Duration Of Arrhythmia Research Articles

ELECTIVE CARDIOVERSION: INDICATIONS, SUCCESS AND COMPLICATIONS. FIVE YEAR EXPERIENCE IN A TERTIARY CARE HOSPITAL IN PAKISTAN

Objectives: This study aimed to determine the indications, success rate of elective cardioversion and its manifest complications. Methodology: It is a retrospective study involving 53 patients. We reviewed the hospital records files for the demographic data including age, gender, as well as indication of cardioversion, duration of arrhythmia and date of cardioversion along with complications. Results: Out of 53 patients, 58.5% (31) were males with a mean age of 48.17 ± 18.43 years. Arrhythmia related symptoms (palpitations and fatigue) were the indication for cardioversion in 44% (23) of the subjects. Our data showed that 98.1%( 52) were cardioverted to sinus rhythm successfully with a median energy of 100 joules. Out of those who underwent successful cardioversion, 92.5% (49) were followed up till 1 year after the cardioversion. At six week follow up, all the patients were found in sinus rhythm. At 6 months follow up, 94.2% (49) remained in sinus rhythm, while at 1 year follow up, 73% (38) of the patients remained in sinus rhythm. All patients were anticoagulated for at least four weeks after cardioversion. None of the patients required pacemaker and none of them developed stroke after cardioversion. Conclusion: Electrical cardioversion for atrial fibrillation and flutter is a low risk procedure in our population and it has a high success rate and relatively low complications.

B-PO02-180 HIGH BURDEN OF INAPPROPRIATE ALARMS BY THE WEARABLE CARDIOVERTER-DEFIBRILLATOR IN OBESE PATIENTS - FINDINGS FROM THE SWISS WCD REGISTRY

The wearable cardioverter-defibrillator (WCD) uses surface electrodes built into the vest to detect underlying arrhythmia before initiating a treatment sequence. Before a shock is administered an alarm consisting of vibratory and auditory signals is emitted to warn the patient. Some patients frequently experience alarms. The aim of this study is to assess the alarm burden in patients and its possible impact on clinical outcomes. The aim of this study is to assess the alarm burden in patients and its possible impact on clinical outcomes. The Swiss WCD Registry is a nationwide retrospective registry including patients with a history of WCD use. Patients were included since 2011 until February 2018. Baseline characteristics and data on WCD usage were analysed. As sustained ventricular tachycardia or fibrillation (VT/VF) requires arrhythmia duration of ≥30s, only recordings ≥30s of length were analysed and categorized as appropriate (VT/VF), or inappropriate (atrial fibrillation, supraventricular tachycardia and artefact). A total of 10’653 alarms were documented in the total registry including 456 patients over a mean WCD wear-time of 2 months (±1.6). One hundred and thirty-two patients (28.9%) had zero alarms. A recording with a length ≥30s was present in 2996. One hundred and eleven (3.7%) of these were VT/VF episodes. The remaining recordings were inappropriate arrhythmia detections: 2736 artefacts (91%), 117 atrial fibrillation episodes (3.7%) and 48 supraventricular tachycardia episodes (1.6%). Two-hundred and seven patients (45%) had ≥3 alarms per months, and 49 patients (10.7%) had ≥1 alarm per day. BMI ≥30kg/m2 was significantly associated with ≥3 alarms per month (p=0.002), and increasing BMI correlated with increasing total number of alarms (p<0.001). ≥3 alarms per months were not associated with a lower average daily wear time (20.8 vs 20.7 hours, p=0.785) or a decreased ICD implantation rate after stopping WCD use (48 vs 47.3%, p=0.156). Inappropriate alarms emitted by the WCD are frequent and significantly associated with obesity. They did not lead to a decreased adherence to WCD therapy.

Ефективність кардіоверсії в пацієнтів з поєднанням фібриляції і тріпотіння передсердь

