Arrhythmias outcome

The desired outcomes for treatment are to terminate the arrhythmia, restore sinus rhythm, and prevent recurrence. Drug therapy is employed to terminate the arrhythmia and restore sinus rhythm nonpharmacologic measures are employed to prevent recurrence. 

Dihydropyridine channel blockers (e.g., nifedipine) have little benefit on clinical outcomes beyond symptom relief. The role of verapamil and diltiazem appears to be limited to symptom relief or control of heart rate in patients with supraventricular arrhythmias in whom /l-blockers are contraindicated or ineffective. 

The desired outcome depends on the underlying arrhythmia. For example, the ultimate treatment goals of treating AF or atrial flutter are restoring sinus rhythm, preventing thromboembolic complications, and preventing further recurrences. 

The response-to-injury hypothesis states that risk factors such as oxidized LDL, mechanical injury to the endothelium, excessive homocysteine, immunologic attack, or infection-induced changes in endothelial and intimal function lead to endothelial dysfunction and a series of cellular interactions that culminate in atherosclerosis. The eventual clinical outcomes may include angina, myocardial infarction, arrhythmias, stroke, peripheral arterial disease, abdominal aortic aneurysm, and sudden death. 

The indications for pulmonary artery catheterization are controversial. Because there is a lack of a well-defined outcome of data associated with this procedure, its use is presently best reserved for complicated cases of shock not responding to conventional fluid and medication therapies. Complications related to catheter insertion, maintenance, and removal include damage to vessels and organs during insertion, arrhythmias, infections, and thromboembolic damage. 

Other phenol-containing products are used as chemical peels to remove skin lesions, and in the treatment of chronic pain or spasticity. These uses have occasionally been associated with adverse outcomes, like cardiac arrhythmias, that have been seen in both adults and children. 

Cardiovascular events There have been rare reports following administration of botulinum toxin type A for other indications of adverse events involving the cardiovascular system, including arrhythmia and Ml, some with fatal outcomes. Some of these patients had risk factors including pre-existing cardiovascular disease. 

Cairns JA, Connolly SJ, Roberts R, et al. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations CAMIAT. Canadian Amiodarone myocardial infarction arrhythmia trial investigators. Lancet. Mar 8 1997 349(9053) 675-682. 

Ideally, if symptomatic sinus node dysfunction occurs in the presence of drugs known to impair sinus node function, the first treatment is to discontinue the offending drug [29]. However, this is typically not feasible in patients with heart failure who are dependent on several medications to improve long-term outcomes, or may need antiarrhythmic drug therapy for symptomatic arrhythmias. Accordingly, the treatment usually becomes a question of whether to apply pacing to increase heart rate. This is further complicated by the appropriate pacemaker prescription once the decision to pace has been made. 

Deflbrillation is one of the few interventions that has been shown to improve outcome from cardiac arrest. The cardiac arrhythmias commonly associated with sudden collapse are (1) asystole and (2) rapid and ineffective depolarization due to ventricular flbrillation (VF), pulseless ventricular tachycardia (VT), or supraventricular tachycardia with 1 1 ventricular response (as can occur with pre-excitation syndromes). The best strategy is to treat collapsed patients who have a broad-complex tachycardia at once by external Direct Current (DC) defibrillation. 

The prospective studies have also demonstrated an association between untreated moderate-to-severe levels of OSAS and hypertension, congestive heart failure, arrhythmias, myocardial infarction, pulmonary hypertension, cor pulmonale, and stroke after adjusting for confounding factors such as obesity (29-32). Preeclampsia and averse fetal outcome have recently been described (33-36). 

In iron storage disease, ascorbic acid should be given only after adequate serum concentrations of deferoxamine have been attained, in order to prevent serious cardiac arrhythmia (14). Opportunistic fungal infections associated with deferoxamine may also involve the heart muscle and usually have a fatal outcome (15-17). 

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