Cardiac Rhythm Disorders Research Articles

Photovoltaic Stimulation Induces Overdrive Suppression in Embryonic Chicken Cardiomyocytes

Abstract In this study, we employed calcium imaging to investigate the dynamics of intracellular calcium levels in embryonic chicken cardiomyocytes upon extracellular, optoelectronic stimulation. A photovoltaic layer of donoracceptor pigments on a flexible PET substrate was used as a wireless stimulation electrode. Our findings revealed a distinct change in their spontaneous activity pattern in cardiac cells following asynchronous light stimulation. A short pause in cellular activity, indicative of overdrive suppression, was observed in recordings from several different cells. The pause in activity signifies a transient refractory period induced by stimulation of the photovoltaic device with red light. These findings suggest that photovoltaic electrodes can be used to effectively modulate the electrical activity of cardiac cells in a wireless, non-pharmacological manner. This opens new avenues for non-invasive and precise light-modulated control of cellular electrophysiology as well as potential therapeutic applications for cardiac rhythm disorders.

Features of treatment of transthyretin amyloid cardiomyopathy: clinical case

For several years, there has been a significant increase in the number of patients diagnosed with cardiac amyloidosis or amyloid cardiomyopathy (AC). The reason is the growing concern of specialists about amyloidosis and the increased accuracy of the instrumental methods of examination of patients of cardiological profile. Nowadays, more than 30 types of amyloidosis are known, however, the two main types are most commonly associated with cardiac involvement: amyloidosis of light chains (AL) and transthyretin amyloidosis (ATTR). Regardless of the underlying pathogenesis of amyloid production, cardiac involvement is the main cause of mortality in systemic amyloidosis. In addition to difficulties in early diagnosis, there are difficulties with further management of the disease. With the appearance of specific treatment, different depending on the type of amyloidosis, the problem of symptomatic therapy in these patients has become acute. Heart failure (HF) signs are usually prevalent in cardiac signs. Besides, patients with AC often have various arrhythmias and heart conduction disorders. However, the selection of heart failure therapy in patients with AC is complicated by the development of restrictive hemodynamic phenotype and concomitant autonomic dysfunction, making it impossible to manage standard heart failure therapy. The article presents a clinical case of a patient with a hereditary type of transthyretin amyloidosis with the cardiac involvement, whose main clinical manifestations were heart failure, cardiac rhythm and conductions disorders. This case demonstrates the importance of comprehensive and personalized approach in the management of ATTR-AC, the features of pathophysiology which require special approaches even to management of symptomatic therapy.

High Risk of Heart Tumors after COVID-19.

A comparative analysis of 173 heart tumors was conducted between 2016 and 2023. Immunohistochemical examination with antibodies against spike SARS-CoV-2 was performed on 21 heart tumors: 10 myxomas operated before 2020 (the control group), four cardiac myxomas, one proliferating myxoma, three papillary fibroelastomas, two myxofibrosarcomas, one chondrosarcoma resected in 2022-2023. Immunohistochemical analysis with antibodies against CD34 and CD68 was also conducted on the same 11 Post-COVID period heart tumors. Immunofluorescent examination with a cocktail of antibodies against spike SARS-CoV-2/CD34 and spike SARS-CoV-2/CD68 was performed in 2 cases out of 11 (proliferating myxoma and classic myxoma). A 1.5-fold increase in the number of heart tumors by 2023 was observed, with a statistically significant increase in the number of myxomas. There was no correlation with vaccination, and no significant differences were found between patients from 2016-2019 and 2021-2023 in terms of gender, age, and cardiac rhythm dis-orders. Morphological examination revealed the expression of spike SARS-CoV-2 in tumor cells, endothelial cells, and macrophages in 10 out of 11 heart tumors. The detection of SARS-CoV-2 persistence in endothelium and macrophages as well as in tumor cells of benign and malignant cardiac neoplasms, the increase in the number of these tumors, especially cardiac myxomas, after the pandemic by 2023 may indicate a trend toward an increased risk of cardiac neoplasms in COVID-19 patients, which re-quires further research on this issue and a search for new evidence.

