1/62. adenosine-induced atrial pro-arrhythmia in children.adenosine has become the preferred acute treatment for common types of supraventricular tachycardia because of its efficacy and safety. There have been a few reports of serious proarrhythmic events associated with its use, including the induction of atrial fibrillation in adult patients. Three instances of adenosine-induced atrial proarrhythmia (two atrial fibrillation and one atrial flutter) have been observed in children with manifest or concealed wolff-parkinson-white syndrome at the Hospital for Sick Children, Toronto, ontario since 1990, which indicates a previously unreported risk of atrial arrhythmia for children as well. Because adenosine may enhance antegrade bypass tract conduction, its use carries a risk of ventricular acceleration, including progression to ventricular fibrillation. Because of such rare and potentially life-threatening adverse effects, appropriate monitoring and precautions are required during the administration of the drug to children and adults.- - - - - - - - - - ranking = 1keywords = atrial flutter, flutter (Clic here for more details about this article) |
2/62. ST segment elevation in the right precordial leads induced with class IC antiarrhythmic drugs: insight into the mechanism of brugada syndrome.We evaluated two patients without previous episodes of syncope who showed characteristic ECG changes similar to brugada syndrome following administration of Class IC drugs, flecainide and pilsicainide, but not following Class IA drugs. Patient 1 had frequent episodes of paroxysmal atrial fibrillation resistant to Class IA drugs. After treatment with flecainide, the ECG showed a marked ST elevation in leads V2 and V3, and the coved-type configuration of ST segment in lead V2. A signal-averaged ECG showed late potentials that became more prominent after flecainide. Pilsicainide, a Class IC drug, induced the same ST segment elevation as flecainide, but procainamide did not. Patient 2 also had frequent episodes of paroxysmal atrial fibrillation. Pilsicainide changed atrial fibrillation to atrial flutter with 2:1 ventricular response, and the ECG showed right bundle branch block and a marked coved-type ST elevation in leads V1 and V2. After termination of atrial flutter, ST segment elevation in leads V1 and V2 continued. In this patient, procainamide and quinidine did not induce this type of ECG change. In conclusion, strong Na channel blocking drugs induce ST segment elevation similar to brugada syndrome even in patients without any history of syncope or ventricular fibrillation.- - - - - - - - - - ranking = 2keywords = atrial flutter, flutter (Clic here for more details about this article) |
3/62. Continuous intravenous quinidine infusion for the treatment of atrial fibrillation or flutter: a case series.BACKGROUND: The purpose of the study was to evaluate a continuous intravenous quinidine infusion (CIQI) for the treatment of cardiac arrhythmias in critically ill patients. methods AND RESULTS: A 2-year retrospective review was conducted in adult patients receiving a CIQI for cardiac arrhythmias. Patient demographics, baseline laboratory values, indication for quinidine, dose, duration of therapy, efficacy, adverse events, and serum concentration were among the collected data. All patients were critically ill and receiving quinidine for the treatment of atrial arrhythmias. quinidine was effective in 14 (61%) of the 23 enrolled patients. Ninety-one percent of the patients received the CIQI after surgery. A total of 8 (35%) patients died. Four (17%) patients had hypotension possibly attributed to the quinidine. CONCLUSIONS: A continuous intravenous infusion of quinidine gluconate may be effective in patients in whom other agents are contraindicated or have failed. However, as with all antiarrhythmic agents, risks of therapy must be carefully considered.- - - - - - - - - - ranking = 1.5096553844092keywords = flutter (Clic here for more details about this article) |
4/62. Using ibutilide to convert atrial fibrillation and flutter.Ibutilide fumarate injection is the first antiarrhythmic drug approved by the food and Drug Administration for acute conversion of atrial fibrillation and flutter of recent onset (up to 90 days). This drug will find its greatest use in critical care units and emergency departments. critical care nurses monitor the patients, recognize and assist in treating adverse events, and evaluate patient outcomes. Advanced practice nurses will find this information useful for teaching patients, colleagues, and new critical care nurses.- - - - - - - - - - ranking = 1.8870692305115keywords = flutter (Clic here for more details about this article) |
5/62. Implantable atrial defibrillator and detection of atrial flutter.The implantable atrial defibrillator (IAD) is designed to detect and treat atrial fibrillation (AF) with low energy synchronized shocks. A patient with a history of persistent AF was implanted with an IAD after ineffective treatment with procainamide and sotalol. Through four months of follow-up, the IAD performed appropriate detection and treatment of AF. During the fifth month, the patient was put on flecainide in an attempt to minimize the AF recurrence rate. On flecainide the patient experienced typical atrial flutter which required IAD reprogramming for appropriate detection and therapy delivery. This case report examines the optimization of the IAD to detect atrial flutter. Six months of follow-up after optimization the IAD has shown appropriate detection of both atrial flutter and AF. During the entire follow-up period the IAD had appropriate detection of sinus rhythm (no false positive detection, i.e. sinus rhythm as AF).- - - - - - - - - - ranking = 7keywords = atrial flutter, flutter (Clic here for more details about this article) |
