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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, 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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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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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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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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Dysrhythmias refers to abnormalities in the heart's rhythm. They result from disruptions in the heart's electrical conduction system, which includes the sinoatrial(SA)node, atrioventricular(AV) node, the bundle of His, bundle branches, and Purkinje fibers.Definition and PathophysiologyDysrhythmias result from disorders of impulse formation, impulse conduction, or both. The heart contains specialized cells in the sinoatrial node, atrioventricular node, and the bundle of His and Purkinje fibers...
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QTc Dynamics Following Cardioversion for Persistent Atrial Fibrillation.

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Electrical cardioversion for atrial fibrillation (AF) can cause temporary QTc prolongation. Continuous Holter monitoring significantly detects more QTc prolongation than standard ECG after cardioversion.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Clinical Monitoring

Background:

  • Atrial fibrillation (AF) management frequently involves cardioversion (CV).
  • Assessing QTc interval changes post-electrical CV (ECV) is crucial for patient safety.
  • Comparing continuous Holter monitoring with conventional ECG follow-up is needed.

Purpose of the Study:

  • To evaluate QTc interval changes over time after ECV for persistent AF.
  • To compare the efficacy of continuous Holter monitoring versus conventional ECG for detecting QTc prolongation.

Main Methods:

  • Prospective observational cohort study of 90 patients undergoing elective ECV for persistent AF.
  • 7-day Holter monitoring initiated pre-ECV, with QTc measured post-procedure.
  • Primary endpoint: QTc prolongation (≥500 ms or ≥10% increase).

Main Results:

  • Median QTc increased significantly from baseline post-ECV (p <0.001).
  • Peak QTc prolongation occurred at 44 hours post-ECV.
  • Holter monitoring detected significant QTc prolongation in 43% of patients versus 3% with conventional ECG (p <0.001).

Conclusions:

  • ECV for persistent AF carries a transient risk of QTc prolongation in nearly half of patients.
  • Peak QTc prolongation is observed around the second day post-ECV.
  • Prolonged ECG monitoring (Holter) is superior to conventional monitoring for detecting significant QTc prolongation.