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BMC Med Educ 2022 Jun 1;22(1):417. Epub 2022 Jun 1.

Department of Internal Medicine, University Medical, Center Hamburg-Eppendorf, Hamburg, Germany.

Background: Guideline-based therapy of cardiac arrhythmias is important for many physicians from the beginning of their training. Practical training of the required skills to treat cardiac arrhythmias is useful for acquiring these skills but does not seem sufficient for skill retention. The aim of this study was to compare different retention methods for skills required to treat cardiac arrhythmias with respect to the performance of these skills in an assessment. Read More

J Am Heart Assoc 2022 02 3;11(4):e021615. Epub 2022 Feb 3.

Sohnis Research Laboratory for Cardiac Electrophysiology and Regenerative Medicine The Rappaport Faculty of Medicine and Research InstituteTechnion‒Israel Institute of Technology Haifa Israel.

Background Optogenetics, using light-sensitive proteins, emerged as a unique experimental paradigm to modulate cardiac excitability. We aimed to develop high-resolution optogenetic approaches to modulate electrical activity in 2- and 3-dimensional cardiac tissue models derived from human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes. Methods and Results To establish light-controllable cardiac tissue models, opsin-carrying HEK293 cells, expressing the light-sensitive cationic-channel CoChR, were mixed with hiPSC-cardiomyocytes to generate 2-dimensional hiPSC-derived cardiac cell-sheets or 3-dimensional engineered heart tissues. Read More

Am J Case Rep 2021 Oct 1;22:e933789. Epub 2021 Oct 1.

Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.

BACKGROUND Lyme disease is a tick-borne illness caused by bacteria of the Borrelia genus, endemic to the northeastern region of the United States. It typically presents with fevers, myalgias, and erythema migrans, but it can result in disseminated symptoms if left untreated. Lyme carditis is a rare, but potentially fatal complication of Lyme disease, occurring in up to 4-10% of untreated cases. Read More

J Clin Med 2021 Jul 21;10(15). Epub 2021 Jul 21.

Division of Cardiology, Garibaldi-Nesima Hospital, 95123 Catania, Italy.

The therapeutic dilemma between rhythm and rate control in the management of atrial fibrillation (AF) is still unresolved and electrical or pharmacological cardioversion (CV) frequently represents a useful strategy. The most recent guidelines recommend anticoagulation according to individual thromboembolic risk. Vitamin K antagonists (VKAs) have been routinely used to prevent thromboembolic events. Read More

Prehosp Disaster Med 2021 Aug 15;36(4):440-444. Epub 2021 Jun 15.

South East Coast Ambulance Service NHS Foundation Trust, Crawley, United Kingdom of Great Britain and Northern Ireland.

Background: Synchronized cardioversion is an internationally accepted standard therapy for unstable tachyarrhythmias, but it is conventionally an in-hospital physician-led intervention. Increasingly, it is being brought forward into the prehospital setting as part of a specialist paramedic scope of practice; however, very little literature exists regarding the epidemiology or efficacy in this setting.

Methods: All patients receiving cardioversion within a United Kingdom (UK) ambulance service were identified using an electronic database. Read More

Int J Clin Pract 2021 Sep 28;75(9):e14480. Epub 2021 Jun 28.

Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Jerusalem, Israel.

Background: The current emergency medicine literature on cardioversion for atrial fibrillation (AF) describes its performance on those who are hemodynamically unstable, present within 48 hours of the onset of the arrhythmia, or are on long-term anticoagulants. For patients who are not anticoagulated and present with atrial fibrillation for more than 48 hours, one option is to perform a transesophageal echocardiogram and then synchronized cardioversion in the absence of atrial clot. The objective of this study is to compare outcomes of patients presenting to the emergency department (ED) with atrial fibrillation (AF) of more than 48 hours who underwent a transesophageal echocardiogram (TEE) and subsequent cardioversion in the ED versus the cardiology ward. Read More

Tex Heart Inst J 2021 06;48(2)

Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania.

