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Edward L C Pritchett - One of the best experts on this subject based on the ideXlab platform.
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CLINICAL INVESTIGATION The spontaneous occurrence of Paroxysmal Supraventricular Tachycardia
2016Co-Authors: Edward L C Pritchett, Elizabeth A. Mccarthy, Mark Stafford Smith, L. Lee, Ph. DAbstract:ABSTRACT The seemingly unpredictable occurrence of Paroxysmal Supraventricular Tachycardia has impeded understanding of its clinical course. We documented recurring Tachycardia by telephone transmission of the electrocardiogram in 14 patients and measured the "Tachycardia-free periods" between the start of therapy and the first recurrence of Tachycardia and between successive recurrences. We showed that attacks of Tachycardia were clinically independent by calculating the autocorrelation function for 12 to 14 consecutive Tachycardia-free periods. We also found that the periods between attacks closely fit an exponential probability distribution, indicating that the occurrence of Tachycardia in time was a type of random event called a Poisson process. Furthermore, occurrence of Tachycardia was uniformly distributed throughout a dosing interval; there was no predilection for Tachycardia to occur late in a dosing interval when plasma drug levels were presumed to be lowest. Measuring the Tachycardia-free period is a simple and useful method for objectively studying Paroxysmal supraven-tricular Tachycardia and may be applied to the study of other Paroxysmal arrhythmias. Circulation 70, No. 1, 1-6, 1984. Paroxysmal Supraventricular Tachycardia occurs sporadically in affected patients; attacks sometimes oc
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Incidence of symptomatic atrial fibrillation in patients with Paroxysmal Supraventricular Tachycardia
Journal of the American College of Cardiology, 1995Co-Authors: Mark E. Hamer, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Robert L. Page, Edward L C PritchettAbstract:Objectives. This study was performed to determine the incidence of symptomatic, sustained atrial fibrillation in a group of patients with Paroxysmal Supraventricular Tachycardia. The effects of the mechanism of Paroxysmal Supraventricular Tachycardia (atrioventricular [AV] node reentry vs. AV reentry through an accessory pathway) and heart rate during the Tachycardia on the occurrence of atrial fibrillation were also assessed. Background. There is a substantial incidence of atrial fibrillation in patients with Paroxysmal Supraventricular Tachycardia, but the precise incidence and the factors that determine it are unknown. Methods. One hundred sixty-nine patients with Paroxysmal Supraventricular Tachycardia were followed up by regular clinic visits and transtelephonic electrocardiographic monitoring during symptomatic episodes of arrhythmia. The Kaplan-Meier product-limit method was used to estimate the proportion of patients remaining free of atrial fibrillation during the observation period. The Cox proportional hazards model was used to assess the effect of mechanism and heart rate during Paroxysmal Supraventricular Tachycardia on the atrial fibrillation—free period. Results. Thirty-two (19%) of the 169 patients had an episode of atrial fibrillation during a mean follow-up period of 31 months. The cumulative percent of patients experiencing an episode of atrial fibrillation was 6% within 1 month, 9% within 4 months and 12% within 1 year. The mechanism of Paroxysmal Supraventricular Tachycardia was not associated with the time to occurrence of atrial fibrillation; the hazard ratio corresponding to classification in the AV node reentry group was 0.8 (p > 0.6). The heart rate during Paroxysmal Supraventricular Tachycardia was not associated with the time to occurrence of atrial fibrillation; the hazard ratio associated with an increase in heart rate of 50 beats/min during the Tachycardia was 1.15 (p > 0.5). Conclusions. This study suggests that atrial fibrillation will develop in ∼12% of patients with Paroxysmal Supraventricular Tachycardia during a 1-year follow-up period. The occurrence of atrial fibrillation is not related to the mechanism or heart rate of the Paroxysmal Supraventricular Tachycardia.
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asymptomatic arrhythmias in patients with symptomatic Paroxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia
Circulation, 1994Co-Authors: Robert L. Page, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:BACKGROUNDParoxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.METHODS AND RESULTSTwenty-two patients with Paroxysmal atrial fibrillation (n = 8) or Paroxysmal Supraventricular Tachycardia (n = 14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, beta-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for al...
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asymptomatic arrhythmias in patients with symptomatic Paroxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia
Circulation, 1994Co-Authors: Robert L. Page, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:BACKGROUNDParoxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.METHODS AND RESULTSTwenty-two patients with Paroxysmal atrial fibrillation (n = 8) or Paroxysmal Supraventricular Tachycardia (n = 14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, beta-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for al...
