High Prevalence Of Arrhythmias Research Articles

Ritmo certo - a new website in arrhythmology designed for primary care

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Electrocardiogram (ECG) is the most performed cardiovascular tool in medicine(1). First described by Einthoven at the beginning of the 20th century, it is now a useful, cheap and safe exam, accessible to millions of people on devices as light as smartwatches. Several studies have demonstrated the variability in the ECG interpretation. A recent systematic review described a low median accuracy of 54%, across different training levels (from students to experimented Cardiologists), and suggested that continuous training with courses, software and databases significantly improves that accuracy(2). With the easy access to this exam, along with the high prevalence of arrhythmias, Primary Care Physicians play an important role in this ECG era. Nevertheless, some articles reported that they too make frequent errors in interpretation and feel "uncomfortable" dealing with the 120 diagnostic ECG patterns described(3). Purpose To develop a website designed to aid Primary Care Physicians in diagnosing and managing patients with most ECG diagnostic patterns. Methods Literature regarding ECG pattern diagnosis and management was reviewed. The research combined European and North American guidelines, medical textbooks and websites, reviews and original articles available on Pubmed. The website information was assembled and written by Primary Care Physicians, then reviewed by Cardiologists that work in the Arrhythmology area. Results It was created an open, free access, nonprofitable, continuously updated website, written in Portuguese, that has 4 main components: 1. A Homepage with a search toolbar; 2. An "Index Page", with all the ECG diagnostic statements organized as a book index (FIGURE1); 3. A "Toolkit" link, with tools that are useful in ECG management such as CHA2DDS2-VASc and HASBLED scores, doses and contraindications of drugs, etc (FIGURE2).; 4. When searching for an ECG pattern, the user can access a summarized text with its definition, causes, exams that might be required (e.g. echocardiogram), and management (FIGURE1). The management section organizes procedures from the most to the less urgent. A version of the website is available and fully functional for testing purposes. The website will be continuously updated with images of all ECG diagnostic patterns from a local hospital database and specific information for pediatrics, pregnant women, and athletes. Conclusion Nowadays, Primary Care Physicians face a fascinating era of increasing amounts of information, fast discoveries and possibilities that demand permanent attention and update. The ECG is a complex but valuable and accessible tool with more than 100 different diagnostic statements. With this website, the aim is to empower Primary Care Physicians so they can confidently interpret ECG, and also manage patients according to the best medical recommendations available, with an updated tool fully designed for them.

PO-05-172 EPIDEMIOLOGY OF TAKOTSUBO CARDIOMYOPATHY WITH ARRHYTHMIAS AND THEIR COMPLICATIONS- AN UPDATED ANALYSIS

Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy that is usually readily reversible. However, it has been associated with many life-threatening arrhythmias. Prolonged QT, changes in cardiac cellular signaling due to catecholamine excess along with certain gender and genetic causes are considered to be the potential causes. We sought to assess the arrhythmia burden and associated complications in patients with Takotsubo cardiomyopathy. National Inpatient sample 2018-2020 was queried for adult patients (age> 18 years) with TCM. These patients were compared to the rest of the adults and analysed for underlying arrhythmias. Further, patients with TCM with and without underlying arrhythmias were studied to look for complications. A total of 200040 adult patients with TCM were admitted from 2018-2020 with a mean age of 67 years. 82.61% of them were females. Caucasians comprised 82.38%; African- Americans comprised 8.2% while the remaining 9.42% of patients with TCM belonged to other race categories (Hispanics, Native- Americans, etc). Patients with TCM were associated with a higher prevalence of arrhythmias as compared to patients without TCM (27.87% vs 16.98%; P<0.0001). Bradyarrhythmias including atrioventricular blocks (AV blocks) as well as tachyarrhythmias including supraventricular tachycardias and ventricular tachycardias were significantly more in the patients admitted with TCM (Table 1). Long QT syndrome and sick sinus syndrome were more prevalent in this patient subgroup as well. (Table 1) On comparing complications in a cohort of TCM, it was observed that mortality, cardiogenic shock, and cardiac tamponade were more commonly seen in patients with an underlying arrhythmia (complete heart block, ventricular tachycardia, ventricular fibrillation, and atrial fibrillation) than in patients without arrhythmias. Incidence of acute heart failure exacerbations was however not statistically different in these two groups. (Table 2) This study substantiates the fact that although TCM is reversible it is not free of complications. These patients are at significant risk of arrhythmias and subsequently further complications. It is advisable to monitor patients with TCM before discharge and warrants close outpatient monitoring as well.

