Management Of Arrhythmias In Patients Research Articles

Ventricular arrhythmias in acute heart failure: a clinical consensus statement of the Association for Acute CardioVascular Care, the European Heart Rhythm Association, and the Heart Failure Association of the European Society of Cardiology.

Patients presenting with or alerting emergency networks due to acute heart failure (AHF) form a diverse group with a plethora of symptoms, risks, comorbidities, and aetiologies. During AHF, there is an increased risk of destabilizing the functional substrate and modulatory adding to the risk of ventricular arrhythmias (VAs) already created by the structural substrate. New VAs during AHF have previously identified patients with higher intra-hospital and 60-day morbidity and mortality. Risk stratification and criteria/best time point for coronary intervention and implantable cardioverter defibrillator implantation, however, are still controversial topics in this difficult clinical setting. The characteristics and logistics of pre-hospital emergency medicine, as well as the density of centres capable of treating AHF and VAs, differ massively throughout Europe. Scientific guidelines provide clear recommendations for the management of arrhythmias in patients with chronic heart failure. However, the incidence, significance, and management of arrhythmias in patients with AHF have been less studied. This consensus paper aimed to address the identification and treatment of VAs that complicate the course of patients who have AHF, including cardiogenic shock.

FUNCTIONAL COMPONENT OF THE CARDIOVASCULAR SYSTEM IN INDIVIDUALS WITH CONNECTIVE TISSUE DYSPLASIA

The article discusses connective tissue dysplasia (CTD) and its genetic basis, classification issuesin the International Classification of Diseases (ICD), research on CTD in Uzbekistan, and the association of CTD with cardiovascular complications, particularly arrhythmias. Various studies and classifications related to CTD are mentioned, emphasizing thegenetic mutations underlying the disease and the prevalence of arrhythmias in syndromic forms such as Marfan syndrome and Ehlers-Danlos syndrome. The text underscores the importance of close monitoring, early detection, and appropriate management of arrhythmias in patients with CTD to optimize outcomes and reduce complications.Based on the foregoing, the purpose of this work is to establish in posttalontogenesis the laws of the formation and involution of bronchial vascular and lymphatic systems in a person, epithelial connective tissue relationships in the air and respiratory parts of the lung (1.4).

EHRA expert consensus document on the management of arrhythmias in frailty syndrome, endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA).

There is an increasing proportion of the general population surviving to old age with significant chronic disease, multi-morbidity, and disability. The prevalence of pre-frail state and frailty syndrome increases exponentially with advancing age and is associated with greater morbidity, disability, hospitalization, institutionalization, mortality, and health care resource use. Frailty represents a global problem, making early identification, evaluation, and treatment to prevent the cascade of events leading from functional decline to disability and death, one of the challenges of geriatric and general medicine. Cardiac arrhythmias are common in advancing age, chronic illness, and frailty and include a broad spectrum of rhythm and conduction abnormalities. However, no systematic studies or recommendations on the management of arrhythmias are available specifically for the elderly and frail population, and the uptake of many effective antiarrhythmic therapies in these patients remains the slowest. This European Heart Rhythm Association (EHRA) consensus document focuses on the biology of frailty, common comorbidities, and methods of assessing frailty, in respect to a specific issue of arrhythmias and conduction disease, provide evidence base advice on the management of arrhythmias in patients with frailty syndrome, and identifies knowledge gaps and directions for future research.

Management of arrhythmias in patients with chronic kidney disease on hemodialysis

Management of arrhythmias in patients with chronic kidney disease on hemodialysis

Ventricular arrhythmia management in patients with genetic cardiomyopathies.

Genetic cardiomyopathies are associated with increased risk for cardiac arrhythmias and sudden cardiac death. The management of ventricular arrhythmias (VAs) in patients with these conditions can be nuanced due to particular disease-based considerations, yet data specifically addressing management in these patients are limited. Here we describe the current evidence-based approach to the management of ventricular rhythm disorders in patients with genetic forms of cardiomyopathy, namely, hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, left ventricular noncompaction, and Brugada syndrome, including recommendations from consensus guideline statements when available.

