Administration Of Antiarrhythmic Drugs Research Articles

Pregnancy Arrhythmias: Management in the Emergency Department and Critical Care.

Pregnancy is closely associated with an elevated risk of arrhythmias, constituting the predominant cardiovascular complication during this period. Pregnancy may induce the exacerbation of previously controlled arrhythmias and, in some instances, arrhythmias may present for the first time in pregnancy. The most important proarrhythmic mechanisms during pregnancy are the atrial and ventricular stretching, coupled with increased sympathetic activity. Notably, arrhythmias, particularly those originating in the ventricles, heighten the likelihood of syncope, increasing the potential for sudden cardiac death. The effective management of arrhythmias during the peripartum period requires a comprehensive, multidisciplinary approach from the prepartum to the postpartum period. The administration of antiarrhythmic drugs during pregnancy necessitates meticulous attention to potential alterations in pharmacokinetics attributable to maternal physiological changes, as well as the potential for fetal adverse effects. Electric cardioversion is a safe and effective intervention during pregnancy and should be performed immediately in patients with hemodynamic instability. This review discusses the pathophysiology of arrythmias in pregnancy and their management.

Factors influencing early recurrence of atrial fibrillation among elderly patients following radiofrequency catheter ablation and the impact of different antiarrhythmic regimens.

Patients with atrial fibrillation (AF) who undergo radiofrequency catheter ablation (RFCA) necessitate the administration of antiarrhythmic drugs to prevent early recurrence. The clinical outcomes among these patients may be influenced by varying antiarrhythmic regimens. To identify the risk factors associated with early recurrence and compare the clinical outcomes among different antiarrhythmic regimens in elderly patients with AF following radiofrequency catheter ablation (RFCA) during a 3-month period. A retrospective observational study encompassed 420 elderly patients with AF following RFCA. Baseline data were collected during the initial postoperative visit and clinical outcomes were carefully monitored over a 3-month follow-up period. Logistic regression and Cox-proportional hazard regression analyses were performed to investigate the relationship between various antiarrhythmic regimens and the clinical outcomes. Multivariate logistic regression analysis revealed that age (p = 0.001), left atrial diameter (p < 0.001), left ventricular diameter (p = 0.015), reactive hyperemia index (RHI) (p < 0.001), antiarrhythmic drug (p < 0.001) and hs-cTnI (p = 0.017) were independent risk factors of early recurrence. Furthermore, in cox survival regression analysis model, survival rate of early recurrence in the amiodarone group was higher than in the propafenone group (HR 2.30, 95%CI 1.17-4.53, p = 0.016) and in the sotalol group (HR 3.60, 95%CI 2.17-5.95, p < 0.001). Compared to the amiodarone group, the incidence of liver dysfunction was lower in the dronedarone group (p = 0.046) and the propafenone group (p = 0.021). The incidence of bradyarrhythmia (p = 0.003), QT interval prolongation (p = 0.035) and atrioventricular transmission block (p = 0.021) were higher in the sotalol group than in the amiodarone group. RHI was identified as an independent risk factor for early recurrence among elderly AF patients after RFCA. Compared to amiodarone, propafenone and sotalol exhibited an elevated risk of early recurrence. Although there was no significant difference in early recurrence between amiodarone and dronedarone, dronedarone emerged as the preferred option due to its lower frequency of adverse drug reactions than amiodarone.

Anthracyclines and the risk of arrhythmias: A systematic review and meta-analysis.

