Skip to main content
SpringerLink
Log in

The Arrhythmia Patient in the CCU – Impact of Echocardiography

  • Chapter
  • First Online:
Echocardiography in the CCU

  • 1502 Accesses

Abstract

Echocardiography is an essential tool in patients with cardiac arrhythmias, particularly in the critical care environment. It plays an important role in the etiological assessment, prognosis, and risk stratification of patients with arrhythmias. In this chapter, we discuss the key role of echocardiography in the arrhythmic patient in the coronary care unit.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wren C, Campbell RW, Hunter S. Role of echocardiography in differential diagnosis of broad complex tachycardia. Br Heart J. 1985;54(2):166–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kotecha D, Mohamed M, Shantsila E, Popescu BA, Steeds RP. Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review. EP Europace. 2017:eux027.

    Google Scholar 

  3. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–71.

    Article  PubMed  Google Scholar 

  4. Donal E, Lund LH, Oger E, Reynaud A, Schnell F, Persson H, et al. Value of exercise echocardiography in heart failure with preserved ejection fraction: a substudy from the KaRen study. Eur Heart J Cardiovasc Imaging. 2015;17(1):106–13.

    PubMed  Google Scholar 

  5. Punjani S, Wu W-C, Cohen S, Sharma SC, Choudhary G. Echocardiographic indices of diastolic function relate to functional capacity and quality of life in ambulatory men with atrial fibrillation. J Am Soc Echocardiogr. 2011;24(5):533–40.e3.

    Article  PubMed  Google Scholar 

  6. Turakhia MP, Santangeli P, Winkelmayer WC, Xu X, Ullal AJ, Than CT, et al. Increased mortality associated with digoxin in contemporary patients with atrial fibrillation: findings from the TREAT-AF study. J Am Coll Cardiol. 2014;64(7):660–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sleeswijk ME, Van Noord T, Tulleken JE, Ligtenberg JJ, Girbes AR, Zijlstra JG. Clinical review: treatment of new-onset atrial fibrillation in medical intensive care patients: a clinical framework. Crit Care. 2007;11(6):233.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Brodsky MA, Allen BJ, Capparelli EV, Luckett CR, Morton R, Henry WL. Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatation. Am J Cardiol. 1989;63(15):1065–8.

    Article  CAS  PubMed  Google Scholar 

  9. Køber L, Torp-Pedersen C, McMurray JJ, Gøtzsche O, Lévy S, Crijns H, et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med. 2008;358(25):2678–87.

    Article  PubMed  Google Scholar 

  10. Chung R, Houghtaling PL, Tchou M, Niebauer MJ, Lindsay BD, Tchou PJ, et al. Left ventricular hypertrophy and antiarrhythmic drugs in atrial fibrillation: impact on mortality. Pacing Clin Electrophysiol. 2014;37(10):1338–48.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Manning WJ, Weintraub RM, Waksmonski CA, Haering JM, Rooney PS, Maslow AD, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi: a prospective, intraoperative study. Ann Intern Med. 1995;123(11):817–22.

    Article  CAS  PubMed  Google Scholar 

  12. Black IW, Hopkins AP, Lee LC, Walsh WF. Left atrial spontaneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol. 1991;18(2):398–404.

    Article  CAS  PubMed  Google Scholar 

  13. Goldman ME, Pearce LA, Hart RG, Zabalgoitia M, Asinger RW, Safford R, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation [SPAF-III] study). J Am Soc Echocardiogr. 1999;12(12):1080–7.

    Article  CAS  PubMed  Google Scholar 

  14. Celeste F, Muratori M, Mapelli M, Pepi M. The evolving role and use of echocardiography in the evaluation of cardiac source of embolism. J Cardiovasc Echogr. 2017;27(2):33.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ayirala S, Kumar S, O'Sullivan DM, Silverman DI. Echocardiographic predictors of left atrial appendage thrombus formation. J Am Soc Echocardiogr. 2011;24(5):499–505.

    Article  PubMed  Google Scholar 

  16. Ono K, Iwama M, Kawasaki M, Tanaka R, Watanabe T, Onishi N, et al. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation. Cardiovasc Ultrasound. 2012;10(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Breitkreutz R, Walcher F, Ilper H, Seeger FH, Price S, Via G, et al. Focused echocardiography in life support: the subcostal window. Eur J Trauma Emerg Surg. 2009;35(4):347–56.

    Article  PubMed  Google Scholar 

  18. Tsou P-Y, Kurbedin J, Chen Y-S, Chou EH, Lee M-tG, Lee MC-H, et al. Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis. Resuscitation. 2017;114:92–9.

