24-hour Heart Rate Research Articles

Prevalence of inappropriate sinus tachycardia among patients with sinus tachycardia

Background: The inappropriate sinus tachycardia (IST) is a syndrome characterized by increased heart rate with disturbing symptoms without obvious cause. IST is defined as a sinus heart rate > 100 bpm at rest with a mean 24-hour heart rate >90 bpm not due to primary causes and is associated with distressing symptoms. This study aims to assess the prevalence of inappropriate sinus tachycardia (IST) among patients presented with sinus tachycardia. Methods: This study enrolled 107 patients. All had been referred to the cardiac center of Shar teaching hospital of Sulaimaniyah city/Iraq, for tachycardia assessment. All candidates had been evaluated first by ECG, those who had resting heart rate more than 100 and had sinus rhythm were selected and further assessed by 24 hours cardiac Holter monitoring. Patients met criteria for IST when a sinus heart rate of ≥100 beats/minute at rest with a mean 24-hour HR of ≥90 bpm , in the absence of any primary cause. Results: One hundred seven patients were enrolled, majority ( 70.1%) were females . 40.2 % of them were in age group of 20-29 years old. The prevalence of IST is 4.7% ( 5 patients ).

Prognostic significance of remotely monitored nocturnal heart rate in heart failure patients with reduced ejection fraction

Elevated resting heart rate is a risk factor for cardiovascular events. The purpose of this study was to investigate the clinical significance of nocturnal heart rate (nHR) and 24-hour mean heart rate (24h-HR) obtained by continuous remote monitoring (RM) of implantable devices. We analyzed daily-sampled trends of nHR, 24h-HR, and physical activity in patients on β-blocker therapy for chronic heart failure and with implantable cardioverter-defibrillators or cardiac resynchronization therapy defibrillators (CRT-Ds). Patients were grouped by average nHR and 24h-HR quartile during follow-up to estimate the respective incidence of nonarrhythmic death and device-treated ventricular tachycardia/fibrillation (VT/VF). The study cohort included 1330 patients (median age 69 years [interquartile range 61-77 years]; 41% [n = 550] with CRT-D; median follow-up 25 months [interquartile range 13-42 months]). Compared with patients in the lowest nHR quartile (≤57 beats/min) group, patients in the highest quartile group (>65 beats/min) had an increased risk of nonarrhythmic death (adjusted hazard ratio [AHR] 2.25; 95% confidence interval [CI] 1.13-4.50; P= .021) and VT/VF (AHR 1.98; 95% CI 1.40-2.79; P < .001) and were characterized by the lowest level of physical activity (P≤.0004 vs every other nHR quartiles). The highest 24h-HR quartile group (>75 beats/min) showed an increased risk of VT/VF (AHR 2.13; 95% CI 1.52-2.99; P< .001) and a weaker though significant association with nonarrhythmic mortality (AHR 1.80; 95% CI 1.00-3.22; P= .05) as compared with the lowest 24h-HR quartile group (≤65 beats/min). In remotely monitored patients with implantable cardioverter-defibrillator/CRT-D on β-blocker therapy for heart failure, elevated heart rates (nHR >65 beats/min and 24h-HR >75 beats/min) were associated with increased mortality and VT/VF risk. nHR showed a stronger association than 24h-HR with worst prognosis and lowest physical activity.

Non-dipping heart rate &amp; major adverse cardiovascular events in type 2 diabetes mellitus

