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PubMed1994

[Electrocardiographic diagnosis of atrial fibrillation and flutter].

The key for the diagnosis of atrial fibrillation is the complete irregularity of the R-R intervals in the absence of P waves. In atrial flutter, the analysis of the flutter waves itself is important. In doing so, common and uncommon flutter can be distinguished. The A-V conduction and therefore the R-R intervals can be constant or irregular. If widened QRS complexes are registered intermittently, aberrant conduction has to be differentiated from ventricular premature beats. In this context die analysis of the width and the shape of the QRS complexes as well as the R-R intervals preceding and following the abnormal beats are important criteria. In principle, this holds true as well for the diagnosis of WPW syndrome in the presence of AF. If the surface ECG does not allow a clear-cut diagnosis, the indication for invasive electrophysiological testing may be given in a few cases.

Atrial Fibrillation↗
PubMed1992

Electrophysiologic effects of sotalol on the immature mammalian heart.

Sotalol is a beta-blocker with class III antiarrhythmic properties that has recently been used in children for the treatment of supraventricular and ventricular arrhythmias. However, little is known about its electrophysiologic effects on the immature heart. Using intracardiac electrocardiographic recordings and stimulation techniques, 15 canine neonates (8-15 days) and 15 adult mongrel dogs were studied with cumulative doses of sotalol (0.5, 1, 2, and 4 mg/kg plus an additional dose of 8 mg/kg for neonates). Heart rate decreased significantly in the two groups, but more in adult dogs (-43% in adult dogs versus -25% in neonates, p less than 0.05). There was no significant change for QRS duration and His-Purkinje system conduction time interval. QT and atrioventricular nodal conduction time intervals increased in adult dogs and neonates. Sinus node recovery time increased significantly in the two groups, but more in adult dogs. Refractory periods of the atrioventricular (AV) node increased significantly in neonates. Atrial flutter was no longer inducible in 12 of 15 neonates after the 2 mg/kg dose. Atrial effective refractory period increased significantly more in neonates (96%, p less than 0.001) than in adult dogs (58%, p less than 0.001). Ventricular effective refractory periods increased significantly both in neonates (46%) and adult dogs (50%), in a similar way. In conclusion, sotalol has greater electrophysiologic effects on the immature heart at the atrial level when compared to the adult, and similar effects on the refractory period of AV node and ventricle.

Animals↗
PubMed1988

The relation between supraventricular tachyarrhythmias and left ventricular dysfunction after acute myocardial infarction.

The clinical characteristics of supraventricular tachyarrhythmias (SVTA) and their relation to left ventricular dysfunction were assessed in 208 consecutive patients with recent myocardial infarction. Arrhythmias were quantified on hospital discharge by 24 hour electrocardiographic recording. All the variables were evaluated between the second and the fourth week after infarction. SVTA occurred in 113 (54%) patients: Supraventricular premature beats (SVPB) in 49 (24%), frequent or repetitive SVPB in 37 (18%), atrial or junctional tachycardia in 23 (11%), atrial flutter or fibrillation in 4 (2%). Most of these arrhythmias occurred in the absence of symptoms, and the most complex forms were always selflimiting. No relation was found among the presence of different forms of SVTA and sex, coronary risk factors, previous history of ischemic heart disease, type or site of acute myocardial infarction, NYHA functional class. Age, left atrial dimension (LAD), cardio-thoracic ratio (CTR) and left ventricular ejection fraction (LVEF) at rest differed significantly among three groups of patients: those without SVTA, those with SVPB less than 100 per hour and those with frequent-repetitive SVPB or atrial-junctional tachycardia. The more SVTA complexity, the worse LAD, CTR, LVEF and the higher the age. Multivariate discriminant analysis showed that CTR was directly and LVEF inversely related to the occurrence of SVPB less than 100 per hour, while the presence of frequent-repetitive SVPB or supraventricular tachycardia was closely related to increasing age, LAD, CTR and decreasing LVEF. Patients with atrial fibrillation always showed the worst values of LAD, CTR, LVEF and age. The results of the present study show that different types of SVTA occurring at discharge from hospital after myocardial infarction are clinically benign, but always suggestive of different degrees of left ventricular dysfunction.

Adult↗
PubMed2001

Safety and effectiveness of ibutilide in a community hospital.