    Article  PubMed  Google Scholar 

  19. Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010;23(12):1225–30.

    Article  PubMed  Google Scholar 

  20. Stub D, Bernard S, Duffy SJ, Kaye DM. Post cardiac arrest syndrome. Circulation. 2011;123(13):1428–35.

    Article  PubMed  Google Scholar 

  21. Cha K-C, Hwang SO, Kim HI, Kim OH, Cha YS, Kim H, et al. Echocardiographic patterns of post-cardiac arrest myocardial dysfunction. Resuscitation. 2018;124:90–5.

    Article  PubMed  Google Scholar 

  22. Mulpuru SK, Konecny T, Madhavan M, Kapa S, Noseworthy PA, McLeod CJ, et al. Atypical variants of right ventricular outflow arrhythmias. J Cardiovasc Electrophysiol. 2014;25(12):1321–7.

    PubMed  Google Scholar 

  23. Ouyang F, Fotuhi P, Ho SY, Hebe J, Volkmer M, Goya M, et al. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol. 2002;39(3):500–8.

    Article  PubMed  Google Scholar 

  24. Yamauchi Y, Aonuma K, Takahashi A, Sekiguchi Y, Hachiya H, Yokoyama Y, et al. Electrocardiographic characteristics of repetitive monomorphic right ventricular tachycardia originating near the His-bundle. J Cardiovasc Electrophysiol. 2005;16(10):1041–8.

    Article  PubMed  Google Scholar 

  25. Chun KR, Satomi K, Kuck KH, Ouyang F, Antz M. Left ventricular outflow tract tachycardia including ventricular tachycardia from the aortic cusps and epicardial ventricular tachycardia. Herz. 2007;32(3):226–32.

    Article  PubMed  Google Scholar 

  26. Padmanabhan D, Sugrue A, Gaba P, Asirvatham SJ. Outflow tract ventricular arrhythmias. Herzschrittmacherther Elektrophysiol. 2017;28(2):177–86.

    Article  PubMed  Google Scholar 

  27. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J. 2010;31(7):806–14.

    Article  PubMed  PubMed Central  Google Scholar 

  28. te Riele ASJM, Tandri H, Sanborn DM, Bluemke DA. Noninvasive Multimodality Imaging in ARVD/C. J Am Coll Cardiol Img. 2015;8(5):597–611.

    Article  Google Scholar 

  29. Mehta D, Lubitz SA, Frankel Z, Wisnivesky JP, Einstein AJ, Goldman M, et al. Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing. Chest. 2008;133(6):1426–35.

    Article  PubMed  Google Scholar 

  30. Ayyala US, Nair AP, Padilla ML. Cardiac sarcoidosis. Clin Chest Med. 2008;29(3):493–508, ix.

    Article  PubMed  Google Scholar 

  31. Sadek MM, Benhayon D, Sureddi R, Chik W, Santangeli P, Supple GE, et al. Idiopathic ventricular arrhythmias originating from the moderator band: electrocardiographic characteristics and treatment by catheter ablation. Heart Rhythm. 2015;12(1):67–75.

    Article  PubMed  Google Scholar 

  32. Rösner A, Avenarius D, Malm S, Iqbal A, Bijnens B, Schirmer H. Severe regional myocardial dysfunction by stress echocardiography does not predict the presence of transmural scarring in chronic coronary artery disease. Eur Heart J Cardiovasc Imaging. 2015;16(10):1074–81.

    Article  PubMed  Google Scholar 

  33. Aarsæther E, Rösner A, Straumbotn E, Busund R. Peak longitudinal strain most accurately reflects myocardial segmental viability following acute myocardial infarction—an experimental study in open-chest pigs. Cardiovasc Ultrasound. 2012;10(1):23.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wolfe CL, Nibley C, Bhandari A, Chatterjee K, Scheinman M. Polymorphous ventricular tachycardia associated with acute myocardial infarction. Circulation. 1991;84(4):1543–51.

    Article  CAS  PubMed  Google Scholar 

  35. Sabia P, Afrookteh A, Touchstone DA, Keller MW, Esquivel L, Kaul S. Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography. Circulation. 1991;84(3 Suppl):I85–92.

    PubMed  CAS  Google Scholar 

  36. Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, et al. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant. 2013;32(2):141–56.

    Article  PubMed  Google Scholar 

  37. Rosenbaum AN, Kremers WK, Duval S, Sakaguchi S, John R, Eckman PM. Arrhythmias in patients with cardiac implantable electrical devices after implantation of a left ventricular assist device. ASAIO J. 2016;62(3):274–80.

