Arrhythmias, Cardiac ; Atrial Flutter/diagnosis* ; Electrocardiography ; Humans

The esophageal electrocardiogram is of increasing significance in the study and diagnosis of cardiac arrhythmia and of posterior myocardial disease. We used both bipolar and unipolar esophageal recording leads and standard electrocardiogram equipment, and compared the effectiveness of esophageal electrocardiogram with co nventional electrocardiogram. The effectiveness of esophageal electrocardiogram were as follows: 1) Differentiation of sinus, atrial, junctional, or ventricular rhythm. 2) Differentiation of origin of premature beats. 3) Differentiation of atrial flutter and fibrillation. 4) Detection of retrograde atrial conduction of extraventricular systole. 5) Detection of electrical alternance of QRS amplitude. 6) Diagnosis of posterior myocardial infarction. The results reported here indicate that the esophageal electrocardiogrm seems to be a valid method in the diagnosis of cardiac arrhythmias without invasiveness.
Arrhythmias, Cardiac ; Atrial Flutter ; Cardiac Complexes, Premature ; Cardiomyopathies ; Diagnosis ; Electrocardiography* ; Myocardial Infarction ; Systole

Atrial Flutter ; diagnosis ; etiology ; therapy ; Electrocardiography ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Treatment Outcome

OBJECTIVETo determine whether the extent of prolongation of the transisthmus interval after ablation predicts complete bidirectional block.

METHODSSince 1996 to 2002, 30 consecutive patients underwent ablation procedures for isthmus-dependent atrial flutter. There were 23 males and 7 females [mean age (47.85 +/- 9.35) years]. With the use of fluoroscopic view of anatomy, radiofrequency ablation was performed during coronary sinus pacing at a cycle length of 600 ms.

RESULTSBidirectional block was achieved with ablation in 29 (97%) of 30 patients. The transisthmus intervals before ablation and after complete transisthmus block were (73.82 +/- 13.01) ms and (140.47 +/- 20.48) ms, respectively, in the clockwise direction (P < 0.0001), and (77.63 +/- 8.36) ms and (138.17 +/- 15.55) ms, respectively, in the counterclockwise direction (P < 0.0001). A period of incomplete isthmus block was observed during 17 (58%) of the 29 ablation procedures. The clockwise transisthmus intervals during incomplete block [(107.65 +/- 21.33) ms] were (45.5 +/- 8.7)% longer than the baseline transisthmus intervals. An increase in the transisthmus interval by > or = 50% in both directions after ablation predicted complete bidirectional block with 100.0% sensitivity and 83.3% specificity. The positive and negative predictive values were 90.6% and 100.0%, respectively. The diagnostic accuracy of a > or = 50% prolongation in the transisthmus interval was 83.3%.

CONCLUSIONThe analysis of transisthmus interval is a valuable method for determining complete bidirectional isthmus block.

Atrial Flutter ; diagnosis ; drug therapy ; physiopathology ; Female ; Humans ; Infant, Newborn ; Male

Cardiac myxoma is often discovered as an incidental finding and presents with various subtle symptoms and signs. Electrocardiographic findings are mostly non-specific. Atrial flutter or conduction abnormalities are known to be rare. We report a case of large left atrial myxoma that was diagnosed by transthoracic echocardiography at a primary care clinic. An asymptomatic, 71-year-old woman presented with serial abnormal electrocardiogram changes during a routine consultation. A diagnosis of left atrial myxoma was obtained through transthoracic echocardiography. We report this case with a review of literature on cardiac myxoma associated with arrhythmia.
Aged ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrial Flutter ; Diagnosis ; Echocardiography ; Electrocardiography* ; Female ; Humans ; Incidental Findings ; Myxoma* ; Primary Health Care

