Diabetic polyneuropathy affects millions of people with diabetes. Although, the symptoms may be highly unpleasant, management have concentrated mainly on the disease process and other more visible or devastating secondary complications like diabetic ulcers and cardiac arrhythmia. Glycemic control remains the most important aspect in the management of diabetes that can deter or decelerate subsequent development of diabetic polyneuropathy. However, concentration on this aspect alone veers away from control of symptoms that may improve quality of life of patients.
NEUROPATHY ; CARDIAC ARRHYTHMIA ; PAIN ; INJURY ; NERVE

Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Electrocardiography ; Humans ; Tachycardia, Supraventricular

Clinical electrophysiological studies(EPS) were done in seven patients with chronic recurrent sustained ventricular tachycardia(VT) in an attempt to delineate the reproducibility and to select the effective antiarrhythmic drugs for the prevention of the recurrence of VT. We could induce and terminate the sustained VT, and could select the effective antiarrhythmic drugs in all patient in the cardiac catheterization laboratory with EPS. With these effective antiarrhythmic drugs VT did not recur for the follow up period of 15 to 20 months. In view of the serious nature of the VT and the demonstrated benefits of EPS, we could conclude that patients with chronic recurrent sustained VT should undergo EPS.
Anti-Arrhythmia Agents ; Cardiac Catheterization ; Cardiac Catheters ; Follow-Up Studies ; Humans ; Recurrence ; Tachycardia, Ventricular*

Amiodarone is an iodinated benzofuran derivative that has been proved effective in the control of supraventricular and ventricular arrhythmias refractory to other antiarrhythmic drugs. In patients treated with amiodarone, subsequent surgical intervention is a common clinical scenario, but unfortunately we do not have definite data about complications due to amiodarone after cardiac surgery. Some reports have shown that amiodarone treatment can be associated with a state of alpha-adrenergic and beta-adrenergic receptor blockade, which requires more pacing and epinephrine infusion for perioperative hemodynamic support. And some reports have also identified a severe form of ARDS in patients on amiodarone therapy which was associated with siginificant morbidity and mortality. We exprienced a patient who expired after mitral valve replacement due to amiodarone-induced ARDS; therefore, we report this case with a brief literature.
Amiodarone ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Epinephrine ; Hemodynamics ; Humans ; Mitral Valve ; Mortality ; Thoracic Surgery

Anti-Arrhythmia Agents ; adverse effects ; therapeutic use ; Arrhythmias, Cardiac ; drug therapy ; Humans

Anti-Arrhythmia Agents ; therapeutic use ; Arrhythmias, Cardiac ; drug therapy ; Child ; Humans ; Sotalol ; therapeutic use

We are presenting the first documented case of amisulpride related ventricular arrhythmia during tracheal intubation and extubation under general anesthesia in an 48 year-old female with psychiatric history of chronic schizophrenia who was treated with amisulpride. This case suggests the threshold of perioperative arrhythmia is possibly decreased in patients with long-term antipsychotic medication. So, the potential risk of antipsychotics-induced perioperative arrhythmia should be evaluated, as well as heart rhythm monitoring, prophylactic use of antiarrhythmic drugs, and preoperative adjustment of antipsychotics should be considered.
Anesthesia, General* ; Anti-Arrhythmia Agents ; Antipsychotic Agents ; Arrhythmias, Cardiac* ; Female ; Heart ; Humans ; Intubation* ; Schizophrenia

Humans ; COVID-19/complications* ; Arrhythmias, Cardiac/diagnosis* ; Anti-Arrhythmia Agents/therapeutic use*

