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20,200 | Drug-Induced QT Prolongation and Torsades de Pointes: An All-Exclusive Relationship or Time for an Amicable Separation? | QT prolongation was perceived as a major antiarrhythmic mechanism, but soon became a surrogate for torsades de pointes (TdP) instead. Drugs that prolong the QT interval range from having potent torsadogenic activity to no proarrhythmic action and even antiarrhythmic effects. Blockade of hERG channels is the primary cause of TdP, but blockade/activation of other channels can also be torsadogenic. TdP is primarily caused by disturbances of TRIaD, but disturbance of wavelength can also contribute to TdP (where TRIaD is triangulation, reverse use dependence, instability and dispersion, and wavelength equals conduction velocity times effective refractory period). The above proarrhythmic parameters do not only result in TdP, but can also lead to ventricular tachycardia (VT) and ventricular fibrillation (VF). Note that QT prolongation (not listed as a causal factor) yields many false positives (potentially depriving patients from much needed drugs) and false negatives (potentially exposing patients to lethal arrhythmias). Thus, drug-induced QT prolongation is a bad surrogate for TdP, VT or VF; it is high time to move away from an oversimplified and erroneous surrogate. |
20,201 | Effect of eplerenone on extracellular cardiac matrix biomarkers in patients with acute ST-elevation myocardial infarction without heart failure: insights from the randomized double-blind REMINDER Study. | Aldosterone stimulates cardiac collagen synthesis. Circulating biomarkers of collagen turnover provide a useful tool for the assessment of cardiac remodeling in patients with an acute myocardial infarction (MI).</AbstractText>The REMINDER trial assessed the effect of eplerenone in patients with an acute ST-elevation Myocardial Infarction (STEMI) without known heart failure (HF), when initiated within 24 h of symptom onset. The primary outcome was almost totally (>90%) driven by natriuretic peptide (NP) thresholds after 1-month post-MI (it also included a composite of cardiovascular death or re-hospitalization or new onset HF or sustained ventricular tachycardia or fibrillation or LVEF ≤40% after 1-month post-MI). This secondary analysis aims to assess the extracellular matrix marker (ECMM) levels with regards to: (1) patients` characteristics; (2) determinants; (3) and eplerenone effect.</AbstractText>Serum levels of ECMM were measured in 526 (52%) of the 1012 patients enrolled in the REMINDER trial. Patients with procollagen type III N-terminal propeptide (PIIINP) above the median were older and had worse renal function (p < 0.05). Worse renal function was associated with increased levels of PIIINP (standardized β ≈ 0.20, p < 0.05). Eplerenone reduced PIIINP when the levels of this biomarker were above the median of 3.9 ng/mL (0.13 ± 1.48 vs. -0.37 ± 1.56 ng/mL, p = 0.008). Higher levels of PIIINP were independently associated with higher proportion of NP above the prespecified thresholds (HR = 1.95, 95% CI 1.16-3.29, p = 0.012).</AbstractText>Eplerenone effectively reduces PIIINP levels when baseline values were above the median. Eplerenone may limit ECMM formation in post-MI without HF.</AbstractText> |
20,202 | [Cardiac arrest in a fitness trainer with apical hypertrophic cardiomyopathy associated with cor triatriatum sinister]. | We report on a 49-year-old fitness trainer, who was admitted to our hospital after cardiac arrest due to ventricular fibrillation. Return of spontaneous circulation was achieved after immediate cardiopulmonary resuscitation. Coronary angiography could exclude coronary artery disease. Echocardiography demonstrated the presence of apical hypertrophic cardiomyopathy, associated with cor triatriatum sinister. Cardiac magnetic resonance imaging additionally showed marked myocardial fibrosis. The patient underwent placement of an implantable cardioverter-defibrillator and was subsequently discharged for rehabilitation in good condition. |
20,203 | Improving trend in ventricular fibrillation/pulseless ventricular tachycardia out-of-hospital cardiac arrest in Rochester, Minnesota: A 26-year observational study from 1991 to 2016. | Mortality from out-of-hospital cardiac arrest (OHCA) is characterized by substantial regional variation. The Institute of Medicine (IOM) recently recommended enhancing the capabilities of EMS systems to improve outcome. In this study, we analyzed the trend in outcome from ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) OHCA in Rochester, MN. Survival from these forms of arrest is commonly employed as a benchmark of Emergency Medical Services (EMS) system performance.</AbstractText>Using a population-based Utstein-style registry in Rochester, MN where a first responder early defibrillation system is utilized, we evaluated outcome from all EMS-treated VF/pVT arrests and the subgroup of bystander-witnessed VF/pVT from 1991 to 2016. Outcome measurement was neurologically intact survival to discharge, defined as Cerebral Performance Category (CPC) 1 or 2. We divided the 26-year study into three periods: 1991-1997, 1998-2008, and 2009-2016, based on initiation of the first responder system of police officers in 1991 and fire-rescue personnel in 1998, and the latter period for comparison with our previous report in 2009.</AbstractText>We observed 355 all VF/pVT arrests and 292 bystander-witnessed VF/pVT arrests between 1991 and 2016. In 2009-2016, neurologically intact survival to discharge from overall VF/pVT and bystander-witnessed VF/pVT increased to 53.7% and 65.2%, respectively, compared with 39.5% and 43.4% in 1991-1997. Using multivariable analysis, survival significantly increased in 2009-2016 among all VF/pVT arrests (adjusted OR, 3.10; 95% CI, 1.54-6.40) and bystander-witnessed VF/pVT (adjusted OR, 4.28; 95% CI, 2.01-9.50), compared with those in 1991-1997.</AbstractText>We observed a significant improving secular trend in neurologically intact survival from VF/pVT cardiac arrests with a relatively high recent survival rate in this EMS System.</AbstractText>Copyright © 2017 Elsevier B.V. All rights reserved.</CopyrightInformation> |
20,204 | [Effect of nicorandil on ventricular arrhythmia in patients with acute ST-segment elevation myocardial infarction underwent emergent percutaneous coronary intervention treatment]. | <b>Objective:</b> To investigate the effect of nicorandil on ventricular arrhythmia in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with emergent percutaneous coronary intervention (PCI). <b>Methods:</b> A total of 120 acute STEMI patients treated with emergent PCI in our hospital from January 2015 to June 2016 were randomly divided into control group and experiment group (<i>n</i>=60 each). Patients in both groups received conventional therapy.Patients in experiment group took 10 mg nicorandil orally before PCI and received oral nicorandil treatment (15 mg/d, three times daily) for 3 days.QT disperse(QTd), correct QTd(QTcd) and the occurrence rate of ventricular arrhythmia were compared between two groups. <b>Results:</b> QTd at 6, 24, 48 and 72 hours((70.6±4.4), (67.2±5.3), (55.7±8.5), (48.2±8.2) ms, respectively) after PCI was significantly lower in the experiment group than those of control group ((77.1±7.1), (71.3±6.5), (65.1±8.1), (57.2±5.4) ms, all <i>P</i><0.05). The level of QTd was also significantly lower in the experiment group at 6, 24, 48 and 72 hours((77.5±7.7), (67.7±8.6), (61.2±7.5), (52.9±8.4) ms, respectively) after PCI comared to those of control group ((88.6±8.1), (79.2±7.8), (74.4±7.4), (69.6±8.6) ms, all <i>P</i><0.05). There was no significant difference in the incidence of reperfusion arrhythmia during PCI procedure between the two groups.The prevalence of the ventricular premature beat in the experiment group (25/60, 41.7%) was significantly lower than in the control group(45/60, 75.0%) within 3 days after PCI(<i>P</i><0.01), the prevalence of the no sustained ventricular tachycardia and ventricular fibrillation in the experiment group(6/60, 10.0%) was also significantly lower than in the control group (18/60, 30.0%, <i>P</i><0.01) within 3 days after PCI. <b>Conclusions:</b> Nicorandil use prior and post PCI could decrease the occurrence rate of ventricular arrhythmia in STEMI patients undergoing emergent PCI, and this effect might be related with reduced QTd and QTcd post medication.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Y P</ForeName><Initials>YP</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Second People's Hospital of Liaocheng, Liaocheng 252600, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zhang</LastName><ForeName>Y</ForeName><Initials>Y</Initials></Author><Author ValidYN="Y"><LastName>Sun</LastName><ForeName>Y R</ForeName><Initials>YR</Initials></Author><Author ValidYN="Y"><LastName>Sun</LastName><ForeName>Z G</ForeName><Initials>ZG</Initials></Author><Author ValidYN="Y"><LastName>Zuo</LastName><ForeName>Z K</ForeName><Initials>ZK</Initials></Author><Author ValidYN="Y"><LastName>Feng</LastName><ForeName>Z R</ForeName><Initials>ZR</Initials></Author><Author ValidYN="Y"><LastName>Chang</LastName><ForeName>F Y</ForeName><Initials>FY</Initials></Author><Author ValidYN="Y"><LastName>Xu</LastName><ForeName>Y C</ForeName><Initials>YC</Initials></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>B Z</ForeName><Initials>BZ</Initials></Author><Author ValidYN="Y"><LastName>Ye</LastName><ForeName>Y Y</ForeName><Initials>YY</Initials></Author></AuthorList><Language>chi</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Zhonghua Xin Xue Guan Bing Za Zhi</MedlineTA><NlmUniqueID>7910682</NlmUniqueID><ISSNLinking>0253-3758</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>260456HAM0</RegistryNumber><NameOfSubstance UI="D020108">Nicorandil</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009203" MajorTopicYN="N">Myocardial Infarction</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020108" MajorTopicYN="Y">Nicorandil</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D062645" MajorTopicYN="Y">Percutaneous Coronary Intervention</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000072657" MajorTopicYN="Y">ST Elevation Myocardial Infarction</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017180" MajorTopicYN="Y">Tachycardia, Ventricular</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 观察尼可地尔对急性ST段抬高型心肌梗死患者行急诊经皮冠状动脉介入治疗(PCI)后室性心律失常的影响。 <b>方法：</b> 前瞻性纳入2015年1月至2016年6月在聊城市第二人民医院住院的120例急性心肌梗死患者，所有患者采用数字表法分为对照组和尼可地尔组，每组60例，两组均给予常规治疗，术前尼可地尔组服用尼可地尔10 mg，对照组则服用安慰剂。术后尼可地尔组患者继续服用尼可地尔5 mg/次、3次/d，对照组继续服用安慰剂，比较两组患者术后3 d的QT间期离散度(QTd)、校正的QT间期离散度(QTcd)以及室性心律失常发生率。 <b>结果：</b> 尼可地尔组术后6、24、48和72 h的QTd分别为(70.6±4.4)、(67.2±5.3)、(55.7±8.5)和(48.2±8.2) ms，均低于对照组的(77.1±7.1)、(71.3±6.5)、(65.1±8.1)和(57.2±5.4) ms(<i>t</i>＝13.523、15.376、17.318、20.315，均<i>P</i><0.05)；尼可地尔组术后6、24、48和72 h的QTcd分别为(77.5±7.7)、(67.7±8.6)、(61.2±7.5)和(52.9±8.4) ms，均低于对照组的(88.6±8.1)、(79.2±7.8)、(74.4±7.4)和(69.6±8.6) ms(<i>t</i>＝15.397、18.582、20.342、27.352，均<i>P</i><0.05)；术中再灌注性心律失常发生率差异无统计学意义，术后3 d内尼可地尔组室性早搏发生率为41.7%(25/60)，明显低于对照组的75.0%(45/60，χ(2)＝6.52，<i>P</i><0.01)；尼可地尔组非持续性室性心动过速及心室颤动发生率为10.0%(6/60)，明显低于对照组的30.0%(18/60，χ(2)＝7.42，<i>P</i><0.01)。 <b>结论：</b> 尼可地尔可减少急性心肌梗死患者PCI术后室性心律失常的发生，其机制可能与QTd及QTcd较低有关。. |
20,205 | Outcome of Patients with Low-Flow/Low-Gradient Severe Aortic Stenosis Who Underwent Aortic Valve Replacement. | It is well-documented that stroke volume and gradient are indexed to classify patients with aortic stenosis into several phenotypes. The purpose of the present study was to estimate the impact of stroke volume and gradient on the clinical outcome of patients with AS who have undergone aortic valve replacement. Methods: A total of 154 consecutive patients were studied. They all had severe aortic stenosis (aortic valve area [AVA] ≤ 1 cm², left ventricular ejection fraction [LVEF] ≥ 50%) and underwent aortic valve replacement (AVR) from January 1, 2004 to December 31, 2010. Clinical and echocardiography data was collected. According to stroke volume index (SVi), low flow (LF, SVi < 35 mL/m²) and normal flow (NF, SVi ≥ 35 mL/m²) were defined, and according to transvalvular pressure gradient, low gradient (LG, gradient < 40 mmHg) and high gradient (HG, gradient ≥ 40 mmHg) were also defined. Based on the above classification, patients were separated into four groups: NF/HG (59 patients), NF/LG (30 patients), LF/HG (40 patients) and LF/LG (25 patients). To estimate the discrepancy between patients with bicuspid aortic valve (BAV) and normal 3-leaflets aortic valve, 154 cases were divided into 2 groups: BAV group and 3-leaflets group. In-hospital mortality and overall survival were followed up. The risk factors of in-hospital mortality and overall survival were estimated by logistic regression analysis and Cox regression analysis. Results: The mean follow-up time was 59 ± 32 months of 154 patients among whom the in-hospital mortality of NF/HG was 1.7% compared with NF/LG (6.7%), LF/HG (12.5%) and LF/LG (10.5%). The overall survival rates among the four groups were NF/HG (72%), NF/LG (92%), LF/HG (55%) and LF/LG (84%). The 5-year survival rate was lower in the BAV group than in the 3-leaflets group (78% and 93%; P < .05). The independent value for the in-hospital mortality included atrial fibrillation, concomitant coronary artery bypass graft, cardiac index, and bicuspid aortic valve. The independent factors for the overall survival included valvulo-arterial impedance, time of cardiopulmonary bypass, atrial fibrillation, bicuspid aortic valve, and concomitant coronary artery bypass graft. Conclusion: The in-hospital outcome of LF/LG is worse than NF/HG and NF/LG, but similar to LF/HG. For the overall outcome, LF/LG is better than NF/HG and LF/HG, but worse than NF/LG. Patients with BAV exhibit worse survival compared to 3-leaflets aortic valve. |
20,206 | Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology. | MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality. |
20,207 | Predictive value of amplitude spectrum area of ventricular fibrillation waveform in patients with acute or previous myocardial infarction in out-of-hospital cardiac arrest. | Amplitude spectrum area (AMSA) of ventricular fibrillation (VF) has been associated with survival from out-of-hospital cardiac arrest (OHCA). Ischemic heart disease has been shown to change AMSA. We studied whether the association between AMSA and survival changes with acute ST-elevation myocardial infarction (STEMI) as cause of the OHCA and/or previous MI.</AbstractText>Multivariate logistic regression with log-transformed AMSA of first artifact-free VF segment was used to assess the association between AMSA and survival, according to presence of STEMI or previous MI, adjusting for resuscitation characteristics, medication use and comorbidities.</AbstractText>Of 716 VF-patients included from an OHCA-registry in the Netherlands, 328 (46%) had STEMI as cause of OHCA. Previous MI was present in 186 (26%) patients. Survival was 66%; neither previous MI (P=0.11) nor STEMI (P=0.78) altered survival. AMSA was a predictor of survival (ORadj: 1.52, 95%-CI: 1.28-1.82). STEMI was associated with lower AMSA (8.4mV-Hz [3.7-16.5] vs. 12.3mV-Hz [5.6-23.0]; P<0.001), but previous MI was not (9.5mV-Hz [3.9-18.0] vs 10.6mV-Hz [4.6-19.3]; P=0.27). When predicting survival, there was no interaction between previous MI and AMSA (P=0.14). STEMI and AMSA had a significant interaction (P=0.002), whereby AMSA was no longer a predictor of survival (ORadj: 1.03, 95%-CI: 0.77-1.37) in STEMI-patients. In patients without STEMI, higher AMSA was associated with higher survival rates (ORadj: 1.80, 95%-CI: 1.39-2.35).</AbstractText>The prognostic value of AMSA is altered by the presence of STEMI: while AMSA has strong predictive value in patients without STEMI, AMSA is not a predictor of survival in STEMI-patients.</AbstractText>Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.</CopyrightInformation> |
20,208 | Epicardial ablation utilizing remote magnetic navigation in a patient with Brugada syndrome and inferior early repolarization. | We report a case of epicardial ablation in a combined Brugada and inferior early repolarization syndrome patient with recurrent defibrillator therapy for spontaneous ventricular fibrillation. Electroanatomic mapping and ablation were achieved with remote magnetic navigation. Highly fractionated electrograms were seen epicardially in the anterior right ventricular outflow tract (RVOT) and at the anterior-inferior right ventricle. Ablation of the RVOT region resulted in resolution Brugada pattern electrocardiogram. The inferior early repolarization persisted despite ablation of the inferior right ventricular epicardium. Our patient remained event free at 12-months follow-up. |
20,209 | Impact of race and gender on clinical outcomes of catheter ablation in patients with atrial fibrillation. | Radiofrequency catheter ablation (CA) is an effective treatment of drug-refractory atrial fibrillation (AF). However, the efficacy of CA by race and gender has not been well characterized. We sought to determine the impact of ethnicity and gender on clinical outcome following CA in patients with AF.</AbstractText>Patients who underwent CA for AF from September 2013 to April 2016 were included in this study. Patients were identified retrospectively and followed prospectively.</AbstractText>A total of 118 patients (15.3% black and 78.8% white, 33% female) comprised the cohort, with mean age at ablation 63.4 ± 10.4 years. Black patients were older at time of the procedure (65.4 vs 63.4 years old) and had more prevalent comorbidities, including hypertension (77.8% vs 63.4%), diabetes (33.3% vs 15.0%), chronic kidney disease (22.2% vs 7.5%), and lower left ventricular ejection fraction (51.8% vs 56.2%). Blacks also had significantly larger left atrial size (P  =  0.03). Late recurrence of AF was similar between blacks and whites (33.3% vs 34.4%, P  =  1) as well as between women and men (28.2% vs 36.7%, P  =  0.41). Early recurrence was predictive of late recurrence in men (P < 0.001) but not in women (P  =  0.48). Enlarged left atrium and early recurrence of AF were significant predictors for late recurrence of AF in the cohort.</AbstractText>CA for AF is equally effective in black patients despite more prevalent comorbidity and increased left atrial size. Early recurrence of AF after CA was not predictive of late recurrence of AF in women but was in men.</AbstractText>© 2017 Wiley Periodicals, Inc.</CopyrightInformation> |
20,210 | Clinical and Prognostic Value of the Electrocardiogram in Patients With Acute Occlusion of the Left Circumflex Coronary Artery. | The utility of the electrocardiogram (ECG) in patients with acute left circumflex (LC) coronary occlusion is not established. This study aimed at determining the clinical, angiographic, and prognostic characteristics associated with the different patterns of ST-segment changes in patients with LC occlusion. A cohort of 314 patients with LC occlusion was categorized according to the admission ECG: (1) ST-segment elevation (ST-E, n=208), (2) isolated ST-segment depression in precordial leads (ST-D, n=62), and (3) negligible ST-segment changes (No-ST, n=44). Clinical variables, coronary angiography, and 30-day major adverse cardiac event (MACE) (in-hospital ventricular fibrillation, 1-month mortality, or heart failure) were compared among the three groups. As compared with No-ST, patients with ST-E or ST-D presented more advanced Killip class, higher troponin peak, lower LV ejection fraction, and were independently associated with MACE (odds ratio 5.43, 95% confidence interval 1.09 to 27.20 and odds ratio 3.39, 95% confidence interval 0.66 to 17.50, respectively). Patients with ST-D were tardily reperfused, had more often mitral regurgitation (23.1% vs 9.3% in ST-E and 3.3% in No-ST, p=0.03), and presented ST-segment elevation in leads V7 to V9 in 12 of 16 cases with available recordings. Culprit proximal LC predominated in ST-D (41.9%), distal LC in ST-E (42.8%), and obtuse marginal in No-ST (59.1%) (all p<0.01). The No-ST had smaller coronary vessels and more collaterals. In conclusion, the three ST-segment patterns of LC occlusion identify patients with different clinical, angiographic, and prognostic characteristics. Patients with ST-depression pattern require a prompt reperfusion therapy and could be better recognized by recording leads V7 to V9. |
20,211 | Predictors of Survival for Nonhighly Selected Patients Undergoing Resuscitation With Extracorporeal Membrane Oxygenation After Cardiac Arrest. | In several case reports and case series, extracorporeal membrane oxygenation during chest compression (CPR) has been shown to be a reasonable tool to improve outcome of patients under resuscitation. Although recommendations for extracorporeal cardiopulmonary resuscitation (ECPR) include younger patients with shockable rhythm and short previous CPR-time, it remains unclear if nonhighly selected patients have a similar outcome. Aim of this study was to determine outcome in our nonhighly selected patient population treated with ECPR and investigate possible predictors of survival. We made a retrospective single-center study of adults who underwent ECPR for in-hospital cardiac arrest between June 2008 and September 2016. Outcome and predictors of survival were identified. In this period of time, 59 patients underwent ECPR due to cardiac arrest. Fifteen patients (25.4%) survived discharge of which all had a good neurological outcome (cerebral performance category ≤ 2). Survival to discharge of patients with shockable rhythm (ventricular fibrillation or ventricular tachycardia) was 40.7%. Serum lactate ≥ 8, pulseless electrical activity (PEA) or asystole and male gender could be identified as predictors for low survival rate. Age, body mass index, renal replacement-dependent kidney injury had no significant influence on survival outcome. Mean CPR-time was 41.1 minutes (interquartile range, ±29.25 minutes). Extracorporeal membrane oxygenation seems to be a useful tool to improve the outcome of CPR also in nonhighly selected patients when compared with CPR alone and could be considered in patients with refractory cardiac arrest also after longer previous CPR-time. Serum lactate and heart rhythm should be taken into account for patient selection. |
20,212 | Left atrial appendage closure for "primary primary" prevention during percutaneous closure of septal defects in patients with large atria but no atrial fibrillation. | Percutaneous atrial septal defect (ASD) closure is a routine procedure to prevent right ventricular failure, pulmonary hypertension, or paradoxical embolism. The latter is the typical reason for percutaneous patent foramen ovale (PFO) closure. Atrial enlargement represents a risk for develop-ing atrial fibrillation (AF). Percutaneous left atrial appendage (LAA) closure is emerging as a preven-tive therapy for patients in AF who suffered from a previous stroke or bleeding (secondary prevention) or patients without previous stroke or bleeding (primary prevention). Percutaneous septal closure, particularly that of large ASDs, may inhibit future percutaneous left atrial access when required for LAA closure. Reported herein is the feasibility and safety of concomitant percutaneous closure of the LAA and a septal shunt, mostly large ASDs, in patients without AF, in the sense of "primary primary" preventive LAA closure. The first "primary" relates to "in anticipation of AF" and potentially also for "for prevention of AF". The second "primary" relates to "prevention of stroke or bleeding".</AbstractText>Thirteen consecutive patients, older than 40 years without any clinical or electrocardio-graphic evidence of AF, underwent percutaneous closure of large ASDs or PFOs in the presence of enlarged atria at the university hospitals of Bern and Zurich between April 2013 and June 2015. They concomitantly received "primary primary" preventive LAA closure after informed consent.</AbstractText>Mean patient age was 58 ± 9 years (46% male). Procedural success was achieved in all pa-tients and no major adverse events occurred acutely or during the following 2.0 ± 0.8 years. No patient developed AF.</AbstractText>Concomitant closure of ASD or PFO in the presence of enlarged atria and LAA for "primary primary" prevention appears feasible and safe but has yet to prove its justification.</AbstractText> |
