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17,200 | Prognostic Value of Serum Uric Acid in Hospitalized Heart Failure Patients With Preserved Ejection Fraction (from the Japanese Nationwide Multicenter Registry). | Elevated serum uric acid (UA) is associated with an increased risk of cardiovascular disease and worse clinical outcome in patients with cardiovascular disease. Nevertheless, the prognostic value of serum UA level in hospitalized heart failure patients with preserved ejection fraction (HFpEF) has not been fully elucidated. The aim of this study was to investigate whether serum UA level on admission could be associated with subsequent mortality in hospitalized patients with HFpEF. We examined 516 consecutive hospitalized HFpEF (left ventricular ejection fraction ≥50%) patients with decompensated heart failure from our HFpEF-specific multicenter registry who had serum UA data on admission. The primary outcome of interest was all-cause death. During a median follow-up period of 749 (interquartile range 540 to 831) days, 90 (17%) patients died. Higher serum UA level was significantly related to increased incidence of all-cause death (p = 0.016). In addition, patients with higher serum UA (≥6.6 mg/dl, median) and plasma B-type natriuretic peptide (≥401.2 pg/ml, median) levels had the highest incidence of all-cause death in the groups (p = 0.002). In multivariable Cox regression analysis, serum UA was an independent determinant of mortality (hazards ratio 1.23, 95% confidence interval 1.10 to 1.39) even after adjustment for prespecified confounders, renal function and the use of diuretics before admission. In conclusions, higher admission serum UA was an independent determinant of mortality in hospitalized HFpEF patients. Our findings indicate the importance of assessing admission serum UA level for further risk stratification in hospitalized patients with HFpEF. |
17,201 | Quantification of left atrial function in patients with non-obstructive hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking imaging: a feasibility and reproducibility study. | Atrial fibrillation (AF) is the most common arrhythmia in hypertrophic cardiomyopathy (HCM) and is associated with adverse outcomes in HCM patients. Although the left atrial (LA) diameter has consistently been identified as a strong predictor of AF in HCM patients, the relationship between LA dysfunction and AF still remains unclear. The aim of this study is to evaluate the LA function in patients with non-obstructive HCM (NOHCM) utilizing cardiovascular magnetic resonance feature tracking (CMR-FT).</AbstractText>Thirty-three patients with NOHCM and 28 healthy controls were studied. The global and regional LA function and left ventricular (LV) function were compared between the two groups. The following LA global functional parameters were quantitively analyzed: reservoir function (total ejection fraction [LA total EF], total strain [εs</sub>], peak positive strain rate [SRs]), conduit function (passive ejection fraction [LA passive EF], passive strain [εe</sub>], peak early-negative SR [SRe]), and booster pump function (active ejection fraction [LA active EF], active strain [εa</sub>], peak late-negative SR [SRa]). The LA wall was automatically divided into 6 segments: anterior, antero-roof, inferior, septal, septal-roof and lateral. Three LA strain parameters (εs</sub>, εe</sub>, εa</sub>) and their corresponding strain rate parameters (SRs, SRe, SRa) during the reservoir, conduit and booster pump LA phases were segmentally measured and analyzed.</AbstractText>The LA reservoir (LA total EF: 57.6 ± 8.2% vs. 63.9 ± 6.4%, p < 0.01; εs</sub>: 35.0 ± 12.0% vs. 41.5 ± 11.2%, p = 0.03; SRs: 1.3 ± 0.4 s- 1</sup> vs. 1.5 ± 0.4 s- 1</sup>, p = 0.02) and conduit function (LA passive EF: 28.7 ± 9.1% vs. 37.1 ± 10.0%, p < 0.01; εe</sub>: 18.7 ± 7.9% vs. 25.9 ± 10.0%, p < 0.01; SRe: - 0.8 ± 0.3 s- 1</sup> vs. -1.1 ± 0.4 s- 1</sup>, p < 0.01) were all impaired in patients with NOHCM when compared with healthy controls, while LA booster pump function was preserved. The LA segmental strain and strain rate analysis demonstrated that the εs</sub>, εe</sub>, SRe of inferior, SRs, SRe of septal-roof, and SRa of antero-roof walls (all p < 0.05) were all decreased in the NOHCM cohort. Correlations between LA functional parameters and LV conventional function and LA functional parameters and baseline parameters (age, body surface area and NYHA classification) were weak. The two strongest relations were between εs</sub> and LA total EF(r = 0.84, p < 0.01), εa</sub> and LA active EF (r = 0.83, p < 0.01).</AbstractText>Compared with healthy controls, patients with NOHCM have LA reservoir and conduit dysfunction, and regional LA deformation before LA enlargement. CMR-FT identifies LA dysfunction and deformation at an early stage.</AbstractText> |
17,202 | How the Deuteration of Dronedarone Can Modify Its Cardiovascular Profile: In Vivo Characterization of Electropharmacological Effects of Poyendarone, a Deuterated Analogue of Dronedarone. | Since deuterium replacement has a potential to modulate pharmacodynamics, pharmacokinetics and toxicity, we developed deuterated dronedarone; poyendarone, and assessed its cardiovascular effects. Poyendarone hydrochloride in doses of 0.3 and 3 mg/kg over 30 s was intravenously administered to the halothane-anesthetized dogs (n = 4), which provided peak plasma concentrations of 108 ± 10 and 1120 ± 285 ng/mL, respectively. The 0.3 mg/kg shortened the ventricular repolarization period. The 3 mg/kg transiently increased the heart rate at 5 min but decreased at 45 min, and elevated the total peripheral vascular resistance and left ventricular preload, whereas it reduced the mean blood pressure at 5 min, left ventricular contractility and cardiac output. The transient tachycardic action is considered to be induced by the hypotension-induced, reflex-mediated increase of sympathetic tone. The 3 mg/kg delayed both intra-atrial and intra-ventricular conductions, indicating Na<sup>+</sup> channel inhibitory action. Moreover, the 3 mg/kg transiently shortened the ventricular repolarization period at 5 min. No significant change was detected in the late repolarization by poyendarone, indicating it might not hardly significantly alter rapidly activating delayed-rectifier K<sup>+</sup> current (I<sub>Kr</sub>). Poyendarone prolonged the atrial effective refractory period greater than the ventricular parameter. When compared with dronedarone, poyendarone showed similar pharmacokinetics of dronedarone, but reduced β-adrenoceptor blocking activity as well as the cardio-suppressive effect. Poyendarone failed to inhibit I<sub>Kr</sub> and showed higher atrial selectivity in prolonging the effective refractory period of atrium versus ventricle. Thus, the deuteration may be an effective way to improve the cardiovascular profile of dronedarone. Poyendarone is a promising anti-atrial fibrillatory drug candidate. |
17,203 | Clinical impact of rapid ventricular pacing on the left atrial posterior wall isolation by a cryoballoon application: a randomized controlled trial. | Rapid ventricular pacing (RVP) was reported to improve the cooling effects of the cryoballoon (CB). The aim of this study was to investigate the safety and efficacy of RVP for left atrial posterior wall isolation (PWI) by the CB.</AbstractText>One hundred consecutive patients (males 80, mean age 63 ± 10 years) with persistent atrial fibrillation underwent left atrial roof (LA-RB) and bottom block line (LA-BB) creation by CB to achieve PWI. Patients were randomized into two groups according to whether they underwent PWI with (RVP group, n = 50) or without RVP (control group, n = 50).</AbstractText>The nadir CB temperature (NCT) during the LA-RB and LA-BB creation was significantly lower in the RVP group than control group (LA-RB - 45.7 °C and - 43.9 °C, p < 0.001, and LA-BB - 42.4 °C and - 40.0 °C, p < 0.001). The success rate of the LA-RB creation was significantly higher in the RVP group than the control group (98% vs. 88%, p = 0.039), however, there were no significant differences regarding the LA-BB creation (66% vs. 52%, p = 0.15) and PWI (66% vs. 50%, p = 0.1) between the two groups. The PWI success rate did not differ whether CB freezing was prematurely terminated due to an excessive luminal esophageal temperature (LET) drop in the RVP group (65.8% vs. 66.7%, respectively, p = 0.96).</AbstractText>RVP significantly decreased the NCT during the CB application resulting in the significant improvement of success rate of the LA-RB. The advantage of RVP in terms of the accomplishing PWI was not affected even when the CB freezing was prematurely terminated due to an excessive LET drop.</AbstractText> |
17,204 | Successful catheter ablation of persistent atrial fibrillation is associated with improvement in functional tricuspid regurgitation and right heart reverse remodeling. | Atrial fibrillation (AF) is a common disease that changes cardiac morphology, especially in the left atrium (LA). It is now known that certain categories of functional mitral regurgitation (MR) are associated with AF; however, the influence of AF on right cardiac morphology is not fully understood. Our aim in this study was to investigate the association between AF and right cardiac morphology. This was a retrospective cohort study of 86 patients with persistent AF without other cardiac disease who underwent catheter ablation (CA). Seventy-one patients had sustained sinus rhythm (SR) (SR Group) and 15 patients had sustained AF (AF Group) during the study period. We compared the changes in the right cardiac dimensions and tricuspid regurgitation (TR) between the groups 12 months after CA. Patients' baseline echocardiographic assessments revealed that the LA volume index was significantly smaller in the SR group than in the AF group (46.8 ± 11.9 ml/m<sup>2</sup> vs 59.3 ± 12.8 ml/m<sup>2</sup>, respectively; p < 0.01). Comparing baseline data with the 12-month follow-up data, in the SR group, right atrial area (RAA, cm<sup>2</sup>), tricuspid annular diameter (mm), and tricuspid regurgitant jet area (cm<sup>2</sup>) were significantly decreased compared with the AF group (19.5 ± 4.5-15.5 ± 3.6 vs 20.7 ± 3.6-19.7 ± 2.3; 30.5 ± 4.9-26.4 ± 3.9 vs 28.7 ± 4.0-28.8 ± 3.1; and 1.4 [interquartile range (IQR) 0.7-2.6]-0.6 [IQR 0.2-1.2] vs 1.2 [IQR 1.1-1.5]-0.9 [IQR 0.4-1.3], respectively). On multivariate analysis, change in RAA correlated with the reduction in tricuspid regurgitant jet area (R = 0.51, p < 0.001). In conclusion, successful CA for persistent AF led to right heart reverse remodeling, and our findings suggested that persistent AF was associated with RAA dilatation and TR. |
17,205 | Computed Tomography Perfusion Identifies Patients With Stroke With Impaired Cardiac Function. | Background and Purpose- Low left ventricular ejection fraction (LVEF) leads to worse outcomes after stroke. We hypothesized that the arterial input function (AIF) variability on perfusion computed tomography, especially the time between scan onset and end of AIF (SO-EndAIF), would reflect reduction of cardiac output. Methods- Retrospective analysis of consecutive stroke patients, who underwent computed tomography between January 2013 and September 2018, was performed in 2 parts. (1) To determine the correlation between SO-EndAIF and LVEF, all patients with a transthoracic echocardiogram performed ±6 months from the time of stroke were included. LVEF was dichotomized as either normal (≥50%) or decreased (<50%). (2) AIF was compared with hypoperfusion volume, defined as delay time >3 seconds and with clinical outcome measured using 3-month modified Rankin Scale. Results- A total of 732 ischemic stroke patients underwent computed tomography, 231 with transthoracic echocardiogram were included in part (1), 393 with outcome data were included in part (2). In part (1), 193/231 (83.5%) had normal LVEF (median 61%) and 38/231 (16.5%) decreased LVEF (median 39%). The low-LVEF group had significantly prolonged SO-EndAIF compared with normal-LVEF group (mean of 39.7 versus 26 second; <i>P</i><0.001), and larger hypoperfusion lesions (94.9 versus 37.6 mL; <i>P</i><0.001). SO-EndAIF time was strongly associated with EF, with an area under the curve of 0.86. Twenty nine seconds was the best threshold to distinguish between normal and impaired EF (area under the curve, 0.77). In part (2), the SO-EndAIF ≥29 second group had larger hypoperfusion volumes (21.8 versus 89.7 mL; <i>P</i><0.001) and infarct core (12.2 versus 2.3 mL; <i>P</i><0.0001) and patients with SO-EndAIF ≥29 seconds had fewer excellent or good clinical outcomes (modified Rankin Scale score 0-1; 40% versus 22%; OR, 2.79; <i>P</i><0.001, modified Rankin Scale score 0-2; 65% versus 35%; OR, 1.41; <i>P</i>=0.033). Conclusions- AIF width correlates with ejection fraction in acute ischemic stroke. A 29-second threshold from scan onset to end of AIF accurately predicts reduced LVEF and identifies patients more likely to have worse outcomes after stroke. |
17,206 | Improved Survival With Extracorporeal Cardiopulmonary Resuscitation Despite Progressive Metabolic Derangement Associated With Prolonged Resuscitation. | The likelihood of neurologically favorable survival declines with prolonged resuscitation. However, the ability of extracorporeal cardiopulmonary resuscitation (ECPR) to modulate this decline is unknown. Our aim was to examine the effects of resuscitation duration on survival and metabolic profile in patients who undergo ECPR for refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest.</AbstractText>We retrospectively evaluated survival in 160 consecutive adults with refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest treated with the University of Minnesota (UMN) ECPR protocol (transport with ongoing cardiopulmonary resuscitation [CPR] to the cardiac catheterization laboratory for ECPR) compared with 654 adults who had received standard CPR in the amiodarone arm of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study). We evaluated the metabolic changes and rate of survival in relation to duration of CPR in UMN-ECPR patients.</AbstractText>Neurologically favorable survival was significantly higher in UMN-ECPR patients versus ALPS patients (33% versus 23%; P</i>=0.01) overall. The mean duration of CPR was also significantly longer for UMN-ECPR patients versus ALPS patients (60 minutes versus 35 minutes; P</i><0.001). Analysis of the effect of CPR duration on neurologically favorable survival demonstrated significantly higher neurologically favorable survival for UMN-ECPR patients compared with ALPS patients at each CPR duration interval <60 minutes; however, longer CPR duration was associated with a progressive decline in neurologically favorable survival in both groups. All UMN-ECPR patients with 20 to 29 minutes of CPR (8 of 8) survived with neurologically favorable status compared with 24% (24 of 102) of ALPS patients with the same duration of CPR. There were no neurologically favorable survivors in the ALPS cohort with CPR ≥40 minutes, whereas neurologically favorable survival was 25% (9 of 36) for UMN-ECPR patients with 50 to 59 minutes of CPR and 19% with ≥60 minutes of CPR. Relative risk of mortality or poor neurological function was significantly reduced in UMN-ECPR patients with CPR duration ≥60 minutes. Significant metabolic changes included decline in pH, increased lactic acid and arterial partial pressure of carbon dioxide, and thickened left ventricular wall with prolonged professional CPR.</AbstractText>ECPR was associated with improved neurologically favorable survival at all CPR durations <60 minutes despite severe progressive metabolic derangement. However, CPR duration remains a critical determinate of survival.</AbstractText> |
17,207 | The association between epicardial adipose tissue thickness around the right ventricular free wall evaluated by transthoracic echocardiography and left atrial appendage function. | Epicardial adipose tissue (EAT) is associated with the development of atrial fibrillation (AF). EAT thickness identified on transthoracic echocardiography (TTE). The relationship between EAT volume and left atrial appendage (LAA) function is not well-known. We aimed to investigate the associations between EAT thickness and LAA emptying flow velocity and LAA orifice area. This single-center retrospective study enrolled 202 patients who underwent both TTE and transesophageal echocardiography (TEE). EAT thickness was measured on TTE in parasternal long-axis view. We measured LAA orifice areas in 41 patients with 3-dimensional TEE data. Spearman's correlation coefficient was used to determine the relationships between EAT thickness and LAA emptying flow velocity and LAA orifice area. We created a receiver operating characteristic curve for low LAA emptying flow velocity (< 20 cm/s) and determined the best cutoff for EAT thickness according to the maximum Youden index. There was a significant negative correlation between EAT thickness and LAA emptying flow velocity (ρ = - 0.56, P < 0.001) and a significant positive correlation between EAT thickness and LAA orifice area (ρ = 0.38, P = 0.014). The best EAT thickness cutoff value for low LAA emptying flow velocity was > 5.1 mm (c-statistics, 75.7%). A thickened EATT was associated with low LAA emptying flow velocity, which increases the risk of thromboembolic phenomena in the presence of AF. |
17,208 | Does Switching Norepinephrine to Phenylephrine in Septic Shock Complicated by Atrial Fibrillation With Rapid Ventricular Response Improve Time to Rate Control? | Atrial fibrillation (AF) frequently develops during critical illness. In septic shock complicated by rapid AF, the use of phenylephrine may be advantageous secondary to its β-1 sparing properties. However, evidence supporting this strategy is lacking.</AbstractText>The purpose of this study is to determine the clinical effect on rate control of transitioning norepinephrine to phenylephrine in septic shock patients who develop AF with a rapid ventricular response (RVR).</AbstractText>A single-center retrospective study of septic shock patients admitted to the medical or surgical intensive care unit (ICU) who developed AF with RVR (heart rate >110 beats per minute [bpm]). Patients who were switched to phenylephrine were compared to those who remained on norepinephrine. The primary end point was sustained achievement of rate control. A time-varying Cox proportional hazards model was used to assess the primary end point.</AbstractText>A total of 67 patients were included in the study, of which 28 were switched to phenylephrine. Baseline characteristics were similar between groups. The unadjusted hazard ratio for achieving rate control was significant at 1.99 (95% confidence interval [CI]: 1.19-3.34; P</i> < .01) for the phenylephrine group. The adjusted hazard ratio was 1.75 (95% CI: 0.86-3.53; P</i> = .12). There were no statistically significant differences in mortality or ICU length of stay.</AbstractText>Our study suggests a potential clinical effect on achieving rate control when switching to phenylephrine cannot be excluded. It remains unclear if there is a benefit on mortality or length of stay outcomes in critically ill patients.</AbstractText> |
17,209 | Predicting drug-disease associations with heterogeneous network embedding. | The prediction of drug-disease associations holds great potential for precision medicine in the era of big data and is important for the identification of new indications for existing drugs. The associations between drugs and diseases can be regarded as a complex heterogeneous network with multiple types of nodes and links. In this paper, we propose a method, namely HED (Heterogeneous network Embedding for Drug-disease association), to predict potential associations between drugs and diseases based on a drug-disease heterogeneous network. Specifically, with the heterogeneous network constructed from known drug-disease associations, HED employs network embedding to characterize drug-disease associations and then trains a classifier to predict novel potential drug-disease associations. The results on two real datasets show that HED outperforms existing popular approaches. Furthermore, some of our predictions have been verified by evidence from literature. For instance, carvedilol, a drug that was originally used for heart failure, left ventricular dysfunction, and hypertension, is predicted to be useful for atrial fibrillation by HED, which is supported by clinical trials. |
17,210 | Costs and long-term outcomes following pulmonary vein isolation for atrial fibrillation in elderly patients using second-generation cryoballoon vs. open-irrigated radiofrequency in China. | Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) vs. radiofrequency (RF) ablation in elderly patients (> 75 years old). The present study aimed to compare the costs and clinical outcomes in elderly patients using these two strategies.</AbstractText>Elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients.</AbstractText>A total of 324 elderly patients were included (RF,176; CB-2,148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs. 135.1 ± 9.9 min, P < 0.001; 53.7 ± 8.9 vs. 65.1.9 ± 9.0 min, P < 0.001) but marked fluoroscopy utilization (22.1 ± 3.3 vs. 18.5 ± 3.6 min, P < 0.001). Complications occurred in 3.3% (CB-2) and 6.2% (RF) of patients with no significant different (p = 0.307). The length of stay after ablation was shorter, but the costs were higher in the CB-2 group (1.94 vs. 2.53 days, P < 0.001 and 91,132.6 ± 3723.5 vs. 81,149.4 ± 6824.1 CNY, P < 0.001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia (ERAA) was lower in the CB-2 group (14.2 vs. 23.3%, P = 0.047), but the long-term success rate was similar between two groups.</AbstractText>CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower ERAA, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long-term success is similar between the two groups.</AbstractText> |
17,211 | A case of cardiac tamponade during the treatment of simultaneous cardio-cerebral infarction associated with atrial fibrillation - Case report. | Simultaneous cerebral and myocardial infarction is called cardio-cerebral infarction (CCI). It is a rare condition, and its management strategy has yet to be determined. We report a case of cardiac tamponade during the treatment of CCI associated with atrial fibrillation.</AbstractText>A 72-year-old man presented with loss of consciousness after chest discomfort. He had taken rivaroxaban for paroxysmal atrial fibrillation. Twelve-lead electrocardiography showed ST elevation at II, III, and aVF. His National Institutes of Health Stroke Scale was 29. We diagnosed him with synchronous cardioembolic stroke and acute myocardial infarction due to atrial fibrillation. The coronary angiography revealed distal occlusion in the posterior descending branch of the right coronary artery, and overall myocardial perfusion seemed sufficient. The diffusion-weighted image showed hyperintense lesions at the cerebellum, and magnetic resonance angiography did not reveal the flow of the basilar artery. The patient's NIH score improved immediately, so we did not perform intravenous tissue plasminogen activator (IV-tPA) administration nor endovascular treatment. Heparin administration was started. After 38 h from the onset, he suffered from hydrocephalus, and cerebral ventricular drainage was performed. Subsequently, circulatory dynamics worsened, and he was diagnosed with cardiac tamponade. Emergency pericardiotomy was performed, and he has been taking intensive care.</AbstractText>Some cases with CCI treated with IV-tPA and endovascular intervention were reported, but the treatment strategy should be still discussed multidisciplinary. Especially, the administration of antithrombotic drugs for CCI should be carefully performed because fatal hemorrhage such as cardiac tamponade can occur.</AbstractText>Copyright: © 2019 Surgical Neurology International.</CopyrightInformation> |
