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1.
Expert Opin Investig Drugs ; 29(1): 1-4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31825681

RESUMO

Introduction: Paroxysmal supraventricular tachycardia (SVT) can be very bothersome and may potentially lead to considerable health-care utilization. Non-parenteral medication is currently unavailable for the rapid termination of paroxysmal SVT. However, an intranasal spray formulation of etripamil, a short-acting calcium-channel blocker, is under investigation as a convenient, safe, and rapidly efficacious means to terminate paroxysmal SVT.Areas covered: This review summarizes the clinical rationale, potential benefit, and clinical trials safety and efficacy data for the use of etripamil nasal spray to terminate paroxysmal SVT.Expert opinion: Based on the efficacy and tolerability demonstrated in phase 1 and 2 clinical trials, etripamil nasal spray is a potential convenient, safe, and effective means for patients to terminate paroxysmal SVT. It has the potential to improve quality of life, reduce health-care burden, and alter the current management paradigm for many patients with SVT. Further ongoing evaluation in ambulatory patients will help to determine its real-life practicality, safety, and effectiveness.


Assuntos
Taquicardia Paroxística/tratamento farmacológico , Taquicardia Supraventricular/tratamento farmacológico , Bloqueadores dos Canais de Cálcio/administração & dosagem , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/farmacologia , Humanos , Sprays Nasais , Qualidade de Vida , Taquicardia Paroxística/fisiopatologia , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo
2.
J Vet Emerg Crit Care (San Antonio) ; 29(3): 326-330, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31044499

RESUMO

OBJECTIVE: To describe the successful management of 2 dogs with septic shock and persistent tachycardia using norepinephrine and esmolol, a short-acting beta receptor antagonist. SERIES SUMMARY: Two cases are reviewed. In the first case, septic shock with ventricular tachycardia was diagnosed in a 4-year-old neutered female Great Dane that underwent jejunoileal resection and anastomosis for a partial mesenteric torsion. The patient's tachyarrhythmias failed to respond to lidocaine, and an esmolol infusion was used for heart rate control. The condition of the dog improved and she was discharged after 4 days of hospitalization. The second case was a 7-year-old neutered female Cavalier King Charles Spaniel with septic peritonitis. Following surgery for intestinal resection and anastomosis, supraventricular tachycardia developed that was not responsive to volume resuscitation and was treated with an esmolol infusion. The condition of the dog improved and she was discharged after 6 days of hospitalization. Both patients were doing well at the time of long-term follow-up. NEW OR UNIQUE INFORMATION PROVIDED: This case series highlights a novel method of managing dogs in septic shock with persistent tachycardia based on recently published data in the human literature. The use of esmolol may be considered in certain veterinary patients with septic shock to improve persistent tachycardia not related to hypovolemia.


Assuntos
Doenças do Cão/tratamento farmacológico , Choque Séptico/veterinária , Taquicardia Supraventricular/veterinária , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Animais , Procedimentos Cirúrgicos do Sistema Digestório/veterinária , Cães , Quimioterapia Combinada/veterinária , Feminino , Norepinefrina/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/veterinária , Propanolaminas/administração & dosagem , Choque Séptico/complicações , Choque Séptico/tratamento farmacológico , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/tratamento farmacológico , Vasoconstritores/administração & dosagem
3.
Prehosp Disaster Med ; 34(3): 297-302, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31043186

