INTRODUCTION: Atrial fibrillation (AF) with rapid ventricular rate (RVR) is a common diagnosis in the Emergency Department (ED) requiring evaluation and treatment. We present the characteristics and outcomes of patients presenting with primary or secondary AF in a tertiary hospital ED. MATERIALS AND METHODS: This retrospective cohort study included consecutive patients ≥21 years old, with a primary or secondary diagnosis of AF with RVR in the ED over a 1-year period from 1 January 2016 to 31 December 2016. Primary AF is defined as AF with no precipitating cause and secondary AF as AF secondary to a precipitating cause. RESULTS: A total of 464 patients presented to the ED from 1 January to 31 December 2016 with primary and secondary diagnosis of AF with RVR; 44.8% had primary diagnosis of AF whereas 55.2% had secondary AF. Overall admission rate from ED was high at 91.8% (primary 84.6% vs secondary 97.7%). Patients with primary AF were younger (68 vs 74 years, <0.001), had lower rates of cardiovascular risk factors, and shorter length of stay (median 4 vs 5 days). Within 30 days of discharge, they had lower ED reattendance (16.3% vs 25.8%, <0.001) and lower readmission (16.3% vs 25.8%, <0.001). There was no mortality in the primary AF group (0% vs 9.8%, <0.001). CONCLUSION Currently, majority of patients with AF with RVR are admitted from the ED. Other study suggests patients with uncomplicated primary AF have lower adverse outcomes and some could potentially be treated as outpatients.
Aged ; Atrial Fibrillation ; diagnosis ; epidemiology ; therapy ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Patient Care Management ; methods ; statistics & numerical data ; Patient Readmission ; statistics & numerical data ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Tachycardia, Ventricular ; diagnosis ; epidemiology ; therapy ; Tertiary Care Centers ; statistics & numerical data

INTRODUCTIONBrugada syndrome (BrS) is a common genetic cause of sudden cardiac arrest (SCA) due to polymorphic ventricular tachycardia and ventricular fibrillation. The current recommended therapy for high-risk BrS patients is the use of an implantable cardioverter defibrillator (ICD). The present study aimed to report the clinical characteristics and treatment outcomes of BrS patients in northeastern Thailand.

METHODSPatients who were diagnosed with BrS or had a Brugada electrocardiogram (ECG) between 2005 and 2012 at Khon Kaen University's hospitals were enrolled in the present study. Patients' clinical characteristics, ECG type, laboratory results and treatment were reviewed.

RESULTSA total of 90 eligible patients were enrolled. Of these, 79 (87.8%) patients were symptomatic--65 (82.3%) had documented SCA and 14 (17.7%) had unexplained syncope. The remaining 11 (12.2%) patients were asymptomatic with Brugada ECG. A majority of the patients enrolled were born in northeastern Thailand. The mean age of the symptomatic patients was 44.49 ± 8.55 years. Among the symptomatic patients, a majority were male (n = 77, 97.5%) and 23 (29.1%) patients had a family history of SCA. Almost all BrS patients who were symptomatic (96.2%) received ICD treatment for secondary prevention. The number of patients who received appropriate ICD therapy was 4.2 times of those who received inappropriate shocks. Only 3 (3.8%) symptomatic BrS patients refused ICD treatment.

CONCLUSIONClinical characteristics did not distinguish between symptomatic BrS patients and asymptomatic patients with Brugada ECGs. The clinical characteristics and treatment outcomes for the symptomatic BrS patients with SCA and unexplained syncope were similar. Among the BrS patients implanted with secondary prevention ICD in Northeastern Thailand, nearly one-third had received appropriate ICD therapy, far exceeding the incidence of device-related complications and inappropriate therapy.

