warfarin and Tachycardia

Topics: Aged; Anticoagulants; Aspirin; Atrial Fibrillation; Clinical Trials as Topic; Creatinine; Diabetes Complications; Drugs, Investigational; Europe; Female; Heart Failure; Hemorrhage; Humans; Hypertension; Myocardial Infarction; North America; Observational Studies as Topic; Pyrazoles; Pyridones; Registries; Renal Insufficiency, Chronic; Severity of Illness Index; Stroke; Tachycardia; Thrombophilia; Treatment Outcome; Warfarin

Topics: Abdominal Pain; Aged; Anticoagulants; Atrial Fibrillation; Back Pain; Diagnosis, Differential; Embolization, Therapeutic; Emergency Service, Hospital; Female; Flank Pain; Humans; Infarction; Kidney; Risk Factors; Tachycardia; Thrombosis; Tomography, X-Ray Computed; Warfarin

Topics: Adult; Anticoagulants; Carcinoma, Renal Cell; Echocardiography; Fibrinolytic Agents; Follow-Up Studies; Heart Atria; Heparin; Humans; Kidney Neoplasms; Male; Nephrectomy; Risk Factors; Tachycardia; Thrombosis; Tissue Plasminogen Activator; Tomography, X-Ray Computed; Treatment Outcome; Vena Cava, Inferior; Vena Cava, Superior; Warfarin

Atrial fibrillation (AF) is associated with an increased long-term risk of stroke, heart failure, and mortality. Previous studies have demonstrated the suboptimal use of anticoagulation therapy in patients with AF.. A retrospective survey of patients (N = 1,113) fitted with dual-chamber pacemakers found 71 patients (age 69 ± 35, mean ± standard deviation) with atrial tachycardia and AF (defined as >5 minutes per day). Their medical records and anticoagulation status were investigated and used to stratify each patient for stroke risk with the Birmingham 2009 schema (CHA(2)DS(2)-VASc) and assessed to determine the rate of appropriate thromboembolism (TE) prophylaxis prescription.. The most common overall concomitant risk factor for stroke was hypertension (54%), followed by age ≥75 (51%), being female and previous stroke/transient ischemic attack/TE (39%). The average CHA(2)DS(2)-VASc score was 3.7 ± 1.6. Fifty-six percent of the patients were not receiving appropriate anticoagulation therapy.. This study demonstrates an underutilization of the oral anticoagulant warfarin in patients with known AF and that the clinicians may not be regarding current stroke risk factors when adopting a thromboprophylaxis strategy.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Heart Rate; Humans; Hypertension; Incidence; Male; Middle Aged; Pacemaker, Artificial; Retrospective Studies; Risk; Sex Factors; Stroke; Tachycardia; Thromboembolism; Wales; Warfarin

The ECG is abnormal in over 70% of patients with pulmonary embolism. Certain ECG abnormalities have been observed to return to normal after treatment. This case report describes an instructive ECG series in a patient with massive bilateral pulmonary embolism as shown by spiral computed tomography. The initial ECG showed sinus tachycardia with P pulmonale, although atrial tachycardia could not definitively be excluded. The patient had an increased troponin I concentration and echocardiographic evidence of right ventricular dysfunction and underwent thrombolysis with alteplase and anticoagulation with warfarin. P wave amplitude gradually decreased throughout admission and her tachycardia resolved. This may reflect a reduction in right atrial strain after treatment. This phenomenon has apparently not been described in this setting. The significance of ECG changes and the role of thrombolysis in pulmonary embolism are briefly discussed.

Topics: Anticoagulants; Electrocardiography; Female; Fibrinolytic Agents; Humans; Middle Aged; Pulmonary Embolism; Tachycardia; Tissue Plasminogen Activator; Treatment Outcome; Warfarin

Paroxysmal atrial fibrillation (PAF) can be eliminated with continuous circular lesions (CCLs) around the pulmonary veins (PVs), but it is unclear whether all PVs are completely isolated.. Forty-one patients with symptomatic PAF underwent 3D mapping, and all PV ostia were marked on the 3D map based on venography. Irrigated radiofrequency energy was applied at a distance from the PV ostia guided by 2 Lasso catheters placed within the ipsilateral superior and inferior PVs. The mean radiofrequency duration was 1550+/-511 seconds for left-sided PVs and 1512+/-506 seconds for right-sided PVs. After isolation, automatic activity was observed in the right-sided PVs in 87.8% and in the left-sided PVs in 80.5%. During the procedure, a spontaneous or induced PV tachycardia (PVT) with a cycle length of 189+/-29 ms was observed in 19 patients. During a mean follow-up of 6 months, atrial tachyarrhythmias recurred in 10 patients. Nine patients underwent a repeat procedure. Conduction gaps in the left CCL in 9 patients and in the right CCL in 2 patients were closed during the second procedure. A spontaneous PVT with a cycle length of 212+/-44 ms was demonstrated in 7 of 9 patients, even though no PVT had been observed in 6 of these 7 patients during the first procedure. No AF recurred in 39 patients after PV isolation during follow-up.. Automatic activity and fast tachycardia within the PVs could reflect an arrhythmogenic substrate in patients with PAF, which could be eliminated by isolating all PVs with CCLs guided by 3D mapping and the double-Lasso technique in the majority of patients.

