Cardiac Conduction Disorders Research Articles

Association between circulating leukocytes and arrhythmias: Mendelian randomization analysis in immuno-cardiac electrophysiology.

Cardiac arrhythmia is a common disease associated with high mortality and morbidity. Circulating leukocyte counts, which serve as a biomarker for assessing systemic immune status, have been linked to arrhythmias in observational studies. However, observational studies are plagued by confounding factors and reverse causality, whether alterations in circulating leukocyte components are causally associated with arrhythmias remains uncertain. The present study explored this question based on genetic evidence. We performed Mendelian randomization (MR) analysis to evaluate whether alterations in leukocyte counts affect aggregated risk of all types of arrhythmia or risk of five specific types of arrhythmia. Single-nucleotide polymorphisms serving as proxies for leukocyte differential counts were retrieved from the Blood Cell Consortium, and statistical data on arrhythmias were obtained from the UK Biobank), FinnGenand a meta-analysis of genome-wide association studies for atrial fibrillation. We applied inverse variance-weighted method as the primary analysis, complemented by a series of sensitivity analyses. Bidirectional analyses were conducted to assess reverse causality. Finally, multivariable MR was performed to study the joint effects of multiple risk factors. We found that genetically predicted differential leukocyte counts were not significantly associated with aggregated occurrence of all types of arrhythmia. In contrast, each 1-standard deviation increase in lymphocyte count was associated with 46% higher risk of atrioventricular block (OR 1.46, 95% CI 1.11-1.93, p=0.0065). A similar effect size was observed across all MR sensitivity analyses, with no evidence of horizontal pleiotropy. Reverse MR analysis suggested that atrioventricular block was unlikely to cause changes in lymphocyte count. Primary MR analysis based on the inverse-variance weighted method suggested that changes in neutrophil count alter risk of right bundle branch block, and changes in basophil count alter risk of atrial fibrillation. However, these causal relationships were not robust in sensitivity analyses. We found no compelling evidence that neutrophil or lymphocyte counts cause atrial fibrillation. Our data support higher lymphocyte count as a causal risk factor for atrioventricular block. These results highlight the importance of immune cells in the pathogenesis of specific cardiac conduction disorders.

What is important for an internist to know about sleep?

Introduction. A variety of patient complaints about sleep disorders and associated quality of life restrictions force patients to turn primarily to internists. Meanwhile, internist doctors often pay insufficient attention to detailing the symptoms associated with the patient's sleep state. Main purpose of the work was to systematize modern data on the relationship between sleep disorders and pathology of internal organs and to increase the awareness of internists about sleep disorders and associated diseases. Materials and methods. Literature sources were selected for the review by the keywords: sleep, sleep disorders, OSAS for the period 2003–2021 in PubMed, GoogleScholar, Web of Science databases. Results and discussion. Disorders of sleep duration and quality in patients influence the development of other internal organ pathologies. Of particular importance is the relationship of sleep disorders with nocturnal cardiac rhythm and conduction disorders, changes in daily BP profile, OSAS, nocturnal heartburn and GERD, accelerated aging. Analysis of a patient's sleep status is of great importance in the practice of an internist and can improve the prognosis for a number of diseases. Conclusion. When working with patients, internists should assess the state of sleep as a potentially modifiable risk factor for diseases of the internal organs.

Electrophysiological study in chagasics with syncope and conduction disorder.

Investigation of syncope involves the use of electrophysiological study, particularly in patients with cardiac conduction disorder. There is conflicting evidence about the role of electrophysiological study in patients with Chagas disease. The objective of this study was to evaluate the electrophysiological study findings in patients with Chagas disease and bundle branch block and/or divisional block presenting with syncope. This is a retrospective study of patients with Chagas disease and cardiac conduction disorder who underwent electrophysiological study from 2017 to 2021 for the investigation of syncope in a tertiary hospital in São Paulo, Brazil. Those with non-interpretable ECG, known coronary artery disease, and/or other cardiomyopathies were excluded. HV interval and electrophysiological study-induced malignant ventricular arrhythmias data were analyzed. A total of 45 patients (60.2±11.29 years, 57.8% males) were included. The mean HV interval was 58.37 ms±10.68; 22.2% of the studied population presented an HV interval of ≥70 ms; and malignant ventricular arrhythmias were induced in 57.8% patients. The use of beta-blockers and amiodarone (p=0.002 and 0.036, respectively), NYHA functional class≥II (p=0.013), wide QRS (p=0.047), increased HV interval (p=0.02), Rassi score >6.5 (p=0.003), and reduced left ventricular ejection fraction (p=0.031) were associated with increased risk of inducible malignant ventricular arrhythmias. More than half of the patients with Chagas disease, syncope, and cardiac conduction disorder have inducible malignant ventricular arrhythmias. Prolonged HV interval was observed in only 20% of population. Wide QRS, prolonged HV, reduced ejection fraction, and higher Rassi score were associated with increased risk of malignant ventricular arrhythmias.