There have been controversial findings from recent studies regarding anthracyclines use and the subsequent risk of arrhythmias. This study aimed to evaluate the existing evidence of the risk of arrhythmias in patients treated with anthracyclines. PubMed, Scopus, and Web of Science databases were searched up to April 2022 using keywords such as "anthracycline" and "arrhythmia." Dichotomous data were presented as relative risk (RR) and confidence interval (CI), while continuous data were presented as mean difference (MD) and CI. Revman software version 5.4 was used for the analysis. Thirteen studies were included with a total of 26891 subjects. Pooled analysis showed that anthracyclines therapy was significantly associated with a higher risk of arrhythmia (RR: 1.58; 95% CI: 1.41-1.76; P < .00001), ST segment and T wave abnormalities (RR: 1.73, 95% CI: 1.18-2.55, P = .005), conduction abnormalities and AV block (RR = 1.86, 95% CI = 1.06-3.25, P = .03), and tachycardia (RR: 1.736, 95% CI: 1.11-2.69, P = .02). Further analyses of the associations between anthracyclines and atrial flutter (RR = 1.30, 95% CI = 0.29-5.89, P = .74), atrial ectopic beats (RR: 1.27, 95% CI: 0.78-2.05, P = .34), and ventricular ectopic beats (RR: 0.93, 95% CI: 0.53-1.65, P = .81) showed no statistically significant results. Higher doses of anthracycline were associated with a higher risk of arrhythmias (RR: 1.49; 95% CI: 1.08-2.05; P = .02) compared to the lower doses (RR: 1.36; 95% CI: 1.00-1.85; P = .05). Newer generations of Anthracycline maintained the arrhythmogenic properties of previous generations, such as Doxorubicin. Anthracyclines therapy was significantly associated with an increased risk of arrhythmias. Accordingly, Patients treated with anthracyclines should be screened for ECG abnormalities and these drugs should be avoided in patients susceptible to arrhythmia. The potential benefit of the administration of prophylactic anti-fibrotic and anti-arrhythmic drugs should also be explored.

Abstract 18508: Usability of Novel Automated Software for Guiding Remote Titration of Antiarrhythmic Drugs

Introduction: We tested the first novel software application to accurately measure QTc using a machine learning algorithm from a mobile ECG and recommend patient-specific antiarrhythmic drug (AAD) dosing. The software was developed to address disparities in AAD hospitalizations that disproportionately affect minority patients. We evaluated the usability of the software interface using the validated Post-Study System Usability Questionnaire (PSSUQ) and mobile Health App Usability Questionnaire (MAUQ). Methods: Ten medical providers, 16 clinic staff, and 16 patients tested the novel software interface for remote titration of Sotalol and Dofetilide medications, followed by the validated PSSUQ and MAUQ surveys. An observer also evaluated each step of the software for completion and noted any challenges. Results: Providers rated the software interface highly, with an overall mean PSSUQ of 6.9 ± 0.2 and MAUQ of 6.8 ± 0.2, and 100% strongly agree on information quality (PSSUQ questions 7-12). Clinic staff and patients provided the highest ratings for system usefulness, with an overall PSSUQ mean of 6.4 ± 1.2 and MAUQ mean of 6.0 ± 1.2, ease of app use and user satisfaction, mean of 6.3 ± 1.1 and 5.9 ± 1.3 respectively. Eighty percent of users found the system easy to use and were satisfied, with 76% rating the app as an acceptable way to receive healthcare services and felt comfortable communicating with their providers using the app. Conclusion: The novel automated software application, designed to improve access to antiarrhythmic drugs and reduce healthcare disparities, received high usability ratings, indicating feasibility for remote administration of antiarrhythmic drugs.

Evaluation of the effectiveness of potassium chloride in the management of out-of hospital cardiac arrest by refractory ventricular fibrillation: Study protocol of the POTACREH study.

Out-of-hospital cardiac arrest (OHCA) has a poor prognosis, with an overall survival rate of about 5% at discharge. Shockable rhythm cardiac arrests (ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT)) have a better prognosis. In case of shockable rhythm, treatment is based on defibrillation, and thereafter, in case of failure of 3 external electric shocks (EES), on direct intravenous administration of 300 mg amiodarone, or lidocaine when amiodarone is unavailable or inefficient. During surgical procedures under extracorporeal circulation, a high potassium cardioplegia solution is administered to interrupt cardiac activity and facilitate surgical procedure. By extension, direct intravenous administration of potassium chloride (KCl) has been shown to convert VF, resulting in return to a hemodynamically efficient organized heart rate within a few minutes. The aim of this study is to provide clinical evidence that direct intravenous injection of KCl, into a patient presenting with OHCA due to refractory VF although 3 EES, should interrupt this VF and then allow rapid restauration of an organized heart rhythm, and thus return of spontaneous circulation (ROSC). A multicenter, prospective, single group, phase 2 study will be conducted on 81 patients presenting with refractory VF. After failure of 3 EES, each patient will receive direct intravenous injection of 20 mmol KCl instead of amiodarone. The primary outcome will be survival rate at hospital admission. Major secondary outcomes will include ROSC and time to ROSC in the prehospital setting, number of VF recidivism after KCl injection, survival rate at hospital discharge with a good neurologic prognostic, and survival rate 3 months after hospital discharge with a good neurologic prognostic. No patient is currently included in the study. Conventional guideline strategy based on antiarrhythmic drug administration, i.e. amiodarone or lidocaine, for OHCA due to shockable rhythm, has not yet demonstrated an increase in survival at hospital admission or at hospital discharge. This may be related to the major cardiodepressant effect of those drugs. ClinicalTrials.gov Identifier: NCT04316611. Registered on March 2020. AP-HP180577 / N° EUDRACT: 2019-002544-24. Funded by the French Health Ministry. https://clinicaltrials.gov/ct2/show/NCT04316611.

