Atrial fibrillation and supraventricular arrhythmias

2021 ◽  
pp. 719-739
Author(s):  
Demosthenes G Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Cycle Length ◽  
Accessory Pathway ◽  
Atrial Arrhythmias ◽  
Supraventricular Arrhythmias ◽  
Acute Setting ◽  
Epidemiology Data ◽  
Life Threatening ◽  
Appropriate Therapy

The term supraventricular tachycardia (SVT) refers to atrial arrhythmias, including atrial fibrillation, atrioventricular nodal reentry, and atrioventricular reentry due to accessory pathway(s). In clinical practice, SVT may present as narrow- or wide-QRS tachycardias, and with the potential exception of atrial fibrillation, most of them are usually, although not invariably, manifest as regular rhythms. They are usually intrusive, symptomatic, and anxiety provoking but not dangerous. However, depending on their cycle length and the patient's background, they could also be, rarely, life-threatening conditions. In the acute setting, consideration of epidemiology data, clinical presentation, and the 12 lead ECG can provide diagnostic clues for differential diagnosis between SVT and ventricular arrhythmias, and guide appropriate therapy.

scholarly journals Scapulothoracic dissociation

2019 ◽  
Vol 92 (1101) ◽  
pp. 20190090
Author(s):  
Kimia Khalatbari Kani ◽  
Felix S Chew
Keyword(s):  
Differential Diagnosis ◽  
Shoulder Girdle ◽  
High Energy ◽  
Imaging Evaluation ◽  
Acute Setting ◽  
High Energy Trauma ◽  
Diagnosis And Management ◽  
Life Threatening ◽  
Spectrum Imaging ◽  
Scapulothoracic Dissociation

Scapulothoracic dissociation is a rare and potentially limb- and life-threatening injury, that results from high-energy trauma. Scapulothoracic dissociation has the potential to be overlooked in the acute setting, especially in the setting of polytrauma. Therefore, a careful search for this condition should be performed in all patients with high-energy shoulder girdle injuries. The goals of this article are to review the anatomy of the scapulothoracic articulation as well as the spectrum, imaging evaluation, differential diagnosis and management of scapulothoracic dissociations.

Atrial fibrillation and supraventricular arrhythmias

2016 ◽  
Author(s):  
Demosthenes Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Definitive Diagnosis ◽  
Acute Management ◽  
Supraventricular Arrhythmias ◽  
Acute Therapy ◽  
Supraventricular Tachycardias

This chapter discusses the acute management of patients presenting with tachyarrhythmias suggestive of regular supraventricular tachycardias (SVT) and/or atrial fibrillation (AF). A classification of narrow- and wide-QRS tachycardias is presented, and the differential diagnosis of narrow- and wide-QRS tachycardias is discussed. Principles of acute therapy are presented either in the context of acute therapy before establishing a definitive diagnosis or for particular arrhythmia entities with an established diagnosis of a regular SVT or AF.

Asymptomatic pre-excitation

ESC CardioMed ◽  
2018 ◽  
pp. 2100-2105
Author(s):  
Jonathan Chrispin ◽  
Hugh Calkins
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Symptoms ◽  
Accessory Pathway ◽  
Clinical Signs ◽  
Epidemiological Data ◽  
Population Based ◽  
Increased Risk ◽  
Pr Interval ◽  
Life Threatening ◽  
Electrocardiogram Ecg

Manifest pre-excitation on the surface electrocardiogram (ECG) with a short PR interval and delta wave occurs in a very small percentage of the population based on epidemiological data. For the vast majority, this ECG finding will have no clinical manifestation and over time the ECG manifestation of pre-excitation may even go away. A small minority of individuals, however, develop clinical signs related to ventricular pre-excitation, most notably atrioventricular reentrant (reciprocating) tachycardia. This non-life-threatening arrhythmia is associated with clinical symptoms of palpitations, dyspnoea, and presyncope. Those with ventricular pre-excitation are at increased risk for atrial fibrillation. Multiple invasive electrophysiological and longitudinal studies have shown that those with atrial fibrillation and robust conduction down the atrioventricular accessory pathway are at an increased risk of sudden cardiac death from ventricular fibrillation. This chapter reviews the available and recommended strategies for assessing the patient with asymptomatic pre-excitation.

