Arrhythmias In Patients Research Articles

False alarm detection in intensive care unit for monitoring arrhythmia condition using bio-signals

PurposeA novel method has been proposed to reduce the false alarm rate of arrhythmia patients regarding life-threatening conditions in the intensive care unit. In this purpose, the atrial blood pressure, photoplethysmogram (PLETH), electrocardiogram (ECG) and respiratory (RESP) signals are considered as input signals.Design/methodology/approachThree machine learning approaches feed-forward artificial neural network (ANN), ensemble learning method and k-nearest neighbors searching methods are used to detect the false alarm. The proposed method has been implemented using Arduino and MATLAB/SIMULINK for real-time ICU-arrhythmia patients' monitoring data.FindingsThe proposed method detects the false alarm with an accuracy of 99.4 per cent during asystole, 100 per cent during ventricular flutter, 98.5 per cent during ventricular tachycardia, 99.6 per cent during bradycardia and 100 per cent during tachycardia. The proposed framework is adaptive in many scenarios, easy to implement, computationally friendly and highly accurate and robust with overfitting issue.Originality/valueAs ECG signals consisting with PQRST wave, any deviation from the normal pattern may signify some alarming conditions. These deviations can be utilized as input to classifiers for the detection of false alarms; hence, there is no need for other feature extraction techniques. Feed-forward ANN with the Lavenberg–Marquardt algorithm has shown higher rate of convergence than other neural network algorithms which helps provide better accuracy with no overfitting.

Risk of Cardiac Arrhythmias in Patients with Late-Onset Pompe Disease—Results from a Long Follow-Up in a Group of 12 Patients and Review of Literature

Background. Pompe disease is a rare, severe, autosomal recessive genetic disorder caused by GAA gene mutations, which cause α-1,4-glucosidase enzyme deficiency. There are two forms of Pompe disease based on the age of onset, the infantile and the adult form (LOPD). Cardiac involvement, previously recognized only in infantile cases, is now also reported in adults. Cardiomyopathy remains an exceptional finding while heart rhythm disorders appear to be more frequent. Methods. We retrospectively evaluated cardiac involvement in 12 patients with late-onset Pompe disease (LOPD) followed for an overall period of 143 years (mean 12.7 ± 7.7) using ECG, Holter ECG, and echocardiography. Results. The mean age of patients (M8:F4) at the first visit was 40.7 ± 16.1 (range 14–63) and 53.7 ± 16.9 (range 21–76) at last visit. Conduction delay was present in three patients; one patient developed ascending aorta ectasia but had a history of hypertension, and one patient showed right heart enlargement on echocardiography, probably due to pulmonary hypertension. No patient died during the FU, nor developed cardiomyopathy. Ectopic supraventricular beats and repeated episodes of ablation-resistant atrial fibrillation were observed in only one patient (8.3%) who required PMK implantation. Conclusions. Benefitting from the long follow-up, this study allows us to state that primary myocardial involvement is rare in patients with LOPD, while rhythm disorders are more frequent and require monitoring to avoid the risk of possible life-threatening complications.

Polymorphic Variants of SCN5A Gene (rs41312433 and rs1805124) Associated with Coronary Artery Affliction in Patients with Severe Arrhythmias.

