scholarly journals Treatment for cardiac arrhythmias in pregnancy: Efficiency and safety

2013 ◽  
Vol 4 (2) ◽  
pp. 81-91
Author(s):  
Yu. A Bunin
Keyword(s):  
Pregnant Women ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Wide Spectrum ◽  
Antiarrhythmic Agents ◽  
Potentially Malignant ◽  
Fetal Safety ◽  
Surgical Treatments ◽  
Practical Recommendations ◽  
New Onset

Pregnancy with its physiological neurohumoral and hemodynamic changes may cause new-onset cardiac arrhythmia or worsen existing arrhythmias. It is important to single out the arrhythmias in pregnant women, which pose no risk for mother or fetus and therefore are not a contraindication to vaginal delivery and occasionally need no medical treatment. On the other hand, the arrhythmias, that impair hemodynamics and those that are referred to as the so-called potentially malignant and malignant cardiac arrhythmias, require specific pharmacotherapy and, in a number of cases, invasive treatments. Arrhythmias pharmacotherapeutic challenges in pregnant women are determined by that many antiarrhythmic agents may be harmful to the fetus and that the results of controlled trials of this problem are few and conflicting. The paper covers the current areas and some disputable issues of medical and surgical treatments for a wide spectrum of supraventricular and ventricular arrhythmias in pregnant women and gives practical recommendations for the use of different classes of antiarrhythmic agents in them to stop and prevent cardiac arrhythmias depending on their fetal safety and the pattern of maternal cardiovascular and concomitant diseases.

scholarly journals Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 601
Author(s):  
Houyu Zhao ◽  
Mei Zhang ◽  
Jiaming Bian ◽  
Siyan Zhan
Keyword(s):  
Pregnant Women ◽  
Ambulatory Care ◽  
National Level ◽  
Mainland China ◽  
Antibiotic Use ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Fetal Safety ◽  
First Trimester Of Pregnancy

Background: Antibiotic use in pregnant women at the national level has rarely been reported in China. Objectives: We aimed to investigate antibiotic prescriptions during pregnancy in ambulatory care settings in China. Methods: Data of 4,574,961 ambulatory care visits of pregnant women from October 2014 to April 2018 were analyzed. Percentages of Antibiotic prescriptions by different subgroups and various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Food and Drug Administration (FDA) pregnancy categories were used to describe the antibiotic prescription patterns. The 95% confidence intervals (CIs) were estimated using the Clopper––Pearson method or Goodman method. Results: Among the 4,574,961 outpatient visits during pregnancy, 2.0% (92,514 visits; 95% CI, 2.0–2.0%) were prescribed at least one antibiotic. The percentage of antibiotic prescriptions for pregnant women aged >40 years was 4.9% (95% CI, 4.7–5.0%), whereas that for pregnant women aged 26–30 years was 1.5% (95% CI, 1.4–1.5%). In addition, percentages of antibiotic prescriptions varied among different trimesters of pregnancy, which were 5.4% (95% CI, 5.3–5.4%) for the visits in the first trimester of pregnancy and 0.5% (95% CI, 0.4–0.5%) in the third trimester of pregnancy. Furthermore, the percentages of antibiotic prescriptions substantially varied among different diagnosis categories and nearly three-quarters of antibiotic prescriptions had no clear indications and thus might be inappropriate. In total, 130,308 individual antibiotics were prescribed; among these, 60.4% (95% CI, 60.0–60.8%) belonged to FDA category B, 2.7% (95% CI, 2.1–3.5%) were classified as FDA category D and 16.8% (95% CI, 16.2–17.4%) were not assigned any FDA pregnancy category. Conclusions: Antibiotic prescriptions in ambulatory care during pregnancy were not highly prevalent in mainland China. However, a substantial proportion of antibiotics might have been prescribed without adequate indications. Antibiotics whose fetal safety has not been sufficiently illustrated were widely used in pregnant women.

scholarly journals Fluoroscopy integrated 3D mapping significantly reduces radiation exposure during ablation for a wide spectrum of cardiac arrhythmias

