scholarly journals Differentiated approach to rhythm conversion in patients with atrial fibrillation and flutter

2021 ◽  
Author(s):  
A. G. Pronin ◽  
A. V. Prokopenko ◽  
D. K. Glukhov
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Atrial Flutter ◽  
Pulse Therapy ◽  
Ventricular Extrasystole ◽  
Huge Number ◽  
Drug Induced ◽  
Number Of Patients ◽  
Atrial Fibrillation And Flutter ◽  
Rate Conversion

The importance of relieving paroxysms of fibrillation and atrial flutter is determined by a huge number of patients suffering from this pathology and its recurrent course.Objective: To create an algorithm for the treatment of patients with atrial fibrillation and atrial flutter by comparing the efficacy and safety of drug-induced rhythm conversion with amiodarone, propafenone, procainamide, niferidil and electropulse therapy.Material and methods. Heart rate conversion was performed in 299 patients. Amiodarone was used as a drug for therapy in 93 patients, propafenone in 34, procainamide in 52, and niferidil in 50. 70 patients underwent electropulse therapy. A comparative analysis was carried out to establish the effectiveness and safety of heart rate conversion by these methods.Results. The effectiveness of conversion rhythm in atrial fibrillation with the help of electropulse therapy, propafenone, niferidil, procainamide and amiadarone has been established, which is 90,3%, 82,4%, 77,4%, 72,5% and 70.5%, respectively. It was also found that the use of electro-pulse therapy and niferidil, in which sinus rhythm recovery occurs in 94.4% and 78.9%, respectively, against 58.3% and 26.7% of patients receiving procainamide and amiodarone, respectively, is most appropriate for the relief of atrial flutter. Often, when using niferidil, ventricular extrasystole and prolongation of the QT interval during electrography developed in comparison with patients of other groups. Ventricular tachycardia, including the "pirouette" type, sinoatrial blockade, AV blockade of various degrees, were also slightly more often registered in these patients.Conclusions. In order to stop atrial fibrillation, there are no differences between medications, and it is better to perform rhythm conversion with atrial flutter with niferidil or electro-pulse therapy. 

scholarly journals Clinical Efficacy of Bepridil for Class I Antiarrhythmic Drug-Induced Atrial Flutter in Patients with Paroxysmal Atrial Fibrillation

2008 ◽  
Vol 24 (2) ◽  
pp. 71-75
Author(s):  
Hidemori Hayashi ◽  
Masataka Sumiyoshi ◽  
Satoru Suwa ◽  
Hidehiko Sakurai ◽  
Yasunobu Kawano ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Clinical Efficacy ◽  
Antiarrhythmic Drug ◽  
Paroxysmal Atrial Fibrillation ◽  
Class I ◽  
Drug Induced ◽  
Class I Antiarrhythmic Drug

scholarly journals Heart Watch Study: protocol for a pragmatic randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054550
Author(s):  
Sanket S Dhruva ◽  
Nilay D Shah ◽  
Sreekanth Vemulapalli ◽  
Abhishek Deshmukh ◽  
Alexis L Beatty ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Atrial Flutter ◽  
Healthcare Utilisation ◽  
Digital Devices ◽  
Patient Reported ◽  
Secondary Outcomes ◽  
The Impact

IntroductionPersonal digital devices that provide health information, such as the Apple Watch, have developed an increasing array of cardiopulmonary tracking features which have received regulatory clearance and are directly marketed to consumers. Despite their widespread and increasing use, data about the impact of personal digital device use on patient-reported outcomes and healthcare utilisation are sparse. Among a population of patients with atrial fibrillation and/or atrial flutter undergoing cardioversion, our primary aim is to determine the impact of the heart rate measurement, irregular rhythm notification, and ECG features of the Apple Watch on quality of life and healthcare utilisation.Methods and analysisWe are conducting a prospective, open-label multicentre pragmatic randomised clinical trial, leveraging a unique patient-centred health data sharing platform for enrolment and follow-up. A total of 150 patients undergoing cardioversion for atrial fibrillation or atrial flutter will be randomised 1:1 to receive the Apple Watch Series 6 or Withings Move at the time of cardioversion. The primary outcome is the difference in the Atrial Fibrillation Effect on QualiTy-of-life global score at 6 months postcardioversion. Secondary outcomes include inpatient and outpatient healthcare utilisation. Additional secondary outcomes include a comparison of the Apple Watch ECG and pulse oximeter features with gold-standard data obtained in routine clinical care settings.Ethics and disseminationThe Institutional Review Boards at Yale University, Mayo Clinic, and Duke University Health System have approved the trial protocol. This trial will provide important data to policymakers, clinicians and patients about the impact of the heart rate, irregular rhythm notification, and ECG features of widely used personal digital devices on patient quality of life and healthcare utilisation. Findings will be disseminated to study participants, at professional society meetings and in peer-reviewed journals.Trial registration numberNCT04468321

Abstract 19766: Prediction of Clinical Atrial Fibrillation induced during Typical Atrial Flutter Ablation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jorge Romero ◽  
Rodolfo Estrada ◽  
Anthony Holmes ◽  
David Goodman ◽  
Norman Roth ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Multivariate Analyses ◽  
Strong Predictor ◽  
Univariate Analysis ◽  
Anticoagulation Management ◽  
Drug Induced ◽  
Typical Atrial Flutter ◽  
History Of

