High Incidence Of Arrhythmias Research Articles

In-hospital outcomes of patients with myelodysplastic syndromes and rheumatic heart disease: A National Inpatient Sample study (2018-2020).

e18525 Background: Autoimmune conditions are relatively uncommon in patients with Myelodysplastic syndromes (MDS), with only a small proportion of patients affected. Among these autoimmune conditions, rheumatic heart disease (RHD) is the most commonly associated with MDS. Very few cases have been reported in literature that show the impact of RHD on patients diagnosed with MDS. In this study, we aimed to investigate the impact of RHD on the patients with myelodysplastic syndrome who were admitted in hospitals from 2018-2020. Methods: We utilized National Inpatient Sample (NIS) 2018-2020 to identify hospitalizations of patients with Myelodysplastic syndromes with a secondary diagnosis of Rheumatic heart disease. The primary outcomes examined were In-patient mortality and average length of stay, All the patients with MDS were divided into two cohorts based on the presence of rheumatic heart disease. Multivariable regression analyses were conducted, taking into account demographics, hospital-level characteristics, and pertinent comorbidities as adjusting factors. Results: Using the NIS dataset from 2018 to 2020, we identified 222,364 patients admitted with MDS during this period. Among them, 4.57% (10,162 patients) also had a diagnosis of rheumatic heart disease (RHD). The average age of patients with MDS and RHD was 80 years. Among these patients, 50.1% were male and 49.9% were female. The mortality rate among patients admitted with MDS and coexisting RHD was 7.7%. Multivariate regression analysis indicated that the presence of RHD increased the likelihood of mortality with an odds ratio (OR) of 1.2 (95% confidence interval [CI]: 1.0-1.4, p-value <0.05). Additionally, RHD was associated with a higher incidence of arrhythmias (OR: 2.9) and congestive heart failure (OR: 5.0) among MDS patients. The total hospital charges were more in patients with RHD than those without RHD ($80108 vs $82843). However, there was no significant difference in the length of stay (LOS) between patients with MDS alone and those with MDS and RHD. Conclusions: Rheumatic heart disease (RHD) cases in patients with MDS are rare in clinical practice, leading to uncertainty regarding the effects of RHD on admitted MDS patients. Our study sheds light on the influence of RHD on mortality and other outcomes in this patient population. The efficacy of timely RHD treatment in reducing mortality and improving outcomes among hospitalized MDS patients remains to be verified in future investigations. [Table: see text]

Patterns of perioperative arrhythmias in adult cardiac surgery: A single center study from Sri Lanka

Introduction: There is no published data on perioperative arrhythmias in adults undergoing cardiac surgery in Sri Lanka. The object of this study was to assess the patterns of peri operative arrhythmias in cardiac surgical patients. Methods and material: This is a prospective descriptive study of 100 patients in a single cardiothoracic unit in a tertiary care hospital in Sri Lanka from November 2018 to May 2020. Demographic data and clinical data were assessed in all patients. Furthermore, 24-hour Mobile Cardiac Outpatient Telemetry MCOT was assessed in a subset of patients. Results: There were 72 males and 28 females. The mean age was 60 (range 37-76 years). The majority (76) had undergone isolated coronary artery bypass grafting (CABG). The mortality was 3.5% in routine and 15% in urgent and emergency operations. Arrhythmias where lowest preoperatively (11%). Arterial fibrillation (AF) (6%) and sinus bradycardia (4%) were the commonest arrhythmias seen preoperatively. Arrhythmias were higher during surgery (29%) and ventricular fibrillation (VF) (25%) was the commonest. Arrhythmias were highest post operatively (34%) and (AF) (12%) was the commonest followed by sinus tachycardia (9%). The higher incidence of arrhythmias in the in-hospital postoperative period as compared to the preoperative period was significant (p=0.0001). A limited in-depth study using a mobile cardiac telemetry (MCOT) device showed a higher incidence of AF preoperatively (11%) and postoperatively (16%) but these differences were not significant when compared with that of routine investigations (p=0.18 and p=0.35 respectively). However, the MCOT detected some arrhythmias completely missed by routine ECG recordings, notably supraventricular tachycardia, both preoperatively (22%) and postoperatively (33%). Conclusions: This study has established baseline values of perioperative arrhythmias in the adult cardiac surgical patients in Sri Lanka. The MCOT methodology shows the potential for a more detailed study of arrhythmias and could inform decision-making in arrhythmia prophylaxis.

Association between Preeclampsia and Long-term Risk of Arrhythmias.

Preeclampsia (PE), a pregnancy-induced hypertensive disorder, affects 4-5% of pregnancies worldwide. It is well known that hypertension is associated with an increased risk of arrhythmias; however, data on the association between PE and arrhythmias are sparse. In this observational cohort study, we identified all primiparous women who gave birth in Denmark (1997-2016) using Danish nationwide registries. The women were stratified on whether they developed PE during primiparous pregnancy, and followed from primiparous pregnancy to incident arrhythmia, emigration, death, or end of study (December 31, 2018). A total of 523,271 primiparous women with a median age of 28 years were included and 23,367 (4.5%) were diagnosed with PE. During a median follow-up of 10.1 years, women with vs without PE were associated with a higher incidence of arrhythmias (1.42% vs 1.02%): 1) Composite of cardiac arrest, ventricular tachycardia/fibrillation, or ICD implantation (adjusted HR 1.60 [95% CI 1.14-2.24]), 2) Composite of advanced 2nd degree or 3rd degree atrioventricular block, sinoatrial dysfunction, or pacemaker implantation (adjusted HR 1.48 [95% CI 0.97-2.23]), 3) Composite of supraventricular tachyarrhythmias or extra systoles (adjusted HR 1.34 [95% CI 1.19-1.51]), 4) Composite of all the above-mentioned arrhythmias (adjusted HR 1.37 [95% CI 1.23-1.54]). Preeclamptic women were associated with a significantly and at hitherto unknown long-term increased rate of arrhythmias. This finding suggests that women with PE may benefit from cardiovascular risk assessment, screening, and preventive education.

