Arrhythmic Episodes Research Articles

Continuous ECG monitoring versus mobile telemetry: A comparison of arrhythmia diagnostics in human- versus algorithmic-dependent systems.

BackgroundClinicians rarely scrutinize the full disclosure of a myriad of FDA-approved long-term rhythm monitors, and they rely on manufacturers to detect and report relevant rhythm abnormalities.ObjectiveThe objective of this study is to compare the diagnostic accuracy between mobile cardiac telemetry (MCT), which uses an algorithm-based detection strategy, and continuous long-term electrocardiography (LT-ECG) monitoring, which uses a human-based detection strategy.MethodsIn an outpatient arrhythmia clinic, we enrolled 50 sequential patients ordered to wear a 30-day MCT, to simultaneously wear a continuous LT-ECG monitor. Periods of concomitant wear of both devices were examined using the associated report, which was over-read by 2 electrophysiologists.ResultsForty-six of 50 patients wore both monitors simultaneously for an average of 10.3 ± 4.4 days (range: 1.2–14.8 days). During simultaneous recording, patients were more often diagnosed with arrhythmia by LT-ECG compared to MCT (23/46 vs 11/46), P = .018. Similarly, more arrhythmia episodes were detected during simultaneous recording with the LT-ECG compared to MCT (61 vs 19), P < .001. This trend remained consistent across arrhythmia subtypes, including ventricular tachycardia (13 patients by LT-ECG vs 7 by MCT), atrioventricular (AV) block (3 patients by LT-ECG vs 0 by MCT), and AV node reentrant tachycardia (2 patients by LT-ECG vs 0 by MCT). Atrial fibrillation (AF) was documented by both monitors in 2 patients; however, LT-ECG monitoring captured 4 additional AF episodes missed by MCT.ConclusionIn a time-controlled, paired analysis of 2 disparate rhythm monitors worn simultaneously, human-dependent LT-ECG arrhythmia detection significantly outperformed algorithm-based MCT arrhythmia detection.

Mediastinal lymph node dissection in older patients with non-small cell lung cancer.

We evaluated the impact of omitting mediastinal lymph node dissection (MLND) from the surgical treatment of non-small cell lung cancer (NSCLC) in older patients. We collected data retrospectively on 2475 patients who underwent pulmonary resection for NSCLC at our hospital between June, 2006 and December 2018. The subjects of this analysis were 209 patients aged ≥ 75years who underwent lobectomy for cN0-1 NSCLC. The patients were divided into two groups based on whether they underwent MLND (ND2 group) or not (group ND0-1). There were more patients aged ≥ 80years in the ND0-1 group than in the ND2 group (p < 0.001). Patients in the ND0-1 group had clinically earlier stage lung cancers than those in the ND2 group (p = 0.053). We matched patient characteristics in the ND0-1 and ND2 groups by age, tumor diameter, cN, histology, and radiological findings. There were no significant differences in overall survival between the groups (p = 0.295). More patients in the ND2 group suffered complications (41.6% vs. 27.3%, p = 0.061) and arrhythmia episodes than those in the ND0-1 group (14.3% vs. 3.9%, p = 0.021). MLND in older patients may not extend survival but it could lead to complications. Thus, the omission of MLND may be considered for patients of advanced age.

Signal Quality Assessment of a Novel ECG Electrode for Motion Artifact Reduction.

Background: The presence of noise is problematic in the analysis and interpretation of the ECG, especially in ambulatory monitoring. Restricting the analysis to high-quality signal segments only comes with the risk of excluding significant arrhythmia episodes. Therefore, the development of novel electrode technology, robust to noise, continues to be warranted. Methods: The signal quality of a novel wet ECG electrode (Piotrode) is assessed and compared to a commercially available, commonly used electrode (Ambu). The assessment involves indices of QRS detection and atrial fibrillation detection performance, as well as signal quality indices (ensemble standard deviation and time–frequency repeatability), computed from ECGs recorded simultaneously from 20 healthy subjects performing everyday activities. Results: The QRS detection performance using the Piotrode was considerably better than when using the Ambu, especially for running but also for lighter activities. The two signal quality indices demonstrated similar trends: the gap in quality became increasingly larger as the subjects became increasingly more active. Conclusions: The novel wet ECG electrode produces signals with less motion artifacts, thereby offering the potential to reduce the review burden, and accordingly the cost, associated with ambulatory monitoring.

Electrophysiological effects and clinical utility of propafenone in children.

