Arrhythmias are categorized as due to abnormal impulse formation, abnormal impulse propagation or combined abnormalities of impulse formation and propagation. The primary tools used in the diagnosis of cardiac arrhythmias are the history, physical examination,12-lead electrocardiogram,24-hour continuous electrocardiographic recording, exercise test,intermittent electrocardiographic recording and clinical electrophysiologic study. Optimal management of cardiac arrhythmias requires knowledge of their mechanism,etiology, natural history and effect on the hemodynamic state.And the antiarrhythmic treatment must be monitored closely for its initial and continued effectiveness and for adverse effects.
Arrhythmias, Cardiac* ; Diagnosis* ; Electrocardiography ; Hemodynamics ; Natural History

Humans ; Arrhythmias, Cardiac/history* ; Biomedical Research/history* ; Cardiology/history* ; Cardiovascular System ; China ; History, 20th Century ; History, 21st Century ; Publishing/history*

Humans ; Arrhythmias, Cardiac/history* ; Biomedical Research/history* ; Cardiology/history* ; Cardiovascular System ; China ; History, 20th Century ; History, 21st Century ; Publishing/history*

Patients with congenital heart diseases (CHD) are confronted with early- and late-onset complications, such as conduction disorders, arrhythmias, myocardial dysfunction, altered coronary flow, and ischemia, throughout their lifetime despite successful hemodynamic and/or anatomical correction. Rhythm disturbance is a well-known and increasingly frequent cause of morbidity and mortality in patients with CHD. Predisposing factors to rhythm disturbances include underlying cardiac defects, hemodynamic changes as part of the natural history, surgical repair and related scarring, and residual hemodynamic abnormalities. Acquired factors such as aging, hypertension, diabetes, obesity, and others may also contribute to arrhythmogenesis in CHD. The first step in evaluating arrhythmias in CHD is to understand the complex anatomy and to find predisposing factors and hemodynamic abnormalities. A practical stepwise approach can lead to diagnosis and prompt appropriate interventions. Electrophysiological assessment and management should be done with integrated care of the underlying heart defects and hemodynamic abnormalities. Catheter ablation and arrhythmia surgery have been increasingly applied, showing increasing success rates with technological advancement despite complicated arrhythmia circuits in complex anatomy and the difficulty of access. Correction of residual hemodynamic abnormalities may be critical in the treatment of arrhythmia in patients with CHD.
Aging ; Arrhythmias, Cardiac ; Catheter Ablation ; Cicatrix ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Hemodynamics ; Humans ; Hypertension ; Ischemia ; Natural History ; Obesity ; Resin Cements ; Risk Factors

Arrhythmias in the neonatal period are not uncommon, and may occur in neonates with a normal heart or in those with structural heart disease. Neonatal arrhythmias are classified as either benign or nonbenign. Benign arrhythmias include sinus arrhythmia, premature atrial contraction, premature ventricular contraction, and junctional rhythm; these arrhythmias have no clinical significance and do not need therapy. Supraventricular tachycardia, ventricular tachycardia, atrioventricular conduction abnormalities, and genetic arrhythmia such as congenital long-QT syndrome are classified as nonbenign arrhythmias. Although most neonatal arrhythmias are asymptomatic and rarely life-threatening, the prognosis depends on the early recognition and proper management of the condition in some serious cases. Precise diagnosis with risk stratification of patients with nonbenign neonatal arrhythmia is needed to reduce morbidity and mortality. In this article, I review the current understanding of the common clinical presentation, etiology, natural history, and management of neonatal arrhythmias in the absence of an underlying congenital heart disease.
Arrhythmia, Sinus ; Arrhythmias, Cardiac* ; Atrial Premature Complexes ; Diagnosis* ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Infant, Newborn ; Mortality ; Natural History ; Prognosis ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Ventricular Premature Complexes

BACKGROUND AND OBJECTIVES: The prognosis and natural history of bradycardia related to drugs such as beta-blockers and non-dihydropyridine calcium channel blockers are not well known. SUBJECTS AND METHODS: We retrospectively analyzed 38 consecutive patients (age 69+/-11, 21 women) with drug-related bradycardia (DRB) between March 2005 and September 2007. A drug-associated etiology for the bradycardia was established based on the medical history and patient response to drug discontinuation. The mean follow-up duration was 18+/-8 months. RESULTS: The initial electrocardiogram (ECG) showed sinus bradycardia (heart rate < or =40/min) in 13 patients, sinus bradycardia with junctional escape beats in 18 patients, and third-degree atrioventricular (AV) block in seven patients. Drug discontinuation was followed by resolution of bradycardia in 60% of patients (n=23). Among them, five (17.8%) patients resumed taking the culprit medication after discharge and none developed bradycardia again. Bradycardia persisted in 10 (26.3%) patients despite drug withdrawal, and a permanent pacemaker was implanted in seven of them. Third-degree AV block, QRS width, and bradycardia requiring temporary transvenous pacing were significantly associated with the bradycardia caused by drugs. CONCLUSION: Beta-blockers were the most common drugs associated with DRB. However, in one quarter of the cases the DRB was not associated with drugs; in these patients permanent pacemaker implantation should be considered.
Arrhythmias, Cardiac ; Atrioventricular Block ; Bradycardia ; Calcium Channel Blockers ; Dichlororibofuranosylbenzimidazole ; Electrocardiography ; Follow-Up Studies ; Humans ; Natural History ; Prognosis ; Retrospective Studies ; United Nations

HCM(=Hypertrophic Cardiomyopathy) is a primary cardiac disease and its characteristic morphologic abnormality is a hypertrophied and nondilated left ventriclar in the absence of another cardiac or systemic disease that itself is capable of producing left ventricle hypertrophy. The symptoms of HCM are varied and include dyspnea, orthopnea, fatigue, chest pain, palpitations and impaired consciousness. The pathophysiologic components of the disease process are left ventricular outlofw obstruction, diastolic dysfunction, myocardial ischemia, and arrhythmia. Predicting the clinical course and outcome for individual patients HCM has been difficult because of variability in natural history and the complexity in disease expression. The present report describe a patient with am asymptomatic, pathologic Q wave in whom HCM was diagnosed by echocardiography, MIBI-SPECT, coronary angiography, and left ventriculography.
Arrhythmias, Cardiac ; Cardiomyopathy, Hypertrophic ; Chest Pain ; Consciousness ; Coronary Angiography ; Dyspnea ; Echocardiography ; Electrocardiography ; Fatigue ; Heart Diseases ; Heart Ventricles ; Humans ; Hypertrophy ; Myocardial Ischemia ; Natural History