Arrhythmias In Patients Research Articles

On the fractal geometry of different heart rhythms

In this study, we explore the possibility that ECG recordings belong to class of multifractal process for which a large number of scaling exponents are required to characterize their scaling structures. We use the BIDMC Congestive Heart Failure database including long term ECG recordings from 11 men, aged 22 to 71, and 4 women, aged 54 to 63 with severe congestive heart failure and the MIT-BIH Arrhythmia database that contains 48 half-hour excerpts of two-channel ambulatory ECG recordings, obtained from 47 subjects studied by the BIH Arrhythmia Laboratory between 1975 and 1979. We compare these two chronic heart diseases with the control people in the MIT-BIH Normal Sinus Rhythm database which includes 18 long-term ECG recordings of 5 men, aged 26 to 45, and 13 women, aged 20 to 50 without significant arrhythmia. The vibration analysis such as power spectral densities (PSD) analysis has been performed for differentiating the time series. Multifractal dynamics of heartbeat interval signals have been assessed by multifractal spectrum analysis to differentiate normal signals with arrhythmia and severe congestive heart failure patients. We apply Higuchi algorithm to find the fractal complexity of each cardiac rhythm and then compare the signals for different time intervals. According to our analysis, we investigate that neither the power spectral densities nor the Higuchi algorithm to find the fractal dimension alone were sufficient to separate different classes of patients and healthy people. However, when multifractal analysis and scaling exponent were used as a classifier, the three classes were well separated. In addition, multifractal analysis revealed that we have a narrow range of exponents for arrhythmia and congestive heart failure subjects and as a result, a clear loss of multifractality for them. It was of great significance to show that we have a narrower range of exponents for arrhythmia subject compared to congestive heart failure subject which is useful to recognize these two classes of patients with heart disease. Our findings provide a comprehensive framework for diagnostic and classifying different patients with cardiac disease such as arrhythmia and congestive heart failure and differentiate them with normal people without heart disease which is crucial in finding the best diagnostic and controlling strategy in fight against chronic heart disease.

Artificial intelligence augments detection accuracy of cardiac insertable cardiac monitors: Results from a pilot prospective observational study

BackgroundInsertable cardiac monitors (ICMs) are indicated for long-term monitoring of patients with unexplained syncope or who are at risk for cardiac arrhythmias. The volume of ICM-transmitted information may result in long data review times to identify true and clinically relevant arrhythmias.ObjectiveThe purpose of this study was to evaluate whether artificial intelligence (AI) may improve ICM detection accuracy.MethodsWe performed a retrospective analysis of consecutive patients implanted with the Confirm RxTM ICM (Abbott) and followed in a prospective observational study. This device continuously monitors subcutaneous electrocardiograms (SECGs) and transmits to clinicians information about detected arrhythmias and patient-activated symptomatic episodes. All SECGs were classified by expert electrophysiologists and by the WillemTM AI algorithm (IDOVEN).ResultsDuring mean follow-up of 23 months, of 20 ICM patients (mean age 68 ± 12 years; 50% women), 19 had 2261 SECGs recordings associated with cardiac arrhythmia detections or patient symptoms. True arrhythmias occurred in 11 patients: asystoles in 2, bradycardias in 3, ventricular tachycardias in 4, and atrial tachyarrhythmias (atrial tachycardia/atrial fibrillation [AT/AF]) in 10; with 6 patients having >1 arrhythmia type. AI algorithm overall accuracy for arrhythmia classification was 95.4%, with 97.19% sensitivity, 94.52% specificity, 89.74% positive predictive value, and 98.55% negative predictive value. Application of AI would have reduced the number of false-positive results by 98.0% overall: 94.0% for AT/AF, 87.5% for ventricular tachycardia, 99.5% for bradycardia, and 98.8% for asystole.ConclusionApplication of AI to ICM-detected episodes is associated with high classification accuracy and may significantly reduce health care staff workload by triaging ICM data.