This retrospective case series study sought to describe the safety and clinical effectiveness of propafenone for the control of arrhythmias in children with and without CHD or cardiomyopathy. We reviewed baseline characteristics and subsequent outcomes in a group of 63 children treated with propafenone at 2 sites over a 15-year period Therapy was considered effective if no clinically apparent breakthrough episodes of arrhythmias were noted on the medication. Sixty-three patients (29 males) were initiated on propafenone at a median age of 2.3 years. CHD or cardiomyopathy was noted in 21/63 (33%). There were no significant differences between demographics, clinical backgrounds, antiarrhythmic details, side effect profiles, and outcomes between children with normal hearts and children with CHD or cardiomyopathy. Cardiac depression at the initiation of propafenone was more common amongst children with CHD or cardiomyopathy compared to children with normal hearts. Systemic ventricular function was diminished in 15/63 patients (24%) prior to starting propafenone and improved in 8/15 (53%) of patients once better rhythm control was achieved. Other than one child in whom medication was stopped due to gastroesophageal reflux, no other child experienced significant systemic or cardiac side effects during treatment with propafenone. Propafenone achieved nearly equal success in controlling arrhythmias in both children with normal hearts and children with congenital heart disease or cardiomyopathy (90% versus 86%, p = 0.88). Propafenone is a safe and effective antiarrhythmic medication in children.

B-PO03-172 PREDICTORS OF IBRUTINIB TREATMENT INTERRUPTION SECONDARY TO ARRHYTHMIAS

Ibrutinib, a tyrosine kinase inhibitor (TKI), used in chronic lymphocytic leukemia, has been associated with increased incidence of atrial fibrillation (AF); with known treatment interruptions due to intractable AF episodes. The details of arrhythmic episodes that are associated with treatment interruptions remain unclear. To determine predictors of ibrutinib treatment interruption secondary to arrhythmias. A retrospective data analysis at a single center using electronic medical records database search tools and individual chart review was conducted to identify consecutive patients who had holter monitors while on ibrutinib therapy. 72 patients who had holter monitors while on ibrutinib therapy were included in analysis. Mean age was 76.9±9.9 years, 25% were female and the average duration of ibrutinib treatment was 32.3±22 months. Ibrutinib treatment was interrupted in n=18 (25%) of patients due to arrhythmias and n=9 (12.5%) were initiated on anti-arrhythmic medications due to arrhythmias secondary to ibrutinib therapy. Interruptions in ibrutinib therapy were associated with >1% PAC burden on holter monitor while on ibrutinib therapy (p=0.002) and a prior history of VT (p=0.005); but not with >1% PVC burden (p=0.285), presence of SVT (p=0.747), AF (p=0.292) or NSVT (p=0.147) on holter monitor. Patients in whom ibrutinib was held for arrhythmias were more likely to be seen by an electrophysiology specialist (p=0.041), along with patients on ibrutinib whose holter monitors showed NSVT (p=0.011). Female patients were referred to a cardiac specialist less than their male counterparts (p=0.051). In this large dataset of holter monitors on patients treated with ibrutinib, interruptions in TKI therapy correlated with certain arrhythmia patterns that could predate intractable arrhythmias and drug cessation in the future; which can help identify patients who may benefit from closer monitoring.

Stellate ganglion blockade for treating refractory electrical storm: a historical cohort study.

Stellate ganglion blockade (SGB) has been used to treat electrical storm (ES) refractory to antiarrhythmic therapy or to stabilize patients before more definitive intervention. Nevertheless, its efficacy is not well understood, with only a few case reports and retrospective case series in the literature. We conducted a historical cohort study on patients with drug-refractory ES who underwent ultrasound-guided unilateral SGB from 1 January 2010 until 19 July 2019 at two hospital sites. Stellate ganglion blockade was performed with variable combinations of bupivacaine, lidocaine, ropivacaine, and dexamethasone. We collected data on demographic and procedural characteristics, the number of arrhythmias and defibrillation episodes, antiarrhythmic and anticoagulant medication, left ventricular ejection fraction (EF), and respiratory support requirement. We identified N = 13 patients; their mean (standard deviation [SD]) age was 64 (13) yr, and 10 (77%) were male. The baseline mean (SD) number of overall arrhythmia and defibrillation episodes per day were 9 (6) and 4 (3), respectively; the mean (SD) pre-SGB EF was 23 (7)%. Seven patients (54%) received dexamethasone in addition to local anesthetic for SGB. One patient experienced hypotension after SGB. Arrhythmias and defibrillation episodes significantly decreased at 24, 48, 72, and 96 hr after SGB; at 96 hr, 62% and 92% of patients had no VA and defibrillation episodes, respectively (P < 0.001 for all time points). Ejection fraction and the number of patients receiving antiarrhythmic medications or requiring respiratory support were unchanged. Unilateral SGB was associated with a reduction in arrhythmias and defibrillation episodes, but did not affect antiarrhythmic medication, respiratory support, or EF. Randomized controlled trials on larger cohorts are needed to confirm these findings.

