Al-Zakhari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Subcutaneous implantable cardioverter-defibrillators (S-ICD) provide an effective treatment option for ventricular arrhythmias. When compared to transvenous implantable cardioverter-defibrillators (TV-ICDs), S-ICDs have a lower infection rate but a higher rate of inappropriate shocks. In patients with end-stage renal disease (ESRD), significant electrolyte disturbances are commonly seen, such as hyperkalemia, which can cause an increase in T wave amplitude. We present a patient with ESRD on hemodialysis who experienced inappropriate shocks from an S-ICD during sinus rhythm due to hyperkalemia-induced T wave oversensing and highlight related cases in the current literature.
Introduction:
Atrial fibrillation is the most common disorder of cardiac rhythm, which is often associated with a high risk of morbidity and mortality. Antiarrhythmic medications (AAMs) continue to be the mainstay in the treatment of paroxysmal atrial fibrillation. However, the use of these medications has been limited by their modest anti-arrhythmic efficacy.
Hypothesis:
We hypothesized that dual AAMs (sodium/potassium channels blockers) improve the chance of maintaining sinus rhythm and decrease the need for catheter ablation when compared to single AAM.
Methods:
We conducted a retrospective observational study; we reviewed medical records of 150 patients with paroxysmal atrial fibrillation over five years at our hospital in New York. We collected the following data: age, sex, comorbidities, electrocardiogram findings, ejection fraction by echocardiography, classes of AAMs, duration and response to treatments. A successful response was defined as the absence of symptoms and the presence of sinus rhythm on electrocardiogram. A failed response was defined as persistence of symptoms and/or atrial fibrillation on electrocardiogram and the subsequent need for catheter ablation.
Results:
86 patients met the inclusion criteria in our analysis. The average age of the patinets was 71.06 years. 45 patients were given the dual AAMs of either amiodarone+flecainide or dronedarone+flecainide, and were treated for an average of 15.4 months. 41 patients received a single AAM then catheter ablation if needed. A chi-square test was performed. X
2
=18.9429, p<.0001. Patients taking dual AAMs were very likely to maintain sinus rhythm and less likely to need catheter ablation (Figure).
Conclusions:
Our preliminary results demonstrate that patients who receive dual AAMs are significantly less likely to need catheter ablation than those who receive single AAM. Well-designed prospective studies are needed to further explore the use of dual AAM therapy and its clinical impact.
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