Sample records for rapid atrial tachycardia

  1. Deglutition induced atrial tachycardia and atrial fibrillation. (United States)

    Kanjwal, Yousuf; Imran, Naser; Grubb, Blair


    Deglutition induced supraventricular tachycardia is an uncommon condition postulated to be a vagally mediated phenomenon due to mechanical stimulation. Patients usually present with mild symptoms or may have severe debilitating symptoms. Treatment with Class I agents, beta blockers, calcium channel blockers, amiodarone and radiofrquency catheter ablation has shown to be successful in the majority of reported cases. We report the case of a 46-year-old healthy woman presenting with palpitations on swallowing that was documented to be transient atrial tachycardia with aberrant ventricular conduction as well as transient atrial fibrillation. She was successfully treated with propafenone with no induction of swallowing-induced tachycardia after treatment. This is also the first case to show swallowing-induced atrial tachycardia and atrial fibrillation in the same patient.

  2. Atrial tachycardia mimicking atrioventricular nodal reentry tachycardia. (United States)

    Eilbert, Wesley P; Patel, Neal


    The term supraventricular tachycardia (SVT) is used to describe tachydysrhythmias that require atrial or atrioventricular nodal tissue for their initiation and maintenance. SVT can be used to describe atrioventricular nodal reentry tachycardia, atrioventricular reentry tachycardia, and atrial tachycardia (AT). AT is the least common of these SVT subtypes, accounting for only 10% of cases. Although the suggested initial management of each SVT subtype is different, they all can present with similar symptoms and electrocardiographic findings. Discuss the pathophysiology, diagnosis, and treatment of AT as compared with other types of SVT. We report a 56-year-old woman with symptoms and electrocardiographic findings consistent with SVT. Although standard treatment with intravenous adenosine failed to convert the SVT, it revealed AT as the cause of the tachydysrhythmia. The AT was successfully terminated with beta-blockade and the patient eventually underwent successful radioablation of three separate AT foci. AT frequently mimics other more common forms of SVT. AT might be recognized only when standard treatment of SVT has failed. Identification of AT in this setting is crucial to allow for more definitive therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. 24. Entrainment of wide complex tachycardia by atrial stimulation is highly accurate and can rapidly elucidate the tachycardia mechanism through analysis of entrainment response

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    Abdulhakim Noman


    Conclusion: Response to atrial entrainment can be helpful in the majority of WCT patients, particularly those with 1:1 AV relationship to diagnose or rule out VT as a mechanism of tachycardia with high accuracy.

  4. Atrial natriuretic peptides during experimental atrial tachycardia : Role of developing tachycardiomyopathy

    NARCIS (Netherlands)

    Schoonderwoerd, BA; Crijns, HJGM; Van Veldhuisen, DJ; Boomsma, F; Van den Berg, MP; Bel, KJ; Van Gelder, IC

    Atrial Natriuretic Peptides During Tachycardiomyopathy. Introduction: Atrial tachycardia and chronic heart failure (CHF) are associated with elevated levels of atrial natriuretic peptide (ANP) and its amino terminal part NT-ANP. Chronic high atrial rates may cause CHF due to a rapid ventricular

  5. Failure of right atrial premature beats to reset atriofascicular tachycardia. (United States)

    Porkolab, F L; Alpert, B L; Scheinman, M M


    A patient with a right atriofascicular (Mahaim) tachycardia was found to have inducible antidromic supraventricular tachycardia, but atrial premature beats from the right atrial free wall failed to reset the tachycardia. An interesting transition from AV nodal reentry tachycardia to Mahaim tachycardia is also presented.

  6. Multifocal Atrial Tachycardia in 2 Children

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    Ming-Yun Hsieh


    Full Text Available The incidence of multifocal atrial tachycardia (MAT is very low and accounts for less than 1% of supraventricular tachycardia in infants and children. In this report, the clinical characteristics, medical treatment and outcome of MAT in 2 children are described. The first patient presented with tachycardia and respiratory failure since the day after birth. First, he received amiodarone, propranolol, and digoxin and then amiodarone alone. The heart rhythm converted to sinus rhythm 2 weeks after hospitalization. Although nonsustained MAT was occasionally observed when the infant suffered from pulmonary infection, the frequency of recurrent MAT decreased as the infant grew up. The second patient was a 5-year-old girl. She had congenital heart disease with double outlets of right ventricle (DORV, patent ductus arte-riosus, coarctation of aorta, and ventricular and atrial septal defects. She underwent total correction at the age of 4 years. MAT was noted 3 months after the operation with the presentation of congestive heart failure. The heart rate slowed down and returned to normal sinus rhythm within several hours after amiodarone use. The symptoms and signs of congestive heart failure also disappeared. The patient took amiodarone regularly, and no tachycardia was detected during the follow-up period. MAT is considered to be a relatively benign arrhythmia with likely good outcome if there is no severe underlying illness. It can be well controlled under appropriate drugs, and a long period of follow-up is suggested. If pharmacologic intervention is required, we suggest that amiodarone may be an excellent choice.

  7. "Cristal tachycardias": origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography. (United States)

    Kalman, J M; Olgin, J E; Karch, M R; Hamdan, M; Lee, R J; Lesh, M D


    We sought to use intracardiac echocardiography (ICE) to identify the anatomic origin of focal right atrial tachycardias and to define their relation with the crista terminalis (CT). Previous studies using ICE during mapping of atrial flutter and inappropriate sinus tachycardia have demonstrated an important relation between endocardial anatomy and electrophysiologic events. Recent studies have suggested that right atrial tachycardias may also have a characteristic anatomic distribution. Twenty-three consecutive patients with 27 right atrial tachycardias were included in the study. ICE was used to facilitate activation mapping in relation to endocardial structures. A 20-pole catheter was positioned along the CT under ICE guidance. ICE was also used to assist in guiding detailed mapping with the ablation catheter in the right atrium. Of 27 focal right atrial tachycardias, 18 (67%, 95% confidence interval [CI] 46% to 83%) were on the CT (2 high medial, 8 high lateral, 6 mid and 2 low). ICE identified the location of the tip of the ablation catheter in immediate relation to the CT in all 18 cases. The 20-pole mapping catheter together with echocardiographic visualization of the CT provided a guide to the site of tachycardia origin along this structure. Radiofrequency ablation was successful in 26 (96%) of 27 (95% CI 81% to 100%) right atrial tachycardias. This study demonstrates that approximately two thirds of focal right atrial tachycardias occurring in the absence of structural heart disease will arise along the CT. Recognition of this common distribution may potentially facilitate mapping and ablation of these tachycardias.

  8. Epicardial Ablation of Focal Atrial Tachycardia Arising From Left Atrial Appendage in Children

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    Abdhija Hanumandla


    Full Text Available Focal left atrial tachycardia (FLAT although a common cause of supraventricular tachycardia(SVT among children, the one's arising from left atrial appendage (LAA present a unique challenge for successful ablation because of anatomical location. We present two children with FLAT arising from the epicardial LAA, successfully mapped and ablated through percutaneuous epicardial approach.

  9. Electrocardiographic artefacts mimicking atrial tachycardia resulted in unnecessary diagnostic and therapeutic measures


    Y-Hassan, Shams; Sylv?n, Christer


    Electrocardiographic (ECG) artefacts may closely simulate both supraventricular and ventricular tachycardias. We describe a case initially diagnosed as rapid atrial fibrillation, based on 12-lead surface ECG (especially the limb leads) and monitor tracing. The arrhythmia was resistant to beta blockers. Because of the at times apparently regular rhythm, an esophageal ECG recording was performed, and adenosine was administered. When the presumed atrial fibrillation terminated after sodium pento...

  10. Spontaneous Localized Persistent Atrial Fibrillation with an Exit Block Mimicking Atrial Tachycardia at the Left Posterior Wall

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    Shoichi Kubota, MD


    Full Text Available We describe a 37-year-old man with spontaneous localized atrial fibrillation (AF with an exit block at the posterior wall of the left atrium (LA. The 12-lead ECG exhibited an atrial tachycardia-like pattern, with distinctive P waves and an isoelectric baseline between the P waves. The cycle length of the P waves ranged from 320 to 500 msec. While the fractionated and rapid deflections were recorded from the posterior wall of the LA, the rest of the atria and the coronary sinus exhibited discrete atrial potentials with irregular intervals. Radiofrequency energy applications to the surrounding tissue created complete isolation of the localized AF area, and the AF was terminated. Fibrillatory activation in the posterior wall of the LA can act as a driver as well as an initiator of atrial fibrillation.

  11. Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

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    Masatsugu Nozoe, MD, PhD


    Full Text Available AT caused by SVC fibrillation: Here, we report a case of a 62-year-old man with a history of incessant atrial tachycardia (AT for several years. An electrophysiological study revealed rapid and irregular activity in the superior vena cava (SVC, but the surface 12-lead electrocardiogram (ECG exhibited a relatively regular AT (atrial cycle length=240 ms. CARTO mapping of the right atrium (RA demonstrated that the earliest atrial activation occurred at the posterior septum of the upper RA (the SVC–RA junction. Intravenous administration of 20 mg adenosine triphosphate (ATP led to an acceleration of the SVC–RA conduction up to 1:1 conduction, and the atrial cycle length decreased, consequently converting the AT to transient atrial fibrillation (AF. Application of single radiofrequency energy at the earliest atrial activation site during tachycardia terminated the AT and achieved isolation of the SVC from the RA, despite the continued presence of fibrillation in the SVC. We speculated that SVC fibrillation with spontaneous conduction block at the SVC–RA junction was the cause of this AT.

  12. Catheter Ablation of Ectopic Atrial Tachycardia Originating from the Left Atrial Appendage using CARTOMERGE® System

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    Masahiko Goya, MD


    Full Text Available A 70-year-old woman was referred because of drug resistant and daily incessant palpitation attack. She had undergone two previous unsuccessful radiofrequency catheter ablations at another hospital. The physical examination, chest X-ray, and echocardiogram were all normal. The 12-lead ECG during tachycardia showed narrow QRS, short PR tachycardia and negative polarity of the P wave in leads I and aVL (Fig. 1A. The ECG monitor showed incessant tachycardia with warming-up phenomenon. Three dimensional electroanatomical map integrated with CT imaging (CARTOMERGE®, Biosense Webster Inc. clearly revealed the radial activation pattern originating from the basalo-postero-inferior aspect of the left atrial appendage. Radiofrequency energy application at this site eliminated tachycardia permanently.

  13. Prenatal features of Costello syndrome: Ultrasonographic findings and atrial tachycardia (United States)

    Lin, Angela E.; O’Brien, Barbara; Demmer, Laurie A.; Almeda, Kristina K.; Blanco, Cynthia L.; Glasow, Patrick F.; Berul, Charles I.; Hamilton, Robert; Innes, A. Micheil; Lauzon, Julie L.; Sol-Church, Katia; Gripp, Karen W.


    Objective Delineate prenatal features of Costello syndrome (caused by HRAS mutations) which consists of mental retardation, facial, cardiovascular, skin, and musculoskeletal anomalies, and tumor predisposition. Methods Literature and new cases classified as Group I (pre-HRAS), Group II (HRAS confirmed), and Group III (HRAS confirmed in natural history study, plus three contributed cases). Results Polyhydramnios occurred in most (mean 79%) pregnancies of cases in Groups I (98), II (107), and III (17), advanced paternal age and prematurity were noted in approximately half. Less frequent were nuchal thickening, ascites, shortened long bones, abnormal hand posture, ventriculomegaly, macrosomia, and macrocephaly. Fetal arrhythmia occurred in 9 cases (6 supraventricular or unspecified tachycardia, 1 unspecified arrhythmia, 2 premature atrial contractions, PACs); excluding 3 new cases and 2 with PACs, the estimated prenatal frequency is 4/222 (2%). Conclusion Costello syndrome can be suspected prenatally when polyhydramnios is accompanied by nuchal thickening, hydrops, shortened long bones, abnormal hand posture, ventriculomegaly, large size, and macrocephaly, and especially fetal atrial tachycardia. Consideration should be given for timely prenatal diagnostic studies for confirmative HRAS gene mutations, and for maternal treatment of serious fetal arrhythmia. PMID:19382114

  14. Focal Left Atrial Tachycardia in a Patient with Left Ventricular Noncompaction

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    Shailendra Singh


    Full Text Available Left ventricular noncompaction (LVNC is a rare disease caused by intrauterine failure of the myocardium to compact. The major clinical manifestations of LVNC include heart failure, ventricular tachyarrhythmia, thromboembolic event, and sudden deaths. Atrial arrhythmia usually seen is atrial fibrillation. We report a rare case of focal left atrial tachycardia in an 18-year-old patient who presented for evaluation of persistent tachycardia. Transthoracic echocardiogram showed severe systolic dysfunction and evidence of noncompaction of the left ventricle. A detailed review of ECG revealed the possibility of ectopic atrial tachycardia, most likely originating from the left side. Electrophysiology study showed sustained atrial tachycardia originating on the ridge anterior to the left sided pulmonary veins. A successful radiofrequency catheter ablation was performed at this site without any complications.

  15. Iatrogenic intra-atrial macro-reenterant tachycardia following transcatheter closure of atrial septal defect treated by radiofrequency ablation

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    Ibrahim Marai


    Full Text Available Percutaneous closure of an atrial septal defect (ASD has been established as a safe and effective alternative to surgical management. We describe a case of a 41-year-old patient in whom an Amplatzer septal occluder device was used to close a moderately large ASD and who subsequently developed incessant intra-atrial macro-reenterant tachycardia. The tachycardia was terminated by radiofrequency ablation guided by electroanatomical mapping.

  16. Atrial Tachycardias Arising from Ablation of Atrial Fibrillation: A Proarrhythmic Bump or an Antiarrhythmic Turn?

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    Ashok J. Shah


    Full Text Available The occurrence of atrial tachycardias (AT is a direct function of the volume of atrial tissue ablated in the patients with atrial fibrillation (AF. Thus, the incidence of AT is highest in persistent AF patients undergoing stepwise ablation using the strategic combination of pulmonary vein isolation, electrogram based ablation and left atrial linear ablation. Using deductive mapping strategy, AT can be divided into three clinical categories viz. the macroreentry, the focal and the newly described localized reentry all of which are amenable to catheter ablation with success rate of 95%. Perimitral, roof dependent and cavotricuspid isthmus dependent AT involve large reentrant circuits which can be successfully ablated at the left mitral isthmus, left atrial roof and tricuspid isthmus respectively. Complete bidirectional block across the sites of linear ablation is a necessary endpoint. Focal and localized reentrant AT commonly originate from but are not limited to the septum, posteroinferior left atrium, venous ostia, base of the left atrial appendage and left mitral isthmus and they respond quickly to focal ablation. AT not only represents ablation-induced proarrhythmia but also forms a bridge between AF and sinus rhythm in longstanding AF patients treated successfully with catheter ablation.

  17. Catheter Ablation for Three Focal Atrial Tachycardias in a Patient with Prior Fontan Surgery for Tricuspid Atresia

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    Masayoshi Kofune, MD


    Full Text Available A 28-year-old woman who had undergone Fontan surgery for tricuspid atresia at 6 years of age was admitted to Nihon University Hospital due to syncope. Supraventricular tachycardia at 141 beats/min was induced with isoproterenol infusion during a tilt table test. The patient showed atresia of the right atrial orifice of the coronary sinus with persistent drainage into the left superior vena cava. Electrophysiological study was performed. Atrial tachycardia (AT was induced by rapid atrial pacing. The AT originated in the lower lateral right atrium and electroanatomical mapping showed a focal origin. After successful ablation of the AT, two additional ATs were induced. These ATs were also shown to be of focal origin and were successfully ablated without recurrence during follow-up.

  18. Trends in quantitative methods used for atrial fibrillation and ventricular tachycardia analyses

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    Edward J. Ciaccio

    Full Text Available Background: Improved quantitative and computational research efforts would be useful for better and more accurate analysis of heart arrhythmias, and to target catheter ablation sites. To pinpoint useful and leading-edge quantitative methods, research trends of articles published in peer-reviewed journals were identified. Methods: The MEDLINE search tool and an in-house developed software program were used to detect quantitative trends in arrhythmia research. The main keywords used were ‘atrial fibrillation’ and ‘ventricular tachycardia’, which were searched in combination with commonly associated quantitative keywords for signal and imaging data. The search period used was 1960–2013. The linear regression trend over the search period was calculated, and the slope and regression coefficient was tabulated along with the onset year of the trend. Results: In 1960, ‘atrial fibrillation’ and ‘ventricular tachycardia’ appeared in the title or abstract of less than 20 peer-reviewed articles each. A sharp increase in ventricular tachycardia publications occurred from 1975 to 1992 to a peak of over 600 publications; since 1992 the number of ventricular tachycardia studies has leveled. However, the number of atrial fibrillation papers has increased sharply since 1978, surpassing ventricular tachycardia studies in 1993, to over 3500 studies in 2013. From 1960 to 2013, the fraction of ventricular tachycardia papers associated with any particular quantitative keyword, versus the total number of ventricular tachycardia publications, was often greater than the fraction of atrial fibrillation papers associated with the same quantitative keyword, versus the total number of atrial fibrillation publications. Studies published in the bioengineering and bioinformatics literature comprise approximately 10% of all quantitative biomedical studies published on atrial fibrillation and ventricular tachycardia. Conclusions: The

  19. Prevalence and characteristics of left atrial tachycardia following left atrial catheter ablation. (United States)

    Hashimoto, Toru; Tada, Hiroshi; Naito, Shigeto; Miyaji, Kohei; Yamada, Minoru; Tadokoro, Kazuyoshi; Kaseno, Kenichi; Oshima, Shigeru; Taniguchi, Koichi


    Left atrial tachycardia (AT) is a complication of left atrial catheter ablation (LACA) of atrial fibrillation (AF). However, its prevalence and characteristics have not been sufficiently clarified. We divided 121 patients who underwent LACA into 2 groups based on the results of AT occurrence after LACA (follow-up period; 12 +/- 7 months): an AT+ group and AT- group. New-onset left AT occurred in 30 patients (25%) 31 +/- 51 days after LACA. Among the 26 patients with an early onset of AT, 4 underwent a second ablation for AT, and 21 became free of AT within 6 months without a repeat ablation procedure. Among the 4 patients with a late onset of AT (> 2 months after the LACA), the tachycardia remitted without a repeat ablation procedure in a single patient within 6 months. Among 71 patients who underwent LACA with additional ablation lines, 22 (31%) developed new-onset left AT. Among 50 patients who underwent LACA alone, 8 (16%) developed new-onset left AT (P = 0.02). New-onset left AT is a frequent complication of LACA for AF, especially in men and in patients with a low left ventricular ejection fraction. Early (< 2 months) onset AT does not require a repeat ablation because it often represents a transient phenomenon and disappears spontaneously.

  20. Inadvertent puncture of the aortic noncoronary cusp during postoperative left atrial tachycardia ablation

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    Dursun Aras, MD


    Full Text Available Transseptal catheterization has become part of the interventional electrophysiologist׳s technical armamentarium since the development of left atrial catheter ablation and percutaneous technologies for treating mitral and aortic valve disease. Although frequently performed, the procedure׳s most feared complication is aortic root penetration. Focal atrial tachycardia has been described as the most common late sequela of surgical valve replacements. We present a complicated case involving the inadvertent delivery of an 8 French sheath across the noncoronary cusp during radiofrequency catheter ablation for left atrial tachycardia originating from the mitral annulus in a patient with prior mitral valve replacement.

  1. Cardiovascular collapse in infants: association with paroxysmal atrial tachycardia. (United States)

    Gikonyo, B M; Dunnigan, A; Benson, D W


    Four infants, aged 16 to 28 days (mean 23 days), were seen in the emergency room with acute cardiovascular collapse and with normal heart rate and rhythm. During evaluation for cardiovascular collapse, no infant had sepsis; cardiac assessment revealed normal intracardiac anatomy but global cardiac chamber enlargement and poor left ventricular systolic function, which resolved with supportive treatment. However, three of the four infants demonstrated ventricular preexcitation on their surface electrocardiogram and, subsequently, two infants had transient episodes of tachycardia. During a transesophageal pacing study to evaluate inducibility and electrophysiologic characteristics of tachycardia, sustained tachycardia was initiated in all four infants. Reentrant tachycardia used an accessory atrioventricular connection as evidenced by the presence of preexcitation during sinus rhythm (three infants), the ability to initiate and terminate tachycardia by programmed electrical stimulation (four infants), minimum ventriculoatrial interval recorded in the esophagus (V-Aeso) exceeded 70 ms (four infants), transient bundle branch block during tachycardia prolonged the cycle length and the V-Aeso by 30 to 50 ms (three infants). Findings in these infants suggested prior episodes of prolonged tachycardia as the probable etiology of the cardiovascular collapse.

  2. Mitral valve m-mode echo in complete heart block with atrial tachycardia

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    Kalathingathodika Sajeer


    Full Text Available We report a 48-year-old man who presented with history of syncope. Electrocardiogram on admission showed infrahisian complete heart block with a ventricular rate of 36 beats per min with wide QRS junctional escape and atrial rate was 188 beats per min. Transthoracic echocardiogram showed fine vibratory movement of both mitral leaflet tips. M-mode evaluation of mitral leaflets showed multiple ′a′ waves corresponding to atrial tachycardia rate.

  3. Differentiation of atrial tachycardia from other long RP tachycardias by electrocardiographic characteristics

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    Atsuhiko Yagishita, MD


    Conclusion: AT accounted for nearly two thirds of long RP tachycardias in this cohort. Electrocardiographic features, including the RP/PR ratio, polarity of the P wave, and P-wave duration were useful in the differentiation of AT.

  4. Acute clenbuterol overdose resulting in supraventricular tachycardia and atrial fibrillation. (United States)

    Daubert, G Patrick; Mabasa, Vincent H; Leung, Vivian W Y; Aaron, Cynthia


    We are presenting a case illustrating the complex metabolic and rhythm disturbances associated with acute clenbuterol intoxication. Clenbuterol is a long-acting beta2-adrenergic agonist primarily used in veterinary medicine in the United States. It has become a common drug of abuse by body builders because of its reported anabolic and lipolytic properties. In this case report, a body builder using veterinary clenbuterol developed significant electrolyte and cardiac manifestations. A 31-year-old man presented to the emergency department approximately 30 minutes after ingesting 1.5 ml (a tenfold dosing error) of Ventipulmin syrup (72.5 mcg/ml clenbuterol HCl). The product was brought to the emergency department (ED) by the patient. He reported no current use of anabolic steroids. He presented in an anxious state with complaints of palpitations and shortness of breath. Vital signs upon examination were as follows: BP, 122/77 mmHg (16.3/10.3 kPa); HR 254 bpm; RR, 22 bpm; Temperature, 97.1 degrees F (36 degrees C); and oxygen saturation, 100% on ambient air. His electrocardiogram (ECG) demonstrated supraventricular tachycardia with a ventricular rate of 254 bpm. Esmolol was recommended for rate control after the unsuccessful use of adenosine and diltiazem. Laboratory studies showed potassium, 2.1 mmol/L; magnesium, 1.3 mg/dL (0.54 mmol/L); phosphorus, 1.0 mg/dL (0.32 mmol/L); serum glucose, 209 mg/dL (11.6 mmol/L); creatinine, 0.8 mg/dL (70.7 micromol/L); AST, 20 U/L; ALT, 55 U/L; hemoglobin, 12.6 g/dL (126 g/L); CPK total, 87 U/L; and troponin I, 0.23 mug/L. The patient's urine was negative for any drugs of abuse. Clenbuterol levels were not obtained. A second ECG, 16 hours post ingestion, reflected atrial fibrillation with a ventricular rate of 125 to 147 bpm. On hospital day 3, he was electively cardioverted to sinus rhythm; heart rate and rhythm returned to normal, and he was discharged with oral metoprolol. Clenbuterol is approved for use in countries outside the U

  5. Atrial tachycardias: Cause or effect with ablation of persistent atrial fibrillation? (United States)

    Yamashita, Seigo; Hooks, Darren A; Shah, Ashok; Relan, Jatin; Cheniti, Ghassen; Kitamura, Takeshi; Berte, Benjamin; Mahida, Saagar; Sellal, Jean-Marc; Jefairi, Nora Al; Frontera, Antonio; Amraoui, Sana; Collotand, Florent; Denis, Arnaud; Derval, Nicolas; Sacher, Frédéric; Cochet, Hubert; Dubois, Rémi; Hocini, Mélèze; Haïssaguerre, Michel; Klein, George; Jaïs, Pierre


    It is largely believed that atrial tachycardias (ATs) encountered during ablation of persistent atrial fibrillation (PsAF) are a byproduct of ablative lesions. We aimed to explore the alternative hypothesis that they may be a priori drivers of AF remaining masked until other AF sources are reduced or eliminated. Radiofrequency ablation of fibrillatory drivers mapped by electrocardiographic imaging (ECGI; ECVUE™, Cardioinsight Technologies, Cleveland, OH, USA) terminated PsAF in 198 (73%) out of 270 patients (61 ± 10 years, 9 ± 9 m). Two hundred and six ATs in 158 patients were subsequently mapped. Their anatomic relationship to the fibrillatory drivers prospectively identified by ECGI was then established. There were 26 (13%), 52 (25%), and 128 (62%) focal, localized, and macrore-entrant ATs, respectively. In focal/localized re-entrant ATs, 64 (82%) were terminated within an AF-driver region, in which 26 (81%) among 32 focal/localized ATs analyzed with 3-D-mapping system merged to driver map occurred from AF-driver regions in 1.0 ± 1.0 cm distance from the driver core. Importantly, there was no attempt at ablation of the associated AF-driver region in 25 of 64 (39%) of focal/localized re-entrant ATs. The sites of ATs origin generally had low-voltage, fractionated, and long-duration electrograms in AF. All but two focal/localized re-entrant ATs were successfully ablated. The majority of post-AF-ablation focal and localized re-entrant ATs originate from the region of prospectively established AF-driver regions. A third of these are localized to regions not subsequently submitted to ablation. These data suggest that many ATs exist, although not necessarily manifest independently, prior to ablation. They may have a role in the maintenance of PsAF in these individuals. © 2017 Wiley Periodicals, Inc.

  6. Successful Non-fluoroscopic Radiofrequency Ablation of Incessant Atrial Tachycardia in a High Risk Twin Pregnancy

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    Dr Zia Zuberi, BSc PhD MRCP


    Full Text Available We describe a patient presenting with incessant ectopic atrial tachycardia during a high risk twin pregnancy. Tachycardia was resistant to escalating doses of beta-blockade with digoxin. Because of increasing left ventricular dysfunction early in the third trimester, catheter ablation was performed successfully at 30 weeks gestation. Electro-anatomic mapping permitted the entire procedure to be conducted without the use of ionizing radiation. The pregnancy proceeded to successful delivery near term and after three years the patient remains recurrence free with normal left ventricular function, off all medication.

  7. Radiofrequency catheter ablation in patients with symptomatic atrial flutter/tachycardia after orthotopic heart transplantation. (United States)

    Li, Yi-gang; Grönefeld, Gerian; Israel, Carsten; Lu, Shang-biao; Wang, Qun-shan; Hohnloser, Stefan H


    Atrial tachycardia or flutter is common in patients after orthotopic heart transplantation. Radiofrequency catheter ablation to treat this arrhythmia has not been well defined in this setting. This study was conducted to assess the incidence of various symptomatic atrial arrhythmias and the efficacy and safety of radiofrequency catheter ablation in these patients. Electrophysiological study and catheter ablation were performed in patients with symptomatic tachyarrhythmia. One Halo catheter with 20 poles was positioned around the tricuspid annulus of the donor right atrium, or positioned around the surgical anastomosis when it is necessary. Three quadripolar electrode catheters were inserted via the right or left femoral vein and positioned in the recipient atrium, the bundle of His position, the coronary sinus. Programmed atrial stimulation and burst pacing were performed to prove electrical conduction between the recipient and the donor atria and to induce atrial arrhythmias. Out of 55 consecutive heart transplantation patients, 6 males [(58 +/- 12) years] developed symptomatic tachycardias at a mean of (5 +/- 4) years after heart transplantation. Electrical propagation through the suture line between the recipient and the donor atrium was demonstrated during atrial flutter or during recipient atrium and donor atrium pacing in 2 patients. By mapping around the suture line, the earliest fragmented electrogram of donor atrium was assessed. This electrical connection was successfully ablated in the anterior lateral atrium in both patients. There was no electrical propagation through the suture line in the other 4 patients. Two had typical atrial flutter in the donor atrium which was successfully ablated by completing a linear ablation between the tricuspid annulus and the inferior vena cava. Two patients had atrial tachycardia which was ablated in the anterior septal and lateral donor atrium. There were no procedure-related complications. Patients were free of

  8. Deglutition-Induced Atrial Tachycardia Localised with Contact Force-Guided Activation Mapping. (United States)

    McLellan, Alex J A; Bates, Matthew G D; Young, Shane D F; Sparks, Paul B


    Deglutition-induced atrial tachycardia is a rare arrhythmia with a poor response to medical therapy. Electrophysiological study is challenging due to the dependence of induction on swallowing. We present a novel approach to management of deglutition-induced atrial tachycardia arising from right superior pulmonary vein. Use of minimal conscious sedation and repeated swallow challenge inductions, together with contact force-guided mapping were key determinants of success. We review published cases, discussing potential mechanisms including oesophageal distension and neural reflexes. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  9. Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle

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    Tadashi Wada


    Full Text Available A 54-year-old man with a surgically repaired double-outlet right ventricle (DORV presented with palpitations and worsening right heart failure. His 12-lead ECG showed atrial tachycardia (AT with an atrial cycle length (CL of 300 ms and an inverted saw-tooth F-wave pattern in the inferior leads II, III, and aVF typical of atrial flutter. Electrophysiological study and radiofrequency catheter ablation were performed. A total of 3 sustained ATs (AT1–AT3 were induced. Using the electroanatomical mapping system, CARTO3, and conventional mapping techniques, the ATs were identified as macroreentrant tachycardias circling around an incisional line on the free wall of the right atrium (AT1, the tricuspid annulus (AT2, and low voltage area in the lateral wall including the right septum (AT3. Accuracy of CARTO3 in three-dimensional reconstruction was sufficient to elucidate anatomical features (including catheter sites, incision, and low voltage areas and macroreentrant circuits. However, conventional mapping techniques were also necessary to identify the mechanism of the tachycardias, and therefore to eliminate all of them successfully. This case demonstrates that the use of combined conventional and electroanatomical mapping techniques, such as CARTO3, can be helpful in identifying the critical isthmus for catheter ablation of macroreentrant AT in patients with surgically corrected congenital heart disease (CHD.

  10. Adenosine Triphosphate-sensitive Micro-reentrant Atrial Tachycardia Originating from the Crista Terminalis in a Patient with Chronic Renal Failure due to Thrombotic Thrombocytopenic Purpura

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    Shinya Sugiura, MD


    Full Text Available A 57-year-old woman with chronic renal failure due to the thrombotic thrombocytopenic purpura complained of palpitation. A 12-lead ECG showed supraventricular tachycardia with a cycle length of 375 ms. During the electrophysiological study, a tachycardia with a cycle length of 375 ms was reproducibly induced and terminated by atrial extrastimulation. The tachycardia exhibited an inverse relationship between the coupling interval of extrastimulus initiating the tachycardia, and the first postpacing return cycle, as well as an increasing pattern of resetting the tachycardia with an atrial extrastimulus. Ventricular burst pacing during tachycardia produced AV dissociation. Intravenous injections of a low dose (4 mg of adenosine triphosphate (ATP terminated the tachycardia without a preceding atrio-His bundle block. The tachycardia was diagnosed as an ATP-sensitive micro-reentrant atrial tachycardia. Real-time endocardial activation mapping using an electroanatomical mapping system revealed that the earliest activation site of the tachycardia was located at the midlateral portion of the crista terminalis. The tachycardia was abolished by focal ablation targeting the earliest activation site during tachycardia. This is the first reported case of an ATP-sensitive micro-reentrant atrial tachycardia associated with thrombotic thrombocytopenic purpura.

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

    Directory of Open Access Journals (Sweden)

    V. Martucci


    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.

  12. Atrial tachycardia treated by coil embolization of a giant coronary artery fistula. (United States)

    Alihanoglu, Yusuf Izzettin; Uludag, Burcu; Kilic, Ismail Dogu; Yildiz, Bekir Serhat; Kocyigit, Ali; Evrengul, Harun


    Coronary artery fistulas are the second most frequently seen coronary anomaly following abnormalities of coronary artery origin and distribution. A coronary fistula is defined as a direct communication between a coronary artery and any cardiac chamber or vessel. Treatment options include percutaneous embolization and surgical intervention. Herein, we present a case of a giant coronary artery fistula and right atrial tachycardia that was induced during a diagnostic electrophysiologic study but was not inducible after the successful treatment of the fistula. This is the first case indicating this association. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Phrenic nerve protection via packing of gauze into the pericardial space during ablation of cristal atrial tachycardia in a child. (United States)

    Takahashi, Kazuhiro; Fuchigami, Tai; Nabeshima, Taisuke; Sashinami, Arata; Nakayashiro, Mami


    The success of catheter ablation of focal atrial tachycardia is limited by possible collateral damage to the phrenic nerve. Protection of the phrenic nerve is required. Here we present a case of a 9-year-old girl having a history of an unsuccessful catheter ablation of a focal atrial tachycardia near the crista terminalis (because of proximity of the phrenic nerve) who underwent a successful ablation by means of a novel technique for phrenic nerve protection: packing of gauze into the pericardial space. This method is a viable approach for patients with a failed endocardial ablation due to the proximity of the phrenic nerve.

  14. Validation of a novel mapping system and utility for mapping complex atrial tachycardias. (United States)

    Honarbakhsh, S; Hunter, R J; Dhillon, G; Ullah, W; Keating, E; Providencia, R; Chow, A; Earley, M J; Schilling, R J


    This study sought to validate a novel wavefront mapping system utilizing whole-chamber basket catheters (CARTOFINDER, Biosense Webster). The system was validated in terms of (1) mapping atrial-paced beats and (2) mapping complex wavefront patterns in atrial tachycardia (AT). Patients undergoing catheter ablation for AT and persistent AF were included. A 64-pole-basket catheter was used to acquire unipolar signals that were processed by CARTOFINDER mapping system to generate dynamic wavefront propagation maps. The left atrium was paced from four sites to demonstrate focal activation. ATs were mapped with the mechanism confirmed by conventional mapping, entrainment, and response to ablation. Twenty-two patients were included in the study (16 with AT and 6 with AF initially who terminated to AT during ablation). In total, 172 maps were created with the mapping system. It correctly identified atrial-pacing sites in all paced maps. It accurately mapped 9 focal/microreentrant and 18 macroreentrant ATs both in the left and right atrium. A third and fourth observer independently identified the sites of atrial pacing and the AT mechanism from the CARTOFINDER maps, while being blinded to the conventional activation maps. This novel mapping system was effectively validated by mapping focal activation patterns from atrial-paced beats. The system was also effective in mapping complex wavefront patterns in a range of ATs in patients with scarred atria. The system may therefore be of practical use in the mapping and ablation of AT and could have potential for mapping wavefront activations in AF. © 2018 Wiley Periodicals, Inc.

  15. Tachycardia | Fast Heart Rate (United States)

    ... tachycardia occurs less commonly with: Heart attack Serious mitral valve disease Symptoms and Complications of Atrial or SVT Some ... tachycardia occurs less commonly with: Heart attack Serious mitral valve disease Symptoms and Complications of Atrial or SVT Some ...

  16. Local activation time sampling density for atrial tachycardia contact mapping: how much is enough? (United States)

    Williams, Steven E; Harrison, James L; Chubb, Henry; Whitaker, John; Kiedrowicz, Radek; Rinaldi, Christopher A; Cooklin, Michael; Wright, Matthew; Niederer, Steven; O'Neill, Mark D


    Local activation time (LAT) mapping forms the cornerstone of atrial tachycardia diagnosis. Although anatomic and positional accuracy of electroanatomic mapping (EAM) systems have been validated, the effect of electrode sampling density on LAT map reconstruction is not known. Here, we study the effect of chamber geometry and activation complexity on optimal LAT sampling density using a combined in silico and in vivo approach. In vivo 21 atrial tachycardia maps were studied in three groups: (1) focal activation, (2) macro-re-entry, and (3) localized re-entry. In silico activation was simulated on a 4×4cm atrial monolayer, sampled randomly at 0.25-10 points/cm2 and used to re-interpolate LAT maps. Activation patterns were studied in the geometrically simple porcine right atrium (RA) and complex human left atrium (LA). Activation complexity was introduced into the porcine RA by incomplete inter-caval linear ablation. In all cases, optimal sampling density was defined as the highest density resulting in minimal further error reduction in the re-interpolated maps. Optimal sampling densities for LA tachycardias were 0.67 ± 0.17 points/cm2 (focal activation), 1.05 ± 0.32 points/cm2 (macro-re-entry) and 1.23 ± 0.26 points/cm2 (localized re-entry), P = 0.0031. Increasing activation complexity was associated with increased optimal sampling density both in silico (focal activation 1.09 ± 0.14 points/cm2; re-entry 1.44 ± 0.49 points/cm2; spiral-wave 1.50 ± 0.34 points/cm2, P density (0.61 ± 0.22 points/cm2 vs. 1.0 ± 0.34 points/cm2, P = 0.0015). Optimal sampling densities can be identified to maximize diagnostic yield of LAT maps. Greater sampling density is required to correctly reveal complex activation and represent activation across complex geometries. Overall, the optimal sampling density for LAT map interpolation defined in this study was ∼1.0-1.5 points/cm2.

  17. [Radiofrequency ablation of long standing persistent atrial fibrillation and post-incisional macroreentrant right atrial tachycardia in patient with advanced biventricular heart failure--case raport]. (United States)

    Zakrzewska, Joanna; Derejko, Paweł; Szufladowicz, Ewa; Bodalski, Robert; Orczykowski, Michał; Przybylski, Andrzej; Szumowski, Lukasz; Michałek, Piotr; Walczak, Franciszek


    We present a case of a 54 year old male with a long-standing atrial fibrillation (AF) who was scheduled for cardiac transplantation due to the progression of heart failure. Previous treatment included pacemaker implantation, mitral valvuloplasty, a-v node modification using RF ablation, and pharmacological therapy. This time the patient underwent complex AF ablation which consisted of pulmonary vein isolation, mitral and left atrial roof line creation, cavo-tricuspid isthmus ablation and ablation of complex fractionated atrial electrograms, which resulted in restoration of sinus rhythm. Because of the right atrial post-incisional tachycardia the patient underwent second ablation session. This complex invasive approach occurred successful. The patient remains in sinus rhythm with improved left ventricular function and better NYHA class over a 12-month follow-up.

  18. Acute Chest Pain and Broad Complex Tachycardia. A Non-typical Case of Pre-excited Atrial Fibrillation


    Arias, Ramon Suarez; Villanueva, Nuria Perez; Cubero, Gustavo Iglesias; Lopez, Jose Rubin


    Wolff-Parkinson-White syndrome is a common condition in the emergency department. A case is presented of a 76-year-old patient with acute chest pain and broad complex tachycardia. Despite the fact that previous and post cardioversion ECG tracings in sinus rhythm showed no signs of pre-excitation, the characteristic pattern of pre-excited atrial fibrillation (AF) is recognized and after successful DC cardioversion the patient is referred for catheter ablation of the accessory pathway. This cas...

  19. Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage. (United States)

    Roca-Luque, Ivo; Rivas Gándara, Nuria; Dos Subirà, Laura; Pascual, Jaume Francisco; Domenech, Antònia Pijuan; Pérez-Rodon, Jordi; Subirana, M Teresa; Santos Ortega, Alba; Miranda, Berta; Rosés-Noguer, Ferran; Ferreira-Gonzalez, Ignacio; Ferrer, Jaume Casaldàliga; García-Dorado García, David; Mitjans, Angel Moya


    Intra-atrial re-entrant tachycardia (IART) is a frequent and severe complication in patients with congenital heart disease (CHD). Cavotricuspid isthmus (CTI)-related IART is the most frequent mechanism. However, due to fibrosis and surgical scars, non-CTI-related IART is also frequent. The main objective of this study was to describe the types of IART and circuit locations and to define a cut-off value for unhealthy tissue in the atria. This observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55 ± 14.9 years, 40.4% with highly complex cardiac disease). During the study, 114 IARTs were ablated (1.21 ± 0.41 IARTs per patient). Cavotricuspid isthmus-related IART was the only arrhythmia in 51% (n = 48) of patients, non-CTI-related IART was the only mechanism in 27.7% (n = 26), and 21.3% of patients (n = 20) presented both types of IART. In cases of non-CTI-related IART, the most frequent location of IART isthmus was the lateral or posterolateral wall of the venous atria, and a voltage cut-off value for unhealthy tissue in the atria of 0.5 mV identified 95.4% of IART isthmus locations. In our population with a high proportion of complex CHD, CTI-related IART was the most frequent mechanism, although non-CTI-related IART was present in 49% of patients (alone or with concomitant CTI-related IART). A cut-off voltage of 0.5 mV could identify 95.4% of the substrates in non-CTI-related IART.

  20. Electrical remodeling and atrial dilation during atrial tachycardia are influenced by ventricular rate : Role of developing tachycardiomyopathy

    NARCIS (Netherlands)

    Schoonderwoerd, BA; Van Gelder, IC; Van Veldhuisen, DJ; Tieleman, RG; Grandjean, JG; Bel, KJ; Allessie, MA; Crijns, HJGM


    Atrial Remodeling in Tachycardiomyopathy. Introduction: Atrial fibrillation (AF) and congestive heart failure (CHF) are two clinical entities that often coincide. Our aim was to establish the influence of concomitant high ventricular rate and consequent development of CHF on electrical remodeling

  1. Acute Chest Pain and Broad Complex Tachycardia. A Non-typical Case of Pre-excited Atrial Fibrillation (United States)

    Arias, Ramon Suarez; Villanueva, Nuria Perez; Cubero, Gustavo Iglesias; Lopez, Jose Rubin


    Wolff-Parkinson-White syndrome is a common condition in the emergency department. A case is presented of a 76-year-old patient with acute chest pain and broad complex tachycardia. Despite the fact that previous and post cardioversion ECG tracings in sinus rhythm showed no signs of pre-excitation, the characteristic pattern of pre-excited atrial fibrillation (AF) is recognized and after successful DC cardioversion the patient is referred for catheter ablation of the accessory pathway. This case illustrates a non-typical presentation of the WPW syndrome, with an older patient than usual with slight signs of pre-excitation. We highlight the need for high grades of suspicion for the early recognition of pre-excited AF when attending patients with tachycardia and the obligation to know the distinctive aspects of its management for this potentially life-threatening arrhythmia. PMID:28352389

  2. An electrocardiography algorithm combined with clinical features could localize the origins of focal atrial tachycardias in adjacent structures. (United States)

    Uhm, Jae-Sun; Shim, Jaemin; Wi, Jin; Mun, Hee-Sun; Pak, Hui-Nam; Lee, Moon-Hyoung; Joung, Boyoung


    It is difficult to differentiate the origins of focal atrial tachycardias (ATs) in adjacent structures by electrocardiography (ECG) alone. The aim of this study was to evaluate whether the clinical features of these ATs may help differentiate their origins. One hundred and ninety-four patients (mean age, 43.5 ± 17.9 years; male, 53.6%) who underwent electrophysiological study for focal AT were included. We evaluated accuracy in differentiating the origin of AT by using ECG alone as well as with the addition of the clinical features. Electrocardiographs of ATs originating from the left superior pulmonary vein (LSPV, n = 24) vs. the left atrial appendage (LAA, n = 6), and from the right superior pulmonary vein (RSPV, n = 14) vs. the superior vena cava (SVC, n = 8) showed similar patterns. However, while no ATs from the LAA were found to be related to paroxysmal atrial fibrillation, 22 out of 24 ATs from the LSPV were associated with this condition. After localizing AT by using ECG, this clinical feature helped differentiate the ATs from the LSPV vs. the LAA with 93% accuracy. Moreover, while an on-and-off tachycardia (initiated and terminated more than 10 times per day) was observed in 4 of 8 ATs from the SVC, this pattern was observed in 13 of 14 ATs from the RSPV. After localizing the ATs by using ECG, on-and-off tachycardia helped differentiate the ATs from the RSPV vs. the SVC with 82% accuracy. The clinical features and Holter monitoring can give additional information for differentiating the focal ATs originating from the adjacent structures. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email:

  3. Atrial and ventricular activation sequence after ventricular induction/entrainment pacing during fast-slow atrioventricular nodal reentrant tachycardia: New insight into the use of V-A-A-V for the differential diagnosis of supraventricular tachycardia. (United States)

    Kaneko, Yoshiaki; Nakajima, Tadashi; Irie, Tadanobu; Iizuka, Takashi; Tamura, Shuntaro; Kurabayashi, Masahiko


    The atrial and ventricular response observed immediately after cessation of ventricular induction/entrainment pacing is commonly analyzed to discriminate atrial tachycardia from other supraventricular tachycardias during electrophysiologic studies. However, the response in fast-slow atrioventricular nodal reentrant tachycardia (F/S-AVNRT) remains poorly investigated. The purpose of this study was to analyze the atrial and ventricular activation patterns after ventricular pacing in F/S-AVNRT. We enrolled 28 patients with F/S-AVNRT incorporating a typical slow pathway (typ-F/S-AVNRT) and 9 patients with F/S-AVNRT incorporating a superior slow pathway (sup-F/S-AVNRT). The V-A-A-V response was observed in 14 patients (38%) with F/S-AVNRT, more commonly in patients with sup-F/S-AVNRT than in those with typ-F/S-AVNRT (89% vs 21%, P = .0003). The underlying mechanisms included (1) a double atrial response (DAR) in 13 patients; (2) an anterograde block at the lower common pathway once after ventricular pacing in 2 patients; and (3) a pseudo-A-A-V response in 2 patients. The DAR was characterized by a V-A-A-V interatrial interval that was 55 ± 60 ms shorter than the tachycardia cycle length, whereas the block at the lower common pathway or infrahisian block had a V-A-A-V interatrial interval that was almost equal to or longer than the tachycardia cycle length. The V-A-A-V activation sequence immediately after ventricular induction/entrainment pacing is observed in patients with F/S-AVNRT, particularly in patients with sup-F/S-AVNRT, and is caused by multiple mechanisms, including a DAR, which is the major etiology. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  4. High resolution mapping of the pulmonary vein and the vein of Marshall during induced atrial fibrillation and atrial tachycardia in a canine model of pacing-induced congestive heart failure. (United States)

    Okuyama, Yuji; Miyauchi, Yasushi; Park, Angela M; Hamabe, Akira; Zhou, Shengmei; Hayashi, Hideki; Miyauchi, Mizuho; Omichi, Chikaya; Pak, Hui Nam; Brodsky, Lauren A; Mandel, William J; Fishbein, Michael C; Karagueuzian, Hrayr S; Chen, Peng Sheng


    The study examined the activations in the pulmonary veins (PVs) and the vein of Marshall (VOM) during atrial fibrillation (AF) in dogs with congestive heart failure (CHF). The patterns of activation within the PVs and the VOM during AF in CHF are unclear. We induced CHF in nine dogs by rapid ventricular pacing. The patterns of activation during induced AF were studied one week after ceasing ventricular pacing. The duration of induced AF averaged 80.7 +/- 177.3 s. The termination of low-amplitude fractionated activity in the PVs preceded the termination of AF in 25 of 29 episodes. High-density mapping (1-mm resolution) showed that the PV was activated by a focal wave front independent of left atrial (LA) activation in 22 AF episodes. Frequent intra-PV conduction blocks and multiple wave fronts in the PVs were recorded during 10 AF episodes. Focal activations were observed within the VOM in 4 of 12 episodes of AF. Three atrial tachycardia (AT) episodes originated from a focus within a PV. Histological studies showed extensive fibrosis in the PVs and in the atria. The PVs in five normal dogs did not have focal or fractionated activity during induced AF. Atrial fibrillation in canine CHF is associated with independent focal activations in the PVs and the VOM, and with complex wave fronts within the PVs. The PVs may also serve as the origin of AT. These findings suggest that electrical and anatomical remodeling of the PVs and the VOM are important in the maintenance of AF and AT in dogs with CHF.

  5. Simplified progressive approach for the ablation of scar related atrial macroreentrant tachycardias. (United States)

    Nava, Santiago; Iturralde-Torres, Pedro; Márquez, Manlio F; Gómez-Flores, Jorge; Cline, Bernardo; Colin-Lizalde, Luis; Victoria, Diana; Hermosillo, Antonio G


    Radiofrequency ablation of scar related right atrial flutter is challenging. Long procedures, prolonged fluoroscopic times and high percentages of recurrences are of concern. We present a simple and progressive approach based on a single electroanatomic map of the right atrium. Twenty-two consecutive patients with atrial flutter and history of cardiac surgery were included. An electrophysiologic study was performed to define localization (left or right) and cavo-tricuspid isthmus participation using entrainment mapping. After a critical isthmus was localized, ablation was performed with an external irrigated tip catheter with a power limit of 30 W. Potential ablation sites were confirmed by entrainment. The predominant cardiopathy was atrial septal defect. All arrhythmias were localized in the right atrium; mean cycle length of the clinical flutter was 274 ± 31 ms. Only 40% had cavo-tricuspid isthmus participation. None of the patients with successful ablation had recurrences after 13 ± 9.4 months of follow-up. A progressive approach with only one activation/voltage CARTO(®) map of the atrium and ablation of all potential circuits is a highly effective method for ablating scar related macroreentrant atrial arrhythmias. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  6. Catheter ablation of atrial tachycardia after interatrial defect repair with patch apposition. (United States)

    Nguyen, B L; Garante, C M; Tersigni, F; Sergiacomi, R; Petrassi, M; Di Matteo, A; Tufano, F; Alessandri, N


    A 54-year-old woman with history of septal atrial mixoma surgically treated and drug-refractory supraventricular tachyarrhythmia underwent catheter ablation of macro-reentry areas near the pericardial patch placed to repair an interatrial defect. The use of ablative therapy has been successful to cure this arrhythmia.

  7. Irregularity and lack of p-waves in short tachycardia episodes predict atrial fibrillation and ischemic stroke. (United States)

    Johnson, Linda S B; Persson, Anders P; Wollmer, Per; Juul-Möller, Steen; Juhlin, Tord; Engström, Gunnar


    Atrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p-waves, with a duration >30s. It is not known whether AF characteristics in shorter SVT episodes predict AF and stroke. To determine if irregularity and lack of p-waves, alone or in combination, at short SVT episodes increased the risk of incident AF and ischemic stroke. The population-based Malmö Diet and Cancer study includes 24hECG screening of 377 AF-free individuals (mean age 64.5 years, 43% men) who were prospectively followed for >13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats were identified and the longest SVT episode was assessed for irregularity and lack of p-waves. The association between SVT classification and AF and stroke was assessed using multivariable adjusted Cox regression. Incidence of AF increased with increasing abnormality of the SVTs. The risk-factor adjusted hazards ratio (HR) for AF was 4.95 (95%CI 2.06-11.9, pSVT episodes without p-waves (HR 14.2 (95%CI 3.76-57.6, pSVT episodes at detected at 24hECG screening are associated with incident AF and ischemic stroke. Short irregular SVTs without p-waves likely represent early stages of AF or atrial myopathy. 24hECG could identify subjects suitable for primary prevention efforts. Copyright © 2018. Published by Elsevier Inc.

  8. Rapid growth of left atrial myxoma after radiofrequency ablation. (United States)

    Rubio Alvarez, José; Martinez de Alegria, Anxo; Sierra Quiroga, Juan; Adrio Nazar, Belen; Rubio Taboada, Carola; Martinez Comendador, José Manuel


    Atrial myxoma is the most common benign tumor of the heart, but its appearance after radiofrequency ablation is very rare. We report a case in which an asymptomatic, rapidly growing cardiac myxoma arose in the left atrium after radiofrequency ablation. Two months after the procedure, cardiovascular magnetic resonance, performed to evaluate the right ventricular anatomy, revealed a 10 × 10-mm mass (assumed to be a thrombus) attached to the patient's left atrial septum. Three months later, transthoracic echocardiography revealed a larger mass, and the patient was diagnosed with myxoma. Two days later, a 20 × 20-mm myxoma weighing 37 g was excised. To our knowledge, the appearance of an atrial myxoma after radiofrequency ablation has been reported only once before. Whether tumor development is related to such ablation or is merely a coincidence is uncertain, but myxomas have developed after other instances of cardiac trauma.

  9. Catheter Ablation of a Complex Atrial Tachycardia after Surgical Repair of Tetralogy of Fallot Guided by Combined Noncontact and Contact Mapping

    Directory of Open Access Journals (Sweden)

    Eitaro Fujii, MD


    Full Text Available A 34-year-old man with a surgically repaired Tetralogy of Fallot complained of palpitation, fatigue, and presyncope. A 12-lead ECG showed atrial tachycardia with a cycle length of 250 ms and a P wave morphology positive in leads II, III and aVF, and negative in lead V1. Although the EnSite system (version 6.OJ made use of noncontact mapping to delineate the counterclockwise reentry around the crista tenninalis, it was difficult to rule out the incisional atrial reentry because the location of the surgical incision was far from the multi-electrode array. Since the bipolar contact mapping of the EnSite system revealed the location of the atriotomy incision, entrainment mapping during the tachycardia demonstrated the critical reentry circuit around the crista terminalis. Radiofrequency ablation targeting the critical isthmus from the lower position of the crista terminalis to the posterior dense scar which was continuous with the inferior vena cava, and to the atriotomy scar, eliminated the tachycardia.

  10. Atrial Ectopics Precipitating Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Johnson Francis


    Full Text Available 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.

  11. Intra-atrial re-entrant tachycardia in patients with congenital heart disease: factors associated with disease severity. (United States)

    Roca-Luque, Ivo; Rivas Gándara, Nuria; Dos Subirà, Laura; Francisco Pascual, Jaume; Pérez-Rodon, Jordi; Pijuan Domenech, Antònia; Subirana, Ma Teresa; Miranda, Berta; Santos Ortega, Alba; Casaldàliga Ferrer, Jaume; García-Dorado García, David; Moya Mitjans, Angel


    Intra-atrial re-entrant tachycardia (IART) is a common complication in patients with congenital heart disease (CHD) and is related to increased morbidity and mortality. Few reports have been published about factors associated to IART severity. The aim of this study is to analyse factors associated to severe clinical presentation of IART. Observational study of all consecutive CHD patients who underwent a first IART ablation from January 2009 to December 2015 (94 patients, 39.4% female, and age: 36.55 ± 14.9 years). Severe clinical presentation was defined as heart failure, syncope, shock, electromechanical dissociation (EMD), or aborted sudden death. The majority of patients had moderately or highly complex cardiac defect (90.4%). Types of IART included cavotricuspid isthmus(CTI) dependent in 51% (48), non-CTI-related in 22.3% (20), and both types in 27.7% (26). In 38 patients (40.4%), a severe event occurred and in 16 (17%), the symptoms included shock, syncope, sudden death, or EMD. In 21 (22.3%), severe symptoms were the first manifestation of IART. In multivariate analysis, transposition of the great arteries (TGA) with right systemic ventricle (OR 5.32, 95% C.I. 1.6-7.02, P = 0.0005) and severe dilation of the venous atrium (VsA) (OR 4.17; 95% CI 1.4-8.12, P = 0.0009) were factors independently associated with severity. In our series of 94 CHD patients with a high proportion of moderately to highly complex cardiac defects, severe consequences of IART were frequent. Transposition of the great arteries with systemic right ventricle and severe dilation of VsA were independently associated to severity. Early invasive procedures should be considered for these high-risk patients.

  12. Development of Lower Loop Reentrant Atrial Tachycardia in a Patient Late after Surgical Operation of Multiple Right-sided Accessory Pathways

    Directory of Open Access Journals (Sweden)

    Yasushi Oginosawa, MD


    Full Text Available A 50-year-old man developed a symptomatic tachyarrhythmia 22 years after surgical division of multiple right-sided accessory pathways. Electro-anatomical mapping during sinus rhythm revealed an electrically isolated ectopic focus on the right atrial free wall near the tricuspid annulus (TA. Activation map during tachycardia indicated the presence of lower loop reentry (LLR with collision of the wavefronts in the high right atrium. The isthmus of slow conduction was located between the surgical incision near the posterior TA and the inferior vena cava. LLR was eliminated by radiofrequency linear ablation at the cavotricuspid isthmus.

  13. Inhomogenic effect of bepridil on atrial electrical remodeling in a canine rapid atrial stimulation model. (United States)

    Fukaya, Hidehira; Niwano, Shinichi; Satoh, Daisuke; Masaki, Yoshihiko; Niwano, Hiroe; Kojima, Jisho; Moriguchi, Masahiko; Izumi, Tohru


    The antiarrhythmic or reverse remodeling effects of bepridil, a multi-ion channel blocker, have been recently reported, but inhomogeneity of the electrical remodeling and effects of bepridil have been observed in previous reports. In this study, the effect of long-term administration of bepridil on atrial electrical remodeling was evaluated in a comparison of the right and left atrium (RA and LA) in a canine rapid atrial stimulation model. In 10 beagle dogs, rapid atrial pacing (400 beats/min) was delivered for 6 weeks and the atrial effective refractory period (AERP), conduction velocity (CV) and inducibility of atrial fibrillation (AF) were evaluated every week. In 5 of the pacing dogs, bepridil (10 mg . kg(-1) . day(-1)) was administered orally, starting 2 weeks after the initiation of the rapid pacing. At the end of the protocol, the hemodynamic parameters and extent of tissue fibrosis were evaluated and the mRNA of SCN5A, Kv4.3, the L-type Ca2+ channel (LCC) and connexin (Cx) 40, 43, and 45 in both atria were examined by quantitative real-time reverse transcriptase-polymerase chain reaction. In the pacing control group, AERP shortening, decreased CV, increased AF inducibility and downregulation of the expression of SCN5A and LCC were observed. In the bepridil group, the AERP exhibited a relatively quick recovery after bepridil was started in the first week and continued to recover gradually until the end of the protocol, but that recovery was smaller in the LA than in the RA. The CV was not affected by bepridil administration. AF inducibility was well suppressed in the RA in the bepridil group, but the induction of short-duration AF could not be suppressed in the LA. The mRNA downregulation of the LCC and SCN5A was negated by bepridil administration in the RA; but not in the LA; however, the data showed similar tendencies. There were no significant differences in the hemodynamic parameters or tissue fibrosis and the mRNA expression of Kv4.3, Cx40, 43, and 45

  14. Correlation between the sudden jump-like increases of the atrio-Hisian interval induced during burst atrial pacing and during programmed atrial stimulation in patients with atrioventricular nodal reentrant tachycardia. (United States)

    Bayraktarova, Iskra H; Stoyanov, Milko K; Kunev, Boyan T; Shalganov, Tchavdar N


    To study the correlation between the sudden prolongations of the atrio-Hisian (AH) interval with ≥50 ms during burst and programmed atrial stimulation, and to define whether the AH jump during burst atrial pacing is a reliable diagnostic criterion for dual AV nodal physiology. Retrospective data on 304 patients with preliminary ECG diagnosis of AV nodal reentrant tachycardia (AVNRT), confirmed during electrophysiological study, was analyzed for the presence of AH jump during burst and programmed atrial stimulation, and for correlation between the pacing modes for inducing the jump. Wilcoxon signed-ranks test and Spearman's bivariate correlation coefficient were applied, significant was P-value jump occurred during burst atrial pacing in 81% of the patients, and during programmed stimulation - in 78%, P = 0.366. In 63.2% AH jump was induced by both pacing modes; in 17.8% - only by burst pacing; in 14.8% - only by programmed pacing; in 4.2% there was no inducible jump. There was negative correlation between both pacing modes, ρ = -0.204, Р<0.001. Burst and programmed atrial stimulation separately prove the presence of dual AV nodal physiology in 81 and 78% of the patients with AVNRT, respectively. There is negative correlation between the two pacing modes, allowing the combination of the two methods to prove diagnostic in 95.8% of the patients. Copyright © 2017 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

  15. Clinical course of acute atrial fibrillation treated with rapid digitalization. (United States)

    Weiner, P; Bassan, M M; Jarchovsky, J; Iusim, S; Plavnick, L


    Forty-seven episodes of acute atrial fibrillation (AF) in 45 patients were examined prospectively to determine the course of the disorder treated with rapid digitalization. Patients received 1.5 mg of digoxin intravenously over 12 hours. In 40 of the 47 attacks, reversion to sinus rhythm occurred with no additional therapy at 1 to 96 hours (median 4 hours) after beginning digoxin. In thirty-two patients, conversion occurred within 8 hours; only one patient showed important ventricular slowing before conversion. Thus, if digoxin facilitates conversion, it does not do so by slowing the ventricular response. Of the 11 patients still in AF at 16 hours, conversion subsequently occurred in only four who were receiving digoxin alone. We conclude that the prognosis for quick reversion to sinus rhythm in patients with acute AF treated with rapid digitalization alone is excellent. If reversion does not occur by 16 to 24 hours, additional measures to restore sinus rhythm are indicated.

  16. Multifocal atrial tachycardia (United States)

    ... the last 6 weeks Overdosed on the drug theophylline Sepsis When the heart rate is less than ... potassium through a vein Stopping medicines, such as theophylline, which can increase heart rate Taking medicines to ...

  17. Rapid slowing of the atrial fibrillatory rate after administration of AZD7009 predicts conversion of atrial fibrillation

    DEFF Research Database (Denmark)

    Aunes, Maria; Egstrup, Kenneth; Frison, Lars


    BACKGROUND: Effects on the atrial fibrillatory rate (AFR) were studied during infusion with the combined potassium and sodium channel blocker AZD7009. METHODS AND RESULTS: Patients with persistent atrial fibrillation (AF) were randomized to AZD7009 or placebo. Thirty-five patients converted to si...... fpm (p=0.02), and at 10 min, -133 vs. -111 fpm (p=0.048). The AFR-SD and the exponential decay decreased. A small left atrial area was the only baseline predictor of conversion to SR. CONCLUSIONS: AZD7009 produced a significantly more rapid decrease of the AFR in converters than in non...

  18. A rare large right atrial myxoma with rapid growth rate. (United States)

    Kelly, Shawn C; Steffen, Kelly; Stys, Adam T


    Atrial myxomas are the most common benign intracavitary cardiac neoplasms. They most frequently occur in the left atrium. Right atrial tumors are rare, comprising 20 percent of myxomas achieving an incidence of 0.02 percent. Due to their rarity, right atrial tumor development and associated clinical symptoms has not been well described. The classical clinical triad for the presentation of left atrial myxomas--heart failure, embolic events, and constitutional symptoms--may not be applicable to right sided tumors. Also, natural development of myxoma is not well described, as surgical resection is the common practice. Previously ascribed growth rates of myxomas refer mostly to left atrial ones, as right atrial tumors are rare. We present a case of right atrial myxoma with growth rates exceeding those previously described.

  19. Effects of Bepridil on Atrial Electrical Remodeling in Short-Term Rapid Pacing

    Directory of Open Access Journals (Sweden)

    Hiroto Tsuchiya, MD


    Conclusions: Bepridil prevented the shortening of the ERP and MAPD90 induced by rapid atrial pacing in the acute phase. The results of this study might explain the efficacy of bepridil for preventing the recurrence of paroxysmal AF.

