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19,000 | Bathroom Entrapment Leading to Cardiac Arrest From Crush Syndrome. | Crush injuries have the potential to cause life-threatening systemic effects such as hyperkalemia, dysrhythmias, acute kidney injury, and renal failure. Systemic involvement is known as crush syndrome (CS) and results from tissue ischemia and muscle necrosis. This is a report of a 76-year-old female who developed a fatal dysrhythmia following release of her extremity from prolonged entrapment in bathroom safety equipment. Hyperkalemia should be presumed in any crush injury and be treated empirically and aggressively. Although tourniquet application prior to extrication is not widely recommended to prevent CS, it should be considered in prolonged extremity entrapment. |
19,001 | Fragmented QRS as a predictor of in-hospital life-threatening arrhythmic complications in ST-elevation myocardial infarction patients. | Fragmented QRS (fQRS) complex is an electrocardiographic pattern that reflects the inhomogeneity of ventricular depolarization. The aims of this study were to determine the prognostic significance of fQRS for predicting in-hospital life-threatening arrhythmic complications in ST-elevation myocardial infarction (STEMI) patients, and to identify the most appropriate duration of cardiac rhythm monitoring in STEMI patients with fQRS.</AbstractText>Patients diagnosed with and treated for STEMI at Siriraj Hospital (Bangkok, Thailand) during 2009-2012 were enrolled. Patients were divided according to fQRS status (having or not having fQRS) at hospital admission. The primary outcome was in-hospital life-threatening arrhythmic events, including sustained ventricular tachycardia and ventricular fibrillation. Time to last life-threatening arrhythmic event from hospital admission was recorded.</AbstractText>Of the 452 patients that were included, 96 patients (21.2%) had fQRS. There were significantly more life-threatening arrhythmic events in the fQRS group than in the non-fQRS group (22.9% vs. 4.5%, respectively; p < 0.001). Median (IQR) time to last life-threatening arrhythmic event from hospital admission was significantly longer in fQRS than in non-fQRS (6.58 hr [3.08-39.34] vs. 2.59 hr [1.75-5.75], respectively; p = 0.047). Multivariate analysis identified fQRS as an independent predictor of in-hospital life-threatening arrhythmic events (OR: 4.162, 95% CI: 1.669-10.384; p = 0.002).</AbstractText>The presence of fQRS complex on admission ECG was found to be an independent predictor of in-hospital life-threatening arrhythmic events in STEMI patients. Since the time to last life-threatening arrhythmic event from admission was longer in fQRS than in non-fQRS, cardiac rhythm monitoring longer than 24-48 hr may be needed in patients with fQRS.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,002 | A rare cause of sudden cardiac arrest: Catecholaminergic polymorphic ventricular tachycardia. | Catecholaminergic polymorphic ventricular tachycardia is a rhythm disorder that develops due to genetic reasons in the absence of structural cardiac abnormalities. Ventricular tachycardia, ventricular fibrillation, cardiac arrest, and death may occur. Two-year-old patient presented to the Emergency Department with sudden cardiac arrest. He had syncope attacks after playing with his brother and he was followed up by the pediatric neurology and cardiology clinics. Cardiopulmonary resuscitation was performed, and he was then transferred to the Intensive Care Unit because of hypotension; dobutamine and norepinephrine treatment was started. After treatment, ventricular tachycardia, ventricular fibrillation, and cardiac arrest developed. Dobutamine and noradrenaline was stopped immediately and amiodarone was started. A genetic test revealed heterozygote missense mutation (c.9110G>A(p.Gly3037Asp)) in exon 64 of the RYR2 gene, which is compatible with catecholaminergic polymorphic ventricular tachycardia. This mutation has been reported in the literature for the first time. This case is presented with the purpose of highlighting catecholaminergic polymorphic ventricular tachycardia. |
19,003 | Rapid and life-threatening heart failure induced by pazopanib. | A 70-year-old man with history of stage IV renal cell carcinoma, chronic atrial fibrillation on warfarin, coronary artery disease status post-percutaneous coronary intervention resulting in an ischaemic cardiomyopathy with left ventricular ejection fraction of 40%-45%, presented with shortness of breath 10 days after starting pazopanib. Within the first week of starting pazopanib, the patient developed fatigue and progressive dyspnoea on exertion. His symptoms quickly worsened and he had compromised mental status. He was transferred to the intensive care unit (ICU) and intubated due to continued respiratory distress. He was found to be in cardiogenic shock and was started on inotropic support with dobutamine and norepinephrine. With maximum support, the patient was slowly weaned off vasopressors and was successfully extubated on ICU day 9. His hospital stay lasted 29 days with management of multiple medical complications, and he was eventually discharged to a rehabilitation facility. |
19,004 | Intravenous ivabradine versus placebo in patients with low cardiac output syndrome treated by dobutamine after elective coronary artery bypass surgery: a phase 2 exploratory randomized controlled trial. | Low cardiac output syndrome (LCOS) is a severe condition which can occur after cardiac surgery, especially among patients with pre-existing left ventricular dysfunction. Dobutamine, its first-line treatment, is associated with sinus tachycardia. This study aims to assess the ability of intravenous ivabradine to decrease sinus tachycardia associated with dobutamine infused for LCOS after coronary artery bypass graft (CABG) surgery.</AbstractText>In a phase 2, multi-center, single-blind, randomized controlled trial, patients with left ventricular ejection fraction below 40% presenting sinus tachycardia of at least 100 beats per minute (bpm) following dobutamine infusion for LCOS after CABG surgery received either intravenous ivabradine or placebo (three ivabradine for one placebo). Treatment lasted until dobutamine weaning or up to 48 h. The primary endpoint was the proportion of patients achieving a heart rate (HR) in the 80- to 90-bpm range. Secondary endpoints were invasive and non-invasive hemodynamic parameters and arrhythmia events.</AbstractText>Nineteen patients were included. More patients reached the primary endpoint in the ivabradine than in the placebo group (13 (93%) versus 2 (40%); P = 0.04). Median times to reach target HR were 1.0 h in the ivabradine group and 5.7 h in the placebo group. Ivabradine decreased HR (112 to 86 bpm, P <0.001) while increasing cardiac index (P = 0.02), stroke volume (P <0.001), and systolic blood pressure (P = 0.03). In the placebo group, these parameters remained unchanged from baseline. In the ivabradine group, five patients (36%) developed atrial fibrillation (AF) and one (7%) was discontinued for sustained AF; two (14%) were discontinued for bradycardia.</AbstractText>Intravenous ivabradine achieved effective and rapid correction of sinus tachycardia in patients who received dobutamine for LCOS after CABG surgery. Simultaneously, stroke volume and systolic blood pressure increased, suggesting a beneficial effect of this treatment on tissue perfusion.</AbstractText>European Clinical Trials Database: EudraCT 2009-018175-14 . Registered February 2, 2010.</AbstractText> |
19,005 | Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators: findings from the national DenHeart study. | Although highly effective in preventing arrhythmic death, there is a high prevalence of anxiety, depression and reduced quality of life among patients who have received an implantable cardioverter defibrillator (ICD). Whether mortality, ICD shock and readmission are predicted by patient-reported outcomes is unknown.</AbstractText>The aim of this study was to describe patient-reported outcomes among patients with ICDs compared by: ICD indication and generator type (ICD or cardiac resynchronisation therapy ICD), and to determine whether patient-reported outcomes at discharge predict mortality, ICD therapy and readmission.</AbstractText>A national cross-sectional survey at hospital discharge ( n=998) with register follow-up. Patient-reported outcomes included the Hospital Anxiety and Depression Scale, Short Form-12, HeartQoL, EQ-5D and Edmonton Symptom Assessment Scale. Register data: ICD therapy, readmissions and mortality within one year following discharge.</AbstractText>Patients with primary prevention ICDs had significantly worse patient-reported outcomes at discharge than patients with secondary prevention ICDs. Likewise, patients with cardiac resynchronisation therapy ICDs had significantly worse patient-reported outcomes at discharge than patients without cardiac resynchronisation therapy. One-year mortality was predicted by patient-reported outcomes, with the highest hazard ratio (HR) being anxiety (HR 2.02; 1.06-3.86), but was not predicted by indication or cardiac resynchronisation therapy. ICD therapy and ventricular tachycardia/ventricular fibrillation were not predicted by patient-reported outcomes, indication or cardiac resynchronisation therapy. Overall, patient-reported outcomes predicted readmissions, e.g. symptoms of anxiety and depression predicted all readmissions within 3 months (HR 1.50; 1.13-1.98) and 1.47 (1.07-2.03), respectively).</AbstractText>Patients with primary indication ICDs and cardiac resynchronisation therapy ICDs report worse patient-reported outcomes than patients with secondary indication and no cardiac resynchronisation therapy. Patient-reported outcomes such as mental health, quality of life and symptom burden predict one-year mortality and acute and planned hospital readmissions.</AbstractText> |
19,006 | High-sensitivity C-reactive protein in heart failure with preserved ejection fraction. | Microvascular inflammation may contribute to the pathogenesis of both heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension (PH). We investigated whether the inflammation biomarker C-reactive protein (CRP) was associated with clinical characteristics, disease severity or PH in HFpEF.</AbstractText>Patients in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart failure (RELAX) trial had baseline high-sensitivity CRP levels measured (n = 214). Clinical characteristics, exercise performance, echocardiographic variables and biomarkers of neurohumoral activation, fibrosis and myocardial necrosis were assessed. Patients with normal (≤3mg/L) versus high (>3mg/L) CRP levels were compared.</AbstractText>The median CRP level was 3.69mg/L. CRP was elevated in 57% of patients. High CRP levels were associated with younger age, higher body mass index (BMI), chronic obstructive pulmonary disease (COPD), lower peak oxygen consumption and higher endothelin-1 and aldosterone levels. CRP increased progressively with the number of comorbidities (0.7mg/L per increment in comorbidity number, P = 0.02). Adjusting for age, BMI and statin use, high CRP levels were additionally associated with atrial fibrillation, right ventricular dysfunction, and higher N-terminal pro-B-type natriuretic peptide levels (P<0.05 for all). CRP was not associated with PH or left ventricular function. CRP did not identify responders to sildenafil(P-value for interaction 0.13).</AbstractText>In HFpEF, high CRP is associated with greater comorbidity burden and some markers of disease severity but CRP was normal in 40% of patients. These findings support the presence of comorbidity-driven systemic inflammation in HFpEF but also the need to study other biomarkers which may better reflect the presence of systemic inflammation.</AbstractText> |
19,007 | Functional status with rhythm- versus rate-control strategy for persistent atrial fibrillation. | Introduction Recent studies have shown that rhythm control does not provide additional benefit over rate control in terms of morbidity or mortality and is less cost effective in patients with atrial fibrillation (AF). It remains to be determined if any of the treatment strategies should be favored on the basis of the quality of life (QoL) or functional capacity. Objectives This HOT CAFE substudy was conducted to compare the functional status of patients with persistent AF assigned either to rate or rhythm control strategy. Patients and methods We enrolled 205 patients (mean [SD] age, 60.8 [11.2] years) with persistent AF who were randomly assigned either to rate or rhythm control strategies. The New York Heart Association (NYHA) functional classification, intensity of arrhythmia‑related symptoms, exercise tolerance, and QoL were analyzed. Results After a mean (SD) of 1.7 (0.4) years, the NYHA class and QoL improved in both groups. Both strategies lead to improvement in AF‑related symptoms. Treadmill test duration and maximal workload increased over time in both groups. In terms of NYHA class improvement, rhythm control was superior to rate control in patients with AF and hypertension (odds ratio [OR], 1.89; 95% CI, 0.98-3.65; P = 0.055) and in those with moderate HF (OR, 2.04; 95% CI, 1.03-4.06; P = 0.04). When success was considered as left ventricular function improvement, the rhythm‑control strategy also proved to be superior in patients with hypertension (OR, 2.64; 95% CI, 1.21-5.74; P = 0.01) and those with NYHA class II or III (OR, 4.27; 95% CI, 1.25-9.85; P <0.001). Conclusions Rate- and rhythm‑control strategies improved functional status in patients with persistent AF. However, rhythm control might be more appropriate for patients with AF and hypertension and those with moderate HF. |
19,008 | Heart failure with preserved ejection fraction in Asia. | Heart failure with preserved ejection fraction (HFpEF) is a global public health problem. Unfortunately, little is known about HFpEF across Asia.</AbstractText>We prospectively studied clinical characteristics, echocardiographic parameters and outcomes in 1204 patients with HFpEF (left ventricular ejection fraction ≥50%) from 11 Asian regions, grouped as Northeast Asia (Hong Kong, Taiwan, China, Japan, Korea, n = 543), South Asia (India, n = 252), and Southeast Asia (Malaysia, Thailand, Singapore, Indonesia, Philippines, n = 409). Mean age was 68 ±12 years (37% were < 65 years) and 50% were women. Seventy per cent of patients had ≥2 co-morbidities, most commonly hypertension (71%), followed by anaemia (57%), chronic kidney disease (50%), diabetes (45%), coronary artery disease (29%), atrial fibrillation (29%) and obesity (26%). Southeast Asian patients had the highest prevalence of all co-morbidities except atrial fibrillation, South Asians had the lowest prevalence of all co-morbidities except anaemia and obesity, and Northeast Asians had more atrial fibrillation. Left ventricular hypertrophy and concentric remodelling were most prominent among Southeast and South Asians, respectively (P < 0.001). Overall, 12.1% of patients died or were hospitalized for heart failure within 1 year. Southeast Asians were at higher risk for adverse outcomes, independent of co-morbidity burden and cardiac geometry.</AbstractText>These first prospective multinational data from Asia show that HFpEF affects relatively young patients with a high burden of co-morbidities. Regional differences in types of co-morbidities, cardiac remodelling and outcomes of HFpEF across Asia have important implications for public health measures and global HFpEF trial design.</AbstractText>© 2018 The Authors. European Journal of Heart Failure & 2018 European Society of Cardiology.</CopyrightInformation> |
19,009 | Acquired drug-induced long QTc: new insights coming from a retrospective study. | Several drug classes (antiarrhythmics, antimicrobials, antidepressants, phenothiazines, opiates, prokinetics of digestive tract, etc.) have been related to ventricular hyperkinetic arrhythmias such as torsade de pointes (TdP). TdPs are usually heralded by an abnormal prolongation of heart rate-corrected QT interval on the electrocardiogram, so-called drug-induced long heart rate-corrected QT (diLQTc). We do not know to what extent the drug-induced QTc prolongation is able to predict malignant arrhythmias. Thus, we have retrospectively examined the clinical history of patients with diLQTc.</AbstractText>The case record, concerning the period January 2008-December 2017, was collected from two hospitals. diLQTc was defined as drug-induced heart rate-corrected QT of ≥ 450 ms or ≥ 470 ms, respectively in male or female patients. The primary purpose was to verify whether in diLQTc patients the length of this electrocardiographic segment was associated with the risk of symptoms or events (TdP, ventricular fibrillation).</AbstractText>Seventy-three validated cases of diLQTc were gathered. Among them, the QTc duration was not able to predict the occurrence of symptoms or events (odds ratio, 0.998; 95% CI, 0.984 to 1.013; p = 0.8821). Likewise, a diQTc lasting longer than 500 ms compared to diQTc comprised between 450 and 500 ms was not associated with an increased risk of arrhythmic events.</AbstractText>In our diLQTc patients, QTc duration did not predict occurrence of symptoms, or arrhythmic events. Thus, other determinants should be postulated to clarify why sometimes diQTc prolongation propitiates ventricular malignant arrhythmias whereas in other cases this arrhythmogenic effect is lacking.</AbstractText> |
19,010 | Cardiopulmonary Arrest and Extracorporeal Membrane Oxygenation: Case Report and Review. | National trends suggest that less than one in four patients experiencing in-hospital cardiac arrest (IHCA) in the United States survive to discharge. This is especially relevant as the rates of IHCA are expected to rise in the years to come. Only a modest upward trend in survival to discharge among patients with IHCA over the past decade warrants evaluation of novel ideas to improve outcomes postcardiopulmonary resuscitation. One such idea is that the use of veno-arterial-extracorporeal membrane oxygenation (VA-ECMO) to augment standard advanced cardiac life support algorithm in patients with an identifiable and reversible cause of cardiac arrest would improve survival to discharge. Here, we present the case of a patient with refractory ventricular fibrillation arrest who was transitioned to VA-ECMO immediately following cardiac catheterization for an IHCA. |
19,011 | Treatment of Ventricular Fibrillation Due to Ammonium Bifluoride Poisoning With Hemodialysis. | Ammonium bifluoride is an inorganic, fluoride-containing compound found in glass and metal etching products, as well as wheel cleaners. Fluoride toxicity is a common cause of preventable poisoning and has been reported to cause life-threatening ventricular dysrhythmias. Here, we report a case of recurrent ventricular fibrillation secondary to ingestion of ammonium bifluoride. The patient presented with vomiting and coma. She was intubated for altered mental status and respiratory failure and subsequently had 5 episodes of ventricular fibrillation, each resolving with a single defibrillation. She developed metabolic acidosis and hypocalcemia, which were treated with sodium bicarbonate and calcium gluconate, respectively. During transfer to a tertiary care children's hospital, ventricular fibrillation recurred despite electrolyte correction. Hemodialysis (HD) was initiated emergently. No further dysrhythmia occurred after initiation of HD. The result of a basic urine drug screen was negative, and a comprehensive drug screen (gas chromatography and mass spectroscopy) revealed only a nonsignificant peak for diphenhydramine. Subsequent laboratory evaluation revealed an elevated serum fluoride level. Diagnostic laryngoscopy and upper endoscopy did not reveal evidence of caustic injury. She was successfully extubated on hospital day 2 and discharged from the hospital on day 4 with no neurologic sequelae. With this example, we demonstrate a potential therapeutic approach to this potentially lethal poisoning. Fluoride toxicity is typically treated with calcium. However, dysrhythmia may result from calcium-independent direct myocardial toxicity. The kinetics of fluoride are amenable to HD, and renal clearance is slow. The potential use of HD in cases of fluoride poisoning refractory to other therapies warrants further study. |
19,012 | A Case of Neurologically Intact Survival after 2 hours and 50 minutes of Euthermic Cardiac Arrest Treated with Mechanical CPR and Intra-arrest Percutaneous Coronary Intervention. | We report a case of a 56 year old male in ventricular fibrillation (VF) cardiac arrest for a total of 2 hours and 50 minutes who was diagnosed with ST elevation myocardial infarction (STEMI) during a brief 10 min period of return of spontaneous circulation (ROSC). The patient underwent successful percutaneous coronary intervention (PCI) while receiving mechanical chest compressions for ongoing VF. Our case demonstrates the potential for neurologically intact survival in VF cardiac arrest patients despite prolonged periods of VF who are treated with mechanical CPR and intra-arrest PCI. |
19,013 | Comparison of Radiofrequency Ablation and Cryoablation for the Recovery of Atrial Contractility and Survival. | Limited comparative data are available on the efficacy of cryoablation versus radiofrequency ablation in patients with atrial fibrillation. This study aimed to compare radiofrequency ablation and cryoablation with regard to clinical outcomes and the restoration of sinus rhythm or atrial contractility.</AbstractText>A total of 239 patients who underwent surgical ablation between August 2003 and December 2016 at our institution were included. The patients were divided into 2 groups according to the energy device that was used (group A: n=140, radiofrequency ablator; group B: n=99, cryoablator). Echocardiographic data, overall survival, and major cardiovascular and cerebrovascular event (MACCE)-free survival were compared between the 2 groups.</AbstractText>At 1 year of follow-up, the atrial contractility recovery rate was 32.2% (19 of 59) in group A and 48.8% (21 of 44) in group B. In addition, cryoablation was found to be a predictive factor for the recovery of atrial contractility (cryoablation vs. radiofrequency ablation: odds ratio, 2.540; 95% confidence interval, 1.063-6.071; p=0.036). The left ventricular ejection fraction was significantly higher in group B (53.1%±11.5% vs. 59.1%±6.3%, p=0.001). The median follow-up duration was 36 months. The 5-year overall survival rate was 80.1%±3.6% in group A and 92.1%±2.9% in group B (p=0.400). The 5-year MACCE-free survival rate was 70.3%±4.0% in group A and 70.9%±5.6% in group B (p=0.818).</AbstractText>Cryoablation was associated with a higher atrial contractility restoration rate and better left ventricular function than radiofrequency ablation. However, no significant relationship was observed between the energy source and overall or MACCE-free survival.</AbstractText> |
