Frequency Of Atrial Arrhythmias Research Articles

Frequency of Atrial Arrhythmias in the Patients With Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) has been linked with various kind of cardiac arrhythmias. The risk of arrhythmias in patients with COPD has been driven by the stage and disease state, with a higher frequency of supraventricular tachycardia during exacerbations. Aim: To evaluate the frequency of atrial arrhythmias (which include atrial fibrillation, atrial flutter, and multifocal atrial tachycardia) in the patients who were suffering from COPD. Methods: It was a cross sectional analysis or prevalence study. This research was piloted in the Medicine Department, Medical Division IV, Services Hospital, Lahore. This research was ended in 365 days after endorsement of synopsis from 1st June, 2017 to 30th May 2018. Results: In our study, 111(46.25%) were in range 40-55 years of age while 129(53.75%) were in range 56-70 years of age, the calculated mean standard deviation was 56.23±8.19 years, 134(55.83%) were male and 106(44.17%) were females, 142(59.17%) between 1-2 years and 98(40.83%) had >2 years of duration. Frequency of atrial arrhythmias in the patients who were suffering from COPD was recorded as 22(9.17%) having Atrial Fibrillation, 53(22.08%) had Atrial flutter and 31(12.92%) had Multifocal atrial tachycardia. Conclusion: Atrial arrhythmias are common findings in patients with COPD. So, it is very important for treating physicians that every patient having COPD, should undergo Electrocardiogram (ECG) for picking up the atrial arrhythmias. Keywords: Chronic obstructive pulmonary disease, atrial arrhythmias, frequency

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.

Frequency of atrial arrhythmias after atrial flutter ablation and the effect of presenting rhythm on the day of ablation

ABSTRACTRadiofrequency catheter ablation of the cavotricuspid isthmus is a proven therapy for typical atrial flutter (AFl); however, in some patients, new atrial arrhythmias (AA) may occur after AFl ablation. This study explored the difference in the occurrence of spontaneous AA after AFl ablation as a function of the patient's presenting rhythm on the day of the AFl ablation. A retrospective study of consecutive patients who underwent AFl ablation at Baylor University Medical Center at Dallas was performed. A total of 188 subjects were included; 50% (94) presented in AFl (Group AFl) on the day of the ablation procedure and 94 presented in sinus rhythm (SR; Group SR). Group AFl patients were older (P < 0.001), more likely to have diabetes (P = 0.03), and more likely to have undergone previous heart surgery (P = 0.03). The median size of the left atrium was 4 cm (range 2.8–6.8) in Group AFl compared with 3.8 cm (range 2.6–5.6) in Group SR (P = 0.009). Atrial fibrillation was induced during the ablation procedure in 7.5% and 21.3% of patients in Groups AFl and SR, respectively (P = 0.007). Overall, 29 of 188 (15.4%) patients developed new AA within 1 year of the procedure, 13.8% in Group AFl vs 17.0% in Group SR (P = 0.57). In conclusion, patients presenting for AFl ablation in SR were younger and healthier but had more atrial fibrillation induced during their ablation procedure, with a trend toward more postablation AA due to additional arrhythmia substrate.

Is NOS uncoupling the missing link between atrial fibrillation and chronic non-ischaemic cardiomyopathy?

Nishijima et al. 1 recently published an article in Cardiovascular Research in which they described the effects of a treatment with the nitric oxide synthase (NOS) cofactor tetrahydrobiopterin (BH4) and the NOS substrate l-arginine on atrial electrophysiological and morphological properties and atrial fibrillation (AF) inducibility in dogs undergoing rapid ventricular pacing. In this model, they provide some experimental evidence for atrial oxidative stress by depletion of BH4 and uncoupling of inducible NOS (iNOS, NOS2). Furthermore, modulation of iNOS activity by administration of its cofactor BH4 could reduce the frequency of atrial arrhythmias during heart failure. The data of Nishijima et al. suggest that oxidative stress might be a clinically relevant target to treat or prevent AF in patients with heart failure. Despite the obvious importance of the study, we do have some methodological remarks. First, the authors …

The prevalence of supraventricular arrhythmias with regard to the type and degree of left ventricular hypertrophy in patients with hypertensive heart disease

