[Long-term anticoagulant treatment in private practice].
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Anticoagulants↗
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Results for “Ventricular Flutter”
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The sick sinus syndrome. Clinical and electrocardiographic spectrum of nine patients.
The paper presents a report on the clinical and electrographic spectrum of nine patients with the sick sinus syndrome with severe symptoms of clinical disturbances and serious disorders of impulse formation and conduction. Seven patients had syncope associated with sinus bradycardia, sinoatrial block or atrial fibrillation with slow ventricular rate. Prolonged episodes of atrial and ventricular asystole occurred and were interrupted by junctional escape beats. Paroxysmal atrial fibrillation and flutter were foun in three patients and infrahisian block in four. Atropine induced a slight acceleration of the heart rate in all the patients studied while the post-suppression S-A node recovery time was prolonged in four.
Arrhythmias, Cardiac↗
[Echocardiographic evaluation of pulmonary arterial hypertension].
We performed an echocardiographic and hemodynamic study in 10 patients with cath proven pulmonary arterial hypertension (PAH). The results show that the echocardiographic pattern of PTH such as flat diastolic pulmonary echo, premature closing, flutter, abscense of "A" wave, in creased opening velocity and changes in the right ventricular systolic time intervals, are equivocal. The most common echo finding in our study, was the increased opening velocity. Other echo data could be absent despite the true presence of pulmonary hypertension in a particular case. This report shows similar findings to a recent one published elsewhere (12) with no correlation between echo and hemodynamic data.
Echocardiography↗
[Obesity, chronic bronchitis, pleural effusion, sleep apnea, atrial flutter].
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Aged↗
Atrial flutter with 1:1 atrioventricular conduction caused by propafenone.
We describe a case of 1:1 atrial flutter in a patient with coronary disease taking propafenone. In atrial flutter, the atrial rate is usually about 300 beats/min with 2:1 AV conduction and a ventricular rate of 150 beats/min. Class IA antiarrhythmic drugs, especially quinidine and disopyramide, may cause 1:1 AV response because they reduce atrial rate and are vagolytic. However, propafenone is a Class IC agent and has no anticholinergic properties, and the occurrence of 1:1 AV conduction at a rate of about 250 beats/min is an important side effect that, although uncommon, should be recognized.
Anti-Arrhythmia Agents↗
[Tachycardia-induced cardiomyopathy].
Dilated cardiomyopathy induces circulatory insufficiency with poor prognosis. Persistent tachyarrhythmias may be the cause of this disease. At particular high risk for heart damage and insufficiency are young people and children. The group of most dangerous arrhythmias consist of: incessant tachycardia in patients with preexcitation syndrome and supraventricular tachyarrhythmias (atrial flutter and fibrillation, ectopic atrial tachycardia) with high rate of ventricles. The result of arrhythmias is dilatation of the heart and thinness of ventricular walls with hemodynamic disorders. The effective therapy of arrhythmias--ablation of the accessory pathway in patients with pre-excitation syndrome or reversion to sinus rhythm (pharmacological or electric cardioversion) in patients with atrial fibrillation and flutter, often leads to normalisation of heart ejection function and diameter. Therefore it exist important question: is dilated cardiomyopathy the cause or consequence of tachyarrhythmias? Causative antiarrhythmic therapy in these second cases gives a possibility to improve the prognosis in patients with such a disease.
Cardiomyopathies↗
The influence of exercise on atrial flutter.
To study the effect of exercise on atrial flutter the electrocardiogram was recorded continuously before, during and after low level treadmill walking in twenty-two ambulatory patients. Atrial flutter rates increased during exercise testing in four patients. Improved A-V conduction with consequent higher ventricular rates occurred during exercise in thirteen subjects. One patient, with 4:1 conduction at rest, continued with 4:1 block throughout exercise testing, was believed to be over-digitalized. During the recovery period after exercise, ten patients transiently developed periods of Wenckebach A-V block. Walking exercise induced 1:1 conduction in six patients and was promoted by the following circumstances: 1) atrial rates of 250/min or less; 2) inadequate dosage of digitalis; and 3) the administration of quinidine. For the patient with chronic atrial flutter, treadmill testing provides a simple method for demonstrating the range of changes of A-V conduction and for deriving implications for appropriate drug therapy.