Hypothermia-induced accelerated idioventricular rhythm after cardiac surgery; a case report

BackgroundAccelerated idioventricular rhythm (AIVR) is a slow ventricular arrhythmia, commonly due to myocardial ischemia in coronary artery disease. It is a transitory rhythm that rarely causes hemodynamic instability or necessitates any specific therapy. Besides, the common predisposing factors for ventricular arrhythmias after open-heart surgery are hemodynamic instability, electrolyte imbalances, hypoxia, hypovolemia, myocardial ischemia and infarction, acute graft closure, reperfusion injury, and administration of inotropes and antiarrhythmic drugs. Here we report a case of AIVR after cardiac surgery, mostly due to hypothermia that to our knowledge, it is the first report.Case presentationWe describe a 76-year-old man presenting with typical chest pain. Following routine investigations, the patient underwent coronary artery bypass grafting. Postoperatively, he was transferred to the intensive care unit with good hemodynamic status. However, about 3 h later, he developed rhythm disturbances, leading to hemodynamic instability without response to volume replacement or inotropic support. His rhythm was AIVR, although, at first glance, it resembled the left bundle branch block. Given his unstable hemodynamic status, he was emergently transferred to the operating room. Cardiopulmonary bypass (CPB) was resumed for hemodynamic support. After the patient was rewarmed to about 35 ºC, AIVR returned to normal. He was weaned from CPB successfully and with an uneventful hospital course.ConclusionsHypothermia is a potential cause of rhythm disturbance. Preventing the causes of arrhythmias, including hypothermia, is the best strategy.

Efficacy of cryoablation versus antiarrhythmic therapy for treatment of atrial fibrillation: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) is a common arrhythmia that causes various complications if left untreated. Current primary care guidelines recommend administration of antiarrhythmic drugs (AAD) as the preferred treatment regimen for first diagnosed AF and considers ablation if there is failure of therapy. However, recent studies show the benefit of cryoablation on the initial treatment of AF. Purpose The primary objective of this study is to determine the efficacy and the safety of cryoablation therapy over AAD as treatment regimen for atrial fibrillation. Methods A comprehensive and relevant search of randomized controlled trials (RCT) was conducted examining the use of cryoablation as initial treatment of AF compared to AAD. Outcome measures for recurrence of atrial arrhythmias and serious adverse effects (SAEs) were extracted and analyzed using Review Manager 5.4. Fixed effects model was used initially for both outcomes; however, if there was substantial heterogeneity (I² &amp;gt; 50%), random effects model was then used. Results Four studies were included in the meta-analysis with a total of 969 subjects analyzed. Initially, a fixed effect model was used to compute for the Risk Ratio (RR) which yielded RR of 0.55 [95% CI: 0.49-0.63], I²=93, p &amp;lt; 0.0001. Since there was substantial heterogeneity among the four RCTs, a random effects model was then used. The heterogeneity may be attributed to the difference in study designs as some of the studies involved a cross-over design. Using the random effects model, the computed RR was 0.50 [95% CI: 0.33-0.85], I²=93, p = 0.01. Hence, cryoballoon therapy is found to be more beneficial in preventing recurrence of atrial arrhythmias. This result can be interpreted as statistically significant given that the p value is &amp;lt; 0.05. On the other hand, the fixed effects model revealed there was no significant difference between cryoballoon therapy and AAD in terms of SAE (RR 0.80 [95%CI: 0.58-1.10], I²=0, p=0.17). SAEs included in the studies included the following but not limited to death, stroke, acute coronary syndrome, syncope, pulmonary embolism, etc. Conclusion Cryoablation therapy is more beneficial in preventing atrial arrhythmias compared to AADs. The rate of serious adverse event is similar between cryoablation therapy and AAD.