The aim – to compare the effectiveness of restoration of sinus rhythm by transesophageal pacing (TEECP) in patients with prolonged episodes of isolated typical atrial flutter (AFl) and in patients with a combination of atrial fibrillation (AF) and AFl.Materials and methods. 325 procedures of TEECP were performed in cases of longlasting episodes of AFl: from 8 days to 2 years (average 68.2±4.76 days). Prior to hospitalization, all subjects underwent ineffective medical cardioversion. The sinus rhythm was restored using TEECP, and in case of its ineffectiveness by means of electropulse therapy (EPT). All patients were divided into two groups: group I (n=237) – patients with a lone atrial flutter, and group II (n=88) – patients with the history of AF or in case of transformation AF into AFl because of antiarrhythmic therapy. Both groups were comparable by age, paroxysm duration, presence of hypertension and organic disorders of the heart conductive system, comorbidities, echocardiographic and hemodynamic parameters. Electrocardiographical parameters revealed no significant differences in the tachycardia cycle length and the average frequency of ventricular contractions.Results and discussion. Patients in the group II were characterized by a significantly longer history of arrhythmia, more severe heart failure, higher frequency of arrhythmia paroxysms and detection of thyroid disorders; recorded significantly lower amplitudes of the F wave on the surface electrocardiogram and A wave on the esophageal electrogram, which was associated with the processes of electrophysiological remodeling of the atria. Also, in contrast to patients with typical AFl, there was a significant decrease in the effectiveness of TEECP (63.6 and 89 %); more frequent use of EPT (10.2 and 3 %) and more often arrhythmia has transformed into a permanent form (25 and 7.2 %).Conclusions. In patients with prolonged episodes of typical AFl, a highly effective method of cardioversion is TEECP, regardless of the arrhythmia duration. In patients with concomitant AF, the restoration of sinus rhythm should be performed by EPT, due to its higher efficancy.

Resveratrol Confers Protection Against Ischemia/Reperfusion Injury by Increase of Angiotensin (1-7) Expression in a Rat Model of Myocardial Hypertrophy.

Left ventricular hypertrophy (LVH) makes the heart vulnerable to ischemia/reperfusion (IR) injury. Angiotensin (Ang) (1-7) is recognized as a cardioprotective peptide. We investigated the effect of polyphenol resveratrol on myocardial IR injury after hypertrophy and examined cardiac content of Ang (1-7) and transcription of its receptor (MasR). Rats were divided into sham-operated, LVH, IR, LVH + IR, and resveratrol + LVH + IR groups. Myocardial hypertrophy and IR models were created by abdominal aortic banding and left coronary artery occlusion, respectively. To evaluate the electrocardiogram parameters and incidence of arrhythmias, electrocardiogram was recorded by subcutaneous leads (lead II). Blood pressure was measured through the left carotid artery. Infarct size was determined by the triphenyl tetrazolium chloride staining. The Ang (1-7) level was evaluated by immunohistochemistry. The Mas receptor mRNA level was assessed by the real-time real time reverse transcription polymerase chain reaction technique. QT-interval duration, infarct size, and incidence of ischemia-induced arrhythmia were significantly higher in the LVH + IR group. However, in the resveratrol-treated group, these parameters were decreased significantly. The cardiac level of Ang (1-7) was decreased in untreated hypertrophied hearts (LVH and LVH + IR groups). Pretreatment with resveratrol normalized the cardiac level of Ang (1-7). The mRNA level of Mas receptor was increased in all of hypertrophied hearts in the presence or absence of resveratrol. Resveratrol can decrease IR injury in rats with LVH. The anti-ischemic effect of resveratrol may be related to the enhancement of Ang (1-7)/MasR axis.

The influence of old age on cardioprotective efficiency of pharmacological postconditioning using lactic acid in ischemia-reperfusion of the myocardium in experiment

Not only the prevalence, but also the death rate from the coronary heart disease, including myocardial infarction, is higher in older people than among young people. A demographic shift towards an aging population will lead to a further increase in the prevalence of cardiovascular diseases among the elderly population. Therefore, one of the urgent aims of modern experimental and clinical medicine is to develop methods aimed at limiting reversible and irreversible damage to the myocardium, including in elderly patients. There are a lot of the data supporting the cardioprotective efficiency of such phenomena as ischemic and pharmacological pre- and postconditioning that reduce ischemic and reperfusion damage in young hearts. However, the information on the effectiveness of these phenomena in experiments on old animals is very scarce, contradictory, and not fully understood. The aim of the study was to experimentally evaluate the influence of old age on the reproducibility of the cardioprotective efficiency of pharmacological postconditioning using lactic acid in ischemia-reperfusion of the myocardium. In the course of the study, it was found that neutral lactate, after being administered into the blood flow of animals at a dose of 10 mg/kg 25 minutes after the onset of reperfusion, leads to a decrease in the infarct size of the left ventricle of the myocardium in old rats. Pharmacological postconditioning using lactate is not effective in reducing the duration of cardiac arrhythmias in ischemia-reperfusion of the myocardium in old rats; however, there is a tendency to reduce the incidence of reperfusion arrhythmias and the total duration of cardiac arrhythmias. The obtained data suggest that the presence of such a risk factor for cardiovascular diseases as old age is not a criterion to exclude the use of pharmacological postconditioning with lactate as a way to reduce ischemia and reperfusion injury of myocardium.