ELECTROCARDIOGRAM PATTERN PRE AND 24 HOURS POST THERAPY IN HYPONATREMIA WITH HEART FAILURE PATIENT

Background : Hyponatremia is the most common electrolyte disturbance in hospitalized heart failure patients, with a prevalence of around 19%-25%. The relationship between hyponatremia and cardiac conduction disorders has not been demonstrated yet. When there is a decrease in extracellular Na+ levels, there is a delay in the depolarization phase. This study was conducted to observe the ECG pattern in hyponatremic patients with heart failure (particularly in the P wave, PR interval, and QRS complex) and ECG changes after 24 hours of therapy. Methode: This study used a longitudinal observational descriptive method. Patients who were included in this study were hyponatremic patients with heart failure at the Wahidin Sudirohusodo Hospital Makassar from April to September 2021. The patient's electrocardiogram data when first admitted and after 24 hours of therapy. Statistical test using McNemar and Wilcoxon Signed Rank Test, where the test results are statistically significant when the p value <0.05. Result : This study included 51 subjects with a distribution of 68.6% men with an age range of 18-85 years. Pre-therapy ECG pattern showed 12 patients with prolonged P-R interval, and 4 patients with widening of the QRS complex. After 24 hours of therapy, 12 people became normonatremia and the mean P wave and P-R interval were lower than pre-therapy, while the QRS complex did not show any changes. Conclusion : The ECG pattern in hyponatremia with heart failure are prolonged P-R interval and widening of the QRS complex, but the ECG changes were not significant to Na+ levels changes.

Conduction system disorders and electrocardiographic findings in COVID-19 deceased patients in 2021, Shiraz, Iran.

Cardiac conduction disorders and electrocardiographic (ECG) changes may occur as a manifestation of coronavirus disease 2019 (COVID-19), especially in severe cases. To describe conduction system disorders and their association with other electrocardiographic parameters in patients who died of COVID-19. In this cross-sectional study, electrocardiographic and clinical data of 432 patients who expired from COVID-19 between August 1st, 2021, and December 1st, 2021, in a tertiary hospital were reviewed. Among 432 patients who died from COVID-19, atrioventricular block (AVB) was found in 40 (9.3%). Among these 40 patients, 28 (6.5%) suffered from 1st degree AVB, and 12 (2.8%) suffered from complete heart block (CHB). Changes in ST-T wave, compatible with myocardial infarction or localized myocarditis, appeared in 189 (59.0%). Findings compatible with myocardial injury, such as fragmented QRS and prolonged QTc, were found in 91 patients (21.1%) and 28 patients (6.5%), respectively. In patients who died of COVID-19, conduction disorder was unrelated to any underlying medical condition. Fragmented QRS, axis deviation, and ST-T changes were significantly related to conduction system disorder in patients who died of COVID-19 (P value < 0.05). Conduction system disorders are associated with several other ECG abnormalities, especially those indicative of myocardial ischemia or inflammation. Most patients (73.14%) who died of COVID-19 demonstrated at least one ECG abnormality parameter. Since a COVID-19 patient's ECG gives important information regarding their cardiac health, our findings can help develop a risk stratification method for at-risk COVID-19 patients in future studies.

Aspects of myocardial heterogeneity in assessment its remodeling

The influence of sports activity on the cardiovascular system is accompanied by physiological adaptation of the organism. Intense physical activity, far exceeding the body’s capabilities, can lead to structural changes or remodeling of the athlete’s myocardium. The review is devoted to the study of myocardial heterogeneity and is aimed at attracting attention of physicians, physiologists, biologists, researchers and developers of ECG computer analysis programs to prognostically significant indicators. Based on the mechanisms of electrical heterogeneity of the ventricular myocardium, the review considers the results of clinical studies by Russian and foreign specialists. The high predictive capabilities of indicators for the detection of fatal and non-fatal cardiovascular events and sudden cardiac death are discussed. It was found that the speed indicators of the electrical activity of the heart are the earliest marker of cardiac arrhythmias and conduction disorders. Risk factors - arterial hypertension, smoking, hypercholesterolemia and overweight - are associated with a decrease in the rate of electrical activity of the heart and an increase in myocardial heterogeneity. The data presented allow us to conclude that myocardial electrical heterogeneity is a prognostically significant indicator for the detection of fatal and non-fatal cardiovascular events; it is widely discussed in foreign literature, but is not used by domestic specialists.