  20. Influence of steroid therapy on the incidence of pericarditis and atrial fibrillation after percutaneous epicardial mapping and ablation for ventricular tachycardia. (United States)

    Dyrda, Katia; Piers, Sebastiaan R D; van Huls van Taxis, Carine F; Schalij, Martin J; Zeppenfeld, Katja


    This study evaluates the influence of 3 therapeutic approaches on the incidence of pericarditis and atrial fibrillation (AF) after percutaneous epicardial mapping and ablation for ventricular tachycardia. Eighty-five consecutive procedures (2006-2011) were retrospectively reviewed. After the first 17 procedures (20.0%), no steroids were administered. For the subsequent 30 procedures (35.3%), systemic steroids were administered intravenously or orally, whereas the last 38 procedures (44.7%) were followed by intrapericardial steroid injection. Compared with no steroids, the incidence of pericarditic chest pain was significantly reduced by intrapericardial steroids (58.8% versus 21.1%; P=0.006) but not by intravenous or oral steroids (58.8% versus 43.4%; P=0.31). There was no significant difference in the incidence of pericarditic ECG with steroids (36.8%, 30.0%, and 41.2% for intrapericardial, intravenous or oral, and none, respectively). There was a nonsignificant reduced incidence of chest pain with ECG changes with steroids (13.2%, 10.0%, and 29.4% for intrapericardial, intravenous or oral, and none, respectively). Radiofrequency applications (65.9% of procedures) did not affect the incidence of pericarditic ECG changes, pericarditic chest pain, or pericarditis (all P>0.05). In 7 (8.3%) patients with no prior history of AF, AF was documented a median 36 hours after procedure. Patients with pericarditic ECG tended to be at greater risk of AF (16.7 versus 3.6%; P=0.091). There is a high incidence of pericarditic chest pain and ECG changes after epicardial ventricular tachycardia mapping and ablation. Pericarditic chest pain is significantly decreased by intrapericardial steroids. Procedure-related AF is relatively frequent and tends to occur more commonly with pericarditic ECG changes. © 2014 American Heart Association, Inc.

  1. A Low-Cost Simulation Model for R-Wave Synchronized Atrial Pacing in Pediatric Patients with Postoperative Junctional Ectopic Tachycardia.

    Directory of Open Access Journals (Sweden)

    Andreas Entenmann

    Full Text Available Postoperative junctional ectopic tachycardia (JET occurs frequently after pediatric cardiac surgery. R-wave synchronized atrial (AVT pacing is used to re-establish atrioventricular synchrony. AVT pacing is complex, with technical pitfalls. We sought to establish and to test a low-cost simulation model suitable for training and analysis in AVT pacing.A simulation model was developed based on a JET simulator, a simulation doll, a cardiac monitor, and a pacemaker. A computer program simulated electrocardiograms. Ten experienced pediatric cardiologists tested the model. Their performance was analyzed using a testing protocol with 10 working steps.Four testers found the simulation model realistic; 6 found it very realistic. Nine claimed that the trial had improved their skills. All testers considered the model useful in teaching AVT pacing. The simulation test identified 5 working steps in which major mistakes in performance test may impede safe and effective AVT pacing and thus permitted specific training. The components of the model (exclusive monitor and pacemaker cost less than $50. Assembly and training-session expenses were trivial.A realistic, low-cost simulation model of AVT pacing is described. The model is suitable for teaching and analyzing AVT pacing technique.

  2. Atrial fibrillation in rats induced by rapid transesophageal atrial pacing during brief episodes of asphyxia: A new in vivo model

    DEFF Research Database (Denmark)

    Haugan, K.; Lam, Henrik Rye; Knudsen, C. B.


    in anesthetized male Sprague-Dawley rats. AF was reproducibly induced in 81% of the rats. The presence of AF was associated with an increased heart rate, and a decreased blood pressure. Treatment with amiodarone, D,L-sotalol, flecainide, and propranolol all reduced duration of AF, whereas verapamil treatment...... of verapamil. Relative to existing models of AF in larger animals, this model offers rapid, predictive, and inexpensive testing of antiarrhythmic/profibrillatory effects of new drugs.......Non-pharmacological in vivo models of atrial fibrillation (AF) have been developed in large animals only. We aimed to develop and characterize a new small animal non-pharmacological in vivo model of AF. AF was induced by transesophageal atrial burst pacing during 35 seconds periods of asphyxia...

  3. Tachycardia induction with ventricular extrastimuli differentiates atypical atrioventricular nodal reentrant tachycardia from orthodromic reciprocating tachycardia. (United States)

    Obeyesekere, Manoj; Gula, Lorne J; Modi, Simon; Leong-Sit, Peter; Angaran, Paul; Mechulan, Alexis; Skanes, Allan C; Krahn, Andrew D; Yee, Raymond; Klein, George J


    Differentiating atypical atrioventricular nodal reentrant tachycardia (AVNRT) from septal orthodromic reentrant tachycardia (ORT(Septal)) is challenging in nonsustained tachycardia. When sustained, the postpacing interval minus tachycardia cycle length following entrainment (PPI(Entrainment) - TCL) and stimulation to atrial interval minus ventriculoatrial interval (Stim-A(Entrainment) - VA) are utilized. We hypothesized that the first tachycardia cycle after tachycardia induction with right ventricular apical extrastimulation would yield comparable information to entrainment, precluding the need for sustained tachycardia. Twenty-four patients with AVNRT (age 47 ± 18 years), 19 with ORT(Septal) (age 42 ± 17 years), and 15 with ORT over a left lateral accessory pathway (ORT(Left)) (age 41 ± 16 years) were included. The ventricular extrastimulus to atrial depolarization at tachycardia initiation (Stim-A(Initiation)) and tachycardia VA interval were measured to establish the Stim-A(Initiation) minus VA interval (Stim-A(Initiation) - VA). The ventricular extrastimulus to the subsequent right ventricular apical depolarization (postpacing interval at initiation, PPI(Initiation)) was utilized to obtain the PPI(Initiation) minus TCL (PPI(Initiation) - TCL). The AH interval associated with the PPI(Initiation) minus the AH in tachycardia was utilized to establish a corrected PPI(Initiation) minus TCL (cPPI(Initiation) - TCL). The intervals after tachycardia initiation were longer for AVNRT than for ORT: mean PPI(Initiation) - TCL (193 ± 44 vs 91 ± 73; P cPPI(Initiation) - TCL (174 ± 44 ms vs 88 ± 50 ms; P cPPI(Initiation) minus TCL against PPI(Entrainment) minus TCL was 0.71. cPPI(Initiation) minus TCL cPPI(Initiation) - TCL < 115 ms excludes AVNRT. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  4. [Catheter ablation in supraventricular tachycardia]. (United States)

    Pitschner, H F; Neuzner, J


    The first report about successful radio frequency ablation of a right-posterior-septal accessory pathway appeared in 1986. Since then, the technology of both guidable ablation catheters and radio frequency generators has been considerably improved in an initially clinical-experimental phase. At the same time, electrophysiologists were equally able to enlarge their knowledge in the field of signal characteristics of arrhythmogenic substrates. This included the discovery of action potentials of accessory pathways (preexcitation syndromes), the location of fast and slow AV node conduction (AV nodal reentrant tachycardia, AVNRT), the functional importance of the anatomical isthmus between the os of the coronary sinus, the tricuspid valve and the inferior caval vein (atrial flutter). Mapping techniques such as transient and concealed entrainment became, among others, significant tools in finding the best localization for radio frequency catheter ablation. Thus, technical development and the increased knowledge of clinical electrophysiologists resulted in firmly establishing the procedure of catheter ablation as the method of first choice in the curative treatment of supraventricular tachycardias in a potential collective of about 5 per mill of the normal population (without atrial fibrillation). Supraventricular tachycardias with a reentry mechanism in the broadest sense (> 95% of all pts. with SVT) and those with focal automaticity ( 90% versus uncommon type 90%). Atrial reentrant tachycardias are rather rare (with the exception of atrial fibrillation/flutter). The literature suggests medical therapy to be successful in about 60% of these patients. Those patients who are presently proposed to receive radio frequency catheter ablation usually continue to be symptomatic despite pharmacological therapy and/or have a potential risk for sudden cardiac death due to atrial fibrillation in WPW syndrome, or rate-dependent hemodynamic compromise secondary to cardiac disease

  5. Extracorporeal CPR and intra-aortic balloon pumping in tachycardia-induced cardiomyopathy complicating cardiac arrest. (United States)

    Lee, Jun Wan; Ahn, Hong Joon; Yoo, Youn Ho; Lee, Jin Woong; Kim, Seung Whan; Choi, Si Wan


    Although tachycardia-induced cardiomyopathy (TIC) due to atrial fibrillation occurs frequently, it is under-recognized in clinical settings. TIC has a wide range of clinical manifestations, from asymptomatic tachycardia to cardiomyopathy leading to end stage heart failure. We present a case of a 48year-old-woman who presented as cardiogenic shock, and rapidly progressed to cardiac arrest from recently diagnosed but undertreated atrial fibrillation, resulting TIC in the emergency department (ED). She was rescued by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest in the ED, and received concomitant intra-aortic balloon counterpulsation (IABP) support for severe left ventricular failure. Cardiogenic shock can present as an initial manifestation of TIC, and E-CPR and subsequent IABP support can be a valuable rescue therapy for severe TIC. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Radiofrequency Catheter Ablation of Coexistent Idiopathic Left Ventricular Tachycardia and Atrioventricular Nodal Reentrant Tachycardia

    Directory of Open Access Journals (Sweden)

    Ken-Pen Weng


    Full Text Available A healthy 15-year-old male patient presented with a 6-month history of recurrent attacks of palpitations. On multiple emergency room visits, a sustained wide QRS complex tachycardia with a right bundle branch block and northwest axis deviation was documented. The tachycardia was not terminated by intravenous adenosine, but was suppressed with intravenous verapamil. There was no evidence of structural heart disease, myocarditis, long QT syndrome, or electrolyte imbalance after a series of standard examinations. Idiopathic left ventricular tachycardia (ILVT was suspected. Electrophysiologic studies revealed 2 inducible tachycardias, which were shown to represent atrioventricular nodal reentrant tachycardia (AVNRT and ILVT. Transformation from AVNRT to ILVT occurred spontaneously following atrial pacing. Successful ablation of ILVT and the slow atrioventricular nodal pathway resulted in cure of the double tachycardia.

  7. Performance of an automatic external cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia. (United States)

    Mattioni, Thomas; Kanaan, Nabil; Riggio, David; Bahu, Marwan; Lin, Don; Welch, Sue; Williams, Claudia


    An automatic external cardioverter-defibrillator (AECD) with a programmable supraventricular-ventricular tachycardia (VT) zone underwent evaluation of arrhythmia discrimination performance in the electrophysiologic laboratory during induced supraventricular tachycardia (SVT) and unipolar and bipolar atrial pacing. The AECD SVT zone was programmed so that the induced SVT rate would fall within this zone. Atrial pacing was also performed at a rate within this zone. The ability of the AECD to accurately discriminate between VT and SVT and to recommend shock delivery was assessed. A total of 98 patients underwent conventional diagnostic electrophysiologic studies (49 men, age 59 +/- 19 years) with a total of 55 inducible sustained SVTs. High right atrial pacing was performed in 56 patients in unipolar and in 82 patients in bipolar fashion. In response to induced sustained SVT, the AECD correctly classified 47 episodes as nonshockable, 4 incorrectly as shockable, and 4 episodes correctly as shockable with a resultant sensitivity of 100% and specificity of 92%. Bipolar high right atrial pacing was correctly identified as nonshockable in 75 episodes, incorrectly identified as shockable in 5 episodes, and correctly identified as shockable in 2 episodes with a resultant sensitivity of 100% and specificity of 94%. The Powerheart AECD accurately discriminates SVT from VT and is expected to correctly deliver automatic external shocks rapidly in the presence of spontaneous life-threatening tachycardia and appropriately withhold therapy during SVT.

  8. Usefulness of vernakalant hydrochloride injection for rapid conversion of atrial fibrillation

    DEFF Research Database (Denmark)

    Pratt, Craig M; Roy, Denis; Torp-Pedersen, Christian


    The objective of the present study was to assess the safety and effectiveness of vernakalant hydrochloride injection (RSD1235), a novel antiarrhythmic drug, for the conversion of atrial fibrillation (AF) or atrial flutter to sinus rhythm (SR). Patients with either AF or atrial flutter were...

  9. [The bradycardia-tachycardia syndrome]. (United States)

    Salazar, E; Cerda, G; Pieniak, M


    Disorders of the heart rhythm which consist basically of sinus bradicardia or sinus arrest correspond to a syndrome which has been named the sick sinus syndrome. Within the framework of this syndrome, there is a subgroup of alternating atrial bradycardia with episodes of atrial tachyarrhythmia. Generally known as the bradycardia-tachycardia syndrome, this subgroup is both electrophysiologically interesting and therapeutically challenging. This report is concerned with the experience obtained at the emergency ward and coronary care unit of the Instituto Nacional de Cardiología de México on the diagnosis and management of 8 patients with this syndrome. Various underlying heart conditions were present with predominance of ischemic heart disease. The clinical picture was dependent upon the hypoperfusion of vital organs secondary to the cardial arrhythmia. The most common symptoms were derived from cerebral circulatory deficit and coronary insufficiency. Half of the patients had moderate cardiac failure. All patients had spontaneous and transient loss of sinus function which lasted more than 2,000 msec. in seven. The bradycardia had a rate below 50 beats per minute in all cases except one. The tachyarrhythmias observed were atrial flutter, atrial fibrillation and paroxysmal supraventricular tachycardia. Three of the patients had more than one of these these tachyarrhythmias during the period of study. A discussion is made on the diagnosis of this syndrome by means of atrial pacing and interventions which modify either vagal or sympathetic tone. Considerations are also made on the frequent associated abnormality of the A-V functional tissues. Emphasis is placed on the problems encountered in the management of these patients. It is concluded that, in most cases, a satisfactory result may be obtained by the implantation of a permanent demand pacemaker associated to the administration of antiarrhythmic drugs.

  10. [Ventricular tachycardia and cardiac hemochromatosis]. (United States)

    Luis Moríñigo, J; Martín Luengo, C; Ledesma, C; Arribas, A; Nieto, A A; Rodríguez, J


    Hemochromatosis is characterized by an excessive iron deposit in different tissues. Cardiac involvement may be observed in one third of the patients due to hemochromatosis and occurs as a consequence of ferritin accumulation in the heart which on one hand induces alterations in systolic and diastolic ventricular function and on the other hand, an arrythmogenic substrate. The clinical manifestations can be indistinctly related to atrial tachyarrhythmia, ventricular tachyarrhythmia, atrio-ventricular blockade and congestive heart failure, with the first being the most frequent. We present the case of one patient with secondary hemochromatosis to repeated transfusions due to sideroblastic anemia with cardiac involvement, whose initial heart manifestations were recurrent atrial tachyarrhythmia and sustained ventricular tachycardia with syncope for which an automatic defibrillator was implanted.

  11. Increased extracellular collagen matrix in myocardial sleeves of pulmonary veins: an additional mechanism facilitating repetitive rapid activities in chronic pacing-induced sustained atrial fibrillation. (United States)

    Chiu, Yung-Tsung; Wu, Tsu-Juey; Wei, Hao-Ji; Cheng, Ching-Chang; Lin, Nai-Nu; Chen, Ying-Tsung; Ting, Chih-Tai


    Increased ECM in canine PVs. Cell uncoupling due to fibrosis or increased extracellular collagen matrix (ECM) affects the formation of ectopic focal activity. Whether or not the increase of ECM also exists in the pulmonary veins (PVs) with rapid atrial pacing is unknown. We sought to test the hypothesis that in chronic atrial pacing dogs with sustained atrial fibrillation (AF), the amount of ECM was increased in both atria and the PVs. We induced sustained AF in dogs by rapid atrial pacing. Computerized mapping techniques were used to map both atria and the PVs. We also used histological assessment to quantify the amount of ECM. After 118+/-24 days of rapid atrial pacing, sustained AF was induced in 7 dogs. Repetitive rapid activities (RRAs) either continuously or intermittently arose from the PVs during sustained AF. Histological study shows that there was no fibrosis in both atrial free walls and the PVs. However, the amount of ECM was increased in these regions. The mean ECM surface area fraction at each region in the dogs with sustained AF was all significantly higher compared to the corresponding region in normal dogs. Similarly, the heterogeneity of the ECM surface area fraction at each region in the dogs with sustained AF was also all significantly higher compared to normal dogs. In chronic atrial pacing-induced sustained AF, structural remodeling (i.e., inhomogeneous increase of ECM) also involves the PVs. Reduced coupling of the myocytes in the PV due to histological changes may provide an additional mechanism facilitating RRAs.

  12. Usefulness of vernakalant hydrochloride injection for rapid conversion of atrial fibrillation

    DEFF Research Database (Denmark)

    Pratt, Craig M.; Roy, Dennis; Torp-Pedersen, Christian


    The objective of the present study was to assess the safety and effectiveness of vernakalant hydrochloride injection (RSD1235), a novel antiarrhythmic drug, for the conversion of atrial fibrillation (AF) or atrial flutter to sinus rhythm (SR). Patients with either AF or atrial flutter were...... infusion of placebo or vernakalant (2 mg/kg) 15 minutes later if the arrhythmia had not terminated. A total of 265 patients were randomized and received treatment. The primary end point was conversion of AF to SR for ≥1 minute within 90 minutes of the start of the drug infusion in the short-duration AF...

  13. Microelectrode array measurement of potassium ion channel remodeling on the field action potential duration in rapid atrial pacing rabbits model. (United States)

    Sun, Juan; Yan, Huang; Wugeti, Najina; Guo, Yujun; Zhang, Ling; Ma, Mei; Guo, Xingui; Jiao, Changan; Xu, Wenli; Li, Tianqi


    Atrial fibrillation (AF) arises from abnormalities in atrial structure and electrical activity. Microelectrode arrays (MEA) is a real-time, nondestructive measurement of the resting and action potential signal, from myocardial cells, to the peripheral circuit of electrophysiological activity. This study examined the field action potential duration (fAPD) of the right atrial appendage (RAA) by MEA in rapid atrial pacing (RAP) in the right atrium of rabbits. In addition, this study also investigated the effect of potassium ion channel blockers on fAPD. 40 New Zealand white rabbits of either sex were randomly divided into 3 groups: 1) the control, 2) potassium ion channel blocker (TEA, 4-Ap and BaCl2), and 3) amiodarone groups. The hearts were quickly removed and right atrial appendage sectioned (slice thickness 500 μm). Each slice was perfused with Tyrode's solution and continuously stimulated for 30 minutes. Sections from the control group were superfused with Tyrode's solution for 10 minutes, while the blocker groups and amiodarone were both treated with their respective compounds for 10 minutes each. The fAPD of RAA and action field action potential morphology were measured using MEA. In non-pace (control) groups, fAPD was 188.33 ± 18.29 ms after Tyrode's solution superfusion, and 173.91 ± 6.83 ms after RAP. In pace/potassium ion channel groups, TEA and BaCl2 superfusion prolonged atrial field action potential (fAPD) (control vs blocker: 176.67 ± 8.66 ms vs 196.11 ± 10.76 ms, 182.22 ± 12.87 ms vs 191.11 ± 13.09 ms with TEA and BaCl2 superfusion, respectively, P action potential in animal heart slices. After superfusing potassium ion channel blockers, fAPD was prolonged. These results suggest that Ito, IKur and IK1 remodel and mediate RAP-induced atrial electrical remodeling. Amiodarone alter potassium ion channel activity (Ito, IKur, IK1 and IKs), shortening fAPD.

  14. Bidirectional tachycardia induced by herbal aconite poisoning. (United States)

    Tai, Y T; Lau, C P; But, P P; Fong, P C; Li, J P


    This report details the clinical, electrocardiographic, and electropharmacological characteristics of an unusual case of bidirectional tachycardia induced by aconites present in a Chinese herbal decoction consumed by a previously healthy subject. The tachycardia showed marked susceptibility to vagotonic maneuvers, cholinesterase inhibition, and adenosine triphosphate. The incessant nature of the tachycardia, rapid recurrence after transient suppression, and failure to respond to direct current cardioversion suggested an automatic tachycardia mechanism consistent with known data on the cellular electrophysiological mechanism of aconitine-mediated arrhythmogenesis. A fascicular or ventricular myocardial origin of the tachycardia with alternating activation patterns, or dual foci with alternate discharge, appeared most plausible. The rootstocks of aconitum plants have been commonly employed in traditional Chinese herbal recipes for "cardiotonic" actions and for relieving "rheumatism." Multiple pitfalls could occur during the processing of these herbs that might have predisposed to aconite poisoning. The need for strict control and surveillance of herbal substances with low margins of safety is highlighted.

  15. Unilateral atrial fibrillation - how common is atrial divorce? (United States)

    Ker, J


    Atrial fibrillation is the most common pathologic supraventricular tachycardia. It has many causes, is an expensive disease, impairs quality of life and leads to an increased risk of death. Atrial dissociation is characterised by the presence of two independent sets of P-waves. This peculiar abnormality may give rise to the scenario where one atrium is in atrial fibrillation while the other is in sinus rhythm. This is the first published case of atrial dissociation where the phenomenon is demonstrated by transmitral and transtricuspid pulsed wave Doppler.

  16. Radiofrequency ablation in an infant with recurrent supraventricular tachycardia and cyanosis

    Directory of Open Access Journals (Sweden)

    Vora Amit


    Full Text Available We report an unusual presentation of supraventricular tachycardia, in an infant, with cyanosis. The child had atrial septal defect with hypoplastic right ventricle. Radiofrequency ablation was performed in view of drug resistant SVT

  17. Junctional ectopic tachycardia after congenital heart surgery. (United States)

    Cools, E; Missant, C


    In this literature review, we try to give anesthesiologists a better understanding about Junctional Ectopic Tachycardia (JET), a narrow complex tachycardia that frequently occurs during and after surgery for congenital heart disease. Information was found in the databases of Pubmed, Science Direct, Medline and the Cochrane Library, by using the mesh terms "Tachycardia, Ectopic Junctional", combined with "Diagnosis", "Etiology", "Physiopathology", "Complications" and "Therapy". The publication date of the articles ranged from 1990 to 2012. Risk factors for the development JET are surgery near the AV node, a duration of cardiopulmonary bypass longer than 90 minutes, young age, the use of inotropic drugs and hypomagnesaemia. The diagnosis of Junctional Ectopic Tachycardia can be made on a 12-lead ECG, demonstrating a narrow-complex tachycardia with inverted P-waves and VA dissociation. Adenosine administration and an atrial electrocardiogram can help to confirm the diagnosis. If JET has a minimal impact on the hemodynamic status of the patient, risk factors should be avoided and the adrenergic tonus should be reduced. Hemodynamic unstable JET can be treated by amiodarone, hypothermia and pacing. Extracorporeal membrane oxygenation (ECMO) and radiofrequency or cryoablation are treatment options for life-threatening and resistant JET. JET is the most frequent arrhythmia during and after congenital cardiac surgery. The ECG is the only available method to diagnose JET, demonstrating inverted P-waves and VA-dissociation. Amiodarone seems to be the most effective treatment option, because it can restore sinus rhythm and reduces the JET rate.

  18. Rapid conversion of persistent atrial fibrillation to sinus rhythm by intravenous AZD7009

    DEFF Research Database (Denmark)

    Geller, J Christoph; Egstrup, Kenneth; Kulakowski, Piotr


    This randomized, double-blind trial compared cardioversion rates between AZD7009 infusion (15-minute 3.25 mg/min, 15-minute 4.4 mg/min, or 30-minute 3.25 mg/min) and placebo infusion (15 or 30 minutes) in patients with atrial fibrillation (AF) scheduled for DC cardioversion. One hundred sixty-eig...

  19. Idiopathic Fascicular Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Johnson Francis


    Full Text Available Idiopathic fascicular ventricular tachycardia is an important cardiac arrhythmia with specific electrocardiographic features and therapeutic options. It is characterized by relatively narrow QRS complex and right bundle branch block pattern. The QRS axis depends on which fascicle is involved in the re-entry. Left axis deviation is noted with left posterior fascicular tachycardia and right axis deviation with left anterior fascicular tachycardia. A left septal fascicular tachycardia with normal axis has also been described. Fascicular tachycardia is usually seen in individuals without structural heart disease. Response to verapamil is an important feature of fascicular tachycardia. Rare instances of termination with intravenous adenosine have also been noted. A presystolic or diastolic potential preceding the QRS, presumed to originate from the Purkinje fibers can be recorded during sinus rhythm and ventricular tachycardia in many patients with fascicular tachycardia. This potential (P potential has been used as a guide to catheter ablation. Prompt recognition of fascicular tachycardia especially in the emergency department is very important. It is one of the eminently ablatable ventricular tachycardias. Primary ablation has been reported to have a higher success, lesser procedure time and fluoroscopy time

  20. Long-term therapy of antitachycardia pacing for supraventricular tachycardia. (United States)

    Jung, W; Mletzko, R; Manz, M; Lüderitz, B


    Long-term antitachycardia pacing therapy with the InterTach 262-12 and 262-16 was evaluated in 32 consecutive patients (mean age 50 +/- 13 years) with recurrent, drug refractory supraventricular tachycardia. AV nodal reentrant tachycardia was present in 20 patients, Wolff-Parkinson-White syndrome in ten patients, and a reentrant tachycardia due to Mahaim fibers in one patient. During follow-up of 39 +/- 17 months, 250 persistent tachycardia episodes occurred in 22 patients. By adjusting detection and termination mode, recurrent supraventricular tachycardia could be controlled in 19 of 32 patients (60%) by antitachycardia pacing alone. Concomitant antiarrhythmic drug therapy was required in ten of 32 patients (30%). During follow-up antitachycardia pacing became ineffective in three patients (10%). Thus, chronic antitachycardia pacing proved to be safe and effective in selected patients with drug refractory supraventricular tachycardia and could significantly improve quality of life by rapid termination of recurrent supraventricular tachycardia episodes.

  1. Supraventricular tachycardia following insertion of a central venous catheter

    Directory of Open Access Journals (Sweden)

    Yavascan Onder


    Full Text Available Placement of central venous catheters (CVCs in patients is associated with several risks including endocardial injury and dysrhythmias. In addition, CVC extending into intracardiac chambers can provoke premature atrial and ventricular complexes, which have been reported to initiate supraventricular tachycardia (SVT. A 15-year-old boy with end-stage renal failure developed SVT after insertion of a CVC.

  2. Differential ventricular entrainment: a maneuver to differentiate AV node reentrant tachycardia from orthodromic reciprocating tachycardia. (United States)

    Segal, Oliver R; Gula, Lorne J; Skanes, Allan C; Krahn, Andrew D; Yee, Raymond; Klein, George J


    Distinguishing atrioventricular node reentry (AVNRT) from orthodromic reentrant tachycardia (ORT) utilizing an accessory pathway (AP) can sometimes be challenging. A pacing maneuver that reliably distinguishes between the two would be of value. This study sought to assess the utility of differential entrainment for the diagnosis of supraventricular tachycardia. Consecutive patients underwent prospective electrophysiological study of regular paroxysmal supraventricular tachycardia. Overdrive pacing with entrainment of tachycardia from each of the right ventricular apex and right ventricular base was performed. The post-pacing interval (PPI), PPI minus the tachycardia cycle length and corrected for AV node decrement (cPPI-TCL), and the ventriculoatrial (VA) interval (last RV pacing stimulus to last entrained high right atrial signal) were calculated at each site. Entrainment at both RV sites was achieved in 35 patients, 16 with typical AVNRT, 1 with atypical AVNRT, and 18 with ORT (13 left free wall, 3 right free wall, and 2 septal APs). The cPPI-TCL and VA intervals were significantly longer from base than apex in AVNRT (cPPI-TCL 61 ms longer, VA 38 ms longer, both P cPPI-TCL >30 ms or VA interval >20 ms identified patients with AVNRT with a positive predictive value, negative predictive value, sensitivity, and specificity of 100%. Differential ventricular entrainment is a useful tool for diagnosing between AVNRT and ORT. A differential cPPI-TCL >30 ms or VA interval of >20 ms reliably predicts AVNRT.

  3. Potential new indication for ivabradine: treatment of a patient with congenital junctional ectopic tachycardia. (United States)

    Al-Ghamdi, Saleh; Al-Fayyadh, Majid I; Hamilton, Robert M


    Ivabradine is a new antiarrhythmic agent with direct inhibition of the pacemaker (If) current. It has been used extensively to decrease sinus rate in the treatment of cardiac failure, and also in a single case of atrial ectopic tachycardia in a child. Here we report the case of a 3-year-old girl with congenital junctional ectopic tachycardia (JET), resistant to conventional antiarrhythmic medications, who was successfully treated with ivabradine. We suggest that ivabradine can be an effective treatment for junctional automatic tachycardias and can be considered as a new line of therapy for this incessant form of tachycardia. © 2013 Wiley Periodicals, Inc.

  4. Resetting criteria during ventricular overdrive pacing successfully differentiate orthodromic reentrant tachycardia from atrioventricular nodal reentrant tachycardia despite interobserver disagreement concerning QRS fusion. (United States)

    Rosman, Jonathan Z; John, Roy M; Stevenson, William G; Epstein, Laurence M; Tedrow, Usha B; Koplan, Bruce A; Albert, Christine M; Michaud, Gregory F


    The beginning of ventricular overdrive pacing (VOP) during supraventricular tachycardia (SVT) accurately distinguishes orthodromic reentrant tachycardia (ORT) from atrioventricular nodal reentrant tachycardia (AVNRT) even when pacing terminates tachycardia. Tachycardia resetting most often occurs during this transition zone (TZ) of QRS fusion in ORT and after this TZ in AVNRT. The end of the TZ is marked by the first beat with a stable QRS morphology but is a subjective assessment. Disagreement concerning this beat may change tachycardia diagnosis. The purpose of this study was to assess interobserver agreement for identifying the TZ and whether disagreement affected diagnosis. Seventy-nine consecutive patients with inducible ORT and AVNRT were included. Resetting of tachycardia was evaluated by (1) atrial timing perturbation and (2) fixed stimulation-atrial activation timing (SA). Two blinded observers identified the end of the TZ and used the two resetting criteria to establish a diagnosis. Diagnostic results were compared with standard criteria for SVT diagnosis. The diagnosis was considered correct if both electrophysiologists' TZ assessment resulted in a correct diagnosis. Agreement on the TZ occurred in 80% (148/186) of VOP trains. In ORT patients, tachycardia resetting occurred during the TZ and correctly diagnosed ORT based on atrial timing perturbation and fixed SA in 91% and 98% of VOP trains, respectively. In AVNRT patients, tachycardia resetting occurred after the TZ and correctly diagnosed AVNRT based on atrial timing perturbation and fixed SA in 93% and 94% of VOP trains, respectively. Resetting criteria used during the VOP TZ accurately differentiate between ORT and AVNRT despite interobserver disagreement concerning identification of the TZ. Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  5. Atrial Fibrillation with Rapid Ventricular Response following use of Dietary Supplement Containing 1,3 Dimethylamylamine and Caffeine. (United States)

    Armstrong, Michael


    Our nation?s servicemembers commonly use dietary supplements to enhance their performance. Despite this prolific use, many of these products have detrimental side-effects that compromise servicemembers? health and could, by proxy, compromise a mission. This paper presents the case of a 32-year old Navy Special Operations Forces (SOF) Sailor who, prior to physical training, used a supplement containing 1,3 Dimethylamylamine (DMAA), and then developed atrial fibrillation with rapid ventricular response. He required intravenous calcium channel blocker administration, followed by beta blockers, for rate control. As military providers, we routinely ask our patients about their use of supplements and while the regulation of these products is beyond the scope of practice for most of us, it is our duty to become better educated about the risks and benefits of these supplements. We must educate our patients and our commands on the potential harm that these supplements may pose. 2012.

  6. Narrow QRS Tachycardia with Alternate Wide QRS Beats: What is the Mechanism?

    Directory of Open Access Journals (Sweden)

    Kartikeya Bhargava


    Full Text Available A 44-year old lady underwent electrophysiology study for recurrent palpitations and documented narrow QRS regular tachycardia. The baseline ECG showed subtle preexcitation that was easily manifest on atrial pacing. The retrograde atrial activation sequence during ventricular pacing was eccentric suggesting retrograde conduction over the accessory pathway. A regular narrow QRS tachycardia with cycle length 280 ms was easily inducible on programmed atrial stimulation. The earliest ventricular activation during sinus rhythm & atrial pacing, and the retrograde atrial activation during ventricular pacing & tachycardia were diagnostic of left free wall accessory pathway and orthodromic atrioventricular reciprocating tachycardia (AVRT. During an episode of tachycardia, an ablation catheter was placed in the region of the lateral mitral annulus using retrograde trans-aortic approach. Once the ablation catheter was stabilized in that region, an interesting change in the AVRT was seen with appearance of wide QRS complexes of right bundle branch block (RBBB morphology and left axis deviation in the alternate beats (Figure 1. The atrial activation sequence during both narrow and wide QRS beats was same with earliest activation in the distal coronary sinus. What is the mechanism of the alternate wide QRS beats during the AVRT?

  7. Vernakalant hydrochloride for rapid conversion of atrial fibrillation - A phase 3, randomized, placebo-controlled trial

    DEFF Research Database (Denmark)

    Roy, D.; Pratt, C.M.; Torp-Pedersen, C.


    .6%; P complete atrioventricular block, and cardiogenic shock) occurred in 3 patients. Conclusion - Vernakalant......Background - The present study assessed the efficacy and safety of vernakalant hydrochloride ( RSD1235), a novel compound, for the conversion of atrial fibrillation ( AF). Methods and Results - Patients were randomized in a 2: 1 ratio to receive vernakalant or placebo and were stratified by AF...... was conversion of AF to sinus rhythm for at least 1 minute within 90 minutes of the start of drug infusion in the short-duration AF group. A total of 336 patients were randomized and received treatment (short duration, n = 220; long duration, n = 116). Of the 145 vernakalant patients, 75 (51.7%) in the short...

  8. Occurrence of atrioventricular block during supraventricular tachycardia: What is its possible mechanism?

    Directory of Open Access Journals (Sweden)

    Ho-Shun Cheng


    Full Text Available A female patient was admitted to our hospital for catheter ablation arising from paroxysmal supraventricular tachycardia (PSVT. In the laboratory, PSVT (the earliest retrograde atrial activation at the coronary sinus ostium with intermittent atrioventricular (AV block could be induced repeatedly. The tachycardia could be terminated during ventricular pacing without retrograde conduction to the atria. Therefore, orthodromic AV reciprocating tachycardia (AVRT and atrial tachycardia (AT could be ruled out and AV nodal re-entrant tachycardia (AVNRT was subsequently considered. Initial attempts using slow or intermediate AV nodal ablation failed to cure the tachycardia. We considered the possibility of orthodromic AV reciprocating tachycardia (AVRT with AV block occurring during the tachycardia. The tachycardia was successfully terminated during the ablation of the right posteroseptal pathway at the coronary sinus ostium. We hypothesized about the possible explanation that might help to clarify the phenomenon of AV block during SVT in order to provide some guidance to other clinicians confronted with similar patient challenges in the future.

  9. Rapid rest/stress regadenoson ungated perfusion CMR for detection of coronary artery disease in patients with atrial fibrillation. (United States)

    Bieging, Erik T; Haider, I; Adluru, G; Chang, L; Suksaranjit, P; Likhite, D; Shaaban, A; Jensen, L; Wilson, B D; McGann, C J; DiBella, E


    Cardiovascular magnetic resonance (CMR) perfusion has been established as a useful imaging modality for the detection of coronary artery disease (CAD). However, there are several limitations when applying standard, ECG-gated stress/rest perfusion CMR to patients with atrial fibrillation (AF). In this study we investigate an approach with no ECG gating and a rapid rest/stress perfusion protocol to determine its accuracy for detection of CAD in patients with AF. 26 patients with AF underwent a rapid rest/regadenoson stress CMR perfusion imaging protocol, and all patients had X-ray coronary angiography. An ungated radial myocardial perfusion sequence was used. Imaging protocol included: rest perfusion image acquisition, followed nearly immediately by administration of regadenoson to induce hyperemia, 60 s wait, and stress image acquisition. CMR perfusion images were interpreted by three blinded readers as normal or abnormal. Diagnostic accuracy was evaluated by comparison to X-ray angiography. 21 of the CMR rest/stress perfusion scans were negative, and 5 were positive by angiography criteria. Majority results of the ungated datasets from all of the readers showed a sensitivity, specificity and accuracy of 80, 100 and 96%, respectively, for detection of CAD. An ungated, rapid rest/stress regadenoson perfusion CMR protocol appears to be useful for the diagnosis of obstructive CAD in patients with AF.

  10. Mechanisms of atrial fibrillation termination by rapidly unbinding Na+ channel blockers: insights from mathematical models and experimental correlates. (United States)

    Comtois, Philippe; Sakabe, Masao; Vigmond, Edward J; Munoz, Mauricio; Texier, Anne; Shiroshita-Takeshita, Akiko; Nattel, Stanley


    Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is a problem of growing proportions. Recent studies have increased interest in fast-unbinding Na(+) channel blockers like vernakalant (RSD1235) and ranolazine for AF therapy, but the mechanism of efficacy is poorly understood. To study how fast-unbinding I(Na) blockers affect AF, we developed realistic mathematical models of state-dependent Na(+) channel block, using a lidocaine model as a prototype, and studied the effects on simulated cholinergic AF in two- and three-dimensional atrial substrates. We then compared the results with in vivo effects of lidocaine on vagotonic AF in dogs. Lidocaine action was modeled with the Hondeghem-Katzung modulated-receptor theory and maximum affinity for activated Na(+) channels. Lidocaine produced frequency-dependent Na(+) channel blocking and conduction slowing effects and terminated AF in both two- and three-dimensional models with concentration-dependent efficacy (maximum approximately 89% at 60 microM). AF termination was not related to increases in wavelength, which tended to decrease with the drug, but rather to decreased source Na(+) current in the face of large ACh-sensitive K(+) current-related sinks, leading to the destabilization of primary generator rotors and a great reduction in wavebreak, which caused primary rotor annihilations in the absence of secondary rotors to resume generator activity. Lidocaine also reduced the variability and maximum values of the dominant frequency distribution during AF. Qualitatively similar results were obtained in vivo for lidocaine effects on vagal AF in dogs, with an efficacy of 86% at 2 mg/kg iv, as well as with simulations using the guarded-receptor model of lidocaine action. These results provide new insights into the mechanisms by which rapidly unbinding class I antiarrhythmic agents, a class including several novel compounds of considerable promise, terminate AF.

  11. Comparison of two antitachycardia pacing modes in supraventricular tachycardia. (United States)

    Jung, W; Mletzko, R; Manz, M; Lüderitz, B


    The comparative efficacy of two different antitachycardia pacing techniques was evaluated in 22 consecutive patients who received the pacemaker Intertach with an atrial electrode for drug refractory, recurrent supraventricular tachycardia (SVT). The Intertach has two consecutive programmable primary and secondary termination modes. The termination programs investigated were adaptive autodecremental burst pacing and adaptive decremental scanning. Atrioventricular nodal reentrant tachycardia was present in 15 patients and atrioventricular reentrant tachycardia due to Wolff-Parkinson-White syndrome in seven patients. The prospective comparison was arranged in a randomized, cross-over study over a period of 12 months. To assess long-term efficacy, diagnostic data of the pacemakers were obtained in intervals of 3 months. In addition, noninvasive programmed stimulation was performed to compare the incidence of pacing-induced atrial fibrillation with both termination programs. During a follow-up of 12 months the overall success rate of autodecremental burst pacing and decremental scanning was 80% and 95%, respectively. Decremental scanning was more effective in 12 patients and less successful in two patients than autodecremental burst pacing. During noninvasive electrophysiological studies, pacing induced atrial fibrillation could be documented in three of ten patients (30%) using autodecremental burst pacing, compared to one of ten patients (10%) using decremental scanning. These data suggest that decremental scanning proved to be more successful in the long-term management of patients with recurrent SVT than autodecremental burst pacing. Furthermore, the occurrence of pacing-induced atrial fibrillation could be documented more frequently with autodecremental burst pacing compared to decremental scanning.

  12. Fetal tachycardia: a role for amiodarone as first- or second-line therapy? (United States)

    Pézard, Philippe Georges; Boussion, Françoise; Sentilhes, Loïc; Lépinard, Catherine; Couvreur, Marie-Hélène; Victor, Jacques; Geslin, Philippe; Descamps, Philippe


    Fetal tachycardias result in serious prenatal and postnatal morbidity and mortality. Intrauterine treatment can improve prognosis dramatically and the therapeutic protocol is well defined. Currently, amiodarone is used as third-line therapy and is reserved for refractory cases. Our aim was to review the management and outcome of fetal tachycardia, giving particular consideration to the efficacy and safety of amiodarone therapy. This was a retrospective study of 24 consecutive cases of sustained fetal tachycardia, treated mainly with digoxin and/or amiodarone administered by the transplacental route. The 24 fetal tachycardias comprised 16 supraventricular tachycardias with 1:1 atrioventricular conduction, seven atrial flutters and one ventricular tachycardia. Seven fetuses were hydropic and eight experienced less severe cardiac failure. Digoxin monotherapy converted 5/12 non-hydropic fetuses and 0/2 hydropic fetuses, with one intrauterine death. Amiodarone monotherapy converted 5/5 fetuses, including two hydropic fetuses: one ventricular tachycardia, two atrial flutters and two supraventricular tachycardias. When administered with digoxin, amiodarone converted all but two fetuses (7/9). No deaths were associated with amiodarone, but there was moderate morbidity, with six transient elevations of thyroid stimulating hormone at birth, two of which required short-term thyroid hormonal substitution therapy. Maternal oral amiodarone seems to be effective and relatively safe, even in hydropic fetuses. We suggest that this treatment could be used earlier than is currently advised.

  13. Idiopathic Paroxysmal Ventricular Tachycardia in Infants and Children (United States)

    Hernandez, Antonio; And Others


    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. [Electrophysiological findings and ablation strategies in patients with atrial tachyarrhythmias after left atrial circumferential ablation in the treatment of atrial fibrillation]. (United States)

    Chen, Ming-long; Yang, Bing; Xu, Dong-jie; Zou, Jian-gang; Shan, Qi-jun; Chen, Chun; Chen, Hong-wu; Li, Wen-qi; Cao, Ke-jiang


    To report the electrophysiological findings and the ablation strategies in patients with atrial tachyarrhythmias (ATAs) or atrial fibrillation (AF) recurrence after left atrial circumferential ablation (LACA) in the treatment of AF. 91 patients with AF had LACA procedure from April 2004 to May 2006, 19 of which accepted the second ablation procedure due to ATAs or AF recurrence. In all the 19 patients [17 male, 2 female, age 25 - 65 (53 +/- 12) years], 11 presented with paroxysmal AF before the first ablation procedure, 2 with persistent AF and 6 with permanent AF. Pulmonary vein potentials (PVP) were investigated in both sides in all the patients. Delayed PVP was identified inside the left circular line in 5 patients, in the right in 1 and both in 2 during sinus rhythm. "Gap" conduction was found and successfully closed guided by circular mapping catheter. In 3 cases, irregular left atrial tachycardia was caused by fibrillation rhythm inside the left ring via decremental "gap" conduction. Reisolation was done successfully again guided by 3-D mapping and made the left atrium in sinus rhythm but the fibrillation rhythm was still inside the left ring. Pulmonary vein tachycardia with 1:1 conduction to the left atrium presented in one case and reisolation stopped the tachycardia. No PVP was discovered in both sides in 4 patients but other tachycardias could be induced, including two right atrial scar related tachycardias, two supraventricular tachycardias mediated by concealed accessory pathway, one cavo-tricuspid isthmus dependent atrial flutter and one focal atrial tachycardia near the coronary sinus ostium. All the tachycardias in these 4 patients were successfully ablated with the help of routine and 3-D mapping techniques. In the rest 3, which were in AF rhythm, LACA was successfully done again. After a mean follow-up of 4 - 26 (11.5 +/- 8.5) months, 16 patients were symptom free without anti-arrhythmic drug therapy; 1 of them had frequent palpitation attack with

  15. Tachycardia-induced Cardiomyopathy (Tachycardiomyopathy ...

    African Journals Online (AJOL)

    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 ...

  16. Idiopathic Fascicular Left Ventricular Tachycardia. (United States)

    Alahmad, Yaser; Asaad, Nidal Ahmad; Arafa, Salaheddin Omran; Ahmad Khan, Shahul Hameed; Mahmoud, Alsayed


    Idiopathic left fascicular ventricular tachycardia (ILFVT) is characterized by right bundle branch block morphology and left axis deviation. We report a case of idiopathic left ventricular fascicular tachycardia in a young 31-year-old male patient presenting with a narrow complex tachycardia.

  17. Idiopathic Fascicular Left Ventricular Tachycardia


    Alahmad, Yaser; Asaad, Nidal Ahmad; Arafa, Salaheddin Omran; Ahmad Khan, Shahul Hameed; Mahmoud, Alsayed


    Idiopathic left fascicular ventricular tachycardia (ILFVT) is characterized by right bundle branch block morphology and left axis deviation. We report a case of idiopathic left ventricular fascicular tachycardia in a young 31-year-old male patient presenting with a narrow complex tachycardia.

  18. Postural orthostatic tachycardia syndrome


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


    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.

  19. Atrial Fibrillation and Stroke (United States)

    ... faulty heart valves, lung disease, and stimulant or alcohol abuse. Some people will have no identifiable cause for their AF. × Definition Atrial fibrillation (AF) describes the rapid, irregular beating ...

  20. Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease. (United States)

    Labombarda, Fabien; Hamilton, Robert; Shohoudi, Azadeh; Aboulhosn, Jamil; Broberg, Craig S; Chaix, Marie A; Cohen, Scott; Cook, Stephen; Dore, Annie; Fernandes, Susan M; Fournier, Anne; Kay, Joseph; Macle, Laurent; Mondésert, Blandine; Mongeon, François-Pierre; Opotowsky, Alexander R; Proietti, Anna; Rivard, Lena; Ting, Jennifer; Thibault, Bernard; Zaidi, Ali; Khairy, Paul


    Atrial arrhythmias are the most common complication encountered in the growing and aging population with congenital heart disease. This study sought to assess the types and patterns of atrial arrhythmias, associated factors, and age-related trends. A multicenter cohort study enrolled 482 patients with congenital heart disease and atrial arrhythmias, age 32.0 ± 18.0 years, 45.2% female, from 12 North American centers. Qualifying arrhythmias were classified by a blinded adjudicating committee. The most common presenting arrhythmia was intra-atrial re-entrant tachycardia (IART) (61.6%), followed by atrial fibrillation (28.8%), and focal atrial tachycardia (9.5%). The proportion of arrhythmias due to IART increased with congenital heart disease complexity from 47.2% to 62.1% to 67.0% in patients with simple, moderate, and complex defects, respectively (p = 0.0013). Atrial fibrillation increased with age to surpass IART as the most common arrhythmia in those ≥50 years of age (51.2% vs. 44.2%; p heart disease, with a predominantly paroxysmal pattern. However, atrial fibrillation increases in prevalence and atrial arrhythmias progressively become permanent as the population ages. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Scott D. N. Else


    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.

  2. Effect of SERCA2a overexpression in the pericardium mediated by the AAV1 gene transfer on rapid atrial pacing in rabbits. (United States)

    Kuken, B N; Aikemu, A N W E; Xiang, S Y; Wulasihan, M H Y T


    To study the effects of overexpression of the sarcoplasmic reticulum ATPase 2a (SERCA2a) gene on the activity and protein expression of SERCA2a after rapid atrial pacing (RAP) in New Zealand white rabbits. New Zealand white rabbits were randomly divided into a sham-operated group (group A), adeno-associated virus 1 (AAV1)/EGFP + atrial fibrillation (AF) model group (group B), or AVV1/SERCA2a + AF group (group C). The sham-operated group was used as a negative control. Each group consisted of 10 animals. Groups B and C were injected with 500 μL of the AAV1-EGFP reporter gene and 500 μL of the AAV1-SERCA2a target gene, respectively. Four weeks after AAV1-mediated gene transfer, the rabbits underwent 24 h of RAP to the right atrium. The animals were sacrificed and protein activity and protein expression in the myocardium were measured using the westernblot method. Four weeks after AAV1-mediated gene transfer, SERCA2a protein activity and expression were significantly higher in Group C than in Groups A and B (P < 0.05). RAP of the right atrium induced atrial fibrillation in rabbits, resulting in decreases in the activity and protein expression of SERCA2a. Pericardial AAV-1 mediated SERCA2a gene transfer resulted in the overexpression of SERCA2a, restoring SERCA2a activity and protein expression.

  3. Management of cardiomyopathy resulting from incessant supraventricular tachycardia in infants and children. (United States)

    Juneja, R; Shah, S; Naik, N; Kothari, S S; Saxena, A; Talwar, K K


    Radiofrequency ablation is considered to be the treatment of choice in patients with ventricular dysfunction related to incessant supraventricular tachycardia. However, reservations regarding its use in infants and children prompted us to try alternative strategies for this group. Eight children (age range: 1 day to 10 years) were diagnosed to have tachycardia-related ventricular dysfunction in the past 6 years. They presented with symptoms of palpitation, dyspnea and/or generalized swelling over the body of 3 months to 2 years'duration. The cardiothoracic ratio at presentation was 64% (52%-70%) and ejection fraction was 22.2% (15%-45%). In 7 patients tachycardia was diagnosed to be ectopic atrial and in 1 it was permanent junctional reciprocating tachycardia. Six of these children were managed with intravenous/oral amiodarone in combination with digoxin (3) and/or propranolol (2). In one child addition of amiodarone to digoxin and propranolol led to polymorphic ventricular tachycardia, and amiodarone was withdrawn. Only one child underwent radiofrequency ablation as the first choice because regular follow-up was not possible due to logistic reasons. Sinus rhythm with normalization of ventricular function was achieved in 6 of the 7 children treated medically. One child continued to have frequent episodes of tachycardia and underwent successful radiofrequency ablation of a high right atrial ectopic focus. Two out of the 6 patients on amiodarone could be managed with only digoxin and propranolol after their ventricular function had returned to normal. A third patient relapsed on stopping amiodarone and underwent successful radiofrequency ablation of a left atrial ectopic tachycardia. Short-term amiodarone in combination with digoxin/propranolol is a safe and effective treatment strategy for infants/children with tachycardiomyopathy. Control of tachycardia is achieved in the majority, leading to recovery of ventricular function. This approach may avoid unnecessary

  4. [Supraventricular reentry tachycardia and athletic fitness]. (United States)

    Furlanello, F; Bertoldi, A; Bettini, R; Vergara, G; Dallago, M


    Paroxysmal supraventricular reciprocating tachycardias (PSRT) which are due to a different type of reentry including the atrioventricular reentry circuit of Wolff-Parkinson-White (WPW) syndrome, may disturb the professional career of an athlete. Moreover even severe episodes of preexcited atrial fibrillation of WPW may occur. PSRT in athletes may present various clinical consequences: unimportant symptoms, or severe hemodynamic effects on the athletic performance particularly during sports activity at intrinsic high risk. The athletes are evaluated by clinical protocol which includes Holter monitoring ergometric test, echocardiography study, thyroid check and transesophageal electrophysiologic study at rest and during exercise. The arrhythmological study should be carefully performed in order to exclude an underlying heart disease, to study electrophysiological mechanisms and possible hemodynamic effect sports activity relate of the inducible and clinical tachyarrhythmias. Sometimes, these PSRT may disappear after interruption of athletic activity because of modifications of electrophysiological conditions related to the sports activity.

  5. [Atrial defibrillator]. (United States)

    Jung, W; Lüderitz, B


    AF by using R wave synchronous shocks and can store intracardiac electrograms (EGMs) for up to 2 minutes from the most recent 6 AF episodes. The device can be programmed into one of the following operating modes: fully automatic, patient activated, monitor mode, bradycardia pacing only, and off. As AF is not life-threatening, in the automatic mode the device is only intermittently active in detecting and treating AF, and this "sleep wake-up" cycle interval is programmable. The device employs extensive processing both for detection and R wave synchronization. In April 1996, the phase I Metrix multicenter clinical trial was started. As of May 1997, a total of 51 Metrix systems had been implanted as part of the phase I multicenter clinical trial. Preliminary data suggest that both defibrillation thresholds and electrograms are stable over time (implant to 3 months). Detection accuracy has been excellent (100% specificity, 92.3% sensitivity) and there have been no errors of R wave selection for synchronization. No proarrhythmias have resulted from over 3700 shocks delivered. The device is effective in electrically converting 96% of the spontaneous episodes of AF. In 27% of episodes several shocks were required because of early recurrence of AF. In 5 patients, the atrial defibrillator was removed: 2 infections, 1 cardiac tamponade, 1 permanent loss of telemetry, 1 patient required His-Bundle ablation because of frequent episodes of drug refractory AF with rapid ventricular response. Initial clinical experience under controlled conditions with the Metrix system suggests that the implantable atrial defibrillator may offer a therapeutic alternative for a subgroup of patients with drug refractory, symptomatic, long lasting, and infrequent episodes of AF. Further efforts must be undertaken to reduce the patient discomfort associated with internal atrial defibrillation in an attempt to make this new therapy acceptable to a larger patient population with AF. (ABSTRACT TRUNCATED)

  6. Entrainment to distinguish orthodromic reciprocating tachycardia from atrioventricular nodal reentry tachycardia in children. (United States)

    Kannankeril, Prince J; Bonney, William J; Dzurik, Matthew V; Fish, Frank A


    Studies in adults suggest that after entrainment from the right ventricle, a post-pacing interval (PPI) minus tachycardia cycle length (TCL), when corrected for atrioventricular node delay (cPPI-TCL), is useful to distinguish atrioventricular nodal reentry tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT), but this has not been evaluated in children. In 100 children undergoing catheter ablation, entrainment of ORT or AVNRT was performed from the right ventricular apex. The atrial-His (AH) interval was measured on the return cycle (post-AH) and during tachycardia just prior to pacing (pre-AH). The cPPI-TCL was calculated as (PPI-TCL) - (post-AH - pre-AH). In the first 50 children, the best cutoff was identified and then validated in the next 50 children. In the first 50 children, cPPI-TCL was longer in AVNRT compared with ORT (122 +/- 19 ms vs 63 +/- 23 ms, P cPPI-TCL exceeded 95 ms in all AVNRT patients, but was less than cPPI-TCL cPPI-TCL > 95 ms was 95% specific for AVNRT. There was even greater separation of cPPI-TCL values comparing AVNRT with ORT utilizing a septal accessory pathway. The cPPI-TCL is a useful technique to distinguish AVNRT from ORT in children. Our data suggest that in children a cPPI-TCL 95 ms is rarely observed in ORT. This technique is particularly useful to distinguish AVNRT from ORT utilizing a septal accessory pathway. (PACE 2010; 469-474).

  7. Catheter ablation of tachycardia arising from the pulmonary venous atrium after surgical repair of congenital heart disease. (United States)

    Moore, Jeremy P; Russell, Matthew; Mandapati, Ravi; Aboulhosn, Jamil A; Shannon, Kevin M


    Tachycardia arising from the pulmonary venous atrium (PVA) has not been adequately characterized in the setting of surgically repaired congenital heart disease (CHD). The purpose of this study was to determine the mechanisms, approach, and outcomes of catheter ablation of PVA tachycardia after CHD repair. The adult CHD procedural database was searched for consecutive ablation procedures over a 4-year period. Procedural characteristics of the population with tachycardia arising from the PVA were compared to those without PVA tachycardia. Groups were classified as (1) biventricular CHD, (2) single ventricle, or (3) d-transposition of the great arteries (DTGA)-baffle. Complete 3-dimensional mapping was possible for 113 of 124 sustained tachycardias during 81 procedures. Of these, 31 (19%) arose from the PVA, including 11 (15%) tachycardias in biventricular CHD, 8 (31%) in single ventricle, and 12 (80%) in DTGA-baffle procedures. Intra-atrial reentrant tachycardia was less frequently observed in the PVA vs the systemic venous atrium (SVA) (P = .012). Independent predictors of PVA tachycardia were absence of biventricular CHD (odds ratio 0.19, confidence interval 0.05-0.64, P = .010) and ipsilateral atrial surgery (odds ratio 15.7, confidence interval 4.8-59.9, P <.001). PVA procedure duration was greater than SVA-only procedures (median 5.3 hours vs 4.0 hours, P = .012), but acute success was similar (87% vs 82%, respectively, P = NS). PVA tachycardia is not unusual after surgical repair of CHD. Predictors include ipsilateral atrial surgery and absence of biventricular CHD. Such procedures involve increased complexity and unique tachycardia substrates but appear equally amenable to catheter ablation. Published by Elsevier Inc.

  8. Chemical cardioversion of recent-onset atrial fibrillation in the emergency department using vernakalant hydrochloride achieves safe and rapid restoration of sinus rhythm and facilitates same day discharge. (United States)

    Stoneman, P; Gilligan, P; Mahon, P; Sheahan, R


    Vernakalant hydrochloride is a rapid-acting antiarrhythmic drug licensed in the EU since 2010 for the conversion of recent-onset atrial fibrillation with proven efficacy and safety when compared with placebo and amiodarone in randomized clinical trials. The aim of our study was to determine the feasibility of same day discharge (following 2 h monitoring) from the emergency department after successful cardioversion using vernakalant hydrochloride. Patients with recent-onset atrial fibrillation treated in the emergency department of a large Dublin academic teaching hospital. Patients received a maximum of two weight based 10 min infusions of vernakalant. Hypotensive events (>30% initial blood pressure), arrhythmias, conversion rates, and time to conversion were recorded. Sinus rhythm was restored in 35 out of 42 patients (83%) in an average of 8.8 min (median 8 min), average CHA2DS2-VASc of 0.92, HAS-BLED of 0.21 and average symptoms duration of 12 h. There were no hypotensive or arrhythmogenic events. 41 out of 42 patients were discharged after 2 h of monitoring. Vernakalant hydrochloride has provided a quick, safe, and practical means of achieving rapid restoration of sinus rhythm in our ED population with stable recent-onset AF who would otherwise not have undergone routine electrically cardioversion and same day discharge.

  9. Treatment of supraventricular tachycardia in a horse. (United States)

    Whelchel, Dorothy D; Tennent-Brown, Brett S; Coleman, Amanda E; Rapoport, Gregg S; Blas-Machado, Uriel; Maisenbacher, Herbert W; Credille, Brenton C; Giguère, Steeve


    To describe the treatment of persistent supraventricular tachycardia (SVT) in a young horse in endurance training. A 6-year-old Arab gelding in endurance training presented for a dysrhythmia and decreased performance. SVT was diagnosed and conversion to a normal sinus rhythm was achieved following administration of a constant rate infusion of amiodarone. However, reversion to SVT occurred shortly after initiation of ridden exercise. A second attempt to convert the dysrhythmia with amiodarone failed, but normal sinus rhythm was achieved with transvenous electrical cardioversion (TVEC). Postmortem examination of the heart revealed extensive fibrous replacement of most of the left atrial myocardium; these changes likely provided the structural substrate for the dysrhythmia. The underlying cause of the fibrosis was not identified. SVT is a form of supraventricular tachyarrhythmia rarely diagnosed in the horse. A recent report has described sudden death of a horse following attempted conversion of SVT with oral flecainide acetate. In the present report, we describe short-term conversion of SVT in a horse using intravenous amiodarone with no significant adverse effects. When the dysrhythmia recurred, the animal was donated for teaching purposes and conversion was achieved with TVEC. Normal sinus rhythm persisted for 2 weeks until the horse was euthanized for postmortem evaluation of the heart. Intravenous amiodarone or TVEC could be considered as treatments for supraventricular tachyarrhyhmias other than atrial fibrillation in the horse. © Veterinary Emergency and Critical Care Society 2017.

  10. Tachycardia-induced Cardiomyopathy (Tachycardiomyopathy ...

    African Journals Online (AJOL)

    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 ...


    NARCIS (Netherlands)


    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

  12. Tachycardia-induced Cardiomyopathy (Tachycardiomyopathy

    Directory of Open Access Journals (Sweden)

    Hassan A. Mohamed


    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.

  13. Postoperative right atrial and pulmonary embolism after prolonged spinal surgery. (United States)

    Hsiao, H J; Yuan, H B; Lio, J T; Din, C K; Neu, S H; Lui, P W; Lee, T Y


    Perioperative pulmonary thromboembolism can proceed rapidly with grave prognosis, in which immediate or accurate diagnosis and management is not easy. According to the literatures, patients receiving spinal surgery are at relatively lower risk of developing thromboembolism. We would like to present a case of postoperative pulmonary thromboembolism which developed after a prolonged lumbar spinal surgery. Tachycardia and unstable hemodynamics were noted postoperatively. Pulmonary and right atrial thrombi were disclosed by transesophageal echocardiography. Although cardiotomy and thrombectomy were immediately performed, the patient finally died 3 days after the operation. The pathogenesis of venous thromboembolism (VTE) in the surgical patients, the risk factors which predispose a patient to VTE, diagnosis, and treatment as well as the prophylactic measures of VTE are herein reviewed and discussed.

  14. Ablation of Focal Right Upper Pulmonary Vein Tachycardia Using Retrograde Aortic Approach

    Directory of Open Access Journals (Sweden)

    Mehrdad Sheikhvatan


    Full Text Available The use of diagnostic and therapeutic methods for assessing pulmonary vein due to its status as a main source of ectopicbeats for the initiation of atrial dysrrythmias is strongly recommended. We report the case of a 13-year-old girl who wasadmitted to our hospital with the electrocardiogram manifestation of an ectopic atrial tachycardia. The focus of arrhythmia was inside the right upper pulmonary vein. The patient underwent successful ablation with a conventional electrophysiology catheter via the retrograde aortic approach. We showed that when the origin of atrial tachycardia is in the right upper pulmonary vein, it is possible to advance the catheter into this vein via the retrograde aortic approach and find the focus of arrhythmia. This case demonstrates that right upper pulmonary vein mapping is feasible through the retrograde aortic approach and it is also possible to ablate the arrhythmia using the same catheter and approach.

  15. A Simple Method to Differentiate Atrioventricular Node Reentrant Tachycardia from Orthodromic Reciprocating Tachycardia. (United States)

    He, Quan; Lei, Sen; Jia, Feng-Peng; Gao, Ling-Yun; W X Zhu, Dennis


    Discrimination between atrioventricular node reentry tachycardia (AVNRT) and orthodromic reciprocating tachycardia (ORT) during an electrophysiological study is sometimes challenging. This study aimed to investigate if the difference in the local VA (ventricle-atrium) interval during ventricular entrainment pacing and during tachycardia (DVA, defined as the shortest local VA interval of coronary sinus [CS] during entrainment minus the shortest local VA interval of CS during tachycardia) was different in patients with AVNRT and patients with ORT.Diagnoses of AVNRT or ORT through a concealed accessory pathway (AP) were made according to conventional electrophysiological criteria and ablation results. Entrainment by right ventricular (RV) pacing was performed in each patient before ablation and patients with successful entrainment were included in the study. The DVA was compared between patients with AVNRT and patients with ORT. The DVA in patients with AVNRT was significantly longer than that in patients with ORT (120 ± 20 versus 5.7 ± 9; P DVA was more than 48 ms. In each patient with ORT using a left free wall accessory pathway (AP), right free wall AP, and septal AP, the DVA was less than 20 ms.DVA was found to be a rapid, useful test in distinguishing patients with AVNRT from those with ORT.

  16. Oxygen therapy reduces postoperative tachycardia

    DEFF Research Database (Denmark)

    Stausholm, K; Kehlet, H; Rosenberg, J


    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....

  17. Right Atrial Diverticulosis and Early-onset Arrhythmia: Rare Cause of Incessant Neonatal Arrhythmia. (United States)

    Aggarwal, Neeraj; Joshi, Raja; Joshi, Reena K; Agarwal, Mridul


    Atrial flutter not responding to medications could be secondary to structural malformations of heart. A 5-year-old child with resistant arrhythmia, with onset in neonatal period. Multiple right atrial diverticuli were detected on CT angiography and cardiac catheterization. Patient reverted to sinus rhythm following surgical excision of diverticuli. In cases of intractable supraventricular tachycardia, structural anomalies of atrium should be suspected.

