Incidence Of Atrial Tachyarrhythmias Research Articles

Evaluation of the effectiveness and safety of a novel substrate-based radiofrequency ablation for persistent atrial fibrillation: a prospective, randomised, parallel-controlled, single-blinded study protocol

IntroductionPulmonary vein isolation (PVI) is the cornerstone of radiofrequency (RF) ablation for atrial fibrillation (AF). However, a single ablation strategy does not always achieve the desired therapeutic effect in all...

Advanced interatrial block: An electrocardiographic marker for stroke recurrence

The presence of interatrial block (IAB) has been directly related to the appearance of various atrial tachyarrhythmias and therefore could be a risk factor for stroke. The objective of this study is to establish whether the presence of IAB could predict stroke recurrence in patients with a previous episode. MethodsWe included all patients discharged from our hospital in 2011 following treatment for stroke, excluding those of cardioembolic or lacunar etiology. For all patients we analyzed the ECG recordings, determined whether the patient presented cardiovascular risk factors, and determined the presence and type of IAB. An IAB was defined as partial if the P-wave duration was ≥120 ms, and advanced if the duration was ≥120 ms and presented biphasic morphology in the inferior leads. The primary endpoint was the recurrence of stroke and the secondary endpoint was the incidence of atrial tachyarrhythmias after the first episode. ResultsA total of 149 patients were identified (80 (71.5–86.0) years, 41% men). After a median follow-up of 3.96 (0.63–5.35) years, 54 deaths (36%) were observed, 27 patients (18%) had experienced stroke recurrence, and 20 (13%) had developed atrial tachyarrhythmias. On multivariate analysis, the presence of advanced IAB [HR: 2.3, 95% CI (1.0–5.5); p = 0.043] and diabetes [HR: 2.5, 95% CI (1.1–5.4); p = 0.018] were significantly associated with stroke recurrence. ConclusionThe presence of advanced IAB predicts the recurrence of stroke in patients with a previous episode. Further studies should be performed to investigate possible interventions.

Incidence of Atrial Tachyarrhythmias in Patients With Early Repolarization Syndrome.

Atrial tachyarrhythmias (ATAs) occur in a significant proportion of Brugada syndrome (BrS) patients and are often an important cause of inappropriate shocks. The aim of this retrospective study was to evaluate the incidence of ATAs and ATA-induced inappropriate shocks in early repolarization syndrome (ERS) patients as compared to BrS patients.We analyzed data from 20 consecutive patients who were diagnosed with ERS and compared them with patients diagnosed with BrS (n = 31). Clinical and ICD interrogation data were collected and analyzed for all events with ICD shocks.Three patients had a history of atrial fibrillation (AF) prior to ICD implantation. One patient had AV reentrant tachycardia and was successfully ablated before ICD implantation. ATAs were newly diagnosed in 4 patients with no prior history of AF. There were no significant differences in gender, age, or left atrial diameter between ATA development. Four (20%) of 20 consecutive patients received inappropriate ICD shocks for ATAs. One suffered from repeat inappropriate shocks triggered by paroxysmal AF and received catheter ablation for AF.ATAs were not infrequent in patients with ERS and seemed to be related to inappropriate ICD therapy. Careful ICD programming is required to reduce ATA-related inappropriate ICD shock in patients with ERS.

Intracardiac Lateral Tunnel Fontan by using Right Atrial Wall

The Fontan procedure is a palliative surgical procedure used in children with complex congenital heart defects. It involves diverting the venous blood from the right atrium to the pulmonary arteries without passing through the morphologic right ventricle. A 23 years old adult male from Noakhali admitted with the diagnosis of transposition of great arteries (D-TGA) with large perimembranous ventricular septal defect (PM VSD) with severe pulmonary stenosis (PS) and single ventricle morphology in National Institute of Cardiovascular Disease (NICVD), Dhaka .He underwent Intracardiac lateral tunnel Fontan by using right atrial wall. Patient recovered uneventfully in his early postoperative period. The lateral tunnel Fontan procedure results in excellent long-term outcome even when used in patients with diverse anatomic diagnoses. The incidence of atrial tachyarrhythmia is low and mainly depends on the underlying cardiac morphology and preoperative arrhythmia. The good long-term outcome after an intracardiac lateral tunnel Fontan procedure should serve as a basis for comparison with other surgical alternatives. But using right atrial wall as a buffle is rare and done first time in Bangladesh.Cardiovasc. j. 2016; 9(1): 68-72

