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15,600 | Organized Structure of Ventricular Fibrillation during Prolonged Heart Perfusion in Dogs. | The aim of the study</b> was to identify the organized ventricular fibrillation (VF) activity in the dog heart and characterize its quantitative parameters during prolonged heart perfusion.</AbstractText>A total of four experiments on isolated dog's hearts perfused with the blood of a supporting dog were performed. Episodes of VF were recorded in the form of an electrogram followed by a spectral analysis by the fast Fourier transform in the range of 0.5-15 Hz. The frequency, spectral power (amplitude), and relative weight (%) of the 1st</sup>, 2nd</sup>, and 3rd</sup> highest amplitude oscillations were determined (frequency - mode; amplitude, relative weight - M±SEM; n=120).</AbstractText>In the perfused dog heart, VF was characterized by an organized activity, as evidenced by the dominant structure of the oscillation frequencies. Oscillations with a frequency of 9-10 Hz (occurring in 1/10 of the 0.5-15 Hz range) represent 42-44% of the spectral power and dominate the structure of the oscillation frequencies. The frequency and spectral power of the dominating oscillations proved to be stable thus indicating that under perfusion, VF did not cause disturbances in the heart organized activity.</AbstractText>Our experimentation with isolated perfused hearts revealed the patterns of VF that could not be revealed in situ</i> under conditions complicated by nerve factors and ischemia in VF. The results of the work are protected with a patent which is applicable for VF diagnosis in implantable defibrillators.</AbstractText> |
15,601 | Permanent pacemaker implantation in a challenging anatomy: Persistent left superior vena cava. | The persistence of the left superior vena cava is one of the most common abnormalities that could affect the thoracic venous return, despite its rare occurrence. It can usually be found as the only or in combination with other congenital cardiac abnormalities. Even though it is usually asymptomatic and it rarely has important consequences on the hemodynamics, it could sometimes represent a serious threat. In this regard, PLSVC often represents an incidental finding during an invasive procedure or imaging. We present an interesting case of a 66-year-old patient, with permanent atrial fibrillation and chronic kidney disease who presented to our clinic for a syncope due to complete atrioventricular block. The implant procedure was marked by the incidental intraprocedural finding of unusual venous anatomy. This anomaly included the absence of the superior vena cava, with the communication of the right brachiocephalic trunk and right subclavian vein with a persistent left superior vena cava which drainage directly into the coronary sinus. The right-side approach, as well as the limitation of using contrast-based venography, due to the kidney disease, made the procedure more difficult, but the final position of an active fixation ventricular lead was successfully achieved with optimal and stable pacing parameters through the formation of a particular curve of the lead stylet. Persistence of the left superior vena cava is a venous anomaly, which is frequently suspicioned at transthoracic echocardiography examination when the examiner found a dilated coronary sinus but diagnosed on the implant table of a cardiac device. These anomalies can pose problems and exponentially increase the procedural time even in experienced hands. |
15,602 | Impact of tricuspid regurgitation on survival in patients with cardiac amyloidosis. | Tricuspid regurgitation (TR) is a common finding and has been associated with poorer outcome in patients with heart failure. This study sought to investigate the prognostic value of TR in patients with cardiac amyloidosis (CA).</AbstractText>Two-hundred and eighty-three patients with CA-172 (61%) wild-type transthyretin amyloidosis (ATTRwt) and 111 (39%) light-chain amyloidosis (AL)-were consecutively enrolled between December 2010 and September 2019. Transthoracic echocardiographies at time of diagnosis were reviewed to establish the presence and severity of TR and its relationship with all-cause mortality during patients' follow-up. Seventy-four (26%) patients had a moderate-to-severe TR. Moderate-to-severe TR was associated with New York Heart Association status (P < 0.001), atrial fibrillation (P = 0.003), greater levels of natriuretic peptides (P = 0.002), worst renal function (P = 0.03), lower left ventricular ejection fraction (P = 0.02), reduced right ventricular systolic function (P = 0.001), thicker tricuspid leaflets (P = 0.019), greater tricuspid annulus diameter (P = 0.001), greater pulmonary artery pressure (P = 0.001), greater doses of furosemide (P = 0.001), and anti-aldosterone (P = 0.01) and more anticoagulant treatment (P = 0.001). One hundred and thirty-four (47%) patients met the primary endpoint of all-cause mortality. After multivariate Cox analysis, moderate-to-severe TR was significantly associated with mortality [hazard ratio 1.89, 95% confidence interval (1.01-3.51), P = 0.044] in patients with ATTRwt. There was no correlation between TR and death [hazard ratio 0.84, 95% confidence interval (0.46-1.51), P = 0.562] in patients with AL.</AbstractText>Moderate-to-severe TR is frequent in CA, and it is an independent prognosis factor in patients with ATTRwt but not in patients with AL.</AbstractText>© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.</CopyrightInformation> |
15,603 | Phantom Shocks Associated With a Wearable Cardioverter Defibrillator. | Wearable cardioverter defibrillators (WCDs) are external devices capable of continuous cardiac rhythm monitoring as well as automatic detection and defibrillation of potentially life-threatening arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF). They are an alternative approach for patients when an implantable cardioverter defibrillator (ICD) is not appropriate. Although treatment with ICD is considered highly effective for the primary and secondary prevention of sudden cardiac death (SCD) in high-risk patients susceptible to VT and VF, patients may still experience psychological difficulties such as fear of shock, avoidance of normal behaviors and reduced quality of life. One of these phenomena is phantom shock (PS), which is defined as a perception of having received a shock with no evidence of recorded defibrillation upon device interrogation. While PS has been reported in the ICD literature, to the best of our knowledge, we present the first known case of WCD-related PS. We also present a review of the current literature to explore the prevalence of PS, the factors associated with its pathogenesis and interventional studies aimed at reducing its occurrence. We highlight this case because PS is considered a phenomenon that few recognize, which should be discriminated from real device shocks before clinicians initiate treatment, device reprogramming or device discontinuation. We describe the psychosocial factors associated with PS to emphasize the importance of managing any associated psychiatric disorders and psychosocial factors both before and after initiation of device treatment. |
15,604 | Personalized Low-Energy Defibrillation Through Feedback Based Resynchronization Therapy. | Defibrillation shocks may cause AV node burnout, scar formation, and pain. In this study, we present a real-time feedback-based control of ventricular fibrillation (VF) with a series of low-energy shocks using ventricular electrical activity as the feedback input.</AbstractText>Isolated rabbit hearts were Langendorff perfused and stained with a fluorescent Vm</sub> dye. The ventricular activity was measured with a pair of photodiodes, and processed with a feedback controller to calculate defibrillation shock parameters in real-time. Shock timing was based on desynchronized activation of the left and right ventricles during VF, and the strength was proportional to the amplitude difference of the photodiode signals. Shocks were delivered with a custom-developed arbitrary waveform trans-conductance amplifier.</AbstractText>Feedback based resynchronization therapy converts VT to MT before sinus rhythm is restored with a reduction of defibrillation energy, compared to a single biphasic shock.</AbstractText>Feedback based resynchronization therapy is based on real-time sensing of ventricular activity, while a series of low-energy shocks are delivered, reducing the risk of associated side effects.</AbstractText> |
15,605 | Acute Effects of Ibrutinib on Ventricular Arrhythmia in Spontaneously Hypertensive Rats. | The Bruton's Tyrosine Kinase Inhibitor ibrutinib is associated with ventricular arrhythmia (VA) and sudden death. However, the pro-arrhythmic electrophysiological dysregulation that results from ibrutinib with age and cardiovascular disease is unknown.</AbstractText>This study sought to investigate the acute effects of ibrutinib on left ventricular (LV) VA vulnerability, cytosolic calcium dynamics, and membrane electrophysiology in old and young spontaneous hypertensive rats (SHRs).</AbstractText>Langendorff-perfused hearts of young (10 to 14 weeks) and old (10 to 14 months) SHRs were treated with ibrutinib (0.1 μmol/l) or vehicle for 30 min. Simultaneously, LV epicardial action potential and cytosolic calcium transients were optically mapped following an incremental pacing protocol. Calcium and action potential dynamics parameters were analyzed. VA vulnerability was assessed by electrically inducing ventricular fibrillations (VFs) in each heart. Western blot analysis was performed on LV tissues.</AbstractText>Ibrutinib treatment resulted in higher vulnerability to VF in old SHR hearts (27.5 ± 7.5% vs. 5.7 ± 3.7%; p = 0.026) but not in young SHR hearts (8.0 ± 4.9% vs. 0%; p = 0.193). In old SHR hearts, following ibrutinib treatment, action potential duration (APD) alternans (p = 0.008) and APD alternans spatial discordance (p = 0.027) were more prominent. Moreover, calcium transient duration 50 was longer (p = 0.032), calcium amplitude alternans ratio was significantly lower (p = 0.001), and time-to-peak of calcium amplitude was shorter (p = 0.037). In young SHR hearts, there were no differences in calcium and APD dynamics.</AbstractText>Ibrutinib-induced VA is associated with old age in SHR. Acute dysregulation of calcium and repolarization dynamics play important roles in ibrutinib-induced VF.</AbstractText>© 2020 The Authors.</CopyrightInformation> |
15,606 | Hypertrophic Cardiomyopathy in Adolescence: Application of Guidelines. | We present the course and management of an adolescent male with hypertrophic cardiomyopathy. The importance of family history, early screening, accurate evaluation of hypertrophy, and risk stratification for eligibility for a defibrillator in hypertrophic cardiomyopathy are emphasized. Learning points are seen in the light of new guidelines. (<b>Level of Difficulty: Intermediate.</b>). |
15,607 | Recurrent Cardiac Arrest With Negative Stress Test: An Unusual Presentation of Catecholaminergic Polymorphic Ventricular Tachycardia. | Catecholaminergic polymorphic ventricular tachycardia is a genetic disorder that causes ventricular tachyarrhythmias via increased release of intracellular calcium. The standard diagnostic measure is an exercise stress test that reveals ventricular ectopy. We present an extraordinary case marked by a normal stress test and no relation to exertion. (<b>Level of Difficulty: Intermediate.</b>). |
15,608 | Inappropriate ICD Shock as a Result of TASER Discharge. | Conducted energy weapon (commonly known as TASER) discharge in patients with implantable cardioverter-defibrillators is known to cause electromagnetic interference and inappropriate ventricular fibrillation sensing without delivery of implantable cardioverter-defibrillators therapy during conducted energy weapon application. We report the first known case of conducted energy weapon discharge resulting in inappropriate implantable cardioverter-defibrillators therapy. (<b>Level of Difficulty: Beginner.</b>). |
15,609 | Urgent Open Atrial Transcatheter Mitral Valve Replacement as Bailout for Planned Surgery. | Hybrid transcatheter mitral valve replacement (TMVR) has shown great promise for patients with severe mitral annular calcification. However, there have been limited reports of its use as a bailout for planned surgical MVR. Here, we present a bailout TMVR with an excellent patient outcome. (<b>Level of Difficulty: Advanced.</b>). |
15,610 | Multimodal Imaging for the Diagnosis of Isolated Cardiac Sarcoidosis. | We report a case of isolated cardiac sarcoidosis (CS) diagnosed using a multimodality imaging approach. A patient presented after an out-of-hospital, ventricular fibrillation-mediated cardiac arrest. The use of echocardiography, cardiac magnetic resonance, and fluorodeoxyglucose-positron emission tomography enabled the diagnosis of isolated CS. (<b>Level of Difficulty: Beginner.</b>). |
15,611 | Ventricular Tachycardia Storm Originating From Moderator Band Requiring Extracorporeal Membrane Oxygenation. | A 67-year-old man presented with dizziness secondary to ventricular tachycardia (VT) originating from the moderator band. The VT was refractory to multiple antiarrhythmic medications requiring extracorporeal membrane oxygenation and eventual curative ablation. We highlight a malignant form of idiopathic VT, unique electrocardiogram characteristics, and ablation considerations. (<b>Level of Difficulty: Intermediate.</b>). |
15,612 | EP Laboratory Nightmare: Catheter Ablation of Malignant Premature Ventricular Complex Complicated by Left Main Injury. | We present a case of ventricular fibrillation triggered by a premature ventricular complex. During ablation from the left coronary cusp, the ablation catheter dislodged inside left main coronary artery, thus resulting in cardiac arrest. We immediately performed angioplasty and stent implantation, and the procedure was accomplished with a guiding catheter left inside the vessel. (<b>Level of Difficulty: Intermediate.</b>). |
15,613 | Ventricular Tachycardia: A Rare Case of Myocardial Silicosis. | Chronic exposure to silica is a recognized health hazard. Manifestations of pulmonary and extrapulmonary silicosis are well described. Secondary pulmonary arterial hypertension and pericardial involvement are described, but myocardial involvement has not been reported. In this case of newly diagnosed pulmonary silicosis, ventricular tachycardia results are shown from pathological involvement of ventricular myocardium. (<b>Level of Difficulty: Beginner.</b>). |
15,614 | Atrial Fibrillation Triggered by Premature Ventricular Complexes: An Under-Recognized Trigger. | Atrial fibrillation (AF) is a triggered rhythm, and ablation of the trigger is a common strategy for rhythm control. We describe a patient with symptomatic AF who was found to have episodes of AF triggered by premature ventricular complexes, likely by retrograde atrioventricular nodal conduction. (<b>Level of Difficulty: Beginner.</b>). |
15,615 | Electrocardiographic "Northwest QRS Axis" in the Brugada Syndrome: A Potential Marker to Predict Poor Outcome. | Conduction delay in the right ventricular outflow tract as manifested in the electrocardiogram constitutes a high-risk predictor of ventricular arrhythmias in patients with Brugada syndrome. We present a case with a right QRS axis between -90° and ±180°. This feature has never been reported in the context of Brugada syndrome. (<b>Level of Difficulty: Advanced.</b>). |
15,616 | Cardiac Sarcoidosis Mimicking Hypertrophic Cardiomyopathy: The Importance of Cardiac Magnetic Resonance Imaging. | A man with a presumed diagnosis of hypertrophic cardiomyopathy presented after a ventricular fibrillation arrest. Review of prior cardiac magnetic resonance imaging revealed a pattern of late gadolinium enhancement that was atypical for hypertrophic cardiomyopathy and most consistent with cardiac sarcoidosis, with diagnosis confirmed by endomyocardial biopsy. (<b>Level of Difficulty: Beginner.</b>). |
15,617 | A Case of an Aortic Dissection After Mechanical Chest Compression by LUCAS. | A 68-year-old man presented following a cardiac arrest. Cardiopulmonary resuscitation was performed by the Lund University Cardiopulmonary Assist System (LUCAS), a mechanical chest compression device. Investigations revealed an aortic dissection, which was likely an iatrogenic injury from mechanical cardiopulmonary resuscitation by LUCAS. This case highlights this potential complication. (<b>Level of Difficulty: Beginner.</b>). |
15,618 | Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy Under Extracorporeal Membrane Oxygenation Support. | We report the case of a 70-year-old woman with hypertrophic obstructive cardiomyopathy, who was admitted because of severe heart failure and cardiogenic shock and mechanical support requiring extracorporeal membrane oxygenation. She recovered well by percutaneous transluminal septal myocardial ablation under the extracorporeal membrane oxygenation support and was discharged without complications. (<b>Level of Difficulty: Advanced.</b>). |
15,619 | Cardiac Transplantation for Refractory Catecholaminergic Polymorphic Ventricular Tachycardia. | We present a patient with catecholaminergic polymorphic ventricular tachycardia who failed maximal antiarrhythmic drug therapy and bilateral sympathetic denervation, who presented with syncope and recurrent ventricular tachycardia for 11 min refractory to 21 shocks. She underwent cardiac transplantation as curative treatment for refractory ventricular arrhythmias in catecholaminergic polymorphic ventricular tachycardia. (<b>Level of Difficulty: Advanced.</b>). |
15,620 | Cardiac Arrest in the Setting of Diffuse Coronary Ectasia: Perspectives on a Unique Ischemic Insult. | A 69-year-old man with a history of coronary artery ectasia, potentially resulting from an underlying heritable connective tissue disorder, presented with ventricular fibrillation. Despite medical management of ischemia, he developed recurrent ventricular tachycardia with poor neurological recovery. We highlight challenges in the management of coronary artery ectasia. (<b>Level of Difficulty: Beginner.</b>). |
15,621 | The association between early impairment in cerebral autoregulation and outcome in a pediatric swine model of cardiac arrest. | Evaluate cerebral autoregulation (CAR) by intracranial pressure reactivity index (PRx) and cerebral blood flow reactivity index (CBFx) during the first four hours following return of spontaneous circulation (ROSC) in a porcine model of pediatric cardiac arrest. Determine whether impaired CAR is associated with neurologic outcome.</AbstractText>Four-week-old swine underwent seven minutes of asphyxia followed by ventricular fibrillation induction and hemodynamic-directed CPR. Those achieving ROSC had arterial blood pressure, intracranial pressure (ICP), and microvascular cerebral blood flow (CBF) monitored for 4 h. Animals were assigned an 8 -h post-ROSC swine cerebral performance category score (1 = normal; 2-4=abnormal neurologic function). In this secondary analytic study, we calculated PRx and CBFx using a continuous, moving correlation coefficient between mean arterial pressure (MAP) and ICP, and between MAP and CBF, respectively. Burden of impaired CAR was the area under the PRx or CBFx curve using a threshold of 0.3 and normalized as percentage of monitoring duration.</AbstractText>Among 23 animals, median PRx was 0.14 [0.06,0.25] and CBFx was 0.36 [0.05,0.44]. Median burden of impaired CAR was 21% [18,27] with PRx and 30% [17,40] with CBFx. Neurologically abnormal animals (n = 10) did not differ from normal animals (n = 13) in post-ROSC MAP (63 vs. 61 mmHg, p = 0.74), ICP (15 vs. 14 mmHg, p = 0.78) or CBF (274 vs. 397 Perfusion Units, p = 0.12). CBFx burden was greater among abnormal than normal animals (45% vs. 24%, p = 0.001), but PRx burden was not (25% vs. 20%, p = 0.38).</AbstractText>CAR is impaired early after ROSC. A greater burden of CAR impairment measured by CBFx was associated with abnormal neurologic outcome.CHOP Institutional Animal Care and Use Committee protocol 19-001327.</AbstractText>© 2020 The Authors.</CopyrightInformation> |
