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At least 1,423 records · Page 79Linked to original sources
PubMed1991

Surgical treatment of cardiac arrhythmias.

This report describes 20 consecutive patients who underwent surgical procedures for treatment of cardiac arrhythmias. 16 patients have been operated for WPW syndrome, always using the epicardial approach, without extracorporeal circulation. Three patients underwent surgery for atrio-ventricular nodal reentrant tachycardia, using a discrete perinodal cryotreatment, during normothermic extracorporeal circulation. In one case we used cryoablation of the atrial myocardium below the coronary sinus to treat atrial flutter. This operation was performed under normothermic extracorporeal circulation. In our observations, there was no early or late death; postoperative complications developed in 1 patient (5%) due to pericarditis. Ablation of the AP was completely successful in all the cases (100%) operated for WPW as well as for AVNRT syndromes and atrial flutter.

Arrhythmias, Cardiac↗
PubMed2006

Tachydysrhythmias.

Tachydysrhythmias arise from different mechanisms that can be characterized as being caused by re-entrant circuits, enhanced or abnormal automaticity, or triggered after-depolarizations. The approach to the tachydysrhythmia should begin with distinguishing sinus from non-sinus rhythms, then assessing QRS complex width and regularity. This article review tachydysrhythmias.

Action Potentials↗
PubMed1996

The present role of radiofrequency catheter ablation in the management of cardiac arrhythmias.

Radiofrequency catheter ablation can be used to treat a variety of cardiac arrhythmias. Yet while the spectrum of arrhythmias amenable to catheter ablation continues to expand, the protocol for whether or not catheter ablation should be recommended for the management of an individual patient has not been firmly established. This article summarizes the experience of one medical center with radiofrequency catheter ablation. The varieties of arrhythmias that may be effectively treated with catheter ablation, the probability of success, and the attendant risks of these procedures in the series are presented. In addition, the future applications of catheter ablation to cardiac arrhythmias are discussed.

Atrial Flutter↗
PubMed1979

Spectrum of echocardiographic findings in tricuspid valve endocarditis.

This report describes a spectrum of M-mode and cross-sectional echocardiographic abnormalities in eight patients with infective endocarditis of the tricuspid valve. The M-mode echocardiogram of the tricuspid valve was abnormal in all but one patient in whom abnormal echoes were seen anterior to the tricuspid valve, in the right ventricular cavity and right ventricular outflow tract. Six patients had shaggy echoes on the tricuspid valve; and one patient showed multilayered echoes on the tricuspid valve which resembled a right atrial myxoma. Irregular diastolic fluttering of the tricuspid valve, indicative of ruptured chordae tendineae, was noted in three patients. The cross-sectional echocardiogram showed abnormal thick shaggy echoes on the tricuspid valve in all five patients on whom the procedure was performed. Contrast echocardiography confirmed the presence of tricuspid regurgitation in four patients. We conclude that echocardiography is useful in the diagnosis of tricuspid valve vegetations, and in detecting complications such as ruptured chordae tendineae and tricuspid regurgitation.

Chordae Tendineae↗
PubMed1996

Palliative Mustard operation for transposition of the great arteries: late results after 15-20 years.

OBJECTIVE: To assess the clinical, functional state, and complications late (15-20 years) after palliative Mustard operation. DESIGN: Examination and evaluation of all patients presenting in adolescence and adult life after palliative Mustard operation for transposition of the great arteries and pulmonary vascular disease. SETTING: Grown-up Congenital Heart Unit specialised in the care of adolescents and adults with congenital heart disease, designated as having "quaternary" status within a tertiary referral centre for cardiac diseases. PATIENTS AND METHODS: Database searched for patients referred after palliative Mustard for classic transposition of the great arteries. Ten patients aged 18-31 (mean (SD) 25.9 (5.2)) years with a palliative Mustard operation performed at age 1.7-15 (mean (SD) 9 (4.6)) years were fully evaluated by echocardiography, exercise testing, Holter monitoring, and magnetic resonance imaging or radionuclide ventriculography, or both 15-20 years later. RESULTS: One patient died aged 25 years with biventricular failure (ability index 3/4), haemoptysis, and atrial flutter, eight were well (ability index 2), and one disabled (ability index 3). Arterial oxygen saturation at rest was 85-98% (mean (SD) 93.8 (4)%) decreasing to 59-87% (mean 77 (9.5)%) after limited exercise. Symptomatic arrhythmias occurred in four patients, atrial flutter being the most common, and two had sinus node dysfunction. Significant tricuspid regurgitation occurred in four patients. CONCLUSION: Patients with palliative Mustard operation have a low incidence of symptomatic ventricular dysfunction and despite exercise limitation by hypoxia, continue to live active, near normal lives until their thirties.

