Arrhythmia, Atrial Fibrillation and Bradycardia

New lessons, from the old chapters of Atrial fibrillation

Dr. S. Venkatesan MD

NOVEMBER 22, 2024

Atrial fibrillation: Think locally act globally It is clear, except in specific situations like HT, LVH, HFpEF, and other left (or right )sided structural heart diseases, the bulk of the AF is part of systemic destabilization of neuro-metabolic homeostasis. Epicardial Fat and Atrial Fibrillation: A Review. 2017.11.001.

Atrial Fibrillation

Atrial Fibrillation Arrhythmia Risk Factors Bradycardia

Dexmedetomidine vs. propofol on arrhythmia in cardiac surgery: a meta-analysis of randomized controlled trials

Frontiers in Cardiovascular Medicine

OCTOBER 9, 2024

The primary outcome was ventricular arrhythmias, the secondary outcomes were bradycardia and atrial fibrillation (AF).ResultsOur Perioperative or postoperative use of DEX reduced the incidence of in-hospital ventricular arrhythmias [Odds Ratio (OR) 0.14, 95% Confidence Interval (CI) 0.03–0.66],

Arrhythmia

Arrhythmia Bradycardia Atrial Fibrillation Hospital

Systematic review of the incidence and clinical risk predictors of atrial fibrillation and permanent pacemaker implantation for bradycardia in Fabry disease

Open Heart

JULY 17, 2023

Cardiac accumulation triggers local tissue injury, electrical instability and arrhythmia. Bradyarrhythmia and atrial fibrillation (AF) incidence are reported in up to 16% and 13%, respectively. Study outcomes included AF or bradycardia requiring therapy. Age was associated with AF (OR 1.05–1.20

Bradycardia

Bradycardia Atrial Fibrillation Pacemaker Risk Factors

Cardiomatics guide: Analyzing arrhythmias made easy

Cardiomatics

APRIL 5, 2024

Sinus bradycardia – sinus rhythm below 60 bpm is a sinus bradycardia. AFIB/AFL – atrial fibrillation or atrial flutter episodes. Other times, an irregular recording can signal a medical emergency, such as a myocardial infarction or a dangerous arrhythmia. Usually does not exceed 160 bpm.

Arrhythmia

Arrhythmia Tachycardia Bradycardia Electrocardiogram

Evaluation of atrial fibrillation using wearable device signals and home blood pressure data in the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) Study: A Subgroup Analysis (MIPACT-AFib)

Frontiers in Cardiovascular Medicine

DECEMBER 19, 2023

Background The rising adoption of wearable technology increases the potential to identify arrhythmias. Herein, we report results of a follow-up screening protocol for incident atrial fibrillation/flutter (AF) within a large observational digital health study. Mean age was 50.5 (SD years, and 46 (53.3%) were female.

Blood Pressure

Blood Pressure Atrial Fibrillation AFIB Arrhythmia

Rationale and design of the NEO-NORMAL-AF study examination of the usefulness of implantable loop recorder for arrhythmia detection including atrial fibrillation in heart failure with non-reduced ejection fraction cases: a pilot study

Open Heart

JULY 28, 2023

Introduction The incidence of arrhythmia in heart failure with non-reduced ejection fraction (HFnon-rEF) in patients who have a history of hospitalisation is unclear. Methods and analysis This is a multicentre single arm study to evaluate the usefulness of ILR for detecting arrhythmia.

Atrial Fibrillation

Atrial Fibrillation Arrhythmia Heart Failure Tachycardia

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

Dr. Smith's ECG Blog

MARCH 15, 2023

Her Apple Watch suddenly told her that she is in atrial fibrillation. Patients with healthy AV nodes who are not on AV nodal blockers and who are not hyperkalemic should have a rapid ventricular response if they have paroxysmal Atrial fibrillation. Baseline bradycardia in endurance athletes limits the use of ß-blockers.

Atrial Fibrillation

Atrial Fibrillation AFIB Arrhythmia Exercise

What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. Is there a long QT? How would you manage this patient?

Cardiac Arrest

Cardiac Arrest Blog Atrial Fibrillation Bradycardia

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ). NOTE: Prediction of cardiac contusion "severity" on the basis of cardiac arrhythmias and ECG findings — is an imperfect science.

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

Why is ECG machine use? What diseases can EKG monitor detect?

Wellnest

DECEMBER 21, 2022

Atrial Fibrillation Atrial fibrillation causes irregular heartbeat, and the heart's normal blood supply is affected. Since atrial fibrillation can also be intermittent, such patients should continuously monitor their heart activity while performing daily activities with a portable ECG device.