15,622 | Echocardiography does not prolong peri-shock pause in cardiopulmonary resuscitation using the COACH-RED protocol with non-expert sonographers in simulated cardiac arrest. | Focused echocardiography during peri-shock pause (PSP) can prognosticate and detect reversible causes in cardiac arrest but minimising interruptions to chest compressions improves outcome. The COACH-RED protocol was adapted from the COACHED protocol to systematically incorporate echocardiography into rhythm check without prolonging PSP beyond the recommended 10 s. The primary objective of this study was to test the feasibility of emergency nurses learning to perform all roles in the COACH-RED protocol. PSP duration and change in participant confidence were secondary outcomes.</AbstractText>After an initial two-hour workshop, five ALS-trained nurses were assessed for the correct use of COACH-RED protocol, without critical error, in three simulated cardiac arrest scenarios of four cycles each. Assessments were repeated on days 7 and 35. On day 35, three COACHED scenarios were also assessed for comparison. Participant roles per scenario and cardiac rhythm per cycle were randomised. Participants completed questionnaires on their confidence levels. Sessions were videotaped for accurate measurement of PSP duration and results tabulated for simple comparison. Statistical analysis was not performed due to small sample size.</AbstractText>There were no critical errors, two minor team-leading errors and two minor echosonography errors. Minor errors occurred in separate scenarios resulting in a 100% pass rate overall by predetermined criteria. Echocardiographic recordings were 100% adequate. Overall median PSP was 9.35 s for COACH-RED and 6.94 s for COACHED. Sub-group analysis of COACH-RED revealed median PSP 10.80 s in shockable rhythms and 8.74 s (∼2 s less) in non-shockable rhythms. Mean participant confidence in performing COACH-RED improved from 1.6 to 4.6, on a 5-point scale.</AbstractText>The COACH-RED protocol can be effectively performed by ALS-trained nurses, in all roles of this protocol, including echocardiography, in a simulated environment, after a single training session. Using this protocol, focused echocardiography does not prolong PSP beyond 10 s.</AbstractText>© 2020 The Author(s).</CopyrightInformation> |
15,623 | Dose optimization of early high-dose valproic acid for neuroprotection in a swine cardiac arrest model. | High-dose valproic acid (VPA) improves the survival and neurologic outcomes after asphyxial cardiac arrest (CA) in rats. We characterized the pharmacokinetics, pharmacodynamics, and safety of high-dose VPA in a swine CA model to advance clinical translation.</AbstractText>After 8 ​min of untreated ventricular fibrillation CA, 20 male Yorkshire swine were resuscitated until return of spontaneous circulation (ROSC). They were block randomized to receive placebo, 75 ​mg/kg, 150 ​mg/kg, or 300 ​mg/kg VPA as 90-min intravenous infusion (n ​= ​5/group) beginning at ROSC. Animals were monitored for 2 additional hours then euthanized. Experimental operators were blinded to treatments.</AbstractText>The mean(SD) total CA duration was 14.8(1.2) minutes. 300 ​mg/kg VPA animals required more adrenaline to maintain mean arterial pressure ≥80 ​mmHg and had worse lactic acidosis. There was a strong linear correlation between plasma free VPA Cmax</sub> and brain total VPA (r2</sup> ​= ​0.9494; p ​< ​0.0001). VPA induced dose-dependent increases in pan- and site-specific histone H3 and H4 acetylation in the brain. Plasma free VPA Cmax</sub> is a better predictor than peripheral blood mononuclear cell histone acetylation for brain H3 and H4 acetylation (r2</sup> ​= ​0.7189 for H3K27ac, r2</sup> ​= ​0.7189 for pan-H3ac, and r2</sup> ​= ​0.7554 for pan-H4ac; p ​< ​0.0001).</AbstractText>Up to 150 ​mg/kg VPA can be safely tolerated as 90-min intravenous infusion in a swine CA model. High-dose VPA induced dose-dependent increases in brain histone H3 and H4 acetylation, which can be predicted by plasma free VPA Cmax</sub> as the pharmacodynamics biomarker for VPA target engagement after CA.</AbstractText>© 2020 The Author(s).</CopyrightInformation> |
15,624 | First-time evaluation of ascending compared to rectangular transthoracic defibrillation waveforms in modelled out-of-hospital cardiac arrest. | Prognosis in out-of-hospital cardiac arrest (OHCA) depends on cardiopulmonary resuscitation (CPR) duration. Therefore, the optimal biphasic defibrillation waveform shows high conversion rates besides low energy. Matthew Fishler theoretically predicted it to be truncated ascending exponential. We realised a prototypic defibrillator and compared ascending with conventional rectangular waveforms in modelled OHCA and CPR.</AbstractText>Approved by the authorities, 57 healthy swine (Landrace ​× ​Piétrain) were randomised to ASCDefib (n</i> 26) or CONVDefib (n</i> 26). Five swine served as sham control. We induced ventricular fibrillation (VF) electrically in anaesthetised swine randomised to ASCDefib or CONVDefib and discontinued mechanical ventilation. After 5 ​min of untreated cardiac arrest, we started CPR with mechanical chest compressions and ventilation. We performed transthoracic biphasic defibrillations after 2, 4, 6 and 8 ​min CPR targeting 4 ​J/kg in either group. Depending on the randomised group, the defibrillation protocol was either three ascending followed by one rectangular waveform (ASCDefib) or three rectangular followed by one ascending waveform (CONVDefib).</AbstractText>Under our model-specific conditions, VF was initially terminated by 13/80 ascending waveforms and 13/79 rectangular waveforms and persistent return of spontaneous circulation was achieved in 8/26 (ASCDefib) vs. 10/26 (CONVDefib) animals. Mean current rather than waveform design was predictive for defibrillation success in a generalised linear model.</AbstractText>Contrary to theoretical assumptions, transthoracic biphasic defibrillation with ascending waveforms is not superior to rectangular waveforms in modelled OHCA. We advocate defibrillation dosage to be guided by current, that has proven its predictive value again.</AbstractText>84-02.04.2017.A176.</AbstractText>© 2020 The Author(s).</CopyrightInformation> |
15,625 | AnaLysIs of Both sex and device specific factoRs on outcomes in pAtients with non-ischemic cardiomyopathy (BIO-LIBRA): Design and clinical protocol. | Outcomes of patients with nonischemic cardiomyopathy and low ejection fraction implanted with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with a defibrillator (CRT-D), especially in contemporary, real-life cohorts, are not fully understood.</AbstractText>We aimed to better characterize outcomes of death and ventricular tachyarrhythmias in patients with nonischemic cardiomyopathy, implanted with an ICD or CRT-D, and specifically assess differences by sex.</AbstractText>The AnaLysIs of Both Sex and Device Specific FactoRs on Outcomes in PAtients with Non-Ischemic Cardiomyopathy (BIO-LIBRA) study was designed to prospectively assess outcomes of device-treated ventricular tachyarrhythmias and all-cause mortality events in nonischemic cardiomyopathy patients, indicated for an ICD or CRT-D implantation for the primary prevention of sudden cardiac death (SCD), with a specific focus on sex differences. We will enroll a total of 1000 subjects across 50 U.S. sites and follow patients for up to 3 years.</AbstractText>The primary objective of BIO-LIBRA is to evaluate the combined risk of all-cause mortality and treated ventricular tachycardia (VT) or ventricular fibrillation (VF) events by subject sex and by implanted device type. We will also assess all-cause mortality, VT or VF alone, cardiac death, and SCD in the total cohort, as well as by subject sex and by the implanted device type. In addition, the previously validated Seattle Proportional Risk Model (SPRM) will be used to compare the SPRM predicted incidence of SCD to the observed incidence.</AbstractText>The BIO-LIBRA study will provide novel and contemporary information regarding outcomes in patients with a NICM who receive a defibrillator.</AbstractText>© 2020 Heart Rhythm Society. Published by Elsevier Inc.</CopyrightInformation> |
15,626 | Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes. | The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to conventional transvenous ICD (TV-ICD) therapy to reduce lead complications.</AbstractText>To evaluate outcomes in channelopathy vs patients with structural heart disease in the EFFORTLESS-SICD Registry and with a previously reported TV-ICD meta-analysis in channnelopathies.</AbstractText>The EFFORTLESS registry includes 199 patients with channelopathies (Brugada syndrome 83, long QT syndrome 24, idiopathic ventricular fibrillation 78, others 14) and 786 patients with structural heart disease.</AbstractText>Channelopathy patients were younger (39 ± 14 years vs 51 ± 17 years; P</i> < .001) with left ventricular ejection fraction 59% ± 9% vs 41% ± 18% (P</i> < .001). The complication rate (follow-up: 3.2 ± 1.5 years vs 3.0 ± 1.5 years) was similar: 13.6% vs 11.2% (P</i> = .42). Appropriate shocks rates were 9.5% vs 10.8% (P</i> = .70), with shocks for monomorphic ventricular tachycardia being 2.0% vs 6.9% (P</i> < .02) and for polymorphic ventricular tachycardia/ventricular fibrillation (VT/VF) 8.0% vs 5.7% (P</i> = .30). Conversion effectiveness of VT/VF episodes was similar: 36 of 37 (97.3%) vs 151 of 155 (97.4%, P</i> = .59). VT/VF storm event (2% vs 0.9%, P</i> = .33) and lower inappropriate shock (IAS) (8.5% vs 12.5%, P</i> = .12) rates were statistically similar between channelopathy and non-channelopathy patients, with 45.5% channelopathy vs 31.4% non-channelopathy patients managed with a conditional zone > 200 beats per minute (P</i> = .0002). Annualized appropriate shock, IAS, and complication rates appear to be lower for the S-ICD vs meta-analysis TV-ICD patients, particularly lead complications.</AbstractText>EFFORTLESS demonstrates similar S-ICD efficacy and a nonsignificant, lower rate of IAS in channelopathy patients as compared to structural heart disease. Comparable IAS rates were achieved with the device programmed to higher rates for channelopathy patients.</AbstractText>Crown Copyright © 2020 Published by Elsevier Inc. on behalf of Heart Rhythm Society.</CopyrightInformation> |
15,627 | Atrioventricular junctional ablation: The good, the bad, the better. | The management of patients with atrial fibrillation and an abnormally fast ventricular response has been through the use of pharmacologic agents. In those cases where rate control cannot be achieved pharmacologically, a standard approach has been atrioventricular (AV) junctional ablation and ventricular pacemaker implantation to achieve a stable ventricular rate. Long-term ventricular pacing has been shown to result in diminished ventricular function that can lead to heart failure.</AbstractText>To describe an experimental and clinical study demonstrating a modified form of AV junction ablation.</AbstractText>Ablation of the slow and fast AV nodal input does not produce AV block. Ablation of the connection between the two induces AV block, leaving the AV node and His bundle intact.</AbstractText>Subsequently the escape heart rate is close to normal and responds well to exercise.</AbstractText>In a clinical study with a 42 month follow-up, the modified procedure resulted in significantly reduced pacemaker dependence and mortality compared to the standard AV ablation procedure.</AbstractText>© 2020 Heart Rhythm Society. Published by Elsevier Inc.</CopyrightInformation> |
15,628 | Assessing the perforation site of cardiac tamponade during radiofrequency catheter ablation using gas analysis of pericardial effusion. | The incidence of pericardial effusion (PE) during radiofrequency catheter ablation (CA) for atrial fibrillation is approximately 1%. PE is a major complication during CA, but there has been limited literature about the perforation site responsible.</AbstractText>This study aimed to retrospectively investigate the characteristics of the procedure and the patients in whom PE developed during CA.</AbstractText>Of 1363 consecutive patients who underwent catheter ablation from January 2015 to June 2019 in Kyorin University Hospital, we reviewed patients who developed PE during CA.</AbstractText>PE during CA occurred in 18 (1.32%) patients (median age, 71 [interquartile range (IQR) 65-77] years, 7 women). The median body mass index was 24 (IQR 20-27). Target arrhythmias for CA of patients with PE include atrial fibrillation (AF) (n = 13, 72%), premature ventricular contraction (n = 2, 11%), ventricular tachycardia (n = 1, 6%), atrial flutter (n = 1, 6%), and orthodromic reciprocating tachycardia (n = 1, 6%). Seventeen patients required pericardiocentesis, resulting in 300 (IQR 192.5-475) mL of drainage. Two patients required emergency surgical repair, and 1 died from aortic dissection. Based on the gas analysis, the drained blood was of venous origin in 47% of the total events and 54% of AF ablation.</AbstractText>PE caused by a diagnostic catheter in the right heart is not uncommon, even in AF ablation.</AbstractText>© 2020 Heart Rhythm Society. Published by Elsevier Inc.</CopyrightInformation> |
15,629 | Chronic dantrolene treatment attenuates cardiac dysfunction and reduces atrial fibrillation inducibility in a rat myocardial infarction heart failure model. | Cardiac ryanodine receptor 2 (RyR2) dysfunction and elevated diastolic Ca2+</sup> leak have been linked to arrhythmogenesis not only in inherited arrhythmia syndromes but also in acquired forms of heart disease including heart failure (HF) and atrial fibrillation (AF). Thus, stabilizing RyR2 may exert therapeutic effects in these conditions.</AbstractText>The purpose of this study was to investigate the effects of stabilizing RyR2 with chronic dantrolene treatment on HF development and AF inducibility in a myocardial infarction (MI)-induced HF model in rats.</AbstractText>MI was induced in adult Sprague-Dawley rats by ligation of the left anterior descending coronary artery. Two weeks after MI surgery, rats with large MI (≥40%) were randomly assigned to MI-vehicle (n = 14) or MI-dantrolene (10 mg/kg/d; n = 13) groups. Sham-surgery rats (n = 7) served as controls.</AbstractText>Compared to the MI-vehicle group, 4-week dantrolene treatment significantly improved cardiac function, with increased left ventricular (LV) fractional shortening (19.48% ± 3.61% vs 15.43% ± 2.65%; P</i> <.01), and decreased LV end-diastolic pressure (12.58 ± 8.52 mm Hg vs 21.91 ± 7.25 mm Hg; P</i> <.01), left atrial diameter (4.97 ± 0.75 mm vs 6.09 ± 1.53 mm; P</i> <.05), and fibrosis content (6.42% ± 0.78% vs 9.76% ± 2.25%; P</i> <.001). Dantrolene significantly decreased AF inducibility (69% in MI-vehicle vs 23% in MI-dantrolene; P</i> <.05). Dantrolene treatment was associated with reduced RyR2 phosphorylation and favorably altered gene expression involving ion channels, sympathetic signaling, oxidative stress, and inflammatory markers.</AbstractText>Chronic dantrolene treatment attenuated LV dysfunction and reduced AF inducibility, which was associated with decreased RyR2 phosphorylation and normalization of many adverse changes in gene expression. Thus, stabilizing RyR2 with chronic dantrolene treatment is a promising novel strategy for decreasing AF in HF.</AbstractText>© 2020 Heart Rhythm Society. Published by Elsevier Inc.</CopyrightInformation> |
15,630 | Novel beta-blocker pretreatment prevents alcohol-induced atrial fibrillation in a rat model. | A case report published in 2019 described a patient who presented with difficult-to-manage atrial fibrillation (AF) that consistently was associated with alcohol consumption. After the patient did not respond to drug therapy, a novel beta-blocker (BB) pretreatment regimen initiated immediately before alcohol consumption successfully prevented AF occurrence.</AbstractText>The purpose of this study was to test the hypothesis that a novel prophylactic BB therapy given before alcohol consumption could prevent AF in a rat model.</AbstractText>An alcohol-induced AF model was developed in adult Sprague-Dawley rats of both sexes by administering alcohol (2 g/kg intraperitoneal [IP]) once every other day for a total of 4 times. Three groups were enrolled: alcohol (EtOH; n = 10); alcohol plus BB (metoprolol 50 mg/kg IP) pretreatment (EtOH+BB; n = 10); and control (n = 9). Cardiac function (assessed by echocardiography and left ventricular hemodynamics) and in vivo</i> atrial electrophysiology and AF inducibility tests were performed 24 hours after the last injection.</AbstractText>All but 1 rat completed the study. Alcohol exposure did not significantly impact cardiac function and the atrial effective refractory period. However, alcohol exposure significantly increased AF inducibility [median (first and third quartile [Q1-Q3]) 0% (0%-0%) in control vs 60% (25%-100%) in the EtOH group; P</i> <.05] and AF duration [0 second (0-0 second) in control vs 0.81 second (0.24-3.67 seconds) in the EtOH group; P</i> <.05]. Compared to the EtOH group, the EtOH+BB group had significantly reduced AF inducibility [0% (0%-22.5%); P</i> <.05] and duration [0 second (0-0.2 second); P</i> <.05].</AbstractText>Metoprolol pretreatment before alcohol administration significantly decreased AF induction in rats. These findings suggest that BB pretreatment is a promising prophylaxis regimen for alcohol-induced AF.</AbstractText>© 2020 Published by Elsevier Inc. on behalf of Heart Rhythm Society.</CopyrightInformation> |
15,631 | Remarkable oxygen consumption improvement after auricular flutter ablation in a patient with constrictive pericarditis and severe mitral stenosis. | Atrial function is a key factor in cardiac output and oxygen consumption (VO<sub>2</sub>). Substantial improvements in VO<sub>2</sub> have been reported after restoring sinus rhythm (SR) in patients with atrial fibrillation. However, there are no published data on how atrial function affects VO<sub>2</sub> in patients with both constrictive pericarditis (CP) and severe mitral stenosis (MS). A 53-year-old caucasian patient consulted for exacerbated heart failure (EHF). His medical record lists ischemic heart disease, severe MS, and CP after thoracic radiotherapy. The electrocardiogram showed atrial flutter (AFL) with controlled ventricular rate. Normal left ventricular ejection fraction was observed. Ergospirometry showed an impaired maximum VO<sub>2</sub> (VO<sub>2</sub> max) of 6 ml/kg/min. On the electrophysiological study typical AFL was diagnosed and ablated achieving a great exercise capacity improvement, correlated with an increase of VO<sub>2</sub> max to 16 ml/kg/min a week after ablation, and disappearance of EHF symptoms. This case illustrates how restoration of SR resulted in a clinical substantial improvement. Radiofrequency catheter ablation is warranted as the most effective option in this context. <<b>Learning objective:</b> Atrial function impairment has a marked impact on cardiac dynamics in patients with both severe constrictive pericarditis and mitral stenosis. In this setting, sinus rhythm restoration should be pursued.>. |
15,632 | The effect of calcium in water hardness on digoxin plasma levels in an experimental rat model. | Digoxin is a drug for ventricular rate control in atrial fibrillation (AF). The major challenge in digoxin therapy is to adjust the appropriate concentration range for this drug due to its narrow therapeutic index. Unique physiochemical properties of drinking water affect the pharmacological actions and delivery of drugs to the body whether they are administered orally, topically, or by injection. The aim of this study was to evaluate water hardness effect on digoxin therapy in an experimental rat model.</AbstractText>48 rats weighing 200-220 g were randomly assigned to three groups that received drinking water with 50, 400, and 800 mg/l hardness degrees for 28 days. Then each group was assigned into two groups. One received digoxin 0.2 mg/kg a day orally for four days. The other group received normal saline (as control group). Continuous recording of electrocardiogram (ECG) was performed by PowerLab system (AD Instruments Company) before and day 4 of digoxin treatment. Then serum samples were collected and assessed for digoxin, sodium, potassium, calcium, magnesium, blood urea nitrogen (BUN), and creatinine levels.</AbstractText>Water hardness in the range of 50-800 mg/l had no effect on serum digoxin levels (P > 0.050), but consuming hard drinking water (400 and 800 mg/l) could increase serum calcium levels and then cause mortality (37.5% in both groups), following changes in ECG due to digoxin consumption.</AbstractText>Consuming hard drinking water probably interferes with digoxin pharmacodynamics in the way of toxicity induction.</AbstractText>© 2020 Isfahan Cardiovascular Research Center & Isfahan University of Medical Sciences.</CopyrightInformation> |
