Instantly Converting Atrial Fibrillation into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male

Clinical Medicine Insights Case Reports ◽

10.1177/117954761000300001 ◽

2010 ◽

Vol 3 ◽

pp. 117954761000300

Author(s):

Cheng-Huai Ruan

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Supraventricular Tachycardia ◽

Vagal Tone ◽

Risk Profile ◽

Electrical Cardioversion ◽

Digital Rectal Exam

Vagal maneuvers cause increase in vagal tone, which has been shown to slow many types supraventricular tachycardia, such as atrial fibrillation (AF). However, the conversion of AF to sinus rhythm is usually not associated with vagal manuvers. Thus, AF is classically treated with medication and electrical cardioversion. Here, we present a 29-year-old male with no cardiovascular history and a low atherosclerotic risk profile who developed AF which converted into sinus rhythm immediately after a digital rectal exam. The patient remained asymptomatic after a 3-month follow-up. This implies that the digital rectal exam can be considered as an additional attempt to convert AF to sinus rhythm in AF patients.

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Electrical cardioversion to assess the association between self-reported symptoms and rhythm status in patients with persistent atrial fibrillation

EP Europace ◽

10.1093/europace/euab116.113 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

ANL Hermans ◽

NAHA Pluymaekers ◽

TAR Lankveld ◽

MJW Van Mourik ◽

S Zeemering ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Symptom Burden ◽

Optimal Strategies ◽

Persistent Atrial Fibrillation ◽

Electrical Cardioversion ◽

Symptom Pattern ◽

Asymptomatic Patients ◽

Symptom Patterns

Abstract Funding Acknowledgements Type of funding sources: None. Background. Knowledge about the association between symptoms and rhythm status (symptom-rhythm correlation) has potential clinical implications as it may identify patients with atrial fibrillation (AF) who profit from rhythm control in regard to reduction in symptom burden and improvement in quality of life. However, standardized strategies to assess symptom-rhythm correlation in AF patients are currently not available. Purpose. This study aimed to assess symptom-rhythm correlation in patients with persistent AF using electrical cardioversion (ECV) as a diagnostic probe. Methods. We used ECV to examine symptom-rhythm correlation in 81 patients with persistent AF. The presence of self-reported symptoms before ECV and at the first outpatient AF clinic follow-up visit (within 1-month) was assessed to determine the prevalence of a symptom-rhythm correlation (defined as self-reported symptoms present during AF and absent in sinus rhythm or absent in AF and yet relief during sinus rhythm). The symptom-rhythm correlation was absent in patients with symptoms before ECV who remained symptomatic during sinus or in patients with symptoms prior to ECV and without symptoms in AF after ECV. Asymptomatic patients before ECV with or without symptoms in AF or sinus rhythm afterwards had no symptom-rhythm correlation as well. The symptom-rhythm correlation was unevaluable in patients who were symptomatic in AF before ECV and at the first outpatient AF clinic follow-up visit. In addition, predominant self-reported symptoms (symptoms with highest self-reported symptom burden) were assessed to evaluate the symptom patterns around ECV. Intra-individually variable symptom patterns were defined as changes in predominant self-reported symptoms within patients around ECV. Results. Symptom-rhythm correlation was assessed in all patients. Only in 18 patients (22%), a symptom-rhythm correlation could be documented. Twenty-eight patients (35%) did not show any symptom-rhythm correlation and 35 patients (43%) had an unevaluable symptom-rhythm correlation as these patients were in symptomatic AF both at baseline and at the first outpatient AF clinic follow-up visit. Importantly, self-reported symptom patterns around ECV were intra-individually variable in 10 patients (12%) without symptom-rhythm correlation (of which 9 patients (11%) had AF recurrence) and in 2 patients (2%) with an unevaluable symptom-rhythm correlation. Conclusions. In patients with persistent AF, the prevalence of a symptom-rhythm correlation around ECV is low, but ECV often changes symptom pattern. Further studies are warranted to identify more optimal strategies to assess symptom-rhythm correlation in patients with persistent AF. Abstract Figure. Symptom-rhythm correlation and patterns

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Atrial mechanical hypofunction after electrical cardioversion of persistent or long-lasting persistent atrial fibrillation: a retrospective cohort study

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2019.1178 ◽

2019 ◽

Vol 89 (3) ◽

Author(s):

Renato De Vecchis ◽

Andrea Paccone ◽

Marco Di Maio

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Sinus Rhythm ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Color Doppler ◽

