POPULARITY
13 episodes with Cardioversion
2 episodes with Cardioversion
2 episodes with Cardioversion
2 episodes with Cardioversion
2 episodes with Cardioversion
2 episodes with Cardioversion
2 episodes with Cardioversion
3 episodes with Cardioversion
2 episodes with Cardioversion
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock.Advantages & use of Biphasic defibrillators.For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.Team safety when performing synchronized cardioversion.Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Safe Meds VIP - Learn about medication safety and download a free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.Defibrillators can be broken down into three basic categories: 1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators.For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!
Unlock the secrets of preventing pediatric perioperative medication errors with insights from our esteemed guests, Eva Lu-Boettcher and Rahul Koka. Pediatric patients face unique challenges due to variations in body weight and dosing calculations, making them particularly vulnerable to medication errors. Join us as we explore the discrepancies between self-reported and observed error rates and gain a deeper understanding of the workflow vulnerabilities anesthesia professionals encounter. We also share findings from the Wake Up Safe Collaborative, revealing the administration phase as the most error-prone and illustrating how preventative and mitigative barriers can effectively manage risks through a bowtie analysis.Our commitment to enhancing patient safety doesn't end there. Discover the APSF Technology Education Initiatives, designed to equip anesthesia professionals with vital knowledge for safe practice. We highlight the Quantitative Neuromuscular Monitoring course, aligned with the ASA 2023 Practice Guidelines, as well as the importance of staying informed through courses on Low Flow Anesthesia and the upcoming Manual External Defibrillation, Cardioversion, and Pacing course. Our mission is to ensure that no one is harmed by anesthesia care, and this episode provides essential education and insights that every professional should incorporate into their practice.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/237-preventing-pediatric-medication-errors/© 2025, The Anesthesia Patient Safety Foundation
We take our lunch hour to hang out and chat with all our friends about what is going on in the world and the CrossFit Space.
[Ep34] You're listening to Episode 7 of 30 ... for National Podcast Post Month! Aka - NaPodPoMo. This episode's featured topic is how to be more precise in our language when deciding to defibrillate or synchronize cardiovert a patient. About National Podcast Post MonthThe event gives everyone in the podcast community a chance to challenge their skills by posting an episode every day for the entire month of November! So that's what High-Fidelity Conversations will be doing. In order to keep my sanity, the episodes will be shorter (a few minutes), and the topics will be all over the place (still healthcare-themed). Each of the episodes associated with this event will be marked with "NaPodPoMo" somewhere in the title, so you know when all this chaos starts and ends. I hope you enjoy this adventure for November! We'll be back to our normal, monthly pattern for December.Do you have ideas for future guests or topics on this podcast? Maybe you have some thoughts on how to improve the show? If that sounds like you, take a moment to answer the 3 questions on our anonymous feedback survey!Podcast artwork was made with the awesome resources from CanvaMusic and Sound FX for the show obtained from Pixabay and Pond5Email the show at hfconversations@gmail.comClosed Captioning Resources:Podnews article (for Apple/Android phones and Google Chrome browsers)Microsoft Windows article (live captions for Windows users)Apple article (live captions for Mac users)Disclaimer:The thoughts and opinions expressed in this podcast belong solely to those saying them, and do NOT represent the positions, strategies or opinions of Trinity Health, or Mount Carmel Health System. This podcast is intended for educational and entertainment purposes only. Nothing in this podcast establishes a patient care relationship with you, the listener. The host(s) and guests of this show are NOT your healthcare provider and if you need medical attention, seek an appropriate and qualified professional.
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: 1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: 1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators. Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!
Some Cochrane Reviews include network meta-analyses to bring together a range of comparisons to help identify the relative effects of different interventions and to rank them based on effectiveness. In June 2024, we published one of these, examining cardioversion for atrial arrhythmias. In this podcast, one of the authors Rui Providencia (left) interviews the first author, Kishore Kukendra‐Rajah (right) both from Barts Health NHS Trust in London in the UK.
Some Cochrane Reviews include network meta-analyses to bring together a range of comparisons to help identify the relative effects of different interventions and to rank them based on effectiveness. In June 2024, we published one of these, examining cardioversion for atrial arrhythmias. In this podcast, one of the authors Rui Providencia (left) interviews the first author, Kishore Kukendra‐Rajah (right) both from Barts Health NHS Trust in London in the UK.
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock.Advantages & use of Biphasic defibrillators. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!
AFR Case Studies V - Tac Cardioversion by Albuquerque Fire Rescue
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: Automated External Defibrillator (AED);Biphasic defibrillators; andMonophasic defibrillators.Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators.For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: 1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators. Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine. Use of an AED to rapidly deliver a shock. Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.Use of an AED to rapidly deliver a shock. Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.Use of an AED to rapidly deliver a shock.Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient.Biphasic defibrillator use and energy setting.For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion.Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine. Use of an AED to rapidly deliver a shock.Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting.For older, monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion.Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.Use of an AED to rapidly deliver a shock.Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient.Biphasic defibrillator use and energy setting.For older, monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.Team safety when performing synchronized cardioversion.Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGood luck with your ACLS class!
This patient was so backed up, his abdomen looked like he was 9 months pregnant! It was so bad that he was tachycardic and hypotensive. In this episode we talk about common post-surgical complications from constipation, to an ileus, to a small bowel obstruction. We break down diagnostics, pharmacological interventions, and surgical options.Ever given neostigmine? Then you are gonna want to hear this episode.Ever heard of Ogilvie's syndrome... if you care for post-surgical patients this is another one you want to be familiar with.Do you want to listen to an entire episode about poop... than you will love this episode!It's amazing how inability to poop can cause such severe and even life threatening complications!
Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: Automated External Defibrillator (AED); Biphasic defibrillators; and Monophasic defibrillators. Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine. Use of an AED to rapidly deliver a shock. Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting. For older, monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Remembering the different suggested energy settings for cardioversion and defibrillation when using different models or types of defibrillators has been made easier with biphasic & AED technology. AEDs are preprogrammed with a set energy setting to maximize the effectiveness of defibrillation. Biphasic defibrillators measure the impedance between the pads and will calculate the suggested energy for us. For monophasic defibrillators, set the energy at 360j and leave it. Cardioversion is similar when using a biphasic defibrillator; the machine does the calculation. Energy setting for narrow and wide complex tachycardias with a pulse using a monophasic defibrillator. AEDs should not be used on patients with a pulse! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Wondering if you should get that X-ray on your pregnant lady who is suffering from hip pain whilst doing Tai Chi, which is associated with inpatient hypertensive spikes that might (just might) be related to your bad singing?No?Well, your ears are still in the right place.Today you have Jon, Barney and Alvin delving into the latest and greatest of medical literature!We cover:Steroid injections for OA - sure?Radiology in pregnancy - risky?Pregnancy HTN - treat?IP Hypertensive episodes - leave?Radiofrequency denervation for HTN - maybe not when on call?Aspirin cessation and use in primary prevention - stop?Music for mental and physical health - sing!Tai chi or Muscle strengthening - do!Nasal Swab or rectal exam for cardioversion?! Hmmmm.....As always:Subscribe / rate on Spotify / Apple.Follow us on Twitter / Instagram. Send us FEEDBACK JournalSpotting@gmail.com. Share with your pals/colleagues/random groups on WhatsApp.
Remembering the different suggested energy settings for cardioversion and defibrillation when using different models or types of defibrillators has been made easier with biphasic & AED technology. AEDs are preprogrammed with a set energy setting to maximize the effectiveness of defibrillation. Biphasic defibrillators measure the impedance between the pads and will calculate the suggested energy for us. For monophasic defibrillators, set the energy at 360j and leave it. Cardioversion is similar when using a biphasic defibrillator; the machine does the calculation. Energy setting for narrow and wide complex tachycardias with a pulse using a monophasic defibrillator. AEDs should not be used on patients with a pulse! Connect with me: Website: https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!
