Journal articles: 'Arrhythmie'

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Brunckhorst, C. B., J. Holzmeister, C. Scharf, C. Binggeli, and F. Duru. "Stress, Depression und kardiale Arrhythmien." Therapeutische Umschau 60, no. 11 (November 1, 2003): 673–81. http://dx.doi.org/10.1024/0040-5930.60.11.673.

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Stress und Depressionen verändern die elektrophysiologischen Eigenschaften des Myokards insbesondere durch den Einfluss des autonomen Nervensystems und können somit Herzrhythmusstörungen auslösen. Durch die asymmetrische autonome Innervation des Herzens wirkt sich die Interaktion von Sympathikus und Parasympathikus auf die verschiedenen Lokalisationen des Reizleitungssystems unterschiedlich aus. Bei einer Arrhythmie handelt es sich um ein komplexes Zusammenspiel aus einem elektrophysiologischen Substrat und einem auslösenden Trigger, der auf einer autonomen Stimulation oder anderen Einflussfaktoren beruht, was einen spezifischen Arrhythmie-Mechanismus auslösen kann. Die Korrelation zwischen dem Auftreten von Arrhythmien und einer gestörten autonomen Balance im Sinne eines reduzierten parasympathischen und gesteigerten sympathischen Tonus ist in der Literatur gut dokumentiert. Die Patienten zeichnen sich klinisch durch eine reduzierte Herzfrequenzvariabilität, verstärkte QT-Dispersion und verminderte Barorezeptorsensitivität aus.Kasuistiken bestätigen, dass autonome Innervationszustände unter bestimmten Umständen Rhythmusstörungen bis hin zu lebensbedrohlichen ventrikulären Arrhythmien triggern können.

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Bischoff, Angelika. "Notfall akute Arrhythmie." MMW - Fortschritte der Medizin 152, no. 18 (May 2010): 20–21. http://dx.doi.org/10.1007/bf03366494.

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Höltgen, Reinhard, and Bernd Lemke. "Modernes Arrhythmie-Management." Herzschrittmachertherapie + Elektrophysiologie 31, no. 1 (February 27, 2020): 1–2. http://dx.doi.org/10.1007/s00399-020-00663-1.

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sti. "Arrhythmie-Mechanismus bestimmt Ablationsstrategie." CardioVasc 16, no. 5 (November 2016): 31. http://dx.doi.org/10.1007/s15027-016-0994-8.

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Müller, Thomas. "Sportsucht: Trainieren bis zur Arrhythmie." InFo Neurologie & Psychiatrie 17, no. 12 (December 2015): 55–56. http://dx.doi.org/10.1007/s15005-015-1580-9.

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Molitor, Nadine, and Corinna B. Brunckhorst. "CME-EKG 67: Arrhythmie bei Belastung." Praxis 109, no. 16 (December 2020): 1231–37. http://dx.doi.org/10.1024/1661-8157/a003607.

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Zusammenfassung. Ventrikuläre Tachykardien sind potenziell lebensbedrohliche Herzrhythmusstörungen mit einer Herzfrequenz >100 Schläge/min und einem Ursprungsort der Arrhythmie unterhalb des Hisbündels im spezifischen Reizleitungssystem oder im ventrikulären Myokard. Die Morphologie im Oberflächen-EKG kann bereits Hinweise auf den zugrundeliegenden Mechanismus und die damit assoziierte Grunderkrankung liefern. Der jeweilige Pathomechanismus ist entscheidend für die weiterführende Therapie. Dieser Artikel soll einen Einblick in die verschiedenen Ursachen und Therapieoptionen sowie die Differenzialdiagnose der ventrikulären Tachykardien geben.

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Leers, Hans. "Der Lochkartenfall: Kardialer Hochdruck mit Arrhythmie." Zeitschrift für Klassische Homöopathie 25, no. 02 (April 2, 2007): 89. http://dx.doi.org/10.1055/s-2006-937959.

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Ortiz, Miriam, Felix Saha, Volker Schmiedel, and Klaus Trinczek. "4 Fachleute – 4 Behandlungsstrategien bei Arrhythmie." Zeitschrift für Komplementärmedizin 07, no. 01 (February 10, 2015): 36–37. http://dx.doi.org/10.1055/s-0035-1545371.

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9

Reißig, Angelika, Rudolf Bartunek, Ulf Hengst, and Claus Kroegel. "Absolute Arrhythmie und Pneumatosis cystoides intestinalis." Medizinische Klinik 97, no. 5 (May 1, 2002): 308. http://dx.doi.org/10.1007/s00063-002-1159-3.

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Epifanio, Hindalis Ballesteros, Marcelo Katz, Melania Aparecida Borges, Alessandra da Graça Corrêa, Fátima Dumas Cintra, Rodrigo Leandro Grinberg, Ana Cristina Pinotti Pedro Ludovice, Bruno Pereira Valdigem, Nilton José Carneiro da Silva, and Guilherme Fenelon. "The use of external event monitoring (web-loop) in the elucidation of symptoms associated with arrhythmias in a general population." Einstein (São Paulo) 12, no. 3 (September 2014): 295–99. http://dx.doi.org/10.1590/s1679-45082014ao2939.

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Objective To correlate arrhythmic symptoms with the presence of significant arrhythmias through the external event monitoring (web-loop). Methods Between January and December 2011, the web-loop was connected to 112 patients (46% of them were women, mean age 52±21 years old). Specific arrhythmic symptoms were defined as palpitations, pre-syncope and syncope observed during the monitoring. Supraventricular tachycardia, atrial flutter or fibrillation, ventricular tachycardia, pauses greater than 2 seconds or advanced atrioventricular block were classified as significant arrhythmia. The association between symptoms and significant arrhythmias were analyzed. Results The web-loop recorded arrhythmic symptoms in 74 (66%) patients. Of these, in only 14 (19%) patients the association between symptoms and significant cardiac arrhythmia was detected. Moreover, significant arrhythmia was found in 11 (9.8%) asymptomatic patients. There was no association between presence of major symptoms and significant cardiac arrhythmia (OR=0.57, CI95%: 0.21-1.57; p=0.23). Conclusion We found no association between major symptoms and significant cardiac arrhythmia in patients submitted to event recorder monitoring. Event loop recorder was useful to elucidate cases of palpitations and syncope in symptomatic patients.

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Overbeck, Peter. "Neuer Arrhythmie-Typ und neue Therapie-Optionen." CME 8, no. 10 (October 2011): 18. http://dx.doi.org/10.1007/bf03360039.

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Molitor, Nadine, and Corinna B. Brunckhorst. "CME-EKG 67/Antworten: Arrhythmie bei Belastung." Praxis 110, no. 1 (January 2021): 19–21. http://dx.doi.org/10.1024/1661-8157/a003608.

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Zusammenfassung. Ventrikuläre Tachykardien sind potenziell lebensbedrohliche Herzrhythmusstörungen mit einer Herzfrequenz >100 Schläge/min und einem Ursprungsort der Arrhythmie unterhalb des Hisbündels im spezifischen Reizleitungssystem oder im ventrikulären Myokard. Die Morphologie im Oberflächen-EKG kann bereits Hinweise auf den zugrundeliegenden Mechanismus und die damit assoziierte Grunderkrankung liefern. Der jeweilige Pathomechanismus ist entscheidend für die weiterführende Therapie. Dieser Artikel soll einen Einblick in die verschiedenen Ursachen und Therapieoptionen sowie die Differenzialdiagnose der ventrikulären Tachykardien geben.

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13

Sridhar, Anuradha, Alessandro Giamberti, Sara Foresti, Riccardo Cappato, Carlos Rubio-Iglesias García, Nerea Delgado Cabrera, Angelo Micheletti, et al. "Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre." Cardiology in the Young 21, no. 6 (May 27, 2011): 665–69. http://dx.doi.org/10.1017/s1047951111000643.