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Treatment of Paroxysmal Supraventricular Tachycardia with oral diltiazem.
Clinical pharmacology and therapeutics, 1992Co-Authors: Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:Symptomatic Paroxysmal Supraventricular Tachycardia is a troubling arrhythmia for many patients. To test the efficacy of oral diltiazem to reduce symptomatic recurrences of Paroxysmal Supraventricular Tachycardia, we enrolled 17 patients in a double-blind, placebo-controlled crossover study. Sixteen of 17 patients completed a dose-ranging phase and were entered into the randomized phase. Although the time to first recurrence of Tachycardia was slightly longer when patients took diltiazem, the difference was not significant (p = 0.15). The hazard ratio of the time to first recurrence on placebo compared with oral diltiazem was 2.7 (95% confidence interval, 0.8 to 9.1). Of the patients who had a recurrence of Tachycardia in both treatment periods, the median reduction in heart rate in patients receiving diltiazem was 20 beats/min. (p < 0.01; 95% confidence interval, 6 to 42). Clinical Pharmacology and Therapeutics (1992) 51, 562–565; doi:10.1038/clpt.1992.63
Alan H. Kadish - One of the best experts on this subject based on the ideXlab platform.
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termination of Paroxysmal Supraventricular Tachycardia by tecadenoson cvt 510 a novel a1 adenosine receptor agonist
Journal of the American College of Cardiology, 2003Co-Authors: Eric N Prystowsky, Imran Niazi, Anne B Curtis, David J Wilber, Tristram D Bahnson, Kenneth A Ellenbogen, Anwer Dhala, Daniel M Bloomfield, Michael S Gold, Alan H. KadishAbstract:AbstractObjectives: The aim of this study was to evaluate tecadenoson safety and efficacy during conversion of Paroxysmal Supraventricular Tachycardia (PSVT) to sinus rhythm.Background: Tecadenoson...
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The Response of Paroxysmal Supraventricular Tachycardia to Overdrive Atrial and Ventricular Pacing
Journal of cardiovascular electrophysiology, 1993Co-Authors: Alan H. KadishAbstract:Pacing During Supraventricular Tachycardia. Introduction: Standard electrophysiologic techniques generally allow discrimination among mechanisms of Paroxysmal Supraventricular Tachycardia. The purpose of this study was to determine whether the response of Paroxysmal Supraventricular Tachycardia to atrial and ventricular overdrive pacing can help determine the Tachycardia mechanism. Methods and Results: Fifty-three patients with Paroxysmal Supraventricular Tachycardia were studied. Twenty-two patients had the typical form of atrioventricular (AV) junctional (nodal) reentry, 18 patients had orthodromic AV reentrant Tachycardia, 10 patients had atrial Tachycardia, and 3 patients had the atypical form of AV nodal reentrant Tachycardia. After Paroxysmal Supraventricular Tachycardia was induced, 15-beat trains were introduced in the high right atrium and right ventricular apex sequentially with cycle lengths beginning 10 msec shorter than the spontaneous Tachycardia cycle length. The pacing cycle length was shortened in successive trains until a cycle of 200 msec was reached or until Tachycardia was terminated. Several responses of Paroxysmal Supraventricular Tachycardia to overdrive pacing were useful in distinguishing atrial Tachycardia from other mechanisms of Paroxysmal Supraventricular Tachycardia. During decremental atrial overdrive pacing, the curve relating the pacing cycle length to the VA interval on the first beat following the cessation of atrial pacing was flat or upsloping in patients with AV junctional reentry or AV reentrant Tachycardia, but variable in patients with atrial Tachycardia. AV reentry and AV junctional reentry could always be terminated by overdrive ventricular pacing whereas atrial Tachycardia was terminated in only one of ten patients (P < 0.001). The curve relting the ventricular pacing cycle length to the VA interval on the first postpacing beat was flat or upsloping in patients with AV junctional reentry and AV reentry, but variable in patients with atrial Tachycardia. The typical form of AV junctional reentry could occasionally be distinguished from other forms of Paroxysmal Supraventricular Tachycardia by the shortening of the AH interval following Tachycardia termination during constant rate atrial pacing. Conclusions: Atrial and ventricular overdrive pacing can rapidly and reliably distinguish atrial Tachycardia from other mechanisms of Paroxysmal Supraventricular Tachycardia and occasionally assist in the diagnosis of other Tachycardia mechanisms. In particular, the ability to exclude atrial Tachycardia as a potential mechanism for Paroxysmal Supraventricular Tachycardia has important implications for the use of catheter ablation techniques to cure Paroxysmal Supraventricular Tachycardia.