Physical activity and cardiac arrhythmias in patients with INOCA on the management with ranolazine

Physical activity and cardiac arrhythmias in patients with INOCA on the management with ranolazine

Cardiac arrhythmias in patients with comorbid conditions and obstructive sleep apnea syndrome according to type 3 portable monitor

Cardiac arrhythmias in patients with comorbid conditions and obstructive sleep apnea syndrome according to type 3 portable monitor

Olfactory Radioanatomical Findings in Patients With Cardiac Arrhythmias, COVID-19, and Healthy Controls.

BackgroundClinical hyposmia and anosmia are commonly seen, most frequently with either post-inflammatory, age-related, or idiopathic causes being most frequent. Actual anatomical abnormalities of the olfactory groove or olfactory bulb are far less common. A recent case report showing a possible link between congenital olfactory bulb agenesis and Wolff-Parkinson-White syndrome suggested that there may be a relationship between cardiac arrhythmia and olfactory bulb development. While Kallmann syndrome (KS) is the classic syndrome involving olfactory bulb agenesis and hypogonadotropic hypogonadism, this case report and a prior report noting isolated hypogonadotropic hypogonadism and the Wolff-Parkinson-White syndrome suggest there may be more rare associations between cardiac arrhythmia and olfactory groove abnormalities.MethodsA retrospective study was conducted to attempt to elucidate whether there may be a link between cardiac arrhythmias and olfactory anatomical abnormalities. The olfactory bulb volume (OBV) and olfactory sulcus depth (OSD) of 44 patients with cardiac arrhythmias were compared to 43 healthy control patients. Additionally, 11 patients with acute COVID-19 were also compared in those groups. Patients were seen between September and December 2020. Available MRI images were utilized.ResultsThe average right and left olfactory bulb volume was 29.42±18.17 mm3 and 25.67±15.29 mm3 for patients with cardiac arrhythmia, 40.79±30.65 mm3 and 38.95±21.87mm3 for healthy controls, and 21.30±15.23 mm3 and 17.75±9.63 mm3 for COVID-19 patients. The average right and left olfactory sulcus depth was 7.68±1.31 mm and 7.47±1.56 mm for patients with cardiac arrhythmia, 10.67±1.53 mm and 10.62±1.67 mm for controls, and 7.91±0.99 mm and 8.02±0.88 mm for COVID-19 patients. The right and left olfactory bulb volume difference versus controls was significant for cardiac arrhythmia patients (p=0.028 and p=0.0038) and for COVID-19 patients (p=0.047 and p=0.0029), and the right and left olfactory sulcus depth difference versus controls was significant for cardiac arrhythmia patients (p<0.0001 and p<0.0001) and for COVID-19 patients (p<0.0001 and p<0.0001). Both COVID-19 and cardiac arrhythmia patients were, on average, significantly older than controls. On multivariate analysis, cardiac arrhythmia or COVID-19 diagnosis did not significantly correlate with smaller olfactory bulb volume, but older age, cardiac arrhythmia diagnosis, and COVID-19 diagnosis did significantly correlate with smaller olfactory sulcus depth. On multivariate analysis, older age was significantly correlated with cardiac arrhythmia diagnosis and COVID-19 diagnosis.ConclusionsOlfactory bulb volume and olfactory sulcus depth in both cardiac arrhythmia and COVID-19 patients appeared significantly smaller than in controls. Cardiac arrhythmia and COVID-19 patients were significantly older than controls. Age, as well as genetic predisposition, may contribute to a difference in the radiographic olfactory anatomical findings in patients with cardiac arrhythmias and COVID-19.

The impact of the clinical diagnosis on the vagal response and heart rate after ganglionated plexus ablation.