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AbstractObjectivesClassical Atriopulmonary Fontan connections tend to fail in the long term due to progressive anastomotic site obstruction, right atrial enlargement, and refractory atrial arrhythmias. Conversion to total cavopulmonary connection with concomitant arrhythmia surgery is a promising treatment but optimal timing of the procedure remains controversial.MethodsBetween the years 2002 and 2009, 15 patients with a median age of 26.2 (12–43) years underwent Fontan conversion operation with concomitant arrhythmia surgery. All were symptomatic and 14 out of the 15 patients had refractory arrhythmias. The duration of pre-operative arrhythmia and the outcome of surgery were correlated to study the impact of delay in surgical intervention on post-operative survival and arrhythmia control.ResultsThere were two patients who died in the early post-operative period (13.3%). At the mid-term follow-up, 53 (20–86) months, late atrial arrhythmias had recurred in two of the 13 surviving patients (15.30%) and one patient developed late sinus node dysfunction. The need for anti-arrhythmic drugs decreased considerably from 93.5% to 15.3% on mid-term follow-up. There was no late death or need for cardiac transplantation. The duration of arrhythmia before surgery was prolonged for more than 10 years in patients who died as well as in those who had complications like late recurrence of arrhythmias, dependence on anti-arrhythmic medications, and worsening of ventricular dysfunction.ConclusionsFontan conversion is a well-established treatment option for salvaging the failing atriopulmonary connections. Concomitant arrhythmia surgery effectively resolves the refractory atrial arrhythmias and improves survival, but we need to optimise the timing of Fontan conversion to improve the long-term outcome.

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Happe, S., R. Felgendreher, U. Tebbe, and A. Cuneo. "60-jährige Patientin mit Arrhythmie und voroperiertem Herzen." DMW - Deutsche Medizinische Wochenschrift 136, no. 09 (January 18, 2011): 415–16. http://dx.doi.org/10.1055/s-0031-1272558.

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15

Poeppel, T. D., M. Reinhardt, E. G. Vester, M. Yong, J. Mau, B. E. Strauer, H. Vosberg, H. W. Müller, and B. J. Krause. "Myocardial perfusion/metabolism mismatch and ventricular arrhythmias in the chronic post infarction state." Nuklearmedizin 44, no. 03 (2005): 69–75. http://dx.doi.org/10.1055/s-0038-1625688.

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Summary Aim: Ventricular arrhythmias have been shown to originate in the myocardial peri-infarct region due to irregular heterotopic conduction. Hypoperfused but viable myocardium is often localised in those areas and may be involved in the pathogenesis of arrhythmias. We tested the hypothesis that these myocardial perfusion/metabolism mismatches (MM) are significantly associated with ventricular arrhythmias in the chronic post infarction state. Patients, methods: 47 post infarction patients were included in the study. 33 suffered from ventricular arrhythmia whereas 14 did not. All patients underwent 99mTc tetrofosmin SPECT and 18F-FDG PET. A region-of-interest(ROI)-analysis was used to assess viable myocardium based on predefined MM-criteria. Univariate analyses as well as a logistic regression model for the multivariate analysis were carried out. Results: 94% of the arrhythmic patients displayed at least one MM-segment as compared to 64% of the non-arrhythmic patients. MMsegments and arrhythmia showed a statistically significant relation (p = 0.018). The logistic regression model predicted the occurrence or absence of arrhythmia in 85% of all cases. Multivariate analysis gave consistent results, after adjusting for symptomatic chronic heart failure (CHF), aneurysms and age. Conclusion: Our results support the hypothesis that hypoperfused but viable myocardium represents an arrhythmogenic substrate and is a relevant risk factor for developing ventricular arrhythmias following myocardial infarction. Therefore, the detection of MM-segments allows the identification of patients with a higher risk for future cardiac events.

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Eftekhari, Helen. "Pharmacotherapy in arrhythmias: an overview of anti-arrhythmic drug therapy." British Journal of Cardiac Nursing 16, no. 4 (April 2, 2021): 1–9. http://dx.doi.org/10.12968/bjca.2021.0044.

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The article provides an overview of the principles in anti-arrhythmic drug prescribing. The cardiac action potential is explained, followed by general principles involved in treating arrhythmias and prescribing decisions. An overview of the five classifications of anti-arrhythmic drugs is given, with examples of the main drugs in the classification and principles to consider within each. Finally, anticoagulation is reviewed, being a cornerstone prescribing decision-making in the most common arrhythmia, atrial fibrillation.

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Eftekhari, Helen. "Pharmacotherapy in arrhythmias: an overview of anti-arrhythmic drug therapy." Journal of Prescribing Practice 2, no. 11 (November 2, 2020): 582–88. http://dx.doi.org/10.12968/jprp.2020.2.11.582.

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The article aims to give an overview of the principles in anti-arrhythmic drug prescribing. Practitioners assessing cardiac patients are highly likely to review anti-arrhythmic drug therapies and need an understanding of the principles of therapy. The cardiac action potential is explained, followed by general principles involved in treating arrhythmias and prescribing decisions. An overview of the five classifications of anti-arrhythmic drugs is given, with examples of the main drugs in the classification and principles to consider within each. Finally anticoagulation is reviewed being a cornerstone prescribing decision in the most common arrhythmia, atrial fibrillation.

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Mengden, Thomas. "Arrhythmie-Gefährdung des Hypertonie-Patienten – Verzahnung von Hypertonietherapie und Rhythmusmanagement." Der Klinikarzt 44, no. 05 (June 2, 2015): 244–48. http://dx.doi.org/10.1055/s-0035-1555650.

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Hong, Bihong, Jianlin He, Qingqing Le, Kaikai Bai, Yongqiang Chen, and Wenwen Huang. "Combination Formulation of Tetrodotoxin and Lidocaine as a Potential Therapy for Severe Arrhythmias." Marine Drugs 17, no. 12 (December 5, 2019): 685. http://dx.doi.org/10.3390/md17120685.

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Severe arrhythmias—such as ventricular arrhythmias—can be fatal, but treatment options are limited. The effects of a combined formulation of tetrodotoxin (TTX) and lidocaine (LID) on severe arrhythmias were studied. Patch clamp recording data showed that the combination of LID and TTX had a stronger inhibitory effect on voltage-gated sodium channel 1.5 (Nav1.5) than that of either TTX or LID alone. LID + TTX formulations were prepared with optimal stability containing 1 μg of TTX, 5 mg of LID, 6 mg of mannitol, and 4 mg of dextran-40 and then freeze dried. This formulation significantly delayed the onset and shortened the duration of arrhythmia induced by aconitine in rats. Arrhythmia-originated death was avoided by the combined formulation, with a decrease in the mortality rate from 64% to 0%. The data also suggests that the anti-arrhythmic effect of the combination was greater than that of either TTX or LID alone. This paper offers new approaches to develop effective medications against arrhythmias.

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Rezwan, Refaya, Sharmin Zafar, Abu Asad Chowdhury, Shaila Kabir, Mohammad Shah Amran, and Mohammad Abdur Rashid. "Studies of Anti-arrhythmic and Hypercholesterolemic Activities of Ayurvedic Preparation Lauhasab in Rat Model." Dhaka University Journal of Pharmaceutical Sciences 16, no. 1 (July 30, 2017): 95–105. http://dx.doi.org/10.3329/dujps.v16i1.33387.

