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Sample records for atrial tachycardia originating

  1. Atrial tachycardia originating from the atrial septum in a patient with dextrocardia and complex structural heart disease.

    Science.gov (United States)

    Niu, Ya-Lei; Chang, Shih-Lin; Lin, Yenn-Jiang; Lo, Li-Wei; Hu, Yu-Feng; Lee, Pi-Chang; Chen, Shih-Ann

    2012-10-01

    We report a case with dextrocardia, corrected transposition of the great arteries. He also had an atrial septum defect (ASD) with patch repair. Activation map showed a centrifugal activation from a focal origin on the systemic lower left atrial ASD patch. Ablation of the origin can terminate the atrial tachycardia.

  2. Atrial Ectopic Tachycardia in a Patient With Marfan Syndrome

    OpenAIRE

    Awerbach, Jordan D.; Khatib, Sammy; Moodie, Douglas S.; Snyder, Christopher S.

    2011-01-01

    The fibrillin defect central to Marfan syndrome is believed to affect myocardial conduction and predispose affected patients to various arrhythmias, including ventricular tachycardia, atrial fibrillation, and atrioventricular nodal reentry tachycardia. Here we describe an adult Marfan patient with atrial ectopic tachycardia. To our knowledge, this is the first reported case of atrial ectopic tachycardia in the setting of Marfan syndrome.

  3. Possible role for cryoballoon ablation of right atrial appendage tachycardia when conventional ablation fails.

    Science.gov (United States)

    Amasyali, Basri; Kilic, Ayhan

    2015-06-01

    Focal atrial tachycardia arising from the right atrial appendage usually responds well to radiofrequency ablation; however, successful ablation in this anatomic region can be challenging. Surgical excision of the right atrial appendage has sometimes been necessary to eliminate the tachycardia and prevent or reverse the resultant cardiomyopathy. We report the case of a 48-year-old man who had right atrial appendage tachycardia resistant to multiple attempts at ablation with use of conventional radiofrequency energy guided by means of a 3-dimensional mapping system. The condition led to cardiomyopathy in 3 months. The arrhythmia was successfully ablated with use of a 28-mm cryoballoon catheter that had originally been developed for catheter ablation of paroxysmal atrial fibrillation. To our knowledge, this is the first report of cryoballoon ablation without isolation of the right atrial appendage. It might also be an alternative to epicardial ablation or surgery when refractory atrial tachycardia originates from the right atrial appendage.

  4. Swallowing‐induced atrial tachycardia: case report

    OpenAIRE

    Xu, Ye; Cheng, Kuan; Zhu, Wenqing

    2015-01-01

    Key Clinical Message A 53‐year‐old man presented with heart palpitations while swallowing. Electrophysiologic study (EPS) and immunohistochemical results of his esophageal leiomyoma suggested that swallowing‐induced atrial tachycardia is related with neural reflex. S100‐immunopositive nerve fibers are demonstrated sympathetic nerves which possibly explain the mechanism. Metoprolol tartrate tablets are effective in our patient.

  5. A re-entry tachycardia triggered by the spontaneous interruption of an atrial tachycardia.

    Science.gov (United States)

    Buttà, Carmelo; Tuttolomondo, Antonino; Di Raimondo, Domenico; Giarrusso, Lucia; Miceli, Giuseppe; Cuttitta, Francesco; La Rosa, Donata; Licata, Giuseppe; Pinto, Antonio

    2015-01-01

    The common atrioventricular nodal re-entry tachycardia is the most common form of paroxysmal supraventricular tachycardia. It starts frequently with a supraventricular ectopic beat that, on finding the fast pathway in refractory period, travels in the slow pathway as to appear as a prolongation of the PR interval on the ECG. In this study, we show a singular case of a common atrioventricular nodal re-entry tachycardia triggered by the spontaneous interruption of an atrial tachycardia.

  6. Atrial ultrastructural changes during experimental atrial tachycardia depend on high ventricular rate

    NARCIS (Netherlands)

    Schoonderwoerd, BA; Ausma, J; Crijns, HJGM; Van Veldhuisen, DJ; Blaauw, EH; Van Gelder, IC

    2004-01-01

    Atrial Ultrastructural Remodeling. Introduction: Atrial structural and electrophysiologic changes occur during atrial tachycardia. The role of high ventricular rate in these processes remains to be established. Methods and Results: Six goats were subjected to 4 weeks of rapid atrioventricular (AV) p

  7. Left atrial myxoma presenting as paroxysmal supraventricular tachycardia.

    Science.gov (United States)

    Seol, Sang-Hoon; Kim, Doo-Il; Jang, Jae-Sik; Yang, Tae-Hyun; Kim, Dae-Kyeong; Kim, Dong-Soo

    2014-02-01

    Cardiac myxomas are benign intracavitary neoplasms. Their incidence in cardiac surgery is approximately 0.3%. Symptoms of cardiac myxomas are typically variable, from obstruction of mitral valve to coronary embolism resulting in acute myocardial infarction. In this case, left atrial myxoma is presented as paroxysmal supraventricular tachycardia.

  8. Atrial Tachycardias Occurring After Atrial Fibrillation Ablation: Strategies for Mapping and Ablation

    Directory of Open Access Journals (Sweden)

    Stavros Mountantonakis, MD

    2010-10-01

    Full Text Available The occurrence of left atrial tachycardias (AT after catheter ablation for atrial fibrillation (AF is common, especially after more extensive ablation of persistent AF. These AT are invariably symptomatic and often do not respond to medical therapy. The initial strategy involves ventricular rate control, cardioversion, and observation as some tachycardias may resolve with time. For persistent ATs, effective management frequently requires catheter intervention. Careful characterization of the tachycardia mechanism is essential in designing an effective ablation strategy that would also avoid further creation of pro-arrhythmic substrate. With this review, we summarize the incidence, mechanism, diagnosis and treatment of ATs occurring after AF ablation.

  9. Management of paroxysmal ectopic atrial tachycardia with long sinus pauses in a teenager.

    Science.gov (United States)

    Balaji, Seshadri

    2015-01-01

    Sinus pauses in the setting of supraventricular tachycardia is rare in children. We describe an asymptomatic teen with irregular heart rate detected during an incidental exam who was found to have short runs of a slow ectopic atrial tachycardia on electrocardiogram and prolonged sinus pauses on routine ambulatory ECG. Successful catheter ablation of the ectopic atrial tachycardia led to resolution of the sinus pauses.

  10. [Atrial fibrillation and regular tachycardia in two young patients--are both treated with atrial fibrillation ablation?].

    Science.gov (United States)

    von Bodman, G; Brömsen, J; Kopf, C; Füller, M; Block, M

    2014-04-17

    Two young patients with documented episodes of symptomatic paroxysmal atrial fibrillation have been referred for pulmonary vein isolation. Both patients had a history of concomitant regular tachycardia. in both cases pulmonaryvein isolation has not been performed but in each patient a supraventricular tachycardia (right focal atrial tachycardia/atrioventricular reentry tachycardia) could be induced and ablated instead. Concomitant supraventricular tachycardia acting as a trigger arrhythmia is frequent in young patients with atrial fibrillation without underlying cardiacdisease. In these patients a concomitant supra-ventricular tachycardia should beexcluded by electrophysiological study or ablated before pulmonary vein isolation or initiating an antiarrhythmic drug therapy. In most cases ablation of supraventricular tachycardia is safe and successful whereas the risks of ablative therapy of atrial fibrillation can not be neglected and success is moderate.

  11. The polyuria of paroxysmal atrial tachycardia

    Science.gov (United States)

    Kinney, M. J.; Stein, R. M.; Discala, V. A.

    1974-01-01

    Two patients with paroxysmal atrial fibrillation and an associated polyuria were studied to delineate the mechanism of the increase in urine flow. A striking saluresis was noted in both patients. The increased sodium excretion was probably due to decreased sodium reabsorption, perhaps at proximal tubular nephron sites. This inhibition of sodium reabsorption could explain both the saluresis and some part or all of the polyuria. Re-evaluation of earlier case reports reveals patterns of concomitant salt and water excretion consistent with this mechanism. The saluresis cannot be explained by the previously favored hypothesis of antidiuretic hormone inhibition.

  12. Management of paroxysmal ectopic atrial tachycardia with long sinus pauses in a teenager

    Science.gov (United States)

    Balaji, Seshadri

    2016-01-01

    Sinus pauses in the setting of supraventricular tachycardia is rare in children. We describe an asymptomatic teen with irregular heart rate detected during an incidental exam who was found to have short runs of a slow ectopic atrial tachycardia on electrocardiogram and prolonged sinus pauses on routine ambulatory ECG. Successful catheter ablation of the ectopic atrial tachycardia led to resolution of the sinus pauses. PMID:27134442

  13. [Transesophageal rapid stimulation of the left atrium in atrial tachycardias (author's transl)].

    Science.gov (United States)

    Sterz, H; Prager, H; Koller, H

    1978-02-01

    A new method to interrupt atrial tachycardias is reported. With an esophageal double-electrode the left atrium is stimulated with an external pacemaker at rates of 400 per minute and with 10 to 20 mAmp; The rhythm-disturbances treated in this way were: atrial tachycardias with constant or inconstant blocks and paroxysmal supraventricular tachycardias. 7 of 9 cases reported showed positive results, i.e. electrically induced atrial fibrillation and sinusrhythm immediately or within the first hour after stopping the pacer (6) or atrial fibrillation after disconnection from the pacer at a lower heart-rate than before (1). In 2 cases the technique was applied without success. The transoesophageal rapid left atrial stimulation (oeRLAS) is painless, can be applied without sterile measures and even without X-ray-control just by observing the oesophageal Ecg. Digitalisation is unimportant. The technique described may prove useful in cases of atrial tachycardias esp; in intensive care units. PMID:636520

  14. Atrial conduction delay predicts atrial fibrillation in paroxysmal supraventricular tachycardia patients after radiofrequency catheter ablation.

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    Xu, Zhen-Xing; Zhong, Jing-Quan; Zhang, Wei; Yue, Xin; Rong, Bing; Zhu, Qing; Zheng, Zhaotong; Zhang, Yun

    2014-06-01

    This study aimed to assess whether intra- and inter-atrial conduction delay could predict atrial fibrillation (AF) for paroxysmal supraventricular tachycardia (PSVT) patients after successful treatment by radiofrequency catheter ablation (RFCA). Echocardiography examination was performed on 524 consecutive PSVT patients (15 patients were excluded). Left atrial dimension, right atrial diameter and intra- and inter-atrial conduction delay were measured before ablation. Patients were divided into group A (n = 32): occurrence of AF after the ablation and group B (n = 477): remained in sinus rhythm during follow-up. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive value of intra- and inter-atrial conduction delay. Both intra- and inter-atrial conduction delay were higher in group A than in group B (4.79 ± 0.30 msec vs. 4.56 ± 0.32 msec; 21.98 ± 1.32 msec vs. 20.01 ± 1.33; p < 0.05). Binary logistic regression analysis showed that intra- and inter-atrial conduction were significant influential factors for the occurrence of AF (odds ratio [OR] = 13.577, 95% confidence interval [CI], 3.469-48.914; OR = 2.569, 95% CI, 1.909-3.459, p < 0.05). The ROC cure analysis revealed that intra-atrial conduction delay ≥ 4.45 msec and inter-atrial conduction delay ≥ 20.65 were the most optimal cut-off value for predicting AF in PSVT patients after RFCA. In conclusion, this is the first study to show that the intra- and inter-atrial conduction delay could effectively predict AF in post-ablation PSVT patients.

  15. Cellular signaling underlying atrial tachycardia remodeling of L-type calcium current

    NARCIS (Netherlands)

    Qi, Xiao Yan; Yeh, Yung-Hsin; Xiao, Ling; Burstein, Brett; Maguy, Ange; Chartier, Denis; Villeneuve, Louis R.; Brundel, Bianca J. J. M.; Dobrev, Dobromir; Nattel, Stanley

    2008-01-01

    Atrial tachycardia (AT) downregulates L-type Ca2+ current (I-CaL) and causes atrial fibrillation -promoting electric remodeling. This study assessed potential underlying signal transduction. Cultured adult canine atrial cardiomyocytes were paced at 0, 1, or 3 Hz (P0, P1, P3) for up to 24 hours. Cell

  16. Spontaneous Transition of Double Tachycardias with Atrial Fusion in a Patient with Wolff-Parkinson-White Syndrome

    Science.gov (United States)

    Kim, Dongmin

    2016-01-01

    Among patients with Wolff-Parkinson-White syndrome, atrioventricular reciprocating tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) can coexist in a single patient. Direct transition of both tachycardias is rare; however, it can occur after premature atrial or ventricular activity if the cycle lengths of the two tachycardias are similar. Furthermore, persistent atrial activation by an accessory pathway (AP) located outside of the AV node during ongoing AVNRT is also rare. This article describes a case of uncommon atrial activation by an AP during AVNRT and gradual transition of the two supraventricular tachycardias without any preceding atrial or ventricular activity in a patient with preexcitation syndrome. PMID:27482269

  17. Regular atrial tachycardias developing after cryoballoon pulmonary vein isolation: Incidence, characteristics, and predictors

    NARCIS (Netherlands)

    E. Mikhaylov (Evgeny); R. Bhagwandien (Rohit); P. Janse (Petter); D.A.M.J. Theuns (Dominic); T. Szili-Torok (Tamas)

    2013-01-01

    textabstractAimsCryoballoon ablation (CBA) is a well-used technique when performing pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). Our aim is to describe incidence, characteristics, and clinical predictors for developing atrial tachycardias (ATs) after cryoballoo

  18. Sustained Dissociated Irregular Tachycardia in Two Pulmonary Veins after Radiofrequency Ablation of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Andreas Haeberlin; Hildegard Tanner

    2014-02-01

    Full Text Available A 64-year-old woman underwent radiofrequency ablation of atrial fibrillation. After pulmonary vein (PV isolation, she converted into sinus rhythm. However, irregular PV tachycardia “trapped” in the right and left superior pulmonary vein (RSPV/LSPV sustained. Fifteen minutes after RSPV isolation, the RSPV tachycardia terminated. However, sustained LSPV tachycardia was still present after one hour. Three months later, a relapse of AF was confirmed and the patient underwent re-ablation. Re-conductance was observed in the RSPV and LSPV.

  19. Atrial activation during atrioventricular nodal reentrant tachycardia: Studies on retrograde fast pathway conduction

    NARCIS (Netherlands)

    D.G. Katritsis; K.A. Ellenbogen; A.E. Becker

    2006-01-01

    BACKGROUND Detailed right and left septal mapping of retrograde atrial activation during typical atrioventricutar nodal reentrant tachycardia (AVNRT) has not been undertaken and may provide insight into the complex physiology of AVNRT, especially the anatomic localization of the fast and stow pathwa

  20. Successful termination of combined rapid atrial flutter/fibrillation and ventricular tachycardia by intravenous sotalol.

    OpenAIRE

    Ramsdale, D. R.; Peterson, C

    1987-01-01

    Combined rapid atrial flutter/fibrillation and recurrent ventricular tachycardia occurred in an 82 year old man with acute myocardial infarction. Both arrhythmias were promptly terminated by intravenous sotalol, suggesting another use for this unique drug in the absence of hypotension, heart block or cardiac failure.

  1. [Paroxysmal supraventricular tachycardia-mechanisms, diagnostic, and treatment].

    Science.gov (United States)

    Tanner, Hildegard

    2014-02-01

    Paroxysmal supraventricular tachycardia have their origin above the His bundle. However, this definition has a historical origin and is imprecise regarding AV-reentry tachycardia using an accessory pathways since this tachycardia use the ventricule a part of the reentry-circuit. The most common supraventricular tachycardia is the atrioventricular nodal re-entry tachycardia, which is caused by a re-entrant tachycardia that involves the AV node and the atrial tissue followed by the atrioventricular re-entry tachycardia using an accessory pathway. More prevalent are sinus tachycardia, which is often physiologic and atrial fibrillation/flutter which are covered in detail by other articles within this issue of Therapeutischen Umschau. Therefore, the main topic of this review is the discussion of the mechanisms, diagnosis and treatment of AV nodal reentry tachycardia, AV reentry tachycardia using an accessory pathway and to a less extent focal atrial tachycardia.

  2. Life-threatening ventricular tachycardia during flecainide treatment for symptomatic atrial fibrillation in a patient with a structural cardiac disorder

    NARCIS (Netherlands)

    Rienstra, M.; Wiesfeld, A.C.; Van Veldhuisen, D.J.; Van Gelder, I.C.

    2006-01-01

    A 37-year-old man with symptomatic acute atrial fibrillation and a low-voltage electrocardiogram was treated with flecainide intravenously. Instead of conversion to sinus rhythm, he developed a wide-complex tachycardia suggestive of ventricular tachycardia. The patient recovered following electric c

  3. Case report of surgical treatment of abnormal atrial flutter (incisional atrial tachycardia in the patient after mitral valve replacement and radiofrequency modification of Maze procedure

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    Revishvili А. Sh.

    2012-12-01

    Conclusion. This type of tachycardia following after an atrial fibrillation surgery may be considered as a failing transmural myocardial damage during the procedure. The catheter method can be used succesfully unless there are no effects of antiarrhythmic therapy. The catheter method enables not only to verify the disconnection between the left atrial pulmonary veins and left atrium myocardium but also to perform the ablation in zones of the atrial myocardium that are anatomic substrates of post surgery tachyarrhythmias.

  4. Effect of cyclosporine-A on electrophysiological properties of atria in tachycardia-induced atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Lei Gao; Wei Yan; Yuqi Liu; Ya Huang; Qi Chen; Yuxiao Zhang; Peng Liu; Caiyi Lu

    2008-01-01

    Objective To investigate the effects of ciyelosporine-A(CsA).a calcinenrin(CAN)inhibitor,on electrophysiological propertiesof atria in canine tachycardia-induced model of AF.Methods Eighteen healthy adult mongrel canines weighing 17.0 to 23.2 kg(rangedfrom 2 to 4 years old)were randomized to 3 groups,Sham group(no pacemaker was implanted),atrial tachypacing group(ATP group)each group at baseline and after 8 weeks' tachypacing.Measurements included atrial effective refractory period(AERP),conductionvelocity(CV),wave length(WE),atrial fibrillation load and rate-adaptability. Results After 8 weeks' atrial tachypacing,ATP andCsA groups showed significant longer duration of the P wave,shorter AERP,decreased adaptation of AERE slower CV,shorter Wland longer AF duration compared to the shamg roup (all P<0.05).AERP of the CsA group was longer than that of ATP group (P<0.05),but there were no differences in rate-adaptability,CV,incidence of induced AF and AF duration between CsA group and ATP group.Conclusions Our results suggest that calcineurin pathway intervention by CsA have a positive effect on tachycardia-inducedelectrical remodeling of atria,but can not prevent or reverse AF.

  5. A Case of Atrial Tachycardia Circulating around a Left Atrial Roof Scar with Diabetes Mellitus and Renal Failure on Hemodialysis.

    Science.gov (United States)

    Hijioka, Naoko; Kamioka, Masashi; Suzuki, Hitoshi; Takeishi, Yasuchika

    2016-01-01

    Introduction. Little is known about the effects of volume change by hemodialysis (HD) and mechanical stress caused by an anatomical structure being in contact with the left atrium on the progression of atrial remodeling. We experienced a case of atrial tachycardia (AT) in a patient who had left atrial (LA) scarring at the LA roof and a low-voltage area with slow conduction around the LA scar as components of AT circuit. Here, we present the conceivable hypothesis of the LA scar and the low-voltage area formation. Our concept can be useful in developing a strategy for ablation in a patient with chronic renal failure (CRF) on HD. Case Report. A 65-year-old man with CRF on HD was referred for AT ablation. Three-dimensional electroanatomical mapping revealed that the AT conducted around an LA scar in a counterclockwise fashion. There was a slow conduction area at the superior side of the LA scar, where the AT was terminated during the ablation. Computed tomography indicated a close relationship between the LA and the anatomical structures (ascending aorta and pulmonary artery). Conclusion. Volume change by HD and close contact of anatomical structures to the LA can promote atrial remodeling, resulting in AT occurrence. PMID:27148367

  6. Blocked Atrial Bi/Trigeminy In Utero Evolving in Supraventricular Tachycardia after Birth

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    V. Martucci

    2012-01-01

    Full Text Available Transient episodes of fetal bradycardia (heart rate less than 110 bpm are usually benign and typically result from increased vagal stimulation in the fetus. Causes of sustained fetal bradycardia include sinus bradycardia, blocked atrial bigeminy/trigeminy, high-degree atrioventricular block, and long QT syndrome. We present the case of a 34-year-old Caucasian patient referred to our department for “blocked atrial bigeminy with pseudobradycardia” detected elsewhere at 33 weeks of gestation. A fetal echocardiography showed during all the examination a blocked atrial trigeminy with a mean fetal heart rate of 100 bpm. After birth three subsequent ECGs until day 3 showed no evidence of atrial extrasystoles, confirming the well-known frequent regression of this kind of fetal benign arrhythmia, but on day 11 recurrence of supraventricular trigeminy and development of episodes of paroxystic supraventricular tachycardia were observed. On the basis of this observation, we recommend that fetuses with complex atrial ectopic beats should be closely monitored before and after birth for evidence of new arrhythmias.

  7. Radiofrequency catheter ablation of atrial tachycardias related to myocardial scar or incision

    Institute of Scientific and Technical Information of China (English)

    Jianqiang HU; Jiang CAO; Shengqiang WANG; Yongwen QIN; Bingyan ZHOU

    2006-01-01

    Intra-atrial re-entrant tachycardias (IARTs) are common late after heart surgery. Conventional mapping and ablation is relatively difficult because of the complicated anatomy and multiple potential re-entry loops. In this study we aimed to evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia (AT) induced by myocardial scar or incision. Methods In 6 patients (three male and three female, aged 33.3+ 11.8 years) who had AT related to myocardial scar or incision,electrophysiological study and radiofrequency catheter ablation (RFCA) were performed. Earliest activation combined with entrainment mapping was adopted to determine a critical isthmus. Results Re-entry related to the lateral atriotomy scar was inducible in 5 of6 patients. With entrainment mapping, the PPI (post-pacing interval)-TCL (tachycardia cycle length) difference was <30 ms when pacing at the inferior margins of the right lateral atriotomy scar. Among them, 3 patients had successful linear ablation between scar area to inferior vena cava, and 2 patients between scar area to tricuspid annulus. Re-entry involving an ASD patch was demonstrated in 1 of 6 patients. PPI-TCL differences <30 ms were observed when entraining tachycardia at sites near the septal patch. But linear ablation failed in terminating AT. There was no complication during procedure. No recurrence of AT related to incision was observed during follow-up except for the failed patient. Conclusion Under conventional electrophysiological mapping, adopting linear ablation from scar area to anatomic barrier, successful ablation can be obtained in patients with IRATs related to myocardial scar or incision.

  8. Radiofrequency ablation for treating paroxysmal supraventricular tachycardia complicated by atrial fibrillation: A single-center retrospective analysis

    Institute of Scientific and Technical Information of China (English)

    WEI Zhan-yang; CHEN Li-hua; MO Jing-lan

    2016-01-01

    Background The effect of selective radiofrequency ablation for treating paroxysmal supraventricular tachycardia (PSVT) and its associated paroxysmal atrial fibrillation (PAF) was assessed.Methods Data were collected retrospectively from patients diagnosed of PSVT and subsequently treated with radiofrequency ablation.Regular monthly follow-up by dynamic electrocardiography (ECG) was performed.Incident rates of atrial fibrillation before and after ablation were compared.Results 382 PSVT patients with 58 having atrial fibrillation were enrolled.The order of complicated PAF from high to low in these patients was displayed as:atrial tachycardia (AT),atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT).Among AVRT patients,PAF was more frequent in patients having accessory pathways.AVNRT patients had significantly lower PAF rate comparing to other patients.PAF incident rate was significantly reduced by radiofrequency ablation therapy.Conclusion We advise regular dynamic ECG for PSVT patients,especially those with atrial flutter,AT or pre-excitation syndrome.Selective radiofrequency ablation is a feasible approach for treating AF complicated PSVT patients.

  9. Macro-reentrant atrial tachycardia conducting through a left superior vena cava after catheter ablation in a patient with paroxysmal atrial fibrillation.

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    Kurotobi, Toshiya; Kino, Naoto; Tonomura, Daisuke; Shimada, Yoshihisa

    2015-01-01

    A left superior vena cava can be a cause of cardiac rhythm or conduction abnormalities, and can also be the arrhythmogenic source of atrial fibrillation (AF) with connections to the coronary sinus and left atrium. In the present study, we report a case with a macro re-entrant atrial tachycardia that coursed through the left superior vena cava after a previous AF ablation, which successfully ablated paroxysmal AF.

  10. How to Recognize Epicardial Origin of Ventricular Tachycardias?

    OpenAIRE

    Fernández-Armenta, Juan; Berruezo, Antonio

    2014-01-01

    Percutaneous pericardial access for epicardial mapping and ablation of ventricular arrhythmias has expanded considerably in recent years. After its description in patients with Chagas disease, the technique has provided relevant in-formation on the arrhythmia substrate in other cardiomyopathies and has improved the results of ablation procedures in various clinical settings. Electrocardiographic criteria proposed for the recognition of the epicardial origin of ventricular tachycardias are mai...

  11. Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics

    NARCIS (Netherlands)

    Leclercq, C.; Padeletti, L.; Cihak, R.; Ritter, P.; Milasinovic, G.; Gras, D.; Paul, V.; Van Gelder, I. C.; Stellbrink, C.; Rieger, G.; Corbucci, G.; Albers, B.; Daubert, J. C.

    2010-01-01

    Little is known about the incidence of paroxysmal atrial tachycardias (PAT) in patients with heart failure (HF). The availability of cardiac resynchronization therapy (CRT) devices with extended diagnostics for AT enables continuous monitoring of PAT episodes. The aim of the study was to assess the

  12. Changes of atrial natriuretic peptide and antidiuretic hormone in children with postural tachycardia syndrome and orthostatic hypertension: a case control study

    Institute of Scientific and Technical Information of China (English)

    Zhao Juan; Yang Jinyan; Du Shuxu; Tang Chaoshu; Du Junbao; Jin Hongfang

    2014-01-01

    Background The abnormal blood volume regulation is one of the most important pathogenesis in postural tachycardia syndrome in children.This study was designed to investigate the plasma atrial natriuretic peptide and antidiuretic hormone levels in postural tachycardia syndrome children,and their associations with the changes in heart rate and blood pressure in head-up test.Methods Twenty-one postural tachycardia syndrome patients ((12±2) years) and 26 healthy children ((12±1) years) were included.According to blood pressure changes in head-up test,the postural tachycardia syndrome patients were divided into two subgroups:postural tachycardia syndrome with orthostatic hypertension and postural tachycardia syndrome without orthostatic hypertension.The plasma atrial natriuretic peptide and antidiuretic hormone levels were measured using enzyme-linked immunosorbent assay.Results The plasma atrial natriuretic peptide level in postural tachycardia syndrome patients was higher than the control (P=0.004),whereas the difference in plasma antidiuretic hormone level between postural tachycardia syndrome and controls was not significant (P=0.222).The plasma antidiuretic hormone level of patients suffering from postural tachycardia syndrome with orthostatic hypertension was much higher than that of children having postural tachycardia syndrome without orthostatic hypertension (P <0.05).In postural tachycardia syndrome patients,the updght max heart rate was positively correlated with the plasma atrial natriuretic peptide level (r=0.490,P<0.05) and the upright systolic blood pressure was positively correlated with the plasma antidiuretic hormone levels (r=0.472,P <0.05).Conclusions There was a disturbance of plasma atrial natriuretic peptide and antidiuretic hormone in postural tachycardia syndrome children.

  13. Late intra-atrial reentrant tachycardia would be prevented by ablation of right atrial potential isthmuses during the surgical operation for congenital heart disease

    Institute of Scientific and Technical Information of China (English)

    SANG Cai-hua; DONG Jian-zeng; LIU Xing-peng; YU Rong-hui; LONG De-yong; TANG Ri-bo; MA Chang-sheng

    2010-01-01

    @@ Intra-atrial reentrant tachycardia (IART) is not uncommon after surgical correction of congenital heart disease (CHD). The patients with IART are often refractory to antiarrhymic agents and present with severe symptoms. Current treatment approach to IART has shifted largely to interventional procedures which have a good short-term success rate, however, late recurrence rate is still high. With the development of mapping technique especially the application of three-dimensional electroanatomic mapping, the exact mechanisms of IART have become clear.

  14. Tachycardia | Fast Heart Rate

    Science.gov (United States)

    ... Heart patient sheets Arrhythmia • Home • About Arrhythmia Introduction Atrial Fibrillation Bradycardia Conduction Disorders Premature Contractions Tachycardia Ventricular Fibrillation Other Rhythm Disorders Types of ...

  15. Sick sinus syndrome, progressive cardiac conduction disease, atrial flutter and ventricular tachycardia caused by a novel SCN5A mutation

    DEFF Research Database (Denmark)

    Holst, Anders G; Liang, Bo; Jespersen, Thomas;

    2010-01-01

    Mutations in the cardiac sodium channel encoded by the gene SCN5A can result in a wide array of phenotypes. We report a case of a young male with a novel SCN5A mutation (R121W) afflicted by sick sinus syndrome, progressive cardiac conduction disorder, atrial flutter and ventricular tachycardia. His...... father carried the same mutation, but had a milder phenotype, presenting with progressive cardiac conduction later in life. The mutation was found to result in a loss-of-function in the sodium current. In conclusion, the same SCN5A mutation can result in a wide array of clinical phenotypes and perhaps...

  16. [Cardiogenic shock after drug therapy for atrial fibrillation with tachycardia : Case report of an 89-year-old woman].

    Science.gov (United States)

    Fey, H; Jost, M; Geise, A T; Bertsch, T; Christ, M

    2016-06-01

    β-Blockers and calcium channel blockers are commonly used drugs in the treatment of atrial fibrillation with tachycardia. However, in patients with high myocardial susceptibility and vulnerability, combination therapy with β-blockers and non-dihydropyridine calcium channel blockers (verapamil or diltiazem) but also individual administration can cause drug-induced cardiogenic shock. Thus, the simultaneous administration of β-blockers and non-dihydropyridine calcium channel blockers is absolutely contraindicated. In case of acute heart failure, isolated application is also contraindicated. In the treatment of a cardiogenic shock induced by β-blockers and/or non-dihydropyridine calcium channel blockers, administration of intravenous calcium, glucagon or high-dose insulin is recommended. PMID:26440099

  17. Cardiac Origins of the Postural Orthostatic Tachycardia Syndrome

    Science.gov (United States)

    Fu, Qi; VanGundy, Tiffany B.; Galbreath, M. Melyn; Shibata, Shigeki; Jain, Manish; Hastings, Jeffrey L.; Bhella, Paul S.; Levine, Benjamin D.

    2010-01-01

    Objectives To test the hypothesis that a small heart coupled with reduced blood volume contributes to the Postural Tachycardia Syndrome (POTS), while exercise training improves this syndrome. Background Patients with POTS have marked increases in heart rate during orthostasis. However, the underlying mechanisms are unknown and the effective therapy is uncertain. Methods Twenty-seven POTS patients underwent autonomic function tests, cardiac MRI, and blood volume measurements. Twenty-five of them participated in a 3-mo specially designed exercise training program with 19 completing the program; these patients were reevaluated after training. Results were compared with those of 16 healthy controls. Results Upright heart rate and total peripheral resistance were greater, while stroke volume and cardiac output were smaller in patients than controls. Baroreflex function was similar between groups. Left ventricular mass (median [25%, 75%], 1.26 [1.12, 1.37] vs 1.45 [1.34, 1.57] g/kg; PSeuss, the main character had a heart that was “two sizes too small.” PMID:20579544

  18. Impact of the origin of sinus node artery on recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhi-jun; CHEN Ke; TANG Ri-bo; gANG Cai-hua; Edmundo Patricio Lopes Lao; YAN Qian; HE Xiao-nan

    2013-01-01

    Background Major atrial coronary arteries,including the sinus node artery (SNA),were commonly found in the areas involved in atrial fibrillation (AF) ablation and could cause difficulties in achieving linear block at the left atrial (LA) roof.The SNA is a major atrial coronary artery of the atrial coronary circulation.This study aimed to determine impact of the origin of SNA on recurrence of AF after pulmonary vein isolation (PVI) in patients with paroxysmal AF.Methods Seventy-eight patients underwent coronary angiography for suspected coronary heart disease,followed by catheter ablation for paroxysmal AF.According to the origin of SNA from angiographic findings,they were divided into right SNA group (SNA originating from the right coronary artery) and left SNA group (SNA originating from the left circumflex artery).Guided by an electroanatomic mapping system,circumferential pulmonary vein ablation (CPVA) was performed in both groups and PVI was the procedural endpoint.All patients were followed up at 1,3,6,9 and 12 months post-ablation.Recurrence was defined as any episode of atrial tachyarrhythmias (ATAs),including AF,atrial flutter or atrial tachycardia,that lasted longer than 30 seconds after a blanking period of 3 months.Results The SNA originated from the right coronary artery in 34 patients (43.6%) and the left circumflex artery in 44 patients (56.4%).Freedom from AF and antiarrhythmic drugs (AADs) at 1 year was 67.9 % (53/78) for all patients.After 1 year follow-up,79.4% (27/34) in right SNA group and 59.1% (26/44) in left SNA group (P=0.042) were in sinus rhythm.On multivariate analysis,left atrium size (HR=1.451,95%CI:1.240-1.697,P <0.001) and a left SNA (HR=6.22,95%CI:2.01-19.25,P=0.002)were the independent predictors of AF recurrence.Conclusions The left SNA is more frequent in the patients with paroxysmal AF.After one year follow-up,the presence of a left SNA was identified as an independent predictor of AF recurrence after CPVA in

  19. Incessant Long R-P Tachycardia.

    Science.gov (United States)

    Abi-Saleh, Bernard; Refaat, Marwan M; Bitar, Fadi F; Khoury, Maurice; Arabi, Mariam

    2016-03-01

    A 13-year-old boy had a positive P wave in V1 with a negative P wave in lead I, aVL, and aVR, as well as a positive P wave in the inferior leads, which correlated with a left atrial appendage (LAA) atrial tachycardia (AT) focus. P-wave morphologies can provide clues regarding an AT's origin, and this P-wave negative in lead I favored LAA AT. Careful mapping along the atria and coronary sinus to determine the earliest site of activation for the surface P wave is a reliable method for precisely localizing the AT origin as a target for catheter ablation. PMID:26920173

  20. Radiofrequency catheter ablation of idiopathic ventricular tachycardia and symptomatic premature ventricular contraction originating from valve annulus

    Institute of Scientific and Technical Information of China (English)

    WU Xiao-yu; LIANG Zhao-guang; TAN Zhen; GU Hong-yue; ZHANG Shu; LI Wei-min

    2008-01-01

    Background Radiofrequency catheter ablation (RFCA) has been established as an effective and curative therapy for ventricular tachycardia (VT) and severely symptomatic premature ventricular contraction (PVC) from the outflow tract in structurally normal hearts.This study aimed to investigate electrophysiologic characteristics and effects of RFCA for patients with idiopathic VT and symptomatic PVC originating from the valve annulus.Methods Characteristics of body surface electrocardiogram (ECG) and endocardiogram in a successful RFCA target were analyzed in 16 patients with idiopathic VT and symptomatic PVC originating from the valve annulus.Additionally,the ECG characteristics of vr or PVC were compared with those of manifest Wolff-Parkinson-White (WPW) syndrome originating from the same site of origin in 15 patients.Results Thirteen patients were successful,2 recurrent and 1 failed.The recurrent cases underwent successful ablation the second time guided by the Ensite 3000 mapping system.In all patients with the WPW syndrome,the characteristics of QRS morphology were well matched with those of the VT and PVC that originated from corresponding sites of origin.Conclusions RFCA is an effective curative therapy for VT and symptomatic PVC originating from the valve annulus.There are specific characteristics in ECG and the ablation site could be located by means of the WPW syndrome accessory pathway's algorithm.

  1. Multifocal atrial tachycardia

    Science.gov (United States)

    ... children. In MAT, many locations in the atria fire signals at the same time. Too many signals ... Tests to diagnose MAT include: ECG Electrophysiologic study (EPS) Heart monitors are used to record the rapid ...

  2. A shared pathway among supraventricular tachycardias

    Directory of Open Access Journals (Sweden)

    Moghaddam M

    1995-07-01

    Full Text Available AVNRT, (Atrioventricular nodal reentry tachycardia, atrial tachycardia and atrial flutter are 3 kinds of supraventricular tachycardia, which their mechanism are explained based on reentry. A 60-years-old man is presented with all of the above-mentioned arrhythmias, responsive to intravenous injection of adenosine. Radiofrequency ablation of the slow pathway territories cured all of them. Therefore, we suggest that there was a common pathway among all kinds of these arrhythmias, which were ablated with single RF lesion.

  3. Cardiomyopathy Due to Nonsustained Ventricular Tachycardia Originating from the Aortic Sinus Cusp

    Directory of Open Access Journals (Sweden)

    Hamidreza Bonakdar

    2013-03-01

    Full Text Available We report a case of idiopathic nonsustained ventricular tachycardia (VT originating from the aortic sinus cusp referred for presyncope and LV dysfunction and frequent premature ventricular complex with no response to 3 months anti-arrhythmic medication for heart failure and arrhythmia. She was then referred to us for frequent PVC's and runs of nonsustained VT. ECG recorded during the nonsustained VT showed a left bundle branch block pattern in the precordial leads and an inferior axis and early transition in precordial leads in V3-V4. QS morphology in lead V1 was noticed with notching on the downward deflection. Electrophysiologic study was conducted to map ventricular outflow tract as a classic method, although pace map failed to find any matched QRS with the spontaneous PVCs. The mapping of aortic cusps was also performed. The best potential was recorded in a region located at the commissure of left-right aortic cusps. A single radiofrequency energy was delivered which resulted in immediate elimination of PVCs. The patient was discharged the day after ablation without any PVC recorded on monitor. Left ventricular ejection fraction(LVEF improved to normal level two months later. There was no PVC detected at serial holter monitoring. It seems logical not to overlook even an isolated or nonsustained ventricular arrhythmia considering the available and effective treatments such as ablation rather than congestive heart failure(CHF therapy especially in a young patient.

  4. Giant atrial septal aneurysm originating from the right coronary artery.

    Science.gov (United States)

    Osada, Hiroaki; Kanemitsu, Naoki; Meshii, Katsuaki; Ohnaka, Motoaki

    2016-08-01

    Giant coronary artery aneurysm is a rare clinical entity and its involvement in the interatrial space is extremely rare. We here report the rare surgical case of a 67-year old man with giant right coronary artery aneurysm located in the atrial septum with fistula formation to the right atrium, complicated with congestive heart failure, rapid atrial fibrillation and left atrial appendage thrombus. The patient eventually recovered fully without sequelae. PMID:27118290

  5. Symptomatic Bradycardia Caused By Premature Atrial Contractions Originating From Right Atrial Appendage

    OpenAIRE

    Alper, AT; Gungor, B; Turkkan, C; Tekkesin, AI

    2013-01-01

    Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation.

  6. Symptomatic bradycardia caused by premature atrial contractions originating from right atrial appendage.

    Science.gov (United States)

    Alper, At; Gungor, B; Turkkan, C; Tekkesin, Ai

    2013-05-01

    Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation. PMID:23840105

  7. Paroxysmal supraventricular tachycardia as first manifestation of right atrial hemangioma during endovascular treatment of intracranial arteriovenous fistulas.

    Science.gov (United States)

    Spanò, Francesca; Cereda, Alberto; Moreo, Antonella; Bonacina, Edgardo; Peritore, Angelica; Roghi, Alberto; Giannattasio, Cristina; Pedrotti, Patrizia

    2015-06-10

    We report the description of a cardiac mass occupying almost the entire right atrium in a young man who developed paroxysmal supraventricular tachycardia during endovascular treatment of intracranial arteriovenous fistulas. The mass was detected at echocardiographic examination, its tissue characteristics were defined with cardiac magnetic resonance and it was successfully surgically removed. The histopathological findings were consistent with a mixed type cavernous-capillary hemangioma of the heart. The intriguing co-existence of cardiac hemangioma and cerebral arteriovenous fistulas, to the best of our knowledge, has not been previously reported in English Literature.

  8. Ablation of the atrioventricular node executed after paranodal ablation of the atrioventricular node for the treatment of paroxysmal atrial-ventricular node of reentry tachycardia in conditions of artificial blood circulation

    Directory of Open Access Journals (Sweden)

    Melikulov A.Kh.

    2014-03-01

    Full Text Available In this clinical observation is shown the data of the patient who was previously undergone paranodal ablation of atrial-ventricular junction for the treatment of atrioventricular (AV nodal reentrant tachycardia. Radiofrequency ablation of right lower isthmus for treatment of the paroxysmal form of atrial flutter was made for the patient. Sick sinus node syndrome and paroxysmal form of atrial fibrillation were diagnosed. Then dual-chamber pacemaker was implanted. Antiarrhythmic therapy about the persistent form of atrial fibrillation had no effect. The decision for the implementation of radio frequency modification of atrioventricular connection using right ventriclar access failed because of the lack of verification of the His bundle's spike. Using retrograde access through the aorta we managed to create AV blockade of III degree. Taking into account the fact that in 1990-ies patients with atrioventricular nodal reentrant tachycardia were operated using paranodal ablation of the AV node using extracorporeal circulation, this case has a practical significance when endovascular catheter modification of AV nodal conduction in this category of patients is made.

  9. Nonlinear Heart Rate Dynamics in Off-pump Coronary Artery Bypass Grafting Patients and The Relevance with Atrial Fibrillation and Ventricular Tachycardia

    Institute of Scientific and Technical Information of China (English)

    Wu Zhongkai; Yao Jianping; Huang Xiaodan; Jari Laurikka; Saila Vikman; Matti R. Tarkka

    2007-01-01

    Objectives To elucidate the clinical relevance of nonlinear HRV with postoperative arrhythmias in patients undergoing off-pump CABG. Methods Twenty-seven elective off-pump CABG patients were recruited in the present study. Atrial fibrillation (AF),ventricular tachycardia (VT), linear and nonlinear HRV were analysed using 24-hour electrocardiogram before and after surgery. Results All time domain (SDNN,pNN50 and rMSSD ), frequency domain (LF and HF)of linear measures of HRV variables and nonlinear measures of HRV variable, the short-term fractal-like correlation α1 decreased significantly after surgery. The postoperative nonlinear HRV variable α1 tended to be lower in patients with postoperative AF ( P = 0.056). Significant depressed α1 was found in patients with postoperative VT(P = 0.022 ). Elder patient's age and longer inotropic treatment time negatively correlated with postoperative α1. Conclusions Off-pump CABG procedures resulted in significant depressed of linear and nonlinear HRV variables. The depressed nonlinear HRV variables α1 related to age, inotropic supports and postoperative AF and VT.

  10. Pheochromocytoma-induced atrial tachycardia leading to cardiogenic shock and cardiac arrest: resolution with atrioventricular node ablation and pacemaker placement.

    Science.gov (United States)

    Shawa, Hassan; Bajaj, Mandeep; Cunningham, Glenn R

    2014-12-01

    Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias. A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, cardiogenic shock and cardiac arrest unresolved by the placement of 2 different ventricular assist devices, but that was completely reversed by radiofrequency ablation of the atrioventricular node and the placement of a temporary pacemaker. We present the patient's clinical, laboratory, and imaging findings, and we review the relevant literature.

  11. [Initial evaluation and management of paroxysmal supraventricular tachycardia].

    Science.gov (United States)

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal; Nielsen, Jens Cosedis; Pareek, Manan

    2016-01-18

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar management strategies. The probable mechanism of paroxysmal SVT can often be diagnosed from the clinical findings and a 12-lead ECG. This review describes the initial evaluation and treatment of patients with paroxysmal SVT, including distinctive features from the most important differential diagnoses.

  12. CHANGES OF PLASMA ENDOTHELIN AND ATRIAL NATRIURETIC PEPTIDE DURING THE ONSET AND AFTER TERMINATION OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

    Institute of Scientific and Technical Information of China (English)

    李春盛; 田茹敏; 朱丽楠; 李丹宇; 冯启刚; 高秀兰

    1995-01-01

    Radioimmunoassays were used to measure the concentration changes of plasma endothelin (ET) and atrial natriuretic peptide (ANP) during the onset and after termination of paroxysmal supraventrieular taehyeardia (SVT). 30 cases were reviewed and comparisons with 42 normal subjects were made. There are very significant differences (P<0. 0001) in the concentration changes of both plasma ET and ANP during the onset and 30 minutes after the termination of SVT. During the offset period of SVT, the plas-ma ET and ANP were markedly elevated and 30 minutes after its termination they were lowered signifi-cantly, but their concentrations were still 2-fold higher than those of the control group. As the biological effects of ANP and ET are antagonistic to each other, their parallel elevation and lowering of plasma con-centratinns during and.after the termination oE SVT reveal that these 2 hormones participate in the patho-physiolngical process of SVT. This phenomenon is possibly one of the homeostatic regulatory functions in the organism.

  13. Tachycardia-Induced Heart Failure

    OpenAIRE

    Patel, Jitenbhai J; Whittaker, Charles T

    2007-01-01

    Heart failure associated with tachyarrhythmias can very often be reversed by dealing with the underlying tachyarrhythmia. Typically characterized by left ventricular dilation and subsequent systolic dysfunction, this disorder can be caused by both atrial and ventricular arrhythmias, most commonly chronic atrial fibrillation. Whereas for most cardiomyopathies there is little that can be done to reverse the progression of the disease, in tachycardia-induced heart failure the patient's often deb...

  14. S4153R is a gain-of-function mutation in the cardiac Ca(2+) release channel ryanodine receptor associated with catecholaminergic polymorphic ventricular tachycardia and paroxysmal atrial fibrillation.

    Science.gov (United States)

    Zhabyeyev, Pavel; Hiess, Florian; Wang, Ruiwu; Liu, Yingjie; Wayne Chen, S R; Oudit, Gavin Y

    2013-08-01

    Mutations in ryanodine receptor 2 (RYR2) gene can cause catecholaminergic polymorphic ventricular tachycardia (CPVT). The novel RYR2-S4153R mutation has been implicated as a cause of CPVT and atrial fibrillation. The mutation has been functionally characterized via store-overload-induced Ca(2+) release (SOICR) and tritium-labelled ryanodine ([(3)H]ryanodine) binding assays. The S4153R mutation enhanced propensity for spontaneous Ca(2+) release and reduced SOICR threshold but did not alter Ca(2+) activation of [(3)H]ryanodine binding, a common feature of other CPVT gain-of-function RYR2 mutations. We conclude that the S4153R mutation is a gain-of-function RYR2 mutation associated with a clinical phenotype characterized by both CPVT and atrial fibrillation.

  15. A novel mutation in the RYR2 gene leading to catecholaminergic polymorphic ventricular tachycardia and paroxysmal atrial fibrillation: dose-dependent arrhythmia-event suppression by β-blocker therapy.

    Science.gov (United States)

    Kazemian, Pedram; Gollob, Michael H; Pantano, Alfredo; Oudit, Gavin Y

    2011-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a genetic condition that presents with exercise-induced polymorphic arrhythmias. We describe a case report of a 25-year-old woman who had a cardiac arrest due to ventricular fibrillation. Genetic analysis revealed a novel missense mutation in exon 90 of the ryanodine receptor (RyR2) gene resulting in substitution of arginine for serine at residue 4153 (S4153R). The patient received an implantable cardioverter-defibrillator and low-dose β-blocker therapy. She had recurrent polymorphic ventricular arrhythmias treated with appropriate cardioverter-defibrillator shocks and paroxysmal atrial fibrillation. Titration of β-blocker to a much higher dose suppressed further episodes of ventricular arrhythmia and paroxysmal atrial fibrillation, resulting in reduction in device therapies.

  16. Incessant Palpitations and Narrow Complex Tachycardia.

    Science.gov (United States)

    Han, Frederick T

    2016-03-01

    Junctional tachycardia (JT) is rare cause of supraventricular tachycardia. The intracardiac activation sequence is similar to atrioventricular nodal reentrant tachycardia (AVNRT). Premature atrial contractions inserted during tachycardia can help distinguish JT from AVNRT. As noted in this case, slow pathway ablation for JT may not always be effective for termination of JT. Activation mapping during JT identified a low-amplitude potential in the region of the coronary sinus ostium and the inferior margin of the triangle of Koch that marked the successful ablation site for JT. PMID:26920171

  17. Electrophysiological characteristics of paroxysmal atrial fibrillation originating from superior vena cava: a clinical analysis of 30 cases

    OpenAIRE

    Shi, Xiang-min; YUAN, HONG-TAO; Guo, Hong-Yang; Guo, Jian-Ping; Shan, Zhao-Liang; Wang, Yu-tang

    2015-01-01

    To analyze characteristics of electrocardiogram (ECG), electrophysiological intracardiac mapping and radiofrequency ablation (RF) of paroxysmal atrial fibrillation (PAF) originating from superior vena cava (SVC), aiming to investigate electrophysiological characteristics of PAF with SVC origin. Clinical data of 30 subjects (18 men and 12 women, aged, 58.6 ± 15.5 years) with PAF of SVC origin were retrospectively analyzed; All patients underwent RF during 2006.9-2012.7. ECG of AF and atrial pr...

  18. Dynamics of Paroxysmal Tachycardia

    Science.gov (United States)

    Glass, Leon

    2004-03-01

    Parosxysmal tachycardia refers to abnormally fast cardiac arrhythmias that suddenly start and stop. Paroxysmal tachycardias can occur in many regions of the heart and may be associated with many different mechanisms. In order to study paroxysmal tachycardias, we have analyzed tissue cultures of cells from embryonic chick heart that are imaged using calcium and voltage sensitive dyes. This model system displays a number of different types of dynamics including dynamics originating from pacemakers, triggered dynamics in which an excitation leads to the initiation of a sequence of waves originating from a single source, and spontaneously iniitiating and terminating rotating spiral waves. Theoretical models that include heterogeneity, spontaneous pacemaker activity, and fatigue or reduced excitability arising as a consequence of rapid excitation can be used to account for these behaviors.

  19. 儿童房性心动过速的电生理标测和射频导管消融%Radiofrequency catheter ablation of atrial tachycardia in children

    Institute of Scientific and Technical Information of China (English)

    高路; 袁越; 林利; 崔烺; 姚焰

    2010-01-01

    目的 报道儿童房性心动过速(房速)的电生理标测及射频导管消融的疗效.方法 43例患儿(男性23例,女性20例),年龄2~14(7.1±3.1)岁,其中33例为无休止房速,17例伴有明显的左心室扩大及慢性心力衰竭.所有患儿均进行电生理标测,在最早激动点进行导管射频消融.结果 39例自发或诱发房速,局灶起源36例(右心房26例,左心房10例),先天性心脏病后大折返房速3例.35例(89.7%)患儿消融术即刻成功,消融术中及术后无严重并发症发生.平均随访(25.2±13.5)个月,34例(87.2%)患儿不服药亦无房速发作,其余均获得明显改善.14例左心室重度扩大及射血分数减低患儿心脏大小及功能恢复正常.结论 儿童房速可经导管消融消除或获得明显改善.%Objective Atrial tachycardia (AT) is a common entity among children.This study was designed to investigate the effects of electrophysiological study (EPS) and radiofrequency (RF) catheter ablation of AT in children. Methods Forty-three children [ mean age: (7. 1 ± 3. 1 ) years ] with AT underwent EPS and catheter ablation. Thirty-three children had demonstrated incessant AT, and 17 children had severely dilated left ventricle (LV) and congestive heart failure before ablation. RF energy was delivered to the earliest activation site of the AT. Results Thirty-nine children have spontaneous or induced AT, 36 of them was verified as focal mechanism (26 foci in the right atrium and 10 in the left atrium),and 3 was macro-reentrant mechanism. The AT originated from right atrial appendage in 12 cases. RF ablation was acutely successful in 35 (89. 7% ) patients without any complications. During a follow-up period of ( 25.2 ± 13.5 ) months, 34/39 (87.2%) children had no recurrence of AT, and the 14 children with severe dilated LV before ablation had normal LV diameter. Conclusion RF catheter ablation is effective and safe for treatment of pediatric AT.

  20. Persistent wandering atrial pacemaker after epinephrine overdosing – a case report

    Directory of Open Access Journals (Sweden)

    Aburawi Elhadi H

    2013-01-01

    Full Text Available Abstract Background Long-term complications of sympathomimetic drug overdosing have not been adequately investigated in infants and young children. Despite reports discouraging their use in children, these formulations are frequently administered for “cold-like symptoms”. Their frequent adverse events are different forms of arrhythmias, including multifocal atrial tachycardia. Case presentation A 3-year-old toddler developed multifocal atrial tachycardia following an iatrogenic overdose of epinephrine accidentally administered intravenously. His ECG showed wandering atrial pacemaker (p-waves with different origins and configurations that persisted for at least one year. This event demonstrated the sensitivity of young children to the sympathomimetic drugs, especially overdosing. Conclusions Health care providers and parents should be warned of toxicities associated with sympathomimetic drug overdosing. Future studies are needed to determine whether wandering atrial pacemaker is a potential long-term complication of high-dose sympathomimetics.

  1. Circus movement in rabbit atrial muscle as a mechanism of tachycardia. II. The role of nonuniform recovery of excitability in the occurrence of unidirectional block, as studied with multiple microelectrodes.

    Science.gov (United States)

    Allessie, M A; Bonke, F I; Schopman, F J

    1976-08-01

    Periods of tachycardia were induced in isolated segments (15 X 15 mm) of rabbit left atrium by local application of a properly timed premature stimulus. We used a special device for multiple synchronous microelectrode recordings of responses of more than 100 fibers during the initiation of tachycardia. We clearly demonstrated circus movement of the impulse through a small area of atrial muscle as the underlying mechanism. The premature impulse was conducted antegrade in only one direction, whereas in the other directions antegrade conduction failed. The local responses of the fibers in the blocked area served as a temporary obstacle for return of the premature impulse. When these fibers recovered their excitability before extinction of the premature impulse, they were reentered in a retrograde direction, and the impulse traveled in a circular route. During the propagation of a premature beat, local block, which set the stage for circus movement, was caused by nonuniform recovery of excitability of the atrium. We related the spread of activation of a premature impulse to the naturally occurring spatial dispersion in refractory periods and found that local conduction block invariably was associated with an area of delayed restoration of excitability. Artificial induction of differences in refractory periods by regional application of carbamylcholine made it clear that a disparity in refractory periods of only 11-6 msec between adjacent areas may be sufficient to cause local conduction block of a properly timed premature impulse. PMID:939001

  2. Anomalous Origin of the Left Atrial Branch from the Left Main Trunk

    OpenAIRE

    Arash Gholoobi

    2015-01-01

    A 78-year-old woman was referred for coronary angiography with the chief complaint of exertional angina and dyspnea of a very long duration during routine daily physical activities. She had a history of poorly controlled hypertension and dyslipidemia. Coronary angiography revealed diffuse three-vessel disease. Interestingly, an unusual branch was noted originating from the mid shaft of the left main trunk with a funnel-shaped root and travelling the course of a left atrial (LA) branch (Figure...

  3. 老年阵发性室上速食道调搏与药物复律的比较%Comparison of Cardioversion between by Transesophageal Atrial Pacing and Drug in Elderly Patients with Paroxysmal Supraventricular Tachycardia

    Institute of Scientific and Technical Information of China (English)

    胡司淦; 徐玮; 王本芳; 蔡鑫

    2013-01-01

    目的 对比观察老年阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)患者通过食道心房调搏(transesophageal atrial pacing,TEAP)与药物复律的效果.方法 45例老年PSVT患者心动过速发作时分别应用TEAP和药物终止PSVT发作,观察心动过速的终止方式、终止时间及并发症的发生情况.TEAP终止PSVT发作采用超速刺激,药物复律采用ATP、心律平及可达龙.结果 TEAP组患者心动过速终止时间(2~30 s)少于药物组(5 s~10h).TEAP组PSVT终止率(100%)高于药物组终止率(94.7%),无统计学意义(P>0.05).药物组患者窦性停搏、低血压并发症高于TEAP组(P<0.05).复律后早搏及胸痛等并发症两组无统计学意义(P>0.05).结论 老年PSVT患者特别是合并器质性心脏病患者首选TEAP术终止心动过速发作.通过TEAP电生理检查能明确心律失常类型,具有安全性高、创伤小及快速终止优点.%Objective To compare the efficacy of cardioveision in elderly patients with paroxysmal supraventricular tachycar-dia(PSVT) by transesophageal atrial pacing (TEAP) and drug. Methods 45 elderly patients with PSVT were applied respectively TEAP and drug to terminate tachycardia, the tachycardia termination mode, termination time and complications were observed. TEAP terminated PSVT using overdrive stimulation. Pharmacologic cardioversion using ATP,propafenone and amiodarone. Results The time of tachycardia termination in TEAP group(2 -30 seconds) was less than that in drug group(5 second - 10 hours). PSVT termination rate in group of TEAP( 100% ) were higher than that in drug group termination rate(94. 7% ) ,P > 0.05. The sinus arrest and hypotension complications in drug group were higher than those in TEAP group ( P < 0. 05 ). Premature beat,chest pain and other complications in the two groups were not statistically significant(P >0.05). Conclusion The TEAP was preferred to terminate tachycardia in elderly

  4. A case of successful radiofrequency ablation of ventricular tachycardia and atrioventricular nodal reentry tachycardia

    Directory of Open Access Journals (Sweden)

    Bockeria L.A.

    2013-12-01

    RVOT tachycardia originated from the anterior wall and slow-fast AVNRT were successfully ablated. Invasive EP study is recommended in patients with paroxysmal tachycardias, especially with ventricular tachycardias. This diagnostic method is really helps to identify patients with arrhythmias pathological substrate and allows the treatment of arrhythmias using RFA with good clinical effect.

  5. ECG criteria for localizing the pulmonary vein origin of spontaneous atrial premature complexes: validation using intracardiac recordings.

    Science.gov (United States)

    Rajawat, Yadavendra S; Gerstenfeld, Edward P; Patel, Vickas V; Dixit, Sanjay; Callans, David J; Marchlinski, Francis E

    2004-02-01

    We have shown that pacemapping from each of the pulmonary veins reveals unique surface ECG characteristics. However, application of these criteria to spontaneous atrial premature complexes is often difficult because of obscuration by the prior T wave. We hypothesized that the pulmonary vein of origin of spontaneous atrial premature complexes can be determined by measuring characteristics of the P wave whether or not the P wave was superimposed on the prior T wave. We analyzed 58 spontaneous atrial premature complexes of known pulmonary vein origin in 30 patients referred for atrial fibrillation ablation. The origin of all the atrial premature complexes was documented by detailed, intracardiac multipolar catheter mapping. Based on previous work, the criteria for distinguishing right-sided from left-sided pulmonary vein origin of atrial premature complex includes: (1) P wave duration wave amplitude in lead I > 0.05 mV; and (3) P wave amplitude in leads II/III > 1.25. The criteria to separate superior from inferior pulmonary veins included the sum of the P wave amplitude in all the inferior leads greater than 0.3 mV. The combination of the P wave duration wave amplitude in leads II/III > 1.25, distinguished right-sided from left-sided pulmonary vein origin of spontaneous atrial premature complexes with a sensitivity of 82% and specificity of 100%. The sum of the P wave amplitude in leads II, III, and aVF > 0.3 mV distinguished superior from inferior pulmonary vein of origin with a sensitivity of 39% and specificity of 73%. The pulmonary vein origin of spontaneous atrial premature complexes can often be localized using careful quantitative analysis of the surface ECG despite superimposition of the P wave upon the T wave. Separation of right-sided from left-sided pulmonary vein origin of spontaneous atrial premature complexes can be determined with good specificity and sensitivity, while the ability to distinguish inferior from superior pulmonary vein origin is limited.

