Frequent Supraventricular Extrasystoles Research Articles

АССОЦИАЦИЯ АНЕМИИ С ЭКСТРАСИСТОЛИЕЙ У ПАЦИЕНТОВ СО СТАРЧЕСКОЙ АСТЕНИЕЙ

According global population aging there is an increase in the absolute and relative numbers of people in older age groups. Therefore, senile asthenia (SA) is very relevant. An association between SA and cardiovascular disease has been proven. In addition, there is an increase of aging anemia. At the same time, mortality in patients with anemia, including anemia, which is caused by cardiovascular diseases, increases. Purpose of the study: To study the association of anemia with cardiovascular pathology in patients who have SA syndrome. 168 over 65-year-old patients were examined. The main group contains 60 patients with SA syndrome (37 men, 23 women); control group includes 108 people (68 men, 40 women) without SA syndrome. The median age of patients in the main group did not statistically significantly differ from the median age of people in the control group (82 years ±7.4 [75.00; 84.00] years versus 78 years ±7.1 [65.00; 82.00] years, p=0.605). All patients had a comprehensive geriatric assessment (CGE). Statistically, anemia in patients with SA is diagnosed more frequently in comparison with patients without SA (51.67% vs. 33.33%, p<0.001). Statistically, significant negative correlations were determined among the hemoglobin level and senile asthenia (r=-0.222; p<0.001), hematocrit and senile asthenia (r=-0.224; p<0.001). There are statistically significant direct correlations between anemia in patients with SA with frequent supraventricular extrasystole (r=0.152; p=0.049) and frequent ventricular extrasystole (r=0.154, p=0.047). Conclusion: The association of SA with anemia was confirmed, whereas anemia in patients, who have SA syndrome, affects the occurrence of frequent supraventricular and frequent ventricular extrasystoles.

Combination of CHARGE AF score and index of 24-hour electrocardiogram to predict incident atrial fibrillation and cardiovascular events

Abstract Background Atrial fibrillation (AF) is associated with increased risks of stroke and heart failure. AF risk prediction can facilitate the efficient deployment of diagnosis or interventions to prevent AF. Purpose We sought to assess the combination prediction value of Holter electrocardiogram (Holter ECG) and the CHARGE-AF score (Cohorts for Aging and Research in Genomic Epidemiology-AF) for the new-onset of AF in a single center study. We also investigated the association between clinical findings and the new-onset of cerebral cardiovascular events. Methods From January 2008 and May 2014, 1246 patients with aged≥20 undergoing Holter ECG for palpitations, dizziness, or syncope were recruited. Among them, 350 patients were enrolled in this study after exclusion of 1) AF history at the time of inspection or before, 2) post cardiac device implantation, 3) follow-up duration <1 year, and 4) no 12-lead ECG records within 6 months around Holter ECG. Results During the 5.9-year follow-up, 40 patients (11.4%) developed AF incidence. Multivariate cox regression analysis revealed that CHARGE-AF score (hazard ratio [HR]: 1.59, 95% confidence interval (95% CI): 1.13–2.26, P<0.01), BMI (HR: 0.91, 95% CI: 0.83–0.99, P=0.03), frequent supraventricular extrasystoles (SVEs) ≥1000 beats/day (HR: 4.87, 95% CI: 2.59–9.13, P<0.001) and first-degree AV block (HR: 3.52, 95% CI: 1.63–7.61, P<0.01) were significant independent predictors for newly AF. The area under the ROC curve (AUC) of the combination of the CHARGE-AF score and frequent SVEs (≥1000) was greater than the CHARGE-AF score alone (0.73, 95% CI: 0.64–0.82 vs 0.66, 95% CI: 0.56–0.75, respectively). On the ROC curve, the CHARGE-AF score of 12.9 was optimum cut-off value for newly AF. Patients with both the CHARGE-AF score≥12.9 and SVEs≥1000 developed AF at 129.0/1000 person-years, compared with those with the CHARGE-AF score<12.9 and SVEs≥1000 (48.9), the CHARGE-AF score≥12.9 and SVEs<1000 (40.0) and the CHARGE-AF score<12.9 and SVEs<1000 (7.4), respectively. In multivariate cox regression analysis, age, past history of congestive heart failure and myocardial infarction, and antihypertensive medication were significant predictors of cerebral cardiovascular events (n=43), all of which signifying the components of the CHARGE-AF score. The AUC of the combination of the CHARGE-AF score and frequent SVEs (≥1000) was not different from the CHARGE-AF score alone (0.73, 95% CI: 0.64–0.81 vs 0.73, 95% CI: 0.64–0.82, respectively). Conclusion CHARGE-AF score has higher predictive power of both the new incident AF and cerebral cardiovascular events. The combination of CHARGE-AF score and SVEs≥1000 beats/day in Holter ECG can demonstrate the additional effect of prediction ability for the new incident AF, but not for cerebral cardiovascular events. Funding Acknowledgement Type of funding sources: None.