1002 A HEART BEYOND A MIRROR: WHEN CCTGA ENCOUNTERS SITUS VISCERUM INVERSUS

Abstract Background Congenitally corrected transposition of great arteries (ccTGA) is an uncommon complex congenital heart disease with atrio-ventricular and ventriculo-arterial connections discondance. ccTGA may be associated with a situs solitus or situs inversus (34% of cases). Situs inversus is a mirror image of normal with the systemic ventricle situated on the right side. Instead, dextrocardia represents 20% of cases. Case clinic and discussion Came to our observation a 61 years old female, symptomatic for dyspnea on exertion (NYHA II). She had no past medical history of cardiovascular events. In anamnesis two full-term pregnancies without complications. Transthoracic echocardiogram found atrioventricular and ventriculo-arterial discordance in absence of significant valvulopathy. Cardiac computed tomography showed pulmonary veins linked to right atrium, superior and inferior cava veins connected to the left atrium; right atrium with tricuspid valve was connected to a morphologically left ventricle and left atrium with mitral valve was linked to morphologically right ventricle; pulmonary artery was connected to morphologically left ventricle instead aorta with aortic valve was linked to morphologically right ventricle. Cardiac MRI confirmed cctga in situs viscerum inversus, mild subpulmonary stenosis, moderate dilatation of arterial pulmonary trunk, and also intramyocardial late gadolinium enhancement due to fibrosis involving anterior and inferior interventricular junctions. Cardiac Holter monitoring showed sinus rhythm with some brief phases of low atrial rhythm, monomorphic isolated ventricular extrasystoles in absence of significant hyperkinetic or hypokinetic arrhythmias. CcTGA represents approximately 0.5% of all congenital heart disease. If undiagnosed in childhood, people usually become symptomatic during the first decades of life. Dyspnea, syncope and fatigue are the most frequent symptoms detected. Cardiac conduction disorders such as atrioventricular blocks are common due to the abnormal development of cardiac structures. Quality of life and its expectancy are related to the latency of the onset of heart failure symptoms. Only few patients remain asymptomatic beyond 50 years old. Symptoms and signs are frequently due to right sided (systemic) heart dysfunction and tricuspid valve insufficiency. A particular clinical situation worthy of attention is pregnancy because of the hemodynamic imbalance occurring. In fact, cardiac output increases of 40–50% above baseline determining an augmentation of stroke volume and heart rate. For these reasons, echo surveillance is needed every 4-8 weeks because of the increased risk of acute heart failure. An accurate assessment of heart rhythm has to be done due to the known predisposition to bradyarrhythmic and tachyarrhythmic events in ccTGA. Conclusions CcTGA patients require a strict cardiological follow up with echocardiographic assessment and periodic heart rhythm monitoring, in order to early detect worsening of cardiac function and significant abnormalities of the rhythm.

Predictors of pacemaker implantation in patients with myocardial infarction and heart block

The aim of the study was to identify predictors of early and delayed pacemaker (PM) implantation in patients with myocardial infarction (MI) and heart block, allowing the development of models for predicting the feasibility of its implantation.Methods. A randomized selection method was used to form a cohort of patients with MI complicated by cardiac conduction disorders. The first (control) group included 72 patients who did not have a PM implanted, the second (n=46) and third (n=68) groups consisted of patients with MI, having, respectively, indications for early (in the acute period of MI) and delayed (average after 3 years) PM implantation. All patients underwent endovascular revascularization of the infarct-dependent artery during hospitalization. Demographic, clinical, and morphological predictors of PM implantation in patients of the second and third groups were evaluated in comparison with the control group. Multiple logistic regression was used to identify factors associated with the need for PM implantation in the short term (hospital period) and in the long-term period.Results. Factors that determine the expediency of a permanent PM in the acute period of MI at the hospital stage, delayed pacemaker implantation 3.2±1.9 years after myocardial infarction, as well as predictors that do not require a permanent PM throughout the entire observation period, were identified. The main factors that require permanent PM implantation in the acute period were identified: 3rd degree atrioventricular (AV) block in NSTEMI, GRACE score 96 or higher, development of 3rd degree AV block in MI of any localization except postero-inferior. Predictors for the need for PM implantation after 3.2±1.9 years (delayed period) were STEMI of anterior localization; at the same time, age had an inversely proportional relationship in predicting the fact of permanent pacing. The factors that determine the need for PM implantation are the presence of anterior MI, the multiple coronary artery lesions.Conclusion. In the acute (hospital) period of NSTEMI, PM implantation is indicated at a high risk of adverse cardiovascular complications (GRACE scale of 96 points and above), in the presence of the 3rd degree AV block in any MI localization, except for the inferior one. Indications for permanent pacing 3.2±1.9 years after an acute coronary event are STEMI of anterior localization and multiple coronary artery lesions.

