Supraventricular Arrhythmias During Acute Mi

Acute Atrial Fibrillation

Supraventricular arrhythmias complicating AMI are commonly associated with increased sympathetic tone. Many factors in the AMI setting can cause a hyperadrenergic state, including fear, anxiety, fever, pain, ongoing ischemia, hypoxia, dyspnea, and pericarditis (93). Management of these arrhythmias requires careful attention to such provocative influences. Persistent sinus tachycardia (see Fig. 12) is deleterious during AMI because of the increased oxygen demands imposed by the rapid heart rate....

Problems And Emerging Solutions For Scarrelated Tachycardias

In some idiopathic and scar-related tachycardias the ablation target is not located on the endocardium, but is intramural or epicardial in location. In these cases, epicardial mapping can be attempted in one of two ways. Electrode catheters can be introduced into the cardiac venous system via the coronary sinus (CS). Small, 2 French multielectrode catheters are available that allow extensive epicardial mapping over regions of the left ventricle by canulating the branches of the CS and great...

Amiodarone in Patients with Structural Heart Disease

Since many of the patients who have AF have significant structural heart disease, attempts should be made to use drugs with mortality-neutral effects. Currently, amiodarone has the largest clinical experience in patients with structural heart disease. The South American GESICA trial 78 demonstrated a reduced morbidity and mortality in patients treated with amiodarone who had severe CHF. Although CAMIAT 79 and EMIAT trials 80 demonstrated a reduced risk of sudden death in patients treated with...

The Evaluation Of Syncope

The cornerstone of the syncope evaluation is a comprehensive history and detailed physical examination 2,11 . The history should include any information on current or previous cardiovascular conditions, current medications, comorbid conditions, and a Young patients lt 35 yr Neurocardiogenic Psychiatric Situational Epileptic seizures Long QT Syndrome Hypertrophic cardiomyopathy Supraventricular tachycardia Mid-life 35-65 yr Neurocardiogenic Cardiac arrhythmias Older patient Arrhythmic...

Ventricular Arrhythmias During Acute Mi

Acute Atrial Fibrillation

The metabolic sequelae of ischemia, including intracellular hypercalcemia and acidosis, anaerobic lipid metabolism, and free-radical production, may contribute to arrhyth-mogenesis during AMI 3 . Rapid efflux of intracellular potassium, leading to membrane depolarization, may be the most important of these effects. In addition, increased sympathetic tone augments electrical instability, provoking both ventricular and supra-ventricular tachyarrhythmias. Enhanced parasympathetic tone, usually...

Vt Related To Regions Of Scar

Scar Related Reentry

The most common cause of VT is reentry through regions of scar, most commonly an old MI Fig. 4 . Other scar-related VTs occur because of arrhythmogenic right ventricular dysplasia, sarcoidosis, Chagas' disease, and other nonischemic cardiomyopathies. Two features of ventricular scarring lead to reentrant VT 40-42 . First, dense scarring creates regions of anatomic conduction block. Second, the scar is not comprised completely of dense fibrotic tissue, but also contains surviving myocyte bundles...

Atrial Tachycardia With Variable Block

Short Avnrt

ECGs in three patients with atrial tachycardia. A Atrial activity is most prominent in lead Vi. Note that the P wave is closer to the next QRS complex than the previous QRS complex a so-called long-RP tachycardia. There is 1 1 conduction until the end of the tracing, when AV nodal block reveals low amplitude P waves. B Atrial tachycardia with 2 1 A V conduction, and left bundle-branch block LBBB aberrancy in a patient with dilated cardiomyopathy. P-wave activity is most evident in lead...

Commotio Cordis

Commotio cordis, or cardiac concussion, refers to sudden death caused by a relatively low-energy chest-wall impact. Although a rare syndrome, it has been reported with increasing frequency in young individuals participating in athletic activities 169-176 . Commotio cordis typically occurs in youths age 5-16, who are participating in athletic activities in which there is blunt impact to the chest. Commotio cordis has usually been described with baseball, but has also been reported with hockey,...

Patients With Minimal Structural Heart Disease or With LVH

In patients with minimal or no significant structural heart disease, any antifibrillatory agent can be employed. A specific agent should be selected by its side-effect profile. Class IC agents such as propafenone and flecainide have an extremely low incidence of ventricular proarrhythmia in normal hearts, and are generally well-tolerated. Sotalol and class IA agents such as disopyramide and procainamide can be used safely in this setting if careful attention is given to the dose-dependent...

Epidemiology And Natural History

Avnrt Antidromic

Data on the prevalence of supraventricular tachyarrhythmias are extremely scarce. Electrocardiographic ECG screening studies of large populations 13,14 suggest a prevalence of the WPW pattern on ECG of 1 to 2 per 1000, but not all of these patients have clinical arrhythmia. In a study of the 50,000 residents of the Marshfield Epidemiologic Study Area MESA in Wisconsin, the prevalence of symptomatic PSVT was 2.25 per 1000, with an incidence of 35 per 100,000 person-years 15 . In this study, PSVT...

Sotalol in Patients With Structural Heart Disease

Other agents such as racemic or DL-sotalol have demonstrated no increased mortality in patients post-MI 84 . When used in the dextrorotatory optical isomer form, d-sotalol, an increased mortality was seen in patients with an ejection fraction greater than 30 85 . Ventricular hypertrophy predisposes the heart to the formation of early afterdepolarizations, which can lead to torsades de pointes. For post-MI patients without left ventricular hypertrophy LVH or CHF, racemic d,l-sotalol is a...

Practical Approach To Nsvt

Practical clinical issues include patient identification and screening, diagnostic evaluation, and treatment selection see Fig. 9 . The population which requires aggressive diagnostic and therapeutic interventions includes patients with CAD and impaired left ventricular function. In this patient population, NSVT can reflect a significantly increased mortality risk. At present, the majority of these potentially high-risk patients with NSVT are not being referred for ICD implantation or...

Pharmacologic Treatment Of Patients With Nsvt

Electro Physiology

For patients at high risk, the concept of primary prevention of death is valid as long as an effective, proven, prophylactic approach exists. Several methods have been attempted antiarrhythmic drug suppression and ICD therapy. ACE inhibitors, spironolactone, and beta-blockers improve survival in high-risk patients with NSVT who have CAD, heart failure and or impaired ventricular function. Even so, death rates in these high-risk groups remain high. Beta-blockers are effective in reducing overall...

Specific Conditions Associated With Nsvt

Acute precipitants of NSVT include MI, cardiac surgery, electrolyte and metabolic abnormalities, antiarrhythmic drugs, QT prolongation, and pulmonary edema. NSVT caused by an acute precipitant often resolves promptly with resolution of the precipitating condition. Chronic treatment depends on the continued presence of the arrhythmia, patient age, heart disease, and symptoms. After patient stabilization and after correction of potential precipitants, evaluation and long-term therapy should be...