RESUMO

INTRODUCTION: Atrial fibrillation (AFIB) with rapid ventricular response (RVR) is a common tachydysrhythmia encountered by Emergency Medical Services (EMS). Current guidelines suggest rate control in stable, symptomatic patients. PROBLEM: Little is known about the safety or efficacy of rate-controlling medications given by prehospital providers. This study assessed a protocol for prehospital administration of diltiazem in the setting of AFIB with RVR for provider protocol compliance, patient clinical improvement, and associated adverse events. METHODS: This was a retrospective, cohort study of patients who were administered diltiazem by providers in the Orange County EMS System (Florida USA) over a two-year period. The protocol directed a 0.25mg/kg dose of diltiazem (maximum of 20mg) for stable, symptomatic patients in AFIB with RVR at a rate of >150 beats per minute (bpm) with a narrow complex. Data collected included patient characteristics, vital signs, electrocardiogram (ECG) rhythm before and after diltiazem, and need for rescue or additional medications. Adverse events were defined as systolic blood pressure <90mmHg or administration of intravenous fluid after diltiazem administration. Clinical improvement was defined as a heart rate decreased by 20% or less than 100bmp. Original prehospital ECG rhythm interpretations were compared to physician interpretations performed retrospectively. RESULTS: Over the study period, 197 patients received diltiazem, with 131 adhering to the protocol. The initial rhythm was AFIB with RVR in 93% of the patients (five percent atrial flutter, two percent supraventricular tachycardia, and one percent sinus tachycardia). The agreement between prehospital and physician rhythm interpretation was 92%, with a Kappa value of 0.454 (P <.001). Overall, there were 22 (11%) adverse events, and 112 (57%) patients showed clinical improvement. When diltiazem was given outside of the existing protocol, the patients had higher rates of adverse events (18% versus eight percent; P = .033). Patients who received diltiazem in adherence with protocols were more likely to show clinical improvement (63% versus 46%; P = .031). CONCLUSION: This study suggests that prehospital diltiazem administration for AFIB with RVR is safe and effective when strict protocols are followed.Rodriguez A, Hunter CL, Premuroso C, Silvestri S, Stone A, Miller S, Zuver C, Papa L. Safety and efficacy of prehospital diltiazem for atrial fibrillation with rapid ventricular response. Prehosp Disaster Med. 2019;34(3):297-302.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Diltiazem/uso terapêutico , Serviços Médicos de Emergência/métodos , Taquicardia Supraventricular/tratamento farmacológico , Adulto , Fatores Etários , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Distribuição de Qui-Quadrado , Estudos de Coortes , Eletrocardiografia/métodos , Feminino , Florida , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Taxa de Sobrevida , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/diagnóstico por imagem , Resultado do Tratamento
4.
Int Heart J ; 60(3): 756-760, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105156

RESUMO

We report a case of atypical fast-slow atrioventricular nodal reentrant tachycardia (AVNRT) using a slow pathway variant extending to the superoanterior right atrium. The AVNRT diagnosis was confirmed by using standard electrophysiological criteria that exclude a diagnosis of atrial tachycardia and atrioventricular reentrant tachycardia. The earliest atrial activation during tachycardia was found in the superoanterior right atrium adjacent to the tricuspid annulus, where the first delivery of radiofrequency energy terminated and eliminated the inducibility of the tachycardia.


Assuntos
Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Trifosfato de Adenosina/administração & dosagem , Trifosfato de Adenosina/uso terapêutico , Assistência ao Convalescente , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/terapia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/tratamento farmacológico , Resultado do Tratamento
5.
J Vet Med Sci ; 81(5): 717-722, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-30956271

RESUMO

Maintaining a good ventricular systolic function is important in the long-term therapy of dogs with supraventricular tachyarrhythmia (SVTA). The objective of this study was to evaluate the inhibitory effect of telmisartan on myocardial injury and the resulting ventricular systolic dysfunction in a canine model of SVTA. A total of 14 dogs were randomly assigned to a Telmisartan (oral telmisartan, 1.0 mg/kg daily, n=7) or a Control (no drug administration, n=7) group; the duration of rapid atrial pacing (RAP) was 3 weeks for both groups. The cardiac troponin I (cTnI) concentration in the Control group was significantly increased after 3 weeks compared to that before RAP initiation (baseline), but no significant difference was observed in the Telmisartan group. Moreover, the cTnI concentration at 3 weeks was significantly lower in the Telmisartan group than in the Control group. The left ventricular fractional shortening was significantly decreased at 3 weeks compared to that at baseline in both groups. However, fractional shortening at 3 weeks was significantly higher in the Telmisartan group than in the Control group. The cardiac output values in the Control group were significantly decreased at 3 weeks compared with those at baseline, but no significant difference was observed in the Telmisartan group. This study demonstrates that telmisartan inhibits the reduction in ventricular systolic function and prevents myocardial injury in a canine model of SVTA. Therefore, telmisartan is suggested as a novel treatment for canine SVTA.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Taquicardia Supraventricular/veterinária , Telmisartan/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Animais , Débito Cardíaco/efeitos dos fármacos , Estimulação Cardíaca Artificial/veterinária , Doenças do Cão/tratamento farmacológico , Cães , Feminino , Frequência Cardíaca/efeitos dos fármacos , Masculino , Miocárdio/patologia , Taquicardia Supraventricular/tratamento farmacológico , Telmisartan/administração & dosagem , Troponina I/sangue , Troponina I/efeitos dos fármacos , Função Ventricular/efeitos dos fármacos
6.
Med Ultrason ; 21(1): 93-95, 2019 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-30779838