Flecainide, a widely prescribed class IC agent used to treat atrial arrhythmias, can in rare cases cause 1:1 atrial flutter with rapid conduction. We describe the case of a 59-year-old man who was on a maintenance regimen of flecainide for refractory atrial fibrillation. When 1:1 atrial flutter with rapid conduction developed, emergency medical technicians attempted synchronized cardioversion, which caused ventricular fibrillation necessitating defibrillation. Read More

Am J Emerg Med 2021 07 18;45:683.e1-683.e3. Epub 2020 Dec 18.

Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN, USA.

Diabetic ketoacidosis (DKA) occurs frequently among children and adolescents with type 1 diabetes. Although a number of complications may occur during episodes of DKA, significant cardiac arrhythmias are uncommon. We present the case of an adolescent who presented with severe DKA and wide complex tachycardia that was unresponsive to multiple doses of adenosine and ultimately required synchronized cardioversion. Read More

Am J Emerg Med 2021 07 12;45:677.e5-677.e7. Epub 2020 Nov 12.

Dept of Emergency Medicine, Sarasota Memorial Hospital, 1540 S. Tamiami Trl. Suite 101, Sarasota, FL 34239, United States of America. Electronic address:

Wide complex tachycardias are rare in the pediatric population and may be due to ventricular tachycardia, aberrant conduction or antidromic tachycardia each with multiple underlying etiologies. We present a 14 yo female in extremis with syncope at rest witnessed by her mother, found in ventricular tachycardia by EMS who challenged with IVF hydration and amiodarone. Consecutive adequate fluid challenges and antiarrhythmics in the emergency department failed requiring synchronized cardioversion for stabilization. Read More

Am J Case Rep 2020 Nov 10;21:e927064. Epub 2020 Nov 10.

Banholzer Clinic, Malcolm Grow, Joint Base Andrews, MD, USA.

BACKGROUND Cardioversion is a safe, commonly used procedure throughout the world. It is performed over 30 000 times per year in the United States, specifically for atrial fibrillation. Procedural risks from cardioversion include clot dislodgement, sedation effects, site pain, burns, hypotension, dysrhythmias, or heart failure. Read More

Pacing Clin Electrophysiol 2021 01 19;44(1):93-100. Epub 2020 Nov 19.

Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

Background: Implantable cardioverter defibrillators use low-voltage shock impedance measurements to monitor the lead integrity. However, previous case reports suggest that low-voltage shock impedance measurements may fail to detect insulation breaches that can cause life-threatening electrical short circuits.

Methods And Results: We report six cases of insulation breaches in transvenous defibrillation leads that were not obvious during standard interrogations and testing of the lead beforehand. Read More

Eur J Clin Invest 2020 Oct 6;50(10):e13274. Epub 2020 Aug 6.

Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Aims: Atrial fibrillation (AF) is a frequent comorbidity among patients with severe mitral regurgitation (MR). Direct current (DC) cardioversion is one of the strategies for rhythm control. However, the safety and feasibility of immediate DC cardioversion after MitraClip are not elucidated. Read More

BMC Pediatr 2020 08 5;20(1):370. Epub 2020 Aug 5.

Department of Prenatal Cardiology, Department for Fetal Malformations Diagnoses & Prevention, Medical University of Lodz, Rzgowska 281/289, 93-338, Łódź, Poland.

Background: Atrial flutter (AFL) is a supraventricular tachyarrhythmia. In the ECG tracing, it is marked by a fast, irregular atrial activity of 280-500 beats per minute. AFL is known to be a rare and also life-threatening rhythm disorder both at the fetus and neonatal period. Read More

J Interv Card Electrophysiol 2021 Mar 3;60(2):329-335. Epub 2020 Jul 3.

Department of Cardiology, Cork University Hospital, Cork, Ireland.

