ABSTRACT
Bradycardia in the acutely symptomatic patient is often associated with a poor prognosis and requires urgent diagnostic and therapeutic intervention. However, sinus bradycardia can also be purely chronic and harmless. In this situation, a structured approach to diagnosis and clinical assessment of the bradycardia is paramount. In this article, an overview of bradycardia, its pathogenesis, and the differential diagnosis is provided.
Subject(s)
Bradycardia , Electrocardiography , Emergency Treatment , Arrhythmias, Cardiac , Bradycardia/therapy , Diagnosis, Differential , HumansABSTRACT
The treatment of symptomatic tachycardia is a key challenge in intensive care medicine and emergency care. Making a quick and authoritative diagnosis on an ECG and applying adequate emergency treatment requires a structured approach to analyzing and treating arrhythmias. This CME article offers a practical categorization of the multitude of tachycardias, with medical and electrical treatment options and ECG examples. Appropriate first- and second-line treatment options are presented for most common tachyarrhythmias.
Subject(s)
Emergency Medical Services/methods , Intensive Care Units , Tachycardia/therapy , Atrial Fibrillation/diagnosis , Atrial Fibrillation/therapy , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Echocardiography , Electrocardiography , Guideline Adherence , Hemodynamics/physiology , Humans , Tachycardia/diagnosis , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/therapy , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/therapy , Thromboembolism/prevention & controlABSTRACT
PURPOSE: Lesion formation is a critical determinant of technical and clinical success of pulmonary vein isolation. Different catheter designs aim to enhance tissue contact during ablation to enable optimized lesion formation. We analyzed procedural characteristics and predictors of clinical success in patients ablated with three different contemporary ablation catheters. METHODS: Two hundred sixty-eight sequentially included patients receiving pulmonary vein isolation (PVI) with conventional (n = 122), contact-force (n = 96) and flexible-tip (n = 60) catheters were followed for a median of 14.1 months with 7d-Holter-monitoring and TTE at 3, 6, 12, and 24 months. Baseline characteristics and follow-up times were homogeneous across all groups. RESULTS: Multivariable Cox proportional hazard regression for arrhythmia recurrence demonstrated a favorable hazard ratio for contact-force and flexible-tip catheters vs. conventional open irrigation catheters. Procedure time and fluoroscopy time were shorter for contact-force and flexible-tip catheters versus conventional catheters, but equal between. Linear lesions were applied in 58 % of contact-force and 66 % of flexible-tip cases, and CFAEs were targeted in 26 % of either. CONCLUSIONS: Our non-randomized prospectively collected data do not show a difference in observed procedure characteristics and in clinical outcome for flexible-tip versus contact-force catheter designs, while both display improved performance against conventional open irrigated-tip catheters. Linear lesions and CFAEs ablation were not associated with improved arrhythmia-free survival.
Subject(s)
Atrial Fibrillation/epidemiology , Atrial Fibrillation/surgery , Catheter Ablation/instrumentation , Catheter Ablation/statistics & numerical data , Monitoring, Intraoperative/instrumentation , Monitoring, Intraoperative/statistics & numerical data , Aged , Atrial Fibrillation/diagnosis , Catheter Ablation/methods , Disease-Free Survival , Elastic Modulus , Equipment Design , Equipment Failure Analysis , Female , Humans , Male , Middle Aged , Monitoring, Intraoperative/methods , Prevalence , Recurrence , Reproducibility of Results , Sensitivity and Specificity , Stress, Mechanical , Treatment OutcomeABSTRACT
BACKGROUND: In heart failure (HF), traditional cardiovascular risk factors (RF) as body mass index (BMI), total cholesterol (TC) and systolic blood pressure (SBP) are associated with better survival. It is unknown at which time point along the disease continuum the adverse impact of these RF ceases and may 'start to reverse'. We analyzed the distribution of RF and their association with survival across HF stages. METHODS: We pooled data from four cohort studies from the German Competence Network HF. Employing ACC/AHA-criteria, patients were allocated to stage A (n=218), B (n=1324), C1 (i.e., New York Heart Association [NYHA] classes I & II; n=1134), and C2+D (NYHA III & IV; n=639). RESULTS: With increasing HF severity median age increased (63/67/67/70 years), whereas the proportion of females (56/52/37/35%), median BMI (26.1/28.8/27.7/26.6 kg/m(2)), TC (212/204/191/172 mg/dl), and SBP (140/148/130/120 mmHg) decreased (P<0.001 for trend for all). In the total cohort, higher levels of all RF were associated with better survival, even after extensive adjustment for multiple confounders. If analyses were stratified, however, a higher RF burden predicted better survival only in clinically symptomatic patients: hazard ratio (HR) per +2 kg/m(2) BMI 0.91 (95% confidence interval 0.88; 0.95); per +10 mg/dl TC 0.93 (0.92; 0.95); per +5 mmHg SBP 0.94 (0.92; 0.95). CONCLUSION: In this well-characterized sample of patients representing the entire HF continuum, reverse associations were only consistently observed in symptomatic HF stages. Our data indicate that the phenomenon of a "reverse epidemiology" in HF is subject to significant selection bias in less advanced disease.
