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Related Concept Videos

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Dysrhythmias IV: Characteristics of Bradyarrhythmias01:18

Dysrhythmias IV: Characteristics of Bradyarrhythmias

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Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
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Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers01:12

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Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of...
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Pulse rhythm01:30

Pulse rhythm

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Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
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Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
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Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers01:24

Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers

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Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
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Increased capture threshold in permanent His-bundle pacing associated with flecainide.

Michael Jiang1, Jeremiah Wasserlauf1, Bradley P Knight1

  • 1Division of Cardiology/Electrophysiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Pacing and Clinical Electrophysiology : PACE
|February 4, 2020
PubMed
Summary

Flecainide acetate may increase His-bundle pacemaker capture thresholds in patients with atrial arrhythmias. Discontinuation of flecainide and switching to dofetilide normalized the threshold, suggesting a drug-related effect.

Keywords:
flecainide acetatepacemakerpacingpermanent His-bundle pacing

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Pharmacology

Background:

  • Permanent His-bundle pacing is an effective strategy for bradyarrhythmias and heart failure.
  • Antiarrhythmic drugs are frequently used for rhythm control in patients with atrial arrhythmias.

Observation:

  • A 64-year-old male experienced a significant increase in selective His-bundle capture threshold one month after initiating flecainide acetate for atrial flutter and fibrillation.
  • The His-bundle capture threshold returned to baseline levels four days after discontinuing flecainide and switching to dofetilide.

Findings:

  • This case report is the first to document a rise in selective His-bundle capture threshold associated with flecainide acetate.
  • The findings suggest a potential pharmacodynamic interaction between flecainide and His-bundle pacing.

Implications:

  • This association could lead to higher pacing capture thresholds, potentially reducing pacemaker battery longevity.
  • Such changes may mimic His-bundle lead failure, necessitating careful medication review in patients with His-bundle pacemakers.