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Lauhasab, an Ayurvedic preparation, is widely used in anemia and cardiovascular diseases. Despite its claim as a cardio-tonic there is paucity of studies on pharmacological activities and toxicities. In this study, the anti-arrhythmic effect and impact on lipid profile were evaluated. Rats were pretreated with 0.28 and 2.8 ml/kg body weight of Lauhasab for 35 days and electrocardiographic tracings were recorded and analyzed to determine heart rate and occurrence of arrhythmia. Electrocardiogram recorded before digoxin administration showed significant decrease in mean heart rate along with longer duration of bradycardia than in digoxin control group after 35 days of chronic pretreatment with both doses of Lauhasab. In animal experiments, various arrhythmias were observed after intraperitoneal injection of digoxin. Lauhasab decreased the duration and delayed onset of time of various arrhythmias. It showed significant increase in cholesterol and triglyceride levels in a dose dependent manner. It can be concluded that Lauhasab possesses significant anti-arrhythmic activity against digoxin-induced arrhythmia. It also revealed hyperlipidemic effects.Dhaka Univ. J. Pharm. Sci. 16(1): 95-105, 2017 (June)

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Li, Jie, Bin Li, Hailiang Huang, Tao Han, and Yang Li. "Allocryptopine: A Review of Its Properties and Mechanism of Antiarrhythmic Effect." Current Protein & Peptide Science 20, no. 10 (September 20, 2019): 996–1003. http://dx.doi.org/10.2174/1389203720666190807123609.

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Abstract：Throughout the last decade, extensive efforts have been devoted to developing a percutaneous catheter ablation and implantable cardioverter-defibrillator technique for patients suffering from ventricular arrhythmia. Antiarrhythmic drug efficacy for preventing arrhythmias remains disappointing because of adverse cardiovascular effects. Allocryptopine is an isoquinoline alkaloid widely present in medicinal herbs. Studies have indicated that allocryptopine exhibits potential anti-arrhythmic actions in various animal models. The potential therapeutic benefit of allocryptopine in arrhythmia diseases is addressed in this study, focusing on multiple ion channel targets and reduced repolarization dispersion. The limitations of allocryptopine research are clear given a lack of parameters regarding toxicology and pharmacokinetics and clinical efficacy in patients with ventricular arrhythmias. Much remains to be revealed about the properties of allocryptopine.

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Schön, Tobias, and Michael Kühne. "Vorhofflimmern." Therapeutische Umschau 73, no. 6 (September 2016): 333–39. http://dx.doi.org/10.1024/0040-5930/a000801.

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Zusammenfassung. Vorhofflimmern ist die häufigste Herzrhythmusstörung mit einer Prävalenz von 1 – 2 % in der Bevölkerung und lässt sich im Elektrokardiogramm diagnostizieren. Wichtige Risikofaktoren sind Alter, arterielle Hypertonie und Adipositas. Jeder vierte bis fünfte Schlaganfall ist mit Vorhofflimmern assoziiert. Durch eine orale Antikoagulation (OAK), die heute ohne Gerinnungskontrollen mit Nicht-Vitamin K-abhängigen oralen Antikoagulantien (NOAKs) durchgeführt werden kann, lässt sich das Schlaganfallrisiko und die Gesamtmortalität senken. Das Risiko intrakranieller Blutungen ist unter NOAKs gegenüber Vitamin K-Antagonisten (VKA) geringer. Die meisten Patienten benötigen nach Risiko-Nutzenanalyse eine lebenslange OAK. Ähnlich wie bei VKA kann die antikoagulatorische Wirkung von NOAKs mit neuen Antidots innerhalb von Minuten antagonisert werden. Liegen Kontraindikation für eine lebenslange OAK vor, kann ein (interventioneller) Verschluss des Vorhofohrs erwogen werden. Leiden Patienten unter der Symptomatik des Vorhofflimmerns oder führt die Arrhythmie zu einer Tachykardiomyopathie, ist besonders in der Frühphase der Arrhythmie eine rhythmuserhaltene Therapie indiziert, die mit Antiarrhythmika, Kardioversion oder Katheterablation umgesetzt werden kann. Dabei ist die Pulmonalvenenisolation zu einem hochstandardisierten Verfahren geworden. Ist eine rhythmuserhaltene Therapie nicht mehr möglich und auch die Frequenzkontrolle nicht ausreichend umsetzbar, bleibt als Ultima ratio die AV-Knotenablation.

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Süfke, Sven, Hasib Djonlagić, and Thomas Kibbel. "Beeinträchtigung des kardialen autonomen Nervensystems und Arrhythmie-Inzidenz bei schwerer Hyperglykämie." Medizinische Klinik 105, no. 12 (December 2010): 858–70. http://dx.doi.org/10.1007/s00063-010-1150-3.

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CHIU, CHUANG-CHIEN, TONG-HONG LIN, and BEN-YI LIAU. "USING CORRELATION COEFFICIENT IN ECG WAVEFORM FOR ARRHYTHMIA DETECTION." Biomedical Engineering: Applications, Basis and Communications 17, no. 03 (June 25, 2005): 147–52. http://dx.doi.org/10.4015/s1016237205000238.

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Arrhythmia is one kind of diseases that gives rise to the death and possibly forms the immedicable danger. The most common cardiac arrhythmia is the ventricular premature beat. The main purpose of this study is to develop an efficient arrhythmia detection algorithm based on the morphology characteristics of arrhythmias using correlation coefficient in ECG signal. Subjects for experiments included normal subjects, patients with atrial premature contraction (APC), and patients with ventricular premature contraction (PVC). So and Chan's algorithm was used to find the locations of QRS complexes. When the QRS complexes were detected, the correlation coefficient and RR-interval were utilized to calculate the similarity of arrhythmias. The algorithm was tested using MIT-BIH arrhythmia database and every QRS complex was classified in the database. The total number of test data was 538, 9 and 24 for normal beats, APCs and PVCs, respectively. The results are presented in terms of, performance, positive predication and sensitivity. High overall performance (99.3%) for the classification of the different categories of arrhythmic beats was achieved. The positive prediction results of the system reach 99.44%, 100% and 95.35% for normal beats, APCs and PVCs, respectively. The sensitivity results of the system are 99.81%, 81.82% and 95.83% for normal beats, APCs and PVCs, respectively. Results revealed that the system is accurate and efficient to classify arrhythmias resulted from APC or PVC. The proposed arrhythmia detection algorithm is therefore helpful to the clinical diagnosis.

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Saccilotto, Ramon. "Synkopen Management – Risikostratifikation." Therapeutische Umschau 70, no. 1 (January 1, 2013): 37–38. http://dx.doi.org/10.1024/0040-5930/a000361.

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Die San Francisco Syncope Rule (SFSR) ist eine klinische Entscheidungshilfe zur Abschätzung des kurzfristigen Risikos von Patienten, die sich mit Synkope auf dem Notfall vorstellen. Sie besteht aus fünf einfachen Punkten und wurde bereits in verschiedenen Populationen und Umgebungen validiert. Die SFSR sollte nur auf Patienten angewendet werden, bei denen in der initialen klinischen Evaluation keine zugrundeliegende Ursache gefunden werden kann. Zur Interpretation sollten zudem alle verfügbaren EKGs sowie kardiales Arrhythmie-Monitoring mit berücksichtigt werden.

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Kim, Esther D., Elsayed Z. Soliman, Josef Coresh, Kunihiro Matsushita, and Lin Yee Chen. "Two-Week Burden of Arrhythmias across CKD Severity in a Large Community-Based Cohort: The ARIC Study." Journal of the American Society of Nephrology 32, no. 3 (January 28, 2021): 629–38. http://dx.doi.org/10.1681/asn.2020030301.