We investigated the correlation between the type and degree of left ventricular hypertrophy and the prevalence of supraventricular arrhythmias in patients with hypertensive heart disease. The study included 179 patients (79 men, 100 women, aged 43-80 years, median 68 years) with left ventricular hypertrophy. Patients were classified into three groups (concentric, eccentric and asymmetric types of hypertrophy) and into three subgroups (mild, moderate and severe hypertrophy). After discontinuation of all medication for 48 h, blood pressure was measured, electrocardiography and echocardiography performed and the prevalence of supraventricular arrhythmias assessed using Holter monitoring and bicycle ergometry. Antihypertensive drugs and duration of previous treatment were taken into consideration. Atrial fibrillation or paroxysmal supraventricular tachycardia were found in 43% of patients. The analysis showed no significant correlation between the prevalence of atrial fibrillation and/or paroxysmal supraventricular tachycardia and the degree (P = 0.607) and type of left ventricular hypertrophy (P = 0.455). However, the frequency of supraventricular premature beats was higher in the concentric and eccentric types than in the asymmetric type (P = 0.048) and increased with the degree of hypertrophy (significantly in men with the concentric type, P = 0.015). Concentric and eccentric types of left ventricular hypertrophy have a greater impact on the frequency of atrial arrhythmias. In the concentric type the prevalence of supraventricular premature beats correlates with the degree of left ventricular hypertrophy. Patients with moderate and severe concentric and eccentric left ventricular hypertrophy should be always tested using Holter monitoring and bicycle ergometry and treated with the maximum tolerable doses of antihypertensives, particularly with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.

Abstract 2378: The MinK G38S Polymorphism Associates with Atrial Arrhythmias after Subarachnoid Hemorrhage

Background: Subarachnoid hemorrhage (SAH) leads to significant death and disability. Cardiac abnormalities after SAH include atrial arrhythmias (AAs). The MinK (KCNE1) G38S polymorphism has been associated with atrial fibrillation, with the G38 allele being linked to increased action potential duration in heterologous expression systems. The relationship of AAs and ion channel polymorphisms after SAH is not known. Methods: In 148 patients admitted for acute, aneurysmal SAH, EKG parameters, 24-hour Holter monitors, serum troponin (TnI), potassium (K), magnesium (Mg), and echocardiograms (ejection fraction [EF] and left atrial diameter [LA D]) were examined. MinK G38S was genotyped using fluorescent primers and analyzed with an ABI Prism 7000. Results: No patient had AAs on presentation, but AAs developed in 101 (68%) patients: SVT (95; 64%); fibrillation (9; 6%); flutter (4; 3%); idioventricular rhythm (2; 1%); and 3° block (1; 1%). AAs were not associated with PR or QTc intervals, TnI, K, Mg, EF, LA D, or stroke severity. AAs were associated with older age (58±9 vs 51±10yrs; p&lt;0.001), lower heart rate (HR; 80±10 vs 84±14bpm; p=0.02), and higher HR variability (SDNN; 97±34 vs 85±32; p=0.05). The MinK S38 allele was associated with AAs (Figure ; GS &amp; SS 70% vs GG 51%; p=0.02), but not LA D. Conclusions: Atrial arrhythmias are common following SAH and the MinK S38 allele is associated with an increased frequency of atrial arrhythmias. The SAH-induced catecholamine surge, followed by increased parasympathetic activity, may enhance the shortening of the atrial effective refractory period in patients carrying the MinK S38 allele and increase susceptibility to atrial arrhythmias.

Cardiac Arrhythmias and Atrioventricular Block in a Cohort of Asymptomatic Individuals without Heart Disease

Aims: To evaluate cardiac arrhythmias and rhythm disturbances on 24 h ambulatory electrocardiographic monitoring in a cohort of asymptomatic healthy individuals with normal clinical examination. Methods and Results: 625 asymptomatic healthy individuals, in the age range 15–83 (mean 42, SD 11.9) years; 276 (44.2%) men and 349 (55.8%) women were submitted to 24-hour ambulatory electrocardiographic monitoring. Statistical analysis was performed with likelihood ratio test and automatic backward logistic regression. The frequency of atrial arrhythmias (p < 0.0001; OR 1.059; 95% CI 1.050–1068) and of ventricular arrhythmias (p < 0.0001; OR 1.023; 95% CI 1.017–1.029) increased for each age increase of 1 year; neither atrial nor ventricular arrhythmias demonstrated a statistically significant difference relative to gender. Transient second-degree atrioventricular block (Mobitz I) was observed in 14 (2.2%) individuals and was more frequent in individuals with resting heart rate <60 bpm (p = 0.006; OR 6.7, 95% CI 1.7–25.5). Conclusion: The frequency of atrial and ventricular arrhythmias increased with age and did not demonstrate a significant difference relative to gender. Transient atrioventricular block was more frequent in individuals with lower resting heart rate.