Feasibility and reliability of whintings scanwatch to record 4-lead Electrocardiogram: A comparative analysis with a standard ECG

The recent technological advances allowed us to produce some new wearable devices, such as smartphones and smartwatches (SW). These devices provide different services to their users through different software applications installed even in the SW or smartphones. Health monitoring functionalities, among these services, are nowadays the new technological fashion. In fact, the monitoring is ensured by the sensor incorporated in the SW. The SW allows the record of only one single lead Electrocardiogram (ECG), which is sufficient to screen or diagnosis of rhythm and conduction disorders, especially during the onset of cardiac symptoms, but insufficient for the detection of ischemic disease and cardiomyopathies. In this context, this paper aims to evaluate the feasibility, and reliability of a SW to obtain ECG recordings in comparison with a standard ECG. For that purpose, 140 patients were recruited for this analysis. At the first step, the 12 lead ECG followed with four lead SW-ECG; using the Withings Scanwatch device, were recorded in the same resting conditions. The four lead SW-ECG consists of Einthoven DI lead recorded with the SW, where the SW was on the left wrist and the right index finger on the crown, and three Wilson-type leads, in the which the V1 was recorded in the fourth right parasternal intercostal space, V3 was recorded in the fifth intercostal space on the midclavicular line, and V6 was recorded in the fifth intercostal space on the left midaxillary line with the right index finger placed on the crown and the left hand encompassing the right wrist. 700 ECGs recordings were collected and statistically analyzed in this study. In total, 97 % of the patients were able to obtain an ECG through the SW. A strong correlation was observed between the two recording methods concerning the duration of the studied parameters (r >90 %). The correlation coefficient showed that 33 out of 44 parameters have a strong correlation with the standard ECG. The similarity of the combined leads in the 4 established subgroups was significantly higher, meaning that increasing the number of leads would improve the detection of electrical anomalies. Our findings confirm the existing data on the high similarity between SW and standard 12-leads ECG. Despite SW not having the accuracy and utility of the standard ECG machine, they should be considered as an interesting screening tool for cardiac rhythm disorders, and a compelling solution to electrical documentation of general cardiac symptoms.

Inflammatory Markers as Predictors of Atrial Fibrillation Recurrence: Exploring the C-Reactive Protein to Albumin Ratio in Cryoablation Patients.

Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with hemodynamic disruptions and thromboembolic events. While antiarrhythmic drugs are often recommended as the initial treatment, catheter ablation has emerged as a viable alternative. However, the recurrence of AF following ablation remains a challenge, and there is growing interest in exploring inflammatory markers as predictors of recurrence. This retrospective, cross-sectional analysis included 249 patients who underwent cryoablation for paroxysmal AF. The relationship between the 'C-reactive protein (CRP) to albumin ratio (CAR)' and AF recurrence was examined. Two hundred and forty-nine patients with paroxysmal non-valvular atrial fibrillation were included. They were divided into two groups: those without recurrence (Group 1) and those with recurrence (Group 2). Significant differences were observed in age (57.2 ± 9.9 vs. 62.5 ± 8.4, p = 0.001) and left atrial size (4.0 ± 0.5 vs. 4.2 ± 0.7, p = 0.001) between the two groups. In blood parameters, significant differences were found in CRP (5.2 ± 1.3 vs. 9.4 ± 2.8, p < 0.001) and neutrophil counts (5.1 ± 2.2 vs. 6.7 ± 3.6, p = 0.001). In univariate regression analysis, age (OR: 1.058, CI: 1.024-1.093, p = 0.001), WBC count (OR: 1.201, CI: 1.092-1.322, p < 0.001), neutrophil count (OR: 1.239, CI: 1.114-1.378, p = 0.001), CAR (OR: 1.409, CI: 1.183-1.678, p < 0.001), and left atrial diameter (OR: 0.968, CI: 0.948-0.989, p = 0.002) showed significant associations with AF recurrence. Inflammation plays a crucial role in the initiation and progression of AF. This study demonstrated that along with age, the CAR can serve as an independent predictor of AF recurrence following cryoablation.

