Holter Electrocardiogram Monitoring Research Articles

Left atrial strain after paroxysmal atrial fibrillation linac-based cardiac radioablation in elderly population.

Catheter ablation of atrial fibrillation (AF) may increase the risk of complication in aged patients. Stereotactic arrhythmia radioablation (STAR) is a non-invasive therapeutic alternative for cardiac arrhythmia. This sub-study evaluated left atrial strain (LAS) in elderly AF patients underwent STAR. Symptomatic paroxysmal AF patients aged > 70 years, with antiarrhythmic drugs failure or intolerance, enrolled in a phase II trial that have demonstrated the feasibility of LINAC-based STAR (total dose of 25Gy single fraction delivered in 3min), performed a 15-day electrocardiogram Holter monitoring to detect AF episodes (≥ 30s) and an echocardiographic LAS evaluation before and after STAR (at 1-, 3-, 6- and 12-month). Out 18 patients underwent STAR in the trial, 16 (7 males, 78 ± 5 years) completed the follow-up for LAS study. No baseline difference in echocardiographic and LAS parameters was observed between the 9 patients with AF recurrence during follow-up and those who maintained sinus rhythm. At 6- and 12-month after STAR, LAS reservoir was lower in patients with AF episodes than those without (respectively, p = 0.039 and p = 0.001). Values of left atrial area and volume as well as LAS conduit and contractile phase were not statistically significant different by patient's outcome across evaluations. Although no baseline LAS parameter before STAR seems predict AF recurrence after treatment in elderly patients, lower values of reservoir phase were observed during follow-up in those experiencing AF episodes. More research is needed to better assess the value of LAS monitoring in paroxysmal AF patients underwent Stereotactic cardiac radioablation.

Left Atrial Reservoir Strain and Recurrence of Atrial Fibrillation Following De-Novo Pulmonary Vein Isolation - Results of the ASTRA-AF Pilot Study.

Achieving early rhythm control and maintaining sinus rhythm are associated with improved outcomes in patients with atrial fibrillation (AF). Pulmonary vein isolation (PVI) is a validated alternative to medical rhythm control. This study determined associations between left atrial strain reservoir (LASR) and AF recurrence after PVI.Methods and Results: In all, 132 patients (88 with paroxysmal AF [PAF], 44 with persisting AF [PersAF]) who presented in sinus rhythm for de novo PVI of AF between December 2017 and January 2019 were included in the study. All patients underwent preprocedural echocardiography. After 12 months, all patients underwent 24-h Holter electrocardiogram monitoring to screen for AF recurrence. Kaplan-Meier curve analysis revealed an association between decreasing LASRand increased AF recurrence, with a cut-off at 31.4%. In univariable Cox regression analysis, LASRdemonstrated an association with AF recurrence, with hazard ratios (HR) of 0.83 (95% confidence interval [CI] 073-0.93; P=0.001) per 5% increase in univariable models and 0.83 (95% CI 073-0.95; P=0.005) in multivariable analysis. When clinical variables with age, sex and type of AF (PAF/PersAF) were included in the multivariable analysis, LASRremained relevant in a model with age (HR 0.86; 95% CI 073-1.00; P=0.046). In patients undergoing de novo PVI for AF, LASRcould be of use in risk stratification regarding AF recurrence.

Interpretation of electrocardiograms and results of daily ECG Holter monitoring in patients with an implanted cardiac contractility modulator

Cardiac contractility modulation (CCM) is a method of non-drug treatment of chronic heart failure (CHF) in patients with no indications for resynchronization therapy. Now, a detailed study of this method and its capabilities is ongoing, and the indications for its use are expanding. As with any other implantable device, it is important to be able to monitor the operation of the CCM, identify its dysfunction and promptly refer patients to specialized institutions. Assessment of the function of CCM- therapy can be carrying out by recording a standard 12‑channel electrocardiogram (ECG), as well as 24‑hour Holter ECG monitoring (HM-ECG). The mechanism of action of CCM-therapy is fundamentally different from that of other implantable devices. Knowledge of the features of the manifestation of CCM-therapy during instrumental studies is necessary for their correct interpretation.

Evaluation of the Diagnostic Performance and Efficacy of Wearable Electrocardiogram Monitoring for Arrhythmia Detection after Cardiac Surgery.

