Frequency Of Ventricular Arrhythmias Research Articles

Electrocardiographic abnormalities are frequently detected in healthy adult Borzoi with a normal echocardiogram.

Borzoi reportedly experience sudden death. The objective of this study was to report ECG intervals, amplitudes, and frequency of ECG abnormalities in clinically healthy Borzoi. 98 clinically healthy Borzoi were prospectively recruited and underwent echocardiogram, ECG, and cardiac troponin I testing between October 2020 and December 2022. Standard ECG measurements were obtained. Early repolarization notches and slurs were recorded. Of 82 Borzoi with a structurally normal echocardiogram, ventricular arrhythmias were documented in 8 (10%) dogs, all of which had normal cardiac troponin I concentrations. Median P wave duration was 55 milliseconds (range, 45 to 70 milliseconds). Median PR interval was 125 milliseconds (range, 80 to 175 milliseconds). Thirty-one (38%) Borzoi had first-degree atrioventricular block (PR interval > 130 milliseconds). Median QRS duration was 65 milliseconds (range, 48 to 90 milliseconds). Median QT interval was 235 milliseconds (range, 185 to 275 milliseconds). Twenty-nine (35%) and 15 (18%) of 82 Borzoi had QT intervals > 240 or > 250 milliseconds, respectively. Sixty-seven of 82 (82%) Borzoi had early repolarization notches or slurs. Seventeen of 82 (21%) Borzoi had an abnormality of the ST segment, most commonly convexity/doming. Convexity of the ST segment was intermittent (n = 9) or persistent (4). Ventricular arrhythmias, early repolarization, prolonged QT intervals, and ST segment abnormalities are not infrequent in clinically healthy Borzoi. P, PR, and QRS durations are commonly prolonged compared to general canine reference intervals. Future study into heritable channelopathies in Borzoi is warranted given the frequency of ventricular arrhythmias, repolarization abnormalities, and sudden death in the breed. Breed-specific ECG reference intervals are needed.

Arrhythmic Mitral Valve Prolapse Syndrome and Ventricular Arrhythmias: A Comprehensive Review and the Role of Catheter Ablation.

Mitral valve prolapse (MVP) affects 2-3% of the general population, and despite its benign prognosis overall, it is associated with sudden death in a small subset of patients. The term "arrhythmic MVP syndrome" (AMVPS) refers to the presence of frequent or complex ventricular arrhythmias, commonly reported in female patients with a stereotypical phenotype including bileaflet myxomatous disease, ECG repolarisation abnormalities in inferior leads, mitral annular disjunction, and significant fibrosis in the inferolateral LV and papillary muscles. Modern imaging technologies have led to the identification of new risk factors that have been implemented in recent risk stratification guidelines; however, screening for patients with MVP who are at risk of sudden cardiac death (SCD) remains challenging. In addition, there is a limited amount of data on the outcomes of different treatment approaches in AMVP and no specific indication for targeted or disease-modifying therapies within current guidelines. Potential arrhythmic substrates in patients with AMVP syndrome have been the subject of interest in previous studies, with areas consisting of fibrosis at the papillary muscle level and the Purkinje system. Premature ventricular contractions (PVCs) originating from these areas have been shown to play an important role as triggers for ventricular fibrillation and SCD in patients with AMVP. Catheter ablation has emerged as a potential treatment modality in patients with MVP and ventricular arrhythmias (VAs), targeting arrhythmic substrates and triggering PVC foci. The aim of this review is to explore the role of catheter ablation in treating patients with AMVP.

Concomitant use of lansoprazole and ceftriaxone is associated with an increased risk of ventricular arrhythmias and cardiac arrest in a large Japanese hospital database

To determine whether concomitant use of ceftriaxone and oral or intravenous lansoprazole increases the risk of ventricular arrhythmia and cardiac arrest in the real-world setting in Japan. The data analyzed were obtained from the JMDC hospital-based administrative claims database for the period April 2014 to August 2022. Patients who received a proton pump inhibitor (PPI) while receiving ceftriaxone or sulbactam/ampicillin were identified. The frequency of ventricular arrhythmia and cardiac arrest was analyzed according to whether oral or intravenous PPI was concomitant with ceftriaxone or sulbactam/ampicillin. Estimates of the incidence of ventricular arrhythmia and cardiac arrest were then compared among the groups, using the Fine-Gray competing risk regression model. The results showed that the risk of ventricular arrhythmia and cardiac arrest was significantly higher with concomitant ceftriaxone and oral lansoprazole (hazard ratio 2.92, 95% confidence interval 1.99-4.29, P<0.01) or intravenous lansoprazole (hazard ratio 4.57, 95% confidence interval 1.24-16.80, P=0.02) than with concomitant sulbactam/ampicillin and oral or intravenous lansoprazole. Oral and intravenous lansoprazole may increase the risk of ventricular arrhythmia and cardiac arrest in patients who are receiving ceftriaxone.

