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19,700 | Corpuls CPR Generates Higher Mean Arterial Pressure Than LUCAS II in a Pig Model of Cardiac Arrest. | According to the European Resuscitation Council guidelines, the use of mechanical chest compression devices is a reasonable alternative in situations where manual chest compression is impractical or compromises provider safety. The aim of this study is to compare the performance of a recently developed chest compression device (Corpuls CPR) with an established system (LUCAS II) in a pig model. <i>Methods</i>. Pigs (<i>n</i> = 5/group) in provoked ventricular fibrillation were left untreated for 5 minutes, after which 15 min of cardiopulmonary resuscitation was performed with chest compressions. After 15 min, defibrillation was performed every 2 min if necessary, and up to 3 doses of adrenaline were given. If there was no return of spontaneous circulation after 25 min, the experiment was terminated. Coronary perfusion pressure, carotid blood flow, end-expiratory CO<sub>2</sub>, regional oxygen saturation by near infrared spectroscopy, blood gas, and local organ perfusion with fluorescent labelled microspheres were measured at baseline and during resuscitation. <i>Results</i>. Animals treated with Corpuls CPR had significantly higher mean arterial pressures during resuscitation, along with a detectable trend of greater carotid blood flow and organ perfusion. <i>Conclusion</i>. Chest compressions with the Corpuls CPR device generated significantly higher mean arterial pressures than compressions performed with the LUCAS II device. |
19,701 | A Patient with Left Bundle Branch Block and Persistent Atrial Fibrillation Treated with Cardiac Catheter Ablation and Pharmacologic Cardiac Resynchronization Therapy without the Use of an Implantable Cardiac Device. | BACKGROUND Left bundle branch block (LBBB) is associated with atrial fibrillation (AF) and systolic heart failure, which can be treated with cardiac resynchronization therapy (CRT) that includes an implantable cardiac device (ICD). However, in some patients, LBBB may vary with heart rate, and during episodes of AF in LBBB, aberrant ventricular conduction, or wide QRS complex tachycardia (Ashman beats) can occur. This report is a case of LBBB treated with pharmacologic CRT, without the use of an ICD. CASE REPORT A 68-year-old man presented with persistent AF and systolic heart failure. Serial electrocardiograms (ECGs) showed AF and mixed narrow (116 ms) and wide (152 ms) QRS duration of LBBB. Echocardiography showed a left ventricular ejection fraction (LVEF) of 30%. Catheter ablation for AF resulted in the restoration of sinus rhythm. The patient was treated with step-wise decreasing doses of amiodarone, from 200 mg to 75 mg daily, and step-wise increasing doses of bisoprolol, from 3.75 mg to 5.0 mg daily, which effectively slowed heart rate, inhibited aberrant cardiac conduction due to LBBB, reduced the symptoms of heart failure, and improved LVEF to 60%, despite persistent sinus bradycardia and the inability of the heart rate to increase during activity (chronotropic incompetence). CONCLUSIONS This report of a case of AF associated with LBBB shows that pharmacologic CRT can restore sinus rhythm following catheter ablation and can reduce heart rate and treat heart failure without the use of an ICD. |
19,702 | Impact of Atrial Fibrillation During ST-Segment-Elevation Myocardial Infarction on Infarct Characteristics and Prognosis. | Atrial fibrillation (AF) is frequently observed in patients with ST-segment-elevation myocardial infarction and associated with worse clinical outcome. However, the mechanisms for this increased risk are not fully understood. The purpose of this study was to investigate the relationship of the presence of AF to cardiac magnetic resonance (CMR) derived myocardial salvage and damage as well as clinical outcomes.</AbstractText>This multicenter CMR study enrolled 786 patients with ST-segment-elevation myocardial infarction. CMR parameters (infarct size, myocardial salvage index, microvascular obstruction, and myocardial function) were assessed 3 (interquartile range [IQR], 2-4) days post-ST-segment-elevation myocardial infarction and compared between patients with or without AF during hospitalization. Major adverse cardiac events were assessed as a composite of all-cause death, reinfarction, and new congestive heart failure at 12 months. AF was documented in 48 (6.1%) patients. There was no significant difference in infarct size (18 [IQR, 9-29]% versus 17 [IQR, 9-25]% of left ventricular mass; P</i>=0.340), myocardial salvage index (51 [IQR, 34-69] versus 51 [IQR, 33-69]; P</i>=0.830), or microvascular obstruction (0.6 [IQR, 0-2.0]% versus 0.0 [IQR, 0-1.8]% of left ventricular mass; P</i>=0.340) between groups. Patients with AF had significantly lower left ventricular (47 [IQR, 34-54]% versus 51 [IQR, 44-58]%; P</i>=0.003) and left atrial (42 [IQR, 17-57]% versus 53 [IQR, 45-59]%; P</i><0.001) ejection fraction. AF was associated with major adverse cardiac events, even when adjusting for clinical risk factors (odds ratio, 2.48 [95% confidence interval, 1.22-5.03]; P</i>=0.0120) or CMR prognosis markers (odds ratio, 3.77 [95% confidence interval, 1.83-7.79]; P</i>=0.001).</AbstractText>This CMR study found no major differences in myocardial salvage, infarct size, or microvascular damage in patients with ST-segment-elevation myocardial infarction or without AF. AF was, however, associated with cardiac dysfunction and independently related to major adverse cardiac events.</AbstractText>URL: http://www.clinicaltrials.gov. Unique identifier: NCT00712101.</AbstractText>© 2018 American Heart Association, Inc.</CopyrightInformation> |
19,703 | The role of conductivity discontinuities in design of cardiac defibrillation. | Fibrillation is an erratic electrical state of the heart, of rapid twitching rather than organized contractions. Ventricular fibrillation is fatal if not treated promptly. The standard treatment, defibrillation, is a strong electrical shock to reinitialize the electrical dynamics and allow a normal heart beat. Both the normal and the fibrillatory electrical dynamics of the heart are organized into moving wave fronts of changing electrical signals, especially in the transmembrane voltage, which is the potential difference between the cardiac cellular interior and the intracellular region of the heart. In a normal heart beat, the wave front motion is from bottom to top and is accompanied by the release of Ca ions to induce contractions and pump the blood. In a fibrillatory state, these wave fronts are organized into rotating scroll waves, with a centerline known as a filament. Treatment requires altering the electrical state of the heart through an externally applied electrical shock, in a manner that precludes the existence of the filaments and scroll waves. Detailed mechanisms for the success of this treatment are partially understood, and involve local shock-induced changes in the transmembrane potential, known as virtual electrode alterations. These transmembrane alterations are located at boundaries of the cardiac tissue, including blood vessels and the heart chamber wall, where discontinuities in electrical conductivity occur. The primary focus of this paper is the defibrillation shock and the subsequent electrical phenomena it induces. Six partially overlapping causal factors for defibrillation success are identified from the literature. We present evidence in favor of five of these and against one of them. A major conclusion is that a dynamically growing wave front starting at the heart surface appears to play a primary role during defibrillation by critically reducing the volume available to sustain the dynamic motion of scroll waves; in contrast, virtual electrodes occurring at the boundaries of small, isolated blood vessels only cause minor effects. As a consequence, we suggest that the size of the heart (specifically, the surface to volume ratio) is an important defibrillation variable. |
19,704 | Infantile-onset Pompe disease with neonatal debut: A case report and literature review. | Infantile-onset Pompe disease, also known as glycogen storage disease type II, is a progressive and fatal disorder without treatment. Enzyme replacement therapy with recombinant human acid alpha-glucosidase (GAA) enhances survival; however, the best outcomes have been achieved with early treatment.</AbstractText>We report a case of a newborn with infantile-onset Pompe disease diagnosed in the first days of life who did not undergo universal neonatal screening. The patient was asymptomatic, with a general physical examination revealing only a murmur. The clinical presentation was dominated by the neonatal detection of hypertrophic cardiomyopathy, without hypotonia or macroglossia.</AbstractText>Pompe disease was confirmed in the first week of life by GAA activity in dried blood spots, and a GAA genetic study showed the homozygous mutation p.Arg854X.</AbstractText>Parents initially refused replacement therapy.</AbstractText>The patient experienced recurrent episodes of ventricular fibrillation during central line placement and could not be resuscitated.</AbstractText>Although Pompe disease is rare, and universal screening has not been established, neonatologists should be alerted to the diagnosis of Pompe in the presence of hypertrophic cardiomyopathy. Diagnosis is achieved in a few days with the aid of dried blood spots.</AbstractText>Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.</CopyrightInformation> |
19,705 | Chronic primary adrenal insufficiency after unilateral adrenonephrectomy: A case report. | Unilateral adrenalectomy as part of surgical resection of renal cell carcinoma (RCC) is not thought to increase the risk of chronic adrenal insufficiency, as the contralateral adrenal gland is assumed to be capable of compensating for the lost function of the resected gland. However, recent studies have indicated that adrenalectomy might cause irreversible impairment of the adrenocortical reserve. We describe a case of chronic primary adrenal insufficiency in a 68-year-old man who previously underwent unilateral adrenonephrectomy, which was complicated by severe postoperative adrenal stress that involved cardiopulmonary disturbance and systemic infection.</AbstractText>A 68-year-old Japanese man presented with weight loss of 6 kg over a 4-month period, and renal biopsy confirmed a diagnosis of RCC. He underwent adrenonephrectomy for the RCC, but developed postoperative septic shock because of a retroperitoneal cystic infection and ventricular fibrillation that was induced by vasospastic angina. The patient was successfully treated using antibiotics and percutaneous coronary intervention, and was subsequently discharged with no apparent complications except decreased appetite and general fatigue. However, his appetite and fatigue did not improve over time and he was readmitted for an examination.</AbstractText>The workup revealed a markedly elevated adrenocorticotropic hormone (ACTH) level (151.4 pg/mL, normal: 7-50 pg/mL) and a mildly decreased morning serum cortisol level (6.4 mg/mL, normal: 7-28 mg/mL). In addition to the patient's clinical symptoms and laboratory results, the results from ACTH and corticotropin-releasing hormone stimulation tests were used to make a diagnosis of primary adrenal insufficiency.</AbstractText>Treatment was initiated using oral prednisolone (20 mg), which rapidly resolved his symptoms. At the 1-year follow-up, the patient had a markedly decreased serum cortisol level (2.0 mg/mL) with an ACTH level that was within the normal range (44.1 pg/mL) before his morning dose of prednisolone, which confirmed the diagnosis of chronic primary adrenal insufficiency.</AbstractText>Clinicians must be aware of chronic adrenal insufficiency as a possible complication of unilateral adrenalectomy, especially when patients who underwent unilateral adrenalectomy experience severe adrenal stress.</AbstractText>Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.</CopyrightInformation> |
19,706 | Characterizing left ventricular mechanical and electrical activation in patients with normal and impaired systolic function using a non-fluoroscopic cardiovascular navigation system. | Cardiac disease frequently has a degenerative effect on cardiac pump function and regional myocardial contraction. Therefore, an accurate assessment of regional wall motion is a measure of the extent and severity of the disease. We sought to further validate an intra-operative, sensor-based technology for measuring wall motion and strain by characterizing left ventricular (LV) mechanical and electrical activation patterns in patients with normal (NSF) and impaired systolic function (ISF).</AbstractText>NSF (n = 10; ejection fraction = 62.9 ± 6.1%) and ISF (n = 18; ejection fraction = 35.1 ± 13.6%) patients underwent simultaneous electrical and motion mapping of the LV endocardium using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™, Abbott). Motion trajectories, strain profiles, and activation times were calculated over the six standard LV walls.</AbstractText>NSF patients had significantly greater motion and systolic strains across all LV walls than ISF patients. LV walls with low-voltage areas showed less motion and systolic strain than walls with normal voltage. LV electrical dyssynchrony was significantly smaller in NSF and ISF patients with narrow-QRS complexes than ISF patients with wide-QRS complexes, but mechanical dyssynchrony was larger in all ISF patients than NSF patients. The latest mechanical activation was most often the lateral/posterior walls in NSF and wide-QRS ISF patients but varied in narrow-QRS ISF patients.</AbstractText>This intra-operative technique can be used to characterize LV wall motion and strain in patients with impaired systolic function. This technique may be utilized clinically to provide individually tailored LV lead positioning at the region of latest mechanical activation for patients undergoing cardiac resynchronization therapy.</AbstractText>URL: http://www.clinicaltrials.gov . Unique identifier: NCT01629160.</AbstractText> |
19,707 | Locating Order-Disorder Phase Transition in a Cardiac System. | To prevent sudden cardiac death, predicting where in the cardiac system an order-disorder phase transition into ventricular fibrillation begins is as important as when it begins. We present a computationally efficient, information-theoretic approach to predicting the locations of the wavebreaks. Such wavebreaks initiate fibrillation in a cardiac system where the order-disorder behavior is controlled by a single driving component, mimicking electrical misfiring from the pulmonary veins or from the Purkinje fibers. Communication analysis between the driving component and each component of the system reveals that channel capacity, mutual information and transfer entropy can locate the wavebreaks. This approach is applicable to interventional therapies to prevent sudden death, and to a wide range of systems to mitigate or prevent imminent phase transitions. |
19,708 | Application of ventricular tachyarrhythmia definitions of the updated Lambeth Conventions provides incompatibility with earlier results, masks antifibrillatory activity and reduces inter-observer agreement. | The Lambeth Conventions (LC I), a landmark guidance document for arrhythmia research was updated and arrhythmia definitions were changed in the new Lambeth Conventions II (LC II). This study examined whether the arrhythmia definitions of LC I and LC II yield the same qualitative results and whether LC II improves inter-observer agreement. Two independent investigators performed blinded arrhythmia analysis of the electrocardiograms of isolated, Langendorff rat hearts subjected to regional ischemia and perfused with Class I antiarrhythmics with 3 or 5 mM K<sup>+</sup> in the perfusate. Data obtained with arrhythmia definitions of LC I and LC II were compared within and between observers. Applying ventricular fibrillation (VF) definition of LC II significantly increased VF incidence and reduced VF onset time irrespective of treatment by detecting 'de novo' VF episodes not found by LC I. LC II reduced the number of ventricular tachycardia (VT) episodes and simultaneously increased the number of VF episodes as compared with the respective values obtained according to LC I. Using VF definition of LC II masked the significant antifibrillatory effects of flecainide and the high K<sup>+</sup> concentration identified with the VF definition of LC I. When VF incidence was tested, a very strong inter-observer agreement was found according to LC I, whereas using VF definition of LC II reduced inter-observer agreement. It is concluded that LC II shifts some tachyarrhythmias from VT to VF class, and thus results obtained by arrhythmia definitions of LC I and LC II are not compatible; VF definition of LC II may change the conclusion of pharmacological, physiological and pathophysiological arrhythmia investigations and may reduce inter-observer agreement. Thus, VT and VF definitions of LC II should be amended in order to increase compatibility and inter-observer agreement. |
19,709 | Catheter Ablation for Atrial Fibrillation with Heart Failure. | Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment.</AbstractText>We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure.</AbstractText>After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medical-therapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P=0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P=0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P=0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P=0.009).</AbstractText>Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF ClinicalTrials.gov number, NCT00643188 .).</AbstractText> |
19,710 | Cardiac Disorders in Patients With Leber Hereditary Optic Neuropathy. | Cardiac abnormalities have been described in patients with Leber hereditary optic neuropathy (LHON). Some are life-threatening because of the risk of ventricular fibrillation and sudden death. The purpose of our study was to better characterize the cardiac abnormalities in a large patient cohort with LHON.</AbstractText>A retrospective study of the electrocardiogram (EKG) results performed on all patients with LHON evaluated at The Reference Center for Rare Diseases in Ophthalmology, Paris, France, from January 2015 to June 2017.</AbstractText>Our series included 73 patients with LHON (9 women/64 men) with a mean age of 30.29 ± 14.48 years. Although only 1 patient had cardiac complaints, cardiac abnormalities were detected in 17 patients (23.2%): 9 patients had an excitation syndrome, 6 had atrioventricular block, and 2 had repolarization abnormalities. All patients harbored mtDNA point mutations 11778 or 3460.</AbstractText>Cardiac abnormalities occur frequently enough in patients with LHON that a baseline EKG is warranted. However, further studies are needed to determine the true cardiac risk associated with specific LHON mtDNA mutations.</AbstractText> |
19,711 | Accelerated real-time cardiac MRI using iterative sparse SENSE reconstruction: comparing performance in patients with sinus rhythm and atrial fibrillation. | To compare accelerated real-time cardiac MRI (CMR) using sparse spatial and temporal undersampling and non-linear iterative SENSE reconstruction (RT IS SENSE) with real-time CMR (RT) and segmented CMR (SEG) in a cohort that included atrial fibrillation (AF) patients.</AbstractText>We evaluated 27 subjects, including 11 AF patients, by acquiring steady-state free precession cine images covering the left ventricle (LV) at 1.5 T with SEG (acceleration factor 2, TR 42 ms, 1.8 × 1.8 × 6 mm3</sup>), RT (acceleration factor 3, TR 62 ms, 3.0 × 3.0 × 7 mm3</sup>), and RT IS SENSE (acceleration factor 9.9-12, TR 42 ms, 2.0 × 2.0 × 7 mm3</sup>). We performed quantitative LV functional analysis in sinus rhythm (SR) patients and qualitatively scored image quality, noise and artefact using a 5-point Likert scale in the complete cohort and AF and SR subgroups.</AbstractText>There was no difference between LV functional parameters between acquisitions in SR patients. RT IS SENSE short-axis image quality was superior to SEG (4.5 ± 0.6 vs. 3.9 ± 1.1, p = 0.007) and RT (3.8 ± 0.4, p = 0.003). There was reduced artefact in RT IS SENSE compared to SEG (4.4 ± 0.6 vs. 3.8 ± 1.2, p = 0.04), driven by arrhythmia performance. RT IS SENSE short-axis image quality was superior to SEG (4.6 ± 0.5 vs. 3.1 ± 1.0, p < 0.001) in the AF subgroup.</AbstractText>Accelerated real-time CMR with iterative sparse SENSE provides excellent clinical performance, especially in patients with AF.</AbstractText>• Iterative sparse SENSE significantly accelerates real-time cardiovascular MRI acquisitions. • It provides excellent qualitative and quantitative performance in sinus rhythm patients. • It outperforms standard segmented acquisitions in patients with atrial fibrillation. • It improves the trade-off between temporal and spatial resolution in real-time imaging.</AbstractText> |