19,014 | Influence of the KCNQ1 S140G Mutation on Human Ventricular Arrhythmogenesis and Pumping Performance: Simulation Study. | The KCNQ1 S140G mutation, which is involved in I<sub>Ks</sub> current, affects atrial fibrillation. However, little is known about its effect on the mechanical behavior of the heart. Therefore, we assessed the influence of the KCNQ1 S140G mutation on ventricular electrophysiological stability and mechanical pumping performance using a multi-scale model of cardiac electromechanics. An image-based electromechanical model was used to assess the effect on electrical propagation and arrhythmogenesis of the KCNQ1 S140G mutation. In addition, it was used to compare the mechanical response under the wild-type (WT) and S140G mutation conditions. The intracellular calcium transient obtained from the electrophysiological model was applied as an input parameter to a mechanical model to implement excitation-contraction coupling. The I<sub>Ks</sub> current equation was modified to account for expression of the KCNQ1 S140G mutation, and it included a scaling factor (ϕ) for mutant expressivity. The WT and S140G mutation conditions were compared at the single-cell and three-dimensional (3D) tissue levels. The action potential duration (APD) was reduced by 60% by the augmented I<sub>Ks</sub> current under the S140G mutation condition, which resulted in shorter QT interval. This reduced the 3D sinus rhythm wavelength by 60% and the sustained re-entry by 56%. However, pumping efficiency of mutant ventricles was superior in sinus rhythm condition. In addition, the shortened wavelength in cardiac tissue allowed a re-entrant circuit to form and increased the probability of sustaining ventricular tachycardia and ventricular fibrillation. In contrast, under the WT condition, a normal wavelength (20.8 cm) was unlikely to initiate and sustain re-entry in the cardiac tissue. Subsequently, the S140G mutant ventricles developed a higher dominant frequency distribution range (2.0-5.3 Hz) than the WT condition (2.8-3.7 Hz). In addition, stroke volume of mutant ventricles was reduced by 65% in sustained re-entry compared to the WT condition. In conclusion, signs of the S140G mutation might be difficult to identify in sinus rhythm even though the mutant ventricles show shortened QT interval. This suggests that the KCNQ1 S140G mutation increases the risk of death by sudden cardiac arrest. In addition, the KCNQ1 S140G mutation can induce ventricular arrhythmia and lessen ventricular contractility under re-entrant conditions. |
19,015 | Non-steroidal anti-inflammatory drugs and the risk of out-of-hospital cardiac arrest: a case-control study. | Non-steroidal anti-inflammatory drugs (NSAIDs), particularly selective COX-2 inhibitors, are associated with an increased risk of cardiovascular adverse events. However, the association between these drugs and out-of-hospital cardiac arrest with electrocardiogram-documented ventricular tachycardia/ventricular fibrillation (VT/VF-OHCA) has not been studied yet. This study was aimed to evaluate the association between the use of selective COX-2 inhibitors or conventional NSAIDs and VT/VF-OHCA compared with non-use.</AbstractText>A case-control study was conducted among 2483 cases with VT/VF-OHCA from the AmsteRdam REsuscitation STudies (ARREST) registry, an ongoing Dutch registry of OHCA, and 10 441 non-VT/VF-OHCA-controls from the Dutch PHARMO Database Network, containing drug dispensing records of community pharmacies, over the period July 2005-December 2011. Up to five controls were matched for age and sex to one case at the date of VT/VF-OHCA (index date). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by conditional logistic regression analysis. Of the cases, 0.5% was currently exposed at the index date to selective COX-2 inhibitors and 2.5% to conventional NSAIDs. Neither current use of selective COX-2 inhibitors nor conventional NSAIDs were associated with an increased risk of VT/VF-OHCA (adjusted OR 1.11, 95% CI: 0.79-1.56 and adjusted OR 0.97, 95% CI: 0.86-1.10, respectively) compared with non-use. Stratification for VT/VF-OHCA with presence/absence of acute myocardial infarction did not change these results.</AbstractText>Exposure to selective COX-2 inhibitors or conventional NSAIDs was not associated with an increased risk of VT/VF-OHCA compared with non-use.</AbstractText> |
19,016 | Pulmonary delivery of flecainide causes a rate-dependent predominant effect on atrial compared with ventricular depolarization duration revealed by intracardiac recordings in an intact porcine model. | Pulmonary delivery of flecainide results in the rapid conversion of atrial fibrillation (AF) to normal sinus rhythm in large-animal models and is safe and well-tolerated by normal human volunteers.</AbstractText>We investigated the effects of pulmonary delivery of flecainide on atrial and ventricular depolarization and repolarization duration.</AbstractText>Intratracheal instillation (1.5 mg/kg, rapid push) of flecainide or sterile water (placebo) was performed in 12 closed-chest, anesthetized Yorkshire pigs with a catheter positioned at the bifurcation of the main bronchi. High-resolution electrograms obtained from catheters fluoroscopically positioned in the right atrium and left ventricle circumvented measurement errors due to the fusion of P and T waves in surface leads when rapid heart rates shortened the TP interval. Pacing was achieved using electrical stimuli delivered via right atrial catheter electrodes.</AbstractText>During sinus rhythm (98 ± 4.7 beats/min), intratracheal flecainide caused comparable (P = 0.56) increases in atrial depolarization (P a</sub> ) duration by 22% (39.8 ± 3.2 to 48.7 ± 3.3  milliseconds) and left ventricular (LV) QRS complex duration by 20% (47.9 ± 1.6 to 57.3 ± 1.8  milliseconds) at peak effect at 2 minutes post-dosing. During right atrial pacing at 180 beats/min, Pa</sub> duration increased by 55% (37.0 ± 2.0 to 57.2 ± 1.6  milliseconds; P < 0.0001). The atrial response was greater (p = 0.001) than the 30% increase in LV QRS complex duration (46.6 ± 1.7 to 60.6 ± 2.5  milliseconds; P = 0.005). Pa</sub> duration and QRS complex duration were unchanged by placebo independent of pacing (P ≥ 0.4 for both). Atrial repolarization duration (PTa</sub> ; P = 0.46) and QTc</sub> interval (P = 0.49) remained unchanged.</AbstractText>Intratracheal flecainide exerts a rate-dependent, predominant effect on atrial compared with ventricular depolarization duration. Pulmonary delivery of flecainide could facilitate AF conversion to sinus rhythm with reduced ventricular proarrhythmia risk.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,017 | Acute inferior myocardial infarction with right ventricular involvement and several clinical-electrocardiographic markers of poor prognosis. | Right ventricular involvement in inferior myocardial infarction is a marker of poor prognosis. We present a case of a 62-year-old man with very recent onset of acute chest pain and cardiac shock with the triad of elevated jugular venous pressure, distension of the jugular veins on inspiration, and clear lung fields. In addition, the admission electrocardiogram showed a slurring J wave or lambda-like wave and conspicuous ST segment depression in several leads, predominantly in the lateral precordial (V4-V6), all clinical-electrocardiographic features of ominous prognosis. |
19,018 | Integration of "omics" techniques: Dronedarone affects cardiac remodeling in the infarction border zone. | Dronedarone improves microvascular flow during atrial fibrillation and reduces the infarct size in acute models of myocardial infarction. However, dronedarone might be harmful in patients with recent decompensated heart failure and increases mortality in patients with permanent atrial fibrillation. A pathophysiological explanation for these discrepant data is lacking. This study investigated the effects of dronedarone on gene and protein expression in the infarcted area and border zone in pigs subjected to anterior ischemia/reperfusion myocardial infarction. The ischemia/reperfusion myocardial infarction was induced in 16 pigs. Eight pigs were treated with dronedarone for 28 days after myocardial infarction, the remaining pigs served as control. Microarray-based transcriptome profiling and 2D-DIGE-based proteome analysis were used to assess the effects of dronedarone on left ventricular gene expression in healthy (LV), infarcted (MI), and border zone tissue. Selected targets were validated by RT-qPCR or immunoblot analyses, with special emphasize given to the transcriptome/proteome overlap. Combined "omics" analysis was performed to identify most significant disease and function charts affected by dronedarone and to establish an integrated network. The levels of 879 (BZ) or 7 (MI) transcripts and 51 (LV) or 15 (BZ) proteins were significantly altered by dronedarone, pointing to a substantial efficacy of dronedarone in the border zone. Transcriptome and proteome data indicate that dronedarone influences post-infarction remodeling processes and identify matricellular proteins as major targets of dronedarone in this setting. This finding is fully supported by the disease and function charts as well as by the integrated network established by combined "omics". Dronedarone therapy alters myocardial gene expression after acute myocardial infarction with pronounced effects in the border zone. Dronedarone promotes infarct healing via regulation of periostin and might contribute to the limitation of its expansion as well as cardiac rupture. Thus, there are no experimental hints that dronedarone per se has direct harmful effects after MI in ventricular tissue. Impact statement Dronedarone reduced the infarct size in models of acute myocardial infarction (MI). Here, we show that dronedarone attenuates many of the substantial changes in gene expression that are provoked by acute myocardial infarction (AMI) in pigs. Dronedarone modifies the expression of gene panels related to post-infarction cardiac healing and remodeling processes and, most remarkably, this occurs predominantly in the infarction border-zone and much less so in the vital or infarcted myocardium. Combined "omics" identified matricellular proteins and ECM as major dronedarone-regulated targets and emphasizes their relevance for Disease Charts and Tox Function Charts associated with tissue remodeling and cellular movement. The results demonstrate dronedarone's capability of regulating cardiac repair and remodeling processes specifically in the infarction border zone and identify underlying mechanisms and pathways that might be employed in future therapeutic strategies to improve long-term cardiac tissue function and stability. |
19,019 | ST-segment elevation myocardial infarction possibly caused by thromboembolism from left atrial appendage thrombus after incomplete surgical ligation. | Coronary embolism (CE) is the underlying cause of 3% of acute coronary syndromes but is frequently overlooked in the differential diagnoses of acute coronary syndromes. The CE may be direct (left sided from the native or prosthetic heart valve, the left atrium, left atrial appendage or pulmonary venous bed), paradoxical (from the venous circulation through a patent foramen ovale, atrial septal defect, ventricular septal defects, cyanotic congenital heart defects or pulmonary arteriovenous malformations), or iatrogenic (following cardiac interventions. In patients with atrial fibrillation (AF), left atrial appendage (LAA) ligation during mitral valve surgery has long been recommended to decrease the future risk of embolic events such as myocardial infarction or ischemic stroke. Recently, Aryana et al reported that in patients with AF who underwent surgical ligation of LAA, the presence of incomplete ligation was associated with a significantly higher risk of stroke/systemic embolization than complete ligation (24% vs 2%). |
19,020 | [Noninvasive mapping for catheter ablation of arrhythmias using the CardioInsight™ ECG vest]. | CardioInsight™ is a noninvasive three-dimensional mapping system technology which offers a unique method for arrhythmia characterization and localization. With a 252-lead ECG vest on the patient's torso and a noncontrast CT scan, epicardial potentials are detected and by means of reconstruction algorithms activation and phase maps are created, offering a deeper understanding of localization and mechanisms of arrhythmias including atrial fibrillation without the need for an endocardial catheter.</AbstractText>The system has proven to be accurate and applicable in the clinical setting of accessory pathways, premature ventricular contractions (PVC), atrial tachycardias and atrial fibrillation. Beat-to-beat analysis offers detection and thus a therapeutic approach for arrhythmias which occur only paroxysmally such as supraventricular extrasystoles, atrial bursts or PVCs. Another advantage is the simultaneous display of various heart chambers such as the left and right atrium. However, major multicenter prospective randomized data are still lacking.</AbstractText>If in the future noninvasive mapping could be achieved with MRI and if the technology was compatible with invasive mapping systems so that catheter positioning and noninvasive maps can be merged, the authors believe that this would represent a new dimension of mapping technology and ablation strategy of arrhythmias.</AbstractText> |
19,021 | Heart failure with preserved ejection fraction (HFpEF): Implications for the anesthesiologists. | Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. American College of Cardiology Foundation / American Heart Association 2013 guidelines have classified HF into two categories: (i) HF with reduced (≤40%) ejection fraction (HFrEF) or systolic HF, and (ii) HF with preserved (≥50%) ejection fraction (HFpEF) or diastolic HF. Risk factors for HFpEF include age more than 70 years, female gender, hypertension, wide pulse pressure, diabetes mellitus, chronic renal insufficiency, left ventricular hypertrophy, atrial fibrillation, smoking, recent weight gain, and exercise intolerance. Cardiac catheterization and echocardiography are used for the confirmation of diagnosis of HFpEF. Intraoperatively, the hemodynamic goals in patients with HFpEF are avoidance of tachycardia, maintenance of sinus rhythm, and maintenance of higher than usual filling pressure. No specific treatment for HFpEF is established, and therapeutic options include an intravenous diuretic, a beta blocker or calcium channel blocker, a venodilator, and management of co-morbidities. |
19,022 | Effect of Atrial Fibrillation and Mitral Valve Gradients on Response to Percutaneous Mitral Valve Repair With the MitraClip System. | Both pre-existing atrial fibrillation (AF) and mitral valve pressure gradients (MVPG) created by MitraClip implantation have demonstrated predictive power for unfavorable outcomes. Therefore, we aimed to assess the impact of MVPG following MitraClip on outcomes in patients with and without AF. A total of 200 patients who underwent MitraClip implantation in our institution were enrolled. Echocardiography was obtained before and after the procedure. The primary endpoint of the study was all-cause mortality 1-year after MitraClip implantation. Secondary end points were clinical improvements in NYHA functional class and reduction in MR severity after MitraClip implantation. Two hundred patients (74 ± 10 years, left ventricular ejection fraction 41% ± 14%, logistic EuroSCORE I 21 ± 15) were enrolled into the final analysis. One hundred twelve patients (56%) had pre-existing AF. One-year all-cause mortality was 17% without any differences between patients with or without pre-existing AF. Comparing postprocedural MVPG of surviving and deceased patients, deceased patients with pre-existing AF exhibited significantly elevated postprocedural MVPG compared with surviving patients without AF (4.8 ± 2.1 mm Hg vs 3.6 ± 1.8 mm Hg; p = 0.010). ROC analysis and Kaplan-Meier survival curves identified significantly reduced survival in AF patients with postprocedural MVPG above 4.0 mm Hg (p = 0.011). After MitraClip, a MVPG above 4.0 mm Hg in patients with pre-existing AF was a significant outcome predictor in univariate and multivariate analysis. In conclusion, we identified a high-risk cohort characterized by postprocedural MVPG above 4.0 mm Hg and pre-existing AF predicting poor long-term outcome. |
19,023 | Catheter ablation for treatment of patients with atrial fibrillation and heart failure: a meta-analysis of randomized controlled trials. | There is a little evidence for the effects of catheter ablation (CA) on hard endpoints in patients with atrial fibrillation (AF) and heart failure (HF).</AbstractText>PubMed, Embase and Cochrane Library were searched for randomized controlled trials (RCTs) enrolling patients with AF and HF who were assigned to CA, rate control or medical rhythm control groups. This meta-analysis was performed by using random-effect models.</AbstractText>Seven RCTs enrolling 856 participants were included in this meta-analysis. CA reduced the risks of all-cause mortality (risk ratio [RR] 0.52, 95% CI 0.35 to 0.76), HF readmission (RR 0.58, 95% CI 0.46 to 0.66) and the composite of all-cause mortality and HF readmission (RR 0.55, 95% CI 0.47 to 0.66) when compared with control. But there was no significant difference in cerebrovascular accident (RR 0.56, 95% CI 0.23 to 1.36) between two groups. Compared with control, CA was associated with improvement in left ventricular ejection fraction (mean difference [MD] 7.57, 95% CI 3.72 to 11.41), left ventricular end systolic volume (MD -14.51, 95% CI -26.84 to - 2.07), and left ventricular end diastolic volume (MD -3.78, 95% CI -18.51 to 10.96). Patients undergoing CA exhibited increased peak oxygen consumption (MD 3.16, 95% CI 1.09 to 5.23), longer 6-min walk test distance (MD 26.67, 95% CI 12.07 to 41.27), and reduced Minnesota Living with Heart Failure Questionnaire scores (MD -9.49, 95% CI -14.64 to - 4.34) than those in control group. Compared with control, CA was associated with improved New York Heart Association class (MD -0.74, 95% CI -0.83 to - 0.64) and lower B-type natriuretic peptide levels (MD -105.96, 95% CI -230.56 to 19.64).</AbstractText>CA was associated with improved survival, morphologic changes, functional capacity and quality of life relative to control. CA should be considered in patients with AF and HF.</AbstractText> |
19,024 | Placement of a Continuous Stellate Ganglion Block for Treatment of Refractory Ventricular Fibrillation in the Setting of Known Prinzmetal Angina During Pregnancy: A Case Report. | A patient with a history of Prinzmetal angina, refractory ventricular fibrillation, cardiac arrest with an implantable cardioverter-defibrillator, and obesity presented to the emergency department at 17 weeks gestational age with a chief complaint of angina and multiple episodes of defibrillation. A T3/4 thoracic epidural was placed to assess the effectiveness of a partial chemical sympathectomy in alleviating symptoms of angina as well as decreasing the amount of defibrillation episodes. Once this proved to be beneficial in accomplishing both of these goals, a more specific approach was designed. A continuous stellate ganglion block was then placed controlling both her angina and preventing further episodes of defibrillation long enough for her pregnancy to progress beyond 24 weeks gestational age. |
19,025 | ECG signal classification for the detection of cardiac arrhythmias using a convolutional recurrent neural network. | The electrocardiogram (ECG) provides an effective, non-invasive approach for clinical diagnosis in patients with cardiac diseases such as atrial fibrillation (AF). AF is the most common cardiac rhythm disturbance and affects ~2% of the general population in industrialized countries. Automatic AF detection in clinics remains a challenging task due to the high inter-patient variability of ECGs, and unsatisfactory existing approaches for AF diagnosis (e.g. atrial or ventricular activity-based analyses).</AbstractText>We have developed RhythmNet, a 21-layer 1D convolutional recurrent neural network, trained using 8528 single-lead ECG recordings from the 2017 PhysioNet/Computing in Cardiology (CinC) Challenge, to classify ECGs of different rhythms including AF automatically. Our RhythmNet architecture contained 16 convolutions to extract features directly from raw ECG waveforms, followed by three recurrent layers to process ECGs of varying lengths and to detect arrhythmia events in long recordings. Large 15  ×  1 convolutional filters were used to effectively learn the detailed variations of the signal within small time-frames such as the P-waves and QRS complexes. We employed residual connections throughout RhythmNet, along with batch-normalization and rectified linear activation units to improve convergence during training.</AbstractText>We evaluated our algorithm on 3658 testing data and obtained an F 1</sub> accuracy of 82% for classifying sinus rhythm, AF, and other arrhythmias. RhythmNet was also ranked 5th in the 2017 CinC Challenge.</AbstractText>Potentially, our approach could aid AF diagnosis in clinics and be used for patient self-monitoring to improve the early detection and effective treatment of AF.</AbstractText> |
19,026 | Multi-stage SVM approach for cardiac arrhythmias detection in short single-lead ECG recorded by a wearable device. | Use of wearable ECG devices for arrhythmia screening is limited due to poor signal quality, small number of leads and short records, leading to incorrect recognition of pathological events. This paper introduces a novel approach to classification (normal/'N', atrial fibrillation/'A', other/'O', and noisy/'P') of short single-lead ECGs recorded by wearable devices.</AbstractText>Various rhythm and morphology features are derived from the separate beats ('local' features) as well as the entire ECGs ('global' features) to represent short-term events and general trends respectively. Various types of atrial and ventricular activity, heart beats and, finally, ECG records are then recognised by a multi-level approach combining a support vector machine (SVM), decision tree and threshold-based rules.</AbstractText>The proposed features are suitable for the recognition of 'A'. The method is robust due to the noise estimation involved. A combination of radial and linear SVMs ensures both high predictive performance and effective generalisation. Cost-sensitive learning, genetic algorithm feature selection and thresholding improve overall performance. The generalisation ability and reliability of this approach are high, as verified by cross-validation on a training set and by blind testing, with only a slight decrease of overall F1-measure, from 0.84 on training to 0.81 on the tested dataset. 'O' recognition seems to be the most difficult (test F1-measures: 0.90/'N', 0.81/'A' and 0.72/'O') due to high inter-patient variability and similarity with 'N'.</AbstractText>These study results contribute to multidisciplinary areas, focusing on creation of robust and reliable cardiac monitoring systems in order to improve diagnosis, reduce unnecessary time-consuming expert ECG scoring and, consequently, ensure timely and effective treatment.</AbstractText> |
19,027 | Ventricular Fibrillation Induced by Coronary Vasospasm in a Patient with Early Repolarization and Hyperthyroidism. | Vasospastic angina (VSA) has been recognized as a cause of ventricular fibrillation (VF) degenerating into sudden cardiac death. We experienced a case of VSA with hyperthyroidism in which VF was provoked with an augmented J-wave amplitude in the inferior leads. The patient underwent insertion of an implantable cardioverter-defibrillator for the secondary prevention of VF in addition to taking Ca-channel antagonists. He has shown no recurrence of fatal arrhythmia or anginal attack for a follow-up period of one year. |