Ganglionated plexi (GP) ablation may be associated with improved syncope or arrhythmia-free survival arrhythmia patients with vasovagal syncope (VVS) and atrial fibrillation (AF), respectively. We aimed to compare the characteristics of vagal response (VR) and clarify the effect on heart rate after GP ablation based on clinical diagnosis. A total of 83 consecutive patients undergoing GP ablation were divided following two groups: (1) GP ablation for VVS (VVS group, n = 43) and (2) GP ablation in addition to pulmonary vein isolation (AF group, n = 40). We examined VR characteristics during RF ablation and high frequency stimulation, respectively, in the VVS and AF groups. To evaluate immediate and long-term heart rate response, a standard 12-lead ECG was obtained at baseline at 24h after ablation and at the last follow-up visit. In the VVS group, the superior and inferior left atrial GPs were the most common GP sites at which a VR was observed. No VR was seen during radiofrequency application in the superior and inferior right atrial GPs in the VVS group. On the contrary, VR was more prevalent in the right-sided GPs during high-frequency stimulation in the AF group. VR was observed during ablation in only one patient with AF. Although the heart rate increased significantly after ablation in both groups, the effect was more prominent and durable in the VVS group. The autonomic response during GP ablation is different in VVS compared to AF, suggesting that VVS and AF may represent distinct forms of autonomic hyperactivity.

Incidence and Predictors of Cardiac Arrhythmias in Patients With COVID-19.

BackgroundCoronavirus disease 2019 (COVID-19) is a systemic disease caused by severe acute respiratory syndrome coronavirus 2. Arrhythmias are frequently associated with COVID-19 and could be the result of inflammation or hypoxia. This study aimed to define the incidence of arrhythmias in patients with COVID-19 and to correlate arrhythmias with pulmonary damage assessed by computed tomography (CT).MethodsAll consecutive patients with a COVID-19 diagnosis hospitalized at Universitair Ziekenhuis Brussel, Belgium, between March 2020 and May 2020, were screened. All included patients underwent a thorax CT scan and a CT severity score, a semiquantitative scoring system of pulmonary damage, was calculated. The primary endpoint was the arrhythmia occurrence during follow-up.ResultsIn this study, 100 patients were prospectively included. At a mean follow-up of 19.6 months, 25 patients with COVID-19 (25%) experienced 26 arrhythmic episodes, including atrial fibrillation in 17 patients, inappropriate sinus tachycardia in 7 patients, atrial flutter in 1 patient, and third-degree atrioventricular block in 1 patient. No ventricular arrhythmias were documented. Patients with COVID-19 with arrhythmias showed more often need for oxygen, higher oxygen maximum flow, longer QTc at admission, and worse damage at CT severity score. In univariate logistic regression analysis, significant predictors of the primary endpoint were: the need for oxygen therapy (odds ratio [OR] 4.59, 95% CI 1.44–14.67, p = 0.01) and CT severity score of pulmonary damage (OR per 1 point increase 1.25, 95% CI 1.11–1.4, p < 0.001).ConclusionsIn a consecutive cohort of patients with COVID-19 the incidence of cardiac arrhythmias was 25%. The need for oxygen therapy and CT severity score were predictors of arrhythmia occurrence during follow-up.

Observation on Clinical Effect of Nursing Intervention to Improve Arrhythmia Patients and Reduce Complications

Observation on Clinical Effect of Nursing Intervention to Improve Arrhythmia Patients and Reduce Complications

Maturation of hiPSC-derived cardiomyocytes in cardiac microtissues promotes adult alternative splicing of sodium channel revealing mutation effects associated with cardiac arrhythmia

