Supraventricular Tachycardia

Ventricular fibrillation during electrical cardioversion of pre-excited atrial fibrillation

“…Early referral is then recommended to a tertiary centre for electrophysiological studies with a view to pathway radiofrequency ablation. 5 Verapamil shortens the effective refractory period of accessory pathway tissue. This may accelerate conduction through the accessory pathway increasing the risk of ventricular fibrillation.…”

Atrial fibrillation with Wolff-Parkinson-White syndrome: A case report

“…In orthodromic AVRT, the atrial impulse is conducted to the ventricles via the normal AV node route and is conducted retrogradely via an accessory pathway; this retrograde conduction allows the impulse to reenter the conduction system and perpetuate the tachycardia. In AVRT with antidromic conduction, the accessory pathway conducts the impulse antegradely, resulting in preexcitation of the ventricles, which is followed by retrograde conduction through the AV node [6,7]. Tachyarrythmia may also be facilitated by direct conduction from the atria to the ventricles via the accessory pathway, bypassing the AV node, seen with AF or atrial flutter in conjunction with WPW.…”

Results From the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) Trial on Atrial Flutter, a Multicentric Prospective Randomized Study Comparing Amiodarone and Radiofrequency Ablation After the First Episode of Symptomatic Atrial Flutter

“…The difference in efficacy is striking; the percentage of recurrence of flutter in the amiodarone group agrees with the results obtained with this drug in patients with AF (Ϸ30%), 2,16,29 -34 whereas the number of recurrences in the RFA group is the same as that reported after cavotricuspid isthmus bidirectional block validation (Ͻ5%). 2,4,[7][8][9][10] The percentage of recurrence of AFL after a first episode is not well known because of the lack of evaluation of medical therapy versus placebo in a large AFL population. 5 Crijns et al 20 reported that the percentages of patients in sinus rhythm after a single cardioversion, without prophylactic antiarrhythmic drugs, were 53%, 47%, and 42% after 0.5, 1, and 5 years, respectively, in a population of 50 consecutive patients.…”

“…[1][2][3][4][5][6] A randomized prospective study is available comparing antiarrhythmic drugs versus RFA in patients with Ͼ2 symptomatic episodes of AFL. 7 That study is weakened by the following: (1) a series not sufficiently powered to provide strong statistical evidence; (2) patient selection based on 2 episodes of symptomatic AFL; (3) the diversity of antiarrhythmic medications tested; and (4) the absence of comparison with amiodarone. 7 All of these limitations must be weighed when treatment options are proposed to patients with a first episode of AFL.…”

“…[12][13][14][15] The American College of Cardiology/ American Heart Association/European Society of Cardiology guidelines state that a first episode of well-tolerated AFL is classified as a IIa indication with a level of evidence B for RFA treatment. 2 It is a logical extension of the state of the art to establish the value of RFA in AFL versus electric cardioversion followed by amiodarone as an adjunct therapy 2,6,16 -20 in a prospective randomized investigation after only 1 episode of symptomatic AFL.…”