Postoperative atrial fibrillation (A-fib) is a serious complication of cardiac surgery that is associated with increased mortality and morbidity. Traditional 24-hour Holter monitors have limitations, which have prompted the development of innovative wearable electrocardiogram (ECG) monitoring devices. This study assessed a patch-type wearable ECG device (MobiCARE-MC100) for monitoring A-fib in patients undergoing cardiac surgery and compared it with 24-hour Holter ECG monitoring. This was a single-center, prospective, investigator-initiated cohort study that included 39 patients who underwent cardiac surgery between July 2021 and June 2022. Patients underwent simultaneous monitoring with both conventional Holter and patchtype ECG devices for 24 hours. The Holter device was then removed, and patch-type monitoring continued for an additional 48 hours, to determine whether extended monitoring provided benefits in the detection of A-fib. This 72-hour ECG monitoring study included 39 patients, with an average age of 62.2 years, comprising 29 men (74.4%) and 10 women (25.6%). In the initial 24 hours, both monitoring techniques identified the same number of paroxysmal A-fib in 7 out of 39 patients. After 24 hours of monitoring, during the additional 48-hour assessment using the patch-type ECG device, an increase in A-fib burden (9%→38%) was observed in 1 patient. Most patients reported no significant discomfort while using the MobiCARE device. In patients who underwent cardiac surgery, the mobiCARE device demonstrated diagnostic accuracy comparable to that of the conventional Holter monitoring system.

Effects of chronotype on sleep, mood and cardiovascular circadian rhythms in rotating night shift medical workers.

Whether chronotype affects the health outcomes of night shift work populations is unknown. This study aimed to assess the influence of different chronotypes in the rotating night shift population on sleep status, mood, blood pressure (BP), and heart rate variability (HRV), as well as the circadian rhythm of BP and HRV. A total of 208 rotating night shift workers were included. All participants completed structured questionnaires to assess chronotype, mood and sleep status. During their daily lives outside of the night shift, they underwent 24-hour Holter electrocardiogram monitoring and 24-hour ambulatory blood pressure monitoring. Day-time and night-time BP and BP dipping were obtained. Day-time and night-time HRV values (SDNN, RMSSD, LF, HF, LF nu, SD1, SD2 and SD2/SD1) were calculated and fitted to the cosine period curve. Three circandian parameters (mesor, amplitude and acrophase) were extracted to quantify the circadian rhythm of the HRV indices. Among all three groups, E-type showed more fatigue and sleepiness. In addition, E-type showed blunted diastolic BP dipping. Notably, E-type showed association with higher RMSSD, LF, HF and SD1 in the night time, and higher mesors of RMSSD and LF and amplitude of SD2/SD1 in circadian analysis. Chronotype is a factor affecting fatigue, sleepiness and cardiovascular circadian rhythms of rotating night shift workers. Chronotype should be taken into consideration for managing night-shift rotation to promote occupational health.