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Marie Skłodowska-Curie Actions - Individual Fellowship Background The cardiac sodium channel encoded by SCN5A gene undergoes fetal-to-adult isoform switch postnatally, regulated by alternative splicing. Various mutations in SCN5A associated with severe cardiac arrhythmia have been previously studied using cardiomyocytes derived from human induced pluripotent stem-cells (hiPSC-CMs), demonstrating the importance of a human cardiac cellular context for such analysis. Mutations in the adult isoform of SCN5A are however of difficult evaluation in hiPSC-CMs, because of their typical immature/fetal-like characteristics. Combining hiPSC-CMs in 3-dimensional microtissues together with hiPSC-derived cardiac fibroblasts and endothelial cells induced maturation in gene expression and functional properties, including electrophysiology. Purpose We investigated whether the maturation promoted by the microtissue system could reveal the functional phenotype of a mutation in the adult isoform of SCN5A. Methods We derived hiPSC-CMs from a cardiac arrhythmia patient carrying two compound mutations in SCN5A: p.W156X in exon 4 and p.R225W in the adult splicing variant of exon 6 (exon 6B). Using CRISPR/Cas9, we corrected exon 4 mutation to investigate specific effects of exon 6B mutation on sodium current by single-cell patch clamp. HiPSC-CMs were matured in tricell-type cardiac microtissues and analysed after dissociation. The mechanism underlying exon 6B expression was investigated by overexpressing or knocking-out the alternative splicing regulator MBNL1 in hiPSC-CMs. Results ddPCR analysis showed low expression of exon 6B-containing transcripts in hiPSC-CMs, accompanied by no effect of exon 6B mutation on the sodium current. Instead, maturing hiPSC-CMs in cardiac microtissues promoted SCN5A exon 6B expression and revealed the contribution of both SCN5A mutations to the diseased cellular electrophysiology. MBNL1 was upregulated in microtissues and indeed its overexpression was sufficient to increase exon 6B levels in hiPSC-CMs, while lack of MBNL1 prevented the switch of SCN5A splicing isoforms. Conclusions Our data demonstrate that a maturation of hiPSC-CMs is required to express the adult SCN5A isoform. This was achieved in the microtissue system via upregulation of MBNL1, and allowed to reveal SCN5A mutation contributions, by dissecting changes in ionic current that cause adult arrhythmic disease phenotypes in humans.

Incidence and predictors of cardiac arrhythmias in patients with systemic sclerosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart involvement in systemic sclerosis patients is frequent and represents a negative prognostic factor with around 25% of SSc patients dying from cardiovascular related causes. Cardiac arrhythmias represent 6% of the overall causes of death in SSc patients. Not only a plethora of conditions typical of the disease seem to favour the presence of an arrhythmic substrate such as microvascular disease or fibrosis but autoimmunity itself has been recognized as a pathogenic mechanism for cardiac arrhythmias. Purpose The aim of our study was to investigate the incidence of arrhythmias in patients with systemic sclerosis and identify potential predictors. Methods Prospective longitudinal study enrolling all consecutive patients with a diagnosis of SSc and no overt cardiac disease nor pulmonary hypertension. Echocardiographic parameters and GLS were obtained at baseline and at each follow up as well as 12 lead ECG. Presence of atrial fibrillation (AF), atrial tachycardia (AT), ventricular ectopic beats &amp;gt;1000/24 h (VEB), supraventricular ectopic beats (SVEB), bundle branch block (BBB) and atrioventricular block (AVB) was registered. Results 160 patients (144 females, 90%, mean age 59±14 years) were enrolled from June 2016 to December 2021. At enrolment, 11.3% of patients with SSc presented a previous history of supraventricular arrhythmia (5.6% supraventricular ectopic beats, 3.1% atrial fibrillation, 2.5% atrial flutter) and 5.6% a history of ventricular arrhythmia (5.0% ventricular ectopic beats, 0.6% ventricular tachycardia). After a median follow-up of 3.1 years (95% CI 1.4-4.8 years), five patients (3.1%) died of cardiovascular causes, of which three (1.8%) experienced a sudden cardiac death. During the same period, 16 patients (10%) presented a new diagnosis of supraventricular arrythmia (8.7% atrial fibrillation, 1.3% atrial flutter) and two patients (1.2%) a new diagnosis of ventricular tachycardia. PR interval significantly increased during the 3.1-year follow-up (154±27 vs. 178±32 ms; p=0.013), as well as corrected QT interval (420±23 vs. 436±19 ms; p=0.001). New diagnosis of complete right and left bundle branch block was made in 18 (11.2%) and two (1.2%) of all SSc patients. Diagnosis of pulmonary arterial hypertension was associated with a 4-fold and a 10-fold increased risk of supraventricular and ventricular arrhythmias, respectively (Figure 1). A diffuse SSc variant (p=0.049), indexed right (p=0.020) and left atrial volumes (p=0.035), and E/E’ ratios (p=0.016) were all associated with an increased risk of supraventricular arrhythmias. TAPSE (p=0.040), as well as right (p=0.030) global longitudinal strain were associated with an increased risk of ventricular arrhythmias. Conclusions Ssc patients are often by an arrhythmic profile with an increased risk of supraventricular and ventricular events as well as sudden cardiac death. A comprehensive cardiological work up may help in lowering the risk of arrhythmic complications.