Abstract Background Type 2 diabetes mellitus (T2DM) is a known major risk factor for cardiovascular disease. Whilst the influence of traditional risk factors such as hypertension, hyperlipidaemia and smoking are well-established determinants of major adverse cardiovascular events (MACE) in subjects with T2DM, the impact of insulin resistance, non-dipping blood pressure and heart rate status have not been adequately investigated. Purpose To determine predictors of MACE in a population of T2DM with underlying target-organ damage at baseline. Methods This study included 196 subjects with T2DM with advanced proliferative diabetic retinopathy. These subjects were recruited in 2008–2009 and were consequently followed up till February 2022 to determine independent predictors of MACE. At baseline, the median age of the participants was 64 years (IQR: 59–71 years) and the median diabetes duration was 18 years (IQR: 10–25 years). At baseline, all underwent 24-hour blood pressure and heart rate (HR) monitoring, and were assessed for markers of inflammation, insulin resistance, albuminuria, presence of peripheral neuropathy and peripheral vascular disease. Subjects whose night-time HR did not decrease by more than 10% as compared to daytime readings were classified as non-dippers. Similarly, a non-dipping BP profile was defined as a nocturnal decline of mean arterial pressure of less than 10%. At follow-up, the all-cause death rate was noted as well as MACE. The latter was defined as all-cause death, non-fatal MI, non-fatal stroke, coronary revascularisation or hospitalisation for unstable angina pectoris or heart failure. Univariate followed by multivariate Cox-regression analysis was performed to determine independent predictors of both all-cause mortality and MACE. Results At follow-up, 46% of the study participants had died whilst 63.1% had exhibited MACE. Multivariate analysis revealed age (OR: 1.05, 95% CI 1.02–1.07, p&amp;lt;0.001), ESR (OR: 1.012, 95% CI: 1.001–1.02, p=0.035), GGT (OR: 1.005, 95% CI 1.001–1.009, p=0.025) and eGFR (OR: 0.99, 95% CI 0.98–0.99, p=0.016) at baseline to be independent determinants of all-cause death. With regards MACE, likewise, age (OR: 1.028, 95% CI 1.007–1.05, p=0.009), GGT (OR: 1.004, 95% CI 1.001–1.008, p=0.017) and eGFR (OR: 0.99, 95% CI 0.98–0.99, p=0.022) were shown to be independent determinants together with diabetes duration (OR: 1.034, 95% CI 1.014–1.055, p=0.001) and presence of non-dipping heart rate at baseline. The latter was shown to be the strongest predictor of MACE (OR: 1.55, 95% CI 1.06–2.26, p=0.024). Conclusion Whereas increasing age and impaired renal function are known risk factors for cardiovascular disease, this long-term follow-up study has highlighted the relevance of non-dipping heart rate in type 2 diabetes mellitus. Previous studies had shown an association between non-dipping heart rate and target-organ damage in diabetic subjects. The impact on MACE merits further investigation. Funding Acknowledgement Type of funding sources: None.

Independent predictors of long-COVID in patients without comorbidities. Data from the Polish long-COVID cardiovascular (PoLoCOV-CVD) study

Abstract Coronavirus disease 2019 (COVID-19) is a serious respiratory disease that results from infection with a newly discovered coronavirus (SARS-COV-2). Patients recovering from SARS-COV2 infection complain of persisting symptoms which may lead to chronic fatigue syndrome and as well as many other complications. The vast majority of COVID-19 patients remaining in isolation/quarantine, due to the mild course of the disease, do not require hospitalization. There are many studies describing the course and complications of patients hospitalized due to COVID-19. There is little published data on how nonhospitalized patients get sick and what are the early and late complications of SARS-CoV-2 infection. Little is also known about Long-COVID (LC) in patients without comorbidities. Therefore, the aim of our analysis was to assess the predictors of long-lasting symptoms in patients without comorbidities suffering from COVID-19. Methods Patients ≥18 years of age diagnosed with COVID-19, were examined after full recovery (resolution of clinical symptoms, minimum 14 days after last symptoms). Patient information, course of the disease with symptoms, post-COVID-19 complaints were collected within 4–8 weeks after the COVID-19 recovery. We followed patients for at least 3 months. Patients were ordered the following tests: 12-lead ECG, 24-hour Holter ECG monitoring, 24-hour Holter blood pressure monitoring, Echocardiographic of the Heart assessment, Biochemical tests: lipid profile, glucose or glycosylated hemoglobin level, D-dimers. In patients with indications, the following were additionally performed: Magnetic resonance imaging of the heart, Computed tomography angiography (CTA) of pulmonary vessels, Angio CT of coronary vessels or other diagnostic tests. Results We identified 701 consecutive patients without comorbidities of whom 488 pts completed 3 month follow-up. Comparisons were made between LC group (n=218) and non-LC group (n=270). The demographic and laboratory characteristics of the studied group are presented in Table 1. Patients with severe course of acute phase of COVID-19 developed LC more often (72 vs. 28%, p&amp;lt;0.001). Significant differences regarding sex, weight, height, body mass index were observed. Patients with LC more often presented with dyspnoea, significant fatigue, chest pain, leg muscle pain, headache, arthralgia and chills. No statistically significant difference was observed regarding laboratory tests, 24-hour systolic and diastolic BP and echocardiographic parameters. LC group had higher 24-hour heart rate (77 [72–83] vs. 75 [70–81], p=0.021). Multivariate regression analysis showed that LC patients had higher BMI (odds ratio 1.057, 95% confidence intervals 1.016–1.100) and almost twice as often had a severe course (1.736, 1.071–2.814) and presented with arthralgia in the acute phase (1.901, 1.225–2.950). Conclusions Severe course of COVID-19, BMI, and arthralgia are independently related to long-COVID in patients without comorbidities. Funding Acknowledgement Type of funding sources: None.