Brugada syndrome: variability of clinical and genetic characteristics

AIM: To evaluate the clinical characteristics of patients with diverse genetic variants of Brugada syndrome.
 MATERIALS AND METHODS: 24 patients (17 male and 7 female) aged 18 to 55 years (median age 32.5 [20; 42] years) with a pattern of Brugada syndrome on electrocardiogram were observed for 3 years. From their ECGs, a type 1 pattern was found in 9 (37.5%) of these patients, type 2 pattern in 14 (58.3%) and type 3 pattern only in 1 patient. The clinical and instrumental study included 12-lead electrocardiogram, 24-hour Holter electrocardiogram monitoring, provocative drug test with intravenous administration of sodium channel blockers (novocainamide), electrophysiologic study according to indications, genealogical history collection and family history of sudden cardiac death, transthoracic echocardiography and cardiac magnetic resonance imaging to detect structural myocardial changes. High-throughput sequencing was utilized to search for mutations in genes linked to the onset of channelopathies and other inherited rhythm disorders.
 RESULTS: In 15 (62.5%) of the 24 probands included in the study, variants of the nucleotide sequence of pathogenicity classes III–V according to The American College of Medical Genetics and Genomics criteria (2015) were found in genes encoding sodium (SCN5A, SCN10A) and potassium (KCNE3, KCNJ2, KCNJ8, KCNA5) channels, as well as in HCN4 and SNTA1 genes linked with these channels. Moreover, 3 variants were identified in ANK2 gene associated with ankyrinopathies, and 3 variants in DSP and DES genes connected with arrhythmogenic right ventricular cardiomyopathy. Four genetic variants in SCN5A gene were of pathogenicity classes IV and V, the rest were variants of uncertain clinical significance (class III). Six (40.0%) of the 15 genotype-positive patients had several genetic variants. The most severe form of the disease, manifested by the development of ventricular fibrillation with successful resuscitation and subsequent cardioverter-defibrillator implantation, was observed in patients with mutations in SCN5A, SCN10A genes. Recurrent syncope, polymorphic ventricular tachycardia induced by programmed ventricular stimulation during electrophysiologic study, followed by cardioverter-defibrillator implantation were observed in patients with variants KCNJ8 and HCN4, DES and MYH11. In 2 patients with clinical manifestations, no mutations were identified. 13 (54.2%) patients were asymptomatic, while 3 of them had pathogenic and likely pathogenic mutations in SCN5A gene, as well as variants of uncertain clinical significance.
 CONCLUSION: Thus, this study examined various genetic variants in patients with Brugada syndrome based on their clinical manifestation. The impact of the genotype on the Brugada syndrome phenotype is not unambiguous. The most severe form of the disease with the development of ventricular fibrillation and successful resuscitation with subsequent cardioverter-defibrillator implantation was observed mainly in patients with variants in several genes (SCN5A and JUP, KCNJ8 and HCN4, DES and MYH11). This substantiate the idea that Brugada syndrome, along with monogenic, may also have a polygenic nature of the disease, in which the clinical phenotype is determined by variants in respective genes linked to the onset of cardiovascular disorders.

Intravenous Cavutilide for Pharmacological Conversion of Paroxysmal and Persistent Atrial Fibrillation in Patients with Heart Failure.

In this retrospective cohort study, 58 patients with stable HF (aged 69 [61;73] years, 30 males, 78% with persistent AF) and 274 patients without HF (aged 63 [57;70] years, 196 males, 56% with persistent AF) were included. The median AF duration in the group with HF was 35.5 [10.6;124] days, and that in the group without HF was 14.5 [3.6;90] days. All patients received 5-30 µg/kg cavutilide intravenously in one to four (if needed) boluses of 5-5-10-10 µg/kg at 15 min intervals. Subsequent boluses were not administered if the patient's sinus rhythm (SR) was restored or if bradycardia, QT prolongation > 500 ms or evidence of proarrhythmia was observed. Holter electrocardiogram monitoring was started before infusion and was continued for 24 h. The main criterion for an antiarrhythmic effect was sinus rhythm restoration within 24 h of the initial bolus. Cavutilide converted AF to SR in 37.9% of patients with HF after bolus 1 (5 µg/kg), in 58.6% after bolus 2 (cumulative dose = 10 µg/kg), in 74% of cases after bolus 3 (cumulative dose = 20 µg/kg) and in 92.8% of cases after bolus 4 (cumulative dose = 30 µg/kg). Cavutilide was effective in 89% of cases with persistent AF with a median duration of 70.5 [30;159] days and in 92% of cases with paroxysmal AF with a median duration of 36 [24;102] h. In the group of patients without HF, the effectiveness of bolus 1 was 36.9%, that of the bolus 2 was 58%, that of the bolus 3 was 77% and that of the bolus 4 was 90.1%. Cavutilide restored SR in 90% of patients with persistent AF with a median duration of 82.5 [28;180] days and in 90% of cases with paroxysmal AF with a median duration of 50 [24;120] h. No statistically significant difference in the probability of SR restoration or the effectiveness of each bolus of cavutilide was found between patients with and without HF. The median time to restoration of SR in patients with HF was 23 [11;55] min, and that in patients without HF was 22 [10;45] min (p = 0.424). No cases of symptomatic/severe bradycardia were observed in either group. QT prolongation over 500 ms after cavutilide injection was registered in 19% of patients without HF and in 15.5% of those with HF (p = 0.58). Short runs of Torsade de pointes tachycardia occurred in one patient (0.4%) without HF after 10 µg cavutilide administration and were successfully treated with MgSO4. Cavutilide demonstrated a high likelihood of AF conversion to SR in paroxysmal (92%) and persistent (89%) arrhythmia and HF. Concomitant HF and its severity do not affect the efficacy and safety of cavutilide.

