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Physiologic Imbalance as a Cause of Cardiac Arrhythmias

  • Conference paper
Critical Care Cardiology in the Perioperative Period

Part of the book series: Topics in Anaesthesia and Critical Care ((TIACC))

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Abstract

The three main causes of cardiac arrhythmias are: enhanced automaticity, reentry, or triggered activity. In the critical care setting patients often show electrical instability of the heart, either due to intrinsic cardiac diseases or to electrolyte and acid-base imbalance. In addition, they are submitted to aggressive drug therapies (inotropes, amines, antiarrhythmics), which may negatively influence myocardial excitability, possibly provoking a proarrhythmic effect [1–3]. In order to improve the therapeutic strategies in such patients, it could perhaps be useful to recall first of all some basic principles about the electrophysiologic properties of the heart, and then to link them to an appropriate choice of antiarrhythmic. Moreover, the possibility should always be considered of some detrimental effects in the presence of pharmacological interactions and myocardial depression.

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References

  1. Task Force of the Working Group on arrhythmias of the European Society of Cardiology. (1991) The Sicilian Gambit. Circulation 84: 1831–1851

    Article  Google Scholar 

  2. Morganroth J (1992) Proarrhythmic effects of antiarrhythmic drugs: evolving concepts. Am Heart J 128: 575–586

    Google Scholar 

  3. Kerin N, Somberg J (1994) Proaarhythmia: definition, risk factors, causes, treatment, and controversies. Am Heart J 128: 575–586

    Article  PubMed  CAS  Google Scholar 

  4. Gettes L (1994) Electrolytes abnormalities as triggers for lethal ventricular arrhythmias. In: Akhtar (ed) Sudden cardiac death. Williams and Wilkins, Philadelphia, pp 327–340

    Google Scholar 

  5. Oreto G (1997) I disordini del ritmo cardiaco. Centro Scientifico Editore, Torino

    Google Scholar 

  6. Tsuji H, Venditti FJ, Evans JC et al (1994) The association of levels of serum potassium and magnesium with ventricular premature complexes (the Framingham Heart Study). Am J Cardiol 74: 232–235

    Article  PubMed  CAS  Google Scholar 

  7. Curran ME, Splawsky I, Timothy KW et al (1995) A molecular basis for cardiac arrhytmias: HERG mutations cause long QT syndrome. Cell 80: 795–803

    Article  PubMed  CAS  Google Scholar 

  8. Singh BN (1993) Controlling cardiac arrhythmias by lengthening repolarization: emerging perspectives. Am J Card 72, 16:1F-124 F

    Article  Google Scholar 

  9. Atlee JL (1997) Perioperative cardiac dysrhythmias. Anestesiology 86: 1397–1424

    Article  CAS  Google Scholar 

  10. Sanguinetti MC, Jiang C, Curran ME et al (1995) A mechanistic link between an inherited and an acquired cardiac arrhythmia: HERG encodes the Ik potassium channel. Cell 81: 299–307

    Article  PubMed  CAS  Google Scholar 

  11. Hondeghem LM (1987) Antiarrhythmic agents. Modulated receptors applications. Circulation 75: 514–520

    Article  PubMed  CAS  Google Scholar 

  12. Nichols CG, Makhina EN, Pearson WL et al (1996) Inward rectification and implications for cardiac excitability. Circ Res 78: 1–7

    Article  PubMed  CAS  Google Scholar 

  13. Atlee JL (1998) New concepts of antiarrhythmic strategies. In: Cullo A (ed) APICE Proceedings. Springer, Milano, pp 291–297

    Google Scholar 

  14. Morganroth J (1992) Proarrhythmic effects of antiarrhythmic drugs: evolving concepts. Am Heart J 123: 1137–9

    Article  PubMed  CAS  Google Scholar 

  15. The CAST Investigators (1989) Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321: 406–412

    Article  Google Scholar 

  16. Roden DM (1994) Risks and benefits of antiarrhythmic therapy. N Engl J Med 331: 785–791

    Article  PubMed  CAS  Google Scholar 

  17. Roden DM (1993) Early afterdepolarizations and Torsade de Pointes: implications for the control of cardiac arrhythmias by controlling repolarization. Eur Heart J 14: 56–61

    Article  PubMed  Google Scholar 

  18. Wenckebach KF (1923) Cinchona derivatives in the treatment of heart disorders. JAMA 81: 472–4

    Article  Google Scholar 

  19. The Sicilian Gambit (1994) Antiarrhytmic therapy: a pathophysiologic approach. Futura publ, Armonk, pp 3–337

    Google Scholar 

  20. Roden DM, Woosley RL (1986) Flecainide. N Engl J Med 315: 36–41

    Article  CAS  Google Scholar 

  21. Turgeon J, Wisialowski TA, Wong W et al (1992) Suppression of longitudinal versus transverse conduction by sodium channel block: effects of sodium bolus. Circulation 85: 2221–2226