Nonpharmacological Approach to Managing Atrial Fibrillation: A Review

Background: AF's global prevalence underscores its significance as a cardiac rhythm disorder that disrupts atrial activity, impairing normal cardiac function. Over five decades of study have illuminated the pathophysiological mechanisms underlying AF, including insights into re-entrant waves and macro-reentrant circuits. The emergence of non-uniform conduction patterns and bidirectional block regions has further enriched our understanding. Risk factors contributing to AF development encompass cardiovascular conditions, advanced age, and atrial structural changes. With its implications on stroke risk and cardiovascular health, AF has become a growing public health concern. The focus on AF epidemiology has expanded, with attention on the relationship between left atrial size and AF development. Individuals with larger left atria exhibit a heightened risk. Additionally, the elevated stroke risk associated with AF has been consistently documented.&#x0D; To optimize clinical management, distinctions are drawn between chronic and paroxysmal AF, as well as the presence of structural heart disease. Mapping techniques have revealed insights into "atrial remodeling" and AF pathology. In managing AF, controlling heart rate, preventing clot formation, and restoring sinus rhythm are principal objectives. This article categorizes AF into acute, chronic, stable, or unstable forms, tailoring management approaches accordingly. While pharmacological interventions have shown efficacy, their limitations drive the exploration of nonpharmacological strategies. Approaches range from medications to cardioversion, including electrical and pharmacological methods.&#x0D; Objective: This paper aimed to provide a comprehensive exploration of non-pharmacological approaches to AF management.&#x0D; Methodology: This paper employed a structured methodology. This method involved a literature review, data synthesis, and critical analysis. During the literature review phase, we systematically searched electronic databases (PubMed, MEDLINE, Embase, and Google Scholar) for studies published from 1960 to 2023. Specific keywords and phrases such as "atrial fibrillation," "non-pharmacological interventions," "electrical cardioversion," "catheter ablation," "lifestyle modifications," "autonomic modulation," "left atrial appendage closure," and "exercise" were used. Our inclusion criteria encompassed studies addressing various non-pharmacological approaches for AF management, including observational studies and randomized controlled trials.&#x0D; Result: The initial stage of our study involved the identification of a substantial number of relevant studies. We conducted a thorough literature search across multiple databases, using specific search terms and criteria relevant to our research topic. This comprehensive search yielded a total of 1,200 studies. After applying these stringent filtering criteria, we were left with 350 studies. To further refine our final sample and categorize the studies according to type, we conducted a detailed review of the remaining 350 studies. We categorized them into various types based on study design, methodology, and focus. We then also excluded studies with duplicate ideas and finally included 103 studies that addressed the objective of our research plan. (See reference list [1-103]).&#x0D; Conclusion: This reviewed a number of non-pharmacological approaches including electrical cardioversion, catheter ablation, lifestyle modifications, autonomic modulation, left atrial appendage closure, and exercise, the paper delves into each method's advantages, potential risks, techniques, and efficacy. By offering this extensive overview, the article contributes to the expanding repository of knowledge on non-pharmacological approaches for AF management. These approaches offer potential for unique management of atrial fibrillations or in addition to pharmacologic management, may improve patient survivability or reduce complication outcomes.&#x0D; In the management of Atrial fibrillation, choice between rhythm and rate control, lifestyle modifications, and patient adherence to treatment plans are critical factors influencing outcomes are factors to consider. Emerging therapies offer promise, but timely diagnosis, individualized care, and ongoing monitoring remain essential to improving AF patients' overall prognosis.

Pollutants, including Organophosphorus and Organochloride Pesticides, May Increase the Risk of Cardiac Remodeling and Atrial Fibrillation: A Narrative Review.

Atrial fibrillation (AF) is the most common type of cardiac rhythm disorder. Recent clinical and experimental studies reveal that environmental pollutants, including organophosphorus-organochloride pesticides and air pollution, may contribute to the development of cardiac arrhythmias including AF. Here, we discussed the unifying cascade of events that may explain the role of pollutant exposure in the development of AF. Following ingestion and inhalation of pollution-promoting toxic compounds, damage-associated molecular pattern (DAMP) stimuli activate the inflammatory response and oxidative stress that may negatively affect the respiratory, cognitive, digestive, and cardiac systems. Although the detailed mechanisms underlying the association between pollutant exposure and the incidence of AF are not completely elucidated, some clinical reports and fundamental research data support the idea that pollutant poisoning can provoke perturbed ion channel function, myocardial electrical abnormalities, decreased action potential duration, slowed conduction, contractile dysfunction, cardiac fibrosis, and arrhythmias including AF.

