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2015 SVT Guideline Data SupplementsTable of Contents TOC \o "1-1" \h \z \t "DS Title Level 1,1" Data Supplement 1. Nonrandomized Trials, Observational Studies, and/or Registries of Clinical Presentation and Differential Diagnosis Based on Symptoms – Section 2.3.1 PAGEREF _Toc428873443 \h 3Data Supplement 2. Randomized Trials Comparing Principles of Acute and Chronic Therapy – Section 2.4 PAGEREF _Toc428873444 \h 8Data Supplement 3. Nonrandomized Trials, Observational Studies, and/or Registries of Principles of Acute and Chronic Therapy – Section 2.4 PAGEREF _Toc428873445 \h 18Data Supplement 4. Randomized Trials Comparing Sinus Tachyarrhythmias – Section 3 PAGEREF _Toc428873446 \h 26Data Supplement 5. Nonrandomized Trials, Observational Studies, and/or Registries of Sinus Tachyarrhythmias – Section 3 PAGEREF _Toc428873447 \h 28Data Supplement 6. Nonrandomized Trials, Observational Studies, and/or Registries of Focal Atrial Tachycardia – Section 4.1 PAGEREF _Toc428873448 \h 33Data Supplement 7. Randomized Trials Comparing Multifocal Atrial Tachycardia – Section 4.2 PAGEREF _Toc428873449 \h 37Data Supplement 8. Nonrandomized Trials, Observational Studies, and/or Registries of Multifocal Atrial Tachycardia – Section 4.2 PAGEREF _Toc428873450 \h 38Data Supplement 9. Randomized Trials Comparing Atrioventricular Nodal Re-Entrant Tachycardia – Section 5 PAGEREF _Toc428873451 \h 39Data Supplement 10. Nonrandomized Trials, Observational Studies, and/or Registries of Atrioventricular Nodal Re-Entrant Tachycardia – Section 5 PAGEREF _Toc428873452 \h 57Data Supplement 11. Randomized Trials Comparing Manifest and Concealed Accessory Pathways – Section 6.1 PAGEREF _Toc428873453 \h 65Data Supplement 12. Nonrandomized Trials, Observations Studies, and/or Registires of Manifest and Concealed Accessory Pathways – Section 6.1 PAGEREF _Toc428873454 \h 66Data Supplement 13. Summary of Included Studies – ERC Report (Section 6.2) PAGEREF _Toc428873455 \h 71Data Supplement 14. Comparators and Outcomes – ERC Report (Section 6.2) PAGEREF _Toc428873456 \h 73Data Supplement 15. Quality Assesment of Included Studies – ERC Report (Section 6.2) PAGEREF _Toc428873457 \h 76Data Supplement 16. Randomized Trials Comparing Atrial Flutter – Section 7 PAGEREF _Toc428873458 \h 77Data Supplement 17. Nonrandomized Trials, Observational Studies, and/or Registries of Atrial Flutter – Section 7 PAGEREF _Toc428873459 \h 95Data Supplement 18. Randomized Trials for Junctional Tachycardia – Section 8 PAGEREF _Toc428873460 \h 99Data Supplement 19. Nonrandomized Trials, Observational Studies, and/or Registries of Junctional Tachycardia – Section 8 PAGEREF _Toc428873461 \h 99Data Supplement 20. Nonrandomized Trials, Observational Studies, and/or Registries of Special Populations – Section 9 PAGEREF _Toc428873462 \h 102Data Supplement 21. Randomized Trials Comparing Special Populations – Section 9 PAGEREF _Toc428873463 \h 122Data Supplement 22. Nonrandomized Trials, Observational Studies, and/or Registries of Quality-of-Life Considerations – Section 10 PAGEREF _Toc428873464 \h 123Data Supplement 23. Nonrandomized Trials, Observational Studies, and/or Registries of Cost Effectiveness – Section 11 PAGEREF _Toc428873465 \h 127Appendix 1. Acute Drug Therapy for SVT, Intravenous Administration* PAGEREF _Toc428873466 \h 132Appendix 2. Ongoing Drug Therapy for SVT, Oral Administration* PAGEREF _Toc428873467 \h 135Appendix 3. Success and Complication Rates for Ablation of SVT* PAGEREF _Toc428873468 \h 140References PAGEREF _Toc428873469 \h 141Methodology and Evidence ReviewThe recommendations listed in this guideline are, whenever possible, evidence based. An extensive evidence review was conducted in April 2014 that included literature published through September 2014. Other selected references published through May 2015 were incorporated by the writing committee. Literature included was derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. The relevant search terms and data are included in Data Supplement evidence tables. Key search words included but were not limited to the following: ablation therapy (catheter and radiofrequency; fast and slow pathway), accessory pathway (manifest and concealed), antiarrhythmic drugs, atrial fibrillation, atrial tachycardia, atrioventricular nodal reentrant (reentry, reciprocating) tachycardia, atrioventricular reentrant (reentry, reciprocating) tachycardia, beta blockers, calcium channel blockers, cardiac imaging, cardioversion, cost effectiveness, cryotherapy, echocardiography, elderly (aged and older), focal atrial tachycardia, Holter monitor, inappropriate sinus tachycardia, junctional tachycardia, multifocal atrial tachycardia, paroxysmal supraventricular tachycardia, permanent form of junctional reciprocating tachycardia, pre-excitation, pregnancy, quality of life, sinoatrial node, sinus node reentry, sinus tachycardia, supraventricular tachycardia, supraventricular arrhythmia, tachycardia, tachyarrhythmia, vagal maneuvers (Valsalva maneuver), and Wolff-Parkinson-White syndrome. Data Supplement 1. Nonrandomized Trials, Observational Studies, and/or Registries of Clinical Presentation and Differential Diagnosis Based on Symptoms – Section 2.3.1StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsSganzerla P1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Sganzerla</Author><Year>1989</Year><RecNum>47</RecNum><IDText>Electrophysiologic and haemodynamic correlates in supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>47</Ref_ID><Title_Primary>Electrophysiologic and haemodynamic correlates in supraventricular tachycardia</Title_Primary><Authors_Primary>Sganzerla,P.</Authors_Primary><Authors_Primary>Fabbiocchi,F.</Authors_Primary><Authors_Primary>Grazi,S.</Authors_Primary><Authors_Primary>Cipolla,C.</Authors_Primary><Authors_Primary>Moruzzi,P.</Authors_Primary><Authors_Primary>Guazzi,M.D.</Authors_Primary><Date_Primary>1989/1</Date_Primary><Keywords>Adult</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>Cardiac Output</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Hemodynamics</Keywords><Keywords>Humans</Keywords><Keywords>Italy</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>32</Start_Page><End_Page>39</End_Page><Periodical>Eur Heart J</Periodical><Volume>10</Volume><Issue>1</Issue><ISSN_ISBN>0195-668X</ISSN_ISBN><Address>Istituto di Cardiologia, University of Milan, Italy</Address><Web_URL>PM:2702964</Web_URL><ZZ_JournalFull><f name="System">European heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(1)2702964Prospective, nonrandomized16AVNRTAll AVNRT Relationship between hemodynamic changes associated w/ artificially induced arrhythmias and the EP properties of the related AV nodal reentryGroup 1 AVNRT w/ short RPGroup 2 AVNRT w/ long RPNo significant difference between the CLs of the two types of SVT (329 and 330-8 ms)Atypical SVT differed from the typical one by a significantly smaller initial decrease and a more rapid recovery of BP. In group 1, cardiac output and arterial pressure were lower in SVR higher and PAP equal.Contraction on a closed valve may be a factor resulting in impaired pulmonary drainage leading to neural factors w/ reduced cardiac output.The induction of typical SVT (long AH) caused a marked initial fall in systemic BP w/ only a partial recovery, leading to stable hypotension and reduction of cardiac output owing to a decrease in stroke volume. On the contrary, in comparison to sinus rhythm, during the atypical SVT (long HA) a lesser degree of initial hypotension, a complete recovery of BP and no significant change in cardiac output were observed. The different hemodynamic response between the two types of SVT took place w/ the same increase in heart rate indicating that rate is not involved per se in the genesis of these circulatory changes. Simultaneous contraction more symptomatic for people. Bhandari AK1992PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJoYW5kYXJpPC9BdXRob3I+PFllYXI+MTk5MjwvWWVhcj48
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ADDIN EN.CITE.DATA (2)1636582Prospective study115 pts who were enrolled in a multicenter clinical trial of flecainidePts w/ SVT or AF or both,49 had SVTDetermine whether sx recorded w/ transtelephonic monitoring correlated w/ SVT or AFAmong 49 pts w/ PSVT, 62.7% of symptomatic calls were associated w/ ECG-documented PSVT as compared?w/ 6.6% of asymptomatic calls (p<0.001).The sensitivity of a symptomatic call was 91% for PSVTLeitch JW1992 ADDIN REFMGR.CITE <Refman><Cite><Author>Leitch</Author><Year>1992</Year><RecNum>41</RecNum><IDText>Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>41</Ref_ID><Title_Primary>Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?</Title_Primary><Authors_Primary>Leitch,J.W.</Authors_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Yee,R.</Authors_Primary><Authors_Primary>Leather,R.A.</Authors_Primary><Authors_Primary>Kim,Y.H.</Authors_Primary><Date_Primary>1992/3</Date_Primary><Keywords>Adult</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>complications</Keywords><Keywords>diagnostic use</Keywords><Keywords>etiology</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Isoproterenol</Keywords><Keywords>methods</Keywords><Keywords>physiology</Keywords><Keywords>physiopathology</Keywords><Keywords>Posture</Keywords><Keywords>Syncope</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Vasomotor System</Keywords><Reprint>Not in File</Reprint><Start_Page>1064</Start_Page><End_Page>1071</End_Page><Periodical>Circulation</Periodical><Volume>85</Volume><Issue>3</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Medicine, University of Western Ontario, London, Canada</Address><Web_URL>PM:1537103</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(3)1537103Prospective, nonrandomizedN=2222 pts w/ SVTAVNRT 13AVRT 8AT 111 had a h/o syncopeExplore the mechanism of syncope during SVTLowest BP found in 1st 10 secCompensated BP w/in 60 sec w/ minimal change in CLshorter and BP lower w/ upright tiltComparison of the 7 pts w/ and the 15 pts w/o syncope. The only significant differences occurred in the extent of BP decrease during tachycardia (decrease in mean BP, 70±4 compared w/ 45+5 mm Hg; p=0.01) and in the frequency w/ which syncope occurred during passive tilt testing in sinus rhythm. The CL of tachycardia, in fact, tended to be longer in pts w/ syncope (311±10 compared w/ 290±+11 msec, p=0.27).Syncope is associated w/ vasodepressor mechanism and is not directly related to the tachycardia CLLee SH1995 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxlZTwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (4)7572623Retrospective review207 consecutive pts w/ h/o SVT107 pts AP mediated, 100 pts w/ AVNRTDetermine effects of pregnancy on SVT3.9% experienced first onset of SVT during pregnancy. Sx were exacerbated in 22% of pts w/ tachycardia in the pregnant and non-pregnant periods. Pregnancy exacerbates SVT in some but not all pts. Drago F1996 ADDIN REFMGR.CITE <Refman><Cite><Author>Drago</Author><Year>1996</Year><RecNum>32</RecNum><IDText>Reciprocating supraventricular tachycardia in children: low rate at rest as a major factor related to propensity to syncope during exercise</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>32</Ref_ID><Title_Primary>Reciprocating supraventricular tachycardia in children: low rate at rest as a major factor related to propensity to syncope during exercise</Title_Primary><Authors_Primary>Drago,F.</Authors_Primary><Authors_Primary>Turchetta,A.</Authors_Primary><Authors_Primary>Calzolari,A.</Authors_Primary><Authors_Primary>Giordano,U.</Authors_Primary><Authors_Primary>Di,Ciommo,V</Authors_Primary><Authors_Primary>Santilli,A.</Authors_Primary><Authors_Primary>Pompei,E.</Authors_Primary><Authors_Primary>Ragonese,P.</Authors_Primary><Date_Primary>1996/8</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Aged</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Child</Keywords><Keywords>complications</Keywords><Keywords>Electrocardiography</Keywords><Keywords>etiology</Keywords><Keywords>Exercise</Keywords><Keywords>Exercise Test</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Italy</Keywords><Keywords>Male</Keywords><Keywords>physiology</Keywords><Keywords>physiopathology</Keywords><Keywords>Syncope</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>280</Start_Page><End_Page>285</End_Page><Periodical>Am Heart J</Periodical><Volume>132</Volume><Issue>2 Pt 1</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Address>Department of Pediatric Cardiology, Bambino Gesu Children's Hospital, Scientific Institute of Research, Rome, Italy</Address><Web_URL>PM:8701888</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(5)8701888Prospective, nonrandomizedN = 22childrenVentriculoatrial interval <70 msec in 11 pts and >70 msec in 11The aim of this study was to evaluate, by using transesophageal atrial pacing and recording, the clinical and EP features of reciprocating SVT at rest and during exercise and to determine the factors related to syncope during high adrenergic tone.Group A = SVT, palpitationsGroup B = SVT near syncopeInduced SVT via esoph pacing in both groups.AVRT faster when induced during exerciseRate of SVT unrelated to sx of pre-syncopeGoyal R1996 ADDIN REFMGR.CITE <Refman><Cite><Author>Goyal</Author><Year>1996</Year><RecNum>36</RecNum><IDText>Comparison of the ages of tachycardia onset in patients with atrioventricular nodal reentrant tachycardia and accessory pathway-mediated tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>36</Ref_ID><Title_Primary>Comparison of the ages of tachycardia onset in patients with atrioventricular nodal reentrant tachycardia and accessory pathway-mediated tachycardia</Title_Primary><Authors_Primary>Goyal,R.</Authors_Primary><Authors_Primary>Zivin,A.</Authors_Primary><Authors_Primary>Souza,J.</Authors_Primary><Authors_Primary>Shaikh,S.A.</Authors_Primary><Authors_Primary>Harvey,M.</Authors_Primary><Authors_Primary>Bogun,F.</Authors_Primary><Authors_Primary>Daoud,E.</Authors_Primary><Authors_Primary>Man,K.C.</Authors_Primary><Authors_Primary>Strickberger,S.A.</Authors_Primary><Authors_Primary>Morady,F.</Authors_Primary><Date_Primary>1996/10</Date_Primary><Keywords>Adult</Keywords><Keywords>Age of Onset</Keywords><Keywords>epidemiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>765</Start_Page><End_Page>767</End_Page><Periodical>Am Heart J</Periodical><Volume>132</Volume><Issue>4</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Misc_3>S0002-8703(96)90308-7</Misc_3><Address>Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA</Address><Web_URL>PM:8831363</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(6)88313631996;132:765-7Observational519 231 AVNRT288 AVRTAVNRT or AVRTAssessment of age of onsetThe mean age of sx onset was 32±18 y for AVNRT and 23±14 y for AP-mediated tachycardia. 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ADDIN EN.CITE.DATA (7)9392809Prospective study of pts w/ SVT N=3213 AVNRT4 atrial flutter15 AVRT32 consecutive pts w/ PSVTHypothesis was that pts w/ AVNRT would have more sx of diuresis because of higher right pressureIncreased diuresis in 12/13 (92%) of pts w/ AVNRT; 2/15 (13%) AVRT; and 1/4 atrial flutter w/ 2:1 AV conduction. Measured right atrial pressure and plasma ANP in 14 of 32 pts. RA pressure higher in AVNRT compared to the other tachycardias (16 vs. 5; p<0.01) and ANP levels also higher (215 vs. 63; p<0.001) Sx of diuresis more common w/ AVNRT. The higher secretion of ANP may be the mechanism because there is a linear relationship between plasma ANP levels and atrial pressure Lessmeier TJ1997 ADDIN REFMGR.CITE <Refman><Cite><Author>Lessmeier</Author><Year>1997</Year><RecNum>43</RecNum><IDText>Unrecognized paroxysmal supraventricular tachycardia. Potential for misdiagnosis as panic disorder</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>43</Ref_ID><Title_Primary>Unrecognized paroxysmal supraventricular tachycardia. Potential for misdiagnosis as panic disorder</Title_Primary><Authors_Primary>Lessmeier,T.J.</Authors_Primary><Authors_Primary>Gamperling,D.</Authors_Primary><Authors_Primary>Johnson-Liddon,V.</Authors_Primary><Authors_Primary>Fromm,B.S.</Authors_Primary><Authors_Primary>Steinman,R.T.</Authors_Primary><Authors_Primary>Meissner,M.D.</Authors_Primary><Authors_Primary>Lehmann,M.H.</Authors_Primary><Date_Primary>1997/3/10</Date_Primary><Keywords>diagnosis</Keywords><Keywords>Diagnosis,Differential</Keywords><Keywords>Diagnostic Errors</Keywords><Keywords>Electrocardiography,Ambulatory</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Panic Disorder</Keywords><Keywords>physiopathology</Keywords><Keywords>Recurrence</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>537</Start_Page><End_Page>543</End_Page><Periodical>Arch.Intern Med</Periodical><Volume>157</Volume><Issue>5</Issue><ISSN_ISBN>0003-9926</ISSN_ISBN><Address>Department of Internal Medicine, Wayne State University, Detroit, USA</Address><Web_URL>PM:9066458</Web_URL><ZZ_JournalFull><f name="System">Archives of internal medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Arch.Intern Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(8)9066458Retrospective survey119 consecutive ptsLimited to AVRT, AVNRTSystematically evaluate the potential for SVT to simulate panic disorderCriteria for panic disorder per DSM-IV were fulfilled in 67%. SVT unrecognized after initial medical evaluation in 59 (55%) including 41% of 32 w/ preexcitation. Physicians attributed sx to panic, anxiety orstress in 32 of the 59 (54%). SVT unrecognized a median of 3.3 yWomen more likely to be labeled w/ panic than men (65% vs. 32% p<0.04SVT diagnosed in 6 (9%) of 64 pts w/ Holters and 8 (47%) of 17 w/ event monitors (p=0.001)SVT can mimic panic disorders and the diagnosis is often delayed by inappropriate rhythm detection techniques or missed preexcitation. Unrecognized SVT often attributed to psychiatric conditions.Perhaps misdiagnosis happens in women more often due to miscategorization of “feeling” in survey Kalusche D1998 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbHVzY2hlPC9BdXRob3I+PFllYXI+MTk5ODwvWWVhcj48
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ADDIN EN.CITE.DATA (9)9812187Observational395 pt w/ AVNRT85 were >65 yLimited to AVNRTMain objective was to analyze risks and outcomes of ablation, but they also characterized presenting sxsElderly patents (mean 70.4 y) more often had syncope or presyncope w/ AVNRT (43.2% vs. 29.8%; P=0.05); had more hospitalizations and emergency department visits because of their sx 56.8 vs. 39.5% p,0.05 even though the CL was longer in the elderly (368 vs. 325 msec; P=0.0001) Elderly pts have more sxs, ER visits, and hospitalizations despite slower tachycardias. (Outcomes of ablation were no different.)Orejarena LA1998 ADDIN REFMGR.CITE <Refman><Cite><Author>Orejarena</Author><Year>1998</Year><RecNum>45</RecNum><IDText>Paroxysmal supraventricular tachycardia in the general population</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>45</Ref_ID><Title_Primary>Paroxysmal supraventricular tachycardia in the general population</Title_Primary><Authors_Primary>Orejarena,L.A.</Authors_Primary><Authors_Primary>Vidaillet,H.,Jr.</Authors_Primary><Authors_Primary>DeStefano,F.</Authors_Primary><Authors_Primary>Nordstrom,D.L.</Authors_Primary><Authors_Primary>Vierkant,R.A.</Authors_Primary><Authors_Primary>Smith,P.N.</Authors_Primary><Authors_Primary>Hayes,J.J.</Authors_Primary><Date_Primary>1998/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Child</Keywords><Keywords>Emergencies</Keywords><Keywords>epidemiology</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Infant</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prevalence</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Wisconsin</Keywords><Reprint>Not in File</Reprint><Start_Page>150</Start_Page><End_Page>157</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>31</Volume><Issue>1</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Misc_3>S0735-1097(97)00422-1</Misc_3><Address>Marshfield Clinic and the Marshfield Medical Research Foundation, Wisconsin 54449, USA</Address><Web_URL>PM:9426034</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(10)9426034Population epidemiologic researchScreened 50,000Identified 1,763 w/ SVTLimited to PSVTStandard ECG criteria for PSVT were employed: 1) paroxysmal, 2) normal QRS complex configuration or preexisting bundle branch block, 3) variation in successive RR intervals ≤40 msec, 4) ventricular rate 120 bpm, 5) no evidence of AV dissociation, and 6) no identifiable P waves preceding the QRS complex during tachycardia. The aim was to determine the epidemiology and clinical significance of PSVT in the general population. The prevalence was 2.25/1,000 persons and the incidence was 35/100,000 person-ys (95% CI: 23-47).Those w/ lone PSVT were younger (mean 37 vs. 69 y; p<0.0002), had a faster PSVT heart rate (mean 186 vs. 155 bpm; p<0.0006) and were more likely to have their condition first documented in the emergency room (69% vs. 30%; p<0.0377). The onset of sxs occurred during the childbearing y in 58% of females w/ lone PSVT vs. 9% of females w/ other cardio- vascular disease (p<0.0272).21 incident pts (64%) had sxsconcordant w/ PSVT before initial ECG documentation.The probability of recurrence by the end of y 2 of f/u was 0.20 (95% CI: 0.06-0.35). There were no predictors of recurrence. For pts w/ a recurrence, all except one had their first recurrence w/in 12 mo of diagnosis and one had hemodynamic instability. 5 pts died during f/u, none due to PSVT Approximately 89,000 new cases/y and 570,000 persons w/ PSVT in the United States. Erdogan A2001 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkVyZG9nYW48L0F1dGhvcj48WWVhcj4yMDAxPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (11)11785371Cohort survey748 pts who underwent ablation responded to a surveyLimited to AVNRTAnalyze the medical h/o pts w/ AVNRTInterval from onset of sx to ablation was 4.1 +/- 1.5 y. Mean age 55.4 female and 58.7 males. Only 6% had SHD. In females AVNRT appeared after age 50 in 16% and <age 20 in 18%. Women were more symptomatic. Women were more likely to delay ablation (average 7 y) (unknown whether this was due to personal preference or bias due to advice given)High rate of pt w/ AVNRT begin in an older stage of lifeFitzsimmons PJ2001 ADDIN REFMGR.CITE <Refman><Cite><Author>Fitzsimmons</Author><Year>2001</Year><RecNum>34</RecNum><IDText>The natural history of Wolff-Parkinson-White syndrome in 228 military aviators: a long-term follow-up of 22 years</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>34</Ref_ID><Title_Primary>The natural history of Wolff-Parkinson-White syndrome in 228 military aviators: a long-term follow-up of 22 years</Title_Primary><Authors_Primary>Fitzsimmons,P.J.</Authors_Primary><Authors_Primary>McWhirter,P.D.</Authors_Primary><Authors_Primary>Peterson,D.W.</Authors_Primary><Authors_Primary>Kruyer,W.B.</Authors_Primary><Date_Primary>2001/9</Date_Primary><Keywords>Adult</Keywords><Keywords>Cohort Studies</Keywords><Keywords>Death,Sudden,Cardiac</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Military Personnel</Keywords><Keywords>pathology</Keywords><Keywords>Patient Selection</Keywords><Keywords>Questionnaires</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Telephone</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>530</Start_Page><End_Page>536</End_Page><Periodical>Am Heart J</Periodical><Volume>142</Volume><Issue>3</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Misc_3>S0002-8703(01)18940-4;10.1067/mhj.2001.117779</Misc_3><Address>Internal Medicine Branch, Aeromedical Consultation Service, US Air Force School of Aerospace Medcine, Brooks AFB, Tex., USA</Address><Web_URL>PM:11526369</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(12)11526369Retrospective review238 aviatorsFocused on manifest WPWReport the natural h/o WPW in a nontertiary care population for the development of SCD and SVT232 males, 6 womenmedian age 35 (17-56)11.7% had sx suggestive of SVT. 1 had syncope and 12 had near syncope. During f/u SVT occurred in 20.6%. SCD in 1 (0.02%)Incidence of SVT is 1% per pt y. SCD risk lowHamdan MH2001 ADDIN REFMGR.CITE <Refman><Cite><Author>Hamdan</Author><Year>2001</Year><RecNum>37</RecNum><IDText>Effect of P-wave timing during supraventricular tachycardia on the hemodynamic and sympathetic neural response</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>37</Ref_ID><Title_Primary>Effect of P-wave timing during supraventricular tachycardia on the hemodynamic and sympathetic neural response</Title_Primary><Authors_Primary>Hamdan,M.H.</Authors_Primary><Authors_Primary>Zagrodzky,J.D.</Authors_Primary><Authors_Primary>Page,R.L.</Authors_Primary><Authors_Primary>Wasmund,S.L.</Authors_Primary><Authors_Primary>Sheehan,C.J.</Authors_Primary><Authors_Primary>Adamson,M.M.</Authors_Primary><Authors_Primary>Joglar,J.A.</Authors_Primary><Authors_Primary>Smith,M.L.</Authors_Primary><Date_Primary>2001/1/2</Date_Primary><Keywords>Baroreflex</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Hemodynamics</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Pacemaker,Artificial</Keywords><Keywords>Peroneal Nerve</Keywords><Keywords>physiopathology</Keywords><Keywords>Regression Analysis</Keywords><Keywords>Sympathetic Nervous System</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>96</Start_Page><End_Page>101</End_Page><Periodical>Circulation</Periodical><Volume>103</Volume><Issue>1</Issue><ISSN_ISBN>1524-4539</ISSN_ISBN><Address>University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas, TX 75216, USA. Hamdan@ryburn.swmed.edu44195</Address><Web_URL>PM:11136692</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(13)11136692Prospective analysis112112 pts w/ pacemakersExamine effect of atrial timing during simulated tachycardia on hemodynamic and neural responses.Decrease in BP greatest w/ simultaneous pacing, less w/ short RP, and least w/ long RPIncrease in CVP followed same trendSNA% increased w/ all three, but most pronounced w/ simultaneous AV and most w/ short RPArterial baroreflex SNA correlated modestly w/ change in CVPSNA increases during all pacing modesDecrease in BP and pulse pressure, which is directly related to the tachycardia rate, cardiac function, and AV synchrony. At any given rate, the timing of atrial systole has been shown to alter the hemodynamic response.Razavi M2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Razavi</Author><Year>2005</Year><RecNum>46</RecNum><IDText>Acute blood pressure changes after the onset of atrioventricular nodal reentrant tachycardia: a time-course analysis</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>46</Ref_ID><Title_Primary>Acute blood pressure changes after the onset of atrioventricular nodal reentrant tachycardia: a time-course analysis</Title_Primary><Authors_Primary>Razavi,M.</Authors_Primary><Authors_Primary>Luria,D.M.</Authors_Primary><Authors_Primary>Jahangir,A.</Authors_Primary><Authors_Primary>Hodge,D.O.</Authors_Primary><Authors_Primary>Low,P.A.</Authors_Primary><Authors_Primary>Shen,W.K.</Authors_Primary><Date_Primary>2005/10</Date_Primary><Keywords>Adult</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiologic Techniques,Cardiac</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Posture</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Time Factors</Keywords><Reprint>Not in File</Reprint><Start_Page>1037</Start_Page><End_Page>1040</End_Page><Periodical>J Cardiovasc Electrophysiol.</Periodical><Volume>16</Volume><Issue>10</Issue><ISSN_ISBN>1045-3873</ISSN_ISBN><Misc_3>JCE40731;10.1111/j.1540-8167.2005.40731.x</Misc_3><Address>Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA</Address><Web_URL>PM:16191112</Web_URL><ZZ_JournalFull><f name="System">Journal of cardiovascular electrophysiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Cardiovasc Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(14)16191112ObservationalN=17AVNRTChange in BP over timeBP decreased immediately after AVNRT initiation, w/ gradual recovery during the first 30 sec from 71.9±16.5 mm Hg to 86±13.8 mm Hg, p<0.01. When upright, the mean BP time course was similar, but mean BP recovery during AVNRT was slowerA short AV interval is associated w/ a greater mean BP decrease at the onset of tachycardia. These observations may explain clinical sxs immediately after the onset of AVNRTWalfidsson U2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Walfridsson</Author><Year>2005</Year><RecNum>48</RecNum><IDText>The impact of supraventricular tachycardias on driving ability in patients referred for radiofrequency catheter ablation</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>48</Ref_ID><Title_Primary>The impact of supraventricular tachycardias on driving ability in patients referred for radiofrequency catheter ablation</Title_Primary><Authors_Primary>Walfridsson,U.</Authors_Primary><Authors_Primary>Walfridsson,H.</Authors_Primary><Date_Primary>2005/3</Date_Primary><Keywords>Adult</Keywords><Keywords>Automobile Driving</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Chi-Square Distribution</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Interviews as Topic</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>physiopathology</Keywords><Keywords>Quality of Life</Keywords><Keywords>Statistics,Nonparametric</Keywords><Keywords>surgery</Keywords><Keywords>Syncope</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>191</Start_Page><End_Page>195</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>28</Volume><Issue>3</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Misc_3>PACE9753;10.1111/j.1540-8159.2005.09753.x</Misc_3><Address>Department of Cardiology, University Hospital, Linkoping, Sweden. ulla.walfridsson@lio.se</Address><Web_URL>PM:15733177</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(15)15733177Survey of pts referred for ablation301 pts226 active driversLimited to AVRT and AVNRTEvaluate the sx in pt w/ SVT and impact on drivingIn 226 active drivers, fatigue 77%, dizziness 47%, diaphoresis 52%, near syncope 50%, and syncope14% reported w/ SVT. Women had more sxs for each category. 57% experienced SVT while driving and 42% had to stop because of it (during that episode). 24 pts considered SVT an obstacle to driving. SVT is frequent while driving and can be associated w/ near syncope or syncope. Women seemed to have worse sxs. Pts w/ near syncope or syncope more likely to consider SVT an obstacle to drivingDrago F2006 ADDIN REFMGR.CITE <Refman><Cite><Author>Drago</Author><Year>2006</Year><RecNum>31</RecNum><IDText>Atrioventricular nodal reentrant tachycardia in children</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>31</Ref_ID><Title_Primary>Atrioventricular nodal reentrant tachycardia in children</Title_Primary><Authors_Primary>Drago,F.</Authors_Primary><Authors_Primary>Grutter,G.</Authors_Primary><Authors_Primary>Silvetti,M.S.</Authors_Primary><Authors_Primary>De,Santis A.</Authors_Primary><Authors_Primary>Di,Ciommo,V</Authors_Primary><Date_Primary>2006/7</Date_Primary><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Body Surface Potential Mapping</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>diagnosis</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrophysiologic Techniques,Cardiac</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Italy</Keywords><Keywords>Male</Keywords><Keywords>pathology</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Recurrence</Keywords><Keywords>Severity of Illness Index</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>454</Start_Page><End_Page>459</End_Page><Periodical>Pediatr.Cardiol</Periodical><Volume>27</Volume><Issue>4</Issue><ISSN_ISBN>0172-0643</ISSN_ISBN><Misc_3>10.1007/s00246-006-1279-2</Misc_3><Address>Department of Pediatric Cardiology, Bambino Gesu Hospital, P.zza Sant'Onofiro, 400165 Rome, Italy. drago@</Address><Web_URL>PM:16835801</Web_URL><ZZ_JournalFull><f name="System">Pediatric cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pediatr.Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(16)16835801Observational62 childrenLimited to AVNRT. Determine whether severity of sxs was related to EP characteristicsWhen pts w/ severe sxs were compared to those w/ mild sxs there was no difference in inducibility, CL of AVNRT, or the ERPs of the fast and slow pathways The severity of sxs was not related to EP characteristics. -Although this study focused on children, the results are probably applicable to adultsGonzalez-Torrecilla E2009 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdvbnphbGV6LVRvcnJlY2lsbGE8L0F1dGhvcj48WWVhcj4y
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ADDIN EN.CITE.DATA (17)19539146Prospective analysis370 consecutive pts who underwent EP studyAVRNT 262 (23 atypical)ORT 108Excluded manifest preexcitationAssess the independent predictive contribution to the ECG of clinical variables to distinguish major forms of SVT370 consecutive ptsECG interpreted by 2 independent observersAVNRT more likely to be female, older age of onset (>30)Correct ECG interpretation more frequent in the AVRT groupRapid pounding in the neck more common w/ AVNRT (51% vs. 25%)Age at the onset of sxs, sensation of rapid regular pounding in the neck during tachycardia, and female sex are the only significant clinical variablesLaurent G2009 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxhdXJlbnQ8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (18)18775049Mechanism of sx in SVT not understood. They evaluated VA timingSurvey included 152 pts w/ AVNRT and 80 w/ AVRTHemodynamic studies on 18 w/ AVRT and AVNRT326 pts w/ a variety of clinically documented tachycardias (AVNRT, AVRT, VT, atrial flutter, AF completed a brief self-administered questionnaire regarding the occurrence of 5 sxs: “neck pounding,” chest pounding, palpitations, “shirt flapping,” and dizziness. This paper focuses on AVRTMeasured left atrial pressure during AVRT and simulated AVRT and AVNRT by the timing of pacing the atria and ventricles. Sx of “shirt flapping” and “neck pounding” occur more frequently in AVNRT. Left atrial contractions during AV valve closure increase left atrial pressure and may explain the differences in sx between AVNRT and AVRT. Other sxs were about the same (chest pounding, palpitations, dizziness)Arterial pressures were significantly lower and left atrial pressures were significantly higher during native AVRT, simulated AVRT and AVNRT compared w/ sinus rhythm. Simulated AVRT created similar hemodynamic conditions as seen during native AVRT. Simulated AVNRT produced significantly higher left atrial pressure (peak and mean) than simulated AVRT.The sx of “shirt flapping” appears to be associated w/ pulsatile reversed flow in the pulmonary veins due to left atrial contraction against closed MV and is more common w/ AVNRTWalfridsson U2009 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldhbGZyaWRzc29uPC9BdXRob3I+PFllYXI+MjAwOTwvWWVh
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ADDIN EN.CITE.DATA (19)19702600QOL survey97 AVNRT79 AVRTFocused on pts w/ AVRT and AVNRTQOL scoresQOL scores were lower for pts w/ AVNRT compared to AVRT. Scores were affected by occurrence more than once a mo, arrhythmia duration, and whether sx occurred not only during exercise but also at rest. The main conclusion was that QOL scores may direct therapy. Kesek M2011 ADDIN REFMGR.CITE <Refman><Cite><Author>Kesek</Author><Year>2011</Year><RecNum>39</RecNum><IDText>Symptomatic improvement after catheter ablation of supraventricular tachycardia measured by the arrhythmia-specific questionnaire U22</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>39</Ref_ID><Title_Primary>Symptomatic improvement after catheter ablation of supraventricular tachycardia measured by the arrhythmia-specific questionnaire U22</Title_Primary><Authors_Primary>Kesek,M.</Authors_Primary><Authors_Primary>Ronn,F.</Authors_Primary><Authors_Primary>Tollefsen,T.</Authors_Primary><Authors_Primary>Hoglund,N.</Authors_Primary><Authors_Primary>Naslund,U.</Authors_Primary><Authors_Primary>Jensen,S.M.</Authors_Primary><Date_Primary>2011/3</Date_Primary><Keywords>Accessory Atrioventricular Bundle</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Questionnaires</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>52</Start_Page><End_Page>59</End_Page><Periodical>Ups.J Med Sci.</Periodical><Volume>116</Volume><Issue>1</Issue><User_Def_5>PMC3039761</User_Def_5><ISSN_ISBN>2000-1967</ISSN_ISBN><Misc_3>10.3109/03009734.2010.517875</Misc_3><Address>Department of Cardiology, Heart Centre, University Hospital, Umea, Sweden. milos.kesek@medicin.umu.se</Address><Web_URL>PM:21077786</Web_URL><ZZ_JournalFull><f name="System">Upsala journal of medical sciences</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ups.J Med Sci.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(20)21077786Assessment of the U22 survey for clinical sxs before and after ablation156 pts who underwent ablation of SVTAVNRT and AVRTQOL scoresMean age 43.9 AVNRT vs. 57.1 AVRTMen 65% AVRT and 38% AVNRT71% took medications prior to ablationQOL scores using either the U22 or SF-36 improved after ablation. Cain N2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Cain</Author><Year>2013</Year><RecNum>30</RecNum><IDText>Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>30</Ref_ID><Title_Primary>Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood</Title_Primary><Authors_Primary>Cain,N.</Authors_Primary><Authors_Primary>Irving,C.</Authors_Primary><Authors_Primary>Webber,S.</Authors_Primary><Authors_Primary>Beerman,L.</Authors_Primary><Authors_Primary>Arora,G.</Authors_Primary><Date_Primary>2013/10/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Asymptomatic Diseases</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>complications</Keywords><Keywords>Death,Sudden,Cardiac</Keywords><Keywords>diagnosis</Keywords><Keywords>Disease Progression</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Male</Keywords><Keywords>mortality</Keywords><Keywords>physiopathology</Keywords><Keywords>Remission,Spontaneous</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>961</Start_Page><End_Page>965</End_Page><Periodical>Am J Cardiol</Periodical><Volume>112</Volume><Issue>7</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(13)01233-2;10.1016/j.amjcard.2013.05.035</Misc_3><Address>Medical University of South Carolina, Charleston, South Carolina. Electronic address: cainn@musc.edu</Address><Web_URL>PM:23827401</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(21)23827401Retrospective review446 pts Pts <21 w/ WPW (median age of diagnosis was 7y)Modes of presentationModes of presentation included SVT (38%), palpitations (22%), chest pain (5%), syncope (4%), AF (0.4%), sudden death (0.2%), and incidental findings (26%); data were unavailable in 4% 64% had sxs at presentation, and an additional 20% developed sxs during f/u. There were 6 sudden deaths (1.3%), w/ an overall incidence of 1.1 per 1,000 pt-y in pts w/ structurally normal hearts and 27 per 1,000 pt-y in pts w/ associated heart disease.Although this was a pediatric study, it provides historical data that we can expect adults to describe. 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ADDIN EN.CITE.DATA (22)23129107Retrospective analysis113AVRT or AVNRT pts (9-13 y)Evaluated cognitive and emotional development in a group of children and adolescents w/ AVRT and AVNRT.Mean age AVRT 8Meant age AVNRT 1132% had hx syncope, more frequently w/ AVRT (37.5% vs. 24%; p=0.16)Deficiencies in cognitive function were prevalent.Anxiety levels increase w/ the appearance of sxs. Both AVRT and AVNRT in childhood and adolescence can have a negative impact on cognitive and emotional development. Pts experiencing AVRT in the first y of life are likely to exhibit particularly severe deficits in cognitive function, including memory.AF indicates atrial fibrillation; AP, accessory pathway; ANP, atrial natriuretic peptide; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; AT, atrial tachycardia; BP, blood pressure; bpm, beats per minute; CL, cycle length; CVP, central venous pressure; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders-IV; ECG, echocardiogram; EP, electrophysiological; ERP, effective refractory period; f/u, follow up; h/o, history of; MV, ??; ORT, orthodromic reentrant tachycardia; PAP, pulmonary arterial pressure; PSVT, paroxysmal supraventricular tachycardia; pt, patient; QOL, quality of life; RA, right arterial; SCD, sudden cardiac death; SF-36, Short-Form (36) Healt Survey; SHD, structural heart disease; SNA, sympathetic nerve activity; SVR, systemic valvular resistance; SVT, supraventricular tachycardia; sx, symptom; sx, symptom; U22 questionnaire, Umea 22 Arrhythmia Questions; VA, ventricular arrhythmia; VT, ventricular tachycardia; w/, with; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 2. Randomized Trials Comparing Principles of Acute and Chronic Therapy – Section 2.4 Study Name, Author, YearAim of StudyStudy Type (Size, N)Study Intervention Group (n)Study Comparator Group (n)Pt PopulationEndpointsP Values, OR: HR: RR: & 95% CI:Study Limitations & Adverse EventsInclusion CriteriaExclusion CriteriaPrimary Endpoint (efficacy) and ResultsSafety Endpoint and ResultsSecondary Endpoint and ResultsMauritson1982 ADDIN REFMGR.CITE <Refman><Cite><Author>Mauritson</Author><Year>1982</Year><RecNum>7</RecNum><IDText>Oral verapamil for paroxysmal supraventricular tachycardia: a long-term, double-blind randomized trial</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>7</Ref_ID><Title_Primary>Oral verapamil for paroxysmal supraventricular tachycardia: a long-term, double-blind randomized trial</Title_Primary><Authors_Primary>Mauritson,D.R.</Authors_Primary><Authors_Primary>Winniford,M.D.</Authors_Primary><Authors_Primary>Walker,W.S.</Authors_Primary><Authors_Primary>Rude,R.E.</Authors_Primary><Authors_Primary>Cary,J.R.</Authors_Primary><Authors_Primary>Hillis,L.D.</Authors_Primary><Date_Primary>1982/4</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Drug Evaluation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Random Allocation</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Time Factors</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>409</Start_Page><End_Page>412</End_Page><Periodical>Ann Intern Med</Periodical><Volume>96</Volume><Issue>4</Issue><ISSN_ISBN>0003-4819</ISSN_ISBN><Web_URL>PM:7065555</Web_URL><ZZ_JournalFull><f name="System">Annals of internal medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Intern Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(23) 7065555Effectiveness and safety of oral verapamil11Verapamil 240 mg/d followed by 480 mg/d (n=11)PlaceboSymptomatic PSVT, ≥2 episodes/mo, ascertained by ECGAVNRT(n=7)AVRT(n=2 w/ WPW, n=3 w/ concealed AP)CHF, severe hypertension, hypotension, VHD or CHD, renal/hepatic failure, SSS, AV block, atrial flutter, AF, AADsEpisodes/d (diary, Holter)Verapamil 0.1±0.1 ,0.3 ±0.5Placebo 0.3±0.3 ,0.7 ±0.7Duration(min) (diary, Holter)Verapamil 3±3 ,1±2Placebo 27±5 ,67±111Minor AEs in 6 pts on verapamil5 pts required a total of 35 cardioversions for sustained tachycardia, 2 during verapamil, 33 during placebo (p<0.001)Programmed electrical stimulation performed at end of study to induce tachycardia. Caused sustained tachycardia in 9 on placebo, 2 on verapamil (p<0.01) N/Ap<0.05 for primary endpointsOral verapamil safe and effective.Small sample size.Unclear which pt withdrew, so numbers of AVNRT vs. AVRT may be similar (i.e., 6 vs. 5). Winniford1984 ADDIN REFMGR.CITE <Refman><Cite><Author>Winniford</Author><Year>1984</Year><RecNum>8</RecNum><IDText>Long-term therapy of paroxysmal supraventricular tachycardia: a randomized, double-blind comparison of digoxin, propranolol and verapamil</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>8</Ref_ID><Title_Primary>Long-term therapy of paroxysmal supraventricular tachycardia: a randomized, double-blind comparison of digoxin, propranolol and verapamil</Title_Primary><Authors_Primary>Winniford,M.D.</Authors_Primary><Authors_Primary>Fulton,K.L.</Authors_Primary><Authors_Primary>Hillis,L.D.</Authors_Primary><Date_Primary>1984/11/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Clinical Trials as Topic</Keywords><Keywords>Digoxin</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Propranolol</Keywords><Keywords>Random Allocation</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>1138</Start_Page><End_Page>1139</End_Page><Periodical>Am J Cardiol</Periodical><Volume>54</Volume><Issue>8</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Web_URL>PM:6388299</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(24)6388299Effect of AV nodal blockers for long-term therapy of PSVT11One mo of:Digoxin 0.375 mg/dPropranolol 240 mg/dVerapamil 480 mg/dDirect comparison between all 3, w/ 1 wk of placebo washoutSymptomatic PSVT, ≥2 episodes/mo, ascertained by ECGECG evidence of preexcitationEpisodes and duration (ascertained by diary and weekly 24 h Holter), adverse effects, SDCs of each drugEpisodes/wk (diary, Holter)Digoxin 2.3±3.1, 1.9±2.9Propranolol 1.5±2.3 ,0.2±0.6Verapamil 2.9±5.7 ,0.6 ±1.6Duration(min) (diary, Holter)Digoxin 75±164, 47±157Propranolol 60±112 ,1±1Verapamil 56±148 ,1±1Mild side effects in 3/11 pts w/ digoxin and propranolol, and 5/11 w/ verapamil. 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ADDIN EN.CITE.DATA (25)2868645Efficacy of esmolol in treatment of PSVT71Multicenter, double-blind, partial-crossover studyEsmolol (n=36)Placebo (n=35)?“SVT” (HR>120)Note: AVNRT in 18% of subjectsVHD, AV block, SSS, significant electrolyteabnormality,precluding treatment w/ beta blockade, bronchialasthma, ventricular arrhythmias requiring drug therapy,cardiogenic shock, CHF (NYHA III-IV), renal or hepatic dysfunction, drug or alcohol abuse, on other beta-adrenergic blockers or calcium channelblockers w/in two half-lives of study entryTherapeutic response: ≥20% reduction in HR, HR<100 bpm, or conversion to NSR.Therapeutic response to esmolol during the initial treatment period (72%) similar when esmolol was given as a second agent4 pts (6%) converted to NSRIn the 80% therapeutic response lost w/in 30 min following discontinuation of esmolol infusionHypotension which occurred in12% on esmolol, 2% w/ placebo.N/Ap=NSRapid onset and short ofaction of esmolol offer safe, effective therapy for acute treatment of pts w/ PSVT. Low numbers of pts w/ AVNRT.Henthorn1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Henthorn</Author><Year>1991</Year><RecNum>11</RecNum><IDText>Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>11</Ref_ID><Title_Primary>Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group</Title_Primary><Authors_Primary>Henthorn,R.W.</Authors_Primary><Authors_Primary>Waldo,A.L.</Authors_Primary><Authors_Primary>Anderson,J.L.</Authors_Primary><Authors_Primary>Gilbert,E.M.</Authors_Primary><Authors_Primary>Alpert,B.L.</Authors_Primary><Authors_Primary>Bhandari,A.K.</Authors_Primary><Authors_Primary>Hawkinson,R.W.</Authors_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Date_Primary>1991/1</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Drug Administration Schedule</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>prevention & control</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>119</Start_Page><End_Page>125</End_Page><Periodical>Circulation</Periodical><Volume>83</Volume><Issue>1</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Division of Cardiology, Christ Hospital, Cincinnati, Ohio 45219</Address><Web_URL>PM:1898640</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(26)1898640Flecainide for treatment of symptomatic PSVT (≥2 episodes)348-wk crossover (after four episodes of PSVT or end of treatment period)?Flecainide(n=34)Placebo(n=34)PSVT Syncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA III-IV) Freedom from symptomatic PSVT at 60 d:79% events vs. 15% (p<0.001)Flecainide slowed symptomatic PSVT HR to 143±12 bpm from 178 ±12 on placebo in 7 pts who had events in the placebo and flecainide treatment phases(p<0.02)Significantly more side effects w/ flecainide (p<0.05)Flecainide vs. placebo:Recurrence:8/34 vs. 29/34 (p<0.001).Median time to first event: 55 vs. 11 d (p<0.001)Median interval between episodes >55 vs. 12 d(p<0.001)?N/ADespite participationof 19 medical centers, only 34 pts completed entire protocol and provided analyzable data.All pts tolerated flecainide, limiting generalizability.Transtelephonic monitoring does not permit assessment of proarrhythmia.6/34 w/ AVNRT, confirmed by EP study, and 18/34 w/ unknown mechanism.Pritchett1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Pritchett</Author><Year>1991</Year><RecNum>10</RecNum><IDText>Flecainide acetate treatment of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation: dose-response studies. The Flecainide Supraventricular Tachycardia Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>10</Ref_ID><Title_Primary>Flecainide acetate treatment of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation: dose-response studies. The Flecainide Supraventricular Tachycardia Study Group</Title_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Authors_Primary>DaTorre,S.D.</Authors_Primary><Authors_Primary>Platt,M.L.</Authors_Primary><Authors_Primary>McCarville,S.E.</Authors_Primary><Authors_Primary>Hougham,A.J.</Authors_Primary><Date_Primary>1991/2</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>297</Start_Page><End_Page>303</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>17</Volume><Issue>2</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Address>Duke University Medical Center, Durham, North Carolina 27710</Address><Web_URL>PM:1899432</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(27) 1899432 Dose-response efficacy of flecainide in patents w/ PSVT, PAF, paroxysmal atrial flutter42Flecainide given in ascending order (2550100150 mg bid)PSVT(n=14, Group 1)PAF or parosysmal atrial flutter(n=28, Group 2)Placebo inserted at random (alternating w/ flecainide) at 30 d intervalsPSVT, PAF, or paroxysmal atrial flutterSyncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA III-IV) .Among 14 pts in Group 1 (PSVT) who qualified for efficacy analysis, 4 (29%) had no tachycardia while taking placebo. Number w/ no tachycardia increased w/ progressively larger flecainide doses; w/ the 150 mg twice daily dose, 12 (86%) of 14 pts had no tachycardia (p<0.01 for overall differences among all treatments).Noncardiac adverse experiences were leading cause of premature study discontinuation during flecainide treatment periods (5 pts in Group 1 and 6 pts in Group 2).N/AN/ASmall sample size, short treatment period. Pritchett1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Pritchett</Author><Year>1991</Year><RecNum>9</RecNum><IDText>Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias. A randomized, placebo-controlled, crossover trial in patients tolerating oral therapy</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>9</Ref_ID><Title_Primary>Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias. A randomized, placebo-controlled, crossover trial in patients tolerating oral therapy</Title_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Authors_Primary>McCarthy,E.A.</Authors_Primary><Authors_Primary>Wilkinson,W.E.</Authors_Primary><Date_Primary>1991/4/1</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>blood</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Propafenone</Keywords><Keywords>Recurrence</Keywords><Keywords>Statistics as Topic</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>539</Start_Page><End_Page>544</End_Page><Periodical>Ann Intern Med</Periodical><Volume>114</Volume><Issue>7</Issue><ISSN_ISBN>0003-4819</ISSN_ISBN><Address>Duke University Medical Center, Durham, North Carolina</Address><Web_URL>PM:2001087</Web_URL><ZZ_JournalFull><f name="System">Annals of internal medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Intern Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(28) 2001087Oral propafenone to prevent symptomatic PSVTRandomized, double-blind, placebo-controlled, crossover phase, w/ each treatment period lasting up to 60 d.23Propafenone (n=23)Placebo(n=23)PSVT(n=14) PAF(n=9)Angina during tachycardia, pulmonary edema, neurologicsxs. PAF w/ WPW, on AADsCompared w/ placebo, propafenone caused an increase in time to first recurrence of arrhythmia (p=0.004)PSVT:p=0.03PAF:p=0.06.Cardiac AEs occurred only in pts w/ PAF (9/11): 2 w/ prolonged episode of AF, 1 w/ atrial flutter w/ a mean ventricularrate of 263 bpm recorded using the telephone monitor.HR during recurrences, and not statistically different between propafenone and placeboN/APropafenone efficacious in treating PSVT and PAF.Major limitation in not knowing how many pts had AVNRT. .Anderson1994 ADDIN REFMGR.CITE <Refman><Cite><Author>Anderson</Author><Year>1994</Year><RecNum>12</RecNum><IDText>Flecainide acetate for paroxysmal supraventricular tachyarrhythmias. The Flecainide Supraventricular Tachycardia Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>12</Ref_ID><Title_Primary>Flecainide acetate for paroxysmal supraventricular tachyarrhythmias. The Flecainide Supraventricular Tachycardia Study Group</Title_Primary><Authors_Primary>Anderson,J.L.</Authors_Primary><Authors_Primary>Platt,M.L.</Authors_Primary><Authors_Primary>Guarnieri,T.</Authors_Primary><Authors_Primary>Fox,T.L.</Authors_Primary><Authors_Primary>Maser,M.J.</Authors_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Date_Primary>1994/9/15</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>blood</Keywords><Keywords>Confounding Factors (Epidemiology)</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Time Factors</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>578</Start_Page><End_Page>584</End_Page><Periodical>Am J Cardiol</Periodical><Volume>74</Volume><Issue>6</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Address>Department of Medicine, University of Utah, Salt Lake City</Address><Web_URL>PM:8074041</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(29)8074041 Long-term efficacy of flecainide (≥6 mo)49PSVT(n=21)PAF(n=28)PlaceboPts enrolled from 3 prior studies evaluating short-term flecainide efficacy Syncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA III-IV) -Number of pts w/o attacks-Time to first attack-Interval between attacks-Average frequency of attacks,-Ventricular rate during attacks.PSVT pts:Of 17 efficacy evaluable pts, 14 (82%) had no SVT attacks during the chronic efficacy study compared w/ 4 (24%) w/ no attacks during placebo therapy at baseline (p=0.013).Time to first arrhythmia attack and time between attacks increasedduring chronic therapy w/ flecainide compared w/ placebo treatment (p=0.008 and p=0.012, respectively)Rates of attack/d not significantly different (p=0.130)No PSVT pts w/ ventricular arrhythmiasNo pt experiencedproarrhythmia, MI, or died during chronic efficacy study.N/AN/ASupports flecainide for chronic therapy of PSVT.Small numbers of pts w/ PSVT, and PSVT not specifically defined.Chimienti1995 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNoaW1pZW50aTwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+
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ADDIN EN.CITE.DATA (30)8682031Compare the long-term safety of flecainide and propafenone335SVT:flecainide 100 mg (n = 72) PAF:flecainide 200 mg (n = 97) SVT:propafenone 450 mg (n=63)PAF: propafenone 450 mg (n=103).SVT(n=135)PAF(n=200)LVEF <35%, AV block, QRS >140 msec, SSS, persistent AF (episodes >72 h), VT (episodes >30 sec), NYHA III-IV, ischemic heart disease, hypertrophic cardiomyopathy, hypotension, valvular disease, renal/hepatic insufficiency, thyroid disease, AADsITT analysis (probability of 12 mo safe and effective tx)PSVT:93% for flecainide and 86% for propafenone (p=0.24)PAF:77% for flecainide and 75% for propafenone (p=0.72)12 pts on flecainide reported 16 cardiac AEs, of whom 6 discontinued the treatment. 7 propafenone pts had 8 cardiac AEs, of whom 5 discontinued the treatment.(1 case of VT on propafenone2 cases of AF w/ rapid ventricular response on flecainideN/AN/ABoth flecainide and propafenone were safe in the long-term treatment of pts w/ PSVT.Only one-third of pts had SVT. UK Propafenone PSVT Study Group1995 ADDIN REFMGR.CITE <Refman><Cite><Year>1995</Year><RecNum>14</RecNum><IDText>A randomized, placebo-controlled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. UK Propafenone PSVT Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>14</Ref_ID><Title_Primary>A randomized, placebo-controlled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. UK Propafenone PSVT Study Group</Title_Primary><Date_Primary>1995/11/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>prevention & control</Keywords><Keywords>Propafenone</Keywords><Keywords>Recurrence</Keywords><Keywords>Risk Factors</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>2550</Start_Page><End_Page>2557</End_Page><Periodical>Circulation</Periodical><Volume>92</Volume><Issue>9</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:7586356</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(31) 7586356Efficacy and tolerability of propafenone at 600 mg and 900 mg daily doses (given bid).2 consecutive crossover periods100Propafenone 300 mg bidPropafenone 300 mg tidPlaceboPSVT(n=52) PAF(n=48) 75 pts in low-dose phase:45 PSVT, 30 PAF59 pts advanced to high-dose phase:34 PSVT, 25 PAF ≥2 symptomatic episodes by transtelephonic monitoring PSVT w/ hemodynamic collapse, LVEF ≤25%, recent MI or unstable angina; hepatic/renal failure, SSS, AV block, AADs, female pts of childbearing potential, COPD, myasthenia gravis.Placebo vs. propafenone:PSVT, low-dose:Arrhythmia recurrence or AERR: 6.8 (95% CI: 2.2-21.2; p<0.001), Arrhythmia recurrenceRR: 7.4 (95% CI: 2.3-23.3, p<0.001).PSVT, high-dose:Arrhythmia recurrence or AERR: 2.2 (95% CI: 0.9-5.3, p=NS);Arrhythmia recurrenceRR: 15.0 (95: CI: 2.0-113, p=0.009). More pts experienced more AEs during propafenone (900 mg >600 mg). Most common adverse events during PSVT and PAF groups were related to the gastrointestinal and neuropsychiatric systems. Total numbers of adverse events on propafenone were 46 and 56 in the low-dose and high-dose PSVT group and 67 and 74 in the low-dose and high-dose PAF groups, respectively.1 episode of wide-complex tachycardia was documented during propafenone therapyPropafenone at 600 mg is effective and well tolerated. A larger dose of 900 mg causes more AEs but may be more effective in those who can tolerate itSequential design (not randomized after low-dose phase) so population is not generalizable at 900 mg dose. Not powered for mortality.Limited in that PSVTs included AVNRT, AT, or AVRT.Dorian1996 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRvcmlhbjwvQXV0aG9yPjxZZWFyPjE5OTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (32)8607397Compare oral flecainide to verapamil in preventing PSVT recurrence121 pts at 32 sitesFlecainide (n=63) (50 mg bid increased to max of 300 mg/d)AVNRT(n=17)AVRT(n=6)Unspecified (n=40)Verapamil (n=58) (80 mg tid increased to max of 480 mg/d)AVNRT(n=10)AVRT(n=7)Unspecified (n=41)PSVT, requiring therapy, majority w/ ≥2 attacks per moAVNRTAVRTUnspecified PSVT but w/ clinical diagnosis of PSVTCoexisting PAF, prior MI/UA, NYHA Class III-IV, AV block, preexcitation, AADs86% of all flecainide 73% of all verapamil pt-mo occurred w/ 0-1 attack19 (30%) pts on flecainide vs. 7 (13% of verapamil completed the trial (>270 d) w/o symptomatic attacks (p= 0.026)f/u 8.1 ±5.1 mo for flecainide and 7.5± 5.4 mo w/ verapamil19% of flecainide group vs. 24% verapamil discontinued due to adverse effects (p=NS).Most common sx: flecainide: dizziness, concentration, sleep, nauseaVerapamil: dyspnea, fatigue, HF sxN/AThese agents confer potential benefit in pts who are not candidates for RFAN/AWanless1997PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldhbmxlc3M8L0F1dGhvcj48WWVhcj4xOTk3PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (33)9124166Sotalol in treatment of PSVT126 Sotalol 80 mg(n=35)AVNRT (23%)Sotalol 160 mg(n=46)AVNRT (22%)Placebo(n=45)AVNRT (24%)Recurrent symptomatic PSVT were eligible for enrollment. AVNRTPAFParoxysmal atrial flutterAVRTParoxysmal AT Decompensated CHF, asthma, chronic obstructive airways disease, second degree or third degree AV block, recent MI (<1 mo), recent coronary artery bypass graft surgery (<2 mo), unstable angina pectoris, bradycardia (<50 bpm), SSS, prolonged QTc interval (>0.45 sec), systemic hypertension (diastolic BP >115 mm Hg), electrolyte imbalance, AADsTime to recurrence of PSVT was less compared w/ placebo when receiving sotalol 80 mg (p=0.04) and sotalol 160 mg (p=0.0009). On subanalysis, sotalol was shown to be effective in the prophylaxis of both PAF (p=0.03) and paroxysmal reentrant arrhythmias (p=0.0003).No deaths, cases of ventricular proarrhythmia, CHF. Treatment of pts receiving sotalol were discontinued because of typical beta blocker side effects, including bradycardia, dyspnea, and fatigue.N/AN/ASotalol efficacious in the prophylaxis of PSVT. Study limited due to grouping of PSVTs.Lim1998 ADDIN REFMGR.CITE <Refman><Cite><Author>Lim</Author><Year>1998</Year><RecNum>3</RecNum><IDText>Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>3</Ref_ID><Title_Primary>Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage</Title_Primary><Authors_Primary>Lim,S.H.</Authors_Primary><Authors_Primary>Anantharaman,V.</Authors_Primary><Authors_Primary>Teo,W.S.</Authors_Primary><Authors_Primary>Goh,P.P.</Authors_Primary><Authors_Primary>Tan,A.T.</Authors_Primary><Date_Primary>1998/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Carotid Sinus</Keywords><Keywords>Electric Countershock</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Emergency Treatment</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Massage</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Keywords>Valsalva Maneuver</Keywords><Reprint>Not in File</Reprint><Start_Page>30</Start_Page><End_Page>35</End_Page><Periodical>Ann Emerg.Med</Periodical><Volume>31</Volume><Issue>1</Issue><ISSN_ISBN>0196-0644</ISSN_ISBN><Misc_3>S0196064498000146</Misc_3><Address>Department of Emergency Medicine, Singapore General Hospital, Singapore</Address><Web_URL>PM:9437338</Web_URL><ZZ_JournalFull><f name="System">Annals of emergency medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Emerg.Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(34)9437338Efficacy of VM or CSM to terminate SVT in the EDN=148 Randomized to VM first (62) or CSM first (86), then crossed-over to other therapy if first not effectiveVM (blow into mouthpiece to achieve 40 mm Hg and sustain for at least 30 sec)CSM (randomized first to left or then right CSM)?10 y of age or olderECG w/ obvious atrial flutter, AF or sinus tachycardia, hemodynamically unstable (including poor cerebral perfusion, pulmonary edema or unstable angina). Pts w/ contraindications for CSM (h/o TIA, CVA, carotid bruit)Conversion to SRNo adverse events directly related to VM or CSM. One pt was diagnosed w/ non-Q wave MI. 4 pts admitted for other medical problems (HF, pneumonia)N/A62 VM first, 19.4% conversion;86 CSMc first, 10.5% conversionCrossover: to CSM, 14.0% conversion, and to VM w/ 16.9% conversionTotal conversion rate (VM and CSM, including cross-overs): 27.7%No difference in efficacy between VM and CSMVM more effective in men, CSM more effective in older ptsRecurrences w/in 2 h; 3 VM pts, 1 CSM ptN/AGupta A1999 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkd1cHRhPC9BdXRob3I+PFllYXI+MTk5OTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (35)10778689Efficacy of IV diltiazem vs. esmolol for terminating PSVTN=32 (study terminated prematurely due to superiority of diltiazem)Prospective randomized crossover, open-labeledEsmolol 0.5 mg/kg twice in 5 min intervalDiltiazem 0.25 mg/kg twice in 5 min intervalSVTHemodynamically tolerated in ICUSHD; AT, AF or atrial flutter excludedConversion to SRN/AN/ADiltiazem terminated SVT in all 16 pts where was first drugEsmolol terminated 4/16 (p<0.001 c/w diltiazem) and other 12 then terminated by diltiazem (total for diltiazem 28/28)Of the 28 pts responding to diltiazem a second dose was needed in 13.All 32 pts subsequently underwent EP study; 17 w/ AVNRT, 15 w/ AVRT. Diltiazem: first bolus converted 5/9 pts w/ AVNRT, and 0/7 w/ AVRT (p<0.0001)Esmolol: equally ineffective for either tachycardia mechanismSmall trial, terminated early due to superiority of diltiazem.Alboni2001 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkFsYm9uaTwvQXV0aG9yPjxZZWFyPjIwMDE8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (36)11216977Effectiveness of self-administered flecianide or diltiazem/propranolol to terminate SVTRandomized to placebo, flecainide (3 mg/kg), 120 mg diltiazem/80 mg propranolol on 3 different d for each ptN=33 (37 enrolled)Flecainide (3 mg/kg) or 120 mg diltiazem w/ 80 mg propranololPlaceboHemodynamically tolerated and long-lasting SVT confirmed by EP study to be reentrant (AVNRT or AVRT)Age 18-75, ≤5 episodes/yPreexcitation, CAD, sinus <50 bpm, LVEF <50% or HF, recent MI, or stroke, need for long term beta blocker, calcium channel blocker, digoxin or AAD or h/o sustained atrial or VTConversion w/in 2 h: 52% placebo, 61% flecainide, 94% diltiazem/propranolol (p<0.001). Conversion faster w/ diltiazem/propranolol (p<0.001)Hypotension, bradycardiaOver 17±12 mo treatment success f/u (SVT terminated in <2 h) in 81% of 26 diltiazem/propanolol pts, 80% of 5 flecainide pts% pts going to ED was 9% down from 100% of prior y (p<0.0001)Adverse events: hypotension in 1 placebo, 2 flecainide and 1 diltiazem/propranolol pts; 3 had sinus <50 bpm (3 diltiazem/propranolol, 1 flecainide)1 diltiazem/propranolol pt had syncope5 pts ultimately referred for ablationUnknown if outpt events that pts self-treated were indeed SVT and time to conversion assessed subjectively by ptOutpt management was not w/ placeboTendera2001 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRlbmRlcmE8L0F1dGhvcj48WWVhcj4yMDAxPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (37) 11431663Comparison of dofetilide to propafenone and placebo in the prevention of PSVT122Dofetilide (n=40)Propafenone (n=41)Placebo (n=41)18-75 y w/ ≥1 episode of PSVT w/in 6 wk documented by ECGPulmonary disease, myasthenia gravis, bundle branch block, resting bradycardia (<50 bpm), AV block, prolonged QTc, MI, unstable angina, recent sudden death, hematologic /hepatic/renal diseaseAfter 6 mo of treatment, pts taking dofetilide, propafenone, and placebo had a 50%, 54%, and 6% probability, respectively, of remaining free of episodes of PSVT (p<0.001 for both dofetilide and propafenone vs. placebo).The hazard ratio for dofetilide vs. placebo was 0.33 (95% CI: 0.18-0.61), and the hazard ratio for propafenone vs. placebo was 0.27 (95% CI: 0.14-0.51).Of 40 pts treated w/ dofetilide and propafenone, 23 (58%) and 25 (61%) had no recurring PSVT, compared w/ 16 (39%) in placebo group.19 of 40 pts (48%) treated w/ dofetilide and 21 of 41 (51%) treated w/ propafenone reported no AEs. No significant differences were noted between 3 groups in incidence of treatment-related adverse events or all-cause adverse events (p=0.73 and p=0.74, respectively).Total number of episodes occurring during treatment, and type and frequency of sxs during episodes of PSVT before and during treatmentFrequency of episodes lower in pts treated w/ dofetilide or propafenone thancompared to placebo. Active treatment did not alter distribution of sxs during a first episode of PSVT.N/ADofetilide is at least as safe and effective as propafenone as an alternative therapeutic option for the treatment of pts w/ PSVT.Limited in that PSVTs not specified.Lim2009 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxpbTwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (38)19261367Efficacy and safety of slow infusion of calcium channel blockade vs. adenosine in the ED (RCT)?N=206Slow infusion of calcium channel blocker: verapamil 1 mg/min to 20 mg total, or diltiazem 2.5 mg/min to 50 mg totalIf failed calcium channel blocker then given adenosineAdenosine (6 mg followed by 12 mg if 6 mg ineffective) vs.(If adenosine ineffective after 12 mg they received a calcium channel blocker infusion)10 y of age or older, SVT not converted by vagal maneuverImpaired cerebral perfusion, subsequent diagnosis of non-SVT rhythm, pregnancyConversion to SRHypotensionOne pt that received calcium channel blocker became hypotensiveN/A102 pts received calcium channel blocker and 98% converted to SR, 104 pts got adenosine, conversion was 86.5% (p=0.002)BP dropped by -13.0/-8.1 verapamil and -7.0/-9.4 for diltiazem.Recurrences w/in 2 h: 1 pt w/ diltiazem, 2 from adenosine groupOne pt that received calcium channel blocker became hypotensiveSlow infusion of verapamil or diltiazem was effective and well tolerated. Fall in BP transient.Unclear how many pts were excluded from analysis as a non-SVT rhythm was then identified – how did this cohort fair?Smith2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Smith</Author><Year>2013</Year><RecNum>4</RecNum><IDText>Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>4</Ref_ID><Title_Primary>Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia</Title_Primary><Authors_Primary>Smith,G.D.</Authors_Primary><Authors_Primary>Dyson,K.</Authors_Primary><Authors_Primary>Taylor,D.</Authors_Primary><Authors_Primary>Morgans,A.</Authors_Primary><Authors_Primary>Cantwell,K.</Authors_Primary><Date_Primary>2013</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Humans</Keywords><Keywords>methods</Keywords><Keywords>physiology</Keywords><Keywords>Randomized Controlled Trials as Topic</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Keywords>Treatment Outcome</Keywords><Keywords>Valsalva Maneuver</Keywords><Reprint>Not in File</Reprint><Start_Page>CD009502</Start_Page><Periodical>Cochrane Database Syst.Rev.</Periodical><Volume>3</Volume><ISSN_ISBN>1469-493X</ISSN_ISBN><Misc_3>10.1002/14651858.CD009502.pub2</Misc_3><Address>Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. gavin.smith@monash.edu</Address><Web_URL>PM:23543578</Web_URL><ZZ_JournalFull><f name="System">The Cochrane database of systematic reviews</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Cochrane Database Syst.Rev.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(39)23543578Determine effectiveness of VM to terminate SVTReview of 3 RCTs: 1) Mehta D 1988 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1laHRhPC9BdXRob3I+PFllYXI+MTk4ODwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (41); 3) Lim 1998 ADDIN REFMGR.CITE <Refman><Cite><Author>Lim</Author><Year>1998</Year><RecNum>3</RecNum><IDText>Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>3</Ref_ID><Title_Primary>Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage</Title_Primary><Authors_Primary>Lim,S.H.</Authors_Primary><Authors_Primary>Anantharaman,V.</Authors_Primary><Authors_Primary>Teo,W.S.</Authors_Primary><Authors_Primary>Goh,P.P.</Authors_Primary><Authors_Primary>Tan,A.T.</Authors_Primary><Date_Primary>1998/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Carotid Sinus</Keywords><Keywords>Electric Countershock</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Emergency Treatment</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Massage</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Keywords>Valsalva Maneuver</Keywords><Reprint>Not in File</Reprint><Start_Page>30</Start_Page><End_Page>35</End_Page><Periodical>Ann Emerg.Med</Periodical><Volume>31</Volume><Issue>1</Issue><ISSN_ISBN>0196-0644</ISSN_ISBN><Misc_3>S0196064498000146</Misc_3><Address>Department of Emergency Medicine, Singapore General Hospital, Singapore</Address><Web_URL>PM:9437338</Web_URL><ZZ_JournalFull><f name="System">Annals of emergency medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Emerg.Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(34).Mehta and Wen studies were in a lab setting, Lim in ED settingN/AN/AN/AN/AReversion to SRCardiovascular effects of VM (hypotension, bradycardia), mortality from VM, frequency and severity of adverse events from VMFailure to revert to SR followed by other therapies Reversion success was 54.3% (19/35) in Mehta, 45.9% (61/133) in Wen and 19.4% in Lim (12/62)Heterogeneity between studies precluded a meta analysis; adverse effects not reportedSpeculated that difference in conversion rates may be due to setting (ED vs. EP lab)AAD indicates antiarrhythmic drug; AE, adverse event; AF, atrial fibrillation; AP, accessory pathway; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; bid, two times per day; bpm, beats per minute; CAD, coronary artery disease; CHF, congestive heart failure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CSM, carotid sinus massage; CVA, cerebral vascular accident; c/w, consistent with; ECG, electrocardiogram; ED, emergency department; EP, electrophysiological; f/u, follow up; HF, heart failure; h/o, history of; HR, heart rate; ICU, intensive care unit; ITT, insulin tolerance test; IV, intravenous; LVEF, left ventricular ejection fraction; MI, myocardial infarction; N/A, not applicable; NS, not significant; NSR, normal sinus rhythm; NYHA, New York Heart Association; PAF, paroxysmal atrial fibrillation; PSVT, paroxysmal supraventricular tachycardia; pt, patient; RCT, randomized controlled trial; RFA, radiofrequency ablation; RR, relative risk; SDC, serum drug concentration; SHD, structural heart disease; SR, sinus rhythm; SSS, sick sinus syndrome; SVT, supraventricular tachycardia; sx, symptom; TIA, transient ischemic attack; tid, three times per day; tx, treatment; UA, unstable angina; VHD, valvular heart disease; VM, Valsalva maneuver; VT, ventricular tachycardia; w/, with; w/o, without; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 3. Nonrandomized Trials, Observational Studies, and/or Registries of Principles of Acute and Chronic Therapy – Section 2.4 StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsWaxman1980 ADDIN REFMGR.CITE <Refman><Cite><Author>Waxman</Author><Year>1980</Year><RecNum>24</RecNum><IDText>Vagal techniques for termination of paroxysmal supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>24</Ref_ID><Title_Primary>Vagal techniques for termination of paroxysmal supraventricular tachycardia</Title_Primary><Authors_Primary>Waxman,M.B.</Authors_Primary><Authors_Primary>Wald,R.W.</Authors_Primary><Authors_Primary>Sharma,A.D.</Authors_Primary><Authors_Primary>Huerta,F.</Authors_Primary><Authors_Primary>Cameron,D.A.</Authors_Primary><Date_Primary>1980/10</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Bundle-Branch Block</Keywords><Keywords>Carotid Sinus</Keywords><Keywords>complications</Keywords><Keywords>drug therapy</Keywords><Keywords>Edrophonium</Keywords><Keywords>Humans</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Phenylephrine</Keywords><Keywords>physiopathology</Keywords><Keywords>Propranolol</Keywords><Keywords>Safety</Keywords><Keywords>Sympathetic Nervous System</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Time Factors</Keywords><Keywords>Vagus Nerve</Keywords><Keywords>Valsalva Maneuver</Keywords><Reprint>Not in File</Reprint><Start_Page>655</Start_Page><End_Page>664</End_Page><Periodical>Am J Cardiol</Periodical><Volume>46</Volume><Issue>4</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Web_URL>PM:7416025</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(42)7416025Prospective cohort consisting of 33 pts in ED (group A) and 35 pts during EP study (Group B) to assess SVT termination using a protocol of successive vagal interventions until SVT terminated: a) L/R CSP (1-5 sec) b) multiple unilateral CSP c) edrophonium IV followed by CSP d)Valsalva (10 sec) e) edrophonium IV followed by Valsalva f) phenylephrine N=68(33 Group A-ED, 38 Group B- EP study)SVT (AVNRT or AVRT (orthodromic). Overt WPW included.Termination to SRIn all 68 pts SVT was terminated. 6 pts required phenylephrine.No complications. Post termination pauses was 1683± 66 msIn group B (EP study) pts, repeated trials were performed w/ overall 92% success in termination.Data not broken down by group. However, text describes that 30/33 group A pts terminated SVT by a maneuver up to and including (e).Rankin AC1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Rankin</Author><Year>1989</Year><RecNum>25</RecNum><IDText>Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>25</Ref_ID><Title_Primary>Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias</Title_Primary><Authors_Primary>Rankin,A.C.</Authors_Primary><Authors_Primary>Oldroyd,K.G.</Authors_Primary><Authors_Primary>Chong,E.</Authors_Primary><Authors_Primary>Rae,A.P.</Authors_Primary><Authors_Primary>Cobbe,S.M.</Authors_Primary><Date_Primary>1989/9</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>diagnosis</Keywords><Keywords>diagnostic use</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>195</Start_Page><End_Page>203</End_Page><Periodical>Br.Heart J</Periodical><Volume>62</Volume><Issue>3</Issue><User_Def_5>PMC1216762</User_Def_5><ISSN_ISBN>0007-0769</ISSN_ISBN><Address>University Department of Medical Cardiology, Royal Infirmary, Glasgow</Address><Web_URL>PM:2789911</Web_URL><ZZ_JournalFull><f name="System">British heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Br.Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(43)2789911Cohort administered adenosine for either spontaneous tachycardia or inducedN=64 of which 54 pts had spontaneous tachycardia and 15 induced by programmed stimulationSpontaneous and induced tachycardia in 16-79 y old ptsTermination to SR and diagnostic efficacy to identify atrial flutter or AT or VTAdenosine terminated 46 of 48 episodes of narrow complex tachyOther tachycardias treated included wide complex (24 pts),Side effects: dysnea, chest pain, flushing, headache. No adverse hemodynamic effectsHigh rate of recurrence (1/3)Adenosine effective for both diagnosis and treatment. Of note administration in wide complex tachycardia was safe. Early recurrences of arrhythmias seen in 35%.Cairns1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Cairns</Author><Year>1991</Year><RecNum>22</RecNum><IDText>Intravenous adenosine in the emergency department management of paroxysmal supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>22</Ref_ID><Title_Primary>Intravenous adenosine in the emergency department management of paroxysmal supraventricular tachycardia</Title_Primary><Authors_Primary>Cairns,C.B.</Authors_Primary><Authors_Primary>Niemann,J.T.</Authors_Primary><Date_Primary>1991/7</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>complications</Keywords><Keywords>diagnosis</Keywords><Keywords>Drug Evaluation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electroencephalography</Keywords><Keywords>Emergencies</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>717</Start_Page><End_Page>721</End_Page><Periodical>Ann Emerg.Med</Periodical><Volume>20</Volume><Issue>7</Issue><ISSN_ISBN>0196-0644</ISSN_ISBN><Misc_3>S0196-0644(05)80829-7</Misc_3><Address>UCLA School of Medicine, Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance 90509</Address><Web_URL>PM:2064090</Web_URL><ZZ_JournalFull><f name="System">Annals of emergency medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Emerg.Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(44)2064090Observational cohortAdenosine to convert SR in ED settingN=2316 y or older presenting to ED in an 8 mo study period w/ sustained SVT, rate >140 bpmExclusion: severe CHF, unstable angina, acute MI by ECG, hemodynamic compromise. Excluded sinus tachycardia, atrial flutter, AF, QRS >140 msConversion to SR2 pts after adenosine identified as not having SVT (a fluter, VT)24 episodes of SVT in 21 pts of which 96% converted w/ adenosine (mean dose 10±6 mg)SVT recurred in 57% of episodes and other antiarrhythmic drugs then used to maintain SR. Adverse effects: 3 pts w/ chest pain, one pt w/ dyspnea but no adverse outcomeAdenosine highly effective in converted SVT but recurrences frequentMcCabe1992 ADDIN REFMGR.CITE <Refman><Cite><Author>McCabe</Author><Year>1992</Year><RecNum>21</RecNum><IDText>Intravenous adenosine in the prehospital treatment of paroxysmal supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>21</Ref_ID><Title_Primary>Intravenous adenosine in the prehospital treatment of paroxysmal supraventricular tachycardia</Title_Primary><Authors_Primary>McCabe,J.L.</Authors_Primary><Authors_Primary>Adhar,G.C.</Authors_Primary><Authors_Primary>Menegazzi,J.J.</Authors_Primary><Authors_Primary>Paris,P.M.</Authors_Primary><Date_Primary>1992/4</Date_Primary><Keywords>Adenosine</Keywords><Keywords>administration & dosage</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>diagnosis</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Emergencies</Keywords><Keywords>Emergency Medical Services</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Injections,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Safety</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>358</Start_Page><End_Page>361</End_Page><Periodical>Ann Emerg.Med</Periodical><Volume>21</Volume><Issue>4</Issue><ISSN_ISBN>0196-0644</ISSN_ISBN><Misc_3>S0196-0644(05)82650-2</Misc_3><Address>University of Pittsburgh Affiliated Residency in Emergency Medicine, Pennsylvania</Address><Web_URL>PM:1554170</Web_URL><ZZ_JournalFull><f name="System">Annals of emergency medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Emerg.Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(45)1554170Prospective cohortAdenosine 6 mg , then 12 mg if ineffective, and 3rd dose of 12 mg if still ineffectiveN=37, prehospital setting18 y or older, w/ SVT assessed by paramedic, QRS <120 ms, rate 150-250 bpmExclusion: hypersensitivity to adenosine or in extremisConversion to SR26/37 in SVT (non-SVT rhythms were 5 AF, 4 sinus tach, 2 VT).23/26 (88%) converted to SR11 pts hypotensive at presentation in SVT and became stable upon conversion9 pts had WCT and no hemodynamic compromise w/ adenosineSmall prospective seriesGausche1994 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdhdXNjaGU8L0F1dGhvcj48WWVhcj4xOTk0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (46)8037382Prospective cohortAdenosine 12 mg as initial dose, followed in 2 min of another 12 mg if no conversionN=129, 106 w/ before and after stripsPrehospital setting18 y or older, w/ SVT assessed by paramedic. QRS <120 msec, rate >140 bpm.Exclusion: pregnancy, hypersensitivity to adenosine, sbp <80 mm Hg, or on carbamazepine or dipyridamoleConversion to SR84/106 had SVT (AF in 13, ST in 5, atrial flutter in 2, and VT in 2 cases)71/84 converted to SR (85%) and 4 needed second 12 mg doseAdverse effects: chest pain (12), flushing (3), shortness of breath (2), nausea (1), anxiety (1), dizziness (1), headache (1)Adenosine safe and effective in prehospital setting.Madsen1995 ADDIN REFMGR.CITE <Refman><Cite><Author>Madsen</Author><Year>1995</Year><RecNum>19</RecNum><IDText>A comparison of adenosine and verapamil for the treatment of supraventricular tachycardia in the prehospital setting</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>19</Ref_ID><Title_Primary>A comparison of adenosine and verapamil for the treatment of supraventricular tachycardia in the prehospital setting</Title_Primary><Authors_Primary>Madsen,C.D.</Authors_Primary><Authors_Primary>Pointer,J.E.</Authors_Primary><Authors_Primary>Lynch,T.G.</Authors_Primary><Date_Primary>1995/5</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>diagnosis</Keywords><Keywords>Diagnostic Errors</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Emergency Medical Services</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medical Records</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>649</Start_Page><End_Page>655</End_Page><Periodical>Ann Emerg.Med</Periodical><Volume>25</Volume><Issue>5</Issue><ISSN_ISBN>0196-0644</ISSN_ISBN><Misc_3>S0196-0644(95)70179-6</Misc_3><Address>City and County of San Francisco, Department of Public Health, Emergency Medical Services Agency, CA, USA</Address><Web_URL>PM:7741343</Web_URL><ZZ_JournalFull><f name="System">Annals of emergency medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Emerg.Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(47)7741343Nonrandomized, prospective 12 mo chart review of adenosine w/ comparison to historical cohort that received verapamilPre-hospital setting (EMS)Verapamil up to 2 IV doses of 2.5 mg and 5 mg, or up to 2 doses of adenosine , 6 mg and 12 mgN=73Age >14 w/ paramedic assessment of narrow complex tachycardia (QRS <120, rate 160-240 bpm)3/1990-2/1991 (verapamil) and 3/1991-2/1992 (adenosine)Pts had to be regarded as stable and first underwent Valsalva prior to administration of verapamil or adenosine by base hospital physician’s orderConversion to SRAlso incidentally analyzed rate of ECG misinterpretation by EMS and base hospital physicianVerapamil given to 17 pts, of which 6 on subsequent review by cardiologist had AF, attach or sinus tach. 7/11 pts converted to SR (64%). Side effects in 5/17 pts (hypotension, NSVT, PACs)Adenosine: given to 64 pts, strips available for review in 56 pts. 24 pts on subsequent review by cardiologist had AF, attach, sinus tach, atrial flutter or VT. Of remaining 32 w/ true SVT that got adenosine, 78% converted to SR. Side effects: ventricular ectoic activity, 1st or 2nd degree AV block of <1 min, asystole (2-10 sec), chest pain, flushing, bronchospasm)Overall misinterpretation of the ECG occurred in 30/73 ptsNo difference in conversion rates between verapamil and adenosineMisinterpretation of the ECG by paramedics and base hospital physician was common.But serious adverse events unlikely – no reported hemodynamic collapse from intervention.Conversion to SR by adenosine or verapamil similar (about 70%)Brady1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJyYWR5PC9BdXRob3I+PFllYXI+MTk5NjwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (48)8727628Nonrandomized, prospective cohort w/ comparison to historical cohortComparison of adenosine (prospective cohort) to verapamil (historical cohort)N=211 Inclusion criteria: any age, narrow QRS tachycardia (120-300 bpm), or wide complex (120-300 bpm) who had received 2 doses of lidocaine, palpable pulse, IV in place.Exclusion: drug sensitivity, cardiac arrest, trauma etiology, for adenosine: prior cardiac transplant, treatment w/ carbamazepine or dipyridamoleExclusion for verapamil: sbp <90, pulmonary edema, LV dysfunction, age <2 y, WCTConversion to SRAdenosine: 87 of 105 pts received drug, 69% converted to SRVerapamil: 52 of 106 pts received drug, 88% converted to SR (p=0.1)Adverse events: adenosine: 4 pts (chest pain, dyspnea, prolonged brady, VT)Verapamil: 4 pts (hypotension, VT, VF) – 2 pts had received verapamil for WCT and both had hemodynamic collapseNoted that EMS commonly misinterpreted non-SVT rhythms as SVT (including AF, ST, VT)Adenosine and verapamil both effective in out of hospital setting to convert SVT. Rhythms were still commonly misidentified by EMSLuber2001 ADDIN REFMGR.CITE <Refman><Cite><Author>Luber</Author><Year>2001</Year><RecNum>23</RecNum><IDText>Paroxysmal supraventricular tachycardia: outcome after ED care</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>23</Ref_ID><Title_Primary>Paroxysmal supraventricular tachycardia: outcome after ED care</Title_Primary><Authors_Primary>Luber,S.</Authors_Primary><Authors_Primary>Brady,W.J.</Authors_Primary><Authors_Primary>Joyce,T.</Authors_Primary><Authors_Primary>Perron,A.D.</Authors_Primary><Date_Primary>2001/1</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Aged</Keywords><Keywords>Calcium Channel Blockers</Keywords><Keywords>complications</Keywords><Keywords>Emergencies</Keywords><Keywords>Emergency Service,Hospital</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Recurrence</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>40</Start_Page><End_Page>42</End_Page><Periodical>Am J Emerg.Med</Periodical><Volume>19</Volume><Issue>1</Issue><ISSN_ISBN>0735-6757</ISSN_ISBN><Misc_3>S0735-6757(01)87678-6;10.1053/ajem.2001.20030</Misc_3><Address>Department of Emergency Medicine, University of Virginia Health Sciences Center, Charlottesville-Albemarle Rescue Squad, Charlottesville, VA 22908, USA</Address><Web_URL>PM:11146016</Web_URL><ZZ_JournalFull><f name="System">The American journal of emergency medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Emerg.Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(49)11146016Observational cohort (retrospective chart review)Outcomes of pts treated for SVT in ED, including recurrence rates, from 1993-1996N=111Narrow complex tachycardia (QRS <120 ms), no P waves, rate 120-300 bpm.1993-1996, single centerRecurrence of SVTDescriptive percentages of therapies given, pt demographicsTherapies given: adenosine (41%), Valsalva (22%), Calcium channel blocker (14%), beta blockers (4%), cardioversion (1%).79 pts (71%) discharged from ED, mean age of 49, mean ED stay of 3.8 h, and 3 pts had recurrent SVT w/in 24 h32 pts (29%) admitted to hospital, mean age 65, 6 pts (19%) had recurrent SVT in the hospital.SVT recurrence more likely in admitted pts (p<0.05), older pts (p<0.01) or h/o cardiac disease (p<0.01)Largely a descriptive paper. Roth A2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlJvdGg8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (50)12586276Prospective cohort study84PSVT 77%AF 23%Effectiveness of DC cardioversion in pts who did not respond promptly to vagal maneuvers that were tried first and then tried again after intravenously administered medical treatment w/ 1 of the following intravenously administered drugs: adenosine,verapamil, digoxin, and/or procainamide. All study pts were hemodynamically compromised but did not require cardiopulmonary resuscitation.DC cardioversion resulted in successful converson to sinus rhythm in all pts after 103 electrical attempts, using 118±69 Joules. No complications; all but 1 pt (w/ pulmonary edema and cardiogenic shock) discharged alive w/in 7 d of hospitalization. Use of DC cardioversion to restore sinus rhythm can be safely and efficaciously applied in the prehospital setting in pts who are hemodynamically compromised but do not require cardiopulmonary resuscitation.Chronic therapy of SVT (exclude WPW and preexcitation, but include if concealed AP)Neuss H1988 ADDIN REFMGR.CITE <Refman><Cite><Author>Neuss</Author><Year>1988</Year><RecNum>27</RecNum><IDText>Long-term efficacy and safety of flecainide for supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>27</Ref_ID><Title_Primary>Long-term efficacy and safety of flecainide for supraventricular tachycardia</Title_Primary><Authors_Primary>Neuss,H.</Authors_Primary><Authors_Primary>Schlepper,M.</Authors_Primary><Date_Primary>1988/8/25</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Clinical Trials as Topic</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Flecainide</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Safety</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Time Factors</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>56D</Start_Page><End_Page>61D</End_Page><Periodical>Am J Cardiol</Periodical><Volume>62</Volume><Issue>6</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Address>St. Vincenz Hospital, Limburg/Lahn, Federal Republic of Germany</Address><Web_URL>PM:3136637</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(51)3136637Open label trial of chronic po flecainide to pts that first given IV dose in EP lab. Pts w/ WPW (concealed or overt) or AVNRT.63 pts (47 WPW of which 8 concealed, 36 w/ AVNRT)Mean f/u 22.8 moWPW (overt or concealed) or AVNRT, previously refractory or intolerant to other antiarrhythmic drugs, verapamil or beta blockade)IV flecainide given during SVT induced at EP study (100 mg over 5 min)Drug efficacy and tolerance based upon diaryEP study also repeated while on therapyIn AVNRT pts (31) – mean observation of 23 mo, mean flecainide dose 257 mg/d, effective in 20 pts and reduced episodes in 4 other pts. Worsening of attacks seen in 2 pts.Adverse effects: visual, nervousness, dizziness, taste, hallucinations, vomiting. Therapy discontinued in 3 pts (AVNRT group)Flecainide effective in reducing subjective episodes – among pts w/ AVNRT was effective in 20/31 pts. Cockrell JL1991 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNvY2tyZWxsPC9BdXRob3I+PFllYXI+MTk5MTwvWWVhcj48
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ADDIN EN.CITE.DATA (52)1898629Open-label, uncontrolled trial of long term efficacy of flecainide63 pts.mean f/u 24 moAll pts w/ AV reentryDrug efficacy and toleranceFlecainide prevented or slowed AVRT in 44 pts. who were then followed and 33 (75%) w/ no adverse effects. Isuprel reversed the effects in 11/21 pts. Overall, 33 of 63 pts responded to and tolerated flecainide. 11 pts stopped due to adverse effects.Flecainide moderately helpful in about 50% of pts over 2 y.Jackman WM1992PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkphY2ttYW48L0F1dGhvcj48WWVhcj4xOTkyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (53)1620170 Prospective observational cohort80Symptomatic AVNRT undergoing RFA of slow-pathwaySuccessful ablation w/ intact AV nodal conduction, guided by atrial slow-path potentialsRFA abolished or modified slow-pathway conduction in 78/80 pts w/o affecting normal AVN conduction. Mean (+/- SD) f/u of 15.5 mo w/o recurrence. Early report of success of RFA of slow-path conduction guided by atrial slow-path potentials—led to slow-pathway ablation being preferred method. Provided evidence that atrial insertions of fast and slow path are anatomically distinct.Gambhir DS1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdhbWJoaXI8L0F1dGhvcj48WWVhcj4xOTk2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (54)8682552 Prospective cohort study9All pts w/ symptomatic AVNRT, recurrent palpitations for 2-12 y EP study performed, IV amiodarone then oral therapy subsequently EP study repeated 1.5-3 mo laterNo pts reported sxs of tachycardia during mean f/u of 65 d on oral amiodaroneIV amiodarone terminated AVNRT in 7/9 pts (retrograde FP in 4/7 and anterograde SP in 3/7)Not inducible on PES after oral therapy, largely to due to prolonging refractoriness in atrium and ventricle, and depressing conduction through FPNo pts reported sxs of tachycardia during mean f/u of 65 d on oral amiodaroneIV amiodarone terminated AVNRT in 7/9 pts (retrograde FP in 4/7 and anterograde SP in 3/7)Not inducible on PES after oral therapy, largely to due to prolonging refractoriness in atrium and ventricle, and depressing conduction through FPSmall series of pts, but all w/ AVNRTOral therapy w/ amiodarone is effective in suppressing AVNRT.IV amiodarone is effective in acute therapy.EP study efficacy.Spector P2009 ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>671</Start_Page><End_Page>677</End_Page><Periodical>Am J Cardiol</Periodical><Volume>104</Volume><Issue>5</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(09)01008-X;10.1016/j.amjcard.2009.04.040</Misc_3><Address>University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA. Peter.Spector@</Address><Web_URL>PM:19699343</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(55)19699343 Systematic review and meta-analysis to evaluate the safety and efficacy of RFA of AVNRT, AP-mediated, and atrial flutter.For AVNRT and AP-mediated: 39 primary studies w/ 49 treatment arms in 7,693 pts.Previous reviews or meta-analyses; animal or in vitro studies; subjects aged <18 y or mixed populations of which >15% were pediatric pts; f/u of <7 d; not studies of RFA; alternative energy sources used for ablation; AV junction ablation w/ pacemaker implantation; <40 pts per arrhythmia or ablation technique; published only in abstract form; published before 1990; and published in languages other than English, Spanish, French, Italian, German, and Portuguese.SVT (AVNRT and AP-mediated)Single- and multiple-procedure success, arrhythmia recurrence, repeat ablation, adverse events, and death Single-procedure success: 93.2% (95% CI 90.8-95.5%). Multiple-procedure success: 94.6%(95% CI 92.4- 96.9).Post-ablation arrhythmia: 5.6% (95% CI 4.1-7.2%). Repeat ablation: 6.5% (95% CI 4.7-8.3%)All-cause mortality: 0.1%Adverse events: 2.9% First meta-analysis of RFA for AVNRT, AVRT (AP-mediated). Demonstrates high efficacy rates and low rates of complications.Bohnen M2011PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJvaG5lbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (56)21699857Prospective observational cohort, single centerIncidence and predictors for major complications of catheter ablation 1676 procedures All pts undergoing ablation in a 2 y period (2009-2011) at a high volume center for variety of arrhythmias (SVT, AF, VT due to SHD or idiopathic)Complications assessed over 30 d post-procedure.524 SVT ablations performed of which major complications (total 0.8%) included perforation (n=1), pseudoaneurysm (groin, n=2), pulmonary edema (1). No instances of conduction system damage Total major complication rate for SVT ablation below 1% in this contemporary prospective study.Outcomes (Registry Data)Hindricks G1993PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhpbmRyaWNrczwvQXV0aG9yPjxZZWFyPjE5OTM8L1llYXI+
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ADDIN EN.CITE.DATA (57)8131762 Prospective cohort4398AT/atrial flutter (n=141, 3.2%)AVJ (n=900, 20.5%)AVNRT (n=815, 18.5%)AVRT: (n = 2222, 50.5%)VT (n=320, 7.3%).Incidence of complicationsComplications occurred in 223 pts (5.1%) overallAT/atrial flutter: 5.0%AVJ: 3.2%AVNRT: 8.0%AVRT: 4.4%VT: 7.5%Complications more in AVNRT RFA compared to AVJ or AP ablation (p<0.001) Complications more in VT compared to AVJ (p<0.002) or AP (p<0.02)Early report showing high incidence of complications after AVNRT ablation.Hindricks G1996 ADDIN REFMGR.CITE <Refman><Cite><Author>Hindricks</Author><Year>1996</Year><RecNum>161</RecNum><IDText>Incidence of complete atrioventricular block following attempted radiofrequency catheter modification of the atrioventricular node in 880 patients. Results of the Multicenter European Radiofrequency Survey (MERFS) The Working Group on Arrhythmias of the European Society of Cardiology</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>161</Ref_ID><Title_Primary>Incidence of complete atrioventricular block following attempted radiofrequency catheter modification of the atrioventricular node in 880 patients. Results of the Multicenter European Radiofrequency Survey (MERFS) The Working Group on Arrhythmias of the European Society of Cardiology</Title_Primary><Authors_Primary>Hindricks,G.</Authors_Primary><Date_Primary>1996/1</Date_Primary><Keywords>adverse effects</Keywords><Keywords>analysis</Keywords><Keywords>Atrioventricular Block</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Cross-Sectional Studies</Keywords><Keywords>epidemiology</Keywords><Keywords>Europe</Keywords><Keywords>Heart Block</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Patients</Keywords><Keywords>Postoperative Complications</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>82</Start_Page><End_Page>88</End_Page><Periodical>Eur Heart J</Periodical><Volume>17</Volume><Issue>1</Issue><ISSN_ISBN>0195-668X</ISSN_ISBN><Web_URL>PM:8682135</Web_URL><ZZ_JournalFull><f name="System">European heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(58)8682135 Prospective cohort4463AVNRT (n=880)Incidence of AV blockAV block (4/ 880, 4.7%). AV block higher in fast pathway ablation (19/361, 5.3%, p<0.05) 6.3% in centers w/ limited experience in RFA (≤30 pts treated, p<0.05), and higher in these low-volume centers for both slow and fast pathway ablation (p<0.05)Early report showing 5% incidence of AV block after RFA for AVNRT, and higher w/ fast pathway ablation.Calkins H1999PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhbGtpbnM8L0F1dGhvcj48WWVhcj4xOTk5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (59)9892593 Prospective cohort1050(previously enrolled in RFA clinical trial)RFA of AVNRT, AP, or AVJAVNRT (n=373)AP (n=500)AVJ (n=121)Efficacy and safety of RFA w/ long-term f/u.Overall success:95%Overall recurrence6%Success:AVNRT: 97%AP: 93%AVJ: 100%Recurrence:AVNRT: 5%AP: 8%AVJ: 2%Predictors of success:-AVNRTOR: 3.94 (95%CI: 1.93-8.04; p=0.0002)-Left free wall APOR: 3.09 (95% CI: 1.46-6.53; p=0.0003)-Experience of ablation center (>39 pts)OR: 2.39 (95% CI: 1.21- 4.71; p=0.012)Joint predictors of mortality:-EF (p=0.003)-SHD (p=0.016)-AVJ ablation (p=0.048)Shows RFA is a favorable option w/ low risk of complications and recurrence, and identifies pts who are at risk. Per-protocol analysisCheng2000PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNoZW5nPC9BdXRob3I+PFllYXI+MjAwMDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (60)11103056Comparison of cost effectiveness of RFA w/ medical management of PSVTSymptomatic pts w/ 4.6 unscheduled visits/y for arrhythmia while on long-term drug therapyRFA:Estimated population:AVNRT: 65%AVRT w/ concealed AP: 30%Efficacy estimates:AVNRT: 97%AVRT w/ concealed AP: 93%Recurrence estimates:AVNRT: 5%AVRT w/ concealed AP: 8%Drug efficacy: 60%Perspective: societalOutcomes: costs (office visit, annual drug rx, EP study, RFA, PPM, PPM replacement)QALYLife-yearsMarginal cost-effectiveness ratiosW/ monthly episodes of PSVT, RFA most effective and least expensive optionRFA reduced lifetime medical expenditures by $27,940 compared w/ long-term pharmacologic therapyLifetime costs:RFA: $61,880Long-term drug rx:$89,820Episodic drug rx:$143,530RFA improved quality-adjusted life expectancy by 3.10 QALYs.RDA improves quality of life and reduces costs when treating highly symptomatic pts.Effects in less symptomatic not studiesScheinman MM2000 ADDIN REFMGR.CITE <Refman><Cite><Author>Scheinman</Author><Year>2000</Year><RecNum>162</RecNum><IDText>The 1998 NASPE prospective catheter ablation registry</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>162</Ref_ID><Title_Primary>The 1998 NASPE prospective catheter ablation registry</Title_Primary><Authors_Primary>Scheinman,M.M.</Authors_Primary><Authors_Primary>Huang,S.</Authors_Primary><Date_Primary>2000/6</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Arteries</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Cardiomyopathies</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Disease</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Hospitals,Teaching</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Recurrence</Keywords><Keywords>Registries</Keywords><Keywords>statistics & numerical data</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Ventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>1020</Start_Page><End_Page>1028</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>23</Volume><Issue>6</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Address>Department of Medicine, University of California, San Francisco, USA. scheinman@ep4.ucsf.edu</Address><Web_URL>PM:10879389</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(61)10879389 Prospective cohort study(NASPE registry)3,357Ablation of AVNRT, AP, AVJ, atrial flutter, AT, IST, VT, idiopathic VTAVNRT (n=1,197 [35.6%)AVJ (n=646)AP (n=654)AT (n=216)Atrial flutter (n=447)IST (n=40)Efficacy and safety of RFA w/ long-term f/u.AVNRTSuccess: 96.1%Complications: 2%AVJ: Success: 96%Complications: 25 ptsRecurrence:3.5%AP:Success: 94-96%Complications: 31 pts totalRecurrence: 4.6%AT:Success: 51-79%Complications:5 totalRecurrence:15.2%Atrial flutter:Success: 86%Complications:12 ptsRecurrence:14.7%IST:Success: 71%Complications:2 ptsRecurrence:10%Large series reporting success of RFA, and stratification by age group confirms safety and efficacy in elderly pts, as well as by type of facility (teaching vs. community).AF, atrial fibrillation; AT, atrial tachycardia; AP, accessory pathway; AV, atrioventricular; AVJ, atrioventricular junction; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; bpm, beats per minute; CHF, congestive heart failure; CI, confidence interval; CSP, carotid sinus pressure; DC, direct current; ECG, electrocardiogram; ED, emergency department; EF, ejection fraction; EMS, emergency medical services; EP, electrophysiological; FP, fast pathway; f/u, follow up; h/o, history of; IST, inappropriate sinus tachycardia; IV, intravenous; LV, left ventricular; MI, myocardial infarction; NASPE, North American Society of Pacing and Electrophysiology; NSVT, non-sustained ventricular tachycardia; OR, odds ratio; PAC, premature atrial complex; PES, programmed electrical stimulation; PPM, prosthesis-patient mismatch; PSVT, paroxysmal supraventricular tachycardia; pt, patient; QALY, quality-adjusted life year; RFA, radiofrequency ablation; rx, prescription; sbp, systolic blood pressure; SD, standard deviation; SHD, structural heart disease; SP, slow pathway; SR, sinus rhythm; ST, sinus tachycardia; SVT, supraventricular tachycardia; VF, ventricular fibrillation; VT, ventricular tachycardia; WCT, wide complex tachycardia; w/, with; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 4. Randomized Trials Comparing Sinus Tachyarrhythmias – Section 3 Study Name, Author, YearAim of StudyStudy Type (Size, N)Study Intervention Group (n)Study Comparator Group (n)Pt PopulationEndpointsP Values, OR: HR: RR: & 95% CI:Study Limitations & Adverse EventsInclusion CriteriaExclusion CriteriaPrimary Endpoint (efficacy) and ResultsSafety Endpoint and ResultsSecondary Endpoint and ResultsBEAUTIFUL2008 ADDIN REFMGR.CITE <Refman><Cite><Author>Fox</Author><Year>2008</Year><RecNum>50</RecNum><IDText>Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>50</Ref_ID><Title_Primary>Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial</Title_Primary><Authors_Primary>Fox,K.</Authors_Primary><Authors_Primary>Ford,I.</Authors_Primary><Authors_Primary>Steg,P.G.</Authors_Primary><Authors_Primary>Tendera,M.</Authors_Primary><Authors_Primary>Ferrari,R.</Authors_Primary><Date_Primary>2008/9/6</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Benzazepines</Keywords><Keywords>complications</Keywords><Keywords>Coronary Disease</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Heart Rate</Keywords><Keywords>Hospital Mortality</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Kaplan-Meier Estimate</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>pharmacology</Keywords><Keywords>Safety</Keywords><Keywords>therapeutic use</Keywords><Keywords>Ventricular Dysfunction,Left</Keywords><Reprint>Not in File</Reprint><Start_Page>807</Start_Page><End_Page>816</End_Page><Periodical>Lancet</Periodical><Volume>372</Volume><Issue>9641</Issue><ISSN_ISBN>1474-547X</ISSN_ISBN><Misc_3>S0140-6736(08)61170-8;10.1016/S0140-6736(08)61170-8</Misc_3><Address>Royal Brompton Hospital, London, UK</Address><Web_URL>PM:18757088</Web_URL><ZZ_JournalStdAbbrev><f name="System">Lancet</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(62)18757088To determine if HR lowering w/ ivabradine reduces cardiovascular death and morbidity in pts w/ coronary disease and LV systolic dysfunctionRandomized, double blind placebo controlled, parallel group. Multicenter10,917 pts enrolled. Intention to treat analysisIvabradine 5 mg increased to 7.5 mg bidPlaceboCoronary artery disease, LVEF <40%Age ≥55, or ≥18 if diabeticSinus rhythm, HR≥60 bpmAngina and HF sxs stable over 3 mo prior to enrollment on stable doses of at least 1 mo of conventional medical therapy MI or coronary revascularization w/in prior 6 moStroke/TIA in prior 3 moPacemaker or ICDVHD needing surgery w/in 3 ySick sinus syndrome, long QT, complete heart block, uncontrolled HTN, NYHA IVOther medications w/ strong CYP P450 3A4 inhibitionComposite of cardiovascular death, hospital admission for acute MI, hospital admission for new onset or worsening HFN/AMortalityCardiac death (MI, HF, due to cardiac procedureCardiovascular deathHospital admit for acute MI or unstable anginaCoronary revascularizationHospital admit for HFHospital admit for acute MIMedian f/u 19 mo. Baseline mean HR 71.6±9.9 bpm, lowered at 12 mo by 6 bpm and by 5 bpm at 24 mo corrected for placeboPrimary endpoint unchanged by ivabradineFor pts w/ HR of 70 bpm or higher, ivabradine reduced admit to hospital for fatal and non fatal MI and coronary revascularization (secondary endpoints)87% were on beta blockersNo difference in serious adverse events between pts treated w/ ivabradine or placeboHeart rate reduction not a specified endpoint of the trial, though is reported.Not an IST population but trial does demonstrate safety of ivabradine in a high risk population in a large, randomized, placebo controlled trialHeart rate reduction modest but baseline heart rates are lower compared to an IST population.SHIFT2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlN3ZWRiZXJnPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48
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ADDIN EN.CITE.DATA (63)20801500To determine if HR lowering w/ ivabradine improves outcomes in HFRandomized, double-blind, placebo-controlled, parallel-group. Multicenter trial that enrolled 6558 pts.Ivabradine 5-7.5 mg bidPlaceboAge ≥18 in sinus w/ resting HR of ≥70Stable HF sxs over prior 4 wkPrior hospital admit for HF in previous 12 moLVEF ≤35%On optimum, stable medical therapy over prior 4 wkCHDPrimary severe valvular diseaseRecent MI (<2 mo)Pacing for ≥40%/dAF/atrial flutterSymptomatic hypotensionPts not allowed to receive non-dihydropyridine calcium channel blocker, class I anti-arrhythmic or strong inhibitor of CYP3A4Composite of cardiovascular death or hospital admission for worsening HF. Intention to treat analysisN/AComposite cardiovascular death or hospital admit for worsening HF in pts receiving at least 50% of target daily dose of beta blocker (metoprolol target dose = 150 mg/d)All cause deathAny CV deathHospital admit (any)CV hospital admitDeath from HFComposite of CV death, hospital admit for worsening HF, hospital admit for non-fatal MIMedian f/u 22.9 mo. HR at 28 d decreased by 15.4±10.7 bpm in ivabradine c/w baseline and by 10.9 (CI 10.4-11.4) bpm c/w placebo. At 1 y, HR reduction was 9.1 (CI 8.5-9.7) bpm c/w placebo, and at study end 8.1 (CI 7.5-8.7) bpm c/w placeboPrimary endpoint reached in 24% of ivabradine group and 29% of placebo (p<0.0001), driven by difference in hospital admission for HF and death due to HF. Fewer serious adverse events in ivabradine group (p=0.025). 5% of ibabradine pts w/ symptomatic bradycardia compared to 1% of placebo (p<0.0001). Visual side effects (phosphenes) in 3% of ivabradine group vs. 1% of placebo (p<0.0001)Heart rate reduction not a specified endpoint of the trial, though is reported.Not an IST population but trial does demonstrate safety of ivabradine in a high risk population in a large, randomized, placebo controlled trialHR reduction modest but baseline heart rates are lower compared to an IST population.Cappato R2012PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhcHBhdG88L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (64)22981555To determine the effectiveness of ivabradine to reduce sxs due to ISTDouble blind, randomized, placebo controlled crossover (N = 21) Ivabradine (2.5-7.5 mg twice daily) for 6 wk then 7 d washout then crossover to placebo for 6 wk (n = 10) Placebo for 6 wk then 7 d washout then crossover to ivabradine for 6 wk (n = 9)Mean resting dtime HR >95 on Holter or >25 bpm symptomatic rise in HR from supine to standing or in response to stressUnderlying SHD (excluded by echocardiogram), SVT, orthostatic hypotension, compensatory sinus tachycardia, on antiarrhythmic therapy, renal or hepatic insufficiency, on inhibitor of CYP3A4Sx resolution from 7 sx indicatorsN/AHR measurements (rest, exercise), exercise capacityIvabradine: >70% sx elimination (RR: 0.25; 95% CI: 0.18-0.34; p<0.001), resting heart rate reduced (p=0.011), and during exertion (p=0.001) and increased exercise performanceDuration of therapy short (6 wk), some pts did not improve in sxs despite heart rate reductions. Long term effectiveness and safety not studied.AF indicates atrial fibrillation; bid, two times per day; bpm indicates beats per min; CI, confidence interval; CPY3A4, cytochrome p450 3A4; CV, cardiovascular; c/w, consistent with; f/u, follow up; HF, heart failure; HR, heart rate; LV, left ventricular; LVEF, left ventricular ejection fraction; MI, myocardial infarction; IAST, inappropriate sinus tachycardia; N/A, not available; pt, patient; RR, relative risk; SHD, structural heart disease; sx, symptom; TIA, transient ischemic attack; and w/, with. Data Supplement 5. Nonrandomized Trials, Observational Studies, and/or Registries of Sinus Tachyarrhythmias – Section 3StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsLee RJ1995PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxlZTwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (65)7586260Prospective observational16 pts (12 w/ SAN modification and 4 w/ SAN ablation)Symptomatic, medically refractory pts w/ IST undergoing RFA enrolledProcedure: - Activation mapping (point-by-point)- Mapping guided by fluoroscopy or ICE (to visualize crista)- IsoproterenolF/u tests:- Autonomic blockade (intrinsic HR) w/ propranolol + atropine before and after ablation - ETT- HolterProcedural success:SAN modification: at least 25% reduction in sinus HR under same conditions of catecholamine infusion w/ either retention of normal P wave axis or low atrial escapeTotal SAN ablation: reduction in HR >50% of tachycardia HR w/ junctional escapeMean f/u = 20.5±0.4 moSAN modification:- Procedural success 12/12 (100%) pts- 2 recurrences during F/U 7.1±1.7 moTotal SAN ablation:- Procedural success 4/4 (100%) pts- No recurrences at F/UComplications:- 2 pts PPM (both had total SAN ablation)- 1 pt transient right diaphragmatic paralysis- 1 pt transient SVC syndrome- SAN modification is feasible and should be considered as alternative to complete AV junction ablation in pts w/ disabling sxs of IST that is refractory to medical therapy. -SAN modification may be aided by ICE. Rakovec P2009 ADDIN REFMGR.CITE <Refman><Cite><Author>Rakovec</Author><Year>2009</Year><RecNum>60</RecNum><IDText>Treatment of inappropriate sinus tachycardia with ivabradine</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>60</Ref_ID><Title_Primary>Treatment of inappropriate sinus tachycardia with ivabradine</Title_Primary><Authors_Primary>Rakovec,P.</Authors_Primary><Date_Primary>2009</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Benzazepines</Keywords><Keywords>diagnosis</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Metoprolol</Keywords><Keywords>Middle Aged</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Sinus</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>715</Start_Page><End_Page>718</End_Page><Periodical>Wien.Klin.Wochenschr.</Periodical><Volume>121</Volume><Issue>21-22</Issue><ISSN_ISBN>1613-7671</ISSN_ISBN><Misc_3>10.1007/s00508-009-1265-9</Misc_3><Address>Department of Cardiology, University Medical Center, Ljubljana, Slovenia. peter.rakovec@kclj.si</Address><Web_URL>PM:19998013</Web_URL><ZZ_JournalFull><f name="System">Wiener klinische Wochenschrift</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Wien.Klin.Wochenschr.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(66)19998013Consecutively treated cohort13Resting HR on ECG >100 bpmNormal thyroid function, SHD excluded by echocardiogramEvaluation at baseline (ECG, Holter) and after 2 wk on ivabradine 15 mg/d (repeat Holter)11 women, 2 men, mean age 42±8 y7/13 were pretreated w/ beta blockers.Mean HR decreased from 94±10 to 74.6±5.2 bpm w/ ivabradine (12 pts whose prior therapy could be discontinued or did not have prior therapy drug therapy). In 10 pts where min and max HR could be determined, the max HR decreased from 150.3±13.4 bpm to 120.6± 9.8 bpm and min HR decreased from 66.7±9.6 to 54.8±6.9.P<0.001 for all HR comparisons (paired t tests).One pt on metoprolol 300 mg/d switched to 15 mg of ivabradine and decrease of 4 bpm noted.Limitation – small cohort, no meaningful comparisons to beta blockade could be made.Calo L2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhbG88L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxSZWNO
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Pm==
ADDIN EN.CITE.DATA (67)20621618Prospective, nonrandomized consecutively enrolled cohort18Inclusion: Symptomatic IST,Exclusion: secondary causes of tachycardia, SHD (echocardiogram performed)Beta blockers and non-dihydropyridine calcium channel blockers interrupted before studyStress test ECG for evaluation of sxs, maximal load, basal HR, maximal HR. Evaluation of stress ECG and 24-h Holter made at baseline, 3 mo, 6 moPts treated w/ ivabradine 5 mg-7.5 mg twice dailyMean and maximal HR on Holter reduced compared to baseline at 3 or 6 mo (p<0.001) and at 6 mo compared to 3 mo (p=0.02)Resting and Maximal HR on stress test reduced and increased achieved maximal loadIvabradine lowers HR and improves sxs over 3 to 6 mo.Limitation – non-randomized, small cohortKaplinsky E2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthcGxpbnNreTwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+
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ADDIN EN.CITE.DATA (68)20544616Prospective, observational cohort4Resting HR ≥100, mean HR ≥90 on 24-h HolterAlso noted: not previously treated w/ beta blocker or verapamil. SHD and secondary causes of tachycardia excludedEvaluation at baseline, wk 1, 2, 3 and 4 and 2nd and 3rd mo. At 3 mo, Holter, ETT and QOL questionnaire performed.Ivabradine initiated at 5 mg bid, increased to 7.5 mg bid after first wk.Ivabradine decreased resting HR from mean of 106.5±3 at baseline to 88.5 ±2 at wk 1 and 77 ±3 by wk 2 and 73.7 ±13 at mo 3. Holter monitor determined mean, max and minimum HR also reduced by 15-24% compared to baseline, exercise time increased, QOL improved. Limitation- small cohortZellerhoff S2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlplbGxlcmhvZmY8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFy
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ADDIN EN.CITE.DATA (69)20859616Prospective observational cohort10Pts had failed or refused conventional therapy (beta blocker, calcium channel blocker, class IC AAD). Blood count, electrolytes and TSH normal. SHD excluded.EP study performed in 3 pts to exclude SVT. One pt w/ prior ablation of sinus node and pacemaker and another pt w/ prior ablation.Ivabradine 5 mg-7.5 mg bid, w/ additional beta blocker therapy in 3 pts and monotherapy in 7 pts.72-h Holter at baseline and during therapy. Sx assessment performed by telephone at mean f/u of 16±9 moIvabradine reduced max and mean HR (baseline, max heart = 176±45, mean 84±11. On ivabradine max HR was 137 ±36 and mean 74±8 bpm, p<0.05. Min HR not significantly changedOf 8 pts contacted on followup at 16±9 mo, sxs improved in 3 pts and completely resolved in 5 pts.Limitation – small cohortBenezet-Mazuecos J2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Benezet-Mazuecos</Author><Year>2013</Year><RecNum>55</RecNum><IDText>Long-term outcomes of ivabradine in inappropriate sinus tachycardia patients: appropriate efficacy or inappropriate patients</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>55</Ref_ID><Title_Primary>Long-term outcomes of ivabradine in inappropriate sinus tachycardia patients: appropriate efficacy or inappropriate patients</Title_Primary><Authors_Primary>Benezet-Mazuecos,J.</Authors_Primary><Authors_Primary>Rubio,J.M.</Authors_Primary><Authors_Primary>Farre,J.</Authors_Primary><Authors_Primary>Quinones,M.A.</Authors_Primary><Authors_Primary>Sanchez-Borque,P.</Authors_Primary><Authors_Primary>Macia,E.</Authors_Primary><Date_Primary>2013/7</Date_Primary><Keywords>Adult</Keywords><Keywords>Benzazepines</Keywords><Keywords>Cardiotonic Agents</Keywords><Keywords>diagnosis</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Longitudinal Studies</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Patient Satisfaction</Keywords><Keywords>Quality of Life</Keywords><Keywords>Syncope</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Sinus</Keywords><Keywords>therapeutic use</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>830</Start_Page><End_Page>836</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>36</Volume><Issue>7</Issue><ISSN_ISBN>1540-8159</ISSN_ISBN><Misc_3>10.1111/pace.12118</Misc_3><Address>Department of Cardiology, Fundacion Jimenez Diaz-Capio, Universidad Autonoma de Madrid, Madrid, Spain. jbenezet@yahoo.es</Address><Web_URL>PM:23510001</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(70)23510001Non randomized prospectively enrolled cohort24Inclusion: symptomatic pts diagnosed w/ IST at single institution (2009-2012) IST defined as resting dtime HR >100; excessive increase in HR w/ activity. Two Holters to confirm ISTExclusion: secondary cause of tachycardiaComparison of baseline to 6 mo of mean, minimal, and maximal HR on Holter, and sxs assessed by SF-36 Health Survey(Secondary – assessment at 1 y and asked to stop treatment and reevaluate by Holter after 1 mo washout)Pts treated w/ ivabradine 5 mg-7.5 mg bidAt 6 mo, maximal HR, mean HR, and minimal HR reduced (p<0.05). SF-36 mean score improved on ivabradine (p<0.001)At 1 y 10 pts accepted to stop ivabradine w/ 2 pts continued to have IST criteriaAt 6 mo ivabradine improved HR indices and sxs. Stopping ivabradine at 1 y showed HR continued to be in normal range in 8/10 pts.Limitation – non randomized, small cohort. Unclear given that pts that stopped the drug at 1 y no longer met criteria for IST that cohort itself may have consisted of pts w/ milder forms of IST or did not truly have IST.Ptaszynski P2013 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlB0YXN6eW5za2k8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy
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ADDIN EN.CITE.DATA (71)22772053Prospective, nonrandomized cohort20(pts treated first w/ metoprolol for 4 wk, then ivabradine for 4 wk)resting HR>100, or mean HR >90 bpm during 24-h HolterAntiarrhythmic therapy discontinued at least 4 wk priorSecondary causes for tachycardia and SHD were excludedAim: Evaluate safety and efficacy of ivabradine compared to metoprololMean and resting HR lower w/ both metoprolol and ivabradine compared to baseline (p<0.001)Exercise capacity (METS) on ETT improved w/ both metoprolol and ivabradine compared to baseline (p<0.001)Sxs reduced more w/ ivabradine compared to metoprolol (p<0.05)70% treated w/ ivabradine were free of sxs related to ISTSide effects: Metoprolol – hypotension in 30%, asymptomatic sinus bradycardia (40-50 bpm) in 25%Ivabradine and metoprolol both reduced HR. Ivabradine better tolerated and improved sxs to greater extentLimitation – short term (4 wk therapy per treatment), small sample size, nonrandomized w/o crossover; no washout period between drugsPtaszynski P2013 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlB0YXN6eW5za2k8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy
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ADDIN EN.CITE.DATA (72)23078130Prospective, nonrandomized cohort14Inclusion: IST w/ resting HR ±100 bpm in sitting position and average HR ±90 bpm in 24-h Holter, following successful slow pathway ablation for AVNRT. Pts had also received at least 3 mo of beta blocker therapyExclusion: secondary cause of tachycardia and SHDEvaluation at baseline, 1 mo and 2 mo of therapy w/ ivabradine (5 mg -7.5 mg bid). Resting ECG, 24-h Holter to determine resting, mean, maximum HR, and evaluation of rhythm from Holter corresponding to sxs. ETT performed at baseline, 4 wk and 8 wk Questionnaire to assess sxs before and after 30 and 60 d – EHRA scoreMean resting HR at 30 and 60 d reduced compared to baseline (p<0.001)24-h Holter w/ reduced mean and mean HR during daily activity (p<0.001). Improved exercise capacity w/ ivabradine (p<0.001)Reduced sxs w/ no severe sxs in any pts by 2 moAt 2 mo severe sxs were eliminated in all pts.Limitation – No long term data for efficacy or if IST resolvedPtaszynski P2013 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlB0YXN6eW5za2k8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy
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ADDIN EN.CITE.DATA (73)23426376Prospective, observational cohort20Inclusion: IST w/ resting HR ≥100 bpm in sitting position and average HR ≥90 bpm in 24-h Holter. Pts previously treated w/ beta blockers or verapamil w/o effect or poorly toleratedExclusion: secondary cause of tachycardia and SHD; postural orthostatic tachycardia or h/o orthostatic intoleranceReceived metoprolol succinate 47.5 mg - 95 mg daily for first 4 wk, then ivabradine added 5 mg- 7.5 mg twice daily for additional 4 wk (combination therapy)Holter and ETT performed baseline, 4 wk, and 8 wk.Sxs assessed by questionnaire (EHRA score)Resting HR: baseline 114.4±7.5, at 4 wk 97.3 ±14.4 and 8 wk 90.5 ±13.3 bpm, P<0.001. Mean and maximal HR on Holter monitor also lower in combination therapy compared to either baseline or monotherapy w/ beta blockade (P<0.001).Exercise capacity also increased.After 1 mo of combined therapy no pts reported IST related sxsLimitation – no long term dataKang KT2014PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbmc8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (74)25015944Retrospective chart review (10 pediatric centers)249 ptsPediatric patient with focal AT (median age at diagnosis: 7.2 y), diagnosed based on ECG, 24-h Holter, or event monitor data consistent w/ EP criteria. 168 pts received antiarrhythmic medications (44 different medication combinations), including 154 pts as initial therapy and 14 pts after initial management with catheter ablation. Median duration of first-line therapy was 89 d. Characterization of current management strategies for focal AT in childrenResolution of focal AT in 89% (including spontaneous resolution w/o catheter ablation in 34%).-antiarrhythmic medications used for initial therapy with control of focal AT in 72% (BB were most common, 53%, and most effective, 42%). 34% of the 154 pts w/ first-line therapy along achieved complete suppression or rate control of focal AT. 9 pts had serious AE while on antiarrhythmic medications.-catheter ablation successful in 109 of 134 pts (81%). -53 of 72 pts (74%) presenting at age <3 y had spontaneous resolution (including 50 pts aged <1 y). Spontaneous resolution observed in 18 of 129 pts >5 y.-Cardiomyopathy observed in 28%. 80% of pts with cardiomyopathy had focal AT resolution at last f/u. Lower recurrence rates when electroanatomic mapping techniques are used vs. conventional mapping techniques (16% vs. 35%; p=0.02). Focal AT is managed successfully in most children. Many pts control focal AT with medications, but catheter ablation is used for most pts and successful for all ages.Spontaeous resolution is common, emphasizing delayed ablation in this group.Limitations:-retrospective study, variable f/u duration (median 2.1 y) and available data. Case seriesCallans DJ1999PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhbGxhbnM8L0F1dGhvcj48WWVhcj4xOTk5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (75)10334440Case series10 pts(13 procedures)Symptomatic, drug refractory pts referred for RFA of ISTProcedure:- Primarily anatomic-based using ICE guidance, but also activation mapping for confirmation (point-by-point or electroanatomic w/ Carto)- Isoproterenol infusionProcedural success: - - Abrupt decrease (≥30 bpm) in sinus rate during RF lesion delivery- Sudden appearance of superiorly directed p wave morphology (negative P in lead III)- Persistence of these features despite isoproterenol up to 4 mcg/min for at least 30 min following final RF lesion11/13 (85%) procedures successfulLocal circumferential swelling w/ reduction in diameter of SVC-RA junction to 12.6±3.3 mm (24% reduction, p=0.0001)Complications – “none”- Reduction in diameter of SVC-RA junction by ≥30% compared w/ baseline observed in 5 pts; no pts had clinical signs for SVC syndrome.- Small adherent thrombi in 4 pts- 1 pt ppm (after complete SN ablation)Conclusions:- RFA for IST can cause considerable swelling and narrowing of SVC-RA junction. - ICE might be useful in preventing excessive tissue swelling that could lead to complications.Man KC2000 ADDIN REFMGR.CITE <Refman><Cite><Author>Man</Author><Year>2000</Year><RecNum>66</RecNum><IDText>Radiofrequency catheter ablation of inappropriate sinus tachycardia guided by activation mapping</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>66</Ref_ID><Title_Primary>Radiofrequency catheter ablation of inappropriate sinus tachycardia guided by activation mapping</Title_Primary><Authors_Primary>Man,K.C.</Authors_Primary><Authors_Primary>Knight,B.</Authors_Primary><Authors_Primary>Tse,H.F.</Authors_Primary><Authors_Primary>Pelosi,F.</Authors_Primary><Authors_Primary>Michaud,G.F.</Authors_Primary><Authors_Primary>Flemming,M.</Authors_Primary><Authors_Primary>Strickberger,S.A.</Authors_Primary><Authors_Primary>Morady,F.</Authors_Primary><Date_Primary>2000/2</Date_Primary><Keywords>Action Potentials</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Body Surface Potential Mapping</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Isoproterenol</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Recurrence</Keywords><Keywords>Reoperation</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Sinus</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>451</Start_Page><End_Page>457</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>35</Volume><Issue>2</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Misc_3>S0735-1097(99)00546-X</Misc_3><Address>Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0022, USA</Address><Web_URL>PM:10676693</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(76)10676693Case series29 ptsConsecutive, drug refractory, symptomatic pts who underwent RFA of ISTProcedure: - Activation mapping (point-by-point)- Isoproterenol infusion 1-2 mcg/minProcedural success: Reduction of baseline sinus rate to <90 bpm, and a 20% or greater reduction in sinus rate during infusion of isoproterenol.Procedural success 22/29 (76%) ptsSxs due to IST recurred in 6/22 (27%) at mean f/u 4.4±3 moAdditional procedures in 3 ptsOverall success 19/29 (66%) pts over long-termComplications in 2/29 (7%) pts- Sinus pauses/near-syncope (ppm)- Paralysis of right hemidiaphragmRFA is at best only modestly effective for managing pts w/ IST.Marrouche NF2002 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1hcnJvdWNoZTwvQXV0aG9yPjxZZWFyPjIwMDI8L1llYXI+
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ADDIN EN.CITE.DATA (77)11897449Case series39 ptsInclusions:“Debilitating” IST (no prior drugs in 6 pts)Exclusions:- Prior sinoatrial node ablation at other center- F/u <2 y- POTSProcedure: - Mapping at baseline and after isoproterenol (or aminophylline)- Earliest site of activation by 3D electroanatomic mapping targeted- Autonomic testing (10 pts w/ resting HR >100) - tested response to esmolol before ablation - ETT before and after ablation- ICE to verify crista Procedural success:HR drop below 120 bmp during isoproterenol 2 mcg/min alone or in combination w/ aminophylline(Look for SN acceleration during RFA delivery)When endpoint achieved, then recreated 3D map of RAObserve for recovery of HR for 45 to 60 min after last ablationSinoatrial node successfully modified in all pts (100%)Drop in mean HR from 99 ±14 bpm to 72±8 bpm, p<0.01Shift in caudal activation along crista terminalis on 3D map was more pronounced after RFA than during esmolol (23 ±11 mm vs. 7±5 mm, p<0.05)No pt underwent ppm after mean f/u 32±9 mo.21% of pts experienced recurrence of IST and were successfully re-ablatedComplications: SVC syndrome (1 pt), requiring dilation3D mapping provides an effective tool to monitor and guide RFA for IST. (Seems to eliminate excessive destruction of SN and reduce or eliminate risk of complete SN ablation.)Difference in caudal shift seen after esmolol and following sinoatrial node modification suggests that adrenergic hypersensitivity is not the only mechanism responsible for IST.Lin D2007 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxpbjwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (78)17338721Case series7 ptsMedically refractory IST referred for ablationProcedure:- Non-contact mapping (Endocardial Solutions, Ensite array, 4 mm Chilli Cooled Ablation system) - Isoproterenol 1-10 mcg/min- Intrinsic HR evaluated w/ BB and atropineEndpoint: Decrease in HR of ≥25% off isoproterenol and associated change in P wave morphology in III and AVF from positive to a flat or negative defection c/w more inferior origin Procedural success: 100%Complications: 1 pt ppm (symptomatic junctional bradycardia requiring ppm 2 wk after procedure) – but also had prior RFANon-contact mapping in conjunction w/ saline-cooled ablation for SN modification may provide effective HR control for treatment of IST.Frankel DS2012 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkZyYW5rZWw8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (79)22471900Case series33 ptsConsecutive, drug refractory, symptomaticProcedure: - Evolved from anatomic approach using ICE to EP approach using multi-electrode mapping (St. Jude Ensite or Biosense Webster)- IsoproterenolProcedural endpoint:- Decrease of >25% in resting HR, w/ blunted HR response to isoproterenol and shift of P wave morphology from positive to flat or negative in leads III and AVF - Cranial to caudal shift in site of earliest RA activation pre and post SAN modification was measured using mapping system (later y)F/u 2.0±1.5 y- 18% recurrent IST- 27% developed non-IST tachyarrhythmia (42% had non-IST arrhythmia prior to SAN modification)2 deaths (unrelated) during long-term f/u:- 1 mechanical fall- 1 pulseless electrical activity (end-stage cardiomyopathy)Complications (long-term):12% required ppm for SAN dysfunctionNon-IST tachyarrhythmias are common in pts w/ IST before and after SAN modification, and are often responsible for sxs during f/u.Takemoto M2012 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRha2Vtb3RvPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48
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ADDIN EN.CITE.DATA (80)22333369Case series6 ptsConsecutive, drug refractory, “debilitating” Procedure:- Non-contact mapping (St. Jude Ensite)- Break-out sites also identified as earliest sites that showed rS pattern w/ sudden increase in peak negative potential on noncontact unipolar electrogram- Isoproterenol 2-5 mcg/minProcedural endpoint:When break-out sites observed at heart rate >100 bpm moved from the tall P wave zone to the normal P wave zone, w/ and w/o IV isoproterenolF/U 29±2 moProcedural success 6/6 (100%)1 y F/U: 0 recurrences1 ? y: 1/6 pts had recurrence of IST and underwent repeat RFA w/ successAlso showed improvement of HR on Holter, BNP, NYHA functional class, exercise tolerance, and time to achieve HR of 130 bpm on ETT post-ablationComplications: noneNon-contact mapping can be used to safely and effectively treat IST.Huang HD2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Huang</Author><Year>2013</Year><RecNum>64</RecNum><IDText>Stellate ganglion block: a therapeutic alternative for patients with medically refractory inappropriate sinus tachycardia?</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>64</Ref_ID><Title_Primary>Stellate ganglion block: a therapeutic alternative for patients with medically refractory inappropriate sinus tachycardia?</Title_Primary><Authors_Primary>Huang,H.D.</Authors_Primary><Authors_Primary>Tamarisa,R.</Authors_Primary><Authors_Primary>Mathur,N.</Authors_Primary><Authors_Primary>Alam,M.</Authors_Primary><Authors_Primary>Makkar,A.</Authors_Primary><Authors_Primary>Birnbaum,Y.</Authors_Primary><Authors_Primary>Afshar-Kharaghan,H.</Authors_Primary><Date_Primary>2013/11</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adult</Keywords><Keywords>Anesthetics,Local</Keywords><Keywords>diagnosis</Keywords><Keywords>drug effects</Keywords><Keywords>Exercise</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>methods</Keywords><Keywords>Nerve Block</Keywords><Keywords>prevention & control</Keywords><Keywords>Stellate Ganglion</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Sinus</Keywords><Keywords>therapy</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>693</Start_Page><End_Page>696</End_Page><Periodical>J Electrocardiol.</Periodical><Volume>46</Volume><Issue>6</Issue><ISSN_ISBN>1532-8430</ISSN_ISBN><Misc_3>S0022-0736(12)00547-X;10.1016/j.jelectrocard.2012.12.010</Misc_3><Address>Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA. Electronic address: Hdhuang@bcm.edu</Address><Web_URL>PM:23313383</Web_URL><ZZ_JournalFull><f name="System">Journal of electrocardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Electrocardiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(81)23313383Case report using stellate ganglion block134 y old woman previously treated w/ verapamil, beta blockers, clonidineBaseline mean HR (Holter) 104 bpm. Tilt table hr increased from 86 to 104 bpm at 2 min (70 deg)Stellate ganglion block performed (transient Horner syndrome) (right, then left 2 d later)Following bilateral stellate ganglion block, Holter w/ mean HR of 73 bpm.Last f/u at 4 mo w/ resting HR of 87 bpm.Following bilateral stellate ganglion block, Holter w/ mean HR of 73 bpm.Last f/u at 4 mo w/ resting HR of 87 bpm.Mechanisms for lasting effect unclear as anesthetic agent used has half-life of 4-5 hAAD indicates antiarrhythmic drug; AVNRT, atrioventricular nodal reentrant tachycardia; bid, two times per day; BNP, B-type natriuretic peptide; bpm indicates beats per min; c/w, consistent with; ECG, electrocardiogram; EHRA, European Heart Rhythm Association; EP, electrophysiological; ETT, exercise tolerance test; f/u, follow up; h/o, history of; HR, heart rate; ICE, intracardiac echocardiography; IST, inappropriate sinus tachycardia; IV, intravenous; METS, metabolic equivalents; NYHA, New York Heart Association; POTS, postural orthostatic tachycardia syndrome; PPM, prosthesis-patient mismatch; pt, patient; QOL, quality of life; RF, radiofrequency; RFA, radiofrequency ablation; SF, short form; SHD, structural heart disease; SN, sinus node; SVC, superior vena cava; SVC-RA, superior vena cava-right atrial; SVT, supraventricular tachycardia; sx, symptom; w/, with; and w/o, without.Data Supplement 6. Nonrandomized Trials, Observational Studies, and/or Registries of Focal Atrial Tachycardia – Section 4.1 StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsGillette PC1977 ADDIN REFMGR.CITE <Refman><Cite><Author>Gillette</Author><Year>1977</Year><RecNum>78</RecNum><IDText>Electrophysiologic and pharmacologic characteristics of automatic ectopic atrial tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>78</Ref_ID><Title_Primary>Electrophysiologic and pharmacologic characteristics of automatic ectopic atrial tachycardia</Title_Primary><Authors_Primary>Gillette,P.C.</Authors_Primary><Authors_Primary>Garson,A.,Jr.</Authors_Primary><Date_Primary>1977/10</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>diagnosis</Keywords><Keywords>Digoxin</Keywords><Keywords>drug therapy</Keywords><Keywords>Drug Therapy,Combination</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Heart Atria</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Injections,Intramuscular</Keywords><Keywords>Injections,Intravenous</Keywords><Keywords>Phenytoin</Keywords><Keywords>Propranolol</Keywords><Keywords>Reserpine</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>571</Start_Page><End_Page>575</End_Page><Periodical>Circulation</Periodical><Volume>56</Volume><Issue>4 Pt 1</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:902384</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(82)902384Observational7 children (6 wks to 9 y of age)Sustained automatic AT taken to EP labProgrammed stimulation and drug testing1 responded to digoxin, 3 responded to propranolol and digoxin; diphenylhydantoin in one and reserpine in1Newborn and pediatric population Creamer JE1985 ADDIN REFMGR.CITE <Refman><Cite><Author>Creamer</Author><Year>1985</Year><RecNum>75</RecNum><IDText>Successful treatment of atrial tachycardias with flecainide acetate</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>75</Ref_ID><Title_Primary>Successful treatment of atrial tachycardias with flecainide acetate</Title_Primary><Authors_Primary>Creamer,J.E.</Authors_Primary><Authors_Primary>Nathan,A.W.</Authors_Primary><Authors_Primary>Camm,A.J.</Authors_Primary><Date_Primary>1985/2</Date_Primary><Keywords>Adult</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>drug therapy</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Piperidines</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>164</Start_Page><End_Page>166</End_Page><Periodical>Br.Heart J</Periodical><Volume>53</Volume><Issue>2</Issue><User_Def_5>PMC481734</User_Def_5><ISSN_ISBN>0007-0769</ISSN_ISBN><Web_URL>PM:3966957</Web_URL><ZZ_JournalFull><f name="System">British heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Br.Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(83)3966957Case report3 (23, 33 and 57 y of age, all man)Symptomatic persistent ATAcute (IV) and long term (oral) response to flecainideAll responded acutely and on long term f/u from 3 mo to 3 yCase report demonstrating flecainide is effective in focal AT in selected pts.Kunze KP1986 ADDIN REFMGR.CITE <Refman><Cite><Author>Kunze</Author><Year>1986</Year><RecNum>81</RecNum><IDText>Effect of encainide and flecainide on chronic ectopic atrial tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>81</Ref_ID><Title_Primary>Effect of encainide and flecainide on chronic ectopic atrial tachycardia</Title_Primary><Authors_Primary>Kunze,K.P.</Authors_Primary><Authors_Primary>Kuck,K.H.</Authors_Primary><Authors_Primary>Schluter,M.</Authors_Primary><Authors_Primary>Bleifeld,W.</Authors_Primary><Date_Primary>1986/5</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adult</Keywords><Keywords>Anilides</Keywords><Keywords>Chronic Disease</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Encainide</Keywords><Keywords>Exercise</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Heart Atria</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Piperidines</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>1121</Start_Page><End_Page>1126</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>7</Volume><Issue>5</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Web_URL>PM:3082957</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(84)3082957Observational5 pts (mean age 37)Chronic symptomatic ectopic AT failed 4 other antiarrhythmic drugs including amiodarone and verapamilAssess acute and long term outcomes w/ encainide and flecainide therapy4/5 pts had complete suppression of AT by encainide and 1/5 had significant reduction at a mean f/u of 8 mo. 3/5 pts did not tolerate encainide. These pts responded to flecainide w/o any side effectsOne of the more comprehensive mechanism-based investigation in human subjects. Differentiation of mechanisms is based on best established criteria although overlaps between reentry and trigger are present; drug response was not specific. It is not apparent whether these were micro- or macro-reentry circuits. Ablation targeted the earliest activation, suggesting micro-reentry.Lucet V1987 ADDIN REFMGR.CITE <Refman><Cite><Author>Lucet</Author><Year>1987</Year><RecNum>416</RecNum><IDText>[Anti-arrhythmia efficacy of propafenone in children. Apropos of 30 cases]</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>416</Ref_ID><Title_Primary>[Anti-arrhythmia efficacy of propafenone in children. Apropos of 30 cases]</Title_Primary><Authors_Primary>Lucet,V.</Authors_Primary><Authors_Primary>Do,Ngoc D.</Authors_Primary><Authors_Primary>Fidelle,J.</Authors_Primary><Authors_Primary>Sidi,D.</Authors_Primary><Authors_Primary>Batisse,A.</Authors_Primary><Authors_Primary>Loth,P.</Authors_Primary><Authors_Primary>Vrancea,F.</Authors_Primary><Authors_Primary>Villain,E.</Authors_Primary><Authors_Primary>Coumel,P.</Authors_Primary><Date_Primary>1987/8</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Amiodarone</Keywords><Keywords>Arrhythmias,Cardiac</Keywords><Keywords>Calcium</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Heart Failure</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Infant</Keywords><Keywords>Male</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Propafenone</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>1385</Start_Page><End_Page>1393</End_Page><Periodical>Arch.Mal.Coeur Vaiss.</Periodical><Volume>80</Volume><Issue>9</Issue><ISSN_ISBN>0003-9683</ISSN_ISBN><Address>Centre de Cardiologie Infantile du Chateau des Cotes, Les Loges-en-Josas</Address><Web_URL>PM:3122689</Web_URL><ZZ_JournalFull><f name="System">Archives des maladies du coeur et des vaisseaux</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Arch.Mal.Coeur Vaiss.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(85)3122689Observational30 children, age 3 mo to 20 yAll pts treated w/ propafenone for a mean period of 14 moClinical outcomes on propafenone therapyStudy cohorts: chronic AT (8), junctional arrhythmia (9), ventricular arrhythmia (13). 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ADDIN EN.CITE.DATA (86) 3339178Observational10 infants and children; median age 6 mo, range from new born to 7.5 yMet ECG critieria for ectopic ATAcute and long term response to a sequence of drug testing. One pt underwent surgical ablation; one pt underwent catheter ablationDigoxin did not suppress any AT but did slow the ventricular rate by 5-20% in 8 pts. IV propranolol was effective in AT suppression in 3/5 pts; oral propranolol was effective in 2/5. Class Ia and Ib antiarrhythmic agents were not effective in AT suppression and worsened the ventricular rate. IV amiodarone was effective in 3 /4 pts and oral amiodarone was effective in one pt. During f/u (10-28 mo), AT resolved in 4 pts and was well controlled in 4 pts. Surgical and catheter ablation was each performed in one ptsThis small study was conducted in new born and very young childrenColloridi V1992 ADDIN REFMGR.CITE <Refman><Cite><Author>Colloridi</Author><Year>1992</Year><RecNum>74</RecNum><IDText>Oral sotalol in pediatric atrial ectopic tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>74</Ref_ID><Title_Primary>Oral sotalol in pediatric atrial ectopic tachycardia</Title_Primary><Authors_Primary>Colloridi,V.</Authors_Primary><Authors_Primary>Perri,C.</Authors_Primary><Authors_Primary>Ventriglia,F.</Authors_Primary><Authors_Primary>Critelli,G.</Authors_Primary><Date_Primary>1992/1</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Child,Preschool</Keywords><Keywords>diagnosis</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Italy</Keywords><Keywords>Male</Keywords><Keywords>pharmacology</Keywords><Keywords>Sotalol</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Atrial</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>254</Start_Page><End_Page>256</End_Page><Periodical>Am Heart J</Periodical><Volume>123</Volume><Issue>1</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Misc_3>0002-8703(92)90785-T</Misc_3><Address>Department of Pediatric Cardiology, University of Rome, La Sapienza, Italy</Address><Web_URL>PM:1729843</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(87)1729843Case study5 pediatric ptsEctopic AT was met by ECG criteriaPts failed a mean of three drugsSotalol was added to digoxin; AT was suppressed in all 5 ptsA small case series study showing effect of sotalol on AT in pediatric ptsvon Bernuth G1992 ADDIN REFMGR.CITE <Refman><Cite><Author>von Bernuth</Author><Year>1992</Year><RecNum>91</RecNum><IDText>Atrial automatic tachycardia in infancy and childhood</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>91</Ref_ID><Title_Primary>Atrial automatic tachycardia in infancy and childhood</Title_Primary><Authors_Primary>von Bernuth,G.</Authors_Primary><Authors_Primary>Engelhardt,W.</Authors_Primary><Authors_Primary>Kramer,H.H.</Authors_Primary><Authors_Primary>Singer,H.</Authors_Primary><Authors_Primary>Schneider,P.</Authors_Primary><Authors_Primary>Ulmer,H.</Authors_Primary><Authors_Primary>Brodherr-Heberlein,S.</Authors_Primary><Authors_Primary>Kienast,W.</Authors_Primary><Authors_Primary>Lang,D.</Authors_Primary><Authors_Primary>Lindinger,A.</Authors_Primary><Authors_Primary>.</Authors_Primary><Date_Primary>1992/10</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Amiodarone</Keywords><Keywords>Atrial Appendage</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>diagnosis</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography,Ambulatory</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Germany</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Male</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Propafenone</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Atrial</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>1410</Start_Page><End_Page>1415</End_Page><Periodical>Eur Heart J</Periodical><Volume>13</Volume><Issue>10</Issue><ISSN_ISBN>0195-668X</ISSN_ISBN><Address>Department of Pediatric Cardiology, RWTH Aachen, Germany</Address><Web_URL>PM:1396817</Web_URL><ZZ_JournalFull><f name="System">European heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(88)1396817Observational21 infants and children Automatic AT was documented by Holter and ECG; 12 were incessant, 7 were repetitive, 2 were undefined; 16/21 were symptomaticAll pts were treated w/ 1-8 antiarrhythmic drugs (median 3)Amiodarone was most effective followed by class Ic drugs: flecainide and propafenone. During a median f/u of 2.5 y (range from 4 mo to 21 y), 12 were in sinus rhythm, 5 were w/o any drugs. Nine pts were still on antiarrhythmic drugs; all were intermittent except oneSmall observational study in the pediatric populationChen SA1994 ADDIN REFMGR.CITE <Refman><Cite><Author>Chen</Author><Year>1994</Year><RecNum>73</RecNum><IDText>Sustained atrial tachycardia in adult patients. Electrophysiological characteristics, pharmacological response, possible mechanisms, and effects of radiofrequency ablation</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>73</Ref_ID><Title_Primary>Sustained atrial tachycardia in adult patients. Electrophysiological characteristics, pharmacological response, possible mechanisms, and effects of radiofrequency ablation</Title_Primary><Authors_Primary>Chen,S.A.</Authors_Primary><Authors_Primary>Chiang,C.E.</Authors_Primary><Authors_Primary>Yang,C.J.</Authors_Primary><Authors_Primary>Cheng,C.C.</Authors_Primary><Authors_Primary>Wu,T.J.</Authors_Primary><Authors_Primary>Wang,S.P.</Authors_Primary><Authors_Primary>Chiang,B.N.</Authors_Primary><Authors_Primary>Chang,M.S.</Authors_Primary><Date_Primary>1994/9</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Atria</Keywords><Keywords>Humans</Keywords><Keywords>Isoproterenol</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Keywords>Valsalva Maneuver</Keywords><Reprint>Not in File</Reprint><Start_Page>1262</Start_Page><End_Page>1278</End_Page><Periodical>Circulation</Periodical><Volume>90</Volume><Issue>3</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC</Address><Web_URL>PM:8087935</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(89)8087935Observational 36 (57+/-13 y of age)Sustained AT referred to the EP lab for ablationProgrammed stimulation, drug testing, Valsalva, monophasic AP recording and ablation to assess AT mechanisms20/36 had reentrant AT,9/36 triggered (DAD)7/36 automaticImmediate success 40/41 (98%)Recurrence 2/40 (5%) in 18 mons f/u2 failed RF, both were triggeredOne of the earlier more comprehensive mechanism-based investigation in human subjects. Differentiation of mechanisms is based on best established criteria although overlaps between reentry and trigger are present; drug response was not specific. It is not apparent whether these were micro- or macro-reentry circuits. Ablation targeted the earliest activation, suggesting micro-reentry.Engelstein ED1994 ADDIN REFMGR.CITE <Refman><Cite><Author>Engelstein</Author><Year>1994</Year><RecNum>415</RecNum><IDText>Mechanism-specific effects of adenosine on atrial tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>415</Ref_ID><Title_Primary>Mechanism-specific effects of adenosine on atrial tachycardia</Title_Primary><Authors_Primary>Engelstein,E.D.</Authors_Primary><Authors_Primary>Lippman,N.</Authors_Primary><Authors_Primary>Stein,K.M.</Authors_Primary><Authors_Primary>Lerman,B.B.</Authors_Primary><Date_Primary>1994/6</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>New York</Keywords><Keywords>Patients</Keywords><Keywords>pharmacology</Keywords><Keywords>physiopathology</Keywords><Keywords>Potassium</Keywords><Keywords>Research</Keywords><Keywords>Sinoatrial Node</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Sinoatrial Nodal Reentry</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>2645</Start_Page><End_Page>2654</End_Page><Periodical>Circulation</Periodical><Volume>89</Volume><Issue>6</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Medicine, New York Hospital-Cornell Medical Center, NY 10021</Address><Web_URL>PM:8205677</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(90)8205677Observational27 pts Automatic (7 pts, age 34+/- 18); sinus node reentry (6 pts, age 58+/- 16); atrial flutter (8 pts, age 62+/- 8); intra-atrial reentry (5 pts, age 70 +/- 8 ); triggered tachycardia (1 pt, age 79)Pts were referred for electrophysiology study (25 pts; 17 for symptomatic SVT, 7 for VT, 1 for syncope) or cardioversion (2 pts w/ atrial flutter)Mechanism of tachycardia was confirmed during electrophysiology study. Response to adenosine was assessed according to EP study determined mechanismsAdenosine terminated all sinus node reentry tachycardia (6/6), triggered tachycardia (1/1). Adenosine transiently suppressed automatic AT (7/7); it had not effect on reentry tachycardia (13/13)These earlier observations established our current understanding of potential mechanisms of AT and drug effects as predicted by underlying mechanisms.Heusch A1994PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhldXNjaDwvQXV0aG9yPjxZZWFyPjE5OTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (91)7527342Observational72 children, mean age was 34 mo (range 0-192)All pts were treated w/ propafenone AT or junctional tachycardia were in 10/72 pts (14%). Other arrhythmias including AV reentrant tachycardia (32 pts, 44%), atrial flutter (16 pts, 22%), atrial reentry tachycardia (3 pts, 4%) and ventricular arrhythmias (11 pts, 16%).Propafenone was effective in controlling atrial or junctional ectopic tachycardia in 83%. Of the entire study cohorts, better outcomes were observed in pts w/ normal hearts and in whom onset of arrhythmias was pre-natal.A mix of many different arrhythmias renders interpretation of results difficult. The study population is young children, many w/ congenital heart conditionsJanousek J1998 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkphbm91c2VrPC9BdXRob3I+PFllYXI+MTk5ODwvWWVhcj48
