Admission blood pressure was 160/110 mmHg, his potassium level was 3,4 mmol/l, his physical examination and echocardiogram normal. Within 30 minutes, an ECG was recorded (fig. The palpitations started precisely when the ice was passing through his oesophagus. The arrhythmia was triggered after having accidentaly swallowed an ice cube while drinking the last glass of Coke. He was exhausted after overnight work - he had not slept in the last 36 hours and had consumed 7 cups of coffee and 4 glasses of Coka-Cola during this period. The 53-year old normotensive male patient with no previous history of cardiac disease and a normal recent coronary CT scan was admitted for sudden onset of palpitations. Case descriptionĪs an introduction, I describe an example, of how atrial tachycardia (clearly triggered by external factors) was falsely diagnosed as flutter. However, only rarely do the doctors actually analyse the circumstances which have brought on the arrhythmia.Īvoiding these triggering circumstances might help in preventing future attacks.įurthermore, certain patients are referred for radiofrequency ablation (which is an effective treatment of "classical" atrial flutter), when in fact their true diagnosis is left atrial focal tachycardia - where radiofrequency ablation is substantially more difficult and provides only questionable long-term benefit. It is treated in daily practice mostly with DC cardioversion and subsequent antiarrhythmic drug use. 2013 369(22):2093–104.Atrial flutter seems to be an easy electrocardiographic (ECG) diagnosis, which can be done by a medical student. Edoxaban versus warfarin in patients with atrial fibrillation. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Apixaban versus warfarin in patients with atrial fibrillation. Granger CB, Alexander JH, McMurray JJV, Lopes RD, Hylek EM, Hanna M, et al. Dabigatran versus warfarin in patients with atrial fibrillation. 2014 37(6):381–5.Ĭonnolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Predictors of long-term maintenance of normal sinus rhythm after successful electrical cardioversion. Early or delayed cardioversion in recent-onset atrial fibrillation. Pluymaekers NAHA, Dudink EAMP, Luermans JGLM, Meeder JG, Lenderink T, Widdershoven J, et al. Lenient versus strict rate control in patients with atrial fibrillation. Van Gelder IC, Groenveld HF, Crijns HJGM, Tuininga YS, Tijssen JGP, Alings AM, et al. ![]() A comparison of rate control and rhythm control in patients with atrial fibrillation. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, et al. An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI). Gibson CM, Mehran R, Bode C, Halperin J, Verheugt F, Wildgoose P, et al. Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant. 2008 118(20):2029–37.ĭouketis JD, Spyropoulos AC, Duncan J, Carrier M, Le Gal G, Tafur AJ, et al. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. 2019 140(2):e125–51.Ĭonnolly SJ, Pogue J, Eikelboom J, Flaker G, Commerford P, Franzosi MG, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. 2012 33(12):1500–10.ĪCTIVE Investigators, Connolly SJ, Pogue J, Hart RG, Hohnloser SH, Pfeffer M, et al. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish atrial fibrillation cohort study. ![]() ![]() ![]() Practical clinical electrophysiology: Lippincott Williams & Wilkins Philadelphia, PA.
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