Part of the Current Clinical Practice book series (CCP)


The physiological impact of an arrhythmia depends on ventricular response rate, duration of arrhythmia, and underlying cardiac function. Bradyarrhythmias may decrease cardiac output owing to heart rate alone in patients with a relatively fixed stroke volume. Loss of atrial contraction may cause a dramatic increase in pulmonary artery pressures in patients with hypertension and diastolic dysfunction. Similarly, tachyarrhythmias can decrease diastolic filling time and reduce cardiac output, resulting in hypotension and possible myocardial ischemia. The impact of a given arrhythmia depends on the patient’s cardiac physiology and function. Treatment is determined by the hemodynamic insult. In this chapter, a systematic approach to diagnosis and evaluation of predisposing factors is presented, followed by consideration of specific arrhythmias.


Atrial Fibrillation Ventricular Tachycardia Catheter Ablation Structural Heart Disease Accessory Pathway 
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.
    Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med 337:1576–1583, 1997.CrossRefGoogle Scholar
  2. 2.
    Antzelevitch C, Brugada P, Borggrefe M, et al. Brugada syndrome: report of the second consensus conference. Heart Rhythm 2:429–440, 2005.PubMedCrossRefGoogle Scholar
  3. 3.
    Atlee JL. Perioperative cardiac dysrhythmias: diagnosis and management. Anesthesiology 86:1397–1424, 1997.PubMedCrossRefGoogle Scholar
  4. 4.
    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 154:1449–1457, 1994.CrossRefGoogle Scholar
  5. 5.
    Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237, 2005.PubMedCrossRefGoogle Scholar
  6. 6.
    Bauernfeind RA, Amat YLF, Dhingra RC, Kehoe R, Wyndham C, Rosen KM. Chronic nonparoxysmal sinus tachycardia in otherwise healthy persons. Ann Intern Med 91:702–710, 1979.PubMedGoogle Scholar
  7. 7.
    Belhassen B, Glick A, Viskin S. Efficacy of quinidine in high-risk patients with Brugada syndrome. Circulation 110:1731–1737, 2004.PubMedCrossRefGoogle Scholar
  8. 8.
    Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation 108:1871–1909, 2003.PubMedCrossRefGoogle Scholar
  9. 9.
    Brugada P, Brugada J, Mont L, Smeets J, Andries EW. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation 83:1649–1659, 1991.PubMedGoogle Scholar
  10. 10.
    Campbell RW, Smith RA, Gallagher JJ, Pritchett EL, Wallace AG. Atrial fibrillation in the preexcitation syndrome. Am J Cardiol 40:514–520, 1977.PubMedCrossRefGoogle Scholar
  11. 11.
    Cardiac Arrhythmia Suppression Trial II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med 327:227–233, 1992.CrossRefGoogle Scholar
  12. 12.
    Carlsson J, Miketic S, Windeler J, et al. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol 41:1690–1696, 2003.PubMedCrossRefGoogle Scholar
  13. 13.
    Chen Q, Kirsch GE, Zhang D, et al. Genetic basis and molecular mechanism for idiopathic ventricular fibrillation. Nature 392:293–296, 1998.PubMedCrossRefGoogle Scholar
  14. 14.
    Chen SA, Tai CT, Yu WC, et al. Right atrial focal atrial fibrillation: electrophysiologic characteristics and radiofrequency catheter ablation. J Cardiovasc Electrophysiol 10:328–335, 1999.PubMedCrossRefGoogle Scholar
  15. 15.
    Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med 324:781–788, 1991.PubMedCrossRefGoogle Scholar
  16. 16.
    Fuster V, Ryden LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): developed in Collaboration With the North American Society of Pacing and Electrophysiology. J Am Coll Cardiol 38:1231–1266, 2001.PubMedCrossRefGoogle Scholar
  17. 17.
    Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. Jama 285:2864–2870, 2001.PubMedCrossRefGoogle Scholar
  18. 18.
    Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. Jama 285:2370–2375, 2001.PubMedCrossRefGoogle Scholar
  19. 19.
    Goldschlager N, Epstein AE, Naccarelli G, Olshansky B, Singh B. Practical guidelines for clinicians who treat patients with amiodarone. Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology. Arch Intern Med 160:1741–1748, 2000.PubMedCrossRefGoogle Scholar
  20. 20.
    Greenberg H, Case RB, Moss AJ, Brown MW, Carroll ER, Andrews ML. Analysis of mortality events in the Multicenter Automatic Defibrillator Implantation Trial (MADIT-II). J Am Coll Cardiol 43:1459–1465, 2004.PubMedCrossRefGoogle Scholar
  21. 21.
    Gregoratos G, Cheitlin MD, Conill A, et al. ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary—a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). Circulation 97:1325–1335, 1998.PubMedGoogle Scholar
  22. 22.
    Grogin HR, Scheinman M. Evaluation and management of patients with polymorphic ventricular tachycardia. Cardiol Clin 11:39–54, 1993.PubMedGoogle Scholar
  23. 23.
    Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666, 1998.PubMedCrossRefGoogle Scholar