20,213 | Right bundle branch block and anterior wall ST elevation myocardial infarction. | We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation. |
20,214 | Role of cannabis in cardiovascular disorders. | The growing popularity of medical and recreational consumption of cannabis, especially among the youth, raises immediate concerns regarding its safety and long-terms effects. The cardiovascular effects of cannabis are not well known. Cannabis consumption has been shown to cause arrhythmia including ventricular tachycardia, and potentially sudden death, and to increase the risk of myocardial infarction (MI). These effects appear to be compounded by cigarette smoking and precipitated by excessive physical activity, especially during the first few hours of consumption. Cannabinoids, or the active compounds of cannabis, have been shown to have heterogeneous effects on central and peripheral circulation. Acute cannabis consumption has been shown to cause an increase in blood pressure, specifically systolic blood pressure (SBP), and orthostatic hypotension. Cannabis use has been reported to increase risk of ischemic stroke, particularly in the healthy young patients. The endocannabinoid system (ECS) is currently considered as a promising therapeutic target in the management of several disease conditions. Synthetic cannabinoids (SCs) are being increasingly investigated for their therapeutic effects; however, the value of their benefits over possible complications remains controversial. Despite the considerable research in this field, the benefits of cannabis and its synthetic derivatives remains questionable even in the face of an increasingly tolerating attitude towards recreational consumption and promotion of the therapeutic complications. More efforts are needed to increase awareness among the public, especially youth, about the cardiovascular risks associated with cannabis use and to disseminate the accumulated knowledge regarding its ill effects. |
20,215 | The impact of alteplase on pulmonary graft function in donation after circulatory death - An experimental study. | Lung transplantation is hampered by the lack of organs resulting in deaths on the waiting list. The usage of donation after circulatory death (DCD) lungs would dramatically increase donor availability. The most optimal organ preservation method, and the need for antithrombotic and fibrinolytic treatment to prevent thrombosis in the donor lungs is currently on debate. The present study investigated, in a simulated clinical DCD situation, whether the addition of alteplase in the flush-perfusion solution at the time of pulmonary graft harvesting could prevent thrombosis in the donor lung and thereby improve pulmonary graft function.</AbstractText>Twelve Swedish domestic pigs were randomized into two groups. All animals underwent ventricular fibrillation and were then left untouched for 1 h after declaration of death. None of the animals received heparin. The lungs were then harvested and flush-perfused with Perfadex®</sup> solution and the organs were then stored at 8 °C for 4 h. In one group alteplase was added to the Perfadex®</sup> solution (donation after cardiac death with alteplase (DCD-A)) and in the other, it was not (DCD). Lung function was evaluated, using ex vivo lung perfusion (EVLP), with blood gases at different oxygen levels, pulmonary vascular resistance (PVR), lung weight, and macroscopic appearance.</AbstractText>During EVLP, there were no significant differences between groups in PaO2</sub> at any investigated FiO2</sub> level (1.0, 0.5, or 0.21). At FiO2</sub> 1.0, the PaO2</sub> in the DCD and DCD-A was 51.7 ± 2.05 kPa and 60.3 ± 3.67 kPa, respectively (p = 0.1320). There were no significant differences between groups PVR levels, in the DCD (372 ± 31 dyne x s/cm5</sup>) and in the DCD-A (297 ± 37 dyne x s/cm5</sup>) groups (p = 0.1720). There was no significant difference between groups in macroscopic appearance.</AbstractText>All the lungs showed excellent blood gases after EVLP, and they all meet the criteria's for clinical lung transplantation. The use of alteplase did not seem to have any obvious benefit to the donor lungs in a DCD situation. The donor lungs treated with alteplas showed slightly better blood gases and slightly lower PVR compared to the group without alteplas, however the difference was not significant. DCD appears to be a safe and effective method to expand the donor pool.</AbstractText> |
20,216 | Congenital Left Ventricular Diverticulum Complicated by Ventricular Fibrillation. | Congenital left ventricular diverticulum (CLVD) is a rare congenital anomaly and may be associated with fatal adverse events. A previously healthy 20-year-old man collapsed as a result of sudden ventricular fibrillation (VF). Despite intractable VF, he had return of spontaneous circulation with cardiopulmonary resuscitation and subsequent introduction of venoarterial extracorporeal membrane oxygenation (ECMO). After ECMO was discontinued, cardiac magnetic resonance imaging revealed CLVD at the posterolateral wall of the left ventricle. Given the risk of recurrent VF and left ventricular rupture, he underwent surgical repair for CLVD and implantation of a subcutaneous implantable cardioverter defibrillator. |
20,217 | Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence. | Spontaneous coronary artery dissection (SCAD) is underdiagnosed and an important cause of myocardial infarction (MI), especially in young women. Long-term cardiovascular outcomes, including recurrent SCAD, are inadequately reported.</AbstractText>This study sought to describe the acute and long-term cardiovascular outcomes and assess the predictors of recurrent SCAD.</AbstractText>Nonatherosclerotic SCAD patients were prospectively followed at Vancouver General Hospital systematically to ascertain baseline, predisposing and precipitating stressors, angiographic features, revascularization, use of medication, and in-hospital and long-term cardiovascular events. Clinical predictors for recurrent de novo SCAD were tested using univariate and multivariate Cox regression models.</AbstractText>The authors prospectively followed 327 SCAD patients. Average age was 52.5 ± 9.6 years, and 90.5% were women (56.9% postmenopausal). All presented with MI; 25.7% had ST-segment elevation MI, 74.3% had non-ST-segment elevation MI, and 8.9% had ventricular tachycardia/ventricular fibrillation. Precipitating emotional stressors were reported in 48.3% and physical stressors in 28.1%. Fibromuscular dysplasia was present in 62.7%, connective tissue disorder in 4.9%, and systemic inflammatory disease in 11.9%. The majority (83.1%) were initially treated medically, with only 16.5% or 2.2% undergoing in-hospital percutaneous coronary intervention or coronary artery bypass graft surgery, respectively. The majority of SCAD patients were taking aspirin and beta-blocker therapy at discharge and at follow-up. Median hospital stay was 3.0 days, and the overall major adverse event rate was 7.3%. Median long-term follow-up was 3.1 years, and overall major adverse cardiac event rate was 19.9% (death rate: 1.2%; recurrent MI: 16.8%; stroke/transient ischemic attack: 1.2%; revascularization: 5.8%). Recurrent SCAD occurred in 10.4% of patients. In multivariate modeling, only hypertension increased (hazard ratio: 2.46; p = 0.011) and beta-blocker use diminished (hazard ratio: 0.36; p = 0.004) recurrent SCAD.</AbstractText>In our large prospectively followed SCAD cohort, long-term cardiovascular events were common. Hypertension increased the risk of recurrent SCAD, whereas beta-blocker therapy appeared to be protective.</AbstractText>Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
20,218 | Coronary Artery Disease in Patients With Out-of-Hospital Refractory Ventricular Fibrillation Cardiac Arrest. | The prevalence of coronary artery disease (CAD) among patients with refractory out-of-hospital (OH) ventricular fibrillation (VF)/ventricular tachycardia (VT) cardiac arrest is unknown.</AbstractText>The goal of this study was to describe the prevalence and complexity of CAD and report survival to hospital discharge in patients experiencing refractory VF/VT cardiac arrest treated with a novel protocol of early transport to a cardiac catheterization laboratory (CCL) for extracorporeal life support (ECLS) and revascularization.</AbstractText>Between December 1, 2015, and December 1, 2016, consecutive adult patients with refractory OH VF/VT cardiac arrest requiring ongoing cardiopulmonary resuscitation were transported by emergency medical services to the CCL. ECLS, coronary angiography, and percutaneous coronary intervention were performed, as appropriate. Functionally favorable survival to hospital discharge (Cerebral Performance Category 1 or 2) was determined. Outcomes in a historical comparison group were also evaluated.</AbstractText>Sixty-two (86%) of 72 transported patients met emergency medical services transport criteria. Fifty-five (89%) of the 62 patients met criteria for continuing resuscitation on CCL arrival; 5 had return of spontaneous circulation, 50 received ECLS, and all 55 received coronary angiography. Forty-six (84%) of 55 patients had significant CAD, 35 (64%) of 55 had acute thrombotic lesions, and 46 (84%) of 55 had percutaneous coronary intervention with 2.7 ± 2.0 stents deployed per patient. The mean SYNTAX score was 29.4 ± 13.9. Twenty-six (42%) of 62 patients were discharged alive with Cerebral Performance Category 1 or 2 versus 26 (15.3%) of 170 in the historical comparison group (odds ratio: 4.0; 95% confidence interval: 2.08 to 7.7; p < 0.0001).</AbstractText>Complex but treatable CAD was prevalent in patients with refractory OH VF/VT cardiac arrest who also met criteria for continuing resuscitation in the CCL. A systems approach using ECLS and reperfusion seemed to improve functionally favorable survival.</AbstractText>Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
20,219 | Association between left atrial enlargement and obstructive sleep apnea in a general population of 71-year-old men. | Left atrial enlargement has been shown to be associated with obstructive sleep apnea in patients with coronary artery disease and in sleep clinic cohorts. However, data from the general population are limited. The aim of this study was to investigate whether there is an association between obstructive sleep apnea and left atrial enlargement in a random sample from a general population of 71-year-old men. As part of the longitudinal population study The Study of Men Born in 1943, we analysed cross-sectional data for 411 men, all 71 years old, who had participated in an overnight home sleep study and a standardized echocardiographic examination. Of the 411 men, 29.4% had moderate to severe obstructive sleep apnea [apnea-hypopnea index score of ≥15 (n = 121)]. These participants showed a significantly higher frequency of systolic heart failure, hypertension, overweight, had greater waist circumference as well as higher left atrial areas compared with men with no or mild obstructive sleep apnea (23.7 ± 5.5 cm<sup>2</sup> versus 21.6 ± 4.5 cm<sup>2</sup> , P < 0.001). In a linear regression analysis, obstructive sleep apnea was significantly associated with left atrial enlargement after adjusting for overweight, atrial fibrillation, heart failure with reduced ejection fraction, hypertension and mitral regurgitation. Compared with individuals without obstructive sleep apnea, the mean left atrial area was 1.7 ± 1.5 cm<sup>2</sup> larger in men with severe obstructive sleep apnea (P < 0.05) and 1.3 ± 1.1 cm<sup>2</sup> larger among men with moderate obstructive sleep apnea (P < 0.05). In this cross-sectional study of 71-year-old men from the general population, left atrial area was independently associated with prevalence and severity of obstructive sleep apnea. |
20,220 | Out-of-hospital cardiac arrest related to coronary arterial spasm in three elderly patients with no obstructive coronary artery disease. | Coronary spastic angina (CSA) is relatively more common in young people than in elderly people. Here, we present three cases of elderly male patients who experienced out-of-hospital cardiac arrest (OHCA) likely due to coronary spasm-induced ventricular fibrillation (Vf) from 2013 to 2016. After defibrillation, emergency coronary arteriography demonstrated severe coronary vasospasm that resolved following intracoronary infusion of nitroglycerin in the right coronary arteries in all three patients, with no organic obstructive lesion in the coronary arteries after nitroglycerin infusion. Case 1 was a 74-year-old patient with a past history of unstable angina and no organic obstructive lesion on coronary arteriography. He was administered oral amlodipine, isosorbide mononitrate, and nicorandil. He survived an OHCA and underwent implantable cardioverter defibrillator (ICD) implantation on day 57. Case 2 was a 71-year-old patient without prior CSA, who suddenly lost consciousness during a break after tennis. Vf was reversed to sinus rhythm by defibrillation in the ambulance. He died of multi-organ failure on day 7. Case 3 was a 66-year-old patient diagnosed with multi-vessel CSA by coronary arteriography with acetylcholine provocation test. He survived an OHCA associated with inferior acute myocardial infarction, rejected ICD implantation, and has not had a chest pain attack or syncope since discharge. <<b>Learning objective:</b> This article reports a case series of out-of-hospital cardiac arrest (OHCA) likely due to coronary spastic angina (CSA) in the presence of non-obstructive coronary artery disease in elderly patients. Although CSA is associated with an increased risk of OHCA, little is known regarding clinical risk factors, the effectiveness of implanted defibrillators for the secondary prevention of cardiac arrest, or the long-term prognosis of elderly CSA patients who survive OHCA.>. |
20,221 | Diagnostic value of brain natriuretic peptide and β-endorphin plasma concentration changes in patients with acute left heart failure and atrial fibrillation. | This study aims to evaluate the diagnostic value of beta-endorphin (β-EP) and brain natriuretic peptid (BNP) plasma concentrations for the early diagnosis of acute left heart failure and atrial fibrillation.</AbstractText>A total of 45 patients were included. These patients comprised 23 male and 22 female patients,and 20 healthy subjects who underwent physical examinations in the Outpatient Department during the same periodwere included and assigned to the control group.</AbstractText>The diagnos stand was that of the Chinese guidelines for the diagnosis and treatment of heart failure.</AbstractText>Enzyme-linked immunosorbent assay was performed to detect the plasma concentration of β-EP and BNP in the treatment and control groups, and electrocardiogram targeting was performed to determine the left ventricular ejection fraction (LVEF).</AbstractText>BNP, β-EP, and LVEF levels were higher in the treatment group (688.01 ± 305.78 ng/L, 394.06 ± 180.97 ng/L, and 70.48 ± 16.62%) compared with the control group (33.90 ± 8.50 ng/L, 76.87 ± 57.21 ng/L, and 32.11 ± 5.25%). The P-values were .015, .019, and .026, respectively, which were <.05. The difference was statistically significant. The BNP and β-EP's 4 correlations (r = 0.895, P <.001), BNP, β-EP, and the combination of BNP and β-EP for acute left heart failure diagnosis in maximizing Youden index sensitivity, specific degree, area under the ROC curve (AUC), and 95% confidence interval (CI) were respectively 93.5%, 81.3%, 0.921, 0.841, 0.921; 80.5%, 78.6%, 0.697, 0.505, 0.697; 94.1%, 83.5%, 0.604 to 0.979, and 0.604. Acute left heart failure in patients with LVEF acuity plasma BNP and β-EP 50% group was obviously lower than that in the LVEF <50% group (P <.01). BNP, β-EP, and LVEF were negatively correlated (r = -0.741, -0.635, P = .013, .018).</AbstractText>β-EP and BNP have high specificity and sensitivity for detecting early acute left heart failure and atrial fibrillation in patients, which is convenient, easy to perform, and suitable for clinical applications.</AbstractText> |
20,222 | Stellate ganglion blockade for the treatment of refractory ventricular arrhythmias: A systematic review and meta-analysis. | Treatment refractory ventricular arrhythmias (VAs) are often driven and exacerbated by heightened sympathetic tone. We aim to conduct a systematic review and meta-analysis of published studies of a temporary percutaneous stellate ganglion block (SGB) on VA burden and defibrillation episodes in patients with treatment refractory VAs.</AbstractText>Relevant studies from January 1960 through May 2017 were identified in PubMed and Google Scholar. We performed a patient-level analysis using Student's t-test to compare outcomes before and after SGB.</AbstractText>We identified 22 unique case series with a total of 35 patients. Patients were 57 ± 17 years old and 69% were males with a high burden of VA. A unilateral (left)-sided SGB was used in 85.7% (30 of 35) of cases and the remaining were bilateral SGB. The use of a unilateral or bilateral SGB resulted in a significant reduction of VA episodes (24-hours pre: mean 16.5 [CI 9.7-23.1] events vs. post: mean 1.4 [CI 0.85-2.01] events; P = 0.0002) and need for defibrillation (24-hours pre: mean 14.2 [CI 6.8-21.6] vs. post: mean 0.6 [CI 0.3-0.9]; P = 0.0026). Furthermore, SGB was significantly associated with a reduction of VA burden regardless of etiology of cardiomyopathy, type of ventricular rhythm, and degree of contractile dysfunction. SGB was followed by surgical sympathectomy in 21% of cases.</AbstractText>Early experience suggests that SGB is associated with an acute reduction in the VA burden and offers potential promise for a broader use in high-risk populations. Randomized controlled studies are needed to confirm the safety and efficacy of this therapy.</AbstractText>© 2017 Wiley Periodicals, Inc.</CopyrightInformation> |
20,223 | Renal denervation decreases susceptibility of the heart to ventricular fibrillation in a canine model of chronic kidney disease. | What is the central question of this study? Renal denervation (RDN) has been shown to be effective and safe, resulting in better control of blood pressure and an improvement in left ventricular hypertrophy in chronic kidney disease (CKD) patients. Ventricular arrhythmias and sudden cardiac death are common causes of death in CKD patients, but previous studies pay almost no attention to the effects of RDN on the risk of ventricular fibrillation associated with CKD. What is the main finding and its importance? Renal denervation could decrease susceptibility of the heart to ventricular fibrillation in a canine CKD model. Improvement of left ventricular hypertrophy, sympathetic activation and inflammation by RDN may be responsible for its beneficial effects. Renal denervation (RDN) has been shown to have therapeutic value in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether RDN could decrease the susceptibility of the heart to ventricular fibrillation in a canine model of CKD. Twenty-one dogs were used. Chronic kidney disease was produced by subtotal nephrectomy in 16 dogs with RDN treatment (CKD + RDN group, n = 8) or sham RDN (CKD group, n = 8). Another five dogs underwent sham operation and sham RDN to serve as controls (CTR group). Parameters of renal function, blood pressure, echocardiography, ECG, noradrenaline and inflammation were measured at baseline and 6 weeks after the surgical procedure. The ventricular fibrillation threshold (VFT) was determined at the end of the study. Subtotal nephrectomy successfully induced a canine CKD model. When compared with the CTR group, subtotal nephrectomy in the CKD group significantly elevated blood pressure; increased the left ventricular mass, end-diastolic left ventricular internal dimension, left ventricular end-diastolic posterior wall thickness and end-diastolic interventricular septum thickness; prolonged the QT interval, corrected QT interval, the interval from the peak to the end of the T wave (Tp-e) and the corrected Tp-e interval; and increased the QT dispersion and the Tp-e/QT ratio; decreased the VFT; and increased the serum concentrations of noradrenaline, C-reactive protein and interleukin-6. Renal denervation significantly attenuated these changes induced by CKD. The study demonstrated that RDN could decrease the susceptibility of the heart to ventricular fibrillation in this CKD model. Improvement of left ventricular hypertrophy, sympathetic activation and inflammation by RDN may be responsible for its beneficial effects. |
20,224 | Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease. | <AbstractText Label="OBJECTIVE:" NlmCategory="UNASSIGNED">To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated.</AbstractText><AbstractText Label="METHODS:" NlmCategory="UNASSIGNED">Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated.</AbstractText><AbstractText Label="RESULTS:" NlmCategory="UNASSIGNED">After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%.</AbstractText><AbstractText Label="CONCLUSION:" NlmCategory="UNASSIGNED">Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.</AbstractText> |
20,225 | Left atrial volume index in patients with heart failure and severely impaired left ventricular systolic function: the role of established echocardiographic parameters, circulating cystatin C and galectin-3. | Backround: Left atrial (LA) enlargement plays an important role in the development of heart failure (HF) and is a robust prognostic factor. Fibrotic processes have also been advocated to evoke HF through finite signalling proteins.</AbstractText>We examined the association of two such proteins, cystatin C (CysC) and galectin-3 (Gal-3), and other clinical, echocardiographic and biochemical parameters with LA volume index (LAVi) in patients with HF with severely impaired left ventricular ejection fraction (LVEF). Severe renal, liver, autoimmune disease and cancer were exclusion criteria.</AbstractText>A total of 40 patients with HF (31 men, age 66.6 ± 1.7) with LVEF = 25.4 ± 0.9% were divided into two groups according to the mean LAVi (51.03 ± 2.9 ml/m2</sup>) calculated by two-dimensional transthoracic echocardiography. Greater LAVi was positively associated with LV end-diastolic volume ( p = 0.017), LV end-systolic volume ( p = 0.025), mitral regurgitant volume (MRV) ( p = 0.001), right ventricular systolic pressure (RVSP) ( p < 0.001), restrictive diastolic filling pattern ( p = 0.003) and atrial fibrillation ( p = 0.005). Plasma CysC was positively correlated with LAVi ( R2</sup> = 0.135, p = 0.019) and log-transformed plasma Gal-3 ( R2</sup> = 0.109, p = 0.042) by simple linear regression analysis. Stepwise multiple linear regression analysis showed that only MRV ( t = 2.236, p = 0.032), CysC ( t = 2.467, p = 0.019) and RVSP ( t = 2.155, p = 0.038) were significant predictors of LAVi.</AbstractText>Apart from known determinants of LAVi, circulating CysC and Gal-3 were associated with greater LA dilatation in patients with HF with reduced LVEF. Interestingly, the correlation between these two fibrotic proteins was positive.</AbstractText> |