S103 Prevalence of Cardiac Conduction Disorders of Interest Among Adults With Moderately-to-Severely Active Ulcerative Colitis in the US: A Real-World Analysis

Background: Ozanimod, a once-daily oral medication, is the first sphingosine 1-phosphate receptor modulator approved for adults with moderately to severely active ulcerative colitis (UC). An electrocardiogram is needed to determine whether conduction abnormalities are present prior to treatment initiation. Contraindications to ozanimod use that may be identified with an electrocardiogram include presence of Mobitz type II second-degree or third-degree (complete) atrioventricular (AV) block, sick sinus syndrome, or sino-atrial block, unless the patient has a functioning pacemaker. This analysis used MarketScan Commercial claims data to estimate the real-world prevalence of select cardiac conduction disorders among adult patients with UC in the US. Methods: Data from October 1, 2016 to September 30, 2021 were obtained for adult patients with ≥2 UC diagnostic claims within 12 months and continuous medical enrollment of 12 months before the index date. The prevalence of an ICD-10-CM diagnosis code for second-degree (I44.1) or complete AV block (I44.2), sick sinus syndrome (I49.5), or sino-atrial block (I45.5) was analyzed. Prevalence rates were stratified by patient demographics, use of heart rate–lowering medications (anti-arrhythmics, beta blockers, calcium channel blockers, disopyramide, or ivabradine), or an implanted pacemaker use. Sensitivity analyses identified cardiac conduction disorders within the pre-index period and in a US claims database (IQVIA PharMetrics Plus). Descriptive analyses are reported. Results: In total, 79,832 patients with UC met the inclusion criteria; 52.5% were female and mean (SD) age was 45.8 (13.1) years. Of all patients, 29 (0.04%) had second-degree AV block, 41 (0.05%) had complete AV block, 145 (0.18%) had sick sinus syndrome, and 12 (0.02%) had sino-atrial block. The prevalence rate of all the selected cardiac conduction disorders for patients aged ≥50 years old (n = 35,912; 0.05%, 0.09%, 0.32%, and 0.03%, respectively) was numerically higher than for patients aged <50 years old (n = 43,920; 0.03%, 0.02%, 0.07%, and 0.01%, respectively). The prevalence rate for those using heart rate–lowering medications (n = 15,468; 0.08%, 0.17%, 0.52%, and 0.03%, respectively) was numerically higher than for patients without heart-rate-lowering medications (n = 64,364; 0.02%, 0.02%, 0.10%, and 0.01%, respectively). Among patients without implanted pacemaker use (n = 79,607), the prevalence rate was 0.02%, 0.02%, 0.11%, and 0.01%, respectively. Prevalence rates observed in sensitivity analyses were similar to those observed in the main analysis. Conclusion(s): Overall, the proportion of patients with cardiac conduction disorders was less than 0.2% in this real-world commercial claims sample of 79,832 adult patients with UC in the US. The prevalence remained less than 0.6% in high-risk populations including patients aged ≥50 old and those receiving heart rate–lowering medications. Though these data may be subject to miscoding (especially overcoding for sick sinus syndrome) given the claims nature of the data source, they highlight the extremely low prevalence of select cardiac condition disorders that may be identified by using an electrocardiogram in patients with UC.

Cardiac arrhythmias and conduction disorders in acute poisoning with cardiotoxic substances