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The response of Paroxysmal Supraventricular Tachycardia to overdrive atrial and ventricular pacing: can it help determine the Tachycardia mechanism?
Journal of cardiovascular electrophysiology, 1993Co-Authors: Alan H. Kadish, Fred MoradyAbstract:Pacing During Supraventricular Tachycardia. Introduction: Standard electrophysiologic techniques generally allow discrimination among mechanisms of Paroxysmal Supraventricular Tachycardia. The purpose of this study was to determine whether the response of Paroxysmal Supraventricular Tachycardia to atrial and ventricular overdrive pacing can help determine the Tachycardia mechanism. Methods and Results: Fifty-three patients with Paroxysmal Supraventricular Tachycardia were studied. Twenty-two patients had the typical form of atrioventricular (AV) junctional (nodal) reentry, 18 patients had orthodromic AV reentrant Tachycardia, 10 patients had atrial Tachycardia, and 3 patients had the atypical form of AV nodal reentrant Tachycardia. After Paroxysmal Supraventricular Tachycardia was induced, 15-beat trains were introduced in the high right atrium and right ventricular apex sequentially with cycle lengths beginning 10 msec shorter than the spontaneous Tachycardia cycle length. The pacing cycle length was shortened in successive trains until a cycle of 200 msec was reached or until Tachycardia was terminated. Several responses of Paroxysmal Supraventricular Tachycardia to overdrive pacing were useful in distinguishing atrial Tachycardia from other mechanisms of Paroxysmal Supraventricular Tachycardia. During decremental atrial overdrive pacing, the curve relating the pacing cycle length to the VA interval on the first beat following the cessation of atrial pacing was flat or upsloping in patients with AV junctional reentry or AV reentrant Tachycardia, but variable in patients with atrial Tachycardia. AV reentry and AV junctional reentry could always be terminated by overdrive ventricular pacing whereas atrial Tachycardia was terminated in only one of ten patients (P < 0.001). The curve relting the ventricular pacing cycle length to the VA interval on the first postpacing beat was flat or upsloping in patients with AV junctional reentry and AV reentry, but variable in patients with atrial Tachycardia. The typical form of AV junctional reentry could occasionally be distinguished from other forms of Paroxysmal Supraventricular Tachycardia by the shortening of the AH interval following Tachycardia termination during constant rate atrial pacing. Conclusions: Atrial and ventricular overdrive pacing can rapidly and reliably distinguish atrial Tachycardia from other mechanisms of Paroxysmal Supraventricular Tachycardia and occasionally assist in the diagnosis of other Tachycardia mechanisms. In particular, the ability to exclude atrial Tachycardia as a potential mechanism for Paroxysmal Supraventricular Tachycardia has important implications for the use of catheter ablation techniques to cure Paroxysmal Supraventricular Tachycardia.
Elizabeth A. Mccarthy - One of the best experts on this subject based on the ideXlab platform.