17,212 | The central role of CT coronary angiography in postcardiac arrest care in the young adult. | A 32-year-old man with no medical history went into ventricular fibrillation while running at the gym. He was transferred to our tertiary centre post successful resuscitation where admission electrocardiography and echocardiography were unremarkable. The initial cause of cardiac arrest was suspected arrhythmogenic and he was admitted for further investigations including exercise testing, ajmaline challenge, CT coronary angiography (CTCA) and cardiovascular MRI, with the likely outcome of cardioverter-defibrillator implantation. CTCA, however, revealed significant stenosis in the proximal left anterior descending artery as the likely cause for his arrest. Invasive coronary angiography confirmed this and facilitated successful stent implantation, avoiding the need for implantable cardioverter-defibrillator implantation. This case highlights the importance of CTCA, a non-invasive and readily-available test in the investigation of young patients postcardiac arrest, who require active exclusion of coronary artery disease and anomalous coronary anatomy, though they represent a low-risk population group. |
17,213 | A Model Incorporating Left Ventricular Impedance Index may be Explanatory for Late Pulmonary Vein Isolation Failure. | To study the influence of a flow-based Impedance Index to attempt to explain the persistent late failure rate of Pulmonary Vein Isolation (PVI) in patients with Atrial Fibrillation (AF).</AbstractText>We recently described a flow-based Impedance Index for left ventricular ejection into the aorta and noted an association with Major Adverse Cardiovascular Event Rate (MACE). While the Impedance Index is not routinely measured in PVI patients it approximates to measures derivable from the left ventricular ejection fraction (EF). We sought to assess the Impedance Index's influence on PVI failure rate in combination with indices of left atrial size.</AbstractText>In AF patients (n=100) undergoing a Cardiovascular Magnetic Resonance (CMR) imaging examination prior to undergoing PVI we assessed baseline characteristics for their influence on the PVI failure rate at 3-12 months. Uni-variable and multi-variable binary logistic models were performed to find predictors of the PVI failure rate at follow-up.</AbstractText>All patients underwent PVI and CMR imaging. A total of 26 (26%) patients had late AF recurrence at 3-12 months follow-up. Multi-variable models that predicted PVI failure were: 1) the baseline Impedance Index and LA volume index (p<0.05) and 2) the baseline Impedance Index and the degree of mitral valve regurgitation (MR) (p<0.001). While the Impedance Index was derived from EF, EF per se was not a predictor of PVI failure (p=0.28).</AbstractText>We have provided evidence of the influence of a flow-based Impedance Index on the PVI late failure rate which is significant and remains explanatory when adjusting for measures of atrial size, MR grade and LA volume index. Direct measure of the Impedance Index was not available here and was derived from EF measures. Further work is needed to directly measure the Impedance Index in a PVI population and determine the mechanism for the influence on PVI failure, which may lead to modification of the ablation procedure to improve the success rate.</AbstractText> |
17,214 | Isolated Neutropenia: An Unexplored Side Effect of Amiodarone. | Amiodarone has been widely used for the treatment of various arrhythmias. It is a potent P450 inhibitor leading to interaction with many commonly prescribed drugs. Also, due to its long half-life, lipophilicity, and broad tissue distribution, it can cause a wide range of toxicities. A 62-year-old male with the unknown past medical history presented to the emergency department following a grand mal seizure. The patient initially presented with atrial flutter, which was controlled with beta blockers but was switched to amiodarone after 2 weeks when he developed atrial fibrillation with the rapid ventricular response. Approximately 1 month into his hospital stay, the patient developed severe isolated neutropenia. After ruling out other etiologies, amiodarone was withdrawn. The patient's absolute neutrophil count recovered 3 days after discontinuation of amiodarone. |
17,215 | Young-onset atrial fibrillation: Sex differences in clinical profile, progression rate and cardiovascular outcome. | Women are underrepresented in major atrial fibrillation (AF) trials. In addition, data regarding clinical profile and outcome in young AF patients is limited. Therefore we aimed to investigate the clinical profile, AF progression rate and cardiovascular outcome between sexes in patients with young-onset AF.</AbstractText>A total of 497 patients with AF-onset <60 years of age were included. Data on clinical profile and cardiovascular outcome were prospectively collected.</AbstractText>Of 497 patients, 125 (25%) patients were women. Women had more often familial AF (34% versus 22%, P</i> = 0.012) and obesity (26% versus 18%, P</i> = 0.03). Men had more often coronary artery disease (11% versus 5%, P</i> = 0.04), a longer PR interval [163 (148-180) versus 150 (138-167) ms, P</i> < 0.001] and higher left ventricular mass index [82 (71-96) versus 72 (61-83) g/m2</sup>, P</i> < 0.001]. During a median follow-up of 7.0 (2.7-10.0) years AF progression rate was comparable (HR 2.03 for men versus women, 95%CI 0.92-4.48; P</i> = 0.08), and no difference in cardiovascular events was observed between women and men (Log rank P</i>-value = 0.07).</AbstractText>In young patients with AF, clinical patient profile is different between the sexes but did not result in differences in cardiovascular outcome.</AbstractText>© 2019 The Authors.</CopyrightInformation> |
17,216 | Usefulness of Preprocedural Left Ventricular End-Systolic Volume Index and Early Diastolic Mitral Annular Velocity in Predicting Improvement in Left Ventricular Ejection Fraction Following Atrial Fibrillation Ablation in Patients With Impaired Left Ventricular Systolic Function. | Catheter ablation of atrial fibrillation (AF) is known to facilitate reverse remodeling of the left ventricle. However, factors that can improve the left ventricular (LV) systolic function remain elusive. In this study, we investigated factors related to LV ejection fraction (LVEF) improvement following AF ablation in patients with systolic dysfunction. A total of 140 patients with impaired LVEF (<50%) who underwent AF ablation were retrospectively evaluated. The primary outcome was LVEF improvement. A total of 68, 9, and 15 patients achieved LVEF improvement at 3, 6, and 12 months after AF ablation, respectively. Five patients achieved late LVEF improvement. The overall LVEF improvement rate was 69%. In the receiver operating characteristic curve analysis, the LV end-systolic volume (LVESVI) and early diastolic mitral annular velocity (e') had larger areas under the curve (0.79 and 0.75, respectively) than other echocardiographic parameters, and the most optimal cutoff values of LVESVI and e' were 49.8 ml/m<sup>2</sup> and 5.4 cm/s, respectively. Moreover, preprocedural LVESVI ≤49.8 ml/m<sup>2</sup> and e' ≥5.4 independently predicted the outcome after adjusting for confounders (hazard ratio 1.74; 95% confidence interval 1.06 to 2.95; p = 0.03; hazard ratio, 1.99; 95% confidence interval 1.13 to 3.64; p = 0.01). LVEF improvement was achieved in 69% of patients who underwent AF ablation, including 4% with late improvement. Lower LVESVI and higher e' could independently predict LVEF improvement. |
17,217 | Bisoprolol transdermal patch for perioperative care of non-cardiac surgery in patients with hypertrophic obstructive cardiomyopathy. | Non-cardiac surgery for hypertrophic obstructive cardiomyopathy (HOCM) is considered to require meticulous perioperative care. β-blockers are considered the first-line drugs for patients with HOCM, and they play a key role in preventing cardiovascular complications in perioperative care. The bisoprolol transdermal patch has recently become available in Japan, and it is useful for patients who are unable to take oral medication during perioperative care. The aim of this case series was to assess the hemodynamic features of patients with HOCM who used the bisoprolol transdermal patch during perioperative care for non-cardiac surgery.</AbstractText>Between August 2016 and August 2018, we retrospectively analyzed 10 consecutive cases of HOCM with the patients using the bisoprolol transdermal patch during perioperative care. Hemodynamic and echocardiographic features were evaluated before and after patients were switched from oral bisoprolol to transdermal patch therapy or started transdermal patch therapy as a new β-blocker medication. In addition, cardiovascular complications (all-cause death, cardiac death, heart failure, ventricular tachycardia, and ventricular fibrillation) during the perioperative period were evaluated.</AbstractText>There was no significant change in the patients' heart rate, blood pressure, ejection fraction, and pressure gradient in the left ventricle after switching from oral bisoprolol to the transdermal patch therapy. On the other hand, patients who started using the bisoprolol transdermal patch as a new ß-blocker medication tended to have a decreased heart rate and pressure gradient thereafter, but there was no significant difference in blood pressure or ejection fraction. No cardiovascular complications occurred during the perioperative period.</AbstractText>We described the utilization of the bisoprolol transdermal patch during perioperative care for non-cardiac surgery in patients with HOCM. We determined that the hemodynamic features of these patients did not change significantly after switching to patch therapy. Further, initiation of the bisoprolol transdermal patch as a new ß-blocker medication sufficiently tended to decrease the pressure gradient. This unique approach can be an alternate treatment option for HOCM.</AbstractText>The registry was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000036703). The date of registration was 10/5/2019 and it was "Retrospectively registered".</AbstractText> |
17,218 | CHA<sub>2</sub>DS<sub>2</sub>-VASc Score and the Risk of Ventricular Tachyarrhythmic Events and Mortality in MADIT-CRT. | Background We hypothesized that multiple cardiovascular comorbidities, incorporated in the CHA<sub>2</sub>DS<sub>2</sub>-VASc score, may be useful in the assessment of ventricular tachyarrhythmias (VTAs) and mortality risk in heart failure (HF) patients. Methods and Results We evaluated the association between the CHA<sub>2</sub>DS<sub>2</sub>-VASc score (dichotomized as high at the upper quartile [≥5] and further assessed as a continuous measure) and the risk of VTA and death among 1804 patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). A high CHA<sub>2</sub>DS<sub>2</sub>-VASc score (n=464; 26%) was inversely associated with the risk of any VTA (hazard ratio [HR]: 0.64; <i>P</i>=0.001), fast VTA >200 beats/min (HR; 0.51; <i>P</i><0.001), and appropriate implantable cardioverter-defibrillator shocks (HR: 0.60; <i>P</i><0.001). In contrast, a high score was directly correlated with mortality risk (HR: 1.92; <i>P</i><0.001) and the risk of HF or death (HR: 1.60; <i>P</i><0.001). Consistently, each 1-U increment in CHA<sub>2</sub>DS<sub>2</sub>-VASc was associated with a significant 13% (<i>P</i>=0.003) reduction in VTA risk but a corresponding 33% (<i>P</i><0.001) increase in mortality risk. Patients with a high CHA<sub>2</sub>DS<sub>2</sub>-VASc score and left bundle-branch block derived a pronounced 53% (<i>P</i><0.001) reduction in the risk of HF or death with cardiac resynchronization therapy with defibrillator versus implantable cardioverter-defibrillator-only therapy. Conclusions Our findings suggest that a high CHA<sub>2</sub>DS<sub>2</sub>-VASc score can be used to identify patients with mild HF who have low VTA risk and high morbidity or mortality risk and may derive a pronounced clinical benefit from cardiac resynchronization therapy without a defibrillator. These data suggest a possible role for the CHA<sub>2</sub>DS<sub>2</sub>-VASc score in device selection among candidates for biventricular pacing. |
17,219 | Caffeinated Energy Drink Induced Ventricular Fibrillation: The Price for Overexcitement. | An otherwise healthy 32-year-old man had an in-hospital cardiac arrest with ventricular fibrillation after a few days of consuming 48 cans of alcohol-mixed energy drinks (EDs) (250-mL per can ). He had collapsed shortly after presenting to the emergency room with complaints of lack of sleep and palpitations. Normal cardiac rhythm was restored by biphasic direct current (D/C) shock. EDs generally contain mainly caffeine, taurine, and other ingredients. Especially in high doses, caffeine can cause palpitations and ventricular arrhythmias. |
17,220 | Routine Continuous Electrocardiographic Monitoring Following Percutaneous Coronary Interventions. | The clinical utility of routine electrocardiographic monitoring following percutaneous coronary interventions (PCI) is not well studied.</AbstractText>We prospectively evaluated the incidence, cost, and the clinical implications of actionable arrhythmia alarms on telemetry monitoring following PCI. One thousand three hundred fifty-eight PCI procedures (989 [72.8%] for acute coronary syndrome and 369 [27.2%] for stable angina) on patients admitted to nonintensive care unit were identified and divided into 2 groups; group 1, patients with actionable alarms (AA) and group 2, patients with non-AA. AA included (1) ≥3 s electrical pause or asystole; (2) high-grade Mobitz type II atrioventricular block or complete heart block; (3) ventricular fibrillation; (4) ventricular tachycardia (>15 beats); (5) atrial fibrillation with rapid ventricular response; (6) supraventricular tachycardia (>15 beats). Primary outcomes were 30-day all-cause mortality. Cost-savings analysis was performed.</AbstractText>Incidence of AA was 2.2% (37/1672). Time from end of procedure to AA was 5.5 (0.5, 24.5) hours. Patients with AA were older, presented with acute congestive heart failure or non-ST-segment-elevation myocardial infarction, and had multivessel or left main disease. The 30-day all-cause mortality was significantly higher in patients with AA (6.5% versus 0.3% in non-AA [P</i><0.001]). Applying the standardized costing approach and tailored monitoring per the American Heart Association guidelines lead to potential cost savings of $622 480.95 for the entire population.</AbstractText>AA following PCI were infrequent but were associated with increase in 30-day mortality. Following American Heart Association guidelines for monitoring after PCI can lead to substantial cost saving.</AbstractText> |
17,221 | Safety of Outpatient Milrinone Infusion in End-Stage Heart Failure: ICD-Level Data on Atrial Fibrillation and Ventricular Tachyarrhythmias. | Milrinone infusion is one of a few select "non-device" therapies for patients with New York Heart Association (NYHA) class IV, stage D heart failure, which has been associated with an increase in ventricular tachyarrhythmia and atrial fibrillation. Milrinone improves hemodynamics and provides symptomatic relief. Many patients with end-stage heart failure die from cardiac pump failure, and the impact of ventricular tachyarrhythmia and atrial fibrillation on their mortality is unclear.</AbstractText>This is a retrospective study of 98 consecutive patients receiving outpatient milrinone in a single center from 2008 to 2016. The primary endpoint of the study was overall survival on milrinone. Secondary endpoints were incidence of post-milrinone implantable cardioverter defibrillator (ICD) shocks and development of ventricular tachyarrhythmia or atrial fibrillation.</AbstractText>Median survival was 581 ± 96 days with no difference between those with prior ventricular tachyarrhythmia and those without at 1 month (92% vs 97%, P = 0.34), 6 months (67% vs 73%, P = 0.75), and 12 months (67% vs 61%, P = 0.88). Seven out of 12 (58%) patients with prior ventricular tachyarrhythmia had ICD shocks, as compared to 5 out of 78 (6.4%) (P <0.001). Thirty-five patients had atrial fibrillation prior to starting milrinone, which decreased to 72% (P <0.05) by the third follow-up time period (7-9 months). Amiodarone use was protective against new onset atrial fibrillation.</AbstractText>Patients with stage D heart failure with a history of ventricular tachyarrhythmia have similar survival on outpatient milrinone compared to those without. However, those with prior ventricular tachyarrhythmia received more ICD shocks for more ventricular tachyarrhythmias. Milrinone remains a viable therapy for patients with stage D heart failure with limited therapeutic options.</AbstractText>Copyright © 2019 Elsevier Inc. All rights reserved.</CopyrightInformation> |
17,222 | Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients. | Endovascular total aortic arch repair (ETAAR) via needle-based in situ fenestration (ISF) is a major challenge for anaesthesiologists because of haemodynamic instability and the risk of cerebral hypoxia. We herein summarise our experience with anaesthetic management of patients who underwent this procedure.</AbstractText>Fourteen patients who underwent ETAAR via ISF for arch pathologies involving the major supra-arch branches were included. Regional cerebral oxygen saturation was measured to monitor cerebral perfusion. Partial extracorporeal circulation (EC) support from the right common femoral vein to the right axillary artery was introduced to provide cerebral perfusion.</AbstractText>During ISF, vessel rupture occurred in three patients and ventricular fibrillation occurred in one patient. The regional cerebral oxygen saturation significantly decreased during the potential risk period for cerebral ischaemia. Establishment of EC effectively prevented cerebral ischaemia.</AbstractText>During ETAAR, the risks of haemodynamic instability caused by the procedure and vessel rupture during ISF need to be overcome. Partial EC ensured good cerebral protection in our study, and regional cerebral oxygen saturation monitoring may help to reduce the rate of desaturation.</AbstractText> |
17,223 | Risk Factors of In-Hospital Lethal Arrhythmia Following Acute Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention　- Insight From the J-MINUET Study. | <b><i>Background:</i></b> Lethal arrhythmias including ventricular tachycardia and fibrillation (VT/VF) are common complications of acute myocardial infarction (AMI). Predictors of in-hospital VT/VF after AMI, however, have not been thoroughly investigated. In this study, we sought to elucidate the predictors of in-hospital VT/VF events after AMI in the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). <b><i>Methods and Results:</i></b> In-hospital VT/VF was defined as a hemodynamically unstable VT or VF in the first week of hospitalization, on which the patients were classified as the VT/VF group. Of the patients in the J-MINUET study, 3,175 were finally enrolled in this study. A total of 114 patients had VT/VF. On multivariate logistic analysis, maximum creatine kinase >3,000 IU/L (adjusted OR, 1.67; 95% CI: 1.085-2.572; P=0.02), Killip class III or IV (adjusted OR, 8.93; 95% CI: 5.668-14.082; P<0.0001), initial Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 or 1 (adjusted OR, 1.67; 95% CI: 1.035-2.709; P=0.03), and concomitant chronic kidney disease (CKD; adjusted OR, 1.80; 95% CI: 1.105-2.938; P=0.02) were identified as independent predictors for in-hospital VT/VF. <b><i>Conclusions:</i></b> From the J-MINUET study, extensive myocardial damage, cardiogenic shock, lower grade initial TIMI flow on coronary angiography, and concomitant CKD were independent predictors of in-hospital VT/VF after AMI. |
17,224 | [Relationship between red blood cell distribution width and left atrial appendage thrombogenic milieu in old patients with non-valvular atrial fibrillation]. | <b>Objective:</b> To estimate the correlation between red cell distribution width (RDW) level and left atrial appendage thrombogenic milieu (LAATM) in elderly patients with non-valvular atrial fibrillation (NVAF). <b>Methods:</b> This was a retrospective case-control study. A total of 782 NVAF patients (age>60 years old) who finished transesophageal echocardiography (TEE) from January 2010 to December 2016 at Chaoyang Hospital was retrospectively screened, and diveded into LAATM group (<i>n=</i>65) and non LAATM group (<i>n=</i>717). RDW level was compared between the two groups. Potential association between RDW and LAATM was analyzed using multivariate logistic regression analysis. The accuracy of RDW for detecting LAATM was evaluated through receiver operating curve (ROC) analysis. <b>Results:</b> There were significant differences in age, history of heart failure, course of atrial fibrillation (AF), type of AF, NT-proBNP level, RDW level, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction (LVEF), left atrial diameter, CHADS(2) score and CHA(2)DS(2)-VASc score between the two groups (<i>P<</i>0.05). RDW level in LAATM group was significant higher than non LAATM group (13.4% (12.6%, 14.1%) vs. 12.1% (11.2%,13.0%), <i>P<</i>0.001). Multivariate logistic regression showed that RDW level associated with LAATM (<i>OR=</i>4.07, 95<i>%CI</i> 2.09-7.91, <i>P<</i>0.001). In ROC analysis, area under the curve was 0.81 (95<i>%CI</i> 0.74-0.88, <i>P<</i>0.001). When RDW level was 13.1%, LAATM could be diagnosed (sensitivity was 73.1% and specificity was 80.5%). <b>Conclusions:</b> RDW value is associated with the presence of LAATM in elderly NVAF patients. The RDW level has a certain reference value for predicting LAATM.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Fu</LastName><ForeName>Y</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Cadiology, Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Li</LastName><ForeName>K B</ForeName><Initials>KB</Initials></Author><Author ValidYN="Y"><LastName>Yang</LastName><ForeName>X C</ForeName><Initials>XC</Initials></Author></AuthorList><Language>chi</Language><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="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020517" MajorTopicYN="Y">Atrial Appendage</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016022" MajorTopicYN="N">Case-Control Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017548" MajorTopicYN="N">Echocardiography, Transesophageal</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004909" MajorTopicYN="N">Erythrocyte Indices</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004912" MajorTopicYN="N">Erythrocytes</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 探讨红细胞分布宽度（RDW）与老年非瓣膜性心房颤动（NVAF）患者左心耳血栓状态（LAATM）的相关性。 <b>方法：</b> 回顾性分析2010年1月至2016年12月在北京朝阳医院接受经食管超声心动图检查的782例年龄>60岁的NVAF患者的资料，根据超声心动图检查结果将患者分为有LAATM组（65例）和无LAATM组（717例）。比较两组患者的RDW水平，采用多因素logistic回归分析RDW是否为NVAF患者发生LAATM的独立相关因素，通过受试者工作持证（ROC）曲线及曲线下面积评估RDW对于判断LAATM存在与否的价值。 <b>结果：</b> 两组间年龄、心力衰竭病史、心房颤动病程及类型、N末端B型利钠肽原（NT-proBNP）水平、RDW水平、左心室收缩末径内径、左心室舒张末径内径、左心室射血分数（LVEF）、左心房内径、CHADS(2)评分及CHA(2)DS(2)-VASc评分比较，差异均有统计学意义（<i>P</i>均<0.05）；LAATM组患者的RDW水平高于无LAATM组患者[13.4%（12.6%，14.1%）比12.1%（11.2%，13.0%），<i>P<</i>0.001]。多因素logistic回归分析显示RDW水平与LAATM独立相关（<i>OR=</i>4.07，95<i>%CI</i> 2.09~7.91，<i>P<</i>0.001）。ROC曲线下面积为0.81（95<i>%CI</i> 0.74~0.88，<i>P<</i>0.001）；RDW=13.1%时，患者可能存在LAATM（敏感度为73.1%，特异度为80.5%）。 <b>结论：</b> 在老年NVAF患者中，RDW水平与LAATM独立相关，RDW水平对于判断LAATM的存在具有一定参考价值。. |