Adult ; Brugada Syndrome ; diagnosis ; therapy ; Death, Sudden, Cardiac ; prevention & control ; Defibrillators, Implantable ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Secondary Prevention ; Syncope ; therapy ; Tachycardia, Ventricular ; prevention & control ; Thailand ; Ventricular Fibrillation ; prevention & control

The initiation of extracorporeal membrane oxygenation (ECMO) in the emergency department (ED) is a rare event. Herein, we report a case of acute fulminant myocarditis in a nine-year-old girl who was successfully resuscitated by early initiation of ECMO support in the paediatric ED of KK Women's and Children's Hospital, Singapore. The patient had rapidly progressed into a witnessed pulseless ventricular tachycardia on presentation, and ECMO was started in the ED following the failure of standard resuscitation measures to establish spontaneous circulation. ECMO was continued for nine days. The patient recovered well with normal neurocognitive function. The initiation of ECMO in the ED is potentially life-saving in the resuscitation of children with witnessed in-hospital cardiac arrest due to a reversible cause.
Cardiopulmonary Resuscitation ; Child ; Disease Progression ; Emergency Medicine ; Emergency Service, Hospital ; Extracorporeal Membrane Oxygenation ; methods ; Female ; Heart Arrest ; therapy ; Hospitalization ; Humans ; Myocarditis ; therapy ; Pediatrics ; methods ; Resuscitation ; Tachycardia ; diagnosis ; Treatment Outcome ; Ventricular Fibrillation

We report a 55-year-old female patient who presented with no P waves but with a wide QRS complex escape rhythm at 44 beats/min and prolonged QTc of 0.55 seconds on ECG. The patient had recurrence of ventricular fibrillations and loss of consciousness, and underwent defibrillation and cardiopulmonary resuscitation (CPR) several times because of cardiac arrest. The transthoracic echocardiography showed dilated cardiomyopathy and enlargement of both atria. The Doppler echocardiography documented the absence of A wave in the tricuspid and mitral valve flow. An electrophysiologic study demonstrated electrical inactivity in the right and left atria. Atrial pacing with maximum output did not capture the atria. These findings together with her electrocardiographic finding indicated atrial standstill. Sudden cardiac death was her first clinical manifestation of ventricular arrhythmia. The patient remained asymptomatic after receiving a single chamber implantable cardioverter-defibrillator (ICD) with VVI pacemaker function.
Bradycardia/*diagnosis/*therapy ; Cardiomyopathy, Dilated/*therapy ; Death, Sudden, Cardiac ; *Defibrillators, Implantable ; Electrocardiography ; Female ; Heart Atria ; Humans ; Middle Aged ; Ventricular Fibrillation/diagnosis/therapy

It is a well known fact that cardiac arrest can occur during general or regional anesthesia. When cardiac arrest occurs, immediate measures to resuscitate and diagnose, whether for ventricular fibrilIation or cardiac standstill, should be taken to save the patients life and to prevent permanent damage to the central nervous system. The authors had experienced of a cirdiac arrest due to ventricular fibrillation during local infiltration anesthesia with xylocaine and epinephrine for tonsillectomy. As soon as the diagnosis of ventricular fibrillation was made by EKG, while the oxygenation and closed cardiac massage were performed, the external D.C. defibrillation was carried out and drug therapy was given. The cardiac rhythm, was ventricular tachyeardia at first, then sinus rhythm was restored after the defibrillation. The patient recovered completely without any complications and was discharged from the hospital two days later.
Anesthesia, Conduction ; Anesthesia, Local ; Central Nervous System ; Diagnosis ; Drug Therapy ; Electrocardiography ; Epinephrine* ; Heart Arrest* ; Heart Massage ; Humans ; Lidocaine ; Oxygen ; Tonsillectomy ; Ventricular Fibrillation

Cardiac arrest is the most serious complication during anesthesia and surgery. Once cardiac arrest is diagnosed, whether the heart is in standstill or in ventricullar fibrillation and whatever is the initial cause, the immediate treatment must be aimed at providing an artificial circulation of oxygenated blood to the vital organs. Authors have experienced cardiac arrest due to ventricular fibrillation during general anesthesia with hypotensive technique. When the diagnosis was established, immediate closed chest cardiac massage was carried out with drug therapy and D.C. defibrillator. Cardiac rhythm was restored immediately after the 100 joules of electric shock was given. The duration of closed chest cardiac massage was 18 minutes. The patient recovered completely without complications.
Anesthesia ; Anesthesia, General ; Defibrillators ; Diagnosis ; Drug Therapy ; Heart ; Heart Arrest* ; Heart Massage ; Humans ; Oxygen ; Shock ; Thorax ; Ventricular Fibrillation*