Early postoperative effects of kidney transplantation on the cardiovascular system in our clinical practice

Among the population suffering from end-stage renal failure and the population after kidney transplantation, the leading reason of death is cardiovascular triggered by left ventricular hypertrophy, volume overload, consecutive arrhythmias, valvular insufficiency and increased artherosclerosis. This study was aimed at examining the effect of kidney transplantation on pump function of the left ventricle, arrhythmic substrates and valvular heart diseases. At the Division of Organ Transplantation, University of Debrecen, we carried out a retrospective data analysis of adult patients (n = 184) who had kidney transplantation in the period between December 2014 and June 2018. Preoperatively and, then, postoperatively (at 6 and 12 months) we studied the echocardiographic parameters, the laboratory results. Statistical analyses were performed using the chi-square/Fisher's exact test and Kruskal-Wallis analysis of variance (ANOVA) test. The results were regarded significant if p<0.05 was found. Preoperatively the end-systolic diameter of the left ventricle was 34.67 mm, whereas 6 and 12 months later these values were 31.82 mm and 32.68 mm (p = 0.01). The prevalence of stroke was 7.87% preoperatively; there was no stroke detected postoperatively (p<0.001). The impact of transplantation on the left atrial diameter (43.68 mm; 41.59 mm; 41.00 mm; p = 0.04) and seral potassium level (4.98 mmol/l; 4.49 mmol/l; 4.49 mmol/l; p<0.01) showed significant improvement. Before transplantation, grade 2 mitral regurgitation was observed in 10.7% of the patients, whereas it reduced to 4.3%, then to 2.1% 6 and 12 months postoperatively (p = 0.03). Preoperative valvular calcification was detected in 45% of the diabetic study population (p = 0.20), 6 and 12 months later, in 46.7% (p = 0.018) and 60.0% (p = 0.024). After transplantation, the left atrial and the end-systolic diameter of the left ventricle regrediated, decreasing the frequency of arrhythmic episodes. The number of the middle grade mitral valve regurgitation decreased and the calcification among diabetic population increased significantly. Orv Hetil. 2021; 162(26): 1052-1062.

Quality of Life after Ablation vs Medication Therapy in Patients With Supraventricular Tachycardia

Objective: Supraventricular tachycardia (SVT) is the most common presentation of patients at cardiac emergency department. This study aims to determine the quality of life in patients with supraventricular tachycardia after they treated with medicines vs. ablation therapy.&#x0D; Methods: This prospective clinical comparative study was held at the National Institute of Cardiovascular Diseases (NICVD). Patients 18 years or older of either gender presenting with the two most common variants of SVT i.e. Atrioventricular nodal reentry tachycardia (AVNRT) and Atrioventricular reentry tachycardia (AVRT) were eligible to be included into the study. Once stabilized at the emergency department (ED) the patients were given the option to undergo electrophysiology study and radiofrequency ablation (EPS and RFA) (group A) or opt for medications only (group B). Quality of life (sense of personal well being, impact on social life, fear of mortality or anxiety about the disease, recurrence of episodes of arrhythmia, and visits to ED) was assessed through a questionnaire filled after six months of receiving treatment.&#x0D; Results: A total of 120 patients were included into our study. Group A and group B were evenly divided with 60 patients each. The overall mean age of the participants and duration of cardiac illness were 44.67±18.91 and 5.42±3.13 years, respectively. Patients who received EPS and RFA (group A) had superior and statistically significant scores (better QoL) for sense of personal well being, impact on social life, fear of mortality or anxiety levels, recurrence of arrhythmia, and visits to the ED as compared to those who received medications alone, p&lt;0.05.&#x0D; Conclusion: EPS and RFA vastly improved the quality of life in patients with SVT post treatment. Medications alone are associated with a high number of post treatment sequels and adverse events; therefore they are best avoided in patients with SVT.

Use of Preoperative Single Dose Ivabradine for Perioperative Hemodynamic Stabilization During Non-Cardiac Elective Surgery Under General Anaesthesia: A Pilot Study.

BackgroundPeri-anesthetic hemodynamic fluctuations during non-cardiac surgeries are sometimes of serious consequences and associated with increased morbidity and mortality, especially in undiagnosed vulnerable patients. Currently used drugs like β-blocker, α2 agonist or sedative analgesic have their own limitations like combined negative ionotropic and chronotropic action, and unwanted bradycardia associated with hypotension, respectively. In this context, ivabradine has been used extensively in cases of cardiac failure, myocardial ischemia and cardiomyopathies for its funny channel associated dependable heart rate reducing property. Hence, for the first time, in search of a better agent for perioperative hemodynamic stabilization, the present study evaluated the role of ivabradine in patients undergoing non-cardiac surgeries.MethodsThis was a prospective, observer blind, randomized, interventional pilot study, conducted among 50 patients belonging undergoing elective abdominal laparoscopic surgeries, under general anesthesia. The study group patients received ivabradine tablet 7.5 mg, 2 h before scheduled time of surgery with a sip of water. All the patients received standardized balanced general anesthesia as practiced in our institute with all standard monitoring with additional minimum alveolar concentration (MAC) monitoring to ensure an adequate depth of anesthesia, and neuromuscular monitoring to ensure adequate and standard muscle relaxation. Hemodynamic stability of the groups was tested by comparing them at time points like induction, incision and operation, and extubation. Mean values of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were compared between groups, and also for variation with lapse of time, using RMANOVA analysis, using baseline parameters as covariate so as to standardize them.ResultsOn multivariate analysis using Wilk’s lambda multivariate test, there was a statistically significant difference (F = 3.587, P = 0.036) in HR between the groups with time, while no significant difference of SBP, DBP and MAP between the groups with time.ConclusionsThe study revealed a significant attenuation of HR response to stressful events like laryngoscopy, intubation and surgical incision with ivabradine. Also, a good intraoperative protection against cardiovascular ischemic and arrhythmic episodes in perioperative period was achieved with this drug ivabradine.