Do y'all treat a-fib? Have you wondered what the best method of rate control is? Should you use diltiazem or metoprolol? How about the best pad placement for electrical Cardioversion? Should you go anterior posterior or anterior lateral? Great questions! Dr. Jarvis reviews two recent papers to help shed the bright light of science on these two questions. See omnystudio.com/listener for privacy information.
Supraventricular tachycardia can present very stable, but this patient rapidly declined. In this episode we explain what exactly is happening with SVT, and go through all the different treatment modalities from vagal maneuvers, to medications, to synchronized cardioversion.
The findings of RAFF2 trial
Unstable patients with tachyarrhythmias may need urgent cardioversion in the emergency department. Dr Eleni Salakidou is a specialist in emergency medicine at the University General Hospital of Heraklion, and she joins Todd on the podcast to share her tips for safe and successful cardioversion. See omnystudio.com/listener for privacy information.
Show notes available at podcast.rnrrounds.ca
In this podcast, Jeffrey Tabas, MD, discusses the pros and cons of cardioversion in the emergency department, which he also talked about during his session at the American College of Emergency Physicians 2021. More at: www.consultant360.com
Enjoy this Curbsiders classic and stay tuned this Wednesday, July 9, 2021 for a brand new Afib Triple Distilled episode. Take control of atrial fibrillation with expert insights and pearls from cardiologist, Dr. James Furgerson, in this jam-packed episode! You'll learn why atrial fibrillation is such a big deal, how to diagnose it, how to treat it and when to call in for reinforcements. Dr. James Furgerson, MD is a cardiologist from San Antonio, Texas with over 20 years in academics. Buckle up – This episode is going to send your heart racing! You might even skip a beat! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Writer and Producer: Cyrus Askin MD Infographic: Cyrus Askin MD Cover Art: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Cyrus Askin MD Editors: Matthew Watto MD Guest: James Furgerson MD Sponsor: American College of Physicians acponline.org/100curb ACP CME 100 virtual video package includes 100 hours of practice-changing updates by expert faculty from Internal Medicine Meeting 2021 acponline.org/100CURB. Plus enjoy an exclusive: 25 bonus CME sessions and access until June 1, 2024! Sponsor: Panacea Financial panaceafinancial.com Visit panaceafinancial.com today to open your account and join a bank built with you in mind. Time Stamps* *Note: Time stamps refer to ad-free version 00:00 Intro, disclaimer and guest bio 03:45 Guest one liner, a bit on physician well-being and some other randomness 08:15 A case of palpitations; risk factors for atrial fibrillation 12:17 Subclinical atrial fibrillation, overdiagnosis of atrial fibrillation; How much afib burden matters? 15:08 Case summary and next steps in initial work up 18:48 Counseling patient about atrial fibrillation and its consequences 21:40 Ischemic heart disease and atrial fibrillation 24:17 Recap of diagnosis, initial work up and risk stratification in atrial fibrillation 25:25 Rate versus rhythm control; AFFIRM trial 30:50 Strict versus lenient rate control; RACE trial 33:30 Deciding on rate versus rhythm control; Downside of antiarrhythmic therapies; When to switch from rate to rhythm control strategy 36:52 Ablation for atrial fibrillation; CASTLE-AF, CABANA trials 40:40 When to refer to cardiology and electrophysiology 42:42 Choice of agent for anticoagulation and latest guidelines for atrial fibrillation; New definition for valvular atrial fibrillation 45:22 DOACs in CKD and some other nuances in choice of agent 52:27 Bleeding and anticoagulation 58:38 Cardioversion for atrial fibrillation (initial versus delayed) 63:32 Anticoagulation before and after cardioversion 67:48 Lifestyles measures for atrial fibrillation 70:45 Atrial fibrillation during critical illness, after CABG and in hyperthyroidism 74:12 Aspirin monotherapy is not appropriate for atrial fibrillation 76:42 Take home points 78:50 Outro
What is congenitally corrected transposition of the great arteries or ccTGA? Historically, people born with ccTGA tended to do fairly well. Why is it today doctors are choosing to operate on the hearts of babies born with ccTGA? What does Dr. Edward Bove think about the future of babies born with ccTGA?Erin Beckemeier is mom to Conway, born in 2007 with ccTGA, a large ventricular septal defect or VSD, and sub-pulmonic stenosis. He was later diagnosed with an Ebsteinoid tricuspid valve. At six months of age, he had an arterial switch with a Senning (a double switch), VSD closure, and resection of the stenosis. Conway's recovery from these procedures was rocky, as he suffered a seizure and complete heart block, requiring a dual-chambered pacemaker. By two years of age, he was struggling with atrial flutter and underwent a mitral annuloplasty and ablation/Maze procedure. At five years, his RV-PA conduit was replaced and he was upgraded to a bi-ventricular or CRT pacing system. At 11 years old he needed a new atrial lead and generator replacement. The new atrial lead became infected and was removed the following month. At age 14 he received 2 new leads and his 4th pacemaker. Due to a significant growth spurt, his mitral valve, RV-PA homograft, and left ventricular function are being closely monitored. Erin lives with her husband Greg and their five children. She is a fourth-grade teacher and she is here today to share her story with Anna.Dr. Edward Bove is a cardiac surgeon at C.S. Mott Children's Hospital and chair of the Department of Cardiac Surgery at the University of Michigan Health System is an internationally acclaimed, board-certified pediatric cardiac and thoracic surgeon and the chair of the Hearts Unite the Globe Medical Advisory Board! Earlier this year, Dr. Bove was awarded the 2021 Earl Bakken Scientific Achievement Award by The Society of Thoracic Surgeons during the organization's virtual 57th Annual Meeting.My long-time Listeners will remember Dr. Edward Bove from Season 9. His show was entitled, “Advancements in Treatments for HLHS Heart Warriors.” We are thrilled Dr. Bove is returning to the program to talk to us about a very complicated ccTGA patient of his. He will also be sharing with us a bit about the history of the double-switch procedure and who would most benefit from that invasive surgery, as well as, predictions for the future of ccTGA Heart Warriors in the years to come.Anna's Buzzsprout Affiliate Link (if you'd like to try Buzzsprout for your podcast and get a bonus gift card -- and Anna will, too!) use this link: https://www.buzzsprout.com/?referrer_id=16817Links to 'Heart to Heart with Anna' Social Media and Podcast Pages:Apple Podcasts: https://itunes.apple.com/us/podcast/heart-to-heart-with-anna/id1132261435?mt=2MeWe: https://mewe.com/i/annajaworskiFacebook: https://www.facebook.com/HearttoHeartwithAnna/Instagram: https://www.instagram.com/hearttoheartwithanna/Twitter: https://twitter.com/AnnaJaworskiYouTube: https://www.youtube.com/channel/UCGPKwIU5M_YOxvtWepFR5ZwWebsite: https://www.hug-podcastnetwork.com/Support the show (https://www.patreon.com/HearttoHeart)
I speak with Dr John Gardiner FACEM about the assessment and management of tachyarrhythmias and the practical aspects of safe cardioversion.