15,633 | Contribution of mechanical and electrical cardiovascular factors in patients with ischemic stroke. | Stroke represents the third - leading cause of death after heart and neoplastic is ease and is one of the biggest cause of disability worldwide. Cardioembolism, through its principal mechanism - atrial fibrillation - constitute an important cause of ischemic stroke. Otherwise, left ventricular hypertrophy (LVH) has been associated with a twofold increase in stroke risk. The study aims at highlighting significant associations between several risk factors of stroke -LVH and atrial fibrillation (AF), respectively LVH and cardiac stenosis contributeng to ischemic stroke. The study comprised of 256 patients with stroke, hospitalized in the County Clinical Emergency Hospital, Sibiu, Romania; they were examined by ultrasound by echocardiography and carotid Duplex echography. The patients were divided in subgroups that were later compared to one another: 167 patients had atrial fibrillation (group A), 89 patients did not have atrial fibrillation (group B). Then both groups were divided in 2 subgroups (with or without LVH). It has been identified another two groups (66 patients with carotid stenosis <50%) and 116 patients with carotid stenosis >50% and each group was divided in 2 subgroups (with or without LVH). LVH is an important contributing factor in ischemic stroke in patients also presenting carotid stenosis > 50%. |
15,634 | Review of Stereotactic Arrhythmia Radioablation Therapy for Cardiac Tachydysrhythmias. | Cardiac tachyarrhythmias are a major cause of morbidity and mortality. Treatments for these tachyarrhythmias include antiarrhythmic drugs, catheter ablation, surgical ablation, cardiac implantable electronic devices, and cardiac transplantation. Each of these treatment approaches is effective in some patients but there is considerable room for improvement, particularly with respect to the most common of the tachydysrhythmias, atrial fibrillation, and the most dangerous of the tachydysrhythmias, ventricular tachycardia (VT) or ventricular fibrillation. Noninvasive stereotactic ablative radiation therapy is emerging as an effective treatment for refractory tachyarrhythmias. Animal models have shown successful ablation of arrhythmogenic myocardial substrates with minimal short-term complications. Studies of stereotactic radioablation involving patients with refractory VT have shown a reduction in VT recurrence and promising early safety data. In this review, we provide the background for the application of stereotactic arrhythmia radioablation therapy along with promising results from early applications of the technology.<CopyrightInformation>© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chiu</LastName><ForeName>Michael H</ForeName><Initials>MH</Initials><AffiliationInfo><Affiliation>Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mitchell</LastName><ForeName>L Brent</ForeName><Initials>LB</Initials><AffiliationInfo><Affiliation>Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ploquin</LastName><ForeName>Nicolas</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Faruqi</LastName><ForeName>Salman</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kuriachan</LastName><ForeName>Vikas P</ForeName><Initials>VP</Initials><AffiliationInfo><Affiliation>Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>11</Month><Day>13</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>CJC Open</MedlineTA><NlmUniqueID>101763635</NlmUniqueID><ISSNLinking>2589-790X</ISSNLinking></MedlineJournalInfo><OtherAbstract Type="Publisher" Language="fre">Les tachyarythmies cardiaques sont une cause importante de morbidité et de mortalité. Les traitements employés comprennent des antiarythmiques, l’ablation par cathéter, l’ablation par chirurgie, l’implantation de dispositifs cardiaques électroniques et la transplantation cardiaque. Toutes ces démarches thérapeutiques sont efficaces dans certains cas, mais les traitements peuvent encore être largement améliorés, en particulier en ce qui concerne la fibrillation auriculaire, qui est la tachyarythmie la plus fréquente, et la tachycardie ventriculaire (TV, aussi appelée fibrillation ventriculaire), qui est la tachyarythmie la plus dangereuse. La radiochirurgie stéréotaxique non invasive se démarque de plus en plus comme traitement efficace des tachyarythmies réfractaires. Des substrats myocardiques arythmogènes ont pu être réséqués avec succès sur des modèles animaux, l’intervention n’ayant entraîné que des complications minimales de courte durée. Dans le cadre d’études menées auprès de patients présentant une TV réfractaire, la radiochirurgie stéréotaxique a permis de réduire le risque de récurrence de la TV, et les premières données sur l’innocuité du traitement sont encourageantes. Dans notre revue, nous précisons le cadre d’application de la radiochirurgie stéréotaxique visant à réséquer le tissu responsable de l’arythmie, et nous présentons les résultats prometteurs des premières applications de la technologie à cette fin. |
15,635 | [Cardiac rhythm management of patients with atrial fibrillation]. | Cardiac rhythm management of patients with atrial fibrillation. Cardiac rhythm management of atrial fibrillation (AF) is essential to improve symptoms as well as outcomes in patients with AF; this can be achieved either by rhythm or rate control strategies. Many studies published between 2000 and 2010 have supported the point that these two strategies were both acceptable therapeutic options (without clear superiority of one to the other), even in heart failure patients, pinpointing the side effects and the lack of efficacy of many antiarrhythmic pharmacological drugs. Nevertheless, many patients remain symptomatic despite adequate ventricular rate control and eventually require sinus rhythm restoration and maintenance. Then, rhythm control options have evolved and now include catheter ablation either by radiofrequency or cryotherapy, which allow maintaining sinus rhythm and reduce AF-associated symptoms more reliably than antiarrhythmic drugs, particularly in younger patients. Furthermore, interest in rhythm control by catheter ablation has been reinvigorated by the results of recently published trials, especially in patients with heart failure. However, the impact of catheter ablation on morbidity and mortality have still to be proven before considering it in asymptomatic patients.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Tréguer</LastName><ForeName>Frédéric</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Clinique Saint-Joseph, Trélazé, France.</Affiliation></AffiliationInfo></Author></AuthorList><Language>fre</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><VernacularTitle>Prise en charge rythmologique des patients ayant une fibrillation atriale.</VernacularTitle></Article><MedlineJournalInfo><Country>France</Country><MedlineTA>Rev Prat</MedlineTA><NlmUniqueID>0404334</NlmUniqueID><ISSNLinking>0035-2640</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000889">Anti-Arrhythmia Agents</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000889" MajorTopicYN="N">Anti-Arrhythmia Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017115" MajorTopicYN="Y">Catheter Ablation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006333" MajorTopicYN="Y">Heart Failure</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="fre">Prise en charge rythmologique des patients présentant une fibrillation atriale. Une prise en charge rythmologique des patients ayant une fibrillation atriale est indispensable afin d’améliorer leurs symptômes et leur pronostic. Cette prise en charge rythmologique consiste soit à contrôler le rythme sinusal, soit à contrôler la fréquence ventriculaire. Des études cliniques menées entre 2000 et 2010 n’avaient pas permis de démontrer la supériorité d’une des deux approches, notamment en termes de mortalité totale, y compris chez les patients insuffisants cardiaques. L’explication venait en partie du manque d’efficacité et de l’iatrogénie des traitements anti arythmiques (pharmacologiques) jusque-là utilisés. Cependant, nombre de patients en FA restent symptomatiques, et la restauration du rythme sinusal doit être privilégiée. L’avènement des techniques ablatives, qui ont montré leur supériorité sur les traitements anti arythmiques, a soulevé un regain d’intérêt pour la stratégie de contrôle du rythme, particulièrement chez les patients jeunes symptomatiques ainsi que chez les insuffisants cardiaques. Des études de morbi-mortalité sont cependant nécessaires avant d’envisager une ablation chez des patients asymptomatiques. |
15,636 | Paroxysmal Atrial Fibrillation of Vagal Mechanism with Episodes of Wide QRS Complex Tachycardia Due to Gouaux-Ashman's Phenomenon. | A 38-year-old male patient consulted for nocturnal palpitations described as fast chest pounding that woke him up from sleep. A physical examination yielded no remarkable findings. A 24-hour Holter ECG monitoring demonstrated nocturnal episodes of paroxysmal atrial fibrillation (PAF) with the coexistence of wide QRS complex tachycardia. To the best of our knowledge, this is the first reported case of nocturnal episodes of wide QRS complex tachycardia during vagally mediated PAF resulting from Gouaux-Ashman's phenomenon. It is paramount for general physicians to recognize this phenomenon because it should be differentiated from ventricular tachycardia, since prognosis and treatment of both entities are entirely different. General and emergency physicians should be aware in order to improve adequate diagnostic and therapeutic management of the arrhythmic episodes. |
15,637 | Six recurrences of myocarditis in 3 years: A case report. | A recent study revealed that recurrence of myocarditis occurs in a significant proportion of patients, but multiple recurrences of myocarditis have rarely been reported. The pathophysiology and best treatments for multiple recurrences of myocarditis remain unclear. A 60-year-old man presented to our emergency department with fever and chest pain. Physical examination, imaging, and laboratory findings were consistent with fulminant myocarditis. Paired titers confirmed adenovirus infection. The patient was treated with intra-aortic balloon pump and percutaneous cardiopulmonary support for 7 days and was discharged with near-normal electrocardiographic and echocardiographic findings on day 26. Over the subsequent 3 years, the patient experienced six episodes of recurrence of myocarditis with a progressive decrease in his ability to perform activities of daily living. At the time of his sixth recurrence, he died of ventricular fibrillation. Autopsy revealed mild enlargement of the left ventricle, extensive inflammatory cell infiltration, and mild interstitial fibrosis, suggesting left ventricle remodeling because of repetitive myocarditis. We have presented a case of multiple recurrences of myocarditis. This is the largest number of recurrences in a single patient reported to date. Further studies are needed to elucidate the underlying pathogenesis and best treatment of this condition. <<b>Learning objective:</b> Although few cases of multiple recurrent myocarditis have been reported, we recently experienced a case of multiple recurrences of myocarditis over a 3-year period. However, we did not definitively diagnose the etiology of myocarditis or perform etiologically based medical therapy, so we could not rescue our patient. In cases of multiple recurrent myocarditis, more aggressive and accurate investigation are required to elucidate the etiology and pathophysiology of this condition.>. |
15,638 | The height as an independent risk factor of atrial fibrillation: A review. | Atrial fibrillation (AF) is characterized by abnormal heart rhythm. Among other well-known associations, recent studies suggest an association of AF with height. Height is related to 50 diseases spanning different body systems, AF is one of them. Since AF, a heterogeneous disease process, is influenced by structural, neural, electrical, and hemodynamic factors, height alters this process through its contribution to increasing atrial and ventricular size, leading to altered conduction patterns, autonomic dysregulation, and development of AF. Multiple underlying mechanisms associate height with AF. Apart from these indirect mechanisms, genome-wide association studies suggest the involvement of the same genes in AF and growth pathways. Tall stature is independently associated with a higher risk of AF development in healthy individuals. Since adult height is achieved much earlier than the onset of AF, protective measures can be taken in individuals with increased height to monitor, manage, and prevent the progression of AF. |
15,639 | Efficacy and Safety of Landiolol in Patients With Ventricular Tachyarrhythmias With or Without Renal Impairment　- Subanalysis of the J-Land II Study. | <b><i>Background:</i></b> Post hoc analysis was used to investigate the effects of renal function on the efficacy and safety of landiolol using data from the J-Land II study, which evaluated landiolol in patients with hemodynamically unstable ventricular tachycardia (VT) or ventricular fibrillation (VF) who were refractory to Class III antiarrhythmic drugs. <b><i>Methods and Results:</i></b> Patient data from the J-Land II study (n=29) were stratified by renal function (estimated glomerular filtration rate [eGFR] <45 and ≥45 mL/min/1.73 m<sup>2</sup>) and analyzed. Continuous landiolol infusion (1 μg/kg/min, i.v.) was initiated after VT/VF was suppressed with electrical defibrillation; subsequent dose adjustments were made (1-40 μg/kg/min). The primary efficacy endpoint was the proportion of patients free from recurrent VT/VF during the assessment period. Safety endpoints were also assessed. In the eGFR <45 and ≥45 mL/min/1.73 m<sup>2</sup> groups, the median doses of landiolol during the assessment period were 9.44 and 8.97 μg/kg/min, the proportions of patients free from recurrent VT/VF were 69.2% and 81.8%, and adverse events occurred in 9 and 10 of 13 patients in each group, respectively. There were no apparent differences in the efficacy or safety of landiolol between the 2 groups. <b><i>Conclusions:</i></b> The data suggest that renal function may not affect the efficacy and safety of landiolol for hemodynamically unstable VT or VF. |
15,640 | Differential Response to Heart Rate Reduction by Carvedilol in Heart Failure and Reduced Ejection Fraction Between Sinus Rhythm and Atrial Fibrillation　- Insight From J-CHF Study. | <b><i>Background:</i></b> Heart rate (HR) reduction by β-blocker might not benefit patients with heart failure and reduced ejection fraction (HFrEF) with atrial fibrillation (AF). <b><i>Methods and Results:</i></b> The J-CHF study was a prospective randomized multicenter trial that assigned 360 HFrEF patients to a 2.5 mg/5 mg/20 mg target dose of carvedilol. Carvedilol was uptitrated over 8 weeks and then the dose was fixed. Of 321 patients available for analysis, AF was identified in 65 (20%). Using the median absolute change in HR at 32 weeks (∆HR), the subjects were further divided into group A (∆HR >-6 beats/min) and B (∆HR ≤-6 beats/min). Both in sinus rhythm (SR) and AF, baseline characteristics and achieved carvedilol dose were similar between groups A and B. In SR, the time-dependent change in left ventricular EF (LVEF) and LV end-diastolic dimension (LVEDD) over 56 weeks was more favorable in B compared with A (∆LVEF, P=0.036; ∆LVEDD, P=0.047), and ∆HR was independently associated with ∆LVEF (P=0.040). Group B had a lower rate of the primary endpoint, defined as a composite of death and hospitalization due to cardiovascular causes including acute decompensated HF at 3 years (P=0.002). ∆HR was an independent predictor of the primary endpoint (P=0.01), but this was not observed in AF. <b><i>Conclusions:</i></b> Response to the carvedilol HR reduction might differ in HFrEF between SR and AF. |
15,641 | Prognostic Significance of Post-Procedural Left Ventricular Ejection Fraction Following Atrial Fibrillation Ablation in Patients With Systolic Dysfunction. | <b><i>Background:</i></b> Atrial fibrillation (AF) ablation is associated with a good prognosis; nevertheless, the effect of post-procedural systolic function on a patient's prognosis remains uncertain. <b><i>Methods and Results:</i></b> Of 1,077 consecutive patients undergoing AF ablation, the prognosis of 150 patients with abnormal left ventricular ejection fraction (LVEF; <50%) was evaluated. Patients were categorized as having reduced LVEF (rEF; LVEF <40%), mid-range ejection fraction (mrEF; 40%≤LVEF<50%), or preserved LVEF (pEF; LVEF ≥50%). Post-procedural LVEF, evaluated 3 months after the procedure, was post-rEF in 28 patients (19%), post-mrEF in 49 (33%), and post-pEF in 73 (49%). During the median follow-up of 31 months, the cumulative ratios of the composite outcome (heart failure hospitalization or death) in the post-rEF, post-mrEF, and post-pEF groups were 18%, 5%, and 2%, respectively, at 1 year and 50%, 13%, and 4%, respectively, at 3 years (P<0.0001). The post-rEF group had a 4.5- to 5.0-fold higher risk of the outcome compared with the post-pEF group, whereas the post-mrEF group showed no risk after adjusting for confounders, including age ≥65 years, preprocedural LVEF category, and recurrence of atrial tachyarrhythmia. <b><i>Conclusions:</i></b> Patients with post-mrEF had a comparable prognosis to those with post-pEF over a relatively long follow-up, whereas those with post-rEF had the poorest outcome of the 3 groups, regardless of preprocedural LVEF status. |
15,642 | Left Ventricular Diastolic Dysfunction Is Associated With the Prevalence of Paroxysmal Atrial Fibrillation Determined on the Latest Echocardiographic Criteria. | <b><i>Background:</i></b> The relationship between left ventricular diastolic dysfunction (LVDD) and paroxysmal atrial fibrillation (PAF) remains unclear because of a lack of standard measures to evaluate LVDD. Accordingly, we examined the association between the prevalence of PAF and each LVDD grade determined according to the latest American Society of Echocardiography guidelines. <b><i>Methods and Results:</i></b> In all, 2,063 patients without persistent AF who underwent echocardiography at Saitama Municipal Hospital from July 2016 to June 2017 were included in the study. Patients were divided into LVDD 6 categories: No-LVDD (n=1,107), Borderline (n=392), Grade 1 (n=204), Indeterminate (n=62), Grade 2 (n=254), and Grade 3 (n=44). PAF was documented in 111 (10.0%), 81 (20.7%), 28 (13.7%), 6 (9.7%), 52 (20.5%), and 24 (54.5%) patients in the No-LVDD, Borderline, Grade 1, Indeterminate, Grade 2, and Grade 3 categories, respectively. PAF prevalence was higher in patients with Grade 3 LVDD across the whole study population. Subgroup analyses showed that the prevalence of PAF increased with increased LVDD grade in patients with reduced left ventricular ejection fraction. This relationship was significant in multivariate analysis including various patient characteristics. <b><i>Conclusions:</i></b> LVDD severity determined on the basis of the latest echocardiographic criteria was associated with the prevalence of PAF. The present findings shed light on the development of new therapeutic markers for PAF. |