The study is devoted to the problems of poisoning by cardiotoxic diseases.&#x0D; The relevance of the study was confirmed by the analysis of literature containing the following information: during recent decades poisoning with cardiotoxic substances while providing medical care to patients has become the main cause of premature death worldwide.&#x0D; Currently, in a number of cases of poisoning several classes of compounds for medical and non-medical purposes with cardiotoxic effects can be found. The pattern of acute poisonings is highly dependent on different regions, especially in developed and developing countries, as well as in urban and coastal areas, and it also depends on socio-economic status, cultural practices, industrial and agricultural development in industry.&#x0D; The results obtained during the study show that the toxic effects of various classes of cardiotoxicants include direct (effects on the heart, blood vessels or nervous system) and indirect effects of the poison associated with the presence of metabolic disorders (hypoxia, acidosis, electrolyte disorders), and the severity of the manifestation of the condition determination of urgent toxic arrhythmias, which worsen the course of the toxic process and most often lead to a sudden death, which is an actual study of mechanisms of toxic rhythm and conduction disorders.&#x0D; The study shows changes in the electrocardiographic patterns and mechanisms of cardiotoxic action, which can be found in the structure of poisonings, their toxic doses (concentration).&#x0D; The purpose of this study was to study the features of rhythm and conduction in case of cardiotropic poisoning.&#x0D; In the course of the study the following scientific tasks were solved: changes in the electrocardiographic pattern and manifestations of cardiotoxic action, which were broadly found in the structure of poisoning, were established, and information about their toxic doses (concentrations) was summarized.&#x0D; In our opinion, the knowledge of signs of poisoning, topical symptoms, mechanisms of formation of their effects is the key to the implementation of measures to provide medical care.&#x0D; The results of the study include practical significance for the analysis and definition of various types of medical care in case of poisoning with cardiotoxic diseases of non-medical purposes.

Incidence risks for subtypes of heart diseases in a Russian cohort of Mayak Production Association nuclear workers.

Heart diseases are one of the main causes of death. The incidence risks were assessed for various types of heart diseases (HDs) in a cohort of Russian nuclear workers of the Mayak Production Association (PA) who had been chronically occupationally exposed to external gamma and/ or internal alpha radiation. The study cohort included all workers (22,377 individuals) who had been hired at the Mayak PA during 1948-1982 and followed up until 31 December 2018. The mean gamma-absorbed dose to the liver (standard deviation) was 0.43 (0.63) Gy, and the mean alpha-absorbed dose to the liver was 0.25 (1.19) Gy. Excess relative risk (ERR) per unit liver-absorbed dose (Gy) was calculated based on maximum likelihood. At the end of the follow-up, 559 chronic rheumatic heart disease (CRHD), 7722 ischemic heart disease (IHD) [including 2185 acute myocardial infarction (AMI) and 3976 angina pectoris (AP)], 4939 heart failure (HF), and 3689 cardiac arrhythmia and conduction disorder (CACD) cases were verified in the study cohort. Linear model fits of the gamma dose response for HDs were best once adjustments for non-radiation factors (sex, attained age, calendar period, smoking status and alcohol consumption) and alpha dose were included. ERR/Gy in males and females was 0.17 (95% confidence intervals: 0.10, 0.26) and 0.23 (0.09, 0.38) for IHD; 0.18 (0.09, 0.29) and 0.26 (0.08, 0.49) for AP; -0.01 (n/a, 0.1) and -0.01 (n/a, 0.27) for AMI; 0.27 (0.16, 0.40) and 0.27 (0.10, 0.49) for HF; 0.32 (0.19, 0.46) and 0.05 (-0.09, 0.22) for CACD; 0.73 (-0.02, 2.40) and -0.12 (-0.50, 0.69) for CRHD, respectively. Sensitivity analyses demonstrated the persistence of a significant dose-response regardless of exclusion/inclusion of adjustments for known potential non-radiation confounders (smoking, alcohol consumption, body mass index, hypertension, diabetes mellitus), and it was only the magnitude of the risk estimate that varied. The risks of HD incidence were not modified with sex (except for the CACD risk). This study provides evidence for a significant association of certain types of HDs with cumulative dose of occupational chronic external exposure to gamma radiation.

Association between cumulated hydroxychloroquine in systemic lupus erythematosus and development of cardiac conduction alterations