Idiopathic left fascicular ventricular tachycardia in children and adolescents.

Idiopathic ventricular tachycardia (VT) in children with structurally normal hearts is generally unrelated to the risk of sudden arrhythmic death. Still, it may be associated with deterioration in the quality of life. VT involving the fascicular conduction system is the most typical form of idiopathic left VT. In this retrospective study, we describe the experience of the clinical presentation, catheter ablation, and long-term follow-up of left fascicular VT in children. An electrophysiological study was performed on consecutive children at a single tertiary center. Clinical fascicular left VT was induced by programmed stimulation, and catheter ablation was guided searching for Purkinje potentials. We included 18 patients (0.8 patients/year): 14 (77.8%) males and four females. The mean age of the first VT episode was 8.5 ± 5 years. Intravenous verapamil administration was effective for paroxysmal fascicular VT but not for prevention of recurrences. The mean age at the time of catheter ablation was 11.1 ± 3.8 years (8 months-16 years). The mean weight was 36.8 ± 16.4 kg (8.7-58 kg). A 100% success rate was observed with catheter ablation after repeated procedures without major complications. Mean follow-up was 2.0 ± 1.2 years (1.0-4.0 years, median 1.5), with permanent success in all patients and no antiarrhythmic drug administration. Fascicular VT has an adverse clinical course in children. In most cases, this condition is drug refractory. Catheter ablation is successful and safe treatment and should represent the first-line approach in symptomatic children.

Successful Recovery from Refractory Hypoxia Due to Right-to-Left Shunting Associated with Iatrogenic Atrial Septal Defect After Catheter Ablation in a Patient with a Left Ventricular Assist Device

<h3>Introduction</h3> Catheter ablation has been reported an effective therapeutic option for ventricular arrhythmias even in patients with a left ventricular assist device (LVAD). However, the issues of right-to-left shunting due to iatrogenic atrial septal defect (iASD) associated with procedures for catheter ablation have not been well documented. <h3>Case Report</h3> A 52-year-old male with a continuous-flow implantable LVAD and progressive right ventricular (RV) dysfunction was admitted because of refractory ventricular tachycardia (VT) and subsequent right heart failure. Since VT could not be controlled by intravenous administration of multiple antiarrhythmic drugs, VT ablation via the transseptal approach was performed. VT was terminated to the sinus rhythm after VT ablation; however, hypoxia associated with significant right-to-left shunting across the iASD was detected. Intensive medical management, such as an adjusted mechanical ventilator to increase pulmonary vascular resistance and adjustment of LVAD pump speed as well as the use of intravenous inotropes to support impaired RV function successfully stabilised the hemodynamic and improved hypoxia due to the disappearance of right-to-left shunting. <h3>Summary</h3> We described a rare case of refractory hypoxia due to significant right-to-left shunting via iASD after catheter ablation. The present case suggests that pre-existing impaired RV function may be responsible for the development of refractory right-to-left shunting after catheter ablation, and implies that evaluation of RV function prior to VT ablation via the transseptal approach is important in postoperative management in a patient with a LVAD.

Time to Antiarrhythmic and Association with Return of Spontaneous Circulation in the United States

Introduction Recent clinical trials have failed to identify a benefit of antiarrhythmic administration during cardiac arrest. However, little is known regarding the time to administration of antiarrhythmic drugs in clinical practice or its impact on return of spontaneous circulation (ROSC). We utilized a national EMS registry to evaluate the time of drug administration and association with ROSC. Methods We utilized the 2018 and 2019 NEMSIS datasets, including all non-traumatic, adult 9-1-1 EMS activations for cardiac arrests with initial shockable rhythm and that received an antiarrhythmic. We calculated the time from 9-1-1 call to administration of antiarrhythmic. We excluded cases with erroneous time stamps. Stratified by initial antiarrhythmic (amiodarone and lidocaine), we created a mixed-effect logistic regression model evaluating the association between every 5-minute increase in time to antiarrhythmic and ROSC. We modeled EMS agency as a random intercept and adjusted for confounders. Results There were 449,630 adults, non-traumatic cardiac arrests identified with 11,939 meeting inclusion criteria. 9,236 received amiodarone and 1,327 received lidocaine initially. The median time in minutes to initial dose for amiodarone was 19.9 minutes (IQR 15.8–25.6) and for lidocaine was 19.5 minutes (IQR 15.2–25.4). Increasing time to initial antiarrhythmic was associated with decreased odds of ROSC for both amiodarone (aOR 0.9; 95% CI 0.9–0.94) and lidocaine (aOR 0.9; 95% CI 0.8–0.97). Conclusion Time to administration of anti-arrhythmic medication varied, but most patients received the first dose of anti-arrhythmic drug more than 19 minutes after the initial 9-1-1 call. Longer time to administration of an antiarrhythmic in patients with an initial shockable rhythm was associated with decreased ROSC rates.