15,643 | Current status and role of programmed ventricular stimulation in patients without sustained ventricular arrhythmias and reduced ejection fraction: Analysis of the Japan cardiac device treatment registry database. | The aim of this study was to clarify the current status and role of programmed ventricular stimulation in patients without sustained ventricular arrhythmias and reduced left ventricular ejection fraction (LVEF).</AbstractText>The follow-up data of the Japan cardiac device treatment registry (JCDTR) was analyzed in 746 patients with LVEF ≦35% and no prior history of sustained ventricular arrhythmias who underwent de novo implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with a defibrillator (CRT-D) implantation between January 2011 and August 2015.</AbstractText>Electrophysiological study (EPS) with programmed ventricular stimulation had been performed before the device implant in 118 patients (15.8%, EPS group). During the mean follow-up of 21 ± 12 months, the rate of freedom from any death and appropriate defibrillator therapy was not significantly different between EPS group (n = 118) and No EPS group (n = 628). NYHA class II-IV, and QRS duration were negatively associated with performing EPS. Among patients in the EPS group, the rate of ventricular tachycardia (VT)/ventricular fibrillation (VF) induction was 48%. The inducibility was not a predictor of appropriate defibrillator therapy, whereas BNP ≧535 pg/mL and no use of amiodarone were significantly associated with a risk of the appropriate therapy.</AbstractText>EPS for induction of VT/VF had been performed in about 16% of patients with reduced LVEF before primary prevention ICD/CRT-D implantation. Elevated BNP levels and no use of amiodarone, but not inducibility of VT/VF, appeared to be associated with appropriate defibrillator therapy in these populations.</AbstractText>© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.</CopyrightInformation> |
15,644 | The challenge of optimising ablation lesions in catheter ablation of ventricular tachycardia. | Radiofrequency catheter ablation has become an established treatment for ventricular tachycardia. The exponential increase in procedures has provided further insights into mechanisms causing arrhythmias and identification of ablation targets with the development of new mapping strategies. Since the definition of criteria to identify myocardial dense scar, borderzone and normal myocardium, and the description of isolated late potentials, local abnormal ventricular activity and decrementing evoked potential mapping, substrate-guided ablation has progressively become the method of choice to guide procedures. Accordingly, a wide range of ablation strategies have been developed from scar homogenization to scar dechanneling or core isolation using increasingly complex and precise tools such as multipolar or omnipolar mapping catheters. Despite these advances long-term success rates for VT ablation have remained static and lower in nonischemic than ischemic heart disease because of the more patchy distribution of myocardial scar. Ablation aims to deliver an irreversible loss of cellular excitability by myocardial heating to a temperatures exceeding 50°C. Many indicators of ablation efficacy have been developed such as contact force, impedance drop, force-time integral and ablation index, mostly validated in atrial fibrillation ablation. In ventricular procedures there is limited data and ablation lesion parameters have been scarcely investigated. Since VT arrhythmia recurrence can be related to inadequate RF lesion formation, it seems reasonable to establish robust markers of ablation efficacy. |
15,645 | Safety of catheter ablation of atrial fibrillation without pre- or peri-procedural imaging for the detection of left atrial thrombus in the era of uninterrupted anticoagulation. | The need for pre- or peri-procedural imaging to rule out the presence of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation (AF) is unclear in the era of uninterrupted direct oral anticoagulant (DOAC) regimen. We sought to examine the safety of catheter ablation in appropriately selected patients with paroxysmal AF without performing screening for left atrial thrombus.</AbstractText>Consecutive patients planned for radiofrequency AF catheter ablation between January 2016 and June 2020 were enrolled, and prospectively studied. All subjects were receiving uninterrupted anticoagulation with DOACs for at least 4 weeks before the procedure. All subjects were in sinus rhythm the day of the procedure. The primary outcome of the study was ischemic stroke or transient ischemic attack (TIA) during at 30 days.</AbstractText>A total of 451 patients (age 59.7 ± 10.2 years, 289 males) with paroxysmal AF were included in the study. The mean CHA2</sub>DS2</sub>-VASc score was 1.4 ± 1.2. The mean left ventricular ejection fraction and left atrial diameter were 60 ± 5% and 39.3 ± 4 mm, respectively. Regarding the anticoagulation regimen, apixaban was used in 197 (43.6%) patients, rivaroxaban in 148 (32.8%) patients, and dabigatran in 106 (23.5%) patients. None of the patients developed clinical ischemic stroke or TIA during the 30-day post-discharged period.</AbstractText>Catheter ablation can be safely performed in low-risk patients with paroxysmal AF without imaging for the detection of left atrial thrombus in the era of uninterrupted DOAC anticoagulation.</AbstractText>© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.</CopyrightInformation> |
15,646 | Improvement in quality of life and cardiac function after catheter ablation for asymptomatic persistent atrial fibrillation. | Catheter ablation (CA) for atrial fibrillation (AF) is widely performed. However, the indication for CA in patients with asymptomatic persistent AF is still controversial.</AbstractText>Among 259 consecutive patients who were hospitalized for initial CA of AF, a total of 45 patients who had asymptomatic persistent AF were retrospectively analyzed. Quality of life (QOL) before and 1 year after CA was evaluated, and changes in the cardiac function over 5 years after CA were also examined. QOL was assessed using the AF QOL questionnaire (AFQLQ) developed by the Japanese Heart Rhythm Society. In addition, cardiac function was assessed by measuring the plasma B-type natriuretic peptide (BNP) level, left ventricular ejection fraction (LVEF), left atrial diameter (LAD) with transthoracic echocardiogram, and left atrial (LA) volume with computed tomography (CT).</AbstractText>The AFQLQ significantly improved after CA in terms of "symptom frequency" and "activity limits and mental anxiety." The plasma BNP level, LVEF, and LAD significantly improved in the first 3 months after the first CA, with no significant changes thereafter (from 149.0 pg/dL [95% confidence intervals {CI}, 114.5-183.5 pg/dL] to 49.8 pg/dL [95% CI, 26.5-70.1], P</i> < .0001; from 60.8% [95% CI, 58.1%-63.6%] to 65.0% [95% CI, 62.6-67.4], P</i> = .001; and from 41.3 mm [95% CI, 39.7-42.9] to 36.8 [95% CI, 34.5-39.1 mm], P</i> < .0001, respectively). LA volume revealed LA reverse remodeling after CA.</AbstractText>Improvement in the QOL and cardiac function after CA of asymptomatic persistent AF was revealed. Asymptomatic persistent AF should be appropriately treated by CA.</AbstractText>© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.</CopyrightInformation> |
15,647 | Artificial Intelligence Segmented Dynamic Video Images for Continuity Analysis in the Detection of Severe Cardiovascular Disease. | In this paper, an artificial intelligence segmented dynamic video image based on the process of intensive cardiovascular and cerebrovascular disease monitoring is deeply investigated, and a sparse automatic coding deep neural network with a four layers stack structure is designed to automatically extract the deep features of the segmented dynamic video image shot, and six categories of normal, atrial premature, ventricular premature, right bundle branch block, left bundle branch block, and pacing are achieved through hierarchical training and optimization. Accurate recognition of heartbeats with an average accuracy of 99.5%. It provides technical assistance for the intelligent prediction of high-risk cardiovascular diseases like ventricular fibrillation. An intelligent prediction algorithm for sudden cardiac death based on the echolocation network was proposed. By designing an echolocation network with a multilayer serial structure, an intelligent distinction between sudden cardiac death signal and non-sudden death signal was realized, and the signal was predicted 5 min before sudden death occurred, with an average prediction accuracy of 94.32%. Using the self-learning capability of stack sparse auto-coding network, a large amount of label-free data is designed to train the stack sparse auto-coding deep neural network to automatically extract deep representations of plaque features. A small amount of labeled data then introduced to micro-train the entire network. Through the automatic analysis of the fiber cap thickness in the plaques, the automatic identification of thin fiber cap-like vulnerable plaques was achieved, and the average overlap of vulnerable regions reached 87%. The overall time for the automatic plaque and vulnerable plaque recognition algorithm was 0.54 s. It provides theoretical support for accurate diagnosis and endogenous analysis of high-risk cardiovascular diseases. |
15,648 | To treat or not to treat: left ventricular thrombus in a patient with cerebral amyloid angiopathy: a case report. | Cerebral amyloid angiopathy (CAA) is an important cause of cognitive impairment and spontaneous lobar intracerebral haemorrhage in older individuals. When necessary, anticoagulant treatment in these patients comes with two dilemmas; significant intracerebral bleeding risk with treatment vs. high risk of embolic stroke with no treatment.</AbstractText>A 66-year-old female patient presented to the emergency clinic with a ST-elevation myocardial infarction. Her past medical history revealed cognitive problems associated with lobar cerebral microbleeds on magnetic resonance imaging suspect for probable CAA. A primary percutaneous coronary intervention of the left anterior descending artery with implantation of drug eluting stent was performed. Dual antiplatelet treatment was started initially. During hospitalization, an impaired left ventricular (LV) function was observed with an apical aneurysm. Six months after the initial event, LV function remained stable however a LV thrombus was observed. Apixaban 5 mg twice daily was started based on multidisciplinary consensus and on its efficacy and safety profile in patients with atrial fibrillation. Despite treatment, patient suffered a new ischaemic stroke probably from the LV thrombus, for which vitamin K antagonist treatment was initiated and Apixaban discontinued.</AbstractText>Evidence for LV thrombus treatment with direct oral anticoagulants in CAA patients is scarce, however feasible based on its efficacy and safety profile. For CAA patients, the cardinal role of both clinical and radiological characteristics in determining the risk-benefit ratio for anticoagulant initiation in this specific subset of patients, is crucial. The clinical course described highlights the therapeutical dilemma of coexisting CAA and the clinical challenge it creates.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,649 | Comparative Effectiveness of Heart Rate Control Medications for the Treatment of Sepsis-Associated Atrial Fibrillation. | Atrial fibrillation (AF) with rapid ventricular response frequently complicates the management of critically ill patients with sepsis and may necessitate the initiation of medication to avoid hemodynamic compromise. However, the optimal medication to achieve rate control for AF with rapid ventricular response in sepsis is unclear.</AbstractText>What is the comparative effectiveness of frequently used AF medications (β-blockers, calcium channel blockers, amiodarone, and digoxin) on heart rate (HR) reduction among critically ill patients with sepsis and AF with rapid ventricular response?</AbstractText>We conducted a multicenter retrospective cohort study among patients with sepsis and AF with rapid ventricular response (HR > 110 beats/min). We compared the rate control effectiveness of β-blockers to calcium channel blockers, amiodarone, and digoxin using multivariate-adjusted, time-varying exposures in competing risk models (for death and addition of another AF medication), adjusting for fixed and time-varying confounders.</AbstractText>Among 666 included patients, 50.6% initially received amiodarone, 10.1% received a β-blocker, 33.8% received a calcium channel blocker, and 5.6% received digoxin. The adjusted hazard ratio for HR of < 110 beats/min by 1 h was 0.50 (95% CI, 0.34-0.74) for amiodarone vs β-blocker, 0.37 (95% CI, 0.18-0.77) for digoxin vs β-blocker, and 0.75 (95% CI, 0.51-1.11) for calcium channel blocker vs β-blocker. By 6 h, the adjusted hazard ratio for HR < 110 beats/min was 0.67 (95% CI, 0.47-0.97) for amiodarone vs β-blocker, 0.60 (95% CI, 0.36-1.004) for digoxin vs β-blocker, and 1.03 (95% CI, 0.71-1.49) for calcium channel blocker vs β-blocker.</AbstractText>In a large cohort of patients with sepsis and AF with rapid ventricular response, a β-blocker treatment strategy was associated with improved HR control at 1 h, but generally similar HR control at 6 h compared with amiodarone, calcium channel blocker, or digoxin.</AbstractText>Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
15,650 | Periprocedural Acute Kidney Injury in Patients With Structural Heart Disease Undergoing Catheter Ablation of VT. | This study sought to examine the impact of periprocedural acute kidney injury (AKI) in scar-related ventricular tachycardia (VT) patients undergoing radiofrequency catheter ablation (RFCA) on short- and long-term outcomes.</AbstractText>The clinical significance of periprocedural AKI in patients with scar-related VT undergoing RFCA has not been previously investigated.</AbstractText>This study included 317 consecutive patients with scar-related VT undergoing RFCA (age: 64 ± 13 years, mean left ventricular ejection fraction: 33 ± 13%, 55% ischemic cardiomyopathy). Periprocedural AKI was defined as an absolute increase in creatinine of ≥0.3 mg/dl over 48 h or an increase of >1.5× the baseline values within 1 week post-procedure.</AbstractText>Periprocedural AKI occurred in 31 patients (10%). Independent predictors of AKI included chronic kidney disease (odds ratio [OR]: 3.43; 95% confidence interval [CI]: 1.48 to 7.96; p = 0.004), atrial fibrillation (OR: 2.42; 95% CI: 1.01 to 5.78; p = 0.047), and peri-procedural acute hemodynamic decompensation (OR: 3.98; 95% CI: 1.17 to 13.52; p = 0.003). After a median follow-up of 39 months (interquartile range: 6 to 65 months), 95 patients (30%) died. Periprocedural AKI was associated with increased risk of early mortality (within 30 days; hazard ratio [HR]: 9.91; 95% CI: 2.87 to 34.22; p < 0.001) and late mortality (within 1 year) (HR: 4.57; 95% CI: 2.08 to 10.05; p < 0.001). After multivariable adjustment, AKI remained independently associated with increased risk of early and late mortality (HR: 4.49; 95% CI: 1.1 to 18.36; p = 0.04, and HR: 3.28; 95% CI: 1.43 to 7.49; p = 0.005, respectively).</AbstractText>Periprocedural AKI occurs in 10% of patients undergoing RFCA of scar-related VT and is strongly associated with increased risk of early and late post-procedural mortality.</AbstractText>Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
15,651 | Catheter Ablation in Patients With Neuroendocrine (Carcinoid) Tumors and Carcinoid Heart Disease: Outcomes, Peri-Procedural Complications, and Management Strategies. | This report describes a series of patients with neuroendocrine tumors with or without carcinoid heart disease undergoing catheter ablation at the authors' institution.</AbstractText>Neuroendocrine (carcinoid) tumors are a rare form of neoplasm with the potential for systemic vasoactive effects and cardiac valvular involvement. These tumors can create peri-operative management challenges for the electrophysiologist. However, there are few data regarding ablation outcomes, periprocedural complications, and management of these patients.</AbstractText>All patients with neuroendocrine tumors undergoing catheter ablation at the Mayo Clinic, Rochester, Minnesota over a 25-year period were retrospectively reviewed. From this cohort, the type of arrhythmias ablated, the recurrence of arrhythmia, perioperative complications, and mortality were reviewed and analyzed.</AbstractText>A total of 17 patients (52.9% male; mean age 62.4 ± 9.3 years) with neuroendocrine tumors underwent catheter ablation during the study period. Primary tumor sites included the gastrointestinal tract (n = 11), lung (n = 4), ovary (n = 1), and lymph node (n = 1). Nine patients had metastatic disease, 5 of whom were on somatostatin analog therapy at the time of ablation. Three patients had active symptoms of carcinoid syndrome at the time of ablation, and 2 of those patients had carcinoid heart disease. Ablations were performed mainly for atrial arrhythmias (76.5%): atrioventricular nodal re-entry tachycardia (n = 7), atrial fibrillation (n = 4), and atrial flutter (n = 2). Four patients underwent ablation of ventricular arrhythmias. During a mean follow-up of 19.2 ± 26.2 months, arrhythmia recurred in 35.3% of patients. Three patients (17.6%) had periprocedural complications: pericardial effusion (n = 1), groin site hematoma (n = 1), and carcinoid crisis (n = 1). No deaths were noted in the peri-operative period.</AbstractText>In a unique cohort of patients with neuroendocrine tumors, catheter ablation was feasible in patients with or without carcinoid syndrome. Carcinoid crisis may occur during the periprocedural period, which can be life-threatening, and a specified protocol for management is important to mitigate this risk.</AbstractText>Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
15,652 | Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest. | The aim of this study was to examine the use of volumetric capnography monitoring to assess cardiopulmonary resuscitation (CPR) effectiveness by correlating it with cardiac output (CO), and to evaluate the effect of epinephrine boluses on both end-tidal carbon dioxide (EtCO <sub>2</sub> ) and the volume of CO <sub>2</sub> elimination (VCO <sub>2</sub> ) in a swine ventricular fibrillation cardiac arrest model. Planned secondary analysis of data collected to investigate the use of noninvasive monitors in a pediatric swine ventricular fibrillation cardiac arrest model was performed. Twenty-eight ventricular fibrillatory arrests with open cardiac massage were conducted. During CPR, EtCO <sub>2</sub> and VCO <sub>2</sub> had strong correlation with CO, measured as a percentage of baseline pulmonary blood flow, with correlation coefficients of 0.83 ( <i>p</i>  < 0.001) and 0.53 ( <i>p</i>  = 0.018), respectively. However, both EtCO <sub>2</sub> and VCO <sub>2</sub> had weak and nonsignificant correlation with diastolic blood pressure during CPR 0.30 ( <i>p</i>  = 0.484) (95% confidence interval [CI], -0.51-0.83) and 0.25 ( <i>p</i>  = 0.566) (95% CI, -0.55-0.81), respectively. EtCO <sub>2</sub> and VCO <sub>2</sub> increased significantly after the first epinephrine bolus without significant change in CO. The correlations between EtCO <sub>2</sub> and VCO <sub>2</sub> and CO were weak 0.20 ( <i>p</i>  = 0.646) (95% CI, -0.59-0.79), and 0.27 ( <i>p</i>  = 0.543) (95% CI, -0.54-0.82) following epinephrine boluses. Continuous EtCO <sub>2</sub> and VCO <sub>2</sub> monitoring are potentially useful metrics to ensure effective CPR. However, transient epinephrine administration by boluses might confound the use of EtCO <sub>2</sub> and VCO <sub>2</sub> to guide chest compression. |
15,653 | The Acetylcholine-Activated Potassium Current Inhibitor XAF-1407 Terminates Persistent Atrial Fibrillation in Goats. | <b>Aims:</b> The acetylcholine-activated inward rectifier potassium current (I<sub>KACh</sub>) has been proposed as an atrial-selective target for the treatment of atrial fibrillation (AF). Using a novel selective I<sub>KACh</sub> inhibitor XAF-1407, the study investigates the effect of I<sub>KACh</sub> inhibition in goats with pacing-induced, short-term AF. <b>Methods:</b> Ten goats (57 ± 5 kg) were instrumented with pericardial electrodes. Electrophysiological parameters were assessed at baseline and during intravenous infusion of XAF-1407 (0.3, 3.0 mg/kg) in conscious animals before and after 2 days of electrically induced AF. Following a further 2 weeks of sustained AF, cardioversion was attempted with either XAF-1407 (0.3 followed by 3 mg/kg) or with vernakalant (3.7 followed by 4.5 mg/kg), an antiarrhythmic drug that inhibits the fast sodium current and several potassium currents. During a final open chest experiment, 249 unipolar electrograms were recorded on each atrium to construct activation patterns and AF cardioversion was attempted with XAF-1407. <b>Results:</b> XAF-1407 prolonged atrial effective refractory period by 36 ms (45%) and 71 ms (87%) (0.3 and 3.0 mg/kg, respectively; pacing cycle length 400 ms, 2 days of AF-induced remodeling) and showed higher cardioversion efficacy than vernakalant (8/9 vs. 5/9). XAF-1407 caused a minor decrease in the number of waves per AF cycle in the last seconds prior to cardioversion. Administration of XAF-1407 was associated with a modest increase in QTc (<10%). No ventricular proarrhythmic events were observed. <b>Conclusion:</b> XAF-1407 showed an antiarrhythmic effect in a goat model of AF. The study indicates that I<sub>KACh</sub> represents an interesting therapeutic target for treatment of AF. To assess the efficacy of XAF-1407 in later time points of AF-induced remodeling, follow-up studies with longer period of AF maintenance would be necessary. |
