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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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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.
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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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Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per...
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Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
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Roof-dependent Atrial Flutter Changed into Single-loop Biatrial Flutter During Ablation.

Jialin Su1, Dominika Zoltowska1, Haisam Ismail2

  • 1Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.

The Journal of Innovations in Cardiac Rhythm Management
|March 23, 2022
PubMed
Summary

A rare single-loop biatrial flutter can emerge during left atrial roof-line ablation. This atypical atrial flutter involves both the right atrium and left atrium, requiring specific ablation strategies for termination.

Keywords:
Ablationbiatrial flutterinteratrial connectionlocal activation time mappingroof-dependent atrial flutter

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Area of Science:

  • Electrophysiology
  • Cardiac Arrhythmias

Background:

  • Atypical atrial flutter, particularly single-loop biatrial flutter, is an uncommon complication following left atrial ablation procedures.
  • Understanding the mechanisms of atypical atrial flutter is crucial for effective management and procedural success.

Observation:

  • A case is presented where a roof-dependent atrial flutter transformed into a single-loop biatrial flutter during roof-line ablation.
  • Activation mapping revealed a specific pathway involving the right atrium (RA) and left atrium (LA), entering the LA posterior to the ablation line.

Findings:

  • The biatrial flutter exhibited a unique activation pattern originating in the RA and propagating to the LA.
  • Successful termination of the biatrial flutter was achieved through ablation between the right and left inferior pulmonary veins.

Implications:

  • This case highlights the importance of considering biatrial flutter in patients with atypical atrial flutter, especially when roof-dependent flutter slows but does not terminate during ablation.
  • Right atrial mapping is essential for diagnosing and guiding ablation of such complex arrhythmias.
  • The findings suggest that specific anatomical pathways, such as Bachmann's bundle, may play a role in the circuit of single-loop biatrial flutter.