Incidence and predictors of cardiac arrhythmias in patients with COVID-19 induced ARDS

IntroductionRecent studies suggest cardiac involvement with an increased incidence of arrhythmias in the setting of coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the risk of potentially lethal arrhythmias and atrial fibrillation in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) and to elicit possible predictors of arrhythmia occurrence. Methods and resultsA total of 107 patients (82 male, mean age 60 ± 12 years, median body mass index 28 kg/m2) treated for COVID-19-induced ARDS in a large tertiary university hospital intensive care unit between March 2020 and February 2021 were retrospectively analyzed. Eighty-four patients (79%) had at least moderate ARDS, 88 patients (83%) were mechanically ventilated, 35 patients (33%) received vvECMO. Forty-three patients (40%) died during their hospital stay. Twelve patients (11%) showed potentially lethal arrhythmias (six ventricular tachycardia, six significant bradycardia). Atrial fibrillation occurred in 27 patients (25%). In a multivariate logistic regression analysis, duration of hospitalization was associated with the occurrence of potentially lethal arrhythmias (p = 0.006). There was no association between possible predictive factors and the occurrence of atrial fibrillation. Invasive ventilation, antipsychotics, and the QTc interval were independently associated with acute in-hospital mortality, but this was not arrhythmia-driven as there was no association between the occurrence of arrhythmias and mortality. ConclusionIn this relatively young population with COVID-19-induced ARDS, the incidence of potentially lethal arrhythmias was low. While overall mortality was high in these severely affected patients, cardiac involvement and arrhythmia occurrence was not a significant driver of mortality.

Electrocardiography is Useful to Predict Postoperative Ventricular Arrhythmia in Patients Undergoing Cardiac Surgery: A Retrospective Study

Background: Preoperative detection of high-/low-risk postoperative ventricular arrhythmia (POVA) patients using a noninvasive method is an important issue in the clinical setting. This study mainly aimed to determine the usefulness of several preoperative electrocardiographic (ECG) markers in the risk assessment of POVA with cardiac surgery. Method: We enrolled 1024 consecutive patients undergoing cardiac surgery, and a total of 823 patients were included in the study. Logistic regression analysis determined preoperative ECG markers. A new risk predicting model were developed to predict occurrence of POVA, and the receiver operating characteristic curve (ROC) was used to validate this model. Results: Of these, 337 patients experienced POVA, and 485 patients did not experience POVA in this retrospective study. Among 15 ECG markers, a univariate analysis found a strong association between POVA and preoperative VA, the R-wave in lead aVR, the QRS wave, index of cardiac electrophysiological balance (iCEB), QT interval corrected (QTc), Tpeak–Tend interval (Tpe) in lead V2, the J wave in the inferolateral leads, pathological Q wave, and SV1+RV5>35 mm. Multivariate analysis showed that a preoperative J wave [adjusted odds ratio (AOR): 3.80; 95% CI: 1.88–7.66; p < 0.001], Tpe >112.5-ms (AOR: 2.80; 95% CI: 1.57–4.99; p < 0.001), and SV1+RV5 >35 mm (AOR: 2.92; 95% CI: 1.29–6.60; p = 0.01) were independently associated with POVA. A new risk predicting model were developed in predicting POVA. Conclusion: The ECG biomarkers including J wave, Tpe >112.5 ms, and SV1+RV5 >35 mm were significantly predicted POVAs. A risk predicting model developed with electrocardiographic risk markers preoperatively predicted POVAs.

Caffeine Induces Spontaneous Ventricular Tachyarrhythmias and Bidirectional Ventricular Tachycardia: Increased Vulnerability with Aging

IntroductionCaffeine is generally suspected to trigger or exacerbate cardiac arrhythmias in patients, but so far clinical data have been conflicting. We have demonstrated previously that caffeine plus dobutamine challenge can induce ventricular tachyarrhythmias in normal rats (Heart Rhythm O2 2020;1:359‐367). However, whether caffeine alone can induce cardiac arrhythmias has not been investigated. We hypothesize that caffeine alone could trigger spontaneous cardiac arrhythmias, which may be affected by aging and sexes. In this study we have investigated the effect of caffeine on spontaneous cardiac arrhythmias in younger and older adult rats of both sexes.MethodsThis study used Sprague‐Dawley rats. Younger (5‐month‐old) and older (1‐year‐old) adult rats of both sexes were enrolled. The study consisted of the following groups: 5‐month‐old male rats (younger male, n=8) and 1‐year‐old male rats (older male, n=9), 5‐month‐old female rats (younger female, n=6) and 1‐year‐old female rats (older female, n=5). These rats received caffeine (80mg/kg, IP) injection. In addition, a group of 5‐month‐old rats (both sexes, n=8) receiving saline injection without caffeine served as the control group. Surface electrocardiogram (ECG, standard Lead II) was continuously monitored and recorded during the experiments.ResultsNo arrhythmia was induced in the control group with saline injection. Caffeine injection induced ventricular tachyarrhythmias in 8/9 older male rats, while only in 2/8 younger male rats (younger versus older male rats, p=0.0152, Fisher's exact test). Similarly, ventricular arrhythmias were induced in 5/5 older female rats, and only in 1/6 younger female rats (older versus younger female rats, p=0.0152). There were no significant differences in male versus female rats in both age groups. Induced ventricular arrhythmias include various premature ventricular contractions (PVC, Figure‐Panel A) in all rats, monomorphic ventricular tachycardia (VT, Panel B) in 3 rats and polymorphic VT and bidirectional VT (Panel C) in all rats. No atrial arrhythmia was observed.ConclusionCaffeine can induce spontaneous ventricular arrhythmias in normal rats, and the younger rats are more resistant to arrhythmia induction. Arrhythmia inducibility increases significantly in older rats. There is no sex difference in caffeine induced ventricular arrhythmias. Although different types of ventricular arrhythmias are induced, the characteristic bidirectional VT is highly prevalent among the caffeine induced arrhythmias and no atrial arrhythmia was observed.

Burden of arrhythmias and predictors of mortality among multiple myeloma patients with arrhythmias

Arrhythmias are a major cardiac complication reported among patients with multiple myeloma (MM), but these have not been further characterized in this population. We explored the prevalence of arrhythmias and...

PO-671-05 ATRIAL ARRHYTHMIAS ASSOCIATED WITH INCREASED MORTALITY IN PATIENTS HOSPITALIZED WITH COVID-19

COVID-19 is a novel, highly contagious virus with a wide array of presentations. Initially characterized by symptoms in the respiratory tract, cardiovascular disease and associated complications often accompany COVID-19 infections thereby increasing morbidity and mortality. Current literature has reported an increased rate of cardiac arrhythmias in patients hospitalized with COVID-19. This retrospective medical analysis sought to evaluate the impact of atrial arrhythmias on morbidity and mortality in patients hospitalized with COVID-19.

Real-Time Spiral CMR Is Superior to Conventional Segmented Cine-Imaging for Left-Ventricular Functional Assessment in Patients with Arrhythmia.