6/62. Termination of acute wide QRS complex atrial fibrillation with ibutilide.Ibutilide is a Vaughan-Williams class III antiarrhythmic agent approved for chemical cardioversion of acute onset atrial fibrillation/flutter. Emergency physicians rarely use ibutilide despite its proven clinical value. We report a case of successful chemical cardioversion using ibutilide in a patient with atrial fibrillation and delayed ventricular depolarization (wide QRS complex). We recommend that ibutilide be considered for wider use in the emergency department and that further studies be conducted.- - - - - - - - - - ranking = 0.3774138461023keywords = flutter (Clic here for more details about this article) |
7/62. Case report: pulmonary vein stenosis following RF ablation of paroxysmal atrial fibrillation: successful treatment with balloon dilation.Paroxysmal atrial fibrillation and atrial tachycardia may originate from a focal source in one or multiple pulmonary veins. A focal origin facilitates a potential cure amendable to radiofrequency ablation. Herein we report the case of a 16 year old adolescent male with a tachycardia induced cardiomyopathy who presented with very frequent paroxysmal episodes of atrial fibrillation, atrial flutter and atrial tachycardia. The origin of the arrhythmia was mapped to the secondary branches of the left lower pulmonary vein using an octapolar micro-mapping catheter. Immediately following application of three radiofrequency lesions, angiography of the left lower pulmonary vein revealed a region of focal stenosis at the site of energy application, with delayed pulmonary venous emptying. Attempts to relieve any element of spasm using direct administration of nitroglycerin were unsuccessful. Three months later repeat catheterization revealed an unchanged region of tight anatomical stenosis. Balloon dilation of two stenotic areas resulted in dramatic relief of the obstruction and improved venous drainage. Recatheterization 6 months later revealed mild restenosis that was successfully redilated. Intracardiac ultrasound demonstrated focal constriction. Care should be exercised in attempting RF ablation in distal arborization sites of the pulmonary veins in children, because of the small caliber compared to adult subjects. Radiofrequency induced focal areas of stenosis may be amenable to balloon catheter dilation.- - - - - - - - - - ranking = 1keywords = atrial flutter, flutter (Clic here for more details about this article) |
8/62. Atypical left atrial flutter after intraoperative radiofrequency ablation of chronic atrial fibrillation: successful ablation using three-dimensional electroanatomic mapping.Curative treatment of chronic atrial fibrillation (AF) remains a challenging task for electrophysiologists. Eliminating the initiating triggers by focal radiofrequency ablation in a subset of patients with paroxysmal AF and modifying the maintaining substrate by performing linear lesions within the left atrium in patients with prolonged episodes of AF are among the alternative approaches for management of these patients. Recently, a new intraoperative treatment procedure aimed at eliminating left atrial anatomic "anchor" reentrant circuits by induction of contiguous lesions using radiofrequency energy under direct vision was introduced. However, atypical left atrial flutter may occur during follow-up after intraoperative ablation of AF. These arrhythmias most likely are due to discontinuities in linear lesions; therefore, they can be successfully mapped and ablated in a subsequent percutaneous catheter ablation procedure. We report and discuss the case of a patient who underwent successful intraoperative ablation of chronic AF, but who developed atypical left atrial flutter postoperatively. Three-dimensional nonfluoroscopic electroanatomic mapping revealed a gap in the linear lesion line connecting the left upper and right upper pulmonary vein orifices. Ablation at the exit site of the breakthrough was successful.- - - - - - - - - - ranking = 6keywords = atrial flutter, flutter (Clic here for more details about this article) |
9/62. Relation between the rapid focal activation in the pulmonary vein and the maintenance of paroxysmal atrial fibrillation.This case report describes a patient with drug refractory paroxysmal atrial fibrillation (PAF). Rapid focal activations with multiple sharp spikes were continuously identified inside the left superior pulmonary vein (PV) during sustained AF. Among seven episodes of AF, cessation of rapid focal activations coincided with the conversion of AF to flutter (n = 4) or immediate AF termination (n = 3). Guided by sharp spikes in the PV, abrupt termination of AF occurred during radiofrequency energy application. Conclusively, rapid focal activations inside the PV are critical in AF maintenance. Cessation of these rapid focal activations underlies the mechanism by which AF converts to flutter.- - - - - - - - - - ranking = 0.7548276922046keywords = flutter (Clic here for more details about this article) |
10/62. Combined cardiomyopathy and skeletal myopathy: a variant with atrial fibrillation and ventricular tachycardia.This article describes a family characterized by combined cardiomyopathy and nonspecific skeletal myopathy who present in the third to fifth decades with cardiac manifestations but earlier have evidence of subtle skeletal muscle dysfunction. They differ from previously defined syndromes and potentially represent a different genetic expression or mutation. Cardiomyopathy presents with atrial arrhythmias including AF and atrial flutter. life-threatening ventricular tachyarrhythmias occur next with onset of ventricular dysfunction. Electrophysiological study revealed sustained monomorphic VT. Affected family members benefitted from an ICD and progression to congestive heart failure (CHF) occurred late. Skeletal myopathy continues with marked progressive muscle weakness and inability to ambulate without assistance. Genetic analysis is currently ongoing. Neurological evaluation in all three family members revealed nonspecific myopathy affecting the psoas and iliopsoas muscles. atrophy and wasting of the facial and temporalis muscles were common. Skeletal muscle biopsy revealed myofiber atrophy consistent with myopathy.- - - - - - - - - - ranking = 1keywords = atrial flutter, flutter (Clic here for more details about this article) |
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