20,226 | Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest. | As most cardiopulmonary resuscitation (CPR) efforts last longer than 15min, the aim of this study was to compare brain blood flow between the Head Up (HUP) and supine (SUP) body positions during a prolonged CPR effort of 15min, using active compression-decompression (ACD) CPR and impedance threshold device (ITD) in a swine model of cardiac arrest.</AbstractText>Ventricular fibrillation (VF) was induced in anesthetized pigs. After 8min of untreated VF followed by 2min of ACD-CPR+ITD in the SUP position, pigs were randomized to 18min of continuous ACD-CPR+ITD in either a 30° HUP or SUP position. Microspheres were injected before VF and then 5 and 15min after start of CPR.</AbstractText>The mean blood flow (ml/min/g, mean±SD) to the brain after 15min of CPR was 0.42±0.05 in the HUP group (n=8) and 0.21±0.04 SUP (n=10), respectively, (p<0.01). The HUP group also had statistically significantly lower intracranial pressures and higher calculated cerebral perfusion pressures after 5, 15, 19 (before adrenaline) and 20 (after adrenaline) minutes of HUT versus SUP CPR.</AbstractText>After prolonged ACD-CPR+ITD in the HUP position, brain blood flow was 2-fold higher versus the SUP position. These positive findings provide strong pre-clinical support to proceed with a clinical evaluation of elevation of the head and thorax during ACD-CPR+ITD in humans in cardiac arrest.</AbstractText>Copyright © 2017. Published by Elsevier B.V.</CopyrightInformation> |
20,227 | Relationship Between Right Ventricular Function and Atrial Fibrillation After Cardiac Surgery. | The aim of this study was to explore the relationship between perioperative right ventricular (RV) function and postoperative atrial fibrillation (POAF) in the context of cardiac surgery.</AbstractText>Prospective, observational study.</AbstractText>A single medical center setting.</AbstractText>The study comprised 92 patients undergoing elective cardiac surgery.</AbstractText>None.</AbstractText>Consecutive patients without previous history of atrial fibrillation referred for cardiac surgery were enrolled prospectively. Comprehensive transesophageal echocardiography was recorded at the following 2 specific timeframes: before sternotomy (T1) and after sternal closure (T2). Four RV measurements, including RV global longitudinal strain (RVGLS), were performed offline. POAF was defined as any sustained episode of atrial fibrillation recorded within 14 days postoperatively. Ninety-two patients (mean age 61.2 ± 10.8 yr, 63 men) were included in this study; 25 patients (27%) experienced POAF, with a median occurrence of 3 days after cardiac surgery. Multivariable logistic regression models demonstrated that RVGLST1</sub> (odds ratio 1.13, p = 0.047) and RVGLST2</sub> (odds ratio 1.38, p = 0.001) were associated independently with POAF. However, changes in RV indices were not correlated to POAF. The optimal cutoff points obtained from the receiver operating characteristic curve analysis were as follows: -16.7% of RVGLST1</sub> (positive likelihood ratio 2.21, negative likelihood ratio 0.59) and -16.1% of RVGLST2</sub> (positive likelihood ratio 2.68, negative likelihood ratio 0.38).</AbstractText>RV dysfunction is associated significantly with the occurrence of POAF in the context of cardiac surgery, and perioperative RVGLS measured using transesophageal echocardiography is a useful index to predict POAF in patients referred for cardiac surgery.</AbstractText>Copyright © 2017 Elsevier Inc. All rights reserved.</CopyrightInformation> |
20,228 | Pediatric survivors of out-of-hospital ventricular fibrillation: Etiologies and outcomes. | In general, the prognosis is poor for pediatric patients who experience out-of-hospital (OOH) cardiac arrest, with survival rates of 12% to 29%.</AbstractText>The purpose of this study was to describe the causes and outcomes of pediatric patients with documented ventricular fibrillation (VF) at resuscitation from OOH cardiac arrest with sustained return of spontaneous circulation after defibrillation and survival to hospital admission.</AbstractText>Retrospective analysis of OOH-VF patients <19 years of age evaluated between 2004 and 2016 was performed. Primary outcome measures included demographics, arrest and resuscitation parameters, cardiac diagnoses, survival, and neurologic outcome.</AbstractText>Forty-five patients fulfilled study criteria (median age 12 years; range 2 months to 18 years). Cardiac arrest occurred in public in 68% of cases, with bystander cardiopulmonary resuscitation in 42% before arrival of emergency medical services. All patients underwent defibrillation (1-6 shocks) with return of spontaneous circulation and survival to hospital admission. Underlying etiologies were primary electrical disease (33%), cardiomyopathy (27%), congenital heart disease (11%), other (13%), and unknown (16%). Before arrest, 40% of patients had a cardiac diagnosis and 26% had symptoms. Ultimately, 40 of 45 patients (89%) survived resuscitation to hospital discharge. During 72 ± 37 months of follow-up, 38% of survivors had a normal neurologic outcome, whereas 32% had mild neurologic impairment and 30% had moderate-to-severe neurologic impairment.</AbstractText>In pediatric patients resuscitated from OOH-VF, a cardiovascular cause was identified in >80%. Regardless of cause, survival and neurologic prognosis appear improved compared to patients with asystole or pulseless electrical activity. These findings support early rhythm assessment and advanced cardiopulmonary resuscitation protocols in pediatric cardiac arrest victims.</AbstractText>Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
20,229 | Role of Electrocardiographic Tpeak-Tend for the Prediction of Ventricular Arrhythmic Events in the Brugada Syndrome. | Some previous studies have proposed the electrocardiographic Tpeak-Tend (TpTe) as a possible predictor of ventricular arrhythmic events in patients with Brugada syndrome (BrS). We sought to analyze the association between the parameters of repolarization dispersion (TpTe, TpTe/QT, TpTe dispersion, QTc, and QTd) and ventricular fibrillation/sudden cardiac death in a large cohort of patients with type 1 BrS. A total of 448 consecutive patients with BrS (men 61%, age 45 ± 16 years) with spontaneous (n = 96, 21%) or drug-induced (n = 352, 79%) type 1 electrocardiogram were retrospectively included. At the time of the diagnosis or during a mean follow-up of 93 ± 47 months (median 88 months), 43 patients (9%) documented ventricular arrhythmias. No significant difference was observed in TpTe, TpTe/QT, maximum TpTe, and TpTe dispersion between asymptomatic patients and those with syncope and malignant arrhythmias. TpTe/QT ratio did not also significantly differ between patients with ventricular fibrillation/sudden cardiac death and those asymptomatic ones. In conclusion, TpTe was not significantly prolonged in those patients with type 1 BrS presenting with unexplained syncope or malignant arrhythmic events during follow-up. |
20,230 | Atrioventricular block masked by posteroseptal bypass tract located in coronary sinus aneurysm. | Atrial fibrillation with concurrent ventricular preexcitation identifies a high-risk arrhythmic substrate and usually results in catheter ablation of the atrioventricular bypass tract. Electrocardiography can only approximate the anatomical location of an accessory pathway. Here we report a case where a bypass tract was localised to a coronary sinus aneurysm and antegrade atrioventricular conduction masked underlying atrioventricular nodal block. |
20,231 | Papillary Muscle Rupture in an Adolescent with No Coronary Lesions. | A 21-year-old man with Wolff-Parkinson-White syndrome presented to the authors' hospital with ventricular fibrillation. Coronary angiography failed to demonstrate coronary stenosis, but temporary mechanical circulatory support resolved the ventricular fibrillation and the patient was extubated eight days later. On the next day, however, he had to be re-intubated with symptoms of congestive heart failure. Echocardiography revealed new severe mitral regurgitation and a mobile mass, while emergency surgery revealed a posteromedial papillary muscle rupture (PMR). The mitral regurgitation was repaired with ruptured papillary muscle relocation, artificial chordae implantation, and ring annuloplasty. Postoperative examinations suggested that an arrhythmia-induced coronary circulation hypoperfusion and septic embolization had caused the PMR. |
20,232 | Serial Assessment of Natriuretic Peptides in Patients Undergoing Interventional Closure of the Left Atrial Appendage. | Closure of the left atrial appendage (LAA) to prevent cardioembolic events is an alternative therapy to oral anticoagulation in patients with non-valvular atrial fibrillation. The LAA is an important source of natriuretic peptides and its exclusion from the circulation may alter the blood level of these hormones, thereby influencing their diagnostic value and clinical effects.</AbstractText>We aimed to prospectively assess potential changes in mid-regional pro A-type natriuretic peptide (MR-proANP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels 6 weeks and 6 months after interventional LAA closure using the WATCHMAN device.</AbstractText>In 29 consecutive patients with successful LAA closure baseline MR-proANP level was 274±208pmol/l and decreased by -24.5±68 (p=0.07) and -15.0±44pmol/l (p=0.10) after 6 weeks and 6 months, respectively. The drop in the MR-proANP level after 6 weeks and 6 months was significant in patients with elevated (≥214pmol/l) baseline MR-proANP level (n=15: -54.3±78.0, p<0.01 and -31.8±45.4pmol/l, p=0.03, respectively) and those with reduced left ventricular ejection fraction (LVEF<45%, n=7: -87.4±97.3, p=0.02 and -60.3±42.6pmol/l, p=0.01, respectively). Baseline NT-proBNP level (median 1054pg/ml; IQR 621-1977pg/ml), sodium, potassium, mean systolic or diastolic blood pressure did not change significantly in the mentioned patient groups.</AbstractText>After LAA closure, MR-proANP level decreased significantly in patients with elevated baseline MR-proANP level or reduced LVEF, whereas NT-proBNP level remained unchanged, thereby altering the correlation coefficient between the two biomarkers. Our findings should be considered when using these biomarkers for diagnostic or prognostic evaluation in patients with interventional LAA closure.</AbstractText>Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.</CopyrightInformation> |
20,233 | Safety of transesophageal echocardiography‑guided electrical cardioversion in patients with atrial fibrillation and inadequate anticoagulation. | INTRODUCTION    Restoring sinus rhythm in patients with atrial fibrillation (AF)/atrial flutter (AFl) requires adequate oral anticoagulation prior to direct current cardioversion (DCC). Some patients eligible for DCC are not properly anticoagulated. OBJECTIVES    The aim of the study was to assess risk factors for thrombus and spontaneous echo contrast (SEC) in the left atrium (LA) as well as the safety profile of transesophageal echocardiography (TEE)-guided DCC in patients with inadequate anticoagulation. PATIENTS AND METHODS    From the cohort of 316 patients admitted for DCC, 139 patients (mean [SD] age, 63.4 [11.5] years) had inadequate anticoagulation; 91 patients were admitted urgently for acute coronary syndrome, heart failure (HF), or poor tolerance of arrhythmia. The mean (SD) CHA2DS2‑VASc score was 3.0 (1.7). RESULTS    TEE revealed a left atrial appendage (LAA) thrombus in 16 patients (11.5%), and SEC in the LA in 63 patients (45.3%). In a univariate analysis, LAA thrombus was more common in patients after myocardial infarction (odds ratio [OR], 3.92; 95% CI, 1.34-11.48; P = 0.009), while SEC in the LA was more common in patients with HF (OR, 2.23; 95% CI, 1.1-4.53; P = 0.02) and left ventricular ejection fraction of less than 40% (OR, 3.65; 95% CI, 1.66-8.06; P = 0.001). In a multivariate model, the most powerful SEC‑predicting factor was the LA size exceeding 45 mm (OR, 3.08; 95% CI, 1.3-7.29). DCC was performed in 105 patients. No complications of TEE or DCC were observed. CONCLUSIONS    AF/AFl inadequately treated with oral anticoagulation predisposes to thrombus formation and SEC in the LA. Once thrombus is excluded, DCC is a safe procedure. There were no predictors of LAA thrombus; therefore, TEE before DCC should be performed in all patients with AF/AFl in accordance with the guidelines. |
20,234 | Prevalence of Early Repolarization Patterns in Adults. | Background The finding of persistent Junction point elevation of 1 mm or more in adjacent leads in electrocardiogram is considered to be due to early repolarization. This condition was considered benign in the past but presently it is believed to be the rare cause of idiopathic ventricular fibrillation and sudden death. Objective The main objective of the study is to find out the prevalence of early repolarization pattern in subjects having electrocardiogram at Kathmandu Medical College Teaching Hospital. Method Twelve lead electrocardiograms of patients attending Kathmandu Medical College Teaching Hospital were studied. Data was collected for patient particulars. Electrocardiograms were analyzed for the type of early repolarization. Result The overall prevalence of early repolarization pattern of electrocardiogram was 2.82 %. It's prevalence in male and female was 4.95 % and 0.77 % respectively. The prevalence of different types of early repolarization electrocardiography pattern was 0.70 %, 1.25% and 0.63% of the population studied for type I, II, and III early repolarization patterns. Type IV or Brugada pattern was not detected in our study. Conclusion The commonest pattern observed was type II that is early repolarization pattern in inferior or inferolateral leads. Having knowledge of early repolarization and its type helps to counsel the physicians about the risk of arrhythmia and sudden cardiac death. |
20,235 | The Role of Radiopharmaceuticals in Amiodarone-Induced Thyroid Pathology. | The use of amiodarone for the treatment of ventricular and supraventricular dysrhythmias brings in organism an increased amount of iodine, interfering with thyroid function. If the treatment needs to be interrupted, iodine remains at abnormal levels for months or even years. The aim of the study was to review the literature regarding the optimal tests for early diagnostic and to analyze the role of nuclear medicine tests in the differential and correct assessment of the amiodarone-induced thyroid pathology.</AbstractText>We made a review of available publications in PUBMED referring the amiodaroneinduced thyroid pathology, focusing on the differential diagnosis, made by nuclear medicine tests, of hypothyroidism (AIH) and hyperthyroidism expressed as: type I amiodarone induced thyrotoxicosis (AIT I), type II amiodarone induced thyrotoxicosis (AIT II), and less frequently as a mixt form, type III amiodarone induced thyrotoxicosis (AIT III). We presented cases from the database of a tertiary center in Cluj-Napoca, Romania.</AbstractText>Despite the frequent complication of thyroid function, this pathology is underestimated and diagnosed. There is a limited number of studies and clear protocols, especially in the mixed forms cases. This increase in iodine uptake interferes seriously with thyroid hormone production and release. The nuclear medicine tests are essential in the correct assessment and differential diagnosis of different forms of induced thyroid dysfunction. The destruction of the follicular cells can result in the release of excessive thyroid hormone into the circulation, with potential development of atrial fibrillation, worsening the cardiac disease, so any benefic therapeutic procedure should be known; the use of radioiodine as therapy alternative, despite the known limitations induced by blockade was clear benefic in the case presented. A special attention needs to be addressed to those patients with differentiated thyroid cancer, which will be submitted to radioiodine therapy and are under chronic therapy with amiodarone.</AbstractText>The nuclear medicine procedures are essential in the correct assessment and differential diagnosis of different forms of induced thyroid dysfunction. The radioiodine is not recommended in AIT, due to stunning effect induced by iodine excess, but in some special, lifethreatening condition, radioiodine I-131 might be a treatment option.</AbstractText>Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.</CopyrightInformation> |
20,236 | Modelling the effects of quinidine, disopyramide, and E-4031 on short QT syndrome variant 3 in the human ventricles.<Pagination><StartPage>1859</StartPage><EndPage>1873</EndPage><MedlinePgn>1859-1873</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1088/1361-6579/aa8695</ELocationID><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">Short QT syndrome (SQTS) is an inherited cardiac channelopathy, but at present little information is available on its pharmacological treatment. SQT3 variant (linked to the inward rectifier potassium current I <sub>K1</sub>) of SQTS, results from a gain-of-function mutation (Kir2.1 D172N) in the KCNJ2-encoded channels, which is associated with ventricular fibrillation (VF). Using biophysically-detailed human ventricular computer models, this study investigated the potential effects of quinidine, disopyramide, and E-4031 on SQT3.</AbstractText><AbstractText Label="APPROACH" NlmCategory="METHODS">The ten Tusscher et al model of human ventricular myocyte action potential (AP) was modified to recapitulate the changes in I <sub>K1</sub> due to heterozygous and homozygous forms of the D172N mutation. Wild-type (WT) and mutant WT-D172N and D172N formulations were incorporated into one-dimensional (1D) and 2D tissue models with transmural heterogeneities. Effects of drugs on channel-blocking activity were modelled using half-maximal inhibitory concentration (IC<sub>50</sub>) and Hill coefficient (nH) values. Effects of drugs on AP duration (APD), effective refractory period (ERP) and QT interval of pseudo-ECGs were quantified, and both temporal and spatial vulnerability to re-entry was measured. Re-entry was simulated in the 2D ventricular tissue.</AbstractText><AbstractText Label="MAIN RESULTS" NlmCategory="RESULTS">At the single cell level, the drugs quinidine, disopyramide, and E-4031 prolonged APD at 90% repolarization (APD<sub>90</sub>), and decreased maximal transmural voltage heterogeneity (δV); this caused the decreased transmural dispersion of APD<sub>90</sub>. Quinidine prolonged the QT interval and decreased the T-wave amplitude. Furthermore, quinidine increased ERP and reduced temporal vulnerability and increased spatial vulnerability, resulting in a reduced susceptibility to arrhythmogenesis in SQT3. In the 2D tissue, quinidine was effective in terminating and preventing re-entry associated with the heterozygous D172N condition. Quinidine exhibited significantly better therapeutic effects on SQT3 than disopyramide and E-4031.</AbstractText><AbstractText Label="SIGNIFICANCE" NlmCategory="CONCLUSIONS">This study substantiates a causal link between quinidine and QT interval prolongation in SQT3 Kir2.1 mutations and highlights possible pharmacological agent quinidine for treating SQT3 patients.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Luo</LastName><ForeName>Cunjin</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>School of Computer Science and Technology, Harbin Institute of Technology (HIT), Harbin 150001, People's Republic of China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Kuanquan</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Zhang</LastName><ForeName>Henggui</ForeName><Initials>H</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>09</Month><Day>21</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Physiol Meas</MedlineTA><NlmUniqueID>9306921</NlmUniqueID><ISSNLinking>0967-3334</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D010880">Piperidines</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D011725">Pyridines</NameOfSubstance></Chemical><Chemical><RegistryNumber>113558-89-7</RegistryNumber><NameOfSubstance UI="C063968">E 4031</NameOfSubstance></Chemical><Chemical><RegistryNumber>GFO928U8MQ</RegistryNumber><NameOfSubstance UI="D004206">Disopyramide</NameOfSubstance></Chemical><Chemical><RegistryNumber>ITX08688JL</RegistryNumber><NameOfSubstance UI="D011802">Quinidine</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Disease" UI="C566504">Short QT Syndrome 3</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000200" MajorTopicYN="N">Action Potentials</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="N">drug effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004206" MajorTopicYN="N">Disopyramide</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="Y">pharmacology</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006329" MajorTopicYN="N">Heart Conduction System</DescriptorName><QualifierName UI="Q000002" MajorTopicYN="Y">abnormalities</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006330" MajorTopicYN="N">Heart Defects, Congenital</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006352" MajorTopicYN="N">Heart Ventricles</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="Y">drug effects</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008954" MajorTopicYN="Y">Models, Biological</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010880" MajorTopicYN="N">Piperidines</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="Y">pharmacology</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011725" MajorTopicYN="N">Pyridines</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="Y">pharmacology</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011802" MajorTopicYN="N">Quinidine</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="Y">pharmacology</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>8</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2018</Year><Month>5</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>8</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28812984</ArticleId><ArticleId IdType="doi">10.1088/1361-6579/aa8695</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedBookArticle><BookDocument><PMID Version="1">20301579</PMID><ArticleIdList><ArticleId IdType="bookaccession">NBK1405</ArticleId></ArticleIdList><Book><Publisher><PublisherName>University of Washington, Seattle</PublisherName><PublisherLocation>Seattle (WA)</PublisherLocation></Publisher><BookTitle book="gene">GeneReviews<sup>®</sup></BookTitle><PubDate><Year>1993</Year></PubDate><BeginningDate><Year>1993</Year></BeginningDate><EndingDate><Year>2023</Year></EndingDate><AuthorList Type="editors" CompleteYN="Y"><Author ValidYN="Y"><LastName>Adam</LastName><ForeName>Margaret P</ForeName><Initials>MP</Initials></Author><Author ValidYN="Y"><LastName>Mirzaa</LastName><ForeName>Ghayda M</ForeName><Initials>GM</Initials></Author><Author ValidYN="Y"><LastName>Pagon</LastName><ForeName>Roberta A</ForeName><Initials>RA</Initials></Author><Author ValidYN="Y"><LastName>Wallace</LastName><ForeName>Stephanie E</ForeName><Initials>SE</Initials></Author><Author ValidYN="Y"><LastName>Bean</LastName><ForeName>Lora JH</ForeName><Initials>LJH</Initials></Author><Author ValidYN="Y"><LastName>Gripp</LastName><ForeName>Karen W</ForeName><Initials>KW</Initials></Author><Author ValidYN="Y"><LastName>Amemiya</LastName><ForeName>Anne</ForeName><Initials>A</Initials></Author></AuthorList><Medium>Internet</Medium></Book><ArticleTitle book="gene" part="jln">Jervell and Lange-Nielsen Syndrome | Short QT syndrome (SQTS) is an inherited cardiac channelopathy, but at present little information is available on its pharmacological treatment. SQT3 variant (linked to the inward rectifier potassium current I K1</sub>) of SQTS, results from a gain-of-function mutation (Kir2.1 D172N) in the KCNJ2-encoded channels, which is associated with ventricular fibrillation (VF). Using biophysically-detailed human ventricular computer models, this study investigated the potential effects of quinidine, disopyramide, and E-4031 on SQT3.</AbstractText>The ten Tusscher et al model of human ventricular myocyte action potential (AP) was modified to recapitulate the changes in I K1</sub> due to heterozygous and homozygous forms of the D172N mutation. Wild-type (WT) and mutant WT-D172N and D172N formulations were incorporated into one-dimensional (1D) and 2D tissue models with transmural heterogeneities. Effects of drugs on channel-blocking activity were modelled using half-maximal inhibitory concentration (IC50</sub>) and Hill coefficient (nH) values. Effects of drugs on AP duration (APD), effective refractory period (ERP) and QT interval of pseudo-ECGs were quantified, and both temporal and spatial vulnerability to re-entry was measured. Re-entry was simulated in the 2D ventricular tissue.</AbstractText>At the single cell level, the drugs quinidine, disopyramide, and E-4031 prolonged APD at 90% repolarization (APD90</sub>), and decreased maximal transmural voltage heterogeneity (δV); this caused the decreased transmural dispersion of APD90</sub>. Quinidine prolonged the QT interval and decreased the T-wave amplitude. Furthermore, quinidine increased ERP and reduced temporal vulnerability and increased spatial vulnerability, resulting in a reduced susceptibility to arrhythmogenesis in SQT3. In the 2D tissue, quinidine was effective in terminating and preventing re-entry associated with the heterozygous D172N condition. Quinidine exhibited significantly better therapeutic effects on SQT3 than disopyramide and E-4031.</AbstractText>This study substantiates a causal link between quinidine and QT interval prolongation in SQT3 Kir2.1 mutations and highlights possible pharmacological agent quinidine for treating SQT3 patients.</AbstractText> |
