Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythm...Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia.The causes of AA are multifactorial.The review begins with a brief history of LT and AA.This review further describes the pathophysiology of the AA.The risk factors,incidence,recipient characteristics including intra-operative factors are elaborated on.Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT,the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia.The strategy of rate control vs rhythm control is discussed.The pros and cons of various drug regimen,need for direct current cardioversion and catheter ablation therapies are considered.Possible methods to prevent or reduce the incidence of AA after LT are considered.The impact of AA on the short-term and long-term outcomes following LT is discussed.展开更多
AIM: To investigate whether landiolol, an ultra-shortacting β1-antagonist, can safely and effectively control heart rate in septic patients with supraventricular tachyarrhythmias.METHODS: We reviewed all patients wit...AIM: To investigate whether landiolol, an ultra-shortacting β1-antagonist, can safely and effectively control heart rate in septic patients with supraventricular tachyarrhythmias.METHODS: We reviewed all patients with sepsis who admitted to our intensive care unit between January 2006 and December 2011. Sixty one septic patients suffered from supraventricular tachyarrhythmias(heart rate ≥ 120 bpm for > 1 h). Among 61 patients, 39 patients were treated with landiolol(landiolol group) and 22 patients were not treated with landiolol(control group). Arterial pressure, heart rate, cardiac rhythm, pulmonary arterial pressure and cardiac output(if a pulmonary arterial catheter was inserted) were compared between the 2 groups at 1, 8 and 24 h after the initiation of tachyarrhythmias. RESULTS: Mean age and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were similar between the 2 groups. Paroxysmal atrial fibrillation/flutter(87%), paroxysmal atrial tachycardia(10%), and paroxysmal supraventricular tachycardia(3%) were observed. The initial landiolol dose administered was 6.3 ± 5.8 g/kg per minute. Rapid and substantial reduction of heart rate was observed in the landiolol group without anydeterioration of hemodynamics. Landiolol significantly reduced heart rate(from 145 ± 14 bpm to 90 ± 20 bpm) compared to the control group(from 136 ± 21 bpm to 109 ± 18 bpm, P < 0.05). The conversion to sinus rhythm was observed more frequently in the landiolol group than in the control group at every point(P < 0.01 at 8 h; P < 0.05 at 1 and 24 h).CONCLUSION: Landiolol safely reduced heart rate and, in part, converted to sinus rhythm in septic patients with supraventricular tachyarrhythmias.展开更多
文摘Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia.The causes of AA are multifactorial.The review begins with a brief history of LT and AA.This review further describes the pathophysiology of the AA.The risk factors,incidence,recipient characteristics including intra-operative factors are elaborated on.Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT,the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia.The strategy of rate control vs rhythm control is discussed.The pros and cons of various drug regimen,need for direct current cardioversion and catheter ablation therapies are considered.Possible methods to prevent or reduce the incidence of AA after LT are considered.The impact of AA on the short-term and long-term outcomes following LT is discussed.
文摘AIM: To investigate whether landiolol, an ultra-shortacting β1-antagonist, can safely and effectively control heart rate in septic patients with supraventricular tachyarrhythmias.METHODS: We reviewed all patients with sepsis who admitted to our intensive care unit between January 2006 and December 2011. Sixty one septic patients suffered from supraventricular tachyarrhythmias(heart rate ≥ 120 bpm for > 1 h). Among 61 patients, 39 patients were treated with landiolol(landiolol group) and 22 patients were not treated with landiolol(control group). Arterial pressure, heart rate, cardiac rhythm, pulmonary arterial pressure and cardiac output(if a pulmonary arterial catheter was inserted) were compared between the 2 groups at 1, 8 and 24 h after the initiation of tachyarrhythmias. RESULTS: Mean age and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were similar between the 2 groups. Paroxysmal atrial fibrillation/flutter(87%), paroxysmal atrial tachycardia(10%), and paroxysmal supraventricular tachycardia(3%) were observed. The initial landiolol dose administered was 6.3 ± 5.8 g/kg per minute. Rapid and substantial reduction of heart rate was observed in the landiolol group without anydeterioration of hemodynamics. Landiolol significantly reduced heart rate(from 145 ± 14 bpm to 90 ± 20 bpm) compared to the control group(from 136 ± 21 bpm to 109 ± 18 bpm, P < 0.05). The conversion to sinus rhythm was observed more frequently in the landiolol group than in the control group at every point(P < 0.01 at 8 h; P < 0.05 at 1 and 24 h).CONCLUSION: Landiolol safely reduced heart rate and, in part, converted to sinus rhythm in septic patients with supraventricular tachyarrhythmias.