15,654 | MLWAVE: A novel algorithm to classify primary versus secondary asphyxia-associated ventricular fibrillation. | <AbstractText Label="INTRODUCTION/HYPOTHESIS" NlmCategory="OBJECTIVE">The outcome of cardiopulmonary resuscitation (CPR) depends on timely recognition of the underlying cause of cardiac arrest. Ventricular fibrillation (VF) waveform analysis to differentiate primary VF from secondary asphyxia-associated VF may allow tailoring of therapies to improve cardiac arrest outcomes. Therefore, the primary goal of this investigation was to develop a novel technique utilizing wavelet synchrosqueezed transform (WSST) and decision-tree classifier that was specifically adapted to discriminate between these two incidents of VF.</AbstractText>Secondary analytical investigation of electrocardiography (ECG) data obtained from swine models of either primary VF (n=18) or secondary asphyxia-associated VF (7min of asphyxia prior to VF induction; n=12). In the primary analysis, WSST technique was applied to the first 35s of the VF ECG signal to identify the most differentiating characteristics of the signal for use as features to develop a machine learning algorithm to classify the arrest as either primary VF vs. secondary asphyxia-associated VF. The performance of this new interactive Machine Learning algorithm with Wavelet Energy features of ECG (MLWAVE) was assessed using both classification accuracy and area under the receiver operating characteristic curve (AUCROC). To evaluate the validity of the new technique, the amplitude spectrum area (AMSA)-based technique, a well-established defibrillation classification method, was also applied to the same ECG signals. The classification accuracy and AUCROC were then compared between the two techniques.</AbstractText>For the primary analysis evaluating the first 35s of the VF waveform, the MLWAVE technique classified the type of VF with high accuracy (28/28 [100%], AUCROC: 1.00). The MLWAVE technique performed better than the AMSA technique across all comparisons, but given the small sample sizes, differences were not statistically significant (accuracy: 100% vs. 85.7%; p=0.24; AUCROC: 1.00 vs. 0.82; p=0.24).</AbstractText>This analytical investigation illustrates the advantages of the MLWAVE signal processing method which was associated with 100% accuracy in classifying the type of VF waveform: primary vs. asphyxia-associated. Such classification could lead to personalized tailoring of resuscitation (e.g., immediate defibrillation vs. continued CPR and treatment of reversible cardiac arrest causes before defibrillation) to improve outcomes for cardiac arrest.</AbstractText> |
15,655 | Case Report: Emergency High-Risk Percutaneous Coronary Intervention Following Transcatheter Aortic Valve Implantation in Bicuspid Anatomy. | <b>Background:</b> Transcatheter aortic valve implantation (TAVR) continues to develop as a valuable alternative to surgical aortic valve replacement (SAVR) in an increasingly wide spectrum of patients with severe symptomatic aortic stenosis (AS). AS frequently coexists with coronary artery disease, and performing technically challenging percutaneous coronary intervention (PCI) following TAVR will become more frequent with increased use of TAVR. <b>Case Summary:</b> We herein report the case of a 53-years-old man with complex medical history including type 1 diabetes and dialysis-dependent renal failure and prior Evolut-R TAVR for critical bicuspid aortic valve stenosis who underwent intravascular ultrasound study (IVUS)-guided PCI to a critical distal left main stem (LMS) and proximal left anterior descending (LAD) lesion after presenting with ventricular fibrillation (VF) secondary to an acute coronary syndrome (ACS). <b>Discussion:</b> Selective engagement of coronary ostia through the side cells of TAVR prosthesis can be challenging, especially in an emergency setting. The particular challenges associated with this case are described, as well as an up-to-date literature search on strategies and equipment that can help in this situation. |
15,656 | The Experimental TASK-1 Potassium Channel Inhibitor A293 Can Be Employed for Rhythm Control of Persistent Atrial Fibrillation in a Translational Large Animal Model. | Upregulation of the two-pore-domain potassium channel TASK-1 (hK2</sub> P</i></sub> 3.1) was recently described in patients suffering from atrial fibrillation (AF) and resulted in shortening of the atrial action potential. In the human heart, TASK-1 channels facilitate repolarization and are specifically expressed in the atria. In the present study, we tested the antiarrhythmic effects of the experimental ion channel inhibitor A293 that is highly affine for TASK-1 in a porcine large animal model of persistent AF.</AbstractText>Persistent AF was induced in German landrace pigs by right atrial burst stimulation via implanted pacemakers using a biofeedback algorithm over 14 days. Electrophysiological and echocardiographic investigations were performed before and after the pharmacological treatment period. A293 was intravenously administered once per day. After a treatment period of 14 days, atrial cardiomyocytes were isolated for patch clamp measurements of currents and atrial action potentials. Hemodynamic consequences of TASK-1 inhibition were measured upon acute A293 treatment.</AbstractText>In animals with persistent AF, the A293 treatment significantly reduced the AF burden (6.5% vs. 95%; P</i> < 0.001). Intracardiac electrophysiological investigations showed that the atrial effective refractory period was prolonged in A293 treated study animals, whereas, the QRS width, QT interval, and ventricular effective refractory periods remained unchanged. A293 treatment reduced the upregulation of the TASK-1 current as well as the shortening of the action potential duration caused by AF. No central nervous side effects were observed. A mild but significant increase in pulmonary artery pressure was observed upon acute TASK-1 inhibition.</AbstractText>Pharmacological inhibition of atrial TASK-1 currents exerts in vivo</i> antiarrhythmic effects that can be employed for rhythm control in a porcine model of persistent AF. Care has to be taken as TASK-1 inhibition may increase pulmonary artery pressure levels.</AbstractText>Copyright © 2021 Wiedmann, Beyersdorf, Zhou, Kraft, Foerster, El-Battrawy, Lang, Borggrefe, Haefeli, Frey and Schmidt.</CopyrightInformation> |
15,657 | Acute Ostial Right Coronary Artery Occlusion During Valve Deployment of Transcatheter Aortic Valve Replacement Leading to Acute Right Ventricular Failure: A Perfect Storm and Successful Navigation. | Acute coronary obstruction is a relatively rare complication of transcatheter aortic valve replacement (TAVR). Left coronary ostial obstruction is much more common compared to right coronary occlusion due to its relatively lower ostial height from the aortic annulus. We present a case of acute ostial right coronary occlusion immediately upon deployment of a 29-mm Sapien 3 transcatheter aortic valve. The acute right coronary ostial occlusion manifested with ventricular fibrillation, acute right ventricular failure, and right-sided cardiogenic shock. The patient, after undergoing an initial unsuccessful attempt at percutaneous revascularization, was placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This was later transitioned to percutaneous right atrial to pulmonary artery right ventricular support, which led to subsequent recovery. |
15,658 | Atrial functional versus ventricular functional mitral regurgitation: Prognostic implications. | Atrial functional mitral regurgitation (FMR) occurs because of left atrial dilatation or atrial fibrillation in heart failure with preserved left ventricular (LV) function, contrary to ventricular FMR, which occurs because of LV dysfunction. Despite pathophysiological differences, current guidelines do not discriminate between these 2 entities.</AbstractText>From January 2002 to March 2019, all adult patients with ≥3+ mitral regurgitation who underwent mitral valve repair or replacement were identified. Postoperative outcomes and midterm time-to-event rates (survival and reoperation) were compared.</AbstractText>Overall, 94 atrial FMR (mean age, 67.6 years) and 84 ventricular FMR (mean age, 64 years) patients met inclusion criteria. Differences in baseline cardiac morphology and function of the atrial FMR and ventricular FMR patients were as follows: concomitant atrial fibrillation (37.2% vs 14.3%), heart failure (42.6% vs 63.1%), LV ejection fraction (60% vs 37%), at least moderate LV dilation (4.8% vs 40.6%), and moderate/severe right heart dysfunction (15.2% vs 5.1%), respectively. Operative mortality was 0% in the atrial FMR versus 1.2% in the ventricular FMR cohort. Actuarial estimates of survival and freedom from reoperation at 5 and 10 years was significantly higher in the atrial FMR cohort versus the ventricular FMR cohort. Ventricular FMR also remained a significant predictor of midterm mortality in our risk-adjusted analysis (adjusted hazard ratio for ventricular FMR, 1.8; 95% confidence interval, 1.001-3.26).</AbstractText>There are important differences in baseline characteristics in terms of cardiac morphology and function among atrial FMR and ventricular FMR patients, which appear to affect in-hospital and midterm outcomes. Because of these discrepancies, early discrimination between these 2 etiologies of FMR might facilitate more tailored approaches to management.</AbstractText>Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
15,659 | An unusual case of high-voltage electrical injury involving fractal wood burning. | A 26-year-old female was brought to the emergency department after an apparent electrocution. She was unresponsive, pulseless, and found to be in ventricular fibrillation upon arrival. The patient achieved return of spontaneous circulation after defibrillation. Further examination showed partial to full thickness burns to both hands, right chest wall, and buttocks. She was stabilized and then transferred to a regional burn center for additional care. Further history revealed the patient had learned how to create art with Lichtenberg figures using a high-voltage transformer extracted from a home microwave oven and a wooden canvas, a process called fractal wood burning. There are countless online video tutorials that describe how to replicate this process; however, the dangers of this practice are frequently omitted and have now become a growing public health concern. This article hopes to expand on the previous single publication, discuss the exceedingly high mortality rate, motivate emergency medicine providers and other clinicians to publish cases related to fractal wood burning-related injuries, and promote public awareness of this perilous practice. |
15,660 | Automated Electrocardiogram Analysis Identifies Novel Predictors of Ventricular Arrhythmias in Brugada Syndrome. | <b>Background:</b> Patients suffering from Brugada syndrome (BrS) are at an increased risk of life-threatening ventricular arrhythmias. Whilst electrocardiographic (ECG) variables have been used for risk stratification with varying degrees of success, automated measurements have not been tested for their ability to predict adverse outcomes in BrS. <b>Methods:</b> BrS patients presenting in a single tertiary center between 2000 and 2018 were analyzed retrospectively. ECG variables on vector magnitude, axis, amplitude and duration from all 12 leads were determined. The primary endpoint was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF) on follow-up. <b>Results:</b> This study included 83 patients [93% male, median presenting age: 56 (41-66) years old, 45% type 1 pattern] with 12 developing the primary endpoint (median follow-up: 75 (Q1-Q3: 26-114 months). Cox regression showed that QRS frontal axis > 70.0 degrees, QRS horizontal axis > 57.5 degrees, R-wave amplitude (lead I) <0.67 mV, R-wave duration (lead III) > 50.0 ms, S-wave amplitude (lead I) < -0.144 mV, S-wave duration (lead aVL) > 35.5 ms, QRS duration (lead V3) > 96.5 ms, QRS area in lead I < 0.75 Ashman units, ST slope (lead I) > 31.5 deg, T-wave area (lead V1) < -3.05 Ashman units and PR interval (lead V2) > 157 ms were significant predictors. A weighted score based on dichotomized values provided good predictive performance (hazard ratio: 1.59, 95% confidence interval: 1.27-2.00, <i>P</i>-value<0.0001, area under the curve: 0.84). <b>Conclusions:</b> Automated ECG analysis revealed novel risk markers in BrS. These markers should be validated in larger prospective studies. |
15,661 | A case of cardiac tamponade due to coronary artery injury caused by atrial screw-in lead. | A 74-year-old man who had a history of paroxysmal atrial fibrillation, visited the emergency department because of syncope. An electrocardiogram showed atrial fibrillation with slow ventricular response and long pauses. A permanent pacemaker was implanted under oral anticoagulation. Two screw-in leads were positioned at the right atrial appendage and the right ventricular apex. Seven hours after the implantation, he collapsed with hypotension due to cardiac tamponade. Vital signs improved after urgent pericardial drainage, but blood was continuously drained from the pericardial catheter. Due to uncontrollable cardiac tamponade, surgical repair was indicated. We found neither of the leads perforated the myocardium, but there was intermittent bleeding from a pin hole injury in the atrial wall site of the right coronary artery. Redness was observed in the right atrial appendage, but there was no bleeding point. We supposed that the screw tip of the atrial lead might have perforated the atrial appendage,　but was retracted spontaneously afterwards. The pin hole was closed with a patch and the postoperative course was uneventful. This is a rare case of cardiac tamponade due to the injury of the coronary artery by a screw-in lead positioned at the right atrial appendage. <<b>Learning objectives:</b> Pacemaker implantation can cause cardiac tamponade due to coronary artery perforation. Right coronary artery perforation due to screwed-in atrial lead can be a cause of cardiac tamponade after pacemaker implantation, especially if proximal portion of right coronary artery meanders close to atrial appendage.>. |
15,662 | Successful management of heart failure 45 years after surgical correction of tetralogy of Fallot. | A 59-year-old Japanese woman was admitted with heart failure due to severe pulmonary regurgitation and tricuspid regurgitation, in addition to atrial fibrillation 45 years after surgical correction of tetralogy of Fallot (TOF). She had been under treatment with medication and catheter ablation for arrhythmia including ventricular tachycardia for the past 28 years. She underwent pulmonary valve replacement as well as tricuspid and mitral valvuloplasty, which obviously improved her status even though her right ventricular end-diastolic volume index exceeded the recommended threshold. Patients who have undergone surgical correction of TOF need to be managed over the long term. <<b>Learning objective:</b> For a long term after surgical correction of tetralogy of Fallot (TOF), appropriate managements are needed for arrhythmia and heart failure related to heart valve disease. Even though her right ventricular end-diastolic volume index exceeded the recommended threshold by the current published guidelines, re-operation for heart valve diseases improved the present patient. We have to accumulate evidence to make useful guideline of re-operation of TOF in Japan.>. |
15,663 | A woman complicated by sudden cardiac arrest owing to spontaneous coronary artery dissection after stillbirth. | Spontaneous coronary artery dissection (SCAD) is the most important cause of acute coronary syndrome in pregnant women. Pregnancy-associated SCAD frequently occurs in the third trimester or postpartum period. However, little is known regarding the relationship between the occurrence of SCAD and stillbirth. We describe here a 41-year-old woman complicated by sudden cardiac arrest owing to SCAD in the distal segment of the right coronary artery 13 days after stillbirth. After contacting emergency medical services, she was resuscitated by an automated external defibrillator because the initial electrocardiographic waveform was ventricular fibrillation. After cardiopulmonary resuscitation, the diagnosis of SCAD was confirmed by coronary angiography and intracoronary imaging, including intravascular ultrasound and optical coherence tomography. The patient was managed with conservative medical therapy because the culprit lesion was present in the distal segment of the right coronary artery and coronary blood flow was preserved. No major adverse cardiovascular events, including recurrent ventricular arrhythmia, were observed during hospitalization. Our findings indicate that pregnancy-associated SCAD leading to sudden cardiac arrest may occur in the postpartum period, even after stillbirth. Intravascular imaging plays a pivotal role in diagnosing SCAD. <<b>Learning objective:</b> Pregnancy-associated spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome in pregnant or postpartum women. However, whether the risk of pregnancy-associated SCAD in the postpartum period is different between normal birth and stillbirth remains unknown. Pregnancy-associated SCAD leading to sudden cardiac arrest owing to acute myocardial ischemia may occur in postpartum women, regardless of fetal survival.>. |
15,664 | Circadian Mechanisms: Cardiac Ion Channel Remodeling and Arrhythmias. | Circadian rhythms are involved in many physiological and pathological processes in different tissues, including the heart. Circadian rhythms play a critical role in adverse cardiac function with implications for heart failure and sudden cardiac death, highlighting a significant contribution of circadian mechanisms to normal sinus rhythm in health and disease. Cardiac arrhythmias are a leading cause of morbidity and mortality in patients with heart failure and likely cause ∼250,000 deaths annually in the United States alone; however, the molecular mechanisms are poorly understood. This suggests the need to improve our current understanding of the underlying molecular mechanisms that increase vulnerability to arrhythmias. Obesity and its associated pathologies, including diabetes, have emerged as dangerous disease conditions that predispose to adverse cardiac electrical remodeling leading to fatal arrhythmias. The increasing epidemic of obesity and diabetes suggests vulnerability to arrhythmias will remain high in patients. An important objective would be to identify novel and unappreciated cellular mechanisms or signaling pathways that modulate obesity and/or diabetes. In this review we discuss circadian rhythms control of metabolic and environmental cues, cardiac ion channels, and mechanisms that predispose to supraventricular and ventricular arrhythmias including hormonal signaling and the autonomic nervous system, and how understanding their functional interplay may help to inform the development and optimization of effective clinical and therapeutic interventions with implications for chronotherapy. |