Targeted Treatment of Inappropriate Sinoatrial Node Tachycardia Based on Electrophysiological and Structural Mechanisms

The purpose of this review is to determine the causal mechanisms and treatment of inappropriate sinoatrial tachycardia (IST), defined as a non-physiological elevation in resting heart rate. IST is defined as a resting daytime sinus rate >100 beats/minute and an average 24-hour heart rate >90 beats/minute. Potential causal mechanisms include sympathetic receptor hypersensitivity, blunted parasympathetic tone, or enhanced intrinsic automaticity within the sinoatrial node (SAN) pacemaker-conduction complex. These anomalies may coexist in the same patient. Recent ex-vivo near-infrared transmural optical imaging of the SAN in human and animal hearts provides important insights into the functional and molecular features of this complex structure. In particular, it reveals the existence of preferential sinoatrial conduction pathways that ensure robust SAN activation with electrical conduction. The mechanism of IST is debated because even high-resolution electroanatomical mapping approaches cannot reveal intramural conduction in the 3-dimensional SAN complex. It may be secondary to enhanced automaticity, intranodal re-entry, or sinoatrial conduction pathway re-entry. Different pharmacological approaches can target these mechanisms. Long-acting β blockers in IST can act on both primarily increased automaticity and dysregulated autonomic system. Ivabradine targets sources of increased SAN automaticity. Conventional or hybrid ablation may target all the described abnormalities. This review provides a state-of-the-art overview of putative IST mechanisms. In conclusion, based on current knowledge, pharmacological and ablation approaches for IST, including the novel hybrid SAN sparing ablation, are discussed.

P04-10 The Physical activity health paradox - what do we know about physiological mechanisms? (editorial)

There is strong and consistent evidence that leisure-time physical activity (LTPA) improves cardiovascular health and reduces the risk of all-cause and cardiovascular mortality. Less is known about health effects of occupational physical activity (OPA), and results are not in favor of a beneficial effect on cardiovascular health. Several large-scale prospective studies have found that high occupational physical activity (OPA) is associated with detrimental or no effects on cardiovascular health and mortality. These contrasting associations with cardiovascular morbidity and mortality for LTPA and OPA have coined ‘The Physical activity health paradox'. Although the underlying physiological mechanisms are not established, a theoretical framework was proposed by Holtermann and colleagues (2018). This framework suggests that due to the nature of OPA (i.e. low intensity, long duration, constrained postures, and limited recovery), it may not result in healthy adaptation to the same extent as LTPA, or even lead to unhealthy responses, such as elevated 24-hour heart rate and blood pressure and increased inflammation. Drawing on theoretical models and empirical findings, the aim is to summarize the literature regarding potential physiological mediators of the physical activity health paradox. This also includes a brief summary of our own research based on accelerometer measurements of physical activity with cardiovascular regulation assessed by heart rate and blood pressure in workers with low occupational class and manual work.

Validation of heart rate spot-check protocol to measure circadian variation and heart rate in healthy dogs and dogs with atrial fibrillation