  6. MMP9 Rs3918242 Polymorphism Affects Tachycardia-Induced MMP9 Expression in Cultured Atrial-Derived Myocytes but Is Not a Risk Factor for Atrial Fibrillation among the Taiwanese

    Directory of Open Access Journals (Sweden)

    Fu-Chih Hsiao

    2016-04-01

    Full Text Available Matrix metalloproteinase (MMP plays an important role in the pathogenesis of atrial fibrillation (AF. The MMP9 promoter has a functional polymorphism rs3918242 that can regulate the level of gene transcription. This study recruited 200 AF patients and 240 controls. The MMP9 rs3918242 was examined by polymerase chain reactions. HL-1 atrial myocytes were cultured and electrically stimulated. Right atrial appendages were obtained from six patients with AF and three controls with sinus rhythm undergoing open heart surgery. The MMP9 expression and activity were determined using immunohistochemical analysis and gelatin zymography, respectively. Rapid pacing induces MMP9 secretion from HL-1 myocytes in a time- and dose-dependent manner. The responsiveness of MMP9 transcriptional activity to tachypacing was significantly enhanced by rs3918242. The expression of MMP9 was increased in fibrillating atrial tissue than in sinus rhythm. However, the distribution of rs3918242 genotypes and allele frequencies did not significantly differ between the control and AF groups. HL-1 myocyte may secrete MMP9 in response to rapid pacing, and the secretion could be modulated by rs3918242. Although the MMP9 expression of human atrial myocyte is associated with AF, our study did not support the association of susceptibility to AF among Taiwanese subjects with the MMP9 rs3918242 polymorphism.

  7. MMP9 Rs3918242 Polymorphism Affects Tachycardia-Induced MMP9 Expression in Cultured Atrial-Derived Myocytes but Is Not a Risk Factor for Atrial Fibrillation among the Taiwanese.

    Science.gov (United States)

    Hsiao, Fu-Chih; Yeh, Yung-Hsin; Chen, Wei-Jan; Chan, Yi-Hsin; Kuo, Chi-Tai; Wang, Chun-Li; Chang, Chi-Jen; Tsai, Hsin-Yi; Tsai, Feng-Chun; Hsu, Lung-An

    2016-01-01

    Matrix metalloproteinase (MMP) plays an important role in the pathogenesis of atrial fibrillation (AF). The MMP9 promoter has a functional polymorphism rs3918242 that can regulate the level of gene transcription. This study recruited 200 AF patients and 240 controls. The MMP9 rs3918242 was examined by polymerase chain reactions. HL-1 atrial myocytes were cultured and electrically stimulated. Right atrial appendages were obtained from six patients with AF and three controls with sinus rhythm undergoing open heart surgery. The MMP9 expression and activity were determined using immunohistochemical analysis and gelatin zymography, respectively. Rapid pacing induces MMP9 secretion from HL-1 myocytes in a time- and dose-dependent manner. The responsiveness of MMP9 transcriptional activity to tachypacing was significantly enhanced by rs3918242. The expression of MMP9 was increased in fibrillating atrial tissue than in sinus rhythm. However, the distribution of rs3918242 genotypes and allele frequencies did not significantly differ between the control and AF groups. HL-1 myocyte may secrete MMP9 in response to rapid pacing, and the secretion could be modulated by rs3918242. Although the MMP9 expression of human atrial myocyte is associated with AF, our study did not support the association of susceptibility to AF among Taiwanese subjects with the MMP9 rs3918242 polymorphism. PMID:27070579

  8. Anomalous Origin of the Left Atrial Branch from the Left Main Trunk

    Directory of Open Access Journals (Sweden)

    Arash Gholoobi

    2015-10-01

    Full Text Available A 78-year-old woman was referred for coronary angiography with the chief complaint of exertional angina and dyspnea of a very long duration during routine daily physical activities. She had a history of poorly controlled hypertension and dyslipidemia. Coronary angiography revealed diffuse three-vessel disease. Interestingly, an unusual branch was noted originating from the mid shaft of the left main trunk with a funnel-shaped root and travelling the course of a left atrial (LA branch (Figures 1 and 2.The left main coronary artery (LMCA usually bifurcates into two major branches: the left anterior descending (LAD and left circumflex (LCx arteries. In some patients, the LMCA trifurcates into the LAD, LCx, and a branch artery named ramus intermedius. This third branch arises between the LAD and LCx arteries. The LCx artery gives rise to one or two left atrial circumflex branches which supply the lateral and posterior aspects of the left atrium. According to our extensive search of the literature, this is the first case to be reported with the LA branch originating from the LMCA.

  9. 1例房颤合并真菌感染患者室性心动过速诱因分析%Inducement Analysis of 1 Case of Ventricular Tachycardia in Patient with Atrial Fibrillation Complicated with Fungal Infection

    Institute of Scientific and Technical Information of China (English)

    郑重践; 林妙娴

    2014-01-01

    To analyze the cause of ventricular tachycardia in patient with atrial fibrillation complicated with fungal infection during the course of treatment.An increased risk of arrhythmia will be caused by many factors, such as hypokalemia, fluconazole combined with ami-odarone, et al.However, greater risk will be caused by a combination of amiodarone and fluconazole (0.4 g・ d-1 ).Great attention should be paid to the dosage of fluconazole under the necessary combination of fluconazole and amiodarone.%分析1例房颤合并真菌感染患者治疗过程中出现室性心动过速的诱因。可能导致本例室性心律失常发生的因素有低钾血症、氟康唑与胺碘酮联用,但氟康唑加量至0.4 g・ d -1时联合使用胺碘酮风险更大。临床在不可避免将氟康唑与胺碘酮联用时,应注意氟康唑的给药剂量。

  10. Wide complex tachycardia in the presence of class I antiarrhythmic agents: a diagnostic challenge.

    Science.gov (United States)

    Bhardwaj, Bhaskar; Lazzara, Ralph; Stavrakis, Stavros

    2014-05-01

    We present two patients with paroxysmal atrial fibrillation on class 1C antiarrhythmic drugs without concomitant atrioventricular (AV) nodal blocking agents who developed atrial flutter with 1:1 AV conduction. Their electrocardiogram revealed wide complex tachycardia with rates >200/minute. Atrial flutter with 1:1 conduction in the presence of class IC antiarrhythmic drugs may present a diagnostic challenge. These cases illustrate the importance of coadministering an AV nodal blocking agent with class IC antiarrhythmic agents in patients with atrial fibrillation. The differential diagnosis of wide complex tachycardia in patients taking class IC agents should include atrial flutter with 1:1 AV conduction.

  11. Clinical course and treatment of ectopic atrial tachycardia in 144 children%儿童房性心动过速144例临床特征及治疗分析

    Institute of Scientific and Technical Information of China (English)

    戈海延; 李小梅; 张宴; 刘海菊; 江河

    2015-01-01

    目的 探讨儿童房性心动过速(房速)的临床特点及治疗效果.方法 回顾性分析清华大学第一附属医院2009年1月至2014年4月收治的144例房速患儿的临床资料,探讨其临床表现、房速特点、抗心律失常药物、射频消融等治疗效果及预后.结果 144例患儿发病年龄0~1岁57例(39.6%),>1~3岁22例(15.3%),>3 ~6岁25例(17.4%),≥6岁40例(27.8%).持续无休止性发作52例(36.1%),短阵性发作76例(52.8%),阵发持续性发作16例(11.1%).在我院接受抗心律失常药物治疗的115例患儿显著有效率62.6%(72/115).目前已停止药物治疗的35例患儿,转窦律时间24(4~90)d,维持疗程310(15~608)d.索他洛尔联合普罗帕酮的显著有效率(54%,41/76),高于单一索他洛尔(36%,24/66)及胺碘酮联合美托洛尔方案(30%,7/23)(x2=6.296,P=0.043).阵发持续性房速药物治疗的显著有效率(94%,15/16),高于短阵性房速(67%,42/63)及持续无休止性房速(42%,15/36) (x2=17.925,P=0.000).药物治疗效果不佳者,射频消融即刻成功率为92%(45/49),远期成功率为67%(33/49).26例患儿并发心动过速性心肌病(18.1%,26/144).资料完整23例患儿左心室射血分数由(43±5)%上升为(61±4)%(t=-10.036,P=0.000).17%(4/23)口服胺碘酮患儿出现甲状腺或肝功能受损,停药均恢复正常.结论 儿童房速持续无休止性发作比较高.索他洛尔联合普罗帕酮治疗儿童房速安全有效.对年长儿童药物疗效不佳者,推荐射频消融治疗.%Objective Ectopic atrial tachycardia (EAT) is a common type of supraventricular tachycardia in pediatric population,and it can be resistant to antiarrhythmic drugs and lead to tachycardia induced cardiomyopathy (TIC) if not properly managed.This study assessed the clinical course and response to treatment of EAT in children.Method A retrospective review included 144 children at the First Hospital of Tsinghua University diagnosed with

  12. A new algorithm to diagnose atrial ectopic origin from multi lead ECG systems--insights from 3D virtual human atria and torso.

    Directory of Open Access Journals (Sweden)

    Erick A Perez Alday

    2015-01-01

    Full Text Available Rapid atrial arrhythmias such as atrial fibrillation (AF predispose to ventricular arrhythmias, sudden cardiac death and stroke. Identifying the origin of atrial ectopic activity from the electrocardiogram (ECG can help to diagnose the early onset of AF in a cost-effective manner. The complex and rapid atrial electrical activity during AF makes it difficult to obtain detailed information on atrial activation using the standard 12-lead ECG alone. Compared to conventional 12-lead ECG, more detailed ECG lead configurations may provide further information about spatio-temporal dynamics of the body surface potential (BSP during atrial excitation. We apply a recently developed 3D human atrial model to simulate electrical activity during normal sinus rhythm and ectopic pacing. The atrial model is placed into a newly developed torso model which considers the presence of the lungs, liver and spinal cord. A boundary element method is used to compute the BSP resulting from atrial excitation. Elements of the torso mesh corresponding to the locations of the placement of the electrodes in the standard 12-lead and a more detailed 64-lead ECG configuration were selected. The ectopic focal activity was simulated at various origins across all the different regions of the atria. Simulated BSP maps during normal atrial excitation (i.e. sinoatrial node excitation were compared to those observed experimentally (obtained from the 64-lead ECG system, showing a strong agreement between the evolution in time of the simulated and experimental data in the P-wave morphology of the ECG and dipole evolution. An algorithm to obtain the location of the stimulus from a 64-lead ECG system was developed. The algorithm presented had a success rate of 93%, meaning that it correctly identified the origin of atrial focus in 75/80 simulations, and involved a general approach relevant to any multi-lead ECG system. This represents a significant improvement over previously developed

  13. Radiofrequency Ablation Mapping with Circumferential Catheter for Paroxys-mal Atrial Fibrillation Originating From the Pulmonary Veins

    Institute of Scientific and Technical Information of China (English)

    刘震; 吴书林; 杨平珍; 方咸宏; 李海杰; 陈泗林; 詹贤章; 薛玉梅

    2002-01-01

    Objectives To assessed thefeasibility and effectiveness of electrophysiologicalmapping of pulmonary veins with a circumferential 10-electrode catheter and radiofrequency catheter abla-tion therapy for patients with paroxysmal atrial fibril-lation. Background Standard mapping and ablationof focal sources of atrial fibrillation are associated withvery long procedure times and low efficacy. Mappingand ablation pulmonary veins guide with a circularcatheter could overcome these limitations. Methods16 patients [male 11, female 5, mean age (51 +14.5) years] with paroxysmal atrial fibrillation refrac-tory to antiarrhythmic drugs were included in thisgroup. A circumferential 10-electrode catheter wasused to pulmonary vein mapping during sinus rhythm orCSd pacing to determine the origin of atrial prematurecontractions. When the ablative target pulmonary veinwas found, the pulmonary vein potentials' distributionand activation were assessment pulmonary veins' ostialablation was performed at the segments showing earliestactivation of pulnonary vein potentials. The end pointwas designed: 1 ) elimination of pulmonary vein po-tential; 2) pulmonary vein potential dissociation fromatrial waves; 3) atrial ectopic beats disappear. ResultsA total of 36 pulmonary veins were ablated, in-cluding 16 left superior, 12 right superior, 7 left in-ferior and 1 right inferior. 1 pulmonary vein in 2 pa-tients was ablated, 2 pulmonary veins in 8 patientswere ablated, 3 pulmonary veins were ablated in 5patients and 4 pulmonary veins were ablated in 1 pa-tient. Procedure duration and fluoroscopy time respec-tively were 186.7 _+ 63.8 min and 51.5 + 15.0 min.During the follow-up 1- 12 months, 11 patients(68.7 % ) were free of AF without any antiarrhythmicdrugs, 2 of them were reablation, effective in 3/16(18.7%) and unsuccessful in 2/16 (12.6%) . 2cases recurred with atrial premature, 1 was treated withamiodarone and the other was repeat electrophysiologi-cal mapping and ablation, 5 cases with

  14. Autoimmune Basis for Postural Tachycardia Syndrome

    Science.gov (United States)

    2016-10-14

    Postural Orthostatic Tachycardia Syndrome; Postural Tachycardia Syndrome; Tachycardia; Arrhythmias, Cardiac; Autonomic Nervous System Diseases; Orthostatic Intolerance; Cardiovascular Diseases; Primary Dysautonomias

  15. 酷似室上性心动过速的室性心动过速1例%Ventricular tachycardia resembles supraventricular tachycardia: A case report

    Institute of Scientific and Technical Information of China (English)

    郭雪娅; 张小卫; 白锋

    2013-01-01

    A 14-year-old young man was admitted for paroxysmal history of palpitation. His electrocardiograms showed wide QRS complex tachycardia; the heart rate was 150 bpm; the retrograde P' waves were clearly visible after QPS complex and the RP' interval was fixed on 0. 20 s. It was diagnosed as paroxysmal supraventricular tachycardia. By transesophageal atrial pacing and intravenous injection of adenosine triphosphate (ATP), we failed to terminate tachycardia of the patient. And 10 minutes after we given intravenous bolus of 70 mg of propafenone, the ventricular rate slowed down and the ECG showed atrioventricular dissociation. So it was diagnosed as ventricular tachycardia.

  16. Electrophysiological characteristics of paroxysmal atrial fibrillation originating from superior vena cava: a clinical analysis of 30 cases.

    Science.gov (United States)

    Shi, Xiang-Min; Yuan, Hong-Tao; Guo, Hong-Yang; Guo, Jian-Ping; Shan, Zhao-Liang; Wang, Yu-Tang

    2015-01-01

    To analyze characteristics of electrocardiogram (ECG), electrophysiological intracardiac mapping and radiofrequency ablation (RF) of paroxysmal atrial fibrillation (PAF) originating from superior vena cava (SVC), aiming to investigate electrophysiological characteristics of PAF with SVC origin. Clinical data of 30 subjects (18 men and 12 women, aged, 58.6 ± 15.5 years) with PAF of SVC origin were retrospectively analyzed; All patients underwent RF during 2006.9-2012.7. ECG of AF and atrial premature contractions (APCs), procedure and fluoroscopic time, numbers of ablation sites within SVC, complications and success rate were studied. Compared with P wave of sinus rhythm (SR), APCs of SVC origin exhibited higher amplitude in lead II (0.23 ± 0.11 vs. 0.15 ± 0.06 mv), III (0.19 ± 0.09 vs. 0.13 ± 0.08 mv), AVF (0.21 ± 0.13 vs. 0.14 ± 0.10 mv), V2 (0.24 ± 0.07 vs. 0.15 ± 0.09 mv) and V3 (0.21 ± 0.09 vs. 0.12 ± 0.05 mv) (P atrial flutter within 1 month after completion of ablation and were controlled by antiarrhythmic drugs. The APCs and AF of SVC origin manifested distinctive ECG features, which could be helpful to distinguish SVC from other foci before ablation, the completion of SVCI required shorter procedure and fluoroscopic time, as well as less ablation points, and meanwhile, the success rate was high with less complication. PMID:25784993

  17. Atrial Ectopics Precipitating Atrial Fibrillation

    OpenAIRE

    Johnson Francis

    2015-01-01

    Holter monitor tracing showing blocked atrial ectopics and atrial ectopic precipitating atrial fibrillation is being demonstrated. Initially it was coarse atrial fibrillation, which rapidly degenerated into fine atrial fibrillation.

  18. Radiofrequency catheter ablation of atrial tachycardia after repairing of the ventricular septal defect in pediatrics%儿童室间隔修补术后远期心房内折返性心动过速的消融

    Institute of Scientific and Technical Information of China (English)

    高路; 袁越; 林利; 崔烺; 姚焰

    2011-01-01

    目的 报道儿童先天性心脏病室间隔缺损(VSD)术后远期出现的心房内折返性心动过速(IART)的电生理标测及导管消融疗效.方法 8例患儿(男、女各4例),平均年龄(7.1±4.1)岁,VSD术后1~5年发生持续性IART,8例均有左心室扩大,其中5例合并慢性心力衰竭.行心房电生理标测,部分应用三维标测( EnSite NavX)技术,标测折返环的关键峡部并行导管消融.结果 8例均自发IART,折返环关键部位分布:6例位于三尖瓣环峡部,1例于右心房界嵴至下腔静脉间,1例于三尖瓣环9点位置至界嵴间.所有(100%)患儿手术即刻成功,无并发症.平均随访(25.2±16.5)个月,2例复发,其中1例再次消融成功,总成功率7/8( 87.5%).左心室大小及射血分数均明显好转.结论 儿童VSD术后IART机制多为三尖瓣环-下腔静脉峡部依赖型心房扑动,可经导管消融治愈或明显改善.三维标测技术能准确快速定位折返环的电生理峡部并指导消融,显著减少曝光时间.%Objective This study aimed to investigate the effects of electrophysiological study(EPS) and radiofrequency (RF) catheter ablation of intra-atrial reentrant tachycardia (IART) after repairing the congenital ventricular septal defect (VSD) in pediatrics.Methods Eight children (4 boys,and 4 girls,mean age 7.1 ± 4.1 years),who experienced incessant IART 1-5 years after VSD surgery,underwent EPS and RF ablation.All children had dilated left ventricle ( LV),and 5 of 8 demonstrated severely LV dilation and congestive heart failure before ablation.RF energy was delivered to the critical isthmus of the reentry circuit of IART.Results All children have spontaneous AT at the beginning of the procedure.All of the IARTs was macro-reentrant mechanism.The critical isthmus was located at the isthmus between inferior vena cava(IVC)-tricuspid valve annulus (TVA)in 6,between the crista teminalis(CT)and IVC in 1,and between CT and 9 o' clock of TVA in 1.RF ablation was

  19. A difficult case of left atrial flutter

    Directory of Open Access Journals (Sweden)

    Reinder Evertz MD; Juan Acosta MD; David Andreu M.Sc; Josep Brugada MD, PhD; Lluis Mont MD, PhD

    2014-08-01

    Full Text Available A 55-year-old male was referred for a third ablation procedure because of recurrent atrial fibrillation. During re-isolation of the inferior right pulmonary vein the patient developed an atypical flutter with an clockwise activation pattern around the mitral annulus. Linear ablation at the left mitral isthmus transformed but did not terminate the tachycardia. The cavotricuspid isthmus proved to be a second critical isthmus and linear ablation at this site terminated the tachycardia.

  20. Radiofrequency ablation of an atypical left atrial flutter after pulmonary vein isolation

    Directory of Open Access Journals (Sweden)

    Bockeria L.A.

    2014-12-01

    Full Text Available In paroxysmal atrial fibrillation usually pulmonary veins isolation is enough, while in persistent and long-standing persistent forms ablation lines in the left atrium are needed. After that post ablational macroreentry tachycardia and focal atrial tachycardia, resistant to antiarrhythmic therapy, occur. Left atrial macroreentry tachycardia are localized perimitrally, around pulmonary veins and septally. There are also roof and posterior wall-associated macroreentry tachycardia. Considering relevance of postablation arrhythmias, we present our case report. A patient had paroxysmal atrial fibrillation. Pulmonary vein isolation was performed. After patient’s radiofrequency pulmonary vein isolation, three-dimensional map of left atrium was made using CARTO XP navigation system. Macroreentry tachycardia around left inferior pulmonary vein was revealed.There were fragmented potentials between left superior and left inferior pulmonary veins. An ablation lineconnecting inferior and superior pulmonary veins was made. After the completion of ablation line sinus rhythmwas restored.

  1. Supraventricular tachycardia in Lown-Ganong-Levine syndrome: atrionodal versus intranodal reentry.

    Science.gov (United States)

    Josephson, M E; Kastor, J A

    1977-10-01

    The mechanism of the abbreviated atrioventricular (A-V) nodal conduction time and paroxysmal supraventricular tachycardia in the Lown-Ganong-Levine syndrome was evaluated in six patients. In each the A-H interval increased in response to rapid atrial pacing and atrial extrastimuli; typical dual A-V nodal pathways were demonstrated. In five patients studied at two cycle lengths prolongation of conduction and refractoriness of the "fast" pathway was noted at the shorter basic cycle length. Propranolol prolonged conduction and refractoriness of the "fast" pathway in three patients and in one produced Wenckebach conduction during atrial pacing which did not occur prior to its administration. In three patients the atrium did not appear necessary to sustain supraventricular tachycardia. These findings suggest that preferential rapidly conducting A-V nodal fibers and intranodal reentry are the responsible mechanisms in those patients with Lown-Ganong-Levine syndrome and reciprocating tachycardia.

  2. Changes in plasma atrial natriuretic factor in patients with idiopathic atrial fibrillation

    International Nuclear Information System (INIS)

    To observe the changes in plasma atrial natriuretic factor (AFN) in patients with idiopathic atrial fibrillation and investigate its mechanism, plasma ANF, platelet count and hematocrit were detected in 21 cases with transient idiopathic atrial fibrillation (group A, A1 representing attack, while A2 termination), 28 with persistent idiopathic atrial fibrillation (group B), 27 suffered from rheumatic heart disease with mitral stenosis and persistent atrial fibrillation (group C), 32 with transient supraventricular tachycardia (group D) and 20 normal controls (group E). It was found that the level of ANF was significantly higher in patients with attacking transient idiopathic atrial fibrillation than that in group A2, D and E (P 0.05), while there was significant difference in hematocrit in group A1 compared with group A2, D, E (P < 0.01). It suggested that ANF and hematocrit play an important role in the attack of idiopathic atrial fibrillation

  3. Verapamil-sensitive idiopathic left ventricular tachycardia in a 6-month-old: unique considerations in diagnosis and management in an infant.

    Science.gov (United States)

    Hiremath, Gurumurthy; Li, Walter; Foltz, Rhonda; Roy-Burman, Arup; Cocalis, Mark; Tanel, Ronn E

    2015-01-01

    Idiopathic left ventricular tachycardia of the Belhassen type is rare in infants. We present a 6-month-old infant girl with a wide-complex tachycardia with right bundle branch block QRS morphology, a superior axis, and atrioventricular dissociation, consistent with a left anterior fascicular tachycardia. Initial echocardiogram revealed depressed ventricular function. The tachycardia was unresponsive to therapeutic trials of adenosine, esmolol, procainamide, and lidocaine. There was brief conversion of the tachycardia to sinus rhythm with transesophageal atrial overdrive pacing, suggesting a reentrant mechanism of the arrhythmia. Ultimately, the judicious administration of intravenous verapamil resulted in termination of the arrhythmia, which has been sustained on oral therapy. PMID:25526021

  4. Mapping strategy for multiple atrial tachyarrhythmias in a transplant heart

    DEFF Research Database (Denmark)

    Jin, Qi; Pehrson, Steen; Jacobsen, Peter Karl;

    2015-01-01

    , and a cavotricuspid isthmus dependent atrial flutter and a focal atrial tachycardia in the donor atria. 3D electroanatomical mapping and ablation were guided by remote magnetic navigation (RMN). Atrial fibrillation continued in the recipient atria even after the donor heart was converted to sinus rhythm by ablation....... CONCLUSIONS: It is critical to understand the surgical anatomy of a bi-atrial anastomosis and its relevant electrical activation pattern before ablation. Appropriate electroanatomical mapping strategy with RMN can facilitate the successful ablation of post-transplant atrial arrhythmias....

  5. Ventricular Tachycardia in Pregnant Patients

    OpenAIRE

    Rouslan Kotchetkov; Ameen Patel; Omid Salehian

    2010-01-01

    Ventricular tachycardia although not common, can occasionally complicate pregnancy. Its presence may indicate an underlying cardiac structural abnormality, or undiagnosed congenital arrhythmic disease. However, some pregnant patients with ventricular tachycardia have structurally normal hearts. Two cases of ventricular tachycardia in pregnant patients with structurally normal hearts are presented and an approach to diagnosis and management of such patients are discussed.

  6. Ventricular Fibrillation in a Patient with Tachycardia-Induced Cardiomyopathy after Liver Transplantation

    OpenAIRE

    Lee, Soo Yong; Kim, Jun; Lee, Sang Hyun; Choi, Jin Hee; Park, Yong Hyun; Kim, June Hong; Chun, Kook Jin

    2013-01-01

    We report a case of atrial fibrillation-related tachycardia induced cardiomyopathy and ventricular fibrillation after liver transplantation in a 41-year-old man with end-stage liver failure. Atrial fibrillation and congestive heart failure occurred postoperatively. Cardiac arrests due to ventricular fibrillation occurred 6 months after the operation with subsequent implantations of an implantable cardioverter-defibrillator. Ventricular arrhythmias did not recur during the 18 months after norm...

  7. Postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Agarwal, A K; Garg, R; Ritch, A; Sarkar, P

    2007-07-01

    Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance which has become better understood in recent years. It is now thought to encompass a group of disorders that have similar clinical features, such as orthostatic intolerance, but individual distinguishing parameters--for example, blood pressure and pulse rate. The clinical picture, diagnosis, and management of POTS are discussed.

  8. Ventricular tachycardia in acromegaly.

    Science.gov (United States)

    Arias, Miguel A; Pachón, Marta; Rodríguez-Padial, Luis

    2011-02-01

    Cases of sudden cardiac death have been reported in patients with acromegaly. Malignant ventricular arrhythmias may play an important role in this fatal complication, but the exact mechanisms are not well understood. We report on an acromegalic patient presenting with documented recurrent syncopal ventricular tachycardia.

  9. Dual chamber pacemaker in the treatment of paroxysmal atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Rađen Goran

    2005-01-01

    Full Text Available Background. Atrial fibrillation is the most frequent cardiac dysrhythmia. The aim of this study was to show the role and the efficacy of a dual chamber pacemaker with the algorithm of atrial dynamic overdrive, in the suppression of paroxysmal atrial fibrillation. Case report. A woman with a classical bradycardia-tachycardia syndrome, and frequent attacks of atrial fibrillation, underwent the implantation of a single chamber permanent pacemaker (VVI. Pacemaker successfully treated the episodes of symptomatic bradycardia, but the patient had frequent attacks of atrial fibrillation, despite the use of different antiarrhythmic drugs, which she did not tolerate well. The decision was made to reimplant a permanent dual chamber pacemaker with the algorithm of atrial dynamic overdrive. The pacemaker was programmed to the basic rate of 75/min, while rate at rest was 55/min. In addition, sotalol was administered. After three months, the patient became asymptomatic with only 4 short − term episodes of atrial fibrillation, and a high level of atrial pacing (99%. Conclusion. In selected patients with bradycardia−tachycardia syndrome, atrial-based pacing seemed to be very effective in reducing the incidence of paroxysmal atrial fibrillation.

  10. Postexertional Supraventricular Tachycardia in Children with Catecholaminergic Polymorphic Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Scott D. N. Else

    2012-01-01

    Full Text Available Catecholaminergic polymorphic ventricular tachycardia (CPVT is a severe arrhythmia associated with sudden death in the young. It is caused by defective calcium handling in ventricular myocytes. The association of supraventricular tachycardia (SVT with CPVT is described in the literature, occurring in the lead-up to ventricular tachycardia during exercise testing. We describe three cases of SVT that were initiated in the recovery period of exercise testing in children with CPVT.

  11. Digoxin delays recovery from tachycardia-induced electrical remodeling of the atria

    NARCIS (Netherlands)

    Tieleman, RG; Blaauw, Y; Van Gelder, IC; De Langen, CDJ; de Kam, PJ; Grandjean, JG; Patberg, KW; Bel, KJ; Allessie, MA; Crijns, JGM

    1999-01-01

    Background-Atrial fibrillation (AF) induces electrical remodeling, which is thought to be responsible for the low success rate of antiarrhythmic treatment in AF of longer duration. Electrical remodeling seems to be related to tachycardia-induced intracellular calcium overload. Due to its vagomimetic

  12. Phase mapping of radionuclide gated biventriculograms in patients with sustained ventricular tachycardia or Wolff-Parkinson-White syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Le Guludec, D.; Bourguignon, M.; Sebag, C.; Valette, H.; Sirinelli, A.; Davy, J.M.; Syrota, A.; Motte, G.

    1987-01-01

    Accuracy of Fourier phase mapping of radionuclide gated biventriculograms in detecting the origin of abnormal ventricular activation was studied during ventricular tachycardia or preexcitation. Group I included six patients suffering from clinical recurrent VT; 3 gated blood pool studies were acquired for each patient: during sinus rhythm, right ventricular pacing, and induced sustained VT-Group II included seven patients with Wolff-Parkinson-White syndrome and recurrent paroxysmal tachycardia; 3 gated blood pool studies were acquired for each patient: during sinus rhythm, right atrial pacing and orthodromic reciprocating tachycardia. Each acquisition lasted 5 min, in 30 degrees-40 degrees left anterior oblique projection. In Group I, the Fourier phase mapping was consistent with QRS morphology and axis during VT (5/6), except in one patient with LV aneurysm and LBBB electrical pattern during VT. Origin of VT on phase mapping was located in the right ventricle (n = 2) or in left ventricle (n = 4), at the border of wall motion abnormalities each time they existed (5/6). In Group II, the phase advance correlated with the location of the accessory pathway determined by ECG and endocardial mapping (n = 6) and per-operative epicardial mapping (n = 1). Discrimination between anterior and posterior localization of paraseptal pathways and location of intermittent preexcitation was not possible. We conclude that Fourier phase mapping is an accurate method for locating the origin of VT and determining its etiology. It can help locate the site of ventricular preexcitation in patients with only one accessory pathway; its accuracy in locating multiple accessory pathways remains unknown.

  13. Evaluation of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Francis E. Marchlinski

    2008-05-01

    Full Text Available Atrial fibrillation (AF is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation. On the ECG fibrillatory (f waves (rapid oscillations with variable amplitude, shape and timing replace normal P waves. Ventricular response becomes irregular and rapid depending of the intrinsic electrophysiological properties of the AV node1 and the balance between vagal and sympathetic tone1. The presence of an irregularly pulse is a clinical sign that can be quickly and reliably identified in any healthcare situation and, indicates AF with a high sensitivity and specificity (95% and 75%, respectively. If the irregularity last for more than 20 seconds the specificity reaches 98% 2-4. Identification of AF can be done by using manual pulse palpation in those presenting with a variety of symptoms. It is desirable to check the blood pressure and pulse in all patients who present with breathlessness, dyspnea, palpitations, syncope, dizziness or chest discomfort. Furthermore, many patients presenting with an acute stroke are found to be in AF albeit asymptomatic with respect to non-neurologic complaints. The finding of a sustained irregular wide QRS complex tachycardia may be suspicious of AF conducted with bundle brunch aberrancy or over an accessory pathway, and in patients with A-V sequential pacemakers can reflect an inadequate configuration with ventricular tracking of sensed atrial activity.

  14. Catheter ablation of a polymorphic ventricular tachycardia inducing monofocal premature ventricular complex.

    Science.gov (United States)

    Uemura, Takashi; Yamabe, Hiroshige; Tanaka, Yasuaki; Morihisa, Kenji; Kawano, Hiroaki; Kaikita, Koichi; Sumida, Hitoshi; Sugiyama, Seigo; Ogawa, Hisao

    2008-01-01

    Ventricular tachycardia originating from the right ventricular outflow tract (RVOT) is considered benign, but sometimes it causes polymorphic ventricular tachycardia and ventricular fibrillation, resulting in sudden cardiac death. A 58-year-old woman without structural heart disease was admitted for evaluation of recurrent episodes of syncope. Surface ECG showed frequent repetitive premature ventricular contraction (PVC) of RVOT origin. Polymorphic ventricular tachycardia triggered by the same PVC was documented by Holter ECG during an episode of syncope. Radiofrequency catheter ablation was performed to eradicate this PVC. No polymorphic ventricular tachycardia has developed after the procedure, and the patient has had no recurrence of syncope.

  15. Reversal of Dilated Cardiomyopathy After Successful Radio-Frequency Ablation of Frequent Atrial Premature Beats, a New Cause for Arrhythmia-Induced Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Paul Louis Vervueren, MD

    2012-12-01

    Full Text Available Incessant atrial premature beats as a potential cause for tachycardia-induced cardiomyopathy was suspected in a patient presenting with dilated non-ischemic cardiomyopathy and severely altered left ventricular ejection fraction. The elimination of a left atrial focus by percutaneous RF ablation led to normalization of the clinical status, of atrial and ventricular dimensions and left ventricular systolic function.

  16. Dual-chamber implantable cardioverter-defibrillator. Is it useful in patient with permanent atrial fibrillation?

    Science.gov (United States)

    Porres-Aracama, José M; Cerezuela, José Luis; García-Urra, Francisco; Luque-Lezcano, Oscar; Herrero, Vicente

    2016-08-01

    In patients with permanent atrial fibrillation (AF) and implantable cardioverter-defibrillator (ICD) implant indication, a single-chamber device is the choice because AF does not provide interesting information for the treatment. It is very unusual to find patients with permanent AF that coexist with atrial tachycardia with various degree of Atrioventricular block. PMID:27525075

  17. LATE ONSET ATRIOVENTRICULAR NODAL TACHYCARDIA

    NARCIS (Netherlands)

    PENTINGA, ML; MEEDER, JG; CRIJNS, HJGM; DEMUINCK, ED; WIESFELD, ACP; LIE, KI

    1993-01-01

    AV nodal tachycardia may present at any age, but onset in late adulthood is considered uncommon. To evaluate whether onset of AV nodal tachycardias at older age is related to organic heart disease (possibly setting the stage for re-entry due to degenerative structural changes) 32 consecutive patient

  18. Fetal tachycardia : diagnosis and treatment

    NARCIS (Netherlands)

    Oudijk, Martijn Alexander

    2003-01-01

    Part I: Fetal tachyarrhythmias Diagnosis Fetal tachycardia is a serious condition warranting specialized evaluation. In chapter 2, methods of diagnosis of fetal tachycardia are described, including doppler and M-mode echocardiography and fetal magnetocardiography. The study presented in chapter 3 d

  19. Tachycardia-induced Cardiomyopathy (Tachycardiomyopathy

    Directory of Open Access Journals (Sweden)

    Hassan A. Mohamed

    2007-01-01

    Full Text Available The term tachycardia-induced cardiomyopathy or tachycardiomyopathy refers to impairment in left ventricular function secondary to chronic tachycardia, which is partially or completely reversible once the tachyarrhythmia is controlled. Tachycardia-induced cardiomyopathy has been shown to occur both in experimental models and in patients with incessant tachyarrhythmia.Data from several studies and from case reports have shown that rate control by means of cardioversion, negative chronotropic agents, and surgical or catheter-based atrioventricular node ablation, resulted in significant improvement of systolic function.The diagnosis of tachycardia-induced cardiomyopathy is usually made following observation of marked improvement in systolic function after normalization of heart rate. Clinicians should be aware that patients with unexplained systolic dysfunction may have tachycardia-induced cardiomyopathy, and that controlling the arrhythmia may result in improvement of systolic function.

  20. Torsade de pointes tachycardia in a patient on dronedarone therapy.

    Science.gov (United States)

    Huemer, Martin; Sarganas, Giselle; Bronder, Elisabeth; Klimpel, Andreas; Garbe, Edeltraut; Haverkamp, Wilhelm

    2015-05-01

    Dronedarone is a promising, relatively new antiarrhythmic agent characterized by structural similarities to amiodarone but without amiodarone's severe organ toxicity. The proarrhythmic potential of dronedarone, however, is of increasing concern. We describe a 76-year-old woman who had been receiving dronedarone 400 mg twice/day to prevent recurrent atrial tachycardia with rapid ventricular response. Several months later, she came to the emergency department with decompensated congestive heart failure and episodes of atrial tachycardia; digoxin 0.5 mg and furosemide 40 mg were administered intravenously. Thereafter nonsustained torsade de pointes (TdP) tachycardia occurred. She was transferred to the intensive care unit where a dose of amiodarone 150 mg was administered intravenously by mistake. Thereafter, the patient showed sustained TdP necessitating cardiac resuscitation. Dronedarone was discontinued, and digoxin and amiodarone were not administered again. Under dronedarone a relevant QT prolongation was documented that was additionally augmented after concomitant treatment with digoxin and amiodarone. Use of the Naranjo adverse drug reaction probability scale indicated a probable adverse drug reaction to dronedarone (score of 7). To our knowledge, this is the first case report of a patient who experienced TdP tachycardias while receiving dronedarone therapy in connection with a worsening of heart failure and possible drug interactions with digoxin and amiodarone. Clinicians should be aware of this potential adverse drug reaction and perform repeated heart rate-corrected QT (QTc) interval measurements as well as screening for congestive heart failure in patients receiving dronedarone therapy. PMID:25823967

  1. Exploiting periodicity to extract the atrial activity in atrial arrhythmias

    Science.gov (United States)

    Llinares, Raul; Igual, Jorge

    2011-12-01

    Atrial fibrillation disorders are one of the main arrhythmias of the elderly. The atrial and ventricular activities are decoupled during an atrial fibrillation episode, and very rapid and irregular waves replace the usual atrial P-wave in a normal sinus rhythm electrocardiogram (ECG). The estimation of these wavelets is a must for clinical analysis. We propose a new approach to this problem focused on the quasiperiodicity of these wavelets. Atrial activity is characterized by a main atrial rhythm in the interval 3-12 Hz. It enables us to establish the problem as the separation of the original sources from the instantaneous linear combination of them recorded in the ECG or the extraction of only the atrial component exploiting the quasiperiodic feature of the atrial signal. This methodology implies the previous estimation of such main atrial period. We present two algorithms that separate and extract the atrial rhythm starting from a prior estimation of the main atrial frequency. The first one is an algebraic method based on the maximization of a cost function that measures the periodicity. The other one is an adaptive algorithm that exploits the decorrelation of the atrial and other signals diagonalizing the correlation matrices at multiple lags of the period of atrial activity. The algorithms are applied successfully to synthetic and real data. In simulated ECGs, the average correlation index obtained was 0.811 and 0.847, respectively. In real ECGs, the accuracy of the results was validated using spectral and temporal parameters. The average peak frequency and spectral concentration obtained were 5.550 and 5.554 Hz and 56.3 and 54.4%, respectively, and the kurtosis was 0.266 and 0.695. For validation purposes, we compared the proposed algorithms with established methods, obtaining better results for simulated and real registers.

  2. Detection of atrial-flutter and atrial-fibrillation waveforms by fetal magnetocardiogram.

    Science.gov (United States)

    Kandori, A; Hosono, T; Kanagawa, T; Miyashita, S; Chiba, Y; Murakami, M; Miyashita, T; Tsukada, K

    2002-03-01

    Two cases of fetal tachycardia are reported: atrial flutter and fibrillation. The waveforms from each case were detected by fetal magnetocardiograms (FMCGs) using a 64-channel superconducting quantum interference device (SQUID) system. Because the magnitude of supraventricular arrhythmia signals is very weak, two subtraction methods were used to detect the fetal MCG waveforms: subtraction of the maternal MCG signal, and subtraction of the fetal ORS complex signal. It was found that atrial-flutter waveforms showed a cyclic pattern and that atrial-fibrillation waveforms showed f-waves with a random atrial rhythm. Fast Fourier transform analysis determined the main frequency of the atrial flutter to be about 7Hz, and the frequency distribution of atrial fibrillation consisted of small, broad peaks. To visualise the current pattern, current-arrow maps, which simplify the observation of pseudo-current patterns in fetal hearts, of the averaged atrial flutter and fibrillation waveforms were produced. The map of the atrial flutter had a circular pattern, indicating a re-entry circuit, and the map of the atrial fibrillation indicated one wavelet, which was produced by a micro-re-entry circuit. It is thus concluded that an FMCG can detect supraventricular arrhythmia, which can be characterised by re-entry circuits, in fetuses. PMID:12043803

  3. Oxygen therapy reduces postoperative tachycardia

    DEFF Research Database (Denmark)

    Stausholm, K; Kehlet, H; Rosenberg, J

    1995-01-01

    Concomitant hypoxaemia and tachycardia in the postoperative period is unfavourable for the myocardium. Since hypoxaemia per se may be involved in the pathogenesis of postoperative tachycardia, we have studied the effect of oxygen therapy on tachycardia in 12 patients randomly allocated to blinded...... air or oxygen by facemask on the second or third day after major surgery. Inclusion criteria were arterial hypoxaemia (oxygen saturation 90 beat.min-1). Each patient responded similarly to oxygen therapy: an increase in arterial oxygen saturation and a decrease...... in heart rate (p oxygen has a positive effect on the cardiac oxygen delivery and demand balance....

  4. Localization of precise origin of idiopathic ventricular tachycardia from the right ventricular outflow tract by a 12-lead ECG: a study of pace mapping using a multielectrode "basket" catheter.

    Science.gov (United States)

    Yoshida, Y; Hirai, M; Murakami, Y; Kondo, T; Inden, Y; Akahoshi, M; Tsuda, M; Okamoto, M; Yamada, T; Tsuboi, N; Hirayama, H; Ito, T; Toyama, J; Saito, H

    1999-12-01

    Radiofrequency catheter ablation guided by pace-mapping techniques has proven effective in eliminating idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT). A method for rapidly identifying the origin of VT from 12-lead electrocardiogram (ECG) findings would be helpful for the catheter ablation procedure. The purpose of this study is to precisely localize the origin of idiopathic VT from the RVOT by a 12-lead ECG from a study of multipoint pace mapping. In one patient with premature ventricular complex (PVC) and 3 with VT, a "basket" catheter was deployed in the RVOT for bipolar pacing from 56 sites in the endocardium of RVOT. Under fluoroscopy the pacing sites were classified into the septum and free wall. We investigated the QRS morphology in leads, I, II, and III; the depth of the QS wave in leads aVR and aVL; and the height of the initial r wave in leads V1 and V2. Pacing was captured in 30-47 of 56 sites (54%-84%). As the pacing sites changed from the anterior to posterior of the septum, the QS notch (-) type in lead I shifted through rs to R, while a shift from R type to rR' or Rr' was noted in leads II and III. As the pacing sites changed from the anterior to posterior of the free wall, lead I showed a shift from the QS notch (+) type to R, while a shift from rR' to Rr' (or rR' unchanged) was found in leads II and III. The depth of the QS wave in leads aVR and aVL showed a tendency for aVR to be deeper than aVL toward the posterolateral attachment of both the septum and free wall, whereas aVL tended to be deeper than aVR toward the anterior attachment. The initial r waves in V1 and V2 became greater as the pacing site was positioned at a higher or more posterior location. These findings may provide more precise and clinically useful diagnostic information on the site of the origin of idiopathic VT originating from the RVOT by a 12-lead ECG.

  5. 快慢综合征心房颤动患者射频消融术后心率及窦房结功能的变化%Changes of heart rate and sinus node function after radiofrequency ablation of paroxymal atrial fibrillation in patients with tachycardia-bradycardia syndrome

    Institute of Scientific and Technical Information of China (English)

    时向民; 王玉堂; 单兆亮; 赵立朝; 杨庭树

    2012-01-01

    of AF were enrolled in this study. All the patients underwent radiofrequency ablation of AF under the guidance of CARTO system. Dynamic electrocardiogram (DCG) was performed for the evaluation of maximum R-R interval ( MRRI),numbers of pause >2 seconds (NP>2 s),minimum heart rate (MNHR),maximum heart rate (MAHR) and mean heart rate (MEHR) and symptoms associated with bradyarrhythmia were recorded before and 1 week,3 months after ablation. Results Fourteen patients were successfully ablated within left atria with electrical isolation of pulmonary antrum plus roof line and left isthmus line,2 cases with additional superior vena cava isolation. Compared with before ablation,MRRI[ (2.4 ± 1. 3)s and (1. 7 ±0. 5) s vs. (5.6 ± 1.6) s,both P2S[ (32.7 ±11.5) and (2. 2 ±1.3) vs. (152.5 ±67. 3),both P<0.05] at 1 week and 3 months after ablation were significantly reduced,and MIHR [ (45. 3 ± 11.3) bpm and (53. 6 ± 9.5) bpm vs. (36.4 ± 8.6) bpm,both P<0.05],MAHR [ (103. 2 ±14. 5) bpm and (122.5 ±15.8) bpm vs. (91.4 ±18.7) bpm,bothP<0.05] and MEHR [(66.5±8.6) bpm and (75.3±12.7) bpm vs. (57.2±10.4) bpm,both P < 0. 05 ] were significantly increased. There was statistical difference between 1 week and 3 months after ablation in every parameter. Conclusions In AF patients with tachycardia-bradycardia syndrome with sinus pause at least 3 seconds,after the termination of AF rather than before the initiation of AF,the function of sinus atrial node can totally recover within 3 months after successful ablation of AF.

  6. Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report

    OpenAIRE

    Yilmaz Yozgat; Ayhan Kilic; Cem Karadeniz; Rahmi Ozdemir; Onder Doksoz; Timur Mese; Nurettin Unal

    2013-01-01

    Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has ...

  7. The comparison of catheter ablation and permanent pacing on patients with paroxysmal atrial fibrillation related tachycardia-bradycardia syndrome%阵发性心房颤动合并长R-R间期导管消融和起搏治疗的对比

    Institute of Scientific and Technical Information of China (English)

    陈英伟; 董建增; 马长生

    2014-01-01

    Objective To evaluate the outcome of AF ablation in patients with paroxysmal atrial fibrillation (AF) related tachycardia-bradycardia syndrome. Methods Fifty consecutive patients with paroxysmal AF and prolonged symptomatic sinus pauses on termination of AF referred to our hospital for ablation were evaluated (ABL group). In another 61 patients, paroxysmal AF was treated with anti-arrhythmic drug and a pacemaker was implanted due to AF related tachycardia-bradycardia syndrome. These patients were used as control (PM group). Results A total of 50 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Re-evaluation at the end of follow-up showed that 47 (94%) patients no longer needed a pacemaker (Class III indication) because of free from AF with no recurrences of pre-syncopal or syncopal events or documented sinus pauses after the last procedure. More patients in the PM group were on AADs (PM 42.6%, ABL 6.0%, P < 0.001) while sinus rhythm maintenance at the end of follow-up was remarkably higher in the ABL group (82.0%vs. 21.3%in PM group, P < 0.001). The total rates of cardiac related re-hospitalization was not significantly different between the two groups, but hospitalizations caused by tachyarrhythmia was significantly higher in the PM group (PM group 14.8%, ABL group 2.0%, P=0.020).The embolic events, heart failure and death rate were not significantly different between the two groups. Conclusions In patients with paroxysmal AF related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.%目的:评估导管消融对阵发性心房颤动(房颤)相关快-慢综合征的疗效。方法连续入选2010年1月至2012年9月在北京安贞医院房颤中心接受导管消融的50例阵发性房颤合并房颤终止后症状性长间歇的

  8. Varying types of circus movement re-entry with both normal and dissociated contralateral conduction causing different right and left atrial rhythms in canine atrial flutter.

    Science.gov (United States)

    Yamauchi, S; Boineau, J P; Schuessler, R B; Cox, J L

    1998-03-01

    The purpose of this study was to develop an animal model of atrial flutter (AFL) or fibrillation (AFB) and to determine precisely the pathway of atrial activation during arrhythmias induced by programmed stimulation. In 10 dogs, a shunt from the left subclavian artery to the left upper pulmonary vein was created to produce left atrial enlargement. Five months later, using programmed electrical stimulation, it was possible to induce 17 sustained atrial tachycardias in 9 of the 10 dogs, including 9 episodes of AFL caused by circus movement re-entry, 6 episodes of focal tachycardia, and 2 episodes of AFB. Short cycle length left atrial tachycardias caused by either circus movement or a focus did not propagate in a uniform 1:1 pattern to the right atrium (RA), resulting in RA dissociation. In these arrhythmias, complex wavefronts from both current and preceding left atrial cycles coexisted in the RA. Circus movement was associated with a spectrum of different re-entrant pathways with different path lengths. These differences in the path length were determined by various ways in which obstacles such as the superior vena cava and orifice of the right atrial appendage or pulmonary vein orifices were combined by contiguous areas of functional block.

  9. Association between CHADS2 score and long-term atrial fibrillation recurrence rate after catheter ablation

    Institute of Scientific and Technical Information of China (English)

    胡晓锋

    2014-01-01

    Objective To investigate the association between CHADS2score and long-term(≥3 years)outcomes post catheter ablation in patients with atrial fibrillation(AF).Methods AF patients who received single catheter ablation in our hospital from January 2004 to March 2009 in our department were included and patients received regular follow-up.AF recurrence was defined as the occurrence of atrial arrhythmias(AF,atrial flutter and atrial tachycardia)recorded by electrocardiogram monitor(≥30 seconds)after ablation during follow-up period(after

  10. Respiratory Cycle-Dependent Atrial Trachycardia; its Unique Characteristics and Relation with Autonomic Nerve System

    Directory of Open Access Journals (Sweden)

    Teppei Yamamoto, MD

    2012-12-01

    Full Text Available Respiration influences the sinus heart rate, however, little is still known about the tachyarrhythmias related to respiration. Atrial tachycardia (AT rarely emerges during inspiration and it also ceases during expiration. This type of AT is thus called respiratory cycle-dependent atrial tachycardia (RCAT, and it demonstrates a centrifugal activation pattern. Based on these peculiar P wave morphologies, the foci converged either around the right superior pulmonary vein (RSPV or inside the superior vena cava where the anterior right ganglionated plexi (ARGP is considered to be located. The mechanism of such AT is therefore thought to be related to the activity of the autonomic system.

  11. Characterization of Left Atrial Tachyarrhythmias in Patients Following Atrial Fibrillation Ablation: Correlation of surface ECG with Intracardiac Mapping

    Directory of Open Access Journals (Sweden)

    Sanjay Dixit

    2010-05-01

    Full Text Available With expected success rates in excess of 80% for achieving long term arrhythmia control, catheter based ablation has become a popular treatment strategy in the management of patients with atrial fibrillation (AF. However, the success of AF ablation has been tempered by the occurrence of post procedure left atrial tachycardias and / or flutters, which can be seen in up to 30% of the patients. These arrhythmias are perpetuated either due to abnormalities of impulse formation (abnormal automaticity / triggered activity, or abnormalities of impulse conduction (micro / macroreentry. Regardless of the underlying mechanism, these tachycardias manifest distinct “P” or flutter waves on the surface ECG, recognition of which may facilitate their characterization / localization. However, because of the frequent overlap in the morphology of P waves, intracardiac mapping is often the only way to distinguish them apart. This is accomplished using a combination of activation, entrainment and electroanatomic mapping techniques. Tachycardias resulting from abnormalities of impulse formation and / or microreentry are characteristically focal and usually confined in and around pulmonary vein (PV segments which have reconnected (septal aspect of right PVs and anterior aspect of left PVs. In contrast, macroreentrant tachycardias manifest a large circuit dimension involving zone(s of slow conduction. These are most commonly seen to occur around the mitral valve but can develop in any part of the left atrium where “gaps” across prior ablation lesion sets create altered conduction. Successful ablation of focal tachycardias is usually accomplished by isolating the reconnected PV segment(s. In case of macroreentrant arrhythmias however, a more extensive ablation approach is typically required in order to achieve conduction block across isthmus of the circuit. Using these strategies, the majority of left atrial tachycardias occurring post AF ablation can be

  12. The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

    OpenAIRE

    Sarah White; Janna Welch; Brown, Lawrence H

    2015-01-01

    Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix r...

  13. Postural orthostatic tachycardia syndrome (POTS).

    Science.gov (United States)

    Sidhu, Bharat; Obiechina, Nonyelum; Rattu, Noman; Mitra, Shanta

    2013-09-16

    Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous group of conditions characterised by autonomic dysfunction and an exaggerated sympathetic response to assuming an upright position. Up till recently, it was largely under-recognised as a clinical entity. There is now consensus about the definition of POTS as a greater than 30/min heart rate increase on standing from a supine position (greater than 40/min increase in 12-19-year-old patients) or an absolute heart rate of greater than 120/min within 10 min of standing from a supine position and in the absence of hypotension, arrhythmias, sympathomimetic drugs or other conditions that cause tachycardia. We present two cases of POTS, followed by a discussion of its pathogenesis, pathophysiology, epidemiology and management.

  14. Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Yilmaz Yozgat

    2013-01-01

    Full Text Available Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs. Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA.

  15. Importance of close follow-up in the fetus with premature atrial contractions accompanied by atrial septal aneurysm: a case report.

    Science.gov (United States)

    Yozgat, Yilmaz; Kilic, Ayhan; Karadeniz, Cem; Ozdemir, Rahmi; Doksoz, Onder; Mese, Timur; Unal, Nurettin

    2013-01-01

    Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA) on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA. PMID:24455349

  16. Atrial fibrillation

    NARCIS (Netherlands)

    Lip, Gregory Y H; Fauchier, Laurent; Freedman, Saul B; Van Gelder, Isabelle; Natale, Andrea; Gianni, Carola; Nattel, Stanley; Potpara, Tatjana; Rienstra, Michiel; Tse, Hung-Fat; Lane, Deirdre A

    2016-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, and increases in prevalence with increasing age and the number of cardiovascular comorbidities. AF is characterized by a rapid and irregular heartbeat that can be asymptomatic or lead to symptoms such as palpitations, dys

  17. The Atrial Fibrillation Ablation Pilot Study

    DEFF Research Database (Denmark)

    Arbelo, Elena; Brugada, Josep; Hindricks, Gerhard;

    2014-01-01

    was achieved in 40.7% of patients (43.7% in paroxysmal AF; 30.2% in persistent AF; 36.7% in long-lasting persistent AF). A second ablation was required in 18% of the cases and 43.4% were under antiarrhythmic treatment. Thirty-three patients (2.5%) suffered an adverse event, 272 (21%) experienced a left atrial...... tachycardia, and 4 patients died (1 haemorrhagic stroke, 1 ventricular fibrillation in a patient with ischaemic heart disease, 1 cancer, and 1 of unknown cause). CONCLUSION: The AFib Ablation Pilot Study provided crucial information on the epidemiology, management, and outcomes of catheter ablation of AFib...

  18. Atrial Fibrillation: Treatment

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Treatment Past Issues / Winter 2015 Table of Contents Treatment for atrial fibrillation depends on how often you have symptoms, how ...

  19. Living with Atrial Fibrillation

    Science.gov (United States)

    ... Topics » Atrial Fibrillation » Living With Atrial Fibrillation Explore Atrial Fibrillation What Is... Types Other Names Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Arrhythmia ...

  20. Atrial Fibrillation and Stroke

    Science.gov (United States)

    ... Find People About NINDS NINDS Atrial Fibrillation and Stroke Information Page Table of Contents (click to jump ... done? Clinical Trials What is Atrial Fibrillation and Stroke? Atrial fibrillation (AF) describes the rapid, irregular beating ...

  1. [Successful selective electrical ablation of the retrograde pathway in atrioventricular nodal reentry tachycardia associated with syncope].

    Science.gov (United States)

    Lukl, J; Cíhalík, C

    1992-01-01

    A 55-year-old man was admitted to the intensive care unit on account of repeatedly occurring syncopes which developed at the peak of physical exertion. The attack was reproduced by exercise on a bicycle ergometer: the patient developed paroxysmal tachycardia with a narrow QRS and a frequency of 160/min leading after 20 sec. to severe hypotension and loss of consciousness. The same tachycardia caused by programmed atrial stimulation caused a drop of tension in the recumbent position by 30 mmHg and after more detailed analysis during electrophysiological examination it was evaluated as atrioventricular nodal reentrant tachycardia. By an electric discharge of 300 J administered by means of a stimulation electrode 7F USCI into the area of the AV node the retrograde conduction through the perinodal rapid pathways was completely interrupted and 1st. degree atrioventricular block developed. Repeated electrophysiological examination and exercise tests on a bicycle ergometer provided evidence of the disappearance of the retrograde pathway and the impossibility to elicit AVNRT. The authors express the view that the rapid perinodal pathway is interrupted in successful cases in both directions and the 1st. degree AV block is due to conduction along a slow pathway and not incidental slowing of conduction along the rapid pathway which is the generally accepted interpretation. Modification of the atrioventricular conduction by interruption of the rapid pathway by fulguration is according to data in the literature and the described patient a method which makes is possible to cure severe atrioventricular nodal reentrant tachycardias.

  2. [Successful selective electrical ablation of the retrograde pathway in atrioventricular nodal reentry tachycardia associated with syncope].

    Science.gov (United States)

    Lukl, J; Cíhalík, C

    1992-01-01

    A 55-year-old man was admitted to the intensive care unit on account of repeatedly occurring syncopes which developed at the peak of physical exertion. The attack was reproduced by exercise on a bicycle ergometer: the patient developed paroxysmal tachycardia with a narrow QRS and a frequency of 160/min leading after 20 sec. to severe hypotension and loss of consciousness. The same tachycardia caused by programmed atrial stimulation caused a drop of tension in the recumbent position by 30 mmHg and after more detailed analysis during electrophysiological examination it was evaluated as atrioventricular nodal reentrant tachycardia. By an electric discharge of 300 J administered by means of a stimulation electrode 7F USCI into the area of the AV node the retrograde conduction through the perinodal rapid pathways was completely interrupted and 1st. degree atrioventricular block developed. Repeated electrophysiological examination and exercise tests on a bicycle ergometer provided evidence of the disappearance of the retrograde pathway and the impossibility to elicit AVNRT. The authors express the view that the rapid perinodal pathway is interrupted in successful cases in both directions and the 1st. degree AV block is due to conduction along a slow pathway and not incidental slowing of conduction along the rapid pathway which is the generally accepted interpretation. Modification of the atrioventricular conduction by interruption of the rapid pathway by fulguration is according to data in the literature and the described patient a method which makes is possible to cure severe atrioventricular nodal reentrant tachycardias. PMID:1561778

  3. Supraventricular tachycardia in a patient with Lown-Ganong-Levine syndrome associated with apical hypertrophic cardiomyopathy.