Cardiac Arrest

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation

How a pause can cause cardiac arrest

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Note: Due to the limited number of normally conducted beats — it is hard to be sure whether the underlying rhythm is sinus with baseline artefact or atrial fibrillation. Note: The patient while on telemetry had alternating atrial fibrillation, sinus rhythm with 1st degree AV block and also periods of Wenckebach conduction.

Cardiac Arrest

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation

Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

Sci 5[4] 268-270, 2015 ) both highlight a likely association between acute development of ischemic J waves — and high risk of developing malignant ventricular arrhythmias.

Cardiac Arrest

Cardiac Arrest Bradycardia Chest Pain Ischemia

Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

JANUARY 21, 2023

This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. ECG met STEMI criteria and was labeled STEMI by computer interpretation.

STEMI

STEMI Bradycardia Arrhythmia Cardiac Arrest

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The rhythm now is atrial fibrillation. The arrhythmia spontaneously converted before defibrillation was achieved. As per Dr. Nossen — today's initial ECG ( LEFT tracing in Figure-2 ) shows sinus bradycardia with QRS widening due to bifascicular block ( RBBB/LAHB ). In the initial ECG (ECG# 1) aVR had ST elevation.

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Another frequent feature of hypothermia is atrial fibrillation (not seen in this case) Core temperature of this patient was 29,5 Celsius. Prominent J waves of this morphology thus are called Osborn waves. Severe hypothermia not uncommonly has accompanying T waves inversions. Troponins were negative in serial blood tests.

Ischemia

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest

Wide-complex tachycardia that didn’t follow the rules

Dr. Smith's ECG Blog

DECEMBER 23, 2019

Detail of Flutter waves The rate of the flutter waves matches the rate of the WCT (about 200/m), proving that the presenting WCT had been 1:1 atrial flutter. The subsequent EP study could not induce VT, only atrial fibrillation. Spontaneous 1:1 atrial flutter Atrial flutter usually has a rate of 300 F/m.

Tachycardia

Tachycardia Atrial Flutter Cardiomyopathy Atrial Fibrillation

A Multicenter, Phase 2, Randomized, Controlled Study of the Efficacy and Safety of Etripamil Nasal Spray for the Acute Reduction of Rapid Ventricular Rate in Patients with Symptomatic Atrial Fibrillation (ReVeRA-201)

Circulation: Arrhythmia and Electrophysiology

NOVEMBER 10, 2023

Circulation: Arrhythmia and Electrophysiology, Ahead of Print. Background:Despite chronic therapies, atrial fibrillation (AF) leads to rapid ventricular rates (RVR) often requiring intravenous treatments.

Atrial Fibrillation

Atrial Fibrillation Bradycardia Electrophysiology Arrhythmia

Wide-complex tachycardia: VT, aberrant, or "other?"

Dr. Smith's ECG Blog

DECEMBER 16, 2018

The patient had a history of paroxysmal atrial fibrillation and several cardioversions. Additionally, her beta-blocker dose had been decreased because of bradycardia, further predisposing her to atrial flutter. This case is contributed by Brooks Walsh , an EM physician and ECG expert from Connecticut.

Tachycardia

Tachycardia Atrial Flutter AFIB Atrial Fibrillation

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

APRIL 8, 2015

PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.

Arrhythmia

Arrhythmia Outcomes Risk Factors Chest Pain

Cardiovascular Update

New lessons, from the old chapters of Atrial fibrillation

Dexmedetomidine vs. propofol on arrhythmia in cardiac surgery: a meta-analysis of randomized controlled trials

Systematic review of the incidence and clinical risk predictors of atrial fibrillation and permanent pacemaker implantation for bradycardia in Fabry disease

Cardiomatics guide: Analyzing arrhythmias made easy

Evaluation of atrial fibrillation using wearable device signals and home blood pressure data in the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) Study: A Subgroup Analysis (MIPACT-AFib)

Rationale and design of the NEO-NORMAL-AF study examination of the usefulness of implantable loop recorder for arrhythmia detection including atrial fibrillation in heart failure with non-reduced ejection fraction cases: a pilot study

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

What is this ECG finding? Do you understand it before you hear the clinical context?

A teenager involved in a motor vehicle collision with abnormal ECG

Why is ECG machine use? What diseases can EKG monitor detect?

How a pause can cause cardiac arrest

Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.

Unconscious + STEMI criteria: activate the cath lab?

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Should we activate the cath lab? A Quiz on 5 Cases.

Wide-complex tachycardia that didn’t follow the rules

A Multicenter, Phase 2, Randomized, Controlled Study of the Efficacy and Safety of Etripamil Nasal Spray for the Acute Reduction of Rapid Ventricular Rate in Patients with Symptomatic Atrial Fibrillation (ReVeRA-201)

Wide-complex tachycardia: VT, aberrant, or "other?"

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

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