Incidence of atrial tachyarrhythmias in patients with early repolarization syndrome and Brugada syndrome: analysis of patients with implantable cardioverter defibrillators

Purpose: The electrocardiographic early repolarization syndrome (ERS) is associated with a risk of sudden cardiac death (SCD). It has not been known whether the arrhythmogenic substrate in patients with ERS is restricted to the ventricular level. The aim of this retrospective study was to evaluate the incidence of inappropriate shocks (IS) due to atrial tachyarrhythmias (ATAs) in patients with ERS as compared with Brugada syndrome (BrS). Methods: We analyzed data from 47 consecutive patients diagnosed with ERS and BrS who underwent implantable cardioverter defibrillator (ICD) implantation from May 1998 to December 2011. Three in patients with BrS had paroxysmal atrial fibrillation (AF). The clinical data were collected and analyzed for all events with shocks. Results: Seventeen patients with ERS (age 38.6±11.1, male=14) and 30 patients with BrS (43.6±11.3, male = 29) were enrolled. Twelve patients experienced AF after defibrillation for ventricular arrhythmia (6 in ERS vs. 6 in BrS, P = NS). During a mean follow-up of 5.3±4.5 years in the ERS and 4.4±4.0 years in the BrS, five patients received appropriate shock (3 in ERS vs. 2 in BrS, P = 0.25). There was no significant difference in the prevalence of ATAs in patients who diagnosed ERS compared with patients in BrS from pre- to post- ICD implantation (9 in ERS vs. 12 in BrS, P = 0.54). Three of 17 (17.6%) ERS and 6 of 30 (20.0%) BrS patients received IS due to ATAs during this periods (Figure, P = 0.72). ![Figure][1] Figure 1 Conclusions: ATA occurred not infrequently in patients with ERS and ICD implantation. There were no differences in the occurrence of ATA and IS in patients with ERS as compared to patients with BrS. [1]: pending:yes

066 Active Versus Passive Fixation Atrial Leads: Incidence of Atrial Tachyarrhythmias Among Patients of the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT)

066 Active Versus Passive Fixation Atrial Leads: Incidence of Atrial Tachyarrhythmias Among Patients of the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT)

The Effect of Short-Term Steroid Therapy for Preventing Atrial Tachyarrhythmias in Blanking Period after Catheter-Ablation of Atrial Fibrillation

Background: Atrial arrhythmias occurring during the first 6–12 weeks (blanking period) after ablation of atrial fibrillation (AF) can be highly symptomatic and often require an anti-arrhythmic drug (AAD), cardioversion or hospitalization. Objectives: The anti-inflammatory effect of corticosteroid may suppress atrial arrhythmias during blanking period. Methods: We prospectively enrolled 83 patients were randomly assigned to 2 groups (steroidand control group). The primary end point was hospitalization (ER visit, re-admission) and cardioversion or AAD administration. Secondary end points were atrial tachyarrhythmias or severe symptomatic PAC on holter monitoring in 1 month of the ablation. Result: During follow-up (median, 28.2 days), A total of 15 patients were hospitalized due to recurrent atrial tachyarrhythmias and cardioversion. There was no significant different in hospitalization and cardioversion between the two groups (23.7% vs 13.3% at a months; P=0.26). But the incidence of AAD administration to control symptomatic atrial arrhythmia was significantly lower in steroid group then control (31.6% vs. 84.4% at a month; P<0.0001). After adjusting clinical and procedural characteristics, short-term steroid administration was independently associated with lower rate of atrial arrhythmia on holter monitoring (adjusted HR 0.08, 95% CI 0.02–0.37, p=0.001). Conclusion: Our data suggest that use of peri-procedural short-term corticosteroid significantly reduced the incidence of atrial tachyarrhythmias and AAD administration during blanking period after ablation of AF.

