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PubMed1988

Echocardiographic diagnosis of congenital left ventricular-right atrial communication.

The clinical diagnosis of congenital left ventricular-right atrial (LV-RA) communication is difficult. Echocardiography appears to be a useful method in the diagnosis of this congenital cardiac defect. In previous reports authors have described M-mode echocardiographic findings of this anomaly. We present here two-dimensional echo findings in a patient with congenital LV-RA communication. A 12 year old boy presented the following echocardiographic findings. A perimembranous septal defect and an abnormal tricuspid septal leaflet were seen. The defect was located at the membranous atrioventricular septum, resulting in a communication between the RA and the LV. Pulsed Doppler echocardiography demonstrated turbulent flow through the defect during systole, suggesting an LV-RA communication. M-mode echo examination of the septal tricuspid leaflet revealed systolic fluttering of the tricuspid valve. Peripheral vein contrast echocardiography showed passage of the echo contrast material from the RA to the LV (positive contrast effect). At the same time there was a negative contrast effect during ventricular systole, indicating a left to right shunt from the LV to the RA. After surgical repair of the anomaly, systolic flutter of the tricuspid valve and the other findings disappeared echocardiographically, as they did in the other reported cases. We can conclude that two-dimensional echocardiography with M-mode evaluation is a reliable method for the diagnosis of congenital LV-RA communication, and that this method should be applied to all cases where this anomaly is suspected clinically.

Child↗
PubMed1979

The effect of intravenous disopyramide phosphate on recurrent paroxysmal tachycardias.

1 Reccurent paroxysmal atrial, atrioventricular and ventricular tachycardias in 50 patients without acute coronary insufficiency, heart failure or metabolic abnormlity were treated with disopyramide phosphate in a dose of 2 mg/kg body weight infused over 5 min. 2 Conversion to sinus rhythm within 10 min of the completed infusion occurred in 10 of 14 (71%) patients with paroxysmal 'lone' atrial fibrillation, 3 of 7 (43%) patients with paroxysmal atrial flutter, 6 of 9 (67%) patients with paroxysmal atrial tachycardia, 5 of 9 (56%) patients with paroxysmal atrioventricular tachycardia associated with the Wolff-Parkinson-White syndrome and 8 of 11 (73%) patients with paroxysmal ventricular tachycardia. 3 Side effects: significant systemic hypotension in 3, high grade AV block in 1, an increased ventricular response producing symptoms in 4, post conversion asystole in 1 land sinus bradycardia in 2. 4 The anti-arrhythmic effect and arrhythmogenic side effects may be related to both the direct membrane stabilizing effect and the anticholinergic effect of disopyramide.

Atrial Fibrillation↗
PubMed2006

A fuzzy clustering neural network architecture for classification of ECG arrhythmias.

Accurate and computationally efficient means of classifying electrocardiography (ECG) arrhythmias has been the subject of considerable research effort in recent years. This study presents a comparative study of the classification accuracy of ECG signals using a well-known neural network architecture named multi-layered perceptron (MLP) with backpropagation training algorithm, and a new fuzzy clustering NN architecture (FCNN) for early diagnosis. The ECG signals are taken from MIT-BIH ECG database, which are used to classify 10 different arrhythmias for training. These are normal sinus rhythm, sinus bradycardia, ventricular tachycardia, sinus arrhythmia, atrial premature contraction, paced beat, right bundle branch block, left bundle branch block, atrial fibrillation and atrial flutter. For testing, the proposed structures were trained by backpropagation algorithm. Both of them tested using experimental ECG records of 92 patients (40 male and 52 female, average age is 39.75 +/- 19.06). The test results suggest that a new proposed FCNN architecture can generalize better than ordinary MLP architecture and also learn better and faster. The advantage of proposed structure is a result of decreasing the number of segments by grouping similar segments in training data with fuzzy c-means clustering.

Adult↗
PubMed2006

Paroxysmal atrial fibrillation precipitated by amiodarone-induced thyrotoxicosis five months after cessation of therapy.

