Mechanism and Management of Chaotic Atrial Mechanism

Abstract

37 patients with chaotic atrial mechanism (CAM) were identified, treated sequentially with corrective anti-arrhythmic agents according to protocol, and analyzed. 30 patients with CAM had chronic obstructive lung disease, and 14 patients developed CAM in association with acute CHF. In five patients, CAM resulted from acute pulmonary embolism. Excessive use of isoproterenol was responsible for CAM in nine patients, while in four digitalis toxicity was the underlying agent. Five patients suffered from space-occupying lesions of the posterior atrial walls.Management was directed toward relief of the underlying responsible illness: 6 of 9 patients with isoproterenol overdose, and 3 of 4 patients with digitalis excess responded to removal of the offending agents. Quinidine and propranolol in combination appeared most efficacious in those patients not responding to control of the immediate underlying event: 10 of 20 of such patients benefited.Distention of either the right or left atrial walls, drug-induced automaticity, invasion of the atria, and acute ischemia or chronic diffuse fibrotic atrial disease accounted for the cases. These are not dissimilar to the currently accepted responsible events for pathologic ventricular automaticity.

Arrhythmias in Children and Young Adults

“…It is associated with significant respiratory disease in adults. It is also associated with hypoxemia, glucose intolerance, hypokalemia, digitalis, and chronic renal failure (Kones et al 1974). 5.1.5.3 Mechanism: Exact mechanism of MAT is unclear; however, automaticity versus triggered activity is postulated (Walsh 2001a).…”

Multifokale atriale Tachykardie im Kindesalter

“…Eine einheitliche Genese scheint unwahrscheinlich, da bei einem Großteil der Erwachsenen zusätzlich andere Vorhofrhythmusstörungen wie z.B.Vorhofflattern, -flimmern, ektope Tachykardie und/oder atrioventrikuläre Überlei-tungsstörungen unterschiedlicher Graduierung [2,14,27] auftraten. Auffallenderweise fanden sich bei einem Groß-teil der Patienten andere Begleiterkrankungen [1,13,45].…”

“…Weiterhin überdurch-schnittlich wurden Diabetes mellitus (in ca. 25% der Fälle) [22,27] und koronare Herzerkrankungen, Herzinsuffizienz und Klappenerkrankungen beobachtet, die mit einer linksatrialen Belastung einhergehen können. Bei einem Teil der erwachsenen Patienten wurde auch eine Digitalistoxizität vermutet.…”