A group of 32 unrelated individuals, aged 63 ± 12 years, was included in the study. All the patients were examined, diagnosed and treated with an implantable cardioverter defibrillator at the Department of Internal Cardiology Medicine, Faculty Hospital Brno. The control group included 87 persons of similar age without afflicted coronary circulation, which was confirmed coronagraphically. Genomic DNA was extracted from samples of peripheral blood according to the standard protocol. Two SCN5A polymorphisms-IVS9-3C/A (rs41312433) and A1673G (rs1805124, H558R)-were examined in association with coronary artery stenosis in the patients. In the case-control study, no significant differences in genotype distribution/allelic frequencies were observed for IVS9-3c>a and A1673G gene polymorphisms between patients with severe arrhythmias and healthy persons. The distribution of SCN5A double genotypes was not significantly different among different types of arrhythmias according to their ejection fraction in arrhythmic patients (p = 0.396). The ventricular arrhythmias with an ejection fraction below 40% were found to be 10.67 times more frequent in patients with multiple coronary stenosis with clinically valid sensitivity, specificity and power tests. In the genotype-phenotype study, we observed a significant association of both SCN5A polymorphisms with the stenosis of coronary vessels in the patients with severe arrhythmia. The double genotype of polymorphisms IVS9-3C/A together with A1673G (CCAA) as well as their simple genotypes were associated with significant multiple stenosis of coronary arteries (MVS) with high sensitivity and specificity (p = 0.05; OR = 5 (95% CI 0.99-23.34); sensitivity 0.70; specificity 0.682; power test 0.359) Moreover, when a concrete stenotic coronary artery was associated with SCN5A genotypes, the CCAA double genotype was observed to be five times more frequent in patients with significant stenosis in the right coronary artery (RCA) compared to those without affliction of this coronary artery (p = 0.05; OR = 5 (95% CI 0.99-23.34); sensitivity 0.682; specificity 0.700; power test 0.359). The CCAA genotype was also more frequent in patients without RCA affliction with MVS (p = 0.008); in patients with ACD affliction but without MVS (p = 0.008); and in patients with both ACD affliction and MVS compared to those without ACD affliction and MVS (p = 0.005). Our study presents a highly sensitive and specific association of two polymorphisms in SCN5A with significant coronary artery stenoses in patients with potentially fatal ventricular arrhythmias. At the same time, these polymorphisms were not associated with arrhythmias themselves. Thus, SCN5A gene polymorphic variants may form a part of germ cell gene predisposition to ischemia.

Difficulties in selecting antiarrhythmic therapy in a patient with left ventricular noncompaction and atrial septal defect: a case report

Introduction. Left ventricular noncompaction (LVNC) is a rare heterogeneous pathology characterized by a two-layered structure with a predominance of non-compact layer in the form of multiple trabeculations and pockets between them, communicating with the left ventricular cavity. One of the rare LVNC phenotypes is a combination with congenital heart defects, including atrial septal defect (ASD).Brief description. The article presents a case report describing the difficulties of selecting antiarrhythmic therapy in a patient with LVNC and ASD, complicated by arrhythmias due to heart failure. The diagnosis of LVNC was confirmed by the Petersen criterion using magnetic resonance imaging.Discussion. Cardiac arrhythmias in patients with LVNC and congenital heart defects, as a result of both anatomical and hemodynamic causes of electrical heart instability, constitute a danger of thromboembolism and sudden cardiac death, and also contribute to heart failure progression. The case is of interest due to the rare combination of LVNC and ASD, complicated by frequent episodes atrial fibrillation and premature ventricular contractions in the form of parasystoles, as well as difficulties in selecting antiarrhythmic therapy. Pulmonary vein cryoballoon ablation eliminated the source of atrial fibrillation. Ventricular ectopic activity was stopped using the anticonvulsant drug carbamazepine.

Multi-network approach for image segmentation in non-contrast enhanced cardiac 3D MRI of arrhythmic patients

Left atrial appendage (LAA) is the source of thrombi formation in more than 90% of strokes in patients with nonvalvular atrial fibrillation. Catheter-based LAA occlusion is being increasingly applied as a treatment strategy to prevent stroke. Anatomical complexity of LAA makes percutaneous occlusion commonly performed under transesophageal echocardiography (TEE) and X-ray (XR) guidance especially challenging. Image fusion techniques integrating 3D anatomical models derived from pre-procedural imaging into the live XR fluoroscopy can be applied to guide each step of the LAA closure. Cardiac magnetic resonance (CMR) imaging gains in importance for radiation-free evaluation of cardiac morphology as alternative to gold-standard TEE or computed tomography angiography (CTA). Manual delineation of cardiac structures from non-contrast enhanced CMR is, however, labor-intensive, tedious, and challenging due to the rather low contrast. Additionally, arrhythmia often impairs the image quality in ECG synchronized acquisitions causing blurring and motion artifacts. Thus, for cardiac segmentation in arrhythmic patients, there is a strong need for an automated image segmentation method. Deep learning-based methods have shown great promise in medical image analysis achieving superior performance in various imaging modalities and different clinical applications. Fully-convolutional neural networks (CNNs), especially U-Net, have become the method of choice for cardiac segmentation. In this paper, we propose an approach for automatic segmentation of cardiac structures from non-contrast enhanced CMR images of arrhythmic patients based on CNNs implemented in a multi-stage pipeline. Two-stage implementation allows subdividing the task into localization of the relevant cardiac structures and segmentation of these structures from the cropped sub-regions obtained from previous step leading to efficient and effective way of automated cardiac segmentation.

Changes in cardiohemodynamics and cardiac arrhythmias in patients after coronavirus infection

Aim: To study cardiac arrhythmias and morpho-functional changes in patients in 3 months after a coronavirus infection.Material and methods. 96 patients, mean age 36 years, treated for coronavirus infection, after 3 months underwent Echo and Holter ECG monitoring. Patients were divided into groups depending on the degree of lung tissue damage according to computed tomography (CT): 1st 27 patients CT0, 2nd 39 patients CT1-2, 3rd 30 patients CT3-4; 22 patients control group. Statistics: considering the distribution of features different from normal, nonparametric methods of hypothesis testing were used.Results. In patients recovered from coronavirus infection a violation of heart rhythm conduction was established after 3 months. An increase in the activity of the sympathetic part of the autonomic nervous system (LF/HF) was found: in patients of group 2, the median value was – 5.9, in group 3 – 6.0; in addition, the global longitudinal systolic strain of the left ventricle decreased (–17.7 and –17.2, respectively). In patients with CT3–4, systolic pressure in the pulmonary artery increased (37.0 mmHg), the size of the left atrium increased, and segmental systolic LV strain decreased in comparison with the studied groups (p < 0.001). Correlations between left ventricular dysfunction and heart rate variability disorders, as well as prolongation of the QT interval (p < 0.001) were established.Conclusion. Cardiac arrhythmias were detected in patients in 3 months after the coronavirus infection. In patients with moderate and severe disease, the activity of the autonomic nervous system also increases, the global systolic strain of the left ventricle decreases. In addition, patients with CT3-4 increased systolic pressure in the pulmonary artery, increased the size of the left atrium, decreased segmental systolic strain of the left ventricle.

Professor Alexey Nikolaevich Kuchmin (on the 60th anniversary of his birth)

On July 27, 2023, Alexey Nikolaevich Kuchmin, the Head of the Department of Propaedeutics of Internal Diseases of the Military Medical Academy, named after S. M. Kirov
 doctor of Medical Sciences, Professor, and former chief therapist of the Ministry of Defense of the Russian Federation, turned 60 years old. A. N. Kuchmin was born on July 27, 1963, in Mineralnye Vody, Stavropol Territory. After graduation, he entered the Faculty of training doctors for the Navy of the Military Medical Academy named after S. M. Kirov, where he graduated with honors in 1986. For 4 years, he served as the Head of the medical center and the infirmary of the Baltic Fleet Naval Aviation. Since 1990, his life and fate have been inextricably linked with the Department of Propaedeutics of Internal Diseases of the Kirov Military Medical Academy, within the walls of which he has passed through a difficult but bright career path from a 3rd-year cadet to an associate Professor, from a teacher to a Professor and Head of the Department. Here, A. N. Kuchmin joined the scientific, pedagogical, and clinical ideas of Professor N. N. Savitsky. Having started his scientific activity under the guidance of Professor Yu. S. Malov, Alexey Nikolaevich devoted himself to the research of the most pressing issues of cardiology, pulmonology, and physiology. After graduating from the adjunct program in 1993 at the Department of Propaedeutics of Internal Diseases of the Academy, A. N. Kuchmin defended his PhD thesis on “The role of salivary glands in maintaining homeostasis in patients with hypertension”. Since that time, he has been a senior resident, then a teacher, associate Professor, and deputy Head of the Department of Propaedeutics of Internal Diseases (for clinical work) since 2005. In 2003, Alexey Nikolaevich defended his doctoral dissertation on cardiac arrhythmias in patients with bronchial asthma. His research interests now include issues in rapidly developing areas, such as endocrinology, ultrasound diagnostics, and functional diagnostics. During his work as the Chief therapist of the Ministry of Defense of the Russian Federation, A. N. Kuchmin proved himself to be a competent Head of the therapeutic service of the Ministry of Defense of the Russian Federation, particularly during the armed conflict in Abkhazia and Georgia. A. N. Kuchmin’s talent as a clinician and organizer of clinical and expert work was also manifested in his leadership from November 2008 to 2010 in the Department of Therapy of the State Institute of Advanced Training of Doctors of the Ministry of Defense of the Russian Federation and since 2015 in his native Department of Propaedeutics of Internal Diseases of the Military Medical Academy named after S. M. Kirov. In all his positions, Alexey Nikolaevich was and remains a highly professional specialist in his field with several clinical interests and knowledge.

The Role of Postoperative Magnesium Infusion in Minimizing Ventricular Arrhythmia Risk after Cardiopulmonary Bypass

Introduction: Cardiopulmonary bypass increases the incidence of postoperative ventricular arrhythmias in cardiac surgery. Magnesium, which is essential for cardiac function and may prevent arrhythmias, is frequently reduced after cardiac surgery. Aim of the Study: This study aimed to investigate the preventive effects of magnesium infusion in reducing the occurrence of ventricular arrhythmias in individuals who have undergone cardiopulmonary bypass. Methods: This study, done at Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2020 to June 2022, involved 120 participants in two groups: one received magnesium sulfate following standard cardiopulmonary bypass surgery (Group A), and the other did not (Group B). Both groups were monitored in the ICU with continuous ECG tracking and assessed for ventricular arrhythmias postoperatively on days 0–3. The inclusion criteria comprised adult cardiac patients in preoperative sinus rhythm with normal magnesium levels, excluding those with a history of ventricular arrhythmias or specific medical conditions. Data collected through a questionnaire, interviews, and medical records were analyzed using SPSS version 26. Result: The mean age of the patients in Group A was 53.83±14.54 years and in Group B was 54.50 ± 10.50 years. The mean difference in postoperative Mg++ was statistically significant (p<0.05) in POD 0, POD 1, POD 2, and POD 3. In this study, there were more VA-positive patients in Group B than in Group A; 16.67% had positive ventricular arrhythmia (PVC 8.3%, VT 3.33%, VF 5.00%), while 83.33% were negative VA. Group B had 66.67% negative VA and 33.33% positive VA (PVC 15.00%, VT 10.00%, VF 8.33%). Conclusion: This study identified that the postoperative Mg infusion after cardio pulmonary bypass reduces the incidence of postoperative arrhythmias in cardiac patients. Based on the findings, we recommend using intravenous magnesium as an alternative to prevent ventricular arrhythmias after CPB in cardiac patients.

Current Status and Challenges of Interventional Therapy for Diagnosis and Treatment of Arrhythmia in China

Abstract There are a large number of arrhythmia patients in China, and the field of interventional therapy for the diagnosis and treatment of arrhythmia has developed rapidly and made remarkable achievements. It is currently in a steady growth trend. In 2021, a total of 99,306 cases of pacemaker, 6547 cases of implantable cardioverter defibrillator, 5333 cases of cardiac resynchronization therapy, and 210,609 cases of catheter ablation were registered in the direct reporting system of arrhythmia interventional therapy information network, all of which increased significantly relative to those in 2020. However, there remains a considerable gap when in comparison with advanced countries. Therefore, there is an urgent need to widely implement and standardize advanced arrhythmia diagnosis and treatment techniques. In the future, it is vital to improve the training and development of arrhythmia physicians and teams, advance graded diagnosis and treatment, and foster international cooperation. In addition, there is a growing demand for increased clinical research to guide practical applications and the promotion of new technologies and devices for arrhythmia diagnosis and treatment.

Künt göğüs travmalı hastalarda Tp-e aralığı, Tp-e/QT oranı ve Tp-e/QTc oranının Klinik Önemi

Objective: Diffirents complications can develop after blunt chest trauma. It has been shown that potentially dectructive arrhythmias may develop after blunt chest trauma. In this study, our main objective is to evaluate the risk of cardiac arrhythmia in patients with blunt chest trauma, using the Tp-e interval, tp-e/QT ratio, and Tp-e/QTc ratio as a potential marker of cardiac arrhythmia. Materials and Methods: Our study consists of all patients who applied to the emergency department with blunt chest trauma between 15.01.2022 and 15.06.2022 in the form of a single-center, prospective case-control. 12-lead ECG documented on were taken from all participants at a paper speed of 50 mm/sec, and Tp-e interval, QT interval and the parameters obtained by their ratio to each other (tp-e/QT, Tp-e/QTc) were compared between the groups. Patients were shared according to trauma severity and parameters were compared. Results: Tpe/QT ratio in trauma patients was found to be statistically significantly higher than the control group (0.23±0.03 vs. 0.19±0.03, p<0.001). In addition, the Tpe/QTc ratio in trauma patients was found to be statistically significantly higher than the control group (0.21±0.02 vs. 0.17±0.02, p<0.001). In addition, when the analysis of age, gender and BMI, which are the factors affecting trauma severity, was performed, no significant difference was found in terms of QT interval, Tp-e/QT and Tp-e/QTc. Conclusıon: Based on the results of our study, we verified that the Tp-e interval in the ECG, Tp-e/QT ratio, and Tp-e/QTc ratio might indicate possible arrhythmia in patients who presented to the emergency department with blunt thoracic trauma, and this was unrelated to the severity of the trauma.

An Innovative Approach for the Prediction of Future Arrhythmia through T-wave Alternans on Surface Electrocardiogram (ECG)

Objective: To explore the techniques for predicting risk-causing arrhythmia in cardiac patients. Study Design: Prospective longitudinal Study Place and Duration of Study: Armed Forces Institute of Cardiology, Rawalpindi Pakistan, and Government College University, Faisalabad from Jul to Oct 2017. Methodology: The Electrocardiograms of 24-hour Holter monitoring were collected from the Electrophysiology Department. Electrocardiogram data was collected in the portable document format that was further transformed into Image format for computational analysis. Administrative data were analysed in multiple episodes of cardiac arrhythmogenesis. Data were classified by using a Convolutional Neural Network (CNN) based on computing the results of selected T-waves in three consecutive peaks within each cardiac cycle of patients. Results: One hundred twenty-six patients diagnosed with arrhythmia were selected. The mean episode of premature ventricular contractions in participants was 21.5±30. The mean duration of significant ECG episodes was 3.33±9.65 (seconds). The accuracy and precision rate of the classifier was about 81% for the overall significance of data that exhibited the risk of causing future life-threatening arrhythmia. Conclusion: This study introduces an innovative approach based on clinical paradigms that may help prevent the upcoming cardiac arrhythmogenesis events.

Redo procedures after sinus node sparing hybrid ablation for inappropriate sinus tachycardia/postural orthostatic sinus tachycardia.

A novel sinus node (SN) sparing hybrid ablation for inappropriate sinus node tachycardia (IST)/postural orthostatic tachycardia syndrome (POTS) has been demonstrated to be an effective and safe therapeutic option in patients with symptomatic drug-resistant IST/POTS. The aim of this study was to evaluate the long-term rate of redo procedures after hybrid IST ablation and procedural strategy, outcomes and safety of redo procedures. All consecutive patients from 2015 to 2023 were prospectively enrolled in the UZ Brussel monocentric IST/POTS registry. They were analysed if the following inclusion criteria were fulfilled: 1) diagnosis of IST or POTS, 2) symptomatic IST/POTS refractory or intolerant to drugs, and 3) hybrid SN sparing ablation performed. The primary endpoint was redo procedure. The primary safety endpoint was pacemaker (PM) implantation. A total of 220 patients undergone to hybrid IST ablation were included, 185 patients (84.1%) were treated for IST and 61 patients (27.7%) for POTS.After a follow-up of 73.3 ± 16.2 months, 34 patients (15.4%) underwent a redo. A total of 23 patients (67.6%) had a redo for IST recurrence and 11 patients (32.4%) for other arrhythmias. Pacemaker implantation was performed in 21 patients (9.5%). Nine patients (4.1%) had no redo procedure and experienced sick sinus syndrome requiring a PM. Twelve patients (5.4%) received a PM as a shared therapeutic choice combined with SN ablation procedure. In a large cohort of patients the long-term free survival from redo procedure after hybrid IST ablation was 84.6% with a low PM implantation rate.

Myocardial work indices in bileaflet mitral valve prolapse patients.

Mechanisms underlying left ventricular dysfunction and arrhythmogenesis in bileaflet mitral valve prolapse (BMVP) patients are not well defined. Myocardial work index (MWI) is a non-invasive assessment that correlates with myocardial oxygen consumption. We aimed to compare global and regional MWI in BMVP patients with normal controls. In this retrospective study, we calculated MWI in BMVP patients and controls using GE EchoPAC (GE Healthcare, Chicago, IL, USA) software. Of 147 BMVP patients (59% women, mean age 54 ± 15 years), 16 had a flail mitral leaflet. There was regional heterogeneity in MWIs, with increased posterolateral trident myocardial work (2099 ± 271 vs. 1895 ± 321 mm Hg%, P = 0.039), constructive work (2831 ± 366 vs. 2257 ± 338 mm Hg%, P < 0.001), wasted work [87 (52-194) vs. 71 (42-103) mm Hg%, P = 0.015], peak systolic strain (-23.0 ± 2.4 vs. -19 ± 3%, P < 0.001), and reduction in myocardial work efficiency [95.00 (93.50-97.75) vs. 96.75 (95.00-97.75) %, P = 0.020] in 100 BMVP patients compared with age- and sex-matched controls. BMVP patients' basal septal wall MWIs were lower than those of controls. The higher work indices in patients with BMVP were reduced in those who developed flail leaflets. No significant differences in work indices were seen between ventricular arrhythmia and non-arrhythmia BMVP patients. Regional differences in MWIs were noted in the BMVP patients compared with controls, with overall reduced myocardial efficiency in the posterolateral trident and basal septal regions. In cross-sectional analysis, MWIs were not different in patients with ventricular tachyarrhythmias. Impact of MWI on long-term prognosis needs to be determined.

Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review.

Cardio-oncology currently faces one of the greatest challenges in the field of health care. The main goal of this discipline is to ensure that patients treated for cancer do not suffer or die from cardiovascular disease. The number of studies on the mechanisms of heart injury during cancer treatment is constantly increasing. However, there is insufficient data on heart rhythm disorders that may result from this treatment. This issue seems to be particularly important in patients with lung cancer, in whom anticancer therapy, especially radiotherapy, may contribute to the onset of cardiac arrhythmias. The observed relationship between cardiac dosimetry and radiotherapy-induced cardiotoxicity in lung cancer treatment may explain the increased mortality from cardiovascular causes in patients after chest irradiation. Further research is essential to elucidate the role of cardiac arrhythmias in this context. Conversely, recent reports have highlighted the application of stereotactic arrhythmia radioablation (STAR) in the treatment of ventricular tachycardia. This review of available studies on the epidemiology, pathogenesis, diagnosis, and treatment of arrhythmias in patients treated for lung cancer aims to draw attention to the need for regular cardiological monitoring in this group of patients. Improving cardiac care for patients with lung cancer has the potential to enhance their overall therapeutic outcomes.

Risk of systemic autoimmune diseases with antiarrhythmic drugs in arrhythmia patients: A retrospective cohort study.

The risk factors for systemic autoimmune disease (SAD)s with antiarrhythmic drug(AAD)s in arrhythmia patients are still unclear. This study was discussed this risk factors for SADs with AADs in arrhythmia patients. This study was a retrospective cohort design and analyzed this relationship in an Asian population. Patients without a prior diagnosis of SADs were identified from Taiwan's National Health Insurance Research Database from January 1, 2000 to December 31, 2013. Cox regression models were estimated the hazard ratio (HR) with 95% confidence interval [CI] of SAD. We estimated the data of participants aged ≧ 20 or ≦ 100 years old and free of SADs at baseline. AAD users (n = 138376) had a significantly increased risk of SADs over non-AAD users. There was a significant higher risk of developing SADs in all age and sex categories. The patients who received AADs, the autoimmune disease with the significantly higher risk was systemic lupus erythematous (SLE) (adjusted HR [aHR] 1.53, 95%CI, 1.04-2.26), Sjögren syndrome (SjS) (adjusted HR [aHR] 2.06, 95%CI, 1.59-2.66) and rheumatoid arthritis (RA) (aHR, 1.57, 95%CI, 1.26-1.94). We concluded that there were statistical associations between AADs and SADs, and the higher incidence was SLE, SjS and RA in arrhythmia patients.

Thyroid gland dysfunction in heart rhythm disorders

Thyroid gland dysfunction is estimated to occur in approximately 5% of the population and affects people of different ages. Cardiovascular diseases can occur in diseases such as hyperthyroidism as well as hypothyroidism. Increased thyroid hormone levels precipitate sympathetic nervous system activation, potentially culminating in heightened heart rate (tachycardia) and disruptions in electrical conduction. This influence can induce QT interval shortening and provoke premature ventricular contractions (PVCs), amplifying the propensity for more severe arrhythmic manifestations. Insufficiency of thyroid hormones decelerates metabolic activity, potentially leading to bradycardia. Hypothyroidism elevates the risk of atrial fibrillation occurrence and additionally elongates QT intervals, enhancing the susceptibility to torsade de pointes. Untreated hormone disorders affect severe cardiac complications, which can occur in patients with previously diagnosed heart disease. Effective management of cardiac arrhythmias in patients with thyroid dysfunction necessitates interdisciplinary collaboration between endocrinologists and cardiologists.

Long-term outcomes of patients with tachycardia-induced cardiomyopathy

Abstract Introduction Tachycardia-induced cardiomyopathy (TCM) is a reversible type of heart failure that occurs after sustained tachyarrhythmia. TCM can occur on its own (pure TCM) or superimposed on another type of CM (impure TCM). Survival data for such patients are lacking. Purpose We aimed to compare the 5-year survival rates of pure and impure TCM patients compared to other types of CM. Methods We retrospectively identified patients with reduced ejection fraction (≤50%) and/or atrial fibrillation or flutter with a left ventricular ejection fraction (LVEF) that improved from baseline (≥ 15% in LVEF at follow-up (FU)) through retrospective chart review. Patients were then divided into four groups (pure TCM, impure TCM, ischemic CM and nonischemic CM). The primary outcome was defined as a composite of death, life-threatening arrhythmia or cardiogenic shock. Secondary outcome was cardiovascular re-admission during FU. Results 238 patients were included (mean age 68 ± 12 years, 31% women). Patients were classified as pure TCM in 35%, impure TCM in 18%, ischemic CM in 24% and non-ischemic CM in 23%. Median FU was 5 (IQR 4-6) years. 13 (5.5%) patients reached the composite outcome at FU. While patients with pure TCM showed similar survival rates as patients with ischemic or nonischemic CM (Figure), a significant difference in survival was observed between impure CM and ischemic and non-ischemic CM with respect to the composite outcome (11% vs 2.7%, p = 0.024). Patients with impure CM showed comparable rates of cardiovascular re-admission during FU compared to patients with ischemic and non-ischemic CM (45% vs. 49%, p = 0.91). Conclusions TCM patients have survival rates similar to patients with another type of CM. Patients with TCM on top of a non-ischemic or ischemic CM (impure TCM) demonstrated the lowest 5-year survival rates. Early detection and treatment of cardiac arrhythmias in patients with impure TCM seem to be warranted.Figure

