CURS 12-Aritmii 2

Semnificaţie – manifestări clinice
•  Simptome:
–  datorate ↓DC
•  cerebral: vertij-lipotimii → sincopa (⊃ sd. Adams-Stokes)
•  cardiace: angina pectorala
•  renale: respiraţie acidotică → comă
•  musculare: astenie fizică / fatigabilitate
–  datorate stazei
•  pulmonare
•  periferice
•  Semne
–  de DC↓
–  de stază
NB!: manifestările clinice depind de mecanismul

tahidicardiei şi de substratul pe care apar
NB!: simptomele se pot datora şi bradiaritmiilor
induse de tahiaritmii
R.V. - Tahiaritmii feb 2012
EGM intracavitare: EPS

RVOT
HRA HBE
CS

Mecanismele TSV sustinute
"   Reintrare:
"   in NSA
"   la nivelul caii lente-
cale rapida: TRNAV
"   la nivelul atriului =
FiA, Fl A
"   pe cale accesorie: TRAV
"   Automatice:
"   Aritmii atriale automatice
"   Aritmii jonctionale
automatice:
"   TJNP pura
"   TJNP cu bloc
Tahicardia sinusala
 
 
 
 
 
 
 
 
 
 
 
Aritmia sinusala respiratorie
 
  ↓

Extrasistolia atriala
 
 
 
 
 
 
 
 
 
 
 
 
 

Tahicardia atriala multifocala
! 
! 
! 
! 
! 
! 
! 
! 
! 
" 

Tahicardia jonctionala neparoxistica
 
 
 
 
 
 
 
 
Context clinic sugestiv: regularizarea frecventei
 
cardiace la pt cu FA cronica tratat cu digitala
 
 
 
Tahicardia prin reintrare in NAV
(TRNAV): mecanism
"  Conducere anterograda = pe “calea lenta” in AD posteroseptal

"  Conducere retrograda = pe “calea rapida” in AD
R.V. anteroseptal
- Tahiaritmii feb 2012
V1
D1
V2
D2
V3
D3
aVR
V4
aVL
V5
aVF
V6

Tratamentul TRNAV
 
 
 
 
 
 
 
 
 
 
 

AHV

A H V A V
H

A
A
H
A H
A H V A
V
V

A
A
H

H
A H V A V

A H V A

Sdr. de preexcitatie
 
 
 
 
 
 
 
 
 
 
 
 
 
  ț

Situatii clinice posibile in prezenta
caii accesorii atrio - ventriculare
  ț
asimptomatica
 
 
 
 
simptomatica

Unda delta intermitenta

Preexcitatie permanenta

Efectul de acordeon :
unda delta de durata variabila

Tahicardia reintranta atrioventriculara (TRAV)
  ≠
 
 
 
 

TRAV cu conducere
antidromica
"  tahiaritmie regulata cu QRS largi prin
prezenta undei delta
"  raspuns ventricular rapid > 180-200/min
"  mecanism:
"  Conducere anterograda pe calea accesorie

"  Conducere retrograda prin NAV
"  dg diferential cu TV monomorfa sustinuta
"  Risc crescut de moarte subita cardiaca in
caz de aparitia FA → FV

TSV in sdr. WPW cu conducere antidromica
! Tahiaritmie regulata cu QRS largi; P ne-evidentiabil; dg dif TV monomorfa

Sdr. WPW cu fibrilatie atriala

Evaluarea riscului vital in WPW
 
 
 
 
 
  250 ms)
 
 

Tratamentul in sdr. WPW
 
 
 
 
 
 
 
 
 
 
 
 
 
A H V
V
A

V A A V

RF

Flutter-ul atrial
 
 
 
 
  ș
 

Caracterele FlA
 
 
 
 
 
 
 
 
 
 
Fl.A: situatii speciale
Efectul adenozinei sau CSC

FlA cu conducere 1:1
"  sub efectul chinidinei
"  produce “sincopa chinidinica”
"   efect anticolinergic pe NAV
"   scade viteza de depolarizare atriala R.V. - Tahiaritmii feb 2012
Tratament
 
 
 
 
 
 
 
