence and prevalence of arrhythmias is less well-defined and there are no PAH-specific guidelines for arrhythmia management. We undertook a literature search identifying 13 relevant papers; detection of arrhythmias was acquired from 12-lead electrocardiogram (ECG) or Holter monitors. In all forms of pulmonary hypertension (PH) the prevalence of supraventricular arrhythmias (SVA) was 26-31%, ventricular arrhythmias (VA) 24% and a 5-year incidence of SVA ~13.2-25.1%. Prevalence and incidence of arrhythmias in PAH is less clear due to limited study numbers and the heterogenous nature of the patient population studied. For arrhythmia treatment, only single-arm studies of therapeutic strategies were reported using antiarrhythmic drugs (AAD), direct current cardioversion (DCCV) and ablation. Periods between ECG or Holter have not been investigated, highlighting the possibility that significant arrhythmias may be undetected. Advances in monitoring allow long-term surveillance via implanted/non-invasive monitors. Use of such technologies may provide an accurate estimate of incidence and prevalence of arrhythmias in patients with PAH, further defining relationships to adverse outcomes, and therapeutic options.
PubMed: 31396515
DOI: 10.3389/fmed.2019.00169 -
Circulation Reports May 2024
PubMed: 38736843
DOI: 10.1253/circrep.CR-24-0022 -
BMC Cardiovascular Disorders Feb 2022Left ventricular noncompaction (LVNC) is a rare type of cardiomyopathy, and one of its clinical manifestations is arrhythmia. Cardiovascular magnetic resonance (CMR) is... (Comparative Study)
Comparative Study
BACKGROUND
Left ventricular noncompaction (LVNC) is a rare type of cardiomyopathy, and one of its clinical manifestations is arrhythmia. Cardiovascular magnetic resonance (CMR) is valuable for the diagnosis and prognosis of LVNC. However, studies are lacking on the use of CMR for LVNC patients with arrhythmia. This study aimed to characterize and compare CMR features and prognosis in LVNC patients with and without arrhythmia.
METHODS
Eighty-four LVNC patients diagnosed by CMR were enrolled retrospectively in this study. Clinical data, arrhythmia characteristics, and CMR parameters were collected. Patients were divided into different groups according to the arrhythmia characteristics and CMR manifestations for statistical analysis and comparison. Ventricular tachycardia (VT), ventricular fibrillation (Vf), ventricular flutter (VFL), III° atrioventricular block (III° AVB), Wolff-Parkinson-White syndrome (WPW) and ventricular escape (VE) were defined as malignant arrhythmias and benign arrhythmias included premature ventricular contraction, atrial premature beats, atrial fibrillation, supraventricular tachycardia, supraventricular premature beat, bundle branch block, atrial flutter and sinus tachycardia. The outcome events were defined as a composition event of cardiac death, rehospitalization for heart failure, heart transplantation, and implantation of an implantable cardioverter defibrillator (ICD).
RESULTS
Sixty-seven LVNC patients (79.76%) mainly presented with arrhythmia, including premature ventricular beat (33 patients [27.73%]), bundle branch block (14 patients [11.77%]), electrocardiogram waveform changes (18 patients [15.13%]), and ventricular tachycardia (11 patients [9.24%]). The cardiac function and structure parameters had no significant difference among the nonarrhythmia group, benign arrhythmia group, and malignant arrhythmia group. However, the presence of late gadolinium enhancement (LGE) was higher in the malignant arrhythmia group than in the other two groups (p = 0.023). At a mean follow-up of 46 months, cardiac events occurred in twenty-three patients (46.94%). Kaplan-Meier analysis showed that there was no statistically significant difference in prognosis among the nonarrhythmia, benign, and malignant arrhythmia groups, but the patients with arrhythmia and association with LGE + or left ventricular ejection fraction (LVEF) < 30% had a higher risk than patients with LGE- or LVEF > 30% (LGE +, HR = 4.035, 95% CI 1.475-11.035; LVEF < 30%, HR = 8.131, 95% CI 1.805-36.636; P < 0.05).
CONCLUSIONS
In LVNC patients, the types of arrhythmias are numerous and unrepresentative, and arrhythmia is not the prognostic factor. Arrhythmia combined with presence of LGE or LVEF < 30% is associated with poor prognosis in LVNC patients.
Topics: Adult; Female; Follow-Up Studies; Heart Ventricles; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Myocardium; Prognosis; Retrospective Studies; Stroke Volume; Tachycardia, Ventricular; Ventricular Function, Left
PubMed: 35109817
DOI: 10.1186/s12872-022-02470-7 -
Children (Basel, Switzerland) May 2023In neonates, cardiac arrhythmias are rare. Electric countershock therapy is an effective alternative to drug therapy for neonatal arrhythmias. There are no randomized... (Review)
Review
BACKGROUND
In neonates, cardiac arrhythmias are rare. Electric countershock therapy is an effective alternative to drug therapy for neonatal arrhythmias. There are no randomized controlled studies investigating electric countershock therapy in neonates.
OBJECTIVE
To identify all studies and publications describing electric countershock therapy (including defibrillation, cardioversion, and pacing) in newborn infants within 28 days after birth, and to provide a comprehensive review of this treatment modality and associated outcomes.
METHODS
For this systematic review we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). All articles reporting electric countershock therapy in newborn infants within 28 days after birth were included.
RESULTS
In terms of figures, 113 neonates who received electric countershock due to arrhythmias were reported. Atrial flutter (76.1%) was the most common arrhythmia, followed by supraventricular tachycardia (13.3%). Others were ventricular tachycardia (9.7%) and torsade de pointes (0.9%). The main type of electric countershock therapy was synchronized cardioversion (79.6%). Transesophageal pacing was used in twenty neonates (17.7%), and defibrillation was used in five neonates (4.4%).
