Atrial Parasystole British Heart Journal 2010 - David Friedberg
2 cases of AP. Analysis of the underlying mechanism shows that atrial parasystolic bigeminy with 'reversed' coupling is a form of escape-capture bigeminy, sinus
escapes being followed by an ectopic capture of the atria. Parasystole is a rhythm in which the parasystolic pacemaker is protected from the effects of the dominant,
usually faster pacemaker. This protection, which is the essence of this arrhythmia, is situated within the immediate vicinity of the parasystolic focus. Reasons are given
for the rarity of atrial fusion beats. The similarities between atrial and ventricular parasystoles are explored. It is suggested that an atrial parasystolic pacemaker may
lie within a major atrial preferential conducting pathway, and may consist of a congenitally ectopic fragment of sinus nodal tissue.
beats (black dots),
occur with varying
are simple multiples
of 120-124. The
rhythm is atrial
QT dynamics early after exercise as a predictor of mortality. Heart Rhythm 2010 Nov.
An abnormal predicted QT interval at 500 ms (120 beats/min) during recovery from exercise independently predicts all-cause mortality.
Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia - Miller Criteria - EHJ 2007
A New Approach to the Differential Diagnosis of a Regular Tachycardia With a Wide QRS Complex - Brugada Criteria - Circ 1991
Randomized open label comparison of ICD therapy (322 patients) and no ICD therapy (342 patients) 6 to 40 days after MI. EF<35% and impaired autonomic function
(depressed HR variability or elevated avg 24 hour HR on Holter). 1ary outcome: Mortality. 2ary outcome: death from arrhythmia.
mean follow up 30 months+/-13, no difference in treatment between ICD and no ICD groups first 40 days
62 deaths ICD group, 58 deaths control group (1.08; 95% CI, 0.76-1.55, p=0.66)
12 deaths due to arrhythmia ICD group, 29 control group (0.42; 95% CI, 0.22-0.83, p=0.009)
50 deaths non arrhythmic causes ICD group, 29 control group (p=0.02)
Prophylactic ICD therapy does not reduce overall mortality early (40 days) post MI
-NSVT + HCM = Class II indication for ICD
-ICD consent: risk of infection, PTX, Bleeding, perforation of cardiac structures, long-term complications of valvular abnormalities, long term infection, chronic pain