EP Europace ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 928-937 ◽  
Author(s):  
Marian Christoph ◽  
Carsten Wunderlich ◽  
Stefanie Moebius ◽  
Mathias Forkmann ◽  
Judith Sitzy ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Cardiac Arrhythmias ◽  
Wide Spectrum ◽  
3D Mapping

scholarly journals New-onset ventricular arrhythmias post radiofrequency catheter ablation for atrial fibrillation

Medicine ◽  
2016 ◽  
Vol 95 (36) ◽  
pp. e4648 ◽  
Author(s):  
Lingmin Wu ◽  
Yanlai Lu ◽  
Yan Yao ◽  
Lihui Zheng ◽  
Gang Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Radiofrequency Catheter Ablation ◽  
New Onset

Idiopathic Atrial Fibrillation and Coronary Arteriovenous Fistulae: Is There a Link?

Cardiology ◽  
2016 ◽  
Vol 134 (4) ◽  
pp. 433-435 ◽  
Author(s):  
Hina K. Jamali ◽  
Umara Raza ◽  
Fahad Waqar
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrhythmias ◽  
Similar Case ◽  
Superior Vena ◽  
Vena Cava ◽  
Definitive Treatment ◽  
Arteriovenous Fistulae ◽  
Coronary Arteriovenous Fistula ◽  
The Right ◽  
New Onset

Despite being one of the most prevalent cardiac arrhythmias, the cause of atrial fibrillation (AF) in a vast majority of patients remains unknown. There is growing evidence of associated AF in patients diagnosed with coronary arteriovenous fistula. In this discussion, we have included an example of a patient who presented with new-onset AF and was subsequently diagnosed with an anomalous fistula between the right coronary artery and the superior vena cava. Definitive treatment of the fistula resulted in permanent resolution of the AF. Based on this case and a similar case reported in the literature, it is proposed that further research will unmask this possibly underdiagnosed and very treatable cause of AF.

New Onset of Atrial Fibrillation" as an Outcome Predictor in Critically Ill Patients with Sepsis: A Systemic Review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed W Mohamed ◽  
Mostafa K Riyad ◽  
Ahmed M Khamis ◽  
Heba F Toulan
Keyword(s):  
Atrial Fibrillation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cardiac Arrhythmias ◽  
Meta Analysis ◽  
Systemic Review ◽  
Common Occurrence ◽  
Severity Of Disease ◽  
Increased Risk ◽  
New Onset

Abstract Background Evidence of various cardiac arrhythmias in septic patients has been demonstrated by multiple clinical reports and observations .Most cardiac arrhythmias in sepsis are new-onset and may be related to sepsis-induced myocardial dysfunction, autonomic dysfunction and, most likely also, by impairment and involvement of the cardiac conduction system. Aim of the Work to describe the incidence of NOAF and to determine the risk factors associated with its development, as well as its clinical course and its effect on the outcome of patients with sepsis admitted to the ICU. Patients and Methods A systematic search was conducted to retrieve articles that investigated the association of NOAF in patients diagnosed with sepsis. We identified potential Englishlanguage sources from the PubMed, Medline, and EMBASE databases. Keywords used were “atrial fibrillation” and (“sepsis” or “septic shock”). In addition, reference lists of any studies meeting inclusion criteria were reviewed manually to identify additional relevant publications. Results In our meta-analysis, we found that NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease. Also, we found that NOAF in sepsis patients is significantly associated with increased risk of ICU. In hospital, and After hospital discharge mortality, as well as, increased risk of developing ischemic stroke. Conclusion NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease. Our Meta-analysis suggests that it is independently associated with poor outcome. In view of these findings there is a need for better quality observational studies, because reliable identification of patients with sepsis who are prone for the development of AF may allow for early pharmacological interventions to prevent this complication.

