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16,700 | Sex Disparities in the Choice of Cardiac Resynchronization Therapy Device: An Analysis of Trends, Predictors, and Outcomes. | There is limited evidence on the influence of sex on the decision to implant a cardiac resynchronization therapy device with pacemaker (CRT-P) or defibrillator (CRT-D) and the existence of sex-dependent differences in complications that may affect this decision.</AbstractText>All patients undergoing de novo CRT implantation (2004-2014) in the United States National Inpatient Sample were included and stratified by device type (CRT-P and CRT-D). Multivariable logistic regression models were conducted to assess the association of female sex with receipt of CRT-D and periprocedural complications.</AbstractText>Out of 400,823 weighted CRT procedural records, the overall percentages of women undergoing CRT-P and CRT-D implantations were 41.5% and 27.8%, respectively, and these percentages increased compared with men over the study period. Women were less likely to receive CRT-D (odds ratio 0.66, 95% confidence interval 0.64-0.67), and this trend remained stable throughout the study period (P = 0.06). Furthermore, compared with men, women were associated with increased odds of procedure-related complications (bleeding, thoracic, and cardiac) in the CRT-D group but not in the CRT-P group. Factors such as atrial fibrillation, malignancies, renal failure, advanced age (> 60 years), and admission to nonurban/small hospitals favoured the receipt of CRT-P over CRT-D, whereas history of ischemic heart disease, cardiac arrest ,or ventricular arrhythmias favoured the receipt of CRT-D over CRT-P.</AbstractText>Women were associated with persistently reduced odds of receipt of CRT-D compared with men over an 11-year period. This study identifies important factors that predict the choice of CRT device offered to patients in the United States.</AbstractText>Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,701 | Omentin-1 is associated with atrial fibrillation in patients with cardiac valve disease. | Epicardial adipose tissue (EAT) remodeling and adipocytokines are associated with structural remodeling in atrial fibrillation (AF). However, the role of omentin-1, a novel adipocytokine, in structural remodeling remains unknown.</AbstractText>Hematoxylin and eosin (H&E) and Masson's trichrome stains were used to investigate the histology of EAT and right atrial appendages. The expression levels of adipocytokines in these human samples were determined by immunohistochemical assay and western blotting. Models of transforming growth factor (TGF)-β1-induced activation of cardiac fibroblasts (CFs) and TGF-β1-induced endothelial-mesenchymal transition (EndMT) of human umbilical vein endothelial cell (HUVEC) were established to explore roles of omentin-1 in these processes. To determine changes in adipocytokines secretion under hypoxia conditions, adipocytes were treated with 5% O2</sub> and 95% N2</sub>, and then CFs and HUVECs were co-cultured with the conditioned medium of adipocytes to determine the effects of hypoxia-treated adipocytes on these cells.</AbstractText>Expression of omentin-1 was downregulated in the EAT and right atrial appendages from patients with AF compared to samples from patients without AF, while the TGF-β1 level was upregulated in EAT from patients with AF. EAT from patients with AF exhibited adipocyte hypertrophy and severe interstitial fibrosis. Omentin-1 inhibited TGF-β1-induced CF activation and reversed TGF-β1-induced HUVEC EndMT. Adipocytes treated with hypoxia exhibited downregulation of omentin-1 and partly activated CFs.</AbstractText>This study demonstrated that omentin-1 was an antifibrotic adipocytokine and was downregulated in patients with AF, which was partly mediated by hypoxia.</AbstractText> |
16,702 | [Control of ventricular rate in permanent atrial fibrillation: cardio-protec-tion and tissue hemodynamics]. | Objective To evaluate myocardial injury and tissue hemodynamics in elderly patients with permanent atrial fibrillation (AF) based on the achieved range of ventricular contraction rate (VCR).Materials and Methods This prospective, randomized, blind study included 75 patients aged ≥60 with permanent AF. All patients were prescribed bisoprolol as a VCR-reducing therapy. Patients were randomized to two groups according to the permuted-block design based on the range of resting VCR goal: group 1, 60-79 bpm (n=38) and group 2, 80-100 bpm (n=37). All patients also received perindopril and apixaban. Troponin I concentration was measured using the high-sensitivity assay (hsTn); parameters of tissue hemodynamics, including the mean blood flow velocity (Vm) and pulsatility index (PI), were measured using high-frequency ultrasound doppler flowmetry; echocardiographic indexes of left heart remodeling were recorded at baseline and after 6 month of VCR monitoring.Results Mean age of patients was 74±7 years. Medians [25th percentile; 75th percentile] of baseline hsTn concentrations were 10.2 [5.25; 21.2] ng / l in group 1 and 10.3 [5.4; 20.4] ng / ml in group 2 (p=0.91). 89.5 % of patients in group 1 and 100 % of patients in group 2 achieved the VCR range goal. At 6 month, resting VCRs were 70±4 bpm in group 1 (n=34) and 88±5 bpm in group 2 (n=37) (p1, p2&lt;0.001). According to echocardiographic data significant progression of myocardial remodeling was not observed. Concentrations of hsTn significantly decreased in both groups but the decrease was more pronounced in group 1, to 8.0 [4.13; 17.23; p1&lt;0.001] ng / l vs. 9.2 [4.8, 17.5] ng / l in group 2 (р1, p2&lt;0.001). A weak direct correlation was found between the VCR decrease and hsTn concentration (rs=0.44; p=0.009 in group 1, and rs=0.41; p=0.01 in group 2); regression coefficient was 0.78 at 95 % confidence interval (CI), from 0.21 to 1.3 (p=0.009) in group 1, and 0.14 at 95 % CI, from 0.04 to 0.24 (p=0.007) in group 2. Vm values were increased to 2.93±0.10 (p&lt;0.001) and 3.21±0.09 cm / sec (p&lt;0.001) and PIs were decreased to 1.42±0.03 conv. units (p&lt;0.01) and to 1.34±0.02 conv. units (p&lt;0.001) in groups 1 and 2, respectively.Conclusion The treatment aimed at VCR control in patients older than 60 with permanent AF was associated with a positive dynamics of myocardial injury (hsTn) and tissue hemodynamics indexes (Vm и РI). This indicates a possibility for using these indexes for further improvement of managing such patients. |
16,703 | Efficacy of combined estrogen-progestin hormone contraception therapy for refractory coronary spastic angina in very young women. | Coronary spastic angina (CSA) in premenopausal women is rare, but has also been suggested to be associated with estrogen decline during the menstrual cycle. In this report, we describe the case of a young premenopausal patient with refractory CSA. She presented with ventricular fibrillation (VF) at the age of 15 years and was diagnosed as having CSA. She underwent implantation of an Implantable Cardioverter Defibrillator (ICD), and despite receiving systemic drug therapy at the maximum doses, she experienced a total of four appropriate ICD shocks over the subsequent six years. Based on careful history-taking, it was suspected that the angina episodes were closely related to the phase of the menstrual cycle. We started the patient on continuous combined estrogen-progestin hormone contraception therapy so as to prevent the reduction of the blood estrogen levels just prior to and during menstruation. After the start of this treatment, the patient became completely free of angina episodes. Although there are a few reports of the efficacy of hormone replacement therapy in premenopausal women with CSA, this is the first report of the efficacy of this therapy in a woman as young as 22 years old. <<b>Learning objective:</b> There are a few reports of episodes of CSA occurring in relation to the phase of the menstrual cycle in premenopausal women. It is considered to be associated with decline of the blood estrogen levels and combined estrogen plus progestin contraception therapy may be effective in such cases.>. |
16,704 | Understanding tricuspid valve remodelling in atrial fibrillation using three-dimensional echocardiography. | Atrial fibrillation (AF) has been associated with tricuspid annulus (TA) dilation in patients with severe functional tricuspid regurgitation (TR); however, the impact of AF is less clear in patients without severe TR. Our aim was to characterize TA remodelling in patients with AF in the absence of severe TR using 3D transoesophageal echocardiography (TOE).</AbstractText>Ninety patients underwent clinically indicated transthoracic and TOE: non-structural (NS)-AF (n = 30); AF with left heart disease (LHD) (n = 30), and controls in sinus rhythm (n = 30). Three-dimensional TOE datasets were analysed to measure TA dimensions using novel dedicated tricuspid valve software. The NS-AF group showed biatrial dilatation and normal right ventricular (RV) size with decreased longitudinal function compared to controls, whereas the LHD-AF group showed biatrial dilatation, RV enlargement, decreased biventricular function, and higher systolic pulmonary artery pressure compared with the other groups. Indexed TA area, minimum diameter, maximum diameter, and total perimeter were significantly larger in the NS-AF group than in controls (measurements in end-diastole: 6.4 ± 1.1 vs. 5.0 ± 0.6 cm2/m2, 1.8 ± 0.3 vs. 1.6 ± 0.2 cm/m2, 2.1 ± 0.3 vs. 1.9 ± 0.2 cm/m2, and 6.6 ± 0.9 vs. 5.9 ± 0.7 cm/m2, respectively, all P < 0.05). There was no significant difference in any indexed TA parameter between AF groups. TA circularity index (ratio between minimum and maximal diameters) and TA fractional area change between end-diastole and end-systole were no different among the three groups.</AbstractText>AF is associated with right atrial and tricuspid annular remodelling independent of the presence of LHD in patients with intrinsically normal tricuspid leaflets without severe TR.</AbstractText>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.</CopyrightInformation> |
16,705 | The polygenic architecture of left ventricular mass mirrors the clinical epidemiology. | Left ventricular (LV) mass is a prognostic biomarker for incident heart disease and all-cause mortality. Large-scale genome-wide association studies have identified few SNPs associated with LV mass. We hypothesized that a polygenic discovery approach using LV mass measurements made in a clinical population would identify risk factors and diseases associated with adverse LV remodeling. We developed a polygenic single nucleotide polymorphism-based predictor of LV mass in 7,601 individuals with LV mass measurements made during routine clinical care. We tested for associations between this predictor and 894 clinical diagnoses measured in 58,838 unrelated genotyped individuals. There were 29 clinical phenotypes associated with the LV mass genetic predictor at FDR q < 0.05. Genetically predicted higher LV mass was associated with modifiable cardiac risk factors, diagnoses related to organ dysfunction and conditions associated with abnormal cardiac structure including heart failure and atrial fibrillation. Secondary analyses using polygenic predictors confirmed a significant association between higher LV mass and body mass index and, in men, associations with coronary atherosclerosis and systolic blood pressure. In summary, these analyses show that LV mass-associated genetic variability associates with diagnoses of cardiac diseases and with modifiable risk factors which contribute to these diseases. |
16,706 | Association of arterial stiffness with left atrial structure and phasic function: a community-based cohort study. | Increased arterial stiffness is currently recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort.</AbstractText>We included 1156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by cardio-ankle vascular index (CAVI). Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit, and pump strain as well as left ventricular global longitudinal strain (LVGLS).</AbstractText>CAVI was negatively correlated with reservoir and conduit strain (r = -0.37 and -0.45, both P < 0.001), whereas weakly, but positively correlated with LA volume index and pump strain (r = 0.12 and 0.09, both P < 0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors and LV morphology and function including LVGLS (standardized β = -0.22 and -0.27, respectively, both P < 0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir and conduit strain (adjusted odds ratio = 2.61 and 3.73 vs. normal CAVI, both P < 0.01) in a fully adjusted model including laboratory and echocardiographic parameters.</AbstractText>Arterial stiffness was independently associated with LA phasic function, even in the absence of overt cardiovascular disease, which may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.</AbstractText> |
16,707 | The prognostic importance of right ventricular remodeling and the circadian blood pressure pattern on the long-term cardiovascular outcome. | We sought to investigate the predictive value of right ventricular (RV) remodeling and 24-h blood pressure (BP) patterns on long-term cardiovascular prognosis in the initially untreated hypertensive patients.</AbstractText>The current study included 505 initially untreated hypertensive patients who were consequently included in this study from 2007 to 2012. All the patients underwent laboratory analysis, 24-h BP monitoring and echocardiographic examination at baseline. The patients were followed for a median period of 9 years. The adverse outcome was defined as the hospitalization due to cardiovascular events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or cardiovascular death).</AbstractText>During the 9-year follow-up period adverse cardiovascular events occurred in 82 hypertensive patients. Night-time SBP, the nondipping BP pattern, left ventricle hypertrophy, RV hypertrophy, right atrial enlargement, RV diastolic dysfunction, and RV systolic dysfunction were associated with adverse cardiovascular events. Nevertheless, night-time SBP, the nondipping BP pattern, mitral E/e', left ventricle hypertrophy, and RV hypertrophy were the only independent predictors of cardiovascular events. When all four BP patterns were included in the model, only the reverse dipping BP pattern was an independent predictor of cardiovascular events.</AbstractText>The present investigation showed that RV hypertrophy and the reverse dipping BP pattern were independent long-term predictors of the cardiovascular outcome. Detailed echocardiographic evaluation and 24-h ambulatory blood pressure monitoring should be performed even in low-risk hypertensive patients.</AbstractText> |
16,708 | [Risk factors for recurrent hospitalizations of patients with atrial fibrillation]. | <b>Objective:</b> To determine the predictors of recurrent hospitalizations among atrial fibrillation (AF) patients. <b>Methods:</b> We analyzed data from the Chinese Atrial Fibrillation Registry (CAFR), a prospective cohort study involving non-valvular atrial fibrillation (NVAF) patients from Augest 2011 to December 2017. A total of 5 349 NVAF patients with a minimum of 48 months follow-up were included for analysis. Data including patient demographics, complications, medical and ablation history were collected. The maximum number of all-cause hospitalizations within one-year for each patient served as the primary endpoint. Patients hospitalized less than twice within one-year were defined as non-recurrent hospitalizations group, those hospitalized at least twice within one-year were definned as recurrent hospitalizations group. Logistic regression model was used to identify associated risk factors for recurrent hospitalizations. <b>Results:</b> Of 5 349 NVAF patients, those hospitalized for 0, 1, 2, 3, 4 and at least 5 times within one-year was 2 703 (50.5%), 1 776 (33.2%), 642 (12.0%), 161(3.0), 52 (1.0%), 15 (0.3%), respectively. Eight hundred and seventy (16.3%) patients were included in recurrent hospitalizations group, 4 479 (83.7%) patients were included in non-recurrent hospitalizations group. Compare with non-recurrent hospitalizations group, patients in recurrent hospitalizations group was more likely to be older and female, more frequently had a history of hypertension, heart failure, coronary heart disesase, ischaemic stroke/transient ischaemic attack, diabetes mellitus, peptic ulcer, a AF duration for more than 1 year, medication including drugs for ventricular rate control, statin, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blocker (ARB) and higher CHA(2)DS(2)-VASc scores (<i>P<</i>0.05), but less frequently had higher education, a history of drinking, smoking and ablation (<i>P<</i>0.05). Multivariable analysis showed that age 50-64 (<i>OR=</i>1.47, 95<i>%CI</i> 1.20-1.80), age≥65 (<i>OR=</i>1.89, 95<i>%CI</i> 1.50-2.38), female (<i>OR=</i>1.21, 95<i>%CI</i> 1.01-1.46), hypertension history (<i>OR=</i>1.42, 95<i>%CI</i> 1.16-1.74), heart failure history (<i>OR=</i>1.73, 95<i>%CI</i> 1.37-2.18), coronary heart disease history (<i>OR=</i>1.63, 95<i>%CI</i> 1.31-2.03), peptic ulcer history (<i>OR=</i>2.00, 95<i>%CI</i> 1.18-3.39) were independent risk factors for recurrent hospitalizations, while higher education (college or above) (<i>OR=</i>0.82, 95<i>%CI</i> 0.69-0.99) was the protective factor for recurrent hospitalizations. <b>Conclusions:</b> Nearly 1 in 6 of AF patients were admitted to hospital more than once within one year in this NVAF cohort. Age≥50, female, hypertension history, heart failure history, coronary heart disease history, peptic ulcer history are associated with an increased risk of recurrent hospitalizations.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Y F</ForeName><Initials>YF</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lu</LastName><ForeName>S X</ForeName><Initials>SX</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Xia</LastName><ForeName>S J</ForeName><Initials>SJ</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jia</LastName><ForeName>Z X</ForeName><Initials>ZX</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jiang</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>He</LastName><ForeName>L</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Du</LastName><ForeName>X</ForeName><Initials>X</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ma</LastName><ForeName>C S</ForeName><Initials>CS</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>chi</Language><GrantList CompleteYN="Y"><Grant><GrantID>2016YFC0900901, 2016YFC1301002</GrantID><Agency>National Key Research and Development Plan</Agency><Country/></Grant><Grant><GrantID>81530016</GrantID><Agency>National Natural Science Foundation of China</Agency><Country/></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Zhonghua Xin Xue Guan Bing Za Zhi</MedlineTA><NlmUniqueID>7910682</NlmUniqueID><ISSNLinking>0253-3758</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002545" MajorTopicYN="Y">Brain Ischemia</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006760" MajorTopicYN="N">Hospitalization</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020521" MajorTopicYN="Y">Stroke</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 探讨心房颤动（房颤）患者发生多次住院事件的影响因素。 <b>方法：</b> 从2011年8月1日至2017年12月31日参加中国心房颤动注册研究的非瓣膜性房颤患者中纳入5 349例，收集一般信息、合并疾病、用药史及射频消融手术史，连续随访至少48个月，随访终点为患者的年最大全因住院次数（年最大住院次数）。将年最大住院次数≥2次的房颤患者定义为多次住院组，<2次的房颤患者定义为非多次住院组，应用logistic回归模型分析房颤患者发生多次住院事件的影响因素。 <b>结果：</b> 5 349例患者的年最大住院次数为0、1、2、3、4、≥5次者分别为2 703例（50.5%）、1 776例（33.2%）、642例（12.0%）、161例（3.0%）、52例（1.0%）和15例（0.3%）。870例（16.3%）纳入多次住院组，4 479例（83.7%）纳入非多次住院组。与非多次住院组比较，多次住院组中年龄≥50岁、女性、房颤病史>1年、合并症[高血压、心力衰竭、冠心病、缺血性卒中/短暂性脑缺血发作（TIA）、糖尿病、消化性溃疡病史]、CHA(2)DS(2)-VASc评分≥2分、服用控制心室率药物、他汀类药物及血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂（ACEI/ARB）药物的患者比例更高（<i>P</i>均<0.05）。非多次住院组中吸烟者、饮酒者、大学及以上学历、既往行射频消融术的患者比例更高（<i>P</i>均<0.05）。多因素logistic回归分析显示，年龄50~64岁（<i>OR=</i>1.47，95<i>%CI</i> 1.20~1.80）、≥65岁（<i>OR=</i>1.89，95<i>%CI</i> 1.50~2.38）、女性（<i>OR=</i>1.21，95<i>%CI</i> 1.01~1.46）、高血压（<i>OR=</i>1.42，95<i>%CI</i> 1.16~1.74）、心力衰竭（<i>OR=</i>1.73，95<i>%CI</i> 1.37~2.18）、冠心病（<i>OR=</i>1.63，95<i>%CI</i> 1.31~2.03）、消化性溃疡病史（<i>OR=</i>2.00，95<i>%CI</i> 1.18~3.39）是房颤患者发生多次住院的独立危险因素，而较高的教育程度（<i>OR=</i>0.82，95<i>%CI</i> 0.69~0.99）是发生多次住院的保护因素。 <b>结论：</b> 近1/6的房颤患者年最大住院次数≥2次。年龄≥50岁、女性、高血压、心力衰竭、冠心病、消化性溃疡病史与多次住院风险增加相关。. |
16,709 | Safety and Effectiveness of a Novel Fluoroless Transseptal Puncture Technique for Lead-free Catheter Ablation: A Case Series. | Increasing awareness of the health risks associated with the exposure of patients and staff in the catheterization laboratory to radiation has encouraged the pursuit of efforts to reduce the use of fluoroscopy during catheter ablation procedures. Although nonfluoroscopic guidance of ablation catheters has been previously described, transseptal access is still perceived as the last remaining barrier to completely fluoroless ablations. This study examined the safety and effectiveness of transseptal puncture and radiofrequency (RF) catheter ablation using a completely fluoroless approach. Three hundred eighty-two consecutive cases that had undergone completely nonfluoroscopic RF catheter ablation were evaluated. Ablation procedures were performed for atrial fibrillation, atrial flutter, atrioventricular reentry tachycardia, and pulmonary vein complex/ventricular tachycardia. Transseptal puncture and RF ablation were conducted under three-dimensional electroanatomic mapping and intracardiac echocardiography image guidance. Fluoroless transseptal puncture and catheter ablation were completed successfully in all cases, with no intraoperative complications. One patient required minimal use of fluoroscopy to visualize sheath advancement through an existing inferior vena cava filter. Procedural time was approximately 2.2 hours from transvenous access until case conclusion; transseptal access was obtained within 28 minutes of procedure initiation. Arrhythmia was found to recur in 27% of cases on average three months after the procedure. We demonstrate the safety and effectiveness of a completely fluoroless transseptal puncture and RF ablation technique that eliminates radiation exposure and enables complex electrophysiology procedures to be performed in a lead-free environment. |
16,710 | Profile of Obesity and Comorbidities in Elderly Patients with Heart Failure. | In Romania, robust data about the prevalence of obesity and heart failure are lacking, especially in the elderly; therefore, this study aims to analyze the profile of overweight and obese patients aged >65 years admitted to a Romanian hospital for worsening heart failure, and also their risk in the presence of comorbidities.</AbstractText>This cross-sectional study was conducted in 126 consecutive elderly patients with overweight and obesity admitted to a Romanian hospital for worsening heart failure. They were divided into three groups: with reduced (<40%) - HFrEF, mid-range (40-49%) - HFmrEF and preserved (≥50%) ejection fraction - HFpEF. Obesity was defined according to the body mass index (BMI) status: obesity, ≥30 kg/m2</sup>; overweight, 25-29.9 kg/m2</sup>. The Charlson Comorbidity Index (CCI) was calculated to evaluate the severity of comorbidity, with a score ranging from 2 (only heart failure present and age >65 years) to 30 (extensive comorbidity).</AbstractText>NT-proBNP values are negatively correlated with BMI only in patients with HFpEF. Creatinine clearance (p=0.0166), the presence of atrial fibrillation (p=0.0095) and NYHA functional class were independent predictors of increased NT-proBNP values. CCI score is negatively correlated with NT-proBNP values in patients with HFmrEF (r= -0.448, p=0.009) and HFpEF (r= -0.273, p=0.043). The CCI risk was not significantly different between the three groups.</AbstractText>Elderly heart failure patients with overweight or obesity have particular characteristics in terms of NT-proBNP values and presence of comorbidities. In the studied population, NT-proBNP levels were strongly influenced by renal function, NYHA functional class, the presence of atrial fibrillation and left ventricular ejection fraction.</AbstractText>© 2020 Dădârlat-Pop et al.</CopyrightInformation> |