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CLINICAL INVESTIGATION The spontaneous occurrence of Paroxysmal Supraventricular Tachycardia
2016Co-Authors: Edward L C Pritchett, Elizabeth A. Mccarthy, Mark Stafford Smith, L. Lee, Ph. DAbstract:ABSTRACT The seemingly unpredictable occurrence of Paroxysmal Supraventricular Tachycardia has impeded understanding of its clinical course. We documented recurring Tachycardia by telephone transmission of the electrocardiogram in 14 patients and measured the "Tachycardia-free periods" between the start of therapy and the first recurrence of Tachycardia and between successive recurrences. We showed that attacks of Tachycardia were clinically independent by calculating the autocorrelation function for 12 to 14 consecutive Tachycardia-free periods. We also found that the periods between attacks closely fit an exponential probability distribution, indicating that the occurrence of Tachycardia in time was a type of random event called a Poisson process. Furthermore, occurrence of Tachycardia was uniformly distributed throughout a dosing interval; there was no predilection for Tachycardia to occur late in a dosing interval when plasma drug levels were presumed to be lowest. Measuring the Tachycardia-free period is a simple and useful method for objectively studying Paroxysmal supraven-tricular Tachycardia and may be applied to the study of other Paroxysmal arrhythmias. Circulation 70, No. 1, 1-6, 1984. Paroxysmal Supraventricular Tachycardia occurs sporadically in affected patients; attacks sometimes oc
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Incidence of symptomatic atrial fibrillation in patients with Paroxysmal Supraventricular Tachycardia
Journal of the American College of Cardiology, 1995Co-Authors: Mark E. Hamer, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Robert L. Page, Edward L C PritchettAbstract:Objectives. This study was performed to determine the incidence of symptomatic, sustained atrial fibrillation in a group of patients with Paroxysmal Supraventricular Tachycardia. The effects of the mechanism of Paroxysmal Supraventricular Tachycardia (atrioventricular [AV] node reentry vs. AV reentry through an accessory pathway) and heart rate during the Tachycardia on the occurrence of atrial fibrillation were also assessed. Background. There is a substantial incidence of atrial fibrillation in patients with Paroxysmal Supraventricular Tachycardia, but the precise incidence and the factors that determine it are unknown. Methods. One hundred sixty-nine patients with Paroxysmal Supraventricular Tachycardia were followed up by regular clinic visits and transtelephonic electrocardiographic monitoring during symptomatic episodes of arrhythmia. The Kaplan-Meier product-limit method was used to estimate the proportion of patients remaining free of atrial fibrillation during the observation period. The Cox proportional hazards model was used to assess the effect of mechanism and heart rate during Paroxysmal Supraventricular Tachycardia on the atrial fibrillation—free period. Results. Thirty-two (19%) of the 169 patients had an episode of atrial fibrillation during a mean follow-up period of 31 months. The cumulative percent of patients experiencing an episode of atrial fibrillation was 6% within 1 month, 9% within 4 months and 12% within 1 year. The mechanism of Paroxysmal Supraventricular Tachycardia was not associated with the time to occurrence of atrial fibrillation; the hazard ratio corresponding to classification in the AV node reentry group was 0.8 (p > 0.6). The heart rate during Paroxysmal Supraventricular Tachycardia was not associated with the time to occurrence of atrial fibrillation; the hazard ratio associated with an increase in heart rate of 50 beats/min during the Tachycardia was 1.15 (p > 0.5). Conclusions. This study suggests that atrial fibrillation will develop in ∼12% of patients with Paroxysmal Supraventricular Tachycardia during a 1-year follow-up period. The occurrence of atrial fibrillation is not related to the mechanism or heart rate of the Paroxysmal Supraventricular Tachycardia.
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asymptomatic arrhythmias in patients with symptomatic Paroxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia
Circulation, 1994Co-Authors: Robert L. Page, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:BACKGROUNDParoxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.METHODS AND RESULTSTwenty-two patients with Paroxysmal atrial fibrillation (n = 8) or Paroxysmal Supraventricular Tachycardia (n = 14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, beta-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for al...
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asymptomatic arrhythmias in patients with symptomatic Paroxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia
Circulation, 1994Co-Authors: Robert L. Page, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:BACKGROUNDParoxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.METHODS AND RESULTSTwenty-two patients with Paroxysmal atrial fibrillation (n = 8) or Paroxysmal Supraventricular Tachycardia (n = 14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, beta-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for al...
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Treatment of Paroxysmal Supraventricular Tachycardia with oral diltiazem.
Clinical pharmacology and therapeutics, 1992Co-Authors: Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:Symptomatic Paroxysmal Supraventricular Tachycardia is a troubling arrhythmia for many patients. To test the efficacy of oral diltiazem to reduce symptomatic recurrences of Paroxysmal Supraventricular Tachycardia, we enrolled 17 patients in a double-blind, placebo-controlled crossover study. Sixteen of 17 patients completed a dose-ranging phase and were entered into the randomized phase. Although the time to first recurrence of Tachycardia was slightly longer when patients took diltiazem, the difference was not significant (p = 0.15). The hazard ratio of the time to first recurrence on placebo compared with oral diltiazem was 2.7 (95% confidence interval, 0.8 to 9.1). Of the patients who had a recurrence of Tachycardia in both treatment periods, the median reduction in heart rate in patients receiving diltiazem was 20 beats/min. (p < 0.01; 95% confidence interval, 6 to 42). Clinical Pharmacology and Therapeutics (1992) 51, 562–565; doi:10.1038/clpt.1992.63
Walter K Clair - One of the best experts on this subject based on the ideXlab platform.