 
  NB!: risc emboligen
  • TEE daca debutul este ≥48h si/sau
  incert
• anticoagulare
RA
LA
T M

Tahicardiile atriale focale
 
 
 
 
 
 
 
•  Tratament:
  •  de obicei rezistenta la tratament

  •  Stop digitala; fenitoina
•  β-blocante, potasiu, Ca-blocante
  •  in BPOC = O2
 
 
P -/0 in aVL si + in V1
Da Nu
Focar AS Focar AD
⊕P in V1≥80 ms focare ⊕P in D1≥50 µV Da P – in aVR Nu
nonPV Inel tricuspidian

Tahicardii
Sept i-a
cristale
PVs stangi PVs drepte P– P+ P – sau ± P + in V5,6

D2,3 aVF D2,3 aVF in 3 deriv durata P in
V2-6 SVT < RS
P in D2 ≥ 100 µV infero-lateral supero-lateral

anular septal
superior

Fibrilatia atriala  
 
 
   
 
 
 
   
Epidemiologia FA
 
 
 
Etiologia FA
   
   
   
   
   
FA IDIOPATICA: pana la 30% din cazuri !

of spontaneous conversion is low and anticoagulation must
Clasificare
considered (see Section 4.1).
(3) Persistent AF is present when an AF episode either la
FA depistata prima oara longer than 7 days or requires termination by cardioversi
either with drugs or by direct current cardioversion (DCC
(4) Long-standing persistent AF has lasted for ≥1 year wh
it is decided to adopt a rhythm control strategy.
(5) Permanent AF is said to exist when the presence of
PAROXISTICA PERSISTENTA
arrhythmia is accepted by the patient (and physician). Hen
(autolimitata) (ne-autolimitata)
rhythm control interventions are, by definition, not pursu
in patients with permanent AF. Should a rhythm cont
PERMANENTA
First diagnosed episode of atrial fibrillation
Paroxysmal
(usually <48 h)
Persistent
(>7 days or requires CV)
Long-standing
Persistent (>1 year)
Permanent
(accepted)
ESC Practice Guidelines. EHJ 2010
Fiziopatologie
 
 
 
 
 
 
  ↑
  ↑
 
 
 
 
 
 

Permanentă Paroxistică
Substrat Trigger
Page 9 of 6
strip (recorded at 25 mm/s) by six. The

,,Perpetuatori’’
ications is not different between short
d forms of the arrhythmia.12 It is there- ‘Upstream’ therapy of concomitant conditions
t paroxysmal AF in order to prevent Anticoagulation
Persistentă
(e.g. stroke). However, short ‘atrial high- Rate control
ed by pacemakers, defibrillators, or other
Antiarrhythmic drugs
first documented
ot be associated with thrombo-embolic

Ablation
r duration exceeds several hours (see
Cardioversion
y as an ischaemic stroke or TIA, and it is AF

most patients experience asymptomatic, silent paroxysmal persistent long-standing permanent
persistent
hythmia episodes before AF is first diag-
currence is 10% in the first year after the R.V. - Tahiaritmii feb 2012
Paroxistică Persistentă Permanentă
Durata

Consecintele FA. Implicatii terapeutice
  ↓
!  CONVERSIA LA RS
! 
  ↓
! 
REDUCEREA AV
! 
  PROFILAXIA EMBOLIILOR
SISTEMICE
Conversia la RS
  Δ  
   
   
   
 
 
 
 
•  50% din FA paroxistice = conversie spontana in 24-48 ore de la debut

Similar to flecainide, propafenone should be avoided in patients than AF.
Conversia la RS: chimica sau electrica