Outcome of previous tricuspid valve operation and arrhythmias in adult patients with congenital heart disease

Background. Tricuspid valve operation or replacement has been associated with high perioperative mortality and poor long-term results. The prevalence of atrial arrhythmias before and after operation in these patients is undefined.Methods. We retrospectively examined the outcome and frequency of atrial arrhythmias in 85 adult patients (46% men) with congenital heart defects who underwent tricuspid valve operation between 1961 and 1995.Results. The majority had either Ebstein’s anomaly (22%), congenitally corrected transposition (19%), tetralogy of Fallot (15%), atrial (13%), or ventricular (11%) septal defects. Forty-two (49%) patients had sustained arrhythmias within 1 year before operation. After tricuspid valve operation, 21 patients (50%) had recurrence of atrial arrhythmias, and 7 in preoperative sinus rhythm developed late rhythm disturbances. Multivariate analysis identified age at operation and preoperative arrhythmias as independent predictors of late arrhythmias. Perioperative mortality was 5%, and there were seven late deaths. Survival was 91% at 5 years, and 83% at 10 years.Conclusions. Surgical intervention does not prevent recurrence of atrial arrhythmias. Tricuspid valve operation in patients with congenital heart disease can be performed with a low risk of perioperative mortality and good long-term outcome.

Auftreten von Vorhofflimmern in Abhängigkeit der atrialen Sondenlage bei Zwei-Kammer-Schrittmachern

This study evaluated the impact of the atrial lead implantation site on the subsequent development of atrial arrhythmias. Dual chamber pacemakers were implanted in 109 consecutive patients. The indication was AV-block in 51 patients, sick sinus syndrome in 58 patients. No patient had chronic atrial fibrillation, but 12 patients (11%) had paroxysmal atrial fibrillation before implantation. Patients were classified according to the atrial lead implantation site: right atrial appendage and right atrial free wall. Preimplant episodes of atrial fibrillation were similar in patients with lead implantation at the free wall and with implantation in the right atrial appendix (13% vs 7.5%, P=0.53). During a mean follow-up of 24+/-13 months, new paroxysmal atrial fibrillation occurred in 5% after lead implantation in the appendix vs 28% of patients after implantation at the right atrial free wall (P = 0.004). The development of atrial arrhythmias in dual chamber pacing is influenced by the implantation site of the atrial lead. The frequency of atrial arrhythmias during follow-up is higher after atrial lead implantation at the right lateral wall than in the appendix.

Effect of diltiazem on cardiac rate and rhythm after myocardial infarction

The a priori hypothesis that diltiazem would reduce the frequency and repetitiveness off ventricular arrhythmias was tested 3 months after myocardial infarction in patients participating in the Multi-center Diltiazem Postinfarction Trial. After 3 months of follow-up, 1,546 of the 2,466 patients enrolled had a 24-hour continuous electrocardiographic recording that contained ≥ 12 hours of analyzable data. They were similar to the patients who survived 3 months but chose not to have a 24-hour ehctrocardiographic recording (i.e., they were representative of the entire group that survived 3 months). After 3 months of follow-up, there were no significant differences between the diltiazem and placebo groups in the prevalence of atrioventricular block, the frequency of atrial arrhythmias or the frequency or repetitiveness of ventricular arrhythmias. Heart rate was significantly lower (67 ± 12 vs 71 ± 12 beats/min) and there was a significantly greater proportion of patients with sinus pauses ≥ 2 seconds in duration in the diltiazem group (6%) than in the placebo group (3%). Comparison with placebo revealed no evidence either for an anti- or proarrhythmic effect of diltiazem. There was no reduction in sudden or arrhythmic death attributable to diltiazem treatment; the fraction of total deaths that were arrhythmic by the Hinkle classification was 41% in the placebo group and 42% in the diltiazent group. It may be that the lack of effect of diltiazem on ventricular arrhythmias is partially responsible for its lack off effect on mortality after myocardial infarction.

Is occult atrial disorder a frequent cause of non-hemorrhagic stroke? Long-term ECG in 86 patients.

To assess the importance of occult atrial disorder with possible embolization as a cause of non-hemorrhagic stroke, 68 patients with neurologic symptoms lasting 24 hours or more and 18 patients with transient ischemic attacks were examined by long-term electrocardiographic recording (LTER). Lacking matched controls we used a reference population of 103 elderly subjects selected at random from the general population for a previous LTER study. Permanent or episodic atrial arrhythmias of types known to cause cerebral embolization were detected by LTER in 32 (47%) of the 68 patients with a clinical diagnosis of cerebral embolization or thrombosis and in 6 (33%) of the 18 patients with transient ischemic attacks. Of the 38 patients with atrial arrhythmia during LTER 17 had such arrhythmias in their standard ECGs. This frequency of atrial arrhythmias during LTER differs from that of the reference population (p less than 0.025). Thirteen of 16 patients with multiple cerebral lesions had signs of atrial arrhythmia during LTER. Patients having occult atrial disorder with episodic atrial arrhythmia may be an important and common risk group for non-hemorrhagic stroke in addition to the previously recognized group of patients with atrial arrhythmia detectable in the standard ECG. LTER may be important in the evaluation of patients with unexplained stroke.