Abstract 11399: Time to Anti-Arrhythmic for Out-of-Hospital Cardiac Arrest

Introduction: Initial shockable rhythm is the strongest predictor of good outcomes for patients with out-of-hospital cardiac arrest (OHCA). While preclinical models have shown benefit of anti-arrhythmics, clinical trials have shown a very modest impact of anti-arrhythmic drugs, possibly related to real-life delays in drug administration. Little is known regarding the time to administration of anti-arrhythmic drugs or the association of time to drug and outcome. We utilized a national EMS registry to evaluate the time of drug administration and the association with outcomes. Methods: We evaluated the 2018 and 2019 NEMSIS dataset, including all non-traumatic, adult 911 EMS encounters for cardiac arrests with initial shockable rhythm. We then calculated the time from 911 call to administration of anti-arrhythmic. We excluded cases with time to administration less than 0 or greater than 120 minutes. Stratified by initial antiarrhythmic (amiodarone and lidocaine), we created a mixed-effect logistic regression model evaluating the association between every 5 minute increase in time to antiarrhythmic and ROSC. We modeled EMS agency as a random intercept and adjusted the analysis for age, sex, race, bystander witnessed arrest, location of arrest and EMS response time. We excluded EMS witnessed arrests and cases with missing ROSC data. Results: There were 449,630 adult, non-traumatic cardiac arrests identified with 55,142 patients (12.3%) having an initial shockable rhythm; 17,769 (32.2%) received amiodarone and 2,855 (5.2%) received lidocaine initially. The median time in minutes to initial dose of amiodarone was 20.4 with IQR (16-26.7). The median time in minutes to initial dose of lidocaine administration was 20.2 with IQR (15.7-27.0). Increasing time to initial antiarrhythmic was associated with decreased odds of ROSC for both amiodarone (aOR 0.9; 95% CI 0.9-0.94) and lidocaine (aOR 0.9; 95% CI 0.8-0.96). Conclusion: Time to administration of anti-arrhythmic medication varied, but most patients received the first does of anti-arrhythmic drug more than 20 minutes after the initial 911 call. Time to administration of antiarrhythmic was linked to ROSC.

Spatial Changes in the Atrial Fibrillation Wave-Dynamics After Using Antiarrhythmic Drugs: A Computational Modeling Study.

Background: We previously reported that a computational modeling-guided antiarrhythmic drug (AAD) test was feasible for evaluating multiple AADs in patients with atrial fibrillation (AF). We explored the anti-AF mechanisms of AADs and spatial change in the AF wave-dynamics by a realistic computational model.Methods: We used realistic computational modeling of 25 AF patients (68% male, 59.8 ± 9.8 years old, 32.0% paroxysmal AF) reflecting the anatomy, histology, and electrophysiology of the left atrium (LA) to characterize the effects of five AADs (amiodarone, sotalol, dronedarone, flecainide, and propafenone). We evaluated the spatial change in the AF wave-dynamics by measuring the mean dominant frequency (DF) and its coefficient of variation [dominant frequency-coefficient of variation (DF-COV)] in 10 segments of the LA. The mean DF and DF-COV were compared according to the pulmonary vein (PV) vs. extra-PV, maximal slope of the restitution curves (Smax), and defragmentation of AF.Results: The mean DF decreased after the administration of AADs in the dose dependent manner (p < 0.001). Under AADs, the DF was significantly lower (p < 0.001) and COV-DF higher (p = 0.003) in the PV than extra-PV region. The mean DF was significantly lower at a high Smax (≥1.4) than a lower Smax condition under AADs. During the episodes of AF defragmentation, the mean DF was lower (p < 0.001), but the COV-DF was higher (p < 0.001) than that in those without defragmentation.Conclusions: The DF reduction with AADs is predominant in the PVs and during a high Smax condition and causes AF termination or defragmentation during a lower DF and spatially unstable (higher DF-COV) condition.