CARDIOVASCULAR TOXICITY IN METASTATIC PROSTATE CANCER TREATMENT: BALANCING RISKS, TREATING CONSEQUENCES

Abstract Introduction Enzalutamide inhibits the receptor of androgen hormones. It is administered for treating metastasized prostate cancer. Enzalutamide is known to have a cardiotoxic effect. Case Report A 76 year–old man on–treatment for hypertension and overall good health underwent radical prostatectomy and bilateral ileo–obturator lymphadenectomy in 2021 for prostate cancer. In July 2023, infiltrated lymph node and lung/bone metastases were identified. Therefore, oncologist started Enzalutamide administration, i.e. Androgen Deprivation Therapy. Ecocardiography before therapy showed no alterations in cardiac morphology with normal left ventricle ejection fraction (LVEF). Three months after Enzalutamide administration, he experienced worsening dyspnea and peripheral lower extremity edema. He was admitted to the emergency Department of our hospital due to worsening dyspnea at rest, diffuse crackles and increased values in brain natriuretic peptide (BNP, 3203 pg/mL) and troponins. He was transferred to Intensive Care Unit for acute heart failure. Instrumental findings: 2D ECHOCARDIOGRAPHY: LVEF ∼20%, marked global hypocontractility at strain evaluation (GLS –9.3%); LUNG ULTRASOUND: abundant bilateral basal pleural effusion on the right extending to the middle field with atelectasis of the contiguous parenchyma; 24h Holter ECG: frequent supraventricular and ventricular ectopic arrhythmias. He begins non–invasive ventilation (NIV), high–dose diuretics, and Levosimendan. We observed amelioration in symptoms, reduction in pleural effusion, peripheral edema, and BNP levels (from 3203 pg/ml to 468.6 pg/ml). We proceed with weaning from NIV by monitoring respiratory function and performance by means of blood gas analysis. Amelioration in congestion status was evaluated by bioimpedance. After clinical stabilization, coronary angiography was performed which highlighted a bi–vessel obstructive coronary artery disease (long critical stenosis, ∼80%, on the proximal–middle section of the left anterior descending artery, ∼70% at middle section of circumflex and proximal section of first margianl). Therefore, revascularization by PCI plus DES was performed on proximal–middle LAD and on CX–MO1. Patient was discharged soon after in stable condition and underwent outpatient follow–up. Conclusions Enzalutamide might provoke important cardiotoxic effects. It might induce acute cardiac impairment and/or coronary artery diseases. Further analysis and evaluations should be performed.

Study on attenuation of miR-1-mediated ischemia-induced arrhythmias and infarction in rats by means of fulvning granule

Patients post myocardial infarction (MI) have a high incidence of frequent and complex ventricular arrhythmias. miR-1 is involved in ischemia-induced arrhythmias. Fulvning Granule (FG) is a prescription for treating ischemia-induced arrhythmias. This research investigated therapeutic effect of FG on ischemia-induced arrhythmias in an depth way, focusing on expression of miR-1. 60 healthy Sprague Dawly rats were assigned to operation group, MI+normal saline group, MI+low dose of FG group, MI+moderate dose of FG group and MI+high dose of FG group, MI+propranolol group and MI+moderate dose of FG+propranolol group. Hemodynamic measurement, arrhythmia classification, infarct area evaluation and miR-1 level quantification with expression of PKA and SRF were adopted 4 weeks after operation. FG improved hemodynamic indexes and inhibited expression of miR-1. The optimal dose of FG was medium (P &lt; 0.05). Combination of FG and propranolol further improved the hemodynamics indexes and inhibited the expression of miR-1, PKA and SRF (P &lt; 0.05). FG regulated miR-1 expression via inhibition of Protein Kinase A (PKA) and serum response factor (SRF) expressions. Meanwhile, β-adrenoceptor/PKA signaling pathway played a role in regulating miR-1 expression, while Fulvning granule combined with propranolol and showed an antiarrhythmic role and improved cardiac function after myocardial infarction.

Dynamics of heart rhythm disorders in combatants with acute myocarditis during a 6-month follow-up