(1) Background: Segmented Cartesian Cardiovascular magnetic resonance (CMR) often fails to deliver robust assessment of cardiac function in patients with arrhythmia. We aimed to assess the performance of a tiny golden-angle spiral real-time CMR sequence at 1.5 T for left-ventricular (LV) volumetry in patients with irregular heart rhythm; (2) Methods: We validated the real-time sequence against the standard breath-hold segmented Cartesian sequence in 32 patients, of whom 11 presented with arrhythmia. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were assessed. In arrhythmic patients, real-time and standard Cartesian acquisitions were compared against a reference echocardiographic modality; (3) Results: In patients with sinus rhythm, good agreements and correlations were found between the segmented and real-time methods, with only minor, non-significant underestimation of EDV for the real-time sequence (135.95 ± 30 mL vs. 137.15 ± 31, p = 0.164). In patients with arrhythmia, spiral real-time CMR yielded superior image quality to the conventional segmented imaging, allowing for excellent agreement with the reference echocardiographic volumetry. In contrast, in this cohort, standard Cartesian CMR showed significant underestimation of LV-ESV (106.72 ± 63.51 mL vs. 125.47 ± 72.41 mL, p = 0.026) and overestimation of LVEF (42.96 ± 10.81% vs. 39.02 ± 11.72%, p = 0.039); (4) Conclusions: Real-time spiral CMR improves image quality in arrhythmic patients, allowing reliable assessment of LV volumetry.

Cardiac arrhythmias in patients with bronchial asthma

Introduction. According to modern data, bronchial asthma (BA) is an independent risk factor for the development of cardiac arrhythmias (CA), and the use of long-acting β2-agonists (LABA) in basic therapy may further increase the risks of CA.Aim. To study the structure and risk factors of cardiac arrhythmias in patients with bronchial asthma. Materials and methods. A retrospective study included 181 patients aged 69.4 ± 0.8 years, hospitalized for asthma, with the presence a CA in medical documentation.Results. Among BA patients with CA, supraventricular CA were found in 71.3% (129) patients, ventricular CA in 16.6% (30), combined CA in 12.2% (22). In 52.5% (95) patients, supraventricular extrasystole was detected, in 35.9% (65) – atrial fibrillation, in 28.7% (52) – ventricular extrasystole, in 1.1% (2) – paroxysmal supraventricular tachycardia, in 0.6% (1) – paroxysmal ventricular tachycardia. It was found that supraventricular CA was significantly more frequent among women (χ2 = 5.974, p = 0.05). The severity of BA and the level of control are not related to the type of observed CA (χ2 = 0.755, p = 0.685 and χ2 = 3.003, p = 0.557, respectively).Discussion. The use of a combination of ICS and LABA in basic BA therapy versus the use of ICS alone does not have a significant effect on the frequency and structure of cardiac arrhythmias (χ2 = 1.172, p = 0.556).Conclusion. In hospitalized BA patients, supraventricular cardiac arrhythmias are most often detected, among which supraventricular extrasystole and atrial fibrillation take the main place.

Serious Cardiac Arrhythmias Detected by Subcutaneous Long-term Cardiac Monitors in Patients With Drug-Resistant Epilepsy.

Epilepsy is associated with an increased risk of cardiovascular disease and premature mortality, including sudden unexpected death in epilepsy (SUDEP). Serious cardiac arrythmias might go undetected in routine epilepsy and cardiac investigations. This prospective cohort study aimed to detect cardiac arrhythmias in patients with chronic drug-resistant epilepsy (≥5 years duration) using subcutaneous cardiac monitors for a minimum follow-up duration of 12 months. Participants with known cardiovascular disease or those with abnormal 12-lead ECGs were excluded. The device was programmed to automatically record episodes of tachycardia ≥140 beats per minute (bpm), bradycardia ≤40 bpm for ≥3 seconds, or asystole ≥3 seconds. Thirty-one patients underwent subcutaneous cardiac monitoring for a median recording duration of 2.2 years (range 0.5-4.2). During this time, 28 patients (90.3%) had episodes of sustained (≥30 seconds) sinus tachycardia, 8/31 (25.8%) had sinus bradycardia, and 3 (9.7%) had asystole. Three patients (9.7%) had serious cardiac arrhythmias requiring additional cardiac interventions. Among them, 2 patients had prolonged sinus arrest and ventricular asystole (>6 seconds), leading to pacemaker insertion in one, and another patient with epileptic encephalopathy had multiple episodes of recurrent nonsustained polymorphic ventricular tachycardia and bundle branch conduction abnormalities. The time to first detection of a clinically significant cardiac arrhythmia ranged between 1.2 and 26.9 months following cardiac monitor insertion. Implantable cardiac monitors detected a high incidence of clinically significant cardiac arrhythmias in patients with chronic drug-resistant epilepsy, which may contribute to the incidence of premature mortality, including SUDEP.

