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Supraventricular rhythms
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Non-sustained episodes of focal atrial tachycardia are commonly seen on ambulatory ECG monitoring and are often asymptomatic. Sustained atrial tachycardia can lead to a tachycardia-induced cardiomyopathy, and it is particularly important not to misdiagnose the rhythm as sinus tachycardia in such cases.
Arrhythmias and electrophysiology
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
ECG findings in aircrew that require further investigation: T wave inversion.ST segment flattening or depression.New complete bundle branch block.Multiple ectopic beats.Atrial tachycardia.Delta waves (in Wolff-Parkinson-White).Brugada phenotypes.
Supraventricular rhythms
Published in Andrew R Houghton, David Gray, Making Sense of the ECG, 2014
Non-sustained episodes of focal atrial tachycardia are commonly seen on ambulatory ECG monitoring, and are often asymptomatic. Sustained atrial tachycardia can lead to a tachycardia-induced cardiomyopathy, and it is particularly important not to misdiagnose the rhythm as sinus tachycardia in such cases.
Updates in the management of congenital heart disease in adult patients
Published in Expert Review of Cardiovascular Therapy, 2022
Danielle Massarella, Rafael Alonso-Gonzalez
Whereas patients with simpler forms of congenital heart disease would be expected to compensate well even in the setting of sustained atrial tachycardia for a significant period of time [13], atrial arrhythmias might be life-threatening in some patients with complex congenital heart disease. Patients having undergone Fontan palliation are at heightened risk of decompensation due to impedance to ventricular filling in the setting of chronic elevation of central venous pressure which limits pulmonary venous return. Therefore, rapid restoration of sinus rhythm should be pursued in this patient population. Rapid atrial tachycardia in patients with d-TGA might lead to reduced cardiac output and relative myocardial ischemia, increasing the risk of sudden cardiac death in these patients. The risk of sudden cardiac death may also be increased in patients presenting with pre-excited atrial fibrillation, a tachyarrhythmia that can be particularly associated with Ebstein anomaly of the tricuspid valve [13]. These and other congenital heart disease patients with particularly fragile physiology benefit from a rhythm over rate control strategy in the management of atrial arrhythmias and should be considered for ablative therapy. In addition, a comprehensive evaluation should be undertaken to rule out potentially treatable risk factors discussed previously, including sources of residual ventricular volume and pressure load for example [1,13].
Cryoballoon ablation beyond pulmonary vein isolation in the setting of persistent atrial fibrillation
Published in Expert Review of Medical Devices, 2022
Vincenzo Miraglia, Antonio Bisignani, Luigi Pannone, Saverio Iacopino, Gian-Battista Chierchia, Carlo de Asmundis
In the case of RAA, no studies reported RAA ablation for non-PV triggers. However, theoretically CB can be used for RAA isolation, as its use has been described for RAA focal atrial tachycardia. The unique structure and thin wall of RAA makes it a complex target for catheter manipulation with a non-negligible possibility of perforation. CB ablation has more stable contact with tissue and can create a wider lesion than radiofrequency ablation. These features make CB a therapeutic option for atrial tachycardia in RAA. Yorgun et al. [66] and Amasyali et al. [67] reported successful ablation cases of RAA tachycardia originating from RAA using a 28-mm CB without RAA isolation. In a case by Chun et al. [68], after failure of radiofrequency and 28 mm CB ablation, the 23 mm CB was used to isolate the RAA, with incessant atrial tachycardia inside the RAA but preserved SR in the atria.
Atrial tachyarrhythmia as a presenting symptom leading to the diagnosis of pulmonary sarcoidosis treated with catheter-based ablation
Published in Baylor University Medical Center Proceedings, 2021
Ayman Haq, Talia G. Meidan, Gaurav Synghal, Hafiza Khan
A 55-year-old woman was referred for 5 months of progressive palpitations. Her father had cardiac sarcoidosis and psoriasis and her daughter had ankylosing spondylitis and psoriatic arthritis. Laboratory studies, electrocardiogram, and echocardiogram were unremarkable. Ambulatory cardiac monitoring revealed an atrial tachycardia (Figure 1). An electrophysiology study revealed left-sided pre-atrial contractions triggering atrial fibrillation and typical and atypical atrial flutter. Cardiac gated computed tomography disclosed no cardiac abnormality but revealed multiple pulmonary nodules (Figure 2). An endobronchial ultrasound-guided fine-needle aspiration was consistent with pulmonary sarcoidosis (Figure 3). Cardiac magnetic resonance imaging (MRI) revealed normal chamber sizes without evidence of myocardial scarring. She underwent radiofrequency ablation of the cavotricuspid isthmus and left common, right superior, and right inferior pulmonary vein isolation via cryoablation. Hydroxychloroquine was initiated 19 days later. She did not have atrial fibrillation or atrial flutter after ablation, and her loop recorder was explanted 3 years after implantation.