Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves' Disease Before and After Anti-Thyroid Therapy.

BACKGROUND: We aimed prospectively to investigate the laboratory and electrocardiographic parameters (heart rate, QRS, QT, QTc, Tpe, Tpe/QTc, and arrhythmia prevalence) in patients with Graves' disease before and after antithyroid therapy. METHODS: Seventy-one patients (48 female, and 23 male), of age between 18-50 years (mean±SD: 36.48±12.20) with GD were included in the study. Patients were treated with antithyroid therapy (thioamides and/or surgical therapy) to maintain euthyroid status. Patients were examined in terms of electrocardiographic parameters before and after the treatment. RESULTS: Mean TSH, free thyroxin (fT4), and tri-iodothyrionine (fT3) levels of all patients were 0.005±0.21, 3.27± 1.81, 11.42±7.44, respectively. While 9 patients (group 2) underwent surgical therapy, had suspicious malignant nodule or large goiter, and unresponsiveness to medical treatment; the other patients (n=62, group 1) were treated with medical therapy. Patients with surgical therapy had more increased serum fT4 (p=0.045), anti-thyroglobulin value (p=0.018) and more severe graves orbitopathy (n=0.051) before treatment when compared to a medical therapy group. Baseline Tpe duration and baseline Tpe/QTc ratio and frequency of supraventricular ectopic beats were found to be significantly higher in group 2 when compared to group 1 (p=0.00, p=0.005). Otherwise, the baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients came at their euthyroid status, group 2 patients still suffered from more sustained supraventricular ectopics beats than group 1. CONCLUSION: Distinct from the medical treatment group, surgical treatment group with euthyroidism for at least 3 months still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).

Diagnosis and management of elite young athletes undergoing arrhythmia intervention.

BACKGROUND: Sudden cardiac death is the most common cause of mortality in young athletes. In some of these, the final pathway is arrhythmia. The authors aimed to identify the incidence, diagnosis and management of athletes undergoing investigation and intervention for cardiac arrhythmias. METHODS: Retrospective analysis of all patients between 10 and 17 years presenting to a supra-regional paediatric cardiac unit for investigation and intervention for a cardiac arrhythmia. Elite athletes (county and national level) were identified from the departmental clinical and arrhythmia databases (October 1997-2007). Patients with significant congenital heart disease were excluded. RESULTS: From 657 patients undergoing 680 interventions, 324 were excluded. From the remaining 333 we identified 11 elite athletes - football (n=3), martial arts (n=2), rugby (n=2), triple jump, netball, canoeing, and motor sport (n=1). Presenting symptoms included palpitations (n=8) and syncope (n=1). Two were asymptomatic and investigated following routine screening. Diagnoses included atrioventricular (AV) re-entry tachycardia (n=3), AV node re-entry tachycardia (n=4), complete heart block (n=1), sinus node dysfunction (n=1), vasovagal syncope (n=1) and pre-excited atrial fibrillation (n=1). Arrhythmia interventions included implantable loop recorder (n=2), diagnostic electrophysiology study (n=9), including radiofrequency ablation (n=5), cryoablation (n=2) and pacemaker implantation (n=2). Following intervention, 10 children returned to competitive sport. There were no deaths. No child required long-term medication post-intervention. CONCLUSION: Of the young competitive athletes identified from the authors' study, there was a high incidence of significant arrhythmias. Intervention is usually successful and most athletes return to elite sport without the need for long-term medication.

A brief cognitive behavioural preimplantation and rehabilitation programme for patients receiving an implantable cardioverter-defibrillator improves physical health and reduces psychological morbidity and unplanned readmissions.