The main factors of an unfavorable prognosis, are life-threatening heart rhythm disorders which determine the severity of the clinical course of myocarditis, in addition to impaired contractility and dilatation of the left ventricle (LV). The aim of the study was to assess the frequency and nature of arrhythmias and establish predictors of their long-term persistence, assess the severity of anxiety and depression, changes in heart rate variability in combatants on the background of changes in the structural and functional state of the left ventricle during a 6-month follow-up. The study included 52 male servicemen (combatants) with acute myocarditis (AM) with an average age of 33.4±2.5 years. All patients were assessed by Questionnaire according to the Hospital Anxiety and Depression Scale (HADS) and underwent 24 hour ECG monitoring, transthoracic echocardiography and cardiac magnetic resonance (CMR) with late enhancement using gadovist. At the onset of AM frequent supraventricular (30.7% of cases) and frequent ventricular (42.3% of cases) extrasystolic arrhythmia, as well as paroxysms of non-sustained ventricular tachycardia (26.9% of cases) on the background of heart rhythm variability disorders were recorded. After 6 months, there was an improvement in the structural and functional state of the heart, which was characterized by a decrease in dilatation and an improvement of LV systolic function, a decrease in the volume of the inflammatory lesion and the total number of affected LV segments revealed on cardiac MRI, which was associated with a decrease in the number of ventricular rhythm disorders and reduction of clinical manifestations of anxiety according to the HADS scale. The obtained data indicate that the persistence of supraventricular rhythm disorders is associated with the long-term presence of anxiety and low values of standard deviation of RR intervals (SDNN) and root mean square of successive differences between normal heartbeats (RMSSD). Also predictors of persistence of non-sustained ventricular tachycardia paroxysms were established – SDNN value ≤80.0 ms, LV end-diastolic volume index ≥95 ml/m2, total number of affected LV segments ≥6 segments, presence of delayed contrasting in ≥3 LV segments, pre­sence of ≥12 points on the HADS scale and predictors of atrial fibrillation – SDNN value ≤80.0 ms, RMSSD value ≤12.0 ms, total number of affected segments of LV≥6 seg. and ≥12 points on the HADS anxiety scale, determined at the onset of AM.

Mid-term outcome of catheter ablation of idiopathic non-outflow tract ventricular arrhythmias

BackgroundCatheter ablation is recommended in patients with frequent and symptomatic ventricular arrhythmias (VAs) in an otherwise normal heart. Right or left outflow tract (OT) are the most common origins, and catheter ablation is highly effective with low complication rates. However, outcome of catheter ablation of VAs other than the OT (non-OTVAs) is limited. The aim of this single-center study was to assess the safety and mid-term outcome of catheter ablation for non-OTVAs.Method and ResultsFrom 2013 to 2018, 251 patients who underwent catheter ablation for idiopathic non-OTVAs were enrolled and grouped according to the origins including His-Purkinje system (HPS, n = 108), papillary muscle / moderator band (PM/MB, n = 47), tricuspid annulus (TA, n = 70), and mitral annulus (MA, n = 26), 244 (97.2%) had acute elimination of VAs. The time of VAs recurrence of the single procedure was 1.69 (0.12,9.72) months, with 66% occurring within the first 3 months. The recurrence rate was significantly higher in the PM/MB group than in the TA (p = 0.025) and MA groups (p = 0.023). The single procedure success rate in all patients was 70.1%, in which 66.7%, 59.6%, 80%, and 76.9% were achieved in the HPS, PM/MB, TA, and MA groups, respectively (p = 0.284). After multiple procedures, the total success rate was 76.5% at the follow-up of 4.38 ± 2.42 years. The rate was significantly lower in the PM/MB group than in the TA group (p = 0.035). In subgroup analysis, no significant difference was observed in the recurrence rate of single procedure in patients with different VA origins within the PM/MB (log-rank test, p = 0.546).ConclusionDespite a certain percentage of recurrences observed in the mid-term follow-up, catheter ablation remained feasible and effective for idiopathic non-OTVAs.

Prolonged mHealth-Based Arrhythmia Monitoring in Patients With Hypertrophic Cardiomyopathy (HCM-PATCH): Protocol for a Single-Center Cohort Study.

Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias and other arrhythmias. Screening for arrhythmias is mandatory to assess the individual SCD risk, but long-term electrocardiography (ECG) is rarely performed in routine clinical practice. Intensified monitoring may increase the detection rate of ventricular arrhythmias and identify more patients with an increased SCD risk who are potential candidates for the primary prophylactic implantation of an implantable cardioverter-defibrillator. To date, reliable data on the clinical benefit of prolonged arrhythmia monitoring in patients with HCM are rare. This prospective study aims to measure the prevalence of ventricular arrhythmias in patients with HCM observed by mobile health (mHealth)-based continuous rhythm monitoring over 14 days compared to standard practice (a 24- and 48-h long-term ECG). The frequency of ventricular arrhythmias in this 14-day period is compared with the frequency in the first 24 or 48 hours for the same patient (intraindividual comparison). Following the sample size calculation, 34 patients with a low or intermediate risk for SCD, assessed by the HCM Risk-SCD calculator, will need to be recruited in this single-center cohort study between June 2023 and February 2024. All patients will receive an ECG patch that records their heart activity over 14 days. In addition, cardiac magnetic resonance imaging and genetic testing data will be integrated into risk stratification. All patients will be asked to complete questionnaires about their symptoms; previous therapy; family history; and, at the end of the study, their experience with the ECG patch-based monitoring. The Hypertrophic Cardiomyopathy: Clinical Impact of a Prolonged mHealth-Based Arrhythmia Monitoring by Single-Channel ECG (HCM-PATCH) study investigates the prevalence of nonsustained ventricular tachycardia (ie, ≥3 consecutive ventricular beats at a rate of 120 beats per minute, lasting for <30 seconds) in low- to intermediate-risk patients with HCM (according to the HCM Risk-SCD calculator) with additional mHealth-based prolonged rhythm monitoring. The study was funded by third-party funding from the Department of Cardiology and Intensive Care Medicine, University Hospital Ostwestfalen-Lippe of Bielefeld University in June 2023 and approved by the institutional review board in May 2023. Data collection began in June 2023, and we plan to end the study in February 2024. Of the 34 patients, 26 have been recruited. Data analysis has not yet taken place. Publication of the results is planned for the fall of 2024. Prolonged mHealth-based rhythm monitoring could lead to differences in the prevalence of arrhythmias compared to 24- and 48-hour long-term ECGs. This may lead to improved identification of patients at high risk and trigger therapeutic interventions that may provide better protection from SCD or atrial fibrillation-related complications such as embolic stroke. Deutsches Register Klinischer Studien DRKS00032144; https://tinyurl.com/498bkrx8. DERR1-10.2196/52035.

Therapy of dysrhythmias in young women with estrogen deficiency, arterial hypertension, and "metabolically healthy" abdominal obesity

Objective. To study the frequency and type of dysrhythmias in young women with arterial hypertension (AH), hypoestrogenemia and «metabolically healthy» abdominal obesity (MHAO), as well as the efficacy of antiarrhythmic drug Allaforte in this cohort of patients. Material and methods. The study included 29 patients with AH, hypoestrogenemia and MHAO, who received the antiarrhythmic drug Allaforte in standard therapy. Patients were comparable in age, severity of course and duration of AH, and therapy. At the beginning of the study and after 4 months of therapy with Allaforte the patients underwent 24-hour ECG Holter monitoring. Results and conclusion. When analyzing the nature and structure of dysrhythmias, it was found that supraventricular extrasystoles, including frequent and allorhythmic ones, are quite often registered in women with AH, estradiol deficiency and MHAO. Similar trends can be traced with respect to the frequency of ventricular arrhythmias. The inclusion of Allaforte in the therapy contributes to the decrease in the number of extrasystoles, normalization of heart rhythm and improvement of general well-being of the patients.

Predictors of and outcomes in arrhythmic mitral valve prolapse

Abstract Background Recently, the European Heart Rhythm Association (EHRA) defined the phenotype of the arrhythmic mitral valve prolapse (AMVP) complex and proposed management approaches. Assessing the incidence of SCD in this small subset of patients is challenging due to the low event-rate and longitudinal real-world data remain scarce. Purpose To determine the predictors of AMVP and study the clinical outcome of patients stratified by ICD indication as proposed by the EHRA consensus statement. Methods All consecutive patients with MVP who underwent cardiac magnetic resonance imaging (CMR) were enrolled in a single-center retrospective registry. AMVP was defined as the presence of frequent or complex ventricular arrhythmias (&amp;gt;5% total PVC burden, non-sustained ventricular tachycardia (VT), VT or ventricular fibrillation) in a patient with MVP without alternative arrhythmic substrates. The medical records of these patients included a comprehensive clinical, rhythmic and echocardiographic characterization allowing to collect the key date of transition to AMVP. A forward conditional multivariable logistic regression was performed to identify clinical risk factors for AMVP reporting the odds ratio (OR) and corresponding 95% confidence interval (95% CI). Incidence rates were calculated for the composite endpoint of SCD, sustained VT, ICD shocks, and all-cause mortality. Results A total of 169 patients (52.1% male, median age 51.4 years) were included, of which 99 (58.6%) were classified as AMVP. Clinical characteristics are presented in Image 1. Patients with non-arrhythmic MVP and AMVP had comparable left ventricular function, mitral valve regurgitation grade and extent of MVP. Multivariable logistic regression identified the presence of late gadolinium enhancement (LGE, OR 2.82, 95%CI 1.45–5.50, p=0.002) and mitral annular disjunction (MAD, OR 1.98, 95%CI 1.02–3.86, p=0.045) on CMR as only predictors of AMVP. Cardiac CMR results are presented in Image 2. The median overall follow-up since first cardiac contact was 8.0 years (IQR 5.0–15.6), while this was 5.0 years (IQR 2.1–7.4 years) after transition to AMVP. The incidence for the composite endpoint in the overall population was 0.4%/year (95%CI 0.2 – 0.9). The 5-year cumulative event rate was 1.8%. According to the EHRA risk stratification the implantation of an ICD would have been reasonable in 69 patients (69.7%). In total, 5 patients were implanted with an ICD for secondary prevention, but all those patients did not classify as AMVP prior to the life threathening arrhythmic event. Conclusion CMR is an important tool in the challenging risk stratification of AMVP given that the presence of MAD and LGE enhancement are predictors of AMVP. There is a lack of longitudinal data to determine when patients transition from MVP to AMVP and how this modifies their outcome.Clinical characteristics and ECG resultsOverview of CMR measurements