    Science.gov (United States)

    Hayano, M; Imamura, Y; Tsuruta, M; Inoue, J; Nakashima, H; Fukuyama, K; Eguchi, Y; Tsuji, S; Matsuo, S; Yano, K

    1988-03-01

    Electrophysiologic study of a 55-year-old patient with Lown-Ganong-Levine syndrome associated with apical hypertrophic cardiomyopathy is reported. The patient had a history of recurrent attacks of tachyarrhythmia and his electrocardiogram showed a short P-R interval (0.10 sec) with narrow QRS complex and left ventricular hypertrophy with giant negative T waves. His cineangiogram showed severe apical hypertrophy. An electrophysiologic study was performed. The results of programmed atrial pacing show the existence of the dual A-V nodal pathways. The A-H interval at rapid atrial pacing increased maximally by 103 msec. Atrial stimulation could depolarize parts of the atrium without altering the supraventricular tachycardia. These findings suggested that preferential rapidly conducting A-V nodal and intranodal reentry are the responsible mechanisms in this reciprocating tachycardia. We conclude that the short P-R interval was due to intranodal reentry through the dual A-V nodal pathways. To our knowledge, a case of Lown-Ganong-Levine syndrome with apical hypertrophic cardiomyopathy has not been previously described in the literature.

  4. Ethanol Infusion in the Vein of Marshall in a Patient with Persistent Atrial Fibrillation.

    Science.gov (United States)

    Choi, Jah Yeon; Park, Eun Jin; Kim, Hee Dong; Park, Sung Hun; Song, Ji Young; Lee, Dae In; Shim, Jaemin; Kim, Young-Hoon

    2015-09-01

    We report the case of a 64-year-old male with persistent atrial fibrillation (AF) terminated by ethanol infusion into vein of Marshall as add-on therapy. Three-dimensional automated complex fractionated atrial electrogram (CFAE) during AF revealed clustering of CFAE at perimitral isthmus (PMI) and its unipolar mapping showed rotor-like activation, which was suggested to be critical in the perpetuation of AF. AF was organized to atrial tachycardia (AT) by 100% ethanol infusion in the vein of Marshall. Adjunctive radiofrequency ablation at PMI successfully terminated AT and led to bidirectional block of PMI. PMID:26413111

  5. Clinical Practice Guidelines for paroxysmal supraventricular tachycardia.

    Directory of Open Access Journals (Sweden)

    Brandy Viera Valdés

    2009-03-01

    Full Text Available Clinical Practice Guidelines for paroxysmal supraventricular tachycardia. These are arrhythmias in which structures placed above the bifurcation of the bundle of His are involved; characterized by tachycardia with abrupt starting and ending. We comment its classification, common characteristics, general treatment and specific conduct for its different variables. It includes assessment guidelines focused on the most important aspects to be accomplished.

  6. Permanent junctional reciprocating tachycardia in a dog.

    Science.gov (United States)

    Santilli, Roberto A; Santos, Luis F N; Perego, Manuela

    2013-09-01

    A 5-year-old male English Bulldog was presented with a 1-year history of paroxysmal supraventricular tachycardia (SVT) partially responsive to amiodarone. At admission the surface ECG showed sustained runs of a narrow QRS complex tachycardia, with a ventricular cycle length (R-R interval) of 260 ms, alternating with periods of sinus rhythm. Endocardial mapping identified the electrogenic mechanism of the SVT as a circus movement tachycardia with retrograde and decremental conduction along a concealed postero-septal atrioventricular pathway (AP) and anterograde conduction along the atrioventricular node. These characteristics were indicative of a permanent junctional reciprocating tachycardia (PJRT). Radiofrequency catheter ablation of the AP successfully terminated the PJRT, with no recurrence of tachycardia on Holter monitoring at 12 months follow-up.

  7. Mapping and Surgical Ablation of Focal Epicardial Left Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Arif Elvan

    2011-01-01

    Full Text Available We describe a technical challenge in a 17-year-old patient with incessant epicardial focal ventricular arrhythmia and diminished LV function. Failure of ablation at the earliest activated endocardial site during ectopy suggested an epicardial origin, which was supported by specific electrocardiographic criteria. Epicardial ablation was not possible due to the localization of the origin of the ventricular tachycardia adjacent to the phrenic nerve. Minimal invasive surgical multielectrode high-density epicardial mapping was performed to localize the arrhythmia focus. Epicardial surgical RF ablation resulted in the termination of ventricular ectopy. After 2 years, the patient is still free from arrhythmias.

  8. ATRIAL FIBROSIS IS A MORPHOLOGICAL BASIS OF ATRIAL FIBRILLATION

    OpenAIRE

    DRAPKINA O.M.; A. V. Emelyanov

    2015-01-01

    Mechanisms of atrial fibrosis including the role of serotonin in the development of this lesion in patients with atrial fibrillation are presented. New approaches to the treatment of atrial fibrillation aimed at atrial fibrosis reduction are discussed.

  9. Research and Treatment Status on Vessel Ablation to Cure Atrial Fibrillation%导管消融治疗心房颤动的研究及治疗现状

    Institute of Scientific and Technical Information of China (English)

    黄从新

    2006-01-01

    上世纪90年代中叶,随着经导管射频消融治疗房室结折返性心动过速(Atrial-ventricular Nodal Reentrant Tachycardia,AVNRT)和房室折返性心动过速(Atrial-ventricular Reentrant Tachycardia,AVRT)取得巨大成功,众多电生理学者的目光开始瞄准心房颤动(Atrial Fibrillation,AF,简称房颤)的根治方法.

  10. Reversible postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Abdulla, Aza; Rajeevan, Thirumagal

    2015-07-16

    Postural orthostatic tachycardia syndrome (POTS) is a relatively rare syndrome recognised since 1940. It is a heterogenous condition with orthostatic intolerance due to dysautonomia and is characterised by rise in heart rate above 30 bpm from base line or to more than 120 bpm within 5-10 min of standing with or without change in blood pressure which returns to base line on resuming supine position. This condition present with various disabling symptoms such as light headedness, near syncope, fatigue, nausea, vomiting, tremor, palpitations and mental clouding, etc. However there are no identifiable signs on clinical examination and patients are often diagnosed to have anxiety disorder. The condition predominantly affects young female between the ages of 15-50 but is rarely described in older people. We describe an older patient who developed POTS which recovered over 12 mo. Recognising this condition is important as there are treatment options available to alleviate the disabling symptoms.

  11. Ondansetron induced fatal ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Chandrakala R

    2008-01-01

    Full Text Available Ondansetron is a serotonin receptor antagonist used widely in the prophylaxis and treatment of postoperative nausea and vomiting (PONV and vomiting associated with cancer chemotherapy. The common side effects of ondansetron are fever, malaise, diarrhoea, constipation, and allergic reactions. Extra-pyramidal reactions are rare and cardiovascular side effects are even rarer. Even though its clinical safety has been established in a large number of studies, its adverse effects have been reported and these include cardiovascular events like acute myocardial ischemia and arrhythmias in adults. [1] Studies of its adverse effects in children are few. We report a rare adverse effect of ondansetron in a 14-year-old girl, presenting as ventricular tachycardia.

  12. Cisplatin induced paroxysmal supraventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Waseem Raja

    2013-01-01

    Full Text Available Cisplatin or cis-diamminedichloroplatinum (CDDP is the first member of a class of platinum-containing anti-cancer drugs that act by binding to and causing cross-linking of deoxyribonucleic acid, which ultimately triggers apoptosis. Cisplatin has a broad-spectrum antineoplastic activity against various types of human tumors. Unfortunately, the optimal usefulness of Cisplatin is limited secondary to its dose related toxicity especially nephrotoxicity. Cisplatin chemotherapy is also associated with cardiotoxic effects that may range from silent arrhythmias to heart failure and even sudden cardiac death. These effects are more pronounced when cisplatin is combined with other cardiotoxic drugs. Here, we report a case of patient of cancer lung who developed paroxysmal supraventricular tachycardia following administration of Cisplatin. A brief review of the literature follows.

  13. Cisplatin induced paroxysmal supraventricular tachycardia.

    Science.gov (United States)

    Raja, Waseem; Mir, M Hussain; Dar, Imtiyaz; Banday, Muzamil Ahmad; Ahmad, Irfan

    2013-10-01

    Cisplatin or cis-diamminedichloroplatinum (CDDP) is the first member of a class of platinum-containing anti-cancer drugs that act by binding to and causing cross-linking of deoxyribonucleic acid, which ultimately triggers apoptosis. Cisplatin has a broad-spectrum antineoplastic activity against various types of human tumors. Unfortunately, the optimal usefulness of Cisplatin is limited secondary to its dose related toxicity especially nephrotoxicity. Cisplatin chemotherapy is also associated with cardiotoxic effects that may range from silent arrhythmias to heart failure and even sudden cardiac death. These effects are more pronounced when cisplatin is combined with other cardiotoxic drugs. Here, we report a case of patient of cancer lung who developed paroxysmal supraventricular tachycardia following administration of Cisplatin. A brief review of the literature follows.

  14. Epidemiology and definition of inappropriate sinus tachycardia.

    Science.gov (United States)

    Pellegrini, Cara N; Scheinman, Melvin M

    2016-06-01

    Inappropriate sinus tachycardia (IST) is a clinical syndrome lacking formal diagnostic criteria. It is generally defined as an elevated resting heart rate (HR; >90-100 bpm) with an exaggerated response to physical or emotional stress and a clearly sinus mechanism. Clinical manifestations are broad from a complete lack of symptoms to incapacitating incessant tachycardia. Now understood to be relatively prevalent, it is observed to have a generally benign prognosis, though symptoms may persist for years. Whether IST is a single discrete entity or a heterogeneous condition with overlap to other syndromes such as postural orthostatic tachycardia syndrome remains a matter of debate. PMID:26310298

  15. Paroxysmal Supraventricular Tachycardia: Pathophysiology, Diagnosis, and Management.

    Science.gov (United States)

    Al-Zaiti, Salah S; Magdic, Kathy S

    2016-09-01

    Paroxysmal supraventricular tachycardia (PSVT) is a well-known and thoroughly studied clinical syndrome, characterized by regular tachycardia rhythm with sudden onset and abrupt termination. Most patients present with palpitations and dizziness, and their electrocardiogram demonstrates a narrow QRS complex and regular tachycardia with hidden or inverted P waves. PSVT is caused by re-entry due to the presence of inhomogeneous, accessory, or concealed conducting pathways. Hemodynamically stable patients are treated by vagal maneuvers, intravenous adenosine, diltiazem, or verapamil, hemodynamically unstable patients are treated by cardioversion. Patients with symptomatic and recurrent PSVT can be treated with long-term drug treatment or catheter ablation.

  16. Atrial Arrhythmias in Astronauts - Summary of a NASA Summit

    Science.gov (United States)

    Barr, Yael R.; Watkins, Sharmila D.; Polk, J. D.

    2010-01-01

    Background and Problem Definition: To evaluate NASA s current standards and practices related to atrial arrhythmias in astronauts, Space Medicine s Advanced Projects Section at the Johnson Space Center was tasked with organizing a summit to discuss the approach to atrial arrhythmias in the astronaut cohort. Since 1959, 11 cases of atrial fibrillation, atrial flutter, or supraventricular tachycardia have been recorded among active corps crewmembers. Most of the cases were paroxysmal, although a few were sustained. While most of the affected crewmembers were asymptomatic, those slated for long-duration space flight underwent radiofrequency ablation treatment to prevent further episodes of the arrhythmia. The summit was convened to solicit expert opinion on screening, diagnosis, and treatment options, to identify gaps in knowledge, and to propose relevant research initiatives. Summit Meeting Objectives: The Atrial Arrhythmia Summit brought together a panel of six cardiologists, including nationally and internationally renowned leaders in cardiac electrophysiology, exercise physiology, and space flight cardiovascular physiology. The primary objectives of the summit discussions were to evaluate cases of atrial arrhythmia in the astronaut population, to understand the factors that may predispose an individual to this condition, to understand NASA s current capabilities for screening, diagnosis, and treatment, to discuss the risks associated with treatment of crewmembers assigned to long-duration missions or extravehicular activities, and to discuss recommendations for prevention or management of future cases. Summary of Recommendations: The summit panel s recommendations were grouped into seven categories: Epidemiology, Screening, Standards and Selection, Treatment of Atrial Fibrillation Manifesting Preflight, Atrial Fibrillation during Flight, Prevention of Atrial Fibrillation, and Future Research

  17. One case of tachycardia-induced cardiomyopathy caused by right ventricular outflow tract-ventricular tachycardia%右室流出道室性心动过速诱发心动过速性心肌病1例

    Institute of Scientific and Technical Information of China (English)

    王广强; 杨洋; 张博; 孙健

    2013-01-01

    A 36-year-old woman has suffered from paroxysmal palpitations, chest tightness and shortness of breath for more than 10 years. ECG showed broad QRS, ventricular tachycardia and atrioventricular separation. The ECG pointed to an origin in the right ventricular outflow tract. Echocardiography showed that the left ventricular end-diastolic diameter was 53 mm and the ejection fraction was 40%. B type natriuretic peptide was 7 920 pg/ ml. A single radiofrequency application at the site of ectopy was immediately effective. Holter monitoring was normal after ablation. Final diagnosis was right ventricular outflow tract-ventricular tachycardia, tachycardia-induced cardiomyopathy.

  18. Atrial Substrate Modification in Atrial Fibrillation: Targeting GP or CFAE? Evidence from Meta-Analysis of Clinical Trials

    Science.gov (United States)

    Qin, Mu; Liu, Xu; Wu, Shao-Hui; Zhang, Xiao-Dong

    2016-01-01

    Several clinically relevant outcomes post atrial substrate modification in patients with atrial fibrillation (AF) have not been systematically analyzed among published studies on adjunctive cardiac ganglionated plexi (GP) or complex fractionated atrial electograms (CFAE) ablation vs. pulmonary vein isolation (PVI) alone. Out of 176 reports identified, the present meta-analysis included 14 randomized and non-randomized controlled trials (1613 patients) meeting inclusion criteria. Addition of GP ablation to PVI significantly increased freedom from atrial tachyarrhythmia in short- (OR: 1.72; P = 0.003) and long-term (OR: 2.0, P = 0.0006) follow-up, while adjunctive CFAE ablation did not after one or repeat procedure (P<0.05). The percentage of atrial tachycardia or atrial flutter (AT/AFL) after one procedure was higher for CFAE than GP ablation. In sub-analysis of non-paroxysmal AF, relative to PVI alone, adjunctive GP but not CFAE ablation significantly increased sinus rhythm maintenance (OR: 1.88, P = 0.01; and OR:1.24, P = 0.18, respectively). Meta regression analysis of the 14 studies indicated that sample size was significant source of heterogeneity either in outcomes after one or repeat procedure. In conclusion, in patients with AF, adjunctive GP but not CFAE ablation appeared to significantly add to the beneficial effects on sinus rhythm maintenance of PVI ablation alone; and CFAE ablation was associated with higher incidence of subsequent AT/AFL. PMID:27764185

  19. Ventricular tachycardia induced by weight loss pills

    DEFF Research Database (Denmark)

    Pareek, Manan; Hansson, Nils Henrik; Grove, Erik Lerkevang

    2013-01-01

    A previously healthy 29-year-old man was admitted with palpitations, dizziness, and near-syncope after he had recently started taking weight loss pills purchased on the internet. The pills contained caffeine and ephedrine. An electrocardiogram and telemetry revealed multiple episodes of non......-sustained monomorphic ventricular tachycardia, which was successfully treated with amiodarone. In conclusion, unauthorized weight loss pills can be harmful. In particular, ephedrine-containing drugs carry a risk of ventricular tachycardia and should be discouraged....

  20. Atrial fibrillation - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000237.htm Atrial fibrillation - discharge To use the sharing features on this ... have been in the hospital because you have atrial fibrillation . This condition occurs when your heart beats faster ...

  1. Atrial fibrillation or flutter

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000184.htm Atrial fibrillation or flutter To use the sharing features on this page, please enable JavaScript. Atrial fibrillation or flutter is a common type of abnormal ...

  2. Atrial fibrillation (acute onset)

    OpenAIRE

    Lip, Gregory Y. H.; Watson, Timothy

    2008-01-01

    Acute atrial fibrillation is rapid, irregular, and chaotic atrial activity of less than 48 hours' duration. It resolves spontaneously within 24 to 48 hours in over 50% of people. In this review we have included studies on patients with onset up to 7 days previously. Risk factors for acute atrial fibrillation include increasing age, CVD, alcohol abuse, diabetes, and lung disease.Acute atrial fibrillation increases the risk of stroke and heart failure.

  3. Paroxysmal supraventricular tachycardia: physiopathology and management

    Directory of Open Access Journals (Sweden)

    Paola Neroni

    2014-06-01

    Full Text Available Paroxysmal supraventricular tachycardia (PSVT is the most frequent arrhythmia in newborns and infants. Most supraventricular tachycardias affect structurally healthy hearts. Apart from occasional detection by parents, most tachycardias in this age group are revealed by heart failure signs, such as poor feeding, sweating and shortness of breath. The main symptom reported by school-age children is palpitations. The chronic tachycardia causes a secondary form of dilative cardiomyopathy. Treatment of acute episode usually has an excellent outcome. Vagal manoeuvres are effective in patients with atrioventricular reentrant tachycardia. Adenosine is the drug of choice at all ages for tachycardias involving the atrioventricular node. Its key advantage is its short half life and minimum or no negative inotropic effects. Verapamil is not indicated in newborns and children as it poses a high risk of electromechanical dissociation. Antiarrhythmic prophylaxis of PSVT recurrence is usually recommended in the first year of life, because the diagnosis of tachycardia may be delayed up to the appearance of symptoms. Digoxin can be administered in all forms of PSVT involving the atrioventricular node, except for patients with Wolff-Parkinson-White syndrome below one year of age. Patients with atrioventricular reentrant PSVT can be treated effectively by class Ic drugs, such as propaphenone and flecainide. Amiodarone has the greatest antiarrhythmic effect, but should be used with caution owing to the high incidence of side effects. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  4. Atrial Fibrillation: Complications

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Complications Past Issues / Winter 2015 Table of Contents ... has two major complications—stroke and heart failure. Atrial Fibrillation and Stroke Click to enlarge image This illustration ...

  5. Atrial Fibrillation in Children

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Atrial Fibrillation in Children Updated:Jul 18,2016 Does your ... content was last reviewed on 04/16/14. Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • ...

  6. Atrial Fibrillation Factsheet

    Science.gov (United States)

    Atrial Fibrillation Atrial fibrillation, often called AFib or AF, is the most common type of heart arrhythmia. An arrhythmia is when the ... Atrium Sinoatrial Node (pacemaker) Atrioventricular Node Left Atrium Atrial Fibrillation AFib Facts 1 • An estimated 2.7–6. ...

  7. The importance of utilizing 24-h Holter monitoring as a non-invasive method of predicting the mechanism of supraventricular tachycardia.

    Science.gov (United States)

    Al Mehairi, M; Al Ghamdi, S A; Dagriri, K; Al Fagih, A

    2011-10-01

    Despite the emergence of advanced invasive technology in identifying the various types of arrhythmia mechanisms, 24-h ambulatory electrocardiogram monitoring as a non-invasive method remains an invaluable informative tool in delineating such mechanisms. Furthermore, one observational study has supported the utilization of 24-h Holter monitoring in exploring AV Node (AVN) characteristics sufficiently in correlation with invasive studies when limited to patients without Wolf Parkinson White syndrome showing a positive predictive value of 98% in their supraventricular tachycardia (SVT) assessment (Fukuda et al., 2005). We describe in this report suspected tachycardia initiation mechanism in three SVT cases based on 24-h Holter recordings. Premature atrial contraction with subsequent AVN fast pathway conduction block initiated the common type AVN re-entrant tachycardia (AVNRT). Dual AVN physiology was documented during the electrophysiological studies in all three cases and a definitive therapy was achieved by the AVN slow pathway modification.

  8. When to go epicardially during ventricular tachycardia ablation? Role of surface electrocardiogram

    OpenAIRE

    Ozcan, Emin Evren; Széplaki, Gábor; Tahin, Tamás; Osztheimer, István; SZILÁGYI Szabolcs; Merkely, Béla; Gellér, László

    2013-01-01

    Early recognition of ventricular tachycardias (VTs) with epicardial circuits is crucial. Surface electrocardiogram (ECG) suggesting an epicardial origin could guide ablation procedures and increase success rates. A 35-year-old female patient with VT treated by combined epicardial and endocardial ablation approach is presented in this report, and the role of surface electrocardiogram and timing of epicardial access is discussed.

  9. Detection of Acute Atrial-Ventricular Arrhythmias Based on ECG Delineator: Evaluation on MIT/BIH Standard Databases

    Directory of Open Access Journals (Sweden)

    Katayoun Shojaian‎

    2008-03-01

    Full Text Available In this paper we use an efficient arrhythmia algorithm based on wavelet transform. In first step, QRS complexes are detected. Then each QRS is delineated by detecting and identifying the peaks of the individual waves, complex onset and end. Then the determination of P and T wave peaks, onset and ends are performed. Finally the Ventricular flutter, ventricular tachycardia, supra ventricular tachycardia, ventricular fibrillation, atrial fibrillation and atrial flutter that are kinds of acute ventricular-atrial arrhythmias are detected. In the proposed algorithm, we used a second order spline as mother wavelet and improved the previous algorithms proposed by other investigators. We evaluated the algorithm on some manually annotated single ECG signals selected from MIT-BIH arrhythmia databases. This algorithm may achieve the mean detection accuracy of about 80% in these arrhythmias.

  10. Clinical characteristics of the patients presented with supraventricular tachycardia in southeast Anatolian region of Turkey

    Directory of Open Access Journals (Sweden)

    Mesut Aydın

    2014-12-01

    Full Text Available Objective: In this study, we aimed to evaluate the characteristic of patients with supraventricular tachycardia for proper diagnosis and treatment in Southeast Anatolian region. Methods: The study was has a retrospective cross-sectional design. One hundred eighty-seven consecutive patients who underwent catheter ablation of SVT between June 2012 and April 2014 at the Dicle University Heart Hospital were included in the study. In those patients, in whom the arrhythmia substrate was identified, ablation therapy was carried out using radiofrequency (RF energy. Results: Among SVTs 119 (63.6% patients had atrioventricular nodal re-entry tachycardia (AVNRT, 20 (10.7% patients had concealed atrioventricular re-entry tachycardia (AVRT, 40 (21.4% patients had Wolf Parkinson White (WPW syndrome, and 8 (4.3% patients had atrial tachycardia. RF ablation was applied on 184 patients. Overall RF ablation success rate was 96.2%. Overall recurrence was 8 (4% of 187 patients during the follow-up period 12 ± 6 (1-23 months. The recurrence was 4 (3.4% of 119 patients in AVNRT, 2(5% of 40 patients in WPW syndrome and 2 (10% of 20 patients in concealed AVRT. There was no statistically significant difference between groups in terms of recurrence. Two patients having AVNRT ablation died due to acute coronary syndrome in clinical follow-up. Conclusion: The acute and long-term success rates of SVT ablation were in accordance with literature. The other characteristics of SVT were similar with the current data.

  11. Efficacy and Mechanism of Intravenous Sotalol for Termination of Paroxysmal Supraventricular Tachycardia

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objectives To study the efficacy and mechanism of intravenous sotalol(Sol) for termination of paroxysmal supra-ventricular tachycardia ( SVT). Methods Sol or normal saline (NS) were administrated intravenously in patients with SVT induced by trans-esophagus left atrial stimulation. Results Conversion to sinus rhythm occurred in 65.2% (15/23) patients who received Sol (Sol group) at total dose of 1.5 mg/kg, the average conversion time being ( 10. 7 ± 11.6) min after the start of sotalol infusion. Conversion to sinus rhythm appeared in 4.8% (1/21) patients who were treated with NS (NS group). The efficacy between two groups was significantly different ( P <0. 01 ). The site of termination of tachycardia was predominantly at the antegrade atrioventricular node ( AV N ) in atrioventricular reentrant tachycardia ( AV RT ) (3/4) and at the retrograde fast pathway of AV N in atrioventricular nodal reentrant tachycardia ( AV N RT ) ( 4 / 6 ) . During the course of Sol infusion, both ventricular rate of SVT and systolic blood pressure ( SBP ) decreased. HR decreased from (173. 3±28. 4) min-1(before So l administration) to (159. 6-±-23. 8) and (152. 0±22. 2)min-1(3,5 minutes after the start of Sol infusion respectively, P < 0. 01) and SBP from (16.31-±-2.27) kPa to (14.82±2. 61) and (14. 61-±-2. 60) kPa(P<0. 01). Transient hypotension ( SBP < 10. 7 kPa ) occurred in 2 patients during the course of Sol administration. There were no significant changes of HR and blood pressure in the NS group. Conclusion It was safe and effective for sotalo l administration on SVT.

  12. Efficacy and Mechanism of Intravenous Sotalol for Termination of Paroxysmal Supraventricular Tachycardia

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objectives To study the efficacy and mechanism of intravenous sotalol(Sol) for termination of paroxysmal supra-ventricular tachycardia ( SVT). Methods Sol or normal saline (NS) were administrated intravenously in patients with SVT induced by trans-esophagus left atrial stimulation. Results Conversion to sinus rhythm occurred in 65.2% (15/23) patients who received Sol (Sol group) at total dose of 1.5 mg/kg, the average conversion time being ( 10. 7 ± 11.6) min after the start of sotalol infusion. Conversion to sinus rhythm appeared in 4.8% (1/21) patients who were treated with NS (NS group). The efficacy between two groups was significantly different ( P <0. 01 ). The site of termination of tachycardia was predominantly at the antegrade atrioventricular node ( AV N ) in atrioventricular reentrant tachycardia ( AV RT ) (3/4) and at the retrograde fast pathway of AV N in atrioventricular nodal reentrant tachycardia ( AV N RT ) ( 4 / 6 ) . During the course of Sol infusion, both ventricular rate of SVT and systolic blood pressure ( SBP ) decreased. HR decreased from (173. 3±28. 4) min-1(before So l administration) to (159. 6-±-23. 8) and (152. 0±22. 2)min-1(3,5 minutes after the start of Sol infusion respectively, P < 0. 01) and SBP from (16.31-±-2.27) kPa to (14.82±2. 61) and (14. 61-±-2. 60) kPa(P<0. 01). Transient hypotension ( SBP < 10. 7 kPa ) occurred in 2 patients during the course of Sol administration. There were no significant changes of HR and blood pressure in the NS group. Conclusion It was safe and effective for sotalo l administration on SVT.

  13. Long-term Prognosis of Paroxysmal Atrial Fibrillation and Predictors for Progression to Persistnt or Chronic Atrial Fibrillation in the Korean Population.

    Science.gov (United States)

    Im, Sung Ii; Chun, Kwang Jin; Park, Seung-Jung; Park, Kyoung-Min; Kim, June Soo; On, Young Keun

    2015-07-01

    Little is known about the long-term prognosis of or predictors for the different clinical types of atrial fibrillation (AF) in Korean populations. The aim of this study was to validate a risk stratification to assess the probability of AF progression from paroxysmal AF (PAF) to persistent AF (PeAF) or permanent AF. A total of 434 patients with PAF were consecutively enrolled (mean age; 71.7 ± 10.7 yr, 60.6% male). PeAF was defined as episodes that are sustained > 7 days and not self-terminating, while permanent AF was defined as an ongoing long-term episode. Atrial arrhythmia during follow-up was defined as atrial premature complex, atrial tachycardia, and atrial flutter. During a mean follow-up of 72.7 ± 58.3 months, 168 patients (38.7%) with PAF progressed to PeAF or permanent AF. The mean annual AF progression was 10.7% per year. In univariate analysis, age at diagnosis, body mass index, atrial arrhythmia during follow-up, left ventricular ejection fraction, concentric left ventricular hypertrophy, left atrial diameter (LAD), and severe mitral regurgitation (MR) were significantly associated with AF progression. In multivariate analysis, age at diagnosis (P = 0.009), atrial arrhythmia during follow-up (P = 0.015), LAD (P = 0.002) and MR grade (P = 0.026) were independent risk factors for AF progression. Patients with younger age at diagnosis, atrial arrhythmia during follow-up, larger left atrial chamber size, and severe MR grade are more likely to progress to PeAF or permanent AF, suggesting more intensive medical therapy with close clinical follow-up would be required in those patients.

  14. Percutaneous Left Atrial Appendage Ligation for Stroke Prevention in Atrial Fibrillation

    OpenAIRE

    Valderrábano, Miguel; Price, Matthew J.

    2015-01-01

    Prevention of thromboembolic complications in atrial fibrillation remains a tremendous clinical challenge. Knowledge that the left atrial appendage (LAA) is the most common anatomical origin of cardioembolic strokes1 has been the main motivation to develop clinical and procedural strategies to exclude the LAA from the circulation, either surgically or percutaneously. This review discusses the rationale behind these strategies, their relative merits, and future prospects for LAA exclusion stra...

  15. Reduced occurrence of atrial fibrillation in acute myocardial infarction treated with streptokinase

    DEFF Research Database (Denmark)

    Nielsen, F E; Sørensen, H T; Christensen, J H;

    1991-01-01

    In a historical follow-up study of 152 hospital patients with acute myocardial infarction, the frequency of life-threatening arrhythmias (ventricular fibrillation, sustained ventricular tachycardia, 3rd degree AV-block, 2nd degree AV-block (Mobitz type II), and asystole) and atrial fibrillation i...... in 76 patients treated with streptokinase was compared with their frequency in 76 patients who did not receive a thrombolytic therapy. Among those treated with streptokinase two patients (3%) developed atrial fibrillation, compared with 12 (16%) in the control group (P = 0.009). Life...

  16. How Is Atrial Fibrillation Treated?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Atrial Fibrillation Treated? Treatment for atrial fibrillation (AF) depends on ... too much thyroid hormone). Who Needs Treatment for Atrial Fibrillation? People who have AF but don't have ...

  17. How Is Atrial Fibrillation Diagnosed?

    Science.gov (United States)

    ... Atrial Fibrillation » How Is Atrial Fibrillation Diagnosed? Explore Atrial Fibrillation What Is... Types Other Names Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Arrhythmia ...

  18. Atrial Fibrillation and Pacing Algorithms

    OpenAIRE

    Terranova, Paolo; Severgnini, Barbara; Valli, Paolo; Dell'Orto, Simonetta; Greco, Enrico Maria

    2006-01-01

    Pacing prevention algorithms have been introduced in order to maximize the benefits of atrial pacing in atrial fibrillation prevention. It has been demonstrated that algorithms actually keep overdrive atrial pacing, reduce atrial premature contractions, and prevent short-long atrial cycle phenomenon, with good patient tolerance. However, clinical studies showed inconsistent benefits on clinical endpoints such as atrial fibrillation burden. Factors which may be responsible for neutral results ...

  19. Supraventricular Tachycardia Atackt Due to Losewieght Drug

    OpenAIRE

    Murat Yalcin

    2016-01-01

    Obesity is an important health problem. Treatment of obesity includes diet, exercise and drugs. Some of these drugs are out of prescription. Advers effects of these drugs have not been known. In this report; we present a case with supraventricular tachycardia attack due to loseweight drug containing mangostana (mango), hibiscus, citrus mate, L-karnitin, guarana.

  20. Cardiac hydatid cyst revealed by ventricular tachycardia

    OpenAIRE

    Ibn Elhadj, Zied; Boukhris, Marouane; Kammoun, Ikram; Halima, Afef Ben; Addad, Faouzi; Kachboura, Salem

    2013-01-01

    Hydatid disease is a human parasitic infestation caused by the larval stage of Echinococcus Granulosus. The liver and the lungs are the most common locations. Cardiac involvement is rare and accounts for 0.5–2% of all hydatid disease. We report an unusual presentation of cardiac hydatid cyst revealed by ventricular tachycardia in a patient with a history of cerebral hydatid cyst.

  1. Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance.

    Science.gov (United States)

    Garland, Emily M; Celedonio, Jorge E; Raj, Satish R

    2015-09-01

    Postural tachycardia syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. The orthostatic tachycardia occurs in the absence of orthostatic hypotension and is associated with a >6-month history of symptoms that are relieved by recumbence. The heart rate abnormality and orthostatic symptoms should not be caused by medications that impair autonomic regulation or by debilitating disorders that can cause tachycardia. POTS is a "final common pathway" for a number of overlapping pathophysiologies, including an autonomic neuropathy in the lower body, hypovolemia, elevated sympathetic tone, mast cell activation, deconditioning, and autoantibodies. Not only may patients be affected by more than one of these pathophysiologies but also the phenotype of POTS has similarities to a number of other disorders, e.g., chronic fatigue syndrome, Ehlers-Danlos syndrome, vasovagal syncope, and inappropriate sinus tachycardia. POTS can be treated with a combination of non-pharmacological approaches, a structured exercise training program, and often some pharmacological support.

  2. Supraventricular Tachycardia Atackt Due to Losewieght Drug

    Directory of Open Access Journals (Sweden)

    Murat Yalcin

    2016-01-01

    Full Text Available Obesity is an important health problem. Treatment of obesity includes diet, exercise and drugs. Some of these drugs are out of prescription. Advers effects of these drugs have not been known. In this report; we present a case with supraventricular tachycardia attack due to loseweight drug containing mangostana (mango, hibiscus, citrus mate, L-karnitin, guarana.

  3. Simulation of monitoring strategies for atrial arrhythmia detection

    Directory of Open Access Journals (Sweden)

    Federica Censi

    2013-06-01

    Full Text Available INTRODUCTION: The current external monitoring strategies used to detect atrial fibrillation (AF and atrial tachycardia (AT episodes are based either on transient periods of short-term ECG recordings or on infrequent period of long-term continuous monitoring. The aim of this study was to investigate the ability of short-term daily ECG monitoring strategies for the detection of AF events. METHODS AND MATERIALS: The investigation was based on simulations performed on data extracted from Burden II study (patients implanted with pacemaker for brady-tachy syndrome, reporting date, time and duration of each episodes. RESULTS AND CONCLUSIONS: We found that a short-term daily temporally-optimized ECG monitoring allows to detect a higher percentage of episodes than 1-day Holter monitoring and to be at least as effective as a 7-days monitoring.

  4. Sinus node dysfunction in non-medicational treatment of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Bockeria L. А.

    2012-12-01

    Full Text Available Sinus node dysfunction or sick sinus syndrome (SSS includes clinical conditions such as symptomatic sinus bradycardia, sinus pauses or arrest, sinus node exit block, atrial tachycardias and chronotropic incompetence. Even though SSS incidence increases in an exponential-like manner with age, it can occur at all ages, including in the newborn. The mean age of patients with the syndrome is 68 years, with both genders being affected in approximately equal proportion. This condition occurs in 1 of every 600 cardiac patients over 65. Degenerative fibrosis of the tissues of the node has been suggested to be a common cause of SSS. Although it is still disputed. SSS is frequently associated with atrial fibrillation and flutter, tachy-bradycardia syndrome. Tachy-bradycardia syndrome is defined as sinus bradycardia coupled with atrial flutter/fibrillation or reciprocal atrial tachycardia. This syndrome is common in young patients following a surgical treatment of a congenital heart disease. Patients with chronic or persistent atrial flutter/fibrillation show high rates of cardiovascular disorders and mortality while sinus bradycardia is thought as an independent risk factor of atrial flutter/fibrillation. There are certain restrictions to medical treatment: long-term administration of the same medication (sotalol, amiodarone for atrial flutter/fibrillation can cause symptomatic bradycardia while administration of other medication (a class 1 drug increases the likelihood of ventricular arrythmias or evident bradycardia that enhances the risk of sudden cardiac death. Following atrial fibrillation ablation patients saw a significant improvement in the sinus node function, or saw a better sinus node function disrupted due to remodelling that takes place during atrial fibrillation. The surgical methods applications proved most efficient in non-medicational treatment of atrial fibrillation. In the late 1980s American surgeon J. L. Cox developed a so-called Maze

  5. Ventricular arrhythmias in patients of atrial fibrillation treated with Flecainide: A case report

    Directory of Open Access Journals (Sweden)

    Barman M, Djamel B

    2014-07-01

    Full Text Available Purpose: Flecainide is a class 1C antiarrhythmic drug, especially used for the management of supraventricular arrhythmia. Flecainide also has a recognized proarrhythmic effect in all age groups of adult patients treated for ventricular tachycardia. It is used to treat a variety of cardiac arrhythmias including paroxysmal fibrillation, Paroxysmal Supraventricular tachycardia and ventricular tachycardia. Flecainide works by regulating the flow of sodium in the heart, causing prolongation of the cardiac action potential. The proarrhythmic effects however noted are not widely reported. Case report: We report a case of paroxysmal atrial fibrillation with structurally normal heart who was treated with oral Flecainide. Despite subjective improvement and no adverse events [QTc prolongation] a repeat holter detected him to have multiple short non sustained ventricular arrhythmias. Results: Development of ventricular arrhythmias, salvos &non sustained ventricular tachycardia after a month of initiation of oral Flecainide detected by 24 hours ECG holter lead to discontinuation of Flecainide and subsequent early electro physiological studies and successful ablation. Conclusion: Initiation of oral Flecainide in a case of atrial fibrillation with subjective improvement and regular ECG monitoring, no QTc prolongation can still lead to development of dangerous ventricular arrhythmias. A cautious approach and thorough investigations and follow up are recommended.

  6. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

    Directory of Open Access Journals (Sweden)

    Tasso Julio Lobo

    2015-01-01

    Full Text Available Background: Heart failure and atrial fibrillation (AF often coexist in a deleterious cycle. Objective: To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF ablation. Methods: Patients with ventricular systolic dysfunction [ejection fraction (EF <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class and echocardiographic (EF, left atrial diameter data were compared (McNemar test and t test before and after ablation. Results: 31 patients (6 women, 25 men, aged 37 to 77 years (mean, 59.8±10.6, underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%. During a mean follow-up of 20.3±17 months, 24 patients (77% were in sinus rhythm, 11 (35% being on amiodarone. Eight patients (26% underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures. Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001. The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005 and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026. No major complications occurred. Conclusion: Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.

  7. Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia: Success Rates and Complications during 14 Years of Experience

    Directory of Open Access Journals (Sweden)

    Mansour Moghaddam

    2010-05-01

    Full Text Available Background: Radiofrequency catheter ablation (RFCA has been introduced as the treatment of choice for supraventricular tachycardia. The aim of this study was to evaluate the success rate as well as procedural and in-hospital complications of RFCA for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT.Methods: Between March 1995 and February 2009, 544 patients (75.9% female, age: 48.89 ± 13.19 years underwent 548 RFCAs for AVNRT in two large university hospitals. Echocardiography was performed for all the patients before and after the procedure. Electrocardiograms were recorded on digital multichannel systems (EP-Med or Bard EP system. Anticoagulation was initiated during the procedure.Results: From the 548 patients, 36 had associated arrhythmias, atrial flutter (4%, atrial fibrillation (0.7%, concurrent atrial fibrillation and atrial flutter (0.7%, and concealed atrioventricular pathway (0.4%. The overall success rate was 99.6%. There were 21 (3.9% transient III-degree AV blocks (up to a few seconds and 4 (0.7% prolonged II- or III-degree AV blocks, 2 (0.25% of which required permanent pacemaker insertion, 3(0.5% deep vein thrombosis, and one (0.2% arteriovenous fistula following the procedure. No difference was observed in the echocardiography parameters before and after the ablation.Conclusion: RFCA had a high success rate. The complication rate was generally low and in the above-mentioned centers it was similar to those in other large centers worldwide. Echocardiography showed no difference before and after the ablation. The results from this study showed that the risk of permanent II or III-degree AV block in patients undergoing RFCA was low and deep vein thrombosis was the second important complication. There was no risk of life-threatening complications.

  8. Left atrial volume index

    DEFF Research Database (Denmark)

    Poulsen, Mikael K; Dahl, Jordi S; Henriksen, Jan Erik;

    2013-01-01

    To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease.......To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease....

  9. Sotalol: A rescue drug in the face of life-threatening refractory ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Ashok Kandasamy

    2014-01-01

    Full Text Available We describe postoperative refractory ventricular tachycardia (VT in a patient following aortic and mitral valve replacement. Following an uneventful separation from cardiopulmonary bypass with dobutamine, the patient developed recurrent VT, 4 hours into the postoperative period. The VT did not respond to standard doses of xylocard, magnesium and amiodarone. Electrolyte and acid base parameters were normal. Multiple cardioversions failed to revert back to a stable rhythm. Intra-aortic balloon pumping was instituted and overdrive right ventricular pacing was unsuccessful. Following intravenous sotalol 80 mg, the VT came under control and reverted to a nodal rhythm, which required atrial pacing for the next 8 hours. Oral sotalol therapy was continued at 40 mg daily. The VT did not recur.

  10. Sotalol: a rescue drug in the face of life-threatening refractory ventricular tachycardia.

    Science.gov (United States)

    Kandasamy, Ashok; Arumugham, Sukumar; Krupanandha, Harshavardhan; Reddy, Bhaktavatsala

    2014-01-01

    We describe postoperative refractory ventricular tachycardia (VT) in a patient following aortic and mitral valve replacement. Following an uneventful separation from cardiopulmonary bypass with dobutamine, the patient developed recurrent VT, 4 hours into the postoperative period. The VT did not respond to standard doses of xylocard, magnesium and amiodarone. Electrolyte and acid base parameters were normal. Multiple cardioversions failed to revert back to a stable rhythm. Intra-aortic balloon pumping was instituted and overdrive right ventricular pacing was unsuccessful. Following intravenous sotalol 80 mg, the VT came under control and reverted to a nodal rhythm, which required atrial pacing for the next 8 hours. Oral sotalol therapy was continued at 40 mg daily. The VT did not recur. PMID:24732625

  11. Exploiting periodicity to extract the atrial activity in atrial arrhythmias

    OpenAIRE

    Llinares Llopis, Raúl; Igual García, Jorge

    2011-01-01

    [EN] Atrial fibrillation disorders are one of the main arrhythmias of the elderly. The atrial and ventricular activities are decoupled during an atrial fibrillation episode, and very rapid and irregular waves replace the usual atrial P-wave in a normal sinus rhythm electrocardiogram (ECG). The estimation of these wavelets is a must for clinical analysis. We propose a new approach to this problem focused on the quasiperiodicity of these wavelets. Atrial activity is characterized by...

  12. Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome.

    Science.gov (United States)

    Brewster, Jordan A; Garland, Emily M; Biaggioni, Italo; Black, Bonnie K; Ling, John F; Shibao, Cyndya A; Robertson, David; Raj, Satish R

    2012-01-01

    Patients with POTS (postural tachycardia syndrome) have excessive orthostatic tachycardia (>30 beats/min) when standing from a supine position. HR (heart rate) and BP (blood pressure) are known to exhibit diurnal variability, but the role of diurnal variability in orthostatic changes of HR and BP is not known. In the present study, we tested the hypothesis that there is diurnal variation of orthostatic HR and BP in patients with POTS and healthy controls. Patients with POTS (n=54) and healthy volunteers (n=26) were admitted to the Clinical Research Center. Supine and standing (5 min) HR and BP were obtained in the evening on the day of admission and in the following morning. Overall, standing HR was significantly higher in the morning (102±3 beats/min) than in the evening (93±2 beats/min; Porthostatic BP in POTS. A greater number of subjects met the POTS HR criterion in the morning compared with the evening (P=0.008). There was significant diurnal variability in orthostatic tachycardia, with a great orthostatic tachycardia in the morning compared with the evening in both patients with POTS and healthy subjects. Given the importance of orthostatic tachycardia in diagnosing POTS, this diurnal variability should be considered in the clinic as it may affect the diagnosis of POTS.

  13. A Rare Venous Port Complication: Supraventriculer Tachycardia

    Directory of Open Access Journals (Sweden)

    Tamer Yoldaş

    2016-04-01

    Full Text Available Implantable central venous port catheters are widely used in the management of children with cancer undergoing long term chemotherapy. These catheters can manifest a number of complications such as arrhythmia. Central venous port catheter was placed on a ten years old boy for chemotherapy. Before insertion of port catheter his physical examination, laboratory parameters, electrocardiography and echocardiography were normal. The patient felt palpitations shortly after the insertion of the port catheter. At that time the heart rate was 200 beats/minute but immediately normal sinus rhythm was restored. A chest roentgenogram revealed that the distal fragment of the port catheter was inside the right atrium. The port catheter was pulled back somewhat and then tachycardia attacks stopped. To our knowledge there are a few reports of supraventricular tachycardia (SVT in children associated with central venous port catheter. Here we aimed to present a pediatric case with SVT after placement of central venous port catheter and his management.

  14. A case of interventional and surgical treatment of ventricular tachycardia and pericardial cyst

    Directory of Open Access Journals (Sweden)

    Bockeria L.A.

    2013-12-01

    Full Text Available Pericardial cysts are infrequent lesions, accounting for approximately 7% of the mediastinal tumors. Asymptomatic patients with mediastinal cysts generally don’t require any surgical intervention. In published articles in Russia and abroad we did’t find any data on pericardial cysts that caused ventricular rhythm disturbances. In 49-years-old woman Holter ECG revealed 15 thousand monomorphic premature ventricular contractions and runs of non-sustained ventricular tachycardia. Transthoracic echocardiography showed deformation of the right atrium. Contrast-enhanced MRI of the heart showed a pericardial cyst. Parasitic origin of the cyst was excluded. After successful radiofrequency catheter ablation of premature ventricular contractions localized in interventricular septum from the left ventricular cavity, runs of non-sustained ventricular tachycardia with LBBB-morphology were diagnosed. Correlation between runs of non-sustained ventricular tachycardia and pericardial cyst was suspected. After successful surgical excision of the pericardial cyst there were no runs of ventricular tachycardia. Appropriate interventions allowed to treat patient with heart rhythm disturbances and to prevent complications due to pericardial cyst.

  15. Postural orthostatic tachycardia syndrome: a clinical review.

    Science.gov (United States)

    Johnson, Jonathan N; Mack, Kenneth J; Kuntz, Nancy L; Brands, Chad K; Porter, Coburn J; Fischer, Philip R

    2010-02-01

    Postural orthostatic tachycardia syndrome was defined in adult patients as an increase >30 beats per minute in heart rate of a symptomatic patient when moving from supine to upright position. Clinical signs may include postural tachycardia, headache, abdominal discomfort, dizziness/presyncope, nausea, and fatigue. The most common adolescent presentation involves teenagers within 1-3 years of their growth spurt who, after a period of inactivity from illness or injury, cannot return to normal activity levels because of symptoms induced by upright posture. Postural orthostatic tachycardia syndrome is complex and likely has numerous, concurrent pathophysiologic etiologies, presenting along a wide spectrum of potential symptoms. Nonpharmacologic treatment includes (1) increasing aerobic exercise, (2) lower-extremity strengthening, (3) increasing fluid/salt intake, (4) psychophysiologic training for management of pain/anxiety, and (5) family education. Pharmacologic treatment is recommended on a case-by-case basis, and can include beta-blocking agents to blunt orthostatic increases in heart rate, alpha-adrenergic agents to increase peripheral vascular resistance, mineralocorticoid agents to increase blood volume, and serotonin reuptake inhibitors. An interdisciplinary research approach may determine mechanistic root causes of symptoms, and is investigating novel management plans for affected patients.

  16. Left atrial ball valve thrombus

    Directory of Open Access Journals (Sweden)

    R. Balaji

    2013-10-01

    Full Text Available "Ball valve thrombus" which is a spherical free floating clot in left atrium is an often quoted, but uncommonly encountered complication in patients with severe mitral stenosis of rheumatic origin, who are in atrial fibrillation. We describe the case of a 31-year-old lady with rheumatic heart disease, severe mitral stenosis and moderately severe aortic stenosis who had undergone closed mitral valvotomy 13 years ago. The patient presented with an episode of non-exertional syncope and breathlessness on exertion of 6 months duration and was in normal sinus rhythm. Echocardiography facilitated ante-mortem diagnosis and prompt institution of surgery was life saving.

  17. Left atrial appendage closure devices for cardiovascular risk reduction in atrial fibrillation patients

    Directory of Open Access Journals (Sweden)

    Cruz-Gonzalez I

    2015-05-01

    Full Text Available Ignacio Cruz-Gonzalez,* Juan Carlos Rama-Merchan,* Javier Rodriguez-Collado, Javier Martin-Moreiras, Alejandro Diego-Nieto, Antonio Arribas-Jimenez, Pedro Luís SanchezDepartment of Cardiology, University Hospital of Cardiology and IBSAL, Salamanca, Spain *Ignacio Cruz-Gonzalez and Juan Carlos Rama-Merchan have contributed equally to this work and should be considered co-first authors Abstract: Atrial fibrillation (AF is the most common sustained arrhythmia in clinical practice. AF is associated with a 4–5-fold increased risk of stroke and systemic embolism. Oral anticoagulant is the first-line therapy for this purpose, but it has various limitations and is often contraindicated or underutilized. Autopsy and surgical data have suggested that 90% of atrial thrombi in nonvalvular AF patients originate from the left atrial appendage, leading to the development of percutaneous closure for thromboembolic prevention. This paper examines the current evidence on left atrial appendage closure devices for cardiovascular risk reduction in AF patients. Keywords: atrial fibrillation, left atrial appendage, stroke, oral anticoagulant, percutaneous closure, thromboembolic prevention

  18. EGC diagnosis of paroxysmal supraventricular tachycardias in patients without preexcitation.

    Science.gov (United States)

    González-Torrecilla, Esteban; Arenal, Angel; Atienza, Felipe; Datino, Tomás; Atea, Leonardo F; Calvo, David; Pachón, Marta; Miracle, Angel; Fernández-Avilés, Francisco

    2011-01-01

    This review is aimed at discussing the diagnostic value of the different electrocardiographic criteria so far described in the differential diagnosis of the major forms of paroxysmal supraventricular tachycardias (PSVTs). The predictive value of different combinations of these independent electrocardiographic (ECG) signs in distinguishing atrioventricular reentrant tachycardias (AVRTs) through a concealed accessory pathway (AP) versus atrioventricular nodal reentrant tachycardias (AVNRTs) are discussed in detail. In addition, the adjunctive diagnostic value of simple, bedside clinical variables and their combinations to the ECG interpretation in differentiating both tachycardia mechanisms is also reviewed.

  19. Artifact versus arrhythmia in pseudo-polymorphic tachycardia; case report

    Directory of Open Access Journals (Sweden)

    Ahmed V

    2015-04-01

    Full Text Available Vaseem Ahmed, Anish Patel, Abhishek Sharma, Dennis Bloomfield Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA Abstract: We present the case of a young male patient in sinus rhythm whose electrocardiogram (ECG was initially misinterpreted as ventricular tachycardia. Electrocardiographic artifact appearing to be ventricular tachycardia commonly occurs and ECG criteria have been described to aid in the discrimination between artifact and true arrhythmia. There are many causes of artifacts and prompt recognition is important to prevent unnecessary interventions. Keywords: artifact, ventricular tachycardia, pseudo-ventricular tachycardia, notch sign, sinus sign

  20. The prevalence and characteristics of intra-atrial right coronary artery anomaly in 9,284 patients referred for coronary computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Opolski, Maksymilian P., E-mail: opolski.mp@gmail.com [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Pregowski, Jerzy, E-mail: jerzypregowski74@gmail.com [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Kruk, Mariusz, E-mail: mariuszkruk2000@yahoo.com [Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Staruch, Adam D., E-mail: adstarman@gmail.com [Medical University of Warsaw, Warsaw (Poland); Witkowski, Adam, E-mail: witkowski@hbz.pl [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Demkow, Marcin, E-mail: mdemkow@ikard.pl [Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Hryniewiecki, Tomasz, E-mail: t.hryniewiecki@ikard.pl [Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw (Poland); Michalek, Piotr, E-mail: p.michalek@ikard.pl [Department of Immediate Diagnostics, Institute of Cardiology, Warsaw (Poland); Ruzyllo, Witold, E-mail: w.ruzyllo@ikard.pl [Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Kepka, Cezary, E-mail: c.kepka@ikard.pl [Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland)

    2014-07-15

    Objective: To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population. Methods: We included 9,284 consecutive subjects who underwent CCTA at a single high-volume center. The presence of IARCA including the number, length and diameter of IARCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Additionally, clinical characteristics and midterm follow-up of IARCA patients were recorded. Results: The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53 mm, and the mean diameter proximal to the entry site was 3.3 ± 0.7 mm. IARCA was more often associated with intramuscular course of the left anterior descending coronary artery (29% vs. 4%, p = 0.001) and anomalous origin of the left circumflex artery from the right aortic sinus (14% vs. 0.3%, p = 0.001) compared with non-IARCA cases. The majority of IARCA patients were women (86%) presenting with supraventricular arrhythmia (71%). Compared with computed tomographic population without IARCA, IARCA subjects were younger (60 ± 12 vs. 54 ± 14 years, p = 0.037) and more often women (51% vs. 86%, p = 0.013). At a mean of 20 months follow-up of IARCA patients there were no adverse cardiac events except for supraventricular tachycardia episodes occurring in 36% of subjects. Conclusions: IARCA occurs rarely and is often associated with additional coronary anomalies. The clinical profile of IARCA patients is most often represented by middle-aged women with supraventricular arrhythmia showing favorable midterm prognosis.

  1. The prevalence and characteristics of intra-atrial right coronary artery anomaly in 9,284 patients referred for coronary computed tomography angiography

    International Nuclear Information System (INIS)

    Objective: To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population. Methods: We included 9,284 consecutive subjects who underwent CCTA at a single high-volume center. The presence of IARCA including the number, length and diameter of IARCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Additionally, clinical characteristics and midterm follow-up of IARCA patients were recorded. Results: The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53 mm, and the mean diameter proximal to the entry site was 3.3 ± 0.7 mm. IARCA was more often associated with intramuscular course of the left anterior descending coronary artery (29% vs. 4%, p = 0.001) and anomalous origin of the left circumflex artery from the right aortic sinus (14% vs. 0.3%, p = 0.001) compared with non-IARCA cases. The majority of IARCA patients were women (86%) presenting with supraventricular arrhythmia (71%). Compared with computed tomographic population without IARCA, IARCA subjects were younger (60 ± 12 vs. 54 ± 14 years, p = 0.037) and more often women (51% vs. 86%, p = 0.013). At a mean of 20 months follow-up of IARCA patients there were no adverse cardiac events except for supraventricular tachycardia episodes occurring in 36% of subjects. Conclusions: IARCA occurs rarely and is often associated with additional coronary anomalies. The clinical profile of IARCA patients is most often represented by middle-aged women with supraventricular arrhythmia showing favorable midterm prognosis

  2. Origins.

    Science.gov (United States)

    Online-Offline, 1999

    1999-01-01

    Provides an annotated list of resources dealing with the theme of origins of life, the universe, and traditions. Includes Web sites, videos, books, audio materials, and magazines with appropriate grade levels and/or subject disciplines indicated; professional resources; and learning activities. (LRW)

  3. Effects of Losartan on acute atrial electrical remodeling

    Institute of Scientific and Technical Information of China (English)

    李悦; 李为民; 薛竟宜; 韩薇; 杨树森; 谷宏越

    2004-01-01

    Background Atrial electrical remodeling (AER) contributes to the maintainance of atrial fibrillation (AF). This study was to compare the effects of Losartan with those of Diltiazem on tachycardia-induced acute AER in rabbits.Methods Twenty-one rabbits paced with maximal atrial capture rate for 3 hours in the right atrium (RA) were randomly divided into saline group, Diltiazem group and Losartan group. After autonomic blockage, we measured atrial effective refractory period (AERP), AERP rate adapting feature, AERP dispersion and RA conduction time at basic cycle lengths (BCLs) of 200 ms and 150 ms at baseline, 0.5 hour, 1 hour, 2 and 3 hours after rapid atrial pacing. Results In the saline group, there was a prompt decrease in AERP as a result of rapid atrial pacing, and AERP200 and AERP150 were shortened sharply within 0.5 hour of pacing (30.2±10.5 ms and 24.1±9.1 ms, respectively). The AERP did not change dramatically in the Diltiazem and Losartan groups. In the saline group, the value of (AERP200-AERP150)/50 ms in high RA was 0.17±0.08 at baseline and became significantly smaller at 0.5 hour (0.08±0.06), 1 hour (0.09±0.06), 2 hours (0.08±0.04) and 3 hours (0.09±0.05) (all P<0.05), suggesting a reduction of rate adaptation of AERP. The value of (AERP200-AERP150)/50 ms in high RA did not change during the 3 hours of pacing in both Diltiazem and Losartan groups. In the saline group, AERP dispersion increased significantly at 2 and 3 hours (P<0.05). However, Diltiazem could not prevent the increase of AERP dispersion at 3 hours (P<0.05). During Losartan infusion, the AERP dispersion was no longer increased after rapid atrial pacing. There was no significant difference in RA conduction time among the three groups.Conclusion Like calcium antagonist Diltiazem, Losartan could prevent AERP shortening and preserve rate adaptation of AERP after rapid atrial pacing. Losartan is more effective than Diltiazem in inhibiting the increase of AERP dispersion.

  4. Anticoagulation in atrial fibrillation

    OpenAIRE

    Steinberg, Benjamin A; Piccini, Jonathan P.

    2014-01-01

    Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also availabl...

  5. Pseudo ventricular tachycardia: a case report.

    LENUS (Irish Health Repository)

    Riaz, A

    2012-02-01

    BACKGROUND: Dramatic artifacts of pseudo flutter have been reported in the past secondary to various factors including tremor (Handwerker and Raptopoulos in N Engl J Med 356:503, 2007) and dialysis machines (Kostis et al. in J Electrocardiol 40(4):316-318, 2007). METHODS: We present this unusual case where the artifact, produced by tremor, was so pronounced to be misdiagnosed and treated as ventricular tachycardia. CONCLUSION: This case highlights the importance of correlating ECG findings with history and clinical examination and of using 12 lead ECGs for rhythm interpretation especially to confirm consistence of arrhythmias in all leads.

  6. Prevention of Recurrent Atrial Fibrillation and Bi-Atrial Resynchronization

    OpenAIRE

    Evrard, P.; Sakalihasan, Natzi; R. Garcia; Van Laere, Anne-Sophie; Patterson, B.

    1999-01-01

    After conversion of atrial fibrillation, it is important to maintain sinus rhythm. In addition antiarrhythmic drugs, biatrial resynchronization seems to prevent recurrences of atrial fibrillation in patients with interatrial conduction block: local experience.

  7. Ventricular tachycardia after administration of sildenafil citrate: a case report

    Directory of Open Access Journals (Sweden)

    Rasmussen Jeppe G

    2007-08-01

    Full Text Available Abstract Background It has not previously been reported that sildenafil citrate causes malignant arrhythmias in humans. Case presentation A 41-year-old man developed sustained ventricular tachycardia following sildenafil citrate administration. Conclusion It cannot be dismissed that this patient experienced ventricular tachycardia as an adverse effect of sildenafil citrate administration.