17,225 | [Correlation between multi-slice spiral CT determined epicardial adipose tissue volume and atrial fibrillation]. | <b>Objective:</b> To determine the relationship between volume of epicardial adipose tissue (EAT) and atrial fibrillation (AF) . <b>Methods:</b> A total of 207 patients who hospitalized in the Department of Cardiology, Nantong University Affiliated Hospital from January 2016 to June 2018 were included in this study. They were divided into two groups, including AF group (<i>n=</i>125) and sinus rhythm group (<i>n=</i>82). The AF group included 80 paroxysmal AF (PAF) and 45 persistent AF (PeAF) patients. Total EAT and left atrial EAT (LA-EAT) volume were measured using 256 rows of multi-slice spiral CT in all patients. Echocardiographic derived left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) were analyzed. Hospholipase A2 and blood lipids were examined in all patients. The baseline data and EAT volume of all groups were compared. The multivariate logistic regression was used to analyze the risk factors related to the occurrence of AF. The correlation between total EAT volume and LA-EAT volume and LAD were analyzed by Pearson correlation. <b>Result:</b> The volume of total EAT in patients with sinus rhythm, AF, PAF and PeAF were (92.2±32.1), (136.0±46.0), (134.2±46.3) and (140.1±52.6)cm(3), respectively. The volume of LA-EAT in patients with sinus rhythm, AF, PeAF and PAF were (27.1±7.5), (39.2±19.2), (35.9± 17.0) and (45.1±21.5)cm(3), respectively. Total EAT and LA-EAT volume were significantly larger in PAF and PeAF groups than in sinus rhythm group (all <i>P<</i>0.01). The LA-EAT volume was larger in PeAF group than in PAF group (<i>P<</i>0.01), but total EAT volume was similar between two groups (<i>P></i>0.05). Logistic regression analysis showed that total EAT volume (<i>OR=</i>1.202, 95<i>%CI</i> 1.083-1.334, <i>P=</i>0.001), LA-EAT volume (<i>OR=</i>1.051, 95<i>%CI</i> 1.003-1.101, <i>P=</i>0.037) and LAD (<i>OR=</i>1.019, 95<i>%CI</i> 1.005-1.032, <i>P=</i>0.006) were the independent related factors of AF. Pearson correlation analysis showed that the total EAT volume was positively correlated with LAD (<i>r=</i>0.466, <i>P<</i>0.01) and LA-EAT volume was positively correlated with LAD (<i>r=</i>0.290, <i>P<</i>0.01). <b>Conclusion:</b> The volume of total EAT and LA-EAT measured by 256-row multi-slice spiral CT is significantly correlated with the incidence of AF.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Zhu</LastName><ForeName>Y M</ForeName><Initials>YM</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Affiliated Hospital of Nantong University, Nantong 226001, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Xu</LastName><ForeName>H X</ForeName><Initials>HX</Initials></Author><Author ValidYN="Y"><LastName>Lu</LastName><ForeName>Q</ForeName><Initials>Q</Initials></Author><Author ValidYN="Y"><LastName>Huang</LastName><ForeName>Y H</ForeName><Initials>YH</Initials></Author><Author ValidYN="Y"><LastName>Jing</LastName><ForeName>H M</ForeName><Initials>HM</Initials></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>X</ForeName><Initials>X</Initials></Author></AuthorList><Language>chi</Language><GrantList CompleteYN="Y"><Grant><GrantID>SJLX16_0569</GrantID><Agency>Reform of Postgraduate Education and Teaching in Jiangsu Province</Agency><Country/></Grant><Grant><GrantID>MS32015030, MS12017003-7</GrantID><Agency>Nantong Municipal Science and Technology Project Fund</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="D000273" MajorTopicYN="N">Adipose Tissue</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006325" MajorTopicYN="N">Heart Atria</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010496" MajorTopicYN="N">Pericardium</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D036542" MajorTopicYN="N">Tomography, Spiral Computed</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 探讨多层螺旋CT测量心外膜脂肪（EAT）体积与心房颤动（房颤）发生的相关性。 <b>方法：</b> 回顾性分析2016年1月至2018年6月南通大学附属医院心内科207例住院患者资料，分为房颤组（125例）和窦性心律组（对照组，82例），其中房颤组又分为阵发性房颤亚组（80例）和持续性房颤亚组（45例）。采用256排多层螺旋CT测量所有患者的总EAT体积及左心房EAT（LA-EAT）体积，超声心动图测量左心室射血分数（LVEF）及左心房内径（LAD），测定血磷脂酶A2及血脂指标。比较各组患者基线资料、EAT体积差异；采用多因素logistic回归分析房颤发生的相关因素；采用Pearson相关分析探讨总EAT体积及LA-EAT体积与LAD的相关性。 <b>结果：</b> 窦性心律组、房颤组、阵发性房颤亚组及持续性房颤亚组的总EAT体积分别为（92.2±32.1）、（136.0±46.0）、（134.2±46.3）和（140.1±52.6）cm(3)，LA-EAT体积分别为（27.1±7.5）、（39.2±19.2）、（35.9±17.0）、（45.1±21.5）cm(3)，房颤组、阵发性及持续性房颤亚组的总EAT和LA-EAT体积均明显大于窦性心律组（<i>P</i>均<0.01）。持续性房颤亚组的LA-EAT体积大于阵发性房颤亚组（<i>P<</i>0.01），但两组的总EAT体积差异无统计学意义（<i>P></i>0.05）。多因素logistic回归分析显示，总EAT（<i>OR=</i>1.202，95<i>%CI</i> 1.083~1.334，<i>P=</i>0.001）、LA-EAT体积（<i>OR=</i>1.051，95<i>%CI</i> 1.003~1.101，<i>P=</i>0.037）及LAD（<i>OR=</i>1.019，95<i>%CI</i> 1.005~1.032，<i>P=</i>0.006）与房颤发生独立相关。Pearson相关分析显示，总EAT体积（<i>r=</i>0.466，<i>P<</i>0.01）、LA-EAT体积（<i>r=</i>0.290，<i>P<</i>0.01）与LAD呈正相关。 <b>结论：</b> 多层螺旋CT测出的总EAT及LA-EAT体积与房颤发生相关，对预测房颤发生有一定价值。. |
17,226 | [Cardioversion efficacy of nifekalan in patients with sustained atrial fibrillation after radiofrequency ablation]. | <b>Objective:</b> To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. <b>Methods:</b> We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non-conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. <b>Results:</b> (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (<i>P<</i>0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non-cardioversion group (both <i>P<</i>0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (<i>P></i>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation (<i>OR=</i>0.980, 95<i>%CI</i> 0.966-0.994, <i>P=</i>0.004) and the left atrial diameter (<i>OR=</i>0.888, 95<i>%CI</i> 0.814-0.967, <i>P=</i>0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. <b>Conclusions:</b> The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Li</LastName><ForeName>F</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Xia</LastName><ForeName>Z</ForeName><Initials>Z</Initials></Author><Author ValidYN="Y"><LastName>Yu</LastName><ForeName>J H</ForeName><Initials>JH</Initials></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Q</ForeName><Initials>Q</Initials></Author><Author ValidYN="Y"><LastName>Hu</LastName><ForeName>J Z</ForeName><Initials>JZ</Initials></Author><Author ValidYN="Y"><LastName>Zhu</LastName><ForeName>B</ForeName><Initials>B</Initials></Author><Author ValidYN="Y"><LastName>Xia</LastName><ForeName>Z R</ForeName><Initials>ZR</Initials></Author><Author ValidYN="Y"><LastName>Huang</LastName><ForeName>Q H</ForeName><Initials>QH</Initials></Author><Author ValidYN="Y"><LastName>Li</LastName><ForeName>J X</ForeName><Initials>JX</Initials></Author><Author ValidYN="Y"><LastName>Hong</LastName><ForeName>K</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Y Q</ForeName><Initials>YQ</Initials></Author><Author ValidYN="Y"><LastName>Cheng</LastName><ForeName>X S</ForeName><Initials>XS</Initials></Author></AuthorList><Language>chi</Language><GrantList CompleteYN="Y"><Grant><GrantID>20195194</GrantID><Agency>Science and Technology Program of Jiangxi Provincial Health and Family Planning Committee</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="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017115" MajorTopicYN="Y">Catheter Ablation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004554" MajorTopicYN="N">Electric Countershock</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006325" MajorTopicYN="N">Heart Atria</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="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 观察尼非卡兰在心房颤动（房颤）患者射频消融术后转复的疗效，评价其有效性和安全性，并分析影响其转复效果的可能影响因素。 <b>方法：</b> 选取南昌大学第二附属医院心内科2016年11月至2018年7月连续收治的行射频消融术的房颤患者，纳入术后仍为房颤节律者进行回顾性分析。所有患者在术后予尼非卡兰（0.4 mg/kg）静脉推注（5 min推完）。观察患者的窦性心律转复情况、心律失常及不良反应；观察用药前及用药后5、10、20、120 min的心率，QT和QTc间期。根据尼非卡兰用药结局分为转复组和未转复组，采用logistic回归分析用药后转复的影响因素。 <b>结果：</b> （1）纳入研究患者共116例（男63例，女53例），年龄（64±18）岁。尼非卡兰静注后转复72例，总体成功率为62.1%。其中持续性房颤84例，转复成功50例（59.2%）；阵发性房颤32例，转复成功22例（68.8%）。转复时间为1.5~12.0（6.8±3.4）min。（2）116例患者用药后QT间期及QTc间期均较用药前明显延长（<i>P<</i>0.01），并在10 min左右达到峰值，120 min恢复至用药前水平。（3）116例患者出现心动过缓8例（6.9%）、频发室性早搏及短阵室性心动过速3例（2.6%）。（4）转复组的房颤持续时间和左心房内径均小于未转复组（<i>P<</i>0.05）。两组间在性别、病史、房颤类型和是否有器质性心脏病等差异均无统计学意义（<i>P></i>0.05）。（5）多因素logistic回归分析显示，房颤持续时间（<i>OR=</i>0.980，95<i>%CI</i> 0.966~0.994，<i>P=</i>0.004）及左心房内径（<i>OR=</i>0.888，95<i>%CI</i> 0.814~0.967，<i>P=</i>0.007）是影响房颤转复的因素。 <b>结论：</b> 尼非卡兰对射频消融术后房颤转复的总体成功率为62.1%，阵发性房颤转复率可达68.8%，且具有转复时间短、不良反应少等特点。左心房内径及房颤持续时间是影响射频消融术后尼非卡兰转复效果的相关因素。. |
17,227 | Rescue Extracorporeal Bypass to Prevent Atrioesophageal Fistula-related Air Embolism. | Atrioesophageal fistula (AEF) is a rare but disastrous complication encountered after radiofrequency catheter ablation for atrial fibrillation or flutter. Furthermore cerebral air embolism due to AEF is considered a strong predictor of mortality. In our case a patient presented with AEF and cerebral air embolism. As a rescue effort ventricular fibrillation was induced and sustained under venoarterial extracorporeal membrane oxygenation support until emergency AEF repair was feasible. Herein we report the successful use of the above measures to prevent further air embolism in a patient with radiofrequency catheter ablation-related AEF. |
17,228 | Conjunctival microcirculation is associated with cerebral cortex microcirculation in post-resuscitation mild hypothermia: A rat model. | This study aimed to compare the changes in sublingual and conjunctival microcirculation occurring with cerebral cortex microcirculation changes during mild hypothermia in a rat model of cardiac arrest.</AbstractText>Twenty-four rats were randomized into mild hypothermia (M) or normothermia (C) groups. Ventricular fibrillation was electrically induced and left untreated for 8 minutes, followed by 8 minutes of cardiopulmonary resuscitation. The core temperature in group M reduced to 33 ± 0.5°C at 13 minutes after restoration of spontaneous circulation and was maintained for 8 hours. In group C, the core temperature was maintained at 37 ± 0.2°C. The hemodynamics and microcirculation in the sublingual region, bulbar conjunctiva, and cerebral cortex were measured at baseline and 1, 2, 3, 4, 6, and 8 hours after restoration of spontaneous circulation.</AbstractText>The M group showed significantly worse sublingual microcirculation at 6 hours post-resuscitation. However, microcirculation in the conjunctiva and cerebral cortex at 3 hours post-resuscitation were better in the M group. In the M group, microcirculation in the cerebral cortex was significantly correlated with that in the conjunctiva but not the sublingual microcirculation.</AbstractText>Changes in conjunctival microcirculation are closely related to cerebral cortex microcirculation during mild hypothermia, indicating that cerebral cortex microcirculation could be monitored by measuring conjunctival microcirculation.</AbstractText>© 2019 John Wiley & Sons Ltd.</CopyrightInformation> |
17,229 | Use of a radiofrequency guidewire to simplify workflow for left atrium access: a case series. | Transseptal puncture (TSP) is widely used in catheter-based cardiac procedures to gain left atrial access, but its workflow has remained largely unchanged in the last 50 years. This study evaluated the safety and efficacy of a novel, simplified technique for TSP with a radiofrequency (RF)-powered guidewire that eliminates multiple exchanges required with standard needles.</AbstractText>TSP was performed in 84 patients undergoing left-sided procedures (72 atrial fibrillation ablations [32 RF, 40 cryoballoon], 4 atrial tachycardia ablations, 2 ventricular arrhythmia ablations, 6 left atrial appendage closure) utilizing a stiff, exchange length RF guidewire. Under fluoroscopic and echocardiographic guidance, the RF guidewire was used to facilitate septal puncture with RF energy and provide a rail for advancing catheters to the left atrium without exchange. All procedures were performed under general anesthesia or sedation.</AbstractText>TSP was achieved in all patients with no complications. The RF guidewire allowed catheters to be tracked back up to the superior vena cava without exchange in cases where another dropdown was desired to locate a preferred puncture site. The stiffness of the wire provided adequate support to advance all sheaths to the left side regardless of outer diameter.</AbstractText>TSP was performed safely and successfully for various left heart procedures with a RF guidewire that served as an RF transseptal device and a stiff guidewire. This allowed for a more efficient and potentially safer technique without the need for re-wiring or an over the wire sheath exchange. This provides substantial savings in both time and materials.</AbstractText> |
17,230 | [Exploration on connotation of Zhigancao Decoction formula syndrome from the perspective of modern pathophysiology and severe cases of critical care and its clinical efficacy on cardioversion,maintenance of sinus rhythm,hemostasis,increasing platelets count,and tonifying deficiency]. | Zhigancao decoction recorded in Treatise on Febrile Disease by Zhang Zhongjing in the Han dynasty have been widely used in treating palpitation and irregular pulse by traditional Chinese medicine physicians for thousands of years. It is all known that Zhigancao Decoction is used to treat consumptive disease. However,why it has been used to treat exogenous febrile disease? According to studies,Fumai Decoctions in Treatise on Differentiation and Treatment of Epidemic Febrile Disease,that was modified based on Zhigancao Decoction,have their names without reality. Serious defects,including unclear diagnosis,curative effect,and prognosis,have been found in ancient and modern medical records about Zhigancao Decoction. The indications of Zhigancao Decoction include atrial premature beats,ventricular premature beats,and viral myocarditis; tachyarrhythmia( supraventricular tachycardia,atrial fibrillation)with long interval or conduction block,during or after severe infection or high fever; chronic consumptive disease due to tumor after radiotherapy and chemotherapy,malignant fluid state of tumor,hematopathy,terminal stage of heart failure after major operation,and acute hemorrhage after control of severe infection and other major diseases; cough,phlegm and asthma due to chronic obstructive pulmonary disease,pulmonary interstitial fibrosis,lung cancer,after lung cancer surgery; increased heart rate and decreased blood pressure due to insufficient capacity after acute blood loss; the symptoms included palpitation,chest tightness,sweating,lassitude,lacking in strength,shortness of breath,syncope,sudden death,cough,expectoration,excessive phlegm,clear and dilute sputum,emaciation,dry and haggard skin,constipation,haemorrhagic,uterine bleeding,enjoy sweet taste,red tongue without moss,knotted pulse,intermittent pulse,thready rapid pulse,and weak pulse. Besides,Zhigancao Decoction has effect on cardioversion and maintenance of sinus rhythm without thrombosis in persistent atrial fibrillation and permanent atrial fibrillation. Zhigancao Decoction could stop bleeding soon for acute upper gastrointestinal bleeding,and achieve positivity of occult blood test; Zhigancao Decoction could promote thrombocytopenia for idiopathic thrombocytopenic purpura,with the number of platelets 1×109/L. Zhigancao Decoction could promote the rise of granulocytic,erythroid and megakaryocytic hematopoietic lines in unexplained severe anemia,thrombocytopenia,and leukocyte reduction. Zhigancao Decoction could treat cough,asthma,and chest tightness in lung cancer and after lung cancer surgery; chronic consumptive disease due to lung cancer after lung cancer surgery,hematopathy and acute blood loss,which all belonged to the scope of consumptive disease. Zhigancao Decoction could ascend platelets,which was considered as " oriental interleukins" for the ancients. Zhigancao Decoction possesses dual-directional regulation on anticoagulant and hemostasis,which was considered as " oriental low molecular heparin" and " oriental proton pump inhibitors". Large dose of Rehmannia glutinosa is the key of the efficacy of Zhigancao Decoction. This study is expected to enrich the guidelines for modern medical diagnosis and treatment. However,the clinical evidence,relevant genes and targeting network need to be deepened in future studies. In conclusion,it may be a shortcut to restore and explain Zhigancao Decoction formula syndromes based on modern pathophysiology and severe cases of critical care. |
17,231 | Hypertrophic Cardiomyopathy and Wolff-Parkinson-White Syndrome in a Young African Soldier with Recurrent Syncope. | Syncope is a common manifestation of both hypertrophic cardiomyopathy (HCM) and Wolff-Parkinson-White (WPW) syndrome. The most common arrhythmia in HCM is ventricular tachycardia (VT) and atrial fibrillation (AF). While preexcitation provides the substrate for reentry and supraventricular tachycardia (SVT), AF is more common in patients with preexcitation than the general population. Concurrence of HCM and WPW has been reported in many cases, but whether the prognosis or severity of arrhythmia is different compared to the individual disorders remains unsettled. We report a case of HCM and Wolff-Parkinson-White (WPW) syndrome in a 28-year-old male Nigerian soldier presenting with recurrent syncope and lichen planus. |
17,232 | C-type natriuretic peptide suppresses ventricular arrhythmias in rats with acute myocardial ischemia. | This study aimed to investigate the effects of C-type natriuretic peptide (CNP) on ventricular arrhythmias in rats with acute myocardial ischemia (AMI). Forty male Sprague-Dawley rats were randomly divided into sham group (n = 10), AMI group (n = 15) and AMI + CNP group (n = 15). AMI model was induced by ligating the left anterior descending branch of the coronary artery, and CNP was pumped through the femoral vein starting 30 min before ischemia and continuing until 1 h after AMI. The occurrence of ventricular arrhythmias after ischemia and heart rate variability (HRV) were recorded and analyzed. The plasma norepinephrine level was detected at 15 min after AMI. Ventricular electrophysiological parameters including ventricular effective refractory period (ERP), ERP dispersion, ventricular action potential duration (APD) alternans and ventricular fibrillation threshold (VFT) were measured one hour after AMI. Then, the expressions of cyclic guanosine monophosphate in myocardial tissue and left stellate ganglion were examined. Compared to sham group, AMI significantly shortened the ERP, augmented ERP dispersion, elevated APD alternans cycle length, reduced VFT, and increased the incidence of ventricular arrhythmias. Moreover, AMI increased the sympathetic component of HRV, raised plasma norepinephrine levels, and decreased the cyclic guanosine monophosphate levels in myocardium and left stellate ganglion. All those changes were attenuated by CNP treatment. These findings suggest that CNP protected against ventricular arrhythmias in rats with AMI, potentially by inhibiting ischemia-induced cardiac sympathetic hyperactivity and cardiac electrophysiology instability. |
17,233 | Targeting pathological leak of ryanodine receptors: preclinical progress and the potential impact on treatments for cardiac arrhythmias and heart failure. | <b>Introduction</b>: Type-2 ryanodine receptor (RyR2) located on the sarcoplasmic reticulum initiate systolic Ca<sup>2+</sup> transients within cardiomyocytes. Proper functioning of RyR2 is therefore crucial to the timing and force generated by cardiomyocytes within a healthy heart. Improper intracellular Ca<sup>2+</sup> handing secondary to RyR2 dysfunction is associated with a variety of cardiac pathologies including catecholaminergic polymorphic ventricular tachycardia (CPVT), atrial fibrillation (AF), and heart failure (HF). Thus, RyR2 and its associated accessory proteins provide promising drug targets to scientists developing therapeutics for a variety of cardiac pathologies.<b>Areas covered</b>: In this article, we review the role of RyR2 in a variety of cardiac pathologies. We performed a literature search utilizing PubMed and MEDLINE as well as reviewed registries of trials from clinicaltrials.gov from 2010 to 2019 for novel therapeutic approaches that address the cellular mechanisms underlying CPVT, AF, and HF by specifically targeting defective RyR2 channels.<b>Expert opinion</b>: The negative impact of cardiac dysfunction on human health and medical economics are major motivating factors for establishing new and effective therapeutic approaches. Focusing on directly impacting the molecular mechanisms underlying defective Ca<sup>2+</sup> handling by RyR2 in HF and arrhythmia has great potential to be translated into novel and innovative therapies. |
17,234 | Comparison of arrhythmia detection by conventional Holter and a novel ambulatory ECG system using patch and Android App, over 24 h period. | Ambulatory electrocardiogram (AECG) is done for evaluation of arrhythmia. Commonly used AECG system is 24 h Holter. Patch based second generation AECG monitoring devices, which can record for longer periods, are now available.</AbstractText>Android App based WebCardio using WiPatch is a new AECG system which records ECG in two leads for 72 h. Our study compared the arrhythmia detection by WebCardio and conventional Holter by simultaneously connecting both for 24 h in patients having indication for AECG.</AbstractText>The AECG of patients who had simultaneous recording with WebCardio and conventional Holter, in the department of Cardiology, Medical College, Thrissur were evaluated. Ability to detect any of the 6 arrhythmias :1) atrial fibrillation (AF), 2) atrioventricular (AV) block, 3) sinus pause of ≥3 s (SP), 4) supraventricular tachycardia (SVT), 5) premature ventricular complex (PVC) and 6) ventricular tachycardia (VT)/ventricular fibrillation (VF) was compared. Detection of each arrhythmia was also compared.</AbstractText>141 patients had simultaneous recordings by both systems of AECG. The WebCardio picked up at least one of the 6 arrhythmias; AF, AV block, SP, SVT, PVC or VT/VF in 98 cases compared to 88 in the Holter (McNemars test, two tail P = 0.006). In eleven cases WebCardio detected an arrhythmia where Holter could not. In one case Holter identified an arrhythmia and WebCardio could not. Individual arrhythmias; AF, SP, SVT and VT/VF were detected equally by both systems. AV block (23 Vs 18, p = 0.0625) and PVCs (83 Vs 74, p = 0.0636) were detected in more number of cases in WebCardio. In the five cases where WebCardio alone identified AV block, four had poor quality of P wave in the Holter.</AbstractText>Arrhythmia was picked up in more number of patients by the WebCardio compared to Holter. This was due to higher pickup of AV block and PVCs by WebCardio. Difference in AV block identification was due to better quality of P in WebCardio. WebCardio is a good alternative to Holter for AECG.</AbstractText>Copyright © 2019 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.</CopyrightInformation> |
17,235 | A multicenter, randomized, double-blind, controlled study to evaluate the efficacy and safety of dantrolene on ventricular arrhythmia as well as mortality and morbidity in patients with chronic heart failure (SHO-IN trial): rationale and design. | Leakage of Ca2+</sup> from the sarcoplasmic reticulum (SR) is a critical contributing factor to heart failure pathophysiology. Therefore, reducing SR Ca2+</sup> leaks may provide significant additive benefits when used in combination with conventional therapies. Dantrolene, a drug routinely used to treat malignant hyperthermia, also stabilizes the cardiac isoform of the release channel (RyR2), thus decreasing SR Ca2+</sup> leaks. The purpose of this study is to evaluate the effect of chronic administration of dantrolene on heart failure and lethal arrhythmia in patients with chronic heart failure and reduced ejection fraction in a multicenter, randomized, double-blind, controlled study.</AbstractText>Patients with chronic heart failure who had functional status of New York Heart Association class II and III and a left ventricular ejection fraction <40% were treated according to the Japanese Circulation Society, the European Society of Cardiology, and the American Heart Association/the American College of Cardiology guidelines for diagnosis and treatment of acute and chronic heart failure. Patients were randomized and divided into two groups in a double-blind fashion: dantrolene group and placebo group (target sample size: 300 cases). These drugs were administered for 96 weeks. The primary endpoint is cardiovascular death, first hospitalization for exacerbation of heart failure, or lethal arrhythmia [ventricular tachycardia (VT) storm, sustained VT, ventricular fibrillation] for 2 years after starting administration of dantrolene 1 cap (25mg) three times daily (if not tolerable, two times daily) or matching placebo.</AbstractText>This paper presents the rationale and trial design of the study. Recruitment for the study started on 8 December 2017.</AbstractText>The results of this trial will clarify the efficacy and safety of dantrolene for ventricular arrhythmia, as well as mortality and morbidity in patients with chronic heart failure and reduced ejection fraction during guideline-directed medical treatment.</AbstractText>Copyright © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation> |
