Multiple and Concurrent Arrhythmia
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Given the unique interventional emphasis in our specialty, Teaching Rounds in Cardiac Electrophysiology has frequently centered on the pearls and pitfalls associated with electrogram analysis and complications of lead implant extraction or ablation and in mapping complex arrhythmia circuits. In this issue of Circulation: Arrhythmia and Electrophysiology, Fabrizio et al,1 in a refreshing departure from this norm, take us to a more classic medical teaching rounds relevant to rhythm management. They present a patient with multiple changing malignant rhythm disorders resulting from caffeine toxicity. Their submission is replete with clinical diagnostic dilemmas, treatment difficulties, and also a succinct but comprehensive discussion of caffeine toxicity and the heart.
See Article by Fabrizio et al
Most often in the electrophysiology laboratory, we deal with one primary arrhythmia in a patient, some which occur in structurally normal hearts and others specifically related to structural cardiac disease. Occasionally, multiple disparate arrhythmias are related, and most of these are well recognized by electrophysiologists. Accessory pathway–related supraventricular tachycardia and atrial fibrillation, atrioventricular (AV) node reentrant tachycardia, and outflow tract ventricular tachycardia (VT) are well-recognized examples. Multiple and changing tachycardias emerging in a relatively short time frame may also occur in the setting of myocarditis or other changing substrate. Less commonly, more than one unrelated rhythm disorder may be present at the same time, such as 2 different VTs producing a bidirectional pattern or the concurrent atrial tachycardias and VTs of digitalis toxicity.
Fabrizio et al discuss the less well appreciated occurrences of multiple as well …