  8. Impact of different termination modes on atrial fibrillation termination in catheter ablation of persistent atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    WANG Ping; MA Chang-sheng; DONG Jian-zeng; LONG De-yong; NING Man; TANG Ri-bo; YU Rong-hui; XUE Zeng-ming; SANG Cai-hua; JIANG Chen-xi

    2012-01-01

    Background The optimal endpoint for catheter ablation of persistent atrial fibrillation (AF) remains ambiguous.This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome.Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion (CV) group.Subgroups were also analyzed based on different termination modes.Follow-up assessment included early recurrence and sinus rhythm (SR) maintenance.Results During initial ablation,33 patients (11.3%) were directly converted to SR,166 patients (56.7%) were converted to atrial tachycardia (AT) that subsequently restored SR with further ablation in 98 patients (33.4%),and a total of 162 patients (55.3%) underwent cardioversion due to persistent atrial arrhythmias.Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence (38.2% vs.43.8%,P=0.328) and SR maintenance (67.2% vs.59.8%,P=0.198) during the (23±7) months follow-up.Even after repeat ablation,the SR maintenance continued to exhibit no statistical difference in above two groups (72.5% vs.70.4%,P=0.686).Further analysis of subgroups,however,demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups (P <0.05).Furthermore,atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode:AF or AT (P <0.05).Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF.AF methods that convert arrhythmia directly to SR have,however,been linked with improved clinical outcomes,although conversions to AT may not be correlated.Atrial arrhythmias observed during the ablation may be used to

  9. Atrial Fibrosis and the Mechanisms of Atrial Fibrillation

    OpenAIRE

    Everett, Thomas H; Olgin, Jeffrey E.

    2006-01-01

    Atrial fibrillation (AF) is commonly associated with congestive heart failure (CHF), and CHF has been shown to be associated with atrial structural remodeling resulting in fibrosis. This atrial interstitial fibrosis has been seen in patients with CHF and animal models of pacing induced heart failure. With atrial fibrosis, conduction abnormalities result in an increase in AF vulnerability. The mechanism of AF that is associated with CHF is still under debate as both focal and reentrant mechani...

  10. Managing the patient with episodic sinus tachycardia and orthostatic intolerance.

    Science.gov (United States)

    Narichania, Aalap D; Schleifer, J William; Shen, Win-Kuang

    2014-01-01

    Patients with episodic sinus tachycardia and associated orthostatic intolerance present a diagnostic and management dilemma to the clinician. We define this group of disorders to include sinus node reentrant tachycardia (SNRT), inappropriate sinus tachycardia (IAST), and postural orthostatic tachycardia syndrome (POTS). After a brief review of the current understanding of the pathophysiology and epidemiology of this group of disorders, we focus on the diagnosis and management of IAST and POTS. Our approach attempts to recognize the considerable overlap in pathophysiology and clinical presentation between these two heterogeneous conditions. Thus, we focus on a mechanism-based workup and therapeutic approach. Sinus tachycardia related to identifiable causes should first be ruled out in these patients. Next, a basic cardiovascular and autonomic workup is suggested to exclude structural heart disease, identify a putative diagnosis, and guide therapy. We review both nonpharmacologic and pharmacologic therapy, with a focus on recent advances. Larger randomized control trials and further mechanistic studies will help refine management in the future.

  11. Exercise in the postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Fu, Qi; Levine, Benjamin D

    2015-03-01

    Patients with the Postural Orthostatic Tachycardia Syndrome (POTS) have orthostatic intolerance, as well as exercise intolerance. Peak oxygen uptake (VO2peak) is generally lower in these patients compared with healthy sedentary individuals, suggesting a lower physical fitness level. During acute exercise, POTS patients have an excessive increase in heart rate and reduced stroke volume for each level of absolute workload; however, when expressed at relative workload (%VO2peak), there is no difference in the heart rate response between patients and healthy individuals. The relationship between cardiac output and VO2 is similar between POTS patients and healthy individuals. Short-term (i.e., 3 months) exercise training increases cardiac size and mass, blood volume, and VO2peak in POTS patients. Exercise performance is improved after training. Specifically, stroke volume is greater and heart rate is lower at any given VO2 during exercise after training versus before training. Peak heart rate is the same but peak stroke volume and cardiac output are greater after training. Heart rate recovery from peak exercise is significantly faster after training, indicating an improvement in autonomic circulatory control. These results suggest that patients with POTS have no intrinsic abnormality of heart rate regulation during exercise. The tachycardia in POTS is due to a reduced stroke volume. Cardiac remodeling and blood volume expansion associated with exercise training increase physical fitness and improve exercise performance in these patients.

  12. Can Atrial Fibrillation Be Prevented?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Can Atrial Fibrillation Be Prevented? Following a healthy lifestyle and taking ... risk for heart disease may help you prevent atrial fibrillation (AF). These steps include: Following a heart healthy ...

  13. 右心室间隔部室性早搏/室性心动过速的心电图特征及射频消融治疗%Electrocardiographic characteristics and radiofrequency catheter ablation of premature ventricular complexes/ventricular tachycardia originating from right ventricular septum

    Institute of Scientific and Technical Information of China (English)

    王永光; 林加锋; 李岳春; 季亢挺; 殷日鹏

    2015-01-01

    Objective To observe the curative efficacy and safety of radiofrequency catheter ablation and the electrocardiographic characteristics of idiopathic premature ventricular complexes/ventricular tachycardia(PVC/VT) originating from right ventricular septum.Methods Electrocardiographic characteristics and variation of PVC/VT originating from right ventricular septum were analyzed in 62 patients [32 males,average age of (57.0 ± 18.8) years old] undergoing radiofrequency catheter ablation.Results Forty-nine patients (79.0%) were successfully ablated without related complications.Its electrocardiographic characteristics and change rulewere as follows:①QRS morphology was mainly R in lead Ⅰ;②most was R,a few was r,m or qr in lead aVL;③QS,qs or r in lead aVR;④The position of the origin was positively associated with R wave amplitude in inferior leads,but negatively correlated with the amplitude of S wave;⑤PVC/VT originating from right ventricular outflow tract always manifested as R wave in the inferior leads,while the majority of PVC/VT originating from right ventricular septum showed S wave in at least one or more inferior leads;⑥In addition to PVC/ VT originating from right ventricular septum adjacent to tricuspid annulus and the middle upper septum was rS in lead V1,most PVC/IVT originating from other parts was QS in lead V1,and with the origin point moving down to the middle and apical segments,the amplitude and distribution of precordial R wave becomes less,while QS wave was deeper and distributed more widely.Conclusion Radiofrequency catheter ablation is safe and effective for treating PVC/VT originating from the right ventricular septum,the electrocardiographic characteristics of different origins have certain change rules,grasping these characteristics will be benefit to determine its origin,shorten the operation time.%目的 探讨右心室间隔部起源特发性室性早搏/室性心动过速(PVC/VT)的体表心电图特点及射频消融治

  14. Inter-subject variability in human atrial action potential in sinus rhythm versus chronic atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Carlos Sánchez

    Full Text Available Human atrial electrophysiology exhibits high inter-subject variability in both sinus rhythm (SR and chronic atrial fibrillation (cAF patients. Variability is however rarely investigated in experimental and theoretical electrophysiological studies, thus hampering the understanding of its underlying causes but also its implications in explaining differences in the response to disease and treatment. In our study, we aim at investigating the ability of populations of human atrial cell models to capture the inter-subject variability in action potential (AP recorded in 363 patients both under SR and cAF conditions.Human AP recordings in atrial trabeculae (n = 469 from SR and cAF patients were used to calibrate populations of computational SR and cAF atrial AP models. Three populations of over 2000 sampled models were generated, based on three different human atrial AP models. Experimental calibration selected populations of AP models yielding AP with morphology and duration in range with experimental recordings. Populations using the three original models can mimic variability in experimental AP in both SR and cAF, with median conductance values in SR for most ionic currents deviating less than 30% from their original peak values. All cAF populations show similar variations in G(K1, G(Kur and G(to, consistent with AF-related remodeling as reported in experiments. In all SR and cAF model populations, inter-subject variability in I(K1 and I(NaK underlies variability in APD90, variability in I(Kur, I(CaL and I(NaK modulates variability in APD50 and combined variability in Ito and I(Kur determines variability in APD20. The large variability in human atrial AP triangulation is mostly determined by I(K1 and either I(NaK or I(NaCa depending on the model.Experimentally-calibrated human atrial AP models populations mimic AP variability in SR and cAF patient recordings, and identify potential ionic determinants of inter-subject variability in human atrial AP

  15. Risk Factors for Atrial Fibrillation

    OpenAIRE

    Krijthe, Bouwe

    2013-01-01

    textabstractAtrial fibrillation is a common cardiac arrhythmia that is characterized by rapid disorganized atrial electrical activity resulting in absence of atrial contractions. It is diagnosed on the basis of typical findings on an electrocardiogram (ECG). The characteristic ECG findings are absence of P-waves, and an irregular heart rate. Symptoms of atrial fibrillation include palpitations, dyspnea, reduced exercise capacity, chest pain and dizziness, but it often goes without symptoms. A...

  16. 针刺治疗室上性心动过速42例%Acupuncture Treatment for Paroxysmal Supraventricular Tachycardia of 42 Cases

    Institute of Scientific and Technical Information of China (English)

    杜丹

    2014-01-01

    Objective:To observe the effect of acupuncture treatment on paroxysmal supraventricular tachycar-dia.Methods:42 patients with paroxysmal supraventricular tachycardia were diagnosed after Heartbeat .In the interictal application of transesophageal atrial pacing induced supraventricular tachycardia to attack Beckoning , then the application of acupuncture was at bilateral Neiguan and Shenmen treatment .Results:According to clin-ical observation of 42 cases,it was effective in 31 cases,accounting for 73.81%;it was invalid in 11 cases,ac-counting for 26 .19%.Conclusion:Acupuncture of Neiguan with Shenmen is effective in the treatment of atrio-ventricular nodal reentrant tachycardia ( AVNRT) and atrial reentrant supraventricular tachycardia ( IART) ,and it is also effective to bypass the reentrant supraventricular tachycardia ( AVRT) ,but the effect on atrial fibrillation ( Af) disease is not obvious .%目的:观察针刺治疗室上性心动过速的疗效。方法:42例阵发性室上性心动过速患者确诊后,在发作间期应用食道心房调搏诱发出室上性心动过速发作,然后应用针刺双侧内关穴和神门穴进行治疗。结果:本组42例患者,有效31例,占73.81%,无效11例,占26.19%。结论:针刺内关穴配合神门穴可有效治疗房室结折返室上速( AVNRT)和房内折返室上速( IART),对旁路折返室上速( AVRT)也有一定疗效,但是对房颤( Af)疗效并不明显。

  17. Atrial Fibrillation (AF or AFib)

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Atrial Fibrillation (AF or AFib) Updated:Feb 10,2016 What ... to the Terms and Conditions and Privacy Policy Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • ...

  18. Stroke prevention in atrial fibrillation.

    NARCIS (Netherlands)

    Verheugt, F.W.A.

    2006-01-01

    The only major and potentially fatal risk for patients with atrial fibrillation is the development of systemic thromboembolism. Stroke occurs five times more frequently in patients with atrial fibrillation than in comparable patients in sinus rhythm. The yearly incidence of stroke in atrial fibrilla

  19. Left atrial appendage occlusion

    Directory of Open Access Journals (Sweden)

    Ahmad Mirdamadi

    2013-01-01

    Full Text Available Left atrial appendage (LAA occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC, it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC and mitral valve replacement (MVR too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.

  20. Anticoagulation in atrial fibrillation.

    Science.gov (United States)

    Steinberg, Benjamin A; Piccini, Jonathan P

    2014-01-01

    Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also available. These novel oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) obviate many of warfarin's shortcomings, and they have demonstrated safety and efficacy in large randomized trials of patients with non-valvular atrial fibrillation. However, the management of patients taking warfarin or novel agents remains a clinical challenge. There are several important considerations when selecting anticoagulant therapy for patients with atrial fibrillation. This review will discuss the rationale for anticoagulation in patients with atrial fibrillation; risk stratification for treatment; available agents; the appropriate implementation of these agents; and additional, specific clinical considerations for treatment. PMID:24733535

  1. Interventional treatment of WPW syndrome and typical atrial flutter in the patient with nonischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Bockeria O. L.

    2012-12-01

    Full Text Available Myocardial noncompaction is associated with the development of heart failure and different arrhythmias. There are no typical arrhythmias for myocardial noncompaction. Various arrhythmias are clinically relevant because they may aggravate heart failure, may favor thromboembolism, like atrial fibrillation or flutter, or may lead to syncope or sudden cardiac death. In accumulated data we didn’t find description of left ventricular myocardial noncompaction, atrial flutter and intermittent Wolff–Parkinson–White (WPW syndrome. During electrophysiology study in patient with intermittent WPW syndrome programmed ventricular stimulation S1 = 500 ms, S2 = 260 ms was performed. Nonsustained ventricular tachycardia was induced. Then as a result of stimulation S1 = 500 ms, S2 = 240 ms fast ventricular tachycardia and ventricular fibrillation was induced. Then ventricular fibrillation was spontaneously terminated and converted into atrial fibrillation transmitted through the bypass tract with self-termination in 40 s. Cardiac contrast-enhanced magnetic resonanse imaging revealed left ventricular (LV myocardial noncompaction in apical and anterior segments of LV. There is no specific management of left ventricular myocardial noncompaction. In the present state of knowledge, an implantable cardioverterdefibrillator (ICD should be implanted in patients with myocardial noncompaction presenting with syncope and symptomatic ventricular arrhythmias in order to prevent sudden cardiac death. In this case patient refused from implanting an ICD.

  2. Integrin β1 Participates in Atrial Remodeling in Rapid Atrial Pacing Induced Canine Atrial Fibrillation Model

    Institute of Scientific and Technical Information of China (English)

    Zhang wei; Yang guirong; Zheng zhaotong; Wang sujia; Zhang yun

    2004-01-01

    @@ Objective Integrin β1 regulates cell to cell and cell to extracellualr matrix interaction in heart. however, its pathop hysiological role in atrial fibrillation is unclear. The purpose of t his study was to determine whether atrial structural remodeling during atrial fibrillation is associated with altered integrinβ1.

  3. The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

    Directory of Open Access Journals (Sweden)

    Sarah White

    2015-01-01

    Full Text Available Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15 mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension. “Why Should Emergency Physicians Be Aware of This?” New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly.

  4. Stroke prevention in atrial fibrillation

    DEFF Research Database (Denmark)

    Freedman, Ben; Potpara, Tatjana S; Lip, Gregory Y H

    2016-01-01

    Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal...... or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K...

  5. A review of postural orthostatic tachycardia syndrome.

    LENUS (Irish Health Repository)

    Carew, Sheila

    2012-01-31

    A 21-year-old female reports an 18-month history of light-headedness on standing. This is often associated with palpitations and a feeling of intense anxiety. She has had two black-outs in the past 12 months. She is not taking any regular medications. Her supine blood pressure was 126\\/84 mmHg with a heart rate of 76 bpm, and her upright blood pressure was 122\\/80 mmHg with a heart rate of 114 bpm. A full system examination was otherwise normal. She had a 12-lead electrocardiogram performed which was unremarkable. She was referred for head-up tilt testing. She was symptomatic during the test and lost consciousness at 16 min. Figure 1 summarizes her blood pressure and heart rate response to tilting. A diagnosis of postural orthostatic tachycardia syndrome with overlapping vasovagal syncope was made.

  6. Clinical Challenges in Catecholaminergic Polymorphic Ventricular Tachycardia.

    Science.gov (United States)

    Imberti, Jacopo F; Underwood, Katherine; Mazzanti, Andrea; Priori, Silvia G

    2016-08-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inheritable cardiac disorder associated with exercise- and stress-induced sudden death in young individuals. Although important steps forward have been made in the comprehension and treatment of this disease, several aspects remain unclear. Firstly, from an epidemiological standpoint the actual prevalence of CPVT is still unknown and possibly underestimated. In addition, the diagnostic process remains very challenging and can be supported by genetic analysis in only about half of the cases. Finally, up to one third of CPVT patients continue to present complex arrhythmias despite beta blocker treatment; the role of newer therapeutic options, such as flecainide and left cardiac sympathetic denervation, needs to be further elucidated. All these points constitute challenges for the cardiologist in the management of CPVT patients and fuel research into new diagnostic, prognostic and therapeutic approaches. PMID:26948768

  7. RELATION BETWEEN LEFT ATRIAL SIZE AND ATRIAL FIBRILLATION IN DIFFERENT DISEASES

    OpenAIRE

    Rajith; Divya

    2014-01-01

    BACKGROUND: Atrial fibrillation is the most common cardiac dysrhythmia and left atrial size is an important factor in the development of atrial fibrillation. In the presence of atrial fibrillation an increase in left atrial size is associated with increased risk of stroke as well as increased morbidity and mortality. In this context, this study entitled “relation between left atrial size and atrial fibrillation in different diseases” was undertaken to study the left atrial size in different d...

  8. Electrocardiographic characteristics and catheter ablation of left ventricular epicardial tachycardia originating from the different parts of great cardiac vein%心大静脉不同部位室性心律失常的心电图特征及射频导管消融治疗

    Institute of Scientific and Technical Information of China (English)

    官学强; 李嘉; 李岳春; 季亢挺; 殷日鹏; 林加锋

    2011-01-01

    Objective To investigate the electrocardiographic characteristics ofpremature ventricular contractions (PVCs) and ventricular tachycardia (VT) originating from the different parts of great cardiac vein (GCV) and to evaluate the efficacy and safety of radio frequency catheter ablation (RFCA).Methods Four patients with PVCs/VTs, including 2 cases of PVC, 1 sustained VT and 1 non- sustained VT, underwent electrophysiologic study using conventional mapping techniques and also received catheter ablation for the arrhythmias via GCV.Mapping and RF energy application at endocardial sites of left and right ventricular outflow tract (LVOT, RVOT) or mitral annulus did not eliminate the arrhythmias in all the patients.The arrhythmias were finally mapped and ablated from coronary venous system.Electrocardiographic characteristics were analyzed in cases with successful ablation via the distalpart (located proximal to the origin of anterior interventricular vein) or the most distal part (located distal to the origin of anterior interventricular vein) of GCV.Results Only 1 case succeeded in the first procedure of catheter ablation using the common temperature- controlled catheter, other 3 cases failed due to unable to delivered RF energy with high impedance within coronary sinus.The arrhythmias in 2 of 3 cases were successfully ablated using irrigated- tip catheter under the guide of Ensite3000 NavXin the second procedure, with the overall success rate of 75 % (3/4).The successful ablation site was located in the distalpart of GCV in 1 patient, the most distal part of GCV in 2 cases.The earliest epicardial activation was preceding the onset of the QRS complex by (36.00± 2.65) ms, and there were atrialand ventricular potentias in sinus rhythm at the successful ablation sites.Pacing reproduced QRS morphology that was similar to the clinical PVCs/VTs in all patients (2 patients with 11/12- lead and 2 patients with 12/12- lead concordance of major and minor deflections

  9. Spontaneous onset of atrial fibrillation

    Science.gov (United States)

    Zemlin, Christian W.; Mitrea, Bogdan G.; Pertsov, Arkady M.

    2009-06-01

    Most commonly, atrial fibrillation is triggered by rapid bursts of electrical impulses originating in the myocardial sleeves of pulmonary veins (PVs). However, the nature of such bursts remains poorly understood. Here, we propose a mechanism of bursting consistent with the extensive empirical information about the electrophysiology of the PVs. The mechanism is essentially non-local and involves the spontaneous initiation of non-sustained spiral waves in the distal end of the muscle sleeves of the PVs. It reproduces the experimentally observed dynamics of the bursts, including their frequency, their intermittent character, and the unusual shape of the electrical signals in the pulmonary veins that are reminiscent of so-called early afterdepolarizations (EADs).

  10. Responses of cardiac natriuretic peptides after paroxysmal supraventricular tachycardia: ANP surges faster than BNP and CNP.

    Science.gov (United States)

    Kuo, Jen-Yuan; Wang, An-Mei; Chang, Sheng-Hsiung; Hung, Chung-Lieh; Chen, Chun-Yen; Shih, Bing-Fu; Yeh, Hung-I

    2016-03-15

    Atrial natriuretic peptide (ANP) secretion increases after 30 min of paroxysmal supraventricular tachycardia (PSVT). Whether this phenomenon also applies to brain or C-type natriuretic peptides (BNP or CNP) remains unknown. Blood samples of 18 patients (41 ± 11 yr old; 4 men) with symptomatic PSVT and normal left ventricular systolic function (ejection fraction 65 ± 6%) were collected from the coronary sinus (CS) and the femoral artery (FA) before and 30 min after the induction, and 30 min after the termination of PSVT. The results showed that the ANP levels rose steeply after the PSVT and then reduced at 30 min after the termination (baseline vs. post-PSVT vs. posttermination: CS: 34.0 ± 29.6 vs. 74.1 ± 42.3 vs. 46.1 ± 32.9; FA: 5.9 ± 3.24 vs. 28.2 ± 20.7 vs. 10.0 ± 4.6 pg/ml; all P tachycardia (BNP, 10.2 ± 6.4 vs. 11.3 ± 7.1 vs. 11.8 ± 7.9; CNP, 4.5 ± 1.2 vs. 4.9 ± 1.4 vs. 5.0 ± 1.4 pg/ml; all P < 0.05). The rise of BNP and CNP in FA was similarly less sharp after the PSVT and remained stationary after the termination. PSVT exerted differential effects on cardiac natriuretic peptide levels. ANP increased greater after a 30-min induced PSVT, but dropped faster after termination of PSVT, compared with BNP and CNP.

  11. The management of atrial fibrillation in heart failure.

    Science.gov (United States)

    Bala, Rupa; Callans, David J

    2006-08-01

    The development of atrial fibrillation (AF) can greatly complicate the course of heart failure (HF). Although recent trials have indicated the nonsuperiority of a rhythm control strategy in the general population with AF, this may not apply to patients with HF. We feel strongly that AF be treated aggressively in patients with HF, defaulting toward an initial rhythm control strategy, to avoid the hemodynamic detriment of irregular rapid ventricular response and the development of tachycardia-related myopathy. The index episode is treated with cardioversion and antiarrhythmic therapy. If significant benefit is demonstrated, the rhythm control strategy is maintained, to the point of catheter ablation for AF if necessary. If there is no change in cardiac performance or symptoms after cardioversion, strict rate control is enforced, to the point of atrioventricular node ablation and pacing if necessary.

  12. [Idiopathic ventricular tachycardia, an arrhythmia with good prognosis].

    NARCIS (Netherlands)

    Camaro, C.; Bos, H.S.; Smeets, J.L.R.M.

    2010-01-01

    Three patients, one experiencing palpitations and two complaining of chest pain in stressful situations, appeared to have monomorphic wide complex tachycardia. After excluding channelopathy, structural abnormalities and ischaemia of the heart, this arrhythmia was classified as idiopathic. Symptoms d

  13. Idiopathic Paroxysmal Ventricular Tachycardia in Infants and Children

    Science.gov (United States)

    Hernandez, Antonio; And Others

    1975-01-01

    Laboratory tests including blood count serum electrolyte measures, and electroencephalograms were performed on seven children ages 1 day to 18 years with recurrent attacks of rapid heart action known as idiopathic paroxysmal ventricular tachycardia. (CL)

  14. Lesson Five Atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    鲁端; 吴文烈

    2003-01-01

    @@ Atrial fibrillation(AF) may occur in paroxysmaland persistent forms. It may be seen in normal subjects,particularly during emotional stress or follow-ing surgery,exercise, or acute alcoholic intoxication.It also may occur in patients with heart or lungdisease who develop acute hypoxia, hypercapnia,ormetabolic or hemodynamic derangements.

  15. What Is Atrial Fibrillation?

    Science.gov (United States)

    ... regular beat. Certain cells in your heart make electric signals that cause the heart to contract and pump blood. These electrical signals show up on an elec- trocardiogram (ECG) recording. Your doctor can read your ECG to find out if the electric signals are normal. In atrial fibrillation (AFib), the ...

  16. Rivaroxaban in atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Giorgi MA

    2012-08-01

    Full Text Available Mariano A Giorgi,1,2 Lucas San Miguel31Cardiology Service, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, 2Department of Pharmacology, School of Medicine, Universidad Austral, 3Department of Cardiology and Cardiovascular Surgery, FLENI, Buenos Aires, ArgentinaAbstract: Warfarin is the traditional therapeutic option available to manage thromboembolic risk in atrial fibrillation. The hemorrhagic risk with warfarin depends mainly on the international normalized ratio (INR. Data from randomized controlled trials show that patients have a therapeutic INR (2.00–3.00 only 61%–68% of the time while taking warfarin, and this target is sometimes hard to establish. Many compounds have been developed in order to optimize the profile of oral anticoagulants. We focus on one of them, rivaroxaban, comparing it with novel alternatives, ie, dabigatran and apixaban. The indication for rivaroxaban in nonvalvular atrial fibrillation was evaluated in ROCKET-AF (Rivaroxaban-once daily, Oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation. In this trial, rivaroxaban was associated with a 12% reduction in the incidence of the primary endpoint compared with warfarin (hazard ratio 0.88; 95% confidence interval [CI] 0.74–1.03; P < 0.001 for noninferiority and P = 0.12 for superiority. However, patients remained in the therapeutic range for INR only 55% of the time, which is less than that in RE-LY (the Randomized Evaluation of Long-Term Anticoagulation Therapy, 64% and in the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation, 66%. This shorter time spent in the therapeutic range has been one of the main criticisms of the ROCKET-AF trial, but could actually reflect what happens in real life. In addition, rivaroxaban exhibits good pharmacokinetic and pharmacoeconomic properties. Novel anticoagulants

  17. Pathogenesis and Individualized Treatment for Postural Tachycardia Syndrome in Children

    Science.gov (United States)

    Xu, Wen-Rui; Jin, Hong-Fang; Du, Jun-Bao

    2016-01-01

    Objective: Postural tachycardia syndrome (POTS) is one of the major causes of orthostatic intolerance in children. We systematically reviewed the pathogenesis and the progress of individualized treatment for POTS in children. Data Sources: The data analyzed in this review are mainly from articles included in PubMed and EMBASE. Study Selection: The original articles and critical reviews about POTS were selected for this review. Results: Studies have shown that POTS might be related to several factors including hypovolemia, high catecholamine status, abnormal local vascular tension, and decreased skeletal muscle pump activity. In addition to exercise training, the first-line treatments mainly include oral rehydration salts, beta-adrenoreceptor blockers, and alpha-adrenoreceptor agonists. However, reports about the effectiveness of various treatments are diverse. By analyzing the patient's physiological indexes and biomarkers before the treatment, the efficacy of medication could be well predicted. Conclusions: The pathogenesis of POTS is multifactorial, including hypovolemia, abnormal catecholamine state, and vascular dysfunction. Biomarker-directed individualized treatment is an important strategy for the management of POTS children. PMID:27625098

  18. Epicardial Ventricular Tachycardia Ablation: Clinical Practice and Recent Developments

    Directory of Open Access Journals (Sweden)

    Michalis Efremidis MD

    2011-08-01

    Full Text Available Mapping and radiofrequency (RF catheter ablation of ventricular tachycardia (VT is a demanding procedure, with variable success rates (1. The presence of deep subendocardial or epicardial re-entry circuits is regarded as one of the reasons of failure of endocardial ablation, and these circuits have been acknowledged in ischemic and non-ischemic dilated cardiomyopathy (CMP, other types of CMP and especially in arrhythmogenic right ventricular cardiomyopathy (ARVC.The significance of epicardial VT circuits was brought to light in Chagas’ disease, which characteristically results in epicardial involvement in approximately 70% of patients (2. A recent study found one third of VTs to be epicardial in origin among patients with nonischemic CMP, about double the incidence among those with ischemic heart disease(3. Mapping and ablation of these epicardial circuits is quite exigent. Although coronary veins can be used to perform epicardial mapping, the manipulation of the catheter is strictly limited to the anatomical distribution of these vessels. Thus, the subxiphoid percutaneous approach to the pericardial space is the only technique that allows extensive, unhampered mapping of the epicardial surface of both ventricles.

  19. Artifact versus arrhythmia in pseudo-polymorphic tachycardia; case report

    OpenAIRE

    Ahmed V; Patel A; Sharma A; Bloomfield D

    2015-01-01

    Vaseem Ahmed, Anish Patel, Abhishek Sharma, Dennis Bloomfield Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA Abstract: We present the case of a young male patient in sinus rhythm whose electrocardiogram (ECG) was initially misinterpreted as ventricular tachycardia. Electrocardiographic artifact appearing to be ventricular tachycardia commonly occurs and ECG criteria have been described to aid in the discrimination between artifact and true arrhythmia. Ther...

  20. Plasma YKL-40 is elevated in patients with recurrent atrial fibrillation after catheter ablation

    DEFF Research Database (Denmark)

    Henningsen, Kristoffer Mads; Nilsson, Brian; Johansen, Julia S;

    2010-01-01

    -81) with paroxysmal/persistent AF were treated with RF catheter ablation; Holter monitoring for 14 days was performed before ablation and after 3 months. Recurrent symptomatic AF or atrial tachycardia >10 min was considered failure, and the patients were offered a second ablation session. YKL-40 was determined...... to ablation compared to patients with recurrence of AF (31 vs. 62 microg/l, P = 0.029). Plasma YKL-40 was not an independent predictor of recurrence of AF after ablation. No significant changes in plasma YKL-40 levels were seen from baseline to follow-up at 12 months. CONCLUSION: In patients with paroxysmal...

  1. NASA's First Atrial Fibrillation Case - Deke Slayton

    Science.gov (United States)

    Tarver, William J.

    2010-01-01

    Concerns about heart dysrhythmia have been present since the earliest days of the US manned space program. While information about an astronaut's health is general kept private, one of the original seven American astronaut's health status was played out in a very public forum. Donald "Deke" Slayton was removed from the second manned space flight when it was discovered he had idiopathic atrial fibrillation. Referencing the original medical documents, details of how this was discovered and managed from the medical perspective will be reviewed. This is NASA's first heart dysrhythmia case in an astronaut and it proves quite interesting when placed in historic perspective.

  2. [Cardioversion for paroxysmal supraventricular tachycardia during lung surgery in a patient with concealed Wolff-Parkinson-White syndrome].

    Science.gov (United States)

    Sato, Yoshiharu; Nagata, Hirofumi; Inoda, Ayako; Miura, Hiroko; Watanabe, Yoko; Suzuki, Kenji

    2014-10-01

    We report a case of paroxysmal supraventricular tachycardia (PSVT) that occurred during video-assisted thoracoscopic (VATS) lobectomy in a patient with concealed Wolff-Parkinson-White (WPW) syndrome. A 59-year-old man with lung cancer was scheduled for VATS lobectomy under general anesthesia. After inserting a thoracic epidural catheter, general anesthesia was induced with intravenous administration of propofol. Anesthesia was maintained with inhalation of desfurane in an air/oxygen mixture and intravenous infusion of remifentanil. Recurrent PSVT occurred three times, and the last episode of PSVT continued for 50 minutes regardless of administration of antiarrhythmic drugs. Synchronized electric shock via adhesive electrode pads on the patient's chest successfully converted PSVT back to normal sinus rhythm. The remaining course and postoperative period were uneventful. An electrophysiological study performed after hospital discharge detected concealed WPW syndrome, which had contributed to the development of atrioventricular reciprocating tachycardia. Concealed WPW syndrome is a rare, but critical complication that could possibly cause lethal atrial tachyarrhythmias during the perioperative period. In the present case, cardioversion using adhesive electrode pads briefly terminated PSVT in a patient with concealed WPW syndrome.

  3. Left atrial appendage dysfunction in a patient with premature ventricular contractions - a risk factor for stroke?

    Science.gov (United States)

    Patel, Sandeep M; Ackerman, Michael J; Asirvatham, Samuel J

    2013-01-01

    A 16-year-old female with ventricular dysfunction and frequent ventricular arrhythmia presented with a cardioembolic stroke. Prior electrophysiology study and ablation was performed for ventricular tachycardia (VT). For remaining ventricular ectopy, the patient was maintained on carvedilol and mexiletine. After one year on this regimen, she presented with an acute stroke. Transesophageal echocardiography revealed no evidence of an intracardiac or ventricular thrombus but demonstrated markedly decreased left atrial appendage (LAA) flow velocity worsened during frequent premature ventricular contractions (PVC). In the absence of atrial fibrillation (AF), the LAA dysfunction was considered secondary to the frequent PVCs and was thought to be the underlying cause for the stroke. We present this case to highlight a potential under recognized association between LAA dysfunction and ventricular arrhythmia, similar to that observed with atrioventricular dyssynchronous pacing. PMID:24086095

  4. Homogenization of atrial electrical activities: conceptual restoration of regional electrophysiological parameters to deter ischemia-dependent conflictogenic atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Dr. Petras Stirbys

    2013-08-01

    Full Text Available Atrial fibrillation (AF as a severe arrhythmia is now spreading worldwide at overwhelmingly high rates, particularly in elderly patients. Despite new insights, the mechanisms underlying AF are not conclusively determined yet. Taking into account the ischemic origin of arrhythmia induction (according to the so-called conflictogenic atrial fibrillation, declared recently restoration of regional electrophysiological parameters is essential in tackling AF. We hypothesized that some atrial electrophysiological parameters, preferably the effective refractory period, might need to be controlled to prevent AF. All the remaining parameters - conduction velocity, conduction time, recovery time, vulnerability, excitability, repolarization etc. being as if secondary and less important could be ignored. Homogenization of the milieu producing AF might be implemented, at least theoretically, through restoration of blood supply in ischemic areas and/or via attenuation of electrophysiological differences between conflicting regions by delivery of atrial sub-threshold non-captured pulse-trains. Adjunctive therapy by drugs containing vasodilatory features and affecting the effective refractory period appears to be fundamental. Thus, stabilization of disorganized atrial cellular activities likely may lead to the recovery of atrial excitable characteristics. Despite the lack of compelling evidence, the application of the concept may be helpful in order to search for more precise and more effective methods to favorably change the refractory period. Further studies are necessary to determine whether restoration or improvement of blood circulation of atrial wall is feasible. On the basis of such considerations a novel preventive AF strategies are to be designed. Abbreviations: AF=atrial fibrillation, ERP=effective refractory period, TMR=transmyocardial revascularization

  5. Atrial fibrillation in the elderly

    Institute of Scientific and Technical Information of China (English)

    Roberto A.Franken; Ronaldo F.Rosa; Silvio CM Santos

    2012-01-01

    This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted.

  6. New Procedure for Treatment of Atrial Fibrillation in Patients with Valvular Heart Disease

    Directory of Open Access Journals (Sweden)

    Naser Safaie

    2010-10-01

    Full Text Available Patients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

  7. New Procedure for Treatment of Atrial Fibrillation in Patients with Valvular Heart Disease

    Directory of Open Access Journals (Sweden)

    Naser Safaie

    2010-09-01

    Full Text Available "nPatients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

  8. Idiopathic ventricular tachycardia: transcatheter ablation or antiarrhythmic drugs?

    Directory of Open Access Journals (Sweden)

    Claudio Tondo; Corrado Carbucicchio; Antonio Dello Russo; Benedetta Majocchi; Martina Zucchetti; Francesca Pizzamiglio; Fabrizio Bologna; Fabio Cattaneo; Daniele Colombo; Eleonora Russo; Michela Casella

    2015-02-01

    Full Text Available Introduction Ventricular tachycardia or frequent premature ventricular contractions (PVCs can occur in the absence of any detectable structural heart disease. In this clinical setting, these arrhythmias are termed idiopathic. Usually, they carry a benign prognosis and any potential ablative intervention is carried out if patients are highly symptomatic or, more importantly, if frequent ventricular arrhythmias can lead to ventricular dysfunction. Methods In this paper, different forms of idiopathic ventricular tachycardia are reviewed. Outflow tract ventricular tachycardia from the right ventricle is the most frequent form of the so-called idiopathic ventricular tachycardia. Other forms of idiopathic ventricular arrhythmias include ventricular tachycardia/PVCs arising from tricuspid annulus, from the mitral annulus, inter-fascicular ventricular tachycardia and papillary muscle ventricular tachycardia. When interventional treatment is deemed necessary, detailed mapping ( earliest activation during VT/PVC, pace mapping is crucial as to identify the successful ablation site. Catheter ablation more than antiarrhythmic drug treatment is usually highly effective in eliminating idiopathic ventricular arrhythmias and providing prevention of recurrence. Conclusion Idiopathic VTs are not considered life-threatening arrhythmias and, prevention of recurrences is often achieved by means of catheter ablation that provides an improvement of quality of life. The overall acute success rate of catheter ablation is about 85-90% with a long–term prevention of arrhythmia recurrence of about 75-80%. It is advisable that the procedure is carried out by electrophysiologists with expertise in VT catheter ablation and extensive knowledge of cardiac anatomy as to ensure a high success rate and reduce the likelihood of major complications.

  9. Rivaroxaban in atrial fibrillation

    OpenAIRE

    Giorgi MA; Miguel LS

    2012-01-01

    Mariano A Giorgi,1,2 Lucas San Miguel31Cardiology Service, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, 2Department of Pharmacology, School of Medicine, Universidad Austral, 3Department of Cardiology and Cardiovascular Surgery, FLENI, Buenos Aires, ArgentinaAbstract: Warfarin is the traditional therapeutic option available to manage thromboembolic risk in atrial fibrillation. The hemorrhagic risk with warfarin de...

  10. Anticoagulation in Atrial Fibrillation

    OpenAIRE

    Ahmad, Yousif; YH Lip, Gregory

    2012-01-01

    Patients with atrial fibrillation (AF) are at increased thromboembolic risk, and they suffer more severe strokes with worse outcomes. Most thromboembolic complications of AF are eminently preventable with oral anticoagulation, and the increasing numbers of AF patients mean antithrombotic therapy is the most crucial management aspect of this common arrhythmia. Despite the proven efficacy of warfarin, a string of limitations have meant that it is underused by physicians and patients alike. This...

  11. Management of atrial fibrillation

    OpenAIRE

    Vergara, Pasquale; Della Bella, Paolo

    1997-01-01

    Atrial fibrillation (AF) is associated with increases in the risk of mortality, congestive heart failure, and stroke. Medical treatment is aimed at preventing thrombo-embolic complications and reducing symptoms and consequences related to the arrhythmia. In the first section of this review, we discuss the principles of mainstream oral anticoagulant therapy and the possible advantages of the new oral anticoagulants. In the second section, we review the catheter ablation approaches to paroxysma...

  12. 盐酸胺碘酮治疗儿童难治性持续性心动过速%Treatment of intractable incessant tachycardia in children with Amiodarone

    Institute of Scientific and Technical Information of China (English)

    李筠; 周爱卿; 杨健萍; 朱敏; 张海燕

    2009-01-01

    目的 提高对盐酸胺碘酮治疗儿童难治性持续性心动过速的认识.方法 对2006年1月-2007年12月80例应用盐酸胺碘酮治疗的难治性心动过速患儿的资料进行总结.其中男52例,女38例;年龄1个月~14岁(平均2.5岁).结果 盐酸胺碘酮具有良好的控制心室率的作用,总有效率为90%左右;同时它有不同程度转复窦性心律的作用,房性心动过速67%,阵发性室上性心动过速92%,交界逸搏性心动过速89%、室性心动过速56%;小剂量β受体阻滞剂具有协同盐酸胺碘酮抗心动过速的作用.治疗过程中7例出现低血压,4例出现心动过缓.结论 Ⅲ类抗心律失常药盐酸胺碘酮具有广泛的抗心律失常作用,它对治疗血流动力学相对稳定的小儿难治性持续性心动过速是安全有效的.%Objective To improve the understanding of Amiodarone in the treatment of intractable incessant tachycardia in children. Methods Data of 80 patients with intractable incessant tachycardia treated by Amiodarone were summarized. Among them 52 were male, 38 were female, and average age was 2.5 years old. Results Amiodarone reduced heart rate effectively, with about 90% effective. Simultaneously, it could convert tachycardia into sinus rhythm and succeeded 67% in atrial tachycardia, 92% in paroxysmal supraventricular tachycardia, 89% in junctional ectopic tachycardia, 56% in ventricular tachycardia respectively. Use of small dosage of β-receptor blocker together with Amiodarone showed synergy. Hypotension and bradycardia are the main side effects. Conclusions Too rapid and sustained tachycardia can lead, to hemodynamic disorders and cause heart failure, it requires urgent and adequate treatment. Amiodarone can be used to treat different kinds of intractable incessant tachycardia, and is safe and effective in patients with relatively stable hemodynamis.

  13. Hyperuricemia and Atrial Fibrillation.

    Science.gov (United States)

    Maharani, Nani; Kuwabara, Masanari; Hisatome, Ichiro

    2016-07-27

    The importance of atrial fibrillation (AF) as a cause of mortality and morbidity has prompted research on its pathogenesis and treatment. Recognition of AF risk factors is essential to prevent it and reduce the risk of death. Hyperuricemia has been widely accepted to be associated with the incidence of paroxysmal or persistent AF, as well as to the risk of AF in post cardiovascular surgery patients. The possible explanations for this association have been based on their relation with either oxidative stress or inflammation. To investigate the link between hyperuricemia and AF, it is necessary to refer to hyperuricemia-induced atrial remodeling. So far, both ionic channel and structural remodeling caused by hyperuricemia might be plausible explanations for the occurrence of AF. Inhibition of xanthine oxidase and nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase, or the use of antioxidants, along with serum uric acid (SUA) level reduction to prevent inflammation, might be useful. Uric acid transporters (UATs) play a key role in the regulation of intracellular uric acid concentration. Intracellular rather than serum uric acid level is considered more important for the pathogenesis of AF. Identification of UATs expressed in cells is thus important, and targeting UATs might become a potential strategy to reduce the risk of hyperuricemia-induced atrial fibrillation. PMID:27396561

  14. Sustained High Quality of Life in a 5-Year Long Term Follow-up after Successful Ablation for Supra-Ventricular Tachycardia. Results from a large Retrospective Patient Cohort

    Directory of Open Access Journals (Sweden)

    Axel Meissner, Irini Stifoudi, Peter Weismüller, Max-Olav Schrage, Petra Maagh, Martin Christ, Thomas Butz, Hans-Joachim Trappe, Gunnar Plehn

    2009-01-01

    Full Text Available Introduction: The ablation of supraventricular tachycardias (SVT using radiofrequency energy (RF is a procedure with a high primary success rate. However, there is a scarcity of data regarding the long term outcome, particularly with respect to quality of life (QoL. Methods and Results: In this retrospective single-center study, 454 patients who underwent ablation of SVT between 2002 and 2007 received a detailed questionnaire addressing matters of QoL. The questionnaire was a modified version of the SF-36 Health Survey questionnaire and the Symptom Checklist – Frequency and Severity Scale. After a mean follow up of 4.5±1.3 years, 309 (68.1% of the contacted 454 patients (269 female, 59.2%, mean age 58+/-6.5 completed the questionnaire. Despite of 27% of relapses in the study group, 91.7% considered the procedure a long-term success. The remainder of patients experienced no change in (3.7% or worsening of (4.7% symptoms. There were no significant differences between the various types of SVT (p=1. QoL in patients with Atrio-Ventricular Nodal Reentry Tachycardia (AVNRT and Atrio-Ventricular Reentry Tachycardia (AVRT improved significantly (p<0.0005 respectively p<0.043, whereas QoL in patients with Ectopic Atrial Tachycardia (EAT showed a non-significant trend towards improvement. Main symptoms before ablation, such as tachycardia (91.5%, increased incidence of tachycardia episodes over time (78.1%, anxiety (55.5% and reduced physical capacity in daily life (52% were significantly improved after ablation (p<0.0001. Conclusion: The high acute ablation success of SVT persists for years in long term follow up and translates into a significant improvement of QoL in most patients.

  15. Hypercoagulability causes atrial fibrosis and promotes atrial fibrillation

    NARCIS (Netherlands)

    Spronk, Henri M H; De Jong, Anne Margreet; Verheule, Sander; De Boer, Hetty C; Maass, Alexander H; Lau, Dennis H; Rienstra, Michiel; van Hunnik, Arne; Kuiper, Marion; Lumeij, Stijn; Zeemering, Stef; Linz, Dominik; Kamphuisen, Pieter Willem; Ten Cate, Hugo; Crijns, Harry J; Van Gelder, Isabelle C; van Zonneveld, Anton Jan; Schotten, Ulrich

    2016-01-01

    AIMS: Atrial fibrillation (AF) produces a hypercoagulable state. Stimulation of protease-activated receptors by coagulation factors provokes pro-fibrotic, pro-hypertrophic, and pro-inflammatory responses in a variety of tissues. We studied the effects of thrombin on atrial fibroblasts and tested the

  16. Left atrial appendage occlusion for stroke prevention in atrial fibrillation

    DEFF Research Database (Denmark)

    Tzikas, Apostolos; Shakir, Samera; Gafoor, Sameer;

    2015-01-01

    Aims: To investigate the safety, feasibility, and efficacy of left atrial appendage occlusion (LAAO) with the AMPLATZER Cardiac Plug (ACP) for stroke prevention in patients with atrial fibrillation (AF). Methods and results: Data from consecutive patients treated in 22 centres were collected...

  17. Study on the changes of serum levels of ANF in patients with atrial fibrillation (AF)

    International Nuclear Information System (INIS)

    Objective: To study the changes of serum levels of ANF in patients with atrial fibrillation and to explore the mechanism of the prethrombotic state induced by AF. Methods: Serum levels of ANF were measured with RIA in 21 patients with isolated paroxysmal atrial fibrillation (IPAF) both during and one week after termination of the attack. Levels were also measured in 28 patients with isolated sustained atrial fibrillation (ISAF), 27 patients with rheumatic mitral stenosis associated with persistent AF (RHD), 32 patients with paroxysmal supraventricular tachycardia (PSVT) and 35 controls. Results: Serum levels of ANF and Hct% readings in: 1) patients with IPAF during attack 2) patients with ISAF and 3) patients with RHD were significantly higher than those in: 1) patients with IPAF one week after termination of the attack 2) patients with PSVT and 3) the controls (p<0.05). Values in patients with PSVT were not much different from those in controls. In patients with IPAF during the attack, serum ANF levels and Hct% readings were positively correlated to the duration of the attack. Serum ANF levels were not related to such parameters as: age, sex, mitral valve area, ejection fraction and inner diameter of left atrium. Conclusion: There is hemoconcentration in patients with atrial fibrillation, which is related to the hypersecretion of ANF in these patients

  18. Pharmacokinetics of pyridostigmine in a child with postural tachycardia syndrome.

    Science.gov (United States)

    Filler, Guido; Gow, Robert M; Nadarajah, Renisha; Jacob, Pierre; Johnson, Gillian; Zhang, Yan-Ling; Christians, Uwe

    2006-11-01

    Pyridostigmine has been proposed for the treatment of postural orthostatic tachycardia syndrome in adults at a dose of 60 mg twice daily, but no dosing recommendation exists for children. With the approval of our local ethics board, we tested the pharmacokinetics of pyridostigmine in 6 children with myasthenia and a pediatric index patient with severe postural orthostatic tachycardia syndrome whose condition failed all conventional therapy and who had developed significant postural hypertension. Pyridostigmine was quantified by using a validated, semiautomated, and specific high-performance liquid chromatography/tandem mass spectrometry assay in combination with online column-switching extraction and turbo electrospray ionization. The patient with postural orthostatic tachycardia syndrome showed a dose-dependent favorable response to oral pyridostigmine. Pharmacokinetic evaluation revealed a short half-life of 2.29 hours, similar to the 2.0 +/- 0.63 hours in the patients with myasthenia. The patient with postural orthostatic tachycardia syndrome has subsequently been treated at a dose of 45 mg in the morning, 30 mg at lunchtime, and 15 mg at bedtime; after 9 months, there has been persistent positive effect and without additional blood pressure medication. No major adverse effects occurred. Pyridostigmine has been a safe and effective treatment modality for this child with postural orthostatic tachycardia syndrome. The short half-life suggests that dosing 3 times per day is preferable.

  19. Paroxysmal supraventricular tachycardia in pregnant women and birth outcomes of their children: a population-based study.

    Science.gov (United States)

    Bánhidy, Ferenc; Ács, Nándor; Puhó, Erzsébet H; Czeizel, Andrew E

    2015-08-01

    The aim of the study was to estimate the possible association of pregnant women with paroxysmal supraventricular tachycardia (PSVT) with the possible risk for adverse birth outcomes, particularly different congenital abnormalities (CAs) in their children. Prospectively and medically recorded PSVT was evaluated in 103 pregnant women who later had offspring with CA (case group) and 149 pregnant women who later delivered newborn infants without CA (control group) and matched to cases in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. Of 252 pregnant women with PSVT, 115 (45.6%) had the onset of this condition before the study pregnancy, that is, their PSVT was a chronic condition, while the rest (N = 137) of PSVT was considered as new onset in the study pregnancy. The comparison of occurrence of PSVT in pregnant women who had offspring with different CA groups and in control mothers showed a higher risk for cardiovascular CAs (adjusted OR with 95% CI: 2.1, 1.1-3.8) explained mainly by secundum atrial septal defect. This association was confirmed in pregnant women with PSVT in the second and/or third gestational month, that is, critical period of cardiovascular CAs. In conclusion PSVT in pregnant women associates with a higher risk of secundum atrial septal defect in their children.

  20. Effects of trimetazidine on atrial structural remodeling and platelet activation in dogs with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    HAN Wei; LI Wei-min; ZHOU Hong-yan; HUO Hong; WEI Na; DONG Guo; CAO Yong; ZHOU Guo; YANG Shu-sen

    2009-01-01

    @@ Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice. AF results in electrophysiological alterations which involve increased atrial effective refractory period and atrial effective refractory period dispersion, reduced rate adaptation of atrial effective refractory period, and slowed atrial conduction.

  1. Persistent atrial fibrillation in a goat model of chronic left atrial overload.

    NARCIS (Netherlands)

    Remes, J.; Brakel, T.J. van; Bolotin, G.; Garber, C.; Jong, MM de; Veen, FH van der; Maessen, J.G.

    2008-01-01

    OBJECTIVES: Atrial dilatation predisposes to atrial fibrillation. Although several animal models focus on the initiating mechanisms of atrial fibrillation in dilated atria, a model of left atrial overload resulting in persistent atrial fibrillation in nonanesthetized animals has not been presented t

  2. The mechanism of supraventricular tachycardia induced by a single premature beat in the isolated left atrium of the rabbit. I. Circus movement as a consequence of unidirectional block of the premature impulse.

    Science.gov (United States)

    Allessie, M A; Bonke, F I; Schopman, F J

    1975-01-01

    In the isolated left atrium of the rabbit tachycardia could be elicited by a single stimulus shortly after the refractory period. The activation pattern of the preparation was mapped by means of multiple extracellular recordings. It could be demonstrated that a circus movement of the activation in a relatively small part of the atrial myocardium was responsible for the tachycardia. This phenomenon was studied on a cellular level with multiple microelectrode recordings. The impulse of the premature beat, when followed by a tachycardia, was one way only, while in the other directions the conduction failed completely or occurred with such decrement that the impulse died out. These differences in conductivity were connected with spatial differences in the refractory period. Therefore the excitability of the fibers surrounding the stimulating electrod was not restored to the same level at the moment the premature beat was elicited. Spatial dispersion in the refractory period was important for the occurrence of unidirectional block and thus for the initiation of circus movement and tachycardia. PMID:1188162

  3. Stimulant medication and postural orthostatic tachycardia syndrome: a tale of two cases.

    Science.gov (United States)

    Cheshire, William P

    2016-06-01

    Stimulant medication may mimic the tachycardia of postural orthostatic tachycardia syndrome. Two case histories illustrate how missing the clinical distinction between a primary dysautonomia and a medication effect may have avoidable adverse consequences.

  4. Stimulant medication and postural orthostatic tachycardia syndrome: a tale of two cases.

    Science.gov (United States)

    Cheshire, William P

    2016-06-01

    Stimulant medication may mimic the tachycardia of postural orthostatic tachycardia syndrome. Two case histories illustrate how missing the clinical distinction between a primary dysautonomia and a medication effect may have avoidable adverse consequences. PMID:26968177

  5. 常规心电图对房室结参与的阵发性窄QRS心动过速的鉴别作用%Value of 12-lead electrocardiogram in differentiating paroxysmal narrow complex tachycardias involving atrioventricular node

    Institute of Scientific and Technical Information of China (English)

    陈刚; 王方正

    2005-01-01

    窄QRS(<0.12s)心动过速,包括(1)心房颤动(atrial fibrillation,AF);(2)窦性心动过速(sinus tachycardia);(3)房性心动过速(atrial tachycardia,AT);(4)心房扑动(atrial flutter,AFL);(5)房室结折返性心动过速(atrial ventrieular node reentrant tachycardia,AVNRT);(6)房室折返性心动过速(atrial ventrieular reentrant tachycardia,AVRT)。而房室结参与的窄QRS心动过速包括后两种,即AVNRT和AVRT。对于不同机制的心动过速,相应的临床处理会有所不同。常规心电图检查简便易行,对于区别这两种心律失常,指导临床治疗具有较大的实际应用意义。

  6. Connexin Remodeling Contributes to Atrial Fibrillation

    OpenAIRE

    Michelle M Jennings; J Kevin Donahue

    2013-01-01

    Atrial fibrillation significantly contributes to mortality and morbidity through increased risk of stroke, heart failure and myocardial infarcts. Investigations of mechanisms responsible for the development and maintenance of atrial fibrillation have highlighted the importance of gap junctional remodeling. Connexins 40 and 43, the major atrial gap junctional proteins, undergo considerable alterations in expression and localization in atrial fibrillation, creating an environment conducive to s...

  7. No incremental benefit of multisite atrial pacing compared with right atrial pacing in patients with drug refractory paroxysmal atrial fibrillation

    OpenAIRE

    Levy, T; Walker, S; Rex, S; Rochelle, J; Paul, V.

    2001-01-01

    OBJECTIVE—To evaluate the incremental antifibrillatory effect of multisite atrial pacing compared with right atrial pacing in patients with drug refractory paroxysmal atrial fibrillation paced for arrhythmia prevention alone.
METHODS—In 20 of these patients (mean (SD) age 64 (8) years; 14 female, six male), a single blinded randomised crossover study was performed to investigate the incremental benefit of one month of multisite atrial pacing compared with one month of right atrial pacing. Out...

  8. Raised plasma concentrations of atrial natriuretic peptide are independent of left atrial dimensions in patients with chronic atrial fibrillation.

    OpenAIRE

    Berglund, H; Boukter, S; Theodorsson, E; Vallin, H; Edhag, O

    1990-01-01

    The aim of the present study was to determine whether left atrial size--a likely indicator of atrial stretching--correlates with the plasma concentration of atrial natriuretic peptide and whether this relation is different in patients in sinus rhythm and in those with atrial fibrillation. Arterial plasma concentrations of immunoreactive atrial natriuretic peptide (ir-ANP), adrenaline, noradrenaline, aldosterone, and vasopressin were measured in 13 patients in sinus rhythm without apparent hea...

  9. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Kernan Scott

    2010-01-01

    Full Text Available Postural orthostatic tachycardia syndrome (POTS is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.

  10. Research on ambulatory electrocardiography of long RP tachycardia%长 RP 心动过速的动态心电图研究

    Institute of Scientific and Technical Information of China (English)

    张麟; 李波; 纳志英; 尹琳; 王月; 冯夏

    2015-01-01

    Objective To study the manifestations of long RP tachycardia on ambulatory electro-cardiography(AECG)and its differential diagnostic basis.Methods By 12-channel AECG recorder, 35 patients with long RP tachycardia were monitored.At the attack of tachycardia,we made compara-tive analysis on its states of induction and termination,duration,frequency,P-wave polarity,clinical characteristics,etc.Results The enrolled 35 patients were divided into 3 groups:separately with persistent atrioventricular reentrant tachycardia(PAVRT),atrial tachycardia(AT),and fast-slow atri-oventricular nodal reentrant tachycardia(F-S-AVNRT).Among the 3 groups,P waves were inverted inⅡ,Ⅲ and aVF leads,aVR leads were upright,and RP intervals were all longer than PR intervals, at the onset of tachycardia.The attack of 6 cases of PAVRT was endless,tachycardia accounting for 32.8%—50.0% in the total heartbeats during 24 hours,with an attacking frequency ranging from 110 times/min to 160 times/min,which was induced by premature ventricular beats.AT was induced by atrial premature beats in 15 cases,with the number of onset episodes ranging from 1 to 186,and onset frequency 107—150 times/min.F-S-AVNRT in 2 cases was induced by atrial premature beats accom-panied with prolonged PR intervals,with an attack frequency ranging from 127 times/min to 182 times /min.Atrial flutter complicating 2 ∶1 atrioventricular conduction in 12 cases was induced by at-rial premature beats;Its onset ventricular rate ranged from 120 times/min to 165 times/min,and the ventricular rate reached 150 times/min when the conditions of the Bix law was met.Conclusion AECG monitoring plays a significant role in identifying the states of induction and termination,dura-tion,and frequency during the onset of long RP tachycardia.It helps to diagnose the disease.%目的:探讨长 RP 心动过速的动态心电图表现及其鉴别诊断依据。方法采用12通道动态心电图记录仪对35例长 RP 心动过速患者进

  11. [Catecholaminergic polymorphic ventricular tachycardia is a rare inherited heart disease.

    DEFF Research Database (Denmark)

    Holst, Anders Gaarsdal; Tfelt-Hansen, 1jacob; Olesen, Morten S;

    2010-01-01

    Catecholaminergic polymorphic ventricular tachycardia is a rare inherited heart disease, which can lead to life-threatening ventricular arrhythmias in patients with a structurally normal heart. The age of onset is usually between two and 12 years and the initial symptom is frequently syncope...

  12. Fetal Tachycardia Treated Successfully with Maternally Administered Propylthiouracil

    Directory of Open Access Journals (Sweden)

    Barbara V. Parilla

    2014-01-01

    Full Text Available Background. Fetal tachycardia may result from the transplacental passage of thyroid stimulating immunoglobulins in a patient with hypothyroidism secondary to ablation of Graves’ disease. Case. A 32-year-old woman, gravida 4, para 2, and abortus 1, with hypothyroidism and a history of Graves’ disease, presented at 23 6/7 weeks of gestation with a persistent fetal tachycardia. The treatment of the fetal tachycardia with maternally administered digoxin and Sotalol was unsuccessful. Maternal thyroid stimulating immunoglobulins were elevated, and treatment with maternally administered propylthiouracil (PTU resulted in a normal sinus rhythm for the remainder of the pregnancy. An induction of labor was performed at 37 weeks. Four to five days after delivery, the neonate exhibited clinical signs of hyperthyroidism necessitating treatment. Conclusion. Fetal tachycardia resulting from the transplacental passage of thyroid stimulating immunoglobulins can be successfully treated with maternally administered PTU. The neonate needs to be followed up closely as clinical signs of hyperthyroidism may occur as thyroid stimulating immunoglobulins continue to circulate in the neonate, while the serum levels of PTU decline.