PURPOSE: RFCA has been proven to be an effective and safe tool for treating different kinds of tachycardia in adults. This study was designed to analyze the efficacy of this method in children and adolescents. METHODS: Seventy-eight patients referred to Gachon Medical School, Gil Hospital for ablation of supraventricular(SVT) and ventricular tachycardia(VT) between January 1997 and February 1999 were included in this study. An electrophysiologic study was performed in the same session to assure the diagnosis, and meet the appropriate criteria for ablation. All patients had regular follow-up at our center. RESULTS: Mean age of the patients was 9.9 years. Thirty-seven patients had Wolff-Parkinson- White syndrome, atrioventricular nodal reentrant tachycardiain in 12 patients, atrial flutter in 11 patients, atrial tachycardia in 9 patients, Mahaim tachycardia in 2 patients, nodoventricular tachycardia in one patients and VT in 6 patients was found. Seventy-seven patients were treated successfully(98.7%), 75 patients were treated in a single procedure, but 2 patients needed a second attempt. RFCA treatment failed in only one patient with nodoventricular tachycardia. In three of the 77 successfully treated patients(3.9%), tachycardia recurred after 1-3 months but could be treated by a further intervention. The duration of follow up after RFCA was from 2 to 27 months. CONCLUSION: RFCA is a highly effective method in the treatment of SVT and VT in children and adolescents. The major benefit of this technique is its potential as a cure for a chronic disease. RFCA can be used as the primary treatment for SVT and VT.
Adolescent* ; Adult ; Atrial Flutter ; Catheter Ablation* ; Child* ; Chronic Disease ; Diagnosis ; Follow-Up Studies ; Humans ; Schools, Medical ; Tachycardia*

Perinatal atrial flutter is a potentially lethal arrhythmia. Management of this disorder is difficult and controversial. Fetal atrial flutter is a serious and life threatening rhythm disorder particulary when it causes hydrops; it may be associated with fetal death or neurological damage. Although the initial episode of flutter may be difficult to control, recurrence of atrial flutter after successful resolution of the arrhythmia seems highly unlikely and long-term prognosis is excellent. We experienced a case of a atrial flutter diagnosed in utero at 38+6 weeks' gestation by fetal cardiac echocardiography. He was treated with maternal digoxin, but he continued to have atrial flutter until delivery. Restoration of sinus rhythm occured with propafenone therapy in this patient after failure of initial digoxin therapy and direct current cardioversion.
Arrhythmias, Cardiac ; Atrial Flutter* ; Diagnosis* ; Digoxin ; Echocardiography* ; Edema ; Electric Countershock ; Fetal Death ; Humans ; Pregnancy ; Prognosis ; Propafenone* ; Recurrence

PURPOSE: For tachycardic patients not in need of immediate cardioversion, the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasize specific rhythm diagnosis and avoidance of simplistic overuse of adenosine. The purpose of this study was to identify the rhythms for which adenosine was inappropriately prescribed at the emergency department after the International Guidelines 2000 had been adopted. METHODS: We retrospectively investigated 128 tachycardic patients who had been prescribed adenosine at the emergency department from September 2000 to March 2003. Patients were divided into two groups. The Appropriate Use Group was comprised of patients for whom had been prescribed for narrow QRS-complex tachycardia on the initial ECG. The Inappropriate Use Group was comprised of patients for whom adenosine had been prescribed for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin on the initial ECG. RESULTS: Of the 128 patients, 31 (24.2%) were in the Inappropriate Use Group. Among them, atrial fibrillation was involved in 15, atrial flutter in 3, atrial tachycardia in 2, sinus tachycardia in 8, and wide QRS-complex tachycardia of unknown origin in 3. CONCLUSION: Approximately 24% of the emergency department patients who were treated with adenosine received the medication unnecessarily for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin. Additional education on electrocardiographic recognition of tachyarrhythmias, and the Tachycardia Algorithms of Guidelines 2000 may be necessary for residents of emergency department.
Adenosine* ; Atrial Fibrillation ; Atrial Flutter ; Cardiopulmonary Resuscitation ; Diagnosis ; Education ; Electric Countershock ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Retrospective Studies ; Tachycardia ; Tachycardia, Sinus

Supraventricular tachycardia (SVT) refers to a heterogeneous group of arrhythmias localized within the upper part of the heart (the His bundle or above). In general, the term SVT does not include atrial fibrillation. Common forms of SVT include atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal atrial tachycardia, and atrial flutter. Other, less common arrhythmias also fall under the category of SVT, including inappropriate sinus tachycardia and junctional reentrant/ectopic tachycardia. Paroxysmal supraventricular tachycardia refers to AVNRT and AVRT. SVTs can be identified and classified by clinical manifestation/physical examination, ECG, and/or electrophysiologic analysis.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrial Flutter ; Bundle of His ; Diagnosis, Differential* ; Electrocardiography ; Heart ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinus ; Tachycardia, Supraventricular*