Comparative Characteristics of Beta-Blockers in Patients with Congenital Long QT Syndrome

Congenital long QT syndrome is a pathology that requires special attention and knowledge about the safety and effectiveness of various medications. Prolongation of the QT interval due to congenital or acquired causes is an important factor in the development of an unfavorable life forecast with the formation of an elongated QT syndrome. With an unfavorable course, patients suffer from loss of consciousness, episodes of tachycardia. Often, stable polymorphic ventricular tachycardia develops. The risk of sudden cardiac death in this pathology can vary from 0.33% to 5%. In people who have suffered an episode of cardiac arrest, and do not have a permanent prescribed antiarrhythmic therapy, the mortality rate reaches 50% within 15 years. Preventive administration of antiarrhythmic drugs is not always effective. A positive result of treatment depends on the severity of long QT syndrome and its genotype. Beta-blockers are often prescribed to patients of different ages with various cardiac pathologies, including for the prevention of arrhythmia in long QT syndrome. Beta-blockers differ in various pharmacokinetic and pharmacodynamic parameters (lipophilicity/hydrophilicity, selectivity, presence/absence of internal sympathomimetic activity), which, along with the variant of the disease genotype, can affect their effectiveness and safety in the considered pathology. This review article presents the results of major studies on the safety and effectiveness of different groups of beta blockers in various variants of long QT syndrome. The preferred beta-blockers for various genotypes of the syndrome were determined, and a comparative characteristic of beta-blockers for their safety and preventive effectiveness was given.

Treatment of Fetal Arrhythmias.

Fetal arrhythmias are mostly benign and transient. However, some of them are associated with structural defects or can cause heart failure, fetal hydrops, and can lead to intrauterine death. The analysis of fetal heart rhythm is based on ultrasound (M-mode and Doppler echocardiography). Irregular rhythm due to atrial ectopic beats is the most common type of fetal arrhythmia and is generally benign. Tachyarrhythmias are diagnosed when the fetal heart rate is persistently above 180 beats per minute (bpm). The most common fetal tachyarrhythmias are paroxysmal supraventricular tachycardia and atrial flutter. Most fetal tachycardias can be terminated or controlled by transplacental or direct administration of anti-arrhythmic drugs. Fetal bradycardia is diagnosed when the fetal heart rate is slower than 110 bpm. Persistent bradycardia outside labor or in the absence of placental pathology is mostly due to atrioventricular (AV) block. Approximately half of fetal heart blocks are in cases with structural heart defects, and AV block in cases with structurally normal heart is often caused by maternal anti-Ro/SSA antibodies. The efficacy of prenatal treatment for fetal AV block is limited. Our review aims to provide a practical guide for the diagnosis and management of common fetal arrythmias, from the joint perspective of the fetal medicine specialist and the cardiologist.

Impact of rate control in hospitalized patients with atrial fibrillation and sepsis: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Fibrillation (AF) is a common complication in patients with sepsis, and imposes a worse prognosis and challenging clinical management. Administration of antiarrhythmics is often needed, to achieve rate or rhythm control, especially in the occurrence of AF with rapid ventricular response; however, it is unclear whether different classes of antiarrhythmics are associated with better outcomes in patients with sepsis and AF. Methods We performed a systematic review and meta-analysis according to PRISMA Guidelines. Pubmed and EMBASE databases were systematically searched for studies reporting outcomes in patients with sepsis and AF, according to the use of Beta-blockers (BBs), calcium-channel blockers (CCBs), digoxin and amiodarone. Random-effect models were used to provide pooled estimates; fixed-effect models were also performed as a sensitivity analysis. Results Among 4,166 studies, 2 articles were included from the literature search, and an additional 1 from the author’s knowledge, yielding a total of 40,593 patients with sepsis and AF included. According to the data available from the included studies, the meta-analysis was performed only for in-hospital mortality. BBs were associated with a reduced risk of in-hospital mortality compared to amiodarone (OR 0.52, 95% CI: 0.46-0.58; I2 = 0%, Figure 1, Panel C), while no significant differences were observed for BBs. vs. CCBs (Figure 1, Panel A) and for BBs vs. digoxin (Figure 1, Panel B). In the pre-specified sensitivity analysis using a fixed-effect model, BBs resulted associated with a lower risk of in-hospital mortality compared with both CCBs and digoxin). Conclusion In patients with AF during sepsis, BBs were associated with reduced risk of in-hospital mortality, compared to amiodarone; inconclusive results emerged for the comparisons between BBs and CCBs or digoxin, although with a benefit of BBs observed in the fixed-effect models. Further studies are needed to provide definitive data and to guide physicians in the choice of the best rate control strategy in this clinical setting. Abstract Figure.