  18. Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation: a prospective multicentre cohort study (United States)

    Violi, Francesco; Pastori, Daniele; Perticone, Francesco; Hiatt, William R; Sciacqua, Angela; Basili, Stefania; Proietti, Marco; Corazza, Gino R; Lip, Gregory Y H; Pignatelli, Pasquale


    Objective To investigate the relationship between Ankle-Brachial Index (ABI) and renal function progression in patients with atrial fibrillation (AF). Design Observational prospective multicentre cohort study. Setting Atherothrombosis Center of I Clinica Medica of ‘Sapienza’ University of Rome; Department of Medical and Surgical Sciences of University Magna Græcia of Catanzaro; Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study. Participants 897 AF patients on treatment with vitamin K antagonists. Main outcome measures The relationship between basal ABI and renal function progression, assessed by the estimated Glomerular Filtration Rate (eGFR) calculated with the CKD-EPI formula at baseline and after 2 years of follow-up. The rapid decline in eGFR, defined as a decline in eGFR >5 mL/min/1.73 m2/year, and incident eGFR60 mL/min/1.73 m2, 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m2. ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m2 (HR 1.851, 95% CI 1.205 to 2.845, p=0.005). Conclusions In patients with AF, an ABI ≤0.90 is independently associated with a rapid decline in renal function and incident eGFR<60 mL/min/1.73 m2. ABI measurement may help identify patients with AF at risk of renal function deterioration. Trial registration number NCT01161251. PMID:25998039

  19. Use of the esophageal lead in the diagnosis of mechanisms of reciprocating supraventricular tachycardia. (United States)

    Gallagher, J J; Smith, W M; Kasell, J; Smith, W M; Grant, A O; Benson, D W


    Recent studies have emphasized the role of concealed accessory pathways in reciprocating supraventricular tachycardia. Diagnosis has generally required multicatheter electrophysiologic study. We recorded esophageal electrograms during study in 16 patients with reciprocating tachycardia due to reentry using an accessory atrioventricular pathway, and in 12 patients with reciprocating tachycardia due to reentry in the AV node. The interval from onset of ventricular depolarization to earliest atrial activation (V-AMIN), earliest atrial activity on the esophageal lead (V-AESO), and high right atrium (V-HRA) was measured. No patient with RT due to an accessory atrioventricular pathway had a V-AMIN or V-AESO less than 70 ms, or a V-HRA less than 95 ms. In contrast, 11 of 12 patients with reentry in the AV node had V-AESO intervals less than 70 ms. Esophageal recording during reciprocating tachycardia provides a simple screening procedure available to all practicing physicians to exclude the diagnosis of accessory atrioventricular pathways in the genesis of paroxysmal supraventricular tachycardia.

  20. Dual AV Nodal Nonreentrant Tachycardia Resulting in Inappropriate ICD Therapy in a Patient with Cardiac Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Ankur A. Karnik, MD


    Full Text Available Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT occurs due to concurrent antegrade conduction over fast and slow atrioventricular nodal pathways and is treated by slow pathway modification. We describe a unique case of a patient with cardiac sarcoidosis who received inappropriate ICD shocks for DAVNNT. Atrial and ventricular device electrograms satisfied both rate and V>A criteria for ventricular tachycardia. We postulate that alterations in refractoriness and conduction as is seen in cardiac sarcoidosis (CS may have contributed to occurrence of DAVNNT.

  1. Junctional ectopic tachycardia evolving into complete heart block

    NARCIS (Netherlands)

    Henneveld, H; Hutter, P; Bink-Boelkens, M; Sreeram, N


    Transition from congenital junctional ectopic tachycardia to complete AV block was observed in an 8 month old girl, over a 36 hour period, during initial hospital admission. Two years later she had evidence of a rapidly increasing left ventricular end diastolic diameter, associated with lowest heart

  2. Tachycardia-Induced Cardiomyopathy in a 12-Year-Old Child With Long QT Syndrome

    Directory of Open Access Journals (Sweden)



    Full Text Available Introduction Tachycardia-induced cardiomyopathy (TIC is a ventricular dysfunction secondary to chronic and persistent tachycardia that can regress partially or completely following heart rate normalization. Paroxysmal atrial tachycardia and permanent junctional reciprocating tachycardia are two types of frequent arrhythmias that can cause cardiomyopathy in children. Case Presentation A 12-year-old child with obesity (body mass index > 26.8 was admitted with fatigue, pallor and tachypnea to the clinic. He had palpitation for the past 24 hours. On the cardiac auscultation, holosystolic 2/6 murmur was heard in the apex as well as gallop rhythm. Electrocardiogram revealed heart rate of 150 - 160 bpm and negative P waves in II, III and AVF leads. The echocardiography revealed dilated cardiomyopathy with an ejection fraction of 30%. Conclusions Diagnosis of tachycardia-induced cardiomyopathy in children is important, since appropriate treatment improves the prognosis. Every child with recurrent and persistent palpitation with the first episode of congestive heart failure should be evaluated for tachycardia- induced cardiomyopathy.

  3. Rapid hemostasis at the femoral venous access site using a novel hemostatic pad containing kaolin after atrial fibrillation ablation. (United States)

    Sairaku, Akinori; Nakano, Yukiko; Oda, Noboru; Makita, Yuko; Kajihara, Kenta; Tokuyama, Takehito; Kihara, Yasuki


    Hemostasis at the femoral venous access site after atrial fibrillation (AF) ablation is often prolonged because of aggressive anticoagulation and the use of several large-sized sheaths. A newly developed hemostatic pad containing a natural mineral called kaolin causes blood to clot quickly. We evaluated the efficacy of this pad for hemostasis at the venous access site after AF ablation. Patients who were scheduled to undergo AF ablation were randomized to be treated with manual compression with (n = 59) or without kaolin-impregnated pads (n = 59) as hemostatic approaches at the femoral venous access site following sheath removal. Hemostasis time, rebleeding frequency, massive hematoma, device-related complications, and deep venous thrombosis (DVT) were compared between the two groups. Hemostasis time in the patients treated with kaolin-impregnated pads was significantly shorter than in those treated without (6.1 ± 2.3 vs. 14.5 ± 4.0 min; p pads was the only independent variable reducing hemostasis time (β = -0.78; p pads; p = 0.35). Only one patient had a massive groin hematoma, and no patient had device-related complications or DVT. Kaolin-impregnated hemostatic pads safely and effectively decreased hemostasis time for the femoral venous access site in patients undergoing AF ablation. However, whether its use allows earlier postprocedural ambulation is difficult to predict.

  4. Predictive value of various Doppler-derived parameters of atrial conduction time for successful atrial fibrillation ablation. (United States)

    Shanks, Miriam; Valtuille, Lucas; Choy, Jonathan B; Becher, Harald


    Various Doppler-derived parameters of left atrial electrical remodeling have been demonstrated to predict recurrence of atrial fibrillation (AF) after AF ablation. The aim of this study was to compare three Doppler-derived measures of atrial conduction time in patients undergoing AF ablation, and to investigate their predictive value for successful procedure. In 32 prospectively enrolled patients undergoing the first AF ablation, atrial conduction time was estimated by measuring the time delay between the onset of P-wave on the surface ECG to the peak of the a'-wave on the pulsed-wave Doppler and color-coded tissue Doppler imaging of the left atrial lateral wall, and to the peak of the A-wave on the pulsed-wave Doppler of the mitral inflow. There was a significant difference in the baseline atrial conduction time measured by different echocardiographic techniques. Most (88%) patients had normal or only mildly dilated left atrium. At 6 months, 12 patients (38%) had recurrent AF/atrial tachycardia. The duration of history of AF was the only predictor of AF/atrial tachycardia recurrence following the first AF ablation (P=0.024; OR 1.023, CI 1.003-1.044). A combination of normal left atrial volume and history of paroxysmal AF of ≤48 months was associated with the best outcome. Predictive value of the Doppler derived parameters of atrial conduction time may be reduced in the early stages of left atrial remodeling. Future studies may determine which echocardiographic parameter correlates best with the extent of left atrial remodeling and is most predictive of successful AF ablation.

  5. Atrial fibrillation

    African Journals Online (AJOL)


    Objective: Atrial fibrillation is the commonest chronic arrhythmia and the etiology is widely varied. The aim of this study was to determine the etiology, clinical characteristics and treatment offered to adult patients with atrial fibrillation managed in a referral hospital in Port Harcourt, southern Nigeria. Methods:A retrospective ...

  6. [Control of tachycardia with intravenous amiodarone in acute left heart failure]. (United States)

    Tomcsányi, J; Arabadzisz, H; Zsoldos, A; Marosi, A; Beck, K


    The treatment of atrial tachycardia in critically ill patients can be difficult. Nine cases were presented with atrial tachyarrhythmias (mean heart rate > 130 beats/min) and left heart failure. Congestive heart failure was diagnosed in 6 patients (ejection fraction heart failure in 3 patients (ejection infarction > 55%). The infusion of amiodarone (450 mg over 10 min and 0.5 mg/min after the bolus administration) was associated with a decrease in heart rate 31 beats/min and an increase in systolic blood pressure of 13 mm Hg after one hour. There was only one adverse effect secondary to amiodarone therapy. In this case the sinus rhythm converted within 24 hours but T-waves alternans and short running torsade de pointes ventricular tachycardia was observed and amiodarone therapy was discontinued.

  7. [Palpitations in competitive athletes. Risks from premature beats, nonsustained tachycardia and preexcitation]. (United States)

    Stühlinger, Markus; Hintringer, Florian; Berger, Thomas


    Cardiovascular screening tests to prevent sudden cardiac death in athletes are discussed controversially, but they should include diligent patient history and physical examination as well as registration of an ECG. If palpitations or tachycardias are described or if preexcitation, supraventricular or ventricular arrhythmias are documented, further risk stratification is mandatory. Specifically the origin and the complexity of the arrhythmia need to be analyzed and any form of structural cardiac pathologies has to be ruled out. Sinus tachycardia, supraventricular and ventricular premature beats, atrial fibrillation as well as supraventricular and ventricular tachycardia may serve as substrate for palpitations. Each of these arrhythmias is associated with a different amount of cardiac risk and can be evidence for certain forms of structural cardiac disease. Recommendations to limit physical activity and specific treatment options depend on the type of the arrhythmia and the presence and the nature of underlying cardiac disease.

  8. Catheter Ablation of Fascicular Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Hygriv B. Rao


    Full Text Available Fascicular ventricular tachycardia (VT is an idiopathic VT with right bundle branch block morphology and left-axis deviation occuring predominantly in young males. Fascicular tachycardia has been classified into three subtypes namely, left posterior fascicular VT, left anterior fascicular VT and upper septal fascicular VT. The mechanism of this tachycardia is believed to be localized reentry close to the fascicle of the left bundle branch. The reentrant circuit is composed of a verapamil sensitive zone, activated antegradely during tachycardia and the fast conduction Purkinje fibers activated retrogradely during tachycardia recorded as the pre Purkinje and the Purkinje potentials respectively. Catheter ablation is the preferred choice of therapy in patients with fascicular VT. Ablation is carried out during tachycardia, using conventional mapping techniques in majority of the patients, while three dimensional mapping and sinus rhythm ablation is reserved for patients with nonmappable tachycardia.

  9. New insights into the clinical signs of supraventricular tachycardia: The "sign of lace-tying". (United States)

    Blommaert, Dominique; Dormal, Fabien; Deceuninck, Olivier; Xhaet, Olivier; Ballant, Elisabeth; De Roy, Luc


    Supraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy. This prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the "sign of lace-tying" that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay. Our series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the "sign of lace-tying." Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT. Overall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the "sign of lace-tying" or body position change before SVT, implying a diagnosis of SVT. © 2017 Wiley Periodicals, Inc.

  10. Utility of 12-lead electrocardiogram for differentiating paroxysmal supraventricular tachycardias in dogs. (United States)

    Santilli, R A; Perego, M; Crosara, S; Gardini, F; Bellino, C; Moretti, P; Spadacini, G


    The 12-lead surface ECG is validated for differentiating supraventricular tachycardias (SVT) in humans. Despite the description of SVT in veterinary medicine, no studies have analyzed the electrocardiographic features of this type of arrhythmias in dogs. To describe the specific electrocardiographic criteria used to differentiate the most common SVT in dogs. Twenty-three dogs examined at Clinica Veterinaria Malpensa for SVT with the mechanism documented by electrophysiologic studies (EPS). Twelve-lead electrocardiographic variables obtained from 14 dogs with orthodromic atrioventricular reciprocating tachycardia (OAVRT) and 9 dogs with focal atrial tachycardia (FAT) were compared. Dogs with FAT had faster heart rates (278 +/- 62 versus 229 +/- 42 bpm; P= .049) and less QRS alternans (33 versus 86%; P= .022). P waves appeared during tachycardia in 22 dogs, with a superior axis in 100% of OAVRT and 22% of FAT (P < .001). OAVRT was characterized by a shorter RP interval (85.0 +/- 16.8 versus 157.1 +/- 37.3 ms; P < .001) and smaller RP/PR ratio (0.60 +/- 0.18 versus 1.45 +/- 0.52; P < .001). Repolarization anomalies were present in 64% of OAVRT and no FAT (P < .001). Multivariate analysis identified QRS alternans and a positive P wave in aVR during tachycardia as independent predictors of arrhythmia type. Electrocardiographic criteria used in people for differentiating SVT can also be applied in dogs.

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

    Directory of Open Access Journals (Sweden)

    Aburawi Elhadi H


    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.

  12. Follow-up of a modified catheter ablation of the atrioventricular junction in patients with atrial tachyarrhythmias. (United States)

    Hsia, C P; Chen, S A; Tsang, W P; Wang, D C; Ting, C T; Wang, S P; Kong, C W; Chiang, B N; Chang, M S


    In order to reduce cumulative energy, minimize barotrauma and infranodal injury, a modified catheter ablation technique was performed on seventeen patients. These patients had drug refractory atrial tachyarrhythmias (AT) consisting of thirteen with paroxysmal atrial fibrillation (PAf), three with sick sinus syndrome (SSS) with PAf, and one having SSS with rapid left atrial tachycardia. This technique, using the femoral approach, consisted of delivering a direct-current (DC) shock using a dual electrode configuration, to the ablation site adjacent the atrioventricular (AV) junction just before the disappearance of His deflection on the His bundle electrogram. After delivering 1-4 DV shock (mean 2.8) (cumulative energy 556 +/- 260 joules), 9 pts had first degree AV block (1st AVB) and 8 pts had complete AV block (CAVB). Only two pts had a right bundle branch block after ablation. During the clinical follow-up (15.4 +/- 2.7 months), sixteen pts were asymptomatic and were free of antiarrhythmic drugs. One pt was asymptomatic with quinidine which was ineffective before ablation. Pacemaker implantation was performed in 10 pts as a back-up for symptomatic SSS and CAVB. The results show this modified technique is relatively safe and effective.

  13. Atrial Fibrillation (United States)

    ... A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders ... heart's two upper chambers—called the atria (AY-tree-uh)—to fibrillate. The ... a difficult decision concerning surgery for patients with atrial fibrillation, the ...

  14. Fetal tachycardias: management and outcome of 127 consecutive cases (United States)

    Simpson, J; Sharland, G


    Objective—To review the management and outcome of fetal tachycardia, and to determine the problems encountered with various treatment protocols.
Study design—Retrospective analysis.
Subjects—127 consecutive fetuses with a tachycardia presenting between 1980 and 1996 to a single tertiary centre for fetal cardiology. The median gestational age at presentation was 32 weeks (range 18 to 42).
Results—105 fetuses had a supraventricular tachycardia and 22 had atrial flutter. Overall, 52 fetuses were hydropic and 75 non-hydropic. Prenatal control of the tachycardia was achieved in 83% of treated non-hydropic fetuses compared with 66% of the treated hydropic fetuses. Digoxin monotherapy converted most (62%) of the treated non-hydropic fetuses, and 96% survived through the neonatal period. First line drug treatment for hydropic fetuses was more diverse, including digoxin (n = 5), digoxin plus verapamil (n = 14), and flecainide (n = 27). The response rates to these drugs were 20%, 57%, and 59%, respectively, confirming that digoxin monotherapy is a poor choice for the hydropic fetus. Response to flecainide was faster than to the other drugs. Direct fetal treatment was used in four fetuses, of whom two survived. Overall, 73% (n = 38) of the hydropic fetuses survived. Postnatally, 4% of the non-hydropic group had ECG evidence of pre-excitation, compared with 16% of the hydropic group; 57% of non-hydropic fetuses were treated with long term antiarrhythmics compared with 79% of hydropic fetuses.
Conclusions—Non-hydropic fetuses with tachycardias have a very good prognosis with transplacental treatment. Most arrhythmias associated with fetal hydrops can be controlled with transplacental treatment, but the mortality in this group is 27%. At present, there is no ideal treatment protocol for these fetuses and a large prospective multicentre trial is required to optimise treatment of both hydropic and non-hydropic fetuses.

 Keywords: fetal

  15. [Wide QRS tachycardia preceded by pacemaker spikes]. (United States)

    Romero, M; Aranda, A; Gómez, F J; Jurado, A


    The differential diagnosis and therapeutic management of wide QRS tachycardia preceded by pacemaker spike is presented. The pacemaker-mediated tachycardia, tachycardia fibrillo-flutter in patients with pacemakers, and runaway pacemakers, have a similar surface electrocardiogram, but respond to different therapeutic measures. The tachycardia response to the application of a magnet over the pacemaker could help in the differential diagnosis, and in some cases will be therapeutic, as in the case of a tachycardia-mediated pacemaker. Although these conditions are diagnosed and treated in hospitals with catheterization laboratories using the application programmer over the pacemaker, patients presenting in primary care clinic and emergency forced us to make a diagnosis and treat the haemodynamically unstable patient prior to referral. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  16. Atrial tachyarrhythmia in adult congenital heart disease (United States)

    Karbassi, Arsha; Nair, Krishnakumar; Harris, Louise; Wald, Rachel M; Roche, S Lucy


    The adult congenital heart disease (ACHD) population continues to grow and most cardiologists, emergency room physicians and family doctors will intermittently come into contact with these patients. Oftentimes this may be in the setting of a presentation with atrial tachyarrhythmia; one of the commonest late complications of ACHD and problem with potentially serious implications. Providing appropriate initial care and ongoing management of atrial tachyarrhythmia in ACHD patients requires a degree of specialist knowledge and an awareness of certain key issues. In ACHD, atrial tachyarrhythmia is usually related to the abnormal anatomy of the underlying heart defect and often occurs as a result of surgical scar or a consequence of residual hemodynamic or electrical disturbances. Arrhythmias significantly increase mortality and morbidity in ACHD and are the most frequent reason for ACHD hospitalization. Intra-atrial reentrant tachycardia and atrial fibrillation are the most prevalent type of arrhythmia in this patient group. In hemodynamically unstable patients, urgent cardioversion is required. Acute management of the stable patient includes anticoagulation, rate control, and electrical or pharmacological cardioversion. In ACHD, rhythm control is the preferred management strategy and can often be achieved. However, in the long-term, medication side-effects can prove problematic. Electrophysiology studies and catheter ablation are important treatments modalities and in certain cases, surgical or percutaneous treatment of the underlying cardiac defect has a role. ACHD patients, especially those with complex CHD, are at increased risk of thromboembolic events and anticoagulation is usually required. Female ACHD patients of child bearing age may wish to pursue pregnancies. The risk of atrial arrhythmias is increased during pregnancy and management of atrial tachyarrhythmia during pregnancy needs specific consideration. PMID:28706585

  17. 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


    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.

  18. Anteroseptal basal right ventricular entrainment is simple and superior to apical entrainment in identifying mechanism of supraventricular tachycardia. (United States)

    Abdelwahab, Amir M; Yahya, Dhaifallah Y; Eweis, Essam B; El Ramly, Mohamed Z


    Differentiation between atrioventricular nodal reentry tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) can be sometimes challenging. Apical right ventricular (RV) entrainment can help in differentiation; however, it has some fallacies. We thought to compare the accuracy of anteroseptal basal RV entrainment to RV apical entrainment in identifying the mechanism of supraventricular tachycardia (SVT). Forty-two consecutive patients with SVT who underwent catheter ablation were prospectively studied. Apical RV entrainment was performed initially followed by basal entrainment from the anteroseptal basal RV avoiding His or atrial capture. Postpacing interval (PPI), PPI-tachycardia cycle length (TCL), corrected PPI-TCL, and stimulus-atrial minus ventricular-atrial (VA) intervals were measured. Entrainment was achieved from both sites of RV in 34 patients (ten men; mean age 42 ± 15 years), 20 with typical AVNRT, 1 with atypical AVNRT, and 13 with AVRT (eight left sided, four right sided, and one septal accessory pathways). PPI-TCL, corrected PPI (cPPI)-TCL, and stimulus-atrial-VA intervals were significantly longer with basal entrainment in AVNRT (171 ± 30 vs. 153 ± 22 ms (p = 0.003), 148 ± 21 vs. 131 ± 20 ms (p = 0.002), and 145 ± 17 vs. 136 ± 15 ms (p = 0.005), respectively). Receiver-operating characteristic curves showed higher AUC for the above parameters with basal entrainment compared to apical entrainment. Cutoff values of basal PPI-TCL of >110 ms and cPPI-TCL of >95 ms had better sensitivities (100 % for both vs. 95 and 90 %, respectively, for apical values) and specificities (85 and 92 % vs. 77 and 92 %, respectively) for diagnosis of AVNRT. Basal RV entrainment from the anteroseptal basal RV is a simple maneuver that is superior to apical ventricular entrainment in identifying the mechanism of SVT.

  19. Troponin elevation in patients with various tachycardias and normal epicardial coronaries

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    Yousuf Kanjwal


    Full Text Available Troponin elevation is usually synonymous with acute coronary syndrome (ACS. Although sensitive for ACS, the elevation of serum troponin, in the absence of clinical evidence of ischemia, should prompt a search for other etiologies of myocardial necrosis. In fact, elevated values of troponin are correlated with myocardial necrosis even though it does not discriminate the mechanism involved. We report a series of seven patients (age range 18-67 years, who presented with complaints of chest discomfort and were found to have regular supraventricular tachycardia (5 patients and one patient each with atrial fibrillation and ventricular tachycardia. All these patients had elevated troponin I and underwent coronary angiography that revealed normal epicardial coronary arteries. This is first case series in which all patients underwent coronary angiography and none of the patients was hemodynamically unstable at the time of presentation. Patients with elevated troponin due to conditions other than ACS can receive inappropriate and delayed definitive diagnosis and treatment.

  20. Supraventricular tachycardia--part I. (United States)

    Lee, Ken W; Badhwar, Nitish; Scheinman, Melvin M


    Supraventricular tachycardias (SVTs) affect all age groups and are a source of significant morbidity. They are frequently encountered in otherwise healthy individuals without structural heart disease. Advances in the understanding of their mechanisms and anatomical locations have led to highly effective pharmacologic and nonpharmacologic treatment strategies. Recognition, identification, and differentiation of the various SVTs are of great importance in formulating an effective treatment strategy. Developments over the past four decades have made possible the accurate diagnosis of SVTs. Today, advances in catheter design, energy delivery systems, mapping systems, and remote navigation systems have rendered the ablation of most SVTs safe and effective. This monograph provides an in-depth discussion of the history, presentation, mechanism, and treatment strategies of the most commonly encountered SVTs. The monograph is divided into two parts. The first part is presented here.

  1. Confounders of vasovagal syncope: postural tachycardia syndrome. (United States)

    Nwazue, Victor C; Raj, Satish R


    Most patients who present to a cardiologist with syncope have vasovagal (reflex) syncope. A busy syncope practice often also sees patients with postural tachycardia syndrome, often presenting with severe recurrent presyncope. Recognition of this syncope confounder might be difficult without adequate knowledge of their presentation, and this can adversely affect optimal management. Postural tachycardia syndrome can often be differentiated from vasovagal syncope by its hemodynamic pattern during tilt table test and differing clinical characteristics. This article reviews the presentation of postural tachycardia syndrome and its putative pathophysiology and presents an approach to nonpharmacologic and pharmacologic management. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Epidemiology and definition of inappropriate sinus tachycardia. (United States)

    Pellegrini, Cara N; Scheinman, Melvin M


    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.

  3. Inappropriate Detection of a Supraventricular Tachycardia as Dual Tachycardia by the PR Logic™ Algorithm

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    Ajit Thachil, MD, DM, CCDS


    Full Text Available Tachycardia detection and therapy algorithms in Implantable Cardioverter-Defibrillators (ICD reduce, but do not eliminate inappropriate ICD shocks. Awareness of the pros and cons of a particular algorithm helps to predict its utility in specific situations. We report a case where PR logic™, an algorithm commonly used in currently implanted ICDs to differentiate supraventricular tachycardia (SVT from ventricular tachycardia resulted in inappropriate detection and shock for an SVT, and discuss several solutions to the problem.

  4. Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope. (United States)

    Raj, Satish; Sheldon, Robert


    Postural tachycardia syndrome (POTS), inappropriate sinus tachycardia (IST) and vasovagal syncope (VVS) are relatively common clinical syndromes that are seen by physicians in several disciplines. They are often not well recognised and are poorly understood by physicians, are associated with significant morbidity and cause significant frustration for both patients and their physicians. The 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope provides physicians with an introduction to these disorders and initial recommendations on their investigation and treatment. Here we summarise the consensus statement to help physicians in the management of patients with these frequently distressing problems.

  5. Early prenatal management of a fetal ventricular tachycardia treated in utero by amiodarone with long term follow-up. (United States)

    Schleich, J M; Bernard Du Haut Cilly, F; Laurent, M C; Almange, C


    Fetal cardiac arrhythmias are one of the causes of intra-uterine congestive heart failure and non-immune hydrops fetalis leading to fetal death. As ventricular tachycardia (VT) is rarely diagnosed in utero, it leads to emergency deliveries. We report a prenatal diagnosis of fetal tachycardia at 20 weeks of gestation associated with non-immune hydrops fetalis. The tachycardia seemed to be supraventricular and was initially treated by digoxin and sotalol. The hydrops increased and sotalol was stopped in order to give the mother a high dose of amiodarone by mouth over a long period. Although the tachycardia, which the ECG recorded at birth revealed to be of ventricular origin, persisted but at a lower rate, the new treatment proved successful. The child is three years old now and health, though with persistent VT. In conclusion, fetal tachycardia with similar ventricular and atrial rates can be a VT and the drug of choice in this case seems to be amiodarone. Copyright 2000 John Wiley & Sons, Ltd.

  6. Catecholaminergic Polymorphic Ventricular Tachycardia in Pregnancy. (United States)

    Romagano, Matthew P; Quiñones, Joanne N; Ahnert, Amy; Martinez, Rafael; Smulian, John C


    Catecholaminergic polymorphic ventricular tachycardia is a genetic disorder in which ventricular tachycardia occurs in the absence of structural heart disease or a prolonged QT interval. If untreated, there is a high incidence of sudden cardiac death. Management of this cardiac condition during pregnancy merits a multidisciplinary approach. A nulliparous woman with catecholaminergic polymorphic ventricular tachycardia presented at 15 weeks of gestation. Her care involved a multidisciplinary team including cardiology, maternal-fetal medicine, obstetric nursing, cardiac nursing, and anesthesia. A simulation scenario was designed to prepare for cardiac events during labor. A term intrapartum cesarean delivery was performed for fetal indications. A multidisciplinary approach to the antepartum, intrapartum, and postpartum care of women with catecholaminergic polymorphic ventricular tachycardia is critical to a team-based successful pregnancy outcome.

  7. A case with catecholaminergic polymorphic ventricular tachycardia

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    Ahmet Ünalır


    Full Text Available Catecholaminergic polymorphic ventricular tachycardia (CPVT is a rare type of polymorphic ventricular tachycardias in individuals without structural cardiac abnormalities. It typically has been induced by exercise or emotional stres. It generally is seen in childhood and adolescent period but rarely is seen in elderly. It usually ends by spontaneus, but rarely cause hemodynamic collapse. In here, we present a case with CPVT of successful treatment with a beta blocker therapy. J Clin Exp Invest 2011;2(2:232-4

  8. Cerebral oximetry during ventricular and supraventricular tachycardia


    Gräser, Saskia


    Background: Ventricular tachycardia (VT) and supraventricular tachycardia (SVT) affect the hemodynamic status of the patient. Standard monitoring in clinical practice includes measurement of peripheral arterial saturation (SaO2) and mean arterial pressure (MAP). However, these parameters only partly reflect the perfusion in different microvascular beds. Therefore, evaluation of microcirculation in end organs may be of clinical value, to prevent end organ damage during VT and SVT. Cerebral...

  9. Confounders of Vasovagal Syncope: Postural Tachycardia Syndrome


    Nwazue, Victor C.; Raj, Satish R.


    Most patients who present to a cardiologist with syncope will have vasovagal (reflex) syncope. A busy syncope practice will often also see patients with postural tachycardia syndrome, often presenting with severe recurrent presyncope. Recognition of this “syncope confounder” might be difficult without adequate knowledge of their presentation, and this can adversely affect optimal management. Patients with postural tachycardia syndrome exhibit an excessive increase in heart rate ≥ 30 bpm withi...

  10. Electrocardiografía clínica: Taquiarritmias supraventriculares de origen atrial

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    Abraham Katime Zúñiga


    Full Text Available  Resumen Las arritmias se pueden definir como “cualquier anormalidad en la frecuencia, regularidad o sitio de origen del impulso cardiaco o trastorno de la conducción que produce una alteración de la activación auricular o ventricular”; mientras que taquicardia se define como “frecuencia cardiaca en adultos, mayor de 100 latidos por minuto (lat/ min.”. Por tanto, las taquiarritmias supraventriculares son “aquellas taquicardias que requieren tejido atrial o de conducción atrioventricular para su iniciación y mantenimiento”. En este artículo se expondrán las características electrocardiográficas de aquellas provenientes del tejido auricular. (DUAZARY 2010, 117 - 124AbstractThe arrhythmias are defined as “any abnormality in the frequency, regularity, or site of origin of the cardiac impulse or conduction disorder that produces an alteration in the atrial or ventricular activation”; whereas tachycardia is defined as a “heart rate in adults greater than 100 beats per minute”. Therefore, supraventricular tachyarrhythmias are “those tachycardias who require atrial tissue or atrioventricular conduction for its initiation and maintenance”. This article explains the electrocardiographic characteristics of those arrhythmias from atrial tissue.Keywords: Tachyarrhythmia; Tachycardia; Atrial; Auricular; Fibrilation; Flutter; Sinusal; Electrocardiography.

  11. Development of ST Elevation Myocardial Infarction and Atrial Fibrillation after an Electrical Injury

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    Erdal Gursul


    Full Text Available Electrical energy is a type of energy that is commonly used in daily life. Ventricular premature beats, ventricular tachycardia, ventricular fibrillation, atrial tachycardia, atrial fibrillation, bundle branch blocks, and AV block are arrhythmic complications that are encountered in case of electric shocks. Myocardial infarction is one of the rarely seen complications of electric shocks yet it has fatal outcomes. Coronary arteries were detected to be normal in most of the patients who had myocardial infarction following an electric shock. So, etiology of myocardial infarction is thought to be unrelated to coronary atherosclerosis in these cases. Coronary artery vasospasm is thought to be the primary etiological cause. In our case report, we presented a patient who developed ST elevation MI with atrial fibrillation after an electric shock.

  12. An Approach to Catheter Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter

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    Mark D O’Neill


    Full Text Available Much of our understanding of the mechanisms of macro re-entrant atrial tachycardia comes from study of cavotricuspid isthmus (CTI dependent atrial flutter. In the majority of cases, the diagnosis can be made from simple analysis of the surface ECG. Endocardial mapping during tachycardia allows confirmation of the macro re-entrant circuit within the right atrium while, at the same time, permitting curative catheter ablation targeting the critical isthmus of tissue located between the tricuspid annulus and the inferior vena cava. The procedure is short, safe and by demonstration of an electrophysiological endpoint - bidirectional conduction block across the CTI - is associated with an excellent outcome following ablation. It is now fair to say that catheter ablation should be considered as a first line therapy for patients with documented CTI-dependent atrial flutter.

  13. Paroxysmal supraventricular tachycardia: physiopathology and management

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    Paola Neroni


    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

  14. Atrial Arrhythmias in Astronauts - Summary of a NASA Summit (United States)

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


    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

  15. Catheter ablation of epicardial ventricular tachycardia

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    Takumi Yamada, MD, PhD


    Full Text Available Ventricular tachycardias (VTs can usually be treated by endocardial catheter ablation. However, some VTs can arise from the epicardial surface, and their substrate can be altered only by epicardial catheter ablation. There are two approaches to epicardial catheter ablation: transvenous and transthoracic. The transvenous approach through the coronary venous system (CVS has been commonly used because it is easily accessible. However, this approach may be limited by the distribution of the CVS and insufficient radiofrequency energy delivery. Transthoracic epicardial catheter ablation has been developed to overcome these limitations of the transvenous approach. It is a useful supplemental or even preferred strategy to eliminate epicardial VTs in the electrophysiology laboratory. This technique has been applied for scar-related VTs secondary to often non-ischemic cardiomyopathy and sometimes ischemic cardiomyopathy, and idiopathic VTs as the epicardial substrates of these VTs have become increasingly recognized. When endocardial ablation and epicardial ablation through the CVS are unsuccessful, transthoracic epicardial ablation should be the next option. Intrapericardial access is usually obtained through a subxiphoidal pericardial puncture. This approach might not be possible in patients with pericardial adhesions caused by prior cardiac surgery or pericarditis. In such cases, a hybrid procedure involving surgical access with a subxiphoid pericardial window and a limited anterior or lateral thoracotomy might be a feasible and safe method of performing an epicardial catheter ablation in the electrophysiology laboratory. Potential complications associated with this technique include bleeding and collateral damage to the coronary arteries and phrenic nerve. Although the risk of these complications is low, electrophysiologists who attempt epicardial catheter ablation should know the complications associated with this technique, how to minimize their

  16. Rapid automatic segmentation of abnormal tissue in late gadolinium enhancement cardiovascular magnetic resonance images for improved management of long-standing persistent atrial fibrillation. (United States)

    Giannakidis, Archontis; Nyktari, Eva; Keegan, Jennifer; Pierce, Iain; Suman Horduna, Irina; Haldar, Shouvik; Pennell, Dudley J; Mohiaddin, Raad; Wong, Tom; Firmin, David N


    Atrial fibrillation (AF) is the most common heart rhythm disorder. In order for late Gd enhancement cardiovascular magnetic resonance (LGE CMR) to ameliorate the AF management, the ready availability of the accurate enhancement segmentation is required. However, the computer-aided segmentation of enhancement in LGE CMR of AF is still an open question. Additionally, the number of centres that have reported successful application of LGE CMR to guide clinical AF strategies remains low, while the debate on LGE CMR's diagnostic ability for AF still holds. The aim of this study is to propose a method that reliably distinguishes enhanced (abnormal) from non-enhanced (healthy) tissue within the left atrial wall of (pre-ablation and 3 months post-ablation) LGE CMR data-sets from long-standing persistent AF patients studied at our centre. Enhancement segmentation was achieved by employing thresholds benchmarked against the statistics of the whole left atrial blood-pool (LABP). The test-set cross-validation mechanism was applied to determine the input feature representation and algorithm that best predict enhancement threshold levels. Global normalized intensity threshold levels T PRE  = 1 1/4 and T POST  = 1 5/8 were found to segment enhancement in data-sets acquired pre-ablation and at 3 months post-ablation, respectively. The segmentation results were corroborated by using visual inspection of LGE CMR brightness levels and one endocardial bipolar voltage map. The measured extent of pre-ablation fibrosis fell within the normal range for the specific arrhythmia phenotype. 3D volume renderings of segmented post-ablation enhancement emulated the expected ablation lesion patterns. By comparing our technique with other related approaches that proposed different threshold levels (although they also relied on reference regions from within the LABP) for segmenting enhancement in LGE CMR data-sets of AF patients, we illustrated that the cut-off levels employed by other centres

  17. Fluid Replacement Monitoring: Effect of Dextran Overload, Norepinephrine Drip, and Positive Pressure Ventilation on Systemic Arterial, Right Atrial Pulmonary Wedge, and Left Atrial Pressures in Dogs (United States)

    Hardy, James D.; Garcia, Jose B.; Hardy, Julia A.; Harkins, Mitchell H.


    The effects of dextran overload, norepinephrine drip and positive pressure ventilation upon right atrial, pulmonary wedge, left atrial and systemic arterial pressures were studied in 15 dogs. Rapid intravenous infusion of Dextran 70 invariably produced a marked and statistically significant (p < .001) rise in right atrial, pulmonary wedge and left atrial pressures. The rise in left atrial pressure invariably exceeded the rise in right atrial pressure, and the difference in maximum pressures averaged 10.8 mm Hg (p < .001). Thus acute fluid overload and pulmonary edema can be produced by rapid infusion of colloid solution in the absence of a marked rise in right atrial pressure, a point of considerable clinical importance. The rapid infusion of dextran produced a rise in systemic arterial blood pressure in all dogs so studied, though this rise was mild in some animals. This finding may explain in part the hypertension exhibited by patients in the recovery room who may have been overtransfused. A norepinephrine drip usually produced an increase in right atrial, wedge, left atrial and systemic arterial blood pressure (p < .01). When there was a significant rise in right atrial pressure and left atrial pressure, the maximum increase in left atrial pressure was always greater than the maximum increase in right atrial pressure (p < .005). This finding again emphasizes the fact that blood transfusion requirements cannot always be accurately assessed on the basis of right and left atrial pressure measurements when a vasopressor agent is being administered. Positive pressure ventilation increased both right and left atrial pressures, as expected. It was again confirmed that pulmonary wedge pressure, as measured with the Swan-Ganz catheter, is approximately equal to left atrial pressure over a wide range of induced variations. The Swan-Ganz catheter, introduced at the bedside in the intensive care unit when necessary, can provide highly useful information regarding left

  18. Flecainide as first-line treatment for fetal supraventricular tachycardia. (United States)

    Ekiz, Ali; Kaya, Basak; Bornaun, Helen; Acar, Deniz Kanber; Avci, Muhittin Eftal; Bestel, Aysegul; Yildirim, Gokhan


    The aim of this study was to evaluate utilization, efficacy, and side effects of flecainide treatment as first-line agent in patients with fetal supraventricular tachycardia (SVT). This retrospective review was conducted on 23 consecutive fetal tachyarrhythmia cases that met inclusion criteria. If the treatment was necessary, then flecainide was used as first-line treatment in all cases. Among the study group, there were 21 (91.3%) cases of SVT and 2 (8.6%) cases of Atrial Flutter (AF). Sixteen fetuses had persistent SVT and five fetuses had intermittent SVT. We treated 17 fetuses with flecainide monotherapy and 15 of them converted to sinus rhythm and remaining two fetuses were refractory to monotherapy. The median time to conversion to sinus rhythm was 3.8 ± 1.6 days. Only one fetus (20%) among the intermittent SVT cases required anti-arrhythmic treatment. Our study has demonstrated that flecainide is an effective first-line treatment for fetal SVT with high success rate (88.2%), low side effect profile and relatively easy utilization. Based on the current study and recently published article results, flecainide can be recommended as the drug of first choice for treatment of fetal SVT cases.

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

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    Mesut Aydın


    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.

  20. Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance. (United States)

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


    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.

  1. Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope


    Raj, Satish; Sheldon, Robert


    Postural tachycardia syndrome (POTS), inappropriate sinus tachycardia (IST) and vasovagal syncope (VVS) are relatively common clinical syndromes that are seen by physicians in several disciplines. They are often not well recognised and are poorly understood by physicians, are associated with significant morbidity and cause significant frustration for both patients and their physicians. The 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycar...

  2. Hybrid ablation for atrial fibrillation: current approaches and future directions. (United States)

    Bisleri, Gianluigi; Glover, Benedict


    Catheter ablation of atrial fibrillation has rapidly evolved during the past decade: although the treatment of paroxysmal atrial fibrillation via a transcatheter approach has been consistently successful, persistent and long-standing atrial fibrillation still represents a major clinical challenge with less favorable outcomes to date. Because novel, minimally invasive surgical approaches have been developed for atrial fibrillation ablation, the aim of the present review is to analyze the current evidence surrounding the integration of surgical and transcatheter strategies in a hybrid fashion for the treatment of atrial fibrillation. Long-standing persistent, atrial fibrillation requires further understanding. Wide antral circumferential ablation of the pulmonary veins represents the cornerstone of any ablation therapy. Additional linear lesions and/or targeting complex fractionated atrial electrograms may also be considered. One of the limitations is achieving a transmural lesion. The combined endocardial and epicardial approach may represent a superior approach. Hybrid ablation of atrial fibrillation represents a novel therapeutic strategy for the treatment of complex scenarios, such as long-standing persistent atrial fibrillation. A specialized team including dedicated surgeons and cardiologists appears to be crucial in order to achieve durable and satisfactory outcomes following hybrid ablation of atrial fibrillation.

  3. A three-dimensional human atrial model with fiber orientation. Electrograms and arrhythmic activation patterns relationship.

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    Catalina Tobón

    Full Text Available The most common sustained cardiac arrhythmias in humans are atrial tachyarrhythmias, mainly atrial fibrillation. Areas of complex fractionated atrial electrograms and high dominant frequency have been proposed as critical regions for maintaining atrial fibrillation; however, there is a paucity of data on the relationship between the characteristics of electrograms and the propagation pattern underlying them. In this study, a realistic 3D computer model of the human atria has been developed to investigate this relationship. The model includes a realistic geometry with fiber orientation, anisotropic conductivity and electrophysiological heterogeneity. We simulated different tachyarrhythmic episodes applying both transient and continuous ectopic activity. Electrograms and their dominant frequency and organization index values were calculated over the entire atrial surface. Our simulations show electrograms with simple potentials, with little or no cycle length variations, narrow frequency peaks and high organization index values during stable and regular activity as the observed in atrial flutter, atrial tachycardia (except in areas of conduction block and in areas closer to ectopic activity during focal atrial fibrillation. By contrast, cycle length variations and polymorphic electrograms with single, double and fragmented potentials were observed in areas of irregular and unstable activity during atrial fibrillation episodes. Our results also show: (1 electrograms with potentials without negative deflection related to spiral or curved wavefronts that pass over the recording point and move away, (2 potentials with a much greater proportion of positive deflection than negative in areas of wave collisions, (3 double potentials related with wave fragmentations or blocking lines and (4 fragmented electrograms associated with pivot points. Our model is the first human atrial model with realistic fiber orientation used to investigate the relationship

  4. Alcohol consumption, sinus tachycardia, and cardiac arrhythmias at the Munich Octoberfest: results from the Munich Beer Related Electrocardiogram Workup Study (MunichBREW). (United States)

    Brunner, Stefan; Herbel, Rebecca; Drobesch, Cathrine; Peters, Annette; Massberg, Steffen; Kääb, Stefan; Sinner, Moritz F


    Alcohol is a risk factor for cardiac arrhythmias. Retrospective analyses suggest supraventricular arrhythmias consecutive to acute alcohol consumption, but prospective data are limited. We intended to prospectively associate acute alcohol consumption with cardiac arrhythmias. At the 2015 Munich Octoberfest, we enrolled 3028 voluntary participants who received a smartphone-based ECG and breath alcohol concentration (BAC) measurements. ECGs were analysed for cardiac arrhythmias (sinus tachycardia, sinus arrhythmia, premature atrial/ventricular complexes, atrial fibrillation/flutter) and respiratory sinus arrhythmia. By multivariable adjusted logistic regression we associated BACs with cardiac arrhythmias. Similarly, we analysed 4131 participants of the community-based KORA S4 Study (Co-operative Health Research in the Region of Augsburg) and associated cardiac arrhythmias with chronic alcohol consumption. In our acute alcohol cohort (mean age 34.4 ± 13.3 years, 29% women), mean BAC was 0.85 ± 0.54 g/kg. Cardiac arrhythmias occurred in 30.5% (sinus tachycardia 25.9%; other arrhythmia subtypes 5.4%). Breath alcohol concentration was significantly associated with cardiac arrhythmias overall (odds ratio (OR) per 1-unit change 1.75, 95% confidence interval (CI) 1.50-2.05; P cardiac arrhythmias and sinus tachycardia in particular. This partly reflects autonomic imbalance as assessed by significantly reduced respiratory sinus arrhythmia. Such imbalance might lead to sympathetically triggered atrial fibrillation resembling the holiday heart syndrome. NCT02550340.

  5. The retrograde P-wave theory: explaining ST segment depression in supraventricular tachycardia by retrograde AV node conduction. (United States)

    Rivera, Santiago; De La Paz Ricapito, Maria; Conde, Diego; Verdu, Mariano Badra; Roux, Jean François; Paredes, Félix Ayala


    Pseudo ischemic ST segment changes during supraventricular tachycardia (SVT) are not yet fully understood. Our aim was to determine whether venticulo-atrial (VA) conduction during SVT may be a possible mechanism for ST depression (STd) in SVT. Patients undergoing SVT ablation (2010-2012) were analyzed (n = 72).Typical atrioventricular node reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) were included. Those with STd were compared to those without STd. VA interval length, tachycardia cycle length (TCL), and retrograde P-wave activation during SVT were assessed. Retrograde P waves arriving simultaneously with the ST segment (PWST) during SVT were considered, whenever an atrial electrogram (measured from the high right atrium) was "on time" with the ST segment. Patients with STd during SVT presented longer VA intervals than those without STd (VA 100 ± 37 ms vs VA 69 ± 22 ms; P = 0.006). No differences in TCL were observed (TCL 333 ± 35 ms vs TCL 360 ± 22 ms; P = 0.1). PWST was observed in 38.5% of patients with AVNRT and STd versus 0% in those without STd. The TCL was similar in both groups (355 ± 25 ms vs 334 ± 18 ms; P = 0.1). In patients with AVRT and STd, PWST was present in 81% of cases versus 0% in those without STd. The TCL was also similar (330 ± 29 ms vs 346 ± 17 ms; P = 0.1). STd during SVT is observed at long VA intervals when the retrograde P wave matches the ST segment, without dependence on the TCL. This suggests that STd is not necessarily rate dependent but a result of a fusion between the ST segment and the P wave. ©2014 Wiley Periodicals, Inc.

  6. Pathophysiological and therapeutic implications in patients with atrial fibrillation and heart failure. (United States)

    Hohendanner, Felix; Heinzel, F R; Blaschke, F; Pieske, B M; Haverkamp, W; Boldt, H L; Parwani, A S


    Heart failure and atrial fibrillation are common and responsible for significant mortality of patients. Both share the same risk factors like hypertension, ischemic heart disease, diabetes, obesity, arteriosclerosis, and age. A variety of microscopic and macroscopic changes favor the genesis of atrial fibrillation in patients with preexisting heart failure, altered subcellular Ca(2+) homeostasis leading to increased cellular automaticity as well as concomitant fibrosis that are induced by pressure/volume overload and altered neurohumoral states. Atrial fibrillation itself promotes clinical deterioration of patients with preexisting heart failure as atrial contraction significantly contributes to ventricular filling. In addition, atrial fibrillation induced tachycardia can even further compromise ventricular function by inducing tachycardiomyopathy. Even though evidence has been provided that atrial functions significantly and independently of confounding ventricular pathologies, correlate with mortality of heart failure patients, rate and rhythm controls have been shown to be of equal effectiveness in improving mortality. Yet, it also has been shown that cohorts of patients with heart failure benefit from a rhythm control concept regarding symptom control and hospitalization. To date, amiodarone is the most feasible approach to restore sinus rhythm, yet its use is limited by its extensive side-effect profile. In addition, other therapies like catheter-based pulmonary vein isolation are of increasing importance. A wide range of heart failure-specific therapies are available with mixed impact on new onset or perpetuation of atrial fibrillation. This review highlights pathophysiological concepts and possible therapeutic approaches to treat patients with heart failure at risk for or with atrial fibrillation.


    Directory of Open Access Journals (Sweden)

    R. R. Mamatkazina


    Full Text Available The clinical case of a rare proarrhythmic effect of antiarrhythmic drugs with a poor prognosis (medication-induced atrial flutter in a patient with "malignant" Kent’s bundle is presented. Radiofrequency ablation (RFA is the most justified treatment method in patients with WPW-syndrome and "malignant" Kent’s bundle. RFA in descripted case has been postponed due to technical reasons. While waiting for RFA and after consideration of the potential risks and benefits the decision to use antiarrhythmic drugs to block the additional bundle was made. Paroxysm of broad-complex tachycardia developed on the third day of the treatment. It was regarded as a paroxysm of atrial fibrillation/flutter in the patient with WPW syndrome induced by taking antiarrhythmic drugs class 1C (allapinine. Review of the literature on the atrial fibrillation induced by antiarrhythmic of 1C class, and association of atrial fibrillation with WPW-syndrome is presented.


    Directory of Open Access Journals (Sweden)

    R. R. Mamatkazina


    Full Text Available The clinical case of a rare proarrhythmic effect of antiarrhythmic drugs with a poor prognosis (medication-induced atrial flutter in a patient with "malignant" Kent’s bundle is presented. Radiofrequency ablation (RFA is the most justified treatment method in patients with WPW-syndrome and "malignant" Kent’s bundle. RFA in descripted case has been postponed due to technical reasons. While waiting for RFA and after consideration of the potential risks and benefits the decision to use antiarrhythmic drugs to block the additional bundle was made. Paroxysm of broad-complex tachycardia developed on the third day of the treatment. It was regarded as a paroxysm of atrial fibrillation/flutter in the patient with WPW syndrome induced by taking antiarrhythmic drugs class 1C (allapinine. Review of the literature on the atrial fibrillation induced by antiarrhythmic of 1C class, and association of atrial fibrillation with WPW-syndrome is presented.

  9. 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


    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...... 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...

  10. Cardiomyopathy induced by incessant fascicular ventricular tachycardia. (United States)

    Velázquez-Rodríguez, Enrique; Rodríguez-Piña, Horacio; Pacheco-Bouthillier, Alex; Deras-Mejía, Luz María


    A 12-year-old girl with symptoms of fatigue, decreased exercise tolerance and progressive dyspnea (New York Heart Association functional class III) with a possible diagnosis of dilated cardiomyopathy secondary to viral myocarditis. Because of incessant wide QRS tachycardia refractory to antiarrhythmic drugs, she was referred for electrophysiological study. The diagnosis was idiopathic left ventricular tachycardia involving the posterior fascicle of the left bundle branch. After successful treatment with radiofrequency catheter ablation guided by a Purkinje potential radiological and echocardiographic evaluation showed complete reversal of left ventricular function in the first 3 months and no recurrence of arrhythmia during 2 years of follow up. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  11. Mechanism for Triggered Waves in Atrial Myocytes. (United States)

    Shiferaw, Yohannes; Aistrup, Gary L; Wasserstrom, J Andrew


    Excitation-contraction coupling in atrial cells is mediated by calcium (Ca) signaling between L-type Ca channels and Ryanodine receptors that occurs mainly at the cell boundary. This unique architecture dictates essential aspects of Ca signaling under both normal and diseased conditions. In this study we apply laser scanning confocal microscopy, along with an experimentally based computational model, to understand the Ca cycling dynamics of an atrial cell subjected to rapid pacing. Our main finding is that when an atrial cell is paced under Ca overload conditions, Ca waves can then nucleate on the cell boundary and propagate to the cell interior. These propagating Ca waves are referred to as "triggered waves" because they are initiated by L-type Ca channel openings during the action potential. These excitations are distinct from spontaneous Ca waves originating from random fluctuations of Ryanodine receptor channels, and which occur after much longer waiting times. Furthermore, we argue that the onset of these triggered waves is a highly nonlinear function of the sarcoplasmic reticulum Ca load. This strong nonlinearity leads to aperiodic response of Ca at rapid pacing rates that is caused by the complex interplay between paced Ca release and triggered waves. We argue further that this feature of atrial cells leads to dynamic instabilities that may underlie atrial arrhythmias. These studies will serve as a starting point to explore the nonlinear dynamics of atrial cells and will yield insights into the trigger and maintenance of atrial fibrillation. Copyright © 2017 Biophysical Society. Published by Elsevier Inc. All rights reserved.

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

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    Mansour Moghaddam


    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.

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


    Bockeria L. А.; Kulikov А. А.


    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 ...

  14. Nationwide experience of catecholaminergic polymorphic ventricular tachycardia caused by RyR2 mutations

    DEFF Research Database (Denmark)

    Broendberg, Anders Krogh; Nielsen, Jens Cosedis; Bjerre, Jesper


    to mutations in the ryanodine receptor-2 (RyR2) gene. METHODS: The study population was identified through the national hereditary heart disease database (Progeny). The study population was divided into three groups: probands, symptomatic and asymptomatic relatives. RESULTS: We identified 23 symptomatic...... probands, 18 symptomatic and 10 asymptomatic relatives with a RyR2 mutation. Twenty (87%) probands and 10 (36%) relatives had severe presenting symptoms (sudden cardiac death (SCD), aborted SCD (ASCD) or syncope).As compared with symptomatic relatives, probands had lower age at onset of symptoms (16 years...... of the 28 ICD treated patients (7%). No patients receiving treatment died during follow-up (57 months (IQR, 32-139)). Multifocal atrial tachycardia was the predominant symptom in five patients. CONCLUSIONS: In a national cohort of RyR2 mutation-positive CPVT patients, SCD, ASCD and syncope were presenting...

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

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    Tasso Julio Lobo


    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.

  16. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes (United States)

    Lobo, Tasso Julio; Pachon, Carlos Thiene; Pachon, Jose Carlos; Pachon, Enrique Indalecio; Pachon, Maria Zelia; Pachon, Juan Carlos; Santillana, Tomas Guillermo; Zerpa, Juan Carlos; Albornoz, Remy Nelson; Jatene, Adib Domingos


    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. PMID:25387404

  17. Clinical efficacy of antazoline in rapid cardioversion of paroxysmal atrial fibrillation -- a protocol of a single center, randomized, double-blind, placebo-controlled study (the AnPAF Study) (United States)


    Background Rapid conversion of atrial fibrillation (AF) to sinus rhythm may be achieved by the administration of class IA, IC and III antiarrhythmic drugs or vernakalant hydrochloride. However, that treatment may be related to potential pro-arrhythmia, lack of efficacy or the exceptionally high cost of a compound used. Antazoline is a first generation antihistaminic agent with chinidin-like properties. When administered intravenously, antazoline exerts a strong antiarrhythmic effect on supraventricular arrhythmia, especially on AF, facilitating rapid conversion to sinus rhythm. Despite a relative lack of published data antazoline has been marketed in Poland and widely used in cardiology wards and emergency rooms for many years due to its efficacy, safety and rapid onset of action within minutes of administration. Methods/design A randomized, double blind, placebo-controlled, superiority clinical trial was designed to assess clinical efficacy of antazoline in rapid conversion of AF to sinus rhythm. Eligible patients will present AF lasting less than 43 hours, will be in stable cardio-pulmonary condition and will have no prior history of advanced heart failure or significant valvular disease. Long-term antiarrhythmic therapy is not considered an exclusion criterion. Subjects who fulfill selection criteria will be randomly assigned to receive intravenously either antazoline or placebo in divided doses and observed for 1.5 hours after conversion to sinus rhythm or after the last i.v. bolus. Primary end point will be the conversion of AF to sinus rhythm confirmed in an electrocardiogram (ECG) during the observation period. Secondary end points will be comprised of time to conversion and return of AF during the observation period. Special consideration will be given to the observation of any adverse events. A sample size of 80 patients was calculated based on the following assumptions: two-tailed test, a type I error of 0.01, a power of 90%, efficacy of placebo 5

  18. Clinical efficacy of antazoline in rapid cardioversion of paroxysmal atrial fibrillation--a protocol of a single center, randomized, double-blind, placebo-controlled study (the AnPAF Study). (United States)

    Farkowski, Michal M; Maciag, Aleksander; Dabrowski, Rafal; Pytkowski, Mariusz; Kowalik, Ilona; Szwed, Hanna


    Rapid conversion of atrial fibrillation (AF) to sinus rhythm may be achieved by the administration of class IA, IC and III antiarrhythmic drugs or vernakalant hydrochloride. However, that treatment may be related to potential pro-arrhythmia, lack of efficacy or the exceptionally high cost of a compound used. Antazoline is a first generation antihistaminic agent with chinidin-like properties. When administered intravenously, antazoline exerts a strong antiarrhythmic effect on supraventricular arrhythmia, especially on AF, facilitating rapid conversion to sinus rhythm. Despite a relative lack of published data antazoline has been marketed in Poland and widely used in cardiology wards and emergency rooms for many years due to its efficacy, safety and rapid onset of action within minutes of administration. A randomized, double blind, placebo-controlled, superiority clinical trial was designed to assess clinical efficacy of antazoline in rapid conversion of AF to sinus rhythm. Eligible patients will present AF lasting less than 43 hours, will be in stable cardio-pulmonary condition and will have no prior history of advanced heart failure or significant valvular disease. Long-term antiarrhythmic therapy is not considered an exclusion criterion. Subjects who fulfill selection criteria will be randomly assigned to receive intravenously either antazoline or placebo in divided doses and observed for 1.5 hours after conversion to sinus rhythm or after the last i.v. bolus. Primary end point will be the conversion of AF to sinus rhythm confirmed in an electrocardiogram (ECG) during the observation period. Secondary end points will be comprised of time to conversion and return of AF during the observation period. Special consideration will be given to the observation of any adverse events. A sample size of 80 patients was calculated based on the following assumptions: two-tailed test, a type I error of 0.01, a power of 90%, efficacy of placebo 5%, efficacy of antazoline 50% and

  19. Clinical efficacy of antazoline in rapid cardioversion of paroxysmal atrial fibrillation -- a protocol of a single center, randomized, double-blind, placebo-controlled study (the AnPAF Study

    Directory of Open Access Journals (Sweden)

    Farkowski Michal M


    Full Text Available Abstract Background Rapid conversion of atrial fibrillation (AF to sinus rhythm may be achieved by the administration of class IA, IC and III antiarrhythmic drugs or vernakalant hydrochloride. However, that treatment may be related to potential pro-arrhythmia, lack of efficacy or the exceptionally high cost of a compound used. Antazoline is a first generation antihistaminic agent with chinidin-like properties. When administered intravenously, antazoline exerts a strong antiarrhythmic effect on supraventricular arrhythmia, especially on AF, facilitating rapid conversion to sinus rhythm. Despite a relative lack of published data antazoline has been marketed in Poland and widely used in cardiology wards and emergency rooms for many years due to its efficacy, safety and rapid onset of action within minutes of administration. Methods/design A randomized, double blind, placebo-controlled, superiority clinical trial was designed to assess clinical efficacy of antazoline in rapid conversion of AF to sinus rhythm. Eligible patients will present AF lasting less than 43 hours, will be in stable cardio-pulmonary condition and will have no prior history of advanced heart failure or significant valvular disease. Long-term antiarrhythmic therapy is not considered an exclusion criterion. Subjects who fulfill selection criteria will be randomly assigned to receive intravenously either antazoline or placebo in divided doses and observed for 1.5 hours after conversion to sinus rhythm or after the last i.v. bolus. Primary end point will be the conversion of AF to sinus rhythm confirmed in an electrocardiogram (ECG during the observation period. Secondary end points will be comprised of time to conversion and return of AF during the observation period. Special consideration will be given to the observation of any adverse events. A sample size of 80 patients was calculated based on the following assumptions: two-tailed test, a type I error of 0.01, a power of 90

  20. Pitx2 prevents susceptibility to atrial arrhythmias by inhibiting left-sided pacemaker specification. (United States)

    Wang, Jun; Klysik, Elzbieta; Sood, Subeena; Johnson, Randy L; Wehrens, Xander H T; Martin, James F


    Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, often coexists with the related arrhythmia atrial flutter (AFL). Limitations in effectiveness and safety of current therapies make an understanding of the molecular mechanism underlying AF more urgent. Genome-wide association studies implicated a region of human chromosome 4q25 in familial AF and AFL, approximately 150 kb distal to the Pitx2 homeobox gene, a developmental left-right asymmetry (LRA) gene. To investigate the significance of the 4q25 variants, we used mouse models to investigate Pitx2 in atrial arrhythmogenesis directly. When challenged by programmed stimulation, Pitx2(null+/-) adult mice had atrial arrhythmias, including AFL and atrial tachycardia, indicating that Pitx2 haploinsufficiency predisposes to atrial arrhythmias. Microarray and in situ studies indicated that Pitx2 suppresses sinoatrial node (SAN)-specific gene expression, including Shox2, in the left atrium of embryos and young adults. In vivo ChIP and transfection experiments indicated that Pitx2 directly bound Shox2 in vivo, supporting the notion that Pitx2 directly inhibits the SAN-specific genetic program in left atrium. Our findings implicate Pitx2 and Pitx2-mediated LRA-signaling pathways in prevention of atrial arrhythmias.

  1. [Treatment of ventricular tachycardia in infancy and childhood with amiodarone]. (United States)

    Batisse, A; Sardet, A; Fermont, L; Kachaner, J


    Ventricular tachycardia, especially in its apparently primary form, is rare in children and difficult to treat, often requiring aggressive methods of reduction or antiarrhythmic drugs unsuited for paediatric practice. Therefore, we investigated the use of amiodarone whose efficacity in the treatment of resistant ventricular tachycardia and good tolerance in children have been established. Three infants, aged from 9 to 15 months, and two children aged 6 and 7 years with apparently primary VT were selected. Etiological investigations were negative in four cases but in one of the older children a left ventricular fibroma was diagnosed and removed surgically. Amiodarone was administered orally at a dose of 500 mg/m2/24 hrs for 5 to 15 days, and then 250 mg/m2/24 hrs for one month in the surgical patient and for 9 to 39 months in the four "idiopathic" cases. Reduction of VT was obtained in all cases 8 to 48 hours after the first dose. There was only one recurrence, attributed to an over-rapid reducing in dosage; it quickly regressed after returning to the initial dosage. Stable sinus rhythm was maintained at long-term: 18 months, 2 years and 5 years after tailing off a course of 20, 40 and 1 month's treatment in 3 children. These cases are considered to be cured, but in one of these children two courses of amiodarone were required, the second for a relapse 3 months after stopping a 9 month's course of therapy. The other two children are still under treatment after 9 and 15 months with no recurrences. There were no hemodynamic, ocular or thyroid side effects. On the other hand, three cases of photosensitivity, two minor and one major requiring termination of therapy after a 20 months course, were observed. In conclusion, amiodarone would appear to be the treatment of choice for ventricular tachycardia in children, reduction of the arrhythmia being obtained in all cases even by oral administration within reasonable limits: its prophylactic value is excellent and clinical

  2. The use of flecainide in critical neonates and infants with incessant supraventricular tachycardias. (United States)

    Ergül, Yakup; Özyılmaz, İsa; Saygı, Murat; Tola, Hasan Tahsin; Akdeniz, Celal; Tuzcu, Volkan


    This study aimed to evaluate the efficacy of flecainide therapy in neonates and infants with drug resistant incessant supraventricular tachycardia. The study included 11 neonates and infants who received medical and/or ablation therapy between January 2010 and December 2013. Mean patient age and weight were 101.6 ± 96 days and 5.3 ± 1.9 kg respectively. Of the 12 patients, 5 underwent ablation between January 2010 and December 2011, and 6 were treated medically between January 2012 and December 2013. Mean follow-up time was 18 months (6 months-4 years). The antiarrhythmic agent flecainide only became available in Turkey in 2012, and the most noteworthy point was its addition to the therapy administered prior to ablation (adenosine, esmolol-propranolol, propafenone, amiodarone and cardioversion). In all 6 patients admitted between January 2012 and December 2013, refractory SVT was successfully treated with the administration of a triple therapy regimen of esmolol-propranolol, amiodarone and flecainide. One patient with myocarditis developed an atrial flutter complicated by a concealed accessory pathway and was put on extracorporeal membrane oxygenation (ECMO) support due to cardiopulmonary failure. The SVT was terminated, but the patient died on the fifteenth day of ECMO support. One patient with recurrent tachycardia, who had previously undergone ablation for a complex cardiac anomaly and Wolf-Parkinson-White syndrome, was treated with ablation again. No recurrence of tachycardia was observed in any of the other 9 patients. It appears that the use of propranolol-esmolol and amiodarone combined with flecainide in the medical treatment of drug-resistant SVT may reduce the need for ablation in critical neonates and infants.