Bariatric Surgery and Cardiovascular Disease Risk in Patients with Pulmonary Hypertension: A Propensity Score Matched Analysis of US National Inpatient Sample.

Previous research has suggested the ameliorating effect of bariatric surgery (BaS) on patients with pulmonary hypertension (PH), but there is a lack of data on the effect of bariatric surgery on the odds of cardiovascular diseases in PH patients. The current study aims to evaluate the association of BaS and coronary artery diseases (CAD), heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), cardiac valve diseases, cardiac rhythm disorders, acute pulmonary embolism, and in-hospital mortality in patients with PH. The national inpatient sample (NIS) data from 2016 to 2019 were analyzed by using ICD-10 codes. A propensity score matching in a 3:1 ratio was performed to match the BaS and non-BaS groups. A total of 3605 patients with a history of BaS and 501419 patients without a history of BaS were included. After propensity matching, BaS was independently associated with a lower CAD hospital admission and a lower rate of in-hospital mortality. On the contrary, BaS was associated with a higher prevalence of atrial fibrillation (AF) and acute pulmonary embolism in patients with PH. HFpEF, HFrEF, other cardiac rhythm disorders, complete heart block, cardiac valve diseases, and ischemic stroke were not significantly different between the two groups in patients with PH. BaS is independently associated with a reduced rate of in-hospital mortality and CAD hospital admission in patients with PH. However, the risk of atrial fibrillation and acute pulmonary embolism was higher in these patients.

Can a best practice advisory improve anticoagulation prescribing to reduce stroke risk in patients with atrial fibrillation?

BackgroundAtrial fibrillation (AF) is the most common cardiac rhythm disorder and a risk factor for stroke. Randomized trials have demonstrated that anticoagulation can reduce strokes in AF patients. Yet, widespread underutilization of this therapy continues. To address this practice gap, we designed a study to implement and evaluate the effectiveness of a best practice advisory (BPA) for an Atrial Fibrillation Decision Support Tool (AFDST) embedded within our electronic health record. MethodsOur intervention is provider-facing, focused on decision support. Clinical setting is ambulatory patients being seen by primary care physicians. We prospectively enrolled 608 patients in our health system who are currently receiving less than optimal anticoagulation therapy as determined by the AFDST and randomized them to one of two arms – 1) usual care, in which the AFDST is available for use; or 2) addition of a BPA to the AFDST notifying clinicians that their patient stands to gain significant benefit from a change in current therapy. Primary outcome was effectiveness of the BPA measured by change to “appropriate thromboprophylaxis” based on the AFDST recommendation at 3 months post-enrollment. Secondary endpoints included Reach and Adoption from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, & Maintenance) framework for implementation studies. ResultsAmong 562 patients with a minimum follow-up of 3 months, addition of a BPA to the AFDST resulted in significant improvement in anticoagulation therapy, 5 % (12/248) versus 11 % (33/314) p = 0.02, odds ratio 2.31 (95 % CI, 1.17–4.87). ConclusionsA BPA added to an AF decision support tool improved anticoagulation therapy among AF patients in a primary care academic health system setting.

Evolution of cardiac pacemakers: a journey from Galvanic experiments to leadless pacemakers

The development of cardiac pacemakers has a rich history spanning over two centuries, beginning with Luigi Galvani's discovery of the heart's response to electrical currents in the late 18th century. Paul Zoll's pioneering work in the 1950s introduced external pacemakers and defibrillators, followed by the first successful implantation of a fully implantable pacemaker in Sweden in 1958. Since then, pacemakers have undergone major improvements, including advancements in lead design and battery technology, as well as the development of telephony and microprocessors. Recent innovations have led to leadless pacemakers with wireless communication capabilities, transforming patient care and monitoring. This evolution has made pacemakers highly sophisticated devices that synchronize with the heart's rhythm, offering hope and improved quality of life for millions of individuals with cardiac rhythm disorders.

An in vitro model to study suction events by a ventricular assist device: validation with clinical data.