Amiodarone is currently indicated for the treatment of life-threatening ventricular dysrhythmias. It is also used for the treatment of supraventricular dysrhythmias and as maintenance therapy after successful cardioversion of atrial flutter or atrial fibrillation. Adverse effects related to its expanded use are increasingly common. We describe a case of amiodarone-induced thyrotoxicosis occurring 5 months after cessation of therapy and discuss the pathophysiology and treatment of this disorder.

Amiodarone↗
PubMed2003

Atrial pacing therapies for prevention of atrial fibrillation in patients with implantable defibrillators.

Atrial fibrillation (AF), atrial flutter and atrial tachycardia (AT) occur frequently in patients following implantation of an implantable cardioverter defibrillator (ICD) for the treatment of ventricular tachyarrhythmias. Some new generation ICDs have incorporated atrial antitachycardia pacing therapy (ATP) and atrial pacing algorithms designed specifically for the prevention of AF. In the GEM III AT clinical evaluation, atrial ATP efficacy for termination of AF and AT was assessed. Overall ATP efficacy for AF/AT, based on device classification, was 40% when adjusted using the Generalized Estimating Equations to account for correlated data that arises from utilizing multiple episodes in some patients. However, many episodes of AF/AT were noted to terminate within 10 minutes of onset. Applying a more conservative definition of efficacy, termination within 20 sec of delivery of the last atrial ATP, efficacy for termination of AF/AT was 26%. 50 Hz burst pacing was shown to have minimal efficacy for termination of AF and modest incremental benefit following ramp or burst pacing therapies for AT. These observations provide a more realistic expectation of the value of atrial ATP in the ICD population with AF. Atrial ATP terminates some episodes of AT but previously reported efficacy rates of 40-50% are exaggerated and in part reflect spontaneous terminations of some AF/AT episodes.

Algorithms↗
PubMed2006

Obesity in diabetic patients undergoing coronary artery bypass graft surgery is associated with increased postoperative morbidity.

BACKGROUND: Despite the fact that obesity is a known risk factor for cardiovascular disease, many studies have failed to demonstrate that obesity is independently associated with an increased risk of cardiovascular morbidity and mortality in nondiabetic patients undergoing coronary artery bypass graft surgery. The authors investigated the influence of obesity on adverse postoperative outcomes in diabetic and nondiabetic patients after primary coronary artery bypass surgery. METHODS: A retrospective cohort study of patients undergoing primary coronary artery bypass surgery (n = 9,862) between January 1995 and December 2004 at the Texas Heart Institute was performed. Diabetic (n = 3,374) and nondiabetic patients (n = 6,488) were classified into five groups, according to their body mass index: normal weight (n = 2,148), overweight (n = 4,257), mild obesity (n = 2,298), moderate obesity (n = 785), or morbid obesity (n = 338). Multivariate, stepwise logistic regression was performed controlling for patient demographics, medical history, and preoperative medications to determine whether obesity was independently associated with an increased risk of adverse postoperative outcomes. RESULTS: Obesity in nondiabetic patients was not independently associated with an increased risk of adverse postoperative outcomes. In contrast, obesity in diabetic patients was independently associated with a significantly increased risk of postoperative respiratory failure (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.41-3.61; P < 0.001), ventricular tachycardia (OR, 2.27; 95% CI, 1.18-4.35; P < 0.02), atrial fibrillation (OR, 1.56; 95% CI, 1.03-2.38; P < 0.04), atrial flutter (OR, 2.38; 95% CI, 1.29-4.40; P < 0.01), renal insufficiency (OR, 1.66; 95% CI, 1.10-3.41; P < 0.03), and leg wound infection (OR, 5.34; 95% CI, 2.27-12.54; P < 0.001). Obesity in diabetic patients was not independently associated with an increased risk of mortality, stroke, myocardial infarction, sepsis, or sternal wound infection. CONCLUSION: Obesity in diabetic patients is an independent predictor of worsened postoperative outcomes after primary coronary artery bypass graft surgery.

Adult↗
PubMed1999

Incessant ectopic atrial tachycardia and tachycardia-related cardiomyopathy: therapeutic options and potential for cure.