Results of holter monitoring in patients with coronary heart disease depending on the severity of atherosclerotic lesions of the coronary arteries

The aim – to conduct a comparative analysis of the presence, frequency and duration of episodes of myocardial ischemia and arrhythmias based on the results of Holter monitoring in patients with coronary heart disease depending on the condition of the coronary arteries.&#x0D; Materials and methods. We examined 53 patients (group I) with stable coronary heart disease (CHD) and slightly altered coronary arteries (INOCA), who were hospitalized in the period from October 2018 to February 2021 at the “City Clinical Hospital № 8” of Kharkiv City Council. Group II included 52 patients with a diagnosis of stable coronary heart disease, and according to coronary angiography (CAG) had stenosis of coronary arteries (CA) more than 50 %.&#x0D; Results. According to the results of comparative analysis, it was found that in group I there were signs of myocardial ischemia – depression of the ST segment in 62.3 % (n=33) and elevation of the ST segment in 11.3 % (n=6), compared with group II -73 % (n=38) and 5.66 % (n=3), respectively. Ventricular arrhythmias (VA) have been reported in 52 patients of group I, and in 44 patients of group II. VA 4 and 5 type according to Laun, was significantly higher in group II compared with group I (p=0.0324). The occurrence of ventricular tachycardia was recorded in 5.7 % (n=3) of patients in group I and 9.3 % (n=5) patients of group II (p=0.347). In group II, there was a tendency to more episodes of ischemia compared with group I (p=0.072). The duration of ischemia was significantly longer in group I, compared with group II (p=0.042).&#x0D; Conclusions. The results of the study did not show significant differences in the development of the number of episodes of myocardial ischemia according to Holter monitoring depending on the condition of the coronary arteries. The duration of episodes of ischemia in patients with INOCA is significantly longer than in patients with obstructive atherosclerosis. In patients with coronary heart disease with obstructive coronary arteries, ventricular arrhythmia was statistically significantly more severe according to Lown

Late arrhythmias in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement using a balloon-expandable valve.

The arrhythmic burden after discharge in patients with new-onset left bundle branch block (LBBB) undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable SAPIEN 3 (S3) valve remains largely unknown. The purpose of this study was to determine the incidence of late arrhythmias in patients with new-onset LBBB undergoing TAVR with the balloon-expandable S3 valve. This was a multicenter, prospective study that included 104 consecutive TAVR patients with new-onset persistent LBBB following TAVR with the S3 valve. An implantable cardiac monitor (Reveal XT, Reveal LINQ) was implanted before discharge. The primary endpoint was the incidence of high-degree atrioventricular block or complete heart block (HAVB/CHB). A total of 40 patients (38.5%) had at least 1 significant arrhythmic event, leading to a treatment change in 17 (42.5%). Significant bradyarrhythmias occurred in 20 of 104 patients (19.2%) (34 HAVB/CHB episodes, 252 severe bradycardia episodes), with 10 of 20 patients (50%) exhibiting at least 1 episode of HAVB/CHB. Most HAVB/CHB episodes (60%) occurred within 4 weeks after discharge. Nine patients (8.7%) underwent permanent pacemaker implantation at 12 months based on the Reveal findings (6 HAVB/CHB, 3 severe bradycardia). S3 valve recipients with new-onset LBBB have a high arrhythmic burden, with more than one-third of patients exhibiting at least 1 significant arrhythmic episode within 12 months (HAVB/CHB in 10% of patients). About one-half of bradyarrhythmic events occurred within 4 weeks after discharge. These results should inform future strategies on the use of continuous electrocardiographic monitoring in TAVR S3 patients with new conduction disturbances following the procedure.