Topics: Adenosine; Aged; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Cardiac Catheterization; Catheter Ablation; Combined Modality Therapy; Coronary Disease; Electrocardiography; Female; Follow-Up Studies; Heart Conduction System; Humans; Hypertension; Male; Middle Aged; Phlebography; Postoperative Complications; Prospective Studies; Pulmonary Veins; Recurrence; Tachycardia; Treatment Outcome; Warfarin

The interaction between amiodarone and warfarin has only been described in patients being followed up for relatively short time periods. The objectives of this study were to characterize the interaction between these two agents in a clinical situation over a longer period of time in a larger cohort of patients, and to determine the relationship between the maintenance dose of amiodarone and the resultant need to adjust the dose of warfarin.. This was an observational trial of a cohort of patients receiving a stable warfarin regimen in whom oral amiodarone was initiated. Patients received both amiodarone and warfarin for at least 1 year, and the dosage of warfarin was adjusted as clinically necessary to achieve an international normalized ratio of 2 to 3. Data from a total of 43 patients were analyzed.. At baseline, prior to initiation of amiodarone, the warfarin dose was 5.2 +/- 2.6 mg/d. The magnitude of the interaction between these two agents peaked at 7 weeks, which resulted in a 44% mean maximum reduction in the warfarin dose. The warfarin dose inversely correlated with the maintenance dose of amiodarone (r(2) = 0.94, p < 0.005). Minor bleeding episodes occurred in five patients (12%). For patients receiving amiodarone maintenance doses of 400, 300, 200, or 100 mg/d, it is recommended that the daily warfarin dose be reduced by approximately 40%, 35%, 30%, or 25%, respectively.. The magnitude of the amiodarone/warfarin interaction is highly dependent on the maintenance dose of amiodarone. This relationship can aid clinicians in adjusting the dose of warfarin patients receiving long-term amiodarone treatment.

Topics: Aged; Amiodarone; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Female; Heart Diseases; Hemorrhage; Humans; Long-Term Care; Male; Middle Aged; Retrospective Studies; Risk Factors; Tachycardia; Warfarin

There are a number of important drug interactions with amiodarone. This agent appears to have a marked effect on the kinetics of some commonly used cardiovascular drugs, such as warfarin, digoxin, quinidine, and procainamide, and has dynamic interactions with others, such as the beta blockers and some calcium antagonists. Bleeding has been reported, apparently caused by a potentiation of the anticoagulant effect of warfarin by amiodarone. Torsades de pointes has been observed when quinidine, propafenone, or mexiletine is given together with amiodarone. Furthermore, amiodarone may interact with beta-blocking agents and some of the calcium antagonists to produce symptomatic sinus bradycardia and sinus arrest, especially in a latent or overt sick sinus syndrome. During surgery, amiodarone may induce hypotension and an atropine-resistant bradycardia, possibly by interacting with anesthetic agents. A knowledge of the time of onset, extent, duration, and possible mechanisms of the interactions of amiodarone with other cardioactive drugs is still incomplete, but further studies are of great therapeutic importance.

Topics: Adrenergic beta-Antagonists; Amiodarone; Anti-Arrhythmia Agents; Arrhythmia, Sinus; Benzofurans; Blood Coagulation Disorders; Calcium; Digoxin; Drug Interactions; Drug Synergism; Heart Arrest; Humans; Kinetics; Quinidine; Tachycardia; Warfarin

Topics: Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Benzofurans; Blood Coagulation Disorders; Dose-Response Relationship, Drug; Drug Interactions; Heart Atria; Heart Ventricles; Humans; Tachycardia; Warfarin

Topics: Adult; Aged; Anti-Arrhythmia Agents; Aortic Valve; Arrhythmias, Cardiac; Death, Sudden; Female; Heart Valve Prosthesis; Heart Ventricles; Humans; Male; Middle Aged; Postoperative Complications; Stroke Volume; Tachycardia; Time Factors; Warfarin

Topics: Disopyramide; Drug Interactions; Humans; Male; Middle Aged; Pyridines; Tachycardia; Warfarin

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Bradycardia; Cardiac Complexes, Premature; Coronary Care Units; Electrocardiography; Female; Humans; Male; Middle Aged; Morphine; Myocardial Infarction; Oxygen Inhalation Therapy; Retrospective Studies; Shock, Cardiogenic; Tachycardia; Time Factors; Warfarin