20,237 | Do All Patients with Atrial Fibrillation Need Long-Term Anticoagulation? | Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide with an estimated number of 2.7-6.1 million cases in the United States (US) alone. The incidence of AF is expected to increase 2.5 fold over the next 50 years in the US. The management of AF is complex and includes mainly three aspects; restoration of sinus rhythm, control of ventricular rate and prevention of systemic thromboembolism. AF as a cause of systemic embolization has been well known for many years, and majority of patients are on oral anticoagulants (OACs) to prevent this. Many times, a patient may not be in AF chronically, nor is the AF burden (the amount of time patient is in AF out of the total monitored time) calculated. We present three cases of new onset transient AF triggered by temporary stressors. We were able to restore normal sinus rhythm (NSR) with chemical cardioversion. As per 2014 American College of Cardiology (ACC)/American Heart Association (AHA) recommendations, we started all three patients on OACs based on CHA<sub>2</sub>DS<sub>2</sub>VASc score ≥2. However, the patients refused long term OACs after restoration of NSR and correction of the temporary enticing stressors. In any case, the decision to start OACs would have had its own risks. Here we describe how antiarrhythmic drugs were used to maintain NSR, all while they were continuously monitored to determine the need to continue OACs. |
20,238 | Syncope During Competitive Events: Interrogating Heart Rate Monitor Watches May Be Useful! | This is a case report of a 45-year-old man who reported complete amnesia during the very first kilometer of a 10-km run. He was wearing a heart rate monitor (HRM). The interrogation of his HRM watch showed 200 bpm tachycardia beginning in the first kilometer and increasing up to 220 bpm during the last kilometer. The patient was asked to wear a Holter-monitor (Holter Research Laboratory; Helena, Montana USA) electrocardiogram (ECG) while practicing a training session. This examination allowed for the diagnosis of an adrenergic paroxysmal atrial fibrillation (AF) with an impressive auriculo-ventricular conduction over 260 bpm. This case highlights that non-medical devices, such as connected watches, can be helpful to diagnose arrhythmias. Thabouillot O , Bostanci K , Bouvier F , Dumitrescu N , Stéfuriac M , Paule P , Roche NC . Syncope during competitive events: interrogating heart rate monitor watches may be useful! Prehosp Disaster Med. 2017;32(6):691-693. |
20,239 | Left Ventricular Apex Venting in High-Risk Redo Sternotomy With Severe Aortic Insufficiency: A Case Report. | Redo cardiac surgery in patients with severe aortic insufficiency can present unique challenges to the anesthesiologist. We report a case highlighting the challenge and importance of interdisciplinary planning between cardiothoracic surgeons and anesthesiologists prior to high-risk surgery. Failure to place an endoaortic balloon and percutaneous coronary sinus catheter due to anatomical abnormalities prompted the adoption of an alternate technique involving apical ventricular venting to assist sternal reentry. Apical left ventricular venting was successfully used to prevent ventricular dilation and dysfunction during institution of cardiopulmonary bypass with significant aortic regurgitation and hypothermia-induced ventricular fibrillation. |
20,240 | <i>In vivo</i> opening of the mitochondrial permeability transition pore in a rat model of ventricular fibrillation and closed-chest resuscitation. | Opening of the mitochondrial permeability transition pore (mPTP) is considered central to reperfusion injury. Yet, most of our knowledge comes from observations in isolated mitochondria, cells, and organs. We used a rat model of ventricular fibrillation (VF) and closed-chest resuscitation to examine whether the mPTP opens <i>in vivo</i> and whether cyclosporine A (CsA) attenuates the associated myocardial injury. Two series of 26 and 18 rats each underwent 10 minutes of untreated VF before attempting resuscitation. In <i>series-1</i>, rats received 50 µCi of tritium-labeled 2-deoxyglucose ([<sup>3</sup>H]DOG) harvesting their hearts at baseline (n=5), during VF (n=5), during resuscitation (n=6), and at post-resuscitation 60 minutes (n=5) and 240 minutes (n=5). mPTP opening was estimated measuring the ratio of mitochondria to left ventricular intracellular [<sup>3</sup>H]. In <i>series-2</i>, rats received 10 mg/kg of CsA or vehicle before resuscitation, measuring mitochondrial NAD<sup>+</sup> content to indirectly assess mPTP opening. In <i>Series-1</i>, the mPTP opening ratio vs baseline (10.4 ± 1.9) increased during VF (16.8 ± 2.4, <i>NS</i>), closed-chest resuscitation (20.8 ± 6.3, <i>P</i><0.05), and at post-resuscitation 60 minutes (20.9 ± 4.7, <i>P</i><0.05) and 240 minutes (25.7 ± 11.0, <i>P</i><0.01). In <i>series 2</i>, CsA failed to attenuate reductions in mitochondrial NAD<sup>+</sup> and did not affect plasma cytochrome <i>c</i>, plasma cardiac troponin I, myocardial function, and survival. We report for the first time in an intact rat model of VF that mPTP opens during closed-chest resuscitation consistent with previous observations in mitochondria, cells, and organs of mPTP opening upon reperfusion. CsA, at the dose of 10 mg/kg neither prevented mPTP opening nor attenuated post-resuscitation myocardial injury. |
20,241 | Association of the Clinical and Genetic Factors With Superior Vena Cava Arrhythmogenicity in Atrial Fibrillation. | Atrial fibrillation (AF) can be initiated from arrhythmogenic foci within the muscular sleeves that extend not only into the pulmonary veins but also into both vena cavae. The superior vena cava (SVC) is a key target site for catheter ablation. Patients with SVC-derived AF often lack the clinical risk factors of AF.Methods and Results:We conducted a meta-analysis of the clinical and genetic factors of 2,170 AF patients with and without SVC arrhythmogenicity. In agreement with previous reports, the left atrial diameter was smaller in AF patients with SVC arrhythmogenicity. Among 6 variants identified in a previous genome-wide association study in Japanese patients, rs2634073 and rs6584555 were associated with SVC arrhythmogenicity. This finding was confirmed in our meta-analysis using independent cohorts. We also found that SVC arrhythmogenicity was conditionally dependent on age, body mass index, and left ventricular ejection fraction.</AbstractText>Both clinical and genetic factors are associated with SVC arrhythmogenicity.</AbstractText> |
20,242 | Cardiac arrest due to ventricular fibrillation in a 23-year-old woman with broken heart syndrome. | Broken heart syndrome, also known as takotsubo cardiomyopathy, is a syndrome characterized by a transient regional systolic dysfunction of the left ventricle associated to a psychological stress. We herein describe a case of a 23-year-old female habitual marijuana user who was resuscitated after cardiac arrest and then diagnosed with midventricular stress cardiomyopathy complicated by subendocardial hemorrhage. We discuss this unique pathological finding, the incidence of arrhythmias in this syndrome, and the possible relation with chronic cannabis and tobacco use. Unfortunately, the patient did not survive, but had she survived, the management of the patient for secondary prevention would have been challenging considering the risk of recurrence with this disease. |
20,243 | Evaluation of the Boussignac Cardiac arrest device (B-card) during cardiopulmonary resuscitation in an animal model. | The purpose of this study was to examine continuous oxygen insufflation (COI) in a swine model of cardiac arrest. The primary hypothesis was COI during standard CPR (S-CPR) should result in higher intrathoracic pressure (ITP) during chest compression and lower ITP during decompression versus S-CPR alone. These changes with COI were hypothesized to improve hemodynamics. The second hypothesis was that changes in ITP with S-CPR+COI would result in superior hemodynamics compared with active compression decompression (ACD) + impedance threshold device (ITD) CPR, as this method primarily lowers ITP during chest decompression.</AbstractText>After 6min of untreated ventricular fibrillation, S-CPR was initiated in 8 female swine for 4min, then 3min of S-CPR+COI, then 3min of ACD+ITD CPR, then 3min of S-CPR+COI. ITP and hemodynamics were continuously monitored.</AbstractText>During S-CPR+COI, ITP was always positive during the CPR compression and decompression phases. ITP compression values with S-CPR+COI versus S-CPR alone were 5.5±3 versus 0.2±2 (p<0.001) and decompression values were 2.8±2 versus -1.3±2 (p<0.001), respectively. With S-CPR+COI versus ACD+ITD the ITP compression values were 5.5±3 versus 1.5±2 (p<0.01) and decompression values were 2.8±2 versus -4.7±3 (p<0.001), respectively.</AbstractText>COI during S-CPR created a continuous positive pressure in the airway during both the compression and decompression phase of CPR. At no point in time did COI generate a negative intrathoracic pressures during CPR in this swine model of cardiac arrest.</AbstractText>Copyright © 2017 Elsevier B.V. All rights reserved.</CopyrightInformation> |
20,244 | Artery of Percheron infarction: a case report. | The artery of Percheron is a rare anatomic variant of arterial supply to the paramedian thalamus and rostral midbrain, and occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with or without midbrain involvement. Acute artery of Percheron infarcts represent 0.1 to 2% of total ischemic stroke. However, of thalamic strokes, occlusion of artery of Percheron is the cause in 4 to 35% of cases. Early diagnosis of artery of Percheron infarction can be challenging because it is infrequent and early computed tomography or magnetic resonance imaging may be negative. Thus, it can be confused with other neurological conditions such as tumors and infections.</AbstractText>This is a retrospective case study of a 56-year-old white man admitted to Umeå University Hospital and diagnosed with an artery of Percheron infarction. Medical records and the neuroradiological database were reviewed, and the diagnosis was made based on typical symptoms and radiological findings of artery of Percheron infarction. We report the case of a 56-year-old man with a history of overconsumption of alcohol who was found in his home unconscious and hypothermic. He had a Reaction Level Scale-85 score of 4. He developed ventricular fibrillation on arrival at our emergency department, and cardiopulmonary resuscitation successfully restored sinus rhythm within an estimated 2 minutes of onset. He was then put on cardiopulmonary bypass for rewarming. The initial head computed tomography performed on admission was wrongly assessed as unremarkable. Bilateral ischemia in the paramedian thalamic nuclei and pons were first documented on a follow-up computed tomography on day 24 after hospitalization. He died on day 35 after hospitalization.</AbstractText>Artery of Percheron infarcts are rare. The radiological diagnosis can initially often be judged as normal and in combination with variability in the neurological symptoms it is a rather difficult condition to diagnose. For these reasons few clinicians have much experience with this type of infarct, which may delay diagnosis and initiation of appropriate treatment.</AbstractText> |
20,245 | Improved Outcomes of Cardiopulmonary Resuscitation in Rats Treated With Vagus Nerve Stimulation and Its Potential Mechanism. | Studies have demonstrated that vagus nerve stimulation (VNS) reduces ischemia/reperfusion injury. In this study, we investigated the protective effects of VNS in a rat model of cardiopulmonary resuscitation (CPR). We further investigated whether the beneficial effects of VNS were dependent on the alpha 7 nicotinic acetylcholine receptor (α7nAChR). Forty animals were randomized into four groups and all underwent CPR (n = 10 each): CPR alone (control); VNS during CPR; α7nAChR antagonist methyllycaconitine citrate (MLA) with VNS; α7nAChR agonist 3-(2, 4-dimethoxybenzylidene) anabaseine (GTS-21 dihydrochloride) without VNS. The right vagus nerve was exteriorized in all animals. Ventricular fibrillation was induced and untreated for 8 min. Defibrillation was attempted after 8 min of CPR. VNS was initiated at the beginning of precordial chest compressions and continued for 4 h after return of spontaneous circulation (ROSC) in both the VNS and MLA groups. Hemodynamic measurements and myocardial function, including ejection fraction and myocardial performance index, were assessed at baseline, 1 and 4 h after ROSC. The neurological deficit score was measured at 24-h intervals for a total of 72 h. The heart rate was reduced in the VNS and MLA groups, while no difference was found in mean arterial pressure between the four groups. Better post-resuscitation myocardial and cerebral function and longer duration of survival were observed in the VNS-treated animals. The protective effects of VNS could be abolished by MLA and imitated by GTS-21. In addition, VNS decreased the number of electrical shocks and the duration of CPR required. VNS improves multiple outcomes after CPR. |
20,246 | The impact of the latest echocardiographic chamber quantification recommendations on the prediction of left atrial appendage thrombus presence by transthoracic echocardiography. | The latest recommendations for echocardiographic chamber quantification have implemented updated normal values for all cardiac chambers.</AbstractText>To evaluate the incidence of normal and abnormal values of routine echocardiographic parameters such as left ventricular ejection fraction (LVEF) and left atrial volume indexed to body surface area (LAVi) in patients with non-valvular atrial fibrillation (AF) and to determine the influence of LVEF and LAVi reclassification on the prediction of LAAT by transthoracic echocardiography.</AbstractText>We retrospectively analysed the database of 1674 transesophageal echocardiograms performed between 2012 and 2015 in our echo lab. The study involved patients (mean age 70 ± 7 years, 80% men) with paroxysmal or persistent AF (35 patients with left atrial appendage thrombus [LAAT] and 35 sex- and age-matched controls without LAAT). LVEF and LAVi were categorised in two ways: semi-quantitative using four-degree scale (normal or abnormal graded from mild and moderate to severe) and qualitative (normal vs. abnormal).</AbstractText>We reclassified 6 (9%) and 4 (6%) patients with regard to LVEF as well as 38 (54%) and 16 (23%) with regard to LAVi on semi-quantitative and qualitative scale, respectively. After adjustment for effective anticoagulation and approved risk factors in the multivariate models, we identified LVEF categorised in semi-quantitative manner according to both documents, LAVi categorised in a binary manner by new guidelines and semi-quantitative scale by both recommendations as independently associated with LAAT.</AbstractText>Differentiation between normal and abnormal value enhanced the diagnostic meaning of LAVi in the aspect of higher LAAT risk. LVEF reclassification had no significant influence.</AbstractText> |
20,247 | Abdominal surgery for gastric cancer following coronary artery bypass grafting using an in situ right gastroepiploic artery graft. | The right gastroepiploic artery (RGEA) is often used for coronary artery bypass grafting (CABG) in Japan. As gastric cancer has a high prevalence in many Asian countries, we investigated problems with surgery for gastric cancer after CABG using the RGEA.</AbstractText>A total of 860 patients underwent CABG using the RGEA between January 1997 and December 2006. Of these, 13 patients underwent surgery for gastric cancer after CABG. In all cases, the RGEA was harvested by the skeletonization technique, and an antegastric route was used for the anastomosis.</AbstractText>Dissection for the No. 6 lymph node was not performed in all cases because of the risk of graft injury. Graft injury during gastric surgery occurred in one patient and post-operative ventricular fibrillation (VF) was observed in two patients. One case of hospital death due to VF and two cases of remote death were encountered.</AbstractText>In planning a resection for gastric cancer following a CABG with a patent RGEA graft, the potential for graft injury must be anticipated. In advanced stages of gastric cancer when the RGEA needs to be resected to dissect the No.6 lymph node, a pre-operative percutaneous coronary intervention or a reoperative CABG may be indicated.</AbstractText>© 2017 Wiley Periodicals, Inc.</CopyrightInformation> |
20,248 | Implant and Midterm Outcomes of the Subcutaneous Implantable Cardioverter-Defibrillator Registry: The EFFORTLESS Study. | The subcutaneous implantable cardioverter-defibrillator (S-ICD) was developed to defibrillate ventricular arrhythmias, avoiding drawbacks of transvenous leads. The global EFFORTLESS S-ICD (Evaluation oF FactORs ImpacTing CLinical Outcome and Cost EffectiveneSS of the S-ICD) registry is collecting outcomes in 985 patients during a 5-year follow-up.</AbstractText>The primary goal of the EFFORTLESS registry is to determine the safety of the S-ICD by evaluating complications and inappropriate shock rate.</AbstractText>This is the first report on the full patient cohort and study endpoints with follow-up ≥1 year. The predefined endpoints are 30- and 360-day complications, and shocks for atrial fibrillation or supraventricular tachycardia.</AbstractText>Patients were followed for 3.1 ± 1.5 years and 82 completed the study protocol 5-year visit. Average age was 48 years, 28% were women, ejection fraction was 43 ± 18%, and 65% had a primary prevention indication. The S-ICD system and procedure complication rate was 4.1% at 30 days and 8.4% at 360 days. The 1-year complication rate trended toward improvement from the first to last quartile of enrollment (11.3% [quartile 1]) to 7.8% [quartile 2], 6.6% [quartile 3], and 7.4% [quartile 4]; quartile 1 vs. quartiles 2 to 4; p = 0.06). Few device extractions occurred due to need for antitachycardia (n = 5), or biventricular (n = 4) or bradycardia pacing (n = 1). Inappropriate shocks occurred in 8.1% at 1 year and 11.7% after 3.1 years. At implant, 99.5% of patients had a successful conversion of induced ventricular tachycardia or ventricular fibrillation. The 1- and 5-year rates of appropriate shock were 5.8% and 13.5%, respectively. Conversion success for discrete spontaneous episodes was 97.4% overall.</AbstractText>This registry demonstrates that the S-ICD fulfills predefined endpoints for safety and efficacy. Midterm performance rates on complications, inappropriate shocks, and conversion efficacy were comparable to rates observed in transvenous implantable cardioverter-defibrillator studies. (Evaluation oF Factors ImpacTing CLinical Outcome and Cost EffectiveneSS of the S-ICD [The EFFORTLESS S-ICD Registry]; NCT01085435).</AbstractText>Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
20,249 | Effects of exercise training on exercise capacity, cardiac function, BMI, and quality of life in patients with atrial fibrillation: a meta-analysis of randomized-controlled trials. | Exercise training has become part of the standard care for patients with cardiovascular disease. We investigated the effects of exercise training on exercise capacity, cardiac function, BMI, and quality of life in patients with atrial fibrillation (AF). We searched for randomized-controlled trials of supervised exercise training versus care without exercise training (the control) in patients with permanent or nonpermanent AF published up to November 2016. Standard mean differences (SMD) or mean differences (MD), and 95% confidence intervals (CIs) were calculated using random-effect models. We identified 259 trials, and after an assessment of relevance, five trials with a combined total of 379 participants were analyzed. In AF patients, exercise training significantly improved exercise capacity and left ventricular ejection fraction compared with the control (SMD: 0.91, 95% CI: 0.70 to 1.12; MD: 4.8%, 95% CIs: 1.56 to 8.03, respectively). Compared with the control, exercise training also significantly reduced BMI (MD: -0.47 kg/m, 95% CIs: -0.89 to -0.06) and significantly improved scores in the 'general health' and 'vitality' sections of the 36-item Short Form Health Status Survey (SMD: 0.71, 95% CIs: 0.30 to 1.12; SMD: 0.81, 95% CIs: 0.40 to 1.23, respectively). Exercise training improved exercise capacity, left ventricular ejection fraction, and some the 36-item Short Form Health Status Survey scores, and reduced BMI in AF patients. |
20,250 | Denervated Myocardium Is Preferentially Associated With Sudden Cardiac Arrest in Ischemic Cardiomyopathy: A Pilot Competing Risks Analysis of Cause-Specific Mortality. | Previous studies have identified multiple risk factors that are associated with total cardiac mortality. Nevertheless, identifying specific factors that distinguish patients at risk of arrhythmic death versus heart failure could better target patients likely to benefit from implantable cardiac defibrillators, which have no impact on nonsudden cardiac death.</AbstractText>We performed a pilot competing risks analysis of the National Institutes of Health-sponsored PAREPET trial (Prediction of Arrhythmic Events with Positron Emission Tomography). Death from cardiac causes was ascertained in subjects with ischemic cardiomyopathy (n=204) eligible for an implantable cardiac defibrillator for the primary prevention of sudden cardiac arrest after baseline clinical evaluation and imaging at enrollment (positron emission tomography and 2-dimensional echo). Mean age was 67±11 years with an ejection fraction of 27±9%, and 90% were men. During 4.1 years of follow-up, there were 33 sudden cardiac arrests (arrhythmic death or implantable cardiac defibrillator discharge for ventricular fibrillation or ventricular tachycardia >240 bpm) and 36 nonsudden cardiac deaths. Sudden cardiac arrest was correlated with a greater volume of denervated myocardium (defect of the positron emission tomography norepinephrine analog 11</sup>C-hydroxyephedrine), lack of angiotensin inhibition therapy, elevated B-type natriuretic peptide, and larger left ventricular end-diastolic volume index. In contrast, nonsudden cardiac death was associated with a higher resting heart rate, older age, elevated creatinine, larger left atrial volume index, and larger left ventricular end-diastolic volume index.</AbstractText>Distinct clinical, laboratory, and imaging variables are associated with cause-specific cardiac mortality in primary-prevention candidates with ischemic cardiomyopathy. If prospectively validated, these multivariable associations may help target specific therapies to those at the greatest risk of sudden and nonsudden cardiac death.</AbstractText>URL: https://clinicaltrials.gov. Unique identifier: NCT01400334.</AbstractText>© 2017 American Heart Association, Inc.</CopyrightInformation> |