Cardiac Surgery Morbidity and Mortality in Hypertensive and Arrhythmic Patients: A Retrospective Analysis

Cardiac Surgery Morbidity and Mortality in Hypertensive and Arrhythmic Patients: A Retrospective Analysis

Abstract 14098: Epidemiology and Clinical Outcomes of Cardiac Arrhythmias in Pulmonary Arterial Hypertension

Background: There is limited evidence regarding the impact of cardiac arrhythmias in patients with pulmonary arterial hypertension (PAH). We aim to comprehensively investigate the epidemiology and clinical outcomes of cardiac arrhythmias in patients with PAH. Methods: In a retrospective cohort study including 512 PAH patients from 2001-2021 at 3 Mayo Clinic sites, PAH patients were identified via echocardiogram, pulmonary function tests, and right heart catheterization. Demographic data at PAH diagnosis and clinical outcomes over a 10-year period were collected. The PAH patients were categorized into three groups based on arrhythmic onset: 1) patients with arrhythmia prior to PAH diagnosis, 2) patients diagnosed with arrhythmia during 10-year PAH follow-up, and 3) patients without arrhythmia during 10-year PAH follow-up. Survival outcomes were analyzed using multivariable Cox proportional hazards regression, adjusted with the REVEAL 2.0 score. Results: Among 512 PAH patients (mean age 56.1 years, 81.8% female), the prevalence of cardiac arrhythmias at PAH diagnosis was 10.5%. The cumulative incidences of new-onset arrhythmias at 1, 5, and 10 years were 6.6%, 18.4%, and 29.2%, respectively. Patients with arrhythmia diagnosed before and after PAH diagnosis showed significantly higher all-cause mortality rates with adjusted HR of 2.06 [95% CI 1.36-3.12] and 1.57 [95% CI 1.17-2.20] respectively (Figure 1). Similarly in both arrhythmic groups, there was a shorter median time to the first all-cause hospitalization (9.5 and 15.9 months vs. 21.2 months) and a higher number of all-cause hospitalizations (0.38 and 0.64 times per year vs. 0.10 times per year) compared to the non-arrhythmic group. Conclusions: Cardiac arrhythmias can develop in nearly one-third of PAH patients within 10 years of PAH diagnosis and independently contribute to increased mortality and hospitalization frequency.

Abstract 16707: Clinical Validation of a Chest-Worn Personal ECG Device for the Detection of Atrial Fibrillation

Introduction: Novel consumer-focused personal ECG devices have the potential to revolutionise the way that cardiac arrhythmias are diagnosed and managed. These devices can be used remotely to monitor patients for arrhythmias, which could lead to earlier detection and treatment. In this study, we aimed to compare the cardiologist's interpretation of clinical 12-lead ECG recordings to a consumer-focused dry-electrode ECG chest strap device (Fourth Frontier FX+). Methods: We included patients seen in an outpatient cardiology clinic at the Sri Jayadeva Institute of Cardiovascular Science and Research, Bangalore, India. A total of 163 paired ECG recordings were captured from 85 adult patients (50% female, median age 54 years, AF present at the time of recording in 38%). Patients with critical cardiac problems or life support systems were excluded. ECG data from the Fourth Frontier FX+ (Fourth Frontier, Bangalore, India) and a standard 12-lead ECG were obtained simultaneously in the supine position. PDF reports for both devices were then generated, and the cardiologist's interpretation of the Fourth Frontier FX+ ECG was compared to the cardiologist's interpreted 12L ECG. Results: The cardiologist's interpretation of the Fourth Frontier FX+ data matched the cardiologist-interpreted 12L data for all patients. One FX+ ECG was excluded from the analysis due to not enough data being captured by the device. A total of 33 patients were correctly identified as having atrial fibrillation. Conclusion: The results of this study demonstrate that the Fourth Frontier FX+ ECG monitor is comparable to a 12-lead ECG for cardiac rhythm monitoring and that it can be used remotely to monitor patients for cardiac arrhythmias. This has the potential to change the way that arrhythmias are diagnosed and managed and lead to earlier detection and treatment at scale.