scholarly journals Supraventricular Tachyarrhythmias in Patients with Ebstein’s Anomaly

2019 ◽  
pp. 57-60
Author(s):  
O. S. Stychynskyi ◽  
P. O. Almiz ◽  
A. V. Topchii ◽  
N. V. Plyska ◽  
A. V. Pokanevich ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Unsatisfactory Result ◽  
Cavotricuspid Isthmus ◽  
Anterolateral Wall ◽  
Supraventricular Tachyarrhythmias ◽  
The Right ◽  
Second Procedure ◽  
Postoperative Scar ◽  
Observation Period

The paper analyzes the experience of catheter treatment of various types of supraventricular arrhythmias in patients with Ebstein’s abnormality (EA) – 19 consecutive cases of the elimination of additional atrioventricular connections (AAVC) and 5 cases of atrial macro-reentry. The elimination of AAVC, just like atrial macroreentry, was preceded by a stage of electrophysiological diagnosis. In a series of observations in 19 patients with EA, 25 AAVC were detected. The article reflects the main electrophysiological differences between “wide” AAVC from multiple ones. In the first procedure, the conduction in all AAVC was eliminated in 16 (84.2%) of 19 patients. 6 of 25 AAVC were qualified by us as “wide”; to eliminate them, a larger number of applications was required – 6 ± 2 (in typical cases – 3 ± 1). In 2 of 3 patients with an unsatisfactory result of the first procedure, AAVC were eliminated during the second procedure. In the long-term period(5.6 ± 3.6 years), recurrences of propagation through AAVC occurred in 2 (10.5%) of 19 patients. All AAVC were permanently eliminated during second procedure. In the group of patients with atrial tachycardia, 3 had a graph characteristic of a typical isthmus-dependent atrial flutter. In one patient with atypical graphics, macro-reentry with excitation circulation around the scar on the anterolateral wall of the right atrium was found. In 3 of 4 patients with isthmus-dependent atrial flutter after radiofrequency exposure, the sinus rhythm was restored and a block of passage through the cavotricuspid isthmus was created. In one case there were changes in the cycle of tachycardia and the morphology of wave P, applying applications between the scar and the tricuspid valve ring led to the creation of a block of passage through this area and to the cessation of arrhythmia. In a patient who initially had reentry with a circulation of excitement around the postoperative scar, arrhythmia was eliminated in a similar way (an additional block was created through the cavotricuspid isthmus). In the observation period of 5.2 ± 2.5 years, there were no recurrences of arrhythmia.

Acute and long-term efficacy and safety of catheter cryoablation of the cavotricuspid isthmus for treatment of type 1 atrial flutter

Heart Rhythm ◽  
2008 ◽  
Vol 5 (7) ◽  
pp. 1009-1014 ◽  
Author(s):  
Gregory K. Feld ◽  
James P. Daubert ◽  
Raul Weiss ◽  
William M. Miles ◽  
William Pelkey
Keyword(s):  
Atrial Flutter ◽  
Efficacy And Safety ◽  
Cavotricuspid Isthmus ◽  
Term Efficacy

scholarly journals The long-term financial impact of electronic health record implementation

2014 ◽  
Vol 22 (2) ◽  
pp. 443-452 ◽  
Author(s):  
Michael J Howley ◽  
Edgar Y Chou ◽  
Nancy Hansen ◽  
Prudence W Dalrymple
Keyword(s):  
Electronic Health Record ◽  
Wound Care ◽  
Financial Impact ◽  
Health Record ◽  
Bottom Line ◽  
Productivity Losses ◽  
Electronic Health ◽  
The Right ◽  
Observation Period

Abstract Objective To examine the financial impact of electronic health record (EHR) implementation on ambulatory practices. Methods We tracked the practice productivity (ie, number of patient visits) and reimbursement of 30 ambulatory practices for 2 years after EHR implementation and compared each practice to their pre-EHR implementation baseline. Results Reimbursements significantly increased after EHR implementation even though practice productivity (ie, the number of patient visits) decreased over the 2-year observation period. We saw no evidence of upcoding or increased reimbursement rates to explain the increased revenues. Instead, they were associated with an increase in ancillary office procedures (eg, drawing blood, immunizations, wound care, ultrasounds). Discussion The bottom line result—that EHR implementation is associated with increased revenues—is reassuring and offers a basis for further EHR investment. While the productivity losses are consistent with field reports, they also reflect a type of efficiency—the practices are receiving more reimbursement for fewer seeing patients. For the practices still seeing fewer patients after 2 years, the solution likely involves advancing their EHR functionality to include analytics. Although they may still see fewer patients, with EHR analytics, they can focus on seeing the right patients. Conclusions Practice reimbursements increased after EHR implementation, but there was a long-term decrease in the number of patient visits seen in this ambulatory practice context.