Echocardiographic but not clinical response to CRT is an independent predictor of a better survival free from arrhythmic events

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac resynchronization therapy (CRT) is of proven benefit in heart failure patients, improving mortality and reducing hospital admissions. There is however uncertainty if the arrhythmic risk is reduced in responders. Purpose We aimed to assess if patients with a CRT implanted for primary prevention had less arrhythmic episodes if they responded to this therapy and if echocardiographic and clinical responses to CRT differ regarding the occurrence of ventricular arrhythmias. Methods We prospectively enrolled patients that underwent CRT implant for primary prevention according to ESC guidelines. Patients were classified as responders if they fulfilled one of four criteria (echocardiographic or clinical) at six months after implant: a 5% absolute improvement in LV ejection fraction (LVEF), a 15% improvement in LVEF, a 15% decrease in LV end-diastolic volume or a decrease in NYHA class. During follow-up with device interrogation, arrhythmic ventricular events (AVE) were classified as appropriate ICD therapies or sustained ventricular tachycardia either occurring in ICD monitoring zones or undetected by the device due to a slower rare, but clinically documented. All patients were further classified according to type of pacing, biventricular or LV only. Demographic characteristics of patients were also assessed. Results We enrolled 73 patients, 58 (79.5%) male, median age of 72 (65-77) years. Median LVEF was 28 (22-35) % (p = 0.95 between groups), ischemic etiology in 36 (46.6%, p = 1.00). The two groups with and without AVE did not differ significantly regarding clinical, echocardiographic, and electrocardiographic characteristics (table). CRT echocardiographic response criteria were met by 50 (68.5%) of patients and clinical criteria by 53 (72.6%) patients. AVE occurred in 15 (20.5%) patients. In univariate regression analysis, echocardiographic response was associated with reduced AVE (OR 0,14; p = 0,005). Clinical response to CRT was not associated with AVE (p = 0.07). LV only pacing was associated with a higher probability of AVE (OR 5.1; p = 0.038). In Cox regression multivariate analysis, response to CRT was the only independent predictor of better survival free from AVE (HR 0.28;CI 95%, p = 0.044) and LV only pacing was not associated with more episodes of ventricular arrhythmias (p = 0.17). Conclusions: Echocardiographic, but not clinical response to CRT therapy, is the only independent predictor of a higher survival free from arrhythmic events. In spite controversies regarding the arrhythmogenic role of LV pacing, this was not associated with higher ventricular arrhythmic events. Abstract Figure.

Ex-post correction of pacemaker mode switch episodes in undersensed atrial fibrillation

BackgroundInformation about short Atrial Fibrillation (AF) episodes can be gathered from the diagnostic records of cardiac implantable electronic devices (CIEDs). CIEDs are not accurate when detecting short arrhythmia episodes. The correlation between mode switching events and AF episodes is significant for long events but prone to errors for short episodes. MethodsExpectation-maximization algorithms are used to estimate the parameters of a mathematical model from a list of AF episodes produced by the CIED. The durations of some of the episodes may be missing. Abnormal mode changes are detected and short episodes are joined into longer events when appropriate. The proposed method does not require that the sensitivity parameters of the device are altered. Post-processing of the data is limited to the detection of false negatives, thus paroxysmal arrhythmia diagnostic evaluations are safer. ResultsA three year-long study was carried out with patients with dual-chamber pacemakers (PM) at the Hospital Universitario Central de Asturias (Spain) between 2012 and 2015. The number of patients in which the proposed algorithm altered the final histogram was 40 out of 76. On average, the algorithm removes 2.79% of episodes shorter than 1 min in length and finds that 1% of the previously unaccounted episodes are longer than 30 min, of which 16% are longer than 24 h. ConclusionThe method is stable and guarantees that long arrhythmia episodes are never eliminated, and at the same time it is the most similar to the human expert in finding new long episodes.

Analyzing Long-Term Electrocardiography Recordings to Detect Arrhythmias in Mice.

Arrhythmias are common, affecting millions of patients worldwide. Current treatment strategies are associated with significant side effects and remain ineffective in many patients. To improve patient care, novel and innovative therapeutic concepts causally targeting arrhythmia mechanisms are needed. To study the complex pathophysiology of arrhythmias, suitable animal models are necessary, and mice have been proven to be ideal model species to evaluate the genetic impact on arrhythmias, to investigate fundamental molecular and cellular mechanisms, and to identify potential therapeutic targets. Implantable telemetry devices are among the most powerful tools available to study electrophysiology in mice, allowing continuous ECG recording over a period of several months in freely moving, awake mice. However, due to the huge number of data points (>1 million QRS complexes per day), analysis of telemetry data remains challenging. This article describes a step-by-step approach to analyze ECGs and to detect arrhythmias in long-term telemetry recordings using the software, Ponemah, with its analysis modules, ECG Pro and Data Insights, developed by Data Sciences International (DSI). To analyze basic ECG parameters, such as heart rate, P wave duration, PR interval, QRS interval, or QT duration, an automated attribute analysis was performed using Ponemah to identify P, Q, and T waves within individually adjusted windows around detected R waves. Results were then manually reviewed, allowing adjustment of individual annotations. The output from the attribute-based analysis and the pattern recognition analysis was then used by the Data Insights module to detect arrhythmias. This module allows an automatic screening for individually defined arrhythmias within the recording, followed by a manual review of suspected arrhythmia episodes. The article briefly discusses challenges in recording and detecting ECG signals, suggests strategies to improve data quality, and provides representative recordings of arrhythmias detected in mice using the approach described above.

