M 68, had a previous diagnostic of paroxysmal Afib and is co | Figure 1

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M 68, had a previous diagnostic of paroxysmal Afib and is coming for #Cardioversion.

We did a control 12 leads ECG before the procedure. We didn’t have more info on him.

Oral Class I and III antiarrhythmic drugs for maintaining sinus rhythm after catheter ablation of atrial fibrillation

We wanted to find out how effective certain classes of antiarrhythmic drugs (medications used to prevent or treat an irregular heart rhythm) are for maintaining sinus rhythm (normal heart rhythm) in people after catheter ablation (a technique using catheters to create controlled burns in the heart to prevent and treat arrhythmia occurrence) for atrial fibrillation (a common type of irregular heart rhythm), compared to catheter ablation alone.

Study characteristics

We conducted the search on 5 August 2022, and identified 4682 citations (papers), out of which nine were eligible randomised controlled trials (a type of study where people are randomly assigned to one of two or more treatment groups). The studies included a total of 3269 participants from six countries, who were assigned to either Class I or III antiarrhythmics (or both) or placebo (sugar pill)/standard treatment. People taking part in the studies were on average 59 years old, and 71% were male. Most people had paroxysmal atrial fibrillation (meaning they were not in atrial fibrillation all the time and alternated with normal rhythms).

Results

We found that the effect of Class I and/or III antiarrhythmic drugs given up to around 3 months after ablation may reduce recurrence of arrhythmia at 0 to 3 months, and likely reduces recurrence at greater than 3 to 6 months, although the benefit does not appear to continue beyond 6 months (the evidence for this last result was very uncertain). We also looked at adverse outcomes (i.e. complications). We found that the use of antiarrhythmics was probably associated with a reduction in hospitalisation at 0 to 3 months. We also found evidence suggesting that antiarrhythmics are not associated with different rates of thromboembolic events (clots in the brain, lungs, or legs), heart attacks, death due to any cause, or requirement for repeat ablation compared with control or standard treatment.

Certainty of the results

Our confidence in the evidence was low for recurrence of arrhythmias at 0 to 3 months, moderate at 3 to 6 months, and very low at greater than 6 months. Our confidence in the evidence for reduction of hospitalisation for arrhythmias was moderate.

Male, 38yo, has a syncope 8 hours ago.

He was OK in the ER but we've noticed irregular pulse. We made an ECG (above). No other health problems, in use of benzodiazepinicos and duloxetin. Any findings? Any thoughts?!

We shocked this patient out of a narrow-complex regular tachyarrhythmia only to achieve these triplets later, degenerating to atrial fibrillation.

How would you describe this EKG? It reminds me of atrial bigeminy (couplets), but these are groups of 3 atrial complexes the first of which has a different morphology.

STUDENTS let's play....

Patient One: What is this rhythm? What clinical findings and procedures did we do in the field prior to hospital? How do you think the patient(s) presented? What medication(s) did we give? Dosage(s)?

Patient Two: When said medication(s) from earlier this week didn't work on patient two, what is the next step we can perform in the field to return the heart to a much more appropriate rate/rhythm? What other unique things can we try for these patients? If you haven't learned anything by the end of this post, always manually feel a pulse. What a shocking week I had. Eh?

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.

She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.

Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse.

No chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?