19,712 | Ventricular Fibrillation Associated With Dynamic Changes in J-Point Elevation in a Patient With Silent Thyroiditis. | A J wave is a common electrocardiographic finding in the general population. Individuals with prominent J waves in multiple electrocardiogram (ECG) leads have a higher risk of lethal arrhythmias than those with low-amplitude J waves. There are few reports about the relationship between thyroid function and J-wave amplitude. We report the case of a 45-year-old man who had unexpected ventricular fibrillation (VF). He had dynamic J-point elevation in multiple ECG leads. Possible early repolarization syndrome was diagnosed. He also had thyrotoxicosis caused by silent thyroiditis, and his J-wave amplitude decreased according to changes in thyroid function because of spontaneous remission of silent thyroiditis. There was a positive correlation between serum triiodothyronine levels and J-wave amplitudes. The findings in case suggested silent thyroiditis may contribute to the occurrence of VF in a patient with dynamic changes in J-point elevation in multiple ECG leads. Thyrotoxicosis is a relatively common endocrine disease; therefore, clinicians should pay attention to J-wave amplitude in the ECG of patients with thyrotoxicosis. |
19,713 | A single electrical pulse within the protective zone of each cardiac cycle prevented reperfusion-induced ventricular tachycardia in conscious mice. | Early pioneering investigators discovered, in anesthetized dogs, a protective period within the cardiac cycle. The protective period was a time within the cardiac cycle when a precisely timed stimulus prevented the initiation of ventricular fibrillation caused by an earlier stimulus. Thus, in addition to the susceptible period of repolarization discussed by Wiggers and Wegria (Am. J. Physiol. 131:296, 1940; Am. J. Physiol. 128:500, 1940), there is also a nearby protective period. This report describes a protective period within the cardiac cycle of conscious mice when a precisely timed stimulus prevented the initiation of ventricular tachycardia caused by an earlier stimulus. In addition, we tested the hypothesis that this precisely timed pulse within the protective period prevents reperfusion-induced ventricular tachyarrhythmias in conscious mice. Mice (n = 6) were prepared to record arterial blood pressure and the electrocardiogram. In addition, a vascular occluder was placed around the left main coronary artery, and stimulating electrodes were secured onto the left ventricle. A single precisely timed electrical pulse (5 msec pulse width and 2.5 V) to the left ventricle arriving 13.9 ± 1.1 msec after the R-wave, caused ventricular tachycardia occurring 24.9 ± 0.9 msec after the R-wave. Importantly, a second precisely timed electrical pulse arriving 18.8 ± 0.5 msec after the first stimulus blocked the induction of ventricular tachycardia caused by the earlier stimulus. On an alternate day, the susceptibility to sustained ventricular tachycardia produced by 3.5 min of occlusion and reperfusion of the coronary artery was determined in conscious mice by use of the vascular occluder. Reperfusion resulted in ventricular tachycardia in all six mice. A precisely timed pulse within the protective period prevented ventricular tachycardia in all mice. |
19,714 | Prolonged corrected QT interval in predicting atrial fibrillation: A systematic review and meta-analysis. | Corrected QT interval (QTc) on the electrocardiogram is a marker of ventricular repolarization. Recent studies have examined its value in predicting the occurrence of atrial fibrillation (AF).</AbstractText>We conducted a meta-analysis to determine whether alterations in QTc interval are associated with an increased risk of incident AF. The PUBMED and EMBASE databases were searched for all studies that evaluated the incident AF associated with prolonged QTc interval published before December 2016. Sensitivity and subgroup analysis were subsequently performed. A total of six studies including eight data sets for prolonged QTc interval were eligible. Subjects with prolonged QTc interval as a categorical variable had a significantly higher risk of AF during follow-up (hazard ratio [HR]: 1.16; 95% confidence interval [CI], 1.09-1.24, I2 </sup> = 90%) based on Bazett formula. In continuous variable analysis, we found a statistically significant risk for AF (HR, 1.17; 95% CI, 1.09-1.25; I2 </sup> = 0) every 10-ms prolongation in QTc. AF type, QTc cut-off value, geographical location, follow-up duration, and study population may be the possible reasons for the significant heterogeneity among the studies.</AbstractText>Prolonged QTc interval is associated with an increased risk of AF. And the potential mechanisms underlying this cause-and-effect relationship need further investigation.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,715 | Antiarrhythmic effect of antazoline in experimental models of acquired short- and long-QT-syndromes. | Antazoline is a first-generation antihistamine with antiarrhythmic properties. This study examines potential electrophysiological effects of antazoline in short-QT-syndrome (SQTS) and long-QT-syndrome (LQTS).</AbstractText>Sixty-five rabbit hearts were Langendorff-perfused. Action potential duration at 90% of repolarization (APD90), QT-interval, spatial dispersion (DISP), and effective refractory period (ERP) were measured. The IK, ATP-opener pinacidil (1 µM, n = 14) reduced APD90 (-14 ms, P < 0.01), QT-interval (-14 ms, P < 0.01), and ERP (-11 ms, P < 0.01), thus simulating acquired SQTS. Additional infusion of 20 µM antazoline prolonged repolarization. Under baseline conditions, ventricular fibrillation (VF) was inducible in 5 of 14 hearts (10 episodes) and in 5 of 14 pinacidil-treated hearts (21 episodes, P = ns). Antazoline significantly reduced induction of VF (0 episodes, P < 0.05 each). Further 17 hearts were perfused with 100 µM sotalol and 17 hearts with 300 µM erythromycin to induce acquired LQTS2. In both groups, prolongation of APD90, QT-interval, and ERP was observed. Spatial dispersion was increased (sotalol: +26 ms, P < 0.01; erythromycin: +31 ms, P < 0.01). Additional infusion of antazoline reduced DISP (sotalol: -22 ms, P < 0.01; erythromycin: -26 ms, P < 0.01). Torsade de pointes (TdP) occurred in 6 of 17 sotalol-treated (22 episodes, P < 0.05 each) and in 8 of 17 erythromycin-treated hearts (96 episodes P < 0.05 each). Additional infusion of antazoline completely suppressed TdP in both groups (P < 0.05 each). Acquired LQTS3 was induced by veratridine (0.5 µM, n = 17) and similar results were obtained (APD90: +24 ms, P < 0.01, QT-interval: +58 ms, P < 0.01, DISP: +38 ms, P < 0.01). Torsade de pointes occurred in 10 of 17 hearts (41 episodes, P < 0.05 each). Antazoline significantly reduced TdP (2 of 17 hearts, 4 episodes, P < 0.05 each).</AbstractText>Antazoline significantly reduced induction of VF in an experimental model of acquired SQTS. In three experimental models of acquired LQTS, antazoline effectively suppressed TdP.</AbstractText> |
19,716 | Assessment of left ventricular dyssynchrony by three-dimensional echocardiography: Prognostic value in patients undergoing cardiac resynchronization therapy. | Systolic dyssynchrony index (SDI) using three-dimensional echocardiography (3DE) was shown to be a reliable measure of left ventricular (LV) dyssynchrony. However, the prognostic value of SDI on long-term outcomes after cardiac resynchronization therapy (CRT) remains unknown.</AbstractText>A total of 414 patients (mean age 67 ± 10 years, 60% ischemic etiology) with 3DE evaluation before CRT implantation were included. SDI was evaluated as continuous value and in quartiles. The study endpoint was combined all-cause mortality, heart transplantation, and LV assist device implantation. At baseline, median SDI was 8.0% (IQR 5.6-11.3%). During a median follow-up of 45 months (IQR 25-59 months), the endpoint was observed in 94 (23%) patients. SDI was independently associated with the endpoint together with ischemic etiology, diabetes, and renal function (HR 0.914, P = 0.003) after adjustment for age, atrial fibrillation, hemoglobin level, NYHA functional class, and posterolateral LV lead position. Patients from the 1st, 2nd, and 3rd SDI quartiles showed similar survival and superior as compared to the 4th quartile with the lowest SDI values (≤5.5%; χ²: 30.4, log-rank P < 0.001). From receiver operating characteristic curve analysis, the optimal SDI cut-off value associated with the endpoint was >6.8% (area under the curve 0.634). Finally, a subgroup analysis (293 patients) demonstrated that a more pronounced reduction in SDI immediately after CRT (resynchronization) was independently associated with superior survival (HR 0.461, P = 0.011) after adjustment for prognostic relevant parameters.</AbstractText>SDI is independently associated with long-term prognosis after CRT and might therefore be important to optimize risk-stratification in these patients.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,717 | Pravastatin Decreases Infarct Size Induced by Coronary Artery Ischemia/Reperfusion with Elevated eNOS Expression in Rats. | Our previous study showed that pravastatin prevents ischemia and reperfusion-induced lethal ventricular fibrillation in rats. This study explored whether pravastatin decreases myocardial infarct size and this effect is associated with endothelial nitric oxide synthase (eNOS) expression in myocardium. Rats were treated with ischemia (30 minutes) and reperfusion (60 minutes) after chronic oral administration of pravastatin, fluvastatin, or vehicle once daily for 22 days. Electrocardiograms and blood pressure were continuously recorded, myocardial infarct size was measured by TTC-staining, and eNOS expression was measured by western blot. The results showed that pravastatin and fluvastatin significantly reduced myocardial infarct size. No statistical differences were found in the areas at risk among all groups. However, a significant reduction in infarct size was observed in three pravastatin groups and one fluvastatin group compared to control. Both pravastatin and fluvastatin significantly increased eNOS protein expression in ischemic and non-ischemic tissues compared to control. Our results suggest that pravastatin decreases cardiovascular mortality beyond its cholesterol-lowering effect. Pravastatin is more potent than fluvastatin in reducing infarct size. These effects may be associated with elevation of eNOS expression. |
19,718 | Implantable cardioverter defibrillator does not cure the heart. | A man with non-ischemic cardiomyopathy, EF 22%, permanent AF and ICD was admitted for elective device replacement. The need for the optimization of the ventricular rate and avoidance of right ventricular pacing made it necessary to up-grade the existing pacing system using direct His bundle pacing and dual chamber ICD. This enabled the regularization of ventricular rate, avoiding the RV pacing and optimize the beta-blocker dose. The one month follow-up already showed reduction in left ventricle diameter, improvement in ejection fraction, NYHA class decrease to II. The His bundle pacing enabled the optimal treatment of the patient resulting in excellent clinical improvement. |
19,719 | Comparison of Survival After In-Hospital Cardiac Arrest in Patients With Versus Without Diabetes Mellitus. | Diabetes mellitus (DM) increases the risk of sudden cardiac death, but the extent to which it influences survival after an in-hospital cardiac arrest (IHCA) remains unclear. We assessed the association of DM and survival after IHCA. The study included 1,009,073 patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA between January 2003 and December 2013, recorded in the Nationwide Inpatient Sample database. The outcomes were survival to hospital discharge and discharge disposition assessed using multivariable logistic regression accounting for relevant covariates and clustering. Of the patients with IHCA, 30.8% (310,825) had DM and were more likely to be older and to have a higher prevalence of co-morbidities including hypertension, dyslipidemia, chronic kidney disease, and previous cardiovascular disease (all p <0.001). The rates of survival to hospital discharge after IHCA were 27.0% and 25.1% in patients with and without DM, respectively. After multivariable adjustment, DM was associated with a modestly lower risk-adjusted survival to hospital discharge (adjusted OR [aOR] 0.96, 95% confidence interval [95% CI] 0.95 to 0.97, p <0.001). This association was influenced by a number of factors (all interaction p <0.001), including a lower risk of survival among patients with DM who were younger (aOR 0.93, 95% CI 0.92 to 0.94 among those aged <75 years), those with a primary cardiovascular diagnosis (aOR 0.88, 95% CI 0.86 to 0.89), and those with ventricular fibrillation/ventricular tachycardia as the cardiac arrest rhythm (aOR 0.88, 95% CI 0.79 to 0.82). Patients with DM had lower odds of being discharged home with self-care after surviving an IHCA (p <0.001). In conclusion, preexisting DM was associated with a modestly lower risk-adjusted chance of survival after an IHCA. |
19,720 | Left atrial appendage resection can be performed minimally invasively with good clinical and echocardiographic outcomes without any severe risk. | The adverse effects of left atrial appendage (LAA) closure have not yet been evaluated. This study aimed to prove the safety and low invasiveness of LAA resection through our thoracoscopic stand-alone left atrial appendectomy experience.</AbstractText>Eighty-seven patients [mean age 68 ± 9 years, 68 men (78%), mean congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischaemic attack to thromboembolism, vascular disease, age 65-74 years and sex category (CHA2DS2-VASc) score 2.9 ± 1.6 points] who had undergone thoracoscopic left atrial appendectomy were selected. The operative and clinical data (left atrial diameter, left ventricular diameter of systole/diastole, ejection fraction, brain natriuretic peptide and human atrial natriuretic peptide) were evaluated. All procedures were performed without cardiopulmonary bypass or cardiac arrest. The LAA was resected with an endoscopic linear cutter device. Except for 1 case with severe pleural adhesion, all operations were performed thoracoscopically.</AbstractText>The preoperative and postoperative data are as follows: left atrial diameter 43 ± 5 mm and 43 ± 5 mm (P = 0.8); left ventricular diameter of systole/diastole 50 ± 5/35 ± 6 mm and 48 ± 5/34 ± 6 mm (P < 0.01); ejection fraction 57 ± 10% and 56 ± 10% (P = 0.11); brain natriuretic peptide 97 ± 77 pg/ml and 72 ± 65 pg/ml (P < 0.01) and human atrial natriuretic peptide 73 ± 64 pg/ml and 96 ± 67 pg/ml (P = 0.03), respectively. The mean volume of bleeding in the operation was very small (<10 ml). The mean length of postoperative in-hospital stay was 3.8 ± 1.8 days. All the patients were discharged while maintaining their preoperative activities of daily living without major complications. No thrombus or residual stumps were detected during the 3-month postoperative computed tomography follow-up. The perioperative heart function did not change significantly in this study. Bleeding with resection was minimal, and no rebleeding events occurred.</AbstractText>LAA resection did not affect negatively on the cardiac function and did not increase the risk of bleeding risk.</AbstractText> |
19,721 | Multiple Roles of Pitx2 in Cardiac Development and Disease. | Cardiac development is a complex morphogenetic process initiated as bilateral cardiogenic mesoderm is specified at both sides of the gastrulating embryo. Soon thereafter, these cardiogenic cells fuse at the embryonic midline configuring a symmetrical linear cardiac tube. Left/right bilateral asymmetry is first detected in the forming heart as the cardiac tube bends to the right, and subsequently, atrial and ventricular chambers develop. Molecular signals emanating from the node confer distinct left/right signalling pathways that ultimately lead to activation of the homeobox transcription factor Pitx2 in the left side of distinct embryonic organ anlagen, including the developing heart. Asymmetric expression of Pitx2 has therefore been reported during different cardiac developmental stages, and genetic deletion of Pitx2 provided evidence of key regulatory roles of this transcription factor during cardiogenesis and thus congenital heart diseases. More recently, impaired Pitx2 function has also been linked to arrhythmogenic processes, providing novel roles in the adult heart. In this manuscript, we provide a state-of-the-art review of the fundamental roles of Pitx2 during cardiogenesis, arrhythmogenesis and its contribution to congenital heart diseases. |
19,722 | Management of Arrhythmias in Heart Failure. | Heart failure patients are predisposed to develop arrhythmias. Supraventricular arrhythmias can exacerbate the heart failure symptoms by decreasing the effective cardiac output and their control require pharmacological, electrical, or catheter-based intervention. In the setting of atrial flutter or atrial fibrillation, anticoagulation becomes paramount to prevent systemic or cerebral embolism. Patients with heart failure are also prone to develop ventricular arrhythmias that can present a challenge to the managing clinician. The management strategy depends on the type of arrhythmia, the underlying structural heart disease, the severity of heart failure, and the range from optimization of heart failure therapy to catheter ablation. Patients with heart failure, irrespective of ejection fraction are at high risk for developing sudden cardiac death, however risk stratification is a clinical challenge and requires a multiparametric evaluation for identification of patients who should undergo implantation of a cardioverter defibrillator. Finally, patients with heart failure can also develop symptomatic bradycardia, caused by sinus node dysfunction or atrio-ventricular block. The treatment of bradycardia in these patients with pacing is usually straightforward but needs some specific issue. |
19,723 | Effects of prasugrel on membrane potential and contractile activity of rat ventricular myocytes. | Though prasugrel is one of the important P2Y12</sub> inhibitors currently in use for antiplatelet therapy, its potential effects on contractility and electrical activity of ventricular myocytes have not yet been investigated. Hence this study was designed to study the impact of prasugrel on contractile function and membrane potential of isolated ventricular myocytes.</AbstractText>Freshly isolated rat ventricular myocytes were used in this study. Myocyte contraction was measured during electrical stimulation of cardiomyocytes and the action potential (AP) recordings were obtained with current clamp mode of the patch-clamp amplifier.</AbstractText>AP duration and fractional shortening of ventricular myocytes did not show any change with the administration of 1μM of prasugrel. However, remarkable depolarization of resting membrane potential followed by apparent fibrillation episodes was detected in the cardiomyocytes. Similar events were observed in the contractile activity of myocytes during field stimulation. Also, a higher concentration of prasugrel (10μM) elicited repeated fibrillations, which disappeared after washout or nitric oxide synthase (NOS) inhibition with L-NAME. In contrast, the same concentration of ticagrelor, another P2Y12</sub> inhibitor did not induce fibrillation events though it decreased the contractility of ventricular myocytes significantly. The perfusion of ventricular myocytes with L-NAME did not alter the negative inotropic effect of ticagrelor.</AbstractText>Prasugrel, a widely used antithrombotic agent, may induce depolarization in the membrane potential of myocytes as well as fibrillation via NO mediated pathway.</AbstractText>Copyright © 2017 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier B.V. All rights reserved.</CopyrightInformation> |
19,724 | Can available mathematical models predict serum digoxin levels in Thai patients? | Digoxin is commonly prescribed for heart failure patients with reduced ejection fraction (HFrEF) and patients with atrial fibrillation (AF). Due to digoxin's narrow therapeutic range, monitoring the serum digoxin concentration (SDC) is important. However, the SDC measurement is not widely available. Equations using clinical parameters can be employed to estimate the SDC but have never been studied in the Thai population. Therefore, we conducted this study to evaluate the correlation between the measured SDC and predicted digoxin level using 2 commonly used equations: the Konishi equation and the Koup and Jusko equation.</AbstractText>This report describes prospective, cross-sectional study conducted at Chiang Mai University. One hundred and fourteen patients were recruited in the study. All of the patients were diagnosed as having HFrEF, AF or both and had been receiving digoxin for at least 4 weeks. The SDC of each patient was measured at steady state and assigned to one of 3 groups according to the classifications of the Digitalis Investigation Group (DIG) trial: in the therapeutic range, over the therapeutic range and in the suboptimal range.</AbstractText>There were significant correlations between the measured and predicted SDCs using both the Konishi equation and the Koup and Jusko equation, which had correlation coefficients (R) of 0.69 and 0.31 (P < .05 for both), respectively. The percentages of patients with measured SDCs in the therapeutic range, over the therapeutic range and in the suboptimal range were 27.2%, 9.6% and 63.2%, respectively. The sensitivity and specificity of the Konishi equation in predicting SDCs in the over the therapeutic range were 72.73% (95% Confidence interval (CI): 39.03%-93.98%) and 80.58% (95% CI: 71.62%-87.72%), respectively. Of the 5 patients (4.4%) who were rehospitalized, 2 patients (0.01%) were readmitted due to acute decompensated heart failure (ADHF). One of the patients had an SDC that was over the therapeutic range. None of the readmitted patients had ventricular arrhythmia.</AbstractText>The Konishi equation yielded better predictions of the SDC, especially in the subgroup of HFrEF patients. Furthermore, the prediction of SDCs in the over the therapeutic range using this equation was superior to that of the Koup and Jusko equation. With further validation in a larger population, this equation should facilitate the detection of patients who are over the therapeutic range in clinical practice.</AbstractText>© 2018 John Wiley & Sons Ltd.</CopyrightInformation> |
