Recognition and Management of Cardiac Arrhythmias: Part I. General Principles and Supraventricular Tachyarrhythmias

1998 ◽  
Vol 13 (1) ◽  
pp. 15-31
Author(s):  
Simon Chakko ◽  
Raul Mitrani
Keyword(s):  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Antiarrhythmic Drugs ◽  
Supraventricular Arrhythmias ◽  
Implantable Defibrillators ◽  
Premature Ventricular Contractions ◽  
New Techniques ◽  
Supraventricular Tachyarrhythmias ◽  
Treatment Of Arrhythmias ◽  
Supraventricular Tachycardias

Management of cardiac arrhythmias has undergone major changes in the last few years. In the first part of this review, general principles of arrhythmia diagnosis are discussed. New techniques such as event recording and signal-averaged electrocardiography have a significant role in the clinical management of arrhythmias. Many new antiarrhythmic drugs are now available. Suppression of premature ventricular contractions to prevent malignant ventricular arrhythmias has been demonstrated to be an ineffective strategy. Implantable defibrillators and radio frequency ablation have revolutionized the treatment of arrhythmias. Differentiation of various supraventricular tachycardias has become very important since some these arrhythmias may be cured by radiofrequency ablation. Diagnosis and treatment of common supraventricular arrhythmias are discussed.

scholarly journals Rates of Cardiac Rhythm Abnormalities in Patients with CKD and Diabetes

2019 ◽  
Vol 14 (4) ◽  
pp. 549-556 ◽  
Author(s):  
Nazem Akoum ◽  
Leila R. Zelnick ◽  
Ian H. de Boer ◽  
Irl B. Hirsch ◽  
Dace Trence ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Cardiac Rhythm ◽  
Cardiac Monitoring ◽  
Premature Ventricular Contractions ◽  
Mortality And Morbidity ◽  
Conduction Abnormalities ◽  
Patients With Diabetes ◽  
New Diagnosis

Background and objectivesCardiac arrhythmias increase mortality and morbidity in CKD. We evaluated the rates of subclinical arrhythmias in a population with type 2 diabetes and patients with moderate to severe CKD who were not on dialysis.Design, setting, participants & measurementsThis is a prospective observational study, using continuous ambulatory cardiac monitors to determine the rate of atrial and ventricular arrhythmias, as well as conduction abnormalities in this group.ResultsA total of 38 patients (34% women), with mean eGFR of 38±13 ml/min per 1.73 m2, underwent ambulatory cardiac monitoring for 11.2±3.9 days. The overall mean rate of any cardiac arrhythmia was 88.8 (95% confidence interval [95% CI], 27.1 to 184.6) episodes per person-year (PY). A history of cardiovascular disease was associated with a higher rate of detected arrhythmia (rate ratio, 5.87; 95% CI, 1.37 to 25.21; P<0.001). The most common arrhythmia was atrial fibrillation, which was observed in two participants with known atrial fibrillation and was a new diagnosis in four patients (11%), none of whom experienced symptoms. Overall, atrial fibrillation episodes occurred at a rate of 37.6 (95% CI, 2.4 to 112.3) per PY. Conduction abnormalities were found in eight patients (21%), a rate of 26.5 (95% CI, 4.2 to 65.5) per PY. Rates of ventricular arrhythmias were low (14.5 per PY; 95% CI, 4.3 to 32.0) and driven by premature ventricular contractions.ConclusionsCardiac rhythm abnormalities are common in patients with diabetes with moderate to severe CKD not requiring dialysis. Rates of atrial fibrillation are high and episodes are asymptomatic. Future studies are needed to determine the role of screening and upstream therapy of cardiac arrhythmias in this group.