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ADDIN EN.CITE.DATA (92)9605053European, retrospective and multicenter study722 infants and children from 27 European centers coordinated by the Working Group on Pediatric Arrhythmias and Electrophysiology of the Association of European Pediatric CardiologistAll pts were treated w/ oral propafenoneSafety outcomesEctopic AT was in 66/722 study cohort. Other arrhythmias included reentrant SVT (388), junctional ectopic tachycardia (39), atrial flutter (21), ventricular premature complexes (140), VT (78) and other (39). 249/722 had SHD. Adverse events included sinus node dysfunction (4), complete heart block (2), SVT proarrhythmia (2), accelerated ventricular rate during atrial flutter (1), ventricular arrhythmias (5), unexplained syncope (1). Cardiac arrest occurred in 6 (0.6%, 2 had WPW, 3 had SHD)A large retrospective multicenter study on the safety of propafenone in the pediatric population. Kalman JM1998 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbG1hbjwvQXV0aG9yPjxZZWFyPjE5OTg8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (94)10355690Observational30 pts (age 55 +/- 18 y)Referred to EP study for evaluation and treatment of tachycardiaAssess response to adenosine according to EP study determined mechanismsAdenosine terminated 14/17 focal AT and transiently suppressed the other 3 pts. Only 1/13 macrorenetrant tachycardia was terminated by adenosine. The termination occurred in the slow of conduction w/ decrementing properties. Verapamil terminated all of the focal ATs when testedThis study highlighted the challenges remain in differentiating automatic vs. triggered focal AT. The proportion of focal AT terminated by adenosine (presumably due to triggered activity) is significantly different from the report from Englestein 1994, from the same lab.Morton JB2001 ADDIN REFMGR.CITE <Refman><Cite><Author>Morton</Author><Year>2001</Year><RecNum>88</RecNum><IDText>Focal atrial tachycardia arising from the tricuspid annulus: electrophysiologic and electrocardiographic characteristics</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>88</Ref_ID><Title_Primary>Focal atrial tachycardia arising from the tricuspid annulus: electrophysiologic and electrocardiographic characteristics</Title_Primary><Authors_Primary>Morton,J.B.</Authors_Primary><Authors_Primary>Sanders,P.</Authors_Primary><Authors_Primary>Das,A.</Authors_Primary><Authors_Primary>Vohra,J.K.</Authors_Primary><Authors_Primary>Sparks,P.B.</Authors_Primary><Authors_Primary>Kalman,J.M.</Authors_Primary><Date_Primary>2001/6</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Cardiac Catheterization</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Electrocardiography</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Valve Diseases</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>pathology</Keywords><Keywords>physiopathology</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Keywords>Tricuspid Valve</Keywords><Reprint>Not in File</Reprint><Start_Page>653</Start_Page><End_Page>659</End_Page><Periodical>J Cardiovasc Electrophysiol.</Periodical><Volume>12</Volume><Issue>6</Issue><ISSN_ISBN>1045-3873</ISSN_ISBN><Address>Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia</Address><Web_URL>PM:11405398</Web_URL><ZZ_JournalFull><f name="System">Journal of cardiovascular electrophysiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Cardiovasc Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(95)11405398Observational9 pts from 64 consecutive pts underwent RFA for RA AT6 male, 50 +/- 20 y; AT from CT; point to point steerable catheterMapping and localization of AT to CT34/67 (51%) from CT; 8 (12%) from CS; 10 (15%) para-Hisian; 9 (13%) from TA. 8/9 were successfully ablated; 1 was not inducibleAT originating from CT is commonKistler PM2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktpc3RsZXI8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (96)12821250Observational7 pts/ 172 consecutive pts w/ focal ATAT from mitral annulusPoint to point mappingMapping and ablation need to make note how they figured out where it was coming fromAll mapped to left fibrous trigone and mitral-aortic continuity; P wave low amplitude in precordial leads, biphasic, negative followed by positive; 100% success rateMitral annular origin is less commonKistler PM2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktpc3RsZXI8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (97)14557361Observational27 pts w/ 28 ATsAT from pulmonary veins; 39 +/- 16 y; point to point mapping w/ or w/o LassoMapping and ablationRight superior pumonlary vein 11, left superior pulmonary vein 11, left inferior pulmonary vein 5, right inferior pulmonary vein 1; 26/28 were ostia; 100% successful; 4 recurrence; 25/28 were focal; 3/28 segmental28/172 consecutive focal ATs (16%) from pulmonary vein; high success rate; majority at ostiaGonzalez MD2004 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdvbnphbGV6PC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48
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ADDIN EN.CITE.DATA (98)15533857Observational10 pts/35 consecutive pts (28%)AT from mitral-aortic continuityMapping and ablationTachycardia CL 340 msec +/- 56; local e-P – 44 msec +/- 14; 100% successfulProvided a brief discussion on mouse embryo and the specialized conduction system in near the mitral-aortic continuity regionKistler PM2005PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktpc3RsZXI8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (99)15862424Observational13 pts (of 193 w/ focal AT)7 female; 41 +/- 6 y; AT from tricuspid annulus (TA); point to point mappingMapping and localization of AT to TANegative p wave in all inferior leads; negative or isoelectric in V1, positive in avL; 11/13 successfully ablated; 2 noninducible; no recurrence in 25 mo13/ 193 (6.7%) of all AT are from coronary sinus os. Eidher U2006 ADDIN REFMGR.CITE <Refman><Cite><Author>Eidher</Author><Year>2006</Year><RecNum>77</RecNum><IDText>Efficacy and safety of ibutilide for the conversion of monomorphic atrial tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>77</Ref_ID><Title_Primary>Efficacy and safety of ibutilide for the conversion of monomorphic atrial tachycardia</Title_Primary><Authors_Primary>Eidher,U.</Authors_Primary><Authors_Primary>Freihoff,F.</Authors_Primary><Authors_Primary>Kaltenbrunner,W.</Authors_Primary><Authors_Primary>Steinbach,K.</Authors_Primary><Date_Primary>2006/4</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>adverse effects</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>diagnosis</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Risk Assessment</Keywords><Keywords>Risk Factors</Keywords><Keywords>Safety</Keywords><Keywords>Sulfonamides</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Atrial</Keywords><Keywords>therapy</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>358</Start_Page><End_Page>362</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>29</Volume><Issue>4</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Misc_3>PACE353;10.1111/j.1540-8159.2006.00353.x</Misc_3><Address>Ludwig-Boltzmann Institute for Arrhythmia Research, Department of Internal Medicine 3 (Cardiology), Wilhelminenspital, Vienna, Austria. dr_eidher@</Address><Web_URL>PM:16650262</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(100)16650262Observational38 pts, 49 episodes of AT“monomorphic” AT, excluded typical atrial flutter and AF; likely included macro-reentry atypical flutterIbutilide conversion to SR in the acute setting19/49 (38.8%) conversionInclusion does not differentiate focal AT from macro-reentry AT; conversion rate appear to be lower than atrial flutter and AF.Ouyang F2006PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk91eWFuZzwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (101)16814658Observational9 pts; 6 failed previous “para-Hisian” ablation; 6 femaleNCC ATLocation and ablationLocal egram preceded His local A by 12 msec; no H on the ablation catheter; all ablation was successful w/o recurrenceAge 54 +/- 12, range 32-66One of the earlier observational studies reported AT localized to NCC and successfully ablated; highlights mapping NCC early if AT appears para-HisianRoberts-Thomson KC2007 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlJvYmVydHMtVGhvbXNvbjwvQXV0aG9yPjxZZWFyPjIwMDc8
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ADDIN EN.CITE.DATA (102)17286568Observational10 pts (of 261 w/ focal AT)9 male, 39 =+/- 20 y; AT from RAA; point to point mapping w/ 4 mm tip deflectable catheterMapping and localization to RAAP wave negative in V1; low amplitude or positive in inferior leads; acute success rate in 100%, no recurrenceRAA AT is less common 10/261 (3.8%)Medi C2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1lZGk8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (103)19422986Case control30 pts w/ cardriomyopathy vs. 301 w/o cardiomyopathyAT induced cardiomyopathyOutcome assessmentAT induced caridomyopathy 10% ( 30/301); incessant, younger (39 +/- 22 vs. 51 +/- 17, 60% males vs. 38%), longer tachycardia CL (502 msec vs. 402 msec); LVEF was restored in 97% ptsPrevalence of AT induced cardiomyopathy 10% in all AT pts; RFA is highly successful in restore LVEFLiu X2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxpdTwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (104)20797494Case control13 study pts15 PAF/PVI25 PAFAT origination from NCCLocal e-gram, activation sequence, electroanatomical mapping, histology, and P-wave morphologyWide initial activation patter in the right atrium (RA), left atrium (LA) from the parahistian area; earliest activation in the NCC; no atrial myocardium in the NCC; NCC was adjacent to the atrial para-septal tissuePresence of “para-Hisian AT” should raise awareness of close anatomical relationship to atrial –paraseptal tissue and NCCEarly mapping and ablation in the NCC may increase ablation success and reduce complicationsP wave morphology may not differentiate NCC-AT from left atrial or RA paraseptal ATBiviano AB2012 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJpdmlhbm88L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (105)21967474Observational24, 14 female, age 48+/- 18Focal left atrial AT; no prior h/o AFLocation and short term ablation outcomeCL 347 msec (190-510 msec); CS, septum (5), free wall, MVA, roof, LAA, ligament of Marshall and PV (6)Immediate success 19/22 ATsA good observational study on the distribution of left atrial AT location; contemporary techniques; no major complications; success rate is consistent w/ the literaturede Loma-Osorio A2013 ADDIN REFMGR.CITE <Refman><Cite><Author>de Loma-Osorio</Author><Year>2013</Year><RecNum>76</RecNum><IDText>Spanish Catheter Ablation Registry. 12th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2012)</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>76</Ref_ID><Title_Primary>Spanish Catheter Ablation Registry. 12th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2012)</Title_Primary><Authors_Primary>de Loma-Osorio,Ferrero</Authors_Primary><Authors_Primary>Diaz-Infante,E</Authors_Primary><Authors_Primary>.</Authors_Primary><Authors_Primary>Macias,Gallego A.</Authors_Primary><Date_Primary>2013/12</Date_Primary><Keywords>Atrial Fibrillation</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Electrophysiology</Keywords><Keywords>methods</Keywords><Keywords>mortality</Keywords><Keywords>Spain</Keywords><Keywords>Tachycardia</Keywords><Reprint>Not in File</Reprint><Start_Page>983</Start_Page><End_Page>992</End_Page><Periodical>Rev.Esp.Cardiol (Engl.Ed)</Periodical><Volume>66</Volume><Issue>12</Issue><ISSN_ISBN>1885-5857</ISSN_ISBN><Misc_3>S1885-5857(13)00274-0;10.1016/j.rec.2013.08.002</Misc_3><Address>Seccion de Electrofisiologia y Arritmias, Sociedad Espanola de Cardiologia, Madrid, Spain. Electronic address: angelferrero@
Seccion de Electrofisiologia y Arritmias, Sociedad Espanola de Cardiologia, Madrid, Spain
Seccion de Electrofisiologia y Arritmias, Sociedad Espanola de Cardiologia, Madrid, Spain</Address><Web_URL>PM:24774111</Web_URL><ZZ_JournalFull><f name="System">Revista espanola de cardiologia (English ed.)</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Rev.Esp.Cardiol (Engl.Ed)</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(106)24774111Spanish registry from 74 centers, voluntary333 of 11042 procedures (3%)Registry included all ablation procedures from 2012Ablation outcomesAcute success rate 284/333 (85.3%); RA 61%, 36% in LA; complications 7/333 (2.1%), 1 permanent pacemaker, 2 vascular, 4 pericardial effusionOne of the few national registriesMano H2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1hbm88L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (107)23595943Case control6 study cohorts, 12 controlsAnatomical substrate for NCC-AT vs. AVNRTComparing P wave duration, PQ, intracardiac intervals and local anatomy between NCC-AT and AVNRTP wave duration, PQ and AH intervals were longer in NCC-AT than AVNRT; AS (aortic roof to IVS angle) angle was steeper and IVS was thickerInteresting details, but not sure how useful for clinical practiceAF indicates atrial fibrillation; AP, accessory pathway; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; CL, cycle length; CT, crista terminalis; DAD, delayed afterdepolarizations; ECG, electrocardiogram; EP, electrophysiological; f/u, follow up; h/o, history of; ICE, intracardiac echocardiography; IV, intravenous; IVS, intraventricular septum; LA, left atrial; LAA, left atrial appendage; LVEF, left ventricular ejection fraction; MVA, mitral valve area; NCC, non-coronary cusp; pt, patient; PV, pulmonary vein; RA, right atrial; RF, radiofrequency; RFA, radiofrequency ablation; SHD, structural heart disease; SR, sinus rhythm; SVT, supraventricular tachycardia; VT, ventricular tachycardia; w/, with; w/o, without; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 7. Randomized Trials Comparing Multifocal Atrial Tachycardia – Section 4.2 Study Name, Author, YearAim of StudyStudy Type (Size, N)Study Intervention Group (n)Study Comparator Group (n)Pt PopulationEndpointsP Values, OR: HR: RR: & 95% CI:Study Limitations & Adverse EventsInclusion CriteriaExclusion CriteriaPrimary Endpoint (efficacy) and ResultsSafety Endpoint and ResultsSecondary Endpoint and ResultsArsura E1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Arsura</Author><Year>1988</Year><RecNum>71</RecNum><IDText>A randomized, double-blind, placebo-controlled study of verapamil and metoprolol in treatment of multifocal atrial tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>71</Ref_ID><Title_Primary>A randomized, double-blind, placebo-controlled study of verapamil and metoprolol in treatment of multifocal atrial tachycardia</Title_Primary><Authors_Primary>Arsura,E.</Authors_Primary><Authors_Primary>Lefkin,A.S.</Authors_Primary><Authors_Primary>Scher,D.L.</Authors_Primary><Authors_Primary>Solar,M.</Authors_Primary><Authors_Primary>Tessler,S.</Authors_Primary><Date_Primary>1988/10</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>blood</Keywords><Keywords>Clinical Trials as Topic</Keywords><Keywords>Digoxin</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Metoprolol</Keywords><Keywords>Patient Selection</Keywords><Keywords>physiopathology</Keywords><Keywords>Random Allocation</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>519</Start_Page><End_Page>524</End_Page><Periodical>Am J Med</Periodical><Volume>85</Volume><Issue>4</Issue><ISSN_ISBN>0002-9343</ISSN_ISBN><Misc_3>S0002-9343(88)80088-3</Misc_3><Address>State University of New York, Health Science Center, Brooklyn</Address><Web_URL>PM:3052051</Web_URL><ZZ_JournalFull><f name="System">The American journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(108)3052051?To determine efficacy of verapamil, metoprolol or placebo in MATRandomized, double-blind, placebo-controlled study of verapamil and metoprolol in treatment of MAT; 13 pts (4 male, 9 female)9 pts verapamil, 9 pts metoprolol10 pts given placebo (2 pts given placebo on both days)MAT diagnosed via ECG. Reversible precipitants of MAT (hypoxia, electrolyte abnormalities, anemia, acidosis, and serum digoxin or theophylline levels outside therapeutic range) – if corrected and pt continued to have MAT, able to participate. CHF; SBP <100 mm Hg; bronchospasm; h/o greater than first-degree heart block; bifascicular block; altered sinus node function; hypersensitivity to either age; estimated survival time <72 h; use of either study agent w/in preceding 72 hConversion to sinus rhythm, a decline in the ventricular rate of ≥15%, or decline in ventricular rate to <100 bpmN/ARepeat physical exam and arterial blood gas values. 2/10 (20%); 4/9 (44%); 8/9 (89%) showed a response to placebo, verapamil, or metoprolol, respectivelyMean slowing of ventricular rate was 3.4, 7.3, and 24.5% for placebo, verapamil, and metoprolol, respectively (p<0.01 for metoprolol vs. placebo). Five pts who had a response to metoprolol had failed to have a response to verapamil.Metoprolol appears more effective than verapamil in treating MAT. Caution must be exercised in selecting ptsMcCord JK 1998 ADDIN REFMGR.CITE <Refman><Cite><Author>McCord</Author><Year>1998</Year><RecNum>70</RecNum><IDText>Usefulness of intravenous magnesium for multifocal atrial tachycardia in patients with chronic obstructive pulmonary disease</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>70</Ref_ID><Title_Primary>Usefulness of intravenous magnesium for multifocal atrial tachycardia in patients with chronic obstructive pulmonary disease</Title_Primary><Authors_Primary>McCord,J.K.</Authors_Primary><Authors_Primary>Borzak,S.</Authors_Primary><Authors_Primary>Davis,T.</Authors_Primary><Authors_Primary>Gheorghiade,M.</Authors_Primary><Date_Primary>1998/1/1</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>complications</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Infusions,Intravenous</Keywords><Keywords>Lung Diseases,Obstructive</Keywords><Keywords>Magnesium</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Single-Blind Method</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time Factors</Keywords><Reprint>Not in File</Reprint><Start_Page>91</Start_Page><End_Page>93</End_Page><Periodical>Am J Cardiol</Periodical><Volume>81</Volume><Issue>1</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>S0002-9149(97)00809-6</Misc_3><Address>Cardiovascular Division, Henry Ford Hospital, Detroit, Michigan 48202, USA</Address><Web_URL>PM:9462615</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(109)9462615To assess the use of IV Mg for MAT in pts w/ COPDRandomized; 14 pts9 pts received 2 grams over 5 min and 10 g over 5 h5 pts received PlaceboPts w/ COPD and MATCr ≥2.0 mg/dL,intolerance to IV infusionRhythm assessment at 5 hPts treated w/ magnesium had a slowing of heart rate from 130 to 99 beats per minPlacebo- no effect on HR.NSR at end of infusion in 7/9 treated w/ Mg vs. 1/5 w/ placebo.N/AN/AN/ACaregivers not blinded. Small sample size with no control group. BP indicates blood pressure; CI, confidence interval; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; Cr, creatinine; ECG, electrocardiogram; HR, heart rate; IV, intravenous; MAT, multifocal atrial tachycardia; N/A, not applicable; OR, odds ratio; pt, patient; RR, relative risk; and SBP, systolic blood pressure. Data Supplement 8. Nonrandomized Trials, Observational Studies, and/or Registries of Multifocal Atrial Tachycardia – Section 4.2 StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsIseri LT1985 ADDIN REFMGR.CITE <Refman><Cite><Author>Iseri</Author><Year>1985</Year><RecNum>92</RecNum><IDText>Magnesium and potassium therapy in multifocal atrial tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>92</Ref_ID><Title_Primary>Magnesium and potassium therapy in multifocal atrial tachycardia</Title_Primary><Authors_Primary>Iseri,L.T.</Authors_Primary><Authors_Primary>Fairshter,R.D.</Authors_Primary><Authors_Primary>Hardemann,J.L.</Authors_Primary><Authors_Primary>Brodsky,M.A.</Authors_Primary><Date_Primary>1985/10</Date_Primary><Keywords>Aged</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>blood</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Heart Atria</Keywords><Keywords>Humans</Keywords><Keywords>Infusions,Parenteral</Keywords><Keywords>Magnesium</Keywords><Keywords>Magnesium Sulfate</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Potassium</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>789</Start_Page><End_Page>794</End_Page><Periodical>Am Heart J</Periodical><Volume>110</Volume><Issue>4</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Misc_3>0002-8703(85)90458-2</Misc_3><Web_URL>PM:4050650</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(110)4050650Observational88 pts w/ MAT received 7-12 Gm IV mag over 5 hNSRN/AMAT was successfully converted to sinus rhythm or sinus tachycardia in seven pts. MAT rhythm (at slow rate) persisted in one pt.Hazard PB1987 ADDIN REFMGR.CITE <Refman><Cite><Author>Hazard</Author><Year>1987</Year><RecNum>93</RecNum><IDText>Treatment of multifocal atrial tachycardia with metoprolol</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>93</Ref_ID><Title_Primary>Treatment of multifocal atrial tachycardia with metoprolol</Title_Primary><Authors_Primary>Hazard,P.B.</Authors_Primary><Authors_Primary>Burnett,C.R.</Authors_Primary><Date_Primary>1987/1</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>complications</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Injections,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Metoprolol</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Pulmonary Gas Exchange</Keywords><Keywords>Respiratory Insufficiency</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Atrial</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>20</Start_Page><End_Page>25</End_Page><Periodical>Crit.Care Med</Periodical><Volume>15</Volume><Issue>1</Issue><ISSN_ISBN>0090-3493</ISSN_ISBN><Web_URL>PM:3792010</Web_URL><ZZ_JournalFull><f name="System">Critical care medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Crit.Care Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(111)3792010 Observational, active treatment w/ metoprolol2525 pts w/ MAT that was complicating severe cardiopulmonary illnessObserved its effect on heart rate and rhythm, BP, and arterial blood gaseAll pts showed slowing of heart rate, averaging 54.0±4.0 bpm (p<0.001)pH and PaCO2 were unaltered; mean PaO2 increased by 12.2 +/- 5.8 torr (p<0.05)Metoprolol is effective in the management of MAT.B indicates blood pressure; bpm, beats per minute; MAT, multifocal atrial tachycardia; N/A, not applicable; NSR, normal sinus rhythm; PaCO2, partial pressure of carbon dioxide; pt, patient; and w/, with. Data Supplement 9. Randomized Trials Comparing Atrioventricular Nodal Re-Entrant Tachycardia – Section 5 Study Name, Author, YearAim of StudyStudy Type (Size, N)Study Intervention Group (n)Study Comparator Group (n)Pt PopulationEndpointsP Values, OR: HR: RR: & 95% CI:Study Limitations & Adverse EventsInclusion CriteriaExclusion CriteriaPrimary Endpoint (efficacy) and ResultsSafety Endpoint and ResultsSecondary Endpoint and ResultsPharmacological TherapyWaxman HL1981 ADDIN REFMGR.CITE <Refman><Cite><Author>Waxman</Author><Year>1981</Year><RecNum>123</RecNum><IDText>Verapamil for control of ventricular rate in paroxysmal supraventricular tachycardia and atrial fibrillation or flutter: a double-blind randomized cross-over study</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>123</Ref_ID><Title_Primary>Verapamil for control of ventricular rate in paroxysmal supraventricular tachycardia and atrial fibrillation or flutter: a double-blind randomized cross-over study</Title_Primary><Authors_Primary>Waxman,H.L.</Authors_Primary><Authors_Primary>Myerburg,R.J.</Authors_Primary><Authors_Primary>Appel,R.</Authors_Primary><Authors_Primary>Sung,R.J.</Authors_Primary><Date_Primary>1981/1</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Placebos</Keywords><Keywords>Random Allocation</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapeutic use</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>1</Start_Page><End_Page>6</End_Page><Periodical>Ann Intern Med</Periodical><Volume>94</Volume><Issue>1</Issue><ISSN_ISBN>0003-4819</ISSN_ISBN><Web_URL>PM:7447203</Web_URL><ZZ_JournalFull><f name="System">Annals of internal medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Intern Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(112)7447203Effectiveness of IV verapamil50Group 1 (n=20) w/ AF or flutterGroup 2 (n=30)PSVT (AVNRT in 8 pts), N/APSVT w/ AF, atrial flutter, PSVTN/AControl of ventricular response in group 1, restoration of sinus rhythm in group 2In Group 1 low-dose verapamil (0.075 mg/kg body weight) decreased the mean ventricular rate from 146 to 114 bpm (p<0.01) compared to a decrease of 145 to 132 bpm (p<0.01) after placebo.In Group 2, 14/29 pts converted to sinus rhythm after low-dose verapamil, 9/15 after high-dose verapamil (0.15 mg/kg), and 1/24 after placebo (p<0.01).N/AN/AN/AVerapamil results in a clinically significant slowing of the ventricular response in AF or atrial flutter and is superior to placebo for conversion of PSVT to sinus rhythmMauritson DR1982 ADDIN REFMGR.CITE <Refman><Cite><Author>Mauritson</Author><Year>1982</Year><RecNum>7</RecNum><IDText>Oral verapamil for paroxysmal supraventricular tachycardia: a long-term, double-blind randomized trial</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>7</Ref_ID><Title_Primary>Oral verapamil for paroxysmal supraventricular tachycardia: a long-term, double-blind randomized trial</Title_Primary><Authors_Primary>Mauritson,D.R.</Authors_Primary><Authors_Primary>Winniford,M.D.</Authors_Primary><Authors_Primary>Walker,W.S.</Authors_Primary><Authors_Primary>Rude,R.E.</Authors_Primary><Authors_Primary>Cary,J.R.</Authors_Primary><Authors_Primary>Hillis,L.D.</Authors_Primary><Date_Primary>1982/4</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Drug Evaluation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Random Allocation</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Time Factors</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>409</Start_Page><End_Page>412</End_Page><Periodical>Ann Intern Med</Periodical><Volume>96</Volume><Issue>4</Issue><ISSN_ISBN>0003-4819</ISSN_ISBN><Web_URL>PM:7065555</Web_URL><ZZ_JournalFull><f name="System">Annals of internal medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Intern Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(23)7065555Effectiveness and safety of oral verapamil11Verapamil 240 mg/d followed by 480 mg/d (n=11)PlaceboSymptomatic PSVT, ≥2 episodes/mo, ascertained by ECGAVNRT(n=7)AVRT(n=2 w/ WPW, n=3 w/ concealed AP)CHF, severe hypertension, hypotension, VHD or CHD, renal/hepatic failure, SSS, AV block, atrial flutter, AF, AADsEpisodes/wk (diary, Holter)Verapamil 0.1±0.1 ,0.3 ±0.5Placebo 0.3±0.3 ,0.7 ±0.7Duration (min) (diary, Holter)Verapamil 3±3 ,1±2Placebo 27±5 ,67±111Minor AEs in 6 pts on verapamil5 pts required a total of 35 cardioversions for sustained tachycardia, 2 during verapamil, 33 during placebo (p<0.001)PES performed at end of study to induce tachycardia. Caused sustained tachycardia in 9 on placebo, 2 on verapamil (p<0.01) N/Ap<0.05 for primary endpointOral verapamil safe and effective.Small sample size.Unclear which pt withdrew, so numbers of AVNRT vs. AVRT may be similar (i.e., 6 vs. 5). Winniford MD1984 ADDIN REFMGR.CITE <Refman><Cite><Author>Winniford</Author><Year>1984</Year><RecNum>8</RecNum><IDText>Long-term therapy of paroxysmal supraventricular tachycardia: a randomized, double-blind comparison of digoxin, propranolol and verapamil</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>8</Ref_ID><Title_Primary>Long-term therapy of paroxysmal supraventricular tachycardia: a randomized, double-blind comparison of digoxin, propranolol and verapamil</Title_Primary><Authors_Primary>Winniford,M.D.</Authors_Primary><Authors_Primary>Fulton,K.L.</Authors_Primary><Authors_Primary>Hillis,L.D.</Authors_Primary><Date_Primary>1984/11/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Clinical Trials as Topic</Keywords><Keywords>Digoxin</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Propranolol</Keywords><Keywords>Random Allocation</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>1138</Start_Page><End_Page>1139</End_Page><Periodical>Am J Cardiol</Periodical><Volume>54</Volume><Issue>8</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Web_URL>PM:6388299</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(24)6388299Effect of AV nodal blockers for long-term therapy of PSVT11One mo of:Digoxin 0.375 mg/dPropranolol 240 mg/dVerapamil 480 mg/dDirect comparison between all 3, w/ one wk of placebo washoutSymptomatic PSVT, ≥2 episodes/mo, ascertained by ECGECG evidence of preexcitationEpisodes and duration (ascertained by diary and weekly 24-h Holter), adverse effects, SDCs of each drugEpisodes/wk (diary, Holter)Digoxin 2.3±3.1, 1.9±2.9Propranolol 1.5±2.3, 0.2±0.6Verapamil 2.9±5.7, 0.6±1.6Duration (min) (diary, Holter)Digoxin 75±164, 47±157Propranolol 60±112, 1±1Verapamil 56±148, 1±1Mild side effects in 3/11 pts w/ digoxin and propranolol, and 5/11 w/ verapamil. All SDCs w/in normal reference range.?N/A?p=NSOnly verapamil had been studied in RCT prior to this (above), and given its proven efficacy, authors felt no need for placebo. Small series of pts.Unclear mechanism of PSVT (authors speculate all pts w/ AVRNT or ORT w/ concealed conduction. Yeh SJ1984 ADDIN REFMGR.CITE <Refman><Cite><Author>Yeh</Author><Year>1985</Year><RecNum>124</RecNum><IDText>Termination of paroxysmal supraventricular tachycardia with a single oral dose of diltiazem and propranolol</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>124</Ref_ID><Title_Primary>Termination of paroxysmal supraventricular tachycardia with a single oral dose of diltiazem and propranolol</Title_Primary><Authors_Primary>Yeh,S.J.</Authors_Primary><Authors_Primary>Lin,F.C.</Authors_Primary><Authors_Primary>Chou,Y.Y.</Authors_Primary><Authors_Primary>Hung,J.S.</Authors_Primary><Authors_Primary>Wu,D.</Authors_Primary><Date_Primary>1985/1</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Atrioventricular Block</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Benzazepines</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>Cardiac Catheterization</Keywords><Keywords>Diltiazem</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Drug Therapy,Combination</Keywords><Keywords>Electric Countershock</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Propranolol</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>104</Start_Page><End_Page>109</End_Page><Periodical>Circulation</Periodical><Volume>71</Volume><Issue>1</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:3964710</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(113) 3964710 Effect of diltiazem and propranolol as pill-in-the-pocket15Combination diltiazem 120 mg/propranolol 160 mg vs. placebosDirect comparison on 2 consecutive dInducible PSVTAVRT (n=13)AVNRT (n=2)N/AW/ placebo PSVT lasted 164±89 min; 4 pts had spontaneous conversion. W/ diltiazem and propranolol PSVT lasted 39±49 min (p<.001). 14 pts had spontaneous conversion in an average of 27 ±15 min. None of the 14 pts had electrical reinduction of sustained PSVT after conversion.Outpatient f/u w/ 50/51 conversion of PSVT w/in 21±16 min, f/u of 5.6 mo. The heart rate was 87±16 bpm before and59±10 bpm at 90 min after diltiazem and propranolol(p<0.001). The systolic and diastolic pressureswere, respectively, 111±11 and 77±10 mmHg before and 88 + 9 and 66 + 9 mm Hg after diltiazem and propranolol (p<0.001)N/AN/ASingle dose of diltiazem/propranolol terminated acute PSVTLimited due to EP study efficacy and low numbers of AVNRT pts. Not placebo controlled. Anderson S1986 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkFuZGVyc29uPC9BdXRob3I+PFllYXI+MTk4NjwvWWVhcj48
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ADDIN EN.CITE.DATA (25)2868645Efficacy of esmolol in treatment of PSVT71Multicenter, double-blind, partial-crossover studyEsmolol (n=36)Placebo (n=35)?“SVT” (HR>120)Note: AVNRT in 18% of subjectsVHD, AV block, SSS, significant electrolyteabnormality,precluding treatment w/ beta blockade, bronchialasthma, ventricular arrhythmias requiring drug therapy,cardiogenic shock, CHF (NYHA III-IV), renal or hepatic dysfunction, drug or alcohol abuse, on other beta-adrenergic blockers or calcium channelblockers w/in two half-lives of study entryTherapeutic response: ≥20% reduction in HR, HR<100 bpm, or conversion to NSR.Therapeutic response to esmolol during the initial treatment period (72%) similar when esmolol was given as a second agent4 pts (6%) converted to NSRIn the 80% therapeutic response lost w/in 30 min following discontinuation of esmolol infusionHypotension which occurred in12% on esmolol, 2% w/ placebo.N/Ap=NSRapid onset and short ofaction of esmolol offer safe, effective therapy for acute treatment of pts w/ PSVT. Low numbers of pts w/ AVNRT.*DiMarco JP1990 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRpTWFyY288L0F1dGhvcj48WWVhcj4xOTkwPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (114)2193560Evaluate dose responses of adenosine in terminating PSVT359 total in both protocols(n=201)Sequential IV bolus doses of adenosine (3, 6, 9, 12 mg) (n=137)Saline placebo(n=64)PSVTSevere CHF, unstable angina, recent MI, severe valvular regurgitation, intracardiac shunts, sleep apnea, current methylxanthine or dipyridamole useAdenosine terminated acute episodes of PSVT, vs. placebo: 3 mg: 35.2% vs. 8.9%6 mg 62.3% vs. 10.7%9 mg: 80.2% vs. 14.3%12 mg: 91.4% vs. 16.1%Adenosine caused mild, transient side effects in 36% of pts (flushing, chest pain/pressure, hypotension, dyspnea)N/A?p<0.0001Overall efficacy of adenosine high, especially w/ increasing doses*DiMarco JP1990 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRpTWFyY288L0F1dGhvcj48WWVhcj4xOTkwPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (114) 2193560Compare adenosine to verapamil in terminating PSVT359 total in both protocols(n=158)6-12 mg adenosine (n=77)5-7.5 mg of verapamil.(n=81)?PSVTSevere CHF, unstable angina, recent MI, severe valvular regurgitation, intracardiac shunts, sleep apnea, current methylxanthine or dipyridamole useCumulative response rates Adenosine:6 mg: 57.412 mg: 93.4% Verapamil:5 mg: 81.3% 7.5 mg: 91.4%Adenosine caused mild, transient side effects in 36% of pts?N/AN/AOverall efficacy of adenosine is similar to verapamil, but onset of action is more rapid.Henthorn RW1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Henthorn</Author><Year>1991</Year><RecNum>11</RecNum><IDText>Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>11</Ref_ID><Title_Primary>Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group</Title_Primary><Authors_Primary>Henthorn,R.W.</Authors_Primary><Authors_Primary>Waldo,A.L.</Authors_Primary><Authors_Primary>Anderson,J.L.</Authors_Primary><Authors_Primary>Gilbert,E.M.</Authors_Primary><Authors_Primary>Alpert,B.L.</Authors_Primary><Authors_Primary>Bhandari,A.K.</Authors_Primary><Authors_Primary>Hawkinson,R.W.</Authors_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Date_Primary>1991/1</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Drug Administration Schedule</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>prevention & control</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>119</Start_Page><End_Page>125</End_Page><Periodical>Circulation</Periodical><Volume>83</Volume><Issue>1</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Division of Cardiology, Christ Hospital, Cincinnati, Ohio 45219</Address><Web_URL>PM:1898640</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(26)1898640Flecainide for treatment of symptomatic PSVT (≥2 episodes)348-wk crossover (after four episodes of PSVT or end of treatment period)?Flecainide(n=34)Placebo(n=34)PSVT Syncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA III-IV) Freedom from symptomatic PSVT at 60 d:79% events vs. 15% (p<0.001)Flecainide slowed symptomatic PSVT HR to 143±12 bpm from 178 ±12 on placebo in 7 pts who had events in the placebo and flecainide treatment phases(p<0.02)Significantly more side effects w/ flecainide (p<0.05)Flecainide vs. placebo:Recurrence:8/34 vs. 29/34 (p<0.001).Median time to first event: 55 vs. 11 d (p<0.001)Median interval between episodes >55 vs. 12 (p<0.001)N/ADespite participationof 19 medical centers, only 34 pts completed entire protocol and provided analyzable data.All pts tolerated flecainide, limiting generalizability.Transtelephonic monitoring does not permit assessment of proarrhythmia6/34 w/ AVNRT, confirmed by EP study, and 18/34 w/ unknown mechanism.Pritchett EL1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Pritchett</Author><Year>1991</Year><RecNum>10</RecNum><IDText>Flecainide acetate treatment of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation: dose-response studies. The Flecainide Supraventricular Tachycardia Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>10</Ref_ID><Title_Primary>Flecainide acetate treatment of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation: dose-response studies. The Flecainide Supraventricular Tachycardia Study Group</Title_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Authors_Primary>DaTorre,S.D.</Authors_Primary><Authors_Primary>Platt,M.L.</Authors_Primary><Authors_Primary>McCarville,S.E.</Authors_Primary><Authors_Primary>Hougham,A.J.</Authors_Primary><Date_Primary>1991/2</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>297</Start_Page><End_Page>303</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>17</Volume><Issue>2</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Address>Duke University Medical Center, Durham, North Carolina 27710</Address><Web_URL>PM:1899432</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(27)1899432 Dose-response efficacy of flecainide in patents w/ PSVT, PAF, paroxysmal atrial flutter42Flecainide given in ascending order (25501001150 mg twice daily)PSVT(n=14, Group 1)PAF or parosysmal atrial flutter(n=28, Group 2)Placebo inserted at random (alternating w/ flecainide) at 30 d intervalsPSVT, PAF, or paroxysmal atrial flutterSyncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA III-IV) .Among 14 pts in Group 1 who qualified for efficacy analysis, 4 (29%) had no tachycardia while taking placebo. Number w/ no tachycardia increased w/ progressively larger flecainide doses; w/ the 150 mg twice daily dose, 12 (86%) of 14 pts had no tachycardia (p<0.01 for overall differences among all treatments).Noncardiac adverse experiences were leading cause of premature study discontinuation during flecainide treatment periods (5 pts in Group 1 and 6 pts in Group 2).N/AN/ASmall sample size, short treatment period. Pritchett EL1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Pritchett</Author><Year>1991</Year><RecNum>9</RecNum><IDText>Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias. A randomized, placebo-controlled, crossover trial in patients tolerating oral therapy</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>9</Ref_ID><Title_Primary>Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias. A randomized, placebo-controlled, crossover trial in patients tolerating oral therapy</Title_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Authors_Primary>McCarthy,E.A.</Authors_Primary><Authors_Primary>Wilkinson,W.E.</Authors_Primary><Date_Primary>1991/4/1</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>blood</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Propafenone</Keywords><Keywords>Recurrence</Keywords><Keywords>Statistics as Topic</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>539</Start_Page><End_Page>544</End_Page><Periodical>Ann Intern Med</Periodical><Volume>114</Volume><Issue>7</Issue><ISSN_ISBN>0003-4819</ISSN_ISBN><Address>Duke University Medical Center, Durham, North Carolina</Address><Web_URL>PM:2001087</Web_URL><ZZ_JournalFull><f name="System">Annals of internal medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Intern Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(28)2001087Oral propafenone to prevent symptomatic PSVTRandomized, double-blind, placebo-controlled, crossover phase, w/ each treatment period lasting up to 60 d.23Propafenone (n=23)Placebo(n=23)PSVT(n=14) PAF(n=9)Angina during tachycardia, pulmonary edema, neurologicsxs. PAF w/ WPW syndrome, on AADsCompared w/ placebo, propafenone caused an increase in time to first recurrence of arrhythmia (p=0.004)PSVT:p=0.03PAF:p=0.06.Cardiac AEs occurred only in pts w/ PAF (9/11): 2 w/ prolonged episode of AF, 1 w/ atrial flutter w/ a mean ventricularrate of 263 bpm recorded using the telephone monitor.N/AN/APropafenone efficacious in treating PSVT and PAF.Major limitation in not knowing how many pts had AVNRT. .Dougherty AH1992 ADDIN REFMGR.CITE <Refman><Cite><Author>Dougherty</Author><Year>1992</Year><RecNum>122</RecNum><IDText>Acute conversion of paroxysmal supraventricular tachycardia with intravenous diltiazem. IV Diltiazem Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>122</Ref_ID><Title_Primary>Acute conversion of paroxysmal supraventricular tachycardia with intravenous diltiazem. IV Diltiazem Study Group</Title_Primary><Authors_Primary>Dougherty,A.H.</Authors_Primary><Authors_Primary>Jackman,W.M.</Authors_Primary><Authors_Primary>Naccarelli,G.V.</Authors_Primary><Authors_Primary>Friday,K.J.</Authors_Primary><Authors_Primary>Dias,V.C.</Authors_Primary><Date_Primary>1992/9/1</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Cardiology</Keywords><Keywords>Diltiazem</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Injections,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Safety</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time</Keywords><Keywords>Time Factors</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>587</Start_Page><End_Page>592</End_Page><Periodical>Am J Cardiol</Periodical><Volume>70</Volume><Issue>6</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Address>Division of Cardiology, University of Texas Medical School, Houston 77225</Address><Web_URL>PM:1510006</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(115)1510006Efficacy and safety of IV diltiazem87AVNRT (n=25)AVRT (n=60)AT (n=2)DiltiazemPlaceboInduction of PSVT w/ PES, requiredto have a rate of 120 bpm and to persist for 115 min.Pts w/ severe congestive heartfailure, sinus node dysfunction, pregnancy, myocardialinfarction w/in 2 wk of study, or hypotension (SBP <90 mm Hg)Conversion to sinus rhythm occurred in 4 of 14 pts (29%) w/ 0.05 mg/kg of diltiazem, 16 of 19 (84%) w/ 0.15 mg/kg, 13 of 13 (100%) w/ 0.25 mg/kg, and 14 of 17 (82%) w/ 0.45 mg/kg compared w/ 6 of 24 (25%) treated w/ placebo. Conversion rates in groups receiving doses of 0.15 to 0.45 mg/kg of diltiazem were superior to that in the placebo group (p<0.001). Time to conversion was 3.0±2.6 min in responding diltiazem pts compared w/ 5.9±6.1 min in responding control pts.N/AMost frequent adverse response to diltiazem was hypotension (7 of 63 pts); however, only 4 pts had sxs related to hypotension.N/AIV diltiazem in doses of 0.15, 0.25 and 0.45 mg/kg is effective and safe for acute management of PSVT.Anderson JL1994 ADDIN REFMGR.CITE <Refman><Cite><Author>Anderson</Author><Year>1994</Year><RecNum>12</RecNum><IDText>Flecainide acetate for paroxysmal supraventricular tachyarrhythmias. The Flecainide Supraventricular Tachycardia Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>12</Ref_ID><Title_Primary>Flecainide acetate for paroxysmal supraventricular tachyarrhythmias. The Flecainide Supraventricular Tachycardia Study Group</Title_Primary><Authors_Primary>Anderson,J.L.</Authors_Primary><Authors_Primary>Platt,M.L.</Authors_Primary><Authors_Primary>Guarnieri,T.</Authors_Primary><Authors_Primary>Fox,T.L.</Authors_Primary><Authors_Primary>Maser,M.J.</Authors_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Date_Primary>1994/9/15</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>blood</Keywords><Keywords>Confounding Factors (Epidemiology)</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Time Factors</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>578</Start_Page><End_Page>584</End_Page><Periodical>Am J Cardiol</Periodical><Volume>74</Volume><Issue>6</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Address>Department of Medicine, University of Utah, Salt Lake City</Address><Web_URL>PM:8074041</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(29)8074041 Long-term efficacy of flecainide (≥6 mo)49PSVT(n=21)PAF(n=28)FlecainidePlaceboPts enrolled from 3 prior studies evaluating short-term flecainide efficacy (2 above, Pritchett and Henthorn—one [Anderson, 1989]) not tabulated above due to PAF-only population)Syncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA III-IV) -Number of pts w/o attacks-Time to first attack-Interval between attacks-Average frequency of attacks,-Ventricular rate during attacks.PSVT pts:Of 17 efficacy evaluable pts, 14 (82%) had no SVT attacks during the chronic efficacy study compared w/ 4 (24%) w/ no attacks during placebo therapy at baseline (p=0.013).Time to first arrhythmia attack and time between attacks increasedduring chronic therapy w/ flecainide compared w/ placebo treatment (p=0.008 and p=0.012, respectively)Rates of attack/d not significantly different (p=0.130)No PSVT pts w/ ventricular arrhythmiasNo pt experiencedproarrhythmia, MI, or died during chronic efficacy study.N/AN/ASupports flecainide for chronic therapy of PSVT.Small numbers of pts w/ PSVT, and PSVT not specifically defined.Chimienti M1995 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNoaW1pZW50aTwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+
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ADDIN EN.CITE.DATA (30)8682031Compare the long-term safety of flecainide and propafenone335AVNRT:flecainide 100 mg (n = 72) PAF:flecainide 200 mg (n = 97) AVNRT:propafenone 450 mg (n=63)PAF: propafenone 450 mg (n=103).PAF(n-200)AVNRT(n=135)LVEF <35%, AV block, QRS >140 msec, SSS, persistent AF (episodes >72 h), VT (episodes >30 sec), NYHA III-IV, ischemic heart disease, hypertrophic cardiomyopathy, hypotension, valvular disease, renal/hepatic insufficiency, thyroid disease, AADsITT analysisPSVT:93% for flecainide and 86% for propafenone (p=0.24)PAF:77% for flecainide and 75% for propafenone (p=0.72)12 pts on flecainide reported 16 cardiac AEs, of whom six discontinued the treatment. 7 propafenone pts had 8 cardiac AEs, of whom 5 discontinued the treatment.(1 case of VT on propafenone2 cases of AF w/ rapid ventricular response on flecainideN/AN/ABoth flecainide and propafenone were safe in the long-term treatment of pts w/ PSVT.Limited in that only one-third of pts w/ AVNRT. UK Propafenone PSVT Study Group1995 ADDIN REFMGR.CITE <Refman><Cite><Year>1995</Year><RecNum>14</RecNum><IDText>A randomized, placebo-controlled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. UK Propafenone PSVT Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>14</Ref_ID><Title_Primary>A randomized, placebo-controlled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. UK Propafenone PSVT Study Group</Title_Primary><Date_Primary>1995/11/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>prevention & control</Keywords><Keywords>Propafenone</Keywords><Keywords>Recurrence</Keywords><Keywords>Risk Factors</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>2550</Start_Page><End_Page>2557</End_Page><Periodical>Circulation</Periodical><Volume>92</Volume><Issue>9</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:7586356</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(31)7586356Efficacy and tolerability of propafenone at 600 and 900 mg daily doses (given twice daily).2 consecutive crossover periods100Propafenone 300 mg bidPropafenone 300 mg tidPlaceboPSVT(n=52) PAF(n=48) 75 pts in low-dose phase:45 PSVT, 30 PAF59 pts advanced to high-dose phase:34 PSVT, 25 PAF ≥2 symptomatic episodes by transtelephonic monitoring PSVT w/ hemodynamic collapse, LVEF ≤25%, recent MI or unstable angina; hepatic/renal failure, SSS, AV block, AADs, female pts of childbearing potential, COPD, myasthenia gravis.Placebo vs. propafenone:Relative risks, PSVT, low-dose:Arrhythmia recurrence or AE6.8 (95% CI: 2.2-21.2; p<0.001)Arrhythmia recurrence7.4 (95% CI: 2.3-23.3; p<0.001)Relative risks, PSVT, high-dose:Arrhythmia recurrence or AE2.2 (95% CI: 0.9-5.3; p=NS)Arrhythmia recurrence15.0 (95% CI: 2.0-113; p=0.009)More pts experienced more adverse events during propafenone (900 mg>600 mg). Most common adverse events during PSVT and PAF groups were related to the gastrointestinal and neuropsychiatric systems. Total numbers of adverse events on propafenone were 46 and 56 in the low-dose and high-dose PSVT group and 67 and 74 in the low-dose and high-dose PAF groups, respectively.1 episode of wide-complex tachycardia was documented during propafenone therapyN/APropafenone at 600 mg is effective and well tolerated. A larger dose of 900 mg causes more adverse effects but may be more effective in those who can tolerate it.Sequential design (not randomized after low-dose phase) so population is not generalizable at 900 mg dose. Not powered for mortality.Limited in that PSVTs included AVNRT, AT, or AVRT.Wanless RS1997 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldhbmxlc3M8L0F1dGhvcj48WWVhcj4xOTk3PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (33)9124166 Sotalol in treatment of PSVT126 Sotalol 80 mg(n=35)AVNRT (23%)Sotalol 160 mg(n=46)AVNRT (22%)Placebo(n=45)AVNRT (24%)Recurrent symptomatic PSVT were eligible for enrollment. AVNRTPAFParoxysmal atrial flutterAVRTParoxysmal AT Decompensated CHF, asthma, chronic obstructive airways disease, second degree or third degree AV block, recent myocardial infarction (<1 mo), recent coronary artery bypass graft surgery (<2 mo), unstable angina pectoris, bradycardia (<50 bpm), SSS, prolonged QTc interval (>0.45 sec), systemic hypertension (diastolic pressure >115 mm Hg), electrolyte imbalance, AADsTime to recurrence of PSVT was less compared w/ placebo when receiving sotalol 80 mg (p=0.04) and sotalol 160 mg (p=0.0009). On subanalysis, sotalol was shown to be effective in the prophylaxis of both PAF (p=0.03) and paroxysmal reentrant arrhythmias (p=0.0003).No deaths, cases of ventricular proarrhythmia, CHF. Treatment of pts receiving sotalol were discontinued because of typical BB side effects, including bradycardia, dyspnea, and fatigue.N/AN/ASotalol efficacious in the prophylaxis of PSVT. Study limited due to grouping of PSVTs.Gupta A 1999PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkd1cHRhPC9BdXRob3I+PFllYXI+MTk5OTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (35)10778689IV diltiazem and esmolol in acute therapy of PSVT32 (initially 50 enrolled, but trial stopped early)Hemodynamically tolerated PSVTN/ATwo sequential doses w/ a 5 min interval of either drug were administered before crossover. Diltiazem was given in a dose of 0.25 mg/kg while the esmolol dose was 0.5 mg/kg.N/ADiltiazem terminated PSVT in all the 16 pts in whom it was given as the first drug. The 12 pts who did not respond to esmolol were also effectively treated w/ diltiazem. 28/28 pts responded to diltiazem while only 4/16 pts responded to esmolol (p<0.001)Of the 28 pts who responded to diltiazem, in 13 pts the second bolus of diltiazem worked after the first one had failed.No significant adverse effects were seen.N/AN/AIV diltiazem is highly effective and safe for terminating PSVT. When the first bolus is ineffective, the second bolus given after 5 min usually succeeds. Esmolol in the dose of 0.5 mg/kg has poor efficacy for terminating PSVT, even when 2 boluses are administered.Alboni P2001 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkFsYm9uaTwvQXV0aG9yPjxZZWFyPjIwMDE8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (36)11216977Pill-in-the-pocket approach to management of PSVT, well-tolerated33Flecainide (n=33)Diltiazem/ propranolol (n=33)Placebo (n=33)AVNRT and AVRT confirmed by EP studyWell-tolerated (no sxs of dyspnea, syncope, presyncope, no interference w/ normal activitiesInfrequent (≤5 episodes/y) w/ ≥1 ED visit/yPSVT documented by ECGPreexcitation, CAD, resting bradycardia <50 bpm, LVEF <50%, h/o HF, severe “general diseases,” recent MI or CVA, acute illness, need for AADs, h/o sustained atrial/ventricular tachyarrhythmiasConversion to sinus rhythm occurred w/in 2 h in 52%, 61%, and 94% of pts on placebo, flecainide and diltiazem/ propranolol, respectively (p<0.001)The conversion time was shorter after diltiazem/ propranolol (32±22 min) than after placebo (77±42 min, p<0.001) or flecainide (74± 37 min, p<0.001).26 pts discharged on diltiazem/ propranolol and 5 on flecainide. During 17±12 mo f/u, treatment successful in 81% of diltiazem/ propranolol pts and in 80% of flecainide pts (all the arrhythmic episodes were interrupted out-of-hospital w/in 2 h). In remaining pts, a failure occurred during ≥1 episodes because of drug ineffectiveness or drug unavailability.During f/u, the percentage of pts calling for emergency room assistance was significantly reduced as compared to the y before enrollment (9% vs. 100%, p<0.0001).Four pts (1 placebo, 1 diltiazem/ propranolol, and 2 flecainide) had hypotension and four (3 diltiazem/ propranolol and 1 flecainide) a sinus rate <50 bpm following SVT interruptionN/AN/AUse of these agents is efficacious in acute therapy, both w/ in-hospital and outpt therapy. However, only 4/5 pts discharged on flecainide. Complications not trivial and all pts pre-tested w/ EP study. Tendera M2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRlbmRlcmE8L0F1dGhvcj48WWVhcj4yMDAxPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (37)11431663 Comparison of dofetilide to propafenone and placebo in the prevention of PSVT122Dofetilide (n=40)Propafenone (n=41)Placebo (n=41)18-75 y w/ ≥1 episode of PSVT w/in 6 wk documented by ECGPulmonary disease, myasthenia gravis, BBB, resting bradycardia (<50 bpm), AV block, prolonged QTc, MI, unstable angina, recent sudden death, hematologic /hepatic/renal diseaseAfter 6 mo of treatment, pts taking dofetilide, propafenone, and placebo had a 50%, 54%, and 6% probability, respectively, of remaining free of episodes of PSVT (p<.001 for both dofetilide and propafenone vs. placebo).The hazard ratio for dofetilide vs. placebo was 0.33 (95% CI: 0.18-0.61), and the hazard ratio for propafenone vs. placebo was 0.27 (95% CI: 0.14-0.51).Of 40 pts treated w/ dofetilide and propafenone, 23 (58%) and 25 (61%) had no recurring PSVT, compared w/ 16 (39%) in placebo group.19 of 40 pts (48%) treated w/ dofetilide and 21 of 41 (51%) treated w/ propafenone reported no adverse events. No significant differences were noted between 3 groups in incidence of treatment-related adverse events or all-cause adverse events (p=0.73 and p=0.74, respectively).N/AN/ADofetilide is at least as safe and effective as propafenone as an alternative therapeutic option for the treatment of pts w/ PSVT.Limited in that PSVTs not specified.Catheter Therapy (including cyroablation vs. RFA studies)Langberg JJ1993PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxhbmdiZXJnPC9BdXRob3I+PFllYXI+MTk5MzwvWWVhcj48
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ADDIN EN.CITE.DATA (116)8491010Slow vs. fast path ablation for AVNRT?50Anterior (n=22)Up to 1 h or 10 RF applications before alternative techniquePosterior (n=28)Up to 1 h or 10 RF applications before alternative technique ?AVNRT None statedPrimary success rates, anterior vs. posterior(55% vs. 68%, p=NS)All pts who failed initial approach were successfully treated by alternative technique w/o developing high-grade AV blockOne pt w/ RBBB during an anterior lesionOne pt w/ complete AV block complete during posterior lesion?N/AN/APosterior (slow path) approach to RF modification of AV node is as effective as the anterior (fast path) approach, and both techniques associated w/ a low risk of complications.Limiting to 1 h or 10 attempts may underestimate success rates.Kalbfleisch SJ1994PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbGJmbGVpc2NoPC9BdXRob3I+PFllYXI+MTk5NDwvWWVh
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ADDIN EN.CITE.DATA (117)8113557Comparison of anatomic vs. EGM mapping for AVNRT ablation (slow path)50Anatomic (n=25)sequential RF energy applications (up to 12) delivered along tricuspid annulus from level of the coronary sinus ostium to His bundle EGM mapping (n= 25)Target sites along posteromedial tricuspid annulus near coronary sinus ostium AVNRT?None statedAnatomic vs. mapping:Effective in 84 vs. 100% (p=0.1)4 w/ an ineffective anatomic approach had a successful outcome w/ mapping approachN/AITT analysisMapping vs. anatomic: Time required for ablation: (28±21 vs. 31±31 min, p=0.7) Duration of fluoroscopy: (27±20 vs. 27±18 min, p=0.9) Mean number of RF applications:(6.3±3.9 vs. 7.2±8.0, p=0.6)N/AThe anatomic and mapping approaches for ablation of the slow AV nodal pathway are comparable in efficacy and duration. Generalizability limited, and applicable only to technique described (e.g., authors cite not applicable for expanded anatomic approach or an EGM mapping approach that required the presence of a slow pathway potential).Small sample; probability of detecting a 20% difference in efficacy between two techniques only 0.67.Kopelman HA2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktvcGVsbWFuPC9BdXRob3I+PFllYXI+MjAwMzwvWWVhcj48
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ADDIN EN.CITE.DATA (118)12633642Efficiency of conventional fluoroscopic and electroanatomic mapping (CARTO) in guiding catheter ablation of AVNRT?20Electroanatomic mapping(n=10)Fluoroscopic mapping (n=10)?AVNRT?None statedElectroanatomic vs. fluoroscopy:Fluoroscopic duration:12.6±6.8 vs. 35.9±18.3 min, p<0.001Fluoroscopic exposure (0.7±0.5 vs. 9.6±5.0 min; p<0.001Total procedure time:83.6±23.6 vs. 114±19.3 min, p=0.008 Total fluoroscopic exposure:4.2±1.4 vs. 15.9±-6.4 min, p<0.001Number of RF applications:2.7±1.6 vs. 5±2.8, p=0.018,Duration of RF:165.3±181.6 vs. 341±177.7 sec, p=0.013Total energy delivery:24.3±3.1 vs. 28.7±4.5 watts, p=0.042No acute or long-term 8.9±2.2 mo) complications or arrhythmia recurrence in either groupN/AN/AElectroanatomic mappingoffers significantly shorter procedure and fluoroscopy times, improving the efficiency of the procedure and reducing X-ray exposure.Small sample size, curious lack of side effects.Cost higher w/ electroanatomical mapping catheter, but likelyoffset by potential for improved efficiency, ptthroughput and X-ray exposure from reductions in procedure and fluoroscopy times.Kimman GP2004PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktpbW1hbjwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (119)15589641CA vs. RFA?63?CA (n=30)RFA (n=33)?AVNRT?None statedProcedural success achieved in 91% RFA and 93% CA N/AMedian number of CA applications lower than RFA (p<0.005)Both fluoroscopy and procedural times were comparableN/ACA useful for treatment of tachyarrhythmias near the compact AV node.Questionable whether lack of junctional rhythm is seen w/ CA makes this approach safer than RFA, as authors remark.Zrenner B2004PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlpyZW5uZXI8L0F1dGhvcj48WWVhcj4yMDA0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (120)15589640CA vs. RFA for AVNRT200CA (n=100)RFA (n=100)AVNRTN/ACumulative incidence of primary endpoint (a combination of procedural failure, permanent complete AV block and AVNRT recurrence) higher in the CA group, p=0.03Transient AV block was encountered in18% pts in the CA group and in 8% in RF group (p<0.04) 21 episodes of transient AV block occurring during cryomapping (n = 4) or CA (n = 17) and 8 episodes during RF applications. The duration of transient AV block ranged from 2-420 s in CA group and from 2-180 s in RF groupProcedural success defined as elimination of slow pathway or noninducibility of AVNRTCA vs. RFA97% vs. 98%N/AEarly pilot study (first prospective randomized investigation comparingCA w/ RFA of AVNRT) showing CA associated w/ a comparable acute success rate but a higher recurrence rate as compared w/ RFA in pts w/ AVNRT.Kardos A2007 ADDIN REFMGR.CITE <Refman><Cite><Author>Kardos</Author><Year>2007</Year><RecNum>127</RecNum><IDText>Ice mapping during tachycardia in close proximity to the AV node is safe and offers advantages for transcatheter ablation procedures</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>127</Ref_ID><Title_Primary>Ice mapping during tachycardia in close proximity to the AV node is safe and offers advantages for transcatheter ablation procedures</Title_Primary><Authors_Primary>Kardos,A.</Authors_Primary><Authors_Primary>Paprika,D.</Authors_Primary><Authors_Primary>Shalganov,T.</Authors_Primary><Authors_Primary>Vatasescu,R.</Authors_Primary><Authors_Primary>Foldesi,C.</Authors_Primary><Authors_Primary>Kornyei,L.</Authors_Primary><Authors_Primary>Szili-Torok,T.</Authors_Primary><Date_Primary>2007/12</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Child</Keywords><Keywords>Cryosurgery</Keywords><Keywords>diagnosis</Keywords><Keywords>Female</Keywords><Keywords>Fluoroscopy</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prospective Studies</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>therapy</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>587</Start_Page><End_Page>591</End_Page><Periodical>Acta Cardiol</Periodical><Volume>62</Volume><Issue>6</Issue><ISSN_ISBN>0001-5385</ISSN_ISBN><Address>Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary</Address><Web_URL>PM:18214124</Web_URL><ZZ_JournalFull><f name="System">Acta cardiologica</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Acta Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(121)18214124Test the feasibility of cryomapping during AVNRT and AVRTNote: ablation performed only if cryomapping terminated the tachycardia w/o prolongation of AV conduction30AVNRT n=17AVRTn=13 Randomized after dx of AVRT or AVNRT made9 APS in CA, 4 in RF?CA (n=13 )RFA (n=17)AVNRT or AVRT w/ anteroseptal pathwayAVRT w/ a posteroseptal, left-sided, or right free wall APCA vs. RFAOverall acute success rate:85 vs. 82.4%, p=0.43CA: in one pt, ablation not attempted because of AV prolongationRFA: two pts w/ temporary second-degree AV block CA vs. RFALong-term success rate (12 mo f/u) similar between the two groupsFluoroscopy and the procedure time similar (p=0.37 and p=0.14, respectively). Mean number of applications: 2 (1-6) vs. 7 (1-41), p=0.002N/AFirst study to assess ICE mapping guided ablation in a prospective randomized method. Cryomapping a feasible method to determine exact location of APs and of slow pathway during tachycardia.Cryomapping performed during tachycardia causes less ablation lesions w/o increasing procedure and fluoroscopy times.Pediatric pts eligible and pts in CA group younger (median age 20 vs. 44). No control, and arguably 2 groups not comparable because RF not safe during tachycardia when substrate located near AV node. LocaLisa system used in CA and RF groups, thus improving performance c/w “conventional” RFA. CRYANO Study 2010 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRlaXNlbmhvZmVyPC9BdXRob3I+PFllYXI+MjAxMDwvWWVh
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ADDIN EN.CITE.DATA (122)21098435 CA vs. RFA for AVNRT509?CA (n=251)?RFA (n=258)?AVNRTPrior AVNRT ablation CHD, prior pacemaker implantation, pregnancy, and inability to follow study protocolImmediate ablation failure, permanent AV block, and AVNRT recurrence during a 6-mo f/u CA vs. RFA12.6% vs. 6.3%, p=0.018)Immediate ablation success: 96.8% vs. 98.4%, p=NSPermanent AV block: 0% vs. 0.4%, p=NSAVNRT recurrence:9.4% vs. 4.4%; P=0.029N/A (AV block in primary endpoint)CA vs. RFA.Procedure duration(138±54 vs. 123±48 min, p=0.0012) Device problems:13 vs. 2 pts, p=0.033) Pain perception lower in the cryoablation group. p<0.001N/ACA for AVNRT is as effective as RFA over short term but associated w/ higher recurrence rate at 6-mo f/u. Risk of permanent AV block does not differ significantly between CA and RFA. Potential benefits of CA relative to ablation safety and pain perception offset by longer procedure times, more device problems, and a high recurrence rate.Rodriguez-Entem FJ2013 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlJvZHJpZ3Vlei1FbnRlbTwvQXV0aG9yPjxZZWFyPjIwMTM8
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ADDIN EN.CITE.DATA (123)23080326Efficacy of CA vs. RFA119?CA (n=60)?RFA (n=59)?AVNRTN/AAcute procedural success achieved in 98% CA group and 59 100% in RFA groupOne pt in RFA group underwent complete AV block and pacemaker implantation CA vs. RFAOver a mean f/u period of 256.6 d, there was a significant difference in AVNRT recurrence (15 vs. 3.4%, p=0.03).N/ACA of AVNRT is a clinically effective alternative to RF ablation, w/ excellent acute success rate. Despite a slightly higher rate of recurrence during long-term f/u, CA may be considered first-line approach, especially in younger people. *Two protocols tested in same study.AAD indicates antiarrhythmic drug; AE, adverse effect; AF, atrial fibrillation; AP, accessory pathway; APS, acute procedureal success; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; BBB, bundle branch block; bid, two times per day; bpm indicates beats per min; CA, cryoablation; CAD, coronary artery disease; CHF, congestive heart failure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CVA, cerebral vascular accident; c/w, consistent with; ECG, electrocardiogram; ED, emergency department; EGM, electrogram; EP, electrophysiological; f/u, follow up; HF, heart failure; h/o, history of; HR, heart rate; ICE, intracardiac echocardiography; ITT, intention to treat; IV, intravenous; LVEF, left ventricular ejection fraction; MI, myocardial infarction; N/A, not applicable; NS, not significant; NSR, normal sinus rhythm; NYHA, New York Heart Association; ORT, orthodromic reciprocating tachycardia; PAF, paroxysmal atrial fibrillation; PES, programmed electrical stimulation; PSVT, paroxysmal supraventricular tachycardia; pt, patient; RBBB, right bundle branch block; RCT, randomized controlled trial; RF, radiofrequency; RFA, radiofrequency ablation; sbp, systolic blood pressure; SDC, serum drug concentration; SSS, sick sinus syndrome; SVT, supraventricular tachycardia; sx, symptom; tid, three times per day; VHD, valvular heart disease; VT, ventricular tachycardia; w/, with; w/o, without; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 10. Nonrandomized Trials, Observational Studies, and/or Registries of Atrioventricular Nodal Re-Entrant Tachycardia – Section 5 StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsVagal Maneuvers/CardioversionMehta D1988PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1laHRhPC9BdXRob3I+PFllYXI+MTk4ODwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (40)2897005 Prospective cohort study comparing 4 vagal maneuvers: right CSM, left CSM, face immersion in water, Valsalva maneuver35AVNRT (n=11)AVRT (n=24)EP study to induce SVT by PESExcluded AADs taken 72 h prior to admission (amiodarone stopped prior to 3 mo), no AADs during admissionTermination of at least 2 of 3 episodes of induced SVTVagal maneuvers terminated tachycardia in 22 (63%)pts.Valsalva maneuversin supine position in 19 pts (54%), right CSM in 6 (17%), left CSM in 2 (5%), and face immersion in 6 (17%). (p<0.001 for difference).Vagal maneuvers more effective in pts w/ AVRT than AVNRT (79% vs. 27%, p<0.01) Pts w/ AVRTterminated by a vagal maneuver were significantlyyounger (p<0.001) than those w/ AVRT who did not respond to vagal maneuver; no such age difference seen w/ AVNRTValsalva most effective vagal maneuver for terminating PSVT. Limited in that study conducted during EP study.Wen ZC1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldlbjwvQXV0aG9yPjxZZWFyPjE5OTg8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (50)12586276Prospective cohort study84PSVT 77%AF 23%Effectiveness of DC cardioversion in pts who did not respond promptly to vagal maneuvers that were tried first and then tried again after intravenously administered medical treatment w/ 1 of the following intraveneously administered drugs: adenosine, verapamil, digoxin, and/or procainamide. All study pts were hemodynamically compromised but did not require cardiopulmonary resuscitation.DC cardioversion resulted in successful converson to sinus rhythm in all pts after 103 electrical attempts, using 118±69 Joules. No complications; all but one pt (w/ pulmonary edema and cardiogenic shock) discharged alive w/in 7 d of hospitalization. Use of DC cardioversion to restore sinus rhythm can be safely and efficaciously applied in the prehospital setting in pts who are hemodynamically compromised but do not require cardiopulmonary resuscitation.Pharmacological TherapyRinkenberger RL1980 ADDIN REFMGR.CITE <Refman><Cite><Author>Rinkenberger</Author><Year>1980</Year><RecNum>153</RecNum><IDText>Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>153</Ref_ID><Title_Primary>Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias</Title_Primary><Authors_Primary>Rinkenberger,R.L.</Authors_Primary><Authors_Primary>Prystowsky,E.N.</Authors_Primary><Authors_Primary>Heger,J.J.</Authors_Primary><Authors_Primary>Troup,P.J.</Authors_Primary><Authors_Primary>Jackman,W.M.</Authors_Primary><Authors_Primary>Zipes,D.P.</Authors_Primary><Date_Primary>1980/11</Date_Primary><Keywords>Administration,Oral</Keywords><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>complications</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Injections,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time Factors</Keywords><Keywords>Verapamil</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>996</Start_Page><End_Page>1010</End_Page><Periodical>Circulation</Periodical><Volume>62</Volume><Issue>5</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:7418184</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(124)7418184 Prospective cohort study28AVNRT (n=6)AVRT (n=6)AF/atrial flutter (15)AT(n=3)Effect of IV and oral verapamilIV verapamil terminated AVNRT in all 6 ptsOral verapamil given to 19/28 pts, 7 reported improvement in sxs after 19 mo f/u (shorter frequency and shorter duration)IV verapamil effective in acute termination, while oral verapamil has selective efficacy. Das G1988PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRhczwvQXV0aG9yPjxZZWFyPjE5ODg8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (125) HYPERLINK "" 2905710 Prospective cohort study113Pts w/ PSVT (HR >100).Efficacy and safety of esmolol. Also investigated feasibility of transferring pts from esmolol to alternate oral AADs w/o loss of therapeutic response.95 (84%) achieved therapeutic response (reduction in heart rate of 15% or more or conversion to sinus rhythm). 93% achieved therapeutic response at esmolol doses of 200 micrograms/kg/min or lower.(88%) pts successfully transferred to oral AADs.Most frequent adverse effect observed during the study was hypotension, which resolved quickly (16±14 min)Esmolol effective in HR reduction or convertion to NSR, and majority of pts successfully treated w/ esmolol can be safely and effectively transferred to oral AADs.Rankin AC1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Rankin</Author><Year>1989</Year><RecNum>25</RecNum><IDText>Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>25</Ref_ID><Title_Primary>Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias</Title_Primary><Authors_Primary>Rankin,A.C.</Authors_Primary><Authors_Primary>Oldroyd,K.G.</Authors_Primary><Authors_Primary>Chong,E.</Authors_Primary><Authors_Primary>Rae,A.P.</Authors_Primary><Authors_Primary>Cobbe,S.M.</Authors_Primary><Date_Primary>1989/9</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>diagnosis</Keywords><Keywords>diagnostic use</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>195</Start_Page><End_Page>203</End_Page><Periodical>Br.Heart J</Periodical><Volume>62</Volume><Issue>3</Issue><User_Def_5>PMC1216762</User_Def_5><ISSN_ISBN>0007-0769</ISSN_ISBN><Address>University Department of Medical Cardiology, Royal Infirmary, Glasgow</Address><Web_URL>PM:2789911</Web_URL><ZZ_JournalFull><f name="System">British heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Br.Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(43)2789911 Cohort study6494 episodes of sustained, regular tachycardia; 40 pts w/ 64 episodes of narrow complex tachycardia (9 induced at EP study)Efficacy of IV adenosineAdenosine restored sinus rhythm in 25 pts 46/48 pts) w/ “junctional tachycardia,” found to be due to AVRT or AVNRTNot specific for AVNRT (defined AVRT and AVNRT as “junctional tachycardia”Amsterdam EA1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Amsterdam</Author><Year>1991</Year><RecNum>147</RecNum><IDText>Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>147</Ref_ID><Title_Primary>Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias</Title_Primary><Authors_Primary>Amsterdam,E.A.</Authors_Primary><Authors_Primary>Kulcyski,J.</Authors_Primary><Authors_Primary>Ridgeway,M.G.</Authors_Primary><Date_Primary>1991/8</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>chemically induced</Keywords><Keywords>Disease</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Hypotension</Keywords><Keywords>Infusions,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Metoprolol</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>714</Start_Page><End_Page>718</End_Page><Periodical>J Clin.Pharmacol</Periodical><Volume>31</Volume><Issue>8</Issue><ISSN_ISBN>0091-2700</ISSN_ISBN><Address>Department of Internal Medicine, University of California School of Medicine, Davis 95817</Address><Web_URL>PM:1880230</Web_URL><ZZ_JournalFull><f name="System">Journal of clinical pharmacology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Clin.Pharmacol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(126) HYPERLINK "" 1880230 Prospective cohort study16AF (n=11)Atrial flutter (n=2)PSVT (n=2)MAT (n=1) In 13 responders (81%), mean ventricular rate decreased from 134±6 to 106±7 bpm 10 min after metoprolol administration and controlled for 40-320 min w/o further therapy. Metoprolol reduced ventricular rate by >15% in 11 (69%) of 16 pts, including 9 (82%) of 11 pts w/ AF. In one w/ AF and one w/ PSVT, ventricular rate was reduced by >12%Hypotension, occurring in five pts, was the most frequent side effect but was transient and readily managed.Metoprolol was rapidly effective in controlling ventricular rate in a majority of pts w/ supraventricular tachyarrhythmias. Limited data for AVNRT.Cairns CB1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Cairns</Author><Year>1991</Year><RecNum>22</RecNum><IDText>Intravenous adenosine in the emergency department management of paroxysmal supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>22</Ref_ID><Title_Primary>Intravenous adenosine in the emergency department management of paroxysmal supraventricular tachycardia</Title_Primary><Authors_Primary>Cairns,C.B.</Authors_Primary><Authors_Primary>Niemann,J.T.</Authors_Primary><Date_Primary>1991/7</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>complications</Keywords><Keywords>diagnosis</Keywords><Keywords>Drug Evaluation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electroencephalography</Keywords><Keywords>Emergencies</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>717</Start_Page><End_Page>721</End_Page><Periodical>Ann Emerg.Med</Periodical><Volume>20</Volume><Issue>7</Issue><ISSN_ISBN>0196-0644</ISSN_ISBN><Misc_3>S0196-0644(05)80829-7</Misc_3><Address>UCLA School of Medicine, Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance 90509</Address><Web_URL>PM:2064090</Web_URL><ZZ_JournalFull><f name="System">Annals of emergency medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Emerg.Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(44)2064090 Observational cohort23Conversion to SR16 y or older presenting to ED in an 8 mo study period w/ sustained SVT, rate >140 bpmExclusion: severe CHF, unstable angina, acute MI by ECG, hemodynamic compromise. 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ADDIN EN.CITE.DATA (127)1615792 Prospective cohort study35 9 pts w/ AVNRT (Age 10-23)Recurrent PSVT documented by ECG; no h/o VT or AF, well-tolerated PSVT not induced by stress9 total pts w/ AVNRT, remainder w/ AVRTTermination of PSVT by flecainide.PSVT terminated in 6/9. Pts prescreened w/ EP study. Non-randomized study, and limited number of pts w/ AVNRT. Gambhir DS1995 ADDIN REFMGR.CITE <Refman><Cite><Author>Gambhir</Author><Year>1995</Year><RecNum>149</RecNum><IDText>Electrophysiologic effects and therapeutic efficacy of intravenous flecainide for termination of paroxysmal supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>149</Ref_ID><Title_Primary>Electrophysiologic effects and therapeutic efficacy of intravenous flecainide for termination of paroxysmal supraventricular tachycardia</Title_Primary><Authors_Primary>Gambhir,D.S.</Authors_Primary><Authors_Primary>Bhargava,M.</Authors_Primary><Authors_Primary>Arora,R.</Authors_Primary><Authors_Primary>Khalilullah,M.</Authors_Primary><Date_Primary>1995/5</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Cardiology</Keywords><Keywords>Disease</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Heart</Keywords><Keywords>Humans</Keywords><Keywords>Injections,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>237</Start_Page><End_Page>243</End_Page><Periodical>Indian Heart J</Periodical><Volume>47</Volume><Issue>3</Issue><ISSN_ISBN>0019-4832</ISSN_ISBN><Address>Department of Cardiology, G.B. Pant Hospital, New Delhi</Address><Web_URL>PM:7558090</Web_URL><ZZ_JournalFull><f name="System">Indian heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Indian Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(128)7558090 Prospective cohort study26All pts w/ symptomatic PSVT, recurrent palpitations for 1-13 yEP study performed, IV flecainide given and then EP study repeated 20-30 min later w/ IV flecainideEffective in terminating all pts w/ AVNRT, 11/12 w/ AVRTTime to termination both similar (146±70 vs. 149±29 sec, AVNRT vs. AVRT)AVNRT reinducible in one pt w/ AVNRT, 4 pts w/ AVRT Selective depression of retrograde limbN/AIV flecainide effective and safe for acute episodes of AVNRT and AVRTOral therapy presumed to be effective given effects in preventing reinducibility.EP study efficacy.Gambhir DS1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdhbWJoaXI8L0F1dGhvcj48WWVhcj4xOTk2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (54)8682552 Prospective cohort study9All pts w/ symptomatic AVNRT, recurrent palpitations for 2-12 y EP study performed, IV amiodarone then oral therapy subsequently EP study repeated 1.5-3 mo laterNo pts reported sxs of tachycardia during mean f/u of 65 d on oral amiodaroneIV amiodarone terminated AVNRT in 7/9 pts (retrograde FP in 4/7 and anterograde SP in 3/7)Not inducible on PES after oral therapy, largely to due to prolonging refractoriness in atrium and ventricle, and depressing conduction through FPN/ASmall series of pts, but all w/ AVNRTOral therapy w/ amiodarone is effective in suppressing AVNRT.IV amiodarone is effective in acute therapy.EP study efficacy.Glatter KA1999PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdsYXR0ZXI8L0F1dGhvcj48WWVhcj4xOTk5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (129) HYPERLINK "" 10051297 Retrospective cohort study229PSVT during EP studyAVRT (n=59)Typical AVNRT (n=82)Artypical AVNRT (n=13)PJRT (n=12)AT (n=53)IST (n=10)Determining the mechanism of PSVT w/ adenosine responseAdenosine of limited value in determining mechanism of PSVT100% of pts w/ AVNRT, AVRT, atypical AVNRT, and PJRT terminated w/ adenosineN/AAblationJackman WM1992PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkphY2ttYW48L0F1dGhvcj48WWVhcj4xOTkyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (53)1620170 Prospective observational cohort80Symptomatic AVNRT undergoing RFA of slow-pathwaySuccessful ablation w/ intact AV nodal conduction, guided by atrial slow-path potentialsRFA abolished or modified slow-pathway conduction in 78/80 pts w/o affecting normal AVN conduction. Mean (±SD) f/u of 15.5 mo w/o recurrence. Early report of success of RFA of slow-path conduction guided by atrial slow-path potentials—led to slow-pathway ablation being preferred method. Provided evidence that atrial insertions of fast and slow path are anatomically distinct.Kay GN1992 ADDIN REFMGR.CITE <Refman><Cite><Author>Kay</Author><Year>1992</Year><RecNum>157</RecNum><IDText>Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia. Evidence for involvement of perinodal myocardium within the reentrant circuit</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>157</Ref_ID><Title_Primary>Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia. Evidence for involvement of perinodal myocardium within the reentrant circuit</Title_Primary><Authors_Primary>Kay,G.N.</Authors_Primary><Authors_Primary>Epstein,A.E.</Authors_Primary><Authors_Primary>Dailey,S.M.</Authors_Primary><Authors_Primary>Plumb,V.J.</Authors_Primary><Date_Primary>1992/5</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Cardiac Catheterization</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Postoperative Complications</Keywords><Keywords>Radio Waves</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>1675</Start_Page><End_Page>1688</End_Page><Periodical>Circulation</Periodical><Volume>85</Volume><Issue>5</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Medicine, University of Alabama, Birmingham 35294</Address><Web_URL>PM:1572026</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(130)1572026 Prospective observational cohort34 Slow pathway ablation (n=30)Fast pathway ablation (n=4)Antegrade conduction over the fast pathway remained intact in all 30 pts after successful selective slow pathway ablationThere was no statistically significant change in the atrio-His interval (68.5±21.8 msec before and 69.6±23.9 msec after ablation) or AV Wenckebach rate (167±27 beats per min before and 178±50 beats per min after ablation) after slow path ablation 3 complications in two pts, including an episode of pulmonary edema and the development of spontaneous AV Wenckebach block during sleep in one pt after slow pathway ablation and the late development of complete AV block in another pt after fast pathway ablation. Over a mean f/u period of 322±73 d, AVNRT recurred in three pts, all of whom were successfully treated w/ a second ablation.Early report suggesting benefits of slow pathway ablation over fast pathway ablation. Bogun F1996 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJvZ3VuPC9BdXRob3I+PFllYXI+MTk5NjwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (132)16814416 Prospective cohort study93Pts w/ AVNRT prospectively followed for mean 13.2 y, compare outcomes of ablation (n=18) vs. AADs (n=24) vs. no therapy (n=38)AADs: flecainide, propafenone, verapamil, sotalol, atenolol, diltiazemAt f/u, asymptomatic for 3 y:Ablation: 100%AADs: 60.8%No therapy: 44.7%Untreated pts who became asymptomatic had a shorter duration of sxs before enrolment (3.7±1.5 vs. 7.1±3.6 y, p<0.05) and a shorter mean length of tachycardia episodes (3.8±2.4 vs. 42.6±17.8 min, p<0.02) than pts from same group who remained symptomatic3 pts died, 10 lost to f/uDuring a long-term f/u a considerable number of untreated pts w/ AVNRT become asymptomatic.Suggests that pts w/ infrequent and minor sxs may be able to be treated conservatively (i.e., no ablation or AADs.Study directly evaluates AVNRT and suggests efficacy of ablation over AADs.Limitations that the results are sx based.Spector P2009 ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>671</Start_Page><End_Page>677</End_Page><Periodical>Am J Cardiol</Periodical><Volume>104</Volume><Issue>5</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(09)01008-X;10.1016/j.amjcard.2009.04.040</Misc_3><Address>University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA. Peter.Spector@</Address><Web_URL>PM:19699343</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(55)19699343 Systematic review and meta-analysis to evaluate the safety and efficacy of RFA of AVNRT, AP-mediated, and atrial flutter.For AVNRT and AP-mediated: 39 primary studies w/ 49 treatment arms in 7,693 ptsPrevious reviews or meta-analyses; animal or in vitro studies; subjects aged <18 y or mixed populations of which >15% were pediatric pts; f/u of <7 d; not studies of RFA; alternative energy sources used for ablation; AV junction ablation w/ pacemaker implantation; <40 pts per arrhythmia or ablation technique; published only in abstract form; published before 1990; and published in languages other than English, Spanish, French, Italian, German, and Portuguese.SVT (AVNRT and AP-mediated)Single- and multiple-procedure success, arrhythmia recurrence, repeat ablation, adverse events, and death Single-procedure success: 93.2% (95% CI: 90.8-95.5%). Multiple-procedure success: 94.6%(95% CI: 92.4- 96.9).Post-ablation arrhythmia: 5.6% (95% CI: 4.1-7.2%). Repeat ablation: 6.5% (95% C:I 4.7-8.3%)All-cause mortality: 0.1%Adverse events: 2.9% First meta-analysis of RFA for AVNRT, AVRT (AP-mediated). Demonstrates high efficacy rates and low rates of complications.Outcomes (Registry Data)Hindricks G1993PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhpbmRyaWNrczwvQXV0aG9yPjxZZWFyPjE5OTM8L1llYXI+
