Skip to main content

Cardiac Arrhythmias

Family Medicine
  • 1596 Accesses

The electrical activation of heart muscle follows a precise and organized pathway which ensures that contraction and relaxation occur in an efficient way to support effective circulation. Arrhythmias result from an abnormal electrical activation of the heart which may lead to an abnormal rhythm and rate of the heart cycle. While some arrhythmias are benign and pose no significant cardiovascular compromise, others degrade the mechanical pumping activity and lead to hemodynamic compromise and, in some cases, to collapse and or death.

Arrhythmias are commonly seen in primary care, and many are diagnosed and managed by primary care physicians, either alone or along with a cardiologist. Although more common among the elderly and those with heart disease, they must be considered in the differential diagnosis of all patients presenting with syncope, lightheadedness, palpitations, fatigue, dyspnea on exertion, and shortness of breath. The main goal in evaluating patients is to first assess...

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Wang PJ, Estes NA. Cardiology patient pages. Supraventricular Tachycardia. Circulation. 2002;106(25):e206–8.

    Article  PubMed  Google Scholar 

  2. Giada F, Gulizia M, Francese M, et al. Recurrent unexplained palpitations (RUP) study comparison of implantable loop recorder versus conventional diagnostic strategy. J Am Coll Cardiol. 2007;49:1951–6.

    Article  PubMed  Google Scholar 

  3. Craig TJ, January L, Wann S, et al. 2014 AHA/ACC/HRS Guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. Published on line 28 Mar 2014. http://circ.ahajournals.org/content/suppl/2014/10/CIR.0000000000000040.DC1.html

  4. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC. 2006 Guidelines for management of patients with ventricular Arrhythmias and the prevention of sudden cardiac death-executive summary. A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death). Circulation. 2006;114:1088–132.

    Article  Google Scholar 

  5. Strickberger SA, Conti J, Daoud EG, et al. Patient selection for cardiac resynchronization therapy: from the Council on Clinical Cardiology Subcommittee on Electrocardiography and Arrhythmias and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Heart Rhythm Society. Circulation. 2005;111(16):2146–50.

    Article  PubMed  Google Scholar 

  6. Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of the cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. [corrected]. Circulation. 2012;126(14):1784–800. Erratum in Circulation 2013;127(3):e357–9. Heart Rhythm Society [added].

    Article  PubMed  Google Scholar 

  7. Jacobs I, Sunde K, Deakin CD, et al. Part 6: defibrillation: 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation. 2010;122 Suppl 2:S325–37.

    Article  PubMed  Google Scholar 

  8. Link MS, Atkins DL, Passman RS, et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S706–19. Erratum in Circulation. 2011;123(6):e235.

    Article  PubMed  Google Scholar 

  9. Dhein S. Antiarrhythmic drugs. In: Offermanns S, editor. Encyclopedia of molecular pharmacology. Berlin/Heidelberg: Spring; 2008. p. 96–102. ISBN 978-3-540-38916-3.

    Chapter  Google Scholar 

  10. Uddin S, Price S. Anti-arrhythmic therapy. In: Hall J, editor, Encyclopedia of intensive care medicine. Berlin/Heidelberg: Springer; 2012. SpringReference www.springerreferrence.com. 2012-08-14 10:55:27 UTC.

  11. Philip JP. Major side effects of beta blockers. Up to date. Nov 2014, last update Dec 2014.

    Google Scholar 

  12. Micromedex. 2014. http://micromedex.com/

  13. Holgate A, Foo A. Adenosine versus intravenous calcium channel antagonists for the treatment of supraventricular tachycardia in adults. Cochrane Database Syst Rev. 2012, issue 2. Art. No:CD005154. doi:10.1002/14651858.CD005154.pub3.

    Google Scholar 

  14. Damiano RJ, Gaynor SL, Bailey M, et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. J Thorac Cardiovasc Surg. 2003;126:2016–21.

    Article  PubMed  Google Scholar 

  15. Healy JS, Crystal E, Lamy A, et al. Left Atrial Appendage Occlusion Study (LAAOS): results of randomized control pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am Heart J. 2005;150:288–93.

    Article  Google Scholar 

  16. Sick PB, Schuler G, Hauptmann KE, et al. Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation. J Am Coll Cardiol. 2007;49:1490–5.

    Article  PubMed  Google Scholar 

  17. Link MS. Evaluation and initial treatment of supraventricular tachycardia. N Engl J Med. 2012;376:1438–48.

    Article  Google Scholar 

  18. Vidaillet H, Granada JF, Chyou PH, et al. A population-based study of mortality among patients with atrial fibrillation or flutter. Am J Med. 2002;113:365–70.

    Article  PubMed  Google Scholar 

  19. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370–5.

    Article  CAS  PubMed  Google Scholar 

  20. Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920–5.