Recognition and Management of Cardiac Arrhythmias: Part II. Ventricular Arrhythmias and Bradyarrhythmias

1998 ◽  
Vol 13 (2) ◽  
pp. 68-77
Author(s):  
Simon Chakko ◽  
Raul Mitrani
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Qrs Complex ◽  
Implantable Defibrillators

This review discusses the treatment of ventricular arrhythmias and bradyarrhythmias. Recent studies addressing the management of nonsustained ventricular arrhythmias in patients with congestive heart failure and those recovering from myocardial infarction are discussed. Determination of the origin of wide QRS complex tachycardia is usually possible at the bedside and the diagnostic criteria are provided. Therapy to prevent recurrent ventricular tachycardia or ventricular fibrillation is difficult and controversial. A widely accepted approach based on electrophysiologic testing and implantable defibrillators appears to be the most effective. Recognition and management of common bradyarrhythmias including the indications for pacemakers are discussed.

Ventricular arrhythmias after repair of congenital heart disease: Who needs treatment?

1991 ◽  
Vol 1 (3) ◽  
pp. 177-181 ◽  
Author(s):  
Arthur Garson
Keyword(s):  
At Risk ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Sudden Death ◽  
Tetralogy Of Fallot ◽  
Ventricular Arrhythmias ◽  
Congenital Heart ◽  
Antiarrhythmic Drugs ◽  
Premature Ventricular Contractions

Sudden death occurs in patients after repair of congenital heart disease. In those with tetralogy of Fallot, or a similar lesion, ventricular tachycardia has been hypothesized as the major arrhythmic mechanism for sudden death. It would be desirable to identify individuals at risk for sudden death, to determine which arrhythmia would be likely to cause sudden death, and to treat those individuals with an appropriate antiarrhythmic to prevent sudden death. For the last 10 years, physicians have been treating patients with antiarrhythmic drugs, based on a number of criteria, the most common of which is the presence of premature ventricular contractions.1,2 The practice has recently been called into question by the CAST trial. It is the purpose of this paper to review the evidence that repair causes ventricular arrhythmias, that ventricular arrhythmias cause sudden death, and that ventricular arrhythmias should be treated prophylactically.

scholarly journals Persistent bradycardia after hypoglycaemia: a case report and a brief literature review

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Beatrice Gasperini ◽  
Pierpaolo Lamanna ◽  
Rocco Serra ◽  
Roberto Montanari ◽  
Antonio Cherubini ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Clinical Case ◽  
Sinus Bradycardia ◽  
Qt Prolongation ◽  
Hypoglycaemic Episode ◽  
Supraventricular Arrhythmias ◽  
Interval Prolongation ◽  
Qt Interval Prolongation

Hypoglycaemia can cause cardiac arrhythmias such as QT interval prolongation and ventricular arrhythmias. Supraventricular arrhythmias and sinus bradycardia were rarely reported. We present the clinical case of an 84- year-old man who developed a persistent bradycardia after a hypoglycaemic episode. After restoration of normoglycaemia, bradycardia persisted for almost eighteen hours, without QT prolongation or any symptoms. Hypoglycaemia is an unusual cause of bradyarrhytmias mainly mediated by neurologic and endocrine systems. Our clinical case supports recent recommendations for more relaxed inpatient glycaemic targets in frail older adults who may be particularly vulnerable to hypoglycaemia and its consequences.

The Use of Disopyramide in Resistant Cardiac Arrhythmias Due to Acute Ischaemic Heart Disease

1977 ◽  
Vol 5 (5) ◽  
pp. 369-373 ◽  
Author(s):  
G Sandler
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Suppressive Therapy ◽  
Blood Levels ◽  
Supraventricular Arrhythmia ◽  
Supraventricular Arrhythmias

Disopyramide, a new anti-arrhythmic drug, has been assessed in twenty-one episodes of cardiac arrhythmia secondary to acute ischaemic heart disease which failed to respond to more conventional suppressive therapy with lignocaine and other standard drugs. The intravenous administration of 100 mg of disopyramide resulted in suppression of two out of seven episodes of supraventricular arrhythmia, and eleven out of fourteen episodes of ventricular arrhythmias. Successful suppression correlated with blood levels of disopyramide in most cases of ventricular arrhythmias but not in the supraventricular arrhythmias. There were no adverse effects on blood pressure or cardiac function. There were minimal effects on conduction in the electrocardiogram. It is concluded that disopyramide, which probably acts by direct depression of myocardial irritability, is a useful new anti-arrhythmic drug in acute myocardial infarction, especially in those patients with ventricular arrhythmias resistant to more conventional anti-arrhythmic therapy.