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Incidence of symptomatic atrial fibrillation in patients with Paroxysmal Supraventricular Tachycardia
Journal of the American College of Cardiology, 1995Co-Authors: Mark E. Hamer, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Robert L. Page, Edward L C PritchettAbstract:Objectives. This study was performed to determine the incidence of symptomatic, sustained atrial fibrillation in a group of patients with Paroxysmal Supraventricular Tachycardia. The effects of the mechanism of Paroxysmal Supraventricular Tachycardia (atrioventricular [AV] node reentry vs. AV reentry through an accessory pathway) and heart rate during the Tachycardia on the occurrence of atrial fibrillation were also assessed. Background. There is a substantial incidence of atrial fibrillation in patients with Paroxysmal Supraventricular Tachycardia, but the precise incidence and the factors that determine it are unknown. Methods. One hundred sixty-nine patients with Paroxysmal Supraventricular Tachycardia were followed up by regular clinic visits and transtelephonic electrocardiographic monitoring during symptomatic episodes of arrhythmia. The Kaplan-Meier product-limit method was used to estimate the proportion of patients remaining free of atrial fibrillation during the observation period. The Cox proportional hazards model was used to assess the effect of mechanism and heart rate during Paroxysmal Supraventricular Tachycardia on the atrial fibrillation—free period. Results. Thirty-two (19%) of the 169 patients had an episode of atrial fibrillation during a mean follow-up period of 31 months. The cumulative percent of patients experiencing an episode of atrial fibrillation was 6% within 1 month, 9% within 4 months and 12% within 1 year. The mechanism of Paroxysmal Supraventricular Tachycardia was not associated with the time to occurrence of atrial fibrillation; the hazard ratio corresponding to classification in the AV node reentry group was 0.8 (p > 0.6). The heart rate during Paroxysmal Supraventricular Tachycardia was not associated with the time to occurrence of atrial fibrillation; the hazard ratio associated with an increase in heart rate of 50 beats/min during the Tachycardia was 1.15 (p > 0.5). Conclusions. This study suggests that atrial fibrillation will develop in ∼12% of patients with Paroxysmal Supraventricular Tachycardia during a 1-year follow-up period. The occurrence of atrial fibrillation is not related to the mechanism or heart rate of the Paroxysmal Supraventricular Tachycardia.
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asymptomatic arrhythmias in patients with symptomatic Paroxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia
Circulation, 1994Co-Authors: Robert L. Page, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:BACKGROUNDParoxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.METHODS AND RESULTSTwenty-two patients with Paroxysmal atrial fibrillation (n = 8) or Paroxysmal Supraventricular Tachycardia (n = 14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, beta-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for al...
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asymptomatic arrhythmias in patients with symptomatic Paroxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia
Circulation, 1994Co-Authors: Robert L. Page, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:BACKGROUNDParoxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.METHODS AND RESULTSTwenty-two patients with Paroxysmal atrial fibrillation (n = 8) or Paroxysmal Supraventricular Tachycardia (n = 14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, beta-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for al...
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Treatment of Paroxysmal Supraventricular Tachycardia with oral diltiazem.
Clinical pharmacology and therapeutics, 1992Co-Authors: Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:Symptomatic Paroxysmal Supraventricular Tachycardia is a troubling arrhythmia for many patients. To test the efficacy of oral diltiazem to reduce symptomatic recurrences of Paroxysmal Supraventricular Tachycardia, we enrolled 17 patients in a double-blind, placebo-controlled crossover study. Sixteen of 17 patients completed a dose-ranging phase and were entered into the randomized phase. Although the time to first recurrence of Tachycardia was slightly longer when patients took diltiazem, the difference was not significant (p = 0.15). The hazard ratio of the time to first recurrence on placebo compared with oral diltiazem was 2.7 (95% confidence interval, 0.8 to 9.1). Of the patients who had a recurrence of Tachycardia in both treatment periods, the median reduction in heart rate in patients receiving diltiazem was 20 beats/min. (p < 0.01; 95% confidence interval, 6 to 42). Clinical Pharmacology and Therapeutics (1992) 51, 562–565; doi:10.1038/clpt.1992.63
William E Wilkinson - One of the best experts on this subject based on the ideXlab platform.