19,028 | Uncommon cause of complicated myocardial infarction with normal coronary arteries in a Saudi patient. | A case of a young Saudi patient with a previous diagnosis of bronchial asthma, nasal polyps, and chronic smoker, presented with atypical chest pain, elevated serum troponin and borderline ischemic electrocardiogram (ECG) changes, with no significant regional wall motion abnormalities at bedside echocardiography is reported. The patient was admitted to the coronary care unit for continuous monitoring as possible acute coronary syndrome, non-ST elevation myocardial infarction (STEMI). One hour after admission, the patient had ventricular fibrillation (VF) cardiac arrest that required three DC shocks and amiodarone bolus before returning of spontaneous circulation, which followed the fourth shock. The resuscitation took 15 minutes of cardiopulmonary resuscitation (CPR). An immediate 12-leads ECG showed significant ST elevation in precordial leads that mandate an urgent coronary angiogram that revealed patent coronary arteries, therefore spasm of normal coronary arteries was postulated as the operative factor. The cardiac magnetic resonance image (MRI) showed a picture of transmural anterior myocardial infarction, which correlates with the follow up echocardiogram reporting hypokinetic anterior wall. A complete history was taken and no use of illicit drugs or alcohol was found. The unusual presentation in such a patient with evidence of extensive anterior STEMI and normal coronary arteries raise the thought of considering uncommon causes. In view of previous medical history and laboratory evidence of eosinophilia, Kounis syndrome was considered dominant in the differential diagnosis. |
19,029 | Deformation imaging of the atria using 2D strain: A noninvasive modality to characterize operating compliance? | This viewpoint with two illustrated case summaries of biventricular and biatrial mechanical function/dysfunction emphasizes the importance of continued research in deformation imaging beyond the left ventricle, as there are no Cinderellas in the heart and we just cannot afford to be nonchalant toward the atria, particularly the right atrium. |
19,030 | Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation. | The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned.</AbstractText>We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001).</AbstractText>HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.</AbstractText>Copyright © 2018. Published by Elsevier B.V.</CopyrightInformation> |
19,031 | Combination of hemoglobin and low-flow duration can predict neurological outcome in the initial phase of out-of-hospital cardiac arrest. | To predict neurological outcome following out-of-hospital cardiac arrest (OHCA) using a combination of hemoglobin (Hb) and low-flow duration (LFD).</AbstractText>We retrospectively examined 131 patients (75 ± 13 years, 64 men) with return of spontaneous circulation (ROSC) following non-traumatic OHCA. The LFD was the duration from the start of cardiopulmonary resuscitation to ROSC. To obtain the Hb/LFD value, we divided the Hb level by the LFD. Multivariate logistic regression analyses were performed to predict full neurological recovery (FNR), defined as Cerebral Performance Category scale scores of 1 or 2 at discharge.</AbstractText>Nineteen patients (15%) achieved FNR. Patients with FNR had high Hb levels (14.9 ± 2.1 vs. 11.3 ± 2.7 g/dl, p = 0.001) and short LFDs (10 [5, 18] vs. 35 [28, 43] min, p = 0.001). Multivariate analyses identified the initial ventricular fibrillation rhythm and Hb/LFD as significant predictors for FNR (odds ratio: 24.9, 3.58; p = 0.001, 0.02, respectively). Receiver operating characteristic (ROC) curve analyses indicated that a high Hb/LFD predicted FNR (cut-off value: 0.50, sensitivity: 94.7%, specificity: 84.5%, area under the curve: 0.933).</AbstractText>Patients with FNR following OHCA had high Hb levels and short LFDs; the Hb/LFD value significantly predicted FNR.</AbstractText>Copyright © 2018 Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,032 | Cardiopulmonary Resuscitation with Extracorporeal Membrane Oxygenation in a Patient with Profound Accidental Hypothermia and Refractory Ventricular Fibrillation. | We describe a patient with severe accidental hypothermia (≤25.4°C) and prolonged refractory ventricular fibrillation, lasting at least 4 hours and 8 minutes, who underwent cardiopulmonary resuscitation with extracorporeal membrane oxygenation and survived without neurologic deficit. |
19,033 | Characteristics and Prognosis of Exercise-Related Sudden Cardiac Arrest. | <b>Introduction:</b> The previous studies about exercise-related sudden cardiac arrest (SCA) have mainly focused on sports activity, but information related to SCA in other forms of physical exercise is lacking. Our aim was to identify characteristics and prognosis of SCA victims in the general population who suffered SCA during physical activity. <b>Methods and results:</b> We collected retrospectively all cases of attempted resuscitation in Oulu University Hospital Area between 2007 and 2012. A total of 300 cases were of cardiac origin. We only included witnessed cases with Emergency Medical System arrival time ≤15 min. Cases of low-intensity physical activity were excluded. A total of 47 SCAs occurred during moderate-to-vigorous physical activity (exercise-group) and 43 cases took place at rest (rest-group). The subjects in exercise-group were younger compared to the rest-group (60 ± 14 years vs. 67 ± 14 years, <i>p</i> = 0.016). The initial rhythm recorded was more often ventricular fibrillation (VF) in exercise-group compared to the rest-group (77 vs. 50%, <i>p</i> = 0.010). Pulseless electrical activity (PEA) was rare in exercise-group compared to the rest -group (2.1 vs. 14%, <i>p</i> = 0.033, respectively). Bystander cardiopulmonary resuscitation (CPR) was more often performed when SCA took place during physical exercise (47 vs. 23 %, <i>p</i> = 0.020). Survival rates to hospital discharge were higher in the exercise-group compared to the rest -group (49 vs. 9.3%, <i>p</i> < 0.0001). <b>Conclusions:</b> SCA occurring during physical activity is more frequently a result of VF and bystander CPR is more often performed. There is also a notably better survival rate to hospital discharge. |
19,034 | Right ventricle to pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation. | To evaluate the prognostic value of the ratio between tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) as a determinant of right ventricular to pulmonary artery (RV-PA) coupling in patients undergoing transcatheter aortic valve replacement (TAVI).</AbstractText>RV function and pulmonary hypertension (PH) are both prognostically important in patients receiving TAVI. RV-PA coupling has been shown to be prognostic important in patients with heart failure but not previously evaluated in TAVI patients.</AbstractText>Consecutive patients with severe aortic stenosis who received TAVI from July 2011 through January 2016 and with comprehensive baseline echocardiogram were included. All individual echocardiographic images and Doppler data were independently reviewed and blinded to the clinical information and outcomes. Cox models quantified the effect of TAPSE/PASP quartiles on subsequent all-cause mortality while adjusting for confounders.</AbstractText>A total of 457 patients were included with mean age of 82.8±7.2 years, left ventricular ejection fraction (LVEF) 54%±13%, PASP 44±17 mm Hg. TAPSE/PASP quartiles showed a dose-response relationship with survival. This remained significant (HR for lowest quartile vs highest quartile=2.21, 95% CI 1.07 to 4.57, p=0.03) after adjusting for age, atrial fibrillation, LVEF, stroke volume index, Society of Thoracic Surgeons Predicted Risk of Mortality.</AbstractText>Baseline TAPSE/PASP ratio is associated with all-cause mortality in TAVI patients as it evaluates RV systolic performance at a given degree of afterload. Incorporation of right-side unit into the risk stratification may improve optimal selection of patients for TAVI.</AbstractText>© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation> |
19,035 | Acute Left Ventricular Unloading Reduces Atrial Stretch and Inhibits Atrial Arrhythmias. | Left atrium (LA) physiology is influenced by changes in left ventricular (LV) performance and load.</AbstractText>The purpose of this study was to define the effect of acute changes in LV loading conditions on LA physiology in subacute myocardial infarction (MI).</AbstractText>MI was percutaneously induced in 19 Yorkshire pigs. One to 2 weeks after MI, 14 pigs underwent acute LV unloading using a percutaneous LV assist device, Impella. The remaining 5 pigs underwent acute LV loading by percutaneous induction of aortic regurgitation. A pressure-volume catheter was inserted into the LA using a percutaneous transseptal approach, and LA pressure-volume loops were continuously monitored. Atrial arrhythmia inducibility was examined by burst-pacing of the right atrium. Nicotinamide adenine dinucleotide phosphate oxidase (NOX) levels and ryanodine receptor phosphorylation were examined in LA tissues to study the potential effect of stretch-dependent oxidative stress.</AbstractText>MI resulted in reduced LV ejection fraction and increased LV end-diastolic pressure with concomitant increase in LA pressure and volumes. Acute LV unloading resulted in a reduction of LV end-diastolic pressure, which led to proportional decreases in mean LA pressure and maximum LA volume. LA pressure-volume loops exhibited a pump flow-dependent, left-downward shift. This was associated with reduced LA passive stiffness, suggesting the alleviation of the LA stretch that was present after MI. Prior to acute unloading of the LV, 71% of the pigs were arrhythmia-inducible; LV unloading reduced this to 29% (p = 0.02). Time to spontaneous termination of atrial arrhythmias was decreased from median 55 s (range 5 to 300 s) to 3 s (range 0 to 59 s). In contrast, acute LV loading with aortic regurgitation increased LA pressure without a significant effect on arrhythmogenicity. Molecular analysis of LA tissue revealed that NOX2 expression was increased after MI, whereas acute LV unloading reduced NOX2 levels and diminished ryanodine receptor phosphorylation.</AbstractText>Acute LV unloading relieves LA stretch and reduces atrial arrhythmogenicity in subacute MI.</AbstractText>Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,036 | Utility of the JT Peak Interval and the JT Area in Determining the Proarrhythmic Potential of QT-Shortening Agents. | Drug-induced long QT increases the risk of ventricular tachyarrhythmia known as <i>torsades de pointes</i> (TdP). Many biomarkers have been used to predict TdP. At present, however, there are few biomarkers for arrhythmias induced by QT-shortening drugs. The objective of the present study was to identify the best biomarkers for predicting arrhythmias caused by the 4 potassium channel openers ICA-105574, NS-1643, R-L3, and pinacidil. Our results showed that, at higher concentrations, all 4 potassium channel openers induced ventricular tachycardia (VT) and ventricular fibrillation (VF) in Langendorff-perfused guinea pig hearts, but not in rabbit hearts. The electrocardiography parameters were measured including QT/QTc, JT peak, Tp-e interval, JT area, short-term beat-to-beat QT interval variability (STV), and index of cardiac electrophysiological balance (iCEB). We found that the potassium channel openers at test concentrations shortened the QT/QTc and the JT peak interval and increased the JT area. Nevertheless, even at proarrhythmic concentrations, they did not always change STV, Tp-e, or iCEB. Receiver operating characteristic curve analysis showed that the JT peak interval representing the early repolarization phase and the JT area reflecting the dispersion of ventricular repolarization were the best predictors of VT/VF. Action potential recordings in guinea pig papillary muscle revealed that except for pinacidil, the potassium channel openers shortened APD<sub>30</sub> in a concentration-dependent manner. They also evoked early or delayed afterdepolarizations at fast pacing rates. Patch-clamp recordings in guinea pig ventricular cardiomyocytes showed that the potassium channel openers enhanced the total outward currents during the early phase of action potential repolarization, especially at proarrhythmic concentrations. We concluded that the JT peak interval and the JT area are surrogate biomarkers identifying the risk of proarrhythmia associated with the administration of QT-shortening agents. The acceleration of early-phase repolarization and the increased dispersion of ventricular repolarization may contribute to the occurrence of arrhythmias. |
19,037 | Effect of compression waveform and resuscitation duration on blood flow and pressure in swine: One waveform does not optimally serve. | Chest compression (CC) research primarily focuses on finding the 'optimum' compression waveform using a variety of compression efficacy metrics. Blood flow is rarely measured systematically with high fidelity. Using a programmable mechanical chest compression device, we studied the effect of inter-compression pauses in a swine model of cardiac arrest, testing the hypothesis that a single 'optimal' CC waveform exists based on measurements of resulting blood flow.</AbstractText>Hemodynamics were studied in 9 domestic swine (∼30 kg) using multiple flow probes and standard physiological monitoring. After 10 min of ventricular fibrillation, five mechanical chest compression waveforms (5.1 cm, varying inter-compression pauses) were delivered for 2 min each in a semi-random pattern, totaling 50 compression minutes. Linear Mixed Models were used to estimate the effect of compression waveform on hemodynamics.</AbstractText>Blood flow and pressure decayed significantly with time in both arteries and veins. No waveform maximized blood flow in all vessels simultaneously and the waveform generating maximal blood flow in a specific vessel changed over time in all vessels. A flow mismatch between paired arteries and veins, e.g. abdominal aorta and inferior vena cava, also developed over time. The waveform with the slowest rate and shortest duty cycle had the smallest mismatch between flows after about 30 min of CPR.</AbstractText>This data challenges the concept of a single optimal CC waveform. Time dependent physiological response to compressions and no single compression waveform optimizing flow in all vessels indicate that current descriptions of CPR don't reflect patient physiology.</AbstractText>Copyright © 2018 Elsevier B.V. All rights reserved.</CopyrightInformation> |
19,038 | Cardiac Rhythm Disturbances in Hemodialysis Patients: Early Detection Using an Implantable Loop Recorder and Correlation With Biological and Dialysis Parameters. | The aim of this study was to identify using implantable loop recorder (ILR) monitoring the mechanisms leading to sudden death (SD) in patients undergoing hemodialysis (HD).</AbstractText>SD accounts for 11% to 25% of death in HD patients.</AbstractText>Continuous rhythm monitoring was performed using the remote monitoring capability of the ILR device in patients undergoing HD at 8 centers. Clinical, biological, and technical HD parameters were recorded and analyzed.</AbstractText>Seventy-one patients (mean age 65 ± 9 years, 73% men) were included. Left ventricular ejection fraction was <50% in 16%. Twelve patients (17%) had histories of atrial fibrillation or flutter at inclusion. During a mean follow-up period of 21.3 ± 6.9 months, 16 patients died (14% patient-years), 7 (44%) of cardiovascular causes. Four SDs occurred, with progressive bradycardia followed by asystole. The incidence of patients presenting with significant conduction disorder and with ventricular arrhythmia was 14% and 9% patient-years, respectively. In multivariate survival frailty analyses, a higher risk for conduction disorder was associated with plasma potassium >5.0 mmol/l, bicarbonate <22 mmol/l, hemoglobin >11.5 g/dl, pre-HD systolic blood pressure >140 mm Hg, the longer interdialytic period, history of coronary artery disease, previous other arrhythmias, and diabetes mellitus. A higher risk for ventricular arrhythmia was associated with potassium <4.0 mmol/l, no antiarrhythmic drugs, and previous other arrhythmias. With ILR monitoring, de novo atrial fibrillation or flutter was diagnosed in 14 patients (20%).</AbstractText>ILR may be considered in HD patients prone to significant conduction disorders, ventricular arrhythmia, or atrial fibrillation or flutter to allow early identification and initiation of adequate treatment. Therapeutic strategies reducing serum potassium variability could decrease the rate of SD in these patients. (Implantable Loop Recorder in Hemodialysis Patients [RYTHMODIAL]; NCT01252823).</AbstractText>Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,039 | Fuzzy and Sample Entropies as Predictors of Patient Survival Using Short Ventricular Fibrillation Recordings during out of Hospital Cardiac Arrest.<ELocationID EIdType="pii" ValidYN="Y">591</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.3390/e20080591</ELocationID><Abstract><AbstractText>Optimal defibrillation timing guided by ventricular fibrillation (VF) waveform analysis would contribute to improved survival of out-of-hospital cardiac arrest (OHCA) patients by minimizing myocardial damage caused by futile defibrillation shocks and minimizing interruptions to cardiopulmonary resuscitation. Recently, fuzzy entropy (FuzzyEn) tailored to jointly measure VF amplitude and regularity has been shown to be an efficient defibrillation success predictor. In this study, 734 shocks from 296 OHCA patients (50 survivors) were analyzed, and the embedding dimension (<i>m</i>) and matching tolerance (<i>r</i>) for FuzzyEn and sample entropy (SampEn) were adjusted to predict defibrillation success and patient survival. Entropies were significantly larger in successful shocks and in survivors, and when compared to the available methods, FuzzyEn presented the best prediction results, marginally outperforming SampEn. The sensitivity and specificity of FuzzyEn were 83.3% and 76.7% when predicting defibrillation success, and 83.7% and 73.5% for patient survival. Sensitivities and specificities were two points above those of the best available methods, and the prediction accuracy was kept even for VF intervals as short as 2s. These results suggest that FuzzyEn and SampEn may be promising tools for optimizing the defibrillation time and predicting patient survival in OHCA patients presenting VF.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chicote</LastName><ForeName>Beatriz</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Irusta</LastName><ForeName>Unai</ForeName><Initials>U</Initials><Identifier Source="ORCID">0000-0001-9521-1852</Identifier><AffiliationInfo><Affiliation>Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Aramendi</LastName><ForeName>Elisabete</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alcaraz</LastName><ForeName>Raúl</ForeName><Initials>R</Initials><Identifier Source="ORCID">0000-0002-0942-3638</Identifier><AffiliationInfo><Affiliation>Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha (UCLM), 16071 Cuenca, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rieta</LastName><ForeName>José Joaquín</ForeName><Initials>JJ</Initials><AffiliationInfo><Affiliation>BioMIT.org, Electronic Engineering Department, Universitat Politécnica de Valencia (UPV), 46022 Valencia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Isasi</LastName><ForeName>Iraia</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alonso</LastName><ForeName>Daniel</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Baqueriza</LastName><ForeName>María Del Mar</ForeName><Initials>MDM</Initials><AffiliationInfo><Affiliation>Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ibarguren</LastName><ForeName>Karlos</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>TEC2015-64678-R</GrantID><Agency>Ministerio de Economía y Competitividad</Agency><Country/></Grant><Grant><GrantID>DPI2017-83952-C3</GrantID><Agency>Ministerio de Economía, Industria y Competitividad, Gobierno de España</Agency><Country/></Grant><Grant><GrantID>PIF15/190</GrantID><Agency>Euskal Herriko Unibertsitatea</Agency><Country/></Grant><Grant><GrantID>GIU17/031</GrantID><Agency>Euskal Herriko Unibertsitatea</Agency><Country/></Grant><Grant><GrantID>PRE-2016-1-0012</GrantID><Agency>Eusko Jaurlaritza</Agency><Country/></Grant><Grant><GrantID>SBPLY/17/180501/000411</GrantID><Agency>Junta de Comunidades de Castilla-La Mancha</Agency><Country/></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>08</Month><Day>09</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Entropy (Basel)</MedlineTA><NlmUniqueID>101243874</NlmUniqueID><ISSNLinking>1099-4300</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">cardiopulmonary resuscitation</Keyword><Keyword MajorTopicYN="N">defibrillation</Keyword><Keyword MajorTopicYN="N">entropy measures</Keyword><Keyword MajorTopicYN="N">fuzzy entropy</Keyword><Keyword MajorTopicYN="N">out-of-hospital cardiac arrest</Keyword><Keyword MajorTopicYN="N">sample entropy</Keyword><Keyword MajorTopicYN="N">shock outcome prediction</Keyword><Keyword MajorTopicYN="N">ventricular fibrillation</Keyword></KeywordList><CoiStatement>The authors declare no conflict of interest.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2018</Year><Month>7</Month><Day>6</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2018</Year><Month>8</Month><Day>4</Day></PubMedPubDate><PubMedPubDate 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D Nonlinear Phenom. 2008;237:3069–3074.</Citation></Reference></ReferenceList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">30084758</PMID><DateRevised><Year>2019</Year><Month>11</Month><Day>20</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2146-8427</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2018</Year><Month>Aug</Month><Day>06</Day></PubDate></JournalIssue><Title>Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation</Title><ISOAbbreviation>Exp Clin Transplant</ISOAbbreviation></Journal>Assessment of Atrial Fibrillation and Ventricular Arrhythmia Risk After Transplant in Patients With End-Stage Renal Disease by P-wave/QT Interval Dispersion, T-Wave Peak-End Interval, and T-Wave Peak-End/QT Interval Ratio. | Optimal defibrillation timing guided by ventricular fibrillation (VF) waveform analysis would contribute to improved survival of out-of-hospital cardiac arrest (OHCA) patients by minimizing myocardial damage caused by futile defibrillation shocks and minimizing interruptions to cardiopulmonary resuscitation. Recently, fuzzy entropy (FuzzyEn) tailored to jointly measure VF amplitude and regularity has been shown to be an efficient defibrillation success predictor. In this study, 734 shocks from 296 OHCA patients (50 survivors) were analyzed, and the embedding dimension (<i>m</i>) and matching tolerance (<i>r</i>) for FuzzyEn and sample entropy (SampEn) were adjusted to predict defibrillation success and patient survival. Entropies were significantly larger in successful shocks and in survivors, and when compared to the available methods, FuzzyEn presented the best prediction results, marginally outperforming SampEn. The sensitivity and specificity of FuzzyEn were 83.3% and 76.7% when predicting defibrillation success, and 83.7% and 73.5% for patient survival. Sensitivities and specificities were two points above those of the best available methods, and the prediction accuracy was kept even for VF intervals as short as 2s. These results suggest that FuzzyEn and SampEn may be promising tools for optimizing the defibrillation time and predicting patient survival in OHCA patients presenting VF.