16,711 | Impact of coronavirus disease 2019 (COVID-19) outbreak on outcome of myocardial infarction in Hong Kong, China. | To determine whether COVID-19 may adversely affect outcome of myocardial infarction (MI) patients in Hong Kong, China.</AbstractText>The COVID-19 pandemic has infected thousands of people and placed enormous stress on healthcare system. Apart from being an infectious disease, it may affect human behavior and healthcare resource allocation which potentially cause treatment delay in MI.</AbstractText>This was a single center cross-sectional observational study. From November 1, 2019 to March 31, 2020, we compared outcome of patients admitted for acute ST-elevation MI (STEMI) and non-ST elevation MI (NSTEMI) before (group 1) and after (group 2) January 25, 2020 which was the date when Hong Kong hospitals launched emergency response measures to combat COVID-19.</AbstractText>There was a reduction in daily emergency room attendance since January 25, 2020 (group 1,327/day vs. group 2,231/day) and 149 patients with diagnosis of MI were included into analysis (group 1 N = 85 vs. group 2 N = 64). For STEMI, patients in group 2 tended to have longer symptom-to-first medical contact time and more presented out of revascularization window (group 1 27.8 vs. group 2 33%). The primary composite outcome of in-hospital death, cardiogenic shock, sustained ventricular tachycardia or fibrillation (VT/VF) and use of mechanical circulatory support (MCS) was significantly worse in group 2 (14.1 vs. 29.7%, p = .02).</AbstractText>More MI patients during COVID-19 outbreak had complicated in-hospital course and worse outcomes. Besides direct infectious complications, cardiology community has to acknowledge the indirect effect of communicable disease on our patients and system of care.</AbstractText>© 2020 Wiley Periodicals, Inc.</CopyrightInformation> |
16,712 | Abnormalities in sodium current and calcium homoeostasis as drivers of arrhythmogenesis in hypertrophic cardiomyopathy. | Hypertrophic cardiomyopathy (HCM) is a common inherited monogenic disease with a prevalence of 1/500 in the general population, representing an important cause of arrhythmic sudden cardiac death (SCD), heart failure, and atrial fibrillation in the young. HCM is a global condition, diagnosed in >50 countries and in all continents. HCM affects people of both sexes and various ethnic and racial origins, with similar clinical course and phenotypic expression. The most unpredictable and devastating consequence of HCM is represented by arrhythmic SCD, most commonly caused by sustained ventricular tachycardia or ventricular fibrillation. Indeed, HCM represents one of the main causes of arrhythmic SCD in the young, with a marked preference for children and adults <30 years. SCD is most prevalent in patients with paediatric onset of HCM but may occur at any age. However, risk is substantially lower after 60 years, suggesting that the potential for ventricular tachyarrhythmias is mitigated by ageing. SCD had been linked originally to sports and vigorous activity in HCM patients. However, it is increasingly clear that the majority of events occurs at rest or during routine daily occupations, suggesting that triggers are far from consistent. In general, the pathophysiology of SCD in HCM remains unresolved. While the pathologic and physiologic substrates abound and have been described in detail, specific factors precipitating ventricular tachyarrhythmias are still unknown. SCD is a rare phenomenon in HCM cohorts (<1%/year) and attempts to identify patients at risk, while generating clinically useful algorithms for primary prevention, remain very inaccurate on an individual basis. One of the reasons for our limited understanding of these phenomena is that limited translational research exists in the field, while most efforts have focused on clinical markers of risk derived from pathology, instrumental patient evaluation, and imaging. Specifically, few studies conducted in animal models and human samples have focused on targeting the cellular mechanisms of arrhythmogenesis in HCM, despite potential implications for therapeutic innovation and SCD prevention. These studies found that altered intracellular Ca2+ homoeostasis and increased late Na+ current, leading to an increased likelihood of early and delayed after-depolarizations, contribute to generate arrhythmic events in diseased cardiomyocytes. As an array of novel experimental opportunities have emerged to investigate these mechanisms, including novel 'disease-in-the-dish' cellular models with patient-specific induced pluripotent stem cell-derived cardiomyocytes, important gaps in knowledge remain. Accordingly, the aim of the present review is to provide a contemporary reappraisal of the cellular basis of SCD-predisposing arrhythmias in patients with HCM and discuss the implications for risk stratification and management. |
16,713 | Characterization of a porcine model of atrial arrhythmogenicity in the context of ischaemic heart failure. | Atrial fibrillation (AF) is a major healthcare challenge contributing to high morbidity and mortality. Treatment options are still limited, mainly due to insufficient understanding of the underlying pathophysiology. Further research and the development of reliable animal models resembling the human disease phenotype is therefore necessary to develop novel, innovative and ideally causal therapies. Since ischaemic heart failure (IHF) is a major cause for AF in patients we investigated AF in the context of IHF in a close-to-human porcine ischaemia-reperfusion model. Myocardial infarction (AMI) was induced in propofol/fentanyl/midazolam-anaesthetized pigs by occluding the left anterior descending artery for 90 minutes to model ischaemia with reperfusion. After 30 days ejection fraction (EF) was significantly reduced and haemodynamic parameters (pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), left ventricular enddiastolic pressure (LVEDP)) were significantly elevated compared to age/weight matched control pigs without AMI, demonstrating an IHF phenotype. Electrophysiological properties (sinus node recovery time (SNRT), atrial/AV nodal refractory periods (AERP, AVERP)) did not differ between groups. Atrial burst pacing at 1200 bpm, however, revealed a significantly higher inducibility of atrial arrhythmia episodes including AF in IHF pigs (3/15 vs. 10/16, p = 0.029). Histological analysis showed pronounced left atrial and left ventricular fibrosis demonstrating a structural substrate underlying the increased arrhythmogenicity. Consequently, selective ventricular infarction via LAD occlusion causes haemodynamic alterations inducing structural atrial remodeling which results in increased atrial fibrosis as the arrhythmogenic atrial substrate in pigs with IHF. |
16,714 | Urgent Off-Pump Coronary Bypass Grafting in Moyamoya Disease: A Case Report. | Moyamoya disease is a rare progressive cerebrovascular occlusive disease that predominantly occurs in countries in Northeast Asia. We report a 54-year-old male patient with moyamoya and coronary artery disease, on whom urgent off-pump coronary artery bypass grafting was performed after cardiopulmonary reanimation due to ventricular fibrillation. This patient had left main trunk disease, a Pudenz peritoneal catheter (Medtronic, Inc., Minneapolis, MN, USA) for liquor drainage, bilateral internal carotid artery occlusion, diffuse peripheral atherosclerotic artery disease, and chronic renal insufficiency. We prefer off-pump surgery to avoid the risk of intraoperative hypotension and minimize the risk of perioperative cerebral ischemic complications. |
16,715 | Endurance exercise in seniors: Tonic, toxin or neither? | Cardiac adaptation to sustained exercise in the athletes is established. However, exercise-associated effect on the cardiac function of the elderly has to be elucidated. The aim of this study was to analyse left (LV) and right ventricular (RV) characteristics at different levels of chronic exercise in the senior heart.</AbstractText>We studied 178 participants in the World Senior Games (mean age 68 ± 8 years, 86 were men; 48%). Three groups were defined based on the type and intensity of sports: low-, moderate- and high-intensity level. Exclusion criteria were coronary artery disease, atrial fibrillation, valvular heart disease or uncontrolled hypertension. LV and RV size and function were evaluated with an echocardiogram.</AbstractText>LV trans-mitral inflow deceleration time decreased in parallel to the intensity of chronic exercise: 242 ± 54 ms in low-, 221 ± 52 ms in moderate- and 215 ± 58 ms in high-intensity level, p = .03. Left atrial volume index (LAVI) was larger in high-intensity group, p = .001. The LAVI remained significantly larger when adjusting for age, gender, heart rate, hypertension and diabetes (p = .002). LV and RV sizes were larger in the high-intensity group. LV ejection fraction and RV systolic function evaluated by tissue Doppler velocity, atrioventricular plane displacement and strain did not differ between groups.</AbstractText>Left ventricular diastolic filling is not only preserved, but may also be enhanced in long-term, top-level senior athletes. Moreover, LV and RV systolic function remain unchanged at different levels of exercise. This supports the beneficial effects of endurance exercise participation in senior hearts.</AbstractText>© 2020 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.</CopyrightInformation> |
16,716 | Differences in Clinical and Echocardiographic Profiles and Outcomes of Patients With Atrial Fibrillation Versus Sinus Rhythm in Medically Managed Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. | Atrial fibrillation (AF) results in the loss of atrial booster pump function and portends poorer outcome in aortic valve stenosis (AS). However, its characteristics and impact on medically managed AS remained under-recognised. We compared these patients with AF to sinus rhythm (SR).</AbstractText>In total, 347 consecutive patients with medically managed severe AS (aortic valve area <1 cm2</sup>) and preserved left ventricular ejection fraction (>50%) were studied, in terms of echocardiographic characteristics and clinical outcomes. Appropriate univariate and multivariate models were used, while Kaplan-Meier curves and Cox regression models were constructed to compare clinical outcomes (mortality, admissions for congestive cardiac failure, and stroke).</AbstractText>Ninety (90) (25.9%) patients had AF. Patients with AF had lower body mass index (BMI 18.5±10.4 vs 23.8±6.2 g/m2</sup>; p<0.001), larger left ventricular mass index (LVMI 127.9±39.0 vs 116.7±36.5; p=0.017), and left atrial volume index (53.2±20.0 vs 31.0±9.2 mL/m2</sup>; p=0.004). Atrial fibrillation was associated with higher mortality (52.2% vs 37.4%; Kaplan-Meier log-rank 7.18; p=0.007), admissions for congestive cardiac failure (log-rank 6.42; p=0.011), and poorer composite outcomes (log-rank 6.29; p=0.012). The incidence of stroke in both groups were similar on follow-up (log-rank 0.08; p=0.776). After adjusting for age, BMI, LVMI, and left atrial volume index on Cox regression, AF remained independently associated with poorer composite clinical outcomes (hazard ratio, 1.66; 95% confidence interval 1.07-2.58).</AbstractText>Atrial fibrillation remained an important comorbidity affecting a quarter of patients with medically managed severe AS. It was independently associated with poorer clinical outcomes and may thus aid in prognostication and management.</AbstractText>Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.</CopyrightInformation> |
16,717 | [Possibilities for predicting of cardiac arrhythmias and conductivity disorders in former athletes.]. | In order to analyze the relationship between the athletic qualification and syndrome of cardiac rhythm and conductivity disturbances in former athletes, a retrospective analysis of medical records of 39 male former athletes with cardiovascular complaints (mean age 61,6±11,3 years, mean duration of career in sports 23,9±17,3 years, mean duration of post-athletic period 20,1±9,9 years) was carried out. The patients were screened for cardiac arrhythmias and underwent echocardiography. The overall prevalence of sustained paroxysms of atrial fibrillation was 42%, increasing with the athletic qualification. Ryan grade 4b-5 premature ventricular contractions were found in 14% of patients. 3 parameters were found to be the independent predictors of arrhythmias in former athletes, i. e. athletic qualification, multifocal atherosclerosis (as an anti-risk factor), and age. The coefficient of determinance for the created prognostic model reached 43%. Further prospective studies are needed to validate an algorithm.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Krysiuk</LastName><ForeName>O B</ForeName><Initials>OB</Initials><AffiliationInfo><Affiliation>Saint-Petersburg State University, 7/9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation, e-mail: zadvoryevsf@yandex.ru.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>International Medical Center «Sogaz», 8 Malaya Konyushennaya str., St. Petersburg 191186, Russian Federation.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Saint-Petersburg State Pediatric Medical University, 2 Litovskaya str., St. Petersburg 194100, Russian Federation.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Obrezan</LastName><ForeName>A G</ForeName><Initials>AG</Initials><AffiliationInfo><Affiliation>Saint-Petersburg State University, 7/9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation, e-mail: zadvoryevsf@yandex.ru.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>International Medical Center «Sogaz», 8 Malaya Konyushennaya str., St. Petersburg 191186, Russian Federation.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zadvorev</LastName><ForeName>S F</ForeName><Initials>SF</Initials><AffiliationInfo><Affiliation>Saint-Petersburg State University, 7/9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation, e-mail: zadvoryevsf@yandex.ru.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>City Multi-field Hospital № 2, 5 Uchebnyi per., St. Petersburg 194354, Russian Federation.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yakovlev</LastName><ForeName>A A</ForeName><Initials>AA</Initials><AffiliationInfo><Affiliation>Saint-Petersburg State University, 7/9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation, e-mail: zadvoryevsf@yandex.ru.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>City Multi-field Hospital № 2, 5 Uchebnyi per., St. Petersburg 194354, Russian Federation.</Affiliation></AffiliationInfo></Author></AuthorList><Language>rus</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Russia (Federation)</Country><MedlineTA>Adv Gerontol</MedlineTA><NlmUniqueID>100971443</NlmUniqueID><ISSNLinking>1561-9125</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D056352" MajorTopicYN="Y">Athletes</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="N">Atrial Fibrillation</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004452" MajorTopicYN="N">Echocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013177" MajorTopicYN="Y">Sports</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="rus">Для выявления характера взаимосвязи спортивного анамнеза лиц, практиковавших в прошлом интенcивные физические нагрузки, и выявленных у них нарушений ритма сердца и внутрисердечной проводимости был проведен ретроспективный анализ медицинских документов 39 мужчин-ветеранов спорта (средний возраст — 61,6±11,3 года, средняя длительность постспортивного периода — 23,9±17,3 года, средний стаж соревновательной деятельности — 20,1±9,9 года), имеющих установленные сердечно-сосудистые заболевания. Проведено скрининговое обследование на предмет нарушений ритма и проводимости сердца, эхокардиографическое исследование. Выявлено, что распространенность устойчивых пароксизмов фибрилляции предсердий составила 42% в совокупной выборке, увеличиваясь с повышением уровня спортивной квалификации. Желудочковые нарушения ритма высокой градации выявлены у 14% обследованных. Лишь три параметра были достоверно связаны с риском нарушений ритма у ветеранов спорта: уровень спортивной квалификации, наличие генерализованного атеросклероза (антириск-фактор), возраст. Риск нарушений ритма у ветеранов спорта на 43% определяется указанными факторами. Был предложен алгоритм скрининга нарушений ритма у ветеранов спорта на основе клинических данных. Необходимы дальнейшие проспективные наблюдения для валидации алгоритма. |
16,718 | Differential Expression of the Angiotensin-(1-12)/Chymase Axis in Human Atrial Tissue. | Heart chymase rather than angiotensin (Ang)-converting enzyme has higher specificity for Ang I conversion into Ang II in humans. A new pathway for direct cardiac Ang II generation has been revealed through the demonstration that Ang-(1-12) is cleaved by chymase to generate Ang II directly. Herein, we address whether Ang-(1-12), chymase messenger RNA (mRNA), and activity levels can be differentiated in human atrial tissue from normal and diseased hearts and if these measures associate with various pathologic heart conditions.</AbstractText>Atrial appendages were collected from 11 nonfailing donor hearts and 111 patients undergoing heart surgery for the correction of valvular heart disease, resistant atrial fibrillation, or ischemic heart disease. Chymase mRNA was analyzed by real-time polymerase chain reaction and enzymatic activity by high-performance liquid chromatography using Ang-(1-12) as the substrate. Ang-(1-12) levels were determined by immunohistochemical staining.</AbstractText>Chymase gene transcripts, chymase activity, and immunoreactive Ang-(1-12) expression levels were higher in left atrial tissue compared with right atrial tissue, irrespective of cardiac disease. In addition, left atrial chymase mRNA expression was significantly higher in stroke versus nonstroke patients and in cardiac surgery patients who had a history of postoperative atrial fibrillation versus nonatrial fibrillation. Correlation analysis showed that left atrial chymase mRNA was positively related to left atrial enlargement, as determined by echocardiography.</AbstractText>As Ang-(1-12) expression and chymase gene transcripts and enzymatic activity levels were positively linked to left atrial size in patients with left ventricular heart disease, an important alternate Ang II forming pathway, via Ang-(1-12) and chymase, in maladaptive atrial and ventricular remodeling in humans is uncovered.</AbstractText>Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,719 | Effects of high-frequency biphasic shocks on ventricular vulnerability and defibrillation outcomes through synchronized virtual electrode responses. | Electrical defibrillation is a well-established treatment for cardiac dysrhythmias. Studies have suggested that shock-induced spatial sawtooth patterns and virtual electrodes are responsible for defibrillation efficacy. We hypothesize that high-frequency shocks enhance defibrillation efficacy by generating temporal sawtooth patterns and using rapid virtual electrodes synchronized with shock frequency. High-speed optical mapping was performed on isolated rat hearts at 2000 frames/s. Two defibrillation electrodes were placed on opposite sides of the ventricles. An S1-S2 pacing protocol was used to induce ventricular tachyarrhythmia (VTA). High-frequency shocks of equal energy but varying frequencies of 125-1000 Hz were used to evaluate VTA vulnerability and defibrillation success rate. The 1000-Hz shock had the highest VTA induction rate in the shorter S1-S2 intervals (50 and 100 ms) and the highest VTA defibrillation rate (70%) among all frequencies. Temporal sawtooth patterns and synchronous shock-induced virtual electrode responses could be observed with frequencies of up to 1000 Hz. The improved defibrillation outcome with high-frequency shocks suggests a lower energy requirement than that of low-frequency shocks for successful ventricular defibrillation. |
16,720 | Evidence of structural and functional plasticity occurring within the intracardiac nervous system of spontaneously hypertensive rats. | Plasticity is a fundamental property of neurons in both the central and peripheral nervous systems, enabling rapid changes in neural network function. The intracardiac nervous system (ICNS) is an extensive network of neurons clustered into ganglionated plexi (GP) on the surface of the heart. GP neurons are the final site of neuronal control of heart rhythm, and pathophysiological remodeling of the ICNS is proposed to feature in multiple cardiovascular diseases, including heart failure and atrial fibrillation. To examine the potential role of GP neuron plasticity in atrial arrhythmia and hypertension, we developed whole cell patch clamp recording techniques from GP neurons in isolated ICNS preparations from aged control (Wistar-Kyoto) and spontaneously hypertensive rats (SHRs). Anesthetized SHRs showed frequent premature ventricular contractions and episodes of atrial arrhythmia following carbachol injection, and isolated SHR atrial preparations were susceptible to pacing induced atrial arrhythmia. Whole cell recordings revealed elevated spontaneous postsynaptic current frequency in SHR GP neurons, as well as remodeled electrophysiology, with significant decreases in action potential amplitude and half-width. SHRs also showed a parallel increase in the number of cholinergic neurons and adrenergic glomus cells in cardiac ganglia, a higher proportion of synaptic α7-subunit but not β2-containing nicotinic receptors, and an elevation in the number of synaptic terminals onto GP neurons. Our data show that significant structural and functional plasticity occurs in the intracardiac nervous system and suggest that enhanced excitability through synaptic plasticity, together with remodeling of cardiac neuron electrophysiology, contributes to the substrate for atrial arrhythmia in hypertensive heart disease.<b>NEW & NOTEWORTHY</b> We have developed intracardiac neuron whole cell recording techniques in atrial preparations from control and spontaneous hypertensive rats. This has enabled the identification of significant synaptic plasticity in the intracardiac nervous system, including enhanced postsynaptic current frequency, increased synaptic terminal density, and altered postsynaptic receptors. This increased synaptic drive together with altered cardiac neuron electrophysiology could increase intracardiac nervous system excitability and contribute to the substrate for atrial arrhythmia in hypertensive heart disease. |