17,236 | Left Bundle Branch Pacing: JACC Review Topic of the Week. | Right ventricular pacing causes electric and mechanical dyssynchrony, which is associated with an increased risk for heart failure and atrial fibrillation. Cardiac resynchronization therapy with biventricular pacing reduces ventricular dyssynchrony and results in clinical benefits in subsets of patients with heart failure with QRS prolongation. Recently, His bundle pacing has increased in use as a physiological pacing modality but is limited by difficult implantation, lower success rates in patients with QRS prolongation, and high, often unstable, pacing capture threshold. Thus, the concept of pacing the conduction system distal to the His bundle to bypass the region of conduction block was proposed. Early clinical studies demonstrated the procedural feasibility of left bundle branch pacing using a transventricular septal approach that generates narrow paced QRS duration, fast synchronized left ventricular activation, and correction of left bundle branch block. The current status and future direction of left bundle branch pacing are summarized in this paper. |
17,237 | Treatment of Atrial Fibrillation Using Ablation Index-Guided Contact Force Ablation: A Matching-Adjusted Indirect Comparison to Cryoballoon Ablation. | Ablation Index, also known as VISITAG SURPOINT™, is a novel lesion-quality marker that improves outcomes in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). There is no direct evidence on the comparative effectiveness of RF ablation with Ablation Index and cryoballoon (CB). The objective of the present study was to conduct a matching-adjusted indirect comparison (MAIC) using individual patient-level data (IPD) to compare the effectiveness of RF ablation with Ablation Index to that of CB on recurrence of atrial arrhythmias 12 months after catheter ablation in patients with paroxysmal AF (PAF).</AbstractText>Individual patient-level data for RF ablation with Ablation Index were obtained from two studies: Solimene et al. [J Interv Card Electrophysiol 54(1):9-15, 2019] and Hussein et al. [J Cardiovasc Electrophysiol 28(9):1037-1047, 2017]. Comparable CB studies identified from a systematic literature review were pooled. Prognostic variables for adjustment were ranked a priori by several practicing electrophysiologists. In the absence of a common treatment arm between the Ablation Index and CB studies, an unanchored MAIC was conducted. Primary analysis compared the Solimene et al. study to pooled CB studies. A secondary analysis compared pooled RF ablation with Ablation Index studies to pooled CB studies. Several scenario and sensitivity analyses were conducted.</AbstractText>Primary analyses showed statistically significant reductions in the rate of arrhythmia recurrence with RF ablation with Ablation Index compared to CB in unmatched, unadjusted (HR 0.50, 95% CI 0.27-0.95) and matched (0.42, 0.21-0.86) analyses. Greater reductions in the rate of arrhythmia recurrence that favored RF ablation with Ablation Index were observed after matching and adjusting for age (0.41, 0.20-0.85), age and left ventricular ejection fraction (0.37, 0.16-0.88), and age, sex, and left ventricular ejection fraction (0.30, 0.13-0.71). Secondary and sensitivity analyses showed similar reductions.</AbstractText>Radiofrequency ablation with Ablation Index was associated with reductions in recurrence of atrial arrhythmias at 12 months compared to CB in unmatched and unadjusted, matched, and matched and adjusted comparisons.</AbstractText> |
17,238 | An outcome study of adult in-hospital cardiac arrests in non-monitored areas with resuscitation attempted using AED. | To investigate the outcomes of patients with in-hospital cardiac arrest (IHCA) who underwent cardiopulmonary resuscitation (CPR) using an automated external defibrillator (AED) in non-monitored areas. Additionally, to detect correlated factors associated with rate of return of spontaneous circulation (ROSC) and survival rate, among collected data.</AbstractText>This study included 109 patients. After investigating patient characteristics and resuscitation-related factors, the correlated factors associated with ROSC rates and survival rate were analyzed using univariate and multivariate analyses.</AbstractText>The rate of survival to hospital discharge was 21.1%. CPR with AED performed since 2013 was associated with a higher ROSC rate (adjusted odds ratio [AOR] 3.24, 95% confidence interval [CI]: 1.21 to 9.52, p < 0.05), but not with the survival rate after ROSC. Tracheal intubation was significantly associated with a higher ROSC rate (AOR 3.62, 95% CI: 1.27 to 11.7, p < 0.05) and a lower survival rate after ROSC (hazard ratio 6.6, 95% CI: 1.2 to 43.3, p < 0.05). Dysrhythmia as the cause of cardiac arrest and intensive care unit (ICU) admission after ROSC were associated with higher survival rates (hazard ratio 0.056, 95% CI: 0.004 to 0.759, p < 0.05, and hazard ratio 0.072, 95% CI: 0.017 to 0.264, p < 0.0001, respectively).</AbstractText>The factors associated with ROSC rate and those associated with the survival rate after ROSC were different. Although initial shockable rhythms on AED were not associated with the survival rate, dysrhythmia as the etiology of cardiac arrest, and ICU admission were significantly associated with higher survival rates after ROSC.</AbstractText>Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
17,239 | [Diagnostics and Treatment of Cardiac Sarcoidosis - Consensus Paper of the German Respiratory Society (DGP) and the German Cardiac Society (DGK)]. | Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Symptomatic cardiac manifestations are found in less than 10 % of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with rhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany remains unclear and large prospective international observational studies.underline the importance of this disease entity. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society and the German Cardiac Society. The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.<CopyrightInformation>© Georg Thieme Verlag KG Stuttgart · New York.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Skowasch</LastName><ForeName>D</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Sektion Pneumologie, Bonn.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gaertner</LastName><ForeName>F</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Universitätsklinikum Bonn, Klinik und Poliklinik für Nuklearmedizin, Bonn.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Marx</LastName><ForeName>N</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Universitätsklinikum Aachen, AöR, Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Med. Klinik I), Aachen.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meder</LastName><ForeName>B</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Universitätsklinikum Heidelberg, Institut für Cardiomyopathien Heidelberg Abteilung für Kardiologie, Angiologie und Pulmologie, Heidelberg.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Müller-Quernheim</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Universitätsklinikum Freiburg, Abteilung Pneumologie, Freiburg im Breisgau.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pfeifer</LastName><ForeName>M</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Klinik Donaustauf, Zentrum für Pneumologie, Psychosomatische Medizin und Psychotherapie, Donaustauf.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schrickel</LastName><ForeName>J W</ForeName><Initials>JW</Initials><AffiliationInfo><Affiliation>Medizinische Klinik und Poliklinik II, Sektion Elektrophysiologie, Universitätsklinikum Bonn.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yilmaz</LastName><ForeName>A</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Universitätsklinikum Münster, Klinik für Kardiologie I, Sektion für Herzbildgebung, Münster.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Grohé</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Ev. Lungenklinik Berlin, Klinik für Pneumologie, Berlin.</Affiliation></AffiliationInfo></Author></AuthorList><Language>ger</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><VernacularTitle>Diagnostik und Therapie der kardialen Sarkoidose.</VernacularTitle><ArticleDate DateType="Electronic"><Year>2019</Year><Month>12</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>Germany</Country><MedlineTA>Pneumologie</MedlineTA><NlmUniqueID>8906641</NlmUniqueID><ISSNLinking>0934-8387</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D002309" MajorTopicYN="N">Cardiology</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="Y">standards</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009202" MajorTopicYN="N">Cardiomyopathies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D032921" MajorTopicYN="N">Consensus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005858" MajorTopicYN="N" Type="Geographic">Germany</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D033183" MajorTopicYN="N">Interdisciplinary Communication</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017410" MajorTopicYN="Y">Practice Guidelines as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015272" MajorTopicYN="N">Pulmonary Medicine</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="N">standards</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017565" MajorTopicYN="N">Sarcoidosis, Pulmonary</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012955" MajorTopicYN="N">Societies, Medical</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="ger">Während 90 % aller Sarkoidosepatienten eine parenchymatöse Beteiligung der Lunge aufweisen, ist die kardiale Sarkoidose (in weniger als 10 % der Fälle klinisch manifest) selten. Generell können alle Strukturen des Herzens von der Granulombildung betroffen sein. Meist jedoch sind das Myokard des linken Ventrikels sowie das Reizleitungssystem beeinträchtigt. Klinisch manifestiert sich die kardiale Sarkoidose als dilatative Kardiomyopathie oder in Form von Herzrhythmusstörungen wie Vorhofflimmern und/oder ventrikulären Tachykardien. Das Spektrum reicht von der benignen, subklinischen Manifestation als Zufallsbefund bis zur lebensbedrohlichen Komplikation, wie akuelle Kohortenstudien zeigen. Diagnostische Schritte und therapeutische Empfehlungen zur kardialen Sarkoidose sollten daher einem einheitlichen Standard unterliegen. Die vorliegende Arbeit ist die Expertenstellungnahme unter dem Schirm der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK). Die nachstehenden Empfehlungen ersetzen jedoch nicht die ärztliche Begutachtung des individuellen Patienten und Anpassung der Diagnostik und Therapie an dessen spezifische Situation. |
17,240 | Amplified P-wave duration predicts new-onset atrial fibrillation in patients with heart failure with preserved ejection fraction. | Atrial fibrillation (AF) increases morbidity and mortality in heart failure with preserved ejection fraction (HFpEF), yet identification of HFpEF-patients at risk for new-onset AF is challenging. Amplified P-wave duration (APWD) non-invasively detects arrhythmogenic atrial substrate with high accuracy. We hypothesized that APWD may help in the prediction of new-onset AF in HFpEF.</AbstractText>Patients with suspected HFpEF (n = 99, left ventricular ejection fraction > 50%, no evidence of valvulopathy, coronary artery disease, or non-cardiac dyspnea) underwent exercise testing with concomitant right-heart catheterization. Normal resting pulmonary capillary wedge pressure (PCWP; < 12 mmHg) with an increase during exercise > 25.5 mmHg/W/kg defined early HFpEF. Advanced HFpEF was diagnosed with PCWP > 12 mmHg at rest. Arrhythmogenic atrial substrate (defined as APWD > 150 ms) was investigated on digitized standard 12-lead ECGs and patients were followed for new-onset AF at 6-month intervals.</AbstractText>Forty-seven patients had normal exercise haemodynamics and served as controls. Early and advanced HFpEF was diagnosed in 29 and 23 patients, respectively. Eighty-seven per cent of patients with advanced HFpEF had evidence of arrhythmogenic atrial substrate, (APWD 175 ± 29 ms vs. 132 ± 14 ms in controls, p < 0.0001), which was associated with a tenfold increased risk for new-onset AF during 4.6 years of follow-up (hazard ratio [HR] 9.684, 95% CI 2.61-35.89, p < 0.0001). Early HFpEF was neither related to APWD (p = 0.395), nor to a higher risk for AF (HR 3.44, 95% CI 0.57-20.72, p = 0.178). Importantly, the presence of arrhythmogenic substrate was independent of left atrial indexed volume.</AbstractText>The analysis of amplified P-wave duration (APWD) allows for the prediction of new-onset AF in patients with advanced HFpEF.</AbstractText> |
17,241 | The anatomic substrate of mitral annular contraction. | Despite the absence of contractile elements, the mitral annulus undergoes sphincter-like "contraction" resulting in an area reduction of approximately 25%. Its anatomic basis has not, however, been delineated. Since annular contraction helps draw the mitral leaflets into apposition, an appreciation of its anatomic basis could enhance our understanding of the pathogenesis of mitral regurgitation.</AbstractText>Gross dissection of >100 bovine, ovine and human hearts as well as histologic examination of 5 ovine hearts was performed to ascertain the origins, course and insertion points of the atrial and ventricular muscle bundles related to the annulus.</AbstractText>Significant circumferentially-oriented left atrial fibers derived from Bachman's bundle flank the annulus internally. These fibers encircle the base of the atrium and insert into the right fibrous trigone. Externally, the annulus is anatomically related to the superficial obliquely-oriented fibers of the left ventricular inlet which course from the subepicardium to the subendocardium.</AbstractText>Intercalation of the annulus between the musculature of the left atrium and left ventricle subjects it to extrinsic contractile forces resulting in sphincter-like narrowing. The circumferential fibers of the left atrial base are favorably positioned such that their contraction imparts a centripetal force onto the inner aspect of the adjacent fibrous annulus which causes it to translate inward in late diastole. During systole, the superficial oblique fibers of the left ventricular inlet, impose a torsional force onto the outer aspect of the annulus causing it to translate inwards. These observations may have mechanistic implications in mitral regurgitation.</AbstractText>Copyright © 2019. Published by Elsevier B.V.</CopyrightInformation> |
17,242 | [Acute eosinophilic pneumonia and illicit psychoactive substance use]. | Illicit psychoactive substance (IPAS) use can lead to a number of respiratory complications, including acute eosinophilic pneumonia (AEP). Systematic literature review of data on AEP in IPAS users (cannabis, cocaine, heroin and amphetamine). Of two cases of cannabis and tobacco users reported to have developed AEP, one, a teenage15 year old boy presented with acute respiratory distress syndrome (ARSD) which necessitated extracorporeal membrane oxygenation (ECMO). Five cases of AEP in cocaine smokers (crack) are reported, one of which was fatal. The patient presented with acute pulmonary edema and ARDS which progressed to ventricular fibrillation and asystole. A 24-year-old woman presented with AEP after repeated inhalation of heroin. Finally, a case of an amphetamine abuser who developed AEP and ARDS after amphetamine inhalation is reported. The time between the first IPAS use and admission in cases reported ranged from 7 days to 4 years, while time between the last IPAS use and admission was short (less than 15 days). IPAS use must be sought in case of AEP, especially in young adults, and practitioners must advise and help users to stop their consumption. |
17,243 | Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators. | To identify predictors of left ventricular ejection fraction (LVEF) improvement in patients with newly detected cardiomyopathy using wearable cardioverter defibrillators (WCDs).</AbstractText>WCDs are useful in preventing sudden cardiac death in patients with reduced LVEF <35% while awaiting implantable cardioverter defibrillator (ICD) placement. In many patients, LVEF improves and an ICD is not indicated.</AbstractText>Patients who received WCDs from November 2013 to November 2015 were identified and followed over a period of 2 years. Clinical variables were examined. The primary outcome was improvement in LVEF ≥35%. Predictors of outcome were determined using a multivariate logistic regression model.</AbstractText>A total of 179 patients were followed. Median age was 65 (interquartile range [IQR]: 56, 73) years, 69.3% were men. Median baseline LVEF was 20% (IQR: 15, 30). LVEF improved ≥35% in 47.5% patients, with patients being younger (62 vs 68.5 years, P = .006), having lower blood urea nitrogen (BUN) (19 vs 24 mg/dL, P = .002), fewer left bundle branch block (LBBB 9.5% vs 25.8%, P = .004), shorter QRS duration (98 vs 112 ms, P < .001), and higher use of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (92.9% vs 74.4%, P = .001) compared to those without LVEF improvement. Absence of LBBB (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.11-0.70), lower BUN (OR 0.13, 95% CI 0.02-0.76), and ACEI/ARB use (OR 3.53, 95% CI 1.28-9.69) were identified as independent predictors. Ventricular tachycardia/ventricular fibrillation was observed in three patients, all of whom received successful WCD shocks.</AbstractText>Absence of LBBB, lower BUN, and ACEI/ARB use predicts LVEF improvement. WCDs help treat arrhythmic events.</AbstractText>© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.</CopyrightInformation> |
17,244 | Risk factors for primary ventricular fibrillation during a first myocardial infarction: Clinical findings from PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during firST myocardIal iNfArcTION). | Few studies prospectively assessed risk factors for ventricular fibrillation (VF) during a first myocardial infarction (MI). We designed a nation-wide study aiming to identify clinical and genetic characteristics associated with primary VF; and report here about clinical features.</AbstractText>PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during a firST myocardIal iNfArcTION) is an Italian case-control, prospective multicentre study. Cases are patients aged 18-80 years with a first MI and at least one VF episodes occurring within 24 h of symptoms onset, before reperfusion. Cases and controls are paired 1: 2 by gender and age (±5 years).</AbstractText>Among 1026 patients enrolled between 2007 and 2017, 970 entered the primary analysis: 375 cases and 595 controls (mean age 59 years, 85% males). Multivariable analysis identified 5 independent predictors of primary VF: systolic blood pressure (OR 0.982, 95% CI: 0.98-0.99 for each mm Hg) and K+</sup> levels <3.5 mEq/L at presentation (OR 2.28, 95% CI: 1.6-3.3), family history of sudden death (OR 1.80, 95% CI: 1.1-3.0), physical inactivity (OR 1.73, 95% CI: 1.1-2.8) and anterior MI (OR 1.52, 95% CI: 1.1-2.1). Excluding K+</sup> levels obtained after VF, the OR associated with K+</sup> levels <3.5 mEq/L was1.99 (95 CI 1.22-3.21).</AbstractText>The present study identified 5 independent predictors of primary VF: familiarity, anterior MI, low systolic blood pressure, physical inactivity and hypokalaemia. Importantly, the last two risk factors are modifiable and, especially in the presence of a family history of sudden death, they should be avoided as much as possible.</AbstractText>Copyright © 2019. Published by Elsevier B.V.</CopyrightInformation> |
17,245 | Ventricular Tachycardia Ablation: Past, Present, and Future Perspectives. | Although implantable cardioverter-defibrillators positively affect survival in patients at increased risk for arrhythmic sudden cardiac death, quality of life can be negatively affected by recurrent therapies. Ventricular tachycardia (VT) ablation targets clinical arrhythmias to prevent recurrence. Although treatment of VT initially required open heart surgery, it has since been replaced by percutaneous ablation, a safe and effective catheter-based therapy to ablate myocardium from either the endocardial or the epicardial surface. Four basic mapping techniques are used to guide VT ablation: activation, entrainment, and pace and substrate mapping. Current recommendations for VT ablation, especially in the setting of structural heart disease, mostly reserve this treatment for patients for whom antiarrhythmic therapy has failed or is not tolerated or desired. These recommendations derive from multiple observational reports and several randomized prospective studies in patients with VT in the setting of ischemic cardiac disease. Patients are usually referred late in their clinical course for VT ablation, limiting enrollment in clinical trials and resulting in limited prospective randomized data on long-term outcomes with ablative therapy. Future research efforts should address unmet needs, including more rigorous assessment of survival benefit from VT ablation, outcomes data of VT ablation in patients with nonischemic cardiomyopathy, and assessment of strategies to improve intramural substrate ablation. Emerging technologies with disruptive potential include the use of lower ionic strength irrigants, energy delivery guided by impedance modulation, simultaneous unipolar and bipolar ablation, and novel ablation catheters, including the retractable needle-tip electrode catheter. Promising alternatives to radiofrequency ablation include alcohol ablation from the coronary arterial or venous system, direct current or pulsed field electroporation, and stereotactic body radiotherapy guided by noninvasive substrate mapping. Future studies are needed to demonstrate the safety and efficacy of these novel technologies compared with standard radiofrequency catheter ablation. |
17,246 | Decline in Left Ventricular Ejection Fraction During Follow-Up in Patients With Severe Aortic Stenosis. | The aim of this study was to investigate the prognostic impact of the decline in left ventricular ejection fraction (LVEF) at 1-year follow-up in patients with severe aortic stenosis (AS) managed conservatively.</AbstractText>No previous study has explored the association between LVEF decline during follow-up and clinical outcomes in patients with severe AS.</AbstractText>Among 3,815 patients with severe AS enrolled in the multicenter CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry in Japan, 839 conservatively managed patients who underwent echocardiography at 1-year follow-up were analyzed. The primary outcome measure was a composite of AS-related deaths and hospitalization for heart failure.</AbstractText>There were 91 patients (10.8%) with >10% declines in LVEF and 748 patients (89.2%) without declines. Left ventricular dimensions and the prevalence of valve regurgitation and atrial fibrillation or flutter significantly increased in the group with declines in LVEF. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the group with declines in LVEF than in the group with no decline (39.5% vs. 26.5%; p < 0.001). After adjusting for confounders, the excess risk of decline in LVEF over no decline for the primary outcome measure remained significant (hazard ratio: 1.98; 95% confidence interval: 1.29 to 3.06). When stratified by LVEF at index echocardiography (≥70%, 60% to 69%, and <60%), the risk of decline in LVEF on the primary outcome was consistently seen in all the subgroups, without any interaction (p = 0.77).</AbstractText>Patients with severe AS with >10% declines in LVEF at 1 year after diagnosis had worse AS-related clinical outcomes than those without declines in LVEF under conservative management. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140).</AbstractText>Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