Prevalência de arritmias em estudantes da área da saúde

This observational study analyzed the prevalence of arrhythmias in healthcare students using a retrospective cohort of quantitative approach. The research was carried out with the application of a structured interview and an electrocardiogram. Students from pharmacy, biomedicine,medicine, psychology, and nursing courses participated. A higher prevalence of arrhythmias was demonstrated in medical students with no statistical significance. What groups had in common was the presence of symptoms that may or may not be related to cardiovascular changes, such as dizziness and palpitation, which may be directly related to the high emotional demand from academic activities overload.

Arrhythmia prevalence among patients with polymyositis-dermatomyositis in the United States: An observational study.

Systemic inflammation has been associated with atherosclerotic cardiovascular diseases (ASCVD) and arrhythmia occurrence in rheumatologic conditions such as rheumatoid arthritis. Polymyositis and dermatomyositis (PD) are rare rheumatologic conditions characterized by symmetrical proximal muscle weakness and, in the case of dermatomyositis, cutaneous eruption. Although there is literature associating PD with ASCVD, no population-level studies have analyzed arrhythmia risk in PD. The purpose of this study was to assess the prevalence of arrhythmia and its subtypes by age and sex in patients with PD and to determine associations between arrhythmia and PD. This retrospective cohort study included adults for whom hospitalizations had been recorded in the National Inpatient Sample database in the United States between 2016 and 2018. Patients with PD were matched (1:10) by age to patients without PD. Prevalence of arrhythmia was calculated in the 2 groups and compared by sex and age groups. Associations between PD and arrhythmia were determined after adjustment for common arrhythmia risk factors. From 107,001,355 hospitalizations, 32,085 adults with PD were matched to 320,850 controls. Patients with PD aged <70 years had a higher prevalence of arrhythmia and higher adjusted odds of arrhythmia compared with controls. This increased risk was only seen for supraventricular arrhythmias. Adults with PD had increased odds of in-hospital mortality if they had an arrhythmia diagnosis (odds ratio 3.3; 95% confidence interval 2.5-4.5; P <.001). We found a higher prevalence and odds of arrhythmias, particularly supraventricular arrhythmias, in young and middle-aged patients with PD compared with matched controls. Arrhythmias were associated with significant mortality among patients with PD.

Risk of ischemic stroke in adult patients with congenital heart disease

Abstract Introduction With an increasing proportion of adults with congenital heart disease (CHD) surviving into middle age and beyond, CHD patients will be at increased risk of acquired cardiovascular conditions, such as ischemic stroke. Compared to controls, patients with CHD have a higher prevalence of arrhythmias, persistent shunts enabling paradoxical embolization, heart failure, mechanical valves as well as potentially hypercoagulable states, all of which can further increase the risk of stroke. Purpose The aim of our study was to investigate the risk of developing ischemic stroke in adults with CHD in Sweden compared to controls from the general population. Methods We used data from the Swedish National Patient and Cause of Death registries to identify all CHD patients ≥18 years of age, born during the period 1930–1998, with a first time diagnosis of ischemic stroke. Follow-up started in January 1970 and went on until December 2017. Approximately ten controls matched for age and sex were randomly selected from the general population for each patient with CHD. CHD diagnoses were classified into six lesion groups according to a previously published hierarchical classification system. Results In total, 43,110 patients with CHD and 474,267 controls were included in the study (51.4% men) and mean follow up time was 25.4±18.4 years. Patients with CHD had a 6 times higher risk of developing an ischemic stroke compared with controls (hazard ratio 6.0, 95% confidence interval 5.8–6.2, p≤0.001), with altogether 8.8% (n=3785) of CHD patients developing ischemic stroke compared with 1.6% (n=7516) of controls. Ischemic stroke was more common in all CHD lesion groups; however, patients with atrial septal defects/patent foramen ovale had the highest incidence rate of ischemic stroke with an incidence rate of 76.1 events/10,000 patient years compared with 8.7 in controls. Patients with CHD and ischemic stroke had markedly less hypertension, diabetes mellitus and hypercholesterolemia, compared with controls (7.1%, 2.0%, 2.9% respectively in CHD patients, compared with 19.6%, 6.6%, 5.3%, in controls, p≤0.001 for all). In addition, atrial fibrillation and heart failure were only slightly more common in CHD patients with ischemic stroke compared to controls (atrial fibrillation: 12.0% in CHD vs 10.4% in controls, p=0.01; heart failure: 8.7% in CHD vs 7.3% in controls, p=0.009). Conclusion In this large nationwide study, we found that the risk of ischemic stroke in adult patients with CHD was six times higher than in controls, despite a lower prevalence of common risk factors for stroke such as hypertension, diabetes mellitus and hypercholesterolemia. In addition, atrial fibrillation and heart failure were only slightly more common in CHD patients compared with controls. This implies that the etiology of ischemic stroke might be different in CHD patients compared with controls. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was funded by the Swedish state under an agreement between the Swedish government and county councils, the ALF agreement (Grant number: 236611) and the Swedish Heart-Lung Foundation (Grant Number: 20090724).