19,725 | Programmed electrical stimulation-guided encircling cryoablation concomitant to surgical ventricular reconstruction for primary prevention of ventricular arrhythmias. | Surgical ventricular reconstruction (SVR) is an effective treatment to improve left ventricular (LV) function in patients with ischaemic heart failure and an LV anterior-apical aneurysm. Ventricular arrhythmia (VA) is an important cause for morbidity and mortality in these patients. Therefore, encircling cryoablation targeting the VA substrate may be required. Programmed electrical stimulation (PES) can identify patients at risk for VA. The objective of this study was to evaluate the incidence and type of VA during long-term follow-up after PES-guided encircling cryoablation concomitant to SVR for primary prevention of VA.</AbstractText>Thirty-eight patients without spontaneous VA referred for SVR who underwent preoperative PES were included (PES group); 27 (71%) patients inducible for aneurysm-related VA received cryoablation. A historical cohort of 39 patients without spontaneous VA, preoperative PES and antiarrhythmic surgery served as the control group. Patients were discharged with an implantable cardioverter defibrillator (ICD).</AbstractText>During 74 ± 35 months of follow-up, no arrhythmic deaths occurred. Five-year survival for the total study population was 78%. Twenty-eight (36%) patients experienced ≥1 VA. There were no differences in the number and type of ICD therapies between groups: shocks, P = 0.699 and antitachypacing, P = 0.403. Five-year VA-free survival was 61% for the PES group and 65% for the control group (hazard ratio 1.67, P = 0.290).</AbstractText>The majority of the patients referred for SVR without previously documented VA was inducible for aneurysm-related VA. During the follow-up, more than one-third of the patients experienced sustained VA and 25% received appropriate ICD therapy. No difference in VA occurrence or ICD therapy was observed between groups.</AbstractText> |
19,726 | First successful prevention of cardiopulmonary resuscitation during high-risk percutaneous coronary intervention by use of a pulsatile left ventricular assist device: baptism of fire of the iVAC2L device: a case report. | Efforts in percutaneous coronary intervention (PCI) lead to interventional treatment of complex stenoses as an alternative to coronary bypass surgery. Nevertheless, complications during PCI can occur with sudden need for circulatory support. Circulatory support devices are helpful tools during high-risk PCI to generate additional output or maintain sufficient circulation in critical situations.</AbstractText>We report the case of the first successful prevention of cardiopulmonary resuscitation by use of transfemoral pulsatile ventricular assist device with up to 2l additional cardiac output during a high-risk PCI in an 80-year old man with complex stenosis and a history of ventricular fibrillation during prior coronary angiography.</AbstractText>The device managed to maintain an adequate circulation during massive vasospasm and bradycardia. The iVAC2L seems to be a useful tool in high-risk PCI. Its general effect on haemodynamics and patients' outcome has to be evaluated in larger multi-centre studies.</AbstractText> |
19,727 | Impact of Renal Denervation on Atrial Arrhythmogenic Substrate in Ischemic Model of Heart Failure. | Myocardial infarction increases the risk of heart failure (HF) and atrial fibrillation. Renal denervation (RDN) might suppress the development of atrial remodeling. This study aimed to elucidate the molecular mechanism of RDN in the suppression of atrial fibrillation in a HF model after myocardial infarction.</AbstractText>HF rabbits were created 4 weeks after coronary ligation. Rabbits were classified into 3 groups: normal control (n=10), HF (n=10), and HF-RDN (n=6). Surgical and chemical RDN were approached through midabdominal incisions in HF-RDN. Left anterior descending coronary artery in HF and HF-RDN was ligated to create myocardial infarction. After electrophysiological study, the rabbits were euthanized and the left atrial appendage was harvested for real-time polymerase chain reaction analysis and Trichrome stain. Left atrial dimension and left ventricular mass were smaller in HF-RDN by echocardiography compared with HF. Attenuated atrial fibrosis and tyrosine hydroxylase levels were observed in HF-RDN compared with HF. The mRNA expressions of Cav1.2, Nav1.5, Kir2.1, KvLQT1, phosphoinositide 3-kinase, AKT, and endothelial nitric oxide synthase in HF-RDN were significantly higher compared with HF. The effective refractory period and action potential duration of HF-RDN were significantly shorter compared with HF. Decreased atrial fibrillation inducibility was noted in HF-RDN compared with HF (50% versus 100%, P</i><0.05).</AbstractText>RDN reversed atrial electrical and structural remodeling, and suppressed the atrial fibrillation inducibility in an ischemic HF model. The beneficial effect of RDN may be related to prevention of the downregulation of the phosphoinositide 3-kinase/AKT/endothelial nitric oxide synthase signaling pathway.</AbstractText>© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.</CopyrightInformation> |
19,728 | Double sequential cardioversion for refractory ventricular tachycardia: A case report. | ABSTRACTSustained monomorphic ventricular tachycardia (VT) can result in hypoperfusion or devolve into more dangerous rhythms such as ventricular fibrillation. In an unstable patient with VT and a pulse, synchronized cardioversion is the first-line treatment. When the VT is refractory to standard cardioversion, the next step is to add an antiarrhythmic, such as amiodarone, that carries with it the risk of lowering blood pressure in the already hypotensive patient. Here we describe a case of double sequential synchronized cardioversion of a patient with unstable VT refractory to standard direct current cardioversion, resulting in a rapid conversion to sinus rhythm and return to hemodynamic stability. The benefit of this technique is that it may obviate the need for rapid infusion of medications, such as amiodarone, in the acute setting that may worsen hypotension in the already unstable patient. |
19,729 | Atrial fibrillation diagnosed by a medical checkup is associated with a poor outcome of catheter ablation. | Atrial fibrillation (AF), especially asymptomatic cases, is often detected by medical checkups. We investigated the outcome of AF ablation in cases detected by medical checkups. We reviewed the data of 735 patients with AF (56 ± 10 years, paroxysmal: 441 patients) who underwent initial catheter ablation. All patients were divided into two groups based on their AF being diagnosed either by a medical checkup (group M) or not (group NM). AF was diagnosed by medical checkups in 263 (36%) patients. In Group M, the age was younger, time from the diagnosis to ablation shorter, left atrium dimension larger, and left ventricular ejection fraction lower than in Group NM. Male gender, persistent AF, and asymptomatic AF were more frequently seen in Group M than in Group NM. A mean of 13 ± 11 months after the initial ablation procedure, AF recurrence was more frequently observed in group M compared to group NM (P = 0.018). While the AF recurrence rate was similar in both groups in persistent AF patients (P = 0.87), it was more frequently observed in Group M than in Group NM in paroxysmal AF patients (P = 0.005). AF diagnosed by medical checkups was often associated with a worse outcome of catheter ablation, especially in paroxysmal AF patients. |
19,730 | Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation. | Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF). The aim of the present study was to evaluate the long-term results of a single radiofrequency catheter ablation procedure in heart failure (HF) patients with AF.</AbstractText>We tested the hypothesis that left atrial ablation is an effective therapeutic modality in patients with heart failure.</AbstractText>Our study included HF patients with LVEF <50% who underwent catheter ablation for AF at our department between January 2010 and March 2017. All patients underwent our institution's protocol for follow-up post-ablation.</AbstractText>The study enrolled a total of 38 patients (mean age, 54.1 ± 12.2 years; 28 [73.7%] males; mean LVEF, 38.2% ± 6.3%). After a mean follow-up period of 38.2 months (range, 5-92 months), 28 patients (73.7%) were free from arrhythmia recurrence. In multivariate analysis, early arrhythmia recurrence (P = 0.03) and amiodarone antiarrhythmic drug administration (P = 0.003) remained independent predictors of arrhythmia recurrence.</AbstractText>The main findings of this study are that (1) a single radiofrequency catheter ablation procedure is an effective and safe modality for AF in patients with concomitant HF; (2) after a mean 3.3 years of follow-up, 73.7% of HF patients remained in sinus rhythm; and (3) early arrhythmia recurrence was a significant predictor of arrhythmia recurrence after the blanking period.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,731 | Cardiopulmonary resuscitation: the science behind the hands. | Sudden cardiac arrest is a leading cause of death worldwide. Despite significant advances in resuscitation science since the initial use of external chest compressions in humans nearly 60 years ago, there continues to be wide variability in rates of successful resuscitation across communities. The American Heart Association (AHA) and European Resuscitation Council emphasise the importance of high-quality chest compressions as the foundation of resuscitation care. We review the physiological basis for the association between chest compression quality and clinical outcomes and the scientific basis for the AHA's key metrics for high-quality cardiopulmonary resuscitation. Finally, we highlight that implementation of strategies that promote effective chest compressions can improve outcomes in all patients with cardiac arrest. |
19,732 | Polish single-centre follow-up of subcutaneous implantable cardioverter-defibrillator (S-ICD) systems implanted for the prevention of sudden cardiac death. | Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective and modern tool used to protect patients at risk of sudden cardiac death (SCD) from potentially life-threatening ventricular arrhythmias. The first S-ICD systems were implanted in Poland in 2014, but since that time the national experience with that therapy has been limited. Our analysis summarises the single-centre experience at the Department of Cardiology and Electrotherapy of the Medical University of Gdansk with the use of S-ICD from the year 2014 to 2017.</AbstractText>The S-ICD therapy was used in 12 patients (five male, seven female, mean age 57.2 ± 12.5 years), in eight of them for the secondary prevention of SCD. No surgical complications of implantation procedures were observed during the perioperative hospitalisation nor during follow-up. During the mean follow-up of 14 ± 13 months we observed the appropriate function of the systems and a ventricular fibrillation episode successfully terminated by the device in one patient, two cases of S-ICD sensing problems (one of which led to inadequate intervention of the device), and an episode of atrial fibrillation also leading to inadequate intervention in another patient.</AbstractText>S-ICD, being an effective and safe method used to treat patients at risk of SCD, may be safely and successfully introduced into clinical practice in centres new to that field. The number of complications during the initial experience and introduction of that method may be kept low if the operating team is experienced enough in cardiac electrotherapy.</AbstractText> |
19,733 | Effect of fibrillatory wave amplitude on coronary blood flow as assessed by thrombolysis in myocardial infarction frame count in patients with atrial fibrillation. | Atrial fibrillation (AF) is the most common arrhythmia, characterized by a lack of atrial contraction and an irregular ventricular rhythm. We assessed the effect of fibrillatory wave amplitude on coronary blood flow in patients with AF using the thrombolysis in myocardial infarction (TIMI) frame count. Sixty-one patients with AF persisting for longer than 30 days were included. For controls, 61 age- and sex-matched patients with sinus rhythm were selected. Coarse AF was defined as any fibrillatory wave ≥ 1 mm and fine AF as any fibrillatory wave < 1 mm. Mean TIMI frame count was significantly higher in patients with AF than in those with sinus rhythm (18 ± 4 vs 30 ± 11, p < 0.001). Multivariate analysis showed that AF was the only determinant of mean TIMI frame count (β = 0.48, p < 0.001). Among patients with AF, 32 had coarse AF and 29 had fine AF. Left atrial volume index (54 ± 14 vs 64 ± 21 ml/m<sup>2</sup>, p = 0.03) was significantly larger, and mean TIMI frame count (26 ± 7 vs 35 ± 12, p < 0.001) was significantly higher in patients with fine AF than in those with coarse AF. Multivariate analysis showed that hypertension (β = - 0.29, p = 0.01) and a fine fibrillatory wave (β = 0.33, p = 0.007) were determinants of mean TIMI frame count. Our data suggest that coronary blood flow is reduced in patients with AF compared with those with sinus rhythm, and that a fine fibrillatory wave is a major determinant of reduced coronary blood flow in patients with AF. |
19,734 | Experimentally-induced ventricular arrhythmias. | Hypoxia and reoxygenation, ischemia and reperfusion, catecholamine infusion, ouabain, sodium pentobarbital and caffeine, can all be used experimentally to induce ventricular arrhythmias. According to the Lambeth Convention guidelines our experimentally-induced ventricular arrhythmias include but are not limited to: ventricular premature beats (VPB), ventricular salvos (VS), ventricular bigeminy (VB), nonsustained ventricular tachycardia (VTn), sustained ventricular tachycardia (VTs) and ventricular fibrillation (VF, or if the heart is not defibrillated, sudden cardiac death). We have studied these arrhythmias in the absence and presence of adenosine deaminase, methyl xanthines, and more recently, acetaminophen. Our laboratory was the first to discover the anti-arrhythmic properties of acetaminophen an analgesic used in Western medicine for more than 100 years before our publication. We have also identified other cardioprotective properties of acetaminophen, and have begun to work out some of the cellular/molecular mechanisms. For example, we know that acetaminophen protects hypoxic/ischemic cardiac mitochondria, in part, by sustaining function of the mitochondrial permeability transition pore (MPTP, a protein involved in regulating mitochondrial pH). Acetaminophen also attenuates the actions of matrix metalloproteinases that can be harmful to myocardial contractile proteins. Of course, like all science, more work is needed to expand on these and related topics. |
19,735 | Asymmetric couplings enhance the transition from chimera state to synchronization. | Chimera state has been well studied recently, but little attention has been paid to its transition to synchronization. We study this topic here by considering two groups of adaptively coupled Kuramoto oscillators. By searching the final states of different initial conditions, we find that the system can easily show a chimera state with robustness to initial conditions, in contrast to the sensitive dependence of chimera state on initial conditions in previous studies. Further, we show that, in the case of symmetric couplings, the behaviors of the two groups are always complementary to each other, i.e., robustness of chimera state, except a small basin of synchronization. Interestingly, we reveal that the basin of synchronization will be significantly increased when either the coupling of inner groups or that of intergroups are asymmetric. This transition from the attractor of chimera state to the attractor of synchronization is closely related to both the phase delay and the asymmetric degree of coupling strengths, resulting in a diversity of attractor's patterns. A theory based on the Ott-Antonsen ansatz is given to explain the numerical simulations. This finding may be meaningful for the control of competition between two attractors in biological systems, such as the cardiac rhythm and ventricular fibrillation, etc. |
19,736 | Safety profile of near-zero fluoroscopy atrial fibrillation ablation with non-fluoroscopic catheter visualization: experience from 1000 consecutive procedures. | Efforts to reduce radiation exposure during catheter ablation procedures have included the use of various technological measures. Significant results have been achieved to the point where near lead-free procedures in routine clinical practice has become a realistic goal. The integration of MediGuide technology [non-fluoroscopic catheter visualization technology (NFCV)] and three-dimensional electroanatomical mapping is one of the methods developed in response to radiation reduction initiatives. We aimed to evaluate the impact of this NFCV technology on atrial fibrillation (AF) catheter ablation in terms of reduction in procedural and radiation time as well as safety aspects.</AbstractText>Between March 2012 and March 2017, a total of 1000 patients underwent AF ablation using NFCV. Patient and procedural data and complications within the first 3 months were entered into a prospective registry and analysed. We assessed procedure time, fluoroscopy time, and dose and complications. In a cohort of 1000 patients (62.9 ± 11 years; 72% men; left ventricular ejection fraction 57%; and left atrial diameter 43.2 mm), the median procedure time was 120 min, median fluoroscopy time was 0.90 min, and the median fluoroscopy dose of was 345.1 cGy · cm2. Stratification of the first (Group 1) and the last 250 (Group 2) cases showed significant improvement in the median procedure time (140-110 min) and reduction in the median fluoroscopy time (6-0.5 min) and the median dose (2263-151.9 cGy · cm2). The overall complication rate was 2.0%.</AbstractText>The use of NFCV technology enables safe, consistent, and 'near lead-free' performance of AF ablation in routine clinical practice.</AbstractText> |
19,737 | Rates and risk of arrhythmias in cancer survivors with chemotherapy-induced cardiomyopathy compared with patients with other cardiomyopathies. | There is little information about arrhythmia burden in cancer survivors with chemotherapy-induced cardiomyopathy (CIC). We hypothesise that the rates and risk of arrhythmias will be similar in CIC when compared with other non-ischaemic cardiomyopathy (NICMO) aetiologies.</AbstractText>We retrospectively identified nine patients with CIC and an implantable defibrillator and 18 age and sex-matched control patients (nine patients with NICMO and nine patients with ischaemic cardiomyopathy (ICMO)). Rates and odds of arrhythmias were calculated by type of cardiomyopathy, adjusting for days since implantable cardioverter defibrillator implantation, history of atrial fibrillation and length of follow-up using logistic regression analysis.</AbstractText>Compared with patients with NICMO, rates and adjusted odds were similar for patients with CIC for atrial arrhythmias (44.4% vs 33.3%; adjusted OR=1.89; 95% CI0.17 to 21.03; P=0.61), non-sustained ventricular tachycardia (NSVT) (44.4% vs 33.3%; OR=2.10; 95% CI 0.21 to 20.56; P=0.53), and the combined outcome of NSVT, sustained ventricular tachycardia and/or ventricular fibrillation (44.4% vs 44.4%; OR=2.70; 95% CI 0.25 to 29.48; P=0.42). Conversely, compared with patients with NICMO, patients with ICMO demonstrated higher rates and adjusted odds of the combined outcome (88.9% vs 44.4%; OR=28.60; 95% CI 1.26 to 648.2; P=0.04) and NSVT (77.8% vs 33.3%; OR=8.95; 95% CI 0.90 to 88.94; P=0.06).</AbstractText>While tentative based on sample size, rates of arrhythmias in patients with CIC appear to be similar to those experienced by patients with other forms of NICMO.</AbstractText> |
