cardiovascular-agents and Atrial-Flutter

Patent foramen ovale (PFO) closure has emerged as a secondary prevention option in patients with PFO and cryptogenic stroke. However, the comparative efficacy and safety of percutaneous closure and medical therapy in patients with cryptogenic stroke and PFO remain unclear.. Randomized controlled trials (RCTs) and comparative observational studies that compared PFO closure against medical therapy, each with a minimal of 20 patients in the closure arm and 1-year follow-up were included.. We analyzed 6961 patients from 20 studies (5 RCTs and 15 observational studies) with a median follow-up of 3.1 years. Moderate-quality evidence showed that PFO closure was associated with a significantly lower incidence of the composite outcome of ischemic stroke, transient ischemic attack (TIA), or all-cause death (odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.38 to 0.85; P = 0.006), mainly driven by lower incidence of stroke (OR: 0.39; 95% CI: 0.24 to 0.63; P < 0.001). The numbers needed to treat were 43 and 39 for the composite outcome and recurrent ischemic stroke respectively. PFO closure increased the risks for atrial fibrillation or atrial flutter (OR: 5.74; 95% CI: 3.08 to 10.70; P < 0.001; high-quality evidence) and pulmonary embolism (OR: 3.03; 95% CI: 1.06 to 8.63; P = 0.038; moderate-quality evidence), with the numbers needed to harm being 30 and 143 respectively. The risks for TIA, all-cause death, and major bleeding were not statistically different. Analyses limited to RCTs showed similar findings, as did a series of other subgroup analyses.. In conclusion, PFO closure reduced the incidences of stroke and the composite outcome of ischemic stroke, TIA, or all-cause death, but increased risks for atrial fibrillation or atrial flutter and pulmonary embolism compared with medical therapy.

Topics: Adult; Atrial Fibrillation; Atrial Flutter; Cardiac Catheterization; Cardiovascular Agents; Female; Foramen Ovale, Patent; Humans; Incidence; Ischemic Attack, Transient; Male; Middle Aged; Observational Studies as Topic; Pulmonary Embolism; Randomized Controlled Trials as Topic; Risk Factors; Stroke; Time Factors; Treatment Outcome

Cardiac arrhythmias comprise of a heterogeneous group of disorders which manifest in a wide range of clinical presentations. They can be associated with underlying cardiac disease and portend a grave prognosis, with some arrhythmias being rapidly fatal. Other arrhythmias, however are relatively benign and can be asymptomatic or may be a mere inconvenience for the patient. All primary care physicians can expect to encounter some forms of arrhythmias during the course of their practice. This review article provides a brief overview of the commonly seen tachyarrhythmias for the general practitioner and provides relevant updates on the recent developments in our understanding of their mechanisms and management.

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiovascular Agents; Catheter Ablation; Electric Countershock; Electrocardiography; Heart Ventricles; Humans; Risk Factors; Tachycardia

Atrial fibrillation and atrial flutter are common supraventricular arrhythmias in patients who present to the emergency department. Under the American Heart Association guidelines, dilTIAZem is the calcium channel blocker frequently used by many practitioners for rate control. Currently, institution-specific data have identified that many patients receiving dilTIAZem for atrial fibrillation or atrial flutter are given initial doses that exceed the recommended dose by more than 10%, resulting in hypotension in some patients.. ED personnel were surveyed to determine their current knowledge of appropriate intravenous dilTIAZem dosing and methods of prescribing intravenous dilTIAZem to determine the causes of higher dosing. Based on the baseline data, an intervention of adding a text alert when withdrawing dilTIAZem from the automated medication dispensing cabinet was implemented.. Following the intervention, 29 patients received intravenous dilTIAZem for rate control of atrial fibrillation or flutter with rapid ventricular response. For the primary outcome, the incidence of high-dose dilTIAZem decreased by 19% (P = 0.03). There was no change in the secondary outcome of a reduction in hypotension (P = 0.3).. The interventions of education and medication alerts resulted in a significant increase in the percentage of patients receiving appropriate doses of dilTIAZem and a nonsignificant decrease in the incidence of hypotension. This process-oriented intervention resulted in an improvement in appropriate dilTIAZem doses at our site. Rate control was not statistically significantly different between the 2 groups. Long-term sustainability of this intervention requires further study.