OBJECTIVE: To assess the clinical and cost effectiveness of a brief home-based cognitive behavioural rehabilitation programme (the ICD Plan) for patients undergoing implantation of a cardiac defibrillator. DESIGN: A prospective multicentred, intention-to-treat, cluster-randomised controlled trial. SETTING: Eight implantable cardioverter-defibrillator (ICD) implantation centres in the UK. PATIENTS: Consecutive series of patients undergoing implantation with an ICD. INTERVENTIONS: The control group received usual care and advice from an experienced healthcare professional. The intervention group received usual care plus the ICD Plan. The plan was introduced before implantation, with three further brief telephone contacts with the nurse over the next 12 weeks. MAIN OUTCOME MEASURES: Health-related quality of life (Short Form Health Survey (SF-12)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), activity limitations (subscale from the Seattle Angina Questionnaire (SAQ)), unplanned admissions and other economic data using a questionnaire developed for the study. RESULTS: 192 patients were recruited to the study (71 intervention, 121 control). At 6 months after surgery the intervention group had better physical health (37.83 vs 34.24; p<0.01), fewer limitations in physical activity (34.02 vs 31.72; p = 0.04), a greater reduction in the proportion of patients with a borderline diagnosis of anxiety (21% vs 13%; p = 0.60) and depression (13% vs 2%; p = 0.30), more planned ECGs (89% vs 66%; p = 0.04) and 50% fewer unplanned admissions (11% vs 22%; p<0.01). CONCLUSIONS: The ICD Plan improved health-related quality of life, reduced the incidence of clinically significant psychological distress and significantly reduced unplanned readmissions. It is a cost effective and easily implemented method for delivering rehabilitation and psychological care to patients undergoing ICD implantation. TRIAL REGISTRATION NUMBER: ISRCTN70212111.

[The medical rehabilitation of patients with an artificial pacemaker]. / Nekotorye aspekty lechebnoi reabilitatsii bol'nykh s iskusstvennym voditelem ritma serdtsa.

AIM: To study prognostic significance of individual rehabilitation of patients with pace-maker with account for leading cardiac syndromes. MATERIALS AND METHODS: 375 patients with artificial pace-maker were treated in a cardiological hospital for cardiac failure, blood hypertension, angina pectoris, cardiac arrhythmias. RESULTS: Congestive heart failure, blood hypertension, secondary cardiac arrhythmia, angina of effort were diagnosed in 57.4, 44.4, 33.0. 30.6% of the studied patients with artificial pace-maker. The patients died primarily of cardiac diseases, cancer and complications of cardiac pacing (71.3, 14.9 and 6.7% of cases, respectively). CONCLUSION: Aftercare of patients with pace-maker should be performed in groups of follow-up (5 groups) according to specially designed programs of diagnostic, therapeutic and prophylactic measures.

Cardioversäo elétrica / Electrical cardioversion

A cardioversäo é um procedimento terapêutico que visa à aboliçäo das arritmias cardíacas, pelo uso de corrente elétrica contínua, liberada em grande quantidade e em curto período de tempo. Discutem-se os aspectos da impedância transtorácica, o requerimento de energia, o emprego do soco no procórdio, a sequência para uso de desfibrilador e a abordagem do paciente em fibrilaçäo ou taquicardia ventriculares sem pulso. Finalmente, säo relacionados os cuidados que devem ser adotados após os procedimentos.

Eletricidade: efeitos sistêmicos e cardiovasculares / Eletricity: systemic and cardiovascular effects

Acidentes por eletricidade continuam sendo responsáveis por um número substancial de morbidade e mortalidade. As vítimas de choque elétrico apresentam um amplo espectro de complicaçöes, variando de uma sensaçäo transitória desagradável secundária a uma exposiçäo a corrente elétrica de baixa intensidade até morte súbita por eletrocussäo acidental. Esta revisäo descreve os mecanismos patogênicos responsáveis, complicaçöes sistêmicas e cardiovasculares, bem como a prevençäo, prognóstico e o tratamento das injúrias e arritmias cardácas.

Exercise testing and training in patients with malignant arrhythmias.

