Treatment Of Arrhythmias In Patients Research Articles

Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review.

Cardio-oncology currently faces one of the greatest challenges in the field of health care. The main goal of this discipline is to ensure that patients treated for cancer do not suffer or die from cardiovascular disease. The number of studies on the mechanisms of heart injury during cancer treatment is constantly increasing. However, there is insufficient data on heart rhythm disorders that may result from this treatment. This issue seems to be particularly important in patients with lung cancer, in whom anticancer therapy, especially radiotherapy, may contribute to the onset of cardiac arrhythmias. The observed relationship between cardiac dosimetry and radiotherapy-induced cardiotoxicity in lung cancer treatment may explain the increased mortality from cardiovascular causes in patients after chest irradiation. Further research is essential to elucidate the role of cardiac arrhythmias in this context. Conversely, recent reports have highlighted the application of stereotactic arrhythmia radioablation (STAR) in the treatment of ventricular tachycardia. This review of available studies on the epidemiology, pathogenesis, diagnosis, and treatment of arrhythmias in patients treated for lung cancer aims to draw attention to the need for regular cardiological monitoring in this group of patients. Improving cardiac care for patients with lung cancer has the potential to enhance their overall therapeutic outcomes.

Efficacy, safety, and economy of shensongyangxin capsules for the treatment of coronary heart disease arrhythmia: a meta-analysis of randomized controlled trials.

Shensong Yangxin Capsules (SSYX) is a proprietary Chinese medicine commonly, used in the treatment of arrhythmia. In recent years, a flurry of randomized controlled trials of SSYX was reported in the treatment of Coronary heart disease arrhythmia in China. However, these experiments have not been systematically evaluated by economics. The purpose of this study was to assess the efficacy, safety, and economy of the SSYX in the treatment of arrhythmia in patients with coronary heart disease. With "Shensong Yangxin Capsules" "Coronary Heart Disease" "Coronary Atherosclerotic Heart Disease"and "Arrhythmia" as the subject words, the relevant journals and conference papers were searched manually in China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, PubMed, Web Of Science, CBM, Embase and The Cochrane Library. The literature of randomized controlled trials of SSYX in the treatment of coronary heart disease arrhythmia was searched until November 2022. All data were analyzed using RevMan 5.3 Sotware and combined with cost-effectiveness for economic evaluation. Twenty randomized controlled trials were included in this study, with a total of 2011 cases. The meta-analysis showed that the therapeutic effect of SSYX-metoprolol is superior to that of metoprolol alone. SSYX is superior to amiodarone in improving the total clinical effective rate, reducing the incidence of adverse reactions, and reducing the junction premature beats. There was no significant difference between the SSYX and amiodarone in the curative effect of ECG, ventricular premature complexes, and atrial premature beats. The results of pharmacoeconomics show that SSYX has a cost-effectiveness advantage in treating coronary heart disease arrhythmia. Single-factor sensitivity analysis also confirmed the stability of the results. In summary, SSYX has a curative effect, safety, and economy in treating coronary heart disease arrhythmia.

Prevalence and Treatment of Arrhythmias in Patients With Transthyretin and Light-Chain Cardiac Amyloidosis.

Background: Various types of arrhythmia are observed in patients with cardiac amyloidosis, but the prevalence of arrhythmia has not been fully investigated. This study investigated the prevalence and treatment of arrhythmias in patients with cardiac amyloidosis before the introduction of new agents for amyloidosis, such as tafamidis. Methods and Results: Of 53 patients who were histologically diagnosed with cardiac amyloidosis at 10 centers in western Japan between 2009 and 2021, 43 who were diagnosed on the basis of immunohistochemical staining were evaluated in this study. Of these 43 patients, 13 had immunoglobulin light-chain (AL) amyloidosis and 30 had transthyretin (ATTR) amyloidosis; further, 27 had atrial tachyarrhythmia, 13 had ventricular tachyarrhythmia, and 17 had bradyarrhythmia. Atrial fibrillation (AF) was the most common arrhythmia in patients with cardiac amyloidosis (n=24; 55.8%), especially among those with ATTR amyloidosis (70.0% of ATTR vs. 23.1% of AL). Eleven (25.6%) patients were treated with a cardiac implantable device. All 3 patients with pacemakers were alive at the last follow-up (median 76.7 months; interquartile range [IQR] 4.8-146.4 months). Of the 8 patients who underwent AF ablation, there was no recurrence in 6 (75%) after a median of 39.3 months (IQR 19.8-59.3 months). Conclusions: The prevalence of various arrhythmias was high in patients with cardiac amyloidosis. AF occurred most frequently in patients with cardiac amyloidosis, especially among patients with ATTR.

