Arrhythmias
Karim Ratib, Gurbir Bhatia, Neal Uren, James Nolan in Emergency Cardiology, 2010
Atrial tachycardia is relatively rare. Unifocal atrial tachycardia arises from a single repetitively discharging area of micro re-entry or enhanced automaticity. During the arrhythmia the ECG will usually show a regular narrow complex tachycardia with a rate of 120–240 bpm (Figure 3.4). Each QRS complex will be preceded by a morphologically abnormal P wave, usually best seen in V1. An upright P wave in V1 indicates the tachycardia is due to a left atrial focus, a positive P wave in AVL indicates a right atrial origin. The arrhythmia can arise in patients with structural heart disease leading to atrial dilatation or dysfunction, particularly in patients with cardiorespiratory co-morbidities, but commonly no cause is found. Atrial tachycardia is often resistant to drug therapy. Nodal blocking drugs will not terminate the arrhythmia, but may slow the ventricular rate. Antiarrhythmic drugs that stabilize atrial electrical activity (such as sotalol, flecainide and amiodarone) may terminate the arrhythmia. If drug therapy fails, overdrive pacing or cardioversion should be considered. Unifocal atrial tachycardias are readily treated by ablation in suitable patients who have recurrent symptoms.
Arrhythmias and electrophysiology
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol in Handbook of Aviation and Space Medicine, 2019
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.
Impairment of cardiovascular functions
Ramar Sabapathi Vinayagam in Integrated Evaluation of Disability, 2019
Dysrhythmia refers to the impairment of function relating to the regular beating of the heart. It may be either bradycardia or tachyarrhythmia. Diseases of the sinus node and atrioventricular node lead to bradycardia. Pacing corrects bradycardia due to sick sinus syndrome. Asystole of more than three seconds in carotid sinus syndrome needs permanent dual-chamber pacing. Atrial fibrillation with symptomatic bradycardia due to sick sinus syndrome benefits from atrial or dual chamber pacemaker (9). Heart failure can increase the risk of atrial fibrillation (10). A first-degree atrioventricular (AV) block does not require any specific treatment. Symptomatic second-degree AV block may benefit from permanent pacing because of the frequent association of the complete AV block resulting in Stokes-Adam attacks. A third-degree AV block (complete heart block) has a greater risk of asystole and requires permanent pacing. Persons with NYHA Class II symptoms and Left bundle branch block (LBBB) with QRS (a complex of wave forms recorded in ECG comprising of ‘Q’ wave, ‘R’ wave, ‘S’ wave) duration ≥150 milliseconds, or LBBB with QRS duration ≥150 milliseconds and Left ventricular ejection fraction (LVEF) ≤30%, or NYHA Class I symptoms and LBBB with QRS duration ≥150 milliseconds secondary to ischemia benefit from cardiac resynchronization therapy with greater reduction of ventricular fibrillation, ventricular tachycardia, and death (11). Atrial tachycardia refractory to medication needs radiofrequency ablation with a permanent dual-chamber pacemaker. Symptomatic atrioventricular re-entrant nodal supraventricular tachycardia with frequent recurrence requires radiofrequency ablation of the slower pathway. Wolff–Parkinson–White syndrome also benefits from radiofrequency ablation of the accessory pathway. Sustained ventricular tachycardia with hemodynamic compromise may benefit from ablation of the right ventricular outflow tract or automatic implantable cardiac defibrillator (AICD) (Illustration 9.2).
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.
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.
Outcome after catheter ablation for left atrial flutter
Published in Scandinavian Cardiovascular Journal, 2019
Mikkel Giehm-Reese, Peter Lukac, Steen Buus Kristiansen, Henrik Kjærulf Jensen, Christian Gerdes, Jens Kristensen, Jan Møller Nielsen, Mads Brix Kronborg, Jens Cosedis Nielsen
Procedural time was longer for patients with recurrence than for patients without recurrence, with median procedural time 295 min (IQR 250–335) compared to 265 min (IQR 215–320) respectively (p = .04,). This result reached statistical significance in the Cox regression analysis, HR = 1.01 (95% CI 1.003–1.02, p = .005). In patients with spontaneous or inducible PMFL, a ML was created. In these patients, recurrence was observed less frequently than in patients without ML (9/27 vs 17/26 patients, p = .02). This result was significant in the Cox regression univariate analysis HR = 0.43 (95% CI 0.19–0.96, p = .03). Eight patients were still inducible to atrial tachycardia at end of the CA procedure, and recurrent arrhythmia occurred in 7/8 patients still inducible compared to 19/45 patients not inducible (p = .02). Procedural time, ML and inducible at end of procedure remained statistically significant in the multivariate analysis (Table 3).
Related Knowledge Centers
- Arrhythmia
- Cardiac Pacemaker
- Digoxin Toxicity
- Multifocal Atrial Tachycardia
- Tachycardia
- Atrium
- Heart
- Ectopic Pacemaker
- Sinoatrial Node
- Cardiac Conduction System