  13. A teenage fainter (dizziness, syncope, postural orthostatic tachycardia syndrome).

    Science.gov (United States)

    Pilcher, Thomas A; Saarel, Elizabeth V

    2014-02-01

    This article informs the general pediatrician about the diagnosis, evaluation, and treatment of teenage patients with presyncope and loss of consciousness. The focus is on distinguishing noncardiac fainting from life-threatening syncope. Current treatment strategies of vasovagal syncope and postural orthostatic tachycardia syndrome are also outlined.

  14. Sustained Ventricular Tachycardia and Cardiogenic Shock due to Scorpion Envenomation.

    Science.gov (United States)

    Miranda, Carlos Henrique; Maio, Karina Tozatto; Moreira, Henrique Turin; Moraes, Marcos; Custodio, Viviane Imaculada do Carmo; Pazin-Filho, Antonio; Cupo, Palmira

    2014-01-01

    We describe a case of severe scorpion envenomation in an adult patient, with the presence of very rapid sustained ventricular tachycardia followed by cardiogenic shock, which was reversed by scorpion antivenom administration. Scorpion venom causes cardiac changes that can lead to an environment favoring arrhythmogenesis. PMID:24715906

  15. Sustained Ventricular Tachycardia and Cardiogenic Shock due to Scorpion Envenomation

    OpenAIRE

    Carlos Henrique Miranda; Karina Tozatto Maio; Henrique Turin Moreira; Marcos Moraes; Viviane Imaculada do Carmo Custodio; Antonio Pazin-Filho; Palmira Cupo

    2014-01-01

    We describe a case of severe scorpion envenomation in an adult patient, with the presence of very rapid sustained ventricular tachycardia followed by cardiogenic shock, which was reversed by scorpion antivenom administration. Scorpion venom causes cardiac changes that can lead to an environment favoring arrhythmogenesis.

  16. "Distal common pathway in atrioventricular node reentrant tachycardia "

    Directory of Open Access Journals (Sweden)

    "Moghaddam M

    2001-06-01

    Full Text Available Anotomical boundary of atrioventricular node reentrant tachycardia (AVNRT is composed of fast and slow pathways right atrium in upper turnaround and common distal pathway in lower turnaround. We performed electophsiologic study (EPS in 152 patients and could show the existence of distal common pathway with decremental conduction properties in approximately 40 patients.

  17. Pharmacological treatment of young children with permanent junctional reciprocating tachycardia

    NARCIS (Netherlands)

    van Stuijvenberg, M; Beaufort-Krol, GCM; Haaksma, J; Bink-Boelkens, MTE

    2003-01-01

    Our objective was to assess the efficacy of pharmacological treatment in reducing the incidence of permanent junctional reciprocating tachycardia in young children, or to bring the mean heart rate over 24 h to a normal level. We included 21 children with a median age of 0.05 year seen with permanent

  18. Sustained Ventricular Tachycardia and Cardiogenic Shock due to Scorpion Envenomation

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Miranda

    2014-01-01

    Full Text Available We describe a case of severe scorpion envenomation in an adult patient, with the presence of very rapid sustained ventricular tachycardia followed by cardiogenic shock, which was reversed by scorpion antivenom administration. Scorpion venom causes cardiac changes that can lead to an environment favoring arrhythmogenesis.

  19. 隐匿性束室纤维介导的心动过速(附一例报告)%Concealed fasciculoventricular fiber in the genesis of paroxysmal tachycardias (with one case report)

    Institute of Scientific and Technical Information of China (English)

    陈明龙; 曹克将; 邹建刚; 朱莉; 李文奇; 杨荣; 丁志坚; 邹瑞秀

    2001-01-01

    a history of tachycardia for more than 7 years. The tachycardia could be terminated by propanfenone, but could not by ATP and verapamil. Careful electrophysiological study was performed 3 times before catheter ablation. Mapping and ablation therapy for the tachycardia was guided by EnSite 3000 mapping system. Results AH interval was 75 ms and HV 44 ms during sinus rhythm. No preexcitation phenomenon could be found during incremental atrial pacing. VA dissociation was present during ventricular pacing at a drive length of 600 ms. The tachycardia could be induced both by programmed atrial and ventricular stimulation, but more easily by ventricular stimulation. The QRS complex, during tachycardia could be in morphology of narrow,left bundle branch block (LBBB) and right bundle branch block(RBBB) with VA dissociation. Wide QRS complex could change to narrow one automatically during tachycardia. Right bundle branch activation was earlier than His in all three kinds of tachycardia. ATP and verapamil could not terminate the tachycardia. Atrial overdrive pacing and programmed stimulation failed to stop the tachycardia but ventricular stimulation did successfully. The cycle length was 300 ms in tachycardia with narrow QRS and RBBB, but prolonged to 316 ms in tachycardia with LBBB. The earliest activation spot was mapped in upper part of the right septum using EnSite 3000 mapping system and circular ablation was done here. The tachycardia could not be induced after ablation and no tachycardia occurred during follow-up of 4 months. Conclusions The tachycardia was mediated by concealed fasciculoventricular fiber. The reentrant circuit incorporates normal His-Purkinje conduction system, the ventricle and the fasciculo-ventricular fiber. Radiofrequency catheter ablation guided by EnSite 3000 mapping system can successully eliminate the tachycardia.

  20. Lesson Thirty-two New Algorithm Using Only Lead aVR for Differential Diagnosis of Wide QRS Complex Tachycardia

    Institute of Scientific and Technical Information of China (English)

    童鸿

    2009-01-01

    @@ Making an accurate rapid diagnosis in patients with wide QRS complex tachycardia remains a signifi-cant clinical problem1. We recently proposed a new simplified four-step decision treelike algorithm to dis-tinguish between regular monomorphic wide QRS com-plex tachycardias caused by supraventricular ventricular tachycardia (SVT) and ventricular tachycardia (VT).

  1. Which is the appropriate arrhythmia burden to offer RF ablation for RVOT tachycardias?

    Directory of Open Access Journals (Sweden)

    Andreas Rillig; Tina Lin; Feifan Ouyang; Karl-Heinz Kuck; Roland Richard Tilz

    2014-12-01

    Full Text Available Premature ventricular complexes (PVCs and ventricular tachycardia (VT in patients with structurally normal hearts originate from the right ventricular outflow tract (RVOT in the majority of cases. In the last few decades catheter ablation of these arrhythmias has been proven to be effective. RVOT VT/PVCs may cause disabling symptoms or arrhythmia induced cardiomyopathy. However, the PVC burden at which catheter ablation should be recommended is still controversial. What adds to the controversy is why some patients with only a low number of PVCs can be highly symptomatic and may even develop arrhythmia induced cardiomyopathy, whilst others may have a higher PVC/VT burden and remain asymptomatic and do not develop cardiomyopathy for a long period of time. Therefore, although catheter ablation of RVOT PVCs has high success and low complication rates, the time point of when ablation should be recommended is currently still under debate. This review discusses the treatment strategies and prognosis for RVOT tachycardias and focuses on the question of which arrhythmia burden is appropriate to offer RF ablation.

  2. Atrial Fibrillation and Heart Failure

    Directory of Open Access Journals (Sweden)

    William G. Stevenson, M.D

    2008-07-01

    Full Text Available Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy. Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking. Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases. Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing. Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.

  3. Antithrombotic therapy in atrial fibrillation.

    OpenAIRE

    Chin, B.; Lip, G. Y.

    1996-01-01

    OBJECTIVE: To review the evidence for antithrombotic therapy in patients with nonrheumatic atrial fibrillation. QUALITY OF EVIDENCE: Five primary prevention trials and one secondary prevention trial compare antithrombotic therapy with placebo or no treatment. Two trials also determine the efficacy and safety of acetylsalicylic acid. MAIN FINDINGS: Warfarin reduces the risk of stroke by 68%. The effect is consistent in all identifiable groups of patients with nonrheumatic atrial fibrillation, ...

  4. Stroke prevention in atrial fibrillation.

    OpenAIRE

    Michael Katsnelson,; Sebastian Koch; Tatjana Rundek

    1997-01-01

    Non-valvular atrial fibrillation is a common and from a neurological perspective the most significant cardiac arrhythmia with a growing world-wide incidence. It also carries a significant associated morbidity and mortality, with cardioembolic strokes arguably being the most disabling sequelae. This brief review will highlight the important studies and the latest treatment modalities available for stroke prevention in patients with non-valvular atrial fibrillation.

  5. Atrial Fibrillation and Heart Failure

    OpenAIRE

    Jens Seiler; Tedrow, Usha B.; Stevenson, William G

    2008-01-01

    Atrial fibrillation is common in heart failure patients and is associated with increased mortality.  Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy.  It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect.  Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of a...

  6. Atrial Fibrillation and Heart Failure

    OpenAIRE

    William G. Stevenson, M.D; Usha B. Tedrow, M.D; Jens Seiler, M.D

    2008-01-01

    Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic dru...

  7. Idiopathic giant right atrial aneurysm

    International Nuclear Information System (INIS)

    A 2-year-old boy with an incidental finding of massive cardiomegaly on a chest X-ray was diagnosed with a giant right atrial aneurysm upon further investigation with echocardiography. The patient underwent successful surgical reduction of the right atrium and closure of the patent foramen ovale to prevent thromboembolic complications and to lower the risk of atrial arrhythmias. The resected atrium had paper-thin walls and pathological features of interstitial fibrosis with endocardial thickening

  8. Probucol attenuates atrial autonomic remodeling in a canine model of atrial fibrillation produced by prolonged atrial pacing

    Institute of Scientific and Technical Information of China (English)

    GONG Yong-tai; LI Wei-min; LI Yue; YANG Shu-sen; SHENG Li; YANG Ning; SHAN Hong-bo; XUE Hong-jie; LIU Wei; YANG Bao-feng; DONG De-li; LI Bao-xin

    2009-01-01

    Background We hypothesize that increased atrial oxidative stress and inflammation may play an important role in atrial nerve sprouting and heterogeneous sympathetic hyperinnervation during atrial fibrillation (AF). To test the hypothesis, we examined whether the antioxidant and anti-inflammatory treatment with probucol attenuates atrial autonomic remodeling in a canine model of AF produced by prolonged rapid right atrial pacing. Methods Twenty-one dogs were divided into a sham-operated group, a control group and a probucol group. Dogs in the control group and probucol group underwent right atrial pacing at 400 beats per minute for 6 weeks, and those in the probucol group received probucol 1 week before rapid atrial pacing until pacing stopped. After 6-week rapid atrial pacing, general properties including left atrial structure and function, atrial hemodynamics and the inducibility and duration of AF were measured in all the groups. Atrial oxidative stress markers and serum C-reactive protein (CRP) concentration were estimated. The degree of nerve sprouting and sympathetic innervation at the right atrial anterior wall (RAAW) and the left atrial anterior wall (LAAW) were quantified by immunohistochemistry, atdal norepinephrine contents were also detected. Atrial beta-nerve growth factor (beta-NGF) mRNA and protein expression at the RAAW and LAAW were assessed by real-time quantitative RT-PCR and Western blotting respectively. Results Atrial tachypacing induced significant nerve sprouting and heterogeneous sympathetic hyperinnervation, and the magnitude of nerve sprouting and hyperinnervation was higher in the RAAW than in the LAAW. Atrial beta-NGF mRNA and protein levels were significantly increased at the RAAW and LAAW, and the upregulation of beta-NGF expression was greater at the RAAW than at the LAAW in the control group. The beta-NGF protein level was positively correlated with the density of sympathetic nerves in all groups. Probucol decreased the increase of

  9. Giant right atrial myxoma

    International Nuclear Information System (INIS)

    Primary tumors of the heart are rare, their estimated incidence ranging between 0.0017-0.19%, and among them cardiac myxomas are the most common (50%). Right atrial localization is uncommon, occurring only in 15-20% of cases. Their clinical presentation ranges from an asymptomatic status to the presence of constitutional symptoms or symptoms pointing to the presence of cardiac obstruction or pulmonary embolism. A case is presented of a 36-year-old male patient with a history of asthenia, palpitations and reduced functional capacity. Transthoracic echocardiography revealed a large mass in the right atrium which prolapsed into the right ventricle and obstructed the tricuspid valve. The patient underwent cardiopulmonary bypass surgery and the mass (9x9 cm) was removed without any complication. Histological examination confirmed the diagnosis of myxoma.

  10. Left atrial electrophysiologic feature specific for the genesis of complex fractionated atrial electrogram during atrial fibrillation.

    Science.gov (United States)

    Hoshiyama, Tadashi; Yamabe, Hiroshige; Koyama, Junjiroh; Kanazawa, Hisanori; Ogawa, Hisao

    2016-05-01

    Complex fractionated atrial electrogram (CFAE) has been suggested to contribute to the maintenance of atrial fibrillation (AF). However, electrophysiologic characteristics of the left atrial myocardium responsible for genesis of CFAE have not been clarified. Non-contact mapping of the left atrium was performed at 37 AF onset episodes in 24 AF patients. Electrogram amplitude, width, and conduction velocity were measured during sinus rhythm, premature atrial contraction (PAC) with long- (L-PAC), short- (S-PAC) and very short-coupling intervals (VS-PAC). These parameters were compared between CFAE and non-CFAE regions. Unipolar electrogram amplitude was higher in CFAE than non-CFAE during sinus rhythm, L-, S- and VS-PAC (1.82 ± 0.73 vs. 1.13 ± 0.38, p genesis of CFAE.

  11. Spectral analysis of electrograms during ventricular tachycardia in a canine model: relation with epicardial isochronal maps.

    Science.gov (United States)

    Sierra, G; de Jesús Gómez, M; Le Guyader, P; Soucy, B; Savard, P; Nadeau, R

    1997-07-01

    The purpose of this study was to assess the capability of magnitude-squared coherence and bicoherence to differentiate monomorphic ventricular tachycardia (MVT) and polymorphic ventricular tachycardia (PVT) in a canine model and to relate these results to the epicardial isochronal maps on a beat-to-beat basis. Unipolar electrograms were simultaneously recorded from the surface of both ventricles with a 127-lead sock electrode array in 12 open-chest anesthetized dogs. The sampling frequency was 500 Hz. Atrioventricular block was induced by formaldehyde injection into the atrioventricular node. The left anterior descending coronary artery was occluded for 60 minutes under ventricular pacing (140 beats/min). During reperfusion, 12 MVT episodes lasting more than 42 seconds were recorded. Left stellate ganglion stimulation induced five PVT episodes lasting more than 42 seconds. Each of these recordings was divided into seven segments of 3,072 points (6.144 seconds). After visual selection, 104 segments were extracted and classified as 73 MVT and 31 PVT segments. Magnitude-squared coherence was estimated as the cross-spectrum from two epicardial signals (on the right and left ventricles, respectively), normalized with the respective autopower spectrum. Bicoherence was estimated as the bispectrum normalized with the autopower spectrum. Magnitude-squared coherence correctly identified 96% of MVT and 81% of PVT segments for a total accuracy of 91%. Bicoherence estimated with the left ventricular lead correctly identified 100% of MVT and 77% of PVT segments with an accuracy of 93%. Beat-to-beat epicardial maps of MVT displayed a cluster of sites of origin close to the reperfusion area, while the sites of origin from beats during PVT were much more dispersed over both ventricles. A strong and significant correlation was found between the number of electrodes with the earliest epicardial activation and coherence (r = .76, P origin. Both spectral techniques seemed powerful

  12. The Electrocardiogram Findings in Patients With LVOT and RVOT Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Shirali A

    2011-11-01

    Full Text Available Background: Distinguishing the origin of ventricular tachycardia (VT by electrocardiogram (ECG which is performed in all patients, helps to diagnose the cause of VT before trying invasive procedures. The aim of this study was to compare the ECG findings in patients with VT originating from Right or Left Ventricular Outflow Tracts (RVOT or LVOT. Methods : Fifty nine patients with VT originating from LVOT or RVOT were selected for this cross-sectional study. The patients were recruited while they were attending Shahid Rajaei Hospital in Tehran, Iran in 2009-2010 for catheter ablation. The participants were evaluated for the prevalence of LVOT and RVOT and were compared for the success rate of radiofrequency catheter ablation. Results : Out of 59 patients, 44.1% were male and 55.9% were female. The mean age of the participants was 41.67 (SD=13.76 years. QRS transition and notch in ECGs were significantly different (respectively, P=0.027 and P=0.007 between patients with LVOT and RVOT. R-to-QRS duration in precordial leads was significantly longer in patients with LVOT than those with RVOT [0.81 (SD=0.06 ms vs. 0.69 (SD=0.16, P=0.015]. Successful ablation was performed in 73.2% of patients with RVOT versus 93.3% of those with LVOT, but despite a higher rate the differences were not statistically significant (P=0.215. Conclusion: In this study, RF catheter ablation was successful like other studies on patients with ventricular tachycardia and RVOT VT and LVOT VT had significant differences in notch, QRS transition and R-to-QRS duration in precordial leads which are important in differentiating between the two conditions.

  13. Atrial Fibrillation: The New Epidemic of the Ageing World

    Directory of Open Access Journals (Sweden)

    Wilbert S. Aronow, MD, FACC, FAHA

    2009-04-01

    Full Text Available The prevalence of atrial fibrillation (AF increases with age. As the population ages, the burden of AF increases. AF is associated with an increased incidence of mortality, stroke, and coronary events compared to sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Immediate direct-current (DC cardioversion should be performed in patients with AF and acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous beta blockers, diltiazem, or verapamil may be administered to reduce immediately a very rapid ventricular rate in AF. An oral beta blocker, verapamil, or diltiazem should be used in persons with AF if a fast ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected patients with symptomatic life-threatening AF refractory to other drugs. Digoxin should not be used to treat patients with paroxysmal AF. Nondrug therapies should be performed in patients with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drugs. Paroxysmal AF associated with the tachycardia-bradycardia syndrome should be treated with a permanent pacemaker in combination with drugs. A permanent pacemaker should be implanted in patients with AF and symptoms such as dizziness or syncope associated with ventricular pauses greater than 3 seconds which are not drug-induced. Elective DC cardioversion has a higher success rate and a lower incidence of cardiac adverse effects than does medical cardioversion in converting AF to sinus rhythm. Unless transesophageal echocardiography has shown no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective DC or drug cardioversion of AF and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer, especially in elderly patients , ventricular rate control plus warfarin rather than

  14. Short and middle term outcome of radiofrequency catheter ablation for paroxysmal and sustained atrial fibrillation

    International Nuclear Information System (INIS)

    The aim of this study was to assess short and middle term outcome of radiofrequency catheter ablation for drug-refractory paroxysmal and sustained atrial fibrillation. Subjects were 30 patients of atrial fibrillation (19 paroxysmal, 11 sustained) who underwent extensive pulmonary vein isolation from January 2007 to August 2009 in our department. Twenty three men and seven women, aged from 44 to 76 years, were enrolled. Follow-up period was one to 32 months. Drug free success was 33%, but symptoms and electrocardiogram (EGG) findings were improved in 93 % of the patients by administration of anti-arrhythmic agents. Five of the six patients with bradycardia-tachycardia syndrome was free from pacemaker implantation. Left ventricular ejection fraction was improved in two patients with dilated cardiomyopathy (DCM)-like left ventricular dysfunction. One case had cardiac tamponade and transient ST elevation due to right coronary air embolism were observed in two cases. There were no death and no cerebrovascular events during the procedures and follow-up periods. In conclusion, radiofrequency catheter ablation for paroxysmal and sustained atrial fibrillation in our department may be highly acceptable new method for improving the symptoms and clinical signs of the patients. (author)

  15. Who Is at Risk for Atrial Fibrillation?

    Science.gov (United States)

    ... Who Is at Risk for Atrial Fibrillation? Explore Atrial Fibrillation What Is... Types Other Names Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Arrhythmia ...

  16. Surgical Ablation of Atrial Fibrillation.

    Science.gov (United States)

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to

  17. [Postural orthostatic tachycardia syndrome (POTS)--pathophysiology, diagnostics, and treatment].

    Science.gov (United States)

    Rek, Marta; Kaczmarek, Krzysztof; Cygankiewicz, Iwona; Wranicz, Jerzy K; Ptaszyński, Paweł

    2014-01-01

    Postural orthostatic tachycardia syndrome (POTS) is one of the most common presentation of orthostatic intolerance. The syndrome is described as a multifactorial affliction. Main symptoms consist of persistent orthostatic tachycardia (heart rate increase at least 30 beats/min, lasting at least 10 min after assumic vertical position) with high noradrenalin serum concentration (measured in stand-up position). Additionally patients with POTS tend to have lover total blood volume. POTS is generally classified into dysatonomia disorders Symptoms in patients affected with POTS are chronic. The syndrome occurs predominantly in young women (approximately 80%). Due to complexity and variable intensity of symptoms POTS can severely impair daily activity and quality of life in otherwise healthy people. The correct diagnosis and identification of potential pathophysiological mechanisms of POTS is necessary before treatment administration. Adequate therapy can significantly reduce symptoms giving the patients a chance for a normal life.

  18. Orthostatic intolerance: postural orthostatic tachycardia syndrome with overlapping vasovagal syncope.

    Science.gov (United States)

    Skerk, Vedrana; Pintarić, Hrvoje; Delić-Brkljacić, Diana; Popović, Zvonimir; Hećimović, Hrvoje

    2012-03-01

    A 28-year-old female with a history of situational syncope and a new-onset right sided hemiparesis is described. Tilt-up table test revealed the postural orthostatic tachycardia syndrome followed by vasovagal syncope. Neurological and internal medicine tests showed no particular disorders. The patient underwent autonomic physical training and the tilt-up test performed three months later showed improvement of the autonomic system in terms of lower heart beat rate of the postural orthostatic tachycardia syndrome and longer duration of the test. This case report describes longstanding idiopathic dysautonomia that can be improved by nonpharmacological treatment, while reminding that this medical condition may also be the cause of syncope.

  19. Mutations in calmodulin cause ventricular tachycardia and sudden cardiac death

    DEFF Research Database (Denmark)

    Nyegaard, Mette; Overgaard, Michael Toft; Sondergaard, M.T.;

    2012-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a devastating inherited disorder characterized by episodic syncope and/or sudden cardiac arrest during exercise or acute emotion in individuals without structural cardiac abnormalities. Although rare, CPVT is suspected to cause...... a substantial part of sudden cardiac deaths in young individuals. Mutations in RYR2, encoding the cardiac sarcoplasmic calcium channel, have been identified as causative in approximately half of all dominantly inherited CPVT cases. Applying a genome-wide linkage analysis in a large Swedish family with a severe...... calmodulin-binding-domain peptide at low calcium concentrations. We conclude that calmodulin mutations can cause severe cardiac arrhythmia and that the calmodulin genes are candidates for genetic screening of individual cases and families with idiopathic ventricular tachycardia and unexplained sudden cardiac...

  20. Case report: successful repeat tricuspid valve replacement combined with atrial flutter ablation during correction of Ebstein's anomaly

    Directory of Open Access Journals (Sweden)

    Bockeria L.A.

    2013-09-01

    Full Text Available Patients with Ebstein's anomaly often suffer from a variety of arrhythmias, such as paroxysmal supraventricular tachycardia, atrial fibrillation and atrial flutter, which in turn adversely affects the prognosis of these patients. This is why early diagnosis and treatment can reduce the risk of sudden cardiac death. Patient V. 34 years old admitted to the department of surgical treatment of interactive pathology Bakoulev's Сenter for Сardiovascular Surgery RAMS. In 1987 the patient underwent tricuspid valve replacement with bioprosthesis made of aortic valve of a pig. After the operation he felt well. Worsening of the disease was noticed in July 2012. Due to worsening of the symptoms the patient admitted to a hospital. Dysfunction of bioprosthesis with calcification and insufficiency were revealed. Atrial flutter was diagnosed as well. 19.10.2012 redo tricuspid valve replacement with bioprosthesis Bioglis (28 in diameter, cryoablation of right isthmus and the dase of right atrial appendage with Atri Cure system. The patient was discharged on postoperative day 12. He felt well and was sent to supervision of cardiologist for follow-up.

  1. The Treatment of Supraventricular Tachycardia%室上性心动过速的治疗方法探讨

    Institute of Scientific and Technical Information of China (English)

    赵锦绣; 刘锟

    2014-01-01

    Paroxysmal supraventricular tachycardia (PSVT) is hereinafter referred to as supraventricular tachycardia. Most of the electrocardiogram performance for normal QRS complex and the fast rhythm of the heart of RR interphase rules. Most supraventricular tachycardia is caused by exhumation mechanism, and patients usually have no organic heart disease, and the patients of different gender and age all can happen. Tachycardia attacks suddenly beginning and ending, and the duration of each are not identical. The symptoms usually include heart palpitations, chest distress, anxiety, dizziness, but rarely with syncope, angina pectoris, heart failure and shock. The symptom severity depends on the attack degree of rapid ventricular rate and duration, and also has relations with the severity of the disease. If the ventricular rate occurs too quickly, it can case the cardiac output and cerebral blood lfow reduction or tachycardia suddenly terminated, and sinoatrial node failed to restore self-discipline cause cardiac standstill, all of them can case syncope. So when the patient have a medical, the ifrst heart sound intensity will be constant, and the rhythm of the heart is well-regulated. The treatment of acute phase includes stimulate the vagus nerve, drug therapy, esophageal atrial cardiac surgery and dc cardioerter.besids, we can use drugs or catheter ablation techniques to prevent the relapse.%阵发性室上性心动过速(PSVT)简称室上速。大多数心电图表现为QRS波群形态正常、RR间期规则的快速心律。大部分室上速由折返机制引起,患者通常无器质性心脏病表现,不同性别与年龄均可发生。心动过速发作突然起始与终止,持续时间各不相同。症状包括心悸、胸闷、焦虑不安、头晕,少见有晕厥、心绞痛、心力衰竭与休克者。症状轻重取决于发作时心室率快速的程度以及持续时间,也与疾病的严重程度有关系。如果心室率发作时过快,使

  2. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder.

    Science.gov (United States)

    Benarroch, Eduardo E

    2012-12-01

    Postural tachycardia syndrome (POTS) is defined by a heart rate increment of 30 beats/min or more within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension; the standing heart rate is often 120 beats/min or higher. POTS manifests with symptoms of cerebral hypoperfusion and excessive sympathoexcitation. The pathophysiology of POTS is heterogeneous and includes impaired sympathetically mediated vasoconstriction, excessive sympathetic drive, volume dysregulation, and deconditioning. POTS is frequently included in the differential diagnosis of chronic unexplained symptoms, such as inappropriate sinus tachycardia, chronic fatigue, chronic dizziness, or unexplained spells in otherwise healthy young individuals. Many patients with POTS also report symptoms not attributable to orthostatic intolerance, including those of functional gastrointestinal or bladder disorders, chronic headache, fibromyalgia, and sleep disturbances. In many of these cases, cognitive and behavioral factors, somatic hypervigilance associated with anxiety, depression, and behavioral amplification contribute to symptom chronicity. The aims of evaluation in patients with POTS are to exclude cardiac causes of inappropriate tachycardia; elucidate, if possible, the most likely pathophysiologic basis of postural intolerance; assess for the presence of treatable autonomic neuropathies; exclude endocrine causes of a hyperadrenergic state; evaluate for cardiovascular deconditioning; and determine the contribution of emotional and behavioral factors to the patient's symptoms. Management of POTS includes avoidance of precipitating factors, volume expansion, physical countermaneuvers, exercise training, pharmacotherapy (fludrocortisone, midodrine, β-blockers, and/or pyridostigmine), and behavioral-cognitive therapy. A literature search of PubMed for articles published from January 1, 1990, to June 15, 2012, was performed using the following terms (or combination of terms): POTS

  3. Panic attacks and supraventricular tachycardias: the chicken or the egg?

    OpenAIRE

    Frommeyer, G.; Eckardt, L; Breithardt, G.

    2012-01-01

    Panic attacks occur in about 2 % of the population. Symptoms include a racing or pounding heart beat, chest pain, dizziness, light-headedness, nausea, difficulty in breathing, tingling or numbness in the hands, flushes or chills, dreamlike sensations or perceptual distortions. The symptoms of paroxysmal supraventricular tachycardia (PSVT) may be similar. A PSVT is often difficult to document on the ECG since it has often ceased before the patient comes to medical attention. Besides, a tachyca...

  4. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder.

    Science.gov (United States)

    Benarroch, Eduardo E

    2012-12-01

    Postural tachycardia syndrome (POTS) is defined by a heart rate increment of 30 beats/min or more within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension; the standing heart rate is often 120 beats/min or higher. POTS manifests with symptoms of cerebral hypoperfusion and excessive sympathoexcitation. The pathophysiology of POTS is heterogeneous and includes impaired sympathetically mediated vasoconstriction, excessive sympathetic drive, volume dysregulation, and deconditioning. POTS is frequently included in the differential diagnosis of chronic unexplained symptoms, such as inappropriate sinus tachycardia, chronic fatigue, chronic dizziness, or unexplained spells in otherwise healthy young individuals. Many patients with POTS also report symptoms not attributable to orthostatic intolerance, including those of functional gastrointestinal or bladder disorders, chronic headache, fibromyalgia, and sleep disturbances. In many of these cases, cognitive and behavioral factors, somatic hypervigilance associated with anxiety, depression, and behavioral amplification contribute to symptom chronicity. The aims of evaluation in patients with POTS are to exclude cardiac causes of inappropriate tachycardia; elucidate, if possible, the most likely pathophysiologic basis of postural intolerance; assess for the presence of treatable autonomic neuropathies; exclude endocrine causes of a hyperadrenergic state; evaluate for cardiovascular deconditioning; and determine the contribution of emotional and behavioral factors to the patient's symptoms. Management of POTS includes avoidance of precipitating factors, volume expansion, physical countermaneuvers, exercise training, pharmacotherapy (fludrocortisone, midodrine, β-blockers, and/or pyridostigmine), and behavioral-cognitive therapy. A literature search of PubMed for articles published from January 1, 1990, to June 15, 2012, was performed using the following terms (or combination of terms): POTS

  5. Atrial fibrillation post cardiac bypass surgery

    OpenAIRE

    Mostafa, Ashraf; EL-Haddad, Mohamed A.; Shenoy, Maithili; Tuliani, Tushar

    2012-01-01

    Atrial fibrillation occurs in 5-40% patients after coronary artery bypass graft surgery. Atrial fibrillation increases mortality and morbidity in the post-operative period. We sought to conduct a comprehensive review of literature focusing on pathophysiology, risk factors, prevention and treatment of post coronary artery bypass graft atrial fibrillation.

  6. Risk of atrial fibrillation in diabetes mellitus

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik L; Schjerning, Anne-Marie; Lindhardt, Tommi B;

    2016-01-01

    AIM: Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patien...

  7. Low atrial septum pacing in pacemaker patients

    NARCIS (Netherlands)

    Voogt, Willem Gijsbert de

    2006-01-01

    In patients with an indication for anti bradycardia pacing, atrial fibrillation (AF) is a common arrhythmia (30-50%) even in the absence of atrial tachy arrhythmias before pacemaker implantation. Pace prevention and pace intervention for atrial tachy arrhythmias could be an interesting adjuvant trea

  8. Obstructive sleep apnea in atrial fibrillation patients.

    Science.gov (United States)

    Arias, Miguel A; Alonso-Fernández, Alberto; García-Río, Francisco; Sánchez, Ana; López, Juana M; Pagola, Carlos

    2006-06-28

    A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. PMID:16309764

  9. Rare presentation of intralobar pulmonary sequestration associated with repeated episodes of ventricular tachycardia.

    Science.gov (United States)

    Rao, D Sheshagiri; Barik, Ramachandra

    2016-07-26

    Arterial supply of an intralobar pulmonary sequestration (IPS) from the coronary circulation is extremely rare. A significant coronary steal does not occur because of dual or triple sources of blood supply to sequestrated lung tissue. We present a 60-year-old woman who presented to us with repeated episodes of monomorphic ventricular tachycardia (VT) in last 3 mo. Radio frequency ablation was ineffective. On evaluation, she had right lower lobe IPS with dual arterial blood supply, i.e., right pulmonary artery and the systemic arterial supply from the right coronary artery (RCA). Stress myocardial perfusion scan revealed significant inducible ischemia in the RCA territory. Coronary angiogram revealed critical stenosis of proximal RCA just after the origin of the systemic artery supplying IPS. The critical stenosis in the RCA was stented. At 12 mo follow-up, she had no further episodes of VT or angina. PMID:27468336

  10. Alternative therapies in the treatment of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Federico Lombardi, MD, FESC; Sebastiano Belletti, MD; Alberto Lomuscio, MD.

    2013-04-01

    Full Text Available Atrial fibrillation (AF is the most common clinical arrhythmia and represents a major social and economic problem. The number of subjects with AF is constantly increasing as a result of aging and improved survival in several cardiac and non-cardiac diseases. Patients with AF are often symptomatic, have a reduced physical capacity and are at high risk for thromboembolic events. Moreover, AF is associated with increased mortality and independently of the management based either on rhythm or rate control strategy, whereas the safety and efficacy of most anti-arrhythmic drugs are questionable. Increasing attention has therefore been addressed to evaluate the possible therapeutic and/or preventive effects of forms of treatment coming from ancient medical traditions of Far East, like acupuncture and yoga. In traditional Chinese medicine, acupuncture has been found effective in managing patients with paroxysmal supraventricular tachycardia. Recently, also in the Western literature, reports have been published supporting the clinical efficacy of acupuncture to treat arterial hypertension and to reduce chest pain. Other studies have evaluated the effects of acupuncture and other methods of Eastern Medicine, i.e., Qigong, Tai Chi Chuan and Yoga, in the treatment of cardiac illnesses associated with supraventricular arrhythmias. Two reports on the effects of acupuncture in preventing or reducing the rate of AF recurrences in patients with persistent or paroxysmal AF have been recently reported . Another ancient traditional eastern form of therapy and prevention, i.e., yoga, has been recently shown to reduce episodes of atrial fibrillation and improve the symptoms of anxiety and depression often associated with this arrhythmia. Growing evidence indicates that acupuncture and yoga are safe, without any pro-arrhythmic effect and with limited cost. All these factors should be considered when evalu­ating the efficacy of therapeutic intervention for an epi

  11. Neuronal and Hormonal Perturbations in Postural Tachycardia Syndrome

    Directory of Open Access Journals (Sweden)

    Philip L Mar

    2014-06-01

    Full Text Available The Postural Tachycardia Syndrome (POTS is the most common disorder seen in autonomic clinics. Cardinal hemodynamic feature of this chronic and debilitating disorder of orthostatic tolerance is an exaggerated orthostatic tachycardia (≥30 bpm increase in HR with standing in the absence of orthostatic hypotension.There are multiple pathophysiological mechanisms that underlie POTS. Some patients with POTS have evidence of elevated sympathoneural tone. This hyperadrenergic state is likely a driver of the excessive orthostatic tachycardia. Another common pathophysiological mechanism in POTS is a hypovolemic state. Many POTS patients with a hypovolemic state have been found to have a perturbed renin-angiotensin-aldosterone profile. These include inappropriately low plasma renin activity and aldosterone levels with resultant inadequate renal sodium retention. Some POTS patients have also been found to have elevated plasma angiotensin II (Ang-II levels, with some studies suggesting problems with decreased angiotensin converting enzyme 2 activity and decreased Ang-II degradation. An understanding of these pathophysiological mechanisms in POTS may lead to more rational treatment approaches that derive from these pathophysiological mechanisms.

  12. Catecholaminergic polymorphic ventricular tachycardia: An exciting new era.

    Science.gov (United States)

    Behere, Shashank P; Weindling, Steven N

    2016-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a highly malignant inheritable cardiac channelopathy. The past decade and a half has provided exciting new discoveries elucidating the genetic etiology and pathophysiology of CPVT. This review of the current literature on CPVT aims to summarize the state of the art in our understanding of the genetic etiology and the molecular pathogenesis of CPVT, and how these relate to our current approach to diagnosis and management. We will also shed light on groundbreaking new work that will continue to refine the management of CPVT in the future. As our knowledge of CPVT continues to grow, further studies will yield a better understanding of the efficacy and pitfalls of established diagnostic approaches and therapies as well as help shape newer diagnostic and treatment strategies. Two separate searches were run on the National Center for Biotechnology Information's (NCBI) website. The first used the medical subject headings (MeSH) database using the term "catecholaminergic polymorphic ventricular tachycardia" that was run on the PubMed database using the age filter (birth to 18 years), and it yielded 58 results. The second search using the MeSH database with the search term "catecholaminergic polymorphic ventricular tachycardia," applying no filters yielded 178 results. The abstracts of all these articles were studied and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.

  13. 阵发性室上性心动过速30例临床分析%A Clinical Analysis on 30 Patients with Paroxysmal Supraventricular Tachycardia

    Institute of Scientific and Technical Information of China (English)

    招忠满

    2013-01-01

    Objective: To analyze clinical features of patients with paroxysmal supraventricular tachycardia(PSVT),so as to summarize the experience of diagnosis and treatment on PSVT.Methods:Clinical data of 30 cases with PSVT were analyzed. Results:Of 30 cases,3 with wide complex tachycardia,27 with narrow complex tachycardia. Of 26 cases treated with drug(Triphosadenine, Verapamil, Lanatoside C, Aramine),22 were recoveried.3 cases were treated through transesophageal atrial pacing.3 cases were treated with electrical cardioversion. 1 case were treated with carotid sinus massage.1 case were recovered automatically without any medical treatment.All patients were cured successfully.Conclusion:Therapeutic regime should be tailored for the patients with PSVT on the basis of their situation.%目的:探讨阵发性室上性心动过速的临床特征,总结其诊治经验。方法:对阵发性室上性心动过速30例临床资料进行分析。结果:宽QRS波型3例,窄QRS波型27例。用药物(三磷酸腺苷、异搏定、西地兰、阿拉明)复律26例,成功22例,食道调搏超速抑制复律3例,电复律3例,按压颈动脉窦复律1例,自动复律1例。30例全部复律成功。结论:阵发性室上性心动过速根据病人的具体情况选择不同的复律方法。

  14. Atrial fibrillation and delayed gastric emptying.

    Directory of Open Access Journals (Sweden)

    Isadora C Botwinick

    Full Text Available BACKGROUND: Atrial fibrillation and delayed gastric emptying (DGE are common after pancreaticoduodenectomy. Our aim was to investigate a potential relationship between atrial fibrillation and DGE, which we defined as failure to tolerate a regular diet by the 7(th postoperative day. METHODS: We performed a retrospective chart review of 249 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009. Data was analyzed with Fisher exact test for categorical variables and Mann-Whitney U or unpaired T-test for continuous variables. RESULTS: Approximately 5% of the 249 patients included in the analysis experienced at least one episode of postoperative atrial fibrillation. Median age of patients with atrial fibrillation was 74 years, compared with 66 years in patients without atrial fibrillation (p = 0.0005. Patients with atrial fibrillation were more likely to have a history of atrial fibrillation (p = 0.03. 92% of the patients with atrial fibrillation suffered from DGE, compared to 46% of patients without atrial fibrillation (p = 0.0007. This association held true when controlling for age. CONCLUSION: Patients with postoperative atrial fibrillation are more likely to experience delayed gastric emptying. Interventions to manage delayed gastric function might be prudent in patients at high risk for postoperative atrial fibrillation.

  15. Phase synchrony reveals organization in human atrial fibrillation.

    Science.gov (United States)

    Vidmar, David; Narayan, Sanjiv M; Rappel, Wouter-Jan

    2015-12-15

    It remains unclear if human atrial fibrillation (AF) is spatially nonhierarchical or exhibits a hierarchy of organization sustained by sources. We utilize activation times obtained at discrete locations during AF to compute the phase synchrony between tissue regions, to examine underlying spatial dynamics throughout both atria. We construct a binary synchronization network and show that this network can accurately define regions of coherence in coarse-grained in silico data. Specifically, domains controlled by spiral waves exhibit regions of high phase synchrony. We then apply this analysis to clinical data from patients experiencing cardiac arrhythmias using multielectrode catheters to simultaneously record from a majority of both atria. We show that pharmaceutical intervention with ibutilide organizes activation by increasing the size of the synchronized domain in AF and quantify the increase in temporal organization when arrhythmia changes from fibrillation to tachycardia. Finally, in recordings from 24 patients in AF we show that the level of synchrony is spatially broad with some patients showing large spatially contiguous regions of synchronization, while in others synchrony is localized to small pockets. Using computer simulations, we show that this distribution is inconsistent with distributions obtained from simulations that mimic multiwavelet reentry but is consistent with mechanisms in which one or more spatially conserved spiral waves is surrounded by tissue in which activation is disorganized. PMID:26475585

  16. [Liquorice consumption may induce torsades de pointes ventricular tachycardia].

    Science.gov (United States)

    Smith, Mette Aaby; Pedersen, Charlotte; Henriksen, Finn Lund

    2016-07-11

    This case report describes an often forgotten cause of hypokalaemia resulting in electrocardiograpic changes in a 75-year-old man known with hypertension, atrial fibrillation and ischaemic heart disease. A detailed anamnesis, a prompt replacement of potassium and cessation of liquorice consumption resulted in a favourable outcome. PMID:27406286

  17. Narrow-QRS and Wide-QRS Tachycardias.

    Science.gov (United States)

    Glancy, David Luke

    2016-07-01

    In a woman with rheumatic heart disease, atrial flutter with a rapid ventricular response, and congestive heart failure, treatment with digoxin slows conduction in the atrioventricular node and thus allows atrioventricular conduction to occur by way of a previously unrecognized accessory pathway. PMID:27178329

  18. Laser Ablation Of Atrial Fibrillation: Mid-term Clinical Experience

    Directory of Open Access Journals (Sweden)

    Li Poa, MD

    2009-08-01

    Full Text Available Background: Atrial Fibrillation is known to account for one third of all the strokes caused in the US in the population above the age of 70. Patients treated with the surgical Cox MAZE operation have been shown to have a 150 fold decrease in the incidence of stroke over an 18 year period. However, the original Cox MAZE although extremely successful in treating atrial fibrillation and decreasing the incidence of strokes was not performed widely because of complexity and invasiveness of the procedure. A variety of alternative energy based curative ablation strategies are now available for more minimally invasive therapeutic management of atrial fibrillation (AF. In this communication, we report our clinical experience in AF therapy utilizing laser energy ablation technology. Methods: Fifty two consecutive AF patients underwent concomitant or isolated ablation prior to any coexisting cardiac procedures that included CABG (coronary artery bypass surgery, MV (mitral valve or AV (aortic valve repairs. All patients had an epicardially based ablation pattern with basic lesions being en bloc box type pulmonary vein isolation which included the antral surface of the left atrium, directed ganglionectomies of the the right anterior and inferior ganglions, posteriomedial ablation of the IVC ( inferior vena cava, and a right isthmus ablation. Twenty seven patients had ligation of their left atrial appendage, 14 patients had resection of the ligament of Marshall, and three patients had endocardial placed lesions of a mitral annular connecting type lesion. In order to maintain the patients in normal sinus rhythm (NSR, electrical cardioversion and anti-arrhythmic drugs were employed as required. Results: At a median follow-up of 250 days, 44 of the total 52 patients (84.6% exhibited NSR.. No complications or mortality were reported due to the laser procedure. Conclusion: Laser ablation was successfully and safely used for endocardial and epicardial AF ablation

  19. Personalized management of atrial fibrillation

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Aliot, Etienne;

    2013-01-01

    The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to de...

  20. [New antithrombotics for atrial fibrillation].

    NARCIS (Netherlands)

    Verheugt, F.W.A.

    2011-01-01

    Cerebral infarction is the most serious complication of atrial fibrillation. Coumarin derivatives (vitamin K antagonists) counteract systemic thromboembolism and reduce the risk of stroke by more than 60%, but carry a risk of serious bleeding. Antiplatelet therapy and subcutaneous low-molecular-weig

  1. Surgical Treatment of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Naghmeh Moshtaghi

    2008-12-01

    Full Text Available Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results.

  2. Atrial Fibrillation and Heart Failure

    Directory of Open Access Journals (Sweden)

    Jens Seiler

    2008-07-01

    Full Text Available Atrial fibrillation is common in heart failure patients and is associated with increased mortality.  Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy.  It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect.  Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy.  Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking.  Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases.  Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing.  Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed. 

  3. Coexistent Types of Atrioventricular Nodal Re-Entrant Tachycardia

    Science.gov (United States)

    Marine, Joseph E.; Latchamsetty, Rakesh; Zografos, Theodoros; Tanawuttiwat, Tanyanan; Sheldon, Seth H.; Buxton, Alfred E.; Calkins, Hugh; Morady, Fred; Josephson, Mark E.

    2015-01-01

    Background— There is evidence that atypical fast–slow and typical atrioventricular nodal re-entrant tachycardia (AVNRT) do not use the same limb for fast conduction, but no data exist on patients who have presented with both typical and atypical forms of this tachycardia. We compared conduction intervals during typical and atypical AVNRT that occurred in the same patient. Methods and Results— In 20 of 1299 patients with AVNRT, both typical and atypical AVNRT were induced at electrophysiology study by pacing maneuvers and autonomic stimulation or occurred spontaneously. The mean age of the patients was 47.6±10.9 years (range, 32–75 years), and 11 patients (55%) were women. Tachycardia cycle lengths were 368.0±43.1 and 365.8±41.1 ms, and earliest retrograde activation was recorded at the coronary sinus ostium in 60% and 65% of patients with typical and atypical AVNRT, respectively. Thirteen patients (65%) displayed atypical AVNRT with fast–slow characteristics. By comparing conduction intervals during slow–fast and fast–slow AVNRT in the same patient, fast pathway conduction times during the 2 types of AVNRT were calculated. The mean difference between retrograde fast pathway conduction during slow–fast AVNRT and anterograde fast pathway conduction during fast–slow AVNRT was 41.8±39.7 ms and was significantly different when compared with the estimated between-measurement error (P=0.0055). Conclusions— Our data provide further evidence that typical slow–fast and atypical fast–slow AVNRT use different anatomic pathways for fast conduction. PMID:26155802

  4. Sympathovagal balance analysis in idiopathic postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Russo, Vincenzo; De Crescenzo, Ilaria; Ammendola, Ernesto; Santangelo, Lucio; Calabrò, Raffaele

    2007-08-01

    The idiopathic postural tachycardia syndrome (POTS) is a complex disorder characterized by chronic orthostatic symptoms and an increase in heart rate within 10 minutes of standing on upright posture, without significant orthostatic hypotension. We describe a case of a 36 year-old patient with POTS, diagnosed by head-up tilt testing. Power spectral analysis of heart rate variability (HRV), performed during the tilt test, revealed the ratio of low and high frequency powers (LF/HF) that increased with the onset of orthostatic intolerance. The increase in LF/HF power ratio may represent sympathetic beta-receptors hyperactivity. Atenolol alleviated his clinical symptoms.

  5. [Pyridostigmine in the treatment of postural orthostatic tachycardia syndrome].

    Science.gov (United States)

    Can, Ilknur; Tholakanahalli, Venkatakrishna

    2014-09-01

    A 34-year-old female patient was admitted with the complaints of inability to stand upright, palpitations, dizziness, and fatigue in the upright posture for the last one year. She was found to stand upright for less than one minute without symptoms. Tilt table testing showed that, compared to baseline her heart rate increased 55 beats/min in the fifth minute of the test with the symptoms of palpitations, fatigue and sweating without any significant change in her blood pressure. Postural orthostatic tachycardia syndrome was diagnosed, and pyridostigmine treatment was started. Four months after treatment her symptoms were relieved so that she was able to function as a nurse.

  6. Risk Factors for Postural Tachycardia Syndrome in Children and Adolescents

    OpenAIRE

    Lin, Jing; Han, Zhenhui; Li, Xueying; Ochs, Todd; Zhao, Juan; Zhang, Xi; Yang, Jinyan; Liu, Ping; Xiong, Zhenyu; Gai, Yong; Tang, Chaoshu; Du, Junbao; Jin, Hongfang

    2014-01-01

    Background Postural tachycardia syndrome (POTS) is prevalent in children and adolescents and has a great impact on health. But its risk factors have not been fully understood. This study aimed to explore possible risk factors for children and adolescents with POTS. Methods and Findings 600 children and adolescents (test group) aged 7–18 (11.9±3.0) years old, 259 males and 341 females, were recruited for identifying its risk factors. Another 197 subjects aged from 7 to 18 (11.3±2.3) years old ...

  7. 具有自动搜索心房滞后功能的起搏器对房性心律失常近期影响研究%Recent impact study of automatic search function of the pacemaker atrial hysteresis on atrial arrhythmias

    Institute of Scientific and Technical Information of China (English)

    李永东; 葛智平; 温慧华; 徐安杰

    2013-01-01

    tachycardia,atrial fibrillation array number increased (P < 0.05) ; APB,atrial tachycardia and atrial fibrillation episodes were increased(P < 0.05).Compared with the automatic search function in atrial hysteresis model opened with and not opened:atrial pacing percentage decreased [0.54(0.41,0.71) vs.0.82(0.65,0.93),P <0.05] ;DCG 24 h showed that APB,atrial tachycardia,atrial fibrillation array number were decreased (P < 0.05).APB,atrial tachycardia and atrial fibrillation episodes were reduced (P < 0.05).Conclusions Automatic search function in atrial hysteresis model can obviously reduce the proportion of atrial pacing,reduce the occurrence of atrial arrhythmias ;opened with automatic search function in atrial hysteresis model was safe and reliablely.

  8. What Are the Signs and Symptoms of Atrial Fibrillation?

    Science.gov (United States)

    ... Twitter. What Are the Signs and Symptoms of Atrial Fibrillation? Atrial fibrillation (AF) usually causes the heart's lower ... Chest pain Dizziness or fainting Fatigue (tiredness) Confusion Atrial Fibrillation Complications AF has two major complications— stroke and ...

  9. Management and prognosis of atrial fibrillation in the diabetic patient

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik Langtved; Lindhardt, Tommi Bo; Olesen, Jonas Bjerring;

    2015-01-01

    The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. I...

  10. Subclinical Atrial Fibrillation and the Risk of Stroke

    NARCIS (Netherlands)

    Healey, Jeff S.; Connolly, Stuart J.; Gold, Michael R.; Israel, Carsten W.; Van Gelder, Isabelle C.; Capucci, Alessandro; Lau, C. P.; Fain, Eric; Yang, Sean; Bailleul, Christophe; Morillo, Carlos A.; Carlson, Mark; Themeles, Ellison; Kaufman, Elizabeth S.; Hohnloser, Stefan H.

    2012-01-01

    BACKGROUND One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. We evaluated whether subclinica

  11. Percutaneous Catheter Closure of Atrial Septal Defect and an Atrial Septal Aneurysm: One Case Report

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We describe a 56-yr-old female presented with palpitation and shortness of breath on exertion and intracardiac echocardiography showed atrial septal defect and an atrial septal aneurysm. She was underwent successfully percutaneous catheter closure with Amplatzer occluder devices.

  12. EXERCISE-INDUCED VENTRICULAR-TACHYCARDIA - A RARE MANIFESTATION OF DIGITALIS TOXICITY

    NARCIS (Netherlands)

    GOSSELINK, ATM; CRIJNS, HJGM; WIESFELD, ACP; LIE, KI

    1993-01-01

    Digitalis intoxication is one of the most common adverse drug reactions. Although some arrhythmias are seen more frequently than others, virtually any rhythm disturbance, including ventricular tachycardia, may occur. However, to our knowledge, exercise-induced ventricular tachycardia as a complicati

  13. Addressing the confounding role of joint hypermobility syndrome and gastrointestinal involvement in postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Farmer, Adam D; Fikree, Asma; Aziz, Qasim

    2014-06-01

    Quantitative and qualitative abnormalities in visceral function have been demonstrated in postural orthostatic tachycardia syndrome. Joint hypermobility is frequently associated with both postural orthostatic tachycardia syndrome and gastrointestinal symptoms. Future studies in this area should appropriately and systematically control for the presence of joint hypermobility syndrome.

  14. Treatment of paroxysmal supraventricular tachycardia with intravenous injection of adenosine triphosphate.

    OpenAIRE

    Saito, D.; Ueeda, M; Abe, Y.; Tani, H; Nakatsu, T.; Yoshida, H.; Haraoka, S; Nagashima, H

    1986-01-01

    Intravenous adenosine triphosphate rapidly terminated all 11 episodes of paroxysmal supraventricular tachycardia in 10 patients. Eight patients reported side effects but these resolved within 20 seconds and did not require treatment. Adenosine triphosphate is a suitable agent for the rapid termination of paroxysmal supraventricular tachycardia.

  15. Cardiac Neurotransmission Imaging with 123I-Meta-iodobenzylguanidine in Postural Tachycardia Syndrome.

    OpenAIRE

    Haensch, Carl-Albrecht; Lerch, Hartmut; Schlemmer, Hans; Jigalin, Anna; Isenmann, Stefan

    2010-01-01

    Abstract Background: Postural orthostatic tachycardia syndrome (POTS) is a disorder of orthostatic intolerance characterized by excessive tachycardia of unknown etiology. Whether this condition involves abnormal cardiac sympathetic innervation or function remains elusive. Metaiodobenzylguanidine (MIBG) resembles guanethidine and is a pharmacologically inactive analogue of norepinephrine, which is similarly metabolized in noradrenergic neurons. MIBG myocardial scintigraphy is clinic...

  16. Ectopic activity induced by elevated atrial pressure in rabbit pulmonary vein in vitro

    Institute of Scientific and Technical Information of China (English)

    LIU Jie; HUANG Cong-xin; BAO Ming-wei; WANG Teng

    2005-01-01

    @@ Atrial fibrillation (AF) is a common tachyarrhythmia and may cause serious complications, such as stroke. When atrial pressure was elevated, the effect refraction period (ERP) was shortened and the conductivity in atria was slowed and the heterogeneity of different parts of atria was increased. These changes facilitate the occurrence and maintenance of AF. Recent researches demonstrated that pulmonary veins (PVs) are important sources of ectopic beats in the initiation of paroxysmal AF. In patients with drug-resistant chronic AF and structural heart disease, after electrical cardioversion, the PVs are also the dominant trigger in reinitiating AF.1 Yamane et al2 reported that, AF patients were often with dilated PVs if the AF was initiated by focal activity in PVs. Atrial myocardial fibers wrap around the PVs entering the left atrium to form PV myocardial sleeves (PVMSs), and this structure is the origin of focal activity. Little is known about the effects of elevated atrial pressure on PV electrophysiology. In the present study, we found that, spontaneous activity in PVMSs could be induced by elevated atrial pressure and it could affect the atrial rhythm.

  17. Treatment of atrial fibrillation with a dual defibrillator in heart failure patients (TRADE HF: protocol for a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Grandinetti Giuseppe

    2011-02-01

    Full Text Available Abstract Background Heart failure(HF and atrial fibrillation(AF frequently coexist in the same patient and are associated with increased mortality and frequent hospitalizations. As the concomitance of AF and HF is often associated with a poor prognosis, the prompt treatment of AF in HF patients may significantly improve outcome. Methods/design Recent implantable cardiac resynchronization (CRT devices allow electrical therapies to treat AF automatically. TRADE-HF (trial registration: NCT00345592; http://www.clinicaltrials.gov is a prospective, randomized, double arm study aimed at demonstrating the efficacy of an automatic, device-based therapy for treatment of atrial tachycardia and fibrillation(AT/AF in patients indicated for CRT. The study compares automatic electrical therapy to a traditional more usual treatment of AT/AF: the goal is to demonstrate a reduction in a combined endpoint of unplanned hospitalizations for cardiac reasons, death from cardiovascular causes or permanent AF when using automatic atrial therapy as compared to the traditional approach involving hospitalization for symptoms and in-hospital treatment of AT/AF. Discussion CRT pacemaker with the additional ability to convert AF as well as ventricular arrhythmias may play a simultaneous role in rhythm control and HF treatment. The value of the systematic implantation of CRT ICDs with the capacity to deliver atrial therapy in HF patients at risk of AF has not yet been explored. The TRADE-HF study will assess in CRT patients whether a strategy based on automatic management of atrial arrhythmias might be a valuable option to reduce the number of hospital admission and to reduce the progression the arrhythmia to a permanent form. Trial registration NCT00345592

  18. Dispersion of refractoriness in patients with paroxysmal atrial fibrillation. Evaluation with simultaneous endocardial recordings from both atria.

    Science.gov (United States)

    Li, Zhen; Hertervig, Eva; Carlson, Jonas; Johansson, Camilla; Olsson, S Bertil; Yuan, Shiwen

    2002-07-01

    This article studies the role of dispersion of atrial refractoriness (DAR) in the genesis of atrial fibrillation (AF). A 20-polar Halo catheter or a 40-polar basket catheter was placed in the right atrium and a 10-polar catheter in the coronary sinus in 21 patients with paroxysmal AF. Bipolar electrograms during AF were recorded from 7 to 16 sites in both atria. As control, electrograms during AF induced by extra-stimulation or burst pacing were also recorded from 4 to 14 sites in both atria in 12 patients with supraventricular tachycardias but without history of AF. The local atrial fibrillation intervals (AFI) during a period of 10 s or 20 s were measured and the mean, median and the 5th, 10th and 15th percentile AFIs at each site were calculated as estimates of the local effective refractory period (AERP). The maximum dispersion and variance of the estimated AERP among the 7-16/4-14 sites were used as measures of the DAR. The maximum dispersion and variance of the 5th and 10th percentile AFIs were significantly greater in the AF group than those in the control group, which were mainly due to the shortening of the minimum 5th and 10th percentile AFIs. No significant differences in dispersion and variance of the mean and median AFIs were shown between the 2 groups. The dispersion and variance of atrial refractoriness during AF estimated from the measurement of short AFIs were significantly greater in patients with paroxysmal AF than in those without clinical AF. The increased dispersion of refractoriness in patients with AF was mainly due to the shortening of the minimum AFIs. These findings suggest the involvement of an increased dispersion of atrial refractoriness in the genesis of paroxysmal AF. PMID:12122613

  19. Strategies in the Surgical Management of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Leanne Harling

    2011-01-01

    Full Text Available Atrial fibrillation (AF is associated with substantial morbidity, mortality, and economic burden and confers a lifetime risk of up to 25%. Current medical management involves thromboembolism prevention, rate, and rhythm control. An increased understanding of AF pathophysiology has led to enhanced pharmacological and medical therapies; however this is often limited by toxicity, variable symptom control, and inability to modulate the atrial substrate. Surgical AF ablation has been available since the original description of the Cox Maze procedure, either as a standalone or concomitant intervention. Advances in novel energy delivery systems have allowed the development of less technically demanding procedures potentially eliminating the need for median sternotomy and cardiopulmonary bypass. Variations in the definition, duration, and reporting of AF have produced methodological limitations impacting on the validity of interstudy comparisons. Standardization of these parameters may, in future, allow us to further evaluate clinical endpoints and establish the efficacy of these techniques.