IntroductionAlternatives for out-of-clinic heart rate (HR) measurement are required to optimise the management of atrial fibrillation (AF) in dogs. Additionally, the presence of circadian variation (CV) in HR in pet dogs remains unknown.We aimed to identify the number and duration of spot-checks required for an accurate estimation of 24-hour HR in canine AF. Circadian variation in HR was examined in healthy dogs and dogs with AF, and spot-check-derived HR was compared with a CV-derived gold standard. Materials and methodsAmbulatory electrocardiogram data from healthy dogs and dogs with AF were retrospectively analysed. Heart rate was calculated from the entire recording and pre-defined periods (spot-checks) of one hour to 30 and 60 s in duration. Circadian variation in HR was determined by cosinor analysis. Bias and limits of agreement of means and median HR with mesor HR were determined by correlation and Bland–Altman analysis. ResultsCircadian variation in HR was identified not only in 18/22 healthy dogs and 14/21 AF dogs but only on ambulatory electrocardiogram recordings.Four-hourly spot-checks provided the most accurate estimate of mesor HR in healthy dogs (bias of the median over 30 s 7.70, limits of agreement 7.48), whereas, in dogs with AF, four, six and eight-hourly spot-checks provided reliable estimates of mesor HR (bias within −1.29 and −29.5). ConclusionsFour, six and eight-hourly HR spot-checks can estimate 24-hourly HR in dogs with AF. There was CV in HR in most healthy pet dogs and dogs with AF. Spot-check protocols cannot identify CV in HR.

Procedural Characteristics, Safety, and Follow-up of Modified Right-Sided Approach for Cardioneuroablation

Background: Cardioneuroablation is one of the emerging therapies in vasovagal syncope. In this study, we present a simple method of cardioneuroablation performed via a right-sided approach, targeting anterior-right and right-inferior ganglionated plexi, along with procedural and follow-up data.Methods: Patients who had underwent cardioneuroablation between March 2018 and September 2019 with vasovagal syncope in 2 clinics were enrolled in the study. All patients underwent radio-anatomically guided radiofrequency ablation targeting anterior-right ganglionated plexi and right-inferior ganglionated plexi. Syncope and symptom burden, 24-hour ambulatory electrocardiogram data at presentation, and at follow-up were assessed along with procedural data.Results: A total of 23 patients underwent modified right-sided cardioneuroablation. Mean basal cycle length decreased significantly from 862.3 ± 174.5 ms at the beginning of the procedure 695.8 ± 152.1 ms following the final radiofrequency ablation (P < .001). Mean 24-hour ambulatory heart rate increased significantly from 66.4 ± 10.7 bpm at baseline to 80 ± 7.6 bpm at follow-up (P < .001). Only 1 patient had 1 episode of syncope following the procedure at the mean follow-up period of 10 ± 2.9 months. The same patient had recurrent presyncope. Conclusion: The right-sided cardioneuroablation approach was found to be an effective treatment for vasovagal syncope and may be regarded as a default initial cardioneuroablation technique.

The Relationship Between Sexual Activity and Heart Rate Variability in Menopausal Women.

Background:Menopause is an important life stage for women, which can bring along sexual and cardiac problems. Increased heart rate variability is an indicator of parasympathetic activity and is associated with mental and physical health and life expectancy. This study aimed to evaluate the effect of sexual activity (only penile–vaginal intercourse but not masturbation or non-coital sex with a partner) on heart rate variability in healthy menopausal women.Methods:We evaluated 130 menopausal patients aged 45-60 years, without chronic disease. The average weekly sexual activity numbers remembered in the last 1 year were questioned. The patients were divided into 2 groups according to the presence of sexual activity. The sexually active group was divided into subgroups as 1 per week and 2 or more per week. Menopause Rating Scale was applied for menopausal symptoms. Heart rate variability was analyzed from the 24-hour electrocardiography Holter recording.Results:Heart rate variability parameters were higher in the sexually active group than in the sexually inactive group (mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording: P = .004; root mean square of differences between adjacent normal RR intervals, expressed in ms: P = .001; number of NN intervals exceeding 50 milliseconds: P = .011; percentage of adjacent RR intervals with a difference of duration >50 ms: P = .009; low frequency: P = .011; high frequency: P = .008, low frequency/high frequency: P = .018). When assessed by multiple linear regression analysis by adjusting for age, body mass index, and menopause duration, the variables mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording, root mean square of differences between adjacent normal RR intervals, expressed in ms, and low frequency were independently associated with the number of sexual activities per week (B = 2.89 ± 1.02, 95% CI = 0.866-4.91, P = .005; B = 4.57 ± 1.83, 95% CI = 0.94-8.2, P = .014; and B = 1174.9 ± 592.2, 95% CI = 2.9-2346.9, P = .049, respectively).Conclusion:In healthy menopausal women, continued sexual activity with penile–vaginal intercourse is associated with better health outcomes on cardiac autonomic function through higher heart rate variability, an index of parasympathetic activity.