Features of Structural and Functional Changes in the Heart in Elderly Patients with Coronary Heart Disease and Atrial Fibrillation

Supraventricular arrhythmias, including atrial fibrillation (AF), are a current problem for patients in the older age group due to the possibility of lifethreatening complications. Elderly patients have pre-conditions for the development of supraventricular rhythm disturbances (age-related structural and functional changes in the myocardium, concomitant diseases).Aim. To study the features of structural and functional changes in the myocardium of the left heart in elderly patients, depending on the presence of supraventricular arrhythmias.Material and methods. The cross-sectional study included 200 individuals aged 60 to 89 years. All participants underwent echocardiographic examination and 24-hour electrocardiogram (ECG) monitoring. The patients of the study cohort were divided into 3 groups: group 1 consisted of patients with coronary heart disease (CHD) without heart rhythm disturbances (n=80); group 2 consisted of patients with CHD and paroxysmal AF (n=40); group 3 consisted of patients with CHD and supraventricular extrasystoles (n=40). The control group consisted of patients of the older age group without CHD and rhythm disturbances (n=40).Results. In patients with paroxysmal AF and frequent supraventricular extrasystoles, large sizes of the left atrium were revealed (anteroposterior dimension: 4.30±0.07 and 4.12±0.12 cm; upper-lower: 6.15±0.03 and 5.96±0.10 cm; medial-lateral: 4.15±0.11 and 3.87±0.09 cm, respectively). In patients with CHD and rhythm disturbances, the presence of a combined increase in the size of the left atrium and a decrease in myocardial contractility was revealed (ejection fraction of the left atrium in groups 2 and 3 – 27.2±0.1% and 27.9±0.1%, respectively, vs 36.3±0.1% and 38.20±0.02%, respectively in group 1 and control). The duration of ischemic changes during 24-hour ECG monitoring was also greater in group 3 compared with groups 1 and 2 (249.6 vs 27.1 and 66.4 min, respectively). In groups 2 and 3, a discordant effect of the sympathetic and parasympathetic nervous systems on heart rate variability was revealed.Conclusion. For elderly patients, morphological and functional changes are characteristic, which consist in the restructuring of the myocardium and changes in heart rate variability with a prevalence of the sympathetic part of the autonomic nervous system.