scholarly journals Drug-Induced Atrial Fibrillation / Atrial Flutter

2022 ◽  
Vol 17 (6) ◽  
pp. 1-18
Author(s):  
O. D Ostroumova ◽  
M. S. Chernyaeva ◽  
A. I. Kochetkov ◽  
A. E. Vorobieva ◽  
D. I. Bakhteeva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Holter Monitoring ◽  
Clinical Situation ◽  
Drug Induced ◽  
Self Monitoring ◽  
Conduction Disturbances ◽  
Treatment And Prevention ◽  
Life Threatening

Drug-induced atrial fibrillation / flutter (DIAF) is a serious and potentially life-threatening complication of pharmacotherapy. Purpose of the work: systematization and analysis of scientific literature data on drugs, the use of which can cause the development of DIAF, as well as on epidemiology, pathophysiological mechanisms, risk factors, clinical picture, diagnosis and differential diagnosis, treatment and prevention of DIAF. Analysis of the literature has shown that many groups of drugs can cause the development of DIAF, with a greater frequency while taking anticancer drugs, drugs for the treatment of the cardiovascular, bronchopulmonary and central nervous systems. The mechanisms and main risk factors for the development of DIAF have not been finally established and are known only for certain drugs, therefore, this section requires further study. The main symptoms of DIAF are due to the severity of tachycardia and their influence on the parameters of central hemodynamics. For diagnosis, it is necessary to conduct an electrocardiogram (ECG) and Holter monitoring of an ECG and echocardiography. Differential diagnosis should be made with AF, which may be caused by other causes, as well as other rhythm and conduction disturbances. Successful treatment of DIAF is based on the principle of rapid recognition and immediate discontinuation of drugs (if possible), the use of which potentially caused the development of adverse drug reactions (ADR). The choice of management strategy: heart rate control or rhythm control, as well as the method of achievement (medication or non-medication), depends on the specific clinical situation. For the prevention of DIAF, it is necessary to instruct patients about possible symptoms and recommend self-monitoring of the pulse. It is important for practitioners to be wary of the risk of DIAF due to the variety of drugs that can potentially cause this ADR.

Atrial fibrillation and supraventricular arrhythmias

2017 ◽  
Author(s):  
Demosthenes Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Definitive Diagnosis ◽  
Acute Management ◽  
Supraventricular Arrhythmias ◽  
Acute Therapy ◽  
Supraventricular Tachycardias

This chapter discusses the acute management of patients presenting with tachyarrhythmias suggestive of regular supraventricular tachycardias (SVT) and/or atrial fibrillation (AF). A classification of narrow- and wide-QRS tachycardias is presented, and the differential diagnosis of narrow- and wide-QRS tachycardias is discussed. Principles of acute therapy are presented either in the context of acute therapy before establishing a definitive diagnosis or for particular arrhythmia entities with an established diagnosis of a regular SVT or AF.

Atrial fibrillation and supraventricular arrhythmias

2015 ◽  
Author(s):  
Demosthenes Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Definitive Diagnosis ◽  
Acute Management ◽  
Supraventricular Arrhythmias ◽  
Acute Therapy ◽  
Supraventricular Tachycardias

This chapter discusses the acute management of patients presenting with tachyarrhythmias suggestive of regular supraventricular tachycardias (SVT) and/or atrial fibrillation (AF). A classification of narrow- and wide-QRS tachycardias is presented, and the differential diagnosis of narrow- and wide-QRS tachycardias is discussed. Principles of acute therapy are presented either in the context of acute therapy before establishing a definitive diagnosis or for particular arrhythmia entities with an established diagnosis of a regular SVT or AF.

scholarly journals Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study).