17,247 | Useful indices of thrombogenesis in the exclusion of intra-cardiac thrombus. | Cardioversion in patients with atrial fibrillation (AF) can cause cardioembolic stroke, and effective clinical management is necessary to reduce morbidity and mortality. Currently, transesophageal echocardiography (TEE) is the accepted standard to diagnose cardiogenic thromboemboli; however, a negative TEE does not eliminate the possibility of left atrial thrombus. The objective of this study was to evaluate the diagnostic value of supplementing the TEE with additional noninvasive markers to ensure thrombus absence.</AbstractText>A prospective study was conducted on 59 patients who underwent TEE for suspected intra-cardiac thrombi. The TEE indications included acute ischemic stroke (45.7%) and AF or flutter (59.3%). D-dimer level and white blood cell counts were assessed.</AbstractText>A negative D-dimer level (<200 ng/mL) excluded the presence of intra-cardiac thrombi. Groups with either negative (n = 14) or positive (n = 45) D-dimer levels had comparable clinical characteristics. Comparing positive D-dimer-level patients with thrombus (n = 7) and without thrombus (n = 33), patients with thrombus had reduced left atrial appendage (LAA) velocity (P = .0024), reduced left ventricular ejection fraction (LVEF) (P = .0263), increased neutrophil percent (P = .0261), decreased lymphocyte percent (P = .0216), and increased monocyte counts (P = .0220). The area under the receiver operating characteristic (ROC) curve for thrombus diagnostics was larger for combinations of clinical and biochemical data than for each parameter individually.</AbstractText>Supplementing the gold standard TEE with the analysis of LAA velocity, noninvasive LVEF, D-dimer, and hemostatic markers provided additional useful diagnostic information. Larger studies are needed to further validate the efficacy of supplementing the TEE to better assess patients for intra-cardiac thrombi.</AbstractText>© 2019 The Authors. Echocardiography published by Wiley Periodicals, Inc.</CopyrightInformation> |
17,248 | Acute and long-term outcomes of left-sided atrioventricular node ablation in patients with atrial fibrillation. | To present our experience regarding acute and long-term outcomes of left-sided atrioventricular node (AVN) ablation in patients with atrial fibrillation (AF).</AbstractText>A total of 47 patients with AF in whom left-sided AVN ablation via retroaortic approach as a first-line approach were enrolled in this retrospective study. Indications for AVN ablation were high ventricular rate refractory to medical therapy, inappropriate implantable cardioverter defibrillator (ICD) shocks, or loss of cardiac resynchronization therapy (CRT) pacing. Both acute and long-term outcomes were assessed for all participants.</AbstractText>Left-sided AVN ablation was successfully performed in 46/47 (98%) patients without any procedural complication. In the remaining 1 patient (2%), right-sided AVN ablation was performed. No mortality was observed within 30 days of the procedure. Upgrade to CRT was performed in 9 (19%) of the patients. During the median 22.5 months of follow-up, all-cause mortality was 25%. Device interrogations on the last clinical visit revealed complete AV block and intrinsic ventricular rate of < 40 bpm in all patients.</AbstractText>Left-sided AVN ablation is a safe and effective procedure without recurrence during long-term follow-up.</AbstractText> |
17,249 | Vildagliptin reduces myocardial ischemia-induced arrhythmogenesis via modulating inflammatory responses and promoting expression of genes regulating mitochondrial biogenesis in rats with type-II diabetes. | Fatal arrhythmias are one of the main manifestations of ischemic heart disease in diabetic patients. Here, we investigated the effect of pretreatment with vildagliptin on myocardial arrhythmias, inflammatory responses, and expression of genes regulating mitochondrial biogenesis following cardiac ischemic injury in type II diabetic male Wistar rats.</AbstractText>Chronic diabetes was modeled by a high-fat diet and low-dose streptozotocin method and lasted for 12 weeks. Vildagliptin (6 mg/dl) was orally administered during the last 4 weeks of the diabetic period. Then, rats' hearts (n = 8/each group) were immediately isolated and transferred to the Langendorff apparatus, in which left anterior descending coronary artery was tightened for 35 min to induce regional ischemia. Electrocardiography was continuously recorded and myocardial arrhythmias were interpreted according to the Lambeth Convention. Inflammatory cytokines in left ventricular samples were measured using ELISA kits, and gene expression was assayed using real-time PCR.</AbstractText>Diabetic groups showed increased incidence and duration of ventricular fibrillation (VF) than controls (P < 0.05). Pretreatment of diabetic rats with vildagliptin resulted in a significant decrease in number, duration, and severity of premature ventricular complexes (PVC), tachycardia (VT), and VF during ischemia, compared to non-treated diabetic group (P < 0.05). Additionally, vildagliptin significantly increased the expression of genes PGC-1α, SIRT-1, and NRF-2 and reduced the levels of myeloperoxidase, creatine kinase release, and myocardial content of TNF-α and IL-1β in nondiabetic and diabetic rats as compared to corresponding controls (P < 0.01-0.05).</AbstractText>Vildagliptin preconditioning reduced the occurrence and severity of fatal ventricular arrhythmias induced by myocardial ischemia in type II diabetic rats through increased activity of mitochondrial biogenesis-regulating genes and reduction of inflammatory reactions.</AbstractText> |
17,250 | Minocycline fails to improve neurologic and histologic outcome after ventricular fibrillation cardiac arrest in rats. | Prolonged cardiac arrest (CA) produces extensive neuronal death and microglial proliferation and activation resulting in neuro-cognitive disabilities. Among other potential mechanisms, microglia have been implicated as triggers of neuronal death after hypoxic-ischemic insults. Minocycline is neuroprotective in some brain ischemia models, either by blunting the microglial response or by a direct effect on neurons.</AbstractText>To improve survival, attenuate neurologic deficits, neuroinflammation, and histological damage after ventricular fibrillation (VF) CA in rats.</AbstractText>Adult male isoflurane-anesthetized rats were subjected to 6 min VF CA followed by 2 min resuscitation including chest compression, epinephrine, bicarbonate, and defibrillation. After return of spontaneous circulation (ROSC), rats were randomized to two groups: (1) Minocycline 90 mg/kg intraperitoneally (i.p.) at 15 min ROSC, followed by 22.5 mg/kg i.p. every 12 h for 72 h; and (2) Controls, receiving the same volume of vehicle (phosphate-buffered saline). The rats were kept normothermic during the postoperative course. Neurologic injury was assessed daily using Overall Performance Category (OPC; 1 = normal, 5 = dead) and Neurologic Deficit Score (NDS; 0% = normal, 100% = dead). Rats were sacrificed at 72 h. Neuronal degeneration (Fluoro-Jade C staining) and microglia proliferation (anti-Iba-1 staining) were quantified in four selectively vulnerable brain regions (hippocampus, striatum, cerebellum, cortex) by three independent reviewers masked to the group assignment.</AbstractText>In the minocycline group, 8 out of 14 rats survived to 72 h compared to 8 out of 19 rats in the control group (P</i> = 0.46). The degree of neurologic deficit at 72 h [median, (interquartile range)] was not different between survivors in minocycline vs</i> controls: OPC 1.5 (1-2.75) vs</i> 2 (1.25-3), P</i> = 0.442; NDS 12 (2-20) vs</i> 17 (7-51), P</i> = 0.328) or between all studied rats. The number of degenerating neurons (minocycline vs</i> controls, mean ± SEM: Hippocampus 58 ± 8 vs</i> 76 ± 8; striatum 121 ± 43 vs</i> 153 ± 32; cerebellum 20 ± 7 vs</i> 22 ± 8; cortex 0 ± 0 vs</i> 0 ± 0) or proliferating microglia (hippocampus 157 ± 15 vs</i> 193 cortex 0 ± 0 vs</i> 0 ± 0; 16; striatum 150 ± 22 vs</i> 161 ± 23; cerebellum 20 ± 7 vs</i> 22 ± 8; cortex 26 ± 6 vs</i> 31 ± 7) was not different between groups in any region (all P</i> > 0.05). Numerically, there were approximately 20% less degenerating neurons and proliferating microglia in the hippocampus and striatum in the minocycline group, with a consistent pattern of histological damage across the individual regions of interest.</AbstractText>Minocycline did not improve survival and failed to confer substantial benefits on neurologic function, neuronal loss or microglial proliferation across multiple brain regions in our model of rat VF CA.</AbstractText>©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.</CopyrightInformation> |
17,251 | [A new method for establishing a ventricular fibrillation model by TCEI in Tibetan miniature pig]. | To explore an economical, convenient, safe and efficient method for establishing a Tibetan miniature pig model of cardiac arrest (CA).</AbstractText>Cardiac puncture was performed in 12 Tibetan miniature pigs using two acupuncture needles. One needle was inserted into the fourth intercostal near the right side of the sternum about 3 cm in depth at an angle of 30° to 60° between the chest and the needle, and the depth was adjusted until the handle of the needle vibrated with the heartbeat without premature ventricular contraction on the electrocardiogram; the other was inserted into the subcutaneous tissue of the left armpit about 3 cm in depth without damaging important organs. The handles of the two needles were connected with 9V dry batteries to form a circuit and generate direct current stimulation. Ventricular fibrillation was produced in the pigs to induce CA by stimulation of transcutaneous electrical induction (TCEI) for 3 s, and the success rate of modeling was recorded. After an interval of 4 min without intervention, cardiopulmonary resuscitation (CPR) was performed using the standard Utstein style, and the survival of the pigs after recovery was observed.</AbstractText>The success rate of ventricular fibrillation modeling was 91.67% (11/12) using this method, and CPR achieved a success rate of 45.45% (5/11) in these models. The subsequent survival of the pigs was 100% (5/5) at 24 h and 80% (4/5) at 72 h. After observation for 72 h, the resuscitated Tibetan miniature pigs were dissected, and no significant damage was found in the vital organs in the thoracic or abdominal cavities.</AbstractText>We successfully established a model of CA using acupuncture needles and dry batteries in Tibetan miniature pigs, and this method is economical, convenient, safe and efficient.</AbstractText> |
17,252 | [Multifactorial Prognostication of the Development of Stent Thrombosis in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention on the background of Dual Antiplatelet Therapy]. | to identify predictors of stent thrombosis in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) for 12 months by creating a miathematical logistic regression model to optimize rehabilitation, secondary prevention of ischemic events in the first year after ACS, as well as a personalized approach to treatment.</AbstractText>The analysis used data from the hospital register, which contained information on all PCIs, performed in the Semashko hospital between September 2016 and August 2018 (2378 patients). For this study we selected a sample of 183 ACS patients (146 men and 37 women) after PCI: 25 with definite stent thrombosis confirmed by repeated coronary angiography (CAG) (the main study group), and 158 without developing definite stent thrombosis (the comparison group) according to the observation for 12 months. All patients during hospitalization and 1 year after discharge received standard medical therapy ACS, according to international recommendations. Laboratory tests, electrocardiography (ECG), echocardiography, 24-hour ECG monitoring were performed for in patients. For determining predictors of the development of stent thrombosis we performed a logistic regression analysis.</AbstractText>A mathematical model of multifactorial prognostication of stent thrombosis in patients with ACS after PCI was created. The model included the following predictors: Killip class &gt;II; life-threatening paroxysmal tachyarrhythmias (atrial fibrillation and/or ventricular fibrillation) as ACS complication of; left ventricular ejection fraction ≤45%; CA dissection; CAG confirmed CA thrombosis before PCI.</AbstractText>The proposed model in patients with ACS allows us to estimate the risk of stent thrombosis after PCI, as well as to improve the accuracy of the event prediction. The model is easy to use, can be applied by practicing cardiologists during hospitalization. This model allows us to personalize secondary prevention in the first year after ACS, and thus help to reduce cardiovascular mortality, incidence of recurrent myocardial infarctions, unstable angina, and emergency revascularization.</AbstractText> |
17,253 | Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment. | Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk-to-benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post-ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients. |
17,254 | Case reports of a c.475G>T, p.E159* lamin A/C mutation with a family history of conduction disorder, dilated cardiomyopathy and sudden cardiac death. | Patients with some mutations in the lamin A/C (LMNA) gene are characterized by the presence of dilated cardiomyopathy (DCM), conduction abnormalities, ventricular tachyarrhythmias (VT), and sudden cardiac death (SCD). Various clinical features have been observed among patients who have the same LMNA mutation. Here, we show a family with cardiac laminopathy with a c.475G > T, p.E159* LMNA mutation, and a family history of conduction disorder, DCM, VT, and SCD.</AbstractText>A proband (female) with atrial fibrillation and bradycardia was implanted with a pacemaker in her fifties. Twenty years later, she experienced a loss of consciousness due to polymorphic VT. She had a serious family history; her mother and elder sister died suddenly in their fifties and sixties, respectively, and her nephew and son were diagnosed as having DCM. Genetic screening of the proband, her son, and nephew identified a nonsense mutation (c.475G > T, p.E159*) in the LMNA gene. Although the proband's left ventricular ejection fraction remained relatively preserved, her son and nephew's left ventricular ejection fraction were reduced, resulting in cardiac resynchronization therapy by implantation of a defibrillator.</AbstractText>In this family with cardiac laminopathy with a c.475G > T, p.E159* LMNA mutation, DCM, SCD, and malignant VT occurred. Clinical manifestation of various atrial and ventricular arrhythmias and heart failure with reduced ejection fraction occurred in an age-dependent manner in all family members who had the nonsense mutation. It appears highly likely that the E159* LMNA mutation is related to various cardiac problems in the family of the current report.</AbstractText> |
17,255 | Association Between Antiarrhythmic, Electrophysiological, and Antioxidative Effects of Melatonin in Ischemia/Reperfusion. | Melatonin is assumed to confer cardioprotective action via antioxidative properties. We evaluated the association between ventricular tachycardia and/or ventricular fibrillation (VT/VF) incidence, oxidative stress, and myocardial electrophysiological parameters in experimental ischemia/reperfusion under melatonin treatment. Melatonin was given to 28 rats (10 mg/kg/day, orally, for 7 days) and 13 animals received placebo. In the anesthetized animals, coronary occlusion was induced for 5 min followed by reperfusion with recording of unipolar electrograms from ventricular epicardium with a 64-lead array. Effects of melatonin on transmembrane potentials were studied in ventricular preparations of 7 rats in normal and "ischemic" conditions. Melatonin treatment was associated with lower VT/VF incidence at reperfusion, shorter baseline activation times (ATs), and activation-repolarization intervals and more complete recovery of repolarization times (RTs) at reperfusion (less baseline-reperfusion difference, ΔRT) (<i>p</i> < 0.05). Superoxide dismutase (SOD) activity was higher in the treated animals and associated with ΔRT (<i>p</i> = 0.001), whereas VT/VF incidence was associated with baseline ATs (<i>p</i> = 0.020). In vitro, melatonin led to a more complete restoration of action potential durations and resting membrane potentials at reoxygenation (<i>p</i> < 0.05). Thus, the antioxidative properties of melatonin were associated with its influence on repolarization duration, whereas the melatonin-related antiarrhythmic effect was associated with its oxidative stress-independent action on ventricular activation. |
17,256 | When Hindsight Is 20/20: Stiff Left Atrium Syndrome Masquerading as Mitral Regurgitation. | Scarring from atrial ablation carries a risk of developing stiff left atrium syndrome, which can mimic mitral valve disease. We present a case of a 73-year-old man whose stiff left atrium syndrome came to light after percutaneous mitral valve repair. (<b>Level of Difficulty: Intermediate.</b>). |
17,257 | Cardiac TRPV1 afferent signaling promotes arrhythmogenic ventricular remodeling after myocardial infarction. | Chronic sympathoexcitation is implicated in ventricular arrhythmogenesis (VAs) following myocardial infarction (MI), but the critical neural pathways involved are not well understood. Cardiac adrenergic function is partly regulated by sympathetic afferent reflexes, transduced by spinal afferent fibers expressing the transient receptor potential cation subfamily V member 1 (TRPV1) channel. The role of chronic TRPV1 afferent signaling in VAs is not known. We hypothesized that persistent TRPV1 afferent neurotransmission promotes VAs after MI. Using epicardial resiniferatoxin (RTX) to deplete cardiac TRPV1-expressing fibers, we dissected the role of this neural circuit in VAs after chronic MI in a porcine model. We examined the underlying mechanisms using molecular approaches, IHC, in vitro and in vivo cardiac electrophysiology, and simultaneous cardioneural mapping. Epicardial RTX depleted cardiac TRPV1 afferent fibers and abolished functional responses to TRPV1 agonists. Ventricular tachycardia/fibrillation (VT/VF) was readily inducible in MI subjects by programmed electrical stimulation or cesium chloride administration; however, TRPV1 afferent depletion prevented VT/VF induced by either method. Mechanistically, TRPV1 afferent depletion did not alter cardiomyocyte action potentials and calcium transients, the expression of ion channels, or calcium handling proteins. However, it attenuated fibrosis and mitigated electrical instability in the scar border zone. In vivo recordings of cardiovascular-related stellate ganglion neurons (SGNs) revealed that MI enhances SGN function and disrupts integrated neural processing. Depleting TRPV1 afferents normalized these processes. Taken together, these data indicate that, after MI, TRPV1 afferent-induced adrenergic dysfunction promotes fibrosis and adverse cardiac remodeling, and it worsens border zone electrical heterogeneity, resulting in electrically unstable ventricular myocardium. We propose targeting TRPV1-expressing afferent to reduce VT/VF following MI. |
17,258 | Racial Differences in the Utilization of Guideline-Recommended and Life-Sustaining Procedures During Hospitalizations for Out-of-Hospital Cardiac Arrest. | Racial and ethnic minorities are at risk for disparities in quality of care after out-of-hospital cardiopulmonary arrest (OHCA). As such, we examined associations between race and ethnicity and use of guideline-recommended and life-sustaining procedures during hospitalizations for OHCA.</AbstractText>This was a retrospective study of hospitalizations for OHCA in all acute-care, non-federal California hospitals from 2009 to 2011. Associations between the use of (1) guideline-recommended procedures (cardiac catheterization for ventricular fibrillation/tachycardia, therapeutic hypothermia), (2) life-sustaining procedures (percutaneous endoscopic gastrostomy (PEG)/tracheostomy, renal replacement therapy (RRT)), and (3) palliative care and race/ethnicity were examined using hierarchical logistic regression analysis.</AbstractText>Among 51,198 hospitalizations for OHCA, unadjusted rates of cardiac catheterization were 34.9% in Whites, 19.8% in Blacks, 27.2% in Hispanics, and 30.9% in Asians (P < 0.01). Rates of therapeutic hypothermia were 2.3% in Whites, 1.1% in Blacks, 1.3% in Hispanics, and 1.9% in Asians (P < 0.01). Rates of PEG/tracheostomy and RRT were 2.2% and 9.8% in Whites, 5.7% and 19.9% in Blacks, 4.2% and 19.9% in Hispanics, and 3.4% and 18.2% in Asians, respectively (P < 0.01). Rates of palliative care were 14.8% in Whites, 9.6% in Blacks, 10.1% in Hispanics, and 14.3% in Asians (P < 0.01). Differences in utilization of procedures persisted after adjustment for patient and hospital-related factors.</AbstractText>Racial and ethnic minorities are less likely to receive guideline-recommended interventions and palliative care, and more likely to receive life-sustaining treatments following OHCA. These findings suggest that significant disparities exist in medical care after OHCA.</AbstractText> |
17,259 | Patient characteristics and in-hospital complications of subcutaneous implantable cardioverter-defibrillator for Brugada syndrome in Japan. | Clinical features and complications of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation for Brugada syndrome have not been well studied.</AbstractText>We used the Japanese Diagnosis Procedure Combination database to retrospectively investigate patients who had undergone ICD implantation between April 2016 and March 2017. We compared the characteristics and in-hospital complications of patients with Brugada syndrome implanted with S-ICD or transvenous (TV)-ICD.</AbstractText>We extracted 3090 patients who received ICD implantation. Among them, we identified 278 Brugada patients. The mean age was 43 ± 14.4 years and 262 (94%) were male. Of these 278 patients, 136 (49%) received S-ICD and 142 (51%) received TV-ICD. TV-ICD recipients had a history of atrial fibrillation more frequently compared with S-ICD recipients. The median (interquartile range) of length of hospital stay was not significantly different between patients with S-ICD and TV-ICD (13 days [10-20.5] vs 12 days [10-18], respectively). The prevalence of in-hospital complications after ICD implantation was similar between the two groups. There were no patients with cardiac tamponade, hemothorax, pneumothorax, cardiovascular event, stroke, and death following the procedure during hospitalization in either group.</AbstractText>Short-term safety of S-ICD implantation may be identical to that of TV-ICD. Large prospective studies are warranted to compare the effects and long-term safety of S-ICD compared with TV-ICD.</AbstractText>© 2019 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.</CopyrightInformation> |