A Compelling Case for Less Aggressive Arrhythmia Management in Patients With Chronic Heart Failure and Long-Standing Atrial Fibrillation

Atrial fibrillation (AF) is common in chronic heart failure, and some have advocated intensive rate and/or rhythm control strategies for these patients. However, the loss of atrial systole and irregularity of the ventricular response has not been shown to contribute to the progression of heart failure, and the presence or rate of long-standing AF in patients with chronic heart failure does not have prognostic significance. In randomized clinical trials, pharmacological rhythm control has not been shown to be superior to rate-control in influencing long-term outcomes, but the use of membrane-active antiarrhythmic drugs can increase the risk of both pump failure and arrhythmic deaths in patients with heart failure. Additionally, intensive efforts to slow the ventricular rate in AF can potentially cause clinically inapparent bradyarrhythmias, which can trigger rate-dependent lethal rhythm disturbances or hemodynamic abnormalities. In patients with AF, a more stringent approach to rate control (target rate <80/min) is not superior to a more lenient strategy (target rate <110/min) on the risk of major events. Little is known about the effects of catheter ablation of long-standing AF in established heart failure, particularly in patients with a preserved or a meaningfully reduced ejection fraction, but ablation can add to the fibrotic burden of the left atrium and impair its capacitance functions. For all of these reasons, the management of heart failure and long-standing AF should be primarily directed to slowing of the progression of their underlying cardiomyopathic process rather than the treatment of the arrhythmia. In addition, patients should receive long-term oral anticoagulation with non-vitamin K-antagonist oral anticoagulants to reduce the risk of thromboembolic events. The utility of intensive rate and rhythm control interventions for long-standing AF in patients with established heart failure requires further study.

An initial experience of high-density mapping-guided ablation in a cohort of patients with adult congenital heart disease.

AimsIn the management of both ventricular and supraventricular tachycardia in patients with congenital heart disease (CHD) catheter ablation has now been recognized as one of the mainstays.Methods and resultsWe review our initial experience of using the Rhythmia mapping system in a cohort of 12 adult CHD patients presenting with multiple arrhythmia substrates. A total of 78 arrhythmia maps were attempted in a total of 15 procedures, but possible due to the dilatation of the target chamber only 44% of maps were able to reconstruct the entire arrhythmia. All patients underwent pre-procedure 3D imaging (either cardiac magnetic resonance or computed tomography), but image integration was suboptimal. A median of two maps per patient were finally analysed and acquisition took in median 22 min with a median number of 12 574 (8230–18 167) mapping points. Procedural data with a total duration amounting to in median 285 (194–403) min, with a median total fluoroscopy exposure of 7.5 (5.2–10.7) min. After a median of 1.5 procedures [median of 12 (8–16 months)], nine patients remained in stable sinus rhythm or atrial paced rhythm, while three patients had further sustained recurrences. One of these passed away in end-staged heart failure.ConclusionThis initial experience of using high-density mapping for arrhythmia management in patients with CHD allowed rapid acquisition of multiple maps with high accuracy to identify surgical scars and fibrosis, however, it was limited by large atrial volumes and a high percentage of incomplete maps resulting in modest clinical success.

P792Image integration of dual radio-nuclide imaging of perfusion and sympathetic activity with 3D CT for ventricular arrhythmia management in patients with ischemic and non-ischemic substrates

P792Image integration of dual radio-nuclide imaging of perfusion and sympathetic activity with 3D CT for ventricular arrhythmia management in patients with ischemic and non-ischemic substrates

Management of arrhythmias in patients with Takotsubo cardiomyopathy: Is the implantation of permanent devices necessary?

Arrhythmias are frequent in Takotsubo cardiomyopathy (TTC) and a major determinant of outcome. The purpose of this study was to provide a rationale for management strategies, particularly for permanent device implantation given the reversible nature of TTC. Treatment strategies of arrhythmias including ventricular fibrillation (VF), ventricular tachycardia (VT), asystole, pulseless electrical activity, and complete atrioventricular (AV) or sinoatrial block were assessed in a bicentric cohort of consecutive patients with TTC (n = 286) with a mean follow-up period of 3.3 ± 2.4 years. The prevalence of arrhythmias during the acute phase of TTC was 12.2% (n = 35), consisting predominantly of VT (n = 16 [5.6%]), VF (n = 7 [2.4%]), and complete AV block (n = 8 [2.8%]). Seven patients received a permanent pacemaker because of complete AV (n = 6) or sinoatrial (n = 1) block. Regular device checkups were available in 2 patients and demonstrated ongoing high-degree AV block despite recovery of left ventricular function. Three patients with transient bradyarrhythmias who did not receive devices died shortly after hospital discharge from unknown causes. One patient received an implantable cardioverter-defibrillator after resuscitation for VF and did not require device interventions during 2-year follow-up. Patients with polymorphic VT (n = 7), monomorphic VT (n = 6), or VF (n = 2) who were discharged from hospital survived or died of noncardiac reasons, with the cause of death remaining unclear in 1 patient with monomorphic sustained VT. Our data suggest that bradyarrhythmias in the acute setting of TTC may require permanent pacemaker implantation. In contrast, polymorphic ventricular arrhythmias might be managed with a temporary approach (eg, wearable cardioverter-defibrillators) until recovery of repolarization time and left ventricular function.

Post-thoracotomy dysrhythmia.