Background: Cardiac-specific markers of myocardial injury, such as troponin I (TnI), are often elevated following procedures that stimulate the myocardium. This study aimed to determine the effect of synchronized direct current (DC) cardioversion of atrial arrhythmias on myocardial injury 6-h post-procedure, as measured by cardiac TnI in patients with and without cardiomyopathy.

Methods: Seventy-three individuals (59 M:14 F) participated in this study. Read More

J Emerg Med 2020 Aug 18;59(2):224-226. Epub 2020 Jun 18.

Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California; Division of Medical Toxicology, UC San Diego Medical Center, San Diego, California.

Background: Methohexital is a short-acting barbiturate used for procedural sedation in the emergency department (ED). As with other sedatives, adverse effects with methohexital include excess sedation and hypotension, but this agent can also lower the seizure threshold. We report a patient who developed a generalized seizure after administration of methohexital. Read More

PLoS One 2020 1;15(5):e0232529. Epub 2020 May 1.

Department of Electrical and Computer Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.

Electrical defibrillation is a well-established treatment for cardiac dysrhythmias. Studies have suggested that shock-induced spatial sawtooth patterns and virtual electrodes are responsible for defibrillation efficacy. We hypothesize that high-frequency shocks enhance defibrillation efficacy by generating temporal sawtooth patterns and using rapid virtual electrodes synchronized with shock frequency. Read More

Int J Cardiol 2020 09 17;314:60-63. Epub 2020 Apr 17.

Heart and Vascular Institute, Stamford Hospital, Stamford, CT, USA. Electronic address:

Backgrounds: Predicting left atrial appendage thrombus (LAAT) in non-valvular atrial fibrillation (NVAF) patients need more precisely quantified risk models. In this study, we attempted to review the risk markers for LAAT and develop a simple and reliable model for LAAT prediction.

Methods: The study included 307 patients with NVAF who were scheduled for transesophageal echocardiography (TEE) to exclude LAA thrombus before synchronized electrical cardioversion or radiofrequency ablation for atrial fibrillation (AF). Read More

Eur Heart J Case Rep 2019 Dec 26;3(4):1-8. Epub 2019 Oct 26.

Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, Avenue du Laerbeek 101, 1090 Jette, Brussels, Belgium.

Background: ST-segment deviation post-electrical cardioversion is a common finding amongst a significant number of patients. However, the mechanism by which this phenomenon occurs and its clinical implications are not fully understood.

Case Summary: Four patients presented to our department with complaints of palpitations. Read More

Medicine (Baltimore) 2020 Feb;99(7):e19156

Letterkenny University Hospital. Co. Donegal, Ireland.

Rationale: Atrial fibrillation (AF) is encountered rarely in pregnancy. Management of maternal AF is challenging as it poses a threat to both maternal and fetal well-being.

Patient Concerns: We report a case of a 35 weeks pregnant woman who presented in emergency with sudden-onset palpitations and mild shortness of breath with no personal/family history of cardiac diseases. Read More

J Asthma 2021 04 6;58(4):471-480. Epub 2020 Jan 6.

Department of Pediatrics Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.

Introduction: Albuterol can trigger supraventricular tachycardia (SVT). The clinical characteristics, incidence, and risk factors of SVT after inhaled SABA treatment in children are currently unknown. Through review of regional care delivery, we will describe cases of SVT during asthma treatment in hospital-based settings, define the incidence of SVT in our population, and evaluate risk factors of SABA-induced SVT. Read More

J Obstet Gynaecol Can 2020 Aug 25;42(8):1012-1015. Epub 2019 Dec 25.

Department of Obstetrics and Gynecology, McGill University, Montréal, QC; Department of Maternal-Fetal Medicine, Jewish General Hospital, Montréal, QC.