19,738 | Stimulation of Epicardial Sympathetic Nerves at Different Sites Induces Cardiac Electrical Instability to Various Degrees. | The cardiac sympathetic nerves distribute across cardiac tissues with uneven density. Yet, to what extent this anatomical heterogeneity affects electrical activity of the left ventricle is largely unknown. Dogs were randomized into non-stimulation control (NC), posterior basal-stimulation (PB), anterior superior-stimulation (AS), apical part-stimulation (AP) group. The epicardial sympathetic nerves at different sites along their distribution were with electrical stimulation (ES) for 4 hours except in the NC group. The myocardial effective refractory period (ERP), ventricular fibrillation threshold (VFT) and density of sympathetic nerves were recorded. Compared with ES at other places, the stimulation at PB site significantly shortened ERP (left ventricular anterior and posterior walls; PB group, 118 ± 4 ms, 106 ± 2 ms; Versus NC group, 155 ± 3.5 ms, 160 ± 3 ms; p < 0.01) and VFT (PB group, 11.5 ± 1.5 V; Versus NC group, 20.5 ± 0.9 V; p < 0.01), and induced remarkable regeneration of the cardiac sympathetic nerves, hence influencing electrical activity of the left ventricle to the most extent. Our study demonstrates that the degree of induced ventricular electrical instability is correlated tightly with the density of sympathetic nerves around ES site, and PB site is a potential target for modulating ventricular electrical activity to the maximal extent. |
19,739 | Sedation in cardiac arrhythmias management. | Procedural sedation is of paramount importance for a plethora of electrophysiological procedures. From electrical cardioversion to electrophysiology studies, device implantations, and catheter ablations, intraprocedural sedation and anesthesia have a pivotal role in allowing procedural success while ensuring patient safety and avoiding discomfort. Areas covered: The present review will discuss the current state-of-the-art in sedation and anesthesia during electrical cardioversion, cardiac implantable electronic device implantation, catheter ablation and electrophysiology studies. Specific information will be provided for each procedure in order to reach the core of this important clinical issue, and specific protocols will be compared. The main pro-arrhythmic and anti-arrhythmic effects of the most commonly used sedatives will also be discussed. Expert commentary: According to much recent evidence, the cardiologist can be the only person responsible for sedation administration in many settings, highlighting few safety issues associated with the absence of a dedicated anesthesiologist thus a concomitant reduction in costs. However, many concerns have been raised in allowing non-anesthesiologists to manage sedatives, as adverse events, while rare, could have catastrophic consequences. The present paper will highlight when a cardiologist-directed sedation is considered safe, how it should be performed, and the pros and cons related to this strategy. |
19,740 | Mitral valve replacement via a left thoracotomy in dextrocardia and situs solitus. | Dextrocardia with situs solitus and severe mitral regurgitation is a rare clinical presentation which posse a surgical challenge and requires specific preoperative planning. A 54-year-old women with this anatomy, multiple thoracic procedures, and severe mitral valve regurgitation underwent successful mitral valve replacement with a 27-mm mechanical prosthesis through a left thoracotomy under ventricular fibrillation, on the basis of computed tomography findings. We emphasize the importance of preoperative planning and a surgical approach through a left thoracotomy and under ventricular fibrillation. |
19,741 | Palliative care utilization following out-of-hospital cardiac arrest in the United States. | Palliative care (PC) has become an integral component of comprehensive care provided to critically ill patients. Little is known about the utilization of palliative care following Out-of-Hospital Cardiac Arrest (OHCA) in the United States.</AbstractText>We used the 2002-2013 National Inpatient Sample database to identify adults ≥18 years old with an ICD-9-CM principal diagnosis code of cardio-respiratory arrest or ventricular fibrillation (VF). Patients were categorized into two groups based on the presence of PC, then compared using Pearson χ2</sup> test for categorical variables and linear regression for continuous variables. Multiple linear and logistic regression models were conducted to identify factors associated with PC, and temporal trends in PC utilization.</AbstractText>Of the 154,177 patients hospitalized with OHCA in the U.S, 11,260 (7.3%) had PC consultations during hospitalization. PC Utilization increased from 1.5% in 2002 to 16.7% in 2013 (P-trend < 0.001). Patients who received Palliative care were older (mean age 70.7 ± 0.3 vs 65.9 ± 0.1), more likely to be female (45.8% vs 40.5%), and had higher Charlson comorbidity index ≥2 (55.8% vs 46.8%). In adjusted analyses, older age, female gender, Caucasian race, higher Charlson comorbidity index, multiorgan failure, metastatic cancer, non-shockable rhythm, admission to larger, urban and teaching hospitals were all associated with higher PC utilization.</AbstractText>We observed significant increase in the utilization of palliative care consultations following OHCA over the study period. This was influenced by multiple patient and hospital factors. Further investigations are needed to identify the appropriate cost-effective use of palliative care following cardiac arrest.</AbstractText>Copyright © 2018 Elsevier B.V. All rights reserved.</CopyrightInformation> |
19,742 | Serum Bilirubin Concentration is Associated with Left Ventricular Remodeling in Patients with Type 2 Diabetes Mellitus: A Cohort Study. | Previous studies have shown that serum bilirubin concentration is inversely associated with the risk of cardiovascular disease. The relationship between serum bilirubin concentration and left ventricular geometry, however, has not been investigated in patients with diabetes mellitus.</AbstractText>In this cohort study, 158 asymptomatic patients with type 2 diabetes mellitus without overt heart disease were enrolled. Left ventricular structure and function were assessed using echocardiography. Serum bilirubin concentration, glycemic control, lipid profile, and other clinical characteristics were evaluated, and their association with left ventricular geometry was determined. Patients with New York Heart Association Functional Classification greater than I, left ventricular ejection fraction less than 50%, history of coronary artery disease, severe valvulopathy, chronic atrial fibrillation, or creatinine clearance less than 30 ml/min, and those receiving insulin treatment, were excluded.</AbstractText>Univariate analyses showed that relative wall thickness (RWT) was significantly correlated with diastolic blood pressure (P = 0.003), HbA1c (P = 0.024), total cholesterol (P = 0.043), urinary albumin (P = 0.023), and serum bilirubin concentration (P = 0.009). There was no association between left ventricular mass index and serum bilirubin concentration. Multivariate linear regression analysis showed that log RWT was positively correlated with diastolic blood pressure (P = 0.010) and that log RWT was inversely correlated with log bilirubin (P = 0.003). In addition, the patients with bilirubin less than 0.8 mg/dl had a higher prevalence of concentric left ventricular remodeling compared with those with bilirubin 0.8 mg/dl or more.</AbstractText>Our study shows that the serum bilirubin concentration may be associated with the progression of concentric left ventricular remodeling in patients with type 2 diabetes mellitus.</AbstractText> |
19,743 | Practical valvular issues in patients requiring ventricular assist devices. | As ventricular assist device (VAD) therapy in patients with advanced heart failure continues to grow, experience with concomitant valvular diseases present either before or after VAD implantation continues to accrue. In this review, we discuss recent data and current practice as it pertains to the subject of concomitant valvular disease in patients requiring VADs.</AbstractText>Persistent aortic valve closure has been identified as a potential contributor to aortic valve 'disuse atrophy' resulting in valve degeneration. Dilation of the aortic root may be predictive of future development of aortic insufficiency. Novel echocardiographic parameters to identify the severity of aortic insufficiency following VAD implantation may be useful for risk stratification. Concomitant repair of significant mitral regurgitation may confer benefit to pulmonary vascular resistance and right ventricular function; however, this remains controversial. Concomitant repair of significant tricuspid regurgitation has not demonstrated early postoperative benefit nor survival benefit. Atrial fibrillation has emerged as a risk factor that may predict accelerated progression of postoperative tricuspid regurgitation.</AbstractText>Management of aortic insufficiency, mitral regurgitation or tricuspid regurgitation in patients requiring VADs continues to be the source of controversy. As experience accrues with varying strategies to prevent or manage these valvular lesions, our understanding of the impact of these strategies continues to evolve.</AbstractText> |
19,744 | Murine Models of Heart Failure with Preserved Ejection Fraction: a "Fishing Expedition". | Heart failure with preserved ejection fraction (HFpEF) is characterized by signs and symptoms of HF in the presence of a normal left ventricular (LV) ejection fraction (EF). Despite accounting for up to 50% of all clinical presentations of HF, the mechanisms implicated in HFpEF are poorly understood, thus precluding effective therapy. The pathophysiological heterogeneity in the HFpEF phenotype also contributes to this disease and likely to the absence of evidence-based therapies. Limited access to human samples and imperfect animal models that completely recapitulate the human HFpEF phenotype have impeded our understanding of the mechanistic underpinnings that exist in this disease. Aging and comorbidities such as atrial fibrillation, hypertension, diabetes and obesity, pulmonary hypertension and renal dysfunction are highly associated with HFpEF. Yet, the relationship and contribution between them remains ill-defined. This review discusses some of the distinctive clinical features of HFpEF in association with these comorbidities and highlights the advantages and disadvantage of commonly used murine models, used to study the HFpEF phenotype. |
19,745 | Ventricular Fibrillation following Varicella Zoster Myocarditis. | Varicella-zoster virus (VZV) infection can rarely lead to serious cardiac complications and life-threatening arrhythmias. We present a case of a 46-year-old male patient who developed VZV myocarditis and presented with recurrent syncopal episodes followed by a cardiac arrest. He had a further collapse eight years later, and cardiac magnetic resonance imaging (MRI) demonstrated mild mid-wall basal and inferolateral wall fibrosis. He was treated with an implantable cardioverter defibrillator (ICD) and represented two years later with ICD shocks, and interrogation of the device revealed ventricular fibrillation episodes. This case demonstrates the life-threatening long-term sequelae of VZV myocarditis in adults. We suggest that VZV myocarditis should be considered in all patients who present with a syncopal event after VZV infection. In these patients, ICD implantation is a potentially life-saving procedure. |
19,746 | Patients' Characteristics and Clinical Course of Hypertrophic Cardiomyopathy in a Regional Japanese Cohort　- Results From Kochi RYOMA Study. | There have been few studies on the clinical course of hypertrophic cardiomyopathy (HCM) in a community-based patient cohort in Japan.Methods and Results:In 2004, we established a cardiomyopathy registration network in Kochi Prefecture (the Kochi RYOMA study) that consisted of 9 hospitals, and finally, 293 patients with HCM were followed. The ages at registration and at diagnosis were 63±14 and 56±16 years, respectively, and 197 patients (67%) were male. HCM-related deaths occurred in 23 patients during a mean follow-up period of 6.1±3.2 years. The HCM-related 5-year survival rate was 94%. In addition, a total of 77 cardiovascular events that were clinically severe occurred in 70 patients, and the HCM-related 5-year event-free rate was 80%. Multivariate Cox proportional hazards model analysis showed that the presence of NYHA class III at registration was a significant predictor of HCM-related deaths and that the presence of atrial fibrillation, lower fractional shortening and presence of left ventricular outflow tract obstruction in addition to NYHA class III were significant predictors of cardiovascular events.</AbstractText>In our unselected registry in an aged Japanese community, HCM mortality was favorable, but one-fifth of the patients commonly suffered from HCM-related adverse cardiovascular events during the 5-year follow-up period. Careful management of HCM patients is needed, particularly for those with the above-mentioned clinical determinants.</AbstractText> |
19,747 | Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit. | Objective To compare the outcomes of patients with and without a mean serum potassium (K<sup>+</sup>) level within the recommended range (3.5-4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients' baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K<sup>+</sup> level, and hospital outcomes were recorded. Patients with a mean K<sup>+</sup> level of 3.5 to 4.5 mEq/L and with all individual K<sup>+</sup> values of 3.0 to 5.0 mEq/L were allocated to the normal K<sup>+</sup> group. The remaining patients were allocated to the abnormal K<sup>+</sup> group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K<sup>+</sup> group comprised 74 (46.3%) patients. The abnormal K<sup>+</sup> group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K<sup>+</sup> level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K<sup>+</sup> levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K<sup>+</sup> levels. |
19,748 | Prophylactic amiodarone vs dronedarone for prevention of perioperative arrhythmias in offpump coronary artery bypass grafting: A pilot randomized controlled trial. | The aim of this study was to compare the effects of prophylactic dronedarone and amiodarone in prevention of arrhythmias during and following off-pump coronary artery bypass grafting (OPCAB). This randomized, controlled, double-blinded, parallel-group study was carried out on 36 adult male patients aged 30-70 years, with modified Parsonnet score 0-10 undergoing offpump coronary artery bypass grafting. After obtaining approval from the institutional ethics committee and informed consent, the patients were randomly allocated to two equal groups (n=18). In one group, patients were given inj. amiodarone 3mg/kg in 100ml of normal saline prior to skin incision intravenously over 20 minutes. In the second group patients received tablet dronedarone 400mg orally twice daily, commencing three days prior to the date of surgery. Patients in the amiodarone group received placebo tablet while patients in the dronedarone group received placebo infusion for the sake of blinding. The frequency and profile of arrhythmias intraoperatively and 24 hours postoperatively were studied. Intraoperative arrhythmias occurred in 50% of patients receiving amiodarone and 16.67% of patients receiving dronedarone. Maximum ventricular rate during atrial fibrillation was significantly lower in the dronedarone group (121 beats per min) than in the amiodarone group (168 beats per min). The study concludes that dronedarone appears to be at least as effective as amiodarone in prophylaxis of intraoperative and postoperative arrhythmias in patients undergoing OPCAB, with a better control of ventricular response. |
19,749 | Role of apamin-sensitive small conductance calcium-activated potassium currents in long-term cardiac memory in rabbits. | Apamin-sensitive small conductance calcium-activated K current (IKAS</sub>) is up-regulated during ventricular pacing and masks short-term cardiac memory (CM).</AbstractText>The purpose of this study was to determine the role of IKAS</sub> in long-term CM.</AbstractText>CM was created with 3-5 weeks of ventricular pacing and defined by a flat or inverted T wave off pacing. Epicardial optical mapping was performed in both paced and normal ventricles. Action potential duration (APD80</sub>) was determined during right atrial pacing. Ventricular stability was tested before and after IKAS</sub> blockade. Four paced hearts and 4 normal hearts were used for western blotting and histology.</AbstractText>There were no significant differences in either echocardiographic parameters or fibrosis levels between groups. Apamin induced more APD80</sub> prolongation in CM than in normal ventricles (mean [95% confidence interval]: 9.6% [8.8%-10.5%] vs 3.1% [1.9%-4.3%]; P <.001). Apamin significantly lengthened APD80</sub> in the CM model at late activation sites, indicating significant IKAS</sub> up-regulation at those sites. The CM model also had altered Ca2+</sup> handling, with the 50% Ca2+</sup> transient duration and amplitude increased at distal sites compared to a proximal site (near the pacing site). After apamin, the CM model had increased ventricular fibrillation (VF) inducibility (paced vs control: 33/40 (82.5%) vs 7/20 (35%); P <.001) and longer VF durations (124 vs 26 seconds; P <.001).</AbstractText>Chronic ventricular pacing increases Ca2+</sup> transients at late activation sites, which activates IKAS</sub> to maintain repolarization reserve. IKAS</sub> blockade increases VF vulnerability in chronically paced rabbit ventricles.</AbstractText>Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,750 | [The efficacy and safety of coil embolization of septal branch in the treatment of patients with obstructive hypertrophic cardiomyopathy]. | <b>Objective:</b> To observe the clinical efficacy and safety of coil embolization of septal branch in the treatment of obstructive hypertrophic cardiomyopathy (HOCM). <b>Methods:</b> Eighteen patients with HOCM hospitalized in our department from September 2014 to October 2016 were enrolled in this study. There were 12 males and 6 females in this cohort and the age of patients ranged from 22 to 64 years old. Left ventricular outflow tract gradient (LVOTG) was derived from echocardiographic apical five-chamber view at pre-operation and at 48 hours and 6 months post operation. 24-hour Holter ECG examination was performed to assess the ventricular tachycardia, atrial fibrillation, atrioventricular block at 3 days and 6 months after the interventional operation. Routine ECG and creatine kinase-MB (CK-MB) examination were performed at pre-operation, at 6, 24 and 48 hours post operation. Cardiac troponin T (cTnT) was detected at pre-operation, at 24, 48 hours and 6 days post operation. The clinical symptoms (including chest tightness, chest pain, shortness of breath, syncope) and NYHA classification were assessed at 1, 6 months after the operation by telephone follow-up or outpatient clinic visit. <b>Results:</b> The average preoperative LVOTG detected by cardiac catheter was 103.6 (92.0, 115.0) mmHg (1 mmHg=0.133 kPa) , and the average LVOTG significantly reduced to 44.3 (41.6, 47.2) mmHg immediately after operation (<i>P<</i>0.01). The average ventricular septal thickness at 48 hours (19.2±3.1) mm and 6 months (17.8±2.8) mm after operation tended to be lower than the preoperative ventricular septal thickness ((20.4±3.5) mm, <i>P></i>0.05). The echocardiographic derived average LVOTG at 48 hours and 6 months after operation was 42.9 (41.1, 45.5) and 39.1 (37.5, 41.0) mmHg, which were significant lower than the preoperative average LVOTG (94.3 (88.5, 101.8) mmHg, both <i>P<</i>0.01). LVOTG at 6 months after operation was significantly lower than that at 48 hours after the operation (<i>P<</i>0.05). The NYHA classification at 6 months after operation was significantly improved compared to pre-operation NYHA classification (<i>P<</i>0.01). During and after the operation, there was no complete atrioventricular block and ventricular tachycardia, no patient developed anterior wall and inferior myocardial infarction. Only one patient experienced transient left bundle branch block. During the 6 months following-up, there was no death, syncope, chest pain, palpitations, shortness of breath, paroxysmal dyspnea and/or lower extremity edema, ventricular tachycardia, atrioventricular block and atrial fibrillation, complete atrioventricular block and ventricular arrhythmia. <b>Conclusion:</b> The coil embolization of septal branch is effective and safe for the treatment of patients with HOCM.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Liu</LastName><ForeName>H</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang 550002, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Q</ForeName><Initials>Q</Initials></Author><Author ValidYN="Y"><LastName>Tan</LastName><ForeName>H W</ForeName><Initials>HW</Initials></Author><Author ValidYN="Y"><LastName>Pang</LastName><ForeName>J</ForeName><Initials>J</Initials></Author></AuthorList><Language>chi</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Zhonghua Xin Xue Guan Bing Za Zhi</MedlineTA><NlmUniqueID>7910682</NlmUniqueID><ISSNLinking>0253-3758</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="N">Atrial Fibrillation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D054537" MajorTopicYN="N">Atrioventricular Block</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001807" MajorTopicYN="N">Blood Vessel Prosthesis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002312" MajorTopicYN="N">Cardiomyopathy, Hypertrophic</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004452" MajorTopicYN="N">Echocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004621" MajorTopicYN="Y">Embolization, Therapeutic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006346" MajorTopicYN="N">Heart Septum</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017180" MajorTopicYN="N">Tachycardia, Ventricular</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D054088" MajorTopicYN="N">Ventricular Septum</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 观察弹簧圈栓塞冠状动脉间隔支治疗梗阻性肥厚型心肌病（HOCM）的临床疗效及安全性。 <b>方法：</b> 回顾性选取贵州省人民医院心内科2014年9月至2016年10月住院成功行弹簧圈栓塞冠状动脉间隔支术的HOCM患者18例，其中男性12例，女性6例，年龄22~64岁。术前及术后48 h和6个月对患者进行超声心动图检查，心尖五腔心切面测量左心室流出道压力阶差（LVOTG）。术后3 d、6个月完善动态心电图检查，评估患者有无室性心动过速、心房颤动、房室传导阻滞等。术前及术后6、24和48 h完善心电图和肌酸激酶同工酶（CK-MB）检查。术前及术后24、48 h和6 d完善心肌肌钙蛋白T（cTnT）检查。术后1、6个月门诊或电话随访患者的临床症状（包括胸闷、胸痛、气促、晕厥等）和纽约心脏协会（NYHA）心功能分级。 <b>结果：</b> 手术时心导管测定显示入选患者术前的LVOTG为103.6 (92.0，115.0) mmHg（1 mmHg=0.133 kPa），术后即刻为44.3 (41.6, 47.2) mmHg，明显降低（<i>P<</i>0.01）。入选患者术后48 h和6个月室间隔平均厚度分别为（19.2±3.1）和（17.8±2.8）mm均较术前[（20.4±3.5）mm]薄，但差异无统计学意义（<i>P</i>均<i>></i>0.05）。入选患者术后48 h和6个月LVOTG分别为42.9 (41.1，45.5)和39.1 (37.5，41.0) mmHg，均较术前94.3 (88.5，101.8) mmHg明显降低（<i>P</i>均<0.01），而术后6个月LVOTG则进一步低于术后48 h（<i>P<</i>0.01）。入选患者术后6个月NYHA心功能分级较术前明显改善（<i>P<</i>0.01）。术中及术后无患者发生完全房室传导阻滞及室性心动过速，无扩张到前壁及下壁心肌梗死心电图表现，仅1例患者发生一过性左束支传导阻滞。随访6个月患者无死亡，未发生晕厥，一般活动无胸闷、胸痛、心悸、气促，无夜间阵发性呼吸困难和（或）双下肢水肿，动态心电图检查未发现室性心动过速、房室传导阻滞和心房颤动，均未发生完全性房室传导阻滞及室性心律失常。 <b>结论：</b> 弹簧圈栓塞冠状动脉间隔支治疗HOCM有效、安全。. |