RESUMO

This report describes a case of fetal supraventricular tachycardia (SVT) diagnosed at 12 weeks of gestation in a pregnant woman with diabetes mellitus. Transplacental digoxin therapy administered orally to the mother was unsuccessful. Subsequently, sotalol was added to digoxin to achieve fetal heart rate (HR) control and the conversion to sinus rhythm was achieved. The fetal HR remained stable until term, and a healthy male baby was born. The newborn electrocardiogram showed sinus rhythm with normal PR and QTc intervals. When the newborn was stable, he was discharged with propanolol. Sustained SVT is extremely rare during the first trimester. The goal of treatment in utero is the conversion to sinus rhythm or reduction of the ventricular rate to tolerable levels, preventing or even reversing fetal hydrops.


Assuntos
Coração Fetal/diagnóstico por imagem , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/embriologia , Ultrassonografia Pré-Natal/métodos , Adulto , Antiarrítmicos/uso terapêutico , Digoxina/uso terapêutico , Ecocardiografia , Feminino , Coração Fetal/embriologia , Seguimentos , Humanos , Recém-Nascido , Masculino , Gravidez , Propranolol/uso terapêutico , Sotalol/uso terapêutico , Taquicardia Supraventricular/tratamento farmacológico , Adulto Jovem
7.
Am J Emerg Med ; 37(3): 562.e5-562.e10, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30514596

RESUMO

A 27-year-old man presented with an intentional overdose of concentrated caffeine powder that he bought over the internet. The patient received benzodiazepines and ondansetron for symptomatic treatment when he arrived in the Emergency Department (ED). Subsequently, he developed recurrent supraventricular tachycardia in the ED. The SVT was successfully treated with metoprolol. The patient's caffeine level was >90 mg/L. This is the first known report of treatment of caffeine-induced supraventricular tachycardia with metoprolol.


Assuntos
Antiarrítmicos/uso terapêutico , Cafeína/envenenamento , Overdose de Drogas/tratamento farmacológico , Metoprolol/uso terapêutico , Taquicardia Supraventricular/induzido quimicamente , Taquicardia Supraventricular/tratamento farmacológico , Adulto , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Masculino , Tentativa de Suicídio , Taquicardia Supraventricular/diagnóstico
8.
Am J Ther ; 26(1): e161-e169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-27759583

RESUMO

Despite proven effectiveness in treating tachyarrhythmias, sotalol is proarrhythmic and can cause torsades de pointes. Given the emergence of studies that show no benefit from rhythm control strategies in managing atrial fibrillation, as well as the introduction of nonpharmacological approaches to treating arrhythmias, we felt it necessary to ascertain if there was any role for sotalol given its side effects. Review of the literature regarding sotalol use in the prevention and treatment of supraventricular and ventricular tachyarrhythmias seems to show that more effective and safer agents and nonpharmacological alternatives are currently available. However, sotalol still seems to be useful in preventing supraventricular tachyarrhythmias postcardiac surgery and in reverting hemodynamically stable sustained ventricular tachycardias in the setting of coronary artery disease. Its role in the prevention of tachyarrhythmias in the setting of arrhythmogenic right ventricular cardiomyopathy requires further investigation.