Retrospective analysis of mode survival, reliability of atrial sensing and incidence of atrial tachyarrhythmias in 307 single-lead VDD pacemaker patients

The aim of this retrospective analysis was to investigate VDD mode survival, development of atrial tachyarrhythmias (AT), and long-term atrial sensing performance of VDD pacing systems. We implanted single-lead VDD pacemakers in patients with isolated atrioventricular block and performed a retrospective analysis of 307 patients who had their devices implanted between May 1994 and September 2001. In 39 patients (12.7%), the pacing mode had to be reprogrammed to a single-chamber ventricular pacing mode, mostly due to permanent AT. In 16 of these patients, the atrial sensing safety margin was less than 150%. The atrial sensing safety margin was insufficient, i.e. less than 100% in only seven patients. Although only 12 (3.9%) of the patients had a history of paroxysmal AT at the time of pacemaker implantation, 200 (65%) patients presented with AT during follow-up. The mean AT burden at the last follow-up was 2.5%. These data illustrate that single-lead VDD pacemakers can be applied without serious complications in a highly selected group of patients. Our main concern is the development of AT in a large part of our population. Over a 10-year period, two thirds of our patients presented with AT.

Incidence of Atrial Tachyarrhythmias in Pacemaker Patients: Results from the Balanced Evaluation of Atrial Tachyarrhythmias in Stimulated Patients (BEATS) Study

The prospective Balanced Evaluation of Atrial Tachyarrhythmias in Stimulated patients (BEATS) study compared atrial tachyarrhythmia (AT) detection by means of serial ECG recordings versus device detection. The annual incidence of AT in patients with dual-chamber pacemakers may be significantly underestimated based on ECG and Holter recordings. A DDD(R) device capable of AT-triggered dual-channel electrogram (EGM) storage was implanted in 254 patients (70 +/- 11 years, 159 men) with a class I pacing indication. Patients were seen at 6, 26, and 52 weeks after pacemaker implantation. At all visits, symptoms were checked, surface ECGs were recorded including a 24-hour Holter recording at 6 weeks, and the pacemakers were interrogated. Primary study endpoint was AT documentation by surface ECG/Holter versus stored EGMs. Secondary endpoints consisted of the association between patients' symptoms and AT documentation, and of the AT incidence depending on pacing indication and a history of AT. ATs were documented by ECG/Holter recordings in 37 patients (15%) and by stored EGMs in 137 patients (54%) (P < 0.0001). Symptoms were absent in 108 of 137 patients (79%) with device-documented AT but present in 70 of 117 patients (60%) without AT documentation. AT documentation was more frequent in patients with a history of AT but not in patients with sinus node compared to AV node disease. ATs occur in pacemaker patients significantly more frequently than estimated by ECG/Holter recordings. Only the analysis of device-stored EGMs allows reliable assessment of the AT burden.

Oral amiodarone prophylaxis reduces atrial tachyarrhythmia following cardiac surgery

People receiving amiodarone had a lower incidence of atrial tachyarrhythmias compared to controls (16.1% vs. 29.5%, hazard ratio 0.52, 95% CI 0.34 to 0.69, po0.001). This trend was sustained in people younger than 65 years, in people older than 65 years, in people who had CABG surgery alone, in people who had valve replacement or repair with or without CABG, in people who received preoperative beta-blockers, and in people who did not receive preoperative beta-blockers. People receiving amiodarone were more likely than controls to have their dosage reduced (11.4% vs 5.3%, p 1⁄4 0.008). There were no significant differences between groups in serious postoperative complications, in-hospital mortality, readmission within six months, or one-year mortality.

Incidence of atrial tachyarrhythmias as a possible cause of resuscitated sudden death outside acute myocardial infarction

Atrial tachyarrhythmias (ATA) (flutter, tachycardia or fibrillation), are known to induce ventricular fibrillation (VF) in some patients (pts), those with a Wolff-Parkinson-White syndrome (WPW) or with hypertrophic cardiomyopathy. In other pts, ATA’s are considered as without risk of sudden cardiac death (SD). The purpose of the study was to determine the incidence of ATA in a general population as a possible cause of resuscitated SD.

Incidence and rate characteristics of atrial tachyarrhythmias in patients with a dual chamber defibrillator.