Background: The hemodynamic and physiological changes of pregnancy may predispose women to cardiac arrhythmias such as atrial fibrillation (AF). Nevertheless, new-onset AF in pregnancy remains rare, and treatment is challenging. Current recommendations are to treat pregnant women with AF as non-pregnant adults, by using pharmacological or synchronized electrical cardioversion, without mention of gestational age or possibility of delivery. Read More

Medicina (Kaunas) 2019 Sep 30;55(10). Epub 2019 Sep 30.

Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Via del Vespro 129, p.c. 90127 Palermo, Italy.

Atrial fibrillation the most common cardiac arrhythmia. Its incidence rises steadily with each decade, becoming a real "epidemic phenomenon". Cardioversion is defined as a rhythm control strategy which, if successful, restores normal sinus rhythm. Read More

Pediatr Emerg Care 2020 Aug;36(8):e451-e455

Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL.

Objective: The aim of the study was to compare emergency medical service resuscitation of pediatric and adult high-fidelity manikins in unstable supraventricular tachycardia. The primary objective was time to cardioversion. The secondary objective was to assess if the cardioversion was synchronized at the correct dosage for the manikin's weight. Read More

Ann Emerg Med 2019 06;73(6):627-630

Emergency Department, Naval Medical Center San Diego, San Diego, CA.

Pacing Clin Electrophysiol 2019 07 29;42(7):830-835. Epub 2019 May 29.

Diabetes Center Bochum-Hattingen, Medical Department I, St Josef-Hospital, University Hospital of the Ruhr-University Bochum, Bochum, Germany.

Background: Near-infrared spectroscopy (NIRS) is a noninvasive method to measure regional tissue oxygenation (rSO ). In patients with atrial fibrillation (AF), cardiac output and endothelial function are altered. Peripheral tissue oxygenation may therefore be reduced. Read More

Pol Merkur Lekarski 2019 Apr;46(274):187-189

Department of Electrocardiology, the John Paul II Hospital, Cracow, Poland, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.

Cardiovascular implantable electronic devices (CIED) encompass permanent cardiac pacemakers (PM) and implantable cardioverterdefibrillators (ICD). CIED play an important role in treatment of cardiac arrhythmias, including significant bradyarrhythmias and tachyarrhythmias. The conventional right ventricular endocardial leads as well as right ventricular pacing may increase valvular defects (especially dysfunction of tricuspid and mitral valve), cause adverse cardiac remodelling and lead to a decrease in left ventricular ejection fraction. Read More

Toxicon 2018 Jun 31;148:33-39. Epub 2018 Mar 31.

Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.

A 42-year-old previously healthy male patient died 16 days after a proven hump-nosed pit viper (Hypnale hypnale) envenoming due to multi-organ failure. On admission he had cardiac arrest that recovered from cardiopulmonary resuscitation then developed atrial fibrillation which was reverted to normal rhythm by application of synchronized electrical cardioversion. He also had persistent coagulopathy and thrombotic microangiopathy comprising the triad of microangiopathic haemolysis, acute kidney injury and thrombocytopenia. Read More

BMC Cardiovasc Disord 2018 03 13;18(1):51. Epub 2018 Mar 13.

Department of Cardiology, Wenzhou People's Hospital, Wenzhou, Zhejiang Province, 325000, China.

Background: Atrial fibrillation (AF) usually originates from pulmonary veins (PVs) but can also be caused by pulmonary veins outside, such as the coronary sinus (CS), the superior vena cava (SVC), and the ligament of Marshall.

Case Presentation: A 69-year-old male with a history of palpitations for 10 years was referred to our institute because of its recurrence for half a day. A dynamic electrocardiogram revealed sinus rhythm (SR) and paroxysmal AF. Read More

Acute Crit Care 2018 Feb 20;33(1):46-50. Epub 2017 Feb 20.

Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.

The most common cardiac complications detected during pregnancy are an arrhythmia. However, idiopathic continuous monomorphic ventricular tachycardia (VT) during pregnancy is unusual. A 31-year-old pregnant woman presented at 20 weeks of gestation with progressive palpitation and episodes of agitation. Read More