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BackgroundCKD is associated with sudden cardiac death and atrial fibrillation (AF). However, other types of arrhythmia and different measures of the burden of arrhythmias, such as presence and frequency, have not been well characterized in CKD.MethodsTo quantify the burden of arrhythmias across CKD severity in 2257 community-dwelling adults aged 71–94 years, we examined associations of major arrhythmias with CKD measures (eGFR and albuminuria) among individuals in the Atherosclerosis Risk in Communities study. Participants underwent 2 weeks of noninvasive, single-lead electrocardiogram monitoring. We examined types of arrhythmia burden: presence and frequency of arrhythmias and percent time in arrhythmias.ResultsOf major arrhythmias, there was a higher prevalence of AF and nonsustained ventricular tachycardia among those with more severe CKD, followed by long pause (>30 seconds) and atrioventricular block. Nonsustained ventricular tachycardia was the most frequent major arrhythmia (with 4.2 episodes per person-month). Most participants had ventricular ectopy, supraventricular tachycardia, and supraventricular ectopy. Albuminuria consistently associated with higher AF prevalence and percent time in AF, and higher prevalence of nonsustained ventricular tachycardia. When other types of arrhythmic burden were examined, lower eGFR was associated with a lower frequency of atrioventricular block. Although CKD measures were not strongly associated with minor arrhythmias, higher albuminuria was associated with a higher frequency of ventricular ectopy.ConclusionsCKD, especially as measured by albuminuria, is associated with a higher burden of AF and nonsustained ventricular tachycardia. Additionally, eGFR is associated with less frequent atrioventricular block, whereas albuminuria is associated with more frequent ventricular ectopy. Use of a novel, 2-week monitoring approach demonstrated a broader range of arrhythmias associated with CKD than previously reported.

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Pereira, Helder, Steven Niederer, and Christopher A. Rinaldi. "Electrocardiographic imaging for cardiac arrhythmias and resynchronization therapy." EP Europace 22, no. 10 (August 5, 2020): 1447–62. http://dx.doi.org/10.1093/europace/euaa165.

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Abstract Use of the 12-lead electrocardiogram (ECG) is fundamental for the assessment of heart disease, including arrhythmias, but cannot always reveal the underlying mechanism or the location of the arrhythmia origin. Electrocardiographic imaging (ECGi) is a non-invasive multi-lead ECG-type imaging tool that enhances conventional 12-lead ECG. Although it is an established technology, its continuous development has been shown to assist in arrhythmic activation mapping and provide insights into the mechanism of cardiac resynchronization therapy (CRT). This review addresses the validity, reliability, and overall feasibility of ECGi for use in a diverse range of arrhythmias. A systematic search limited to full-text human studies published in peer-reviewed journals was performed through Medline via PubMed, using various combinations of three key concepts: ECGi, arrhythmia, and CRT. A total of 456 studies were screened through titles and abstracts. Ultimately, 42 studies were included for literature review. Evidence to date suggests that ECGi can be used to provide diagnostic insights regarding the mechanistic basis of arrhythmias and the location of arrhythmia origin. Furthermore, ECGi can yield valuable information to guide therapeutic decision-making, including during CRT. Several studies have used ECGi as a diagnostic tool for atrial and ventricular arrhythmias. More recently, studies have tested the value of this technique in predicting outcomes of CRT. As a non-invasive method for assessing cardiovascular disease, particularly arrhythmias, ECGi represents a significant advancement over standard procedures in contemporary cardiology. Its full potential has yet to be fully explored.

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Rasheed, A., M. D. Khan, A. K. Duke, M. Tofeig, A. Ng, P. Stafford, F. A. Bu'Lock, R. K. Firmin, and G. J. Peek. "Abstracts for the British Congenital Cardiac Association Annual Meeting: The Barbican, London, 24–25 November 2005: Poster Presentations: ECMO support for lifethreatening arrhythmia in infancy permits successful radiofrequency treatment." Cardiology in the Young 16, no. 3 (June 2006): 318–19. http://dx.doi.org/10.1017/s1047951106270239.

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The majority of arrhythmias presenting in infancy cardiovert readily or rapidly respond to conventional medical therapy. A small number prove highly refractory to anti-arrhythmic medications. Myocardial performance may be severely compromised by the combination of fast heart rate and negatively inotropic drugs. Some babies die. We have recently supported 2 babies with refractory arrhythmias on ECMO, both to pursue drug therapy and eventually, to support the circulation during radiofrequency ablation, with very successful results. The first patient was a 2.5 kg neonate presenting with collapse secondary to atrial ectopic tachycardia with a rate of 300/minute. Myocardial function was severely impaired. The arrhythmia was adenosine resistant and after iv amiodarone loading had no effect, esmolol infusion was started. This produced profound hypotension and the arrhythmia rapidly recommenced after DC cardioversion. In the face of such severe haemodynamic disturbance, VA ECMO was instituted. Further anti-arrhythmics were tried on-circulatory support, but the arrhythmia was incessant despite multiple DC cardioversions. Therefore radiofrequency ablation of the atrial ectopic focus was attempted on ECMO support. This was achieved uneventfully and the myocardial function rapidly improved, with decannulation 24 hours later. Unfortunately the arrhythmia recurred 2 weeks later, but was successfully treated by further ablation without ECMO. The child remains well with normal development on no medication. An 11-month-old baby presented to the GP with acute onset of lethargy and poor feeding and a heart rate of 350 bpm was noted! This was a broad complex tachycardia with independent p wave activity (confirmed with adenosine); ie ventricular tachycardia. Although initially well tolerated, the tachycardia resisted DC “cardioversion” even up to 60 J. Progressive and severe myocardial dysfunction and hypotension ensued, exacerbated by any attempts at drug therapy. The patient was therefore placed on VA ECMO. Some slowing of the ventricular rhythm was achieved with amiodarone and flecainide. The patient was then decannulated but the rapid arrhythmia recurred and ECMO was reinstituted. Electro-physiological mapping was then undertaken on ECMO support. NAVEX mapping identified a right ventricular outflow tract focus. This was resistant to conventional RF energy but was eventually successfully ablated with a “Cool-tip” catheter. Myocardial function improved rapidly, the patient was decannulated after 48 hours observation and there has been no recurrence of the arrhythmia since discharge. Although viewed as a very invasive technique, VA ECMO support here has prevented two otherwise unavoidable deaths in babies with conditions readily treated by radio-frequency techniques in older children. Not only did ECMO permit institution of aggressive drug therapy but also safely supported catheter interventions in very small patients. ECMO support should be considered early for small patients with refractory arrhythmias, before irreversible neurological compromise ensues. It could also be used electively to permit radiofrequency ablation in children whose size causes concern for safe catheter manipulation.

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Wong, OF, TSK Lam, and HT Fung. "Two Cases of Chloral Hydrate Overdose." Hong Kong Journal of Emergency Medicine 16, no. 3 (July 2009): 161–67. http://dx.doi.org/10.1177/102490790901600307.

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Chloral hydrate overdose is associated with cardiac toxicities, gastrointestinal tract injuries, central nervous system and respiratory depression. Among all the complications, cardiac arrhythmias are particularly concerning and frequently reported in the literature. The majorities of fatalities from chloral hydrate overdose are due to refractory cardiac arrhythmia. Chloral hydrate-induced arrhythmias are resistant to most of the standard anti-arrhythmic agents but have good response to propranolol. We report two cases of severe chloral hydrate overdose presenting with alarming cardiac rhythm disturbances. One of the patients was successfully treated with intravenous propranolol in the accident and emergency department. The management of chloral hydrate overdose in particular to its cardiac toxicity is reviewed.

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Kobza, Richard. "Aktuelle Therapie des Vorhofflatterns." Therapeutische Umschau 71, no. 2 (February 1, 2014): 93–97. http://dx.doi.org/10.1024/0040-5930/a000487.