16,721 | Early ICD lead failure in defibrillator systems with multiple leads via cephalic access. | Implantable cardioverter defibrillators (ICDs) are proven to prevent sudden death in patients at elevated risk for sustained ventricular tachycardia or fibrillation. Complications related to ICD failure can stem from lead dysfunction, manufacturing defects, patient characteristics, or implantation technique. We conducted a review of all ICD leads implanted at our center from 2011 to 2017 to determine risk factors for premature lead failure.</AbstractText>We conducted a retrospective review of patients of all ICD leads implanted from December 2011 to June 2017 at our institution. A total of 660 patients (Biotronik Linox S/SD, n = 281; Sprint Quatro, n = 207; Durata, n = 121; Endotak, n = 51) underwent ICD implantations. Patient and lead characteristics, procedural outcomes and complications were recorded. Lead failure was defined per Heart Rhythm Society lead-management consensus as a lack of procedural or clinical success, thus requiring an extraction of the lead. Patient and lead outcomes were recorded and variables associated with lead failure were assessed by the Kaplan-Meier method.</AbstractText>Overall failure rate was similar for all leads: Linox S/SD-0.29%/year; Sprint Quattro-0.21%/year, Durata-0.39%/year and Endotak Reliance-0.0% (P = .769). No difference was found in overall survival when comparing all ICD manufacturers during the study period. Subgroup analysis revealed the risk of premature lead failure was particularly pronounced in multi-lead ICD systems implanted via cephalic access (P < .001). The estimated failure rate of Linox leads implanted via cephalic access in multi-lead systems was 19%/year. The estimated failure rate of non-Linox leads implanted via cephalic access in multi-lead systems was 11%/year. Neither age, nor gender were risk factors for lead failure in the Linox, or non-Linox cohorts.</AbstractText>All analyzed ICD leads were found to have a similar overall risk of premature failure. ICD lead implantation via cephalic access in multilead ICD systems may be a previously unidentified risk factor for premature ICD lead failure, although these findings require further validation.</AbstractText>© 2020 Wiley Periodicals LLC.</CopyrightInformation> |
16,722 | Detection of atrial shunt lesions with a single echocardiographic parameter. | Unrepaired left to right atrial shunt lesions can cause significant right ventricular (RV) volume overload. The parameter pulmonary to systemic shunt volume ratio (Qp:Qs) has been shown to detect even small differences between left and right ventricular stroke volume; however, four parameters are needed for its calculation. This study was carried out to evaluate the accuracy of the single parameter right ventricular outflow tract (RVOT) velocity time integral (VTI) to identify atrial shunt lesions.</AbstractText>All patients who underwent transesophageal echocardiography (TEE) examination at this institution between 1 January 2013 and 1 January 2018 were retrospectively analyzed. The RVOT-VTI was measured in the transthoracic echocardiography performed immediately before each TEE. The diagnostic accuracy for detection of atrial shunt lesions was tested.</AbstractText>A total of 2797 patients with a median age of 67 years (interquartile range, IQR 54-77 years) were included in the final analysis. A total of 113 (4%) patients had a relevant atrial shunt lesion. The mean RVOT-VTI of the shunt group was 25 cm (SD ± 8.1 cm) and was significantly higher than that of the non-shunt group with 17 cm (SD ± 4.8 cm) (p < 0.001). The area under the curve (AUC) was 0.81. A total of 106 patients (93.8%) of the shunt group had a VTI of ≥16 cm. If the RVOT-VTI was <16 cm, the negative predictive value was 99.3%. If the RVOT-VTI was ≥25 cm, 22% of patients proved to have a significant shunt lesion.</AbstractText>In this large retrospective analysis it could be shown that a low RVOT-VTI predicted the absence of significant atrial shunt lesions, while a high RVOT-VTI predicted the presence. The parameter should be applied in all patients with suspected atrial shunt lesions where calculation of Qp:Qs is impossible.</AbstractText> |
16,723 | The natural history of hypertrophic cardiomyopathy in a large Mediterranean cohort. | Hypertrophic cardiomyopathy (HCM) represents the most common inherited cardiomyopathy and it is characterized by phenotypic and genetic heterogeneity. The purpose of our study was to investigate the natural history of HCM in a large Mediterranean cohort and to identify predictors of outcomes.</AbstractText>The clinical and echocardiographic characteristics of 690 patients with HCM were examined. The predictors of mortality and sudden cardiac events were examined during a mean follow-up of 8.5 years.</AbstractText>Asymmetrical hypertrophy was the most common among our cohort (82.9%) followed by apical hypertrophy pattern (13.6%). Atrial fibrillation was present in 22.3%, whereas nonsustained ventricular tachycardia occurred in 10.4% of the patients. During follow-up, a total of 7.4% of patients died. Specifically, 5.5% HCM patients died from cardiovascular causes, including 2.8% from heart failure and 2% from sudden death. Obstructive phenotype did not have any effect on mortality. Atrial fibrillation, ejection fraction and right ventricular systolic pressure (RVSP) were common independent predictors for overall and cardiovascular mortality. A total of 6.1% of HCM patients suffered sudden arrhythmic events and maximal wall thickness, ejection fraction, nonsustained ventricular tachycardia, syncopal episodes and, more importantly, the presence of an apical aneurysm were all independent risk factors.</AbstractText>HCM is a relatively benign cardiomyopathy in Greece, similarly to other countries. Apical hypertrophy pattern is more common in Greece than in the other European countries, whereas the presence of apical aneurysm is the most important risk factor for arrhythmic events on top of the established risk factors for sudden death.</AbstractText> |
16,724 | Deep learning for comprehensive ECG annotation. | Increasing utilization of long-term outpatient ambulatory electrocardiographic (ECG) monitoring continues to drive the need for improved ECG interpretation algorithms.</AbstractText>The purpose of this study was to describe the BeatLogic® platform for ECG interpretation and to validate the platform using electrophysiologist-adjudicated real-world data and publicly available validation data.</AbstractText>Deep learning models were trained to perform beat and rhythm detection/classification using ECGs collected with the Preventice BodyGuardian® Heart monitor. Training annotations were created by certified ECG technicians, and validation annotations were adjudicated by a team of board-certified electrophysiologists. Deep learning model classification results were used to generate contiguous annotation results, and performance was assessed in accordance with the EC57 standard.</AbstractText>On the real-world validation dataset, BeatLogic beat detection sensitivity and positive predictive value were 99.84% and 99.78%, respectively. Ventricular ectopic beat classification sensitivity and positive predictive value were 89.4% and 97.8%, respectively. Episode and duration F1</sub> scores (range 0-100) exceeded 70 for all 14 rhythms (including noise) that were evaluated. F1</sub> scores for 11 rhythms exceeded 80, 7 exceeded 90, and 5 including atrial fibrillation/flutter, ventricular tachycardia, ventricular bigeminy, ventricular trigeminy, and third-degree heart block exceeded 95.</AbstractText>The BeatLogic platform represents the next stage of advancement for algorithmic ECG interpretation. This comprehensive platform performs beat detection, beat classification, and rhythm detection/classification with greatly improved performance over the current state of the art, with comparable or improved performance over previously published algorithms that can accomplish only 1 of these 3 tasks.</AbstractText>Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,725 | Early clinical experience of radiofrequency catheter ablation using an audiovisual telesupport system. | An audiovisual telesupport system that enables real-time audiovisual communications between 2 long-distance hospitals is one method of telemedicine. The usefulness and safety of radiofrequency catheter ablation (RFCA) using an audiovisual telesupport system has not been well established.</AbstractText>The purpose of this study was to evaluate the effectiveness and safety of RFCA using an audiovisual telesupport system.</AbstractText>An audiovisual telesupport system using a strictly secured virtual network was established between Kamisu Saiseikai Hospital (operator with 10 years' experience and 800 procedures) and the University of Tsukuba (advisor with >20 years' experience and 8000 procedures). We evaluated 19 initial consecutive patients who underwent RFCA using this system for tachyarrhythmia: 10 with atrial fibrillation (AF), 5 with paroxysmal supraventricular tachycardia (PSVT), 3 with premature ventricular contraction (PVC), and 1 with atrial flutter. Electrophysiological and procedural characteristics were retrospectively assessed.</AbstractText>Acute success was achieved in all 19 patients without any major complications, with the advisor's audiovisual assistance. Mean procedure time and fluoroscopic time were 161 ± 44 minutes and 24 ± 14 minutes for AF, 110 ± 17 minutes and 28 ± 8 minutes for PVC, and 132 ± 19 minutes and 32 ± 2 minutes for PSVT, respectively. There was no recurrence of clinical arrhythmia in 17 of the 19 patients (89%) during 13 ± 9 month follow-up.</AbstractText>An audiovisual telesupport system for RFCA is a useful and safe method that enabled the electrophysiologist with limited human resources to make an optimal decision regarding procedural strategy and endpoint with the remote advisor's audiovisual assistance.</AbstractText>Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,726 | [Recurrent ventricular tachycardia as a cause of circulatory decompensation in the case of various comorbid diseases]. | Ventricular arrhythmias, including tachycardia and ventricular fibrillation are often a dangerous consequence other co-existing conditions in the phase of their destabilization. Causal and symptomatic treatment diseases such as: ischemic heart disease, cardiac insufficiency, hyperthyroidism, or cancer, can be effectively stabilized without necessity for the implantation of cardioverter-defibrillator (ICD).</AbstractText>The 62-year-old patient was admitted to the cardiology department after a second episode of unconsciousness last week due to recurrent VT. Despite many diagnostic difficulties, the possibility of effective conservative treatment has been demonstrated.</AbstractText>© 2020 MEDPRESS.</CopyrightInformation> |
16,727 | COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. | The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer. The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically, SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane angiotensin-converting enzyme 2 (ACE2) -a homologue of ACE-to enter type 2 pneumocytes, macrophages, perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis. Hence, patients should not discontinue their use. Moreover, renin-angiotensin-aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm [interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures (social distancing and social isolation) also increase cardiovascular risk. Cardiovascular considerations of therapies currently used, including remdesivir, chloroquine, hydroxychloroquine, tocilizumab, ribavirin, interferons, and lopinavir/ritonavir, as well as experimental therapies, such as human recombinant ACE2 (rhACE2), are discussed. |
16,728 | Case report: intravascular ultrasound sonography-guided re-entry technique in crushed stent. | Stent thrombosis (ST) is a rare, but potentially fatal complication. Procedural problems, such as stent under-dimension/under-expansion or dual antiplatelet drug resistance may result into ST. These conditions are more frequent during primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI).</AbstractText>A 60-year-old male patient presented to our hospital with an inferior STEMI. In the emergency department, a dual antiplatelet therapy was administered with ticagrelor 180 mg and aspirin 250 mg IV. During the observation, the patient experienced a ventricular fibrillation. Urgent coronary angiography showed an occlusion of the proximal right coronary artery. Thrombus aspiration was performed followed by implantation of one drug-eluting stent. After 45 min early ST occurred and was treated by immediate thrombus aspiration and post-dilatation. Intravascular ultrasound sonography (IVUS) showed severe strut malapposition due to a partial crush after post-dilatation. Since it was not possible to directly insert the first guidewire in the stent lumen, the IVUS probe was placed between the vessel wall and the crushed stent to guide the manoeuvre.</AbstractText>Crushed stent is a rare complication, being caused by an incorrect passage of the guidewire between the stent's struts and the vessel wall in case of severe underexpansion. In this case, an IVUS-guided re-entry could be an option to gain the stent true lumen and avoid a second stent implantation.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
16,729 | Pharmacological spasm provocation testing in 2500 patients: provoked spasm incidence, complications and cardiac events. | Pharmacological spasm provocation tests such as acetylcholine (ACh) and ergonovine (ER) had been performed in the clinic. We retrospectively analyzed the incidence of provoked spasm, complications during testing and the cardiac events after these tests. From January 1991 and October 2018, we performed pharmacological spasm provocation tests in 2500 patients: 1810 ACh tests, 1232 ER tests, 542 both tests, and 310 ACh added after ER tests. ACh was injected in incremental doses of 20/50/100/200 μg into the LCA and 20/50/80 μg into the RCA. ER was administered as a total dose of 64 μg into the LCA and 40 μg into the RCA. When adding ACh after ER, the total dose was 50/80 μg into the RCA and 100/200 μg into the LCA. Positive spasm was defined as ≥ 90% stenosis and usual chest pain or ischemic ECG changes. Mean follow-up duration was 47.5 ± 29.9 months. Overall, provoked positive spasm was found in 1095 patients (43.8%). The incidence of positive provoked spasm during ACh testing was significantly higher than that during other tests (ACh: 48.7% vs. ER: 28.9%, Both: 24%, ACh added after ER: 33.5%, p < 0.001). Multiple spasms were remarkably more frequent during ACh testing compared with the other 3 types of testing (ACh: 28.2% vs. ER: 7.4%, Both: 4.1%, ACh added after ER: 13.2%, p < 0.001). No death or acute myocardial infarction was observed, while major complications during ACh testing were significantly more frequent than during ER testing. Readmission due to recurrent angina pectoris in spasm-positive patients was remarkably more frequent than in spasm-negative patients. The incidence of sudden cardiac death, ventricular fibrillation, and acute coronary syndrome were not different between the spasm-positive and spasm-negative groups during the follow-up periods. We could perform all spasm provocation tests without any irreversible complications. All sequential spasm provocation tests were useful for documenting coronary spasm. |
16,730 | Pure Robotic-assisted Level IV Inferior Vena Cava Thrombectomy for Angiomyolipoma Without Cardiopulmonary Bypass: A First Report. | To report the initial case of robotic-assisted level IV inferior vena cava (IVC) tumor thrombectomy, with the supra- and infradiaphragmatic caval segments managed purely by a robotic-assisted technique.</AbstractText>A 67-year-old female presented with a 5.3 × 2.4 cm right renal tumor and a level IV IVC tumor thrombus, 16.5 cm in length, extending 1.5 cm into the right atrium. Through a robotic trans-abdominal approach, the infrarenal and retrohepatic IVC, left renal vein and right kidney were secured. Using a robotic transthoracic approach, the thrombus was milked out of the right atrium. The intrapericardial caval segment was secured and the right atrium was excluded. No cardiopulmonary bypass was used. A cavotomy was made at the right renal vein os and the tumor thrombus was extracted en bloc in a retrograde manner under transesophageal echocardiographic visualization.</AbstractText>Total operative time was 211 minutes, including robotic docking, with 90 minutes spent on taking down intraabdominal adhesions. Caval clamp time was 13 minutes. Estimated blood loss was 100 mL. Postoperatively, the patient developed atrial fibrillation with rapid ventricular rate (RVR) requiring diltiazem infusion (Clavien Grade II). Hospital stay was 5 days. There were no further complications. Pathology revealed an Angiomyolipoma and negative surgical margins.</AbstractText>This is the initial report of a purely robotic-assisted level IV IVC tumor thrombectomy. We used this technique for an angiomyolipoma with tumor thrombus extending 1.5cm into the right atrium, managing both the supra- and infradiaphragmatic caval segments robotically. This report further extends the field of robotic surgery.</AbstractText>Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,731 | Cardiac arrhythmias in pregnant women: need for mother and offspring protection. | Cardiac arrhythmias are the most common cardiac complication reported in pregnant women with and without structural heart disease (SHD); they are more frequent among women with SHD, such as cardiomyopathy and congenital heart disease (CHD). While older studies had indicated supraventricular tachycardia as the most common tachyarrhythmia in pregnancy, more recent data indicate an increase in the frequency of arrhythmias, with atrial fibrillation (AF) emerging as the most frequent arrhythmia in pregnancy, attributed to an increase in maternal age, cardiovascular risk factors and CHD in pregnancy. Importantly, the presence of any tachyarrhythmia during pregnancy may be associated with adverse maternal and fetal outcomes, including death. Thus, both the mother and the offspring need to be protected from such consequences. The use of antiarrhythmic drugs (AADs) depends on clinical presentation and on the presence of underlying SHD, which requires caution as it promotes pro-arrhythmia. In hemodynamically compromised women, electrical cardioversion is successful and safe to both mother and fetus. Use of beta-blockers appears quite safe; however, caution is advised when using other AADs, while no AAD should be used, if at all possible, during the first trimester when organogenesis takes place. Regarding the anticoagulation regimen in patients with AF, warfarin should be substituted with heparin during the first trimester, while direct oral anticoagulants are not indicated given the lack of data in pregnancy. Finally, for refractory arrhythmias, ablation and/or device implantation can be performed with current techniques in pregnant women, when needed, using minimal exposure to radiation. All these issues and relevant current guidelines are herein reviewed. |
16,732 | Fabry cardiomyopathy: Gb3-induced auto-reactive panmyocarditis requiring heart transplantation. | Resistance to enzyme replacement therapy (ERT) is a major therapeutic challenge in Fabry disease (FD). Recent reports attribute to immune-mediated inflammation a main role in promoting disease progression and resistance to ERT. Aim of the study is to report a Gb3-induced auto-reactive panmyocarditis causing inefficacy of ERT and severe electrical instability, which required cardiac transplantation. Examining the explanted heart from a 57-year-old man with FD cardiomyopathy (CM) on 3-year ERT presenting incoming ventricular fibrillation, we documented a severe virus-negative myocarditis extended to cardiomyocytes, intramural coronary vessels, conduction tissue, and subepicardial ganglia. Serology was positive for anti-Gb3, anti-heart, and anti-myosin antibodies. In vitro Gb3 stimulation of patient's peripheral blood mononuclear cells (PBMC) induced high amount production of inflammatory cytokine IL1-β, IL-6, IL-8, and TNF-α. PBMC were stained using the monoclonal antibodies CD3-V500, CD4-V450, CD8-APCcy7, CD45RO-PerCPcy5.5 and CD27-FITC from BD Biosciences and CD56-PC7 from Bekman Coulter. The phenotypic analysis of PBMC showed a lower frequency of CD8 (9.2%) vs. 19.3% and NKT cells (1.6% vs. 2.4%) in Fabry patient respect to healthy donor, suggesting a possible homing to peripheral tissues. A Gb3-induced auto-reactive myocarditis is suggested as a possible cause of FDCM progression and ERT resistance. Immune-mediated inflammation of systemic Fabry cells may coexist and be controlled by implemental immunosuppressive therapy. |
16,733 | Analysis of electropharmacological effects of AVE0118 on the atria of chronic atrioventricular block dogs: characterization of anti-atrial fibrillatory action by atrial repolarization-delaying agent. | AVE0118, an inhibitor of I<sub>Kur</sub>, I<sub>to</sub> and I<sub>K,ACh</sub>, was in the drug pipeline for atrial fibrillation. To investigate the limitation of AVE0118 as an anti-atrial fibrillatory drug, we studied its electropharmacological effects particularly focusing on the anti-atrial fibrillatory action as reverse translational research. We adopted the chronic atrioventricular block beagle dogs (n = 4), having a pathophysiology of bradycardia-associated, volume overload-induced chronic heart failure, in which the atrial fibrillation was induced by 10 s of burst pacing on atrial septum. AVE0118 in doses of 0.24 and 1.2 mg/kg, i.v. over 10 min hardly altered electrophysiological variables. Meanwhile, AVE0118 in a dose of 6 mg/kg, i.v. over 10 min delayed the inter-atrial conduction in a frequency-dependent manner and prolonged the atrial effective refractory period in a reverse frequency-dependent manner, whereas it did not significantly alter the duration of atrial fibrillation or its cycle length. The increment of atrial effective refractory period was 3.3 times greater compared with that of ventricular one at a basic cycle length of 400 ms. Torsade de pointes was not induced during the experimental period. Thus, AVE0118 may possess a favorable cardiac safety pharmacological profile, but its weak anti-atrial fibrillatory effect would indicate the limitation of atrial repolarization-delaying agents for suppressing atrial fibrillation. |
16,734 | Association of non-shockable initial rhythm and psychotropic medication in sudden cardiac arrest. | Asystole (ASY) and pulseless electrical activity (PEA) have a poor outcome during sudden cardiac arrest (SCA). Psychotropic medication has been associated with a risk for sudden cardiac death (SCD). Our aim was to study the association of psychotropic medication with ASY/PEA during SCA.</AbstractText>A total of 659 SCA subjects were derived from the emergency data of Oulu University Hospital (2007-2012). Subjects with non-cardiac origin of SCA and over 30-minute delay to rhythm recording were excluded. Population included 222 subjects after exclusions (mean age 64 ± 14 years, 78% males). Initial rhythm was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 123 (55%), ASY in 67 (30%) and PEA in 32 (14%) subjects. The delay (collapse to rhythm recording) was similar in VF/VT and ASY/PEA subjects (median 8 min [1st-3rd quartile 3-12 min] versus 10 [0-14] minutes, p = 0.780). Among VF/VT subjects underlying cardiac disease was more often ischemic compared to ASY/PEA subjects (85% versus 68%, p = 0.003). Psychotropic medication was associated with ASY/PEA rhythm (OR 3.18, 95%CI 1.40-7.23, p = 0.006) after adjustment for gender, age and underlying cardiac disease. Subsequently, antipsychotics (OR 4.27, 95%CI 1.28-14.25, p = 0.018) were more common in the ASY/PEA group. Benzodiazepines and antidepressants were not associated with ASY/PEA.</AbstractText>Psychotropic medication and especially antipsychotics are associated with non-shockable rhythm during SCA and may lower the possibility of survival from the event. This might partly explain the risk of SCD related to psychotropic medication.</AbstractText>© 2020 The Authors.</CopyrightInformation> |