Abstract 3121: Gender And Racial Differences In Complications Of Coronary Angiography

Background: Coronary angiography is an effective diagnostic tool for assessing coronary lesions and visualizing vascularization. Although research has been conducted on the occurrence of complications of the procedure, limited research is available comparing the occurrence of postoperative complications between various patient populations. Our study aims to bridge this gap by assessing the gender and racial disparities in outcomes of coronary angiography. Methods: Data was obtained from TriNetX, a national database of deidentified medical records with IRB pre-approval. Two distinct pairs of cohorts were identified - patients that underwent coronary angiography divided by gender (male and female) and race (White and Black). Cohorts were matched with a propensity score model. Four complications were studied 0-3 days post procedure: acute myocardial infarction (MI), cerebral infarction, arrhythmias, and acute renal failure. Statistical analysis included risk differences with a significance value of p ≤ 0.05. Results: (*incidence values included in parentheses are percentages) Gender: We identified 162,408 male patients and 102,461 female patients that had a coronary angiography performed. No significant difference between male and female patients was observed in the incidence of stroke (0.422 vs 0.482, p = 0.0820). Males had a higher incidence of MI (9.251 vs 7.547, p ≤ 0.001), arrhythmias (3.786 vs 2.877, p ≤ 0.001), and acute renal failure (1.385 vs 1.19, p = 0.003) Race: We identified 178,024 white patients and 24,616 black patients that had a coronary angiography performed. No significant difference between white and black patients was observed in the incidence of MI (8.485 vs 8.215, p = 0.2808). White patients had a higher incidence of arrhythmias (3.077 vs 2.722, p = 0.0191), whereas black patients had a higher likelihood of stroke (0.401 vs 0.666, p ≤ 0.001) and acute renal failure (0.335 vs 0.781, p ≤ 0.001). Conclusion: Gender and racial differences in complications of coronary angiography are evident within 72 hours (about 3 days) of the procedure. Male and Black patients had a higher risk of life-threatening complications. Physicians can use this information for postprocedural monitoring of high-risk patients to improve outcomes.

Cardiorespiratory Disturbances in Alzheimer's Disease: A Focus on the Contribution of Sympathetic Premotor Neurons

While therapeutic approaches targeting neurodegenerative mechanisms associated with cognitive impairment in Alzheimer's disease (AD) have been intensively explored, other comorbidities closely linked to AD progression, such as sleep-disordered breathing and autonomic dysfunction, have not been thoroughly investigated. In preliminary studies, we showed an increase in neural activity of catecholaminergic premotor neurons located in the rostral ventrolateral medulla region (RVLM-C1), a main region involved in cardiorespiratory regulation, in experimental AD. Therefore, in the present study, we aimed first to characterize cardiorespiratory function in AD patients and then to determine the role of RVLM-C1 neurons in autonomic and sleep-disordered breathing in APP/PS1 double transgenic mice, an experimental model showing AD-like pathology. Sixteen subjects (8 AD and 8 age-matched controls) were enrolled to assess sleep breathing disorders and to record cardiac autonomic function. Whole-body plethysmography and blood pressure monitoring in freely moving mice were used to study sleep-associated cardiorespiratory disorders. Bilateral stereotaxic injections of anti-dopamine β-hydroxylase-saporin (DβH-SAP) into the RVLM were used to selectively destroy C1 neurons. Compared to age-matched healthy subjects, patients with AD showed larger increases in neural sympathetic discharges during autonomic testing. In addition, heart rate variability analysis in AD patients showed a shift in spectral components towards a more sympathetic influence. Remarkably, we found that autonomic function impairment in the APP/PS1 mice resembles what we found in AD patients. Compared to wild type (WT), APP/PS1 mice displayed sympatho-excitation (ΔHR: -80±5 vs -125±10, WT vs APP/PS1, respectively), a higher incidence of cardiac arrhythmias (events/h 6.0±1.0 vs 12±1.5, WT vs APP/PS1, respectively), and sleep-disordered breathing (AHI: 8.5±2.0 vs 18.0±3.0, WT vs APP/PS1, respectively). Partial ablation of RVLM-C1 neurons (~70%) in APP/PS1 mice resulted in a two-fold and three-fold reduction in cardiac sympathetic drive and arrhythmogenesis, respectively. Furthermore, APP/PS1 mice treated with DβH-SAP showed marked improvements in breathing regularity (IS: 7.9±1.1 vs 16.9±2.2, APP/PS1DβH-SAP vs APP/PS1, respectively) and a restoration of normal sleep effciency (SE: 75.5±4.3 vs 58.1±6.4, APP/PS1DβH-SAP vs APP/PS1, respectively) compared to untreated APP/PS1 mice. Our results show that RVLM-C1 neurons play a main role in the development/maintenance of cardiorespiratory disorders in experimental AD. FONDECYT 11220962, 1220950. This is the full abstract presented at the American Physiology Summit 2024 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.

Complications and Efficacies of Surgical Versus Transcatheter Closure for Pediatric Ostium Secundum Atrial Septal Defect: A Meta-Analysis.

