scholarly journals Atrial Arrhythmias in Pulmonary Hypertension: Pathogenesis, Prognosis and Management

2018 ◽  
Vol 7 (1) ◽  
pp. 43 ◽  
Author(s):  
Brett Wanamaker ◽  
Thomas Cascino ◽  
Vallerie McLaughlin ◽  
Hakan Oral ◽  
Rakesh Latchamsetty ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Atrial Flutter ◽  
Clinical Outcomes ◽  
Current Evidence ◽  
Atrial Arrhythmias ◽  
Practical Implications

Atrial arrhythmias, including atrial fibrillation and atrial flutter, are common in patients with pulmonary hypertension and are closely associated with clinical decompensation and poor clinical outcomes. The mechanisms of arrhythmogenesis and subsequent clinical decompensation are reviewed. Practical implications and current evidence for the management of atrial arrhythmias in patients with pulmonary hypertension are summarised.

scholarly journals Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA2DS2-VASc Score

2018 ◽  
Vol 1 (4) ◽  
pp. e180941 ◽  
Author(s):  
Yu-Sheng Lin ◽  
Yung-Lung Chen ◽  
Tien-Hsing Chen ◽  
Ming-Shyan Lin ◽  
Chi-Hung Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Clinical Outcomes

The Atrial Fibrillation Better Care (ABC) pathway in atrial fibrillation: a systematic review and meta-analysis of 285,000 patients

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
GF Romiti ◽  
D Pastori ◽  
JM Rivera-Caravaca ◽  
WY Ding ◽  
YX Gue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Random Effect ◽  
Significant Proportion ◽  
Cardiovascular Death ◽  
Current Evidence ◽  
Meta Regression

Abstract Funding Acknowledgements Type of funding sources: None. Background The ‘Atrial Fibrillation Better Care’ (ABC) pathway has been recently proposed as a holistic approach for the comprehensive management of patients with Atrial Fibrillation (AF), standing on three main pillars: ‘A’ Avoid stroke (with Anticoagulants); ‘B’ Better symptom management; ‘C’ Cardiovascular and Comorbidity management. The ABC pathway is now recommended in several clinical guidelines, including the recent European Society of Cardiology (ESC) AF management guidelines. We performed a systematic review of the current evidence for use of the ABC pathway on clinical outcomes. Methods We performed a systematic review and meta-analysis according to PRISMA Guidelines. Pubmed and EMBASE were searched for studies reporting the prevalence of ABC pathway adherent management in AF patients, and its impact on clinical outcomes (all-cause death, cardiovascular death, stroke, and major bleeding). Metanalysis of odds ratio (OR) was performed with random-effect models; subgroup analysis and meta-regression were performed to account for heterogeneity; a CHA2DS2-VASc-stratified sensitivity analysis was also performed. Results Among 2862 records retrieved from the literature search, 8 studies were included. The pooled prevalence of ABC adherent management was 21% (95% confidence intervals (CI), 13-34%), with a high grade of heterogeneity; in a multivariable meta-regression model, adherence to each criteria of the ABC pathway explained most part of the heterogeneity (R2 = 98.9%). Patients treated according to the ABC pathway showed a lower risk of all-cause death (OR:0.42, 95%CI 0.31-0.56), cardiovascular death (OR:0.37, 95%CI 0.23-0.58), stroke (OR:0.55, 95%CI 0.37-0.82) and major bleeding (OR:0.69, 95%CI 0.51-0.94), with moderate heterogeneity. Meta-regressions showed that the increasing prevalence of diabetes mellitus, coronary artery disease, chronic heart failure and history of stroke were associated with a reduced effectiveness of the ABC pathway for all-cause and cardiovascular death; each comorbidity was able to explain a significant proportion of heterogeneity at univariate meta-regression. Conversely, longer follow-up time was associated with more effectiveness of the ABC pathway for all outcomes. Adherence to ABC pathway was associated with a progressively greater reduction of the all-cause death risk amongst patients with higher CHA2DS2-VASc scores; no difference in ABC pathway effectiveness was found across CHA2DS2-VASc strata for CV death and stroke occurrence. Conclusions Adherence to the ABC pathway was suboptimal, being adopted in 1 in every 5 patients. Adherence to the ABC pathway was associated with a reduction in the risk of major adverse outcomes. Our data supports extensive application of the ABC pathway for the management of AF. Abstract Figure.