  3. [Supraventricular tachycardia in newborns and its association with gastroesophageal reflux disease]. (United States)

    Fuertes, Ángeles; Alshweki, Ayham; Pérez-Muñuzuri, Alejandro; Couce, María-Luz


    Supraventricular tachycardia (SVT) is the most common arrhythmia in the neonatal period, but its association with other triggering processes is not well established. The aim of the study was to analyse the possible relationship between neonatal SVT and gastroesophageal reflux disease (GERD), a condition which was recently linked to atrial arrhythmias. A retrospective longitudinal descriptive study was conducted over a period of 5years on newborns who were diagnosed with SVT in a level III neonatal unit, assessing morphological aspects, associated symptoms, and treatments received. Its association with GERD and the impact of this on SVT was studied. Eighteen patients (1.2 per 1000 newborns) were diagnosed with SVT. Fifty percent of them were combined with clinically significant GERD (P=.01), and all of them received drug treatment. The average time of control of SVT without GERD since diagnosis was 6 days (95% CI: 2.16-9.84, with a median of 3) and 7.6 days when both pathologies were present (95% CI: 4.14-10.9, with a median of 7) (P=.024). Patients with SVT in the neonatal period frequently have GERD, and this combination leads to more difficulty in controlling the tachycardia. The reflux could act as a trigger or perpetuator of arrhythmia, therefore it is important to find and treat GERD in infants with SVT. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Atrial epicardial pacing with long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis. (United States)

    Kazmierczak, J; Kornacewicz-Jach, Z; Wojtarowicz, A


    Atrial epicardial pacing with a long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis is discussed. Arrhythmogenic right ventricular dysplasia (ARVD) is associated with a high incidence of malignant ventricular arrhythmias. Most patients with ARVD need antiarrhythmic drugs, catheter ablation, or an implantable cardioverter defibrillator. We report a patient with ARVD in whom effective treatment with sotalol caused severe, symptomatic sinus bradycardia requiring permanent pacing. Due to leftward displacement of the right ventricle and the presence of two thrombi in the right atrium, an epicardial atrial lead and AAI pacemaker were implanted. A long stimulus to P wave interval caused by severe dilatation of the right atrium was recorded. During a 6 months of follow-up on sotalol treatment there were neither ventricular tachycardia (VT) attacks nor pacing problems.

  5. Cetirizine-Induced atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Altuğ Osken


    Full Text Available Atrial fibrillation (AF is the most common observed arrhythmia in clinical practice. In the literature, AF events associated with drug induction are available. Cetirizine is a second-generation histamine antagonist used in the treatment of allergies, angioedema, and urticaria. We wish to present an atypical case who took cetirizine medication for relieving symptoms of upper tract respiratory system infection, experienced rapid ventricular response AF and treated successfully. To best of our knowledge, this is the first case of cetirizine-induced AF.

  6. Atrial Fibrillation and Hyperthyroidism

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    Jayaprasad N


    Full Text Available Atrial fibrillation occurs in 10 – 15% of patients with hyperthyroidism. Low serum thyrotropin concentration is an independent risk factor for atrial fibrillation. Thyroid hormone contributes to arrythmogenic activity by altering the electrophysiological characteristics of atrial myocytes by shortening the action potential duration, enhancing automaticity and triggered activity in the pulmonary vein cardio myocytes. Hyperthyroidism results in excess mortality from increased incidence of circulatory diseases and dysrhythmias. Incidence of cerebral embolism is more in hyperthyroid patients with atrial fibrillation, especially in the elderly and anti-coagulation is indicated in them. Treatment of hyperthyroidism results in conversion to sinus rhythm in up to two-third of patients. Beta-blockers reduce left ventricular hypertrophy and atrial and ventricular arrhythmias in patients with hyperthyroidism. Treatment of sub clinical hyperthyroidism is controversial. Optimizing dose of thyroxine treatment in those with replacement therapy and beta-blockers is useful in exogenous subclinical hyperthyroidism.

  7. Antiadrenergic autoimmunity in postural tachycardia syndrome. (United States)

    Fedorowski, Artur; Li, Hongliang; Yu, Xichun; Koelsch, Kristi A; Harris, Valerie M; Liles, Campbell; Murphy, Taylor A; Quadri, Syed M S; Scofield, Robert Hal; Sutton, Richard; Melander, Olle; Kem, David C


    Postural tachycardia syndrome (POTS), a common and debilitating cardiovascular disorder, is characterized by an exaggerated heart rate increase during orthostasis and a wide spectrum of adrenergic-related symptoms. To determine the aetiology of POTS, we examined a possible pathophysiological role for autoantibodies against α1-adrenergic (α1AR) and β1/2-adrenergic receptors (β1/2AR). Immunoglobulin G (IgG) derived from 17 POTS patients, 7 with recurrent vasovagal syncope (VVS), and 11 normal controls was analysed for its ability to modulate activity and ligand responsiveness of α1AR and β1/2AR in transfected cells and to alter contractility of isolated rat cremaster arterioles in vitro. Immunoglobulin G activation of α1AR and β1/2AR was significantly higher in POTS compared with VVS and controls in cell-based assays. Eight, 11, and 12 of the 17 POTS patients possessed autoantibodies that activated α1AR, β1AR and β2AR, respectively. Pharmacological blockade suppressed IgG-induced activation of α1AR and β1/2AR. Eight of 17 POTS IgG decreased the α1AR responsiveness to phenylephrine and 13 of 17 POTS IgG increased the β1AR responsiveness to isoproterenol irrespective of their ability to directly activate their receptors. Postural tachycardia syndrome IgG contracted rat cremaster arterioles, which was reversed by α1AR blockade. The upright heart rate correlated with IgG-mediated β1AR and α1AR activity but not with β2AR activity. These data confirm a strong relationship between adrenergic autoantibodies and POTS. They support the concept that allosteric-mediated shifts in the α1AR and β1AR responsiveness are important in the pathophysiology of postural tachycardia.

  8. [Atrial fibrillation and stroke]. (United States)

    Aamodt, Anne Hege; Sandset, Per Morten; Atar, Dan; Tveit, Arnljot; Russell, David


    More than 70,000 Norwegians have atrial fibrillation, which is a major risk factor for ischemic stroke. A large proportion of ischemic strokes caused by atrial fibrillation could be prevented if patients receive optimal prophylactic treatment. This article describes the risk for ischemic stroke in patients with atrial fibrillation, and discusses who should receive prophylactic treatment and which therapy provides the best prevention. The article is based on recently published European, American and Canadian guidelines, a search in PubMed and the authors' own clinical experience. The new risk score CHA2DS2-VASc is better than the CHADS2 score for identifying patients with atrial fibrillation who have a truly low risk of ischemic stroke and are not in need of antithrombotic treatment. Oral anticoagulation therapy is recommended for patients with two or more risk factors for thromboembolism in addition to atrial fibrillation (CHA2DS2-VASc ≥ 2). Patients with atrial fibrillation and a single additional risk factor (CHA2DS2-VASc =1) an individual assessment should be made as to who should receive oral anticoagulants, and for patients with CHA2DS2-VASc = 0 antithrombotic treatment is not recommended. New oral anticoagulants are at least as effective as warfarin for preventing ischemic stroke in patients with nonvalvular atrial fibrillation, they carry a lower risk of cerebral haemorrhage, especially intracranial haemorrhage and are more practical in use. Platelet inhibitors have a minimal role in stroke prevention in patients with atrial fibrillation. Risks stratifying patients using the CHA2DS2-VASc score is a better method for assessing which patients with atrial fibrillation who should receive oral anticoagulation. The introduction of new oral anticoagulants will simplify preventive treatment and hopefully lead to a more efficient anticoagulation treatment in a larger number of patients with atrial fibrillation.

  9. Pseudo ventricular tachycardia: a case report.

    LENUS (Irish Health Repository)

    Riaz, A


    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.

  10. Chronic ventricular pacing with ventriculo-atrial conduction versus atrial pacing in three patients with symptomatic sinus bradycardia. (United States)

    El Gamal, M I; Van Gelder, L M


    Three patients with symptomatic sinus bradycardia due to sick sinus syndrome were treated with permanent ventricular pacing for periods ranging from 2.5 to 4 years. All three patients had ventriculo-atrial conduction on routine electrocardiography. Although ventricular pacing was effective, they complained of fatigue, lightheadedness, and near syncope. Hemodynamic studies revealed the presence of regular cannon waves in the right atrium as well as in the pulmonary artery wedge pressure curves. Temporary atrial pacing resulted in disappearance of the cannon waves and a significant rise in cardiac output (32-48%). After normal atrio-ventricular conduction was confirmed by rapid atrial stimulation and His bundle electrocardiography, the pacing mode was changed to permanent atrial pacing on demand. The effort tolerance of the patients markedly improved, and the previously mentioned symptoms disappeared. Control hemodynamic studies 9 to 12 months after implantation of the atrial demand pacemaker showed that the improvement in cardiac performance was maintained.

  11. Newly created animal model of human postoperative junctional ectopic tachycardia. (United States)

    Moak, Jeffrey P; Mercader, Marco A; He, Dingchao; Kumar, T K Susheel; Trachiotis, Gregory; McCarter, Robert; Jonas, Richard A


    Junctional ectopic tachycardia complicates the postoperative recovery from open heart surgery in children. The reported risk factors include younger age, prolonged cardiopulmonary bypass times, and administration of inotropic agents. Junctional ectopic tachycardia occurs early after open heart surgery, in the setting of relative postoperative sinus node dysfunction, and exhibits QRS morphology consistent with an origin from the atrioventricular node or proximal conduction system. Our goal was to develop a reproducible animal model for postoperative junctional ectopic tachycardia. Eleven pigs, aged 2 to 4 months, underwent open heart surgery after induction of general anesthesia. Electrodes were sewn to the left atrium and right ventricle. Sinus node dysfunction was created using clamp crushing without or with radiofrequency ablation (successful in 1 of 5 pigs) or sinus node removal (successful in 4 of 4). After prolonged cardiopulmonary bypass (>120 minutes) alone and with isoproterenol infusion, no spontaneous junctional ectopic tachycardia developed. Junctional ectopic tachycardia or fascicular tachycardia could be initiated after either slow atrioventricular nodal pathway ablation and/or digoxin administration. Junctional ectopic tachycardia occurred in 8 of 9 pigs (mean ventricular rate, 171 ± 32 bpm), and fascicular tachycardia occurred in 9 of 9 pigs (mean ventricular rate, 187 ± 39 bpm). His and right bundle recordings confirmed the conduction system origin. Experimental junctional ectopic tachycardia or fascicular tachycardia can occur in the intraoperative setting of sinus node dysfunction, prolonged cardiopulmonary bypass, and enhanced conduction system automaticity. Conduction system automaticity occurred after either physical injury (ablation or tricuspid valve stretch) or measures to augment the transient inward current of the conduction system (isoproterenol and digoxin). This animal model can serve as the basis to assess new treatments of

  12. Electrophysiological Mechanisms of Atrial Flutter

    Directory of Open Access Journals (Sweden)

    Ching- Tai Tai


    Full Text Available Atrial flutter (AFL is a common arrhythmia in clinical practice. Several experimental models such as tricuspid regurgitation model, tricuspid ring model, sterile pericarditis model and atrial crush injury model have provided important information about reentrant circuit and can test the effect of antiarrhythmic drugs. Human atrial flutter has typical and atypical forms. Typical atrial flutter rotates around tricuspid annulus and uses the crista terminalis and sometimes sinus venosa as the boundary. The IVC-tricuspid isthmus is a slow conduction zone and the target of radiofrequency ablation. Atypical atrial flutter may arise from the right or left atrium. Right atrial flutter includes upper loop reentry, free wall reentry and figure of eight reentry. Left atrial flutter includes mitral annular atrial flutter, pulmonary vein-related atrial flutter and left septal atrial flutter. Radiofrequency ablation of the isthmus between the boundaries can eliminate these arrhythmias.

  13. Nonsustained Repetitive Upper Septal Idiopathic Fascicular Left Ventricular Tachycardia: Rare Type of VT


    Gokhan Aksan


    Upper septal fascicular ventricular tachycardia is a very rare form of idiopathic fascicular ventricular tachycardia. Upper septal fascicular tachycardia uses the posterior fascicle as the anterograde limb and the septal fascicle as the retrograde limb. When evaluating the electrocardiography for this form of tachycardia, the presence of narrow QRS morphology and normal axis may be misinterpreted as supraventricular tachycardia. Here, we report a very rare subtype of fascicular tachycardia th...

  14. Evaluation and Management of Neonatal Supraventricular Tachycardia

    Directory of Open Access Journals (Sweden)



    Full Text Available Background Supraventricular Tachycardia (SVT is the most frequent arrhythmia requiring a medical treatment in neonates. Objectives The aim of our study was to evaluate and manage neonatal supraventricular tachycardia. Methods This study was performed on 22 newborns that were diagnosed with SVT at two neonatal intensive care units (NICU in south west of Iran from October 2012 to October 2015. Data on gender, age, weight, maternal age, gestational age, presence of congenital heart disease, blood pressure in admission, duration of hospitalization period, duration of SVT, medicine for the control of SVT, list of medicine administered at releasing time were collected. Echocardiography was performed for all patients. Data was analyzed by the SPSS version 18 software. Results Twelve neonates were male (54.5% and ten (45.5% were female. The mean age was 11.68 ± 8.17 days. Three neonates (13.6% had congenital heart disease. The mean duration of hospitalization was 6.54 ± 3.98 days. Nine patients (41% only had responded adenosine. One patient had hypotensive that received D/C shock. Conclusions We concluded that in most SVT patients, conventional treatment can be helpful and an only minor percentage of patients need to receive flecainide as the last line of treatment.

  15. Postural tachycardia syndrome: time frequency mapping (United States)

    Novak, V.; Novak, P.; Opfer-Gehrking, T. L.; Low, P. A.


    Orthostatic tachycardia is common but its specificity remains uncertain. Our preliminary work suggested that using autonomic function testing in conjunction with time-frequency mapping (TFM), it might be possible to characterize a subset of the postural tachycardia syndrome (POTS), that is due to a restricted autonomic neuropathy. We describe 20 patients (17 women and 3 men, aged 14-43 years) with florid POTS and 20 controls (14 women and 6 men, aged 20-41 years). Autonomic failure was quantified by its distribution (cardiovagal, adrenergic and sudomotor) and severity, a symptom profile was generated, and spectral indices, based on modified Wigner distribution during rest and head-up tilt (80 degrees) were evaluated. During tilt-up POTS patients differed from controls by an excessive heart rate (> 130 bpm) (P tilt-up (P tilt-up and returned to normal levels afterwards. The index of sympatho-vagal balance (NONRF-Systolic BP (SBP)/RF-RRI) was dramatically increased in POTS (P < 0.001). Distal postganglionic sudomotor failure was observed, and impairment of the BP responses to the Valsalva maneuver (phase II) suggested peripheral adrenergic dysfunction. Persistent orthostatic dizziness, tiredness, gastrointestinal symptoms and palpitations were common in POTS patients. It is possible to identify a subset of POTS patients who have a length-dependent autonomic neuropathy, affecting the peripheral adrenergic and cardiovagal fibers, with relative preservation of cardiac adrenergic fibers.

  16. Postural orthostatic tachycardia syndrome: Anesthetic management in the obstetric patient

    Directory of Open Access Journals (Sweden)

    Youssef Motiaa


    Full Text Available Postural orthostatic tachycardia syndrome (POTS is an autonomic disorder which is characterized by postural tachycardia and orthostatic symptoms without associated hypotension. We report a case of a parturient, after her consent, with POTS, who underwent a cesarean section under spinal anesthesia. The anesthetic implications are also discussed.

  17. Right ventricular outflow tract tachycardia worsened during pregnancy

    African Journals Online (AJOL)

    Right ventricular outflow tract tachycardia worsened during pregnancy. Y Kambiré, L Konaté, GRC Millogo, E Sib, M Amoussou, LVA Nebié, A Niakara. Abstract. We report the case of a 35 years old woman without underlying heart disease who was diagnosed with a right ventricular outflow tract tachycardia worsened during ...

  18. Low Energy Multi-Stage Atrial Defibrillation Therapy Terminates Atrial Fibrillation with Less Energy than a Single Shock (United States)

    Li, Wenwen; Janardhan, Ajit H.; Fedorov, Vadim V.; Sha, Qun; Schuessler, Richard B.; Efimov, Igor R.


    Background Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multi-stage defibrillation therapy and tested it in a canine model of AF. Methods and Results AF was induced by burst pacing during vagus nerve stimulation. Our novel defibrillation therapy consisted of three stages: ST1 (1-4 low energy biphasic shocks), ST2 (6-10 ultra-low energy monophasic shocks), and ST3 (anti-tachycardia pacing). Firstly, ST1 testing compared single or multiple monophasic (MP) and biphasic (BP) shocks. Secondly, several multi-stage therapies were tested: ST1 versus ST1+ST3 versus ST1+ST2+ST3. Thirdly, three shock vectors were compared: superior vena cava to distal coronary sinus (SVC>CSd), proximal coronary sinus to left atrial appendage (CSp>LAA) and right atrial appendage to left atrial appendage (RAA>LAA). The atrial defibrillation threshold (DFT) of 1BP shock was less than 1MP shock (0.55 ± 0.1 versus 1.38 ± 0.31 J; p =0.003). 2-3 BP shocks terminated AF with lower peak voltage than 1BP or 1MP shock and with lower atrial DFT than 4 BP shocks. Compared to ST1 therapy alone, ST1+ST3 lowered the atrial DFT moderately (0.51 ± 0.46 versus 0.95 ± 0.32 J; p = 0.036) while a three-stage therapy, ST1+ST2+ST3, dramatically lowered the atrial DFT (0.19 ± 0.12 J versus 0.95 ± 0.32 J for ST1 alone, p=0.0012). Finally, the three-stage therapy ST1+ST2+ST3 was equally effective for all studied vectors. Conclusions Three-stage electrotherapy significantly reduces the AF defibrillation threshold and opens the door to low energy atrial defibrillation at or below the pain threshold. PMID:21980076

  19. Neonatal atrial flutter after insertion of an intracardiac umbilical venous catheter

    Directory of Open Access Journals (Sweden)

    Marcos Moura de Almeida


    Full Text Available Abstract Objective: To describe a case of neonatal atrial flutter after the insertion of an intracardiac umbilical venous catheter, reporting the clinical presentation and reviewing the literature on this subject. Case description: A late-preterm newborn, born at 35 weeks of gestational age to a diabetic mother and large for gestational age, with respiratory distress and rule-out sepsis, required an umbilical venous access. After the insertion of the umbilical venous catheter, the patient presented with tachycardia. Chest radiography showed that the catheter was placed in the position that corresponds to the left atrium, and traction was applied. The patient persisted with tachycardia, and an electrocardiogram showed atrial flutter. As the patient was hemodynamically unstable, electric cardioversion was successfully applied. Comments: The association between atrial arrhythmias and misplaced umbilical catheters has been described in the literature, but in this case, it is noteworthy that the patient was an infant born to a diabetic mother, which consists in another risk factor for heart arrhythmias. Isolated atrial flutter is a rare tachyarrhythmia in the neonatal period and its identification is essential to establish early treatment and prevent systemic complications and even death.

  20. Effects of beta-blockade on atrial and atrioventricular nodal refractoriness, and atrial fibrillatory rate during atrial fibrillation in pigs

    NARCIS (Netherlands)

    van den Berg, MP; van de Ven, LLM; Witting, W; Crijns, JGM; Haaksma, J; Bel, KJ; de Langen, CDJ; Lie, KI


    Despite their widespread use in atrial fibrillation, the effects of beta-adrenoceptor blockers on atrial and atrioventricular (AV) nodal refractoriness, and atrial fibrillatory rate during atrial fibrillation have been incompletely characterised. In particular, it is unknown whether additional

  1. [An analysis of clinical characteristics and acute treatment of supraventricular tachycardia in children from a multicenter study]. (United States)

    Li, X M; Ge, H Y; Liu, X Q; Shi, L; Guo, B J; Li, M T; Jiang, H; Zhang, Y; Liu, H J; Zheng, X C; Li, A J; Zhang, Y Y


    Objective: The study assessed the clinical characteristics and response to acute intravenous antiarrhythmic drug therapy of supraventricular tachycardia (SVT) in children. Methods: This was a multicenter prospective descriptive study including 257 children from First Hospital of Tsinghua University, Peking University First Hospital, Children's Hospital Affiliated to Capital Institute of Pediatrics and Beijing Anzhen Hospital who received intravenous antiarrhythmic drug therapy for SVT from July 2014 to February 2017. The clinical and tachycardia features, response to intravenous antiarrhythmic drug therapy of these children were characterized. Statistical analyses were performed using t test, Mann-Whitney U test, χ(2) test and H test. Results: The onset of SVT occurred at any age with a distribution with positive skewness, 57.6% ( n =148) childrenSVT types were 49.4% ( n =127) for atrioventricular reentry tachycardia (AVRT), 4.3% ( n =11) for atrioventricular nodal reentry tachycardia (AVNRT), 26.8% ( n =69) for unclassified paroxysmal SVT and 19.5% ( n =50) for atrial tachycardia (AT), respectively. Tachycardia-induced cardionyopathy (TIC) secondary to SVT developed in 30 of 225 (13.3%). Left ventricular ejection fraction (LVEF) of the 27 children attacked by TIC returned to normal after successful control of SVT (41.1%±6.3% vs. 60.3%±9.2%, t =-10.397, P =0.000). Complete termination of SVT by antiarrhythmic drugs was achieved in 164 of 257 (63.8%), partial termination rate was 18.7% (48 of 257) and failure to terminate rate was 17.5% (45 of 257). Propafenone (complete cardioversion in 98 (73.1%) of 134) and amiodarone (complete cardioversion in 23 (76.7%) of 30) showed better efficacy for SVT termination than adenosine (complete cardioversion in 26 (44.1%) 59) (χ(2)=20.524, P =0.000). Paroxysmal SVT had a higher termination rate on pharmacological therapy than AT (67.1% vs. 50.0%, χ(2)=6.337, P =0.042). Patients of different age groups had significantly

  2. Catastrophic Systemic Embolization from a Left Atrial Myxoma (United States)

    Shirazi, Farheen; Swadley, Matthew J.; Williams, Byron R.; Kumar, Gautam; Rab, S. Tanveer


    We report the fatal course of a left atrial myxoma: its systemic embolization to the coronary, cerebral, renal, and peripheral vascular beds in a 39-year-old woman resulted in rapid clinical deterioration, multiorgan failure, and death. Among reported cases of left atrial myxoma, this degree of embolic burden is exceedingly rare. In addition to reporting the patient's case, we discuss the presentation and diagnosis of possible intracardiac sources of systemic emboli. PMID:24512404

  3. Atrial mass: a myxoma?

    National Research Council Canada - National Science Library

    Chatzis, Andrew C; Kostopanagiotou, Kostas; Kousi, Theofili; Mitropoulos, Fotios


    A middle‐aged woman with a history of resected colorectal cancer and receiving chemotherapy presented with a right atrial mass and the provisional diagnosis of myxoma supported by echocardiography, computed...

  4. Pulmonary vein isolation as an end point for left atrial circumferential ablation of atrial fibrillation. (United States)

    Lemola, Kristina; Oral, Hakan; Chugh, Aman; Hall, Burr; Cheung, Peter; Han, Jihn; Tamirisa, Kamala; Good, Eric; Bogun, Frank; Pelosi, Frank; Morady, Fred


    We sought to determine whether elimination of pulmonary vein (PV) arrhythmogenicity is necessary for the efficacy of left atrial circumferential ablation (LACA) for atrial fibrillation (AF). The PVs often provide triggers or drivers of AF. It has been shown that LACA is more effective than PV isolation in eliminating paroxysmal AF. However, it is not clear whether complete PV isolation is necessary for the efficacy of LACA. In 60 consecutive patients with paroxysmal (n = 39) or chronic (n = 21) AF (mean age 53 +/- 12 years), LACA to encircle the left- and right-sided PVs, with additional lines in the posterior left atrium and along the mitral isthmus, was performed under the guidance of an electroanatomic navigation system. The PVs were mapped with a decapolar ring catheter before and after LACA. If PV isolation was incomplete, no attempts at complete isolation were made. After LACA, there was incomplete electrical isolation of one or more PVs in 48 (80%) of the 60 patients. The prevalence of PV tachycardias was 82% before and 8% after LACA (p LACA.

  5. A review of postural orthostatic tachycardia syndrome.

    LENUS (Irish Health Repository)

    Carew, Sheila


    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. Bidirectional Tachycardia after an Acute Intravenous Administration of Digitalis for a Suicidal Gesture

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    Diletta Sabatini


    Full Text Available Acute digoxin intoxication is a life-threating condition associated with severe cardiotoxicity. Female gender, age, low lean body mass, hypertension, and renal insufficiency may worsen the prognosis. Arrhythmias caused by digitalis glycosides are characterized by an increased automaticity coupled with concomitant conduction delay. Bidirectional tachycardia is pathognomonic of digoxin intoxication, but it is rarely observed. An 83-year-old woman was admitted to the Emergency Department after self-administration of 5 mg of digoxin i.v. for suicidal purpose. Her digoxin serum concentration was 17.4 ng/mL. The patient developed a bidirectional tachycardia and the Poison Control Center of the hospital provided digoxin immune fab. Bidirectional tachycardia quickly reversed and the patient remained stable throughout the hospital stay. This case shows that a multiple disciplinary approach, involving cardiologists and toxicologists, is essential for the management of digoxin intoxication. The optimal treatment of this rare event depends on the clinical conditions and on the serum drug concentration of the patient. Digoxin immune fab represents a safe, effective, and specific method for rapidly reversing digitalis cardiotoxicity and should be started as soon as the diagnosis is defined.

  7. Intra-uterine tachycardia associated with multicystic encephalomalacia (MCE). (United States)

    van Doornik, M C; Cats, B P; Barth, P G; van Bodegom, F; Moulaert, A J


    Multiple cystic brain lesions in neonates have been described as a result of a variety of causes. All events described thus far in association with multicystic encephalomalacia (MCE) seem to point to hypoxic-ischaemic injury as the common factor for this particular form of central nervous system damage. We describe a neonate in whom repeated, prolonged episodes of intrauterine tachycardia had been documented. Congestive heart failure and fetal hydrops were present at birth and MCE at the age of 13 wk. The obvious relationship between this child's intrauterine tachycardia and his MCE points to the fact that any fetus with prolonged tachycardia should be considered at risk of severe brain damage.

  8. Relationship between exposure of (-)-N-{2-[(R)-3-(6,7-dimethoxy-1,2,3,4-tetrahydroisoquinoline-2-carbonyl)piperidino]ethyl}-4-fluorobenzamide (YM758), a "funny" if current channel inhibitor, and heart rate reduction in tachycardia-induced beagle dogs. (United States)

    Umehara, Ken-ichi; Wada, Kouichi; Noguchi, Kiyoshi; Iwatsubo, Takafumi; Usui, Takashi; Kamimura, Hidetaka


    (-)-N-{2-[(R)-3-(6,7-Dimethoxy-1,2,3,4-tetrahydroisoquinoline-2-carbonyl)piperidino]ethyl}-4-fluorobenzamide (YM758), a novel "funny" If current channel (If channel) inhibitor, is developed as a treatment for stable angina and atrial fibrillation. In this study, the pharmacokinetic/pharmacodynamic (PK/PD) relationship after intravenous administration of YM758 to tachycardia-induced dogs was investigated and described based on the simplified compartment model. The PK of YM758 in dogs did not differ between the nontreated and tachycardia-induced groups. A drug-induced reduction in heart rate (HR) was clearly observed, and the half-life of the duration of the effect (approximately 4.0 h) was longer than that of the plasma concentration of the unchanged drug. The fitting and simulation procedure from the PK/PD relationship between the time profiles for YM758 plasma concentration and HR reduction had an ECe(50) value (YM758 concentration in the effective compartment resulting in a 50% decrease of the maximum effect) of 6.0 ng/ml, which did not agree with the results of the in vitro experiment using right atria isolated from guinea pigs (EC(30), 70.4 ng/ml). In addition, in the in vitro experiments, YM758 metabolites had a weak inhibitory effect, if any, on the spontaneous beat rate of the right atria from guinea pigs. These data, along with the previous finding that YM758 and its metabolites are eliminated rapidly from rat hearts, indicate that the duration of the pharmacological effect of YM758 (compared with the rapid elimination of the plasma drug concentration) may be the result of strong binding and/or slower dissociation of YM758 in the If channel. Such PK/PD analyses allow the pharmacological profiles of many drugs, especially cardiovascular drugs, to be more readily understood and better predicted during the clinical stages.

  9. Effects of nitric oxide synthase inhibition on sympathetically-mediated tachycardia (United States)

    Whalen, E. J.; Johnson, A. K.; Lewis, S. J.


    The aim of the present study was to determine whether inhibition of nitric oxide (NO) synthesis directly alters the tachycardia produced by sympathetically-derived norepinephrine. The NO synthase inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME; 50 micromol/kg, i.v.), produced a marked rise in mean arterial blood pressure. This pressor response was associated with a fall in heart rate which involved the withdrawal of cardiac sympathetic nerve activity. The NO-donor, sodium nitroprusside (5 microg/kg, i.v.), produced a pronounced fall in mean arterial blood pressure but only a minor increase in heart rate. The beta-adrenoceptor agonist, isoproterenol (0.5 micromol/kg, i.v.), and the membrane-permeable cAMP analogue, 8-(4-chlorophenylthiol)-cAMP (10 micromol/kg, i.v.), produced falls in mean arterial blood pressure and pronounced increases in heart rate. The indirectly acting sympathomimetic agent, tyramine (0.5 mg/kg, i.v.), produced a pressor response and a tachycardia. The effects of sodium nitroprusside, tyramine, isoproterenol and 8-(4-chlorophenylthiol)-cAMP on mean arterial blood pressure were not markedly affected by L-NAME. However, the tachycardia produced by these agents was considerably exaggerated in the presence of this NO synthesis inhibitor. These findings suggest that L-NAME potentiates the tachycardia produced by sympathetically-derived norepinephrine. The increased responsiveness to norepinephrine may involve (i) a rapid up-regulation of cardiac beta1-adrenoceptors and cAMP signaling in cardiac pacemaker cells due to the loss of the inhibitory influence of cardiac NO, and (ii) the up-regulation of beta1-adrenoceptor-mediated signal transduction processes in response to the L-NAME-induced withdrawal of cardiac sympathetic nerve activity.

  10. Atrial-selective K+ channel blockers: potential antiarrhythmic drugs in atrial fibrillation? (United States)

    Ravens, Ursula


    In the wake of demographic change in Western countries, atrial fibrillation has reached an epidemiological scale, yet current strategies for drug treatment of the arrhythmia lack sufficient efficacy and safety. In search of novel medications, atrial-selective drugs that specifically target atrial over other cardiac functions have been developed. Here, I will address drugs acting on potassium (K+) channels that are either predominantly expressed in atria or possess electrophysiological properties distinct in atria from ventricles. These channels include the ultra-rapidly activating, delayed outward-rectifying Kv1.5 channel conducting IKur, the acetylcholine-activated inward-rectifying Kir3.1/Kir3.4 channel conducting IK,ACh, the Ca2+-activated K+ channels of small conductance (SK) conducting ISK, and the two-pore domain K+ (K2P) channels (tandem of P domains, weak inward-rectifying K+ channels (TWIK-1), TWIK-related acid-sensitive K+ channels (TASK-1 and TASK-3)) that are responsible for voltage-independent background currents ITWIK-1, ITASK-1, and ITASK-3. Direct drug effects on these channels are described and their putative value in treatment of atrial fibrillation is discussed. Although many potential drug targets have emerged in the process of unravelling details of the pathophysiological mechanisms responsible for atrial fibrillation, we do not know whether novel antiarrhythmic drugs will be more successful when modulating many targets or a single specific one. The answer to this riddle can only be solved in a clinical context.

  11. Acute atrial fibrillation during dengue hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Veloso Henrique Horta


    Full Text Available Dengue fever is a viral infection transmitted by the mosquito, Aedes aegypti. Cardiac rhythm disorders, such as atrioventricular blocks and ventricular ectopic beats, appear during infection and are attributed to viral myocarditis. However, supraventricular arrhythmias have not been reported. We present a case of acute atrial fibrillation, with a rapid ventricular rate, successfully treated with intravenous amiodarone, in a 62-year-old man with dengue hemorrhagic fever, who had no structural heart disease.

  12. Left atrial appendage occlusion

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    Ahmad Mirdamadi


    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.

  13. A Giant Left Atrial Myxoma

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    Medhat F. Zaher


    Full Text Available Atrial myxomas are the most common primary cardiac tumors. Patients with left atrial myxomas generally present with mechanical obstruction of blood flow, systemic embolization, and constitutional symptoms. We present a case of an unusually large left atrial myxoma discovered incidentally in a patient with longstanding dyspnea being managed as bronchial asthma.

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

    NARCIS (Netherlands)

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


    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

  15. Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias

    Directory of Open Access Journals (Sweden)

    Kostas Polymeropoulos


     min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94% in the ibutilide arm and in all patients (100% in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA.

  16. Calsequestrin 2 deletion causes sinoatrial node dysfunction and atrial arrhythmias associated with altered sarcoplasmic reticulum calcium cycling and degenerative fibrosis within the mouse atrial pacemaker complex1 (United States)

    Glukhov, Alexey V.; Kalyanasundaram, Anuradha; Lou, Qing; Hage, Lori T.; Hansen, Brian J.; Belevych, Andriy E.; Mohler, Peter J.; Knollmann, Björn C.; Periasamy, Muthu; Györke, Sandor; Fedorov, Vadim V.


    Aims Loss-of-function mutations in Calsequestrin 2 (CASQ2) are associated with catecholaminergic polymorphic ventricular tachycardia (CPVT). CPVT patients also exhibit bradycardia and atrial arrhythmias for which the underlying mechanism remains unknown. We aimed to study the sinoatrial node (SAN) dysfunction due to loss of CASQ2. Methods and results In vivo electrocardiogram (ECG) monitoring, in vitro high-resolution optical mapping, confocal imaging of intracellular Ca2+ cycling, and 3D atrial immunohistology were performed in wild-type (WT) and Casq2 null (Casq2−/−) mice. Casq2−/− mice exhibited bradycardia, SAN conduction abnormalities, and beat-to-beat heart rate variability due to enhanced atrial ectopic activity both at baseline and with autonomic stimulation. Loss of CASQ2 increased fibrosis within the pacemaker complex, depressed primary SAN activity, and conduction, but enhanced atrial ectopic activity and atrial fibrillation (AF) associated with macro- and micro-reentry during autonomic stimulation. In SAN myocytes, CASQ2 deficiency induced perturbations in intracellular Ca2+ cycling, including abnormal Ca2+ release, periods of significantly elevated diastolic Ca2+ levels leading to pauses and unstable pacemaker rate. Importantly, Ca2+ cycling dysfunction occurred not only at the SAN cellular level but was also globally manifested as an increased delay between action potential (AP) and Ca2+ transient upstrokes throughout the atrial pacemaker complex. Conclusions Loss of CASQ2 causes abnormal sarcoplasmic reticulum Ca2+ release and selective interstitial fibrosis in the atrial pacemaker complex, which disrupt SAN pacemaking but enhance latent pacemaker activity, create conduction abnormalities and increase susceptibility to AF. These functional and extensive structural alterations could contribute to SAN dysfunction as well as AF in CPVT patients. PMID:24216388

  17. Exercise-based cardiac rehabilitation for adults with atrial fibrillation

    DEFF Research Database (Denmark)

    Risom, Signe S.; Zwisler, Ann-Dorthe; Johansen, Pernille P.


    Background: Exercise-based cardiac rehabilitation may benefit adults with atrial fibrillation or those who had been treated for atrial fibrillation. Atrial fibrillation is caused by multiple micro re-entry circuits within the atrial tissue, which result in chaotic rapid activity in the atria....... Objectives: To assess the benefits and harms of exercise-based rehabilitation programmes, alone or with another intervention, compared with no-exercise training controls in adults who currently have AF, or have been treated for AF. Search methods: We searched the following electronic databases; CENTRAL...... and the Database of Abstracts of Reviews of Effectiveness (DARE) in the Cochrane Library, MEDLINE Ovid, Embase Ovid, PsycINFO Ovid, Web of Science Core Collection Thomson Reuters, CINAHL EBSCO, LILACS Bireme, and three clinical trial registers on 14 July 2016. We also checked the bibliographies of relevant...

  18. Esmolol for the treatment of recurrent ventricular tachycardia


    Simone Savastano; Alessandra Greco; Benedetta Matrone


    Cardiac arrest and electrical storm are two major emergencies. The use of beta blockers in these clinical conditions has been proposed; however, definite data about the emergency use of beta blockers in recurrent ventricular tachycardia with pulse have never been published. We report two cases of recurrent ventricular tachycardia, which were unresponsive to the standard pharmacological treatment but successfully responsive to esmolol infusion. Both cases showed a reduced left ventricle ejecti...

  19. Bedside Echocardiography for Rapid Diagnosis of Malignant Cardiac Tamponade

    Directory of Open Access Journals (Sweden)

    Alaina Brinley


    Full Text Available History of present illness: A 47-year-old female with metastatic breast cancer presented to the Emergency Department with chest pain and shortness of breath. She was hypotensive and her EKG showed sinus tachycardia with low voltage. A bedside ultrasound was performed that detected a pericardial effusion and evidence of cardiac tamponade. The patient’s vitals improved with a fluid bolus and she went emergently to the cardiac catheterization lab for fluoroscopy and echocardiography guided pericardiocentesis. A total of 770 mL of fluid was removed from her pericardial space. Significant findings: The video shows a subxiphoid view of the heart with evidence of a large pericardial effusion with tamponade – note the anechoic stripe in the pericardial sac (see red arrow. This video demonstrates paradoxical right ventricular collapse during diastole and right atrial collapse during systole which is indicative of tamponade.1,2 Figure 1 is from the same patient and shows sonographic pulsus paradoxus. This is an apical 4 chamber view of the heart with the sampling gate of the pulsed wave doppler placed over the mitral valve. The Vpeak max and Vpeak min are indicated. If there is more than a 25% difference with inspiration between these 2 values, this is highly suggestive of tamponade.1 In this case, there is a 32.4% difference between the Vpeak max 69.55 cm/s and Vpeak min 46.99 cm/s. Discussion: Cardiac tamponade is distinguished from pericardial effusion by right ventricular compression/collapse and hemodynamic instability. Findings can include hypotension, tachycardia, distant heart sounds, and jugular venous distension.3,4 One might also see a plethoric IVC without respiratory variation indicative of elevated right atrial pressures.1 Detection of right ventricular collapse for cardiac tamponade has sensitivities ranging from 48%-100% and specificities ranging from 33%-100%.5 A larger effusion is more likely to lead to cardiac tamponade. However

  20. Clinical presentation of inappropriate sinus tachycardia and differential diagnosis. (United States)

    Peyrol, Michael; Lévy, Samuel


    Inappropriate sinus tachycardia (IST) is a syndrome characterized by a sinus tachycardia not related to a medical condition, to a physiological response, or to medication or drugs and associated with symptoms, often invalidating and altering the quality of life of affected patients. It occurs predominantly in adolescents and young adults, and in the female sex. The diagnosis requires a complete work-up in order to exclude other causes of sinus tachycardia and one or several additional tests: 24-h ECG ambulatory recordings, echocardiogram, exercise testing, and autonomous nervous system assessment. It should be differentiated from the postural orthostatic tachycardia syndrome, with which it shares a number of symptoms, and other supraventricular tachycardias originating in the high right atrium. An electrophysiological study should be considered in selected cases in order to differentiate IST from other supraventricular tachycardias. The mechanism is still unclear, and possible etiologies may include intrinsic abnormality of the sinus node, autonomic dysfunction, hypersensitivity of the sinus node to catecholamines, blunted vagal system, or a combination of the above. The authors emphasize the wide spectrum of clinical presentations and the need to better define the IST and the criteria required to ascertain its diagnosis.

  1. Responses of cardiac natriuretic peptides after paroxysmal supraventricular tachycardia: ANP surges faster than BNP and CNP. (United States)

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


    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 ANP, the increases of BNP and CNP in CS after the PSVT were less sharp, but continued to rise after the termination of 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 ANP increased greater after a 30-min induced PSVT, but dropped faster after termination of PSVT, compared with BNP and CNP. Copyright © 2016 the American Physiological Society.

  2. The value of adrenaline in the induction of supraventricular tachycardia in the electrophysiological laboratory. (United States)

    Cismaru, Gabriel; Rosu, Radu; Muresan, Lucian; Puiu, Mihai; Andronache, Marius; Hengan, Erika; Ispas, Daniel; Gusetu, Gabriel; Pop, Dana; Mircea, Petru Adrian; Zdrenghea, Dumitru


    The most commonly used drug for the facilitation of supraventricular tachycardia (SVT) induction in the electrophysiological (EP) laboratory is isoprenaline. Despite isoprenaline's apparent indispensability, availability has been problematic in some European countries. Alternative sympatomimethic drugs such as adrenaline have therefore been tried. However, no studies have determined the sensitivity and specificity of adrenaline for the induction of SVT. The objective of this study was to determine the sensitivity and specificity of adrenaline for the induction of SVT. Between February 2010 and July 2013, 336 patients underwent an EP study for prior documented SVT. In 66 patients, adrenaline was infused because tachycardia was not induced under basal conditions. This group was compared with 30 control subjects with no history of SVT. Programmed atrial stimulation was carried out during baseline state and repeated after an infusion of adrenaline (dose ranging from 0.05 mcg/kgc to 0.3 mcg/kgc). The endpoint was the induction of SVT. Among 66 patients with a history of SVT but no induction under basal conditions, adrenaline facilitated induction in 54 patients (82%, P SVT was not induced in any patient (0%) after infusion. Adrenaline was generally well tolerated, except for two patients (3.0%), where it had to be discontinued due to headache and high blood pressure or lumbar pain. Adrenaline infusion has a high sensitivity (82%) and specificity (100%) for the induction of SVT in patients with prior documented SVT. Therefore, it could serve as an acceptable alternative to isoprenaline, when the latter is not available. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email:

  3. Postural orthostatic tachycardia syndrome following Lyme disease. (United States)

    Kanjwal, Khalil; Karabin, Beverly; Kanjwal, Yousuf; Grubb, Blair P


    A subgroup of patients suffering from Lyme disease (LD) may initially respond to antibiotics only to later develop a syndrome of fatigue, joint pain and cognitive dysfunction referred to as 'post treatment LD syndrome'. We report on a series of patients who developed autonomic dysfunction in the form of postural orthostatic tachycardia syndrome (POTS). All of the patients in this report had suffered from LD in the past and were successfully treated with antibiotics. All patients were apparently well, until years later when they presented with fatigue, cognitive dysfunction and orthostatic intolerance. These patients were diagnosed with POTS on the basis of clinical features and results of the tilt table (HUTT) testing. Five patients (all women), aged 22-44 years, were identified for inclusion in this study. These patients developed symptoms of fatigue, cognitive dysfunction, orthostatic palpitations and either near syncope or frank syncope. The debilitating nature of these symptoms had resulted in lost of the employment or inability to attend school. Three patients were also suffering from migraine, two from anxiety and depression and one from hypertension. All patients demonstrated a good response to the employed treatment. Four of the five were able to engage in their activities of daily living and either resumed employment or returned to school. In an appropriate clinical setting, evaluation for POTS in patients suffering from post LD syndrome may lead to early recognition and treatment, with subsequent improvement in symptoms of orthostatic intolerance.

  4. Cardiac Imaging in Patients With Ventricular Tachycardia. (United States)

    Mahida, Saagar; Sacher, Frédéric; Dubois, Rémi; Sermesant, Maxime; Bogun, Frank; Haïssaguerre, Michel; Jaïs, Pierre; Cochet, Hubert


    Ventricular tachycardia (VT) is a major cause of sudden cardiac death. The majority of malignant VTs occur in patients with structural heart disease. Multimodality imaging techniques play an integral role in determining the underlying etiology and prognostic significance of VT. In recent years, advances in imaging technology have enabled characterization of the structural arrhythmogenic substrate in patients with VT with increasing precision. In parallel with these advances, the role of cardiac imaging has expanded from a largely diagnostic tool to an adjunctive tool to guide interventional approaches for treatment of VT. Invasive and noninvasive imaging techniques, often used in combination, have made it possible to integrate structural and electrophysiological information during VT ablation procedures. An important area of current development is the use of noninvasive imaging techniques based on body surface electrocardiographic mapping to elucidate the mechanisms of VT. In the future, these techniques may provide a priori information on mechanisms of VT in patients undergoing interventional procedures. This review provides an overview of the role of cardiac imaging in patients with VT. © 2017 American Heart Association, Inc.

  5. Atrial natriuretic peptide in patients with heart failure and chronic atrial fibrillation : Role of duration of at atrial fibrillation

    NARCIS (Netherlands)

    Van Den Berg, MP; Crijns, HJGM; Van Veldhuisen, DJ; Van Gelder, IC; De Kam, PJ; Lie, KI

    The purpose of this study was to analyze the determinants of atrial natriuretic peptide level in patients with congestive heart failure and atrial fibrillation. In particular, the duration of atrial fibrillation was analyzed because atrial fibrillation per se might have a specific effect on atrial

  6. Pharmacological Treatment for Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Kaoru Sugi, MD PhD


    Full Text Available Pharmacological treatment for atrial fibrillation has a variety of purposes, such as pharmacological defibrillation, maintenance of sinus rhythm, heart rate control to prevent congestive heart failure and prevention of both cerebral infarction and atrial remodeling. Sodium channel blockers are superior to potassium channel blockers for atrial defibrillation, while both sodium and potassium channel blockers are effective in the maintenance of sinus rhythm. In general, digitalis or Ca antagonists are used to control heart rate during atrial fibrillation to prevent congestive heart failure, while amiodarone or bepridil also reduce heart rates during atrial fibrillation. Anticoagulant therapy with warfarin is recommended to prevent cerebral infarction and angiotensin converting enzyme antagonists or angiotensin II receptor blockers are also used to prevent atrial remodeling. One should select appropriate drugs for treatment of atrial fibrillation according to the patient's condition.

  7. AAIR versus DDDR pacing in the bradycardia tachycardia syndrome: a prospective, randomized, double-blind, crossover trial. (United States)

    Schwaab, B; Kindermann, M; Schätzer-Klotz, D; Berg, M; Franow, H; Fröhlig, G; Schieffer, H


    In 19 patients paced and medicated for bradycardia tachycardia syndrome (BTS), AAIR and DDDR pacing were compared with regard to quality of life (QoL), atrial tachyarrhythmia (AFib), exercise tolerance, and left ventricular (LV)function. Patients had a PQ interval AAIR mode. The incidence of AFib was 12 episodes in 2 patients with AAIR versus 22 episodes in 7 patients with DDDR pacing (P = 0.072). In AAIR mode, 164 events of second and third degree AV block were detected in 7 patients (37%) with pauses between 1 and 4 seconds. During CPX, exercise duration and work load were higher in AAIR than in DDDR mode (423+/-127 vs 402+/-102 s and 103+/-31 vs 96+/-27 Watt, P AAIR. Hence, AAIR and DDDR pacing seem to be equally effective in BTS patients. In view of a considerable rate of high degree AV block during AAIR pacing, DDDR mode should be preferred for safety reasons.

  8. Increased amount of atrial fibrosis in patients with atrial fibrillation secondary to mitral valve disease

    NARCIS (Netherlands)

    Geuzebroek, Guillaume S. C.; van Amersfoorth, Shirley C. M.; Hoogendijk, Mark G.; Kelder, Johannes C.; van Hemel, Norbert M.; de Bakker, Jacques M. T.; Coronel, Ruben


    Objective: Atrial fibrosis is related to atrial fibrillation but may differ in patients with mitral valve disease or lone atrial fibrillation. Therefore, we studied atrial fibrosis in patients with atrial fibrillation + mitral valve disease or with lone atrial fibrillation and compared it with

  9. Test Characteristics of Neck Fullness and Witnessed Neck Pulsations in the Diagnosis of Typical AV Nodal Reentrant Tachycardia (United States)

    Sakhuja, Rahul; Smith, Lisa M; Tseng, Zian H; Badhwar, Nitish; Lee, Byron K; Lee, Randall J; Scheinman, Melvin M; Olgin, Jeffrey E; Marcus, Gregory M


    Summary Background Claims in the medical literature suggest that neck fullness and witnessed neck pulsations are useful in the diagnosis of typical AV nodal reentrant tachycardia (AVNRT). Hypothesis Neck fullness and witnessed neck pulsations have a high positive predictive value in the diagnosis of typical AVNRT. Methods We performed a cross sectional study of consecutive patients with palpitations presenting to a single electrophysiology (EP) laboratory over a 1 year period. Each patient underwent a standard questionnaire regarding neck fullness and/or witnessed neck pulsations during their palpitations. The reference standard for diagnosis was determined by electrocardiogram and invasive EP studies. Results Comparing typical AVNRT to atrial fibrillation (AF) or atrial flutter (AFL) patients, the proportions with neck fullness and witnessed neck pulsations did not significantly differ: in the best case scenario (using the upper end of the 95% confidence interval [CI]), none of the positive or negative predictive values exceeded 79%. After restricting the population to those with supraventricular tachycardia other than AF or AFL (SVT), neck fullness again exhibited poor test characteristics; however, witnessed neck pulsations exhibited a specificity of 97% (95% CI 90–100%) and a positive predictive value of 83% (95% CI 52–98%). After adjustment for potential confounders, SVT patients with witnessed neck pulsations had a 7 fold greater odds of having typical AVNRT, p=0.029. Conclusions Although neither neck fullness nor witnessed neck pulsations are useful in distinguishing typical AVNRT from AF or AFL, witnessed neck pulsations are specific for the presence of typical AVNRT among those with SVT. PMID:19479968


    Dosdall, Derek J.; Ideker, Raymond E.


    Intravascular ventricular defibrillation and intravascular atrial defibrillation have many similarities, some of which are as follows. An important factor influencing the outcome of the shock is the potential gradient field created throughout the ventricles or the atria by the shock. A minimum potential gradient is required throughout the ventricles and probably the atria to defibrillate. The value of this minimum potential gradient is affected by several factors including the duration, tilt, and number of phases of the waveform. For shock strengths near the defibrillation threshold, earliest activation following failed shocks arises in a region in which the potential gradient is low. The defibrillation threshold energy can be decreased by adding a third and even a fourth defibrillation electrode in regions where the shock potential gradient is low for the shock field created by the first two defibrillation electrodes and giving two sequential shocks, each through a different set of electrodes. However, the addition of more electrodes and sequential shocks complicates both the device and its implantation. Since patients are conscious when the atrial defibrillation shock is given, they experience pain during the shock, which is one of the main drawbacks of intravascular atrial defibrillation. Unfortunately, the pain threshold for defibrillation shocks is so low that a shock of less than 1 Joule is uncomfortable and is not much less painful than shocks several times stronger. Therefore, even though electrode configurations exist that have lower atrial defibrillation threshold energy requirements than the atrial defibrillation threshold with standard defibrillation electrode configurations used in implantable cardioverter/defibrillators (ICDs) for ventricular defibrillation, they are not clinically practical because their shocks are almost as painful as with the standard ICD electrode configurations and they would cause the ICD to be more complicated and to take

  11. Sudden death in a young patient with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    María Tamargo


    Full Text Available Sudden cardiac death (SCD in young patients without structural heart disease is frequently due to inherited channelopathies such as long QT syndrome (LQTS, Brugada syndrome or Catecholaminergic polymorphic ventricular tachycardia. Accordingly, the addition of genetic testing to clinical data may be useful to identify the cause of the sudden death in this population. Mutations in the KCNQ1 encoded Kv7.1 channel are related to type 1 LQTS, familial atrial fibrillation (AF, short QT syndrome, and SCD. We present a clinical case where the presence of AF after resuscitation in a young man with cardiac arrest was the key clinical data to suspect an inherited disorder and genetic testing was the main determinant for identifying the cause of the cardiac arrest. The KCNQ1 p.Arg231His mutation explained the combined phenotype of AF and susceptibility to ventricular arrhythmias. The case highlights the importance of continued research in genetics and molecular mechanisms of channelopathies.

  12. Nonsustained Repetitive Upper Septal Idiopathic Fascicular Left Ventricular Tachycardia: Rare Type of VT

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    Gokhan Aksan


    Full Text Available Upper septal fascicular ventricular tachycardia is a very rare form of idiopathic fascicular ventricular tachycardia. Upper septal fascicular tachycardia uses the posterior fascicle as the anterograde limb and the septal fascicle as the retrograde limb. When evaluating the electrocardiography for this form of tachycardia, the presence of narrow QRS morphology and normal axis may be misinterpreted as supraventricular tachycardia. Here, we report a very rare subtype of fascicular tachycardia that originates more proximally in the His-Purkinje system at the base of the heart.

  13. Scn3b knockout mice exhibit abnormal sino-atrial and cardiac conduction properties (United States)

    Hakim, P; Brice, N; Thresher, R; Lawrence, J; Zhang, Y; Jackson, A P; Grace, A A; Huang, C L-H


    Aim In contrast to extensive reports on the roles of Nav1.5 α-subunits, there have been few studies associating the β-subunits with cardiac arrhythmogenesis. We investigated the sino-atrial and conduction properties in the hearts of Scn3b−/− mice. Methods The following properties were compared in the hearts of wild-type (WT) and Scn3b−/− mice: (1) mRNA expression levels of Scn3b, Scn1b and Scn5a in atrial tissue. (2) Expression of the β3 protein in isolated cardiac myocytes. (3) Electrocardiographic recordings in intact anaesthetized preparations. (4) Bipolar electrogram recordings from the atria of spontaneously beating and electrically stimulated Langendorff-perfused hearts. Results Scn3b mRNA was expressed in the atria of WT but not Scn3b−/− hearts. This was in contrast to similar expression levels of Scn1b and Scn5a mRNA. Immunofluorescence experiments confirmed that the β3 protein was expressed in WT and absent in Scn3b−/− cardiac myocytes. Lead I electrocardiograms from Scn3b−/− mice showed slower heart rates, longer P wave durations and prolonged PR intervals than WT hearts. Spontaneously beating Langendorff-perfused Scn3b−/− hearts demonstrated both abnormal atrial electrophysiological properties and evidence of partial or complete dissociation of atrial and ventricular activity. Atrial burst pacing protocols induced atrial tachycardia and fibrillation in all Scn3b−/− but hardly any WT hearts. Scn3b−/− hearts also demonstrated significantly longer sinus node recovery times than WT hearts. Conclusion These findings demonstrate, for the first time, that a deficiency in Scn3b results in significant atrial electrophysiological and intracardiac conduction abnormalities, complementing the changes in ventricular electrophysiology reported on an earlier occasion. PMID:19796257

  14. [Radiofrequency catheter ablation therapy in elderly patients with supraventricular tachycardia]. (United States)

    Shimizu, A; Yamagata, T; Tatsuno, H; Esato, M; Ueyama, T; Hayano, T; Oomura, M; Tamura, K; Matsuzaki, M


    138 patients with Wolf-Parkinson-White (WPW) syndrome (n = 96), atrioventricular nodal reentrant tachycardia (AVNRT; n = 27) and the other supraventricular tachycardia (n = 15), were divided into two groups, a control group (less than 65 years old; n = 108) and an elderly group (more than 66 years old; n = 30). We then estimated the success rate and safety of radiofrequency ablation for supraventricular tachycardia in elderly patients. For WPW syndrome, there were 76 (97%) successes and 9 (13%) recurrences in the control group (n = 78). In the elderly group of WPW patients, the number of successes was 18 (100%) and the number of recurrences one (63%). In 27 patients with AVNRT, the number of successes was 26 (96%) and there were no recurrences. In 15 patients with some other supraventricular tachycardia, there were 11 patients (73%) successes and one recurrence (11%). Major complications consisted of cardiac tamponade in 2 patients, dissecting aneurysm in one patient and cerebral embolism in one patients. All major complications occurred in patients with WPW syndrome. The cause of the complications, except the cerebral embolism was manipulation of the electrical or ablation catheter. Three of four patients with major complications belonged to the control group. It is possible that radiofrequency catheter ablation for supraventricular tachycardia in elderly patients is safe and highly effective. However, it is still invasive therapy. Ablation on a left accessory pathway by the transaortic valve approach especially needs meticulous care.

  15. Coronary vasodilator reserve persists despite tachycardia and myocardial ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Bristow, J.D.; McFalls, E.O.; Anselone, C.G.; Pantely, G.A. (Oregon Health Sciences Univ., Portland (USA))


    During myocardial ischemia, the authors tested whether coronary blood flow measured with radioactive microspheres labeled with {sup 141}Ce, {sup 51}Cr, {sup 103}Ru, and {sup 95}Nb would increase in response to tachycardia thereby employing known coronary flow reserve. The authors instrumented the left anterior descending (LAD) coronary circulation in anesthetized pigs and performed three sets of experiments while coronary pressure was controlled and several heart rate increases were produced. (1) Pacing-induced tachycardia at normal LAD pressure was characterized by increased LAD flow and myocardial oxygen consumption, without production of lactate. (2) Tachycardia at a mean LAD pressure of 38 mmHg was associated with a lower, fixed coronary flow and oxygen consumption. Lactate was produced at all rates and local myocardial function declined progressively. (3) Coronary flow at low LAD pressure doubled during tachycardia when intracoronary adenosine was added. The increase to the subepicardium was >100%, whereas subendocardial flow changed little. There is persistent coronary flow reserve during moderately severe myocardial ischemia, even when metabolic demand is increased by tachycardia. This reserve, however, is predominantly subepicardial.

  16. 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


    -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...


    Directory of Open Access Journals (Sweden)

    I. M. Marusenko


    Full Text Available Review on a problem of the development of atrial fibrillation in patients with thyrotoxicosis is presented. Thyrotoxicosis is one of the most frequent endocrine diseases, conceding only to a diabetes mellitus. The most frequent reasons of hyperthyroidism are Graves’ disease and functional thyroid autonomy. The authors give an analysis of data on the cardiac effects of thyrotoxicosis, features of heart remodeling under the influence of thyroid hyperfunction, prevalence of atrial fibrillation in thyrotoxicosis, depending on age, as well as the possibility of restoring sinus rhythm in the combination of these diseases. Particular attention is paid to the effect on the heart of subclinical thyrotoxicosis, which is defined as a dysfunction of the thyroid gland, characterized by low serum concentration of thyrotropin, normal values of free thyroxine and free triiodothyronine. Subclinical hyperthyroidism is also capable of causing heart remodeling and diastolic dysfunction.Prevalence of thyrotoxicosis in elderly people is higher in areas of iodine deficiency; it is relevant for our country due to the large territory of iodine deficiency. In elderly patients, the cardiac effects of thyrotoxicosis prevail in the clinical picture, that makes it difficult to diagnose endocrine disorders, and correction of thyrotoxicosis is critically important for the successful control of the heart rhythm. The article also discusses the problem of thyrotoxic cardiomyopathy, caused by the toxic effect of excess thyroid hormones: features of this heart disorder, factors affecting its formation, clinical significance and contribution to the development of rhythm disturbances. The greatest significance is the development of atrial fibrillation as a result of thyrotox-icosis in older patients who already have various cardiovascular diseases.Atrial fibrillation is the most frequent heart rhythm disorder in thyrotoxicosis. The main cause of arrhythmia in hyperthyroidism is the

  18. Assessment of the neutrophil/lymphocyte ratio in patients with supraventricular tachycardia. (United States)

    Aydın, Mesut; Yıldız, Abdülkadir; Yüksel, Murat; Polat, Nihat; Aktan, Adem; İslamoğlu, Yahya


    The neutrophil/lymphocyte ratio (NLR) has been evaluated as a new predictor of cardiovascular risk. Inflammation has been shown to be associated with various arrhythmias including supraventricular tachycardias (SVTs). In this study, we aimed to investigate the relation between NLR and SVT in patients with a documented atrial tachyarrhythmia. The study used a retrospective cross-sectional design. Patients who had SVT but were otherwise healthy were included. The exclusion criteria included drug use (except antiarrhythmic agents), morbid obesity, acute or chronic infection, inflammatory diseases, systemic diseases, and cancer. Total and differential leukocyte counts and routine biochemical tests were performed before the ablation procedure. The study included 150 patients with SVT and 98 healthy controls. The biochemical and hematological parameters were comparable between the groups, except neutrophil and lymphocyte counts. The neutrophil count was significantly higher (4.7±1.5x103/µL versus 4.1±1.0x103/µL; pSVT group than in the control group. As a result, the SVT group had significantly higher NLR values than the control group (2.2±0.9 versus 1.7±0.5; pSVT remained significant after multivariate analysis (odds ratio: 1.5, 95% confidence interval: 1.001-2.263, p=0.049). Our study indicated that NLR values were significantly higher in patients with documented SVT than in control subjects. Inducibility of SVT during EPS was associated with higher NLR values.

  19. Supraventricular tachycardia-Part II: History, presentation, mechanism, and treatment. (United States)

    Lee, Ken W; Badhwar, Nitish; Scheinman, Melvin M


    Supraventricular tachycardias (SVTs) affect all age groups and are a source of significant morbidity. They are frequently encountered in otherwise healthy individuals without structural heart disease. Advances in the understanding of their mechanisms and anatomical locations have led to highly effective pharmacologic and nonpharmacologic treatment strategies. Recognition, identification, and differentiation of the various SVTs are of great importance in formulating an effective treatment strategy. Developments over the past four decades have made possible the accurate diagnosis of SVTs, and technological advances have led to ablative cures of most of these arrhythmias. This monograph provides an in-depth discussion of the history, presentation, mechanism, and treatment strategies of the most commonly encountered SVTs. The monograph is divided in two parts. Arrhythmias and related syndromes that are covered in detail in the first part include atrioventricular nodal reentrant tachycardia, Wolf-Parkinson-White syndrome, and atrioventricular reentrant tachycardia. The remaining SVTs are covered in the second part, which is presented here.

  20. The Postural Tachycardia Syndrome (POTS: Pathophysiology, Diagnosis & Management

    Directory of Open Access Journals (Sweden)

    Satish R Raj


    Full Text Available Postural tachycardia syndrome (POTS, characterized by orthostatic tachycardia in the absence of orthostatic hypotension, has been the focus of increasing clinical interest over the last 15 years 1. Patients with POTS complain of symptoms of tachycardia, exercise intolerance, lightheadedness, extreme fatigue, headache and mental clouding. Patients with POTS demonstrate a heart rate increase of ≥30 bpm with prolonged standing (5-30 minutes, often have high levels of upright plasma norepinephrine (reflecting sympathetic nervous system activation, and many patients have a low blood volume. POTS can be associated with a high degree of functional disability. Therapies aimed at correcting the hypovolemia and the autonomic imbalance may help relieve the severity of the symptoms. This review outlines the present understanding of the pathophysiology, diagnosis, and management of POTS.

  1. [Our experience in the diagnosis and treatment of postural orthostatic tachycardia syndrome, vasovagal syncope, and inappropriate sinus tachycardia in children]. (United States)

    Ugan Atik, Sezen; Dedeoğlu, Reyhan; Koka, Aida; Öztunç, Funda


    The aim of this study was to share our experience in the diagnosis and treatment of patients who presented at our clinic with syncope, pre-syncope, dizziness, and palpitations. Patients who were treated at pediatric cardiology clinic for complaints of syncope, dizziness, and palpitations between 2014 and 2016 were enrolled in the study. Detailed history of the patients, physical examination findings, laboratory and electrocardiogram results were recorded. Tilt table test, 24-hour Holter rhythm monitoring, and exercise test were performed, as required. Patients were diagnosed as vasovagal syncope, postural orthostatic tachycardia syndrome (POTS), or inappropriate sinus tachycardia based on these findings. Treatment of the patients was evaluated. Thirty patients were diagnosed as vasovagal syncope, 7 patients as POTS, and 2 as inappropriate sinus tachycardia. POTS accompanied Raynaud's phenomenon in 1 patient, hypertrophic cardiomyopathy in 1 patient, and homocystinuria in another patient. Complaints of patients with vasovagal syncope improved with non-medical therapy. Medical treatment was administered to the patients with diagnosis of POTS and inappropriate sinus tachycardia. In patients with complaints of syncope, pre-syncope, dizziness, and palpitations without structural heart disease or non-rhythm problems, cardiovascular autonomic disorders, such as POTS and inappropriate sinus tachycardia should be kept in mind, as well as vasovagal syncope.