Introduction: Ventricular assist devices (LVADs) are a valuable therapy for end-stage heart failure patients. However, some adverse events still persist, such as suction that can trigger thrombus formation and cardiac rhythm disorders. The aim of this study is to validate a suction module (SM) as a test bench for LVAD suction detection and speed control algorithms. Methods: The SM consists of a latex tube, mimicking the ventricular apex, connected to a LVAD. The SM was implemented into a hybrid in vitro-in silico cardiovascular simulator. Suction was induced simulating hypovolemia in a profile of a dilated cardiomyopathy and of a restrictive cardiomyopathy for pump speeds ranging between 2,500 and 3,200rpm. Clinical data collected in 38 LVAD patients were used for the validation. Clinical and simulated LVAD flow waveforms were visually compared. For a more quantitative validation, a binary classifier was used to classify simulated suction and non-suction beats. The obtained classification was then compared to that generated by the simulator to evaluate the specificity and sensitivity of the simulator. Finally, a statistical analysis was run on specific suction features (e.g., minimum impeller speed pulsatility, minimum slope of the estimated flow, and timing of the maximum slope of the estimated flow). Results: The simulator could reproduce most of the pump waveforms observed in vivo. The simulator showed a sensitivity and specificity and of 90.0% and 97.5%, respectively. Simulated suction features were in the interquartile range of clinical ones. Conclusions: The SM can be used to investigate suction in different pathophysiological conditions and to support the development of LVAD physiological controllers.

Cardiovascular system damage in the late-onset Pompe disease

The article presents a clinical case of metabolic hypertrophic cardiomyopathy against the background of a late-onset form of Pompe disease, illustrating the difficulties of differential diagnostic search for the cause of the disease. The clinical, laboratory and genetic aspects of the diagnosis of Pompe disease are highlighted. The features of laboratory diagnostics, the difficult path to the correct diagnosis and the appointment of enzyme replacement therapy are discussed. Much attention is paid to the clinical symptoms of the disease — the most significant damage to the cardiovascular system, there is no damage to the musculoskeletal sphere. Clinical picture of late Pompe disease is presented: cardiac rhythm and conduction disorders (ventricular preexcitation syndrome — multiple additional atrioventricular fenestrations), unstable ventricular tachycardia, supraventricular tachycardia, sinus node weakness syndrome. Considered approaches to the prevention of sudden cardiac death the patient underwent surgical treatment: radiofrequency ablation, endocardial implantation of a cardioverter defibrillator. Pathogenetic therapy for Pompe disease has been started.

Clinical phenotype associated with variants in TANGO2: A case study

Transport and Golgi organization 2 (TANGO2) disease is a severe inherited disorder that presents with multiple symptoms and a broad spectrum of phenotypes, including metabolic crisis, encephalopathy, cardiac arrhythmia, and hypothyroidism. The clinical picture of a TANGO2 gene biallelic mutation involves encephalopathy and rhabdomyolysis and is marked by cardiac rhythm disorders and neurological regression. The presentation of encephalopathy varies and can range from isolated language delay and cognitive impairment to multiple disabilities and spastic quadriparesis. A TANGO2 gene mutation causes serious illness with a limited life expectancy due to the unpredictable risk of cardiac rhythm disorder and death, particularly during rhabdomyolysis. Clinicians must therefore consider the TANGO2 gene when confronted with rhabdomyolysis in a patient suffering from an early developmental disorder. Currently, managing this disease is purely symptomatic. Here, we report the clinical features of a 10-year-old girl with mutations in the TANGO2 gene. Unique to our case was the lack of elevated creatine kinase during the early acute crises of cardiac failure and multi-organ failure, as well as the lack of any prior mental retardation associated with the aberrant heart rhythm.

Increased Epicardial Adipose Tissue and Heart Characteristics Are Correlated with BMI and Predict Silent Myocardial Infarction in Sudden Cardiac Death Subjects: An Autopsy Study.