20,251 | Mechanically Induced Ectopy via Stretch-Activated Cation-Nonselective Channels Is Caused by Local Tissue Deformation and Results in Ventricular Fibrillation if Triggered on the Repolarization Wave Edge (Commotio Cordis). | External chest impacts (commotio cordis) can cause mechanically induced premature ventricular excitation (PVEM</sub>) and, rarely, ventricular fibrillation (VF). Because block of stretch-sensitive ATP-inactivated potassium channels curtailed VF occurrence in a porcine model of commotio cordis, VF has been suggested to arise from abnormal repolarization caused by stretch activation of potassium channels. Alternatively, VF could result from abnormal excitation by PVEM</sub>, overlapping with normal repolarization-related electric heterogeneity. Here, we investigate mechanisms and determinants of PVEM</sub> induction and its potential role in commotio cordis-induced VF.</AbstractText>Subcontusional mechanical stimuli were applied to isolated rabbit hearts during optical voltage mapping, combined with pharmacological block of ATP-inactivated potassium or stretch-activated cation-nonselective channels. We demonstrate that local mechanical stimulation reliably triggers PVEM</sub> at the contact site, with inducibility predicted by local tissue indentation. PVEM</sub> induction is diminished by pharmacological block of stretch-activated cation-nonselective channels. In hearts where electrocardiogram T waves involve a well-defined repolarization edge traversing the epicardium, PVEM</sub> can reliably provoke VF if, and only if, the mechanical stimulation site overlaps the repolarization wave edge. In contrast, application of short-lived intraventricular pressure surges neither triggers PVEM</sub> nor changes repolarization. ATP-inactivated potassium channel block has no effect on PVEM</sub> inducibility per se, but shifts it to later time points by delaying repolarization and prolonging refractoriness.</AbstractText>Local mechanical tissue deformation determines PVEM</sub> induction via stretch-activation of cation-nonselective channels, with VF induction requiring PVEM</sub> overlap with the trailing edge of a normal repolarization wave. This defines a narrow, subject-specific vulnerable window for commotio cordis-induced VF that exists both in time and in space.</AbstractText>© 2017 The Authors.</CopyrightInformation> |
20,252 | Cardiovascular Event Prediction by Machine Learning: The Multi-Ethnic Study of Atherosclerosis. | Machine learning may be useful to characterize cardiovascular risk, predict outcomes, and identify biomarkers in population studies.</AbstractText>To test the ability of random survival forests, a machine learning technique, to predict 6 cardiovascular outcomes in comparison to standard cardiovascular risk scores.</AbstractText>We included participants from the MESA (Multi-Ethnic Study of Atherosclerosis). Baseline measurements were used to predict cardiovascular outcomes over 12 years of follow-up. MESA was designed to study progression of subclinical disease to cardiovascular events where participants were initially free of cardiovascular disease. All 6814 participants from MESA, aged 45 to 84 years, from 4 ethnicities, and 6 centers across the United States were included. Seven-hundred thirty-five variables from imaging and noninvasive tests, questionnaires, and biomarker panels were obtained. We used the random survival forests technique to identify the top-20 predictors of each outcome. Imaging, electrocardiography, and serum biomarkers featured heavily on the top-20 lists as opposed to traditional cardiovascular risk factors. Age was the most important predictor for all-cause mortality. Fasting glucose levels and carotid ultrasonography measures were important predictors of stroke. Coronary Artery Calcium score was the most important predictor of coronary heart disease and all atherosclerotic cardiovascular disease combined outcomes. Left ventricular structure and function and cardiac troponin-T were among the top predictors for incident heart failure. Creatinine, age, and ankle-brachial index were among the top predictors of atrial fibrillation. TNF-α (tissue necrosis factor-α) and IL (interleukin)-2 soluble receptors and NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) levels were important across all outcomes. The random survival forests technique performed better than established risk scores with increased prediction accuracy (decreased Brier score by 10%-25%).</AbstractText>Machine learning in conjunction with deep phenotyping improves prediction accuracy in cardiovascular event prediction in an initially asymptomatic population. These methods may lead to greater insights on subclinical disease markers without apriori assumptions of causality.</AbstractText>URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005487.</AbstractText>© 2017 American Heart Association, Inc.</CopyrightInformation> |
20,253 | <i>Lamin A/C</i>-Related Cardiac Disease: Late Onset With a Variable and Mild Phenotype in a Large Cohort of Patients With the Lamin A/C p.(Arg331Gln) Founder Mutation. | Interpretation of missense variants can be especially difficult when the variant is also found in control populations. This is what we encountered for the LMNA</i> c.992G>A (p.(Arg331Gln)) variant. Therefore, to evaluate the effect of this variant, we combined an evaluation of clinical data with functional experiments and morphological studies.</AbstractText>Clinical data of 23 probands and 35 family members carrying this variant were retrospectively collected. A time-to-event analysis was performed to compare the course of the disease with carriers of other LMNA</i> mutations. Myocardial biopsies were studied with electron microscopy and by measuring force development of the sarcomeres. Morphology of the nuclear envelope was assessed with immunofluorescence on cultured fibroblasts. The phenotype in probands and family members was characterized by atrioventricular conduction disturbances (61% and 44%, respectively), supraventricular arrhythmias (69% and 52%, respectively), and dilated cardiomyopathy (74% and 14%, respectively). LMNA p.(Arg331Gln) carriers had a significantly better outcome regarding the composite end point (malignant ventricular arrhythmias, end-stage heart failure, or death) compared with carriers of other pathogenic LMNA</i> mutations. A shared haplotype of 1 Mb around LMNA</i> suggested a common founder. The combined logarithm of the odds score was 3.46. Force development in membrane-permeabilized cardiomyocytes was reduced because of decreased myofibril density. Structural nuclear LMNA</i>-associated envelope abnormalities, that is, blebs, were confirmed by electron microscopy and immunofluorescence microscopy.</AbstractText>Clinical, morphological, functional, haplotype, and segregation data all indicate that LMNA p.(Arg331Gln) is a pathogenic founder mutation with a phenotype reminiscent of other LMNA</i> mutations but with a more benign course.</AbstractText>© 2017 American Heart Association, Inc.</CopyrightInformation> |
20,254 | Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass: The LICORN Randomized Clinical Trial. | Low cardiac output syndrome after cardiac surgery is associated with high morbidity and mortality in patients with impaired left ventricular function.</AbstractText>To assess the ability of preoperative levosimendan to prevent postoperative low cardiac output syndrome.</AbstractText><AbstractText Label="DESIGN, SETTING, AND PARTICIPANTS">Randomized, double-blind, placebo-controlled trial conducted in 13 French cardiac surgical centers. Patients with a left ventricular ejection fraction less than or equal to 40% and scheduled for isolated or combined coronary artery bypass grafting with cardiopulmonary bypass were enrolled from June 2013 until May 2015 and followed during 6 months (last follow-up, November 30, 2015).</AbstractText>Patients were assigned to a 24-hour infusion of levosimendan 0.1 µg/kg/min (n = 167) or placebo (n = 168) initiated after anesthetic induction.</AbstractText>Composite end point reflecting low cardiac output syndrome with need for a catecholamine infusion 48 hours after study drug initiation, need for a left ventricular mechanical assist device or failure to wean from it at 96 hours after study drug initiation when the device was inserted preoperatively, or need for renal replacement therapy at any time postoperatively. It was hypothesized that levosimendan would reduce the incidence of this composite end point by 15% in comparison with placebo.</AbstractText>Among 336 randomized patients (mean age, 68 years; 16% women), 333 completed the trial. The primary end point occurred in 87 patients (52%) in the levosimendan group and 101 patients (61%) in the placebo group (absolute risk difference taking into account center effect, -7% [95% CI, -17% to 3%]; P = .15). Predefined subgroup analyses found no interaction with ejection fraction less than 30%, type of surgery, and preoperative use of β-blockers, intra-aortic balloon pump, or catecholamines. The prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%), and other adverse events did not significantly differ between levosimendan and placebo.</AbstractText>Among patients with low ejection fraction who were undergoing coronary artery bypass grafting with cardiopulmonary bypass, levosimendan compared with placebo did not result in a significant difference in the composite end point of prolonged catecholamine infusion, use of left ventricular mechanical assist device, or renal replacement therapy. These findings do not support the use of levosimendan for this indication.</AbstractText>EudraCT Number: 2012-000232-25; clinicaltrials.gov Identifier: NCT02184819.</AbstractText> |
20,255 | Neurohormonal Blockade in Heart Failure. | A key feature of chronic heart failure (HF) is the sustained activation of endogenous neurohormonal systems in response to impaired cardiac pumping and/or filling properties. The clinical use of neurohormonal blockers has revolutionised the care of HF patients over the past three decades. Drug therapy that is active against imbalance in both the autonomic and renin-angiotensin-aldosterone systems consistently reduces morbidity and mortality in chronic HF with reduced left ventricular ejection fraction and in sinus rhythm. This article provides an assessment of the major neurohormonal systems and their therapeutic blockade in patients with chronic HF. |
20,256 | Reduced dose apixaban resolving dual cardiac chamber thrombi in a patient with ischaemic cardiomyopathy in sinus rhythm. | Left atrial (LA) thrombus is a known sequela of atrial fibrillation (AF) but it is less frequently encountered in patients in sinus rhythm. Left ventricular (LV) dysfunction may predispose patients without evidence of atrial tachyarrhythmias to atrial thrombosis. Warfarin is the standard treatment for cardiac chamber thrombosis and prevention of the associated thromboembolic complications. Despite that apixaban was found to be superior to warfarin in prevention of stroke and systemic embolism in patients with AF, evidence for its use in treatment of cardiac chamber thrombi is scarce and is limited to case reports. We report a case of simultaneously occurring LV and LA thrombi successfully treated with reduced dose apixaban in a patient with ischaemic cardiomyopathy and in sinus rhythm. Although apixaban maybe a potential effective treatment for intracardiac thrombi, further studies are needed to demonstrate efficacy and safety of this agent in larger patient populations. |
20,257 | Treatment of calmodulinopathy with verapamil. | Pathological variants in genes encoding calmodulin are associated with severe clinical presentations, including recurrent ventricular fibrillation and sudden death. Beta-receptor antagonists (beta-blockers) and sodium-channel antagonists have been reported as pharmacotherapies in these disorders; however, recent data have demonstrated the importance of derangements in calcium channel inactivation. We report a sustained attempt to use calcium-channel antagonists to treat calmodulinopathy and review the treatment strategies reported in the literature to date. |
20,258 | Reliability of pulse palpation in the detection of atrial fibrillation in an elderly population. | Atrial fibrillation (AF) may first present as an ischemic stroke. Pulse palpation is a potential screening method for asymptomatic AF. We aimed to assess the reliability of pulse palpation by the elderly in detecting AF.</AbstractText>After brief information and training session conducted by a nurse, 173 subjects aged ≥75 years were instructed to palpate their pulse regularly for a month. After this, their ability to distinguish sinus rhythm (SR), SR with premature ventricular contractions (PVC) and AF by pulse palpation was assessed using an anatomic human arm model programmable with various rhythms. A control group of 57 healthcare professionals received the same information but not the training. Subjects unable to find the pulse were excluded (25 (14.5%) of the elderly and none in the healthcare group).</AbstractText>The median age of the elderly subjects was 78.4 [3.9] years and 98 (56.6%) were women. There were no differences between the elderly and healthcare groups in detecting SR (97.3% vs. 96.5%) or SR with PVCs (74.3% vs. 71.4%), but the elderly subjects identified slow (81.8% vs. 56.1%) and fast AF (91.9% vs. 80.7%) significantly better than the healthcare group. The ability to recognize SR with PVCs by the elderly was independently predicted by previous pulse palpation experience, secondary or higher level of education and one-point increase in MMSE score, while identifying the other rhythms had no predictors.</AbstractText>The elderly can learn to reliably distinguish a normal rhythm after education. Pulse self-palpation may be a useful low-cost method to screen for asymptomatic AF.</AbstractText> |
20,259 | Heritability in a SCN5A-mutation founder population with increased female susceptibility to non-nocturnal ventricular tachyarrhythmia and sudden cardiac death. | Heritable cardiac-sodium channel dysfunction is associated with various arrhythmia syndromes, some predisposing to ventricular fibrillation. Phenotypic diversity among carriers of identical-by-descent mutations is often remarkable, suggesting influences of genetic modifiers.</AbstractText>The purpose of this study was to identify a unique SCN5A-mutation founder population with mixed clinical phenotypes and sudden cardiac death, and to investigate the heritability of electromechanical traits besides the SCN5A-mutation effect.</AbstractText>The 16-generation founder population segregating SCN5A c.4850_4852delTCT, p.(Phe1617del), was comprehensively phenotyped. Variance component analysis was used to evaluate the mutation's effects and assess heritability.</AbstractText>In 45 p.(Phe1617del) positives, the mutation associated strongly with QTc prolongation (472 ± 60 ms vs 423 ± 35 ms in 26 mutation negatives; P <.001; odds ratio for long-QT syndrome 22.4; 95% confidence interval 4.5-224.2; P <.001) and electromechanical window (EMW) negativity (-29 ± 47 ms vs 34 ± 26 ms; P <.001). Overlapping phenotypes including conduction delay and Brugada syndrome were noted in 19. Polymorphic ventricular tachyarrhythmias occurred mostly in the daytime, after arousal-evoked heart-rate acceleration and repolarization prolongation. Cox proportional hazards regression analysis revealed female gender as an independent risk factor for cardiac events (hazard ratio 5.1; 95% confidence interval 1.6-16.3; P = .006). p.(Phe1617del) was an important determinant of QTcbaseline</sub>, QTcmax</sub>, and EMW, explaining 18%, 28%, and 37%, respectively, of the trait's variance. Significant heritability was observed for PQ interval (P = .003) after accounting for the p.(Phe1617del) effect.</AbstractText>This SCN5A-p.(Phe1617del) founder population with phenotypic divergence and overlap reveals long-QT syndrome-related and arousal-evoked ventricular tachyarrhythmias with a female preponderance. Variance component analysis indicates additional genetic variance for PQ interval hidden in the genome, besides a dominant p.(Phe1617del) effect on QTc and EMW.</AbstractText>Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
20,260 | The anti-influenza drug oseltamivir reduces atrial fibrillation in an experimental whole-heart model. | Recent experimental studies suggested direct effects of the anti-influenza drug oseltamivir on cardiac electrophysiology. We therefore aimed at analyzing potential antiarrhythmic effects of oseltamivir on atrial fibrillation (AF) in an experimental whole-heart model. Twelve rabbit hearts were isolated and Langendorff perfused. Thereafter, hearts were paced at cycle lengths of 350, 250, and 200 ms in the atrium. A standardized protocol employing atrial burst pacing induced AF in 4 of 12 hearts under baseline conditions (33%, 11 episodes). Subsequently, a combination of acetylcholine (1 μM) and isoproterenol (1 μM) was administered to increase AF occurrence. Two monophasic action potential recordings on the left and two on the right atrial epicardium displayed a decrease of atrial action potential duration (aAPD, -38 ms, p < 0.01) and atrial effective refractory period (aERP; -20 ms, p < 0.05). Under the influence of acetylcholine/isoproterenol AF was inducible in 8 of 12 hearts (66%; 69 episodes). Additional infusion of oseltamivir (100 μM) resulted in a significant increase of both aAPD (+ 29 ms, p < 0.05) and aERP (+ 40 ms, p < 0.01) leading to an increase of atrial post-repolarization refractoriness (aPRR). Under the influence of oseltamivir only 3 of 12 hearts (25%, 8 episodes) remained inducible. In six additional hearts oseltamivir (50 μM and 100 μM) did not significantly alter ventricular APD, QRS duration and QT interval but induced a significant increase of ventricular ERP. In the present experimental study, acute infusion of the anti-influenza drug oseltamivir reduced atrial fibrillation. The antiarrhythmic effect can be explained by a significant increase in aERP and aPRR. These results suggest an antiarrhythmic potential of oseltamivir in atrial arrhythmias. |
20,261 | Impact of electrical defibrillation on infarct size and no-reflow in pigs subjected to myocardial ischemia-reperfusion without and with ischemic conditioning. | Ventricular fibrillation (VF) occurs frequently during myocardial ischemia-reperfusion (I/R) and must then be terminated by electrical defibrillation. We have investigated the impact of VF/defibrillation on infarct size (IS) or area of no reflow (NR) without and with ischemic conditioning interventions. Anesthetized pigs were subjected to 60/180 min of coronary occlusion/reperfusion. VF, as identified from the ECG, was terminated by intrathoracic defibrillation. The area at risk (AAR), IS, and NR were determined by staining techniques (patent blue, triphenyltetrazolium chloride, and thioflavin-S). Four experimental protocols were analyzed: I/R (<i>n</i> = 49), I/R with ischemic preconditioning (IPC; <i>n</i> = 22), I/R with ischemic postconditioning (POCO; <i>n</i> = 22), or I/R with remote IPC (RIPC; <i>n</i> = 34). The incidence of VF was not different between I/R (44%), IPC (45%), POCO (50%), and RIPC (33%). IS was reduced by IPC (23 ± 12% of AAR), POCO (31 ± 16%), and RIPC (22 ± 13%, all <i>P</i> < 0.05 vs. I/R: 41 ± 12%). NR was not different between protocols (I/R: 17 ± 15% of AAR, IPC: 15 ± 18%, POCO: 25 ± 16%, and RIPC: 18 ± 17%). In pigs with defibrillation, IS was 50% larger than in pigs without defibrillation but independent of the number of defibrillations. Analysis of covariance confirmed the established determinants of IS, i.e., AAR, residual blood flow during ischemia (RMBFi), and a conditioning protocol, and revealed VF/defibrillation as a novel covariate. VF/defibrillation in turn was associated with larger AAR and lower RMBFi. Lack of dose-response relation between IS and the number of defibrillations excluded direct electrical injury as the cause of increased IS. Obviously, AAR size and RMBFi account for both IS and the incidence of VF. IS and NR are mechanistically distinct phenomena.<b>NEW & NOTEWORTHY</b> Ventricular fibrillation/defibrillation is associated with increased infarct size. Electrical injury is unlikely the cause of such association, since there is no dose-response relation between infarct size and number of defibrillations. Ventricular fibrillation, in turn, is associated with a larger area at risk and lower residual blood flow. |
20,262 | Double right coronary artery and its clinical significance: Review of the literature. | Double right coronary artery is a very rare anomaly that is usually discovered incidentally during conventional coronary angiography. Double right coronary artery may have clinical implications in symptomatic patients requiring percutaneous coronary intervention and may be associated with other congenital abnormalities, myocardial ischemia and ventricular fibrillation in the absence of atherosclerosis. Here the reported cases in the literature are reviewed and a case of double right coronary artery with ischemia in inferior left ventricular wall is presented. |