Background: Atrial fibrillation (AF) and isthmus dependent atrial flutter (AFL) are two separate entities that in many patients coexist. We sought to investigate whether AF inducibility (spontaneous or drug induced) during isthmus AFL ablation predicted the occurrence of AF at follow up after successful AFL ablation. Methods: Two hundred seventy three consecutive patients with isthmus dependent AFL undergoing ablation of AFL at our institution were enrolled in this study. 119 (43%) patients were excluded since they had evidence of AF prior to AFL ablation. Univariate and multivariate analyses were performed. Results: A total of 154 patients (male: 72%, age: 61 ±13) with AFL and without history of AF composed our patient population. All patients underwent successful AFL ablation. During ablation, AF was induced in 28 (18%) patients. After a mean follow up of 34 ± 23.5 months a total of 50 (32%) experienced AF. Univariate and multivariate analyses showed that only age and AF inducibility during AFL ablation were predictors of AF. Univariate analysis (age: p=0.038 and inducible AF p=0.032 and multivariate analysis (age: p=0.011 inducible AF: p=0.016) ) with and adjusted odds ratio of 3.3 [95% CI (1.250-8.676)] (Table 1). A total of 169 (62%) patients experienced AF before or after AFL ablation. Conclusion: AF inducibility in patients undergoing isthmus dependent AFL without history of AF is a strong predictor of AF recurrence. This has an important clinical relevance on anticoagulation management of these patients.

Atrial Overdrive Pacing for Conversion of Atrial Flutter in Children

PEDIATRICS ◽  
1985 ◽  
Vol 75 (4) ◽  
pp. 730-736
Author(s):  
Robert M. Campbell ◽  
Macdonald Dick ◽  
Janice M. Jenkins ◽  
Robert L. Spicer ◽  
Dennis C. Crowley ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Atrial Flutter ◽  
Direct Current ◽  
Cycle Length ◽  
Right Atrial ◽  
Atrial Pacing ◽  
Direct Current Cardioversion ◽  
Overdrive Pacing ◽  
Mean Heart Rate

Twenty-three successive patients with 27 different episodes of sustained atrial flutter were treated with atrial pacing for conversion of the tachyarrhythmia; 15 patients with 16 episodes of atrial flutter underwent intracardiac right atrial pacing and eight patients with 11 episodes of atrial flutter were treated with transesophageal atrial pacing. Ten of sixteen episodes (63%) and eight of 11 episodes (73%) were successfully converted using intracardiac and transesophageal techniques, respectively. Mean flutter cycle length for all 27 episodes was 219 ms (mean heart rate 274 beats per minute); successful pacing conversion cycle length (n = 15) was 72% of the flutter cycle length. Hemodynamic, electrophysiologic, and roentgenographic data were not predictive of conversion by either technique. Induction of localized atrial fibrillation or failure to meet critical pacing criteria may explain pacing failures. Based on this experience, a trial of transesophageal atrial pacing for acute conversion of any episode of atrial flutter in children prior to direct current cardioversion is recommended.

Incidence of new-onset atrial fibrillation after cavotricuspid isthmus ablation for isolated typical atrial flutter: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Griffin ◽  
A Thiyagarajah ◽  
M Middeldorp ◽  
D Lau ◽  
P Sanders
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Cavotricuspid Isthmus ◽  
Kaplan Meier ◽  
Typical Atrial Flutter ◽  
Number Of Patients ◽  
Implantable Loop Recorders ◽  
Drug Free ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a lack of consensus guidelines regarding the continuation of anticoagulant therapy following cavotricuspid isthmus (CTI) ablation for typical atrial flutter.  This is despite a significant number of patients developing new-onset atrial fibrillation (AF) following the procedure.  Furthermore, a summary of Kaplan-Meier estimates for drug-free, arrhythmia-free survival has never been reported. Purpose  To estimate the incidence of drug-free, new-onset AF stratified by rhythm monitoring strategy in patients undergoing  CTI ablation for isolated typical atrial flutter. Methods PubMed, Embase and MEDLINE databases were searched to identify relevant studies. Only studies where anti-arrhythmic drugs were discontinued post-ablation and that accounted for patient censoring by reporting results in the form of time to event data were included.  Data was extracted from published Kaplan-Meier curves using a digitizing software and confidence intervals for the survivor function were estimated based on the number at risk at the time point of interest. Results were pooled in a random effects model using the DerSimonian-Laird estimator. Results  Thirteen relevant studies incorporating 1712 patients (79 % male, mean age 63.2 +/-11.2 years,  LVEF 55.2 +/-10.8%) were identified. The estimated  freedom from  new-onset atrial fibrillation was 89.7% (95% CI: 80.3-90.1%) at 1 year and 86.2% (95% CI: 78.4-94.0%) at 2 years in patients undergoing predominantly symptom –based monitoring, 74.6% (95%CI: 67.0-82.3%) at 1 year and 69.5% (95%CI: 63.5-75.6%) at 2 years  in patients undergoing regular clinic follow-up with periodic Holter monitoring and 51.4% (95% CI: 41.8-61.0%) at 1 year and 22.7% (95% CI: 8.7% - 36.6%) at 2 years in patients with implantable loop recorders. Conclusion  With the advent of implantable loop recorders, it is apparent that most patients with isolated atrial flutter manifest new-onset AF following CTI ablation and the merits of discontinuing anticoagulation must be carefully considered in this population.  Symptom-based monitoring likely severely underestimates the incidence of new-onset AF and may lead to adverse outcomes, particularly in patients with a high risk of stroke.

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