Protective Effects of 3,4-Seco-Lupane Triterpenes from Food Raw Materials of the Leaves of Eleutherococcus Senticosus and Eleutherococcus Sessiliflorus on Arrhythmia Induced by Barium Chloride.

As a traditional wild vegetable and food raw material, the leaves of Eleutherococcus senticosus and Eleutherococcus sessiliflorus are rich in 3,4-seco-lupane triterpenes, including chiisanoside (CSS), divaroside (DVS), sessiloside-A (SSA), and chiisanogenin (CSG). This study was conducted to evaluate the anti-arrhythmic effects of these 3,4-seco-lupane triterpenes. Evaluation of the cytotoxicity of compounds was performed by measuring cell viability and apoptosis with the CCK-8 assay. In vivo, arrhythmia was induced by rapid injection of BaCl2 via rat caudal vein. The occurrence time and duration of arrhythmias in rats were studied. The levels of SOD and MDA in serum, and Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase in myocardial homogenate were detected by ELISA. The histopathological changes of rats myocardial were observed by HE staining. Changes in the expression of PKA and related proteins were detected by Western blot. The 3,4-seco-lupane triterpenes interactions with protein kinase A were analyzed by molecular docking. In the present study, we found that 3,4-seco-lupane triterpenes exhibited powerful anti-arrhythmic activity, especially DVS completely relieved the ventricular arrhythmia induced by BaCl2 . This study suggests that the leaves of E. senticosus and E. sessiliflorus might be used as functional food materials to prevent arrhythmia, and DVS can potentially be further developed as an anti-arrhythmic drug.

Predictors of myocardial recovery in arrhythmia-induced cardiomyopathy: A multicenter study.

Arrhythmia-induced cardiomyopathy (AIC) is characterized by improvement in left ventricular ejection fraction (LVEF) following arrhythmia treatment. Predictors of recovery in LVEF are not well understood. We evaluated predictors of AIC recovery in a large multicenter cohort. In total, 243 patients (age 65 ± 11, 73% male) with AIC caused by atrial fibrillation (49%), atrial tachycardia (20%), and premature ventricular contractions (PVCs; 31%) were treated and included. LVEF was assessed before and after treatment. Patients were stratified by arrhythmia duration (known [KN, n = 132] vs. unknown [UKN, n = 111]), arrhythmia type, LVEF, and presence of structural heart disease (SHD). Arrhythmia treatment was rhythm control in 95%. Median arrhythmia duration in the KN group was 47 months (25-75th percentile, 24-80 months). Post treatment LVEF was higher in KN group (55.9 ± 7 vs. 46.2 ± 12%; p < .0001) but the degree of LVEF improvement was similar (21.2 ± 9 vs. 19.4 ± 11; p = .16). Comparing highest quartile (longest arrhythmia duration) versus the rest of the KN group, the extent of LVEF improvement was similar (21.5 ± 8 vs. 21 ± 9%; p = .1). Patients in lowest index LVEF quartile (n = 74) had more PVC-induced AIC, greater EF improvement after treatment (24 ± 17 vs. 19 ± 7%; p < .0001) but lower post treatment EF (45 ± 14 vs. 54 ± 8%; p < .0001) versus other patients. Patients with SHD had lower index EF (28 ± 8 vs. 34 ± 8%; p < .0001) and lower final EF (47 ± 12 vs. 56 ± 7; p ≪ .0001). In multivariate regression, low index LVEF predicted myocardial recovery (odds ratio, 11.4; p < .005). In this AIC cohort, LVEF improved regardless of arrhythmia duration or type but those with PVCs had lower index LVEF and had less recovery. Low index LVEF predicted LVEF recovery following arrhythmia treatment.

Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias.