Ультразвукова діаґностика і моніторинґ нерегулярного ритму серця плода

Aim. The work is devoted to the development of ultrasound differential diagnostic criteria for assessing of fetal heart rhythm and a complex of practical indicators for fetal hemodynamics assessment, as well as algorithms of dynamic observation of the fetuses with different types of arrhythmia, which is necessary for optimization of antenatal care. Material and Methods. Reports of 2073 ultrasound examinations of fetal heart from 1996 to 2016 were retrospectively studied, and 213 diagnosed cases of fetal arrhythmias were analyzed. All the examinations were carried out according to the general protocol. The evaluation of the fetal heart anatomy was based on segmental analysis. The rhythm assessment was performed by reconstructing the fetal EGC using ultrasound techniques and foreseeing the determination of the heart rate of the fetus, atrioventricular ratio, duration and ratio of cardiac cycle intervals. According to the results of the work, algorithms for differential diagnosis of fetal arrhythmias have been developed. To determine hemodynamic complications, a scoring scale was created. For the statistical processing of the obtained results, all the subjects were divided into groups based on the age of pregnant women, and onthe term of pregnancy. All arrhythmias were divided into groups based on the types of detected arrhythmias, duration, clinical significance and thedegree of hemodynamic complications. Based on the obtained findings, the prognostic significance of the fetal arrhythmias was determined, and the algorithms of pregnancy maintenance were developed. Results and Discussion. The total frequency of fetal arrhythmias was 10.3 %. Irregular rhythm is the largest group of arrhythmias - 143 cases, which amounts to 6,9% of the total number of examined patients and 67% of the number of arrhythmias. Supraventricular extrasystoles was the most numerous occurrence- 132 cases (92.3%). Sinus arrhythmia and ventricular extrasystoles were significantly less commonly diagnosed; in 5 cases (3,5%) and 6 cases (4,2%) respectively. The results of statistical treatment indicate that the probability of fetal irregular rhythm is lower among women over 30 years (p<0.0003). Frequency of arrhythmia up to 20 and after 36 weeks of gestation is significantly higher than duriingother periods, and from 26 to 30 weeks - the lowest (p<0.01). Elevenfetuses (7.7%) had irregular rhythm combined with structural heart defect. In more than 60% of cases, arrhythmia was short-lived and prognostically benign, while in 141 fetuses (98.6%) no disorders of fetal hemodynamic were detected. Hemodynamic complications have been documented twice: as a result of fetal tachyarrhythmias and in combination with congenital heart disease. In cases of prolonged allorithmic (bi-, tri-, quadrigeminia) blocked supraventricular extrasystoles (approximately 2%), which caused a significant decrease frequency of ventricular contractions, differential diagnosis with an atrientricular block of the II degree has been performed. This is necessary because of different predictive value of arrhythmias and important for choosing the correct prenatal strategy. In cases of frequent supraventricular extrasystoles, tighter fetal control has been performed due to a higher (up to 15%) risk of induction of fetal tachyarrhythmia, which could provoke significant hemodynamic complications and fetal death.  Thus, in the absolute majority of fetuses of group I, there was an uncomplicated course of arrhythmia, which was manifested by the absence of hemodynamic effects (p<0.00001), and it was clearly observed in comparison with other types of arrhythmias (p<0.002). Conclusions. Irregular rhythm is the largest group of fetal arrhythmias. The majority of the disturbances in this group, about 90%, is due to supraventricular extrasystoles. Irregular rhythm has a benign course, since it does not cause any fetal hemodynamic disorders; it usually disappears before the baby is born, and therefore does not require treatment. Certain types of arrhythmias in this group require a differential diagnosis with atrioventricular blockade, second degree, or control over the fetal rhythm because of the possibility of occurrence of super-ventricular tachycardia. Irregular rhythm is predominantly found in a structurally normal fetal heart. In cases of combination of arrhythmia with congenital heart disease, the risk of hemodynamic complications may increase, so it is necessary to conduct control tests for monitoing of fetal condition. In uncomplicated cases, delivery should be performednaturally. The need for the follow-up after birth is determined according to the clinical situation.

CARDIAC ARRHYTHMIAS AFTER TRANSCATHETER CORRECTION IN PATIENTS WITH SECONDARY ATRIAL SEPTAL DEFECT

SUMMARY In order to study the dynamics of cardiac arrhythmias in patients with secondary atrial septal defect (ASD) examined 50 patients in the age of from 3 to 68 (mean age 24,2±2,1 years) with secondary defect investigated arrhythmias changes in the nearest (till 3 months) and remote (till 1 year) the periods after transcatheter closings of arial septal defect using the amplatzer septal occluder were examined. Already in 3 day after transcatheter correction marked decrease frequent (67,8 ±29,4 till 62,5±25 in hour) group supraventricular extrasystoles, disappear episodes paroxysmal atrial fibrillation and paroxysmal supraventricular taxycardias. By 6 months the disappearance of the group and reduction of frequent supraventricular extrasystoles. In relation to ventricular arrhythmias on day 3 observations marked deerease in the number of VEs (254,1±171,2 till 32,6±3,6 in hour), the complete disappearance of VEs high grade to 12 months. Thus, after transcatheter closure of ASD in the coming secondary (3 hours) and long-term (6-12 months). Deadlines are not observed occurrence of serious cardiac arrhythmias, and available undergoing a significant improvement towards a significant reduction in the number of premature beats until their complete disappearance. This fact confirms the effectiveness and safety of this method of treatment of secondary ASD. Key words: secondary interatrial septum defect, electrocardiographia, Amplatzer occluder, supraventricular and ventricular extrasystols.

FRI0121 Treat to target strategy in early rheumatoid arthritis: necessity of achieving tight control of disease and aggressive monitoring of cardiovascular risk

BackgroundThe risk of cardiovascular events (CVE) in rheumatoid arthritis (RA) is significantly higher than in general population, however at what stage it increases remains unclear.ObjectivesTo determine the level of cardiovascular...

Usefulness of Frequent Supraventricular Extrasystoles and a High CHADS2 Score to Predict First-Time Appearance of Atrial Fibrillation

Frequent supraventricular extrasystoles (SVEs) are associated with the subsequent first-time appearance of atrial fibrillation (AF) and ischemic stroke. The aim of this study was to investigate the combined role of SVEs and an AF-related risk score for ischemic stroke, the CHADS2 score, on the occurrence of new AF in patients in sinus rhythm. The Shinken Database 2004-2010 lists 3,263 patients who underwent 24-hour Holter monitoring. A total of 2,589 patients were analyzed, after excluding 674 patients previously diagnosed with AF. Frequent SVEs were defined as ≥102 beats/day (the top quartile) and the presence of a clinical background for a CHADS2 score ≥2 points as a high CHADS2 score. During the mean follow-up period of 571.4 ± 606.4 days, new AF occurred in 38 patients (9.4 per 1,000 patient-years). The incidence of new AF was 2.7 and 37.7 per 1,000 patient-years for patients with nonfrequent SVEs (<102 beats/day) and low CHADS2 scores and those with frequent SVEs and high CHADS2 scores, respectively. Multivariate Cox regression analysis showed that the hazard ratio for frequent SVEs and a high CHADS2 score compared with nonfrequent SVEs and a low CHADS2 score was 9.49 (95% confidence interval 3.20 to 28.15, p <0.001), even after adjustment for gender, age, medications, and echocardiographic parameters. In conclusion, frequent SVEs and a high CHADS2 score independently and synergistically predict the first-time appearance of AF in patients in sinus rhythm, indicating an approximately 10-fold higher risk. Patients meeting these criteria should have more aggressive early intervention for preventing AF.

Two concomitant arrhythmias in a transplanted heart

A 61-year-old man was admitted to our center complaining from palpitations due to frequent supraventricular extrasystoles (SVES). The patient had received an orthotopic heart-transplantation in 1989 due to dilated cardiomyopathy. In 2005, isthmus-dependent typical atrial flutter was documented and successfully ablated. Before the current admission, a 3-day Holter ECG recording was done which showed 15,000 SVES per day. There had been no signs of rejection and the left ventricular ejection fraction was 65%. On the 12-lead surface ECG a sinus rhythm with frequent SVES was noted with a P wave morphology closely resembling the sinus rhythm. Since the patient was highly symptomatic, we decided to perform an invasive electrophysiological study and ablation [1–3]. The patient gave written informed consent for the procedure of electrophysiology study and catheter ablation. After femoral vascular access, a steerable decapolar (Inquiry , Irvine Biomedical, Inc., Irvine CA, USA) and a non-steerable quadripolar catheter (Supreme , St. Jude Medical Inc., St. Paul MN, USA) were placed in coronary sinus and right ventricular apex, respectively. Electroanatomical mapping of right atrium was done using a 4-mm tip ablation catheter (Navi-Star, Biosense-Webster, Diamond Bar CA, USA) and the CARTO XP system (BiosenseWebster, Diamond Bar CA, USA). The surface ECG and the coronary sinus catheter showed sinus rhythm with frequent SVES; however, mapping of the posterior (recipient) right atrium showed an organized atrial arrhythmia, most probably an atypical atrial flutter with a cycle length of 170 ms which was electrically disconnected from the rest of the donor atria (Fig. 1). In the border zone between electrically isolated recipient and donor atria, both sinus rhythm and atypical atrial flutter were recorded at the same time on the mapping catheter (Fig. 1). We did not perform the activation mapping of the atypical atrial flutter in the recipient right atrium. Due to similar P wave morphologies of sinus rhythm and SVES, we decided to perform electroanatomical activation mapping during the sinus rhythm and SVES (Fig. 1) which showed a close proximity of sinus node and the ectopic focus of SVES (10 mm). An ablation was then performed successfully at the ectopic focus during which the SVES ceased and the patient remained in stable sinus rhythm during the rest of the hospitalization. During the procedure we did not note any signs of electrical conduction between the recipient and the donor heart although this has previously been described [4, 5]. The most common arrhythmia 2in heart transplant recipients is sinus node dysfunction leading to pacemaker implantation. Vaseghi et al. [6] studied recently the incidence, clinical course, and management of supraventricular tachycardia in 729 orthotopic heart transplant patients. The most common arrhythmia, atrial flutter, occurred in 9% of this cohort. Persistent or paroxysmal atrial fibrillation occurred in 7%, 57% in the perioperative period. Persistent or paroxysmal atrial fibrillation beyond the postoperative period was observed only in the presence of rejection or transplant vasculopathy. Other persistent or paroxysmal supraventricular tachycardias were seen in 47 patients (7%). Of these, 24 patients underwent EPS. Accessory and dual atrioventricular nodal pathways in the donor heart caused SVT in 3 patients. Macro-reentrant atrial tachycardia was seen in 7 patients, and isthmus-dependent atrial flutter occurred in 14 patients. In conclusion, the majority of supraventricular tachycardias in stable orthotopic heart F. Frogner A. Arya (&) C. Piorkowski G. Hindricks Department of Electrophysiology, Heart Center, University of Leipzig, Strumpellstrasse 39, 04289 Leipzig, Germany e-mail: dr.arasharya@gmail.com