Adult↗
[The usefulness of adenosine triphosphate in supraventricular paroxysmal tachycardias].
With the objective to evaluate adenosine triphosphate (ATP) usefulness in supraventricular paroxysmal tachycardia (SPT), doses of 0.25 mg/kg, of ATP are administered fastly i.v. in bolus, to fifty consecutive patients with SPT resistant to vagal stimulation maneuvers. The effect achieved allowed to identify two groups: a) 39 patients in whom tachycardia was interrupted; b) 11 patients in whom tachycardia did not cease, but the induced transient provoked atrial-ventricular (A-V) blockage allowed to identify the underlying mechanism of tachycardia (in 6 of them atrial tachycardia and in 5 atrial flutter). In both groups the ATP effect was present in less than 30 seconds. In seven patients (five from group (a) and two from group b) the QRS duration was over 0.12 s. Six patients had a left ventricular ejection fraction below 30%. Side effects were frequent, but always short. ATP could become the drug of choice in the treatment of SPT without response to vagal maneuvers, due to the fact that, to its therapeutic activity, it must be added its diagnostic usefulness, its fast action and metabolization, together with the fact that it does not induce severe side effects.
Adenosine Triphosphate↗
Iatrogenic ventricular tachycardia from endocardial pacemaker late after repair of tetralogy of Fallot.
A 34-year-old woman, who had undergone radical repair for tetralogy of Fallot at the age of 8 years, was left with moderate-to-severe pulmonary regurgitation. VT developed after endocardial pacing for symptomatic pauses and atrial flutter. The possibility that the new VT originated from the apical endocardial lead was suggested by the unusual morphology of the VT, which was similar to paced. Surgical removal of the lead, which was deeply embedded at the same time as a pulmonary valve was replaced, cured the arrhythmia. This unusual cause of VT highlights possible risks associated with setting up a dangerous reentry circuit by inserting a right ventricular endocardial pacemaker lead.
Adult↗
Factors influencing the one-year mortality of dilated cardiomyopathy.
This study was designed to determine prognostic risk indicators of nonischemic dilated cardiomyopathy (DC). Sixty-nine patients were studied. Each patient underwent physical examination (including a history), electrocardiography, echocardiography, cardiac catheterization, 24-hour monitoring and endomyocardial biopsy. The mortality rate at 1 year was 35% (24 deaths). Univariate analysis revealed that the most powerful predictor of prognosis was the left intraventricular conduction delay (p = 0.003). The pulmonary capillary wedge pressure was also predictive of mortality (p = 0.005). Other significant factors, in order of importance, were ventricular arrhythmias (p = 0.007), mean right atrial pressure (p = 0.008), angiographic ejection fraction (p = 0.03), atrial fibrillation or flutter (p = 0.01) and the presence of an S3 gallop (p = 0.05). Factors such as duration of symptoms, presence of mitral regurgitation, end-diastolic diameter, myocardial cell size and percent fibrosis in the biopsy and treatment with vasodilators, antiarrhythmic and anticoagulant drugs were not significant predictors. Multivariate analysis was used to determine which combination of factors could most accurately predict survival and death. The most important factors were left conduction delay, ventricular arrhythmias and mean right atrial pressure. An equation was derived that can be applied to the prognosis of patients with DC. Thus, the clinical assessment of patients with DC can accurately predict the probability of surviving or dying in 1 year.
Adult↗
Tricuspid valve fluttering.
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Echocardiography↗
[Paroxysmal tachycardia in infants with a ventricular rate of 343 beats per minute].
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Atrial Flutter↗
Arrhythmias after pediatric lung transplantation.