Table 12 Drugs and doses for pharmacological conversion of (recent-o
 
  Drug Dose Follow-up dose R
Amiodarone 5 mg/kg i.v. over 1 h 50 mg/h P
  A
Flecainide 2 mg/kg i.v. over N/A N
10 min, d
or in
  200–300 mg p.o. d
v
Ibutilide 1 mg i.v. over 1 mg i.v. over 10 min after C
10 min waiting for 10 min p
W
Propafenone 2 mg/kg i.v. over N
10 min, d
or t
450–600 mg p.o. v
c
Vernakalant 3 mg/kg i.v. over Second infusion of 2 mg/kg i.v. S
10 min over 10 min after15 min rest
  a
Vernakalant has recently been recommended for approval by the European Medicines Agency for rapid car
non-surgical patients; ≤3 days for surgical patients).68,69 A direct comparison with amiodarone in the AVR
  Active-controlled, multi-center, superiority study of Vernakalant injection versus amiodarone in subjects with
amiodarone for the rapid conversion of AF to sinus rhythm (51.7% vs. 5.7% at 90 min after the start of treatm
  over 10 min), followed by 15 min of observation and a further i.v. infusion (2 mg/kg over 10 min), if necess
pressure ,100 mm Hg, severe aortic stenosis, heart failure (class NYHA III and IV), ACS within the previo
should be adequately hydrated. ECG and haemodynamic monitoring should be used, and the infusion can b
R.V.heart
patients with stable coronary artery disease, hypertensive - Tahiaritmii feb
disease, or mild 2012
heart failure. The clinical pos
Profilaxia recurentei: chimica
 
 
  AA de clasa Ic preferabil asociate cu βB
 
  ↓
 
 
 
 

Controlul frecventei cardiace
- in FA permanenta sau in caz de contraindicatii de conversie -
   
  !  β
  !  β
 
 
 
! 
  ! 
 
 

Riscul de AVC in FA: CHADS2
"  Elemente scorului CHADS2:
"   Insuficienta cardiaca congestiva: 1 pt
"   Hipertensiune: 1 pt
"   Varsta: 1 pt
"   Diabet: 1 pt
"   AVC sau AIT: 2 pt
Rockson SG, Albers GW. JACC 2004;43:929.

sk factors.OAC
a
Vascular disease Age 65–74 1
pproach
tientsRisc AVC in FA: CHA2DS2-VASc
(b) comes
Risk factor-based
at maximum
(Note: ‘moderate
from variousapproachpublished
score isrisk’
expressed asana-
scoring system, with the acronym CHA2DS2-VASc
9 since(currently
a point based
defined
age may contribute 0, 1, or 2 points)
Sex category (i.e. female sex)
Maximum score
1
9
1, i.e.Riskonefactor risk factor) still derive significant Score (c) Adjusted stroke rate according to CHA2DS2-VASc score
OAC (or aspirin)
overCongestive
aspirinheart use,failure/LV
oftendysfunction
with low rates of 1
Nothing (or aspirin) CHA2DS2-VASc Patients (n = 7329) Adjusted stroke
Importantly,
Hypertension prescription of an antiplatelet 1 score rate (%/year)b
iatedAgewith >75 a lower risk of adverse events. 2
0 1 0%
score does
Diabetes not include many stroke risk 1
mellitus
e prevention in AF. AF ¼ atrial fibrillation; OAC ¼ oral anticoagulant; 1 422 1.3%
roke risk
on modifiers’
Stroke/TIA/thrombo-embolism
be found page 13. need to be considered 2
trokeVascular
risk disease
assessment
a (Table 8). 1 2 1230 2.2%
ors Age (previously
65–74 referred to as ‘high’ risk 1 3 1730 3.2%
troke Sexor
Table 10 TIA,(i.e.
category or
Clinical
femalethrombo-embolism,
characteristics comprising
sex) and the 1 4 1718 4.0%
s). HAS-BLED
The presence
Maximum score of
bleeding some
risk types
score of valvular 9 5 1159 6.7%
stenosis or prosthetic
(c) Adjusted stroke rate according heart valves) would
to CHA2DS2-VASc score
Letter Clinical characteristica Points awarded 6 679 9.8%
valvular’
CHA2DS AF patients
-VASc as ‘high
Patients risk’.
(n = 7329) Adjusted stroke
HscoreHypertension
2
1
ant non-major’ risk factors (previously rate (%/year)b 7 294 9.6%
Abnormal renal and liver
rate’ risk A factors)
0 function (1are pointheart
each) failure
1 [especially
1 or 2 0%
8 82 6.7%
systolic SLV1 Stroke dysfunction, defined 422 arbitrarily 1as 1.3% 9 14 15.2%
on fraction (LVEF) ≤40%],1230
B 2 Bleeding hypertension, or 1 2.2%
cally relevant
L 3 Labilenon-major’
INRs risk
1730 factors (pre- 1 3.2%
See text for definitions.
s ‘less validated
E 4 Elderly (e.g. riskagefactors’)
>65 years)
1718 include female 1 4.0% a
Prior myocardial infarction, peripheral artery disease, aortic plaque. Actual rates
and vascular
D 5 Drugs disease
or alcohol(specifically,
(1 point each) myocardial
1159 1 or 2 6.7% of stroke in contemporary cohorts may vary from these estimates.
b
Based on Lip et al. 53
ortic plaque 6
and PAD). Note 679
that risk factors
Maximum 9 points
9.8% AF ¼ atrial fibrillation; EF ¼ ejection fraction (as documented by
he simultaneous presence of two or more echocardiography, radionuclide ventriculography, cardiac catheterization, cardiac
a
7 294 9.6%
Hypertension’ is defined as systolic blood pressure .160 mmHg. ‘Abnormal magnetic resonance imaging, etc.); LV ¼ left ventricular;
n-major’ risk factors would justify a stroke
8
kidney function’ is defined as the presence82 of chronic dialysis or renal
6.7%
TIA ¼ transient ischaemic attack.
gh transplantation
to requireoranticoagulation.
serum creatinine ≥200 mmol/L. ‘Abnormal liver function’ is
9 14 15.2%
Recomandarile de tratament anti-trombotic in
functie de profilul de risc in FiA (ACCP/VII)
Nivel de risc Indicatorii riscului Tratament