Cardiac arrhythmias in pregnant women: need for mother and offspring protection

2020 ◽  
Vol 36 (7) ◽  
pp. 1225-1243
Author(s):  
Theodora A. Manolis ◽  
Antonis A. Manolis ◽  
Evdoxia J. Apostolopoulos ◽  
Despoina Papatheou ◽  
Helen Melita ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Cardiac Arrhythmias ◽  
Offspring Protection

Fluoroless catheter ablation of supraventricular and ventricular arrhythmias in pregnancy: validation of a standard approach in a large multicenter registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Stec ◽  
K Styczkiewicz ◽  
J Sledz ◽  
A Sledz ◽  
M Chrabaszcz ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmia ◽  
Pregnant Women ◽  
Ventricular Arrhythmias ◽  
Study Group ◽  
Heart Team ◽  
Femoral Access ◽  
Electroanatomic Mapping System ◽  
Multicenter Registry ◽  
In Pregnancy

Abstract Background An increasing experience in zero- (ZF) or near-zero fluoroscopy catheter ablation (CA) supports the implementation of early, fluoroless approach for recurrent, symptomatic arrhythmias in pregnancy. Purpose The aim of the study was to evaluate the feasibility, efficacy, and safety of CA with a standardized ZF approach during pregnancy. Methods Data were derived from a large prospective multicenter registry (ELEKTRO-RARE-A-CAREgistry). Between 2012 and 2019, more than 2655 CA procedures were performed in women in intention-to-treat using a ZF fluoroscopy approach. The procedures were performer using: 1) femoral access, 2) double-catheter technique, without intracardiac echocardiography, 3) electroanatomic mapping system (Ensite, Abbott, USA) for mapping and navigation, 4) conscious, light sedation. Shared decision making approach was applied, including a pregnancy heart team consultations. Results The study group consisted of 18 pregnant women (mean age: 30.3±5.0 years; range: 19–38 years; mean gestational age during CA: 21.4±9.2 weeks; range: 7–36 weeks). All pregnant women had no overt structural heart disease. Among women in reproductive age, pregnant women referred for ZF-CA approach accounted for approximately 2% of procedures. In the study group, the major indications for CA included: AVNRT (n=10); OAVRT/WPW (n=2); focal idiopathic ventricular arrhythmia (n=4), AT (n=1) and AF (n=1). Five women had double substrate for CA. In AF case general anesthesia and transesophageal echocardiography were used to monitor ZF-transseptal puncture and right-sided pulmonary vein isolation. All procedures were successfully completed without fluoroscopy, and without serious maternal or fetal complications. The procedure and ablation application times were 55.0±30.0 min and 394±338 s, respectively. In one patient second procedure for idiopathic ventricular arrhythmia was postponed after delivery. Conclusion Implementation of pregnancy heart team and a standard fluoroless protocol for CA in daily electrophysiological practice allowed an early, safe, and effective CA of maternal supraventricular tachycardia and idiopathic ventricular arrhythmias in pregnancy. Funding Acknowledgement Type of funding source: None

Cardiac instability amplified by use-dependent Na channel blockade

1992 ◽  
Vol 262 (4) ◽  
pp. H1305-H1310 ◽  
Author(s):  
C. F. Starmer ◽  
A. R. Lancaster ◽  
A. A. Lastra ◽  
A. O. Grant
Keyword(s):  
Sudden Death ◽  
Cardiac Arrhythmias ◽  
Tricyclic Antidepressants ◽  
Spatial Dispersion ◽  
Na Channel ◽  
Antiarrhythmic Agents ◽  
Channel Blockade ◽  
Vulnerable Period ◽  
Conditioning Stimuli ◽  
Increased Susceptibility

Drugs that exhibit use-dependent Na channel blockade, including antiarrhythmic agents, tricyclic antidepressants, opiate-like analgesics, and cocaine, are linked with an increased susceptibility to cardiac arrhythmias and sudden death. Computer simulations indicate that Na channel blockade retards recovery of excitability, thereby increasing the spatial dispersion of refractoriness, a precursor of many cardiac arrhythmias. In isolated rabbit left atria, stimuli timed to occur at increasing intervals following conditioning stimuli reveal an unstable interval (vulnerable period) during which single stimuli initiate trains of responses. The vulnerable period is extended by use-dependent Na channel blockade and provides a model for assaying proarrhythmic potential and probing cardiac instability.

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