Atrial arrhythmias have been reported after congenital heart surgery involving extensive atrial suture lines. Experimental studies involving bilateral lung transplantation (Tx) suggest that the left atrial suture lines predispose to atrial flutter. The overall incidence and type of arrhythmias after pediatric lung Tx have not previously been described and therefore the purpose of this study was to prospectively screen and describe arrhythmias in a subset of our lung transplant population. Over a 1-yr study period, all recipients of bilateral lung Tx were admitted to a full-disclosure telemetry unit. Single-lead electrocardiograms were recorded continuously and reviewed daily via a beat-by-beat analysis. A total of 314 patient days (range 9-93, median 43 days) were recorded from seven patients. The incidence of arrhythmias observed per total patient days included junctional escape rhythm (4.8%), non-sustained ventricular tachycardia (4.1%), accelerated junctional (2.5%), sinus bradycardia (2.2%), non-sustained supraventricular tachycardia (1.3%), ectopic atrial tachycardia (1.0%), sustained ventricular tachycardia (0.3%), junctional ectopic tachycardia (0.3%), and second degree heart block (0.3%). No patient had sustained supraventricular tachycardia, atrial flutter, atrial fibrillation, or complete heart block. Arrhythmias were treated in two patients. During the follow-up period, one patient received amiodarone for ventricular tachycardia (which was also noted and treated prior to transplant). We conclude that among pediatric lung transplant recipients admitted for their transplant surgery, arrhythmia is uncommon and rarely requires therapy.
Adolescent↗
A new and simple method for distinguishing complete from incomplete block through the cavotricuspid isthmus.
BACKGROUND: A complete line of block (CLOB) in the cavotricuspid isthmus (CTI) is the endpoint of typical atrial flutter ablation. Before CTI block is obtained, a progressive CTI conduction delay due to an incomplete line of block (InLOB) can be difficult to distinguish from CLOB. The purpose of this study was to assess a new simple approach based on the changes in atrio-ventricular (AV) conduction delays during septal and lateral right atrial pacing, to distinguish a CLOB from an InLOB during typical atrial flutter (AFL) ablation. METHODS AND RESULTS: Forty patients who presented an InLOB before a CLOB, and a stable (AV) conduction delay at 600 ms cycle length pacing (when in sinus rhythm), during AFL ablation were included in this study. A 24-pole mapping catheter was positioned so that 2 adjacent dipoles bracketed the targeted CTI line of block (LOB), with proximal dipoles lateral to the LOB and distal dipoles in the coronary sinus. Two pacing sites were lateral (position L1 and L2) and one was septal (position S) to the LOB, with locations L1 and S closest to the LOB. During L1, L2 and S site pacing, the delay between the pacing artefact and the peak of the R wave in a surface ECG (lead II) was measured. We measured the following conduction delays (mean +/- SD in ms), during InLOB versus CLOB: (L1 to R) 320.5 +/- 68.0 versus 367.0 +/- 62.0, p = 0.001; (L2 to R) 333.0 +/- 59.0 versus 338.0 +/- 62.0, p = 0.663, (S to R) 259.4 +/- 51.5 versus 247.1 +/- 55.5, p = 0.987. We calculated the following data during an InLOB versus a CLOB: (L1R-L2R) -12.3 +/- 7 versus 20.2 +/- 12.7, p = 0.001; (L1R-SR) 51.1 +/- 21.5 versus 120.1 +/- 16.6, p < 0.05. The sensitivity, specificity, positive and negative predictive values for CLOB with (L1R-SR > 94 ms) and with (L1R-L2R > 0 ms) were respectively; 100%, 98%, 98% and 100%. CONCLUSIONS: This study establishes that lateral versus septal right atrial pacing sites combined with the measure of AV conduction delay on a surface ECG can be useful to distinguish a CLOB from an InLOB during AFL ablation.
Atrial Flutter↗
[Arrhythmias in the elderly].
A survey was made on a population of 6059 subjects aged more than 60 years with the aim to assess 1. the prevalence of heart arrhythmias and 2. the relationships between arrhythmias and some other ecg alterations. Arrhythmias resulted present in 29.0% of the whole population with a significantly higher prevalence among males (30.7% vs 28.1%, P less than 0.05) and among subjects over 75 years of age (33.2% vs 23.9%, P less than 0.001). Supraventricular extrasystoles (SE, 11.55%), atrial fibrillation (AF, 10.44%) and ventricular extrasystoles (VE, 8.91%) were the most frequent arrhythmias, followed by sinus bradycardia (SB, 2.04%), sinus arrhythmia (SA, 1.35%), atrial flutter (AFL, 1.09%) and junctional rhythms (JR, 0.20%). AF and AFL resulted significantly more frequent among females, whilst SE, VE and SB were more frequent among males. All the above arrhythmias, with the exception of AFL and JR resulted significantly more frequent among subjects over 75. A significantly higher prevalence of ecg signs of left ventricular hypertrophy, ischemia, previous myocardial infarction (MI) and of the so-called "minor" T-wave changes (MTC) was found among the subjects with arrhythmia as compared with those free from rhythm disturbances. Ecg signs of MI and MTC were significantly more frequent among males and MTC were more frequent among females and among subjects over 75. It is concluded that in an old person the presence of an arrhythmia should lead to a careful evaluation of the general and cardiological clinical situation in order to avoid 1. to prescribe an unnecessary and potentially dangerous antiarrhythmic treatment, and 2. to misdiagnose an underlying clinical condition liable to a decisive improvement under adequate treatment.