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Nach Vorhofflimmern ist Vorhofflattern die häufigste anhaltende Arrhythmie. Die Therapieziele zur Behandlung von Vorhofflattern beinhalten die Verhinderung von systemischen Thrombo-Embolien, die ventrikuläre Frequenzkontrolle sowie die Wiederherstellung und Erhaltung von Sinusrhythmus (Rhythmuskontrolle). In der Akutbehandlung von Vorhofflattern ist die medikamentöse Therapie weiterhin unbestritten, jedoch hat sich das kathetertechnische Behandlungsverfahren mittels Hochfrequenzstromablation als kurative Therapie der ersten Wahl im klinischen Alltag bei rezidivierendem symptomtischem oder hämodynamisch relevantem typischem Vorhofflattern durchgesetzt. Die Thrombo-Embolie-Prophylaxe sollte bei Vorhofflattern analog wie beim Vorhofflimmern durchgeführt werden.

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Israel, C. W., J. B. Böckenförde, B. Nowak, W. Hartung, D. Gascon, G. Campanale, D. Lellouche, et al. "Automatische Speicherung von Elektrogrammen zur Arrhythmie-Erfassung bei Patienten mit VDD-Schrittmacher." Herzschrittmachertherapie und Elektrophysiologie 11, S1 (January 2000): 73–74. http://dx.doi.org/10.1007/bf03042535.

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Zygmunt, M., and W. Künzel. "Antepartales und intrapartales CTG bei fetaler Arrhythmie und hypoplastischem Linksherz-Syndrom (HLHS)." Der Gynäkologe 31, no. 4 (1998): 373. http://dx.doi.org/10.1007/s001290050273.

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Zhu, Yujie, Isaac Shamblin, Efrain Rodriguez, Grace E. Salzer, Lita Araysi, Katherine A. Margolies, Ganesh V. Halade, et al. "Progressive cardiac arrhythmias and ECG abnormalities in the Huntington’s disease BACHD mouse model." Human Molecular Genetics 29, no. 3 (December 9, 2019): 369–81. http://dx.doi.org/10.1093/hmg/ddz295.

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Abstract Huntington’s disease (HD) is a dominantly inherited neurodegenerative disease. There is accumulating evidence that HD patients have increased prevalence of conduction abnormalities and compromised sinoatrial node function which could lead to increased risk for arrhythmia. We used mutant Huntingtin (mHTT) expressing bacterial artificial chromosome Huntington’s disease mice to determine if they exhibit electrocardiogram (ECG) abnormalities involving cardiac conduction that are known to increase risk of sudden arrhythmic death in humans. We obtained surface ECGs and analyzed arrhythmia susceptibility; we observed prolonged QRS duration, increases in PVCs as well as PACs. Abnormal histological and structural changes that could lead to cardiac conduction system dysfunction were seen. Finally, we observed decreases in desmosomal proteins, plakophilin-2 and desmoglein-2, which have been reported to cause cardiac arrhythmias and reduced conduction. Our study indicates that mHTT could cause progressive cardiac conduction system pathology that could increase the susceptibility to arrhythmias and sudden cardiac death in HD patients.

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Baghel, Anita, Manoj Kumar, J. P. Soni, Mudit Agarwal, and Ravi Kumar. "Experience with Holter monitoring for evaluation of infant arrhythmia." International Journal of Contemporary Pediatrics 6, no. 3 (April 30, 2019): 1362. http://dx.doi.org/10.18203/2349-3291.ijcp20192044.

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Background: Arrhythmia is defined as abnormal heart rates. Sometimes they are intermittent and difficult to diagnose on routine ECG. Neonatologist and Pediatrician needs to rapidly establish accurate diagnosis and management for infants suspected to have arrhythmia. Hence Holter monitoring of the infants presenting with symptoms suggestive of arrhythmia is necessary as it provides a continuous record of heart’s electrical activity. The aim of this paper is to find out the role of continuous ambulatory electrocardiographic monitoring in daily clinical practice of Pediatrics.Methods: All infants including neonates, either inborn or brought to the paediatric emergency with risk factors, between January 2016 to January 2018, were included in this prospectively study. Evaluation including chest X-ray, standard 12-lead electrocardiography, 24 hours continuous ECG monitoring using Mortara holter, echocardiography, biochemical and haematological analysis.Results: A total of 73 babies were enrolled in present study. In this study arrhythmia was found in 29 (39.72%) new-borns. The most common arrhythmia observed was supraventricular tachycardia (SVT) (41.3%). Other arrhythmia observed were ventricular tachycardia (VT), AV block (34.4%), atria premature beats (3.4%) and ventricular premature beats (6.89%), tachy-bradyarrhythmia (3.4%) and junctional rhythm (3.4%). Of 29 arrhythmia patients four were diagnosed solely by Holter monitoring. None of the babies had long QT syndrome on Holter monitoring.Conclusions: Cardiac arrhythmias are important causes of infant morbidity, and mortality if undiagnosed and untreated. It is important for the neonatologist and paediatrician to be aware of these of arrhythmias and the various diagnostic modalities available for them. A Holter electrocardiogram may be of value in identification of these transient arrhythmic events.

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Rätz Bravo, Tchambaz, Krähenbühl-Melcher, Hess, Schlienger, and Krähenbühl. "Prävalenz potentieller Arzneimittelinteraktionen bei ambulanten Patienten unter Statin-Therapie." Praxis 95, no. 5 (February 1, 2006): 139–46. http://dx.doi.org/10.1024/0369-8394.95.5.139.

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Studienziel: Ziel der vorliegenden Studie war, die Prävalenz von potentiell kritischen Arzneimittelinterkationen (AMI) bei ambulanten Patienten unter Statin-Therapie zu bestimmen. Methoden: Die Daten (Alter, Geschlecht, Statin, Komorbiditäten, Anzahl verschriebener Medikamente, Anzahl Diagnosen) wurden von 242 niedergelassenen Ärzten unterschiedlicher Fachausrichtung erfasst. Die Medikation wurde mittels eines computerisierten AMI-Programms auf potentiell kritische AMI gescreent. Resultate: Es wurden 2742 Patienten, die mit einem Statin therapiert wurden, in die Studie eingeschlossen. Das Durchschnittsalter lag bei 65.1+/-11.2 (Standardabweichung) Jahren, die Patienten hatte durchschnittlich 3.2+/-1.6 Diagnosen und 4.9+/-2.4 verschriebene Arzneimittel. Sie stammten zu 53.3% aus der Deutschschweiz, 36.0% kamen aus der Romandie und 10.7% aus der italienisch-sprechenden Schweiz. Von 2742 Patienten hatten 401 (14.6%) insgesamt 591 potentiell kritische AMI; 190 Patienten (6.9%) hatten eine potentiell kritische Statin-Interaktion, 288 (10.5%) eine potentiell kritische Nicht-Statin-Interaktion. Die Prävalenz der AMI war in den verschiedenen Sprachregionen vergleichbar und zeigte keine Unterschiede bezüglich jeweiligem Fachgebiet des verschreibenden Arztes. Wichtige Risikofaktoren für potentiell kritische AMI waren die Anzahl verschriebener Arzneimittel sowie eine Diagnose einer Herzinsuffizienz oder Arrhythmie. Schlussfolgerung: Potentiell kritische AMI bei Patienten unter Statin-Therapie sind – aufgrund der Pharmakotherapie anderer Komorbiditäten – häufig. Ein spezielles Augenmerk sollte in dieser Population auf Patienten mit Polypharmazie sowie einer Pharmakotherapie für Arrhythmien respektive Herzinsuffizienz gerichtet sein.

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Liu, Yan, Hong-li Sun, Dan-lu Li, Li-yan Wang, Yang Gao, Yu-ping Wang, Zhi-min Du, Yan-jie Lu, and Bao-feng Yang. "Choline produces antiarrhythmic actions in animal models by cardiac M3 receptors: improvement of intracellular Ca2+ handling as a common mechanism." Canadian Journal of Physiology and Pharmacology 86, no. 12 (December 2008): 860–65. http://dx.doi.org/10.1139/y08-094.