Incessant ectopic atrial tachycardia (IEAT) is a rare cause of cardiomyopathy. Cardiomyopathy is reversible by curative ablation using surgery or radiofrequency current. We report our experience with 5 patients with IEAT. Three patients presented with palpitations and were diagnosed to have paroxysmal supraventricular tachycardia (2 patients) and atrial flutter with 1:1 conduction (1 patient), but 2 presented insidiously with congestive cardiac failure. All the initial echocardiograms showed left ventricular dysfunction. The patients underwent electrophysiological studies which confirmed the diagnosis of IEAT. The first patient had surgical cryoablation and the other patients had successful radiofrequency catheter ablation. Follow-up for 2 to 7 years has shown no recurrences. All patients had significant improvement in left ventricular function on echocardiography. In conclusion, curative ablation by surgery or radiofrequency current is safe and effective. Because of its low morbidity, radiofrequency catheter ablation should be the treatment of choice for IEAT, especially if complicated by tachycardia-related cardiomyopathy.

Adolescent↗
PubMedDate not supplied

Papillary muscle rupture following nonpenetrating chest trauma: report of a case with hemodynamic and serial echocardiographic findings and successful surgical treatment.

The pre- and postoperative echocardiographic features of a patient with severe mitral incompetence due to rupture of a papillary muscle following nonpenetrating chest trauma are presented. The mitral valve echocardiogram showed chaotic diastolic flutter suggestive of a ruptured papillary muscle or ruptured chordae tendineae. The preoperative ultrasound recording of the left ventricle revealed left ventricular enlargement and excessive motion of the interventricular septum. The echocardiogram taken 7 weeks after mitral valve replacement showed considerable regression of the left ventricular enlargement.

Adult↗
PubMedDate not supplied

[Frequent arrhythmias in Wolff-Parkinson-White syndrome].

The real knowledge of the natural history in preexcitation syndrome is not possible, Circus movement reciprocal atrioventricular tachycardia is seen en 60% of the patients. Mostly of them are orthodromic. In this group, A-H increases in duration. H-V become normal and the delta wave disappears in the electrophysiologic study during the tachycardia. In the antidromic group, A-delta decreases and H deflexion cannot be recognized. Pre-excitation with atrial flutter is a rare but very dangerous situation when atrial impulses are conducted by the anomalous bundle, because the very high ventricular rate with 250 mseg R-R intervals. The same happens in patients with atrial fibrillation, observed in 5% of the patients with WPW syndrome; this arrhythmia may provoke multiform ventricular tachycardia, ventricular fibrillation and sudden death. Sudden death occurs in 0.1% of asymptomatic patients with WPW in 1% in those with reciprocal tachycardias and in 5.6% of the patients with atrial fibrillation and R-R intervals of 250 mseg of less.

Arrhythmias, Cardiac↗
PubMed1984

Atrial infarction complicating an acute inferior myocardial infarction.

Atrial fibrillation, coronary sinus rhythm, and slow atrial flutter developed in a patient with ECG findings of an acute inferior myocardial infarction. Hemodynamic measurements were suggestive of predominantly right ventricular involvement. A gated cardiac blood pool study demonstrated normal right and left ventricular wall motion with an enlarged, non-contracting right atrium. This led to the antemortem diagnosis of atrial fibrillation.

Aged↗
PubMed1978

[Ventricular fibrillation under quinidine medication--quinidine syncope (author's transl)].

Ventricular fibrillation which may occur unexpected under quinidine medication--called quinidine syncope--is one of the most dangerous complications of quinidine application. These life threatening accidents occur in 0,5-4,4% treated cases. The quinidine syncope occurs mostly at the attempt to eliminate atrial fibrillation or flutter. This dangerous side effect is dose independent. The ECG shows an increased QT duration and large U-waves. It seems to be a reentry-tachycardia caused by unequal recovery times in different parts of the ventricular myocardium.

Digitoxin↗
PubMed2000

New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience.