An irregular, often rapid heart rate that commonly causes poor blood flow. The heart's upper chambers (atria) beat out of coordination with the lower chambers (ventricles). This condition may have no symptoms, but when symptoms do appear they include palpitations, shortness of breath, and fatigue. Treatments include drugs, electrical shock (cardioversion), and minimally invasive surgery (ablation). Tikosyn: This medication is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as atrial fibrillation/flutter). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat. Dofetilide is known as an anti-arrhythmic drug. Cardioversion is a procedure used to return an abnormal heartbeat to a normal rhythm. This procedure is used when the heart is beating very fast or irregular. This is called an arrhythmia. Arrhythmias can cause problems such as fainting, stroke, heart attack, and even sudden cardiac death. Cardioversion is a medical procedure by which an abnormally fast heart rate or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Wikipedia People also search for: Catheter ablation, Defibrillation, Ablation, MORE Tachycardia refers to a heart rate that's too fast. How that's defined may depend on your age and physical condition. Generally speaking, for adults, a heart rate of more than 100 beats per minute (BPM) is considered too fast. Heart failure can occur if the heart cannot pump (systolic) or fill (diastolic) adequately. Symptoms include shortness of breath, fatigue, swollen legs, and rapid heartbeat. Treatments can include eating less salt, limiting fluid intake, and taking prescription medications. In some cases a defibrillator or pacemaker may be implanted. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/chrisabraham/message Support this podcast: https://anchor.fm/chrisabraham/support
CardioNerd (Amit Goyal), cardioobstetrics series co-chair Dr. Natalie Stokes, Cardionerds Duke University CardioNerds Ambassador and episode lead fellow, Dr. Kelly Arps, join Dr. Andrea Russo, Director of Electrophysiology and Arrhythmia Services at Cooper Medical School of Rowan University and immediate past president Heart Rhythm Society, for a discussion about pregnancy and arrhythmia. Stay tuned for a message from Dr. Sharonne Hayes about WomenHeart. Audio editing by Gurleen Kaur. Claim free CME for enjoying this episode! Dr. Russo's disclosures: Johnson and Johnson, Medtronic, Inc., Boston Scientific Corporation, Kestra, Medilynx, Up-to-Date, and ABIM. Abstract • Pearls Notes • References • Guest Profiles • Production Team CardioNerds Cardio-Obstetrics Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Episode Abstract Pregnant patients may have exacerbation of underlying arrhythmic syndromes or unmasking of previously undiagnosed arrhythmic syndromes. Management of atrial and ventricular tachyarrhythmias should proceed with increased urgency in pregnant patients due to risk of adverse hemodynamic events in the mother and fetus. Cardioversion of atrial and ventricular arrhythmias is safe in pregnancy. Preferred antiarrhythmic agents in pregnant patients include metoprolol, propranolol, verapamil, flecainide, propafenone, sotalol, procainamide, and lidocaine. Management of arrhythmias in pregnancy should include collaboration with obstetrics and maternal-fetal medicine teams. Pearls Pre-conception counseling is a shared decision making process; include obstetrics and maternal-fetal medicine colleagues in challenging cases. Have a high sense of urgency for acute arrhythmias in pregnancy due to risk of impaired fetal perfusion. Goals of acute arrhythmic management should include rapid treatment while avoiding hypotension. In scenarios when beta blockers are indicated, metoprolol and propranolol are first choice. Avoid atenolol as this drug has the highest risk of fetal bradycardia and intra-uterine growth retardation in the class. Lidocaine or procainamide should be first line for ventricular arrhythmias in pregnancy. Amiodarone is potentially teratogenic and should not be used in pregnant patients unless all other options have been exhausted. Show notes 1. What are the expected electrophysiologic changes associated with pregnancy? Increase in resting heart rate which peaks in third trimesterPR shorteningECG axis shift leftward and upwardNon-specific ST and T wave changes These changes, along with increased cardiac output and volume with increased stretch in all chambers, increase the risk of re-entrant arrhythmias in those who are predisposed. ↑ atrial volume -> ↑ stretch -> ↑ ectopy -> ↑ risk for re-entrant arrhythmias 2. What is the approach to pre-conception counseling for patients with known arrhythmias or arrhythmic syndromes? Anticipate frequency and potential severity of adverse arrhythmic outcomes during pregnancy and post-partum periodConsider available options for rhythm control and anticoagulation therapy, as appropriate, during the pre-conception, pregnancy, and post-partum periodsConsider catheter ablation prior to pregnancy, particularly for curable arrhythmias such as Wolff-Parkinson-White (WPW) and AVNRT Offer genetic counseling about hereditary risk to fetus for inherited arrhythmias such as Brugada syndrome and Long QT syndrome 3. What is the management of SVT in pregnancy? Consider the increased risk of tachyarrhythmias in pregnancy: Typically benign arrhythmias can lead to more rapid decompensation in mother due to increased baseline cardiac output. Typically benign arrhythmias can lead to rapid danger to the fetus due to maternal hypotension and shortened diastolic ...
In this podcast Dr. Chris Solie, an ER physician with EMPAC, and Dr. Abby Elliott, with Lakeview Clinic, cover a variety of topic areas from six journal articles. If you like to skip to the conclusion part of the article, this podcast is for you. Enjoy the podcast! Objectives: Upon completion of this podcast, participants should be able to: Differentiate if chest pulmonary CTs are necessary when patients present with suspected venous thromboembolism (VTE). Name at least 2 benefits of nighttime antihypertensive dosing for patients. Assess when cardioversion would be deemed necessary for individuals experiencing A-fib. Identify the risks of short-term steroid use. Identify the relevance of lumbar MRI and its findings. Summarize the findings that IV contrast causing acute kidney injury is a myth. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Journal Review Day - with Drs. Chris Solie and Abby Elliott" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics. Any re-reproduction of any of the materials presented would be infringement of copyright laws. It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: Journal Article 1: "Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability" PEs and DVTs can be elusive. There are rising numbers of chest pulmonary CTAs being done with lower yields. These can result in increased cost and health risks. In this study, the adjusted d-dimer was looked at to see if the number of CTs being ordered can be reduced. The Wells criteria was used to place patients into low, moderate or high clinical pretest probability for venous thromboembolism of VTE. In the podcast, "clinical pretest probability" is referred to as risk. Of the entire 2000 patients enrolled, the diagnosis of VTEW was only made in 7%. Participants that qualified as low risk numbered 1742 and 1200 of these had d-dimer less than 1000. No VTWE was found in these patients for the next 90 days. For those with a d-dimer between 500 and 999, none had a VTE at 90 days. In moderate-risk groups with d-dimer less than 500, none had VTE at 90 days. Combining low-risk patients with a d-dimer less than 1000, non of these patients had evidence of VTE at 90 days. Even in the 467 patients with a d-dimer greater than 1000, only 87 had a VTE. Moderate- or high-risk patients are not applicable for this study. According to the article, if the d-dimer is greater than 1000, and the patient is low-risk, there was a 20% incidence of VTE. While it is an impressive study, it is one peice of data and should not replace clinical gestalt and decision making when truly concerned about the presence of VTE. Journal Article 2: "Bedtime Hypertension Treatment Improves Cardiovascular Risk Reduction: The Hygia Chronotherapy Trial" HTN is difficult to manage in many patients. This was a large study out of Spain of approximately twenty thousand patients. Patients were selected to take their medication either in the AM or nighttime and 48-hour blood pressure monitoring was performed. Patients were followed for 6 years. Night time dosed patients had significantly lower cardiovascular event rates than the daytime group, as well as better blood pressure management. There is little evidence to not advise nighttime antihypertensive dosing for patients, unless there would be compliance concerns. Medications that would not be tolerated, or specific medications, like