scholarly journals Atypical Amiodarone toxicity: Iatrogenic ataxia and dysarthria in an elderly female

2021 ◽  
Vol 7 (4) ◽  
pp. 13
Author(s):  
Amanda Warren ◽  
Dana Lin ◽  
Ashlyn Katz ◽  
Pola Boazak
Keyword(s):  
Ventricular Arrhythmias ◽  
Antiarrhythmic Drugs ◽  
Healthcare Professionals ◽  
Cardiac Toxicity ◽  
Neurological Complications ◽  
Frequency Of Occurrence ◽  
Elderly Female ◽  
Corneal Deposits ◽  
Life Threatening ◽  
Supraventricular Tachyarrhythmias

Amiodarone is one of the most frequently used antiarrhythmic drugs on the market, treating both life-threatening ventricular arrhythmias as well as supraventricular tachyarrhythmias. Some of its most commonly known side effects include corneal deposits, cardiac toxicity, pneumonitis, thyroid hormone fluctuation, and dermatological reactions. Despite the frequency of occurrence of neurological complications secondary to Amiodarone they remain to be under-recognized by healthcare professionals. This casereport aims to increase awareness of the neurological complications of Amiodarone.

Clinical Pearls in Using Antiarrhythmic Drugs in the Outpatient Setting

2015 ◽  
Vol 29 (1) ◽  
pp. 77-86 ◽  
Author(s):  
Mary H. Parker ◽  
Cynthia A. Sanoski
Keyword(s):  
Clinical Practice ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Antiarrhythmic Drugs ◽  
Outpatient Setting ◽  
Vital Role ◽  
Efficacy And Safety ◽  
Appropriate Use ◽  
Nonpharmacologic Therapy ◽  
Key Issues

A role for oral antiarrhythmic drugs (AADs) remains in clinical practice for patients with atrial and ventricular arrhythmias in spite of advances in nonpharmacologic therapy. Pharmacists play a vital role in the appropriate use of AAD dosing, administration, adverse effects, interactions, and monitoring. Pharmacists who are involved in providing care to patients with cardiac arrhythmias must remain updated regarding the efficacy and safety of the most commonly used AADs. This review will address key issues for appropriate initiation and maintenance of commonly selected Vaughan-Williams Class Ic and III agents in the outpatient setting.

Cardiac arrhythmias and conduction disturbances in the obstructive sleep apnea syndrome

2018 ◽  
Vol 2 (47) ◽  
pp. 10-15
Author(s):  
Danuta Łoboda ◽  
Karolina Simionescu ◽  
Anna Szajerska-Kurasiewicz ◽  
Dorota Lasyk ◽  
Grzegorz Jarosiński ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Arrhythmias ◽  
Sleep Apnea Syndrome ◽  
The Body ◽  
Apnea Hypopnea Index ◽  
Premature Ventricular Contractions ◽  
Mortality And Morbidity ◽  
Conduction Disturbances ◽  
Obstructive Sleep

Cardiac arrhythmias during sleep are reported in almost half of the population suffering from obstructive sleep apnea (OSA). The most common are bradyarrhythmias and atrial fibrillation whereas premature ventricular contractions and nonsustained ventricular tachycardia are less frequent. The risk of arrhythmia is proportional to the body mass index (BMI), number of respiratory events per hour of sleep described with apnea/hypopnea index (AHI) and the level of oxygen desaturation during these episodes. Continuous positive airway pressure (CPAP) treatment in OSA reduces the incidence of cardiac arrhythmias therefore reduce mortality and morbidity from cardiovascular disease.

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