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chicote</LastName><ForeName>Beatriz</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Irusta</LastName><ForeName>Unai</ForeName><Initials>U</Initials><Identifier Source="ORCID">0000-0001-9521-1852</Identifier><AffiliationInfo><Affiliation>Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Aramendi</LastName><ForeName>Elisabete</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alcaraz</LastName><ForeName>Raúl</ForeName><Initials>R</Initials><Identifier Source="ORCID">0000-0002-0942-3638</Identifier><AffiliationInfo><Affiliation>Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha (UCLM), 16071 Cuenca, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rieta</LastName><ForeName>José Joaquín</ForeName><Initials>JJ</Initials><AffiliationInfo><Affiliation>BioMIT.org, Electronic Engineering Department, Universitat Politécnica de Valencia (UPV), 46022 Valencia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Isasi</LastName><ForeName>Iraia</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alonso</LastName><ForeName>Daniel</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Baqueriza</LastName><ForeName>María Del Mar</ForeName><Initials>MDM</Initials><AffiliationInfo><Affiliation>Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ibarguren</LastName><ForeName>Karlos</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>TEC2015-64678-R</GrantID><Agency>Ministerio de Economía y Competitividad</Agency><Country/></Grant><Grant><GrantID>DPI2017-83952-C3</GrantID><Agency>Ministerio de Economía, Industria y Competitividad, Gobierno de España</Agency><Country/></Grant><Grant><GrantID>PIF15/190</GrantID><Agency>Euskal Herriko Unibertsitatea</Agency><Country/></Grant><Grant><GrantID>GIU17/031</GrantID><Agency>Euskal Herriko Unibertsitatea</Agency><Country/></Grant><Grant><GrantID>PRE-2016-1-0012</GrantID><Agency>Eusko Jaurlaritza</Agency><Country/></Grant><Grant><GrantID>SBPLY/17/180501/000411</GrantID><Agency>Junta de Comunidades de Castilla-La Mancha</Agency><Country/></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>08</Month><Day>09</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Entropy 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The aim of this study was to investigate whether kidney transplant has any effect on P-wave dispersion, a predictor of atrial fibrillation and corrected QT interval dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio, which are predictors of ventricular arrhythmias in patients with end-stage renal disease.<AbstractText Label="MATERIALS AND METHODS" NlmCategory="METHODS">In a retrospective study, 234 patients (125 kidney transplant and 109 healthy control patients) were examined. P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio values before and 3, 6, and 12 months after transplant were calculated and compared in transplant recipients. Baseline values of the control group were compared with 12-month values of kidney transplant patients.<AbstractText Label="RESULTS" NlmCategory="RESULTS">We observed a statistically significant decline in P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio values among the pretransplant and 3-, 6-, and 12-month posttransplant measurements (P < .001 for all comparisons). However, the values of these measurements in the transplant group at 12 months were significantly higher than baseline values of the control group (P < .001 for all comparisons).<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio were shown to be attenuated after transplant, although they remained higher than baseline measurements in healthy individuals. These results indirectly offer that there may be a reduction in risk of atrial fibrillation and ventricular arrhythmias after transplant. |
19,040 | [Relationship between levels of sex hormones and response to cardiac resynchronisation therapy in men]. | To study the relationship between levels of sex hormones and effectiveness of cardiac resynchronisation therapy (CRT) in men with chronic heart failure (CHF).</AbstractText>The best response to CRT (mean time, 38 [19,0;53,7] months) was identifed by a maximum decrease in left ventricular end-systolic volume (LVESV) in 58 men (mean age, 54.8±9.6) with CHF (61% IHD). Based on testosterone (TES) level, patients were divided into group 1 (n=28; 48%) - TES < median value (13.8 nmol/l) and group 2 (n=30; 52%) - TES > median value. Exercise tolerance (ET), echocardiography (EchoCG) parameters, plasma levels of NTproBNP, interleukin (IL) - 1β, IL-6, IL-10, tumor necrosis factor α (TNF-α), С-reactive peptide (CRP), galectin-3 (Gal-3), matrix metalloprotease-9 (ММР-9), tissue inhibitors of metalloproteinases TIMP-1, TIMP-4, and the indexes MMP-9/TIMP-1 and MMP-9/TIMP-4 were evaluated in dynamics. Levels of TES, progesterone (PGN), dehydroepiandrosterone sulphate (DHEAS), and estradiol (Е2) were measured at baseline. Based on LVESV changes, non-responders (LVESV decrease by 15% but 30%) were identifed.</AbstractText>In group 2, atrial fibrillation (р=0.064) and radiofrequency ablation of atrioventricular connection (р=0.014) were observed more frequently; incidence of diabetes mellitus was lower (р=0.017); QRS was smaller (р=0.001); ET was higher both at baseline (р=0.022) and in dynamics (р=0.018); numbers of responders and super-responders were greater (р=0.007); levels of PGN (р=0.028), Il-1β (р=0.020), IL-10 (р=0.013), TNF- α (р=0.006) were higher; and Е2/TES was lower (р=0.004). While EchoCG parameters did not differ at baseline, group 2 showed a tendency towards greater changes in LVESV (р=0.069) and LV end systolic dimension (р=0.087), and a greater increase in LV ejection fraction (р=0.007). In dynamics: In group 1, a decrease in NT-proBNP was observed (р=0.015); in group 2, decreases in IL-1β (р=0.001), IL-6 (р=0.015), IL-10 (р=0.001), TNF-α (р=0.001), TIMP-1 (р=0.046), and Gal-3 (р=0.051) were observed. Levels of sex hormones were correlated with EchoCG parameters, biomarkers of immune inflammation, fibrosis, and NTproBNP. The ROC analysis showed that a TES level not lower than 13.8 nmol/l was a predictor for a positive response to CRT with a sensitivity of 63.4% and specifcity of 76.5% (AUC=0.687; р=0.026).</AbstractText>High levels of TES and PGN were associated with beter effectivity of CRT, higher ET, greater proportions of responders and super-responders, and reduced immune inflammation activity and fibrosis. A level of TES not lower than 13.8 nmol/l was a predictor for a positive response to CRT.</AbstractText> |
19,041 | Effect of transcatheter aortic valve replacement on left atrial function. | To investigate the effect of transcatheter aortic valve replacement on left atrial volumetric function and left atrial volume for the prediction of adverse outcomes.</AbstractText>This is a retrospective analysis of 121 patients in sinus rhythm who underwent TAVR for severe AS. Maximum LA volume index (LAVI max), minimum LA volume index (LAVI min), and "pre-A" volume index (LAVIpre-A, the volume before atrial contraction) were measured by biplane Simpson's method at baseline, 1 month, and 1 year. The reservoir function, conduit function, booster pump function were calculated. All patients were followed for new-onset of atrial fibrillation, hospitalization and all-cause mortality.</AbstractText>The reservoir function, conduit function and booster function before TAVR were 46%, 21%, 32%, respectively. LA volumetric function assessment demonstrated that reservoir function, conduit function increased over the time (all P < 0.01). There was no difference in booster function after TAVR (P = 0.18). Baseline markedly enlarged LA was significantly increased for AF (HR: 4.72; 95% CI, 1.11-20.13, P = 0.04). In addition, There was a progressive decrease in LAVI max (P = 0.02) and RVSP (P = 0.03) over the time in non-AF group but not in AF group (P = 0.62 and P = 0.65, respectively). Although, the proportion of high left ventricular filling pressure decreased in both groups but a marked decrease was noted in non AF group in compared with AF group.</AbstractText>Reservoir function, conduit function increased over time. Lack of negative LA remodeling post TAVR was associated with higher incidence of AF.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,042 | Efficacy of pentamidine analogue 6 in dogs with chronic atrial fibrillation. | The inward rectifier inhibitor pentamidine analogue 6 (PA-6) is effective in cardioversion of goats with persistent rapid pacing induced atrial fibrillation (AF) and is not proarrhythmic in dogs with experimental chronic 3rd-degree AV block. Efficacy and safety in the clinical setting are unknown.</AbstractText>That PA-6 would be effective in converting AF to sinus rhythm (SR) in dogs with naturally occurring AF, without the presence of overt adverse effects.</AbstractText>Ten client-owned large and giant breed dogs.</AbstractText>Animals with persistent or permanent AF were recruited for our prospective study. PA-6 was administered IV as a bolus of 2.5 mg/kg 10 min-1</sup> followed by a maintenance infusion of 0.04 mg/kg min-1</sup> for a maximum of 50 minutes in conscious dogs. Standard 6 lead limb ECG was recorded during the infusion. Visible and audible signs of adverse effects were scored during the entire procedure.</AbstractText>PA-6 did not induce changes in QRS duration (54.7 ± 4.6 versus 56.7 ± 6.1 ms, P = .42), QTc interval (241.1 ± 19.5 versus 258.7 ± 19.8 ms, P = .061) or RR interval (363.4 ± 84.6 versus 440.8 ± 96.3 ms, P = .072) at the end of the bolus. No cardioversion to SR was observed in any dog. Three dogs displayed no adverse effects. Five dogs had premature ventricular depolarizations during PA-6 infusion on the ECG. Respiratory distress with laryngeal stridor, subtle muscle twitching, and mild generalized muscular weakness were noncardiac adverse effects observed in 5 dogs. Adverse effects resolved spontaneously.</AbstractText>Chronic naturally occurring AF in large and giant breed dogs could not be cardioverted to SR by PA-6.</AbstractText>© 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.</CopyrightInformation> |
19,043 | Beta-Blockers and ACE Inhibitors Are Associated with Improved Survival Secondary to Ventricular Tachyarrhythmia. | The study sought to assess the impact of treatment with beta-blocker (BB) or ACE inhibitor/angiotensin receptor blocker (ACEi/ARB) on secondary survival in patients presenting with ventricular tachyarrhythmia.</AbstractText>Data regarding outcome of patients presenting with ventricular tachyarrhythmia treated with BB and ACEi/ARB is limited.</AbstractText>A large retrospective registry was used including consecutive patients presenting with ventricular tachycardia and fibrillation from 2002 to 2016 on admission. Applying propensity-score matching for harmonization, the impact of "BB" and "ACEi/ARB" was comparatively evaluated. The primary prognostic outcome was long-term all-cause death at 3 years.</AbstractText>A total of 972 matched patients were included. Both patients with BB (long-term mortality rate 18 versus 27%; log rank p = 0.041; HR = 0.661; 95% CI = 0.443-0.986; p = 0.043) and with ACEi/ARB (long-term mortality rate 13 versus 23%; log rank p = 0.004; HR = 0.544; 95% CI = 0.359-0.824; p = 0.004) revealed better secondary survival compared to patients without after presenting with ventricular tachyarrhythmia on admission. The prognostic benefit of BB was comparable to ACEi/ARB (long-term mortality rate 21 versus 26%; log rank p = 0.539).</AbstractText>BB and ACEi/ARB were associated with improved secondary survival in patients surviving ventricular tachyarrhythmia on admission.</AbstractText>ClinicalTrials.gov identifier: NCT02982473.</AbstractText> |
19,044 | Association of Transthoracic Echocardiography Findings and Long-Term Outcomes in Patients Undergoing Workup of Stroke. | Transthoracic echocardiography (TTE) has become routine as part of initial stroke workup to assess for sources of emboli. Few studies have looked at other TTE findings such as ejection fraction, wall motion abnormalities, valve disease, pulmonary hypertension and left ventricular hypertrophy and their association with various subtypes of stroke, long-term outcomes of recurrent stroke, and all-cause mortality.</AbstractText>Computed tomography and magnetic resonance imaging brain imaging and TTE reports were reviewed for 2464 consecutive patients referred for TTE as part of a workup for acute stroke between 1/1/01 and 9/30/07. Study patients were 67 ± 15years, 60% female, 75% minorities and had hypertension (76%), diabetes (41%), chronic kidney disease (27%) and atrial fibrillation (18%). On TTE, a mass, thrombus, or vegetation was identified in only 4 cases (0.2%), whereas a clinically significant abnormality (ejection fraction < 50%, left ventricle or right ventricle wall motion abnormalities, severe valve disease, pulmonary hypertension, or left ventricular hypertrophy) was identified in 16%. Those with an abnormal TTE had increased risk for death at 10years (hazard ratio [HR] 1.8; 95% confidence interval [CI]: 1.6, 2.0; P < .01), although risk for readmission with stroke was not increased. Abnormal TTE remained associated with increased risk of death at 10years after adjustment for age, sex, race, and cardiovascular risk factors (HR 1.4; 95% CI: 1.2, 1.7; P < .01).</AbstractText>TTE performed as part of an initial workup for stroke had minimal yield for identifying sources of embolism. Clinically important abnormalities found on TTE were independently associated with increased long-term mortality, but not recurrent stroke.</AbstractText>Copyright © 2018. Published by Elsevier Inc.</CopyrightInformation> |
19,045 | Prognostic Implication of Electrocardiographic Left Ventricular Strain in Patients Who Underwent Transcatheter Aortic Valve Implantation. | Electrocardiographic (ECG) strain has been linked to excess cardiovascular morbidity and mortality in asymptomatic patients with aortic stenosis. We aim to determine the differential impact of baseline ECG-strain on long-term mortality after transcatheter aortic valve implantation (TAVI). Patients who underwent TAVI from January 2012 to March 2016 at Mayo Clinic were included. Left ventricular (LV) strain was defined as the presence of ≥1mm convex ST-segment depression with asymmetrical T-wave inversion in leads V5 to V6 on baseline ECG. Primary end point was all-cause long-term mortality. Of the 520 patients screened, 130 were excluded due to left bundle branch block or paced rhythm. Median follow-up was 1.5 years, IQR (0.9 to 2.7). In the 390 included patients, 47 (12%) had strain pattern on pre-TAVI ECG. Patients in the strain group had higher prevalence of peripheral vascular disease (83% vs 68%, p = 0.04), and atrial fibrillation/flutter (51% vs 37%, p = 0.06). They also had lower mean LV-ejection fraction (51 ± 16% vs 58±12%, p = 0.003, larger LV-internal diameter in systole (3.71 ± 1.04cm vs 3.26 ± 0.75 cm), higher LV-mass-index (136 ± 44 vs 121 ± 29 g/m<sup>2</sup>; p = 0.044), and higher estimated pulmonary artery systolic pressure (50 ± 13 vs 43 ± 15mm Hg; p = 0.02). Kaplan-Meier survival analysis showed a cumulative probability of survival at 3 years of 35.4% ± 8% in patients with LV-strain compared with 67% ± 3.4% in patients without LV-strain (log-rank p <0.001). In a multivariate logistic regression analysis, ECG-strain was an independent predictor of long-term mortality (Hazard ratio 2.67, 95% CI [1.72 to 4.05]; p <0.001). In conclusion, ECG strain is an independent predictor of long-term mortality post TAVI. Systematic strain measurements might aid in risk-stratifying patients who underwent TAVI. |
19,046 | Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillators: The RAID Trial. | Ventricular tachycardia (VT) and ventricular fibrillation (VF) remain a challenging problem in patients with implantable cardioverter-defibrillators (ICDs).</AbstractText>This study aimed to determine whether ranolazine administration decreases the likelihood of VT, VF, or death in patients with an ICD.</AbstractText>This was double-blind, placebo-controlled clinical trial in which high-risk ICD patients with ischemic or nonischemic cardiomyopathy were randomized to 1,000 mg ranolazine twice a day or placebo. The primary endpoint was VT or VF requiring appropriate ICD therapy or death, whichever occurred first. Pre-specified secondary endpoints included ICD shock for VT, VF, or death and recurrent VT or VF requiring ICD therapy.</AbstractText>Among 1,012 ICD patients (510 randomized to ranolazine and 502 to placebo) the mean age was 64 ± 10 years and 18% were women. During 28 ± 16 months of follow-up there were 372 (37%) patients with primary endpoint, 270 (27%) patients with VT or VF, and 148 (15%) deaths. The blinded study drug was discontinued in 199 (39.6%) patients receiving placebo and in 253 (49.6%) patients receiving ranolazine (p = 0.001). The hazard ratio for ranolazine versus placebo was 0.84 (95% confidence interval: 0.67 to 1.05; p = 0.117) for VT, VF, or death. In a pre-specified secondary analysis, patients randomized to ranolazine had a marginally significant lower risk of ICD therapies for recurrent VT or VF (hazard ratio: 0.70; 95% confidence interval: 0.51 to 0.96; p = 0.028). There were no other significant treatment effects in other pre-specified secondary analyses, which included individual components of the primary endpoint, inappropriate shocks, cardiac hospitalizations, and quality of life.</AbstractText>In high-risk ICD patients, treatment with ranolazine did not significantly reduce the incidence of the first VT or VF, or death. However, the study was underpowered to detect a difference in the primary endpoint. In prespecified secondary endpoint analyses, ranolazine administration was associated with a significant reduction in recurrent VT or VF requiring ICD therapy without evidence for increased mortality. (Ranolazine Implantable Cardioverter-Defibrillator Trial [RAID]; NCT01215253).</AbstractText>Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,047 | Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery. | Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health-care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta-analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF.</AbstractText>A systematic search of PubMed, MEDLINE, and EMBASE databases was performed.</AbstractText>Twenty-four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta-analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non-POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47-0.63), left atrial diameter (0.45: 0.15-0.75), and left ventricular ejection fraction (0.30: 0.14-0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31-1.96), chronic obstructive pulmonary disease (1.36: 1.13-1.64), hypertension (1.29: 1.12-1.48), and myocardial infarction (1.18: 1.05-1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00-1.13).</AbstractText>The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.</AbstractText>Georg Thieme Verlag KG Stuttgart · New York.</CopyrightInformation> |
19,048 | Opioids and Cardiac Arrhythmia: A Literature Review. | One of the most important side effects of opioids is their influence on the electrical activity of the heart. This review focusses on the effects of opioids on QT interval prolongation and their arrhythmogenic liability.</AbstractText>By using various keywords, papers published up to 2018 in different databases were searched and identified. The search terms were opioids names, corrected QT interval, human-ether-a-go-go gene, torsades de pointes (TdP), cardiac arrhythmias, opioid dependence and other relevant terms. It emphasized the effects of each opioid agent alone on electrocardiogram (ECG) and some interactions.</AbstractText>Available data indicate that some opioids such as methadone are high-risk even at low doses, and have potential for prolongation of the QT interval and development of TdP, a dangerous ventricular tachycardia. A number of opioids such as tramadol and oxycodone are intermediate risk drugs and may develop long QT interval and TdP in high doses. Some other opioids such as morphine and buprenorphine are low-risk drugs and do not produce QT interval prolongation and TdP at least in routine doses. Opium-consumers are at higher risk of supra-ventricular arrhythmias, sinus bradycardia, cardiac block and atrial fibrillation.</AbstractText>The cardiac arrhythmogenicity of various opioids is different. Methadone has a higher capability to induce long QT interval and dangerous arrhythmias in conventional doses than others. To reduce of arrhythmogenic risk, high doses of opioids must be used cautiously with periodic monitoring of ECG in high-risk consumers such as patients under opioid maintenance treatment.</AbstractText>©2018 The Author(s) Published by S. Karger AG, Basel.</CopyrightInformation> |
19,049 | Epicardial fat in heart failure patients with mid-range and preserved ejection fraction. | Adipose tissue and inflammation may play a role in the pathophysiology of patients with heart failure (HF) with mildly reduced or preserved ejection fraction. We therefore investigated epicardial fat in patients with HF with preserved (HFpEF) and mid-range ejection fraction (HFmrEF), and related this to co-morbidities, plasma biomarkers and cardiac structure.</AbstractText>A total of 64 HF patients with left ventricular ejection fraction >40% and 20 controls underwent routine cardiac magnetic resonance examination. Epicardial fat volume was quantified on short-axis cine stacks covering the entire epicardium and was related to clinical correlates, biomarkers associated with inflammation and myocardial injury, and cardiac function and contractility on cardiac magnetic resonance. HF patients and controls were of comparable age, sex and body mass index. Total epicardial fat volume was significantly higher in HF patients compared to controls (107 mL/m2</sup> vs. 77 mL/m2</sup> , P <0.0001). HF patients with atrial fibrillation and/or type 2 diabetes mellitus had more epicardial fat than HF patients without these co-morbidities (116 vs. 100 mL/m2</sup> , P =0.03, and 120 vs. 97 mL/m2</sup> , P =0.001, respectively). Creatine kinase-MB, troponin T and glycated haemoglobin in patients with HF were positively correlated with epicardial fat volume (R =0.37, P =0.006; R =0.35, P =0.01; and R =0.42, P =0.002, respectively).</AbstractText>Heart failure patients had more epicardial fat compared to controls, despite similar body mass index. Epicardial fat volume was associated with the presence of atrial fibrillation and type 2 diabetes mellitus and with biomarkers related to myocardial injury. The clinical implications of these findings are unclear, but warrant further investigation.</AbstractText>© 2018 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.</CopyrightInformation> |