diuretics, that can disrupt sleep. This was an impressive study that demonstrates a rather simple maneuver to effect a remarkable change in cardiovascular risk. Bear in mind, diet and lifestyle may also contribute to the results, but those were not assessed in this study. Journal Article 3: "Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation" A-Fib is a common presentation in primary care practice and in Emergency Departments. In this study of early cardioversion strategy vs delayed, 437 patients, aged 18 and above, were reviewed. Necessary criteria included A-fib bit less than 36-hours and hemodynamic stability. The conclusion was that neither strategy delayed or early cardioversion was an inferior approach. A large number of patients in this study spontaneously converted to normal sinus rhythm without demonstrating higher rates of stroke. However, this study was not powered to assess risk of long-term stroke, and this remains unknown. Though based on other studies referenced today, it's known that a patient cardioverted after 12-hours of A-fib has an increased risk of stroke. Psychologically, being in A-fib can be disturbing for the individual, and remaining in A-fib is not always desirable from the patient perspective. There are also potential logistical and cost considerations with delayed approach including numerous repeat clinics and ER visits for a small number of patients. Journal Article 4: "Short-term Use of Oral Corticosteroids and Related Harms Among Adults in the United States: Population-based Cohort Study" An impressive review of three hundred thousand patients was performed. Corticosteroids were given for mostly musculoskeletal, respiratory and allergic issues. Sepsis, VTE and fracture were monitored for over a 90-day time period and statistically significant higher rates of all of these were noted. Bear in mind, this was a study without true placebo, and patients essentially compared their experience on steroids to their experience not on steroids. It should probably be followed up with a prospective trial to help further validate these concerning findings. Still, this study only looked at 3 different complications and the numbers here are pretty striking, with 205 of adults receiving steroids. There are a number of studies which have shown no evidence of benefit in the use of steroids for a variety of indications, including conditions, such as urticaria and even anaphylaxis. Journal Article 5: "No Association Between MRI Changes In The Lumbar Sone and Intensity of Pain, Quality of Life, Depressive and Anxiety Symptoms in Patients With Low Back Pain" In this study, out of Poland, patients were referred for a lumbar spine MRI by neurologists, surgeons or other specialists, but not by primary care. These MRIs were graded in the study based on criteria derived from the reading radiologists. The endpoint of the study was to compare the severity of MRI findings with the patient's self-assessment and scoring of pain, quality of life, etc. The study ultimately showed there was no correlation. However, age and BMI, and total MRI scores did correlate. Physically active patients had better scores. Learning new ways of coping with pain and helping our patients with this reality can equal a more efficient use of time and money. Per this study, medications or a reassuring MRI, does not correlate to resolution of pain. Of course, MRIs are often indicated in the setting of significant neurologic findings and emergencies, but outside of those settings, some patients may not be convinced that an MRI is not necessary. Using articles like this one can assist to better counsel patients and reduce unnecessary MRIs. Journal Article 6: "Contrast Associated Acute Kidney Injury Is A Myth: Yes" IV contract is often blamed for acute kidney injury, or AKI. It turns out, like many time honored beliefs in medicine, this is not likely the case. While attempting to research and write a paper on this subject, the investigators quickly discovered that ample data already exists that shows CIN or contrast induced nephropathy, appears to be more a myth than truth. One senior author of this paper demonstrated in a pool of thousands of patients in two other separate studies that there's no association between contrast and AKI. Another investigator who is a cardiologist demonstrated actually less incidence of AKI in a cohort of patients. So, while personal clinical experience and Gestalt should not be ignored, we also must maintain a desire to debunk dogma that is unfounded time and again in the scientific literature. With regard to AKI from IV contrast, maybe there will be a prospective randomized trial looking at this, but there seems to be a preponderance of evidence already to suggest it may not be necessary. Thanks for listening. Sources/Links: Kearon C, de Wit K, Parpia S, et al. Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability. N Engl J Med. 2019;381(22):2125-2134. doi:10.1056/NEJMoa1909159 Available: https://www.nejm.org/doi/10.1056/NEJMoa1909159?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Hermida RC, Crespo JJ, Domínguez-Sardiña M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J. 2020;41(48):4565-4576. doi:10.1093/eurheartj/ehz754 Available: https://academic.oup.com/eurheartj/article/41/48/4565/5602478 Pluymaekers NAHA, Dudink EAMP, Luermans JGLM, et al. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. N Engl J Med. 2019;380(16):1499-1508. doi:10.1056/NEJMoa1900353 Available: https://www.nejm.org/doi/full/10.1056/NEJMoa1900353 Airaksinen, K. E., Grönberg, T., Nuotio, I., Nikkinen, M., Ylitalo, A., Biancari, F., & Hartikainen, J. E. (2013). Thromboembolic Complications After Cardioversion of Acute Atrial Fibrillation. Journal of the American College of Cardiology, 62 (13), 1187-1192. doi:10.1016/j.jacc.2013.04.089 Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415. Published 2017 Apr 12. doi:10.1136/bmj.j1415 Available: https://www.bmj.com/content/357/bmj.j1415 Yao, T., Huang, Y., Chang, S., Tsai, S., Wu, A. C., & Tsai, H. (2020). Association Between Oral Corticosteroid Bursts and Severe Adverse Events. Annals of Internal Medicine, 173 (5), 325-330. doi:10.7326/m20-0432 Babińska, A., Wawrzynek, W., Czech, E., Skupiński, J., Szczygieł, J., & Łabuz-Roszak, B. (2018). No association between MRI changes in the lumbar spine and intensity of pain, quality of life, depressive and anxiety symptoms in patients with low back pain. Neurologia I Neurochirurgia Polska . doi:10.5603/pjnns.a2018.0006 Available: file:///C:/Users/E55983/Downloads/No_association_between_MRI_changes_in_the_lumbar_s.pdf Ehrmann, S., Aronson, D., & Hinson, J. S. (2018). Contrast-associated acute kidney injury is a myth: Yes. Intensive Care Medicine, 44 (1), 104-106. doi:10.1007/s00134-017-4950-6 Available: file:///C:/Users/E55983/Downloads/Ehrmann2018_Article_Contrast-associatedAcuteKidney.pdf Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., Mcdonald, R. J., Weinreb, J. C. (2020). Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294 (3), 660-668. doi:10.1148/radiol.2019192094
You shouldn't throw stones if you live in a glass house And if you got a glass jaw, you should watch your mouth Cause I'll break your face, have your ass running 50 Cent - Patiently Waiting GlassJaw: 1.) Someone who can't take a punch. Glass jaw (noun) a weak jaw that is easily broken, especially as an indication of a fighter's vulnerability to an opponent's punches. Glass jaw (plural glass jaws) (chiefly boxing) A fighting vulnerability where one is easily knocked out via a single hard blow to the chin or jaw (due to lack of conditioning, insufficient training or damage from past cerebral concussions). Metaphorically, a vulnerability of that sort. Glass Jaw is the redemption story of Travis Austin, a one time champion boxer who goes to prison and loses everything. After his release, he experiences the trials and tribulations of redeeming his reputation, his belt, and his true love. A glass jaw is a term, used in combat sport, to describe a limited 'ability' to absorb blows to the jaw or chin. It's a significant disadvantage, but the likes of Amir Khan and Wladimir Klitschko have managed to become champions despite supposedly weak mandibles. Afib (Atrial fibrillation) An irregular, often rapid heart rate that commonly causes poor blood flow. Tachycardia: A rapid heartbeat that may be regular or irregular, but is out of proportion to age and level of exertion or activity. A fast heart rate can have causes that aren't due to underlying disease. Examples include exercise, fear, anxiety, stress, anger, or love. Heart failure can occur if the heart cannot pump (systolic) or fill (diastolic) adequately. Symptoms include shortness of breath, fatigue, swollen legs, and rapid heartbeat. A chronic condition in which the heart doesn't pump blood as well as it should. High blood pressure: a condition in which the force of the blood against the artery walls is too high. Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120. Cardioversion is a medical procedure by which an abnormally fast heart rate or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Dofetilide: Brand name: Tikosyn: Description: Antiarrhythmic: It can treat an irregular heartbeat (arrhythmia). Edema: Swelling can have causes that aren't due to underlying disease. Examples include muscle injury, prolonged standing, or eating large amounts of salt. Pulmonary edema is usually caused by a heart condition. Other causes include pneumonia, exposure to certain toxins and drugs, and being at high elevations. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/chrisabraham/message Support this podcast: https://anchor.fm/chrisabraham/support