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ADDIN EN.CITE.DATA (57)8131762 Prospective cohort4398AT/atrial flutter (n=141, 3.2%)AVJ (n=900, 20.5%)AVNRT (n=815, 18.5%)AVRT: (n = 2222, 50.5%)VT (n=320, 7.3%).Incidence of complicationsComplications occurred in 223 pts (5.1%) overallAT/atrial flutter: 5.0%AVJ: 3.2%AVNRT: 8.0%AVRT: 4.4%VT: 7.5%Complications more in AVNRT RFA compared to AVJ or AP ablation (p<0.001) Complications more in VT compared to AVJ (p<0.002) or AP (p<0.02)Early report showing high incidence of complications after AVNRT ablation.Hindricks G1996 ADDIN REFMGR.CITE <Refman><Cite><Author>Hindricks</Author><Year>1996</Year><RecNum>161</RecNum><IDText>Incidence of complete atrioventricular block following attempted radiofrequency catheter modification of the atrioventricular node in 880 patients. Results of the Multicenter European Radiofrequency Survey (MERFS) The Working Group on Arrhythmias of the European Society of Cardiology</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>161</Ref_ID><Title_Primary>Incidence of complete atrioventricular block following attempted radiofrequency catheter modification of the atrioventricular node in 880 patients. Results of the Multicenter European Radiofrequency Survey (MERFS) The Working Group on Arrhythmias of the European Society of Cardiology</Title_Primary><Authors_Primary>Hindricks,G.</Authors_Primary><Date_Primary>1996/1</Date_Primary><Keywords>adverse effects</Keywords><Keywords>analysis</Keywords><Keywords>Atrioventricular Block</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Cross-Sectional Studies</Keywords><Keywords>epidemiology</Keywords><Keywords>Europe</Keywords><Keywords>Heart Block</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Patients</Keywords><Keywords>Postoperative Complications</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>82</Start_Page><End_Page>88</End_Page><Periodical>Eur Heart J</Periodical><Volume>17</Volume><Issue>1</Issue><ISSN_ISBN>0195-668X</ISSN_ISBN><Web_URL>PM:8682135</Web_URL><ZZ_JournalFull><f name="System">European heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(58)8682135 Prospective cohort4463AVNRT (n=880)Incidence of AV blockAV block (4/ 880, 4.7%). AV block higher in fast pathway ablation (19/361, 5.3%, p<0.05) 6.3% in centers w/ limited experience in RFA (≤30 pts treated, p<0.05), and higher in these low-volume centers for both slow and fast pathway ablation (p<0.05)Early report showing 5% incidence of AV block after RFA for AVNRT, and higher w/ fast pathway ablation.Calkins H1999PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhbGtpbnM8L0F1dGhvcj48WWVhcj4xOTk5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (59)9892593 Prospective cohort1050(previously enrolled in RFA clinical trial)RFA of AVNRT, AP, or AVJAVNRT (n=373)AP (n=500)AVJ (n=121)Efficacy and safety of RFA w/ long-term f/u.Overall success:95%Overall recurrence6%Success:AVNRT: 97%AP: 93%AVJ: 100%Recurrence:AVNRT: 5%AP: 8%AVJ: 2%Predictors of success:-AVNRTOR: 3.94 (95% CI: 1.93-8.04; p=0.0002)-Left free wall APOR: 3.09 (95% CI: 1.46-6.53; p=0.0003)-Experience of ablation center (>39 pts)OR: 2.39 (95% CI: 1.21-4.71; p=0.012)Joint predictors of mortality:-EF (p=0.003)-SHD (p=0.016)-AVJ ablation (p=0.048)Shows RFA is a favorable option w/ low risk of complications and recurrence, and identifies pts who are at risk. Per-protocol analysisScheinman MM2000 ADDIN REFMGR.CITE <Refman><Cite><Author>Scheinman</Author><Year>2000</Year><RecNum>162</RecNum><IDText>The 1998 NASPE prospective catheter ablation registry</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>162</Ref_ID><Title_Primary>The 1998 NASPE prospective catheter ablation registry</Title_Primary><Authors_Primary>Scheinman,M.M.</Authors_Primary><Authors_Primary>Huang,S.</Authors_Primary><Date_Primary>2000/6</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Arteries</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Cardiomyopathies</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Disease</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Hospitals,Teaching</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Recurrence</Keywords><Keywords>Registries</Keywords><Keywords>statistics & numerical data</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Ventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>1020</Start_Page><End_Page>1028</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>23</Volume><Issue>6</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Address>Department of Medicine, University of California, San Francisco, USA. scheinman@ep4.ucsf.edu</Address><Web_URL>PM:10879389</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(61)10879389 Prospective cohort study(NASPE registry)3,357Ablation of AVNRT, AP, AVJ, atrial flutter, AT, IST, VT, idiopathic VTAVNRT (n=1,197 [35.6%)AVJ (n=646)AP (n=654)AT (n=216)Atrial flutter (n=447)IST (n=40)Efficacy and safety of RFA w/ long-term f/u.AVNRTSuccess: 96.1%Complications: 2%AVJ: Success: 96%Complications: 25 ptsRecurrence: 3.5%AP:Success: 94-96%Complications: 31 pts totalRecurrence: 4.6%AT:Success: 51-79%Complications: 5 totalRecurrence: 15.2%Atrial flutter:Success: 86%Complications: 12 ptsRecurrence: 14.7%IST:Success: 71%Complications: 2 ptsRecurrence: 10%Large series reporting success of RFA, and stratification by age group confirms safety and efficacy in elderly pts, as well as by type of facility (teaching vs. community).Special Ablation TechniquesFriedman PL2004PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkZyaWVkbWFuPC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48
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ADDIN EN.CITE.DATA (133)15851143 Multicenter prospective study157(166 initially enrolled)AVNRT (n=101)AVRT (n=44)AF (n=12)Efficacy of cryomapping/ablation Acute success overall 83%Success in AVNRT 91%, 69% AVRT and 67% AVJ (p<0.001)Per-protocol:Success in AVNRT 93%, 77% for AVRT and 67% for AVJLong-term success after 6 mo 91% overall, 94% for AVNRTCryomapping successfully identified ablation targets in 64% of pts, effects completely reversible w/in minutes in 94% of attemptsAcute success lower for CA compared to studies in RFA, but w/ no difference in long-term outcomes or arrhythmia recurrence.Later reports show improved success.de Sisti A2011 ADDIN REFMGR.CITE <Refman><Cite><Author>de Sisti</Author><Year>2012</Year><RecNum>163</RecNum><IDText>Cryoablation of atrioventricular nodal reentrant tachycardia: a clinical review</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>163</Ref_ID><Title_Primary>Cryoablation of atrioventricular nodal reentrant tachycardia: a clinical review</Title_Primary><Authors_Primary>de Sisti,A.</Authors_Primary><Authors_Primary>Tonet,J.</Authors_Primary><Date_Primary>2012/2</Date_Primary><Keywords>Atrioventricular Block</Keywords><Keywords>Cardiology</Keywords><Keywords>Cryosurgery</Keywords><Keywords>Humans</Keywords><Keywords>mortality</Keywords><Keywords>Prevalence</Keywords><Keywords>Risk Assessment</Keywords><Keywords>Risk Factors</Keywords><Keywords>surgery</Keywords><Keywords>Survival Analysis</Keywords><Keywords>Survival Rate</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Keywords>utilization</Keywords><Reprint>Not in File</Reprint><Start_Page>233</Start_Page><End_Page>240</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>35</Volume><Issue>2</Issue><ISSN_ISBN>1540-8159</ISSN_ISBN><Misc_3>10.1111/j.1540-8159.2011.03244.x</Misc_3><Address>Rhythmology Unit, Cardiology Institute, Pitie-Salpetriere Hospital, Paris, France</Address><Web_URL>PM:22017562</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(134)22017562 Systematic review22 studies w/ 2,654 ptsCryoablation for AVNRT compared to RFAOverall success 95% (95% CI: 85-99%), but recurrence rate 11% (95% CI: 2-20%). RFA recurrence rate reported at 3-5%. N/ACryoablation effective and safe, but lower long-term clinical efficacy compared to RFA. Hanninen M2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhhbm5pbmVuPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48
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ADDIN EN.CITE.DATA (135)24016223 Systematic review and meta-analysis14 studies (5 RCTs), 5,617 pts (1990-2012). 3 studies pediatricPts w/ AVNRT treated w/ cryoablation vs. RFA (81%)AVNRT recurrence (>2 mo post procedure; acute procedural failure and AV block requiring pacingAcute failure w/ cryoablation was nonsignificantly slightly higher than w/ RFA (RR: 1.44; p=0.12).Long-term recurrence higher w/ cryoablation (RR: 3.66; p=0.0002) RFA associated w/ permanent AV block in 0.75% of pts, none w/ cryoablation (p=0.01).Although late-recurrence more common w/ cryoablation than w/ RFA, avoidance of permanent AV block is advantageous Santangeli P2014 ADDIN REFMGR.CITE <Refman><Cite><Author>Santangeli</Author><Year>2014</Year><RecNum>166</RecNum><IDText>Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>166</Ref_ID><Title_Primary>Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia</Title_Primary><Authors_Primary>Santangeli,P.</Authors_Primary><Authors_Primary>Proietti,R.</Authors_Primary><Authors_Primary>Di,Biase L.</Authors_Primary><Authors_Primary>Bai,R.</Authors_Primary><Authors_Primary>Natale,A.</Authors_Primary><Date_Primary>2014/3</Date_Primary><Keywords>analysis</Keywords><Keywords>Atrioventricular Block</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Female</Keywords><Keywords>Fluoroscopy</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>physiology</Keywords><Keywords>Recurrence</Keywords><Keywords>Risk</Keywords><Keywords>Safety</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>111</Start_Page><End_Page>119</End_Page><Periodical>J Interv.Card.Electrophysiol.</Periodical><Volume>39</Volume><Issue>2</Issue><ISSN_ISBN>1572-8595</ISSN_ISBN><Misc_3>10.1007/s10840-013-9842-2</Misc_3><Address>Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA, pasquale.santangeli@</Address><Web_URL>PM:24293174</Web_URL><ZZ_JournalFull><f name="System">Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Interv.Card.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(136)24293174 Systematic review and meta-analysis14 studies (9 observational) w/ 2,340 pts (1980-2013)Pts w/ AVNRT treated w/ CA (54%) vs. RFA (46%)Successful ablation, procedural time, fluoroscopy time, complicationsAcute success in 88% w/ RFA, vs. 83% treated w/ CA (OR: 0.72; p=0.16)RFA associated w/ shorter total procedure time (p=0.004), but slightly longer fluoroscopy time (p=0.002). Permanent AV block occurred in 0.9% RF case, none in CA cases (OR:?3.60; p=0.035). Freedom from recurrent AVNRT (10.5 mo median f/u) 97% in RF group vs. 90.9% in the CA group (OR:?0.40; p<?0.001).RF significantly reduces the risk of long-term arrhythmia recurrence compared to cryoablation, but is associated w/ a higher risk of permanent AV block. No significant difference in acute success. AAD indicates antiarrhythmic drug; AF, atrial fibrillation; AP, accessory pathway; AT, atrial tachycardia; AV, atrioventricular; AVJ, atrioventricular junction; AVN, atrioventricular node; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; bpm, beats per min; CA, cryoablation; CHF, congestive heart failure; CSM, carotid sinus massage; DC, direct current; ECG, electrocardiogram; ED, emergency department; EF, ejection fraction; EP, electrophysiological; FP, fast pathway; f/u, follow up; HR, heart rate; IST, inappropriate sinus tachycardia; IV, intravenous; MAT, multifocal atrial tachycardia; N/A, not applicable; NASPE, North American Society of Pacing and Electrophysiology; OR, odds ratio; PES, programmed electrical stimulation; PJRT, permanent junctional reciprocating tachycardia; PSVT, paroxysmal supraventricular tachycardia; pt, patient; RFA, radiofrequency ablation; RR, relative risk; SD, standard deviation; SHD, structural heart disease; SP, slow pathway; SR, sinus rhythm; SVT, supraventricular tachycardia; sx, symptom; VT, ventricular tachycardia; w/, with; and w/o, without.Data Supplement 11. Randomized Trials Comparing Manifest and Concealed Accessory Pathways – Section 6.1Study Name, Author, YearAim of StudyStudy Type (Size, N)Study Intervention Group (n)Study Comparator Group (n)Pt PopulationEndpointsP Values, OR: HR: RR: & 95% CI:Study Limitations & Adverse EventsInclusion CriteriaExclusion CriteriaPrimary Endpoint (efficacy) and ResultsSafety Endpoint and ResultsSecondary Endpoint and ResultsHenthorn RW 1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Henthorn</Author><Year>1991</Year><RecNum>11</RecNum><IDText>Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>11</Ref_ID><Title_Primary>Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group</Title_Primary><Authors_Primary>Henthorn,R.W.</Authors_Primary><Authors_Primary>Waldo,A.L.</Authors_Primary><Authors_Primary>Anderson,J.L.</Authors_Primary><Authors_Primary>Gilbert,E.M.</Authors_Primary><Authors_Primary>Alpert,B.L.</Authors_Primary><Authors_Primary>Bhandari,A.K.</Authors_Primary><Authors_Primary>Hawkinson,R.W.</Authors_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Date_Primary>1991/1</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Drug Administration Schedule</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>prevention & control</Keywords><Keywords>Recurrence</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>119</Start_Page><End_Page>125</End_Page><Periodical>Circulation</Periodical><Volume>83</Volume><Issue>1</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Division of Cardiology, Christ Hospital, Cincinnati, Ohio 45219</Address><Web_URL>PM:1898640</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(26)1898640 Double blind placebo controlled crossover trial of flecainide34 pts8 wk on flecainide8 wk on placebo13 w/ AVRT7 w/ AVNRT3 w/ AT28 unknownSyncopy, angina, and/or neurological sxs during tachycardia. Second or third degree AV block. NYHA CHF class III, IVFlecainide superior to placebo. Flecainide associated w/ 79% freedom from PSVT and placebo 15% p<0.001. Median time to 1st PSVT 11 d in placebo group and 55 d in flecainide group. Flecainide slowed PSVT to 143±12 bpm from 178±12 bpm on placebo. Side effects: flec 63% and placebo 36%. All not significant.Flecainide was well tolerated.Flecainide associated w/ 79% freedom from PSVT and placebo 15% p<0.001. Median time to 1st PSVT 11 d in placebo group and 55 d in flecainide group. Flecainide slowed PSVT to 143±12 bpm from 178±12 bpm on placebo. Side effects on flec 63% and placebo 36%. All not significant.Study period was briefPritchett EL 1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Pritchett</Author><Year>1991</Year><RecNum>9</RecNum><IDText>Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias. A randomized, placebo-controlled, crossover trial in patients tolerating oral therapy</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>9</Ref_ID><Title_Primary>Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias. A randomized, placebo-controlled, crossover trial in patients tolerating oral therapy</Title_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Authors_Primary>McCarthy,E.A.</Authors_Primary><Authors_Primary>Wilkinson,W.E.</Authors_Primary><Date_Primary>1991/4/1</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>blood</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Propafenone</Keywords><Keywords>Recurrence</Keywords><Keywords>Statistics as Topic</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>539</Start_Page><End_Page>544</End_Page><Periodical>Ann Intern Med</Periodical><Volume>114</Volume><Issue>7</Issue><ISSN_ISBN>0003-4819</ISSN_ISBN><Address>Duke University Medical Center, Durham, North Carolina</Address><Web_URL>PM:2001087</Web_URL><ZZ_JournalFull><f name="System">Annals of internal medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Ann Intern Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(28)2001087 Double blind placebo controlled crossover trial of propafenone33 pts60 d on propafenone60 d on propafenone16 pts w/ PSVT and 17 w/ PAF. Not clear number of APNYHA class III or IV HF. Second or third degree AV block. Sxs of syncope, angina, neurological events during tachycardia.Well-designed study showing propafenone superior to placebo. Propafenone prolonged the recurrence rate of arrhythmia and was 20% the recurrence rate of placebo.No serious side effectsN/ATime to first recurrence prolonged for the propafenone group, p=0.004.The study was brief and not clear how many AP pts studied.?UK Propafenone Study Group 1995 ADDIN REFMGR.CITE <Refman><Cite><Year>1995</Year><RecNum>14</RecNum><IDText>A randomized, placebo-controlled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. UK Propafenone PSVT Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>14</Ref_ID><Title_Primary>A randomized, placebo-controlled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. UK Propafenone PSVT Study Group</Title_Primary><Date_Primary>1995/11/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>prevention & control</Keywords><Keywords>Propafenone</Keywords><Keywords>Recurrence</Keywords><Keywords>Risk Factors</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>2550</Start_Page><End_Page>2557</End_Page><Periodical>Circulation</Periodical><Volume>92</Volume><Issue>9</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:7586356</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(31)7586356 Double blind, placebo controlled study of propafenone100 ptsPropafenonePlaceboPSVT 52 ptsAF 48 ptsUnclear if any AP ptsDocumented second or third degree AV block. 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ADDIN EN.CITE.DATA (32)8607397Randomized multicenter study of verapamil vs. flecainide for treatment of PSVT121 ptsVerapamilFlecainide63 pts on flecainide and 58 verapamil. Followed for 8.1±5.1 and 7.5±5.4 mo, respectively.Prior AF, atrial flutter, myocardial infarction, unstable angina. NYHA Class III or IV CHF. Second or third degree AV block.86% of flecainide pt-mo and 73% of verapamil pt-mos w/ 0 or 1 episode of PSVT. N/AN/A30% on flecainide and 13% on verapamil were free of PSVT (p=0.026)Flecainide and verapamil were moderately effective for the prevention of PSVT.AF indicates atrial fibrillation; AP, accessory pathway; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; bpm, beats per min; CHF, congestive heart failure; CI, confidence interval; HF, heart failure; N/A, not applicable; NYHA, New York Heart Association; PAF, paroxysmal atrial fibrillation; PSVT, paroxysmal supraventricular tachycardia; pt, patient; sx, symptom; and w/, with.Data Supplement 12. Nonrandomized Trials, Observations Studies, and/or Registires of Manifest and Concealed Accessory Pathways – Section 6.1 StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsRisk Stratification of Symptomatic Patients with Manifest PathwaysKlein GJ1979 ADDIN REFMGR.CITE <Refman><Cite><Author>Klein</Author><Year>1979</Year><RecNum>169</RecNum><IDText>Ventricular fibrillation in the Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>169</Ref_ID><Title_Primary>Ventricular fibrillation in the Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Bashore,T.M.</Authors_Primary><Authors_Primary>Sellers,T.D.</Authors_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Authors_Primary>Smith,W.M.</Authors_Primary><Authors_Primary>Gallagher,J.J.</Authors_Primary><Date_Primary>1979/11/15</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Arrhythmias,Cardiac</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Child</Keywords><Keywords>complications</Keywords><Keywords>Electrocardiography</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prevalence</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Tachycardia</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1080</Start_Page><End_Page>1085</End_Page><Periodical>N.Engl.J Med</Periodical><Volume>301</Volume><Issue>20</Issue><ISSN_ISBN>0028-4793</ISSN_ISBN><Misc_3>10.1056/NEJM197911153012003</Misc_3><Web_URL>PM:492252</Web_URL><ZZ_JournalFull><f name="System">The New England journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">N.Engl.J Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(137)492252Observational study of pts w/ WPW and VF2525 WPW pts w/ VF compared to 73 pts w/oComparing EP findingsPts w/ WPW and VF had higher prevalence of AVRT (14/25 vs. 18/73, p=0.004) and multiple APs (5/25 vs. 4/73; p=0.012). The shortest preexcited RR was less in VF pts (mean RR 180 vs. 240 msec; p<0.0001) as was the mean RR (mean 269 vs. 340 msec; p<0.0001).WPW pts w/ h/o VF had more rapid AF (mean RR 180 msec) and increased prevalence of AVRT and multiple APs compared to control.Rinne E1987 ADDIN REFMGR.CITE <Refman><Cite><Author>Rinne</Author><Year>1987</Year><RecNum>172</RecNum><IDText>Relation between clinical presentation and induced arrhythmias in the Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>172</Ref_ID><Title_Primary>Relation between clinical presentation and induced arrhythmias in the Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Rinne,C.</Authors_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Sharma,A.D.</Authors_Primary><Authors_Primary>Yee,R.</Authors_Primary><Authors_Primary>Milstein,S.</Authors_Primary><Authors_Primary>Rattes,M.F.</Authors_Primary><Date_Primary>1987/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>complications</Keywords><Keywords>diagnosis</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Male</Keywords><Keywords>Patients</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>576</Start_Page><End_Page>579</End_Page><Periodical>Am J Cardiol</Periodical><Volume>60</Volume><Issue>7</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>0002-9149(87)90308-0</Misc_3><Web_URL>PM:3630940</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(138)3630940 Observational study of clinical vs. induced rhythms126 WPW pts w/ clinical AVRT and AF Relation between clinical and induced arrhythmiasThe shortest RR of clinical AF compared w/ the induced AF (r=0.72; p<0.00001). 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ADDIN EN.CITE.DATA (139)3598007 Observational study comparing noninvasive and EP study67WPW pts w/ noninvasive and EP testingComparing findings of noninvasive tests and EP tests.EP study (AF w/ shortest RR<250 msec) identified 7/9 pts w/ clinical VF. Continuous preexcitation during exercise testing had a sensitivity of 80%, specificity of 28.6% and predictive accuracy of 11.8%.EP testing was more accurate than stress testing in predicting WPW pts at risk for VF. Stess testing had high sensitivity.Gaita F1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Gaita</Author><Year>1989</Year><RecNum>168</RecNum><IDText>Stress and pharmacologic tests as methods to identify patients with Wolff-Parkinson-White syndrome at risk of sudden death</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>168</Ref_ID><Title_Primary>Stress and pharmacologic tests as methods to identify patients with Wolff-Parkinson-White syndrome at risk of sudden death</Title_Primary><Authors_Primary>Gaita,F.</Authors_Primary><Authors_Primary>Giustetto,C.</Authors_Primary><Authors_Primary>Riccardi,R.</Authors_Primary><Authors_Primary>Mangiardi,L.</Authors_Primary><Authors_Primary>Brusca,A.</Authors_Primary><Date_Primary>1989/9/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Child</Keywords><Keywords>complications</Keywords><Keywords>Death,Sudden</Keywords><Keywords>diagnostic use</Keywords><Keywords>etiology</Keywords><Keywords>Exercise Test</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Italy</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Procainamide</Keywords><Keywords>Propafenone</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>487</Start_Page><End_Page>490</End_Page><Periodical>Am J Cardiol</Periodical><Volume>64</Volume><Issue>8</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>0002-9149(89)90426-8</Misc_3><Address>Istituto di Medicina e Chirurgia Cardiovascolare, Universita di Torino, Italy</Address><Web_URL>PM:2773792</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(140)2773792 Observational study of accuracy of noninvasive tests65Consecutive WPW pts studied w/ procainamide, stress testing and EP. 15 pts were asymptomatic; 50 had parison of noninvasive tests to EP findings.24 pts had high risk AF (shortest RR <250 msec, AP ERP<250 msec). Persistence of the delta wave during stress testing has a sens of 96%, spec of 17% to identify high-risk pts (PPV 40% and NPV 88%). Stress tests and IV procainamide tests had good sensitivity and NPV but low specificity and PPV for identifying high risk WPW ptsBeckman KJ1990 ADDIN REFMGR.CITE <Refman><Cite><Author>Beckman</Author><Year>1990</Year><RecNum>167</RecNum><IDText>The predictive value of electrophysiologic studies in untreated patients with Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>167</Ref_ID><Title_Primary>The predictive value of electrophysiologic studies in untreated patients with Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Beckman,K.J.</Authors_Primary><Authors_Primary>Gallastegui,J.L.</Authors_Primary><Authors_Primary>Bauman,J.L.</Authors_Primary><Authors_Primary>Hariman,R.J.</Authors_Primary><Date_Primary>1990/3/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Arrhythmias,Cardiac</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>complications</Keywords><Keywords>Electrophysiology</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Predictive Value of Tests</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>640</Start_Page><End_Page>647</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>15</Volume><Issue>3</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Misc_3>0735-1097(90)90639-7</Misc_3><Address>Department of Medicine, University of Illinois, Chicago 60680</Address><Web_URL>PM:2303633</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(141)2303633 Observational study of ability of EP study to predict arrhythmic events42WPW pts w/ no sxs up to clinical AVRT/AF. Assessing if EP findings predicted clinical eventsDuring a f/u of 7.5±4.9 y, showed the only variables that correlated w/ subsequent arrhythmia were h/o documented arrhythmias before EP study (p<0.01) and inducible AVRT at EP study (p<0.05).H/o arrhythmia and inducible arrhythmia predict subsequent events.Pappone C2012PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (142)22215859 Observational study identifying risk factors in symptomatic WPW pts369 WPW pts followed to assess predictive factors from EP studyEvaluate the predictors of malignant rhythmsMean f/u 42.1±10 mo. 29 pts w/ malignant arrhythmias, 168 asymptomatic on f/u, 172 w/ AVRT/AF. Malignant arrhythmia pts had shorter AP ERP (p<0.001), AVRT triggering AF (p<0.001), and multiple APs.Short AP ERP, AVRT triggering AF, were independent predictors of malignant arrhythmias.Spar DS2012PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNwYXI8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (143)22221954 Observational study of the utility of exercise testing 76 pediatric pts <22 y. WPW pts w/ exercise and EP testingExercise test results compared to EP findings11 pts w/ sudden loss of delta, 18 gradual, and 47 no loss during exercise. Of pts w/ 1:1 AP conduction <270 msec, none in sudden loss group and 18 in no loss group. Pts in gradual loss group more likely to have a left sided AP.Pts w/ sudden loss of preexcitation during exercise had longer 1:1 conduction when the AP blocked and none had 1:1 over the AP <270 msec.Wackel P2012PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldhY2tlbDwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (144)22978820 Observational study of long term f/u of noninvasive tests24 pediatric pts <22 yWPW pts w/ Holter, stress test, ECG and EPNoninvasive test results compared to EP findings24 pts w/ at least one noninvasive test showing loss of preexcitation. 2 of the 24 had rapid AP conduction (1:1 over AP <260 msec). The noninvasive tests had a PPV of 92% and a NPV of 31%. 16 of 24 had loss of delta during stress test and none of those had rapid conduction at EP.Small study showed loss of preexcitation during noninvasive testing had a high PPV and specificity for slow AP conduction during EP. Pappone C2014PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (145)25052405 Prospective single center registry of WPW pts 2169 ptsAll pts w/ a manifest AP underwent EP study±RF. Followed 8 yBoth asymptomatic and symptomatic pts studied at EP to identify risk factors for VF1001 pts (550 asymptomatic) did not undergo RF and 1168 (550 asymptomatic) underwent RF. F/u of 8 y. VF occurred in 1.5% of the no-RF group (mean age 11 y) and no VF occurred in the RF treated group (p<0.001). VF was associated w/ a short ERP of the AP w/ an optimal cut-off of 240 msec (p<0.001) and AVRT initiating AF (p<0.001).Large single center registry showing that EP findings identified pts w/ a manifest AP at high risk for VF and the risk was eliminated w/ ablation.Acute TreatmentSellers TD1977 ADDIN REFMGR.CITE <Refman><Cite><Author>Sellers</Author><Year>1977</Year><RecNum>191</RecNum><IDText>Digitalis in the pre-excitation syndrome. Analysis during atrial fibrillation</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>191</Ref_ID><Title_Primary>Digitalis in the pre-excitation syndrome. Analysis during atrial fibrillation</Title_Primary><Authors_Primary>Sellers,T.D.,Jr.</Authors_Primary><Authors_Primary>Bashore,T.M.</Authors_Primary><Authors_Primary>Gallagher,J.J.</Authors_Primary><Date_Primary>1977/8</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>analysis</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Digoxin</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>therapeutic use</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>260</Start_Page><End_Page>267</End_Page><Periodical>Circulation</Periodical><Volume>56</Volume><Issue>2</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:872319</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(146)872319Acute EP study of IV digitalis effects on AF in WPW21 ptsWPW pts w/ AF induced during EP study and given IV digitalisSafety for AF in WPWDigitalis shortened the CL of the shortest preexcited RR in 6/21 pts increased the CL in 7/21 pts and had no effect in 5/21. Digitalis directly related to onset of AF degenerating to VF in 9/21 pts. Each of these 9 had a shortest RR <230 msec during AF baseline.This study is old but highlights the risk of digitalis in WPW pts w/ AFSellers TD1977 ADDIN REFMGR.CITE <Refman><Cite><Author>Sellers</Author><Year>1977</Year><RecNum>192</RecNum><IDText>Effects of procainamide and quinidine sulfate in the Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>192</Ref_ID><Title_Primary>Effects of procainamide and quinidine sulfate in the Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Sellers,T.D.,Jr.</Authors_Primary><Authors_Primary>Campbell,R.W.</Authors_Primary><Authors_Primary>Bashore,T.M.</Authors_Primary><Authors_Primary>Gallagher,J.J.</Authors_Primary><Date_Primary>1977/1</Date_Primary><Keywords>Atrial Fibrillation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Patients</Keywords><Keywords>pharmacology</Keywords><Keywords>physiopathology</Keywords><Keywords>Procainamide</Keywords><Keywords>Quinidine</Keywords><Keywords>Research</Keywords><Keywords>therapeutic use</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>15</Start_Page><End_Page>22</End_Page><Periodical>Circulation</Periodical><Volume>55</Volume><Issue>1</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:830205</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(147)830205Single center study of IV procainamide and quinidine in WPS pts w/ induced33 ptsAll pts w/ a manifest AP and induced AFIV procainamide studied to assess effects on conduction during AFIV procainamide prolonged the shortest RR between preexcited complexes during AF by 20-70 msec in 15 of 21 pts and no change in 6 pts.IV procainamide prolonged the shortest RR between preexcited complexes in induced AFHamer A1981 ADDIN REFMGR.CITE <Refman><Cite><Author>Hamer</Author><Year>1981</Year><RecNum>184</RecNum><IDText>Effects of verapamil on supraventricular tachycardia in patients with overt and concealed Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>184</Ref_ID><Title_Primary>Effects of verapamil on supraventricular tachycardia in patients with overt and concealed Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Hamer,A.</Authors_Primary><Authors_Primary>Peter,T.</Authors_Primary><Authors_Primary>Platt,M.</Authors_Primary><Authors_Primary>Mandel,W.J.</Authors_Primary><Date_Primary>1981/5</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>chemically induced</Keywords><Keywords>drug therapy</Keywords><Keywords>Echocardiography</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Evaluation Studies as Topic</Keywords><Keywords>Female</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Injections,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Time</Keywords><Keywords>Verapamil</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>600</Start_Page><End_Page>612</End_Page><Periodical>Am Heart J</Periodical><Volume>101</Volume><Issue>5</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Web_URL>PM:7223599</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(148)7223599 Single center study of IV verapamil in pts w/ AVRT19 ptsAll pts had AVRT: 12 w/ a manifest and 7 w/ a concealed APlV verapamil to assess EP changes and effects on AVRTIV verapamil prolonged refractoriness and delayed conduction in the AV node but no effect on the AP. Sustained AVRT initiated in 15 pts and terminated by verapamil in 13 pts.IV verapamil was effective in terminating AVRTHombach V1981 ADDIN REFMGR.CITE <Refman><Cite><Author>Hombach</Author><Year>1981</Year><RecNum>186</RecNum><IDText>Antiarrhythmic effects of acute betablockade with atenolol on supraventricular tachycardias at rest and during exercise</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>186</Ref_ID><Title_Primary>Antiarrhythmic effects of acute betablockade with atenolol on supraventricular tachycardias at rest and during exercise</Title_Primary><Authors_Primary>Hombach,V.</Authors_Primary><Authors_Primary>Braun,V.</Authors_Primary><Authors_Primary>Hopp,H.W.</Authors_Primary><Authors_Primary>Gil-Sanchez,D.</Authors_Primary><Authors_Primary>Behrenbeck,D.W.</Authors_Primary><Authors_Primary>Tauchert,M.</Authors_Primary><Authors_Primary>Hilger,H.H.</Authors_Primary><Date_Primary>1981/2/2</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atenolol</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>drug therapy</Keywords><Keywords>Electric Stimulation</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Exercise</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Physical Exertion</Keywords><Keywords>Propanolamines</Keywords><Keywords>Research</Keywords><Keywords>Rest</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>123</Start_Page><End_Page>133</End_Page><Periodical>Klin.Wochenschr.</Periodical><Volume>59</Volume><Issue>3</Issue><ISSN_ISBN>0023-2173</ISSN_ISBN><Web_URL>PM:7206601</Web_URL><ZZ_JournalFull><f name="System">Klinische Wochenschrift</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Klin.Wochenschr.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(149)7206601 Acute EP study of IV atenolol for treatment of induced PSVT18 ptsMixed group: 5 w/ AVRT, 2 w/ AVNRT, 6 w/ atrial flutter, 6 w/ AT, 1 w/ VTIV atenolol given for treatment of induced PSVTAtenolol was effective in preventing pacing induced AVRT in 3 of 5 pts w/ WPW. Small study published in Klin Wochenschr showing IV atenolol prevented reinduction of AVRT in 3 of 5 pts.Scheinman BD1982 ADDIN REFMGR.CITE <Refman><Cite><Author>Sheinman</Author><Year>1982</Year><RecNum>189</RecNum><IDText>Acceleration of ventricular rate by fibrillation associated with the Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>189</Ref_ID><Title_Primary>Acceleration of ventricular rate by fibrillation associated with the Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Sheinman,B.D.</Authors_Primary><Authors_Primary>Evans,T.</Authors_Primary><Date_Primary>1982/10/9</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Amiodarone</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Benzofurans</Keywords><Keywords>chemically induced</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Patients</Keywords><Keywords>Tachycardia</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>999</Start_Page><End_Page>1000</End_Page><Periodical>Br.Med J (Clin.Res Ed)</Periodical><Volume>285</Volume><Issue>6347</Issue><User_Def_5>PMC1500376</User_Def_5><ISSN_ISBN>0267-0623</ISSN_ISBN><Web_URL>PM:6812745</Web_URL><ZZ_JournalFull><f name="System">British medical journal (Clinical research ed.)</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Br.Med J (Clin.Res Ed)</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(150)6812745Case report1 ptWPW pt w/ AFIV amiodarone given to treat AFThe ventricular rate during AF increased from 170 to 230 bpmIV amiodarone accelerated the rate of AF in a pt w/ WPWMorady F, et al., 1987 ADDIN REFMGR.CITE <Refman><Cite><Author>Morady</Author><Year>1987</Year><RecNum>527</RecNum><IDText>Effect of propranolol on ventricular rate during atrial fibrillation in the Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>527</Ref_ID><Title_Primary>Effect of propranolol on ventricular rate during atrial fibrillation in the Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Morady,F.</Authors_Primary><Authors_Primary>DiCarlo,L.A.,Jr.</Authors_Primary><Authors_Primary>Baerman,J.M.</Authors_Primary><Authors_Primary>de,Buitleir M.</Authors_Primary><Date_Primary>1987/5</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Rate</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Propranolol</Keywords><Keywords>therapeutic use</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>492</Start_Page><End_Page>496</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>10</Volume><Issue>3 Pt 1</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Web_URL>PM:2439997</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(151)2439997Observational study of IV propranolol administered during AF10 ptsAll pts w/ preexcited AF.The effects of IV propranolol during preexcited AF were assessed.AF terminated in 3 of the 10 pts. The mean ventricular rate during preexcited AF was slowed by 15-56 bpm in 6 pts; no effect in 3 pts; and increased from 203 to 267 bpm in 1 pt. The authors concluded that IV propranolol should not be used in pts w/ preexcited AF if most QRS complexes are preexcited.Schutzenberger W, et al., 1987 ADDIN REFMGR.CITE <Refman><Cite><Author>Schutzenberger</Author><Year>1987</Year><RecNum>190</RecNum><IDText>Enhanced accessory pathway conduction following intravenous amiodarone in atrial fibrillation. A case report</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>190</Ref_ID><Title_Primary>Enhanced accessory pathway conduction following intravenous amiodarone in atrial fibrillation. A case report</Title_Primary><Authors_Primary>Schutzenberger,W.</Authors_Primary><Authors_Primary>Leisch,F.</Authors_Primary><Authors_Primary>Gmeiner,R.</Authors_Primary><Date_Primary>1987/7</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Amiodarone</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>complications</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>therapeutic use</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>93</Start_Page><End_Page>95</End_Page><Periodical>Int.J Cardiol</Periodical><Volume>16</Volume><Issue>1</Issue><ISSN_ISBN>0167-5273</ISSN_ISBN><Web_URL>PM:3610399</Web_URL><ZZ_JournalFull><f name="System">International journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Int.J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(152)3610399Case report1 ptWPW pt w/ AFIV amiodarone given to treat AFIV amiodarone accelerated the rate of preexcited AFIV amiodarone accelerated the rate of AF in a pt w/ WPWHuycke EC1989PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkh1eWNrZTwvQXV0aG9yPjxZZWFyPjE5ODk8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (153)2918157IV Diltiazem vs. placebo for the termination of PSVT54 pts20 pts AVNRT34 pts AVRT (19 pts w/ manifest and 15 w/ concealed APs)Safety and efficacy for termination of AVNRT and AVRTPSVT terminated in 90% of pts w/ diltiazem and 19% w/ placebo. 100% of AVNRT pts converted and 81% of AVRT pts converted. Side effects: adverse effects in 6%. IV diltiazem is safe and effective for treatment of AVRTDiMarco JP1990PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRpTWFyY288L0F1dGhvcj48WWVhcj4xOTkwPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (114)2193560Placebo controlled study of the acute treatment of PSVT w/ adenosine and IV verapamil359 ptsPSVT pts given adenosine, placebo, or verapamil for termination. 36% had AVNRT and 64% had AVRT. 22% of pts had manifest APs.Safety and efficacy of adenosine for PSVTDose ranging study. IV adenosine doses of 6, 9, 12 mg converted 62.3%, 80.2%, and 91.4% of PSVT. Placebo converted 10.7%, 14.3%, and 16.1% w/ 4-dose sequence. In trial 2, adenosine 6 mg followed by 12 mg had success of 57.4% and 93.4% (average time to termination 30 sec). AVNRT success 92% and AVRT success 97%. 61 total pts received adenosine.IV verapamil 5 mg followed by 7.5 mg if necessary was successful in 81.3% and 91.4%. 95% pts w/ AVNRT and 96% pts w/ AVRT were successfully converted w/ verapamil. 64 total pts received verapamil; manifest pts not excluded.Side effects: 36% w/ adverse effects lasting <1 min. Severe side effects in 2.3% including flushing, chest pain, and dyspnea.Both IV adenosine and IV verapamil effective for acute treatment of AVNRT and AVRT.Furlong R1995PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkZ1cmxvbmc8L0F1dGhvcj48WWVhcj4xOTk1PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (154)7605518 Acute prospective case series study of adenosine for termination of PSVT31 ptsPSVT of undocumented mechanismAdenosine given prehospital for management of PSVT31 pts w/ PSVT, 28 (90%) converted to sinus after the first (16) or second or third (13) dose. No significant complications reportedAdenosine was effective for treating PSVT (unclear how many pts had AVRT)Boriani G1996 ADDIN REFMGR.CITE <Refman><Cite><Author>Boriani</Author><Year>1996</Year><RecNum>178</RecNum><IDText>Ventricular fibrillation after intravenous amiodarone in Wolff-Parkinson-White syndrome with atrial fibrillation</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>178</Ref_ID><Title_Primary>Ventricular fibrillation after intravenous amiodarone in Wolff-Parkinson-White syndrome with atrial fibrillation</Title_Primary><Authors_Primary>Boriani,G.</Authors_Primary><Authors_Primary>Biffi,M.</Authors_Primary><Authors_Primary>Frabetti,L.</Authors_Primary><Authors_Primary>Azzolini,U.</Authors_Primary><Authors_Primary>Sabbatani,P.</Authors_Primary><Authors_Primary>Bronzetti,G.</Authors_Primary><Authors_Primary>Capucci,A.</Authors_Primary><Authors_Primary>Magnani,B.</Authors_Primary><Date_Primary>1996/6</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Amiodarone</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiovascular Diseases</Keywords><Keywords>chemically induced</Keywords><Keywords>complications</Keywords><Keywords>Disease</Keywords><Keywords>drug therapy</Keywords><Keywords>Humans</Keywords><Keywords>Infusions,Intravenous</Keywords><Keywords>Italy</Keywords><Keywords>Male</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1214</Start_Page><End_Page>1216</End_Page><Periodical>Am Heart J</Periodical><Volume>131</Volume><Issue>6</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Address>Institute of Cardiovascular Diseases, Bologna, Italy</Address><Web_URL>PM:8644602</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(155)8644602Case report 1 ptWPW pt w/ AFIV amiodarone given to treat AFIV amiodarone given to treat WPW w/ preexcited AF resulted in VFIV amiodarone resulted in ventricular fibrillationWen ZC1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldlbjwvQXV0aG9yPjxZZWFyPjE5OTg8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (156)11602497 Acute study of IV ibutilide in pts w/ WPW + AF22 ptsWPW pts w/ AF at time of EP studyEP properties, safety and AF terminationIbutilide terminated AF in 95%. In 18 additional pts ibutilide prolonged the AP ERP from 275±40 to 320±60 msec p<0.01. No placebo arm. Ibutilide sass safe and effective terminating AF is WPW.Shiraishi H2002 ADDIN REFMGR.CITE <Refman><Cite><Author>Shiraishi</Author><Year>2002</Year><RecNum>193</RecNum><IDText>Two cases of polymorphic ventricular tachycardia induced by the administration of verapamil against paroxysmal supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>193</Ref_ID><Title_Primary>Two cases of polymorphic ventricular tachycardia induced by the administration of verapamil against paroxysmal supraventricular tachycardia</Title_Primary><Authors_Primary>Shiraishi,H.</Authors_Primary><Authors_Primary>Ishibashi,K.</Authors_Primary><Authors_Primary>Urao,N.</Authors_Primary><Authors_Primary>Hyogo,M.</Authors_Primary><Authors_Primary>Tsukamoto,M.</Authors_Primary><Authors_Primary>Keira,N.</Authors_Primary><Authors_Primary>Hirasaki,S.</Authors_Primary><Authors_Primary>Seo,Y.</Authors_Primary><Authors_Primary>Shirayama,T.</Authors_Primary><Authors_Primary>Nakagawa,M.</Authors_Primary><Date_Primary>2002/6</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>chemically induced</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiologic Techniques,Cardiac</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Tachycardia,Ventricular</Keywords><Keywords>Treatment Outcome</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>445</Start_Page><End_Page>448</End_Page><Periodical>Intern Med</Periodical><Volume>41</Volume><Issue>6</Issue><ISSN_ISBN>0918-2918</ISSN_ISBN><Address>Kyoto Prefectural Yosanoumi Hospital</Address><Web_URL>PM:12135176</Web_URL><ZZ_JournalFull><f name="System">Internal medicine (Tokyo, Japan)</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Intern Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(157)12135176Case report 1 ptPt w/ a concealed pathway and AVRTIV verapamil given to treat AVRTIV verapamil terminated AVRT the pt developed non-sustained polymorphic VT. Authers did EP study and mechanism unknown.IV verapamil terminated AVRT in pt w/ concealed pathway but non-sustained polymorphic VT then developedNeumar RW, et al., 2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk5ldW1hcjwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (158)20956224AHA ACLS GuidelinesN/AAcute treatment of pts w/ bradycardia and tachycardiaExpert developed guidelinesReviews role of direct current electrical cardioversion, vagal maneuvers and antiarrhythmic drug therapy for the treatment of supraventridular tachycardia in the emergency department including WPW w/ AF and SVTElectrical cardioversion recommended for the treatment of WPW w/ AF or SVT and hemodynamic instabilityDelaney B2011 ADDIN REFMGR.CITE <Refman><Cite><Author>Delaney</Author><Year>2011</Year><RecNum>180</RecNum><IDText>The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>180</Ref_ID><Title_Primary>The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis</Title_Primary><Authors_Primary>Delaney,B.</Authors_Primary><Authors_Primary>Loy,J.</Authors_Primary><Authors_Primary>Kelly,A.M.</Authors_Primary><Date_Primary>2011/6</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Confidence Intervals</Keywords><Keywords>drug therapy</Keywords><Keywords>Emergencies</Keywords><Keywords>Humans</Keywords><Keywords>Hypotension</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>148</Start_Page><End_Page>152</End_Page><Periodical>Eur J Emerg.Med</Periodical><Volume>18</Volume><Issue>3</Issue><ISSN_ISBN>1473-5695</ISSN_ISBN><Misc_3>10.1097/MEJ.0b013e3283400ba2</Misc_3><Address>Joseph Epstein Centre for Emergency Medicine Research, Australia</Address><Web_URL>PM:20926952</Web_URL><ZZ_JournalFull><f name="System">European journal of emergency medicine : official journal of the European Society for Emergency Medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur J Emerg.Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(159)20926952 Meta-analysis of the efficacy of adenosine vs. verapamil for treatment of stable PSVT692 pts/eventsPSVT of undocumented mechanism8 trials included that compared verapamil and adenosineAdenosine converted 90.8% and verapamil 89.9%. More minor side effects w/ adenosine. More hypotension w/ verapamil (3.7% vs. 0.6%).Both adenosine and verapamil were effective for termination of PSVT. Verapamil had more associated hypotension.Smith GD, et al., 2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Smith</Author><Year>2013</Year><RecNum>4</RecNum><IDText>Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>4</Ref_ID><Title_Primary>Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia</Title_Primary><Authors_Primary>Smith,G.D.</Authors_Primary><Authors_Primary>Dyson,K.</Authors_Primary><Authors_Primary>Taylor,D.</Authors_Primary><Authors_Primary>Morgans,A.</Authors_Primary><Authors_Primary>Cantwell,K.</Authors_Primary><Date_Primary>2013</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Humans</Keywords><Keywords>methods</Keywords><Keywords>physiology</Keywords><Keywords>Randomized Controlled Trials as Topic</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Keywords>Treatment Outcome</Keywords><Keywords>Valsalva Maneuver</Keywords><Reprint>Not in File</Reprint><Start_Page>CD009502</Start_Page><Periodical>Cochrane Database Syst.Rev.</Periodical><Volume>3</Volume><ISSN_ISBN>1469-493X</ISSN_ISBN><Misc_3>10.1002/14651858.CD009502.pub2</Misc_3><Address>Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. gavin.smith@monash.edu</Address><Web_URL>PM:23543578</Web_URL><ZZ_JournalFull><f name="System">The Cochrane database of systematic reviews</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Cochrane Database Syst.Rev.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(39)23543578Cochrane Database review of randomized trials of Valsalva316 pts iAll pts w/ SVT. Number of pts w/ AVRT was not specified.Valsalva compared to “other” vagal maneuversThe reversion of SVT to sinus rhythm following Valsalva in the 3 studies was 19.4%, 45.9%, and 54.3%Valsalva was effective in converting SVT to sinus rhythm.Long-Term Pharmacological TreatmentSellers TD1977 ADDIN REFMGR.CITE <Refman><Cite><Author>Sellers</Author><Year>1977</Year><RecNum>191</RecNum><IDText>Digitalis in the pre-excitation syndrome. Analysis during atrial fibrillation</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>191</Ref_ID><Title_Primary>Digitalis in the pre-excitation syndrome. Analysis during atrial fibrillation</Title_Primary><Authors_Primary>Sellers,T.D.,Jr.</Authors_Primary><Authors_Primary>Bashore,T.M.</Authors_Primary><Authors_Primary>Gallagher,J.J.</Authors_Primary><Date_Primary>1977/8</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>analysis</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Digoxin</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>therapeutic use</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>260</Start_Page><End_Page>267</End_Page><Periodical>Circulation</Periodical><Volume>56</Volume><Issue>2</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:872319</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(146)872319 Acute EP study of IV digitalis effects on AF in WPW21 ptsWPW pts w/ AF induced during EP study and given IV digitalisSafety for AF in WPWDigitalis shortened the CL of the shortest preexcited RR in 6/21 pts increased the CL in 7/21 pts and had no effect in 5/21. 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ADDIN EN.CITE.DATA (160)7438370Single center study of multiple drugs given IV and then long term for AV node reentry21 pts studied acutely; 18 pts followed 6-50 moAll pts w/ AV node reentryDrug efficacy at minimal f/u of 6 moPts were tested w/ IV drug to determine if the drug prevented induction of AVNRT. Successful pts were then treated long term w/ oral drugs. 18 pts followed at least 6 mo, 72% w/o recurrence: 3 of 5 pts on digoxin only; 2 of 3 pts on digoxin plus propranolol; 4 of 4 pts on propranolol only; 1 of 3 pts on procainamide; and 3 of 3 pts on quinidine only.Small number of pts on each medication showing moderate success.Sakurai M1983 ADDIN REFMGR.CITE <Refman><Cite><Author>Sakurai</Author><Year>1983</Year><RecNum>199</RecNum><IDText>Acute and chronic effects of verapamil in patients with paroxysmal supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>199</Ref_ID><Title_Primary>Acute and chronic effects of verapamil in patients with paroxysmal supraventricular tachycardia</Title_Primary><Authors_Primary>Sakurai,M.</Authors_Primary><Authors_Primary>Yasuda,H.</Authors_Primary><Authors_Primary>Kato,N.</Authors_Primary><Authors_Primary>Nomura,A.</Authors_Primary><Authors_Primary>Fujita,M.</Authors_Primary><Authors_Primary>Nishino,T.</Authors_Primary><Authors_Primary>Fujita,K.</Authors_Primary><Authors_Primary>Koike,Y.</Authors_Primary><Authors_Primary>Saito,H.</Authors_Primary><Date_Primary>1983/4</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>blood</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Humans</Keywords><Keywords>Injections,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time</Keywords><Keywords>Time Factors</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>619</Start_Page><End_Page>628</End_Page><Periodical>Am Heart J</Periodical><Volume>105</Volume><Issue>4</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Web_URL>PM:6837416</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(161)6837416Single center study of IV and oral verapamil for PSVT15 pts studied acutely and followed 3 to 31 mo (mean 15 mo)AVNRT in 4 and AVRT in 11 (all w/ a concealed AP)Drug efficacy at minimal f/u of 3 mo13 pts followed 3-31 (mean 15) mo w/ 8 having no recurrent PSVT and 5 having decreased frequency and duration. Mild constipation in 4.Small, uncontrolled study of oral verapamil for PSVT including some pts w/ AVRTFeld GK1984 ADDIN REFMGR.CITE <Refman><Cite><Author>Feld</Author><Year>1984</Year><RecNum>196</RecNum><IDText>Electrophysiologic basis for the suppression by amiodarone of orthodromic supraventricular tachycardias complicating pre-excitation syndromes</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>196</Ref_ID><Title_Primary>Electrophysiologic basis for the suppression by amiodarone of orthodromic supraventricular tachycardias complicating pre-excitation syndromes</Title_Primary><Authors_Primary>Feld,G.K.</Authors_Primary><Authors_Primary>Nademanee,K.</Authors_Primary><Authors_Primary>Weiss,J.</Authors_Primary><Authors_Primary>Stevenson,W.</Authors_Primary><Authors_Primary>Singh,B.N.</Authors_Primary><Date_Primary>1984/5</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Amiodarone</Keywords><Keywords>Benzofurans</Keywords><Keywords>complications</Keywords><Keywords>Digoxin</Keywords><Keywords>drug effects</Keywords><Keywords>Electrocardiography</Keywords><Keywords>etiology</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Pre-Excitation Syndromes</Keywords><Keywords>Propranolol</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1298</Start_Page><End_Page>1307</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>3</Volume><Issue>5</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Web_URL>PM:6707383</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(162)6707383EP testing after amiodarone loading and then long term f/u10 ptsEP test at ≥4 wkAll pts w/ AP and AVRTAssessment of EP properties9 pts no longer had inducible AVRT. 1 pt had nonsustained AVRT. 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ADDIN EN.CITE.DATA (163)3336964EP testing and long term assessment of amiodarone10 ptsAcute EP study and mean 30 mo f/uAll pts w/ WPW and AF w/ a rapid ventricular responseEP measurement of drug effect and long term f/u of rhythm controlEP study—amiodarone prolonged the AP ERP 38% (p<0.01) and atrial ERP 34% (p<0.01). Amiodarone prolonged the mean RR 90% and minimum RR 104% (p<0.01) during AF.Long-term f/u—no AF or VF. SVT in 1 who went to surgery.1 serious and 5 minor side effectsAmiodarone was safe and effective preventing AF in a small number of pts although side effect were significant.Chimienti M 1995PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNoaW1pZW50aTwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+
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ADDIN EN.CITE.DATA (30)8682031 Open label, no placebo comparison of flecainide vs. propafenone335 pts12 mo mean f/uPSVT 135PAF 200Unclear number of AVRT or WPWArrhythmia recurrenceProbability of 12 mo safe and effective treatment for PSVT was 93% for flecainide and 86% for propafenone p=0.24. For AF it was 77% for flecainide and 75% for propafenone p=0.72. One VT on propafenone, Two rapid AF on flecainidePropafenone and flecainide had similar efficacy for PSVT and AF Hopson JR 1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhvcHNvbjwvQXV0aG9yPjxZZWFyPjE5OTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (164)8607395Open-label multicenter trial of flecainide151 pts1 yPSVT 67PAF 67CAF 17, unclear number of AVRT or WPWArrhythmia recurrenceAt 1 y of treatment, 87% of PSVT, 73% of PAF, and 56% of CAF had improved symptomatically. Proarrhythmia is 3, CHF in 7. 65% w/ visual sx or headachePoor study design, flecainide effective but important cardiac events. Study done before results of CAST known.Catheter Ablation: Ablation of Standard APsJackman WM 1991PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkphY2ttYW48L0F1dGhvcj48WWVhcj4xOTkxPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (165)2030716Observational study of RF ablation and short term f/u for WPW166166 WPW pts w/ 177 pathwaysAcute ablation success and at 8 moAP conduction eliminated in 164 of 166 pts (99%) by a median of 3 RF applications. F/u at 8±5.4 mo showed preexcitation or AVRT returned in 15 pts who underwent a 2nd RF. EP study at 3±9 mo after RF in 75 pts verified absence of AP. 3 pts (1.8%) w/ complications – AV block, cardiac tamponade, pericarditis.Large series reporting success and safety of RF for treating AP in WPW.Calkins H1992PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhbGtpbnM8L0F1dGhvcj48WWVhcj4xOTkyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (166)1555278 Observational study of RF in WPW250183 pts w/ manifest AP and 84 concealed. Failed 2.0+/-1.6 AADsAcute, 3 mo EP study, and 10±4 mo success250 pts w/ 267 APs. 94% w/ both acute success and free of tachycardia at 10 mo. 4% w/ complications: MI-1, AV block-3, valve damage-1, TIA-1, vascular-2Large series reporting success and safety of RF in pts w/ APsKugler J1994PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkt1Z2xlcjwvQXV0aG9yPjxZZWFyPjE5OTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (167)8164700Observational multicenter study of RF ablations in young pts SVT652615 APsAcute and short-term f/u 13.5 moSuccess highest in left free wall APs (89%), high volume centers; lowest in right free wall AP’s (69%), pt weight >80 kg, or presence of CHD. Recurrence in 12-40%, higher in right free wall AP or presence of CHD. 3.7%; one procedural death; AV block, pericardial eff/usion; higher if weight <15 kg; One post procedural death in 5 wk old infant w/ torn mitral valve.Large multicenter series, RF acceptable treatment for AP w/ attention to pt age and body weight and center experience. Calkins H1999PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhbGtpbnM8L0F1dGhvcj48WWVhcj4xOTk5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (59)9892593 Multicenter observational study of RF using Atakr for PSVT1050500 pts w/ AP; 373 w/ AVNRT; 121 of AV junctionAcute and long term safety and f/u.; median f/u 6.3 moAcute AP success 93% for single APs and 86% for multiple APs. 7.8% of pts w/ AP had a recurrence. 3% w/ major complication and 8.2% minor. Death-3, stroke-2, AV block-10, tamponade-6, valve damage-1, MI-1Large series showing good acute success, 8% recurrence, and major complications in 3%. This is the most accurate study listing complications.Dagres N1999PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRhZ3JlczwvQXV0aG9yPjxZZWFyPjE5OTk8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (168)10581141Observational study of RF for APs519All pts w/ APsAcute and long term f/u at 22.6±12.4 mo398 pts responded to f/u questionnaire. 85.4% asymptomatic and 10.6% taking AADs. 41% of pts w/ failed ablations were asymptomatic.Large series reporting good long term success w/ RF for APsSchlapfer J2001 ADDIN REFMGR.CITE <Refman><Cite><Author>Schlapfer</Author><Year>2001</Year><RecNum>209</RecNum><IDText>Late clinical outcome after successful radiofrequency catheter ablation of accessory pathways</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>209</Ref_ID><Title_Primary>Late clinical outcome after successful radiofrequency catheter ablation of accessory pathways</Title_Primary><Authors_Primary>Schlapfer,J.</Authors_Primary><Authors_Primary>Fromer,M.</Authors_Primary><Date_Primary>2001/4</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Arrhythmias,Cardiac</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Child</Keywords><Keywords>complications</Keywords><Keywords>diagnosis</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patient Satisfaction</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Recurrence</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Treatment Outcome</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>605</Start_Page><End_Page>609</End_Page><Periodical>Eur Heart J</Periodical><Volume>22</Volume><Issue>7</Issue><ISSN_ISBN>0195-668X</ISSN_ISBN><Misc_3>10.1053/euhj.2000.2409;S0195668X00924096</Misc_3><Address>Division of Cardiology, University Hospital, Lausanne, Switzerland</Address><Web_URL>PM:11259148</Web_URL><ZZ_JournalFull><f name="System">European heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(169)11259148Observational study of RF for APs followed long term180Pts. w/ APs undergoing RF failing 1.75+/- 1.25 AADsLong-term f/u at a median of 48.1 moAll pts has successful procedure. Pts followed median of 48.1 mo—79% remained asymptomatic. 10% required further RF’ or meds. 4% w/ procedure complications: vascular-5, valve perforation-1, TIA-2Large study of acute RF success w/ 21% having sxs by 4 y but only 10% requiring additional therapy.Belhassen B 2007PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJlbGhhc3NlbjwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+
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ADDIN EN.CITE.DATA (170)17491219Observational study of RF for APs508508 pts w/ 535 APs.Acute and long term RF results 85±43 mo f/u46.8% manifest and 44.4% concealed. 572 procedures in the 508 pts. Acute RF success 93.1% and multiple RF 95.3%. 9.9% recurrence after 1st RF. At 85 mo f/u, 94.9% cure. 2 major complications—pericardial effusion, MILarge series showing long-term success and safety of RF for APs. Pappone C, et al., 2014 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (145)25052405Prospective single center registry of WPW pts 2169 ptsAll pts w/ a manifest AP underwent EP±RF. Followed 8 yBoth asymptomatic and symptomatic pts studied at EP to identify risk factors for VF1001 pts (550 asymptomatic) did not undergo RF and 1168 (550 asymptomatic) underwent RF. F/u of 8 y. VF occurred in 1.5% of the no-RF group (mean age 11 y) and no VF occurred in the RF treated group (p<0.001). VF was associated w/ a short ERP of the AP w/ an optimal cut-off of 240 msec (p<0.001) and AVRT initiating AF (p<0.001).Large single center registry showing that EP findings identified pts w/ a manifest AP at high risk for VF and the risk was eliminated w/ ablation.AAD indicates antiarrhythmic drugs; ACLS, Advanced Cardiovascular Life Support; AF, atrial fibrillation; AHA, American Heart Association; AP, accessory pathway; AT, atrial tachycardia; AV, atrioventricular; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; bpm, beats per min; CAF, chronic atrial fibrillation; CHF, congestive heart failure; CL, cycle length; EP, electrophysiological; ERP, effective refractory period; f/u, follow up; h/o, history of; IV, intravenous; MI, myocardial infarction; N/A, not applicable; NPV, negative predictive value; PAF, paroxysmal atrial fibrillation; PPV, positive predictive value; PSVT, paroxysmal supraventricular tachycardia; pt, patient; FR, radiofrequency; RVR, rapid ventricular response; SVT, supraventricular tachycardia; sx, symptom; TIA, transient ischemic attack; VF, ventricular fibrillation; w/, with; w/o, without; and WPW, Wolff–Parkinson-White syndrome. Data Supplement 13. Summary of Included Studies – ERC Report (Section 6.2)Study (Author, Year)Study DesignSample Size (N)Participant CharacteristicsInclusion CriteriaExclusion CriteriaMilstein S1986 ADDIN REFMGR.CITE <Refman><Cite><Author>Milstein</Author><Year>1986</Year><RecNum>514</RecNum><IDText>Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>514</Ref_ID><Title_Primary>Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Milstein,S.</Authors_Primary><Authors_Primary>Sharma,A.D.</Authors_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Date_Primary>1986/5/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Child</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Rest</Keywords><Keywords>Tachycardia</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1097</Start_Page><End_Page>1100</End_Page><Periodical>Am J Cardiol</Periodical><Volume>57</Volume><Issue>13</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>0002-9149(86)90681-8</Misc_3><Web_URL>PM:3706161</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(171)3706161Uncontrolled prospective cohort study. All pts underwent an EP study.42Mean age (±SD) 36 y (±12 y); age range 7-77 yGender: 21 (50%) men and 21 (50%) women SHD: --- WPW pattern seen on a routine ECG. These pts were considered asymptomatic because they had neither documented arrhythmias nor a h/o sustained palpitations ---Satoh M1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Satoh</Author><Year>1989</Year><RecNum>515</RecNum><IDText>Electrophysiologic evaluation of asymptomatic patients with the Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>515</Ref_ID><Title_Primary>Electrophysiologic evaluation of asymptomatic patients with the Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Satoh,M.</Authors_Primary><Authors_Primary>Aizawa,Y.</Authors_Primary><Authors_Primary>Funazaki,T.</Authors_Primary><Authors_Primary>Niwano,S.</Authors_Primary><Authors_Primary>Ebe,K.</Authors_Primary><Authors_Primary>Miyajima,S.</Authors_Primary><Authors_Primary>Suzuki,K.</Authors_Primary><Authors_Primary>Aizawa,M.</Authors_Primary><Authors_Primary>Shibata,A.</Authors_Primary><Date_Primary>1989/3</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>diagnosis</Keywords><Keywords>diagnostic use</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Isoproterenol</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>413</Start_Page><End_Page>420</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>12</Volume><Issue>3</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Address>First Department of Internal Medicine, Niigata University School of Medicine, Japan</Address><Web_URL>PM:2466266</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(172)2466266Uncontrolled observational cohort study. All pts underwent an EP study.95 (34 asymptomatic and 61 symptomatic pts)Mean age (± SD) 32 y (± 19 y)Male 73%SHD 13%Intermittent preexcitation 23%WPW patternAsymptomatic (neither documented tachycardia, nor a h/o palpitations suggestive of paroxysmal tachycardia.)---Klein GJ1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Klein</Author><Year>1989</Year><RecNum>512</RecNum><IDText>Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>512</Ref_ID><Title_Primary>Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern</Title_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Yee,R.</Authors_Primary><Authors_Primary>Sharma,A.D.</Authors_Primary><Date_Primary>1989/5/11</Date_Primary><Keywords>Atrial Fibrillation</Keywords><Keywords>Canada</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>London</Keywords><Keywords>Longitudinal Studies</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Refractory Period,Electrophysiological</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1229</Start_Page><End_Page>1233</End_Page><Periodical>N.Engl.J Med</Periodical><Volume>320</Volume><Issue>19</Issue><ISSN_ISBN>0028-4793</ISSN_ISBN><Misc_3>10.1056/NEJM198905113201901</Misc_3><Address>Clinical Electrophysiology Laboratory, University Hospital, London, ON, Canada</Address><Web_URL>PM:2710202</Web_URL><ZZ_JournalFull><f name="System">The New England journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">N.Engl.J Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(173)2710202Uncontrolled prospective observational study. All pts underwent an EP study.29Age (±SD): 50 y (±18 y) in the preexcitation lost subgroup39 y (±11 y) in the preexcitation persistent subgroupGender: 17/29 (58.6%) men, 12/29 (41.4%) womenSHD: ---Asymptomatic WPW ECG patternNo documented tachycardia and no h/o sustained tachycardia. ---Leitch JW1990 ADDIN REFMGR.CITE <Refman><Cite><Author>Leitch</Author><Year>1990</Year><RecNum>513</RecNum><IDText>Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>513</Ref_ID><Title_Primary>Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Leitch,J.W.</Authors_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Yee,R.</Authors_Primary><Authors_Primary>Murdock,C.</Authors_Primary><Date_Primary>1990/11</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Canada</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>diagnosis</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>London</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Models,Statistical</Keywords><Keywords>mortality</Keywords><Keywords>Ontario</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time Factors</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1718</Start_Page><End_Page>1723</End_Page><Periodical>Circulation</Periodical><Volume>82</Volume><Issue>5</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Medicine, University Hospital, London, Ontario, Canada</Address><Web_URL>PM:2225373</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(174)2225373Uncontrolled prospective observational study. 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ADDIN EN.CITE.DATA (175)11707045Uncontrolled prospective observational study. All pts underwent testing w/ transesophageal stimulation.92Mean age (±SD): 34 y (±15 y), age range 11-69 y68 men, 24 womenNo SHDAsymptomatic WPW ECG patternNo documented tachycardia and no h/o sustained tachycardia Documentation of SVT at any timePappone C2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (176)12535816Uncontrolled prospective observational study. All pts underwent an EP study.212Mean age of overall population (± SD): 35.8 y (± 20.5 y), age range 7-63 y. Gender in overall population: N/A. SHD in overall population was present in 10/212 (5%) (5 w/ MVP, 2 w/ HCM, 3 w/ hypertension)Mean age (±SD) of the 162 pts w/ complete f/u 33.6 y (±14.3 y), age range 7-63 y. Male 105/162 (65%). SHD was present in 4/162 (3 w/ MVP, 1 w/ HCM) Asymptomatic WPW pattern was found either incidentally at routine examination or during a medical check-up before admission to a competitive sport or a high-risk occupation---Pappone C2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (177)14602878Combined RCT and prospective observational cohort study. All pts underwent EP study. Pts w/ inducible arrhythmia on EP study who were ≤35 y were randomized to ablation vs. no ablation. The remaining pts were followed as an observational cohort.224 (EP study identified 76 high-risk pts who were then enrolled in a RCT and 148 low-risk pts enrolled in a prospective observational cohort study)Median (IQR) age 23 y (15-30 y) for ablation group and 22 y (15-30 y) for no ablation group. Male sex 53% in ablation arm and 47% in no ablation group. No SHD in either group. Median (IQR) age for observational cohort 36 y (27-48 y). Male sex 59% in this cohort. SHD 7%.Ventricular preexcitation documented by 12-lead ECGAbsence of arrhythmia-related sxsParticipation in other investigational protocolsAge <13 yPregnancyConcomitant medical conditionsSantinelli V2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNhbnRpbmVsbGk8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFy
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ADDIN EN.CITE.DATA (178)19808453Uncontrolled prospective observational study. All pts underwent an EP study293 Median age (IQR) 36 y (28-48 y)Male 61%Incidental WPW pattern on ECGAsymptomatic based on an accurate historyParticipation in other research studiesPappone C2014PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (145)25052405Uncontrolled prospective observational study. All pts underwent an EP study. They reported data by treatment w/ catheter ablation.2169 (756 asymptomatic and 550 asymptomatic and w/ no ablation and 1413 symptomatic pts)Median age 19 y, male preponderance among asymptomatic pts (63%).SHDs were found in 1.5% of asymptomatic ptsAsymptomatic and symptomatic pts w/o prior ablation or documented life-threatening arrhythmias who consented to undergo a baseline EP study---CAD indicates coronary artery disease; ECG, electrocardiogram; EP, electophysiological; HCM, hypertrophic cardiomyopathy; IQR, interquartile range; MVP, mitral valve prolapse; N/A, not applicable; pt, patient; RCT, randomized controlled trial; SD, standard deviation; SHD, structural heart disease; SVT, supraventricular tachycardia; sx, symptom; VHD, valvular heart disease; w/, with; w/o, without; WPW, Wolff-Parkinson-White syndrome; and ---, not available. Data Supplement 14. Comparators and Outcomes – ERC Report (Section 6.2)Study (Author, Year)Study GroupsResults of Noninvasive TestingResults of Invasive EP StudyAcute Outcome of Catheter AblationClinical Outcomes of InterestDuration of F/uLoss to F/uMilstein S1986 ADDIN REFMGR.CITE <Refman><Cite><Author>Milstein</Author><Year>1986</Year><RecNum>514</RecNum><IDText>Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>514</Ref_ID><Title_Primary>Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Milstein,S.</Authors_Primary><Authors_Primary>Sharma,A.D.</Authors_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Date_Primary>1986/5/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Child</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Rest</Keywords><Keywords>Tachycardia</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1097</Start_Page><End_Page>1100</End_Page><Periodical>Am J Cardiol</Periodical><Volume>57</Volume><Issue>13</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>0002-9149(86)90681-8</Misc_3><Web_URL>PM:3706161</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(171)3706161Group 1: Asymptomatic WPW patternN/A43 APs in 42 asymptomatic pts. Mean ERP of AP was 333±106 msec in asymptomatic pts vs. 298± 42 msec in asymptomatic pts (p<0.025). Mean shortest RR interval during AF 277±48 msec in the asymptomatic groups vs. 247±51 msec in the symptomatic group (p<0.025). Sustained AVRT could be induced in only 1 pt. No ablation1 pt died of metastatic carcinoma after 43 mo, 1 pt died suddenly after he had agreed to participate in the study but before EP study could be performed. 4 pts received propranolol because of undocumented "skipped beats." All other pts remained asymptomatic.29±18 moNoneKlein GJ1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Klein</Author><Year>1989</Year><RecNum>512</RecNum><IDText>Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>512</Ref_ID><Title_Primary>Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern</Title_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Yee,R.</Authors_Primary><Authors_Primary>Sharma,A.D.</Authors_Primary><Date_Primary>1989/5/11</Date_Primary><Keywords>Atrial Fibrillation</Keywords><Keywords>Canada</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>London</Keywords><Keywords>Longitudinal Studies</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Refractory Period,Electrophysiological</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1229</Start_Page><End_Page>1233</End_Page><Periodical>N.Engl.J Med</Periodical><Volume>320</Volume><Issue>19</Issue><ISSN_ISBN>0028-4793</ISSN_ISBN><Misc_3>10.1056/NEJM198905113201901</Misc_3><Address>Clinical Electrophysiology Laboratory, University Hospital, London, ON, Canada</Address><Web_URL>PM:2710202</Web_URL><ZZ_JournalFull><f name="System">The New England journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">N.Engl.J Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(173)2710202Group 1: Invasive EP study w/o catheter ablationN/A28/29 (97%) pts had only 1 AP and 1/29 (3%) pts had more than 1 AP. The mean (± SD) ERP of pathway(s) at baseline 334 msec (±105 msec) on the initial study and 301 msec (±78 msec) on the f/u study. The shortest RR interval (±SD) during induced AF was 266 msec (±39 msec). Sustained AF was induced in 2/29 (7%) pts on the initial study and 11/29 (38%) pts on the f/u study. No ablationSustained PSVT 2/29 (7%) (during 36-79 mo); 27/29 (93%) remained asymptomatic;9/29 (31%) lost WPW pattern on ECG.36-79 mo NoneSatoh M1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Satoh</Author><Year>1989</Year><RecNum>515</RecNum><IDText>Electrophysiologic evaluation of asymptomatic patients with the Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>515</Ref_ID><Title_Primary>Electrophysiologic evaluation of asymptomatic patients with the Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Satoh,M.</Authors_Primary><Authors_Primary>Aizawa,Y.</Authors_Primary><Authors_Primary>Funazaki,T.</Authors_Primary><Authors_Primary>Niwano,S.</Authors_Primary><Authors_Primary>Ebe,K.</Authors_Primary><Authors_Primary>Miyajima,S.</Authors_Primary><Authors_Primary>Suzuki,K.</Authors_Primary><Authors_Primary>Aizawa,M.</Authors_Primary><Authors_Primary>Shibata,A.</Authors_Primary><Date_Primary>1989/3</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>diagnosis</Keywords><Keywords>diagnostic use</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Isoproterenol</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>413</Start_Page><End_Page>420</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>12</Volume><Issue>3</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Address>First Department of Internal Medicine, Niigata University School of Medicine, Japan</Address><Web_URL>PM:2466266</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(172)2466266Group 1: Asymptomatic pts w/ WPW patternIntermittent preexcitation on ECG recording 23%Number of pts w/ multiple APs not reported. Baseline mean ERP of AP was 288±29 msec in asymptomatic pts. Shortest RR in AF not reported. AVRT induced in 6/34 (18%) pts in the asymptomatic group, sustained AF was induced in 2/34 (6%) of asymptomatic pts. No ablationGroup 1: no eventsGroup 2: 2 pts w/ symptomatic WPW syndrome had VF and were resuscitated successfully Mean 15 mo (range 2 to 47 mo)---Leitch JW1990 ADDIN REFMGR.CITE <Refman><Cite><Author>Leitch</Author><Year>1990</Year><RecNum>513</RecNum><IDText>Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>513</Ref_ID><Title_Primary>Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Leitch,J.W.</Authors_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Yee,R.</Authors_Primary><Authors_Primary>Murdock,C.</Authors_Primary><Date_Primary>1990/11</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Canada</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>diagnosis</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>London</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Models,Statistical</Keywords><Keywords>mortality</Keywords><Keywords>Ontario</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time Factors</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1718</Start_Page><End_Page>1723</End_Page><Periodical>Circulation</Periodical><Volume>82</Volume><Issue>5</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Medicine, University Hospital, London, Ontario, Canada</Address><Web_URL>PM:2225373</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(174)2225373Group 1: Invasive EP study w/o catheter ablationN/AAt baseline, the median ERP of the AP was 293 msec (IQR 280-310 msec), and the median retrograde ERP of the AP was 288 msec (IQR 240-320 msec).The median shortest RR interval during preexcited AF was 274 msec (IQR 240-325 msec) in 72 pts, was ≤250 msec in 23 pts and was ≤200 msec in 8 pts.AVRT was induced in 12/75 (16%) and sustained AF was induced in 23/75 (31%). No ablation3/75 (4%) died of noncardiac causes, 1/75 (1%) pt died suddenly after initial consultation but before EP study was done. 5/75 (7%) developed symptomatic AVRT. 1/75 (1%) developed symptomatic AF. The presence of sustained AVRT at EP study did not differentiate pts who remained asymptomatic from pts who became symptomatic. Only 1 (4%) pt developed clinical AF of the 23 pts in whom AF was induced at EP study. Median 4.3 y (range 1-9 y)NoneBrembilla-Perrot B2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJyZW1iaWxsYS1QZXJyb3Q8L0F1dGhvcj48WWVhcj4yMDAx
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ADDIN EN.CITE.DATA (175)11707045Group 1: Transesophageal stimulation All pts had 24-h Holter and stress test performed prior to study entry and only those w/o supraventricular arrhythmia were includedThe number of APs found was not reported. The ERP of pathway(s) at baseline and during isoproterenol infusion were not reported. Shortest RR interval (<250 msec) during induced AF was present in 20/92 (22%) pts. Atrial tachyarrhythmia was induced in 27% of pts.No ablation3/92 (3%) pts developed symptomatic AF several y later. Of these 3 pts, 1 presented w/ AF and then VF 1 d after an aortic aneursymectomy. Among the 42 pts considered to have a benign form of WPW syndrome, there was no clinical event, except a death related to an accident.--- ---Pappone C2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (176)12535816Group 1: Invasive EP study w/o catheter ablationN/A17/162 (10%) had multiple APs. Baseline mean (± SD) ERP 275.2 msec (± 33.8 msec). Isoproterenol mean (± SD) ERP 246.1 msec (± 30.5 msec). Shortest RR in AF not reported47/162 (29%) had inducible arrhythmia: nonsustained AF in 17, sustained AF in 19, inducible AVRT that degenerated into totally preexcited sustained AF in 11.No ablation129/209 (62%) remained asymptomatic at the end of follow- up, whereas 33 (16%) developed arrhythmic events: SVT in 25, AF in 8, documented VF in 3/209 (aborted sudden death in 2 (both had developed sxs due to AF) and sudden death in 1/209) 37.7±16.1 mo; range 14 to 60 mo 3/212 (1.4%) 47/212 who ref/used the 5-y EP study were excluded from the analysisPappone C2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (177)14602878Group 1: AblationGroup 2: No ablationGroup 3: Low-risk group followed as an observational cohortN/A15/37 (41%) pts in the ablation group had inducible AVRT. In 8 additional pts, AVRT degenerated into sustained AF.The median number of RF applications was 9 (range, 5 to 22). Ablation was acutely successful in all pts. Complications related to EP study (2 pneumothoraxes and 1 large femoral hematoma) developed in 3 (1%) pts. An ablation-related complication (permanent right bundle-branch block) developed in 1/37 (3%) pt w/ an anteroseptal AP.2/37 (5%) pts in the ablation group had an arrhythmic event found on EP study to be due to AVNRT in both pts. W/in a mean of 15 mo, 21/35 (60%) pts in the no ablation group had an arrhythmic event which was SVT in 15 pts, AF in 5 pts, and VF (not preceded by sxs) in 1 pt. Among the high-risk controls (group 2), the 5-y rate of arrhythmic events was 77% vs. 7% in the ablation group. In the observational cohort, sxs of SVT developed in 6 pts and 20 pts lost ventricular preexcitation. Ablation group median f/u 27 mo, range 9-60 mo. Control group median f/u 21 mo, range 8-60 mo.NoneSantinelli V2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNhbnRpbmVsbGk8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFy
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ADDIN EN.CITE.DATA (178)19808453Group 1: Invasive EP study w/o catheter ablationN/AAnterograde ERP of AP ≤250 msec was present in 39/293 (13%) pts.Multiple APs were found in 13 (4%) pts.Inducible arrhythmia was found in 47 (16%) pts.No ablation262/293 (89%) pts did not experience arrhythmic events, remaining totally asymptomatic, whereas 31/293 (11%) pts had an arrhythmic event, which was potentially life-threatening in 17 of them. Potentially life-threatening tachyarrhythmias resulted in resuscitated cardiac arrest (1 pt), presyncope (7 pts), syncope (4 pts), or dizziness (5 pts).Median duration of f/u after EP study was 67 mo (range 8 to 90)---Pappone C2014PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (145)25052405Group 1: Asymptomatic pts w/ WPW pattern (they presented data on symptomatic pts and by whether or not catheter ablation of the AP was done), but the groups were not matched and selection bias was not adjusted for)---No ablation: Multiple APs in 59 (6%), median (IQR) ERP of AP 280 msec (250-300 msec). Inducible AVRT triggering AF on EP study was found in 47 (5%) of pts. W/ Ablation:Multiple APs in 80 (7%), median ERP (IQR) of AP 280 msec (250-300 msec). Inducible AVRT triggering AF on EP study was found in 73 (6%) of pts.206/756 asymptomatic pts were treated w/ ablation; ablation was successful in 98.5%.No ablation: during a median f/u of 22 mo VF occurred in 13/550 (2%) asymptomatic pts (almost exclusively in children). During a median f/u of 46.5 mo, 48/550 (9%) additional asymptomatic pts experienced malignant arrhythmias 86/756 (11%) of the asymptomatic pts developed benign arrhythmias (AVRT and AF).W/ ablation: no pt developed malignant arrhythmias or VF over the 8 y of f/u.Median 96 moNo ablation: completeness of f/u was 99.8% at 1 y and 92.3% at the end of the studyW/ ablation: completeness of f/u was 95.5% at 1 y and 90.2% at the end of the studyAF indicates atrial fibrillation; AP, accessory pathway; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventrial reentrant tachycardia; ECG, echocardiogram; EP, electrophysiological; ERP, effective refractory period; f/u, follow up; IQR, interquartile range; N/A, not applicable; pt, patient; RF, radiofrequency; SD, standard deviation; SVT, supraventricular tachycardia; VF, ventricular fibrillation; w/, with; w/o, without; WPW, Wolf-Parkinson-White syndrome; and ---, not available. Data Supplement 15. Quality Assesment of Included Studies – ERC Report (Section 6.2)Study (Author, Year)Representativeness of the CohortSelection of a Nonexposed CohortAscertainment of ExposureDemonstration that Outcome of Interest was not Present at EnrollmentIndependent Blind Assessment of OutcomesWas Follow Up Long Enough for Outcomes to Occur?Adequacy of Follow Up of Cohort (Including Loss to Follow Up)Precision of FindingsMilstein S1986 ADDIN REFMGR.CITE <Refman><Cite><Author>Milstein</Author><Year>1986</Year><RecNum>514</RecNum><IDText>Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>514</Ref_ID><Title_Primary>Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Milstein,S.</Authors_Primary><Authors_Primary>Sharma,A.D.</Authors_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Date_Primary>1986/5/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Child</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Rest</Keywords><Keywords>Tachycardia</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1097</Start_Page><End_Page>1100</End_Page><Periodical>Am J Cardiol</Periodical><Volume>57</Volume><Issue>13</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>0002-9149(86)90681-8</Misc_3><Web_URL>PM:3706161</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(171)3706161YesN/A (all pts underwent EP study)All pts underwent EP studyYes---YesYesImprecise due to small sample sizeKlein GJ1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Klein</Author><Year>1989</Year><RecNum>512</RecNum><IDText>Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>512</Ref_ID><Title_Primary>Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern</Title_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Yee,R.</Authors_Primary><Authors_Primary>Sharma,A.D.</Authors_Primary><Date_Primary>1989/5/11</Date_Primary><Keywords>Atrial Fibrillation</Keywords><Keywords>Canada</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>London</Keywords><Keywords>Longitudinal Studies</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Refractory Period,Electrophysiological</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1229</Start_Page><End_Page>1233</End_Page><Periodical>N.Engl.J Med</Periodical><Volume>320</Volume><Issue>19</Issue><ISSN_ISBN>0028-4793</ISSN_ISBN><Misc_3>10.1056/NEJM198905113201901</Misc_3><Address>Clinical Electrophysiology Laboratory, University Hospital, London, ON, Canada</Address><Web_URL>PM:2710202</Web_URL><ZZ_JournalFull><f name="System">The New England journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">N.Engl.J Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(173)2710202YesN/A (no comparator group)All pts underwent EP study2/29 had SVT between scheduling EP study and when EP study was performed---YesYesN/A (no comparator group)Satoh M1989 ADDIN REFMGR.CITE <Refman><Cite><Author>Satoh</Author><Year>1989</Year><RecNum>515</RecNum><IDText>Electrophysiologic evaluation of asymptomatic patients with the Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>515</Ref_ID><Title_Primary>Electrophysiologic evaluation of asymptomatic patients with the Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Satoh,M.</Authors_Primary><Authors_Primary>Aizawa,Y.</Authors_Primary><Authors_Primary>Funazaki,T.</Authors_Primary><Authors_Primary>Niwano,S.</Authors_Primary><Authors_Primary>Ebe,K.</Authors_Primary><Authors_Primary>Miyajima,S.</Authors_Primary><Authors_Primary>Suzuki,K.</Authors_Primary><Authors_Primary>Aizawa,M.</Authors_Primary><Authors_Primary>Shibata,A.</Authors_Primary><Date_Primary>1989/3</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>diagnosis</Keywords><Keywords>diagnostic use</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Isoproterenol</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>413</Start_Page><End_Page>420</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>12</Volume><Issue>3</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Address>First Department of Internal Medicine, Niigata University School of Medicine, Japan</Address><Web_URL>PM:2466266</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(172)2466266YesN/A (all pts underwent EP study)All pts underwent EP studyYes---Yes---Imprecise (no events)Leitch JW1990 ADDIN REFMGR.CITE <Refman><Cite><Author>Leitch</Author><Year>1990</Year><RecNum>513</RecNum><IDText>Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>513</Ref_ID><Title_Primary>Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern</Title_Primary><Authors_Primary>Leitch,J.W.</Authors_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Yee,R.</Authors_Primary><Authors_Primary>Murdock,C.</Authors_Primary><Date_Primary>1990/11</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Canada</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>diagnosis</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>London</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Models,Statistical</Keywords><Keywords>mortality</Keywords><Keywords>Ontario</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time Factors</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1718</Start_Page><End_Page>1723</End_Page><Periodical>Circulation</Periodical><Volume>82</Volume><Issue>5</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Medicine, University Hospital, London, Ontario, Canada</Address><Web_URL>PM:2225373</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(174)2225373QuestionableN/A (no comparator group)All pts underwent EP studyYes---YesYesN/A (no comparator group)Brembilla-Perrot B2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJyZW1iaWxsYS1QZXJyb3Q8L0F1dGhvcj48WWVhcj4yMDAx
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ADDIN EN.CITE.DATA (145)25052405QuestionableN/A (no comparator group)All pts underwent EP studyYes---Yes---N/A (no comparator group)CI indicates confidence intervals; ECG, echocardiogram; EP, electrophysiological; f/u, f/u; N/A, not applicable; pt, patient; SVT, supraventricular tachycardia; sx, symptom; w/, with; and ---, not available.Data Supplement 16. Randomized Trials Comparing Atrial Flutter – Section 7 Study Name, Author, YearAim of StudyStudy Type (Size, N)Study Intervention Group (n)Study Comparator Group (n)Pt PopulationEndpointsP Values, OR: HR: RR: & 95% CI:Study Limitations & Adverse EventsInclusion CriteriaExclusion CriteriaPrimary Endpoint (efficacy) and ResultsSafety Endpoint and ResultsSecondary Endpoint and ResultsPlatia EV1989PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBsYXRpYTwvQXV0aG9yPjxZZWFyPjE5ODk8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (179)2564725The effects of esmolol, an ultrashort-acting beta blocker, and verapamil were compared in controlling ventricular response in 45 pts w/ AF or atrial flutterRandomized, parallel, open-label study. 45 ptsEsmolol (n = 21) Verapamil (n = 24)Pts w/ either new onset (less than 48 h, n = 31) or old onset (greater than 48 h, n = 14) of AF or flutter w/ rapid ventricular rateUncontrolled CHF, SSS w/o pacemaker, h/o intolerance to beta blockers or ca-channel blockers, AMI <3 d, impaired renal and hepatic function, SVT other that AF or atrial flutter, digitalis toxicity, SBP <100 mm Hg unless it was usualDrug efficacy was measured by ventricular rate reduction and conversion to sinus rhythm.HR declined w/ esmolol from 139 to 100 bpm and w/ verapamil from 142 to 97 bpm. 50% of esmolol-treated pts w/ new onset of arrhythmias converted to NSR vs. 12% w/ verapamil.N/AN/AHR decline w/ esmolol (p<0.001); HR decline w/ verapamil (p<0.001).Conversion w/ esmolol vs. verapamil (<0.03).Mild hypotension both groupsSalerno DM1989PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNhbGVybm88L0F1dGhvcj48WWVhcj4xOTg5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (180)2650517study evaluates the effectiveness and safety of IV diltiazem for the treatment of AF and atrial flutter.Double-blind, parallel, randomized, placebo-controlled.113 pts w/ AF or fluttIV diltiazem 0.25 mg/kg/2 min followed 15 min later by 0.35 mg/kg/2 min if the first dose was tolerated but ineffective. If a pt did not respond, the code was broken and the pt was allowed to receive open-label diltiazem if placebo had been given.Identical placebo113 pts w/ AF or flutter, a ventricular rate greater than or equal to 120 bpm and systolic BP greater than or equal to 90 mm Hg.Severe HFOf 56 pts, 42 (75%) randomized to receive diltiazem responded to 0.25 mg/kg and 10 of 14 responded to 0.35 mg/kg, for a total response rate of 52 of 56 pts (93%), whereas 7 of 57 pts (12%) responded to placebo.Mild hypotensionN/AResponse to diltiazem vs. placebo (p<0.001)IV diltiazem was rapidly effective for slowing the ventricular response in most pts w/ AF or atrial flutter. BP decreased slightly. Side effects were mild.Van Gelder IC1989PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZhbiBHZWxkZXI8L0F1dGhvcj48WWVhcj4xOTg5PC9ZZWFy
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ADDIN EN.CITE.DATA (181)2511744Efficacy and safety of flecainide acetate in the maintenance of sinus rhythm after electrical cardioversion of chronic AF or atrial flutter.81 ptsN/AN/AChronic AF or flutterAge <16 or >80 y; CHF or angina pectoris > III (NYHA); MI <2 y, flecainide intolerance, BBB, SSS w/o pacemaker, antiarrhythmics, severe systemic diseaseMultiple regression analysis showed New York Heart Association class I for exercise tolerance (p=0.0004) and flecainide treatment (p=0.01) to be the main factors increasing the arrhythmia-free episode. However, Mantel-Cox lifetable analysis did not reveal significant differences between arrhythmia-free survival curves of both treatment groups. In the flecainide-treated group, 9% of pts experienced side effects, mostly related to negative dromotropic effects. The incidence of ventricular proarrhythmia in this group of pts was low.N/AN/AN/A9% of pts treated w/ flecainide had adverse events (e.g,sinus arrest, AV block, rate related LBBB).Moderate doses of flecainide (not >300 mg) recommended after cardioversionSuttrop MJ1990 ADDIN REFMGR.CITE <Refman><Cite><Author>Suttorp</Author><Year>1990</Year><RecNum>232</RecNum><IDText>The value of class IC antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>232</Ref_ID><Title_Primary>The value of class IC antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm</Title_Primary><Authors_Primary>Suttorp,M.J.</Authors_Primary><Authors_Primary>Kingma,J.H.</Authors_Primary><Authors_Primary>Jessurun,E.R.</Authors_Primary><Authors_Primary>Lie,A.Huen</Authors_Primary><Authors_Primary>van Hemel,N.M.</Authors_Primary><Authors_Primary>Lie,K.I.</Authors_Primary><Date_Primary>1990/12</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>adverse effects</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiology</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Propafenone</Keywords><Keywords>Safety</Keywords><Keywords>Single-Blind Method</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time</Keywords><Keywords>Time Factors</Keywords><Reprint>Not in File</Reprint><Start_Page>1722</Start_Page><End_Page>1727</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>16</Volume><Issue>7</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Misc_3>0735-1097(90)90326-K</Misc_3><Address>Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands</Address><Web_URL>PM:2123909</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(182)2123909Cardioversion w meds: Single blind randomized study of IV propafenone (2 mg/kg per 10 min) vs. flecainide (2 mg/kg per 10 min)50 pts w/ AF or atrial flutterAF or flutterGroup A- 20 pts w/ AF treated w/ propafenoneGroup C- 5 pts w/ atrial flutter treated w/ proopafenoneAF or flutterGroup B-20 pts w/ AF treated w/ flecainideGroup D- 5 pts w/ atrial flutter treated w/ flecainideAF or atrial flutter <6 mo w/ ventricular rate >100 bpm at rest w/ no HF signsConduction disturbances more that 1st degree AV block, on class I antiarrythmics, WPW syndrome, SSS, AMI, Hyperthyroidism, cardiac surgery <2 wks, atrial enlargement, w/ AF or atrial flutter w/o appropriate anticoagulants, body weight >100 kgConversion to NSR w/in 1 H11/20 (55%)pts w/ AF treated w/ propafenone 18/20 (90%)pts w/ AF treated w/ flecainide (p<0.02)2/5 (40%) pts w/ atrial flutter treated w/ propafenone1/5 (20%) pts w/ atrial flutter treated w/ flecainide. P=NSQRS lengthening (83±15 to 9920 msec) was observed only in the pts treated w/ flecainide (p<0.001).N/AConversion from AF w/ flecainide vs. propafenone (p<0.02).Conversion from atrial flutter w/ fleainidec vs. propafenone (p=NS).Transient AE flecainide vs. propafenone more common (p<0.001)Flecainide 2 mg/kg in 10 min is more effective than propafenone for conversion of AF to NSR but not for conversion of flutter. Few AE w/ propafenone- may be related to low dose. Ellenbogen KA 1991 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkVsbGVuYm9nZW48L0F1dGhvcj48WWVhcj4xOTkxPC9ZZWFy
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ADDIN EN.CITE.DATA (183)1894861To demonstrate the safety and efficacy of a continuous IV diltiazem infusion for 24 h heart rate control Randomized, double-blind, parallel, placebo-controlled IV diltiazem vs. placeboPlaceboPts >18 y w/ AF or atrial flutter w/ duration >24 h and HR >120 bpm Severe CHF, sinus node dysfunction, 2nd or 3rd degree AV block, WPW syndrome or hypotension Therapeutic response (ventricular response <100 bpm, ≥20% decrease in heart rate from baseline or conversion to NSR 74% vs. 0% N/AN/Ap<0.001IV diltiazem is safe and effective at slowing heart rate in AF or fluttVan Gelder IC1991PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZhbiBHZWxkZXI8L0F1dGhvcj48WWVhcj4xOTkxPC9ZZWFy
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ADDIN EN.CITE.DATA (184)2058558Cardioversion: reassess prospectively the immediate and long-term results of direct-current electrical cardioversion in chronic AF or atrial flutter, and to determine factors predicting clinical outcome of the arrhythmia after direct-current cardioversion246 ptsMultivariate analysis to identify factors predicting short- and long-term arrhythmia outcome following DC cardioversionN/AAF or atrial flutterSinus rhythm, unstable HF, cardiogenic shock, severs systemic disease, SSS, AMI, contraindication to anticoagulantsCardioversion successful in 70% of pts w/ AF and in 96% of pts w/ flutter. Stepwise logistic regression analysis revealed that arrhythmia duration, type of arrhythmia and age independently influenced conversion rate. 42 and 36% of pts remained in sinus rhythm during 1 and 2 y, respectively. Multivariate regression analysis revealed that the type of arrhythmia), low precardioversion functional class and the presence of nonrheumatic mitral valve disease independently increased the length of the arrhythmia-free episode. Rheumatic heart disease shortened this period.N/AN/AArrhythmia duration (p<0.001); AF vs. atrial flutter (p<0.02) and age (p<0.05) influenced DCV rates. MVanalysis showed arrhythmia type (p=0.0008), functional class (p=0.002) and presence of nonrheumatic disease (p=0.03) increased arrhythmia free period. Rheumatic heart disease decreased arrhythmia free period (p=0.03)Predictors for successful cardioversion include flutter vs. AF. FC, age and rheumatic heart disease affect cardioversion.Kingma JH1992 ADDIN REFMGR.CITE <Refman><Cite><Author>Kingma</Author><Year>1992</Year><RecNum>222</RecNum><IDText>Acute pharmacologic conversion of atrial fibrillation and flutter: the role of flecainide, propafenone, and verapamil</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>222</Ref_ID><Title_Primary>Acute pharmacologic conversion of atrial fibrillation and flutter: the role of flecainide, propafenone, and verapamil</Title_Primary><Authors_Primary>Kingma,J.H.</Authors_Primary><Authors_Primary>Suttorp,M.J.</Authors_Primary><Date_Primary>1992/8/20</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiology</Keywords><Keywords>Drug Evaluation</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Propafenone</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>Single-Blind Method</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time</Keywords><Keywords>Time Factors</Keywords><Keywords>Verapamil</Keywords><Reprint>Not in File</Reprint><Start_Page>56A</Start_Page><End_Page>60A</End_Page><Periodical>Am J Cardiol</Periodical><Volume>70</Volume><Issue>5</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Address>Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands</Address><Web_URL>PM:1510000</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(185)1510000Cardioversion w meds: Single-blind randomized study design. Efficacy and safety of IV propafenone (2 mg/kg per 10 min) vs. flecainide (2 mg/kg per 10 min) vs. verapamil 10 mg in 1 min.in pts w/ AF or flutt90 Conversion to NSR w/in 1 hr of start of infusion: First 40: flecainide and verapamil assessedConversion to NSR w/in 1 hr of start of infusion:Second 50: flecainide and propafenone comparedConsecutive pts w/ AF or flutterMore than 1st degree AV block, class I antiarrhtyhmics, WPW syndrome, SSS, AMI, hyperthyroidism, cardiac surgery <2 wk, left atrial enlargement with AF or atrial flutter >2 d w/o appropriate anticoagulants, body weight >100 kgConversion to NSR in: 32/37 (86%) AF w/ flecainide11/20 (55%) AF w/ PPFIn recent onset AF, flecainide conversion 24/25 (96%) vs. 8/14 (57%) propafenone, p<0.05.1/8 (13%) atrial flutter w/ flecainide2/5 (40%) atrial flutter propafenone, p=NSOverall verapamil 1/20 (5%)QRS widening occurred in flecainide-treated pts (83±15 to 99±20 msec; p<0.001), but not after propafenone (83±11 to 86±12 msec).N/ARecent onset AF flecainide more effective than propafenone at conversion ((p<0.05)Flutter conversion no difference in conversion w/ flecainide vs. propafenone (p=NS)Verapamil ineffective.QRS widening more common w/ flecainide than propafenone (p<0.001)Flecainide is more effective than propafenone at converting recent onset AF, but not flutter. Verapamil was not effective at converting AF or atrial flutter w/in 1 hrRoberts SA1993PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlJvYmVydHM8L0F1dGhvcj48WWVhcj4xOTkzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (186)8362772Clinical effectiveness and cost of digoxin at controlling HR in AF and atrial flutter in prospective , observational study at 18 academic centers115 pts Assessed time to HR control w/ digoxin N/A18 yAF or atrial flutter w/ ventricular rates ≥ 120 BPMNYHA class III, IV, HF, surgery, AMIThe median time to ventricular rate control (i.e., resting ventricular rate <100 bpm, decrease in ventricular rate of >20%, or sinus rhythm) was 11.6 h from the first dose of digoxin for all evaluable pts (n = 105) and 9.5 h for those only receiving digoxin (n = 64). Before ventricular rate control, the mean ±SD dose of digoxin administered was 0.80±0.74 mg, and a mean of 1.4±1.8 serum digoxin concentrations were ordered per pt.N/AN/AN/AObservational studyTucker KJ1993 ADDIN REFMGR.CITE <Refman><Cite><Author>Tucker</Author><Year>1993</Year><RecNum>234</RecNum><IDText>A comparison of transoesophageal atrial pacing and direct current cardioversion for the termination of atrial flutter: a prospective, randomised clinical trial</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>234</Ref_ID><Title_Primary>A comparison of transoesophageal atrial pacing and direct current cardioversion for the termination of atrial flutter: a prospective, randomised clinical trial</Title_Primary><Authors_Primary>Tucker,K.J.</Authors_Primary><Authors_Primary>Wilson,C.</Authors_Primary><Date_Primary>1993/6</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Atrial Function</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Cardiology</Keywords><Keywords>Digoxin</Keywords><Keywords>Electric Countershock</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Block</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiology</Keywords><Keywords>physiopathology</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Safety</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapy</Keywords><Keywords>United States</Keywords><Reprint>Not in File</Reprint><Start_Page>530</Start_Page><End_Page>535</End_Page><Periodical>Br.Heart J</Periodical><Volume>69</Volume><Issue>6</Issue><User_Def_5>PMC1025166</User_Def_5><ISSN_ISBN>0007-0769</ISSN_ISBN><Address>Department of Medicine, Naval Hospital, Oakland, California</Address><Web_URL>PM:8343321</Web_URL><ZZ_JournalFull><f name="System">British heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Br.Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(187)8343321Pace terminationProspective randomized clinical trial: Comparison of safety and efficacy of transesophageal atrial pacing vs. DC cardioversion in pts on medical therapy.21 consec ptsGroup A- 11 pts treated w/ TAPGroup B- 10 pts treated w/ DC cardioversionConsecutive pts w/ flutter- HD stable. - Had failed 1A or 1C antiarrhythmic therapy-All pts received digoxin to control HR to <100 BPMN/ANSR achieved w/ interventionGroup A- 8/11 TAP ptsGroup B- 9/10 DC cardioversion ptsP= 0.31Nonsustained VT was more frequent in DC cardioversion Group A- 0/11 TAPGroup B 6/10 DC cardioversionP=0.02 N/AP=0.31 NSR in TAP vs. DC cardioversionNSVT p= 0.02 Group A vs. BTAP is safe and effective and was well tolerated and is as efficacious as DC cardioversionEllenbogen KA1995 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkVsbGVuYm9nZW48L0F1dGhvcj48WWVhcj4xOTk1PC9ZZWFy
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ADDIN EN.CITE.DATA (188)7801862To demonstrate the efficacy of various doses of IV diltiazem for heart rate controlOpen label, dose titration study. 84 pts w/ AF, atrial flutter, or bothBolus dose of diltiazem followed by continuous infusion w/ monitoring of heart rate and BPN/A84 consecutive pts w/ AF or flutter, or both, received an IV bolus dose of diltiazem followed by a continuous infusion of diltiazem at 5, 10, and 15 mg/h.>18 y, women of child-bearing age, SSS, 3rd degree AV block, WPW, hypotensive SBP <90 mm Hg, allergic to diltiazem. 94% of pts (79 of 84) responded to the bolus dose w/ a >20% reduction in HR from baseline, a conversion to sinus rhythm, or a heart rate <100 bpm. 78 pts received the continuous infusion. After 10 h of infusion, 47% of pts had maintained response w/ the 5 mg/h infusion, 68% maintained response after the infusion was titrated to 10 mg/h, and 76% after titration from the 5 and 10 mg/h infusion to the 15 mg/h dose. For the 3 diltiazem infusions studied, mean (±SD) heart rate was reduced from a baseline value of 144±14 bpm to 98±19, 107±25, 107±22, 101±22, 91±17, and 88±18 bpm at infusion times 0, 1, 2, 4, 8, and 10 h, respectively. By the end of the infusion, 18% of pts (14 of 78) had conversion to sinus rhythmStatistically significant change in BP before and after 20 mg bolus during infusion. NS difference in BP, after infustion at h 0, 1, 2, 4, 8, and 10. N/AContinuous infusion 10 h response at 5 mg/h (95% CI for 5 mg/h: 36-59; 95% CI for 10 mg/hr: 57-79%)IV diltiazem is safe and effective at slowing heart rate in AF or flutter. Treatment related symptomatic hypotension (3.5-13% w/ hypotension) was most common. Hou ZY1995PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhvdTwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (189)7671898Cardioversion w meds: Randomized, open label, digoxin-controlled study to observe efficacy and safety of dosing regimen of amiodarone in recent-onset, persistent AF and atrial flutter w/ ventircular rates >130 BPM.51Randomly assigned to either IV amiodarone (n=26) or digoxin (n=24)Amiodarone infused over 24 h (decreasing doses/h)Digoxin inf/used- 0.013 mg/kg in 3 divided dosesAmiodarone vs. digoxinPotentially useful for a recommendationRecent-onset, persistent, AF and flutter w/ ventricular rates above 130 beats.Heart rate control: Mean HR in amiodarone group decreased from 157 + 20 to 122+ 25 BPM in 1 hr (p<0.05) and further stabilized to 96±25 BPM after 6 h (p<0.05).Fewer HR reductions in digoxin group (p<0.05)amiodarone infusion was prematurely aborted in two pts due to severe bradycardia and death after conversion in one pt and aggravation of HF in the otherN/AAmiodarone reduced HR significantly more than digoxin at 1 and 6 h (p<0.05 both time frames)Demonstrated HR control w/ amiodarone.Sung RJ1995PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlN1bmc8L0F1dGhvcj48WWVhcj4xOTk1PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (190)7900626Cardioversion w medsMulticenter, randomized, double-blind, placebo controlled study: Placebo vs. sotalol93Two phased study:Phase 1: randomized placebo infusion vs. 1.0 or 1.5 mg/kg IV sotalol. (30 min observation)Phase 2: if not converted or if HR not fall to <100, 1.5 mg/kg sotalol givenPhase 1 sotalol vs. placeboPhase 2 no comparetorSpontaneous or induced SVT (n=45) or atrial flutter/fibrillation (n=48)N/ASVT phase 1 conversion to NSR 2/14 (14%) w/ placeboSVT phase 1 conversion to NSR 10/15 (67%) sotalol 1.0 mh/kg (p<0.05 vs. placebo)SVT phase 1 conversion to NSR 10/15 (67%) sotalol 1.5 mg/kg (p<0.05 vs. placebo)SVT open label 7/17 (41%) conversion to NSR w/ 1.5 mg/kg sotalolAF phase 1 conversion to NSR 2/14 (14%) w/ placeboAF phase 1- 2/11 (11%) conversion to NSR w/ 1.0 mg/kg sotalol (p=NS vs. placebo)AF phase 1- 2/16 (13%) to NSR 1.5 mg/kg sotalol (p=NS vs. placebo)N/AN/APhase 1 SVT sotalol 1.0 mg/kg and 1.5 mg/kg vs. placebo, sotalol superior (p<0.05 for each dose)Phase 1 sotalol vs. placebo conversion of AF 1.0 mg/kg and 1.5 mg kg not different (p=NS for both doses)Sotalol was effective at terminating SVT but not AFDoni F1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRvbmk8L0F1dGhvcj48WWVhcj4xOTk2PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (191)8945077Pace termination (randomized):Comparison of TAP in Type 2 atrial flutter w/ or w/o propafenone12 pts w/ type 2 atrial flutter12 pts w/ type 2 flutter randomized to 2 groups:Group A- TAP on no medsGroup B- TAP 2 h after propafenone 600 mgMean age = 59 y. Symptomatic atrial flutter, all pts had negative P waves in leads II, III, and aVF. N/ANSR achieved in Group A-0/6 (no meds)Group B- 4/6 on PPFFlutter CL: propafenone slowed flutter cycle: 219±33 vs. 168±8 msec, p<0.05N/ANSR in Group A vs. Group B (P<0.05).Flutter cycle legth propafenone vs. no meds, p<0.05Propafenone facilitated pace termination in those pts in whom a slowing of flutter CL occurred but not in those w/ unchanged atrial flutter CLEllenbogen KA1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkVsbGVuYm9nZW48L0F1dGhvcj48WWVhcj4xOTk2PC9ZZWFy
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ADDIN EN.CITE.DATA (192)8752805Cardioversion w meds: Randomized to single IV dose Efficacy of IV ibutilide vs. placebo for AF or flutter –dose response study. 200 pts AF or atrial flutter 3H-90 dPts randomized to single IV dose vs. placebo159 randomized to ibutilde:41 at 0.005 mg/kg40 at 0.10 mg/kg38 at 0.015 mg/kg40 at 0.025 mg/kg41 randomized to placeboAF or A flutter 3 h- 90 dChildbearing age, MI <3 m, class I and III antiarrhythmics discontinued for 5 half lives, AF >3 d, anticoags >2 wk before ibutilideConversion to NSR during or w/in 60 min of infusion:24% conversion to NSR in drug treated group vs. 3% in placebo. Conversion rates at successive doses: 12%, 33%, 45%, 46%. Polymorphic VT occurred in 3.6%N/APlacebo and 0.005 mg/kg ibutilide vs. all other groups lower success (p<0.05).No other statisticIbutilide can rapidly terminate AF and flutterStambler BS1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlN0YW1ibGVyPC9BdXRob3I+PFllYXI+MTk5NjwvWWVhcj48
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ADDIN EN.CITE.DATA (193)8840852Multicenter study . Safety and efficacy study Varying doses of ibutilide226133 AF133 atrial flutterRandomized to up to 2 10-min doses Ibutilide separated by 10 min. Ibutilide doses= 1.0 and 0.5 mg or 1.0 and 1.0 mg. This was compared to placebo.AF and atrial flutter.Arrhythmia of 3 h to 45 d durationPt could not be <18 y, weight >300lbs, h/o of torsade, on ibutilide previously, MI, cardiac surgery <30 d, have digoxin toxicity, hyperthyroidism, not on class IConversion rates were:47% w/ ibutilide vs. 2% w/ placebo (p<0.001)Efficacy in flutter >AF: 63% vs. 31%, p<0.001In AF (but not flutter) conversion rates higher in those w/ shorter duration arrhythmiaThe 2 ibutilide dosing regimens did not differ in conversion efficacy (44% vs. 49%).Polymorphic VT in 8.3% (15 pts) (3 required cardioversion, 12 did not)N/AIbutilide vs. placebo (p<0.001)Efficacy in flutter vs. AF: (p<0.001)No difference in conversion at different doses (p=NS)Ibutilide in repeated doses is effective in terminating AF and flutterVolgman AS1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZvbGdtYW48L0F1dGhvcj48WWVhcj4xOTk4PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (194)9581743Cardioversion w meds: Multicenter study- compare efficacy and safety of ibutilide vs. procainamide for conversion of recent onset AF or flutt127Conversion to NSR: randomized to either 2 10 min infusions of 1 mg ibutilide separated by 10 min vs. 3 successive 10 mg- /IV infusions of 400 mg procainamide120 pts eval for efficacy:60 received ibutilide60 received proc(Ibutilide vs. procainamide)2 h to 90 d AF or flutterN/A120 evaluated for efficacy of conversion in 1.5 h:35/60 (58%) ibutilide to NSR11/60 (18.3%) procain converted to NSR (p=0.0001)Flutter- ibutilide significantly more effective than procain (76% 13/17 vs. 4% 3/22; p=0.001.AF- ibutilide significantly more effective than procain (51% 22/43 vs. 21% 8/38; p=0.005.PMVT- 1 pt in ibutilide groupHypotension- 7 pt in procainamide groupN/AIbutilide more successful at conversion n 1.5 h vs. procainamide (p<0.0001)Flutter: ibutlide superior to procain (p=0.001)AF- ibutilide superior to procain (p=0.005Ibutilide was superior to procainamide at converting either AF or flutt. Hypotension was major AE for procainamide. Low incidence of serious proarrhythmia wth ibutilide.Vos MA1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZvczwvQXV0aG9yPjxZZWFyPjE5OTg8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (195)10078083Cardioversion w meds: Randomized to receive one of 2 doses of ibutilde or DL sotalol. To compare safety and efficacy308 pts: 251 AF, 57 atrial flutter. Three treatment groups:99 received 1 mg ibutilide106 received 2 mg ibutilide103 received 1.5 mg/kg DL-SotalolN/AAF or flutter: Duration 3 h - 45 dHyperthyroidism, UA, bronchospasm, MI or cardiac surgery <30 ds, 2 and 3rd degree AV block, BBB, WPW, torsade de pointesConversion to NSR w/in 1 hr of treatment.Both drugs were more effective w/ atrial flutter than fib. Ibutilide was more effective than DL-sotalol achieving SNR in atrial flutter in: 70% and 56% vs. 19%.High dose ibutilide was more effective than DL-Sot in AF (44% vs. 11%) and than low dose ibutilide (44% vs. 20%, p<0.01)Bradycardia (6.5%) and hypotension (3.7%) were more common side effects w/ DL-sotalol. Of 211 pts given ibutilide, two (0.9%) who received the higher dose developed polymorphic VT, one of whom required direct current cardioversionN/AHigh dose I more effective than. DL Sotalol and than low dose I in AF (p<0.01)Ibutilide was more effective than DL sotalol. Duration of atrial flutter or AF was predictor of success.Benditt DG1999 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJlbmRpdHQ8L0F1dGhvcj48WWVhcj4xOTk5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (196)10496434Prospective dose finding studyRandomizedSotalol 80 BID (59) Sotalol 120 BID (63) Sotalol 160 BID (62) Placebo (69) N/A50 pts - outpatient134 pts - inpatientSHD 57%H/o torsade de pointes, CHF, QI >450 msec, hypokalemia, hypomagenesemia, bradycardia. Time to first recurrent symptomatic AF and/or atrial flutter after reaching drug steady state (p=0.004, significant longer time to recurreance for sotalol 120 mg BID vs. placebo)No cases of VT/VF/torsadeQT>520 ms in 7 pts (4 in 120 mg BID and 3 in 160 mg BID)Premature discontinuation due to AEs 25% inpatients, but 6% of outpatients (bradycardia predominantly)N/AN/AIt is unrealistic to define efficacy in tx of AF and atrial flutter.HF pts for AF and atrial flutter not evaluated.Doni F2000PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRvbmk8L0F1dGhvcj48WWVhcj4yMDAwPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (197)170334595Pace termination of atrial flutter via trans esophageal pacing.Randomized to 4 groups ?80Randomized to 4 groups:A) Short bursts (5 sec) atrial pacing w/o drugB) Short bursts (5 sec) atrial pacing after propafenone 600 mgC) Long burst (30 sec) atrial pacing w/o drugD) Long burst (30 sec) atrial pacing after propafenone 600 mgN/AAtrial flutter- new onsetN/ASuccessful flutter pace termination in: 20% 55%50%85% N/AN/A(p<0.05: C vs. A) (p<0.05: D vs. B).(p<0.05: B vs. A and D vs. C)No other stats providedPropafenone + long bursts of atrial pacing was best at terminating atrial flutter?Natale A2000PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk5hdGFsZTwvQXV0aG9yPjxZZWFyPjIwMDA8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (198)10841241Multicenter prospective randomized comparison of antiarrhythmic therapy vs. first-line RF ablation in pts w/ atrial flutter.61Group 1: 30 randomized to drug therapy Group 2: 31 randomized to RFAInclusion: At least two symptomatic episodes of atrial flutter in the last four mo. .Exclusion:1) prior evidence of AF (AF); 2) the presence of significant left atrial enlargement (≥4.5 cm); and 3) previous treatment w/ antiarrhythmic medications1) Rehospitalization: medication group- 63% required one or more rehospitalizations, vs. post-RF ablation, 22% of pts were rehospitalized (p<0.01). 2) Post RF ablation, 29% developed AF vs. 53% of pts receiving medications (p<0.05). 3) Sense of well being (pre-RF 2.0±0.3 vs. post-RF 3.8±0.5, p<0.01) and function in daily life (pre-RF 2.3±0.4 vs. post-RF 3.6±0.6, p<0.01) improved after ablation, but did not change significantly in pts treated w/ drugs.N/AN/A1) Rehospitalization more common w/ meds (p<0.01)2) AF more common post RFA than meds (p<0.05)3) Sense on well being improved w/ RFA but not meds (change in scoe p<0.01)RF ablation could be considered a first-line therapy due to the better success rate and impact on QOL, the lower occurrence of AF and the lower need for rehospitalization at f/u.Delacretaz E2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRlbGFjcmV0YXo8L0F1dGhvcj48WWVhcj4yMDAxPC9ZZWFy
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ADDIN EN.CITE.DATA (199)11345382Ablation: Single center, non-randomized trial comparing ablation of multi IART circuits in adults w/ CHD guided by entrainment mapping w/ and w/o 3D electroananatomic mapping20 pts (47 circuits)To define an approach for mapping and ablation, combining anatomy, activation sequence data and entrainment mapping. a) 7 pts w/ ablation guided by entrainment mapping onlyb)13 pts w/ ablation guided by entrainment and 3D electroanatomic mappingN/ARecurrent IART refractory to meds.Late post repair of CHDOverall 38 (81%) of 47 IARTs successfully ablated. In f/u ranging from 3-46 mo:a)16 (80%) of 20 pts remains free of recurrenceb)Success similar in both groups but fluoroscopy time decreased from 60 +/- 30 to 24 +/- 9 min/procedure w/ addition of 3D electroanatomic mappingN/AN/ANo statistical analysisEntrainment mapping combined w/ 3D electroanatomic mapping allows delineation of complex re-entry circuits and critical isthmuses as targets for RFA as a satisfactory treatment modality for IARTs related to CHD.Delle Karth G2001 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRlbGxlIEthcnRoPC9BdXRob3I+PFllYXI+MjAwMTwvWWVh
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ADDIN EN.CITE.DATA (200)11395591To compare the efficacy of IV diltiazem bolus/infusion vs. IV amiodarone bolus vs. IV amiodarone bolus/infusion for immediate (4 h) and 24-h rate control during AF Randomized prospective, controlledIV diltiazem bolus/infusion vs. IV amiodarone bolus vs. IV amiodarone bolus/infusion N/ACritically ill pts w/ recent-onset AF w/ ventricular rate >120 bpm N/ASustained heart rate reduction ≥30% w/in 4 h 70% vs. 55% vs. 75% Bradycardia or hypotension 35% vs. 0% vs. 5% Uncontrolled tachycardia 0% vs. 45% vs. 5% 1° endpoint: NS 2° endpoint p<0.00016 Safety endpoint p=0.01 The study speaks about rate control during recent AF or atrial flutter in really sick pts.DIAMOND2001 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBlZGVyc2VuPC9BdXRob3I+PFllYXI+MjAwMTwvWWVhcj48
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ADDIN EN.CITE.DATA (201)11457747 RCT, double-blind To evaluate the efficacy of dofetilide to maintain SR in pt w/ LV dysfunction 506 ptsDofetilide 500 mcg/d (249)Placebo (257)Inclusion: Persistent AF associated w/ either HF or recent acute MI Dose reduction for renal insufficiency BBB), K <3.6 or >5.5, CrCl <20 mL/min Exclusion: HR: <50 bpm, QTc >460 msec (500 msec w/Probability of maintaining SR at 1 y 79% dofetilide 42% w/ placebo (p<0.001) No effect on all-cause mortality Dofetilide associated w/ reduced rate of rehospitalization N/ATorsade de pointes occurred in 4 dofetilide pts (1.6%) Subjects not stratified by rhythm. Differences in population, Lft atrial size, LV diastolic dysfunction, and MR could have influenced results.Gallagher MM2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdhbGxhZ2hlcjwvQXV0aG9yPjxZZWFyPjIwMDE8L1llYXI+
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ADDIN EN.CITE.DATA (202)11691530Cardioversion: design a more efficient protocol for the electrical cardioversion of atrial arrhythmias1838 attempts at cardioversion of AF and 678 attempts at cardioversion of flutterAnalyzed the effects of different energy deliveries at terminating either AF or atrial flutter in pts w/ arrhythmias of varying duration.N/AAF or atrial flutter undergoing DC cardioversionN/AConversion rates were:a) AF of >30 d duration = 5.5% at <200 J; 35% at 200 J and 56% at 360 J. b) atrial flutter= 68% at 100 J c) AF of >30 d duration, shocks of <200 J = 6.1% d) AF >180 d= 2.2% at 200 JN/AN/AFor AF >180 d, initial use of a 360 J shock was associated w/ the eventual use of less electrical energy than w/ an initial shock of ≤100 J (581±316 J vs. 758±433 J, p<0.01, Mann-Whitney U test).An initial energy setting of ≥360 J can achieve cardioversion of AF more efficiently in pts than traditional protocols, particularly w/ AF of longer duration.Wazni O2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldhem5pPC9BdXRob3I+PFllYXI+MjAwMzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (203)14610012Randomized study comparing combined pulmonary vein-left atrial junction disconnection and cavotricuspid isthmus ablation vs. pulmonary vein-left atrial junction disconnection alone in pts presenting w/ typical atrial flutter and AF.108Consecutive pts w/ documented symptomatic AF and typical atrial flutter were randomly assigned to have PV-LAJ disconnection combined w/ CTI ablation (group 1, n=49) or PV-LAJ disconnection alone (group 2, n=59).PV-LAJ disconnection combined w/ CTI ablation (group 1, n=49) or PV-LAJ disconnection alonePreablation proof of both atrial flutter and AF on ECG, 1 documented episode of typical atrial flutter while not on antiarrhythmicsN/AW/in the first 8 wk after ablation, 32 of the group 2 pts had typical atrial flutter documented, whereas none was seen in group 1. Twenty of these 32 converted to sinus rhythm after initiating AADs. Twelve were cardioverted, and AADs were started. After 8 wk, all AADs were stopped, and only 3 pts continued to have recurrent sustained typical atrial flutter that was eliminated by CTI ablation. Beyond 8 wk of f/u, 7 pts in group 1 and 6 pts in group 2 (14% and 11%, respectively) continued to have AF. Ten of these 13 pts underwent a repeat PV-LAJ disconnection procedure and were cured. The remaining 3 remained in normal sinus rhythm while taking AADs.N/AN/AN/AIsolating of all 4 pulmonary vs. is challenging. No f/u beyond 1 y. LADIP Trial2006PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRhIENvc3RhPC9BdXRob3I+PFllYXI+MjAwNjwvWWVhcj48
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ADDIN EN.CITE.DATA (204)17030680Randomized study comparing amiodarone and RF ablation after the first episode of symptomatic atrial flutter104 pts w/ atrial flutter:group I= 52 pts treated w/ RFA as 1st lineGroup2 treated w/ cardioversion and amiodarone as 1st line1 episode of symptomatic typical atrial flutterN/ARecurrence of flutter: 3.8% after RFA vs. 29.5% w/ amiodarone and cardioversion; p<0.0001Complications of treatment:Five complications (10%) were noted in group II (SSS in 2, hyperthyroidism in 1, and hypothyroidism in 2) and none in group I (0%) (P=0.03).long-term risk of subsequent AF (AF):25% after RFA vs. 18% after amiodarone and cardioversion (p=NS)RFA reduced recurrences of flutter vs. amiodarone and caridoversion (p<0.0001)RFA not different than amiodarone and cardioversion at occurrence of AF (p=NS). Fewer complications w/ RFA than amiodarone + cardioversion (p=0.03)RFA should be considered first line therapy even after 1 recurrence of atrial flutterKuniss M2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkt1bmlzczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (205) 19959115Prospective randomized comparison of durability ofbidirectional conduction block in the cavotricuspid isthmus inpts after ablation of common atrial flutter usingcryothermy and RF energy: The CRYOTIP study191Cryoablation Do people use this for atrial flutter ablation?Vs. standard RFAInclusion: 1. One episode of ECG-documented typical atrial flutter symptomatic w/ eligibility for ablation treatment2. Age between 18 and 80 y3. Written informed consent for the ablation procedure andthe invasive f/u procedure after 3 mo.Exclusion: atypical flutterAcute success rates: 91% (83/91) in the RF group vs. 89% (80/90) in the cryoablation group (P=NS). Invasive2) f/u 3 mo EP study available for 60 pts in the RF group and 64 pts in cryoablation group. 3) Persistent BCB confirmed in 85% of the RF group vs. 65.6% of the cryoablation group. 4)The primary end-point= nonpersistence of BCB block was seen in 15% of the RF group vs. 34.4% of the cryoablation group (P<0.014). N/ASecondary end-point-pain perception during ablation was significant lower in the cryoablation group (P<0.001)Acute success RFA vs. cryoablation (p=NS)Pesristent BCB- cryoablation inferior to RFA (p<0.014)Persistence of BCB in pts treated w/ cryoablationreinvestigated after 3 mo is inferior to that ptstreated w/ RF ablation, as evidenced by the higher recurrencerate of common atrial flutter seen in this study.Steinwender C2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlN0ZWlud2VuZGVyPC9BdXRob3I+PFllYXI+MjAxMDwvWWVh
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ADDIN EN.CITE.DATA (206)19136164Randomized placebo controlled Trial: Assess pretreatment w/ magnesium for conversion w/ Ibutilide: Randomized 117 pts (58 w/ and 59 w/o pre-injection of magnesium; 65 w/ typical atrial flutter and 52 w/ atrypical atrial flutter. 117- 65 typical flutter; 52 atypical flutter2 randomized groups:Group 1) 4 g of IV magnesiumsulfate Vs. Group 2) placebo immediately before administration of a maximum dose of 2 mg of ibutilide fumarateTypical and atypical atrial flutterN/A1) TAF: pre-injection IV magnesium improved efficacy of ibutilide for conversion (85% w/ magnesium vs. 59% w/ placebo, p=0.017).Atypical atrial flutter: no significant difference in conversion rates between pts receiving magnesium vs. placebo (48% vs. 56%,p=0.189)No effect of magnesium on QTc interval.QTc intervals at 30 min after ibutilitde did not differ between patients w/ and w/o ventricular ectopyN/APreinjcention w/ Mg superior for conversion w/ ibutilide in trypical atrial flutter (p=0.017)Preinjection w/ Mg for conversion w/ ibutilide no different (p=NS)Preinjection wih Mg did not affect QT (no statistic offered)Pre-injection of magnesium significantly enhances the efficacy of ibutilide for the conversion of typical atrial flutter but not of atypical atrial flutter.Bastani H2012PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJhc3Rhbmk8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (207)22927662 Randomized comparison in pts w/ typical atrial flutter. RFA- 3.5 mm open-irrigated-tip catheter and Cryoablation a 9 F, 8 mm tip catheter. Ablation endpoint was bidirectionalCTI block.153Ablation RFA- 3.5 mm open-irrigated-tip catheter (N= 75)Cryoablation a 9 F, 8 mm tip catheter (N=78)Inclusion: Pts w/ a h/o AF included if they had predominant atrial flutter under chronic treatment w/ class I or III antiarrhythmic agents.Exculsion: (i) prior ablation for atrial flutter; (ii) atrial flutter related to recently undergone surgery, hyperthyroidism or other severe disease; (iii) inability to adhere w/ the study protocol; (iv) pregnancy; (v) predominant AF; and (vi) contraindication to warfarin.Primary endpoint: demonstration of long-term efficacydefined as no symptomatic recurrence of atrial flutter at the 6-mo f/u.Success rate at 6-mo f/u was 93% (73 of 78) for Cryoablation vs. 97% (73 of 75) for RF (p= 0.86).safety assessed by the rate of periprocedural complications, procedure and fluoroscopy times, and the level of pain experienced by the pt during the ablation procedureProcedural time was longer in the cryoablation group (152±54 min) than the RF group (116±41 min) (P<0.001). Cryoablation was less painful compared w/ RF (mean VAS-Cryoablation 0.7±1.2 vs. VAS-RF 4.6±2.0; P<0.001). Secondary end-points: acute ablation success defined as bidirectional CTI-block;Acute success rate 92% for cryoablation vs. 95% for RF (p=0.58).1) Acute success rate for Cryoablation vs. RF (p=0.58).2) Procedural time was longer in the Cryoablation group vs. RF group (p<0.001). 3) Cryoablation was less painful compared vs. RF (p<0.001). 4) Success rate at 6-mo f/u was no different for Cryoablation vs. RF (P= 0.86). No major adverse events occurred in any group.Cryoablation is not inferior to RFA for typical flutterMohanty s2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1vaGFudHk8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (208) 23572499Single-blind, randomized study- Examined the impact of different ablation strategies on AF recurrence and QOL in coexistent AF and atrial flutter.360 pts w/ documented AF and atrial flutterBlinded and randomized to group 1, AF±atrial flutter ablation (n=182), or group 2, atrial flutter ablation only (n=178). AF recurrence was evaluated w/ event recording and 7-d Holter at 3, 6, 9, and 12-mo f/us. QOL was assessed at baseline and at the 12-mo f/u w/ 4 questionnaires.AF ± atrial flutter ablation vs. atrial flutter ablation only1 antiarrhythmic and preablation evidence of typical atrial flutter by 12-lead surface ECG.<18 or >85 y old, previous ablation, left atrium size ≥5 cm, or contraindication to oral anticoagulationAt 21±9 mo of f/u, 117 in group 1 (64%) and 34 in group 2 (19%) were arrhythmia free (P<0.001). In group 1, scores on most quality-of-life subscales showed significant improvement at f/u, whereas group 2 pts derived relatively minor benefit.N/AN/AGroup 1 vs. Group 2 p<0.001Questionnaires didn’t address comorbidities, smaller sample sizeAAD, antiarrhythmic drug; AE, adverse events; AF, atrial fibrillation; AMI, acute myocardial infarction; AV, atrioventricular; BBB, bundle branch block; BCB, bidirectional conduction block; bid, two times per day; BP, blood pressure; bpm, beats per min; CHD, congenital heart disease; CHF, congestive heart failure; CI, confidence interval; CL, cycle length; CrCl, creatinine clearance; CTI, cavotricuspid isthmus; DC, direct current; ECG, electrocardiogram; EP, electrophysiological; f/u, follow up; HF, heart failure; h/o, history of; HR, heart rate; IART, intraatrial reentrant tachycardia; IV, intravenous; LBBB, left bundle branch block; LV, left ventricular; MI, myocardial infarction; MR, mitral regurgitation; N/A, not applicable; NS, non-significant; NSR, normal sinus rhythm; NSVT, non-sustatined supraventricular tachycardia; NYHA, New York Heart Association; pt, patient; PV-LAJ, pulmonary vein-left atrial junction; QTc, corrected QT interval; RCT, randomized controlled trial; RF, radiofrequency; RFA, radiofrequency ablation; SBP, systolic blood pressure; SD, standard deviation; SHD, structural heart disease; SR, sinus rhythm; SSS, sick sinus syndrome; SVT, supraventricular tachycardia; TAP, transesophageal atrial pacing; tx, transplant; VAS, visual analog scale; VF, ventricular fibrillation; VT, ventricular tachycardia; w/, with; w/o, without; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 17. Nonrandomized Trials, Observational Studies, and/or Registries of Atrial Flutter – Section 7StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsVan Gelder IC1989PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZhbiBHZWxkZXI8L0F1dGhvcj48WWVhcj4xOTg5PC9ZZWFy
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ADDIN EN.CITE.DATA (181)2511744 Persistent AF and atrial flutter after cardioversion randomized to flecainide or no therapy to reduce recurrence81 pts (16 pts with atrial flutter – 6 in flecainide group and 10 in control group)Inclusion: Persistent AF and atrial flutter referred for cardioversion. All pts w/ atrial flutter received verapamil 240 mg daily to reduce 1:1 AV conduction.Exclusion: <16 y or >80 y, CHF, angina, MI <2 y before, bifascicular block or bundle branch block, sick sinus syndrome without pacemaker, severe systemic diseaseArrhythmia-free survival after cardioversionNo significant difference in arrhythmia free survival. However, it postponed time to arrhythmia recurrence.Adverse effects: 9% flecainide group experience side effects. 3 pts in flecainide group required pacemaker (2 w/ symptomatic sinus arrest and 1 with AV block). 1 pt had increase ventricular ectopy burden requiring discontinuation.No significant difference in arrhythmia free survival in pts w/ persistent AF or atrial flutter. However, it postponed time to arrhythmia recurrence after cardioversion.Pietersen 1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Pietersen</Author><Year>1991</Year><RecNum>633</RecNum><IDText>Usefulness of flecainide for prevention of paroxysmal atrial fibrillation and flutter. Danish-Norwegian Flecainide Multicenter Study Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>633</Ref_ID><Title_Primary>Usefulness of flecainide for prevention of paroxysmal atrial fibrillation and flutter. Danish-Norwegian Flecainide Multicenter Study Group</Title_Primary><Authors_Primary>Pietersen,A.H.</Authors_Primary><Authors_Primary>Hellemann,H.</Authors_Primary><Date_Primary>1991/4/1</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Denmark</Keywords><Keywords>Drug Evaluation</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>prevention & control</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>713</Start_Page><End_Page>717</End_Page><Periodical>Am J Cardiol</Periodical><Volume>67</Volume><Issue>8</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Address>Medical Department B, Rigshospitalet, Copenhagen University, Denmark</Address><Web_URL>PM:1900978</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(209)1900978Randomized, placebo controlled cross over design trial flecainide 150 mg bid vs. placebo. Pts received 3 mo of therapy w/ another 3 mo of crossover therapy.43 ptsInclusion: Paroxysmal AF or atrial flutter >3 episodes <3 mo prior to enrollmentExclusion: CHF, reduced LV fractional shortening, WPW, syncope, thyroid disease, sinus node dysfunction w/o pacer, more than isolated PVC’sNumber of symptomatic recurrencesOutcome: Significant reduction in number of episodes with flecainide treatment (p<0.002).Adverse events: 1 pt developed 1:1 conduction of atrial flutter. 1 sudden death in flecainide group (bathing in the cold Norway sea after drinking alcohol). Other minor adverse events occurred in 74% (mostly visual changes, dizziness, and GI side effects) resulting in 2 withdrawals.Flecainide significantly redcuced the number of recurrent episodes of AF or flutter. Aliot E1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkFsaW90PC9BdXRob3I+PFllYXI+MTk5NjwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (211)8800118Single center trial evaluating efficacy of anatomically based RFA ablation for the treatment of IART in pts w/ previous atrial surgery14 ptsH/o atrial surgery and clinical intraatrial reentrant tachycardiaFreedom from recurrence of IARTSuccessfully terminated in 13 pts (93%). Six pts required repeat ablation for recurrence. Twelve (86%) remained free of IART at 7.5 mo.RFA is effective technique for IART in pts w/ previous atrial surgeryKalman JM1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbG1hbjwvQXV0aG9yPjxZZWFyPjE5OTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (212)8565168Single center observation cohort study to evaluate the success of RFA for IART in CHD using targeted ablation of critical isthmus18 ptsIART and repaired CHDAcute successSuccessful termination in 15 pts (21 arrhythmias). During f/u (mean 17 mo), 11 pts (61%) remained free of recurrence (2 remained on antiarrhythmic drug)Describes early experience w/ targeted RF to critical isthmus in pts w/ repaired CHD. Successful ablation IART can be achieved w/ ablation to critical isthmus of conduction.Triedman1997PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRyaWVkbWFuPC9BdXRob3I+PFllYXI+MTk5NzwvWWVhcj48
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ADDIN EN.CITE.DATA (213)9316535Single center retrospective trial evaluating the short and mid term efficacy of RFA for IART in CHD45 ptsPts w/ CHD w/ IART undergoing RFANon-isthmus dependent flutter instead of IARTFreedom from recurrence of IART73% acutely successful. Recurrence 53% during mean f/u of 17.4 mo. Seven underwent repeat ablation.Early experience w/ RFA for IART in CHD reduced events in population of pts. However, recurrence was frequent often w/ new IART circuits.Huang DT1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkh1YW5nPC9BdXRob3I+PFllYXI+MTk5ODwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (214)9607453Single center trial assessing efficacy of combining pharmacologic and simple ablative therapies in treating AF in small targeted subset of pts13 pts w/ AF who converted to electrocardiographic atrial flutter during anti-arrhythmic treatment“Typical” atrial flutter in 11 pts and “atypical” atrial flutter in 2 suggested by surface ECG.Intracardiac mapping and entrainment studies found 9 pts w/ CCW isthmus dependent atrial flutter and remaining 4 had complex activation patterns.Successful ablation w/o recurrence at mean f/u 14.3±6.9 moAll 9 pts w/ typical atrial flutter had successful ablation and 88.9% maintained sinus rhythm in f/u period (while continued on antiarrhythmic drugs)None of 4 pts w/ complex activation patterns had successful ablationIn pts who experience conversion of AF to typical isthmus dependent flutter during anti-arrhythmic drug therapy, ablation and continuation of pharmacologic therapy is effective in maintaining sinus rhythm.Chan DP2000 ADDIN REFMGR.CITE <Refman><Cite><Author>Chan</Author><Year>2000</Year><RecNum>243</RecNum><IDText>Importance of atrial flutter isthmus in postoperative intra-atrial reentrant tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>243</Ref_ID><Title_Primary>Importance of atrial flutter isthmus in postoperative intra-atrial reentrant tachycardia</Title_Primary><Authors_Primary>Chan,D.P.</Authors_Primary><Authors_Primary>Van Hare,G.F.</Authors_Primary><Authors_Primary>Mackall,J.A.</Authors_Primary><Authors_Primary>Carlson,M.D.</Authors_Primary><Authors_Primary>Waldo,A.L.</Authors_Primary><Date_Primary>2000/9/12</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Child,Preschool</Keywords><Keywords>congenital</Keywords><Keywords>Disease</Keywords><Keywords>Electrophysiology</Keywords><Keywords>etiology</Keywords><Keywords>Heart</Keywords><Keywords>Heart Diseases</Keywords><Keywords>Humans</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Research</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Reprint>Not in File</Reprint><Start_Page>1283</Start_Page><End_Page>1289</End_Page><Periodical>Circulation</Periodical><Volume>102</Volume><Issue>11</Issue><ISSN_ISBN>1524-4539</ISSN_ISBN><Address>Division of Pediatric Cardiology, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA</Address><Web_URL>PM:10982544</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(215)10982544Single center study assessing the importance of atrial flutter isthmus in post-operative IART19 postoperative CHD pts w/ IARTAll study pts underwent EP study w/ entrainment mapping of atrial flutter isthmuses to determine PPIs. RFA performed at identified isthmus to create line of block.Successful ablation 21 IARTS identified in 19 ptsAtrial flutter isthmus part of circuit in 15 of 21 (71.4%)Sites near atrial incisions or suture lines in remaining 6 of 21 Ablation successful in 19 of 21 (90.4%) of IARTs and in 14 of 15 cases of at the atrial flutter isthmus (93.3%)When IART occurs late after repair of CHD, atrial flutter isthmus may be part of reentrant circuit and should be evaluated as a target for ablation. Jais2000 ADDIN REFMGR.CITE <Refman><Cite><Author>Jais</Author><Year>2000</Year><RecNum>247</RecNum><IDText>Mapping and ablation of left atrial flutters</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>247</Ref_ID><Title_Primary>Mapping and ablation of left atrial flutters</Title_Primary><Authors_Primary>Jais,P.</Authors_Primary><Authors_Primary>Shah,D.C.</Authors_Primary><Authors_Primary>Haissaguerre,M.</Authors_Primary><Authors_Primary>Hocini,M.</Authors_Primary><Authors_Primary>Peng,J.T.</Authors_Primary><Authors_Primary>Takahashi,A.</Authors_Primary><Authors_Primary>Garrigue,S.</Authors_Primary><Authors_Primary>Le,Metayer P.</Authors_Primary><Authors_Primary>Clementy,J.</Authors_Primary><Date_Primary>2000/6/27</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Atrial Function,Left</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>France</Keywords><Keywords>Heart Block</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Neural Conduction</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Pulmonary Veins</Keywords><Keywords>Radiosurgery</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>2928</Start_Page><End_Page>2934</End_Page><Periodical>Circulation</Periodical><Volume>101</Volume><Issue>25</Issue><ISSN_ISBN>1524-4539</ISSN_ISBN><Address>Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France</Address><Web_URL>PM:10869265</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(216)10869265Single center retrospective observational trial to assess efficacy of mapping guided RFA22 ptsPts w/ persistent left atrial flutter predominantly in pts w/ SHD. 18 (81%) failed amiodarone.Acute success and mid-term f/uComplete activation map achieved in 17/22 pts. 20 pts (90%) in sinus rhythm at the end of procedure.7 pts required 2 procedures and 1 pt required 3 procedures. During mean 15 mo f/u, 16 pts (73%) remained free of recurrence (2 remained on antiarrhythmic).Describes various left atrial reentrant circuits and demonstrated feasibility of mapping guided RFAReithmann C2000 ADDIN REFMGR.CITE <Refman><Cite><Author>Reithmann</Author><Year>2000</Year><RecNum>250</RecNum><IDText>Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>250</Ref_ID><Title_Primary>Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation</Title_Primary><Authors_Primary>Reithmann,C.</Authors_Primary><Authors_Primary>Hoffmann,E.</Authors_Primary><Authors_Primary>Spitzlberger,G.</Authors_Primary><Authors_Primary>Dorwarth,U.</Authors_Primary><Authors_Primary>Gerth,A.</Authors_Primary><Authors_Primary>Remp,T.</Authors_Primary><Authors_Primary>Steinbeck,G.</Authors_Primary><Date_Primary>2000/4</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Amiodarone</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>chemically induced</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Germany</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>565</Start_Page><End_Page>572</End_Page><Periodical>Eur Heart J</Periodical><Volume>21</Volume><Issue>7</Issue><ISSN_ISBN>0195-668X</ISSN_ISBN><Misc_3>S0195668X99918651</Misc_3><Address>Medizinische Klinik I, Klinikum Grosshadern, Universitat Munchen, Germany</Address><Web_URL>PM:10775011</Web_URL><ZZ_JournalFull><f name="System">European heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(217)10775011Single center trial assessing catheter ablation of CTI on amiodarone-induced atrial flutter and subsequent incidence of AF in comparison to CTI ablation of regular typical atrial flutter92 consecutive pts w/ typical atrial flutter who underwent CTI ablation3 groups28 pts w/o h/o AF10 pts w/ atrial flutter following amiodarone treatment for PAF54 pt w/ AF and atrial flutterSuccessful CTI ablation w/ bidirectional block eliminating atrial flutter and recurrence of AF during mean f/u 8±3 moSuccessful ablation achieved in 90% of amiodarone-treated pt’s and 93% of pts w/o amiodarone therapyRecurrence of AF occurred in 20% amiodarone treated pts which was similar to pts w/o preexisting AF (25%) and markedly lower than pts w/ atrial flutter plus preexisting PAF (76%)CTI ablation w/ bidirectional block and continuation of amiodarone therapy is effective for treatment of atrial flutter due to amiodarone therapy for PAF.Hybrid therapy belongs in this guideline? 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ADDIN EN.CITE.DATA (218)11499727Single center study assessing the coexistence of IART and IDAF in pts w/ SVTs after surgical correction of CHD16 consecutive pts diagnosed w/ both IART and IDAF IART and IDAF diagnosed by standard criteria and entrainment mapping. 7 pts had classic atrial flutter morphology on surface ECG, whereas 9 had atypical morphologySuccessful ablation w/o procedural complication or recurrence at mean f/u of 24 moSuccessful ablation performed in 13 of 14 (93%) IART and 9 of 10 (90%) IDAF circuits.1 IART recurrence otherwise none reported at 24 moSlow conduction zone involved region of right atriotomy scar in 12 of 14 (86%) IART circuitsNo procedural complicationsIDAF and IART are the most common and commonly coexistant mechanisms of atrial re-entrant tachyarrhythmias in pts w/ surgically corrected CHD. Majority of IART circuits involve lateral RA and may be successfully ablated by lesion extending to IVC.Nakagawa2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk5ha2FnYXdhPC9BdXRob3I+PFllYXI+MjAwMTwvWWVhcj48