Assuntos
Antiarrítmicos/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Sotalol/efeitos adversos , Taquicardia Supraventricular/tratamento farmacológico , Torsades de Pointes/induzido quimicamente , Antiarrítmicos/uso terapêutico , Displasia Arritmogênica Ventricular Direita/complicações , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Recidiva , Prevenção Secundária/métodos , Sotalol/uso terapêutico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/prevenção & controle , Resultado do Tratamento
9.
Biomed Res Int ; 2018: 3059478, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30402470

RESUMO

Objective: This study aims to (i) translate, culturally adapt, and preliminarily validate the arrhythmia-specific Umea22 (U22) questionnaire and (ii) assess the impact of radiofrequency (RF) ablation and medical treatment on the quality of life of patients with supraventricular tachycardias (SVTs). Methods: A total of 140 patients with atrioventricular nodal re-entry tachycardia (AVNRT) and atrioventricular re-entry tachycardia (AVRT) were enrolled in the study. Of these, 100 patients underwent RF ablation (group A) and 40 patients were managed with antiarrhythmic medications (group B). Health-related quality of life (HRQoL) was assessed for both groups using the Short Form-36 Health Survey (SF-36) and the arrhythmia-specific Umea22 (U22) questionnaire at baseline and 3-month follow-up. Exploratory and confirmatory factor analyses were performed to assess the validity of the U22 questionnaire. Univariate comparisons of HRQoL scores between study timepoints and multivariate regression analyses adjusting for baseline confounders were conducted. Results: The factor analysis of the U22 questionnaire yielded a six-factor model ("burden of spells"; "heart contractility"; "character of spells"; "general/non-specific feeling"; "other specific somatic symptoms"; "fear") with acceptable fit results. Patients of group A showed significant improvement in all SF-36 and U22 scores at 3 months' follow-up compared to baseline (all p<0.05). Patients of group B presented deterioration of the total SF-36 score (p=0.001) and improvement of certain U22 measures, namely, well-being (p=0.004), heartbeat speed, and intensity during arrhythmia spells (p<0.0001 for both measures) at 3 months' follow-up, compared to baseline. Employment status, male sex, and urban residence emerged as important predictors. Conclusion: The Greek version of the U22 questionnaire is a valid tool to assess SVT-related symptoms. RF ablation appears to exert more pronounced beneficial outcomes on HRQoL of patients with SVTs compared to medical treatment. Prompt referral of patients with SVTs to specialist centers may favorably affect their quality of life and should be encouraged.


Assuntos
Antiarrítmicos/uso terapêutico , Qualidade de Vida , Ablação por Radiofrequência , Inquéritos e Questionários , Taquicardia Supraventricular/tratamento farmacológico , Taquicardia Supraventricular/cirurgia , Adulto , Análise Fatorial , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Reprodutibilidade dos Testes
11.
Arq. bras. cardiol ; 111(3 supl.1): 124-124, set., 2018.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1026857

RESUMO

INTRODUÇÃO: As taquicardias supraventriculares no período perinatal habitualmente tem evolução benigna e remissão espontânea ou de fácil controle após a otimização da terapia medicamentosa (principalmente as taquicardias atriais). Entretanto algumas taquicardias de PR inferior aos RP' semelhante às taquicardias atriais tem evolução arrastada e de difícil controle. O diagnóstico diferencial deve ser realizado com taquicardias mantidas por via acessória de condução retrograda exclusiva decremental (Taquicardia de Coumel) que ainda dentro da infância necessitam de tratamento invasivo pelo potencial risco de evolução para disfunção ventricular (taquicardiomiopatia). Entretanto os riscos vasculares da ablação são sempre um obstáculo ao tratamento invasivo precoce. OBJETIVO: Descrever um caso de uma criança portadora de taquicardia de Coumel mantida sob seguimento clínico rigoroso e terapia medicamentosa para melhor momento de indicação da terapia invasiva para eliminação da via acessória. DESCRIÇÃO DO CASO: Menina de 3 anos com histórico de taquicardia detectada aos 7 dias de vida foi admitida no serviço de eletrofisiologia pediátrica com alteração do ECG em consulta de rotina após o nascimento. Apresentava coração estruturalmente normal. O eletrocardiograma evidenciava taquicardia supraventricular reentrante, com FC de 120bpm e PR menor que RP' e ondas P nítidas na parede inferior. Havia decremento do intervalo RP mostrando o comportamento decremental da condução pela via acessória e interrupção da taquicardia pelo complexo QRS característico da taquicardia de Coumel. Como a função ventricular estava preservada e a criança apresentava- se assintomática optou-se pelo tratamento medicamentoso e monitorização cardiológica e pediátrica mensal. Tal medida possibilitou crescimento da criança com segurança e desenvolvimento do sistema vascular o que facilitara o procedimento de ablação. Houve manutenção do ganho pondero estatural e da função ventricular em 36 meses de seguimento, estando a paciente no momento em programação de ablação por radiofrequência aos 5 anos de idade. CONCLUSÃO: 1) O diagnóstico correto e diferencial entre taquicardia atrial e taquicardia de Coumel permite ao médico a programação adequada do tratamento ao paciente. Em pacientes com diagnóstico no período perinatal o tratamento medicamentoso pode ser tentado para postergar a ablação e aguardar o desenvolvimento vascular desde que não exista repercussão cardiovascular para o menor. (AU)