The optimal approach for pediatric ostium secundum atrial septal defect (ASD) closure remains uncertain. This study aims to assess complications and efficacies of surgical and transcatheter closures. Systematic search in Medline, Cochrane, and EMBASE databases identified cohort studies until July 2023. Complications, length of hospital stay, and efficacy outcomes were evaluated. Subgroup analyses considered ethnicity, ASD size, age, and rim deficiency involvement. Fourteen cohort studies involving 9695 patients were comprehensively analyzed. Regarding complications, the pediatric patients in the surgery group exhibited higher occurrences of cardiac arrhythmia (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.87, p=0.004), pericardial effusion (OR: 14.80, 95% CI: 6.97-31.43, p<0.00001), and pulmonary complications (OR: 2.58, 95% CI: 1.73-3.85, p<0.00001) compared with those in the transcatheter group. However, no significant difference in fever incidence was observed (OR: 2.57, 95% CI: 0.90-7.34, p=0.08). Furthermore, length of hospital stay was notably shorter in the pediatric transcatheter group (mean difference [MD]: 4.00, 95% CI: 1.71-6.29, p=0.0006). Regarding efficacies, both groups demonstrated similar rates of successful closure (OR: 1.97, 95% CI: 0.56-6.92, p=0.29) and residual shunting (OR: 0.55, 95% CI: 0.17-1.77, p=0.31) in the pediatric cohort. Subgroup analyses revealed that surgical residual shunting was notably lower in the European pediatric population (OR: 0.18, 95% CI: 0.07-0.45, p=0.0002), in cases with ASD size exceeding 15 mm (OR: 0.19, 95% CI: 0.08-0.49, p=0.0006), and in pediatric patients younger than 8 years (OR: 0.33, 95% CI: 0.12-0.92, p=0.03). Interestingly, residual shunting involving complex ASD with rim deficiency was more pronounced in the surgery group (OR: 2.66, 95% CI: 1.33-5.32, p=0.006). Both surgical and transcatheter closures are equally effective, with transcatheter closure showing significantly fewer complications. This meta-analysis offers pivotal insights for clinicians grappling with the optimal approach to pediatric ostium secundum ASD closure. The observed higher incidence of cardiac arrhythmias, pericardial effusions, and pulmonary complications in surgical closures underscores the challenges associated with this modality. In contrast, transcatheter closure, with its comparable efficacy and shorter hospital stays, emerges as an appealing and less invasive alternative. These findings equip clinicians with evidence to make informed decisions, optimizing patient outcomes. Subgroup analyses further refine recommendations, emphasizing tailored considerations for European pediatric patients, larger ASDs, and those under 8 years old, ultimately fostering personalized and improved care strategies.

Pattern of Arrhythmia among Hypertensive Patients in South-South, Nigeria: A 24-H Ambulatory ECG (Holter ECG) Study

Background: Regular 12-lead electrocardiogram (ECG) often fail to detect cardiac conduction abnormalities. Among hypertensive patients, conduction irregularities such as atrial fibrillation and ventricular tachycardia are recognized occurrences and these can be intermittent or asymptomatic. This study aims to evaluate the conduction abnormalities identified among hypertensives by Holter ECG in a private medical facility in South-South, Nigeria. Methods: This is a retrospective study of five hundred and thirteen patients consisting of 255 males and 258 females Holter ECG who presented at a private medical facility from January 2015- December 2016. Holter ECG data was acquired using Schiller type (MT-101) Holter ECG Machine. Results: Out of the 370 hypertensive patients reviewed, with a mean age of 55.18 ±.14.78, 205(55.41%) had tachycardia, 180(48.65%) had bradycardia, 184(49.73%) had ventricular ectopics while 169(45.68%) had supraventricular ectopics. The most common clinical indication was palpitation 150 (40.54%). The most prevalent age group was 41-60 years; 230 (44.83%) as compared to other age groups in the study. Tachycardia was the most common type of arrhythmia among the subjects. There was a higher incidence of arrhythmias in the female subjects than in the male. Conclusion: Tachycardia and ventricular ectopics were the most common conduction abnormalities observed. Beta blockers and anti-arrhythmics would be helpful for optimization of cardiovascular care. Holter ECG is beneficial in describing and characterizing arrhythmias in hypertensive patients in this population therefore, further studies on larger populations and diverse disease conditions are advocated.

Racial disparities among patients with cardiac sarcoidosis and arrhythmias in the United States: A propensity matched-analysis from the national inpatient sample database 2016-2020

BackgroundCardiac sarcoidosis (CS) is frequently associated with conduction abnormalities and arrhythmias. In this study, we aim to evaluate racial disparities in the frequency of arrhythmias, and associated co-morbidities, among patients with CS. MethodsWhite and African American (AA) patients diagnosed with CS were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. ResultsA total of 7,935 patients with CS were included in the study. The propensity-matched sample comprised of 5,570 patients, of whom 2,785 were White and 2,785 were AA. AA patients had a longer mean length of hospital stay (LOS) (7.84 vs. 6.94, p<0.01), a higher mean Charlson Comorbidity Index (CCI) score (3.10 vs. 2.84, p<0.01), and significantly higher incidences of cardiogenic shock [(9.2% vs 6.3%, p<0.01), aOR 1.45 (95% CI 1.17-1.78), p<0.01] and acute kidney injury (AKI) [(34.3% vs. 26.9%, p<0.01), aOR 1.41 (95% CI 1.24-1.61), p<0.01]. From an arrhythmia perspective, AA CS patients were shown to have a lower frequency of: (1) ventricular tachycardia (32.5% vs. 37.9%, p<0.01), (2) ventricular fibrillation (5.4% vs.7.2%, p<0.01), (3) first-degree AV block (1.8% vs. 4.1%, p<0.01), (4) complete AV block (6.3% vs. 14.2%, p<0.01), and (5) atrial fibrillation (31.8% vs. 34.8%, p=0.016) when compared to Whites with CS. Mortality remained higher for AAs (3.8% vs. 2.7%, p=0.024). ConclusionOur study demonstrates a higher incidence of cardiac arrhythmias among White patients but a higher incidence of cardiogenic shock, AKI, mean LOS, and mortality among AA patients with cardiac sarcoidosis.