17,260 | Osimertinib-Induced Cardiotoxicity: A Retrospective Review of the FDA Adverse Events Reporting System (FAERS). | The goal of this study was to compare the risk of cardiotoxicity with osimertinib versus all other drugs and versus epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) (erlotinib, afatinib, and gefitinib) in the U.S. Food and Drug Administration Adverse Events Reporting System (FAERS), a pharmacovigilance database.</AbstractText>Osimertinib has been shown to improve outcomes in T790M-positive non-small cell lung cancer patients who progress on EGFR-TKI therapy and in the frontline setting in EGFR mutated non-small cell lung cancer. In pivotal trials, osimertinib was associated with higher rates of cardiotoxicity compared with the control arm.</AbstractText>FAERS was queried for "Cardiac failure," "Electrocardiogram QT-prolonged," "Atrial Fibrillation (AF)," "Myocardial Infarction (MI)," and "Pericardial Effusion" secondary to "Osimertinib," "Erlotinib," "Afatinib," "Gefitinib," and all other drugs from 2016 to 2018. Disproportionality signal analysis was performed by calculating the reporting odds ratio (ROR) with its 95% confidence interval (CI). The ROR was considered significant when the lower limit of the 95% CI was >1.0.</AbstractText>The ROR (95% CI) for cardiac failure, atrial fibrillation (AF), QT prolongation, myocardial infarction, and pericardial effusion due to osimertinib versus all other drugs in FAERS was 5.4 (4.2 to 7.1), 4.0 (2.8 to 5.8), 11.2 (7.9 to 15.8), 1.6 (0.9 to 2.6), and 8.2 (4.8 to 14), respectively. The ROR (95% CI) for cardiac failure, AF, QT prolongation, myocardial infarction, and pericardial effusion in comparing osimertinib versus other EGFR-TKIs was 2.2 (1.5 to 3.2), 2.1 (1.3 to 3.5), 6.6 (3.4 to 12.8), 1.2 (0.6 to 2.3), and 1.6 (0.8 to 3.3).</AbstractText>The RORs for cardiac failure, AF, and QT prolongation were higher due to osimertinib compared with other TKIs. Electrocardiographic monitoring for QT prolongation and monitoring for signs and symptoms of heart failure should be considered in patients taking osimertinib.</AbstractText>© 2019 The Authors.</CopyrightInformation> |
17,261 | Single Bolus Rosuvastatin Accelerates Calcium Uptake and Attenuates Conduction Inhomogeneity in Failing Rabbit Hearts With Regional Ischemia-Reperfusion Injury. | Acute statin therapy reduces myocardial ischemia/reperfusion (IR) injury-induced ventricular fibrillation (VF), but the underlying electrophysiological mechanisms remain unclear. This study sought to investigate the antiarrhythmic effects of a single bolus rosuvastatin injection in failing rabbit hearts with IR injury and to unveil the underlying molecular mechanisms. Rabbits were divided into rosuvastatin, rosuvastatin + L-NAME, control, and L-NAME groups. Intravenous bolus rosuvastatin (0.5 mg/kg) and/or L-NAME (10 mg/kg) injections were administered 1 hour and 15 minutes before surgery, respectively. Heart failure was induced using rapid ventricular pacing. Under general anesthesia with isoflurane, an IR model was created by coronary artery ligation for 30 minutes, followed by reperfusion for 15 minutes. Plasma NO end product levels were measured during IR. Then, hearts were excised and Langendorff-perfused for optical mapping studies. Cardiac tissues were sampled for Western blot analysis. Rosuvastatin increased plasma NO levels during IR, which was abrogated by L-NAME. Spontaneous VF during IR was suppressed by rosuvastatin (P < 0.001). Intracellular calcium (Cai) decay and conduction velocity were significantly slower in the IR zone. Rosuvastatin accelerated Cai decay, ameliorated conduction inhomogeneity, and reduced the inducibility of spatially discordant alternans and VF significantly. Western blots revealed significantly higher expression of enhancing endothelial NO-synthase and phosphorylated enhancing endothelial NO-synthase proteins in the Rosuvastatin group. Furthermore, SERCA2a, phosphorylated connexin43, and phosphorylated phospholamban were downregulated in the IR zone, which was attenuated or reversed by rosuvastatin. Acute rosuvastatin therapy before ischemia reduced IR-induced VF by improving SERCA2a function and ameliorating conduction disturbance in the IR zone. |
17,262 | Improving Appropriate Dosing of Intravenous dilTIAZem in Patients With Atrial Fibrillation or Flutter With Rapid Ventricular Response in the Emergency Department. | Atrial fibrillation and atrial flutter are common supraventricular arrhythmias in patients who present to the emergency department. Under the American Heart Association guidelines, dilTIAZem is the calcium channel blocker frequently used by many practitioners for rate control. Currently, institution-specific data have identified that many patients receiving dilTIAZem for atrial fibrillation or atrial flutter are given initial doses that exceed the recommended dose by more than 10%, resulting in hypotension in some patients.</AbstractText>ED personnel were surveyed to determine their current knowledge of appropriate intravenous dilTIAZem dosing and methods of prescribing intravenous dilTIAZem to determine the causes of higher dosing. Based on the baseline data, an intervention of adding a text alert when withdrawing dilTIAZem from the automated medication dispensing cabinet was implemented.</AbstractText>Following the intervention, 29 patients received intravenous dilTIAZem for rate control of atrial fibrillation or flutter with rapid ventricular response. For the primary outcome, the incidence of high-dose dilTIAZem decreased by 19% (P = 0.03). There was no change in the secondary outcome of a reduction in hypotension (P = 0.3).</AbstractText>The interventions of education and medication alerts resulted in a significant increase in the percentage of patients receiving appropriate doses of dilTIAZem and a nonsignificant decrease in the incidence of hypotension. This process-oriented intervention resulted in an improvement in appropriate dilTIAZem doses at our site. Rate control was not statistically significantly different between the 2 groups. Long-term sustainability of this intervention requires further study.</AbstractText>Copyright © 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
17,263 | Ventricular arrhythmias in patients with biventricular assist devices. | Ventricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implant and are associated with worse outcomes. However, the prevalence and impact of VA in patients with durable biventricular assist device (BIVAD) is unknown. We performed a retrospective cohort study of patients with BIVADs to evaluate the prevalence of VA and their clinical outcomes.</AbstractText>Consecutive patients who received a BIVAD between June 2014 and July 2017 at our medical center were included. The prevalence of VA, defined as sustained ventricular tachycardia or fibrillation requiring defibrillation or ICD therapy, was compared between BIVAD patients and a propensity-matched population of patients with LVAD from our center. The occurrence of adverse clinical events was compared between BIVAD patients with and without VA.</AbstractText>Of the 13 patients with BIVADs, 6 patients (46%) experienced clinically significant VA, similar to a propensity-matched LVAD population (38%, p = 1.00). There were no differences in baseline characteristics between the two cohorts, except patients in the non-VA group who had worse hemodynamics (mitral regurgitation and right-sided indices), had less history of VA, and were younger. BIVAD patients with VA had a higher incidence of major bleeding (MR 3.05 (1.07-8.66), p = 0.036) and worse composite outcomes (log-rank test, p = 0.046). The presence of VA was associated with worse outcomes in both LVAD and BIVAD groups.</AbstractText>Ventricular arrhythmias are common in patients with BIVADs and are associated with worse outcomes. Future work should assess whether therapies such as ablation improve the outcome of BIVAD patients with VA.</AbstractText> |
17,264 | Restitution metrics in Brugada syndrome: a systematic review and meta-analysis. | Brugada syndrome (BrS) is an ion channelopathy that predisposes affected subjects to ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death. Restitution analysis has been examined in BrS patients but not all studies have reported significant differences between BrS patients and controls. Therefore, we conducted a systematic review and meta-analysis to investigate the different restitution indices used in BrS.</AbstractText>PubMed and Embase were searched until April 7, 2019, identifying 20 and 27 studies.</AbstractText>A total of ten studies involving 178 BrS (mean age 38 years old, 63% male) and 102 controls (mean age 31 years old, 42% male) were included in this systematic review. Pacing was carried out at the right ventricular outflow tract (RVOT)/right ventricular apex (RPA) (n = 4), RPA (n = 4), or right atrium (RA) (n = 1). Basic cycle lengths of 400 (n = 4), 500 (n = 2), 600 (n = 6) and 750 ms (n = 1) were used. Recording methods include electrograms (n = 4), monophasic action potentials (n = 5), and electrocardiograms (n = 1). Signals were obtained from the RVOT (n = 8), RVA (n = 3), RA (n = 1), or the body surface (n = 1). The maximum restitution slope for endocardial repolarization at the RVOT was 0.87 for BrS patients (n = 5; 95% confidence interval [CI] 0.68-1.07) compared with 0.74 in control subjects (n = 4; 95% CI 0.42-1.06), with a significant mean difference of 0.40 (n = 4; 95% CI 0.11-0.69; P = 0.007).</AbstractText>Steeper endocardial repolarization restitution slopes are found in BrS patients compared with controls at baseline. Restitution analysis can provide important information for risk stratification in BrS.</AbstractText> |
17,265 | The evolving role of novel treatment techniques in the management of patients with refractory VF/pVT out-of-hospital cardiac arrest. | The purpose of this review is to provide a brief overview of new life-saving interventions and novel techniques that have been proposed as viable treatment options for patients presenting with refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrest (OHCA).</AbstractText>We conducted a comprehensive literature search of PubMed recent, Medline and Embase databases via the Ovid interface and Google Scholar from inception to July 2019. Eligible studies were observational in nature reporting outcomes of extracorporeal membrane oxygenation (ECMO), esmolol, double sequential defibrillation (DSD), and stellate ganglion block (SGB). Two investigators conducted the literature search, study selection, and data extraction. Any disagreements were resolved by consensus.</AbstractText>Our database search identified 5331 records. We included in our review 23 articles that met our inclusion criteria. The selected studies included 16 observational studies on ECMO, 2 observational studies on esmolol, and 5 observational studies on DSD.</AbstractText>We would like to suggest that there is not enough evidence in the existing literature to support at large-scale the effects of these techniques in the treatment of refractory VF/pVT OHCA. Randomized studies are warranted to evaluate the significant effects of these approaches against the best current standard of care.</AbstractText>Copyright © 2019 Elsevier Inc. All rights reserved.</CopyrightInformation> |
17,266 | The cardiac sympathetic co-transmitter neuropeptide Y is pro-arrhythmic following ST-elevation myocardial infarction despite beta-blockade. | ST-elevation myocardial infarction is associated with high levels of cardiac sympathetic drive and release of the co-transmitter neuropeptide Y (NPY). We hypothesized that despite beta-blockade, NPY promotes arrhythmogenesis via ventricular myocyte receptors.</AbstractText>In 78 patients treated with primary percutaneous coronary intervention, sustained ventricular tachycardia (VT) or fibrillation (VF) occurred in 6 (7.7%) within 48 h. These patients had significantly (P < 0.05) higher venous NPY levels despite the absence of classical risk factors including late presentation, larger infarct size, and beta-blocker usage. Receiver operating curve identified an NPY threshold of 27.3 pg/mL with a sensitivity of 0.83 and a specificity of 0.71. RT-qPCR demonstrated the presence of NPY mRNA in both human and rat stellate ganglia. In the isolated Langendorff perfused rat heart, prolonged (10 Hz, 2 min) stimulation of the stellate ganglia caused significant NPY release. Despite maximal beta-blockade with metoprolol (10 μmol/L), optical mapping of ventricular voltage and calcium (using RH237 and Rhod2) demonstrated an increase in magnitude and shortening in duration of the calcium transient and a significant lowering of ventricular fibrillation threshold. These effects were prevented by the Y1 receptor antagonist BIBO3304 (1 μmol/L). Neuropeptide Y (250 nmol/L) significantly increased the incidence of VT/VF (60% vs. 10%) during experimental ST-elevation ischaemia and reperfusion compared to control, and this could also be prevented by BIBO3304.</AbstractText>The co-transmitter NPY is released during sympathetic stimulation and acts as a novel arrhythmic trigger. Drugs inhibiting the Y1 receptor work synergistically with beta-blockade as a new anti-arrhythmic therapy.</AbstractText>© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation> |
17,267 | Generation of ECG signals from a reaction-diffusion model spatially discretized. | We propose a model to generate electrocardiogram signals based on a discretized reaction-diffusion system to produce a set of three nonlinear oscillators that simulate the main pacemakers in the heart. The model reproduces electrocardiograms from healthy hearts and from patients suffering various well-known rhythm disorders. In particular, it is shown that under ventricular fibrillation, the electrocardiogram signal is chaotic and the transition from sinus rhythm to chaos is consistent with the Ruelle-Takens-Newhouse route to chaos, as experimental studies indicate. The proposed model constitutes a useful tool for research, medical education, and clinical testing purposes. An electronic device based on the model was built for these purposes. |
17,268 | Feasibility and Efficacy of His Bundle Pacing or Left Bundle Pacing Combined With Atrioventricular Node Ablation in Patients With Persistent Atrial Fibrillation and Implantable Cardioverter-Defibrillator Therapy. | Background Persistent atrial fibrillation may lead to a higher probability of inappropriate shocks in heart failure patients with an implantable cardioverter-defibrillator (ICD). The aim of this study was to evaluate the impact of His-Purkinje conduction system pacing combined with atrioventricular node ablation in improving heart function and preventing inappropriate shock therapy in these patients. Methods and Results A total of 86 consecutive patients with persistent atrial fibrillation and heart failure who had indications for ICD implantation were enrolled from January 2010 to March 2018. His-Purkinje conduction system pacing with ICD and atrioventricular node ablation was attempted in 55 patients, and the remaining patients underwent ICD implantation only. Left ventricular (LV) ejection fraction, LV end-systolic volume, New York Heart Association (NYHA) classification, shock therapies, and drug therapy were assessed during follow-up. Overall, 31 patients received ICD implantation with optimal drug therapy (group 1). atrioventricular node ablation combined with His-Purkinje conduction system pacing was successfully achieved in 52 patients (group 2). During follow-up, patients in group 2 had lower incidence of inappropriate shock (15.6% versus 0%, <i>P</i><0.01) and adverse events (<i>P</i>=0.011). Meanwhile, improvement in LV ejection fraction and reduction in LV end-systolic volume were significantly higher in group 2 than in group 1 (15% versus 3%, <i>P</i><0.001; and 40 versus 2 mL, <i>P</i><0.01, respectively). NYHA functional class improved in both groups from a baseline 2.57±0.68 to 1.73±0.74 in group 1 and 2.73±0.59 to 1.42±0.53 in group 2 (<i>P</i><0.01). Conclusions His-Purkinje conduction system pacing combined with atrioventricular node ablation is feasible and safe with a high success rate in persistent atrial fibrillation patients with heart failure and ICD indication. It can significantly reduce the incidence of inappropriate shocks and improve LV function. |
17,269 | Sex differences in implantable cardiac defibrillator therapy according to arrhythmia detection times. | In implantable cardiac defibrillators (ICDs), long-detection times safely reduce unnecessary and inappropriate therapies. We aimed to evaluate ICD treatment of ventricular arrhythmias in women, compared with men, also taking into account ICD detection.</AbstractText>The Advance III trial randomised patients implanted with an ICD for primary or secondary prevention in two arms-long and nominal ventricular arrhythmias detection times before therapy delivering (number of intervals needed to detect (NID) 30/40 and 18/24, respectively). The main endpoint of this post hoc analysis was the incidence of ICD therapies evaluated through Kaplan-Meier method and univariate Cox regression models.</AbstractText>Overall, 1902 patients (304 women, 65±11 years) were randomised. Women showed a lower risk of ICD therapy (HR 0.63, 95% CI 0.43 to 0.93, p=0.022); this difference was observed only in the long-detection arm (HR 0.37, p=0.013) and not in the short detection arm (HR 0.82, p=0.414). No significant sex differences were observed concerning inappropriate therapies and mortality rate. Long-detection settings significantly reduced overall ICD therapies and appropriate ICD therapies, both in women (overall HR 0.31, p=0.007; appropriate HR 0.33, p=0.033) and in men (overall HR 0.69, p=0.006; appropriate HR 0.73, p=0.048).</AbstractText>In patients with ICDs, the strategy of setting a long-detection time to treat ventricular arrhythmias (NID 30/40) reduces overall delivered therapies, both in women and men, when compared with nominal setting (NID 18/24). The reduction was significantly higher in women. Overall, women were less likely to experience ICD therapies than men; this result was only observed in the long-detection arm.</AbstractText>NCT00617175.</AbstractText>© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation> |
17,270 | Atrial Fibrillation-Mediated Cardiomyopathy. | AF-mediated cardiomyopathy (AMC) is an important reversible cause of heart failure that is likely underdiagnosed in today's clinical practice. AMC describes AF either as the sole cause for ventricular dysfunction or exacerbating ventricular dysfunction in patients with existing cardiomyopathy or heart failure. Studies suggest that irreversible ventricular and atrial remodeling can occur in AMC, making timely diagnosis and intervention critical to optimize clinical outcome. Clinical correlation between AF onset/burden and progression of cardiomyopathy/heart failure symptoms provides strong evidence for the diagnosis of AMC. Cardiac MRI, continuous cardiac monitoring, and biomarkers are important diagnostic tools. From the therapeutic standpoint, early data suggest that AF ablation may improve long-term outcomes in AMC patients compared with medical rate and rhythm control. Patients with more AF burden and less severe underlying structural heart disease are more likely to experience left ventricle function recovery with successful AF ablation. Despite recent advances, significant knowledge gaps exist in our understanding of the epidemiology, mechanisms, diagnosis, management strategies, and prognosis of AMC. |
17,271 | Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review. | Recent studies have evaluated the relationship associating non-alcoholic fatty liver disease (NAFLD) with several electrocardiogram (ECG) findings, but the results have been inconsistent. The aim of this systematic review is to assess the association between NAFLD with ECG modifications.</AbstractText>We conducted a systematic search on PubMed with predefined keywords identifying observational studies published till 22 February 2019 with NAFLD diagnosed either by biopsy, imaging, surrogate markers or ICD code and ECG findings by either a standard ECG, 24-hour Holter ECG or ICD code. Quality assessment was performed using the quality assessment tools from the National Heart, Lung, and Blood Institute.</AbstractText>A total of 20 observational studies (1 case-control, 4 cohort, 15 cross-sectional studies, 401,745 individuals) were included. Twelve studies evaluated cardiac arrhythmias in NAFLD subjects, out of which 10 evaluated atrial fibrillation (AF). Although results were inconsistent, most studies rated as "good" demonstrated that hepatic steatosis was independently associated with an increased risk for prevalent AF in NAFLD patients. Diabetic patients with NAFLD were associated with an increased risk of ventricular arrhythmias in only one study rated as "good". Two studies rated as "good" demonstrated that hepatic steatosis was associated with a prolonged QTc interval. Four studies supported the association between cardiac conduction abnormalities and NAFLD, out of which two were rated as "good". Two studies assessed ECG modifications of ischemic heart disease (IHD), but only one having a "good" rating confirmed this independent association.</AbstractText>Studies of high quality and with low risk of bias demonstrated that NAFLD is independently associated with AF, a prolonged QTc interval, bundle branch and atrioventricular blocks. Diabetic patients with NAFLD present an increased risk for developing ventricular arrhythmias.</AbstractText> |
17,272 | Impact of early intravenous amiodarone administration on neurological outcome in refractory ventricular fibrillation: retrospective analysis of prospectively collected prehospital data. | The 2015 AHA guidelines recommend that amiodarone should be used for patients with refractory ventricular fibrillation (RVF). However, the optimal time interval between the incoming call and amiodarone administration (call-to-amiodarone administration interval) in RVF patients has not been investigated. We hypothesized that the time elapsed until amiodarone administration could affect the neurological outcome at hospital discharge in patients with RVF.</AbstractText>This study is a retrospective analysis of prospectively collected data. One hundred thirty-four patients were enrolled. In univariate logistic regression, the probability of a good neurological outcome at hospital discharge decreased as the time elapsed until amiodarone administration increased (OR 0.89 [95% CI = 0.80-0.99]). In multivariate logistic regression, the patients who were administered amiodarone in less than 20 min showed higher rates of prehospital ROSC, survival at hospital arrival, any ROSC, survival at admission, survival to discharge, and good CPC at hospital discharge. The call-to-amiodarone administration interval of ≤20 min (OR 6.92, 95% CI 1.72-27.80) was the independent factor affecting the neurological outcome at hospital discharge.</AbstractText>Early amiodarone administration (≤ 20 min) showed better neurological outcome at hospital discharge for OHCA patients who showed initial ventricular fibrillation and subsequent RVF.</AbstractText> |
17,273 | The autonomic nervous system and ventricular arrhythmias in myocardial infarction and heart failure. | Ventricular arrhythmias (VA) can range in presentation from asymptomatic to cardiac arrest and sudden cardiac death (SCD). Sustained ventricular tachycardias/ventricular fibrillation (VT/VF) are a common cause of SCD in the setting of myocardial infarction (MI) and heart failure. A particularly arrhythmogenic cardiac syncytia in these conditions can be attributed to both sympathetic activation and parasympathetic dysfunction, while appropriate neuromodulation has the potential to reduce occurrence of VT/VF. In this review, we outline the components of the autonomic nervous system that play an important role in normal cardiac electrophysiology and function. In addition, we discuss changes that occur in the setting of cardiac disease including adverse neural remodeling and neurohormonal activation which significantly contribute to propensity for VT/VF. Finally, we review neuromodulation strategies to mitigate VT/VF which predominantly rely on increasing parasympathetic drive and blockade of sympathetic neurotransmission. |