Atrial tachyarrhythmias play an important role in the treatment of patients with malignant ventricular tachyarrhythmias not only with respect to inappropriate discharges but also to left ventricular function and stroke risk. A combined dual chamber defibrillator provides separate therapies for atrial and ventricular tachyarrhythmias. To assess the incidence of atrial tachyarrhythmias in patients with this dual chamber implantable defibrillator, 40 patients with ventricular tachyarrhythmias and concomitant atrial tachyarrhythmias and/or AV conduction disturbances were included in a prospective study. During a mean follow-up of 25 +/- 11 months, 26 of 40 patients had a total of 1,430 recurrences of atrial tachyarrhythmias. The vast majority of the atrial tachyarrhythmias with regular atrial cycles had a mean median atrial cycle length of 235 +/- 37 ms and a mean duration of 34 +/- 144 minutes. Atrial tachyarrhythmias with irregular atrial cycles exhibited a median atrial cycle length of 198 +/- 31 ms and had a mean duration of 246 +/- 1,264 minutes. In addition, 67% of 375 tachyarrhythmias, in which the median ventricular cycle length during the ongoing episode could be documented, had a ventricular rate <100 beats/min. Continuous atrial arrhythmia detection with a dual chamber ICD reveals a high incidence of atrial tachyarrhythmias with a predominantly short duration of paroxysmal recurrences <1 hour in the vast majority of episodes.

The Influence of Concomitant Drug Therapy on the Efficacy of Atrial Overdrive Stimulation for Prevention of Atrial Tachyarrhythmias

Data from the completed "Suppression of Atrial Fibrillation by DDD+ Overdrive Pacing with Inos2 CLS (closed-loop system) Pacemakers" multicenter trial were retrospectively evaluated to examine the influence of concomitant antiarrhythmic drugs on the clinical success of conventional single site right atrial overdrive pacing compared with DDD pacing. The DDD+ overdrive algorithm provided > 90% atrial pacing at a rate slightly above the intrinsic atrial rate. Seventy-five patients with conventional pacing indications and paroxysmal, recurrent atrial tachyarrhythmia have completed the study. They were randomized to 6 months of DDD or DDD+ pacing, followed by mode crossover and an additional 6-month follow-up in the alternate mode. The incidence of atrial tachyarrhythmia during each period was compared using data on sustained (> 60 s) mode switch episodes stored in the pacemaker memory. A stable antiarrhythmic drug regimen was allowed during the study. beta-Adrenergic blockers and Class III antiarrhythmics, prescribed to 54.7% and 40.0% of patients respectively, were linked to minimal or no benefit of overdrive pacing compared with DDD pacing. In contrast, patients untreated with beta-adrenergic blockers or Class III drugs had a significant reduction in atrial tachyarrhythmia burden of > 5 hours/patient per week (P < 0.05) during overdrive. Changes with Class I and Class IV antiarrhythmic drugs, prescribed to 18.7% and 13.3% of patients, respectively, were insignificant. Our data indicate that clinical trials that prohibit the use of beta-adrenergic blockers may record more favorable outcomes with dynamic atrial overdrive algorithms versus conventional DDDR pacing, than studies allowing concomitant beta-adrenergic blockade.