Although many thromboembolism risk factors are well defined, formation of thrombus or dense spontaneous contrast (sludge) in the left atrium remains enigmatic and confounding. Exclusion of the thrombus is extremely important with respect to planned reversal of sinus rhythm. Data regarding the routine transesophagal echocardiography (TEE) before cardioversion are inconclusive. The authors focused on analyzing the usefulness of TEE before cardioversion by assessment of factors influencing the risk of thrombus and/or dense spontaneous echo contrast with the intention of extending indications for TEE in the group with a high risk of thrombus or to forgo TEE in the low risk group. Two hundred sixty-nine consecutive patients with persistent (> 48 h) atrial fibrillation or atrial flutter, in whom a direct current cardioversion was planned, were undergoing TEE for the detection of the left atrial thrombus or dense spontaneous echo contrast. Additional clinical and echocardiographic data were collected. The relationship between both thrombus and dense spontaneous echo contrast and covariates was analyzed with the use of binary logistic regression. Left atrium (LA) appendage (LAA) thrombus and/or sludge were detected in 79 (29%) patients. Signs of dementia in mini-mental state examination (hazard ratio [HR]: 1.16; p = 0.005), low velocities in LAA (HR: 3.38; p = 0.032); presence of spontaneous echo contrast in LA (HR: 3.38; p = 0,003) consecutive episode of AF (HR: 2.27; p = 0,046); longer duration of atrial fibrillation (HR: 1.009; p = 0.022); were significant predictors of thrombus and/or dense spontaneous echo contrast. None of the patients with a CHA2DS2VASc score ≤ 1 had thrombus or sludge in the LAA. Among patients with a CHA2DS2VASc score > 1, the prevalence of thrombus or sludge in LAA was independent of the CHA2DS2VASc score value. Amongst many factors, including an established as risk for thromboembolism only a few of them increased the risk for the presence of thrombus in LAA: low velocities in LAA, presence of spontaneous echo contrast, longer duration of arrhythmia, consecutive (not first) arrhythmia episode and signs of dementia from a mini-mental state examination questionnaire. It was believed that there could be a need for an extension of indications of TEE in vast majority of the patients with atrial arrhythmias, due most often to an unpredictable occurrence of thrombus and potentially disastrous thromboembolism. The only exception could have been the group of the patients with a CHA2DS2VASc score ≤ 1.

A Clinical Study on the Influence of Shenmai Injection on the Cardiac Function and Arrhythmias in Patients with Chronic Heart Failure

To investigate the clinical effect of Shenmai injection on cardiac function and arrhythmias in patients with chronic heart failure. A total of 120 patients with chronic heart failure who were hospitalized in our hospital from December 2017 to June 2019 were selected and randomly divided into Shenmai group and control group after signing the informed consent form. The patients in the control group were given conventional treatment and the Shenmai group was treated with Shenmai injection on the basis of the control group. The course of the treatment in both groups was 14 d. Holter was performed in both groups before and after treatment, and the differences in the frequency and duration of atrial or ventricular arrhythmias were compared between the two groups. The main adverse cardiovascular events were recorded during 6-12 mo follow-up. The clinical total effective rate of Shenmai group was 87.66 % and that of control group was 85.96 % (p<0.05). After treatment, the frequency and duration of atrial or ventricular arrhythmias in Shenmai group were significantly improved (p<0.05); the frequency of atrial arrhythmias in the control group were increased and the difference was statistically significant (p<0.05), but there was no significant difference in the duration of atrial arrhythmias and the frequency or duration of ventricular arrhythmias before and after treatment. There was no significant difference in main adverse cardiovascular events between the two groups after 6-12 mo of follow-up (χ2=1.115, p>0.05). Shenmai injection has a definite effect in the treatment of chronic heart failure, which can effectively improve the heart function, arrhythmias and life quality of the patients with good safety.

Effects of atorvastatin and ticagrelor combination therapy on renal function and the levels of suppression of tumorigenicity 2 and interleukin-33 in patients with ST-segment elevation myocardial infarction.

ObjectiveWe evaluated the effects of atorvastatin and ticagrelor combination therapy on renal function and the levels of suppression of tumorigenicity 2 (ST2) and interleukin 33 (IL-33) in patients with ST-segment elevation myocardial infarction (STEMI).MethodsEighty-four STEMI patients who underwent emergency percutaneous coronary intervention at our hospital from January 2015 to March 2018 were retrospectively analyzed and divided into a control group (n = 44) and an observation group (n = 40). The control group was treated with atorvastatin as routine STEMI treatment, whereas the observation group was concurrently administered ticagrelor.ResultsAfter treatment, significantly better outcomes were observed in the control group than in the observation group in terms of clinical indices, including chest pain relief, enzyme levels, duration of reperfusion-associated arrhythmia, and depression of the ST segment. Both groups exhibited improvements in cardiac ultrasound indices, whereas the observation group showed lower left ventricular end-diastolic and end-systolic diameters and higher left ventricular ejection fractions than the control group.ConclusionsAtorvastatin and ticagrelor combination therapy is clinically effective and safe for STEMI patients as it reduces the degree of myocardial infarction, protects the heart and renal functions, improves inflammation, and reduces adverse cardiac event incidences.

Seria niefortunnych zdarzeń — przewlekła okluzja tętnicy wieńcowej, migotanie przedsionków i udar niedokrwienny. Czy optymalna antykoagulacja jest w tym przypadku możliwa?

Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been related to discordant benefits concerning clinical and quality life measures. We present a patient previously diagnosed with hypertrophic cardiomyopathy with left ventricular outflow obstruction referred for a CTO of the left anterior descending artery PCI. Crossing via left anterior descending artery was complicated by perforation resulting in haemopericardium (no evidence of tamponade; the patient remained hemodynamically stable). On subsequent days the patient presented with two asymptomatic paroxysmal atrial fibrilation (AF) episodes ( de novo ). In this patient’s case, the stroke’s risk factors did not mandate anticoagulation due to haemopericardium and arrhythmia duration of < 48 hours. Twenty-six hours after the second AF episode, the patient suffered a large ischemic stroke in the territory supplied by the right middle cerebral artery. Despite mechanical thrombectomy (MT), the patient died. Even though CTO PCI is an appealing choice in patients with complex coronary artery disease and chronic total occlusion, the risk still should not be underestimated. Another issue is assessing the thromboembolic risk associated with acute cardioversion of patients with AF estimated to be of < 48 hours duration — it is usually considered low. However, there is increasing evidence that short runs of AF confer a significant risk of stroke. Moreover, it was shown that, among patients undergoing MT for acute ischemic stroke, women had worse outcomes at 90 days.

Abstract 15796: The Inverse Correlation Between Lifetime Occupational Radiation Exposure Duration and Prevalence of Atrial Arrhythmia

Introduction: Fluoroscopy assisted procedures have increased occupational radiation exposure among Cardiologists. Radiation has been linked to cardiovascular complications but its effects on cardiac rhythm has not been extensively explored. Hypothesis: We hypothesized that radiation exposure is associated with increased risk of atrial arrhythmias (AA) despite appropriate leaded body coverage. Methods: Demographic, social, occupational, and medical history was collected from board-certified cardiologists via an electronic survey. Bivariate and multivariable logistic regression analyses were performed. Results: We received 1478 responses from cardiologists; 85.4% were males, 79% were White and 66.1% were ≤65 yrs of age. 35.6% of respondents were interventional cardiologists and 16.4% were electrophysiologists, and of those, 92.2% wore lead apparel during all times of radiation exposure. Cardiologists &gt;50 yrs of age, with &gt;10,000 hours of occupational radiation exposure, had a significantly lower prevalence of AA compared to those with ≤10,000 hours of radiation exposure (11.1% vs 16.7%, p =0.019). A multivariate logistic regression was performed and among cardiologists &gt;50 years of age, exposure to &gt;10,000 radiation hours was significantly associated with lower likelihood of AA, after adjusting for age, sex, DM, HTN and OSA (adjusted OR 0.57; 95% CI 0.38 - 0.85, p =0.007). Traditional risk factors such as age, sex, HTN, DM and OSA were more prevalent in those with AA and cataracts, a well-established complication of radiation exposure in cardiologists, was more prevalent in those exposed to &gt;10,000 radiation hours compared to those exposed to ≤10,000 radiation hours, validating the dependent (AA) and independent variables (radiation exposure), respectively. Conclusions: Radiation exposure in Cardiologists with appropriate lead apparel is inversely related to AA. Large scale prospective studies are needed to validate our findings.

Abstract 13383: The Vascular Endothelial Barrier: A Novel Therapeutic Target for Preventing Atrial Fibrillation

Atrial fibrillation (AF), the most common arrhythmia, is associated with inflammation and vascular dysfunction. AF patients have elevated levels of vascular endothelial growth factor (VEGF; 90-580 pg/ml), which promotes vascular leak and edema. We have previously identified edema-induced disruption of sodium channel (Na V 1.5) -rich intercalated disk (ID) nanodomains as a novel arrhythmia mechanism. We hypothesized that (i) elevated VEGF levels promote AF by disrupting ID nanodomains, and slowing atrial conduction, and (ii) protection of the vascular barrier can prevent these arrhythmias. Clinically-relevant VEGF levels (500 pg/ml, 60 minutes) increased FITC-dextran extravasation (99.3% vs. 24.3% in vehicle controls) in WT mouse hearts, consistent with increased vascular leak. Electron microscopy revealed ID nanodomain swelling, near both gap junctions (perinexi; 64±9nm vs 17±1nm) and mechanical junctions (63±4nm vs 27±2nm) in VEGF-treated hearts relative to controls. Super-resolution STORM microscopy revealed Na V 1.5 enrichment at perinexi (9±2 fold) and N-cadherin-rich sites (7±1 fold) relative to non-junctional ID sites in control hearts. VEGF reduced Na V 1.5 enrichment at both sites (6±1 and 4±1 fold, respectively), consistent with Na V 1.5 translocation from ID nanodomains. Atrial conduction, assessed by optical mapping, was slowed by VEGF (10±0.4 cm/s vs 21.3±1.3 cm/s at baseline). VEGF increased atrial arrhythmia burden both ex vivo (80% vs 0% in vehicle controls) and in vivo (70% vs 20% in vehicle controls). Next, we tested two strategies shown to prevent vascular barrier breakdown. Blocking connexin43 hemichannels (αCT11 peptide) decreased both incidence (40%) and duration (1.45±3.42s) of VEGF-induced arrhythmias. Likewise, blocking pannexin1 channels (Panx1-IL2 peptide) shortened VEGF-induced arrhythmias (2.48±0.83s). Mefloquine and spironolactone, which are small molecules that respectively inhibit Cx43 hemichannels and pannexin channels, were also found to effectively prevent VEGF-induced atrial arrhythmias. These results highlight VEGF-induced vascular leak as a novel mechanism for AF, and suggest vascular barrier protection as an anti-arrhythmic strategy.