19,050 | National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018. | Heart failure (HF) is a clinical syndrome that is secondary to an abnormality of cardiac structure or function. These clinical practice guidelines focus on the diagnosis and management of HF with recommendations that have been graded on the strength of evidence and the likely absolute benefit versus harm. Additional considerations are presented as practice points. Main recommendations: Blood pressure and lipid lowering decrease the risk of developing HF. Sodium-glucose cotransporter 2 inhibitors decrease the risk of HF hospitalisation in patients with type 2 diabetes and cardiovascular disease. An echocardiogram is recommended if HF is suspected or newly diagnosed. If an echocardiogram cannot be arranged in a timely fashion, measurement of plasma B-type natriuretic peptides improves diagnostic accuracy. Angiotensin-converting enzyme inhibitors, β-blockers and mineralocorticoid receptor antagonists improve outcomes in patients with HF associated with a reduced left ventricular ejection fraction. Additional treatment options in selected patients with persistent HF associated with reduced left ventricular ejection fraction include switching the angiotensin-converting enzyme inhibitor to an angiotensin receptor neprilysin inhibitor; ivabradine; implantable cardioverter defibrillators; cardiac resynchronisation therapy; and atrial fibrillation ablation. Multidisciplinary HF disease management facilitates the implementation of evidence-based HF therapies. Clinicians should also consider models of care that optimise medication titration (eg, nurse-led titration). Changes in management as a result of the guideline: These guidelines have been designed to facilitate the systematic integration of recommendations into HF care. This should include ongoing audit and feedback systems integrated into work practices in order to improve the quality of care and outcomes of patients with HF. |
19,051 | Galectin-3 level predicts response to ablation and outcomes in patients with persistent atrial fibrillation and systolic heart failure. | Mechanisms of maintenance of both atrial fibrillation and structural left ventricular disease are known to include fibrosis. Galectin-3, a biomarker of fibrosis, is elevated both in patients with heart failure and persistent atrial fibrillation. We sought to find whether galectin-3 has a prognostic value in patients with heart failure and a reduced left ventricular ejection fraction undergoing ablation of persistent atrial fibrillation.</AbstractText>Serum concentrations of galectin-3 were determined in a consecutive series of patients with an ejection fraction ≤40%, addressed for ablation of persistent atrial fibrillation. Responders to ablation were patients in sinus rhythm and with an ejection fraction ≥50% at 6 months. A combined endpoint of heart failure hospitalization, transplantation and/or death was used at 12 months.</AbstractText>Seventy-five patients were included (81% male, age 63±10 years, ejection fraction 34±7%, galectin-3 21±12 ng/mL). During follow-up, eight patients were hospitalized for decompensated heart failure, 1 underwent heart transplantation, and 4 died; 50 patients were considered as responders to ablation. After adjustment, galectin-3 level independently predicted both 6-month absence of response to ablation (OR = 0.89 per unit increase, p = 0.002). Patients with galectin-3 levels <26 had a 95% 1-year event-free survival versus 46% in patients with galectin-3 ≥26 ng/mL (p<0.0001).</AbstractText>Galectin-3 levels independently predict outcomes in patients with reduced left ventricular systolic function addressed for ablation of persistent AF, and may be of interest in defining the therapeutic strategy in this population.</AbstractText> |
19,052 | Pacing Mediated Heart Rate Acceleration Improves Catheter Stability and Enhances Markers for Lesion Delivery in Human Atria During Atrial Fibrillation Ablation. | This study sought to investigate the effect of pacing mediated heart rate modulation on catheter-tissue contact and impedance reduction during radiofrequency ablation in human atria during atrial fibrillation (AF) ablation.</AbstractText>In AF ablation, improved catheter-tissue contact enhances lesion quality and acute pulmonary vein isolation rates. Previous studies demonstrate that catheter-tissue contact varies with ventricular contraction. The authors investigated the impact of modulating heart rate on the consistency of catheter-tissue contact and its effect on lesion quality.</AbstractText>Twenty patients undergoing paroxysmal AF ablation received ablation lesions at 15 pre-specified locations (12 left atria, 3 right atria). Patients were assigned randomly to undergo rapid atrial pacing for either the first half or the second half of each lesion. Contact force and ablation data with and without pacing were compared for each of the 300 ablation lesions.</AbstractText>Compared with lesion delivery without pacing, pacing resulted in reduced contact force variability, as measured by contact force SD, range, maximum, minimum, and time within the pre-specified goal contact force range (p < 0.05). There was no difference in the mean contact force or force-time integral. Reduced contact force variability was associated with a 30% greater decrease in tissue impedance during ablation (p < 0.001).</AbstractText>Pacing induced heart rate acceleration reduces catheter-tissue contact variability, increases the probability of achieving pre-specified catheter-tissue contact endpoints, and enhances impedance reduction during ablation. Modulating heart rate to improve catheter-tissue contact offers a new approach to optimize lesion quality in AF ablation. (The Physiological Effects of Pacing on Catheter Ablation Procedures to Treat Atrial Fibrillation [PEP AF]; NCT02766712).</AbstractText>Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,053 | Clinical Outcomes and Modes of Death in Timothy Syndrome: A Multicenter International Study of a Rare Disorder. | The objective of this study was to evaluate contemporary clinical outcomes and identify triggers for arrhythmias or sudden death in an international cohort of Timothy Syndrome (TS) patients including those with novel TS-associated CACNA1C mutations.</AbstractText>TS is an extremely rare genetic disorder of the L-type cardiac channel Cav</sub>1.2 encoded by CACNA1C. The syndrome is characterized by multisystem abnormalities consisting of QT prolongation, congenital heart defects, syndactyly, facial dysmorphism, and neurological symptoms.</AbstractText>Patients diagnosed with TS between January 1, 1994, and April 1, 2016, from 12 international tertiary care pediatric centers were included in this retrospective study. Data were gathered via survey from the patients' electrophysiologists.</AbstractText>Seventeen patients diagnosed with TS were identified. Length of follow-up was 4.9 years (range 3.0 to 19.0 years). Mean QTc was 640 ms (range 500 to 976 ms). All patients were treated with beta-blockers; 13 patients (76%) were also treated with an implantable defibrillator. Eleven patients experienced an episode of aborted cardiac arrest, 6 associated with general anesthesia and 2 with hypoglycemia. Four patients died suddenly due to ventricular fibrillation, 2 of whom had associated hypoglycemia.</AbstractText>This study shows that mortality in TS patients is due to multifactorial mechanisms, which include ventricular arrhythmias, pulseless electrical activity, and hypoglycemia. A simple nomenclature for ongoing studies of TS and related syndromes is described. A worldwide prospective registry is needed for continued exploration of this syndrome.</AbstractText>Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,054 | Transcatheter closure of atrial septal communication: impact on P-wave dispersion, duration, and arrhythmia in mid-term follow-up. | Atrial septal communications (ASCs) include atrial septal defects (ASDs) and patent foramen ovale (PFO).</AbstractText>The purpose of this study was to assess P-wave dispersion (PWD) and the prevalence of arrhythmia in patients before and after ASC closure.</AbstractText>We analysed the clinical history and performed 12-lead electrocardiograms, echocardiograms, and 24-h Holter electrocardiograms in patients with ASC, before and six months after ASC closure.</AbstractText>We included patients with ASD (n = 56) and PFO (n = 73). PWD before percutaneous ASC closure was predicted by right ventricular outflow tract (RVOT) proximal diameter, left atrial area, ASD, smoking, and paroxysmal dyspnoea, R2 = 0.67; p < 0.001. RVOT proximal diameter was an independent predictor of PWD, both in patients with ASD and PFO. Six months after successful closure of ASC, a reduction in PWD was observed in the whole group of patients as well as in patients with ASD and PFO considered separately. A decrease in PWD was associated with reduction of maximum P-wave duration. At the same time, in the whole group, we noticed a reduction in the number of supraventricular and ventricular extrasystolic beats and fewer atrial fibrillation (AF) episodes, p < 0.04 for all variables. Postprocedural AF episodes in patients with ASD were predicted by PWD of 80 ms.</AbstractText>Percutaneous closure of ASC is associated with a reduction of PWD and fewer arrhythmia episodes six months after the procedure. PWD predicts AF episodes after ASD closure.</AbstractText> |
19,055 | Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. | To evaluate whether catheter ablation is superior to conventional therapy for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF).</AbstractText>Electronic databases were searched for randomized, controlled trials of AF ablation compared with conventional therapy in adults with AF and HFrEF. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method.</AbstractText>There were seven trials including 856 patients (mean age 62 years, male 86%). All-cause mortality in patients who underwent ablation was 10% vs. 19% in those who received conventional treatment (four trials, 668 patients, 47% relative reduction, 9% absolute reduction; OR 0.46, 95% CI 0.29-0.72). Improvement in the left ventricular ejection fraction was significantly higher for patients undergoing ablation (+ 9 ± 10%) compared to conventional treatment (+ 2 ± 7%) (seven trials, 856 patients, SMD 0.68, 95% CI 0.28-1.08). Freedom from AF was higher in patients undergoing ablation (seven trials, 856 patients, 70% vs. 18%, respectively; 64% relative reduction, 52% absolute reduction; OR 0.03 95% CI 0.01-0.11). There was no significant difference in major complications between both strategies (OR 1.13, 95% CI 0.58-2.20).</AbstractText>Catheter ablation for AF in patients with HFrEF decreases mortality and AF recurrence and improves left ventricular function, functional capacity, and quality of life, when compared to conventional management, without increasing complications.</AbstractText> |
19,056 | The role of the Purkinje network in premature ventricular complex-triggered ventricular fibrillation. | The Purkinje network (PN) is the distal part of the ventricular conduction system, which has shown to play a central role in the pathophysiology of ventricular fibrillation (VF). Abnormal automaticity and triggered activity are commonly seen in the PN, and the resulting premature ventricular complexes (PVCs) are frequently recognized as triggers of this life-threatening arrhythmia. Catheter ablation targeting PN-related PVCs can be successfully performed in patients with medically refractory VF in a variety of arrhythmic substrates. |
19,057 | Clinical Use of Digitalis: A State of the Art Review. | The history of digitalis is rich and interesting, with the first use usually attributed to William Withering and his study on the foxglove published in 1785. However, some knowledge of plants with digitalis-like effects used for congestive heart failure (CHF) was in evidence as early as Roman times. The active components of the foxglove (Digitalis purpurea and Digitalis lanata) are classified as cardiac glycosides or cardiotonic steroids and include the well-known digitalis leaf, digitoxin, and digoxin; ouabain is a rapid-acting glycoside usually obtained from Strophanthus gratus. These drugs are potent inhibitors of cellular membrane sodium-potassium adenosine triphosphatase (Na<sup>+</sup>/K<sup>+</sup>-ATPase). For most of the twentieth century, digitalis and its derivatives, especially digoxin, were the available standard of care for CHF. However, as the century closed, many doubts, especially regarding safety, were raised about their use as other treatments for CHF, such as decreasing the preload of the left ventricle, were developed. Careful attention is needed to maintain the serum digoxin level at ≤ 1.0 ng/ml because of the very narrow therapeutic window of the medication. Evidence for benefit exists for CHF with reduced ejection fraction (EF), also referred to as heart failure with reduced EF (HFrEF), especially when considering the combination of mortality, morbidity, and decreased hospitalizations. However, the major support for using digoxin is in atrial fibrillation (AF) with a rapid ventricular response when a rate control approach is planned. The strongest support of all for digoxin is for its use in rate control in AF in the presence of a marginal blood pressure, since all other rate control medications contribute to additional hypotension. In summary, these days, digoxin appears to be of most use in HFrEF and in AF with rapid ventricular response for rate control, especially when associated with hypotension. The valuable history of the foxglove continues; it has been modified but not relegated to the garden or the medical history book, as some would advocate. |
19,058 | Coronary Artery Dominance May Predict Future Risk of Atrial Fibrillation. | Ischemia of the atria and conductive system of the heart results in greater atrial electrophysiological changes and propensity for atrial fibrillation. P wave duration and dispersion have been proposed to be useful for the prediction of paroxysmal atrial fibrillation (PAF). This study aimed to investigate the effect of coronary artery dominance on P wave duration and dispersion.</AbstractText>The study population included 194 patients with left dominant circulation (LDC) and 200 age- and gender-matched controls with right dominant circulation (RDC) and without coronary artery disease based on invasive coronary angiography findings. P wave dispersion (PWD) was defined as the difference between the maximum and minimum P wave duration. Arrhythmias were identified by 24-hour Holter electrocardiogram at 3 years of follow-up.</AbstractText>PWD was significantly prolonged in the patients with LDC compared to the controls with RDC (p = 0.001). There were positive correlations between PWD and age (r: 0.502, p = 0.009), left ventricular mass (LVM) (r: 0.614, p = 0.001), LVM index (r: 0.727, p < 0.001) and left atrium (LA) diameter (r: 0.558, p = 0.003) in the LDC group. Multivariate logistic regression analysis showed that age, LVM index, LA diameter and LDC were independent predictors of prolonged PWD. At 3 years of follow-up, 7 (3.9%) patients with LDC and 1 (0.5%) patient with RDC had PAF in Holter electrocardiogram (p < 0.001).</AbstractText>LDC could lead to an increased risk of atrial fibrillation through prolonged PWD. We recommend following up these patients to assess the development of atrial fibrillation.</AbstractText> |
19,059 | Simple risk model and score for predicting of incident atrial fibrillation in Japanese. | Investigating regarding a predicted risk score of incident atrial fibrillation (AF) for an Asian general population has not been enough. Whether addition of electrocardiogram (ECG) variables to risk factors improves prediction of incident AF is unclear in a context that ECGs are extensively used at medical check-ups and outpatient clinics in Japan.</AbstractText>Participants undergoing periodic health check-ups during 2008-2014 followed-up by December 2015 including 96,841 (65.1% male) aged 40-79 years were pooled to derive prediction models and risk scores for incident AF. Multivariable Cox regression identified clinical risk factors associated with incident AF in 7 years among 65,984 eligible participants including 349 AF cases.</AbstractText>A 7-year prediction model ("Simple-model") including the variables of age, waist circumference, diastolic blood pressure, alcohol consumption, heart rate, and cardiac murmur, had good discrimination (C-statistic, 0.77), requiring no blood sampling. Addition model of the ECGs variables ("Added-model") including left ventricular hypertrophy, atrial enlargement, atrial premature contraction, and ventricular premature contraction, improved significantly the overall model discrimination (C-statistic, 0.78; categorical net reclassification improvement, 0.063; 95%CI, 0.031-0.099). The risk scores derived from the two models respectively showed an approximation of the observed and predicted probability for each score. Participants with score ≤4 or ≥9 points had, respectively, ≤1% and ≥5% predicted probability of incident AF in 7 years. The receiver-operating characteristics curve for the risk score of the added-model was significantly higher than the simple-model (0.769 vs 0.753, p<0.001). Atrial enlargement on ECG and the highest age group were the highest risk points of the significant predictors.</AbstractText>We developed 7-year risk scores for incident AF using usually available clinical factors including ECGs in primary care. These risk scores could identify individuals with high risk of incident AF at health check-up and outpatient clinics.</AbstractText>Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation> |
19,060 | Indications for and outcome in patients with the wearable cardioverter-defibrillator in a nurse-based training programme: results of the Austrian WCD Registry. | The wearable cardioverter-defibrillator is a treatment option for patients at temporarily high risk of sudden cardiac death or in whom implantation of a cardioverter-defibrillator is temporarily not possible.</AbstractText>The aim of this study was to provide real-world data on patients receiving this therapy in a nurse-based wearable cardioverter-defibrillator training programme.</AbstractText>A registry including all patients prescribed with a wearable cardioverter-defibrillator in Austria between 2010 and 2016. Overall, 448 patients received a wearable cardioverter-defibrillator in 48 centres. Patients received structured nurse-based wearable cardioverter-defibrillator educational initial training followed by remote monitoring.</AbstractText>Main indications were: severe non-ischaemic cardiomyopathy (21%); recent myocardial infarction and percutaneous coronary intervention (20%); and stable coronary artery disease with percutaneous coronary intervention/coronary artery bypass grafting (14%). Eleven patients (2.5%) received 22 appropriate wearable cardioverter-defibrillator shocks. Two patients (0.4%) received three inappropriate shocks. The risk of sudden cardiac death varied between different aetiologies. Eight out of 11 (73%) patients received their first wearable cardioverter-defibrillator shock within 30 days. The main reasons for termination of the wearable cardioverter-defibrillator therapy were implantable cardioverter-defibrillator implantation (55.5%) and improvement of left ventricular ejection fraction to more than 35% (33%).</AbstractText>The wearable cardioverter-defibrillator is an effective and safe treatment option in patients at either transiently elevated risk of ventricular tachycardia/ventricular fibrillation or mandated postponed implantable cardioverter-defibrillator implantation, with a 2.5% shock rate over a median 54 days wearable cardioverter-defibrillator treatment period. However, both the wearable cardioverter-defibrillator shock rate and implantable cardioverter-defibrillator implantation rate vary widely depending on the wearable cardioverter-defibrillator indication. Nurse-based wearable cardioverter-defibrillator training is associated with high patient adherence, with a median wearing duration per day of 23.5 (1-24) hours.</AbstractText> |
19,061 | Tetralogy of Fallot - Clinical Course and Treatment as a Mirror of Contemporary Cardiology/Cardiac Surgery Development in Correction of Congenital Heart Disease in the Adults. | The aim of this paper was to present a 65 year old female patient with chronic heart disease, surgically treated for congenital heart defect type Tetralogy of Fallot.</AbstractText>In the sixth year of life the patient underwent palliative Potts anastomosis surgery which created an anastomosis between the left pulmonary artery and the descending aorta. Total correction was made in 34 years of life, six months after catheterization, which indicated malignant pulmonary hypertension. She is regularly followed up by the cardiologists and receives daily therapy. The present state of the patient is satisfactory with cardiomegaly, light left ventricular dysfunction, moderate mitral and tricuspid regurgitation, pulmonary arterial hypertension, and aneurysmatic dilatation of left pulmonary artery as well as atrial fibrillation.</AbstractText>The intense development of cardiology and cardiac surgery in the USA in children and adults over the last fifty years has led to the extension and improvement of the quality of life.</AbstractText> |
19,062 | Takotsubo as Initial Manifestation of Non-Myopathic Cardiomyopathy Due to the Titin Variant c.1489G > T. | Background</b>: Whether patients with subclinical cardiomyopathy (CMP) are more prone to experience Takotsubo syndrome (TTS) than patients without CMP, is unknown. We present a patient with TTS as the initial manifestation of a hitherto unrecognized genetic CMP. Method</b>: case report. Results</b>: At age 55 after the unexpected death of her father, a now 61-year-old female had developed precordial pressure. Work-up revealed moderately reduced systolic function, dyskinesia of the interventricular septum, and indications for a TTS. Coronary angiography was normal but ventriculography showed TTS. Cardiac MRI confirmed reduced systolic function and TTS. TTS resolved without treatment and sequelae. At age 57 atrial fibrillation was recorded. After deterioration of systolic function at age 59 dilated CMP was diagnosed. Despite application of levosimendan, sacubitril, valsartan, and ivabradine, complete remission could not be achieved. Upon genetic work-up by means of a gene panel, the heterozygous mutation c.1489G > T (p. E497X) in exon 9 of the titin</i> gene was detected and made responsible for the phenotype. Neurological work-up precluded involvement of the skeletal muscles. The further course was complicated by ventricular arrhythmias, requiring implantation of an implantable cardioverter defibrillator (ICD).</AbstractText>previously subclinical CMP may initially manifest as TTS. Since patients with titin CMP are at risk of developing ventricular arrhythmias and thus to experience sudden cardiac death, appropriate anti-arrhythmic therapy needs to be established.</AbstractText> |