Year in Review in Cardiac Electrophysiology.

In the past year, there have been numerous advances in our understanding of arrhythmia mechanisms, diagnosis, and new therapies. We have seen advances in basic cardiac electrophysiology with data suggesting that secretoneurin may be a biomarker for patients at risk of ventricular arrhythmias, and we have learned of the potential role of an NPR-C (natriuretic peptide receptor-C) in atrial fibrosis and the role of an atrial specific 2-pore potassium channel TASK-1 as a therapeutic target for atrial fibrillation. We have seen studies demonstrating the role of sensory neurons in sleep apnea-related atrial fibrillation and the association between bariatric surgery and atrial fibrillation ablation outcomes. Artificial intelligence applied to electrocardiography has yielded estimates of age, sex, and overall health. We have seen new tools for collection of patient-centered outcomes following catheter ablation. There have been significant advances in the ability to identify ventricular tachycardia termination sites through high-density mapping of deceleration zones. We have learned that right ventricular dysfunction may be a predictor of survival benefit after implantable cardioverter-defibrillator implantation in patients with nonischemic cardiomyopathy. We have seen further insights into the role of His bundle pacing on improving outcomes. As our understanding of cardiac laminopathies advances, we may have new tools to predict arrhythmic event rates in gene carriers. Finally, we have seen numerous advances in the treatment of arrhythmias in patients with congenital heart disease.

Continuous Positive Airway Pressure Effectively Alleviates Arrhythmias in Patients with Obstructive Sleep Apnea: Possible Relationship with Counteracting Oxidative Stress.

This work is aimed at exploring the clinical efficacy of continuous positive airway pressure (CPAP) in treatment of patients with arrhythmias combined with obstructive sleep apnea (OSA). Through evaluating serum native thiol, malonaldehyde (MDA) and nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase) in these patients and describing the effects on oxidative parameters of CPAP therapy for 3 months, we confirmed the impact of oxidative stress on arrhythmias. A total of 64 patients with OSA combined with arrhythmias were collected from April 2014 to April 2017 with full clinical information. Patients were divided into two groups (paired experiment design): 32 patients in group A (control group), who received unchanged anti-arrhythmia treatment and 32 patients in group B, who were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP. OSA related parameters were compared between the two groups after 3-month therapy. And the levels of parameters of oxidative stress in patients were measured before and after CPAP therapy. After 3 months of CPAP therapy, compared with the control group, the percentage of sage N3 (NREM 3) and stage R (REM) in total sleep time was significantly increased, while apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) score were evidently decreased. Meanwhile, the lowest oxygen saturation (LSpO2) was also elevated after CPAP treatment for 3 months. The CPAP therapy significantly prevented the occurrence of arrhythmias (P<0.05). Both the MDA level and NADPH oxidase levels were significantly lower in the group B than in the group A (P<0.05). But serum native thiol was improved by CPAP treatment (P<0.05). In conclusion, proper use of CPAP therapy provides significant benefits for the treatment of arrhythmia in patients with OSA.

Year in Review in Cardiac Electrophysiology.

In the past year, there have been numerous advances in our understanding of arrhythmia mechanisms, diagnosis, and new therapies. We have seen advances in basic cardiac electrophysiology with data suggesting that secretoneurin may be a biomarker for patients at risk of ventricular arrhythmias, and we have learned of the potential role of an NPR-C (natriuretic peptide receptor-C) in atrial fibrosis and the role of an atrial specific 2-pore potassium channel TASK-1 as a therapeutic target for atrial fibrillation. We have seen studies demonstrating the role of sensory neurons in sleep apnea-related atrial fibrillation and the association between bariatric surgery and atrial fibrillation ablation outcomes. Artificial intelligence applied to electrocardiography has yielded estimates of age, sex, and overall health. We have seen new tools for collection of patient-centered outcomes following catheter ablation. There have been significant advances in the ability to identify ventricular tachycardia termination sites through high-density mapping of deceleration zones. We have learned that right ventricular dysfunction may be a predictor of survival benefit after implantable cardioverter-defibrillator implantation in patients with nonischemic cardiomyopathy. We have seen further insights into the role of His bundle pacing on improving outcomes. As our understanding of cardiac laminopathies advances, we may have new tools to predict arrhythmic event rates in gene carriers. Finally, we have seen numerous advances in the treatment of arrhythmias in patients with congenital heart disease.

