Search Our Scientific Publications & Authors

Int J Clin Pract 2021 Jun 9:e14480. Epub 2021 Jun 9.

Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Shmu'el Bait St 12, Jerusalem, Israel, 9103102.

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 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

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 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 Apr 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

CJEM 2018 10 23;20(S2):S56-S60. Epub 2018 Jan 23.

†St. Michael's Hospital,Emergency Medicine,Toronto,ON.

ABSTRACTSustained monomorphic ventricular tachycardia (VT) can result in hypoperfusion or devolve into more dangerous rhythms such as ventricular fibrillation. In an unstable patient with VT and a pulse, synchronized cardioversion is the first-line treatment. When the VT is refractory to standard cardioversion, the next step is to add an antiarrhythmic, such as amiodarone, that carries with it the risk of lowering blood pressure in the already hypotensive patient. Read More

Circ Arrhythm Electrophysiol 2017 Dec;10(12)

From the Nora Eccles Harrison Cardiovascular Research and Training Institute (N.P., R.R., D.J.D.), Division of Cardiothoracic Surgery, Department of Surgery (D.J.D.), and Division of Cardiovascular Medicine, Department of Medicine (L.L., R.R., D.J.D.), University of Utah, Salt Lake City; and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (J.H., R.E.I.).

Background: Understanding the mechanisms that drive ventricular fibrillation is essential for developing improved defibrillation techniques to terminate ventricular fibrillation (VF). Distinct organization patterns of chaotic, regular, and synchronized activity were previously demonstrated in VF that persisted over 1 to 2 minutes (long-duration VF [LDVF]). We hypothesized that activity on the endocardium may be driving these activation patterns in LDVF and that unsuccessful defibrillation shocks may alter activation patterns. Read More

Vet Clin North Am Small Anim Pract 2017 Sep 20;47(5):977-988. Epub 2017 Jun 20.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853-6401, USA. Electronic address:

A rate control, or a rhythm control, strategy can be applied to the management of atrial fibrillation. Rate control of atrial fibrillation consists of decreasing the ventricular response rate by limiting the number of supraventricular impulses that can travel through the atrioventricular node. The goal of decreasing heart rate in dogs with atrial fibrillation is usually achieved with a combination of the calcium channel blocker diltiazem and digoxin. Read More

Ann Emerg Med 2018 Jan 27;71(1):109-112. Epub 2017 May 27.

Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR.

The simultaneous use of 2 external defibrillators to administer either dual or sequential cardioversion or defibrillation for refractory cardiac arrhythmias is increasing in both the out-of-hospital and inhospital settings. Using 2 defibrillators to administer higher energy levels than can be achieved with a single defibrillator is considered off-label and is currently not part of published advanced cardiac life support guidelines. We report the first case in which the use of dual-dose cardioversion was associated with external defibrillator damage. Read More

Am J Cardiol 2017 06 29;119(12):1997-2002. Epub 2017 Mar 29.

Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, China.

Use of the antiarrhythmic ibutilide after isolated pulmonary vein isolation (PVI) might distinguish atrial remodeling severity and cases requiring further substrate modification, thereby improving efficacy of persistent atrial fibrillation (AF) treatment. Ninety-six consecutive patients with persistent AF were randomized after PVI to either direct current synchronized cardioversion (DCC group, n = 48) or 1 mg of intravenous ibutilide (ibutilide group, n = 48) followed by no further intervention if AF converted to sinus rhythm (SR) within 30 minutes (ibutilide conversion subgroup) or by complex fractionated atrial electrogram (CFAE) ablation until SR recovery or complete CFAE elimination (ibutilide nonconversion subgroup). With similarly distributed baseline characteristics and no serious postablation complications, the primary end point of 12-month SR maintenance rate after PVI was significantly higher for ibutilide versus the DCC group before (75% vs 56%; p = 0. Read More

Curr Med Res Opin 2017 08 8;33(8):1497-1504. Epub 2017 Jun 8.

a First Department of Cardiology , Hippokration Hospital, University of Athens , Athens , Greece.

Background: Atrial fibrillation (AF) constitutes a relatively infrequent pregnancy complication, which may be a therapeutic Gordian knot. Indeed, sparse data exist regarding the prevalence, prognosis, and management of AF during pregnancy. In general, AF occurs as a benign, self-limited arrhythmia, but occasionally may have severe hemodynamic consequences in pregnant patients suffering from heart failure, congenital heart disease, or other comorbidities. Read More

PLoS One 2017 28;12(3):e0174510. Epub 2017 Mar 28.

Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China.

Objective: To evaluate the effect of catheter ablation vs. direct current synchronized cardioversion (DCC) in patients with persistent atrial fibrillation (AF) and left ventricular systolic dysfunction, and to define baseline features of patients that will get more benefit from ablation.

Methods: From July 2013 to October 2014, 97 consecutive single-center patients with persistent AF and symptomatic heart failure (left ventricular ejection fraction (LVEF) <50%) underwent DCC followed by amiodarone (n = 40) or circumferential pulmonary vein isolation (PVI; n = 57) according to patient's preference were recruited in the study. Read More

J Pediatr 2017 02 29;181:177-182.e2. Epub 2016 Nov 29.

Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address:

Objective: To characterize the management of acute pediatric supraventricular tachycardia (SVT), placing special emphasis on infants, patients refractory to adenosine (refractory SVT), and patients with hypotension, poor perfusion, or altered mental status (unstable SVT).

Study Design: Retrospective cohort study of patients 0-18 years of age without congenital heart disease who presented to our pediatric hospital from January 2003 to December 2012 for the treatment of acute SVT. Multiple logistic regression was applied to identify whether age was a risk factor for different SVT therapies. Read More

CJEM 2017 Jul 13;19(4):312-316. Epub 2016 Sep 13.

*Department of Internal Medicine,Jena University Hospital,Jena,Germany.

Atrial fibrillation (AF) is a frequent reason for emergency department visits. According to current guidelines either rate- or rhythm-control are acceptable therapeutic options in such situations. In this report, we present the complicated clinical course of a patient with AF and a rapid ventricular response. Read More