Sudden cardiac death (SCD) is a significant global public health issue and the leading cause of death worldwide. Its etiopathogenesis is complex and multilayered, involving dynamic factors interacting with a preexistent cardiovascular pathology, frequently unknown, and resulting in cardiac rhythm disorders and cardiac arrest; Methods: This study conducted a retrospective descriptive analysis over a one-year period, identifying 321 autopsy cases of sudden deaths from the Institute of Legal Medicine in Mures County, Romania, in 2019. From the 321 sudden death cases, 189 autopsy reports were selected for analysis based on inclusion and exclusion; Results: The autopsies had a mean age of 61.16 years and included 140 males and 49 females. No significant differences were found between the silent myocardial infarction (SMI) and no-SMI groups regarding demographic data. The SMI group exhibited higher thickness of LV (left ventricle), IV (interventricular septum), EAT LCx (epicardial adipose tissue at left circumflex artery), EAT LAD (epicardial adipose tissue at left anterior descending artery), heart weight, and BMI (body mass index). The left coronary artery showed a higher incidence of type V plaques, while the right coronary artery showed higher incidences of type V and type VI plaque. The SMI group also exhibited a higher incidence of moderate and severe valvular atherosclerosis, severe left ventricle dilatation, and a lower incidence of mild left ventricle dilatation. In addition, the SMI group showed a higher presence of contraction band necrosis on histological examination. Multivariate analysis revealed that type V and type VI plaques for the right and left coronary arteries, moderate and severe valvular atherosclerosis, severe left ventricle dilatation, heart weight, EAT LCx, EAT LAD, LV thickness, IV thickness, BMI, and the presence of contraction band necrosis are all independent predictors of SMI; Conclusions: The findings suggest that SCD is a complex condition, and its etiopathogenesis involves dynamic factors interacting with pre-existing cardiovascular pathology. The risk factors of SCD are similar to those of ischemic heart disease. The findings of this study could guide clinicians in identifying patients at risk of SCD and implementing preventive measures.

Nurses Knowledge regarding Permanent Pacemaker Care for Adult Patients with Cardiac Rhythm Disorder

Now a day, number of implantations increases day by day. It's crucial to evaluate the understanding of patients and their caretakers to prevent any issues or malfunctions and offer quick treatment. Objective: To assess nurses’ knowledge regarding permanent pacemaker care for adult patients with cardiac rhythm disorder. Methods: Descriptive Cross-sectional study conducted in Punjab institute of cardiology. A total of 185 the nurses working on the clinical side were selected based on inclusion and exclusion criteria. The questionnaire was used to collect data analyzed using SPSS with statistical test chi-square with p &lt; 0.05 for categorical variable. Results: According to this study, most of the participants (77.3%) were women aged 21 to 30 years, unmarried (57.3%), and had completed their diploma (50.8%). The study found that 66.5% of nurses were with satisfactory level of knowledge in nursing care for adult patients with pacemakers, while 33.5% had an unsatisfactory level of knowledge. The knowledge of nurses who held a BSN or a POST RN qualification was significantly higher than those who only held a diploma with a p-value of 0.001. Conclusions: Majority of the participants possessed satisfactory knowledge regarding the care of patients with permanent pacemakers. The study also revealed a significant association between the level of education of nurses and their knowledge scores. The study concludes that consistency in the provision of education is necessary for the enhancement of nurses' knowledge, expertise, and competencies in providing care to patients with permanent pacemakers

Interference of cardiac implantable electronic devices and computed tomography imaging in the current era with a phantom model.

Cardiac implantable electronic devices are used in patients with cardiac rhythm disorders. Computed tomography irradiation is not prohibited for patients with cardiac implantable electronic devices, despite adverse events being reported. Hence, appropriate preparation and knowledge are required before computed tomography irradiation can be carried out in these patients. Since there is limited knowledge or literature about the influence of computed tomography irradiation in cases with recent cardiac implantable electronic devices, we aimed to evaluate the adverse events and elucidate the necessary and sufficient safety measures associated with this therapy. We placed cardiac implantable electronic devices on an anthropomorphic phantom model and observed their electrical activity in electrograms, while various protocols of computed tomography irradiation were implemented and adverse events evaluated. Oversensing with pauses of up to 3.2 s was observed in standard computed tomography protocols, but ventricular tachyarrhythmia or other clinically significant events could not be confirmed. Oversensing with pauses of up to 8.0 s was observed and ventricular tachyarrhythmia was detected in the maximum-dose protocols. However, treatments such as antitachycardia pacing or shock therapy for ventricular tachyarrhythmia were not observed because of their absence. Computed tomography irradiation for patients using cardiac implantable electronic devices is highly unlikely to cause clinically significant adverse events with the device settings and computed tomography protocols currently being used. Changing or monitoring the device settings routinely before computed tomography irradiation is not necessarily required for most patients.

The role of the arrhythmologist in a sports cardiology centre: the devil is in the detail

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The role of the arrhythmologist in a sports cardiology centre (SCC) is to provide comprehensive care to athletes with cardiac arrhythmias. Objective To determine the proportion of athletes with arrhythmias examined at a SCC. To define the differences in care between an athlete with and without arrhythmia. Methods Retrospective analysis of the registry of all athletes of one SCC. Identification of patients=athletes with arrhythmias, description of key differences in access to arrhythmology subunits. Cohort: Between 1/2020-6/2022, a total of 115 cases of athletes, 100 males and 15 females (13%), aged 26 (+/-11 years), were examined and definitively closed at SCC. Twenty-two athletes (19%) received care for cardiac rhythm disorders. Duration of sports activity was at the borderline of statistical significance in demographic parameters (see Table No. 1), with 15 (+/-11) vs 12 (+/-8) years for athletes with non-arrhythmic diagnoses (p=0.085). Results In the statistical comparison of the groups without and with arrhythmias (Table No. 2), we see a statistically significantly higher proportion of athletes presenting because of symptoms and with pathological findings of the pre-participation screening, with a higher proportion of family history of sudden cardiac death, with a higher proportion of coronary CT use and an extraordinary statistical significance of cardiac MRI use. Conversely, there is no statistically significant difference in diagnosis and impact on sports eligibility. The sports cardiologist must be particularly cautious in the diagnosis and treatment of ventricular extrasystoles, which have a different "diagnostic-eligibility" pathway for athletes. Similarly, they must listen to the medical history more than non-athletes and be willing and able to use various sports monitor records. In invasive methods of diagnosing and treating arrhythmias, it is necessary to understand when arrhythmias occur in real life and try to mimic the diagnostic conditions of this situation (e.g., when inducing clinical arrhythmias that an athlete has in real life during the peak moments of a match or race). Last but not least, the sports cardiologist must communicate the potential changes that may occur by ablative treatment of the arrhythmia (e.g., a decrease in maximal heart rate after AVNRT ablation on the so-called slow pathway, or, e.g. a possible increase in resting heart rate after pulmonary vein isolation with radiofrequency or laser energy). Conclusion Athletes with arrhythmias are different in many aspects, and the role of the arrhythmologist in the sports cardiology team is to be prepared to respect these differences in an effort to provide the best possible care for the athlete.

Role of ephaptic coupling in discordant alternans domain sizes and action potential propagation in the heart.

Discordant alternans, the spatially out-of-phase alternation of the durations of propagating action potentials in the heart, has been linked to the onset of fibrillation, a major cardiac rhythm disorder. The sizes of the regions, or domains, within which these alternations are synchronized are critical in this link. However, computer models employing standard gap junction-based coupling between cells have been unable to reproduce simultaneously the small domain sizes and rapid action potential propagation speeds seen in experiments. Here we use computational methods to show that rapid wave speeds and small domain sizes are possible when a more detailed model of intercellular coupling that accounts for so-called ephaptic effects is used. We provide evidence that the smaller domain sizes are possible, because different coupling strengths can exist on the wavefronts, for which both ephaptic and gap-junction coupling are involved, in contrast to the wavebacks, where only gap-junction coupling plays an active role. The differences in coupling strength are due to the high density of fast-inward (sodium) channels known to localize on the ends of cardiac cells, which are only active (and thus engage ephaptic coupling) during wavefront propagation. Thus, our results suggest that this distribution of fast-inward channels, as well as other factors responsible for the critical involvement of ephaptic coupling in wave propagation, including intercellular cleft spacing, play important roles in increasing the vulnerability of the heart to life-threatening tachyarrhythmias. Our results, combined with the absence of short-wavelength discordant alternans domains in standard gap-junction-dominated coupling models, also provide evidence that both gap-junction and ephaptic coupling are critical in wavefront propagation and waveback dynamics.

