There are many arrhythmia related achievements in 2016. The authors selected a set of articles to provide potentially influential information in everyday practice. First, arrhythmia and catheter ablation 1. Supraventricular tachycardia: diagnosis and treatment Supraventricular tachycardia (SVT) remains a common cause of emergency hospitalization. The REVERT study evaluated the best and most effective first-aid strategy for SVT and compared the modified posture (15 seconds in the supine position after 15 seconds of leg elevation) with the standard Valsalva action (ie, forced exhalation to bring the pressure gauge to 40 mmHg, And insist on 15 seconds). The proportion of patients with SVT termination in the modified posture group (43%, n=214) was significantly higher than that in the standard exercise group (17%, n=214; P <0.0001). Therefore, patients in the study group who required adenosine (50% vs. 69%) or emergency antiarrhythmia therapy (57% vs. 80%) had a significant reduction in termination of arrhythmia events, and there was no difference in discharge time. This finding may significantly affect daily practice and reduce drug-related discomfort in patients with SVT during emergency treatment. The latest SVT diagnosis and treatment can be found in the 2016 EHRA / ESC consensus on SV treatment. 2. Atrial fibrillation: pathophysiology, risk, treatment opportunities, and new ESC AF guidelines An atrial remodeling trial and clinical study led to a rigorous scientific discussion of the pathophysiology of atrial fibrillation, particularly the driver of AF progression. The results showed that atrial adipose tissue (previously considered a strong risk factor for AF development) was gradually replaced by fibrotic tissue that underlies AF progression. These data may further explain the link between obesity and AF described in recent clinical studies. However, these studies have also shown that weight loss does not significantly reduce the burden of AF, and I am now particularly interested in whether the reduction in AF burden can be consistent with myocardial remodeling, and vice versa (Figure 1). MRI-based fibrosis detection and quantification can record changes in myocardium over time and provide further insight into important aspects of future AF pathology. (Fig. 2) However, various methodological barriers need to be overcome, mainly due to the thin atrial wall, and proper protocols are essential. Controlling heart rate is the most common treatment option for AF patients worldwide. The best medication data that supports heart rate control to alleviate symptoms and reduce the risk associated with atrial fibrillation is limited and somewhat controversial. A recent study in Taiwan analyzed the long-term effects of beta-blockers, calcium channel blockers, and digitalis on heart rate in patients with persistent atrial fibrillation. After adjusting for baseline differences, the researchers found that 43 879 patients with beta blockers and 18,466 patients treated with calcium channel blockers had a significantly lower risk of death than 168,678 patients who did not receive any control of heart rate. Group of patients. In contrast, patients treated with digoxin have a higher risk of death. A recent meta-analysis of drugs that control heart rate did not show that beta blockers have this beneficial effect. These findings contribute to future debates about the effects of heart rate medications on the risk of all-cause mortality in patients with persistent AF, and randomized trials are needed to address this related problem. Figure 1. Different kinetics of scar progression with progressive fibrosis over a three-year period following atrial fibrillation ablation. Panel (A) depicts patients with little or no increase in cardiac fibrosis, while panel (B) depicts patients with a large increase in cardiac fibrosis at 1 and 3 years (green) that coincide with multiple recurrence. Figure 2 MRI imaging of atrial wall fibrosis. The MRI cross section is at the level of the left atrium (left) and the 5-chamber view (right). Atrial fibrosis can be detected in various areas of the atrial wall (white spots). Only the left atrial appendage (LAA) has no scars.
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