  2. Tachycardia-related cardiomyopathy: a review of the literature

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    Maurizio Ongari


    Full Text Available A fast heart rate or an irregular ventricular rhythm can produce various degrees of functional impairment and structural remodeling of the ventricle referred to as tachycardiarelated cardiomyopathy or tachycardiomyopathy. This form of myocardial dysfunction can be caused by supraventricular or ventricular tachyarrhythmias that are incessant and associated with ventricular rates higher than 120 bpm. It can be reversed with pharmacological or nonpharmacological rate control or arrhythmia reversion. The prevalence of ventricular and supraventricular tachyarrhythmias is high among patients with heart failure. Consequently, in clinical settings, it may be difficult to determine whether a patient with severe ventricular dysfunction and supraventricular tachyarrhythmia associated with a rapid ventricular response is suffering from tachycardiomyopathy or from heart failure complicated by the subsequent development of a supraventricular tachyarrhythmia (e.g. atrial fibrillation. This typical ‘‘chicken-or-the-egg’’ dilemma can be resolved by treating the arrhythmia (pharmacological or nonpharmacological rate and/or rhythm control and closely monitoring the evolution of the left ventricular dysfunction. Proper management of tachycardiomyopathy requires appropriate decision making, use of both pharmacological and nonpharmacological treatment approaches, and close follow-up. The purpose of this review article is to examine currently available data (experimental and clinical on this complex clinical entity and on rate-control therapy.

  3. Anterograde conduction to the His bundle during right ventricular overdrive pacing distinguishes septal pathway atrioventricular reentry from atypical atrioventricular nodal reentrant tachycardia. (United States)

    Nagashima, Koichi; Kumar, Saurabh; Stevenson, William G; Epstein, Laurence M; John, Roy M; Tedrow, Usha B; Koplan, Bruce A; Michaud, Gregory F


    Distinguishing orthodromic atrioventricular reciprocating tachycardia (ORT) using a retrograde septal accessory pathway (AP) from atypical atrioventricular nodal reentrant tachycardia (AVNRT) may be challenging. Specifically, excluding the presence and participation of an AP may require multiple diagnostic maneuvers. The purpose of this study was to assess the relative value of commonly used right ventricular (RV) pacing maneuvers, including identification of anterograde His-bundle activation with entrainment, to differentiate ORT using a retrograde septal AP from atypical AVNRT. From March 2009 to June 2014, 56 patients (28 female; age 43.9 ± 17.4 years) who underwent electrophysiologic study and ablation for supraventricular tachycardia (26 ORT using septal AP and 30 atypical AVNRT) that exhibited a concentric atrial activation pattern and a septal ventriculoatrial interval >70 ms were analyzed. Overdrive pacing maneuvers or ventricular extrastimuli failed on at least 1 occasion to correctly identify a septal AP. Overall, 16 ORT patients and 26 AVNRT patients had successful RV entrainment, and 12 (75%) ORT patients showed anterograde His capture (11 patients) and/or anterograde septal ventricular capture (3 patients). None of the patients with atypical AVNRT showed anterograde conduction to the His bundle with entrainment. RV pacing maneuvers are useful to exclude an AP in patients with AVNRT having concentric atrial activation sequence and a septal ventriculoatrial interval >70 ms; however, none are consistently diagnostic. When observed in this patient population, anterograde His-bundle or septal ventricular capture during RV entrainment was diagnostic for ORT using a septal AP. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  4. Inappropriate sinus tachycardia – cardiac syndrome or anxiety related disorder?

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    Paweł Rasmus


    Full Text Available Introduction: Inappropriate sinus tachycardia is generally defined as an elevated resting heart rate (>90–100 bpm with an exaggerated response to physical or emotional stress and a clearly sinus mechanism which is not secondary to a diagnosed somatic disease. Anxiety, a significant risk factor for cardiovascular disease, is recently recognized as a crucial issue in younger and older adults, with a causal relation to other risk factors, such as depression, substance use, overweight, sleep difficulties, or a sedentary life style. The aim of the study was to evaluate a possible relation between the level of anxiety, control of emotions in patients with manifestation of inappropriate sinus tachycardia and diagnosis of this syndrome. Material and methods: The study included 33 female patients with inappropriate sinus tachycardia (age range 31.8 ± 8.72 and 33 women (28.7 ± 4.4 without any cardiac diseases. The diagnosis of inappropriate sinus tachycardia was given by a cardiologist during hospitalisation of the patients in the 2nd Department of Cardiology and Department of Electrocardiology, Medical University of Lodz, Lodz, Poland. For psychological assessment the State-Trait Anxiety Inventory and Courtauld Emotional Control Scale both self-report, paper and pencil inventories were used. Results: A statistically significant difference was found between the group of women with inappropriate sinus tachycardia and the group of healthy women regarding the Anxiety-Trait. The results of the study have shown no other statistically significant differences between tested groups. Conclusions: Inappropriate sinus tachycardia is related to increased anxiety. More clinical trials are needed to confirm its psychogenic basis.

  5. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of inducible paroxysmal supraventricular tachycardia without pre-excitation syndromes: A cohort study of 1960 patients included over 25 years (United States)

    Brembilla-Perrot, Béatrice; Sellal, Jean Marc; Olivier, Arnaud; Villemin, Thibaut; Beurrier, Daniel; Vincent, Julie; Manenti, Vladimir; de Chillou, Christian; Bozec, Erwan


    Aim To investigate the influence of increasing age on clinical presentation, treatment and long-term outcome in patients with inducible paroxysmal supraventricular tachycardia (SVT) without pre-excitation syndromes. Methods Clinical and electrophysiological study (EPS) data, as well as long-term clinical outcome (mean follow-up 2.4±4.0 years) were collected in patients referred for regular tachycardia with inducible SVT during EPS without pre-excitation. Results Among 1960 referred patients, 301 patients (15.4%) were aged ≥70 (70–97). In this subset, anticoagulants were prescribed in 49 patients following an erroneous diagnosis of atrial tachycardia and 14 were previously erroneously diagnosed with ventricular tachycardia because of wide QRS. Ablation was performed more frequently in patients ≥70 despite more frequent failure and complications. During follow-up, higher risks of AF, stroke, pacemaker implantation and death were observed in patients ≥70 whereas SVT recurrences were similar in both age groups. In multivariable analysis, age ≥70 was independently associated with higher risks of SVT-related adverse events prior to ablation (OR = 1.93, 1.41–2.62, pSVT without pre-excitation syndromes are elderly. These patients exhibit higher risks of erroneous tachycardia diagnosis prior to EPS as well as failure and/or complication of ablation, but similar risk of SVT recurrence. These results support performing transesophageal EPS in most patients and intracardiac EPS in selected patients. EPS may furthermore prove useful in elderly patients with regular tachycardia, mainly by avoiding treatment based on an erroneous diagnosis. PMID:29304037

  6. Intrauterine management of fetal supraventricular tachycardia (SVT) with cardiac failure. (United States)

    Muniswaran, G; Japaraj, R P; Asri Ranga, A R; Cheong, H K


    Fetal arrhythmias are not uncommon in pregnancy. The diagnosis can be established on routine ultrasound scan. Fetal supraventricular tachycardia (SVT) is the most common cause of fetal tachycardia. If left undiagnosed and untreated, these fetuses may develop cardiac failure, hydrops fetalis and eventually death. We report two fetuses diagnosed antenatally to have fetal SVT. Both fetuses were in cardiac failure and were successfully treated with maternal administration of antiarrhythmic medications. Digoxin, and in severe instances, a combination with flecanaide significantly improved fetal outcomes and prevented fetal mortality. The long term prognosis of such patients are good.

  7. [Long QRS tachycardia secondary to Aconitum napellus alkaloid ingestion]. (United States)

    Gaibazzi, Nicola; Gelmini, Gian Paolo; Montresor, Graziano; Canel, Daniela; Comini, Teresa; Fracalossi, Claudio; Martinetti, Claudio; Poeta, Maria Luisa; Ziacchi, Vigilio


    The roots and seeds of the aconite (Aconitum napellus) contain alkaloids with modulatory activity on the sodium voltage-dependent channels; most fatal cases have been determined by ventricular tachycardia and respiratory paralysis. The only established treatment is supportive. We report a case of poisoning from Aconitum napellus, ingested by a husband and wife who thought the plant was "mountain chicory". They both had tachyarrhythmias, but the husband had more malignant episodes of hemodynamically unstable wide QRS tachycardia and respiratory paralysis requiring mechanical ventilation.

  8. Esmolol for the treatment of recurrent ventricular tachycardia

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    Simone Savastano


    Full Text Available Cardiac arrest and electrical storm are two major emergencies. The use of beta blockers in these clinical conditions has been proposed; however, definite data about the emergency use of beta blockers in recurrent ventricular tachycardia with pulse have never been published. We report two cases of recurrent ventricular tachycardia, which were unresponsive to the standard pharmacological treatment but successfully responsive to esmolol infusion. Both cases showed a reduced left ventricle ejection fraction due to an acute myocardial infarction and to an idiopathic dilated cardiomyopathy respectively. Nevertheless, the use of esmolol was shown to be both safe and effective without inducing low output syndrome.

  9. The mechanisms of atrial fibrillation in hyperthyroidism

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    Bielecka-Dabrowa Agata


    Full Text Available Abstract Atrial fibrillation (AF is a complex condition with several possible contributing factors. The rapid and irregular heartbeat produced by AF increases the risk of blood clot formation inside the heart. These clots may eventually become dislodged, causing embolism, stroke and other disorders. AF occurs in up to 15% of patients with hyperthyroidism compared to 4% of people in the general population and is more common in men and in patients with triiodothyronine (T3 toxicosis. The incidence of AF increases with advancing age. Also, subclinical hyperthyroidism is a risk factor associated with a 3-fold increase in development of AF. Thyrotoxicosis exerts marked influences on electrical impulse generation (chronotropic effect and conduction (dromotropic effect. Several potential mechanisms could be invoked for the effect of thyroid hormones on AF risk, including elevation of left atrial pressure secondary to increased left ventricular mass and impaired ventricular relaxation, ischemia resulting from increased resting heart rate, and increased atrial eopic activity. Reentry has been postulated as one of the main mechanisms leading to AF. AF is more likely if effective refractory periods are short and conduction is slow. Hyperthyroidism is associated with shortening of action potential duration which may also contribute to AF.

  10. Brugada ECG Pattern Unmasked by IV Flecainide in an Individual with Idiopathic Fascicular Ventricular Tachycardia

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    Andrew R. Gavin, MBChB


    Full Text Available A 45-year old man presents with stable monomorphic ventricular tachycardia. He had previously been diagnosed with idiopathic fascicular ventricular tachycardia. Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG. We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

  11. Harder Roads to Trek? Paradoxical Slowing of an Atrioventricular Reentrant Tachycardia With Contralateral Bundle Branch Block. (United States)

    Divakara Menon, Syamkumar M; Ayati, Maryam; Healey, Jeff S


    Slowing of the tachycardia with increase in cycle length and increase in VA time with ipsilateral bundle branch block is a characteristic feature of accessory pathway mediated AVRT. Contralateral bundle branch block has no effect on the tachycardia as it is not a part of the tachycardia circuit. We present an interesting phenomenon in which contralateral bundle branch block resulted in tachycardia slowing in a case of WPW syndrome. © 2016 Wiley Periodicals, Inc.

  12. Left bundle-branch block with right axis deviation--a unique aberrancy during supraventricular tachycardia. (United States)

    Lokhandwala, Yash; Panicker, Gopi Krishna; Shah, Mandar; Wellens, Hein J J


    A tachycardia with left bundle-branch block morphology and right axis deviation points to the diagnosis of ventricular tachycardia. Conversely, any supraventricular tachycardia with left bundle-branch block is typically associated with a normal or leftward QRS axis. We present the case of a 34-year-old man showing atrioventricular nodal reentrant tachycardia with left bundle-branch block/right axis deviation as an exception to this rule.

  13. Occlusion of left atrial appendage in patients with atrial fibrillation

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    О. Н. Ганеева


    Full Text Available The article reviews a new method of prophylaxis of thromboembolitic complications, specifically occlusion of left atrial appendage, in patients with atrial fibrillation. Indications and contraindications for the procedure, as well as a step-by-step process of the intervention itself are described. Special emphasis is placed on the up-to-date evidence and the review of clinical trials.

  14. Pharmacologic Therapy in the Elderly with Atrial Fibrillation

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    Shih-Huang Lee


    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia, and its prevalence significantly increases with age. Morphologic changes in the atrial myocardium associated with AF may result from underlying cardiovascular disease and/or physiologic aging processes. Congestive heart failure, tachycardia-induced cardiomyopathy and thromboembolic events resulting from AF are more common in elderly patients. It is important to assess any comorbidity and potential triggers of AF before considering pharmacologic therapy for AF. Proper rate control should include control in response to exercise, together with an avoidance of bradycardias and symptomatic pauses in patients with AF. Digoxin, β-blockers and calcium channel blockers can all be effective in controlling ventricular rate in elderly patients with AF. In the elderly, amiodarone is probably the safest drug for short-term administration to exert chemical cardioversion, facilitate electrical cardioversion, and prevent recurrence of AF. Warfarin has been shown to be highly effective in preventing stroke in the elderly with AF; however, many studies also have documented underuse of warfarin, may be because of the increased risk of warfarin-induced hemorrhage in such patients. These findings have raised concerns regarding quality of care, physician adherence to guidelines, and translation of clinical trial results into real-world practice in anticoagulation therapy in the elderly with AF. [International Journal of Gerontology 2008; 2(1: 1–6

  15. Slow-fast Form of Atrioventricular Nodal Reentrant Tachycardia with Unusual Retrograde Activation in the Right Atrium —Possible Conduction Disturbance across the Tendon of Todaro Related to the Genesis of Positive Component of Biphasic Retrograde P Wave—

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    Kazuya Ishibashi, MD


    Full Text Available We report a rare case of slow-fast form of atrioventricular nodal reentrant tachycardia with delayed activation in the low septal right atrium (His bundle area. During supraventricular tachycardia (SVT, electrocardiogram showed “pseudo-positive P waves” in II, III, and aVF leads. SVT was induced by atrial extrastimulus with marked AH prolongation (i.e., jump phenomenon. Ventricular pacing showed a decremental retrograde conduction without jump phenomenon. Double atrial potentials were observed in the His bundle area during SVT and during ventricular pacing. The first electrogram of these split potentials, which was the earliest activation during SVT and during ventricular pacing, showed a dull and small deflection, whereas the second electrogram was sharp and clear. The interval of these discrete potentials was 70 msec during SVT. After a standard slow pathway ablation, SVT could never be induced by any programmed stimuli. It was concluded that in this case, the conduction disturbance across the tendon of Todaro was likely to cause the delayed atrial activation in the His bundle area, which created the pseudo-positive (biphasic. retrograde P wave.

  16. Atrial fibrillation: inflammation in disguise?

    NARCIS (Netherlands)

    Lappegard, K.T.; Hovland, A.; Pop, G.A.M.; Mollnes, T.E.


    Atrial fibrillation is highly prevalent, and affected patients are at an increased risk of a number of complications, including heart failure and thrombo-embolism. Over the past years, there has been increasing interest in the role of inflammatory processes in atrial fibrillation, from the first

  17. Atrial fibrillation and female sex. (United States)

    Anselmino, Matteo; Battaglia, Alberto; Gallo, Cristina; Gili, Sebastiano; Matta, Mario; Castagno, Davide; Ferraris, Federico; Giustetto, Carla; Gaita, Fiorenzo


    Atrial fibrillation is the most common supraventricular arrhythmia. Its prevalence increases with age and preferentially affects male patients. Over 75 years of age, however, female patients being more prevalent, the absolute number of patients affected is similar between sexes. Despite this, few data are available in the literature concerning sex-related differences in atrial fibrillation patients. The present systematic review therefore considers comorbidities, referring symptoms, quality of life, pharmacological approaches and trans-catheter ablation in female rather than in male atrial fibrillation patients in search of parameters that may have an impact on the treatment outcome. In brief, female atrial fibrillation patients more commonly present comorbidities, leading to a higher prevalence of persistent atrial fibrillation; moreover, they refer to hospital care later and with a longer disease history. Atrial fibrillation symptoms relate to low quality of life in female patients; in fact, atrial fibrillation paroxysm usually presents higher heart rate, leading to preferentially adopt a rate rather than a rhythm-control strategy. Female atrial fibrillation patients present an increased risk of stroke, worsened by the lower oral anticoagulant prescription rate related to the concomitant higher haemorrhagic risk profile. Trans-catheter ablation is under-used in female patients and, on the contrary, they are more commonly affected by anti-arrhythmic drug side effects.

  18. Junctional ectopic tachycardia following repair of congenital heart ...

    African Journals Online (AJOL)

    Background: Postoperative junctional ectopic tachycardia (JET) is a rare and transient phenomenon occurring after repair of congenital heart defects. Report on this arrhythmia in the subregion is rare. We set out to determine the incidence of this arrhythmia and review the treatment and outcomes of treatment in our centre.

  19. Gender disparities in torsade de pointes ventricular tachycardia

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    Verkerk, A. O.; Wilders, R.; Tan, H. L.


    Background. Gender disparities in the incidence of torsade de pointes (TdP) ventricular tachycardia exist, but the mechanisms in humans are unresolved. We addressed this issue using a mathematical model of a human ventricular cell. Methods. We implemented gender differences in the Priebe-Beuckelmann

  20. Fetal Tachycardia Treated Successfully with Maternally Administered Propylthiouracil

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    Barbara V. Parilla


    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.

  1. Ivabradine for junctional ectopic tachycardia in post congenital heart surgery. (United States)

    Kumar, Vivek; Kumar, Gaurav; Joshi, Sajan; Sharma, Vipul

    We report two cases of malignant junctional ectopic tachycardia (JET), in infants following congenital heart surgery. After the failure of conventional therapy the arrhythmia was controlled by oral Ivabradine, a drug which is routinely used to lower heart rate in angina and heart failure in adult practice. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  2. Ivabradine in treatment of sinus tachycardia mediated vasovagal syncope. (United States)

    Sutton, Richard; Salukhe, Tushar V; Franzen-McManus, Ann-Christine; Collins, Andrea; Lim, Phang Boon; Francis, Darrel P


    Ivabradine, an I(f) current blocker, has shown promising results in treatment of postural orthostatic tachycardia syndrome (POTS). There is a subgroup of vasovagal syncope (VVS) patients, who demonstrate sinus tachycardia before collapse on tilt testing mimicking some features of POTS. These patients may also respond to ivabradine therapy. University Hospital Syncope Clinic where ivabradine was prescribed in a prospective fashion on humanitarian grounds between October 2008 and December 2011. Twenty-five patients of mean age 33±years presenting syncope in all and palpitation in 23, duration 9±years underwent tilt testing with reproduction of usual symptoms including tachycardia preceding collapse. Ivabradine was prescribed in doses of 5-20 mg/day, mean 10.7 mg, as once or twice daily medication. The response to treatment was classified as deterioration in none, no change in 5, improvement in 10, and symptoms abolished in 8 patients. Side effects were minimal; one patient required discontinuation. In this pilot study of ivabradine, in patients with VVS, of patients who demonstrated sinus tachycardia before collapse on tilt, 72% reported a marked benefit or complete resolution of symptoms. The drug was well tolerated. A randomized controlled trial against placebo is justified.

  3. A teenage fainter (dizziness, syncope, postural orthostatic tachycardia syndrome). (United States)

    Pilcher, Thomas A; Saarel, Elizabeth V


    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. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Amiodarone therapy for drug-refractory fetal tachycardia

    NARCIS (Netherlands)

    Strasburger, JF; Cuneo, BF; Michon, MM; Gotteiner, NL; Deal, BJ; McGregor, SN; Oudijk, MA; Meijboom, EJ; Feinkind, L; Hussey, M; Parilla, BV


    Background - Fetal tachycardia complicated by ventricular dysfunction and hydrops fetalis carries a significant risk of morbidity and mortality. Transplacental digoxin is effective therapy in a small percentage, but there is no consensus with regard to antiarrhythmic treatment if digoxin fails. This

  5. Effects of ventricular pacing-induced tachycardia on aortic mechanics in man. (United States)

    Stefanadis, C; Dernellis, J; Vavuranakis, M; Tsiamis, E; Vlachopoulos, C; Toutouzas, K; Diamandopoulos, L; Pitsavos, C; Toutouzas, P


    Effects of pacing-induced tachycardia on left ventricular function have been studied extensively. However, little attention has been focused on aortic elastic properties during heart rate increments. The aim was to determine the effects of right ventricular pacing on the aortic elastic properties. We studied 14 normal subjects (baseline blood pressure, 129/84 +/- 10/6 mmHg; aortic diameter, 23.5/21.3 +/- 2.4/1.9 mm) at rest, during rapid right ventricular pacing (at five stepwise heart rate increases of 20 bpm every 2 min) and after 5 min recovery. Shifts as well as changes in the slope and the stiffness constant of the pressure diameter (p-d) relation, derived from simultaneous tip-micromanometer aortic pressure recordings and high-fidelity ultrasonic intravascular aortic diameter recordings, were used as indices of aortic stiffness. Wave reflection was also studied. Aortic pulse pressure and strain significantly decreased after pacing-induced tachycardia (p < 0.0001 and < 0.05, respectively). During pacing, the slope of the linear p-d relation as well as the stiffness constant were decreased, followed by increases at recovery (p < 0.0001). The augmentation index and the aortoventricular coupling ratio were significantly decreased (p < 0.0001). Pacing-induced increases in pulse frequency may result in improved aortic distensibility and aortoventricular coupling.

  6. Chronic Atrial Fibrillation Ablation with Harmonic Scalpel during Mitral Valve Surgery

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    Alexandre Visconti Brick

    Full Text Available Abstract Objective To evaluate surgical treatment of chronic atrial fibrillation with ultrasound in patients with mitral valve disease, considering preoperative clinical characteristics of patients undergoing surgical procedure and follow-up in the immediate postoperative period, in hospital and up to 60 months after discharge. Methods: We studied 100 patients with chronic atrial fibrillation and mitral valve disease who underwent surgical treatment using ultrasound ablation. Patient data were reviewed by consulting the control reports, including signs and symptoms, underlying disease, functional class, hospital stay, surgical procedure time, ablation time, immediate complications, and complications at discharged and up to 60 months later. Actuarial curve (Kaplan-Meier was used for the study of permanence without recurrence after 12, 24, 36, 48 and 60 months. Results: 86% of the patients had rheumatic mitral valve disease, 14% had degeneration of the mitral valve, 40% had mitral regurgitation, and 36% had mitral stenosis. Main symptoms included palpitations related to tachycardia by chronic atrial fibrillation (70%, congestive heart failure (70%, and previous episodes of acute pulmonary edema (27%. Early results showed that 94% of the patients undergoing ultrasound ablation reversed the rate of chronic atrial fibrillation, 86% being in sinus rhythm and 8% in atrioventricular block. At hospital discharge, maintenance of sinus rhythm was observed in 86% of patients and there was recurrence of chronic atrial fibrillation in 8% of patients. At follow-up after 60 months, 83.8% of patients maintained the sinus rhythm. Conclusion: Surgical treatment of chronic atrial fibrillation with ultrasound concomitant with mitral valve surgery is feasible and satisfactory, with maintenance of sinus rhythm in most patients (83.8% after 60 months of follow-up.

  7. Catheter ablation of atrial fibrillation without the use of fluoroscopy. (United States)

    Reddy, Vivek Y; Morales, Gustavo; Ahmed, Humera; Neuzil, Petr; Dukkipati, Srinivas; Kim, Steve; Clemens, Janet; D'Avila, Andre


    In performing catheter ablation of paroxysmal atrial fibrillation (PAF), the advent of electroanatomical mapping (EAM) has significantly reduced fluoroscopy time. Recent advances in the ability of EAM systems to simultaneously visualize multiple catheters have allowed some operators to perform certain procedures, such as catheter ablation of supraventricular tachycardias, with zero fluoroscopy use. The purpose of this study was to evaluate the feasibility and safety of pulmonary vein (PV) isolation with zero fluoroscopy use, using a combination of three-dimensional EAM and intracardiac echocardiography (ICE). Using the NavX EAM system, the right atrial (RA) and coronary sinus (CS) geometries were created without fluoroscopy. Fluoroless transseptal puncture was performed under ICE guidance. Using a deflectable sheath and a multipolar catheter, the left atrial (LA) and PV anatomies were rendered and, in select cases, integrated with a three-dimensional computed tomography (CT) image. Irrigated radiofrequency ablation was performed to encircle each pair of ipsilateral PVs. This series included 20 consecutive PAF patients. RA/CS mapping required 5.5 ± 2.6 minutes. In all patients, single (n = 18) or dual (n = 2) transseptal access was successfully achieved. The LA-PV anatomy was rendered using either a circular (14 patients) or penta-array (six patients) catheter in 22 ± 10 minutes; CT image integration was used in 11 patients. Using 49 ± 18 ablation lesions/patient, electrical isolation was achieved in 38/39 ipsilateral PV isolating lesion sets (97%). The procedure time was 244 ± 75 minutes. There were no complications. Completely fluoroless catheter ablation of paroxysmal AF is safely feasible using a combination of ICE and EAM. Copyright © 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  8. Dementia and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Pastori, Daniele; Miyazawa, Kazuo; Lip, Gregory Y H


    The risk of developing dementia is increased in patients with atrial fibrillation (AF), with the incidence of both conditions increasing with aging. Patients with dementia frequently do not receiving adequate thrombo-prophylaxis, because of the inability to monitor INR and/or to achieve...... in therapeutic range during VKAs therapy, the assessment of cognitive impairment may help identify those patients who may benefit from switching to NOACs. In conclusion, patients with AF and dementia benefit from anticoagulation and should not be denied receiving adequate stroke prevention. Cognitive function...

  9. [Recurrent left atrial myxoma]. (United States)

    Moreno Martínez, Francisco L; Lagomasino Hidalgo, Alvaro; Mirabal Rodríguez, Roger; López Bermúdez, Félix H; López Bernal, Omaida J


    Primary cardiac tumors are rare. Mixomas are the most common among them; 75% are located in the left atrium, 20% in the right atrium, and the rest in the ventricles. The seldom appear in atrio-ventricular valves. Recidivant mixoma are also rare, appearing in 1-5% of all patients that have undergone surgical treatment of a mixoma. In this paper we present our experience with a female patient, who 8 years after having been operated of a left atrial mixoma, began with symptoms of mild heart failure. Transthoracic echocardiography revealed recurrence of the tumor, and was therefore subjected to a second open-heart surgery from which she recovered without complications.

  10. Long-term follow-up shows excellent transmural atrial lead performance in patients with complex congenital heart disease. (United States)

    Williams, Matthew R; Shepard, Suzanne M; Boramanand, Nicole K; Lamberti, John J; Perry, James C


    Many patients with congenital heart disease require permanent pacing for rhythm management but cannot undergo transvenous lead placement. In others, epicardial scarring prohibits adequate sensing and pacing thresholds using epicardial leads. This study describes long-term lead performance using a transmural atrial (epicardial to endocardial) pacing approach in patients with congenital heart disease. For transmural atrial (TMA) lead access, a bipolar, steroid-eluting transvenous lead was placed from the epicardium via purse-string incision or atriotomy and affixed to atrial endocardium. Records were reviewed for patient data and acute and long-term lead performance for TMA leads placed 1998 to 2004. Forty-two of 48 TMA leads remain active at last follow-up. Two leads fractured, 4 were functional at >5-year follow-up but no longer active. Freedom from lead failure 98% (95% confidence interval, 86%-100%) at mean follow-up 7.8 years. TMA leads gave excellent sensing and pacing characteristics at implant and chronically. Median acute and chronic sensing thresholds were 3 and 2.8 mV, respectively; median acute and chronic pacing thresholds at 0.5 ms were 0.9 and 0.7 V, respectively. TMA leads performed similarly in Fontan patients. Overdrive pacing for intra-atrial re-entrant tachycardia was successful in 7 of 8 patients. One patient with high baseline risk died of stroke 7 years after implant. No lead-associated thrombi were observed. TMA pacing leads had excellent longevity, initial, and chronic functional properties and provide an alternative to epicardial leads in patients with congenital heart disease. Patients who cannot receive transvenous leads, have epicardial scarring or have intra-atrial re-entrant tachycardia could benefit most from routine use of this technique. © 2014 American Heart Association, Inc.

  11. Abnormal Ca2+ homeostasis, atrial arrhythmogenesis and sinus node dysfunction in murine hearts modelling RyR2 modification

    Directory of Open Access Journals (Sweden)

    Yanmin eZhang


    Full Text Available RyR2 mutations are implicated in catecholaminergic polymorphic ventricular tachycardia thought to result from altered myocyte Ca2+ homeostasis reflecting inappropriate ‘leakiness’ of RyR2-Ca2+ release channels arising from increases in their basal activity, alterations in their phosphorylation, or defective interactions with other molecules or ions. The latter include calstabin, calsequestrin-2, Mg2+, and extraluminal or intraluminal Ca2+. Recent clinical studies additionally associate RyR2 abnormalities with atrial arrhythmias including atrial tachycardia, fibrillation and standstill, and sinus node dysfunction. Some RyR2 mutations associated with CPVT in mouse models also show such arrhythmias that similarly correlate with altered Ca2+ homeostasis. Some examples show evidence for increased Ca2+/calmodulin-dependent protein kinase II phosphorylation of RyR2. A homozygotic RyR2-P2328S variant demonstrates potential arrhythmic substrate resulting from reduced conduction velocity in addition to delayed afterdepolarizations and ectopic action potential firing. Finally, one model with an increased RyR2 activity in the sino-atrial node shows decreased automaticity in the presence of Ca2+-dependent decreases in ICa,L and diastolic sarcoplasmic reticular Ca2+ depletion.

  12. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. (United States)

    Sapp, John L; Wells, George A; Parkash, Ratika; Stevenson, William G; Blier, Louis; Sarrazin, Jean-Francois; Thibault, Bernard; Rivard, Lena; Gula, Lorne; Leong-Sit, Peter; Essebag, Vidal; Nery, Pablo B; Tung, Stanley K; Raymond, Jean-Marc; Sterns, Laurence D; Veenhuyzen, George D; Healey, Jeff S; Redfearn, Damian; Roux, Jean-Francois; Tang, Anthony S L


    Recurrent ventricular tachycardia among survivors of myocardial infarction with an implantable cardioverter-defibrillator (ICD) is frequent despite antiarrhythmic drug therapy. The most effective approach to management of this problem is uncertain. We conducted a multicenter, randomized, controlled trial involving patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite the use of antiarrhythmic drugs. Patients were randomly assigned to receive either catheter ablation (ablation group) with continuation of baseline antiarrhythmic medications or escalated antiarrhythmic drug therapy (escalated-therapy group). In the escalated-therapy group, amiodarone was initiated if another agent had been used previously. The dose of amiodarone was increased if it had been less than 300 mg per day or mexiletine was added if the dose was already at least 300 mg per day. The primary outcome was a composite of death, three or more documented episodes of ventricular tachycardia within 24 hours (ventricular tachycardia storm), or appropriate ICD shock. Of the 259 patients who were enrolled, 132 were assigned to the ablation group and 127 to the escalated-therapy group. During a mean (±SD) of 27.9±17.1 months of follow-up, the primary outcome occurred in 59.1% of patients in the ablation group and 68.5% of those in the escalated-therapy group (hazard ratio in the ablation group, 0.72; 95% confidence interval, 0.53 to 0.98; P=0.04). There was no significant between-group difference in mortality. There were two cardiac perforations and three cases of major bleeding in the ablation group and two deaths from pulmonary toxic effects and one from hepatic dysfunction in the escalated-therapy group. In patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite antiarrhythmic drug therapy, there was a significantly lower rate of the composite primary outcome of death, ventricular tachycardia storm, or appropriate ICD shock among

  13. ECG of the month. Irregular rhythm in a 25-year-old man with three prior cardiac operations. Coarse atrial fibrillation with a rapid ventricular response, left anterior fascicular block, left ventricular hypertrophy with repolarization abnormality. (United States)

    Glancy, D Luke; Ahmed, Jameel; Ayalloore, Siby G; LeLorier, Paul A; Diwan, Pranav M; Helmcke, Frederick R


    The patient underwent closure of an atrial septal defect at age 3, had a leaking "mitral" valve repaired at age 9, and at age 13 had a "mitral" valve replacement. He began taking warfarin sodium at that time and remained symptom-free until 10 days before his initial visit here when he presented to another hospital with dyspnea and palpitations. Treatment there consisted of lisinopril 10 mg qd, carvedilol 6.25 mg bid, aldactone 25 mg qd, furosemide 40 mg qd, digoxin 0.25 mg qd, and a continuation of warfarin sodium 7.5 mg qd. An echocardiogram showed a left ventricular ejection fraction of 20%. After diuresis, he was referred to our cardiology clinic. On his initial visit here, his heart rate was an irregular 120 beats/min, his blood pressure was 106/77 mmHg, and closing and opening snaps of a normally functioning mechanical mitral valvular prosthesis were heard. He was obese (height, 5' 9"; weight, 272 lbs). An electrocardiogram was recorded (Figure 1).

  14. Concomitant atrial fibrillation surgery for people undergoing cardiac surgery (United States)

    Huffman, Mark D; Karmali, Kunal N; Berendsen, Mark A; Andrei, Adin-Cristian; Kruse, Jane; McCarthy, Patrick M; Malaisrie, S C


    Background People with atrial fibrillation (AF) often undergo cardiac surgery for other underlying reasons and are frequently offered concomitant AF surgery to reduce the frequency of short- and long-term AF and improve short- and long-term outcomes. Objectives To assess the effects of concomitant AF surgery among people with AF who are undergoing cardiac surgery on short-term and long-term (12 months or greater) health-related outcomes, health-related quality of life, and costs. Search methods Starting from the year when the first “maze” AF surgery was reported (1987), we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March 2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database of Abstracts of Reviews of Effects (DARE, April 2015), and Health Technology Assessment Database (HTA, March 2016). We searched trial registers in April 2016. We used no language restrictions. Selection criteria We included randomised controlled trials evaluating the effect of any concomitant AF surgery compared with no AF surgery among adults with preoperative AF, regardless of symptoms, who were undergoing cardiac surgery for another indication. Data collection and analysis Two review authors independently selected studies and extracted data. We evaluated the risk of bias using the Cochrane ‘Risk of bias’ tool. We included outcome data on all-cause and cardiovascular-specific mortality, freedom from atrial fibrillation, flutter, or tachycardia off antiarrhythmic medications, as measured by patient electrocardiographic monitoring greater than three months after the procedure, procedural safety, 30-day rehospitalisation, need for post-discharge direct current cardioversion, health-related quality of life, and direct costs. We calculated risk ratios (RR) for dichotomous data with 95% confidence intervals (CI) using a fixed-effect model when heterogeneity was low (I2 ≤ 50%) and random

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

    DEFF Research Database (Denmark)

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


    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......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...... 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...

  16. Recurrent Ventricular Tachycardia in Sheehan’s Syndrome

    Directory of Open Access Journals (Sweden)

    Bashir Ahmad Laway


    Full Text Available Sheehan’s syndrome is one of the common causes of hypopituitarism in developing countries. Electrocardiographic (ECG abnormalities in Sheehan’s syndrome are not well documented. However, in hypopituitarism due to other causes, ECG findings include low-voltage QRS complex, ST segment depression, T-wave inversion and prolonged QT interval. We hereby describe a 45-year-old female who presented with a history of recurrent syncope for last three years. Electrocardiography revealed ventricular tachycardia, which reverted back with hormone replacement therapy. Since it is a common problem in our community, clinicians should consider Sheehan’s syndrome as an etiology of metabolic disturbances leading to ventricular tachycardia in women.

  17. Orthostatic intolerance: postural orthostatic tachycardia syndrome with overlapping vasovagal syncope. (United States)

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


    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.

  18. [Case of thyroid crisis with persistent tachycardia diagnosed postoperatively]. (United States)

    Tamada, Nao; Kasuya, Yohei; Yorozu, Tomoko; Iijima, Takehiko; Iwao, Yasuhide


    A 35-year-old man with multiple bone fractures underwent an emergency operation. On arriving at the operating room, his heart rate was 160 beats x min(-1), and blood pressure was 100/50 mmHg. We anesthetized him with oxygen, sevoflurane, fentanyl and remifentanil. We suspected hypovolemia, and treated him with crystalloid and transfused red cells and fresh frozen plasma so that heart rate and blood pressure could be stabilized. Tachycardia of 140 beats x min(-1) persisted, and landiolol was continuously administered at a rate of 5-10 mg x hr(-1) after a 2.5 mg bolus injection. Heart rate became controlled around 120 beats x min(-1) without hypotension during anesthesia. Finally, we noticed thyroid crisis in this case, and diagnosed it with laboratory data after operation. We should be aware that atypical tachycardia is caused by thyroid crisis.

  19. Postural Tachycardia Syndrome: A Heterogeneous and Multifactorial Disorder (United States)

    Benarroch, Eduardo E.


    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

  20. Management of postoperative junctional ectopic tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland. (United States)

    Entenmann, Andreas; Michel, Miriam; Herberg, Ulrike; Haas, Nikolaus; Kumpf, Matthias; Gass, Matthias; Egender, Friedemann; Gebauer, Roman


    Postoperative junctional ectopic tachycardia (JET) is a frequent complication after pediatric cardiac surgery. Current recommendations on how and when to treat JET are inconsistent. We evaluated the management strategies of postoperative JET in German-speaking countries. We sent an online survey to 30 centers of pediatric cardiology that perform surgery for congenital heart defects in Germany (24), Austria (4), and Switzerland (2). The survey asked 18 questions about how and in what treatment sequence postoperative JET was managed. All 30 centers completed the survey (100% return rate). There was general agreement that the management of JET is based on administration of antiarrhythmic drugs, body surface cooling, and temporary pacing. Many centers presented treatment algorithms based on published literature, all centers named amiodarone as the first drug of choice. Significant disagreement was found concerning the timing and sequential order of additional therapeutic measures and particularly about the dosing of amiodarone and the role of R-wave synchronized atrial pacing. This survey reveals that from center to center, the treatment of postoperative JET may vary substantially. Future work should focus on those treatment modalities where a high rate of variation is found. Such studies may be of value to achieve commonly adopted treatment recommendations. What is known: • Treatment of postoperative junctional ectopic tachycardia is predominantly based on administration of antiarrhythmic drugs, therapeutic cooling, and temporary pacing. • Amiodarone is the antiarrhythmic drug of choice in this context. What is new: • Dosing and duration of administration of amiodarone differ relevantly from center to center. • The sequential order of drug administration, therapeutic cooling, and pacing is not consistent.

  1. Familial orthostatic tachycardia due to norepinephrine transporter deficiency (United States)

    Robertson, D.; Flattem, N.; Tellioglu, T.; Carson, R.; Garland, E.; Shannon, J. R.; Jordan, J.; Jacob, G.; Blakely, R. D.; Biaggioni, I.


    Orthostatic intolerance (OI) or postural tachycardia syndrome (POTS) is a syndrome primarily affecting young females, and is characterized by lightheadedness, palpitations, fatigue, altered mentation, and syncope primarily occurring with upright posture and being relieved by lying down. There is typically tachycardia and raised plasma norepinephrine levels on upright posture, but little or no orthostatic hypotension. The pathophysiology of OI is believed to be very heterogeneous. Most studies of the syndrome have focused on abnormalities in norepinephrine release. Here the hypothesis that abnormal norepinephrine transporter (NET) function might contribute to the pathophysiology in some patients with OI was tested. In a proband with significant orthostatic symptoms and tachycardia, disproportionately elevated plasma norepinephrine with standing, impaired systemic, and local clearance of infused tritiated norepinephrine, impaired tyramine responsiveness, and a dissociation between stimulated plasma norepinephrine and DHPG elevation were found. Studies of NET gene structure in the proband revealed a coding mutation that converts a highly conserved transmembrane domain Ala residue to Pro. Analysis of the protein produced by the mutant cDNA in transfected cells demonstrated greater than 98% reduction in activity relative to normal. NE, DHPG/NE, and heart rate correlated with the mutant allele in this family. CONCLUSION: These results represent the first identification of a specific genetic defect in OI and the first disease linked to a coding alteration in a Na+/Cl(-)-dependent neurotransmitter transporter. Identification of this mechanism may facilitate our understanding of genetic causes of OI and lead to the development of more effective therapeutic modalities.

  2. Neuronal and Hormonal Perturbations in Postural Tachycardia Syndrome

    Directory of Open Access Journals (Sweden)

    Philip L Mar


    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.

  3. Screening for Atrial Fibrillation

    DEFF Research Database (Denmark)

    Freedman, Ben; Camm, A. John; Calkins, Hugh


    in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health......Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed...... or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace...

  4. Idiopathic giant right atrial aneurysm (United States)

    Uppu, Santosh C; Sachdeva, Ritu; Imamura, Michiaki


    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. PMID:23626440

  5. Efficacy of antiarrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias. (United States)

    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


    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 maintaining sinus rhythm after conversion. This was a multicenter retrospective study including adults with CHD and first-onset SVT from January 2008 to January 2011. First-onset SVT occurred in 92 of 7,171 patients without previous SVT (mean age 51 ± 16 years, 57% women). SVTs included atrial fibrillation and flutter in >80% of the patients. Most of these patients had septal defects (50%) and left-sided lesions (21%). The acute management of SVTs resulted in sinus rhythm in 83 patients, and 89% of these patients were instituted on oral antiarrhythmics to prevent SVT recurrence. After a mean follow-up of 2.5 ± 1.4 years, only 45% of the patients were free from SVT. Class III antiarrhythmics (85% sotalol and 15% amiodarone) were associated with a significantly lesser risk of SVT recurrence compared with all other antiarrhythmic drugs (hazard ratio 0.5, 95% confidence interval 0.27 to 0.96, p = 0.036). However, adverse effects of medication occurred in 22% of the patients, mainly in patients taking amiodarone. In conclusion, in adults with CHD and first-onset SVTs, class III antiarrhythmics are more efficacious in maintaining sinus rhythm after cardioversion than other antiarrhythmics. Sotalol may be considered as the first-choice therapy as this is associated with fewer adverse effects than amiodarone. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Re-entry using anatomically determined isthmuses: a curable ventricular tachycardia in repaired congenital heart disease. (United States)

    Kapel, Gijsbert F L; Reichlin, Tobias; Wijnmaalen, Adrianus P; Piers, Sebastiaan R D; Holman, Eduard R; Tedrow, Usha B; Schalij, Martin J; Stevenson, William G; Zeppenfeld, Katja


    Ventricular tachycardia (VT) is an important cause of late morbidity and mortality in repaired congenital heart disease. The substrate often includes anatomic isthmuses that can be transected by radiofrequency catheter ablation similar to isthmus block for atrial flutter. This study evaluates the long-term efficacy of isthmus block for treatment of re-entry VT in adults with repaired congenital heart disease. Thirty-four patients (49±13 years; 74% male) with repaired congenital heart disease who underwent radiofrequency catheter ablation of VT in 2 centers were included. Twenty-two (65%) had a preserved left and right ventricular function. Patients were inducible for 1 (interquartile range, 1-2) VT, median cycle length: 295 ms (interquartile range, 242-346). Ablation aimed to transect anatomic isthmuses containing VT re-entry circuit isthmuses. Procedural success was defined as noninducibility of any VT and transection of the anatomic isthmus and was achieved in 25 (74%) patients. During long-term follow-up (46±29 months), all patients with procedural success (18/25 with internal cardiac defibrillators) were free of VT recurrence but 7 of 18 experienced internal cardiac defibrillator-related complications. One patient with procedural success and depressed cardiac function received an internal cardiac defibrillator shock for ventricular fibrillation. None of the 18 patients (12/18 with internal cardiac defibrillators) with complete success and preserved cardiac function experienced any ventricular arrhythmia. In contrast, VT recurred in 4 of 9 patients without procedural success. Four patients died from nonarrhythmic causes. In patients with repaired congenital heart disease with preserved ventricular function and isthmus-dependent re-entry, VT isthmus ablation can be curative. © 2014 American Heart Association, Inc.

  7. A new cryoenergy for ventricular tachycardia ablation: a proof-of-concept study. (United States)

    Berte, Benjamin; Sacher, Frédéric; Wielandts, Jean-Yves; Mahida, Saagar; Pillois, Xavier; Weerasooriya, Rukshen; Bernus, Olivier; Jaïs, Pierre


    Lack of transmural lesion formation during radiofrequency (RF) ablation for ventricular tachycardia (VT) is an important determinant of arrhythmia recurrence. The aim of this proof-of-concept study was to evaluate safety and efficacy of a new and more powerful cryoablation system for ventricular ablation. Five healthy female sheep (59 ± 6 kg) underwent a surgical sternotomy for epicardial and endocardial access [endocardial access via right atrial appendage and left ventricular (LV) apex]. A cryoablation system with liquid nitrogen (IceCure) was used to create 3 min freezes at the right ventricle (RV). Left ventricular cryoablation was performed with either a 6 min or 2 × 4 min freezes. To assess safety, ablation was also performed on the mid left anterior descending artery and the proximal coronary sinus. A total of 45 lesions were created (RV epicardial, n = 12; LV epicardial, n = 18; RV endocardial, n = 7; LV endocardial, n = 8; LAD, n = 4; and CS, n = 4). The mean lesion volume was 5055 ± 92 mm3 (length: 32 ± 4.6 mm, width: 16.0 ± 6.4 mm, and depth: 11.2 ± 4.4 mm). Lesions were transmural in 28/45 (62%) and >10 mm in depth in 35/45 (78%). Of the endocardial lesions, 12/15 were transmural (80%). There was no benefit of the bonus freeze in LV lesions (6 vs. 2 × 4 min: 6790 ± 44 vs. 5595 ± 63 mm3; P = 0.44). All ablated vascular structures appeared macroscopically normal without acute stenosis. One animal died due to incessant Ventricular fibrillation (VF). Our results indicate that a more powerful cryoablation system is able to create large, transmural ventricular lesions from both the endocardium and the epicardium. The technology may hold potential for both surgical and catheter-based VT ablation in humans.

  8. Clinical Benefit of Ablating Localized Sources for Human Atrial Fibrillation: The Indiana University FIRM Registry. (United States)

    Miller, John M; Kalra, Vikas; Das, Mithilesh K; Jain, Rahul; Garlie, Jason B; Brewster, Jordan A; Dandamudi, Gopi


    Mounting evidence shows that localized sources maintain atrial fibrillation (AF). However, it is unclear in unselected "real-world" patients if sources drive persistent atrial fibrillation (PeAF), long-standing persistent atrial fibrillation (LPeAF), or paroxysmal atrial fibrillation (PAF); if right atrial sites are important; and what the long-term success of source ablation is. The aim of this study was to analyze the role of rotors and focal sources in a large academic registry of consecutive patients undergoing source mapping for AF. One hundred seventy consecutive patients (mean age 59 ± 12 years, 79% men) with PAF (37%), PeAF (31%), or LPeAF (32%). Of these, 73 (43%) had undergone at least 1 prior ablation attempt (mean 1.9 ± 0.8; range: 1 to 4). Focal impulse and rotor modulation (FIRM) with an endocardial basket catheter was used in all cases. FIRM analysis revealed sources in the right atrium in 85% of patients (1.8 ± 1.3) and in the left atrium in 90% of patients (2.0 ± 1.3). FIRM ablation terminated AF to sinus rhythm or atrial flutter or tachycardia in 59% (PAF), 37% (PeAF), and 19% (LPeAF) of patients, with 15 of 67 terminations due to right atrial ablation. On follow-up, freedom from AF after a single FIRM procedure for the entire series was 95% (PAF), 83% (PeAF), and 82% (LPeAF) at 1 year and freedom from all atrial arrhythmias was 77% (PAF), 75% (PeAF), and 57% (LPeAF). In the Indiana University FIRM registry, FIRM-guided ablation produced high single-procedure success, mostly in patients with nonparoxysmal AF. Data from mapping, acute terminations, and outcomes strongly support the mechanistic role of biatrial rotors and focal sources in maintaining AF in diverse populations. Randomized trials of FIRM-guided ablation and mechanistic studies to determine how rotors form, progress, and regress are needed. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. Pitx2c increases in atrial myocytes from chronic atrial fibrillation patients enhancing IKs and decreasing ICa,L. (United States)

    Pérez-Hernández, Marta; Matamoros, Marcos; Barana, Adriana; Amorós, Irene; Gómez, Ricardo; Núñez, Mercedes; Sacristán, Sandra; Pinto, Ángel; Fernández-Avilés, Francisco; Tamargo, Juan; Delpón, Eva; Caballero, Ricardo


    Atrial fibrillation (AF) produces rapid changes in the electrical properties of the atria (electrical remodelling) that promote its own recurrence. In chronic AF (CAF) patients, up-regulation of the slow delayed rectifier K(+) current (IKs) and down-regulation of the voltage-gated Ca(2+) current (ICa,L) are hallmarks of electrical remodelling and critically contribute to the abbreviation of action potential duration and atrial refractory period. Recent evidences suggested that Pitx2c, a bicoid-related homeodomain transcription factor involved in directing cardiac asymmetric morphogenesis, could play a role in atrial remodelling. However, its effects on IKs and ICa,L are unknown. Real-time quantitative polymerase chain reaction analysis showed that Pitx2c mRNA expression was significantly higher in human atrial myocytes from CAF patients than those from sinus rhythm patients. The expression of Pitx2c was positively and negatively correlated with IKs and ICa,L densities, respectively. Expression of Pitx2c in HL-1 cells increased IKs density and reduced ICa,L density. Luciferase assays demonstrated that Pitx2c increased transcriptional activity of KCNQ1 and KCNE1 genes. Conversely, its effects on ICa,L could be mediated by the atrial natriuretic peptide. Our results demonstrated for the first time that CAF increases Pitx2c expression in isolated human atrial myocytes and suggested that this transcription factor could contribute to the CAF-induced IKs increase and ICa,L reduction observed in humans. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email:

  10. Active Atrial Function and Atrial Scar Burden After Multiple Catheter Ablations of Persistent Atrial Fibrillation. (United States)

    Nührich, Jana M; Geisler, Anne C; Steven, Daniel; Hoffmann, Boris A; Schäffer, Benjamin; Lund, Gunnar; Stehning, Christian; Radunski, Ulf K; Sultan, Arian; Schwarzl, Michael; Adam, Gerhard; Willems, Stephan; Muellerleile, Kai


    Extensive and repeated substrate modification (SM) is frequently performed as an ablation strategy in persistent atrial fibrillation (persAF). The effect of these extended ablation strategies on atrial function has not been investigated sufficiently so far. The purpose was to assess atrial function by cardiac magnetic resonance (CMR) and its association with left atrial (LA) scar burden by electroanatomical voltage-mapping after multiple persAF ablation procedures. We included 16 persAF patients who had ≥2 SM procedures and a control group (CG) of 21 persAF patients without prior ablation. CMR was performed in sinus rhythm at least 4 weeks after the last cardioversion. Active left and right (RA) atrial emptying fractions (AEF) as well as peak active left atrial appendage (LAA) emptying velocities were obtained by CMR flow measurements. Furthermore, LA scar burden was quantified on electroanatomical voltage maps by the portion of points with local voltage amplitude scar burden to be higher (40 [20-68] vs nine [3-18] %, P scar burden after multiple extensive persAF ablations. ©2016 Wiley Periodicals, Inc.

  11. Bidirectional ventricular tachycardia with myocardial infarction: A case report with insight on mechanism and treatment


    Wase, Abdul; Masood, Abdul-Mannan; Garikipati, Naga V.; Mufti, Omar; Kabir, Anwarul


    Bidirectional ventricular tachycardia (BVT) is a rare variety of tachycardia with morphologically distinct presentation: The QRS axis and/or morphology is alternating in the frontal plane leads. Since its original description in association with digitalis,1 numerous cases of this fascinating tachycardia with disparate etiologies and mechanisms have been postulated. We report a patient with BVT in association with non-ST elevation myocardial infarction and severe cardiomyopathy in the absence ...

  12. Atrial natriuretic peptide (ANP)-granules: ultrastructure ...

    African Journals Online (AJOL)



    ANP) are present in the four regions of the atrial-auricular complex (two atria and two auricles). ANP-immunoreactivity was detected in all granules from the four regions. Ultrastructurally, atrial myocytes show the presence of very ...

  13. Atrial fibrillation in KCNE1-null mice

    NARCIS (Netherlands)

    Temple, Joel; Frias, Patricio; Rottman, Jeffrey; Yang, Tao; Wu, Yuejin; Verheijck, E. Etienne; Zhang, Wei; Siprachanh, Chanthaphaychith; Kanki, Hideaki; Atkinson, James B.; King, Paul; Anderson, Mark E.; Kupershmidt, Sabina; Roden, Dan M.


    Although atrial fibrillation is the most common serious cardiac arrhythmia, the fundamental molecular pathways remain undefined. Mutations in KCNQ1, one component of a sympathetically activated cardiac potassium channel complex, cause familial atrial fibrillation, although the mechanisms in vivo are

  14. A Large Right Atrial Myxoma Associated with Atrial Flutter Rhythm

    Directory of Open Access Journals (Sweden)

    Onursal Buğra


    Full Text Available A 22 year-old man presented to the emergency unit with the complaint of difficulty in breathing. In the physical exam, dyspnea and orthopnea were found. In the electocardiographic exam (ECG atrial flutter rhythm was seen. The transthoracic echocardiographic exam revealed a large atrial mass that was originating from interatrial septum. During surgery, complete surgical removal of the right atrial mass was successfully performed under moderate hypothermia. Histological investigations revealed a mass of 15 x 3 cm in diameter and the pathological examination showed that the lesion is a myxoma. Twelve months after surgical excision, clinical and chocardiographicalfollow-up showed a satisfactory exercise tolerance, sinus rhythm in ECG exam, and cardiac functions within normal limits.

  15. Identifying non-inducible ventricular tachycardia origin utilizing defibrillator electrograms. (United States)

    Tschabrunn, Cory M; Anter, Elad; Marchlinski, Francis E


    Developing an ablation strategy when the clinical arrhythmia cannot be induced is a challenge. A 72-year-old man is transferred to our facility for ventricular tachycardia (VT) storm. Endocardial and epicardial voltage mapping was normal and program stimulation failed to induce any arrhythmias. Implantable cardioverter-defibrillators (ICD) electrograms (EGMs) were recorded while pacing and compared to the stored clinical events. Ablation lesions were delivered across a narrow area of matching ICD EGM pace maps. The patient has remained arrhythmia free for 11 months. ICD EGMs may be useful in facilitating successful VT ablation when the clinical arrhythmia cannot be induced in the EP lab.

  16. Atrioventricular nodal reentrant tachycardia ablation and inferior vena cava agenesis. (United States)

    Galand, Vincent; Pavin, Dominique; Behar, Nathalie; Mabo, Philippe; Martins, Raphaël P


    Congenital anomalies of the inferior vena cava (IVC) are rare and very often diagnosed in asymptomatic patients during computed tomography performed for other purposes. These anomalies can have significant clinical implications, for example if electrophysiology procedures are needed. Diagnostic and ablation procedures are difficult since catheter manipulation and positioning are more complex. We present here a case of successful atrioventricular nodal reentrant tachycardia ablation in a patient with unexpected IVC agenesis, using an azygos route. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Treatment of persistent ventricular tachycardia: Drugs or ablation? (United States)

    MacIntyre, Ciorsti J; Sapp, John L


    Implantable cardioverter defibrillators (ICDs) reduce the mortality risk associated with recurrent ventricular tachycardia (VT) and can frequently terminate VT episodes painlessly, but do not prevent recurrent episodes. For patients with symptomatic recurrences, frequent asymptomatic recurrences, ICD shocks, or VT storm, most clinicians recommend strategies to suppress VT. The proarrhythmic mortality risk of antiarrhythmic drugs (AADs) may be mitigated by the presence of an ICD, but these medications are limited by high recurrence rates, and unfavorable side effect profiles. Catheter ablation is an alternative or adjunctive option, but is also limited by incomplete efficacy and procedural risk. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Postural tachycardia syndrome with asystole on head-up tilt. (United States)

    Alshekhlee, Amer; Guerch, Meziane; Ridha, Faisal; Mcneeley, Kevin; Chelimsky, Thomas C


    Enhanced sympathetic activity causes an exaggerated heart rate response to standing in the postural tachycardia syndrome (POTS). All patients describe symptoms of orthostatic intolerance such as dizziness, blurred vision, shortness of breath, palpitations, tremulousness, chest discomfort, headache, lightheadedness and nausea, but only one third suffer loss of consciousness. We report four patients with POTS, who had long ventricular pauses (i.e. asystole) and syncope during head-up tilt test. This suggests that a subset of patients with POTS can have a surge in parasympathetic outflow that precedes vasovagal syncope.

  19. Catheter Ablation for Ventricular Tachycardia in Patients with Nonischemic Cardiomyopathy. (United States)

    Thompson, Nathaniel; Frontera, Antonio; Takigawa, Masateru; Cheniti, Ghassen; Massoullie, Gregoire; Cochet, Hubert; Denis, Arnaud; Chaumeil, Arnaud; Derval, Nicolas; Hocini, Meleze; Haissaguerre, Michel; Jais, Pierre; Sacher, Frederic


    Although catheter ablation has been successful in reducing the recurrence of ventricular tachycardia in patients with ischemic disease, outcomes in patients with nonischemic cardiomyopathy (NICM) have not met with the same results. Success is predicated on a methodical approach to diagnosis of disease type and identification of critical substrate, and the ablation strategies used. Cardiac MRI with delayed enhancement is able to identify areas of substrate involvement, particularly in situations when conventional catheter mapping is not able to do so. Radiofrequency needle, irrigated bipolar radiofrequency, and transcoronary alcohol ablation are effective and alternative techniques to endocardial and epicardial ablation. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. What Next After Failed Septal Ventricular Tachycardia Ablation?

    Directory of Open Access Journals (Sweden)

    Laurent Roten, MD


    Full Text Available Ablation of ventricular tachycardia (VT by conventional radiofrequency ablation can be impossible if the ventricular wall at the targeted ablation site is very thick, as for example the ventricular septum. We present a case of a patient with incessant, non-sustained slow VT originating from the septal part of the lower outflow tracts. Radiofrequency catheter ablation from both ventricles as well as from the anterior cardiac vein were not successful. Both high power radiofrequency ablation and bipolar radiofrequency ablation neither were successfull. Finally, ethanol ablation of the first septal perforator successfully terminated arrhythmia. We discuss the possibilities to overcome failed conventional radiofrequency VT ablation of a septal focus.

  1. Tachycardia-Induced J-Wave Changes in Patients With and Without Idiopathic Ventricular Fibrillation. (United States)

    Aizawa, Yoshiyasu; Takatsuki, Seiji; Nishiyama, Takahiko; Kimura, Takehiro; Kohsaka, Shun; Kaneko, Yoshiaki; Inden, Yasuya; Takahashi, Naohiko; Nagase, Satoshi; Aizawa, Yoshifusa; Fukuda, Keichi


    To know the underlying mechanisms of J waves, the response to atrial pacing was studied in patients with idiopathic ventricular fibrillation (IVF) and patients with non-IVF. In 8 patients with IVF, the J-wave amplitude was measured before, during, and after atrial pacing. All patients had episodes of ventricular fibrillation without structural heart disease. The responses of J waves were compared with those of the 17 non-IVF control subjects who revealed J waves but no history of cardiac arrest and underwent electrophysiological study. The IVF patients were younger than the non-IVF patients (28±10 versus 52±14 years, respectively; P=0.002) and had larger J waves with more extensive distribution. J waves decreased from 0.35±0.26 to 0.22±0.23 mV (P=0.025) when the RR intervals were shortened from 782±88 to 573±162 ms (P=0.001). A decrease (≥0.05 mV) in the J-wave amplitude was observed in 6 of the 8 patients. In addition, 1 patient showed a distinct reduction of J waves in the unipolar epicardial leads. In contrast, J waves were augmented in the 17 non-IVF subjects from 0.27±0.09 to 0.38±0.10 mV (PJ waves to rapid pacing suggest different mechanisms: early repolarization in IVF patients and conduction delay in non-IVF patients. The response to atrial pacing was different between the IVF and non-IVF patients, which suggests the presence of different mechanisms for the genesis of J waves. © 2017 American Heart Association, Inc.

  2. Effects of enhanced parasympathetic tone on atrioventricular nodal conduction during atrioventricular nodal reentrant tachycardia. (United States)

    Belz, M K; Stambler, B S; Wood, M A; Pherson, C; Ellenbogen, K A


    The effects of various physiologic and pharmacologic stimuli on the anterograde slow pathway in patients with atrioventricular nodal reentrant tachycardia are well characterized. We sought to further characterize the nature of anterograde and retrograde conduction during tachycardia and to define the differential input of the parasympathetic nervous system to these pathways. A custom-made neck suction collar was placed to stimulate the carotid body baroreceptors during supraventricular tachycardia. Neck suction at -60 mm Hg was applied and changes in tachycardia cycle length, AH, and ventriculoatrial intervals were measured in 20 patients. These measurements were repeated after intravenous administration of 10 mg of edrophonium to enhance vagal tone. We observed a 15 +/- 6 ms increase in tachycardia cycle length from baseline (p <0.0001) and a 14 +/- 6 ms increase in AH interval (p <0.0001), but no change in the VA interval with neck suction alone. The tachycardia cycle length prolonged 26 +/- 55 ms (p <0.0001) with edrophonium and an additional 12 +/- 43 ms (p <0.001) with neck suction after edrophonium. There was no change in the VA interval before or after edrophonium during neck suction. There were 10 tachycardia terminations in 8 patients during anterograde slow pathway block during neck suction, with tachycardia cycle length prolongation and mean AH prolongation before termination of 45 +/- 37 ms (vs 15 +/- 7 ms increase in AH interval without tachycardia termination, p = 0.10). There were 12 tachycardia terminations in 4 patients with retrograde block during neck suction, only after edrophonium, without any preceding change in tachycardia cycle length during 11 episodes. We conclude that anterograde slow pathway demonstrates gradual conduction slowing with parasympathetic enhancement, whereas retrograde fast pathway responds with abrupt block.

  3. Calcium signalling silencing in atrial fibrillation. (United States)

    Greiser, Maura


    Subcellular calcium signalling silencing is a novel and distinct cellular and molecular adaptive response to rapid cardiac activation. Calcium signalling silencing develops during short-term sustained rapid atrial activation as seen clinically during paroxysmal atrial fibrillation (AF). It is the first 'anti-arrhythmic' adaptive response in the setting of AF and appears to counteract the maladaptive changes that lead to intracellular Ca(2+) signalling instability and Ca(2+) -based arrhythmogenicity. Calcium signalling silencing results in a failed propagation of the [Ca(2+) ]i signal to the myocyte centre both in patients with AF and in a rabbit model. This adaptive mechanism leads to a substantial reduction in the expression levels of calcium release channels (ryanodine receptors, RyR2) in the sarcoplasmic reticulum, and the frequency of Ca(2+) sparks and arrhythmogenic Ca(2+) waves remains low. Less Ca(2+) release per [Ca(2+) ]i transient, increased fast Ca(2+) buffering strength, shortened action potentials and reduced L-type Ca(2+) current contribute to a substantial reduction of intracellular [Na(+) ]. These features of Ca(2+) signalling silencing are distinct and in contrast to the changes attributed to Ca(2+) -based arrhythmogenicity. Some features of Ca(2+) signalling silencing prevail in human AF suggesting that the Ca(2+) signalling 'phenotype' in AF is a sum of Ca(2+) stabilizing (Ca(2+) signalling silencing) and Ca(2+) destabilizing (arrhythmogenic unstable Ca(2+) signalling) factors. Calcium signalling silencing is a part of the mechanisms that contribute to the natural progression of AF and may limit the role of Ca(2+) -based arrhythmogenicity after the onset of AF. © 2017 The Authors. The Journal of Physiology © 2017 The Physiological Society.