Arrhythmogenic cardiomyopathy phenotype associated with the pathogenic founder variant c.1211dup in PKP2

Abstract Background Arrhythmogenic cardiomyopathy results in life-threatening ventricular arrhythmia and heart failure. Phenotypic features vary according to genetic aetiology. Genotype-phenotype research is therefore crucial for patient counselling and treatment decisions such as implantable cardioverter defibrillator therapy. By collecting data from patient records we characterized the clinical phenotype associated with variant c.1211dup (p.Val406Serfs*4) in the plakophilin-2 gene (PKP2), common in the Dutch population. Purpose We aimed to investigate the incidence of ventricular arrhythmia and heart failure in families carrying the PKP2 c.1211dup variant. Furthermore, we aimed to determine the founder status of this variant, and compare phenotype severity with other truncating PKP2 variants. Methods Clinical data were collected retrospectively from medical records of 106 PKP2 c.1211dup heterozygous carriers (&amp;gt;85% of known carriers in The Netherlands) in a Castor EDC database. Using occurrence of ventricular arrhythmia and heart failure, event-free survival was compared between males and females, and probands and family members, using log-rank tests. Using data from a central curated arrhythmogenic cardiomyopathy database, c.1211dup was compared to three other truncating PKP2 variants (c.235C&amp;gt;T (p.Arg79*), c.397C&amp;gt;T (p.Gln133*) and c.2489+1G&amp;gt;A (p.?)) on ventricular arrhythmia-free survival by a Cox proportional hazards model, corrected for sex and proband status. Results Forty-seven carriers (44%) were diagnosed with arrhythmogenic cardiomyopathy at 41 years on average. As shown in figure 1, 29 participants (27%) experienced episodes of ventricular arrhythmia and 12 (11%) developed heart failure, with male carriers showing significantly higher risks than females on both endpoints (p&amp;lt;0.05). Based on available magnetic resonance imagery and echocardiographic data, 46% of carriers showed either right ventricular dilatation and/or dysfunction, and a substantial minority of 37% showed some form of left ventricular involvement. Both geographical distribution of carriers (figure 2) and haplotype analysis suggested PKP2 c.1211dup to be a founder variant originating from the South-Western coast of the Netherlands. Finally, a Cox proportional hazards model suggested significant differences in ventricular arrhythmia-free survival between four PKP2 truncating founder variants, including c.1211dup. Conclusions The PKP2 c.1211dup variant is a Dutch founder variant associated with a typical right ventricular-dominant arrhythmogenic cardiomyopathy phenotype, but also notable left ventricular involvement. Males were most susceptible to the frequent ventricular arrhythmia, and less frequent heart failure was observed in general. Finally, c.1211dup possibly leads to a more severe phenotype than other Dutch PKP2 founder variants.Phenotype onset stratified by sexGeographic distribution carriers

Epidemiological Features of Non-Sustained Ventricular Tachycardia in Acute Coronary Syndrome with ST Segment Elevation.

Background: Non-Sustained Ventricular Tachycardia is the most frequent ventricular arrhythmias in acute coronary syndrome with ST segment elevation, the assessment of its incidence and prognosis have been the subject of several international studies, but its epidemiological data is lacking in Algeria. Aims: The main objective of our study is the determination of the frequency of Non-Sustained ventricular tachycardia in acute coronary syndrome with ST segment elevation, the secondary objective was the analysis of predictive factors of this arrhythmia, and related mortality. Methods and materials: In this prospective study, conducted in the cardiology department of Hussein Dey hospital (Algiers-Algeria), 467 patients with acute coronary syndrome with elevated ST segment (87 women and 380 men) were enrolled between 28 February 2014 and 16 July 2015. The average age is 60 ± 13 years; at admission, a Holter recorder was attached for continuous ECG monitoring during 48 hours Kruskal’s ANNOVA or H tests were used for comparison of quantitative variables, χ2 test or Fisher’s exact test, were used for qualitative variables, all tests were performed with 1st species risk of 5%. Results: The frequency of Non-Sustained Ventricular Tachycardia is 28.3 % (132 patients), CI 95%: [24.2%-32.4%], multivariate analysis identified the following independent predictors: Age ≤ 58 years, current active smoking, presence of akinetic segment in echocardiography, and short time from symptom onset to emergency room. The risk of in-hospital mortality is low, but not significant (Hazard Ration of 0.156. CI 95%: [0.21-1.177], p = 0.072) Conclusion: NonSustained Ventricular tachycardia is the most frequent arrhythmias during acute coronary syndrome with elevated ST segment, its predictive factors according to our study are: Age ≤ 58 years, current active smoking, presence of akinetic segment in echocardiography, and short time from symptom onset to emergency room. The risk of in-hospital mortality is low, but not significant