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It is well known that choline has protective effects on ischemic arrhythmias. We designed the present study to evaluate the antiarrhythmic effects of choline and to detect its related mechanisms in aconitine-induced rat and ouabain-induced guinea pig models of arrhythmia. Laser scanning confocal microscopy and patch-clamp technique were utilized to study the action of choline on intracellular calcium concentration and L-type calcium current (ICa-L) of cardiac myocytes. M3 receptor antagonist 4-DAMP (4-diphenylacetoxy-N-methylpiperidine-methiodide) was applied preliminarily to evaluate the role of the M3 receptor. Choline significantly increased the survival time of arrhythmic rats and guinea pigs, delayed the onset of arrhythmias and ventricular tachycardia, and decreased the arrhythmia score. The overload of intracellular Ca2+ induced by aconitine or ouabain was reduced in isolated myocytes pretreated with choline. Choline reduced the increased density of ICa-L induced by aconitine or ouabain. Moreover, the beneficial effects of choline were reversed by 4-DAMP. Choline produced antiarrhythmic actions on arrhythmia models by stimulating the cardiac M3 receptor. The mechanism may be related to the improvement of Ca2+ handling.

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Thiruganasambandamoorthy, V., M. Sivilotti, M. A. Mukarram, C. Leafloor, K. Arcot, G. A. Wells, B. H. Rowe, A. Krahn, L. Huang, and M. Taljaard. "LO98: Optimal length of observation for emergency department patients with syncope: a time to event analysis." CJEM 19, S1 (May 2017): S62. http://dx.doi.org/10.1017/cem.2017.160.

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Introduction: Concern for occult serious conditions leads to variations in ED syncope management [hospitalization, duration of ED/inpatient monitoring including Syncope Observation Units (SOU) for prolonged monitoring]. We sought to develop evidence-based recommendations for duration of ED/post-ED ECG monitoring using the Canadian Syncope Risk Score (CSRS) by assessing the time to serious adverse event (SAE) occurrence. Methods: We enrolled adults with syncope at 6 EDs and collected demographics, time of syncope and ED arrival, CSRS predictors and time of SAE. We stratified patients as per the CSRS (low, medium and high risk as ≤0, 1-3 and ≥4 respectively). 30-day adjudicated SAEs included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism or serious hemorrhage. We categorized arrhythmias, interventions for arrhythmias and death from unknown cause as arrhythmic SAE and the rest as non-arrhythmic SAE. We performed Kaplan-Meier analysis using time of ED registration for primary and time of syncope for secondary analyses. Results: 5,372 patients (mean age 54.3 years, 54% females, and 13.7% hospitalized) were enrolled with 538 (10%) patients suffering SAE (0.3% died due to an unknown cause and 0.5% suffered ventricular arrhythmia). 64.8% of SAEs occurred within 6 hours of ED arrival. The probability for any SAE or arrhythmia was highest within 2-hours of ED arrival for low-risk patients (0.65% and 0.31%; dropped to 0.54% and 0.06% after 2-hours) and within 6-hours for the medium and high-risk patients (any SAE 6.9% and 17.4%; arrhythmia 6.5% and 18.9% respectively) which also dropped after 6-hours (any SAE 0.99% and 2.92%; arrhythmia 0.78% and 3.07% respectively). For any CSRS threshold, the risk of arrhythmia was highest within the first 15-days (for CSRS ≥2 patients 15.6% vs. 0.006%). ED monitoring for 2-hours (low-risk) and 6-hours (medium and high-risk) and using a CSRS ≥2 cut-off for outpatient 15-day ECG monitoring will lead to 52% increase in arrhythmia detection. The majority (82.2%) arrived to the ED within 2-hours (median time 1.1 hours) and secondary analysis yielded similar results. Conclusion: Our study found 2 and 6 hours of ED monitoring for low-risk and medium/high-risk CSRS patients respectively, with 15-day outpatient ECG monitoring for CSRS ≥2 patients will improve arrhythmia detection without the need for hospitalization or observation units.

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Parianos, Danaë, and Ardan M. Saguner. "CME." Praxis 106, no. 5 (February 2017): 235–41. http://dx.doi.org/10.1024/1661-8157/a002638.

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Zusammenfassung. Das Brugada-Syndrom ist ein seltenes, meist familiäres Arrhythmie-Syndrom mit autosomal-dominantem Vererbungsmuster und stellt eine wichtige Differenzialdiagnose von rhythmogenen Synkopen bzw. überlebtem plötzlichen Herztod bei jungen Erwachsenen ohne strukturelle Herzerkrankung dar. Die Diagnostik ist meist erschwert, da die pathognomonischen EKG-Zeichen häufig transient sind und zur definitiven Diagnose oft eine medikamentöse Demaskierung mittels Natriumblocker nötig ist. Die ICD-Implantation ist die einzige effektive Therapie zur Prävention des plötzlichen Herztodes. Für die diesbezügliche Therapieentscheidung ist vor allem bei Zufallsbefunden und asymptomatischen Patienten eine individuelle Risikostratifizierung nötig.

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Batul, Syeda Atiqa, Brian Olshansky, John D. Fisher, and Rakesh Gopinathannair. "Recent advances in the management of ventricular tachyarrhythmias." F1000Research 6 (June 29, 2017): 1027. http://dx.doi.org/10.12688/f1000research.11202.1.

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Ventricular arrhythmias are an important cause of cardiovascular morbidity and mortality, particularly in those with structural heart disease, inherited cardiomyopathies, and channelopathies. The goals of ventricular arrhythmia management include symptom relief, improving quality of life, reducing implantable cardioverter defibrillator shocks, preventing deterioration of left ventricular function, reducing risk of arrhythmic death, and potentially improving overall survival. Guideline-directed medical therapy and implantable cardioverter defibrillator implantation remain the mainstay of therapy to prevent sudden cardiac death in patients with ventricular arrhythmias in the setting of structural heart disease. Recent advances in imaging modalities and commercial availability of genetic testing panels have enhanced our mechanistic understanding of the disease processes and, along with significant progress in catheter-based ablative therapies, have enabled a tailored and more effective management of drug-refractory ventricular arrhythmias. Several gaps in our knowledge remain and require further research. In this article, we review the recent advances in the diagnosis and management of ventricular arrhythmias.

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Harkness, Weston, Paula Watts, Michael Kopstein, Oliwier Dziadkowiec, Gregory Hicks, and Dmitriy Scherbak. "Correcting Hypokalemia in Hospitalized Patients Does Not Decrease Risk of Cardiac Arrhythmias." Advances in Medicine 2019 (September 24, 2019): 1–4. http://dx.doi.org/10.1155/2019/4919707.

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Background. It is currently standard practice to correct hypokalemia for the purpose of preventing cardiac arrhythmias in all hospitalized patients. However, the efficacy of this intervention has never been previously studied. Objective. The objective of our study was to evaluate whether patients without acute coronary syndrome or history of arrhythmias were at increased risk of clinically significant cardiac arrhythmias if their potassium level was not corrected to ≥3.5 mEq/L. Design. A retrospective case control study. Setting. A community hospital. Participants. We enrolled selected patients who had episodes of hypokalemia during their hospital stay and were monitored on telemetry. Patients were split into groups based on success of replacing serum potassium to ≥3.5 mEq/L after 24 hours. Measurements. The primary outcome was the development of an arrhythmia. Arrhythmias included supraventricular tachycardia, atrial fibrillation, atrial flutter, Mobitz type II second-degree or third-degree AV block, ventricular tachycardia, or ventricular fibrillation. A one-tailed Fisher’s exact test and logistic regression were used for analysis. Results. A total of 1338 hypokalemic patient days were recorded. Out of these days, 22 arrhythmia events (1.6% of patient days) were observed, 8 in the uncorrected group (1% patient days) and 14 in the corrected group (2.6% patient days). We found no statistically significant relationship between successfully correcting potassium to ≥3.5 mEq/L and number of arrhythmic events (p=0.037, OR = 2.38 (95% CI: 0.99, 6.03)). Logistic regression revealed that correction of potassium does not seem to be significantly related to arrhythmias (β = 0.869, p=0.0517). Conclusions. In the acute care setting, we found that patients with hypokalemia whose potassium level did not correct to ≥3.5 mEq/L were not at increased odds of having an arrhythmia. This study suggests that the common practice of checking and replacing potassium is likely inconsequential.

