1497: EFFECT OF VASOPRESSOR CHOICE ON ATRIAL FIBRILLATION WITH RAPID VENTRICULAR RESPONSE IN SEPTIC SHOCK

Background: Atrial fibrillation (AF) frequently develops during critical illness. In septic shock complicated by rapid AF, the use of phenylephrine may be advantageous secondary to its β-1 sparing properties. However, evidence supporting this strategy is lacking. Objective: The purpose of this study is to determine the clinical effect on rate control of transitioning norepinephrine to phenylephrine in septic shock patients who develop AF with a rapid ventricular response (RVR). Methods: A single-center retrospective study of septic shock patients admitted to the medical or surgical intensive care unit (ICU) who developed AF with RVR (heart rate >110 beats per minute [bpm]). Patients who were switched to phenylephrine were compared to those who remained on norepinephrine. The primary end point was sustained achievement of rate control. A time-varying Cox proportional hazards model was used to assess the primary end point. Results: A total of 67 patients were included in the study, of which 28 were switched to phenylephrine. Baseline characteristics were similar between groups. The unadjusted hazard ratio for achieving rate control was significant at 1.99 (95% confidence interval [CI]: 1.19-3.34; P < .01) for the phenylephrine group. The adjusted hazard ratio was 1.75 (95% CI: 0.86-3.53; P = .12). There were no statistically significant differences in mortality or ICU length of stay. Conclusion: Our study suggests a potential clinical effect on achieving rate control when switching to phenylephrine cannot be excluded. It remains unclear if there is a benefit on mortality or length of stay outcomes in critically ill patients.

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The ineffective use of digitalis to control rapid ventricular response in a patient with atrial fibrillation in septic shock

The American Journal of Emergency Medicine ◽

10.1016/0735-6757(89)90311-2 ◽

1989 ◽

Vol 7 (6) ◽

pp. 668-669

Author(s):

Douglas A. Propp ◽

Timothy Erickson

Keyword(s):

Atrial Fibrillation ◽

Septic Shock ◽

Ventricular Response

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P2752 Comparative efficacy of digoxin, bisoprolol and their combination to control ventricular response at rest and during exercise in congestive heart failure and atrial fibrillation

European Heart Journal ◽

10.1016/s0195-668x(03)95530-8 ◽

2003 ◽

Vol 24 (5) ◽

pp. 514

Author(s):

L TUMASYAN

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Comparative Efficacy ◽

Ventricular Response

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Posterior circulation stroke: an easily overlooked complication of catheter ablation of atrial fibrillation

BMJ Case Reports ◽

10.1136/bcr-2020-234661 ◽

2020 ◽

Vol 13 (8) ◽

pp. e234661

Author(s):

Tahir Nazir ◽

Mohiuddin Sharief ◽

James Farthing ◽

Irfan M Ahmed

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Treatment Options ◽

Posterior Circulation ◽

Diagnosis And Treatment ◽

Neurological Deficits ◽

Cerebellar Infarction ◽

Af Ablation ◽

Posterior Circulation Stroke ◽

Ventricular Response

Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.

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Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation

BMJ Open Quality ◽

10.1136/bmjoq-2020-001270 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001270

Author(s):

Jonathan James Hyett Bray ◽

Elin Fflur Lloyd ◽

Firdaus Adenwalla ◽

Sarah Kelly ◽

Kathie Wareham ◽

...

Keyword(s):

Atrial Fibrillation ◽

Community Setting ◽

Cost Effective ◽

Ventricular Rate ◽

Service Improvement ◽

Community Monitoring ◽

Ventricular Response ◽

Community Diagnosis ◽

New Onset

BackgroundCommunity management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting.MethodsDuring the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician.ResultsSeventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF.ConclusionsWe have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.

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Variability of the ventricular response in atrial fibrillation and prognosis in chronic nonischemic mitral reurgitation

The American Journal of Cardiology ◽

10.1016/0002-9149(94)90584-3 ◽

1994 ◽

Vol 74 (9) ◽

pp. 906-911 ◽

Cited By ~ 54

Author(s):

Kenneth M. Stein ◽

Jeffrey S. Borer ◽

Clare Hochreiter ◽

Richard B. Devereux ◽

Paul Kligfield

Keyword(s):

Atrial Fibrillation ◽

Ventricular Response

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Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.038 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

E Marcusohn ◽

O Kobo ◽

M Postnikov ◽

D Epstein ◽

Y Agmon ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lv Function ◽

Ventricular Ejection Fraction ◽

Prosthetic Valves ◽

Ventricular Response ◽

History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR). Aim The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL). Methods This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF >50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded. Results From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction. Conclusion In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

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