Differences in population characteristics and prognosis between cardiogenic shock in right ventricular infarction and anterior infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction According to the literature, cardiogenic shock in the setting of right ventricular infarction (RV) has a high mortality, even equal to that related to left ventricular anterior infarction in some series. However, as well as many of the topics in acute cardiovascular care, more information is still necessary. Purpose We aim to assess the presence of differences in a cohort of patients with cardiogenic shock due to RV infarction versus anterior infarction. In order to achieve it, we analyzed the differences in baseline characteristics, in-hospital complications and mortality. Methods Descriptive, retrospective, observational, and single-center analysis of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock admitted to our Coronary Care Unit between July 2011 and August 2022. We collected the data of patients with cardiogenic shock and compared basal characteristics and prognosis according to the infarction location (anterior or RV). Results A total of 241 patients were included, 30.7% with RV infarction. The mean age of our patients was 68.6 years and 68% were male. There were no differences in the main cardiovascular risk factors between the two groups. Regarding complications during their hospitalization, there was a significantly higher percentage of patients requiring invasive mechanical ventilation and hemodialysis in patients with shock due to anterior infarction. There was also no significant differences in the frequency of ventricular arrhythmias or atrioventricular block. At last, in our cohort, there is a higher in-hospital mortality rate among patients with shock associated with anterior infarction. Conclusions Despite the fact that in some series the high mortality in shock due to RV infarction is similar to the shock caused by anterior infarction, in our study cardiogenic shock related to anterior infarction involve worse prognosis with higher in-hospital mortality, as well as a higher need of mechanical ventilation and renal replacement therapy.

Electrical auricular tragus stimulation induces release of circulating cardioprotective factors in healthy human volunteers.

Background: Vagal activation during remote ischemic conditioning (RIC) with subsequent release of cardioprotective factors from the spleen into the circulation reduces infarct size. These humoral cardioprotective factors can be transferred with plasma-dialysate from donors undergoing RIC to isolated recipient hearts where they reduce infarct size. Electrical auricular tragus stimulation (ATS) has been demonstrated to reduce the cardiac injury biomarker release and the frequency of ventricular arrhythmias and to improve contractile function in patients with acute myocardial infarction. Aim: To determine whether ATS, as RIC, induces release of cardioprotective factors into the circulation. Methods: Healthy volunteers (3 females, 7 males, 26±5 years) were randomized to receive ATS or RIC, respectively, with an interval of at least two weeks between protocols. ATS was induced by bipolar electrical rectangular pulses of 200μs width at a frequency of 30 Hz (Curamed TEN630, CURAmed, Shenzen Dongdixin Technology, Shenzhen, China). The amplitude (5.5 ± 0.81 mA) was set for each volunteer to not be perceived as uncomfortable over the total stimulation period. A microprocessor-controlled circuit periodically interrupted the stimulation signal after 5 s of stimulation for 5 s. ATS was continued over 30 min. RIC served as a reference to induce the release of cardioprotective factors by 3 x 5 min blood pressure cuff inflation at 200 mmHg on the left upper arm/ 5 min deflation. Venous blood samples were taken before and 60 min after ATS or RIC, respectively, and used to prepare plasma-dialysates (1:10 dialysis against buffer for 24 h, cut-off 12-14 kDa). Male Lewis rats were sacrificed and their hearts isolated and perfused at constant pressure with buffer. Plasma-dialysates from samples taken before and 60 min after ATS or RIC, respectively, were infused for 8 min followed by 2 min washout into rat hearts before global 30 min ischemia/ 120 min reperfusion. Infarct size was demarcated by triphenyl tetrazolium chloride staining and calculated as percent of ventricular mass. Results: With infusion of plasma-dialysate before ATS infarct size was 30.9±4.5% of ventricular mass and not different from that with infusion of plasma-dialysate before RIC (35.8±5.8%). Infusion of plasma-dialysate after ATS reduced infarct size to 18.3±3.9%. This cardioprotective effect was similar to that seen with infusion of plasma-dialysate after RIC (20.1±3.5%). Conclusion: ATS induces release of cardioprotective factors into the circulation of healthy volunteers. Plasma-dialysates after ATS or RIC, respectively, reduce myocardial infarct size by the same magnitude in ex vivo isolated perfused rat hearts with global ischemia/ reperfusion. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Antiarrhythmic Drug Therapy in Arrhythmogenic Right Ventricular Cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable progressive myocardial disorder that predisposes patients to ventricular arrhythmias and sudden cardiac death. Antiarrhythmic medications have an important role in reducing the frequency of ventricular arrhythmias and the morbidity associated with recurrent implantable cardioverter-defibrillator (ICD) shocks. Although several studies have examined the use of antiarrhythmic drugs in ARVC, these have been mostly retrospective in nature and inconsistent in their methodology, patient population and endpoints. Thus, current prescribing practices are largely based on expert opinion and extrapolation from other diseases. Herein, we discuss the major studies of the use of antiarrhythmics in ARVC, present the current approach employed at the Johns Hopkins Hospital and identify areas where further research is needed. Most notably, there is a great need for high-quality studies with consistent methodology and randomized controlled trial data into the use of antiarrhythmic drugs in ARVC. This would improve management of the condition and ensure antiarrhythmic prescribing is based on robust evidence.

