(FIT)-Module 4 Workshop 7: Electrocradiogrpahic and Electrophysiological Correlations, Atrial Fibrillation, Clinical Scenarios and Syndromes-Poole Workshop 7

Poole Workshop 7

Pdf Summary

This workshop covered various topics related to electrocardiography, electrophysiology, and clinical scenarios in atrial fibrillation. The workshop consisted of multiple cases with accompanying ECG tracings and questions for the audience to answer. The cases covered a range of topics including the pharmacologic mechanisms of antiarrhythmic drugs and their effects on ECG findings, the use of medications in specific genetic mutations, the management of different types of tachycardias, and the evaluation of patients for pacemaker or ICD therapy.<br /><br />Some key takeaways from the workshop include:<br /><br />- Case 1 involved a patient with paroxysmal atrial fibrillation who was placed on a medication that blocks voltage-gated Na channels, which can lead to conduction abnormalities at higher heart rates.<br />- Case 2 discussed the use of mexiletine in patients with long QT syndrome caused by a gain-of-function mutation in the sodium channel gene SCN5A. Mexiletine can help reduce the risk of sudden cardiac death in these patients.<br />- Case 3 examined a patient with rapid palpitations and a narrow complex regular tachycardia. The patient was given adenosine, which resulted in the conversion of the tachycardia to preexcited atrial fibrillation. The recommended treatment in this case was intravenous procainamide.<br />- Case 4 involved a patient who took loperamide, an over-the-counter medication, in large quantities to relieve gastrointestinal symptoms. Loperamide can cause QT prolongation and increase the risk of torsades de pointes.<br />- Case 5 discussed the management of a patient with symptomatic recurrent atrial fibrillation and CAD. The recommended next step was to consider catheter ablation of atrial fibrillation.<br />- Case 6 focused on a patient with recurrent syncope, which was likely due to vasovagal syncope. Risk factor modification, such as changes in posture and hydration, was recommended as the first-line treatment.<br />- Case 7 explored the treatment options for a patient with non-ischemic cardiomyopathy. Considering the patient's atrial arrhythmias and wide QRS complex, the best next step was to first address the atrial arrhythmias before considering ICD or CRT therapy.<br />- Case 8 highlighted the potential cardiac effects of lithium, a commonly used medication for bipolar depression. Lithium can cause repolarization abnormalities and unmask Brugada syndrome on ECG.<br /><br />Overall, the workshop provided valuable insights into the management of arrhythmias, including the selection of appropriate antiarrhythmic medications, the importance of genetic testing in certain cases, and the consideration of various treatment modalities such as ablation and device therapy.

Keywords

electrocardiography

atrial fibrillation

antiarrhythmic drugs

SCN5A mutation

mexiletine

tachycardia management

QT prolongation

catheter ablation

vasovagal syncope

cardiac device therapy