16,735 | Electrical storm: A focused review for the emergency physician. | Electrical storm is a dangerous condition presenting to the Emergency Department that requires rapid diagnosis and management.</AbstractText>This article provides a review of the diagnosis and management of electrical storm for the emergency clinician.</AbstractText>Electrical storm is defined as ≥3 episodes of sustained ventricular tachycardia, ventricular fibrillation, or shocks from an implantable cardioverter defibrillator within 24 h. Patients may present with a wide array of symptoms. Initial evaluation should include an electrocardiogram with a rhythm strip and continuous cardiac monitoring, a medication history, assessment of hemodynamic stability, and identification of potential triggers. Management includes an antiarrhythmic and a beta blocker. Refractory patients may benefit from double-sequential defibrillation or more invasive procedures such as intra-aortic balloon pumps, catheter ablation and extracorporeal membrane oxygenation for critically ill patients. These patients will typically require admission to an intensive care unit.</AbstractText>Electrical storm is a condition associated with significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the evaluation and management of these patients.</AbstractText>Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,736 | [Predictors of Left Atrial Severe Fibrosis in Patients with Nonvalvular Atrial Fibrillation]. | Objective The search for predictors of severe (&gt;35 %) left atrial (LA) fibrosis in patients (pts) with nonvalvular atrial fibrillation (AF) directed for catheter ablation (CA).Materials and Methods 69 pts with nonvalvular AF (57 paroxismal and 12 persistent) aged from 32 to 69 years (mean age 57.1±8.4, 28 females) were included in the study, among them 59 pts (86 %) with arterial hypertension (AH), 24 (34.8 %) - with AH and CAD. Complete physical study, laboratory tests (including NT-proBNP level), comprehensive echocardiography were performed. As a surrogate substrate of LA fibrosis, the area of low-voltage (&lt;0.5 mV) zones in LA was estimated in the process of voltage electroanatomic mapping, as the first stage of CA. The total square of LA fibrosis in absolute values (Sf, cm2) and in percent of total LA square (Sf%), as well as the degree of fibrosis: degree I - &lt;5 %, II - 5-19 %, III - 20-35 %, IV - &gt;35 % were calculated. Degree IV of fibrosis was considered as severe fibrosis.Results Extent of fibrosis didn't depend on sex, age, body weight, presence of diabetes, CHA2DS2VASc scores, duration of AF history. There was a tendency to smaller Sf in pts with spontaneous termination of AF compared to those who required cardioversion: 7.2 cm2 (4.4; 17.1) and 12.6 cm2 (4.2; 30.5), respectively (p=0.069). Although NT-proBNP level was normal in 62 % of pts (&lt;125 pg / ml), it was higher in Sf% ≥20 % than in Sf% &lt;5 %: 146.0 (48.0; 276.0) and 42.8 (24.2; 91.0) pg / ml, respectively (p=0.0216). The distribution of pts by left ventricular (LV) geometry types was as follows: normal geometry (t.1) - 34, concentric remodeling (t.2) - 16, concentric LV hypertrophy (t.3) - 8, eccentric LV hypertrophy (t.4) - 11. Compared to pts with t. 1 (reference level), pts with t.3 and t.4 had higher LA volume and LV myocardial mass index, and pts with t.4 had larger end-diastolic LV volume and lower LV ejection fraction. Pts with t.4 tended to have higher Sf% than t.1: 31.1 (10.2; 46.2) and 11.2 (5.1; 28.0), respectively (p=0.053). Using logistic regression 3 independent predictors of LA severe fibrosis were detected: type 4 geometry of LV - OR=8.893 (95 % CI 1.150; 68.78), NT-proBNP &gt;128 pg / ml - OR=6.184 (1.01; 37.99), LA volume index &gt;34 ml / m2 - OR=5.92 (1.05; 33.38). According to ROC analysis, the area of the curve AUC = 0.839 (p&lt;0.001), model specificity - 85.1 %, sensitivity - 70.0 %, predictive accuracy - 82.5 %.Conclusion In pts with nonvalvular AF predictors of severe (&gt;35 %) LA fibrosis were LV geometry type in the form of eccentric LV hypertrophy, LA volume index &gt;34 ml / m2 and NT-proBNP &gt;128 pg / ml. |
16,737 | Alternative sites of ventricular pacing: His bundle pacing. | Since its introduction right ventricular apical (RVA) pacing has been the mainstay in cardiac pacing. However, in recent years there has been an upsurge of interest in permanent His bundle pacing (HBP), given the scientific evidence of the harmful role of dyssynchronous ventricular activation, induced by RVA pacing, in promoting the onset of heart failure and atrial fibrillation. After an intermediate period in which attention was focused on algorithms aimed at minimizing ventricular pacing, with partially inadequate and harmful results, scientific attention shifted to HBP, which proved to ensure a physiological electro-mechanical activation of the ventricles. The encouraging results obtained have allowed the introduction of HBP in recent guidelines for cardiac pacing in patients with bradicardia and cardiac conduction delay. Recent studies have also demonstrated the potential of HBP in patients with left bundle branch block and heart failure. HBP is promising as an attractive way to achieve physiological stimulation in patients with an indication for cardiac resynchronization therapy (CRT). Comparative studies of HB-CRT and biventricular pacing have shown similar results in numerically modest cohorts, although HB-CRT has been shown to promote better ventricular electrical resynchronization as demonstrated by a greater QRS narrowing. A widespread use of this pacing tecnique also depends on improvements in technology, as well as further validation of effectiveness in large randomised clinical trials. |
16,738 | Predictors of left atrial appendage thrombus despite NOAC use in nonvalvular atrial fibrillation and flutter. | A small but significant proportion of patients with atrial fibrillation or atrial flutter (AF) develop left atrial appendage thrombus (LAAT) despite non-vitamin K antagonist oral anticoagulant (NOAC) prescription. This study examines clinical and echocardiographic risk factors associated with LAAT by transesophageal echocardiogram (TEE) despite NOAC use in patients with non-valvular AF, to inform the decision whether a TEE should be performed prior to cardioversion.</AbstractText>We compared clinical and echocardiographic characteristics of patients with LAAT despite NOAC prescription for >3 weeks (n = 38) with a consecutive sample of patients on NOAC without LAAT (n = 101).</AbstractText>The prevalence of LAAT despite NOAC prescription was 2.6%. Left atrial dilation (adjusted odds ratio [aOR] 3.310, 95% CI 1.144-9.580, p = 0.02) and greater CHA2</sub>DS2</sub>-VASC score (per-point increase, aOR 1.293, 1.027-1.628, p = 0.03) increased the odds for LAAT. Higher LVEF (per 5%, aOR 0.834, 0.704-0.987, p = 0.03) and presence of severe mitral regurgitation (aOR 0.147, 0.048-0.446, p = 0.002) were protective against LAAT. LAA emptying velocities were also independently associated with presence of LAAT (aOR per 10 cm/s, 0.46, 0.27-0.77).</AbstractText>Left atrial dilation, greater CHA2</sub>DS2</sub>-VASC score, absence of severe mitral regurgitation and lower left ventricular ejection fraction are associated with LAAT despite NOAC therapy. In addition to suspected NOAC noncompliance, presence of such high-risk features may warrant pre-cardioversion TEE. Similarly, in patients with LVEF > 50% and CHA2</sub>DS2</sub>-VASC < 2, risk of LAAT was exceedingly low and thus TEE before cardioversion is low-yield.</AbstractText>Copyright © 2020 Elsevier B.V. All rights reserved.</CopyrightInformation> |
16,739 | Integrating the STOP-BANG Score and Clinical Data to Predict Cardiovascular Events After Infarction: A Machine Learning Study. | OSA conveys worse clinical outcomes in patients with coronary artery disease. The STOP-BANG score is a simple tool that evaluates the risk of OSA and can be added to the large number of clinical variables and scores that are obtained during the management of patients with myocardial infarction (MI). Currently, machine learning (ML) is able to select and integrate numerous variables to optimize prediction tasks.</AbstractText>Can the integration of STOP-BANG score with clinical data and scores through ML better identify patients who experienced an in-hospital cardiovascular event after acute MI?</AbstractText>This is a prospective observational cohort study of 124 patients with acute MI of whom the STOP-BANG score classified 34 as low (27.4%), 30 as intermediate (24.2%), and 60 as high (48.4%) OSA-risk patients who were followed during hospitalization. ML implemented feature selection and integration across 47 variables (including STOP-BANG score, Killip class, GRACE score, and left ventricular ejection fraction) to identify those patients who experienced an in-hospital cardiovascular event (ie, death, ventricular arrhythmias, atrial fibrillation, recurrent angina, reinfarction, stroke, worsening heart failure, or cardiogenic shock) after definitive MI treatment. Receiver operating characteristic curves were used to compare ML performance against STOP-BANG score, Killip class, GRACE score, and left ventricular ejection fraction, independently.</AbstractText>There were an increasing proportion of cardiovascular events across the low, intermediate, and high OSA risk groups (P = .005). ML selected 7 accessible variables (ie, Killip class, leukocytes, GRACE score, c reactive protein, oxygen saturation, STOP-BANG score, and N-terminal prohormone of B-type natriuretic peptide); their integration outperformed all comparators (area under the curve, 0.83 [95% CI, 0.74-0.90]; P < .01).</AbstractText>The integration of the STOP-BANG score into clinical evaluation (considering Killip class, GRACE score, and simple laboratory values) of subjects who were admitted for an acute MI because of ML can significantly optimize the identification of patients who will experience an in-hospital cardiovascular event.</AbstractText>Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,740 | Impact of atrial fibrillation in patients with heart failure and reduced, mid-range or preserved ejection fraction. | To determine the prognostic value of atrial fibrillation (AF) in patients with heart failure (HF) and preserved, mid-range or reduced ejection fraction (EF).</AbstractText>Patients hospitalised for acute HF were enrolled in the Korean Acute Heart Failure registry, a prospective, observational, multicentre cohort study, between March 2011 and February 2014. HF types were defined as reduced EF (HFrEF, LVEF <40%), mid-range EF (HFmrEF, LVEF 40%-49%) or preserved EF (HFpEF, LVEF ≥50%).</AbstractText>Of 5414 patients enrolled, HFrEF, HFmrEF and HFpEF were seen in 3182 (58.8%), 875 (16.2%) and 1357 (25.1%) patients, respectively. The prevalence of AF significantly increased with increasing EF (HFrEF 28.9%, HFmrEF 39.8%, HFpEF 45.2%; p for trend <0.001). During follow-up (median, 4.03 years; IQR, 1.39-5.58 years), 2806 (51.8%) patients died. The adjusted HR of AF for all-cause death was 1.06 (0.93-1.21) in the HFrEF, 1.10 (0.87-1.39) in the HFmrEF and 1.22 (1.02-1.46) in the HFpEF groups. The HR for the composite of all-cause death or readmission was 0.97 (0.87-1.07), 1.14 (0.93-1.38) and 1.03 (0.88-1.19) in the HFrEF, HFmrEF and HFpEF groups, respectively, and the HR for stroke was 1.53 (1.03-2.29), 1.04 (0.57-1.91) and 1.90 (1.13-3.20), respectively. Similar results were observed after propensity score matching analysis.</AbstractText>AF was more common with increasing EF. AF was seen to be associated with increased mortality only in patients with HFpEF and was associated with an increased risk of stroke in patients with HFrEF or HFpEF.</AbstractText>NCT01389843.</AbstractText>© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation> |
16,741 | Cardiac surgery in infective endocarditis and predictors of in-hospital mortality. | Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy.</AbstractText>To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality.</AbstractText>We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017.</AbstractText>The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery.</AbstractText>There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.</AbstractText>Copyright © 2020 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.</CopyrightInformation> |
16,742 | Outcomes of patients operated for acute type A aortic dissection requiring preoperative cardiopulmonary resuscitation. | Acute type A aortic dissection (AAAD) is a life-threatening condition. The emergency operation usually results in 20% perioperative mortality. If preoperative cardiopulmonary resuscitation (CPR) is necessary, there is an increase in the rate of mortality. The aim of the present study was to report the outcomes of AAAD surgery in patients requiring preoperative CPR in a high-volume center.</AbstractText>A retrospective analysis of preoperative, intraoperative, postoperative, and follow-up data in patients requiring preoperative CPR in the setting of AAAD surgery was performed.</AbstractText>Between January 2006 and December 2018, 637 patients underwent emergency surgery for AAAD. In total, 26 (4%) patients received CPR; the mean age was 63 ± 13 years; and 18 were male (69%). The reason for CPR was acute tamponade (N = 14, 54%), pulseless electrical activity (N = 5, 19%), asystole or ventricular fibrillation (N = 7, 27%), and four (15%) patients were not operated due to prolonged CPR and severe initial neurological impairment. There was no intraoperative mortality. The in-hospital mortality rate was 50% (N = 11), due to severe cerebral damage confirmed by computed tomography, and six patients (55%) were older than 70 years. The median follow-up was 35 months (7-149), which was 100% complete; two patients had permanent hemiplegia, one had anterior spinal syndrome, and other two died during the follow-up. The overall survival rate was 41% (n = 9).</AbstractText>Surgery outcomes were still reasonable in AAAD patients requiring preoperative CPR in a high-volume center.</AbstractText>© 2020 Wiley Periodicals, Inc.</CopyrightInformation> |
16,743 | Implantable loop recorder monitoring in patients with cryptogenic stroke - Detection and treatment of different clinically relevant arrhythmias. | Implantable loop recorders (ILR) are recommended to detect atrial fibrillation (AF) in cases of cryptogenic stroke. However, real life data besides controlled trials are rare. Aim of the study was the detection of atrial fibrillation with a special focus on other arrhythmias according to criteria defined in earlier clinical trials.</AbstractText>We performed a retrospective analysis of 64 patients with cryptogenic stroke who underwent ILR implantation between 4/2014 and 1/2018. The primary endpoint was the detection of atrial fibrillation, significant bradycardia (<40 bpm) or tachycardia (>150 bpm). ILR interrogation was performed after implantation and 6, 12 and 24 months thereafter.</AbstractText>Mean patients age was 65.4 ± 12 years, 50% were male. Mean follow-up duration was 419.2 ± 309 days. One death occurred during follow-up. 23 patients (35.9%) experienced a symptomatic clinical neurological or cardiac event during follow-up. Overall rate of detected arrhythmias was 35% (23/64). The most frequent arrhythmia was atrial fibrillation which was observed in 16 patients (25%). 6 of 16 patients presenting with atrial fibrillation had no clinical symptoms. Bradycardias requiring subsequent pacemaker implantations were detected in 9.4%. A ventricular tachycardia was observed in one patient (1.6%).</AbstractText>In this group of patients with cryptogenic stroke the rate of arrhythmic events was high. Besides a high rate of atrial fibrillation (25%), an unexpectedly high rate of bradyarrhythmias (9.4%) occurred in our patient collective. Since many of those episodes were clinically asymptomatic, the ILR helps to detect and treat those clinically silent arrhythmias.</AbstractText>Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,744 | Correction: Seasonality of ventricular fibrillation at first myocardial infarction and association with viral exposure. | [This corrects the article DOI: 10.1371/journal.pone.0226936.]. |
16,745 | Factor Xa inhibitors in patients with continuous-flow left ventricular assist devices. | Warfarin is standard anticoagulation therapy for patients with a continuous-flow left ventricular assist device (CF-LVAD). However, warfarin requires regular monitoring and dosage adjustments and fails for many patients, causing thromboembolic and bleeding events. Factor Xa inhibitors have been shown to be noninferior to warfarin in preventing strokes and are associated with less intracranial hemorrhage in patients with atrial fibrillation. We evaluated treatment safety and effectiveness in CF-LVAD patients who switched from warfarin to a factor Xa inhibitor (apixaban or rivaroxaban) after warfarin failure.</AbstractText>This was a retrospective, single-center study of patients treated between 2008 and 2018. We assessed the occurrence of stroke, non-central nervous system (CNS) embolism, pump thrombosis, and major gastrointestinal bleeding and intracranial hemorrhage during therapy.</AbstractText>We identified seven patients: five were male, the average body mass index was 30 kg/m2</sup>, and average age was 56 years. Preimplantation comorbidities included hypertension (all patients) and diabetes mellitus, ischemic cardiomyopathy, atrial fibrillation, and previous myocardial infarction (four patients each). Overall, patients received warfarin for 3968 days and apixaban/rivaroxaban for 1459 days. The warfarin group was within the therapeutic INR range (2.0-3.0) 30% of the time. Complication rates did not differ between warfarin and apixaban/rivaroxaban: strokes, 0.20 vs none, non-CNS embolism, 0.54 vs none; pump thrombosis, 0.27 vs none; major gastrointestinal bleeding, 0.20 vs 0.50; intracranial hemorrhage, 0.13 vs none.</AbstractText>Factor Xa inhibitors may be viable treatment options for CF-LVAD patients for whom warfarin therapy has failed. Large prospective studies are necessary to confirm these results.</AbstractText> |
16,746 | Value of surface electrocardiography in His bundle pacing. | His bundle pacing (HBP) provides physiological ventricular activation and is frequently used to treat patients with bradyarrhythmias. HBP reduces the risk of developing heart failure and atrial fibrillation by preventing ventricular electromechanical dyssynchrony associated with conventional right ventricular pacing. There are two types of HBP, including selective (S-HBP) and non-selective HBP (NS-HBP). It is important to determine the type of HBP during implantation and follow-up. This review discusses the role of standard surface electrocardiography in differentiating S‑HBP and NS-HBP and diagnosing loss of His bundle capture. |
16,747 | Impact of Decreased Transmural Conduction Velocity on the Function of the Human Left Ventricle: A Simulation Study. | This study investigates the impact of reduced transmural conduction velocity (TCV) on output parameters of the human heart. In a healthy heart, the TCV contributes to synchronization of the onset of contraction in individual layers of the left ventricle (LV). However, it is unclear whether the clinically observed decrease of TCV contributes significantly to a reduction of LV contractility. The applied three-dimensional finite element model of isovolumic contraction of the human LV incorporates transmural gradients in electromechanical delay and myocyte shortening velocity and evaluates the impact of TCV reduction on pressure rise (namely, (<i>dP</i>/<i>dt</i>)<sub>max</sub>) and on isovolumic contraction duration (IVCD) in a healthy LV. The model outputs are further exploited in the lumped "Windkessel" model of the human cardiovascular system (based on electrohydrodynamic analogy of respective differential equations) to simulate the impact of changes of (<i>dP</i>/<i>dt</i>)<sub>max</sub> and IVCD on chosen systemic parameters (ejection fraction, LV power, cardiac output, and blood pressure). The simulations have shown that a 50% decrease in TCV prolongs substantially the isovolumic contraction, decelerates slightly the LV pressure rise, increases the LV energy consumption, and reduces the LV power. These negative effects increase progressively with further reduction of TCV. In conclusion, these results suggest that the pumping efficacy of the human LV decreases with lower TCV due to a higher energy consumption and lower LV power. Although the changes induced by the clinically relevant reduction of TCV are not critical for a healthy heart, they may represent an important factor limiting the heart function under disease conditions. |
16,748 | Distinguishing Ventricular Arrhythmias Originating from the Posterior Right Ventricular Outflow Tract, or Near the Right Coronary Cusp or Near the His-Bundle. | Differentiation of outflow tract ventricular arrhythmias (OT-VAs) which originate from the posterior right ventricular outflow tract (RVOT), right coronary cusp (RCC) or near the His-bundle are still a challenge until now. This study was aimed to develop a stepwise electrocardiogram (ECG) algorithm to distinguish their locations. Seventy-five consecutive patients with VAs successfully ablated from the posterior RVOT (n = 57), near the His-bundle (n = 5) or RCC (n = 13) were enrolled in our study. Measurements with highest diagnostic performance were chosen to develop a diagnostic algorithm. Of all these ECG measurements, the R-wave amplitude in lead I and V2S/V3R index showed the best diagnostic performance to discriminate these anatomical sites. The optimal ECG discriminators were different combination of lead I and V2S/V3R index as follows: the posterior RVOT, Lead I R-wave amplitude <0.65 mV and V2S/V3R index>1.5 (96.2% sensitivity, 69.6% specificity); the near the His-bundle, lead I R-wave amplitude ≥0.65 mV and V2S/V3R index>1.5 (100% sensitivity, 70% specificity); RCC, lead I R-wave amplitude<0.65 mV and V2S/V3R index ≤1.5 (52.9% sensitivity, 93.1% specificity). Sequential algorithmic application of these criteria resulted in an overall accuracy of 83% in predicting site of OT-VA origin. A predominantly positive R-wave in lead I is seen in OT-VAs originated near the His-bundle. A stepwise ECG algorithm of combination with R-wave amplitude in lead I and V2S/V3R index could localize the origins of OT-VAs from the posterior RVOT, near the His-bundle and the RCC with a high accuracy. |
16,749 | Long-term atrial arrhythmias incidence after heart transplantation. | Atrial arrhythmias after heart transplantation have rarely been investigated. The aim of this study is to assess incidence, type and predictors of atrial arrhythmias during a long-term follow-up in a large population of heart-transplanted patients.</AbstractText>Consecutive patients undergone to heart transplantation at our Centre from 1990 to 2017 were enrolled. All documented atrial arrhythmias were systematically reviewed during a long-term follow-up after heart transplantation. Atrial fibrillation (AF), atrial flutter and tachycardias were defined according to current guidelines.</AbstractText>Overall, 364 patients were included and followed for 120 ± 70 months. During the follow-up period 108 (29.7%) patients died and 3 (0.8%) underwent re-transplantation. Sinus rhythm was present in 355 (97.5%) patients. Nine patients had persistent atrial arrhythmias: 8 (2.2%) presented atypical flutter and one (0.3%) patient AF. Paroxysmal sustained arrhythmias were detected in 42 (11.5%) patients, always atrial flutters. At univariate analysis several echocardiographic (left ventricular end-diastolic diameter, TEI index, mitral and tricuspid regurgitation grade) hemodynamic (systolic and diastolic pulmonary pressure, capillary wedge pressure) and clinical (dyslipidaemia, weight, pacemaker implantation) parameters related to higher incidence of atrial arrhythmias.</AbstractText>Persistent atrial arrhythmias, and most of all AF, are rare among heart transplantation carriers, despite substantial comorbidities resulting in significant mortality. It can be speculated that the lesion set provided by the surgical technique, a complete and transmural electrical isolation of the posterior left atrium wall, represents an effective lesion set to prevent persistent AF.</AbstractText>Copyright © 2020. Published by Elsevier B.V.</CopyrightInformation> |