Arrhythmic mitral valve prolapse in 2023: Evidence-based update.

Patients with mitral valve prolapse (MVP) may develop ventricular arrhythmias, ranging from premature ventricular contractions through more complex non-sustained ventricular tachycardia to sustained life-threatening ventricular arrhythmias. The prevalence of MVP in autopsy series of young adults who died suddenly has been estimated to be between 4% and 7%. Thus, "arrhythmic MVP" has been reported as an underappreciated cause of sudden cardiac death, leading to a renewed interest in the study of this association. The term "arrhythmic MVP" refers to a small subset of patients who have, in the absence of any other arrhythmic substrate, MVP, with or without mitral annular disjunction, and frequent or complex ventricular arrhythmias. Our understanding of their coexistence in terms of contemporary management and prognosis is still incomplete. While literature regarding the arrhythmic MVP may be contrasting despite recent consensus document, the present review summarizes the relevant evidence concerning the diagnostic approach, prognostic implications, and targeted therapies for MVP-related ventricular arrhythmias. We also summarize recent data supporting left ventricular remodeling, which complicates the coexistence of MVP with ventricular arrhythmias. As the evidence for a putative link between MVP-associated ventricular arrhythmias and sudden cardiac death is scarce and based on scant and retrospective data, risk prediction remains a challenge. Thus, we aimed at listing potential risk factors from available seminal reports for further use in a more reliable prediction model that requires additional prospective data. Finally, we summarize evidence and guidelines on targeted therapies of ventricular arrhythmias in the setting of MVP, including implantable cardioverter defibrillators and catheter ablation. Our review highlights current knowledge gaps and provides an action plan for structured research on the pathophysiological genesis, diagnosis, prognostic impact, and optimal management of patients with arrhythmic MVP.

Screenning of Arrhythmias in Patients Treated for Heart Failure in Parakou in 2017

Introduction: Rhythm disorders (RDs) or arrhythmias are poor prognostic factors during heart failure (HF). Our objective was to study the frequency of rhythm disorders presented by patients treated for HF in Parakou, Benin in 2017.&#x0D; Methods: This was a cross-sectional, descriptive and analytical study. It consisted of a systematic recruitment of all patients admitted for heart failure in the cardiology units of the city of Parakou from March to August 2017. The diagnosis of RDs was made by cardiac auscultation completed by electrocardiographic recording (standard and Holter over 24 hours). The Lown classification was used to describe the severity of ventricular TRs. The threshold for significance was p &lt; 5%.&#x0D; Results: A total of 83 heart failure patients aged 61.47 ± 15.97 years with a sex ratio of 1.08 were selected. Arrhythmia was detected by auscultation in 20.48%; by standard electrocardiogram (ECG) in 25.83% and by Holter ECG in 97.59% of patients. Among the arrhythmias detected by Holter ECG, 81.48% were atrial, including 28.79% of atrial fibrillation. RDs was ventricular in 90.12% of which 47.95% were severe. Left ventricular systolic dysfunction was significantly associated with ventricular arrhythmias. On the other hand, the frequency of ventricular arrhythmias was not associated with the severity of the HF according to the NYHA classification.&#x0D; Conclusion: In Parakou, RDs are frequent in patients with HF. Holter ECG should be included in the follow-up of heart failure patients in order to improve their management.

Investigation of the frequency of left ventricular hypertrophy in hypertensive patients by the hospital anxiety and depression scale

The development of left ventricular hypertrophy (LVH) in patients with hypertension increases the frequency of ventricular arrhythmias and sudden death. It is known that psychiatric conditions such as anxiety and depression are associated with hypertension (HT) and other cardiovascular diseases. HT patients were assessed using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic and laboratory data of the patients were recorded. LVH was seen in 34 of 103 patients, and LVH was not seen in 69 patients. The mean age was 47.8 years in the group with LVH and 49.5 in the group with non-LVH. According to the results of our study, there was no significant difference between the LVH group and the Non-LVH group in terms of age, gender, BMI, smoking, loneliness status, and EF. The most striking result of our study was that the HADS score was significantly higher in the group with LVH than in the group with Non-LVH (p&lt;0.001). The glucose level was significantly higher in the group with LVH than in the group with non-LVH (p&lt;0.001). Patients should be aware of adverse cardiac outcomes according to their anxiety level, and precautions should be taken while performing mental health interventions and treatments. In order to better explain the causes and pathophysiology that may lead to LVH in anxiety disorders and depression, more comprehensive and molecular-level investigations are required.