17,274 | A Pilot Study on the Diagnosis of Fatal Electrocution by the Detection of Myocardial Microhemorrhages. | In electrocutions, death may be caused by alterations in the heart conduction system provoking ventricular fibrillation. This study aims to identify histological cardiac markers of high- and low-voltage electrocution. Two groups of decedents were evaluated: group A included 14 fatalities caused by high- or low-voltage electrocution and group B (control) included 14 fatalities due to other traumatic or disease causes. Myocardial sampling with microscopic examination was performed on all the hearts using the hematoxylin and eosin and Masson's trichrome stains to investigate morphological characteristics that could indicate the damage caused by high- and low-voltage electrocutions. Interstitial myocardial hemorrhagic infiltration was the only differentiating finding, which was shown only in high-voltage electrocution. This pathological finding has not been previously reported, and it may be specific to high-voltage electrocution deaths. Further studies are warranted. |
17,275 | Serum tenascin-C levels in atrium predict atrial structural remodeling processes in patients with atrial fibrillation. | Fibro-inflammatory processes in the extracellular matrix are closely associated with progressive structural remodeling in atrial fibrillation (AF). Serum concentrations of tenascin-C (TNC), an extracellular matrix glycoprotein, and of high-sensitivity C-reactive protein (CRP) might serve as a marker of remodeling and progressive inflammation of the aorta and in myocardial diseases. This study aimed to clarify relationships between TNC and CRP in patients with AF.</AbstractText>This study included 38 patients with AF and five controls without left ventricular dysfunction who underwent catheter ablation. Blood was collected immediately before ablation from the left atrium (LA), right atrium (RA), and femoral artery (FA), and left and right atrial pressure was measured. Levels of TNC in the LA (TNC-LA), RA (TNC-RA), and FA (TNC-FA) and high-sensitivity C-reactive protein (CRP) were measured. Atrial size was also determined by echocardiography.</AbstractText>Levels of TNC corrected by atrial size were maximal in the LA, followed by the RA (3.69 ± 0.32 and 2.87 ± 0.38 ng/mL/cm, respectively). Mean transverse diameter corrected by body surface area was larger and mean atrial pressure was greater in the LA than the RA. A relationship was found between CRP from the femoral vein and TNC-LA and TNC-RA, but not TNC-FA. None of TNC-LA, TNC-RA, or TNC-FA correlated with ANP or BNP in the femoral vein.</AbstractText>Intracardiac (atrial) TNC expression plays an important role in the development of remodeling processes in the atrium with AF. Tenascin-C from the LA and RA (but not TNC, ANP, and BNP from FA) might serve as novel markers of these processes.</AbstractText> |
17,276 | "Incompatible Housemates": Hypertrophic Obstructive Cardiomyopathy and Takotsubo Syndrome. | This case report concerns an 81-year-old woman with previously well-controlled hypertrophic obstructive cardiomyopathy (HOCM). She was referred to our hospital because of the acute onset of takotsubo syndrome. Echocardiography revealed basal hyperkinesis due to takotsubo syndrome superimposed on septal hypertrophy, which resulted in the reappearance of prominent left ventricular outflow tract obstruction (LVOTO). Although she developed cardiogenic shock triggered by atrial fibrillation, LVOTO was successfully mitigated by aggressive fluid resuscitation, rhythm control, and the administration of β-blocker. We herein report a rare case with catastrophic hemodynamics due to the incidental combination of HOCM and takotsubo syndrome. |
17,277 | Sex-Related Differences in Heart Failure With Preserved Ejection Fraction. | To describe characteristics and outcomes in women and men with heart failure with preserved ejection fraction.</AbstractText>Baseline characteristics (including biomarkers and quality of life) and outcomes (primary outcome: composite of first heart failure hospitalization or cardiovascular death) were compared in 4458 women and 4010 men enrolled in CHARM-Preserved (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) (EF≥45%), I-Preserve (Irbesartan in heart failure with Preserved ejection fraction), and TOPCAT-Americas (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial).</AbstractText>Women were older and more often obese and hypertensive but less likely to have coronary artery disease or atrial fibrillation. Women had more symptoms and signs of congestion and worse quality of life. Despite this, the risk of the primary outcome was lower in women (hazard ratio, 0.80 [95% CI, 0.73-0.88]), as was the risk of cardiovascular death (hazard ratio, 0.70 [95% CI, 0.62-0.80]), but there was no difference in the rate for first hospitalization for heart failure (hazard ratio, 0.92 [95% CI, 0.82-1.02]). The lower risk of cardiovascular death in women, compared with men, was in part explained by a substantially lower risk of sudden death (hazard ratio, 0.53 [0.43-0.65]; P</i><0.001). E/A ratio was lower in women (1.1 versus 1.2).</AbstractText>There are significant differences between women and men with heart failure with preserved ejection fraction. Despite worse symptoms, more congestion, and lower quality of life, women had similar rates of hospitalization and better survival than men. Their risk of sudden death was half that of men.</AbstractText>URL: https://www.clinicaltrials.gov. Unique identifier: NCT00853658, NCT01035255.</AbstractText> |
17,278 | Renewal Theory as a Universal Quantitative Framework to Characterize Phase Singularity Regeneration in Mammalian Cardiac Fibrillation. | Despite a century of research, no clear quantitative framework exists to model the fundamental processes responsible for the continuous formation and destruction of phase singularities (PS) in cardiac fibrillation. We hypothesized PS formation/destruction in fibrillation could be modeled as self-regenerating Poisson renewal processes, producing exponential distributions of interevent times governed by constant rate parameters defined by the prevailing properties of each system.</AbstractText>PS formation/destruction were studied in 5 systems: (1) human persistent atrial fibrillation (n=20), (2) tachypaced sheep atrial fibrillation (n=5), (3) rat atrial fibrillation (n=4), (5) rat ventricular fibrillation (n=11), and (5) computer-simulated fibrillation. PS time-to-event data were fitted by exponential probability distribution functions computed using maximum entropy theory, and rates of PS formation and destruction (λf</sub>/λd</sub>) determined. A systematic review was conducted to cross-validate with source data from literature.</AbstractText>In all systems, PS lifetime and interformation times were consistent with underlying Poisson renewal processes (human: λf</sub>, 4.2%/ms±1.1 [95% CI, 4.0-5.0], λd</sub>, 4.6%/ms±1.5 [95% CI, 4.3-4.9]; sheep: λf</sub>, 4.4%/ms [95% CI, 4.1-4.7], λd</sub>, 4.6%/ms±1.4 [95% CI, 4.3-4.8]; rat atrial fibrillation: λf</sub>, 33%/ms±8.8 [95% CI, 11-55], λd</sub>, 38%/ms [95% CI, 22-55]; rat ventricular fibrillation: λf</sub>, 38%/ms±24 [95% CI, 22-55], λf</sub>, 46%/ms±21 [95% CI, 31-60]; simulated fibrillation λd</sub>, 6.6-8.97%/ms [95% CI, 4.1-6.7]; R</i>2</i></sup>≥0.90 in all cases). All PS distributions identified through systematic review were also consistent with an underlying Poisson renewal process.</AbstractText>Poisson renewal theory provides an evolutionarily preserved universal framework to quantify formation and destruction of rotational events in cardiac fibrillation.</AbstractText> |
17,279 | Relaxin reverses maladaptive remodeling of the aged heart through Wnt-signaling. | Healthy aging results in cardiac structural and electrical remodeling that increases susceptibility to cardiovascular diseases. Relaxin, an insulin-like hormone, suppresses atrial fibrillation, inflammation and fibrosis in aged rats but the mechanisms-of-action are unknown. Here we show that relaxin treatment of aged rats reverses pathological electrical remodeling (increasing Nav1.5 expression and localization of Connexin43 to intercalated disks) by activating canonical Wnt signaling. In isolated adult ventricular myocytes, relaxin upregulated Nav1.5 (EC<sub>50</sub> = 1.3 nM) by a mechanism inhibited by the addition of Dickkopf-1. Furthermore, relaxin increased the levels of connexin43, Wnt1, and cytosolic and nuclear β-catenin. Treatment with Wnt1 or CHIR-99021 (a GSK3β inhibitor) mimicked the relaxin effects. In isolated fibroblasts, relaxin blocked TGFβ-induced collagen elevation in a Wnt dependent manner. These findings demonstrate a close interplay between relaxin and Wnt-signaling resulting in myocardial remodeling and reveals a fundamental mechanism of great therapeutic potential. |
17,280 | Intra-Aortic Balloon Pump Catheter Insertion Using a Novel Left External Iliac Artery Approach in A Case of Chronic Heart Failure Due to Dilated Cardiomyopathy. | BACKGROUND The use of an intra-aortic balloon pump (IABP) in patients with advanced heart failure can provide interim mechanical support as a bridge to further treatment, including cardiac transplantation. The femoral artery, axillary artery, and subclavian artery are the main approaches to IABP catheter placement. A case is reported of the use of a left external iliac artery approach to IABP catheter placement using a subcutaneous channel in a patient with chronic heart failure. CASE REPORT A 67-year-old woman presented with a history of heart failure. She had New York Heart Association (NYHA) Functional Class IV symptoms. The patient had a history of chronic heart failure due to dilated cardiomyopathy with a left ventricular ejection fraction of 25%, severe mitral regurgitation, paroxysmal atrial fibrillation, and hypothyroidism. Immediate pharmacological treatment began, and an IABP catheter was initially inserted using femoral artery access. During 115 days of hospital treatment, several unsuccessful attempts were made to remove the IABP catheter. Due to prolonged patient immobility, the IABP catheter access was changed from the femoral artery to the external iliac artery. A prosthetic Dacron graft and a subcutaneous channel were used. Optimal pharmacotherapy commenced, and the patient underwent rehabilitation and mobilization with significant improvement in cardiac function. At 195 days after changing the IABP catheter access, the patient underwent successful heart transplantation. CONCLUSIONS This report demonstrated that in a patient with chronic heart failure requiring long-term femoral IABP catheter placement, an external iliac artery approach using a subcutaneous channel provided a bridge to cardiac transplantation. |
17,281 | The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left Ventricular Remodeling. | We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population. |
17,282 | The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study. | Hemodialysis catheter-related superior vena cava (SVC) occlusions can cause considerable morbidity for patients and be challenging to treat if refractory to conventional guide wire transversal. This pilot study assessed the feasibility and safety of sharp recanalization of SVC occlusion in hemodialysis patients.</AbstractText>This study retrospectively enrolled hemodialysis patients treated in West China Hospital diagnosed with SVC occlusion who failed traditional guide wire transversal from January 2014 to November 2017. In brief, a guide wire from the femoral approach was advanced to the lower end of the obstructive lesion to act as a target, while the stiff end of hydrophilic wire was advanced though a jugular approach. Under fluoroscopic guidance in biplane imaging, the occlusive SVC lesion was penetrated with the stiff wire that was snared and pulled through. Graded dilation of the SVC and subsequent tunneled-cuffed catheter implantation were performed. Demographic information and clinical outcomes were recorded and evaluated.</AbstractText>Sixteen patients with a mean age of 62 ± 13 years (13 females and 3 males) who received SVC sharp recanalization were included in this study. The sharp recanalization procedure was successfully performed in 14 patients (87.5%). Two patients were complicated with SVC laceration and hemopericardium but remained asymptomatic and required no surgical repair. One patient suffered ventricular fibrillation during procedure. Despite the return of spontaneous circulation, the patient unfortunately died of gastrointestinal tract bleeding after 3 days in ICU. Follow-up suggested the 6-month catheter patency to be 92.85% and 12-month catheter patency to be 58.33%. No long-term procedure-related complications were recorded.</AbstractText>Sharp recanalization might be a feasible strategy in managing SVC occlusion in hemodialysis patients. The potential life-threatening complications (cardiac arrhythmia and SVC laceration) necessitate strict eligibility screening, skillful operation, and avoidance of over-dilation of SVC.</AbstractText>© 2019 International Society for Hemodialysis.</CopyrightInformation> |
17,283 | Outcome of rescue ablation in patients with refractory ventricular electrical storm requiring mechanical circulation support. | The management of refractory electrical storm (ES) requiring mechanical circulation support (MCS) remains a clinical challenge in structural heart disease (SHD).</AbstractText>The study sought to explore the 30-day and 1-year outcome of rescue ablation for refractory ES requiring MCS in SHD.</AbstractText>A total of 81 patients (mean age: 55.3 ± 18.9, 73 men [90.1%]) undergoing ablation were investigated, including 26 patients with ES requiring MCS (group 1) and 55 patients without (group 2). The 30-day and 1-year outcome, including mortality and recurrent ventricular tachyarrhythmias (VAs) receiving appropriate implantable cardioverter defibrillators therapies, were assessed.</AbstractText>The patients in group 1 were characterized by older age, more ischemic cardiomyopathies, worse left ventricular ejection fraction, and more comorbidities. Thirty days after ablation, overall events were seen in 15 patients (mortality in 10 and recurrent VA in 7), including pumping failure-related mortality in 6 (60%). During a 30-day follow-up, higher mortality was noted in group 1. After a 1-year follow-up, in spite of the higher mortality in group 1 (P < .001), the overall events and VA recurrences were similar between these two groups (P = .154 and P = .466, respectively). There was a significant reduction of VA burden in both groups and two patients had recurrent ES.</AbstractText>Higher 30-day mortality was observed in patients undergoing rescue ablation for refractory ES requiring MCS, and pumping failure was the major cause of periprocedural death. Rescue ablation successfully prevented VA recurrences and resulted in a comparable 1-year prognosis between ES with and without MCS.</AbstractText>© 2019 Wiley Periodicals, Inc.</CopyrightInformation> |
17,284 | The relationship between β<sub>1</sub> -adrenergic and M<sub>2</sub> -muscarinic receptor autoantibodies and hypertrophic cardiomyopathy. | What is the central question of this study? The concentrations of β1</sub> -adrenergic receptor and M2</sub> -muscarinic receptor autoantibodies in hypertrophic cardiomyopathy (HCM) patients and the relationship between the cardiac autoantibodies and clinical manifestations of HCM have rarely been reported. What is the main finding and its importance? We found that the concentrations of the two autoantibodies in HCM patients were significantly higher than those in control subjects. Furthermore, we found that the concentrations of the two autoantibodies could reflect myocardial injury and diastolic dysfunction in HCM patients to some extent and might be involved in the occurrence of arrhythmia. These findings might be valuable in exploration of the mechanisms of occurrence and progression of HCM.</AbstractText>Increasing attention is being given to the role of immunological mechanisms in the development of heart failure. The purpose of this study was to investigate the concentration of serum β1</sub> -adrenergic receptor autoantibody (β1</sub> -AAb) and M2</sub> -muscarinic receptor autoantibody (M2</sub> -AAb) in patients with hypertrophic cardiomyopathy (HCM), and the relationship between β1</sub> -AAb, M2</sub> -AAb and clinical indices. One hundred and thirty-four patients with HCM were recruited consecutively into the HCM group. Forty healthy subjects were assigned as the normal controls (NCs). Serum samples were collected to measure the concentrations of β1</sub> -AAb and M2</sub> -AAb by enzyme-linked immunosorbent assay. The clinical data of HCM patients were collected. The serum concentrations of β1</sub> -AAb and M2</sub> -AAb of HCM patients were significantly higher than those of NCs. In HCM patients, those with a left atrial diameter ≥50 mm or moderate-to-severe mitral regurgitation had significantly higher concentrations of the two autoantibodies. Patients with a history of syncope had higher concentrations of β1</sub> -AAb. Female patients and patients with a family history of sudden cardiac death or atrial fibrillation had higher concentrations of M2</sub> -AAb. Maximal wall thickness, interventricular septum thickness and resting left ventricular outflow tract gradient were positively correlated with log β1</sub> -AAb or log M2</sub> -AAb in HCM patients. In conclusion, the serum concentrations of β1</sub> -AAb and M2</sub> -AAb of HCM patients were significantly higher than those of NCs. Being female, syncope, a family history of sudden death, atrial fibrillation, left atrial diameter ≥50 mm, moderate-to-severe mitral regurgitation, maximal wall thickness, interventricular septum thickness and resting left ventricular outflow tract gradient may affect the concentrations of the two autoantibodies.</AbstractText>© 2019 The Authors. Experimental Physiology © 2019 The Physiological Society.</CopyrightInformation> |
17,285 | Safety and efficacy of catheter ablation in atrial fibrillation patients with left ventricular dysfunction. | Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients reduced the mortality but may increase complications and raise the safety concern.</AbstractText>CA for AF in HF patients may not increase the complications vs medical treatment, and it may reduce hospitalizations and mortality and improve heart function.</AbstractText>Three groups of AF patients were included in the study: 120 congestive HF for their first CA (AFHF-CA), 150 congestive HF who were undergoing medical therapy (AFHF-Med), and 150 patients with normal left ventricular (LV) ejection fraction (LVEF) (AF-CA).</AbstractText>After 30 ± 6 months of follow up, 45.8% of patients in the AFHF-CA and 61.3% of patients in the AF-CA groups maintained sinus rhythm (SR) in comparison with 2.7% in AFHF-Med (P < .01). Hospitalization for HF was significantly lower in AFHF-CA than in AFHF-Med groups (P < .01). Death occurred in 7.5% of patients in the AFHF-CA group, which was lower than 18% in the AFHF-Med group (P < .01). Significant improvements in heart function were shown in the AFHF-CA group compared to the AFHF-Med group, including LVEF (P < .01), LV end-diastolic diameter (P < .01), and New York Heart Association classification (P < .01), as well as the left atrial diameter (P < .01). AFHF-CA patients required additional ablation more often (P < .05). CA had a better prognosis in paroxysmal AF and tachycardia-related diseases.</AbstractText>CA for AF reduced hospitalizations and mortality and improved heart function, vs medical treatment, and was as safe as CA in those with normal heart function.</AbstractText>© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.</CopyrightInformation> |
17,286 | Cardiac Arrest with Multi-vessel Coronary Artery Disease and Successful Treatment After Long Conventional Cardiopulmonary Resuscitation: How Long Is Too Long? | Coronary artery disease (CAD) is the most common killer disease, responsible for about one-third of all deaths at ages above 35. The majority of all survivors of out-of-hospital cardiac arrests present to the emergency department (ED) with an initial shockable rhythm (ventricular fibrillation or pulse-less ventricular tachycardia), which is a predictor of survival. Odds for survival are less for non-shockable rhythm and favorable neurologic outcomes decrease as the length of cardiopulmonary resuscitation (CPR) increases. The median time-to-return of spontaneous circulation among those with favorable neurological outcomes is less than 10 minutes. On the other hand, a large review of more than 64,000 patients with in-hospital cardiac arrests showed that patients with longer median resuscitation times had a greater chance of the return of spontaneous circulation and survival to discharge. We described a case of prolonged resuscitation lasting almost three hours of CPR followed by successful percutaneous intervention with a favorable neurologic outcome. |
17,287 | Prospective blinded Evaluation of the smartphone-based AliveCor Kardia ECG monitor for Atrial Fibrillation detection: The PEAK-AF study. | The AliveCor Kardia ECG monitor (ACK) offers a smartphone-based one-lead ECG recording for the detection of atrial fibrillation. We compared ACK lead I recordings with the 12-lead ECG and introduce a novel parasternal lead (NPL).</AbstractText>Consecutive cardiac inpatients were recruited. In all patients a 12-lead ECG, ACK lead I and NPL were obtained. Two experienced electrophysiologists were blinded and separately evaluated all ECG. We calculated sensitivity, specificity, and predictive values of the ACK ECG compared to the 12-lead ECG.</AbstractText>296 ECG from 99 patients (38 female, age 64 ± 15 years, BMI 27.8 ± 5.1 kg/m2</sup>) were analyzed. 20% of ACK lead I recordings contained a critical amount of artifact. The electrophysiologists' interpretation of the ACK recordings yielded a sensitivity of 100% and specificity of 94% for atrial fibrillation or flutter in lead I (κ = 0.90) and a sensitivity of 96% and specificity of 97% in the NPL (κ = 0.92). The ACK diagnostic algorithm displayed a significantly lower sensitivity (55-70%), specificity (60-69%), and accuracy (κ = 0.4-0.53) but a high negative predictive value (100%). Patients with atrial flutter (n = 5) and with ventricular stimulation (n = 12) had a high likelihood of being misclassified by the algorithm.</AbstractText>The AliveCor Kardia ECG monitor allows a highly accurate detection of atrial fibrillation by an interpreting electrophysiologist both in the standard lead I and a novel parasternal lead. The diagnostic algorithm offered by the system may be useful in screening recordings for further review. Diagnostic challenges present in atrial flutter and ventricular pacemaker stimulation.</AbstractText>Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.</CopyrightInformation> |
17,288 | Pacemaker lead as an iatrogenic cause of right heart failure: Case report. | Technical advances in health care have improved patient survival and quality of life, but are not devoid of complications. We present the case of a 74-year-old woman with a history of hypertensive heart disease with preserved systolic function, atrial fibrillation and dyslipidemia. She had a DDDR pacemaker implanted in 2005 due to symptomatic complete atrioventricular block. The patient reported progressive fatigue, weakness, ascites with abdominal discomfort, and lower limb edema, accompanied by non-specific hepatic cholestasis on biochemical testing. Abdominal ultrasound revealed homogeneous hepatomegaly and dilatation of the inferior vena cava and upper hepatic veins, suggestive of congestive hepatopathy. Echocardiography revealed tricuspid regurgitation progressively worsening over the previous four years and dilatation and progressive dysfunction of the right ventricle, with preserved left ventricular function. The transesophageal echocardiogram revealed severe tricuspid regurgitation with flail septal leaflet and marked dilatation of the tricuspid annulus due to mechanical interference of the pacemaker lead, which was adhering to the septal leaflet. Minimally invasive surgical treatment was performed with partial resection of the leaflet, placement of a tricuspid annuloplasty ring and replacement of the pacemaker lead. Regression of the congestive symptoms was observed, and the postoperative echocardiogram showed the tricuspid annuloplasty ring with no evidence of stenosis and only slightly dilated right chambers with moderate pulmonary hypertension. Six months after the procedure, the patient suffered an acute neurological event and died. |