    Article  PubMed  Google Scholar 

  21. Pederson OD, Abildstrom SZ, Ottesen MM, et al. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction. Eur Heart J. 2006;27:290–5.

    Article  Google Scholar 

  22. Gutierrez C, Blanchard D. Atrial fibrillation: diagnosis and treatment. Am Fam Physician. 2011;83:61–8.

    PubMed  Google Scholar 

  23. Chen HS, Wen JM, Wu SN, et al. Catheter ablation for paroxysmal and persistent atrial fibrillation. Cochrane Database Syst Rev. 2012;4:CD007101.

    PubMed  Google Scholar 

  24. Sherman DG, Kim SG, Boop BS, et al. Occurrence and characteristics of stroke events in the Atrial Fibrillation Follow-up Investigation of Sinus Rhythm Management (AFFIRM) study. Arch Intern Med. 2005;165:1185–91.

    Article  PubMed  Google Scholar 

  25. Hagens VE, Ranchor AV, Van Sonderen E, et al. Effect of rate or rhythm control on quality of life in persistent atrial fibrillation. Results from the Rate Control Versus Electrical Cardioversion (RACE) Study. J Am Coll Cardiol. 2004;43(2):241–7.

    Article  PubMed  Google Scholar 

  26. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347(23):1834–40.

    Article  PubMed  Google Scholar 

  27. Lip GY. Implications of the CHA2DS2-VASc and HAS-BLED scores for thromboprophylaxis in atrial fibrillation. Am J Med. 2011;124:111–4.

    Article  PubMed  Google Scholar 

  28. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.

    Article  PubMed  Google Scholar 

  29. Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58:395–401.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Apostolakis S, Lane DA, Guo Y, et al. Performance of the HEMORR(2)HAGES, ATRIA, and HAS-BLED bleeding risk–prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (evaluating the use of SR34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation) study. J Am Coll Cardiol. 2012;60:861–7.

    Article  PubMed  Google Scholar 

  31. Roldan V, Marin F, Fernandez H, et al. Predictive value of the HAS-BLED and ATRIA bleeding scores for the risk of serious bleeding in a “real world” population with atrial fibrillation receiving anticoagulation therapy. Chest. 2013;143:179–84.

    Article  PubMed  Google Scholar 

  32. Perez-Gomez F, Alegria E, Berjon J, et al. Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation: a randomized multicenter study. J Am Coll Cardiol. 2004;44(8):1557–66.

    Article  CAS  PubMed  Google Scholar 

  33. Connolly S, Pogue J, Hart R, et al. ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomized controlled trial. Lancet. 2006;367:1903–12.

    Article  CAS  PubMed  Google Scholar 

  34. Ruff CT, Giugliano RT, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomized trials. Lancet. 2014;383:955–62.

    Article  CAS  PubMed  Google Scholar 

  35. Aguilar MI, Hart R, Pearce LA. Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks. Cochrane Database Syst Rev. 2007;3:CD006186.

    Google Scholar 

  36. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51.

    Article  CAS  PubMed  Google Scholar 

  37. Weitz JI, Connolly SJ, Patel I, et al. Randomized, parallel-group, multicenter, multinational phase 2 study comparing edoxaban, an oral factor Xa inhibitor, with warfarin for stroke prevention in patients with atrial fibrillation. Thromb Haemost. 2010;104:633–41.

    Article  CAS  PubMed  Google Scholar 

  38. Steinberg BA, Piccini JP. Anticoagulation in atrial fibrillation. BMJ. 2014;348:g2116.

    Article  PubMed  Google Scholar 

  39. Bacon D, Philips B. Ventricular Arrhythmias. In: Hall J, Vincent J, editors, Encyclopedia of intensive medicine. Berlin/Heidelberg: Springer; 2012. Spring Reference. www.springerreference.com, 2012-08-14 10:55:00 UTC.

  40. Hallstrom AP, Ornato JP, Weisfeldt M, et al. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med. 2004;351:637–46.

    Article  CAS  PubMed  Google Scholar 

  41. Huang Y, He Q, Yang LJ, et al. Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest. Cochrane Database of systematic reviews 2014, Issue 9. Art. No.: CD 009803. doi:10.1002/14651858.CD009803.pub2.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cecilia Gutierrez .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this entry

Cite this entry

Gutierrez, C., Hatamy, E. (2015). Cardiac Arrhythmias. In: Paulman, P., Taylor, R. (eds) Family Medicine. Springer, Cham. https://doi.org/10.1007/978-1-4939-0779-3_84-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0779-3_84-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-1-4939-0779-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Cardiac Arrhythmias
    Published:
    26 July 2020

    DOI: https://doi.org/10.1007/978-1-4939-0779-3_84-2

  2. Original

    Cardiac Arrhythmias
    Published:
    08 September 2015

    DOI: https://doi.org/10.1007/978-1-4939-0779-3_84-1