Cardiac Arrhythmias

  • Michael S. Klinkman


Cardiac arrhythmias are frequently seen in routine primary care practice, and “palpitations” or patient concerns about “skipped heartbeats” are among the most common presenting complaints in primary care. Surprisingly, many symptomatic patients do not have significant cardiac arrhythmias, whereas a substantial proportion of clinically significant arrhythmias are detected in asymptomatic patients. As more information has become available regarding the natural history of many arrhythmias in the primary care setting, we are moving from an era of overtreatment via aggressive pharmacologic management to an era of selective treatment with increased use of nonpharmacologic interventions such as surgical or catheter ablation.


Atrial Fibrillation Cardiac Arrhythmia Atrial Flutter Sick Sinus Syndrome Advance Cardiac Life Support 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Graboys T. Appropriate indications for ambulatory electrocardiographic monitoring. Cardiol Clin 1992;10:551–4.PubMedGoogle Scholar
  2. 2.
    Weitz HH, Weinstock PJ. Approach to the patient with palpitations. Med Clin North Am 1995;79:449–57.PubMedGoogle Scholar
  3. 3.
    Manning WJ, Silverman DI, Gordon SPF, Krumholz HM, Douglas PJ. Cardioversion from atrial fibrillation without prolonged anticoagulation with use of transesophageal echocardiography to exclude presence of atrial thrombi. N Engl J Med 1993;328:750–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Ukani ZA, Ezekowitz MD. Contemporary management of atrial fibrillation. Med Clin North Am 1995;79:1135–52.PubMedGoogle Scholar
  5. 5.
    Waldo AL. An approach to therapy of supraventricular tachyarrhythmias: an algorithm versus individualized therapy. Clin Cardiol 1994;17 Suppl II:21–6.Google Scholar
  6. 6.
    Wilber DJ, Olshamsky B, Moral JF, et al. Electrophysiological testing and nonsustained ventricular tachycardia: use and limitations in patients with coronary artery disease and impaired ventricular function. Circulation 1990;82:350–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Hamdan M, Scheinman M. Current approaches in patients with ventricular tachyarrhythmias. Med Clin North Am 1995; 79:1097–1120.PubMedGoogle Scholar
  8. 8.
    Gomes JA, Mehta D, Langan MN. Sinus node reentrant tachycardia. PACE 1995;18(Part I):1045–57.PubMedCrossRefGoogle Scholar
  9. 9.
    Huang SK. Radio-frequency catheter ablation of cardiac arrhythmias: appraisal of an evolving therapeutic modality. Am Heart J 1989;118:1317–29.PubMedCrossRefGoogle Scholar
  10. 10.
    Chun HM, Sung RJ. Supraventricular tachyarrhythmias. Med Clin North Am 1995;79:1121–34.PubMedGoogle Scholar
  11. 11.
    Vaughan-Williams EM. A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol 1984;24:129–47.PubMedCrossRefGoogle Scholar
  12. 12.
    Epstein AE, Bigger JT, Wyse GD, et al. Events in the Cardiac Arrhythmia Suppression Trial (CAST): mortality in the entire population enrolled. J Am Coll Cardiol 1991;18:14–19.PubMedCrossRefGoogle Scholar
  13. 13.
    Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecanide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989;321:406–12.Google Scholar
  14. 14.
    Cardiac Arrhythmia Suppression Trial-II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med 1992;327:227–33.Google Scholar
  15. 15.
    Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. JAMA 1982;247:1707–14.Google Scholar
  16. 16.
    Teo KK, Yusuf S, Furberg CD. Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction: an overview of the results from randomized controlled trials. JAMA 1993;270:1589–95.PubMedCrossRefGoogle Scholar
  17. 17.
    Burkart B, Pfisterer M, Kiowski W, et al. Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS). J Am Coll Cardiol 1990;16:1711–8.PubMedCrossRefGoogle Scholar
  18. 18.
    CASCADE Investigators. Randomized antiarrhythmic drug therapy in survivors of cardiac arrest (the CASCADE study). Am J Cardiol 1991;67:578–84.Google Scholar
  19. 19.
    Mason JW, for the Electrophysologic Study versus Electrocardiographic Monitoring Investigators. A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias. N Engl J Med 1993;329:452–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Kirschenbaum HL, Rosenberg JM. Clinical experience with sotalol in the treatment of cardiac arrhythmias. Clin Ther 1994;16:347–65.Google Scholar
  21. 21.
    Alpert MA, Hashimi MW, Concannon MD, Bikkina M, Mukerji V. Pathogenesis, recognition, and management of common cardiac arrhythmias. Part II. Supraventricular premature beats and tachyarrhythmias. South Med J 1995; 88:153–74.PubMedCrossRefGoogle Scholar
  22. 22.
    Vukmir RB. Cardiac arrhythmia therapy. Am J Emerg Med 1995;13:459–70.PubMedCrossRefGoogle Scholar
  23. 23.
    Kerin NZ, Somberg J. Proarrhythmia: definition, risk factors, causes, treatment, and controversies. Am Heart J 1994;128: 575–85.PubMedCrossRefGoogle Scholar