Long-term results of simultaneous hybrid ablation of therapy-resistant atrial fibrillation

Abstract Background A hybrid technique using thoracoscopic epicardial and standard endocardial ablation of atrial fibrillation (AF) is a strategy used to treat AF patients with therapy-resistant symptomatic AF. We conducted comparative study of efficacy and safety of simultaneous hybrid ablation in patients with non-paroxysmal forms of AF and evaluated the factors that determine success and quality of life. Methods The study included 56 consecutive patients who underwent simultaneous hybrid ablation. First, epicardial ablation was performed using thoracoscopic access: to isolate the pulmonary veins and the posterior wall of the left atrium. After this, an endocardial electrophysiological assessment was carried out from the pulmonary veins to the left atrium and additional endocardial ablation was performed, where necessary. The next day, a loop ECG recorder was implanted subcutaneously in the thoracic region. Efficiency was evaluated using implanted loop ECG recorders. The average follow up was 24 months, the studied patients came to the clinic every 3 months to receive diagnostic reports from loop recorders. Recurrence was defined as AF, atrial flutter and other atrial tachycardia, recorded in reports of loop recorders lasting &amp;gt;30 sec during follow up period. Results Continuous follow up was carried out in 56 patients, the average age of which was 57±9 years. Of these, 39 (70%) men, 6 (10%) paroxysmal, 38 (68%) persistent and 12 (22%) long-standing persistent AF. Within 24 months of follow up, 45 (80%) maintened a sinus rhythm. Most recurrenses were atrial flutter (8/11 patients). Success was associated with factors such as left atrial size, patient age and duration of arrhythmia. Patients with paroxysmal AF had the highest success, patients with long-standing persistent AF had the least success. 5 (9%) patients had complications associated with the procedure. Quality of life after ablation improved in patients with sinus rhythm. Conclusion The efficiency of simultaneuous hybrid AF ablation was 80% for 24 months of continuous follow up period associated with the type of AF. Quality of life improved significantly, complications associated with the procedure occurred in 9%. Funding Acknowledgement Type of funding source: None

Mathematical Models for the Prediction of Coagulation Activity in Patients with Paroxysmal Atrial Fibrillation

Our previous studies showed activation of coagulation in the early hours of the clinical manifestation of paroxysmal atrial fibrillation (PAF). Plasma coagulation activity of factor II, factor V, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, vWF, tissue factor levels, FVIII, vWF, prothrombin fragment 1+2(F1 + 2) and fibrinopeptide A (FPA) were significantly increased as early as the first twenty-four hours of the disease. The results suggest that there is a correlation between the studied parameters and development of the disease. Aim: To search for a statistical model that predicts coagulation activity in PAF patients. Materials and methods: Coagulation parameters were examined in 51 PAF patients (26 males, 25 females; mean age 59.84 ±1.60 years, onset of PAF episode &lt; 24h prior to hospitalization). Controls included 52 individuals (26 males, 26 females; mean age 59.50 ± 1.46 years) with no prior anamnestic or ECG AF data, corresponding to patients in sex, age, BMI and comorbidities. A linear regression model was used to predict coagulation activity in PAF. Regression models showed good correlation between the duration of arrhythmia and six of the fourteen coagulation parameters studied: F1+2 (r = 0.83, p &lt;0.001), FPA (r = 0.84, p &lt;0.001), FVIII levels (r = 0.85, p &lt;0.001) as well as activity of FII (r = 0.83, p &lt;0.001), FVIII (r = 0.83, p &lt;0.001) and FXII (r = 0.78, p &lt;0.001). Changes in F1+2 plasma levels were most sensitive to PAF duration, where the contribution of duration to the values of the indicator is the greatest (b = 15.31). Conclusion: Linear regression analysis allowed us to create models with a high correlation coefficient for predicting the values of F1+2, FPA, FVIII levels, as well as activity of FII, FVIII and FXII in PAF patients. These models could allow for quantification of the procoagulatory process and thrombotic potential of the disease.