17,289 | Impact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure. | Moderate and moderately severe renal impairment are common in patients with heart failure and reduced ejection fraction, but whether beta-blockers are effective is unclear, leading to underuse of life-saving therapy.</AbstractText>This study sought to investigate patient prognosis and the efficacy of beta-blockers according to renal function using estimated glomerular filtration rate (eGFR).</AbstractText>Analysis of 16,740 individual patients with left ventricular ejection fraction <50% from 10 double-blind, placebo-controlled trials was performed. The authors report all-cause mortality on an intention-to-treat basis, adjusted for baseline covariates and stratified by heart rhythm.</AbstractText>Median eGFR at baseline was 63 (interquartile range: 50 to 77) ml/min/1.73 m2</sup>; 4,584 patients (27.4%) had eGFR 45 to 59 ml/min/1.73 m2</sup>, and 2,286 (13.7%) 30 to 44 ml/min/1.73 m2</sup>. Over a median follow-up of 1.3 years, eGFR was independently associated with mortality, with a 12% higher risk of death for every 10 ml/min/1.73 m2</sup> lower eGFR (95% confidence interval [CI]: 10% to 15%; p < 0.001). In 13,861 patients in sinus rhythm, beta-blockers reduced mortality versus placebo; adjusted hazard ratio (HR): 0.73 for eGFR 45 to 59 ml/min/1.73 m2</sup> (95% CI: 0.62 to 0.86; p < 0.001) and 0.71 for eGFR 30 to 44 ml/min/1.73 m2</sup> (95% CI: 0.58 to 0.87; p = 0.001). The authors observed no deterioration in renal function over time in patients with moderate or moderately severe renal impairment, no difference in adverse events comparing beta-blockers with placebo, and higher mortality in patients with worsening renal function on follow-up. Due to exclusion criteria, there were insufficient patients with severe renal dysfunction (eGFR <30 ml/min/1.73 m2</sup>) to draw conclusions. In 2,879 patients with atrial fibrillation, there was no reduction in mortality with beta-blockers at any level of eGFR.</AbstractText>Patients with heart failure, left ventricular ejection fraction <50% and sinus rhythm should receive beta-blocker therapy even with moderate or moderately severe renal dysfunction.</AbstractText>Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
17,290 | Echocardiographic Features of Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction. | The PARAGON-HF (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction) trial tested the efficacy of sacubitril-valsartan in patients with heart failure with preserved ejection fraction (HFpEF). Existing data on cardiac structure and function in patients with HFpEF suggest significant heterogeneity.</AbstractText>The aim of this study was to characterize cardiac structure and function, quantify their associations with clinical outcomes, and contextualize these findings with other HFpEF studies.</AbstractText>Echocardiography was performed in 1,097 of 4,822 PARAGON-HF patients within 6 months of enrollment. Associations with incident first heart failure hospitalization or cardiovascular death were assessed using Cox proportional hazards models adjusted for age, sex, region of enrollment, randomized treatment, N-terminal pro-brain natriuretic peptide, and clinical risk factors.</AbstractText>Average age was 74 ± 8 years, 53% of patients were women, median N-terminal pro-brain natriuretic peptide level was 918 pg/ml (interquartile range: 485 to 1,578 pg/ml), 94% had hypertension, and 35% had atrial fibrillation. The mean left ventricular (LV) ejection fraction was 58.6 ± 9.8%, prevalence of LV hypertrophy was 21%, prevalence of left atrial enlargement was 83%, prevalence of elevated E/e' ratio was 53%, and prevalence of pulmonary hypertension was 31%. Heart failure hospitalization or cardiovascular death occurred in 288 patients at 2.8-year median follow-up. In fully adjusted models, higher LV mass index (hazard ratio [HR]: 1.05 per 10 g/m2</sup>; 95% confidence interval [CI]: 1.00 to 1.10; p = 0.03), E/e' ratio (HR: 1.04 per unit; 95% CI: 1.02 to 1.06; p < 0.001), pulmonary artery systolic pressure (HR: 1.51 per 10 mm Hg; 95% CI: 1.29 to 1.76; p < 0.001), and right ventricular end-diastolic area (HR: 1.04 per cm2</sup>; 95% CI: 1.01 to 1.07; p = 0.003) were each associated with this composite, while LV ejection fraction and left atrial size were not (p > 0.05 for all). Appreciable differences were observed in cardiac structure compared with other HFpEF clinical trials, despite similar E/e' ratio, pulmonary artery systolic pressure, and event rates.</AbstractText>Diastolic dysfunction, left atrial enlargement, and pulmonary hypertension were common in PARAGON-HF. LV hypertrophy, elevated left- and right-sided pressures, and right ventricular enlargement were independently predictive of incident heart failure hospitalization or cardiovascular death. Echocardiographic differences among HFpEF trials despite similar clinical event rates highlight the heterogeneity of this syndrome. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).</AbstractText>Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
17,291 | Permanent His bundle pacing and atrioventricular node ablation in a case with drug-refractory atrial fibrillation. | Permanent His bundle pacing (HBP) activates the ventricles through the normal conduction system and has become a useful technique for patients with a high ventricular pacing rate. Presently described is a case of drug-refractory atrial fibrillation (AF) with a high ventricular rate that was treated with atrioventricular (AV) node ablation and permanent HBP. A 62-year-old woman with persistent AF and a drug-refractory high ventricular response was referred for exercise intolerance and palpitation. She had a history of failed catheter ablation attempts and amiodarone toxicity. Permanent HBP and AV node ablation was planned to achieve rate control with a stepwise approach. Initially, implantation of a permanent pacemaker was performed. The His lead and right ventricular back-up leads were implanted successfully, in the manner described previously. The His lead was connected to the atrial channel of the pacemaker battery and programmed to AAI pacing mode. The AV node was ablated successfully 3 weeks later without any threshold changes in the His lead. No His lead threshold changes were observed during or after AV node ablation and the patient was subsequently asymptomatic with twice daily apixaban 5 mg. Permanent HBP after AV node ablation can be a beneficial treatment option to prevent pacing-induced ventricular dyssynchrony and heart failure in patients who are not eligible for cardiac resynchronization therapy. |
17,292 | Esmolol for cardioprotection during resuscitation with adrenaline in an ischaemic porcine cardiac arrest model. | The effectiveness of adrenaline during resuscitation continues to be debated despite being recommended in international guidelines. There is evidence that the β-adrenergic receptor (AR) effects of adrenaline are harmful due to increased myocardial oxygen consumption, post-defibrillation ventricular arrhythmias and increased severity of post-arrest myocardial dysfunction. Esmolol may counteract these unfavourable β-AR effects and thus preserve post-arrest myocardial function. We evaluated whether a single dose of esmolol administered prior to adrenaline preserves post-arrest cardiac output among successfully resuscitated animals in a novel, ischaemic cardiac arrest porcine model.</AbstractText>Myocardial infarction was induced in 20 anaesthetized pigs by inflating a percutaneous coronary intervention (PCI) balloon in the circumflex artery 15 min prior to induction of ventricular fibrillation. After 10 min of untreated VF, resuscitation with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated and the animals were randomized to receive an injection of either 1 mg/kg esmolol or 9 mg/ml NaCl, prior to adrenaline. Investigators were blinded to allocation. Successful defibrillation was followed by a 1-h high-flow VA-ECMO before weaning and an additional 1-h stabilization period. The PCI-balloon was deflated 40 min after inflation. Cardiac function pre- and post-arrest (including cardiac output) was assessed by magnetic resonance imaging (MRI) and invasive pressure measurements. Myocardial injury was estimated with MRI, triphenyl tetrazolium chloride (TTC) staining and serum concentrations of cardiac troponin T.</AbstractText>Only seven esmolol and five placebo-treated pigs were successfully resuscitated and available for post-arrest measurements (p = 0.7). MRI revealed severe but similar reductions in post-arrest cardiac function with cardiac output 3.5 (3.3, 3.7) and 3.3 (3.2, 3.9) l/min for esmolol and control (placebo) groups, respectively (p = 0.7). The control group had larger left ventricular end-systolic and end-diastolic ventricular volumes compared to the esmolol group (75 (65, 100) vs. 62 (53, 70) ml, p = 0.03 and 103 (86, 124) vs. 87 (72, 91) ml, p = 0.03 for control and esmolol groups, respectively). There were no other significant differences in MRI characteristics, myocardial infarct size or other haemodynamic measurements between the two groups.</AbstractText>We observed similar post-arrest cardiac output with and without a single dose of esmolol prior to adrenaline administration during low-flow VA-ECMO in an ischaemic cardiac arrest pig model.</AbstractText> |
17,293 | The Effect of Ranolazine on Glycemic Control: a Narrative Review to Define the Target Population. | Ranolazine is an anti-anginal medication that reduces the sodium-dependent calcium overload via the inhibition of the late sodium current. After its approval for the treatment of chronic angina in 2006 in the USA, ranolazine has been reported to have several pleiotropic effects on various cardiac conditions, such as atrial fibrillation, ventricular arrhythmias, diastolic and microvascular dysfunction, and pulmonary arterial hypertension. Recently, several studies reported some promising results on the potential benefits of ranolazine on glycemic control. Though the mechanism of the antihyperglycemic effect is still unknown, ranolazine may exert the effect through β cell preservation, inhibition of glucose secretion, and enhancement of insulin secretion in a glucose-dependent manner. Given the increased risk of cardiovascular disease in patients with diabetes, it will be useful if one medication can simultaneously improve chronic angina and diabetes. Therefore, ranolazine could be a favored choice among other anti-anginal agents for patients with comorbidity of chronic angina and diabetes mellitus. In this review, we summarize the available data from clinical studies and provide valuable insight into defining the target population for the antihyperglycemic effect of ranolazine. |
17,294 | Management of paroxysmal atrial flutter that occurred in an outpatient prior to dental surgery: a case report. | It is essential to accomplish the appropriate emergency care particularly in patients undergoing stressful dento-oral surgical procedures. Atrial flutter may be induced by sympathetic hypertonia due to excessive mental and physical stress. There is no report regarding dental care in patients with atrial flutter. Herein, we describe a rare case of the antiarrhythmic management in an outpatient who presented with an electrocardiographic finding of paroxysmal atrial flutter before the initiation of the dento-oral surgical procedure.</AbstractText>A 60-year-old male patient was scheduled for a dental extraction. He had a history of angina pectoris, diabetes mellitus, and paroxysmal atrial fibrillation with medication. The preoperative electrocardiogram (ECG) revealed left ventricular hypertrophy and ST-T segment abnormality. Immediately before the dental extraction, II-lead ECG revealed atrial flutter; however, he complained of few subjective symptoms, such as precordial discomfort or palpitation. Observing the vital signs, ECG findings, and the general condition of the patient, low dose diltiazem was immediately administered by continuous infusion in order to control the heart rate and prevent atrial flutter-induced supraventricular tachyarrhythmia. Special attention was paid to prevent any critical cardiovascular condition under a preparation of intravenous disopyramide and verapamil and a defibrillator. The intravenous administration of diltiazem progressively restored the sinus rhythm after converting atrial flutter into atrial fibrillation, resulting in the prevention of tachycardia, and then was found to be appropriate as a prophylactic therapy of tachyarrhythmia.</AbstractText>The present case suggests that it is possible to successfully manage some of such patients using our method during dento-oral surgery which is likely to be associated with mental and physical stress. Therefore, it is essential to accomplish an initial emergency care in parallel to the differential diagnosis of unforeseen serious medical conditions or paroxysmal arrhythmia such as atrial flutter.</AbstractText> |
17,295 | Predictive value of ATRIA risk score for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction. | The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) risk score used to detect the thromboembolic and hemorrhagic risk in atrial fibrillation patients has been shown recently to predict poor clinical outcomes in patients with acute myocardial infarction (ACS), regardless of having atrial fibrillation (AF). We aimed to analyze the relationship between different risk scores and contrast-induced nephropathy (CIN) development in patients with ACS who underwent urgent percutaneous coronary intervention (PCI) and compare the predictive ability of the ATRIA risk score with the MEHRAN risk score.</AbstractText>We analyzed 429 patients having St-segment Elevation Myocardial Infarction (STEMI) who underwent urgent PCI between January 2016 and February 2017. Patients were divided into two groups: those with and those without CIN and both groups were compared according to clinical, laboratory, and demographic features, including the CHA2DS2-VASc and ATRIA risk score. Predictors of CIN were determined by multivariate regression analysis. Receiver operating characteristics (ROC) curve analysis was used to analyze the prognostic value of CHA2DS2-VASc and ATRIA risk score for CIN, following STEMI.</AbstractText>Multivariate regression analysis showed that Athe TRIA risk score, Opaque/Creatinine Clearance ratio, and low left ventricular ejection fraction was an independent predictor of CIN. The C-statistics for the ATRIA risk score and CHA2DS2-VASC risk score were 0.66 and 0.64 (p<0.001, and p<0.001), respectively. A pair-wise comparison of ROC curves showed that both scores were not inferior to the MEHRAN score in predicting CIN.</AbstractText>The ATRIA and CHA2DS2-VASC scoring systems were useful for detecting CIN following STEMI.</AbstractText> |
17,296 | Association of Race With Disease Expression and Clinical Outcomes Among Patients With Hypertrophic Cardiomyopathy. | Racial differences are recognized in multiple cardiovascular parameters, including left ventricular hypertrophy and heart failure, which are 2 major manifestations of hypertrophic cardiomyopathy. The association of race with disease expression and outcomes among patients with hypertrophic cardiomyopathy is not well characterized.</AbstractText>To assess the association between race, disease expression, care provision, and clinical outcomes among patients with hypertrophic cardiomyopathy.</AbstractText><AbstractText Label="DESIGN, SETTING, AND PARTICIPANTS">This retrospective cohort study included data on black and white patients with hypertrophic cardiomyopathy from the US-based sites of the Sarcomeric Human Cardiomyopathy Registry from 1989 through 2018.</AbstractText>Self-identified race.</AbstractText>Baseline characteristics; genetic architecture; adverse outcomes, including cardiac arrest, cardiac transplantation or left ventricular assist device implantation, implantable cardioverter-defibrillator therapy, all-cause mortality, atrial fibrillation, stroke, and New York Heart Association (NYHA) functional class III or IV heart failure; and septal reduction therapies. The overall composite outcome consists of the first occurrence of any component of the ventricular arrhythmic composite end point, cardiac transplantation, left ventricular assist device implantation, NYHA class III or IV heart failure, atrial fibrillation, stroke, or all-cause mortality.</AbstractText>Of 2467 patients with hypertrophic cardiomyopathy at the time of analysis, 205 (8.3%) were black (130 male [63.4%]; mean [SD] age, 40.0 [18.6] years) and 2262 (91.7%) were white (1351 male [59.7%]; mean [SD] age, 45.5 [20.5] years). Compared with white patients, black patients were younger at the time of diagnosis (mean [SD], 36.5 [18.2] vs 41.9 [20.2] years; P < .001), had higher prevalence of NYHA class III or IV heart failure at presentation (36 of 205 [22.6%] vs 174 of 2262 [15.8%]; P = .001), had lower rates of genetic testing (111 [54.1%] vs 1404 [62.1%]; P = .03), and were less likely to have sarcomeric mutations identified by genetic testing (29 [26.1%] vs 569 [40.5%]; P = .006). Implantation of implantable cardioverter-defibrillators did not vary by race; however, invasive septal reduction was less common among black patients (30 [14.6%] vs 521 [23.0%]; P = .007). Black patients had less incident atrial fibrillation (35 [17.1%] vs 608 [26.9%]; P < .001). Black race was associated with increased development of NYHA class III or IV heart failure (hazard ratio, 1.45; 95% CI, 1.08-1.94) which persisted on multivariable Cox proportional hazards regression (hazard ratio, 1.97; 95% CI, 1.34-2.88). There were no differences in the associations of race with stroke, ventricular arrhythmias, all-cause mortality, or the overall composite outcome.</AbstractText>The findings suggest that black patients with hypertrophic cardiomyopathy are diagnosed at a younger age, are less likely to carry a sarcomere mutation, have a higher burden of functionally limited heart failure, and experience inequities in care with lower use of invasive septal reduction therapy and genetic testing compared with white patients. Further study is needed to assess whether higher rates of heart failure may be associated with underlying ancestry-based disease pathways, clinical management, or structural inequities.</AbstractText> |
17,297 | Left ventricular extracellular volume expansion does not predict recurrence of atrial fibrillation following catheter ablation. | A recent study reported that diffuse left ventricular (LV) fibrosis is a predictor of atrial fibrillation (AF) recurrence following catheter ablation, by measuring postcontrast cardiac T1</sub> (an error prone metric as per the 2017 Society for Cardiovascular Magnetic Resonance consensus statement) using an inversion-recovery pulse sequence (an error prone method in arrhythmia) in AF ablation candidates. The purpose of this study was to verify the prior study, by measuring extracellular volume (ECV) fraction (an accurate metric) using a saturation-recovery pulse sequence (accurate method in arrhythmia).</AbstractText>This study examined 100 AF patients (mean age = 62 ± 11 years, 69 males and 31 females, 67 paroxysmal [pAF] and 33 persistent [peAF]) who underwent a preablation cardiovascular magnetic resonance (CMR) exam. LV ECV and left atrial (LA) and LV functional parameters were quantified using standard analysis methods. During an average follow-up period of 457 ± 261 days with 4 ± 3 rhythm checks per patient, 72 patients maintained sinus rhythm. Between those who maintained sinus rhythm (n = 72) and those who reverted to AF (n = 28), the only clinical characteristic that was significantly different was age (60 ± 12 years vs 66 ± 9 years); for CMR metrics, neither mean LV ECV (25.1 ± 3.3% vs 24.7 ± 3.7%), native LV T1</sub> (1093.8 ± 73.5 ms vs 1070.2 ± 115.9 ms), left ventricular ejection fraction (54.1 ± 11.2% vs 55.7 ± 7.1%), nor LA end diastolic volume/body surface area (42.4 ± 14.8 mL/m2</sup> vs 43.4 ± 19.6 mL/m2</sup> ) were significantly different (P ≥ .23). According to Cox regression tests, none of the clinical and imaging variables predict AF recurrence.</AbstractText>Neither LV ECV nor other CMR metrics predict recurrence of AF following catheter ablation.</AbstractText>© 2019 Wiley Periodicals, Inc.</CopyrightInformation> |
17,298 | Effects of angiotensin receptor neprilysin inhibition on P-wave dispersion in heart failure with reduced ejection fraction. | Angiotensin receptor neprilysin inhibitors (ARNI; sacubitril/valsartan combination) decrease morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). Increased P‑wave duration and P‑wave dispersion (Pd</sub>) reflect prolongation of atrial conduction and correlate with atrial fibrillation. Here, we aimed to assess the effects of switching from valsartan to ARNI treatment on the basis of P‑wave indices.</AbstractText>A total of 28 patients with HFrEF (mean age, 64.8 ± 10.6 years; 18 males, 78.6% ischemic etiology) were included. All patients had New York Heart Association functional class II-III, left ventricular ejection fraction ≤35%, and had been switched from valsartan to ARNI treatment. Standard 12-lead electrocardiograms from patients on valsartan treatment and electrocardiograms 1 month after ARNI treatment were analyzed; heart rate, maximum P‑wave duration (Pmax</sub>), minimum P‑wave duration (Pmin</sub>), and Pd</sub> were calculated. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores and N‑terminal pro-brain natriuretic peptide (NT-proBNP) values were recorded.</AbstractText>The Pmax</sub> (135.6 ± 32.1 ms vs. 116.1 ± 14.1 ms, p = 0.041) and Pd</sub> (33.6 ± 7.9 vs. 28.6 ± 5.3, p = 0.006) values were significantly reduced after ARNI treatment. Furthermore, ARNI treatment was associated with an improvement in MLWHFQ scores (31.2 ± 6.2 ms vs. 23.2 ± 7.0 ms, p < 0.001) and with a reduction in NT-proBNP values (1827.3 ± 1287.3 pg/ml vs. 1074.4 ± 692.3 pg/ml, p < 0.001). There were moderately positive correlations between the reduction in Pd</sub> and the improvement in MLWHFQ scores (r = 0.408, p = 0.031) and the reduction in NT-proBNP values (r = 0.499, p = 0.007) CONCLUSION: Switching to ARNI treatment alters Pd</sub> and Pmax</sub> favorably in patients with HFrEF. The reduction in atrial inhomogeneous conduction assessed by Pd</sub> was correlated with clinical improvement and reduced NT-proBNP levels in patients with HFrEF.</AbstractText> |
17,299 | Interventricular septal diverticulum and rheumatic mitral valve disease identified and managed concurrently in middle age. | Cardiac diverticula represent an extremely rare but serious cause of cardiac morbidity and mortality. They can result to arrhythmia, sudden cardiac death and ventricular dysfunction but may have no pathological implications. Here is a case of a 60-year-old Maori farmer with both rheumatic mitral valve disease and left ventricular (LV) septal diverticulum. The requirement for mitral valve replacement raised the complex decision of whether to undergo concurrent diverticulum repair. The haemodynamic significance of the diverticulum was impossible to ascertain, although we could not in good conscience leave such a large diverticulum with potential to influence further systolic deterioration. Three months after the procedures, the patient developed severe tricuspid regurgitation which is a first reported association postseptal diverticulum repair. The case highlights that careful consideration is required in repairing LV septal diverticula and an emphasis should be placed on complications and the requirement for repeat surgery during the consent process. |
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