16,750 | Cardiac sympathetic denervation in patients with nonischemic cardiomyopathy and refractory ventricular arrhythmias: a single-center experience. | Cardiac sympathetic denervation (CSD) is an effective therapy for selected patients with drug refractory ventricular arrhythmias (VA). Data about the role of CSD in patients with structural heart disease and VAs are sparse. We herein present our experience of CSD in patients with nonischemic cardiomyopathy and VAs despite prior ablation procedure and/or antiarrhythmic drug (AAD) therapy.</AbstractText>A total of ten patients (mean age 61.6 ± 19.6, mean LVEF 29.5 ± 12.1%) with nonischemic dilated cardiomyopathy (NICM) (n = 9) and hypertrophic cardiomyopathy (HCM) (n = 1) underwent CSD (left sided in six and bilateral in four patients) due to refractory VA despite multiple AADs (mean number of AADs was 1.6 ± 0.7) and prior VT ablation (mean number of procedures per patient was 1.5 ± 1.3).</AbstractText>Mean follow-up was 10.1 ± 6.9 months. The median number of VA and ICD shocks decreased significantly from 9.0 and 2.5 episodes 6 months prior to CSD to 0 and 0 episodes within 6 months after CSD (p = 0.012 and p = 0.011). Five patients remained free from sustained VA recurrences. Two patients experienced single ICD shock due to a polymorphic VT (triggered by severe hypokalemia in one patient) and one patient a single shock due to monomorphic VT. One patient had five episodes of slow VT under amiodarone therapy (three of them terminated by antitachycardia pacing) and underwent endo- epicardial re-ablation. Two patients died 1 month after CSD. One of them due to electrical storm and cardiogenic shock and the second one due to refractory cardiogenic shock, without recurrence of VAs though. No major complications of CSD occurred. No patient suffered from Horner syndrome.</AbstractText>In this study, CSD was effective for treatment of VAs in patients with structural heart disease refractory to antiarrhythmic drugs and catheter ablation. Further larger studies are required to confirm these findings.</AbstractText> |
16,751 | Characterization of Atrial and Ventricular Structural Remodeling in a Porcine Model of Atrial Fibrillation Induced by Atrial Tachypacing. | <b>Background:</b> Atrial fibrillation (AF) is characterized by electrical and structural remodeling. Irregular and/or fast atrio-ventricular (AV) conduction during AF can result in AV dyssynchrony, tachymyopathy, pressure and volume overload with subsequent dilatation, valve regurgitation, and ventricular dysfunction with progression to heart failure. <b>Objective:</b> To gain further insight into the myocardial pathophysiological changes induced by right atrial tachypacing (A-TP) in a large animal model. <b>Methods:</b> A total of 28 Landrace pigs were randomized as 14 into AF-induced A-TP group and 14 pigs to control group. AF pigs were tachypaced for 43 ± 4 days until in sustained AF. Functional remodeling was investigated by echocardiography (after cardioversion to sinus rhythm). Structural remodeling was quantified by histological preparations with picrosirius red and immunohistochemical stainings. <b>Results:</b> A-TP resulted in decreased left ventricular ejection fraction (LVEF) accompanied by increased end-diastolic and end-systolic left atrium (LA) volume and area. In addition, A-TP was associated with mitral valve (MV) regurgitation, diastolic dysfunction and increased atrial and ventricular fibrotic extracellular matrix (ECM). <b>Conclusions:</b> A-TP induced AF with concomitant LV systolic and diastolic dysfunction, increased LA volume and area, and atrial and ventricular fibrosis. |
16,752 | Computational Study to Identify the Effects of the KCNJ2 E299V Mutation in Cardiac Pumping Capacity. | The KCNJ2 gene mutations induce short QT syndrome (SQT3) by directly increasing the <i>I</i> <sub>K1</sub> current. There have been many studies on the electrophysiological effects of mutations such as the KCNJ2 D172N that cause the SQT3. However, the KCNJ2 E299V mutation is distinguished from other representative gene mutations that can induce the short QT syndrome (SQT3) in that it increased <i>I</i> <sub>K1</sub> current by impairing the inward rectification of K<sup>+</sup> channels. The studies of the electromechanical effects on myocardial cells and mechanisms of E299V mutations are limited. Therefore, we investigated the electrophysiological changes and the concomitant mechanical responses according to the expression levels of the KCNJ2 E299V mutation during sinus rhythm and ventricular fibrillation. We performed excitation-contraction coupling simulations using a human ventricular model with both electrophysiological and mechanical properties. In order to observe the electromechanical changes due to the expression of KCNJ2 E299V mutation, the simulations were performed under normal condition (WT), heterogeneous mutation condition (WT/E299V), and pure mutation condition (E299V). First, a single-cell simulation was performed in three types of ventricular cells (endocardial cell, midmyocardial cell, and epicardial cell) to confirm the electrophysiological changes and arrhythmogenesis caused by the KCNJ2 E299V mutation. In three-dimensional sinus rhythm simulations, we compared electrical changes and the corresponding changes in mechanical performance caused by the expression level of E299V mutation. Then, we observed the electromechanical properties of the E299V mutation during ventricular fibrillation using the three-dimensional reentry simulation. The KCNJ2 E299V mutation accelerated the opening of the <i>I</i> <sub>K1</sub> channel and increased <i>I</i> <sub>K1</sub> current, resulting in a decrease in action potential duration. Accordingly, the QT interval was reduced by 48% and 60% compared to the WT condition, for the WT/E299V and E299V conditions, respectively. During sustained reentry, the wavelength was reduced due to the KCNJ2 E299V mutation. Furthermore, there was almost no ventricular contraction in both WT/E299V and E299V conditions. We concluded that in both sinus rhythm and fibrillation, the KCNJ2 E299V mutation results in very low contractility regardless of the expression level of mutation and increases the risk of cardiac arrest and cardiac death. |
16,753 | Awake and aware with ongoing ventricular fibrillation during LVAD treatment: is it possible? | Left ventricular assist devices (LVADs) are currently used as destination therapy or bridge to heart transplantation in patients with advanced chronic heart failure (CHF). It has been proved to reduce mortality and symptoms in these patients. Patients with advanced CHF are known to have increased risk of ventricular arrhythmias (ventricular tachycardia or ventricular fibrillation (VF)) despite the presence of LVAD. We report the case of patients with ongoing VF during LVAD treatment while being awake and aware. We discuss the challenges introduced along with the increasing use of LVAD treatment. The decision whether a patient with LVAD automatically should have an implantable cardioverter-defibrillator is challenging. Randomised trials are warranted to shed light on these challenging decisions. |
16,754 | Management of Arrhythmias in Cardiac Amyloidosis. | Cardiac amyloidosis is characterized by extracellular protein fibril deposition in the myocardium leading to restrictive heart failure. Both atrial and ventricular arrhythmias, along with conduction disease, are common in cardiac amyloidosis, and are often highly symptomatic and poorly tolerated. Many commonly used therapeutics such as beta-blockers, calcium-channel blockers, and digoxin may be poorly tolerated and lead to clinical decompensation in this population, adding complexity to the co-management of these conditions. In addition, studies have shown that atrial fibrillation with cardiac amyloidosis carries a high risk of stroke and systemic embolism, making anticoagulation indicated in all patients regardless of CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Ventricular arrhythmias are common, whereas an implantable cardioverter-defibrillator has not been shown to improve survival. Conduction disease is also common and permanent pacemaker placement is often needed. High-quality evidence and guideline recommendations are limited with regard to the management of arrhythmias in cardiac amyloidosis. Providers are often left to clinical experience and expert consensus to aid in decision-making. In this focused review, we outline current guideline recommendations, summarize both historical and contemporary data, and describe evidence-based strategies for managing arrhythmias and their sequelae in patients with cardiac amyloidosis. |
16,755 | Pro-Arrhythmic Signaling of Thyroid Hormones and Its Relevance in Subclinical Hyperthyroidism. | A perennial task is to prevent the occurrence and/or recurrence of most frequent or life-threatening cardiac arrhythmias such as atrial fibrillation (AF) and ventricular fibrillation (VF). VF may be lethal in cases without an implantable cardioverter defibrillator or with failure of this device. Incidences of AF, even the asymptomatic ones, jeopardize the patient's life due to its complication, notably the high risk of embolic stroke. Therefore, there has been a growing interest in subclinical AF screening and searching for novel electrophysiological and molecular markers. Considering the worldwide increase in cases of thyroid dysfunction and diseases, including thyroid carcinoma, we aimed to explore the implication of thyroid hormones in pro-arrhythmic signaling in the pathophysiological setting. The present review provides updated information about the impact of altered thyroid status on both the occurrence and recurrence of cardiac arrhythmias, predominantly AF. Moreover, it emphasizes the importance of both thyroid status monitoring and AF screening in the general population, as well as in patients with thyroid dysfunction and malignancies. Real-world data on early AF identification in relation to thyroid function are scarce. Even though symptomatic AF is rare in patients with thyroid malignancies, who are under thyroid suppressive therapy, clinicians should be aware of potential interaction with asymptomatic AF. It may prevent adverse consequences and improve the quality of life. This issue may be challenging for an updated registry of AF in clinical practice. Thyroid hormones should be considered a biomarker for cardiac arrhythmias screening and their tailored management because of their multifaceted cellular actions. |
16,756 | Validation of quantitative measure of repolarization reserve as a novel marker of drug induced proarrhythmia. | Repolarization reserve, the robustness of a cell to repolarize even when one of the repolarization mechanisms is failing, has been described qualitatively in terms of ionic currents, but has not been quantified by a generic metric that is applicable to drug screening. Prolonged repolarization leading to repolarization failure is highly arrhythmogenic. It may lead to ventricular tachycardia caused by triggered activity from early afterdepolarizations (EADs), or it may promote the occurrence of unidirectional conduction block and reentry. Both types of arrhythmia may deteriorate into ventricular fibrillation (VF) and death. We define the Repolarization Reserve Current (RRC) as the minimum constant current necessary to prevent normal repolarization of a cell. After developing and testing RRC for nine computational ionic models of various species, we applied it experimentally to atrial and ventricular human induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM), and isolated guinea-pig ventricular cardiomyocytes. In simulations, repolarization was all-or-none with a precise, model-dependent critical RRC, resulting in a discrete shift in the Action Potential Duration (APD) - RRC relation, in the occurrence of EADs and repolarization failure. These data were faithfully reproduced in cellular experiments. RRC allows simple, fast, unambiguous quantification of the arrhythmogenic propensity in cardiac cells of various origins and species without the need of prior knowledge of underlying currents and is suitable for high throughput applications, and personalized medicine applications. |
16,757 | SCN5A mutation identified in a patient with short-coupled variant of torsades de pointes. | Short-coupled variant of torsades de pointes (scTdP) is a disease characterized by TdP without QT prolongation, which is initiated by extremely short-coupled ventricular extra-systoles. Its genetic background remains rarely unveiled.</AbstractText>We aimed to identify genetic variations in patients with scTdP and to analyze the functional change of the mutant Na+</sup> channel identified in a scTdP patient.</AbstractText>We performed genetic analysis for inherited arrhythmia-related 45 genes using next-generation sequencer (MiSeq, Illumina) among seven consecutive scTdP patients. We identified an SCN5A mutation R800H in a 38-year-old male who suffered ventricular fibrillation during dinner and was resuscitated. Two months later, he lost his consciousness at work. His Holter electrocardiogram showed scTdP. He had no family history of sudden cardiac death or heart disease. Functional analysis of the SCN5A-R800H channels showed a significantly shortened recovery time from inactivation. Peak sodium current densities in SCN5A-R800H were larger than those in wild type but the difference was not statistically significant.</AbstractText>We identified an SCN5A mutation in a scTdP patient and confirmed that the mutant channel caused the shortness of recovery time from inactivation. SCN5A might be a candidate gene for scTdP.</AbstractText>© 2020 Wiley Periodicals, Inc.</CopyrightInformation> |
16,758 | Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death. | There is limited data on the experience with insertable cardiac monitors (ICMs) in patients with Brugada syndrome.</AbstractText>To evaluate the outcome of ICM in symptomatic patients with Brugada syndrome who are at suspected low risk of sudden cardiac death (SCD).</AbstractText>We conducted a prospective single-center cohort study including all symptomatic patients with Brugada syndrome who received an ICM (Reveal LINQ) between July 2014 and October 2019. The main indication for monitoring was to exclude ventricular arrhythmias as the cause of symptoms and to establish a symptom-rhythm relationship.</AbstractText>A total of 20 patients (mean age, 39 ± 12 years; 55% male) received an ICM during the study period. Nine patients (45%) had a history of syncope (presumed nonarrhythmogenic), and 5 patients had a recent syncope (<6 months). During a median follow-up of 32 months (interquartile range, 11-36 months), 3 patients (15%) experienced an episode of nonsustained ventricular arrhythmia. No patient died suddenly or experienced a sustained ventricular arrhythmia, and no patient had a recurrence of syncope. Overall, 17 patients (85%) experienced symptoms during follow-up, of whom 10 patients had an ICM-detected arrhythmia. In 4 patients (20%), the ICM-detected arrhythmia was an actionable event. ICM-guided management included antiarrhythmic drug therapy for symptomatic ectopic beats (n = 3), pulmonary vein isolation, and oral anticoagulation for atrial fibrillation (n = 1), electrophysiological study for risk stratification (n = 1), and pacemaker implantation for atrioventricular block (n = 1).</AbstractText>An ICM can be used to exclude ventricular arrhythmias in symptomatic patients with Brugada syndrome at low risk of SCD. Furthermore, an ICM-detected arrhythmia changed clinical management in 20% of patients.</AbstractText>© 2020 The Author(s) Published by S. Karger AG, Basel.</CopyrightInformation> |
16,759 | Prevalence of atrial FDG uptake and association with atrial arrhythmias in patients with cardiac sarcoidosis. | There is increasing evidence that a proportion of patients with cardiac sarcoidosis (CS) have atrial arrhythmias (AA). Although 18F-fluorodeoxy-glucose (FDG) uptake in the ventricle on positron emission tomography/computed tomography (PET/CT) is well studied, FDG uptake in the atrium has not been elucidated in detail.</AbstractText>To evaluate FDG uptake in the atrium and its relationship with AA in patients with CS.</AbstractText>We retrospectively investigated 62 CS patients. All patients underwent echocardiography and PET/CT. Serum angiotensin converting enzyme (ACE) and soluble IL-2 receptor (sIL-2R) levels, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations were also evaluated. ECG, Holter monitoring and device interrogations were used to detect AA.</AbstractText>Of the studied population, 25 patients (40.3%) had AA, of which 2 patients had atrial tachycardia (AT) and 23 patients had atrial fibrillation (AF). Eighteen patients with AA had atrial FDG uptake on PET/CT, whereas 14 patients without AA had atrial FDG uptake (72.0% vs 37.8%, P = 0.017). Multivariate analysis revealed a significant association between AA and age (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.01-1.31, P = 0.040), atrial FDG uptake (odds ratio [OR]: 7.23; 95% confidence interval [CI]: 1.91-27.36, P = 0.004), and left atrial diameter (OR: 1.08; 95% CI: 1.01-1.16, P = 0.027). Meanwhile, gender, serum ACE and BNP levels, and left ventricular ejection fraction were not associated with AA.</AbstractText>Atrial FDG uptake was common in patients with CS and strongly associated with AA.</AbstractText>Copyright © 2020 Elsevier B.V. All rights reserved.</CopyrightInformation> |
16,760 | Underdiagnosis of VT due to cycle length variation among cardiac sarcoidosis patients having ICD: Problem with stability discriminator. | Implantable cardioverter defibrillator (ICD) is recommended for patients with ventricular tachycardia (VT) due to cardiac sarcoidosis (CS). Programming supraventricular tachycardia (SVT) discriminators (onset, stability, and morphology/template match) is generally recommended to minimize inappropriate therapies. However, VT in patients with CS is known to show cycle length variability (CLV) and pleomorphism.</AbstractText>To determine whether the stability criterion, designed to prevent inappropriate therapy during atrial fibrillation with rapid ventricular rates, could potentially lead to incorrect classification of VT as SVT and inappropriately delay or inhibit ICD therapy.</AbstractText>Cases of biopsy-proven CS with VT were analyzed. For patients with implanted devices, all recorded electrograms of tachycardia episodes and ICD therapies were analyzed at last follow up.</AbstractText>A total of 142 patients were included (mean age 38 years, 87 males). One hundred and three of 142 patients had implanted devices (ICD or CRT-D). Thirty eight of 103 (36.9%) patients received appropriate ICD therapies over 3 ± 2.2 years follow up. Four of 38 (10.5%) of patients experienced delayed-detection or underdetection of VT related to CLV, resulting in VT counters being repeatedly "reset" (classified as "unstable" rhythms). Retrospective analysis of other VT episodes in 70 of 103 (68%) patients revealed that 25 of 80 (31.3%) episodes had > 50 ms cycle length oscillations.</AbstractText>Among CS patients with VT, CLV is a common occurrence seen in two-thirds of VT episodes. Routine programming of the stability criterion may result in underdetection of VT in a subset of such patients. We recommend that the stability criterion should be programmed "OFF" for patients with CS, unless the patient has documented atrial fibrillation.</AbstractText>© 2020 Wiley Periodicals LLC.</CopyrightInformation> |
16,761 | Determinants of cerebral radiological progression in Fabry disease. | It is unclear which patients with Fabry disease (FD) are at risk for progression of white matter lesions (WMLs) and brain infarctions and whether enzyme replacement therapy (ERT) changes this risk. The aim of this study was to determine the effect of ERT and clinical characteristics on progression of WMLs and infarctions on MRI in patients with FD.</AbstractText>MRIs were assessed for WMLs (Fazekas scale), infarctions and basilar artery diameter (BAD). The effect of clinical characteristics (renal and cardiac involvement, cardiovascular risk factors, cardiac complications, BAD) and ERT on WML and infarction progression was evaluated using mixed models.</AbstractText>One hundred forty-nine patients were included (median age: 39 years, 38% men, 79% classical phenotype). Median follow-up time was 7 years (range: 0-13 years) with a median number of MRIs per patient of 5 (range: 1-14), resulting in a total of 852 scans. Variables independently associated with WML and infarction progression were age, male sex and a classical phenotype. Progression of WMLs and infarctions was not affected by adding ERT to the model, neither for the whole group, nor for early treated patients. Progression was highly variable among patients which could not be explained by other known variables such as hypertension, cholesterol, atrial fibrillation and changes in kidney function, left ventricular mass or BAD.</AbstractText>Progression of WMLs and cerebral infarctions in FD is mainly related to age, sex and phenotype. Additional effects of established cardiovascular risk factors, organ involvement and treatment with ERT are probably small to negligible.</AbstractText>© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation> |
16,762 | Resting Cardiac Efficiency Affects Survival Following Transcatheter Aortic Valve Replacement. | Cardiac power to left ventricular mass (LVM) ratio, also termed cardiac efficiency (CE), reflects the rate of cardiac work delivered to the potential energy stored in LVM. We sought to assess the association between baseline resting CE and survival post transcatheter aortic valve replacement (TAVR).</AbstractText>We retrospectively extracted data of patients who received TAVR in the Mayo Clinic Foundation with follow up data available at 1 year. Cardiac output was measured using Doppler echocardiography at baseline. CE was calculated using the formula, (cardiac output × mean arterial blood pressure)/(451 × LVM × 100) W/100 g. Survival score analysis was performed to identify cut off value for CE to identify the maximum difference in mortality in the study cohort. Patients were subsequently divided into 2 groups CE < 0.38 W/100 g and CE ≥ 0.38 W/100 g. Survival was determined using Kaplan-Meier method.</AbstractText>We included 954 patients in the final analysis. CE in group1 vs group 2 was 0.31 ± 0.05 W/100 g vs 0.59 ± 0.18 W/100 g. Patients in group1 were more likely to be male, had a higher prevalence of atrial fibrillation, prior myocardial infarction, mitral and tricuspid regurgitation. They also had a higher STS risk score, NYHA functional class, and lower aortic valve area. The remainder of the baseline characteristics was similar in both groups. A lower CE was associated with higher 1-year mortality following TAVR based on multivariate analysis. (Group1: 22.18% vs Group 2: 9.89%, p < .0001).</AbstractText>In our cohort, a low baseline CE (<0.38 W/100 g) conferred higher mortality risk following TAVR.</AbstractText>Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,763 | The ratio of circulating endothelin-1 to endothelin-3 associated with TIMI risk and dynamic TIMI risk score in ST elevation acute myocardial infarction. | In ST segment elevation acute myocardial infarction (STEMI), the endothelin (ET) system imbalance, reflected by the circulating ET-1:ET-3 ratio has not been investigated. This study's primary objective was to measure the circulating ET-1:ET-3 ratio and correlate it with the risk stratification for 1 year mortality of STEMI based on TIMI score. On admission, the TIMI risk score and at discharge, the dynamic TIMI risk score were calculated in 68 consecutive subjects with STEMI. Subjects with high TIMI risk score were associated with higher mean ET-1 level and ET-1:ET-3 ratio. The ET-1:ET-3 ratio more accurately predicted the high on admission TIMI risk score than the ET-1 level. Subjects with high dynamic TIMI risk score were associated with higher mean ET-1 level and ET-1:ET-3 ratio. The ET-1:ET-3 ratio more accurately predicted the high at discharge dynamic TIMI risk score than ET-1 level. From multivariable analysis, the ET-1:ET-3 ratio was not independently associated with high on admission TIMI risk score but independently predicted high at discharge dynamic TIMI risk score (odds ratio = 9.186, <i>p</i> = 0.018). In conclusion, combining the ET-1 and ET-3 levels into the ET-1:ET-3 ratio provided a prognostic value by independently predicting the increased risk to 1 year mortality as indicated by at discharge dynamic TIMI risk score in patients with STEMI. |