19,751 | Identifying unmet clinical need in hypertrophic cardiomyopathy using national electronic health records. | To evaluate unmet clinical need in unselected hypertrophic cardiomyopathy (HCM) patients to determine the risk of a wide range of subsequent cardiovascular disease endpoints and safety endpoints relevant for trial design.</AbstractText>Population based cohort (CALIBER, linked primary care, hospital and mortality records in England, period 1997-2010), all people diagnosed with HCM were identified and matched by age, sex and general practice with ten randomly selected people without HCM. Random-effects Poisson models were used to assess the associations between HCM and cardiovascular diseases and bleeding.</AbstractText>Among 3,290,455 eligible people a diagnosis of hypertrophic cardiomyopathy was found in 4 per 10,000. Forty-one percent of the 1,160 individuals with hypertrophic cardiomyopathy were women and the median age was 57 years. The median follow-up was 4.0 years. Compared to general population controls, people with HCM had higher risk of ventricular arrhythmia (incidence rate ratio = 23.53, [95% confidence interval 12.67-43.72]), cardiac arrest or sudden cardiac death (6.33 [3.69-10.85]), heart failure (4.31, [3.30-5.62]), and atrial fibrillation (3.80 [3.04-4.75]). HCM was also associated with a higher incidence of myocardial infarction ([MI] 1.90 [1.27-2.84]) and coronary revascularisation (2.32 [1.46-3.69]).The absolute Kaplan-Meier risks at 3 years were 8.8% for the composite endpoint of cardiovascular death or heart failure, 8.4% for the composite of cardiovascular death, stroke or myocardial infarction, and 1.5% for major bleeding.</AbstractText>Our study identified major unmet need in HCM and highlighted the importance of implementing improved cardiovascular prevention strategies to increase life-expectancy of the contemporary HCM population. They also show that national electronic health records provide an effective method for identifying outcomes and clinically relevant estimates of composite efficacy and safety endpoints essential for trial design in rare diseases.</AbstractText> |
19,752 | Comparing Methods for Cardiac Output: Intraoperatively Doppler-Derived Cardiac Output Measured With 3-Dimensional Echocardiography Is Not Interchangeable With Cardiac Output by Pulmonary Catheter Thermodilution. | Estimation of cardiac output (CO) is essential in the treatment of circulatory unstable patients. CO measured by pulmonary artery catheter thermodilution is considered the gold standard but carries a small risk of severe complications. Stroke volume and CO can be measured by transesophageal echocardiography (TEE), which is widely used during cardiac surgery. We hypothesized that Doppler-derived CO by 3-dimensional (3D) TEE would agree well with CO measured with pulmonary artery catheter thermodilution as a reference method based on accurate measurements of the cross-sectional area of the left ventricular outflow tract.</AbstractText>The primary aim was a systematic comparison of CO with Doppler-derived 3D TEE and CO by thermodilution in a broad population of patients undergoing cardiac surgery. A subanalysis was performed comparing cross-sectional area by TEE with cardiac computed tomography (CT) angiography. Sixty-two patients, scheduled for elective heart surgery, were included; 1 was subsequently excluded for logistic reasons. Inclusion criteria were coronary artery bypass surgery (N = 42) and aortic valve replacement (N = 19). Exclusion criteria were chronic atrial fibrillation, left ventricular ejection fraction below 0.40 and intracardiac shunts. Nineteen randomly selected patients had a cardiac CT the day before surgery. All images were stored for blinded post hoc analyses, and Bland-Altman plots were used to assess agreement between measurement methods, defined as the bias (mean difference between methods), limits of agreement (equal to bias ± 2 standard deviations of the bias), and percentage error (limits of agreement divided by the mean of the 2 methods). Precision was determined for the individual methods (equal to 2 standard deviations of the bias between replicate measurements) to determine the acceptable limits of agreement.</AbstractText>We found a good precision for Doppler-derived CO measured by 3D TEE, but although the bias for Doppler-derived CO by 3D compared to thermodilution was only 0.3 L/min (confidence interval, 0.04-0.58), there were wide limits of agreement (-1.8 to 2.5 L/min) with a percentage error of 55%. Measurements of cross-sectional area by 3D TEE had low bias of -0.27 cm (confidence interval, -0.45 to -0.08) and a percentage error of 18% compared to cardiac CT angiography.</AbstractText>Despite low bias, the wide limits of agreement of Doppler-derived CO by 3D TEE compared to CO by thermodilution will limit clinical application and can therefore not be considered interchangeable with CO obtained by thermodilution. The lack of agreement is not explained by lack of agreement of the 3D technique.</AbstractText> |
19,753 | Down-regulation of miR-133a/b in patients with myocardial infarction correlates with the presence of ventricular fibrillation. | MicroRNAs (miRNAs) are important regulators of physiologic and pathologic conditions of the heart. Animal models of heart diseases have shown that miRNAs may contribute to the development of arrhythmias. However, little is known about the expression of muscle- and cardiac-specific miRNAs in patients with myocardial infarction (MI) who have developed ventricular fibrillation (VF). Our study included 47 patients who had died from myocardial infarction (MI), 23 with clinically proven VF and 24 without VF. Autopsy samples of infarcted tissue and remote myocardium were available (n = 94). Heart tissue from 8 healthy trauma victims was included as control. Expression of miR-1, miR-133a/b and miR-208 was analyzed using real-time PCR (qPCR). In patients with MI with VF, we observed down-regulation of miR-133a/b, and this down-regulation was even stronger 2-7 days after MI. miR-208 was up-regulated in remote myocardium irrespective of the presence of VF. Deregulation of miR-1 and miR-208 was not related to the presence of VF. Our results suggest that down-regulation of miR-133a/b might contribute to the development of VF in patients with MI. However, up-regulation of miR-1 and miR-208 in remote myocardium might play a role in cardiac remodeling after MI, at least to certain degree. |
19,754 | Optimal Medications and Appropriate Implantable Cardioverter-defibrillator Shocks in Aborted Sudden Cardiac Death Due to Coronary Spasm. | Objective Life-threatening ventricular arrhythmias are recognized in patients with coronary spastic angina. Implantable cardioverter-defibrillators (ICDs) are effective in patients with structural heart disease and ventricular fibrillation. However, the optimal medication for patients with aborted sudden cardiac death (SCD) due to coronary artery spasm after the implantation of ICD remains controversial. Methods We investigated the medications and the numbers of appropriate ICD shocks in 137 patients with a history of aborted SCD due to coronary spasm. Results Appropriate ICD shocks were observed in 24.1% (33/137) of patients with aborted SCD due to coronary spasm during 41 months of follow-up. Only 15 (15.6%) of the 96 patients with ICDs received aggressive medical therapy, including two or three calcium-channel antagonists. The rate of appropriate ICD shocks was significantly higher in Western countries than in Asian countries (42.9% vs. 19.3%, p<0.01), whereas the medications did not differ between the two regions. Appropriate ICD shocks successfully resuscitated 33 patients. Three patients died due to second serious fatal arrhythmias. Conclusion Appropriate ICD shocks were recognized in a quarter of patients with aborted SCD due to coronary spasm and ICD implantation was effective for suppressing the next serious fatal arrhythmia in these patients. We should reconsider prescribing more medications after ICD implantation in patients with aborted SCD due to coronary artery spasm. |
19,755 | [The PRKAG2 cardiac syndrome with familial hypertrophic cardiomyopathy: an inherited burden. A case report. Review of the literature]. | We report the case of a young man without prior medical history who presented with a left ventricular heart failure because of a new onset atrial fibrillation. The evolution is characterized by a sinus rythm dysfunction, a complete atrioventricular block, a non-sustained ventricular tachycardia (which required a dual-chamber defibrillator implantation) and an ischemic testicular necrosis treated by orchidectomy. After ruling out differential diagnosis we evoked an hypertrophic cardiomyopathy. Medical family anamnesis revealed an hereditary component, and we concluded to a PRKAG2 cardiac syndrome presenting as a familial hypertrophic cardiomyopathy. Two years later, he presented with a type B aortic dissection. We review the literature and differentials diagnosis.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cordier</LastName><ForeName>L</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Etudiants en Médecine, ULB.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vanderbist</LastName><ForeName>R</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Etudiants en Médecine, ULB.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cilla</LastName><ForeName>N</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Etudiants en Médecine, ULB.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Baldassarre</LastName><ForeName>S</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Service de Cardiologie, C.H.U. Ambroise Paré, Mons.</Affiliation></AffiliationInfo></Author></AuthorList><Language>fre</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D004740">English Abstract</PublicationType></PublicationTypeList><VernacularTitle>La cardiomyopathie hypertrophique familiale dans le contexte de la mutation PRKAG2 : un lourd héritage. A propos d’un cas. Revue de la littérature.</VernacularTitle></Article><MedlineJournalInfo><Country>Belgium</Country><MedlineTA>Rev Med Brux</MedlineTA><NlmUniqueID>8003474</NlmUniqueID><ISSNLinking>0035-3639</ISSNLinking></MedlineJournalInfo><OtherAbstract Type="Publisher" Language="fre">Le cas que nous présentons est celui d’un jeune patient sans antécédent médical qui présente une décompensation cardiaque gauche sur fibrillation auriculaire de novo. L’évolution est caractérisée par une dysfonction sinusale, un bloc atrioventriculaire syncopal, de la tachycardie ventriculaire non soutenue avec nécessité d’implanter un défibrillateur double chambre et par une nécrose testiculaire d’origine ischémique indiquant une orchidectomie. Plusieurs diagnostics différentiels sont évoqués. Les investigations plus poussées mettent en évidence une cardiomyopathie hypertrophique jusqu’alors asymptomatique. L’anamnèse familiale révèle une composante héréditaire qui nous amènera à évoquer le diagnostic de cardiomyopathie hypertrophique familiale liée à la mutation PRKAG2. Deux ans plus tard, il se présente avec une dissection aortique de type B. La littérature concernant cette pathologie et les diagnostics différentiels sont revus à cette occasion. |
19,756 | Trends and predictors of implantable cardioverter defibrillator implantation after sudden cardiac arrest: Insight from the national inpatient sample. | Implantable cardioverter defibrillator (ICD) has a class IA indication in survivors of sudden cardiac arrest (SCA) provided no reversible cause is identified. We sought to determine trends and predictors of ICD implant in SCA patients from a national sample of the United States population.</AbstractText>Data were gathered from National Inpatient Sample (NIS) from January 2003 to December 2014. All patients ≥18 years of age with a primary discharge diagnosis of SCA, ventricular fibrillation (VF), ventricular flutter, and ventricular tachycardia (VT) were included. Patients died during hospitalization, had a previous ICD implant, and with a reversible cause of SCA were excluded. Primary outcome of interest was rate of new ICD implant at discharge. Logistic regression analysis was then performed to determine predictors for ICD implantation. A total of 176,876 patients were identified to have SCA, VF, ventricular flutter, and VT. After applying exclusion criteria, we were left with 22,054 patients. Out of this, 6,908 (31%) patients were implanted with an ICD prior to discharge. There was a linear trend toward reduced ICD utilization over our study period (40% in 2003 vs 25% in 2014, P trend = 0.0004). Advanced age, black race, and chronic renal disease are independently associated with low ICD utilization.</AbstractText>We found low trend of ICD implant in survivors of SCA without any reversible cause. There is a need to identify etiologies behind low ICD utilization in this vulnerable group who are at most risk for a subsequent SCA.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,757 | Post-procedural N-terminal pro-brain natriuretic peptide predicts one-year mortality after transcatheter aortic valve implantation. | Natriuretic peptides are ubiquitously used for diagnosis, follow-up and prognostic assessment in various heart conditions. N-terminal pro-brain natriuretic peptide (NT-proBNP) correlates with aortic stenosis severity, however its significance after transcatheter aortic valve implantation (TAVI) is not well established.</AbstractText>We aimed to assess the prognostic value of NT-proBNP at one year in patients undergoing TAVI.</AbstractText>This single-center retrospective analysis included 151 patients in whom both baseline and one-month post-procedure NT-proBNP were measured, from 206 consecutive patients undergoing TAVI between November 2008 and December 2014. The best cut-off values of both baseline and one-month post-TAVI NT-proBNP for one-year mortality were determined by receiver operating characteristic curve analysis. Independent predictors of one-year mortality were assessed by Cox regression.</AbstractText>The areas under the curve of baseline and post-procedural NT-proBNP for one-year mortality were 0.60 and 0.72, with the best cut-off values of 1350 and 2500 pg/ml, respectively. Atrial fibrillation, procedure-related major bleeding, baseline NT-proBNP higher than 1350 pg/ml, post-procedural NT-proBNP higher than 2500 pg/ml, higher creatinine and Society of Thoracic Surgeons score, and lower left ventricular ejection fraction were associated with one-year mortality. Only post-procedural NT-proBNP was independently and negatively associated with one-year survival (HR 5.9, 95% CI 1.6-21.7, p=0.008).</AbstractText>Baseline NT-proBNP did not predict one-year mortality; on the other hand one-month post-procedural NT-proBNP higher than 2500 pg/ml may identify a high-risk subset of patients, allowing better management, care and hypothetically outcome.</AbstractText>Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.</CopyrightInformation> |
19,758 | Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin-Fab. | The aim of the present study was to compare clinical features of patients with elevated serum digoxin concentrations who were treated with digoxin-Fab with those where the immunotherapy was not given by a tertiary hospital toxicology service.</AbstractText>This was a retrospective series of patients with supratherapeutic serum digoxin concentrations referred to the toxicology service from August 2013 to October 2015. Data collected included demographics, presenting complaint, digoxin dose, other medications taken, serum digoxin, potassium and creatinine concentration on presentation and initial and post-digoxin-Fab heart rate.</AbstractText>There were 47 referrals. Digoxin-Fab was administered in 21 cases. It was given more commonly when the heart rate was <51/min or serum potassium was >5.0 mmol/L. Patients receiving digoxin-Fab were more likely to be on maintenance therapy with beta-blockers or calcium channel blockers (95% vs 61%; OR 13.1; 95% CI 1.5-113) and/or potassium-sparing medications (95% vs 54%; OR 17.1; 95% CI 2.0-147). They had elevated serum creatinine (76% vs 42%; OR 8.2; 95% CI 1.9-34), higher serum potassium (median: 5.1 mmol/L vs 4.2 mmol/L, P = 0.02), higher serum digoxin concentration (median: 3.5 nmol/L vs 2.3 nmol/L, P = 0.02) and pretreatment heart rate <51/min (66% vs 31%; OR 4.5; 95% CI 1.3-15). There were no patients with ventricular arrhythmias or hypotension. Median heart rate increased by 10/min 1 and 4 h after digoxin-Fab. However, individual heart rate response to digoxin-Fab was variable.</AbstractText>Digoxin-Fab was more commonly administered when heart rate was <51/min. It had a small effect on increasing heart rate; however, individual response to digoxin-Fab was variable as patients were using other negative chronotropic medications. In symptomatic bradycardic patients on multiple heart failure medications, positive chronotropic and potassium-lowering therapies should be considered in concert with digoxin-Fab.</AbstractText>© 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.</CopyrightInformation> |
19,759 | Dysautonomy in different death risk groups (Rassi score) in patients with Chagas heart disease. | It has been difficult to prove that "catecholamine-induced cardiomyopathy" contributes to the mechanism of sudden cardiac death in Chagas heart disease. Also, it is almost impossible to rule out the possibility that it is not involved in the process. More importantly, the vagal-cholinergic pathway in the ventricle plays a direct role in the prevention of the initiation of complex ventricular arrhythmias, including nonsustained ventricular tachycardia, ventricular fibrillation responsible for sudden death.</AbstractText>To determine frequency of parasympathetic autonomic indices among the different groups of risk of cardiovascular death when stratified by Rassi score.</AbstractText>Patients with Chagas heart disease were selected and divided into three risk groups by Rassi score. A fourth group, non-Chagas group, was of similar age and gender. All were subjected to analysis of heart rate variability during controlled breathing (RSA) and tilt table passive test (tilt test). High frequency and low frequency/high frequency ratio were calculated and presented by box-plot. Also, t-test was used to compare the two groups.</AbstractText>It was observed that the parasympathetic and sympathetic component were affected, when the risk group increased the response was worsened to the stimulus (RSA or Tilt). Also, the low-risk group was jeopardized, when compared to the non-Chagas group.</AbstractText>The loss of parasympathetic modulation was present in all Rassi risk groups, including the low risk, indicating that a morphological change of the myocardium represents a detectable neurofunctional change.</AbstractText>© 2018 Wiley Periodicals, Inc.</CopyrightInformation> |