Chronic bronchial infection and incident cardiovascular events in chronic obstructive pulmonary disease patients: A long-term observational study.

Cardiovascular (CV) diseases are frequent in patients with chronic obstructive pulmonary disease (COPD). Likewise, chronic bronchial infection (CBI) is also frequent in COPD and it is associated with systemic inflammation, a well-known CV risk factor. The objective of this study was to investigate the relationship between CBI, systemic inflammation and incident CV events. A post hoc analysis of prospectively collected cohort of 201 COPD patients [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II-IV] followed up every 3-6months for 84 months was conducted. CBI was defined as ≥3 positive pathogenic microorganisms sputum cultures over 1year, separated by ≥3months. Systemic inflammation was assessed by circulating levels of C-reactive protein and fibrinogen. Fatal and non-fatal CV events, including coronary and cerebrovascular events as well as arrhythmia episodes, were prospectively recorded. For analysis, they were analysed separately and combined in a composite variable. As hypothesized, CBI was associated with persistent systemic inflammation and a significantly higher incidence of CV events (HR: 3.88; 95% CI: 1.83-8.22), mainly of coronary origin independent of age, number and severity of exacerbations, comorbidities, other CV risk factors, lung function, BMI, smoking status and treatments. These associations were particularly significant in patients with CBI by Pseudomonas aeruginosa (PA). CBI, particularly by PA, is associated with sustained and enhanced systemic inflammation and a higher incidence of CV events (especially coronary events). The possibility that treating CBI may decrease systemic inflammation and CV events in COPD deserves prospective, interventional studies.

Bilateral thoracoscopic sympathectomy for cardiac denervation in pediatric population: Does Kuntz nerve cauterization have an impact on success?

Cardiac sympathetic denervation (CSD) is an effective procedure for the treatment of inherited channelopathies. Left CSD has traditionally been recommended as neuromodulation to prevent arrhythmia episodes; however, it is thought that bilateral sympathectomy in combination with Kuntz ablation may have additional effects effective due to the anatomical variability of preganglionic sympathetic fibers. The aim of the study was to share our single-center clinical experience with bilateral thoracoscopic sympathectomy for cardiac denervation in different groups of pediatric patients with malignant arrhythmias. Fourteen patients (seven with CPVT, five with LQTS, one with resistant ventricular tachycardia as a sequela of myocarditis, and one with cardiomyopathy and atrial tachycardia) underwent bilateral thoracoscopic sympathectomy for cardiac denervation. In all patients, arrhythmia episodes persisted despite medical therapy, and patients with implantable cardioverter-defibrillator received appropriate therapies. The rate of appropriate therapies was 3.25 per year (1-5 per year) in the year before sympathectomy. No major complications related to the procedure were observed in any of the patients. The QTc interval of LQTS patients decreased from 506.2 ± 16.9 ms before the procedure to 476 ± 28.8 ms after the procedure. The mean duration of follow-up after the procedure was 23.3 months (11-47 months). Only two patients received single episodes of therapy 12 and 22 months after CSD, and one patient had arrhythmic events due to noncompliance to medical therapy. Due to the anatomical variability of preganglionic fibers bilateral CSD with Kuntz nerve ablation effective treatment and is a safe option.