16,764 | [Clinical features and prognosis of patients with different types of heart failure in relation to coronary artery disease]. | <b>Objective:</b> To analyze whether there is a difference in the influence of coronary artery disease (CAD) on the clinical features and prognosis of three different types of heart failure patients. <b>Methods:</b> Complete clinical data of 1 520 hospitalized patients with heart failure from Tianjin Medical University General Hospital and Tianjin Chest Hospital from March 2014 to February 2016 was retrospectively reviewed. According to left ventricular ejection fraction (LVEF), the patients were divided into three groups: heart failure with reduced ejection fraction group (HFrEF), heart failure with mid-range ejection fraction group (HFmrEF)and heart failure with preserved ejection fraction group (HFpEF). Each group was further classified into two subgroups according to absence or presence of CAD (No CAD' and 'With CAD'). In the HFrEF group, 197 patients were categorized into 'No CAD' sub-group while 435 patients were into 'With CAD' sub-group. Likewise, 63 patients in HFmrEF group fell into 'No CAD' sub-group while 367 were into 'With CAD' sub-group. Seventy two patients in the HFpEF group were in the 'No CAD' sub-group with 386 in the 'With CAD' sub-group. Clinical features and 2-year prognosis between different subgroups were compared. <b>Results:</b> (1) The relationship between CAD and clinical features of different types of heart failure: the proportions of HFrEF, HFmrEF and HFpEF combined with CAD were 68.8%, 85.3% and 84.3%, respectively (<i>P<</i>0.05). Compared with the 'No CAD' subgroups, patients in the 'With CAD' subgroups were older, and had higher NT-proBNP levels, higher rates of hypertension and diabetes, and lower rates of atrial fibrillation. Also, there were more use of antiplatelet and nitrate drugs in the 'With CAD' sub-groups (<i>P<</i>0.05). (2) Risk of different types of heart failure combined with CAD: after multivariate adjustment, HFrEF had a lower risk of CAD (HFrEF vs HFmrEF: <i>RR=</i>0.389, 95<i>%CI</i> 0.281-0.540; HFrEF vs HFpEF: <i>RR=</i>0.408, 95<i>%CI</i> 0.298-0.560). (3)The influence of CAD on the prognosis of different types of heart failure: CAD increased the risk of mortality in the HFrEF group (<i>HR</i>=1.631, 95<i>%CI</i> 1.119-2.377), and cardiovascular events in all three types of heart failure (<i>HR</i>: HFrEF 1.725, 95<i>%CI</i> 1.325-2.246; HFmrEF 1.815, 95<i>%CI</i> 1.144-2.879; HFpEF 1.900, 95<i>%CI</i> 1.218-2.963). <b>Conclusions:</b> Patients with HFmrEF and HFpEF have a higher prevalence and risk of CAD than patients with HFrEF. CAD is associated with an increased risk of cardiovascular events in all types of heart failure and increases the risk of all-cause mortality among HFrEF group. CAD is an important factor influencing the clinical features and prognosis of patients with all types of heart failure.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Zhou</LastName><ForeName>Y</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Tianjin Medical University General Hospital, Tianjin 300052, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mo</LastName><ForeName>T</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Tianjin Medical University General Hospital, Tianjin 300052, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bao</LastName><ForeName>Y P</ForeName><Initials>YP</Initials><AffiliationInfo><Affiliation>Tianjin Medical University General Hospital, Tianjin 300052, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>L</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Tianjin Medical University General Hospital, Tianjin 300052, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zhong</LastName><ForeName>R R</ForeName><Initials>RR</Initials><AffiliationInfo><Affiliation>Tianjin Medical University General Hospital, Tianjin 300052, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tian</LastName><ForeName>J L</ForeName><Initials>JL</Initials><AffiliationInfo><Affiliation>Tianjin Medical University General Hospital, Tianjin 300052, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>chi</Language><GrantList CompleteYN="Y"><Grant><GrantID>20150011</GrantID><Agency>Medical Key Fund Project of Tianjin Heart Association</Agency><Country/></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Zhonghua Yi Xue Za Zhi</MedlineTA><NlmUniqueID>7511141</NlmUniqueID><ISSNLinking>0376-2491</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D003324" MajorTopicYN="Y">Coronary Artery Disease</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006333" MajorTopicYN="Y">Heart Failure</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011379" MajorTopicYN="N">Prognosis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013318" MajorTopicYN="N">Stroke Volume</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016277" MajorTopicYN="N">Ventricular Function, Left</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 分析冠心病（CAD）对三种不同类型心力衰竭（简称心衰）患者临床特征及预后的影响是否存在差异。 <b>方法：</b> 采用回顾性队列研究方法，纳入天津医科大学总医院和天津胸科医院两所医院2014年3月至2016年2月期间以心衰为主要病因、NYHA心功能分级Ⅱ-Ⅳ、且临床资料完整的住院心衰患者资料，共计1 520例。按照左室射血分数（LVEF）不同分为射血分数减低心衰（HFrEF；LVEF<40%）、射血分数中间值心衰（HFmrEF；LVEF40%~49%）和射血分数保留心衰（HFpEF；LVEF≥50%）3组，每组根据是否合并CAD再各分两个亚组，其中，HFrEF不合并CAD组197例，HFrEF合并CAD组435例，HFmrEF不合并CAD组63例，HFmrEF合并CAD组367例，HFpEF不合并CAD组72例，HFpEF合并CAD组386例。比较各类型心衰不同亚组间临床特征及2年预后差异。 <b>结果：</b> （1）CAD与不同类型心衰临床特征的关系：HFrEF、HFmrEF和HFpEF合并CAD的比率分别为68.8%、85.3%和84.3%（<i>P<</i>0.05）；与不合并CAD亚组相比，三个合并CAD亚组年龄更大，NT-proBNP水平更高，同时合并高血压、糖尿病的比率更高，合并房颤比率更低，更多使用抗血小板和硝酸酯类药物（均<i>P<</i>0.05）。（2）不同类型心衰合并CAD的风险：经多变量调整后，HFrEF有较低的患CAD的风险[HFrEF比HFmrEF：风险比（<i>RR</i>）=0.389，95<i>%CI</i> 0.281~0.540；HFrEF比HFpEF：<i>RR=</i>0.408，95<i>%CI</i> 0.298~0.560]。（3）CAD对不同类型心衰预后的影响：CAD增加了HFrEF组的全因死亡风险（<i>HR</i>=1.631，95<i>%CI</i> 1.119~2.377），CAD增加了所有3个类型心衰的心血管事件的风险（<i>HR</i>分别为：HFrEF 1.725，95<i>%CI</i> 1.325~2.246；HFmrEF 1.815，95<i>%CI</i> 1.144~2.879；HFpEF 1.900，95<i>%CI</i> 1.218~2.963）。 <b>结论：</b> HFmrEF和HFpEF患者较HFrEF患者有更高的CAD的患病率及患病风险，CAD与所有类型的心衰的心血管事件的风险增加相关，并且增加了HFrEF的全因死亡风险。CAD是各种类型心衰患者临床特征及预后的重要影响因素。. |
16,765 | Improvement in sudden cardiac death risk prediction by the enhanced American College of Cardiology/American Heart Association strategy in Chinese patients with hypertrophic cardiomyopathy. | The lack of validated and effective sudden cardiac death (SCD) risk prediction methods is the biggest barrier to perform the lifesaving treatment with a prophylactic implantable cardioverter-defibrillator in Chinese patients with hypertrophic cardiomyopathy (HCM).</AbstractText>This study aimed to evaluate the efficacy of 3 existing SCD risk prediction methods recommended by the 2011 American College of Cardiology Foundation and American Heart Association (ACCF/AHA) guideline, the 2014 European Society of Cardiology (ESC) guideline, and the 2019 enhanced American College of Cardiology (ACC)/AHA strategy in Chinese patients with HCM.</AbstractText>The present study consisted of 1369 consecutive adult patients with HCM without a history of SCD events. The primary end point was a composite of SCD and equivalent events, namely, resuscitation from cardiac arrest and appropriate implantable cardioverter-defibrillator shock therapy for ventricular tachycardia or fibrillation.</AbstractText>During follow-up of 3.2 ± 2.4 years, 39 patients reached SCD end points, of whom 26 (66.7%) were correctly predicted as those at a high risk of SCD by using methods recommended by the 2019 enhanced ACC/AHA strategy, 20 (51.3%) by the 2011 ACCF/AHA guideline, but only 5 (12.8%) by the 2014 ESC guideline. The 2019 enhanced ACC/AHA strategy showed a higher C-statistic (0.647) for SCD prediction than did the 2011 ACCF/AHA guideline (0.598) and 2014 ESC guideline (0.605) and resulted in the correct reclassification of SCD risk when compared with the 2011 ACCF/AHA guideline (net reclassification index 0.113; P = .074) and 2014 ESC guideline (net reclassification index 0.245; P = .038).</AbstractText>The 2019 enhanced ACC/AHA strategy showed better predictive performance for SCD risk stratification in Chinese patients with HCM, with a notably high sensitivity.</AbstractText>Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,766 | Evaluating the Therapeutic Efficacy and Safety of Landiolol Hydrochloride for Management of Arrhythmia in Critical Settings: Review of the Literature. | Landiolol hydrochloride, a highly cardio-selective beta-1 blocker with an ultra-short-acting half-life of 4 minutes, was originally approved by Japan for treatment of intraoperative tachyarrhythmias. This review aims to provide an integrated overview of the current state of knowledge of landiolol hydrochloride in the management of arrhythmia in critical settings.</AbstractText>We searched MEDLINE, EMBASE, and the Cochrane Library to retrieve relevant articles with a total of 65 records identified.</AbstractText>The high β1 selectivity (β1/β2 ratio of 255:1) of landiolol causes a more rapid heart rate (HR) decrease compared to esmolol while avoiding decreases in mean arterial blood pressure. Recently, it has been found useful in left ventricular dysfunction patients and fatal arrhythmia requiring emergency treatment. Recent random clinical trials (RCT) have revealed therapeutic and prophylactic effects on arrhythmia, and very low-dose landiolol might be effective for preventing postoperative atrial fibrillation (POAF) and sinus tachycardia. Likewise, landiolol is an optimal choice for perioperative tachycardia treatment during cardiac surgery. The high β1 selectivity of landiolol is useful in heart failure patients as a first-line therapy for tachycardia and arrhythmia as it avoids the typical depression of cardiac function seen in other β-blockers. Application in cardiac injury after percutaneous coronary intervention (PCI), protection for vital organs (lung, kidney, etc.) during sepsis, and stabilizing hemodynamics in pediatric patients are becoming the new frontier of landiolol use.</AbstractText>Landiolol is useful as a first-line therapy for the prevention of POAF after cardiac/non-cardiac surgery, fatal arrhythmias in heart failure patients and during PCI. Moreover, the potential therapeutic effect of landiolol for sepsis in pediatric patients is currently being explored. As positive RCT results continue to be published, new clinical uses and further clinical studies in various settings by cardiologists, intensivists and pediatric cardiologists are being conducted.</AbstractText>© 2020 Matsuishi et al.</CopyrightInformation> |
16,767 | Burden of Arrhythmias in Acute Myocardial Infarction Complicated by Cardiogenic Shock. | There are limited data on arrhythmias in acute myocardial infarction with cardiogenic shock (AMI-CS). Using a 17-year AMI-CS population from the National Inpatient Sample, we identified common arrhythmias - atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, and atrioventricular blocks (AVB). Admissions with concomitant cardiac surgery were excluded. Outcomes of interest included temporal trends, predictors, in-hospital mortality, and resource utilization in cohorts with and without arrhythmias. Of the 420,319 admissions with AMI-CS during 2000 to 2016, arrhythmias were noted in 213,718 (51%). AF (45%), ventricular tachycardia (35%) and ventricular fibrillation (30%) were the most common arrhythmias. Compared with those without, the cohort w`ith arrhythmias was more often male, of white race, with ST-segment elevation AMI-CS presentation, and had higher rates of cardiac arrest and acute organ failure (all p <0.001). Temporal trends of prevalence revealed a stable trend of atrial and ventricular arrhythmias and declining trend in AVB. The cohort with arrhythmias had higher unadjusted (42% vs 41%; odds ratio [OR] 1.03 [95% confidence interval 1.02 to 1.05]; p <0.001), but not adjusted (OR 1.01 [95% CI 0.99 to 1.03]; p = 0.22) in-hospital mortality compared with those without. The cohort with arrhythmias had longer hospital stay (9 ± 10 vs 7 ± 9 days; p <0.001) and higher hospitalization costs ($124,000 ± 146,000 vs $91,000 ± 115,000; p <0.001). In the cohort with arrhythmias, older age, female sex, non-white race, higher co-morbidity, presence of acute organ failure, and cardiac arrest, predicted higher in-hospital mortality. In conclusion, cardiac arrhythmias in AMI-CS are a marker of higher illness severity and are associated with greater resource utilization. |
16,768 | Risk Factors for the Development of Functional Tricuspid Regurgitation and Their Population-Attributable Fractions. | The objective of this study was to determine risk factors for progression to hemodynamically significant tricuspid regurgitation (TR) and the population burden attributable to these risk factors.</AbstractText>Few data are available with regard to risk factors associated with the development of hemodynamically significant functional TR.</AbstractText>A total of 1,552 subjects were studied beginning with an index echocardiogram demonstrating trivial or mild TR. Risk factors for progression to moderate or severe TR were determined by using logistic regression and classification trees. Population attributable fractions were calculated for each risk factor.</AbstractText>During a median follow-up time of 38 (interquartile range [IQR]: 26 to 63) months, 292 patients (18.8%) developed moderate/severe TR. Independent predictors of TR progression were age, female sex, heart failure, pacemaker electrode, atrial fibrillation (AF), and indicators of left heart disease, including left atrial (LA) enlargement, elevated pulmonary artery pressure (PAP), and left-sided valvular disease. Classification and regression tree analysis demonstrated that the strongest predictors of TR progression were PAP of ≥36 mm Hg, LA enlargement, age ≥60 years, and AF. In the absence of these 4 risk factors, progression to moderate or severe TR occurred in ∼3% of patients. Age (28.4%) and PAP (20.5%) carried the highest population-attributable fractions for TR progression. In patients with TR progression, there was a marked concomitant increase of incident cases of elevated PAP (40%); mitral and aortic valve intervention (12%); reductions in left ventricular ejection fraction (19%), and new AF (32%) (all p < 0.01).</AbstractText>TR progression is determined mainly by markers of increased left-sided filling pressures (PAP and LA enlargement), AF, and age. At the population level, age and PAP are the most important contributors to the burden of significant TR. TR progression entails a marked parallel increase in the severity of left-sided heart disease.</AbstractText>Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,769 | Unplanned Thirty-Day Readmission After Alcohol Septal Ablation for Hypertrophic Cardiomyopathy (From the Nationwide Readmission Database). | Alcohol septal ablation (ASA) is indicated for symptomatic hypertrophic cardiomyopathy (HC) patients. We sought to analyze the incidence of the 30-day readmission rate, predictors, causes of readmission, and incremental healthcare resource (cost and length of stay) utilization after ASA. Nationwide Readmission Database from 2010 January to 2015 September was queried to identify 30-day unplanned readmission after ASA for HC by using the International Classification of Disease, 9th Revision, Clinical Modification. Those readmitted were similar in terms of age and sex but had higher burden of co-morbidities compared with those not readmitted within 30-days. The 30-day unplanned readmission rate was 10.4% (511/4,932) after ASA. Readmissions lead to an additional mean hospitalization cost of 8,433 US dollars and mean of 4.9 days of length of stay. Predictors of 30-day unplanned readmission were liver disease (adjusted odds ratio [aOR] 2.62, 95% confidence interval [CI] 1.22 to 5.59), renal failure (aOR 2.30, 95%CI 1.52 to 3.50), previous myocardial infarction (aOR 1.97, 95%CI 1.16 to 3.33), previous pacemaker (aOR 1.50, 95%CI 1.09 to 2.08), atrial fibrillation (aOR 1.43, 95%CI 1.08 to 1.89), Medicaid (aOR 1.74, 95%CI 1.12 to 2.68), and weekend admission (aOR 1.75, 95%CI 1.12 to 2.75). Common reasons for readmissions were atrial fibrillation (12.6%), acute on chronic systolic heart failure (12.6%), paroxysmal ventricular tachycardia (6.4%), atrioventricular block (4.9%), and HC (3.0%). Unplanned readmissions after ASA occur in patients with higher burden of co-morbidities and are mainly caused by cardiac etiologies. |
16,770 | Single Coil Implantable Cardioverter Defibrillator Leads in Patients With Hypertrophic Cardiomyopathy. | Patients with hypertrophic cardiomyopathy (HC) may require higher energies to terminate ventricular fibrillation (VF); thus, dual coil defibrillation leads are often implanted. However, single coil leads may be preferred in young patients. All patients with HCM implanted with a transvenous ICD from years 2000 to 2014 were included. Of 249 patients, 223 underwent VF testing including 150 with a dual coil lead and 73 a single coil. Patients tested with dual coil compared with single coil had lower successful VF energies (15.7 ± 6.1 joule to 20.2 ± 7.9 joule (p <0.0001)). Adequate safety margin for defibrillation was noted in 97.3% of patients. Notably, 6 (4 with single coil leads) had inadequate safety margins (defined as ≥10 joule). Three of these 6 patients required replacement of a single coil lead with a dual coil lead. The remaining 3 underwent waveform tilt alteration, higher energy ICD, or removal of the can from the shock vector. There were no clinical or implant predictors of inadequate safety margins. In follow-up of 16 ± 30 months (range 0 to 170), there were 24 arrhythmias including 13 VF, all successfully terminated. In conclusion, in HC patients undergoing ICD implantation, single coil leads can provide adequate safety margins. In conclusion, defibrillation testing should be considered in all HC patients undergoing ICD implantation, and should be performed in those undergoing implantation with a single coil lead. |
16,771 | Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial. | The primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).</AbstractText>Appropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics.</AbstractText>Participants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia).</AbstractText>Of the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results.</AbstractText>Improved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation.</AbstractText>NCT03127085.</AbstractText>© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation> |
16,772 | Usefulness of positive T wave in lead aVR in predicting arrhythmic events and mortality in patients with hypertrophic cardiomyopathy. | Positive T wave in lead aVR (TaVR) has been associated with increased risk of adverse events in patients with various cardiovascular diseases.</AbstractText>The purpose of this study was to investigate the prevalence and prognostic significance of positive TaVR in patients with hypertrophic cardiomyopathy (HCM).</AbstractText>This study investigated 421 consecutive patients with HCM (177 women; age 51.1 ± 14.9 years). Admission electrocardiogram was examined for the presence of a positive TaVR. The primary endpoint was defined as a composite of major arrhythmic events (MAEs), which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Cardiovascular mortality and all-cause death were evaluated as secondary endpoints.</AbstractText>During median follow-up period of 6.0 years (interquartile range 4.0-11.6 years), 53 patients (12.6%) experienced the primary endpoint. On multivariable competing analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be an independent and strong predictor of the primary composite endpoint. Time-dependent receiver operating characteristic analysis, net reclassification index, and integrated discrimination improvement showed that the addition of positive TaVR to conventional HCM risk factors improved prediction of arrhythmic events. However, in subgroup analysis, a positive TaVR lost statistical significance in patients with apical HCM but remained significant in patients with all other hypertrophy patterns.</AbstractText>Positive TaVR is associated with MAE in HCM patients, independent of and incremental to traditional risk factors.</AbstractText>Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,773 | Influence of the tubular network on the characteristics of calcium transients in cardiac myocytes. | Transverse and axial tubules (TATS) are an essential ingredient of the excitation-contraction machinery that allow the effective coupling of L-type Calcium Channels (LCC) and ryanodine receptors (RyR2). They form a regular network in ventricular cells, while their presence in atrial myocytes is variable regionally and among animal species We have studied the effect of variations in the TAT network using a bidomain computational model of an atrial myocyte with variable density of tubules. At each z-line the t-tubule length is obtained from an exponential distribution, with a given mean penetration length. This gives rise to a distribution of t-tubules in the cell that is characterized by the fractional area (F.A.) occupied by the t-tubules. To obtain consistent results, we average over different realizations of the same mean penetration length. To this, in some simulations we add the effect of a network of axial tubules. Then we study global properties of calcium signaling, as well as regional heterogeneities and local properties of sparks and RyR2 openings. In agreement with recent experiments in detubulated ventricular and atrial cells, we find that detubulation reduces the calcium transient and synchronization in release. However, it does not affect sarcoplasmic reticulum (SR) load, so the decrease in SR calcium release is due to regional differences in Ca2+ release, that is restricted to the cell periphery in detubulated cells. Despite the decrease in release, the release gain is larger in detubulated cells, due to recruitment of orphaned RyR2s, i.e, those that are not confronting a cluster of LCCs. This probably provides a safeguard mechanism, allowing physiological values to be maintained upon small changes in the t-tubule density. Finally, we do not find any relevant change in spark properties between tubulated and detubulated cells, suggesting that the differences found in experiments could be due to differential properties of the RyR2s in the membrane and in the t-tubules, not incorporated in the present model. This work will help understand the effect of detubulation, that has been shown to occur in disease conditions such as heart failure (HF) in ventricular cells, or atrial fibrillation (AF) in atrial cells. |