20,263 | Sufentanil-medetomidine anaesthesia compared with fentanyl/fluanisone-midazolam is associated with fewer ventricular arrhythmias and death during experimental myocardial infarction in rats and limits infarct size following reperfusion. | To improve infarct healing following myocardial infarction in humans, therapeutic interventions can be applied during the inflammatory response. Animal models are widely used to study this process. However, induction of MI in rodents is associated with high mortality due to ventricular fibrillation (VF) during coronary artery ligation. The anaesthetic agent used during the procedure appears to influence the frequency of this complication. In this retrospective study, the effect on ventricular arrhythmia incidence during ligation and infarct size following in vivo reperfusion of two anaesthetic regimens, sufentanil-medetomidine (SM) and fentanyl/fluanisone-midazolam (FFM) was evaluated in rats. Anaesthetics were administered subcutaneously using fentanyl/fluanisone (0.5 mL/kg) with midazolam (5 mg/kg) (FFM group, n = 48) or sufentanil (0.05 mg/kg) with medetomidine (0.15 mg/kg) (SM group, n = 47). The coronary artery was ligated for 40 min to induce MI. Heart rate and ventricular arrhythmias were recorded during ligation, and infarct size was measured via histochemistry after three days of reperfusion. In the SM group, heart rate and VF incidence were lower throughout the experiment compared with the FFM group (6% versus 30%) ( P < 0.01). Fatal VF did not occur in the SM group whereas this occurred in 25% of the animals in the FFM group. Additionally, after three days of reperfusion, the infarcted area following SM anaesthesia was less than half as large as that following FFM anaesthesia (8.5 ± 6.4% versus 20.7 ± 5.6%) ( P < 0.01). Therefore, to minimize the possibility of complications related to VF and acute death arising during ligation, SM anaesthesia is recommended for experimental MI in rats.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ter Horst</LastName><ForeName>Ellis N</ForeName><Initials>EN</Initials><AffiliationInfo><Affiliation>1 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>2 Netherlands Heart Institute, Utrecht, The Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>3 Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>4 Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Krijnen</LastName><ForeName>Paul A J</ForeName><Initials>PAJ</Initials><AffiliationInfo><Affiliation>3 Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>4 Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Flecknell</LastName><ForeName>Paul</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>5 Comparative Biology Centre, Newcastle University, Newcastle upon Tyne, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meyer</LastName><ForeName>Klaas W</ForeName><Initials>KW</Initials><AffiliationInfo><Affiliation>6 Amsterdam Animal Research Centre, VU University, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kramer</LastName><ForeName>Klaas</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>6 Amsterdam Animal Research Centre, VU University, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>van der Laan</LastName><ForeName>Anja M</ForeName><Initials>AM</Initials><AffiliationInfo><Affiliation>1 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Piek</LastName><ForeName>Jan J</ForeName><Initials>JJ</Initials><AffiliationInfo><Affiliation>1 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Niessen</LastName><ForeName>Hans W M</ForeName><Initials>HWM</Initials><AffiliationInfo><Affiliation>3 Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>4 Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>7 Department of Cardiac Surgery, VU University, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>08</Month><Day>04</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Lab Anim</MedlineTA><NlmUniqueID>0112725</NlmUniqueID><ISSNLinking>0023-6772</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D019162">Anesthetics, Combined</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D002090">Butyrophenones</NameOfSubstance></Chemical><Chemical><RegistryNumber>1D0W98U1I4</RegistryNumber><NameOfSubstance UI="C005014">fluanisone</NameOfSubstance></Chemical><Chemical><RegistryNumber>AFE2YW0IIZ</RegistryNumber><NameOfSubstance UI="D017409">Sufentanil</NameOfSubstance></Chemical><Chemical><RegistryNumber>MR15E85MQM</RegistryNumber><NameOfSubstance UI="D020926">Medetomidine</NameOfSubstance></Chemical><Chemical><RegistryNumber>R60L0SM5BC</RegistryNumber><NameOfSubstance UI="D008874">Midazolam</NameOfSubstance></Chemical><Chemical><RegistryNumber>UF599785JZ</RegistryNumber><NameOfSubstance UI="D005283">Fentanyl</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D019162" MajorTopicYN="N">Anesthetics, Combined</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000818" MajorTopicYN="N">Animals</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002090" MajorTopicYN="N">Butyrophenones</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005283" MajorTopicYN="N">Fentanyl</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020926" MajorTopicYN="N">Medetomidine</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008874" MajorTopicYN="N">Midazolam</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009203" MajorTopicYN="N">Myocardial Infarction</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D051381" MajorTopicYN="N">Rats</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017208" MajorTopicYN="N">Rats, Wistar</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017409" MajorTopicYN="N">Sufentanil</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="fre">Les interventions thérapeutiques au cours de la réponse inflammatoire après un infarctus du myocarde (IM) visent à améliorer la guérison des patients. Les modèles animaux sont largement utilisés pour étudier ce processus. Cependant, l'induction d'IM chez les rongeurs est associée à une mortalité élevée due à la fibrillation ventriculaire (FV) au cours de la ligature de l'artère coronaire. L'agent anesthésique utilisé pendant la procédure semble influer sur la fréquence de cette complication. L'étude rétrospective actuelle évalue l'effet sur l'incidence des arythmies ventriculaires au cours de la ligature et l'étendue de l'infarctus après reperfusion in vivo de deux régimes d'anesthésie, le sufentanil-médétomidine (SM) et le fentanyl/fluanisone-midazolam (FFM) chez le rat. Les anesthésiques ont été administrés par voie sous-cutanée en associant du fentanyl/fluanisone (0.5 ml/kg) au midazolam (5 mg/kg) (Group FFM, <i>n</i> = 48) ou du sufentanil (0.05 mg/kg) à de la médétomidine (0.15 mg/kg), (groupe SM <i>n</i> = 47). L'artère coronaire a été ligaturée pendant 40 minutes pour induire l'IM. La fréquence cardiaque et les arythmies ventriculaires ont été enregistrées au cours de la ligature et l'étendue de l'infarctus a été mesurée via une histochimie après trois jours de reperfusion. Dans le groupe SM, la fréquence cardiaque et l'incidence de FV étaient plus faibles tout au long de l'expérience par rapport au groupe FFM (6% contre 30%) (<i>P</i> < 0,01). Aucune FV mortelle ne s'est produite dans le groupe SM alors qu'elle s'est produite chez 25% des animaux du groupe FFM. En outre, après trois jours de reperfusion, la zone de l'infarctus suivant une anesthésie SM était au moins à moitié plus petite qu'après une anesthésie FFM (8.5 ± 6.4 % et 20.7 ± 5.6 %) (<i>P</i> < 0.01). Par conséquent, afin de minimiser le risque de complications liées à la FV et les décès aigus survenant au cours de la ligature, l'anesthésie SM est recommandée pour étudier l'IM chez le rat.</OtherAbstract><OtherAbstract Type="Publisher" Language="ger">Therapeutische Eingriffe während der entzündlichen Reaktion auf Myokardinfarkt (MI) beim Menschen bezwecken eine bessere Infarktheilung. Tiermodelle werden zur Untersuchung dieses Prozesses häufig verwendet. Allerdings ist die Induzierung von MI bei Nagern mit einer hohen Sterblichkeit aufgrund von Kammernflimmern (VF) während der Ligatur der Koronararterie verbunden. Das für den Eingriff verwendete Narkosemittel scheint Einfluss auf die Häufigkeit dieser Komplikation zu haben. In der vorliegenden retrospektiven Studie wurde die Auswirkung von in-Vivo-Reperfusion zweier Anästhetikagaben, Sufentanil-Medetomidin (SM) und Fentanyl/Fluanison-Midazolam (FFM), auf das Auftreten ventrikulärer Arrhythmie während der Ligatur und auf die Infarktgröße bei Ratten untersucht. Es erfolgte subkutane Anästhesie-Verabreichung von Fentanyl/Fluanison (0.5 ml/kg) mit Midazolam (5 mg/kg) (FFM-Gruppe, <i>n</i> = 48) oder Sufentanil (0.05 mg/kg) mit Medetomidin (0.15 mg/kg) (SM-Gruppe, <i>n</i> = 47). Die Koronararterie wurde 40 Minuten lang zwecks Induzierung von MI ligiert. Herzfrequenz und ventrikuläre Arrhythmien wurden während der Ligatur erfasst, und die Infarktgröße wurde mittels Gewebechemie nach drei Tagen Reperfusion gemessen. Bei der SM-Gruppe waren Herzfrequenz und Auftreten von VF während des gesamten Versuchs geringer als bei der FFM-Gruppe (6% versus 30%) (<i>P</i> < 0.01). Tödliche VF trat in der SM-Gruppe nicht auf, während dies bei 25 % der Tiere in der FFM-Gruppe der Fall war. Zudem war drei Tage nach Reperfusion der infarzierte Bereich nach SM-Narkose weniger als halb so groß als nach FFM-Narkose (8.5 ± 6.4 % versus 20.7 ± 5.6 %) (<i>P</i> < 0.01). Beim experimentellen MI bei Ratten empfiehlt sich daher der Einsatz von SM-Anästhesie, um die Möglichkeit von Komplikationen im Zusammenhang mit VF und plötzlichem Tod während der Ligatur zu minimieren.</OtherAbstract><OtherAbstract Type="Publisher" Language="spa">Las intervenciones terapéuticas durante la respuesta inflamatoria tras un infarto miocardio (IM) en personas trata de mejorar la recuperación del infarto. Para estudiar este proceso se utilizan muchos modelos de animales. No obstante, la inducción de IM en roedores se asocia a un alto número de mortalidad debido a una fibrilación ventricular (FV) durante la ligadura de la arteria coronaria. El agente anestésico utilizado durante el procedimiento parece influir en la frecuencia de esta complicación. En el actual estudio retrospectivo, se evaluó utilizando ratas el efecto en la incidencia de arritmias ventriculares durante la ligadura y el tamaño del infarto después de una reperfusión en vivo de dos regímenes anestésicos, sufentanil-medetomidina (SM) y fentanil/fluanisona-midazolam (FFM). Se administraron anestésicos de forma subcutánea utilizando fentanil/fluanisona (0.5 ml/kg) con midazolam (5 mg/kg) (grupo FFM, <i>n</i> = 48) o sufentanil (0.05 mg/kg) con medetomidina (0.15 mg/kg) (grupo SM, <i>n</i> = 47). La arteria coronaria fue ligada durante 40 minutos para inducir la IM. Se registraron el ritmo cardíaco y arritmias ventriculares durante la ligadura y el tamaño de infarto fue medido mediante histoquímica después de tres días de reperfusión. En el grupo SM, el ritmo cardíaco y la incidencia FV fue inferior durante todo el experimento en comparación al grupo FFM (6% frente a 30%) (<i>P</i> < 0.01). En el grupo SM no hubo ninguna fatalidad de FV mientras que sí que la hubo en el 25% de los animales del grupo FFM. Asimismo, después de tres días de reperfusión, el área del infarto después de la anestesia SM era menos de la mitad de grande que con la anestesia FFM (8.5 ± 6.4% frente a 20.7 ± 5.6%) (<i>P</i> < 0.01). Por tanto, para minimizar la posibilidad de complicaciones relacionadas con FV y muerte aguda durante la ligadura, se recomienda la anestesia SM para IM experimental en ratas. |
20,264 | Outcomes of patients with periprocedural atrial fibrillation undergoing percutaneous coronary intervention for chronic total occlusion. | Successful CTO recanalization has been associated with clinical benefit. Outcomes of patients with atrial fibrillation undergoing CTO PCI have not been investigated, yet.</AbstractText>This study sought to evaluate the association between atrial fibrillation and outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).</AbstractText>Consecutive patients undergoing CTO PCI between January 2005 and December 2013 were divided into patients with and without atrial fibrillation, and propensity-matched models used to adjust for baseline differences between groups. The primary outcome was all-cause mortality at a median follow-up of 3.2 (interquartile range 3.1-4.5) years.</AbstractText>Of 2002 patients undergoing CTO PCI, atrial fibrillation was present in 169 (8.4%) patients. Patients with atrial fibrillation were older, and more frequently had hypertension, left ventricular systolic dysfunction, and chronic kidney disease. Before matching, all-cause mortality was 39.6 and 14.5% in the atrial fibrillation and the sinus rhythm groups (HR 2.92, 95% CI 2.23-3.82, p < 0.001). In the propensity-matched model, atrial fibrillation remained associated with an increased risk of mortality (HR 1.62, 95% CI 1.06-2.47, p = 0.03). In the unmatched patient cohort, all-cause mortality was significantly reduced in patients with procedural success, both in the atrial fibrillation (34.9 versus 55.0%, adjusted HR 0.99, 95% CI 0.97-1.00, p = 0.02) and the sinus rhythm groups (12.8 versus 23.0%, adjusted HR 0.70, 95% CI 0.53-0.92, p = 0.01).</AbstractText>Although atrial fibrillation is independently associated with mortality after CTO PCI, substantial survival benefit of successful CTO recanalization is observed in both patients with and without atrial fibrillation.</AbstractText> |
20,265 | Risk Factors and Prediction of Stroke in a Population with High Prevalence of Diabetes: The Strong Heart Study. | American Indians have a high prevalence of diabetes and higher incidence of stroke than that of whites and blacks in the U.S. Stroke risk prediction models based on data from American Indians would be of clinical and public health value.</AbstractText>A total of 3483 (2043 women) Strong Heart Study participants free of stroke at baseline were followed from 1989 to 2010 for incident stroke. Overall, 297 stroke cases (179 women) were identified. Cox models with stroke-free time and risk factors recorded at baseline were used to develop stroke risk prediction models. Assessment of the developed stroke risk prediction models regarding discrimination and calibration was performed by an analogous C-statistic (C) and a version of the Hosmer-Lemeshow statistic (HL), respectively, and validated internally through use of Bootstrapping methods.</AbstractText>Age, smoking status, alcohol consumption, waist circumference, hypertension status, an-tihypertensive therapy, fasting plasma glucose, diabetes medications, high/low density lipoproteins, urinary albumin/creatinine ratio, history of coronary heart disease/heart failure, atrial fibrillation, or Left ventricular hypertrophy, and parental history of stroke were identified as the significant optimal risk factors for incident stroke.</AbstractText>The models produced a C = 0.761 and HL = 4.668 (p = 0.792) for women, and a C = 0.765 and HL = 9.171 (p = 0.328) for men, showing good discrimination and calibration.</AbstractText>Our stroke risk prediction models provide a mechanism for stroke risk assessment designed for American Indians. The models may be also useful to other populations with high prevalence of obesity and/or diabetes for screening individuals for risk of incident stroke and designing prevention programs.</AbstractText> |
20,266 | Frequency of exercise-induced ST-T-segment deviations and cardiac arrhythmias in recreational endurance athletes during a marathon race: results of the prospective observational Berlin Beat of Running study. | While regular physical exercise has many health benefits, strenuous physical exercise may have a negative impact on cardiac function. The 'Berlin Beat of Running' study focused on feasibility and diagnostic value of continuous ECG monitoring in recreational endurance athletes during a marathon race. We hypothesised that cardiac arrhythmias and especially atrial fibrillation are frequently found in a cohort of recreational endurance athletes. The main secondary hypothesis was that pathological laboratory findings in these athletes are (in part) associated with cardiac arrhythmias.</AbstractText>Prospective observational cohort study including healthy volunteers.</AbstractText>One hundred and nine experienced marathon runners wore a portable ECG recorder during a marathon race in Berlin, Germany. Athletes underwent blood tests 2-3 days prior, directly after and 1-2 days after the race.</AbstractText>Overall, 108 athletes (median 48 years (IQR 45-53), 24% women) completed the marathon in 249±43 min. Blinded ECG analysis revealed abnormal findings during the marathon in 18 (16.8%) athletes. Ten (9.3%) athletes had at least one episode of non-sustained ventricular tachycardia, one of whom had atrial fibrillation; eight (7.5%) individuals showed transient ST-T-segment deviations. Abnormal ECG findings were associated with advanced age (OR 1.11 per year, 95% CI 1.01 to 1.23), while sex and cardiovascular risk profile had no impact. Directly after the race, high-sensitive troponin T was elevated in 18 (16.7%) athletes and associated with ST-T-segment deviation (OR 9.9, 95% CI 1.9 to 51.5), while age, sex and cardiovascular risk profile had no impact.</AbstractText>ECG monitoring during a marathon is feasible. Abnormal ECG findings were present in every sixth athlete. Exercise-induced transient ST-T-segment deviations were associated with elevated high-sensitive troponin T (hsTnT) values.</AbstractText>ClinicalTrials.gov NCT01428778; Results.</AbstractText>© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</CopyrightInformation> |
20,267 | Ectopy on a Single 12-Lead ECG, Incident Cardiac Myopathy, and Death in the Community. | Atrial fibrillation and heart failure are 2 of the most common diseases, yet ready means to identify individuals at risk are lacking. The 12-lead ECG is one of the most accessible tests in medicine. Our objective was to determine whether a premature atrial contraction observed on a standard 12-lead ECG would predict atrial fibrillation and mortality and whether a premature ventricular contraction would predict heart failure and mortality.</AbstractText>We utilized the CHS (Cardiovascular Health) Study, which followed 5577 participants for a median of 12 years, as the primary cohort. The ARIC (Atherosclerosis Risk in Communities Study), the replication cohort, captured data from 15 792 participants over a median of 22 years. In the CHS, multivariable analyses revealed that a baseline 12-lead ECG premature atrial contraction predicted a 60% increased risk of atrial fibrillation (hazard ratio, 1.6; 95% CI, 1.3-2.0; P</i><0.001) and a premature ventricular contraction predicted a 30% increased risk of heart failure (hazard ratio, 1.3; 95% CI, 1.0-1.6; P</i>=0.021). In the negative control analyses, neither predicted incident myocardial infarction. A premature atrial contraction was associated with a 30% increased risk of death (hazard ratio, 1.3; 95% CI, 1.1-1.5; P</i>=0.008) and a premature ventricular contraction was associated with a 20% increased risk of death (hazard ratio, 1.2; 95% CI, 1.0-1.3; P</i>=0.044). Similarly statistically significant results for each analysis were also observed in ARIC.</AbstractText>Based on a single standard ECG, a premature atrial contraction predicted incident atrial fibrillation and death and a premature ventricular contraction predicted incident heart failure and death, suggesting that this commonly used test may predict future disease.</AbstractText>© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.</CopyrightInformation> |
20,268 | Frontal plane T-wave axis orientation predicts coronary events: Findings from the Moli-sani study. | The orientation of the frontal plane T-wave axis (T axis) is a reliable measure of ventricular repolarisation. We investigated the association between T-axis and the risk of coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), stroke and cardiovascular (CVD) mortality.</AbstractText>A sample of 21,287 Moli-sani participants randomly recruited from the general adult (≥35 y) Italian population, free of CVD disease, were followed for a median of 4.4 years. T-axis was measured from a standard 12-lead resting ECG.</AbstractText>After adjusting for CVD risk factors, subjects with abnormal T-axis showed an increase in the risk of both CHD (Hazard Ratio (HR) = 2.65; 95% CI = 1.67-4.21), HF (HR = 2.56; 1.80-3.63), AF (HR = 2.48; 1.56-3.94) and CVD mortality (HR = 2.83; 1.50-5.32). The association with CHD and HF, but not with AF or CVD death, remained significant after further adjustment for ECG abnormalities. Subjects with abnormal T-axis showed higher levels of subclinical inflammation, hs-troponin I and hs-NT-proBNP (p < 0.001 for all). However, further adjustment for troponin I and/or NT-proBNP determined a reduction of HRs ranging from 12.1 to 24.0% for CHD, while additional adjustment for inflammation markers did not change any association.</AbstractText>An abnormal T-axis orientation is associated with an increased risk of both CHD and HF, independently of common CVD risk factors and other ECG abnormalities. This association was partially explained by increased hs-troponin I and hs-NT-proBNP levels.</AbstractText>Copyright © 2017 Elsevier B.V. All rights reserved.</CopyrightInformation> |
20,269 | Metastatic cardiac tumor presenting as atrial fibrillation in a previously healthy woman: A case report. | Metastatic cardiac tumor (MCT) is rare in clinical practice. MCT presenting initially as atrial fibrillation (AF) is even rarer.</AbstractText>We report a 47-year-old woman with no previous medical history presented with intermittent palpitation for 3 days.</AbstractText>The electrocardiography showed AF with rapid ventricular rate. The transthoracic echocardiography showed a 4 × 4 cm mass occupying the left atrium (LA). The contrast enhanced computed tomography (CT) showed a left lower lung mass with invasion to the LA and left upper pulmonary vein (PV). The chest CT guided biopsy revealed poorly differentiated squamous cell carcinoma. Further workup including bone scan showed no significant findings. The diagnosis of lung squamous cell carcinoma with cardiac invasion was made.</AbstractText>She went on to received palliative chemotherapy.</AbstractText>She is being followed up regularly at the outpatient department.</AbstractText>Tumor invasion of the LA and PV was thought to be the cause of the AF. This condition is rare, but clinically important. Physicians should be alert that MCT could be an important differential diagnosis in patients presenting with unexplained AF.</AbstractText> |
20,270 | Prognostic value of cardiovascular magnetic resonance imaging for life-threatening arrhythmia detected by implantable cardioverter-defibrillator in Japanese patients with hypertrophic cardiomyopathy. | Implantable cardioverter-defibrillator (ICD) is effective to prevent sudden death in HCM patients. We reviewed ICD records to analyze the relation between life-threatening arrhythmia and late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in Japanese hypertrophic cardiomyopathy (HCM) patients. In 102 consecutive patients (median age 63 years, 63 males) implanted with an ICD after CMR with gadolinium enhancement (median follow-up 2.8 years), the outcome of life-threatening arrhythmic events (appropriate ICD interventions for ventricular tachycardia or ventricular fibrillation) was examined. Appropriate interventions rate were 10.3% per year for secondary prevention and 7.4% per year for primary prevention. The annualized ICD-related complication rate was 3.7%. 43/91 patients (47%) implanted ICD for primary prevention had maximum wall thickness ≥20 mm plus LGE in ≥4 of 17 left ventricular segments (cut-off value obtained from ROC curve); the appropriate ICD intervention rate was significantly higher in this group than in other patients group (annualized event rate, 11.1 vs. 4.6%; log-rank P = 0.038). A combination of myocardial hypertrophy and LGE is a useful outcome predictive factor for life-threatening ventricular arrhythmia in Japanese HCM patients. |
20,271 | Relationship between left ventricular diastolic dysfunction and very late recurrences after multiple procedures for atrial fibrillation ablation. | Although very late recurrences (VLRs) (first recurrence >12 months after the last catheter ablation) of atrial fibrillation (AF) after multiple catheter ablation procedures are rare, it remains a critical issue. The risk factors for VLRs remain largely unclear. From December 2011 to April 2014, 253 patients underwent an initial catheter ablation. Of the 253 patients, 21 had AF recurrences within 1 year after the last catheter ablation. The study was conducted in the remaining 232 patients. Left ventricular diastolic dysfunction (LVDD) was assessed by echocardiography using composite categories with tissue Doppler imaging and left atrial volume measurements, i.e., a septal e' < 8 cm/s, lateral e' < 10 cm/s, and left atrium volume index (LAV/body surface area) (LAVI) ≥34 mL/m<sup>2</sup>. LVDD was observed in 40 patients. Sinus rhythm was preserved in 220 patients after multiple catheter procedures, and 12 had VLRs. The clinical factors possibly related to VLRs were examined, and a multivariate regression analysis showed that LVDD was the only independent risk factor for VLRs (hazard ratio: 10.31, 95% confidence interval: 2.78-38.18, P < 0.0001). LVDD at baseline is a risk factor for a VLR after multiple catheter ablation procedures for AF. |