Normal sinus rhythm is defined as the rhythm of a healthy heart. It means the electrical impulse from your sinus node is being properly transmitted. In adults, normal sinus rhythm usually accompanies a heart rate of 60 to 100 beats per minute. However, normal heart rates vary from person to person. Edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your body, you may notice it more in your hands, arms, feet, ankles, and legs. Atrial fibrillation (Afib): An irregular, often rapid heart rate that commonly causes poor blood flow. The heart's upper chambers (atria) beat out of coordination with the lower chambers (ventricles). This condition may have no symptoms, but when symptoms do appear they include palpitations, shortness of breath, and fatigue. Treatments include drugs, electrical shock (cardioversion), and minimally invasive surgery (ablation). Tachycardia: A rapid heartbeat that may be regular or irregular, but is out of proportion to age and level of exertion or activity. Cardioversion is a medical procedure by which an abnormally fast heart rate or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Heart failure can occur if the heart cannot pump (systolic) or fill (diastolic) adequately. Symptoms include shortness of breath, fatigue, swollen legs, and rapid heartbeat. Don Fitch's deceptively easy Get Fit, Get Fierce with Kettlebell Swings ebook Get Strong: The Natural, No-Sweat, Whole-Body Approach to Stronger Muscles and Bones Pavel Tsatsouline's Kettlebell Simple & Sinister method The Maffetone Method: The Holistic, Low-Stress, No-Pain Way to Exceptional Fitness: The Holistic, Low-stress, No-pain Way to Exceptional Fitness by Philip Maffetone on my Kindle Row Daily, Breathe Deeper, Live Better, by Dustin Ordway The Maffetone Method by Dr. Philip Maffetone Slow Jogging by Hiroaki Tanaka Slow Running by Chris Bore --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/chrisabraham/message Support this podcast: https://anchor.fm/chrisabraham/support
Should we be giving procainamide to patients with atrial fibrillation/ flutter? We discuss two clinical trials that may give us some answers. References:Stiell IG, Clement CM, Symington C, et al. Emergency department use of intravenous procainamide for patients with acute atrial fibrillation or flutter. Acad Emerg Med. 2007; 14: 1158-1164Stiell IG, Sivilotti MLA, Taljaard M, et al. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomized trial. Lancet. 2020; 395 (10221): 339-349
Cardioversion Literature Cardioversion Quick Summary A look at the RAFF2 trial comparing procainimide versus placebo followed by cardioversion for new onset afib.
Emergent treatment of rapid atrial fib/flutter with Dr. Dave Zull. Please see below for Evidence based annotated articles Arrigo M. New Onset Atrial Fibrillation in critically ill patients and it’sassociation with mortality. Int J Cardiol 266:95-99, Sept 2018Bosch, NA, et al. Atrial Fibrillation in the ICU CHEST 154:1424-1434. Dec 2018Nice review of A fib in the critically ill patient. Emphasis first on correcting precipitants like sympathomimetics, electrolytes, volume and intercurrent illness. Esmolol implied to be best rate control drugDeSouza IA, et al. Pharmacologic Cardioversion of recent onset Atrial Fibrillation and Flutter in the Emergency Department. Ann Emerg Med 76:14-30. July 2020Looking at 360 patients with acute a fib. Ibutilide converted 50% of A fib and 75% of A flutter patients. Two patients had VT as a complication, but none received Magnesium prophylaxis.Nikki, AHA, et al. Early or Delayed Cardioversion in recent onset Atrial Fibrillation. N Engl J Med 380:1499-1508, Apr 2019Oral H, et al. Facilitating Transthoracic Cardioversion of atrial Fibrillation with Ibutilide pretreatment. N Engl J Med 340:1849, Jun 199972% converted to NSR with electrical cardioversion without pretreatment whereas 100% converted with Ibutilide pretreatment before electicityPatsilinakos S, et al. Effect of high doses of Magnesium on converting Ibutilide to a safe and more effective agent. Am J Cardiol 106:673, Sept 2010Magnesium sulfate 4-5 gm infused over one hour before Ibutilide prevents TorsadesSleeswijk ME, et al. Efficacy of Magnesium-Amiodarone step-up scheme in critically ill patients with new onset atrial fibrillation. J Intensive Care Med 23:61, Jan/Feb 2008Magesium infusion followed by Amiodarone infusion in A fib with RVR in the ICU. Half had acceptable rate or rhythm control with Mag alone. At the end of 24 hours 90% of patients converted to NSR.Stiell, Ian, et al. Electrical vs Pharmacologic cardioversion for emergency department patients with acute Atrial Fibrillation. RAFF2 Lancet 395:339-349, Feb 2020Canada’s aggressive protocol for conversion of acute A fib in the ER. IV Procoinamide infusion converted 50% to NSR. Electrical cardioversion worked in 92%. Only 3% of new A fib patients required admissionTercius AJ, et al. Intravenous Magnesium sulfate enhances the ability of intravenous Ibutilide to successfully convert atrial fibrillation or flutter. Pacing Clin Electrophysiol 30:1331, Nov 2007Vinson DR, et al. Ibutilide effectiveness and safety in the Cardioversion of atrial fibrillation and flutter in the community emergency department. Ann EmergMed71:96, Jan 2018Wyse DG, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation (AFFIRM trial). N Engl J Med 247:1825-33, Dec 2002Internists and cardiologist love to quote the AFFIRM trial as proof that attempts to convert are fruitless and we stick to rate control only. These patient were all in chronic a fib and of course we would never convert these patients unless there is life threat. This study has NO application to acute a fib less than 48 hoursZimetbaum P. Atrial Fibrillation. Annal Intern Med. March 2017Everything you ever wanted to know about atrial fibrillation
In today's VETgirl online veterinary continuing education podcast, we review the use of lidocaine for chemical cardioversion of AV tachycardia in dogs. Accessory pathways (APs) refer to interruptions of the normal fibrous band that forms the junction between the atria and ventricles (AV junction). Such pathways generally consist of myocardial cells that can conduct electrical impulses between the atria and ventricles, which under normal circumstances occurs only at the atrioventricular (AV) node. Accessory pathways may conduct electrical impulses in the anterograde, retrograde, or both anterograde and retrograde directions. Anterograde conduction results in ventricular preexcitation (i.e., depolarization of a portion of the ventricular myocardium independent of the typical conduction pathway). Retrograde conduction across an accessory pathway creates the potential for a macroreentrant circuit incorporating the atrial myocardium, AV node-His-Purkinje system, ventricular myocardium and the accessory pathway. This scenario can result in a form of supraventricular tachycardia (SVT) known as orthodromic atrioventricular reciprocating tachycardia (OAVRT).
In today's VETgirl online veterinary continuing education podcast, we review the use of lidocaine for chemical cardioversion of AV tachycardia in dogs. Accessory pathways (APs) refer to interruptions of the normal fibrous band that forms the junction between the atria and ventricles (AV junction). Such pathways generally consist of myocardial cells that can conduct electrical impulses between the atria and ventricles, which under normal circumstances occurs only at the atrioventricular (AV) node. Accessory pathways may conduct electrical impulses in the anterograde, retrograde, or both anterograde and retrograde directions. Anterograde conduction results in ventricular preexcitation (i.e., depolarization of a portion of the ventricular myocardium independent of the typical conduction pathway). Retrograde conduction across an accessory pathway creates the potential for a macroreentrant circuit incorporating the atrial myocardium, AV node-His-Purkinje system, ventricular myocardium and the accessory pathway. This scenario can result in a form of supraventricular tachycardia (SVT) known as orthodromic atrioventricular reciprocating tachycardia (OAVRT).