16,774 | Association of Fine Particulate Matter Exposure With Bystander-Witnessed Out-of-Hospital Cardiac Arrest of Cardiac Origin in Japan. | Out-of-hospital cardiac arrests (OHCAs) are a major public health concern and a leading cause of death worldwide. Exposure to ambient air pollution is associated with increases in morbidity and mortality and has been recognized as a leading contributor to global disease burden.</AbstractText>To examine the association between short-term exposure to particulate matter with a diameter of 2.5 μm or smaller (PM2.5) and the incidence of OHCAs of cardiac origin and with the development of initial cardiac arrest rhythm.</AbstractText><AbstractText Label="DESIGN, SETTING, AND PARTICIPANTS">This case-control study used data from cases registered between January 1, 2005, and December 31, 2016, in the All-Japan Utstein Registry, a prospective, nationwide, population-based database for OHCAs across all 47 Japanese prefectures. These OHCA cases included patients who had bystander-witnessed OHCAs and for whom emergency medical services responders initiated resuscitation before hospital transfer. A case-crossover design was employed for the study analyses. A prefecture-specific, conditional logistic regression model to estimate odds ratios was applied, and a random-effects meta-analysis was used to obtain prefecture-specific pooled estimates. All analyses were performed from May 7, 2019, to January 23, 2020.</AbstractText>The main outcome was the association of short-term PM2.5 exposure with the incidence of bystander-witnessed OHCAs of cardiac origin. The differences in the distribution of initial cardiac arrest rhythm in OHCAs among those with exposure to PM2.5 were also examined.</AbstractText>In total, 103 189 OHCAs witnessed by bystanders were included in the final analysis. Among the patients who experienced such OHCAs, the mean (SD) age was 75 (15.5) years, and 62 795 (60.9%) were men. Point estimates of the percentage increase for a 10-μg/m3 increase in PM2.5 at lag0-1 (difference in mean PM2.5 concentrations measured on the case day and 1 day before) demonstrated a statistically significantly higher incidence of OHCA across most of the 47 prefectures, without significant heterogeneity (I2 = 20.1%; P = .12). A stratified analysis found an association between PM2.5 exposure and OHCAs (% increase, 1.6; 95% CI, 0.1%-3.1%). An initial shockable rhythm, such as ventricular fibrillation or pulseless ventricular tachycardia (% increase, 0.6; 95% CI, -2.0% to 3.2%), was not associated with PM2.5 exposure. However, an initial nonshockable rhythm, such as pulseless electrical activity and asystole, was associated with PM2.5 exposure (% increase, 1.4; 95% CI, 0.1%-2.7%).</AbstractText>Findings from this study suggest that increased PM2.5 concentration is associated with bystander-witnessed OHCA of cardiac origin that commonly presents with nonshockable rhythm. The results support measures to reduce PM2.5 exposure to prevent OHCAs of cardiac origin.</AbstractText> |
16,775 | The role of echocardiography for diagnosis and prognostic stratification in hypertrophic cardiomyopathy. | Hypertrophic cardiomyopathy (HCM) is the most frequent cardiac disease with genetic substrate, affecting about 0.2-0.5% of the population. While most of the patients with HCM have a relatively good prognosis, some are at increased risk of adverse events. Identifying such patients at risk is important for optimal treatment and follow-up. While clinical and electrocardiographic information plays an important role, echocardiography remains the cornerstone in assessing patients with HCM. In this review, we discuss the role of echocardiography in diagnosing HCM, the key features that differentiate HCM from other diseases and the use of echocardiography for risk stratification in this setting (risk of sudden cardiac death, heart failure, atrial fibrillation and stroke). The use of modern echocardiographic techniques (deformation imaging, 3D echocardiography) refines the diagnosis and prognostic assessment of patients with HCM. The echocardiographic data need to be integrated with clinical data and other information, including cardiac magnetic resonance, especially in challenging cases or when there is incomplete information, for the optimal management of these patients. |
16,776 | Functional tricuspid regurgitation of degenerative mitral valve disease: a crucial determinant of survival. | To assess functional tricuspid regurgitation (FTR) determinants, consequences, and independent impact on outcome in degenerative mitral regurgitation (DMR).</AbstractText>All patients diagnosed with isolated DMR 2003-2011, with structurally normal tricuspid leaflets, prospective FTR grading and systolic pulmonary artery pressure (sPAP) estimation by Doppler echocardiography at diagnosis were identified and long-term outcome analysed. The 5083 DMR eligible patients [63 ± 16 years, 47% female, ejection fraction (EF) 63 ± 7%, and sPAP 35 ± 13 mmHg] presented with FTR graded trivial in 45%, mild in 37%, moderate in 15%, and severe in 3%. While pulmonary hypertension (PHTN-sPAP ≥ 50 mmHg) was the most powerful FTR severity determinant, other strong FTR determinants were older age, female sex, lower left ventricle EF, DMR, and particularly atrial fibrillation (AFib) (all P ≤ 0.002). Functional tricuspid regurgitation moderate/severe was independently linked to more severe clinical presentation, more oedema, lower stroke volume, and impaired renal function (P ≤ 0.01). Survival (95% confidence interval) throughout follow-up [70% (69-72%) at 10 years] was strongly associated with FTR severity [82% (80-84%) for trivial, 69% (66-71%) for mild, 51% (47-57%) for moderate, and 26% (19-35%) for severe, P < 0.0001]. Excess mortality persisted after comprehensive adjustment [adjusted hazard ratio 1.40 (1.18-1.67) for moderate FTR and 2.10 (1.63-2.70) for severe FTR, P ≤ 0.01]. Excess mortality persisted adjusting for sPAP/right ventricular function (P < 0.0001), by matching [adjusted hazard ratios 2.08 (1.50-2.89), P < 0.0001] and vs. expected survival [risk ratio 1.79 (1.48-2.16), P < 0.0001]. Within 5-year of diagnosis valve surgery was performed in 73% (70-75%) and 15% (13-17%) of severe and moderate DMR and in only 26% (19-34%) and 6% (4-8%) of severe and moderate FTR. Valvular surgery improved outcome without alleviating completely higher mortality associated with FTR (P < 0.0001).</AbstractText>In this large DMR cohort, FTR was frequent and causally, not only linked to PHTN but also to other factors, particularly AFib. Higher FTR severity is associated at diagnosis with more severe clinical presentation. Long term, FTR is independently of all confounders, associated with considerably worse mortality. Functional tricuspid regurgitation moderate and even severe is profoundly undertreated. Thus careful assessment, consideration for tricuspid surgery, and testing of new transcatheter therapy is warranted.</AbstractText>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.</CopyrightInformation> |
16,777 | Conversion from Nonshockable to Shockable Rhythms and Out-of-Hospital Cardiac Arrest Outcomes by Initial Heart Rhythm and Rhythm Conversion Time. | The conversion from a nonshockable rhythm (asystole or pulseless electrical activity (PEA)) to a shockable rhythm (pulseless ventricular tachycardia or ventricular fibrillation) may be associated with better out-of-hospital cardiac arrest (OHCA) outcomes. There are insufficient data on the prognostic significance of such conversions by initial heart rhythm and different rhythm conversion time.</AbstractText>Among 24,849 adult OHCA patients of presumed cardiac etiology with initial asystole or PEA in the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry (version 3, 2011-2015), we examined the association of shockable rhythm conversion with prehospital return of spontaneous circulation (ROSC), survival, and favorable functional outcome (modified Rankin Scale score ≤3) at hospital discharge by initial rhythm and rhythm conversion time (time from cardiopulmonary resuscitation (CPR) initiation by emergency medical providers to first shock delivery), using logistic regression adjusting for key clinical characteristics.</AbstractText>Of 16,516 patients with initial asystole and 8,333 patients with initial PEA, 16% and 20% underwent shockable rhythm conversions; the median rhythm conversion time was 12.0 (IQR: 6.7-18.7) and 13.2 (IQR: 7.0-20.5) min, respectively. No difference was found in odds of prehospital ROSC across rhythm conversion time, regardless of initial heart rhythm. Shockable rhythm conversion was associated with survival and favorable functional outcome at hospital discharge only when occurred during the first 15 min of CPR, for those with initial asystole, or the first 10 min of CPR, for those with initial PEA. The associations between shockable rhythm conversion and outcomes were stronger among those with initial asystole compared with those with initial PEA.</AbstractText>The conversion from a nonshockable rhythm to a shockable rhythm was associated with better outcomes only when occurred early in initial nonshockable rhythm OHCA, and it has greater prognostic significance when the initial rhythm was asystole.</AbstractText>Copyright © 2020 Wanwan Zhang et al.</CopyrightInformation> |
16,778 | Comparison of Electromechanical Delay during Ventricular Tachycardia and Fibrillation under Different Conductivity Conditions Using Computational Modeling. | Electromechanical delay (EMD) is the time interval between local myocyte depolarization and the onset of myofiber shortening. Previously, researchers measured EMD during sinus rhythm and ectopic pacing in normal and heart failure conditions. However, to our knowledge, there are no reports regarding EMD during another type of rhythms or arrhythmia. The goal of this study was to quantify EMD during sinus rhythm, tachycardia, and ventricular fibrillation conditions. We hypothesized that EMD under sinus rhythm is longer due to isovolumetric contraction which is imprecise during arrhythmia. We used a realistic model of 3D electromechanical ventricles. During sinus rhythm, EMD was measured in the last cycle of cardiac systole under steady conditions. EMD under tachycardia and fibrillation conditions was measured during the entire simulation, resulting in multiple EMD values. We assessed EMD for the following 3 conduction velocities (CVs): 31 cm/s, 51 cm/s, and 69 cm/s. The average EMD during fibrillation condition was the shortest corresponding to 53.45 ms, 55.07 ms, and 50.77 ms, for the CVs of 31 cm/s, 51 cm/s, and 69 cm/s, respectively. The average EMD during tachycardia was 58.61 ms, 58.33 ms, and 52.50 ms for the three CVs. Under sinus rhythm with action potential duration restitution (APDR) slope 0.7, the average EMD was 66.35 ms, 66.41 ms, and 66.60 ms in line with the three CVs. This result supports our hypothesis that EMD under sinus rhythm is longer than that under tachyarrhythmia conditions. In conclusion, this study observed and quantified EMD under tachycardia and ventricular fibrillation conditions. This simulation study has widened our understanding of EMD in 3D ventricles under chaotic conditions. |
16,779 | Incident heart failure in outpatients with chronic coronary syndrome: results from the international prospective CLARIFY registry. | The contemporary incidence of heart failure (HF) in patients with chronic coronary syndrome is unclear. We aimed to study the incidence and predictors of cardiovascular (CV) death, HF hospitalization or new-onset HF not requiring hospitalization, in patients included in the CLARIFY registry.</AbstractText>CLARIFY is a contemporary, international registry of ambulatory patients with chronic coronary artery disease, conducted in 45 countries. At baseline, data on demographics, ethnicity, CV risk factors, medical history, cardiac parameters and medication were collected. Patients were followed up yearly up to 5 years. In this analysis, 26 769 patients with no HF history were included. At 5-year follow-up, 4393 patients (16.4%) reached the primary endpoint comprising CV death, HF hospitalization, or new-onset HF. Only 16.7% of them (n = 732) required hospitalization for HF. All-cause death occurred in 6.6% of patients (61.4% were CV). Age over 70 years, left ventricular ejection fraction <50%, Canadian Cardiovascular Society class ≥2 angina, atrial fibrillation or paced rhythm on the ECG, body mass index <20 kg/m2</sup> , and a history of stroke, were the most robust predictors of the primary outcome. Age <50 years, Asian ethnicity, and percutaneous revascularization were negative predictors of the outcome.</AbstractText>A sizeable proportion of patients with chronic coronary syndrome develop HF, which only infrequently requires hospitalization. Early identification of patients with HF may lead to early treatment, and help to further decrease mortality and morbidity. This concept needs confirmation in future studies.</AbstractText>© 2020 European Society of Cardiology.</CopyrightInformation> |
16,780 | Ibutilide Reduces Ventricular Defibrillation Threshold and Organizes Ventricular Fibrillation Activation in Canine Heart Failure Model. | To compare the effects of class III antiarrhythmic agents (amiodarone vs. ibutilide) on ventricular fibrillation (VF) and hemodynamic status in a canine heart failure (HF) model.</AbstractText>A total of 12 beagles were used to establish the HF model by rapid pacing for 4 consecutive weeks. These canines were randomly divided into two groups based on the administration of ibutilide and amiodarone. A 12 × 12 unipolar electrode plaque was used for ventricular epicardial mapping, and a 6-electrode plunge needle was inserted for ventricular transmural mapping. The restitution curve was estimated from activation recovery intervals (ARIs) by pacing from the plaque electrodes before and after drug administration. The defibrillation threshold (DFT) and VF activation patterns, including the activation rate, cycle length (VF-CL) and the transmural dispersion of the activation rate, were evaluated and the hemodynamic parameters were mearsured and compared before and after drug administration.</AbstractText>Compared to HF baseline, ibutilide administration has markedly decreased the DFT by 28% (18 ± 2 J vs. 13 ± 2.7 J, P < 0.01) without affecting the canine's hemodynamics (mean arterial pressure 91 ± 15 mmHg vs. 92 ± 17 mmHg, P > 0.05). Furthermore, VF activation pattern became more organized, and spontaneous termination was observed only after ibutilide administration. Conversely, amiodarone has significantly compromised the hemodynamic status (mean arterial pressure 92 ± 6.1 mmHg vs. 52 ± 11.6 mmHg, P < 0.05), but did not alter the DFT (17 ± 2.3 J vs. 16 ± 2.0 J, P > 0.05). Compared to pre-medication, both ibutilide and amiodarone have significantly prolonged the VERP (178 ± 9.6 ms vs. 208 ± 8.9 ms, P < 0.05; 185 ± 10.5 ms vs. 202 ± 7.5 ms, P < 0.05, respectively) and reduced the dispersion of refractoriness, the maximal slope of restitution curve, and the epicardial dispersion during pacing. Additionally, both drugs have significantly increased the VF-CL and reduced the transmural dispersion of the VF activation rate.</AbstractText>Ibutilide had potential antifibrillatory properties, which was shown by decreasing the DFT and organizing the VF activation in HF, and with no apparent impact on the hemodynamic status. In contrast, intravenous amiodarone administration demonstrated prominent negative effects on the hemodynamic status possibly by affecting the myocardial contractility before and after defibrillation but did not alter the DFT.</AbstractText> |
16,781 | Multicellular <i>In vitro</i> Models of Cardiac Arrhythmias: Focus on Atrial Fibrillation. | Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice with a large socioeconomic impact due to its associated morbidity, mortality, reduction in quality of life and health care costs. Currently, antiarrhythmic drug therapy is the first line of treatment for most symptomatic AF patients, despite its limited efficacy, the risk of inducing potentially life-threating ventricular tachyarrhythmias as well as other side effects. Alternative, in-hospital treatment modalities consisting of electrical cardioversion and invasive catheter ablation improve patients' symptoms, but often have to be repeated and are still associated with serious complications and only suitable for specific subgroups of AF patients. The development and progression of AF generally results from the interplay of multiple disease pathways and is accompanied by structural and functional (e.g., electrical) tissue remodeling. Rational development of novel treatment modalities for AF, with its many different etiologies, requires a comprehensive insight into the complex pathophysiological mechanisms. Monolayers of atrial cells represent a simplified surrogate of atrial tissue well-suited to investigate atrial arrhythmia mechanisms, since they can easily be used in a standardized, systematic and controllable manner to study the role of specific pathways and processes in the genesis, perpetuation and termination of atrial arrhythmias. In this review, we provide an overview of the currently available two- and three-dimensional multicellular <i>in vitro</i> systems for investigating the initiation, maintenance and termination of atrial arrhythmias and AF. This encompasses cultures of primary (animal-derived) atrial cardiomyocytes (CMs), pluripotent stem cell-derived atrial-like CMs and (conditionally) immortalized atrial CMs. The strengths and weaknesses of each of these model systems for studying atrial arrhythmias will be discussed as well as their implications for future studies. |
16,782 | Potential Embolic Sources and Outcomes in Embolic Stroke of Undetermined Source in the NAVIGATE-ESUS Trial. | Background and Purpose- Emboli in embolic stroke of undetermined source (ESUS) may originate from various potential embolic sources (PES), some of which may respond better to anticoagulation, whereas others to antiplatelets. We analyzed whether rivaroxaban is associated with reduction of recurrent stroke compared with aspirin in patients with ESUS across different PES and by number of PES. Methods- We assessed the presence/absence of each PES (atrial cardiopathy, atrial fibrillation, arterial atherosclerosis, left ventricular dysfunction, cardiac valvulopathy, patent foramen ovale, cancer) in NAVIGATE-ESUS (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source) participants. Prevalence of each PES, as well as treatment effect and risk of event for each PES were determined. Results by number of PES were also determined. The outcomes were ischemic stroke, all-cause mortality, cardiovascular mortality, and myocardial infarction. Results- In 7213 patients (38% women, mean age 67years) followed for a median of 11 months, the 3 most prevalent PES were atrial cardiopathy (37%), left ventricular disease (36%), and arterial atherosclerosis (29%). Forty-one percent of all patients had multiple PES, with 15% having ≥3 PES. None or a single PES was present in 23% and 36%, respectively. Recurrent ischemic stroke risk was similar for rivaroxaban- and aspirin-assigned patients for each PES, except for those with cardiac valvular disease which was marginally higher in rivaroxaban-assigned patients (hazard ratio, 1.8 [95% CI, 1.0-3.0]). All-cause mortality risks were similar across treatment groups for each PES while too few myocardial infarctions and cardiovascular deaths occurred for meaningful assessment. Increasing number of PES was not associated with increased stroke recurrence nor all-cause mortality, and outcomes did not vary between rivaroxaban- and aspirin-assigned patients by number of PES. Conclusions- A large proportion of patients with ESUS had multiple PES which could explain the neutral results of NAVIGATE-ESUS. Recurrence rates between rivaroxaban- and aspirin-assigned patients were similar across the spectrum of PES. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT02313909. |
16,783 | The Effect of Sacubitril/Valsartan on Device Detected Arrhythmias and Electrical Parameters among Dilated Cardiomyopathy Patients with Reduced Ejection Fraction and Implantable Cardioverter Defibrillator. | Sacubitril/valsartan therapy reduces sudden cardiac death (SCD) among patients with reduced ejection fraction (HFrEF) when compared to guidelines recommended doses of enalapril, however the mechanism is still not clear. There are few, contrasting results about the effect of sacubitril/valsartan on arrhythmias in the clinical context of dilated cardiomyopathy (DCM) and there are no clinical data about its effect on measured implantable cardioverter defibrillator (ICD) electrical parameters, such as atrial/ventricular electrograms sensing and pacing threshold. We conducted a 12 month follow-up observational study in 167 ischemic and nonischemic DCM patients (mean age 68.1 ± 11.6 years; 85% male), with dual-chamber ICD on sacubitril/valsartan treatment, to evaluate the incidence of device detected tachyarrhythmia events, both atrial and ventricular, and the change in measured ICD electrical parameters. We collected data on clinical, electrocardiographic and echocardiographic parameters to find a possible electro-mechanical correlation within results. Our results show that DCM patients with reduced ejection fraction and ICD on sacubitril/valsartan treatment experienced a reduction in both atrial and ventricular arrhythmias incidence and an improvement in ICD electrical atrial parameters. The findings might be explained by the electro-mechanical cardiac reverse remodeling induced by sacubitril/valsartan therapy. |
16,784 | [Atrial Fibrillation: How Important is Rhythm Control Therapy?]. | Rhythm control therapy, comprising antiarrhythmic drugs, cardioversion, and AF ablation, is an important component in the management of patients with atrial fibrillation (AF). Catheter ablation for AF, mainly targeting isolation of the pulmonary veins (AF ablation), has markedly improved the effectiveness of rhythm control therapy. Rhythm control improves symptoms and quality of life in patients with symptomatic AF. AF ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy. Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Different lifestyle interventions might additionally improve symptoms and rhythm stability in patients with AF. AF ablation appears to improve left ventricular function in a subset of patients. Summarized, rhythm control therapy in patients with symptomatic AF is safe and improves quality of life, including elderly patients with stroke risk factors. Further studies are needed to determine whether rhythm control therapy reduces AF-related complications while improving patient outcome with regard to prognosis. |
16,785 | [Is There Still a Need for Medical Antiarrhythmic Therapy?]. | The use of medical antiarrhythmic therapy apart from beta-blockers has been steadily decreasing in the recent past. This can partly be attributed to technological progress that has rendered the ablation of complex cardiac arrhythmias like atrial fibrillation, focal atrial tachycardias and ventricular arrhythmias feasible and efficacious. Furthermore, an awareness regarding pro-arrhythmic and toxic side-effects of antiarrhythmic medication has evolved. Nevertheless, medical antiarrhythmic therapy still plays a fundamental role in acute therapy of arrythmias as well as certain indications for long-term therapy. This review comprehensively summarizes the current role of medical antiarrhythmic therapy in daily clinical practice focusing on mechanisms and therapies of the most common cardiac arrythmias. |