  24. 24.
    Hart RG, Pearce LA, McBride R, Rothbart RM, Asinger RW. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I–III clinical trials. The Stroke Prevention in Atrial Fibrillation (SPAF) Investigators. Stroke 30:1223–1229, 1999.PubMedGoogle Scholar
  25. 25.
    Hindman MC, Wagner GS, Jaro M, et al. The clinical significance of bundle branch block complicating acute myocardial infarction. Indications for temporary and permanent pacemaker insertion. Circulation 58:689–699, 1978.PubMedGoogle Scholar
  26. 26.
    Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 351:2481–2488, 2004.PubMedCrossRefGoogle Scholar
  27. 27.
    Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation—Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 356:1789–1794, 2000.PubMedCrossRefGoogle Scholar
  28. 28.
    Jackman WM, Wang XZ, Friday KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 324:1605–1611, 1991.PubMedCrossRefGoogle Scholar
  29. 29.
    Jais P, Haissaguerre M, Shah DC, et al. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 95:572–576, 1997.PubMedGoogle Scholar
  30. 30.
    Jalife J. Experimental and clinical AF mechanisms: bridging the divide. J Interv Card Electrophysiol 9:85–92, 2003.PubMedCrossRefGoogle Scholar
  31. 31.
    Kastor J. Arrhythmias. Philadelphia: WB Saunders, 1994.Google Scholar
  32. 32.
    Lee KL, Chun HM, Liem LB, Sung RJ. Effect of adenosine and verapamil in catecholamine-induced accelerated atrioventricular junctional rhythm: insights into the underlying mechanism. Pacing Clin Electrophysiol 22:866–870, 1999.PubMedCrossRefGoogle Scholar
  33. 33.
    Levine JH, Michael JR, Guarnieri T. Treatment of multifocal atrial tachycardia with verapamil. N Engl J Med 312:21–25, 1985.PubMedCrossRefGoogle Scholar
  34. 34.
    Manning W, J., Silverman DI, Gordon SPF, Krumholz HM, Douglas PS. Conversion from atrial fibrillation without prolonged anticoagulation with use of transesophageal echocardiography to exclude the presence of atrial thrombi. N Engl J Med 328:750–755, 1993.PubMedCrossRefGoogle Scholar
  35. 35.
    Marriott HJL. Practical Electrocardiography. Baltimore: Williams & Wilkins, 1988.Google Scholar
  36. 36.
    Mazgalev TN, Tchou PJ. Surface potentials from the region of the atrioventricular node and their relation to dual pathway electrophysiology. Circulation 101:2110–2117, 2000.PubMedGoogle Scholar
  37. 37.
    McCord J, Borzak S. Multifocal atrial tachycardia. Chest 113:203–209, 1998.PubMedGoogle Scholar
  38. 38.
    Moss AJ, Hall WJ, Cannom DS, et al., and Investigators MADIT. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 335:1933–1940, 1996.PubMedCrossRefGoogle Scholar
  39. 39.
    Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883, 2002.PubMedCrossRefGoogle Scholar
  40. 40.
    Myerburg RJ, Mitrani R, Interian A, Jr, Castellanos A. Interpretation of outcomes of antiarrhythmic clinical trials: design features and population impact. Circulation 97:1514–1521, 1998.PubMedGoogle Scholar
  41. 41.
    Napolitano C, Priori SG, Schwartz PJ. Torsade de pointes. Mechanisms and management. Drugs 47:51–65, 1994.PubMedCrossRefGoogle Scholar
  42. 42.
    Priori SG, Aliot E, Blomstrom-Lundqvist C, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 22:1374–1450, 2001.PubMedCrossRefGoogle Scholar
  43. 43.
    Rathore SS, Berger AK, Weinfurt KP, et al. Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 101:969–974, 2000.PubMedGoogle Scholar
  44. 44.
    Roden DM. Torsade de pointes. Clin Cardiol 16:683–686, 1993.PubMedGoogle Scholar
  45. 45.
    Scheinman MM, Huang S. The 1998 NASPE prospective catheter ablation registry. Pacing Clin Electrophysiol 23:1020–1028, 2000.PubMedCrossRefGoogle Scholar
  46. 46.
    Snow V, Weiss KB, LeFevre M, et al. Management of newly detected atrial fibrillation: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med 139:1009–1017, 2003.PubMedGoogle Scholar
  47. 47.
    Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347:1834–1840, 2002.PubMedCrossRefGoogle Scholar
  48. 48.
    Wang L, Yao R. Radiofrequency catheter ablation of accessory pathway-mediated tachycardia is a safe and effective long-term therapy. Arch Med Res 34:394–398, 2003.PubMedCrossRefGoogle Scholar
  49. 49.
    Wilde AA, Antzelevitch C, Borggrefe M, et al. Proposed diagnostic criteria for the Brugada syndrome. Eur Heart J 23:1648–1654, 2002.PubMedGoogle Scholar
  50. 50.
    Wolf PA, Dawber TR, Thomas HE, Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 28:973–977, 1978.PubMedGoogle Scholar
  51. 51.
    Wood MA, Brown-Mahoney C, Kay GN, Ellenbogen KA. Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis. Circulation 101:1138–1144, 2000.PubMedGoogle Scholar
  52. 52.
    Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347:1825–1833, 2002.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2006

Personalised recommendations