Evaluation of combined late gadolinium-enhancement and functional cardiac magnetic resonance imaging using spiral real-time acquisition.

The purpose of the current study was to implement and validate joint real-time acquisition of functional and late gadolinium-enhancement (LGE) cardiac magnetic resonance (MR) images during free breathing. Inversion recovery cardiac real-time images with a temporal resolution of 50 ms were acquired using a spiral trajectory (IR-CRISPI) with a pre-emphasis based on the gradient system transfer function during free breathing. Functional and LGE cardiac MR images were reconstructed using a low-rank plus sparse model. Late gadolinium-enhancement appearance, image quality, and functional parameters of IR-CRISPI were compared with clinical standard balanced steady-state free precession breath-hold techniques in 10 patients. The acquisition of IR-CRISPI in free breathing of the entire left ventricle took 97 s on average. Bland-Altman analysis and Wilcoxon tests showed a higher artifact level for the breath-hold technique (p = 0.003), especially for arrhythmic patients or patients with dyspnea, but an increased noise level for IR-CRISPI of the LGE images (p = 0.01). The estimated transmural extent of the enhancement differed by not more than 25% and did not show a significant bias between the techniques (p = 0.50). The ascertained functional parameters were similar for the breath-hold technique and IR-CRISPI, that is, with a minor, nonsignificant (p = 0.16) mean difference of the ejection fraction of 2.3% and a 95% confidence interval from -4.8% to 9.4%. IR-CRISPI enables joint functional and LGE imaging in free breathing with good image quality but distinctly shorter scan times in comparison with breath-hold techniques.

SARS-CoV-2 Infection Induces Ferroptosis of Sinoatrial Node Pacemaker Cells.

Background:Increasing evidence suggests that cardiac arrhythmias are frequent clinical features of coronavirus disease 2019 (COVID-19). Sinus node damage may lead to bradycardia. However, it is challenging to explore human sinoatrial node (SAN) pathophysiology due to difficulty in isolating and culturing human SAN cells. Embryonic stem cells (ESCs) can be a source to derive human SAN-like pacemaker cells for disease modeling.Methods:We used both a hamster model and human ESC (hESC)–derived SAN-like pacemaker cells to explore the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pacemaker cells of the heart. In the hamster model, quantitative real-time polymerase chain reaction and immunostaining were used to detect viral RNA and protein, respectively. We then created a dual knock-in SHOX2:GFP;MYH6:mCherry hESC reporter line to establish a highly efficient strategy to derive functional human SAN-like pacemaker cells, which was further characterized by single-cell RNA sequencing. Following exposure to SARS-CoV-2, quantitative real-time polymerase chain reaction, immunostaining, and RNA sequencing were used to confirm infection and determine the host response of hESC-SAN–like pacemaker cells. Finally, a high content chemical screen was performed to identify drugs that can inhibit SARS-CoV-2 infection, and block SARS-CoV-2–induced ferroptosis.Results:Viral RNA and spike protein were detected in SAN cells in the hearts of infected hamsters. We established an efficient strategy to derive from hESCs functional human SAN-like pacemaker cells, which express pacemaker markers and display SAN-like action potentials. Furthermore, SARS-CoV-2 infection causes dysfunction of human SAN-like pacemaker cells and induces ferroptosis. Two drug candidates, deferoxamine and imatinib, were identified from the high content screen, able to block SARS-CoV-2 infection and infection-associated ferroptosis.Conclusions:Using a hamster model, we showed that primary pacemaker cells in the heart can be infected by SARS-CoV-2. Infection of hESC-derived functional SAN-like pacemaker cells demonstrates ferroptosis as a potential mechanism for causing cardiac arrhythmias in patients with COVID-19. Finally, we identified candidate drugs that can protect the SAN cells from SARS-CoV-2 infection.