Risc scazut varsta ≤ 65 ani Aspirina 325 mg/zi
fara FR aditionali
Intermediar Varsta 65-75 ani ACO (INR: 2,0-3,0)
DZ sau ASA
B coronara
Inalt Varsta > 75 ani ACO (INR: 2,0-3,0)
Istoric de AVC, AIT sau ES
HTA, DZ
Disfunctie VS sau ICC

Terapia ablativă
PVI
PVp PVp PVp

TAHIARITMIILE
VENTRICULARE
Tahiaritmii cu QRS larg

Extrasistolele ventriculare

Clasificare si semnificatie
clinica
   
   
 
 
 
 
    →
   
Myerburg et al. Am J Cardiol 1984;54:1355-8.

Clasificare si semnificatie clinica
Morganroth et al. JACC 1986.

Tratamentul ESV
  β
 
 
 
 

Studiul CAST-I:
cresterea mortalitatii sub AA clasa I la pacienti cu IM in
antecedente

TV: definitie si caractere ECG
 
 
  →
 
 
 
 
 
Mecanismele TV
 
 
 
 
 
 
 
 

TV monomorfa sustinuta

TV monomorfa: diagnostic
•  tahiaritmie regulata >
120/
•  QRS larg > 120 msec
•  Disociatie AV
•  Batai de fuziune
•  Capturi ventriculare
Criterii morfologice
   
   
    ț
   
   
 
  →
   
   

Tahicardia ventriculara
neparoxistica (RIVA) =
AUTOMATISM CRESCUT

TV polimorfa: torsada varfurilor
PDP
•  TV rapida, degenereaza in FV
•  produsa prin PDP
•  cu QT lung sau cu QT normal
•  Cauze:
•  sdr. de QT lung
•  hipo K, hipo Mg
•  AA Ia si III
•  Tratament:
•  MgSO4 IV
•  “Overdrive pacing”
•  isuprel lent
•  xilina, fenitoina
•  QT lung: AICD, beta-blocante,
flecainida, stelectomie.
Dg ≠ TV vs. TSV cu QRS largi
 
 
 
 
 
 
 
 
 
 
 
 
 
Tratament TV
 
  β
 
 
 
 
 
 
 
 
 