To determine the safety and effectiveness of ibutilide, we conducted a retrospective study of patients in a community hospital from December 1997-January 2000, reviewing hospital and pharmacy records for 12 inpatients (aged 68+/-13 yrs) receiving ibutilide for atrial fibrillation or flutter. The cumulative conversion rate with ibutilide 0.012+/-0.004 mg/kg was 58%. Serious cardiovascular adverse events were documented in six patients; of those patients, five had baseline QTc intervals above 440 msec, two experienced ventricular fibrillation, and four experienced symptomatic bradycardia (range 49-60 beats/minute) requiring medical intervention. The effectiveness of ibutilide was similar to that found in previous studies. However, more complications were seen in this setting where ibutilide was used infrequently and without stringent patient selection criteria or standardized administration protocols. To ensure optimal patient care, institutions should consider implementing guidelines or education strategies to reduce the potential for serious adverse effects associated with improper screening, dosing, and monitoring of patients receiving ibutilide.

Aged↗
PubMed1978

[Propafenon and lidoflazine in chronic atrial fibrillation and flutter (author's transl)].

60 patients with chronic atrial fibrillation and flutter were randomly allotted to two groups and treated alternately with two different therapy regimes. 30 patients (group I) received lidoflazine in increasing dosage up to 480 mg/24 h and in cases where there was no conversion to sinus rhythm propafenon in a maximal daily dosage of 1800 mg orally. The duration of treatment was limited to 4 days for each substance. 30 patients (group II) were treated in the reverse order, i.e. propafenon and in cases of ineffectiveness with lidoflazine. Atrial fibrillation could be overcome in 21 patients in group I and in 23 patients in group II. The combined success rate in both groups was 73%. The conversion rates for the individual substances were 41% for propafenon (17 out of 41 patients) and 59% for lidoflazine (27 out of 46 patients). The difference was not statistically significant. Successive use of both substances leads to an increased conversion rate. Dangers arising from therapy are a conduction inhibitory action and depression of sinus node function as far as propafenol is concerned and the risk of ventricular ectopy and tachyarrhythmia in lidoflazine.

Aged↗
PubMed1978

Echocardiographic and hemodynamic correlation in transposition of the great arteries.

Echocardiography was performed in 36 patients with transposition of the great arteries (TGA). Twenty patients were studied before a Mustard operation, 14 patients after operation and two patients both before and after operation. Right ventricular end-diastolic dimension (RVED) was larger than normal in each patient and tended to increase postoperatively. In contrast, the left ventricular end-diastolic dimension (LVED) was significantly reduced postoperatively in all patients. A linear relationship was demonstrated between the ratio of LVED/RVED and the ratio of peak systolic pressures in the left and right ventricles in studies both before and after Mustard operation. Systolic anterior motion of the mitral valve was observed in 18% of peroperative patients and increased to 44% postoperatively. The incidence of fluttering of the mitral valve increased from 50% to 94% after the operation. Abnormal septal motion was found in 39% of cases. Abnormal movement of the mitral valve and of the interventricular septum seems to be related to a reversed pressure relationship in the ventricles. Shifting of the ventricular septum toward the left ventricle and consequent distortion of the left ventricular cavity and mitral valve apparatus may be responsible for the abnormal echocardiographic findings. Serial echocardiographic studies may be useful as a noninvasive tool in the assessment of left ventricular pressure or the status of the pulmonary vascular bed in TGA.

Adolescent↗
PubMed1992

Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual-chamber pacing.

Nine hundred fifty patients who received three modes of primary pacemaker systems (581 dual-chamber universal [DDD], 84 atrioventricular-sequential ventricular-inhibited [DVI] and 285 ventricular-inhibited [VVI]) over 12 years were studied retrospectively to determine the effect of pacing mode on patient longevity and the subsequent development of chronic atrial fibrillation or flutter. All patients were followed up continuously for 7 to 8 years. Patients were classified according to indication for permanent pacing (sick sinus syndrome or other indication), age at pacemaker implantation (less than or equal to 70 or greater than 70 years) and history of atrial tachyarrhythmia. Fourteen percent of patients developed atrial fibrillation at some time during the study period. Of those, 4% had a DDD pacemaker, 8% had a DVI pacemaker and 19% had a VVI pacemaker. At 7 years, atrial fibrillation was significantly more frequent in the VVI group than in the DDD and DVI groups. In patients with sick sinus syndrome, the incidence rate was even higher in the VVI group but approximately the same in the DDD and DVI groups. Patients in the VVI and DVI groups who had had previous atrial tachyarrhythmia had a significantly higher incidence of atrial fibrillation at 7 years than did those in the DDD group. During the entire period there were 130 deaths in the study group, including 22% of patients with a DDD pacemaker, 38% of those with a DVI pacemaker and 50% of those with a VVI pacemaker. Patient survival at 7 years was lower in the VVI group than in the DDD or DVI groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2000

Amiodarone for rapid cardioversion of chronic atrial tachyarrhythmia?