Role of LVA Ca channels in norepinephrine-induced automatic activity in rat pulmonary vein myocardial sleeve

Ectopic foci in pulmonary veins (PV) are involved in the onset of atrial fibrillation. Norepinephrine (NE) induces in rat PV cardiomyocytes (CM) an automatic activity in saw-tooth pattern (catecholaminergic automatic activity or CAA), consisting of bursts of slow action potentials which depends on Ca (upstroke) and Na (inter burst) channels. We have previously shown the co-existence in rat PVCM, of a fast LVA (FLVA) non selective TTX-sensitive cationic channel and of T-type Ca channels. To evaluate in male Wistar rat PV myocardial sleeve the contribution of these channels to triggering NE-induced ectopic foci. Whole-cell currents were studied at room temperature in enzymatically isolated PVCM. Mechanical activity of PV rings was recorded in an organ bath at 37 °C and CAA was induced by application of 10 μM NE. The FLVA Ca current was increased by the Cav3.x blockers TTA-A2 (10-100 nM, n = 11) and NiCl2 (40 μM, n = 9) whereas a large LVA Ca current, present in 10 out of 80 PVCM, was partially reduced by 100 nM TTA-A2. Study of K currents revealed the presence of an inward rectifying current sensitive to TRAM-34 (1 μM, n = 6), a blocker of the Ca-activated K channel SK4. In PV rings, TTA-A2 (1-5 μM) decreased CAA incidence. Total arrhythmia duration, measured over the last 10 min of a 30 min long drug application, was reduced as well as burst duration and the number of spontaneous twitches within a burst. On the other hand, 40 μM NiCl2 or 1-2 μM TRAM-34 increased total arrhythmia duration by decreasing the interval between bursts (no significant effect on the burst characteristics). Only NiCl2 had a significant negative inotropic effect (∼80% inhibition of L-type calcium current). Our results suggest that Ca influx through Cav3.1 channels contribute to triggering bursts of automatic activity and that Cav3.2 Ca channels, through activation of SK4 channels, are involved in the regulation of the interval between bursts.

Paroxysmal atrial fibrillation is associated with early coagulation activity regardless of risk factors for embolism.

Paroxysmal atrial fibrillation (PAF) is associated with an increased incidence of embolic events, even in patients with no embologenic risk factors. This fact raises the question for the hypercoagulability in PAF as a state closely related to the arrhythmia itself, independent of other well established embologenic risk factors. The scarce data on that topic predisposed our aim that was to study coagulation activity in the early hours (up to the twenty-fourth hour) of the disease. Fifty-one non-anticoagulated patients (26 men, 25 women; mean age 59.84±1.60 years) and 52 controls (26 men, 26 women; mean age 59.50±1.46 years) were consequently selected for the study. Plasma coagulation activity of factor II (FII), factor V (FV) and factor X (FX) was examined. In the PAF group, there was a higher activity of FII (167.81±9.12% vs. 100.43±5.77%, P<0.001), FV (198.47±10.88% vs. 121.53±4.79%, P<0.001) and FX (193.20±11.85 vs. 116.20±5.86, P<0.001). The deviations were independent of age, sex, body mass index, presence of hypertension and CHA<inf>2</inf>DS<inf>2</inf>-VASc risk score (P>0.05). PAF duration was a significant predictor of FII activity (r=0.83, P<0.001) but no correlation was established between FV and FX activity and the arrhythmia duration (r=0.10, P>0.05; r=0.11, P>0.05, respectively). We established high coagulation activity during the first twenty-four hours of PAF. The observed deviations in the studied parameters give us reason to consider PAF a procoagulant state independent of the well-established prothrombotic risk factors, even in its early clinical manifestation.

Up-regulation of miR-195 contributes to cardiac hypertrophy-induced arrhythmia by targeting calcium and potassium channels.

Previous studies have confirmed that miR‐195 expression is increased in cardiac hypertrophy, and the bioinformatics website predicted by Targetscan software shows that miR‐195 can directly target CACNB1, KCNJ2 and KCND3 to regulate Cavβ1, Kir2.1 and Kv4.3 proteins expression. The purpose of this study is to confirm the role of miR‐195 in arrhythmia caused by cardiac hypertrophy. The protein levels of Cavβ1, Kir2.1 and Kv4.3 in myocardium of HF mice were decreased. After miR‐195 was overexpressed in neonatal mice cardiomyocytes, the expression of ANP, BNP and β‐MHC was up‐regulated, and miR‐195 inhibitor reversed this phenomenon. Overexpression of miR‐195 reduced the estimated cardiac function of EF% and FS% in wild‐type (WT) mice. Transmission electron microscopy showed that the ultrastructure of cardiac tissues was damaged after miR‐195 overexpression by lentivirus in mice. miR‐195 overexpression increased the likelihood of arrhythmia induction and duration of arrhythmia in WT mice. Lenti‐miR‐195 inhibitor carried by lentivirus can reverse the decreased EF% and FS%, the increased incidence of arrhythmia and prolonged duration of arrhythmia induced by TAC in mice. After miR‐195 treatment, the protein expressions of Cavβ1, Kir2.1 and Kv4.3 were decreased in mice. The results were consistent at animal and cellular levels, respectively. Luciferase assay results showed that miR‐195 may directly target CACNB1, KCNJ2 and KCND3 to regulate the expression of Cavβ1, Kir2.1 and Kv4.3 proteins. MiR‐195 is involved in arrhythmia caused by cardiac hypertrophy by inhibiting Cavβ1, Kir2.1 and Kv4.3.

Quality of Life of Patients with Arrhythmia

Introduction: Quality of life must be perceived in two levels - objective and subjective. Heart arrhythmia is a disease of the cardiovascular system that, by its subjective and objective symptoms, can affect the individual's life physically, mentally, and also socially. It can limit a person in his or her everyday activities or in activities that make them happy or satisfied.Objectives: The aim of the research was to map the quality of life of patients with arrhythmia and to verify whether the duration of arrhythmia has an effect on the quality of life of patients with arrhythmia.Methods: A standardized ASTA (Arrhythmia - Specific Questionnaire in Tachycardia and Arrhythmias) questionnaire was used to collect quantitative data. The research group consisted of adult patients diagnosed with hearth arrhythmia, hospitalized at the Department of Cardiology of the Ceske Budejovice Hospital (Nemocnice České Budějovice a.s.). A total of 127 valid questionnaires were used for data processing.Results: The research revealed that the most common symptom of arrhythmia in 58% cases was rapid heartbeat, irregular heartbeat, and a sense of heart failure. Most respondents agreed with the claim that heart rhythm disorder makes it impossible for them to perform work, study, and perform daily life activities. No statistically significant differences were found in the evaluation of the influence of the arrhythmia duration on the patients' quality of life.Conclusions: Arrhythmia duration in the selected sample does not affect the overall health status and quality of life measured by the ASTA series questionnaires. Arrhythmia restricts the patient to perform work tasks, study, and perform daily life activities.

Effect of acupuncture at different layers of local "Neiguan" (PC6) tissue on arrhythmia and expression of myocardial Cx43 in rabbits

To compare the therapeutic effect of shallow and deep needling at "Neiguan"(PC6) in the treatment of arrhythmia in rabbits. Male New Zealand rabbits were randomly divided into saline (n＝15), model (n＝12), shallow needling (n＝13) and deep needling (n＝12) groups. The arrhythmia model was established by ear intravenous injection of Barium chloride (0.4%, 1 mL/kg). Acupuncture needle was inserted into the superficial fascia (about 3 mm beneath the skin) or deep layer (5 to 8 mm, near the median nerve) of local PC6 tissue (fore limb), manipulated for a while and then retained for 10 min. Histopathological changes of myocardium was observed after H．E. stain, and the immunoactivity of connexin 43 (Cx43) detected by immunohistochemistry(IHC). Various degrees of arrhythmia and down-regulated expression of myocardial Cx43 were observed in all rabbits after modeling. After EA intervention and compared with the model group, the initial time of arrhythmia and Cx43 expression were obviously increased (P<0.01), and the duration of arrhythmia was significantly shortened in both deep and shallow needling groups (P<0.01). Compared with the shallow needling group, the Cx43 expression was increased in the deep needling group (P<0.01). H．E. staining showed disordered and wavy arrangement of myocardial fibers, with exudation of serous and erythrocytes in the myocardial interstitium in the model group, which was relatively mild in both needling groups. IHC showed disordered distribution of Cx43 in the ventricular myocytes and almost no obvious band-like distribution at the discs in rabbits of the model group, and abundant distribution of Cx43 in the sacral disc in the deep needling group, and strip-shaped, cluster-like, point-like, visible at both end-to-end connections and side-to-side connections in the shallow needling group. Both shallow and deep needling can significantly reduce the duration of arrhythmia in arrhythmia rabbits, which may be associated with its effect in up-regulating expression of myocardial Cx43 protein.