A scoring algorithm for the accurate differential diagnosis of regular wide QRS complex tachycardia.

BACKGROUND: The differential diagnosis of regular wide QRS complex tachycardia (RWQRST) remains the subject of numerous publications, all of which aim at diagnosis during the acute phase. Although an accurate diagnosis is necessary to make long-term decisions, it often leads to invasive testing. METHODS: Criteria with high positive predictive values (PPVs) for diagnosis can be obtained by analyzing the electrocardiogram (ECG) data during RWQRST and comparing them with these data at baseline. By assigning points to these criteria, a scoring algorithm to accurately diagnose numerous patients can be obtained. A total of 352 consecutive patients with RWQRST were included. Two electrophysiologists blind to patient condition analyzed the 16 criteria considered as having high PPVs. RESULTS: A total of 149 (42.3%) cases were supraventricular tachycardia (SVT), and 203 (57.7%) cases were ventricular tachycardia (VT). A higher percentage of patients with VT had structural heart disease (86.7% vs 16.1%). Seven of the 16 criteria analyzed had PPVs > 95%, and each criterion was assigned a score. A final score of -1 was indicative of SVT (PPV 98%); a score of 1 was indicative of VT (PPV 98%); and a score of ≥2 was indicative of VT (PPV 100%). A score of ≠0 was obtained for 51.7% of all cases of tachycardia, making it possible to reach a highly accurate diagnosis in approximately half of all cases. No cases of VT scored -1, and no cases of SVT scored ≥2. CONCLUSIONS: The current scoring system stands out for its high PPV (98%) and specificity (98%), enabling an accurate diagnosis for more than half of the patients.

Uso e implicaciones clínicas del mantenimiento de la anticoagulación tras una cardioversión eficaz / Use and clinical implications of anticoagulation maintenance after a successful cardioversion

Pacientes y método: Dado que las guías sobre fibrilación auricular no especifican la duración idónea de la anticoagulación tras una cardioversión por una fibrilación auricular persistente, analizamos su utilización en 422 pacientes con riesgo de embolia bajo o moderado, así como su relación riesgo/beneficio en un seguimiento a un año. Resultados: Tras el primer mes, la anticoagulación se mantuvo en el 80% y tras los 12 meses en el 43% de los pacientes en ritmo sinusal. Su suspensión en los que permanecieron en ritmo sinusal se relacionó con una mayor incidencia de embolias, aunque sin ser las diferencias significativas (2,8 frente a 0,7%; p=0,37). En los pacientes anticoagulados la incidencia de hemorragias mayores fue del 4,9%, y la edad ≥75 años (OR 5,3; p=0,02) el único factor relacionado. Conclusiones: Es frecuente la anticoagulación a largo plazo tras una cardioversión en pacientes sin alto riesgo de embolia, aunque no parece tener un perfil riesgo/beneficio favorable con un CHADS2=0 o=1 cuando son ≥75 años (AU)

Patients and method: We studied the use of anticoagulation following cardioversion due to persistent atrial fibrillation in 422 patients with low or moderate risk of embolism, as well as its benefit during a follow-up of one year.Results: Oral anticoagulation was maintained after the first month in 80% of patients who showed sinus rhythm and in 43% after 12 months. Its maintenance in patients in sinus rhythm was related to a trend to lower incidence of embolic events (2.8% vs. 0.7%; p=0.37). The incidence of major bleeding in patients who remained on oral anticoagulation was 4.9%, and age ≥75 years (OR 5.3; p=0.02) was the only independently related factor.Conclusions: Anticoagulation is frequently maintained to long-term in patients without high risk of embolism but it seems that this treatment doe not have a favorable risk profile with a CHADS2=0 or 1 older than ≥75 (AU)

[Use and clinical implications of anticoagulation maintenance after a successful cardioversion]. / Uso e implicaciones clínicas del mantenimiento de la anticoagulación tras una cardioversión eficaz.

PATIENTS AND METHOD: We studied the use of anticoagulation following cardioversion due to persistent atrial fibrillation in 422 patients with low or moderate risk of embolism, as well as its benefit during a follow-up of one year. RESULTS: Oral anticoagulation was maintained after the first month in 80% of patients who showed sinus rhythm and in 43% after 12 months. Its maintenance in patients in sinus rhythm was related to a trend to lower incidence of embolic events (2.8% vs. 0.7%; p=0.37). The incidence of major bleeding in patients who remained on oral anticoagulation was 4.9%, and age ≥75 years (OR 5.3; p=0.02) was the only independently related factor. CONCLUSIONS: Anticoagulation is frequently maintained to long-term in patients without high risk of embolism but it seems that this treatment doe not have a favorable risk profile with a CHADS(2)=0 or 1 older than ≥75.

Disfunción de marcapasos como causa de hipo incoercible / Pacemaker disfunction as a cause of intractable hiccup

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