 
Oprirea TV prin overdrive pacing

Tratamentul profilactic al TV
  β

Fibrilatia
ventriculara
•  Unde fibrilatorii de amplitudine diferita, in absenta
complexelor QRS
•  Asistola mecanica urmata de asistola electrica
•  Colaps, stop respirator si deces in 3-5 minute de la
instalare in absenta CPR
•  Cauze:
–  Ischemia acuta din IMA aritmii V spontane
severe
–  Cardiomiopatii (CMHO !) FA din WPW
–  CHT cu HVS hipoxia din BPOC
–  Iatrogen: medicamente, diselectrolitemii, cateterism cardiac
–  Sdr. de QT lung cu TdP SEE nesincron
•  Precedata sau nu de TV
•  Tratament:
Tratamentul aritmiilor V maligne:
defibrilatorul implantabil
 
 
 
 
   
  ș III  
•  CMH   ↓
•  CAVD  
•  LQT
  ↓
•  Brugada
•  SQT
ICD reduc mortalitatea cu ~ 40%
atât in prevenţia primară cât şi în cea secundară
40
Control
54%
73% 51% ICD
30
39%
36%
20% 38% 0 31%
0
20
41% 0 23%
10
Prevenţie secundară Prevenţie primară

Al-Khatib SM et al, Am Heart J 2005

RMVT Gallavardin

Caracteristici
•  70% din VT idiopatice •  ECG
•  Origine –  TV 140-180/min
–  90-85% RV –  BRS cu ax inferior
•  septul RVOT –  tranzițiaΔ (>precoce = >septal/stg)
•  zona de admisie
•  rădăcina a.P.
•  EPS - PDT
–  10-15% LVOT (cuspele coronariene –  induse de burst/catech
stg>dr) –  oprite de A, V, βB
•  mecanisme •  Evoluție
–  benignă la majoritatea
–  denervări simpatice localizate
–  MSC rar
–  alterări localizate ale recaptării •  tachyCMP
NA# $catech sinaptice și • 

• 
forma malignă (short-coupled)
ARVC/D
% rec
•  risc$
•  20-30Y, XX≥XY, >anduranță –  sincopă
•  asimtomatici / discret (după efort) –  AV f. rapidă (>230bpm)
–  palpitații –  frecvente (>20 000/zi)
–  vertij discret –  ESV cu cuplaj foarte scurt
–  sincopa excepțional
TV fasciculară Belhassen
•  20-40 ani •  ECG

•  răspunde la V –  BRD cu ax sup. >> ax inferior
•  nu depinde de efort •  EPS
•  simtomatică (rar sincopă) –  indusă de ✪ programată
–  entrainment
•  evoluție
–  isuprel NU induce (poate fi util
–  benignă
asociat cu pacingul)
–  rar MSC
–  excepțional tachyCMP
•  Tratament:
–  V ± βB
•  Origine cel. Purkinje aN –  ablația
(conducere decrementală)
–  VS midseptal/post.-sept. inferior
(FPI)
–  rar VS ant.-sup (FAS)
LQT

Genetica LQT

SQT
•  tip 1: Δ$-fx HERG/KCNH2, IKr
•  tip 2: Δ$-fx KVLQT1/KCNQ1, IKs
•  tip 3: Δ$-fx KCNJ2/Kir2.1, IK1; ECG caracteristic
•  unde T ample și marcat asimetrice
–  ram ascendent cvasinormal
–  ram descendent extrem de abrupt
•  ,,overlaping’’ syndromes: Δ%-fx can. Ca2+ de tip L

–  subunitatea α1 (CACNA1C, sindromul de QT tip 4)
–  subunitatea β (CACNB2b, sindromul de QT tip 5)
–  fenotipul mixt: QTc% + ΔECG sd. Brugada

Sd. Brugada

FV idiopatică
sd. de repolarizare precoce malign

ARVC/D
•  Au. dom. / recesiv

•  boală desmozomală
•  înlocuirea fibro-grăsoasă a pereților VD ±
VS [#75%] (siv relativ conservat)
–  clasică (39%): afectare VD izolat / predominant
–  biventriculară (56%): afectare ambii V
–  dominantă stg. (5%): afectare predominantă VS
•  prevalență 1/1000 (posibil subdg. în
anumite zone)
–  N Italiei: 11% din MSC la tineri și 22% din
MSC la atleti