20,272 | Elongated ascending aorta predicts a short distance between his-bundle potential recording site and coronary sinus ostium. | When performing catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT), it can be difficult to maintain a safe distance from the His recording site to avoid AV block in patients with a short distance between this recording site to the coronary sinus (CS) ostium (small triangle of Koch [TOK]). In this study, we sought to identify parameters predicting small TOK and test these parameters in patients undergoing AVNRT catheter ablation.</AbstractText>Twenty-eight patients who underwent catheter ablation of atrial fibrillation using a three-dimensional (3D) electroanatomical mapping system (EAM) with computed tomography (CT) merge (23 males; mean age, 65.8±12.1 years) were included. The shortest distance between the CS ostium and His recording sites (His-CSd) was measured on the EAM. Aortic (Ao) unfolding in chest X-ray scan, Ao angle to the LV, Ao length, Ao to the right ventricular distance, size of the Valsalva in the CT scan, and parameters of echocardiogram were evaluated. The identified parameters were subsequently tested as predictors for small TOK in patients undergoing AVNRT ablation.</AbstractText>The size of TOK was associated with Ao length (r</i> = -0.70, p</i><0.01), left ventricular end-systolic dimension (LVDs) (r</i> = -0.51, p</i><0.01), and Ao unfolding. In patients with AVNRT, only Ao unfolding predicted a smaller TOK.</AbstractText>Small TOK was associated with longer Ao, larger LVDs, and Ao unfolding. Of these, Ao unfolding was associated with smaller TOK in patients with AVNRT.</AbstractText> |
20,273 | Simulation of ventricular rate control during atrial fibrillation using ionic channel blockers. | The atrioventricular (AV) node is the only compartment that conducts an electrical impulse between the atria and the ventricles. The main role of the AV node is to facilitate efficient pumping by conducting excitation slowly between the two chambers as well as reduce the ventricular rate during atrial fibrillation (AF).</AbstractText>Using computer simulations, we investigated excitation conduction from the right atrium to the bundle of His during high-rate atrial excitation with or without partial blocking of the calcium or potassium ionic current.</AbstractText>Our simulations revealed differences in rate reduction and repolarization effects between calcium and potassium current blocking and high degree of potassium current blocking required to reduce the ventricular rate during AF.</AbstractText>Our simulation results explain why potassium current blockers are not recommended for controlling ventricular rate during AF.</AbstractText> |
20,274 | The evolving role of ankyrin-B in cardiovascular disease. | Over the past decade, ankyrin-B has been identified as a prominent player in cardiac physiology. Ankyrin-B has a multitude of functions, with roles in expression, localization, and regulation of proteins critical for cardiac excitability, cytoskeletal integrity, and signaling. Furthermore, human ANK2 variants that result in ankyrin-B loss of function are associated with "ankyrin-B syndrome," a complex cardiac phenotype that may include bradycardia and heart rate variability, conduction block, atrial fibrillation, QT interval prolongation, and potentially fatal catecholaminergic polymorphic ventricular tachycardia. However, our understanding of the molecular mechanisms underlying ankyrin-B function at baseline and in disease is still not fully developed owing to the complexity of ankyrin-B gene regulation, number of ankyrin-B-associated molecules, multiple roles of ankyrin-B in the heart and other organs that modulate cardiac function, and a host of unexpected clinical phenotypes. In this review, we summarize known roles of ankyrin-B in the heart and the impact of ankyrin-B dysfunction in animal models and in human disease as well as highlight important new findings illustrating the complexity of ankyrin-B signaling. |
20,275 | Clinical Significance of the Forsaken aVR in Evaluation of Tachyarrhythmias: A Reminder. | Mechanism of a regular, monomorphic Wide QRS Complex Tachycardia (WCT) is an important diagnostic challenge in day to day practice for the clinicians and affects further management and prognosis. Many of the WCT and Narrow Complex Tachycardia (NCT) produce certain characteristic changes in lead aVR by which we can differentiate between them.</AbstractText>The present study was aimed to evaluate tachyarrhythmias in relation to lead aVR and to highlight the clinical significance of lead aVR, "The Neglected Lead".</AbstractText>This is prospective study in which 55 consecutive cases of tachyarrhythmias excluding sinus tachycardia, atrial fibrillation and atrial flutter were taken for the study admitted in from ICCU of Department of Medicine at S.S. Medical College and S.G.M. Hospital Rewa (M.P.), India, during July 2014 to September 2015, fulfilling the required study protocol. The data was collected regarding detailed history, physical examination; necessary investigations (including ECG and echocardiography) were done.</AbstractText>Among 55 patients, 30 were of WCT and 25 were of NCT. The most common cause of WCT was Ventricular Tachycardia (VT) (83.3%) and rest were Supra Ventricular Tachycardia (SVT) with aberrancy (16.7%). The most common cause of NCT was Atrioventricular Nodal Tachycardia (AVNRT) (84%) followed by Atrioventricular Reciprocating Tachycardia (AVRT) (16%). The present study observed that 38.1% of the AVNRT cases and 50% of AVRT cases showed positive 'p' wave in lead aVR. The present study observed that 75% cases of AVRT showed ST segment elevation in lead aVR while only 33.3% cases of AVNRT showed ST elevation. In the present study 80% of the patients with WCT were diagnosed to have VT using Brugada algorithm while using Vereckei's new aVR algorithm, 83.3% were diagnosed to have VT.</AbstractText>Lead aVR, one of the most neglected leads on 12 lead ECG, is a very important diagnostic tool for identification and categorization of different type of tachyarrhythmias. The presence of ST elevation in lead aVR on ECG showing NCT is relatively sensitive for diagnosing AVRT. New aVR algorithm by Vereckei is more sensitive for differential diagnosis of WCT. One should pay careful attention to lead aVR which provides essential diagnostic information.</AbstractText> |
20,276 | [Risk Factors of Cardiovascular Complications After Beating-Heart Coronary Artery Bypass Grafting in Patients With Type Two Diabetes]. | to determine risk factors of early cardiovascular complications after beating-heart coronary artery bypass grafting (CABG) in patients with ischemic coronary disease (IHD) and type two diabetes (D2).</AbstractText>We included into this study 188 patients (mean age 59 years, 85.1% men) with IHD and D2 who underwent off-pump CABG. The following cardiovascular complications (CVC) registered within 7 days after surgery were analyzed: myocardial infarction (MI), stroke/transient ischemic attack (S/TIA), atrial fibrillation (AF). The control group of patients without CVC was formed by case-control method. In the study groups we compared IHD severity, coronary angiography, brachiocephalic and peripheral arteries duplex ultrasonography data, blood pressure level, glomerular filtration rate, EuroSCORE II risk, preoperative glycemic parameters and hypoglycemic therapy, as well as CABG volume and severity. Factors associated with postoperative CVC were determined by multiple stepwise logistic regression.</AbstractText>CVC were registered in 47 patients (MI - in 18, S/TIA - in 2, AF - in 27). As compared with the control group patients with CVC had higher Canadian Cardiovascular Society angina class and EuroSCORE II risk, lower left ventricular ejection fraction and glomerular filtration rate; they more frequently had left main coronary artery involvement, total coronary artery occlusions, carotid and peripheral artery disease. Group of patients with CVC had higher levels of glycosylated hemoglobin, serum glucose and its diurnal variability, as well as higher proportion of patients switched preoperatively from oral hypoglycemic agents to rapid-acting insulin. According to logistic regression most informative predictors of CVC were peripheral artery disease (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.7-7.1), diurnal serum glucose variability on admission day (OR 13.2, 95% CI 5.9-30.0 per 0.1 mmol/l) and the day before surgery (OR 1.3, 95%CI 1.2-2.4 per 0.1 mmol/l), and switching from oral hypoglycemic agents to insulin (OR 2.5, 95%CI 1.2-5.5).</AbstractText> |
20,277 | [Severe ventricular arrhythmias in a patient with dilated cardiomyopathy and automated implantable defibrillator (AID)]. | Severe ventricular arrhythmias are frequent during heart failure; they are a life-threatening condition due to the increased risk of sudden death. Efficient management remains limited in sub-Saharan Africa because of the limited or unavailable medical resources as automated implantable defibrillator (AID). We report the case of a 56-year old patient with non ischemic dilated cardiomyopathy with very low left ventricular ejection fraction (LVEF)who underwent AID implantation for primary prevention of sudden cardiac death due to ventricular arrhythmias in 2012. Maintenance therapy combined diuretic, angiotensin-converting enzyme (ACE) inhibitor and anti-vitamin K. In the month of November 2014 the patient had iterative episodes requiring the delivery of electric shocks by the AID, without the sensation of palpitations suggestive of episodes of arrhythmias. Clinical examination is a poor screening test, especially for heart failure. AID detected multiple episodes of tachycardia and ventricular fibrillation justifying antitachycardia pacing (ATP) therapy or the delivery of electric shocks of 15J. The patient was treated with amiodarone and beta blocker. Evolution was favorable at 3-months follow-up. The patients had resumed normal activities, without experiencing new episodes requiring the delivery of electric shocks. This study emphasizes the essential role of anti-arrhythmic drug therapy for severe ventricular arrhythmias, even in the presence of AID.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ikama</LastName><ForeName>Stéphane Méo</ForeName><Initials>SM</Initials><AffiliationInfo><Affiliation>Service de Cardiologie, CHU de Brazzaville, Congo.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Makani</LastName><ForeName>Jospin</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Service de Cardiologie, CHU de Brazzaville, Congo.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ellenga-Mbolla</LastName><ForeName>Bertrand</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Service de Cardiologie, CHU de Brazzaville, Congo.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ondze-Kafata</LastName><ForeName>Louis Igor</ForeName><Initials>LI</Initials><AffiliationInfo><Affiliation>Service de Cardiologie, CHU de Brazzaville, Congo.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gombet</LastName><ForeName>Thierry Raoul</ForeName><Initials>TR</Initials><AffiliationInfo><Affiliation>Service des Urgences, CHU de Brazzaville, Congo.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kimbally-Kaky</LastName><ForeName>Gisèle</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Service de Cardiologie, CHU de Brazzaville, Congo.</Affiliation></AffiliationInfo></Author></AuthorList><Language>fre</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><VernacularTitle>Orage rythmique chez un patient porteur d’une cardiomyopathie dilatée et un défibrillateur automatique implantable (DAI).</VernacularTitle><ArticleDate DateType="Electronic"><Year>2017</Year><Month>05</Month><Day>11</Day></ArticleDate></Article><MedlineJournalInfo><Country>Uganda</Country><MedlineTA>Pan Afr Med J</MedlineTA><NlmUniqueID>101517926</NlmUniqueID></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000889">Anti-Arrhythmia Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>N3RQ532IUT</RegistryNumber><NameOfSubstance UI="D000638">Amiodarone</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000638" MajorTopicYN="N">Amiodarone</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000889" MajorTopicYN="N">Anti-Arrhythmia Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002311" MajorTopicYN="N">Cardiomyopathy, Dilated</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016757" MajorTopicYN="N">Death, Sudden, Cardiac</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017147" MajorTopicYN="Y">Defibrillators, Implantable</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005500" MajorTopicYN="N">Follow-Up Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006333" MajorTopicYN="N">Heart Failure</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</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="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018487" MajorTopicYN="N">Ventricular Dysfunction, Left</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="fre">Les arythmies ventriculaires graves sont fréquentes au cours de l’insuffisance cardiaque, mettant en jeu le pronostic vital du fait du risque accru de mort subite. Leur prise en charge efficace reste limitée en Afrique Subsaharienne, du fait des moyens limités ou non disponibles comme le défibrillateur automatique implantable (DAI). Nous rapportons l’observation d’un patient de 56 ans, porteur d’une cardiomyopathie dilatée non ischémique à fraction d’éjection du ventricule gauche (FEVG) très abaissée, et qui a bénéficié en 2012 de l’implantation d’un DAI en prévention primaire de mort subite pour des arythmies ventriculaires. Le traitement d’entretien associait un diurétique, un IEC, et un anti-vitamine K. Le patient a présenté au mois de novembre 2014 des épisodes itératifs de décharges électriques délivrées par le DAI, sans sensation de palpitations suggestives d’épisodes d’arythmies. L’examen clinique est pauvre, en particulier pas de signes d’insuffisance cardiaque. L’interrogation du DAI a objectivé de nombreux épisodes de tachycardie et fibrillation ventriculaires ayant justifié le traitement par ATP ou par chocs de 15 joules. Le patient est mis sous amiodarone et bêtabloquant. L’évolution a été favorable avec un recul de trois mois, marquée par la reprise d’une vie normale, sans nouvel épisode de choc. Les anti-arythmiques gardent une importance capitale en cas d’arythmies ventriculaires graves, même en présence d’un DAI. |
20,278 | Position of Subcutaneous Implantable Cardioverter-Defibrillators and Possible Interference on Myocardial Perfusion Imaging. | Implanted cardioverter-defibrillators can prevent sudden cardiac death in at-risk patients. In comparison with conventional transvenous systems, entirely subcutaneous implantable cardioverter-defibrillators have produced similar reductions in the rate of sudden cardiac death but with fewer sequelae. An infrequently reported drawback of subcutaneous devices, however, is the potential for generating attenuation artifact during nuclear myocardial perfusion imaging. We had concerns about potential attenuation artifact in a 65-year-old man with coronary artery disease but found that having positioned the pulse generator in the midaxillary zone avoided problems. |
20,279 | Effects of trimetazidine on mitochondrial respiratory function, biosynthesis, and fission/fusion in rats with acute myocardial ischemia. | Myocardial ischemia affects mitochondrial functions, leading to ionic imbalance and susceptibility to ventricular fibrillation. Trimetazidine, a metabolic agent, is clinically used in anti-anginal therapy.</AbstractText>In this study, the rats were orally treated by gavage with trimetazidine 10 mg/kg/d for 7 days, and the effects of trimetazidine on mitochondrial respiratory function, biosynthesis, and fission/fusion in rats with acute myocardial ischemia were evaluated.</AbstractText>It has been suggested that acute myocardial ischemia leads to a damage to mitochondrial functions. However, compared with ischemia group without trimetazidine administration, a significant reduction in the infarct size was observed in trimetazidine-treated ischemia group (31.24±3.02% vs. 52.87±4.89%). Trimetazidine preserved the mitochondrial structure and improved respiratory control ratio and complex I activity. Furthermore, trimetazidine improved mitochondrial biosynthesis and fission/fusion, as demonstrated by the promotion of peroxisome proliferator-activated receptor gamma (PPARγ) co-activator 1α (PGC-1α), mitofusins 1 (Mfn1), dynamin-related protein 1 (Drp1), and optic atrophy 1 (Opa1) expressions in rats with acute myocardial ischemia.</AbstractText>Taken together, it was suggested that in this rat model of myocardial ischemia, trimetazidine demonstrated cardioprotective effects attributing to the preservation of mitochondrial respiratory function, biosynthesis, and fission/fusion and, thus, could be considered as an agent for cardioprotection.</AbstractText> |
20,280 | Implantable cardiac monitors in high-risk post-infarction patients with cardiac autonomic dysfunction and moderately reduced left ventricular ejection fraction: Design and rationale of the SMART-MI trial. | Most deaths after myocardial infarction (MI) occur in patients with left ventricular ejection fraction (LVEF) >35%, for whom no specific prophylactic strategies exist. Deceleration capacity (DC) of heart rate and periodic repolarization dynamics (PRD) are noninvasive electrophysiological markers depending on the vagal and sympathetic tone. The combination of abnormal DC and/or PRD identifies a new high-risk group among postinfarction patients with LVEF 36%-50%. This new high-risk group has similar characteristics with respect to prognosis and patient numbers to those of the established high-risk group identified by LVEF ≤ 35%.</AbstractText>The SMART-MI trial is an investigator-initiated randomized prospective multicenter trial that tests the efficacy of implantable cardiac monitors (ICM) in this new high-risk group. The study will enroll approximately 1,600 survivors of acute MI with sinus rhythm and an LVEF of 35%-50% in 17 centers in Germany who will be tested for presence of cardiac autonomic dysfunction. Four hundred patients with either abnormal DC (≤2.5 ms) and/or PRD (≥5.75deg2</sup>) will be randomized in a 1:1 fashion to intensive follow-up via telemonitoring using an ICM device (experimental arm) or conventional follow-up (control arm). For the ICM arm, specific treatment paths have been developed according to current guidelines.</AbstractText>The primary end point is time to detection of predefined serious arrhythmic events during follow-up, including atrial fibrillation ≥6minutes, nonsustained ventricular tachycardia (cycle length≤320 ms; ≥40 beats), atrioventricular block ≥IIb, and sustained ventricular tachycardia/ventricular fibrillation. The median follow-up period is 18months with a minimum follow-up of 6months. The effect of remote monitoring on clinical outcomes will be tested as secondary outcome measure (ClinicalTrials.gov NCT02594488).</AbstractText>Copyright © 2017 Elsevier Inc. All rights reserved.</CopyrightInformation> |
20,281 | Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis. | Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with stroke, cognitive impairment, and cardiovascular death. Some predisposing factors - as aging, diabetes, hypertension - induce and maintain electrophysiological and ultrastructural remodeling that usually includes fibrosis. Interatrial conduction disturbances play a crucial role in the initiation of atrial fibrosis and in its associated complications. The diagnosis of interatrial blocks (IABs) is easy to perform using the surface ECG. IAB is classified as partial when the P wave duration is ≥120 ms, and advanced if the P wave also presents a biphasic pattern in II, III and aVF. IAB is very frequent in the elderly and, particularly in the case of the advanced type, is associated with AF, AF recurrences, stroke, and dementia. The anticoagulation in elderly patients at high risk of AF without documented arrhythmias is an open issue but recent data suggest that it might have a role, particularly in elderly patients with structural heart disease, high CHA<sub>2</sub>DS<sub>2</sub>VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age ≥ 75 [doubled], Diabetes, Stroke [doubled] - Vascular disease, Age 65-74, and Sex category [female]), and advanced IAB. In this debate, we discuss the association of surface ECG IAB, a marker of atrial fibrosis, with AF and stroke. We also present the rationale that justifies further studies regarding anticoagulation in some of these patients. |
20,282 | Neurocardiology: Cardiovascular Changes and Specific Brain Region Infarcts. | There are complex and dynamic reflex control networks between the heart and the brain, including cardiac and intrathoracic ganglia, spinal cord, brainstem, and central nucleus. Recent literature based on animal model and clinical trials indicates a close link between cardiac function and nervous systems. It is noteworthy that the autonomic nervous-based therapeutics has shown great potential in the management of atrial fibrillation, ventricular arrhythmia, and myocardial remodeling. However, the potential mechanisms of postoperative brain injury and cardiovascular changes, particularly heart rate variability and the presence of arrhythmias, are not understood. In this chapter, we will describe mechanisms of brain damage undergoing cardiac surgery and focus on the interaction between cardiovascular changes and damage to specific brain regions. |
20,283 | [Main novelties of the last set of European guidelines for the management of heart failure]. | Heart failure is the main chronic disease in cardiology. Its prognosis remains poor despite improvements in its management that allow patients to live increasingly longer with this disease, alternating periods of stability and episodes of decompensation. Treatment guidelines are regularly updated to integrate new results of recent trials that are likely to influence routine care. These guidelines are proposed with different classes of recommendations and difference levels of evidence. It is of paramount importance to summarize the guidelines to make them accessible to the vast majority of cardiologists and easier to read to promote their application. Among the main novelties of the last set of European guidelines for the management of heart failure, we note the proposal for a new classification based on the level of left ventricular ejection fraction (LVEF) with a new class, called heart failure with mid-range ejection fraction (LVEF 40-50 %), new algorithms for diagnosis and treatment, including the diagnosis of heart failure with preserved ejection fraction, a special focus on preventive strategies, the management of comorbidities including iron deficiency, simplification of the indications for cardiac resynchronization therapy, and finally a growing attention to patient pathways and to the management of hospital discharge. According to these guidelines, it is important that the physician choose the appropriate medications; but it is equally fundamental that the patient understands the disease and acquires self-care skills needed to become a real player in its management. This requires patient education, which is underdeveloped in France. |
20,284 | Inappropriate ICD Shock From Perceived Ventricular Fibrillation During Balloon Manipulation at the Time of Percutaneous Coronary Intervention. | The authors demonstrate that device manipulation during percutaneous coronary intervention can result in "noise," which can be perceived as an arrhythmia resulting in an inappropriate shock. Although rare, this possibility should be considered when an operator encounters a difficult to traverse lesion in a patient with an ICD. |