Direct analysis in real time-mass spectrometry for rapid quantification of five anti-arrhythmic drugs in human serum: application to therapeutic drug monitoring

Therapeutic drug monitoring (TDM) is necessary for the optimal administration of anti-arrhythmic drugs in the treatment of heart arrhythmia. The present study aimed to develop and validate a direct analysis in real time tandem mass spectrometry (DART–MS/MS) method for the rapid and simultaneous determination of five anti-arrhythmic drugs (metoprolol, diltiazem, amiodarone, propafenone, and verapamil) and one metabolite (5-hydroxy(OH)-propafenone) in human serum. After the addition of isotope-labeled internal standards and protein precipitation with acetonitrile, anti-arrhythmic drugs were ionized by DART in positive mode followed by multiple reaction monitoring (MRM) detection. The use of DART–MS/MS avoided the need for chromatographic separation and allowed rapid and ultrahigh throughput analysis of anti-arrhythmic drugs in a total run time of 30 s per sample. The DART–MS/MS method yielded satisfactory linearity (R2 ≥ 0.9906), accuracy (86.1–109.9%), and precision (≤ 14.3%) with minimal effect of biological matrixes. The method was successfully applied to analyzing 30 clinical TDM samples. The relative error (RE) of the concentrations obtained by DART–MS/MS and liquid chromatography-tandem mass spectrometry (LC–MS/MS) was within ± 13%. This work highlights the potential usefulness of DART for the rapid quantitative analysis of anti-arrhythmic drugs in human serum and gives rapid feedback in the clinical TDM practices.

Successful trans-maternal nadolol pharmacotherapy in a fetus presenting with long QT syndrome type 2 complicated by torsade de pointes

Fetuses with congenital long QT syndrome (LQTS) may experience life-threatening arrhythmias, such as torsade de pointes (TdP), and/or functional atrioventricular block. However, trans-maternal pharmacotherapy for these cases is rarely reported and management practices have yet to be established. The fetus of a mother with genetically-confirmed LQTS type 2 (LQT2) presented with complex arrhythmias, diagnosed via magnetocardiography as ventricular arrhythmias (including TdP), at 28 weeks of gestation. After initiation of trans-maternal nadolol administration at 15 mg/d initial dosage and 30 mg/d subsequent dosage, the frequency of fetal ventricular arrhythmias decreased and almost disappeared within several days. The mother gave birth to the baby at full term without significant complications in either the mother or fetus. This is the first report that demonstrates the efficacy and safety of trans-maternal administration of nadolol for treatment of symptomatic LQT2 fetuses with TdP.<Learning objective: Prenatal diagnosis of congenital long QT syndrome (LQTS) is challenging, but characteristic arrhythmias, including sinus bradycardia, intermittent atrioventricular block and torsade de pointes (TdP), as well as family history of LQTS, can be clues to the diagnosis. If TdP is diagnosed in the fetus, trans-maternal administration of anti-arrhythmic drugs, such as beta-blockers, sodium channel blockers, and magnesium, could be effective to restore sinus rhythm and avoid intrauterine fetal death.>

Association between Bone Marrow Mesenchymal Stem Cell Characterizations and the Administration of Antiarrhythmic Drugs in Patients with Severe Left Ventricular Dysfunction after Off-Pump Bypass Surgery