    Article  PubMed  Google Scholar 

  38. Vollkron M, Voitl P, Ta J, Wieselthaler G, Schima H. Suction events during left ventricular support and ventricular arrhythmias. J Heart Lung Transplant. 2007;26(8):819–25.

    Article  PubMed  Google Scholar 

  39. Andersen M, Videbæk R, Boesgaard S, Sander K, Hansen PB, Gustafsson F. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). J Heart Lung Transplant. 2009;28(7):733–5.

    Article  PubMed  Google Scholar 

  40. Reesink K, Dekker A, Van der Nagel T, Beghi C, Leonardi F, Botti P, et al. Suction due to left ventricular assist: implications for device control and management. Artif Organs. 2007;31(7):542–9.

    Article  PubMed  Google Scholar 

  41. Estep JD, Stainback RF, Little SH, Torre G, Zoghbi WA. The role of echocardiography and other imaging modalities in patients with left ventricular assist devices. J Am Coll Cardiol Cardiovasc Imaging. 2010;3(10):1049–64.

    Article  Google Scholar 

  42. Stainback RF, Estep JD, Agler DA, Birks EJ, Bremer M, Hung J, et al. Echocardiography in the management of patients with left ventricular assist devices: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2015;28(8):853–909.

    Article  PubMed  Google Scholar 

  43. Sacher F, Reichlin T, Zado ES, Field ME, Viles-Gonzalez JF, Peichl P, et al. Characteristics of ventricular tachycardia ablation in patients with continuous flow left ventricular assist devices. Circ Arrhythm Electrophysiol. 2015;8(3):592–7.

    Article  PubMed  Google Scholar 

  44. Moss JD, Flatley EE, Beaser AD, Shin JH, Nayak HM, Upadhyay GA, et al. Characterization of ventricular tachycardia after left ventricular assist device implantation as destination therapy: a single-center ablation experience. JACC Clin Electrophysiol. 2017;3(12):1412–24.

    Article  PubMed  Google Scholar 

  45. Pedretti S, Cipriani M, Bonacina E, Vargiu S, Ad VG, Frigerio M, et al. Refractory ventricular tachycardia caused by inflow cannula mechanical injury in a patient with left ventricular assist device: catheter ablation and pathological findings. J Arrhythmia. 2017;33(5):494–6.

    Article  Google Scholar 

  46. Ng PK, Ault MJ, Ellrodt AG, Maldonado L. Peripherally inserted central catheters in general medicine. Mayo Clin Proc. 1997;72(3):225–33.

    Article  CAS  PubMed  Google Scholar 

  47. Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol. 2003;14(5):527–34.

    Article  PubMed  Google Scholar 

  48. Toh N, Nishii N, Nakamura K, Tada T, Oe H, Nagase S, et al. Cardiac dysfunction and prolonged hemodynamic deterioration after implantable cardioverter-defibrillator shock in patients with systolic heart failure. Circ Arrhythm Electrophysiol. 2012;5(5):898–905.

    Article  CAS  PubMed  Google Scholar 

  49. Malawista M. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med. 1980;93(Part 1):8–16.

    PubMed  Google Scholar 

  50. Sapp JL, Wells GA, Parkash R, Stevenson WG, Blier L, Sarrazin JF, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375(2):111–21.

    Article  CAS  PubMed  Google Scholar 

  51. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(1):32–8.

    Article  PubMed  Google Scholar 

  52. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2009;53(19):1798–803.

    Article  PubMed  Google Scholar 

  53. Pedersen ME, Leo M, Kalla M, Malhotra A, Stone M, Wong K, et al. Management of tamponade complicating catheter ablation for atrial fibrillation: early removal of pericardial drains is safe and effective and reduces analgesic requirements and hospital stay compared to conventional delayed removal. JACC Clin Electrophysiol. 2017;3(4):367–73.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA

    Alan Sugrue, Subir Bhatia, Vaibhav Vaidya & Sam Asirvatham

  2. Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

    Sam Asirvatham

Authors
  1. Alan Sugrue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Subir Bhatia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vaibhav Vaidya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sam Asirvatham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sam Asirvatham .

Editor information

Editors and Affiliations

  1. Mount Sinai St Luke’s Hospital, New York, New York, USA

    Eyal Herzog

  2. Mount Sinai St Luke’s Hospital, New York, New York, USA

    Edgar Argulian

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sugrue, A., Bhatia, S., Vaidya, V., Asirvatham, S. (2018). The Arrhythmia Patient in the CCU – Impact of Echocardiography. In: Herzog, E., Argulian, E. (eds) Echocardiography in the CCU. Springer, Cham. https://doi.org/10.1007/978-3-319-90278-4_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90278-4_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90277-7

  • Online ISBN: 978-3-319-90278-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation