Cardiac Rhythm Disorders Research Articles

Apport du Doppler tissulaire spectral (rapport E/e’) dans la prise en charge des patients en fibrillation auriculaire

Atrial fibrillation is the most common cardiac rhythm disorder encountered in daily clinical practice. It carries high morbidity and mortality rates, mainly related to sudden death, heart failure and stroke. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is therefore attractive in this clinical setting. The spectral tissue Doppler-derived E/e’ ratio is a simple and user-friendly index which has been validated in the assessment of left ventricular diastolic pressures, regardless of rhythm. A septal E/e’ >11 is associated with invasive left ventricular diastolic pressures >15mmHg in patients with atrial fibrillation. Several studies have reported the clinical relevance of abnormal values of E/e’ at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. There is now convincing evidence that increased E/e’ is associated with adverse outcome in patients with atrial fibrillation and predicts the recurrence of arrhythmia after cardioversion or catheter ablation. In conclusion, we recommend the measurement of E/e’ in each patient with atrial fibrillation referred for clinically indicated transthoracic Doppler echocardiography.

Theory of the development of alternans in the heart during controlled diastolic interval pacing.

The beat-to-beat alternation in action potential durations (APDs) in the heart, called APD alternans, has been linked to the development of serious cardiac rhythm disorders, including ventricular tachycardia and fibrillation. The length of the period between action potentials, called the diastolic interval (DI), is a key dynamical variable in the standard theory of alternans development. Thus, methods that control the DI may be useful in preventing dangerous cardiac rhythms. In this study, we examine the dynamics of alternans during controlled-DI pacing using a series of single-cell and one-dimensional (1D) fiber models of alternans dynamics. We find that a model that combines a so-called memory model with a calcium cycling model can reasonably explain two key experimental results: the possibility of alternans during constant-DI pacing and the phase lag of APDs behind DIs during sinusoidal-DI pacing. We also find that these results can be replicated by incorporating the memory model into an amplitude equation description of a 1D fiber. The 1D fiber result is potentially concerning because it seems to suggest that constant-DI control of alternans can only be effective over only a limited region in space.

Coronary arteritis as a cause of cardiac rhythm disorders

Coronary arteritis as a cause of cardiac rhythm disorders

Automatic Atrial Fibrillation detection: A novel approach using discrete wavelet transform and heart rate variability.

Early detection of Atrial Fibrillation (AF) is crucial in order to prevent acute and chronic cardiac rhythm disorders. In this study, a novel method for robust automatic AF detection (AAFD) is proposed by combining atrial activity (AA) and heart rate variability (HRV), which could potentially be used as a screening tool for patients suspected to have AF. The method includes an automatic peak detection prior to the feature extraction, as well as a noise cancellation technique followed by a bagged tree classification. Simulation studies on the MIT-BIH Atrial Fibrillation database was performed to evaluate the performance of the proposed method. Results from these extensive studies showed very promising results, with an average sensitivity of 96.51%, a specificity of 99.19%, and an overall accuracy of 98.22%.

Age- and gender-related peculiarities of patients with delirium in the cardiac intensive care unit.

The overall evidence base regarding delirium has been growing steadily over the past few decades. There has been considerable analysis of delirium concerning, for example, mechanically ventilated patients, patients in the general intensive care unit (ICU) setting, and patients with exclusively postoperative delirium. Nevertheless, there are few studies regarding delirium in a cardiovascular ICU (ICCU) setting and especially scarce literature about the particular features of delirium relating to patient age and gender. We aimed to determine particular features of delirium not induced by alcohol or other psychoactive substances, relating to patient age and gender in an ICCU setting. An observational cross-sectional study was conducted to evaluate patients with delirium in a Lithuanian ICCU. From a sample of 19,007 ICCU admissions, 337 (1.8%) had documented delirium diagnosed through liaison and consultation with a psychiatrist and were included in the final analysis. The obtained data was then evaluated and analysed according to patients' gender and four categorised age groups: < 65 years, 65-74 years, 75-84 years, and ≥ 85 years. Female patients who experienced delirium demonstrated a higher prevalence of hypertension, hyponatraemia, heart failure, cardiac rhythm and conduction disorders, myocardial infarction (MI), and dementia. The men, who were on average seven years younger than the women, significantly more often had hypokalaemia, double- or triple-vessel coronary artery disease, and sepsis. Furthermore, MI, ST-segment elevated MI, and Killip class 4 were most frequent amongst patients less than 65 years of age. Moreover, the youngest patient group demonstrated the highest mortality. Our investigation presented a number of associated peculiarities related to gender and age. It was shown that delirium is a severe complication that more often affects men amongst patients < 65 years old and more frequently affects women in the age group of ≥ 85 years. Male patients < 65 years old, who develop delirium should be treated with more caution because they tend to have more serious forms of disorder and a poorer prognosis.

Evaluation of long-term results of surgical treatment of toxic goiter

Purpose – to improve the methodology for assessing the long-term results of surgical treatment of toxic goiter. Materials and methods. Studies conducted in 150 surgically treated patients with moderate (48) and severe (102) toxic goiter. We developed methodology of long-term results assessment with gradations of good, satisfactory, unsatisfactory and ineffective treatment. One year after surgery in comparison with baseline data we studied the changes in general condition, structural and functional disorders of the heart muscle, severity and functional class of heart failure, heart rhythm disorders. Results and discussion. In patients with hyperthyroidism of moderate severity good result was found in 26 (54.2%) cases, satisfactory – in 21 (43.7%) patients and unsatisfactory – in 1 (2.1%). In patients with severe thyrotoxicosis remote outcome was assessed as good in 9 (8.8%), satisfactory – in 36 (35.3%), unsatisfactory – in 33 (32.4%) cases. Ineffective surgical treatment was found in 24 (23.5%) patients. We established that long-term results depend on the severity and duration of hyperthyroidism. Unsatisfactory results and ineffective surgical treatment were found in patients with severe rhythm disorders, structural and functional changes in the heart muscle and II or III functional class of heart failure. Conclusions. Long-term results of surgical treatment of toxic goiter determined by the severity of structural changes in the heart muscle and cardiac functional disorders. Along with the growth of the severity and duration of hyperthyroidism increases the number of cardiac rhythm disorders: from supraventricular beats to persistent / permanent atrial fibrillation. In cases of severe thyrotoxicosis, the need of surgical treatment should be considered as soon as possible, at least before development of severe rhythm disorders and cardiac structural and functional changes in the heart muscle.

Predicting Determinants of Atrial Fibrillation or Flutter for Therapy Elucidation in Patients at Risk for Thromboembolic Events (PREDATE AF) Study

Atrial fibrillation (AF) is the most common clinically significant cardiac rhythm disorder. There is considerable interest in screening for AF, as it is a leading cause of stroke, and oral anticoagulants (OACs) have been shown to significantly reduce the risk of stroke in patients with AF. Improved screening for AF with subsequent treatment may help improve long-term outcomes, but the optimal patient population and screening intensity are unknown. In this study, we prospectively evaluated the use of the CHA2DS2-VASc score for the prediction of new-onset AF using insertable cardiac monitors (ICMs) and examined whether this screening led to the initiation of OAC therapy. We enrolled 245 subjects with no history of AF and CHA2DS2-VASc score ≥2 to be screened for AF with an ICM. The ICMs were programmed to record AF episodes ≥6 minutes in duration. Subjects were followed for 18 months with monthly remote interrogations and all events adjudicated by cardiologists. In subjects diagnosed with AF, medical records were reviewed to determine subsequent care. During a mean follow-up of 451 ± 185 days, the incidence of AF was 22.4% (95% confidence interval 17.2%-27.7%) with a mean time to detection of 141.3 ± 139.5 days. Among subjects newly diagnosed with AF, 76.4% were prescribed anticoagulation with either a novel OAC (n = 38) or warfarin (n = 4). In this large prospective cohort of subjects with CHA2DS2-VASc scores ≥2, 22.4% were newly diagnosed with AF and the majority of these subjects were given OACs, suggesting a potential role of ICMs in AF screening.

Features of cardiac rhythm disorders and conduction disturbances in patients with arterial hypertension

Objective – to study features of cardiac rhythm disorders and conduction disturbances in patients with arterial hypertension.Methods of the study. Under our observation there were 110 patients with first-third degree hypertension stage II, aged 38 to 72 years (mean age – 50.63 ± 1.34 years). The gender distribution of patients was as follows: 61 female (55 %) and 49 male patients (45 %). The control group comprised 30 healthy individuals, of whom 13 were male and 17 female (43 % and 57 % respectively) and whose mean age was 49.75 ± 1.83 years. Cardiac arrhythmias and conduction disorders were detected by means of Holter ECG. Statistical analysis was carried out on a personal computer, using such programs as Excel-7.0 (Microsoft Corp., USA) and «Statistica® for Windows 6.0» (StatSoft Inc., License number AXXR712D833214FAN5) through parametric and nonparametric methods.Results. Cardiac arrhythmias were found in 71 (65 %) patients with arterial hypertension and were characterized by the presence of supraventricular extrasystole in 43 (39 %) patients and paroxysmal atrial fibrillation in 10 (9 %) patients. Ventricular extrasystole and episodes of unstable ventricular tachycardia were diagnosed in 13 (12 %) and 5 (5 %) patients, respectively. In hypertensive patients supraventricular arrhythmias were detected in 2.8 times more likely (p &lt; 0.01), and single ventricular premature beats – 6.2 times more likely (p &lt;0.01) than the control group. It was found that in patients with moderate and severe hypertension observed a statistically significant increase in the number of single supraventricular and ventricular premature beats – 21.5 % (p &lt; 0.05) and 29.6 % (p &lt; 0.05) respectively, compared with the subgroup of mild hypertension.Conclusions. Patients with arterial hypertension are characterized by a wide range of supraventricular and ventricular arrhythmias, namely extrasystole, atrial fibrillation, ventricular tachycardia.

ELECTROCARDIOGRAPHIC CONTROL FOR CARDIOVASCULAR SYSTEM IN SPORTSMEN AT PRECOMPETITION TRAINING

Aim. To investigate on the electrocardiographic specifics of sportsmen at various stages of training and competition processes according to the sport type, intensity and training load type. Material and methods. Totally, 136 male sportsmen assessed. Qualified sportsmen 116 persons (groups of improvement and mastery, age 22,07±4,10 y.o., in-sport time 5-15 years) were selected to the groups: I — wrestling (n=30), II — ski racing, biathlon (n=27), III — powerlifting (n=33), IV — volleyball (n=26). Group V — the controls (n=20), age 17,95±1,55 y.o., in-sport less than 3 years. Study methods were electrocardiography (ECG), Holter monitoring of ECG, echocardiography (EchoCG), veloergometry (VEM). Results. During the preparation period of training-competition process, ECG changes, including cardiac rhythm disorders (CRD), were found in 93 of 136, that is 86 (63,2%) of quality sportsmen and 7 (5,1%) of controls (p=0,00001); during competition period — in 104 (76,5%) and 8 (5,9%) (p=0,00001), respectively. The prevalence of ECG changes in quality sportsmen at preparation tranings was 116 cases, in competition period — 165 (p&lt;0,05). During the competition period, there was not just an increase of total number of CRD sportsmen, but sinus bradicardia cases number (p=0,0321), His bundle branches blocks (p=0,0455), repolarization disorders (p=0,0034) and other changes, including concomitant. In 15 sportsmen there were first time discovered CRD required more detailed investigation (serious bradicardia, ventricular extrasystoly (VE), two-bundle blocks, WPW phenomenon, serious repolarization disorders). Conclusion. With the increase of mastery, there is increased rate of ECG changes and CRD cases, that demands additional dynamic electrocardiographic control during the process of intensive training at competition period.

THE PREVALENCE AND CLINICAL SIGNIFICANCE OF CARDIAC ARRHYTHMIAS

Arrhythmias are one of the most complex, insufficiently studied, and therefore one of the most urgent problems of modern cardiology. A wide spectrum of clinical manifestations of cardiac rhythm disorders (CRDs), their detection both in various diseases and in healthy people, necessitate the study of their prevalence in populations. In the majority of conducted epidemiological studies a single recording of electrocardiogram (ECG) was used. This is the most usable method for examination of large populations but a little informative for detecting arrhythmias. The small frequency of CRDs detected during ECG recording is due to the short duration of its registration. An increase in the duration of ECG recording (ECG recording for 2 minutes, continuous recording of 100 cardiocycles) leads to an increase in arrhythmias frequency. With a wide introduction in the practice of ECG monitoring by Holter as well as the use of individual recorders of electrocardiogram (handheld ECG recording) data appeared indicating a much higher frequency of CRDs. Data obtained in numerous studies on the prevalence of arrhythmias are very contradictory and depend both on the characteristics of populations and on methodological approaches, which requires further epidemiological studies. At the same time, the main initiating point of such researches is the clinical significance of certain CRDs. However, if the clinical significance of ventricular tachyarrhythmias and atrial fibrillation does not currently cause any doubt, the clinical significance of extrasystoles is highly controversial, despite the high their prevalence, including this in prognostically unfavorable groups of patients. In recent years, the results of a number of studies have been published that allow to think about the adverse effects of both supraventricular and ventricular extrasystoles of the course of certain cardiovascular diseases. Very heterogeneous results of the performed studies, as well as data about the high clinical significance of individual CRDs, make further epidemiological studies in this field extremely urgent.

TREATMENT OF PERIPARTUM CARDIOMYOPATHY (REVIEW)

The presented review concerns discussion about current insights into treatment of peripartum cardiomyopathy. The definition of peripartum cardiomyopathy and general issues about diagnosis and pathogenesis of the disorder are provided at the head of the review. Particularly, the role of the system «prolactin — cathepsin D — prolactin 16 kDa» in cardiomyopathy development is disclosed. The general approaches to management of the patients are highlighted. The review provides detailed data about indications, adverse effects and derived clinical experience concerning the main pharmacological drugs which had been used in peripartum cardiomyopathy treatment given their possible unfavorable influence on fetus maturation and maternal lactation. The detailed description is provided on diuretics including loop, thiazide and potassium-sparing drugs. It was noted relative safety and efficiency of nitrates and hydralazine in conditions of limited choice from vasodilator group and, particularly, angiotensinconverting-enzyme inhibitors and angiotensin-II receptor blockers which are contraindicated in pregnancy. A special attention is paid to the group of inotropic drugs: levosimendan, milrinone, and cardiac glycosides. The role of β-blockers and ivabradine is disclosed in heart failure treatment of peripartum cardiomyopathy. Anticoagulants were presented in details given that these drugs are justified in severe cardiac chambers dilation, decrease in ejection fraction, and in presence of intracardiac thrombosis. The place of antiarrhythmic drugs administrating in various cardiac rhythm disorders is discussed in the review. The data is given with account of potential influence on fetus in antenatal peripartum cardiomyopathy in which lidocaine and sotalol are the most preferable drugs; adenosine, quinidine, and flecainide are useful with caution, but amiodarone and dronedarone are absolutely contraindicated. Taking into account proposed pathogenic mechanisms of this cardiomyopathy, the information about pharmacological drugs directed to correction of possible links of development mechanism of this pathology is introduced. On the basis of analyzed data authors discuss relevance, indications and side effects of immunosuppressive therapy, immunoglobulin, pentoxifylline, and prolactin secretion inhibitors — bromocriptine and cabergoline. The experience of cardiac transplantation is specified in patients with refractory peripartum cardiomyopathy, and issues of delivery are highlighted in women suffering from this disease.

FIRST EXPERIENCE OF BOSENTAN IN COMPLEX MANAGEMENT OF A CHILD WITH VENA GALENI ANEURYSM

During postnatal period, the causes of progressing heart failure are not only the inborn defects or cardiac rhythm disorders, but extracardiac diseases as well. Among such pathologies are the arterial-venous malformations of the brain vessels, including vena Galeni aneurysm. Inside the aneurysmatic sacks of the brain vessels, up to 80% of blood ejected from the left ventricle could be shunted, which leads then through the right chambers and causes heart failure and pulmonary hypertension. Recent drug treatment makes it to effectively treat pulmonary hypertension, compensate the signs of heart failure and stabilize the condition of a newborn before surgery. The case presented, is a bright evidence of this.

DIAGNOSTIC SIGNIFICANCE OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN PATIENTS WITH PRIMARY MITRAL VALVE PROLAPSE

Aim. To evaluate diagnostic significance of the type A vascular endothelial growth factor (VEGF-A) and its receptors type 1 and 2 (VEGF-R1 and VEGF-R2) in primary mitral valve prolapse (MVP) patients. Material and methods. Totally, 83 MVP patients studied: 61 males, 22 females; mean age 21,93±4,22 y. o. The signs of systemic inflammation were assessed, as the grade of connective tissue involvement. Immune enzyme analysis was done for serum levels of VEGF-А, VEGF-R1 and VEGF-R2 (“Bender MedSystems GmbH”,Austria). Controls included 20 healthy volunteers — 14 males, 6 females, mean age 21,10±0,55 y. o. with no MVP and any other dysplastic features. Results. In the MVP group, the decreased levels of circulating VEGF-R1 were found, as the increase of cases number of high (42,17%) and low (32,53%) concentration of VEGF-А. In low levels of VEGF-A and VEGF-A/ VEGF-R1 prevalence of grade II mitral regurgitation increases 5,1 times comparing to the group of retained balance of VEGF-A and VEGF-R1 — 95% confidence interval (CI) 1,25-20,88, and the prevalence of clinically significant cardiac rhythm and conduction disorders increases 5,25 times in comparison to the cases with elevated VEGF-A and VEGF-R1 — 95% CI 1,33-20,76 and 4,09 times — comparing MVP patients with retained balance of VEGF-A and VEGF-R1 — 95% CI 1,18-14,17. Conclusion. In primary MVP patients, regardless clinical phenotype of monogenic hereditary syndromes, the heterogeneity of deviation and regulation of VEGF has been established. Highest number of II grade mitral regurgitation, significant rhythm disorders was found in the group with low VEGF-A and VEGF-A/VEGF-R1, that might be implemented as optimized risk stratification in heterogenic MVP patients population.

Clinical Features, Risk Factors, and Short-term Outcome of Ischemic Stroke, in Patients with Atrial Fibrillation: Data from a Population-based Study.

Objectives:Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder associated with stroke. This study was done to describe risk factors, clinical features, and short-term outcomes of stroke patients with AF.Materials and Methods:This study was a part of the Indian Council of Medical Research funded “Ludhiana urban population based Stroke Registry.” Data were collected using WHO STEPS stroke method. All patients ≥18 years of age, who developed ischemic stroke between March 26, 2011, and March 25, 2013, were included in this study. Data about demographic details, clinical features, and risk factors were collected. The outcome was assessed at 28 days using modified Rankin scale (mRs) (good outcome: mRS ≤2; poor outcome >2). The statistical measures calculated were descriptive statistics, Chi-square test, Fischer's exact test, and independent t-test.Results:Of the total 7199 patients enrolled in the registry, data of 1942 patients who fulfilled inclusion criteria were analyzed, and AF was seen in 203 (10%) patients. AF patients were older (AF 62 ± 14 vs. non-AF 60 ± 15 years, P = 0.01), had more hypertension (AF 176 [87%] vs. non-AF 1396 [80%], P = 0.03), hyperlipidemia (AF 60 [32%] vs. non-AF 345 [21%], P = 0.001), coronary artery disease (AF 60 [30%] vs. non-AF 195 [11%], P < 0.0001), and carotid stenosis (AF 14 [7%] vs. non-AF 57 (3%), P = 0.02). They had worse outcome (mRS >2; AF 90 [50%] vs. non-AF 555 [37%], P = 0.001).Conclusions:Ten percent of stroke patients had AF. They were older, had multiple risk factors and worse outcome. There was no gender difference in this large cohort.

Multifocal atrial tachycardia: Looking for new solutions to an old problem

Multifocal atrial tachycardia (MAT) is a cardiac rhythm disorder frequently diagnosed in elderly patients affected by several comorbidities. However, MAT can be observed also in younger ages as an incidental finding or in association with heart and lung diseases. MAT is characterized by heart rate >100 beats/min and at least three different P waves when compared to sinus P wave. Recent guidelines recommend the use of beta-blockers and verapamil for rate control and ongoing management of MAT. Unfortunately, electrical cardioversion and antiarrhythmic drugs have been demonstrated not always effective in MAT treatment. Intravenous magnesium seems a promising therapy in restoring sinus rhythm in patients who developed MAT. Moreover, in the last years, innovative strategies such as atrioventricular junction modification, ablate and pace approach, and electrophysiological isolation of firing sites have been successfully tested as curative treatment in selected cases of MAT resistant to drug therapy.

Bayés syndrome and acute cardioembolic ischemic stroke.

Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block. Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration > 120 ms with biphasic morphology ± in the inferior leads. The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias, particularly atypical atrial flutter and atrial fibrillation. Likewise, Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia. Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation, left atrial electromechanical dysfunction or atrial tachyarrhythmia (paroxysmal or persistent atrial fibrillation), conditions predisposing to thromboembolism. Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke. In summary, Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.

Reactive cholecystitis as the leading sign of subacute perforation of the right ventricle with the electrode of an implantable cardioverter defibrillator

Subacute lead perforation of the right ven-tricle caused acute, reactive, acalculous cholecystis, which initially distracted the attention of physicians from the develop-ment of hematopericard. Implantation of a cardioverter defibrillator in a young patient after sudden cardiac arrest, but be-fore treatment of significant stenosis of the proximal left anterior descending artery, resulted in a life-threatening condition only 36 days after arrest. After removing the implantable cardioverter defibrillator, there was no sign of pathological cardiac rhythm disorders.

The Impact of Risk Factors and Comorbidities on The Incidence of Atrial Fibrillation.

Introduction:Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in clinical practice and its prevalence increases with age. Patients who develop AF also have cardiovascular risk factors, structural heart disease, and comorbidities, all of which can increase mortality. AF causes a significant economic burden with the increasing trend in AF prevalence and hospitalizations.Research Objectives:The objective of our study is to evaluate the impact of the most common known risk factors on the incidence of atrial fibrillation as an important precursor of cardiac and cerebrovascular morbidity and mortality among our patients in Bosnia and Herzegovina during median follow up period (September 2006 - September 2016). The other objective is to estimate the CHA2DS2-VASc score among our patients based on clinical parameters.Patients and methods:This study includes 2352 ambulant and hospitalized patients with atrial fibrillation. All patients underwent clinical evaluation which includes thorough assessment for potential risk factors and concomitant conditions in order to determine which of them represent the most common among examinees with atrial fibrillation.Results:The results show that male gender has slightly more incidence of AF. Obesity and overweight with BMI ≥ 27, cigarettes smoking and sedentary life style are almost present in patients with AF. Arterial hypertension, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal dysfunction, structural and valvular heart disease and peripheral vascular disease are the most common comorbidities among our patients. The mean CHA2DS2-VASc score was 3.2±1.4 and the mean HAS-BLED score was 2.1±1.2.Conclusion:Atrial fibrillation is the most common sustained cardiac rhythm disorder. The study shows that obesity, alcohol consumption, smoking cigarettes and dyslipidemia can be considered as triggers and predisposing factors for appearance of AF. Arterial hypertension, coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus, Peripheral vascular disease and chronic kidney disease are playing important role in developing of AF.

Bendamustine-Based (BeEAM) Conditioning before Autologous Stem Cell Transplantation: Result of a French Multicenter Study of 386 Patients from Lysa Centers

Unavailability of Carmustine and its dramatically increased cost by nearly 10 fold has led to its replacement by bendamustine (Be) and an increase use of Bendamustine-based (BeEAM) conditioning regimen before autologous stem cell transplantation for lymphoma. The aim of this study was to evaluate the safety of the BeEAM regimen in the real life use in several French centers. Median age of the 386 patients (233 male, 153 female) was 55 years (17-72). The majority of patients had aggressive B-cell (40%), follicular (17%), Hodgkin’s (17%) and mantle cell lymphoma (15%). Two hundred and forty six patients (64%) were transplanted after 2nd line chemotherapy and the median number of prior lines of chemotherapy of 2 (1-9). Two hundred and sixty patients (67%) had received prior platinum chemotherapy and only 4% had a history of prior chronic renal failure (Table 1). The median creatinine level at conditioning initiation was 71(36-206) µmol/l.Be was administered at a median dose of 191 mg/m2/day (50-250) on day -7 and -6. Thirty two percent received 100-160 mg/m²/d and 58% of patients received more than 160 mg/m²/d. Median 24h-hydration volume was 3 l (1-6) which began within median time of 18 h (1-72) prior to conditioning initiation. The median duration time of Be perfusion was 60 min (30-143).Grade 1-4 acute renal failure (ARF) was reported in 107 cases (28%) (G ≥2; 34%) and appeared after a median time of 2 days (1-18) after conditioning start. Melphalan dosage was reduced, due to renal failure, in 10% of patients (Table 2). 84% of patients normalized their creatinine level within a median time of 10 days (1-77). The most frequent reported Grade 1-4 toxicities were mucositis (84%), gastroenteritis (53%), skin toxicity (34%), colitis (29%), liver toxicity (19%), pneumonitis (5%) and cardiac rhythm disorders (4%). Opportunistic infection was documented in 9.5% of patients, HHV6 reactivation in 6% of patients. Ten percent of patients needed intensive care management and toxic death was estimated at 5% (Table 3). Patients received a median of 3 (0-34) packed red blood cells and 4 (0-56) platelets units. The median time to neutrophils > 0.5 G/L and platelets > 20 G/L were 10 (0-50) and 12 (0-210) days. The median time of hospital stay was 23 (12-85) days. In comparison with the group of patient without renal failure, the group of patients with ARF had older age (58 vs 54), higher rate of pre-transplant chronic renal failure (10% vs 1%), higher rate of platinum treatment (77% vs 64%), higher day1 creatinine level (81 vs 69) and received higher median bendamustine (199 vs 182). Colitis (p=0.039), pneumonitis (p=0.008), cardia arrhythmia (p=<0.0001), intensive care admission (p=<0.0001), need for blood transfusion (p=<0.0001), hospital stay duration (p=<0.0001), and death (p=<0.0001), were more frequent in patients with post conditioning renal failure. In multivariate analysis, creatinine level at day1, bendamustine dose>160mg/m2 and age were independent prognostic factors for ARF. A three-point clinical predictor score for acute renal failure was identified and included creatinine level>65µmol/l, bendamustine dose >160mg/m² and age>57 years. ARF stratified by score, was 4% with score 0, 17% with score 1, 30% with score 2 and 45% with score 3.In conclusion, BeEAM induced 5% non-relapse mortality with high rate of renal toxicity. A simple, three-point scoring system can stratify patients by levels of risk for ARF. Rapid identification of higher risk patients may allow a reduction of the bendamustine dose to improve clinical outcomes. Prospective comparative studies are needed to confirm toxicity extents of this conditioning as compared with other type of high dose therapy. [Display omitted] [Display omitted] [Display omitted] DisclosuresSoussain:Pharmacyclics: Research Funding; Celgene: Research Funding; Roche: Research Funding. Malak:Novartis: Membership on an entity's Board of Directors or advisory committees.

Optimization of Life-Threatening Ventricular Ectopy and Sudden Cardiac Death Prevention in Patients with Postinfarction Cardiosclerosis

The objective of the research was to optimize treatment of patients with ischemic heart disease (postinfarction cardiosclerosis) and concomitant phenomenon of heart rate turbulence based on the study of heart rate turbulence and heart rate variability.Materials and methods. The study included 100 patients with ischemic heart disease and postinfarction cardiosclerosis complicated by cardiac rhythm disorder (ventricular ectopic beats). Patients were divided into 2 groups according to the type of prophylaxis: Group I received bisoprolol; Group II received quercetin in addition to bisoprolol. A daily dose of bisoprolol was 0.07 mg/kg body weight while a daily dose of quercetin was 1g for 7 days. The control of therapy effectiveness was performed using Holter monitoring of heart rate turbulence and heart rate variability.Results. Bisoprolol intake by patients with ischemic heart disease and concomitant heart rate turbulence led to significant increase in the stress index as well as the decrease in the overall tension of body regulation, either parasympathetic or sympathetic divisions of the autonomic nervous system and the vasomotor center. Drug intake did not lead to the abnormal physiological correlation between the activity of the subcortical and peripheral components of the nervous systems. While analyzing the changes in the indices of heart rate turbulence and heart rate variability, there was found, that during combination treatment of patients with ischemic heart disease using bisoprolol and quercetin, positive changes appeared in the regulatory parts of the body.Conclusions. Combination treatment of post-myocardial infarction patients with bisoprolol and quercetin allows us: a) to achieve complete reduction in ventricular ectopic activity in more than half of patients; b) to reduce the number of patients with life-threatening ventricular ectopic beats significantly; c) to maintain the physiological value and the activity of the autonomic nervous system as well as the vasomotor center of the body; d) to decrease the level of turbulence onset and maintain the value of turbulence slope.