Background and Aim: Atrial fibrillation is the most common arrhythmia after coronary artery bypass grafting (CABG) and occurs in up to 30% of patients with heart failure. Mesenchymal stem cells (MSCs) can regenerate and improve cardiac function after tissue damage and are used in clinical trials. Due to the possible ability of MSCs to improve cardiac functions, in this work, we aimed to examine the probable association of the MSCs proliferation rate with the requirement for antiarrhythmic drugs in patients with severe left ventricular dysfunction after off-pump CABG. Methods: Bone marrow samples were obtained from the sternum of 30 patients who underwent off-pump CABG at Afshar Hospital and Seyed Al-Shohada Hospital. For calculating MSCs doubling time, the cells were counted after 4, 7, and 14 days using trypan-blue color and a hemocytometer. Results: There were no significant differences between MSCs' doubling time and the patient's age and gender. The percentage of women patients who require antiarrhythmic medicine was significantly higher than men after surgery. Also, we demonstrated that the BMSCs doubling time in female patients who received antiarrhythmic drugs was less than that of male patients who received antiarrhythmic drugs, but these differences were not significant. Conclusion: Based on this research, we concluded that women patients who received antiarrhythmic drugs were significantly higher than men, but there was no apparent relevancy between MSCs doubling time and antiarrhythmic drugs requirement in patients with severe left ventricular dysfunction. *Corresponding Author: Zakieh Sadat Sheikhalishahi; Email: z.sheikhalishahi@gmail.com Please cite this article as: Esmailidehaj M, Mirhosseini SJ, Sheikhalishahi ZS. Association between Bone Marrow Mesenchymal Stem Cell Characterizations and the Administration of Antiarrhythmic Drugs in Patients with Severe Left Ventricular Dysfunction after Off-Pump Bypass Surgery. Arch Med Lab Sci. 2020;6:1-5 (e2). https://doi.org/10.22037/amls.v6.31297

Yenidoğanda Dirençli Supraventriküler Taşikardi Olgusu

Supraventricular tachycardia is more severe in newborns when compared to children from other age groups. Methods such as medical treatment, synchronized cardioversion, and ablation treatment are used in order to restore the patients to sinus rhythm. In this article, the phenomenon of persistent supraventricular tachycardia in newborns, in which a response cannot be obtained form various antiarrhythmic agents and synchronized cardioversion, is presented. Furthermore, the significance of the preparation process in order to provide careful administration of antiarrhythmic drugs, the prevention of severe complications based on synchronized cardioversion and the significance of discharge training process in order to prevent the recurrence of the attacks are emphasized

P3356Antiarrhythmic therapy with amiodarone decreases the uptake of 82-Rubidium-PET: studies in a rodent model

Abstract Introduction Myocardial perfusion imaging using positron emission tomography (PET) with 82Rubidium (82Rb) is used as a standard clinical examination. 82Rb-PET provides important information for the correct diagnosis and aids in prognostic risk assessment in patients with ischemic heart disease. 82Rb enters the myocardial cells by active transport of the sodium/potassium adenosine triphosphate transporter. Some antiarrhythmic drugs inhibits sodium/potassium adenosine triphosphate transporter. Purpose To determent if the uptake of 82Rb-PET using standard uptake value (SUV) is affected by administration of antiarrhythmic drugs. Methods Twenty-one Sprague-Dawley rats were baseline PET/CT scanned with 82Rb, using a Siemens preclinical PET/CT Inveon MM system and a Cardiogen-82 Rb generator. After baseline scan, the rats were divided into three groups. One control group without any treatment, and two received treatment with either orally administered Metoprolol 50mg/kg/24h or orally administered Amiodarone 120mg/kg/24h for seven days. All three groups were again PET/CT scanned with 82Rb-PET after the last administration on day seven. Data are presented as mean ±SEM. Results In the control group, there was no difference in mean SUV in the heart from day one to day seven (SUVmean 3.47±0.11 vs 3.45±0.35 p=0.97). In the group treated with metoprolol, likewise there was no difference in mean SUV in the heart from day one to day seven (SUVmean 3.87±0.13 vs 4.4±0.21 p=0.096). In contrast, in the group treated with amiodarone there was a significant difference in mean SUV from day one to day seven (SUVmean 4.14±0.15 vs 3.38±0.18 p=0.001). In all three groups there was no difference in mean SUV from day one to day seven in the liver and kidney. Conclusions The antiarrhythmic drug amiodarone had a clear impact on SUVmean in the heart. To the best of our knowledge, this is the first time it has been shown, that amiodarone lowers the SUV in 82Rb-PET in the heart. Amiodarone therefore seems to change to uptake of 82Rb in the myocyte. This could potentially influence the calculation to estimate absolute flow through the coronary arteries and lead to wrong conclusions regarding myocardial perfusion in patients treated with amiodarone. Further studies are needed to characterize the mechanism and to confirm the effect clinically.