scholarly journals Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Patients With Pulmonary Hypertension: Feasibility and Long-Term Outcome

2021 ◽  
Vol 12 ◽  
Author(s):  
Bin Zhou ◽  
Yong-Jian Zhu ◽  
Zheng-Qin Zhai ◽  
Si-Xian Weng ◽  
Ya-Zhe Ma ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Catheter Ablation ◽  
Success Rate ◽  
Atrial Flutter ◽  
Radiofrequency Catheter Ablation ◽  
Electrophysiological Study ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cavotricuspid Isthmus

BackgroundSupraventricular tachycardia (SVT) occurs commonly and is strongly correlated with clinical deterioration in patients with pulmonary hypertension (PH). This study aimed to investigate the feasibility and long-term outcome of radiofrequency catheter ablation (RFCA) in PH patients with SVT.Materials and MethodsConsecutive PH patients with SVT who were scheduled to undergo electrophysiological study and RFCA between September 2010 and July 2019 were included. The acute results and long-term success of RFCA were assessed after the procedure.ResultsIn total, 71 PH patients with 76 episodes of SVT were analyzed. Cavotricuspid isthmus-dependent atrial flutter (n = 33, 43.5%) was the most common SVT type, followed by atrioventricular nodal reentrant tachycardia (n = 16, 21.1%). Of the 71 patients, 60 (84.5%) underwent successful electrophysiological study and were subsequently treated by RFCA. Among them, acute sinus rhythm was restored in 54 (90.0%) patients, and procedure-related complications were observed in 4 (6.7%) patients. Univariate logistic regression analysis showed that cavotricuspid isthmus-independent atrial flutter [odds ratio (OR) 25.00, 95% confidence interval (CI) 3.45–180.98, p = 0.001] and wider pulmonary artery diameter (OR 1.19, 95% CI 1.03–1.38; p = 0.016) were associated with RFCA failure. During a median follow-up of 36 (range, 3–108) months, 7 patients with atrial flutter experienced recurrence, yielding a 78.3% 3-year success rate for RFCA treatment.ConclusionThe findings suggest that RFCA of SVT in PH patients is feasible and has a good long-term success rate. Cavotricuspid isthmus-independent atrial flutter and a wider PAD could increase the risk for ablation failure.

Long-term ECG monitoring using an implantable loop recorder for the detection of atrial fibrillation after cavotricuspid isthmus ablation in patients with atrial flutter

Heart Rhythm ◽  
2013 ◽  
Vol 10 (11) ◽  
pp. 1598-1604 ◽  
Author(s):  
Suneet Mittal ◽  
Evgeny Pokushalov ◽  
Alexander Romanov ◽  
Martha Ferrara ◽  
Aysha Arshad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Implantable Loop Recorder ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Cavotricuspid Isthmus

Atrial flutter: management

ESC CardioMed ◽  
2018 ◽  
pp. 2211-2217
Author(s):  
Tilman Maurer ◽  
Christine Lemes ◽  
Karl-Heinz Kuck
Keyword(s):  
Atrial Flutter ◽  
Structural Heart Disease ◽  
Term Treatment ◽  
Non Invasive ◽  
Surface Ecg ◽  
Long Term Treatment ◽  
The Common ◽  
The Right ◽  
Electrocardiogram Ecg

Atrial flutter (AFL) is the most common macroreentry tachycardia in patients with and without structural heart disease. In the majority of cases, the arrhythmia is associated with a pre-existing comorbidity such as heart failure or lung disease. AFL refers to an electrocardiogram (ECG) pattern of a regular tachycardia with an atrial rate of more than 240 beats per minute and a lack of an isoelectric baseline between deflections. The most frequent form is termed ‘common’ or ‘typical’ if biphasic waves are present in the inferior leads, resembling a ‘saw-tooth’ pattern. Common AFL is diagnosed in 90% of cases and its mechanism is a macroreentry within the right atrium involving the cavotricuspid isthmus. ‘Atypical’ AFL refers to any ECG flutter morphology different from the common type. While the surface ECG provides a widely available and non-invasive diagnostic tool, a definite diagnosis of the underlying tachycardia mechanism can only be established by invasive electrophysiological testing. Acute management of AFL includes measures for rate control by pharmacological treatment or rhythm control by antiarrhythmic drugs or electrical cardioversion. For long-term treatment, catheter ablation offers a safe, effective, and curative approach for common flutter and is also a treatment option for atypical AFL. Anticoagulation should be initiated according to risk stratification based on the CHA2DS2-VASc score to prevent thromboembolic complications. This chapter provides a detailed overview on the pathophysiology and electrocardiographic characteristics of AFL and discusses the clinical management of the arrhythmia.

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