    Article  PubMed  CAS  Google Scholar 

  22. Hohnloser SH, Woosley LR (1994) Sotalol. N Engl J Med 331–338

    Google Scholar 

  23. Julian DG, Prescott RJ, Jackson FS, Szekely P (1982) Controlled trial of sotalol for one year after myocardial infarction. Lancet 1: 1142–1147

    Article  PubMed  CAS  Google Scholar 

  24. Mason JW (1987) Amiodarone. N Engl J Med 316: 455–458

    Article  CAS  Google Scholar 

  25. Kowey PR, Marinchak RA et al (1997) Intravenous amiodarone. J Am Coll Cardiol 29: 1190–1198

    Article  PubMed  CAS  Google Scholar 

  26. Daoud EG, Strickberger SA, Man KC et al (1997) Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med 337: 1785–1791

    Article  PubMed  CAS  Google Scholar 

  27. Camm AJ, Garratt CJ (1991) Adenosine and supraventricular tachycardia. N Engl J Med 325: 1621–1622

    Article  PubMed  CAS  Google Scholar 

  28. Tzivoni D, Banai S, Schuger C et al (1988) Treatment of Torsade de Pointes with magnesium sulfate. Circulation 77: 392–397

    Article  PubMed  CAS  Google Scholar 

  29. Choy AM, Lang CC, Chomsky DM et al (1997) Normalization of acquired QT prolongation in humans by intravenous potassium. Circulation 96: 2149–2154

    Article  PubMed  CAS  Google Scholar 

  30. Berlyne GM (1980) A course in clinical disorders of the body fluids and electrolytes. Blackwell, Oxford, pp 131–148

    Google Scholar 

  31. Bailiei D, Zipes D (1988) Magnesium suppression of early afterdepolarizations and ventricular tachiarrhythmias induced by cesium in dogs. Circulation 77: 1395–1402

    Article  Google Scholar 

  32. Yang T, Roden DM (1996) Extracellular potassium modulation of drug block of Ikr. Implications for Torsade de Pointes and reverse use-dependence. Circulation 93: 407–441

    Google Scholar 

  33. Schiraldi F (1993) Acqua, elettroliti, equilibrio acido-base: l’essenziale. Idelson, Napoli

    Google Scholar 

  34. Ragsdale DS, McPhee JC, Scheyer T, Catterall WA et al (1994) Molecular determinants of state-dependent block of Na channels by local anesthetics. Science 265: 1724–1728

    Article  PubMed  CAS  Google Scholar 

  35. Funck-Brentano C, Kroemer HK, Lee JT, Roden DM (1990) Propafenone. N Engl J Med 322: 518–525

    Article  CAS  Google Scholar 

  36. Hohnloser SH, Van de Loo A (1995). Efficacy and proaarhythmic hazards: prospective comparison of sotalol versus quinidine. J Am Coll Cardiol 26: 852–858

    Article  PubMed  CAS  Google Scholar 

  37. Steinbach KK, Merl O, Frohner K et al (1994) Haemodynamics during ventricular tachyarrhythmias. Am Heart J 127: 1102–1106

    Article  PubMed  CAS  Google Scholar 

  38. Soroker D, Ezri T, Szmuk P et al (1995) Perioperative Torsade de Pointes ventricular tachycardia induced by hypocalcemia and hypokalemia. Anesth Analg 80: 630–633

    PubMed  CAS  Google Scholar 

  39. Viskin S (1999) Long QT syndromes and Torsade de pointes. Lancet 354: 1625–1633

    Article  PubMed  CAS  Google Scholar 

  40. Artucio H, Pereira M (1990) Cardiac arrhythmias in critically ill patients: epidemiologic study. 18: 1383–1388

    CAS  Google Scholar 

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Authors
  1. F. Schiraldi
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  2. P. Ferraro
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  3. F. Paladino
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Editor information

Editors and Affiliations

  1. Department of Anaesthesiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA

    J. L. Atlee

  2. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium

    J.-L. Vincent

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© 2001 Springer-Verlag Italia

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Schiraldi, F., Ferraro, P., Paladino, F. (2001). Physiologic Imbalance as a Cause of Cardiac Arrhythmias. In: Atlee, J.L., Vincent, JL. (eds) Critical Care Cardiology in the Perioperative Period. Topics in Anaesthesia and Critical Care. Springer, Milano. https://doi.org/10.1007/978-88-470-2955-2_8

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  • DOI: https://doi.org/10.1007/978-88-470-2955-2_8

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0133-6

  • Online ISBN: 978-88-470-2955-2

  • eBook Packages: Springer Book Archive

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