Manifestări clinice
Aritmiile V
•  vârsta medie 30y (10-50) •  %≈ cu severitatea bolii
•  simptome •  de obicei simptomatice
–  MSC –  ESV#TV susținute
•  ¾ în timpul activităților de rutină
•  10% perioperator
•  morfologie BRS
•  3,5% sport –  ax inf#RVOT
–  sincopa 32% –  ax sup
–  palpitații 67% •  QS în toate precordialele (m.a.V3,4) #
apex VD
–  dureri toracice atipice 27%
•  ax inf, QS <V4 # subtricuspidian
–  dispnee 11%
–  IC dr. tardiv 6% Aritmii SV
–  asimptomatici descop. întâplător   # 25%
•  ΔECG
•  FA / TA (macroreinrari AD) / FL.A
•  ESV/TVNS Holter/ECG de efort

ECG

ECG
40-50% au ECG normal Δ ECG evolutive
initial, în 6 ani TOȚI au
ΔECG
  $ pantei S cu >10 ms #69%
  $QRS cu >10 ms #66%
•  QRS largit >110 ms (24-75%)
•  extensia T ,,- în 1 deriv precord
•  BRD incomplet
•  BR nou apărut (11%)
•  panta S prelungită > 55 ms
•  unda ε (30%)
•  unde T inversate V1-3
  $ dispersiei QT

Localizare

Boulos M. et al.
J Am Coll Cardiol 2001
Garcia FC. et al.

Circulation 2009

CURS 12-Aritmii 2

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Semnificaţie – manifestări clinice

NB!: manifestările clinice depind de mecanismul

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

" Conducere anterograda = pe “calea lenta” in AD posteroseptal

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

prezenta undei delta

" raspuns ventricular rapid > 180-200/min

" Conducere anterograda pe calea accesorie

" dg diferential cu TV monomorfa sustinuta

" Risc crescut de moarte subita cardiaca in

R.V. - Tahiaritmii feb 2012

! Tahiaritmie regulata cu QRS largi; P ne-evidentiabil; dg dif TV monomorfa

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

Efectul adenozinei sau CSC

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

• de obicei rezistenta la tratament

⊕P in V1≥80 ms focare ⊕P in D1≥50 µV Da P – in aVR Nu

nonPV Inel tricuspidian

PVs stangi PVs drepte P– P+ P – sau ± P + in V5,6

P in D2 ≥ 100 µV infero-lateral supero-lateral

R.V. - Tahiaritmii feb 2012

FA IDIOPATICA: pana la 30% din cazuri !

R.V. - Tahiaritmii feb 2012

strip (recorded at 25 mm/s) by six. The

ot be associated with thrombo-embolic

y as an ischaemic stroke or TIA, and it is AF

R.V. - Tahiaritmii feb 2012

• 50% din FA paroxistice = conversie spontana in 24-48 ore de la debut

Conversia la RS: chimica sau electrica

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

" Elemente scorului CHADS2:

" Insuficienta cardiaca congestiva: 1 pt

" AVC sau AIT: 2 pt

Rockson SG, Albers GW. JACC 2004;43:929.

R.V. - Tahiaritmii feb 2012

Nivel de risc Indicatorii riscului Tratament

R.V. - Tahiaritmii feb 2012

R.V. - Tahiaritmii feb 2012

Tahiaritmii cu QRS larg

"  Conducere anterograda = pe “calea lenta” in AD posteroseptal

"  raspuns ventricular rapid > 180-200/min

"  Conducere anterograda pe calea accesorie

"  dg diferential cu TV monomorfa sustinuta

"  Risc crescut de moarte subita cardiaca in

! Tahiaritmie regulata cu QRS largi; P ne-evidentiabil; dg dif TV monomorfa

  •  de obicei rezistenta la tratament

•  50% din FA paroxistice = conversie spontana in 24-48 ore de la debut

"  Elemente scorului CHADS2:

"   Insuficienta cardiaca congestiva: 1 pt

"   AVC sau AIT: 2 pt

•  QRS larg > 120 msec

NA# $catech sinaptice și • 

•  20-40 ani •  ECG

•  ,,overlaping’’ syndromes: Δ%-fx can. Ca2+ de tip L

•  Au. dom. / recesiv