Atrial pacing and administration of nifekalant hydrochloride for unstable atrial fibrillation: a case report

Abstract Background Atrial fibrillation (AF) is a common arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and can deteriorate haemodynamic status. Case summary We report a case of a 77-year-old woman with cardiogenic shock due to paroxysmal AF, complicated with HCM and aortic stenosis. Atrial fibrillation was successfully managed with temporary atrial pacing and administration of nifekalant hydrochloride without invasive mechanical circulatory support until surgery. Septal myectomy, aortic valve replacement, and pulmonary vein isolation were performed. Discussion This case suggests that atrial pacing and nifekalant may be safe and effective for rhythm control.

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Short-term outcomes of surgical atrial ablation and septal myectomy

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-3-51-60 ◽

2021 ◽

Vol 25 (3) ◽

pp. 51

Author(s):

A. S. Zalesov ◽

A. V. Bogachev-Prokophiev ◽

A. V. Afanasyev ◽

R. M. Sharifulin ◽

A. V. Sapegin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Sinus Node ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Radiofrequency Energy ◽

Short Term ◽

Surgical Ablation ◽

Septal Myectomy ◽

Atrial Ablation ◽

Obstructive Hypertrophic Cardiomyopathy

Background. Hypertrophic cardiomyopathy is one of the most common types of cardiomyopathy. The appearance of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy is associated with significant clinical worsening. Outcomes of surgical ablation and septal myectomy in these patients are limited. Aim. This retrospective study aimed to evaluate short-term outcomes of concomitant surgical ablation and septal myectomy in patients with obstructive hypertrophic cardiomyopathy and atrial fibrillation. Methods. Fifty-five patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent concomitant surgical ablation and septal myectomy between 2014 and 2019 were analysed. Patients with paroxysmal atrial fibrillation predominantly underwent left atrial ablation, and those with nonparoxysmal atrial fibrillation predominantly underwent the Maze IV procedure. Surgical ablation was performed using cryoablation alone (83.6%) or in combination with radiofrequency energy (16.4%). Results. Hospital mortality was 1.8%. Incidence of major adverse events was 3.6%. Sinus node dysfunction and atrioventricular block occurred in 7.3% and 1.8% of patients, respectively. Bleeding requiring revision occurred in 2 (3.6%) patients. Forty-nine (89.1%) patients had stable sinus rhythm and five (9.1%) were on dual-chamber pacemaker stimulation at the time of discharge. Conclusion. Concomitant septal myectomy and surgical ablation are feasible and safe in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.Received 5 April 2021. Revised 16 May 2021. Accepted 17 May 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors Conception and study design: A.S. Zalesov, A.V. Bogachev-Prokophiev Data collection and analysis: A.S. Zalesov, S.A. Budagaev, A.V. Sapegin Statistical analysis: A.S. Zalesov, A.V. Afanasyev, R.M. Sharifulin Drafting the article: A.S. Zalesov Critical revision of the article: A.V. Bogachev-Prokophiev, S.I. Zheleznev, I.I. Demin Final approval of the version to be published: A.S. Zalesov, A.V. Bogachev-Prokophiev, A.V. Afanasyev, R.M. Sharifulin, A.V. Sapegin, S.A. Budagaev, S.I. Zheleznev, I.I. Demin

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The Role of Multisite Atrial Pacing in Rhythm Control in AF: Insights from Sub-analyses of the Dual Site Atrial Pacing for Prevention of Atrial Fibrillation Study

Pacing and Clinical Electrophysiology ◽

10.1046/j.1460-9592.2003.t01-2-00231_3.x ◽

2003 ◽

Vol 26 (7p1) ◽

pp. 1565-1565 ◽

Cited By ~ 5

Author(s):

Sanjeev Saksena

Keyword(s):

Atrial Fibrillation ◽

Rhythm Control ◽

Atrial Pacing ◽

Dual Site

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Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211042136 ◽

2021 ◽

pp. 021849232110421

Author(s):

Michael Seco ◽

Jonathan CL Lau ◽

Caroline Medi ◽

Paul G Bannon

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Hypertrophic Cardiomyopathy ◽

Left Atrial ◽

Atrial Tachyarrhythmias ◽

Left Atrial Diameter ◽

Septal Myectomy ◽

Concomitant Surgery ◽

Recurrent Atrial Fibrillation

Introduction Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibrillation surgery were included. Results A total of 10 observational studies were identified, including 644 patients. Most patients had paroxysmal atrial fibrillation. The proportion with prior unsuccessful ablation ranged from 0 to 19%, and preoperative left atrial diameter ranged from 44 ± 17 to 52 ± 8 mm. Cox–Maze IV (n = 311) was the most common technique used, followed by pulmonary vein isolation (n = 222) and Cox–Maze III (n = 98). Patients with persistent or longstanding atrial fibrillation more frequently received Cox–Maze III/IV. Ranges of early postoperative outcomes included: mortality 0 to 7%, recurrence of atrial tachyarrhythmias 4.4 to 48%, cerebrovascular events 0 to 1.5%, and pacemaker insertion 3 to 21%. Long-term data was limited. Freedom from atrial tachyarrhythmias at 1 year ranged from 74% to 96%, and at 5 years from 52% to 100%. Preoperative predictors of late atrial tachyarrhythmia recurrence included left atrial diameter >45 mm, persistent or longstanding preoperative atrial fibrillation and longer atrial fibrillation duration. Conclusion In patients with atrial fibrillation undergoing septal myectomy, the addition of ablation surgery adds low overall risk to the procedure, and likely reduces the risk of recurrent atrial fibrillation in the long term. Future randomised studies comparing septal myectomy with or without concomitant AF ablation are needed.

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