Effect of intermittent fasting and chronotherapy on blood pressure control in hypertensive patients during Ramadan

Background: During Ramadan, repeated cycles of fasting, associated with alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients. Studies on the effects of fasting on the blood pressure of hypertensive patients are rare, and have provided inconclusive results. The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive individuals taking their treatment once daily. Material and methods: The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of Habib Thameur Hospital in Tunis. A 24-hour blood pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. We compared the average values of 24-hour awake and asleep systolic and diastolic blood pressure and 24-hour awake and asleep heart rate. Results: We studied 29 women and 15 men, mean age was 58.7 years. Fifteen patients were diabetics, 20 had dyslipidemia and 7 patients had coronaropathy. Twenty patients were on monotherapy, 19 on dual therapy and 5 on a triple antihypertensive therapy. During Ramadan, 25 patients took their treatment during the dinner (group1), whereas 19 took their treatment during the S’hour (group 2). Average 24-hour blood pressure in the whole group was 129 ± 18/74 ± 10 mm Hg before Ramadan and 129 ± 19/74 ± 10 mm Hg during Ramadan (p &gt; 0.05). Daytime and night-time mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender. However, during Ramadan, those who took their treatment after dinner had significantly higher values of 24-hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the S’hour (p &lt; 0.05). Conclusions: In this study, there were no significant changes in systolic and diastolic blood pressures or in heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the S’hour is observed.

Insights From Matched Office and Ambulatory Blood Pressure in Youth: Clinical Relevance.

Information on the relationship between ambulatory blood pressure (ABP) and concurrently office blood pressure (BP) values in youth still suffers from limitations. We provide information on the differences between office BP and ABP, the factors related, and the clinical implications. Three thousand six hundred ninety matched measurements of office BP and ABP on the same day, from 2390 children, aged 5 to 15 years, of both sexes were eligible. Office BP was measured using an oscillometric device (Omron 705 IT) and 24-hour ABP using oscillometric SpaceLabs 90207. Average of office, 24-hour, daytime, nighttime, systolic, and diastolic BP and heart rate was calculated. BP categories according to the European guidelines and phenotype of mismatch office BP versus ABP were defined. Both daytime systolic and diastolic BP were higher than office BP with a progressive reduction of the differences from 5 to 15 years. The office minus daytime BP differences were the largest in normotensive subjects, less at high-normal, and reversed in hypertensive ones, independently of age and weight status. White coat and masked hypertension covered no more than 13.6% at all ages. In youth, it is inaccurate to obtain reference values for ABP by extrapolating from office BP values. The differences between office BP and ABP are minimal in children with office BP values in the range of hypertension, reinforcing the recommendation to use ABP measurement at the time to confirm hypertension.

Twenty-four-hour blood pressure and heart rate variability are reduced in patients on left ventricular assist device support.

Limited data exist on the circadian blood pressure (BP) and heart rate (HR) variations that occur in heart failure (HF) patients on left ventricular assist device (LVAD) support. We prospectively recorded clinic and 24-hour ambulatory BP and HR data in patients on HeartMate II LVAD support. Results were compared to HF patients with ejection fraction ≤30% and controls with no history of cardiovascular disease. Physiologic nocturnal BP and HR dipping was defined as a ≥10% decline compared to daytime values. Twenty-nine LVAD patients (age 59 ± 15 years, 76% male, 38% ischemic etiology), 25 HF patients (age 64 ± 13 years, 84% male, 32% ischemic etiology) and 26 controls (age 56 ± 9 years, 62% male) were studied. Normal nocturnal BP dipping was less frequent in LVAD patients (10%) than in HF patients (28%) and controls (62%) and reversed BP dipping (BP increase at night) was more common in LVAD patients (24%), compared to HF (16%) and controls (8%), (p < 0.001, for all comparisons). Physiologic HR reduction was less frequent in LVAD patients (14%), compared to HF (16%) and controls (59%) (p < 0.001, for all comparisons). Among LVAD patients, 36% exhibited sustained hypertension over the 24-hours and 25% had white-coat hypertension. Treatment of advanced HF with an LVAD does not restore physiologic circadian variability of BP and HR; additionally, BP was not adequately controlled in more than a third of LVAD patients, and a quarter of them exhibited white-coat hypertension. Future studies are warranted to confirm these findings and investigate prognostic and management implications in this population.