Incident cardiac arrhythmias associated with metabolic dysfunction-associated steatotic liver disease: a nationwide histology cohort study

BackgroundPrior studies suggest a link between metabolic dysfunction-associated steatotic liver disease (MASLD) and incident arrhythmias, including atrial fibrillation (AF). However, robust data are lacking from cohorts with liver histology, which remains the gold standard for staging MASLD severity.MethodsThis population-based cohort included all Swedish adults with histologically-confirmed MASLD and without prior cardiac arrhythmias (1966–2016; n = 11,206). MASLD was defined from prospectively-recorded histopathology, and characterized as simple steatosis, non-fibrotic steatohepatitis (MASH), non-cirrhotic fibrosis, or cirrhosis. MASLD patients were matched to ≤ 5 controls without MASLD or arrhythmias, by age, sex, calendar year and county (n = 51,856). Using Cox proportional hazards modeling, we calculated multivariable-adjusted hazard ratios (aHRs) for incident arrhythmias (including AF, bradyarrhythmias, other supraventricular arrhythmias, ventricular arrhythmias/cardiac arrest).ResultsOver a median follow-up of 10.8 years, incident arrhythmias were confirmed in 1351 MASLD patients (10.3/1000 person-years [PY]) and 6493 controls (8.7/1000PY; difference = 1.7/1000PY; aHR = 1.30, 95%CI 1.22–1.38), and MASLD patients had significantly higher rates of incident AF (difference = 0.9/1000PY; aHR = 1.26, 95%CI 1.18–1.35). Rates of both overall arrhythmias and AF were significantly elevated across all MASLD histological groups, particularly cirrhosis (differences, 8.5/1000PY and 5.3/1000PY, respectively). In secondary analyses, MASLD patients also had significantly higher rates of incident ventricular arrhythmias/cardiac arrest (aHR = 1.53, 95%CI 1.30–1.80), bradyarrhythmias (aHR = 1.26, 95%CI 1.06–1.48), and other supraventricular arrhythmias (aHR = 1.27, 95%CI 1.00–1.62), compared to controls.ConclusionsCompared to matched controls, patients with biopsy-confirmed MASLD had modest but significantly higher incidence of cardiac arrhythmias, including AF, bradyarrhythmias, other supraventricular arrhythmias and ventricular arrhythmias/cardiac arrest. Excess risk was observed across all stages of MASLD and was highest with cirrhosis.

Abstract 14474: Racial Disparities in Arrhythmias Among Patients With Cardiac Sarcoidosis in the United States From 2016-2020

Background: Cardiac sarcoidosis (CS) is frequently associated with conduction abnormalities and arrhythmias. In this study, we aim to evaluate racial disparities in the frequency of arrhythmias, and associated co-morbidities, among patients with CS. Methods: Caucasian and African American (AA) patients with a diagnosis of CS were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. Results: A total of 8825 patients with cardiac sarcoidosis comprising 44.1% Caucasian and 45.8% AA patients were included. Both cohorts had a male preponderance (Caucasian males: 64.3% vs. AA males 55.2%, p&lt;0.01). AA patients had a longer mean length of stay (7.74 vs. 6.64 days, p&lt;0.01), a higher mean Charlson Comorbidity Index score (3.36 vs. 2.63, p&lt;0.01), a greater prevalence of cirrhosis (3.2% vs. 2.1%, p&lt;0.01), diabetes (44.7% vs. 31.2%, p&lt;0.01), alcohol abuse (4.0% vs. 2.2%, p&lt;0.01), smoking (37.4% vs. 26.8%, p&lt;0.01), obesity (31.1% vs. 27.9%, p&lt;0.01) and chronic kidney disease (40% vs. 28.1%, p&lt;0.01). Caucasian patients had a greater history of hypertension (17.1% vs. 14.5%, p&lt;0.01) and prior percutaneous coronary intervention (6.2% vs. 3.1%, p&lt;0.01). Moreover, AA patients had a lower incidence of various cardiac arrhythmias (vs. Caucasians) such as atrial fibrillation (31.3% vs. 36.2% vs, p&lt;0.01), ventricular tachycardia (29.8% vs. 37.9% p&lt;0.01), ventricular fibrillation (5.3% vs. 7.2%, p&lt;0.01) and complete atrioventricular block (AVB) (6.4% vs. 14.6%, p&lt;0.01). However, a higher incidence of complications such as cardiogenic shock, acute kidney injury and death were reported among AA patients (Table 1). Conclusion: Our study demonstrates a higher incidence of cardiac arrhythmias among Caucasian patients but higher complications and mortality among AA patients with cardiac sarcoidosis. Keywords: Cardiac sarcoidosis, arrhythmias, racial disparities.

ЧАСТОТА ГОСПИТАЛЬНЫХ ОСЛОЖНЕНИЙ И ГОДОВЫЕ ИСХОДЫ У ПАЦИЕНТОВ ПОСЛЕ АКШ В ЗАВИСИМОСТИ ОТ ПЕРЕНЕСЕННОЙ COVID-19

Introduction. Despite the decrease in activity and the trend towards the end of the pandemic of a new coronovirus infection (NCI), the burden of NCI remains a serious problem of modern healthcare. Since the beginning of the NCI pandemic, evidence has been obtained that the long-term consequences of COVID-19 infection for patients with cardiovascular pathology will be characterized by an unfavorable prognosis. The ability to predict complications in the early and late postoperative period after CABG for patients after CCI is an important tool to influence the prognosis. Materials and methods. We examined 60 patients with various forms of coronary artery disease who were selected for CABG. The first group consisted of 30 patients who had previously undergone NCI. The second group consisted of 30 persons without NCI in history. The groups were comparable in terms of gender (21 men (70%) in the first group and 25 (83.3%) men in the second, p=0.2) and age (mean age 64.4±1.1 years in the first group and 63.3±1.04 in the second, p=0.46). In all patients, except for standard laboratory and instrumental diagnostic methods, Echo-KG parameters, EuroScore and Syntax index, the frequency of concomitant diseases and postoperative complications were evaluated. Statistical analysis was carried out using the Microsoft Excel 2017 program, the calculation of the significance of differences (p) was carried out using the Fisher test. Results: Most patients of both groups had AH (29 each (96.6%), p=0.4), CHF was observed in 7 (23.3%) persons of the first group and 6 (20%) of the second (p=0, 47). The Syntax SCORE index was initially statistically significantly higher in patients of the first group than in the second - 25.55 ps 21.62 (p=0.03). DM was somewhat more common in patients of the first group than in the second (15 (50% ps 9 (30%, p=0.13). 0.87 hours, p = 0.008. In 5 (16.6%) patients of the first group, the postoperative period was complicated by major bleeding, in the second group, this complication had 2 (6.6%) patients p = 0.28. In most patients of both groups in the postoperative period, hydrothorax was diagnosed (25 (83.3% of persons of the first group and 24 (80%) of the second, p = 0.4), four patients of the first group (13.3%) had hydropericardium, in the second group of similar cases not noted, p=0.04).Atrial fibrillation was observed in more patients of the first group than the second - 11 (36.6%) ps 6 (20%), p=0.19.12 months after the surgical treatment An analysis of late complications of surgery was carried out.There were no differences between the groups in the frequency of newly emerging angina pectoris (5 patients in each group (16.6%)). Clinical CHF was more often observed in patients of the first group — 16 (53.3%) than in the second — 11 (36.6%) p=0.19. Atrial fibrillation was more common in patients of the first group — 4 (13.3%) ps 2 (6.6%) (p=0.67). The high frequency of detection of oncological diseases in patients after undergoing NCI is cause for concern - 5 (16.6%); in patients of the second group, oncological diseases were not diagnosed (p=0.05). Conclusion: Thus, patients with NCI were more likely to have diabetes, bleeding in the perioperative period, they had a longer duration of EC. The late postoperative period for this group of patients was characterized by a higher incidence of cardiac arrhythmias, a higher incidence of CHF, and a rather high (compared with the group after CABG without a history of NCI) incidence of newly diagnosed oncological diseases. The data obtained indicate a higher risk of late perioperative complications after CABG in patients after CCI, which emphasizes the need for more detailed preparation of this category of patients and the development of individual follow-up follow-up programs, as well as more in-depth oncological screening.

Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease

BackgroundPatients with congenital heart disease (CHD) have a higher incidence of arrhythmias during pregnancy, yet the utility of mobile cardiac telemetry (MCT) to predict adverse outcomes is unknown. ObjectivesThe purpose of this study is to determine whether arrhythmias on screening MCT correlate with adverse pregnancy outcomes. MethodsPatients with CHD prospectively enrolled in the Standardized Outcomes in Reproductive Cardiovascular Care initiative underwent 24-hour MCT (within 18 months prior to pregnancy). Positive findings on MCT were defined as episodes of bradyarrhythmia, symptomatic atrioventricular block, ectopic atrial or ventricular activity, and supraventricular or ventricular tachycardia. Clinically significant arrhythmia events (CSAEs) were those requiring medical or device intervention or an emergency room visit. Clinical events during the antepartum, intrapartum, and postpartum periods were compared using Fisher’s exact test. Analyses were performed using Stata version 16. ResultsIn 141 pregnancies in 118 patients with CHD, MCT detected positive findings in 17%. Adverse cardiac outcomes occurred in 11% of pregnancies, of which CSAE occurred in 3.5%. Positive MCT was significantly associated with subsequent CSAE (21% vs 0%, P < 0.001) and cumulative adverse maternal cardiac outcomes (33% vs 7%, P = 0.001) but did not correlate with obstetric (46% vs 41%, P = 0.660) or neonatal outcomes (33% vs 31%, P = 0.810). Of the patients with CSAE, 75% had ≥moderate CHD complexity. ConclusionsPatients with CHD had a high rate of positive MCT findings. This was associated with CSAE and adverse maternal cardiac outcomes. Patients with ≥moderate CHD complexity may benefit from screening MCT to improve preconceptual counseling and planning.

The world upside down - after 20 years of follow-up of dextro-transposition of the great arteries.

