Ivabradine as a stabilising anti-arrhythmic agent for multifocal atrial tachycardia

2020 ◽  
Vol 30 (6) ◽  
pp. 899-902
Author(s):  
Mitchell I. Cohen ◽  
Jordan A. Cohen ◽  
Connor Shope ◽  
Lauren Stollar ◽  
Lucas Collazo
Keyword(s):  
Atrial Fibrillation ◽  
Extracorporeal Membrane Oxygenation ◽  
Sinus Rhythm ◽  
Critically Ill ◽  
Paroxysmal Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Blocking Agent ◽  
First Report ◽  
Membrane Oxygenation ◽  
Fibrillatory Conduction

AbstractMultifocal atrial tachycardia has certain electrocardiographic similarities to atrial fibrillation. The mechanism of atrial fibrillation is heterogenous but in some cases may arise from a single ectopic driver with fibrillatory conduction to the rest of the atria. This has led to the speculation that multifocal atrial tachycardia may have a similar mechanistic unifocal site that disperses through the atrium in a fibrillatory pattern. Ivabradine has been reported to be efficacious in an adult with paroxysmal atrial fibrillation as well as in children with junctional or ectopic atrial tachycardias. This is the first report of successfully using ivabradine, a novel anti-arrhythmic If blocking agent, to convert multifocal atrial tachycardia in a 5-month-old critically ill infant to a pattern indicating a single ectopic atrial focus. This allowed the patient’s single atrial focus to be ablated with return to sinus rhythm and decannulation from ventriculoarterial extracorporeal membrane oxygenation. This case suggests that multifocal atrial tachycardia may arise from a single automatic focus with downstream fibrillatory conduction to the atria.

Abstract 15927: Successful Pharmacological Cardioversion by Oral Amiodarone Therapy is Correlated With Favorable Post-Ablation Clinical Outcomes in Non-Paroxysmal Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kiyoshi Otomo ◽  
Kaname Takizawa ◽  
Naoto Inoue ◽  
Taiichiro Meguro
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Atrial Flutter ◽  
Clinical Outcomes ◽  
Paroxysmal Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Amiodarone Therapy ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Pharmacological Cardioversion

Backgrounds: Catheter ablation (CA) for non-paroxysmal atrial fibrillation (AF)(non-PAF) is less successful in patients (pts) with highly remodeled atria. It is still controversial that how far CA should be indicated in non-PAF pts with highly remodeled atria. Impacts of successful pharmacological cardioversion of non-PAF by oral amiodarone (AMD) on post-CA clinical outcomes remain to be evaluated. Purposes: To assess efficacy of oral AMD and implications of successful cardioversion by AMD in advance to CA on post-CA clinical outcomes in non-PAF pts. Methods: In consecutive 418 non-PAF pts (age: 63±9 years, AF duration: 28±37 months, LA diameter: 44±5mm), oral AMD (300 mg/day for 2 weeks and 100 mg/day thereafter) was initiated at outpatient clinic one month prior to the initial CA procedure. Recurrence-free survival after last CA procedure was compared between those with successful pharmacological conversion to sinus rhythm, atrial flutter or atrial tachycardia by the time of the initial CA procedure (Group non-AF) and those without (Group AF) . Results: At the beginning of initial CA procedure, 79 pts were in sinus rhythm, 8 in typical atrial flutter, 3 in atrial tachycardia (Group non-AF: 90 pts (22%)) and the remaining 328 still in AF (Group AF: 78%) . During follow-up period of 287±204 days after last CA procedure (procedure number:1.6±0.7/pt, range: 1-4), 45 pts (11%) were followed up while taking AMD, whereas the other 373 pts (89%) without any antiarrhythmic drugs. Kaplan-Meier analysis revealed that recurrence-free survival after last CA procedure was significantly higher in Group non-AF than in Group AF (88 (98%) vs. 291 (89%) pts; p=0.02) . Group non-AF pts exhibited significantly shorter AF duration (9±9 (range: 1-46) vs. 33±41 months (range: 1-240): p<0.0001) and smaller LA diameter (42±5 (range: 28-54) vs. 44±5 mm (range: 31-61): p<0.0001) as compared with those in Group AF pts. Conclusions: Successful cardioversion by AMD in advance to CA was correlated with higher recurrence-free survival after last CA procedure. This simple criterion is helpful to find pts with less remodeled atria and good candidates for CA who will benefit from CA in non-PAF pts.

scholarly journals Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ahmet Demirkiran ◽  
Raquel P. Amier ◽  
Mark B. M. Hofman ◽  
Rob J. van der Geest ◽  
Lourens F. H. J. Robbers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Flow Velocity ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Peak Flow ◽  
Thrombus Formation ◽  
Clinical Value ◽  
4D Flow ◽  
Ssfp Cine

AbstractThe pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.

scholarly journals Predictors of insufficient peak amikacin concentration in critically ill patients on extracorporeal membrane oxygenation

Critical Care ◽  
2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Cyril Touchard ◽  
Alexandra Aubry ◽  
Philippine Eloy ◽  
Nicolas Bréchot ◽  
Guillaume Lebreton ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Membrane Oxygenation

scholarly journals The value of class IC antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm

1990 ◽  
Vol 16 (7) ◽  
pp. 1722-1727 ◽  
Author(s):  
Maarten J. Suttorp ◽  
J.Herre Kingma ◽  
Emile R. Jessurun ◽  
Loraine Lie-A-Huen ◽  
Norbert M. Van Hemel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Antiarrhythmic Drugs

scholarly journals Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pierre Bay ◽  
Guillaume Lebreton ◽  
Alexis Mathian ◽  
Pierre Demondion ◽  
Cyrielle Desnos ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Left Ventricular ◽  
Arterial Lactate ◽  
Saps Ii ◽  
Membrane Oxygenation ◽  
Saps Ii Score ◽  
Va Ecmo ◽  
Vv Ecmo

Abstract Background Systemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can require intensive care unit (ICU) admission because of multiorgan involvement with end-organ failure(s). Critically ill SRD patients requiring extracorporeal membrane oxygenation (ECMO) were studied to gain insight into their characteristics and outcomes. Methods This French monocenter, retrospective study included all SRD patients requiring venovenous (VV)- or venoarterial (VA)-ECMO admitted to a 26-bed ECMO-dedicated ICU from January 2006 to February 2020. The primary endpoint was in-hospital mortality. Results Ninety patients (male/female ratio: 0.5; mean age at admission: 41.6 ± 15.2 years) admitted to the ICU received VA/VV-ECMO, respectively, for an SRD-related flare (n = 69, n = 38/31) or infection (n = 21, n = 10/11). SRD was diagnosed in-ICU for 31 (34.4%) patients. In-ICU and in-hospital mortality rates were 48.9 and 51.1%, respectively. Nine patients were bridged to cardiac (n = 5) or lung transplantation (n = 4), or left ventricular assist device (n = 2). The Cox multivariable model retained the following independent predictors of in-hospital mortality: in-ICU SRD diagnosis, day-0 Simplified Acute Physiology Score (SAPS) II score ≥ 70 and arterial lactate ≥ 7.5 mmol/L for VA-ECMO–treated patients; diagnosis other than vasculitis, day-0 SAPS II score ≥ 70, ventilator-associated pneumonia and arterial lactate ≥ 7.5 mmol/L for VV-ECMO–treated patients. Conclusions ECMO support is a relevant rescue technique for critically ill SRD patients, with 49% survival at hospital discharge. Vasculitis was independently associated with favorable outcomes of VV-ECMO–treated patients. Further studies are needed to specify the role of ECMO for SRD patients.

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