Utilization and Predictors of Electrical Cardioversion in Patients Hospitalized for Atrial Fibrillation

Atrial fibrillation (AF) is a common arrhythmia in adults associated with thromboembolic complications. External electrical cardioversion (DCCV) is a safe procedure used to convert AF to normal sinus rhythm. We sought to study factors that affect utilization of DCCV in hospitalized patients with AF. The study sample was drawn from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project in the United States. Patients with a primary discharge diagnosis of AF that received DCCV during hospitalization in the years 2000–2010 were included. An estimated 2,810,530 patients with a primary diagnosis of AF were hospitalized between 2001 and 2010, of which 1,19,840 (4.26%) received DCCV. The likelihood of receiving DCCV was higher in patients who were males, whites, privately insured, and aged < 40 years and those with fewer comorbid conditions. Higher CHADS2 score was found to have an inverse association with DCCV use. In-hospital stroke, in-hospital mortality, length of stay, and cost for hospitalization were significantly lower for patients undergoing DCCV during AF related hospitalization. Further research is required to study the contribution of other disease and patient related factors affecting the use of this procedure as well as postprocedure outcomes

A patient with mexiletine-related psychosis

Mexiletine is a commonly used Class IB (Vaughan William classification) antiarrhythmic drug. We report a case of mexiletine-induced psychosis that was successfully managed by decreasing the dose and using alternative medications for management of ventricular tachycardia

Recurrent A V block following ablation for AVNRT

Slow pathway modification has become the mainstay for the treatment of atrio-ventricular nodal re-entrant tachycardia (AVNRT) ablation because of high success rate and low incidence of complications. Our patient had a rare complication of slow pathway modification by radiofrequency ablation (RFA) in form of delayed complete heart block, occurring 10 days after the procedure and resolving in 6 weeks to normal conduction. Complete AV block is a rare immediate complication of RFA but can present weeks later. Transient atrio-ventricular (AV) block during the procedure is seen in all patients who develop delayed AV block and these patients should be monitored closely

Inappropriate Sinus Tachycardia Following Viral Illness

A 67-year-old female patient with a past medical history of menopause, migraines, and gastro-esophageal disease presented with palpitation, fatigue, and shortness of breath. One month prior to her presentation, she reported having flu-like symptoms. Her EKG showed sinus tachycardia with no other abnormality. Laboratory findings, along with imaging, showed normal results. The event monitor failed to detect any arrythmias. We report a case of inappropriate sinus tachycardia secondary to viral infection as a diagnosis of exclusion

ST Segment Elevation and Depressions in Supraventricular Tachycardia without Coronary Artery Disease

ST segment changes are well documented in literature during supraventricular tachycardias. We present a case of a 21-year-old male who presents with chest pain, shortness of breath, and dizziness with an ECG showing atrioventricular reentrant tachycardia and diffuse ST segment depressions. Patient spontaneously converted to sinus rhythm, but he was still complaining of crushing chest pain. ECG taken after conversion showed sinus rhythm at a rate of 65 and showed obvious persistence of ST depressions in majority of leads. Emergent left heart catheterization showed normal coronaries. Such ST depression is suggestive of global ischemia in small intracardiac vessels that cannot be evaluated by left heart catheterization

Amiodarone-related hyponatremia: rare but potentially lethal.

Amiodarone is a one of the most commonly used antiarrhythmic drug with efficacy in both supraventricular and ventricular tachycardia. Hepatic, pulmonary, and thyroid adverse effect profiles of this drug are well described and mandate a close follow-up. We report a case of amiodarone-related hyponatremia, which is one of the rarest side effects associated with this medication and our case was unlike other previous case reports because severity of symptoms required hemodialysis for correction of hyponatremia despite trying dose reduction strategy