Adolescent↗
PubMed2003

[Anatomy of the atria for rhythmologists].

The anatomy of the atria is always in the mind of interventional rhythmologists. There is a mental superposition of the anatomical structures and the references obtained by different incidences of fluoroscopy and the endocavitary electrocardiogram. But understanding the anatomy also requires a certain knowledge of dissection to determine, for example, the orientation of bundles of muscle fibres and anatomical sections. The sino-atrial node is situated at a distance from the endocardium. It is long and protected by its own artery which makes it difficult to reach. The atrio-ventricular node has multiple posterior expansions which correspond to the sites where radiofrequency ablation is effective. The cavo-tricuspid isthmus is the target zone for the treatment of atrial flutter but radiofrequency ablation which must be long may be applied at three different levels: inferolateral, median (the most common site) or inferoseptal. Finally, atrial fibrillation has incited many studies of the muscular extensions of the left atrium to the pulmonary veins, the morphological variations of these veins and the organisation of the muscle fibres of the left atrial wall. They have inspired new concepts of atrial fibrillation.

Arrhythmias, Cardiac↗
PubMed1996

[Therapeutic electrophysiology].

Due to tremendous technical progress during the last decade, electrophysiology offers now a therapeutic option to patients suffering from cardiac arrhythmias owing to radiofrequency catheter ablation. This article focuses particularly on the different radiofrequency ablation approaches used in the most common encountered supraventricular arrhythmias.

Atrial Flutter↗
PubMed1997

Low energy transvenous cardioversion of short duration atrial tachyarrhythmias in humans using a single lead system.

The purpose of this study was to investigate the efficacy and safety of atrial cardioversion using an endocardial single lead system presently used for ventricular defibrillation. The study population consisted of 26 recipients of an ICD in combination with a conventional endocardial single lead system with the proximal spring electrode as anode in the SVC and the distal as cathode in the apex of the RV. Atrial tachyarrhythmias were induced by right atrial burst pacing. If the arrhythmia sustained > 1 minute, biphasic shocks synchronized with the R wave were delivered using the implanted device, beginning with an energy of 4 J. If 4 J failed to terminate the arrhythmia, energy was increased stepwise, if the first shock was successful, a step-down testing was performed after reinduction of atrial tachyarrhythmias. The mean atrial defibrillation threshold was 2.3 +/- 1.2 J (range, 0.5-5 J). A total of 154 shocks were delivered and no adverse effects were observed. The mean defibrillation threshold for atrial flutter was somewhat lower than that for AF (1.8 +/- 1 J vs 2.7 +/- 1.4 J, P = 0.08). There was no correlation between the atrial defibrillation threshold and a history of previously occurring atrial tachyarrhythmias, the kind of the underlying heart disease, a prescription of antiarrhythmic drugs, the dimension of the LA, the LVEF, or the ventricular DFT. Internal atrial cardioversion of short duration atrial tachyarrhythmias using a transvenous single lead system designed for ventricular defibrillation is feasible and safe at low energies, and may have important clinical applications.

Adult↗
PubMed1989

[Short- and medium-term treatment of ventricular hyperkinetic arrhythmia with flecainide].

Our study group included 12 patients (4 males, 8 females), mean age 60 yr, with symptomatic or threatening tachyarrhythmias (Lown classes IV A, B, V); 2 patients were suffering from mitral valve prolapse syndrome, 2 from ischemic heart disease; 4 from cardiac insufficiency caused by hypertensive or ischemic heart disease; 4 had no evident clinical signs of cardiopathy. Patients suffering from: cardiac insufficiency (F.C. III e IV NYHA); II and III degree BAV; atrial flutter and fibrillation; long QT syndrome; acute ischemic heart disease were excluded from the study. During short-term treatment, patients received placebo for four days and subsequently flecainide 200 mg daily for four days. During medium-term treatment patients received flecainide 200 mg daily (for six months). Several Holter/24-hour monitorings were performed for evaluation of therapy. No significant reduction in the number of ectopic ventricular beats (B.E.V.) was found with placebo whereas reductions of B.E.V. number (97% and 95%, respectively) were found during short and medium-term treatment with flecainide. Flecainide produced: changes in Lown class: from IV A, B and V to II and I; a marked reduction of subjective symptoms (dyspnea, giddiness syncope, precordial pain); ECG changes: increases in: PR: 5-25%; QRS: 11-12%; QT: 11-22%. Flecainide produced no pro-arrhythmic effects or changes in echocardiographic ventricular function index. Flecainide can be considered one of the most effective new antiarrhythmic drugs.

Aged↗
PubMed1986

[Oral propafenone in refractory arrhythmia. Apropos of 68 patients].