Dextro-transposition of the great arteries (D-TGA) is a congenital heart disease (CHD) classically palliated with atrial switch (ATR-S) and nowadays corrected with arterial switch (ART-S). Our aim was to observe a group of D-TGA patients followed in an adult CHD outpatient clinic. We analyzed a group of D-TGA patients born between 1974 and 2001. Adverse events were defined as a composite of death, stroke, myocardial infarction or coronary revascularization, arrhythmia, and ventricular, baffle, or significative valvular dysfunction. A total of 79 patients were enrolled, 46% of whom were female, with a mean follow-up of 27±6 years after surgery. ATR-S was performed in 54% and ART-S in 46%; the median age at procedure was 13 months and 10 days, respectively. During follow-up, almost all ART-S remained in sinus rhythm versus 64% of ATR-S (p=0.002). The latter group had a higher incidence of arrhythmias (41% versus 3%, p<0.001), mostly atrial flutter or fibrillation; the median time to first arrhythmia was 23 years. Systemic ventricle systolic dysfunction (SVSD) was more frequent in ATR-S (41% versus 0%, p<0.001); the mean time to SVSD was 25 years. In ART-S, the most frequent complication was significant valvular regurgitation (14%). Regarding time-to-event analysis, 80% and 40% of ATR-S maintained adverse events-free after 20 and 30 years, respectively; the time-to-first adverse event was 23 years, and there was no difference compared to ART-S (Log-rank=0.596). ART-S tended to maintain more preserved biventricular function than ATR-S (Log-rank=0.055). After a long term free of adverse events, ATR-S patients experienced more arrhythmias and SVSD. ART-S complications were predominantly anastomosis-related; SVSD or arrhythmias were rare.

НАРУШЕНИЯ СЕРДЕЧНОГО РИТМА И ПРОВОДИМОСТИ У МУЖЧИН МОЛОЖЕ 50 ЛЕТ С КАРДИОГЕННЫМ ШОКОМ ПРИ ИНФАРКТЕ МИОКАРДА

Relevance. Cardiogenic shock remains one of the most common causes of death in myocardial infarction. Aim. To evaluate the features of cardiac rhythm and conduction disturbances in myocardial infarction complicated by cardiogenic shock, as well as their significance for the development of this complication in males under 50 years old to improve prevention and outcomes. Material and methods. The study included males aged 19-49 years old with type I myocardial infarction. The patients were divided into age- comparable groups. The study group consisted of seven patients with cardiogenic shock, the control group - without cardiogenic shock - 223 patients. A comparative analysis of arrhythmias among the variants of the clinical course, complications, as well as their structure in selected groups were performed. The influence of the studied parameters on the risk of cardiogenic shock development in the examined patients was assessed by the method of risk analysis using the Pearson Chi-square test. Results. In the study group, a higher incidence of arrhythmias in the structure of MI complications (85.7%) was revealed than in the control group (24.2%; p=0.003). They were observed in combination with complications of the group of contractile myocardial insufficiency and its mechanical failure (57.1% and 6.3%, respectively; р˂0.0001) and only contractile insufficiency (28.6% and 11.2%; р˂0,0001). In the structure of arrhythmias in the study group, the frequency of observation of atrial fibrillation and flutter (66.7%) prevailed over the control group (4.9%; р˂0.0001), ventricular fibrillation (50.0 and 2.4%, respectively; р˂ 0.0001), supraventricular tachycardias (33.3% and 1.5%; р˂0.0001), supraventricular (33.3% and 8.3%; р=0.03) and polytopic extrasystoles (33.3% and 3 .9%; p=0.0003), ventricular tachycardias (16.7% and 2.0%; p=0.02), complete atrioventricular blockades (16.7% and 2.0%; p=0.02) and asystole (16.7% and 1.5%; p=0.007). The risk of cardiogenic shock development increased with these arrhythmias. Conclusions. The listed types of arrhythmias should be used in the formation of high-risk groups for the cardiogenic shock development in myocardial infarction for monitoring and timely implementation of the necessary treatment. It is also expedient to take them in the prognostic modeling of this complication.

Incidence and Types of Arrhythmias in Acute Coronary Syndrome: An Observational Study

their diagnosis is not considered in contemporary acute coronary syndrome patients. This study investigates the incidence and types of arrhythsmias among acute coronary syndrome patients presenting to the emergency department, as well as their association with various factors and patient outcomes. Methods: The current prospective observational study was conducted at a tertiary care center in Kolkata, India. Data were collected from 76 acute coronary syndrome patients admitted between October 2020 and May 2021 to the emergency department. Information was gathered through semi-structured interviews and relevant investigations. Results: The majority of the patients were aged 61-70 years, with three fourth of the study population being male. The incidence of arrhythmia was diagnosed in 77.6% of the patients. The most common arrhythmias were sinus tachycardia, ventricular premature complex, atrial fibrillation, sinus bradycardia, and complete heart block. Arrhythmias were more prevalent among ST-elevation myocardial infarction (62.7%) and unstable angina (8.5%) patients. Patients with Left Ventricular Ejection Fraction ≤ 40% had a higher incidence of arrhythmias (93.5%). The mortality rate during hospital stay was 11.9% among acute coronary syndrome patients with arrhythmias, while all acute coronary syndrome patients without arrhythmia had a 100% survival rate. Conclusion: This study highlights the incidence and types of arrhythmias in acute coronary syndrome patients presenting to the emergency department. It reveals a higher prevalence of arrhythmias in specific subgroups, such as patients with ST-elevation myocardial infarction and those with a reduction in left ventricular function. These findings contribute to our understanding of arrhythmias in acute coronary syndrome and their association with patient outcomes, emphasizing the importance of appropriate management and monitoring in this population.