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Incidence of symptomatic atrial fibrillation in patients with Paroxysmal Supraventricular Tachycardia
Journal of the American College of Cardiology, 1995Co-Authors: Mark E. Hamer, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Robert L. Page, Edward L C PritchettAbstract:Objectives. This study was performed to determine the incidence of symptomatic, sustained atrial fibrillation in a group of patients with Paroxysmal Supraventricular Tachycardia. The effects of the mechanism of Paroxysmal Supraventricular Tachycardia (atrioventricular [AV] node reentry vs. AV reentry through an accessory pathway) and heart rate during the Tachycardia on the occurrence of atrial fibrillation were also assessed. Background. There is a substantial incidence of atrial fibrillation in patients with Paroxysmal Supraventricular Tachycardia, but the precise incidence and the factors that determine it are unknown. Methods. One hundred sixty-nine patients with Paroxysmal Supraventricular Tachycardia were followed up by regular clinic visits and transtelephonic electrocardiographic monitoring during symptomatic episodes of arrhythmia. The Kaplan-Meier product-limit method was used to estimate the proportion of patients remaining free of atrial fibrillation during the observation period. The Cox proportional hazards model was used to assess the effect of mechanism and heart rate during Paroxysmal Supraventricular Tachycardia on the atrial fibrillation—free period. Results. Thirty-two (19%) of the 169 patients had an episode of atrial fibrillation during a mean follow-up period of 31 months. The cumulative percent of patients experiencing an episode of atrial fibrillation was 6% within 1 month, 9% within 4 months and 12% within 1 year. The mechanism of Paroxysmal Supraventricular Tachycardia was not associated with the time to occurrence of atrial fibrillation; the hazard ratio corresponding to classification in the AV node reentry group was 0.8 (p > 0.6). The heart rate during Paroxysmal Supraventricular Tachycardia was not associated with the time to occurrence of atrial fibrillation; the hazard ratio associated with an increase in heart rate of 50 beats/min during the Tachycardia was 1.15 (p > 0.5). Conclusions. This study suggests that atrial fibrillation will develop in ∼12% of patients with Paroxysmal Supraventricular Tachycardia during a 1-year follow-up period. The occurrence of atrial fibrillation is not related to the mechanism or heart rate of the Paroxysmal Supraventricular Tachycardia.
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asymptomatic arrhythmias in patients with symptomatic Paroxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia
Circulation, 1994Co-Authors: Robert L. Page, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:BACKGROUNDParoxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.METHODS AND RESULTSTwenty-two patients with Paroxysmal atrial fibrillation (n = 8) or Paroxysmal Supraventricular Tachycardia (n = 14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, beta-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for al...
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asymptomatic arrhythmias in patients with symptomatic Paroxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia
Circulation, 1994Co-Authors: Robert L. Page, Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:BACKGROUNDParoxysmal atrial fibrillation and Paroxysmal Supraventricular Tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.METHODS AND RESULTSTwenty-two patients with Paroxysmal atrial fibrillation (n = 8) or Paroxysmal Supraventricular Tachycardia (n = 14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, beta-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for al...
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Treatment of Paroxysmal Supraventricular Tachycardia with oral diltiazem.
Clinical pharmacology and therapeutics, 1992Co-Authors: Walter K Clair, Elizabeth A. Mccarthy, William E Wilkinson, Edward L C PritchettAbstract:Symptomatic Paroxysmal Supraventricular Tachycardia is a troubling arrhythmia for many patients. To test the efficacy of oral diltiazem to reduce symptomatic recurrences of Paroxysmal Supraventricular Tachycardia, we enrolled 17 patients in a double-blind, placebo-controlled crossover study. Sixteen of 17 patients completed a dose-ranging phase and were entered into the randomized phase. Although the time to first recurrence of Tachycardia was slightly longer when patients took diltiazem, the difference was not significant (p = 0.15). The hazard ratio of the time to first recurrence on placebo compared with oral diltiazem was 2.7 (95% confidence interval, 0.8 to 9.1). Of the patients who had a recurrence of Tachycardia in both treatment periods, the median reduction in heart rate in patients receiving diltiazem was 20 beats/min. (p < 0.01; 95% confidence interval, 6 to 42). Clinical Pharmacology and Therapeutics (1992) 51, 562–565; doi:10.1038/clpt.1992.63