Electrical cardioversion of atrial tachyarrhythmia has disadvantages, such as the need for general anaesthesia, skin burns and thoracic pain. Pharmacodynamic cardioversion is without these side effects, but the reports of the efficacy of the treatment vary a lot. Amiodarone has been the only drug so far reported to give a combination of high efficacy and low frequency of serious side effects such as ventricular tachycardia and shock. The purpose of the present study was to assess the effect of amiodarone on chronic atrial tachycardia. Seventeen patients with chronic atrial fibrillation or flutter were given an oral dose of 30 mg/kg amiodarone. Serial blood tests after amiodarone ingestion were taken to document absorption. Patients, who did not convert to sinus rhythm within 24 hr were treated by electrical cardioversion. No patients converted pharmacodynamically to sinus rhythm. Twelve patients (71%) reached the recommended serum concentration of amiodarone (2-2.5 mg/l, median 2.4 mg/l, range 0.96-4.7). The concentration of desethylamiodarone remained low (<0.2 mg/l), and there were no objective or subjective side effects following the treatment. Sixteen patients (94%) were converted to sinus rhythm the day after by electrical cardioversion without complications. A single high dose of amiodarone is a safe but ineffective method of converting chronic atrial fibrillation and flutter, and may be used as adjuvant therapy in combination with electrical cardioversion.

Administration, Oral↗
PubMed1992

[Proarrhythmic effects of antiarrhythmic drugs].

The proarrhythmic effects of antiarrhythmic drugs are complications which have been described over several decades but the mechanisms (reentry, increased automaticity, ectopic faci, induced repetitive activity, vagal or adrenergic triggers) and the predisposing factors (underlying cardiac disease, previous severe arrhythmia, metabolic disorders, ischaemia, etc...) have only recently been identified. The appreciation of their true frequency poses problems of methodology (mode of recruitment, therapeutic converse proof), of definitions and depends to a great extent on the methods of detection used. Their severity cannot be denied and has been demonstrated both in experience of isolated cases and in recent prospective studies, the conclusions of which must be interpreted critically. Proarrhythmic effects may be observed at atrial (vagal or sympathetic arrhythmias, 1/1 flutter, acceleration of atrial fibrillation in preexcitation syndromes), junctional (artificial unidirectional block created by the antiarrhythmic drug which may be very effective at higher dosages: biphasic effect) or ventricular (aggravation of ventricular extrasystoles, torsades de pointe, ventricular tachycardia/fibrillation) levels. It is curious that no antiarrhythmic drug seems to be statistically less exposed to this type of complication which may result from phenomena of toxicity or idiosyncrasy. Given the potential gravity measures must be taken to prevent this complication, by observing simple rules (respect of contraindication, use of progressive dosage regimens, avoidance of loading doses, elimination of predisposing factors and abstention from dangerous therapeutic associations) and by carefully following up high risk patients.

Anti-Arrhythmia Agents↗
PubMedDate not supplied

[Radiofrequency treatment of cardiac arrhythmias at the Cardiology Center in Iaşi ].

UNLABELLED: It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmias is effective and devoid of significant complications. However, in our country, the experience of this technique is not so large and requires more clinical studies to validate it. OBJECTIVES: The aim of this was to present our experience in the RFCA of cardiac tachycardias. METHODS: Between July 2002 and February 2003, in Iaşi Cardiology Center, we performed a total of 79 diagnosis procedures. Of these 57 (72%) were radiofrequency ablation procedures at 51 patients, mean age 48 +/- 16 years (12-81), men majority 32 (63%). The electrophysiology diagnosis was: 22 (39%) common atrial flutter, 3 (5%) atrial tachycardias, 13 (23%) atrioventricular nodal reentrant tachycardia, 12 (21%) Wolff-Parkinson-White syndrome, 4 (7%) orthodromic tachycardia using concealed accessory pathway, 2 (3%) ventricular tachycardias and 1 (2%) ablation of the atrioventricular junction. RESULTS: The initial ablation procedure was effective in 44/ 51 patients (86%), with a total duration of 130 +/- 42 min, using 24 +/- 10 min of radioscopy. During follow-up 13 +/- 1.3 (11-16 months), recurrence occurred in 7 patients 14%. In 7 of them a second effective procedure was performed in 4 patients. Finally, radiofrequency ablation was effective in 48/51 of patients (94%), improving the procedural success rate at 95% (54/57 patients). No complications occurred during follow-up. CONCLUSION: The treatment of cardiac arrhythmias by radiofrequency catheter ablation is effective and safe and is the only way to cure the supraventricular and ventricular tachyarrhythmias.

Adolescent↗