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Kwon, Soonil, So-Ryoung Lee, Eue-Keun Choi, Hyo-Jeong Ahn, Hee-Seok Song, Young-Shin Lee, and Seil Oh. "Validation of Adhesive Single-Lead ECG Device Compared with Holter Monitoring among Non-Atrial Fibrillation Patients." Sensors 21, no. 9 (April 30, 2021): 3122. http://dx.doi.org/10.3390/s21093122.

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There are few reports on head-to-head comparisons of electrocardiogram (ECG) monitoring between adhesive single-lead and Holter devices for arrhythmias other than atrial fibrillation (AF). This study aimed to compare 24 h ECG monitoring between the two devices in patients with general arrhythmia. Twenty-nine non-AF patients with a workup of pre-diagnosed arrhythmias or suspicious arrhythmic episodes were evaluated. Each participant wore both devices simultaneously, and the cardiac rhythm was monitored for 24 h. Selective ECG parameters were compared between the two devices. Two cardiologists independently compared the diagnoses of each device. The two most frequent monitoring indications were workup of premature atrial contractions (41.4%) and suspicious arrhythmia-related symptoms (37.9%). The single-lead device had a higher noise burden than the Holter device (0.04 ± 0.05% vs. 0.01 ± 0.01%, p = 0.024). The number of total QRS complexes, ventricular ectopic beats, and supraventricular ectopic beats showed an excellent degree of agreement between the two devices (intraclass correlation coefficients = 0.991, 1.000, and 0.987, respectively). In addition, the minimum/average/maximum heart rates showed an excellent degree of agreement. The two cardiologists made coherent diagnoses for all 29 participants using both monitoring methods. In conclusion, the single-lead adhesive device could be an acceptable alternative for ambulatory ECG monitoring in patients with general arrhythmia.

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Jecht, M. "Kardiale Arrhythmie und nächtliche Hypoglykämie bei Patienten mit einem Diabetes mellitus Typ 1." Der Diabetologe 5, no. 2 (March 2009): 122–23. http://dx.doi.org/10.1007/s11428-009-0395-z.

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Лидохова, O. Lidokhova, Макеева, A. Makeeva, Тумановский, Yu Tumanovskiy, Крюков, et al. "Hyperbaric oxygen correction of experimental cardiac arrhythmias caused by the aconitine." Journal of New Medical Technologies. eJournal 8, no. 1 (November 5, 2014): 1–4. http://dx.doi.org/10.12737/4111.

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In experiments on white rats the authors simulated the cardiac arrhythmias with intravenous introduction of the Aconitine (30 mg / kg body weight) and the registration of ECG II standard lead. Introduction of the Aconitine in rats caused abnormal heart rhythm as a function of changes in excitability, which was manifested in the emergence of paired and group of ventricular arrythmias. Electrocardiographic changes in the rats were observed and were associated with the development of hypoxia in the myocardium and metabolic disorders of electrolytes at excessive accumulation of sodium ions in cardiomyocytes. Arrhythmia caused death of all experimental animals within 120 minutes after drag introduction. Application of hyperbaric oxygenation (HBO) (300 kPa, 60 min) in animals with Aconitine arrhythmia contributed to the recovery of heart rate to 40-min HBO session. After decompression, the viability of experimental animals during the first 120 minutes of observation was 70%. Positive effect of hyperbaric oxygen at aconitine arrhythmias is due to elimination of hypoxia, reduction of energy deficit in the myocardium and normalization of electrolyte metabolism in the heart muscle. The obtained results allow the authors to recommend a method of HBO as an important component in the complex treatment of cardiac arrhythmias by means of the pharmacological anti-arrhythmic drags.

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Deanfield, John E., Seamus Cullen, and Marc Gewillig. "Arrhythmias after surgery for complete transposition: Do they matter?" Cardiology in the Young 1, no. 1 (January 1991): 91–96. http://dx.doi.org/10.1017/s1047951100000147.

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SummaryConcern about long-term complications after intraatrial repair of complete transposition has been used as an argument in favor of “anatomic” repair by the arterial switch operation. Late arrhythmias, including loss of sinus rhythm and the development of supraventricular tachycardias, particularly atrial flutter, are widely reported after intraatrial repair. Despite modifications of technique, the electrophysiologic substrate for arrhythmia results from the extensive atrial surgery required. Arrhythmias occur, even in the “modern surgical era” after both Mustard and Senning operations, are progressive, and appear to be inevitable. The circulation after an intraatrial repair is more vulnerable to the effects of excessive tachycardia, and this may place the patient at risk from sudden cardiac death. Current attempts at individual stratification of risk are disappointing using even aggressive electrophysiologic approaches, and a combined assessment involving hemodynamics is likely to be necessary. The electrophysiologic and arrhythmic consequences of the arterial switch operation have been less extensively researched but, as might be expected, are quite different from those seen after intraatrial repair. The atrial activation sequence is relatively undisturbed, and sinus nodal dysfunction and supraventricular arrhythmia are uncommon. Ventricular extrasystoles are the arrhythmia most consistently found during the short follow-up currently available. In the longer term, myocardial ischemia, hemodynamic disturbances and autonomic imbalance may predispose to late arrhythmia. Current evidence would suggest that the lack of clinically significant arrhythmia and the restoration of the left ventricle to the systemic circulation are significant advantages of the arterial switch operation over intraatrial repair procedures.

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Garson, Arthur. "Ventricular arrhythmias after repair of congenital heart disease: Who needs treatment?" Cardiology in the Young 1, no. 3 (July 1991): 177–81. http://dx.doi.org/10.1017/s1047951100000342.

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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.

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Wagner, Michael, Mirna S. Sadek, Nataliya Dybkova, Fleur E. Mason, Johann Klehr, Rebecca Firneburg, Eleder Cachorro, et al. "Cellular Mechanisms of the Anti-Arrhythmic Effect of Cardiac PDE2 Overexpression." International Journal of Molecular Sciences 22, no. 9 (May 1, 2021): 4816. http://dx.doi.org/10.3390/ijms22094816.

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Background: Phosphodiesterases (PDE) critically regulate myocardial cAMP and cGMP levels. PDE2 is stimulated by cGMP to hydrolyze cAMP, mediating a negative crosstalk between both pathways. PDE2 upregulation in heart failure contributes to desensitization to β-adrenergic overstimulation. After isoprenaline (ISO) injections, PDE2 overexpressing mice (PDE2 OE) were protected against ventricular arrhythmia. Here, we investigate the mechanisms underlying the effects of PDE2 OE on susceptibility to arrhythmias. Methods: Cellular arrhythmia, ion currents, and Ca2+-sparks were assessed in ventricular cardiomyocytes from PDE2 OE and WT littermates. Results: Under basal conditions, action potential (AP) morphology were similar in PDE2 OE and WT. ISO stimulation significantly increased the incidence of afterdepolarizations and spontaneous APs in WT, which was markedly reduced in PDE2 OE. The ISO-induced increase in ICaL seen in WT was prevented in PDE2 OE. Moreover, the ISO-induced, Epac- and CaMKII-dependent increase in INaL and Ca2+-spark frequency was blunted in PDE2 OE, while the effect of direct Epac activation was similar in both groups. Finally, PDE2 inhibition facilitated arrhythmic events in ex vivo perfused WT hearts after reperfusion injury. Conclusion: Higher PDE2 abundance protects against ISO-induced cardiac arrhythmia by preventing the Epac- and CaMKII-mediated increases of cellular triggers. Thus, activating myocardial PDE2 may represent a novel intracellular anti-arrhythmic therapeutic strategy in HF.