Topics: Aged; Atrial Fibrillation; Atrial Flutter; Cardiovascular Agents; Diltiazem; Dose-Response Relationship, Drug; Emergency Service, Hospital; Female; Heart Ventricles; Humans; Injections, Intravenous; Male; Middle Aged; Retrospective Studies

The study was designed to characterize "on-label" use of i.v. diltiazem in patients with acute atrial fibrillation or flutter (AFF).. An IRB-approved, single-center, retrospective, observational design was used. Eligible patients had acute AFF with heart rate >120 bpm and received i.v. diltiazem from June 1, 2012, to June 30, 2014. The primary outcome was frequency of on-label use of i.v. diltiazem, defined as use of at least one FDA-approved weight-based bolus dose followed by an infusion, if appropriate, in the absence of contraindications.. A total of 300 patients were screened; 97 patients were included for analysis. I.V. diltiazem was used on-label in only 14 patients (14%). Of the 96 patients who received an initial diltiazem bolus injection, the median dose was significantly higher in patients for whom the diltiazem dose was on-label, as follows: 17.5 mg (interquartile range [IQR]), 10-20 mg vs. 10.0 mg (IQR, 10-20 mg), p < 0.02). Twenty-nine patients (35%) in the off-label group had a therapeutic response to diltiazem alone compared with 8 patients (57%) in the on-label group (p = 0.11). More patients treated with off-label diltiazem bolus injection required additional rate control medications (41% vs. 7%, p < 0.04).. In most patients, i.v. diltiazem was not used in accordance with FDA labeling. For most, i.v. diltiazem doses were lower than recommended and many of these patients required additional rate control medications to achieve a therapeutic response.

Topics: Acute Disease; Aged; Atrial Fibrillation; Atrial Flutter; Cardiovascular Agents; Diltiazem; Dose-Response Relationship, Drug; Female; Heart Rate; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Middle Aged; Retrospective Studies

Topics: Anticoagulants; Atrial Flutter; Cardiovascular Agents; Diltiazem; Electric Countershock; Electrocardiography; Heart Block; Humans; Male; Middle Aged; Stroke

Topics: Animals; Atrial Flutter; Cardiovascular Agents; Dog Diseases; Dogs; Echocardiography; Electrocardiography; Heart Murmurs; Lameness, Animal; Tachycardia; Tricuspid Valve Insufficiency

Topics: Atrial Flutter; Benzazepines; Bradycardia; Cardiovascular Agents; Catheter Ablation; Cyclic Nucleotide-Gated Cation Channels; Electrocardiography, Ambulatory; Humans; Ivabradine; Male; Middle Aged

Atrial flutter and fibrillation are being increasingly reported in patients with pulmonary hypertension but little is known about their clinical implications. We sought to determine the incidence and clinical impact of these arrhythmias in patients with pulmonary hypertension.. In a 5-year, prospective study, we assessed the incidence of new-onset atrial flutter and fibrillation as well as risk factors, clinical consequences, management, and impact on survival in patients with pulmonary arterial hypertension (PAH, n=157) or inoperable chronic thromboembolic pulmonary hypertension (CTEPH, n=82).. The cumulative 5-year incidence of new-onset atrial flutter and fibrillation was 25.1% (95% confidence interval, 13.8-35.4%). The development of these arrhythmias was frequently accompanied by clinical worsening (80%) and signs of right heart failure (30%). Stable sinus rhythm was successfully re-established in 21/24 (88%) of patients initially presenting with atrial flutter and in 16/24 (67%) of patients initially presenting with atrial fibrillation. New-onset atrial flutter and fibrillation were an independent risk factor of death (p=0.04, simple Cox regression analysis) with a higher mortality in patients with persistent atrial fibrillation when compared to patients in whom sinus rhythm was restored (estimated survival at 1, 2 and 3 years 64%, 55%, and 27% versus 97%, 80%, and 57%, respectively; p=0.01, log rank analysis).. Atrial flutter and fibrillation develop in a sizable number of patients with PAH or inoperable CTEPH and often lead to clinical deterioration and right heart failure. Mortality is high when sinus rhythm cannot be restored.

Topics: Aged; Atrial Fibrillation; Atrial Flutter; Cardiovascular Agents; Cohort Studies; Electric Countershock; Female; Follow-Up Studies; Humans; Hypertension, Pulmonary; Male; Middle Aged; Prospective Studies

Topics: Animals; Atrial Flutter; Cardiovascular Agents; Diagnosis, Differential; Diltiazem; Dog Diseases; Dogs; Electrocardiography; Female; Treatment Outcome

To investigate the incidence of atrial fibrillation after successful radiofrequency ablation for typical atrial flutter (AFL) and to compare its incidence with that of a reference population from the Framingham Heart Study to determine whether atrial flutter is an independent predictor for development of atrial fibrillation.. Medical records of 234 patients who underwent radiofrequency ablation for AFL between January 1, 2002, and June 30, 2006, were reviewed. Patients were excluded if they had a history of atrial fibrillation or sustained atrial arrhythmia other than AFL or if they had atrial tachyarrhythmias other than AFL that could be induced during electrophysiology study (133 total patients excluded). The remaining 101 patients who underwent successful radiofrequency ablation for AFL were monitored for new-onset atrial fibrillation.. During the mean+/-SD follow-up period of 574+/-315 days, atrial fibrillation developed in 13 (12.9%) of 101 patients. Atrial fibrillation developed in 12 of these patients within 6 months of ablation. The cumulative event-free rates (95% confidence intervals) were 97% (94%-100%) at 1 month, 91% (87%-97%) at 3 months, and 86% (81%-94%) at 6 months. Compared with the general population, patients aged 50 to 79 years who had ablation had a significantly higher incidence of atrial fibrillation (50-59 years, P=.01; 60-69 years, P=.001; 70-79 years, P=.007).. Our finding of atrial fibrillation in 12.9% of patients whose atrial flutter was successfully eradicated suggests that patients with atrial flutter are at increased risk of developing atrial fibrillation, especially within the first 6 months after ablation.