Alterations of sarcoplasmic reticulum-mediated Ca2+ uptake in a model of premature ventricular contraction (PVC)-induced cardiomyopathy.

Premature ventricular contractions (PVCs) are the most frequent ventricular arrhythmias in the overall population. PVCs are known to acutely enhance contractility by the post-extrasystolic potentiation phenomenon, but over time persistent PVCs promote PVC-induced cardiomyopathy (PVC-CM), characterized by a reduction of the left ventricular (LV) ejection fraction. Ca2+ cycling in myocytes commands muscle contraction and in this process, SERCA2 leads the Ca2+ reuptake into the sarcoplasmic reticulum (SR) shaping cytosolic Ca2+ signal decay and muscle relaxation. Altered Ca2+ reuptake can contribute to the contractile dysfunction observed in PVC-CM. To better understand Ca2+ handling using our PVC-CM model (canines with 50% PVC burden for 12weeks), SR-Ca2+ reuptake was investigated by measuring Ca2+ dynamics and analyzing protein expression. Kinetic analysis of Ca2+ reuptake in electrically paced myocytes showed a ~ 21ms delay in PVC-CM compared to Sham in intact isolated myocytes, along with a ~ 13% reduction in SERCA2 activity assessed in permeabilized myocytes. Although these trends were not statistically significant between groups using hierarchical statistics, relaxation of myocytes following contraction was significantly slower in PVC-CM vs Sham myocytes. Western blot analyses indicate a 22% reduction in SERCA2 expression, a 23% increase in phospholamban (PLN) expression, and a 50% reduction in PLN phosphorylation in PVC-CM samples vs Sham. Computational analysis simulating a 20% decrease in SR-Ca2+ reuptake resulted in a ~ 22ms delay in Ca2+ signal decay, consistent with the experimental result described above. In conclusion, SERCA2 and PLB alterations described above have a modest contribution to functional adaptations observed in PVC-CM.

Abstract 15001: Correlating Site of Origin in Ventricular Arrhythmias With Site of Inflammation in Patients With Underlying Myocardial Inflammation via FDG-PET Scan

Introduction: Patients with underlying myocardial inflammation often present with otherwise unexplained ventricular arrhythmias. We seek to further elucidate if these arrhythmias originate from the areas of inflammatory FDG uptake, suggesting a direct arrhythmogenic substrate. Hypothesis: To determine if sites of inflammation on Fluorodeoxyglucose (FDG)-PET scan correlate with the site of origin on electroanatomic mapping for PVC/VT ablation in underlying myocardial inflammation. Methods: We retrospectively reviewed patients presenting with frequent ventricular arrhythmias (PVC/VT) with positive FDG-PET scans indicative of underlying myocardial inflammation, and included patients who had persisting, symptomatic, burdensome arrhythmias despite multiple cycles of immunosuppressive therapy or resolution of inflammation that eventually required catheter ablation for PVC/VT. Patients were then reviewed to see if their site of origin (SOO) of PVCs or VT correlated with the site of inflammation (SOI) seen on FDG-PET scan. Results: We studied 42 patients with documented PVCs or VT, a positive FDG-PET scan and eventual PVC/VT ablation. Mean age was 58.9 years + 14.5. Mean EF was 42.6 + 8.6%. Average PET SUV Max was 3.8 + 1.2, with an average involvement of 2.7 + 2.1 segments. Nearly all patients had multiple sites of FDG uptake (95.2%), with 69.% localized vs 31.0% diffuse distributions. The 42 patients had SOO in the following distribution: RVOT (30.1%), Inferoseptal (26.2%), RCC area, (19.0%), LVOT: (14.3%), Anteroseptal: (14.3%), Basal (11.9%), LV Summit (9.5%), and anterolateral (4%). 35.7% of patients had multiple SOO. Exact correlation between SOO-SOI was seen in 23/42 (54.8%), whereas partial correlation (matching sites with additional PVC locations vs uptake distributions, or additional uptake distributions vs PVC locations) was seen in 10/42 (23.8%). No correlation was seen in 9/42 (21.4%). Of the 19 that had partial or no correlation, the most frequent distributive area of uptake without PVC correlation was anterolateral, present in 7/19 (36.8%). Conclusions: In our retrospective study, patients undergoing cardiac FDG-PET scans to confirm myocarditis, had a positive correlation of site of PVC/VT origin and site of inflammation.