Inflammation and autonomic balance in cirrhosis: Association between sympathetic nervous system and osteopontin, interleukin‐22, interleukin‐6 and interleukin‐1Ra concentrations according to portal hypertension and disease severity

AbstractBackgroundThe autonomic nervous system is linked to hyperdynamic circulation in cirrhosis and several studies have highlighted the crucial role that systemic inflammation elicits in altering sympathovagal equilibrium with the consequent reduction in heart rate variability (HRV).To investigate the correlation between time‐domain HRV parameters, serum cytokines concentrations and portal hypertension, we studied a cohort of patients with cirrhosis, accounting for etiology and treatments.MethodsIn this cross‐sectional, observational cohort study, 107 outpatients with non‐alcoholic cirrhosis were assessed consecutively by abdominal ultrasound and by upper gastrointestinal endoscopy to search for esophagogastric varices. 24‐h electrocardiogram Holter monitoring with time‐domain HRV measurement (square root of the mean of successive differences of Normal‐to‐Normal [NN] [RMSSD], standard deviation or the square root of variance [SDNN] and standard deviation of the means of the NN intervals calculated over a 5‐min period [SDANN]) was performed and serum concentrations of osteopontin (OPN), interleukin (IL)‐22, IL‐6, IL‐1Ra and IL‐17 were obtained in all patients.ResultsIL‐6, OPN, IL‐22 and IL‐1Ra concentrations in cirrhotic patients were associated with disease severity expressed by Child‐Pugh and MELD score, to some portal hypertension's indirect signs and some of its complications. A significant increase in systemic concentrations of OPN in patients with hepatocellular carcinoma was encountered. SDANN and SDNN values were indirectly related to serum levels of IL‐6, OPN, IL‐1Ra and IL‐22.ConclusionsThis study underlines the interaction between the alteration of the ANS and the activation of inflammatory pathways that characterize cirrhosis taking into account clinical characteristics and treatments.

Heart Rate Variability Indices of Student Pilots Undergo Modifications During Flight Training.

INTRODUCTION: Heart rate variability (HRV) indicates the temporal fluctuation of the intervals between adjacent beats. HRV expresses neuro-cardiac activity and is generated by heart-brain interactions and dynamics related to the function of the autonomous nervous system and other components. To investigate this issue, we started a series of experiments by coupling the flight tasks of student pilots and their HRV.METHODS: Before each experimental session, the participating student was fitted with a five-electrode, three-channel Holter electrocardiogram monitor. We defined three time-phases for each training mission: before flight operations on the ground, during flight operations, and after flight operations on the ground. The HRV analysis was performed by quantifying some indices of the time domain and the frequency domain.RESULTS: The analysis of RR-wave intervals revealed two types of trends: 1) students whose RR intervals decreased during flight operations compared to before flight ground operations; and 2) students whose RR intervals increased during flight operations compared to before flight ground operations. These differences found in the RR intervals produced changes in the indices of both the time and frequency domains of the two students' samples.DISCUSSION: Flight training involves regular and advanced tasks and/or emergency situations. When this happens, the total power of the heart decreases because the RR intervals are forced toward low values. Flight activity involves continuous demanding tasks that can be potentially read by an analysis of the HRV; a high HRV ensures better management of tasks that require a greater commitment of cardiovascular function.Li Volsi G, Monte IP, Aruta A, Gulizzi A, Libra A, Mirulla S, Panebianco G, Patti G, Quattrocchi F, Bellantone V, Castorina W, Arcifa S, Papale F. Heart rate variability indices of student pilots undergo modifications during flight training. Aerosp Med Hum Perform. 2023; 94(11):835-842.