15,665 | A wearable real-time telemonitoring electrocardiogram device compared with traditional Holter monitoring. | Arrhythmias are very common in the healthy populations as well as patients with cardiovascular diseases. Among them, atrial fibrillation (AF) and malignant ventricular arrhythmias are usually associated with some clinical events. Early diagnosis of arrhythmias, particularly AF and ventricular arrhythmias, is very important for the treatment and prognosis of patients. Holter is a gold standard commonly recommended for noninvasive detection of paroxysmal arrhythmia. However, it has some shortcomings such as fixed detection timings, delayed report and inability of remote real-time detection. To deal with such problems, we designed and applied a new wearable 72-hour triple-lead H3-electrocardiogram (ECG) device with a remote cloud-based ECG platform and an expert-supporting system. In this study, 31 patients were recruited and 24-hour synchronous ECG data by H3-ECG and Holter were recorded. In the H3-ECG group, ECG signals were transmitted using remote real-time modes, and confirmed reports were made by doctors in the remote expert-supporting system, while the traditional modes and detection systems were used in the Holter group. The results showed no significant differences between the two groups in 24-hour total heart rate (HR), averaged HR, maximum HR, minimum HR, premature atrial complexes (PACs) and premature ventricular complexes (PVCs) ( <i>P</i>>0.05). The sensitivity and specificity of capture and remote automatic cardiac events detection of PACs, PVCs, and AF by H3-ECG were 93% and 99%, 98% and 99%, 94% and 98%, respectively. Therefore, the long-term limb triple-lead H3-ECG device can be utilized for domiciliary ECG self-monitoring and remote management of patients with common arrhythmia under medical supervision. |
15,666 | Redo mitral valve replacement through minithoracotomy on ventricular fibrillation: Bailout for a nightmare Redo. | A 56-year-old woman entered the emergency department due to worsening dyspnea. Severe mitral regurgitation and pulmonary artery dilation with flow compatible with fistula were observed by transthoracic and transesophageal echocardiography. The patient had history of an ALCAPA (anomalous left coronary artery from pulmonary artery) syndrome having undergone coronary artery bypass grafting (saphenous venous graft to left anterior descending artery) 30 years before. Coronary angiography and computed tomography revealed patency of the graft, with the dilated vein running across the front of the ascending aorta and being responsible for the perfusion of the left anterior descending artery and circumflex artery. We resent this case for discussion of which surgical strategy/options are available in order to treat the mitral valve and avoid injuring the patent graft. |
15,667 | Hydroxychloroquine/Azithromycin Therapy and QT Prolongation in Hospitalized Patients With COVID-19. | This study aimed to characterize corrected QT (QTc) prolongation in a cohort of hospitalized patients with coronavirus disease-2019 (COVID-19) who were treated with hydroxychloroquine and azithromycin (HCQ/AZM).</AbstractText>HCQ/AZM is being widely used to treat COVID-19 despite the known risk of QT interval prolongation and the unknown risk of arrhythmogenesis in this population.</AbstractText>A retrospective cohort of COVID-19 hospitalized patients treated with HCQ/AZM was reviewed. The QTc interval was calculated before drug administration and for the first 5 days following initiation. The primary endpoint was the magnitude of QTc prolongation, and factors associated with QTc prolongation. Secondary endpoints were incidences of sustained ventricular tachycardia or ventricular fibrillation and all-cause mortality.</AbstractText>Among 415 patients who received concomitant HCQ/AZM, the mean QTc increased from 443 ± 25 ms to a maximum of 473 ± 40 ms (87 [21%] patients had a QTc ≥500 ms). Factors associated with QTc prolongation ≥500 ms were age (p < 0.001), body mass index <30 kg/m2</sup> (p = 0.005), heart failure (p < 0.001), elevated creatinine (p = 0.005), and peak troponin (p < 0.001). The change in QTc was not associated with death over the short period of the study in a population in which mortality was already high (hazard ratio: 0.998; p = 0.607). No primary high-grade ventricular arrhythmias were observed.</AbstractText>An increase in QTc was seen in hospitalized patients with COVID-19 treated with HCQ/AZM. Several clinical factors were associated with greater QTc prolongation. Changes in QTc were not associated with increased risk of death.</AbstractText>Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
15,668 | Renal Denervation for the Management of Refractory Ventricular Arrhythmias: A Systematic Review. | The authors performed a systematic review and meta-analysis to determine the efficacy of renal denervation (RDN) in patients with refractory ventricular arrhythmias (VA) or electrical storm (ES).</AbstractText>Although catheter ablation is efficacious for the treatment of structural heart disease ventricular tachycardia (VT), there are proportion of patients who have refractory VT despite multiple procedures. In this setting, novel adjunctive therapies such as renal denervation have been performed.</AbstractText>A systematic review of published data was performed. Studies that evaluated patients undergoing RDN for VA or ES were included. Outcome measures of VA, sudden cardiac death, ES, or device therapy were required. Case reports, editorials, and conference presentations were excluded. Random effects meta-analysis was conducted to explore change or final mean values in the study outcomes.</AbstractText>A total of 328 articles were identified by the literature search. Seven studies met the eligibility criteria and were included in the systematic review, with a total of 121 pooled patients. The weighted mean age was 63.8 ± 13.1 years, ejection fraction 30.5 ± 10.3%, 76% were men, 99% were on a beta blocker, 79% were on amiodarone, 46% had previously undergone catheter ablation, and 8.3% had previously undergone cardiac sympathetic denervation. Meta-analysis demonstrated a significant effect of RDN in reducing implantable cardiac defibrillator therapies, with a standardized mean difference (SMD) of -3.11 (p < 0.001). RDN also reduced the number of VA episodes (SMD -2.13; p < 0.001), antitachycardia pacing episodes (SMD -2.82; p = 0.002), and shocks (SMD -2.82; p = 0.002).</AbstractText>RDN is an effective treatment for refractory VAs and ES, although randomized data are lacking.</AbstractText>Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
15,669 | Cone repair for Ebstein's anomaly and atrial fibrillation ablation in an adult patient. | We present a 52-year-old woman with Ebstein's anomaly not previously treated. In this subset of patients, there are no clear guidelines regarding the best surgical strategy for treating the tricuspid valve: replace it or repair it.  In this case, extensive repair of the tricuspid valve and the right ventricle is achieved using the cone repair technique popularized by Dr. José Pedro Da Silva. Because the patient also presented with symptomatic paroxysmal atrial fibrillation, a right atrial maze procedure combined with isolation of the pulmonary veins was performed using both radiofrequency and cryotherapy. At the last follow-up, 2 years after the repair, the patient is asymptomatic and maintains sinus rhythm. The last echocardiogram showed mild tricuspid regurgitation with normal right ventricular function. |
15,670 | Is Current Drug Therapy for Heart Failure Sufficient to Control Heart Rate of Patients? | Studies have shown that heart failure (HF) patients with heart rate (HR) < 70 bpm have had a better clinical outcome and lower morbidity and mortality compared with those with HR > 70 bpm. However, many HF patients maintain an elevated HR.</AbstractText>To evaluate HR and the prescription of medications known to reduce mortality in HF patients attending an outpatient cardiology clinic.</AbstractText>We consecutively evaluated patients seen in an outpatient cardiology clinic, aged older than 18 years, with diagnosis of HF and left ventricular ejection fraction (LVEF) < 45%. Patients with sinus rhythm were divided into two groups - HR ≤ 70 bpm (G1) and HR > 70 bpm (G2). The Student's t-test and the chi-square test were used in the statistical analysis, and a p-value < 0.05 was considered statistically significant. The SPSS software was used for the analyses.</AbstractText>A total of 212 consecutive patients were studied; 41 (19.3%) had atrial fibrillation or had a pacemaker implanted and were excluded from the analysis, yielding 171 patients. Mean age of patients was 63.80 ± 11.77 years, 59.6% were men, and mean LVEF 36.64±7.79%. The most prevalent HF etiology was ischemic (n=102; 59.6%), followed by Chagasic (n=17; 9.9%). One-hundred thirty-one patients (76.6%) were hypertensive and 63 (36.8%) diabetic. Regarding HR, 101 patients had a HR ≤70 bpm (59.1%) and 70 patients (40.93%) had a HR >70 bpm (G2). Mean HR of G1 and G2 was 61.5±5.3 bpm and 81.8±9.5 bpm, respectively (p<0.001). Almost all patients (98.8%) were receiving carvedilol, prescribed at a mean dose of 42.1±18.5 mg/day in G1 and 42.5±21.1mg/day in G2 (p=0.911). Digoxin was used in 5.9% of patients of G1 and 8.5% of G2 (p=0.510). Mean dose of digoxin in G1 and G2 was 0.19±0.1 mg/day and 0.19±0.06 mg/day, respectively (p=0,999). Most patients (87.7%) used angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), and 56.7% used spironolactone. Mean dose of enalapril was 28.9±12.7 mg/day and mean dose of ARB was 87.8±29.8 mg/day. The doses of ACEI and ARB were adequate in most of patients.</AbstractText>The study revealed that HR of 40.9% of patients with HF was above 70 bpm, despite treatment with high doses of beta blockers. Further measures should be applied for HR control in HF patients who maintain an elevated rate despite adequate treatment with beta blocker. (Arq Bras Cardiol. 2020; 115(6):1063-1069).</AbstractText> |
15,671 | Atrial fibrillation in horses Part 2: Diagnosis, treatment and prognosis. | Atrial fibrillation (AF) is suspected by an irregularly irregular rhythm during auscultation at rest and should be confirmed by electrocardiography. Heart rate monitoring is potentially interesting for AF detection by horse owners, based on the disproportionally high heart rate during exercise or increased heart rate variability. Echocardiography and laboratory analysis are useful to identify underlying cardiac disease. Horses with severe cardiac disease should not undergo cardioversion due to the risk of recurrence. Cardioversion is recommended especially in horses performing high intensity exercise or showing average maximal heart rates higher than 220 beats per min or abnormal ventricular complexes during exercise or stress. Pharmacological cardioversion can be performed using quinidine sulphate administered orally, with an overall mean reported success rate around 80%. Other therapeutic drugs have been described such as flecainide, amiodarone or novel atrial specific compounds. Transvenous electrical cardioversion (TVEC) is performed by delivering a shock between two cardioversion catheters positioned in the left pulmonary artery and right atrium, with a success rate of >95%. After cardioversion, most horses return to their previous level of performance. However, the recurrence rate after pharmacological or electrical cardioversion is up to 39%. Recurrence has been related to previous unsuccessful treatment attempts, valvular regurgitation and the presence of atrial premature depolarisations or low atrial contractile function after cardioversion. Large atrial size and long AF duration have also been suggested as risk factors. Different approaches for preventing recurrence have been described such as the administration of sotalol, however, large clinical studies have not been published. |
15,672 | Clinical characteristics and risk factors of arrhythmia during follow-up of patients with idiopathic ventricular fibrillation. | The current knowledge of idiopathic ventricular fibrillation (IVF) is limited. We aimed to investigate the nature of IVF, including clinical assessment and later diagnosis, and risk factors of implantable cardioverter defibrillator (ICD) therapy in the follow-up period.</AbstractText>Between 2007 and 2019 we systematically identified all patients from Rigshospitalet, Denmark, with a resuscitated sudden cardiac arrest (SCA) with no identifiable cause. All patients were followed routinely in the ICD outpatient clinic and the majority also in an inherited heart disease outpatient clinic. Outcomes were analysed with Cox regressions models and cumulative incidence curves.</AbstractText>We identified 84 patients with an initial diagnosis of IVF; of these, three (3.6%) patients were later diagnosed with a cardiac disease. The remaining IVF patients (n = 81, median age 45 years; men 71.6%) were followed a median follow-up of 5.2 years (interquartile range, 2.0-7.6). A total of 24 (29.6%) patients had appropriate ICD therapy and 12 (14.8%) patients had inappropriate ICD therapy. No predominant type of ventricular arrhythmia at first appropriate ICD therapy was observed. Early repolarization at baseline was not associated with an increased risk of appropriate ICD therapy (P = .842). Repeated cardiac arrest at index SCA increased the risk of appropriate ICD therapy (hazard ratio, 2.63 [95% CI, 1.08-6.40; P = .033]).</AbstractText>Most patients remained idiopathic throughout the follow-up period and the overall long-term prognosis of IVF was good. Repeated cardiac arrest at index SCA was a risk factor of appropriate ICD therapy and early repolarization was not associated with an increased risk of appropriate ICD therapy.</AbstractText>© 2020 Wiley Periodicals LLC.</CopyrightInformation> |
15,673 | Asymptomatic ventricular fibrillation in peripartum cardiomyopathy with a left ventricular assist device. | Ventricular fibrillation (VF) is a dangerous ventricular arrhythmia that results in pulselessness and sudden cardiac death. We present a 43-year-old woman with peripartum cardiomyopathy with a left ventricular assist device (LVAD) and recalcitrant right-sided heart failure who presented with unsuccessful defibrillator shocks. The patient was asymptomatic while in persistent VF for over 4 hours. Echocardiography showed the heart to be in asystole. We hypothesize that a combination of chronic right heart failure and LVAD kept her asymptomatic. Patients supported with LVAD can survive prolonged periods with VF. |
15,674 | Catecholaminergic polymorphic ventricular tachycardia complicated by dilated cardiomyopathy: a case report. | Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe genetic arrhythmogenic disorder characterized by adrenergically induced ventricular tachycardia manifesting as stress-induced syncope and sudden cardiac death. While CPVT is not associated with dilated cardiomyopathy (DCM) in most cases, the combination of both disease entities poses a major diagnostic and therapeutic challenge.</AbstractText>We present the case of a young woman with CPVT. The clinical course since childhood was characterized by repetitive episodes of exercise-induced ventricular arrhythmias and a brady-tachy syndrome due to rapid paroxysmal atrial fibrillation and sinus bradycardia. Medical treatment included propranolol and flecainide until echocardiography showed a dilated left ventricle with severely depressed ejection fraction when the patient was 32 years old. Cardiac magnetic resonance imaging revealed non-specific late gadolinium enhancement. Myocardial inflammation, however, was excluded by subsequent endomyocardial biopsy. Genetic analysis confirmed a mutation in the cardiac ryanodine receptor but no pathogenetic variant associated with DCM. Guideline-directed medical therapy for HFrEF was limited due to symptomatic hypotension. Over the next months, the patient developed progressive heart failure symptoms that were finally managed by heart transplantation.</AbstractText>Management in patients with CPVT and DCM is challenging, as Class I antiarrhythmic drugs are not recommended in structural heart disease and prophylactic internal cardioverter-defibrillator implantation without adjuvant antiarrhythmic therapy can be detrimental. Regular echocardiographic screening for DCM is recommendable in patients with CPVT. A multidisciplinary team of heart failure specialists, electrophysiologists, geneticists, and imaging specialists is needed to collaborate in the delivery of clinical care.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,675 | Upgrade of cardiac resynchronization therapy by utilizing additional His-bundle pacing in patients with inotrope-dependent end-stage heart failure: a case series. | His-bundle pacing (HBP) alone may become an alternative to conventional cardiac resynchronization therapy (CRT) utilizing right ventricular apical (RVA) and left ventricular (LV) pacing (BiVRVA+LV</sub>) in selected patients, but the effects of CRT utilizing HBP and LV pacing (BiVHB+LV</sub>) on cardiac resynchronization and heart failure (HF) are unclear.</AbstractText>We presented two patients with inotrope-dependent end-stage HF in whom the upgrade from conventional BiVRVA+LV</sub> to BiVHB+LV</sub> pacing by the addition of a lead for HBP improved their HF status. Patient 1 was a 32-year-old man with lamin A/C cardiomyopathy, atrial fibrillation, and complete atrioventricular (AV) block. Patient 2 was a 70-year-old man with ischaemic cardiomyopathy complicated by AV block and worsening of HF resulting from ablation for ventricular tachycardia storm. The HF status of both patients improved dramatically following the upgrade from BiVRVA+LV</sub> to BiVHB+LV</sub> pacing.</AbstractText>End-stage HF patients suffer from diffuse intraventricular conduction defect not only in the LV but also in the right ventricle (RV). The resulting dyssynchrony may not be sufficiently corrected by conventional BiVRVA+LV</sub> pacing or HBP alone. Right ventricular apical pacing itself may also impair RV synchrony. An upgrade to BiVHB+LV</sub> pacing could be beneficial in patients who become non-responsive to conventional BiV pacing as the His-Purkinje conduction defect progresses.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,676 | Absence of shock therapy related to improper sensing of noise on the defibrillation test during subcutaneous implantable cardioverter-defibrillator implantation: a case report. | Subcutaneous implantable cardioverter-defibrillator (S-ICD) represents an efficient alternative to transvenous ICD in patients who do not require pacing. The intraoperative defibrillation test (DFT) is recommended during S-ICD implantation to confirm appropriate sensing and successful 65-J termination of induced ventricular fibrillation (VF). However, few cases of oversensing of noise inhibiting therapies have been reported.</AbstractText>We report the case of a 50-year-old man who underwent S-ICD implantation for secondary prevention of sudden cardiac death. Immediately after S-ICD implantation, VF was induced using a 50-Hz burst; however, shock was not delivered owing to sustained noise on the electrogram in the primary vector. Therefore, an external rescue shock was needed at 150 J. We changed the sensing vector from primary to secondary and performed a second DFT. The S-ICD could deliver an appropriate shock and was able to successfully terminate VF without noise markers in the secondary vector. During the second DFT, one back-up pacing was delivered after the shock; the sensing vector then automatically switched from the secondary to the alternate vector. However, noise was observed in the alternate vector despite sinus rhythm restoration.</AbstractText>The present case demonstrated that noise was recorded in two different vectors during DFT, possibly supporting the hypothesis that the muscle spasm of the diaphragm induced by the 50-Hz burst causes oversensing of noise by the S-ICD.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,677 | Delayed occurrence of an accelerated idioventricular rhythm with alternating bundle branch block after myocardial infarction as predictor of sudden cardiac arrest: a case report. | Accelerated idioventricular rhythm (AIVR) is known as reperfusion arrhythmia in the setting of acute myocardial infarction (AMI). In healthy individuals, it is usually considered to be benign. Alternating bundle branch block (ABBB) often progresses to complete atrioventricular block requiring permanent pacemaker implantation. We report a case of delayed appearance of AIVR following myocardial infarction (MI) in combination with ABBB as precursor of sudden cardiac arrest due to ventricular fibrillation (VF).