19,063 | Direct Comparison of Severity Grading Assessed by Two-Dimensional, Three-Dimensional, and Doppler Echocardiography for Predicting Prognosis in Asymptomatic Aortic Stenosis. | Reliable assessment of aortic stenosis (AS) severity relies on stroke volume (SV) determination using Doppler echocardiography, but it can also be estimated with two-dimensional/three dimensional echocardiography (2DE/3DE). The aim of this study was to compare SV measurements and AS subgroup classifications among the three modalities and determine their prognostic strength in asymptomatic AS.</AbstractText>We prospectively enrolled 359 patients with asymptomatic AS. SV was determined using three methods, and the patients were divided into four AS subgroups according to indexed aortic valve area (iAVA) and SV index (SVI) determined by each method and mean pressure gradient. The primary end point was major adverse cardiovascular events (MACEs), which included cardiac death, ventricular fibrillation, heart failure, and aortic valve replacement. We also assessed the presence or absence of upper septal hypertrophy.</AbstractText>Doppler-derived SVI was significantly larger than that derived from 2DE/3DE with modest correlations (r = 0.33 and 0.47). Thus, group classification varied substantially by modality. During the median follow-up period of 17 months, 112 patients developed a major adverse cardiovascular event. Although iAVA assessed by Doppler echocardiography had a significantly better net reclassification improvement compared with iAVA by 2DE or 3DE, prognostic values were nearly identical among the three methods. Ventricular septal geometry affected the accuracy of risk stratification.</AbstractText>AS severity grading varied considerably according to the methods applied for calculating SV. Thus, SV measurements are not interchangeable, even though their prognostic power is similar. Hence, examiners should select one of the three methods to assess AS severity and should use the same method in longitudinal examinations.</AbstractText>Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,064 | Clinical presentation and outcome of tricuspid regurgitation in patients with systolic dysfunction. | The impact of tricuspid regurgitation (TR) in patients with left ventricular systolic dysfunction on presentation and clinical outcome is uncertain due to confounding comorbidities and mediocre regurgitation ascertainment.</AbstractText>In a cohort of patients with left ventricular systolic dysfunction (ejection fraction, EF < 50%) and functional TR (assessed quantitatively), we matched TR grade-groups for age, sex, EF, and TR velocity. Association of quantified TR (effective regurgitant orifice, ERO, severe if ≥0.4 cm2) to clinical presentation and outcome was analysed. In the 291 cohort patients (age 70 ± 12 years) with left ventricular dysfunction (EF 31 ± 10%), functional TR ERO was 0.26 ± 0.3 cm2. Presentation with right heart failure was strongly related to TR quantified severity [adjusted odds ratios were 4.15 (1.95-8.84), P = 0.0002 for moderate TR and 6.86 (3.34-14.1), P < 0.0001 for severe TR]. Effective regurgitant orifice ≥0.4 cm2 was associated with increased mortality [hazard ratio 1.6 (1.17-2.2), P = 0.003] unadjusted and after comprehensive adjustment [hazard ratio 1.8 (1.16-2.8), P = 0.009]. Furthermore, ERO ≥0.4 cm2 was associated with increased cardiac events (mortality, new atrial fibrillation or heart failure) unadjusted [hazard ratio 1.9 (1.3-2.7), P = 0.002] and after comprehensive adjustment [hazard ratio 2.2 (1.1-4.6), P = 0.02].</AbstractText>Tricuspid regurgitation, even moderate, is associated at diagnosis with more severe heart failure presentation. While moderate TR is associated with heart failure at presentation, our quantitative data show that the threshold associated with reduced survival and more cardiac events is ERO ≥0.4 cm2. These data emphasize the clinical impact of functional TR and warrant large cohort-analysis and clinical trials of treatment of TR associated with left ventricular dysfunction.</AbstractText> |
19,065 | Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea. | Patients with heart failure and sleep apnea are at increased risk for developing arrhythmias. Whether treatment of sleep apnea reduces arrhythmias is unknown.</AbstractText>The purpose of this study was to determine whether adaptive servo-ventilation (ASV) with optimal medical therapy (OMT) reduces atrial fibrillation (AF) and/or ventricular tachycardia/ventricular fibrillation (VT/VF) burden compared to OMT alone.</AbstractText>We conducted a prospective substudy of patients with pacemakers/defibrillators in the Cardiovascular Improvements with Minute Ventilation-Targeted ASV Therapy in Heart Failure (CAT-HF) trial. Change in arrhythmia burden was compared using a mixed model analysis to account for multiple measurements per patient.</AbstractText>Among 35 randomized patients eligible and analyzed (19 ASV, 16 OMT only) in the AF cohort, mean age was 64 ± 12 years, 23% were women (n = 8), 49% had previous AF (n = 17), 89% had reduced ejection fraction (n = 31), and mean apnea hypopnea index was 41 ± 17 events per hour. Baseline characteristics were similar between groups. Change in AF burden from baseline to follow-up was -15.8% ± 36.5% with ASV vs +23.7% ± 36.2% with OMT (P = .034). There was no significant change in the AF cohort in the mean number of VT/VF events: +3.3 ± 14.9 events with ASV vs -0.3 ± 7.3 events with OMT (P = .58). Five subjects had appropriate therapies for VT/VF in the ASV arm vs 6 subjects in the OMT arm.</AbstractText>This study provides proof of concept that treatment of sleep apnea with ASV leads to reduction in AF burden compared with OMT alone, without an increase in VT/VF events. This hypothesis should be tested in a large outcomes trial.</AbstractText>Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,066 | Impact of Pre-Existing Bradycardia on Subsequent Need for Pacemaker Implantation After Radiofrequency Catheter Ablation for Atrial Fibrillation. | The incidence of subsequent need for permanent pacemaker implantation (PMI) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in real world patients with and without pre-existing bradycardia has not yet been fully evaluated. Methods and Results: A total of 1,131 consecutive patients undergoing first-time RFCA for AF who had no previous or planned device implantation, were enrolled in the present study. Of 799 paroxysmal AF (PAF) patients, 121 (15.1%) had sinus node dysfunction (SND). Of 332 non-PAF patients, 73 (22.0%) had slow ventricular response (VR), defined as heart rate <80 beats/min at rest without any rate-control drugs. The 5-year cumulative incidence of PMI after RFCA in PAF patients with and without SND was 14.8% and 1.7%, respectively (P<0.001). The 5-year cumulative incidence of PMI after RFCA in non-PAF patients with and without slow VR was 14.8% and 4.7%, respectively (P<0.001). SND and female gender in PAF patients, as well as slow VR and age ≥75 years in non-PAF patients, were independent and additive predictors of PMI. The 5-year cumulative incidence of PMI was 26.3% in female PAF patients with SND and 33.3% in elderly non-PAF patients with slow VR.</AbstractText>PMI was avoided in >85% of patients undergoing RFCA for PAF with pre-existing SND, although care should be taken for female patients. Decision-making regarding RFCA for non-PAF patients with slow VR, especially in the elderly, should be cautious.</AbstractText> |
19,067 | Extracorporeal Membrane Oxygenation Improving Survival and Alleviating Kidney Injury in a Swine Model of Cardiac Arrest Compared to Conventional Cardiopulmonary Resuscitation. | <b>体外膜肺氧合较心肺复苏可以提高猪心脏骤停模型生存率并减轻肾损伤</b><b>摘要</b><b>背景：</b>急性肾损伤常见于心肺复苏病人，目前比较体外膜肺氧合（ECMO）和常规心肺复苏（CCPR）对急性肾损伤影响的研究极少，同时其潜在分子机制也少有研究。本研究旨在利用心脏骤停猪模型比较ECMO和CCPR对其生存率和急性肾损伤的影响同时探究相关机制。 <b>方法：</b>16只猪经室颤建立心脏骤停模型，同时分成两组，ECPR组接受CCPR和ECMO治疗（n=8）；CCPR组只接受CCPR治疗（n=8）。研究终点为自主循环恢复（ROSC）6小时或死亡。收集基线及ROSC各时间点血清和尿液样本。急性肾损伤相关标志物经酶联免疫法检测。利用透射电镜和TUNEL方法观察肾小管上皮细胞凋亡水平。同时利用免疫染色和免疫印记检测凋亡相关基因。实验数据以平均值 ± 标准差比较并用Student's <i>t</i>-检验进行比较。 <b>结果：</b>ECPR组均成功复苏，其6小时生存率（8/8；100%）高于CCPR组（6/8；75%）。包括TIMP、IGFBP、LFABP、KIM-1在内的急性肾损伤标志物在ECPR和CCPR组均随观察时间而增加。同时发现ECPR组各标志物水平均显著低于CCPR组。特别是 ROSC4（0.58 ± 0.10 ng<sup>2</sup>/ml<sup>2</sup> vs. 1.18 ± 0.38 ng<sup>2</sup>/ml<sup>2</sup>，<i>t</i>=4.33，<i>P</i>=0.003）和ROSC6（1.79 ± 0.45 ng<sup>2</sup>/ml<sup>2</sup> vs. 3.00 ± 0.44 ng<sup>2</sup>/ml<sup>2</sup>，<i>t</i>=5.49，<i>P</i><0.001）时间点的尿液TIMP与IGFBP水平之积；ROSC6时间点的尿液LFABP水平（0.74 ± 0.06 pg/ml vs. 0.85 ± 0.11 pg/ml，<i>t</i>=2.41，<i>P</i>=0.033）；以及ROSC4（0.66 ± 0.09 pg/ml vs. 0.83 ± 0.06 pg/ml，<i>t</i> = 3.99，<i>P</i> = 0.002）和ROSC6（0.73 ± 0.12 pg/ml vs. 0.89 ± 0.08 pg/ml，<i>t</i> = 2.82， <i>P</i> = 0.016）时间点的尿液Kim-1水平。在光学显微镜和透射电镜下，均可观察到ECPR组肾组织形态损伤水平要低于CCPR组。ECPR组肾组织凋亡水平也得到了缓解。 <b>结论：</b>与常规心肺复苏相比，体外膜肺氧合可以提高心脏骤停生存率并缓解急性肾损伤。其分子机制可能是，体外膜肺氧合较常规心肺复苏降低了急性肾损伤标志物水平以及肾组织中的凋亡水平。. |
19,068 | Reprogramming the tachycardia parameters with long-detection strategy in patients with pre-existing implantable cardioverter-defibrillator. | <b>Background:</b> A long-detection interval (LDI) programming has been proved to reduce shock therapy in patients who underwent <i>de novo</i> implantable cardioverter defibrillator (ICD) implantation. We aimed to evaluate effectiveness and safety of this new strategy in old ICD recipients. <b>Methods:</b> We included 147 primary prevention patients with ischaemic and non-ischaemic aetiology. Conventional setting parameters (18 of 24 intervals to detect ventricular arrhythmias (VA's)) were reprogrammed with LDI strategy (30 of 40 intervals to detect VA's). One monitoring zone (between 360 and 330 ms) and two therapy zones were programmed, treating all rhythms of cycle length <330 ms that met the duration criterion of 30/40 intervals and were discriminated as ventricular tachycardia/ventricular fibrillation (VT/VF). The supraventricular tachycardia (SVT) discriminators were used in all patients. <b>Results:</b> At a median follow-up of 24 months, 12.9% (<i>n</i> = 19) of patients received shock therapies (± antitachycardia pacing (ATP)). Appropriate and inappropriate shocks occurred in 7.5 and 5.4% of patients during follow-up, respectively. Only one patient experienced an arrhythmic syncope during the follow-up period. There was no death related to LDI programming. The LDI programming helped to stop unnecessary in 10 patients (6.8%), who otherwise would have been treated in the conventional programming. <b>Conclusions:</b> LDI programming was found safe and effective. Hence, old ICD recipients will benefit from this strategy. |
19,069 | Real-time optical spectroscopic monitoring of nonirrigated lesion progression within atrial and ventricular tissues. | Despite considerable advances in guidance of radiofrequency ablation (RFA) therapy for the treatment of cardiac arrhythmias, success rates have been hampered by a lack of tools for precise intraoperative evaluation of lesion extent. Near-infrared spectroscopic (NIRS) techniques are sensitive to tissue structural and biomolecular properties, characteristics that are directly altered by radiofrequency (RF) treatment. In this work, a combined NIRS-RFA catheter is developed for real-time monitoring of tissue reflectance during RF energy delivery. An algorithm is proposed for processing NIR spectra to approximate nonirrigated lesion depth in both atrial and ventricular tissues. The probe optical geometry was designed to bias measurement influence toward absorption enabling enhanced sensitivity to changes in tissue composition. A set of parameters termed "lesion optical indices" are defined encapsulating spectral differences between ablated and unablated tissue. Utilizing these features, a model for real-time tissue spectra classification and lesion size estimation is presented. Experimental validation conducted within freshly excised porcine cardiac specimens showed strong concordance between algorithm estimates and post-hoc tissue assessment. |
19,070 | Imaging sequence for joint myocardial T<sub>1</sub> mapping and fat/water separation. | To develop and evaluate an imaging sequence to simultaneously quantify the epicardial fat volume and myocardial T1</sub> relaxation time.</AbstractText>We introduced a novel simultaneous myocardial T1</sub> mapping and fat/water separation sequence (joint T1</sub> -fat/water separation). Dixon reconstruction is performed on a dual-echo data set to generate water/fat images. T1</sub> maps are computed using the water images, whereas the epicardial fat volume is calculated from the fat images. A phantom experiment using vials with different T1</sub> /T2</sub> values and a bottle of oil was performed. Additional phantom experiment using vials of mixed fat/water was performed to show the potential of this sequence to mitigate the effect of intravoxel fat on estimated T1</sub> maps. In vivo evaluation was performed in 17 subjects. Epicardial fat volume, native myocardial T1</sub> measurements and precision were compared among slice-interleaved T1</sub> mapping, Dixon, and the proposed sequence.</AbstractText>In the first phantom, the proposed sequence separated oil from water vials and there were no differences in T1</sub> of the fat-free vials (P = .1). In the second phantom, the T1</sub> error decreased from 22%, 36%, 57%, and 73% to 8%, 9%, 16%, and 26%, respectively. In vivo there was no difference between myocardial T1</sub> values (1067 ± 17 ms versus 1077 ± 24 ms, P = .6). The epicardial fat volume was similar for both sequences (54.3 ± 33 cm3</sup> versus 52.4 ± 32 cm3</sup> , P = .8).</AbstractText>The proposed sequence provides simultaneous quantification of native myocardial T1</sub> and epicardial fat volume. This will eliminate the need for an additional sequence in the cardiac imaging protocol if both measurements are clinically indicated.</AbstractText>© 2018 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.</CopyrightInformation> |
19,071 | Risk factors for incident heart failure with preserved or reduced ejection fraction, and valvular heart failure, in a community-based cohort. | The lack of effective therapies for heart failure with preserved ejection fraction (HFpEF) reflects an incomplete understanding of its pathogenesis.</AbstractText>We analysed baseline risk factors for incident HFpEF, heart failure with reduced ejection fraction (HFrEF) and valvular heart failure (VHF) in a community-based cohort.</AbstractText>We recruited 2101 men and 1746 women ≥60 years of age with hypertension, diabetes, ischaemic heart disease (IHD), abnormal heart rhythm, cerebrovascular disease or renal impairment. Exclusion criteria were known heart failure, left ventricular ejection fraction <50% or valve abnormality >mild in severity. Median follow-up was 5.6 (IQR 4.6-6.3) years.</AbstractText>Median time to heart failure diagnosis in 162 participants was 4.5 (IQR 2.7-5.4) years, 73 with HFpEF, 53 with HFrEF and 36 with VHF. Baseline age and amino-terminal pro-B-type natriuretic peptide levels were associated with HFpEF, HFrEF and VHF. Pulse pressure, IHD, waist circumference, obstructive sleep apnoea and pacemaker were associated with HFpEF and HFrEF; atrial fibrillation (AF) and warfarin therapy were associated with HFpEF and VHF and peripheral vascular disease and low platelet count were associated with HFrEF and VHF. Additional risk factors for HFpEF were body mass index (BMI), hypertension, diabetes, renal dysfunction, low haemoglobin, white cell count and β-blocker, statin, loop diuretic, non-steroidal anti-inflammatory and clopidogrel therapies, for HFrEF were male gender and cigarette smoking and for VHF were low diastolic blood pressure and alcohol intake. BMI, diabetes, low haemoglobin, white cell count and warfarin therapy were more strongly associated with HFpEF than HFrEF, whereas male gender and low platelet count were more strongly associated with HFrEF than HFpEF.</AbstractText>Our data suggest a major role for BMI, hypertension, diabetes, renal dysfunction, and inflammation in HFpEF pathogenesis; strategies directed to prevention of these risk factors may prevent a sizeable proportion of HFpEF in the community.</AbstractText>NCT00400257, NCT00604006 and NCT01581827.</AbstractText> |
19,072 | [Cardiac arrhythmias and their non-pharmacological treatment in the valvular heart diseases]. | Cardiac arrhythmias most often arise in the mechanism of disorders of impulse formation (automaticity, triggered activity), disorders of impulse conduction (reentry, block) or a combination of both. Atrial fibrillation (AF) most often occurs in the course of mitral stenosis and/or mitral regurgitation, rarely in the defects of the aortic valve. Ventricular arrhythmias may be associated with the most valvular heart diseases. Among the disturbances of automatism and conduction in valvular heart diseases, the most common are atrioventricular blocks (AV blocks) and intraventricular blocks. In addition to defect correction and pharmacological treatment, non-pharmacological treatment of cardiac arrhythmias (transcatheter ablative techniques, permanent pacemakers, implantable cardioverter-defibrillators, implantable cardiac resynchronization devices) plays a significant role in the treatment. It is important for the practitioner to understand about the mechanisms of arrhythmia and nonpharmacological treatment in patients with acquired valvular heart diseases. |
19,073 | Medical facilities in the neighborhood and incidence of sudden cardiac arrest. | Medical establishments in the neighborhood, such as pharmacies and primary care clinics, may play a role in improving access to preventive care and treatment and could explain previously reported neighborhood variations in sudden cardiac arrest (SCA) incidence and survival.</AbstractText>The Cardiac Arrest Blood Study Repository is a population-based repository of data from adult cardiac arrest patients and population-based controls residing in King County, Washington. We examined the association between the availability of medical facilities near home with SCA risk, using adult (age 18-80) Seattle residents experiencing cardiac arrest (n = 446) and matched controls (n = 208) without a history of heart disease. We also analyzed the association of major medical centers near the event location with emergency medical service (EMS) response time and survival among adult cases (age 18+) presenting with ventricular fibrillation from throughout King County (n = 1537). The number of medical facilities per census tract was determined by geocoding business locations from the National Establishment Time-Series longitudinal database 1990-2010.</AbstractText>More pharmacies in the home census tract was unexpectedly associated with higher odds of SCA (OR:1.28, 95% CI: 1.03, 1.59), and similar associations were observed for other medical facility types. The presence of a major medical center in the event census tract was associated with a faster EMS response time (-53 s, 95% CI: -84, -22), but not with short-term survival.</AbstractText>We did not observe a protective association between medical facilities in the home census tract and SCA risk, orbetween major medical centers in the event census tract and survival.</AbstractText>Copyright © 2018 Elsevier B.V. All rights reserved.</CopyrightInformation> |
19,074 | Factor Xa inhibition by rivaroxaban attenuates cardiac remodeling due to intermittent hypoxia. | Patients with obstructive sleep apnea (OSA) have a high prevalence of atrial fibrillation (AF). Rivaroxaban, a coagulation factor Xa inhibitor, has recently been reported to show pleiotropic effects. This study investigated the influence of rivaroxaban on cardiac remodeling caused by intermittent hypoxia (IH). Male C57BL/6J mice were exposed to IH (repeated cycles of 5% oxygen for 1.5 min followed by 21% oxygen for 5 min) for 28 days with/without rivaroxaban (12 mg/kg/day) or FSLLRY, a protease-activated receptor (PAR)-2 antagonist (10 μg/kg/day). IH caused endothelial cell degeneration in the small arteries of the right atrial myocardium and increased the level of %fibrosis and 4-hydroxy-2-nonenal protein adducts in the left ventricular myocardium. IH also increased the expression of PAR-2 as well as the phosphorylation of extracellular signal-regulated kinase (ERK)-1/2 and nuclear factor-kappa B (NF-κB) were increased in human cardiac microvascular endothelial cells. However, rivaroxaban and FSLLRY significantly suppressed these changes. These findings demonstrate that rivaroxaban attenuates both atrial and ventricular remodeling induced by IH through the prevention of oxidative stress and fibrosis by suppressing the activation of ERK and NF-κB pathways via PAR-2. Treatment with rivaroxaban could potentially become a novel therapeutic strategy for cardiac remodeling in patients with OSA and AF. |
19,075 | A randomized, double-blind, placebo-controlled trial assessing the efficacy of S66913 in patients with paroxysmal atrial fibrillation. | Antiarrhythmic drugs (AADs) for the treatment of atrial fibrillation (AF) are associated with limited efficacy and adverse effects. Inhibition of the atrial current IKur, absent from the ventricle, is expected to be antiarrhythmic, without adverse cardiac effects, particularly ventricular pro-arrhythmic effects.</AbstractText>A randomized clinical trial in symptomatic paroxysmal AF patients being considered for ablation. The primary endpoint was AF burden (AFB) as measured by insertable continuous monitoring (ICM) devices. Screened patients had an ICM implanted and were included if AFB was between 1% and 70% after 4 weeks of recording. They were randomly allocated to 4-week treatment of a selective IKur inhibitor S66913 (5 mg, 25 mg, or 100 mg orally per day) or placebo. The study was to enroll 160 patients. The study was terminated prematurely, due to non-study related preclinical safety concerns, after 58 patients had been enrolled. The median AFB ranged from 4.3% to 10.3% at baseline in the four treatment groups. S66913 had no significant effect on AFB or on AFB plus atrial tachycardia (AT) burden, at any dosage; nor on any secondary endpoints including the number and duration of AT or AF episodes, and symptoms. The drug was well tolerated with no safety concern during the treatment or the extended clinical follow-up.</AbstractText>DIAGRAF-IKUR was the first study to show that using ICM to assess the effect of an AAD is feasible. The selective IKur inhibitor S66913 was safe but had no clinically meaningful effect at the time of early termination of the study.</AbstractText> |
19,076 | The Effects of the Duration of Aortic Balloon Occlusion on Outcomes of Traumatic Cardiac Arrest in a Porcine Model. | Aortic balloon occlusion (ABO) facilitates the success of cardiopulmonary resuscitation (CPR) in non-traumatic cardiac arrest, and is also effective in controlling traumatic hemorrhage; however, a prolonged occlusion results in irreversible organ injury and death. In this study, we investigated the effects of ABO on CPR outcomes and its optimal duration for post-resuscitation organ protection in a porcine model of traumatic cardiac arrest (TCA).Twenty-seven male domestic pigs weighing 33 ± 4 kg were utilized. Forty percent of estimated blood volume was removed within 20 min. The animals were then subjected to 5 min of untreated ventricular fibrillation and 5 min of CPR. Coincident with the start of CPR, the animals were randomized to receive either 30-min ABO (n = 7), 60-min ABO (n = 8) or control (n = 12). Meanwhile, fluid resuscitation was initiated by the infusion of normal saline with 1.5 times of hemorrhage volume in 1 h, and finished by the reinfusion of 50% of the shed blood in another 1 h. The resuscitated animals were monitored for 6 h and observed for an additional 18 h.During CPR, coronary perfusion pressure was significantly increased followed by a higher rate of resuscitation success in the 30 and 60-min ABO groups compared with the control group. However, post-resuscitation cardiac, neurologic dysfunction, and injuries were significantly milder accompanied with less renal and intestinal injuries in the 30-min ABO group than in the other two groups.In conclusion, ABO augmented the efficacy of CPR after TCA, and furthermore a 30-min ABO improved post-resuscitation cardiac and neurologic outcomes without exacerbating the injuries of kidney and intestine. |