  20. INTRAOPERATIVE RADIOFREQUENCY AND CRYOABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH VALVULAR HEART DISEASE

    Directory of Open Access Journals (Sweden)

    N. Maghamipour N. Safaie

    2007-05-01

    Full Text Available Patients with valvular heart disease and suffering atrial fibrillation of more than 12 months duration have a low probability of remaining in sinus rhythm after valve surgery alone. We performed intra-operative radiofrequency ablation or cryoablation as an alternative to surgical maze ІІІ procedure to create linear lesion lines for conversion of this arrhythmia to sinus rhythm. A total of 30 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant maze procedure with radiofrequency or cryo probes. These patients aged 48.10 ± 9.84 years in radiofrequency ablation group and 51.10 ± 13.93 years in cryoablation group. Both atrial ablation with radiofrequency probes, needed 26.15 ± 3.67 min extra ischemic time and ablation by mean of cryo-probes needed an extra ischemic time of 29.62 ± 4.27 min. There was one in hospital death postoperatively because of respiratory failure but no other complication. 6 months after the operation, among 30 patients with both atrial ablations, 25 patients were in sinus rhythm, no patient had junctional rhythm and 5 patients had persistent atrial fibrillation. At 12 months follow up, freedom from atrial fibrillation was 85% in radiofrequency group and 80% in cryo group. Doppler echocardiography in these patients demonstrated atrial contractility in 70% of the patients. Intraoperative radiofrequency or cryo-ablation of both atriums are effective and less invasive alternatives for the original maze procedure to eliminate the atrial fibrillation, and can be done in patients with valvular heart disease without increasing the risk of operation.

  1. Validation of Standard and New Criteria for the Differential Diagnosis of Narrow QRS Tachycardia in Children and Adolescents

    OpenAIRE

    Deutsch, Karol; Stec, Sebastian; Kukla, Piotr; Morka, Aleksandra; Jastrzebski, Marek; Baszko, Artur; Pitak, Maciej; Sledz, Janusz; Fijorek, Kamil; Mazij, Mariusz; Ludwik, Bartosz; Gubaro, Marcin; Szydlowski, Leslaw

    2015-01-01

    Abstract To establish an appropriate treatment strategy and determine if ablation is indicated for patients with narrow QRS complex supraventricular tachycardia (SVT), analysis of a standard 12-lead electrocardiogram (ECG) is required, which can differentiate between the 2 most common mechanisms underlying SVT: atrioventricular nodal reentry tachycardia (AVNRT) and orthodromic atrioventricular reentry tachycardia (OAVRT). Recently, new, highly accurate electrocardiographic criteria for the di...

  2. Deadly proposal: a case of catecholaminergic polymorphic ventricular tachycardia.

    Science.gov (United States)

    Heiner, Jason D; Bullard-Berent, Jeffrey H; Inbar, Shmuel

    2011-11-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare adrenergically mediated arrhythmogenic disorder classically induced by exercise or emotional stress and found in structurally normal hearts. It is an important cause of cardiac syncope and sudden death in childhood. Catecholaminergic polymorphic ventricular tachycardia is a genetic cardiac channelopathy with known mutations involving genes affecting intracellular calcium regulation. We present a case of a 14-year-old boy who had cardiopulmonary arrest after an emotionally induced episode of CPVT while attempting to invite a girl to the school dance. Review of his presenting cardiac rhythm, induction of concerning ventricular arrhythmias during an exercise stress test, and genetic testing confirmed the diagnosis of CPVT. He recovered fully and was treated with β-blocker therapy and placement of an implantable cardioverter-defibrillator. In this report, we discuss this rare but important entity, including its molecular foundation, clinical presentation, basics of diagnosis, therapeutic options, and implications of genetic testing for family members. We also compare CPVT to other notable cardiomyopathic and channelopathic causes of sudden death in youth including hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, long QT syndrome, short QT syndrome, and Brugada syndrome. PMID:22068070

  3. Detection of false arrhythmia alarms with emphasis on ventricular tachycardia.

    Science.gov (United States)

    Rodrigues, Rui; Couto, Paula

    2016-08-01

    Our approach to detecting false arrhythmia alarms in the intensive care unit breaks down into several tasks. It involves beat detection on different signals: electrocardiogram, photoplethysmogram and arterial blood pressure. The quality of each channel has to be estimated in order to evaluate the reliability of obtained beat detections. The information about the heart rate from the different channels must be integrated in order to find a final conclusion. Some alarm types require particular detectors as is the case of ventricular fibrillation. To identify false ventricular tachycardia alarms we needed to classify heart beats as normal/ventricular. For that purpose we introduce a new feature, QRS polarity type. This feature was important in order to reduce misclassification of ventricular beats: there was an improvement in the ventricular tachycardia alarm true positive rate from 69% to 81%. However, the true negative rate was reduced from 95% to 69% and our global challenge score (real-time event) dropped from 79.02 to 74.28. Our challenge algorithm achieved the third best score in the 2015 PhysioNet/CinC challenge event 1 (real time). PMID:27454934

  4. Resting tachycardia, a warning sign in anorexia nervosa: case report

    Directory of Open Access Journals (Sweden)

    Krantz Mori J

    2004-07-01

    Full Text Available Abstract Background Among psychiatric disorders, anorexia nervosa has the highest mortality rate. During an exacerbation of this illness, patients frequently present with nonspecific symptoms. Upon hospitalization, anorexia nervosa patients are often markedly bradycardic, which may be an adaptive response to progressive weight loss and negative energy balance. When anorexia nervosa patients manifest tachycardia, even heart rates in the 80–90 bpm range, a supervening acute illness should be suspected. Case presentation A 52-year old woman with longstanding anorexia nervosa was hospitalized due to progressive leg pain, weakness, and fatigue accompanied by marked weight loss. On physical examination she was cachectic but in no apparent distress. She had fine lanugo-type hair over her face and arms with an erythematous rash noted on her palms and left lower extremity. Her blood pressure was 96/50 mm Hg and resting heart rate was 106 bpm though she appeared euvolemic. Laboratory tests revealed anemia, mild leukocytosis, and hypoalbuminemia. She was initially treated with enteral feedings for an exacerbation of anorexia nervosa, but increasing leukocytosis without fever and worsening left leg pain prompted the diagnosis of an indolent left lower extremity cellulitis. With antibiotic therapy her heart rate decreased to 45 bpm despite minimal restoration of body weight. Conclusions Bradycardia is a characteristic feature of anorexia nervosa particularly with significant weight loss. When anorexia nervosa patients present with nonspecific symptoms, resting tachycardia should prompt a search for potentially life-threatening conditions.

  5. Dermatological Manifestations of Postural Tachycardia Syndrome Are Common and Diverse

    Science.gov (United States)

    Deb, Anindita; Culbertson, Collin; Morgenshtern, Karen; DePold Hohler, Anna

    2016-01-01

    Background and Purpose Postural tachycardia syndrome (POTS) is a syndrome of orthostatic intolerance in the setting of excessive tachycardia with orthostatic challenge, and these symptoms are relieved when recumbent. Apart from symptoms of orthostatic intolerance, there are many other comorbid conditions such as chronic headache, fibromyalgia, gastrointestinal disorders, and sleep disturbances. Dermatological manifestations of POTS are also common and range widely from livedo reticularis to Raynaud's phenomenon. Methods Questionnaires were distributed to 26 patients with POTS who presented to the neurology clinic. They were asked to report on various characteristics of dermatological symptoms, with their answers recorded on a Likert rating scale. Symptoms were considered positive if patients answered with "strongly agree" or "agree", and negative if they answered with "neutral", "strongly disagree", or "disagree". Results The most commonly reported symptom was rash (77%). Raynaud's phenomenon was reported by over half of the patients, and about a quarter of patients reported livedo reticularis. The rash was most commonly found on the arms, legs, and trunk. Some patients reported that the rash could spread, and was likely to be pruritic or painful. Very few reported worsening of symptoms on standing. Conclusions The results suggest that dermatological manifestations in POTS vary but are highly prevalent, and are therefore of important diagnostic and therapeutic significance for physicians and patients alike to gain a better understanding thereof. Further research exploring the underlying pathophysiology, incidence, and treatment strategies is necessary. PMID:26610893

  6. Catecholaminergic polymorphic ventricular tachycardia: An exciting new era

    Directory of Open Access Journals (Sweden)

    Shashank P Behere

    2016-01-01

    Full Text Available Catecholaminergic polymorphic ventricular tachycardia (CPVT is a highly malignant inheritable cardiac channelopathy. The past decade and a half has provided exciting new discoveries elucidating the genetic etiology and pathophysiology of CPVT. This review of the current literature on CPVT aims to summarize the state of the art in our understanding of the genetic etiology and the molecular pathogenesis of CPVT, and how these relate to our current approach to diagnosis and management. We will also shed light on groundbreaking new work that will continue to refine the management of CPVT in the future. As our knowledge of CPVT continues to grow, further studies will yield a better understanding of the efficacy and pitfalls of established diagnostic approaches and therapies as well as help shape newer diagnostic and treatment strategies. Two separate searches were run on the National Center for Biotechnology Information's (NCBI website. The first used the medical subject headings (MeSH database using the term “catecholaminergic polymorphic ventricular tachycardia” that was run on the PubMed database using the age filter (birth to 18 years, and it yielded 58 results. The second search using the MeSH database with the search term “catecholaminergic polymorphic ventricular tachycardia,” applying no filters yielded 178 results. The abstracts of all these articles were studied and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.

  7. Left Atrial Linear Ablation of Paroxysmal Atrial Fibrillation Guided by Three-dimensional Electroanatomical System

    DEFF Research Database (Denmark)

    Zhang, Dai-Fu; Li, Ying; Qi, Wei-Gang;

    2005-01-01

    Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D...

  8. Atrial – Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    T Panagiotopoulos

    2009-05-01

    Full Text Available Atrial and ventricular septal defect constitute the most common congenital heart disease.Aim: Τhe aim of the present retrospective study was to record data and factors that affect atrial and ventricular septal defect.Method and material: The sample study included patients of both sexes who were hospitalized with diagnosis atrial and ventricular septal defect in a Cardiac Surgery hospital of Athens. A specially constructed printed form was used for data collection, where were recorded the demographic and personal variables, the pathological, surgical, cardiology and obstetric history, the habits of adults, as well as the personal characteristics of mothers. Analysis of data was performed by descriptive statistical analysis.Results: The sample study consisted of 101 individuals with diagnosis atrial or ventricular Septal Defect, of which 40% were boys and 60% girls. The 70% of the sample study suffered from atrial Septal Defect and the 30% suffered from ventricular Septal Defect. Regarding age, 12% of the sample study was 0-1 years old, 35% was >1 years old, 8% was >12-18 years old and 45% over than 18 years old. Regarding educational status of the adult participants, 9% was of 0-6 years education, 22%>6 -12 years, 13%>12 years. 14% of the adult paticipants smoked, 4% consumed alcohol and 5% smoked in conjunction with alcohol. In terms of the obstetric history of the sample studied, 32% of the cases had normal birth, 4% had a twin birth and 1% had a triplet one. According to the variables related to mothers, the mean age of the mother was 30 years and 3 months, 10% were smokers at pregnancy and 3% used chemical substance and mainly hair color. Also, the results of the present study showed that individuals of 12-18 and >18 years old did not suffer from ventricular Septal Defect, whereas the infants 0-1 years old did not suffer from Atrial Septal Defect. The mean value of age at the admission in intensive care unit was 7 months (12% for the infants

  9. Left Atrial Appendage Exclusion for Stroke Prevention in Atrial Fibrillation

    OpenAIRE

    Patel, Taral K.; Yancy, Clyde W; Knight, Bradley P.

    2012-01-01

    The public health burden of atrial fibrillation (AF) and associated thromboembolic stroke continues to grow at alarming rates. AF leads to a fivefold increase in the risk of stroke. Therefore, stroke prevention remains the most critical aspect of AF management. Current standard of care focuses on oral systemic anticoagulation, most commonly with warfarin and now with newer agents such as dabigatran, rivaroxaban, and apixaban. However, the challenges and limitations of oral anticoagulation hav...

  10. Implementation of antithrombotic management in atrial fibrillation

    OpenAIRE

    Lairikyengbam, S; Davies, A; Jones, P.

    2000-01-01

    The aim of the study was to assess the extent to which published recommendations on the antithrombotic management of atrial fibrillation had been adopted into clinical practice in a busy district general hospital, and the impact of clinical audit on subsequent management. In the initial audit, 185 consecutive patients with atrial fibrillation were studied using their case notes to identify any further clinical risk factors for stroke. A management algorithm stratified patients with atrial fib...

  11. Minimally Invasive Surgical Therapies for Atrial Fibrillation

    OpenAIRE

    Chu, Michael W.A.; Yoshitsugu Nakamura; Bob Kiaii

    2012-01-01

    Atrial fibrillation is the most common sustained arrhythmia and is associated with significant risks of thromboembolism, stroke, congestive heart failure, and death. There have been major advances in the management of atrial fibrillation including pharmacologic therapies, antithrombotic therapies, and ablation techniques. Surgery for atrial fibrillation, including both concomitant and stand-alone interventions, is an effective therapy to restore sinus rhythm. Minimally invasive surgical ablat...

  12. Low atrial septum pacing in pacemaker patients

    OpenAIRE

    Voogt, Willem Gijsbert de

    2006-01-01

    In patients with an indication for anti bradycardia pacing, atrial fibrillation (AF) is a common arrhythmia (30-50%) even in the absence of atrial tachy arrhythmias before pacemaker implantation. Pace prevention and pace intervention for atrial tachy arrhythmias could be an interesting adjuvant treatment in the prevention of the arrhythmia related complications. These treatment modalities when available in pacemaker systems could come at a relative low cost as the indication for pacemaker imp...

  13. Digoxin:A systematic review in atrial fibrillation,congestive heart failure and post myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Sebastiano; Virgadamo; Richard; Charnigo; Yousef; Darrat; Gustavo; Morales; Claude; S; Elayi

    2015-01-01

    AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction. METHODS: A comprehensive Pub Med search was performed using the key words "digoxin and congestive heart failure", "digoxin and atrial fibrillation", "digoxin, atrial fibrillation and systolic congestive heart failure", and "digoxin and myocardial infarction". Only articles written in English were included in this study. We retained studies originating from randomized controlled trials, registries and included at least 500 patients. The studies included patients with atrial fibrillation or heart failure or myocardial infarction and had a significant proportion of patients(at least 5%) on digoxin. A table reviewing the different hazard ratios was developed based on the articles selected. Our primary endpoint was the overall mortality in the patients on digoxin vs those without digoxin, among patients with atrial fibrillation and also among patients with atrial fibrillation and systolic heart failure. We reviewed the most recent international guidelines to discuss current recommendations.RESULTS: A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm(n = 5), atrial fibrillation with and without systolic congestive heart failure(n = 9), and myocardial infarction(n = 4). Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is employed. However, most of the observational studies evaluating digoxin use in atrial fibrillation without systolic congestive heart failure showed an increase in overall mortality when taking digoxin. In the studies evaluated in this systematic review, the data among patients with atrial fibrillation and systolic congestive heart failure, as well as post myocardial infarction were

  14. Present treatment options for atrial fibrillation

    OpenAIRE

    Lairikyengbam, S; Anderson, M.,; Davies, A

    2003-01-01

    Atrial fibrillation is the commonest sustained cardiac arrhythmia. It accounts for >35% of all hospital admissions for cardiac arrhythmias in the United States. The presence of atrial fibrillation increases the mortality of a population by up to twofold. The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50–59 years of age to up to 23.5% for such patients aged 80–89 years. Although the diagnosis of atrial fibrillation is usually straightforward, effective treatme...

  15. Aspirin Often Wrongly Prescribed for Atrial Fibrillation

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_159459.html Aspirin Often Wrongly Prescribed for Atrial Fibrillation Blood thinners -- not aspirin -- dramatically cut the risk of stroke, researchers say ...

  16. Oclusão percutânea do apêndice atrial esquerdo com o Amplatzer Cardiac PlugTM na fibrilação atrial Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Márcio José Montenegro

    2012-02-01

    , anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation. Objective: To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation. Methods: We report our initial experience with Amplatzer Cardiac PlugTM (St. Jude Medical Inc., Saint Paul, Estados Unidos in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months. Results: In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up. Conclusion: Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.

  17. Mapping Atrial Fibrillation: 2015 Update

    OpenAIRE

    Chirag R. Barbhayia; Saurabh Kumar; Gregory F. Michaud

    2015-01-01

    Atrial fibrillation requires a trigger that initiates the arrhythmia and substrate that favors perpetuation. Cardiac mapping is necessary to locate triggers and substrate so that an ablation strategy can be optimized. The most commonly used cardiac mapping approach is isochronal or activation mapping, which aims to create a spatial model of electrical wavefront propagation. Historically, activation mapping has been successful for mapping point source and single or double wave reentrant arr...

  18. Atrial fibrillation care improvement collaborative

    OpenAIRE

    Robelia, Paul; Kopecky, Stephen; Thacher, Tom

    2015-01-01

    Atrial fibrillation (AF) is an increasingly common cardiac arrhythmia. Many patients with new onset or recurrent AF present to the emergency department and are subsequently admitted to the hospital and seen by cardiology specialists for follow up. In an attempt to address this high utilization of acute health care resources, reduce costs, and improve patient care, our institution instituted a collaborative project between the departments of emergency medicine, cardiology, family medicine, and...

  19. Atrial fibrillation in the elderly

    Institute of Scientific and Technical Information of China (English)

    Roger Kerzner; Michael W. Rich

    2005-01-01

    Atrial fibrillation (AF) is an extremely common condition in the elderly, with increasing prevalence around the world as the population ages. AF may be associated with serious health consequences, including stroke, heart failure, and decreased quality of life, so that careful management of AF by geriatric health care providers is required. With careful attention to anticoagulation therapy, and prudent use of medications and invasive procedures to minimize symptoms, many of the adverse health consequences of AF can be prevented.

  20. Atrial fibrillation after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Once considered as nothing more than a nuisance after cardiac surgery, the importance of postoperative atrial fibrillation (POAF has been realized in the last decade, primarily because of the morbidity associated with the condition. Numerous causative factors have been described without any single factor being singled out as the cause of this complication. POAF has been associated with stroke, renal failure and congestive heart failure, although it is difficult to state whether POAF is directly responsible for these complications. Guidelines have been formulated for prevention of POAF. However, very few cardiothoracic centers follow any form of protocol to prevent POAF. Routine use of prophylaxis would subject all patients to the side effects of anti-arrhythmic drugs, while only a minority of the patients do actually develop this problem postoperatively. Withdrawal of beta blockers in the postoperative period has been implicated as one of the major causes of POAF. Amiodarone, calcium channel blockers and a variety of other pharmacological agents have been used for the prevention of POAF. Atrial pacing is a non-pharmacological measure which has gained popularity in the prevention of POAF. There is considerable controversy regarding whether rate control is superior to rhythm control in the treatment of established atrial fibrillation (AF. Amiodarone plays a central role in both rate control and rhythm control in postoperative AF. Newer drugs like dronedarone and ranazoline are likely to come into the market in the coming years.

  1. A report of acute atrial fibrillation induced by misapplication of epinephrine

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2015-06-01

    Full Text Available Urticaria is a systemic allergic reaction leading to wheal formation with skin itching. Occasionally we come across some intractable cases, in which we may administrate epinephrine infusion besides steroid and anti-histamine. A 19 year-old man suffered from intractable urticaria for 2 days, although anti-histamine and steroids were used. Titration of adrenaline was considered in the treatment of intractable urticaria. He was administrated 1 mg epinephrine intravenous bolus due to mis-dilution by the nurse. Transient atrial fibrillation with cardiac ischemia occurred. After 12.5 mg labetalol i.v., and 11-hour observation in the emergency room, he gradually recovered to normal sinus rhythm without ST-T change. In the past, ventricular tachycardia, hypertension, chest pain, pulmonary edema, the need to intubate, renal failure requiring renal transplant, coronary artery spasm, myocardial ischemia/infarction and hypokalemia have been reported after mis-diluted or excessive doses of epinephrine in treating anaphylaxis. To our knowledge, our case is the first worldwide to describe transient atrial fibrillation after epinephrine overdose, and the patient was successfully resuscitated by 12.5 mg labetalol. It is important to know how to rescue accidental epinephrine intravenous injection patients.

  2. A report of acute atrial fibrillation induced by misapplication of epinephrine

    Institute of Scientific and Technical Information of China (English)

    Yu-Jang Su

    2015-01-01

    Urticaria is a systemic allergic reaction leading to wheal formation with skin itching. Occasionally we come across some intractable cases, in which we may administrate epinephrine infusion besides steroid and anti-histamine. A 19 year-old man suffered from intractable urticaria for 2 days, although anti-histamine and steroids were used. Titration of adrenaline was considered in the treatment of intractable urticaria. He was administrated 1 mg epinephrine intravenous bolus due to mis-dilution by the nurse. Transient atrial fibrillation with cardiac ischemia occurred. After 12.5 mg labetalol i.v., and 11-hour observation in the emergency room, he gradually recovered to normal sinus rhythm without ST-T change. In the past, ventricular tachycardia, hypertension, chest pain, pulmonary edema, the need to intubate, renal failure requiring renal transplant, coronary artery spasm, myocardial ischemia/infarction and hypokalemia have been reported after mis-diluted or excessive doses of epinephrine in treating anaphylaxis. To our knowledge, our case is the first worldwide to describe transient atrial fibrillation after epinephrine overdose, and the patient was successfully resuscitated by 12.5 mg labetalol. It is important to know how to rescue accidental epinephrine intravenous injection patients.

  3. Atrial natriuretic factor: radioimmunoassay and effects on adrenal and pituitary glands

    Energy Technology Data Exchange (ETDEWEB)

    Gutkowska, J.; Horky, K.; Schiffrin, E.L.; Thibault, G.; Garcia, R.; De Lean, A.; Hamet, P.; Tremblay, J.; Anand-Srivastava, M.B.; Januszewicz, P.

    1986-06-01

    A simple and sensitive radioimmunoassay was developed for measurement of immunoreactive atrial natriuretic factor (IR-ANF) in rat and human plasma and in rat atria. The two atria contain about 20 ..mu..g ANF per rat. The right atrium contained 2.5 times more ANF than did the left. Ether anesthesia and morphine markedly increased IR-ANF in rat plasma. The concentration of IR-ANF in plasma of clinically normal human subjects was 65.3 +/- 2.5 pg/ml. Paroxysmal tachycardia and rapid atrial pacing significantly increased IR-ANF in human plasma. Two- to seven-fold higher concentrations were found in coronary sinus blood than in the peripheral circulation. In the plasma of rats and humans, circulating ANF is probably a small-molecular-weight peptide. ANF acts on the adrenal and the pituitary. ANF inhibits aldosterone secretion from rat zona glomerulosa and steroid secretion by bovine adrenal zona glomerulosa and fasciculata. ANF stimulated the basal secretion of arginine vasopressin (AVP) in vitro and inhibited KCl-stimulated release of AVP.

  4. Electrocardiographic characteristics and radiofrequency catheter ablation of ventricular tachycardia and frequent ventricular premature contractions originating from left ventricular outflow tract%射频消融治疗起源于左室流出道的室性心动过速和频发室性期前收缩

    Institute of Scientific and Technical Information of China (English)

    陈宏; 张薇薇; 李荣琴; 李占全; 崔然

    2008-01-01

    目的 探讨源自左室流出道部位的室性心动过速(室速)和室性期前收缩(室早)的心电图特点和射频消融的安全性.方法 对9例于左室流出道部位消融的室速/室早病例的心电图和射频消融情况进行归纳总结.结果 消融成功部位6例在左冠窦内,3例在主动脉瓣下.心电图特点:(1)Ⅱ、Ⅲ、avF导联均呈高R波;(2)aVR和aVL导联均呈QS型,且aVL振幅多大于aVR;(3)Ⅰ导联多呈QS型;(4)V1导联R波偏高:R/S>0.62;(5)胸前导联R波移行不规则;(6)V5、V6多呈R型.9例均消融成功,无复发病例,无左主干及主动脉瓣损伤.结论 源自左室流出道的室速/室早具有独特的心电图表现,射频消融能安全有效地根治此类心律失常.%Objective To investigate the electrocardiographic(ECG) characteristics and assess the safety of radiofrequency catheter ablation (RFCA) of ventricular tachyeardia (VT), and frequent ventricular premature con- tractious(VPCs) originating from left ventricular outflow tract(LVOT). Methods Twelve-lead ECG analysis and RFCA were performed in 9 patient with VT or VPCs originating from LVOT. Results The sites to be successfully ablated were in left valsalva sinus in 6 patients,and subaortic valve in 3 patient. ECG revealed tall R wave in leads Ⅱ, Ⅲ ,aVF, V5 and V6. QS morphology in both leads aVR and aVL,QS morphology in lead Ⅰ in most cases. R wave in lead Ⅰ was relative tall, the R/S wave amplitude in lead V1 was over 0.62 ,and precordia R wave transition was irregular. All 9 patients were successfully ablated. No death or recurrenced case during follow-up. Conclusion Ventricular taehycardia and frequent ventricular premature rcontractions originating from left ventricutar outflow tract could be known by some specific ECG characteristics and could be radically treated safely by RFCA.

  5. Osteopathic manipulative treatment for postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Goodkin, Michael B; Bellew, Lawrence J

    2014-11-01

    Postural orthostatic tachycardia syndrome (POTS) is associated with many symptoms including orthostatic intolerance, fatigue, palpitations, and cognitive dysfunction. Treatment, which typically consists of exercise, increased dietary sodium and fluids, compression garments, and medications for orthostatic intolerance, frequently produces unsatisfactory results. The authors report the case of a 26-year-old woman who presented with a 6-year history of severe fatigue, orthostatic intolerance, heat intolerance, cognitive dysfunction, and diffuse pain. She had previously injured her jaw on an obstacle course. Results of a standing test were consistent with POTS. After standard medical therapy was unsuccessful, the patient was referred for osteopathic manipulative treatment. At her 18-month follow-up, the patient's symptoms had improved dramatically. Physicians should consider osteopathic evaluation and manipulative treatment when caring for patients with POTS.

  6. Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Andreas Müssigbrodt

    2015-01-01

    Full Text Available Radiofrequency (RF ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.

  7. Long-term results of a minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Shuai Zheng

    Full Text Available BACKGROUND: Ganglionated plexi (GP ablation has been become an adjunct to pulmonary vein isolation (PVI. This study describes the long-term results of minimally invasive surgical PVI, ablation of GPs, and exclusion of the left atrial appendage for atrial fibrillation (AF. METHODS: Long-term follow-up of 55 months was performed in 139 consecutive patients (age 58.3±20.8 years with symptomatic, drug-refractory lone AF who underwent minimally invasive surgical PVI, GPs ablation, and exclusion of the left atrial appendage. Success was defined as freedom from AF, atrial flutter, or atrial tachycardia off antiarrhythmic drugs. RESULTS: AF was paroxysmal in 77.7%, persistent in 12.2% and long-standing persistent in 10.1%. Single-procedure success rate was 71.7%, 59.4% and 46.6% at 12, 24 and 60 months respectively. Single-procedure success rate was 72.9%, 62.6% and 51.8% for paroxysmal AF, 64.7%, 35.3%, and 28.2% for persistent AF, 71.4%, 64.3% and 28.6% for long-standing persistent AF at 12, 24 and 60 months respectively. Duration of AF>24 months (hazard ratio [HR]: 3.09, 95% confidence interval [CI]: 1.51 to 6.32; p = 0.002, left atrial diameter≥40 mm (HR: 4.03, 95% CI: 1.88 to 8.65; p<0.001, early recurrence of AF (HR: 4.66, 95% CI: 2.25 to 9.63; p<0.001 independently predicted long-term recurrence of AF. There was no procedure-related death. One patient converted to median sternotomy because of uncontrolled bleeding. Two patients underwent perioperative cerebrovascular events. CONCLUSIONS: At nearly 5-year of clinical follow-up, single-procedure success rate of minimally invasive surgical PVI with GP ablation was 51.8% for paroxysmal AF, 28.2% for persistent AF, 28.6% for long-standing persistent AF after initial procedure. Patients with AF duration≤24 months, left atrial diameter<40 mm and no early recurrence of AF, had favorable outcomes.

  8. Atrial Arrhythmia Summit: Post Summit Report

    Science.gov (United States)

    Barr, Yael

    2010-01-01

    The Atrial Arrhythmia Summit brought together nationally and internationally recognized experts in cardiology, electrophysiology, exercise physiology, and space medicine in an effort to elucidate the mechanisms, risk factors, and management of atrial arrhythmias in the unique occupational cohort of the U.S. astronaut corps.

  9. PAROXYSMAL ATRIAL FIBRILLATION: CHOICE OF CARDIOVERSION THERAPY

    Directory of Open Access Journals (Sweden)

    B. A. Tatarskii

    2015-12-01

    Full Text Available Characteristics and classification of different patterns of paroxysmal atrial fibrillation are presented. Main indications to restoration of sinus rhythm are discussed. The features of main medications used to terminate of atrial fibrillation are given. The choice of antiarrhythmic drug is considerate. Necessity of individual approach to therapy tactics is proved.

  10. A novel and simple atrial retractor.

    Science.gov (United States)

    Kofidis, Theo; Lee, Chuen Neng

    2011-05-01

    Minimally invasive cardiac operations require specialized equipment. Atrial retractors are a frequently used tool to expose heart valves for minimally invasive and open procedures. The models currently available in the market are efficient; however, they may be complex, bulky, or expensive. We introduce a novel, very simple atrial retractor we designed using ubiquitously available materials. PMID:21524488

  11. 4246 Hypercoagulability promotes atrial fibrosis and fibrillation

    NARCIS (Netherlands)

    Schotten, Ulrich; Verheule, Sander; De Jong, Anne-Margreet; De Boer, Hetty; Maass, Alexander H.; Lau, Dennis H.; Rienstra, Michiel; Kamphuisen, Pieter W.; Ten Cate, Hugo; Crijns, Harry J.G.; Van Gelder, Isabelle C.; Van Zonneveld, Anton J.; Spronk, Henri

    2014-01-01

    Introduction: Atrial fibrillation (AF) induces a hypercoagulable state. Coagulation factors provoke pro-fibrotic, pro-hypertrophic, and pro-inflammatory responses in a variety of tissues by stimulation of protease-activated receptors. We studied whether hypercoagulability causes atrial fibrosis and

  12. Corticosteroids and the risk of atrial fibrillation

    NARCIS (Netherlands)

    van der Hooft, CS; Heeringa, J; Brusselle, GG; Hofman, A; Witteman, JCM; Kingma, JH; Sturkenboom, MCJM; Stricker, BHC

    2006-01-01

    Background: High-dose ( pulse) corticosteroid therapy has been associated with the development of atrial fibrillation. This association, however, is mainly based on case reports. Methods: To test the hypothesis that high-dose corticosteroid exposure increases the risk of new-onset atrial fibrillatio

  13. A novel and simple atrial retractor.

    Science.gov (United States)

    Kofidis, Theo; Lee, Chuen Neng

    2011-05-01

    Minimally invasive cardiac operations require specialized equipment. Atrial retractors are a frequently used tool to expose heart valves for minimally invasive and open procedures. The models currently available in the market are efficient; however, they may be complex, bulky, or expensive. We introduce a novel, very simple atrial retractor we designed using ubiquitously available materials.

  14. Blocked atrial bigeminy presenting with bradycardia.

    Science.gov (United States)

    Akdeniz, Celal; Tanidir, Ibrahim Cansaran; Tuzcu, Volkan

    2012-01-01

    Blocked premature atrial contractions can cause bradycardia by resetting sinoatrial node and prolonging the RR intervals. Herein, we report the management of a patient with frequent premature atrial contractions in bigeminal pattern. The patient presented with symptomatic bradycardia and was successfully treated with propafenone. PMID:22469245

  15. Galectin-3 in patients undergoing ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Nicolas Clementy

    2014-11-01

    Conclusions: Persistent type of atrial fibrillation is an independent predictor of higher Galectin-3 concentration. This biomarker of fibrosis may be implied in the mechanisms of atrial remodeling and maintenance of atrial fibrillation, and thus be helpful for the design of therapeutic strategy in patients with atrial fibrillation.

  16. Aliskiren protecting atrial structural remodeling from rapid atrial pacing in a canine model.

    Science.gov (United States)

    Zhao, Zhiqiang; Chen, Yan; Li, Weimin; Wang, Xinghua; Li, Jian; Yang, Wansong; Cheng, Lijun; Liu, Tong; Liu, Enzhao; Li, Guangping

    2016-08-01

    Atrial fibrillation (AF) contributing to the increasing mortality risk is the most common disease in clinical practice. Owing to the side effects and relative inefficacy of current antiarrhythmic drugs, some research focuses on renin-angiotensin-aldosterone system (RAS) for finding out the new treatment of AF. The purpose of this study is to confirm whether aliskiren as a proximal inhibitor of renin, which completely inhibits RAS, has beneficial effects on atrial structural remodeling in AF. In this study, rapid atrial pacing was induced at 500 beats per minute for 2 weeks in a canine model. A different dose of aliskiren was given orally for 2 weeks before rapid atrial pacing. HE staining and Masson's staining were used for analysis of myocardial fibrosis. TGF-β1, signal pathways, and pro-inflammatory cytokines were shown for the mechanism of structural remodeling after the treatment of aliskiren. Serious atrial fibrosis was induced by rapid atrial pacing, followed by the elevated TGF-β1, upregulated MEK and ERK1/2, and increased inflammatory factors. Aliskiren could apparently improve myocardial fibrosis by reducing the expression of TGF-β1, inhibiting MEK and ERK1/2 signal pathways, and decreasing IL-18 and TLR4 in both serum and atrial tissue. In conclusion, aliskiren could prevent atrial structural remodeling from rapid atrial pacing for 2 weeks. Aliskiren may play a potential beneficial role in the treatment of AF induced by rapid atrial pacing. PMID:27118660

  17. Atrial and ventricular volume and function in persistent and permanent atrial fibrillation, a magnetic resonance imaging study

    DEFF Research Database (Denmark)

    Therkelsen, Susette Krohn; Groenning, Bjoern Aaris; Svendsen, Jesper Hastrup;

    2005-01-01

    Left atrial size is independently related to cardiovascular morbidity and mortality, and atrial fibrillation (AF) is strongly associated with atrial size. Our aims were to report atrial and ventricular dimensions in patients with AF evaluated with magnetic resonance imaging (MRI), and to assess t...

  18. Differential gene expression during atrial structural remodeling in human left and right atrial appendages in atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Hui Zhu; Wei Zhang; Ming Zhong; Gong Zhang; Yun Zhang

    2011-01-01

    Extracellular matrix (ECM) remodeling increases the vulnerability to atrial fibrillation (AF). Some gene expressions are crucial for the metabolism of ECM. The left atrium plays an important role in maintaining AF.However, most studies investigated only the right atrial tissue. We therefore chose human tissue samples from both the left and right atrial to detect the different gene expressions during structural remodeling in AF. The atrial appendages tissue samples from 24 patients with chronic AF and 12 patients with sinus rhythm were obtained when they were undergoing mitral/aortic valve replacement operation. The mRNA levels of matrix metalloproteinases-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), disintegrin, metalloproteases-15, and integrins β1 were determined by reverse transcriptionpolymerase chain reaction (RT-PCR). in AF group, the level of MMP-9 in left atrial appendage (LAA) was increased (P<0.001), while integrin β1 level was decreased (P< 0.05) compared with those expressed in right atrial appendage (RAA) tissue. The levels of disintegrin, metalloproteinases-15, and TIMP-1 genes in the LAA and RAA had no significant differences. The results demonstrated that the gene expressions in the LAA and RAA are different during AF, which implied that the mechanism of atrial structural remodeling in AF is due to multiple sources and is complicated.

  19. Simultaneous wide and narrow QRS complex tachycardia: what is the mechanism?

    NARCIS (Netherlands)

    Rodriguez-Manero, M.; Bayrak, F.; Namdar, M.; Casado-Arroyo, R.; Ricciardi, D.; Chierchia, G.B.; Sarkozy, A.; Asmundis, C. de; Brugada, P.

    2013-01-01

    We present the case of a 50-year-old patient with several episodes of syncope and documented simultaneous wide and narrow QRS complex tachycardia. We then review this tacharrhythmia, focusing on electrophysiological findings and pathophysiology, diagnosis and treatment.

  20. Orthodeoxia and postural orthostatic tachycardia in patients with pulmonary arteriovenous malformations: a prospective 8-year series.

    Science.gov (United States)

    Santhirapala, V; Chamali, B; McKernan, H; Tighe, H C; Williams, L C; Springett, J T; Bellenberg, H R; Whitaker, A J; Shovlin, C L

    2014-11-01

    Postural changes in 258 patients with pulmonary arteriovenous malformations (PAVMs) reviewed between 2005 and 2013 were evaluated prospectively using validated pulse oximetry methods. Of the 257 completing the test, 75 (29%) demonstrated orthodeoxia with an oxygen saturation fall of at least 2% on standing. None described platypnoea (dyspnoea on standing). The heart rate was consistently higher in the erect posture: 74 (29%) had a postural orthostatic tachycardia of ≥20 min(-1), and in 25 (10%) this exceeded 30 min(-1). Orthostatic tachycardia was more pronounced in PAVM patients than controls without orthodeoxia (age-adjusted coefficient 5.5 (95% CIs 2.6, 8.4) min(-1), ppostural orthostatic tachycardia syndrome, in this population, there was a trend for more pronounced orthostatic tachycardia to be associated with better exercise tolerance.

  1. Current Issues in Atrial Fibrillation

    OpenAIRE

    Khaykin, Yaariv; Shamiss, Yana

    2012-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It places an enormous burden on the patients, caregivers, and the society at large. While the main themes in the care of an AF patient have not changed over the years and continue to focus on stroke prevention, control of the ventricular, rate and rhythm maintenance, there have been a number of new developments in each of these realms. This paper will discuss the “hot” topics in AF in 2012 including new and upcoming med...

  2. Dysphagia Lusoria with atrial septal defect: Simultaneous repair through midline

    International Nuclear Information System (INIS)

    An aberrant right subclavian artery from the descending aorta is almost always reported as an isolated anomaly. We present the case of a four-year-old child with an anomalous origin of the right subclavian artery from the descending aorta, associated with an ostium secundum atrial septal defect. The patient underwent simultaneous repair of both the anomalies through median sternotomy, with implantation of the subclavian artery into the right common carotid artery. We believe that median sternotomy is the optimal surgical approach for the management of these lesions. Other operative approaches are also discussed

  3. Case report of Plasmodium falciparum malaria presenting as wide complex tachycardia

    Institute of Scientific and Technical Information of China (English)

    Sunil Kumar; Diwan SK; Mahajan SN; Shilpa Bawankule; Chetan Mahure

    2011-01-01

    Malaria caused by Plasmodium falciparum is a multisystem disorder and may have diversity of clinical presentations. We are presenting a case report of patients of falciparum malaria who presented to us with palpitation and fever. On electrocardiogram he had wide complex tachycardia. This case reiterates the need to think of malaria in any case with symptoms of fever with chills, even with various unusual presentations like palpitation due to wide complex tachycardia, especially in endemic country like India.

  4. Characterization of the 5-HT4 receptor mediating tachycardia in piglet isolated right atrium.

    OpenAIRE

    Medhurst, A. D.; Kaumann, A J

    1993-01-01

    1. In order to explore whether 5-HT4 receptor subtypes exist, we have characterized further the 5-HT4 receptor that mediates tachycardia in the piglet isolated right atrium. All experiments were carried out in the presence of propranolol (400 nM) and cocaine (6 microM). We used tryptamine derivatives, substituted benzamides and benzimidazolone derivatives as pharmacological tools. 2. Tachycardia responses to 5-hydroxytryptamine (5-HT) were mimicked by other tryptamine derivatives with the fol...

  5. A novel approach for the diagnosis of ventricular tachycardia based on phase space reconstruction of ECG

    OpenAIRE

    Koulaouzidis, George; Das, Saptarshi; Cappiello, Grazia; Mazomenos, Evangelos; Maharatna, Koushik; Morgan, John

    2014-01-01

    Ventricular arrhythmias comprise a group of disorders which manifest clinically in a variety of ways from ventricular premature beats (VPB) and no sustained ventricular tachycardia (in healthy subjects) to sudden cardiac death due to ventricular tachyarrhythmia in patients with and/or without structural heart disease. Ventricular fibrillation (VF) and ventricular tachycardia (VT) are the most common electrical mechanisms for cardiac arrest. Accurate and automatic recognition of these arrhythm...

  6. Electrical and Hemodynamic Evaluation of Ventricular and Supraventricular Tachycardias with an Implantable Cardiac Stimulator

    OpenAIRE

    Claudio Pandozi MD; Franco Di Gregorio BiolScD; Carlo Lavalle MD; Renato Pietro Ricci MD; Sabina Ficili MD; Marco Galeazzi MD; Maurizio Russo MD; Angela Pandozi MD; Furio Colivicchi MD; Massimo Santini MD

    2014-01-01

    The discrimination between ventricular and supraventricular tachycardia and the evaluation of their hemodynamic impact are essential issues in the arrhythmia management. A new pacing device features a tachycardia diagnostic system relying on simultaneous recording of the transvalvular impedance (TVI) and the iECG, which is an integrated electric signal derived by the whole set of endocardial electrodes. The iECG waveform is sensitive to the pattern of ventricular activation, similarly to the ...

  7. Exercise-Induced Right Ventricular Outflow Tract Tachycardia in a Patient with Isolated Left Ventricular Noncompaction

    OpenAIRE

    Mehmet Eren; Erkan İlhan; Ahmet Taha Alper; Tolga Sinan Güvenç

    2011-01-01

    Isolated left ventricular noncompaction is a hereditary cardiomyopathy in which a variety of supraventricular and ventricular arrhythmias could be observed. We report a patient with exercise-induced ventricular tachycardia with left bundle branch block morphology that had characteristics of an idiopathic ventricular tachycardia who was subsequently diagnosed as left ventricular noncompaction. Successful remission of arrhythmia was ensured after the introduction of oral beta-blocker therapy.

  8. Relationships of High-sensitive C-reactive Protein and P-wave Dispersion in Lone Atrial Fibrillation

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    Li-Hui Zheng

    2015-01-01

    Full Text Available Background: Current evidence links atrial fibrillation (AF to the inflammation. Inflammatory indexes such as high-sensitive C-reactive protein (hs-CRP have been related to the development and persistence of AF. However, the role of inflammation in the atrial electrophysiological remodeling indexed by P-wave dispersion (P d remains unclear. Methods: The study consisted of 71 patients with lone paroxysmal AF (AF group and 71 age- and gender-matched controls of paroxysmal supraventricular tachycardia without history of AF (control group. Electrocardiography, P d , hs-CRP, and other clinical characteristics were compared between the two groups. Results: There was no significant difference between the two groups regarding age, gender, hyperlipidemia, etc. Compared to controls, left atrial diameter (44 ± 7 vs 39 ± 7 mm, P d (49 ± 13 vs 26 ± 8 ms, and hs-CRP (2.17 [1.46-2.89] vs 1.12 [0.74-1.41] mg/L were increased (P < 0.05, respectively. Linear regression identified hs-CRP as an independent correlation of P d level both in the total population and the AF group (r = 0.464 and 0.313; P < 0.001, respectively. Multiple logistic regression revealed hs-CRP as an independent determinant of AF (odds ratio [OR] =15.430, 95% confidence interval: 6.031-39.476: P <0.001. Further adjusted for P d , both P d and hs-CRP were independent predictors for AF, but the OR for hs-CRP in predicting AF has been attenuated from 15.430 to 6.246. Conclusions: In lone AF, P d and plasma hs-CRP concentration are inter-associated and related to AF. The interaction between hs-CRP and AF may be mediated by P d , suggesting an important role of inflammation in the atrial electrophysiological remodeling predisposing to AF.

  9. The developing pulmonary veins and left atrium: implications for ablation strategy for atrial fibrillation.

    Science.gov (United States)

    Sherif, Hisham M F

    2013-11-01

    The majority of cases of atrial fibrillation (AF) are the result of triggers originating in the area of the pulmonary veins. The reason for the predilection for that area remains unclear. We sought to examine the different mechanisms responsible for this observation through an extensive search of the medical literature, examining the development of the pulmonary veins, genetics of AF and left to -right cardiac chamber differentiation. Results confirm that the LAA is anatomically and embryologically different from other areas of the atrial walls and develops under distinct genetic and transcriptional pathways. Findings support an ablation strategy whose primary focus should be the creation of a 'box' lesion set, plus additional lines to prevent propagation to the left atrial appendage, the isthmus of the left atrium and the right atrium are likely to be more effective than simple pulmonary vein isolation.

  10. Avaliação da atividade elétrica atrial em pacientes submetidos ao tratamento cirúrgico da valvopatia mitral Evaluation of atrial electrical activity in patients operated on mitral valve disease

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    Cesar Augusto Ferreira

    2002-01-01

    . The classical right lateral subseptal access may sometimes provide difficult exposure, so that alternative approaches are used whose effects on atrial electrical activity are contradictory. OBJECTIVE:To standardize an investigative method to evaluate heart electrical activity post-op. METHODS: Ten consecutive adult patients with mitral valve disease were operated on. Surface electrocardiogram and continuous electrocardiographic monitoring (Holter system pre and post-op., and epicardical cardioestimulation post-op. were used to study cardiac electric activity. RESULTS: There was no mortality. All patients with sinus rhythm presented supraventricular ectopia, with episodes of supraventricular tachycardia in 57%, atrial flutter in 10%, and junctional rhythm in 10%. All patients presented ventricular ectopia, with a low incidence in 70% of them and with unsustained ventricular tachycardia in 30%. During the postoperative period there was a 40% rate of new supraventricular arrhythmias (atrial fibrillation, junctional rhythm, low atrial rhythm, and paroxistic supraventricular tachycardia, with no ventricular arrhythmias. Post-op. sinus node function was preserved. There was a significant reduction of supraventricular ectopia, with reversal of atrial fibrillation to sinus rhythm in one patient. Although there was a significant reduction in left atrium size post-op, P wave duration, as well as ventricular ectopia rate remained unchanged. Interatrial conduction time correlated with left atrium size measured pre and post-op. CONCLUSION: The methods proved useful to evaluate atrial electric activity in patients operated upon by the classic subseptal access, thus permitting future comparisons with other surgical approaches to the mitral valve.

  11. 经食道心房调博对阵发性室上性心动过速的疗效%The Efficacy of Transesophageal atrical Pacing on Paroxysmal Supraventricular Tachycardia

    Institute of Scientific and Technical Information of China (English)

    韦晓兰

    2013-01-01

    Objective To evaluate clinical value of paroxysmal supraventricular tachycardia (PSVT) by transesophageal atrial pacing (TEAP). Methods 70 patients with PSVT used TEAP. Results 66 patients with PSVT could been terminated by TEAP, the total effective rate is 94.29%. Conclusions TEAP had high clinical value to the PSVT.%  目的评价经食管心房调搏(TEAP)对阵发性室上性心动过速(PSVT)的疗效.方法对70例 PSVT 患者进行 TEAP.结果66例病人发生的 PSVT 经TEAP 终止,总有效率94.29%.结论 TEAP 治疗 PSVT 效果满意.

  12. Cardioversion in Acute Atrial Fibrillation without Anticoagulation

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    KE Juhani Airaksinen, MD, PhD; Wail Nammas, MD, PhD; Ilpo Nuotio, MD, PhD

    2013-12-01

    Full Text Available The main alternative therapeutic strategies for acute atrial fibrillation are rate versus rhythm control. A major concern in cardioversion of newly detected atrial fibrillation is the risk of thromboembolic events. The vast majority of these events occur in the first week following cardioversion. Transesophageal echocardiography has demonstrated that thrombus and dense spontaneous echo contrast may occur in the left atrium and left atrial appendage also in patients with acute atrial fibrillation (<48 hours scheduled for cardioversion. Moreover, atrial function may become impaired immediately following successful cardioversion. Thus, the current North American and European guidelines recommend that patients with acute atrial fibrillation should undergo cardioversion under cover of unfractionated or low-molecular weight heparin followed by oral anticoagulation for at least 4 weeks in patients in patients at moderate-to-high risk for stroke. In line with the guidelines, new evidence from a large patient population suggests that after successful cardioversion of acute atrial fibrillation, patients have a low overall risk of thromboembolic events without any anticoagulation when they have no risk factors for thromboembolism. In contrast, the risk is in the range of 10% in patients with multiple classic risk factors for thromboembolism.

  13. Acute treatment of atrial fibrillation.

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    Kowey, P R; Marinchak, R A; Rials, S J; Filart, R A

    1998-03-12

    Atrial fibrillation (AFib) is a common clinical entity, responsible for significant morbidity and mortality, but it also accounts for a large percentage of healthcare dollar expenditures. Efforts to treat this arrhythmia in the past have focused on subacute antithrombotic therapy and eventually use of antiarrhythmic drugs for maintenance of sinus rhythm. However, there has been a growing interest in the concept of acute electrical and pharmacologic conversion. This treatment strategy has a number of benefits, including immediate alleviation of patient symptoms, avoidance of antithrombotic therapy, and prevention of electrophysiologic remodeling, which is thought to contribute to the perpetuation of the arrhythmia. There is also increasing evidence that this is a cost-effective strategy in that it may obviate admission to the hospital and the cost of long-term therapy. This article represents a summary of the treatments that may be used acutely to control the ventricular response to AFib, prevent thromboembolic events, and provide for acute conversion either pharmacologically or electrically. It includes information on modalities that are currently available and those that are under active development. We anticipate that an active, acute treatment approach to AFib and atrial flutter will become the therapeutic norm in the next few years, especially as the benefits of these interventions are demonstrated in clinical trials. PMID:9525568

  14. Impact of pulmonary vein isolation on atrial vagal activity and atrial electrical remodeling

    Institute of Scientific and Technical Information of China (English)

    Yingxue Dong; Shulong Zhang; Lianjun Gao; Hongwei Zhao; Donghui Yang; Yunlong Xia; Yanzong Yang

    2008-01-01

    Objective Mechanisms of pulmonary vein isolation (PVI) for atrial fibrillation remain controversy.This study aimed to investigate the impact of PVI on vagal modulation to atria.Methods Eighteen adult mongrel dogs under general anesthesia were randomly divided into two groups.Bilateral cervical sympathovagal trunks were decentralized and sympathetic effects was blocked by metoprolol administration.Atrial electrical remodeling (AER) was established by rapid right atrial pacing at the rate of 600 bpm for 30 minutes.PVI was performed in group A.Atrial effective refractory period (ERP),vulnerability window (VW) of atrial fibrillation,and sinus rhythm cycle length (SCL) were measured at baseline and during vagal stimulation before and after atrial rapid pacing with and without PVI at fight atrial appendage (RAA),left atrial appendage (LAA),distal coronary sinus (CSd) and proximal coronary sinus (CSp).Results (1) Effects of PVI on vagal modulation:Shortening of SCL during vagal stimulation decreased significantly after PVI compared with that before PVI in group A (P<0.001).Shortening of ERP during vagal stimulation decreaseed significantly after PVI compared with that before PVI (P<0.05).VW of atrial fibrillation during vagal stimulation decreased significantly after PVI compared with that before PVI (P<0.05).(2) Effects of PVI on AER:shortening of ERP before and after atrial rapid pacing increased significantly at baseline and vagal stimulation in group B compared with that in group A (P<0.05).VW during vagal stimulation increased significantly after atrial rapid pacing in group B (P<0.05).Conclusion PVI attenuates the vagal modulation to the atria,thereby decreases the susceptibility to atrial fibrillation mediated by vagal activity.PVI releases AER,which maybe contributes to the vagal denervation.Our study indicates that PVI not only can eradicate triggered foci but also modify substrates for AF.(J Geriatr Cardiol 2008;5:28-32)

  15. Extracellular Matrix Remodeling in Atrial Fibrosis: Mechanisms and Implications in Atrial Fibrillation

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    Pellman, Jason; Lyon, Robert C.; Sheikh, Farah

    2009-01-01

    Atrial fibrosis has been strongly associated with the presence of heart diseases/arrhythmias, including congestive heart failure (CHF) and atrial fibrillation (AF). Inducibility of AF as a result of atrial fibrosis has been the subject of intense recent investigation, since it is the most commonly encountered arrhythmia in adults and can substantially increase the risk of premature death. Rhythm and rate control drugs as well as surgical interventions are used as therapies for AF; however, in...

  16. Sinus Venosus Atrial Septal Defect as a Cause of Palpitations and Dyspnea in an Adult: A Diagnostic Imaging Challenge

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    Michael S. Donovan

    2015-01-01

    Full Text Available Sinus venosus atrial septal defects (SV-ASD have nonspecific clinical presentations and represent a diagnostic imaging challenge. Transthoracic echocardiography (TTE remains the initial diagnostic imaging modality. However, detection rates have been as low as 12%. Transesophageal echocardiography (TEE improves diagnostic accuracy though it may not detect commonly associated partial anomalous pulmonary venous return (PAPVR. Cardiac magnetic resonance (CMR imaging provides a noninvasive, highly sensitive and specific imaging modality of SV-ASD. We describe a case of an adult male with exercise-induced, paroxysmal supraventricular tachycardia who presented with palpitations and dyspnea. Despite nondiagnostic imaging results on TTE, CMR proved to be instrumental in visualizing a hemodynamically significant SV-ASD with PAPVR that ultimately led to surgical correction.

  17. Changes in autonomic activity preceding onset of nonsustained ventricular tachycardia

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    Osaka, M.; Saitoh, H.; Sasabe, N.; Atarashi, H.; Katoh, T.; Hayakawa, H.; Cohen, R. J.

    1996-01-01

    Background: The triggering role of the autonomic nervous system in the initiation of ventricular tachycardia has not been established. To investigate the relationship between changes in autonomic activity and the occurrence of nonsustained ventricular tachycardia (NSVT) we examined heart rate variability (HRV) during the 2-hour period preceding spontaneous episodes of NSVT. Twenty-four subjects were identified retrospectively as having had one episode of NSVT during 24-hour Holter ECC recording. Methods: We measured the mean interval between normal heats (meanRR), the standard deviation of the intervals between beats (SD), the percentage of counts of sequential intervals between normal beats with a change of >50 ms (%RR50), the logarithms of low- and high-frequency spectral components (lnLF, lnHF) of HRV for sequential 10-minute segments preceding NSVT. The correlation dimension (CDim) of HRV was calculated similarly for sequential 20-minute segments. We assessed the significance of the time-course change of each marker over the 120-minute period prior to NSVT onset. Results: MeanRR (P < 0.05), lnLF (P < 0.0001), lnHF (P < 0.0001), the natural logarithm of the ratio of LF to HF (ln[LF/HF]; P < 0.05), and CDim (P < 0.05) showed significant time-course changes during that period, while SD and %RR50 did not. MeanRR, lnLF, lnHF, and CDim all decreased prior to the onset of NSVT, whereas ln(LF/HF) increased. We divided the subjects into two groups: one consisting of 12 patients with coronary artery disease; and the second group of 12 patients without known coronary artery disease. Both groups showed significant changes (P < 0.05) of CDim, lnLF, and lnHF preceding the episodes of NSVT. Conclusions: Changes in the pattern of HRV prior to the onset of episodes of NSVT suggest that changes in autonomic activity may commonly play a role in the triggering of spontaneous episodes of NSVT in susceptible patients. The measured changes suggest a reduction in parasympathetic

  18. Left atrial appendage morphology in patients with suspected cardiogenic stroke without known atrial fibrillation.

    Science.gov (United States)

    Korhonen, Miika; Muuronen, Antti; Arponen, Otso; Mustonen, Pirjo; Hedman, Marja; Jäkälä, Pekka; Vanninen, Ritva; Taina, Mikko

    2015-01-01

    The left atrial appendage (LAA) is the typical origin for intracardiac thrombus formation. Whether LAA morphology is associated with increased stroke/TIA risk is controversial and, if it does, which morphological type most predisposes to thrombus formation. We assessed LAA morphology in stroke patients with cryptogenic or suspected cardiogenic etiology and in age- and gender-matched healthy controls. LAA morphology and volume were analyzed by cardiac computed tomography in 111 patients (74 males; mean age 60 ± 11 years) with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology other than known atrial fibrillation (AF). A subgroup of 40 patients was compared to an age- and gender-matched control group of 40 healthy individuals (21 males in each; mean age 54 ± 9 years). LAA was classified into four morphology types (Cactus, ChickenWing, WindSock, CauliFlower) modified with a quantitative qualifier. The proportions of LAA morphology types in the main stroke group, matched stroke subgroup, and control group were as follows: Cactus (9.0%, 5.0%, 20.0%), ChickenWing (23.4%, 37.5%, 10.0%), WindSock (47.7%, 35.0%, 67.5%), and CauliFlower (19.8%, 22.5%, 2.5%). The distribution of morphology types differed significantly (P<0.001) between the matched stroke subgroup and control group. The proportion of single-lobed LAA was significantly higher (P<0.001) in the matched stroke subgroup (55%) than the control group (6%). LAA volumes were significantly larger (P<0.001) in both stroke study groups compared to controls patients. To conclude, LAA morphology differed significantly between stroke patients and controls, and single-lobed LAAs were overrepresented and LAA volume was larger in patients with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology. PMID:25751618

  19. Left atrial appendage morphology in patients with suspected cardiogenic stroke without known atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Miika Korhonen

    Full Text Available The left atrial appendage (LAA is the typical origin for intracardiac thrombus formation. Whether LAA morphology is associated with increased stroke/TIA risk is controversial and, if it does, which morphological type most predisposes to thrombus formation. We assessed LAA morphology in stroke patients with cryptogenic or suspected cardiogenic etiology and in age- and gender-matched healthy controls. LAA morphology and volume were analyzed by cardiac computed tomography in 111 patients (74 males; mean age 60 ± 11 years with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology other than known atrial fibrillation (AF. A subgroup of 40 patients was compared to an age- and gender-matched control group of 40 healthy individuals (21 males in each; mean age 54 ± 9 years. LAA was classified into four morphology types (Cactus, ChickenWing, WindSock, CauliFlower modified with a quantitative qualifier. The proportions of LAA morphology types in the main stroke group, matched stroke subgroup, and control group were as follows: Cactus (9.0%, 5.0%, 20.0%, ChickenWing (23.4%, 37.5%, 10.0%, WindSock (47.7%, 35.0%, 67.5%, and CauliFlower (19.8%, 22.5%, 2.5%. The distribution of morphology types differed significantly (P<0.001 between the matched stroke subgroup and control group. The proportion of single-lobed LAA was significantly higher (P<0.001 in the matched stroke subgroup (55% than the control group (6%. LAA volumes were significantly larger (P<0.001 in both stroke study groups compared to controls patients. To conclude, LAA morphology differed significantly between stroke patients and controls, and single-lobed LAAs were overrepresented and LAA volume was larger in patients with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology.