</AbstractText>A 62-year-old male with pre-existing left bundle branch block (LBBB) was admitted with an acute non-ST segment elevation MI. He underwent successful percutaneous coronary intervention (PCI) of a subtotal proximal left anterior descending artery (LAD) stenosis. Before and after PCI the electrocardiogram (ECG) demonstrated sinus rhythm with LBBB. The patient was discharged 5 days after PCI, left ventricular function at this time was moderately reduced (ejection fraction of 40%). After another 5 days, the patient was admitted for elective cardiac rehabilitation. At this time, the ECG demonstrated an AIVR with right bundle branch block morphology. Due to ABBB, the patient was scheduled for permanent pacemaker implantation. Before pacemaker implantation could take place, the patient developed a sudden cardiac arrest due to VF and was successfully resuscitated. A follow-up coronary angiography revealed no novel lesions. A cardiac resynchronization therapy defibrillator was implanted for secondary prevention of sudden cardiac death.</AbstractText>Delayed occurrence of AIVR in combination with ABBB following AMI could be a predictor of sudden cardiac death. These patients are probably at high risk for malignant ventricular arrhythmias.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,678 | Evaluation of Index of Cardio-Electrophysiological Balance in Patients With Atrial Fibrillation on Antiarrhythmic-Drug Therapy. | Index of cardio-electrophysiological balance (iCEB) has been described as a novel risk marker for predicting malignant ventricular arrhythmia. There remains limited evidence on the effects of amiodarone and propafenone used for sinus rhythm maintenance on iCEB in patients with atrial fibrillation (AF). The aim of this study was to evaluate iCEB in patients with AF on antiarrhythmic-drug therapy.</AbstractText>A total of 108 patients with AF (68 patients using amiodarone and 40 patients using propafenone) and 50 healthy subjects were included in the study. All groups underwent a standard 12-lead surface electrocardiogram. QRS duration, QT, T wave peak-to-end (Tp-e) intervals, iCEB (QT/QRS) and iCEBc (heart rate-corrected QT (QTc)/QRS) rates were calculated from the electrocardiogram and compared between groups.</AbstractText>QT, Tp-e intervals and Tp-e/QT ratio were significantly longer in the amiodarone group than the propafenone and control groups (P < 0.001, for all). iCEB was similar in the amiodarone and control groups (4.4 ± 0.6 and 4.2 ± 0.4; P > 0.05), while iCEB values in the propafenone group were significantly lower than the amiodarone group and control groups (3.9 ± 0.5; P < 0.001). There was a significantly difference in iCEBc values among the amiodarone, control and propafenone groups (4.8 ± 0.6, 4.6 ± 0.4 and 4.3 ± 0.6; P < 0.001, respectively).</AbstractText>In this study, higher iCEBc parameters were observed in patients using amiodarone, while iCEBc values were lowest among patients with AF using propafenone. Further studies are needed to determine whether these electrophysiological changes are associated with ventricular arrhythmias for patients with AF on antiarrhythmic-drug therapy.</AbstractText>Copyright 2021, Afsin et al.</CopyrightInformation> |
15,679 | Predictors of Mitral Regurgitation Severity Improvement in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation. | Mitral regurgitation (MR) is frequently associated with severe aortic stenosis (AS). Significant MR is associated with less favorable prognosis after transcatheter aortic valve implantation (TAVI), including higher early and late mortality rate. The severity of MR is improved in about half of patients undergoing TAVI. However, the predictors of MR improvement after TAVI are unknown. We sought to investigate whether several demographic, clinical, echocardiographic and laboratory parameters and procedure characteristics are predictive of MR severity improvement after TAVI procedure.</AbstractText>A total of 309 consecutive patients with severe symptomatic AS underwent TAVI procedure in our center from July 1, 2015 till December 31, 2019. The 85 patients had concomitant significant (grade 2 or 3) MR. We performed logistic regression analysis of age, sex, atrial fibrillation, left ventricular ejection fraction, end diastolic diameter, end systolic diameter, left atrial diameter, left atrial area, MR etiology (functional vs. degenerative), CHA2DS2-VASc score, pre-procedure B-type natriuretic peptide (BNP) levels and type of TAVI bioprosthesis as possible predictors of post-TAVI improvement of severity of MR.</AbstractText>The 35 patients have at least one grade reduction in the severity of MR in follow-up echo. None of the analyzed parameters were predicting of the MR severity improvement.</AbstractText>In this small single-center cohort study, we were unable to find any feasible demographic, clinical, echocardiographic or laboratory predictors of MR improvement after TAVI. There was no correlation between etiology of MR or type of TAVI bioprosthesis used and MR improvement.</AbstractText>Copyright 2021, Lubovich et al.</CopyrightInformation> |
15,680 | The comparison of procedural and clinical outcomes of thrombolytic-facilitated and primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction (STEMI): Findings from PROVE/ACS study. | There is still a controversy in the preferred method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI), when the achievement of well-defined "golden time" is difficult. We sought to evaluate the procedural and in-hospital outcomes of the strategy of "thrombolytic administration and rescue or routine percutaneous coronary intervention (PCI)" versus "primary PCI (PPCI)" strategy in acute STEMI.</AbstractText>In this observational prospective study, the data of 237 patients with acute STEMI presented or referred to Chamran Cardiovascular Research Center in Isfahan, Iran, were collected (PROVE/ACS study). Baseline characteristics, thrombolysis in myocardial infarction (TIMI) flow grade of infarct-related artery (IRA), left ventricular ejection fraction (LVEF), and in-hospital outcomes were evaluated.</AbstractText>The mean age of patients was 61.4 ± 13.0 years, 86.9% were men, 13.1% were diabetic, and 67.9% had anterior STEMI. Patients in the "thrombolytic then PCI" group were younger, more smoker, more often male with higher body weight and lower systolic blood pressure (SBP). The pre-PCI TIMI flow grade 3 was more often seen in the "thrombolytic then PCI" group (39.4% vs. 21.0%, P < 0.001) and less thrombectomy was performed in this group of patients (12.9% vs. 26.7%, P = 0.011). Time to reperfusion was significantly longer in PPCI group (182.4 ± 233.7 minutes vs. 44.6 ± 93.4 minutes, respectively, P < 0.001). No difference in mortality, mean of LVEF, and incidence of atrial fibrillation (AF) was observed in two groups.</AbstractText>If the PPCI strategy could not be performed in the golden time, the strategy of thrombolytic administration and rescue or routine PCI leads to more initial IRA patency and less thrombectomy with similar clinical outcomes.</AbstractText>© 2020 Isfahan Cardiovascular Research Center & Isfahan University of Medical Sciences.</CopyrightInformation> |
15,681 | Storm and STEMI: a case report of unexpected cardiac complications of thyrotoxicosis. | Thyroid storm is a rare condition with well-known cardiovascular manifestations including tachycardia, atrial fibrillation, heart failure, and myocardial infarction (MI). Several uncommon conditions that can mimic MI are associated with thyrotoxicosis and discussed in this case.</AbstractText>A 23-year-old previously healthy male presented after the onset of generalized weakness and inability to rise from bed in the setting of 35 kg of unintentional weight loss, and was found to have profound hypokalaemia, elevated thyroid hormone, and suppressed thyroid-stimulating hormone consistent with thyrotoxicosis secondary to Grave's disease. Following hospital admission, he developed worsening tachycardia with dynamic anteroseptal ST-segment elevations and elevated cardiac biomarkers concerning for MI. He was treated with aspirin, ticagrelor, and a heparin infusion, but was unable to tolerate beta-blockade acutely due to hypotension. Echocardiography demonstrated a severely dilated left ventricle (left ventricular end-diastolic volume index 114 mL/m2</sup>) and severely reduced systolic function (ejection fraction 23%) with global hypokinesis. Following initiation of propylthiouracil, iodine solution, and stress-dosed steroids his tachycardia and ST-elevations resolved. Computed tomography (CT) coronary angiography demonstrated no evidence of coronary stenosis. He was discharged on methimazole, metoprolol, and lisinopril and found to have recovered left ventricular systolic function at 2-month follow-up.</AbstractText>Thyrotoxicosis can rarely cause coronary vasospasm, stress cardiomyopathy, and autoimmune myocarditis. These conditions should be suspected in hyperthyroid patients with features of MI and normal coronary arteries. Workup should include laboratory evaluation, electrocardiography (ECG), echocardiography, and non-invasive or invasive ischaemic evaluation.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,682 | Takotsubo syndrome after mitral valve surgery: a case report. | Takotsubo syndrome is a frequent entity; however, it has never been described after a mitral valve surgery.</AbstractText>We present the case of a 79-year-old woman, with background of atrial fibrillation and a left atrial appendage closure device, who was admitted for elective mitral valve replacement, because of asymptomatic severe primary mitral regurgitation. Biologic mitral valve was implanted without incidences, but in the postoperative, she developed cardiogenic shock. Electrocardiogram (ECG) showed inverted T waves in precordial leads and an echocardiography showed severe left ventricular (LV) dysfunction with mid to distal diffuse hypokinesis, and better contractility in basal segments. Troponin levels were mildly elevated. With the suspicion of a postoperative acute coronary syndrome, a coronary angiography was performed and showed no significant coronary lesions. The haemodynamic situation was compromised for the next 48 h, in which vasoactive support and intra-aortic balloon counterpulsation were implemented. After 48 h, the haemodynamic situation suddenly improved. The ECG was normalized, and a control echocardiogram showed partial recovery of the LV function with resolution of regional wall motion abnormalities. The patient could be discharged at 1 week. The clinical picture was interpreted as a stress cardiomyopathy after mitral valve surgery.</AbstractText>Takotsubo syndrome is a threatening condition; complications in acute phase could lead to a fatal outcome. Mitral valve surgery has to be considered as a trigger for this entity, after excluding coronary involvement, specially of left circumflex artery.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,683 | Subcutaneous implantable cardioverter-defibrillator was inappropriate for use in a patient with aborted sudden cardiac death due to coronary spastic angina: a case report. | Implantable cardioverter-defibrillator (ICD) is recommended for secondary prevention in patients with coronary spastic angina and aborted sudden cardiac death. The effectiveness of subcutaneous ICD (S-ICD) for patients with coronary artery spastic angina is controversial.</AbstractText>A 54-year-old man presented with ventricular fibrillation. Emergent coronary angiography showed diffuse narrowing of the coronary arteries that was reversible with isosorbide dinitrate. He was diagnosed with coronary spastic angina. S-ICD was implanted after the administration of a calcium-channel blocker and nicorandil. Seven months after the implantation, he collapsed again due to sinus node dysfunction and atrioventricular block caused by cardiac ischaemia. He developed cardiac arrest at both admissions. Six hours after the admission, electrocardiogram showed transient right bundle branch block. Inappropriate shocks were delivered because of low R-wave amplitude and T-wave oversense. S-ICD was replaced with a transvenous device in order to manage these two arrhythmias and inappropriate shocks.</AbstractText>Patients with coronary artery spasm and aborted sudden cardiac death are candidates for implantation of S-ICD, but there are risks of bradycardia and inappropriate shocks in other ischaemic events.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,684 | Severe multivessel coronary artery spasm detected by computed tomography: a case report. | Ventricular arrhythmia and sudden cardiac arrest caused by multivessel coronary artery spasm (CAS) is rare. Although coronary angiography (CAG) with provocation testing is the diagnostic gold standard in current vasospastic angina guidelines, it can cause severe procedure-related complications. Here, we report a novel technique involving dual-acquisition coronary computed tomography angiography (CCTA) to detect multivessel CAS in a patient who survived out-of-hospital cardiac arrest (OHCA).</AbstractText>A 58-year-old healthy Korean male survived OHCA caused by ventricular fibrillation (VF), experiencing seven episodes of defibrillation and cardiopulmonary resuscitation, and was referred to the Emergency Room. Vital signs were stable and physical examination, electrocardiogram, chest, and brain CT did not show any abnormal findings, except elevated hs-Troponin I levels (0.1146 ng/mL). Echocardiogram revealed a regional wall motion abnormality in the inferior wall, with a low normal left ventricular ejection fraction (50%). A multivessel CAS (both left and right) was detected using a dual-acquisition CCTA technique (presence and absence of intravenous nitrate). During CAG with the 2nd</sup> injection of ergonovine, a prolonged and refractory total occlusion in the proximal-ostial right coronary artery was completely relieved after a seven-cycle intracoronary injection regimen of nitroglycerine. The patient was discharged with the recommendation of smoking and alcohol cessation. Nitrate and calcium channel blockers were also prescribed. The patient had no further events at 3 months of follow-up after discharge.</AbstractText>Dual-acquisition CCTA is a promising tool to detect multivessel CAS.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,685 | The de Winter's pattern revisited: a case series. | The de Winter's electrocardiogram (ECG) pattern signifying proximal left anterior descending (LAD) artery occlusion was first described in 2008. The ECG changes were thought to be static and mechanisms for this were suggested. In addition, the optimal management of these patients was reported to be via a primary percutaneous coronary intervention (PCI) strategy.</AbstractText>Case 1</i>: A 48-year-old gentleman presented with a 2-h history of ischaemic chest pain with initial de Winter's pattern on ECG. This progressed to anterior ST-elevation myocardial infarction (STEMI) complicated by ventricular fibrillation. Emergency angiography revealed a mid-vessel LAD occlusion which was successfully reperfused. Case 2</i>: A 34-year-old female presented with a 2-h history of ischaemic chest pain with initial ECG showing a de Winter's pattern. Due to concerns of performing PCI timeously, a pharmacoinvasive strategy of reperfusion was adopted with resolution of the de Winter's pattern. Urgent angiography revealed a proximal LAD lesion which was successfully stented.</AbstractText>The two cases highlight that the de Winter's pattern may in fact not be static, but rather lie along the continuum of ischaemia and may evolve into STEMI. In addition, we provide further evidence that if primary PCI cannot be offered in a timeous manner, thrombolytic therapy may be considered in such patients. The de Winter's pattern remains a high-risk ECG pattern that requires early recognition and intervention.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,686 | Cannabis induced cardiac arrhythmias: a case series. | Cannabis use is known to be associated with significant cardiovascular morbidity. We describe three cases of cannabis-related malignant arrhythmias, who presented to the cardiac department at our institution within the last 2 years. All three patients were known to smoke cannabis on daily basis.</AbstractText>Case 1: A 30-year-old male, presented with recent onset of palpitations. A 12-lead electrocardiogram (ECG), transthoracic echocardiogram (TTE), and blood tests were all normal. During an inpatient exercise treadmill test (ETT) he developed polymorphic ventricular tachycardia (VT), which converted spontaneously to supraventricular tachycardia (SVT) in the recovery phase of the test. Subsequent risk stratification with cardiac magnetic resonance imaging and coronary angiography showed no abnormalities and an electrophysiological study was negative for sustained VT, however, SVT was easily induced with rapid conversion to atrial fibrillation. The patient successfully stopped smoking all tobacco products including cannabis and was treated with beta-blockers, with no further episodes of arrhythmia. Case 2: A 30-year-old male presented to the Emergency Department with palpitations, chest pain, and dizziness that improved during exertion. His initial ECG demonstrated complete atrioventricular block (AVB). Subsequent traces showed Mobitz Type I and second-degree AVB, which converted to atrial flutter after exertion. Routine blood tests, TTE, and an ETT were all normal and he was discharged home with no conduction abnormalities. Case 3: A 24-year-old male presented with two episodes of syncope. Baseline examination was normal, with an ECG showing a low atrial rhythm. Interrogation of his implantable loop recorder showed episodes of early morning bradycardia episodes with no associated symptoms.</AbstractText>Cannabis-related arrhythmia can be multiform regarding their presentation. Therefore, ambiguous combinations of arrhythmia should raise suspicion of underlying cannabis abuse, where clinically appropriate. Although causality with regards to cannabis use cannot be proven definitively in these cases, the temporal relationship between drug use and the onset of symptoms suggests a strong association.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,687 | Myocardial infarction and ventricular fibrillation due to iatrogenic right coronary artery occlusion following tricuspid valve annuloplasty: a case report. | Iatrogenic right coronary artery (RCA) injury is a rare complication of tricuspid valve annuloplasty. Given that surgical intervention is increasingly favoured for tricuspid regurgitation, it is of great importance to recognize potential complications following tricuspid valve surgery.</AbstractText>A 72-year-old man underwent surgical mitral and tricuspid valve repair. The early post-operative course was complicated by recurrent ventricular fibrillation episodes. Due to haemodynamic instability, a re-sternotomy and another cardiopulmonary bypass run were required. The patient subsequently underwent coronary angiography study which confirmed RCA occlusion. The occluded posterior left ventricular (PLV) branch was reopened by balloon angioplasty. However, despite multiple attempts it was not possible to pass a coronary guide wire into the posterior descending artery (PDA). An intravascular ultrasound examination revealed that the ostium of the PDA was compressed by external factors leaving a narrow slit-like appearance with no accessible lumen. Subsequently, a drug-eluting stent was placed into the PLV branch. The PDA was not accessible on repeated re-canalization attempts. The patient later successfully recovered from the right ventricular myocardial infarction.</AbstractText>Right coronary artery occlusion should be considered as a differential diagnosis for significant rhythm disturbances and haemodynamic instability in the peri- and post-operative period following tricuspid valve annuloplasty. A low threshold for diagnostic angiography is needed to avoid potential delay in life-saving revascularization.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,688 | The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation: Program description, performance, and outcomes. | We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA).</AbstractText>This observational cohort study analyzed consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium's ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18-75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS™), and 5) estimated transfer time of < 30 min. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included 3-month functionally favorable survival, program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit.</AbstractText>From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31-56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2.</AbstractText>This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months, as well as safety. The program provides a potential model of this approach for other communities.</AbstractText>The Helmsley Charitable Trust.</AbstractText>© 2020 The Authors.</CopyrightInformation> |