  4. AV nodal reentrant tachycardia or AV reentrant tachycardia using a concealed bypass tract-related adverse events. (United States)

    Brembilla-Perrot, Béatrice; Bénichou, Maxime; Brembilla, Alice; Bozec, Erwan; Dorlet, Sarah; Sellal, Jean Marc; Olivier, Arnaud; Manenti, Vladimir; Villemin, Thibaut; Beurrier, Daniel; Moulin-Zinsch, Anne; De Chillou, Christian; Girerd, Nicolas


    To jointly study paroxysmal supraventricular tachycardia (SVT)-related adverse events (AE) and ablation-related complications, with specific emphasis on the predictors of SVT-related AE as well as their significance by investigating their association with long-term mortality. 1770 patients were included, aged 6 to 97, with either atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic atrioventricular reciprocal tachycardia (AVRT) mediated by concealed accessory pathway, consecutively referred for SVT work-up in a tertiary care center. SVT-related AE were identified in 339 patients (19%). Major AEs were identified in 23 patients (1%; 15 cardiac arrests or ventricular arrhythmias requiring cardioversion and 8 hemodynamic collapses). Other AE were related to syncope (n=236), acute coronary syndrome (n=57) and heart failure/rhythmic cardiomyopathy (n=21). In multivariable analysis, higher age, heart disease and requirement of isoproterenol to induce SVT were independently associated with a higher risk for SVT-related AE. During follow-up (2.8±3.0years), death occurred more frequently in patients with SVT-related AE, especially in patients with major adverse events (pSVT-related AE remained significantly associated with occurrence of death (HR=6.72, IC=(2.58-17.52), pSVT-related AE in the whole population referred for SVT were more frequent than immediate major ablation complications in patients undergoing SVT ablation (5/1186 vs. 23/1770, p=0.02). SVT-related AE are independent predictors of mortality and are more frequent than immediate major ablation complications in patients undergoing SVT ablation. The present findings support systematically performing SVT ablation in patients with SVT-related adverse events. Copyright © 2015. Published by Elsevier Ireland Ltd.

  5. CT findings of atrial myxoma

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    Tsuchiya, F.; Kohno, A.; Saitoh, R.; Shigeta, A.


    The computed tomographic (CT) appearance of six atrial myxomas was analyzed. Five of the myxomas were located in the left atrium and one was in the right atrium. The margin of the myxoma was at least slightly lobulated in five cases and the content was inhomogeneous in all. Calcification was demonstrated in three cases. The site of attachment of the myxoma was demonstrated by CT to be the arial septum in all cases. The CT finding correlated well with the operative findings. It is concluded that it is possible with CT to diagnose atrial myxoma by the location and nature of the intracardiac mass and to differentiate it from thrombus.

  6. Abnormal atrial activation in young patients with lone atrial fibrillation

    DEFF Research Database (Denmark)

    Holmqvist, Fredrik; Olesen, Morten S; Tveit, Arnljot


    -wave morphology distribution was seen between patients with early-onset, lone paroxysmal AF and age- and gender-matched healthy control subjects. This finding indicates that alterations in atrial electrophysiology are common in the early stage of the arrhythmia, and since it occurs in young patients without co...

  7. [Congenital junctional ectopic tachycardia. Pharmacologic management during infancy]. (United States)

    Benjamín, Mónica N; Infante, Juan; Olmedo, Julián; Abello, Mauricio; Moltedo, José M


    Congenital junctional ectopic tachycardia (JET) is a rare arrhythmia that can be refractory to medical therapy with high morbidity and mortality rates. The aim of this study was to report our experience with pharmacologic management of congenital JET in infants. Seven patients with congenital JET were identified between 2008 and 2010. Only two of them presented dilated cardiomyopathy. There were no congenital structural defects. Amiodarone was given to all the patients, as single therapy in one, and in combination with propranolol in four. In one patient flecainide was administered together with amiodarone and propranolol, and in another patient was used combined with amiodarone. During follow- up with an average time of 12.2 months (median 9.75 months, range 1-28 months), sinus rhythm alternating with slow junctional tachycardia was successfully achieved in 3 patients; no side effects were detected. There was only one death in our study group. The combination of different antiarrhythmics (amiodarone plus propranolol, and eventually flecainide) is a valid option for rhythm control and management of JET in infants.

  8. Catecholaminergic polymorphic ventricular tachycardia: An exciting new era

    Directory of Open Access Journals (Sweden)

    Shashank P Behere


    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.

  9. 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.

  10. [Heart-minute volume during persistent ventricular tachycardia: anti-arrhythmia intervention using ajmaline]. (United States)

    Mletzko, R; Jung, W; Manz, M; Lüderitz, B


    The hemodynamic effect of the intravenous application of ajmaline (50 mg) was studied during persistent ventricular tachycardia. With the onset of ventricular tachycardia an increase of heart rate up to 177 +/- 40 bpm and a simultaneous decrease of cardiac output from 7.1 +/- 2.7 l/min to 3.4 +/- 1.1 l/min (p less than 0.001) could be demonstrated. Ajmaline prolonged the QRS interval and slowed the ventricular tachycardia rate to 133 +/- 28 bpm. Simultaneously, an increase of cardiac output to 5.9 +/- 2.3 l/min (p less than 0.001) could be documented. A significant correlation between the increase of cardiac output and the change of ventricular tachycardia rate was found. A drug-induced termination of ventricular tachycardia by ajmaline was possible in 60% of patients. Intravenous application of ajmaline during persistent ventricular tachycardia leads to a hemodynamic improvement caused by the reduction of the tachycardia rate. This temporary stabilization of the hemodynamic status is important for emergency treatment of ventricular tachycardia.

  11. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation

    NARCIS (Netherlands)

    de Bakker, J. M.; van Capelle, F. J.; Janse, M. J.; Wilde, A. A.; Coronel, R.; Becker, A. E.; Dingemans, K. P.; van Hemel, N. M.; Hauer, R. N.


    In this report we describe electrophysiologic and histologic findings in hearts and endocardially resected preparations from patients with sustained ventricular tachycardias in the chronic phase of myocardial infarction. We recorded simultaneously from 64 endocardial sites during tachycardia in 72

  12. Differentiation of atrioventricular nodal reentrant tachycardia from orthodromic reciprocating tachycardia by the resetting response to ventricular extrastimuli: comparison to response to continuous ventricular pacing. (United States)

    Javier García-Fernández, F; Almendral, Jesús; Marta Pachón; González-Torrecilla, Esteban; Martín, Javier; Gallardo, Rodrigo


    The usefulness of ventricular entrainment to differentiate AV nodal reentrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT) by substracting the corrected postpacing interval (cPPI) from the tachycardia cycle length (TCL) or the ventriculoatrial interval during stimulation (SA) from that during tachycardia (VA) have been widely validated. However, some tachycardias are interrupted by pacing trains but may not be so by ventricular extrastimuli resulting in resetting. To validate prospectively the diagnostic yield of cPPI-TCL and SA-VA measurements after resetting and to determine the proportion of AVNRT and ORT that can be entrained and/or reset from the right ventricular apex (RVA). 223 consecutive patients with inducible AVNRT or ORT underwent pacing trains and single extrastimulus (also double extrastimuli if singles did not reset tachycardia) at the RVA. We calculated cPPI-TCL and SA-VA during entrainment and resetting. Entrainment could not be achieved in 15.2% of tachycardias because of consistent tachycardia interruption by pacing; resetting was observed in 99.5%. Values of cPPI-TCL and SA-VA > 110 milliseconds after resetting identified AVNRT as accurately as after entrainment. Values for cPPI-TCL/ SA-VA were: sensitivity: 98/100%; specificity: 96/98%; positive predictive value: 98/99%; negative predictive value: 98/100%. Determinations of cPPI-TCL and SA-VA after resetting with single or double RVA extrastimuli are useful maneuvers to differentiate AVNRT from ORT and can be used for nearly every inducible AVNRT or ORT, even if they are interrupted by ventricular trains. © 2012 Wiley Periodicals, Inc.

  13. Myocardial remodeling and bioelectric changes in tachycardia-induced heart failure in dogs

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    Song, B.; Wang, B.N.; Chen, D.N.; Luo, Z.G. [Department of Cardiovascular Medicine, The First Affiliated Hospital, Anhui Medical University, HeFei, Anhui Province (China)


    In this study, electrical and structural remodeling of ventricles was examined in tachycardia-induced heart failure (HF). We studied two groups of weight-matched adult male mongrel dogs: a sham-operated control group (n=5) and a pacing group (n=5) that underwent ventricular pacing at 230 bpm for 3 weeks. Clinical symptoms of congestive HF were observed in both groups. Their hemodynamic parameters were determined and the severity of the HF was evaluated by M-mode echocardiography. Changes in heart morphology were observed by scanning electron and light microscopy. Ventricular action potential duration (APD), as well as the 50 and 90% APD were measured in both groups. All dogs exhibited clinical symptoms of congestive HF after rapid right ventricular pacing for 3 weeks. These data indicate that rapid, right ventricular pacing produces a useful experimental model of low-output HF in dogs, characterized by biventricular pump dysfunction, biventricular cardiac dilation, and non-ischemic impairment of left ventricular contractility. Electrical and structural myocardial remodeling play an essential role in congestive HF progression, and should thus be prevented.

  14. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. (United States)

    Nattel, Stanley; Harada, Masahide


    Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. AF and its complications are responsible for important population morbidity and mortality. Presently available therapeutic approaches have limited efficacy and nontrivial potential to cause adverse effects. Thus, new mechanistic knowledge is essential for therapeutic innovation. Atrial arrhythmogenic remodeling, defined as any change in atrial structure or function that promotes atrial arrhythmias, is central to AF. Remodeling can be due to underlying cardiac conditions, systemic processes and conditions such as aging, or AF itself. Recent work has underlined the importance of remodeling in AF, provided new insights into basic mechanisms, and identified new biomarker/imaging approaches to follow remodeling processes. The importance of intracellular Ca(2+) handling abnormalities has been highlighted, both for the induction of triggered ectopic activity and for the activation of Ca(2+)-related cell signaling that mediates profibrillatory remodeling. The importance of microRNAs, which are a new class of small noncoding sequences that regulate gene expression, has emerged in both electrical and structural remodeling. Remodeling related to aging, cardiac disease, and AF itself is believed to underlie the progressive nature of the arrhythmia, which contributes to the complexities of long-term management. New tools that are being developed to quantify remodeling processes and monitor their progression include novel biomarkers, imaging modalities to quantify/localize fibrosis, and noninvasive monitoring/mapping to better characterize the burden of AF and identify arrhythmic sources. This report reviews recent advances in the understanding of the basic pathophysiology of atrial remodeling and potential therapeutic implications. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. Safety and efficacy of vernakalant for acute cardioversion of atrial fibrillation: an update

    Directory of Open Access Journals (Sweden)

    Dobrev D


    Full Text Available Yukiomi Tsuji,1 Dobromir Dobrev1–3 1Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, 2Division of Experimental Cardiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, 3Deutsches Zentrum für Herz-Kreislauf-Forshcung [German Center for Cardiovascular Research], partner site Heidelberg/Mannheim, Mannheim, Germany Abstract: Intravenous vernakalant has recently been approved in Europe as an atrial-selective antiarrhythmic drug for the conversion of recent-onset atrial fibrillation (AF. It inhibits atrial-selective K+ currents (IK,ACh and IKur and causes rate-dependent atrial-predominant Na+ channel block, with only a small inhibitory effect on the rapid delayed rectifier K+ current (IKr in the ventricle. Due to its atrial-selective properties, vernakalant prolongs the effective refractory period of the atria with minimal effects on the ventricles, being associated with a low proarrhythmic risk for torsades de pointes arrhythmias. Five pivotal clinical trials consistently demonstrated that vernakalant rapidly terminates AF with stable maintenance of sinus rhythm for up to 24 hours. A head-to-head comparative trial showed that the 90-minute conversion rate of vernakalant was substantially higher than that of amiodarone. Initially, a longer-acting oral formulation of vernakalant was shown to be effective and safe in preventing AF recurrence after cardioversion in a Phase IIb study. However, the clinical studies testing oral vernakalant for maintenance of sinus rhythm after AF cardioversion were prematurely halted for undisclosed reasons. This review article provides an update on the safety and efficacy of intravenous vernakalant for the rapid cardioversion of AF. Keywords: atrial fibrillation, antiarrhythmic drug, atrial-selective K+ currents, Na+ channel block, ventricles

  16. Safety and efficacy of vernakalant for acute cardioversion of atrial fibrillation: an update. (United States)

    Tsuji, Yukiomi; Dobrev, Dobromir


    Intravenous vernakalant has recently been approved in Europe as an atrial-selective antiarrhythmic drug for the conversion of recent-onset atrial fibrillation (AF). It inhibits atrial-selective K(+) currents (I(K,ACh) and I(Kur)) and causes rate-dependent atrial-predominant Na(+) channel block, with only a small inhibitory effect on the rapid delayed rectifier K(+) current (I(Kr)) in the ventricle. Due to its atrial-selective properties, vernakalant prolongs the effective refractory period of the atria with minimal effects on the ventricles, being associated with a low proarrhythmic risk for torsades de pointes arrhythmias. Five pivotal clinical trials consistently demonstrated that vernakalant rapidly terminates AF with stable maintenance of sinus rhythm for up to 24 hours. A head-to-head comparative trial showed that the 90-minute conversion rate of vernakalant was substantially higher than that of amiodarone. Initially, a longer-acting oral formulation of vernakalant was shown to be effective and safe in preventing AF recurrence after cardioversion in a Phase IIb study. However, the clinical studies testing oral vernakalant for maintenance of sinus rhythm after AF cardioversion were prematurely halted for undisclosed reasons. This review article provides an update on the safety and efficacy of intravenous vernakalant for the rapid cardioversion of AF.

  17. Tachycardia-dependent augmentation of "notched J waves" in a general patient population without ventricular fibrillation or cardiac arrest: not a repolarization but a depolarization abnormality? (United States)

    Aizawa, Yoshifusa; Sato, Masahito; Kitazawa, Hitoshi; Aizawa, Yoshiyasu; Takatsuki, Seiji; Oda, Eiji; Okabe, Masaaki; Fukuda, Keiichi


    J waves can be observed in individuals of the general population, but electrocardiographic characteristics are poorly understood. The purpose of this study was to examine the J-wave dynamicity in a general patient population. The responses of J waves (>0.1 mV above the isoelectric line in 2 contiguous leads) to varying RR intervals were analyzed. Patients with aborted sudden cardiac death, documented ventricular fibrillation, or a family history of sudden cardiac death were excluded. The J-wave amplitude was measured at baseline, in beats with short RR intervals in conducted atrial premature beats (APBs) or atrial stimulation during the electrophysiology study, and in the beats next to APBs with prolonged RR intervals. Mainly notched J waves were identified in 94 of 701 (24.5%) general patients (13.4%), and APBs were present in 23 of 94 (24.5%) patients. The mean baseline amplitude of J waves was 0.20 ± 0.06 mV at the baseline RR interval of 853 ± 152 ms, 0.25 ± 0.11 mV at the RR interval in the conducted APB of 545 ± 133 ms (P = .0018), and 0.19 ± 0.08 mV at the RR interval of 1146 ± 314 ms (P = .3102). The clinical characteristics were not different between patients with and without tachycardia-dependent augmentation of J waves. Augmentation of J waves was confirmed by the electrophysiology study: 0.28 ± 0.12 mV vs 0.42 ± 0.11 mV at baseline and in the beats of atrial stimulation, respectively (P = .0001). However, no bradycardia-dependent augmentation (>0.05 mV) was observed. Such tachycardia-dependent augmentation can represent depolarization abnormality rather than repolarization abnormality. J waves in a general patient population were augmented at shorter RR intervals, but not at prolonged RR intervals. Mechanistically, conduction delay is most likely responsible for this. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  18. Personalized management of atrial fibrillation

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Aliot, Etienne


    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...

  19. Right Atrial Myxoma and Syncope. (United States)

    Babs Animashaun, Islamiyat; Akinseye, Oluwaseun A; Akinseye, Leah I; Akinboboye, Olakunle O


    Right atrial myxoma accounts for 15-20% of cardiac myxomas and syncope is a very rare manifestation. We present the case of an 89-year-old man with right atrial myxoma and syncope, and discuss the role of cardiac magnetic resonance imaging (MRI) in the diagnosis of myxomas. An 89-year-old man with a history of hypertension, hyperlipidemia, chronic kidney disease stage 4, mild dementia, and benign prostatic hyperplasia presented to the emergency department with an episode of syncope. Physical examination demonstrated normal and regular heart sounds, and normal respiratory rate and oxygen saturation. Echocardiogram described a well-circumscribed echo-dense mass in the right atrial cavity, which was attached to the septum but not obstructing the tricuspid annulus, measuring 1.7×2.2 cm at its widest diameter. Cardiac MRI revealed a mass with dark intensity which enhanced heterogeneously following intravenous administration of gadolinium-chelate, consistent with a myxoma. The location of this myxoma, coupled with the presence of a stalk allowing mobility, provides a clue to how this patient experienced transient obstruction of the tricuspid valve leading to syncope. Right heart tumors should be considered in the differential diagnosis of unexplained syncope. Cardiac MRI with gadolinium-chelate administration can help differentiate this tumor from a right-sided atrial thrombus, which can pose a diagnostic challenge.

  20. Genetic aspects of atrial fibrillation

    NARCIS (Netherlands)

    Wiesfeld, ACP; Hemels, MEW; Van Tintelen, JP; Van den Berg, MP; Van Veldhuisen, DJ; Van Gelder, IC


    Atrial fibrillation (AF) occurs predominantly in the elderly and is commonly associated with underlying cardiac diseases. A significant number of patients, however, have early onset AF that is not associated with any underlying disease. At present, it is unknown how often this form of AF is familial

  1. Deglutition-Induced Atrial Fibrillation (United States)

    Malik, Amyn; Ali, Syed Sohail; Rahmatullah, Amin


    We present the case of 38-year-old woman who experienced palpitations on swallowing, which were later found to be atrial fibrillation. Her symptoms improved on treatment with disopyramide and verapamil. Within 9 months, she was weaned from both medications without recurrence of symptoms. PMID:16429915

  2. Progressive wheeze: atrial myxoma masquerading as chronic obstructive pulmonary disease. (United States)

    Sinha, Aish; Apps, Andrew; Liong, Wei Chuen; Firoozan, Soroosh


    Atrial myxoma, the commonest primary cardiac neoplasm, presents with symptoms of heart failure, embolic phenomena or constitutional upset. We present an atypical case, with wheeze and symptomatic exacerbations typical of chronic obstructive pulmonary disease. With no early clinical evidence of heart failure, the patient was managed with inhaled steroids and bronchodilators, with little relief. Only when the patient was in extremis requiring intubation, due to respiratory failure, did clinical evidence of left heart failure become apparent, with echocardiography demonstrating a massive left atrial myxoma obstructing the mitral valve annulus. Following successful surgical resection, the patient's symptoms fully abated. This case highlights the importance of considering cardiac wheeze in those initially managed as obstructive airway disease not responding in a typical fashion to initial bronchodilator therapy, and particularly in those with rapidly progressive symptoms. Such patients should be referred early for cardiac imaging. The excellent prognosis and quick recovery after timely surgical resection of a myxoma are also highlighted. 2015 BMJ Publishing Group Ltd.

  3. Unexpected guest: Atrial fibrillation due to electrical shock

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    Mehmet Zihni Bilik


    Full Text Available Cardiac arrhythmias due to electrical injuries are rare among emergency service admittances. A 35 year-old female patient was admitted to emergency service with palpitation after electrical injury as a result of contact with a domestic low-voltage source. Electrocardiography (ECG showed atrial fibrillation with rapid ventricular response. Transthoracic echocardiography findings were normal. Atrial fibrillation spontaneously converted to normal sinus rhythm after rate limiting treatment with beta-blocker. The patient was discharged without any complication on the third day of hospitalization. Although cardiac arrhythmias rarely occur after electrical injury, cardiac monitoring is recommended for all patients with documented rhythm disorder, loss of consciousness, or abnormal ECG at admission.

  4. The right atrial thrombus: the sword of Damocles with real risk of massive pulmonary embolism. (United States)

    Kirin, Marijan; Cerić, Reuf; Spoljarić, Marko; Pehar, Mario; Cavrić, Gordana; Spoljarić, Ivana Rajćan; Kirin, Ivan


    Cases of 6 patients admitted at the intensive care unit for massive pulmonary embolism are reported. All patients presented with dyspnea, tachypnea, and tachycardia, and 4 were hypotensive and had syncope. Lung ventilation/ perfusion scans revealed perfusion defects in 4 patients. Transthoracic echocardiography (TTE) demonstrated acute cor pulmonale. It also revealed mobile right atrial thrombi in 5 patients, adherent thrombus in the right atrium in 1 patient and patent foramen ovale in 4 patients. Thrombolytic therapy was initiated in 4 patients, and 2 patients received heparin infusion only. Effects of thrombolysis were monitored using bedside TTE during the first 24 hours and in follow-up. The outcome of 4 patients who received thrombolytic therapy was good whereas other 2 patients, who received only heparin, died. Thrombotic mass disappeared 8 to 12 hours after initiation of therapy, and 10 weeks after discharge TTE showed normalized right ventricle dimensions and function in all 4 patients.

  5. 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


    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......±15. After a follow-up of 6.0 months, 24 patients maintained sinus rhythm. 3 patients suffered from less frequent paroxysmal atrial fibrillation during the first 3.0 months after the ablation and remained Af free after 6 months. I patient had atrial fibrillation episodes and I patient had atrial fibrillation...... attacks unchanged. No pulmonary vein narrowing was observed. Conclusion Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system was safe and effective....

  6. Effects of postshock atrial pacing on atrial defibrillation outcome in the isolated sheep heart

    NARCIS (Netherlands)

    Skanes, A. C.; Gray, R. A.; Zuur, C. L.; Jalife, J.


    BACKGROUND: Failed atrial defibrillation shocks are associated with organization of postshock activity and a substantial postshock electrical quiescence. We investigated the ability of a train of pacing stimuli to capture or locally entrain atrial myocardium during the quiescent period after

  7. Malignant ventricular tachycardia in acromegaly: a case report

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    Zhe An

    Full Text Available CONTEXT: In patients with acromegaly, cardiovascular complications are the main cause of death; sudden death has been associated with ventricular tachyarrhythmias. In other patients with life-threatening malignant ventricular tachyarrhythmias, surgical placement of an implantable cardioverter-defibrillator (ICD has proved highly effective in reducing sudden death rates. CASE REPORT: The present article reports the case of a 50-year-old male acromegalic patient who presented symptoms of syncope induced by ventricular tachycardia. An ICD was surgically implanted and a pituitary adenoma, which was responsible for the acromegaly, was completely removed in the same procedure. The surgery was successful and the ventricular arrhythmias were effectively terminated. During six months of follow-up, no documented arrhythmic episodes occurred. CONCLUSION: In patients with acromegaly, malignant ventricular tachyarrhythmia might be effectively controlled by implantation of an ICD and surgical removal of the pituitary adenoma.

  8. Congenital left ventricular apical aneurysm presenting as ventricular tachycardia. (United States)

    Amado, José; Marques, Nuno; Candeias, Rui; Gago, Paula; de Jesus, Ilídio


    The authors present the case of a 34-year-old male patient seen in our department due to palpitations. On the electrocardiogram monomorphic ventricular tachycardia (VT) was documented, treated successfully with amiodarone. The subsequent study revealed a normal echocardiogram and an apical aneurysm of the left ventricle on magnetic resonance imaging, confirmed by computed tomography coronary angiography that also excluded coronary disease. He underwent an electrophysiological study to determine the origin of the VT and to perform catheter ablation using electroanatomical mapping. VT was induced and radiofrequency applications were performed in the left ventricular aneurysm area. VT was no longer inducible, with acute success. Despite this it was decided to implant a subcutaneous implantable cardioverter-defibrillator (ICD). Eight months after the ablation the patient was admitted again due to VT, treated by the ICD. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

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    Andreas Müssigbrodt


    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.

  10. Substrate Based Ablation of Ventricular Tachycardia Through An Epicardial Approach

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    Aman Makhija


    Full Text Available Ventricular tachycardia (VT occurring late after myocardial infarction is often due to reentry circuit in the peri-infarct zone. The circuit is usually located in the sub-endocardium, though subepicardial substrates are known. Activation mapping during VT to identify target regions for ablation can be difficult if VT is non inducible or poorly tolerated. In the latter, a substrate based approach of mapping during sinus rhythm in conjunction with pace mapping helps to define the reentry circuit and select target sites for ablation in majority of patients with hemodynamically unstable VT. Percutaneous epicardial catheter ablation has been attempted as an approach where ablation by a conventional endocardial access has been unsuccessful. We report a case of post myocardial infarction scar VT which could be successfully ablated with a substrate based approach from the epicardial aspect.

  11. Osteopathic manipulative treatment for postural orthostatic tachycardia syndrome. (United States)

    Goodkin, Michael B; Bellew, Lawrence J


    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. © 2014 The American Osteopathic Association.

  12. Atrioverter : An implantable device for the treatment of atrial fibrillation

    NARCIS (Netherlands)

    Wellens, HJJ; Lau, CP; Luderitz, B; Akhtar, M; Waldo, AL; Camm, AJ; Timmermans, C; Tse, HF; Jung, W; Jordaens, L; Ayers, G


    Background-During atrial fibrillation, electrophysiological changes occur in atrial tissue that favor the maintenance of the arrhythmia and facilitate recurrence after conversion to sinus rhythm. An implantable defibrillator connected to right atrial and coronary sinus defibrillation leads allows

  13. Postnatal Outcomes of Fetal Supraventricular Tachycardia: a Multicenter Study. (United States)

    Hinkle, Kevin A; Peyvandi, Shabnam; Stiver, Corey; Killen, Stacy A S; Weng, Hsin Yi; Etheridge, Susan P; Puchalski, Michael D


    Supraventricular tachycardia (SVT), the most common fetal tachycardia, can be difficult to manage in utero. We sought to better understand predictors of the postnatal clinical course in neonates who experienced fetal SVT. We hypothesized that fetuses with hydrops or those with refractory SVT (failure of first-line SVT therapy) are more likely to experience postnatal SVT. This was a retrospective multicenter cohort study of subjects diagnosed with fetal SVT between 2006 and 2014. Fetuses with structural heart disease were excluded. Descriptive comparative statistics and univariate analysis with logistic regression were utilized to determine factors that most strongly predicted postnatal SVT and preterm delivery. The cohort consisted of 103 subjects. Refractory SVT was found in 37% (N = 38) of the cohort with this group more likely to be delivered prematurely (median = 36 vs. 37.5 weeks, p = 0.04). Refractory SVT did not increase the risk of postnatal SVT (p = 0.09). Postnatal SVT was seen in 61% (N = 63). Of those, 68% (N = 43) had postnatal SVT at ≤2 days of age. Postnatal SVT was associated with a later fetal SVT diagnosis (median = 30 vs. 27.5 weeks, p = 0.006). We found a strong correlation between postnatal SVT and later gestational age at fetal SVT diagnosis. Subjects with refractory SVT or hydrops did not have a higher risk of postnatal SVT. We propose strong consideration for term delivery in the absence of significant clinical compromise. Further studies to assess whether outcomes vary for preterm delivery versus expectant management in those with refractory SVT should be performed.

  14. Successful ablation of incessant idiopathic right ventricular tachycardia arising from unusual sites in children. (United States)

    Wu, Lin; Tian, Hong; Wang, Feng; Liang, Xuecun; Chen, Gang


    Most idiopathic right ventricular tachycardias originate from the outflow tract. We present a case series of idiopathic incessant ventricular tachycardia arising from unusual sites of the right ventricle in children, which were well resolved by catheter ablation. A retrospective review was performed of all three patients who underwent ablation of idiopathic ventricular tachycardia below the level of the right ventricular outflow tract using three-dimensional mapping in our institute. Result All three patients presented with tachycardia-induced cardiomyopathy due to incessant ventricular tachycardia on first admission. The sites of successful ablation were at the proximal right bundle branch, distal right bundle branch, and apex of the right ventricle, respectively. No complications occurred, and there has been no recurrence of ventricular tachycardia after the final ablation at an average follow-up period of 9 months. All three patients have achieved normalisation of left ventricular size and systolic function. Incessant idiopathic ventricular tachycardia originating from unusual sites of the right ventricle in children, resulting in significant symptoms and impaired ventricular function, can be successfully treated with catheter ablation.

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

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    Grandinetti Giuseppe


    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; 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

  16. Congenital left atrial appendage aneurysm: Atypical presentation

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    Mehdi Bamous


    Full Text Available Congenital left atrial appendage aneurysm is a rare condition caused by dysplasia of the atrial muscles. We report a case of a 14-year-old boy, with a 5-month history of cough and in sinus rhythm. Transthoracic echocardiography and computerized tomographic angiography confirmed the aneurysm of the left atrial appendage which was resected through median sternotomy on cardiopulmonary bypass. This case is presented not only for its rarity but also for its atypical clinical presentation.

  17. Atrial Fibrillation after Robotic Cardiac Surgery




    Atrial fibrillation is a common arrhythmia after conventional open heart surgery. A minimally invasive robotic approach has the potential to lower its occurrence. We sought to review the literature on the incidence of post operative atrial fibrillation in robotic heart surgery and compare it to the incidence in conventional cardiac surgery. The types of operation investigated were: coronary artery bypass surgery, mitral valve repair, atrial septal defect closure and myxoma excision. Operation...

  18. Comparing the efficacy and safety of a novel monophasic waveform delivered by the passive implantable atrial defibrillator with biphasic waveforms in cardioversion of atrial fibrillation. (United States)

    Manoharan, Ganesh; Evans, Noel; Allen, Desmond; Anderson, John; Adgey, Jennifer


    The passive implantable atrial defibrillator (PIAD) (with no battery or discharging capacitor and powered transcutaneously by radio-frequency energy) delivering a novel monophasic low-tilt waveform is more efficacious than the standard monophasic waveform at atrial defibrillation. Standard biphasic (STB) waveforms, however, are more efficacious and safer than monophasic waveforms. This study compared the efficacy and safety of the PIAD waveform with biphasic waveforms. Sustained atrial fibrillation (AF) was induced by rapid atrial pacing. Cardioversion was attempted via 2 atrial defibrillation leads. The efficacy of the PIAD was compared with 3 biphasic waveforms (standard, single rounded, and double rounded) at varying voltage settings in 10 pigs. After a synchronized shock, hemodynamic changes between the PIAD, standard biphasic, and monophasic waveforms were compared at 1.5 and 3.0 J in 12 pigs. Myocardial injury (biochemical and histological) after ten 5-J PIAD shocks was compared with a no-shock group in 14 pigs. The PIAD 100-V setting was significantly more efficacious than the STB (100/-50 V: 100% [1.88+/-0.02 J] versus 90% [0.89+/-0.0 J]; P=0.025). No arrhythmic, hemodynamic, or myocardial injury was observed with the PIAD waveform. Defibrillation with the PIAD is more efficacious than with the STB waveform and appears safe. This device could provide a more effective option for cardioversion.

  19. Bidirectional ventricular tachycardia with myocardial infarction: a case report with insight on mechanism and treatment. (United States)

    Wase, Abdul; Masood, Abdul-Mannan; Garikipati, Naga V; Mufti, Omar; Kabir, Anwarul


    Bidirectional ventricular tachycardia (BVT) is a rare variety of tachycardia with morphologically distinct presentation: The QRS axis and/or morphology is alternating in the frontal plane leads. Since its original description in association with digitalis,(1) numerous cases of this fascinating tachycardia with disparate etiologies and mechanisms have been postulated. We report a patient with BVT in association with non-ST elevation myocardial infarction and severe cardiomyopathy in the absence of digoxin toxicity. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  20. Electrophysiological Mechanisms of Atrial Flutter

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    Ching-Tai Tai


    Full Text Available Atrial flutter (AFL is a common arrhythmia in clinical practice. Several experimental models, such as tricuspid regurgitation model, tricuspid ring model, sterile pericarditis model and atrial crush injury model, have provided important information about reentrant circuit and can test the effects of antiarrhythmic drugs. Human AFL has typical and atypical forms. Typical AFL rotates around the tricuspid annulus and uses the crista terminalis and sometimes sinus venosa as the boundary. The tricuspid isthmus is a slow conduction zone and the target of radiofrequency ablation. Atypical AFL may arise from the right or left atrium. Right AFL includes upper loop reentry, free wall reentry and figure-of-8 reentry. Left AFL includes mitral annular AFL, pulmonary vein-related AFL and left septal AFL. Radiofrequency ablation of the isthmus between the boundaries can eliminate these arrhythmias.

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

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    Erick A Perez Alday


    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

  2. Characterisation of sleep disturbances in postural orthostatic tachycardia syndrome: a polysomnography-based study. (United States)

    Pengo, M F; Higgins, S; Drakatos, P; Martin, K; Gall, N; Rossi, G P; Leschziner, G


    Postural orthostatic tachycardia syndrome (PoTS) has been frequently associated with sleep disturbances but objective sleep data are lacking. In addition, although regional autonomic denervation has been described, less is known about autonomic nervous activity overnight in these patients. A full polysomnography and heart rate variability were performed on 37 patients diagnosed with PoTS . In addition, a multiple sleep latency test (MSLT) was conducted on a subgroup of patients with excessive daytime sleepiness. The polysomnographic data did not show major pathological findings except the percentage spent in rapid eye movement (REM) sleep which was slightly reduced at 18.4%. The MSLT did not confirm excessive daytime sleepiness as median mean sleep latency was 14.4 min (11.8-17.5). When comparing patients with and without subjective daytime sleepiness, it was found that the latter had a reduced parasympathetic activation at night as expressed by the average high frequency [6936.5 ms(2) (6028.2-8675.5) vs. 4689.5 (3922.7-7685.2) p sleep pathologies nor objective daytime sleepiness. Subjective daytime sleepiness is associated with enhanced activation of the parasympathetic nervous system. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Sympathetic dysfunction in vasovagal syncope and the postural orthostatic tachycardia syndrome. (United States)

    Lambert, Elisabeth; Lambert, Gavin W


    Orthostatic intolerance is the inability to tolerate the upright posture and is relieved by recumbence. It most commonly affects young women and has a major impact on quality of life and psychosocial well-being. Several forms of orthostatic intolerance have been described. The most common one is the recurrent vasovagal syncope (VVS) phenotype which presents as a transient and abrupt loss of consciousness and postural tone that is followed by rapid recovery. Another common type of orthostatic intolerance is the postural orthostatic tachycardia syndrome (POTS) which is characterized by an excessive rise in heart rate upon standing and is associated with symptoms of presyncope such as light-headedness, fatigue, palpitations, and nausea. Maintenance of arterial pressure under condition of reduced central blood volume during the orthostasis is accomplished in large part through sympathetic efferent nerve traffic to the peripheral vasculature. Therefore sympathetic nervous system (SNS) dysfunction is high on the list of possible contributors to the pathophysiology of orthostatic intolerance. Investigations into the role of the SNS in orthostatic intolerance have yielded mixed results. This review outlines the current knowledge of the function of the SNS in both VVS and POTS.

  4. Sympathetic dysfunction in vasovagal syncope and the postural orthostatic tachycardia syndrome

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    Elisabeth eLambert


    Full Text Available Orthostatic intolerance is the inability to tolerate the upright posture and is relieved by recumbence. It most commonly affects young women and has a major impact on quality of life and psychosocial well being. Several forms of orthostatic intolerance have been described. The most common one is the recurrent vasovagal syncope (VVS phenotype which presents as a transient and abrupt loss of consciousness and postural tone that is followed by rapid recovery. Another common type of orthostatic intolerance is the postural orthostatic tachycardia syndrome (POTS which is characterized by an excessive rise in heart rate upon standing and is associated with symptoms of presyncope such as light-headedness, fatigue, palpitations and nausea. Maintenance of arterial pressure under condition of reduced central blood volume during the orthostasis is accomplished in large part through sympathetic efferent nerve traffic to the peripheral vasculature. Therefore sympathetic nervous system (SNS dysfunction is high on the list of possible contributors to the pathophysiology of orthostatic intolerance. Investigations into the role of the SNS in orthostatic intolerance have yielded mixed results. This review outlines the current knowledge of the function of the SNS in both VVS and POTS.

  5. Discrimination between monomorphic and polymorphic ventricular tachycardia using cycle length variability measured by wavelet transform analysis. (United States)

    Sierra, G; Gómez, M J; Le Guyader, P; Trelles, F; Cardinal, R; Savard, P; Nadeau, R


    The objective of this study was to assess the capability of wavelet transform (WT) analysis to differentiate between monomorphic (MVTs) and polymorphic ventricular tachycardias (PVTs) in a canine model and to relate these results to epicardial isochronal maps on a beat-by-beat basis. Unipolar electrograms were simultaneously recorded from the surface of both ventricles with a 127-lead sock electrode array in 24 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 stimuli/min) followed by reperfusion. Ventricular tachycardias were obtained during reperfusion and during left stellate ganglion stimulation. After visual selection, a total of 97 segments of 2,048 samples (4.096 seconds) were extracted and classified as 67 MVTs and 30 PVTs. A parameter based on the cycle length variability was defined in the second scale of the WT decomposition, normalized by its mean value. Similar assessment of cycle length variability was performed based on the detection of the point of most rapid change in potential with a negative slope in excess of -0.5 mV/ms in each individual electrogram to test the accuracy of the results obtained with the WT parameter. The WT parameter correctly identified 97% MVT and 83.3% PVT segments, for an overall accuracy of 92.8%. Beat-by-beat epicardial maps of MVT displayed a cluster of sites of initial activation close to the reperfusion area, while the sites of breakthrough 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 the WT parameter (r = .78, P accuracy of the results obtained, a comparison was performed between the WT parameter (0.082 +/- 0.007) and the cycle length variability, estimated as the

  6. Assessment of global atrial fibrillation organization to optimize timing of atrial defibrillation. (United States)

    Everett, T H; Moorman, J R; Kok, L C; Akar, J G; Haines, D E


    We hypothesized that frequency domain analysis of a wide bipolar interatrial electrogram describes the global organization of atrial fibrillation (AF) and should vary over time. By timing shocks to periods of high organization of AF, cardioversion efficacy should improve. A total of 15 dogs (weight, 28.2+/-3.4 kg) were rapidly paced for 48 to 72 hours to induce AF. Coil electrodes with a surface area of 1.80 cm(2) were then placed in the left and right atria to form a wide bipole. Wide bipolar electrograms were digitally filtered, and a fast Fourier transform was performed over a sliding 2-s window every 0.5 s. The organization index (OI) was calculated as the ratio of the area of the dominant peak and its harmonics to the total area of the magnitude spectrum. The atrial defibrillation threshold (ADFT(50)) was determined using a 3-ms/3-ms biphasic shock and an up-down-up protocol. Additional shocks with higher and lower energies were delivered in a random sequence to develop a distribution curve. The OI varied over time, with a mean of 0.42+/-0.03, a maximum of 0.65+/-0.07, and a minimum of 0.20+/-0.06. The OI changed rapidly, with durations of high organization (OI>0.5) ranging from 1 to 5 s. The ADFT(50) for QRS complex-synchronized shocks was 183+/-56 V, versus 142+/-49 V for shocks synchronized to an OI>0.5 (P0.5. AF signals show a high degree of variability. Shock efficacy is increased when shocks are delivered during periods of high AF organization as determined by the OI method.

  7. Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation (CASTLE-AF) - study design. (United States)

    Marrouche, Nassir F; Brachmann, Johannes


    Electrical isolation of the pulmonary veins by catheter ablation is an emerging treatment modality for the treatment of atrial fibrillation (AF) and is increasingly used in patients with heart failure. The catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation trial (CASTLE-AF) is a randomized evaluation of ablative treatment of atrial fibrillation in patients with left ventricular dysfunction. The primary endpoint is the composite of all-cause mortality or worsening of heart failure requiring unplanned hospitalization using a time to first event analysis. Secondary endpoints are all-cause mortality, cardiovascular mortality, cerebrovascular accidents, worsening of heart failure requiring unplanned hospitalization, unplanned hospitalization due to cardiovascular reason, all-cause hospitalization, quality of life, number of therapies (shock and antitachycardia pacing) delivered by the implantable cardioverter-defibrillator (ICD), time to first ICD therapy, number of device-detected ventricular tachycardia and ventricular fibrillation episodes, AF burden, AF free interval, left ventricular function, exercise tolerance, and percentage of right ventricular pacing. CASTLE-AF will randomize 420 patients for a minimum of 3 years at 48 sites in the United States, Europe, Australia, and South America.

  8. Ondansetron-induced ventricular tachycardia in a patient of caesarian section

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    Arpita Saxena


    Full Text Available We report a rare adverse effect of ondansetron in a 24-year-old female undergoing caesarian section, presenting as ventricular tachycardia and ectopics. Patient was treated with cardioversion and intravenous Amiodarone 150 mg.

  9. 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.


    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.

  10. Cryoablation of ventricular tachycardia arising from the left-coronary sinus cusp. (United States)

    Uppu, Santosh C; Tuzcu, Volkan


    Ventricular tachycardia (VT) arising from the coronary sinus cusps and mimicking right-ventricular morphology is a rare entity. In this report, we report the successful cryoablation of left-coronary sinus cusp VT.

  11. Flecainide Therapy Reduces Exercise-Induced Ventricular Arrhythmias in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia

    NARCIS (Netherlands)

    van der Werf, Christian; Kannankeril, Prince J.; Sacher, Frederic; Krahn, Andrew D.; Viskin, Sami; Leenhardt, Antoine; Shimizu, Wataru; Sumitomo, Naokata; Fish, Frank A.; Bhuiyan, Zahurul A.; Willems, Albert R.; van der Veen, Maurits J.; Watanabe, Hiroshi; Laborderie, Julien; Haïssaguerre, Michel; Knollmann, Björn C.; Wilde, Arthur A. M.


    Objectives This study evaluated the efficacy and safety of flecainide in addition to conventional drug therapy in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). Background CPVT is an inherited arrhythmia syndrome caused by gene mutations that destabilize cardiac

  12. Recent heart rate history affects QT interval duration in atrial fibrillation (United States)

    Riad, Fady S.; Razak, Eathar; Saba, Samir; Shalaby, Alaa; Nemec, Jan


    QT interval prolongation is associated with a risk of polymorphic ventricular tachycardia. QT interval shortens with increasing heart rate and correction for this effect is necessary for meaningful QT interval assessment. We aim to improve current methods of correcting the QT interval during atrial fibrillation (AF). Digitized Holter recordings were analyzed from patients with AF. Models of QT interval dependence on RR intervals were tested by sorting the beats into 20 bins based on corrected RR interval and assessing ST-T variability within the bins. Signal-averaging within bins was performed to determine QT/RR dependence. Data from 30 patients (29 men, 69.3±7.3 years) were evaluated. QT behavior in AF is well described by a linear function (slope ~0.19) of steady-state corrected RR interval. Corrected RR is calculated as a combination of an exponential weight function with time-constant of 2 minutes and a smaller “immediate response” component (weight ~ 0.18). This model performs significantly (pQT response to heart rate changes in AF is similar to previously published QT dynamics during atrial pacing and in sinus rhythm. PMID:28273109

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

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su


    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.

  14. His-Purkinje system-related incessant ventricular tachycardia arising from the left coronary cusp

    Directory of Open Access Journals (Sweden)

    Eiji Sato, MD


    Full Text Available We describe the case of a 23-year-old woman who had His-Purkinje system-related incessant ventricular tachycardia with a narrow QRS configuration. The ventricular tachycardia was ablated successfully in the left coronary cusp where the earliest endocardial activation had been recorded. We hypothesize that a remnant of the subaortic conducting tissue was the source of the ventricular arrhythmias.

  15. Catecholaminergic Polymorphic Ventricular Tachycardia: A Rare Cause of Cardiac Arrest Following Blunt Chest Trauma


    Ozyilmaz, Isa; Ozyilmaz, Sinem; Ergul, Yakup; Akdeniz, Celal; Tuzcu, Volkan


    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an electrophysiological disorder of a physically normal heart that occurs in children when the body is subjected to intense emotional or physical stress that causes adrenergic discharge. This troubling disease can be sporadic (spontaneous) or familial (genetic/inherited). Unfortunately, its associated ventricular tachycardia may cause sudden death, so early diagnosis of CPVT is very important. Treatment modalities include medical...

  16. Improved survival with amiodarone in patients with hypertrophic cardiomyopathy and ventricular tachycardia.


    McKenna, W. J.; Oakley, C M; Krikler, D. M.; Goodwin, J. F.


    The effect of amiodarone on survival was assessed in patients with hypertrophic cardiomyopathy and ventricular tachycardia in a drug trial with historical controls. During 1976 and 1977, 24 hour (seven) or 48 hour (79) electrocardiographic monitoring was performed in 86 consecutive patients; 24 had ventricular tachycardia and received conventional antiarrhythmic agents. Nineteen clinical, echocardiographic, and haemodynamic features were assessed. Seven patients died suddenly during follow up...

  17. Polymorphic Ventricular Tachycardia/Ventricular Fibrillation and Sudden Cardiac Death in the Normal Heart. (United States)

    Shah, Ashok J; Hocini, Meleze; Denis, Arnaud; Derval, Nicolas; Sacher, Frederic; Jais, Pierre; Haissaguerre, Michel


    Primary electrical diseases manifest with polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) and along with idiopathic VF contribute to about 10% of sudden cardiac deaths (SCDs) overall. These disorders include long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, and early repolarization syndrome. This article reviews the clinical electrophysiological management of PMVT/VF in a structurally normal heart affected with these disorders. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. [Giant congenital intrapericardial left atrial appendage aneurysm: about a case and review of the literature]. (United States)

    Zhari, Bouchra; Bellamlih, Habib; Boumdine, Hassan; Amil, Touriya; Bamous, Mehdi; En-Nouali, Hassan


    Left atrial appendage aneurysm is a very rare heart anomaly. It may be congenital or acquired, secondary to inflammatory or degenerative processes. Most cases are asymptomatic. The prevalence of these lesions in pediatric age has been very rarely reported. As it can cause potentially fatal arrhythmias or thrombus, surgery is required immediately after diagnosis. This study reports the case of a 14-year-old boy with rapidly progressive dyspnea, palpitations, sensation of repetitive dizziness and fainting, in whom congenital left atrial appendage aneurysm was detected. Diagnosis was based on coronary CTA data. The patient was successfully treated with surgical resection of the aneurysm.

  19. Managing atrial fibrillation in active patients and athletes. (United States)

    Reiss, R A


    Atrial fibrillation in young or middle-aged active patients can often be managed with medication. Evaluation should address associated conditions and predisposing factors such as idiopathic hypertrophic subaortic stenosis, Wolff-Parkinson-White syndrome, congenital heart disease, hyperthyroidism, excess alcohol or other drug use, and exercise-induced catecholamine release. Diagnostic studies may include an ECG, 24-hour Holter or event monitoring, exercise treadmill testing, stress echocardiography, electrophysiologic studies, and laboratory testing. Electrocardioversion provides rapid, predictable treatment, but ablation therapy is sometimes needed.

  20. The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia. (United States)

    Sousa, Pedro A; Pereira, Salomé; Candeias, Rui; de Jesus, Ilídio


    Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin, it is the 12-lead surface electrocardiogram that usually enables this differentiation. Since 1978, various electrocardiographic criteria have been proposed for the differential diagnosis of wide complex tachycardias, particularly the presence of atrioventricular dissociation, and the axis, duration and morphology of QRS complexes. Despite the wide variety of criteria, diagnosis is still often difficult, and errors can have serious consequences. To reduce such errors, several differential diagnosis algorithms have been proposed since 1991. However, in a small percentage of wide QRS tachycardias the diagnosis remains uncertain and in these the wisest decision is to treat them as ventricular tachycardias. The authors' objective was to review the main electrocardiographic criteria and differential diagnosis algorithms of wide QRS tachycardia. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Electrophysiological and haemodynamic effects of lidocaine and ajmaline in the management of sustained ventricular tachycardia. (United States)

    Manz, M; Mletzko, R; Jung, W; Lüderitz, B


    The electrophysiological and haemodynamic effects of lidocaine (100 mg) and ajmaline (50 mg) were evaluated while attempting to interrupt sustained ventricular tachycardia. The study was performed as a prospective, non-blinded, randomized investigation in 61 patients. Lidocaine terminated ventricular tachycardia in four of 31 patients, ajmaline in 19 of 30 patients (P less than 0.001). QRS and RR intervals during ventricular tachycardia were prolonged by ajmaline from 164 +/- 28 ms to 214 +/- 49 ms and from 371 +/- 86 ms to 479 +/- 137 ms (P less than 0.001), respectively; lidocaine did not influence these parameters. The duration of the return cycles after termination of ventricular tachycardia did not differ between the two groups. Lidocaine did not change cardiac output during ventricular tachycardia whereas cardiac output increased significantly under ajmaline from 3.5 +/- 1.21.min-1 to 5.5 +/- 1.91.min-1 (P less than 0.001). It is concluded that anti-arrhythmic agents such as ajmaline, which slow conduction velocity and prolong refractoriness, are more effective than lidocaine in the medical treatment of haemodynamically stable, sustained ventricular tachycardia.

  2. Atrial natriuretic peptide (ANP)-granules: ultrastructure ...

    African Journals Online (AJOL)

    ANP) are present in the four regions of the atrial-auricular complex (two atria and two auricles). ANP-immunoreactivity was detected in all granules from the four regions. Ultrastructurally, atrial myocytes show the presence of very electron dense ...

  3. A new system for right atrial cooling

    NARCIS (Netherlands)

    Huybregts, Marinus A. J. M.; de Vroege, Roel; van Oeveren, Wim

    Purpose. Controlled hypothermia of the right atrium has been shown to reduce postoperative atrial fibrillation after on-pump coronary artery bypass grafting. A device has been developed that couples right atrial and nodal cooling with modified dual-stage venous drainage by circulating cold sterile

  4. Atrial fibrillation in patients with ischemic stroke

    DEFF Research Database (Denmark)

    Thygesen, Sandra Kruchov; Frost, Lars; Eagle, Kim A


    BACKGROUND: Atrial fibrillation is a major risk factor for ischemic stroke. However, the prognostic impact of atrial fibrillation among patients with stroke is not fully clarified. We compared patient characteristics, including severity of stroke and comorbidity, quality of in-hospital care and o...

  5. Genetics Home Reference: familial atrial fibrillation (United States)

    ... to be associated with familial atrial fibrillation was KCNQ1 , which provides instructions for making a channel that ... atrial fibrillation ABCC9 GJA5 KCNA5 KCNE2 KCNH2 KCNJ2 KCNQ1 LMNA MYL4 NKX2-5 NPPA NUP155 PRKAG2 RYR2 ...

  6. Blocked atrial bigeminy presenting with bradycardia. (United States)

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


    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. © 2012 Wiley Periodicals, Inc.

  7. Efficacy and safety of novel epicardial circumferential left atrial ablation with pulmonary vein isolation in sustained atrial fibrillation. (United States)

    Jiang, Zhaolei; Yin, Hang; He, Yi; Ma, Nan; Tang, Min; Liu, Hao; Ding, Fangbao; Mei, Ju


    The aim of this study was to examine the efficacy and safety of this novel epicardial circumferential left atrial ablation (CLAA) with pulmonary vein isolation (PVI) in sustained atrial fibrillation (AF). Thirty domestic pigs were divided equally into 3 groups: AF without ablation (AF group), AF with PVI (PVI group), and AF with CLAA and PVI (CLAA + PVI group). AF was induced by rapid atrial pacing. After AF was induced, CLAA and PVI were performed for pigs in CLAA + PVI group, and PVI was performed for pigs in PVI group. AF vulnerability, AF duration, and histology were performed in all groups. All pigs developed sustained AF after 6.27 ± 0.69 weeks of rapid atrial pacing. All pigs successfully underwent isolated PVI or CLAA with PVI on the beating heart in PVI group or CLAA + PVI group. Isolated PVI terminated AF in 3 of 20 pigs (15 %), and CLAA with PVI terminated AF in 5 of 8 pigs (62.5 %, P = 0.022). Compared with AF group (10/10), the incidence of sustained AF by burst pacing was significantly decreased in PVI group (3/10, P = 0.003) or CLAA + PVI group (0/10, P CLAA + PVI group (P = 0.211). AF duration was significantly decreased in CLAA + PVI group (734.70 ± 177.81 s, 95 % CI 607.51-861.89) compared with PVI group (1217.90 ± 444.10 s, 95 % CI 900.21-1535.59, P = 0.008). Also, AF duration was significantly decreased in PVI group (P = 0.003) or CLAA + PVI group (P CLAA could ablate the left atrial roof and posterior wall together safely and reliably. Compared with PVI alone, CLAA with PVI may be able to improve the rate of acute termination of persistent AF. It may be useful in selecting the best ablation approaches for patients with persistent AF.

  8. In silico assessment of genetic variation in KCNA5 reveals multiple mechanisms of human atrial arrhythmogenesis

    DEFF Research Database (Denmark)

    Colman, Michael A; Ni, Haibo; Liang, Bo


    investigated at the cellular level. In tissue, we assessed the effects of the mutations on the vulnerability to unidirectional conduction patterns and dynamics of re-entrant excitation waves. Gain-of-function mutations shortened the action potential duration in single cells, and stabilised and accelerated re......A recent experimental study investigating patients with lone atrial fibrillation identified six novel mutations in the KCNA5 gene. The mutants exhibited both gain- and loss-of-function of the atrial specific ultra-rapid delayed rectifier K+ current, IKur. The aim of this study is to elucidate...... and quantify the functional impact of these KCNA5 mutations on atrial electrical activity. A multi-scale model of the human atria was updated to incorporate detailed experimental data on IKur from both wild-type and mutants. The effects of the mutations on human atrial action potential and rate dependence were...

  9. Factors associated with the occurrence and treatment of supraventricular tachycardia in a pediatric congenital heart disease cohort. (United States)

    Tripathi, Avnish; Black, George B; Park, Yong-Moon Mark; Jerrell, Jeanette M


    In patients with congenital heart disease (CHD), the association between supraventricular tachycardia (SVT), type of pathophysiology, and therapeutic interventions in a population-based cohort warrants further examination. A retrospective, longitudinal 15-year data set (1996-2010) was analyzed. Inclusion criteria included age ≤17 years, enrolled in South Carolina State Medicaid, and diagnosed as having one or more CHDs as well as SVT. SVT was diagnosed in 6.5 % of CHD patients (N = 1,169) during the 15-year epoch investigated. SVT was less likely to occur in African-American (hazard ratio [HR] = 0.76) or male patients (HR = 0.88), but it was significantly more likely to occur in patients age ≤12 months or in adolescents ≥13 years in those undergoing multiple surgeries/medical interventions for their CHD (HR = 1.14), those receiving antiarrhythmic/diuretic/preload-/afterload-reducing medications (HR = 5.46), and those with severe/cyanotic CHDs (HR = 1.52) or chromosomal abnormalities (HR = 1.64). Children who had an atrial septal defect secundum (adjusted odds ratio [aOR] = 3.03) and those treated with diuretic or antiarrhythmic medication (aOR = 1.80) were significantly more likely to undergo SVT ablation, whereas those with late-onset pulmonary hypertension (ages 6-12 years old) were significantly less likely to undergo SVT ablation. SVT recurred in only 14 of 166 patients who underwent SVT ablation. Multiple medical interventions at an early age may increase the risk of SVT occurrence in young CHD patients regardless of the severity/complexity of the CHD.

  10. Atrial Fibrillation With Rapid Ventricular Response in Pregnancy

    Directory of Open Access Journals (Sweden)

    Chia-Hui Lin


    Conclusion: Arrhythmias with underlying heart disease can result in serious hemodynamic deterioration. Electrical cardioversion is well-tolerated and effective in pregnant women and should not be withheld if clinically indicated.

  11. A focus on pharmacological management of catecholaminergic polymorphic ventricular tachycardia. (United States)

    Barbanti, Claudio; Maltret, Alice; Sidi, Daniel


    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a channelopathy characterized by adrenergic mediated ventricular arrhythmia. Untreated CPVT is a malignant syndrome with more than 50% of arrhythmic event and up to 25% of fatal or near-fatal cardiac event at 8 years follow-up. Prevention of sudden cardiac death starts with exclusion of competitive sports. Beta blockers (BB) are the cornerstone pharmacological therapy for prevention of cardiac event in CPVT patients. Dose of BB should be the highest tolerable, preferably nadolol. Efficiency of BB is undeniable but uncompleted. Therefore, on top of BB, on can propose the use of Calcium channel blockers or Class 1c antiarrythmic drugs. Indeed Flecainide allows reducing exercise-induced premature ventricular contraction and ventricular arrhythmia. Pharmacological management should be a stepwise approach with BB as the first line chose. At each step or therapeutic changes, heart rhythm during exercise should be monitored by Holter monitoring and exercise testing. If the pharmacological management fails, left cardiac sympathetic denervation or implantation of cardioverter defibrillator should be considered. Copyright© Bentham Science Publishers; For any queries, please email at

  12. Sodium permeable and "hypersensitive" TREK-1 channels cause ventricular tachycardia. (United States)

    Decher, Niels; Ortiz-Bonnin, Beatriz; Friedrich, Corinna; Schewe, Marcus; Kiper, Aytug K; Rinné, Susanne; Seemann, Gunnar; Peyronnet, Rémi; Zumhagen, Sven; Bustos, Daniel; Kockskämper, Jens; Kohl, Peter; Just, Steffen; González, Wendy; Baukrowitz, Thomas; Stallmeyer, Birgit; Schulze-Bahr, Eric


    In a patient with right ventricular outflow tract (RVOT) tachycardia, we identified a heterozygous point mutation in the selectivity filter of the stretch-activated K2P potassium channel TREK-1 (KCNK2 or K2P2.1). This mutation introduces abnormal sodium permeability to TREK-1. In addition, mutant channels exhibit a hypersensitivity to stretch-activation, suggesting that the selectivity filter is directly involved in stretch-induced activation and desensitization. Increased sodium permeability and stretch-sensitivity of mutant TREK-1 channels may trigger arrhythmias in areas of the heart with high physical strain such as the RVOT We present a pharmacological strategy to rescue the selectivity defect of the TREK-1 pore. Our findings provide important insights for future studies of K2P channel stretch-activation and the role of TREK-1 in mechano-electrical feedback in the heart. © 2017 The Authors. Published under the terms of the CC BY 4.0 license.

  13. Cardiac origins of the postural orthostatic tachycardia syndrome. (United States)

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


    The purpose of this study was to test the hypothesis that a small heart coupled with reduced blood volume contributes to the postural orthostatic tachycardia syndrome (POTS) and that exercise training improves this syndrome. Patients with POTS have marked increases in heart rate during orthostasis. However, the underlying mechanisms are unknown and the effective therapy is uncertain. Twenty-seven POTS patients underwent autonomic function tests, cardiac magnetic resonance imaging, and blood volume measurements. Twenty-five of them participated in a 3-month specially designed exercise training program with 19 completing the program; these patients were re-evaluated after training. Results were compared with those of 16 healthy controls. Upright heart rate and total peripheral resistance were greater, whereas stroke volume and cardiac output were smaller in patients than in controls. Baroreflex function was similar between groups. Left ventricular mass (median [25th, 75th percentiles], 1.26 g/kg [1.12, 1.37 g/kg] vs. 1.45 g/kg [1.34, 1.57 g/kg]; p Dr. Seuss, the main character had a heart that was "two sizes too small." Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Current Management of Ventricular Tachycardia: Approaches and Timing

    Directory of Open Access Journals (Sweden)

    Roy M. John, MBBS, PhD


    Full Text Available Ventricular tachycardia (VT in the presence of structural heart disease is associated with sudden cardiac death and warrants prompt attention. Implantable cardioverter defibrillators (ICDs while highly effective in terminating sustained ventricular arrhythmias and reducing mortality, have no effect on the arrhythmia substrate and recurrent shocks for VT termination occur in approximately 20% of patients. Shocks worsen quality of life and are associated with progression of heart failure and increased mortality. Antiarrhythmic drugs, mainly in the form of beta-blockers or amiodarone, are moderately effective in reducing ICD therapies but drug intolerance and serious toxicities of amiodarone necessitate drug cessation in a quarter of patients. Catheter ablation has emerged as an effective treatment for control of frequent VT episodes and can be life saving in cases of incessant VT or VT storm. As experience increases, it is being used increasingly earlier, rather than a last resort therapy. Efficacy varies with the nature of the underlying heart disease. Intramural arrhythmia substrate and failure to create permanent ablation lesions remain challenges and repeat procedures are necessary in a third to a half of patients. For idiopathic VTs or PVCs that are symptomatic or worsen LV function, catheter ablation is often an effective therapy.

  15. Zoledronic acid and atrial fibrillation in cancer patients. (United States)

    Arslan, Cagatay; Aksoy, Sercan; Dizdar, Omer; Dede, Didem S; Harputluoglu, Hakan; Altundag, Kadri


    Treatment with a bisphosphonate was found to be associated with a significantly increased risk for atrial fibrillation (AF) in a few studies. A recent study showed that once-yearly infusions of intravenous zoledronic acid (ZA) significantly increased the risk of serious AF in postmenopausal women with osteoporosis. This study was conducted to determine the frequency of atrial fibrillation among cancer patients receiving the standard treatment of ZA. Patients with bone metastases who presented to our outpatient clinic for any reason (routine control, chemotherapy, or ZA administration) were included in the study. All patients had been receiving 4 mg ZA at 4-week intervals, with each dose administered over 15 min. A short survey was completed and standard 12-lead ECG recordings were obtained. One hundred and twenty-four cancer patients with documented bone metastases were evaluated. Mean age of the patients was 55 ± 13.0 years, 60% of the patients were female. Forty-one percent of the patients had breast cancer, 18% had non-small cell lung cancer, and the remainder had other solid tumors. Mean duration of ZA administration was 13.4  ± 15.0 months. Mean total cumulative dose was 54  ± 15.0 mg per patient. Sixty patients (48%) had previously been treated with anthracycline-containing regimens, and 37 (30%) had received chest radiotherapy that might affect the heart. Twenty-three percent of the patients had hypertension, 10% had diabetes mellitus, 3.7% had myocardial infarction history, 1.9% had congestive heart failure, and 1% had valvular disease; 10.5% were current smokers and 32% ex-smokers. On ECG evaluation, we observed normal sinus rhythm in 58%, sinus tachycardia in 15%, sinus bradicardia in 3.2%, and ventricular extrasystole in 5.7% of the patients. There was no AF in any of the cases. There was no increase in the risk of AF frequency in cancer patients who were treated with intravenous ZA, although most of the patients had additional risk factors

  16. Time Course of Atrial Fibrillation in Patients With Congenital Heart Defects. (United States)

    Teuwen, Christophe P; Ramdjan, Tanwier T T K; Götte, Marco; Brundel, Bianca J J M; Evertz, Reinder; Vriend, Joris W J; Molhoek, Sander G; Dorman, Henderikus G R; van Opstal, Jurren M; Konings, Thelma C; van der Voort, Pepijn; Delacretaz, Etienne; Houck, Charlotte; Yaksh, Ameeta; Jansz, Luca J; Witsenburg, Maarten; Roos-Hesselink, Jolien W; Triedman, John K; Bogers, Ad J J C; de Groot, Natasja M S


    The incidence of atrial fibrillation (AF) is rising in the aging patients with congenital heart defects (CHD). However, studies reporting on AF in patients with CHD are scarce. The aim of this multicenter study was to examine in a large cohort of patients with a variety of CHD: (1) the age of onset and initial treatment of AF, coexistence of atrial tachyarrhythmia and (2) progression of paroxysmal to (long-standing) persistent/permanent AF during long-term follow-up. Patients (n=199) with 15 different CHD and documented AF episodes were studied. AF developed at 49±17 years. Regular atrial tachycardia (AT) coexisting with AF occurred in 65 (33%) patients; 65% initially presented with regular AT. At the end of a follow-up period of 5 (0-24) years, the ECG showed AF in 81 patients (41%). In a subgroup of 114 patients, deterioration from paroxysm of AF to (long-standing) persistent/permanent AF was observed in 29 patients (26%) after only 3 (0-18) years of the first AF episode. Cerebrovascular accidents/transient ischemic attacks occurred in 26 patients (13%), although a substantial number (n=16) occurred before the first documented AF episode. Age at development of AF in patients with CHD is relatively young compared with the patients without CHD. Coexistence of episodes of AF and regular AT occurred in a considerable number of patients; most of them initially presented with regular AT. The fast and frequent progression from paroxysmal to (long-standing) persistent or permanent AF episodes justifies close follow-up and early, aggressive therapy of both AT and AF. © 2015 American Heart Association, Inc.