Abstract 10400: The Characteristics and Outcomes of Heart Failure Associated With Methamphetamine Use

Introduction: Heart failure (HF) remains a significant cause of morbidity and mortality in the United States (US). Approximately 6.2 million adults in the United Status have HF and results in an estimated 13.4% of deaths annually. While the development of HF is linked to a variety of risk factors, the incidence and prevalence of methamphetamine-associated HF (HF-Meth) is rising secondary to the methamphetamine epidemic that is plaguing America. This study aims to compare the characteristics and outcomes of HF-Meth with other forms of HF. Methods: The discharge data of the National Inpatient Sample (NIS) from 2009 to 2014 were analyzed and records for HF hospitalization were identified using all ICD-9 codes for HF. These were further stratified based on meth use with the ICD-9 codes (304.40, 305.7, 969.72). We compared frequency of in-hospital mortality,incidence of cardiac arrhythmias, sudden cardiac death (SCD), rates of unemployment, and homelessness between patients with and without ICD-9 codes indicative of meth use. Percentage and chi-square-based P-values were reported. Results: Out of the 25,209,723 sampling weight-adjusted patients with ICD-9 codes indicative of HF, 58,359 (0.23%) had ICD codes indicative of Meth use. Relative to other patients with HF, HF-Meth experienced a lower in-hospital mortality rate (2.9 vs 5.0%, p &lt;0.001), had a higher incidence of cardiac arrhythmias (7.1 vs 5.9%, p &lt;0.001) and SCD (2.6 vs 1.8%, p &lt;0.001), a higher rate of unemployment (0.49 vs 0.03%, p &lt;0.001) and homelessness (6.1 vs 0.2%, p &lt;0.001). In addition, HF-Meth was associated with a higher rate of alcohol abuse (21.1 vs 2.9%, p &lt;0.001), cigarette smoking (73.8 vs 28.2%, p&lt;0.001) and essential hypertension (43.8 vs 40.3%, p &lt;0.001). Diabetes and hyperlipidemia were more prevalent in patients with other forms of HF (29.3 vs 43.44%, p &lt;0.001 and 0.26 vs 0.45%, p &lt;0.001 respectively). Conclusions: Patients with HF-Meth had a higher rate of cardiac arrhythmias, SCD, unemployment and homelessness. Additionally, they had a lower in-hospital mortality when compared with those not associated with meth use.

Negative impact of SARS-CoV-2 infection in acute coronary syndrome mortality in a Latin American cohort study.

PurposeCOVID-19 infection has been associated with a high risk of complications and death among patients with acute coronary syndrome (ACS). However, there is little information on the simultaneous involvement in Latin American countries.MethodsIn the period between May 2020 and February 2021, an observational, longitudinal, prospective cohort study with two parallel branches was conducted in private and public hospitals in Brasilia, Brazil, including patients with ACS with and without a positive SARS-CoV-2 test result during hospitalization.ResultsA total of 149 patients with ACS were included (75 with COVID-19 and 74 controls). Patients with COVID-19 exhibited an average of 62 years of age, 57% men, 40% diabetics, 67% hypertensive, 48% had an ACS with ST-segment elevation, Killip I was predominant, a low Syntax Score in 72%, with an average Grace Score of 117, and a length of hospitalization of 43 days in average. The control branch was similar in clinical characteristics, except for a lower proportion of ST-segment elevation ACS (16%, p < 0.01) and a higher incidence of arrhythmias (8 vs. 20 %, p = 0.03). Using the Cox regression method of analysis of covariates collected in the study, it was identified that patients with COVID-19 had a risk of death 2.34 times higher than patients without COVID-19 (p = 0.049).ConclusionIn this study conducted in a Latin American capital, SARS-CoV-2 infection predicted a higher chance of death in patients admitted with ACS, which is a finding that reinforces the need for greater care when diseases develop in overlapping ways.

Anti‐depressant lithium compounds reliefs cardiorespiratory disturbances and improves cardiac function in experimental non‐ischemic heart failure

Non‐ischemic heart failure (HF) is a complex medical problem with a high incidence among the older population. While several efforts have been made to improve HF outcomes there is an urgent need for new strategies to reduce mortality rates. Sympathoexcitation and disordered breathing are both considered hallmarks of HF and are closely related to disease progression. Lithium salts has been largely used as anti‐depressants; however, lithium compounds also showed several pleiotropic effects some of them linked to the origin of cardiorespiratory disorders in HF (i.e. oxidative stress). Accordingly, using drug repurposing strategy we aimed to define whether lithium treatment improve cardiorespiratory function in experimental HF. Male Sprague‐Dawley rats underwent volume overload to induce non‐ischemic HF. Four weeks after HF induction, an osmotic minipump containing lithium chloride (Li+, 2 meq/Kg/day) was subcutaneously implanted for drug delivery. Cardiac autonomic and baroreflex function, ventilatory chemoreflex drive and disordered breathing were evaluated after 4 weeks of Li+ treatment in freely moving rats. In addition, cardiac function was determine using PV‐loops. Compared to Sham rats, HF animals displayed autonomic imbalance, reduced baroreflex sensitivity, higher incidence of cardiac arrhythmias, enhanced central chemoreflex and breathing disorders. Cardiac diastolic dysfunction was evident in HF animals compared to Sham animals. HF rats that underwent Li+ treatment showed significant (p&lt;0.05) improvements in cardiac autonomic function as evidenced by reduced low‐to‐high frequency ratio of heart rate variability (LF/HF: 2.8 ± 0.3 vs. 0.9 ± 0.4; HF+Veh vs. HF+Li+), baroreflex sensitivity (BRS: 2.0 ± 0.5 vs. 5.8 ± 1.0 ms/mmHg; HF+Veh vs. HF+Li+) and reduced cardiac arrhythmogenesis (PVC: 220 ± 50 vs. 30 ± 10 events/h; HF+Veh vs. HF+Li+). Furthermore, Li+ treatment in HF completely normalized central chemoreflex drive. Indeed, hypercapnic ventilatory responses obtained in HF+Li+ rats were undistinguishable from the ones obtained in Sham rats (HCVR: 1.7 ± 0.4 vs. 2.0 ± 0.4 DVe/FiCO2; HF+Veh vs. HF+Li+). Also, breathing disorders (i.e. apneas/hypopneas) were markedly reduced by Li+ treatment in HF (AHI: 8.5 ± 1.0 vs. 3.7 ± 0.8; HF+Veh vs. HF+Li+). Lastly, HF+Li+ treated rats displayed marked improvements in cardiac diastolic function (~2.5‐fold reduction in EDPVR) compared to HF+Veh treated rats. We found that the beneficial effects of Li+were partially associated with upregulation of the Nrf2 pathway and related antioxidant genes (i.e. SOD2), reductions in tissue oxidative stress and decreases in the expression of pro‐inflammatory cytokines (i.e. TNF‐a) in HF rats. Our results support the notion that lithium compounds may offer new avenues for the treatment of cardiorespiratory disorders and cardiac diastolic dysfunction in non‐ischemic HF.