Abstract Background/Introduction Hydroxychloroquine (HCQ) is a widely used drug in Systemic Lupus Erythematosus (SLE). It may cause cardiac alterations which includes short term arrhythmic events (via QT interval prolongation) and medium-late term dose dependent cardiomyopathy1. The few research articles published on the medium-late term effects of HCQ in cardiac conduction disorder do not show relevant alterations. Purpose To assess the effect of HCQ in cardiac conduction in a consecutive SLE population. Methods Observational, single University hospital study of all consecutive SLE patients with an electrocardiogram (EKG) at HCQ onset and at least one EKG in follow-up, with a period of at least 3 months on HCQ treatment was performed. We assessed conduction alteration by electrocardiogram (EKG), defined as any degree of atrio-ventricular block or bundle branch block. The EKGs were gathered from the clinical history and interpreted at the beginning of the treatment and during the 15.2 years (CI95% 13.24–17.16) follow-up period. We defined cumulated HCQ (cHCQ) as the multiple of the mean annual dose of the sample. Results We studied 109 (96 women/ 13 men) SLE patients with a mean (±.SD) age of 61 ±. 2.78 years. A statistically significant association was observed between the cHCQ, and the development of cardiac conduction alterations [OR 1.1 CI95% 1.02–1.19; p=0.011] (Table &amp; Figure). A total of 8 covariates were included. Among them, those that had the greatest influence on the development of the primary event were previous conduction alterations [OR 4.15 CI95% 6.39–624.54; p&amp;lt;0.01]; valvular heart disease [OR 7.15 CI95% 1.31–38.91; p=0.023] and age [OR 1.07 95% CI 1.0–1.14; p=0.04] (Table). There was no statistical association between the cHCQ and atrio-ventricular block. Conclusion According to our study, it seems to be an association between the cHCQ and development of cardiac conduction alterations regardless of other variables evaluated. Wider longitudinal studies are required with a protocolized EKG performance in successive visits to further analyze this association. Funding Acknowledgement Type of funding sources: None.

Cardiovascular disease-wide association study to investigate shared genetics with peak oxygen uptake

Abstract Introduction Cardiorespiratory fitness, measured as peak oxygen uptake (VO2peak), is a strong predictor of cardiovascular disease (CVD) morbidity and mortality and is estimated to have a large genetic component (∼60%). However, the genetic determinants are yet to be established. Our research group recently identified novel genetic variants associated with directly measured VO2peak. Interestingly, most were specific to females. Looking into genetic pleiotropy between VO2peak and CVD can help elucidate the biological mechanisms explaining the link between this fitness related trait and disease, and potentially identify new therapeutic targets. Purpose The association study aims to investigate if genetic variants found to be associated with VO2peak in women is associated with any cardiovascular disease phenotypes. Methods 34,188 female participants with genotype data from the Trøndelag Health Study (HUNT) were included in this study. ICD-coded hospital data related to cardiovascular disease was collected on each participant and the ICD codes were mapped to Phecodes, resulting in 100 disease-specific phenotypes. 26 single nucleotide polymorphisms (SNPs) previously found to be associated with directly measured VO2peak (p&amp;lt;5e-6) were included in the analyses, all common variants (minor allele frequency ≥1%). Each of the 26 genetic variants were tested for association with the 100 phenotypes using a logistic mixed model as implemented in SAIGE. The analysis was adjusted for birthyear and ten principal components of ancestry. The Benjamini-Hochberg false discovery rate (FDR) procedure controlling the FDR at 0.05 was used to correct for the number of tested SNPs and phenotypes. Results After testing each of the 26 SNPs for association with 100 cardiovascular disease phenotypes, 133 SNP-phenotype associations were nominally significant (p&amp;lt;0.05). The association between rs17066736 and myocarditis had the lowest p-value (1.7e-4). Among the other tested SNP-phenotype pairs were phenotypes related to ischemic heart disease, cardiac conduction disorders, heart failure, cerebrovascular disease, and diseases of arteries and veins. However, when adjusting for multiple testing, none reached overall statistical significance. Conclusions The findings showed no statistically significant associations between genetic variants associated with VO2peak and cardiovascular disease phenotypes in women. The role of inborn VO2peak in prediction of CVD (in women) needs further assessment. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): NTNU biotechnology

Cardiac arrhythmias and conduction disorders monitoring after transcatheter aortic valve replacement procedure, using a mobile electrocardiogram 6 lead device

Abstract Background In the early post transcatheter aortic valve replacement (TAVR) discharge era, rate of readmission for permanent pacemaker implantation (PPM-I) due to delayed conduction disturbances (CDs) has significantly increased. This issue has powered post procedural ambulatory electrocardiogram (AECG) monitoring by using implantable cardiac monitors or mobile cardiac telemetry devices, despite several disadvantages as frequent electrode changes and costs. Purpose In this scenario we aimed to evaluate the incidence of post-TAVR new onset arrhythmias and delayed CDs, performing an AECG monitoring through a 30s spot digital ECG (AeECG), by using a mobile electrocardiogram 6 lead (ME6L) device in a 30 days period after a TAVR procedure. Methods Between March 2021 and February 2022 we consecutively enrolled all patients undergoing a TAVR at the University Hospital of Pisa, excepting who already had a PM. At discharge, all patients received ME6L device and were asked to record a spot eECG for 1 month: 1 eECG per day during the first week and then 1 eECG per week. Clinical and follow-up data were collected and analyzed, and eECG scheduling compliance and quality recordings were explored. Results Among 185 consecutive TAVR patients, 12 were excluded due to pre-existing pacing device and 33 due to PPM-I &amp;lt;2 days post TAVR; 3 died before enrollment and 10 refused the enrollment; 18 were excluded because failed the ME6L training phase, 6 for severe postprocedural complications and the last 3 because affected by isolated aortic regurgitation.The remaining ones (100) had 30-day AeECG data. Delayed CDs with a Class I/IIa indications for PPM-Ioccurred in 8 patients with a median of 6 days (range 4–8 days) post-TAVR. New onset documented arrhythmias were AT/AF in 3 patients, isolated PVCs in 10 patients, and competitive transitory junctional rhythm in 2 patients. Delayed PPM-I versus non-delayed PPM-Ipatients were more likely to have a non-self-expandable valve (3 vs 69; p=0.02) and longer PR and QRS intervals at discharge (250.00±53,29 ms vs 179.17±39.17 ms; p=0,003; 125±33.38 ms vs 102.55±30.48 ms; p=0,04). The overall eECG schedule level compliance was 96.5%. Out of a total of 965 sent eECGs, 950 (98,4%) have been correctly recorded and transmitted. Conclusion Delayed CDs requiring PPM-I are the most important drawback of TAVR procedure. In our study, AeECG was seen to be safe and helpful in the identification and treatment of delayed CDs requiring PPM-I, with a very high eECG schedule level of compliance and quality. Further prospective studies are needed to better identify patient selection for outpatient monitoring, making safer and safer the early post TAVR discharge approach. Funding Acknowledgement Type of funding sources: None.

ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ ИНФАРКТА МИОКАРДА, ОСЛОЖНЕННОГО ОСТРОЙ ЗАДЕРЖКОЙ МОЧИ, У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА

Abstract. Relevance. Acute urinary retention (AUR) in myocardial infarction (MI) negatively affects the course and prognosis of the disease. Aim. To evaluate the MI clinical course of AUR development during the acute and subacute periods of disease in men under 60 years old to improve prevention and outcomes. Materials and methods. The study included men aged 19-60 years with type I myocardial in-farction. Patients were divided into two age-comparable groups: I - study group, with ACR - 22 patients; II - control, without urination disorders - 644 patients. A comparative analysis of the features of the medical history and clinical course in the selected groups were performed. Pear-son's Chi-square method was used to analyze the risks of ACR development. Results of the study. The study group differed from the control group in a higher frequency of cardiac arrhythmias and conduction disorders at the onset of coronary artery disease (I: 61.9; II: 24.9%; p = 0.0007), higher incidence of multiple MI complications (100 and 44.0%; ; respectively; p &lt; 0.0001), severe and extremely severe condition of patients (59.0 and 19.6%; p &lt; 0.0001). Asystole (absolute risk: 42.1%; relative: 18.0; p &lt; 0.0001), hydrothorax (41.7%; 15.9; p &lt; 0.0001), the patient’s severe condition in the first hours of illness (30%; 36.5; p &lt; 0.0001), and onset of CHD with heart rhythm and conduction disturbances (7.7%; 4.6; p = 0.0001) were the most significant ACR predictors. Conclusion. Patients with ACR are characterized by a more severe MI course. Combinations of listed above factors indicate an increased risk of development this complication. It is advisable to use them for predictive modeling and the formation of risk groups for timely prevention.

Atrial Flutter in PRKAG2 Syndrome: Clinical and Electrophysiological Characteristics.

PRKAG2 syndrome is a rare autosomal dominant disease, a phenocopy of hypertrophic cardiomyopathy characterized by intracellular glycogen accumulation. Clinical manifestations include ventricular preexcitation, cardiac conduction disorder, ventricular hypertrophy, and atrial arrhythmias. To compare the clinical and electrophysiological characteristics observed in patients with atrial flutter, with and without PRKAG2 syndrome. An observational study comparing patients with atrial flutter: group A consisted of five patients with PRKAG2 syndrome from a family, and group B consisted of 25 patients without phenotype of PRKAG2 syndrome. The level of significance was 5%. All patients in group A had ventricular preexcitation and right branch block, and four had pacemakers (80%). Patients in group A were younger (39±5.4 vs 58.6±17.6 years, p=0.021), had greater interventricular septum (median=18 vs 10 mm; p<0.001) and posterior wall thickness (median=14 vs 10 mm; p=0.001). In group A, four patients were submitted to an electrophysiological study, showing a fasciculoventricular pathway, and atrial flutter ablation was performed in tree. All patients in group B were submitted to ablation of atrial flutter, with no evidence of accessory pathway. Group B had a higher prevalence of hypertension, diabetes mellitus, coronary artery disease and sleep apnea, with no statistically significant difference. Patients with PRKAG2 syndrome presented atrial flutter at an earlier age and had fewer comorbidities when compared to patients with atrial flutter without mutation phenotype. The occurrence of atrial flutter in young individuals, especially in the presence of ventricular preexcitation and familial ventricular hypertrophy, should raise the suspicion of PRKAG2 syndrome.