Concealed structural heart disease discovered at cardiac magnetic resonance in patients with ventricular extrasystoles from ventricular outflow tract and apparently normal hearts.

Outflow tract (OT) premature ventricular contractions (PVCs) are commonly found in clinical practice; in most cases, PVCs are benign and observed in structurally normal hearts, not requiring any therapeutic intervention. In this study, we therefore sought to evaluate with cardiac magnetic resonance (CMR) patients with PVC and apparently normal heart at echocardiographic examination, in order to identify possible substrates linked with higher prevalence of arrhythmias or structural heart disease. Thirty-three consecutive patients with frequent PVCs originating from the ventricular OT (right and left) were enrolled in the study and assessed by echocardiography and CMR. All patients had normal baseline electrocardiogram. CMR showed structural changes in 5 patients out of 33; in 3 cases, areas of fibrosis limited in one case to the middle basal segments of the interventricular septum and in two patients to the middle basal segments of the inferior-lateral wall were found. In 2 other cases, however, late gadolinium enhancement showed significant anomalies characterized in one patient by extensive areas of subepicardial fibrosis of the left ventricle, suitable with arrhythmogenic left dominant dysplasia; in another patient, a marked trabeculation of left ventricular medium apical segments suitable with non-compaction myocardium was present. CMR may identify cases of structural heart disease in subjects with OT PVCs and apparently normal electrocardiogram and echocardiogram examinations. A preliminary screening with CMR may be considered before any further invasive electrophysiology assessment and therapeutic planning.

Rapid screening for cardiac arrhythmias in competition draft horses

Cardiac arrhythmias may cause decreased performance and sudden death during exercise. Our objectives were: (1) to determine prevalence of unrecognised arrhythmias in a population of competition draft horses by performing short duration screening electrocardiograms (ECGs) at rest; and (2) to assess utility of a commercial handheld device for recording equine ECGs. Owners or trainers of 244 draft horses (age 0.5-16 years), including 82 Percherons, 69 Belgians, 69 Clydesdales, 11 Belgian mules, 8 Shires, and 5 Percheron mules, were queried to determine signalment, performance history, and known arrhythmias. All horses were auscultated for 30 s and ECGs were obtained in 204 horses using a handheld recording device (AliveCor®). ECGs were reviewed for quality and used to determine heart rate (HR) and rhythm. When ECG tracing quality permitted, PQ and QT intervals were also measured. ECGs displaying RR intervals adequate for HR determination and rhythm assessment were recorded from 161 horses (79%) while tracings with consistent P waves, QRS complexes, and T waves were recorded from only 47 horses (23%). Four arrhythmias were detected by both auscultation and ECG: atrial fibrillation (1), premature complexes (1), and second-degree atrioventricular block (2). None of these horses had a history of poor performance or previous recognition of an arrhythmia. The prevalence of unrecognised, and potentially clinically significant, arrhythmias in draft horses at rest appears to be low (2/244; 0.8%, 95% confidence interval 0.1-2.9%). Longer recordings at rest, as well as recordings during and immediately after exercise, would likely have revealed a higher prevalence of arrhythmias.

Identification of Two Novel LAMP2 Gene Mutations in Danon Disease

BackgroundDanon disease is a rare X-linked inherited disorder characterized by massive left ventricular hypertrophy, skeletal muscle dystrophy, and mental retardation. The disease is caused by mutations in the LAMP2 gene encoding for lysosome-associated membrane protein-2. MethodsTwo young male patients with hypertrophic cardiomyopathy, characterized by marked, concentric left ventricular hypertrophy, elevated levels of creatine kinase, and manifest limb-girdle muscular dystrophy in 1 case, were investigated. Genetic screening included direct sequencing of the whole coding sequence of the LAMP2 gene. ResultsGenetic analysis identified 2 novel LAMP2 gene mutations. In Family A, a G-A transition (c.962G > A) leading to a nonsense mutation at codon 321 (p.Trp321Ter), and in Family B, a one-nucleotide insertion (c.973insC) leading to a full frame-shift (p.Pro324+24X) was detected in exon 8 of the LAMP2 gene. Family screening identified 8 mutation carriers, with 4 nonpenetrant cases and 3 additional, probably affected family members without DNA diagnosis. The cardiac phenotype was hypertrophic cardiomyopathy in all cases, including female mutation carriers. Five disease-related deaths occurred in the families, at an average age of 33 ± 16 years, which was clearly lower in male than in female patients (28 ± 7 vs 42 ± 25 years). A high prevalence of arrhythmias or conduction abnormalities was also observed. ConclusionsThe reported 2 novel LAMP2 gene mutation carrier families, one of them being one of the largest reported to date, highlight the malignant clinical course of Danon disease, characterized by a high rate of disease-related death at an early age and a high prevalence of arrhythmias or conduction abnormalities.

