Subject(s)
Electrodes, Implanted/adverse effects , Endocarditis, Bacterial/etiology , Hypothyroidism/etiology , Pacemaker, Artificial/adverse effects , Pulmonary Embolism/etiology , Aged , Cough/etiology , Dyspnea/etiology , Echocardiography, Transesophageal , Endocarditis, Bacterial/diagnosis , Female , Humans , Hypothyroidism/blood , Hypothyroidism/drug therapy , Pulmonary Embolism/diagnosis , Tomography, X-Ray ComputedABSTRACT
Despite recent large scale trials, the management of atrial fibrillation remains very variable. The authors report the results of a prospective study of the management of atrial fibrillation in their department. One hundred consecutive patients admitted for atrial fibrillation were included in the study. The epidemiological and clinical data and the results of the therapeutic strategy were recorded prospectively. Three embolic complications occurred before hospital admission. The hospital stay was marked by spontaneous reduction of atrial fibrillation in 14 cases in the 6 hours following admission. The therapeutic strategy was the following: 40 arrhythmias were respected (well tolerated, > 1 year or with a left atrium 60 mm). Oral amiodarone (30 mg/Kg and 15 mg/Kg the next day) was given to 22 patients. Only 9 patients (41%) were converted (average delay of 12 hours). Four patients received intravenous amiodarone, reducing two arrhythmias. Twenty patients were treated by external electrical cardioversion of first intent and 14 after failure of pharmacological reduction. All of these procedures, early (after 48 hours anticoagulation and transoesophageal echocardiography), or late (after 1 month of anticoagulation), restored sinus rhythm without complications, especially embolic. This register showed a relatively low efficacy of oral amiodarone in the reduction of atrial fibrillation and underlines the efficacy and safety of external electrical cardioversion, even when performed early.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Administration, Oral , Aged , Amiodarone , Atrial Fibrillation/epidemiology , Atrial Fibrillation/pathology , Electric Countershock , Female , Hospitalization , Humans , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
We report a case of tachycardia due to reentry within the His-Purkinje system (HPS) occurring after introduction of flecainide. The patient presented with a mild mitral regurgitation and normal left ventricular function. He had incomplete left bundle branch block with left-axis deviation. At the electrophysiology study, a prolonged HV interval was observed at baseline, and the tachycardia could be reproduced after ajmaline infusion. Six months after interruption of flecainide, the patient remains free of arrhythmia recurrence. The authors emphasize that proarrhythmic effects of flecainide may include reentry within the HPS in patients with underlying HPS disease.
Subject(s)
Anti-Arrhythmia Agents/adverse effects , Bundle of His/physiopathology , Bundle-Branch Block/chemically induced , Flecainide/adverse effects , Purkinje Fibers/physiopathology , Administration, Oral , Aged , Ajmaline/administration & dosage , Anti-Arrhythmia Agents/administration & dosage , Bundle of His/drug effects , Bundle-Branch Block/drug therapy , Bundle-Branch Block/physiopathology , Electrocardiography/drug effects , Female , Flecainide/administration & dosage , Humans , Infusions, Intravenous , Purkinje Fibers/drug effects , Tachycardia, Ventricular/drug therapy , Tachycardia, Ventricular/physiopathologyABSTRACT
This study evaluated the paced QT interval in the days after radiofrequency ablation of the atrioventricular junction in patients with chronic rapid atrial fibrillation. There is an abnormality in the dynamics of the paced QT interval until the second day after ablation, resulting in an increased duration when the paced heart rate is <75 beats/min.
Subject(s)
Atrial Fibrillation/surgery , Atrioventricular Node/surgery , Catheter Ablation , Electrocardiography , Aged , Atrial Fibrillation/physiopathology , Chronic Disease , Female , Heart Block/physiopathology , Heart Block/therapy , Heart Rate , Humans , Male , Pacemaker, Artificial , Postoperative PeriodABSTRACT
Extraction of three chronically implanted pacemaker leads was performed via the implant vein in a 71-year-old man. One of the leads broke in the subclavian scar tissue. The lead fragment migrated into the left peroneotibial trunk artery. Transesophageal echocardiography showed patent foramen ovale associated with right-to-left atrial shunt. This complication of lead extraction is discussed along with the role of echocardiography prior to lead removal.
