Biomedical subjects

Brett Heilbron

Publications and source records attributed to Brett Heilbron.

3 recordsLinked to original sources

PubMed2005

Atrial fibrillation following cardiac surgery.

Atrial tachyarrhythmias, usually atrial fibrillation or atrial flutter, are the most common complications of cardiac surgery. Atrial tachyarrhythmias are associated with patient discomfort/anxiety, hemodynamic deterioration, cognitive impairment, thromboembolic events (including stroke), exposure to the risks of antiarrhythmic treatments, longer hospital stays and increased costs. Many approaches to the prevention of postoperative atrial tachyarrhythmias have been studied. Of these, studies using perioperative beta-blocking agents or amiodarone provide level A evidence of efficacy and, in properly selected patients, have shown a high degree of safety. Less convincing, level B evidence exists for the use of postoperative temporary atrial pacing and for perioperative intravenous magnesium treatment. The treatment of postoperative atrial tachyarrhythmias is similar to those occurring in other settings and includes excluding other potential causes of atrial tachyarrhythmias, antithrombotic or anticoagulation therapy, control of the ventricular response rate and consideration of restoring/maintaining sinus rhythm. The selection of therapies to achieve these goals should consider the sympathetic nervous system discharge state of the postoperative environment and the natural history of postoperative atrial fibrillation, which includes spontaneous resolution of the arrhythmogenic tendency after approximately six weeks. The Canadian Cardiovascular Society Consensus Conference recommendations for the prevention of atrial tachyarrhythmias after cardiac surgery and for the treatment of atrial tachyarrhythmias that occur after cardiac surgery are presented along with evidence that supports these recommendations.

Atrial Fibrillation↗

PubMed2005

Management of atrial fibrillation in the emergency department and following acute myocardial infarction.

Atrial fibrillation (AF) is the most common arrhythmia managed by emergency physicians and there is increasing evidence that selected patients with acute AF can be safely managed in the emergency department without the need for hospital admission. The principles of management are identification and treatment of precipitating or underlying causes, hemodynamic stabilization/rate control, reduction of thromboembolism risk and the conversion/maintenance of sinus rhythm. A strategy of rate or rhythm control should be chosen based on the patient's clinical status, the duration of AF, the experience of the treating physician and the status of anticoagulation. Before either electric or pharmacological cardioversion, anticoagulation should be considered. Most patients should be given heparin or low molecular weight heparin while preparing for cardioversion. All patients should be considered for long-term anticoagulation based on their thromboembolic risk and bleeding risk from antithrombotic therapy. Following restoration of sinus rhythm, a decision regarding the use of antiarrhyhmic drugs should be made based on the estimated frequency of recurrence and degree of symptoms. In the setting of acute myocardial infarction, beta-blockers should be administered whenever possible. If beta-blockers are contraindicated, the rate can be slowed with digoxin or amiodarone. Cardioversion should be performed if the patient is hemodynamically unstable. Class IC antiarrhythmic drugs should not be administered in this setting.

Atrial Fibrillation↗

PubMed2004

Electrocardiogram artifacts caused by deep brain stimulation.

BACKGROUND: Deep brain stimulation (DBS) is increasingly used to treat a variety of neurological conditions (e.g. movement disorders and chronic pain). This prospective study was designed to detect electrocardiogram (ECG) artifacts induced by deep brain stimulation and to investigate which factors (patient disease, electrode position within the brain or type of stimulation) produced these artifacts. METHODS: Twelve patients (four women, eight men) with deep brain stimulators were enrolled in the study. Patients were selected to represent the common indications for DBS (Parkinson's disease, tremor, dystonia), the common electrode locations (pallidum, thalamus, subthalamic nucleus) and the two types of stimulation (monopolar, bipolar). Patients had one ECG with the DBS turned 'on' and another with the DBS turned 'off'. The ECGs were then randomized and read by a cardiologist blinded to the status of the patient and DBS and artifacts were noted to be either present or absent. RESULTS: The six patients using monopolar stimulation all had artifacts on their electrocardiograms. These artifacts were severe enough to interfere with ECG interpretation. There were no artifacts detected in the six patients using bipolar stimulation. Electrode location and patient disease appeared to have no effect on ECG artifact. CONCLUSIONS: Deep brain stimulation can cause ECG artifacts when monopolar settings are used. These artifacts are not present with bipolar settings or when the DBS is turned 'off'. Knowledge of these potential ECG artifacts and how to avoid them is essential to facilitate accurate ECG interpretation.

Adult↗