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Drakopoulou, Maria, Heba Nashat, Aleksander Kempny, Rafael Alonso-Gonzalez, Lorna Swan, Stephen J. Wort, Laura C. Price, et al. "Arrhythmias in adult patients with congenital heart disease and pulmonary arterial hypertension." Heart 104, no. 23 (May 18, 2018): 1963–69. http://dx.doi.org/10.1136/heartjnl-2017-312881.

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ObjectivesApproximately 5%–10% of adults with congenital heart disease (CHD) develop pulmonary arterial hypertension (PAH), which affects life expectancy and quality of life. Arrhythmias are common among these patients, but their incidence and impact on outcome remains uncertain.MethodsAll adult patients with PAH associated with CHD (PAH-CHD) seen in a tertiary centre between 2007 and 2015 were followed for new-onset atrial or ventricular arrhythmia. Clinical variables associated with arrhythmia and their relation to mortality were assessed using Cox analysis.ResultsA total of 310 patients (mean age 34.9±12.3 years, 36.8% male) were enrolled. The majority had Eisenmenger syndrome (58.4%), 15.2% had a prior defect repair and a third had Down syndrome. At baseline, 14.2% had a prior history of arrhythmia, mostly supraventricular arrhythmia (86.4%). During a median follow-up of 6.1 years, 64 patients developed at least one new arrhythmic episode (incidence 3.47% per year), mostly supraventricular tachycardia or atrial fibrillation (78.1% of patients). Arrhythmia was associated with symptoms in 75.0% of cases. The type of PAH-CHD, markers of disease severity and prior arrhythmia were associated with arrhythmia during follow-up. Arrhythmia was a strong predictor of death, even after adjusting for demographic and clinical variables (HR 3.41, 95% CI 2.10 to 5.53, p<0.0001).ConclusionsArrhythmia is common in PAH-CHD and is associated with an adverse long-term outcome, even when managed in a specialist centre.

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Cannatà, Antonio, Giulia De Angelis, Andrea Boscutti, Camilla Normand, Jessica Artico, Piero Gentile, Massimo Zecchin, Stephane Heymans, Marco Merlo, and Gianfranco Sinagra. "Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction." Heart 106, no. 9 (January 21, 2020): 656–64. http://dx.doi.org/10.1136/heartjnl-2019-315942.

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Sudden cardiac death and arrhythmia-related events in patients with non-ischaemic dilated cardiomyopathy (NICM) have been significantly reduced over the last couple of decades as a result of evidence-based pharmacological and non-pharmacological therapeutic strategies. Nevertheless, the arrhythmic stratification in patients with NICM remains extremely challenging, and the simple indication based on left ventricular ejection fraction appears to be insufficient. Therefore, clinicians need to go beyond the current criteria for implantable cardioverter-defibrillator implantation in the direction of a multiparametric evaluation of arrhythmic risk. Several parameters for arrhythmic risk stratification, ranging from electrocardiographic, echocardiographic, imaging-derived and genetic markers, are crucial for proper arrhythmic risk stratification and a multiparametric evaluation of risk in patients with NICM. In particular, integration of cardiac magnetic resonance parameters (mostly late gadolinium enhancement) and specific genetic information (ie, presence of LMNA, PLN, FLNC mutations) appears fundamental for proper implementation of the current arrhythmic risk stratification. Finally, a novel approach focused on both arrhythmic risk and prediction of left ventricular reverse remodelling during follow-up might be useful for effective multiparametric and dynamic arrhythmic risk stratification in NICM. In the future, a complete and integrated evaluation might be mandatory to implement arrhythmic risk prediction in patients with NICM and to discriminate the competing risk between heart failure-related events and life-threatening arrhythmias.

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Shomanova, Zornitsa, Bernhard Ohnewein, Christiane Schernthaner, Killian Höfer, Christian A. Pogoda, Gerrit Frommeyer, Bernhard Wernly, et al. "Classic and Novel Biomarkers as Potential Predictors of Ventricular Arrhythmias and Sudden Cardiac Death." Journal of Clinical Medicine 9, no. 2 (February 20, 2020): 578. http://dx.doi.org/10.3390/jcm9020578.

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Sudden cardiac death (SCD), most often induced by ventricular arrhythmias, is one of the main reasons for cardiovascular-related mortality. While coronary artery disease remains the leading cause of SCD, other pathologies like cardiomyopathies and, especially in the younger population, genetic disorders, are linked to arrhythmia-related mortality. Despite many efforts to enhance the efficiency of risk-stratification strategies, effective tools for risk assessment are still missing. Biomarkers have a major impact on clinical practice in various cardiac pathologies. While classic biomarkers like brain natriuretic peptide (BNP) and troponins are integrated into daily clinical practice, inflammatory biomarkers may also be helpful for risk assessment. Indeed, several trials investigated their application for the prediction of arrhythmic events indicating promising results. Furthermore, in recent years, active research efforts have brought forward an increasingly large number of “novel and alternative” candidate markers of various pathophysiological origins. Investigations of these promising biological compounds have revealed encouraging results when evaluating the prediction of arrhythmic events. To elucidate this issue, we review current literature dealing with this topic. We highlight the potential of “classic” but also “novel” biomarkers as promising tools for arrhythmia prediction, which in the future might be integrated into clinical practice.

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Abdel Gawad, Tarek Ahmed, Waleed Mohamed Elguindy, Omneya Ibrahim Youssef, and Tamer Ashraf Abosalem. "The Prevalence and Risk Factors of Early Arrhythmias Following Pediatric Open Heart Surgery in Egyptian Children." Open Access Macedonian Journal of Medical Sciences 5, no. 7 (December 5, 2017): 940–44. http://dx.doi.org/10.3889/oamjms.2017.177.

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Abstract:

AIM: This study aimed to assess the prevalence of early postoperative arrhythmias after cardiac operation in the pediatric population, and to analyse possible risk factors.MATERIAL AND METHODS: Cross-sectional study included 30 postoperative patients, with age range four up to 144 months. They were selected from those admitted to the Cardiology Unit in the Pediatric department of Ain Shams University hospitals, after undergoing cardiopulmonary bypass (CPB) surgery for correction of congenital cardiac defects. All patients had preoperative sinus rhythm and normal preoperative electrolytes levels. All patients’ records about age, weight, type of surgery, intraoperative arrhythmias, cardiopulmonary bypass time, ischemic time and use of inotropic drugs were taken before they were admitted to the specialised pediatric post-surgery intensive care unit (ICU).RESULTS: Arrhythmia was documented in 15 out of 30 patients (50%). Statistically significant difference between the arrhythmic and non-arrhythmic group were recorded in relation to the age of operation (23 vs 33 months), weight (12 vs. 17 kg), ischemic time (74.5 vs. 54 min), cardiopulmonary bypass time (125.5 vs. 93.5min), inotrope use (1.6 vs. 1.16) and postoperative ICU stay (5.8 vs. 2.7 days), P<0.05.CONCLUSION: Early postoperative arrhythmias following surgery for congenital heart disease are relatively frequent in children (50%).Younger age, lower body weight, longer ischemic time and bypass time, and more inotrope use are all risk factors for postoperative arrhythmias and lead to increase the hospital stay.

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Journal articles on the topic 'Arrhythmie'

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