Using electrical therapy for defibrillation, cardioversion and pacing can be intimidating at the bedside. This webinar will provide practical tips and strategies for successful use of energy for all these situations. In addition, newer evidence for vagal manoeuvres for SVT will also be discussed.
In this EM Quick Hits podcast we have Paul Dorion on immediate cardioversion vs rate control/delayed cardioversion for atrial fibrillation, Justin Morgenstern & Justin Hensley on emergency management of snake bites, Brit Long on reliability of clinical features in the diagnosis of ovarian torsion, Michelle Klaiman on emergency management of crystal methamphetamine use disorder, Hans Rosenberg & Rob Ohle on workup of suspected aortic dissection, and Anand Swaminathan on epinephrine and magnesium sulphate in severe asthma... The post EM Quick Hits 12 AFib Early vs Delayed Cardioversion, Snake Bites, Ovarian Torsion Myths, Crystal Meth, Aortic Dissection, Severe Asthma Meds appeared first on Emergency Medicine Cases.
Do to overwhelming positive feedback and requests we are running this episode for TWO WEEKS! Featuring Bill Hennessey who had a cardiac event after boarding a Chicago Metra train and the two bystanders that weren't about to let these be his LAST train ride!
Blake Briggs is all on his lonesome as he shares his favorite activity in the ED- ELECTRICITY! Why we do it, rapid ACLS indications and key points regarding defibrillation, and stats on common cardioversion questions. Website: www.emboardbombs.com
Commentary by Dr. Valentin Fuster
Dr Paul Wang: Welcome to the monthly podcast, On the Beat for Circulation: Arrhythmia and Electrophysiology. I'm Dr Paul Wang, editor in chief, with some of the key highlights from this month's issue. In our first paper, in a single‐center observational cohort study, Owen Donnellan and Associates compared arrhythmia recurrence rates in morbidly obese patients who underwent prior bariatric surgery, with those of non-obese patients following atrial fibrillation ablation. In addition to morbidly obese patients who did not undergo bariatric surgery, they matched 51 morbidly obese patients' body mass index, 40 kilograms per meter squared, who had undergone prior bariatric surgery in a two to one manner with 102 non-obese patients, and 102 morbidly obese patients without bariatric surgery on the basis of age, gender, and timing of atrial fibrillation ablation. From the time of bariatric surgery to ablation, bariatric surgery was associated with a significant reduction in BMI. 47.6 to 36.7 and reduction in systolic blood pressure, 145 to 118, P < 0.001. During a mean follow up of 29 months following ablation, recurrent arrhythmia occurred in 10 out of 51 or 20 patients in a bariatric surgery group, compared to 25 out of 102 patients, 24.5% in a non-obese group, and 56 out of 102 or 55% in the non-bariatric surgery morbidly obese group. No procedural complications were observed in the bariatric surgery group. In our next paper, Martin Andreas and Associates examined whether noninvasive, low-level, transcutaneous electrical stimulation of the greater auricular nerve reduced the risk of postoperative atrial fibrillation, in a pilot of patients undergoing cardiac surgery. After cardiac surgery, electrodes were applied in the triangular fossa of the ear. Stimulation, amplitude 1-million-amp frequency, one Hertz for 40 minutes, followed by a 20-minute break, was performed for up to two weeks after cardiac surgery. Patients were randomized into sham, N equals 20 or treatment group, N equals 20, for low- level, transcutaneous electrical stimulation. Patients receiving low-level, transcutaneous stimulation had a significant reduced incidence of postoperative atrial fibrillation. Four out of 20, compared to controls 11 out of 20. P equals 0.02. The median duration of postoperative atrial fibrillation was comparable between the treatment group and control group. No effect on low-level stimulation on CRP or IL-6 levels was detectable. In our next paper, Kazuki Iso and Associates examine whether the vagal response phenomenon is common to patients without atrial fibrillation. Continuous, high- frequent stimulation of the left atrial ganglion and plexus was performed in 42 patients, undergoing ablation for atrial fibrillation. In 21 patients undergoing ablation for left-sided accessory pathway, the high frequency stimulation, 20 Hertz at 25 milliamps of 10 millisecond pulse duration, was applied for five seconds at three sites within the presumed anatomical area of each of the five major left atrial ganglion plexus, for a total of 15 sites per patient. The authors define vagal response to high frequency stimulation, as prolongation of the R interval by > 50% in comparison to the mean pre-high-frequency stimulation RR interval, average over 10 beats. In active ganglion plexus areas, is areas in which vagal response was elicited. Overall, more active ganglion plexi or GP areas were found in the atrial fibrillation group patients, than in the non-atrial fibrillation group patients. And in all five major GPS, the maximum R interval during high-frequency stimulation was significantly prolonged in atrial fibrillation patients. After multivariate adjustment, association was established between the total number of vagal response sites and the presence of atrial fibrillation. The authors concluded that the significant increase in vagal responses elicited in patients with atrial fibrillation, compared to responses in non-atrial fibrillation patients, suggests that the vagal responses is to hypercan stimulations, reflect an abnormally increased ganglion plexi activity, specific to atrial fibrillation substrates. In our next paper, Vidal Essebag and Associates combine the data from the Bruise Control One and Two studies to evaluate the effect of concomitant antiplatelet therapy on clinically significant hematomas, and to understand the relative risk of clinically significant hematomas in patients treated with DOAC versus continued Warfarin. The Bruise Control study demonstrated that perioperative Warfarin continuation, reduced clinically- significant hematomas by 80%, compared to Heparin bridging. 3.5% versus 16%. Bruise Control Two observed a similarly low risk of clinically-significant hematomas when comparing continued versus interrupted direct oral anticoagulant. 2.1% in both groups. A total of 1,343 patients were included in Bruise Control One and Bruise Control Two, the primary outcome for both trials with clinically-significant hematomas. There are 408 patients identified as having continued either a single or dual antiplatelet agent at the time of device surgery. Anti-platelet use versus non-use was associated with clinically-significant hematomas in 9.8% versus 4.3%. P less than 0.001 and remained a strong independent predictor with multi-variate adjustment. Odds ratio 1.965, however, multivariate analysis adjusting for anti-platelet use, there was no significant difference in clinically-significant hematomas observed between direct oral anticoagulant use, compared with continued Warfarin. In our next paper, Markus Rottmann and associates examine the relationship between activation slowing during sinus rhythm, and vulnerability for reentry, and correlated the areas with components of the circuit. In a porcine model of healed infarction, of 15 swine, nine had inducible ventricular tachycardia, 5.2 per animal. While in six swine, VT could not be induced despite stimulation from four RV and LV sites at two drive trains in six extra stimuli down to refract refractoriness. Infarcts with ventricular tachycardia had a greater magnitude of activation slowing, during sinus rhythm, a minimal endocardial activation velocity cutoff, less than 0.1 meters per second. Differentiated inducible from non-inducible infarctions. P equals 0.15. Regions of maximal endocardial slowing during the sinus rhythm corresponded to the VT isthmus. Area under the curve equals 0.84 while bystander sites exhibited near normal activation during sinus rhythm. VT circuits were complex, with 41.7 exhibiting discontinuous propagation with intramural bridges of slow conduction in delayed quasi -simultaneous endocardial activation. Regions forming the VT isthmus borders had facts or activation during sinus rhythm, while regions forming the inner isthmus were activated faster during ventricular tachycardia. In our next paper, Mary Rooney and Associates sought to define the prevalence of subclinical atrial fibrillation in a community-based elderly population, and to characterize subclinical atrial fibrillation and the incremental diagnostic yield of four versus two weeks of continuous ECG monitoring. They conducted a cross-sectional analysis within the community- based, multi-centered observational atherosclerosis risk in communities. Erik Study, using visit five, 2016 to 2017 data. The 2,616 Erik Study participants who wore a lead-less ambulatory ECG monitor for up to