Cardiovascular risks awareness in coaches and amateur athletes

Abstract Funding Acknowledgements Type of funding sources: None. Background Regular physical activity is an important component of therapy for most сardiovascular diseases and is associated with reduced cardiovascular and all-cause mortality. The promotion of the physical activity and regular exercise is an important preventive measure that affects the prognosis. Purpose To assess the awareness of the prevalence of cardiovascular disease in exercising population and its influence on the safety of the patients and healthy adults among coaches and people actively engaged in sports activities. Methods An open non-randomized observation was conducted. The questionnaire created by our team included 45 questions about cardiovascular diseases and sport. 111 athletes and coaches aged from 19 to 46 were enrolled in the study. 61,5% (68) are men and 38,5% (42) of the respondents are women. 30,3% (33) of the respondents are coaches. 45,5% (15) of them have over 5 years of coaching experience. 44% (48) of all respondents prefer endurance sport, 25,7% (28) train strength exercise. 63,6% (70) train 3-8 hours per week, 12,7% (14 [7 women and 7 men]) train more than 8 hours each week. Results 18,5% (20 [6 women and 14 men]) think that ECG is enough for screening for cardiovascular diseases. 20% (4) of them are coaches. Only 69,5% (77) of all respondents know about treadmill test. And 41,6% (32/77) of them know about the necessary screening for arrhythmogenic condition. 13% (10/77) of them train more than 8 hours per week. And only 27,3% (21/77) of people who know about treadmill test, passed it themselves. Also 21,6% (24) of all respondents think that any episode of arrhythmia is the contraindication for any sport. But 96,4% (107) of the respondents know that it is necessary to regularly screen the cardiovascular system, even in the absence of complaints. 9% (10) of the interviewed think that diet is not important for people with cardiovascular diseases. And 18,9% (21) of the respondents don’t know about the effect of electrolytes on the body and the work of the heart muscle. Only 53,2% (59 [21 women and 38 men]) of the respondents trust the doctors more than coaches or themselves. And this is one of the reasons why it is necessary to talk about the basic principles of sports cardiology not only to doctors. 8,1% (9) of the respondents have never heard about any cases of sudden death of an athlete during training or at competitions due to «heart problems». 63,6% (21) of the coaches would not train a person who has suffered a heart attack. 71,8% (56) of the sportsmen would like to return to training after a heart attack. Conclusions Despite the fact that most people prefer a sedentary lifestyle, high-intensity fitness and long-distance endurance sport is getting more popular. Our survey proves the relatively low level of education about the underlying health conditions and possible risks associated with sports not only among athletes but professional coaches as well. There are no conflicts of interest to declare.

Six-month outcomes of a high intensity exercise programme in young patients with hypertrophic cardiomyopathy: The SAFE-HCM trial

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Cardiac Risk in the Young Background Moderate intensity exercise training in older patients with hypertrophic cardiomyopathy (HCM) can improve functional capacity, without significant harm. However, younger patients are attracted to high intensity training (HIT) regimes. The SAFE-HCM study demonstrated that an individually tailored, HIT programme in young patients with HCM was feasible, and provided both health and psychological benefits, without an increase in the burden of arrhythmia. Purpose To assess whether observed benefits of a HIT programme in young patients with HCM are sustained at 6 months. Methods Eighty patients with HCM (45.7y+/-8.6) underwent baseline clinical and psychological assessment. Individuals were randomised to a 12-week HIT programme (n = 40) or usual care (n = 40). Baseline evaluation was repeated at 12 weeks (T12). Feasibility, safety, health and psychological benefits were assessed. At 12-weeks individuals were encouraged to continue with the frequency and intensity of physical activity (PA) achieved at the end of the cardiac rehabilitation programme. Participants in the exercise arm were invited to follow-up at 6 months (T6m). Results The majority (83%) of participants completed the 12-week study. At T12 there was no significant difference between groups in the composite arrhythmia safety outcome (p = 0.99). The indices of exercise capacity were significantly improved in the exercise compared to the control group; peak VO2 (+3.7ml/kg/min [CI 1.1,6.3], p = 0.006), VO2/kg at anaerobic threshold (VO2/kgAT) (+2.44ml/kg/min [CI 0.6,4.2], p = 0.009), time to AT (+115s [CI 54.3,175.9], p &amp;lt; 0.001) and exercise time (max ET) (+108s [CI 33.7,182.2], p = 0.005). The exercise group also demonstrated greater reduction in systolic BP (-7.3mmHg [CI -11.7,-2.8], p = 0.002), BMI (-0.8kg/m2 [CI-1.1,-0.4], p &amp;lt; 0.001), anxiety (-2.6 [CI-3.6,-1.6], p= &amp;lt;0.001) and depression (-1.1 [CI -2.0,-0.2], p = 0.015) scores. At T6m patient reported exercise adherence was comparable to baseline PA in 33/34 of the exercise group attending for follow up. Most exercise gains dissipated with the exception of time to AT (p = 0.002), max ET (p = 0.003), VO2/kgAT (p = 0.04) and anxiety score (p &amp;lt; 0.001) (Figure 1). There were no sustained episodes of atrial or ventricular arrhythmias. The incidence of NSVT did not differ between time points (p = 0.09). Conclusion A 12-week HIT programme in young patients with HCM offers considerable gains in fitness and psychological outcomes, with no increase in arrhythmic burden. At T6m exercise levels as well as most physiological adaptations and health benefits returned to baseline, as seen in other studies when formal participation in an exercise programme comes to an end. This highlights the importance of the implementation of strategies to encourage ongoing engagement in PA. Potential solutions include identification of barriers to exercise, as well as adoption of novel tele-rehabilation approaches. Abstract Figure 1 Sustained benefits at T6m

The Necessity of an ICD-Therapy in Patients with Indications for Primary Prevention of Sudden Cardiac Death. One Center Experience.

Aim Analysis of responses of cardioverter-defibrillators implanted in patients with cardiomyopathies (CMPs) of various origins and a high risk of sudden cardiac death (SCD) to assess the effectiveness of a modern strategy for primary prevention of SCD.Material and methods In the Federal Center for High Medical Technologies in Kaliningrad from 2014 through 2018, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) were installed in 165 patients. Major indications for device implantation in these patients included left ventricular (LV) systolic dysfunction with ejection fraction (EF) ≤35 %; chronic heart failure (CHF) consistent with the New York Heart Association (NYHA) functional class (FC) II-III (IV for CRT-D) without previous episodes of life-threatening ventricular arrhythmias, circulatory arrest and resuscitation, which was consistent with the current international strategy for primary prevention of SCD. The study patients were divided into two groups based on the CMP origin; group 1 included 101 (61.2 %) patients with CMP of ischemic origin (ICMP) and group 2 consisted of 64 (38.8 %) patients with CMP of non-ischemic origin (NCMP). Information about arrhythmic episodes and device activation was retrieved from the device electronic memory during visits of patients to the clinic and was also transmitted to the clinic by a remote monitoring system. This information was studied and evaluated for the validity and effectiveness of the device triggering. If necessary, the parameters of detection and treatment were adjusted taking into account the obtained information. Information was analyzed and statistically processed with the SPSS Statistics 20.0 software.Results The patients were followed up for 28.3 ± 15.6 months, during which the devices delivered therapy to 55 (33.3%) patients of the entire group. In the ICMP group, the devices were activated in 44 (26.7 %) patients and in the NCMP group, the devices were activated in 11 (6.7 %) patients. In group 1 (ICMP), appropriate triggering was observed in 33 (20.0%) patients and inappropriate triggering was observed in 11 (6.7%) patients. In group 2 (NCMP), appropriate triggering was observed in 2 (1.2 %) patients and inappropriate triggering was observed in 9 (5.5 %) patients. The main cause of inappropriate triggering was atrial fibrillation (AF). 17 (10.3 %) patients with ICMP had sustained ventricular tachycardia (VT), which did not reach the detection frequency for ICD therapy; these VTs were only detected by devices and terminated spontaneously. Intragroup differences in the number of patients who received an appropriate treatment were statistically significant: 33 (32.6 %) in the ICMP group vs. 2 (3.1 %) in the NCMP group (р&lt;0.006). Differences in the number of patients who received an inappropriate treatment were not statistically significant although their number was greater in the NCMP group than in the ICMP group (9 (14.1 %) vs. 11 (10.9 %), р&gt;0.05).Conclusion A higher requirement for the ICD treatment was revealed in patients with ICMP compared to patients with NCMP. The low demand for the ICD treatment in patients with NCMP and the more frequent inappropriate actuation of the devices in this patient group due to AF allow a conclusion that the criteria for primary prevention of SCD with ICD (LV EF ≤35% and clinically significant CHF) are not equally effective indications for ICD implantation in patients with ICMP and NCMP. It can be assumed that life-threatening ventricular arrhythmias are evident in patients with NCMP before the development of hemodynamically significant LV dysfunction and CHF, which warrants further research in this direction.

Impact of COVID-19 on the incidence of cardiac arrhythmias in implantable cardioverter defibrillator recipients followed by remote monitoring

The coronavirus disease 2019 (COVID-19) has been a fast-growing worldwide pandemic. We aimed to investigate the incidence of cardiac arrhythmias among a large French cohort of implantable cardioverter defibrillator recipients over the first 5 months of 2020. Five thousand nine hundred and fifty-four implantable cardioverter defibrillator recipients were followed by remote monitoring during the COVID-19 period (from 01 January to 31 May 2020). Data were obtained from automated remote follow-up of implantable cardioverter defibrillators utilizing the Implicity® platform. For all patients, the type of arrhythmia (atrial fibrillation, ventricular tachycardia or ventricular fibrillation), the number of ventricular arrhythmia episodes and the type of implantable cardioverter defibrillator-delivered therapy were recorded. A total of 472 (7.9%) patients presented 4917 ventricular arrhythmia events. An increase in ventricular arrhythmia incidence was observed after the first COVID-19 case in France, and especially during weeks #10 and #11, at the time of major governmental measures, with an increase in the incidence of antitachycardia pacing delivered therapy. During the 11 weeks before the lockdown order, the curve of the percentage of live-stream television coverage of COVID-19 information matched the ventricular arrhythmia incidence. During the lockdown, the incidence of ventricular arrhythmia decreased significantly compared with baseline (0.05±0.7 vs. 0.09±1.2 episodes per patient per week, respectively; P<0.001). Importantly, no correlation was observed between ventricular arrhythmia incidence and the curve of COVID-19 incidence. No changes were observed regarding atrial fibrillation/atrial tachycardia episodes over time. An increase in ventricular arrhythmia incidence was observed in the 2 weeks before the lockdown order, at the time of major governmental measures. Ventricular arrhythmia incidence decreased dramatically during the lockdown.