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ADDIN EN.CITE.DATA (219)11156882Characterize the circuit of IART in pts w/ repaired CHD and evaluate success of RFA of w/in channels defined by electroanatomic mapping13 pts w/ 15 IARTsPts w/ repaired CHD and IARTAcute and medium term successAblation acutely eliminated inducibility of all 15 IARTs. During f/u of median 13.5 mo, 13 pts (81%) remained free of recurrence. Large area of low voltage scar identified in all pts w/ macroreentrant tachycardias.RFA of IART in pts w/ repaired CHD using electroanatomic mapping and targeting channels has a reasonable success rate. Deal BJ2002PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRlYWw8L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (220)12147539Retrospective non-randomized comparison of cryoablation of inferomedial RA vs. extensive modified RA maze in pts undergoing Fontan revision w/ AT23 ptsPts undergoing Fontan revision w/ ATMaybe shouldn’t be in here since surgical; may be more recent papers breaking down the differences by types of CHDInducibility at f/u EP and long-term freedom from recurrence of ATInducibility of AT: 62% inferomedial RA ablation7% modified RA MAZEP<0.02Freedom from AT (mean 43 mo f/u):62% inferomedial RA ablation0% modified RA MAZEP<0.001Modified RA maze procedure is superior to anatomic isthmus block in treating reentrant AT in postoperative Fontan ptsSpector P2010 ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>671</Start_Page><End_Page>677</End_Page><Periodical>Am J Cardiol</Periodical><Volume>104</Volume><Issue>5</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(09)01008-X;10.1016/j.amjcard.2009.04.040</Misc_3><Address>University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA. Peter.Spector@</Address><Web_URL>PM:19699343</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(55)19699343Meta-analysis of ablation of atrial flutter and SVT.A meta-analysis of 21 studies RFA in atrial flutter:18 primary studies w/ 22 treatment arms and 1,323 pts)N/AEvaluate the safety and efficacy of RFA of typical atrial flutter and AV node-dependent SVT in adult ptsSingle-procedure success for atrial flutter was 91.7% (95% CI: 88.4%-94.9%). Multiple-procedure success was 97.0% (95% CI: 94.7%-99.4%). Postablation arrhythmia was noted in 13.2% of pts (95% CI: 7.5%-18.9%), while repeat ablation was reported in 8% (95% CI: 4.5%-11.4%).RFA for the treatment of pts w/ atrial flutter and SVT report high efficacy rates and low rates of complications.70% of pts who got ablation didn’t need it; interrelationship for AF and atrial flutter. When to ablate? discussion. AF ablation covered in consensus document. Drive by protein disulfide isomerase vs. drive by flutter ablation. Both ways. Coffey JO2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNvZmZleTwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (221)23385050Retrospective multicenter cohort study to assess the efficacy of RFA on atypical atrial flutter/AT91 pts w/ 171 ATs (1.9 / pt)Pts w/ atypical atrial flutter/AT in pts w/ prior catheter ablation for AF, MAZE or other cardiac surgery, or idiopathic scar. Pts w/ on CTI-dependent flutter were excluded.Acute and long-term successAcute success was 97% for non-septal AT and 77% for septal AT. Long-term success rates 82% in pts w/ no septal AT and 67% in pts w/ 1 or more septal AT. Long-term success rates were 75%, 88%, and 57% for pts w/ ATs associated w/ prior catheter ablation, cardiac sugery/MAZE or idiopathic scar, respectively.High-density activation mapping combined w/ selective entrainment mapping allows for reasonable successful RFA of non-CTI dependent ATs occurring after AF ablation, cardiac surgery, or in the setting of idiopathic scar.Ghali WA2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Ghali</Author><Year>2005</Year><RecNum>657</RecNum><IDText>Atrial flutter and the risk of thromboembolism: a systematic review and meta-analysis</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>657</Ref_ID><Title_Primary>Atrial flutter and the risk of thromboembolism: a systematic review and meta-analysis</Title_Primary><Authors_Primary>Ghali,W.A.</Authors_Primary><Authors_Primary>Wasil,B.I.</Authors_Primary><Authors_Primary>Brant,R.</Authors_Primary><Authors_Primary>Exner,D.V.</Authors_Primary><Authors_Primary>Cornuz,J.</Authors_Primary><Date_Primary>2005/2</Date_Primary><Keywords>analysis</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Canada</Keywords><Keywords>complications</Keywords><Keywords>Echocardiography</Keywords><Keywords>Electric Countershock</Keywords><Keywords>etiology</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Prognosis</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>Thromboembolism</Keywords><Reprint>Not in File</Reprint><Start_Page>101</Start_Page><End_Page>107</End_Page><Periodical>Am J Med</Periodical><Volume>118</Volume><Issue>2</Issue><ISSN_ISBN>0002-9343</ISSN_ISBN><Misc_3>S0002-9343(04)00687-4;10.1016/j.amjmed.2004.06.048</Misc_3><Address>Department of Medicine, University of Calgary, Alberta, Canada. wghali@ucalgary.ca</Address><Web_URL>PM:15694889</Web_URL><ZZ_JournalFull><f name="System">The American journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(222)Systematic review and meta-analysis of observational studies that investigated risk of thromboembolism associated with atrial flutter.The meta analysis included 13 studies on embolic risk around time of cardioversion that included 1546 patients. For chronic risk, there were 14 studies involving 17,691 patients.MEDLINE, EMBASE, bibliographies, and consultation with clinical experts were used to identify studies that report the risk of thromboembolism associated with attempted cardioversion and longer-term risk in patients with atrial flutter.Risk of thromboembolism associated with atrial flutter around time of cardioversion or over the long term in chronic atrial flutter.Around the time of cardioversion, the risk of thromboembolic events ranged from 0% to 7.3% depending of clinical factors.Lower event rates were observed in patients taking anticoagulants.The long term risk rate of thromboembolism was approximately 3% with sustained atrial flutter.The findings of this systematic review strongly suggest that atrial flutter does indeed impart a risk of thromboembolism. AF indicates atrial fibrillation; AT, atrial tachycardia; AV, atrioventricular; bid, two times per day; CCW, counter-clockwise; CHD, congenital heart disease; CHF, congestive heart failure; CI, confidence interval; CTI, cavotricuspid isthmus; ECG, electrocardiogram; EP, electrophysiological; f/u, follow up; GI, gastrointestinal; h/o, history of; IART, intraatrial reentrant tachycardia; IDAF, isthmus-dependent atrial flutter; IVC, inferior vena cava; LV, left ventricular; MI, myocardial infarction; N/A, not applicable; PAF, paroxysmal atrial fibrillation; PPI, postpacing interval; pt, patient; PVC, premature ventricular contraction; RA, right atrial; RF, radiofrequency; RFA, radiofrequency ablation; SHD, structural heart disease; SVT, supraventricular tachycardia; w/, with; w/o, without; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 18. Randomized Trials for Junctional Tachycardia – Section 8Study Name, Author, YearAim of StudyStudy Type (Size, N)Study Intervention Group (n)Study Comparator Group (n)Pt PopulationEndpointsP Values, OR: HR: RR: & 95% CI:Study Limitations & Adverse EventsInclusion CriteriaExclusion CriteriaPrimary Endpoint (efficacy) and ResultsSafety Endpoint and ResultsSecondary Endpoint and ResultsMamchur SE2012 ADDIN REFMGR.CITE <Refman><Cite><Author>Mamchur</Author><Year>2012</Year><RecNum>94</RecNum><IDText>High-amplitude pace mapping increases safety of radiofrequency catheter ablation of parahisian ectopic foci</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>94</Ref_ID><Title_Primary>High-amplitude pace mapping increases safety of radiofrequency catheter ablation of parahisian ectopic foci</Title_Primary><Authors_Primary>Mamchur,S.E.</Authors_Primary><Authors_Primary>Kurilin,M.Y.</Authors_Primary><Date_Primary>2012/12</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrioventricular Block</Keywords><Keywords>Bundle of His</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Chi-Square Distribution</Keywords><Keywords>complications</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Patient Safety</Keywords><Keywords>physiopathology</Keywords><Keywords>prevention & control</Keywords><Keywords>Recurrence</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Reprint>Not in File</Reprint><Start_Page>1458</Start_Page><End_Page>1463</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>35</Volume><Issue>12</Issue><ISSN_ISBN>1540-8159</ISSN_ISBN><Misc_3>10.1111/j.1540-8159.2012.03515.x</Misc_3><Address>Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation. sergei_mamchur@mail.ru</Address><Web_URL>PM:22978723</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(223)22978723 Assess the risk of AV block during ablation of parahisian ectopic foci prior to ablation by high-amplitude pace mapping. RCT (N=20)Ablation at site where high-amplitude (15-30 mA) pacing revealed absence of His capture (wide QRS complexes) (n=11)Ablation performed in conventional manner (n=9)Pts w/ parahisian ectopic foci (i.e., pts w/ focal JT) Pts w/ SHD Group 1: Ablation (standard approach) effective in 6/11 (55%); Group 2: Ablation effective w/ high amplitude pacing in 9/9 (100%),p=0.02Group 1: 27% AV block; Group 2: no complications,p=0.09Late recurrence of ectopic activity similar in both groups, p=NSGroup 1: Ablation effective in 6/11 (55%); Group 2: Ablation effective in 9/9 (100%),p=0.02. Group 1: 27% AV block; Group 2: no complications,p=0.09. Late recurrence of ectopic activity similar in both groups, p=NS. Small sample, generalizability unclear. Cannot use method for ectopic focus in right coronary sinus or the aorta.AV indicates atrioventricular; NS, non-significant; pt, patient; RCT, randomized controlled trial; SHD, structural heart disease; and w/, with.Data Supplement 19. Nonrandomized Trials, Observational Studies, and/or Registries of Junctional Tachycardia – Section 8StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsPharmacological TherapyRuder1986 ADDIN REFMGR.CITE <Refman><Cite><Author>Ruder</Author><Year>1986</Year><RecNum>310</RecNum><IDText>Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>310</Ref_ID><Title_Primary>Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults</Title_Primary><Authors_Primary>Ruder,M.A.</Authors_Primary><Authors_Primary>Davis,J.C.</Authors_Primary><Authors_Primary>Eldar,M.</Authors_Primary><Authors_Primary>Abbott,J.A.</Authors_Primary><Authors_Primary>Griffin,J.C.</Authors_Primary><Authors_Primary>Seger,J.J.</Authors_Primary><Authors_Primary>Scheinman,M.M.</Authors_Primary><Date_Primary>1986/5</Date_Primary><Keywords>Adult</Keywords><Keywords>analysis</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electric Stimulation</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Exercise</Keywords><Keywords>Female</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Heart Ventricles</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Isoproterenol</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>pharmacology</Keywords><Keywords>physiopathology</Keywords><Keywords>Procainamide</Keywords><Keywords>Propranolol</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>930</Start_Page><End_Page>937</End_Page><Periodical>Circulation</Periodical><Volume>73</Volume><Issue>5</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Web_URL>PM:3698238</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(224)3698238Case reportn=55 adult pts w/ JT (one pt refused drug therapy)Control or eradication of arrhythmiaAll pts responded to beta-blockers (nadolol, propranolol), and best response w/ beta-blockers w/ procainamide.First report of JT in adults. Good response to beta-blockers. Only 4/5 pts underwent EP study to definitively identify junctional origin. Cook1988 ADDIN REFMGR.CITE <Refman><Cite><Author>Cook</Author><Year>1991</Year><RecNum>303</RecNum><IDText>An incessant form of junctional ectopic tachycardia in an adult responsive to a class 1C agent</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>303</Ref_ID><Title_Primary>An incessant form of junctional ectopic tachycardia in an adult responsive to a class 1C agent</Title_Primary><Authors_Primary>Cook,J.R.</Authors_Primary><Authors_Primary>Steinberg,J.S.</Authors_Primary><Date_Primary>1991/11</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Administration,Oral</Keywords><Keywords>Adult</Keywords><Keywords>diagnosis</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Flecainide</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Reprint>Not in File</Reprint><Start_Page>1487</Start_Page><End_Page>1489</End_Page><Periodical>Am Heart J</Periodical><Volume>122</Volume><Issue>5</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Address>Department of Medicine, Columbia-Presbyterian Medical Center, New York, N.Y</Address><Web_URL>PM:1951023</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(225)1951023Case reportn=119 y w/ refractory JTFlecainide therapy for JT refractory to AV nodal blockers, burst atrial or ventricular pacingFlecainide 150 mg bid successful in restoring SRFirst report of successful treatment of “incessant” JT w/ class Ic agent. 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ADDIN EN.CITE.DATA (226)3144166Case seriesn=316 total pts w/ ectopic atrial tachyarrhythmia in study, 2 spontaneous JT (not inducible), 1 incessant JTFlecainide and encainide therapy for JTFlecainide effective in 2 pts w/ spontaneous JT (200 and 300 mg/d). Pt w/ incessant JT had prolongation of H-V interval and hypotension.Encainide arm not valid for guidelines, but flecainide results valid for treatment of spontaneous JT. Builds on Cook’s data above.Villain1990 ADDIN REFMGR.CITE <Refman><Cite><Author>Villain</Author><Year>1990</Year><RecNum>312</RecNum><IDText>Evolving concepts in the management of congenital junctional ectopic tachycardia. A multicenter study</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>312</Ref_ID><Title_Primary>Evolving concepts in the management of congenital junctional ectopic tachycardia. A multicenter study</Title_Primary><Authors_Primary>Villain,E.</Authors_Primary><Authors_Primary>Vetter,V.L.</Authors_Primary><Authors_Primary>Garcia,J.M.</Authors_Primary><Authors_Primary>Herre,J.</Authors_Primary><Authors_Primary>Cifarelli,A.</Authors_Primary><Authors_Primary>Garson,A.,Jr.</Authors_Primary><Date_Primary>1990/5</Date_Primary><Keywords>Amiodarone</Keywords><Keywords>Bundle of His</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>congenital</Keywords><Keywords>Digoxin</Keywords><Keywords>Drug Therapy,Combination</Keywords><Keywords>Echocardiography</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Multicenter Studies as Topic</Keywords><Keywords>Pacemaker,Artificial</Keywords><Keywords>Patients</Keywords><Keywords>Propranolol</Keywords><Keywords>Research</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>1544</Start_Page><End_Page>1549</End_Page><Periodical>Circulation</Periodical><Volume>81</Volume><Issue>5</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Pediatrics, Baylor College of Medicine, Houston, Texas</Address><Web_URL>PM:2184944</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(227)2184944Multicenter study; pediatric population n=26Infants w/ JTAAD therapy in congenital JT, w/ success defined as HR <150 bpm, partial success as HR >150 bpm w/ sx reliefCombinations of digoxin, propranolol, amiodarone, quinidine, flecainide, chlorpromazine, phenytoin. 10 pts treated w/ amiodarone monotherapy —6 successes, 2 partial successes, 2 failures. One death in f/u. Amiodarone combination therapy less effective.Amiodarone monotherapy is effective for congenital JT, but associated w/ some mortality. Authors comment that ablation should be reserved for drug-refractory JT. Digoxin ineffective in rate control, and may be harmful--specifically, incriminated in producing VF in 4 wk old child; and atrial tachycardia and then atrial flutter in 10 d old infant.Paul1992 ADDIN REFMGR.CITE <Refman><Cite><Author>Paul</Author><Year>1992</Year><RecNum>308</RecNum><IDText>Efficacy and safety of propafenone in congenital junctional ectopic tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>308</Ref_ID><Title_Primary>Efficacy and safety of propafenone in congenital junctional ectopic tachycardia</Title_Primary><Authors_Primary>Paul,T.</Authors_Primary><Authors_Primary>Reimer,A.</Authors_Primary><Authors_Primary>Janousek,J.</Authors_Primary><Authors_Primary>Kallfelz,H.C.</Authors_Primary><Date_Primary>1992/10</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>congenital</Keywords><Keywords>diagnosis</Keywords><Keywords>Drug Evaluation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrocardiography,Ambulatory</Keywords><Keywords>epidemiology</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Germany</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Propafenone</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Safety</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Time Factors</Keywords><Reprint>Not in File</Reprint><Start_Page>911</Start_Page><End_Page>914</End_Page><Periodical>J Am Coll Cardiol</Periodical><Volume>20</Volume><Issue>4</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Misc_3>0735-1097(92)90192-P</Misc_3><Address>Children's Hospital, Hannover Medical School, Germany</Address><Web_URL>PM:1527301</Web_URL><ZZ_JournalFull><f name="System">Journal of the American College of Cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Am Coll Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(228)1527301Case series; pediatric populationn=4Infants w/ congenital JTPropafenone therapy for congenital JTEffective at restoring SR w/ doses of 300 mg/m2 w/ f/u ranging 1-36 moEfficacy of propafenone in pediatric population can avoid need for ablation in young population, and early toxicity of amiodarone.Heusch 1994PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhldXNjaDwvQXV0aG9yPjxZZWFyPjE5OTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (91)7527342Retrospective cohort study; pediatric populationn=372 pediatric pts w/ supraventricular arrhythmias treated w/ propafenone, only 3 pts had JTEfficacy of propafenone in suppressing supraventricular arrhythmiaSuccessful in 2/3 pts w/ JTSupports results of Paul et al for use of propafenone, despite small subset of pts w/ JT.Raja P1994PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlJhamE8L0F1dGhvcj48WWVhcj4xOTk0PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (229)7946778 Retrospective cohort study; pediatric populationn=16Postoperative (CHD) JETEfficacy of amiodarone for rate controlMean HR of 200 bpm, reduced to mean 153-170 in 24-h f/uAmiodarone effective in HR and hemodynamic control for postoperative JT.Lee1999PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxlZTwvQXV0aG9yPjxZZWFyPjE5OTk8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (230)10392383Prospective cohort studyn=17 (age 12-83)Pts developed JT during EP study, and all inducible w/ isoproterenolEffect of adenosine and verapamil in catecholamine-inducible JTAdenosine terminated rhythm in all pts, 11 w/ transient AV block. IV verapamil terminated rhythm in all 10 pts given the drugSupports treatment of JT due to enhanced automaticity w/ adenosine and verapamil. Presence of AV block w/ adenosine suggests differential effect on automaticity and AV conduction. Age range spans pediatric and adult. Sarubbi 2002 ADDIN REFMGR.CITE <Refman><Cite><Author>Sarubbi</Author><Year>2002</Year><RecNum>311</RecNum><IDText>Congenital junctional ectopic tachycardia in children and adolescents: a 20 year experience based study</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>311</Ref_ID><Title_Primary>Congenital junctional ectopic tachycardia in children and adolescents: a 20 year experience based study</Title_Primary><Authors_Primary>Sarubbi,B.</Authors_Primary><Authors_Primary>Musto,B.</Authors_Primary><Authors_Primary>Ducceschi,V.</Authors_Primary><Authors_Primary>D'Onofrio,A.</Authors_Primary><Authors_Primary>Cavallaro,C.</Authors_Primary><Authors_Primary>Vecchione,F.</Authors_Primary><Authors_Primary>Musto,C.</Authors_Primary><Authors_Primary>Calabro,R.</Authors_Primary><Date_Primary>2002/8</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Amiodarone</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Cardiology</Keywords><Keywords>Child</Keywords><Keywords>congenital</Keywords><Keywords>Digoxin</Keywords><Keywords>drug therapy</Keywords><Keywords>Drug Therapy,Combination</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Italy</Keywords><Keywords>Male</Keywords><Keywords>Propafenone</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>188</Start_Page><End_Page>190</End_Page><Periodical>Heart</Periodical><Volume>88</Volume><Issue>2</Issue><User_Def_5>PMC1767240</User_Def_5><ISSN_ISBN>1468-201X</ISSN_ISBN><Address>Second University of Naples, Division of Paediatric Cardiology, Monaldi Hospital, Naples, Italy. bsarubb@tin.it</Address><Web_URL>PM:12117855</Web_URL><ZZ_JournalFull><f name="System">Heart (British Cardiac Society)</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Heart</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(231)12117855Retrospective cohort studyn = 9, age 2-6 mo5/9 pts w/ family h/o JT; 6/9 w/ decreased ventricular functionEffects of digoxin, propafenone, amiodaroneDigoxin alone ineffective; propafenone alone effective in 2/9 pts; amiodarone in combination w/ propafenone or flecainide effective in 6 ptsDigoxin or propafenone alone ineffective; Amiodarone effective as part of combination therapy w/ propafenone; or flecainide; genetic contribution noted. Ablation TherapyScheinman MM1994 ADDIN REFMGR.CITE <Refman><Cite><Author>Scheinman</Author><Year>1994</Year><RecNum>99</RecNum><IDText>Clinical and electrophysiologic features and role of catheter ablation techniques in adult patients with automatic atrioventricular junctional tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>99</Ref_ID><Title_Primary>Clinical and electrophysiologic features and role of catheter ablation techniques in adult patients with automatic atrioventricular junctional tachycardia</Title_Primary><Authors_Primary>Scheinman,M.M.</Authors_Primary><Authors_Primary>Gonzalez,R.P.</Authors_Primary><Authors_Primary>Cooper,M.W.</Authors_Primary><Authors_Primary>Lesh,M.D.</Authors_Primary><Authors_Primary>Lee,R.J.</Authors_Primary><Authors_Primary>Epstein,L.M.</Authors_Primary><Date_Primary>1994/9/15</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Carotid Sinus</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Isoproterenol</Keywords><Keywords>Male</Keywords><Keywords>Massage</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>physiopathology</Keywords><Keywords>Prospective Studies</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Reprint>Not in File</Reprint><Start_Page>565</Start_Page><End_Page>572</End_Page><Periodical>Am J Cardiol</Periodical><Volume>74</Volume><Issue>6</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>0002-9149(94)90745-5</Misc_3><Address>Department of Medicine, University of California, San Francisco 94143-1354</Address><Web_URL>PM:8074039</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(232)8074039Case seriesn=8Adult pts w/ JTRFA of JT6/8 w/ JT underwent ablation, 2 underwent AVJ ablation. 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ADDIN EN.CITE.DATA (233)8960595 Case seriesn=11Pts w/ JT (age 1-66)RFA of JTRFA successful w/o complications in 9/11 pts (82%). 7/9 successful w/ ablation at site of earliest atrial activation and 2 pts required empiric lesions in posteroseptal area due to lack of VA conduction. CHB developed in 1 pt, and RFA failed in 1 pt. F/u 1-20 mo.RF ablation a largely successful strategy in series of pts, half of which were adults. Law IH2006 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxhdzwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (234)16876738Retrospective cohort study; pediatric population n=6 (range 7-36 y, median 8 y)All pts who underwent cryoablation for symptomatic, non-postoperative JT, refractory to AADs (primarily beta-blockers), at 2 hospitals.Efficacy and safety of cryoablation for JT4 pts had no JT at end of procedure. All 5 pts who underwent procedure were free of JT on up to 2 y of f/u.Early report of cryoablation of JT, safe and effective (except w/ proximity to His-Purkinje system), and may confer long term benefit. This study studied a small number of primarily pediatric pts at two institutions. Pharmacologic therapy not attempted in all pts. One pt had an ectopic focus proximal to His-Purkinje, and cryomapping resulted in transient CHB, so cryoablation not performed.EP Study DiagnosisMeiltz A2006 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1laWx0ejwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (235)16627404 Retrospective cohort, multicentern=49Adults w/ PJRT confirmed at EP study, both paroxysmal (53%) and incessantDescribe results of RFA in adults w/ PJRTRFA successful in 94% w/o complications, and long term success 100% w/o AADs, w/ 49 mo mean f/u. Rare report of PJRT in adults only, so results pertinent to guidelines, and support RF ablation as first line therapy. Padanilam BJ2006 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhZGFuaWxhbTwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+
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ADDIN EN.CITE.DATA (236)19007691Prospective cohort studyn=39Adults w/ AVNRT, JT, or “clinically indeterminate.” To distinguish JT or AVNRT based on specific responses to PACs delivered at different phases of the tachycardia cyclePACs introduced during His refractoriness did not affect tachycardia. Earlier PACs preexcite the immediate His and ventricle, w/o terminating tachycardia, confirming JT. For AVNRT, 61% sensitivity, 100% specificity; for JT, 100% sensitivity and specificity.The response to PACs during tachycardia can distinguish JT from AVNRT w/ 100% specificity and high sensitivity. However, PACs introduced during His refractoriness can lead to misdiagnosis of JT as AVNRT if dual AV nodal physiology is present. Furthermore, if double ventricular responses are present, a PAC during AVNRT can advance the His w/ continuation of the tachycardia, misdiagnosed as JT.Srivathsan K2007 ADDIN REFMGR.CITE <Refman><Cite><Author>Srivathsan</Author><Year>2008</Year><RecNum>105</RecNum><IDText>Differentiating atrioventricular nodal reentrant tachycardia from junctional tachycardia: novel application of the delta H-A interval</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>105</Ref_ID><Title_Primary>Differentiating atrioventricular nodal reentrant tachycardia from junctional tachycardia: novel application of the delta H-A interval</Title_Primary><Authors_Primary>Srivathsan,K.</Authors_Primary><Authors_Primary>Gami,A.S.</Authors_Primary><Authors_Primary>Barrett,R.</Authors_Primary><Authors_Primary>Monahan,K.</Authors_Primary><Authors_Primary>Packer,D.L.</Authors_Primary><Authors_Primary>Asirvatham,S.J.</Authors_Primary><Date_Primary>2008/1</Date_Primary><Keywords>diagnosis</Keywords><Keywords>Diagnosis,Differential</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Isoproterenol</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Reproducibility of Results</Keywords><Keywords>Sensitivity and Specificity</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Reprint>Not in File</Reprint><Start_Page>1</Start_Page><End_Page>6</End_Page><Periodical>J Cardiovasc Electrophysiol.</Periodical><Volume>19</Volume><Issue>1</Issue><ISSN_ISBN>1540-8167</ISSN_ISBN><Misc_3>JCE961;10.1111/j.1540-8167.2007.00961.x</Misc_3><Address>Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA</Address><Web_URL>PM:17916156</Web_URL><ZZ_JournalFull><f name="System">Journal of cardiovascular electrophysiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Cardiovasc Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(237)17916156Retrospective cohort studyn=35Typical AVNRT and evidence of JT during EP study and/or ablationTo assess the utility of delta H-A interval (difference in the H-A intervals observed during tachycardia and basal RV pacing to differentiate AVNRT and JT—delta HA = HA during pacing minus HA during tachycardia. (Helps to distinguish whether H-A interval represents true his conduction to the atria, or whether atria and His activated simultaneously from common focal source.)Average H-A interval was -10 msec during AVNRT and 9 msec during JT (p<0.00001). Delta HA ≥0 has sensitivity/specificity of 89%/83%, PPV/NPV 84%/88% for diagnosis of JT.Delta HA is a useful metric that can aid differentiation of AVNRT and JT during EP study. Utility in that JT ablation confers high risk of AV block. Limited in that spontaneous JT may be mechanistically different from JT seen w/ slow path modification. Fan R2011 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkZhbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (238)21220046 Prospective cohort studyn=21Adult pts referred to a single center for EP study and subsequent AVNRT ablation.To investigate whether the tachycardia response to atrial overdrive pacing at a CL shorter than the tachycardia CL can elucidate whether the tachycardia is JT or AVNRT. The paced AH interval was shorter for JT compared w/ AVNRT (86±19 msec vs. 338±59 msec, p<0.0001).The mean CL of JT longer compared w/ AVNRT (614±118 msec vs. 373±65 msec, p<0.0001)Atrial overdrive pacing during tachycardia can help to rapidly differentiate JT from AVNRT (transiently suppresses JT, entrains AVNRT). Diagnosis of JT made on clinical grounds, although JT only observed post-ablation. Potential for misdiagnosis of AVNRT as JT. Included only spontaneous JT after AVNRT ablation (excluded “clinical” JT, i.e. not due to AVNRT ablation).AAD indicates antiarrhythmic drug; AV, atrioventricular; AVJ, atrioventricular junction; AVNRT, atrioventricular nodal reentrant tachycardia; bid, two times per day; bpm, beats per min; CHB, complete heart block; CHD, congenital heart disease; CL, cycle length; EP, electrophysiological; f/u, follow up; h/o, history of; HR, heart rate; IV, intravenous; JET, junctional ectopic tachycardia; JT, junctional tachycardia; NPV, negative predictive value; PAC, premature atrial contractions; PJRT, permanent junctional reciprocating tachycardia; PPV, positive predictive value; pt, patient; RFA, radiofrequency ablation; SR, sinus rhythm; sx, symptom; VA, ventriculoatrial; VF, ventricular fibrillation; w/, with; and w/o, without. Data Supplement 20. Nonrandomized Trials, Observational Studies, and/or Registries of Special Populations – Section 9StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsPediatrics: Epidemiology Lundberg A1982 ADDIN REFMGR.CITE <Refman><Cite><Author>Lundberg</Author><Year>1982</Year><RecNum>255</RecNum><IDText>Paroxysmal atrial tachycardia in infancy: long-term follow-up study of 49 subjects</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>255</Ref_ID><Title_Primary>Paroxysmal atrial tachycardia in infancy: long-term follow-up study of 49 subjects</Title_Primary><Authors_Primary>Lundberg,A.</Authors_Primary><Date_Primary>1982/10</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>congenital</Keywords><Keywords>diagnosis</Keywords><Keywords>Disease</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Male</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>Time Factors</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>638</Start_Page><End_Page>642</End_Page><Periodical>Pediatrics</Periodical><Volume>70</Volume><Issue>4</Issue><ISSN_ISBN>0031-4005</ISSN_ISBN><Web_URL>PM:7122164</Web_URL><ZZ_JournalStdAbbrev><f name="System">Pediatrics</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(239)7122164Retrospective, single center4949 babies SVT in infancy, 40 SVT, 9 atrial flutter/AF 86% malesF/u mean 24 ySVT recurrence after infancyMales w/ WPW: 60% recurrence. Pts w/o WPW: 30% recurrenceRecurrent SVT after infant SVT: 30-60%Deal BJ1985PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRlYWw8L0F1dGhvcj48WWVhcj4xOTg1PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (240)3964800Retrospective multicenter9090 babies WPW and SVT ≤4 mo of age. SHD 20%. AVRT, one atrial flutter, no AF. Mean f/u 6.5 y. WPW outcomes infants w/ SVTCardioversion success 87%, chronic digoxin 85 pts. Deaths: 4.4%, 2 w/o SHD: all receiving digoxin. One no SHD developed cardiomyopathy thought due to recurrent high dose cardioversions. Mortality 4.4%, (2 no SHD), all receiving digoxin. 1/3 pts developing wide QRS tachycardia died. Perry JC 1990PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBlcnJ5PC9BdXRob3I+PFllYXI+MTk5MDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (242)7850817Retrospective, single center9090 pts w/ SVT <15 y old, median f/u 215 mo. CHF 16%. Stroke 1 pt.Recurrent SVT vs. age onset SVTSVT age 1-5 y: 40% recurrent SVT prenatal SVT lowest risk recurrent SVT, followed by age <1 y, then 1-5 y; onset >5 y highest risk. First SVT ≥5 y: highest risk for recurrent SVT vs. age 1-5 y, or age <1 y Riggs TW 1999 ADDIN REFMGR.CITE <Refman><Cite><Author>Riggs</Author><Year>1999</Year><RecNum>257</RecNum><IDText>Recurrence risk of supraventricular tachycardia in pediatric patients</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>257</Ref_ID><Title_Primary>Recurrence risk of supraventricular tachycardia in pediatric patients</Title_Primary><Authors_Primary>Riggs,T.W.</Authors_Primary><Authors_Primary>Byrd,J.A.</Authors_Primary><Authors_Primary>Weinhouse,E.</Authors_Primary><Date_Primary>1999</Date_Primary><Keywords>Adolescent</Keywords><Keywords>analysis</Keywords><Keywords>Cardiology</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>diagnosis</Keywords><Keywords>Electrocardiography,Ambulatory</Keywords><Keywords>epidemiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Male</Keywords><Keywords>Michigan</Keywords><Keywords>Odds Ratio</Keywords><Keywords>Patients</Keywords><Keywords>Pregnancy</Keywords><Keywords>Recurrence</Keywords><Keywords>Regression Analysis</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>Survival Analysis</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>25</Start_Page><End_Page>30</End_Page><Periodical>Cardiology</Periodical><Volume>91</Volume><Issue>1</Issue><ISSN_ISBN>0008-6312</ISSN_ISBN><Misc_3>6873;6873</Misc_3><Address>Department of Cardiology, University of Michigan Medical School, Ann Arbor, Mich., USA</Address><Web_URL>PM:10393395</Web_URL><ZZ_JournalStdAbbrev><f name="System">Cardiology</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(243)10393395Retrospective, single center7070 pediatric pts w/ SVT, vs. WPW and age.Recurrent SVT: 29% w/ SVT <1 y, vs. 94% w/ SVT onset >1 y. Risk recurrent SVT in young ptsOnly sig predictor of recurrent SVT was age at presentationWPW not significant multivariate. 11First SVT after age 1 y: high likelihood recurrent SVT vs. onset SVT <1 y (OR: 34.6). Tortoriello TA2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRvcnRvcmllbGxvPC9BdXRob3I+PFllYXI+MjAwMzwvWWVh
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ADDIN EN.CITE.DATA (245)18489621 Retrospective, single center109109 pts SVT <30 d, 1971-1997. SVT = AVRT or AVNRTOutcomes neonatal SVTFreedom from arrhythmia: 52% 1 y, 82% 5 y, 83% 10 y. Recurrence 31% WPW vs. 6% no overt WPW. Mortality 2.7% related to arrhythmia/CHF. Recurrences higher overt WPW, multiple meds, or >6 d to obtain initial arrhythmia control. Santinelli V2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNhbnRpbmVsbGk8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFy
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ADDIN EN.CITE.DATA (246)19147045Prospective, single center1841995-2005, 184 pts ≤12 y (median 10 y, 8-12 y) w/ asymptomatic WPW evaluated and followed, median 57 mo. Natural h/o asymptomatic WPW in children 72% remained asymptomatic. 28% sxs: 10% considered “POTS life-threatening”: cardiac arrest 1.6%; Syncope 1.6%Cardiac arrest 1.6%Multivariate risk: APERP ≤240 msec (p=.001)And multiple AC (p= .001)Salerno JC2011 ADDIN REFMGR.CITE <Refman><Cite><Author>Salerno</Author><Year>2011</Year><RecNum>258</RecNum><IDText>Case fatality in children with supraventricular tachycardia in the United States</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>258</Ref_ID><Title_Primary>Case fatality in children with supraventricular tachycardia in the United States</Title_Primary><Authors_Primary>Salerno,J.C.</Authors_Primary><Authors_Primary>Garrison,M.M.</Authors_Primary><Authors_Primary>Larison,C.</Authors_Primary><Authors_Primary>Seslar,S.P.</Authors_Primary><Date_Primary>2011/7</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>analysis</Keywords><Keywords>Cardiomyopathies</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>diagnosis</Keywords><Keywords>Disease</Keywords><Keywords>epidemiology</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Hospitalization</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Prognosis</Keywords><Keywords>Regression Analysis</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>United States</Keywords><Keywords>Young Adult</Keywords><Reprint>Not in File</Reprint><Start_Page>832</Start_Page><End_Page>836</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>34</Volume><Issue>7</Issue><ISSN_ISBN>1540-8159</ISSN_ISBN><Misc_3>10.1111/j.1540-8159.2011.03073.x</Misc_3><Address>Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington 98105, USA. jack.salerno@</Address><Web_URL>PM:21418251</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(247) HYPERLINK "" 21418251Retrospective multi-center review1755Reviewed hospital databases 41 children’s hospitals between 1/03-9/08Discharge dx SVT, age <25 y Case fatalityOverall 68 deaths (4%)6% w/ SHD died vs. 1% of pts w/o SHDCase fatality increased in:Age <1 mo, OR: 2.41 (95% CI: 1.35-4.32)SHD, OR: 2.67 (95% CI: 1.22-5.80)Cardiomyopathy, OR: 6.72 (95% CI: 1.79-25.28) regardless of SHDCase fatality in absence of SHD is low, 1%, Vs. 6% in presence of SHDCase fatality highest in cardiomyopathy regardless of presence of SHDCain N2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Cain</Author><Year>2013</Year><RecNum>30</RecNum><IDText>Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>30</Ref_ID><Title_Primary>Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood</Title_Primary><Authors_Primary>Cain,N.</Authors_Primary><Authors_Primary>Irving,C.</Authors_Primary><Authors_Primary>Webber,S.</Authors_Primary><Authors_Primary>Beerman,L.</Authors_Primary><Authors_Primary>Arora,G.</Authors_Primary><Date_Primary>2013/10/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Asymptomatic Diseases</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>complications</Keywords><Keywords>Death,Sudden,Cardiac</Keywords><Keywords>diagnosis</Keywords><Keywords>Disease Progression</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Male</Keywords><Keywords>mortality</Keywords><Keywords>physiopathology</Keywords><Keywords>Remission,Spontaneous</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>961</Start_Page><End_Page>965</End_Page><Periodical>Am J Cardiol</Periodical><Volume>112</Volume><Issue>7</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(13)01233-2;10.1016/j.amjcard.2013.05.035</Misc_3><Address>Medical University of South Carolina, Charleston, South Carolina. Electronic address: cainn@musc.edu</Address><Web_URL>PM:23827401</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(21)23827401Retrospective, single center446446 pts WPW; median age dx 7 y, 61% male, 9% SHD. Presentation: 64% w/ sxs--SVT 38%; chest pain or palps 27%; syncope 4%, AF 0.4%; cardiac arrest 0.2%. Natural h/o WPWDuring f/u: additional 20% developed sx. 54% SVT, AF 1.6%. Pts dx ≤3 mo, 35% WPW resolved, vs. 5.8% dx >3 mo. Sudden death 1.3%, 2.8/1000 pt y. Sudden death: 1.3%No heart disease: 1.1/1000 pt ySHD: 27/1000 pt y.Pediatrics: Mechanisms of SVTGarson A 1981 ADDIN REFMGR.CITE <Refman><Cite><Author>Garson</Author><Year>1981</Year><RecNum>264</RecNum><IDText>Electrophysiologic studies of supraventricular tachycardia in children. I. Clinical-electrophysiologic correlations</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>264</Ref_ID><Title_Primary>Electrophysiologic studies of supraventricular tachycardia in children. I. Clinical-electrophysiologic correlations</Title_Primary><Authors_Primary>Garson,A.,Jr.</Authors_Primary><Authors_Primary>Gillette,P.C.</Authors_Primary><Date_Primary>1981/8</Date_Primary><Keywords>abnormalities</Keywords><Keywords>Adolescent</Keywords><Keywords>Atrioventricular Node</Keywords><Keywords>Catheterization</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>complications</Keywords><Keywords>congenital</Keywords><Keywords>diagnosis</Keywords><Keywords>Digoxin</Keywords><Keywords>Disease</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Heart</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Defects,Congenital</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prognosis</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Sinoatrial Node</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>233</Start_Page><End_Page>250</End_Page><Periodical>Am Heart J</Periodical><Volume>102</Volume><Issue>2</Issue><ISSN_ISBN>0002-8703</ISSN_ISBN><Misc_3>S0002-8703(81)80015-4</Misc_3><Web_URL>PM:7258098</Web_URL><ZZ_JournalFull><f name="System">American heart journal</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am Heart J</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(248)7258098Retrospective, single center103Intracardiac EP study in pts 2 d-17 y, mean 4.2 y. Determine mechanisms of SVT in young pts w/ clinical SVTAVRT 50%, AVNRT 24%, AT 21%55% of AP tachycardia w/ manifest WPWPredominance of AP mediated tachycardia in young pts Ko JK1992 ADDIN REFMGR.CITE <Refman><Cite><Author>Ko</Author><Year>1992</Year><RecNum>266</RecNum><IDText>Supraventricular tachycardia mechanisms and their age distribution in pediatric patients</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>266</Ref_ID><Title_Primary>Supraventricular tachycardia mechanisms and their age distribution in pediatric patients</Title_Primary><Authors_Primary>Ko,J.K.</Authors_Primary><Authors_Primary>Deal,B.J.</Authors_Primary><Authors_Primary>Strasburger,J.F.</Authors_Primary><Authors_Primary>Benson,D.W.,Jr.</Authors_Primary><Date_Primary>1992/4/15</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Age Distribution</Keywords><Keywords>Age Factors</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>Disease</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Male</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Probability</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>1028</Start_Page><End_Page>1032</End_Page><Periodical>Am J Cardiol</Periodical><Volume>69</Volume><Issue>12</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Address>Department of Pediatrics, Northwestern University Children's Memorial Hospital, Chicago, Illinois</Address><Web_URL>PM:1561973</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(249)1561973Retrospective, single center137EP study (TEP 110, intracardiac 14, both 13) performed in pts <18 y of age, excluding significant heart disease or neuromuscular disordersDetermine mechanism of SVT in young pts w/ clinical SVTAVRT 73%, AT 14%, AVNRT 13%.AVNRT rarely present <2 y of age; AVRT and AT occurred throughout childhoodWeindling SN1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldlaW5kbGluZzwvQXV0aG9yPjxZZWFyPjE5OTY8L1llYXI+
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ADDIN EN.CITE.DATA (250)8554021Retrospective, single center112SVT in infants, 7/85-3/93. Mechanism of SVT in infants w/ SVTAVRT 77%, AVNRT 9%, Atrial reentry 10%, ectopic atrial 4%. 106 pts treated: 70% digoxin, propranolol, or both, Class I or III used in 12% each. 8% ablation failed med rx: 1/9 died related to ablation (VF after discharge). Overall mortality 4.4%, 4/5 w/ SHD. Ablation for medically refractory SVT. Neonate w/o SHD died related to complications of ablation.Recommends ablation for rare infants: fail aggressive med rx, rx comp by ventricular dysfunction, severe sx, complex SHD. Gross GJ 1998 ADDIN REFMGR.CITE <Refman><Cite><Author>Gross</Author><Year>1998</Year><RecNum>265</RecNum><IDText>Characteristics, management, and midterm outcome in infants with atrioventricular nodal reentry tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>265</Ref_ID><Title_Primary>Characteristics, management, and midterm outcome in infants with atrioventricular nodal reentry tachycardia</Title_Primary><Authors_Primary>Gross,G.J.</Authors_Primary><Authors_Primary>Epstein,M.R.</Authors_Primary><Authors_Primary>Walsh,E.P.</Authors_Primary><Authors_Primary>Saul,J.P.</Authors_Primary><Date_Primary>1998/10/15</Date_Primary><Keywords>Adrenergic beta-Antagonists</Keywords><Keywords>Adult</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Boston</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Digoxin</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart Defects,Congenital</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>956</Start_Page><End_Page>960</End_Page><Periodical>Am J Cardiol</Periodical><Volume>82</Volume><Issue>8</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>S0002-9149(98)00512-8</Misc_3><Address>Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</Address><Web_URL>PM:9794351</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(251)9794351Retrospective, single center15Infants AVNRT <1 y mean age 58 d, 5/15 after CHD palliation. Typical AVNRT 14/15. Mean f/u 45 mo. Outcome of AVNRT in first y of lifeDigoxin: 87%, successful 38%. 40% digoxin + propranolol, successful 4/6. Class III in 3 pts: 2/3 RFA: ages 4.1 and 6.7 y. All pts alive and well, minority syx beyond infancy. Digoxin questionalble benefit. AVNRT remained inducible in asymptomatic pts. Anand RG2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkFuYW5kPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (252)19925541Retrospective, multicenter3556Registry of pediatric EP reviewed for pts undergoing ablation for SVT between 1999-2004.Ages <7 y: 378; 7-12: 964; 12-21 y: 2214; males 55%; white 82%Assess influence of age, gender, ethnicity on SVTAP: 68%; decreased w/ increasing ageAVNRT 32%In age 12-21 y, females more likely to have AVNRT than APBlack and Hispanic pts had less SVT than representation in population; whites more SVT than population. Proportion of SVT due to AP decreases w/ increasing age.After age 12 y, females more likely to have AVNRT than males. More whites in registry than expected based on population. Brembilla Perrot2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJyZW1iaWxsYS1QZXJyb3Q8L0F1dGhvcj48WWVhcj4yMDEz
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ADDIN EN.CITE.DATA (253)23609066Retrospective, single center140Sxs of palpitations/SVT w/ normal ECG, underwent transesophageal pacing. Mean age 15±3 yUtility of TEP to identify SVT in pts w/o preexcitation59% AVNRT, AVRT 37%, AT 0.7%, VT 3%. High risk antegrade conduction over AP >240 bpm baseline or >290 bpm isoproterenol found in 1.4%.Preexcitation found in 13.5% w/ atrial pacing. Pediatrics: SVT Pharmacological TherapyPfammatter JP1998 ADDIN REFMGR.CITE <Refman><Cite><Author>Pfammatter</Author><Year>1998</Year><RecNum>272</RecNum><IDText>Re-entrant supraventricular tachycardia in infancy: current role of prophylactic digoxin treatment</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>272</Ref_ID><Title_Primary>Re-entrant supraventricular tachycardia in infancy: current role of prophylactic digoxin treatment</Title_Primary><Authors_Primary>Pfammatter,J.P.</Authors_Primary><Authors_Primary>Stocker,F.P.</Authors_Primary><Date_Primary>1998/2</Date_Primary><Keywords>analysis</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Cardiology</Keywords><Keywords>complications</Keywords><Keywords>Digoxin</Keywords><Keywords>Disease</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Defects,Congenital</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Male</Keywords><Keywords>Patients</Keywords><Keywords>prevention & control</Keywords><Keywords>Recurrence</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Treatment Failure</Keywords><Keywords>Treatment Outcome</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>101</Start_Page><End_Page>106</End_Page><Periodical>Eur J Pediatr.</Periodical><Volume>157</Volume><Issue>2</Issue><ISSN_ISBN>0340-6199</ISSN_ISBN><Address>Paediatric Cardiology, Children's Hospital, Freiburgstrasse, Berne, Switzerland</Address><Web_URL>PM:9504781</Web_URL><ZZ_JournalFull><f name="System">European journal of pediatrics</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur J Pediatr.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(254)9504781Retrospective single center26SVT in infants <4 mo of ageMean age presentation 7 dSHD 31%; WPW 35%All AVRTDigoxin for neonatal SVTDigoxin successful: 65%Failure 27%Mean f/u 54 mo, 73% no meds no recurrences; 8% recurrent SVTDigoxin success 65%73% no early recurrences8% symptomatic recurrencesVillain E 1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZpbGxhaW48L0F1dGhvcj48WWVhcj4xOTk4PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (256)9922414Multicenter prospective and retrospective 8282 pts w/ 95 episodes SVT ≤18 y, in pediatric ED. 25 episodes <1 y of age. 10% SHD. Adenosine doses: low 0.1 mg/kg, medium 0.1-0.2 mg/kg, high ≥0.3 mg/kg. Adenosine for pediatric SVTAdenosine success 72%; AV node-dependent SVT success 79%. Successful dose: low 6%, medium 62%, high 32%. Adenosine cardioversion 72%; low dose rarely effective. Dixon J2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Dixon</Author><Year>2005</Year><RecNum>270</RecNum><IDText>Guidelines and adenosine dosing in supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>270</Ref_ID><Title_Primary>Guidelines and adenosine dosing in supraventricular tachycardia</Title_Primary><Authors_Primary>Dixon,J.</Authors_Primary><Authors_Primary>Foster,K.</Authors_Primary><Authors_Primary>Wyllie,J.</Authors_Primary><Authors_Primary>Wren,C.</Authors_Primary><Date_Primary>2005/11</Date_Primary><Keywords>Adenosine</Keywords><Keywords>administration & dosage</Keywords><Keywords>Adolescent</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Cardiology</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>Drug Administration Schedule</Keywords><Keywords>drug therapy</Keywords><Keywords>Great Britain</Keywords><Keywords>Guidelines</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Practice Guidelines as Topic</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>1190</Start_Page><End_Page>1191</End_Page><Periodical>Arch.Dis Child</Periodical><Volume>90</Volume><Issue>11</Issue><User_Def_5>PMC1720194</User_Def_5><ISSN_ISBN>1468-2044</ISSN_ISBN><Misc_3>90/11/1190;10.1136/adc.2005.077636</Misc_3><Address>Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, UK</Address><Web_URL>PM:16243875</Web_URL><ZZ_JournalFull><f name="System">Archives of disease in childhood</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Arch.Dis Child</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(257)16243875Retrospective single center35SVT rx w/ adenosine 1/98-5/03. 53 episodes. 23 infants, 12 children <16 y. Dosing of adenosine to terminate SVTAdenosine efficacy vs. dose: Infants: 50 mcg/kg, 9%, 150 mcg/kg, 35%; median effective 200 mcg/kg. Children: 50 mcg/kg: 9%,100 mcg/kg: <50%. median effective dose 150 mcg/kgAdenosine in recommended dose has low efficacy, <10%. Recommend minimum dose 100 mcg/kg children, 150-200 mcg/kg infants. Chang PM 2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNoYW5nPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (258)20194798Retrospective single center37Refractory SVT: 40 episodes, 37 pts. 7/04-8/06. Median 34 d, 0-19 y. 65 SHD. IV procainamide: 50, Amiodarone 158 pts. AVRT 11, IART 18, EAT 11. Median dose amiodarone 2.5 mg/kg; procainamide 10 mg/kg.IV procainamide vs. amiodarone for terminating SV12Success: full + partial: Procainamide 71%, amiodarone 34%. Full success, Procainamide 50%, amiodarone 15%. IV procainamide more efficacious than IV amiodarone for acute termination of SVTDiza-Parra S 2014 ADDIN REFMGR.CITE <Refman><Cite><Author>Diaz-Parra</Author><Year>2014</Year><RecNum>269</RecNum><IDText>Use of adenosine in the treatment of supraventricular tachycardia in a pediatric emergency department</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>269</Ref_ID><Title_Primary>Use of adenosine in the treatment of supraventricular tachycardia in a pediatric emergency department</Title_Primary><Authors_Primary>Diaz-Parra,S.</Authors_Primary><Authors_Primary>Sanchez-Yanez,P.</Authors_Primary><Authors_Primary>Zabala-Arguelles,I.</Authors_Primary><Authors_Primary>Picazo-Angelin,B.</Authors_Primary><Authors_Primary>Conejo-Munoz,L.</Authors_Primary><Authors_Primary>Cuenca-Peiro,V.</Authors_Primary><Authors_Primary>Duran-Hidalgo,I.</Authors_Primary><Authors_Primary>Garcia-Soler,P.</Authors_Primary><Date_Primary>2014/6</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Cardiology</Keywords><Keywords>Cardiovascular Diseases</Keywords><Keywords>Disease</Keywords><Keywords>Emergencies</Keywords><Keywords>Guidelines</Keywords><Keywords>Heart</Keywords><Keywords>Incidence</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Spain</Keywords><Keywords>Tachycardia</Keywords><Reprint>Not in File</Reprint><Start_Page>388</Start_Page><End_Page>393</End_Page><Periodical>Pediatr.Emerg.Care</Periodical><Volume>30</Volume><Issue>6</Issue><ISSN_ISBN>1535-1815</ISSN_ISBN><Misc_3>10.1097/PEC.0000000000000144</Misc_3><Address>From the *Department for Critical Care and Emergencies, and daggerPediatric Cardiology Unit, Heart and Cardiovascular Diseases Department, Department of Pediatrics, Hospital Regional Universitario Carlos Haya, Malaga, Spain</Address><Web_URL>PM:24849273</Web_URL><ZZ_JournalFull><f name="System">Pediatric emergency care</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pediatr.Emerg.Care</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(259)24849273Retrospective, single center26Ped ED: 44 episodes SVT in 26 pts, mean age 3.1 y. 1/07-12/11. Adenosine given to 89%, increasing dosages. Efficacy of adenosine pediatric SVTAdenosine efficacy 75%. 30% responded to single dose, mean 112 mcg/kg; 41% 2 doses, mean response dose 188 mcg/kg; 24% 3 doses, mean response dose 249 mcg/kg. 66% discharged home. Mean effective dose of adenosine 173 mcg/kgm, higher than usual recommended dose. Mean number doses 1.7. Pediatrics: JET Risk FactorsBatra AS2006PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJhdHJhPC9BdXRob3I+PFllYXI+MjAwNjwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (261)18196218Retrospective single center, case-control874874 pts <16 y, CHD surgery 1/98-12/05Among JET pts: 26% had VSD closure; more often in pts w/ high RACHS score; 25% had surgery NOT near the AVN.Identify risk factors for postop JETIncidence 10.2%, CPB >90 min (OR: 2.6); high inotropes (OR: 2.6); high postop CK-MB (OR: 3.1). Mortality increased: 13.5% vs. 1.7%; 12 deaths. Prolonged LOS.Rx protocol: sedation/electrolytes; reduced inotropes; reduced core temp to 34-35 d C; muscle relaxation, IV amiodarone.Borgman KY 2012PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJvcmdtYW48L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (262)21740877Retrospective Single center,36CHD pts developing JET postop compared w/ CHD pts w/o JETAssess genetic polymorphism in CHD pts who develop postop JETRisks for JET postop included, age, inotrope score, bypass time, crossclamp time. ACE I/D genotype associated w/ 2-fold increase in risk for JET.ACE I/D polymorphism may be risk factor for JETMakhoul M2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1ha2hvdWw8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (264)7677480Retrospective single center6Postop JET treated w/ hypothermia. 6 consecutive pts, surface cooling to rectal temperature 32-34 d C; sedated, vent. Cooling maintained 24-88 h. Assess rx postop JET w/ hypothermiaMean interval Dx JET and start hypothermia 4 h. JET rate ↓from 219 to 165 bpm mean.Early institution moderate hypothermia effective in lowering HRWalsh EP 1997PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldhbHNoPC9BdXRob3I+PFllYXI+MTk5NzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (265)9120158Prospective, single center71Staged rx for JET 1986-1994. 71 pts, HR >170 bpm. Stages: ↓catecholamines; correct feve; atrial pacing; digoxin; phenytoine or propranolol or verap; procaine or hypothermia; combine procainamide + hypothermiaAssess rx JET postopSuccess: reduce HR <170 w/in 2 h.Treatment success 70/71 pts. JET associated w/ young age, transient AV block, VSD closures Only correction of fever and combined procainamide + hypothermia efficacious. Laird WP 2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxhaXJkPC9BdXRob3I+PFllYXI+MjAwMzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (266)12370794Retrospective, single center1111 pediatric postop CHD pts w/ JET, mean HR 203 bpm. IV amiodarone 5 mg/kg x2 given, followed by infusion 10-15 mg/kg/d for 48-72 h. Amiodarone efficacy for postop JETAmiodarone in higher dose (10 mg/kg vs. 5 mg/kg) achieved control more rapids. Hypotension/bradycardia 2 pts. Amiodarone 10 mg/kg IV effective for rapid control of postop JET; continuous infusion necessary.Plumpton K2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Plumpton</Author><Year>2005</Year><RecNum>569</RecNum><IDText>Amiodarone for post-operative junctional ectopic tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>569</Ref_ID><Title_Primary>Amiodarone for post-operative junctional ectopic tachycardia</Title_Primary><Authors_Primary>Plumpton,K.</Authors_Primary><Authors_Primary>Justo,R.</Authors_Primary><Authors_Primary>Haas,N.</Authors_Primary><Date_Primary>2005/2</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>adverse effects</Keywords><Keywords>Amiodarone</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Bradycardia</Keywords><Keywords>Cardiac Surgical Procedures</Keywords><Keywords>diagnosis</Keywords><Keywords>drug therapy</Keywords><Keywords>etiology</Keywords><Keywords>Heart</Keywords><Keywords>Heart Defects,Congenital</Keywords><Keywords>Heart Rate</Keywords><Keywords>Heart Septal Defects,Ventricular</Keywords><Keywords>Humans</Keywords><Keywords>Hypotension</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Intensive Care</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Keywords>Tetralogy of Fallot</Keywords><Keywords>therapeutic use</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>13</Start_Page><End_Page>18</End_Page><Periodical>Cardiol.Young</Periodical><Volume>15</Volume><Issue>1</Issue><ISSN_ISBN>1047-9511</ISSN_ISBN><Misc_3>S1047951105000041;10.1017/S1047951105000041</Misc_3><Address>Paediatric Cardiac Intensive Care Unit, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia</Address><Web_URL>PM:15831155</Web_URL><ZZ_JournalFull><f name="System">Cardiology in the young</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Cardiol.Young</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(267)15831155Retrospective, single center1515 postop pediatric CHD pts, JET, median 2.6 mo. JET rates 182-229 bpm, median 192 bpm. IV amiodaroneAmiodarone efficacy for postop JETAmiodarone controlled tachycardia, median time 4.5 h, median dose 5.9 mg/kg. Hypotension or bradycardia in 2 pts. Amiodarone controlled post-op JET rapidly. Haas NA 2008 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhhYXM8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (268)19026806Prospective observational 7171 of 2106 CPB pts repair CHD received amiodarone for postop atrial (70) or ventricular (7) tachycardia. Median age 3 mo. JET 37, ectopic AT 10, atrial flutter 8, AF 1, IART 1. Early rx: w/in 60 min of arrhythmia detection vs. >60 min. Protocol: reduce inotropes, correct lytes; IV amiodarone. Dose 5 mg/kg over 1-4 h, infusion 5-15 mcg/kg/min. Repeat boluses; infusion 5-10 mg/kg/d. Assess response of postop tachycardia to IV amiodaroneEarly rx postop tachycardia reduced rate (156 vs. 300 bpm, p<0.01); time to control (400 vs. 1038 min, p<0.001), reduced dose (28 vs. 67 mg, p<0.025), and ICU LOS (3.3 vs. 5.3 d, p<0.01). Early RX w/ amiodarone (60 min) significant improved outcomes. Collins KK2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNvbGxpbnM8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (269)19232902Multicenter retrospective 94Non postoperative JET, median age 0.8 y, range fetus – 16 y). . Time frame 1969-2008. CHF 16%. VA dissociated 56%, 1:1 VA 32%; both 3%, NOS 9%. Median f/u 4.5 y. Assess outcomes of rx for non postop JET in pediatric ptsMedications used in 89%; 62% ≥2 medications.Amiodarone used 60%, alone in 20%, combo w/ beta blocker (15%), procainamide, dif, flecainide, propafenone. Ablation: indication CHF or refractory to medications; elective 15%. RF 17, cryoablation 27, efficacy 82 vs. 85%, p=NS; recurrence 13-14%; inadvertent CHB 18% of RF pts. AV node ablation 3%, pacer 14%. Deaths 4%, all age ≤6 mo. 70% no chronic medical rx for JET. Amiodarone effective in 60%; Ablation: 47%: efficacy 82-85%, recurrence 13-14%, 18% inadvertent CHB in RF pts; 3% underwent intentional ablation AVN.Pacers 14% of ablation pts. Kovacikova L 2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktvdmFjaWtvdmE8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFy
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ADDIN EN.CITE.DATA (270)19632422Retrospective single center40Postop CHD ptsIV amiodarone 2 mg/kg boluses, continuous infusion 10=15 mcg/kg/minAssess IV amiodarone as rx for postop JETAmiodarone effective 45%; SR in 7, decreased HR 11; allowed effective atrial pacing w/ AV synchrony. Failure of amiodarone associated w/ higher AV oxygen saturation difference, lower body temp. Amiodarone achieved SR in 45% as first line; recommend in combo w/ hypothermia. Pediatrics: EP Study/RiskKlein GJ1979492252 ADDIN REFMGR.CITE <Refman><Cite><Author>Klein</Author><Year>1979</Year><RecNum>169</RecNum><IDText>Ventricular fibrillation in the Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>169</Ref_ID><Title_Primary>Ventricular fibrillation in the Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Klein,G.J.</Authors_Primary><Authors_Primary>Bashore,T.M.</Authors_Primary><Authors_Primary>Sellers,T.D.</Authors_Primary><Authors_Primary>Pritchett,E.L.</Authors_Primary><Authors_Primary>Smith,W.M.</Authors_Primary><Authors_Primary>Gallagher,J.J.</Authors_Primary><Date_Primary>1979/11/15</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Arrhythmias,Cardiac</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Child</Keywords><Keywords>complications</Keywords><Keywords>Electrocardiography</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Prevalence</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Tachycardia</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1080</Start_Page><End_Page>1085</End_Page><Periodical>N.Engl.J Med</Periodical><Volume>301</Volume><Issue>20</Issue><ISSN_ISBN>0028-4793</ISSN_ISBN><Misc_3>10.1056/NEJM197911153012003</Misc_3><Web_URL>PM:492252</Web_URL><ZZ_JournalFull><f name="System">The New England journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">N.Engl.J Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(137)To assess risk of VF in WPW pts.73WPW + h/o VF vs. preexcitation, WPW pts w/ no h/o VFVFThese pts also had high prevelance of reciprocating tachycardia and AF (14 of 25 vs. 18 of 73 [P=0.004]) and multiple APs (5 of 25 vs. four of 73 [P=0.012]). WPW + h/o AF and tachycardia demonstrate rapid conduction over AP during AF.VF was initial manifestation of WPW in 10% of pts: ages 8,9, 16 y. Timmermans C1995 ADDIN REFMGR.CITE <Refman><Cite><Author>Timmermans</Author><Year>1995</Year><RecNum>384</RecNum><IDText>Aborted sudden death in the Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>384</Ref_ID><Title_Primary>Aborted sudden death in the Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>Timmermans,C.</Authors_Primary><Authors_Primary>Smeets,J.L.</Authors_Primary><Authors_Primary>Rodriguez,L.M.</Authors_Primary><Authors_Primary>Vrouchos,G.</Authors_Primary><Authors_Primary>van den Dool,A.</Authors_Primary><Authors_Primary>Wellens,H.J.</Authors_Primary><Date_Primary>1995/9/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiology</Keywords><Keywords>Chi-Square Distribution</Keywords><Keywords>Child,Preschool</Keywords><Keywords>complications</Keywords><Keywords>Death,Sudden,Cardiac</Keywords><Keywords>Electrophysiology</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Heart Septum</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Sex Factors</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Keywords>Ventricular Fibrillation</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>492</Start_Page><End_Page>494</End_Page><Periodical>Am.J.Cardiol.</Periodical><Volume>76</Volume><Issue>7</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>S0002914999801362</Misc_3><Address>Department of Cardiology, Academic Hospital, Maastricht, The Netherlands</Address><Web_URL>PM:7653450</Web_URL><ZZ_JournalFull><f name="System">Am.J.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(271)7653450Retrospective, single center1515/690 pts w/ WPW referred 1/79-2/95 presented w/ cardiac arrest. 53% not known to have WPW. EP study done to assess AP characteristics. Characterize WPW pts w/ arrestVF initial manifestation in 8 pts. 10/15 exercising. 7 pts known ORT/AF. 9/11 EP study: AP ERP≤250 msec. Multiple AP not a risk. VF 2.2% of series; all under age 45 y, half under age 30y. Ceresnak SR2012 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNlcmVzbmFrPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48
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ADDIN EN.CITE.DATA (272) 22324823Retrospective, multi-center 301147 pts w/ WPW underwent EP study; 30 pts (2.6%) w/ ADT. Mean age 16±3 y. Assess EP characteristics of pts w/ ADT7% w/ CHD13% more than one APLeft sided AP 53%; right 47% often septalHigh risk in 17 pts (57%)ADT rare in children w/ WPW undergoing ablation, 2.6%57% w/ ADT had high risk characteristicsBrembilla Perot B2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJyZW1iaWxsYS1QZXJyb3Q8L0F1dGhvcj48WWVhcj4yMDEz
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ADDIN EN.CITE.DATA (273)23148120Retrospective, single center63807 pts w/ WPW underwent EP study; ADT induced in 63 pts (8%)Ages Assess EP characteristics of pts w/ WPW and ADTPts w/ ADT more likely to have AF induction (41 vs. 24%, p<.002), and high risk characteristics (22 vs. 12%, p<.02)No difference in age, gender, clinical presentation, ORTClinical outcome did not differ in pts w/ ADT; older pts less likely to have high risk characteristicsPappone C2014PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBhcHBvbmU8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (145)25052405Prospective single center21692169 pts w/ WPW, 8 y prospective study. 1001: no RFA; 1168: RFA. EP study in all. Median f/u 96 mo. 92% f/u. Assess VF or malignant arrhythmias in WPWIn no RFA group, 1.5% experienced VF, vs. 0.4% in no RFA group. VF: 13/15 were children, median age 11 y. Associated w/ short AP ERP (APERP <240 msec) (P <0.001) and AVRT initiating AF, but no sxs. Posteroseptal AP more common among VF pts. VF w/ exertion in 4, at rest in 11. 1.5% VF, almost all in children; risk higher in asymptomatic pts13/15 pts w/ VF <15 y; 2 age 32 y. Pediatrics: AblationKugler JD1994PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkt1Z2xlcjwvQXV0aG9yPjxZZWFyPjE5OTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (167)8164700Retrospective, multi-center 652652 pts underwent 725 ablation procedures between 1/91-9/92,Median age 13.5 y, 84% no SHDAssess outcomes and complications of ablation in young ptsSuccess rates: AVRT and AVNRT 83%; highest in LFW AP and ↑institutional experience; lower in RFW AP, structural heart disease, body weight >80 plications 4.8%, higher in very low weight <15 kg and less institutional experienceUncontrolled, voluntary registryKugler J 1997PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkt1Z2xlcjwvQXV0aG9yPjxZZWFyPjE5OTc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (274)9399718Retrospective, multi-center 413546 centers, pts 0.1-20.9 y undergoing ablation 1/91-9/15/9688% no SHD58% performed due to family/pt choiceDetermine safety and efficacy of ablation in childhoodSuccess rates: AVRT 90%, higher left >right, 95 vs. 86%; AVNRT 96%; Mean fluoroscopy time 47.6±40 min;Major complications 3.2%Deaths 4 pts, 1 immediate, 3 late (2 infant deaths)Freedom from recurrence at 3 y: AP 77%, AVNRT 71%.Ablation evolving into treatment of choice for SVT in older ptsDeaths in 2 infants noted Higher recurrence than adult pts, but possibly due to higher f/u.Schaffer msec2000PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNjaGFmZmVyPC9BdXRob3I+PFllYXI+MjAwMDwvWWVhcj48
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ADDIN EN.CITE.DATA (275)10980215Retrospective multicenter10Rviewed 4651 cases in Pediatric RFCA Registry; deaths 0.22%5/4092 w/ normal hearts 0.12%Assess incidence/causes of deathDeaths: all in left sided AP; mural injury, perforation, thromboembolism, vent arrhythmiaWeight 32.7 kg vs. 55.6 kg (p=.023)Number of lesions 26.3 vs. 8.7, (p=.019)Mortality 0.12-0.22% in left sided AP ablations; lower weight, greater number of lesionsBlaufox AD 2001 ADDIN REFMGR.CITE <Refman><Cite><Author>Blaufox</Author><Year>2001</Year><RecNum>386</RecNum><IDText>Radiofrequency catheter ablation in infants </=18 months old: when is it done and how do they fare?: short-term data from the pediatric ablation registry</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>386</Ref_ID><Title_Primary>Radiofrequency catheter ablation in infants </=18 months old: when is it done and how do they fare?: short-term data from the pediatric ablation registry</Title_Primary><Authors_Primary>Blaufox,A.D.</Authors_Primary><Authors_Primary>Felix,G.L.</Authors_Primary><Authors_Primary>Saul,J.P.</Authors_Primary><Date_Primary>2001/12/4</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Body Weight</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>complications</Keywords><Keywords>Disease</Keywords><Keywords>Drug Resistance</Keywords><Keywords>Heart</Keywords><Keywords>Heart Diseases</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Postoperative Complications</Keywords><Keywords>Registries</Keywords><Keywords>Safety</Keywords><Keywords>statistics & numerical data</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>2803</Start_Page><End_Page>2808</End_Page><Periodical>Circulation</Periodical><Volume>104</Volume><Issue>23</Issue><ISSN_ISBN>1524-4539</ISSN_ISBN><Address>Childrens' Heart Program of South Carolina, Medical University of South Carolina, Charleston, USA. blaufoad@musc.edu</Address><Web_URL>PM:11733398</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(276) 11733398Retrospective multicenter137Reviewed Pediatric RFCA Registry, 1989-1999, age ≤18 mo, median 0.7 y, weight median 10 kg. 152 procedures, CHD 36%. Outcomes ablation in age ≤18 moSuccess 87.6%, vs. 90.6%, NSMajor comps 4.6% vs. 2.9%, p=.17No difference in success or complications ≤18 moBlaufox AD 2004PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJsYXVmb3g8L0F1dGhvcj48WWVhcj4yMDA0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (277)14764175Retrospective single center1818 RFA in pts <15 kg 1/88-8/01; median weight 5.7 kg, age 5.8 mo; 4 CHD, 4 CHFOutcomes ablation <15 kgORT 9, MAT 1, VT 4; success all AP; no plications 3/18 myocardial infarct 1 occluding left circ, CHF, mitral valve replacement; torn mitral leaflet 1Complications 16% associated w/ RF dose indexed for body size (duration and number)Mitral valve replacementVan Hare G2004PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZhbiBIYXJlPC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48
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ADDIN EN.CITE.DATA (279)15851152Prospective, multi-center481 481 pts w/ AVRT or AVNRT, excluding pts w/ significant heart diseaseAges 0.1-16 yFollowed at 2,6,12 mo following ablationAssess recurrence following successful ablation Recurrence at 2,6, 12 mo was 7, 9.2, and 10.7%Recurrence highest right septal AP 24.6%, RFW 15.8%, LFW 9.3%, left septal 4.8%; AVNRT 4.8% vs. 12.9% for AP at 12 moRecurrence after initially successful ablation occurs commonly in children, 10.7%Recurrence less common for AVNRT 4.8%, most common for right sided AP >25% at one yAiyagari R 2005PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkFpeWFnYXJpPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48
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ADDIN EN.CITE.DATA (280)16132307Retrospective, single center69All pts ≤20 kg undergoing ablation between 1/94-1/03Group 1, <15 kg, 25 ptsGroup 2, 15.1-20 kg, 44 ptsCompare safety and efficacy of ablation in pts <15 kg vs. 15.1-20 kgSHD more common in pts <15 kg 28% vs. 7%, p<0.01.No difference in mechanism SVT, number lesions, temperature, procedure time, success rates 91% vs. 89%.Major complications 8% in Group 1, 2.3% Group 2, p=0.39. Outcomes similar between groupsComplications 8% in smaller children, although not statistically significantLee PC2007PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxlZTwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (281)17461876Retrospective, single center228228 pts 5-18 y old undergoing ablation 12/89 to 8/05Mean age 9±7 y; mean f/u 86±38 moAssess results of ablation in pediatric pts 5-18 yAVRT 61%, AVNRT 29%, AT 5%, atrial flutter 5%. Success rates 92% AVRT, 97% AVNRT, 82% AT, 91% atrial flutter. Complications 8.7%, major 0.9% AV block; Recurrence 4.7% AVRT incidence higher than in adults; Success rates lowest for AT 82%; other mechanisms 91-97%. Complications 8.7%, recurrence 4.7%Chiu SN 2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJ1ZGRoZTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (282)19609044Retrospective single center2727/210 pts underwent RF at age <6 y. Median age 4.4 y (8 mo-5.9 y). Median weight 15 kg (6.6-30 kg). AVRT 55%, atrial flutter 19%, AVNRT 15%. SHD 33%. Outcomes ablation <6 y. Indications: drug refractory SVT, or tach-induced cardiomyopathy. Acute success 93%, recurrence 7.4%. Acute success 93%, recurrence 7.4%.CHB 3.7% in 5 y old. Schneider HE2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNjaG5laWRlcjwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+