The influence of combined effects of hyperbaria and hyperoxia on human heart rate variability during exercise strain

With the participation of 8 male volunteers, the dynamics of values of heart rate autonomic regulation were studied at response to physical load on a bicycle ergometer twice: both respirating by the room air under normobaric environment and simulating effects of the altered hyperoxic respiratory gas mixture (HRGM) by the rebreathe respiration methods from a rebreather at the high-pressure chamber (at «depth» 7 m). The devices and methods of Holter electrocardiogram monitoring were used under 24 hours research. The specialized software to analyze the data was used. The electrocardiogram (ECG) and calculated time series of cardiac intervals data obtained were subjected to mathematical processing to calculate statistical and spectral values of heart rate variability (HRV). Additionally, the geometric and nonlinear analysis methods of HRV were investigated. It has been established that influencing factors (compound and pressure of the HRGM) affect the autonomic regulation of heartbeats both at rest and during physical load. Clinical practitioners the HRV values are studied at rest and during strictly regulated tests, i.e. in stationary conditions. The analysis of non-stationary processes, for example, when it is necessary to continuously analyze data, the so-called transient processes under increasing psychological stress, to assess changes in the autonomic regulation of the heart during breathing of gas mixtures with different compositions (hypoxic therapy, hyperbaric oxygenation, etc.), and, especially during physically upload are used the methods of nonlinear and geometric analysis of HRV that are independent of the degree of nonstationary processes and, to some extent, of artifactual cardiac intervals. During the breathing the respiratory gas mixtures with an increased substance of O2 under conditions of high pressure, the activity of the parasympathetic branches of the autonomic nervous system (ANS) significantly increases. The nonlinear dynamics indexes reflect significant differences in the activity of autonomic components under experimental conditions in the direction of strengthening the parasympathetic links of the ANS. The use of nonlinear analysis values is more acceptable when evaluating obtained of non-stationary processes. In general, the study confirms that the regulatory response to the effects of hyperbaria and hyperoxia when performing a bicycle ergometer test with stepwise increase exercise strain is manifested by the prevalence of the activity of the parasympathetic part of the ANS autonomic regulation of cardiac rhythm compared to regular room air and barometric pressure.

Parkinson´s disease cardiovascular symptoms: A new complex functional and structural insight.

The known impairments of the cardiovascular system in Parkinson´s disease (PD) are caused by autonomic dysfunction and manifested mainly in postural hypotension, chronotropic insufficiency, and reduced heart rate variability. Other dysfunctions, mainly stress response, arrhythmia occurrence, and heart morphology changes, are still the subject of research. To assess the heart rate and blood pressure reaction during exercise, advanced measurements of heart volumes and mass using cardiac magnetic resonance (CMR), and occurrence of arrhythmias in PD patients. Thirty PD patients (19 men, mean age 57.5 years) without known cardiac comorbidities underwent bicycle ergometry, electrocardiogram Holter monitoring and CMR. Exercise and CMR parameters were compared with controls (24 subjects for ergometry, 20 for CMR). PD patients had lower baseline systolic blood pressure (SBP) (117.8 vs. 128.3 mmHg, p < 0.01), peak SBP (155.8 vs. 170.8 mmHg, p < 0.05), and lower heart rate increase (49.7 vs. 64.3 beats per minute, p < 0.01). PD patients had higher indexed left and right ventricular end-diastolic volumes (68.5 vs. 57.3, p = 0.003 and 73.5 vs. 61.0 mL/m2 , respectively) and also indexed left and right ventricular end-systolic volumes (44.1 vs. 39.0, p = 0.013 and 29.0 vs. 22.0 mL/m2 , p = 0.013, respectively). A high prevalence of atrial fibrillation (8 subjects, 26.7%) was found. This novel study combining functional and structural approaches showed that PD is linked with weaker blood pressure and heart rate reaction during exercise, increased myocardial mass and heart volumes compared to controls, and a high prevalence of atrial fibrillation.

Twelve-Lead ECG, Holter Monitoring Parameters, and Genetic Testing in Brugada Syndrome: Insights from Analysis of Multigenerational Family with a History of Sudden Cardiac Arrest during Physical Activity.