0103 Feasibility of examining component-specific effects of yogic breathing on heart rate variability during sleep: A three-arm pilot RCT

Abstract Introduction Wearable devices and mind-body interventions (MBIs) continue to receive widespread interest as tools for improving sleep. This study investigated the feasibility of using an automated electronic survey system and wearable heart rate (HR) monitor in the context of a fully remote clinical trial study to produce detailed measures of participant adherence, daily sleep quality, and associations with physiological outcomes captured by wearable devices. Methods Eighteen healthy participants (age 18-30yrs, 12 female) were randomized to one of three 8-week long interventions: slow-paced breathing (SPB, N=5, 24.6 ± 2.1 years, 4 female), mindfulness (M, N=6, 23.7 ± 3.7 years, 4 female), or yogic breathing (SPB+M, N=7, 24.3 ± 3.1 years). Participants completed two weeks of daily sleep logs prior to a virtual laboratory visit, consisting of a 60-min intervention-specific training with 20-min guided practice, and subsequent tasks including experimental stress induction. Participants started a 24-hour HR recording using a Polar H10 chest strap on the night prior. Then, participants were instructed to repeat their assigned intervention practice daily, using a guided audio similar to their initial training, while concurrently recording HR data and completing a detailed practice log. HR interbeat interval data were examined with spectral analysis using full spectrograms for inspection of timecourse and frequency-specific patterns in both the nocturnal recordings and daily practice sessions. Results Participants completed an average of 75% of daily practice sessions across the 8-week intervention period (SPB: 77%, M: 65%, SPB+M: 77%). An automated procedure was developed to analyze and visualize the timecourse of HRV-derived breathing patterns in the 754 completed practice sessions and 36 nocturnal recordings. The three groups were then successfully distinguishable based on breathing rates and mindfulness questionnaires. Nocturnal HR recordings demonstrated visually identifiable patterns of interindividual variability and intraindividual consistency. Statistical analysis is ongoing to further characterize these patterns. Conclusion These findings support feasibility for a fully remote, semi-automated clinical trial study assessing component-specific effects of these MBIs on sleep, including detailed spectral analysis of high-quality HR data. Future studies would benefit from examining scalability of this type of study design with wearable physiology in both clinical and nonclinical populations. Support (If Any) Pilot Research Grant, Osher Center for Integrative Medicine of Harvard Medical School and Brigham &amp; Women’s Hospital; National Institutes of Health (5T32HL007901-22)

Effect of ICD/CRT-D Implantation on Adverse Events and Readmission Rate in Patients with Chronic Heart Failure (CHF).

Objective To explore the effect of implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator (ICD/CRT-D) implantation on adverse events and the readmission rate in patients with chronic heart failure (CHF). Methods Sixty patients with CHF treated in our hospital from April 2019 to July 2021 were enrolled. The patients were randomly assigned into the control group and study group. The control group received routine intervention, and the study group received remote management with ICD/CRT-D implantation. Results First of all, we compared the general data of the two groups. There was no significant difference in LVEF, NYHA grade, concomitant disease, and history of arrhythmia (P > 0.05). Secondly, we compared the end-point events. In the study group, 5 cases of heart failure were readmitted, 0 cases died, and 4 cases were admitted to hospital with arrhythmia and ICD events, with a total incidence of 30.0%, while in the control group, 12 cases were rehospitalized with heart failure, 3 cases died, 25 cases were admitted with arrhythmia and ICD events, and the total incidence rate was 56.67% (P < 0.05). In terms of the readmission rate of patients with heart failure in grade NYHAII and grade III, among the patients with grade NYHAII, the number of patients with heart failure less than once in the study group was higher compared to that in the control group and the number of patients with heart failure ≥ once in the study group was lower compared to that in the control group (P < 0.05). Among the patients with grade NYHAIII, the number of patients with heart failure less than once in the study group was higher compared to that in the control group and the number of patients with heart failure ≥ once in the study group was lower compared to that in the control group. There exhibited no significant difference in the data (P > 0.05). Considering the occurrence of VT and VF events, the study team reported that 14 patients recorded a total of 276 ventricular arrhythmias: 261 ventricular tachycardia and 15 ventricular fibrillations. Among them, 24 VT (9.2%) and 4 VF (26.7%) were determined to be misrecognition of the equipment. A total of 178 ventricular arrhythmias were recorded in 13 patients in the control group, including 152 ventricular tachycardia and 26 ventricular fibrillations. Among them, 10 VT (6.6%) and 8 VF (30.8%) were determined as misrecognition of the device. In regard to the treatment results of the two groups, after admission to the hospital for radio frequency, ablation, and adjustment of drug treatment to reprogram control, the patients did not reappear to have CRT-D misidentification and misdischarged. Finally, we compared the diagnosis time of VT/VE events. The time from VT/VE events to diagnosis in 14 patients in the study group was 2.55 ± 1.41 days, and that in 13 patients in the control group was 37.32 ± 15.31 days. The discovery of ICD events in the study group was significantly earlier compared to that in the routine follow-up group (P < 0.05). This gives doctors enough time to assess the patient's condition and determine a further diagnosis and treatment plan. Conclusion Using ICD/CRT-D implantation to remotely monitor patients with CHF, through remote monitoring of the 24-hour average heart rate and the heart rate at rest and patient activity and other parameters and early intervention, the readmission rate caused by the deterioration of heart failure can be reduced. Compared with routine follow-up, remote monitoring significantly reduced the diagnosis time of VT/VE events.