BACKGROUND: Atrial fibrillation (AF) or flutter occurring after myocardial infarction may occur alone or in association with other complications. Whether the arrhythmia portends a poor prognosis independent of other complications with contemporary therapy is unknown. METHODS AND RESULTS: As part of the Global Use of Strategies To Open occluded coronary arteries (GUSTO-III) trial, we evaluated whether postinfarction complications were associated with the subsequent development of AF and whether AF independently predicted death over periods of 30 days and 1 year. Information including exact timing was collected on deaths and major in-hospital postinfarction complications up to 30 days. Of the 13,858 patients with sinus rhythm at enrollment, 906 later had AF or flutter and 12, 952 did not. We compared outcomes between these 2 groups, adjusting for differences in baseline characteristics and prefibrillation complications. Worsening heart failure, hypotension, third-degree heart block, and ventricular fibrillation were independent predictors of new-onset AF. The unadjusted odds ratio (OR) for death among patients with versus those without AF was 2.74 (95% confidence interval [95% CI], 2.56-3.34). After adjusting for baseline differences, the OR was reduced to 1.63 (95% CI, 1.31-2.02). Adjustment for other in-hospital complications before the onset of AF further reduced the OR to 1.49 (95% CI, 1.17-1.89). CONCLUSIONS: Atrial fibrillation or flutter occurs secondary to other postinfarction complications but independently portends a worse prognosis. Prevention and management may improve outcome.

Aged↗
PubMed1981

Cardiac arrhythmias in space. Role of vagotonia.

Rhythm disorders observed in space have always been minor but they are not unfrequent. They include: ventricular or supra-ventricular extrasystoles, nodal arrhythmias, auriculo-ventricular conduction disorders. There are several etiopathogenetic hypotheses: a strict selection must permit its elimination of an underlying heart disease; the potassium deficiency is often advanced but its role is not certain; the role of catecholamines is also discussed; the role of hypervagotony is extensively analysed as great clinical and electro-cardiographic evidence speaks for it. It can induce disorders which are more serious than those observed so far, particularly fibrillation or intermittent atrial flutter; weightlessness itself could partly condition the vagotonic state; and the effects of fluid shifts are also discussed from this point of view. The possible therapies for various atrial, nodal, ventricular disorders are reviewed, with greater detail for vagal atrial arrhythmias.

Adaptation, Physiological↗
PubMed2001

Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU.

OBJECTIVE: To determine the frequency and types of significant, sustained arrhythmias in a mixed ICU. DESIGN AND SETTING: Prospective, observational study in a medical-cardiological-postoperative ICU at a university hospital. PATIENTS: 133 consecutive patients with arrhythmias. MEASUREMENTS AND RESULTS: All patients had continuous ECG monitoring and automatic arrhythmia detection. We assessed: (a) sustained (>30 s) tachyarrhythmias; (b) all tachyarrhythmias requiring therapy; (c) bradycardias of fewer than 40 beats/min or requiring intervention. There were 310 arrhythmia episodes: 278 tachyarrhythmias (108 narrow-QRS complex, 168 wide-QRS complex; 179 regular, 97 irregular) and 32 bradycardias. Of the 278 tachycardias in 54 patients, 135 (48.6%) were ventricular. There were 13 episodes of torsade de pointes (4.67%) in five patients. Of the 278 tachycardiac episodes 83 were atrial fibrillation (29.8%, 63 patients), 10 atrial flutter (3.6%, 8 patients), 21 supraventricular tachycardias (7.55%, 7 patients), and 2 ectopic junctional tachycardia (0.72%, 1 patient). The number of patients showing significant arrhythmias was comparable over the years (11-12/1996: 4/28 [14.3], 1997: 52/302 [17.2%], 1998: 55/286 [19.2%], 22/140 [15.7%] 1-7/1999). The ICU stay was significantly longer in arrhythmia patients than in 623 patients without arrhythmias (median 4 vs. 14 days), and there was a trend towards higher mortality (40/133, 30.8%, vs. 132/623, 21.2%, P=0.061, log-rank). CONCLUSION: Only one-fifth of patients in this mixed ICU had significant arrhythmias, taking a contemporary definition of arrhythmias. Ventricular tachycardia and atrial fibrillation were the most frequent arrhythmias.