  17. Non-ventricular, Clinical, and Functional Features of the RyR2(R420Q) Mutation Causing Catecholaminergic Polymorphic Ventricular Tachycardia. (United States)

    Domingo, Diana; Neco, Patricia; Fernández-Pons, Elena; Zissimopoulos, Spyros; Molina, Pilar; Olagüe, José; Suárez-Mier, M Paz; Lai, F Anthony; Gómez, Ana M; Zorio, Esther


    Catecholaminergic polymorphic ventricular tachycardia is a malignant disease, due to mutations in proteins controlling Ca(2+) homeostasis. While the phenotype is characterized by polymorphic ventricular arrhythmias under stress, supraventricular arrhythmias may occur and are not fully characterized. Twenty-five relatives from a Spanish family with several sudden deaths were evaluated with electrocardiogram, exercise testing, and optional epinephrine challenge. Selective RyR2 sequencing in an affected individual and cascade screening in the rest of the family was offered. The RyR2(R420Q) mutation was generated in HEK-293 cells using site-directed mutagenesis to conduct in vitro functional studies. The exercise testing unmasked catecholaminergic polymorphic ventricular tachycardia in 8 relatives (sensitivity = 89%; positive predictive value = 100%; negative predictive value = 93%), all of them carrying the heterozygous RyR2(R420Q) mutation, which was also present in the proband and a young girl without exercise testing, a 91% penetrance at the end of the follow-up. Remarkably, sinus bradycardia, atrial and junctional arrhythmias, and/or giant post-effort U-waves were identified in patients. Upon permeabilization and in intact cells, the RyR2(R420Q) expressing cells showed a smaller peak of Ca(2+) release than RyR2 wild-type cells. However, at physiologic intracellular Ca(2+) concentration, equivalent to the diastolic cytosolic concentration, the RyR2(R420Q) released more Ca(2+) and oscillated faster than RyR2 wild-type cells. The missense RyR2(R420Q) mutation was identified in the N-terminus of the RyR2 gene in this highly symptomatic family. Remarkably, this mutation is associated with sinus bradycardia, atrial and junctional arrhythmias, and giant U-waves. Collectively, functional heterologous expression studies suggest that the RyR2(R420Q) behaves as an aberrant channel, as a loss- or gain-of-function mutation depending on cytosolic intracellular Ca(2

  18. Postoperative atrial fibrillation in patients with left atrial myxoma. (United States)

    Sahin, Muslum; Tigen, Kursat; Dundar, Cihan; Ozben, Beste; Alici, Gokhan; Demir, Serdar; Kalkan, Mehmet Emin; Ozkan, Birol


    The aim of this study was to determine the factors associated with postoperative atrial fibrillation (AF) in patients with left atrial (LA) myxoma. Thirty-six consecutive patients with LA myxoma (10 men, mean age: 49.3 ± 15.7 years), who were operated on between March 2010 and July 2012, were included in this retrospective study. Pre-operative electrocardiograms and echocardiographic examinations of each patient were reviewed. Postoperative AF developed in 10 patients, whereas there was no evidence of paroxysmal AF after resection of the LA myxoma in the remaining 26 patients. The patients who developed AF postoperatively were significantly older than those who did not develop AF (median: 61.5 vs 46 years; p = 0.009). Among the electrocardiographic parameters, only P-wave dispersion differed significantly between postoperative AF and non-AF patients (median: 57.6 vs 39.8 ms, p = 0.004). Logistic regression analysis revealed P- wave dispersion (OR: 1.11, 95% CI: 1.003-1.224, p = 0.043) and age (OR: 1.13, 95% CI: 1.001-1.278, p = 0.048) as independent predictors of postoperative AF in our cohort of patients. P-wave dispersion is a simple and useful parameter for the prediction of postoperative AF in patients with LA myxoma.

  19. Isthmus Dependent Atrial Flutter Cycle Length Correlates with Right Atrial Cross-Sectional Area

    Directory of Open Access Journals (Sweden)

    Kousik Krishnan


    Full Text Available Background: Right atrial flutter cycle length can prolong in the presence of antiarrhythmic drug therapy. We hypothesized that the cycle length of right atrial isthmus dependent flutter would correlate with right atrial cross-sectional area measurements. Methods: 60 patients who underwent ablation for electrophysiologically proven isthmus dependent right atrial flutter, who were not on Class I or Class III antiarrhythmic drugs and had recent 2-dimensional echocardiographic data comprised the study group. Right atrial length and width were measured in the apical four chamber view. Cross-sectional area was estimated by multiplying the length and width. 35 patients had an atrial flutter rate ≥250 bpm (Normal Flutter Group and 25 patients had an atrial flutter rate < 250 bpm (Slow Flutter Group. Results: Mean atrial flutter rate was 283 bpm in the normal flutter group and 227 bpm in the slow flutter group. Mean atrial flutter cycle length was 213 ms in the Normal Flutter Group and 265 ms in the Slow Flutter Group (p<0.0001. Mean right atrial cross sectional area was 1845 mm2 in the Normal Flutter group and 2378 mm2 in the Slow Flutter Group, (p< 0.0001. Using linear regression, CSA was a significant predictor of cycle length (β =0.014 p = 0.0045. For every 1 mm2 increase in cross-sectional area, cycle length is 0.014 ms longer.Conclusion: In the absence of antiarrhythmic medications, right atrial cross sectional area enlargement correlates with atrial flutter cycle length. These findings provide further evidence that historical rate-related definitions of typical isthmus dependent right atrial are not mechanistically valid.

  20. A MicroRNA-Transcription Factor Blueprint for Early Atrial Arrhythmogenic Remodeling

    Directory of Open Access Journals (Sweden)

    Mario Torrado


    Full Text Available Spontaneous self-terminating atrial fibrillation (AF is one of the most common heart rhythm disorders, yet the regulatory molecular mechanisms underlying this syndrome are rather unclear. MicroRNA (miRNA transcriptome and expression of candidate transcription factors (TFs with potential roles in arrhythmogenesis, such as Pitx2, Tbx5, and myocardin (Myocd, were analyzed by microarray, qRT-PCR, and Western blotting in left atrial (LA samples from pigs with transitory AF established by right atrial tachypacing. Induced ectopic tachyarrhythmia caused rapid and substantial miRNA remodeling associated with a marked downregulation of Pitx2, Tbx5, and Myocd expression in atrial myocardium. The downregulation of Pitx2, Tbx5, and Myocd was inversely correlated with upregulation of the corresponding targeting miRNAs (miR-21, miR-10a/10b, and miR-1, resp. in the LA of paced animals. Through in vitro transient transfections of HL-1 atrial myocytes, we further showed that upregulation of miR-21 did result in downregulation of Pitx2 in cardiomyocyte background. The results suggest that immediate-early miRNA remodeling coupled with deregulation of TF expression underlies the onset of AF.

  1. Dronedarone for the treatment of atrial fibrillation and atrial flutter. (United States)

    Maund, E; McKenna, C; Sarowar, M; Fox, D; Stevenson, M; Pepper, C; Palmer, S; Woolacott, N


    This paper presents a summary of the evidence review group (ERG) report on the clinical effectiveness and cost-effectiveness of dronedarone for the treatment of atrial fibrillation (AF) or atrial flutter based upon a review of the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The population considered in the submission were adult clinically stable patients with a recent history of or current non-permanent AF. Comparators were the current available anti-arrhythmic drugs: class 1c agents (flecainide and propafenone), sotalol and amiodarone. Outcomes were AF recurrence, all-cause mortality, stroke, treatment discontinuations (due to any cause or due to adverse events) and serious adverse events. The main evidence came from four phase III randomised controlled trials, direct and indirect meta-analyses from a systematic review, and a synthesis of the direct and indirect evidence using a mixed-treatment comparison. Overall, the results from the different synthesis approaches showed that the odds of AF recurrence appeared statistically significantly lower with dronedarone and other anti-arrhythmic drugs than with non-active control, and that the odds of AF recurrence are statistically significantly higher for dronedarone than for amiodarone. However, the results for outcomes of all-cause mortality, stroke and treatment discontinuations and serious adverse events were all uncertain. A discrete event simulation model was used to evaluate dronedarone versus antiarrhythmic drugs and standard therapy alone. The incremental cost-effectiveness ratio of dronedarone was relatively robust and less than 20,000 pounds per quality-adjusted life-year. Exploratory work undertaken by the ERG identified that the main drivers of cost-effectiveness were the benefits assigned to dronedarone for all-cause mortality and stroke. Dronedarone is not cost-effective relative to its comparators when

  2. New developments in atrial antiarrhythmic drug therapy (United States)

    Burashnikov, Alexander; Antzelevitch, Charles


    Atrial fibrillation (AF) is a growing clinical problem associated with increased morbidity and mortality. Currently available antiarrhythmic drugs (AADs), although highly effective in acute cardioversion of paroxysmal AF, are generally only moderately successful in long-term maintenance of sinus rhythm. The use of AADs is often associated with an increased risk of ventricular proarrhythmia, extracardiac toxicity, and exacerbation of concomitant diseases such as heart failure. AF is commonly associated with intracardiac and extracardiac disease, which can modulate the efficacy and safety of AAD therapy. In light of the multifactorial intracardiac and extracardiac causes of AF generation, current development of anti-AF agents is focused on modulation of ion channel activity as well as on upstream therapies that reduce structural substrates. The available data indicate that multiple ion channel blockers exhibiting potent inhibition of peak INa with relatively rapid unbinding kinetics, as well as inhibition of late INa and IKr, may be preferable for the management of AF when considering both safety and efficacy. PMID:20179721

  3. 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


    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...

  4. Bilateral passive leg raising attenuates and delays tourniquet deflation-induced hypotension and tachycardia under spinal anaesthesia: a randomised controlled trial. (United States)

    Huang, Go-Shine; Wang, Chih-Chien; Hu, Mei-Hua; Cherng, Chen-Hwan; Lee, Meei-Shyuan; Tsai, Chien-Sung; Chan, Wei-Hung; Hsieh, Xhang-Xian; Lin, Leou-Chyr


    The pneumatic tourniquet is frequently used in total knee arthroplasty. Tourniquet deflation may result in hypotension and tachycardia caused by the rapid shift of blood volume back to the ischaemic limb and a decrease in cardiac preload. Passive leg raising (PLR) represents a 'self-volume challenge' that can result in an increase in preload. Such a PLR-induced increase in preload was hypothesised to attenuate the decrease in preload resulting from tourniquet deflation. To evaluate the effect of PLR on hypotension and tachycardia following tourniquet deflation. A randomised controlled trial. Single medical centre. Seventy patients who underwent unilateral total knee arthroplasty were randomised into two groups: tourniquet deflation with PLR (n = 35) or without PLR (control group, n = 35). Patients in both groups were administered a single dose of plain bupivacaine for spinal anaesthesia. The pneumatic tourniquet was inflated on the thigh and the surgery was performed. The study composed of four steps: for the PLR group, step 1 - inflation of the tourniquet while the patient was supine; step 2 - the patient's legs were raised to a 45° angle; step 3 - the tourniquet was deflated while the patient's legs were still raised; and step 4 - the legs were returned to the supine position. In the control group, the same perioperative procedure was used, but PLR was not conducted. The patients' blood pressure and heart rate were measured before, during and after tourniquet deflation. After tourniquet deflation, the magnitude of the changes in blood pressure and heart rate was less in the PLR group than that in the control group. In addition, the blood pressure nadir also occurred later in the PLR group than in the controls. Bilateral PLR is a simple, reversible manoeuvre that mimics rapid fluid loading. Bilateral PLR attenuates the severity of, and delays the time to, hypotension and tachycardia following deflation of a lower limb tourniquet. number


    Papiashvili, G; Tabagari-Bregvadze, N; Brugada, J


    The aim of the study was to evaluate the incidence of different personality types and state and trait anxiety levels in patients with paroxysmal supraventricular tachycardia and their association with patients age, gender and the mechanism of the paroxysmal SVT. 62 patients with documented paroxysmal supraventricular tachycardia who underwent endocardial eletrophysiological study and catheter ablation of the paroxysmal SVT were included in the study. The patients were asked to fill out the Myers-Brigss Type Indicator and State-Trait Anxiety Inventory questionnaires and the results were analyzed and correlated with the arrhythmia mechanism determined during electrophysiological study and catheter ablation procedure, and the patients' demographics (age and gender). There was no significant difference in State (mean 41.53±13.51, p=0.893) or Trait (mean 44.70±12.62, p=0.315) anxiety scores according to gender although higher scores were found in females. Older patients (≥50 years old compared to anxiety scores but with no statistical significance (p=0.344 for state anxiety and p=0.100 for trait anxiety). The patients with AVNRT had significantly higher Trait anxiety scores (mean 46.82±10.52) than the patients with AVRT or AT (mean 40.59±10.91) (p=0.032). State anxiety score was not significantly different between patients with different SVT types (p=0.706). Anxiety is an important factor to be considered in patients with paroxysmal supraventricular tachycardia. It doesn't seem to be associated with different personality types. Female and older patients tend to show higher anxiety levels. The atrioventricular Nodal Reentrant Tachycardia (AVNRT) is associated with significantly higher trait anxiety levels compared to other types of paroxysmal supraventricular tachycardia.

  6. Magnetic resonance imaging of suspected atrial tumors. (United States)

    Menegus, M A; Greenberg, M A; Spindola-Franco, H; Fayemi, A


    Two-dimensional echocardiography has become the standard technique for evaluation of cardiac and paracardiac mass lesions. We have used magnetic resonance imaging (MRI) as an independent assessment of cardiac-associated masses in patients with echocardiograms demonstrating sessile atrial tumors. MRI was performed in seven patients, ages 33 to 84, whose echocardiographic diagnoses included left atrial mass (five), right atrial mass (one), and interatrial mass (one). In four of the patients with a diagnosis of left atrial mass, MRI showed extracardiac compression of the atrium, simulating a tumor (hiatal hernia, tortuous descending aorta, bronchogenic cyst). MRI was entirely normal in one patient with an apparent left atrial mass. MRI elucidated extension of an extracavitary mass into the interatrial septum in two patients. One of these patients with an echocardiographic right atrial mass had extension of a lipoma into the interatrial septum without atrial tumor. MRI confirmed the echocardiographic diagnosis of an interatrial mass in the other patient. We conclude that MRI, because of its ability to define anatomic relationships and tissue characteristics, is a powerful noninvasive tool for evaluating suspected cardiac mass lesions. Although echocardiography remains the primary screening test for the detection of cardiac masses, MRI is a more specific modality for precise diagnosis. Correct MRI interpretation may obviate the need for invasive studies or surgery.

  7. [Systematic assessment of the paediatrician's performance during simulated supraventricular tachycardia]. (United States)

    Oulego Erroz, I; Rodríguez Núñez, A; Alonso Quintela, P; Mora Matilla, M; Iglesias Vázquez, A; Fernández Sanmartín, M; Civantos Fuentes, E; Sánchez Santos, L


    The aims of this study are to: a) assess the quality in clinical management during a simulated scenario of acute supraventricular tachycardia (SVT) by means of a structured task-based checklist and to b) detect pitfalls and grey areas where reinforcement in training may be needed. We systematically reviewed SVT simulated scenarios during simulation courses between June 2008 and April 2010. Three scenarios were programmed using SimBaby® simulation system, and included stable SVT (S-SVT), stable progressing to unstable SVT (SU-SVT) and unstable SVT (U-SVT). Scenarios were evaluated by means of an 18-task checklist based on ILCOR international recommendations. A total of 45 scenarios were assessed with the participation of 167 paediatricians, including 15 S-SVT, 25 SU-SVT and 5 U-SVT scenarios. Out of a total of 551 possible tasks, 328 (59.5%) were completed correctly. The mean percentage of correct tasks per scenario was 63.4 (16.7) for S-SVT, 47.8 (20.3) for SU-ST and 38.6 (31) for U-SVT (p=0.028). There were no significant differences between primary care paediatricians and hospital paediatricians. Most of the participants correctly identified non-sinus rhythm as SVT. However, important pitfalls were observed, including failure to identify haemodynamic instability in 20 out of 43 (48%) cases, an incorrect dose of adenosine in 18 out of 39 (48%), incorrect adenosine administration in 23 out of 39 (59%), and non-recognition of indication to emergent cardioversion in 15 out of 31 (48%). Paediatricians are able to diagnose SVT correctly, but need to improve their skills in treatment. Systematic analysis of clinical performance in a simulated scenario allows the identification of strengths, as well as weak points, where reinforcement is needed. Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  8. Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency (United States)

    Shannon, J. R.; Flattem, N. L.; Jordan, J.; Jacob, G.; Black, B. K.; Biaggioni, I.; Blakely, R. D.; Robertson, D.


    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

  9. A prehospital treat-and-release protocol for supraventricular tachycardia. (United States)

    Minhas, Rajan; Vogelaar, Gregory; Wang, Dongmei; Almansoori, Wadhah; Lang, Eddy; Blanchard, Ian E; Lazarenko, Gerald; McRae, Andrew


    Paroxysmal supraventricular tachycardia (SVT) is a common dysrhythmia treated in the prehospital setting. Emergency medical service (EMS) agencies typically require patients treated for SVT to be transported to the hospital. This retrospective cohort study evaluated the impact, paramedic adherence, and patient re-presentation rates of a treat-and-release (T+R) protocol for uncomplicated SVT. Data were linked from the Alberta Health Services EMS electronic patient care record (EPCR) database for the City of Calgary to the Regional Emergency Department Information System (REDIS). All SVT patients treated by EMS between September 1, 2010, and September 30, 2012, were identified. Databases were queried to identify re-presentations to EMS or an emergency department (ED) within 72 hours of T+R. There were 229 confirmed SVT patient encounters, including 75 T+R events. Of these 75 T+R events, 10 (13%, 95% confidence interval [CI] [7.4, 23]) led to an EMS re-presentation within 72 hours, and 4 (5%, 95% CI [2.1, 13]) led to an ED. All re-presentations were attributed to a single individual. After excluding 15 records that were incomplete due to limitations in the EPCR platform, 43 of 60 (72%) T+R encounters met all protocol criteria for T+R. The T+R protocol evaluated in this study applied to a significant proportion of patients presenting to EMS with SVT. Risk of re-presentation following T+R was low, and paramedic protocol adherence was reasonable. T+R appears to be a viable option for uncomplicated SVT in the prehospital setting.

  10. Quality of life in patients with postural tachycardia syndrome. (United States)

    Benrud-Larson, Lisa M; Dewar, Melanie S; Sandroni, Paola; Rummans, Teresa A; Haythornthwaite, Jennifer A; Low, Phillip A


    To quantify quality of life and identify demographic and clinical correlates of functioning in a well-characterized sample of patients with postural tachycardia syndrome (POTS). Prospective patients were those seen at the Mayo Clinic Autonomic Disorders Laboratory from September 2000 to June 2001. Neurologists made diagnoses of POTS according to established criteria. Patients completed a questionnaire packet that included measures of quality of life (36-Item Short-Form Health Survey [SF-36]) and symptom severity (Autonomic Symptom Profile). Additional clinical information was abstracted from medical records. Ninety-four patients (89% female; mean age, 34.2 years) were enrolled in the study. Patients with POTS reported impairment across multiple domains on the SF-36. Physical functioning, role functioning, bodily pain, general health, vitality, and social functioning were all significantly impaired compared with a healthy population (P<.01 for all) and similar to that reported by patients with other chronic, disabling conditions. Hierarchical regression analyses revealed that symptom severity (beta = -.36, P<.001) and disability status (beta = -36, P<.001) were independent predictors of SF-36 physical component scores, with the full model accounting for 54% of the variance (P<.001). None of the variables examined accounted for a significant amount of the variance in SF-36 mental component scores. Patients with POTS experience clear limitations across multiple domains of quality of life, including physical, social, and role functioning. Treatment should address the multiple and varied impairments experienced by these patients and may require a multidisciplinary approach. Future research must further delineate factors, both disease related and psychosocial, that predict functioning and adjustment in this population.

  11. Certain cardiovascular indices predict syncope in the postural tachycardia syndrome (United States)

    Sandroni, P.; Opfer-Gehrking, T. L.; Benarroch, E. E.; Shen, W. K.; Low, P. A.


    Patients with postural tachycardia syndrome (POTS) represent a patient population with orthostatic intolerance; some are prone to syncope, others are not. The underlying neurocardiovascular mechanisms are not completely understood. The current study was undertaken to assess if certain cardiovascular indices are predictive of syncope in POTS. We compared the response to tilt-up and the Valsalva maneuver in four groups: POTS patients who fainted (POTS-f; n = 11;31 +/- 11 years): POTS patients who did not faint (POTS-nf; n = 9; 29 +/- 9 years); normal controls (NLS; n = 13; 39 +/- 11 years); patients with generalized autonomic failure with orthostatic hypotension and syncope (n = 10; 59 +/- 14 years). Beat-to-beat heart rate (HR), systolic arterial pressure, diastolic arterial pressure (DAP) and pulse pressure (PP) were monitored using Finapres. Cardiac output, stroke volume (SV) and end-diastolic volume (EDV), and calculated total peripheral resistance (TPR) were recorded using thoracic electrical bioimpedance. An autonomic reflex screen which quantitates the distribution and severity of autonomic failure was also done. With the patient supine, all POTS patients (POTS-nf; POTS-f) had increased HR (p < 0.001) and reduced SV/EDV (p < 0.001) when compared with NLS. On tilt-up, POTS-f patients were significantly different from both NLS and POTS-nf patients; the most consistent alteration was a fall instead of an increase in TPR; other changes were a greater reduction in PP, a reduction (instead of an increment) in DAP, and a different pattern of changes during the Valsalva maneuver (excessive early phase II, attenuated or absent late phase II). Our results suggest alpha-adrenergic impairment with increased pooling or hypovolemia in POTS-f patients. We conclude that it is possible to identify the mechanism of syncope in POTS patients, and perhaps other patients with orthostatic intolerance and an excessive liability to syncope.

  12. Junctional ectopic tachycardia after infant heart surgery: incidence and outcomes. (United States)

    Zampi, Jeffrey D; Hirsch, Jennifer C; Gurney, James G; Donohue, Janet E; Yu, Sunkyung; LaPage, Martin J; Hanauer, David A; Charpie, John R


    Junctional ectopic tachycardia (JET) is an arrhythmia observed almost exclusively after open heart surgery in children. Current literature on JET has not focused on patients at the highest risk of both developing and being negatively impacted by JET. The purpose of this study was to determine the overall incidence of JET in an infant patient cohort undergoing open cardiac surgery, to identify patient- and procedure-related factors associated with developing JET, and to assess the clinical impact of JET on patient outcomes. We performed a nested case-control study from the complete cohort of patients at our institution younger than 1 year of age who underwent open heart surgery between 2005 and 2010. JET patients were compared with an age matched control group undergoing open heart surgery without JET regarding potential risk factors and outcomes. The overall incidence of JET in infants after open cardiac surgery was 14.3 %. From multivariate analyses, complete repair of tetralogy of Fallot [adjusted odds ratio (AOR) 2.0, 95 % CI 1.12-3.57] and longer aortic cross clamp times (AOR 1.02, 95 % CI 1.01-1.03) increased the risk of developing JET. Patients with JET had longer length of intubation, intensive care unit stays, and total length of hospitalization, and were more likely to require extracorporeal membrane oxygenation support (13 vs. 4.3 %). JET is a common postoperative arrhythmia in infants after open heart operations. Both anatomic substrate and surgical procedure contribute to the overall risk of developing JET. Developing JET is associated with worse clinical outcomes.

  13. Certain cardiovascular indices predict syncope in the postural tachycardia syndrome (United States)

    Sandroni, P.; Opfer-Gehrking, T. L.; Benarroch, E. E.; Shen, W. K.; Low, P. A.


    Patients with postural tachycardia syndrome (POTS) represent a patient population with orthostatic intolerance; some are prone to syncope, others are not. The underlying neurocardiovascular mechanisms are not completely understood. The current study was undertaken to assess if certain cardiovascular indices are predictive of syncope in POTS. We compared the response to tilt-up and the Valsalva maneuver in four groups: POTS patients who fainted (POTS-f; n = 11;31 +/- 11 years): POTS patients who did not faint (POTS-nf; n = 9; 29 +/- 9 years); normal controls (NLS; n = 13; 39 +/- 11 years); patients with generalized autonomic failure with orthostatic hypotension and syncope (n = 10; 59 +/- 14 years). Beat-to-beat heart rate (HR), systolic arterial pressure, diastolic arterial pressure (DAP) and pulse pressure (PP) were monitored using Finapres. Cardiac output, stroke volume (SV) and end-diastolic volume (EDV), and calculated total peripheral resistance (TPR) were recorded using thoracic electrical bioimpedance. An autonomic reflex screen which quantitates the distribution and severity of autonomic failure was also done. With the patient supine, all POTS patients (POTS-nf; POTS-f) had increased HR (p tilt-up, POTS-f patients were significantly different from both NLS and POTS-nf patients; the most consistent alteration was a fall instead of an increase in TPR; other changes were a greater reduction in PP, a reduction (instead of an increment) in DAP, and a different pattern of changes during the Valsalva maneuver (excessive early phase II, attenuated or absent late phase II). Our results suggest alpha-adrenergic impairment with increased pooling or hypovolemia in POTS-f patients. We conclude that it is possible to identify the mechanism of syncope in POTS patients, and perhaps other patients with orthostatic intolerance and an excessive liability to syncope.

  14. Atrial Na,K-ATPase increase and potassium dysregulation accentuate the risk of postoperative atrial fibrillation

    DEFF Research Database (Denmark)

    Tran, Cao Thach; Schmidt, Thomas Andersen; Christensen, John Brochorst


    BACKGROUND: Postoperative atrial fibrillation is a common complication to cardiac surgery. Na,K-ATPase is of major importance for the resting membrane potential and action potential. The purpose of the present study was to evaluate the importance of Na,K-ATPase concentrations in human atrial...... biopsies and plasma potassium concentrations for the development of atrial fibrillation. METHODS: Atrial myocardial biopsies were obtained from 67 patients undergoing open chest cardiac surgery. Na,K-ATPase was quantified using vanadate-facilitated 3H-ouabain binding. Plasma potassium concentration...... with postoperative atrial fibrillation. CONCLUSIONS: The present study supports the increasing evidence of dysregulation of the potassium homeostasis as an important factor in the development of cardiac arrhythmias. High atrial Na,K-ATPase and sudden plasma potassium concentration increase may contribute...

  15. Idiopathic left ventricular tachycardia with a change from left to right axis deviation during radiofrequency catheter ablation. (United States)

    Okumura, Yasuo; Watanabe, Ichiro; Ohkubo, Kimie; Hashimoto, Kenichi; Ashino, Sonoko; Kofune, Masayoshi; Sugimura, Hidezou; Shindo, Atsushi; Nakai, Toshiko; Saito, Satoshi


    A 62 year-old-woman presented with a right bundle branch block (RBBB) and left axis deviation (LAD) tachycardia. Radiofrequency (RF) energy was delivered to the left posterior fascicle (LPF) where 2 presystolic Purkinje potentials (P1 and P2) preceding onset of the QRS complex were recorded. During RF energy applications, the QRS morphology of the tachycardia changed from RBBB and LAD to RBBB and right axis deviation without termination of the tachycardia. The Purkinje potential was observed following the QRS complex during the tachycardia because of conduction block of the LPF distal to the reentry circuit due to RF catheter ablation.

  16. Catheter ablation vs electrophysiologically guided thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: The CASA-AF Study. (United States)

    Haldar, Shouvik K; Jones, David G; Bahrami, Toufan; De Souza, Anthony; Panikker, Sandeep; Butcher, Charlie; Khan, Habib; Yahdav, Rashmi; Jarman, Julian; Mantziari, Lilian; Nyktari, Eva; Mohiaddin, Raad; Hussain, Wajid; Markides, Vias; Wong, Tom


    Catheter ablation (CA) outcomes for long-standing persistent atrial fibrillation (LSPAF) remain suboptimal. Thoracoscopic surgical ablation (SA) provides an alternative approach in this difficult to treat cohort. To compare electrophysiological (EP) guided thoracoscopic SA with percutaneous CA as the first-line strategy in the treatment of LSPAF. Fifty-one patients with de novo symptomatic LSPAF were recruited. Twenty-six patients underwent electrophysiologically guided thoracoscopic SA. Conduction block was tested for all lesions intraoperatively by an independent electrophysiologist. In the CA group, 25 consecutive patients underwent stepwise left atrial (LA) ablation. The primary end point was single-procedure freedom from atrial fibrillation (AF) and atrial tachycardia (AT) lasting >30 seconds without antiarrhythmic drugs at 12 months. Single- and multiprocedure freedom from AF/AT was higher in the SA group than in the CA group: 19 of 26 patients (73%) vs 8 of 25 patients (32%) (P = .003) and 20 of 26 patients (77%) vs 15 of 25 patients (60%) (P = .19), respectively. Testing of the SA lesion set by an electrophysiologist increased the success rate in achieving acute conduction block by 19%. In the SA group, complications were experienced by 7 of 26 patients (27%) vs 2 of 25 patients (8%) in the CA group (P = .07). In LSPAF, meticulous electrophysiologically guided thoracoscopic SA as a first-line strategy may provide excellent single-procedure success rates as compared with those of CA, but there is an increased up-front risk of nonfatal complications. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  17. 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

    Directory of Open Access Journals (Sweden)

    Cesar Augusto Ferreira


    . 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.

  18. The circadian variation of premature atrial contractions

    DEFF Research Database (Denmark)

    Larsen, Bjørn Strøier; Kumarathurai, Preman; Nielsen, Olav W


    AIMS: The aim of the study was to assess a possible circadian variation of premature atrial contractions (PACs) in a community-based population and to determine if the daily variation could be used to assess a more vulnerable period of PACs in predicting later incidence of atrial fibrillation (AF...... variation in heart rate. After adjusting for relevant risk factors, the risk of AF was equal in all time intervals throughout the day. CONCLUSION: Premature atrial contractions showed a circadian variation in subjects with frequent PACs. No specific time interval of the day was more predictive of AF than...

  19. Ablation for atrial fibrillation: an evidence-based analysis. (United States)


    To review the effectiveness, safety, and costing of ablation methods to manage atrial fibrillation (AF). The ablation methods reviewed were catheter ablation and surgical ablation. Atrial fibrillation is characterized by an irregular, usually rapid, heart rate that limits the ability of the atria to pump blood effectively to the ventricles. Atrial fibrillation can be a primary diagnosis or it may be associated with other diseases, such as high blood pressure, abnormal heart muscle function, chronic lung diseases, and coronary heart disease. The most common symptom of AF is palpitations. Symptoms caused by decreased blood flow include dizziness, fatigue, and shortness of breath. Some patients with AF do not experience any symptoms. According to United States data, the incidence of AF increases with age, with a prevalence of 1 per 200 people aged between 50 and 60 years, and 1 per 10 people aged over 80 years. In 2004, the Institute for Clinical Evaluative Sciences (ICES) estimated that the rate of hospitalization for AF in Canada was 582.7 per 100,000 population. They also reported that of the patients discharged alive, 2.7% were readmitted within 1 year for stroke. One United States prevalence study of AF indicated that the overall prevalence of AF was 0.95%. When the results of this study were extrapolated to the population of Ontario, the prevalence of AF in Ontario is 98,758 for residents aged over 20 years. Currently, the first-line therapy for AF is medical therapy with antiarrhythmic drugs (AADs). There are several AADs available, because there is no one AAD that is effective for all patients. The AADs have critical adverse effects that can aggravate existing arrhythmias. The drug selection process frequently involves trial and error until the patient's symptoms subside. Ablation has been frequently described as a "cure" for AF, compared with drug therapy, which controls AF but does not cure it. Ablation involves directing an energy source at cardiac tissue

  20. Coupled personalization of cardiac electrophysiology models for prediction of ischaemic ventricular tachycardia. (United States)

    Relan, Jatin; Chinchapatnam, Phani; Sermesant, Maxime; Rhode, Kawal; Ginks, Matt; Delingette, Hervé; Rinaldi, C Aldo; Razavi, Reza; Ayache, Nicholas


    In order to translate the important progress in cardiac electrophysiology modelling of the last decades into clinical applications, there is a requirement to make macroscopic models that can be used for the planning and performance of the clinical procedures. This requires model personalization, i.e. estimation of patient-specific model parameters and computations compatible with clinical constraints. Simplified macroscopic models can allow a rapid estimation of the tissue conductivity, but are often unreliable to predict arrhythmias. Conversely, complex biophysical models are more complete and have mechanisms of arrhythmogenesis and arrhythmia sustainibility, but are computationally expensive and their predictions at the organ scale still have to be validated. We present a coupled personalization framework that combines the power of the two kinds of models while keeping the computational complexity tractable. A simple eikonal model is used to estimate the conductivity parameters, which are then used to set the parameters of a biophysical model, the Mitchell-Schaeffer (MS) model. Additional parameters related to action potential duration restitution curves for the tissue are further estimated for the MS model. This framework is applied to a clinical dataset derived from a hybrid X-ray/magnetic resonance imaging and non-contact mapping procedure on a patient with heart failure. This personalized MS model is then used to perform an in silico simulation of a ventricular tachycardia (VT) stimulation protocol to predict the induction of VT. This proof of concept opens up possibilities of using VT induction modelling in order to both assess the risk of VT for a given patient and also to plan a potential subsequent radio-frequency ablation strategy to treat VT.

  1. Effective Management of Atrioventricular Interval for Paroxysmal Atrial Fibrillation That Developed After DDDR Pacemaker Implantation in a Sick Sinus Syndrome Patient. (United States)

    Tasaki, Hirofumi; Ashizawa, Naoto; Nagao, Shoichi; Fukushima, Kiyoyasu; Furukawa, Ryuji; Fukae, Satoki; Maemura, Koji


    A 68-year-old man with sick sinus syndrome (SSS) was referred to our department for pacemaker implantation. After implantation of a pacemaker with rate-responsive dual chamber (DDDR) mode and minimized ventricular pacing (MVP) functions, paroxysmal atrial fibrillation (PAF) repeatedly developed. Pacemaker memory showed that the intrinsic atrioventricular (AV) (atrial pacing-ventricular sensing [Ap-Vs]) interval was paradoxically prolonged during rate-responsive atrial single-chamber (AAIR) mode rapid pacing because of MVP. Accordingly, to eliminate the paradoxical prolongation of the AV interval during rapid atrial pacing, we changed MVP to medium AV hysteresis and conducted DDDR mode pacing with rate-dependent AV delay. PAF then sharply decreased without antiarrhythmic drugs.

  2. Characteristics and identification of sites of chagasic ventricular tachycardia by endocardial mapping

    Directory of Open Access Journals (Sweden)

    Távora Maria Zildany P.


    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.

  3. Right ventricular outflow tract tachycardia after an initial dose of amantadine. (United States)

    Kocaş, Cüneyt; Türkmen, Yusuf; Çetinkal, Gökhan; Doğan, Sait Mesut


    Amantadine hydrochloride is an antiviral agent that is also effective in the treatment of Parkinson's disease. In the literature, cardiac arrhythmia is reported in toxic doses of amantadine, but in this paper we report a patient with right ventricular outflow tract (RVOT) tachycardia after an initial dose of amantadine. A 47-year-old female patient was admitted to the emergency department with the complaint of palpitation and dizziness after taking 200 mg amantadine. A 12-lead standard ECG showed wide QRS complex tachycardia with a heart rate of 167/min. The wide QRS complex tachycardia had an inferior axis and left bundle branch block morphology, compatible with RVOT ventricular tachycardia (RVOT-VT). Tachycardia terminated spontaneously and sinus ECG was completely normal. No arrhythmia was inducible at the electrophysiological study. To the best of our knowledge, this is the first case in the literature to describe RVOT-VT after amantadine intake. Amantadine may cause RVOT-VT as well as other cardiac arrhythmias.

  4. Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery. (United States)

    El Amrousy, Doaa Mohamed; Elshmaa, Nagat S; El-Kashlan, Mohamed; Hassan, Samir; Elsanosy, Mohamed; Hablas, Nahed; Elrifaey, Shimaa; El-Feky, Wael


    Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery. A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with PHeart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P0.005). Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  5. Tachycardia-bradycardia syndrome: Electrophysiological mechanisms and future therapeutic approaches (Review) (United States)

    Tse, Gary; Liu, Tong; Li, Ka Hou Christien; Laxton, Victoria; Wong, Andy On-Tik; Chan, Yin Wah Fiona; Keung, Wendy; Chan, Camie W.Y.; Li, Ronald A.


    Sick sinus syndrome (SSS) encompasses a group of disorders whereby the heart is unable to perform its pacemaker function, due to genetic and acquired causes. Tachycardia-bradycardia syndrome (TBS) is a complication of SSS characterized by alternating tachycardia and bradycardia. Techniques such as genetic screening and molecular diagnostics together with the use of pre-clinical models have elucidated the electrophysiological mechanisms of this condition. Dysfunction of ion channels responsible for initiation or conduction of cardiac action potentials may underlie both bradycardia and tachycardia; bradycardia can also increase the risk of tachycardia, and vice versa. The mainstay treatment option for SSS is pacemaker implantation, an effective approach, but has disadvantages such as infection, limited battery life, dislodgement of leads and catheters to be permanently implanted in situ. Alternatives to electronic pacemakers are gene-based bio-artificial sinoatrial node and cell-based bio-artificial pacemakers, which are promising techniques whose long-term safety and efficacy need to be established. The aim of this article is to review the different ion channels involved in TBS, examine the three-way relationship between ion channel dysfunction, tachycardia and bradycardia in TBS and to consider its current and future therapies. PMID:28204831

  6. Left atrial and left atrial appendage function in paroxysmal atrial fibrillation. (United States)

    Erdei, T; Erdei, Tamás; Dénes, M; Kardos, A; Földesi, C; Földesi, A; Temesvári, A; Temesvári, M; Lengyel, M


    In patients with paroxysmal atrial fibrillation (PAF) little information is available about left atrial (LA)function, and there is less information about LA appendage (LAA) function, and about their relations. 46 patients were selected for catheter ablation (CA) because of nonvalvular PAF.Transthoracic, tissue Doppler and transoesophageal echocardiography was performed before CA. LA volumes and volume index (LAVI) were calculated. LA function was assessed by LA filling fraction (LAFF), LA emptying fraction (LAEF), systolic fraction of pulmonary venous flow (PVSF) and late diastolic velocities of mitral annulus(Aa,, A5at) LAA function was assessed by peak LAA emptying flow velocity (PLAAEFV). Diastolic dysfunction(DD) was also assessed. Dilated LAVI in 32, LA dysfunction in 20, DD with elevated LV filling pressure in 19 patients was found. Aa,at and Aa,p correlated with LAFF (r:0.53; p<0.001 and r:0.43; p<0.05), LAEF (r:0.51;p<0.001 and r:0.63; p<0.001), PVSF (r:0.49; p<0.001 and r:0.46; p<0.005) and PLAAEFV (r:0.58; p<0.001 and r:0.45; p<0.01). In PAF patients Aa velocity is useful to assess LA function and correlates positively with other TTE derived LA functional parameters and LAA function by TEE derived PLAAEFV.

  7. Frequency and significance of right atrial appendage thrombi in patients with persistent atrial fibrillation or atrial flutter. (United States)

    Cresti, Alberto; García-Fernández, Miguel Angel; Miracapillo, Gennaro; Picchi, Andrea; Cesareo, Francesca; Guerrini, Francesco; Severi, Silva


    Atrial fibrillation (AF) and atrial flutter (AFL) are strong atrial thrombosis (THR) risk factors. In recent-onset tachyarrhythmias, the incidence of left atrial appendage (LAA) THR, detected by transesophageal echocardiography (TEE), has been widely studied, ranging from 6% to 18% (AF) and 4% to 11% (AFL). On the contrary, few studies have assessed right atrial appendage (RAA) THR, and there is no information on the relation between the RAA flow characteristics and the presence of RAA THR. The aims of this study were to evaluate the incidence of RAA THR in a population of patients undergoing TEE-guided cardioversion for recent-onset atrial tachyarrhythmias and to analyze RAA Doppler flow and its relation to thrombus formation. From 1998 to 2012, patients admitted to the emergency department for persistent, non-self-terminating atrial tachyarrhythmia lasting >2 days who gave informed consent for TEE-guided cardioversion were prospectively enrolled in the study. Among 1,042 patients, complete anatomic and functional studies of the LAA and RAA were feasible in 983 (AF, n = 810 [23%]; AFL, n = 173 [5%]). The presence of RAA and LAA THR, appendage emptying velocities, and the presence of severe spontaneous echocardiographic contrast were studied. The overall incidence of atrial THR was 9.7% (96 of 983). The incidence of THR was 9.3% (91 of 983) in the LAA and 0.73% (seven of 983) in the RAA (P thrombi are significantly less frequent than LAA thrombi but may reach large dimensions. Multiplane TEE allows RAA morphologic and functional assessment. Before TEE-guided cardioversion, both the LAA and the RAA must be routinely studied. Copyright © 2014 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  8. Inhibition of potassium currents is involved in antiarrhythmic effect of moderate ethanol on atrial fibrillation. (United States)

    Yang, Baode; Li, Chenxing; Sun, Junyi; Wang, Xinghui; Liu, Xinling; Yang, Chun; Chen, Lina; Zhou, Jun; Hu, Hao


    Excessive consumption of alcohol is a well-established risk factor of atrial fibrillation (AF). However, the effects of moderate alcohol drinking remain to be elucidated. This study was designed to determine the effects of moderate ethanol ingestion on atrial fibrillation and the electrophysiological mechanisms. In acetylcholine-induced canine and mouse AF models, the moderate ethanol prevented the generation and persistence of AF through prolonging the latent period of AF and shortening the duration of AF. The action potential duration (APD) was remarkably prolonged under the concentration range of 12.5-50.0mM ethanol in guinea pig atrial myocytes. Ultra-rapid delayed rectified potassium currents (IKv1.5) were markedly inhibited by 12.5-50.0mM ethanol in a concentration-dependent manner. Ethanol with 50.0mM could inhibit rapid delayed rectifier potassium currents (IhERG). Ethanol under 6.25-50.0mM did not affect on inward rectifier potassium currents (IKir2.1). Collectively, the present study provided an evidence that moderate ethanol intake can prolong the APD of atrial myocytes by inhibition of IKv1.5 and IhERG, which contributed to preventing the development and duration of AF. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. 3D virtual human atria: A computational platform for studying clinical atrial fibrillation. (United States)

    Aslanidi, Oleg V; Colman, Michael A; Stott, Jonathan; Dobrzynski, Halina; Boyett, Mark R; Holden, Arun V; Zhang, Henggui


    Despite a vast amount of experimental and clinical data on the underlying ionic, cellular and tissue substrates, the mechanisms of common atrial arrhythmias (such as atrial fibrillation, AF) arising from the functional interactions at the whole atria level remain unclear. Computational modelling provides a quantitative framework for integrating such multi-scale data and understanding the arrhythmogenic behaviour that emerges from the collective spatio-temporal dynamics in all parts of the heart. In this study, we have developed a multi-scale hierarchy of biophysically detailed computational models for the human atria--the 3D virtual human atria. Primarily, diffusion tensor MRI reconstruction of the tissue geometry and fibre orientation in the human sinoatrial node (SAN) and surrounding atrial muscle was integrated into the 3D model of the whole atria dissected from the Visible Human dataset. The anatomical models were combined with the heterogeneous atrial action potential (AP) models, and used to simulate the AP conduction in the human atria under various conditions: SAN pacemaking and atrial activation in the normal rhythm, break-down of regular AP wave-fronts during rapid atrial pacing, and the genesis of multiple re-entrant wavelets characteristic of AF. Contributions of different properties of the tissue to mechanisms of the normal rhythm and arrhythmogenesis were investigated. Primarily, the simulations showed that tissue heterogeneity caused the break-down of the normal AP wave-fronts at rapid pacing rates, which initiated a pair of re-entrant spiral waves; and tissue anisotropy resulted in a further break-down of the spiral waves into multiple meandering wavelets characteristic of AF. The 3D virtual atria model itself was incorporated into the torso model to simulate the body surface ECG patterns in the normal and arrhythmic conditions. Therefore, a state-of-the-art computational platform has been developed, which can be used for studying multi

  10. A porcine model of early atrial fibrillation using a custom-built, radio transmission-controlled pacemaker. (United States)

    Schwarzl, Michael; Alogna, Alessio; Zweiker, David; Verderber, Jochen; Huber, Stefan; Manninger, Martin; Scherr, Daniel; Antoons, Gudrun; Pieske, Burkert M; Post, Heiner; Lueger, Andreas


    Mechanisms underlying atrial remodeling toward atrial fibrillation (AF) are incompletely understood. We induced AF in 16 pigs by 6weeks of rapid atrial pacing (RAP, 600bpm) using a custom-built, telemetrically controlled pacemaker. AF evolution was monitored three times per week telemetrically in unstressed, conscious animals. We established a dose-response relationship between RAP duration and occurrence of sustained AF >60minutes. Left atrial (LA) dilatation was present already at 2weeks of RAP. There was no evidence of left ventricular heart failure after 6weeks of RAP. As a proof-of-principle, arterial hypertension was induced in 5/16 animals by implanting desoxycorticosterone acetate (DOCA, an aldosterone-analog) subcutaneously to accelerate atrial remodeling. RAP+DOCA resulted in increased AF stability with earlier onset of sustained AF and accelerated anatomical atrial remodeling with more pronounced LA dilatation. This novel porcine model can serve to characterize effects of maladaptive stimuli or protective interventions specifically during early AF. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Towards Low Energy Atrial Defibrillation

    Directory of Open Access Journals (Sweden)

    Philip Walsh


    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

  12. Alcohol consumption and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; Wium-Andersen, Marie Kim; Ørsted, David Dynnes


    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...


    Directory of Open Access Journals (Sweden)

    Johnson Francis


    Full Text Available Atrial fibrillation is the most common perioperative cardiac arrhythmia. Sympathetic overactivity, inflammatory state and oxidative stress are important contributors to the genesis of postoperative atrial fibrillation. Advancing age and mitral valve disease along with left atrial size are important parameters in noted in multivariate prediction model. Genetic predisposition has also been noted. Preventive strategies tried include beta blockers, statins, posterior pericardiotomy, carperitide infusion and thoracic epidural analgesia. Treatment options include rate and rhythm control along with anticoagulation if it persists more than 48 hours with high CHADS2 score. Some of the therapeutic modalities which have been found to be NOT useful in preventing post operative atrial fibrillation are dexamethasone, magnesium infusion and concomitant pulmonary vein isolation.

  14. Changes in hemodynamic parameters and cerebral saturation during supraventricular tachycardia. (United States)

    Hershenson, Jared A; Ro, Pamela S; Miao, Yongjie; Tobias, Joseph D; Olshove, Vincent; Naguib, Aymen N


    Induced supraventricular tachycardia (SVT) during electrophysiology studies (EPS) can be associated with hemodynamic changes. Traditionally, invasive arterial blood pressure has been used for continuous monitoring of these changes. This prospective study evaluated the efficacy of near-infrared spectroscopy (NIRS) monitoring during SVT. The use of NIRS has expanded with evidence of its accuracy and benefit in detecting cerebral hypoperfusion. This study aimed first to determine the hemodynamic changes associated with electrophysiology testing for SVT and second to determine whether the hemodynamic changes are associated with similar changes in the cerebral saturation as determined by NIRS. The study enrolled 30 patients 5-20 years of age with a history of SVT who underwent an EPS. The demographic data included age, gender, weight, height, and type of SVT. Hemodynamic data (invasive blood pressure and heart rate), NIRS, bispectral index (BIS), end-tidal carbon dioxide, and pulse oximetry were collected before and during three episodes of induced SVT. The linear correlation coefficient (r) was measured to calculate the relationship of the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) to the changes in NIRS values during the SVT episodes. Data from 22 patients were collected. The induction of SVT was associated mainly with a change in SBP and a less prominent change in DBP and MAP from baseline. The changes in hemodynamic status were associated with minimal changes in cerebral saturations, as evidenced by an average absolute change in NIRS of SVT during electrophysiology testing is associated with hemodynamic changes, mainly in SBP. In this study, these hemodynamic changes resulted in a minimal decrease in cerebral perfusion, as evidenced by minimal changes in the cerebral saturation measured by NIRS (0.7% from baseline). Although the changes in the cerebral saturation were minimal, these changes were

  15. Psychosomatic correlations in atrial fibrillations

    Directory of Open Access Journals (Sweden)

    Vladimir Ernstovich Medvedev


    Full Text Available Patients with atrial fibrillations (AF and comorbid mental disorders were examined. Two patient groups differing in the structure of psychosomatic ratios were identified. Group 1 comprised patients with AF and signs of reactivity lability that manifested itself as psychopathological reactions to the primary manifestations of AF; Group 2 included those who had developed mental disorders mainly in end-stage cardiovascular disease (predominantly a permanent form of AF in the presence of such events as chronic heart failure (CHF. The results of the study suggest that the patients with AF have frequently anxiety and hypochondriacal disorders, which agrees with the data available in the literature. In addition, end-stage AF is marked by depressive syndromes caused by the severe course of cardiovascular diseases resulting in CHF.

  16. Dronedarone for atrial fibrillation therapy. (United States)

    Marzocchi, Michele; Lombardi, Federico


    Dronedarone is a new benzofuran derivative that has been developed as an antiarrhythmic agent on the basis of the amiodarone molecular structure with the intent of maintaining the same pharmacological effects while reducing thyroid and pulmonary toxicity. The drug is a multichannel blocker with antiadrenergic properties: it reduces heart rate and prolongs the action potential duration. Dronedarone is primarily metabolized by cytochrome P450; its half-life is much shorter than that of amiodarone because of a lower lipophilicity. As a consequence, only 7 days are needed to reach steady-state plasma levels. It has been tested in clinical trials both for rate and rhythm control and, even if its antiarrhythmic efficacy seems to be somehow lower than that of amiodarone, dronedarone is less often discontinued due to adverse reactions or organic toxicity. For these reasons, dronedarone can be very useful in long-term treatment of atrial fibrillation, by reducing hospitalizations and mortality.

  17. Impact of left atrial size reduction on chronic atrial fibrillation in mitral valve surgery. (United States)

    Scherer, Mirela; Dzemali, Omer; Aybek, Tayfun; Wimmer-Greinecker, Gerhard; Moritz, Anton


    Left atrial enlargement is a risk factor for the development of atrial fibrillation (AF). Large atrial size increases thromboembolic risk and reduces the success rate of cardioversion. The study aim was to evaluate if left atrial size reduction affects cardiac rhythm in patients with chronic AF undergoing mitral valve surgery. Twenty-seven patients were analyzed prospectively. The left atrial incision was extended to the left inferior pulmonary vein. Left atrial size reduction was achieved by closure of the left atrial appendage from inside with a double running suture. The same suture plicated the left lateral atrial wall to the roof of the left pulmonary vein inflow and the inferior atrial wall. The atrial septum was plicated by placing stitches of the closing suture line across the fossa ovalis. Rhythm, neurological complications, cardioversion, anticoagulation and anti-arrhythmic medication were evaluated at one year postoperatively and at recent follow up (mean 40 +/- 15 months). At discharge, five patients (19%) were in sinus rhythm (SR). At one year postoperatively, SR was restored in 17 patients (63%), but five (19%) reported episodes of arrhythmia and AF persisted in 10 (37%). At recent follow up, four patients had died and three were lost to follow up. Among 20 patients examined, 13 (65%) had SR but six reported episodes of arrhythmia and AF persisted in seven (35%). LA diameter was significantly reduced, from 60.2 +/- 9.8 mm preoperatively to 44.5 +/- 7.0 mm at one year after surgery. The addition of left atrial size reduction to mitral valve surgery is technically simple, and was effective in 63% of patients with chronic AF, restoring predominant SR. In order to influence pathogenetic factors other than size, additional ablative steps may further increase the SR conversion rate. Size reduction may also improve the outcome of other ablative approaches.

  18. Advances in Left Atrial Appendage Occlusion Strategies


    Arash Aryana; Sheldon M. Singh; Shephal K. Doshi; Andr� d�Avila


    Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and associated with an elevated risk of thromboembolic stroke and systemic embolization. The evidence suggests that ~90% of thrombi in patients with non-valvular AF are localized to the left atrial appendage (LAA). Therefore, it seems reasonable to consider LAA exclusion in selected patients with AF for stroke prevention. LAA exclusion can be achieved through a variety of surgical and percutaneous techniques. Surgical me...

  19. [Anticoagulation in atrial fibrillation - an update]. (United States)

    Antz, Matthias; Hullmann, Bettina; Neufert, Christian; Vocke, Wolfgang


    The correct anticoagulation regimen for prevention of thromboembolic events is essential in patients with atrial fibrillation. However, only a minority of patients receives anticoagulation according to the guidelines. The current guidelines are intended to make the indication for anticoagulation more simple and are summarized in the present article. This includes recommendations for chronic anticoagulation, prevention of thromboembolic events after cardioversion and in ablation of atrial fibrillation.

  20. [Automatic, implantible cardioverter-defibrillator in a patient with chronic Chagas cardiopathy and sustained ventricular tachycardia]. (United States)

    Rodríguez, H; Muñoz, M; Llamas, G; Iturralde, P; Medeiros, A; Delgado, L; Mar, R; Rucinque, F; Bayram, E


    We studied a 48 years old woman, with chronic Chagasic cardiopathy, manifested with cardiomegaly, heart failure and syncope, due to a sustained ventricular tachycardia (SVT) of two different configurations (left bundle branch block and right bundle branch block). During electrophysiological testing, both types of ventricular tachycardia were reproduced. Successful ablation therapy of the right branch of His was performed due to suspicion of the bundle branch reentrant tachycardia, with a left bundle branch block. The patient continued to show SVT episodes, now with right bundle branch block pattern. Cardioverter Defibrillator was implanted. We report this case due to the rare frequency of Chagas' disease, where it could be a cause of heart disease, since the existence of the parasite (trypanosoma cruzi) and its vector (Triatoma) has been identified in some rural and suburban zones in the state of Aguascalientes, Mexico.

  1. Surgical Cryoablation of Drug Resistant Ventricular Tachycardia and Aneurysmectomy of Postinfarction Left Ventricular Aneurysm

    Directory of Open Access Journals (Sweden)

    Marek Pojar


    Full Text Available Heart failure is usually associated with left ventricle remodelling, wall thickening, and worsening of the systolic function. Ventricular tachycardia is a common and a negative prognostic factor in patients with endocardial scarring following myocardial infarction and aneurysm formation. The authors present a case of a 51-year-old man with ischemic heart disease, who suffered myocardial infarction four years ago. The patient was admitted to the hospital with sustained ventricular tachycardia despite maximal pharmacotherapy and also underwent unsuccessful percutaneous radiofrequency ablation in the right ventricle. Transthoracic echocardiography revealed left ventricle dysfunction with ejection fraction of 25%, aneurysm of the apex of the left ventricle with thrombus formation inside the aneurysm. Surgical therapy consisted of the cryoablation applied at the transitional zone of the scar and viable tissue and the resection of the aneurysm. The patient remained free of any ventricular tachycardia four months later.

  2. Relationship between nocturnal hypoxaemia, tachycardia and myocardial ischaemia after major abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, I; Rosenberg-Adamsen, S; Lie, C


    BACKGROUND: Episodic hypoxaemia, cardiac arrhythmias, and myocardial ischaemia may be related after major abdominal surgery. METHODS: We studied 52 patients on the second and third nights after major abdominal operations, using continuous pulse oximetry and Holter ECG. We recorded the amount...... of 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 tachycardia, and 265 (individual range 1-73) episodes of ST segment deviation. Of the 52 patients, 50 had episodes of hypoxaemia and tachycardia, and 19 patients had one or more episodes of ST segment deviation. For 38% of the episodes of ST deviation, there was an episode of hypoxaemia at the same time...

  3. Successful cryoablation of atrioventricular nodal reentrant tachycardia and coexisting accessory pathways without fluoroscopy. (United States)

    Gul, Enes Elvin; Ugur, Fatma Seyma; Akdeniz, Celal; Tuzcu, Volkan


    We report the case of a 14-year-old boy patient admitted to our outpatient clinic with palpitations and documented supraventricular tachycardia. Electrophysiological study and ablation were planned. In the electrophysiological study, two tachycardias with different cycle lengths and morphologies were induced. After elimination of the slow pathway, left posterior accessory pathway was detected and successfully ablated. Another pathway was detected following that ablation. Due to the slow retrograde conduction of this pathway, diltiazem infusion was started to uncover the accessory pathway. The second accessory pathway was at the left posteroseptal region and was successfully ablated. After a 30-minute waiting period, no tachycardia was induced. In addition, no fluoroscopy was used during the procedure. © 2012 Wiley Periodicals, Inc.

  4. Thromboembolic risk in atrial flutter. The FLASIEC (FLutter Atriale Società Italiana di Ecografia Cardiovascolare) multicentre study. (United States)

    Corrado, G; Sgalambro, A; Mantero, A; Gentile, F; Gasparini, M; Bufalino, R; Morabito, A; Trocino, G; Schiavina, R; Mandorla, S; Mangia, R; Tovena, D; Savino, K; Jacopi, F; Pellegrino, E M; Agostini, F; Centonze, G; Bovenzi, F; Caprino, E; Tadeo, G; Santarone, M


    Patients with atrial flutter are believed to be at lower risk of thromboembolism than patients with atrial fibrillation. However, the incidence of atrial thrombi and the need for anticoagulation in patients with atrial flutter is not well established. A prospective observational multicentre study was undertaken to assess the frequency of atrial thrombi and spontaneous echocontrast and the prevalence for aortic complex atherosclerotic lesions in a cohort of unselected patients with atrial flutter. We evaluated 134 patients (102 male, aged 70+/-9 years); exclusion criteria were history of atrial fibrillation, rheumatic mitral valve disease and mitral mechanical prosthesis. The median of atrial flutter duration was 33 days. Twelve patients had been taking warfarin for more than 7 days. One hundred and twenty-four patients (94%) underwent a transoesophageal echocardiogram, which revealed left atrial appendage thrombi in two patients (1.6%) and right atrial thrombi in one patient (1%). At least moderate left atrial echocontrast was found in 16/124 patients (13%). Complex atherosclerotic aortic plaques were detected in 10 patients (8%). Atrial flutter conversion was attempted in 93/134 patients (69%). At the 1-month follow-up, two patients experienced a thromboembolic event following restoration of sinus rhythm. Atrial thrombi and echocontrast, and complex aortic atherosclerotic plaques are relatively uncommon in patients with atrial flutter. Post-cardioversion embolism was observed in two patients in our study population.

  5. Dynamic and dual-site atrial pacing in the prevention of atrial fibrillation: The STimolazione Atrial DInamica Multisito (STADIM) Study. (United States)

    De Simone, Antonio; Senatore, Gaetano; Donnici, Giovanni; Turco, Pietro; Romano, Enrico; Gazzola, Carlo; Stabile, G


    The impact of new algorithms to consistently pace the atrium on the prevention of atrial fibrillation (AF) remains unclear. Our randomized, crossover study compared the efficacy of single- and dual-site atrial pacing, with versus without dynamic atrial overdrive pacing in preventing AF. We studied 72 patients (mean age = 69.6 +/- 6.5 years, 34 men) with sick sinus syndrome (SSS) and paroxysmal or persistent AF, who received dual-chamber pacemakers (PM) equipped with an AF prevention algorithm and two atrial leads placed in the right atrial appendage (RAA), by passive fixation, and in the coronary sinus ostium (CS), by active fixation, respectively. At implant, the patients were randomly assigned to unipolar CS versus RAA pacing. The PM was programmed in DDDR mode 1 month after implant. Each patient underwent four study phases of equal duration: (1) unipolar, single site (CS or RAA) pacing with the AF algorithm ON (atrial lower rate = 0 ppm); (2) unipolar, single site pacing with the AF algorithm OFF (atrial lower rate = 70 bpm); (3) bipolar, dual-site pacing with AF algorithm ON; (4) bipolar, dual-site pacing with the AF algorithm OFF. Among 40 patients (56%), who completed the follow-up (15 +/- 4 months) no difference was observed in the mean number of automatic mode switch (AMS) corrected for the duration of follow-up, in unipolar (5.6 +/- 22.8 vs 2.6 +/- 5.5) or bipolar mode (3.3 +/- 12.7 vs 2.1 +/- 4.9) with, respectively, the algorithm OFF or ON. With the AF prevention algorithm ON, the percentage of atrial pacing increased significantly from 78.7 +/- 22.1% to 92.4 +/- 4.9% (P < 0.001), while the average ventricular heart rate was significantly lower with the algorithm ON (62.4 +/- 17.5 vs 79.9 +/- 3 bpm (P < 0.001). The AF prevention algorithm increased the percentage of atrial pacing significantly, regardless of the atrial pulse configuration and pacing site, while maintaining a slower ventricular heart rate. It had no impact on the number of AMS in the

  6. 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


    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.

  7. Efficacy of dexmedetomidine for the control of junctional ectopic tachycardia after repair of tetralogy of Fallot. (United States)

    Rajput, Randhir S; Das, Sambhunath; Makhija, Neeti; Airan, Balram


    Junctional ectopic tachycardia occurs frequently after congenital cardiac surgery and can be a cause of increased morbidity and mortality. Dexmedetomidine (DEX) is an α2 adrenoreceptor agonist, has properties of controlling tachyarrhythmia by regulating the sympatho-adrenal system. To evaluate the efficacy of DEX for control of junctional ectopic tachycardia after repair of Tetralogy of Fallot (TOF). 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). 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 = ectopic tachycardia in patients undergoing repair for TOF.

  8. Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart. (United States)

    Law, Ian H; Von Bergen, Nicholas H; Gingerich, Jean C; Saarel, Elizabeth V; Fischbach, Peter S; Dick, Macdonald


    Junctional ectopic tachycardia in the normal heart is rare and often is resistant to pharmacologic management. Transcatheter ablation using radiofrequency energy places the AV node at risk. The purpose of this study was to report our experience with transcatheter cryothermal ablation using three-dimensional mapping in six patients with junctional ectopic tachycardia. A review of clinical and electrophysiologic data was performed on all patients with structurally normal hearts who underwent cryothermal ablation for treatment of junctional ectopic tachycardia at two institutions. Six patients (age 7.7-36.5 years) underwent attempted transcatheter cryothermal ablation using three-dimensional mapping. Only one patient had achieved arrhythmia suppression on medical management. Cryothermal mapping (-30 degrees C) localized the junctional focus while normal conduction was monitored. The junctional focus was high in the triangle of Koch in four patients and was low in one patient. The sixth patient had only one run of junctional ectopic tachycardia during the procedure and therefore received an empiric cryoablation (-70 degrees C) lesion. Subsequent cryoablation lesions were delivered at and around the junctional focus. In one patient, cryomapping eliminated the junctional focus but resulted in transient complete AV block; therefore, cryoablation was not performed. All patients who received the cryoablation lesions had elimination of their junctional ectopic tachycardia at 6-week follow-up. The patient who did not receive a cryoablation lesion remained in a slower junctional rhythm at follow-up. Cryoablation of junctional ectopic tachycardia is safe and effective. Nonetheless, proximity to the His-Purkinje system may preclude success. Empiric cryoablation can be effective; cryotherapy may not yield immediate success, but a delayed salutary effect can follow.