Chromosomal Region 11p14.1 is Associated with Pharmacokinetics and Pharmacodynamics of Bisoprolol.

PurposeBisoprolol is a widely used beta-blocker in patients with cardiovascular diseases. As with other beta-blockers, there is variability in response to bisoprolol, but the underlying reasons for this have not been clearly elucidated. Our aim was to investigate genetic factors that affect bisoprolol pharmacokinetics (PK) and pharmacodynamics (PD), and potentially the clinical outcomes.Patients and MethodsPatients with non-ST elevation acute coronary syndrome were recruited prospectively on admission to hospital and followed up for up to 2 years. Patients from this cohort who were on treatment with bisoprolol, at any dose, had bisoprolol adherence data and a plasma sample, one month after discharge from index hospitalisation were included in the study. Individual bisoprolol clearance values were estimated using population pharmacokinetic modeling. Genome-wide association analysis after genotyping was undertaken using an Illumina HumanOmniExpressExome-8 v1.0 BeadChip array, while CYP2D6 copy number variations were determined by PCR techniques and phenotypes for CYP2D6 and CYP3A were inferred from the genotype. GWAS significant SNPs were analysed for heart rate response to bisoprolol in an independent cohort of hypertensive subjects.ResultsSix hundred twenty-two patients on bisoprolol underwent both PK and genome wide analysis. The mean (IQR) of the estimated clearance in this population was 13.6 (10.0–18.0) L/h. Bisoprolol clearance was associated with rs11029955 (p=7.17×10−9) mapped to the region of coiled-coil domain containing 34 region (CCDC34) on chromosome 11, and with rs116702638 (p=2.54×10−8). Each copy of the minor allele of rs11029955 was associated with 2.2 L/h increase in clearance. In an independent cohort of hypertensive subjects, rs11029955 was associated with 24-hour heart rate response to 4-week treatment with bisoprolol (p= 9.3×10−5), but not with rs116702638.ConclusionA novel locus on the chromosomal region 11p14.1 was associated with bisoprolol clearance in a real-world cohort of patients and was validated in independent cohort with a pharmacodynamic association.

HP07: A 24-hour heart rate variability analysis in Tunisian patients under hemodialysis is an indicator of autonomic nervous system activity

Heart rate variability (HRV) is a useful tool to evaluate autonomic nervous system activity in patients under hemodialysis (HD). The aim of the study was to evaluate the autonomic nervous system activity in Tunisian patients under HD using HRV analysis. Patients and methods: It was a prospective study including 27 patients under HD for at least 3 months. A Holter-ECG recording was realized for 48 hours. Time- and frequency-domain were analyzed. Statistical analysis were done using SPSS20. Results: The different HRV parameters were decreased. Only LF/HF ratio was increased indicating a deviation of the sympatico-vagal balance. The time-domain analysis showed a significant variation of the RR and the RMSSD during sleep-wake cycle. The latter parameters were increased during sleep. The frequency-domain analysis showed a significant increase in HF and LF during sleep. Nevertheless, LF/HF ratio decreased during sleep while the LF increased, however, without being significantly different. Conclusion: Our study showed an autonomic nervous system dysfunction in patients under HD. This dysfunction was characterized by a hyperactivation of the sympathetic system associated to a decreased parasympathetic activity. However, the physiological activation of the parasympathetic system during sleep was preserved. A HRV alteration is an independent cardiovascular risk factor.