Assuntos
Taquicardia Supraventricular/tratamento farmacológico , Assistência Perinatal
12.
Eur J Clin Pharmacol ; 74(10): 1273-1279, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30116829

RESUMO

PURPOSE: The clinical usefulness of therapeutic drug monitoring (TDM) of propafenone, a sodium channel blocker, has been unclear due to the lack of information regarding optimal blood sampling time and therapeutic concentration range. Antiarrhythmic effects of sodium channel blockers are affected by the activity of the cardiac sodium channel (SCN5A). We investigated the optimal sampling time and the clinical implication of the SCN5A promoter haplotype in propafenone TDM. METHODS: We evaluated serum concentrations of propafenone, the SCN5A promoter haplotype, and antiarrhythmic efficacy in 55 patients with supraventricular tachy-arrhythmias. Blood samples obtained 1.5-6 and 10-24 h after the last dose were categorized as peak and trough samples, respectively. RESULTS: The peak propafenone concentration was significantly higher in effectively treated patients than that in patients showing insufficient response (337 ± 213 vs. 177 ± 93 ng/mL, P = 0.005), but the trough propafenone concentration was not significantly different between the two groups (68 ± 48 vs. 42 ± 36 ng/mL). Clinically relevant propafenone efficacy was achieved significantly more often in SCN5A haplotype B carriers than in wild-type haplotype A homozygotes (90 vs. 60%, P < 0.05). Among the haplotype A homozygotes, peak propafenone concentration was higher in effectively treated patients than that in patients showing insufficient response (299 ± 177 vs. 177 ± 93 ng/mL, P = 0.061). CONCLUSION: The present study found that antiarrhythmic efficacy of propafenone was associated with peak propafenone concentration rather than trough concentration and was affected by the SCN5A promoter haplotype.


Assuntos
Monitoramento de Medicamentos/métodos , Canal de Sódio Disparado por Voltagem NAV1.5/genética , Propafenona , Taquicardia Supraventricular/tratamento farmacológico , Adulto , Antiarrítmicos , Eletrocardiografia/métodos , Feminino , Haplótipos , Homozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Variantes Farmacogenômicos , Regiões Promotoras Genéticas , Propafenona/administração & dosagem , Propafenona/sangue , Propafenona/farmacocinética , Bloqueadores dos Canais de Sódio/administração & dosagem , Bloqueadores dos Canais de Sódio/sangue , Bloqueadores dos Canais de Sódio/farmacocinética , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/genética , Fatores de Tempo , Resultado do Tratamento
13.
J Am Coll Cardiol ; 72(5): 489-497, 2018 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-30049309