This article reviews and summarizes the pathophysiology, risk factors, and the management of arrhythmias in patients undergoing noncardiac thoracic surgery. Cardiac arrhythmias are common findings in the perioperative period, particularly with increasing age. They often complicate the course of the patient's recovery after operation. The most common postoperative arrhythmia is atrial fibrillation. It requires either a rate or rhythm control strategy, and the need for anticoagulation has to be assessed depending on the duration of the arrhythmia and risk factors. Fortunately, malign sustained ventricular tachyarrhythmias (ventricular tachycardia, ventricular fibrillation) are rare. Acute treatment and, in the absence of a reversible cause, a long-term preventive strategy may be warranted. Transient bradyarrhythmias can be managed by atropine or with temporary pacing. Arrhythmias are common after thoracotomy. Physicians treating patients with postoperative arrhythmias should bear in mind that arrhythmia management does not only comprise a specific therapy for the arrhythmia itself, but also includes the correction of transient and correctable predisposing and causative factors.

Utility of noninvasive arrhythmia mapping in patients with adult congenital heart disease.

Arrhythmia management in patients with adult congenital heart disease (ACHD) is a challenge on many levels, as tachycardic episodes may lead to hemodynamic impairment in otherwise compensated patients even if episodes are only transient. Recently several technical advances, including 3-dimensional (3D) image integration, 3D mapping, and remote magnetic navigation, have been introduced to facilitate curatively intended ablation procedures in patients with ACHD. This review attempts to outline the role of a novel technology of simultaneous, noninvasive mapping in this patient cohort, and gives details of the authors' single-center experience.

Management of arrhythmias in patients with a tetralogy of Fallot

Although arrhythmias are commonly found in patients with all different types of congenital heart disease, perhaps no patient is at higher risk of late development of arrhythmias that may result in sudden death than in the patient following tetralogy of Fallot repair. Despite major improvement in the surgical repair of this disease, a significant percentage of these patients continue to remain at risk for the late development of arrhythmias, and a small percentage will develop life-threatening arrhythmias and sudden death. Which patients remain at highest risk is still not clearly delineated. Diligent arrhythmia surveillance and aggressive treatment strategies are necessary to minimise this risk. This article highlights important strategies to manage arrhythmia development and prevention in this patient population.

Management of arrhythmias in patients with tetralogy of Fallot

Patients with tetralogy of Fallot are subject to arrhythmic sequelae that substantially impact morbidity and mortality. This review focuses on recent advances in our understanding of the prevalence and types of arrhythmias encountered. Diagnostic and prognostic tools are considered and therapeutic options discussed. Multicenter studies have characterized the arrhythmia burden, assessed the impact of implantable cardioverter-defibrillators, and generated a risk score for primary prevention. Left ventricular hemodynamics are increasingly recognized as important contributors to risk for sudden death. Arrhythmia circuits have been characterized, and the impact of pulmonary valve replacement on sudden death has been further questioned. Recent studies cast doubt on the value of right ventricular pacing alone for cardiac resynchronization and provide a rationale for biventricular pacing. Supraventricular arrhythmias exceed ventricular arrhythmias in prevalence, as atrial fibrillation increases with the aging population. Sudden death is the leading cause of late mortality, although therapeutic advances may alter this profile. Combinations of factors should be considered in risk stratification schemes to select appropriate implantable cardioverter-defibrillator candidates. The role of concomitant intraoperative ablation during pulmonary valve replacement surgery remains to be defined. Cardiac resynchronization therapy, particularly biventricular pacing, offers promise, but requires careful study before widespread implementation.

Treatment of arrhythmias in patients with congestive heart failure

Both ventricular and atrial arrhythmias are commonly encountered in patients with ventricular dysfunction. In fact, roughly half of the deaths occurring in patients with ventricular dysfunction are caused by ventricular arrhythmias. Atrial arrhythmias in this patient population compromise left ventricular filling and if uncontrolled can exacerbate (and in some cases cause) the underlying myopathic process. Consequently, the diagnosis and treatment of these complex, and often life-threatening, arrhythmias is a critical component in the management of congestive heart failure (CHF). As the complexity of pharmacologic and nonpharmacologic antiarrhythmic therapy evolves, it has become increasingly important to understand the potential benefits and limitations of the various treatment modalities in the setting of patients with CHF. The management of arrhythmias in patients with CHF includes conventional drug therapies, as well as therapies directed specifically at treating the arrhythmias that are encountered. The treatment of atrial arrhythmias may include anticoagulation, drugs for rate control, rhythm control, or radiofrequency ablation. The treatment of ventricular arrhythmias, conversely, uses the implantable cardioverter-defibrillator to prevent sudden death, with adjuvant drug therapy or ablation for refractory ventricular tachycardia. This article provides an overview of the current state-of-the-art arrhythmia management in patients with CHF.

Pharmacologic management of arrhythmias in patients with congenital heart disease.