The pharmacological therapy of cardiac arrhythmias is still challenging. As is well known, antiarrhythmic drugs have a narrow therapeutic-toxic window and can induce lethal proarrhythmia (antiarrhythmic drug-induced arrhythmia). The harmful effect of antiarrhythmic drug was proven by CAST and so many clinical trials. Thus we need strict indications for prescription and objective parameters for monitoring of the drug action and side effects. The cardiac arrhythmias are classified as ectopic beats, bradyarrhythmia, and tachyarrhythmia. The main target of antiarrhythmic drugs is tachyarrhythmia. The clinical role of antiarrhythmic drugs is the acute conversion of arrhythmia to sinus rhythm and the chronic suppression/prevention of tachycardia. The cardiac arrhythmia (arrhythmogenesis) occurs in harmony of 3 components, namely, substrate, precipitating (modulating) factors, and trigger. The acute modification of arrhythmogenic environment by drug may be efficient, but the chronic suppression of arrhythmia only by the drug may not be complete. Recently, the clinical role of chronic drug therapy is replaced by RFCA (in patients with SVT except atrial fibrillation) and ICD (VT/SCD). The antiarrhythmic drugs are usually classified into Class I (sodium channel blocker), Class II (beta-blocker), Class III (potassium channel blocker), Class IV (calcium channel blocker), and others (digoxin and adenosine), according to Vaughn-Williams suggestion. Nowadays, the clinical electrophysiologist reclassified the agents into calcium channel-dependent drug (Class II, IV, digoxin, and adenosine) and sodium/potassium channel-dependent drug (Class I and III). The drug is effective only when the concentration in blood or tissue is sufficient to modify the arrhythmogenic substrate. We need to know the pharmacokinetic and pharmacodynamic properties of antiarrhythmic drugs exactly. We can expect the blood concentration of a drug if we know the elimination half-life and the dosing schedule of the drug because most drugs (including antiarrhythmic agents) have the first-order (elimination) kinetic. For a new steady-state of drug concentration, we should wait for 3 to 4 times of the half-life after changing the dosage (prescription). Finally, the consideration and management of the underlying heart disease and precipitating/modulating factors are needed for the effective antiarrhythmic drug therapy.
Anti-Arrhythmia Agents ; Appointments and Schedules ; Arrhythmias, Cardiac ; Bradycardia ; Calcium ; Digoxin ; Drug Therapy ; Half-Life ; Heart Diseases ; Humans ; Prescriptions ; Tachycardia

BACKGROUND: With mitral valvular heart disease, chronic atrial fibrillation(AF) is not likely to return to sinus rhythm after the operation. We evaluate the long term results and factors in recurrence of AF after modified Maze operation with mitral valve surgery. MATERIAL AND METHOD: From 1990 to 1996, 35 patients with chronic AF underwent modified Maze operation with mitral valve procedure in patients with chronic AF. The mean duration of AF was 7.7 +/-4.5 years. The concomitant operations were 34 mitral valve replacement(with 4 tricuspid annuloplasty and 3 tricuspid valve replacement)and 1 mitral valve repair. We analyzed the long term results and factors in recurrence of AF. RESULT: At immediate postoperatively, 33 of the 35 patients(93.9%) were converted to sinus rhythm. There was one operative death. However, AF recurred in 12 out of 35 patients during hospitalization and AF in these 12 patients were treated with antiarrhythmic drugs and electrical defibrillation 2-3 months later. Two out of twelve patients were failed in conversion to sinus rhythm after cessation of medication with side effects. During follow-up(71.1 +/-17.5 months, range 3-9 years), AF recurred in 9 patients and overall conversion rate to sinus rhythm was 73.5%. Predictors of postoperative AF included: duration of preoperative AF(maintenance group: recurrence group=6.3 years VS. 10.3 years, p=0.008) and cardiothoracic ratio on preoperative chest X-ray(0.58 VS. 0.72, p=0.009). CONCLUSION: AF surgery with mitral valve procedure increase the chance of recovery into sinus rhythm, reduce the incidence of atrial arrhythmia, and reduce the left atrial size with decreasing wall stress simultaneously. In order to decrease the incidence of postoperative arrhythmia, proper modification of the surgery with medical therapy should be considered.
Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Heart Valve Diseases ; Hospitalization ; Humans ; Incidence ; Mitral Valve ; Recurrence ; Thorax ; Tricuspid Valve