RESUMO

BACKGROUND: There is no nonparenteral medication for the rapid termination of paroxysmal supraventricular tachycardia. OBJECTIVES: The purpose of this study was to assess the efficacy and safety of etripamil nasal spray, a short-acting calcium-channel blocker, for the rapid termination of paroxysmal supraventricular tachycardia (SVT). METHODS: This phase 2 study was performed during electrophysiological testing in patients with previously documented SVT who were induced into SVT prior to undergoing a catheter ablation. Patients in sustained SVT for 5 min received either placebo or 1 of 4 doses of active compound. The primary endpoint was the SVT conversion rate within 15 min of study drug administration. Secondary endpoints included time to conversion and adverse events. RESULTS: One hundred four patients were dosed. Conversion rates from SVT to sinus rhythm were between 65% and 95% in the etripamil nasal spray groups and 35% in the placebo group; the differences were statistically significant (Pearson chi-square test) in the 3 highest active compound dose groups versus placebo. In patients who converted, the median time to conversion with etripamil was <3 min. Adverse events were mostly related to the intranasal route of administration or local irritation. Reductions in blood pressure occurred predominantly in the highest etripamil dose. CONCLUSIONS: Etripamil nasal spray rapidly terminated induced SVT with a high conversion rate. The safety and efficacy results of this study provide guidance for etripamil dose selection for future studies involving self-administration of this new intranasal calcium-channel blocker in a real-world setting for the termination of SVT. (Efficacy and Safety of Intranasal MSP-2017 [Etripamil] for the Conversion of PSVT to Sinus Rhythm [NODE-1]; NCT02296190).


Assuntos
Bloqueadores dos Canais de Cálcio/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Sprays Nasais , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo
14.
Dtsch Arztebl Int ; 115(19): 335-341, 2018 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-29875055

RESUMO

BACKGROUND: Heart failure affects 1­2% of the population and is associated with elevated morbidity and mortality. Cardiac arrhythmias are often a result of heart failure, but they can cause left-ventricular systolic dysfunction (LVSD) as an arrhythmia-induced cardiomyopathy (AIC). This causal relationship should be borne in mind by the physician treating a patient with systolic heart failure in association with cardiac arrhythmia. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed (1987­2017) and on the recommendations in current guidelines. RESULTS: The key criterion for the diagnosis of an AIC is the demonstration of a persistent arrhythmia (including pathological tachycardia) together with an LVSD whose origin cannot be explained on any other basis. Nearly any type of tachyarrhythmia or frequent ventricular extrasystoles can lead, if persistent, to a progressively severe LVSD. The underlying pathophysiologic mechanisms are incompletely understood; the increased ventricular rate, asynchronous cardiac contractions, and neurohumoral activation all seem to play a role. The most common precipitating factors are supraventricular tachycardias in children and atrial fibrillation in adults. Recent studies have shown that the causal significance of atrial fibrillation in otherwise unexplained LVSD is underappreciated. The treatment of AIC consists primarily of the treatment of the underlying arrhythmia, generally with drugs such as beta-blockers and amiodarone. Depending on the type of arrhythmia, catheter ablation for long-term treatment should also be considered where appropriate. The diagnosis of AIC is considered to be well established when the LVSD normalizes or improves within a few weeks or months of the start of targeted treatment of the arrhythmia. CONCLUSION: An AIC is potentially reversible. The timely recognition of this condition and the appropriate treatment of the underlying arrhythmia can substantially improve patient outcomes.


Assuntos
Arritmias Cardíacas/complicações , Cardiomiopatias/etiologia , Disfunção Ventricular Esquerda/diagnóstico , Antiarrítmicos/farmacologia , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/fisiopatologia , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Flutter Atrial/complicações , Flutter Atrial/tratamento farmacológico , Cardiomiopatias/fisiopatologia , Humanos , Prognóstico , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/tratamento farmacológico
15.
A A Pract ; 11(8): 219-220, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-29750661