Intracardiac leadless versus transvenous permanent pacemaker implantation: Impact on clinical outcomes and healthcare utilization

BackgroundTransvenous permanent pacemakers are used frequently to treat cardiac rhythm disorders. Recently, intracardiac leadless pacemakers offer potential treatment using an alternative insertion procedure due to their novel design. Literature comparing outcomes between the two devices is scarce. We aim to assess the impact of intracardiac leadless pacemakers on readmissions and hospitalization trends. MethodsWe analyzed the National Readmissions Database from 2016 to 2019, seeking patients admitted for sick sinus syndrome, second-degree-, or third-degree atrioventricular block who received either a transvenous permanent pacemaker or an intracardiac leadless pacemaker. Patients were stratified by device type and assessed for 30-day readmissions, inpatient mortality, and healthcare utilization. Descriptive statistics, Cox proportional hazards, and multivariate regressions were used to compare the groups. ResultsBetween 2016 and 2019, 21,782 patients met the inclusion criteria. The mean age was 81.07 years, and 45.52 % were female. No statistical difference was noted for 30-day readmissions (HR 1.14, 95 % CI 0.92–1.41, p = 0.225) and inpatient mortality (HR 1.36, 95 % CI 0.71–2.62, p = 0.352) between the transvenous and intracardiac groups. Multivariate linear regression revealed that length of stay was 0.54 (95 % CI 0.26–0.83, p < 0.001) days longer for the intracardiac group. ConclusionHospitalization outcomes associated with intracardiac leadless pacemakers are comparable to traditional transvenous permanent pacemakers. Patients may benefit from using this new device without incurring additional resource utilization. Further studies are needed to compare long-term outcomes between transvenous and intracardiac pacemakers.

Effect of the Red Bull Energy Drink on Perfusion-Related Variables in Women Undergoing Microsurgical Breast Reconstruction: Protocol and Analysis Plan for a Prospective, Multicenter Randomized Controlled Trial

Maintaining a sufficiently high systolic blood pressure is essential for free flap perfusion after microsurgical breast reconstruction. Yet, many women undergoing these procedures have low postoperative systolic blood pressure. Intravenous volume administration or vasopressors may be needed to maintain systolic blood pressure above a predefined threshold. However, excessive volume administration may lead to volume overload and flap stasis, and the postoperative use of vasopressors may be limited depending on institutional standards. Additional nonpharmacological measures to raise blood pressure might be beneficial. Evidence suggests that the Red Bull energy drink could raise blood pressure. It has been shown to increase systolic and diastolic blood pressure in healthy volunteers and athletes. The primary objective of this study is to determine the difference in systolic blood pressure between an intervention group receiving Red Bull and a control group receiving still water after microsurgical breast reconstruction. Secondary objectives include postoperative heart rate, 24-hour fluid balance, pain level, or necessity for revision surgery due to flap complications. The Red Bull study is a prospective, multicenter randomized controlled trial comparing the effect of postoperative ingestion of Red Bull energy drink against still water in female patients undergoing unilateral microsurgical breast reconstruction. A total of 250 mL of Red Bull (intervention group) or 250 mL of still water (control group) will be administered to the study participants 2 hours postoperatively as well as for breakfast and lunch on postoperative day 1, amounting to a total volume of 750 mL per 24 hours. Female patients between 18 and 70 years of age undergoing unilateral microsurgical breast reconstruction will be included. Exclusion criteria are a history of arterial hypertension, cardiac rhythm disorder, diabetes mellitus, gastric or duodenal ulcer, thyroid disease, and current use of antihypertensive or antiarrhythmic drugs or thyroid hormones, as well as intolerance to Red Bull. Recruitment for the study started in June 2020 and was completed in December 2022. There is evidence that the Red Bull energy drink increases blood pressure in healthy volunteers and athletes. We hypothesize that postoperative ingestion of Red Bull will increase systolic blood pressure in women after microsurgical breast reconstruction. Red Bull could hence be used as a nonpharmacological adjunct to vasopressors or volume administration in women with hypotensive blood pressure after microsurgical breast reconstruction. This paper describes the Red Bull study trial protocol and analysis plan. The information will increase the transparency of the data analysis for the Red Bull study. ClinicalTrials.gov NCT04397419; https://clinicaltrials.gov/ct2/show/NCT04397419. DERR1-10.2196/38487.