Use of flecainide in combination antiarrhythmic therapy in patients with arrhythmogenic right ventricular cardiomyopathy

Antiarrhythmic therapy is commonly used for suppression of arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) in conjunction with implantable cardioverter-defibrillators and catheter ablation. The efficacy of combination flecainide and sotalol/metoprolol therapy for patients refractory to single agents and/or catheter ablation has not been well established. The purpose of this study was to describe our experience with the addition of flecainide in combination with sotalol/metoprolol for treatment of arrhythmias in patients with ARVC. We reviewed all patients within our genetic arrhythmia program with a definite diagnosis of ARVC (45 patients) and identified 8 patients treated with a combination of flecainide with sotalol/metoprolol after failure of single-agent therapy and/or catheter ablation. These patients were monitored with at least yearly clinic visits and device interrogations focused on the detection of major ventricular arrhythmias. Of the 8 patients reviewed, 6 demonstrated excellent arrhythmia control after initiation of combination therapy with flecainide and sotalol/metoprolol. These patients have been arrhythmia-free for an average of 35.5 months. Two patients have demonstrated recurrent arrhythmias despite combination therapy and have undergone repeat epicardial and endocardial ablation. Recurrence was noted to occur within 2 months of therapy. Patients were diverse with regard to the severity of disease as well as in the presence of genetic mutations. The addition of flecainide in combination with sotalol/metoprolol may be an effective antiarrhythmic strategy for the control of ventricular arrhythmias in patients with ARVC refractory to single-agent therapy and/or catheter ablation.

Quality of life improvement after radiofrequency catheter ablation of outfl ow tract ventricular arrhythmias in patients with structurally normal hearts

Introduction Patients with structurally normal hearts (SNH) suff ering from ventricular tachycardia (VT) or frequent premature ventricular contractions (PVCs) are at low risk of sudden cardiac death. Any treatment ameliorates symptoms without a substantial infl uence on survival. The aim of this study was to prospectively evaluate the health-related quality of life (QoL) of patients with SNH undergoing elective radiofrequency ablation (RFA) of VT or PVCs.Material and methods Patients scheduled for RFA of VT or PVCs in SNH were enrolled. They underwent 24-h Holter ECG and QoL assessment (SF-36 questionnaire) at baseline and at 3-month follow-up. Results were compared within and between VT and PVCs groups.Results Among 44 enrolled patients: (i) 23 had VT; (ii) 21 had PVCs with a mean count of 18,711 ± 10,378 beats/24h. Antiarrhythmic drugs (sotalol, propafenone) were more frequently used in the VT group than in the PVC group. All patients underwent successful RFA with no major complications with 2 cases of early reablation. At follow-up, a signifi cant improvement 6 of 8 domains of SF-36 was observed in the VT and PVCs groups respectively with no signifi cant diff erence in physical and mental component summary score between both groups.Conclusions Favourable outcome of radiofrequency ablation in terms of quality of life and safety supports the idea of aggressive treatment of ventricular arrhythmia in patients with structurally normal hearts who are symptomatic and/or prone to cardiomyopathy. Comparable improvement of QoL in patients with PVCs and VT is an additional argument for performing ablation in symptomatic patients with frequent ventricular contractions.

Pharmacological modulation of connexin-formed channels in cardiac pathophysiology.

Coordinated electrical activity in the heart is supported by gap junction channels located at the intercalated discs of cardiomyocytes. Impaired gap junctional communication between neighbouring cardiomyocytes contributes to the development of re-entry arrhythmias after myocardial ischaemia. Current antiarrhythmic therapy is hampered by a lack of efficiency and side effects, creating the need for a new generation of drugs. In this review, we focus on compounds that increase gap junctional communication, thereby increasing the conduction velocity and decreasing the risk of arrhythmias. Some of these compounds also inhibit connexin 43 (Cx43) hemichannels, thereby limiting adenosine triphosphate loss and volume overload following ischaemia/reperfusion, thus potentially increasing the survival of cardiomyocytes. The compounds discussed in this review are: (i) antiarrythmic peptide (AAP), AAP10, ZP123; (ii) GAP-134; (iii) RXP-E; and (vi) the Cx mimetic peptides Gap 26 and Gap 27. None of these compounds have effects on Na(+) , Ca(2+) and K(+) channels, and therefore have no proarrhythmic activity associated with currently available antiarrhythmic drugs. GAP-134, RXP-E, Gap 26 and Gap 27 are pharmalogical agents with a favorable clinical safety profile, as already confirmed in phase I clinical trials for GAP-134. These agents show an excellent promise for treatment of arrhythmias in patients with ischaemic cardiomyopathy.