The management of cardiac arrhythmias has evolved rapidly over the past decade. This includes the development of more effective antiarrhythmic medications as well as catheter- and device-based therapies. Antiarrhythmic medications remain the primary treatment modality for most acute arrhythmias; however, the long term use of these medications may be accompanied by severe adverse effects. For this reason, antiarrhythmic medications are increasingly used in conjunction with other forms of therapy, such as catheter ablation or pacemaker implantation. Patients with congenital heart disease often have an increased propensity for cardiac arrhythmias due to both inherent conduction system abnormalities and impaired ventricular function. The purpose of this review is to examine the currently available antiarrhythmic drugs and assess their role in the treatment of arrhythmias in patients with congenital heart disease. It is important to emphasize that patients with congenital heart disease often have hemodynamic limitations and may be at an increased risk for developing adverse effects with antiarrhythmic agents. An awareness of the arrhythmias associated with congenital heart disease, the natural history of these arrhythmias, and the potential benefit of treatment with antiarrhythmic medications versus other forms of therapy provides a rational basis for therapy in this challenging population of patients.

Recognition and Management of Cardiac Arrhythmias: Part II. Ventricular Arrhythmias and Bradyarrhythmias

This review discusses the treatment of ventricular arrhythmias and bradyarrhythmias. Recent studies addressing the management of nonsustained ventricular arrhythmias in patients with congestive heart failure and those recovering from myocardial infarction are discussed. Determination of the origin of wide QRS complex tachycardia is usually possible at the bedside and the diagnostic criteria are provided. Therapy to prevent recurrent ventricular tachycardia or ventricular fibrillation is difficult and controversial. A widely accepted approach based on electrophysiologic testing and implantable defibrillators appears to be the most effective. Recognition and management of common bradyarrhythmias including the indications for pacemakers are discussed.

Problems in Managing Patients with Long QT Syndrome and Implantable Cardioverter Defibrillators: A Report of Two Cases

Implantable cardioverter-defibrillators (ICDs) have been a successful adjunct to the management of arrhythmias in patients with Long QT syndrome (LQTS). In two patients, interactions between LQTS and the ICD were diagnosed and corrected. Oversensing of T waves was confirmed in the first, while in the second, the arrhythmia disappeared when T wave abnormalities improved after cessation of H2 blocker therapy. In patients with LQTS and an ICD, T wave oversensing should be considered. Interventions that may have an adverse effect on repolarization should be avoided.

Persistent atrial standstill documented over a 22-year period

This international multidisciplinary document is intended to guide electrophysiologists, cardiologists, other clinicians, and health care professionals in caring for patients with arrhythmic complications of neuromuscular disorders (NMDs). The document presents an overview of arrhythmias in NMDs followed by detailed sections on specific disorders: Duchenne muscular dystrophy, Becker muscular dystrophy, and limb-girdle muscular dystrophy type 2; myotonic dystrophy type 1 and type 2; Emery-Dreifuss muscular dystrophy and limb-girdle muscular dystrophy type 1B; facioscapulohumeral muscular dystrophy; and mitochondrial myopathies, including Friedreich ataxia and Kearns-Sayre syndrome, with an emphasis on managing arrhythmic cardiac manifestations. End-of-life management of arrhythmias in patients with NMDs is also covered. The document sections were drafted by the writing committee members according to their area of expertise. The recommendations represent the consensus opinion of the expert writing group, graded by class of recommendation and level of evidence utilizing defined criteria. The recommendations were made available for public comment; the document underwent review by the Heart Rhythm Society Scientific and Clinical Documents Committee and external review and endorsement by the partner and collaborating societies. Changes were incorporated based on these reviews. By using a breadth of accumulated available evidence, the document is designed to provide practical and actionable clinical information and recommendations for the diagnosis and management of arrhythmias and thus improve the care of patients with NMDs.

Pediatric cardiovascular intensive care: Arrhythmia management

Cardiac arrhythmias in children in the pediatric cardiovascular intensive care unit are a function of the interaction between the intrinsic disease, complications of successful palliation and treatment, and the moment-to-moment homeostatic state of the patient (autonomic tone, electrolyte balance, hemodynamic status, therapeutic agents). Knowledge regarding all three factors are critical for the successful management of arrhythmias in patients in the pediatric cardiovascular intensive care unit. Continuous electrocardiographic monitoring with an archival system is essential for instantaneous and accurate detection of potentially life-threatening tachy and bradyarrhythmias. Intensivists, cardiologists and intensive care nursing personnel must constantly process data that lead to rapid diagnosis and definitive management of an abnormal cardiac rhythm in these highly vulnerable children.

Management of Arrhythmias in Patients with Severe Lung Disease

Management of Arrhythmias in Patients with Severe Lung Disease