19,077 | Sex Differences in Heart Failure. | Heart failure (HF) represents a global pandemic health problem with a high impact on health-care costs, affecting about 26 million adults worldwide. The overall HF prevalence and incidence are ~2% and ~0.2% per year, respectively, in Western countries, with half of the HF population with reduced ejection fraction (HFpEF) and half with preserved (HFpEF) or mid-range ejection fraction (HFmrEF). Sex differences may exist in HF. More males have HFrEF or HFmrEF and an ischemic etiology, whereas more females have HFpEF and hypertension, diastolic dysfunction, and valvular pathologies as HF etiologies. Females are generally older, have a higher EF, higher frequency of HF-related symptoms, and lower NYHA functional status. Generally, it is observed that female HF patients tend to have more comorbidities such as atrial fibrillation, diabetes, hypertension, anemia, iron deficiency, renal disease, arthritis, frailty, depression, and thyroid abnormalities. However, overall, females have better prognosis in terms of mortality and hospitalization risk compared with men, regardless of EF. Potential sex differences in HF characteristics may be underestimated because of the underrepresentation of females in cardiovascular research and, in particular, the sex imbalance in clinical trial enrollment may avoid to identify sex-specific differences in treatments' benefit. |
19,078 | Sex-Specific Physiology and Cardiovascular Disease. | Sex differences in cardiovascular diseases can be classified as those which are specific to one sex and those that differ in incidence, prevalence, etiology, symptomatology, response to treatment, morbidity, and mortality in one sex compared to the other. All sex differences in cardiovascular conditions have their basis in the combined expression of genetic and hormonal differences between women and men. This chapter addresses how understanding basic mechanisms of hormone responses, imaging diagnostics, and integration of genomics and proteomics has advanced diagnosis and improved outcomes for cardiovascular conditions, apart from those related to pregnancy that are more prevalent in women. These conditions include obstructive coronary artery disease, coronary microvascular dysfunction, spontaneous coronary artery dissection, diseases of the cardiac muscle including heart failure and takotsubo cardiomyopathy, and conditions related to neurovascular dysregulation including hot flashes and night sweats associated with menopause and effects of exogenous hormones on vascular function. Improvement in technologies allowing for noninvasive assessment of neuronally mediated vascular reactivity will further improve our understanding of the basic etiology of the neurovascular disorders. Consideration of sex, hormonal status, and pregnancy history in diagnosis and treatment protocols will improve prevention and outcomes of cardiovascular disease in women as they age. |
19,079 | Independent effect of atrial fibrillation on natriuretic peptide release. | We investigated whether the increase of plasma natriuretic peptides (NPs) in atrial fibrillation (AF) is independent of the effect of AF on the left atrial (LA) hemodynamics.</AbstractText>Hemodynamically stable patients scheduled for AF ablation underwent assessment of B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP), echocardiography, and direct measurement of left atrial (LA) pressure. Concentrations of the NPs were compared between patients in AF (n = 31) and controls in sinus rhythm (SR; n = 31) who were matched for age, gender, heart rate, left ventricular ejection fraction, LA volume index, and directly measured mean LA pressure. Eighteen patients underwent serial measurement of NPs and LA pressure during native SR and after 20 min of pacing-induced AF.</AbstractText>Compared to the patients in SR, the patients in AF had 2.6 times higher unadjusted BNP [median (inter-quartile range), 101 (63, 129) vs. 38 (26, 79) ng/L] and two times higher unadjusted MR-proANP [183 (140, 230) vs. 91 (67, 135) pmol/L; both p < 0.001]. Concentrations of both NPs correlated with mean LA pressure in the patients in SR (r = 0.75 for BNP and 0.62 for MR-proANP, both p < 0.001) but not in the patients in AF (r = 0.18 and 0.04, respectively, both p > 0.3). Both NPs increased significantly during induced AF [adjusted median (IQR) relative change, BNP: 27 (22; 40)%, MR-proANP: 75 (64; 99)%, both p < 0.001] without a significant change in the LA pressure.</AbstractText>The increase of NPs in AF was independent of its effect on the LA hemodynamics.</AbstractText> |
19,080 | Relation of Echocardiographic Markers of Left Atrial Fibrosis to Atrial Fibrillation Burden. | In patients with atrial fibrillation (AF), left atrial (LA) fibrosis is a major determinant of the progression to, and burden of AF. LA reservoir strain and total atrial conduction time (PA-TDI) reflect LA fibrotic content. We aimed to investigate the relation between LA reservoir strain and PA-TDI in AF patients and control subjects. Six-hundred two patients (mean age 56 years, 53% men) with first episode of AF and 342 controls (mean age 64 years, 71% men) without structural heart disease underwent echocardiography. LA volumes, PA-TDI, LA reservoir strain, and left ventricular global longitudinal strain (GLS) were compared. Compared with controls, patients with paroxysmal AF and patients with persistent AF had longer PA-TDI (128 ± 25 millisecond, 140 ± 31 millisecond, and 154 ± 33 millisecond, respectively; p <0.001) and a progressive decline in LA reservoir strain (36.9 ± 11.6%, 29.8 ± 13.4%, 24.2 ± 12.3%, respectively; p <0.001). LA reservoir strain was negatively correlated with PA-TDI (r = -0.43, p <0.001). On multivariate analyses, LA reservoir strain, diabetes mellitus, and burden of AF were independent correlates of PA-TDI (R<sup>2</sup> = 0.23, p <0.001); whereas only PA-TDI was an independent correlate of LA reservoir strain (R<sup>2</sup> = 0.43, p <0.001); controlling for age, hypertension, coronary artery disease, body mass index, severity of mitral regurgitation, left ventricular global longitudinal strain, and LA volume. In conclusion, PA-TDI and LA reservoir strain are negatively correlated in all subjects, irrespective of the presence or burden of AF. Patients with persistent AF have longer PA-TDI and impaired LA reservoir strain compared with paroxysmal AF and controls, suggesting increasing burden of fibrosis and LA structural remodeling in the progression of AF. |
19,081 | Pericardiectomy for a patient with constrictive pericarditis and multivessel coronary artery disease. | Pericardiectomy for patients with constrictive pericarditis and multivessel coronary artery disease is rare. Therefore, there is limited experience of pericardiectomy in these patients.</AbstractText>We performed only pericardiectomy under the support of intra-aortic balloon pumping (IABP) for a patient with tuberculous constrictive pericarditis and multivessel coronary artery disease who refused to accept revascularization. The postoperative course was uneventful.</AbstractText>There is limited experience of pericardiectomy in patients with constrictive pericarditis and coronary artery disease, especially in those who want to perform only pericardiectomy and refuse to accept revascularization. There has only been one case report of a patient who had constrictive pericarditis and coronary artery disease, and hemodynamic instability postoperatively who did not have revascularization performed. Cardiopulmonary bypass facilitates dissecting grossly thickened pericardium off the heart and coronary artery exposure, but is associated with higher mortality and reoperation rates, renal failure, and atrial fibrillation. In our patient, cutting grossly thickened pericardium to expose the coronary artery under cardiopulmonary bypass was unnecessary because he refused to accept revascularization. Therefore, we performed only pericardiectomy under the support of IABP to avoid hemodynamic instability.</AbstractText>Performing only pericardiectomy under the support of IABP for a patient with constrictive pericarditis and multivessel coronary artery disease is safe and effective as long as the left ventricular ejection fraction is normal.</AbstractText>Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.</CopyrightInformation> |
19,082 | Dynamicity of hypothermia-induced J waves and the mechanism involved. | J waves develop during hypothermia, but the dynamicity of hypothermia-induced J waves is poorly understood.</AbstractText>The purpose of this study was to investigate the mechanism of the rate-dependent change in the amplitude of hypothermia-induced J waves.</AbstractText>Nineteen patients with severe hypothermia were included (mean age 70 ± 12 years; 16 men [84.2%]). The rectal temperature at the time of admission was 27.8° ± 2.5°C. In addition to prolonged PR, QRS complex, and corrected QT intervals, the distribution of prominent J waves was widespread in all 19 patients.</AbstractText>Nine patients showed changes in RR intervals. When the RR interval shortened from 1353 ± 472 to 740 ± 391 ms (P = .0002), the J-wave amplitude increased from 0.50 ± 0.29 to 0.61 ±0.27 mV (P = .0075). The J-wave amplitude increased in 7 patients (77.8%) and decreased in 2 patients (22.2%) after short RR intervals. The augmentation of J waves at short RR intervals was associated with a significant prolongation of ventricular activation time (35 ± 5 ms vs 46 ± 5 ms; P = .0020), suggesting accentuated conduction delay. Increased conduction delay at short RR intervals was suggested to accentuate the phase 1 notch of the action potential and J waves in hypothermia. None developed ventricular fibrillation, and in 2 of 9 patients with atrial fibrillation, atrial fibrillation persisted after rewarming to normothermia.</AbstractText>J waves in severe hypothermia were augmented after short RR intervals in 7 patients as expected for depolarization abnormality, whereas 2 patients showed a bradycardia-dependent augmentation as expected for transient outward current-mediated J waves. Increased conduction delay at short RR intervals can be responsible for the accentuation of the transient outward current and J waves during severe hypothermia.</AbstractText>Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,083 | PR interval genome-wide association meta-analysis identifies 50 loci associated with atrial and atrioventricular electrical activity. | Electrocardiographic PR interval measures atrio-ventricular depolarization and conduction, and abnormal PR interval is a risk factor for atrial fibrillation and heart block. Our genome-wide association study of over 92,000 European-descent individuals identifies 44 PR interval loci (34 novel). Examination of these loci reveals known and previously not-yet-reported biological processes involved in cardiac atrial electrical activity. Genes in these loci are over-represented in cardiac disease processes including heart block and atrial fibrillation. Variants in over half of the 44 loci were associated with atrial or blood transcript expression levels, or were in high linkage disequilibrium with missense variants. Six additional loci were identified either by meta-analysis of ~105,000 African and European-descent individuals and/or by pleiotropic analyses combining PR interval with heart rate, QRS interval, and atrial fibrillation. These findings implicate developmental pathways, and identify transcription factors, ion-channel genes, and cell-junction/cell-signaling proteins in atrio-ventricular conduction, identifying potential targets for drug development. |
19,084 | [Ultrasonic monitoring of carotid blood flow in interposed abdominal pulling-pressing cardiopulmonary resuscitation]. | To explore the difference in ultrasonic monitoring in carotid blood flow, resuscitation effects and prognosis between interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) and standard cardiopulmonary resuscitation (STD-CPR).</AbstractText>Seventy-five cardiac arrest (CA) patients admitted to emergency department of Shijingshan Teaching Hospital of Capital Medical University from June 2015 to December 2017 were enrolled. The patients were divided into STD-CPR group and IAPP-CPR group according to the treatment orders of them and the desire of relatives. All patients were given persistent external compression, airway open, tube intubation, and mechanical ventilation, vasoactive drugs application, defibrillation if required. STD-CPR group was operated according to the 2015 American Heart Association (AHA) CPR guidelines. On the basis of the standard CPR, IAPP-CPR group was recovered using abdominal lifting and compressing CPR instrument to press down to lift the upper abdomen continuously, when the chest compressing relaxed (frequency 100 times/min, down and lift time ratio 1:1, compressing strength 50 kg, lifting strength 30 kg). The patients' gender, age and CA etiology were recorded in the two groups. The vital signs and blood flow of carotid artery were monitored with ultrasonic Doppler during the CPR. The return of spontaneous circulation (ROSC) rate and 48-hour survival rate were observed in patients. The influence factors of ROSC were screened by Logistic regression analysis.</AbstractText>The data of 75 patients with CA were enrolled finally, with STD-CPR group of 38 patients and IAPP-CPR group of 37 patients. There were no significant differences in patients' gender, age or CA etiology between the two groups. Comparing with STD-CPR group, the peak blood flow velocity of carotid artery in IAPP-CPR group was speeded up significantly (cm/s: 107.16±13.75 vs. 78.99±14.77, P < 0.01), the overall blood flow volume of carotid artery was increased significantly (mL/min: 989.06±115.88 vs. 751.62±118.92, P < 0.01), but there was no significant difference in inner diameter of carotid artery between the two groups (mm: 4.55±0.25 vs. 4.61±0.21, P > 0.05). During the CPR, the mean arterial pressure (MAP) and the transcutaneous oxygen saturation (SpO2</sub>) in IAPP-CPR group were significantly higher than those of STD-CPR group, but no significant difference was found in heart rate between the two groups. Four patients in STD-CPR group got ROSC, and 3 survived over 48 hours (1 myocardial infarction patient died of ventricular fibrillation) while 6 patients in IAPP-CPR group got ROSC and survived over 48 hours. There was no significant difference in ROSC rate or 48-hour survival rate between the two groups, but data of IAPP-CPR group was slightly higher than that of STD-CPR group [ROSC rate: 16.22% (6/37) vs. 10.53% (4/38), 48-hour survival rate: 16.22% (6/37) vs. 7.89% (3/38), both P > 0.05]. Multivariate Logistic regression analysis showed that the higher the MAP during CPR, the greater the possibility of ROSC was [odds ratio (OR) = 1.361, 95% confidence interval (95%CI) = 1.182-1.669, P = 0.030].</AbstractText>IAPP-CPR was superior to traditional STD-CPR in improving arterial blood flow and resuscitation effect, but no superiority was found in ROSC rate and survival rate, which may be relate to the small number of patients that included in this study. More clinic trials are needed.</AbstractText> |
19,085 | An analysis of the relationship between the applied medical rescue actions and the return of spontaneous circulation in adults with out-of-hospital sudden cardiac arrest. | Sudden cardiac arrest (SCA) is a significant medical and social issue, the main cause of death in Europe and the United States.The aim of the research was to evaluate the effectiveness of emergency medical procedures applied by emergency medical teams in prehospital care in the context of return of spontaneous circulation (ROSC).The case-control study was based on the medical documentation of the Rescue Service in Katowice (responsible for monitoring 2.7 million inhabitants of the region) referring to 2016. The research involved exclusively adults (ie, individuals older than 18 years) with out-of-hospital cardiac arrest (OHCA). After considering the above inclusion criteria, there were 1603 dispatch order forms (0.64% of all dispatch orders) involved in further research.On the basis of the emergency medical procedure forms, the actions of emergency medical teams were verified as medical procedures (endotracheal intubation, the use of suction pumps, defibrillation, the use of alternatives providing airway patency and ROSC was determined.The analysis covered 1603 cases of OHCA. SCA turned out more frequent in men than in women (P = .000). Most often, SCA occurred in domestic conditions during the day and was witnessed by a third person. In 59.9% of the cases, actions were taken by witnesses, which increased the probability of ROSC. Patients were usually intubated (51.4%). Respirators were used less frequently (20.2%). Ventricular fibrillation (VF) was reported only in 22.0% of the cases. The ROSC rate was higher in the group of patients with diagnosed VF than in those with nonshockable rhythms (VF, 55.43% vs asystole, 24.05%; P = .000).Successful resuscitation depends on the quality of emergency medical procedures performed at the place of incident. The highest probability of ROSC is related with defibrillation (in the cases of VF or ventricular tachycardia with no pulse), intubation, the application of a respirator, and performing mechanical ventilation, as well as with a shorter time from dispatch to arrival. |
19,086 | Prognostic Significance of Serum Cysteine-Rich Protein 61 in Patients with Acute Heart Failure. | <AbstractText Label="BACKGROUND/AIMS" NlmCategory="OBJECTIVE">Cyr61-cysteine-rich protein 61 (CCN1/CYR61) is a multifunctional matricellular protein involved in the regulation of fibrogenesis. Animal experiments have demonstrated that CCN1 can inhibit cardiac fibrosis in cardiac hypertrophy. However, no study has been conducted to assess the relation between serum CCN1 and prognosis of acute heart failure (AHF).</AbstractText>We measured the serum CCN1 levels of 183 patients with AHF, and the patients were followed up for 6 months. The associations between CCN1 levels and some clinical covariates, especially left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), atrial fibrillation and age, were estimated. The AHF patients were followed up for 6 months. The endpoint was all-cause mortality. Kaplan-Meier curve analysis and multivariable Cox proportional hazards analysis were employed to evaluate the prognostic ability of CCN1. We used calibration, discrimination and reclassification to assess the mortality risk prediction of adding CCN1.</AbstractText>Serum CCN1 concentrations in AHF patients were significantly increased compared with those in individuals without AHF (237 pg/ml vs. 124.8 pg/ml, p< 0.001). CCN1 level was associated with the level of NT-proBNP (r=0.349, p< 0.001) and was not affected by LVEF, eGFR, age or atrial fibrillation in AHF patients. Importantly, Kaplan-Meier curve analysis illustrated that the AHF patients with serum CCN1 level > 260 pg/ ml had a lower survival rate (p< 0.001). Multivariate Cox hazard analysis suggests that CCN1 functions as an independent predictor of mortality for AHF patients (LgCCN1, hazard ratio 5.825, 95% confidence interval: 1.828-18.566, p=0.003). In addition, the inclusion of CCN1 in the model with NT-proBNP significantly improved the C-statistic for predicting death (0.758, p< 0.001). The integrated discrimination index was 0.019 (p< 0.001), and the net reclassification index increased significantly after addition of CCN1 (23.9%, p=0.0179).</AbstractText>CCN1 is strongly predictive of 6-month mortality in patients with AHF, suggesting serum CCN1 as a promising candidate prognostic biomarker for AHF patients.</AbstractText>© 2018 The Author(s). Published by S. Karger AG, Basel.</CopyrightInformation> |
19,087 | A standardized protocol to reliably visualize the left atrial appendage with intracardiac echocardiography: Importance of multiple imaging sites. | Currently, there is no accepted protocol for left atrial appendage (LAA) imaging with intracardiac echocardiography (ICE).</AbstractText>This study aimed to assess the utility of ICE to reliably visualize the entire cavity of the LAA and propose a specific procedural protocol to achieve the above objective.</AbstractText>We created a three-dimensional reconstruction of the LAA, using two-dimensional ICE sections obtained from three different location (the right atrium [RA], right ventricle inflow [RVI], and right ventricular outflow [RVOT]). We then compared the three-dimensional LAA reconstruction by ICE with one obtained by cardiac computed tomography angiography (CCTA) for morphological and volume differences.</AbstractText>Three-dimensional reconstruction with ICE could reliably reproduce the LAA as visualized with CCTA but only when ICE sampling was performed from at least two catheter positions. There was no statistically significant difference between LAA volumes obtained with ICE and CCTA (P = 0.33). The contribution of each anatomical location to the total volume was 17% ± 16.6%, 74% ± 13.3%, and 33% ± 26% for RA, RVI, and RVOT, respectively.</AbstractText>In comparison with CCTA, the LAA can be reliably visualized in its entity by ICE, but only if multiple imaging positions (RA, RV inflow, and RVOT) are used.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,088 | Prospects of using cardiovascular magnetic resonance in the identification of arrhythmogenic substrate in autoimmune rheumatic diseases. | Sudden cardiac death (SCD) is due to ventricular tachycardia/fibrillation (VT/VF) and may occur with or without any structural or functional heart disease. The presence of myocardial edema, ischemia and/or fibrosis plays a crucial role in the pathogenesis of VT/VF, irrespective of the pathophysiologic background of the disease. Specifically, in autoimmune rheumatic diseases (ARDs), various entities such as myocardial/vascular inflammation, ischemia and fibrosis may lead to VT/VF. Furthermore, autonomic dysfunction, commonly found in ARDs, may also contribute to SCD in these patients. The only non-invasive, radiation-free imaging modality that can perform functional assessment and tissue characterization is cardiovascular magnetic resonance (CMR). Due to its capability to detect and quantify edema, ischemia and fibrosis in parallel with ventricular function assessment, CMR has the great potential to identify ARD patients at high risk for VT/VF, thus influencing both cardiac and anti-rheumatic treatment and modifying perhaps the criteria for implantation of cardioverter defibrillators. |