  20. The totally thoracoscopic left atrial maze procedure for the treatment of atrial fibrillation.

    Science.gov (United States)

    van Laar, Charlotte; Geuzebroek, Guillaume S C; Hofman, Frederik N; Van Putte, Bart P

    2016-01-01

    The totally thoracoscopic left atrial maze (TT-maze) is a recent, minimally invasive surgical procedure for the treatment of atrial fibrillation, with promising results in terms of freedom from atrial fibrillation. The TT-maze consists of a bilateral, epicardial pulmonary vein isolation with the creation of a box using radiofrequency and exclusion of the left atrial appendage (LAA). In addition, the box is connected with the base of the LAA and furthermore with the mitral annulus with the so-called trigonum line. In this report, we describe our surgical approach and short-term results. PMID:26993056

  1. Transcatheter Closure of Atrial Septal Defect with Amplatzer Device in Children and Adolescents: Short and Midterm Results; an Iranian Experience

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    Saiyed-Habibollah Hosseini

    2011-06-01

    Full Text Available Objective:Transcatheter closure of secundum atrial septal defect (ASD with Amplatzer device is an alternative procedure to surgical repair, with some limitations. The aim of this study was to assess the initial and mid-term results of the treatment of ASD with Amplatzer septal occluder in children and adolescents. Methods:From May 2003 to January 2008 sixty three consecutive children and adolescent patients underwent transcatheter closure of ASD at a mean±SD age of 8.5±4.8 years (range 2.2 to 18 years. All procedures were performed under local anesthesia and moderate sedation or general anesthesia with transthoracic echocardiography and fluoroscopic guidance. Stretch diameter of ASD was determined by balloon sizing catheter. Device selection was based on and matched to the standard diameter of the septal defect. Follow up at 24 hours, 1 month, 6 months, 12 months and yearly thereafter included physical examination, electrocardiography and transthoracic echocardiography. Findings:The mean ASD diameter, measured with transthoracic echocardiography and balloon catheter were 19.5± 5.5 mm and 20.9± 6.2 mm, respectively. The mean follow up period was 32.4±18.8 months. Deployment of the device was successful in 57 (90.5% and failed in 6 (9.5% patients. The major complication included dislodgement of device in 1 patient and device embolization to right ventricular inlet (surgically removed in 1 patient. The minor complication included transient atrial tachycardia in 10 patients, paroxysmal supraventricular tachycardia in 2 patients during procedure, successfully terminated with medication. At 24 hour, 1 month, 6 month and 1 year follow up, total occlusion rates were 73.6 %, 91%, 94.7%, and 94.7%, respectively. Conclusion:Transcatheter occlusion of ASD with Amplatzer device is an effective and safe procedure with minimal complication rate and short hospital stay, as well as excellent short and intermediate outcome in children and adolescents.

  2. The Spatiotemporal Stability of Dominant Frequency Sites in In-Silico Modeling of 3-Dimensional Left Atrial Mapping of Atrial Fibrillation.

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    Changyong Li

    Full Text Available We previously reported that stable rotors were observed in in-silico human atrial fibrillation (AF models, and were well represented by dominant frequency (DF. We explored the spatiotemporal stability of DF sites in 3D-AF models imported from patient CT images of the left atrium (LA.We integrated 3-D CT images of the LA obtained from ten patients with persistent AF (male 80%, 61.8 ± 13.5 years old into an in-silico AF model. After induction, we obtained 6 seconds of AF simulation data for DF analyses in 30 second intervals (T1-T9. The LA was divided into ten sections. Spatiotemporal changes and variations in the temporal consistency of DF were evaluated at each section of the LA. The high DF area was defined as the area with the highest 10% DF.1. There was no spatial consistency in the high DF distribution at each LA section during T1-T9 except in one patient (p = 0.027. 2. Coefficients of variation for the high DF area were highly different among the ten LA sections (p < 0.001, and they were significantly higher in the four pulmonary vein (PV areas, the LA appendage, and the peri-mitral area than in the other LA sections (p < 0.001. 3. When we conducted virtual ablation of 10%, 15%, and 20% of the highest DF areas (n = 270 cases, AF was changed to atrial tachycardia (AT or terminated at a rate of 40%, 57%, and 76%, respectively.Spatiotemporal consistency of the DF area was observed in 10% of AF patients, and high DF areas were temporally variable. Virtual ablation of DF is moderately effective in AF termination and AF changing into AT.

  3. Impact of different ablation strategies on the delayed cure after trans-catheter ablation for treating patients with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    DONG Jian-zeng; MA Chang-sheng; LIU Xing-peng; LONG De-yong; LIU Xiao-qing; WANG Jing; Fang Dong-ping; HAO Peng; LI Yong-sheng; LIU Chuang

    2005-01-01

    Background Delayed cure had been observed in recurrent cases after index ablation of atrial fibrillation (AF), however, its mechanism and incidence have not been elucidated in detail. This study aims to investigate the impact of different ablation strategies on the incidence of delayed cure and its possible mechanisms after trans-catheter ablation of AF. Methods One hundred and fifty-one consecutive cases with highly symptomatic, drug refractory AF were included in this study [M/F=109/42, mean age (56.0±11.2) (18-79) years]. Segmental pulmonary vein ablation (SPVA) was performed in 83 patients with the guidance of circular mapping catheter (SPVA Group), circumferential PV linear ablation (CPVA) was carried out in the rest 68 cases under the guidance of 3 dimensional mapping system in conjunction with circular mapping catheter (CPVA Group). Delayed cure was defined as that early recurrence of atrial tachyarrhythmias (AF, atrial tachycardia, or atrial flutter) after ablation procedure was no longer observed during subsequent follow-up, and stable sinus rhythm was maintained ≥2 months. Results Early recurrence of atrial tachyarrhythmias was detected in 41 cases from SPVA group and 23 cases from CPVA group, and delayed cure occurred in 21.9% (9/41) of the cases from SPVA group and 47.8% (11/23) of the cases from CPVA group, more delayed cure in later group was observed (P<0.05). Meanwhile, patients in SPVA group took a longer time to achieve a delayed cure [(27.0±18.0) days vs (14.0±8.1) days, P<0.05], and presented more recurrent episodes [(3.50±1.08) times a week vs (2.42±1.11) times a week, P<0.05]. However, recurrent episodes after index ablation were markedly decreased in cases with delayed cure from both groups (P<0.05). Conclusions Despite of an early recurrence of atrial tachyarrhythimas after index ablation of AF, delayed cure occurs in a significant number of patients undergoing either SPVA or CPVA. However, different ablation strategies place

  4. [Exercise test and ventricular tachycardia: the French experience].

    Science.gov (United States)

    Douard, H; Mora, B; Broustet, J P

    1987-03-01

    The incidence of severe ventricular arrhythmia requiring electric shock or prompt intravenous therapy was evaluated during or immediately after 458,000 exercise tests performed in 46 french centres between 1975 and 1985; 177,000 tests were performed exclusively in cardiac patients during supervised exercise training sessions. Sixty cases of severe arrhythmia (ventricular fibrillation 23, ventricular tachycardia 35, asystole 2) occurred (1/7600 tests). One or several electric shocks were necessary in 35 cases. Six patients died (1/76,333 tests), 2 of them during training sessions; 5 had phase II or III myocardial infarction, and the 6th patient had moderately tight valvular aortic stenosis. The five coronary patients were taking various anti-arrhythmic drugs. Among the 54 survivors, 14 were lost sight of and 4 died, 2 of these suddenly including one who passed away during a bicycle ride. All others are alive after a 3.25 +/- 2.9 years follow-up. The association of a multiple-vessel disease with an extensive fibrous plaque is a syndrome that is highly sensitive but fortunately little specific in predicting severe arrhythmia during exercise tests.

  5. Ventricular fibrillation and tachycardia classification using a machine learning approach.

    Science.gov (United States)

    Li, Qiao; Rajagopalan, Cadathur; Clifford, Gari D

    2014-06-01

    Correct detection and classification of ventricular fibrillation (VF) and rapid ventricular tachycardia (VT) is of pivotal importance for an automatic external defibrillator and patient monitoring. In this paper, a VF/VT classification algorithm using a machine learning method, a support vector machine, is proposed. A total of 14 metrics were extracted from a specific window length of the electrocardiogram (ECG). A genetic algorithm was then used to select the optimal variable combinations. Three annotated public domain ECG databases (the American Heart Association Database, the Creighton University Ventricular Tachyarrhythmia Database, and the MIT-BIH Malignant Ventricular Arrhythmia Database) were used as training, test, and validation datasets. Different window sizes, varying from 1 to 10 s were tested. An accuracy (Ac) of 98.1%, sensitivity (Se) of 98.4%, and specificity (Sp) of 98.0% were obtained on the in-sample training data with 5 s-window size and two selected metrics. On the out-of-sample validation data, an Ac of 96.3% ± 3.4%, Se of 96.2% ± 2.7%, and Sp of 96.2% ± 4.6% were obtained by fivefold cross validation. The results surpass those of current reported methods. PMID:23899591

  6. [Cardiovascular autonomic reflexes on the postural orthostatic tachycardia syndrome].

    Science.gov (United States)

    Benjelloun, Ho; Benjelloun, Ha; Aboudrar, S; Coghlan, L; Benomar, M

    2009-02-01

    Postural orthostatic tachycardia syndrome (POTS) is an inadequately understood pathology because its diagnosis is not based on the conventional methods of investigation. The orthostatic test allows to make the diagnosis easily. The objective of this study is to determine cardiovascular autonomic reflexes of 70 patients having POTS. The tests of exploration of the autonomic nervous system practised are: deep breathing, hand grip, mental stress and orthostatic test. The analysis of orthostatic test showed that the increase of the cardiac frequency, relative to the state of "beta" peripheral sympathetic hyperactivity occurred before the 2nd minute in 80% of patients. The POTS was considered "florid" in 43% of patients and had complicated of a rough and severe fall of systolic blood pressure inferior to 70 mmHg in four patients, after the fifth minute of the test. The analysis of the different tests had shown vagal hyperactivity in 63% of patients on deep breathing, in 93% of patients on hand grip and in 100% on orthostatic test. The "alpha" central sympathetic activity was increased in 76% of the cases and "beta" central sympathetic activity was high in 83% of cases. The "alpha" peripheral hyperactivity was observed in 63% of patients on hand grip, and in 44% on orthostatic test. The analysis of cardiovascular autonomic reflexes in patients affected by POTS allowing the determination of their autonomic profile, will contribute probably to a better understanding of this pathology and to a better orientation of its care.

  7. Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

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    P.R. Benchimol-Barbosa

    2009-03-01

    Full Text Available Atrial fibrillation (AF affects subjects with Chagas' disease and is an indicator of poor prognosis. We investigated clinical, echocardiographic and electrocardiographic variables of Chagas' disease in a long-term longitudinal study as predictors of a new-onset AF episode lasting >24 h, nonfatal embolic stroke and cardiac death. Fifty adult outpatients (34 to 74 years old, 62% females staged according to the Los Andes classification were enrolled. During a follow-up of (mean ± SD 84.2 ± 39.0 months, 9 subjects developed AF (incidence: 3.3 ± 1.0%/year, 5 had nonfatal stroke (incidence: 1.3 ± 1.0%/year, and nine died (mortality rate: 2.3 ± 0.8%/year. The progression rate of left ventricular mass and left ventricular ejection fraction was significantly greater in subjects who experienced AF (16.4 ± 20.0 g/year and -8.6 ± 7.6%/year, respectively than in those who did not (8.2 ± 8.4 g/year; P = 0.03, and -3.0 ± 2.5%/year; P = 0.04, respectively. In univariate analysis, left atrial diameter ≥3.2 cm (P = 0.002, pulmonary arterial hypertension (P = 0.035, frequent premature supraventricular and ventricular contraction counts/24 h (P = 0.005 and P = 0.007, respectively, ventricular couplets/24 h (P = 0.002, and ventricular tachycardia (P = 0.004 were long-term predictors of AF. P-wave signal-averaged ECG revealed a limited long-term predictive value for AF. In chronic Chagas' disease, large left atrial diameter, pulmonary arterial hypertension, frequent supraventricular and ventricular premature beats, and ventricular tachycardia are long-term predictors of AF. The rate of left ventricular mass enlargement and systolic function deterioration impact AF incidence in this population.

  8. Towards Low Energy Atrial Defibrillation

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    Philip Walsh

    2015-09-01

    Full Text Available A wireless powered implantable atrial defibrillator consisting of a battery driven hand-held radio frequency (RF power transmitter (ex vivo and a passive (battery free implantable power receiver (in vivo that enables measurement of the intracardiac impedance (ICI during internal atrial defibrillation is reported. The architecture is designed to operate in two modes: Cardiac sense mode (power-up, measure the impedance of the cardiac substrate and communicate data to the ex vivo power transmitter and cardiac shock mode (delivery of a synchronised very low tilt rectilinear electrical shock waveform. An initial prototype was implemented and tested. In low-power (sense mode, >5 W was delivered across a 2.5 cm air-skin gap to facilitate measurement of the impedance of the cardiac substrate. In high-power (shock mode, >180 W (delivered as a 12 ms monophasic very-low-tilt-rectilinear (M-VLTR or as a 12 ms biphasic very-low-tilt-rectilinear (B-VLTR chronosymmetric (6ms/6ms amplitude asymmetric (negative phase at 50% magnitude shock was reliably and repeatedly delivered across the same interface; with >47% DC-to-DC (direct current to direct current power transfer efficiency at a switching frequency of 185 kHz achieved. In an initial trial of the RF architecture developed, 30 patients with AF were randomised to therapy with an RF generated M-VLTR or B-VLTR shock using a step-up voltage protocol (50–300 V. Mean energy for successful cardioversion was 8.51 J ± 3.16 J. Subsequent analysis revealed that all patients who cardioverted exhibited a significant decrease in ICI between the first and third shocks (5.00 Ω (SD(σ = 1.62 Ω, p < 0.01 while spectral analysis across frequency also revealed a significant variation in the impedance-amplitude-spectrum-area (IAMSA within the same patient group (|∆(IAMSAS1-IAMSAS3[1 Hz − 20 kHz] = 20.82 Ω-Hz (SD(σ = 10.77 Ω-Hz, p < 0.01; both trends being absent in all patients that failed to cardiovert

  9. Atrial Fibrillation During an Exploration Class Mission

    Science.gov (United States)

    Lipsett, Mark; Hamilton, Douglas; Lemery, Jay; Polk, James

    2011-01-01

    This slide presentation reviews a possible scenario of an astronaut having Atrial Fibrillation during a Mars Mission. In the case review the presentation asks several questions about the alternatives for treatment, medications and the ramifications of the decisions.

  10. Alcohol consumption and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; Wium-Andersen, Marie Kim; Ørsted, David Dynnes;

    2016-01-01

    BACKGROUND: The aim of this study was to test the hypothesis that alcohol consumption, both observational (self-reported) and estimated by genetic instruments, is associated with a risk of atrial fibrillation and to determine whether people with high cardiovascular risk are more sensitive towards...... register. As a measure of alcohol exposure, both self-reported consumption and genetic variations in alcohol metabolizing genes (ADH1B/ADH1C) were used as instrumental variables. The endpoint was admission to hospital for atrial fibrillation as recorded in a validated hospital register. RESULTS: A total...... of 3493 cases of atrial fibrillation occurred during follow-up. High alcohol consumption was associated with a risk of atrial fibrillation among men, but not among women. Among the men who drank 28-35 and 35+ drinks/week, the hazards ratios were 1.40 (95% confidence interval 1.09-1.80) and 1.62 (95...

  11. Atrial Fibrillation - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Atrial Fibrillation URL of this page: https://medlineplus.gov/languages/atrialfibrillation.html Other topics A-Z A B ...

  12. Genetics Home Reference: familial atrial fibrillation

    Science.gov (United States)

    ... or Free article on PubMed Central Roberts R. Mechanisms of disease: Genetic mechanisms of atrial fibrillation. Nat Clin Pract Cardiovasc Med. ... with a qualified healthcare professional . About Genetics Home Reference Site Map Contact Us Selection Criteria for Links ...

  13. Calpain I Inhibition prevents atrial structural remodeling in a canine model with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    XUE Hong-jie; SHAN Hong-bo; LIU Jie; LI Wei-min; LI Yue; GONG Yong-tai; YANG Bao-feng; JIN Cheng-luo; SHENG Li; CHU Shan; ZHANG Li

    2008-01-01

    Background Atrial fibrillation (AF) is accompanied by atrial structural remodeling. Calpain activity is induced during AR To lest a causal relationship between calpain activation and atrial structural changes, N-acetyl-Leu-Leu-Met (ALLM), a calpain inhibitor, was utilized in a canine AF model.Methods Fifteen dogs were randomly divided into 3 groups: sham-operated group, control group and calpain inhibitor group; each with 5 dogs. Sustained AF was induced by rapid right atrium pacing at 600 beats per minute for 3 weeks. ALLM was administered at a dosage of 1.0 mg-kg-1·d-1 in the calpain inhibitor group. Three weeks later, the proteolysis, protein expression of TnT and myosin, calpain l localization and expression and structural changes were examined in left atrial free walls, right atrial free walls and the interatrial septum respectively. Atrial size and contractile function were also measured by echocardiography.Results Long-term rapid atrial pacing induced marked structural changes such as enlarged atrial volume, myolysis, degradation of TnT and myosin, accumulation of glycogen and changes in mitochondrial shape and size, which were paralleled by an increase in calpain activity. The positive correlation between calpain activity and the degree of myolysis (rs=0.90 961, P<0.0001) was demonstrated. In addition to structural abnormalities, pacing-induced atrial contractile dysfunction was observed in this study. The pacing-induced atrial structural alterations and loss of contractility were partially prevented by the calpain inhibitor ALLM.Conclusions Activation of calpain represents key features in the progression towards overt structural remodeling. Calpain inhibitor, ALLM, suppressed the increased calpain activity and reversed structural remodeling caused by sustained atrial fibrillation in the present model. Calpain Inhibition may therefore provide a possibility for therapeutic Intervention in AF.

  14. Assessment of atrial fibrillation and vulnerability in patients with Wolff-Parkinson-White syndrome using two-dimensional speckle tracking echocardiography.

    Directory of Open Access Journals (Sweden)

    Jing-Jie Li

    Full Text Available PURPOSE: The aim was to assess atrial fibrillation (AF and vulnerability in Wolff-Parkinson-White (WPW syndrome patients using two-dimensional speckle tracking echocardiography (2D-STE. METHODS: All patients were examined via transthoracic echocardiography and 2D-STE in order to assess atrial function 7 days before and 10 days after RF catheter ablation. A postoperative 3-month follow-up was performed via outpatient visit or telephone calls. RESULTS: Results showed significant differences in both body mass index (BMI and supraventricular tachycardia (SVT duration between WPW patients and DAVNP patients (both P<0.05. Echocardiography revealed that the maximum left atrial volume (LAVmax and the left ventricular mass index (LVMI in diastole increased noticeably in patients with WPW compared to patients with DAVNP both before and after ablation (all P<0.05. Before ablation, there were obvious differences in the levels of SRs, SRe, and SRa from the 4-chamber view (LA in the WPW patients group compared with patients in the DAVNP group (all P<0.05. In the AF group, there were significant differences in the levels of systolic strain rate (SRs, early diastolic strain rate (SRe, and late diastolic strain rate (SRa from the 4-chamber view (LA both before and after ablation (all P<0.05. In the non-AF group, there were decreased SRe levels from the 4-chamber view (LA/RA pre-ablation compared to post-ablation (all P<0.05. CONCLUSION: Our findings provide convincing evidence that WPW syndrome may result in increased atrial vulnerability and contribute to the development of AF. Further, RF catheter ablation of AAV pathway can potentially improve atrial function in WPW syndrome patients. Two-dimensional speckle tracking echocardiography imaging in WPW patients would be necessary in the evaluation and improvement of the overall function of RF catheter ablation in a long-term follow-up period.

  15. Postural orthostatic tachycardia syndrome: a dermatologic perspective and successful treatment with losartan.

    Science.gov (United States)

    Landero, James

    2014-08-01

    The postural orthostatic tachycardia syndrome is a disease characterized by excessively increased heart rate during orthostatic challenge associated with symptoms of orthostatic intolerance including dizziness, exercise intolerance, headache, fatigue, memory problems, nausea, blurred vision, pallor, and sweating, which improve with recumbence. Postural orthostatic tachycardia syndrome patients may present with a multitude of additional symptoms that are attributable to vascular vasoconstriction. Observed signs and symptoms in a patient with postural orthostatic tachycardia syndrome include tachycardia at rest, exaggerated heart rate increase with upright position and exercise, crushing chest pain, tremor, syncope, loss of vision, confusion, migraines, fatigue, heat intolerance, parasthesia, dysesthesia, allodynia, altered traditional senses, and thermoregulatory abnormalities. There are a number of possible dermatological manifestations of postural orthostatic tachycardia syndrome easily explained by its recently discovered pathophysiology. The author reports the case of a 22-year-old woman with moderate-to-severe postural orthostatic tachycardia syndrome with numerous dermatological manifestations attributable to the disease process. The cutaneous manifestations observed in this patient are diverse and most noticeable during postural orthostatic tachycardia syndrome flares. The most distinct are evanescent, hyperemic, sharply demarcated, irregular patches on the chest and neck area that resolve upon diascopy. This distinct "evanescent hyperemia" disappears spontaneously after seconds to minutes and reappears unexpectedly. Other observed dermatological manifestations of this systemic disease include Raynaud's phenomenon, koilonychia, onychodystrophy, madarosis, dysesthesia, allodynia, telogen effluvium, increased capillary refill time, and livedo reticularis. The treatment of this disease poses a great challenge. The author reports the unprecedented use of an oral

  16. Atrial Fibrillation in Congestive Heart Failure

    OpenAIRE

    Lubitz, Steven A.; Benjamin, Emelia J.; Ellinor, Patrick T.

    2010-01-01

    Atrial fibrillation and congestive heart failure are morbid conditions that share common risk factors and frequently coexist. Each condition predisposes to the other, and the concomitant presence of the two identifies individuals at increased risk for mortality. Recent data have emerged which help elucidate the complex genetic and non-genetic pathophysiological mechanisms that contribute to the development of atrial fibrillation in individuals with congestive heart failure. Clinical trial res...

  17. Stroke Prevention in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Massaro, Ayrton R; Lip, Gregory Y.H.

    2016-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including...... hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention. The use...... of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled...

  18. Antithrombotic treatment of atrial fibrillation: new insights.

    Science.gov (United States)

    Le Heuzey, J Y

    2012-10-01

    The incidence and prevalence of atrial fibrillation are quickly increasing, mainly due to the ageing of the population. Atrial fibrillation is, to date, a problem of public health. Atrial fibrillation is associated to a five-fold risk of stroke, which may be identified by score risks, such as CHADS(2) score. The classical antithrombotic treatment of atrial fibrillation is based on vitamin K antagonists. Trials made in the 90's have clearly shown that vitamin K antagonists were able to decrease stroke risk by about 60%. New oral anticoagulants are now available on the market to treat patients with atrial fibrillation. These drugs are dabigatran which has demonstrated an interest in the RE-LY trial. Two doses may be prescribed, 110 mg bid and 150 mg bid. Anti Xa have also demonstrated an interest : rivaroxaban in the ROCKET AF trial and apixaban in the AVERROES (versus aspirin) and ARISTOTLE trials. In the future these drugs will have a major place in the armamentarium used to treat patients with atrial fibrillation. In all these trials a decrease in intra cranial haemorrhages has been demonstrated. In the everyday practice it will be necessary to be very cautious in patients with impaired renal function, as all these drugs are eliminated by kidneys.

  19. Home Screening for Detecting Subclinical Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Renato Pietro Ricci; Taya V. Glotzer

    2015-12-01

    Full Text Available The advent of cardiac implanted electronic devices with accurate atrial arrhythmia diagnostic capabilities has revealed a large burden of “silent “ atrial fibrillation that is present in the cardiac population. Many studies have been completed, and many more are ongoing, to determine the correct treatment course when these atrial arrhythmias are detected. Alongside the development of accurate atrial diagnostics within the devices, has been the growth an entire network of wireless home monitoring capability. It is now possible to see, over the internet, individual patients’ atrial arrhythmia burden on every day. This capability has tremendous promise for patient care, with the possibility of reducing strokes, decreasing heart failure, preventing cardiomyopathies, and likely substantially reducing health care costs. As this innovative diagnostic capability is generating large amounts of data, protocols for what should be done with the plethora of new information are being developed. In the pages that follow, we will present what is known about home monitoring for silent atrial fibrillation, and present the results of recent studies published in this arena.

  20. Dofetilide in patients with congestive heart failure and left ventricular dysfunction: safety aspects and effect on atrial fibrillation. The Danish Investigators of Arrhythmia and Mortality on Dofetilide (DIAMOND) Study Group

    DEFF Research Database (Denmark)

    Møller, M; Torp-Pedersen, C T; Køber, L

    2002-01-01

    INTRODUCTION. Atrial fibrillation is a frequent cause of worsening of symptoms in patients with congestive heart failure. The drugs currently available for maintenance of sinus rhythm all have major side effects. METHODS. In 34 Danish coronary care units, 1518 patients with congestive heart failure...... to sinus rhythm, 78%/43% of patients in the dofetilide/placebo groups remained in sinus rhythm for at least 1 year. There were 25 instances (3%) of torsade de pointes ventricular tachycardia in the dofetilide group and none in the placebo group. CONCLUSION. In patients with congestive heart failure......, dofetilide can effectively convert atrial fibrillation to sinus rhythm and maintain sinus rhythm after conversion. Hospitalization for congestive heart failure is reduced. Dofetilide does not affect mortality. (c)2001 by CHF, Inc....

  1. Nkx genes regulate heart tube extension and exert differential effects on ventricular and atrial cell number.

    Science.gov (United States)

    Targoff, Kimara L; Schell, Thomas; Yelon, Deborah

    2008-10-15

    Heart formation is a complex morphogenetic process, and perturbations in cardiac morphogenesis lead to congenital heart disease. NKX2-5 is a key causative gene associated with cardiac birth defects, presumably because of its essential roles during the early steps of cardiogenesis. Previous studies in model organisms implicate NKX2-5 homologs in numerous processes, including cardiac progenitor specification, progenitor proliferation, and chamber morphogenesis. By inhibiting function of the zebrafish NKX2-5 homologs, nkx2.5 and nkx2.7, we show that nkx genes are essential to establish the original dimensions of the linear heart tube. The nkx-deficient heart tube fails to elongate normally: its ventricular portion is atypically short and wide, and its atrial portion is disorganized and sprawling. This atrial phenotype is associated with a surplus of atrial cardiomyocytes, whereas ventricular cell number is normal at this stage. However, ventricular cell number is decreased in nkx-deficient embryos later in development, when cardiac chambers are emerging. Thus, we conclude that nkx genes regulate heart tube extension and exert differential effects on ventricular and atrial cell number. Our data suggest that morphogenetic errors could originate during early stages of heart tube assembly in patients with NKX2-5 mutations.

  2. Predictors of left atrial appendage stunning after electrical cardioversion of non-valvular atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    杨沙宁; 黄从新; 胡晓军; 金立军; 李凤翥; 彭水先

    2003-01-01

    Objective To identify predictors of left atrial appendage stunning after the use of electrical cardioversion to restore sinus rhythm in patients with non-valvular atrial fibrillation.Methods A total of 68 consecutive patients (45 men, 23 women, 60.5±8.7 years of age) with non-valvular atrial fibrillation undergoing electrical cardioversion were enlisted in this study. Clinical and echocardiographic variables were analyzed by univariate regression and multivariate logistic regression to investigate the relationship between occurrences of left atrial appendage stunning and these factors. Results Univariate analysis revealed that, in comparing patients without and with left atrial appendage stunning, there were significant differences in the duration of atrial fibrillation > 8 weeks (32.3% vs 75.5%, P 50 mm (29.0% vs 54.1%, P 8 weeks (OR=7.249, 95%CI=1.998-26.304, P 50 mm (OR=3.896, 95%CI=1.105-13.734, P8 weeks, left atrial diameter >50 mm, left ventricular ejection fraction <50%, and cumulative energy of electrical cardioversion are independent predictors of left atrial appendage stunning. Anticoagulation treatment should be individualized for patients undergoing electrical cardioversion to reduce the risk of both cardioversion-related thromboembolic events and hemorrhagic complications caused by warfarin treatment.

  3. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion

    DEFF Research Database (Denmark)

    Osmanagic, Armin; Möller, Sören; Osmanagic, Azra;

    2016-01-01

    BACKGROUND: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial...

  4. Intra-atrial endothelial lesion resulting from transseptal puncture for catheter ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Samir M. Said

    2012-06-01

    Full Text Available Thromboembolic events are known complications of left atrial ablation therapy. We describe a complication which may also lead to systemic thromboembolism that has not been reported so far: the formation of a moving structure attached to the fossa ovalis after an attempted transseptal puncture in a 66-year old patient with symptomatic paroxysmal atrial fibrillation.

  5. Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency

    Science.gov (United States)

    Shannon, J. R.; Flattem, N. L.; Jordan, J.; Jacob, G.; Black, B. K.; Biaggioni, I.; Blakely, R. D.; Robertson, D.

    2000-01-01

    BACKGROUND: Orthostatic intolerance is a syndrome characterized by lightheadedness, fatigue, altered mentation, and syncope and associated with postural tachycardia and plasma norepinephrine concentrations that are disproportionately high in relation to sympathetic outflow. We tested the hypothesis that impaired functioning of the norepinephrine transporter contributes to the pathophysiologic mechanism of orthostatic intolerance. METHODS: In a patient with orthostatic intolerance and her relatives, we measured postural blood pressure, heart rate, plasma catecholamines, and systemic norepinephrine spillover and clearance, and we sequenced the norepinephrine-transporter gene and evaluated its function. RESULTS: The patient had a high mean plasma norepinephrine concentration while standing, as compared with the mean (+/-SD) concentration in normal subjects (923 vs. 439+/-129 pg per milliliter [5.46 vs. 2.59+/-0.76 nmol per liter]), reduced systemic norepinephrine clearance (1.56 vs. 2.42+/-0.71 liters per minute), impairment in the increase in the plasma norepinephrine concentration after the administration of tyramine (12 vs. 56+/-63 pg per milliliter [0.07 vs. 0.33+/-0.37 pmol per liter]), and a disproportionate increase in the concentration of plasma norepinephrine relative to that of dihydroxyphenylglycol. Analysis of the norepinephrine-transporter gene revealed that the proband was heterozygous for a mutation in exon 9 (encoding a change from guanine to cytosine at position 237) that resulted in more than a 98 percent loss of function as compared with that of the wild-type gene. Impairment of synaptic norepinephrine clearance may result in a syndrome characterized by excessive sympathetic activation in response to physiologic stimuli. The mutant allele in the proband's family segregated with the postural heart rate and abnormal plasma catecholamine homeostasis. CONCLUSIONS: Genetic or acquired deficits in norepinephrine inactivation may underlie hyperadrenergic

  6. Characteristics and identification of sites of chagasic ventricular tachycardia by endocardial mapping

    Directory of Open Access Journals (Sweden)

    Távora Maria Zildany P.

    1999-01-01

    Full Text Available OBJECTIVE: To study electrophysiological characteristics that enable the identification and ablation of sites of chagasic tachycardia. METHODS: Thirty-one patients with chronic Chagas' heart disease and sustained ventricular tachycardia (SVT underwent electrophysiological study to map and ablate that arrhythmia. Fifteen patients had hemodinamically stable SVT reproducible by programmed ventricular stimulation, 9 men and 6 women with ages ranging from 37 to 67 years and ejection fraction varying from 0.17 to 0.64. Endocardial mapping was performed during SVT in all patients. Radiofrequency (RF current was applied to sites of presystolic activity of at least 30 ms. Entrainment was used to identify reentrant circuits. In both successful and unsuccessful sites of RF current application, electrogram and entrainment were analyzed. RESULTS: Entrainment was obtained during all mapped SVT. In 70.5% of the sites we observed concealed entrainment and ventricular tachycardia termination in the first 15 seconds of RF current application. In the unsuccessful sites, significantly earlier electrical activity was seen than in the successful ones. Concealed entrainment was significantly associated with ventricular tachycardia termination. Bystander areas were not observed. CONCLUSION: The reentrant mechanism was responsible for the genesis of all tachycardias. In 70.5% of the studied sites, the endocardial participation of the slow conducting zone of reentrant circuits was shown. Concealed entrainment was the main electrophysiological parameter associated with successful RF current application. There was no electrophysiological evidence of bystander regions in the mapped circuits of SVT.

  7. Outcomes after ablation for typical atrial flutter (from the Loire Valley Atrial Fibrillation Project).

    Science.gov (United States)

    Clementy, Nicolas; Desprets, Laurent; Pierre, Bertrand; Lallemand, Bénédicte; Simeon, Edouard; Brunet-Bernard, Anne; Babuty, Dominique; Fauchier, Laurent

    2014-11-01

    Similar predisposing factors are found in most types of atrial arrhythmias. The incidence of atrial fibrillation (AF) among patients with atrial flutter is high, suggesting similar outcomes in patients with those arrhythmias. We sought to investigate the long-term outcomes and prognostic factors of patients with AF and/or atrial flutter with contemporary management using radiofrequency ablation. In an academic institution, we retrospectively examined the clinical course of 8,962 consecutive patients admitted to our department with a diagnosis of AF and/or atrial flutter. After a median follow-up of 934 ± 1,134 days, 1,155 deaths and 715 stroke and/thromboembolic (TE) events were recorded. Patients with atrial flutter undergoing cavotricuspid isthmus ablation (n = 875, 37% with a history of AF) had a better survival rate than other patients (hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.25 to 0.49, p <0.0001). Using Cox proportional hazards model and propensity score model, after adjustment for main other confounders, ablation for atrial flutter was significantly associated with a lower risk of all-cause mortality (HR 0.55, 95% CI 0.36 to 0.84, p = 0.006) and stroke and/or TE events (HR 0.53, 95% CI 0.30 to 0.92, p = 0.02). After ablation, there was no significant difference in the risk of TE between patients with a history of AF and those with atrial flutter alone (HR 0.83, 95% CI 0.41 to 1.67, p = 0.59). In conclusion, in patients with atrial tachyarrhythmias, those with atrial flutter with contemporary management who undergo cavotricuspid isthmus radiofrequency ablation independently have a lower risk of stroke and/or TE events and death of any cause, whether a history of AF is present or not.

  8. Determinants of Left Atrial Volume in Patients with Atrial Fibrillation

    Science.gov (United States)

    Hochgruber, Thomas; Krisai, Philipp; Zimmermann, Andreas J.; Aeschbacher, Stefanie; Pumpol, Katrin; Kessel-Schaefer, Arnheid; Stephan, Frank-Peter; Handschin, Nadja; Sticherling, Christian; Osswald, Stefan; Kaufmann, Beat A.; Paré, Guillaume; Kühne, Michael; Conen, David

    2016-01-01

    Introduction Left atrial (LA) enlargement is an important risk factor for incident stroke and a key determinant for the success of rhythm control strategies in patients with atrial fibrillation (AF). However, factors associated with LA volume in AF patients remain poorly understood. Methods Patients with paroxysmal or persistent AF were enrolled in this study. Real time 3-D echocardiography was performed in all participants and analyzed offline in a standardized manner. We performed stepwise backward linear regression analyses using a broad set of clinical parameters to determine independent correlates for 3-D LA volume. Results We included 210 patients (70.9% male, mean age 61±11years). Paroxysmal and persistent AF were present in 95 (45%) and 115 (55%) patients, respectively. Overall, 115 (55%) had hypertension, 11 (5%) had diabetes, and 18 (9%) had ischemic heart disease. Mean indexed LA volume was 36±12ml/m2. In multivariable models, significant associations were found for female sex (β coefficient -10.51 (95% confidence interval (CI) -17.85;-3.16), p = 0.0053), undergoing cardioversion (β 11.95 (CI 5.15; 18.74), p = 0.0006), diabetes (β 14.23 (CI 2.36; 26.10), p = 0.019), body surface area (BSA) (β 34.21 (CI 19.30; 49.12), pglomerular filtration rate (β -0.21 (CI -0.36; -0.06), p = 0.0064) and plasma levels of NT-pro brain natriuretic peptide (NT-proBNP) (β 6.79 (CI 4.05; 9.52), p<0.0001), but not age (p = 0.59) or hypertension (p = 0.42). Our final model explained 52% of the LA volume variability. Conclusions In patients with AF, the most important correlates with LA volume are sex, BSA, diabetes, renal function and NT-proBNP, but not age or hypertension. These results may help to refine rhythm control strategies in AF patients. PMID:27701468

  9. Patient's Guide to Antithrombotic Therapy in Atrial Fibrillation

    Science.gov (United States)

    ... to Antithrombotic A Patient’s Guide to AntithromboticTherapy in Atrial Fibrillation AMERICAN COLLEGE OF CHEST PHYSICIANS Therapy in Atrial Fibrillation PATIENT EDUCATION GUIDE AMERICAN COLLEGE OF CHEST PHYSICIANS ...

  10. Who Is at Risk for Atrial Fibrillation (AF or AFib)?

    Science.gov (United States)

    ... living with AFib Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • Understand your Risk for AFib Children • Symptoms of AFib • Treatment & Prevention of AFib Treatment Guidelines of AFib Treatment Options ...

  11. Risk of atrial fibrillation and stroke in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Ahlehoff, Ole; Gislason, Gunnar Hilmar;

    2012-01-01

    To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke.......To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke....

  12. A Case of Giant Right Atrial Aneurysm in a Child.

    Science.gov (United States)

    Pawar, Ravindra S; Tiwari, Ashish; Suresh, P V; Raj, Vimal; Kaushik, Pradeepkumar

    2016-07-01

    Giant right atrial aneurysm is a rare entity in infants and children. It needs to be distinguished from an atrial diverticulum, which can have similar presentation. Generally, an incidental finding in children, it can present with varied symptoms. We report a case of a giant right atrial aneurysm in an asymptomatic child with a large clot in the dilated right atrium, who underwent successful resection of the atrial aneurysm. PMID:26884450

  13. Galectin-3 in patients undergoing ablation of atrial fibrillation

    OpenAIRE

    Nicolas Clementy; Eric Piver; Nazih Benhenda; Anne Bernard; Bertrand Pierre; Edouard Siméon; Laurent Fauchier; Jean-Christophe Pagès; Dominique Babuty

    2014-01-01

    Background: Mechanisms of maintenance of atrial fibrillation are known to include fibrosis. Galectin-3, as a biomarker of fibrosis, may be a valuable marker of atrial remodeling. We sought to find whether there was a link between clinical features and higher galectin-3 levels in patients with atrial fibrillation. Methods: Serum concentrations of Galectin-3 were determined in a consecutive series of patients addressed for ablation of atrial fibrillation. Results: One-hundred-and-eighty-s...

  14. Optimizing therapy in patients with atrial fibrillation and heart failure

    OpenAIRE

    Mulder, Bart Antonius

    2015-01-01

    Atrial fibrillation is the most common cardiac arrhythmia and the prevalence is expected to increase in the coming years. The same is true for heart failure. Atrial fibrillation may result in heart failure, and vice versa, but they can also exacerbate each other. The combination of atrial fibrillation and heart failure has important therapeutic implications to treat both diseases and create optimal outcomes for these patients. We started with patients with permanent atrial fibrillation. These...

  15. Heart failure and atrial fibrillation: current concepts and controversies

    OpenAIRE

    Berg, van den, T.J.T.P.; Tuinenburg, A. E.; Crijns, H. J. G. M.; Gelder, De; Gosselink, A. T.; Lie, K. I.

    1997-01-01

    Heart failure and atrial fibrillation are very common, particularly in the elderly. Owing to common risk factors both disorders are often present in the same patient. In addition, there is increasing evidence of a complex, reciprocal relation between heart failure and atrial fibrillation. Thus heart failure may cause atrial fibrillation, with electromechanical feedback and neurohumoral activation playing an important mediating role. In addition, atrial fibrillation may promote heart failure; ...

  16. Giant right atrial myxoma: characterization with cardiac magnetic resonance imaging.

    LENUS (Irish Health Repository)

    Ridge, Carole A

    2012-02-01

    A 53-year-old woman presented to the emergency department with a 2-week history of dyspnoea and chest pain. Computed tomography pulmonary angiography was performed to exclude acute pulmonary embolism (PE). This demonstrated a large right atrial mass and no evidence of PE. Transthoracic echocardiography followed by cardiac magnetic resonance imaging confirmed a mobile right atrial mass. Surgical resection was then performed confirming a giant right atrial myxoma. We describe the typical clinical, radiologic, and pathologic features of right atrial myxoma.

  17. Reentrant Supraventricular Tachycardia in a Pediatric Trauma Patient Masquerading as a Cardiac Contusion

    Directory of Open Access Journals (Sweden)

    Bradbum, Christopher

    2005-01-01

    Full Text Available Establishing the etiology of tachycardia in a trauma patient is often difficult. Pediatric trauma patients present an even tougher challenge. Cardiac contusion should be suspected when other more common traumatic injuries that produce hypoxia and blood loss are excluded. The diagnosis of cardiac contusion is notoriously difficult to make largely due to the controversy over the definition of the disease, and the lack of a true gold standard confirmatory test. Atrioventricular nodal reentrant tachycardia (AVNRT is a common form of supraventricular tachycardia (SVT that can also present a diagnostic challenge to emergency physicians. While electrophysiologic studies are the gold standard for confirming the diagnosis, there are certain aspects of the history, electrocardiogram (ECG, and responses to cardiac maneuvers that strongly suggest the diagnosis. We present the case of a pediatric trauma patient that presented with new onset AVNRT masquerading as cardiac contusion.

  18. Postural orthostatic tachycardia syndrome after surgical correction of an aortic coarctation: a case report

    Directory of Open Access Journals (Sweden)

    Fernex Lucie

    2012-08-01

    Full Text Available Abstract Introduction We report a case of postural tachycardia syndrome occurring after the surgical correction of an aortic coarctation, and coexisting with upper airway resistance syndrome. Case presentation A 29-year-old Caucasian man complained of extreme fatigue, daytime sleepiness, shortness of breath on exertion, light-headedness and general weakness on standing. These symptoms began shortly after the surgical correction of an aortic coarctation and became progressively more debilitating, impairing any daily activity. An extensive work-up revealed postural tachycardia syndrome and a coexisting sleep-related breathing disorder, characterized as upper airway resistance syndrome. Conclusion This is the first reported case describing the occurrence of postural tachycardia syndrome after the surgical correction of an aortic coarctation. This case also provides evidence for the suggestion that this syndrome may coexist with upper airway resistance syndrome, although the exact nature of their relationship must still be better established.

  19. [About military medical examination of patients with paroxysmal supraventricular reciprocating tachycardia].

    Science.gov (United States)

    Simonenko, V B; Kuvshinov, K É; Steklov, V I; Gorbatov, E A; Morozov, D A; Emel'ianenko, M V

    2013-11-01

    140 patients with paroxysmal supraventricular reciprocating tachycardia were treated with the help of radio frequency ablation; results of treatment were analyzed. First group consisted of 76 patients with atrioventricular nodal reentrant tachycardia, second group--64 patients with atrioventricular reentrant tachycardia accompanied with WPW syndrome and preexcitation syndrome. In first group the operation ended up with success in 94.7%, in the second group--90.6%, after the second operation--100% and 96.1% relatively. Different complications in patients from the first group occured in 3.9%, in the second group--in 6.3%. Taking into account high effectivennes and safety of radio frequency ablation, it is recommended to reconsider principals of categorisation of fitness for service among conscripts and servicemen doing call-up and under the contract military service and also citizens, entering military educational institutions.

  20. 婴儿阵发性室上性心动过速38例药物治疗及临床分析%Clinical Characteristics and Treatment of Infants with Paroxysmal Supraventricular Tachycardia: 38 Cases Report

    Institute of Scientific and Technical Information of China (English)

    王野峰; 黄希勇; 陈智

    2012-01-01

    Objective: To investigate the diagnostic value of ECG types and to evaluate the efficacy of drugs in the treatment of infants with paroxysmal supraventricular tachycardia (PSVT). Methods: Analysis of 38 cases of clinical data and medication of infants with PSVT after admission. Results: Seventeen cases were atrioventricular reentrant tachycardia (AVRT) (44. 7% ) ; twelve cases were atrioventricular nodal reentrant tachycardia (AVNRT) (31.6%); two cases were self-regulation of atrial tachycardia (5.2%); seven cases (18.4% ) were not classified; eleven cases combined organic heart disease (28. 9% ). In treating AVRT patients, the conversion rate of propafenone, ATP and digoxin were 100% , 75. 0% and 37. 5% ; while in treating AVNRT patients, the conversion rate of propafenone, ATP, digoxin, amiodarone were 90.0% , 83.3% , 40.0% and 66.7%. Conclusions: Correct diagnosis of ECG types is valuable for the correct choice of drugs in the treatment of infants with PSVT. Efficacy of drugs is varied with different types of PSVT.%目的:探讨婴儿阵发性室上性心动过速(PSVT)的心电图分型和药物治疗情况,总结药物治疗经验.方法:分析38例婴儿PSVT入院后的临床资料和药物治疗情况.结果:房室折返性心动过速(AVRT) 17例(44.7%),房室结折返性心动过速(AVNRT) 12例(31.6%),自律性房性心动过速2例(5.2%),未分型7例(18.4%),合并器质性心脏病11例(28.9%).AVRT患儿用普罗帕酮转复率为100%,ATP为75.0%,地高辛为37.5%;AVNRT用普罗帕酮转复率为90.0%,ATP为83.3%,地高辛为40.0%,胺碘酮为66.7%.结论:正确的心电图分型对婴儿PSVT治疗药物的选择有指导意义,不同药物对不同类型的PSVT的治疗效果不同.

  1. Gene expression of the natriuretic peptide system in atrial tissue of patients with paroxysmal and persistent atrial fibrillation

    NARCIS (Netherlands)

    Tuinenburg, AE; Brundel, BJJM; Van Gelder, IC; Henning, RH; Van den Berg, MP; Driessen, C; Grandjean, JG; Van Gilst, WH; Crijns, HJGM

    1999-01-01

    Natriuretic Peptide System in AF. Introduction: Circulating cardiac natriuretic peptides play an important role in maintaining volume homeostasis, especially during conditions affecting hemodynamics. During atrial fibrillation (AF), levels of plasma atrial natriuretic peptide (ANP) becomes elevated.

  2. Efficacy of dexmedetomidine for the control of junctional ectopic tachycardia after repair of tetralogy of Fallot

    Directory of Open Access Journals (Sweden)

    Randhir S Rajput

    2014-01-01

    Full Text Available Background: Junctional ectopic tachycardia occurs frequently after congenital cardiac surgery and can be a cause of increased morbidity and mortality. Dexmedetomidine (DEX is an a2 adrenoreceptor agonist, has properties of controlling tachyarrhythmia by regulating the sympatho-adrenal system. Objective: To evaluate the efficacy of DEX for control of junctional ectopic tachycardia after repair of Tetralogy of Fallot (TOF. Materials and Methods: Two hundred and twenty pediatric cardiac patients with TOFs were enrolled in a prospective randomized control study. Patients underwent correction surgery. They were divided into two groups, i.e., Group 1 (DEX and Group 2 (control. Heart rate, rhythm, mean arterial pressure (MAP were recorded after the anesthetic induction (T1, after termination of bypass (T2, after 04 hours (T3, and 08 hours after transferring the patient to intensive care unit (ICU; T4. Results: Heart rate was comparable between two groups before starting the drug but statistically significant after bypass until 08 hours after transferring the patient to ICU. Junctional ectopic tachycardia occurred more in Group-2 (20% as compared to Group-1 (9.09%; P = 0.022. Junctional ectopic tachycardia occurs early in Group-2 (0.14 ± 0.527 hours as compared to Group 1 (0.31 ± 1.29 hours; P = 0.042. The duration of junctional ectopic tachycardia was more prolonged in Group-2 (1.63 ± 3.64 hours as compared to Group-1 (0.382 ± 1.60 hours; P = 0.012. The time to withdraw from mechanical ventilation and ICU stay of Group 1 patient was less than of Group 2 patients (P = <0.001. Conclusion: DEX had a therapeutic role in the prevention of junctional ectopic tachycardia in patients undergoing repair for TOF.

  3. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal;

    2016-01-01

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar manage...

  4. Information Learned from Animal Models of Atrial Fibrillation

    OpenAIRE

    Finet, J. Emanuel; Rosenbaum, David S.; Donahue, J. Kevin

    2009-01-01

    Animal models of atrial fibrillation have taught us about mechanisms of this common disease. A variety of animal models exist, including models of lone atrial fibrillation and models of atrial fibrillation in the setting of heart failure, aging or pericardial inflammation. This chapter reviews these various models.

  5. Cardiac Remodeling After Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Li-Wei Lo, MD; Shih-Ann Chen, MD

    2013-06-01

    Full Text Available Radiofrequency catheter ablation procedures are considered a reasonable option for patients with symptomatic, drug refractory atrial fibrillation (AF. Ablation procedures have been reported to effectively restore sinus rhythm and provide long-term relief of symptoms. Both electrical and structural remodeling occurs with AF. A reversal of the electrical remodeling develops within 1 week after restoration to sinus rhythm following the catheter ablation. The recovery rate is faster in the right atrium than the left atrium. Reverse structural remodeling takes longer and is still present 2 to 4 months after restoration of sinus rhythm. The left atrial transport function also improves after successful catheter ablation of AF. Left atrial strain surveys from echocardiography are able to identify patients who respond to catheter ablation with significant reverse remodeling after ablation. Pre-procedural delayed enhancement magnetic resonance imaging is also able to determine the degree of atrial fibrosis and is another tool to predict the reverse remodeling after ablation. The remodeling process is complex if recurrence develops after ablation. Recent evidence shows that a combined reverse electrical and structural remodeling occurs after ablation of chronic AF when recurrence is paroxysmal AF. Progressive electrical remodeling without any structural remodeling develops in those with recurrence involving chronic AF. Whether progressive atrial remodeling is the cause or consequence during the recurrence of AF remains obscure and requires further study.

  6. Surgical Treatment of Atrial Fibrillation: A Review

    Directory of Open Access Journals (Sweden)

    Nadine Hiari

    2011-01-01

    Full Text Available Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1 reduce embolic complications, particularly stroke, (2 alleviate symptoms, and (3 prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources.

  7. A novel approach for the diagnosis of ventricular tachycardia based on phase space reconstruction of ECG

    CERN Document Server

    Koulaouzidis, George; Cappiello, Grazia; Mazomenos, Evangelos B; Maharatna, Koushik; Morgan, John

    2014-01-01

    Ventricular arrhythmias comprise a group of disorders which manifest clinically in a variety of ways from ventricular premature beats (VPB) and no sustained ventricular tachycardia (in healthy subjects) to sudden cardiac death due to ventricular tachyarrhythmia in patients with and/or without structural heart disease. Ventricular fibrillation (VF) and ventricular tachycardia (VT) are the most common electrical mechanisms for cardiac arrest. Accurate and automatic recognition of these arrhythmias from electrocardiography (ECG) is a crucial task for medical professionals. The purpose of this research is to develop a new index for the differential diagnosis of normal sinus rhythm (SR) and ventricular arrhythmias, based on phase space reconstruction (PSR).

  8. Postural Orthostatic Tachycardia Syndrome (POTS)--A novel member of the autoimmune family.

    Science.gov (United States)

    Dahan, S; Tomljenovic, L; Shoenfeld, Y

    2016-04-01

    Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder of the autonomic nervous system in which a change from the supine position to an upright position causes an abnormally large increase in heart rate or tachycardia (30 bpm within 10 min of standing or head-up tilt). This response is accompanied by a decrease in blood flow to the brain and hence a spectrum of symptoms associated with cerebral hypoperfusion. Many of these POTS-related symptoms are also observed in chronic anxiety and panic disorders, and therefore POTS is frequently under- and misdiagnosed.

  9. [Myocardial damage and paroxysmal ventricular tachycardia in a dog after Albuterol intoxication].

    Science.gov (United States)

    Matos, J; Jenni, S; Fischer, N; Bienz, H; Glaus, T

    2012-07-01

    Intoxication with the beta2-agonist Albuterol may lead to immediate signs of beta-adrenergic stimulation like excitation, tachypnea and tachycardia. Furthermore, it typically causes severe hypokalemia, which then leads to muscle weakness and which predisposes to ventricular arrhythmias. We describe a dog where albuterol intoxication caused runs of fast paroxysmal ventricular tachycardia that persisted after normalization of the hypokalemia. Based on a markedly elevated serum troponin I level acute myocardial damage was identified as cause of the tachyarrhythmia. Repeated Troponin I measurements and Holter-ECGs were the means to document complete cure.

  10. Coincidence of paroxysmal supraventricular tachycardia and panic disorder: two case reports

    Directory of Open Access Journals (Sweden)

    Breithardt Günter

    2010-04-01

    Full Text Available Abstract Panic disorder (PD is characterised by sudden attacks of intense fear with somatic symptoms including palpitations and tachycardia. Reciprocally, palpitations caused by paroxysmal supraventricular tachycardia (PSVT are commonly associated with anxiety and may therefore be misdiagnosed as PD. As demonstrated by two case reports, PSVT and PD can occur comorbidly in a chronological sequence, with PSVT possibly precipitating and maintaining PD via interoceptive processes or, alternatively, with PD increasing the risk for PSVT by elevating stress levels. As both PSVT and PD require different treatments, potentially helpful differential clinical diagnostic criteria are proposed.

  11. Modified Calgary score in differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in children.

    Science.gov (United States)

    Yang, Jinyan; Zhu, Lulu; Chen, Stella; Li, Xueying; Zhang, Qingyou; Zhang, Fengwen; Chen, Li; Tang, Chaoshu; Du, Junbao; Jin, Hongfang

    2013-06-01

    The present study was designed to analyse the usefulness of a modified Calgary score system during differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope through a large sample sized clinical investigation. The study included 213 children, including 101 boys and 112 girls, with cardiac syncope or postural orthostatic tachycardia syndrome-associated syncope in the age group of 2-19 years (mean 11.8 ± 2.9 years). A modified Calgary score was created, which was analysed to predict differential diagnoses between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope using a receiver operating characteristic curve. The median of modified Calgary scores for cardiac syncope was -5.0, which significantly differed from that of postural orthostatic tachycardia syndrome (0.0; p postural orthostatic tachycardia syndrome-associated syncope in the clinic.

  12. Risk factors for postural tachycardia syndrome in children and adolescents.

    Directory of Open Access Journals (Sweden)

    Jing Lin

    Full Text Available BACKGROUND: Postural tachycardia syndrome (POTS is prevalent in children and adolescents and has a great impact on health. But its risk factors have not been fully understood. This study aimed to explore possible risk factors for children and adolescents with POTS. METHODS AND FINDINGS: 600 children and adolescents (test group aged 7-18 (11.9 ± 3.0 years old, 259 males and 341 females, were recruited for identifying its risk factors. Another 197 subjects aged from 7 to 18 (11.3 ± 2.3 years old were enrolled in the validation group. Heart rate (HR and blood pressure (BP were monitored during upright test. Risk factors were analyzed and sensitivity and specificity for predicting POTS were tested via receiver operating characteristic curve. Among 600 subjects, 41 were confirmed with POTS patients (6.8% based on clinical manifestation and upright test. The results showed a significant difference in daily water intake, the daily sleeping hours, supine HR, HR increment and maximum HR during upright test between POTS and the unaffected children (P<0.05. Likelihood of POTS would increase by 1.583 times if supine HR was increased by 10 beats/min (95%CI 1.184 to 2.116, P<0.01, by 3.877 times if a child's water intake was less than 800 ml/day (95%CI 1.937 to 7.760, P<0.001, or by 5.905 times (95%CI 2.972 to 11.733, P<0.001 if sleeping hours were less than 8 hours/day. Supine HR, daily water intake and sleeping hours showed the capability of predicting POTS in children and adolescents with an AUC of 83.9% (95% CI: 78.6%-89.1%, sensitivity of 80.5% and specificity of 75%. Furthermore, in validation group, predictive sensitivity and specificity were 73.3% and 72.5%. CONCLUSION: Faster supine HR, less water intake and shorter sleeping hours were identified as risk factors for POTS.

  13. [Antithrombotic management in atrial fibrillation].

    Science.gov (United States)

    Fauchier, Laurent; Taillandier, Sophie; Clementy, Nicolas

    2013-02-01

    There is increasing recognition of the value of oral anticoagulation for stroke prevention in atrial fibrillation (AF), and the availability of new oral anticoagulants that overcome the limitations of vitamin K antagonists (VKA). Stroke risk assessment using the CHA2DS2-Vasc score allows identification of patients who are at truly low risk (score = 0) who should need no antithrombotic therapy, while all others (CHA2DS2-Vasc score > or = 1 with a risk of thromboembolic event > 1% per year) would be considered for oral anticoagulation. The HAS-BLED score has been recently proposed to easily assess bleeding risk in AF patients. A score of > or = 3 indicates "high risk" and some caution and regular review of the patient are needed. It also makes the clinician think of correctable common bleeding risk factors. The direct thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban and apixaban are new oral anticoagulants that are at least as efficacious and safe as VKA in non valvular AF. Their advantages are easier use, predictable anticoagulant effects, low propensity for food and drug interactions, and lower rates of intracranial bleeding than with VKA, but they should not be used in patients with kidney disease at the present time. Overall, one may expect that more AF patients will be appropriately treated with oral anticoagulation in the next years. PMID:23513780

  14. Increased susceptibility to atrial fibrillation secondary to atrial fibrosis in transgenic goats expressing transforming growth factor - B1

    Science.gov (United States)

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in people with significant morbidity and mortality. There is a strong association between atrial fibrosis and AF. Transforming growth factor B1 (TGF-B1) is an essential mediator of atrial fibrosis in animal models and human pat...

  15. Study on Effect of Compound Salvia Pellet in Preventing Atrial Fibrillation with Left Atrial Thrombosis

    Institute of Scientific and Technical Information of China (English)

    连耀植; 李玉光; 张汉灵; 张元春; 闫纯英; 林建才; 许端敏; 张钰; 郑宝群; 麦芒

    2004-01-01

    @@ Atrial fibrillation (AF) is a kind of common arrhythmia, which, besides affecting cardiac function, has another serious outcome, that is, it is easy to form atrial thrombosis and induce thrombus/embolus, especially cerebral embolus.The incidence of left atrial thrombosis (LAT)could reach 25%-30%(1), the incidence of embolic complication per year could reach 2. 98%-6.30%, even 20% or more(2,3). To prevent thrombosis so as to lower the incidence of cerebral stroke and other embolic complications has been so far the focal point of AF treatment.

  16. Determinants and importance of atrial pressure morphology in atrial septal defect.

    OpenAIRE

    Parikh, D N; J. Fisher; Moses, J W; Goldberg, H.L.; Levin, A. R.; Engle, M. A.; Borer, J S

    1984-01-01

    A prominent "v" wave relative to the "a" wave in the jugular vein and right atrial pressure tracing is considered to be a common haemodynamic sign of atrial septal defect. Since the prevalence, age relation, and haemodynamic determinants of the "v" greater than or equal to "a" wave configuration have not been studied the pressure recordings from 15 adults and 80 children with an isolated secundum atrial septal defect in sinus rhythm and from 40 adults and 55 children in sinus rhythm without s...