Ventricular Tachycardia in a Neonate with Prenatally Diagnosed Cardiac Tumors: A Case with Tuberous Sclerosis

We report a patient with prenatally diagnosed tuberous sclerosis. Fetal ultrasonography demonstrated multiple cardiac tumors and arrhythmia. After birth, because of frequent supraventricular extrasystoles, the infant was admitted to the neonatal intensive care unit. Findings on 24-hour ambulatory electrocardiogram (ECG) showed frequent supraventricular tachycardia and ventricular tachycardia with four beats as the longest run. At the age of 12 days, he developed cardiopulmonary arrest after crying out. A monitored ECG showed ventricular tachycardia. Twenty minutes after onset, a 12-lead ECG showed ventricular fibrillation, which returned to normal sinus rhythm with repeated DC cardioversion. Oral antiarrhythmic therapy with carteolol hydrochloride was effective. The patient showed no further symptoms after oral medication was initiated and the tumors regressed spontaneously.

Arrhythmias and their treatment in patients with heart failure

Heart failure is almost without exception associated with arrhythmias, which may be either supraventricular or ventricular. Supraventricular arrhythmias include frequent supraventricular extrasystoles, and episodic or chronic atrial fibrillation. The absence of atrial contraction may further reduce cardiac output, as may impaired control of QRS frequency. Therefore, supraventricular arrhythmias may be markers of the degree of heart failure and these arrhythmias will respond to heart failure therapy including diuretics, nitrates and, possibly, angiotensin-converting enzyme (ACE) Inhibitors. Ventricular rate will be controlled by cardiac glycosides and further rate reduction obtained by verapamil or diltiazem. The rationale for this therapy is to optimize heart rate without compromising contractility. Severe heart failure is generally accompanied by severe ventricular arrhythmias including repetitive forms. Improving left ventricular function by ACE inhibition is accompanied by a reduction in the number of ventricular premature complexes and also a reduction in the rate of ventricular tachycardia. ACE inhibition reduces mortality but does not seem to influence sudden death rate, and sudden death patients may have different neurohormonal responses compared with patients destined to die of progressive heart failure. Uncontrolled trials with class IA or class III antiarrhythmic drugs have suggested that prognosis may be improved, but other studies have pointed out the increased risk of proarrhythmic responses in patients with low ejection fraction.

Cardiac arrhythmias in subarachnoid haemorrhage.

In this prospective study 52 patients with spontaneous subarachnoid haemorrhage were examined with respect to cardiac arrhythmias and their relationship to cerebral lesions. A continuous ECG was registered over an average of five days. Sinus tachycardia was the most frequently recorded arrhythmia, followed by multifocal ventricular extrasystoles, couplets, frequent supraventricular extrasystoles, non-sustained ventricular tachycardia, asystolia and sinus arrhythmia. A significant correlation was found between the clinical manifestation of a midbrain syndrome and sinus arrhythmia, and multifocal ventricular extrasystoles. This correlation points to the autonomic cardiovascular centres as the structures involved.

Fever and Cardiac Rhythm

To study the effect of fever on cardiac rhythm and conduction, we recorded 24-hour electrocardiograms in 27 young men during an uncomplicated acute febrile infection (12 patients had adenovirus, four had influenza, three had Mycoplasma pneumoniae, and eight were undefined) and after recovery. During the first 24-hour recording period, the mean axillary temperature in the whole group was 38.4 degrees C. The mean heart rate during the febrile period was 84.0 beats per minute. After recovery, it was 66.5 beats per minute. When the temperature rose by 1 degree C, the heart rate increased on the average by 8.5 beats per minute. During the febrile period, the heart rate remained high, even during sleep. The PR interval shortened significantly at a heart rate of 60 beats per minute and occasional first- or second-degree atrioventricular blocks were rarer. The QT interval shortened significantly at heart rates of 60, 80, and 100 beats per minute. Simple and complex ventricular extrasystoles were not increased by fever. In contrast, frequent supraventricular extrasystoles developed in two patients during high fever, but not during the control recording. If an acute febrile infection induces a prolongation of the atrioventricular conduction or the QT interval, or if frequent ventricular extrasystolic beats are triggered, complications must be suspected.