Patients with malignant arrhythmias are a challenge when they present to the laboratory for exercise testing and training. The complex metabolic and electrophysiological changes that occur during and after exercise may suppress or potentiate arrhythmias and alter the efficacy and safety of antiarrhythmic agents. The presence of an ICD adds a level of complexity to the study; however, a general understanding of how ICDs function and a review of the programmed parameters before the study will result in a lesser likelihood of complication and more efficient and appropriate action, should a complication occur. Exercise testing and training are valuable methods for the evaluation and treatment of patients with malignant ventricular arrhythmias. Exercise testing is a useful adjunctive technique in the exposure of arrhythmia and the evaluation of the efficacy and proarrhythmic potential of antiarrhythmic agents. These patients are excellent candidates for rehabilitation and exercise training programs, which may result in increased functional capacity and improved quality of life. With this knowledge and adherence to the appropriate guidelines for patient selection and testing, exercise testing and training of patients with malignant arrhythmias can be prescribed and conducted in a safe, controlled manner in an atmosphere of confidence and professionalism.

Exercise testing and training of patients with malignant ventricular arrhythmias.

Malignant ventricular arrhythmias account for a significant number of deaths annually. Improved therapies have increased survival for this patient population. These patients, however, remain at high risk due to their history of sudden cardiac death and the preponderance of poor ventricular function in this population. This high risk status may have excluded them from participation in cardiac rehabilitation programs or from undergoing exercise testing in some medical centers. Although the risk of complications, especially arrhythmias, is quite real, the experience in some centers has indicated that it is manageable. This experience and some guidelines for exercise testing and training of patients with malignant ventricular arrhythmias are reviewed in this paper.

Enfoque Práctico de las Arritmias de Urgencia

Existen ciertas reglas de oro que facilitan la evaluación de un pacientecon arritmia y encausan hacia el adecuado manejo de estos pacientes según el tipo de arritmia que padezcan ya sea ventricuar o supraventricular y si se trata de una emergencia o no. Este último criterrio se evalúa con base en el estado hemodinámico del paciente; es por esto que una arritmia supraventricular catalogada como emergencia se trata con cardioversión eléctrica, si no lo es se debe determinar el ritmo, evaluar los síntomas del paciente manejar la respuesta ventricular, intervalo R-R, restaurar el ritmo sinusal, prevenir la recurrencia y curar la arritmia en los casos en que sea posible. Si se está frente a una arritmia ventricular y es una emergencia la conducta a seguir es cardioversión eléctrica; si no es emergencia pero es maligna se debe optar por un manejo agresivo y si no es maligna se debe estudiar al paciente de manera íntegra

Exercise testing in special situations.

This article discusses exercise testing in valvular heart disease, hypertension, and the evaluation of patients for surgery. It also provides information on the effects of drugs on the exercise test and the clinical significance of block patterns and arrhythmias encountered during exercise.

Heart rate levels and ventricular ectopic activity during cardiac rehabilitation.

The heart rate levels and the incidence and types of premature ventricular complexes (PVCs) during the rehabilitation of 40 patients with coronary artery disease, were compared with those during 24-hour ambulatory monitoring and during a symptom-limited exercise test. Thirty-six patients were studied 3 months or later after a myocardial infarction and four patients were studied after coronary bypass surgery. The last patient suffered from moderate angina pectoris. Peak heart rates during rehabilitation exceeded those during other activities in 34 out of 40 patients. Half of the patients reached even higher heart rate levels during the exercise test. Twenty-three patients had PVC during rehabilitation; frequent, multiform or repetitive PVC occurred in nine of these. During the exercise test, 24 patients had PVCs, while PVCs were observed on the ambulatory tape recording in 34 patients. Frequent, multiform, and repetitive PVCs occurred in eight patients during exercise testing and in 20 patients during monitoring. No relation was found between either the incidence or the type of PVC in individual patients under these three conditions. Thus, selection of patients with a high risk for arrhythmias during rehabilitation is not feasible by either exercise testing or ambulatory tape recording.