2021 ◽  
Author(s):  
Eduardo Franco ◽  
Cristina Lozano ◽  
Roberto Matía ◽  
Antonio Hernandez-Madrid ◽  
Inmaculada Sánchez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cycle Length ◽  
The Other ◽  
Atrial Arrhythmias ◽  
Density Mapping ◽  
Ablation Success ◽  
Focal Ablation ◽  
One Year ◽  
Mapping Catheter

Introduction. Unstable reentrant atrial tachycardias (ATs) (i.e. those with frequent circuit modification or conversion to atrial fibrillation) are challenging to ablate. We have tested a strategy to achieve arrhythmia stabilization into mappable stable ATs based on the detection and ablation of rotors. Methods and Results. From May 2017 to December 2019, 97 consecutive patients with reentrant ATs were ablated. Of these, 18 (18.6%) presented unstable circuits and were included. Mapping was performed using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV or Advisor HD Grid). Rotors were subjectively identified as fractionated continuous (or quasi-continuous) electrograms on 1-2 adjacent bipoles of the mapping catheter, without dedicated software. 13 patients (72%) had detectable rotors (median 2 [1–3] rotors per patient); focal ablation achieved conversion into stable AT or sinus rhythm in 12 (92%). In the other 6 patients, sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles were targeted. 17 sites with spatiotemporal dispersion were detected and focally ablated. Globally, and excluding 1 patient with spontaneous AT stabilization, ablation success to stabilize the AT was achieved in 16/17 patients (94.1%). One-year freedom from atrial arrhythmias was similar between patients with unstable and stable ATs (66.7% Vs 65.8%, p=0.946). Conclusion. Most unstable reentrant ATs show detectable rotors, identified as sites with single-bipole fractionated quasi-continuous signals, or spatiotemporal dispersion plus non-continuous fractionation. Ablation of these sites is highly effective to stabilize the AT or convert it into sinus rhythm.

Clinical Experience with a Novel, Irrigated, Flexible Tip Ablation Catheter to Optimise Therapy Delivery

2010 ◽  
Vol 6 (3) ◽  
pp. 66 ◽  
Author(s):  
Carlo Pappone ◽  
Luigi Giannelli ◽  
Vincenzo Santinelli ◽  
◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Clinical Experience ◽  
Accessory Pathway ◽  
Surrounding Tissue ◽  
Ablation Catheter ◽  
Innovative Design ◽  
Cavotricuspid Isthmus ◽  
Arrhythmogenic Substrate ◽  
Therapy Delivery

Innovative technologies are being developed to make current ablation procedures safer and easier. Sometimes conventional ablation catheters cannot easily adapt to anatomical targets, making radiofrequency applications challenging, time consuming or even ineffective. The Cool Flex is a novel, flexible and fully-irrigated tip catheter with an innovative design and various angular orientations to better adapt the ablation tip to the surrounding tissue. Here, peliminary experience with this new ablation catheter is reported in the treatment of different tachyarrhythmias, including slow and accessory pathway ablation, cavotricuspid isthmus-dependent atrial flutter and atrial fibrillation. One or two radiofreqency applications may be sufficient to eliminate the arrhythmogenic substrate in most patients without complications.

Ion Channel Remodelling in Atrial Fibrillation

2011 ◽  
Vol 7 (2) ◽  
pp. 97 ◽  
Author(s):  
Niels Voigt ◽  
Dobromir Dobrev ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Ion Channel ◽  
Antiarrhythmic Drugs ◽  
Current Knowledge ◽  
Bleeding Complications ◽  
Large Size ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
Life Threatening ◽  
Underlying Mechanisms

Atrial fibrillation (AF) is the most common arrhythmia and is associated with substantial cardiovascular morbidity and mortality, with stroke being the most critical complication. Present drugs used for the therapy of AF (antiarrhythmics and anticoagulants) have major limitations, including incomplete efficacy, risks of life-threatening proarrhythmic events and bleeding complications. Non-pharmacological ablation procedures are efficient and apparently safe, but the very large size of the patient population allows ablation treatment of only a small number of patients. These limitations largely result from limited knowledge about the underlying mechanisms of AF and there is a hope that a better understanding of the molecular basis of AF may lead to the discovery of safer and more effective therapeutic targets. This article reviews the current knowledge about AF-related ion-channel remodelling and discusses how these alterations might affect the efficacy of antiarrhythmic drugs.

Sign in / Sign up

Export Citation Format

Share Document