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ADDIN EN.CITE.DATA (283) 19324303Prospective, single center 212212 pts ages <21 y undergoing ablation for SVT underwent selective coronary angiography before and 30 min after RFA or cryoablation; CHD present in 15%Median age 12 y (0.3-20.4 y)Median weight 47 kg (5.5–130 kg)Assess incidence of coronary injury following ablationAP 53%; AVNRT 40%, both 7%Coronary artery narrowing identified in 2/117 pts (1.7%) w/ AP, both in posteroseptal region. Coronary artery injury present in 1.7% of AP ablations: both in posteroseptal regionConsider coronary angiography w/ ablation in posteroseptal regionKantoch MJ 2011PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbnRvY2g8L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (282)22452328Retrospective single center1551/05-12/09, 155 pts ablation for SVT. Mean age 13.4±3.7 y. 22% African American. RF 107, Cryoablation 11, Both 97. AVRT 74%, AVNRT 17%; SNRT 5%, His bundle reentry 4%. . Median f/u 41 mo. Outcomes ablation during longer f/uAcute success 98%; 5 y f/u 83% success. Recurrences higher w/ right anterior-anteroseptal AC (33%), multiple (27%), or broad distribution. Recurrence not statistical different RF (14%) vs. Cryoablation (22%) or both (20%)17% recurrence WPW or SVT during mean f/u 38 mo. Recurrences higher vs. age, 11.7 y vs. 13.6 y (p<0.05).Pediatrics: QOL & Cost EffectivenessGarson A1997 ADDIN REFMGR.CITE <Refman><Cite><Author>Garson</Author><Year>1997</Year><RecNum>396</RecNum><IDText>Management of the child with Wolff-Parkinson-White syndrome and supraventricular tachycardia: model for cost effectiveness</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>396</Ref_ID><Title_Primary>Management of the child with Wolff-Parkinson-White syndrome and supraventricular tachycardia: model for cost effectiveness</Title_Primary><Authors_Primary>Garson,A.,Jr.</Authors_Primary><Authors_Primary>Kanter,R.J.</Authors_Primary><Date_Primary>1997/11</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>analysis</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>Chronic Disease</Keywords><Keywords>Cost-Benefit Analysis</Keywords><Keywords>Disease</Keywords><Keywords>Humans</Keywords><Keywords>Intensive Care</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Recurrence</Keywords><Keywords>Sensitivity and Specificity</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Reprint>Not in File</Reprint><Start_Page>1320</Start_Page><End_Page>1326</End_Page><Periodical>J.Cardiovasc.Electrophysiol.</Periodical><Volume>8</Volume><Issue>11</Issue><ISSN_ISBN>1045-3873</ISSN_ISBN><Address>Baylor College of Medicine, Houston, Texas, USA</Address><Web_URL>PM:9395176</Web_URL><ZZ_JournalFull><f name="System">J.Cardiovasc.Electrophysiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(285)9395176Cost modelingN/ACost-effectiveness modeling for ablation vs. medications or surgery for WPW treatment in pts age 5-21 yIdentify long term cost effectiveness of treatment strategiesAblation cost 39% of surgical rx, and 57% of medical management. Estimated mortality ablation 0.15% = 10% of medical rx, and 28% of surgical rxMorbidity ablation = 32% of medications, and 36% of surgeryCatheter ablation has lower cost, mortality and morbidity than either medical rx or surgery, and is treatment of choice for the child 5 y of age or older w/ WPW and SVT. Pfammatter JP2004 ADDIN REFMGR.CITE <Refman><Cite><Author>Pfammatter</Author><Year>2004</Year><RecNum>397</RecNum><IDText>Impact of curative ablation on pharmacologic management in children with reentrant supraventricular tachycardias</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>397</Ref_ID><Title_Primary>Impact of curative ablation on pharmacologic management in children with reentrant supraventricular tachycardias</Title_Primary><Authors_Primary>Pfammatter,J.P.</Authors_Primary><Authors_Primary>Pavlovic,M.</Authors_Primary><Authors_Primary>Bauersfeld,U.</Authors_Primary><Date_Primary>2004/4</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Aged</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>drug therapy</Keywords><Keywords>Humans</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Keywords>Time</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>279</Start_Page><End_Page>282</End_Page><Periodical>Int.J.Cardiol.</Periodical><Volume>94</Volume><Issue>2-3</Issue><ISSN_ISBN>0167-5273</ISSN_ISBN><Misc_3>10.1016/j.ijcard.2003.05.023;S0167527303004030</Misc_3><Address>Division of Pediatric Cardiology, University Children's Hospital Berne, CH 3010 Bern, Switzerland. jean.pierre.pfammatter@insel.ch</Address><Web_URL>PM:15093993</Web_URL><ZZ_JournalFull><f name="System">Int.J.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(286)15093993Retrospective, single center 88Compare drug therapy vs. ablation as first line in 2 time periods: 1989-94, N = 40, and 1995-2000, N = 48. 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ADDIN EN.CITE.DATA (287)21106019Prospective, single group, pre-test-posttest design27Consecutive pts w/ SVT referred for catheter ablation between 10/04 – 6/06. Pre and 6 mo post ablation. Ages 5-18 y. Assess impact of ablation on QOL scoresPre test lowest scores in social and physical functioning; post test greatest improvement in physical functioning. Significant improvement in all QOL scores following successful elimination of SVTSignificant improvement in all QOL scores following successful elimination of SVTWood KA2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldvb2Q8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (288)20109982Prospective, single group, pre-test-posttest design52Consecutive pts w/ SVT referred for catheter ablation ≥13 y, Mean age 41±17 y, range 13-85 yFemale 65%AVNRT 57%, AVRT 31%, AT 12%Comparison of QOL, sxs before and after ablation procedure for SVTAll sxs decreased but not completely eliminated at 1 mo f/uImprovements in palpitations, p=0.001, Fatigue, p=0.001, Dizziness, p<0.01, resp or chest pressure p<0.001QOL improvements in number, severity and impact of sxs, p<0.001All sxs improved after ablation, women reported larger changes in sxs and QOL than menCHD: Incidence of SVTEngelfriet P2005PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkVuZ2VsZnJpZXQ8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFy
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ADDIN EN.CITE.DATA (289)15996978Retrospective, multicenter4110CONCOR national registry >8600 pts ACHD >17y of age: Pts w/ ACHD of 8 major types seen in 1998, w/ complete f/u to 2003: (ASD, VSD, TGA, TOF, single ventricle, coarctation, Marfan’s, cyanotic heart disease); followed until 12/2003assess endocarditis, arrhythmias, vascular eventsMedian age 27.9 y, (21.7-38.6y), 79% <50 y oldmedian f/u 5.1 y (3.6-5.7 y); SVA occurred in TOF 20%, TGA 26%; ASD 28%, Fontan 45%Young population w/ ACHD, overall 18% developed SVAVerheugt C2008PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZlcmhldWd0PC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48
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ADDIN EN.CITE.DATA (291)19822808Retrospective multicenter38,428 Adult registry Canada; ACHD median age 42 y; 1983-2005; 5812 pts ATAssess risk of developing atrial arrhythmias as adultPrevalence 15.1% AT; impact: 20 y risk for 20 y old 7%, 50 y old 38%; adverse event HR 2.5; mortality 1.47; stroke, CHF 2.21 >50% severe CHD developed AT by age 65 y; 2-3↑ death, stroke, CHFTrojnarska O 2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRyb2puYXJza2E8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFy
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ADDIN EN.CITE.DATA (292)19437395Retrospective, multicenter1304National Polish registry, ACHD pts followed 1995-2004; mean age 29.4±10.6 y, mean f/u 3.5±1.8 yAssess outcomes of SVASVA developed in 10.3% of pts; multivariable predictors; presence of HF (HR: 4.66) CHD complexity (HR: 2.31), age (HR: 1.32) gender NS10.3% developed SVAIncreased w/ CHF, complex CHD, increasing ageBernier M2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJlcm5pZXI8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (294)20713900Retrospective, multicenter566AARCC (Alliance for Adult Research in Cong Card); 11 centers; ACHD ages ≥18 y; study period 9/07-10/08Assess arrhythmia prevalence in TOF adultsMean age 36.8±12 y; f/u; Prevalence SVA 20.1%; risk factors reentrant AT: right atrial enlargement (OR: 6.2); HTN (OR: 2.3), number of cardiac surgeries (OR: 1.4); ventricular arrhythmias 14.6%20.1% of TOF w/ SVACuypers JA 2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkN1eXBlcnM8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (295) 23886606Retrospective single center85135 pts, Netherlands; surgical ASD closure <15 y of age, (mean 7.5± 3.5 y) between 1968-1980; f/u on 131 ptsAssess SVA development late after ASD closureMean f/u 35 y (30-41 y), 16% developed SVA; 12% developed AF16% AT in f/u ASDValente AM 2014 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlZhbGVudGU8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (296)24179163Multicenter, prospective 873Repaired TOF Median age 24.4 y, undergoing standard eval ECG, Exercise, MRIAssess TOF primary outcome of VT or deathSVA developed in 11% (7% atrial flutter, 4% AF); total 3.7% death or VT; Risk for VT or sudden death included ↑RV mass (HR: 5.04), ↓LVEF (HR: 3.34) or h/o atrial arrhythmia (HR: 3.65)TOF pts develop SVA in 11%; SVA significant risk factor for VT or sudden death, HR: 3.65CHD: Mechanisms of SVTCollins KK 2000PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNvbGxpbnM8L0F1dGhvcj48WWVhcj4yMDAwPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (218)11499727Retrospective single center16Consecutive repaired ACHD pts, EP study & ablation, mean ages 32±18 y; 24 circuits. Mean f/u 24 mo ASD/VSD 9; TOF 3, UVH 4. ECG: 44% typical atrial flutter; 56% atypical. Frequency of typical atrial flutter vs. IART in CHD19% typical atrial flutter only; 37% IART alone; 44% both atrial flutter/IART;Isthmus dependent 86% IART;92% successful ablation; only failure=Fontan44% both atrial flutter and IART: Surface ECG did not predict mechanism7% recurrence 2 y. Delacretaz E 2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRlbGFjcmV0YXo8L0F1dGhvcj48WWVhcj4yMDAxPC9ZZWFy
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ADDIN EN.CITE.DATA (199) 11345382Retrospective, single center2047 Atrial reentry circuits mapped in 20 pts, repaired CHD, ASD 10, TOF 6; mean age 43 ±15 yAssess sites of reentry circuitsLateral RA wall 40%, CTI 38%; ASD patch 17%. Acute success 80% pts; mean f/u 19 mo, 20% recurrence. ALL RA macro-reentry, largely ASD or TOF pts; Circuits in 3 sites: lateral RA wall ? CTIDe Groot NM 2006PFJlZm1hbj48Q2l0ZT48QXV0aG9yPmRlIEdyb290PC9BdXRob3I+PFllYXI+MjAwNjwvWWVhcj48
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ADDIN EN.CITE.DATA (299)21539636Retrospective, single center 58Repaired TOF or DORV pts, 1/97 to 3/10; 58 pts w/ 127 AT circuits, mean age 35 yAssess atrial reentry circuits in TOFRA reentry 75%; focal/ectopic 13%; AF 12%; CTI 53% of IART; CTI and lateral RA wall = 85% of IART; AT ablation acute success 90%; 34% recurrence w/in 3 y13% focal; AF 12%; IART 75%:Of IART 53% involve isthmus; acute success high, recurrence moderate; target both isthmus and lateral RA wallKoyak Z 2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktveWFrPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (300)23993125Retrospective multicenter92ACHD pts, CONCOR Dutch database; First onset SVT 1/08-1/11 mean age 51±16 y; AF/atrial flutter >80%; septal defects 50%, left sided CHD 21%.Mech of SVT in ACHDMechanism of SVT described as AF 68%, atrial flutter 14%, AVNRT 8%, “AT” 7%, unspecified 3%AF 68%, atrial flutter 14%AVNRT 8%AT ? focal 7%Wasmer K 2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Wasmer</Author><Year>2013</Year><RecNum>412</RecNum><IDText>Isthmus-dependent right atrial flutter as the leading cause of atrial tachycardias after surgical atrial septal defect repair</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>412</Ref_ID><Title_Primary>Isthmus-dependent right atrial flutter as the leading cause of atrial tachycardias after surgical atrial septal defect repair</Title_Primary><Authors_Primary>Wasmer,K.</Authors_Primary><Authors_Primary>Kobe,J.</Authors_Primary><Authors_Primary>Dechering,D.G.</Authors_Primary><Authors_Primary>Bittner,A.</Authors_Primary><Authors_Primary>Monnig,G.</Authors_Primary><Authors_Primary>Milberg,P.</Authors_Primary><Authors_Primary>Baumgartner,H.</Authors_Primary><Authors_Primary>Breithardt,G.</Authors_Primary><Authors_Primary>Eckardt,L.</Authors_Primary><Date_Primary>2013/10/3</Date_Primary><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Germany</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>2447</Start_Page><End_Page>2452</End_Page><Periodical>Int.J.Cardiol.</Periodical><Volume>168</Volume><Issue>3</Issue><ISSN_ISBN>1874-1754</ISSN_ISBN><Misc_3>S0167-5273(13)00430-0;10.1016/j.ijcard.2013.03.012</Misc_3><Address>Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Munster, Germany. Electronic address: wasmerk@ukmuenster.de</Address><Web_URL>PM:23540398</Web_URL><ZZ_JournalFull><f name="System">Int.J.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(301)23540398Retrospective, single center 5454 pts repaired ASD, mean age 47.3 y at study, 11/95-12/01, 2 pts w/ AF, 10 no inducible AT: 42 pts studied; f/u 7.7 yAssess RA reentry circuits in ASDCTI dependent 69%, of which 40% were clockwise; scar related 17%, both 12%; CTI ablation performed in non-inducible/AF; acute success ~90%; 60% arrhythmia free at 7.7 yASD Ablation aimed at CTI highly successful; 11% developed AFCHD: Pharmacological TherapyFish FA 1991 ADDIN REFMGR.CITE <Refman><Cite><Author>Fish</Author><Year>1991</Year><RecNum>438</RecNum><IDText>Proarrhythmia, cardiac arrest and death in young patients receiving encainide and flecainide. The Pediatric Electrophysiology Group</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>438</Ref_ID><Title_Primary>Proarrhythmia, cardiac arrest and death in young patients receiving encainide and flecainide. The Pediatric Electrophysiology Group</Title_Primary><Authors_Primary>Fish,F.A.</Authors_Primary><Authors_Primary>Gillette,P.C.</Authors_Primary><Authors_Primary>Benson,D.W.,Jr.</Authors_Primary><Date_Primary>1991/8</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Anilides</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Arrhythmias,Cardiac</Keywords><Keywords>chemically induced</Keywords><Keywords>Child</Keywords><Keywords>Death,Sudden</Keywords><Keywords>Disease</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Encainide</Keywords><Keywords>epidemiology</Keywords><Keywords>Flecainide</Keywords><Keywords>Heart</Keywords><Keywords>Heart Arrest</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>Patients</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Risk Factors</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>356</Start_Page><End_Page>365</End_Page><Periodical>J.Am.Coll.Cardiol.</Periodical><Volume>18</Volume><Issue>2</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Address>Department of Pediatrics, Children's Memorial Hospital, Northwestern University, Chicago, Illinois</Address><Web_URL>PM:1906902</Web_URL><ZZ_JournalFull><f name="System">J.Am.Coll.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(302)1906902Retrospective multi-center 455455/579 rx for SVT (79%);369 pts rx flecainide (81%) . encainide 19%,Mean age of flecainide death or CA: 9.9 y, range 4d-26 yPro-arrhythmia, cardiac arrest or death w/ flecainide/encainide in young ptsOverall death/CA; 25 pts; 18/25 w/ CHD;Flecainide for SVT: efficacy 7.1%, proarrhythmia 7.4%; cardiac arrest 2.3%;12 pts cardiac arrest; 8/12 CHD: 7/8 mild-mod ventricular dysfunction or single vent or systemic RV Flecainide efficacy SVT 70%; pro-arrhythmia 7.4%; Flecainide rx SVT + CHD: 8.3% death or CA. vs. 0.3% w/o CHD.Deaths flecainide + CHD, average 16.1 y 4 flecainide deaths in structurally normal hearts, 3 of 4 normal function. 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ADDIN EN.CITE.DATA (303) 10402444Retrospective single center92ACHD, mean age 34.9 y, receiving amiodarone for ≥6 mo; case-control group. Mean duration 3 y, mean dose 191 mgReview side effects of chronic oral amio36% developed thyroid dysfunction: 19 hyper, 14 hypothyroid. Sig risk factors: Female gender (OR: 3.0) cyanotic HD (OR: 7.0); Fontan (OR :4.0); dosage >200 mg/d (OR: 4.0)Pts w/ CHD at higher risk for amiodarone adverse effects, especially women, cyanosis, Fontan, or dose >200 mgPass RH 2000 ADDIN REFMGR.CITE <Refman><Cite><Author>Pass</Author><Year>2000</Year><RecNum>546</RecNum><IDText>Continuous intravenous diltiazem infusion for short-term ventricular rate control in children</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>546</Ref_ID><Title_Primary>Continuous intravenous diltiazem infusion for short-term ventricular rate control in children</Title_Primary><Authors_Primary>Pass,R.H.</Authors_Primary><Authors_Primary>Liberman,L.</Authors_Primary><Authors_Primary>Al-Fayaddh,M.</Authors_Primary><Authors_Primary>Flynn,P.</Authors_Primary><Authors_Primary>Hordof,A.J.</Authors_Primary><Date_Primary>2000/9/1</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Arrhythmias,Cardiac</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Calcium</Keywords><Keywords>Calcium Channel Blockers</Keywords><Keywords>Cardiology</Keywords><Keywords>Child</Keywords><Keywords>Diltiazem</Keywords><Keywords>drug therapy</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infusions,Intravenous</Keywords><Keywords>New York</Keywords><Keywords>Patients</Keywords><Keywords>Tachycardia</Keywords><Reprint>Not in File</Reprint><Start_Page>559</Start_Page><End_Page>62, A9</End_Page><Periodical>Am.J.Cardiol.</Periodical><Volume>86</Volume><Issue>5</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>S0002-9149(00)01016-X</Misc_3><Address>Division of Pediatric Cardiology, Babies and Children's Hospital of New York, New York Presbyterian Medical Center, 10032-3784, USA. Pediheart@</Address><Web_URL>PM:11009280</Web_URL><ZZ_JournalFull><f name="System">Am.J.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(304)11009280Retrospective single center10IV diltiazem for AT w/ rapid response. Includes 3 adults w/ AT and repaired CHD, ages 18-21 y. Efficacy diltiazem for AT Diltiazem 0.25 mg/kg over 5 min + infusion 0.11 mg/kg/h. HR median 166 pre-treatment, fell to 23 bpm w/in 10 min. No HTN. Diltiazem effectively decreased ventricular rate w/in 10 min.Hoyer AW 2007 ADDIN REFMGR.CITE <Refman><Cite><Author>Hoyer</Author><Year>2007</Year><RecNum>432</RecNum><IDText>The safety and efficacy of ibutilide in children and in patients with congenital heart disease</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>432</Ref_ID><Title_Primary>The safety and efficacy of ibutilide in children and in patients with congenital heart disease</Title_Primary><Authors_Primary>Hoyer,A.W.</Authors_Primary><Authors_Primary>Balaji,S.</Authors_Primary><Date_Primary>2007/8</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Bradycardia</Keywords><Keywords>Cardiology</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>congenital</Keywords><Keywords>Disease</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Defects,Congenital</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Pacemaker,Artificial</Keywords><Keywords>Patients</Keywords><Keywords>Safety</Keywords><Keywords>Sulfonamides</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapeutic use</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>1003</Start_Page><End_Page>1008</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>30</Volume><Issue>8</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Misc_3>PACE799;10.1111/j.1540-8159.2007.00799.x</Misc_3><Address>Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR 97239, USA</Address><Web_URL>PM:17669084</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(305)17669084Retrospective single center1915 w/ CHD, 4 w/ normal hearts.74 episodes of atrial flutter 4 AF. 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ADDIN EN.CITE.DATA (307)18931451Retrospective single center27 44 ACHD, mean age 23±12 y, f/u 13±12 mo; oral sotalol 2002-2007; 27 pts SVTEfficacy & safety sotalol in ACHDOverall 41% control; for SVT 52% complete control; Not effective for AFAT w/ AF risk factor for rx failure, OR: 18.3One death 34 y old, AT + AFRao SO2009 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlJhbzwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (308)18653253Prospective, non-randomized1919 pts ACHD, mean age 20 y; present in AT, given oral sotalol 2 mg/kg as inpatientsSotalol for conversionFocal AT 21%, IART 79%;84% conversion w/in 98-145 min; 75% of focal and 87% IART. One fatality after 2 d: thromboembolism. High efficacy 84% for oral sotalol in ACHD acute conversion of ATWells R2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldlbGxzPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (309)19691680Retrospective multicenter20ACHD pts, 4 institutions, 7 y, rx w/ dofetilide, median age 30 y, 19-53 y.11/20 pts Fontan surgeries. AF 4, IART 13, AF + IART 3. Dosage 125-500 mcg bid. Median f/u ~ 12 mo. Dofetilide efficacy AT in ACHDConversion to SR: 85%. Torsades de pointes: 10%, immediate. Recurrent AT: 65%. 55% taking dofetilide at 1 y. Dofetilide effective acute termination of AT (85%) w/ 10% Torsades de pointes. 65% recurrent AT in 12 mo.ie 35% control AT x 1 y. Garnock-Jones KP 2012 ADDIN REFMGR.CITE <Refman><Cite><Author>Garnock-Jones</Author><Year>2012</Year><RecNum>547</RecNum><IDText>Esmolol: a review of its use in the short-term treatment of tachyarrhythmias and the short-term control of tachycardia and hypertension</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>547</Ref_ID><Title_Primary>Esmolol: a review of its use in the short-term treatment of tachyarrhythmias and the short-term control of tachycardia and hypertension</Title_Primary><Authors_Primary>Garnock-Jones,K.P.</Authors_Primary><Date_Primary>2012/1/1</Date_Primary><Keywords>Adrenergic beta-1 Receptor Antagonists</Keywords><Keywords>adverse effects</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Disease</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Heart</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Hypertension</Keywords><Keywords>Hypotension</Keywords><Keywords>Morbidity</Keywords><Keywords>Myocardial Infarction</Keywords><Keywords>Patients</Keywords><Keywords>pharmacokinetics</Keywords><Keywords>pharmacology</Keywords><Keywords>Propanolamines</Keywords><Keywords>Randomized Controlled Trials as Topic</Keywords><Keywords>Risk</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time Factors</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>109</Start_Page><End_Page>132</End_Page><Periodical>Drugs.</Periodical><Volume>72</Volume><Issue>1</Issue><ISSN_ISBN>0012-6667</ISSN_ISBN><Misc_3>8;10.2165/11208210-000000000-00000</Misc_3><Address>Adis, a Wolters Kluwer Business, Auckland, New Zealand. demail@adis.co.nz</Address><Web_URL>PM:22191799</Web_URL><ZZ_JournalFull><f name="System">Drugs</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Drugs.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(310)22191799Meta-analysis of databasesMEDLINE, EMBASE, and AdisBases databases searched for esmolol and tachycardia, and heart surgery, through 11/2011. Review of databases using esmololIncludes comparison trials w/ other meds: placebo, propranolol, diltiazem, ibutilide, for treatment of SVT and for prophylaxis during heart surgeryHypotension in 2-40% of SVT pts. Resulted in discontinuation in 3-23%Koyak Z 2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktveWFrPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (300)23993125Retrospective multicenter92ACHD pts, CONCOR databse; First onset SVT 1/08-1/11 mean age 51±16 y; AF/atrial flutter >80%; septal defects 50%, left sided CHD 21%.Sotalol used in 34%, (mean dose 156 mg) ) and amiodarone 15%,( mean dose 350 mg)Long term efficacy of AA meds90% achieved sinus rhythm. 84% rx w/ chronic oral agents; f/u 2.5±1.4 y; 45% free from SVT. Sotalol or Amiodarone: significantly fewer recurrences, (HR: 0.5); 22% adverse events; all amiodarone pts w/ side effects, thyroid 80%, AVB 20%. Class III agents sotalol and amiodarone more efficacious in maintaining SR; sotalol considered as first choice medRelatively high dose amiodarone associated w/ significant adverse eventsBanchs JE2014 ADDIN REFMGR.CITE <Refman><Cite><Author>Banchs</Author><Year>2014</Year><RecNum>440</RecNum><IDText>Clinical efficacy of dofetilide for the treatment of atrial tachyarrhythmias in adults with congenital heart disease</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>440</Ref_ID><Title_Primary>Clinical efficacy of dofetilide for the treatment of atrial tachyarrhythmias in adults with congenital heart disease</Title_Primary><Authors_Primary>Banchs,J.E.</Authors_Primary><Authors_Primary>Baquero,G.A.</Authors_Primary><Authors_Primary>Nickolaus,M.J.</Authors_Primary><Authors_Primary>Wolbrette,D.L.</Authors_Primary><Authors_Primary>Kelleman,J.J.</Authors_Primary><Authors_Primary>Samii,S.</Authors_Primary><Authors_Primary>Grando-Ting,J.</Authors_Primary><Authors_Primary>Penny-Peterson,E.</Authors_Primary><Authors_Primary>Davidson,W.R.,Jr.</Authors_Primary><Authors_Primary>Young,S.K.</Authors_Primary><Authors_Primary>Naccarelli,G.V.</Authors_Primary><Authors_Primary>Gonzalez,M.D.</Authors_Primary><Date_Primary>2014/5</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>congenital</Keywords><Keywords>Disease</Keywords><Keywords>Heart</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Potassium</Keywords><Keywords>Recurrence</Keywords><Keywords>Safety</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>221</Start_Page><End_Page>227</End_Page><Periodical>Congenit.Heart Dis.</Periodical><Volume>9</Volume><Issue>3</Issue><ISSN_ISBN>1747-0803</ISSN_ISBN><Misc_3>10.1111/chd.12129</Misc_3><Address>Penn State Hershey Heart & Vascular Institute, Penn State University, Hershey, Pa, USA</Address><Web_URL>PM:23947935</Web_URL><ZZ_JournalFull><f name="System">Congenit.Heart Dis.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(311)23947935Prospective non randomized13ACHD, 4 TOF, 1 pulmonary atresia, 2 ASD, 1 dextro-TGA ; 2 L-TGA, 2 tricuspid atresia, 1 asd and vsd, 1 vsd pulmonary atresia, 1 noncompaction; mean age 40±11; median f/u 16 moDofetilide efficacy and safety for AT in ACHD Mechanism of SVT described as AF, atrial flutter or AT70% conversion15% control of recurrencesAverage time to recurrence 5.5 mo39% ddischarge medication due to recurrenceDofetilide well tolerated, Effective for conversion in 70%Recurrence still frequent.Stan MN2014 ADDIN REFMGR.CITE <Refman><Cite><Author>Stan</Author><Year>2012</Year><RecNum>482</RecNum><IDText>A risk prediction index for amiodarone-induced thyrotoxicosis in adults with congenital heart disease</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>482</Ref_ID><Title_Primary>A risk prediction index for amiodarone-induced thyrotoxicosis in adults with congenital heart disease</Title_Primary><Authors_Primary>Stan,M.N.</Authors_Primary><Authors_Primary>Hess,E.P.</Authors_Primary><Authors_Primary>Bahn,R.S.</Authors_Primary><Authors_Primary>Warnes,C.A.</Authors_Primary><Authors_Primary>Ammash,N.M.</Authors_Primary><Authors_Primary>Brennan,M.D.</Authors_Primary><Authors_Primary>Thapa,P.</Authors_Primary><Authors_Primary>Montori,V.M.</Authors_Primary><Date_Primary>2012</Date_Primary><Keywords>Adult</Keywords><Keywords>Amiodarone</Keywords><Keywords>analysis</Keywords><Keywords>congenital</Keywords><Keywords>Disease</Keywords><Keywords>Heart</Keywords><Keywords>Medicine</Keywords><Keywords>Multivariate Analysis</Keywords><Keywords>Patients</Keywords><Keywords>Risk</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>210529</Start_Page><Periodical>J Thyroid Res.</Periodical><Volume>2012</Volume><User_Def_5>PMC3306911</User_Def_5><ISSN_ISBN>2042-0072</ISSN_ISBN><Misc_3>10.1155/2012/210529</Misc_3><Address>Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA</Address><Web_URL>PM:22518347</Web_URL><ZZ_JournalFull><f name="System">Journal of thyroid research</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Thyroid Res.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(312)22518347Retrospective single center23ACHD pts developing amiodarone-induced thyrotoxicosis after ≥3 mo amiodarone, Mayo Clinic 1987-2009; median f/u 3.1 y. Identify incidence and risk factors amiodarone thyrotoxicosis13.6% (23/169) ACHD pts developed amiodarone thryrotoxicosis.Highest Risk: low BMI <21, cyanotic heart diseaseCHD: Atrial PacingOlshansky B 1988 ADDIN REFMGR.CITE <Refman><Cite><Author>Olshansky</Author><Year>1988</Year><RecNum>426</RecNum><IDText>Use of procainamide with rapid atrial pacing for successful conversion of atrial flutter to sinus rhythm</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>426</Ref_ID><Title_Primary>Use of procainamide with rapid atrial pacing for successful conversion of atrial flutter to sinus rhythm</Title_Primary><Authors_Primary>Olshansky,B.</Authors_Primary><Authors_Primary>Okumura,K.</Authors_Primary><Authors_Primary>Hess,P.G.</Authors_Primary><Authors_Primary>Henthorn,R.W.</Authors_Primary><Authors_Primary>Waldo,A.L.</Authors_Primary><Date_Primary>1988/2</Date_Primary><Keywords>administration & dosage</Keywords><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Combined Modality Therapy</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Infusions,Intravenous</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Procainamide</Keywords><Keywords>Prospective Studies</Keywords><Keywords>Research</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>359</Start_Page><End_Page>364</End_Page><Periodical>J.Am.Coll.Cardiol.</Periodical><Volume>11</Volume><Issue>2</Issue><ISSN_ISBN>0735-1097</ISSN_ISBN><Misc_3>0735-1097(88)90102-7</Misc_3><Address>Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, Ohio 44106</Address><Web_URL>PM:3339174</Web_URL><ZZ_JournalFull><f name="System">J.Am.Coll.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(313)3339174Retrospective single center12Rapid atrial pacing ≥15 sec at ≥10 msec shorter than AT, 12 adult pts, mean 55 y, 2/12 ACHD: VSD, VSD +ASD; mean atrial CL 233 msecConversion rates of AT/atrial flutter w/ rapid atrial pacing2/12 converted w/ rapid atrial pacing10 pts received procaine then repeat rapid atrial pacing: successful in 10 ptsProcaine needed to assist RAP conversion in pts w/ ACHDSilka MJ1990 ADDIN REFMGR.CITE <Refman><Cite><Author>Silka</Author><Year>1990</Year><RecNum>544</RecNum><IDText>Bradycardia-mediated tachyarrhythmias in congenital heart disease and responses to chronic pacing at physiologic rates</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>544</Ref_ID><Title_Primary>Bradycardia-mediated tachyarrhythmias in congenital heart disease and responses to chronic pacing at physiologic rates</Title_Primary><Authors_Primary>Silka,M.J.</Authors_Primary><Authors_Primary>Manwill,J.R.</Authors_Primary><Authors_Primary>Kron,J.</Authors_Primary><Authors_Primary>McAnulty,J.H.</Authors_Primary><Date_Primary>1990/2/15</Date_Primary><Keywords>Aged</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Bradycardia</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Child</Keywords><Keywords>complications</Keywords><Keywords>congenital</Keywords><Keywords>Disease</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Heart</Keywords><Keywords>Heart Defects,Congenital</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Pacemaker,Artificial</Keywords><Keywords>Patients</Keywords><Keywords>Pediatrics</Keywords><Keywords>prevention & control</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>488</Start_Page><End_Page>493</End_Page><Periodical>Am.J.Cardiol.</Periodical><Volume>65</Volume><Issue>7</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>0002-9149(90)90816-J</Misc_3><Address>Department of Pediatrics, Oregon Health Sciences University, Portland 97201</Address><Web_URL>PM:2305688</Web_URL><ZZ_JournalFull><f name="System">Am.J.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(314)2305688Retrospective single center2121 pts, CHD, AT or VT and anti-bradycardia pacing. 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ADDIN EN.CITE.DATA (315)9455751Retrospective single center1818 ACHD pts, recurrent late IART, implanted atrial pacemakers programmed for atrial pacing >80% of time. Atrial anti-brady pacing effect on IART recurrenceRecurrent AT in 29% in first 6 mo. Late recurrences in 11%; 83% arrhythmia free, 2 pts on AA meds.Chronic atrial pacing reduced IART recurrences to 11%. One late sudden death. Brockmeier K2002 ADDIN REFMGR.CITE <Refman><Cite><Author>Brockmeier</Author><Year>2002</Year><RecNum>430</RecNum><IDText>Termination of atrial reentrant tachycardias by using transesophageal atrial pacing</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>430</Ref_ID><Title_Primary>Termination of atrial reentrant tachycardias by using transesophageal atrial pacing</Title_Primary><Authors_Primary>Brockmeier,K.</Authors_Primary><Authors_Primary>Ulmer,H.E.</Authors_Primary><Authors_Primary>Hessling,G.</Authors_Primary><Date_Primary>2002</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Algorithms</Keywords><Keywords>Amiodarone</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Cardiology</Keywords><Keywords>Child</Keywords><Keywords>Child,Preschool</Keywords><Keywords>congenital</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Esophagus</Keywords><Keywords>Germany</Keywords><Keywords>Heart</Keywords><Keywords>Heart Atria</Keywords><Keywords>Heart Defects,Congenital</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Postoperative Complications</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>159</Start_Page><End_Page>163</End_Page><Periodical>J Electrocardiol.</Periodical><Volume>35 Suppl</Volume><ISSN_ISBN>0022-0736</ISSN_ISBN><Misc_3>10.1054/jelc.2002.37174;S0022073602000614</Misc_3><Address>Department of Pediatric Cardiology, University of Heidelberg, Heidelberg, Germany. konrad_brockmeier@med.uni-heidelberg.de</Address><Web_URL>PM:12539114</Web_URL><ZZ_JournalFull><f name="System">Journal of electrocardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Electrocardiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(316)12539114Retrospective single center3962 conversions in 39 pts, 31 postop CHD, median age 12.5 y (0.1-33 y); “typical atrial flutter 21”, median CL 235 msec TEP conversion of AT in CHD81% successful conversions w/ TEP; 19% underwent CDDVUsed AEST 4-6 x (CL-20) to minimum 120 msec; mA 24-28 TEP converted 81% atrial flutter or ARTStephenson EA2003PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlN0ZXBoZW5zb248L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFy
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ADDIN EN.CITE.DATA (318)20934227Retrospective single center6363 ACHD underwent 80 DCCV 6/00-7/03. Flutter most common 46%. f/u 387 dOutcome of DCCVDCCV successful in 94%.60% ACHD pts recurred during f/uall cause mortality was 11% during one y f/u.DCCV safe and effective in ACHD. Recurrence rate is 60%/1 y; AF predicted recurrence, and spontaneous echocardiography contrast in LACHD: Catheter Ablation - NOSTriedman JK1995 ADDIN REFMGR.CITE <Refman><Cite><Author>Triedman</Author><Year>1995</Year><RecNum>488</RecNum><IDText>Radiofrequency ablation of intra-atrial reentrant tachycardia after surgical palliation of congenital heart disease</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>488</Ref_ID><Title_Primary>Radiofrequency ablation of intra-atrial reentrant tachycardia after surgical palliation of congenital heart disease</Title_Primary><Authors_Primary>Triedman,J.K.</Authors_Primary><Authors_Primary>Saul,J.P.</Authors_Primary><Authors_Primary>Weindling,S.N.</Authors_Primary><Authors_Primary>Walsh,E.P.</Authors_Primary><Date_Primary>1995/2/1</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Boston</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Child</Keywords><Keywords>complications</Keywords><Keywords>congenital</Keywords><Keywords>Disease</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Heart Defects,Congenital</Keywords><Keywords>Humans</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Postoperative Complications</Keywords><Keywords>Research</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Reprint>Not in File</Reprint><Start_Page>707</Start_Page><End_Page>714</End_Page><Periodical>Circulation</Periodical><Volume>91</Volume><Issue>3</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Cardiology, Children's Hospital, Boston, Mass 02115</Address><Web_URL>PM:7828297</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(319)7828297Retrospective single center1010 consecutive ACHD pts, median age 18.4 y (12-43 y). Fontan 6, TGA atrial 2, 2 biVS. 30 IART circuits. Ablate 22 circuits. Median f/u 4 mo. ACHD ablation outcomesCircuits in 4 areas of RA.77% acute success (circuits)50% recurrence short term77% acute success, 50% recurrence short term 4 moKalman JM1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbG1hbjwvQXV0aG9yPjxZZWFyPjE5OTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (212)8565168Retrospective single center1818 consecutive ACHD pts, 26 IART circuits, mean age 26 ±15 y map & Ablation 1992-1995. ASD 50%, Fontan 22%, TGA atrial switch 22%, Rastelli 5%; conventional mapping, f/u mean 17 mo. ACHD ablation outcomesAcute success 83%Fontan 50% successAcute success 83%, 50% asymptomatic, no medications during f/u.33% recurrence, plus 7% AFTanner H2004PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRhbm5lcjwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (320)15851168Multicenter retrospective 3636 consecutive ACHD pts, median age 46 y. ASD 20, TOF 8, TGA 5, VSD 1, UVH 1, cc-TGA 1. Mean f/u 17 moACHD ablation outcomes 52 IART circuits; 48 ablations. 65% CTI dependent. 27% incisional, 8% LA. Acute success: 87%. 87% acute success ablation ACHD (2 ventricles predominantly)25% on chronic AA meds92% free of recurrence14% developed AFLukac P2005PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkx1a2FjPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (322)20194797Retrospective single center53Ablation in 53 ACHD pts, age 38±15 y. Examine characteristics of recurrences after ablation ACHDAtrial flutter 51%; IART 42%; Focal 9%. Acute success 65%; recurrence 59% w/in one y. Repeat ablation 15: 7 similar mechanism.f/u: 5± 3 y: death 9%; AA meds 57%; 31% recurrent AT ACHD: High recurrence 59%; 57% meds; 9% deathRecurrent AT may be different mechanism. Yap SC2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPllhcDwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (323) 21029876Retrospective single center130193 ablations performed in ACHD 130 pts, mean age 40 ±13 y; median f/u 3.4 y. Type of CHD ASD 21%, TGA 18%; UVH 20%; TGA 18%, other 12%Acute & long term outcomes ablation of IART in ACHDAcute success 69%; 5% major comps; pacers 3%; 62% discharged on AA meds;IART recurrence: 4 y =51%; repeat ablation 35%; death 4%. Older age and Fontan palliation predictors of recurrence. Differential outcomes of ablation based on type of CHD: in Fontan pts, 4 y r freedom from recurrence 15% vs.~42% in ASD, TOF, MustardUeda A2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlVlZGE8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (324) 23685536Retrospective single center116Ablation 116 ACHD pts, mean age 41 y; 154 procedures, 228 circuits using remote navigation, 3D mapping. F/u mean 20 mo, Group A: manual mappping/ablation; B: remote navigation; C: remote navigation +difficult access. Assess outcomes ablation ACHDCompare simple vs. complex lesions or complex vascular access. AVNRT 5-13%; AVRT 4-7%; Focal 11-26%; atrial flutter 11-39%; IART 23-45%; AF 6-18%. No difference acute success 82-91%, recurrence 20-24%.ACHD population: ablationAcute success >80%; 20-25% recurrence w/in 20 moCHD: Catheter Ablation – ASDTeh AW 2011 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRlaDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (325)21208243Retrospective single center20Ablation AT after ASD repair; mean age 53±13 y; post ASD closure interval 29±15 y. ASD Outcome atrial flutter ablation in All CTI dependent atrial flutter; + other circuits.Acute success 100%; 25% repeat abl at 13 mo. F/u 3.2±1.6 y, 30% documented AF; stroke 5%; 35% AF interventionExcellent acute ablation success ASD: 100%; 25% recur-repeat ablation, 30% AF in 3 y of f/uWasmer K 2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Wasmer</Author><Year>2013</Year><RecNum>412</RecNum><IDText>Isthmus-dependent right atrial flutter as the leading cause of atrial tachycardias after surgical atrial septal defect repair</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>412</Ref_ID><Title_Primary>Isthmus-dependent right atrial flutter as the leading cause of atrial tachycardias after surgical atrial septal defect repair</Title_Primary><Authors_Primary>Wasmer,K.</Authors_Primary><Authors_Primary>Kobe,J.</Authors_Primary><Authors_Primary>Dechering,D.G.</Authors_Primary><Authors_Primary>Bittner,A.</Authors_Primary><Authors_Primary>Monnig,G.</Authors_Primary><Authors_Primary>Milberg,P.</Authors_Primary><Authors_Primary>Baumgartner,H.</Authors_Primary><Authors_Primary>Breithardt,G.</Authors_Primary><Authors_Primary>Eckardt,L.</Authors_Primary><Date_Primary>2013/10/3</Date_Primary><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Germany</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Time</Keywords><Reprint>Not in File</Reprint><Start_Page>2447</Start_Page><End_Page>2452</End_Page><Periodical>Int.J.Cardiol.</Periodical><Volume>168</Volume><Issue>3</Issue><ISSN_ISBN>1874-1754</ISSN_ISBN><Misc_3>S0167-5273(13)00430-0;10.1016/j.ijcard.2013.03.012</Misc_3><Address>Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Munster, Germany. Electronic address: wasmerk@ukmuenster.de</Address><Web_URL>PM:23540398</Web_URL><ZZ_JournalFull><f name="System">Int.J.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(301)23540398Retrospective single center54Consecutive Repaired ASD pts underwent EP study & ablation, mean age 47 y. Mean 22 y postop.f/u in 83%, 7.7 y. Mean AT CL 270 msec. ASD ablation & mechanisms of ATAT at EP study in 78%: RA macroreentry in 100%; CTI dependent 69%; typical atrial flutter 41%. 10% not inducible. CTI ablation in AF or non-inducible. Ablation acute success: 93%93% acute success ablation ASD. 4% recurred w/ different mechanism.60% arrhythmia free during f/u11% developed AFScaglione M2014 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNjYWdsaW9uZTwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+
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ADDIN EN.CITE.DATA (326)24843050Retrospective single center4646 repaired ASD pts, mean age 49 y; 89% secundum ASD. ECG atrial flutter 48%, atypical atrial flutter 35%, AT 17%. 41% also AF. Onset AT 19±12 y postop. Complete f/u, 7.3 yASD mechanisms & ablation outcomesTypical AF: 48%, atypical 35%, AT 17%. CTI dependent 26%, 74% atriotomy dependent; Ablation acute success 100%; recur 24%Recur same mechanism w/ gaps. 70% atypical atrial flutter had ECG concordance. ALL RA macro-reentry; no focal.High success ablation for ASD:100%, 24% recurrence20% repeat ablationsCHD: Catheter Ablation – Ebstein’sCappato R 1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhcHBhdG88L0F1dGhvcj48WWVhcj4xOTk2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (327)8759079Retrospective single center21Ebstein pts w/ AVRT: EP study + attempted RFA. 34 right sided AP in 21 pts. Mean age 28±14 y. Mean f/u 22 mo. Ebstein’s ablation outcomes76% acute success ablation AP. 24% recurrent SVT (5 pts, including 4/5 w/ acute success)—4/16 successful ablations-rec SVT=Cath ablation success 76%; 25% recurrence in 22 mo in pts w/ acutely successful ablation.Reich JD 1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlJlaWNoPC9BdXRob3I+PFllYXI+MTk5ODwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (328)9869537Retrospective multi-center6565 Ebstein’s pts, age 9.8±5.4 y, 82 accessory connections: 62% right, 34% septal, 4% left; only 52% w/ single AP; 9% AP plus atrial tachycardia; 9% non-AP tachycardia.Ebstein’s ablation outcomes Acute success 75-89%. Mild tricuspid regurgitation and BSA <1.7 predicted acute success. SVT related to AC 82%; 18% other atrial tachycardia mechanisms.CHD: Catheter Ablation – UVHDe Groot NM 2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPmRlIEdyb290PC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48
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ADDIN EN.CITE.DATA (329)19808474Retrospective single center1919 Pts w/ UVH, age 29±9 y; 41 SVT circuits; Procedural outcomes of ablation in UVHMechanisms: IART 73%; Typical atrial flutter 10%; Focal 15%; AF 2%. Acute ablation success: 73% IART; 75% atrial flutter; 100% focal f/u 53±34 mo: 16% died; 11% transplantUVH pts: Acute success ~78%Death or OHT : 27%Recurrence: 27% by 53 moYap SC2012PFJlZm1hbj48Q2l0ZT48QXV0aG9yPllhcDwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (330)22035149Retrospective single center11Ablation in Fontan pts vs. 30 other ACHD pts; atriopulmonary and AV Fontan, mean age 33±0 y. Assess AT substrate after Fontan surgeryFontan pts larger RA (p<.001), larger low-voltage area (p=.01). Acute success Fontan 54% vs. 83% other CHD (p=.04). F/u 2.3±1.6 y, IART recurrence 47%. Fontan pts lower acute success vs. other ACHD high recurrence 47% at 2.3 y all pts; Fontan 50 ±19%, vs. 32 ±10% non-Fontan pts at 2 yLarger RA size and low voltage areas predicted IART recurrenceCorrea R2015PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNvcnJlYTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (331)25583982Retrospective single center3252 consectutive pts underwent 57 EP studies 2006-2012. Mean age 18.4±11.8 y, all with TCPC type Fontans. 32 ablations, 31 for SVT. VT induced in 5/52 pts studied. No f/u in 19%. In others, median f/u 18 mo.Procedural outcomes of ablation in UVH.47 procedures w/ 54 defined SVT mechanisms. IART 46%, AVNRT 24%, focal 15%, AP 7%, twin AVN 7%. Additional 21 undefined AT. Ablation for SVT acute success 80%. Two major adverse events 6%: death, pulmonary embolus. 50% recurrence short term, improved arrhythmia scores.78% acute success for SVT. 50% recurrence short term; improved arrhythmia scores. 6% major adverse cardiac events. CHD: Catheter Ablation – TGAJones DG2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkpvbmVzPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (332)23219079Retrospective single center9AT ablations TGA Mustard; 9 procedures, 12 circuits between 2007-2012, median age 38 y (18-56 y), used Carto and irrigated tips. Median f/u 15 mo. Ablation outcomes TGA atrial switch ptsTransbaffle puncture in all. AT mechs: CTI dep: 75%, focal 25% (pulmonary venous ?). Acute success 100%; 25% recurrence w/in 16 mo. Death 11% (1/9); recurrent AT w/ CHF. ICD’s in 3/9. Ablation in pulmonary venous atrium needed in all pts. Acute success 100%, recurrence 25% short-term. Wu J2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPld1PC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVjTnVt
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ADDIN EN.CITE.DATA (333)23355133Retrospective single center26Ablation in 26 TGA pts s/p atrial switch repairs, mean age 28.7±6.7 y; 34 ablation procedures. Assess outcomes ablation in TGA atrial switch pts34 AT: IART 88%; AVNRT 12%. Acute success 85% of circuits. Mean f/u 34±24 mo, 30% recurrence IART. TGA atrial switch: high acute success, 34% recurrence <3 yCHD: Surgical therapyPressley JC 1992PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlByZXNzbGV5PC9BdXRob3I+PFllYXI+MTk5MjwvWWVhcj48
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ADDIN EN.CITE.DATA (334)1394922Retrospective, single center3838 pts, WPW and Ebstein anomly, surgical AP ablation and repair. Mean age 26.3 ±12.3 y, 1968-88. Compared to 384 pts undergoing AP surgery w/o Ebstein. 76% documented AVRT; 42% AF. F/u 6.2± 3.8 y.Assess surgical impact AP ablation during Ebstein repair.Mult AP 50%, right sided 79%, posteroseptal 58%, left 7.9%. Surgery mortality 5.3%, both <15 y old. 28/38 surgery repair + AP ablation; Successful AP ablation: 95%. 82% NS arrhythmias during f/u. Pts w/ Ebstein anomaly improved after surgery w/ AP ablation. Late AF reduced from 42% to 9%, p<.001.Misaki T 1995PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1pc2FraTwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (335)8523883Retrospective, single center4242 pts WPW = Ebstein, surgery 1973-1993. Mean age 35±14 y. 52 APs, 48 right or posteroseptal. Division of AP at surgery; 35 TV operation. Assess outcome WPW surgery in EbsteinAll 52 AP successfully rx at surg. 2 reops due to SVT: additional AP. Hospital mortality 7.1%. no late deaths f/u mean 94 moN/ATheodoro DA1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRoZW9kb3JvPC9BdXRob3I+PFllYXI+MTk5ODwvWWVhcj48
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ADDIN EN.CITE.DATA (336)9456109Retrospective, single center1818 ACHD pts mean age 34.9 y underwent RA Maze for AT/atrial flutter or AF:Ebstein 15, tricuspid regurgitation 2, ASD1. Mean f/u 8 mo. Assess outcome RA maze in ACHDNo early deaths. Early postop SVT 3. RA maze performed, even in pts w/ AF. Inclusion RA maze in ACHD pt w/ RA dilatation and AT is effective in eliminating or reducing AT. Huang CJ 2000 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkh1YW5nPC9BdXRob3I+PFllYXI+MjAwMDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (337)11145402Retrospective, single center3030 pts w/ Ebstein:surg repair 1973-1997. Preop EP study performed in 11 after 1980: surg ablation performed in 10/11: WPW 4, AVNRT 2, atrial flutter/AF 3, VT1. Assess survival difference w/ op ablation Ebstein. No mort in ablated pts. 7/30 died: 1-infection, 6 died suddenly. None of 6 sudden deaths underwent preop EP study. Detailed preop EP study in Ebstein: “mandatory”:Aggressive surg intervention for arrhythmia may reduce risk of sudden death. Mavroudis C 2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1hdnJvdWRpczwvQXV0aG9yPjxZZWFyPjIwMDE8L1llYXI+
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ADDIN EN.CITE.DATA (338) 11689789Retrospective, single center4040 Fontan conversions w/ arrhythmia surgery; mean age 18.7±9 y. All pts w/ AT; AF in 15.Assess impact of arrhythmia surgery on AT in FontanIsthmus ablation 10 pts, RA Maze 16, Biatrial maze 14. No mortality. Mean f/u 2.5±1.9 y, OHT 7.5%. Arrhythmia recurrence 12.5% Largely AP Fontan population; arrhythmia recurrence 12.5% at 2.5 yDeal BJ2002PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRlYWw8L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (220) 12147539Retrospective, single center23Comparison isthmus ablation (8) w/ RA maze (15) in AP Fontan pts w/ AT; median age 10.9 y (2-33 y)Assess efficacy of operative ablation techniques Fontan. Isthmus ablation: 62% recurrent AT; f/u 5.6 yRA maze: no recurrence, f/u 2.8 yRA maze superior to isthmus ablation in Fontan ptsKhositseth A2004PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktob3NpdHNldGg8L0F1dGhvcj48WWVhcj4yMDA0PC9ZZWFy
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ADDIN EN.CITE.DATA (339)15573066Retrospective single center8383129 adult Ebstein pts w/ SVT underwent arrhy procedure w/ surgery for Ebstein. 41: AP, mean age 18 y; 7 AVNRT, mean 18 y ; 48 atrial flutter/AF (RA maze 38, isthmus 10), mean 33 y. Assess arrhythmia surgery in EbsteinIncidence SVT: atrial flutter/AF 54%, AP 32%, AVNRT 8%. Surgical outcomes: AP or AVNRT: 0 recurrence 48 mo; Atrial flutter/AF 75% freedom from recurrence at 34 mo. Arrhy surg interventions should be added to surgical repair Ebstein in pts w/ SVT: AP, AVNRT, or atrial flutter/AF. AS AT present in 54% and increases w/ age, recommend AT surgery as well as AP surgery.Bockeria L 2005 PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJvY2tlcmlhPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48
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ADDIN EN.CITE.DATA (340)16179193Retrospective, single center5353 pts, Ebstein + SVT, mean age 21.6±10.7 y. Surgery + operative ablation: 32 pts; preop RFablation later surg: 21 pt. WPW 26, AVNRT 3, focal 3. Assess combined arrhythmia surgery in Ebstein vs. RFA + surgery.Mortality 3.1% in combined ablation operation vs. 0% in 2 staged. Efficacy: Surgery ablation 94% op vs. 76% catheter.Surgery efficacy WPW 92%, AVNRT 100%, focal 66%. Combined operative ablation + surg repair showed improved AT elimination vs. catheter ablation approach followed by surgery. Giamberti A 2006PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdpYW1iZXJ0aTwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+
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ADDIN EN.CITE.DATA (341)16996928Retrospective, single center1515 ASD pts, >40 y, surgical closure ASD w/ intraop RF ablation. All SVT: 8 AF, 7 AT/atrial flutter. 2002-2004. RA Maze 8, biatrial cox maze iii 7 pts. F/u mean 24 mo. Assess op ablation AT in ASD ptsNo mortality, one pacemaker. AF recurrentce 6.5%, no AT recurrence. Rec add intraop RF ablation to surgical ASD closure, safe & effective. Karamlou T 2006PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthcmFtbG91PC9BdXRob3I+PFllYXI+MjAwNjwvWWVhcj48
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ADDIN EN.CITE.DATA (343)16631672Retrospective, single center991993-2003, 99 pts RA maze w/ ACHD repair. Median age 43 y. Did not distinguish between AT and AF. Ebsteins 47, TR 19, UVH 11, ASD 8, TOF 8, other 6. Impact arrhythmia surgery on AT: ACHD. 6% early mortality. 28% early ATArrhythmia recurrence 7%, f/u 2.7 y; AA medications 55%.ACHD: 55% on AA meds; 93% not in AT at 2.7 yMavroudis C 2007PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1hdnJvdWRpczwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+
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ADDIN EN.CITE.DATA (344)17954046Retrospective, single center1111994-2007, 111 Fontan conversions w/ arrhythmia surgery; mean age 22.5 y. Mainly AP Fontan. Assess arrhythmia recurrence, survival FontanEarly mortality 0.9%, late death/OHT 11%. Late AT 13.5%, f/u 7.9 yLate AT in Fontan 13.5% at ~ 8 y;Giamberti A2008PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdpYW1iZXJ0aTwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+
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ADDIN EN.CITE.DATA (346)18721574Retrospective, single center100Arrhythmia operations, 11 no HD; 89 associated CHD (33 UVH); mean age 15.9 y. SVT 87, VT 13Assess surgical arrhythmia outcome ACHDMechs AT: ART 45, AF 11, AC 19, AVNRT 6, Focal 6; early mortality 3%, late death/OHT 6%; 10 y Freedom from AT 85%, 68% VTFreedom from AT at 10 y: 85% in mixed population ACHDAboulhosn J2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkFib3VsaG9zbjwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+
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ADDIN EN.CITE.DATA (347)21087427Retrospective, single center2727 atriopulm Fontan adults converted to TCPC; 67% extracardiac. 89% w/ atrial tach. 21/27 w/ arrhythmia surg: RA 12, RA + LA 9. Mean age 30 y (18-52 y)Mean f/u 4.2 y. Assess arrhythmia recurrence after Fontan arrhythmia surgery. Operative mortality 7.4%. Arrhythmia recurrence 14% (3/21)PLE 3; 1 died 27 mo postop, 2 resolved.Recurrrent AT in 14% w/ 4 y f/uGutierrez SD2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkd1dGllcnJlejwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+
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ADDIN EN.CITE.DATA (348)23280242Retrospective, single center2424 ACHD pts w/ AA undergoing surgery, mean age 40.9 y; incorporated cox maze procedure. 2004-2010. TOF 8, AVSD 4; RVOT repair 10, TV repair 8, ASD 7. Mean F/u 2.8 y, (.1-5.7 y). Assess outcome of cox maze procedure in ACHDPreop AT: 19, AF 5. Mortality: 16.5%, (12.5% early, 1 late)74% of survivors arrhythmia free. Pts w/ CHD and atrial arrhythmias, majority free of arrhythmias w Cox Maze procedure. Terrada T2013PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlRlcmFkYTwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (349)24887891Retrospective, single center2525 consecutive pts undergoing Fontan conversion 1/04-3/12. Mean age 21 6.3 y. 24/25 underwent arrhyth surg: RA maze 15, isthmus 3, biatrial 6. Mean f/u 21 mo(11-86 mo)Assess outcome Fontan arrhythmia surgery.Late AT recurrence 12.5%Operative mortality: 0. 16/25 no pacemaker implanted. 5 pts reoperation to implant pacer. Recurrent AT 12. 5%, Said SM2014PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNhaWQ8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (350)24786860Retrospective, single center7070 Fontan pts underwent Fontan conversion 1994-2011. Median age 23 y (4-46 y)AT present 89%TCPC intra-atrial 59%; extracardiac 26%, Lateral tunnel 16%. 49/70 arrhythmia surgery. Mean f/u 5 y. Assess outcome Fontan arrhythmia surgery.Late Recurrent AT in 16% of pts w/ arrhythmia surgeryOperative mortality 14%. 10 y survival 67%Periop death predictors: Age >27 y, AV valve regurgitation, males. PLE improved in 1/7 pts. Late Recurrent AT in 16%Pregnancy: Acute Conversion of AV Node-Dependent Tachycardia Ghosh N2011 ADDIN REFMGR.CITE <Refman><Cite><Author>Ghosh</Author><Year>2011</Year><RecNum>114</RecNum><IDText>The acute treatment of maternal supraventricular tachycardias during pregnancy: a review of the literature</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>114</Ref_ID><Title_Primary>The acute treatment of maternal supraventricular tachycardias during pregnancy: a review of the literature</Title_Primary><Authors_Primary>Ghosh,N.</Authors_Primary><Authors_Primary>Luk,A.</Authors_Primary><Authors_Primary>Derzko,C.</Authors_Primary><Authors_Primary>Dorian,P.</Authors_Primary><Authors_Primary>Chow,C.M.</Authors_Primary><Date_Primary>2011/1</Date_Primary><Keywords>Adenosine</Keywords><Keywords>Adrenergic beta-Antagonists</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Calcium Channel Blockers</Keywords><Keywords>Cohort Studies</Keywords><Keywords>drug therapy</Keywords><Keywords>Electric Countershock</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Pregnancy</Keywords><Keywords>Pregnancy Complications,Cardiovascular</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>17</Start_Page><End_Page>23</End_Page><Periodical>J Obstet.Gynaecol.Can</Periodical><Volume>33</Volume><Issue>1</Issue><ISSN_ISBN>1701-2163</ISSN_ISBN><Address>Department of Medicine, St. Michael's Hospital, Toronto ON</Address><Web_URL>PM:21272431</Web_URL><ZZ_JournalFull><f name="System">Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Obstet.Gynaecol.Can</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(351)21272431Review of all reports published 1950-2010 on acute termination of SVT138 ptsVariety of drugs. Most common adenosine w/ 58 cases. Also electrical DCCV 18 casesSuccessful termination of SVTAdenosine was most successful at terminating SVT. Beta blockers and verapamil second, led to more hypotension. Antiarrhythmic drugs not very effective.Variety of interventions was reported on acute termination of SVT. Most common adenosine w/ 58 cases. Also electrical DCCV 18 cases, verapamil 16 cases and beta blockers 13 cases. Diversity of antiarrhythmic drugs as well. Most effective was adenosine w/ 84% success, followed by beta blockers and verapamil. Cardioversion safe.Pregnancy: Catheter AblationDamilakis J2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRhbWlsYWtpczwvQXV0aG9yPjxZZWFyPjIwMDE8L1llYXI+
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ADDIN EN.CITE.DATA (352)11514375Conceptus radiation dose and risk determination for catheter ablation procedures.2020 women of childbearing ages who underwent ablation proceduresEstimation of radiation dose using phantom pregnancyTypical dose to conceptus was <1 mGyA typical ablation procedure results in very small increase in risk of harmful effects to the conceptus.Berruezo A2007 ADDIN REFMGR.CITE <Refman><Cite><Author>Berruezo</Author><Year>2007</Year><RecNum>115</RecNum><IDText>Low exposure radiation with conventional guided radiofrequency catheter ablation in pregnant women</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>115</Ref_ID><Title_Primary>Low exposure radiation with conventional guided radiofrequency catheter ablation in pregnant women</Title_Primary><Authors_Primary>Berruezo,A.</Authors_Primary><Authors_Primary>Diez,G.R.</Authors_Primary><Authors_Primary>Berne,P.</Authors_Primary><Authors_Primary>Esteban,M.</Authors_Primary><Authors_Primary>Mont,L.</Authors_Primary><Authors_Primary>Brugada,J.</Authors_Primary><Date_Primary>2007/10</Date_Primary><Keywords>Adult</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Female</Keywords><Keywords>Fetus</Keywords><Keywords>Fluoroscopy</Keywords><Keywords>Humans</Keywords><Keywords>Pregnancy</Keywords><Keywords>Pregnancy Complications,Cardiovascular</Keywords><Keywords>Radiation Dosage</Keywords><Keywords>radiation effects</Keywords><Keywords>Spain</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>1299</Start_Page><End_Page>1302</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>30</Volume><Issue>10</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Misc_3>PACE858;10.1111/j.1540-8159.2007.00858.x</Misc_3><Address>Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Barcelona, Spain. berruezo@clinic.ub.es</Address><Web_URL>PM:17897139</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(353)17897139Case report of ablation w/ low radiation exposure2 ptsPt w/ drug refractory SVT; ablation of SVT w/ radiation dosimeterSuccessful ablation; adverse effectsAll pathways eliminated successfullyBoth pts treated, fetus dose was very low, below dangerous limit.Szumowski2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlN6dW1vd3NraTwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+
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ADDIN EN.CITE.DATA (354)20158563Observational, multicenter report experience w/ ablation of SVT in pregnancy9 ptsPt w/ severe SVT refractory to medical therapy; ablation w/ low radiation exposureSuccessful ablation; adverse effectsAll pathways eliminated successfullyAll pts treated successfully, w/ either no radiation at all to very low dose.Pregnancy: Prophylactic Antiarrhythmic Drug TherapyWen Z1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPldlbjwvQXV0aG9yPjxZZWFyPjE5OTg8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (41)9851958Prospective cohort study133AVRT (n=85) AVNRT (n=48)EP study to induce PSVT by PESExcluded atrial flutter, AF organic heart disease or other systemic diseases involving the autonomic function (e.g., diabetes), those who could not blow into an aneroid manometer to maintain a pressure of 35 mm Hg for 20 sec, and those w/ unstable hemodynamics during tachycardia.Termination of PSVTVagal maneuvers more effective in terminating AVRT than AVNRT (53 vs. 33%, p<0.05). AVNRT: vagal maneuvers terminated tachycardia in antegrade slow pathway (14%) or in retrograde fast pathway (19%). Baroreflex sensitivity was poorer but isoproterenol sensitivity test better in pts w/ AVNRT.Vagal maneuvers effective, more so for AVRT. Limited in that study conducted during EP study.Lydakis C 1999 ADDIN REFMGR.CITE <Refman><Cite><Author>Lydakis</Author><Year>1999</Year><RecNum>119</RecNum><IDText>Atenolol and fetal growth in pregnancies complicated by hypertension</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>119</Ref_ID><Title_Primary>Atenolol and fetal growth in pregnancies complicated by hypertension</Title_Primary><Authors_Primary>Lydakis,C.</Authors_Primary><Authors_Primary>Lip,G.Y.</Authors_Primary><Authors_Primary>Beevers,M.</Authors_Primary><Authors_Primary>Beevers,D.G.</Authors_Primary><Date_Primary>1999/6</Date_Primary><Keywords>Adult</Keywords><Keywords>adverse effects</Keywords><Keywords>Antihypertensive Agents</Keywords><Keywords>Atenolol</Keywords><Keywords>Cohort Studies</Keywords><Keywords>complications</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Embryonic and Fetal Development</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Hypertension</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Pregnancy</Keywords><Keywords>Pregnancy Complications,Cardiovascular</Keywords><Keywords>Pregnancy Outcome</Keywords><Keywords>Prevalence</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>therapeutic use</Keywords><Reprint>Not in File</Reprint><Start_Page>541</Start_Page><End_Page>547</End_Page><Periodical>Am J Hypertens.</Periodical><Volume>12</Volume><Issue>6</Issue><ISSN_ISBN>0895-7061</ISSN_ISBN><Misc_3>S0895-7061(99)00031-X</Misc_3><Address>University Department of Medicine, City Hospital, Birmingham, United Kingdom</Address><Web_URL>PM:10371362</Web_URL><ZZ_JournalFull><f name="System">American journal of hypertension</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Hypertens.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(355)10371362Retrospective study on the effect of Atenolol and other drugs on fetal growth78Atenolol given to 78 pregnant women and compared to other parison of adverse effects to fetal growthIncreased risk of fetal growth retardationPossible increased risk of fetal growth retardation on atenolol compared to other drugs, risk related to duration of treatment.Von Dadelszen P 2000 ADDIN REFMGR.CITE <Refman><Cite><Author>von Dadelszen</Author><Year>2000</Year><RecNum>314</RecNum><IDText>Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>314</Ref_ID><Title_Primary>Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis</Title_Primary><Authors_Primary>von Dadelszen,P.</Authors_Primary><Authors_Primary>Ornstein,M.P.</Authors_Primary><Authors_Primary>Bull,S.B.</Authors_Primary><Authors_Primary>Logan,A.G.</Authors_Primary><Authors_Primary>Koren,G.</Authors_Primary><Authors_Primary>Magee,L.A.</Authors_Primary><Date_Primary>2000/1/8</Date_Primary><Keywords>analysis</Keywords><Keywords>Antihypertensive Agents</Keywords><Keywords>Birth Weight</Keywords><Keywords>blood</Keywords><Keywords>Blood Pressure</Keywords><Keywords>Canada</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Hypertension</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Infant,Small for Gestational Age</Keywords><Keywords>methods</Keywords><Keywords>Pregnancy</Keywords><Keywords>Pregnancy Complications,Cardiovascular</Keywords><Keywords>Pressure</Keywords><Keywords>Regression Analysis</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>87</Start_Page><End_Page>92</End_Page><Periodical>Lancet</Periodical><Volume>355</Volume><Issue>9198</Issue><ISSN_ISBN>0140-6736</ISSN_ISBN><Misc_3>S0140673698080490</Misc_3><Address>Department of Obstetrics and Gynaecology, University of Toronto, Canada</Address><Web_URL>PM:10675164</Web_URL><ZZ_JournalStdAbbrev><f name="System">Lancet</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(356)10675164Metanalysis of different drugs, mainly beta blockers, inpregnancy3773Meta analysis of different drugs for pregnancy induced HTN to try to determine if growth retardation is due to drugs or disease.The association of treatment-induced difference in mean arterial pressure with measures of fetoplacental growthRelationship was observed between fall in MAP and growth retardation, but was not related to drugs.Beta blockers mainly safe during pregnancy, growth retardation likely due to fall in BP.Bartalena2001 ADDIN REFMGR.CITE <Refman><Cite><Author>Bartalena</Author><Year>2001</Year><RecNum>117</RecNum><IDText>Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>117</Ref_ID><Title_Primary>Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment</Title_Primary><Authors_Primary>Bartalena,L.</Authors_Primary><Authors_Primary>Bogazzi,F.</Authors_Primary><Authors_Primary>Braverman,L.E.</Authors_Primary><Authors_Primary>Martino,E.</Authors_Primary><Date_Primary>2001/2</Date_Primary><Keywords>abnormalities</Keywords><Keywords>adverse effects</Keywords><Keywords>Amiodarone</Keywords><Keywords>Breast Feeding</Keywords><Keywords>chemically induced</Keywords><Keywords>complications</Keywords><Keywords>diagnosis</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Fetus</Keywords><Keywords>growth & development</Keywords><Keywords>Humans</Keywords><Keywords>Hypothyroidism</Keywords><Keywords>Infant</Keywords><Keywords>Infant,Newborn</Keywords><Keywords>Italy</Keywords><Keywords>Lactation</Keywords><Keywords>Maternal-Fetal Exchange</Keywords><Keywords>Nervous System</Keywords><Keywords>Pregnancy</Keywords><Keywords>Psychomotor Disorders</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>116</Start_Page><End_Page>130</End_Page><Periodical>J Endocrinol.Invest</Periodical><Volume>24</Volume><Issue>2</Issue><ISSN_ISBN>0391-4097</ISSN_ISBN><Address>University of Insubria, Varese, Italy</Address><Web_URL>PM:11263469</Web_URL><ZZ_JournalFull><f name="System">Journal of endocrinological investigation</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">J Endocrinol.Invest</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(357)11263469Review of case reports when amiodarone was given during pregnancy64Review of case reports when amiodarone was given. There were 64 identified and effect on babies was reported.Adverse effects documented on progeny of mothers who received amiodarone.Hypothyroidism reported in 17%, which most of the time was transient. Some developmental disabilities seen even in euthyroid.Maternal use of amiodarone can cause hypothyroidism in progeny and occasionally neurodevelopmental abnormalities. Qasqas SA 2004 ADDIN REFMGR.CITE <Refman><Cite><Author>Qasqas</Author><Year>2004</Year><RecNum>109</RecNum><IDText>Cardiovascular pharmacotherapeutic considerations during pregnancy and lactation</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>109</Ref_ID><Title_Primary>Cardiovascular pharmacotherapeutic considerations during pregnancy and lactation</Title_Primary><Authors_Primary>Qasqas,S.A.</Authors_Primary><Authors_Primary>McPherson,C.</Authors_Primary><Authors_Primary>Frishman,W.H.</Authors_Primary><Authors_Primary>Elkayam,U.</Authors_Primary><Date_Primary>2004/7</Date_Primary><Keywords>Abnormalities,Drug-Induced</Keywords><Keywords>adverse effects</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Anticoagulants</Keywords><Keywords>blood supply</Keywords><Keywords>Breast Feeding</Keywords><Keywords>Cardiac Glycosides</Keywords><Keywords>Cardiovascular System</Keywords><Keywords>drug effects</Keywords><Keywords>drug therapy</Keywords><Keywords>Female</Keywords><Keywords>Fetus</Keywords><Keywords>Humans</Keywords><Keywords>Infant</Keywords><Keywords>Lactation</Keywords><Keywords>Maternal-Fetal Exchange</Keywords><Keywords>pharmacokinetics</Keywords><Keywords>Pregnancy</Keywords><Keywords>Prenatal Exposure Delayed Effects</Keywords><Keywords>prevention & control</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>201</Start_Page><End_Page>221</End_Page><Periodical>Cardiol Rev.</Periodical><Volume>12</Volume><Issue>4</Issue><ISSN_ISBN>1061-5377</ISSN_ISBN><Misc_3>10.1097/01.crd.0000102420.62200.e1;01.crd.0000102420.62200.e1</Misc_3><Address>Departments of Medicine, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri, USA</Address><Web_URL>PM:15191632</Web_URL><ZZ_JournalFull><f name="System">Cardiology in review</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Cardiol Rev.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(358)15191632Review article on all cardiovascular drugs in pregnancy.N/AThis is a review article. 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ADDIN EN.CITE.DATA (359) 21931080 Nonrandomized multicenter comparison of different drugs administered for transplacental therapy of fetal SVT159The authors reviewed 159 consecutive referrals w/ fetal SVT (n=114) and AF (n=45). Of these, 75 fetuses w/ SVT and 36 w/ AF were treated nonrandomly w/ transplacental flecainide (n=35), sotalol (n=52), or digoxin (n=24) as a first-line agent.Effectiveness of different drugs reported.Flecainide and digoxin were superior to sotalol for fetal SVT.This was a study for fetal SVT, but showed that flecainide sotalol and digoxin are well tolerated in pregnant women.SVT in the ElderlyChen SA 1995PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNoZW48L0F1dGhvcj48WWVhcj4xOTk1PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (360)7490388Observational66 pts w/ AVRT and AVNRT w/ initial sx onset after age 65 vs. 440 pts w/ sxs onset before age 30All pts underwent EP study and RFA;4 mm tip temperature control deflectable catheterCompare clinical characteristics in the older vs. younger grooupsOlder group: 32/66 had AVRT, 34/66 had AVNRTYounger group: 283/440 AVRT, 157/444 AVNRTSxs of syncope and cardioversion were similar between two age groups; older pts had more atrial and ventricular ectopic beats on Holter; dispersion of anterograde ERP was greater in older pts; Success rate was 97-98% in all groups; Recurrence was similar (6-7%; f/u duration was not stated in the paper); complications were significantly higher (13-14% in older pts than younger pts (1%) (for AVRT: 2 arterial thrombosis, 1 TIA, 1 DVT; for AVNRT: 1 DVT, 1 AV block)Greater dispersion of ERP and increased atrial and ventricular ectopic beats may explain the later onset of sxs in older pts.Chen SA1996PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNoZW48L0F1dGhvcj48WWVhcj4xOTk2PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (361)8540455Observational3966 consecutive EP study and 2593 ablation procedures Tertiary referral center in Taiwan, 1987 – 19944 mm tip temperature control deflectable catheterRisk factors associated w/ complicationsOverall complications, RFA vs. EP study, 3.1% vs. 1.1% (p 0.00002); Older (≥65 y) vs. younger, 2.2% vs. 0.5% (p 0.0002) for EP study and 6.1% vs. 2.0% for RFA. Older age and presence of systemic disease are independent predictors for plications included pericardial eff/usion, tamponade, AVB, vascular injury, systemic emboli)Data suggest older age is an independent risk for EP study and RFA. These data are somewhat out dated. Older pts had more co-morbidies and the presence of systemic diseases (co-morbidities) is an independent predictor of acute complications.Boulos M1998 ADDIN REFMGR.CITE <Refman><Cite><Author>Boulos</Author><Year>1998</Year><RecNum>315</RecNum><IDText>Age dependence of complete heart block complicating radiofrequency ablation of the atrioventricular nodal slow pathway</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>315</Ref_ID><Title_Primary>Age dependence of complete heart block complicating radiofrequency ablation of the atrioventricular nodal slow pathway</Title_Primary><Authors_Primary>Boulos,M.</Authors_Primary><Authors_Primary>Hoch,D.</Authors_Primary><Authors_Primary>Schecter,S.</Authors_Primary><Authors_Primary>Greenberg,S.</Authors_Primary><Authors_Primary>Levine,J.</Authors_Primary><Date_Primary>1998/8/1</Date_Primary><Keywords>adverse effects</Keywords><Keywords>Age Factors</Keywords><Keywords>Aged</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Electrocardiography</Keywords><Keywords>etiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart</Keywords><Keywords>Heart Block</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Postoperative Complications</Keywords><Keywords>Recurrence</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Risk</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Reprint>Not in File</Reprint><Start_Page>390</Start_Page><End_Page>391</End_Page><Periodical>Am J Cardiol</Periodical><Volume>82</Volume><Issue>3</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>S0002-9149(98)00289-6</Misc_3><Address>Cardiac Arrhythmia and Pacemaker Center, St. Francis Hospital, Long Island, New York, USA</Address><Web_URL>PM:9708674</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(362)9708674Observational 271 consecutive ptsAVNRT from a single center undergoing RFA, 1991 – 1995.4 mm tip deflectable catheter were used to map and ablateSlow pathway ablationAcute success rate 98.1%, recurrence rate 4.1%; CHB 2.2%, 2% for pts <65 y of age, 8% in older pts; Older age is associated w/ higher risk of CHB.Data are historical.The focus was on AVB complicating slow pathway ablation; no other complications were reported.Kalusche1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbHVzY2hlPC9BdXRob3I+PFllYXI+MTk5ODwvWWVhcj48
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ADDIN EN.CITE.DATA (9)9812187 Retrospective cohort study395 pts undergoing AVNRT RFA. 85 (22%) ≥65 y (mean 70 y). Consecutive pts from a single center in Germany, 1992 – 19979 pts were excluded due to more than one tachycardia inducible4 mm tip temperature controlled deflectable catheterClinical presentation and outcomes in young vs. elderly during AVNRT ablationSimilar to younger pts, elderly more often had organic heart disease (CAD w/ or w/o MI,19.3% vs. 2.6%; P<0.02), syncope or presyncope w/ AVNRT (43.2% vs. 29.8%; P<0.05). 17.5% vs. 6.5% (P<0.05) the fast pathway approach was chosen as the first therapy. The overall success rate (96.8% vs. 95.3%) and recurrence rate (5.8% vs. 4.9%) were similar in both pt groups.Details of complications not listed: “minor complications such as hematoma; severe complications such as need of a PM” (2 in older group, 1 in younger group); f/u 2-68 mo.Elderly pts have more severe sxs and more comorbid illnesses, but RFA safe. Zado2000PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlphZG88L0F1dGhvcj48WWVhcj4yMDAwPC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (363)10676694 Prospective cohort study695 pts were divided into: ≥80 y (n=37), 60-79 (n=275), and <60 y (n=383)Ablation for SVT, VT (only 8% VT, 43% His ablation)Determine whether catheter ablation is safe and effective in pts >80 y.Overall success rate 95% (e groups (97% ≥80 y; 94% 60-79 y; 95%, <60 y). The overall complication rate for the entire group was 2.6%; no difference in complication rates among the groups (0%, ≥80 y; 2.2%, 60 to 79 y; 3.1%, <60 y)RFA safe in elderly. However ,only 37 pts were >80 y. Li YG2001PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxpPC9BdXRob3I+PFllYXI+MjAwMTwvWWVhcj48UmVjTnVt