APACHE↗
PubMed1978

Endocardial and His bundle electrocardiograms.

Endocardial electrocardiograms permit the analysis of auricular depolarization and contribute to the study of ventricular activation. Direct recording of auriculograms from the right atrium and indirect recording of the left auriculograms through the coronary sinus and pulmonary artery, show the different auricular activation pathways in common atrial flutter, atrial tachycardia and in case of retrograde atrial depolarization (via the AV node, septal or parietal accessory pathway). His bundle electrograms obtained via the femoral vein or, less easy, via the brachial vein, has introduced an essential mark in the analysis of intracardiac activation enabling us to precisely locate lesions of the AV conduction system, making easier differential diagnosis between aberrant ventricular conduction and ventricular ectopic rhythms and contributing to the study of ventricular preexcitation. Endocavitary stimulation at increasing rate and by the single extrastimulus technique is the complement of intracardiac electrocardiography in evaluating sinus node function, conduction times and refractory periods at different levels, electrophysiological properties of accessory pathways and studies of the antiarrhythmic drugs. Programmed stimulation allows the recognition of reentry as the mechanism of many tachyarrhythmias. The recording of monophasic action potential by the suction--electrode technique is another step in the intracavitary electrophysiological investigation.

Action Potentials↗
PubMed1993

A comparison of transoesophageal atrial pacing and direct current cardioversion for the termination of atrial flutter: a prospective, randomised clinical trial.

OBJECTIVE: To compare the safety and efficacy of transoesophageal atrial pacing (TAP) with an easily swallowed pill electrode and direct current cardioversion (DCC) in patients with atrial flutter that was refractory to appropriate medical treatment. DESIGN: Prospective, randomised clinical trial. SETTING: Community based United States naval hospital. SUBJECTS: Twenty one consecutive patients with refractory atrial flutter selected consecutively from the inpatient cardiology consultation service. All patients were haemodynamically stable and medical treatment with a class IA or IC antiarrhythmic agent had failed. Eleven patients were treated with TAP and 10 patients were treated with DCC. INTERVENTIONS: Digoxin was given to all patients to control the ventricular rate to < 100/minute. MAIN OUTCOME MEASURE: Conversion to normal sinus rhythm and arrhythmias after cardioversion. RESULTS: Conversion to normal sinus rhythm was similar in both groups (TAP 8/11, DCC 9/10, p = 0.31). Arrhythmias after cardioversion including third degree heart block and non-sustained ventricular tachycardia were more frequent in the DCC group (TAP 0/11, DCC 6/10, p = 0.02). CONCLUSION: Transoesophageal atrial pacing with an easily swallowed pill electrode is safe, well tolerated, and is as efficacious as DCC for refractory atrial flutter.

Aged↗
PubMed1998

Atrial flutter in the neonate and early infancy.

Atrial flutter is a rare arrhythmia in the neonate and early infancy. We retrospectively reviewed the clinical presentations, treatment and outcome of seven patients who presented clinically with atrial flutter. The age of onset ranged from 1 day to 3 months. Atrial flutter was diagnosed in the first 3 days of life in 4. Three cases presented as atrial flutter with 2:1 atrioventricular conduction and the remaining 4 with variable AV block. Heart failure was present in 3 patients and 6 patients showed normal intracardiac structure on echocardiography. Electrical cardioversion was attempted as the first treatment in 4 cases, followed by digoxin in three of the four. Digoxin was given as an initial therapy in 2 patients. One patient recovered spontaneously without treatment. In the 6 patients who received therapy, 5 converted to normal sinus rhythm within 2 days. The remaining patient had ventricular ectopic beats for about 4 months. Only 2 cases were maintained on oral digoxin for at least 4 months after discharge. No patient had a recurrence of atrial flutter during the follow-up period which ranged from 6 months to 7 years. We conclude that there is a good long-term prognosis for atrial flutter in the neonate. Digoxin and DC cardioversion may be effective as initial therapy. Long-term digoxin prophylaxis after conversion to sinus rhythm may be not necessary.

Age of Onset↗