20,285 | Predictors of ventricular arrhythmia after left ventricular assist device implantation: A large single-center observational study. | Ventricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implantation.</AbstractText>The purpose of this study was to determine the predictors of VAs and their impact on mortality in LVAD patients.</AbstractText>A total of 98 consecutive patients with an implantable cardioverter-defibrillator (ICD) (86 [88%] male, mean age 57 ± 10 years), 57 [58%] with nonischemic dilated cardiomyopathy) who had received an LVAD between May 2011 and December 2013 at our institution were included in the study.</AbstractText>Mean left ventricular ejection fraction and left ventricular end-diastolic diameter were 20% ± 8% and 73 ± 11 mm, respectively. Seventy-three patients (75%) had atrial fibrillation (AF). During the 12 months before LVAD implantation, 38 patients (39%) had experienced ≥1 episode of VAs (11.5 ± 20) requiring ICD therapies. The number of patients with VAs was comparable among all types of ICDs (P = .48). During the 12-month follow-up after LVAD implantation, 48 patients (49%) experienced ≥1 episode of VAs (30 ± 98) with appropriate ICD therapies. The prevalence of VAs was significantly higher among patients with pre-LVAD VAs compared to those without VAs during the year before LVAD implantation (66% vs 38%; P = .008). In a binary multiple logistic regression analysis, pre-LVAD VAs (hazard ratio 5.36, 95% confidence interval 2.0-14.3; P = .001) and AF (hazard ratio 3.1, 95% confidence interval 1.1-11.9; P = .024) predicted post-LVAD VAs.</AbstractText>Pre-LVAD VAs and AF predict the occurrence of VAs after LVAD implantation. According to the latest data on the negative impact of post-LVAD VAs on all-cause mortality, further studies should clarify the reasonability of maintaining sinus rhythm in patients with AF and/or prophylactic catheter ablation of ventricular tachycardias before LVAD implantation.</AbstractText>Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</CopyrightInformation> |
20,286 | Ablative Radiotherapy as a Noninvasive Alternative to Catheter Ablation for Cardiac Arrhythmias. | Stereotactic radioablation is a commonly utilized technology to noninvasively treat solid tumors with precision and efficacy. Using a robotic arm mounted delivery system, multiple low-dose ionizing radiation beams are delivered from multiple angles, concentrating ablative energy at the target tissue. Recently, this technology has been evaluated for treatment of cardiac arrhythmias. This review will present the basic underlying principles, proof-of-principle studies, and clinical experience with stereotactic arrhythmia radioablation.</AbstractText>Most recently, stereotactic radioablation has been used to safely and effectively treat a limited number of patients with malignant arrhythmias, including ventricular tachycardia (VT) and atrial fibrillation (AF). Treatment protocols, outcomes, ongoing studies, and future directions will be discussed. Stereotactic radioablation is a well-established technology that has been shown to be a safe and effective therapy for patients with drug-refractory cardiac arrhythmias, including VT and AF. Further clinical evaluation to define safety and efficacy in larger populations of patients is needed.</AbstractText> |
20,287 | A Potential-Based Inverse Spectral Method to Noninvasively Localize Discordant Distributions of Alternans on the Heart From the ECG. | T-wave alternans (TWA), defined as the beat-to-beat alternation in amplitude of the T-waves, has been shown to be linked to ventricular fibrillation (VF). However, current TWA tests have high sensitivity but low specificity in determining who is at risk. To overcome this limitation, it might be helpful to determine the spatial distribution of any regions on the heart that alternate in opposite phase. Understanding these spatial distributions in relation to the regular activation of the heart could help explain the mechanism for the genesis of VF and thus disambiguate the low specificity of TWA.</AbstractText>Image the spatial distribution of TWA on the heart surface from ECG measurements.</AbstractText>We introduced the inverse spectral method (ISM), a tailored inverse (or ElectroCardioGraphic Imaging) solution designed specifically to noninvasively image cases of TWA on the heart.</AbstractText>We evaluate the ISM on its capacity to reliably detect the spatial distributions of TWA compared against a standard TWA detection method applied directly to the electrograms on the heart surface. We report on results from both a series of synthetic simulations of TWA generated using the ECGSIM software and a set of continuous epicardial surface voltage recordings from a canine experiment. ISM detected TWA distributions that matched the phase of the true underlying out-of-phase regions over and of the heart surface, respectively.</AbstractText>Our results suggest that ISM is capable of reliably detecting the different regions present in a TWA distribution across a wide variety of TWA locations on the heart in simulation and in the face of transients and nonidealities in the canine recordings.</AbstractText> |
20,288 | Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy. | Hypertrophic cardiomyopathy (HCM) is traditionally classified based on a left ventricular outflow tract (LVOT) pressure gradient of 30mmHg at rest or with provocation. There are no data on whether 30mmHg is the most informative cut-off value and whether provoked gradients offer any information regarding outcomes.</AbstractText>Resting and provoked peak LVOT pressure gradients were measured by Doppler echocardiography in patients fulfilling guidelines criteria for HCM. A composite clinical outcome including new onset atrial fibrillation, ventricular tachycardia/fibrillation, heart failure, transplantation, and death was examined over a median follow-up period of 2.1years.</AbstractText>Among 536 patients, 131 patients had resting LVOT gradients greater than 30mmHg. Subjects with higher resting gradients were older with more cardiovascular events. For provoked gradients, a bi-modal risk distribution was found. Patients with provoked gradients >90mmHg (HR 3.92, 95% CI 1.97-7.79) or <30mmHg (HR 2.15, 95% CI 1.08-4.29) have more events compared to those with gradients between 30 and 89mmHg in multivariable analysis. The introduction of two cut-off points for provoked gradients allowed HCM to be reclassified into four groups: patients with "benign" latent HCM (provoked gradient 30-89mmHg) had the best prognosis, whereas those with persistent obstructive HCM had the worst outcome.</AbstractText>Provoked LVOT pressure gradients offer additional information regarding clinical outcomes in HCM. Applying cut-off points at 30 and 90mmHg to provoked LVOT pressure gradients further classifies HCM patients into low-, intermediate- and high-risk groups.</AbstractText>Copyright © 2017 Elsevier B.V. All rights reserved.</CopyrightInformation> |
20,289 | HeartWare Ventricular Assist Device as a Bridge-to-Transplant in a Small Boy with Complicated Kawasaki Disease. | We report a case of HeartWare ventricular assist device (HVAD) implant as a Bridge-to-Transplant in the smallest and the youngest known patient, a 32-month-old boy (body surface area of 0.66 m2) with known Kawasaki disease and giant coronary artery aneurysms. The disease course was complicated by coronary thromboembolism resulting in acute myocardial infarction, ventricular fibrillation, and cardiac arrest. After short-term support with extracorporeal membrane oxygenation for 7 days and long-term support with an HVAD for 5 months, he underwent heart transplantation and is doing well 2 months after the transplant. |
20,290 | Detection and characterization of intermittent complexity variations in cardiac arrhythmia. | A frequent observation during cardiac fibrillation is a fluctuation in complexity where the irregular pattern of the fibrillation is interrupted by more regular phases of varying length.</AbstractText>We apply different measures to sliding windows of raw ECG signals for quantifying the temporal complexity. The methods include permutation entropy, power spectral entropy, a measure for the extent of the set of reconstructed states and several wavelet measures.</AbstractText>Using these methods, variations of fibrillation patterns over time are detected and visualized.</AbstractText>These quantifications can be used to characterize different phases of the ECG during fibrillation and might improve diagnosis and treatment methods for heart diseases.</AbstractText> |
20,291 | Prevalence and prognostic relevance of atrial fibrillation in patients with Takotsubo syndrome. | Takotsubo syndrome (TTS) is associated with a considerable risk of complications during the acute phase and substantial long-term mortality rates. Concomitant atrial fibrillation may have an impact on outcome in these patients. Aim of this study was to assess the prevalence and prognostic relevance of atrial fibrillation in TTS.</AbstractText>We performed an international, multicenter study including 387 TTS patients consecutively enrolled at 3 centers. Atrial fibrillation was defined as known history before admission or documented episodes during hospital stay. Long-term mortality was evaluated in median 2.9years after the acute event.</AbstractText>Atrial fibrillation was found in 97 TTS patients (25.1%) and was associated with older age (p<0.01), less emotional triggers (p=0.03), higher incidence of cardiogenic shock (p<0.01), lower left ventricular ejection fraction (p<0.01), and a prolonged hospital stay (p<0.01). Determinants of atrial fibrillation at admission (n=34 patients; 9.0%) in multivariate logistic regression analysis were age (p=0.001) and cardiogenic shock (p=0.013). Long-term mortality was significantly higher in TTS patients with as compared to patients without atrial fibrillation (35.2% versus 15.3%; hazard ratio 3.02, 95% confidence interval 1.90-4.78; p<0.001). In multivariate Cox regression analysis atrial fibrillation was identified as an independent determinant of outcome even after adjustment for clinical variables, left ventricular functional parameters (ballooning pattern, ejection fraction), and cardiogenic shock.</AbstractText>In TTS patients, atrial fibrillation is frequent and associated with increased long-term mortality rates. Furthermore, our study identifies atrial fibrillation as an independent predictor of outcome and a potential tool for risk stratification in TTS.</AbstractText>Copyright © 2017. Published by Elsevier B.V.</CopyrightInformation> |
20,292 | Sensitive Troponin I and Stress Testing in the Emergency Department for the Early Management of Chest Pain Using 2-Hour Protocol. | Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs.</AbstractText>We conducted a single center randomized trial at Presence St. Francis Hospital Chest pain center in Evanston, Illinois enrolling sixty-four consecutive patients with atypical chest pain and non-diagnostic ECG, participants were randomized to accelerated 2 hrs protocol or our pre-existing 4-hrs protocol. Sixty patients completed the protocol and were randomized to either a 2-hour (29 patients) or 4-hour protocol using both I-STAT and PATHFAST cTnI (31 Patients). Troponin I was evaluated at 0 and at 2 hours from ED presentation with and additional draw for patients in the 4-hour rule out-group. Patients with normal serial biomarkers were then evaluated with stress testing and qualified for earlier discharge if the stress test was negative, while those with a positive biomarker at any time were admitted. Thirty-six patients had exercise treadmill stress test and 24 patients had either nuclear or Echo stress test.</AbstractText>Fifty-three patients had a normal stress test and were discharged home. One patient in the 4-hour group with normal serial troponins developed ventricular tachycardia/fibrillation during the recovery period of a regular stress test. Six patients had a positive PATHFAST cTnI and a normal I-STAT cTnI at 2-hours. Two out of these six patients evaluated by coronary angiography. One patient had severe tortuous coronaries but no significant obstructive lesion and one had a severe CAD who needed Coronary artery bypass grafting (CABG). Three of the six patients had a normal stress test and one patient decided to leave without further testing. None of the patients with a normal stress test had a major cardiac event or adverse cardiac outcome at six-month follow up.</AbstractText>This study demonstrates that the 2 hours accelerated protocol using high sensitivity Troponin assay at 0 and 2 hours with comprehensive clinical evaluation and ECG followed by stress testing might be successful in identifying low-risk patient population who may benefit from early discharge from ED reducing associated costs and length of stay.</AbstractText> |
20,293 | Role of peak current in conversion of patients with ventricular fibrillation. | Peak currents are the final arbiter of defibrillation in patients with ventricular fibrillation (VF). However, biphasic defibrillators continue to use energy in joules for electrical conversion in hopes that their impedance compensation properties will address transthoracic impedance (TTI), which must be overcome when a fixed amount of energy is delivered. However, optimal peak currents for conversion of VF remain unclear. We aimed to determine the role of peak current and optimal peak levels for conversion in collapsed VF patients.</AbstractText>Adult, non-pregnant patients presenting with non-traumatic VF were included in the study. All defibrillations that occurred were included. Impedance values during defibrillation were used to calculate peak current values. The endpoint was return of spontaneous circulation (ROSC).</AbstractText>Of the 197 patients analysed, 105 had ROSC. Characteristics of patients with and without ROSC were comparable. Short duration of collapse < 10 minutes correlated positively with ROSC. Generally, patients with average or high TTI converted at lower peak currents. 25% of patients with high TTI converted at 13.3 ± 2.3 A, 22.7% with average TTI at 18.2 ± 2.5 A and 18.6% with low TTI at 27.0 ± 4.7 A (p = 0.729). Highest peak current conversions were at < 15 A and 15-20 A. Of the 44 patients who achieved first-shock ROSC, 33 (75.0%) received < 20 A peak current vs. > 20 A for the remaining 11 (25%) patients (p = 0.002).</AbstractText>For best effect, priming biphasic defibrillators to deliver specific peak currents should be considered.</AbstractText>Copyright: © Singapore Medical Association</CopyrightInformation> |
20,294 | Singapore Defibrillation Guidelines 2016. | The most common initial rhythm in a sudden cardiac arrest is ventricular fibrillation or pulseless ventricular tachycardia. This is potentially treatable with defibrillation, especially if provided early. However, any delay in defibrillation will result in a decline in survival. Defibrillation requires coordination with the cardiopulmonary resuscitation component for effective resuscitation. These two components, which form the key links in the chain of survival, have to be brought to the cardiac victim in a timely fashion. An effective chain of survival is needed in both the institution and community settings. |
20,295 | Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy. | We evaluated the outcomes of patients with aortic valve pathology in the setting of a left ventricular ejection fraction ≤35% who underwent minimally invasive aortic valve replacement (AVR), with or without concomitant mitral valve (MV) surgery.</AbstractText>All minimally invasive AVR in patients with a left ventricular ejection fraction ≤35%, performed via a right thoracotomy for aortic stenosis or regurgitation between January 2009 and March 2013, were retrospectively evaluated. The operative characteristics, perioperative outcomes, and 30-day mortality were analyzed.</AbstractText>There were 75 patients identified: 51 who underwent isolated AVR, and 24 who had combined AVR plus MV surgery for moderate to severe mitral regurgitation. In patients undergoing MV surgery, there were 22 (91.7%) MV repairs [ring annuloplasty =7 (37.5%), transaortic edge-to-edge repair =15 (62.5%)], and 2 (8.3%) replacements. No patient required conversion to sternotomy for inadequate surgical field exposure. The median total mechanical ventilation time and intensive care unit length of stay were 14 (IQR, 8-20) and 42 hours (IQR, 26-93 hours) in the isolated AVR group, and 16.5 hours (IQR, 12-61.5 hours) and 95.5 hours (IQR, 43.5-159 hours) in the AVR plus MV surgery group, respectively. The most common post-operative complication was new-onset atrial fibrillation, which occurred in 15 (29.4%) isolated AVR and 4 (16.7%) AVR plus MV surgery patients. The median hospital length of stay and 30-day mortality was 7 days (IQR, 5-12 days) and 1 (2%) in the isolated AVR group, and 10.5 days (IQR, 5-21 days) and 1 (4.3%) for AVR plus MV surgery.</AbstractText>In patients with aortic valve pathology in the setting of a left ventricular ejection fraction ≤35%, minimally invasive AVR can be performed, with or without concomitant MV surgery, with a low morbidity and mortality.</AbstractText> |
20,296 | Outcomes of minimally invasive double valve surgery. | Double valve surgery is associated with an increased peri-operative morbidity and mortality. A less invasive right thoracotomy approach may be a viable alternative to median sternotomy surgery in these higher-risk patients.</AbstractText>We retrospectively analyzed the baseline demographics, operative characteristics, and post-operative outcomes of patients who underwent minimally invasive double valve surgery between January 2009 and December 2011 at our institution.</AbstractText>The cohort consisted of 117 patients, of which 68 (58.1%) were female. The mean age was 73±11 years, and the mean left ventricular ejection fraction was 52±11%. There were 43 (36.8%) patients with a history of congestive heart failure, 45 (38.5%) with chronic obstructive pulmonary disease, and 5 (4.3%) had a history of chronic kidney disease. The patients underwent primary (90.6%) or re-operative (9.4%) double valve surgery, which consisted of 50 (42.7%) aortic valve replacement and mitral valve repair, 31 (26.5%) mitral and tricuspid valve repair, 18 (15.4%) aortic and mitral valve replacement, 17 (14.5%) mitral valve replacement with tricuspid valve repair, and 1 (0.9%) aortic valve replacement with tricuspid valve repair. Post-operatively, there were 40 (34.2%) cases of prolonged ventilation, 9 (7.7%) acute kidney injury, 6 (5.1%) re-operations for bleeding, 1 (0.9%) cerebrovascular accident, and 15 (12.8%) cases of atrial fibrillation. The mean total hospital length of stay was 12±12 days, with an in-hospital mortality of 2 (1.7%).</AbstractText>A minimally invasive right thoracotomy approach to primary or re-operative double valve surgery is feasible, may be utilized with acceptable peri-operative morbidity and mortality.</AbstractText> |
20,297 | Comparison and Validation of Recommended QT Interval Correction Formulas for Predicting Cardiac Arrhythmias in Patients With Advanced Heart Failure and Cardiac Resynchronization Devices. | QT interval prolongation is an important marker for the development of cardiac arrhythmias (CAs). Optimal methods to estimate QT/QTc intervals in patients with ventricular pacing (VP) and its correlation with CA have not been widely investigated. We aimed to validate the currently available formulas for QT determination during VP and to compare their abilities in predicting the occurrence of CA (atrial fibrillation [AF] and malignant ventricular arrhythmias [VAs] in patients with advanced heart failure and cardiac resynchronization therapy). Consecutive patients with advanced heart failure who underwent cardiac resynchronization therapy implantation between August 2001 and April 2015 were included in a retrospective study. Four proposed formulas for QT correction in VP rhythms were evaluated. One hundred eighty patients were enrolled. During 44 months of follow-up, 43 patients (37.7%) developed AF and 16 patients (8.9%) developed VA. There was no correlation between corrected QT increments and AF risk with any of the formulas for paced rhythms. Regarding VA, higher corrected QT values measured with Massachusetts' formula (QTcM) were found to have a higher risk of event (p = 0.036) (Beta = 1.012 [1.001 to 1.023]). Each 1 ms increase in QTc increased the probability of experiencing VA by 12‰. QTcM >444 was found to be a strong predictor of VA. In conclusion, there are significant differences in mean QTc interval measured by the currently advised formulas. QTc interval was not associated with AF in any of the formulas. Only the QTcM formula showed a significant stepwise increase in the risk of experiencing malignant VA. |
20,298 | Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients. | Atrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke.</AbstractText>First-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and PQ interval were performed automatically using the University of Glasgow 12-lead ECG analysis algorithm. The P-wave vector magnitude (Pvm) was calculated automatically as the square root of the sum of the squared P-wave magnitudes in leads V6, II and one half of the P-wave amplitude in V2 ([Formula: see text]), based on the P-wave magnitude (Pvm) as defined by the visually transformed Kors' Quasi-orthogonal method.</AbstractText>The median age was 73 (IQR 63-80) years at stroke onset (135 males, 92 females). Multivariate predictors of new-onset atrial fibrillation included age > 65 years, hypertension, and Pd/Pvm. A cut-off value of 870 ms/mV gave sensitivity, specificity, positive and negative predictive values of 51, 79, 30 and 87%, respectively. The Pd/Pvm was the only ECG predictor of AF with a significant multivariate hazard ratio of 2.02 (95% CI 1.18 to 3.46, p = 0.010).</AbstractText>P-wave dispersion as measured by the Pd/Pvm was the only ECG parameter measured which independently predicted subsequent AF identification in a cohort of stroke patients. Further prospective studies in larger cohorts are needed to validate its clinical usefulness.</AbstractText> |
20,299 | Risk stratification in patients with heart failure: the value of considering both global longitudinal left ventricular strain and mechanical dispersion. | In previous studies, mechanical dispersion (MD) predicted ventricular arrhythmias independently of left ventricular ejection fraction (LVEF). Moreover, the combination of MD and global longitudinal strain (GLS) increased the prediction of arrhythmic events. We investigated the prognostic value of a new 2-dimensional strain index, GLS/MD, in patients with heart failure (HF). We analyzed 340 consecutive HF outpatients in sinus rhythm. Echocardiography was performed at 1.6 ± 0.4 months after hospital discharge. The end point included sudden cardiac death, ventricular fibrillation, and sustained ventricular tachycardia (SCD/VA). During the follow-up period (36 ± 9 months), SCD/VA occurred in 48 patients (14.1%). A multivariate Cox regression analysis, which included LVEF, early diastolic transmitral / mitral annular velocity ratio (E/E'), GLS, MD, and GLS/MD in the model, revealed that GLS/MD was the best independent predictor of SCD/VA (HR = 3.22, 95% confidence interval = 1.72-6.15, p = 0.03). Separate inclusion of LVEF, systolic mitral annular velocity, E/E', GLS, and MD together with GLS/MD showed that GLS/MD remained the best predictor of SCD/VA (each p < 0.05). The optimal GLS/MD cutoff value to predict SCA/VA was -0.20%/ms (80% sensitivity, 76% specificity). Irrespective of LVEF, free survival was significantly better in patients with GLS/MD ≤ -0.2%/ms (log-rank test, p < 0.001). In conclusion, GLS/MD may improve cardiovascular risk stratification in subjects with HF. |
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