68 patients with rhythmical disorders unresponsive to treatment with one or several antiarrhythmics (quinidine derivatives 52 patients, amiodarone 28 patients, beta-blockers 24 patients) were treated by mouth with propafenone, with a mean postponement of 5.6 +/- 8.5 months (1 day to 33 months). Auricular arrhythmia was observed in 41 patients with the following results: 16 successes among the 24 patients with paroxysmal fibrillation of flutter, 3 successes among the 8 patients with an arrhythmia reduced by cardioversion, and 3 successes among the 9 patients with auricular tachycardia, including 6 systolic tachycardias. Of 8 patients with an intranodal reciprocal rhythm, 7 were treated successfully with propafenone, which acts on the retrograde part of the cycle. Successes were also recorded in 2 out of 3 patients with Wolff-Parkinson-White syndrome. In 19 cases of ventricular tachycardia, propafenone proved to be efficacious in 3 out of 5 cases presenting rapid discharges and in 7 out of 14 patients with continuous arrhythmias, notably those with a catecholaminergic component. Side-effects were digestive (5 patients), cardiac decompensation (3 patients), asthenia and asthma (1 patient) and the transformation of a flutter from 2/1 to 1/1 (1 patient).

Administration, Oral↗
PubMed1975

[High-frequency electric stimulation of the atrium in treatment of supraventricular tachycardias and atrial flutter].

The authors report the results of rapid atrial stimulation in the treatment of 12 cases of junctional tachycardia (J.T.), 20 cases of atrial tachycardia (A.T.) and 43 cases of atrial flutter (A.F.). Sinus rhythm was restored in 91.6%, 70% and 60.4% of the cases for J.T., A.T. and A.F. respectively, either when pacing was discontinued or following a period of atrial fibrillation (from a few minutes to several hours). Fifteen per cent of the cases of A.T. and 25.5% of the cases of A.F. turned into stable atrial fibrillation with reduction of ventricular rate. The authors believe that this technique is a valuable alternative to D.C. countershock when medical treatment has proved ineffective and when countershock may be hazardous.

Adult↗
PubMed1998

Is there a future for antiarrhythmic drug therapy?

Drug therapy has traditionally been the mainstay of treatment for both ventricular and supraventricular arrhythmias. However, increasing knowledge about the potentially significant adverse effects of these medications, together with the emergence of new, nonpharmacological approaches to the treatment of arrhythmias, has led some to question the future of antiarrhythmic drug therapy. Antiarrhythmic drugs are quite effective in terminating a variety of arrhythmias, including atrioventricular (AV) node re-entrant and AV tachycardias (particularly calcium antagonists and adenosine), atrial flutter (class III agents) and atrial fibrillation (class IA and IC drugs. The chronic use of antiarrhythmic drugs has been increasingly limited by a fear of adverse effects (especially proarrhythmia) and the availability of highly effective nonpharmacological alternatives (particularly ablation for re-entrant tachycardias involving the AV node and bypass tracts and cardiovertor/defibrillators for malignant ventricular arrhythmias. Atrial fibrillation (AF) continues to be a therapeutic challenge for which there is no safe and curative nonpharmacological therapy. Antiarrhythmic drugs of classes IA, IC and III show efficacy in preventing recurrence of AF but there are concerns about possible pro-arrhythmic complications. In the future, antiarrhythmic agents will continue to be used acutely to terminate a broad range of sustained arrhythmias. Chronic use is likely to depend on the development of safer and/or more effective compounds, as well as on improved ways of predicting which patients are likely to develop pro-arrhythmic reactions. The development of molecular electrophysiology will allow for the identification of agents with selected ion channel blocking profiles which may prove efficacious with a lower risk of complications. Finally, an improved understanding of arrhythmia substrates may permit the identification of therapy that prevents arrhythmias by acting on the underlying substrate, rather than simply trying to modify the electrical end product.

Anti-Arrhythmia Agents↗
PubMed2001

Ibutilide: a class III rapidly acting antidysrhythmic for atrial fibrillation or atrial flutter.

Ibutilide is an intravenous Class III antidysrhythmic approved for the treatment of recent onset atrial fibrillation or atrial flutter. Pharmacological effect occurs within 30 min, and the efficacy approaches 40%. In contrast to DC electrical cardioversion, which requires anesthesia, pharmacologic cardioversion offers an alternative in which sedation can be avoided. Patients receiving ibutilide should be monitored for at least 4 h after completed drug administration because of a small chance of ventricular dysrhythmia, mainly torsades de pointes. Careful patient selection is the key to avoiding dysrhythmic complications. The purpose of this article is to review the mechanisms, clinical applications, potential complications, and appropriate use of ibutilide.

Anti-Arrhythmia Agents↗