RESUMO

Intranasal dexmedetomidine administered as premedication before anesthesia and cardioversion appears to have the potential to facilitate the return of sinus rhythm. Two children, 3.5 and 1.5 years old, with recurrent supraventricular tachycardia in need of cardioversion have now on several occasions spontaneously returned to sinus rhythm within 20-40 minutes after intranasal administration of dexmedetomidine (4 µg/kg) with a mucosal atomization device. Both children were observed on all occasions at the pediatric outpatient clinic and could return home within 2 hours of cardioversion. For children with supraventricular tachycardia, a selective α2-agonist might be a valuable alternative to cardioversion with adenosine.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Dexmedetomidina/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Hipnóticos e Sedativos/administração & dosagem , Pré-Medicação , Taquicardia Supraventricular/tratamento farmacológico , Administração Intranasal , Pré-Escolar , Cardioversão Elétrica , Feminino , Humanos , Lactente , Masculino , Taquicardia Supraventricular/cirurgia
17.
Drugs ; 78(3): 377-388, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29470800

RESUMO

Intravenous landiolol [Rapibloc® (EU)], an ultra short-acting highly cardioselective ß1-blocker, is approved in the EU for the rapid short-term control of tachyarrhythmias in the perioperative and intensive care settings. It has long been used in Japan to treat perioperative tachyarrhythmias. The efficacy of landiolol has been demonstrated in a large number of randomized controlled clinical trials. Landiolol significantly reduced heart rate in patients with postoperative or intraoperative supraventricular tachycardia relative to placebo and in those with atrial fibrillation/flutter and left ventricular dysfunction relative to digoxin. It was more effective than diltiazem in converting postoperative atrial fibrillation (POAF) to normal sinus rhythm. Perioperative prophylactic administration of landiolol significantly reduced the incidence of POAF during the first week after cardiac and other surgeries, compared with diltiazem, placebo or no landiolol treatment. Landiolol also attenuated adverse haemodynamic and other responses to invasive procedures such as percutaneous coronary intervention, tracheal intubation, extubation and electroconvulsive therapy. Landiolol was generally well tolerated, with a relatively low risk of hypotension and bradycardia. Landiolol has more favourable pharmacological properties than esmolol, a short-acting ß-blocker commonly used for the rapid control of heart rate. Although additional comparative studies are warranted to define the place of landiolol relative to esmolol, current evidence suggest that landiolol is a useful option for the rapid short-term control of tachyarrhythmias. Landiolol offers a simple dosage scheme and is available in two easy-to-use formulations (concentrate and powder).


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Morfolinas/uso terapêutico , Taquicardia/tratamento farmacológico , Ureia/análogos & derivados , Administração Intravenosa , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Antagonistas de Receptores Adrenérgicos beta 1/efeitos adversos , Antagonistas de Receptores Adrenérgicos beta 1/farmacologia , Fibrilação Atrial/tratamento farmacológico , Relação Dose-Resposta a Droga , Aprovação de Drogas , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Humanos , Japão , Morfolinas/administração & dosagem , Morfolinas/efeitos adversos , Morfolinas/farmacologia , Taquicardia Supraventricular/tratamento farmacológico , Resultado do Tratamento , Ureia/administração & dosagem , Ureia/efeitos adversos , Ureia/farmacologia , Ureia/uso terapêutico , Disfunção Ventricular Esquerda/tratamento farmacológico
18.
Zhonghua Er Ke Za Zhi ; 56(1): 13-18, 2018 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-29342991