Roc Curves ◽

Persistent Atrial Fibrillation ◽

Electrical Cardioversion

In the present retrospective cohort study, we have evaluated the missed or delayed atrial mechanical recovery in a population of patients with persistent or long-lasting persistent AF who achieved restoration of sinus rhythm on the ECG by electrical cardioversion (ECV). The endpoint of our study was the failure to recover the normal mechanics of the left atrium. Inclusion criterion was the persistent or long-lasting persistent atrial fibrillation successfully treated by means of ECV , provided that a pertinent documentation was made available, comprising ECG, conventional 2D echo-color-Doppler and speckle tracking echocardiography(STE) evaluation, with also a STE assessment of the atria at the days 1, 30 and 90 from the ECV freely available within the clinical record of the patient. Out of a total of 80 patients with persistent or long-standing persistent AF, retrospectively enrolled, as many as 22.5% of them did not achieve the normalization of their atrial STE profile, even though they had been converted to sinus rhythm on the ECG by means of ECV. The building of ROC curves allowed us to establish that early measurements of global atrial strain could serve to predict both the risk of failure to recover the atrial mechanical function and the one of AF relapses over a 12 month follow-up. The values of 18% and 17% were also calculated to serve as cut off values, respectively, for the risk of atrial mechanical dysfunction and for the risk of AF relapses over a 12 month follow-up. Failure to recover the atrial reservoir function can accompany a restoration of sinus rhythm on the ECG in patients with long-standing persistent AF. In this case, a serial STE evaluation could be useful to evaluate the atrial hypofunction over time.

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Poor maintenance of sinus rhythm after electrical cardioversion of patients with atrial fibrillation or flutter: a 5‐year follow‐up of 268 consecutive patients

Scandinavian Cardiovascular Journal ◽

10.1080/14017430310016090 ◽

2003 ◽

Vol 37 (6) ◽

pp. 324-328 ◽

Cited By ~ 16

Author(s):

Jan Dahlin ◽

Pia Svendsen ◽

Niels Gadsbøll

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Electrical Cardioversion

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Faculty Opinions recommendation of Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718304428.793492111 ◽

2014 ◽

Author(s):

Paolo Della Bella ◽

Pasquale Vergara

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm

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Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

European Heart Journal ◽

10.1093/ehjci/ehaa946.0139 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Philabout ◽

L Soulat-Dufour ◽

I Benhamou-Tarallo ◽

S Lang ◽

S Ederhy ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Cardiac Rhythm ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cardiac Chamber ◽

Deformation Imaging ◽

And Function

Abstract Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p<0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p<0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p<0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure). Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

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Multi-catheter cryotherapy compared with radiofrequency ablation in long-standing persistent atrial fibrillation: a randomized clinical trial

EP Europace ◽

10.1093/europace/euaa289 ◽

2020 ◽

Author(s):

Mark M Gallagher ◽

Gang Yi ◽

Hanney Gonna ◽

Lisa W M Leung ◽

Idris Harding ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Persistent Atrial Fibrillation ◽

Rf Ablation ◽

Ablation Efficiency ◽

Mapping System ◽

3D Mapping System ◽

Front Advance

Abstract Aims Restoring sinus rhythm (SR) by ablation alone is an endpoint used in radiofrequency (RF) ablation for long-standing persistent atrial fibrillation (AF) but not with cryotherapy. The simultaneous use of two cryotherapy catheters can improve ablation efficiency; we compared this with RF ablation in chronic persistent AF aiming for termination to SR by ablation alone. Methods and results Consecutive patients undergoing their first ablation for persistent AF of >6 months duration were screened. A total of 100 participants were randomized 1:1 to multi-catheter cryotherapy or RF. For cryotherapy, a 28-mm Arctic Front Advance was used in tandem with focal cryoablation catheters. Open-irrigated, non-force sensing catheters were used in the RF group with a 3D mapping system. Pulmonary vein (PV) isolation and non-PV triggers were targeted. Participants were followed up at 6 and 12 months, then yearly. Acute PVI was achieved in all cases. More patients in the multi-catheter cryotherapy group were restored to SR by ablation alone, with a shorter procedure duration. Sinus rhythm continued to the last available follow-up in 16/49 patients (33%) in the multi-catheter at 3.0 ± 1.6 years post-ablation and in 12/50 patients (24%) in the RF group at 4.0 ± 1.2 years post-ablation. The yearly rate of arrhythmia recurrence was similar. Conclusion Multi-catheter cryotherapy can restore SR by ablation alone in more cases and more quickly than RF ablation. Long-term success is difficult to achieve by either methods and is similar with both.

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High-dose adenosine for refractory supraventricular tachycardia: a case report and literature review

Cardiology in the Young ◽

10.1017/s1047951116002626 ◽

2016 ◽

Vol 27 (5) ◽

pp. 981-984 ◽

Cited By ~ 3

Author(s):

Gal Dadi ◽

Daniel Fink ◽

Giora Weiser

Keyword(s):

Heart Failure ◽

Case Report ◽

Literature Review ◽

Cardiogenic Shock ◽

Sinus Rhythm ◽

Supraventricular Tachycardia ◽

Electrical Cardioversion ◽

High Dose ◽

Prompt Treatment ◽

Unstable Patient

AbstractSupraventricular tachycardia is the most common significant arrhythmia in children. If prolonged, it may cause heart failure and progress to cardiogenic shock warranting prompt treatment. The recommended interventions following vagal manoeuvres are intravenous adenosine and in the unstable patient electrical cardioversion. We present an infant with an unstable supraventricular tachycardia that was resistant to electrical cardioversion and recommended doses of adenosine. He reverted to sinus rhythm with a higher dose of adenosine, suggesting that such doses may be required in refractory supraventricular tachycardia.

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