19,760 | Report on the Ion Channel Symposium : Organized by the German Cardiac Society Working Group on Cellular Electrophysiology (AG 18). | To support scientific exchange and activity in the field of cardiac cellular electrophysiology, the German Cardiac Society Working Group on Cellular Electrophysiology (AG 18) established a two-day symposium to be held every 2 years. The second Ion Channel Symposium entitled "Göttingen Channels 2017-Of Benches and Beds" took place in Göttingen from September 22nd to 23rd under the auspices of the German Cardiac Society. A group of national and international experts presented scientific advances in cardiac electrophysiology and rhythmology. The symposium's primary focus was the significance of cellular electrophysiology findings for the optimization of diagnostic and therapeutic strategies against cardiac arrhythmias. To this end, speakers, chairpersons and attendees discussed the contribution of specific molecular alterations to the initiation and perpetuation of atrial and ventricular arrhythmias. Furthermore, the meeting highlighted how discoveries in electrophysiological research may lead to novel therapeutic targets. The interdisciplinary assessment of mechanisms and therapeutic strategies of cardiac arrhythmias represented a key feature of the meeting. A unique combination of topics and speakers representing both basic science and clinical electrophysiology ensured the scientific success of the "Göttingen Channels 2017" symposium. The next Ion Channel Symposium is planned to be hosted by the incoming co-chair of the German Cardiac Society Working Group on Cellular Electrophysiology in fall 2019. |
19,761 | Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure gradient. | To determine potential predictors of ventricular tachyarrhythmia and sudden cardiac death (SCD) occurring late after repair of tetralogy of Fallot (TOF).</AbstractText>Since 1964, 415 patients had undergone total repair for TOF at Niigata University Hospital. Of these, 89 patients who were followed for more than 10 years at our institute were retrospectively reviewed.</AbstractText>The mean follow-up period was 24.3 years. During the study period, one patient died of cerebral bleeding, and two patients had SCD. The overall survival rates at 20, 30, and 40 years were 100%, 94.6%, and 94.6%, respectively. Eight (9.0%) patients required re-intervention during the late period associated with right ventricular outflow (n=4), tricuspid valve (n=3), aortic valve (n=2), and others (n=2). Ten (11.2%) patients had a history of ventricular tachycardia (VT) or ventricular fibrillation (VF), and six underwent implantation of an implantable cardiac defibrillator. Multivariate analysis selected the change rate of QRS duration [ms/year; odds ratio (OR), 2.44; 95% confidence interval (CI): 1.28-4.65; P=0.007] and the pressure gradient at tricuspid valve regurgitation on echocardiography (OR, 1.12; 95% CI: 1.02-1.22; P=0.017) as risk factors for VT/VF or SCD. Trans-annular patch (TAP) repair was not an independent risk factor for ventricular arrhythmia.</AbstractText>The combination of rapid change rate of QRS duration and higher-pressure gradient at tricuspid regurgitation were risk factors for ventricular tachyarrhythmia late after TOF repair. Adequate surgical or catheter intervention for pressure and volume load in the right ventricle might decrease the prevalence of VT/VF and SCD.</AbstractText> |
19,762 | The Interplay between Obstructive Sleep Apnea and Atrial Fibrillation. | Atrial fibrillation (AF) is the most common cardiac arrhythmia. Obstructive sleep apnea (OSA) is also an increasingly common condition. Both entities are risk factors for ischemic stroke and both conditions are linked with increased mortality. Mechanical effects of obesity and sleep apnea can lead to increased afterload, left ventricular hypertrophy, and left atrial fibrosis and remodeling. These changes can result in an increased risk of AF development. The current paper summarizes the evidence for the bidirectional relationship between AF and OSA. The merits of selective screening for these two conditions are also discussed. |
19,763 | Increased Left Ventricular Filling Pressure and Arterial Occlusion in Stroke Related to Atrial Fibrillation. | We investigated whether left ventricular filling pressure is associated with arterial occlusion in patients with ischemic stroke related to atrial fibrillation (AF).</AbstractText>Ninety-nine patients with AF-related stroke were included. Left ventricular filling pressure was assessed by E (early mitral inflow velocity)/e' (early diastolic velocity of the mitral valve annulus velocity) ratio based on tissue Doppler echocardiography. Arterial occlusion was evaluated by computed tomography or magnetic resonance angiography. In addition, the presence of a hyperdense middle cerebral artery sign (HMCAS) on noncontrast brain computed tomography, a marker of acute thrombus burden, was assessed. Multiple logistic regression was used to evaluate the association of E/e' with arterial occlusion and the HMCAS.</AbstractText>The mean age was 73.2 (±10.2), and 56% were men. Thirty-six (36.4%) patients had arterial occlusion on imaging. E/e' ratios were independently associated with arterial occlusion with an odds ratio of 1.24 (per 1 increase, 95% confidence interval 1.11-1.38). The receiver operating characteristics curve demonstrated that E/e' ratios have an excellent discriminatory capacity in predicting arterial occlusion with an area under the curve of .77 (P < .001). In addition, E/e' ratios were higher in patients with HMCAS than in those without (19.1 versus 14.0, P < .001).</AbstractText>E/e' ratios were associated with arterial occlusion in AF-related stroke and may play a role in identifying patients at high risk of severe stroke.</AbstractText>Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
19,764 | Arrhythmias in Children in Early Postoperative Period After Cardiac Surgery. | Postoperative arrhythmias are a known complication after cardiac surgical repairs for congenital heart disease.</AbstractText>Data were reviewed pertaining to incidence, diagnosis, potential risk factors, and management of postoperative arrhythmias in 369 consecutive patients under 18 years of age, undergoing elective open heart surgery. All children were admitted to the intensive care unit and continuous electrocardiographic monitoring was performed. Patient factors such as Aristotle Basic Complexity Score, total surgical duration, hypotension, tachycardia, serum lactate level, and inotropic score were analyzed. Univariate analysis was done to assess associations between these factors and the occurrence of postoperative arrhythmias.</AbstractText>Twenty-five (6.7%) patients developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia occurring in 15 (60%) patients, followed by supraventricular tachycardia in 3 (12%), ventricular premature contractions in 3 (12%), hemodynamically unstable ventricular tachycardia and fibrillation in 3 (12%), and atrial fibrillation in 1 (4%) patient. Different grades of heart block were noted in 13 patients. Aristotle score (P = .014), total surgical duration (P < .01), hypotension (P = .02), heart rate (beats per minute) (P = .001), serum lactate level (P = .04), and inotropic score (P = .02) in the early postoperative period were associated with arrhythmia occurrence. Surgeries for ventricular septal defect alone or in association with other diseases including tetralogy of Fallot (TOF) and transposition of the great arteries (TGA) were found to be associated with higher risk of arrhythmias.</AbstractText>This study showed a low incidence of arrhythmias, JET being the commonest, seen more in TOF repair and these could be treated efficiently. Higher Aristotle score, longer surgical time, hypotension, tachycardia, high inotropic score, and high serum lactate levels were associated with the occurrence of arrhythmias postoperatively.</AbstractText> |
19,765 | Diaphragmatic Rupture and Hernia after Cardiopulmonary Resuscitation. | A 55-year-old man underwent surgical replacement of a mitral valve 10 years earlier. In a retrospective evaluation of a chest radiograph, the diaphragm was intact at the time of initial surgery. He was then admitted to our emergency room with a complaint of vertigo. During evaluation, he developed decreased consciousness. Ventricular fibrillation was diagnosed, and external massage and full cardiopulmonary resuscitation were performed. After 20 minutes, his sinus rhythm returned and hemodynamic status stabilized with inotropic drugs. Transthoracic echocardiography showed normal valvular function and no evidence of left cardiac malfunction or clot. Electrocardiography showed ST elevation in inferior leads, and levels of cardiac enzymes were elevated. Angiography showed an embolic lesion in the mid right coronary artery that was treated with percutaneous coronary intervention (PCI) and insertion of a stent. After 24 hours, the patient was extubated in good condition, but had mild dyspnea that progressed to CO<sub>2</sub> narcosis and subsequent reintubation. Post-extubation chest radiography showed herniation of abdominal organs into the right hemithorax. The diaphragmatic defect was closed with a polytetrafluoroethylene patch by a thoracic surgeon, and the postoperative course was uncomplicated. |
19,766 | Concealed abnormal atrial phenotype in patients with Brugada syndrome and no history of atrial fibrillation. | The electrocardiogram (ECG) of patients with BrS in sinus rhythm might reflect intrinsic atrial electrical abnormalities independent from any previous atrial fibrillation (AF). Aim of this study is to investigate the presence of P-wave abnormalities in patients with BrS and no history of AF, and to compare them with those displayed by patients with documented paroxysmal AF and by healthy subjects.</AbstractText>Continuous 5-min 16-lead ECG recordings in sinus rhythm were obtained from 72 participants: 32 patients with a type 1 Brugada ECG, 20 patients with a history of paroxysmal AF and 20 age-matched healthy subjects. Different ECG-based features were computed on the P-wave first principal component representing the predominant morphology across leads and containing the maximal information on atrial depolarization: duration, full width half maximum (FWHM), area under the curve and number of peaks in the wave.</AbstractText>Patients with BrS and no history of AF (mean age: 53±12years; males: 28 pts., spontaneous type 1 ECG: 20 pts., SCN5A mutation: 10 pts) presented with longer P-wave duration, higher FWHM and wider area under the curve in comparison with the other two groups. Although P-wave features were abnormal in BrS patients, no significant difference was found between patients with spontaneous type 1 ECG and ajmaline-induced type 1 ECG, symptomatic and asymptomatic ones, and between patients with a pathogenic SCNA5 mutation and patients without a known gene mutation.</AbstractText>Patients with BrS without previous occurrence of AF present with a concealed abnormal atrial phenotype. In these patients atrial electrical abnormalities can be detected even in the absence of an overt ECG ventricular phenotype, symptoms and a SCN5A mutation.</AbstractText>Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.</CopyrightInformation> |
19,767 | Echocardiographic and electrocardiographic abnormalities in adults living with human immunodeficiency virus: a cross-sectional study in the Yaoundé Central Hospital, Cameroon. | Cardiac involvement is frequent in the course of human immunodeficiency virus (HIV) infection disease. This work aimed at studying the profile of echocardiographic and electrocardiography (ECG) abnormalities in adults living with HIV (PLHIV), compared to those not infected with HIV at the treatment unit of the Yaoundé Central Hospital.</AbstractText>We carried out a case-control study over three months at the HIV treatment unit. We included adults of both sexes, aged ≥21 years, HIV-infected (cases), and age and sex matched controls. Those with a history of heart disease were excluded. We collected sociodemographic, clinical, ECG, and echocardiographic data.</AbstractText>We included 59 PLHIV and 59 age-sex matched controls without HIV infection. The prevalence of echocardiographic abnormalities was 28.8% in cases, and 8.5% in the control group (P=0.005). The prevalence of ECG abnormalities was 28.8% in the cases, and 18.6% in the control group (P=0.195). The main echocardiographic abnormalities (cases versus controls) were aortic regurgitation (10.2% versus 3.4%, P=0.144), right atrial dilation (6.8% versus 1.7%, P=0.178), diastolic dysfunction (5.1% versus 1.7%, P=0.310), and Left ventricular hypertrophy (5.1% versus 0%, P=0.080). The main ECG abnormalities (cases versus controls) were abnormal repolarization (11.9% versus 5.1%, P=0.187), sinus tachycardia (10.2% versus 6.8%, P=0.510), and atrial fibrillation (5.1% versus 0%, P=0.080). HIV infection was significantly associated with echocardiographic abnormalities and not with ECG abnormalities. The degree of immune deficiency was independently associated with the occurrence of echocardiographic and ECG abnormalities.</AbstractText>HIV infected adults have more echocardiographic and ECG abnormalities compared to non-infected adults. The ECG and echocardiographic anomalies varied, and depends on the severity of immune deficiency.</AbstractText> |
19,768 | No-touch aorta robot-assisted atrial septal defect repair via two ports. | Atrial septal defect (ASD) repairs have been successfully performed on arrested hearts with robotic assistance. The present study assessed the feasibility, safety, and efficacy of totally endoscopic cardiac surgery using a no-touch aorta technique for ASD via only 2 ports, and we named this procedure two-port robotic cardiac surgery (TROCS).</AbstractText>Between May 2014 and June 2016, 8 consecutive patients underwent TROCS for ASD using the da Vinci surgical system (Intuitive Surgical Inc.) at our institute. All of the procedures were performed via only 2 port incisions in the right chest. One was the camera port, and the other was the port for the robotic instruments. Both robotic instruments were inserted through this port and crossed while being prevented from colliding with each other. The surgeon console was set to the reverse of default settings so that both masters would control the inverse instrument. TROCS for ASD was carried out under ventricular fibrillation induced by combinations of an electrical fibrillator, injection of potassium, and hypothermia without aortic cross-clamping.</AbstractText>All cases were successfully repaired. The mean operation, cardiopulmonary bypass and ventricular fibrillation times were 129.6 ± 29.0 min, 66.9 ± 24.5 min and 9.6 ± 5.9 min, respectively, and the estimated blood loss volume was 28.1 ± 58.6 ml. No patients required blood transfusion during their hospital stay, and their cosmetic results were excellent.</AbstractText>TROCS for ASD using no-touch aorta technique was achieved safely with good clinical results and excellent cosmetic results.</AbstractText> |
19,769 | Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry. | Atrial fibrillation (AF) is an independent risk factor for ischaemic stroke. The CHA2DS2-VASc is the most widely used risk stratification model; however, echocardiographic refinement may be useful, particularly in low risk AF patients. The present study examined the association between advanced echocardiographic parameters and ischaemic stroke, independent of CHA2DS2-VASc score.</AbstractText>One thousand, three hundred and sixty-one patients (mean age 65±12 years, 74% males) with first diagnosis of AF and baseline transthoracic echocardiogram were followed by chart review for the occurrence of stroke over a mean of 7.9 years. Left atrial (LA) volumes, LA reservoir strain, P-wave to A' duration on tissue Doppler imaging (PA-TDI, reflecting total atrial conduction time), and left ventricular (LV) global longitudinal strain (GLS) were evaluated in patients with and without stroke. The independent association of these echocardiographic parameters with the occurrence of ischaemic stroke was evaluated with Cox proportional hazard models. One-hundred patients (7%) developed an ischaemic stroke, representing an annualized stroke rate of 0.9%. The incident stroke rate in the year following the first diagnosis of AF was 2.6% in the entire population and higher than the remainder of the follow-up period. Left atrial reservoir (14.5% vs. 18.9%, P = 0.005) and conduit strains were reduced (10.5% vs. 13.5%, P = 0.013), and PA-TDI lengthened (166 ms vs. 141 ms, P < 0.001) in the stroke compared with non-stroke group, despite similar LV dimensions, LV ejection fraction, GLS, and LA volumes. Left atrial reservoir strain and PA-TDI were independently associated with risk of stroke in a model including CHA2DS2-VASc score, age, and anticoagulant use.</AbstractText>The assessment of LA reservoir strain and PA-TDI on echocardiography after initial CHA2DS2-VASc scoring provides additional risk stratification for stroke and may be useful to guide decisions regarding anticoagulation for patients upon first diagnosis of AF.</AbstractText> |
19,770 | Presence of chest tubes does not affect the hemodynamic efficacy of standard cardiopulmonary resuscitation. | During cardiopulmonary resuscitation (CPR), chest tubes can hinder increases in intrathoracic pressure by venting the pressure during chest compressions, thus reducing the blood flow generated by the thoracic pump effect. The aim of the present study was to investigate the effects of chest tubes on hemodynamic efficacy during standard CPR in a swine model of cardiac arrest.</AbstractText>Twelve domestic male pigs weighing 39.6 ± 8.4 kg underwent bilateral tube thoracostomy and received a total of 12 min of standard manual CPR, which comprised of two 6-min courses of CPR after 2 min of electrically induced ventricular fibrillation. Each 6-min set consisted of 3 min of CPR with clamped chest tubes (CCT-CPR) and 3 min of CPR with unclamped chest tubes (UCT-CPR). The sequence of CCT-CPR and UCT-CPR was randomized.</AbstractText>Hemodynamic parameters including aortic pressure, left ventricular pressure, right ventricular pressure, right atrial pressure, and minimal and maximal dp/dt did not differ significantly between CCT-CPR and UCT-CPR. No significant differences were noted in carotid blood flow, end-tidal CO2</sub>, or coronary perfusion pressure between CCT-CPR and UCT-CPR.</AbstractText>The presence of chest tubes did not affect the hemodynamic efficacy of standard CPR. There is no need to clamp chest tubes during standard CPR.</AbstractText> |
19,771 | Vagal stimulation after acute coronary occlusion: The heart rate matters. | There is a well documented causal link between autonomic imbalance and cardiac elec-trical instability. However, the mechanisms underlying the antiarrhythmic effect of vagal stimulation are poorly understood. The vagal antiarrhythmic effect might be modulated by a decrease in heart rate.</AbstractText>The proximal anterior interventricular artery was occluded in 16 pigs by clamping under general anaesthesia. Group 1: heart rates remained spontaneous (n = 6; 12 occlusions); Group 2: heart rates were fixed at 190 bpm with atrial electrical stimulation (n = 10; 20 occlusions). Each pig received two occlusions, 30 min apart, one without and one with vagal stimulation (10 Hz, 2 ms, 5-20 mA). The antiarrhythmic effect of vagal activation was defined as the time to the appearance of ventricular fibrillation (VF) after occlusion.</AbstractText>In Group 1, vagal stimulation triggered a significant decrease in basal heart rate (132 ± 4 vs. 110 ± 17 bpm, p < 0.05), and delayed the time to VF after coronary occlusion (1102 ± 85 vs. 925 ± ± 41 s, p < 0.05). In Group 2, vagal stimulation did not modify the time to VF (103 ± 39 vs. 91 ± 20 s). Analyses revealed that heart rate and the time to VF were positively linearly related.</AbstractText>Maintaining a constant heart rate with atrial electrical stimulation in pigs prevented vagal stimulation from modifying the time to VF after acute coronary occlusion.</AbstractText> |
19,772 | A case of probable Amiodarone-induced pancreatitis in the treatment of atrial fibrillation: a literature review and case report. | Amiodarone is an effective medication used in the treatment of several different arrhythmias. Its most well-known adverse effects include pulmonary fibrosis, thyroid dysfunction, and hepatotoxicity. A less common side effect is acute pancreatitis. A 67-year-old male being treated for atrial fibrillation in rapid ventricular response with Amiodarone developed acute epigastric abdominal pain 24 hours after initiation of therapy. He was diagnosed as having acute pancreatitis based on characteristic findings seen on an abdominal CT scan. Commonly encountered etiologies of pancreatitis were ruled out through a combination of the history, laboratory values, and imaging results. Based on the temporal association of the acute presentation and initiation of Amiodarone therapy, in conjunction with a lack of support for any other etiology, the diagnosis of Amiodarone-induced pancreatitis was made. Within 7 days following the cessation of Amiodarone therapy, the patient's symptoms had completely resolved. Amiodarone-induced pancreatitis is an often overlooked medication association and is one that has been infrequently reported throughout the literature. Given the substantial morbidity and mortality associated with acute pancreatitis, and the ease of treatment (withdrawing Amiodarone), this is a critical side effect that should be recognized in the appropriate clinical setting. |