RESUMO

Objective: The study assessed the clinical characteristics and response to acute intravenous antiarrhythmic drug therapy of supraventricular tachycardia (SVT) in children. Methods: This was a multicenter prospective descriptive study including 257 children from First Hospital of Tsinghua University, Peking University First Hospital, Children's Hospital Affiliated to Capital Institute of Pediatrics and Beijing Anzhen Hospital who received intravenous antiarrhythmic drug therapy for SVT from July 2014 to February 2017. The clinical and tachycardia features, response to intravenous antiarrhythmic drug therapy of these children were characterized. Statistical analyses were performed using t test, Mann-Whitney U test, χ(2) test and H test. Results: The onset of SVT occurred at any age with a distribution with positive skewness, 57.6% (n=148) children<1 year, 17.5% (n=45) children1~<3 years, 10.5% (n=27) children 3~<6 years and 14.4% (n=37) children ≥ 6 years of age. The percentages of SVT types were 49.4% (n=127) for atrioventricular reentry tachycardia (AVRT), 4.3% (n=11) for atrioventricular nodal reentry tachycardia (AVNRT), 26.8% (n=69) for unclassified paroxysmal SVT and 19.5% (n=50) for atrial tachycardia (AT), respectively. Tachycardia-induced cardionyopathy (TIC) secondary to SVT developed in 30 of 225 (13.3%). Left ventricular ejection fraction (LVEF) of the 27 children attacked by TIC returned to normal after successful control of SVT (41.1%±6.3% vs. 60.3%±9.2%, t=-10.397, P=0.000). Complete termination of SVT by antiarrhythmic drugs was achieved in 164 of 257 (63.8%), partial termination rate was 18.7% (48 of 257) and failure to terminate rate was 17.5% (45 of 257). Propafenone (complete cardioversion in 98 (73.1%) of 134) and amiodarone (complete cardioversion in 23 (76.7%) of 30) showed better efficacy for SVT termination than adenosine (complete cardioversion in 26 (44.1%) 59) (χ(2)=20.524, P=0.000). Paroxysmal SVT had a higher termination rate on pharmacological therapy than AT (67.1% vs. 50.0%, χ(2)=6.337, P=0.042). Patients of different age groups had significantly different response to antiarrhythmic therapy (χ(2)=13.904, P=0.031). Children<1 year of age showed the least response to antiarrhythmic drug therapy with complete termination in 51 (55.4%) of 92. Adverse effects occurred in 9 patients (3.5%): Four patients had severe hypotensive shock using propafenone (n=3) and adenosine (n=1), and 3 patients had sinus arrest using adenosine. Conclusion: Most (57.6%) children with SVT have their first clinical episode within 1 year of age, and AVRT is the most common type. TIC occurs in 13.3% of children with SVT. Intravenous antiarrhythmic drug therapy has a 63.8% complete termination rate for children with SVT and incidence of adverse effects is 3.5%. Propafenone and amiodarone are more effective for SVT termination in children than adenosine. Serious adverse effects may occur when using propafenone.


Assuntos
Antiarrítmicos/uso terapêutico , Taquicardia por Reentrada no Nó Atrioventricular , Taquicardia Supraventricular/tratamento farmacológico , Adenosina/uso terapêutico , Amiodarona/uso terapêutico , Criança , Pré-Escolar , Feminino , Parada Cardíaca , Humanos , Incidência , Lactente , Masculino , Estudos Prospectivos , Taquicardia por Reentrada no Nó Atrioventricular/tratamento farmacológico , Taquicardia Paroxística , Taquicardia Supraventricular/patologia , Função Ventricular Esquerda
19.
J Electrocardiol ; 51(1): 121-125, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29021090

RESUMO

RBBB tachycardia with NW axis is considered to be VT unless proved otherwise. However underlying conduction system disease can produce electrocardiographic patterns suggestive of bundle branch block with extreme left axis which can cause difficulty in differentiating VT from SVT as in this case.


Assuntos
Eletrocardiografia , Taquicardia Supraventricular/diagnóstico , Fármacos Cardiovasculares/uso terapêutico , Diltiazem/uso terapêutico , Feminino , Transplante de Coração , Humanos , Taquicardia/tratamento farmacológico , Taquicardia Supraventricular/tratamento farmacológico , Adulto Jovem
20.
J Electrocardiol ; 51(1): 126-128, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29033052

RESUMO

We present a 21-year-old woman status post orthotopic heart transplantation initially presenting with a regular narrow complex tachycardia at 159beats/min. With intravenous diltiazem the rhythm transitioned to a regular tachycardia at 106beats/min, 2/3rd of the initial heart rate. We demonstrate this to be a novel description of 3:2second-degree Mobitz type I atrioventricular block (Wenckebach) with the absence of the hallmark regularly irregular (grouped beating) pattern.


Assuntos
Bloqueio Atrioventricular/fisiopatologia , Nó Atrioventricular/fisiopatologia , Eletrocardiografia , Transplante de Coração , Taquicardia Supraventricular/tratamento farmacológico , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/diagnóstico , Fármacos Cardiovasculares/uso terapêutico , Diltiazem/uso terapêutico , Feminino , Humanos , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/fisiopatologia , Adulto Jovem
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