ВАРИАНТ ГЕНА TNNI3K, АССОЦИИРОВАННЫЙ С СЕМЕЙНЫМ ЗАБОЛЕВАНИЕМ ПРОВОДЯЩЕЙ СИСТЕМЫ СЕРДЦА И СУПРАВЕНТРИКУЛЯРНОЙ ТАХИКАРДИЕЙ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Studying the genetic nature of cardiac arrhythmias and conduction disorders is extremely important. The genes (SCN5A, TRPM4, TNNI3K, LMNA, NKX2.5) associated with the development of sick sinus syndrome and diseases of heart conduction system are described. TNNI3K is a cardiospecific gene that encodes a MAP kinase that interacts with cardiac Troponin I. The enzyme TNNI3K kinase modulates cardiac conduction and myocardial function and plays an important role in the regulation of heart rate and cardiac contractility. A description of a family with an identified variant in the TNNI3K gene (c.1577G&gt;A) and damage to the heart conduction system and supraventricular tachycardia is presented. The features of the familial clinical case represented by the authors are various phenotypic manifestations of the disease in different family members, the congenital nature of arrhythmia in some family members as well as the concentration of cases of sudden cardiac death in the family. It was the genetic diagnosis of the disease that determined the need to assess the condition of the heart cavities and its contractility in order to be able to timely correct the initial signs of dilated cardiomyopathy in the described family members.

Indications for genetic examinations in children with bradyarrhythmias

The nature of hereditary cardiac conduction diseases can be determined by using genetic testing. However, due to the absence of large studies, as well as the phenotypic variability of the electrocardiographic and clinical manifestations in patients with bradyarrhythmias, and a positive genetic test there are difficulti to evaluate its effectiveness. The article presents indications for genetic examinations in children with bradyarrhythmias, developed in the Children’s Center for Cardiac Arrhythmias and summarizes the recommendations for patients with cardiac conduction disorders.

Epicardial fat thickness assessment by multi-slice computed tomography for predicting cardiac outcomes in patients undergoing transcatheter aortic valve implantation.

Chronic inflammation promotes aortic valve calcification. It is known that epicardial fat is a source of inflammation. The aim of this study was to investigate the relationship between epicardial fat thickness, cardiac conduction disorders and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). During a three-year period, 45 patients with severe aortic stenosis who underwent TAVI were recruited to the study. Data were collected retrospectively. Epicardial fat was defined as the adipose tissue between the epicardium and the visceral pericardium. Mean epicardial fat thickness was determined by multi-slice computed tomography, which was performed before the procedure. The average thickness of epicardial fat was 13.06 ± 3.29 mm. This study failed to reveal a significant correlation between epicardial fat thickness and post-procedural left bundle branch block, right bundle branch block, paravalvular aortic regurgitation and pacemaker implantation rates (p > 0.05). The results of this study failed to show a significant relationship between epicardial fat thickness, cardiac conduction disorders and outcomes, however further studies with larger sample numbers are required to explore the relationship.

A comparative study of MRI-induced RF heating in pediatric and adult populations with epicardial and endocardial implantable electronic devices.

Patients with congenital heart defects, inherited arrhythmia syndromes, and congenital disorders of cardiac conduction often receive a cardiac implantable electronic device (CIED). At least 75% of patients with CIEDs will need magnetic resonance imaging (MRI) during their lifetime. In 2011, the US Food and Drug Administration approved the first MR-conditional CIEDs for patients with endocardial systems, in which leads are passed through the vein and affixed to the endocardium. The majority of children, however, receive an epicardial CIED, where leads are directly sewn to the epicardium. Unfortunately, an epicardial CIED is a relative contraindication to MRI due to the unknown risk of RF heating. In this work, we performed anthropomorphic phantom experiments to investigate differences in RF heating between endocardial and epicardial leads in both pediatric and adult-sized phantoms, where adult endocardial CIED was the control. Clinical Relevance-This work provides a quantitative comparison of MRI RF heating of epicardial and endocardial leads in pediatric and adult populations.