19,773 | Individualized surgical strategies for left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. | Surgical strategies to treat drug refractory left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy include septal myectomy (SM) and, less frequently, mitral valve (MV) repair or replacement. The primary aim of this study was to report the surgical technique and management outcomes in a consecutive group of patients with variable phenotypes of hypertrophic cardiomyopathy in a broad national specialist practice.</AbstractText>A total of 203 consecutive patients, 132 men (mean age 48.6 ± 14.6 years) underwent surgery for the management of LVOTO. Surgical approaches included SM (n = 159), SM with MV repair (n = 25), SM with MV replacement (n = 9) and MV replacement alone (n = 10). Specific surgical approaches were performed based on the underlying mechanism of obstruction. Eleven (5.4%) patients had previous alcohol septal ablation for the management of LVOTO. Concomitant non-mitral cardiac procedures were carried out in 22 (10.8%) patients.</AbstractText>Operative survival rate was 99.0% with 2 deaths within 30 days. The mean bypass time was 92.9 ± 47.8 min, with a mean length of hospital stay of 10.5 ± 7.8 days. Surgical complications included 3 ventricular septal defects requiring repair (1.5%), 1 Gerbode defect surgically repaired, 2 aortic valve repairs (1.0%), 2 transient ischaemic attacks (1.0%) and 4 strokes (2.0%). Thirty-nine (19.2%) patients had perioperative new-onset atrial fibrillation and 8 (3.9%) patients had unexpected atrioventricular block requiring a permanent pacemaker. Mean resting left ventricular outflow tract gradient improved from 70.6 ± 40.3 mmHg preoperatively to 11.0 ± 10.5 mmHg at 1 year postoperatively (P < 0.001). Mean New York Heart Association class improved from 2.6 ± 0.5 preoperatively to 1.6 ± 0.6 at 1 year after the procedure.</AbstractText>In variable phenotypes of LVOTO in hypertrophic cardiomyopathy, an individualized surgical approach provided effective reductions in left ventricular outflow tract gradients and good symptomatic relief with acceptable mortality and morbidity.</AbstractText> |
19,774 | The long-QT syndrome and exercise practice: The never-ending debate. | Today, understanding the true risk of adverse events in long-QT syndrome (LQTS) populations may be extremely complex and potentially dependent on many factors such as the affected gene, mutation location, degree of QTc prolongation, age, sex, and other yet unknown factors. In this context, risk stratification by genotype in LQTS patients has been extremely difficult, also during exercise practice, especially due to the lack of studies that would lead to a better understanding of the natural history of each mutation and its impact upon athletes. The creation of individualized guidelines for sport participation is a goal yet to be achieved not only due to the complexity of genotype effect on the phenotype in this patient population, but also due to penetrance in genotype-positive patients. This article summarizes current knowledge and raises questions concerning the difficult relationship between exercise practice and LQTS. |
19,775 | Predictors of Mortality in Patients With Atrial Fibrillation (from the Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events [ACTIVE A]). | The mortality rate of most patients with atrial fibrillation (AF) exceeds the stroke rate, but predictors of mortality have not been well defined. The Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE A) recruited patients with AF who were unsuitable to receive vitamin K-antagonists and were randomized to aspirin alone versus aspirin plus clopidogrel. We investigated independent predictors of all-cause mortality by multivariable Cox regression analysis and explored interactions with assigned antiplatelet therapy. Of the 7,554 patients enrolled with a mean age of 71 years, 1,687 (22%) patients died during the median follow-up of 3.7 years (annualized mortality rate 6.4%/year). Assignment to dual antiplatelet therapy had no effect on mortality (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.90 to 1.1) or on vascular and nonvascular death. Independent predictors of all-cause mortality were advancing age, lower body mass index (HR 1.4 < 25 kg/m<sup>2</sup>, 95% CI 1.3 to 1.6), diabetes mellitus, Latin American ethnicity (HR 1.4, 95% CI 1.1 to 1.6), previous stroke or transient ischemic attack, peripheral artery disease, increased resting heart rate (HR 1.3, 95% CI 1.1 to 1.4 per 30 bpm), lower diastolic blood pressure, coronary artery disease, heart failure, left ventricular systolic dysfunction, hemoglobin level of <13 mg/dl, and reduced estimated glomerular filtration rate. In conclusion, in this large clinical trial cohort of patients with AF, treatment with clopidogrel plus aspirin versus aspirin monotherapy did not affect all-cause mortality, vascular death, or nonvascular death. Novel independent predictors of increased mortality included lower diastolic blood pressure and Latin American ethnicity. |
19,776 | Intraoperative Implantation of Micra Leadless Pacemaker During Valve Surgery. | The Micra transcatheter leadless pacemaker, a single-chamber leadless ventricular pacemaker, is implanted percutaneously through the femoral vein. We present the case of a patient in whom the Micra leadless pacemaker was implanted during valve surgery. |
19,777 | A rare cause of fatal cardiac arrhythmia: Inhalation of butane gas. | Pamuk U, Gürsu HA, Emeksiz S, Özdemir-Sahan Y, Çetin İ. A rare cause of fatal cardiac arrhythmia: Inhalation of butane gas. Turk J Pediatr 2018; 60: 755-756. Butane gas, especially available in lighters, is commonly misused among adolescents and its side effects are rarely observed but serious. A 14-yearold male was brought to our emergency department. The electrocardiographic (ECG) examination showed biphasic T waves in leads V4-V6, and long QTc at 481ms. Echocardiographic study showed left ventricular systolic dysfunction. Troponin I level was found to be high at 9.1 ng/ml. Taking into consideration the patient`s history, clinical and laboratory findings, ventricular fibrillation and myocardial injury resulting from butane gas inhalation was diagnosed. |
19,778 | Protective effect of fenofibrate against ischemia-/reperfusion-induced cardiac arrhythmias in isolated rat hearts. | Fenofibrate is a peroxisome proliferator-activated receptor (PPAR)-α activator that lowers triglycerides and influences cytochrome P-450 (CYP-450) epoxygenase-dependent arachidonic acid (AA) metabolism. CYP-450 epoxygenase metabolizes AA to epoxyeicosatrienoic acids (EETs). EETs have coronary dilating and cardiac and renal protective properties. Fibrates possess similar properties due to their CYP-450 epoxygenase-inducing properties that lead to increase in endogenous EET production. In the current investigations, fenofibrate (100 mg/kg, orally) for 2 weeks decreased ischemia-/reperfusion (I/R)-induced premature ventricular contractions (PVCs), ventricular tachycardia (VT), and ventricular fibrillation (VF) in the isolated rat hearts. Fenofibrate caused marked inhibition of the reperfusion-induced cardiac arrhythmias. The incidence of reperfusion-induced VF decreased from 80% in the control vehicle-treated animals to 33% in the fenofibrate-treated animals (P < 0.001). PVCs were also significantly (P < 0.01) decreased from 223.2 ± 51 in control vehicle-treated animals to 136.8 ± 22 in fenofibrate-treated animals. Total duration of reperfusion-induced VT decreased from 29.2 ± 6.3 s in control, vehicle-treated animals to 4.8 ± 1.3 s in fenofibrate-treated animals, P < 0.001. Heart rate and perfusion pressure were not significantly affected by fenofibrate pretreatment. Diltiazem, a clinically used anti-arrhythmic agent, produced complete protection against I/R-induced cardiac arrhythmias in this model reducing the incidence of VF from 80% in control, vehicle-treated animals to 10% in diltiazem-treated hearts. These findings indicate that fenofibrate suppresses arrhythmias in isolated rat hearts subjected to I/R-induced injury. |
19,779 | Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden - A population-based register study of more than 18,000 cases. | In-hospital cardiac arrest (IHCA) constitutes a major contributor to cardiovascular mortality. The aim of the present study was to investigate factors of importance to 30-day survival after IHCA in Sweden.</AbstractText>A retrospective register study based on the Swedish Register of Cardiopulmonary Resuscitation (SRCPR) 2006-2015. Sixty-six of 73 hospitals in Sweden participated. The inclusion criterion was a confirmed cardiac arrest in which resuscitation was attempted among patients aged >18years.</AbstractText>In all, 18,069 patients were included, 39% of whom were women. The median age was 75years. Thirty-day survival was 28.3%, 93% with a CPC score of 1-2. One-year survival was 25.0%. Overall IHCA incidence in Sweden was 1.7 per 1000 hospital admissions. Several factors were found to be associated with 30-day survival in a multivariable analysis. They included cardiac arrest (CA) at working days during the daytime (08-20) compared with weekends and night-time (20-08) (OR 1.51 95% CI 1.39-1.64), monitored CA (OR 2.18 95% CI 1.99-2.38), witnessed CA (OR 2.87 95% CI 2.48-3.32) and if the first recorded rhythm was ventricular fibrillation/tachycardia, especially in combination with myocardial ischemia/infarction as the assumed aetiology of the CA (OR for interaction 4.40 95% CI 3.54-5.46).</AbstractText>30-day survival after IHCA is associated with the time of the event, the aetiology of the CA and the degree of monitoring and this should influence decisions regarding the appropriate level of monitoring and care.</AbstractText>Copyright © 2017 Elsevier B.V. All rights reserved.</CopyrightInformation> |
19,780 | The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction. | Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools.</AbstractText>The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed.</AbstractText>In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk.</AbstractText>Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies.</AbstractText>© 2017 John Wiley & Sons Ltd.</CopyrightInformation> |
19,781 | Hydrogen Inhalation is Superior to Mild Hypothermia for Improving Neurological Outcome and Survival in a Cardiac Arrest Model of Spontaneously Hypertensive Rat. | Postcardiac arrest syndrome is the consequence of whole-body ischemia-reperfusion events that lead to multiple organ failure and eventually to death. Recent animal studies demonstrated that inhalation of hydrogen greatly mitigates postresuscitation myocardial dysfunction and brain injury. However, the influence of underlying heart disease on the efficacy of hydrogen is still unknown. In the present study, we investigated the effects of hydrogen inhalation on neurological outcome and survival in a cardiac arrest model of spontaneously hypertensive rat (SHR).</AbstractText>Cardiopulmonary resuscitation was initiated after 4 min of untreated ventricular fibrillation in 40 SHRs. Immediately after successful resuscitation, animals were randomized to be ventilated with 98% oxygen and 2% nitrogen under normothermia (Ctrl), 2% nitrogen under hypothermia (TH), 2% hydrogen under normothermia (H2), or 2% hydrogen under hypothermia (H2+TH) for 2 h. Hypothermia was maintained at 33°C for 2 h. Animals were observed up to 96 h for assessment of survival and neurologic recovery.</AbstractText>No statistical differences in baseline measurements were observed among groups and all the animals were successfully resuscitated. Compared with Ctrl, serum cardiac troponin T measured at 5 h and myocardial damage score measured at 96 h after resuscitation were markedly reduced in H2, TH, and H2+TH groups. Compared with Ctrl and TH, astroglial protein S100 beta measured during the earlier postresuscitation period, and neurological deficit score and neuronal damage score measured at 96 h were considerably lower in both H2 and H2+TH groups. Ninety-six hours survival rates were significantly higher in the H2 (80.0%) and H2+TH (90.0%) groups than TH (30.0%) and to Ctrl (30.0%).</AbstractText>Hydrogen inhaling was superior to mild hypothermia for improving neurological outcome and survival in cardiac arrest and resuscitation model of systemic hypertension rats.</AbstractText> |
19,782 | Brugada Syndrome Induced by an Interscalene Block: A Case Report. | A 57-year-old woman with no noteworthy medical or surgical history underwent an interscalene block with bupivacaine in preparation for an arthroscopic rotator cuff repair. Following administration of the bupivacaine, the patient sustained a ventricular fibrillation arrest. After successful cardiopulmonary resuscitation, she was diagnosed with Brugada syndrome. An implantable cardioverter-defibrillator was placed, and the rotator cuff repair was performed 1 month later.</AbstractText>Brugada syndrome is an abnormality of the cardiac conduction system that leads to cardiac arrhythmias. Several anesthetic agents trigger Brugada-like electrocardiographic abnormalities. To our knowledge, this is the first report of an interscalene block inducing Brugada syndrome.</AbstractText> |
19,783 | Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest. | Prior studies have reported higher in-hospital survival with prompt defibrillation and epinephrine treatment in patients with in-hospital cardiac arrest (IHCA). Whether this survival benefit persists after discharge is unknown.</AbstractText>We linked data from a national IHCA registry with Medicare files and identified 36 961 patients ≥65 years of age with an IHCA at 517 hospitals between 2000 and 2011. Patients with IHCA caused by pulseless ventricular tachycardia or ventricular fibrillation were stratified by prompt (≤2 minutes) versus delayed (>2 minutes) defibrillation, whereas patients with IHCA caused by asystole or pulseless electric activity were stratified by prompt (≤5 minutes) versus delayed (>5 minutes) epinephrine treatment. The association between prompt treatment and long-term survival for each rhythm type was assessed with multivariable hierarchical modified Poisson regression models.</AbstractText>Of 8119 patients with an IHCA caused by ventricular tachycardia or ventricular fibrillation, the rate of 1-year survival was higher in those treated with prompt defibrillation than with delayed defibrillation (25.7% [1466 of 5714] versus 15.5% [373 of 2405]; adjusted relative risk [RR], 1.49; 95% confidence interval [CI] 1.32-1.69; P</i><0.0001). This survival advantage persisted at 3 years (19.1% versus 11.0%; adjusted RR, 1.45; 95% CI, 1.23-1.69; P</i><0.0001) and at 5 years (14.7% versus 7.9%; adjusted RR, 1.50; 95% CI, 1.22-1.83; P</i><0.0001). Of 28 842 patients with an IHCA caused by asystole/pulseless electric activity, the rate of 1-year survival with prompt epinephrine treatment was higher than with delayed treatment (5.4% [1341 of 24 885] versus 4.3% [168 of 3957]; adjusted RR, 1.20; 95% CI, 1.02-1.41; P</i>=0.02), but this survival benefit was no longer present at 3 years (3.5% versus 2.9%; adjusted RR, 1.17; 95% CI, 0.95-1.45; P</i>=0.15) and at 5 years (2.3% versus 1.9%; adjusted RR, 1.18; 95% CI, 0.88-1.58; P</i>=0.27).</AbstractText>Prompt defibrillation for IHCA caused by ventricular tachycardia or ventricular fibrillation was associated with higher rates of long-term survival throughout 5 years of follow-up, whereas prompt epinephrine treatment for asystole/pulseless electric activity was associated with greater survival at 1 year but not at 3 or 5 years. By quantifying the greater survival associated with timely defibrillation and epinephrine administration, these findings provide important insights into the durability of survival benefits for 2 process-of-care measures in current resuscitation guidelines.</AbstractText>© 2017 American Heart Association, Inc.</CopyrightInformation> |
19,784 | [Peculiarities of therapy for heart rhythm disorders in patients with chronic heart failure]. | This review focuses on peculiarities of therapy for heart rhythm disorders in patients with CHF. Efficacy and safety of antiarrhythmic drugs and a high incidence of pro-arrhythmic effects are discussed. It is shown that the underlying disease and severity of structural damage to the heart are of critical significance. Treatment of ventricular arrhythmias and atrial fibrillation are discussed. |
19,785 | [Left ventricular diastolic dysfunction in endovascular treatment of atrial fibrillation in patients with preserved ejection fraction]. | To study prevalence of left ventricular diastolic dysfunction (LVDD) and to evaluate the effect of pulmonary vein catheter isolation on left ventricular (LV) diastolic function in patients with paroxysmal and persistent forms of atrial fibrillation (AF).</AbstractText>109 patients with paroxysmal (n=90; 82.6 %) and persistent (n=19; 17.4 %) AF were evaluated after 109 pulmonary vein catheter isolations. The patients were divided into two groups based on the operation efficacy. Heart ultrasound including evaluation of the LV diastolic function was performed for all patients on the day of operation and at 6 and 12 months.</AbstractText>After the surgery, 61 (56.5 %) patients maintained sinus rhythm (SR) for 12 months and comprised Group 1. Group 2 consisted of patients with a relapse of AF (47 patients; 43.5 %). At baseline, LVDD with SR was observed in 53 patients (48.6 %), at 6 months - in 34 (31.2 %) patients (p=0.001), and at 12 months - in 27 patients (24.8 %) (p.</AbstractText> |
19,786 | [Comparison of early clinical effects of ablation with surgery treatment in patients with hypertrophic cardiomyopathy]. | <b>Objective:</b> To compare the early clinical effect of septal myectomy and percutaneous transluminal septal myocardial ablation (PTMSA) on the left ventricular outflow obstruction and the rate of complication in patients with hypertrophic obstructive cardiomyopathy (HOCM). <b>Methods:</b> A total of 204 patients with HOCM who received septal reduction treatment were recruited. These patients were divided into two groups, surgery group (<i>n</i>=135) (65 patients with modified Morrow procedure, 70 patients with non-Morrow myomectomy) and PTMSA group (<i>n</i>=69). The baseline characteristics, disease status, other history of surgery and echocardiography parameters before and after septal reduction were collected, as well as the complication within 1 week after operation. <b>Results:</b> The mean age in surgery group was (46±14) years old, with 76 males (56.3%); mean age was (47±11) years old and with 51 males (73.9%) in PTMSA group. There was no significant difference in age, gender, the time of symptom and diagnosis, syncope, family history and atrial fibrillation between the two groups (all <i>P</i>>0.05). The proportion of mitral valve prolapse in the surgery group was higher than that in PTMSA group (75.8% vs 44.2%, <i>P</i><0.05). Baseline left ventricular outflow tract (LVOT) gradient was comparable (82.7 mmHg in surgery group vs 77.7 mmHg in PTMSA group, <i>P</i>>0.05). The mean resting LVOT gradient after septal reduction therapy was lower (16.55 mmHg in surgery group, 26.68mmHg in PTMSA group) than that before operation, with lower gradient in surgery group (<i>P</i><0.05). Compared with PTMSA group, the duration of hospitalization was longer in surgery group (<i>P</i><0.05). There was similar rate of operation related complications in the two groups. <b>Conclusions:</b> Both septal reduction therapies can improve the LVOT obstruction, more significant in surgery group, but with longer hospital stay. The rate of operation related complication is similar in both groups.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ruan</LastName><ForeName>Y P</ForeName><Initials>YP</Initials><AffiliationInfo><Affiliation>Department of Ultrasound, Maternal-fetal Medicine Research Consultation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Liu</LastName><ForeName>X W</ForeName><Initials>XW</Initials></Author><Author ValidYN="Y"><LastName>Zhang</LastName><ForeName>Y</ForeName><Initials>Y</Initials></Author><Author ValidYN="Y"><LastName>Han</LastName><ForeName>J C</ForeName><Initials>JC</Initials></Author><Author ValidYN="Y"><LastName>Lai</LastName><ForeName>Y Q</ForeName><Initials>YQ</Initials></Author><Author ValidYN="Y"><LastName>Lü</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>He</LastName><ForeName>Y H</ForeName><Initials>YH</Initials></Author></AuthorList><Language>chi</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Zhonghua Yi Xue Za Zhi</MedlineTA><NlmUniqueID>7511141</NlmUniqueID><ISSNLinking>0376-2491</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002312" MajorTopicYN="N">Cardiomyopathy, Hypertrophic</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001026" MajorTopicYN="N">Coronary Artery Bypass</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004452" MajorTopicYN="N">Echocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006346" MajorTopicYN="N">Heart Septum</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014694" MajorTopicYN="N">Ventricular Outflow Obstruction</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 探讨室间隔部分切除术和经皮室间隔化学消融术(PTMSA)的肥厚型梗阻性心肌病(HOCM)患者临床特征及术后早期效果。 <b>方法：</b> 回顾性选择2006年1月1日至2016年12月31日在首都医科大学附属北京安贞医院进行室间隔部分切除(手术组135例)或经室间隔化学消融(介入组69例)的HOCM患者，治疗前及治疗后1至2周内进行心脏超声检查，比较两组患者治疗前后室间隔厚度、左室流出道压差变化及短期内并发症发生情况。 <b>结果：</b> 手术组患者135例，年龄(46±14)岁，男性76例(56.3%)，介入组患者69例，年龄(47±11)岁，男性51例(73.9%)。两组年龄、性别、出现症状及诊断时间、晕厥症状、家族史、房颤方面比较差异无统计学意义(<i>P</i>>0.05)。与治疗前相比，手术组室间隔厚度(22.17 mm比18.31 mm，<i>P</i><0.05)、左室流出道压差[82.74 mmHg比16.55 mmHg(1 mmHg＝0.133 kPa)，<i>P</i><0.05]均下降，介入组室间隔厚度(21.70 mm比19.27 mm，<i>P</i><0.05)、左室流出道压差(77.71比26.68 mmHg，<i>P</i><0.05)均下降，以手术组降低更为明显(<i>P</i><0.05)。而手术组患者平均住院时间明显长于介入组(18.57 d比9.35 d，<i>P</i><0.001)。手术组和介入组患者在术后2周内并发症发生情况差异无统计学意义(<i>P</i>>0.05)。 <b>讨论：</b> 室间隔部分切除术与PTMSA均可有效降低LVOT梗阻的情况，手术治疗效果更为明显，且常常可同时修复或置换二尖瓣改善其反流，但是住院时间较消融组长，两组短期内并发症发生情况无差异。. |