Indications, contraindications, and clinical significance of Holter monitoring device

Holter electrocardiogram monitoring devices are mainly indicated to assess the 24-hour heart rate and rhythm, enabling clinicians and physicians to evaluate the underlying disorders, possibly arrhythmias. The clinical significance of these modalities was apparent in different clinical events, including cardiac and non-cardiac ones. Many applications and clinical advantages were reported since the device was first reported, which changed the way how healthcare settings deal with and monitor cardiac rhythm and associated abnormalities. Evidence shows that Holter monitoring devices are useful in the appropriate patient populace and are very efficacious in diagnosing and following cardiac arrhythmias and other different cardiac conditions, which can significantly enhance the prognosis and management of cardiovascular patients. In this context, it has been shown that primary healthcare physicians should always be aware that many patients might be present with asymptomatic cardiac arrhythmias. However, not many studies have adequately assessed them in the non-cardiac population, which calls for conducting more future investigations. In the present literature review study, we aim to discuss the indications, contraindications, and clinical significance of using the Holter monitoring device based on data from the relevant studies in the literature.

24-hour Heart Rate, Sleep, and Autonomic Nerves in Children

24-hour Heart Rate, Sleep, and Autonomic Nerves in Children

Indications, Contraindications, and Clinical Significance of Holter Monitoring Device

Holter electrocardiogram monitoring devices are mainly indicated to assess the 24-hour heart rate and rhythm, enabling clinicians and physicians to evaluate the underlying disorders, possibly arrhythmias. The clinical significance of these modalities was apparent in different clinical events, including cardiac and non-cardiac ones. Many applications and clinical advantages were reported since the device was first reported, which changed the way how healthcare settings deal with and monitor cardiac rhythm and associated abnormalities. Evidence shows that Holter monitoring devices are useful in the appropriate patient populace and are very efficacious in diagnosing and following cardiac arrhythmias and other different cardiac conditions, which can significantly enhance the prognosis and management of cardiovascular patients. In this context, it has been shown that primary healthcare physicians should always be aware that many patients might be present with asymptomatic cardiac arrhythmias. However, not many studies have adequately assessed them in the non-cardiac population, which calls for conducting more future investigations. In the present literature review study, we aim to discuss the indications, contraindications, and clinical significance of using the Holter monitoring device based on data from the relevant studies in the literature.

The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura

Objective: Henoch-Schonlein Purpura (HSP) is the most common vasculitis of childhood. The aim of this study is to determine the prevalence and type of cardiac involvement on Henoch-schonlein purpura. Materials and Methods: In this study 38 children with Henoch-Schonlein Purpura (HSP) (patient group) and 20 healthy children (control group) were included. Physical examination, electrocardiography, echocardiography (ECG) and 24 hours Holter monitoring was performed. Results: The mean age of patient and control groups were 9.3±3.2 years (range: 4-17 years) and 9.7±3 years (range: 4-14 years), respectively. Also the female to male ratios were 1.37 and 0.66, respectively. The percentage of involvement of systems and organs were as following; skin 100%, joint 71%, gastrointestinal system 71%, kidney 31%. The mean heart rate in ECG was significantly higher in patient group (p=0.03). The mean values of aortic valve velocity and pulmonary valve velocity were significantly lower in patient group than control group (p 0.05). In patient group minimal pericardial effusion was detected in only one case. In 24-hour Holter monitoring mean heart rate values (p>0.05) and heart rate variability parameters were similar between patient and control groups (p>0.05). Also no clinically important arrhythmia and other conduction disorders were detected in both groups. Conclusion: Cardiac involvement in patients with HSP is not common. The patients may be assessed with the echocardiography if signs and symptoms related to cardiac involvement were observed.