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Author's Accepted Manuscript The Metabolic Syndrome, Atrial Fibrillation and Stroke: Tackling An Emerging Epidemic Reza Hajhosseiny MBBS BSc, Gareth K. Matthews MBBS PhD, Gregory YH Lip MD FRCP DFM FACC FESC www.elsevier.com/locate/buildenv PII: DOI: Reference: S1547-522-7 HRTHM6337 To appear in: Heart Rhythm Cite this article as: Reza Hajhosseiny MBBS BSc, Gareth K. Matthews MBBS PhD, Gregory YH Lip MD FRCP DFM FACC FESC, The Metabolic Syndrome, Atrial Fibrillation and Stroke: Tackling An Emerging Epidemic, Heart Rhythm, org/10.1016/j.hrthm.2015.06.038 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

The metabolic syndrome, atrial fibrillation and stroke: tackling an emerging epidemic Short/Running Title: Metabolic syndrome, Atrial Fibrillation and Stroke Reza Hajhosseiny MBBS BSc1*, Gareth K. Matthews MBBS PhD2 and Gregory YH Lip MD FRCP DFM FACC FESC3,4 1 BHF Centre of Cardiovascular Excellence, St.

Abstract In children with structurally normal hearts, the mechanisms of arrhythmias are usually the same as in the adult patient. Some arrhythmias are particularly associated with young age and very rarely seen in adult patients. Arrhythmias in structural heart disease may be associated either with the underlying abnormality or result from surgical intervention. Unch na 6p3s 2017. Chronic haemodynamic stress of congenital heart disease (CHD) might create an electrophysiological and anatomic substrate highly favourable for re-entrant arrhythmias. As a general rule, prescription of antiarrhythmic drugs requires a clear diagnosis with electrocardiographic documentation of a given arrhythmia.

Risk–benefit analysis of drug therapy should be considered when facing an arrhythmia in a child. Prophylactic antiarrhythmic drug therapy is given only to protect the child from recurrent supraventricular tachycardia during this time span until the disease will eventually cease spontaneously. In the last decades, radiofrequency catheter ablation is progressively used as curative therapy for tachyarrhythmias in children and patients with or without CHD. Even in young children, procedures can be performed with high success rates and low complication rates as shown by several retrospective and prospective paediatric multi-centre studies. Three-dimensional mapping and non-fluoroscopic navigation techniques and enhanced catheter technology have further improved safety and efficacy even in CHD patients with complex arrhythmias. During last decades, cardiac devices (pacemakers and implantable cardiac defibrillator) have developed rapidly. The pacing generator size has diminished and the pacing leads have become progressively thinner.