Practical stepwise approach to rhythm disturbances in congenital heart diseases

Patients with congenital heart diseases (CHD) are confronted with early- and late-onset complications, such as conduction disorders, arrhythmias, myocardial dysfunction, altered coronary flow, and ischemia, throughout their lifetime despite successful hemodynamic and/or anatomical correction. Rhythm disturbance is a well-known and increasingly frequent cause of morbidity and mortality in patients with CHD. Predisposing factors to rhythm disturbances include underlying cardiac defects, hemodynamic changes as part of the natural history, surgical repair and related scarring, and residual hemodynamic abnormalities. Acquired factors such as aging, hypertension, diabetes, obesity, and others may also contribute to arrhythmogenesis in CHD. The first step in evaluating arrhythmias in CHD is to understand the complex anatomy and to find predisposing factors and hemodynamic abnormalities. A practical stepwise approach can lead to diagnosis and prompt appropriate interventions. Electrophysiological assessment and management should be done with integrated care of the underlying heart defects and hemodynamic abnormalities. Catheter ablation and arrhythmia surgery have been increasingly applied, showing increasing success rates with technological advancement despite complicated arrhythmia circuits in complex anatomy and the difficulty of access. Correction of residual hemodynamic abnormalities may be critical in the treatment of arrhythmia in patients with CHD.

Acute Cardiac Care: Subspecialty Accreditation ante Portas

Coronary Care Units (CCUs) appeared in 1961 and their importance in the treatment of fatal arrhythmias in patients with an acute myocardial infarction was immediately confirmed (1). However, cardiology is rapidly changing and the role of CCUs today is totally different. In the era of early invasive reperfusion, the natural history of myocardial infarction has changed and most patients need a short CCU stay. On the other hand, the population is aging; patients with cardiac conditions live much longer and present with many comorbidities requiring longer and more complex critical cardiac care. Thus, the cardiologist should be able to understand the patient’s pathophysiology and provide treatment in the CCU in complex cases with, among other things, heart failure and renal failure, diabetes, respiratory failure on mechanical ventilation, sepsis and bleeding. Indeed, CCUs should be called intensive cardiac care units (ICCUs) because cardiac patients suffering from multisystem diseases are treated in these units. These changes are also reflected in the recommendations for the structure, organization, and operation of intensive cardiac care units (ICCUs). (2) In consequence, training a new type of cardiologist with expertise in intensive cardiac care is urgently needed on both sides of the Atlantic (3). Today these patients are treated by different specialists, often intensivists or anesthesiologists, without proper cardiology training, who do not use all the resources that modern cardiology could offer the patient. Currently, there is no formal training in acute cardiac care and to the best of our knowledge none of the National Cardiac Societies in Europe has developed any training program with these objectives. Nevertheless, the Working Group (WG) on Acute Cardiac Care of the European Society of Cardiology has recognized the need for better training of the cardiologists working in ICCUs. To work towards that end, the WG has prepared the Core Curriculum for a subspecialty on Acute Cardiac Care and the Accreditation will start later this year. The complexity of this subspecialty is reflected also in the contents of every issue of our journal (4–13). In the current issue a broad spectrum of subjects is presented, from acute coronary syndromes to arrhythmias, acute heart failure, hyponatremia and ventricular assist devices. It is clear that in the future Acute Cardiac Care will be one of the most important subspecialties of cardiology. And probably, the future is now!

Hemodialysis Complications

Hemodialysis Complications

Pilsicainide in breast milk from a mother: comparison with disopyramide and propafenone

Pilsicainide in breast milk from a mother: comparison with disopyramide and propafenone

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.