CONCLUSION
Electric countershock therapy is an effective treatment option in the neonatal period. In atrial flutter especially, excellent outcomes are reported with direct synchronized electric cardioversion.
PubMed: 37238386
DOI: 10.3390/children10050838 -
Annals of Noninvasive Electrocardiology... Sep 2017Differentiation of a wide complex arrhythmia can pose as a clinical challenge in the acute care setting. Two broad differentials exist including ventricular tachycardia...
Differentiation of a wide complex arrhythmia can pose as a clinical challenge in the acute care setting. Two broad differentials exist including ventricular tachycardia versus supraventricular tachycardia with aberrancy, underlying bundle branch block or intrinsic conduction defect. To aid in distinguishing between supraventricular tachycardia and ventricular tachycardia, Brugada criteria is commonly used, albeit new algorithms have become more common. Marriott's sign, a taller peak in the first R wave when compared to R' is considered a specific criterion for distinguishing between these two entities and strongly favors the diagnosis of ventricular tachycardia. In this case we present a wide complex tachycardia, which is an exception to Marriott's sign.
Topics: Diagnosis, Differential; Electrocardiography; Humans; Male; Middle Aged; Tachycardia, Supraventricular; Tachycardia, Ventricular
PubMed: 28467014
DOI: 10.1111/anec.12449 -
Annual International Conference of the... Jul 2019The advent of portable cardiac monitoring devices has enabled real-time analysis of cardiac signals. These devices can be used to develop algorithms for real-time...
The advent of portable cardiac monitoring devices has enabled real-time analysis of cardiac signals. These devices can be used to develop algorithms for real-time detection of dangerous heart rhythms such as ventricular arrhythmias. This paper presents a Markov model based algorithm for real-time detection of ventricular tachycardia, ventricular flutter, and ventricular fibrillation episodes. The algorithm does not rely on any noise removal pre-processing or peak annotation of the original signal. When evaluated using ECG signals from three publicly available databases, the model resulted in an AUC of 0.96 and F1-score of 0.91 for 5-second long signals and an AUC of 0.97 and F1-score of 0.93 for 2-second long signals.
Topics: Algorithms; Arrhythmias, Cardiac; Electrocardiography; Humans; Signal Processing, Computer-Assisted; Tachycardia, Ventricular; Ventricular Fibrillation
PubMed: 31946175
DOI: 10.1109/EMBC.2019.8856504 -
Circulation Journal : Official Journal... Mar 2019Landiolol, an ultra-short acting β-selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and...
BACKGROUND
Landiolol, an ultra-short acting β-selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and left ventricular (LV) dysfunction. The impact of the type of atrial tachyarrhythmias on the effectiveness of landiolol is uncertain. We evaluated the efficacy and safety of landiolol on tachycardiac atrial fibrillation (AF) and tachycardiac atrial flutter/atrial tachycardia (AFl/AT) in patients with reduced LV function. Methods and Results: Seventy-seven patients treated with landiolol were retrospectively analyzed. There were no significant differences in the baseline characteristics between the AF group (n=65) and AFl/AT group (n=12). Despite a higher dosage, the %change in HR from baseline to 12 and 24 h was only -10.2±12.7% and -16.1±19.4% in the AFl/AT group, while it was -28.3±13.2% and -31.3±11.3% in the AF group (P<0.02), respectively. The prevalence of the responders to landiolol treatment was much greater in the AF group than in the AFl/AT group (P<0.001). Alternative treatments such as i.v. amiodarone and electrical cardioversion were required in 83% of the AFl/AT patients.
CONCLUSIONS
Landiolol was ineffective in the majority of AFl/AT patients. An alternative management to prevent any worsening of heart failure might be considered in those patients.
Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Humans; Male; Middle Aged; Morpholines; Retrospective Studies; Tachycardia; Urea; Ventricular Dysfunction, Left
PubMed: 30814430
DOI: 10.1253/circj.CJ-18-1131 -
Journal of Arrhythmia Dec 2021A 63-year-old gentleman presented to the emergency room (ER) with complaints of sudden onset of palpitation for the last 1 hour. He denied any presyncope or syncope. He...
A 63-year-old gentleman presented to the emergency room (ER) with complaints of sudden onset of palpitation for the last 1 hour. He denied any presyncope or syncope. He was tachycardic with pulse rate of 120 beats per minute. His blood pressure was 110/70 mm Hg. A 12-lead electrocardiogram (ECG) was taken. What is the likely diagnosis?
PubMed: 34887966
DOI: 10.1002/joa3.12645 -
Cureus Sep 2023The current guidelines state that propafenone can be used in combination with a beta-blocker or a calcium channel blocker for pharmacologic cardioversion of recent-onset...
The current guidelines state that propafenone can be used in combination with a beta-blocker or a calcium channel blocker for pharmacologic cardioversion of recent-onset atrial fibrillation in patients without structural heart disease. To prevent the conversion from atrial fibrillation to atrial flutter with a rapid ventricular rate, it is recommended to administer propafenone following the administration of a beta-blocker or a calcium channel blocker. However, this combination carries the potential risk of cardiogenic shock. There are several scenarios where this combination can lead to shock, attributed to the variable pharmacokinetics of propafenone among individuals and its significant drug interactions with commonly used AV nodal blockers, such as metoprolol and diltiazem. Additionally, a significant proportion of the population has genetic polymorphisms that affect the metabolism of these medications. While pill-in-the-pocket propafenone is also employed in outpatient settings, unexpected severe and life-threatening reactions have been reported. In this context, we present a case report of severe propafenone toxicity in a closely monitored inpatient setting aimed at converting atrial fibrillation.
PubMed: 37908936
DOI: 10.7759/cureus.46282