19,089 | Brugada Syndrome-Associated Genetic Loci Are Associated With J-Point Elevation and an Increased Risk of Cardiac Arrest. | <b>Introduction:</b> A previous genome-wide association study found three genetic loci, rs9388451, rs10428132, and rs11708996, to increase the risk of Brugada Syndrome (BrS). Since the effect of these loci in the general population is unknown, we aimed to investigate the effect on electrocardiogram (ECG) parameters and outcomes in the general population. <b>Materials and Methods:</b> A cohort of 6,161 individuals (median age 45 [interquartile range (IQR) 40-50] years, 49% males), with available digital ECGs, was genotyped and subsequently followed for a median period of 13 [IQR 12.6-13.4] years. Data on outcomes were collected from Danish administrative healthcare registries. Furthermore, ~400,000 persons from UK Biobank were investigated for associations between the three loci and cardiac arrest/ventricular fibrillation (VF). <b>Results:</b> Homozygote carriers of the C allele in rs6800541 intronic to <i>SCN10A</i> had a significantly larger J-point elevation (JPE) compared with wildtype carriers (11 vs. 6 μV, <i>P</i> < 0.001). There was an additive effect of carrying multiple BrS-associated risk alleles with an increased JPE in lead V1. None of the BrS-associated genetic loci predisposed to syncope, atrial fibrillation, or total mortality in the general Danish population. The rs9388451 genetic locus adjacent to the <i>HEY2</i> gene was associated with cardiac arrest/VF in an analysis using the UK Biobank study (odds ratio = 1.13 (95% confidence interval: 1.08-1.18), <i>P</i> = 0.006). <b>Conclusions:</b> BrS-associated risk alleles increase the JPE in lead V1 in an additive manner, but was not associated with increased mortality or syncope in the general population of Denmark. However, the <i>HEY2</i> risk allele increased the risk of cardiac arrest/VF in the larger population study of UK Biobank indicating an important role of this common genetic locus. |
19,090 | [Surgical Cardiac Resynchronization Therapy for Patients with Severe Left Ventricular Systolic Dysfunction]. | We applied cardiac resynchronization therapy with an implantable cardioverter-defibrillator( CRT-D) and with concomitant cardiac surgery to 2 patients with left ventricular (LV) systolic dysfunction and dyssynchronous ventricular activation. A patient had severe ischemic dilated cardiomyopathy with coronary artery aneurysms (LV ejection fraction 12%, LV diastolic dimension 81 mm, LV systolic dimension 75 mm and atrial fibrillation, with complete left bundle branch block). Another patient had severe dilated cardiomyopathy with mitral valve regurgitation (LV ejection fraction 25%, LV diastolic dimension 75 mm, LV systolic dimension 61 mm atrial fibrillation, and complete left bundle branch block). Both epicardial LV leads were surgically implanted on the posterolateral wall. CRT-D achieved the resynchronization of the LV contraction, and improved cardiac function. The patients had an uneventful postoperative course and were discharged from hospital after operation. A key advantage of surgical epicardial lead placement is that lead placement is not confined to anatomic branches of the LV venous circulation as is the case with transvenous placement. CRT-D combined with cardiac surgery might be available for patients with LV systolic dysfunction. |
19,091 | Current Perspectives on Sudden Cardiac Death in Hemodialysis Patients. | Recent lines of evidence suggest that, as in other countries, sudden cardiac death (SCD) is more common in the Japanese dialysis clinical setting than we previously thought.</AbstractText>Three specific important findings may underlie the increased incidence of SCD in dialysis patients. Even after successful coronary revascularization, hemodialysis (HD) patients continue to have a higher incidence of SCD than the general population. Second, about 70% or more of end-stage kidney disease patients have concentric and eccentric left ventricular hypertrophy, which predisposes many dialysis patients to interstitial fibrosis, decreased coronary perfusion reserve, and decreased ischemia tolerance. Third, mildly impaired left ventricular dysfunction, with an ejection fraction <50%, is associated with a greater risk of SCD in dialysis patients. We have believed and accepted a common sense theory that paroxysmal ventricular tachycardia and fibrillation are the central cause of SCD in HD patients, because such cardiac functional morphological abnormalities were observed, and there are many chances for ventricular arrhythmia triggers, such as volume expansion and electrolyte shift, to develop. However, the type of fatal arrhythmia responsible for SCD differs between before and after HD. Sudden cardiac arrest (SCA) from ventricular fibrillation (VF) was more often seen in the post-HD setting, while SCA from non-VF, which may be bradyarrhythmia, was more often seen in the pre-HD setting. This may imply that the causes of SCA are bradyarrhythmia due to hyperkalemia in the pre-HD setting on the day after a long interval, and fatal ventricular arrhythmia due to a prolonged QT interval in the post-HD setting, because some recent evidence suggests that shifts of electrolytes, such as potassium and calcium, during HD cause rapid prolongation of the QT interval after HD, which may lead to the onset of ventricular arrhythmia and SCD. In fact, a higher calcium gradient, defined as the difference between the pre-HD corrected total serum calcium level and the dialysate calcium level, was associated with a higher risk of SCD in HD patients. Key Messages: Further study is needed to determine which combination of calcium, potassium, and bicarbonate concentrations in dialysate is optimal to avoid SCD in high-risk HD patients.</AbstractText>© 2018 S. Karger AG, Basel.</CopyrightInformation> |
19,092 | Comparison of ventricular tachyarrhythmia recurrence between ischemic cardiomyopathy and dilated cardiomyopathy: a retrospective study. | The use of an implantable cardioverter-defibrillator (ICD) has been established as an effective secondary prevention strategy for ventricular tachycardia (VT)/ventricular fibrillation (VF). However, few reports discuss the difference in clinical predictors for recurrent VT/VF between patients with ischemic cardiomyopathy (ICM) and patients with dilated cardiomyopathy (DCM).</AbstractText>From May 2004 to December 2015, 132 consecutive patients who had ICM (n</i> = 94) or DCM (n</i> = 38) and had received ICD implantation for secondary prevention were enrolled in this study. All anti-tachycardia events during follow-up were validated. The clinical characteristics and echocardiographic parameters were obtained for comparison. The incidence of recurrence of VT/VF, cardiovascular mortality, all-cause mortality, the change of left ventricular ejection fraction (LVEF) and LV volume were analyzed.</AbstractText>At a mean follow-up of 3.62 ± 2.93 years, 34 patients (36.2%) in the ICM group and 22 patients (57.9%) in the DCM group had a recurrence of VT/VF episodes (p</i> = 0.032). The DCM group had a lower LVEF (p</i> = 0.019), a larger LV end-diastolic volume (LVEDV) (p</i> = 0.001), a higher prevalence of LVEDV >158 mL (p</i> = 0.010), and a larger LV end-systolic volume (p</i> = 0.010) than the ICM group. LVEDV >158 mL and no use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker were independent predictors of recurrences of VT/VF in ICM patients but not in DCM patients. There were no difference in cardiovascular mortality and all-cause mortality between the ICM and DCM patients.</AbstractText>The DCM patients had a higher recurrence rate of VT/VF than did the ICM patients during long-term follow-up. An enlarged LV is an independent predictor of the recurrence of VT/VF in ICM patients receiving ICD for secondary prevention.</AbstractText> |
19,093 | Meta-Analysis Comparing Catheter-Guided Ablation Versus Conventional Medical Therapy for Patients With Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction. | The prognostic benefit of catheter ablation (CA) for atrial fibrillation in the setting of heart failure (HF) with reduced ejection fraction (EF) is unclear. A systematic search of medical literature was limited to randomized controlled trials. The primary outcome was all-cause mortality, and secondary outcomes were HF hospitalizations, stroke, left ventricular EF improvement, change in 6-minute walk test, and change in Minnesota living with HF questionnaire (Δ MLHFQ). Random effects risk ratios (RR) were calculated for categorical outcomes and standardized mean differences (SMD) for continuous ones, using Der-Simonian and Liard model. A total of 775 ambulatory patients from 6 trials were included. The mean EF was 31% with a mean New York Heart Association classification class 2.5. At a mean follow-up of 26 months, CA was associated with lower incidences of all-cause mortality (RR 0.50, 95% confidence intervals [CI] 0.34 to 0.74, I<sup>2</sup> = 0%, p <0.0001), and HF hospitalizations (RR 0.58, 95% CI 0.41 to 0.81, p = 0.002, I<sup>2</sup> = 0%), with similar incidences of stroke. Left ventricular EF improvement (SMD = 2.58, 95% CI 0.88 to 4.27), and change in Minnesota living with heart failure HF questionnaire (SMD = -0.40, 95% CI -0.65 to -0.14) were also in favor of CA, with no difference noted in change in 6-minute walk test. The incidence of all reported procedural complications (including major and minor) was 7.3%. In conclusion, CA of atrial fibrillation appears to be associated with improved survival and HF hospitalizations compared with medical therapy, with evidence of low ablation-related complications. |
19,094 | Predicting Outcomes in Patients With AsymptomaticModerate to Severe Aortic Stenosis. | Outcomes in asymptomatic patients with aortic stenosis (AS) have been reported primarily from tertiary centers. Whether observations from a community hospital cohort would be similar or if clinical variables would assume a more important role remains uncertain. This retrospective cohort study from one community hospital followed asymptomatic patients with moderate to severe AS for 3 years following an index echocardiogram. Patients underwent standard echocardiographic imaging and assessment of AS severity. Outcomes included aortic valve replacement, onset of Class 4 heart failure and cardiovascular death. Inclusion or exclusion criteria were met by 190 patients (body mass index of 30.8 ± 7.5 kg/m<sup>2</sup> and age 70.9 ± 13.0 years). In this obese and racially diverse cohort, adverse outcomes occurred in 72 of 190 (38%), aortic valve replacement in 33 of 72 (46%), heart failure in 30 of 72 (42%), and cardiovascular death in 9 of 72 (13%). Univariate analyses found that the echocardiographic variables assessing AS severity (Vmax, mean aortic valve gradient, and the dimensionless index) were strongly associated with outcomes. A model predicting time to adverse outcomes included age, gender, Charlson index, Vmax, aortic valve area, the electrocardiographic variables of atrial fibrillation and left ventricular strain, and echocardiographic variables unrelated to the direct measurements of stenosis severity. In conclusion, direct echocardiographic measures of AS severity, echocardiographic parameters unrelated to AS severity plus the electrocardiographic variables of atrial fibrillation and left ventricular strain were the dominant predictors of adverse outcomes in a community hospital cohort of asymptomatic patients with moderate to severe AS. |
19,095 | Intramural conduction system gradients and electrogram regularity during ventricular fibrillation.<Pagination><StartPage>195</StartPage><EndPage>200</EndPage><MedlinePgn>195-200</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.ipej.2018.07.006</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S0972-6292(18)30043-3</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">The His-Purkinje system has been shown to harbor triggers for ventricular fibrillation (VF) initiation. However, the substrate responsible for VF maintenance remains elusive. We hypothesized that standard, electrode-based, point-to-point mapping would yield meaningful insight into site-specific patterns and organization which may shed light on the critical substrate for maintenance of VF.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">VF was induced under general anesthesia by direct current (DC) application to the right ventricle in 7 acute canines. A standard EPT Blazer mapping catheter (Boston Scientific, Natuck, MA) was used for mapping in conjunction with a Prucka recording system. We collected 30 consecutive electrograms at 24 distinct sites, confirmed by fluoroscopy and intracardiac echo. These sites included both endocardial and epicardial locations throughout the ventricles and conduction system.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">A total of 5040 individual data points were collected in 7 separate canine studies. During VF mapping, a transmural disparity was found between the epicardium (average cycle length [CL] of 1136 m s) and the endocardium (average CL of 123 m s) with a p value of <0.01. An additional, intramural gradient was found when comparing the proximal, insulated conduction system to the distal, non-insulated conduction system (average CL 218 versus 111 m s [p = 0.03]).</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Our data are supportive of a novel observation of intramural difference between insulated and non-insulated regions of the His-Purkinje network in canines. In addition, certain areas exhibited periods of regular electrogram characteristics; this was despite the heart remaining in terminal VF. These early canine data merit further study to investigate if specific ablation of the distal conduction system can perturb or extinguish VF.</AbstractText><CopyrightInformation>Copyright © 2018 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Tri</LastName><ForeName>Jason</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Mayo Clinic Research Internship, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Asirvatham</LastName><ForeName>Roshini</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Mayo Clinic Research Internship, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>DeSimone</LastName><ForeName>Christopher V</ForeName><Initials>CV</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Killu</LastName><ForeName>Ammar M</ForeName><Initials>AM</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sugrue</LastName><ForeName>Alan M</ForeName><Initials>AM</Initials><AffiliationInfo><Affiliation>Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Suddendorf</LastName><ForeName>Scott H</ForeName><Initials>SH</Initials><AffiliationInfo><Affiliation>Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ladewig</LastName><ForeName>Dorothy J</ForeName><Initials>DJ</Initials><AffiliationInfo><Affiliation>Mayo Clinic Ventures, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kapa</LastName><ForeName>Suraj</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Friedman</LastName><ForeName>Paul A</ForeName><Initials>PA</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>McLeod</LastName><ForeName>Christopher J</ForeName><Initials>CJ</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Asirvatham</LastName><ForeName>Samuel J</ForeName><Initials>SJ</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA. Electronic address: asirvatham.samuel@mayo.edu.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>07</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Indian Pacing Electrophysiol J</MedlineTA><NlmUniqueID>101157207</NlmUniqueID><ISSNLinking>0972-6292</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Conduction system</Keyword><Keyword MajorTopicYN="N">Endocardium</Keyword><Keyword MajorTopicYN="N">Epicardium</Keyword><Keyword MajorTopicYN="N">His-purkinje network</Keyword><Keyword MajorTopicYN="N">Purkinje</Keyword><Keyword MajorTopicYN="N">Transmural gradient</Keyword><Keyword MajorTopicYN="N">Ventricular fibrillation</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2018</Year><Month>3</Month><Day>5</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2018</Year><Month>6</Month><Day>6</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2018</Year><Month>7</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2018</Year><Month>7</Month><Day>24</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2018</Year><Month>7</Month><Day>24</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>7</Month><Day>24</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">30036650</ArticleId><ArticleId IdType="pmc">PMC6303163</ArticleId><ArticleId IdType="doi">10.1016/j.ipej.2018.07.006</ArticleId><ArticleId IdType="pii">S0972-6292(18)30043-3</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Zipes D.P., Wellens H.J.J. 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The study included 113 patients aged 59.3±10.1 years, after radiofrequency ablation (RFA) with pulmonary veins isolation (PVI) for atrial fibrillation (AF), RFA of cava-tricuspid isthmus (CTI) for atrial flutter (AFl), or combined RFA PVI and CTI. Presence of arrhythmia recurrence episodes, blood pressure (BP) levels, electrocardiographic and echocardiographic indices were assessed before RFA, in acute postoperative period (3-5 days) and 3 months after RFA in the groups of AF, AFl, and AF/AFl combination. In acute postoperative period, arrhythmia recurrence of was most often recorded in the AF/AFl group, less often in groups of isolated AF and AFl, 3 months later - the frequency of recurrence decreased in all groups, but the largest remained in group of combined AF/AFl. In first 3 months after RFA of AF a decreased heart rate (HR), right atrium (RA) and ventricle (RV) size, an increased QTc interval duration and BP; after RFA of AFl - a decreased HR, end-diastolic volume (EDV) and RA; and after RFA of AF/AFl - a decreased ejection fraction (EF), an increased BP, QTc interval duration, and the end-systolic volume (EDV) were recorded. The results showed that effectiveness of RFA of isolated AF and AFl is higher than RFA of combined AF/AFl in the first 3 months after the procedure. Isolated AF and AFl after RFA were associated with BP and QTc interval duration increase, HR, EDV, RA and RV decrease; combined RFA of AF and AFl - with BP, QTc interval duration and ESV increase and left ventricular EF decrease. |
19,096 | Editor's Choice-The treatment of electrical storm: an educational review. | Electrical storm is characterised by a state of severe electrical instability that occurs in a rare combination of circumstances, and may lead to multiple implantable cardioverter defibrillator shocks and haemodynamic instability, and possible death. The main goal of treating electrical storm is to eliminate the trigger and modify the substrate of the arrhythmia. The aim of this educational review is to provide information for a better understanding of the underlying mechanisms and therefore help to improve the treatment of electrical storm patients. |
19,097 | Aripiprazole-induced atrial fibrillation in a patient with concomitant risk factors. | Aripiprazole is an atypical antipsychotic drug with a polypharmacological mechanism of action and a favorable tolerability profile. Its major indications are schizophrenia and mania in adults and adolescents. Here we present the case of a 43-year-old Caucasian man with schizophrenia who developed atrial fibrillation (AF) after starting aripiprazole treatment. Prior to this treatment, he had never received any antipsychotic drugs. On admission to our inpatient unit, he showed severe psychotic symptoms and was started on aripiprazole with a rapid titration regimen (15 mg on the first day and then 15 mg twice daily thereafter) in combination with lorazepam (2.5 mg thrice a day). On the third day, the patient exhibited vomiting and an irregular pulse. An electrocardiogram (ECG) revealed new-onset AF with rapid ventricular response. Aripiprazole was discontinued and cardioversion was obtained with intravenous amiodarone. A different antipsychotic treatment was thus started (perphenazine 12 mg/d), which led to symptom remission without any relevant adverse effects. During the 2-year follow-up observation, neither psychotic symptoms nor ECG abnormalities were detected. Besides aripiprazole, other co-occurring factors might have contributed to the onset of AF in our patient, namely hypertension, low-grade diastolic dysfunction, chronic inflammatory disease, CYP2D6 polymorphism, corticosteroid and antiulcer treatment, and a family loading for myocardial infarction. In conclusion, our case study suggests that although aripiprazole has fewer cardiovascular effects than other antipsychotic drugs, in the presence of concomitant risk factors, high dose, and rapid titration regimen, regular monitoring of clinical parameters and ECG is highly recommended. (PsycINFO Database Record (c) 2018 APA, all rights reserved). |
19,098 | Cyclophosphamide-induced Atrial Fibrillation With Rapid Ventricular Rate. | Cyclophosphamide (CYA), also known as cytophosphane, is a medication used as a chemotherapeutic agent and immune suppressor.Its common adverse effects include nausea, vomiting, diarrhea, bone marrow suppression, hemorrhagic cystitis, alopecia, lethargy, and cardiotoxicity. Cyclophosphamide-related cardiac toxicity is not uncommon and causes potentially serious complications in patients. In this review, we present a case of a 65-years-old patient who developed atrial fibrillation with rapid ventricular rate (RVR) after receiving a single dose of CYA. In this case, the advanced age of the patient, pre-treatment with prednisone, and renal insufficiency most likely predisposed the patient to CYA-induced cardiac toxicity. A relevant literature review was also conducted to determine the pathogenesis, risk factors, and spectrum of CYA-induced cardiac toxicity. |
19,099 | Isolated Mitral Valve Surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis. | Data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database were analyzed to identify trends in patient characteristics and outcomes of mitral valve operations in North America.</AbstractText>All patients with isolated primary mitral valve operations with or without tricuspid valve repair, surgical atrial fibrillation ablation, or atrial septal defect closure performed July 2011 to September 2016 were identified. A subgroup analysis assessed patients with degenerative leaflet prolapse (DLP).</AbstractText>Isolated primary mitral valve operations were performed on 87,214 patients at 1,125 centers, increasing by 24% between 2011 (n = 14,442) and 2016 (n = 17,907). The most common etiology was DLP (60.7%); 4.3% had functional mitral regurgitation. Preoperatively, 47.3% of patients had an ejection fraction less than 60% and 34.2% had atrial fibrillation. Overall mitral valve repair rate was 65.6%, declining from 67.1% (2011) to 63.2% (2016; p < 0.0001). Repair rates were related to etiology (DLP, 82.5%; rheumatic, 17.5%). Of the 29,970 mitral valve replacements, 16.2% were preceded by an attempted repair. Repair techniques included prosthetic annuloplasty (94.3%), leaflet resection (46.5%), and artificial cord implantation (22.7%). Bioprosthetic valves were implanted with increasing frequency (2011, 65.4%; 2016, 75.8%; p < 0.0001). Less-invasive operations were performed in 23.0% and concomitant tricuspid valve repair in 15.7%. Unadjusted operative mortality was 3.7% (replacements) and 1.1% (repairs).</AbstractText>Patients undergoing primary isolated mitral valve operations commonly have ventricular dysfunction, atrial fibrillation, and heart failure. Although contemporary outcomes are excellent, earlier guideline-directed referral and increased frequency and quality of repair may further improve results of mitral valve operations.</AbstractText>Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
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