Arrhythmias, conduction disturbances, and neurocardiogenic syncope

2010 ◽  
pp. 113-174
Author(s):  
Juan Carlos Kaski
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Paroxysmal Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Acute Onset ◽  
Atrial Arrhythmias ◽  
Neurocardiogenic Syncope ◽  
Conduction Disturbances ◽  
Permanent Atrial Fibrillation ◽  
Onset Atrial Fibrillation

Atrial fibrillation 114 New (acute)-onset atrial fibrillation 116 Paroxysmal atrial fibrillation 118 Persistent atrial fibrillation 120 Permanent atrial fibrillation 122 Secondary atrial fibrillation 124 Drugs used in electrical and chemical cardioversion 126 Antithrombotic treatment 128 Atrial flutter 132 Supraventricular (narrow complex) tachycardias 134 Landmark trials for atrial arrhythmias ...

scholarly journals The Short QTc Is a Marker for the Development of Atrial Flutter and Atrial Fibrillation

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Simon W. Rabkin ◽  
Jacky K. K. Tang
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Qt Interval ◽  
Atrial Arrhythmias ◽  
Exclusion Criteria ◽  
Bundle Branch Block ◽  
Qt Intervals ◽  
Ecg Database ◽  
Age And Sex ◽  
Important Marker

A short QT interval has been difficult to define, and there is debate whether it exists outside of an extremely small group of individuals with inherited channelopathies and whether it predicts cardiac arrhythmias. The objective was to identify cases with short QT and their consequences. Our hospital ECG database was screened for cases with a QTc based on the Bazett formula (QTcBZT) of less than 340 ms. The QTc was recalculated using the spline (QTcRBK) formula, which more accurately adjusts for the heart rate and identifies cases based on percentile distribution of the QT interval. The exclusion criteria were presence of bundle branch block, arrhythmias, or electronic pacemakers. An age- and sex-matched cohort was obtained from individuals with normal QT intervals with the same exclusion criteria. There were 28 cases with a short QTc (QTcRBK < 380 ms). The age was 69.6 ± 14.6 years (mean ± SD) (50% males). The QT interval was 305.7 ± 61.1 ms with QTcRBK 308.4 ± 31.4 ms. Subsequent ECGs showed atrial flutter in 21%, atrial fibrillation in 18%, and atrial tachycardia in 4% of cases. Thus, atrial arrhythmias occurred in 43% of cases. This incidence was significantly ( p < 0.0001 ) greater than the incidence of atrial arrhythmias in age- and sex-matched controls. In conclusion, a short QT interval can be readily identified based on the first percentile of the new QTc formula. A short QTc is an important marker for the development of atrial arrhythmias, including atrial flutter and atrial fibrillation, with the former predominating. It should be part of patient assessment and warrants consideration to develop strategies for detection and prevention of atrial arrhythmias.

scholarly journals Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1149-1161 ◽  
Author(s):  
Axel Brandes ◽  
Harry J G M Crijns ◽  
Michiel Rienstra ◽  
Paulus Kirchhof ◽  
Erik L Grove ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Control Strategy ◽  
Rhythm Control ◽  
Current Evidence ◽  
Thromboembolic Complications ◽  
Common Procedure ◽  
Risk Factors For Recurrence ◽  
Practical Guidance ◽  
Pharmacological Cardioversion

Abstract Cardioversion is widely used in patients with atrial fibrillation (AF) and atrial flutter when a rhythm control strategy is pursued. We sought to summarize the current evidence on this important area of clinical management of patients with AF including electrical and pharmacological cardioversion, peri-procedural anticoagulation and thromboembolic complications, success rate, and risk factors for recurrence to give practical guidance.

Model assisted biosignal analysis of atrial electrograms

2016 ◽  
Vol 83 (2) ◽  
pp. 102-111
Author(s):  
Olaf Dössel ◽  
Gustavo Lenis ◽  
Axel Loewe ◽  
Markus Rottmann ◽  
Gunnar Seemann ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Data Analysis ◽  
Atrial Flutter ◽  
Human Heart ◽  
Plane Waves ◽  
Ground Truth ◽  
Atrial Arrhythmias ◽  
Biosignal Analysis ◽  
Electric Signals ◽  
Extract Information

Abstract Cardiologists measure electric signals inside the human heart aiming at a better diagnosis and optimized therapy of atrial arrhythmias like atrial flutter and atrial fibrillation. The catheters that are used for this purpose are improving: now they are able to pick up the electric signals at up to 64 positions inside the heart simultaneously. The patterns of electric depolarization are sometimes very simple, comparable to plane waves. But in case of patients with severe atrial arrhythmias they can be quite complex: U-turns around a line of block, ectopic centres, break throughs, reentry circuits, rotors, fractionated signals and chaotic patterns are often observed. Methods of biosignal analysis can support the cardiologists in classifying the signals and extract information of high diagnostic relevance. Computer models of the electrophysiology of the human heart can serve to design better algorithms for data analysis and to test algorithms, because the “ground truth” is known.