15,689 | Can We Predict Good Survival Outcomes by Classifying Initial and Re-Arrest Rhythm Change Patterns in Out-of-Hospital Cardiac Arrest Settings? | Objective The purpose of this study was to investigate whether a change in prehospital arrest rhythms could allow medical personnel to predict survival outcomes in patients who achieved a return of spontaneous circulation (ROSC) in the setting of out-of-hospital cardiac arrest (OHCA). Methods The design of this study was retrospective, multi-regional, observational, and cross-sectional with a determining period between August 2015 and July 2016. Cardiac arrest rhythms were defined as a shockable rhythm (S), which refers to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), and non-shockable rhythm (NS), which refers to pulseless electrical activity or asystole. Survival to admission, survival to discharge, and good cerebral performance category (CPC) (CPC 1 or 2) were defined as good survival outcomes. Results A total of 163 subjects were classified into four groups according to the rhythm change pattern: NS→NS (98), S→S (27), S→NS (23), and NS→S (15). NS→NS pattern was used as the reference in logistic regression analysis. In the case of survival to hospital admission, the odds ratio (OR) (95% CI) of the S→S pattern was the highest [12.63 (3.56-44.85), p: <0.001 by no correction] and [7.29 (1.96-27.10), p = 0.003 with adjusting]. In the case of survival to hospital discharge, the OR (95% CI) of the S→S pattern was the highest [37.14 (11.71-117.78), p: <0.001 by no correction] and [13.85 (3.69-51.97), p: <0.001 with adjusting]. In the case of good CPC (CPC 1 or 2) at discharge, the OR (95% CI) of the S→S pattern was the highest [96 (19.14-481.60), p: <0.001 by no correction] and [149.69 (19.51-1148.48), p: <0.001 with adjusting]. Conclusions The S→S group showed the highest correlation with survival to hospital admission, survival to hospital discharge, and good CPC (CPC 1 or 2) at discharge compared to the NS→NS group. Verifying changes in initial cardiac arrest rhythm and prehospital re-arrest (RA) rhythm patterns after prehospital ROSC can help us predict good survival outcomes in the OHCA setting. |
15,690 | Cardiac MRI to Manage Atrial Fibrillation. | AF is the most common arrhythmia in clinical practice. In addition to the severe effect on quality of life, patients with AF are at higher risk of stroke and mortality. Recent studies have suggested that atrial and ventricular substrate play a major role in the development and maintenance of AF. Cardiac MRI has emerged as a viable tool for interrogating the underlying substrate in AF patients. Its advantage includes localisation and quantification of structural remodelling. Cardiac MRI of the atrial substrate is not only a tool for management and treatment of arrhythmia, but also to individualise the prevention of stroke and major cardiovascular events. This article provides an overview of atrial imaging using cardiac MRI and its clinical implications in the AF population. |
15,691 | Sudden Cardiac Death Risk Stratification and Prevention in Chagas Disease: A Non-systematic Review of the Literature. | Chagas disease is an important public health problem in Latin America. However, migration and globalisation have resulted in the increased presence of Chagas disease worldwide. Sudden cardiac death is the leading cause of death in people with Chagas disease, most often due to ventricular fibrillation. Although more common in patients with documented ventricular arrhythmias, sudden cardiac death can also be the first manifestation of Chagas disease in patients with no previous symptoms or known heart failure. Major predictors of sudden cardiac death include cardiac arrest, sustained and non-sustained ventricular tachycardia, left ventricular dysfunction, syncope and bradycardia. The authors review the predictors and risk stratification score developed by Rassi et al. for death in Chagas heart disease. They also discuss the evidence for anti-arrhythmic drugs, catheter ablation, ICDs and pacemakers for the prevention of sudden cardiac death in these patients. Given the widespread global burden, understanding the risk stratification and prevention of sudden cardiac death in Chagas disease is of timely concern. |
15,692 | Iatrogenic ventricular fibrillation caused by inappropriately synchronized cardioversion in a patient with pre-excited atrial fibrillation: A case report. | Direct-current (DC) cardioversion is effective at terminating arrhythmias in an emergency. During treatment, energy delivery synchronizing with the QRS complex is essential to avoid ventricular fibrillation (VF) caused by a shock on the T wave, which is the vulnerable period of ventricular repolarization. However, distinguishing the QRS from the T wave is difficult in some patients with abnormal, irregular, and varying QRS complexes. We report the case of a 45-year-old man who had iatrogenic VF caused by inappropriate synchronization with the T wave during cardioversion of pre-excited atrial fibrillation due to high ventricular rates and varying R wave amplitude affected by an accessory pathway. <<b>Learning objective:</b> During direct-current cardioversion, energy delivery synchronizing with the QRS complex is essential to avoid ventricular fibrillation (VF) caused by a shock on the T wave. However, distinguishing the QRS from the T wave is difficult in some patients with abnormal, irregular, and varying QRS complexes. We report a case of iatrogenic VF caused by failed synchronization with the R wave in a patient with pre-excited atrial fibrillation (AF). Clinicians managing pre-excited AF should be aware of the possibility of iatrogenic VF triggered by cardioversion.>. |
15,693 | A conservative screening algorithm to determine candidacy for robotic mitral valve surgery. | Patient selection for robotically assisted mitral valve repair remains controversial. We assessed outcomes of a conservative screening algorithm developed to select patients with degenerative mitral valve disease for robotic surgery.</AbstractText>From January 2014 to January 2019, a screening algorithm that included transthoracic echocardiography and computed tomography scanning was rigorously applied by 3 surgeons to assess candidacy of 1000 consecutive patients with isolated degenerative mitral valve disease (age 58 ± 11 years, 67% male) for robotic surgery. Screening results and hospital outcomes of those selected for robotic versus sternotomy approaches were compared.</AbstractText>With application of the screening algorithm, 605 patients were selected for robotic surgery. Common reasons for sternotomy (n = 395) were aortoiliac atherosclerosis (n = 74/292, 25%), femoral artery diameter <7 mm (n = 60/292, 20%), mitral annular calcification (n = 83/390, 21%), aortic regurgitation (n = 100/391, 26%), and reduced left ventricular function (n = 126/391, 32%). Mitral valve repair was accomplished in 996. Compared with sternotomy, patients undergoing robotic surgery had less new-onset atrial fibrillation (n = 144/582, 25% vs n = 125/373, 34%; P = .002), fewer red blood cell transfusions (n = 61/601, 10% vs 69/395, 17%; P < .001), and shorter hospital stay (5.2 ± 2.9 days vs 5.9 ± 2.1 days; P < .001). No hospital deaths occurred, and occurrence of postoperative stroke in the robotic (n = 3/605, 0.50%) and sternotomy (n = 4/395, 1.0%; P = .3) groups was similar.</AbstractText>This conservative screening algorithm qualified 60% of patients with isolated degenerative mitral valve disease for robotic surgery. Outcomes were comparable with those obtained with sternotomy, validating this as an approach to select patients for robotic mitral valve surgery.</AbstractText>Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
15,694 | Mapping catheter-related mitral valve injury: a case report. | An increasing number of catheter ablations are performed for symptomatic tachyarrhythmias and commonly involve the left atrium, increasing the risk of catheter interaction with the mitral valve (MV) complex. Mitral valve trauma at the time of atrial fibrillation (AF) ablations remains a rare yet emergent situation that requires prompt diagnosis and management to prevent the long-term sequelae of heart failure secondary to MV dysfunction.</AbstractText>We present a case of a 69-year-old female with symptomatic paroxysmal AF and atrial flutter who underwent a combined ablation procedure. During the pulmonary vein isolation procedure, the mapping catheter became entangled within the MV apparatus but was freed. She presented to our hospital 2 weeks later with dyspnoea, lethargy, and a cough. Clinical examination revealed a pansystolic murmur and right moderate pleural effusion. Transthoracic echocardiogram (TTE) demonstrated a flail posterior MV leaflet with severe eccentric mitral regurgitation (MR). She underwent urgent valve repair at the regional cardiothoracic centre. Upon review 2 months later, she was symptom free with surveillance TTE demonstrating a preserved left ventricular systolic function with a trace of MR.</AbstractText>Mitral valve injury secondary to catheter entrapment at the time of left-sided ablations is a rare yet serious complication and can present as an emergent situation requiring prompt recognition and early surgical management to salvage valve and cardiac function.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
15,695 | A Systematic Review of the Incidence of Arrhythmias in Hemodialysis Patients Undergoing Long-Term Monitoring With Implantable Loop Recorders. | Establishing the frequency and nature of arrhythmias in hemodialysis (HD) is an important step in improving outcomes of these patients. We undertook this systematic review and meta-analysis to characterize arrhythmia frequency in maintenance HD patients.</AbstractText>We identified studies on arrhythmias in adult patients on maintenance HD detected via implantable loop recorders (ILRs). Studies included were in English and reported ILR-detected arrhythmia incidence in HD patients. Data were extracted by one author using electronic spreadsheets and verified by a second author. Random effects models were used for pooled inferences. The I</i> 2</sup> statistic was used to quantify heterogeneity.</AbstractText>Five studies qualified for inclusion (317 patients). The overall estimates for the annualized rate of death and sudden cardiac death (SCD) was 0.14 (95% confidence interval [CI]: 0.11-0.18) and 0.06 (95% CI: 0.03-0.10), respectively. Across all 5 studies, the combined annualized rate of patients experiencing at least 1 bradycardia/asystole event was 0.19 (95% CI: 0.11-0.33) but heterogeneity was high (I</i> 2</sup> = 79.8%). The average annualized rate of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes (0.02, 95% CI: 0.01-0.05) was significantly lower (P</i> < 0.001) than the rate of bradycardia/asystole reported in the same patients. Incidence of atrial fibrillation (AF) varied significantly across the studies (from 0.07 to 0.83 patients per year) reflecting variable definitions (new-onset vs. total number of episodes).</AbstractText>The incidence of arrhythmias among chronic HD patients is high, with bradycardia/asystole occurring more frequently than ventricular arrhythmias. Additional studies to refine estimates particularly of AF are needed.</AbstractText>© 2020 International Society of Nephrology. Published by Elsevier Inc.</CopyrightInformation> |
15,696 | Explainable artificial intelligence for heart rate variability in ECG signal. | Electrocardiogram (ECG) signal is one of the most reliable methods to analyse the cardiovascular system. In the literature, there are different deep learning architectures proposed to detect various types of tachycardia diseases, such as atrial fibrillation, ventricular fibrillation, and sinus tachycardia. Even though all types of tachycardia diseases have fast beat rhythm as the common characteristic feature, existing deep learning architectures are trained with the corresponding disease-specific features. Most of the proposed works lack the interpretation and understanding of the results obtained. Hence, the objective of this letter is to explore the features learned by the deep learning models. For the detection of the different types of tachycardia diseases, the authors used a transfer learning approach. In this method, the model is trained with one of the tachycardia diseases called atrial fibrillation and tested with other tachycardia diseases, such as ventricular fibrillation and sinus tachycardia. The analysis was done using different deep learning models, such as RNN, LSTM, GRU, CNN, and RSCNN. RNN achieved an accuracy of 96.47% for atrial fibrillation data set, 90.88% accuracy for CU-ventricular tachycardia data set, and also achieved an accuracy of 94.71, and 94.18% for MIT-BIH malignant ventricular ectopy database for ECG lead I and lead II, respectively. The RNN model could only achieve an accuracy of 23.73% for the sinus tachycardia data set. A similar trend is shown by other models. From the analysis, it was evident that even though tachycardia diseases have fast beat rhythm as their common feature, the model was not able to detect different types of tachycardia diseases. The deep learning model could only detect atrial fibrillation and ventricular fibrillation and failed in the case of sinus tachycardia. From the analysis, they were able to interpret that, along with the fast beat rhythm, the model has learned the absence of P-wave which is a common feature for ventricular fibrillation and atrial fibrillation but sinus tachycardia disease has an upright positive P-wave. The time-based analysis is conducted to find the time complexity of the models. The analysis conveyed that RNN and RSCNN models could achieve better performance with lesser time complexity. |
15,697 | Effects of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker on one-year outcomes of patients with atrial fibrillation: insights from a multicenter registry study in China. | To evaluate the effect of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) therapy on the prognosis of patients with atrial fibrillation (AF).</AbstractText>A total of 1, 991 AF patients from the AF registry were divided into two groups according to whether they were treated with ACEI/ARB at recruitment. Baseline characteristics were carefully collected and analyzed. Logistic regression was utilized to identify the predictors of ACEI/ARB therapy. The primary endpoint was all-cause mortality, while the secondary endpoints included cardiovascular mortality, stroke and major adverse events (MAEs) during the one-year follow-up period. Univariable and multivariable Cox regression were performed to identify the association between ACEI/ARB therapy and the one-year outcomes.</AbstractText>In total, 759 AF patients (38.1%) were treated with ACEI/ARB. Compared with AF patients without ACEI/ARB therapy, patients treated with ACEI/ARB tended to be older and had a higher rate of permanent AF, hypertension, diabetes mellitus, heart failure (HF), left ventricular ejection fraction (LVEF) < 40%, coronary artery disease (CAD), prior myocardial infarction (MI), left ventricular hypertrophy, tobacco use and concomitant medications (all P</i> < 0.05). Hypertension, HF, LVEF < 40%, CAD, prior MI and tobacco use were determined to be predictors of ACEI/ARB treatment. Multivariable analysis showed that ACEI/ARB therapy was associated with a significantly lower risk of one-year all-cause mortality [hazard ratio (HR) (95% CI): 0.682 (0.527-0.882), P</i> = 0.003], cardiovascular mortality [HR (95% CI): 0.713 (0.514-0.988), P</i> = 0.042] and MAEs [HR (95% CI): 0.698 (0.568-0.859), P</i> = 0.001]. The association between ACEI/ARB therapy and reduced mortality was consistent in the subgroup analysis.</AbstractText>In patients with AF, ACEI/ARB was related to significantly reduced one-year all-cause mortality, cardiovascular mortality and MAEs despite the high burden of cardiovascular comorbidities.</AbstractText>Copyright and License information: Journal of Geriatric Cardiology 2020.</CopyrightInformation> |
15,698 | Transcriptomic Bioinformatic Analyses of Atria Uncover Involvement of Pathways Related to Strain and Post-translational Modification of Collagen in Increased Atrial Fibrillation Vulnerability in Intensely Exercised Mice. | Atrial Fibrillation (AF) is the most common supraventricular tachyarrhythmia that is typically associated with cardiovascular disease (CVD) and poor cardiovascular health. Paradoxically, endurance athletes are also at risk for AF. While it is well-established that persistent AF is associated with atrial fibrosis, hypertrophy and inflammation, intensely exercised mice showed similar adverse atrial changes and increased AF vulnerability, which required tumor necrosis factor (TNF) signaling, even though ventricular structure and function improved. To identify some of the molecular factors underlying the chamber-specific and TNF-dependent atrial changes induced by exercise, we performed transcriptome analyses of hearts from wild-type and TNF-knockout mice following exercise for 2 days, 2 or 6 weeks of exercise. Consistent with the central role of atrial stretch arising from elevated venous pressure in AF promotion, all 3 time points were associated with differential regulation of genes in atria linked to mechanosensing (focal adhesion kinase, integrins and cell-cell communications), extracellular matrix (ECM) and TNF pathways, with TNF appearing to play a permissive, rather than causal, role in gene changes. Importantly, mechanosensing/ECM genes were only enriched, along with tubulin- and hypertrophy-related genes after 2 days of exercise while being downregulated at 2 and 6 weeks, suggesting that early reactive strain-dependent remodeling with exercise yields to compensatory adjustments. Moreover, at the later time points, there was also downregulation of both collagen genes and genes involved in collagen turnover, a pattern mirroring aging-related fibrosis. By comparison, twofold fewer genes were differentially regulated in ventricles vs. atria, independently of TNF. Our findings reveal that exercise promotes TNF-dependent atrial transcriptome remodeling of ECM/mechanosensing pathways, consistent with increased preload and atrial stretch seen with exercise. We propose that similar preload-dependent mechanisms are responsible for atrial changes and AF in both CVD patients and athletes. |
15,699 | J waves induced during coronary angiography in patients with vasospastic angina and its implication. | J waves may develop during coronary angiography (CAG).</AbstractText>Seven patients (61±6 years, 6 male) had vasospastic angina. ST-segment elevation and ventricular fibrillation were documented in all patients. CAG revealed normal arteries, but slurring or notching (J waves) with an amplitude of 0.20±0.06 mV appeared for the first time (n=6) or in an augmented manner (n=1) with distinct alterations in QRS morphology when contrast medium was injected into the right coronary artery.</AbstractText>In patients with vasospastic angina, J waves observed during CAG can be a manifestation of a local conduction delay caused by contrast medium-induced myocardial ischemia.</AbstractText>Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInformation> |
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