Paul Schweitzer

Timing of thromboembolic events after electical cardioversion of atrial fibrillation or flutter: a retrospective analysis

Pooled data from 32 studies were reviewed to assess the timing of thrombolic complications after cardioversion of atrial fibrillation or flutter. We found that 98% of embolic episodes occurred within 10 days of cardioversion.

Ventricular arrhythmias in patients treated with methadone for opioid dependence

PurposeOver the last decade, there has been a significant rise in reported cases of methadone induced QT prolongation (QTP) and Torsades de Pointes (TdP) in patients treated for opioid dependence. Optimal management of these patients is challenging.MethodsWe report a case series of 12 consecutive patients admitted to our institution with methadone-induced QTP and ventricular arrhythmias.ResultsAll patients survived the presenting arrhythmia. Successful transition to buprenorphine was accomplished in three patients. QT interval normalized and none of these patients had recurrent arrhythmias. Methadone dose was reduced in five patients with improvement of QT interval and resolution of arrhythmia. Four patients, including two with ICDs, refused or did not tolerate a reduction in their methadone dose.ConclusionVentricular arrhythmias in patients on methadone are an uncommon but important problem. Buprenorphine, a partial µ-opiate–receptor agonist and a κ-opiate–receptor antagonist does not cause QTP or TdP. Buprenorphine is a useful and effective alternative to methadone in a select group of patients, including those with documented ventricular arrhythmias on methadone. Pacemakers or defibrillators should be reserved for patients who have failed buprenorphine or a reduced methadone dose.

Complete atrioventricular block with ventricular asystole following infusion of intravenous phenytoin.

A case of complete atrioventricular block with ventricular asystole in a patient receiving intravenous phenytoin is presented. Although the potential for hypotension is generally recognized with the intravenous administration of phenytoin, conduction abnormalities are rarely reported. The differential diagnosis of atrioventricular block and the effects of phenytoin on cardiac conduction are discussed.

Obstructive sleep apnea-induced supraventricular tachycardia.

Obstructive sleep apnea has been associated with various cardiac arrhythmias; however, supraventricular tachycardia has not been reported to occur in this disorder. This case report describes a patient who developed episodes of supraventricular tachycardia during periods of apnea and oxygen desaturation. With the initiation of nasal continuous positive airway pressure during sleep, the arrhythmia was abolished. The etiology and possible mechanisms responsible for the supraventricular tachycardia are discussed.

Prognostic impact of terminal T wave inversions on presentation in patients with ST-Elevation myocardial infarction undergoing urgent percutaneous coronary intervention

INTRODUCTION Terminal T wave inversions (TTWI) indicate advanced stages of ST-elevation myocardial infarction (STEMI). The present study investigated whether TTWI predict unfavorable in-hospital outcomes in STEMI patients treated with urgent percutaneous coronary intervention (PCI). METHODS A retrospective cohort study was performed with consecutive 188 STEMI cases undergoing urgent PCI. The primary endpoint was in-hospital major adverse cardiac event (MACE), and the secondary endpoints were ST resolution (STR) after PCI and length of stay (LOS). RESULTS TTWI on presentation were independently associated with higher incidence of in-hospital MACE (adjusted OR 2.8; 95% CI 1.1-7.0; p=0.03), inadequate STR (adjusted OR 5.5; 95% CI 2.1-14.3; p=0.01), and longer LOS (adjusted mean increase 4.1 days; 95% CI 0.3-7.9; p=0.03). TTWI predicted these outcomes better than patient-reported ischemic time or pathologic Q waves. CONCLUSIONS TTWI on presentation are an independent risk factor for poor inpatient prognosis among patients presenting with STEMI undergoing urgent PCI.

The initial (earliest) report of polymorphous ventricular tachycardia

In these short historical notes, we describe the early history of polymorphic ventricular tachycardia. Polymorphous ventricular tachycardia was probably first noted in 1918 by Wilson and Robinson. In a publication describing complete heart block and ventriculophasic arrhythmia, they noted a tachyarrhythmia characterized by multiple extrasystoles of different types at a rapid rate. Also, we briefly discuss the earliest recognized torsades de pointes by Dessertenes in 1966 and the first description of catecholaminergic polymorphic ventricular tachycardia, by Reid in 1977.

Wide QRS tachycardia: what is the rhythm?

We report a case of an elderly man who presented to the emergency room complaining of palpitations. Electrocardiogram revealed wide QRS tachycardia with a narrow beat within the tachycardia. Most commonly, a narrow complex beat during a wide complex tachycardia suggests a capture or fusion beat in the setting of ventricular tachycardia. However, there are situations where supraventricular tachycardia can also manifest this way. In our patient a pacemaker interrogation clarified the diagnosis.