  9. Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair. (United States)

    Imamura, Michiaki; Dossey, Amy M; Garcia, Xiomara; Shinkawa, Takeshi; Jaquiss, Robert D B


    Junctional ectopic tachycardia is common after pediatric heart surgery. After tetralogy of Fallot repair, the incidence of junctional ectopic tachycardia may be as high as 15% to 20%. We introduced prophylactic amiodarone for tetralogy repair. This study was conducted to evaluate the effectiveness of the prophylactic amiodarone. A continuous infusion of amiodarone was started in the operating room at the time of rewarming during cardiopulmonary bypass at a rate of 2 mg/kg/d and continued for 48 hours. Between November 2005 and November 2009, 63 consecutive patients underwent primary repair of tetralogy, of whom 20 had prophylactic amiodarone (amiodarone group) and 43 did not (control group). Variables studied included demographic and bypass data, surgical procedure details (transannular or nontransannular patch), preoperative and postoperative echocardiography findings, and postoperative inotropic support. Univariate and stepwise multivariate analyses were conducted to determine factors associated with the occurrence of junctional ectopic tachycardia. The incidence of junctional ectopic tachycardia was 37% in the control group and 10% in the amiodarone group. The groups were similar in age, weight, bypass time, rate of transannular patch usage, and preoperative and postoperative gradient through the right ventricular outflow tract. Prophylactic amiodarone was significantly negatively associated with junctional ectopic tachycardia by both univariate (P = .039) and multivariate (P = .027) analyses. There were no adverse events attributable to prophylactic amiodarone use. Prophylactic amiodarone is well tolerated and significantly associated with a decreased incidence of junctional ectopic tachycardia after tetralogy repair. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  10. RR-Interval variance of electrocardiogram for atrial fibrillation detection (United States)

    Nuryani, N.; Solikhah, M.; Nugoho, A. S.; Afdala, A.; Anzihory, E.


    Atrial fibrillation is a serious heart problem originated from the upper chamber of the heart. The common indication of atrial fibrillation is irregularity of R peak-to-R-peak time interval, which is shortly called RR interval. The irregularity could be represented using variance or spread of RR interval. This article presents a system to detect atrial fibrillation using variances. Using clinical data of patients with atrial fibrillation attack, it is shown that the variance of electrocardiographic RR interval are higher during atrial fibrillation, compared to the normal one. Utilizing a simple detection technique and variances of RR intervals, we find a good performance of atrial fibrillation detection.

  11. QT prolongation and polymorphous ventricular tachycardia associated with trasodone-amiodarone combination. (United States)

    Mazur, A; Strasberg, B; Kusniec, J; Sclarovsky, S


    Trasodone, a second generation antidepressant, has been shown to equal standard tricyclics in clinical efficacy while causing significantly fewer cardiac side effects. Although clinical trials have demonstrated a relatively safe arrhythmogenic profile, trasodone has been implicated in the pathogenesis of ventricular arrhythmias. This report describes a patient in whom the administration of trasodone in addition to previously well-tolerated long-term amiodarone therapy was associated with a marked prolongation of the QT interval and polymorphous ventricular tachycardia. Caution in the concurrent use of trasodone and other medications known to cause QT prolongation and polymorphous ventricular tachycardia is recommended.

  12. A case of an infant with bundle branch reentrant ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Satoki Fujii


    Full Text Available Catheter ablation of the right bundle branch was performed on an 11-month-old infant for the treatment of drug-resistant bundle branch reentrant ventricular tachycardia. The occurrence of right bundle branch block could not be used as an endpoint of treatment because the patient had presented with incomplete right bundle branch block pattern during sinus rhythm. We performed ablation of the right bundle branch and utilized changes of duration and morphology of the QRS complex as indicators. Eight years have passed with no development of any atrioventricular block or tachycardia episode.

  13. Ventricular tachycardia in a Brugada syndrome patient caused by a novel deletion in SCN5A

    DEFF Research Database (Denmark)

    Tfelt-Hansen, J; Jespersen, T; Hofman-Bang, J


    The aim of the present study was to identify the molecular mechanism behind ventricular tachycardia in a patient with Brugada syndrome. Arrhythmias in patients with Brugada syndrome often occur during sleep. However, a 28-year-old man with no previously documented arrhythmia or syncope who...... experienced shortness of breath and chest pain during agitation is described. An electrocardiogram revealed monomorphic ventricular tachycardia; after he was converted to nodal rhythm, he spontaneously went into sinus rhythm, and showed classic Brugada changes with coved ST elevation in leads V(1) to V(2...

  14. Bundle-branch reentry ventricular tachycardia after transcatheter aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Adriana de la Rosa Riestra


    Full Text Available An 83-year-old male suffering from severe symptomatic aortic valve stenosis received an implant of a biological aortic prosthesis through the femoral artery without complications. Seven days after dischargement he experienced a syncope. The patient was wearing an ECG holter monitor that day, which showed a wide QRS complex tachycardia of 300 beats per minute. The electrophysiological study revealed a bundle-branch reentry ventricular tachycardia as the cause of the syncope. Radio-frequency was applied on the right-bundle branch. Twelve months later, the patient has remained asymptomatic.

  15. 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


    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).

  16. Electrocardiogram artifact caused by rigors mimicking narrow complex tachycardia: a case report. (United States)

    Matthias, Anne Thushara; Indrakumar, Jegarajah


    The electrocardiogram (ECG) is useful in the diagnosis of cardiac and non-cardiac conditions. Rigors due to shivering can cause electrocardiogram artifacts mimicking various cardiac rhythm abnormalities. We describe an 80-year-old Sri Lankan man with an abnormal electrocardiogram mimicking narrow complex tachycardia during the immediate post-operative period. Electrocardiogram changes caused by muscle tremor during rigors could mimic a narrow complex tachycardia. Identification of muscle tremor as a cause of electrocardiogram artifact can avoid unnecessary pharmacological and non-pharmacological intervention to prevent arrhythmias.

  17. 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.

  18. Electrical treatment of atrial arrhythmias in heart failure patients implanted with a dual defibrillator CRT device. Results from the TRADE-HF study. (United States)

    Botto, Giovanni Luca; Padeletti, Luigi; Covino, Gregorio; Pieragnoli, Paolo; Liccardo, Mattia; Mariconti, Barbara; Favale, Stefano; Molon, Giulio; De Filippo, Paolo; Bolognese, Leonardo; Landolina, Maurizio; Raciti, Giovanni; Boriani, Giuseppe


    Ventricular and atrial arrhythmias commonly occur in heart failure patients and are a significant source of symptoms, morbidity and mortality. Some specific generators referred to as dual defibrillators, Dual CRT-Ds, have the ability to treat atrial and ventricular arrhythmias. TRADE-HF is a prospective two-arm randomized study aimed at assessing the benefits of complete automatic management of atrial arrhythmias in patients implanted with a dual CRT-D. Primary objective of the TRADE-HF study was to document reduction of unplanned hospital admission for cardiac reasons or death for cardiovascular causes or progression to permanent AF, by comparing fully-automatic device driven therapy for atrial tachycardia or fibrillation (AT/AF) to an in-hospital approach for treatment of symptomatic AT/AF. Randomized Patients were followed every 6months for 3years to assess the primary objective. Four-hundred-twenty patients have been enrolled in the study. At the end of the study 30 subjects died for cardiovascular causes, 60 had at least one hospitalization for cardiovascular causes and 14 developed permanent AF. Eighty-seven patients experienced a composite event. Hazard Ratio for device-managed automatic therapy arm compared to traditional was 0.987 (95% CI: 0.684-1.503; p=0.951). The primary endpoint analysis resulted in no difference between the device managed and in-hospital treatment arm. The TRADE-HF study failed to demonstrate a reduction in the composite of unplanned hospitalizations for cardiovascular causes or death for cardiovascular causes or progression to permanent AF using automatic atrial therapy compared to a traditional approach including hospitalization for symptomatic episodes and/or in-hospital treatment of AT/AF. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Development of the right ventricular inflow tract and moderator band: a possible morphological and functional explanation for Mahaim tachycardia

    NARCIS (Netherlands)

    Jongbloed, M. R. M.; Wijffels, M. C. E. F.; Schalij, M. J.; Blom, N. A.; Poelmann, R. E.; van der Laarse, A.; Mentink, M. M. T.; Wang, Z.; Fishman, G. I.; Gittenberger-de Groot, A. C.


    Atriofascicular accessory bundles with AV-node like conduction properties can sustain atrioventricular (AV) re-entrant tachycardia (Mahaim tachycardia). During early embryogenesis, the AV canal is situated above the primitive left ventricle (LV), and a right AV connection has not been achieved yet.

  20. Longstanding atrial fibrillation causes depletion of atrial natriuretic peptide in patients with advanced congestive heart failure

    NARCIS (Netherlands)

    van den Berg, MP; de Kam, PJ; Boomsma, F; Crijns, HJGM; van Veldhuisen, DJ

    Background: Congestive heart failure (CHF) is characterized by neurohormonal activation, including increased plasma concentrations of atrial natriuretic peptide (ANP) and N-terminal ANP (N-ANP). Onset of atrial fibrillation (AF) further increases these peptides, but it may be hypothesized that

  1. The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter

    DEFF Research Database (Denmark)

    Sethi, Naqash J; Feinberg, Joshua; Nielsen, Emil E


    strategies versus rate control strategies for atrial fibrillation and atrial flutter. METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, Web of Science, BIOSIS, Google Scholar,, TRIP, EU-CTR, Chi-CTR, and ICTRP for eligible trials comparing any rhythm control strategy with any rate...

  2. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion

    DEFF Research Database (Denmark)

    Osmanagic, Armin; Möller, Sören; Osmanagic, Azra


    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...

  3. Atrial defibrillation threshold in humans minutes after atrial fibrillation induction; "A stitch in time saves nine". (United States)

    Vardas, P E; Manios, E G; Kanoupakis, E M; Dermitzaki, D N; Mavrakis, H E; Kallergis, E M


    To assess the effects of atrial fibrillation duration on the defibrillation threshold in atrial fibrillation patients seconds or minutes after initiation of the arrhythmia. Nineteen patients with recurrent symptomatic atrial fibrillation were evaluated. After programmed induction of atrial fibrillation, the defibrillation threshold was assessed after two sequential periods of arrhythmia in the same patient: an "ultrashort" period of 30 s duration and a "short" period, which lasted 10 min. After the specified period, internal cardioversion was attempted using a balloon-guided catheter that allows the delivery of biphasic shocks between one electrode array placed in the left pulmonary artery and a proximal electrode array on the lateral right atrial wall. The defibrillation threshold was assessed with energy steps of 0.5 J with a starting level of 0.5 J. Mean time from induction to successful defibrillation was 92+/-30 s after the "ultrashort" period of atrial fibrillation and 910+/-86 s after the short period. The defibrillation threshold was significantly greater after 10 min of atrial fibrillation than after 30 s of arrhythmia (2.32+/-0.61 J vs 1.31+/-0.66 J, Pdefibrillation threshold. Prolongation of atrial fibrillation over minutes in patients with paroxysmal arrhythmia increases the energy requirements for successful defibrillation. Copyright 2001 The European Society of Cardiology.

  4. Determinants of Left Atrial Volume in Patients with Atrial Fibrillation.

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    Matthias Bossard

    Full Text Available 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.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.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, p<0.0001, glomerular 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.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.

  5. Atrial fibrillation increases production of superoxide by the left atrium and left atrial appendage: role of the NADPH and xanthine oxidases. (United States)

    Dudley, Samuel C; Hoch, Nyssa E; McCann, Louise A; Honeycutt, Clegg; Diamandopoulos, Laura; Fukai, Tohru; Harrison, David G; Dikalov, Sergey I; Langberg, Jonathan


    Atrial fibrillation (AF) is associated with an increased risk of stroke due almost exclusively to emboli from left atrial appendage (LAA) thrombi. Recently, we reported that AF was associated with endocardial dysfunction, limited to the left atrium (LA) and LAA and manifest as reduced nitric oxide (NO*) production and increased expression of plasminogen activator inhibitor-1. We hypothesized that reduced LAA NO* levels observed in AF may be associated with increased superoxide (O2*-) production. After a week of AF induced by rapid atrial pacing in pigs, O2*- production from acutely isolated heart tissue was measured by 2 independent techniques, electron spin resonance and superoxide dismutase-inhibitable cytochrome C reduction assays. Compared with control animals with equivalent ventricular heart rates, basal O2*- production was increased 2.7-fold (P<0.01) and 3.0-fold (P<0.02) in the LA and LAA, respectively. A similar 3.0-fold (P<0.01) increase in LAA O2*- production was observed using a cytochrome C reduction assay. The increases could not be explained by changes in atrial total superoxide dismutase activity. Addition of either apocyanin or oxypurinol reduced LAA O2*-, implying that NADPH and xanthine oxidases both contributed to increased O2*- production in AF. Enzyme assays of atrial tissue homogenates confirmed increases in LAA NAD(P)H oxidase (P=0.04) and xanthine oxidase (P=0.01) activities. Although there were no changes in expression of the NADPH oxidase subunits, the increase in superoxide production was accompanied by an increase in GTP-loaded Rac1, an activator of the NADPH oxidase. AF increased O2*- production in both the LA and LAA. Increased NAD(P)H oxidase and xanthine oxidase activities contributed to the observed increase in LAA O2*- production. This increase in O2*- and its reactive metabolites may contribute to the pathological consequences of AF such as thrombosis, inflammation, and tissue remodeling.

  6. Effects of novel oral anticoagulants on left atrial and left atrial appendage thrombi: an appraisal. (United States)

    Marsico, Fabio; Cecere, Milena; Parente, Antonio; Paolillo, Stefania; de Martino, Fabiana; Dellegrottaglie, Santo; Trimarco, Bruno; Perrone Filardi, Pasquale


    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and predisposes to an increased risk of thromboembolic events. Patients affected by AF exhibit an increased risk of stroke compared with those in sinus rhythm, with the most common location of thrombi in the left atrial appendage. Until 2009, warfarin and other vitamin K antagonists were the only class of oral anticoagulants available. More recently, dabigatran, rivaroxaban, apixaban, and edoxaban have been approved by regulatory authorities for prevention of stroke in patients with non-valvular AF. Few data are available about the efficacy of novel oral anticoagulants for the treatment of left atrial and left atrial appendage thrombosis. Aim of this review is to summarize available evidence regarding the effectiveness of novel oral anticoagulants on left atrial appendage thrombosis.

  7. Vernakalant (RSD1235) in the management of atrial fibrillation: a review of pharmacological properties, clinical efficacy and safety

    DEFF Research Database (Denmark)

    Weeke, Peter; Andersson, Charlotte; Brendorp, Bente


    Vernakalant (RSD1235) is a novel antiarrhythmic agent for conversion of rapid onset atrial fibrillation (AF). It is an atria-selective multichannel ion blocker (blocks I(Kur), I(Na), I(Ca, L), I(to) and I(Kr)), with a small effect on ventricular repolarization. In clinical Phase II and III studies...

  8. Vernakalant (RSD1235) in the management of atrial fibrillation: a review of pharmacological properties, clinical efficacy and safety

    DEFF Research Database (Denmark)

    Weeke, Peter; Andersson, Charlotte; Brendorp, Bente


    Vernakalant (RSD1235) is a novel antiarrhythmic agent for conversion of rapid onset atrial fibrillation (AF). It is an atria-selective multichannel ion blocker (blocks I(Kur), I(Na), I(Ca, L), I(to) and I(Kr)), with a small effect on ventricular repolarization. In clinical Phase II and III studie...

  9. Effect of biologically active coating on biocompatibility of Nitinol devices designed for the closure of intra-atrial communications

    NARCIS (Netherlands)

    Kong, XQ; Grabitz, RG; van Oeveren, W; Klee, D; van Kooten, TG; Freudenthal, F; Qing, M; von Bernuth, G; Seghaye, MC

    Anti-thrombogenicity and rapid endothelialisation are prerequisites for the use of closure devices of intra-atrial communications in order to reduce the risk of cerebral embolism. The purpose of this study was therefore to assess the effect of bioactive coatings on biocompatibility of Nitinol coils

  10. Applying non-linear dynamics to atrial appendage flow data to understand and characterize atrial arrhythmia

    Energy Technology Data Exchange (ETDEWEB)

    Chandra, S.; Grimm, R.A. [Cleveland Clinic Foundation, Cleveland, Ohio 44195 (United States); Katz, R. [Naval Undersea Warfare Center, New London, Connecticut 06320 (United States); Thomas, J.D. [Cleveland Clinic Foundation, Cleveland, Ohio 44195 (United States)


    The aim of this study was to better understand and characterize left atrial appendage flow in atrial fibrillation. Atrial fibrillation and flutter are the most common cardiac arrhythmias affecting 15% of the older population. The pulsed Doppler velocity profile data was recorded from the left atrial appendage of patients using transesophageal echocardiography. The data was analyzed using Fourier analysis and nonlinear dynamical tools. Fourier analysis showed that appendage mechanical frequency ({ital f{sub f}}) for patients in sinus rhythm was always lower (around1 Hz) than that in atrial fibrillation (5-8 Hz). Among patients with atrial fibrillation spectral power below {ital f{sub f}} was significantly different suggesting variability within this group of patients. Results that suggested the presence of nonlinear dynamics were: a) the existence of two arbitrary peak frequencies {ital f{sub 1}, f{sub 2}}, and other peak frequencies as linear combinations thereof ({ital mf{sub 1}{+-}nf{sub 2}}), and b) the similarity between the spectrum of patient data and that obtained using the Lorenz equation. Nonlinear analysis tools, including Phase plots and differential radial plots, were also generated from the velocity data using a delay of 10. In the phase plots, some patients displayed a torus-like structure, while others had a more random-like pattern. In the differential radial plots, the first set of patients (with torus-like phase plots) showed fewer values crossing an arbitrary threshold of 10 than did the second set (8 vs. 27 in one typical example). The outcome of cardioversion was different for these two set of patients. Fourier analysis helped to: differentiate between sinus rhythm and atrial fibrillation, understand the characteristics of the wide range of atrial fibrillation patients, and provide hints that atrial fibrillation could be a nonlinear process. Nonlinear dynamical tools helped to further characterize and sub-classify atrial fibrillation.

  11. Differential atrial performance at rest and exercise in athletes: Potential trigger for developing atrial dysfunction? (United States)

    Gabrielli, L; Bijnens, B H; Brambila, C; Duchateau, N; Marin, J; Sitges-Serra, I; Mont, L; Brugada, J; Sitges, M


    Highly trained athletes show an increased risk of atrial arrhythmias. Little is known about atrial volumes and function during exercise in this population. Our aim was to analyze atrial size and contractile function during exercise. Fifty endurance athletes with 11 ± 8 h of training per week and 30 sedentary control subjects were included. Echocardiography was performed at baseline and during exercise. Left (LA) and right atrial (RA) size and function were assessed by two-dimensional echocardiography. Peak negative strain (Sa) during atrial contraction and active atrial emptying volume (AEV) were measured. Athletes and control subjects showed a significant increment of deformation and AEV of both atria with exercise (P athletes, a subgroup with significant LA (n = 8)/RA (n = 15) dilatation (≥40 mL/m(2) ) showed a significantly lower increment in AEV with exercise (LA∆AEV: 1.4 ± 1.1 mL/m(2) vs 2.1 ± 0.9 mL/m(2) , P = 0.04; RA∆AEV: 0.9 ± 0.8 mL/m(2) vs 2.3 ± 1.1 mL/m(2) , P athletes (LA∆Sa: -3.2 ± 2.9% vs -9.5 ± 4.4%, P athletes compared to controls, but due to larger atrial volumes, they reached similar increases in atrial emptying volume. However, this overall lesser deformation increases from a subgroup with significant atrial dilatation showing impairment in atrial contractile reserve. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Triggered intracellular calcium waves in dog and human left atrial myocytes from normal and failing hearts. (United States)

    Aistrup, Gary L; Arora, Rishi; Grubb, Søren; Yoo, Shin; Toren, Benjamin; Kumar, Manvinder; Kunamalla, Aaron; Marszalec, William; Motiwala, Tej; Tai, Shannon; Yamakawa, Sean; Yerrabolu, Satya; Alvarado, Francisco J; Valdivia, Hector H; Cordeiro, Jonathan M; Shiferaw, Yohannes; Wasserstrom, John Andrew


    Abnormal intracellular Ca2+ cycling contributes to triggered activity and arrhythmias in the heart. We investigated the properties and underlying mechanisms for systolic triggered Ca2+ waves in left atria from normal and failing dog hearts. Intracellular Ca2+ cycling was studied using confocal microscopy during rapid pacing of atrial myocytes (36 °C) isolated from normal and failing canine hearts (ventricular tachypacing model). In normal atrial myocytes (NAMs), Ca2+ waves developed during rapid pacing at rates ≥ 3.3 Hz and immediately disappeared upon cessation of pacing despite high sarcoplasmic reticulum (SR) load. In heart failure atrial myocytes (HFAMs), triggered Ca2+ waves (TCWs) developed at a higher incidence at slower rates. Because of their timing, TCW development relies upon action potential (AP)-evoked Ca2+ entry. The distribution of Ca2+ wave latencies indicated two populations of waves, with early events representing TCWs and late events representing conventional spontaneous Ca2+ waves. Latency analysis also demonstrated that TCWs arise after junctional Ca2+ release has occurred and spread to non-junctional (cell core) SR. TCWs also occurred in intact dog atrium and in myocytes from humans and pigs. β-adrenergic stimulation increased Ca2+ release and abolished TCWs in NAMs but was ineffective in HFAMs making this a potentially effective adaptive mechanism in normals but potentially arrhythmogenic in HF. Block of Ca-calmodulin kinase II also abolished TCWs, suggesting a role in TCW formation. Pharmacological manoeuvres that increased Ca2+ release suppressed TCWs as did interventions that decreased Ca2+ release but these also severely reduced excitation-contraction coupling. TCWs develop during the atrial AP and thus could affect AP duration, producing repolarization gradients and creating a substrate for reentry, particularly in HF where they develop at slower rates and a higher incidence. TCWs may represent a mechanism for the initiation

  13. Adenosine versus intravenous calcium channel antagonists for supraventricular tachycardia. (United States)

    Alabed, Samer; Sabouni, Ammar; Providencia, Rui; Atallah, Edmond; Qintar, Mohammed; Chico, Timothy Ja


    People with supraventricular tachycardia (SVT) frequently are symptomatic and present to the emergency department for treatment. Although vagal manoeuvres may terminate SVT, they often fail, and subsequently adenosine or calcium channel antagonists (CCAs) are administered. Both are known to be effective, but both have a significant side effect profile. This is an update of a Cochrane review previously published in 2006. To review all randomised controlled trials (RCTs) that compare effects of adenosine versus CCAs in terminating SVT. We identified studies by searching CENTRAL, MEDLINE, Embase, and two trial registers in July 2017. We checked bibliographies of identified studies and applied no language restrictions. We planned to include all RCTs that compare adenosine versus a CCA for patients of any age presenting with SVT. We used standard methodological procedures as expected by Cochrane. Two review authors independently checked results of searches to identify relevant studies and resolved differences by discussion with a third review author. At least two review authors independently assessed each included study and extracted study data. We entered extracted data into Review Manager 5. Primary outcomes were rate of reversion to sinus rhythm and major adverse effects of adenosine and CCAs. Secondary outcomes were rate of recurrence, time to reversion, and minor adverse outcomes. We measured outcomes by calculating odds ratios (ORs) and assessed the quality of primary outcomes using the GRADE approach through the GRADEproGDT website. We identified two new studies for inclusion in the review update; the review now includes seven trials with 622 participants who presented to an emergency department with SVT. All included studies were RCTs, but only three described the randomisation process, and none had blinded participants, personnel, or outcome assessors to the intervention given. Moderate-quality evidence shows no differences in the number of people reverting to

  14. Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia. (United States)

    Smith, Gavin D; Fry, Meagan M; Taylor, David; Morgans, Amee; Cantwell, Kate


    People with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring sinus rhythm by terminating the SVT involves increasing the refractoriness of atrioventricular nodal tissue within the myocardium by means of vagal manoeuvres, pharmacological agents, or electrical cardioversion. A commonly used first-line technique to restore the normal sinus rhythm (reversion) is the Valsalva Manoeuvre (VM). This is a non-invasive means of increasing myocardial refractoriness by increasing intrathoracic pressure for a brief period, thus stimulating baroreceptor activity in the aortic arch and carotid bodies, resulting in increased parasympathetic (vagus nerve) tone. To assess the evidence of effectiveness of the VM in terminating SVT. We updated the electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 7); MEDLINE Ovid (1946 to August week 3, 2014); EMBASE Classic and EMBASE Ovid (1947 to 27 August 2014); Web of Science (1970 to 27 August 2014); and BIOSIS Previews (1969 to 22 August 2014). We also checked trials registries, the Index to Theses, and the bibliographies of all relevant publications identified by these strategies. We included all randomised controlled trials (RCTs) that examined the effectiveness of VM in terminating SVT. Two review authors independently extracted the data using a standardised form. We assessed each trial for internal validity, resolving any differences by discussion. We then extracted and entered data into Review Manager 5. In this update, we did not identify any new RCT studies for inclusion. We identified two RCT studies as ongoing that we are likely to include in future updates. Accordingly, our results are unchanged and include three RCTs with a total of 316 participants. All three studies compared the effectiveness of VM in reverting SVT with that of other vagal manoeuvres in a cross-over design. Two

  15. Management of Atrial Fibrillation in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Mattia Arrigo


    Full Text Available Atrial fibrillation (AF is common in ICU patients and is associated with a two- to fivefold increase in mortality. This paper provides a reappraisal of the management of AF with a special focus on critically ill patients with haemodynamic instability. AF can cause hypotension and heart failure with subsequent organ dysfunction. The underlying mechanisms are the loss of atrial contraction and the high ventricular rate. In unstable patients, sinus rhythm must be rapidly restored by synchronised electrical cardioversion (ECV. If pharmacological treatment is indicated, clinicians can choose between the rate control and the rhythm control strategy. The optimal substance should be selected depending on its potential adverse effects. A beta-1 antagonist with a very short half-life (e.g., esmolol is an advantage for ICU patients because the effect of beta-blockade on cardiovascular stability is unpredictable in those patients. Amiodarone is commonly used in the ICU setting but has potentially severe cardiac and noncardiac side effects. Digoxin controls the ventricular response at rest, but its benefit decreases in the presence of adrenergic stress. Vernakalant converts new-onset AF to sinus rhythm in approximately 50% of patients, but data on its efficacy and safety in critically ill patients are lacking.

  16. [No Hodgkin Linfoma diagnosis with intra-atrial infiltration]. (United States)

    Alcocer Gamba, Marco Antonio; León González, Salvador; Castro Montes, Eliodoro; Loarca Piña, Luis Martín; Lugo Gavidia, Leslie Marisol; García Hernández, Enrique; González Galindo, Ulises; Paredes Serrano, Miguel Isaías


    Cardiac tumors are rare entities in clinical practice, with an incidence of 0.05%. Approximately 75% are benign and 25% malignant. Among these, Lymphomas are uncommon, representing about 0.25%. The non-Hodgkin lymphomas can occur in extranodal tissues in 20% of the cases and 80% of these non-Hodgkin lymphomas are composed of diffuse B cells. The extranodal presentation is most frequent in young adults, with a high degree of malignancy and rapid growth. It can present with primary infiltration of various organs; cardiac involvement occurs in 20 to 28% of cases, usually located in the right chambers and with nonspecific symptoms, depending on the location and extent of the tumor. The diagnostic test in these cases is undoubtedly the biopsy of the lymph node or the affected tissue. We present the case of non-Hodgkin disease of diffuse large cells, with right intra-atrial involvement in a 23-year-old-female patient, who presented with progressive dyspnea. A transesophageal echocardiography was performed and an intra-atrial tumor mass was detected. A biopsy was performed, by femoral venous catheterization, allowing the establishment of the histopathological diagnosis and treatment. At a one year follow up, the patient shows complete remission.

  17. Risk of atrial fibrillation and stroke in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Ahlehoff, Ole; Gislason, Gunnar Hilmar


    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....

  18. Atrial fibrillation in elite athletes. (United States)

    Furlanello, F; Bertoldi, A; Dallago, M; Galassi, A; Fernando, F; Biffi, A; Mazzone, P; Pappone, C; Chierchia, S


    Atrial fibrillation (AF) is a rare event in people younger than 25 years of age, but is probably more frequent in competitive athletes. We analyzed the presence of AF, paroxysmal or chronic, in a population of young elite athletes, including previous Olympic and World champions, who were studied for arrhythmias that endangered their athletic careers. From 1974 to June 1977, 1,772 athletes identified with arrhythmias (1,464 males and 308 females; mean age 21 years) underwent individualized work-ups. Among these, 146 (122 males and 24 females; mean age 24 years) were young elite athletes. They were studied from 1985 to 1997, with a mean follow-up of 62 months. Of the 146 young elite athletes, 13 (9%) had AF (paroxysmal in 11 and chronic in 2); all were male. The paroxysmal AF occurred during effort (n = 7), after effort (n = 1), or at rest (n = 3) and was reinduced by transesophageal pacing or endocavitary electrophysiologic testing under the same clinical circumstances. AF was the cause of symptoms in 13 (40%) of 22 young elite athletes with long-lasting palpitations. Five young elite athletes had a substrate for AF: Wolff-Parkinson-White syndrome (WPW) in 3, arrhythmogenic right ventricular dysplasia (ARVD) in 1, healed myocarditis in 1, and was considered idiopathic in 8. All elite athletes are alive with a mean follow-up of 62 months and 7 continue in their sports: 3 after radiofrequency catheter ablation (of WPW in 2 and AF with maze-type nonfluoroscopic approach in 1) and 4 after a period of de-training. AF, occurring in young elite athletes and affecting only males, is one of the most frequent causes of prolonged palpitations and is reproduced easily by transesophageal atrial pacing or electrophysiologic testing. AF may be a cause of disqualification from sports eligibility, but may disappear if the athletic activity is stopped for an adequate period of time, if trigger mechanisms are corrected (i.e., WPW), or if the substrate is modified.

  19. Giant right atrial myxoma: characterization with cardiac magnetic resonance imaging.

    LENUS (Irish Health Repository)

    Ridge, Carole A


    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.

  20. Rupture of the left atrial roof due to blunt trauma. (United States)

    Ryu, Dae Woong; Lee, Sam Youn; Lee, Mi Kyung


    Cardiac rupture after blunt trauma is rare and associated with high mortality. The anatomic pattern of blunt cardiac rupture has been demonstrated with the right cardiac chambers more frequently affected than the left. Furthermore, left atrial injury is usually restricted to the atrial appendage and the pulmonary vein-atrial junction. Herein, we report the first case of a 61-year old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury.

  1. Rupture of the left atrial roof due to blunt trauma


    Ryu, Dae Woong; Lee, Sam Youn; Lee, Mi Kyung


    Cardiac rupture after blunt trauma is rare and associated with high mortality. The anatomic pattern of blunt cardiac rupture has been demonstrated with the right cardiac chambers more frequently affected than the left. Furthermore, left atrial injury is usually restricted to the atrial appendage and the pulmonary vein–atrial junction. Herein, we report the first case of a 61-year old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury.

  2. Supraventricular tachycardia induced by chocolate: is chocolate too sweet for the heart? (United States)

    Parasramka, Saurabh; Dufresne, Alix


    Conflicting studies have been published concerning the association between chocolate and cardiovascular diseases. Fewer articles have described the potential arrhythmogenic risk related to chocolate intake. We present a case of paroxysmal supraventricular tachycardia in a woman after consumption of large quantity of chocolate. A 53-year-old woman with no significant medical history presented to us with complaints of palpitations and shortness of breath after consuming large amounts of chocolate. Electrocardiogram showed supraventricular tachycardia at 165 beats per minute, which was restored to sinus rhythm after adenosine bolus injection. Electrophysiology studies showed atrioventricular nodal reentry tachycardia, which was treated with radiofrequency ablation. Chocolate contains caffeine and theobromine, which are methylxanthines and are competitive antagonists of adenosine and can have arrhythmogenic potential. Our case very well describes an episode of tachycardia precipitated by large amount of chocolate consumption in a patient with underlying substrate. There are occasional case reports describing association between chocolate, caffeine, and arrhythmias. A large Danish study, however, did not find any association between amount of daily caffeine consumption and risk of arrhythmia.

  3. Radiofrequency ablation of regular narrow complex supraventricular tachycardia in elderly and pediatric

    Directory of Open Access Journals (Sweden)

    Wael Abd El-Latief


    Conclusion: We have concluded that catheter ablation of supraventricular tachycardia is a very good option for management of patients with drug resistant SVT in both young and old patients. The success rate was very high almost with no complications and very low recurrence rate in the elderly and no recurrence in the young during the 6 months follow-up.

  4. 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.


    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

  5. Efficacy of antiarrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias

    NARCIS (Netherlands)

    Koyak, Z.; Kroon, B.; Groot, J.R. de; Wagenaar, L.J.; Dijk, A.P.J. van; Mulder, B.A.; Gelder, I.C.; Post, M.C.; Mulder, B.J.; Bouma, B.J.


    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

  6. Tako-tsubo cardiomyopathy triggered by paroxysmal supraventricular tachycardia in an octogenarian

    NARCIS (Netherlands)

    Hartmann, M.; Hartmann, M.; van Houwelingen, G.K.; Lambregts, H.P.C.M.; Verhorst, P.M.J.; von Birgelen, Clemens


    An 82-year-old emotionally stressed woman was admitted with palpitations and chest pain. Her blood pressure was 95/60 mmHg and heart rate 150 beats/min. The electrocardiogram (ECG) showed a regular small QRS-complex tachycardia (Fig. 1a). Serum levels of creatinine (220 μmol/l) and troponin I (0.12

  7. A Single Shock During An Episode Of Ventricular Tachycardia: Is The Device Working Properly? (United States)

    Jimenez-Lopez, Jesus; Arias, Miguel A; Akerstrom, Finn; Pachon, Marta; Puchol, Alberto


    Emergency department admissions due to implantable cardioverter-defibrillator (ICD) shocks constitute an important patient group. The correct evaluation includes a review of system integrity and a careful analysis of stored intracardiac electrograms. We present a patient admitted with a single ICD discharge due to an episode of sustained monomorphic ventricular tachycardia, and an unexpected finding. PMID:23071384

  8. A Single Shock During An Episode Of Ventricular Tachycardia: Is The Device Working Properly?

    Directory of Open Access Journals (Sweden)

    Jesus Jimenez-Lopez, MD


    Full Text Available Emergency department admissions due to implantable cardioverter-defibrillator (ICD shocks constitute an important patient group. The correct evaluation includes a review of system integrity and a careful analysis of stored intracardiac electrograms. We present a patient admitted with a single ICD discharge due to an episode of sustained monomorphic ventricular tachycardia, and an unexpected finding.

  9. Arterial baroreflex control of heart rate during exercise in postural tachycardia syndrome. (United States)

    Masuki, Shizue; Eisenach, John H; Schrage, William G; Dietz, Niki M; Johnson, Christopher P; Wilkins, Brad W; Dierkhising, Ross A; Sandroni, Paola; Low, Phillip A; Joyner, Michael J


    Patients with postural tachycardia syndrome (POTS) have excessive tachycardia without hypotension during orthostasis as well as exercise. We tested the hypothesis that excessive tachycardia during exercise in POTS is not related to abnormal baroreflex control of heart rate (HR). Patients (n = 13) and healthy controls (n = 10) performed graded cycle exercise at 25, 50, and 75 W in both supine and upright positions while arterial pressure (arterial catheter) and HR (ECG) were measured. Baroreflex sensitivity of HR was assessed by bolus intravenous infusion of phenylephrine at each workload. In both positions, HR was higher in the patients than the controls during exercise. Supine baroreflex sensitivity (HR/systolic pressure) in POTS patients was -1.3 +/- 0.1 beats.min(-1).mmHg(-1) at rest and decreased to -0.6 +/- 0.1 beats.min(-1).mmHg(-1) during 75-W exercise, neither significantly different from the controls (P > 0.6). In the upright position, baroreflex sensitivity in POTS patients at rest (-1.4 +/- 0.1 beats.min(-1).mmHg(-1)) was higher than the controls (-1.0 +/- 0.1 beats.min(-1).mmHg(-1)) (P pulse pressure in the patients than in the controls with 56 and 90% higher coefficient of variations, respectively (P tachycardia during exercise in POTS was not due to abnormal baroreflex control of HR.

  10. Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope. (United States)

    Lin, Jing; Jin, Hongfang; Du, Junbao


    Postural tachycardia syndrome and vasovagal syncope are common causes of orthostatic intolerance in children. The supplementation with water, or salt, or midodrine, or β-blocker was applied to children with postural tachycardia syndrome or vasovagal syncope. However, the efficacy of such medication varied and was not satisfied. This review aimed to summarise the current biomarkers in the treatment of the diseases. Studies were collected from online electronic databases, including OVID Medline, PubMed, ISI Web of Science, and associated references. The main areas assessed in the included studies were clinical improvement, the cure rate, and the individualised treatment for postural tachycardia syndrome and vasovagal syncope in children. Haemodynamic change during head-up tilt test, and detection of 24-hour urinary sodium excretion, flow-mediated vasodilation, erythrocytic H₂S, and plasma pro-adrenomedullin as biological markers were the new ways that were inexpensive, non-invasive, and easy to test for finding those who would be suitable for a specific drug and treatment. With the help of biomarkers, the therapeutic efficacy was greatly increased for children with postural tachycardia syndrome and vasovagal syncope.

  11. Reversible postural tachycardia syndrome due to inadvertent overuse of Red Bull. (United States)

    Terlizzi, Rossana; Rocchi, Camilla; Serra, Maria; Solieri, Laura; Cortelli, Pietro


    Postural tachycardia syndrome associated with a vasovagal reaction was recorded in a young volleyball player after an excess intake of Red Bull as a refreshing energy drink. Considering the widespread use of Red Bull among young people who are often unaware of the drink's drug content, this case report suggest Red Bull be considered a possible cause of orthostatic intolerance.

  12. 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


    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...

  13. Taquicardia ventricular polimórfica catecolaminérgica Catecholaminergic polymorphic ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Alejandro Velasco


    Full Text Available Catecholaminergic Polymorphic Ventricular Tachycardia is an inherited heart rhythm disorder recently discovered by genetic and electrophysiological diagnostic advancements. It consists of an inherited disorder characterized by the induction of bi-directional ventricular tachycardia in the presence of catecholamines, without a structural cardiac abnormality. Mutations in the Ryanodine receptor gene RyR2, have been linked with an autosomic dominant form, while mutations in the Calsequestrin gene CASQ 2 have showed correlation with an autosomic recessive form. The average age of onset is between 7 and 9 years of age, and clinical symptoms vary from syncope to sudden cardiac death. The diagnosis is confirmed by inducting ventricular tachycardia through a stress test or during an infusion of sympathicomimetic drugs like Isoproterenol, aided by the identification of mutations in the RyR2 and CASQ2 genes through gene analysis. Implantable cardiodefibrillator devices remain a valid therapeutic option in many cases due to the fact that antiarrhythmic drugs have not shown efficacy. Sympathetic cardiac denervation can be useful in some special cases. Catecholaminergic Polymorphic Ventricular Tachycardia opens a wide field for the development of new antiarrhythmic drugs and the use of gene therapy for cardiac rhythm disorders.

  14. Surgical ventricular reconstruction and subendocardial resection for the treatment of refractory ventricular tachycardia. (United States)

    Ismail, N A; Bence, J; Spyt, T J


    We describe a case of 64-year-old female patient with ventricular tachycardia intractable to medical treatment and acute heart failure following myocardial infarction. Emergency surgical ventricular reconstruction and subendocardial resection was undertaken. We discuss the option of surgical intervention in this difficult and unusual clinical scenario.

  15. Ventricular tachycardia in a Brugada syndrome patient caused by a novel deletion in SCN5A

    DEFF Research Database (Denmark)

    Tfelt-Hansen, J; Jespersen, Thomas; Hofman-Bang, J


    The aim of the present study was to identify the molecular mechanism behind ventricular tachycardia in a patient with Brugada syndrome. Arrhythmias in patients with Brugada syndrome often occur during sleep. However, a 28-year-old man with no previously documented arrhythmia or syncope who...

  16. Successful cryoablation of Mahaim tachycardia in a child with Ebstein's anomaly. (United States)

    Ergul, Yakup; Akdeniz, Celal; Kiplapinar, Neslihan; Tuzcu, Volkan


    Mahaim fibers with decremental atrioventricular (AV) node-like conduction properties comprise less than 3 % of accessory pathways. Radiofrequency ablation of right atriofascicular pathways guided by a distinct Mahaim potential detected at the anterolateral to posterolateral tricuspid annulus or in the right ventricular free wall is a safe and highly effective treatment method. The case report presents a 16-year-old boy with Ebstein's anomaly and symptomatic wide complex tachyarrhythmia. The electrophysiologic study and the entire ablation procedure were performed using a three-dimensional mapping system (EnSite Velocity; St. Jude Medical Inc., St. Paul, MN, USA). No fluoroscopy was used during the procedure. Electrophysiologic evaluation demonstrated typical atrioventricular nodal reentrant tachycardia and Mahaim tachycardia with a wide QRS and a left bundle branch block pattern. After Mahaim potential was located at the lateral tricuspid annulus, successful cryoablation was performed with an 8-mm-tip catheter followed by slow pathway ablation to eliminate typical atrioventricular nodal reentrant tachycardia. Cryoablation with an 8-mm-tip catheter can be an alternative treatment option for children with Mahaim tachycardia.

  17. Evaluation of optimal treatment approach in patients with early recurrence of atrial fibrillation after the first ablation procedure

    Directory of Open Access Journals (Sweden)

    В. В. Шабанов


    Full Text Available 182 patients with paroxysmal AF underwent ablation (circumferential pulmonary vein isolation with linear lesions and were monitored with an implantable cardiac monitor (Reveal XT, Medtronic. Patients were randomly assigned to group 1 or group 2. Group 1 patients were treated only with antiarrhythmic drugs for 6 weeks, with no early reablation during the 3-month postablation period. In the case of AF recurrence after the 3-month postablation period, patients underwent reablation. Group 2 patients were treated according to the onset mechanism of AF recurrences, as detected and stored by the implantable cardiac monitor: antiarrhythmic drug therapy, but no reablation if AF was not preceded by triggers; early reablation if premature atrial beats or atrial tachycardias or flutter triggered AF. All patients were followed up for 1 year to assess the sinus rhythm maintenance in each group. On 12-month follow-up examination, 67 patients (76% out of 88 in group 1 and 78 patients (92% out of 89 in group 2 had no AF recurrences (P<0,009 versus group 1. The patients with AF recurrences caused by a trigger mechanism after the first ablation demonstrated high long-term efficacy after early reablation.

  18. Maximal heart rate does not limit cardiovascular capacity in healthy humans: insight from right atrial pacing during maximal exercise. (United States)

    Munch, G D W; Svendsen, J H; Damsgaard, R; Secher, N H; González-Alonso, J; Mortensen, S P


    In humans, maximal aerobic power (VO2 max ) is associated with a plateau in cardiac output (Q), but the mechanisms regulating the interplay between maximal heart rate (HRmax) and stroke volume (SV) are unclear. To evaluate the effect of tachycardia and elevations in HRmax on cardiovascular function and capacity during maximal exercise in healthy humans, 12 young male cyclists performed incremental cycling and one-legged knee-extensor exercise (KEE) to exhaustion with and without right atrial pacing to increase HR. During control cycling, Q and leg blood flow increased up to 85% of maximal workload (WLmax) and remained unchanged until exhaustion. SV initially increased, plateaued and then decreased before exhaustion (P rate pressure product and RAP (P heart can be paced to a higher HR than observed during maximal exercise, suggesting that HRmax and myocardial work capacity do not limit VO2 max in healthy individuals. A limited left ventricular filling and possibly altered contractility reduce SV during atrial pacing, whereas a plateau in LVFP appears to restrict Q close to VO2 max .

  19. Echocardiographic assessment of left atrial size in patients with end-stage renal disease. (United States)

    Koçinaj, Dardan; Gashi, Masar; Berisha, Merita; Koçinaj, Allma; Ramadani, Naser; Korça, Hajrije


    Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease, silent myocardial ischaemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, annular mitral and aortic valve calcification, and enlargement of the left atrium, than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels. In this study, we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease. We analysed data from 123 patients who were on regular haemodialysis, by means of traditional transthoracic echocardiographic examination. The usual statistical parameters, correlations and the Student's t-test were performed, with levels of significance of p < 0.01 and p < 0.05. The most presented age group was 60 to 69 years old, with a predomination of females (56.1%). We found dilated left atrium in 26.02% of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium. Evaluation of left atrial size should be determined by several different measurements, and left atrial enlargement should be seen as a risk factor for advancing disease.

  20. Interobserver variation in interpretation of electrocardiographic signs of atrial infarction

    DEFF Research Database (Denmark)

    Christensen, J H; Nielsen, F E; Falstie-Jensen, N


    The electrocardiogram (ECG) is the only means of diagnosing atrial infarction antemortem. Certain ECG changes (PR-segment displacements) have been taken earlier as signs of atrial infarction. The purpose of this study was to assess the interobserver variation on suggested ECG signs of atrial infa...

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

    DEFF Research Database (Denmark)

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


    BACKGROUND: Different atrial arrhythmias can coexist in the recipient and donor atria after heart transplantation. CASE PRESENTATION: We report an unusual case of a patient with three different types of atrial arrhythmia after heart transplantation: an atrial fibrillation in the recipient atria, ...

  2. Effects of chronic atrial fibrillation on active and passive force generation in human atrial myofibrils. (United States)

    Belus, Alexandra; Piroddi, Nicoletta; Ferrantini, Cecilia; Tesi, Chiara; Cazorla, Olivier; Toniolo, Luana; Drost, Maurice; Mearini, Giulia; Carrier, Lucie; Rossi, Alessandra; Mugelli, Alessandro; Cerbai, Elisabetta; van der Velden, Jolanda; Poggesi, Corrado


    Chronic atrial fibrillation (cAF) is associated with atrial contractile dysfunction. Sarcomere remodeling may contribute to this contractile disorder. Here, we use single atrial myofibrils and fast solution switching techniques to directly investigate the impact of cAF on myofilament mechanical function eliminating changes induced by the arrhythmia in atrial myocytes membranes and extracellular components. Remodeling of sarcomere proteins potentially related to the observed mechanical changes is also investigated. Myofibrils were isolated from atrial samples of 15 patients in sinus rhythm and 16 patients with cAF. Active tension changes following fast increase and decrease in [Ca(2+)] and the sarcomere length-passive tension relation were determined in the 2 groups of myofibrils. Compared to sinus rhythm myofibrils, cAF myofibrils showed (1) a reduction in maximum tension and in the rates of tension activation and relaxation; (2) an increase in myofilament Ca(2+) sensitivity; (3) a reduction in myofibril passive tension. The slow beta-myosin heavy chain isoform and the more compliant titin isoform N2BA were up regulated in cAF myofibrils. Phosphorylation of multiple myofilament proteins was increased in cAF as compared to sinus rhythm atrial myocardium. Alterations in active and passive tension generation at the sarcomere level, explained by translational and post-translational changes of multiple myofilament proteins, are part of the contractile dysfunction of human cAF and may contribute to the self-perpetuation of the arrhythmia and the development of atrial dilatation.

  3. [Left atrial appendage in rheumatic mitral valve disease: The main source of embolism in atrial fibrillation]. (United States)

    García-Villarreal, Ovidio A; Heredia-Delgado, José A

    To demonstrate that surgical removal of the left atrial appendage in patients with rheumatic mitral valve disease and long standing persistent atrial fibrillation decreases the possibility of stroke. This also removes the need for long-term oral anticoagulation after surgery. A descriptive, prospective, observational study was conducted on 27 adult patients with rheumatic mitral valve disease and long standing persistent atrial fibrillation, who had undergone mitral valve surgery and surgical removal of the left atrial appendage. Oral anticoagulation was stopped in the third month after surgery. The end-point was the absence of embolic stroke. An assessment was also made of postoperative embolism formation in the left atrium using transthoracic echocardiography. None of the patients showed embolic stroke after the third post-operative month. Only one patient exhibited transient ischaemic attack on warfarin therapy within the three postoperative months. Left atrial thrombi were also found in 11 (40.7%) cases during surgery. Of these, 6 (54.5%) had had embolic stroke, with no statistical significance (P=.703). This study suggests there might be signs that the left atrial appendage may be the main source of emboli in rheumatic mitral valve disease, and its resection could eliminate the risk of stroke in patients with rheumatic mitral valve disease and long-standing persistent atrial fibrillation. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  4. Is There a Difference in Tachycardia Cycle Length during SVT in Children with AVRT and AVNRT? (United States)

    Mills, Marcos F; Motonaga, Kara S; Trela, Anthony; Dubin, Anne M; Avasarala, Kishor; Ceresnak, Scott R


    There are limited adult data suggesting the tachycardia cycle length (TCL) of atrioventricular reentry tachycardia (AVRT) is shorter than atrioventricular nodal reentry tachycardia (AVNRT), though little data exist in children. We sought to determine if there is a difference in TCL between AVRT and AVNRT in children. A single-center retrospective review of children with supraventricular tachycardia (SVT) from 2000 to 2015 was performed. Age ≤ 18 years, invasive electrophysiology study (EPS) confirming AVRT or AVNRT. Atypical AVNRT, congenital heart disease, antiarrhythmic medication use at time of EPS. Data were compared between patients with AVRT and AVNRT via t-test, χ 2 test, and linear regression. A total of 835 patients were included (12 ± 4 years, 52 ± 31 kg, TCL 321 ± 55 ms), 539 (65%) with AVRT (270 Wolff-Parkinson-White, 269 concealed pathways) and 296 (35%) with AVNRT. Patients with AVRT were younger (11.7 ± 4.1 years vs 13.0 ± 3.6 years, P SVT, there was no difference in TCL (290 ± 49 ms vs 297 ± 49 ms, P = 0.26). When controlling for age, there was no difference in TCL between AVRT and AVNRT at baseline or on isoproterenol. The regression equation for TCL in the baseline state was TCL = 290 + 4 (age), indicating the TCL will increase by 4 ms above a baseline of 290 ms for each year of life. When controlling for age, there is no difference in the TCL between AVRT and AVNRT in children. Age, not tachycardia mechanism, is the most significant factor in predicting TCL. © 2016 Wiley Periodicals, Inc.

  5. Epicardial-endocardial breakthrough during stable atrial macroreentry: Evidence from ultra-high-resolution 3-dimensional mapping. (United States)

    Pathik, Bhupesh; Lee, Geoffrey; Sacher, Frédéric; Haïssaguerre, Michel; Jaïs, Pierre; Massoullié, Grégoire; Derval, Nicolas; Sanders, Prashanthan; Kistler, Peter; Kalman, Jonathan M


    Evidence for epicardial-endocardial breakthrough (EEB) is derived from mapping inferences in patients with atrial fibrillation who may also have focal activations. The purpose of this study was to investigate whether EEB could be discerned during stable right atrial (RA) macroreentry using high-density high-spatial resolution 3-dimensional mapping. Macroreentry was diagnosed using 3-dimensional mapping and entrainment. Bipolar maps were reviewed for EEB defined as (1) presence of focal endocardial activation with radial spread unaccounted for by an endocardial wavefront and (2) present with the same timing on every tachycardia cycle. The EEB site was always in proximity to a line of endocardial conduction slowing or block. Distance and conduction velocity from the line of block to the EEB site was calculated. Electrograms at EEB sites were individually analyzed for morphology and to confirm direction of activation. Entrainment was performed at EEB sites. Twenty-six patients were studied. Fourteen examples of EEB were seen: 11 at the posterior RA (4 at the superior portion of the posterior wall and 7 at the inferior section) and 1 each at the cavotricuspid isthmus postablation, RA septum, and inferolateral RA. The mean area of the EEB site was 0.6 ± 0.2 cm2. A mean of 79.5% ± 18.6% of unipolar electrograms at the EEB site demonstrated an rS morphology. The mean distance and conduction velocity from the line of endocardial block to the EEB site at the posterior RA was 13.6 ± 2.3 mm and 59.3 ± 12.3 cm/s, respectively. In 4 patients, entrainment demonstrated that EEB sites were within the circuit and in 1 of these patients critical to arrhythmia maintenance. Activation maps during tachycardia and coronary sinus pacing demonstrated EEB at the same anatomic site. EEB sites were demonstrated in stable atrial macroreentry supported by systematic entrainment confirmation and demonstration of the same phenomenon during pacing. Copyright © 2017 Heart Rhythm Society

  6. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators

    DEFF Research Database (Denmark)

    van Walraven, Carl; Hart, Robert G; Connolly, Stuart


    on the relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation. METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which...... contains patient level-data from randomized trials of stroke prevention in atrial fibrillation. We used Cox regression models with age as a continuous variable that controlled for sex, year of randomization, and history of cerebrovascular disease, diabetes, hypertension, and congestive heart failure...

  7. Increased susceptibility to atrial fibrillation secondary to atrial fibrosis in transgenic goats expressing transforming growth factor - B1 (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...

  8. Pulmonary Vein, Dorsal Atrial Wall and Atrial Septum Abnormalities in Podoplanin Knockout Mice With Disturbed Posterior Heart Field Contribution

    NARCIS (Netherlands)

    Douglas, Yvonne L.; Mahtab, Edris A. F.; Jongbloed, Monique R. M.; Uhrin, Pavel; Zaujec, Jan; Binder, Bernd R.; Schalij, Martin J.; Poelmann, Robert E.; Deruiter, Marco C.; Gittenberger-De Groot, Adriana C.

    The developing sinus venosus myocardium, derived from the posterior heart field, contributes to the atrial septum, the posterior atrial wall, the sino-atrial node, and myocardium lining the pulmonary and cardinal veins, all expressing podoplanin, a coelomic and myocardial marker. . We compared

  9. Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease

    NARCIS (Netherlands)

    Brakel, T.J. van; Krieken, T. van der; Westra, S.W.; Laak, J.A.W.M. van der; Smeets, J.L.R.M.; Swieten, H.A. van


    PURPOSE: This study was conducted to investigate the degree of fibrosis in atrial appendages of patients with and without atrial fibrillation (AF) undergoing cardiac surgery. In addition, we hypothesized that areas of atrial fibrosis can be identified by electrogram fractionation and low voltage for

  10. Atrial fibrillation: non cardiologist physicians approach

    Directory of Open Access Journals (Sweden)

    Forero-Gómez, Julián Eduardo


    Full Text Available Atrial fibrillation is the most frequent arrhythmia. Its classification according to pattern and clinical type allows to decide the therapeutic strategy to use, that most include control of symptoms and prevention of cardioembolic events. The election of the treatment depends on the presence of triggering events, risk factors for thromboembolism, risk factors for bleeding, cardiac function, patient funcionality, medication costoefectiveness and health care access. The type of anticoagulant has to be supported on the type of atrial fibrillation and the presence of contraindications, documented ineffective anticoagulation or high risk of failure to warfarin. In case of contraindications for anticoagulation this could still be used in high bleeding risk patients, when risk factors are controllable or corrected; leaving left atrial appendage closure as an option for patients that remain in high risk for bleeding events.

  11. [Secondary pulmonary embolism to right atrial myxoma]. (United States)

    Vico Besó, L; Zúñiga Cedó, E


    A case of pulmonary thromboembolism secondary to atrial myxoma right. The myxoma is a primary cardiac tumor, namely, has his origin in the cardiac tissue. Primary cardiac tumors are rare, including myxomas, the most common type. Have a predilection for females and the most useful tool for diagnosis is echocardiography. About 75% of myxomas occur in the left atrium of the heart and rest are in the right atrium. Right atrial myxomas in some sometimes associated with tricuspid stenosis and atrial fibrillation. The most common clinical manifestations include symptoms of this neoplasm constitutional, and embolic phenomena resulting from the obstruction to the flow intracavitary. The treatment of this condition is surgical. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  12. Antihypertensive treatment and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Marott, Sarah C W; Nielsen, Sune F; Benn, Marianne


    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......, and hyperthyroidism at baseline and none received any other antihypertensive medication. We studied risk of atrial fibrillation, and used risk of stroke, influenced by lowering blood pressure rather than renin-angiotensin system blockade per se, as an indicator of the importance of blood pressure lowering per se...... of stroke did not differ among the five antihypertensive medications. CONCLUSION: Use of ACEis and ARBs compared with β-blockers and diuretics associates with a reduced risk of atrial fibrillation, but not stroke, within the limitations of a retrospective study reporting associations. This suggests...

  13. Effect of cardiac resynchronization therapy on ventricular tachycardias in patients with dilated cardiomyopathy and severe heart failure

    Directory of Open Access Journals (Sweden)

    Д. И. Лебедев


    Full Text Available The aim of the study was to elucidate the effects of cardiac resynchronization therapy (CRT on ventricular tachycardias in patients with dilated cardiomyopathy and to analyze the prospects of radionuclide diagnostic methods for prediction of life-threatening arrhythmias in the presence of therapy. The study included 70 patients (mean age 55 12 years aged 32 to 75 years with dilated cardiomyopathy, NYHA FC III heart failure, left ventricular (LV ejection fraction (EF of 30.1 3.8%, and end-diastolic volume (EDV of 220.7 50.9 mL. Group 1 comprised 35 patients (50% diagnosed with paroxysms of ventricular tachycardia, while Group 2 consisted of 35 patients (50% without episodes of ventricular tachycardia. After one year of CRT, positive clinical changes were documented in all patients: LV EF increased to 42.8 4.8% (p 0.001; functional class of heart failure decreased to II; LV EDV decreased to 197.9 47.8 mL (p 0.005. The patients whose EF increased by 14% and EDV decreased by 35 mL during one-year CRT had no episodes of ventricular tachycardia. The patients, whose paroxysms of ventricular tachycardia persisted during the entire period of the study, showed EF increase by 9% and EDV decrease by 13 mL. The second stage of the study consisted in evaluating the effects of myocardial metabolism defects (MMD. No ventricular tachycardia episodes were registered in patients whose MMD became less than 15% during CRT; if the size of DMM exceeded 15%, paroxysms of ventricular tachycardia were observed. Thus, efficacious CRT in patients with dilated cardiomyopathy results in a statistically significant reduction of the number of ventricular tachycardia episodes. The improvement of fatty acid metabolism contributes to a decrease in the number of ventricular tachycardia episodes in the course of CRT.

  14. Vagal Techniques for Terminating Paroxysmal Tachycardia in Children: Assessment of Clinical Electrophysiological Factors of Valsalva Test Effectiveness

    Directory of Open Access Journals (Sweden)

    T. K. Kruchina


    Full Text Available Background: Vagal techniques constitute the first line of medical care for terminating paroxysmal supraventricular tachycardia in children and adults due to ease of application, relative safety and possibility of avoiding injection of antiarrhythmic drugs. Effectiveness of vagal techniques depends on the method of execution, as well as a range of clinical and electrophysiological factors, which require study and specification. Objective: Our aim was to study effectiveness of the modified Valsalva test for terminating paroxysmal tachycardia in children. Methods: Effectiveness of the Valsalva test for terminating paroxysmal tachycardia induced in the course of a transesophageal electrophysiological examination in children aged 7–18 years was studied retrospectively. Results: Data of 306 children (mean age — 13.1 ± 3.2 years were analyzed; 130 of them (42.5% suffered from paroxysmal AV nodal reentrant tachycardia (PAVNRT, 176 — from paroxysmal AV reentrant tachycardia involving an additional AV connection (PAVRT. Valsalva test was effective in 88 children (28.8% — 44 children (33.8% with PAVNRT and 44 children (25.1% with PAVRT. In most cases, tachycardia was terminated by means of anterograde block: PAVRT — in 65.5% of the cases, PAVNRT — in 92.7% of the cases. Children with ineffective Valsalva test featured longer duration of the disorder (p = 0.035, higher rate of the initial sinus rhythm before a tachycardic paroxysm (p = 0.043 and higher rhythm rate during tachycardia (p = 0.019, as well as high level of AV node conduction (p = 0.038. Conclusion: Valsalva test terminates paroxysmal tachycardia in not more than 1/3 of children with paroxysmal AV reentrant tachycardia. Test effectiveness depends on duration of the disorder and electrophysiological characteristics of AV node conduction. Valsalva test is especially effective in the onset of tachycardic paroxysm and terminates it by means of anterograde AV node block in most cases. 

  15. Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol

    Directory of Open Access Journals (Sweden)

    Nakanishi Kazuhiro


    Full Text Available Abstract Background Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF after cardiac surgery. Methods Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3–5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group and those who did not receive any β-blockers during surgery (control group. An unpaired t test and Fisher’s exact test were used to compare between-group differences in mean values and categorical data, respectively. Results Seventeen of the 105 patients (16.2% developed postoperative atrial fibrillation: 5/57 (8.8% in the landiolol group and 12/48 (25% in the control group. There was a significant difference between the two groups (P=0.03. The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant. Conclusions Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.

  16. [Painless delivery under lumbar epidural anesthesia for a pregnant woman with syncope caused by paroxysmal ventricular tachycardia]. (United States)

    Nakagawa, H; Yoda, K; Fujiwara, A; Tanaka, Y; Miyazaki, M


    A 32-year-old pregnant woman complained of palpitation and syncope caused by paroxysmal ventricular tachycardia. The electrophysiological study was normal. The evidence that catecholamines were extremely increased in urine suggested that this arrhythmia resulted from imbalance in the autonomic nervous system. Medication by beta-blocking drugs during pregnancy decreased the frequency of ventricular tachycardia. In order to avoid the increase of catecholamines during the delivery, lumbar epidural anesthesia was administered, which resulted in painless vaginal delivery and impeded the attack of ventricular tachycardia. Although the baby was small for date, fortunately he was delivered normally.

  17. [Atrial myxoma: a challenge for the pneumologist]. (United States)

    Potre, Rodica; Ularu, D; Tudorache, V; Bertici, Nicoleta


    It presents a 59 years old woman with atypical symptoms, which orientated the diagnostic thinking during one year to a reccurrent pneumonitis, bronchial asthma, colagenosis, interstitial pulmonary fibrosis and so on. The appearance of pulmonary edema determined a couple of cardiologic exams which came to obiectivate as the main cause, the existence of a left atrial mixoma who was invaginated in left mitral cusp. Surgical intervention permitted not only specific determination of histological type of tumor, but lead to healing of the patient. It is a discussion over epidemiology, clinical areas of manifestation and methods of diagnostic of atrial tumors.

  18. Multimorbidity in Older Adults with Atrial Fibrillation. (United States)

    Chen, Michael A


    Older adults with atrial fibrillation often have multiple comorbid conditions, including common geriatric syndromes. Pharmacologic therapy, whether for rate control or rhythm control, can result in complications related to polypharmacy in patients who are often on multiple medications for other conditions. Because of uncertainty about the relative risks and benefits of rate versus rhythm control (including antiarrhythmic or ablation therapy), anticoagulation, and procedural treatments (eg, ablation, left atrial appendage closure, pacemaker placement) in older patients with multimorbidity, shared decision-making is essential. However, this may be challenging in patients with cognitive dysfunction, high fall risk, or advanced comorbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Bilateral Atrial Myxoma: A Case Report. (United States)

    Susupaus, Attapoom; Foofuengmonkolkit, Kumpoo


    Among the rare cardiac tumors, myxoma, which is mostly located in the left atrium, is the most common type. Bilateral atrial myxoma is extremely rare, and requires urgent surgery. The authors report the case of a 34-year-old male, who presented with one month of right hemiparesis and aphasia and subsequently diagnosed with bilateral atrial myxoma based on transthoracic echocardiography. An urgent operation for intra-cardiac tumor removal was performed with the biatrial approach. Once a diagnosis of myxoma has been made, an urgent operation for tumor removal is necessary due to the risk of serious complications, including sudden death from normal blood flow obstruction.

  20. Cryoballoon Catheter Ablation in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cevher Ozcan


    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.