Targeted temperature management following out-of-hospital cardiac arrest: a systematic review and network meta-analysis of temperature targets.

Targeted temperature management (TTM) may improve survival and functional outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA), though the optimal target temperature remains unknown. We conducted a systematic review and network meta-analysis to investigate the efficacy and safety of deep hypothermia (31-32°C), moderate hypothermia (33-34°C), mild hypothermia (35-36°C), and normothermia (37-37.8°C) during TTM. We searched six databases from inception to June 2021 for randomized controlled trials (RCTs) evaluating TTM in comatose OHCA survivors. Two reviewers performed screening, full text review, and extraction independently. The primary outcome of interest was survival with good functional outcome. We used GRADE to rate our certainty in estimates. We included 10 RCTs (4218 patients). Compared with normothermia, deep hypothermia (odds ratio [OR] 1.30, 95% confidence interval [CI] 0.73-2.30), moderate hypothermia (OR 1.34, 95% CI 0.92-1.94) and mild hypothermia (OR 1.44, 95% CI 0.74-2.80) may have no effect on survival with good functional outcome (all low certainty). Deep hypothermia may not improve survival with good functional outcome, as compared to moderate hypothermia (OR 0.97, 95% CI 0.61-1.54, low certainty). Moderate hypothermia (OR 1.23, 95% CI 0.86-1.77) and deep hypothermia (OR 1.27, 95% CI 0.70-2.32) may have no effect on survival, as compared to normothermia. Finally, incidence of arrhythmia was higher with moderate hypothermia (OR 1.45, 95% CI 1.08-1.94) and deep hypothermia (OR 3.58, 95% CI 1.77-7.26), compared to normothermia (both high certainty). Mild, moderate, or deep hypothermia may not improve survival or functional outcome after OHCA, as compared to normothermia. Moderate and deep hypothermia were associated with higher incidence of arrhythmia. Routine use of moderate or deep hypothermia in comatose survivors of OHCA may potentially be associated with more harm than benefit.

Risk factors for the development of arrhythmias after the fontan surgery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Fontan surgery or total cavopulmonary connection is a palliative procedure for complex congenital heart disease with univentricular physiology, without the possibility of biventricular surgical correction. This surgery has a high mortality rate (70%), with heart failure and arrhythmias being the main causes of death. Objective Identify the pre, intra and post-surgical factors that may predispose to arrhythmias in patients undergoing to Fontan surgery. Methods We conducted a retrospective review of the patients who underwent a total cavopulmonary connection from January 2003 to December 2018. We performed an analysis employing the Chi-square test to determine which variables were associated with the development of arrhythmias. Results During the mentioned period, 115 patients underwent to Fontan surgery, of which 51.3% were women, the average age at the time of surgery was 8 years. The most frequent diagnosis was tricuspid atresia in 44 patients (38.2%), followed by pulmonary atresia in 18 patients (15.7%) and double outlet right ventricle in 14 patients (12.2%). Regarding the type of the procedures performed, 93.9% (n = 108) were total extracardiac cavopulmonary connection and 6.1% (n = 7) were intracardiac. Also, 8.6% (n = 10) were taken to fenestration, the mean size of the fenestration was 7 mm (7 ± 3 mm) After Fontan surgery, there was a high incidence of arrhythmias which was 38% (n = 44). 22 patients (50%) presented them in the late postoperative period, being this, the most frequent time for the appearance of arrhythmias. We found that the intracardiac surgery presented an OR of 4.423 (95% CI 0.819 - 23.879, p&amp;gt; 0.05), being not statistically significant. Instead, the bidirectional cavopulmonary shunt previous to the Fontan surgery presented an OR of 0.255 (95% CI 0.081 - 0.806, p &amp;lt;0.05) and on the other hand the QRS duration &amp;gt; 120 ms was significantly associated with the appearance of arrythmias with an OR 2.99 (95% CI 1.2-4.2, p &amp;lt;0.05). Conclusions In patients undergoing to Fontan surgery, the previous bidirectional cavopulmonary bypass is a protective factor for the development of arrhythmias. And an QRS duration &amp;gt; 120 ms is a parameter that predicts the apparence of arrhythmias. Abstract Figure. QRS INTERVAL POST FONTAN SURGERY