  17. Non-Invasive Estimation of Left Atrial Dominant Frequency in Atrial Fibrillation from Different Electrode Sites: Insight from Body Surface Potential Mapping

    OpenAIRE

    Marjan Bojarnejad; James R Blake; John Bourke; Ewan Shepherd; Alan Murray; Philip Langley

    2014-01-01

    The dominant driving sources of atrial fibrillation are often found in the left atrium, but the expression of left atrial activation on the body surface is poorly understood. Using body surface potential mapping and simultaneous invasive measurements of left atrial activation our aim was to describe the expression of the left atrial dominant fibrillation frequency across the body surface. 20 patients in atrial fibrillation were studied. The spatial distributions of the dominant atrial fib...

  18. Antihypertensive treatment and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Marott, Sarah C W; Nielsen, Sune F; Benn, Marianne;

    2014-01-01

    AIMS: To examine the associations between antihypertensive treatment with angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs), β-blockers, diuretics, or calcium-antagonists, and risk of atrial fibrillation. We examined these associations using the entire Danish...... population from 1995 through 2010. METHODS AND RESULTS: Excluding medication used in atrial fibrillation, we matched individuals on ACEi monotherapy 1:1 with individuals on β-blocker (n = 48 658), diuretic (n = 69 630), calcium-antagonist (n = 57 646), and ARB monotherapy (n = 20 158). Likewise, individuals...... on ARB monotherapy were matched 1:1 with individuals on β-blocker (n = 20 566), diuretic (n = 20 832), calcium-antagonist (n = 20 232), and ACEi monotherapy (n = 20 158). All were free of atrial fibrillation and of predisposing diseases like heart failure, ischaemic heart disease, diabetes mellitus...

  19. Effects of irbesartan on atrial cell electrophysiology

    Institute of Scientific and Technical Information of China (English)

    HUANG Cong-xin; CAO Feng; JIANG Hong; WANG Teng; LI Xia

    2005-01-01

    @@ Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice.1 Its incidence increases with age and the presence of structural heart disease. It is a major cause of stroke, especially in the elderly. It has been shown that angiotensin converting enzyme inhibitor (ACEI) can reduce the incidence of AF after acute myocardial infarction.2 Several studies have shown that activation of the rennin-angiotensin system is associated with the mechanisms of AF. Irbesartan is a long-acting angiotensin Ⅱ type 1 receptor antagonist used widely in the treatment of hypertension.3 In recent years, it has been demonstrated that patients treated with amiodarone plus irbesartan had a lower rate of recurrence of atrial fibrillation than did patients treated with amiodarone alone.4 These findings suggest that the inhibition of angiotensin Ⅱ may prevent AF, but its underlying electrophysiological mechanisms are obscure. The purpose of this study is to investigate the effects of irbesartan on atrial cell electrophysiology.

  20. Ablation therapy for left atrial autonomic modification.

    Science.gov (United States)

    Malcolme-Lawes, Louisa; Sandler, Belinda C; Sikkel, Markus B; Lim, Phang Boon; Kanagaratnam, Prapa

    2016-08-01

    The autonomic nervous system is implicated in the multifactorial pathogenesis of atrial fibrillation (AF) but few studies have attempted neural targeting for therapeutic intervention. We have demonstrated that short bursts of stimulation, at specific sites of left atrial ganglionated plexi (GPs), trigger fibrillation-inducing atrial ectopy and importantly continuous stimulation of these sites may not induce AV block, the 'conventional' marker used to locate GPs. We have shown that these ectopy-triggering GP (ET-GP) sites are anatomically stable and can be rendered inactive by either ablation at the site or by ablation between the site and the adjacent pulmonary vein (PV). This may have important implications for planning patient specific strategies for ablation of paroxysmal AF in the future. PMID:27595199

  1. Atrial Electrical Remodeling and Sleep Disordered Breathing

    Directory of Open Access Journals (Sweden)

    Adrian Baranchuk; Diego Conde

    2013-08-01

    Full Text Available To the Editor: We read with interest the article from Bitter et al. (1 published in the last volume of JAFIB. This non-systematic review covers some of the most important physiopathological aspects of the link between sleep disordered breathing (SDB and atrial fibrillation (AFib. We do agree with the authors on the role of hypertension, endothelial dysfunction and inflammation. These topics were, to our understanding and perspective, very well covered by the authors on this review. However, despite that the authors mentioned atrial remodeling a couple of times during their review, we are not sure that this topic and specifically atrial electrical remodeling, was properly discussed and referenced. The pathophysiology linking SDB to AF is multifactorial and may involve repetitive hypoxemia, increased sympathetic drive, fluctuations in intrathoracic pressure and systemic inflammation (2. These physiologic changes may induce structural and electrical remodeling serving as a substrate to the development of AFib. An indirect marker for such electrical remodeling is the prolongation of atrial conduction time, represented by increased maximum P-wave duration in the surface ECG. In a prior study, we showed that an increased P-wave duration has been associated with SDB (3. Interatrial block (IAB, defined as a surface P-wave duration > 120 ms, was more prevalent in patients with moderate-severe SDB (34.7% SDB vs. 0% controls, p 25 were independent predictors of maximum P-wave duration (p=0.001 and p<0.001 respectively (3. Another non-invasive method to determine atrial electrical remodeling is the Signal-averaged P-wave (SAPW duration. The SAPW duration represents the average of all P-wave durations in a given number of consecutive heartbeats. We recently postulated that SAPW would be useful to identify atrial electrical remodeling in patients with severe SDB and that treatment with C-PAP for 4-6 weeks may induce reverse atrial electrical remodeling (4

  2. The Use of Cryoballoon Ablation in Atrial Fibrillation: Simplifying Pulmonary Vein Isolation?

    Directory of Open Access Journals (Sweden)

    Gian Battista Chierchia, MD

    2010-12-01

    Full Text Available Atrial fibrillation (AF is certainly the most common arrhythmia encountered in clinical practice, reaching epidemic proportions in occidental society. Nowadays, transcatheter ablation using radiofrequency (RF has become a popular technique in the treatment of drug-resistant AF. Since ectopic beats originating from the pulmonary veins (PVs have been shown to be the main trigger initiating AF, electrical isolation of these venous structures has become the goal when performing this procedure.

  3. Diagnosis and Treatment of Atrial Fibrillation.

    Science.gov (United States)

    Gutierrez, Cecilia; Blanchard, Daniel G

    2016-09-15

    Atrial fibrillation is a supraventricular arrhythmia that adversely affects cardiac function and increases the risk of stroke. It is the most common arrhythmia and a major source of morbidity and mortality; its prevalence increases with age. Pulse rate is sensitive, but not specific, for diagnosis, and suspected atrial fibrillation should be confirmed with 12-lead electrocardiography. Because normal electrocardiographic findings do not rule out atrial fibrillation, home monitoring is recommended if there is clinical suspicion of arrhythmia despite normal test results. Treatment is based on decisions made regarding when to convert to normal sinus rhythm vs. when to treat with rate control, and, in either case, how to best reduce the risk of stroke. For most patients, rate control is preferred to rhythm control. Ablation therapy is used to destroy abnormal foci responsible for atrial fibrillation. Anticoagulation reduces the risk of stroke while increasing the risk of bleeding. The CHA2DS2-VASc scoring system assesses the risk of stroke, with a score of 2 or greater indicating a need for anticoagulation. The HAS-BLED score estimates the risk of bleeding. Scores of 3 or greater indicate high risk. Warfarin, dabigatran, factor Xa inhibitors (e.g., rivaroxaban, apixaban, edoxaban), and aspirin are options for stroke prevention. Selection of therapy should be individualized based on risks and potential benefits, cost, and patient preference. Left atrial appendage obliteration is an option for reducing stroke risk. Two implantable devices used to occlude the appendage, the Watchman and the Amplatzer Cardiac Plug, appear to be as effective as warfarin in preventing stroke, but they are invasive. Another percutaneous approach to occlusion, wherein the left atrium is closed off using the Lariat, is also available, but data on its long-term effectiveness and safety are still limited. Surgical treatments for atrial fibrillation are reserved for patients who are undergoing

  4. Atrial tachyarrhythmia in Rgs5-null mice.

    Directory of Open Access Journals (Sweden)

    Mu Qin

    Full Text Available AIMS: The aim of this study was to elucidate the effects of regulator of G-protein signaling 5 (Rgs5, a negative regulator of G protein-mediated signaling, on atrial repolarization and tachyarrhythmia (ATA in mice. METHODS AND RESULTS: In present study, the incidence of ATA were increased in Rgs5(-/- Langendorff-perfused mouse hearts during program electrical stimulation (PES (46.7%, 7 of 15 and burst pacing (26.7%, 4 of 15 compared with wild-type (WT mice (PES: 7.1%,1 of 14; burst:7.1%,1 of 14 (P30 s but none of them observed in WT mice. Atrial prolonged repolarization was observed in Rgs5(-/- hearts including widened P wave in surface ECG recording, increased action potential duration (APD and atrial effective refractory periods (AERP, all of them showed significant difference with WT mice (P<0.05. At the cellular level, whole-cell patch clamp recorded markedly decreased densities of repolarizing K(+ currents including I(Kur (at +60 mV: 14.0±2.2 pF/pA and I(to (at +60 mV: 16.7±1.3 pA/pF in Rgs5(-/- atrial cardiomyocytes, compared to those of WT mice (at +60 mV I(to: 20.4±2.0 pA/pF; I(kur: 17.9±2.0 pF/pA (P<0.05. CONCLUSION: These results suggest that Rgs5 is an important regulator of arrhythmogenesis in the mouse atrium and that the enhanced susceptibility to atrial tachyarrhythmias in Rgs5(-/- mice may contribute to abnormalities of atrial repolarization.

  5. Cryoballoon Catheter Ablation in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cevher Ozcan

    2011-01-01

    Full Text Available Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

  6. [Obesity as a risk factor for atrial fibrillation].

    Science.gov (United States)

    Duraj, Iwona; Broncel, Marlena

    2016-01-01

    Atrial fibrillation (AF) and obesity is a growing problem of public health both in Poland and in the whole world. AF risk factors may be summarized as elderliness, male sex, smoking, hypertension, diabetes, obesity, coronary heart disease, heart failure, valvular heart disease, cardiac surgery. Once obesity is an independent, potentially modifiable risk factor for AF. The connection between obesity and atrial fibrillation is very up-to-date because of incremental prevalence, almost epidemic of obesity in the whole world. The probability of AF among obese patients increases with concomitant obstructive sleep apnea. Regardless many researches it hasn't been assessed yet how obesity itself predisposes to AF. It could be an effect of change in the atrial anatomy, the rise of atrial pressure, mechanical stretch, interstitial atrial fibrosis and disruption of atrial electric integrity. A great role is ascribed to inflammation, especially proinflammatory cytokines increased by adipocites of left atrial epicardial adiposity.

  7. Reduced kidney function is a risk factor for atrial fibrillation.

    Science.gov (United States)

    Laukkanen, Jari A; Zaccardi, Francesco; Karppi, Jouni; Ronkainen, Kimmo; Kurl, Sudhir

    2016-08-01

    There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to evaluate whether various biomarkers of kidney function are associated to the risk of atrial fibrillation. The study population consisted of 1840 subjects (615 women and 1225 men) aged 61-82 years. Cystatin C- and creatinine-based estimation of glomerular filtration rate (eGFRcys and eGRFcreat , respectively) and urinary albumin/creatinine ratio (ACR) were assessed to investigate their relationship with the risk of atrial fibrillation. During a median follow-up of 3.7 years, a total of 159 incident atrial fibrillation cases occurred. After adjustment for potential confounders, the risk of atrial fibrillation was increased (hazard ratio 2.74, 95% confidence interval (CI) 1.56-4.81, P atrial fibrillation (hazard ratio 2.16, CI 1.35-2.82, P atrial fibrillation. PMID:26780558

  8. Atrioventricular Junction Ablation in Atrial Fibrillation: Choosing The Right Patient and Pacing Device

    Directory of Open Access Journals (Sweden)

    Finn Akerstr�m; Mois�s Rodr�guez-Ma�ero; Marta Pach�n; Alberto Puchol; X. Alberte Fern�ndez-L�pez; Luis Mart�nez-Sande; Miguel Valderr�bano MD; Miguel A. Arias.

    2015-08-01

    Full Text Available Atrial fibrillation (AF is the most common cardiac arrhythmia and despite advancements in rhythm control through direct catheter ablation, maintaining sinus rhythm is currently not possible in a large proportion of AF patients. Furthermore, in some instances pharmacological rate control may be insufficient, resulting in a highly symptomatic patient at risk of developing tachycardia-induced cardiomyopathy and heart failure (HF. Catheter ablation of the atrioventricular junction (AVJ with subsequent permanent pacemaker implantation provides definite rate control and represents an attractive therapeutic option when pharmacological rate control is not achieved. In those with reduced ventricular function, cardiac resynchronization therapy (CRT should be considered over right ventricular apical (RVA pacing in order to avoid the deleterious effects associated with a high amount of chronic RVA pacing. Another group of patients that may also benefit from AVJ ablation are HF patients with concomitant AF receiving CRT. In this patient cohort AVJ ablation ensures near 100% biventricular pacing, thus allowing optimization of the therapeutic effects of CRT.

  9. An intelligent telecardiology system using a wearable and wireless ECG to detect atrial fibrillation.

    Science.gov (United States)

    Lin, Chin-Teng; Chang, Kuan-Cheng; Lin, Chun-Ling; Chiang, Chia-Cheng; Lu, Shao-Wei; Chang, Shih-Sheng; Lin, Bor-Shyh; Liang, Hsin-Yueh; Chen, Ray-Jade; Lee, Yuan-Teh; Ko, Li-Wei

    2010-05-01

    This study presents a novel wireless, ambulatory, real-time, and autoalarm intelligent telecardiology system to improve healthcare for cardiovascular disease, which is one of the most prevalent and costly health problems in the world. This system consists of a lightweight and power-saving wireless ECG device equipped with a built-in automatic warning expert system. This device is connected to a mobile and ubiquitous real-time display platform. The acquired ECG signals are instantaneously transmitted to mobile devices, such as netbooks or mobile phones through Bluetooth, and then, processed by the expert system. An alert signal is sent to the remote database server, which can be accessed by an Internet browser, once an abnormal ECG is detected. The current version of the expert system can identify five types of abnormal cardiac rhythms in real-time, including sinus tachycardia, sinus bradycardia, wide QRS complex, atrial fibrillation (AF), and cardiac asystole, which is very important for both the subjects who are being monitored and the healthcare personnel tracking cardiac-rhythm disorders. The proposed system also activates an emergency medical alarm system when problems occur. Clinical testing reveals that the proposed system is approximately 94% accurate, with high sensitivity, specificity, and positive prediction rates for ten normal subjects and 20 AF patients. We believe that in the future a business-card-like ECG device, accompanied with a mobile phone, can make universal cardiac protection service possible. PMID:20371411

  10. Atrial Fibrillation and Heart Failure Parallels: Lessons for Atrial Fibrillation Prevention

    OpenAIRE

    McManus, David D.; Shaikh, Amir Y; Abhishek, FNU; Vasan, Ramachandran S.

    2011-01-01

    Heart failure (HF) and atrial fibrillation (AF) are two of the most common cardiovascular diseases encountered in clinical practice, and the prevalence of these diseases continues to grow world-wide with the aging of the global population.

  11. New risk factors for atrial fibrillation : causes of 'not-so-lone atrial fibrillation'

    NARCIS (Netherlands)

    Schoonderwoerd, Bas A.; Smit, Marcelle D.; Pen, Lucas; Van Gelder, Isabelle C.

    2008-01-01

    Atrial fibrillation (AF) is a prevalent arrhythmia in patients with cardiovascular disease. The classical risk factors for developing AF include hypertension, valvular disease, (ischaemic) cardiomyopathy, diabetes mellitus, and thyroid disease. In some patients with AF, no underlying (cardiovascular

  12. Late Sodium Current in Human Atrial Cardiomyocytes from Patients in Sinus Rhythm and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Poulet, Claire; Wettwer, Erich; Grunnet, Morten;

    2015-01-01

    Slowly inactivating Na+ channels conducting "late" Na+ current (INa,late) contribute to ventricular arrhythmogenesis under pathological conditions. INa,late was also reported to play a role in chronic atrial fibrillation (AF). The objective of this study was to investigate INa,late in human right......, and lower in AF than in SR. In conclusion, We confirm for the first time a TTX-sensitive current (INa,late) in right atrial cardiomyocytes from SR and AF patients at room temperature, but not at physiological temperature. While our study provides evidence for the presence of INa,late in human atria...... atrial cardiomyocytes as a putative drug target for treatment of AF. To activate Na+ channels, cardiomyocytes from transgenic mice which exhibit INa,late (ΔKPQ), and right atrial cardiomyocytes from patients in sinus rhythm (SR) and AF were voltage clamped at room temperature by 250-ms long test pulses...

  13. Radiofrequency ablation therapy of intractable ventricular tachycardia present with a left ventricular assist device

    DEFF Research Database (Denmark)

    Nielsen, Jan Møller; Kristiansen, Steen Buus; Gerdes, Christian;

    2015-01-01

    Ventricular tachycardia (VT) occurs in up to 59% of patients with left ventricular assist devices (LVAD). In some of these patients, the VT cannot be managed medically or by implantable cardioverter-defibrillator. In this case, a 66-year-old male was successfully treated with radiofrequency...

  14. New exome data question the pathogenicity of genetic variants previously associated with catecholaminergic polymorphic ventricular tachycardia

    DEFF Research Database (Denmark)

    Jabbari, Javad; Jabbari, Reza; Nielsen, Morten Wagner;

    2013-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a lethal, rare hereditary disease with an estimated prevalence of 1:10 000. The genetic variants that cause CPVT are usually highly penetrant. To date, about 189 variants in 5 genes (RYR2, CASQ2, CALM1, TRND, and KCNJ2) have been...

  15. Postpartum Postural Orthostatic Tachycardia Syndrome in a Patient with the Joint Hypermobility Syndrome

    Directory of Open Access Journals (Sweden)

    Khalil Kanjwal

    2009-01-01

    Full Text Available Postural orthostatic tachycardia syndrome (POTS commonly affects women of childbearing age. We report on a 37-year-old woman who developed symptoms of recurrent syncope in the postpartum period. Her head up tilt test and clinical presentation was consistent with POTS.

  16. Postpartum Postural Orthostatic Tachycardia Syndrome in a Patient with the Joint Hypermobility Syndrome

    OpenAIRE

    Khalil Kanjwal; Beverly Karabin; Yousuf Kanjwal; Grubb, Blair P.

    2009-01-01

    Postural orthostatic tachycardia syndrome (POTS) commonly affects women of childbearing age. We report on a 37-year-old woman who developed symptoms of recurrent syncope in the postpartum period. Her head up tilt test and clinical presentation was consistent with POTS.

  17. Electrophysiologic and antiarrhythmic effects of intravenous bisoprolol in atrioventricular nodal reentry tachycardia

    NARCIS (Netherlands)

    vandeVen, LLM; Crijns, HJGM; deMuinck, ED; VanGelder, IC; VanWijk, LM; Lie, KI

    1996-01-01

    Beta-blockade may be useful in the termination and prevention of atrioventricular nodal reentry tachycardia (AVNRT), An electrophysiologic study was performed in 9 patients (4 men and 5 women; mean +/- SD age, 56 +/- 16 years) with documented AVNRT before and after the intravenous administration of

  18. Simultaneous wide and narrow QRS complex tachycardia: what is the mechanism?

    Science.gov (United States)

    Rodríguez-Mañero, Moisés; Bayrak, Fatih; Namdar, Mehdi; Casado-Arroyo, Rubén; Ricciardi, Danilo; Chierchia, Gian-Battista; Sarkozy, Andrea; de Asmundis, Carlo; Brugada, Pedro

    2013-05-01

    We present the case of a 50-year-old patient with several episodes of syncope and documented simultaneous wide and narrow QRS complex tachycardia. We then review this tacharrhythmia, focusing on electrophysiological findings and pathophysiology, diagnosis and treatment. PMID:23688775

  19. Relationship between nocturnal hypoxaemia, tachycardia and myocardial ischaemia after major abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, I; Rosenberg-Adamsen, S; Lie, C;

    2004-01-01

    time spent with oxygen saturation values less than 90, 85, and 80% during the night, and noted episodes of hypoxaemia, tachycardia, bradycardia, and ST-segment changes. RESULTS: In 87 study nights there were 2403 (individual range 1-229) episodes of hypoxaemia, 3509 (individual range 1-234) episodes of...

  20. Efficacy of Antiarrhythmic Drugs in Adults With Congenital Heart Disease and Supraventricular Tachycardias

    NARCIS (Netherlands)

    Koyak, Zeliha; Kroon, Bart; de Groot, Joris R.; Wagenaar, Lodewijk J.; van Dijk, Arie P.; Mulder, Bart A.; Van Gelder, Isabelle C.; Post, Marco C.; Mulder, Barbara J. M.; Bouma, Berto J.

    2013-01-01

    Supraventricular tachycardias (SVTs) are a major cause of morbidity in adults with congenital heart disease (CHD). Few data exist on safety and efficacy of antiarrhythmic drugs in this population. Our aim was to determine the efficacy of antiarrhythmic drugs in adults with CHD and first-onset SVT on

  1. A case of catecholaminergic polymorphic ventricular tachycardia caused by two calsequestrin 2 mutations

    NARCIS (Netherlands)

    De La Fuente, Sam; Van Langen, Irene M.; Postma, Alex V.; Bikker, Henni; Meijer, Albert

    2008-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an uncommon heritable disease presenting with syncope or sudden cardiac death. Two genes involved in calcium homeostasis, the ryanodine receptor gene and the calsequestrin 2 (CASQ2) gene, have been implicated in this disease. We describ

  2. A Case of Slow Coronary Flow Presented with Supraventricular Tachycardia and Troponin Positive Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Mustafa Akçakoyun

    2009-12-01

    Full Text Available Slow coronary flow (SCF but normal epicardial coronary arteries phenomenon frequently have asymptomatic course, however, some reports have showed that this phenomenon may cause angina pectoris, myocardial ischemia and infarction. We described a patient presented with supraventricular tachycardia and Troponin elevation and whose coronary angiography’s had previously revealed slow flow in entire major epicardial coronary arteries.

  3. Dabigatran etexilate in atrial fibrillation.

    Science.gov (United States)

    Vora, Amit

    2013-12-01

    Atrial fibrillation (AF) affects millions worldwide. Stroke is the most devastating complication of AF and is associated with a huge disease burden. As a preventive measure, anticoagulant therapy is recommended for most AF patients based on presence of stroke risk factors. For the past six decades warfarin remained the gold standard for stroke prevention in AF (SPAF). However, it is associated with numerous limitations such as a high risk of drug-drug, drug-food interactions and need for frequent INR (2-3) monitoring. Novel oral anticoagulant (NOAC) dabigatran etexilate is a selective, specific, reversible direct thrombin inhibitor that has been approved in India for SPAF and primary venous thromboembolism prevention. The efficacy and safety of dabigatran in AF has been established the "Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY)", a randomized clinical trial. RE-LY (n = 18,113) demonstrated that the efficacy of dabigatran 110 mg BID was as good as well controlled warfarin and dabigatran 150 mg BID reduced the risk of ischaemic stroke by 25% (P = 0.03). Till date, 150mg dabigatran is the only NOAC offering a superior reduction in most commonly seen ischemic strokes due to AF compared to warfarin. Additionally, both doses of dabigatran significantly reduced the risk of total bleeds, intracranial, and life threatening bleeds versus warfarin (p bleeding and good renal function to achieve a superior ischemic stroke reduction, whereas, the 110 mg dose should be considered in elderly patients, those with mild to moderate renal function or those with high risk of bleeding. PMID:24968547

  4. The antiarrhythmic peptide analog ZP123 prevents atrial conduction slowing during metabolic stress

    DEFF Research Database (Denmark)

    Haugan, Ketil; Olsen, Kristine Boisen; Hartvig, Line;

    2005-01-01

    OBJECTIVE: As atrial conduction slowing is important in the pathogenesis of atrial reentry arrhythmias, a drug that increases atrial conduction or prevents atrial conduction slowing could serve to prevent atrial reentry arrhythmias. In this study, we investigated whether the novel stable antiarrh...

  5. Left Atrial Appendage Closure for Stroke Prevention in Patients with Atrial Fibrillation and Hereditary Hemorrhagic Telangiectasia

    OpenAIRE

    Sebastiaan Velthuis; Swaans, Martin J.; Mager, Johannes J.; Rensing, Benno J. W. M.; Lucas V. A. Boersma; Post, Martijn C.

    2012-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions of individuals worldwide, and a major risk factor for disabling cerebral embolic stroke. Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disorder, characterized by vascular abnormalities with high-bleeding tendency and therefore intolerance for oral anticoagulation. We report a case of percutaneous closure of the left atrial appendage, which might be a good alternative strategy in...

  6. Left atrial appendage occlusion for stroke prevention in atrial fibrillation in Europe

    DEFF Research Database (Denmark)

    Lip, Gregory Y.H.; Dagres, Nikolaos; Proclemer, Alessandro;

    2013-01-01

    The purpose of this EP wire survey was to assess clinical practice in relation to the use of left atrial appendage occlusion (LAAO) devices for stroke prevention in atrial fibrillation (AF) among members of the European Heart Rhythm Association research network. The average number of performed LAAO...... are most often performed by interventional cardiologists. Experience varied widely, and this was reflected in the wide range of thromboembolic and procedural (tamponade, bleeding) complications reported by the respondents to this EP wire survey....

  7. Dronedarone for the treatment of atrial fibrillation and atrial flutter: approval and efficacy

    OpenAIRE

    Deborah Wolbrette, Deborah

    2010-01-01

    Deborah Wolbrette, Mario Gonzalez, Soraya Samii, Javier Banchs, Erica Penny-Peterson, Gerald NaccarelliPenn State Heart and Vascular Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USAAbstract: Dronedarone, a new Class III antiarrhythmic agent, has now been approved by the US Food and Drug Administration for use in patients with atrial fibrillation or atrial flutter. Approval came in March 2009 due to the positive results of the ATHENA trial showing significant r...

  8. Valsartan Reduced Atrial Fibrillation Susceptibility by Inhibiting Atrial Parasympathetic Remodeling through MAPKs/Neurturin Pathway

    Directory of Open Access Journals (Sweden)

    Lei Liu

    2015-07-01

    Full Text Available Background/Aims: Angiotensin II receptor blockers (ARBs have been proved to be effective in preventing atrial structural and electrical remodelinq in atrial fibrillation (AF. Previous studies have shown that parasympathetic remodeling plays an important role in AF. However, the effects of ARBs on atrial parasympathetic remodeling in AF and the underlying mechanisms are still unknown. Methods: Canines were divided into sham-operated, pacing and valsartan + pacing groups. Rats and HL-1 cardiomyocytes were divided into control, angiotensin II (Ang II and Ang II + valsartan groups, respectively. Atrial parasympathetic remodeling was quantified by immunocytochemical staining with anti-choline acetyltransferase (ChAT antibody. Western blot was used to analysis the protein expression of neurturin. Results: Both inducibility and duration were increased in chronic atrial rapid-pacing canine model, which was significantly inhibited by the treatment with valsartan. The density of ChAT-positive nerves and the protein level of neurturin in the atria of pacing canines were both increased than those in sham-operated canines. Ang II treatment not only induced atrial parasympathetic remodeling in rats, but also up-regulated the protein expression of neurturin. Valsartan significantly prevented atrial parasympathetic remodeling, and suppressed the protein expression of neurturin. Meanwhile, valsartan inhibited Ang II -induced up-regulation of neurturin and MAPKs in cultured cardiac myocytes. Inhibition of MAPKs dramatically attenuated neurturin up-regulation induced by Ang II. Conclusion: Parasympathetic remodeling was present in animals subjected to rapid pacing or Ang II infusion, which was mediated by MAPKs/neurturin pathway. Valsartan is able to prevent atrial parasympathetic remodeling and the occurrence of AF via inhibiting MAPKs/neurturin pathway.

  9. Computational models of atrial cellular electrophysiology and calcium handling, and their role in atrial fibrillation.

    Science.gov (United States)

    Heijman, Jordi; Erfanian Abdoust, Pegah; Voigt, Niels; Nattel, Stanley; Dobrev, Dobromir

    2016-02-01

    The complexity of the heart makes an intuitive understanding of the relative contribution of ion channels, transporters and signalling pathways to cardiac electrophysiology challenging. Computational modelling of cardiac cellular electrophysiology has proven useful to integrate experimental findings, extrapolate results obtained in expression systems or animal models to other systems, test quantitatively ideas based on experimental data and provide novel hypotheses that are experimentally testable. While the bulk of computational modelling has traditionally been directed towards ventricular bioelectricity, increasing recognition of the clinical importance of atrial arrhythmias, particularly atrial fibrillation, has led to widespread efforts to apply computational approaches to understanding atrial electrical function. The increasing availability of detailed, atrial-specific experimental data has stimulated the development of novel computational models of atrial-cellular electrophysiology and Ca(2+) handling. To date, more than 300 studies have employed mathematical simulations to enhance our understanding of atrial electrophysiology, arrhythmogenesis and therapeutic responses. Future modelling studies are likely to move beyond current whole-cell models by incorporating new data on subcellular architecture, macromolecular protein complexes, and localized ion-channel regulation by signalling pathways. At the same time, more integrative multicellular models that take into account regional electrophysiological and Ca(2+) handling properties, mechano-electrical feedback and/or autonomic regulation will be needed to investigate the mechanisms governing atrial arrhythmias. A combined experimental and computational approach is expected to provide the more comprehensive understanding of atrial arrhythmogenesis that is required to develop improved diagnostic and therapeutic options. Here, we review this rapidly expanding area, with a particular focus on Ca(2+) handling, and

  10. Ischaemic stroke with intact atrial septum--exclude arteriovenous malformations.

    Science.gov (United States)

    Doering, Friederike; Eicken, Andreas; Hess, John

    2014-02-01

    A 44-year-old woman was referred to our centre for interventional cardiac catheterisation. The diagnostic work-up after a preceding ischaemic stroke led to the assumption of a patent foramen ovale due to a positive bubble study. Before the planned percutaneous closure of the patent foramen ovale, we performed a second bubble study, which showed an intact atrial septum. However, after two to three heart cycles bubbles could be detected in the left atrium, assuming a right-to-left shunt of an extracardiac origin most likely in the lung. We therefore performed cardiac catheterisation, yielding a pulmonary arteriovenous malformation in the lower lobe of the right lung. This was successfully closed interventionally by placing a Cook coil, as well as several plugs into the malformation and feeding vessels. PMID:23347820

  11. Signal processing techniques for atrial fibrillation source detection.

    Science.gov (United States)

    Ambadkar, Minal; Leonelli, Fabio M; Sankar, Ravi

    2014-01-01

    In clinical practice, Atrial Fibrillation (AF) is the most common and critical cardiac arrhythmia encountered. The treatment that can ensure permanent AF removal is catheter ablation, where cardiologists destroy the affected cardiac muscle cells with RF or Laser. In this procedure it is necessary to know exactly from which part of the heart AF triggers are originated. Various signal processing algorithms provide a strong tool to track AF sources. This study proposes, signal processing techniques that can be exploited for characterization, analysis and source detection of AF signals. These algorithms are implemented on Electrocardiogram (ECG) and intracardiac signals which contain important information that allows the analysis of anatomic and physiologic aspects of the whole cardiac muscle.

  12. ANTIARRHYTMIC EFFICACY OF SOTALOL IN PATIENTS WITH TACHY-BRADY SYNDROME HAVING ATRIAL PACEMAKER WITH DIFFERENT ATRIAL ELECTRODE POSITION

    Directory of Open Access Journals (Sweden)

    T. N. Novikova

    2016-01-01

    Full Text Available Aim. To evaluate efficacy of the combined therapy (sotalol and constant electric cardiostimulation in AAI regimen at two atrial electrode position: in low back part of interatrial septum (IAS and in right atrial auricle (RAA.Material and methods. 20 patients with tachy-brady syndrome were examined. They were randomized in 2 groups depending on atrial electrode position. Sotalol (160 mg daily was prescribed to all patients in a month after implantation of constant atrial pacemaker (CAP. A number of atrial fibrillation paroxysms (AFP was evaluated initially, in a month after CAP implantation and in a month after start of sotalol therapy.Results. Significant AFP reduction was observed in IAS stimulation, unlike RAA stimulation. Sotalol addition had essential significance in the termination or reduction of AFP. Sotalol effect did not depend on atrial electrode position.Conclusion. Sotalol usage together with constant electric cardiostimulation significantly reduces AFP irrespectively of atrial electrode position. 

  13. Structural and functional atrial remodeling in patients after catheter and surgical ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Bockeria L.A.

    2016-03-01

    Full Text Available Atrial fibrillation (AF is the most common supraventricular arrhythmia which occurs in 1.5–2.0% of population. Morbidity of AF increased by 13% over the past two decades. Modern treatment of AF includes drug therapy, catheter radiofrequency ablation and various modifications of Cox Maze operations. The purpose of this review was to assess the atrial remodeling according to world literature. This involved a search of published articles in Medline, Web of Science, PubMed, Cochrane Central Register of Controlled Trials medical databases. During the primary stage of analysis 25 articles of 456 were identified. The researches carried out demonstrate that after catheter ablation and Cox Maze operation in patients with atrial fibrillation left atrium volume decrease, atrial contractile function improvment and sinus rhythm restoration are observed. In the absence of AF recurrence and postoperative atrial arrhythmias in early and late postoperative periods in some patients atrial remodeling is expressed. All data were confirmed by echocardiography, computer tomography and magnetic resonance imaging studies both before and after surgery.

  14. Assessment of atrial fibrosis for the rhythm control of atrial fibrillation.

    Science.gov (United States)

    Begg, Gordon A; Holden, Arun V; Lip, Gregory Y H; Plein, Sven; Tayebjee, Muzahir H

    2016-10-01

    Rhythm control of atrial fibrillation (AF) remains challenging, with modest long-term success rates. Atrial fibrosis has been associated with AF, but the clinical utility of assessment of this fibrosis has yet to be fully elucidated. In this paper we review the current state of understanding of the pathophysiology of atrial fibrosis in AF, and its impact upon the instigation and propagation of the arrhythmia. Fibrosis causes an increase in volume of dysfunctional extracellular matrix, and is associated with cellular alterations such as hypertrophy, apoptosis and membrane dysfunction within the atrial myocardium. In turn, these cause pathological alterations to atrial conduction, such as increased anisotropy, conduction block and re-entry, which can lead to AF. We review current methods of assessing atrial fibrosis and their impact upon the prediction of success of interventional rhythm control strategies such as ablation and cardioversion. We focus particularly on circulating biomarkers of fibrosis and scar formation; their role in the fibrotic process, and their value in the prediction of rhythm control success. We also review imaging and invasive electrocardiographic mapping techniques that may identify fibrosis, and again assess their potential predictive value. In this area there exist many unanswered questions, but further work will help to refine techniques to reliably identify and treat those patients who are most likely to benefit from rhythm control treatment strategies. PMID:27389440

  15. Characterization of Cardiac Troponin Elevation in the Setting of Pediatric Supraventricular Tachycardia.

    Science.gov (United States)

    Moore, Jeremy P; Arcilla, Lisa; Wang, Shuo; Lee, Michael S; Shannon, Kevin M

    2016-02-01

    Cardiac troponin (cTn) is currently considered the gold standard biomarker for detection of myocardial necrosis. Patients with supraventricular tachycardia (SVT) often present with symptoms resulting in cTn assessment; however, there are no data on the results of such testing in childhood. We hypothesized that cTn elevation would be common in the pediatric SVT population and would portend a benign prognosis. A retrospective review of all pediatric patients (≤21 years) presenting with SVT was performed. Clinical and electrocardiographic variables from the emergency department (ED) presentation were reviewed and clinical outcomes during subsequent follow-up assessed. Of 128 patients seen in the ED for SVT, cTn was assessed in 48 (38 %). Of patients with cTn assessment, 14 (29 %) patients demonstrated cTn elevation. Univariate predictors of cTn elevation included presentation with respiratory or gastrointestinal symptoms (50 vs 12 % and 42 vs 9 %; p = 0.008 and p = 0.01, respectively), lower mean arterial blood pressure (73 vs 85 mm Hg, p = 0.009), higher age-adjusted tachycardia rate (z score 9.3 vs 7.2, p < 0.001), and longer tachycardia duration (4.2 vs 1.0 h, p = 0.02). Multivariate logistic regression confirmed the association of age-adjusted tachycardia rate (odds ratio [OR] 3.8 per heart rate z score, confidence interval [CI] 1.9-11.8, p = 0.003) and duration (OR 1.5 per hour, CI 1.1-2.5, p = 0.03). Clinical outcome was excellent with no adverse sequelae during a median of 2.9 years of follow-up. Cardiac Tn elevation is common in the pediatric population presenting with SVT. Episode severity, characterized by respiratory or gastrointestinal symptoms, lower mean blood pressure, and increased tachycardia rate and duration are predictive. Clinical follow-up is favorable.

  16. A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation

    DEFF Research Database (Denmark)

    Camm, A John; Capucci, Alessandro; Hohnloser, Stefan H;

    2011-01-01

    Objectives This randomized double-blind study compared the efficacy and safety of intravenous vernakalant and amiodarone for the acute conversion of recent-onset atrial fibrillation (AF). Background Intravenous vernakalant has effectively converted recent-onset AF and was well tolerated in placebo...... with 32.8% of amiodarone patients; p = 0.0012). Serious adverse events or events leading to discontinuation of study drug were uncommon. There were no cases of torsades de pointes, ventricular fibrillation, or polymorphic or sustained ventricular tachycardia. Conclusions Vernakalant demonstrated efficacy......-controlled studies. Methods A total of 254 adult patients with AF (3 to 48 h duration) eligible for cardioversion were enrolled in the study. Patients received either a 10-min infusion of vernakalant (3 mg/kg) followed by a 15-min observation period and a second 10-min infusion (2 mg/kg) if still in AF, plus a sham...

  17. Attitudes Towards Catheter Ablation for Atrial Fibrillation

    DEFF Research Database (Denmark)

    Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis;

    2015-01-01

    BACKGROUND: Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians´ attitudes towards catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish...

  18. Spontaneous conversion of first onset atrial fibrillation

    DEFF Research Database (Denmark)

    Lindberg, Søren Østergaard; Hansen, Sidsel; Nielsen, Tonny

    2011-01-01

    Background  We studied all patients admitted to hospital with first onset atrial fibrillation (AF) to determine the probability of spontaneous conversion to sinus rhythm and to identify factors predictive of such a conversion. Methods and Results  We retrospectively reviewed charts of 438...

  19. Genetic aspects of lone atrial fibrillation

    DEFF Research Database (Denmark)

    Andreasen, Laura; Nielsen, Jonas B; Olesen, Morten S

    2015-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia. A subgroup of patients presents with AF without traditional risk factors and is diagnosed before the age of 60 years. Such patients are commonly referred as having "lone AF" and comprise 10-20% of all cases. A number of studies have...

  20. Bleeding Risk Assessment in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Lane, Deirdre A

    2016-01-01

    Stroke prevention is central to the management of atrial fibrillation (AF), and effective thromboprophylaxis requires oral anticoagulation (OAC). Even a single stroke risk factor confers excess risk, and the net clinical benefit of treatment is positive for OAC compared to no treatment or aspirin...

  1. Right juxtaposition of the atrial appendages.

    Science.gov (United States)

    Mathew, R; Replogle, R; Thilenius, O G; Arcilla, R A

    1975-04-01

    We present an infant with right-sided juxtaposition of atrial appendages who had open heart surgery for ventricular septal defect and patent ductus arteriosus. Of 12 cases thus far reported, ventricular d-loop was observed in nine, and normal position of great vessels in four. Contrary to previous views, this condition may not be accompanied by severe conotruncal anomalies.

  2. Hypercoagulability promotes atrial fibrosis and fibrillation

    NARCIS (Netherlands)

    Spronk, Henri M.H.; De Jong, Anne-Margreet; De Boer, Hetty C.; Maas, Alexander; Verheule, Sander; Rienstra, Michiel; Kamphuisen, Pieter W.; Ten Cate, Hugo; Crijns, Harry J.; Van Gelder, Isabelle; Van Zonneveld, Anton Jan; Schotten, Ullrich

    2014-01-01

    Background: It is well known that atrial fibrillation (AF) induces a hypercoagulable state, which significantly increases stroke risk in patients with AF contributing to morbidity and mortality in these patients. Active coagulation factors can also provoke diverse cellular responses through stimulat

  3. An "account" of digitalis and atrial fibrillation

    NARCIS (Netherlands)

    Meijler, F.L.

    1985-01-01

    This review deals with the mechanisms by which digitalis exerts its "opium-Iike" action on the ventricular rate in patients with atrial fibrillation. To understand the effect of digitalis on ventricular rate and rhythm, it is essential to learn more about the basic electrophysiologic principles resp

  4. Epicardial adipose tissue and atrial fibrillation.

    Science.gov (United States)

    Hatem, Stéphane N; Sanders, Prashanthan

    2014-05-01

    Atrial fibrillation (AF) is the most frequent cardiac arrhythmia in clinical practice. AF is often associated with profound functional and structural alterations of the atrial myocardium that compose its substrate. Recently, a relationship between the thickness of epicardial adipose tissue (EAT) and the incidence and severity of AF has been reported. Adipose tissue is a biologically active organ regulating the metabolism of neighbouring organs. It is also a major source of cytokines. In the heart, EAT is contiguous with the myocardium without fascia boundaries resulting in paracrine effects through the release of adipokines. Indeed, Activin A, which is produced in abundance by EAT during heart failure or diabetes, shows a marked fibrotic effect on the atrial myocardium. The infiltration of adipocytes into the atrial myocardium could also disorganize the depolarization wave front favouring micro re-entry circuits and local conduction block. Finally, EAT contains progenitor cells in abundance and therefore could be a source of myofibroblasts producing extracellular matrix. The study on the role played by adipose tissue in the pathogenesis of AF is just starting and is highly likely to uncover new biomarkers and therapeutic targets for AF. PMID:24648445

  5. Effect of catheter radiofrequency ablation on C-reactive protein, brain natriuretic peptide and echocardiograph in patients with persistent and permanent atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Huang Qiong; Yuan Yiqiang; Qiu Chunguang; Zhao Yujie; Mao Youlin; Wang Ruimin; Wang Qian

    2014-01-01

    Background Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has developed rapidly,and is a commonly performed ablation in many major hospitals throughout the world,due to its satisfactory results.The aim of this study was to detect the effect of RFCA on C-reactive protein (CRP),brain natriuretic peptide (BNP),and echocardiograph in patients with persistent and permanent AF.Methods A total of 120 patients (71 males,mean age (50.8±12.0) years) with persistent and permanent AF undergoing RFCA under guidance of the Carto merge technique were studied.Left atrial diameter (LAD),right atrial diameter (RAD),left ventricular ejection fraction (LVEF),CRP,and BNP were observed 3,6 and 12 months after RFCA and compared with results before RFCA.The recurrence of atrial arrhythmias was observed 3 and 12 months after the procedure.Results Compared with that before RFCA,LAD and RAD decreased and LVEF increased significantly after RFCA.Meanwhile,the levels of CRP and BNP were reduced significantly at 3,6,and 12 months after RFCA (P<0.05).In the non-recurrent patients,LVEF was increased significantly compared with the recurrent patients at 3,6,and 12 months after RFCA (P<0.05).CRP and BNP levels were decreased significantly in the non-recurrent patients compared with the recurrent patients at 3,6,and 12 months after RFCA (P<0.05).After one or two applications of RFCA,during a follow-up of 12 months,12 patients (10.0%) had AF,10 patients (8.3%) had atrial flutter,and 5 patients had atrial tachycardia (4.2%).Conclusions Conversion of AF to sinus rhythm by RFCA,has been shown to reduce LA size and improve LVEF.It can also significantly decrease the levels of CRP and BNP in patients with persistent and permanent AF and reduce the risk of inflammation and developing heart failure.

  6. 78 FR 11207 - Clinical Study Designs for Surgical Ablation Devices for Treatment of Atrial Fibrillation...

    Science.gov (United States)

    2013-02-15

    ... Treatment of Atrial Fibrillation; Guidance for Industry and Food and Drug Administration Staff; Availability... Ablation Devices for Treatment of Atrial Fibrillation.'' This guidance provides FDA's recommendations on clinical trial designs for surgical ablation devices intended for the treatment of atrial...

  7. Vernakalant hydrochloride for the rapid conversion of atrial fibrillation after cardiac surgery

    DEFF Research Database (Denmark)

    Kowey, Peter R; Dorian, Paul; Mitchell, L Brent;

    2009-01-01

    Postoperative atrial arrhythmias are common and are associated with considerable morbidity. This study was designed to evaluate the efficacy and safety of vernakalant for the conversion of atrial fibrillation (AF) or atrial flutter (AFL) after cardiac surgery....

  8. Assessment of the dynamics of atrial signals and local atrial period series during atrial fibrillation: effects of isoproterenol administration

    Directory of Open Access Journals (Sweden)

    Mantica Massimo

    2004-10-01

    Full Text Available Abstract Background The autonomic nervous system (ANS plays an important role in the genesis and maintenance of atrial fibrillation (AF, but quantification of its electrophysiologic effects is extremely complex and difficult. Aim of the study was to evaluate the capability of linear and non-linear indexes to capture the fine changing dynamics of atrial signals and local atrial period (LAP series during adrenergic activation induced by isoproterenol (a sympathomimetic drug infusion. Methods Nine patients with paroxysmal or persistent AF (aged 60 ± 6 underwent electrophysiological study in which isoproterenol was administered to patients. Atrial electrograms were acquired during i sinus rhythm (SR; ii sinus rhythm during isoproterenol (SRISO administration; iii atrial fibrillation (AF and iv atrial fibrillation during isoproterenol (AFISO administration. The level of organization between two electrograms was assessed by the synchronization index (S, whereas the degree of recurrence of a pattern in a signal was defined by the regularity index (R. In addition, the level of predictability (LP and regularity of LAP series were computed. Results LAP series analysis shows a reduction of both LP and R index during isoproterenol infusion in SR and AF (RSR = 0.75 ± 0.07 RSRISO = 0.69 ± 0.10, p AF = 0.31 ± 0.08 RAFISO = 0.26 ± 0.09, p SR = 99.99 ± 0.001 LPSRISO = 99.97 ± 0.03, p AF = 69.46 ± 21.55 LPAFISO = 55 ± 24.75; p SR = 0.49 ± 0.08 RSRISO = 0.46 ± 0.09 p AF = 0.29 ± 0.09 RAFISO = 0.28 ± 0.08 n.s.. Conclusions The proposed parameters succeeded in discriminating the subtle changes due to isoproterenol infusion during both the rhythms especially when considering LAP series analysis. The reduced value of analyzed parameters after isoproterenol administration could reflect an important pro-arrhythmic influence of adrenergic activation on favoring maintenance of AF.

  9. Importância da anatomia da circulação coronária atrial na operação de Cox para controle da fibrilação atrial The importance of atrial coronary circulation on Cox surgery for control atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Marcelo B. JATENE

    1999-01-01

    Full Text Available Com o advento de novas técnicas cirúrgicas para o tratamento das arritmias cardíacas, em especial da fibrilação atrial, como a cirurgia de Cox, o conhecimento das características e do trajeto das artérias coronárias atriais assumiu grande importância. O objetivo deste trabalho é o estudo desta circulação e a definição dos padrões de irrigação atrial. Para tanto, utilizamos 30 corações a fresco de indivíduos sem cardiopatia prévia, cujas artérias coronárias e ramos foram visibilizados através de injeção de resina vinílica corada com tinta laca preta, seguida de cuidadosa dissecção. Após avaliação macroscópica das peças, não foram encontrados padrões de irrigação uniforme dos átrios. Porém, a artéria do nó sinoatrial (ANSA, quando analisada isoladamente, revelou não apenas padrões de origem, como também padrões de trajeto. Foram descritos 7 padrões de origem e trajeto da ANSA, considerando-se pontos de referências da estrutura anatômica dos átrios. Os padrões descritos, diferente dos encontrados por outros autores, são de fácil interpretação e de aplicabilidade direta em técnicas cirúrgicas que abordam os átrios.Since the appearance of new surgical techniques such as Cox surgery employed for the treatment of cardiac arrhythmia, especially for atrial fibrillation, the knowledge of coronary artery characteristics and courses has been of increasing importance. The aim of this study was the analysis of this circulation and definition of atrial irrigation patterns. Hence, the coronary arteries of 30 normal human hearts were injected with colored resin and carefully dissected. After macroscopic evaluation of the hearts, no atrial irrigation patterns were found. However, when only the sinus atrial node was analyzed, it showed origin patterns as well as course patterns. Seven origin and route patterns of this artery are described, considering the anatomical structure of the atria as reference

  10. When narrow and wide complex tachycardia meet in one patient

    Institute of Scientific and Technical Information of China (English)

    Fatimah Lateef

    2014-01-01

    Evaluation of arrhythmias, especially in the acute setting can be challenging.One of the most crucial steps is to accurately differentiate whether a tachyarrhythmia is of supraventricular(with aberrant conduction) or ventricular origin.A12-lead electrocardiogram may be useful in some cases where specific morphology or features can be sought.

  11. Enhanced expression of ROCK in left atrial myocytes of mitral regurgitation: a potential mechanism of myolysis

    OpenAIRE

    Chen, Huang-Chung; Chang, Jen-Ping; Chang, Tzu-Hao; Lin, Yu-Sheng; Huang, Yao-Kuang; Pan, Kuo-Li; Fang, Chih-Yuan; Chen, Chien-Jen; Ho, Wan-Chun; Chen, Mien-Cheng

    2015-01-01

    Background Severe mitral regurgitation (MR) may cause myolysis in the left atrial myocytes. Myolysis may contribute to atrial enlargement. However, the relationship between Rho-associated kinase (ROCK) and myolysis in the left atrial myocytes of MR patients remain unclear. Methods This study comprised 22 patients with severe MR [12 with atrial fibrillation (AF) and ten in sinus rhythm]. Left atrial appendage tissues were obtained during surgery. Normal left atrial tissues were purchased. Immu...

  12. 导管消融具有双向传导特性的Mahaim结室纤维%Participation of a nodoventricular fiber presenting with bidirectional conduction property in the genesis of narrow QRS tachycardia

    Institute of Scientific and Technical Information of China (English)

    陈明龙; 徐东杰; 杨兵; 居维竹; 陈红武; 李文奇; 曹克将

    2009-01-01

    bidirectional conduction property and the method of its catheter ablation.Methods The study case,female,34 years old,had the history of recurrent palpitation for more than 7 years.Baseling ECG was essentially normal and ECG during palpitation attack showed a narrow QRS tachycardia.Intravenous bolus injection of verapamil and propafenone could terminate the tachycardia.Physical examination and echocardiography excluded the evidence of structural heart disease.Results Baseline electrophysiological study showed AH interval of 73 ms and HV interval of 42 ms with normal QRS complex in sinus rhythm.The tachycardia could be induced by atrial increamental pacing and had the same morphology as that of sinus rhythm.Endocardial recording demonstrated ventriculoatrial(VA) dissociation during tachycardia and HV interval was idendical to that of sinus rhythm.Sometimes,VA 1:1 conduction was noticed and the earliest atrial activation was in His recording.VA dissociation was observed during right ventricular apical pacing with the cycle lenth of 400 ms.QRS complex was progressively pre-excited with HV interval shortening and H deflection merging into the QRS complex during atrial increamental pacing.The interval between pacing signal and the onset of the QRS complex was concurrently prolonged until the QRS was fully pre-excited.When further decreased the cycle length of atrial pacing,the pre-excited QRS complex was suddenly shifted to normal and narrow QRS taehycardia was initiated after the abrupt increase in the AH interval.ATP could terminate the tachycardia and disclose accessory pathway conduction.When completely pre-excited,the earliest ventricular activation with "QS"unipolar recording was found at 4 o' clock of tricuspid ring( LAO 45° ) and radiofrequency energy delivery successfully blocked the accessory pathway conduction.No junctional rhythm was observed during ablation and AV jump conduction could still be noticed after ablation.No tachycardia occurred after a follow-up of 18

  13. Relationships of High-sensitive C-reactive Protein and P-wave Dispersion in Lone Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    Li-Hui Zheng; Yan Yao; Ling-Min Wu; Kui-Jun Zhang; Shu Zhang

    2015-01-01

    Background:Current evidence links atrial fibrillation (AF) to the inflammation.Inflammatory indexes such as high-sensitive C-reactive protein (hs-CRP) have been related to the development and persistence of AF.However,the role of inflammation in the atrial electrophysiological remodeling indexed by P-wave dispersion (Pd) remains unclear.Methods:The study consisted of 71 patients with lone paroxysmal AF (AF group) and 71 age-and gender-matched controls of paroxysmal supraventricular tachycardia without history of AF (control group).Electrocardiography,Pd,hs-CRP,and other clinical characteristics were compared between the two groups.Results:There was no significant difference between the two groups regarding age,gender,hyperlipidemia,etc.Compared to controls,left atrial diameter (44 ± 7 vs 39 ± 7 mm),Pd (49 ± 13 vs 26 ± 8 ms),and hs-CRP (2.17 [1.46-2.89] vs 1.12 [0.74-1.41] mg/L) were increased (P < 0.05),respectively.Linear regression identified hs-CRP as an independent correlation of Pd level both in the total population and the AF group (r =0.464 and 0.313;P < 0.001,respectively).Multiple logistic regression revealed hs-CRP as an independent determinant of AF (odds ratio [OR] =15.430,95% confidence interval:6.031-39.476:P <0.001).Further adjusted for Pd,both Pd and hs-CRP were independent predictors for AF,but the OR for hs-CRP in predicting AF has been attenuated from 15.430 to 6.246.Conclusions:In lone AF,Pd and plasma hs-CRP concentration are inter-associated and related to AF.The interaction between hs-CRP and AF may be mediated by Pd,suggesting an important role of inflammation in the atrial electrophysiological remodeling predisposing to AF.

  14. Postpacing abnormal repolarization in catecholaminergic polymorphic ventricular tachycardia associated with a mutation in the cardiac ryanodine receptor gene

    NARCIS (Netherlands)

    E. Nof; B. Belhassen; M. Arad; Z.A. Bhuiyan; C. Antzelevitch; R. Rosso; R. Fogelman; D. Luria; D. El-Ani; M.M.A.M. Mannens; S. Viskin; M. Eldar; A.A.M. Wilde; M. Glikson

    2011-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an arrhythmogenic disease for which electrophysiological studies (EPS) have shown to be of limited value. This study presents a CPVT family in which marked postpacing repolarization abnormalities during EPS were the only consistent phen

  15. Elimination of incisional tachycardias in a patient with atriofascicular tract after surgical isolation and electric destruction of atrioventricular conduction

    Directory of Open Access Journals (Sweden)

    Artyukhina E.A.

    2015-09-01

    Catheter ablation can successfully resolve incisional tachycardia, wherein atriofascicular (Mahaim accessory pathways conduction may remain for decades because their anatomic substrate includes elements of regular conducting system of the heart.

  16. Atrial infarction is a unique and often unrecognized clinical entity

    Directory of Open Access Journals (Sweden)

    Rosana G. G. Mendes

    1999-03-01

    Full Text Available A patient with heart failure and acute atrial fibrillation received the final diagnosis of atrial infarction associated with ventricular infarction based on clinical findings of ischemia in association with atrial fibrillation and heart failure (mechanisms probably involved: contractile dysfunction and loss of atrial contribution. Although a transesophageal echocardiography, which could refine the diagnosis of anatomic abnormalities, was not performed, all evidence led to the diagnosis of atrial involvement. Electrocardiographic findings were consistent with Liu's major criterion 3. Therapy with digitalis, quinidine and angiotensin-converting enzyme inhibitors was chosen, as the patient had acute pulmonary edema. The use of beta-blockers and verapamil was restricted. No other complications, such as thrombo-embolism or atrial rupture, were noted.

  17. Dronedarone for atrial fibrillation: a new therapeutic agent

    Directory of Open Access Journals (Sweden)

    Pawan D Patel

    2009-08-01

    Full Text Available Pawan D Patel, Rohit Bhuriya, Dipal D Patel, Bhaskar L Arora, Param P Singh, Rohit R AroraDepartment of Cardiology, Chicago Medical School, Chicago, IL, USAAbstract: Atrial fibrillation is the most common of the serious cardiac rhythm disturbances and is responsible for substantial morbidity and mortality. Amiodarone is currently one of the most widely used and most effective antiarrhythmic agents for atrial fibrillation. But during chronic usage amiodarone can cause some serious extra cardiac adverse effects, including effects on the thyroid. Dronedarone is a newer therapeutic agent with a structural resemblance to amiodarone, with two molecular changes, and with a better side effect profile. Dronedarone is a multichannel blocker and, like amiodarone, possesses both a rhythm and a rate control property in atrial fibrillation. The US Food and Drug Administration approved dronedarone for atrial fibrillation on July 2, 2009. In this review, we discuss the role of dronedarone in atrial fibrillation.Keywords: dronedarone, amiodarone, atrial fibrillation

  18. Cardiac ion channels and mechanisms for protection against atrial fibrillation

    DEFF Research Database (Denmark)

    Grunnet, Morten; Bentzen, Bo Hjorth; Sørensen, Ulrik S;

    2011-01-01

    Atrial fibrillation (AF) is recognised as the most common sustained cardiac arrhythmia in clinical practice. Ongoing drug development is aiming at obtaining atrial specific effects in order to prevent pro-arrhythmic, devastating ventricular effects. In principle, this is possible due to a different...... the recent discovery that Ca(2+)-activated small conductance K(+) channels (SK channels) are important for the repolarisation of atrial action potentials. Finally, an overview of current pharmacological treatment of AF is included....

  19. Stroke and atrial fibrillation: is stroke prevention treatment appropriate beforehand?

    OpenAIRE

    DEPLANQUE, D; Corea, F; Arquizan, C; Parnetti, L.; Mas, J.; Gallai, V.; Leys, D; the, S

    1999-01-01

    OBJECTIVE—To undertake a pilot study before conducting a large European multicentre prospective study, to determine the proportion of patients with atrial fibrillation who were not receiving antithrombotic treatment before stroke onset, and their characteristics.
DESIGN AND PATIENTS—The stroke in atrial fibrillation ensemble (SAFE) I study was an observational study conducted in 213 patients with atrial fibrillation consecutively admitted in 1997 to three European centres for an acute stroke ...

  20. Atrial fibrillation in a primary care practice: prevalence and management

    OpenAIRE

    Upshur Ross E; Ceresne Lance

    2002-01-01

    Abstract Background Atrial fibrillation is a common serious cardiac arrhythmia. Knowing the prevalence of atrial fibrillation and documentation of medical management are important in the provision of primary care. This study sought to determine the prevalence of atrial fibrillation in a primary care population and to identify and quantify the treatments being used for stroke prevention in this group of patients. Methods A prevalence study through chart audit was conducted in the family medici...