two weeks were age 79 years, 42% men and 26% black. In its subset, 386 participants without clinically-recognized atrial fibrillation wore the monitor twice, each time for two weeks. They characterize the prevalence of subclinical atrial fibrillation, atrial fibrillation detected without clinically recognized atrial relation. Over two weeks of monitoring and the diagnostic yield of four versus two weeks, the authors found that the prevalence of subclinical atrial relation was 2.5%. the prevalence of subclinical each relation was 3.3% among white men, 2.5% among white women, 2.1% among black men and 1.6% among black women. Subclinical A Fib was mostly intermittent, 75%. Among those with intermittent subclinical atrial fibrillation, 91% had an AF burden of less than or equal to 10%, during the monitoring period. In a subset of 386 patients without clinical atrial fibrillation, 78% more subclinical atrial fibrillation was detected by four weeks versus two weeks of ECG monitoring. In this study, the prevalence of subclinical A Fib was lower than previously reported. And monitoring beyond two weeks provided substantial incremental diagnostic yield. In our next study, Rafael Ramirez and Yoshio Takemoto and Associates investigated arrhythmic mechanisms of Ranolazine in sheet models, in paroxysmal and persistent atrial fibrillation. Paroxysmal atrial fibrillation was maintained during acute stretch and persistent atrial relation was induced by long-term atrial tachypacing. Isolated Langendorff-perfused sheet parts were optically mapped. In paroxysmal atrial fibrillation, Ranolazine 10 micromolar reduced dominance frequency from 8.3 to 6.2 Hertz. P less than 0.01, before converting to sinus rhythm, decreased singularity point density for 0.07 to 0.039 and left atrial epicardium and prolonged atrial fibrillation cycling. Road or duration tip trajectory in variants of Afib cycle lengths were unaltered. In persistent atrial fibrillation, Ranolazine reduced dominance frequency, prolonged atrial fibrillation cycle length, increased the variance of atrial fibrillation cycling and had no effect on singularity point density, and failed to convert atrial fibrillation to sinus rhythm. Doubling the Ranolazine concentration or supplementing with Dofetilide failed to convert persistent atrial fibrillation to sinus rhythm. In computer simulations or rotors, reducing the sodium current decreased dominant frequency, increased tip meandering, and produce vortex shedding upon wave interaction with un-excitable regions. Thus, the authors concluded that paroxysmal atrial fibrillation and persistent atrial relation respond differently to Ranolazine. Cardioversion in the paroxysmal atrial fibrillation can be attributed partly to decrease dominant frequency and singularity point density and prolongation of atrial fibrillation cycling. In persistent atrial fibrillation, increased dispersion of atrial-like cycle length and likely vortex shedding, contributes to rotor formation, compensating for any rotor loss, and may underline the inefficacy of Ranolazine to terminate persistent atrial fibrillation. In our next paper, Pyotr Platonov and Associates assess the risk of atrial fibrillation and its relationship to Long-QT syndrome genotype, and the long-term prognosis in Long-QT syndrome patients. Genotype- positive patients with Long-QT syndrome. 784 with LQT1. 746 with LQT2, and 233 with LQT3, were compared with 2043 genotype-negative family members. In patients followed from birth to 60 years, LQT3 patients had an increased risk of atrial fibrillation compared to genotype-negative family members. Hazard ratio 6.62. While neither LQT1 or LQT2 demonstrated increased atrial fibrillation risk. After the age of 60 years, LQT2 patients had significant lower risk of atrial fibrillation compared with genotype-negative controls. Hazard ratio of 0.07. Atrial fibrillation was a significant predictor of cardiac events in LQT3 patients, through the age of 60. Hazard ratio, 5.38. The authors concluded that there's an increased risk of early-age atrial fibrillation in LQT3 patients and a protective effect of LQT2 genotype, resulting in a decreased risk of atrial fibrillation after the age of 60. In our next paper, Julia Ramírez and Associates evaluated the cardiovascular prognostic value of T-waves morphology restitution in 55,222 individuals undergoing an exercise stress test in the UK biobank, and identify any genetic contribution. They found that 1,743 or 3.2% of individuals had a cardiovascular event. T-wave morphology restitution during recovery from exercise was significantly associated with cardiovascular events. Hazard ratio 1.11. Independent of clinical variables and other ECG markers, T-wave morphology restitution during recovery from exercise was also associated with all-cause mortality. Hazard ratio 1.1. And ventricular arrhythmias, hazard ratio 1.16. They identified 12 genetic loci, in total for T-wave morphology restitution during exercise, in T wave morphology restitution during recovery, of which nine are associated with another ECG marker. Individuals with the top 20% of T-wave morphology restitution during recovery, genetic risk scores, were significantly more likely to have a cardiovascular in the full UK biobank. 5.3% than individuals in the bottom percent, a 20% hazard ratio of 1.07. We have two other research letters in a special report. Wassim Mosleh, Sharma Kattel report that Galectin-3 is a predictor of mortality after cardiac arrest. In the next research letter, Jerry Jez and Associates report on remotely-navigated ablations in ventricular myocardium, that result in acute lesion-size, comparable to force sensing manual navigation. In a special report, Sohaib Virk and Saurabh Kumar report on a meta-analysis of remote magnetic versus manual catheter navigation for atrial fibrillation ablation. That's it for this month. We'll hope that you'll find the journal to be the go-to place for everyone interested in the field. See you next time. This program is copyright, American Heart Association 2019.
Afib of The Night Chemical vs Electrical First Cardioversion by SAEM
With Freek Verheugt, Heartcenter, Onze Lieve Vrouwe Gasthuis (OLVG) - Netherlands. Link to paper Link to editorial
Take control of atrial fibrillation with expert insights and pearls from cardiologist, Dr. James Furgerson, in this jam-packed episode! You’ll learn why atrial fibrillation is such a big deal, how to diagnose it, how to treat it and when to call in for reinforcements. Dr. James Furgerson, MD is a cardiologist from San Antonio, Texas with over 20 years in academics. Buckle up - This episode is going to send your heart racing! You might even skip a beat! Full notes at https://thecurbsiders.com. ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Writer and Producer: Cyrus Askin MD Infographic: Cyrus Askin MD Cover Art: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Cyrus Askin MD Editors: Matthew Watto MD Guest: James Furgerson MD Time Stamps 00:00 Intro, disclaimer and guest bio 03:45 Guest one liner, a bit on physician well-being and some other randomness 08:15 A case of palpitations; risk factors for atrial fibrillation 12:17 Subclinical atrial fibrillation, overdiagnosis of afib; How much afib burden matters? 15:08 Case summary and next steps in initial work up 18:48 Counseling patient about afib and its consequences 21:40 Ischemic heart disease and atrial fibrillation 24:17 Recap of diagnosis, initial work up and risk stratification in atrial fibrillation 25:25 Rate versus rhythm control; AFFIRM trial 30:50 Strict versus lenient rate control; RACE trial 33:30 Deciding on rate versus rhythm control; Downside of antiarrhythmic therapies; When to switch from rate to rhythm control strategy 36:52 Ablation for atrial fibrillation; CASTLE-AF, CABANA trials 40:40 When to refer to cardiology and electrophysiology 42:42 Choice of agent for anticoagulation and latest guidelines for atrial fibrillation; New definition for valvular atrial fibrillation 45:22 DOACs in CKD and some other nuances in choice of agent 52:27 Bleeding and anticoagulation 58:38 Cardioversion for atrial fibrillation (initial versus delayed) 63:32 Anticoagulation before and after cardioversion 67:48 Lifestyles measures for atrial fibrillation 70:45 Atrial fibrillation during critical illness, after CABG and in hyperthyroidism 74:12 Aspirin monotherapy is not appropriate for atrial fibrillation 76:42 Take home points 78:50 Outro
Andre Maddison, General Internal Medicine (GIM) fellow at Western University, is hosting this week's episode on The Rounds Table alongside his wife, Emily Wilson, family physician in London and adjunct professor at Western University. Together they are covering risk factors, death, and cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and early or delayed ...The post A Shock to The Heart: Risk Factors and Cardiovascular Events in T2DM and Cardioversion in AFib appeared first on Healthy Debate.