16,786 | Bariatric Surgery in Patients with Severe Heart Failure. | Obesity and cardiac failure are globally endemic and increasingly intersecting. Bariatric surgery may improve cardiac function and act as a bridge-to-transplantation. We aim to identify effects of bariatric surgery on severe heart failure patients and ascertain its role regarding cardiac transplantation.</AbstractText>A retrospective study of a prospectively collected database identified heart failure patients who underwent bariatric surgery between 1 January 2008 and 31 December 2017. Patients were followed up 12 months post-operatively. Cardiac investigations, functional capacity, cardiac transplant candidacy, morbidity and length of stay were recorded.</AbstractText>Twenty-one patients (15 males, 6 females), mean age 48.7 ± 10, BMI 46.2 kg/m2</sup> (37.7-85.3) underwent surgery (gastric band (18), sleeve gastrectomy (2), biliopancreatic diversion (1)). There were no loss to follow-up. There was significant weight loss of 26.0 kg (5.0-78.5, p < 0.001), significant improvement of left ventricular ejection fraction (LVEF) (10.0 ± 11.9%, p < 0.001) and significant reduction of 0.5 New York Heart Association (NYHA) classification (0-2, p < 0.001). Multivariate models delineated the absence of atrial fibrillation and pre-operative BMI < 49 kg/m2</sup> as significant predictors (adjusted R-square 69%) for improvement of LVEF. Mean length of stay was 3.6 days and in-hospital morbidity rate was 42.9%. One patient subsequently underwent a heart transplant, and two patients were removed from the waitlist due to clinical improvements.</AbstractText>Bariatric surgery is safe and highly effective in obese patients with severe heart failure with substantial improvements in cardiac function and symptoms. A threshold pre-operative BMI of 49 kg/m2</sup> and absence of atrial fibrillation may be significant predictors for improvement in cardiac function. There is a role for bariatric surgery to act as a bridge-to-transplantation or even ameliorate this requirement.</AbstractText> |
16,787 | Tachycardiomyopathy Caused by a Pseudo-Ventricular Tachycardia: The Role of Imaging and Ablation in Diagnosis and Treatment. | A 50-year-old man presented with general fatigue on exertion. Investigations revealed tachycardia-induced cardiomyopathy induced by Wolff-Parkinson-White syndrome and atrial fibrillation. He was successfully treated with catheter ablation. Cardiac magnetic resonance imaging revealed that delayed enhancement throughout the left ventricle disappeared within 2 months after ablation. (<b>Level of Difficulty: Beginner.</b>). |
16,788 | Impact of Left Ventricular Ejection Fraction on Recurrent Ventricular Tachyarrhythmias in Recipients of Implantable Cardioverter Defibrillators. | This study evaluates the impact of left ventricular ejection fraction (LVEF) on recurrences of ventricular tachyarrhythmias in recipients of implantable cardioverter defibrillator (ICD).</AbstractText>Data regarding recurrences of ventricular tachyarrhythmias in ICD recipients according to LVEF is limited.</AbstractText>A large retrospective registry was used, including all consecutive ICD recipients with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016. Patients with LVEF <35% were compared to patients with LVEF ≥35%. The primary end point was first recurrences of ventricular tachyarrhythmias at 5 years. Secondary end points were ICD-related therapies, rehospitalization, and all-cause mortality at 5 years. Cox regression, Kaplan Meier, and propensity score matching analyses were applied.</AbstractText>A total of 528 consecutive ICD recipients were included (51% with LVEF ≥35% and 49% with LVEF <35%). LVEF <35% was associated with reduced freedom from recurrent ventricular tachyarrhythmias (40 vs. 49%, log rank p = 0.014; hazard ratio [HR] = 1.381; 95% confidence interval [CI] 1.066-1.788; p = 0.034), mainly attributed to recurrent sustained VT in primary preventive ICD recipients. Accordingly, LVEF <35% was associated with reduced freedom from first appropriate ICD therapies (28 vs. 41%, log rank p = 0.001; HR = 1.810; 95% CI 1.185-2.766; p = 0.001). Finally, LVEF <35% was associated with a higher rate of rehospitalization (23 vs. 34%; p = 0.005) and all-cause mortality at 5 years (13 vs. 29%; p = 0.001).</AbstractText>LVEF <35% was associated with reduced freedom from recurrent ventricular tachyarrhythmias, appropriate device therapies, rehospitalization and all-cause mortality secondary to index ventricular tachyarrhythmias.</AbstractText>© 2020 S. Karger AG, Basel.</CopyrightInformation> |
16,789 | Prognostic indicators of new onset atrial fibrillation in patients with acute coronary syndrome. | This study aims to estimate prognostic indicators of new onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS) through 3 to 5 years of follow-up.</AbstractText>For patients with ACS, some prognostic indicators can be used to predict new onset AF.</AbstractText>The Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) program was launched in 2014 by a collaborative initiative of the American Heart Association and Chinese Society of Cardiology. We enrolled 866 patients with ACS in a telephone follow-up program. We inquired about each patient's general health and invited each patient to our hospital for further consultation. We also performed ambulatory electrocardiography and other relevant examinations.</AbstractText>A total of 743 ACS patients were included in the study. After 3 to 5 years, 50 (0.67%) patients developed AF. In multivariable Cox models adjusting for AF risk factors in ACS patients, we found that NT-proBNP [hazard ratio (HR) 2.625, 1.654-4.166, P < .05], creatine kinase-MB (CK-MB) (HR 4.279, 1.887-9.703, P < .05), and left ventricular ejection fraction (LVEF) (HR 0.01, 0.001-0.352, P < .05) were significantly associated with AF receiver operating characteristic (ROC) curves were used to determine a cutoff level for AF screening. NT-proBNP using a cutoff of 1705 ng/L resulted in a sensitivity of 58% and a specificity of 89.8%. CK-MB using a cutoff of 142.5 ng/L resulted in a sensitivity of 73.3% and a specificity of 58.3%.</AbstractText>For patients with ACS, NT-proBNP, CK-MB, and LVEF have a considerable prognostic value for predicting whether AF would be detected during follow-up.</AbstractText>© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.</CopyrightInformation> |
16,790 | Non-coding RNA and Cardiac Electrophysiological Disorders. | Cardiac arrhythmias are common diseases affecting millions of people worldwide. A broad and diverse array of arrhythmias exists, ranging from harmless ones such as sinus arrhythmia to fatal disorders such as ventricular fibrillation. The underlying pathophysiology of arrhythmogenesis is complex and still not fully understood. Since their discovery, non-coding RNAs (ncRNAs) and especially microRNAs (miRNAs) came into the spotlight of arrhythmia research as it has been shown that they play an important role in regulating normal development of the cardiac conduction system and are involved in remodeling processes leading to arrhythmias. This chapter will give a brief overview on basic electrophysiologic concepts and will summarize the current knowledge on ncRNAs and their role in arrhythmogenesis. |
16,791 | Clinical and Epidemiological Characteristics of Severe Acute Adult Poisoning Cases in Martinique: Implicated Toxic Exposures and Their Outcomes. | The epidemiology of severe acute poisonings in the French overseas departments of the Americas remains poorly reported. The main objective of this study was to determine the epidemiology and characteristics of severe acutely poisoned adult patients.</AbstractText>A retrospective descriptive study was conducted from 1 January 2000 to 31 December 2010 in severely poisoned patients presenting to the emergency department (ED) of the University Hospital of Martinique, and the general public hospitals of Lamentin and Trinité.</AbstractText>During the study period, 291 patients were admitted for severe poisoning, giving an incidence rate of 7.7 severe cases/100,000 inhabitants. The mean age was 46 ± 19 years and 166 (57%) were male. Psychiatric disorders were recorded in 143 (49.8%) patients. Simplified Acute Psychological Score (SAPS II) at admission was 39 ± 23 points and Poisoning Severity Score (PSS) was 2.7 ± 0.8 points. Death was recorded in 30 (10.3%) patients and hospital length of stay was 6 ± 7 days. The mode of intoxication was intentional self-poisoning in 87% of cases and drug overdose was recorded in 13% of cases. The toxic agent involved was a therapeutic drug in 58% and a chemical product in 52% of cases. The predominant clinical manifestations were respiratory failure (59%), hemodynamic failure (27%), neurologic failure (45%), gastrointestinal manifestations (27%), and renal failure (11%). Polypnea, shock, ventricular fibrillation or tachycardia, and gastro-intestinal disorders were the main symptoms associated with death. The main biological abnormalities associated with death in our patients were metabolic acidosis, hypokalemia, hyperlactatemia, hypocalcemia, renal injury, rhabdomyolysis, increased aspartate aminotransferases, and thrombocytopenia. Extracorporal membrane oxygenation (ECMO) was used in three patients and specific antidotes were used in 21% of patients.</AbstractText>Acute poisonings remain a major public health problem in Martinique with different epidemiological characteristics to those in mainland France, with a high incidence of poisoning by rural and household toxins.</AbstractText> |
16,792 | Validity of administrative claims-based algorithms for ventricular arrhythmia and cardiac arrest in the pediatric population. | Identify administrative claims-based algorithms for capturing out-of-hospital ventricular arrhythmias (VA) and cardiac arrests (CA) due to cardiac causes in the pediatric population with high positive-predictive value (PPV).</AbstractText>Within a single pediatric center, a retrospective cohort of patients hospitalized or seen in the emergency room for VA or CA were identified from the electronic health records. Eligible encounters were blindly reviewed and linked to administrative data, including ICD-9/ICD-10 codes. Test characteristics, including PPV, for different diagnostic and procedure codes were generated using a 50% training sample. The gold standard was definite or suspected out-of-hospital VA or CA due to cardiac cause verified based on clinical criteria. Algorithms with the highest PPV were then applied to a 50% validation sample to validate performance.</AbstractText>From 2004-2017, 598 encounters met eligibility criteria. 174 (29%) had an outcome of interest, with remainder being an inpatient event or CA due to other cause. Within the training sample (n = 263), VA codes in primary position had a PPV 94% (95%CI 81%-99%) with low sensitivity (44%, 95%CI 33%-56%). CA codes in any position or VA codes in nonprimary positions had low PPV (18%-19%, 31% respectively). Applying the top three performing algorithms to the validation sample (n = 252) yielded similar PPV values.</AbstractText>Contrary to adults, algorithms including a CA code do not perform well for identifying out-of-hospital VA and CA due to cardiac cause in the pediatric populations. Researchers should be aware of the potential implications for future pediatric drug safety studies for these outcomes.</AbstractText>© 2020 John Wiley & Sons Ltd.</CopyrightInformation> |
16,793 | Comparison of clinical characteristics of patients with heart failure and preserved ejection fraction with atrial fibrillation versus sinus rhythm: Insights from the APOLLON registry. | The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF.</AbstractText>This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared.</AbstractText>In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p<0.001) and more symptomatic, with a higher rate of classification as New York Heart Association functional class III-IV, paroxysmal nocturnal dyspnea, orthopnea, palpitations, fatigue, pulmonary crepitations, and peripheral edema. The hospitalization rate for heart failure was higher (28.4% vs 12.6%; p<0.001) in patients with AF, and participants with AF had higher level of N-terminal pro-B-type natriuretic peptide (887 pg/mL vs 394.8 pg/mL; p<0.001) and higher left atrial volume index level. Patients without AF had a higher burden of diabetes mellitus, obstructive sleep apnea, and coronary artery disease. The prescription rate of nondihydropyridine calcium blockers, digoxin, loop diuretics, and anticoagulant drugs was higher in the AF group.</AbstractText>The results of this study revealed that in a large Turkish cohort with HFpEF, significant clinical differences were present between those with and without AF and. Further prospective studies are needed to clarify the prognostic implications of AF in this growing heart failure population in our country.</AbstractText> |
16,794 | Catheter Ablation in Patients With Cardiogenic Shock and Refractory Ventricular Tachycardia. | There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support.</AbstractText>Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010-2017).</AbstractText>All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction-induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia.</AbstractText>Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.</AbstractText> |
16,795 | Left atrial enlargement and non-paroxysmal atrial fibrillation as risk factors for left atrial thrombus/spontaneous Echo contrast in patients with atrial fibrillation and low CHA<sub>2</sub>DS<sub>2</sub>-VASc score. | To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation (AF) and low CHA2</sub>DS2</sub>-VASc scores, which remain undefined.</AbstractText>We retrospectively analyzed the baseline clinical characteristics, routine laboratory parameters, and echocardiographic measurements of 705 patients (71.1% male; mean age: 52.10 ± 9.64 years) with low CHA2</sub>DS2</sub>-VASc score (0 or 1; 1 point for female sex) out of 1346 consecutive patients with non-valvular AF who underwent transesophageal echocardiography (TEE) at Guangdong Cardiovascular Institute between January 2013 and December 2015.</AbstractText>Patients with left atrial thrombus (LAT) or spontaneous echo contrast (SEC) on TEE (24/705, 4%) showed a higher incidence rate of vascular disease (54.2% vs</i>. 32.9%, P</i> = 0.045) and non-paroxysmal AF (79.2% vs</i>. 29.4%, P</i> < 0.001), larger left atrial diameter (43.08 ± 4.59 vs</i>. 36.02 ± 5.53 mm, P</i> < 0.001), and lower left ventricular ejection fraction (58.23 ± 8.82% vs</i>. 64.15 ± 7.14%, P</i> < 0.001) than those without. Multivariate logistic regression analysis identified left atrial diameter [odds ratio (OR) = 1.171, 95% confidence interval (CI): 1.084-1.265, P</i> < 0.001] and non-paroxysmal AF (OR = 3.766, 95% CI: 1.282-11.061, P</i> = 0.016) as independent risk factors for LAT/SEC. In ROC curve analysis, a left atrial dimeter cutoff of 37.5 mm yielded 95.0% sensitivity and 62.7% specificity (AUC: 0.847, P</i> < 0.0001, 95% CI: 0.793-0.914).</AbstractText>In patients with non-valvular AF with low CHA2</sub>DS2</sub>-VASc score, the presence of LAT or SEC was associated with left atrial enlargement, which had moderate predictive value, and non-paroxysmal AF.</AbstractText>Institute of Geriatric Cardiology.</CopyrightInformation> |
16,796 | Meta-analysis of cardiomyopathy-associated variants in troponin genes identifies loci and intragenic hot spots that are associated with worse clinical outcomes. | Troponin (TNN)-encoded cardiac troponins (Tn) are critical for sensing calcium and triggering myofilament contraction. TNN variants are associated with development of cardiomyopathy; however, recent advances in genetic analysis have identified rare population variants. It is unclear how certain variants are associated with disease while others are tolerated.</AbstractText>To compare probands with TNNT2, TNNI3, and TNNC1 variants and utilize high-resolution variant comparison mapping of pathologic and rare population variants to identify loci associated with disease pathogenesis.</AbstractText>Cardiomyopathy-associated TNN variants were identified in the literature and topology mapping conducted. Clinical features were compiled and compared. Rare population variants were obtained from the gnomAD database. Signal-to-noise (S:N) normalized pathologic variant frequency against population variant frequency. Abstract review of clinical phenotypes was applied to "significant" hot spots.</AbstractText>Probands were compiled (N = 70 studies, 224 probands) as were rare variants (N = 125,748 exomes; 15,708 genomes, MAF <0.001). TNNC1-positive probands demonstrated the youngest age of presentation (20.0 years; P = .016 vs TNNT2; P = .004 vs TNNI3) and the highest death, transplant, or ventricular fibrillation events (P = .093 vs TNNT2; P = .024 vs TNNI3; Kaplan Meir: P = .025). S:N analysis yielded hot spots of diagnostic significance within the tropomyosin-binding domains, α-helix 1, and the N-Terminus in TNNT2 with increased sudden cardiac death and ventricular fibrillation (P = .004). The inhibitory region and C-terminal region in TNNI3 exhibited increased restrictive cardiomyopathy (P =.008). HCM and RCM models tended to have increased calcium sensitivity and DCM decreased sensitivity (P < .001). DCM and HCM studies typically showed no differences in Hill coefficient which was decreased in RCM models (P < .001). CM models typically demonstrated no changes to Fmax</sub> (P = .239).</AbstractText>TNNC1-positive probands had younger ages of diagnosis and poorer clinical outcomes. Mapping of TNN variants identified locations in TNNT2 and TNNI3 associated with heightened pathogenicity, RCM diagnosis, and increased risk of sudden death.</AbstractText>Copyright © 2020 Elsevier Ltd. All rights reserved.</CopyrightInformation> |
16,797 | Direct Thrombin Inhibitors as an Alternative to Heparin During Catheter Ablation: A Multicenter Experience. | The goal of this study was to report a multicenter series of left-sided catheter ablations performed by using intravenous direct thrombin inhibitors (DTIs) as an alternative to heparin.</AbstractText>Amidst a looming worldwide shortage of heparin, there are insufficient data to guide nonheparin-based peri-procedural anticoagulation in patients undergoing catheter ablation.</AbstractText>This study reviewed all catheter ablations at 6 institutions between 2006 and 2019 to assess the safety and efficacy of DTIs for left-sided radiofrequency catheter ablation of atrial fibrillation and ventricular tachycardia.</AbstractText>In total, 53 patients (age 63.0 ± 9.3 years, 68% male, CHA₂DS₂-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category] score 2.8 ± 1.6, left ventricular ejection fraction 46 ± 15%) underwent ablation with DTIs (75% bivalirudin, 25% argatroban) due to heparin contraindication(s) (72% heparin-induced thrombocytopenia, 21% heparin allergy, 4% protamine reaction, and 4% religious reasons). The patient's usual oral anticoagulant was continued without interruption in 69%. Procedures were performed for atrial fibrillation (64%) or ventricular tachycardia/premature ventricular contractions (36%). Transseptal puncture was undertaken in 81%, and a contact force-sensing catheter was used in 70%. Vascular ultrasound was used in 71%, and femoral arterial access was gained in 36%. A bolus followed by infusion was used in all but 4 cases, and activated clotting time was monitored peri-procedurally in 72%, with 32% receiving additional boluses. Procedure duration was 216 ± 116 min, and ablation time was 51 ± 22 min. No major bleeding or embolic complications were observed. Four patients had minor self-limiting bleeding complications, including a small pericardial effusion (<1 cm), a small groin hematoma, and hematuria.</AbstractText>In this multicenter series, intravenous DTIs were safely used as an alternative to heparin for left-sided catheter ablation.</AbstractText>Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
16,798 | Hemodynamic profile of patients with severe aortic valve stenosis and atrial fibrillation versus sinus rhythm. | In patients with severe aortic stenosis (AS), atrial fibrillation (AF) is associated with increased long-term mortality after aortic valve replacement (AVR), which may be due to unfavorable hemodynamics in AF. We aimed to analyze the hemodynamic profile of patients with severe AS and AF versus sinus rhythm (SR).</AbstractText>We performed cardiac catheterization in 486 patients (age 74 ± 10 years, 58% males) with severe AS [indexed aortic valve area 0.41 ± 0.13 cm2</sup>, left ventricular ejection fraction 58 ± 12%]: 50 patients had AF, and 436 patients had SR. All patients underwent surgical (n = 350) or transcatheter (n = 136) AVR.</AbstractText>Despite similar indexed aortic valve area (0.41 ± 0.11 vs. 0.41 ± 0.12 cm2</sup>/m2</sup>; p = 0.45) patients with AF had lower left ventricular ejection fraction, larger left atrial size, lower tricuspid annular plane systolic excursion, higher mean pulmonary artery pressure (34 ± 13 vs. 24 ± 9 mmHg), mean pulmonary artery wedge pressure (mPAWP; 22 ± 8 vs. 15 ± 7 mmHg), and pulmonary vascular resistance (2.8 ± 1.9 vs. 2.0 ± 1.3 Wood units) and lower stroke volume index (26 ± 9 vs. 37 ± 10 ml/m2</sup>) than patients with SR (p < 0.05 for all). Patients with AF and SR had a different mPAWP-left ventricular end-diastolic pressure (LVEDP) relationship with higher mPAWP in AF and higher LVEDP in SR. After a median follow-up of 49 (interquartile range, 35-64) months post-AVR patients with AF (p = 0.05) and patients with a larger difference between mPAWP and LVEDP (p = 0.005) had higher mortality.</AbstractText>Patients with severe AS and concomitant AF have a distinct and significantly worse hemodynamic profile compared to patients with SR associated with worse clinical outcome.</AbstractText>Copyright © 2020 Elsevier B.V. All rights reserved.</CopyrightInformation> |
16,799 | A novel ECG-biomarker for cardiac arrest during hypothermia. | Treatment of arrhythmias evoked by accidental or therapeutic hypothermia and rewarming remains challenging. We aim to find an ECG-biomarker that can predict ventricular arrhythmias at temperatures occurring in therapeutic and accidental hypothermia.</AbstractText>Evaluation of ECG-data from accidental and therapeutic hypothermia patients and experimental data on ECG and ventricular fibrillation (VF) threshold in hypothermic New Zealand White Rabbits. VF threshold was measured in rabbit hearts cooled to moderate (31 °C) and severe (17 °C) hypothermia. QRS-interval divided by corrected QT-interval (QTc) was calculated at same temperatures. Clinical QRS/QTc data were obtained after a systematic literature review. Rabbit QRS/QTc values correlated with risk for VF (correlation coefficient: 0.97). Human QRS/QTc values from hypothermic patients, showed similar correlation with risk for ventricular fibrillation in the experimental data (correlation coefficient: 1.00).</AbstractText>These calculations indicate that QRS/QTc has potential as novel biomarker for predicting risk of hypothermia-induced cardiac arrest. Our findings apply both to victims of accidental hypothermia and to patients undergoing therapeutic hypothermia during surgery or after e.g. cardiac arrest.</AbstractText> |
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