  24. 24.
    Faber TS, Zehender M, Just H. Drug-induced torsade de pointes: incidence, management and prevention. Drug Saf 1994;11:463–76.PubMedCrossRefGoogle Scholar
  25. 25.
    Wellens HJJ, Atie J, Penn OC, Gorgels APM, Brugada P, Smeets J. Diagnosis and treatment of patients with accessory pathways. Cardiol Clin 1990;8:503–21.PubMedGoogle Scholar
  26. 26.
    Cox JL, Ferguson BT. Cardiac arrhythmia surgery. Curr Probl Surg 1989;26:199–221.CrossRefGoogle Scholar
  27. 27.
    Cox J, Ferguson BT, Lindsay BD, et al. Perionodal cryosurgery for atrioventricular node reentry tachycardia in 23 patients. J Thorac Cardiovasc Surg 1990;90:490–6.Google Scholar
  28. 28.
    Kadish A, Goldberger J. Ablative therapy for atrioventricular nodal reentry arrhythmias. Prog Cardiovasc Dis 1995; 37:273–293.PubMedCrossRefGoogle Scholar
  29. 29.
    Kupersmith J, Holmes-Rovner M, Hogan A, Rovner D, Gardiner J. Cost-effectiveness analysis in heart disease. III. Ischemia, congestive heart failure, and arrhythmias. Prog Cardiovasc Dis 1995;37:307–46.PubMedCrossRefGoogle Scholar
  30. 30.
    Winkle RA, Mead RH, Ruder MA, et al. Long-term outcome with the automatic implantable cardioverter-defibrillator. J Am Coll Cardiol 1989:13:1353–61.PubMedCrossRefGoogle Scholar
  31. 31.
    Sung RJ, Lauer MR, Chun H. Atrioventricular node reentry: current concepts and new perspectives. Pacing Clin Electrophysiol 1994;17:1413–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Schwartz M, Rodman D, Lowenstein S. Recognition and treatment of multifocal atrial tachycardia: a critical review. J Emerg Med 1994;12:353–60.PubMedCrossRefGoogle Scholar
  33. 33.
    DeMarco JP, Miles W, Akhtar M, et al. Adenosine for paroxysmal supraventricular tachycardia: dose ranging and comparison with verapamil: assessment in placebo-controlled, multicenter trials. Ann Intern Med 1990;113:104–10.CrossRefGoogle Scholar
  34. 34.
    Camm AJ, Garratt CJ. Adenosine and supraventricular tachycardia. N Engl J Med 1991;325:1621–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Waldo AL. Clinical evaluation and therapy of patients with atrial fibrillation and flutter. Cardiol Clin 1990;8:479–90.PubMedGoogle Scholar
  36. 36.
    Wolf PA, Abbott R, Savage D. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 1991;22:983–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Petersen P, Boysen G, Godtfredson J, Andersen E, Andersen B. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK study. Lancet 1989;1:175–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Connolly SJ, Laupacis A, Gent M, Roberts RS, Cairns JA, Joyner C. Canadian Atrial Fibrillation Anticoagulation (CAFA) study. J Am Coll Cardiol 1991;18:349–55.PubMedCrossRefGoogle Scholar
  39. 39.
    Ezekowitz MD, Bridges SL, James KE, et al. Warfarin in the prevention of stroke associated with nonrheumatic atrialfibrillation. Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med 1992; 327:1406–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Stroke Prevention in Atrial Fibrillation Investigators. Stroke Prevention in Atrial Fibrillation Study: final results. Circulation 1991;84:527–39.Google Scholar
  41. 41.
    Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 1990;323:1505–11.Google Scholar
  42. 42.
    Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994;154:1449–57.Google Scholar
  43. 43.
    Matchar DB, McCrory DC, Barnett HJM, Feussner JR. Medical treatment for stroke prevention. Ann Intern Med 1994; 121:41–53.PubMedCrossRefGoogle Scholar
  44. 44.
    Gage BF, Cardinalli AB, Albers GW, Owens DK. Cost-effectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation. JAMA 1995;274: 1839–45.PubMedCrossRefGoogle Scholar
  45. 45.
    Arnold AZ, Mick MJ, Mazurck RP, Loup FD. Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. J Am Coll Cardiol 1992;19:851–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Alpert MA, Mukerji V, Bikkina M, Concannon MD, Hashimi MW. Pathogenesis, recognition, and management of common cardiac arrhythmias. I. Ventricular premature beats and tachyarrhythmias. South Med J 1995;88:1–21.PubMedCrossRefGoogle Scholar
  47. 47.
    Aronow WS. Treatment of ventricular arrhythmias in older adults. J Am Geriatr Soc 1995;43:688–95.PubMedGoogle Scholar
  48. 48.
    Kerin NZ, Somberg J. Proarrhythmia: definition, risk factors, causes, treatment, and controversies. Am Heart J 1994;128: 575–85.PubMedCrossRefGoogle Scholar
  49. 49.
    Roden DM. Risks and benefits of antiarrhythmic therapy. N Engl J Med 1994;331:785–91.PubMedCrossRefGoogle Scholar
  50. 50.
    Gilman JK, Jala S, Naccarelli GV. Predicting and preventing sudden death from cardiac causes. Circulation 1994;90: 1083–92.PubMedCrossRefGoogle Scholar
  51. 51.
    Hohnloser S, Woasley R. Sotalol. N Engl J Med 1994;331:31–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Michael S. Klinkman

There are no affiliations available

Personalised recommendations