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ADDIN EN.CITE.DATA (364)11133214Observational18 pts among 346 pts w/ prolong PR at baselineSlow pathway ablation in pts w/ AVNRT4 mm tip temperature control deflectable catheterLate occurrence of AVB after complete short pathway ablation in AVNRT18/346 pts w/ prolong PR before RFA, age 62±7; Holters were obtained before, 1 d, 1 wk, 1, 3, 6 mo after ablation. Incidence of delayed AVB occurred in 6/18 pts w/ preexisting PR prolongation; antepgrade ERP was longer in the study groupRisk of AVB is increased after short pathway ablation in pts w/ pre-existing PR prolongation. These data have not been confirmed in the contemporary era.Porter MJ2004PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBvcnRlcjwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (365)15851189Observational 1754 consecutive pts, 1856 PSVT from a single center 1991-2003PSVT undergoing RFA; exclude IAST, flutter and fibrillation, age <5Mapping and ablation techniques were not described. Age and gender correlation to PSVTMean age 49±19 (5-96), women 62%; AVNRT 1042 (56%), AVRT 500 (27%), AT 315 (17%); AVRT decreases w/ age in both genders; AVNRT and AT increased w/ older age; majority (54.6%) of AVRT were men; majority of AVNRT and AT were women; In women, 63% had AVNRT, 20% AVRT and 17% AT; in men, 45% AVNRT, 39% AVRT, 17% ATSVT is age and gender dependent in this single center study among pts referred for RFA. It is unknown whether this reflects the epidemiology in the general population due to the evolution of ablation from 1990 – current and whether referral bias, specifically related to age.This is an age and gender dependent mechanism study; not an outcome studyRostock 2005PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlJvc3RvY2s8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (366)15946358 Retrospective cohort study<75 y (n=508) and pts ≥75 y (n=70)All pts w/ symptomatic AVNRT referred for slow-pathway ablation Determine whether catheter ablation is safe and effective in pts ≥75 y.Preexisting prolonged PR interval was present in 3.3 vs. 37% in pts <75 vs. older, p<0.0001). Following successful slow-pathway ablation, no induction of an AV block was observed in >75 y group. No recurrences occurred pts ≥75 y.Slow-pathway ablation in elderly pts effective and safe and should be considered as first line therapy in this pt population. Challenges evidence that preexisting PR prolongation found to be associated w/ a higher risk of developing a delayed high-degree AV block.Kihel J2006PFJlZm1hbj48Q2l0ZT48QXV0aG9yPktpaGVsPC9BdXRob3I+PFllYXI+MjAwNjwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (367)16687422Observational, case control42 pts ≥75 y vs. 234 pts <75 yConsecutive pts w/ AVNRT from a single center in France, 1997 – 2004. 4 mm tip deflectable catheters were used for mapping and ablationDetermine whether catheter ablation is safe and effective comparing older vs. younger ptsSuccess rate 100% in the elderly vs. 99.6% in the younger pts; 1 minor complication of groin hematoma occurred in older pts (2.4%), 4 (1.7%) in younger pts including one PE, one pericardial effusion, 2 hematoma. Recurrent was 0 in older pts, 3.4% in the younger pts (p 0.5)F/u duration was 28 mo and 35 mo in older and younger groups, respectively.Catheter ablation for AVNRT is reasonable w/ high success rate and low complication rate. The data are more contemporary.No difference between older and younger groups.Dagres N 2007PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRhZ3JlczwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (368)17434888Observational131 consecutive pts ≥80 y old undergoing ablation Consecutive pts from 3 centers: Greece, Germany and Switzerland, 1998 – 2004“Temperature guided” approach Determine pt characteristics and ablation outcomesFlutter most common (54%), AVNRT 22%, AF 18%. 52% had SHD. AVN ablation was performed in pts w/ AF. Overall success rate was 97% w/ one pts had a CVA after isthmus ablation for flutter. Minor complications such as hematoma occurred in 3.1% of study populationIn selected elderly pts, ablation is highly successful for flutter, AVNRT and AVN ablation. More than half of the elderly pts have SHD when undergoing RFA. The consistent theme w/ other contemporary studies is that elderly have more co-morbid conditions but the overall ablation outcomes are highly successful w/ acceptable low complications. None of these studies are randomized studies; selection bias cannot be excluded.Haghjoo M 2007PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhhZ2hqb288L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (369)17069836Observational case control268 consecutive pts underwent RFA for AVNRT; 2001 - 2005Dichotomized at 65 y of ageAblation outcomes156/112 : younger/older; CL longer in older pts; success rate, complications, the recurrences were similar between older and younger ptsNo significant differences in outcomes between the two age groups dichotomized at 65 y of agePedrinazzi C 2007PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlBlZHJpbmF6emk8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFy
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ADDIN EN.CITE.DATA (370)17823861ObservationTotal of 605 ptsConsecutive pts undergoing RFA for all arrhythmias in a single center in Italy, 2000-20054 mm tip temperature control deflectable catheterRFA outcomesOlder pts had more co-morbidities; 69% <70 y of age, 24% 70-79 y, 7% ≥80 y; complications were similar 1.2 vs. 1.4 vs. 2%; Complications included pneumothorax, pericardial eff/usion, and hematoma; success rates were similar 92 vs. 88 vs. 88%; recurrence was followed up to 12 mo; AT and flutter had higher recurrence rate than AVNRT or AVRTOutcomes of RFA for SVT and VT were similar in younger and older pt groups.No major complicationsYangni N’Da’ O2008 ADDIN REFMGR.CITE <Refman><Cite><Author>Yangni</Author><Year>2008</Year><RecNum>327</RecNum><IDText>Clinical characteristics and management of paroxysmal junctional tachycardia in the elderly</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>327</Ref_ID><Title_Primary>Clinical characteristics and management of paroxysmal junctional tachycardia in the elderly</Title_Primary><Authors_Primary>Yangni,N'Da' O.</Authors_Primary><Authors_Primary>Brembilla-Perrot,B.</Authors_Primary><Date_Primary>2008/3</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Comorbidity</Keywords><Keywords>complications</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart Rate</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>physiology</Keywords><Keywords>physiopathology</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Syncope</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Ectopic Junctional</Keywords><Keywords>Tachycardia,Paroxysmal</Keywords><Keywords>therapy</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>143</Start_Page><End_Page>148</End_Page><Periodical>Arch.Cardiovasc Dis</Periodical><Volume>101</Volume><Issue>3</Issue><ISSN_ISBN>1875-2136</ISSN_ISBN><Misc_3>S1875-2136(08)71795-9</Misc_3><Address>Service de cardiologie, Centre hospitalier universitaire de Brabois, Vandoeuvre-les-Nancy</Address><Web_URL>PM:18477940</Web_URL><ZZ_JournalFull><f name="System">Archives of cardiovascular diseases</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Arch.Cardiovasc Dis</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(371)18477940Observational141/816 (17%) elderly >70 y of age admitted for recurrent SVTParoxysmal junctional tachycardia actually included AVNRT and AVRTTemperature controlled catheterClinical outcomes after RFAIn the acute setting: Cardiac decompenstation 10, syncope 26, ACS 14, vascular event 5; typical AVNRT 73%; atypical AVNRT more common in older pts than in younger pts (15% vs. 4%); ablation was performed in 79% of the older pts vs. 57% in the younger pts; complications more common 7% vs. 2.5% in older pts; more AF induced during study (19% vs. 5%)Older pts have more severe sxs associated w/ SVT at baseline; Atypical AVNRT is more common in older pts. Complications are higher in older pts.Very difficult paper to understand; did not specifically, or clearly, state the types of complications.Hoffman BA2011PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhvZmZtYW5uPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48
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ADDIN EN.CITE.DATA (372)21315834German registry; 48 trial centers in Germany3234 consecutive pts undergoing AVNRT ablation from 3/2007 to 5/2010AVNRT pts: >50 yGroup 1, n=1,268 [39.2%]; median age 40 y (95% CI: 30.0–45.0 y), 74.1% women, Group 2 50–75 y old(n=1,707 [52.8%]; 63.0 y [95% CI: 58.0–69.0] y, 63.0%women)Group 3 >75 y old (n =259 [8.0%]; 79.0 [95% CI: 77.0–82.0] y, 50.6% women).Acute and long term success rate, complications and recurrenceNo differences were observed among the three groups w/ regard to primary CA success rate (98.7% vs. 98.8% vs. 98.5%; P=0.92)Hemodynamically stable pericardial eff/usion occurred in five group 2 (0.3%) and two group 3 (0.8%) ptsbut in none of the group 1 (P=0.05) ptsAV block requiring permanent pacemaker implantation occurredin two pts in group 1 (0.2%) and six pts in group 2(0.4%) but none in group 3 (P= 0.41)During a median f/u of 511 d, recurrence rate was 5.7% in all ptsCatheter ablation for AVNRT is highly effective and safe and does not pose an increased risk for complete AV block in pts over 75 y of age, despite a higher prevalence of structural heartdisease.Ghali WA2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Ghali</Author><Year>2005</Year><RecNum>657</RecNum><IDText>Atrial flutter and the risk of thromboembolism: a systematic review and meta-analysis</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>657</Ref_ID><Title_Primary>Atrial flutter and the risk of thromboembolism: a systematic review and meta-analysis</Title_Primary><Authors_Primary>Ghali,W.A.</Authors_Primary><Authors_Primary>Wasil,B.I.</Authors_Primary><Authors_Primary>Brant,R.</Authors_Primary><Authors_Primary>Exner,D.V.</Authors_Primary><Authors_Primary>Cornuz,J.</Authors_Primary><Date_Primary>2005/2</Date_Primary><Keywords>analysis</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Canada</Keywords><Keywords>complications</Keywords><Keywords>Echocardiography</Keywords><Keywords>Electric Countershock</Keywords><Keywords>etiology</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Patients</Keywords><Keywords>Prognosis</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>Risk Factors</Keywords><Keywords>Thromboembolism</Keywords><Reprint>Not in File</Reprint><Start_Page>101</Start_Page><End_Page>107</End_Page><Periodical>Am J Med</Periodical><Volume>118</Volume><Issue>2</Issue><ISSN_ISBN>0002-9343</ISSN_ISBN><Misc_3>S0002-9343(04)00687-4;10.1016/j.amjmed.2004.06.048</Misc_3><Address>Department of Medicine, University of Calgary, Alberta, Canada. wghali@ucalgary.ca</Address><Web_URL>PM:15694889</Web_URL><ZZ_JournalFull><f name="System">The American journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(222)Systematic review and meta-analysis of observational studies that investigated risk of thromboembolism associated with atrial flutter.The meta analysis included 13 studies on embolic risk around time of cardioversion that included 1546 patients. For chronic risk, there were 14 studies involving 17,691 patients.MEDLINE, EMBASE, bibliographies, and consultation with clinical experts were used to identify studies that report the risk of thromboembolism associated with attempted cardioversion and longer-term risk in patients with atrial flutter.Risk of thromboembolism associated with atrial flutter around time of cardioversion or over the long term in chronic atrial flutter.Around the time of cardioversion, the risk of thromboembolic events ranged from 0% to 7.3% depending of clinical factors.Lower event rates were observed in patients taking anticoagulants.The long term risk rate of thromboembolism was approximately 3% with sustained atrial flutter.The findings of this systematic review strongly suggest that atrial flutter does indeed impart a risk of thromboembolism. AA indicates antiarrhythmic; AARCC, Allicance for Adult Research in Congential Cardiology; AC, atrioventricular connections; ACE I/D, angiotensin converting enzyme insertion/deletion; ACHD, adult congenital heart disease; ACS, acute coronary syndrome; ADT, antidromic tachycardia; AF, atrial fibrillation; AICD, automatic implantable cardioverter defibrillator; AP, accessory pathway; APERP, accessory pathway effective refractory period; ART, atrioventricular tachycardia; ASD, atrioventricular septal defect; AT, atrial tachycardia; ATP, antitachycardia pacing; AVB, atrioventricular block; AVN, atrioventricular node; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; AVSD, atrioventricular septal defects; BMI, body mass index; bpm, beats per min; BP, blood pressure; BSA, body surface area; CAD, coronary artery disease; cc-TGA, congenitally corrected transposition of the great arteries; CHD, congenital heart disease; CHF, congestive heart failure; CK-MB, creatinine kinase myocardial enzyme; CL, cycle length; CONCOR, Interuniversity Cardiology Institute of the Netherlands and the Netherlands Heart Foundation; CPB, cardiopulmonary bypass; CTI, cavotricuspid isthmus; CVA, cerebral vascular accident; DCCV, direct current cardioversion; DOVR, double outlet right ventricle; DVT, deep vein thrombosis; dx, diagnosis; EAT, ectopic atrial tachycardia; ECG, electrocardiogram; ECMO, extracorporeal membrane oxygenation; ED, emergency department; EP, electrophysiological; ERP, effective refractory period; f/u, follow up; HF, heart failure; h/o, history of; HR, heart rate; HTN, hypertension; IART, intraatrial reentrant tachycardia; IAST, inappropriate sinus tachycardia; ICD, implantable cardioverter defibrillator; ICU, intensive care unit; intraop, intraoperative; IV, intravenous; JET, junctional ectopic tachycardia; LA, left atrium; LFW, left free wall; LOS, length of stay; LVEF, left ventricular ejection fraction; MAP, mean arterial pressure; MAT, multifocal atrial tachycardia; MI, myocardial infarction; MRI, magnetic resonance imaging; NOS, nitric oxide synthase; NS, non-significant; NSVT, nonsustained ventricular tachycardia; OHT, orthotopic herat transplant; OR, odds ratio; ORT, orthodromic tachycardia; PES, programmed electrical stimulation; PLE, protein-losing enteropathy; postop, postoperative; POTS, postural tachycardia syndrome; preop, preoperative; PSVT, paroxysmal supraventricular tachycardia; pt, patient; QOL, quality of life; RA, right atrium; RACHS, risk adjustment for congenital heart surgery; RF, radiofrequency; RFA, radiofrequency ablation; RFCA, radiofrequency catheter ablation; RFW, right free wall; RV, right ventricular; RVOT, right ventricular outflow tract; rx, therapy; SHD, structural heart disease; s/p, status post; SR, sinus rhythm; SVA, supraventricular arrhythmia; SVT, supraventricular tachycardia; sx, symptom; TCPC, total cavopulmonary connection; TEP, transesophageal pacing; TGA, transposition of the great arteries; TIA, transischemic attack; TOF, tetralogy of Fallot; TSH, thyroid stimulating hormone; TV, tricuspid valve; UVH, univentricular heart; VA, ventriculoatrial; VF, ventricular fibrillation; VSD, ventricular septal defect; VT, ventricular tachycardia; w/, with; w/o, without; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 21. Randomized Trials Comparing Special Populations – Section 9 Study Name, Author, YearAim of StudyStudy Type (Size, N)Study Intervention Group (n)Study Comparator Group (n)Pt PopulationEndpointsP Values, OR: HR: RR: & 95% CI:Summary/ConclusionsInclusion CriteriaExclusion CriteriaPrimary Endpoint (efficacy) and ResultsSafety Endpoint and ResultsSecondary Endpoint and ResultsSaul JP 2005PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNhdWw8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA (373)16316969IV amiodarone efficacy/safetyMulticenter randomized double-blind (N=61)Ages <16 y, median 1.6 y. SVT 26, JET 31. 71% SHD. Dosages: low 1 mg/kg, medium 5 mg/kg, high 10 mg/kg, plus 47 h maintenance. 30 d f/u.N/AAges <16 y, median 1.6 y, SVT 26, JET 31. 71% SHD. Amidarone use <3 mo, drug intereaction w/ amiodarone, imminent death, intentional hypothermia to <35 degrees CEndpoint: time to success. Success low 47%, medium 80%, high 73%.Adverse events 87%, 5 deaths, 2 related to drug: profound hypotension medium and high dose.N/AMedium or high dose effective 2.1-2.6 h.Efficacy JET 67-83%. SVT 33-89%.Lim SH2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxpbTwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA (38)19261367Compare efficacy of bolus adenosine vs. slow calcium channel blockers in ED rx SVTProspective randomized trial (N=206). Mean ages 48.3±18.6 y.104 pts; adenosine 6 mg followed by 12 mg given as needed. Stopped w/ SVT conversion102 pts infusion verapamil 1 mg/min to max 20 mg, or dilitazem 2.5 mg/min to max 50 mg. Stopped w/ SVT conversion.Pts ≥10 y in ED w/ narrow QRS tachycardia, ECG dx SVT, not converting w/ vagal maneuvers.N/AConversion to SR: calcium channel blockers 98% vs. adenosine 86.5% (RR: 1/13; p= 0.002)N/ADrop in BP more common in calcium blockers group, mean SBP ↓13-7 mm Hg vs. no change w/ adenosine.N/ACalcium channel blockers effective and safe alternative to adenosine for conversion SVT; implications for cost. Manrique AM 2010PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1hbnJpcXVlPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48
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ADDIN EN.CITE.DATA (374)19819469Assess magnesium sulfate supplementation during CPB on risk of JETRandomized, double-blind, controlled trial (N=99)2/05-8/06, pts <17 y undergoing CPB repair CHD randomized to receive MgSO4 during rewarmingPlacebo: 3 groups: Mg 25 mg/kg, 50 mg/kg or placebo.Pts from birth-17 y w/ elective cardiac surgery.Pts with Mg supplements for malnutrition, sepsis, pancreatitis, neonates.Total incidence JET 7.0%.JET incidences: Placebo 31%, low Mg 10%; higher Mg 0%. N/AN/AYounger age <1 mo, complex CHD Aristotle score ≥4, prior CHF correlated w/ JET. MgSO4 reduced incidence of postop JETSanatani S2012PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlNhbmF0YW5pPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48
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ADDIN EN.CITE.DATA (375)22962431Compare digoxin vs. propranolol for control of infant SVTMulticenter randomized double-blind (N=61)Digoxin (27)Propranolol (34)Infants <4 mo w/ SVT, AVRT or AVNRT.Excluding manifest WPW.Recurrent SVT. 27 digoxin, 34 propranolol SVT recurred 19% digoxin, 31% propranolol (p=0.25, NS). Recurrence free status 79% digoxin, 67% propranolol, NS.No deaths, no serious adverse events.Time to recurrence, adverse events. No first recurrence after 10 d.N/ANo difference between digoxin and propranolol in preventing recurrent SVT. As recurrences did not occur >110 d, may not need prolonged rx. AVNRT indicates atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; BP, blood pressure; CHD, congenital heart disease; CHF, congestive heart failure; CPB, cardiopulmonary bypass; dx, diagnosis; ECG, echocardiogram; ED, emergency department; IV, intravenous; JET, junctional ectopic tachycardia; N/A, not applicable; NS, non-significant; pt, patient; rx, therapy; SBP, systolic blood pressure; SHD, structural heart disease; SR, sinush rhythm; SVT, supraventricular tachycardia; w/, with; and WPW, Wolff-Parkinson-White syndrome. Data Supplement 22. Nonrandomized Trials, Observational Studies, and/or Registries of Quality-of-Life Considerations – Section 10StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsLau CP1995 ADDIN REFMGR.CITE <Refman><Cite><Author>Lau</Author><Year>1995</Year><RecNum>351</RecNum><IDText>The effects of radiofrequency ablation versus medical therapy on the quality-of-life and exercise capacity in patients with accessory pathway-mediated supraventricular tachycardia: a treatment comparison study</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>351</Ref_ID><Title_Primary>The effects of radiofrequency ablation versus medical therapy on the quality-of-life and exercise capacity in patients with accessory pathway-mediated supraventricular tachycardia: a treatment comparison study</Title_Primary><Authors_Primary>Lau,C.P.</Authors_Primary><Authors_Primary>Tai,Y.T.</Authors_Primary><Authors_Primary>Lee,P.W.</Authors_Primary><Date_Primary>1995/3</Date_Primary><Keywords>Adult</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Cardiac Pacing,Artificial</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Exercise</Keywords><Keywords>Exercise Test</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Quality of Life</Keywords><Keywords>Research</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapeutic use</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>424</Start_Page><End_Page>432</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>18</Volume><Issue>3 Pt 1</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Address>Department of Medicine, University of Hong Kong, Queen Mary Hospital</Address><Web_URL>PM:7770362</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(376)7770362 QOL and exercise capacity in pts w/ PSVT due to AP treated medically vs. ablationN=55Random allocation to ablation vs. medical therapyPts w/ PSVT (including WPW) on stable medications for 3 moRandomly selected for ablation or continuing medical therapyQOL questionnaire and ETT performed at baseline and every 3 mo for 1 y Assessed PSVT frequency/duration of episodes; hemodynamic disturbance, presence of preexcited AF46 pts selected for ablation and 9 for medical therapy36/46 successfully ablated, and they improved in QOL at 3 mo post ablation (total scores on General Health Questionnaire, Somatic Symptoms Inventory and Sickness Impact Profile) P<0.01for all 3Improvements held at 1 yExercise capacity increased from 13.1±5.5 to 14.9 ±4.5 min at 3 mo after successful ablation (p<0.002) (due mostly to suppressing exercised induced PSVT).Medical group or those w/ unsuccessful ablation had no change in QOL or exercise capacityWhile pts randomly assigned to ablation vs. medical therapy, only 9 pts allocated to medical therapyPopulation – WPW, not other forms of PSVTBubien RS1996 ADDIN REFMGR.CITE <Refman><Cite><Author>Bubien</Author><Year>1996</Year><RecNum>346</RecNum><IDText>Effect of radiofrequency catheter ablation on health-related quality of life and activities of daily living in patients with recurrent arrhythmias</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>346</Ref_ID><Title_Primary>Effect of radiofrequency catheter ablation on health-related quality of life and activities of daily living in patients with recurrent arrhythmias</Title_Primary><Authors_Primary>Bubien,R.S.</Authors_Primary><Authors_Primary>Knotts-Dolson,S.M.</Authors_Primary><Authors_Primary>Plumb,V.J.</Authors_Primary><Authors_Primary>Kay,G.N.</Authors_Primary><Date_Primary>1996/10/1</Date_Primary><Keywords>Activities of Daily Living</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>Arrhythmias,Cardiac</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Emergencies</Keywords><Keywords>Female</Keywords><Keywords>Health Status</Keywords><Keywords>Heart Diseases</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Quality of Life</Keywords><Keywords>Recurrence</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>1585</Start_Page><End_Page>1591</End_Page><Periodical>Circulation</Periodical><Volume>94</Volume><Issue>7</Issue><ISSN_ISBN>0009-7322</ISSN_ISBN><Address>Department of Medicine, University of Alabama at Birmingham 35294, USA</Address><Web_URL>PM:8840848</Web_URL><ZZ_JournalStdAbbrev><f name="System">Circulation</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(377)8840848 Prospective cohort study, QOL of PSVT188AVNRT (n=59)AVRT (n=46)AF s/p AVJ ablation (n=22)Atrial flutter/AT (n=22)VT (n=10)QOL before, compared w/ 1 and 6 mo after RFA using SF-36 and disease-specific sx checklist—Frequency and Severity ScaleRFA associated w/ significant improvement in QOL sustained over 6 mo (p<0.005).RFA followed by improved performance of ADLs and a marked decrease in number of visits to physicians and emergency rooms in the 6 mo after RFA compared w/ 6 mo before.Pt's perception of impact of arrhythmias on health improved after ablation, maintained between 1 and 6 mo after ablation.90% of pts indicated that heart rhythm problems influenced health perception at baseline, and declined to 59% at 1 mo and 58% at 6 mo.N/AOverall demonstrates benefit of RFA on variety of arrhythmias. 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ADDIN EN.CITE.DATA (378)9732885Prospective comparison of the impact of QOL and CE between RFA and pharmacologic therapy for PSVT79 w/ newly-documented PSVT Average number of drugs 1.35/pt(CCB, BB, most common)Exclusions: drug-refractory pts, prior treatment, AF, atrial flutter, preexcitationSF-36 used to measure QOL after 12-mo f/uRFA vs. medicationBodily pain:63±24 vs. 81±20p<0.005General health:69±21 vs. 79±21p<0.05Vitality:55±21 vs. 66±22p<0.05Role emotion:78±36 vs. 94±17p<0.05Ablation resulted in complete amelioration of sxs in 33% vs. 74%. First study to prospectively evaluate QOL and resource utilization between RFA vs. medical therapy.Both effective, but RFA improves QOL to a greater extent.Larson msec1999 ADDIN REFMGR.CITE <Refman><Cite><Author>Larson</Author><Year>1999</Year><RecNum>563</RecNum><IDText>Quality of life before and after radiofrequency catheter ablation in patients with drug refractory atrioventricular nodal reentrant tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>563</Ref_ID><Title_Primary>Quality of life before and after radiofrequency catheter ablation in patients with drug refractory atrioventricular nodal reentrant tachycardia</Title_Primary><Authors_Primary>Larson,M.S.</Authors_Primary><Authors_Primary>McDonald,K.</Authors_Primary><Authors_Primary>Young,C.</Authors_Primary><Authors_Primary>Sung,R.</Authors_Primary><Authors_Primary>Hlatky,M.A.</Authors_Primary><Date_Primary>1999/8/15</Date_Primary><Keywords>Aged</Keywords><Keywords>Anti-Arrhythmia Agents</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>drug therapy</Keywords><Keywords>Electrocardiography</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>psychology</Keywords><Keywords>Quality of Life</Keywords><Keywords>Research</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>Risk Factors</Keywords><Keywords>surgery</Keywords><Keywords>Survival Rate</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>therapeutic use</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>471</Start_Page><End_Page>3, A9</End_Page><Periodical>Am.J.Cardiol.</Periodical><Volume>84</Volume><Issue>4</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>S0002-9149(99)00338-0</Misc_3><Address>Department of Health Research and Policy, Stanford University School of Medicine, California 94305-5405, USA</Address><Web_URL>PM:10468092</Web_URL><ZZ_JournalFull><f name="System">Am.J.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(379)10468092Retrospective single center evaluation161 pts w/ RFA for drug-refractory AVNRTNot specifiedDuke Activity Status Index used for physical function, Symptom Checklist—Frequency and Severity Scale, both used in telephone surveyMean number of sxs declined from 5.83.1 (p<0.001)Moderate-severe sxs declined 4.61.1 (p<0.0001)Urgent care visits declined from mean of 4.60.4/y (p<0.001)Heath score increased from mean of 56.677.3 (p<0.0001)Pt utility increased from mean of 0.71 to 0.88 (p<0.0001)RFA effective in improving QOL. Although single center, Kaiser is a large health care system.Susceptible to recall bias*Goldberg AS2002PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkdvbGRiZXJnPC9BdXRob3I+PFllYXI+MjAwMjwvWWVhcj48
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ADDIN EN.CITE.DATA (380)11988206 Prospective comparison on long-term effects of QOL between RFA and pharmacologic therapy for PSVT83 pts w/ newly-diagnosed symptomatic PSVTAverage number of drugs 1.49/pt(BB most common)39 w/ initial RFA, 44 w/ initial medical therapy (of which 22/44 underwent RFA)Referred specifically for ablationExcluded AF and atrial flutterAVNRT (67%)AVRT w/ AP (28%)AT (5%)SF-36 used to measure QOL after 1-y and 5-y f/uAt 5-y f/u, both RFA and pharmacologic therapy w/ improved scores (cumulative p<0.05 and p<0.001, respectively)RFA significantly improved in physical function, physical role, emotional role, mental health (p<0.05)At 5-y f/u, there was greater sx reduction in RFA group (p<0.01) compared to medical therapyImprovement in sxs who underwent initial RFA or cross-over to RFA after 5 y, compared to medical therapy (p<0.05)Over 5 y, the average cumulative cost for pts in the ablation therapy group was $7,507± $1,098. The cumulative cost for pts in medical therapy group was significantly lower than in pts initially treated w/ ablation therapy: $6,249±$1,421, p<0.05.N/ARFA was associated w/ higher QOL in all health concepts at 1 y; this improvement was sustained in the physical function, emotional role, physical role, and mental health subsets at 5 y.Cost estimated to be higher in RFA group.Offers 5 y f/u and includes pts who were not drug-refractory.Walfridsson U2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Walfridsson</Author><Year>2005</Year><RecNum>48</RecNum><IDText>The impact of supraventricular tachycardias on driving ability in patients referred for radiofrequency catheter ablation</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>48</Ref_ID><Title_Primary>The impact of supraventricular tachycardias on driving ability in patients referred for radiofrequency catheter ablation</Title_Primary><Authors_Primary>Walfridsson,U.</Authors_Primary><Authors_Primary>Walfridsson,H.</Authors_Primary><Date_Primary>2005/3</Date_Primary><Keywords>Adult</Keywords><Keywords>Automobile Driving</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Chi-Square Distribution</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Interviews as Topic</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>physiopathology</Keywords><Keywords>Quality of Life</Keywords><Keywords>Statistics,Nonparametric</Keywords><Keywords>surgery</Keywords><Keywords>Syncope</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Reprint>Not in File</Reprint><Start_Page>191</Start_Page><End_Page>195</End_Page><Periodical>Pacing Clin.Electrophysiol.</Periodical><Volume>28</Volume><Issue>3</Issue><ISSN_ISBN>0147-8389</ISSN_ISBN><Misc_3>PACE9753;10.1111/j.1540-8159.2005.09753.x</Misc_3><Address>Department of Cardiology, University Hospital, Linkoping, Sweden. ulla.walfridsson@lio.se</Address><Web_URL>PM:15733177</Web_URL><ZZ_JournalFull><f name="System">Pacing and clinical electrophysiology : PACE</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Pacing Clin.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(15)15733177Impact of PSVT on perceived ability to drive N=301Interview w/ structured questionsPts referred for ablation, of which 226 were active driversN/ASxs among drivers (irrespective of driving): fatigue 77%, dizziness 47%, cold sweat (52%), near syncope (50%), syncope (14%). Women more symptomatic than men (p<0.05). 57% had sxs while driving, 42% of those pts needed to stop driving and 24 pts regarded their tachycardia as an obstacle to driving, w/ correlation (p<0.001) if near syncope was a sxPSVT common while driving. Correlation of near syncope as sx w/ deciding that PSVT was obstacle to driving.Meissner A2009PFJlZm1hbj48Q2l0ZT48QXV0aG9yPk1laXNzbmVyPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48
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ADDIN EN.CITE.DATA (288)20109982QOL pre-post RFA52AVNRT (n=30)AVRT (n=16)AT (n=6)QOL following ablation, measured w/ Patient Perception scale, 3 subscales of SF-36, 2 subscales from Medical Outcomes Study, disease-specific measuresSignificant improvement in most sxs post-ablation (p<0.05)No sxs completely eliminated at one mo f/uEffect greater in womenAblation improves QOL on several measures, both generic and PSVT-specific measures.Short f/u.Yildrim O2010 ADDIN REFMGR.CITE <Refman><Cite><Author>Yildirim</Author><Year>2012</Year><RecNum>349</RecNum><IDText>The effect of radiofrequency ablation treatment on quality of life and anxiety in patients with supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>349</Ref_ID><Title_Primary>The effect of radiofrequency ablation treatment on quality of life and anxiety in patients with supraventricular tachycardia</Title_Primary><Authors_Primary>Yildirim,O.</Authors_Primary><Authors_Primary>Yontar,O.C.</Authors_Primary><Authors_Primary>Semiz,M.</Authors_Primary><Authors_Primary>Erdem,A.</Authors_Primary><Authors_Primary>Canan,F.</Authors_Primary><Authors_Primary>Yontar,G.</Authors_Primary><Authors_Primary>Kugu,N.</Authors_Primary><Date_Primary>2012/12</Date_Primary><Keywords>Adult</Keywords><Keywords>Anxiety</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>psychology</Keywords><Keywords>Quality of Life</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Reprint>Not in File</Reprint><Start_Page>2108</Start_Page><End_Page>2112</End_Page><Periodical>Eur.Rev.Med.Pharmacol.Sci.</Periodical><Volume>16</Volume><Issue>15</Issue><ISSN_ISBN>1128-3602</ISSN_ISBN><Address>Department of Psychiatry, Abant Izzet Baysal University, Bolu, Turkey</Address><Web_URL>PM:23280027</Web_URL><ZZ_JournalFull><f name="System">European review for medical and pharmacological sciences</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Eur.Rev.Med.Pharmacol.Sci.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(382)23280027QOL pre-post RFA50 AVNRT (n=28)AVRT (n=22)WHOQOL-BREF and STAI domainsPrior to RFA, greater than average anxiety score (p<0.05)All items significantly improved post-RFA—anxiety, QOL, and health satisfaction scoresRFA improves anxiety and QOL.Limited by 3 mo f/u, but consistent w/ prior work.Farkowski MM2014PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkZhcmtvd3NraTwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+
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ADDIN EN.CITE.DATA (383)24919538Prospective cohort, gender-related differences in outcomes pre-post RFA64AVNRT (n=40, 32 women, 8 men)AVRT (n=26, 11 women, 15 men)(2 pts did not complete f/u)QOL measured by PPAQ, EQ-5D-3L41 women completed survey.No significant baseline differences except AVNRT prevalence, and HRQOL by genderWomen reported higher severity of sxs on PPAQ than men (p<0.001)At 2 mo after RFA, women reported higher severity of sxs (p=0.02) on PPAQ and more heart skipping than men (p=0.0014)No significant difference in healthcare resource utilization during the y preceding RFAAADs more often prescribed to women pre-procedure (p=0.022)Small but significant gender-related difference in outcome of RFA in pts w/ AVNRT or AVRT measured w/ a disease-specific instrumentNo significant difference in QOL or access to healthcare resources between women and men.*Study addressed both CE and QoLAAD indicates antiarrhythmic drug; ADL, activities of daily living; AF, atrial fibrillation; AP, accessory pathway; AT, atrial tachycardia; AVJ, atrioventricular junction; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; BB, beta blocker; CCB, calcium channel blocker; CE, cost effectiveness; EQ-5D-3L, EuroQol Research Foundation questionnaire; ETT, exercisetreadmill test; f/u, follow up; HRQOL, health-related quality of life; N/A, not applicable; PPAQ, Patient Perception of Arrhythmia Questionnaire; PSVT, paroxysmal supraventricular tachycardia; pt, patient; QOL, quality of life; RFA, radiofrequency ablation; SF-36, Short Form (36) Health Survey; s/p, status post; STAI, State and Trait Anxiety Inventory; sx, symptom; VT, ventricular tachycardia; w/, with; WHOQOL-BREF, World Health Organization Quality of Life Scale; and WPW, Wolff-Parkison-White syndrome. Data Supplement 23. Nonrandomized Trials, Observational Studies, and/or Registries of Cost Effectiveness – Section 11 StudyName, Author, YearStudy Type/DesignStudy SizeInclusion/Exclusion CriteriaPrimary EndpointResults/p ValuesSummary/ConclusionsDe Buitlier M1990 ADDIN REFMGR.CITE <Refman><Cite><Author>de Buitleir</Author><Year>1990</Year><RecNum>564</RecNum><IDText>Cost of catheter versus surgical ablation in the Wolff-Parkinson-White syndrome</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>564</Ref_ID><Title_Primary>Cost of catheter versus surgical ablation in the Wolff-Parkinson-White syndrome</Title_Primary><Authors_Primary>de Buitleir,M.</Authors_Primary><Authors_Primary>Bove,E.L.</Authors_Primary><Authors_Primary>Schmaltz,S.</Authors_Primary><Authors_Primary>Kadish,A.H.</Authors_Primary><Authors_Primary>Morady,F.</Authors_Primary><Date_Primary>1990/7/15</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Costs and Cost Analysis</Keywords><Keywords>economics</Keywords><Keywords>Electrocoagulation</Keywords><Keywords>Female</Keywords><Keywords>Heart Conduction System</Keywords><Keywords>Hospitalization</Keywords><Keywords>Humans</Keywords><Keywords>Length of Stay</Keywords><Keywords>Male</Keywords><Keywords>Medicine</Keywords><Keywords>Michigan</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Retrospective Studies</Keywords><Keywords>surgery</Keywords><Keywords>therapy</Keywords><Keywords>Time</Keywords><Keywords>Wolff-Parkinson-White Syndrome</Keywords><Keywords>Work</Keywords><Reprint>Not in File</Reprint><Start_Page>189</Start_Page><End_Page>192</End_Page><Periodical>Am.J.Cardiol.</Periodical><Volume>66</Volume><Issue>2</Issue><ISSN_ISBN>0002-9149</ISSN_ISBN><Misc_3>0002-9149(90)90586-P</Misc_3><Address>Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109</Address><Web_URL>PM:2371949</Web_URL><ZZ_JournalFull><f name="System">Am.J.Cardiol.</f></ZZ_JournalFull><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(384)2371949Retrospective cohort study to evaluate CE of AP RFA c/w surgical ablation22Pts w/ APs who underwent RFA or surgical ablation(n=11 RFA)(n=11 surgical ablation)Health care cost, w/ secondary endpoint LOSRFA success: 73% (all w/ posteroseptal AP)Surgical success: 100% (right, left lateral, posteroseptal AP)RFA LOS 6±2 dSurgical LOS 8±4 dRFA cost: 14,116±4,493 c/w 34,175±5,434 in surgical group (p<0.0001).Mean time lost from work or school was 10± 5 d in RFA group c/w 60±16 d in surgical group (p<0.01).1988 dollarsRFA of APs substantially lower in cost and LOS c/w surgical ablation.De Buitlier M1991PFJlZm1hbj48Q2l0ZT48QXV0aG9yPmRlIEJ1aXRsZWlyPC9BdXRob3I+PFllYXI+MTk5MTwvWWVh
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ADDIN EN.CITE.DATA (385)1746469Retrospective cohort study to evaluate CE of AP RFA c/w surgical ablation50Pts w/ APs who underwent RFA or surgical ablation(n=25 RFA, 1990)(n=25 surgical ablation, 1989)Health care cost, w/ secondary endpoint LOSSuccess rate was 96% for both groups. Mean LOS was 3±1 d in RFA group and 9±4 d in surgical group (p<0.0001). RFA total cost $14,919 c/w $53,265 in the surgical group (p<0.0001). 1990/1991 dollarsRFA of APs substantially lower in cost and LOS c/w surgical ablation.Kalbfleisch SJ1992PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbGJmbGVpc2NoPC9BdXRob3I+PFllYXI+MTk5MjwvWWVh
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ADDIN EN.CITE.DATA (386)1593054Retrospective review to establish cost-advantage of RFA for AVNRT15Symptomatic AVNRT who underwent RFARFA cost of $15,893 would be advantageous after 10 y in pts who visit ED once per y (in study medical therapy more expensive after 2 y due to frequent ED visits in study population). Perspective: ptOutcomes: annual chargesN/A1991 dollarsEarly report using hospital charges showing cost advantage of RFA for AVNRTMedical therapy at the time more expensive given drugs may not have been at generic prices.Hogenhuis W1993PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkhvZ2VuaHVpczwvQXV0aG9yPjxZZWFyPjE5OTM8L1llYXI+
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ADDIN EN.CITE.DATA (387)8222191 CE of management in WPWMarkov model, none-specified, but costs estimated from convenience sample of 13 ptsN/AEvaluation of 5 different strategies:-observation- observation until SCD-therapy guided by noninvasive monitoring, -initial RFA -initial surgical ablationPerspective: largely pt-perspectiveOutcomes: QALY and mortality, using Markov ModelRFA yields life expectancy greater than or equal to other strategies40 y-old pt:Observation: $2360RFA: $5,150-6,250Surgery: $15,120Observation w/ RFA at cardiac arrest: $16,860Drug therapy: $20,250In cardiac arrest survivors and pts who have had PSVT/AF w/ hemodynamic compromise, RFA should both prolong survival and save resourcesFor pts w/ PSVT/AF w/o hemodynamic compromise, the marginal cost-effectiveness of attempted RFA ranges from $6,600 per QALY gained for 20-y old pts to $19,000 per QALY gained for 60-y old pts. For asymptomatic pts, RFA costs from $174,000 per QALY gained for 20-y old pts to $540,000 per QALY gained for 60-y old ptsSupports RFA in WPW syndrome who survive cardiac arrest or who experience PSVT/AF. but also supports the current practice of observing asymptomatic ptsKalbfleisch SJ1993PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkthbGJmbGVpc2NoPC9BdXRob3I+PFllYXI+MTk5MzwvWWVh
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ADDIN EN.CITE.DATA (388)8436736Prospective cohort study to evaluate safety, feasibility, and cost of AP RFA as an outpt137Exclusion: <13 or >70 y, anteroseptal AP, obesity, or clinical indication for hospitalizationRFA of AP cost as outpt procedure97% success rate, w/ 73% performed as outpatients. In 70 cases the pt was discharged the d of ablation, and in 30 cases the pt required a short (≤18 h) overnight stay due to scheduling issues.Mean duration of observation was 4.8±1.5 h for outpts and 15±1.4 h for pts who underwent overnight hospitalization. Mean cost of the procedure was $10,183±$1,082 in 30 pts studied for cost analysis. 22 outpts vs. 8 overnight pts :Total charges: $9,873 vs. $11,034 (p<0.01)Professional fees: $6,163 vs. $6,286 (p=NS)Hospital charges: $3,710 vs. $4,748 (p<0.01)2 pts w/ complications: femoral artery pseudoaneurysm notes 3-4 wk after procedure, one in outpt, one after 13 h overnight stay.Outpt ablation of AP, w/ possible overnight observation, is feasible in low-risk ptsKertes PJ1993 ADDIN REFMGR.CITE <Refman><Cite><Author>Kertes</Author><Year>1993</Year><RecNum>568</RecNum><IDText>Cost effectiveness of radiofrequency catheter ablation in the treatment of symptomatic supraventricular tachyarrhythmias</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>568</Ref_ID><Title_Primary>Cost effectiveness of radiofrequency catheter ablation in the treatment of symptomatic supraventricular tachyarrhythmias</Title_Primary><Authors_Primary>Kertes,P.J.</Authors_Primary><Authors_Primary>Kalman,J.M.</Authors_Primary><Authors_Primary>Tonkin,A.M.</Authors_Primary><Date_Primary>1993/8</Date_Primary><Keywords>Adolescent</Keywords><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>analysis</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Cost-Benefit Analysis</Keywords><Keywords>drug therapy</Keywords><Keywords>Echocardiography</Keywords><Keywords>economics</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Medical Records</Keywords><Keywords>methods</Keywords><Keywords>Middle Aged</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Supraventricular</Keywords><Keywords>therapy</Keywords><Keywords>Time</Keywords><Keywords>Victoria</Keywords><Reprint>Not in File</Reprint><Start_Page>433</Start_Page><End_Page>436</End_Page><Periodical>Aust.N.Z.J.Med.</Periodical><Volume>23</Volume><Issue>4</Issue><ISSN_ISBN>0004-8291</ISSN_ISBN><Address>Department of Cardiology, Austin Hospital Melbourne, Vic., Heidelberg</Address><Web_URL>PM:8240167</Web_URL><ZZ_JournalFull><f name="System">Australian and New Zealand journal of medicine</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Aust.N.Z.J.Med.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(389)8240167CE of RFA compared to AADs in Australia26AVNRT (n=16)WPW (n=10)Mean cost of RFA $4067, c/w AAD of $700/ yNOTE: these are likely Australian dollars, although authors do not specifyExtrapolating over 20 y and allowing for an annual 5% inflation factor, RFA becomes cost saving in 5.5 y Over 20 y, AAD estimated at 4-5 times more expensive than RFPerspective: pt and societal perspectiveOutcomes: cost analysis w/ “cost-saving” criterion used to define effectiveness, on the assumption that RFA is at least as effective as AADs in long-term control of PSVT; authors used annual chargesN/ARFA more cost-effective than AADs.Limited to Australian population, but results consistent w/ other series.Used pt data in constructing cost-analysis, not simulation.Ikeda T1994PFJlZm1hbj48Q2l0ZT48QXV0aG9yPklrZWRhPC9BdXRob3I+PFllYXI+MTk5NDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (390)7823285Prospective cohort, CE evaluation of CE of RFA for PSVT20Symptomatic PSVT, on AADs, all w/ successful RFAAVNRT (n=5)WPW (n=15)Mean total charge for ablation 982,806 yen and 5.7 times the outpt charges in the previous yMean total life-expectancy charges w/ AADs were estimated at 7,064,726 yen, 41.0 times the outpt chargesTotal RFA charge 14% of total estimated charges of estimated lifetime medical treatment w/o RFA (p<0.001) Perspective: pt-perspective, societal componentOutcomes: total life-expectancy charges, total ablation chargesN/ASmall study, limited to Japan, but suggests RFA effective and reduces medical costs.Utilizes hospital charges, and not a cost-simulation model.*Bathina MN1998PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkJhdGhpbmE8L0F1dGhvcj48WWVhcj4xOTk4PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (378)9732885Prospective comparison of the impact of QOL and CE between RFA and pharmacologic therapy for PSVT79 w/ newly-documented PSVT Average number of drugs 1.35/pt(CCB, BB, most common)Exclusions: drug-refractory pts, prior treatment, AF, atrial flutter, preexcitationSF-36 and direct costsPerspective: pt-perspectiveOutcomes: direct hospital chargesRFA vs. medicationPotential long-term costs similar, but w/ specific assumptions about ED visits, pharmacologic costs will exceed RFAFirst study to prospectively evaluate QOL and resource utilization between RFA vs. medical therapy.Cumulative cost of medical therapy equal to, or less than RFA. This is in contrast to studies by Cheng and Ikeda, which have stronger methodology. Cheng CH 2000PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNoZW5nPC9BdXRob3I+PFllYXI+MjAwMDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (60)11103056Comparison of CE of RFA w/ medical management of PSVTSymptomatic pts w/ 4.6 unscheduled visits/y for arrhythmia while on long-term drug therapyRFA:Estimated population:AVNRT: 65%AVRT w/ concealed AP: 30%Efficacy estimates:AVNRT: 97%AVRT w/ concealed AP: 93%Recurrence estimates:AVNRT: 5%AVRT w/ concealed AP: 8%Drug efficacy: 60%Perspective: societalOutcomes: Costs (office visit, annual drug rx, EP study, RFA, PPM, PPM replacement)QALYLife-ysMarginal CE ratiosW/ monthly episodes of PSVT, RFA most effective and least expensive optionRFA reduced lifetime medical expenditures by $27,940 compared w/ long-term pharmacologic therapyLifetime costs:RFA: $61,880Long-term drug rx:$89,820Episodic drug rx:$143,530RFA improved quality-adjusted life expectancy by 3.10 QALYs.RFA improves QOL and reduces costs when treating highly symptomatic pts.Effects in less symptomatic not studiesDewland TA2013 ADDIN REFMGR.CITE <Refman><Cite><Author>Dewland</Author><Year>2014</Year><RecNum>353</RecNum><IDText>Healthcare utilization and clinical outcomes after catheter ablation of atrial flutter</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>353</Ref_ID><Title_Primary>Healthcare utilization and clinical outcomes after catheter ablation of atrial flutter</Title_Primary><Authors_Primary>Dewland,T.A.</Authors_Primary><Authors_Primary>Glidden,D.V.</Authors_Primary><Authors_Primary>Marcus,G.M.</Authors_Primary><Date_Primary>2014</Date_Primary><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>diagnosis</Keywords><Keywords>Electrophysiology</Keywords><Keywords>Emergencies</Keywords><Keywords>epidemiology</Keywords><Keywords>Hospitalization</Keywords><Keywords>Medicine</Keywords><Keywords>Patients</Keywords><Keywords>Proportional Hazards Models</Keywords><Keywords>Research</Keywords><Keywords>Risk</Keywords><Keywords>United States</Keywords><Keywords>utilization</Keywords><Reprint>Not in File</Reprint><Start_Page>e100509</Start_Page><Periodical>PLoS One</Periodical><Volume>9</Volume><Issue>7</Issue><User_Def_5>PMC4077565</User_Def_5><ISSN_ISBN>1932-6203</ISSN_ISBN><Misc_3>10.1371/journal.pone.0100509;PONE-D-13-52331</Misc_3><Address>Department of Internal Medicine, Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, United States of America
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
Department of Internal Medicine, Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, United States of America</Address><Web_URL>PM:24983868</Web_URL><ZZ_JournalStdAbbrev><f name="System">PLoS One</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(391)24983868Observational cohortPts w/ atrial flutter in the California HCUP database, 2005-2009 (n=33,004), median f/u 2/1 yExclusion: Non-California residence, concomitant AF, missing admission date dataWhether catheter ablation of atrial flutter associated w/ reductions in healthcare utilization, AF, or CVA2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation (in 8.2% of pts) lowered adjusted risk of inpt hospitalization and ED visits (p<0.001); overall hospital-based healthcare utilization (p?=?0.001); and 11% reduction in AF( p?=?0.01). Risk of CVA not reduced after ablation (p?=?0.57).Robust registry data supports early atrial flutter ablation to significantly reduce hospital-based healthcare utilization and risk of AF. *Study addressed both CE and QoLAAD indicates antiarrhythmic drug; AF, atrial fibrillation; AP, accessory pathway; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular tachycardia; BB, beta blocker; CCB, calcium channel blocker; CE, cost effectiveness; CVA, cerebrovascular accident; c/w, consistent with; ED, emergency department; EP, electrophysiological; HCUP, Healthcare Cost and Utilization Project; LOS, length of stay; N/A, not applicable; NS, non-significant; PPM, permanent pacemaker; PSVT, paroxysmal supraventricular tachycardia; pt, patient; QALY, quality-adjusted life year; QOL, quality of life; RF, radiofrequency; RFA, radiofrequency ablation; rx, therapy; SCD, sudden cardiac death; SF-36, Short Form (36) Heatlh Survey; w/, with; and w/o, without. Appendix 1. Acute Drug Therapy for SVT, Intravenous Administration*Drug?Initial DoseSubsequent or Maintenance DosePotential Adverse EffectsPrecautions (Exclude or Use With Caution) and InteractionsNucleoside Adenosine6-mg rapid IV bolus (injected into IV as proximal or as close to the heart as possible), administered over 1–2 s, followed by rapid saline flush If no result within 1–2 min, 12-mg rapid IV bolus; can repeat 12-mg dose 1 time. The safe use of 18-mg bolus doses has been reported PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkRvbWFub3ZpdHM8L0F1dGhvcj48WWVhcj4xOTk0PC9ZZWFy
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ADDIN EN.CITE.DATA (392).Transient AV block, flushing, chest pain, hypotension, or dyspnea, AF can be initiated or cause decompensation in the presence of pre-excitation, PVCs?/?ventricular tachycardia, bronchospasm (rare), or coronary steal. Minor side effects are usually transient because of adenosine’s very short half-life. AV block greater than first degree or SA node dysfunction (in absence of pacemaker)Reactive airway diseaseConcomitant use of verapamil or digoxinWPWBeta blockersEsmolol 500-mcg/kg IV bolus over 1 minInfusion at 50–300 mcg/kg/min, with repeat boluses between each dosing increaseHypotension, worsening HF, bronchospasm, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Decompensated systolic HFHypotensionCardiogenic shockReactive airway diseaseRenal dysfunctionDrugs with SA and/or AV nodal–blocking propertiesMetoprolol tartrate 2.5–5.0-mg IV bolus over 2 minCan repeat 2.5- to 5.0-mg IV bolus in 10 min, up to 3 dosesHypotension, worsening HF, bronchospasm, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Decompensated systolic HFHypotensionReactive airway diseaseDrugs with SA and/or AV nodal–blocking propertiesPropranolol1 mg IV over 1 minCan repeat 1 mg IV at 2-min intervals, up to 3 dosesHypotension, worsening HF, bronchospasm, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Cardiogenic shockReactive airway diseaseDecompensated HFHypotensionHepatic or renal dysfunctionDrugs with SA and/or AV nodal–blocking propertiesNondihydropyridine calcium channel antagonistsDiltiazem0.25-mg/kg IV bolus over 2 minInfusion at 5–10 mg/h, up to 15 mg/hHypotension, worsening HF in patients with pre-existing ventricular dysfunction, bradycardia, abnormal liver function studies, acute hepatic injury (rare)AV block greater than first degree or SA node dysfunction (in absence of pacemaker)WPW with AF?/?atrial flutterHypotension?Decompensated systolic HF/LV dysfunctionDrugs with SA and/or AV nodal–blocking properties Hepatic or renal dysfunctionDiltiazem is a substrate of CYP3A4 (major) and a moderate CYP3A4 inhibitorApixaban, itraconazole, bosutinib, ceritinib, cilostazol, cyclosporine, everolimus, ibrutinib, idelalisib, ivabradine, lomitapide, olaparib, posaconazole, ranolazine, rifampin, simeprevir, voriconazoleVerapamil5–10-mg (0.075–0.15-mg/kg) IV bolus over 2 min If no response, can give an additional 10 mg (0.15 mg/kg) 30 min after first dose; then infusion at 0.005 mg/kg/minHypotension, worsening HF in patients with pre-existing ventricular dysfunction, pulmonary edema in patients with hypertrophic cardiomyopathy, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Decompensated systolic HF/ LV dysfunctionDrugs with SA and/or AV nodal–blocking properties Hypotension?Cardiogenic shockWPW with AF?/?atrial flutterHepatic or renal dysfunctionVerapamil is a moderate CYP3A4 inhibitor and also inhibits P-glycoproteinContraindicated with dofetilide Itraconazole, bosutinib, ceritinib, cilostazol, colchicine, cyclosporine, everolimus, dabigatran, edoxaban, flecainide, ibrutinib, ivabradine, olaparib, posaconazole, ranolazine, rivaroxaban, rifampin, silodosin, simeprevir, rivaroxaban, rifampin, simvastatin, topotecan, trabectedin, vincristine, voriconazole, grapefruit juiceCardiac glycosidesDigoxin0.25–0.5-mg IV bolus Can repeat 0.25-mg IV bolus, up to maximum dose of 1.0 mg over 24 h (i.e., maximum loading dose 8–12 mcg/kg), given at 6–8-h intervals; maintenance dose based on patient’s age, lean body weight, renal function, and concomitant drugs (IV 2.4–3.6 mcg/kg/d)Anorexia, nausea, vomiting, visual changes and cardiac arrhythmias if digoxin toxicity (associated with levels >2 ng/mL, although symptoms may also occur at lower levels)Renal dysfunctionWPW with AF?/?atrial flutterAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Drugs with AV nodal-blocking propertiesDigoxin is a P-glycoprotein substrateDronedarone (reduce dose by at least 50%), amiodarone (reduce dose by 30%–50%)Verapamil, clarithromycin, cyclosporine, erythromycin, flecainide, itraconazole, posaconazole, propafenone, voriconazole: Monitor digoxin levelsA large retrospective study suggested an increased risk in mortality in patients who were treated with digoxin for newly diagnosed AF or atrial flutter; although the data were collected from a population that was different from SVT patients, digoxin should be used with caution PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlR1cmFraGlhPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48
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ADDIN EN.CITE.DATA (393).Class III antiarrhythmic agentsAmiodarone150 mg IV over 10 minInfusion at 1 mg/min (360 mg) over next 6 h; then 0.5 mg/min (540 mg) over remaining 18 hHypotension, bradycardia, phlebitis, QT prolongation, torsades de pointes (rare), increased INRSinus or AV conduction disease (in absence of pacemaker)Inflammatory lung disease (acute)Hepatic dysfunctionDrugs with SA and/or AV nodal–blocking propertiesAmiodarone is a substrate of and inhibits p-glycoprotein and CYP2C9 (moderate), CYP2D6 (moderate), and CYP3A4 (weak); amiodarone is a substrate for CYP3A4 (major) and CYP2C8 (major);amiodarone is an inhibitor of OCT2 Reduce warfarin dose by 50% and reduce digoxin dose by 30%–50%Agalsidase alfa, agalsidase beta, azithromycin, bosutinib, ceritinib, colchicine, dabigatran, edoxaban, flecainide, ivabradine, ledipasvir/sofosbuvir, lopinavir, lopinavir/ritonavir, lovastatin, nelfinavir, pazopanib, propafenone, simvastatin, ritonavir, rivaroxaban, saquinavir, sofosbuvir, topotecan, vincristine, grapefruit juiceIbutilideContraindicated when QTc >440 ms║; 1 mg over 10 min (if ≥60 kg); if <60 kg, then 0.01 mg/kgCan repeat 1 mg once, if the arrhythmia does not terminate within 10 min§QT prolongation, torsades de pointes, AV blockProlonged QT intervalHistory of torsades de pointesAvoid other QT interval–prolonging drugsConcurrent administration of high-dose magnesium has been associated with enhanced efficacy and safety PFJlZm1hbj48Q2l0ZT48QXV0aG9yPlN0ZWlud2VuZGVyPC9BdXRob3I+PFllYXI+MjAxMDwvWWVh
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bj4A
ADDIN EN.CITE.DATA (206, 394) Note: For this reference table, drugs are presented in alphabetical order within the drug classes, not by COR and LOE. *When 1 drug is used in combination with other drugs, appropriate dosing adjustments should be made with consideration of at least additive effects during dosage titration. All potential drug–drug interactions are not included in this list. For a more detailed list of drug–drug interactions, clinicians should consult additional resources. ?If hypotension is a consideration, a slow infusion of diltiazem (2.5 mg/min) or verapamil (1 mg/min) for up to 20 minutes may lessen the potential for hypotension PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkxpbTwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJlY051
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c3BpdGFsLCBPdXRyYW0gUm9hZCwgU2luZ2Fwb3JlIDE2OTYwOCwgU2luZ2Fwb3JlPC9BZGRyZXNz
PjxXZWJfVVJMPlBNOjE5MjYxMzY3PC9XZWJfVVJMPjxaWl9Kb3VybmFsU3RkQWJicmV2PjxmIG5h
bWU9IlN5c3RlbSI+UmVzdXNjaXRhdGlvbjwvZj48L1paX0pvdXJuYWxTdGRBYmJyZXY+PFpaX1dv
cmtmb3JtSUQ+MTwvWlpfV29ya2Zvcm1JRD48L01ETD48L0NpdGU+PC9SZWZtYW4+
ADDIN EN.CITE.DATA (38). §The infusion should be stopped as soon as the arrhythmia is terminated or in the event of sustained or nonsustained ventricular tachycardia or marked prolongation of QT or corrected QT interval. ║QTc calculation used the Bazett’s Formula in most clinical studies. Patients should be observed with continuous ECG monitoring for at least 4 h after infusion or until QTc has returned to baseline.AF indicates atrial fibrillation; AV, atrioventricular; BID, twice daily; CrCl, creatinine clearance; ECG, electrocardiogram/electrocardiographic; HF, heart failure; INR, international normalized ratio; LV, left ventricular; QD, once daily; QID, four times a day; QTc, corrected QT interval; SA, sinoatrial; SVT, supraventricular tachycardia; TID, 3-times a day; and WPW, Wolff-Parkinson-White. Appendix 2. Ongoing Drug Therapy for SVT, Oral Administration*Drug?Initial Daily Dose(s)Maximum Total Daily Maintenance DosePotential Adverse EffectsPrecautions (Exclude or Use With Caution) and InteractionsBeta blockersAtenolol25–50 mg QD100 mg QD(reduced dosing in patients with severe renal dysfunction)Hypotension, bronchospasm, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Decompensated systolic HFHypotensionReactive airway disease Severe renal dysfunctionDrugs with SA and/or AV nodal–blocking propertiesMetoprolol tartrate25 mg BID 200 mg BIDHypotension, bronchospasm, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Decompensated systolic HFHypotensionReactive airway disease Drugs with SA and/or AV nodal–blocking propertiesMetoprolol succinate (long-acting)50 mg QD400 mg QDHypotension, bronchospasm, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Decompensated systolic HFHypotensionReactive airway disease Drugs with SA and/or AV nodal–blocking propertiesNadolol40 mg QD320 mg QD(reduced dosage with renal impairment)Hypotension, bronchospasm, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Reactive airway diseaseCardiogenic shockDecompensated HFHypotensionRenal dysfunctionDrugs with SA and/or AV nodal–blocking propertiesPropranolol30–60 mg in divided or single dose with long-acting formulations40–160 mg in divided or single dose with long-acting formulationsHypotension, worsening HF, bronchospasm, bradycardiaAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Reactive airway diseaseDecompensated systolic HFHypotensionDrugs with SA and/or AV nodal–blocking propertiesNondihydropyridine calcium channel antagonistsDiltiazem120 mg daily in divided or single dose with long-acting formulations360 mg daily in divided or single dose with long-acting formulationsHypotension, worsening HF in patients with pre-existing ventricular dysfunction, bradycardia, abnormal liver function studies, acute hepatic injury (rare)AV block greater than first degree or SA node dysfunction (in absence of pacemaker)Hypotension?Decompensated systolic HF?/?severe LV dysfunctionWPW with AF?/?atrial flutterDrugs with SA and/or AV nodal–blocking propertiesDiltiazem is a substrate of CYP3A4 (major) and a moderate CYP3A4 inhibitorApixaban, itraconazole, bosutinib, ceritinib, cilostazol, cyclosporine, everolimus, ibrutinib, idelalisib, ivabradine, lomitapide, olaparib, ranolazine, rifampin, simeprevirVerapamil120 mg daily in divided or single dose with long-acting formulations480 mg daily in divided or single dose with long-acting formulationsHypotension, worsening HF in patients with pre-existing ventricular dysfunction, pulmonary edema in patients with hypertrophic cardiomyopathy, bradycardia, abnormal liver function studiesAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Decompensated systolic HF?/?severe LV dysfunctionHypotension?WPW with AF?/?atrial flutterVerapamil is a moderate CYP3A4 inhibitor and also inhibits P-glycoproteinContraindicated with dofetilide Itraconazole, bosutinib, ceritinib, cilostazol, colchicine, cyclosporine, everolimus, dabigatran, edoxaban, flecainide, ibrutinib, ivabradine, olaparib, ranolazine, rivaroxaban, rifampin, silodosin, simeprevir, rivaroxaban, rifampin, simvastatin, topotecan, trabectedin, vincristine, grapefruit juiceCardiac glycosidesDigoxinLoading: 0.5 mg, with additional 0.125–0.25-mg doses administered at 6–8-h intervals until evidence of adequate effect (maximum dose 8–12 mcg/kg over 24 h)0.25 mg QDMaintenance: 0.125–0.25 mg QD, with dosing based on patient’s age, lean body weight, and renal function and drug interactions; occasionally down to 0.0625 mg in cases of renal impairment (trough serum digoxin level 0.5 to 1 ng/mL)Bradycardia, heart block, anorexia, nausea, vomiting, visual changes and cardiac arrhythmias in cases of digoxin toxicity (associated with levels >2 ng/mL, although symptoms may also occur at lower levels)Renal dysfunctionWPW with AF?/?atrial flutterAV block greater than first degree or SA node dysfunction (in absence of pacemaker)Drugs with SA and/or AV nodal–blocking propertiesReduce dose by 30%–50% when administering with amiodarone and by 50% when administering with dronedaroneMonitor digoxin concentrations with verapamil, clarithromycin, erythromycin, itraconazole, cyclosporine, propafenone, flecainideClass Ic antiarrhythmic agentsFlecainide50 mg every 12 h150 mg every 12 h(PR and QRS intervals should be monitored. May consider monitoring flecainide plasma levels, keeping trough plasma levels below 0.7–1.0 mcg/mL)Atrial flutter with 1:1 AV conduction§, QT prolongation, torsades de pointes, worsening HF, bradycardiaSinus or AV conduction disease (in absence of pacemaker)Cardiogenic shockAvoid in structural heart disease (including ischemic heart disease)Atrial flutter (unless concomitant AV nodal therapy to avoid 1:1 conduction)Brugada syndromeRenal dysfunctionHepatic dysfunctionQT-prolonging drugsAmiodarone, digoxin, ritonavir, saquinavir, tipranavirPropafenone150 mg every 8 h (immediate release);225 mg every 12 h (extended release)300 mg every 8 h (immediate release);425 mg every 12 h (extended release)(PR and QRS interval should be monitored. Consider dosage reduction with hepatic impairment)Atrial flutter with 1:1 AV conduction§, QT prolongation, torsades de pointes, bradycardia, bronchospasmSinus or AV conduction disease (in absence of pacemaker) Cardiogenic shockHypotensionReactive airway disease Avoid in structural heart disease (including ischemic heart disease)Atrial flutter (unless concomitant AV nodal therapy to avoid 1:1 conduction)Brugada syndromeHepatic dysfunctionQT-prolonging drugsDrugs with SA and/or AV nodal–blocking propertiesAmiodarone, ritonavir, saquinavir, tipranavirClass III antiarrhythmic agentsAmiodarone400–600 mg QD in divided doses for 2-4 wk (loading dose); followed by 100–200 mg QD (maintenance dose)Up to 1200 mg QD may be considered in an inpatient monitoring setting (loading dose); up to 200 mg QD maintenance (to minimize long-term adverse effects)Bradycardia, QT prolongation, torsades de pointes (rare), gastrointestinal upset, constipation, hypothyroidism, hyperthyroidism, pulmonary fibrosis, hepatic toxicity, corneal deposits, optic neuritis, peripheral neuropathy, photosensitivity, adult respiratory distress syndrome after cardiac or noncardiac surgery (rare)Sinus or AV conduction disease (in absence of pacemaker) Inflammatory lung diseaseHepatic dysfunctionHypothyroidism, hyperthyroidismPeripheral neuropathyAbnormal gait?/?ataxiaOptic neuritisDrugs with SA and/or AV nodal–blocking propertiesAmiodarone is a substrate of and inhibits p-glycoprotein and CYP2C9 (moderate), CYP2D6 (moderate), and CYP3A4 (weak); amiodarone is a substrate for CYP3A4 (major) and CYP2C8 (major); amiodarone is an inhibitor of OCT2Reduce warfarin dose by 50%, and reduce digoxin dose by 30%–50%Agalsidase alfa, agalsidase beta, azithromycin, bosutinib, ceritinib, colchicine, dabigatran, edoxaban, flecainide, ivabradine, ledipasvir/sofosbuvir, lopinavir, lopinavir/ritonavir, lovastatin, nelfinavir, pazopanib, propafenone, simvastatin, ritonavir, rivaroxaban, saquinavir, sofosbuvir, topotecan, vincristine, grapefruit juiceDofetilide500 mcg every 12 h (if CrCl >60 mL/min)250 mcg every 12 h (if CrCl 40–60 mL/min)125 mcg every 12 h (if CrCl 20 to <40 mL/min)Not recommended if CrCl <20 mL/minAdjust dose for renal function, body size, and ageInitiate for minimum of 3 d in a facility that can provide continuous ECGmonitoring and cardiac resuscitationContraindicated if the baseline QTc interval or QTc >440 ms║ or 500 ms in patients with ventricular conduction abnormalitiesRepeat ECG 2–3 h after administering the first dose to determine QTc; if the QTc increased by >15% compared with baseline or if QTc is >500 ms║ (550 ms in patients with ventricular conduction abnormalities), subsequent dosing should be downtitrated by 50%; at 2–3 h after each subsequent dose, determine QTc (for in-hospital doses 2–5); if at any time after the second dose the QTc is >500 ms║ (550 ms in patients with ventricular conduction abnormalities), dofetilide should be discontinuedQT prolongation, torsades de pointesSevere renal dysfunction (contraindicated if CrCl <20 mL/min)Prolonged QT History of torsades de pointesConcomitant use of hydrochlorothiazide, cimetidine, dolutegravir, itraconazole, ketoconazole, megestrol, trimethoprim, prochlorperazine trimethoprim/sulfamethoxazole or verapamil, contraindicatedAvoid other QT-prolonging drugsSotalol40–80 mg every 12 h (Patients initiated or reinitiated on sotalol should be placed in a facility that can provide cardiac resuscitation and continuous electrocardiographic monitoring for a minimum of 3 d. Contraindicated if the QTc║ interval is >450 ms. CrCl should be calculated before dosing. If CrCl >60 mL/min, then dosing frequency is twice daily. If CrCl 40-60 mL/min, dosing interval is every 24 h. If CrCl <40 mL/min, should not be used.)160 mg every 12 h(During initiation and titration, the QT interval should be monitored 2–4 h after each dose. If the QT interval prolongs to ≥500 ms, the dose must be reduced or the drug discontinued.)QT prolongation, torsades de pointes, bradycardia, bronchospasmProlonged QTRenal dysfunctionHypokalemiaDiuretic therapyAvoid other QT-prolonging drugsSinus or AV nodal dysfunction (in absence of pacemaker)Decompensated systolic HFCardiogenic shockReactive airway diseaseDrugs with SA and/or AV–nodal blocking propertiesMiscellaneousIvabradine5 mg BID7.5 mg BIDPhosphenes, AFConcomitant drugs that can exacerbate bradycardiaContraindicated in decompensated HFContraindicated if BP <90/50 mm?HgContraindicated in severe hepatic impairmentHypertensionIvabradine is a substrate of CYP3A4 (major)Avoid use with concomitant strong CYP3A4 inhibitors (boceprevir, clarithromycin, indinavir, itraconazole, lopinavir/ritonavir, nelfinavir, ritonavir, saquinavir, telaprevir, posaconazole, voriconazole)Avoid use with strong CYP3A4 inducers (carbamazepine, phenytoin, rifampin, St. John’s wort)Avoid use with diltiazem, verapamil, grapefruit juiceNote: For this reference table, drugs are presented in alphabetical order within the drug classes, not by COR and LOE. *When 1 drug is used in combination with other drugs, appropriate dosing adjustments should be made with consideration of at least additive effects during dosage titration. All potential drug–drug interactions and adverse reactions are not included in this list. For a more detailed list of drug interactions and adverse responses, clinicians should consult additional resources; for example, may be consulted for potential prolongation of the QT interval. §Recommended given in conjunction with a beta blocker or nondihydropyridine calcium channel antagonist. ║QTc calculation used the Bazett’s Formula in most clinical studies.AF indicates atrial fibrillation; AV, atrioventricular; BID, twice daily; BP, blood pressure; CrCl, creatinine clearance; ECG, electrocardiogram/electrocardiographic; HF, heart failure; INR, international normalized ratio; LV, left ventricular; QD, once daily; QID, 4 times a day; QTc, corrected QT interval; SA, sinoatrial; SVT, supraventricular tachycardia; TID, 3 times a day; and WPW, Wolff-Parkinson-White.Appendix 3. Success and Complication Rates for Ablation of SVT* ArrhythmiaAcute SuccessRecurrence RateMajor ComplicationsReferencesCommon SVTsAVNRT96%–97% PFJlZm1hbj48Q2l0ZT48QXV0aG9yPkNhbGtpbnM8L0F1dGhvcj48WWVhcj4xOTk5PC9ZZWFyPjxS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cmRzPjxLZXl3b3Jkcz5SZWN1cnJlbmNlPC9LZXl3b3Jkcz48S2V5d29yZHM+UmVzZWFyY2g8L0tl
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cz48S2V5d29yZHM+c3VyZ2VyeTwvS2V5d29yZHM+PEtleXdvcmRzPlRhY2h5Y2FyZGlhPC9LZXl3
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QWRkcmVzcz48V2ViX1VSTD5QTTo5ODkyNTkzPC9XZWJfVVJMPjxaWl9Kb3VybmFsU3RkQWJicmV2
PjxmIG5hbWU9IlN5c3RlbSI+Q2lyY3VsYXRpb248L2Y+PC9aWl9Kb3VybmFsU3RkQWJicmV2Pjxa
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U3BlY3RvcjwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJlY051bT4xNTg8L1JlY051bT48SURU
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dmVudHJpY3VsYXIgdGFjaHljYXJkaWE8L0lEVGV4dD48TURMIFJlZl9UeXBlPSJKb3VybmFsIj48
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PEtleXdvcmRzPlRhY2h5Y2FyZGlhPC9LZXl3b3Jkcz48S2V5d29yZHM+VGFjaHljYXJkaWEsQXRy
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IE91dGNvbWU8L0tleXdvcmRzPjxSZXByaW50Pk5vdCBpbiBGaWxlPC9SZXByaW50PjxTdGFydF9Q
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aXZlcnNpdHkgb2YgVmVybW9udCBDb2xsZWdlIG9mIE1lZGljaW5lIGFuZCBGbGV0Y2hlciBBbGxl
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ADDIN EN.CITE.DATA (59)Overall 2.8% ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>671</Start_Page><End_Page>677</End_Page><Periodical>Am J Cardiol</Periodical><Volume>104</Volume><Issue>5</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(09)01008-X;10.1016/j.amjcard.2009.04.040</Misc_3><Address>University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA. Peter.Spector@</Address><Web_URL>PM:19699343</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(55)PPM 0.3% ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>671</Start_Page><End_Page>677</End_Page><Periodical>Am J Cardiol</Periodical><Volume>104</Volume><Issue>5</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(09)01008-X;10.1016/j.amjcard.2009.04.040</Misc_3><Address>University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA. Peter.Spector@</Address><Web_URL>PM:19699343</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(55)Death 0.1% ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>671</Start_Page><End_Page>677</End_Page><Periodical>Am J Cardiol</Periodical><Volume>104</Volume><Issue>5</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(09)01008-X;10.1016/j.amjcard.2009.04.040</Misc_3><Address>University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA. 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ADDIN EN.CITE.DATA (55, 59)CTI-dependent atrial flutter97% ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>671</Start_Page><End_Page>677</End_Page><Periodical>Am J Cardiol</Periodical><Volume>104</Volume><Issue>5</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(09)01008-X;10.1016/j.amjcard.2009.04.040</Misc_3><Address>University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA. Peter.Spector@</Address><Web_URL>PM:19699343</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(55) 10.6% atrial flutter ADDIN REFMGR.CITE <Refman><Cite><Author>Perez</Author><Year>2009</Year><RecNum>517</RecNum><IDText>Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>517</Ref_ID><Title_Primary>Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis</Title_Primary><Authors_Primary>Perez,F.J.</Authors_Primary><Authors_Primary>Schubert,C.M.</Authors_Primary><Authors_Primary>Parvez,B.</Authors_Primary><Authors_Primary>Pathak,V.</Authors_Primary><Authors_Primary>Ellenbogen,K.A.</Authors_Primary><Authors_Primary>Wood,M.A.</Authors_Primary><Date_Primary>2009/8</Date_Primary><Keywords>analysis</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Disease</Keywords><Keywords>Heart</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>methods</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Quality of Life</Keywords><Keywords>Recurrence</Keywords><Keywords>surgery</Keywords><Keywords>Time</Keywords><Keywords>Treatment Outcome</Keywords><Keywords>Tricuspid Valve</Keywords><Reprint>Not in File</Reprint><Start_Page>393</Start_Page><End_Page>401</End_Page><Periodical>Circ Arrhythm.Electrophysiol.</Periodical><Volume>2</Volume><Issue>4</Issue><ISSN_ISBN>1941-3084</ISSN_ISBN><Misc_3>CIRCEP.109.871665;10.1161/CIRCEP.109.871665</Misc_3><Address>Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0053, USA</Address><Web_URL>PM:19808495</Web_URL><ZZ_JournalFull><f name="System">Circulation.Arrhythmia and electrophysiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Circ Arrhythm.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(395), 33% atrial fibrillation ADDIN REFMGR.CITE <Refman><Cite><Author>Perez</Author><Year>2009</Year><RecNum>517</RecNum><IDText>Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>517</Ref_ID><Title_Primary>Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis</Title_Primary><Authors_Primary>Perez,F.J.</Authors_Primary><Authors_Primary>Schubert,C.M.</Authors_Primary><Authors_Primary>Parvez,B.</Authors_Primary><Authors_Primary>Pathak,V.</Authors_Primary><Authors_Primary>Ellenbogen,K.A.</Authors_Primary><Authors_Primary>Wood,M.A.</Authors_Primary><Date_Primary>2009/8</Date_Primary><Keywords>analysis</Keywords><Keywords>Atrial Fibrillation</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Cardiology</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>Disease</Keywords><Keywords>Heart</Keywords><Keywords>Humans</Keywords><Keywords>Incidence</Keywords><Keywords>methods</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>physiopathology</Keywords><Keywords>Quality of Life</Keywords><Keywords>Recurrence</Keywords><Keywords>surgery</Keywords><Keywords>Time</Keywords><Keywords>Treatment Outcome</Keywords><Keywords>Tricuspid Valve</Keywords><Reprint>Not in File</Reprint><Start_Page>393</Start_Page><End_Page>401</End_Page><Periodical>Circ Arrhythm.Electrophysiol.</Periodical><Volume>2</Volume><Issue>4</Issue><ISSN_ISBN>1941-3084</ISSN_ISBN><Misc_3>CIRCEP.109.871665;10.1161/CIRCEP.109.871665</Misc_3><Address>Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0053, USA</Address><Web_URL>PM:19808495</Web_URL><ZZ_JournalFull><f name="System">Circulation.Arrhythmia and electrophysiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Circ Arrhythm.Electrophysiol.</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(395)Overall 0.5% ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter 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Peter.Spector@</Address><Web_URL>PM:19699343</Web_URL><ZZ_JournalFull><f name="System">The American journal of cardiology</f></ZZ_JournalFull><ZZ_JournalStdAbbrev><f name="System">Am J Cardiol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>(55)PPM 0.2% ADDIN REFMGR.CITE <Refman><Cite><Author>Spector</Author><Year>2009</Year><RecNum>158</RecNum><IDText>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>158</Ref_ID><Title_Primary>Meta-analysis of ablation of atrial flutter and supraventricular tachycardia</Title_Primary><Authors_Primary>Spector,P.</Authors_Primary><Authors_Primary>Reynolds,M.R.</Authors_Primary><Authors_Primary>Calkins,H.</Authors_Primary><Authors_Primary>Sondhi,M.</Authors_Primary><Authors_Primary>Xu,Y.</Authors_Primary><Authors_Primary>Martin,A.</Authors_Primary><Authors_Primary>Williams,C.J.</Authors_Primary><Authors_Primary>Sledge,I.</Authors_Primary><Date_Primary>2009/9/1</Date_Primary><Keywords>Adult</Keywords><Keywords>Atrial Flutter</Keywords><Keywords>Catheter Ablation</Keywords><Keywords>complications</Keywords><Keywords>Humans</Keywords><Keywords>Medicine</Keywords><Keywords>mortality</Keywords><Keywords>Patients</Keywords><Keywords>Recurrence</Keywords><Keywords>Research</Keywords><Keywords>Safety</Keywords><Keywords>surgery</Keywords><Keywords>Tachycardia</Keywords><Keywords>Tachycardia,Atrioventricular Nodal Reentry</Keywords><Keywords>Treatment Outcome</Keywords><Reprint>Not in File</Reprint><Start_Page>671</Start_Page><End_Page>677</End_Page><Periodical>Am J Cardiol</Periodical><Volume>104</Volume><Issue>5</Issue><ISSN_ISBN>1879-1913</ISSN_ISBN><Misc_3>S0002-9149(09)01008-X;10.1016/j.amjcard.2009.04.040</Misc_3><Address>University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA. 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ADDIN EN.CITE.DATA (233, 234, 269)Non–CTI-dependent atrial flutter73%–100%7%–53%0–7%PFJlZm1hbj48Q2l0ZT48QXV0aG9yPmRlIExvbWEtT3NvcmlvPC9BdXRob3I+PFllYXI+MjAxMzwv
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ADDIN EN.CITE.DATA (106, 211, 213, 215, 216, 218, 219, 221, 398)*Data in this table are derived from multiple observational studies and registries, and as such may not always reflect current practice.AT indicates atrial tachycardia; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; CHB, complete heart block; CTI, cavotricuspid isthmus; JT, junctional tachycardia; N/A, not available; PPM, permanent pacemaker; and SVT, supraventricular tachycardia. ADDIN REFMGR.REFLIST References1. Sganzerla P, Fabbiocchi F, Grazi S, et al. Electrophysiologic and haemodynamic correlates in supraventricular tachycardia. Eur Heart J. 1989;10:32-9.2. Bhandari AK, Anderson JL, Gilbert EM, et al. Correlation of symptoms with occurrence of paroxysmal supraventricular tachycardia or atrial fibrillation: a transtelephonic monitoring study. The Flecainide Supraventricular Tachycardia Study Group. Am Heart J. 1992;124:381-6.3. Leitch JW, Klein GJ, Yee R, et al. 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