Arrhythmias in Children Having a Single Left Superior Vena Cava and Minimal Structural Heart Disease

The presence of a single left superior vena cava in the absence of complex congenital heart disease is uncommon, and, in the absence of hemodynamic consequences, it would not be expected to result in cardiovascular signs or symptoms. Single case reports and our anecdotal experience suggested to us that this anomaly is highly associated with cardiac arrhythmias. We sought to describe the clinically important arrhythmias in a population of young patients having this anomaly. A retrospective chart review was performed from all patients <20 years old and who were determined by echocardiography over an 11-year-period to have a single left superior vena cava and minor or no coexisting congenital heart defects. The prevalence of nonsinus pacemaker, age-corrected sinus rate percentile, and prevalence of brady- or tachyarrhythmias was compared with a control group of patients having bilateral superior vena cavae. Eight patients having a single left and 55 patients having bilateral superior vena cava(e) were identified. The existence of this anomaly tended to be associated with a lower age-corrected sinus rate percentile (17.5% vs 75%, P = 0.09), and was associated with a higher prevalence of arrhythmias (50% vs 7%, P = 0.014) compared with the control group. In the study group, one patient each had clinically relevant sinus node dysfunction, third-degree AV block, Wolff-Parkinson-White syndrome and atrial fibrillation, and AV nodal reentrant tachycardia. Even in the absence of symptoms, patients found to have a single left superior vena cava should be monitored long-term for clinically important arrhythmias.

Arrhythmia and conduction disturbances in patients with congenital heart disease during pregnancy: multicenter study.

The incidence, manifestation and management of arrhythmia in congenital heart disease (CHD) during pregnancy were evaluated in a multicenter study. Of 126 pregnancies in patients with CHD in 17 institutions from January 1991 to December 2000, 29 cases of pregnancy in 27 patients after cardiac repair (mean age, 29+/-4.9 years) were identified with arrhythmias (supraventricular tachyarrhythmia (SVT) in 15, ventricular tachycardia (VT) in 9, high-grade atrioventricular block in 4 and sick sinus syndrome in 3) (group A) and 29 control pregnancies from 29 patients with repaired CHD and no arrhythmias (group B). SVT tended to require anti-arrhythmic medication more than VT (10/15 vs 2/9, p=0.04). Nine different types of anti-arrhythmic agents were successfully administered without maternal complications. There were no maternal deaths in either group. In the comparison of group A with group B, there was lower cardiac functional class (8/29, p=0.04), higher incidence of polysplenia (4/29, p=0.04), and higher incidence of low-birthweight infant (7/29, p=0.02) in the former. It appears that there is a high prevalence of arrhythmias during pregnancy in patients with repaired CHD. Patients with CHD and low cardiac functional class and/or polysplenia could have arrhythmia during pregnancy that results in a low-birthweight infant. Meticulous care for these patients during pregnancy is recommended.

High prevalence of arrhythmias in elderly male athletes with a lifelong history of regular strenuous exercise

ObjectiveTo characterise cardiac arrhythmias and cardiac autonomic function in 11 elderly men (mean (SD) age 73.2 (2.8) years) with a lifelong history of regular very strenuous exercise. A control group...

Specific sequelae after Fontan operation at mid- and long-term follow-up: Arrhythmia, liver dysfunction, and coagulation disorders