Treatment of Arrhythmia in Patients with Heart Failure

Pacing and Clinical ElectrophysiologyVolume 13, Issue 11 p. 1510-1515 Treatment of Arrhythmia in Patients with Heart Failure STEPHEN S. GOTTLIEB, Corresponding Author STEPHEN S. GOTTLIEB Cardiac Care Unit, University of Maryland, Baltimore, MarylandAddress for reprints: Stephen S. Gottlieb, M.D., Division of Cardiology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201.Search for more papers by this author STEPHEN S. GOTTLIEB, Corresponding Author STEPHEN S. GOTTLIEB Cardiac Care Unit, University of Maryland, Baltimore, MarylandAddress for reprints: Stephen S. Gottlieb, M.D., Division of Cardiology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201.Search for more papers by this author First published: November 1990 https://doi.org/10.1111/j.1540-8159.1990.tb04031.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume13, Issue11November 1990Pages 1510-1515 RelatedInformation

Transient increase in the contractile force induced by antiarrhythmic drugs in guinea pig cardiac muscles

During clinical treatment of arrhythmia in patients with chronic heart failure, cardiac function sometimes worsens due to the use of class I antiarrhythmic drugs. Morganroth and Horowitz 1 reviewed the risk of chronic heart failure induced by antiarrhythmic drugs. The class I drugs are classified as local anesthetics because of their sodium channel-inhibiting property. Suppression of the fast sodium current causes a decrease in intracellular calcium concentration and, therefore, a decrease in contractile force of muscles. 2–4 Dennis and Vaughan Williams 5 discussed the role of a reduction in the slow inward current in the negative inotropic effect of antiarrhythmic drugs. Recently, Honerjaeger et al 6 compared several class I antiarrhythmic drugs and tetrodotoxin. They concluded that class I antiarrhythmic drugs have negative inotropic effects due to the sum of sodium channel block and variable additional inotropic properties. They 6 examined calcium channel inhibition as a major additional mechanism underlying the negative inotropic effects, and suggested that several effects result from the sodium, potassium-adenosine triphosphatase inhibition. Concerning the inotropic properties of class I antiarrhythmic drugs, we now report that eibenzoline and aprindine (but not quinidine or disopyramide) transiently increase force by enhancing the effects of intrinsic adrenergic nerves in ventricular muscle at concentrations comparable to those used clinically.

Considerations in the Diagnosis and Treatment of Arrhythmias in Patients with End‐Stage Renal Disease

SummaryPatients with ESRD have arrhythmias similar to those in patients without renal complications. It is unclear whether ESRD itself is a risk factor for the development of arrhythmias or whether it is simply a marker for other diseases which predispose to arrhythmias. Regardless, therapy can be undertaken but special caution is required because of metabolic alterations and drug interactions which can make antiarrhythmic therapy more risky than in the general population. With meticulous attention to detail, therapy can be provided safely.

Tolerability and antiarrhythmic efficacy of disopyramide compared to lignocaine in selected patients with suspected acute myocardial infarction

In a randomized open study with intravenous lignocaine and disopyramide in patients with suspected acute myocardial infarction and ventricular premature contractions the occurrence of cardiac events, adverse reactions, withdrawals and arrhythmias were compared. Of the total 68 patients included in the study, 33 were randomized to disopyramide and 35 to lignocaine treatment. The treatment was given for 24 hours or until withdrawal due to occurrence of serious cardiac events or side-effects possibly related to the drugs. Sustained ventricular tachycardia occurred in one patient in each treatment group. 15 per cent of the patients treated with disopyramide and 14 per cent of the patients treated with lignocaine were withdrawn because of adverse reactions. Withdrawals due to depressed left ventricular function and sinoatrial and atrioventricular conduction disturbances were not different in the two treatment groups. However, more patients treated with lignocaine had supraventricular arrhythmias compared to disopyramide. Significantly more patients treated with disopyramide obtained complete abolition of premature ventricular contractions on Holter recordings compared to lignocaine treatment (P less than 0.001). The results indicate that disopyramide and lignocaine can be used alternatively in the treatment of ventricular arrhythmias in patients with suspected acute myocardial infarction.

Diagnosis and Treatment of Cardiac Arrhythmias in Patients with Familial Long QT Syndrome (LQTS); Long-Term Results

Diagnosis and Treatment of Cardiac Arrhythmias in Patients with Familial Long QT Syndrome (LQTS); Long-Term Results