Andre Maddison, General Internal Medicine (GIM) fellow at Western University, is hosting this week's episode on The Rounds Table alongside his wife, Emily Wilson, family physician in London and adjunct professor at Western University. Together they are covering risk factors, death, and cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and early or delayed ... The post A Shock to The Heart: Risk Factors and Cardiovascular Events in T2DM and Cardioversion in AFib appeared first on Healthy Debate.
Commentary by Dr. Valentin Fuster
This is the eighth podcast in the What are Palpitations? series and it focuses on the treatment options for arrhythmias. We will be discussing everything from lifestyle modifications that may help reduce arrhythmias as well as medications that are often used in arrhythmia treatment. Topics include: Lifestyle, Can exercise cause heart-rhythm problems?, Medications, Anticoagulation, Ablation, and Cardioversion. Please check back with the Heart-Rhythm-Center.com for future podcasts to include: The Electrophysiology Study and Ablation Procedure, Possible Complications of Electrophysiology Studies and Ablations, Postoperative Care after an EP Study (and possible ablation), and Psychosocial Impact of Arrhythmias.
Acupuncture and herbs restore normal sinus rhythm to the heart.
Dr. Michael Ezekowitz and Dr. C. Michael Gibson Discuss
Author: Aaron Lessen, M.D. Educational Pearls Atrial fibrillation is common. One of the best treatments for a fib is cardioversion back into sinus rhythm. Cardioversion may increase stroke risk if A-Fib duration is greater than 48 hours, but some new data suggests that this risk may happen as soon as 12 hours. However, newer studies show that cardioversion is generally safe as a treatment for A-Fib. References: Aatish Garg, Monica Khunger, Sinziana Seicean, Mina K. Chung, Patrick J.Tchou Incidence of Thromboembolic Complications Within 30 Days of Electrical Cardioversion Performed Within 48 Hours of Atrial Fibrillation Onset. JACC: Clinical Electrophysiology Aug 2016, 2 (4) 487-494; DOI: 10.1016/j.jacep.2016.01.018
This week we delve into the argument for cardioversion in recent-onset AF as well as the logistics of getting it done. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_98_0_Final_Cut.m4a Download Leave a Comment Tags: Atrial Fibrillation, Atrial Flutter, Cardiology, Cardioversion Show Notes Read More Core EM: Podcast 64.0 – Rate Control in AF Core EM: Recent Onset Atrial Fibrillation Core EM: 30-Day Outcomes After Aggressive AF Management in the ED The SGEM: SGEM#88: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol References Nuito I et al. Time to cardioversion for acute atrial fibrillation and thromboembolic complications. JAMA 2014; 312(6): 647-9. PMID: 25117135 Stiell IG et al. Association of the Ottawa aggressive protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation and flutter.
This week we delve into the argument for cardioversion in recent-onset AF as well as the logistics of getting it done. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_98_0_Final_Cut.m4a Download Leave a Comment Tags: Atrial Fibrillation, Atrial Flutter, Cardiology, Cardioversion Show Notes Read More Core EM: Podcast 64.0 – Rate Control in AF Core EM: Recent Onset Atrial Fibrillation Core EM: 30-Day Outcomes After Aggressive AF Management in the ED The SGEM: SGEM#88: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol References Nuito I et al. Time to cardioversion for acute atrial fibrillation and thromboembolic complications. JAMA 2014; 312(6): 647-9. PMID: 25117135 Stiell IG et al. Association of the Ottawa aggressive protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation and flutter. Can J Emerg Med 2010; 12(3): 181-91. PMID: 20522282
Your most favorite resuscitation items such as oxygen, bolus epinephrine, intubation and cardioversion may in fact be harmful for the pediatric cardiac patient presenting to the emergency department in extremis. Due to the physiology of certain complex congenital heart diseases, the usual resuscitation maneuvers may in fact kill the patient instead of helping. Supplemental oxygen can worsen the pulmonary to systemic blood flow ratio in single ventricle patients and cause them to have rising lactate levels and cardiac arrest from low systemic cardiac output. Intubation and positive pressure ventilation may impede pulmonary blood flow in patients with a Glenn shunt and the patient can become more desaturated. With increasing PEEP and higher respiratory rates the patients will continue to deteriorate and desaturate. Regular dosing of epinephrine boluses in patients with single ventricle physiology who are dwindling (nearly arresting), can actually worsen their systemic output by increasing systemic vascular resistance and promoting pulmonary overcirculation. Cardioversion of a previously healthy pediatric patient might be tempting when you see what looks like a stable ventricular tachycardia. This wide complex rhythm has fooled many people into shocking it. You might in fact be dealing with something else and can make the patient infinitely worse by shocking.
Commentary by Dr. David Wilber
Cardiology Mazwi, M Introduction To Cardioversion Podcast 080714 by OPENPediatrics
When parents are told their children will be born with a heart defect, they often wonder what kind of life their children will have. Will they constantly be hospitalized? Will they have to endure one surgery after another? Will they be able to run and play with other children? Then as our children age and start answering some of those early questions we parents have new questions popping into our minds. Will our children graduate? Go to the prom? Have a first love? Then even more serious questions enter our minds. Will our children find someone to love and who will love them, despite the fact that they have a heart defect? Will our children be able to have children of their own? If they do have children, will those children be born with heart defects? So many of us parents have a million questions and as our children age, our questions seem to multiply. This show is the first show to feature only the spouse of an adult born with a critical congenital heart defect. Tune in to hear Brittany tell us about falling in love with Shawn, the life they've built together and the future they hope to have.Support the show (https://www.patreon.com/HearttoHeart)
Aims: Transesophageal echocardiography (TEE) is the gold standard for the detection of thrombi in patients with atrial fibrillation (AF) before undergoing early electrical cardioversion (CV). However, TEE generates inconclusive results in a considerable number of patients. This study investigated the influence of contrast enhancement on interpretability of TEE for the detection of left atrial (LA) thrombi compared to conventional TEE and assessed, whether there are differences in the rate of thromboembolic events after electrical cardioversion. Methods: Of 180 patients with AF (51 females, 65.2 +/- 13 years) who were referred to CV, 90 were examined with native imaging and contrast enhancement within the same examination (group 1), and 90 were examined with native TEE alone and served as control (group 2). Cineloops of the multiplane examination of the LA and LA appendage (LAA) were stored digitally before and, in group 1, after intravenous bolus application of a transpulmonary contrast agent. Images of group 1 were assessed offline and the diagnosis of LA thrombi was made semi-quantitatively: 1= thrombus present; 2=inconclusive result; 3=no thrombus. The presence of spontaneous echocontrast (SEC) was registered and flow velocity in the LA appendage (LAA-flow) was measured. All patients in whom CV was performed were followed up for 1 year or until relapse of AF. CV related adverse events were defined as any thromboembolic event within 1 week after CV. Results: No serious adverse events occurred during TEE and contrast enhanced imaging. In group 1 atrial thrombi were diagnosed in 14 (15.6%) during native and in 10 (11.1%) patients during contrast enhanced imaging (p
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