Patients who have undergone a Fontan-type operation usually have an elevated systemic venous pressure. To determine the sequelae of this nonphysiologic condition, we evaluated 66 patients 1 to 14 years after a Fontan-type operation. Fifty-one patients were apparently in good clinical condition, and 15 patients had symptoms and were restricted in their daily life. Bicycle exercise capacity, tested in 41 patients, ranged from 50% to 110% (mean 85%) of the predicted value for length. In 16 patients, a decreased capacity (< 85%) was, among others, related to arrhythmias and the presence of protein-losing enteropathy. A 24-hour ambulatory electrocardiogram was available in 56 patients and found to be normal in 32 (57%) patients. Arrhythmias were present in 21 patients, six of whom had symptoms. Three patients had previous pacemaker implantation. One or more abnormalities in liver enzyme and function tests were present in 40 patients (61%) and in coagulation factors in 46 patients (69%). The most pronounced was a protein C deficiency, a known thrombotic risk factor, present in 41 patients. The occurrence of arrhythmias increased with time of follow-up (p < 0.004), the occurrence of protein C deficiency decreased with time (p < 0.0001), and the occurrence of abnormal liver enzyme and function tests was not related to time of follow-up. With regard to age at operation, arrhythmias did not occur in patients who underwent operation at a mean age of 4 +/- 1.9 years (standard deviation), in contrast to patients who underwent operation at a mean age of 7.6 +/- 4 years (standard deviation) (p < 0.001). The occurrence of the two other types of sequelae was not related to the age at operation. With regard to the type of operation, only patients with a valved right atrium-to-pulmonary artery connection had a higher prevalence of arrhythmias than patients with a nonvalved or direct right atrium-to-pulmonary artery connection (p < or = 0.001). The latter patients also had a higher prevalence of protein C deficiency (p < or = 0.001). No relationship was found among the other types of operation, the underlying structure, or the hemodynamic condition measured at rest and the presence of arrhythmias, abnormal liver enzyme and function tests, or protein C deficiency. This point survey shows that even patients with an apparently good clinical condition are at risk for arrhythmias, abnormal liver enzyme and function tests, and coagulation factor abnormalities. Serial statement of affairs is recommended to ensure that adequate preventive measures can be taken.

Determinants of Ventricular Arrhythmias in Cardiac Hypertrophy

Ventricular arrhythmias occur with increased frequency in both experimental and human cardiac hypertrophy. Although the process of hypertrophy itself may be arrhythmogenic, other factors may contribute to the high prevalence of arrhythmias in hypertensive patients with left ventricular hypertrophy (LVH). Disease of the large epicardial coronary arteries or of the small intramyocardial vessels (coronary microangiopathy) may lead to myocardial ischemia and thus predispose to arrhythmia. Myocardial fibrosis, a common sequelae of cardiac hypertrophy, has also been shown to be associated with ventricular arrhythmias in experimental models. Other possible determinants of ventricular arrhythmias in this group of patients include metabolic abnormalities; studies relating to the importance of hypokalemia in particular have yielded conflicting results. Thus a number of factors may combine to explain the high prevalence of ventricular arrhythmias in hypertensive patients with LVH.

Effect of Ibopamine, a Dopamine Congener, on Arrhythmias in Heart Failure

Patients with heart failure exhibit a high prevalence of both ventricular and supraventricular arrhythmias, and the ventricular arrhythmias are characterized by multiform, bigeminal and paired beats as well as nonsustained ventricular tachycardia. The prognosis of heart failure is severe and approximately half of the patients die suddenly. In view of the high prevalence of arrhythmias in heart failure and the complex ventricular arrhythmias, it is important to consider the effect of antifailure treatment on such arrhythmias. Dopaminergic drugs represent one interesting therapeutic alternative. Ibopamine is an orally active dopaminergic substance and acts mainly as a vasodilator in patients with heart failure. According to published investigations on ibopamine in heart failure, this drug does not seem to have a proarrhythmic effect.

Exercise-induced arrhythmias in diuretic-treated patients with uncomplicated systemic hypertension

Although hypertensioe patients have been shown to have a higher prevalence of arrhythmias during ambulatory monitoring when treated with diuretic drugs than when untreated, the effects of maximal aerobic stress on arrhythmia frequency in such patients is unknown. The incidence of arrhythmias during graded maximal treadmill exercise in a group of 68 subjects with mild, clinically uncomplicated systemic hypertension treated chronically with diuretics alone for a median of 4.5 years was compared with that in an age-matched normotensive control group. The prevalence of exercise-induced arrhythmias was higher in the group treated with diuretics, than in the control group, 57% vs 38% (p <0.05) This difference was entirely due to the higher incidence of isolated atrial or ventricular premature complexes in the diuretic-treated patients, 44% vs 26% (p <0.05). There was no difference in the incidence of frequent (more than 10% of beats) or complex supraventricular or ventricular premature complexes between the diuretic-treated and control groups. Within the diuretic group, no difference in the incidence of simple or complex arrhythmia was found between men and women, between those with and those without rest or exercise-induced electrocardiographic abnormalities or between those with a serum potassium level of less than 3.7 mEq/liter vs those with a level of 3.7 mEq/liter or greater. Thus, patients with uncomplicated hypertension treated with chronic diuretic monotherapy do not appear to be at increased risk for major arrhythmias during aerobic exercise.