Aged↗
Proarrhythmic effect of adenosine in a patient with atrial flutter.
Adenosine has been proposed as a useful diagnostic agent in patients with narrow complex regular tachycardia of uncertain origin. Its effects are usually transient owing to its extremely short plasma half life and, as a consequence, it is thought to be safer than other drugs used in the acute treatment of such arrhythmias. However, adenosine had a proarrhythmic effect when administered to a patient in order to confirm the diagnosis of atrial flutter. As expected, a transient increase in atrioventricular block was seen but this was followed by a doubling of the ventricular rate and haemodynamic compromise requiring immediate DC cardioversion. It is postulated that the secondary catecholamine-mediated effects of adenosine were responsible for this phenomenon.
Adenosine↗
[The clinical features and long-term follow-up of atrial fibrillation or atrial flutter complicating Wolff-Parkinson-White syndrome].
Twenty six patients (20 male, 6 female, aged 50 +/- 14) with recurrent episodes of atrial fibrillation or atrial flutter (Af/AF) associated with WPW syndrome were retrospectively studied and followed. During Af/AF, 17 patients showed ventricular preexcitation. Of them, 15 patients had hypotention, 8 syncope, 4 precipitating acute heart failure and 4 spontanous degenerated into ventricular fibrillation. Hypotention was found only in 2 of the 9 patients without pre-excited ventricular beats. The mean shortest prexcited R-R intervals of the former were shorter (247 +/- 47 ms) and the average ventricular rates (198 +/- 43 beat/min) were faster than those of the latter (393 +/- 80 ms & 144 +/- 22 beat/min) respectively (P < 0.01). When pre-excited Af/AF occurred, both cardioversion and antiarrhythmic agents of class I and II had marked effect in terminating the Af/AF or slowing pre-exicted ventricular responses. Digitalis and verapamil caused deterioration in the clinical condition of 6 patients (4 with hypotention, one syncope, and one ventricular fibrillation). Management of patients for WPW complicating Af/AF without pre-excited QRS was the same as for the ordinary Af/AF. Over a period of 53 +/- 44 months of follow-up, 5 died (3 of sudden death, one of heart failure, and one of noncardiac cause) in the group with preexcited Af/AF, but all of the patients without preexcited QRS during Af/AF were alive. Conclusion, clinical severity, response to the treatment, and long-term prognosis of patients of WPW with preexcited Af/AF are different from those without.
Anti-Arrhythmia Agents↗
A wide, complex look at cardiac dysrhythmias.
The diagnosis and treatment of cardiac dysrhythmias answers the following four questions: Is the patient stable? Is the rate fast or slow? Are the ventricular complexes wide or narrow? Is the rhythm regular or irregular? The most common narrow complex regular tachycardias are sinus tachycardia, atrial flutter, atrial tachycardia that blocks, and paroxysmal supraventricular tachycardia. Carotid sinus massage is useful in differentiation. Irregular narrow-complex tachycardias are usually atrial fibrillation. An ultra-rapid wide-complex or polymorphous irregular tachycardia is likely to be atrial fibrillation with ventricular preexcitation. Wide-complex regular tachycardias present a special challenge, since wide beats may result from supraventricular or ventricular impulse formation. Ventricular tachycardia is more likely than supraventricular tachycardia in the presence of underlying ischemic heart disease, atrioventricular dissociation, fusion or capture beats, or a very broad (greater than .14 seconds) QRS complex. Still, misdiagnosis is common; the most costly mistake is over-diagnosis of SVT. In emergencies, where vital organ hypoperfusion is present, the origin of the impulse and the name of the dysrhythmia are unimportant. With the exception of sinus tachycardia, all life-threatening, rapid tachycardias should be terminated by electrical cardioversion.
Anti-Arrhythmia Agents↗