19,787 | New-onset arrhythmias following transcatheter aortic valve implantation: a systematic review and meta-analysis. | To evaluate the prevalence and clinical impact of new-onset arrhythmias in patients following transcatheter aortic valve implantation (TAVI).</AbstractText>We systematically identified studies reporting new-onset arrhythmias after TAVI other than atrioventricular conduction disturbances. We summarised monitoring strategies, type and prevalence of arrhythmias and estimated their effect on risk of death or cerebrovascular events by using random-effects meta-analysis. The study is registered withInternational prospective register of systematic reviews (PROSPERO) (CRD42017058053).</AbstractText>Sixty-five studies (43 506 patients) reported new-onset arrhythmias following TAVI. The method of arrhythmia detection was specified only in 31 studies (48%). New-onset atrial fibrillation (NOAF) (2641 patients), bradyarrhythmias (182 patients), supraventricular arrhythmias (29 patients), ventricular arrhythmias (28 patients) and non-specified major arrhythmias (855 patients) were reported. In most studies (52 out of 65), new-onset arrhythmia detection was limited to the first month following TAVI. The most frequently documented arrhythmia was NOAF with trend of increasing summary prevalence of 11%, 14%, 14% and 25% during inhospital, 30-day, 1-year and 2-year follow-ups, respectively (P for trend=0.011). Summary prevalence estimates of NOAF at 30-day follow-up differ significantly between studies of prospective and retrospective design (8% and 21%, respectively, P=0.002). New episodes of bradyarrhythmias were documented with a summary crude prevalence of 4% at 1-year follow-up. NOAF increased the risk of death (relative risk 1.61, 95% CI 1.35 to 1.98, I2</sup>=47%) and cerebrovascular events (1.79, 95% CI 1.24 to 2.64, I2</sup>=0%). No study commented on therapeutic modifications following the detection of new-onset arrhythmias.</AbstractText>Systematic identification of new-onset arrhythmias following TAVI may have considerable impact on subsequent therapeutic management and long-term prognosis in this patient population.</AbstractText>© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</CopyrightInformation> |
19,788 | Postanoxic alpha, theta or alpha-theta coma: Clinical setting and neurological outcome. | The aim of this study was to determine the prognosis of 26 consecutive adults with alpha coma (AC), theta coma (TC) or alpha-theta coma (ATC) following CRA and to describe the clinical setting and EEG features of these patients.</AbstractText>We retrospective analyzed a prospectively collected cohort of adult patients diagnosed as having AC, TC or ATC after CRA between January 2008 and June 2016. None of patients included in this analysis underwent therapeutic hypothermia (TH). Neurological outcome was expressed as the best score 6 months after CRA using the five-point Glasgow-Pisttsburgh Cerebral Performance Categories (CPC) RESULTS: Twenty-six patients were identified with a diagnosis of postanoxic AC, TC or ATC coma. There were 20 (77%) men and 6 (23%) women. The mean age was 63 ± 16 years. The most frequent EEG pattern was TC (21 patients, 80%), followed by AC (3 patients, 12%) and ATC (2 patients, 8%). The cardiac rhythm as primary origin of the CRA was ventricular fibrillation (VF) in 16 patients (61.5%), asystole in 8 patients (34.6%) and ventricular tachycardia (VT) in one patient (3.8%). The presence of EEG reactivity was present in 8 patients (30%). The mortality rate was 85%. Of the 4 surviving patients, two (3.8%) had moderate disability (CPC 2), one (3.8%) had severe disability (CPC 3) and one (3.8%) reached a good recovery. The age was significantly lower in survivors 46.2 ± 10.8 versus nonsurvivors 63.3 ± 15.5 (p = 0.04). There was increased association of EEG reactivity with survival (p = 0.07).</AbstractText>Hypoxic-ischemic AC, TC and ATC are associated with a poor prognosis and a high rate of mortality. In younger patients with AC, TC and ATC and incomplete forms showing reactivity on the EEG, there is a greater probability of clinical recovery.</AbstractText>Copyright © 2018 Elsevier B.V. All rights reserved.</CopyrightInformation> |
19,789 | Repolarization in perfused myocardium predicts reperfusion ventricular tachyarrhythmias. | Aim of the study was to find out which myocardial repolarization parameters predict reperfusion ventricular tachycardia and fibrillation (VT/VF) and determine how these parameters express in ECG.</AbstractText>Coronary occlusion and reperfusion (30/30min) was induced in 24 cats. Local activation and end of repolarization times (RT) were measured in 88 intramyocardial leads. Computer simulations of precordial electrograms were performed.</AbstractText>Reperfusion VT/VF developed in 10 animals. Arrhythmia-susceptible animals had longer RTs in perfused areas [183(177;202) vs 154(140;170) ms in susceptible and resistant animals, respectively, P<0.05]. In logistic regression analysis, VT/VFs were associated with prolonged RTs in the perfused area (OR 1.068; 95% CI 1.012-1.128; P=0.017). Simulations demonstrated that prolonged repolarization in the perfused/border zone caused precordial terminal T-wave inversion.</AbstractText>The reperfusion VT/VFs were independently predicted by the longer RT in the perfused zone, which was reflected in the terminal negative phase of the electrocardiographic T-wave.</AbstractText>Copyright © 2017. Published by Elsevier Inc.</CopyrightInformation> |
19,790 | Malignant Early Repolarization. | A 27-year-old man presents with successfully resuscitated ventricular fibrillation. Structural and electrical causes of ventricular fibrillation in the young are presented along with a diagnostic strategy. Electrocardiographic features of malignant early repolarization are discussed. |
19,791 | Acute Kidney Infarction Due to Left Ventricular Thrombus Embolization In Patient with Isolated Left Ventricular Noncompaction: A Case Report. | Noncompaction of the ventricular myocardium (NVM) is a rare congenital cardiomyopathy that is characterized by multiple prominent trabeculations and deep intertrabecular recesses, and occurs due to arrest of normal embryogenesis of the endocardium and myocardium. It is also referred to as isolated left ventricular noncompaction (LVNC), because lesions are mainly in the left ventricle. The main clinical manifestations are heart failure, arrhythmia, systemic embolism, and sudden death. Systemic embolism is related to the occurrence of atrial arrhythmias or thrombus formation in the left ventricle. Most resulting thromboembolisms are cerebral or in the arteries of the lower limbs, and renal artery embolisms are rare. There are reports of a few previous cases of renal infarction with diagnoses of NVM on echocardiography, but a thrombus from the left ventricle has never been identified as the cause of a renal artery embolism. This paper reports a 53-year-old male who was admitted to our hospital for LVNC and renal infarction. He had a history of atrial fibrillation 3 years previously. We diagnosed LVNC with a thrombus in the left ventricle using echocardiography. The patient was discharged after renal replacement therapy and treatment with an anticoagulant. During the 2 years of follow-up, his condition remained stable. |
19,792 | Efficacy of Stellate Ganglion Blockade in Managing Electrical Storm: A Systematic Review. | The efficacy of percutaneous stellate ganglion block (SGB) for managing electrical storm (ES) is not well understood.</AbstractText>To characterize the efficacy of SGB as a treatment for ES.</AbstractText>We conducted literature searches using PubMed/Medline and Google Scholar, for mixed combinations of terms including "stellate ganglion block", *ganglion block (ade)", "sympathetic block (ade)" and "arrhythmia", "ventricular arrhythmia (VA)" or "tachycardia" (VT), "ventricular fibrillation" (VF), "electrical storm". Inclusion criteria were presentation with guideline-defined ES and treatment with SGB. Exclusion criteria: presentation with any supraventricular arrhythmia, VA without ES, or surgical sympathectomy. Studies lacking basic demographic data, arrhythmia description, and outcomes were excluded.</AbstractText>Of 3,374 publications reviewed, 38 patients from 23 studies met study criteria (52 ± 19.1 years, 11 F, 17 with ischemic cardiomyopathy). Anti-arrhythmics were used in all patients. Mean Left ventricular ejection fraction was 31 ± 10%. ES was triggered by acute myocardial infarction in 15 patients and QT prolongation in 7 patients. The most common local anesthetic used for SGB was bupivacaine (0.25-0.5%). SGB resulted in a significant decrease in VA burden (12.4±8.8 vs. 1.04±2.12 episodes/day, p< 0.001) and number of external and ICD shocks (10.0±9.1 vs. 0.05±0.22 shocks/day, p< 0.01). Following SGB, 80.6% of patients survived to discharge.</AbstractText>SGB is an effective acute treatment for ES. However, larger prospective randomized studies are needed to better understand the role of SGB in ES and other VAs.</AbstractText> |
19,793 | Clinical and Echocardiographic Predictors of Arrhythmias Detected With 24-Hour Holter Electrocardiography Among Hypertensive Heart Failure Patients in Nigeria. | Hypertensive heart failure (HHF) is the commonest form of heart failure in Nigeria. There is paucity of data in Nigeria on 24-hour Holter electrocardiography (24-HHECG) and important predictors of arrhythmias among HHF patients.</AbstractText>To determine the 24-HHECG characteristics among HHF patients. To determine the clinical and echocardiographic predictors of arrhythmias detected using 24-HHECG among HHF patients.</AbstractText>A total of 100 HHF patients as well as 50 age-matched and sex-matched apparently healthy controls were prospectively recruited over a period of 1 year. They all had baseline laboratory tests, echocardiography, and 24-HHECG.</AbstractText>Hypertensive heart failure patients had significantly higher counts of premature ventricular contractions (PVCs) than the controls (P</i> ≤ .001). Ventricular tachycardia (VT) was recorded in 29% of HHF patients as compared with controls who had no VT on 24-HHECG. The standard deviation of all normal to normal sinus RR intervals over 24 hours (SDNN) was abnormally reduced among HHF patients when compared with controls (P</i> = .046). There was positive correlation between atrial fibrillation (AF) and the following parameters: PVCs (r</i> = .229, P</i> = .015), New York Heart Association (NYHA) (r</i> = .196, P</i> = .033), and VT (r</i> = .223, P</i> = .018). Following multiple linear regression, left ventricular ejection fraction (LVEF) (P</i> ≤ .001) and serum urea (P</i> = .037) were predictors of PVCs among HHF patients. Serum creatinine (P</i> ≤ .001), elevated systolic blood pressure (SBP) (P</i> = .005), and PVCs (P</i> ≤ .001) were important predictors of VT among HHF patients.</AbstractText>Renal dysfunction and reduced LVEF were important predictors of ventricular arrhythmias. High counts of PVCs and elevated SBP were predictive of the occurrence of VT among HHF patients. The NYHA class and ventricular arrhythmias have a significant positive correlation with AF. The SDNN is reduced in HHF patients.</AbstractText> |
19,794 | Echocardiography in cardiac arrest: An emergency medicine review. | Cardiac arrest management primarily focuses on optimal chest compressions and early defibrillation for shockable cardiac rhythms. Non-shockable rhythms such as pulseless electrical activity (PEA) and asystole present challenges in management. Point-of-care ultrasound (POCUS) in cardiac arrest is promising.</AbstractText>This review provides a focused assessment of POCUS in cardiac arrest, with an overview of transthoracic (TTE) and transesophageal echocardiogram (TEE), uses in arrest, and literature support.</AbstractText>Cardiac arrest can be distinguished between shockable and non-shockable rhythms, with management varying based on the rhythm. POCUS provides a diagnostic and prognostic tool in the emergency department (ED), which may improve accuracy in clinical decision-making. Several protocols incorporate POCUS based on different cardiac views. TTE includes parasternal long axis, parasternal short axis, apical 4-chamber, and subxiphoid views, which may be used in cardiac arrest for diagnosis of underlying cause and potential prognostication. TEE is conducted by inserting the probe into the esophagus of intubated patients, with several studies evaluating its use in cardiac arrest. It is associated with few adverse effects, while allowing continued compressions (and evaluation of those compressions) and not interrupting resuscitation efforts.</AbstractText>POCUS is a valuable diagnostic and prognostic tool in cardiac arrest, with recent literature supporting its diagnostic ability. TTE can guide resuscitation efforts dependent on the rhythm, though TTE should not interrupt other resuscitation measures. TEE can be useful during arrest, but further studies based in the ED are needed.</AbstractText>Published by Elsevier Inc.</CopyrightInformation> |
19,795 | A Rare Cause of Left Ventricular Assist Device (LVAD) Obstruction: Left Atrial Dissection. | Left atrial dissection is a rare factor that may cause left ventricular assist device obstruction. Prompt diagnosis and surgical repair are essential. This case report describes our experience and a successful surgical management in a patient after HeartMate 3 implantation and mitral valve inflow obstruction due to a left atrial dissection. |
19,796 | Subcutaneous Implantable Cardioverter Defibrillator: Early Experience. | The implantable cardioverter defibrillator had been increasing the survival of patients at high risk for sudden cardiac death. The subcutaneous implantable cardioverter defibrillator was developed to mitigate the complications inherent to lead placement into cardiovascular system.</AbstractText>To report the initial experience of 18 consecutive cases of subcutaneous implantable cardioverter defibrillator implantation showing the indications, potential pitfalls and perioperative complications.</AbstractText>Between September 2016 and March 2017, 18 patients with indication for primary and secondary prevention of sudden cardiac death, with no concomitant indication for artificial cardiac pacing, were included.</AbstractText>The implantation of the subcutaneous implantable cardioverter defibrillator successfully performed in 18 patients. It was difficult to place the subcutaneous lead at the parasternal line in two patients. One patient returned a week after the procedure complaining about an increase in pain intensity at pulse generator pocket site, which was associated with edema, temperature rising and hyperemia. Two patients took antialgic medication for five days after surgery. A reintervention was necessary in one patient to replace the lead in order to correct inappropriate shocks caused by myopotential oversensing.</AbstractText>In our initial experience, although the subcutaneous implantable cardioverter defibrillator implantation is a less-invasive, simple-accomplishment procedure, it resulted in a bloodier surgery perhaps requiring an operative care different from the conventional. Inappropriate shock by oversensing is a reality in this system, which should be overcame in order not to become a limiting issue for its indication.</AbstractText> |
19,797 | Prevalence of electrocardiographic abnormalities in primary care patients according to sex and age group. A retrospective observational study. | Knowledge of the prevalence of electrocardiographic abnormalities in a population is useful for interpreting the findings. The aim here was to assess the prevalence of electrocardiographic abnormalities and self-reported comorbidities and cardiovascular risk factors according to sex and age group among Brazilian primary care patients.</AbstractText>Observational retrospective study on consecutive primary care patients in 658 cities in the state of Minas Gerais, Brazil, whose digital electrocardiograms (ECGs) were sent for analysis to the team of the Telehealth Network of Minas Gerais (TNMG).</AbstractText>All ECGs analyzed by the TNMG team in 2011 were included. Clinical data were self-reported and electrocardiographic abnormalities were stratified according to sex and age group.</AbstractText>A total of 264,324 patients underwent ECG examinations. Comorbidities and cardiovascular risk factors were more frequent among women, except for smoking. Atrial fibrillation and flutter, premature beats, intraventricular blocks, complete right bundle branch block and left ventricular hypertrophy were more frequent among men, and nonspecific ventricular repolarization abnormalities and complete left bundle branch block among women.</AbstractText>Electrocardiographic abnormalities were relatively common findings, even in the younger age groups. The prevalence of electrocardiographic abnormalities increased with age and was higher among men in all age groups, although women had higher frequency of self-reported comorbidities.</AbstractText> |
19,798 | Clinical predictors of outcome in patients with inflammatory dilated cardiomyopathy. | The study objectives were to identify predictors of outcome in patients with inflammatory dilated cardiomyopathy (DCMi).</AbstractText>From 2004 to 2008, 55 patients with biopsy-proven DCMi were identified and followed up for 58.2±19.8 months. Predictors of outcome were identified in a multivariable analysis with a Cox proportional hazards analysis. The primary endpoint was a composite of death, heart transplantation and hospitalization for heart failure or ventricular arrhythmias.</AbstractText>For the primary endpoint, a QTc interval >440msec (HR 2.84; 95% CI 1.03-7.87; p = 0.044), a glomerular filtration rate (GFR) <60ml/min/1.73m2 (HR 3.19; 95% CI 1.35-7.51; p = 0.008) and worsening of NYHA classification during follow-up (HR 2.48; 95% CI 1.01-6.10; p = 0.048) were univariate predictors, whereas left ventricular ejection fraction at baseline, NYHA class at entry, atrial fibrillation, treatment with digitalis or viral genome detection were not significantly related to outcome. After multivariable analysis, a GFR <60ml/min/1.73m2 (HR 3.04; 95% CI 1.21-7.66; p = 0.018) remained a predictor of adverse outcome.</AbstractText>In patients with DCMi, a prolonged QTc interval >440msec, a GFR<60ml/min/1.73m2 and worsening of NYHA classification during follow-up were univariate predictors of adverse prognosis. In contrast, NYHA classification at baseline, left ventricular ejection fraction, atrial fibrillation, treatment with digitalis or viral genome detection were not related to outcome. After multivariable analysis, a GFR <60ml/min/1.73m2 remained independently associated with adverse outcome.</AbstractText> |
19,799 | Sudden cardiac death after acute heart failure hospital admission: insights from ASCEND-HF. | The incidence of and factors associated with sudden cardiac death (SCD) early after an acute heart failure (HF) hospital admission have not been well defined.</AbstractText>We assessed SCD and ventricular arrhythmias in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial, which included patients with acute HF with reduced or preserved ejection fraction. SCD, resuscitated SCD (RSCD), and sustained ventricular tachycardia/ventricular fibrillation (VT/VF) were adjudicated from randomization through 30 days and were combined into a composite endpoint. Baseline characteristics associated with this composite were determined by logistic regression. RSCD and VT/VF were included as time-dependent variables in a Cox model evaluating the association of these variables with 180-day all-cause mortality. Among 7011 patients, the 30-day all-cause mortality rate was 3.8%; SCD accounted for 17% of these deaths. The 30-day composite event rate was 1.8% (n = 121). Ten patients had more than one event with 30-day Kaplan-Meier event rates of 0.6% for SCD [95% confidence interval (CI) 0.5%-0.9%, n = 43], 0.4% for RSCD (95% CI 0.2%-0.5%, n = 24), and 0.9% for VT/VF (95% CI 0.7%-1.2%, n = 64). In the multivariable model, chronic obstructive pulmonary disease, history of VT, male sex, and longer QRS duration were associated with SCD, RSCD, or VT/VF. A RSCD or VT/VF event was associated with higher 180-day mortality (adjusted hazard ratio 6.6, 95% CI 4.8-9.1, P < 0.0001).</AbstractText>Approximately 2% of patients admitted for acute HF experienced SCD, RSCD, or VT/VF within 30 days of admission, and SCD accounted for 17% of all deaths within 30 days.</AbstractText>© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.</CopyrightInformation> |
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