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Recognition of common arrhythmias
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Nicholas P. Kerr, Rajesh N. Subbiah
Multifocal atrial tachycardia is an uncommon irregular atrial rhythm seen most often in patients with advanced pulmonary disease. The ECG diagnosis is made when at least three different P-wave morphologies are present. It is distinguished from AF by the presence of a flat isoelectric baseline between P waves.
Practical recommendations for the use of beta-blockers in chronic obstructive pulmonary disease
Published in Expert Review of Respiratory Medicine, 2020
Cardiac arrhythmias are transmission abnormalities in the cardiac conduction system that often result from ischemia or structural heart defects in response to an acute injury or longstanding insults from chronic diseases, such as hypertension, lung disease, etc. Atrial tachyarrhythmias, such as multifocal atrial tachycardia, atrial fibrillation, and atrial flutter occur commonly in COPD [57,58] and are seen more frequently as the severity of COPD increases [59]. The reasons for this are not completely clear; however, increased sympathetic activity and beta-agonist therapy may play a role [60,61]. Data suggest that atrial abnormalities on the electrocardiogram are associated with an increased risk of COPD exacerbation [62,63]. The diagnosis of paroxysmal atrial arrhythmias remains challenging despite the association with poor prognosis and progression to sustained tachyarrhythmia [64,65]. There are no recommended screening criteria for arrhythmias in COPD. Treatment is comprised of several classes of medications including rate-controlling medications such as non-dihydropyridine calcium channel blockers and beta-blockers as well as rhythm controlling agents, such as amiodarone. Guidelines advise consideration of obstructive lung disease when evaluating for treatment; however, recommendations on specific therapeutic agents are not included, and beta-blockers are not contraindicated [66].
Current challenges in managing comorbid heart failure and COPD
Published in Expert Review of Cardiovascular Therapy, 2018
J. Alberto Neder, Alcides Rocha, Maria Clara N. Alencar, Flavio Arbex, Danilo C. Berton, Mayron F. Oliveira, Priscila A. Sperandio, Luiz E. Nery, Denis E. O’Donnell
Owing to its inotropic properties, digitalis has been used for centuries in the treatment of HF. The safety of digitalis has been questioned by recent meta-analysis [121]. Indeed, digitalis has a narrow therapeutic range: age, decreased renal function, and low body weight are known risk factors for digitalis toxicity [122]. Patients with HF–COPD are generally older [52], the cardiorenal syndrome is commonly associated with negative lung-right heart-kidney interactions [123], and cachexia is a common feature in HF–COPD [124]. Moreover, digitalis may add to the increased sympathetic stimulation in some patients with COPD causing calcium overload and multifocal atrial tachycardia, the commonest tachyarrhythmia in COPD [125]. These considerations make digitalis a poorly attractive treatment nowadays in HF–COPD patients, except for controlling HR on top of β-blockers in the presence of atrial fibrillation (Afib) (Table 3).
Prevalence of arrhythmia in COVID-19 patients with mild/moderate and severe illness: a prospective cohort study
Published in Expert Review of Cardiovascular Therapy, 2023
Praveen Gupta, Sandeep Bansal, Anunay Gupta, Kapil Gupta, Sumita Saluja, Sudheesh Kumar Kattumannil
The arrhythmias were specified as the presence of atrial fibrillation (AF), atrial flutter (AFL), atrial tachycardia (AT), multifocal atrial tachycardia, sustained and non-sustained ventricular tachycardia (VT), ventricular fibrillation (VF), second-degree type II atrioventricular (AV) block, or complete heart block. New onset arrhythmias were described as a patient who did not have any history of arrhythmias (atrial fibrillation, atrial tachycardia, atrial flutter, ventricular arrhythmia, or high-grade atrioventricular block) documented or treated in the past and who developed arrhythmias during their hospital stay. Berlin’s criteria were applied to define Acute respiratory distress syndrome (ARDS) [12].