Long-term results of the lateral tunnel Fontan operation

Objectives: Completion of a total cavopulmonary anastomosis with an intra-atrial lateral tunnel is known to yield good early and midterm results. In this study, we sought to determine the long-term outcome (10 years) after a lateral tunnel Fontan procedure. Methods: Between October 1987 and December 1991, 220 patients (aged 11 months to 32 years) with a wide range of underlying diagnoses underwent a fenestrated or nonfenestrated lateral tunnel Fontan procedure at our institution. Current follow-up information was available for 196 patients (94%, mean follow-up = 10.2 ± 0.6 years). Risk factor analysis included patient-related and procedure-related variables, with death, failure, and bradyarrhythmia or tachyarrhythmia as outcome parameters. Results: There were 12 early deaths (<30 days or hospital death), 7 late deaths, 4 successful takedown operations, and 4 heart transplantations. Kaplan-Meier estimated survival was 93% at 5 years and 91% at 10 years, and freedom from failure was 90% at 5 years and 87% at 10 years. Freedom from new supraventricular tachyarrhythmia was 96% at 5 years and 91% at 10 years; freedom from new bradyarrhythmia was 88% at 5 years and 79% at 10 years. Three patients had evidence of protein-losing enteropathy. Multivariable risk factors for development of supraventricular tachyarrhythmia included heterotaxy syndrome, atrioventricular valve abnormalities, and preoperative bradyarrhythmia. Risk factors for bradyarrhythmia included systemic venous anomalies. The sole risk factor for late failure was a previous coarctation repair. Conclusion: The lateral tunnel Fontan procedure results in excellent long-term outcome even when used in patients with diverse anatomic diagnoses. The incidence of atrial tachyarrhythmia is low and mainly depends on the underlying cardiac morphology and preoperative arrhythmia. The good long-term outcome after an intracardiac lateral tunnel Fontan procedure should serve as a basis for comparison with other surgical alternatives. (J Thorac Cardiovasc Surg 2001;121:28-41)

Beat-to-beat mode switching for effective ventricular rate control in the presence of atrial tachyarrhythmias – How to maintain a stable ventricular rhythm

Background: Mode switching aims to maintain a ventricular rhythm that matches metabolic needs during both sinus rhythm and atrial tachyarrhythmias. This allows patients with atrial arrhythmias to benefit from AV synchronous pacing modes.Aim and method: Beat-to-beat mode switching in Diamond and Clarity pacemakers is designed to maintain a relatively stable ventricular rhythm, ensuring consistent ventricular filling patterns. Atrial tachyarrhythmia detection is based on a continuous analysis of the atrial rhythm. A too rapid increase of the atrial rate with a beat-to-beat acceleration > 15 bpm is considered to be an atrial tachyarrhythmia. Mode switching occurs on detection of the first premature atrial event: atrial tracking is stopped and the ventricular rate is determined by the rate indicated by the dual sensor (QT interval and activity). Atrial pacing restores AV synchrony immediately after cessation of the atrial tachyarrhythmia, effectively avoiding retrograde conduction. Dedicated diagnostic functions allow one to monitor the incidence of atrial tachyarrhythmias and to study atrial and ventricular events just prior to its onset. Both the mode switching and rate responsive function are fully automatic, rendering follow-up procedures easy and less time-consuming. Conclusion: Reliable detection of all atrial events is essential to guarantee appropriate mode switching. Therefore, the pacemaker stores the distribution of the amplitude of all atrial events, both during sinus rhythm and atrial tachyarrhythmias, which facilitates the appropriate programming of the atrial sensitivity.

Atrial tachyarrhythmias in acute myocardial infarction

Causative factors, clinical consequences and treatment of atrial tachyarrhythmias were reviewed in 917 monitored patients with definite acute myocardial infarction. Significant atrial tachyarrhythmias were found in 104 (11 per cent) of them and included atrial fibrillation in 67, atrial flutter in 29 and paroxysmal atrial tachycardia in 33. These episodes were single in 79 patients and multiple in 25, and began within the first four days of acute myocardial infarction in 90 per cent of the patients. Fifty per cent of these atrial tachyarrhythmias were heralded by premature atrial contractions. The incidence of atrial tachyarrhythmia was not related to the location of the acute myocardial infarction or to the presence or degree of power failure; however, atrial tachyarrhythmias were significantly more frequent in patients with pericarditis. Atrial tachyarrhythmias were well tolerated in almost one fifth of the patients, caused marginal compromise in almost two thirds and led to severe clinical deterioration in one fifth. Paroxysmal atrial tachycardia rarely required specific treatment, atrial fibrillation was best managed with intravenous administration of digoxin except when associated with severe clinical compromise, and atrial flutter generally required cardioversion or rapid intravenous therapy and usually caused severe clinical deterioration. Over-all, atrial tachyarrhythmia was not associated with a significantly increased mortality, and in those who died, death was not related specifically to the atrial tachyarrhythmia but rather to the severity of the underlying acute myocardial infarction. However, persisting atrial tachyarrhythmias, particularly atrial flutter which tends to be refractory to both heart rate control and cardioversion, may contribute indirectly to morbidity and mortality.