scholarly journals Flecainide-Induced Atrial Flutter With 1:1 Conduction Complicated by Ventricular Fibrillation After Electrical Cardioversion

2021 ◽  
Vol 48 (2) ◽  
Author(s):  
Timothy Colangelo ◽  
Drew Johnson ◽  
Reginald Ho
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
High Risk ◽  
Ventricular Fibrillation ◽  
Atrial Flutter ◽  
Electrical Cardioversion ◽  
Emergency Medical Technicians ◽  
Atrial Arrhythmias ◽  
High Risk Patients ◽  
Risk Patients

Flecainide, a widely prescribed class IC agent used to treat atrial arrhythmias, can in rare cases cause 1:1 atrial flutter with rapid conduction. We describe the case of a 59-year-old man who was on a maintenance regimen of flecainide for refractory atrial fibrillation. When 1:1 atrial flutter with rapid conduction developed, emergency medical technicians attempted synchronized cardioversion, which caused ventricular fibrillation necessitating defibrillation. The patient ultimately underwent radiofrequency ablation and cryoablation to resolve his symptomatic atrial flutter. We discuss the atrial proarrhythmic effects of flecainide and how to mitigate complications in high-risk patients.

scholarly journals Subjective identification and ablation of drivers in persistent atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Franco ◽  
C Lozano-Granero ◽  
R Matia ◽  
A Hernandez-Madrid ◽  
I Sanchez-Perez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Atrial Flutter ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Atrial Arrhythmias ◽  
Ablation Success ◽  
Tailored Approach ◽  
Approach Group

Abstract Background Ablation of drivers in persistent atrial fibrillation (AF) has shown controversial results. Purpose To test the efficacy of a tailored approach for persistent AF ablation which includes pulmonary vein isolation (PVI) plus “subjective” identification and ablation of drivers. Methods From May 2017 to December 2019, selected patients with persistent AF and ongoing AF at the beginning of the ablation procedure were included. Conventional high-density mapping catheters (PentaRay NAV, IntellaMap Orion or Advisor HD Grid) were used. Drivers were subjectively identified as: a) fractionated continuous (or quasi-continuous) electrograms on 1–2 adjacent bipoles, without dedicated software (Figure 1A, dashed line; PR = PentaRay NAV); and b) sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles (Figure 1B, arrows; in panels A and B: paper speed 200 mm/s; ORB = 24-pole ORBITER Woven catheter, blue bipoles around tricuspid annulus and green bipoles into the coronary sinus). Ablation included PVI + focal or linear ablation targeting sites with drivers. Ablation success was defined as conversion to sinus rhythm or atrial flutter during ablation. Follow-up included visits with 24h Holter ECG at 3–6–12 months. Survival free from atrial arrhythmias lasting &gt;30 seconds was compared between patients ablated with this tailored approach, and all consecutive patients with persistent AF treated with a PVI-only strategy during the same period. Results 158 Patients received ablation: 35 with the tailored approach (61,7±10,2 years; 29% females) and 123 with only PVI (62,5±9,6 years; 25% females; 89% cryoablation). Basal characteristics were similar (Table 1). In the tailored-approach group, 14 patients (40%) presented 28 detectable sites with continuous fractionated electrograms, 26 on the left atrium and 2 on the right atrium, which was only mapped if ablation of drivers in the left atrium was not successful; 12 (43%) were located within the pulmonary vein antra. 27 patients (77%) showed 103 sites with spatiotemporal dispersion (4 [3–5] per patient). Ablation success was achieved in 17 patients (48%; conversion to sinus rhythm, n=7; conversion to atrial flutter, n=10) in the tailored-approach group and 1 patient (0,8%, sinus rhythm) in the PVI-only group. Excluding a 3-month blanking period, the tailored approach, compared to only PVI, improved one-year freedom from atrial arrhythmias (71% Vs 51%, p=0,05) and mean survival free from atrial arrhythmias (26±3 months; 95% CI 21–32 months Vs 18±2 months; 95% CI 15–22 months) (Figure 1C), at the cost of a longer median procedural time (246 [212–277] vs 108 [81–143] min, p&lt;0,001) and fluoroscopy time (51 [36–76] vs 33 [21–45] min, p&lt;0,001). Conclusion Subjective identification and ablation of drivers, added to PVI, improved freedom from atrial arrhythmias. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Basal characteristics Figure 1

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