Topics: Aged; Atrial Fibrillation; Atrial Flutter; Cardiovascular Agents; Catheter Ablation; Electrophysiology; Female; Heart Diseases; Humans; Kaplan-Meier Estimate; Male; Medical Records; Middle Aged; Risk Factors; Ultrasonography

In older patients who are known to be at greater risk for atrial fibrillation, we aimed to determine whether patients who develop atrial fibrillation-flutter (AF) after major thoracic surgery have an exaggerated white blood cell (WBC) count in response to surgical stress compared with those who do not develop AF.. Using a prospective database, 272 patients 60 years or older who were in sinus rhythm before surgery and had elective lobectomy, pneumonectomy, or esophagectomy were studied. Patients did not receive perioperative medications to prevent AF. Clinical characteristics and preoperative 12-lead electrocardiogram were examined and WBC counts were recorded for patients prior to and for up to five days after surgery.. Atrial fibrillation-flutter was observed in 74 of 272 (27%) patients a median of 3 days after surgery. The increase in WBC count from preoperative to postoperative day 1 and age were jointly significant predictors of AF by multiple logistic regression (area under the receiver operating characteristic curve = 0.69). Using this model, a twofold increase in WBC from presurgery to postoperative day 1 corresponded to a 3.3-fold increase in the odds of developing AF (95% confidence interval [CI] 2.0 to 8.3) and for each 10 year increase in age, a 1.8-fold increase in risk of AF (95% CI 1.1 to 2.8) was seen.. Increments in WBC were greater in patients with AF and coincided with the peak onset of AF. These prospective data support an important role for stress-mediated autonomic mechanisms in the pathogenesis of AF after major thoracic surgery. We aim to examine further whether WBC elevations on postoperative day one can help further risk stratify patients younger than 60 years or those with the highest risk who could benefit from one or more AF prevention strategies.

Topics: Age Factors; Aged; Anti-Inflammatory Agents; Atrial Fibrillation; Atrial Flutter; Autonomic Nervous System; Cardiovascular Agents; Disease Susceptibility; Esophagectomy; Female; Humans; Inflammation; Leukocyte Count; Leukocytosis; Male; Middle Aged; Odds Ratio; Pneumonectomy; Postoperative Complications; Postoperative Period; Prospective Studies; Risk Factors; Stress, Physiological

To evaluate the prophylactic effect of diltiazem on the incidence of atrial arrhythmia (fibrillation and/or flutter) following coronary artery bypass grafting (CABG). Data were retrospectively gathered.. Patients undergoing elective CABG by one surgeon at one institution over a three-year period were considered for inclusion. Those selected were divided into 3 groups: A (patients placed on intravenous diltiazem intraoperatively, then converted to oral diltiazem upon initiation of oral intake); B (patients started on oral diltiazem upon initiation of oral intake without prior intravenous diltiazem); and C (patients receiving no diltiazem). A comparison of postoperative rates of atrial fibrillation was made between the 3 (demographically balanced) groups using logistic regression.. Two hundred and eighty seven patients met inclusion criteria. The incidence of postoperative atrial fibrillation in the entire sample was 19.9% (57/287). Incidence of postoperative atrial fibrillation within each group was: A = 16.3% (22/135); B = 12.7% (7/55); C = 28.9% (28/97). Statistical significance was demonstrated for the following comparisons: A versus C (p = 0.0451) and B versus C (p = 0.0065). In an alternate model groups A and B were combined and compared to C (p = 0.0181).. A lower incidence of atrial fibrillation following CABG was observed in patients treated prophylactically with diltiazem. Differences were statistically significant whether the drug was administered intravenously and orally (A) or only orally (B). Diltiazem, which has an established role in the management of atrial fibrillation, may prove to be well suited for prophylaxis due to low cost and relative safety.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Flutter; Cardiovascular Agents; Coronary Artery Bypass; Diltiazem; Female; Humans; Incidence; Infusions, Intravenous; Intraoperative Care; Male; Middle Aged; Postoperative Care; Retrospective Studies

Topics: Atrial Flutter; Cardiovascular Agents; Cardiovascular Diseases; Digitalis; Drug-Related Side Effects and Adverse Reactions

Topics: Animals; Arrhythmias, Cardiac; Atrial Appendage; Atrial Fibrillation; Atrial Flutter; Cardiovascular Agents; Dihydroergotamine; Dogs; Ergot Alkaloids