Brugada syndrome (BrS) is an arrhythmogenic disorder increasing the risk of syncopal episodes and sudden cardiac death. BrS usually runs through families with reduced penetrance and variable expression. We analyzed the multigenerational family of a patient who died after sudden cardiac arrest with post-mortem diagnosis of BrS. We analyzed clinical history, comprehensive arrhythmic risk, genetic findings, and additional tests, including electrocardiogram (ECG), detailed 24-hour Holter ECG results, and standard echocardiography findings, and followed up the patients in the ambulatory clinic. We analyzed a pedigree of 33 members of four generations of the family (19 male and 14 female patients). In this family, we identified 7 patients with BrS (median Modified Shanghai Score and Sieira model: 4.5 (4-6) and 1 (0-4) points, respectively), including both parents of the deceased patient, and 8 relatives with negative sodium channel blocker drug challenge test. Genetic testing revealed a novel mutation in sodium voltage-gated channel alpha subunit 5 (SCN5A) c.941A>G, (p.Tyr314Cys) inherited from the father of the proband. Patients with BrS were characterized by longer P-wave duration (120 (102-155) vs. 92.5 (88-110) ms, p = 0.013) and longer PR intervals (211.3 ±26.3 vs. 161.6 ± 18.9 ms, p = 0.001), along with more frequent positive aVR sign, but did not differ in terms of QRS duration or T-wave characteristics in resting ECGs. BrS patients were characterized by lower mean, minimal, and maximal (for all p ≤ 0.01) heart rates obtained from Holter ECG monitoring, while there was no difference in arrhythmias among investigated patients. Moreover, visual diurnal variability of ST segment changes and fragmented QRS complexes were observed in patients with BrS in Holter ECG monitoring. There were no major arrhythmic events during median follow-up of 68.7 months of alive BrS patients. These results suggest ECG features which may be associated with a diagnosis of BrS and indicate a novel SCN5A variant in BrS patients. Twelve-lead Holter ECG monitoring, with modified precordial leads placement, may be useful in BrS diagnostics and risk stratification in personalized medicine.

Clinical and Laboratory Parameters and Complication Rates In Patients With Myocardial Infarction Without Obstructive Coronary Artery Disease

To evaluate clinical, anamnestic and laboratory data and the incidence rate of complications in patients with myocardial infarction (MI) without obstructive coronary artery (CA) disease. This study included 158 patients with MI without obstructive CA disease (main group), 150 patients with MI and obstructive CA disease (comparison group), and 55 patients without documented ischemic heart disease (IHD) (control group). Clinical and anamnestic data, carbohydrate and lipid metabolism, concentrations of high-sensitivity troponin and C-reactive protein (CRP) were evaluated, and electrocardiography, Holter electrocardiogram monitoring, echocardiography, and coronary angiography were performed for all patients. The incidence rate of MI without obstructive CA disease was 1.9%, which was in general consistent with international data. Patients with MI without obstructive CA disease were somewhat younger than patients of the comparison group. Traditional risk factors, such as arterial hypertension (AH), acute cerebrovascular disease, diabetes mellitus (DM), and obesity were more frequently observed in patients with MI and obstructive CA disease, but the body weight index was significantly higher in MI patients without obstructive CA disease. The multivariate regression analysis identified the most significant factors associated with the development of MI in the group without obstructive CA disease: lipid metabolism disorders, AH, DM, male gender, smoking, and family history of IHD. Patients with MI without obstructive CA disease had a lower troponin level but a higher CRP level. Patients with MI without obstructive CA disease had a higher left ventricular (LV) ejection fraction (EF); acute heart failure (AHF), acute LV aneurism, and arrhythmias were the most frequent complication in this group. Patients with MI without obstructive CA disease had a higher LV EF, and their most frequent complications were AHF, acute LV aneurism, and arrhythmias.

Five-Year Experience of Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation from a Tertiary Cardiac Care Center of Pakistan: A Retrospective Chart Review

Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using second-generation cryoballoon, Arctic Front Advance, Medtronic (CB-Adv) as a rhythm control strategy for drug-resistant paroxysmal atrial fibrillation (PAF) in a cardiac tertiary care center of Pakistan. Methodology: Fifty patients had PVI with CB-Adv for symptomatic drug-resistant PAF at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, during 2017-2022. Patients were followed-up in the clinic on the 1st, 3rd, and 6th month after the ablation. Twenty-four hours of Holter monitoring of electrocardiogram was obtained on each visit. We conducted a retrospective chart review after approval from the ethical review committee. We collected all the patients' demographic and clinical data, procedural results, and reports of Holter monitoring. The primary outcome was successful PVI and freedom from atrial tachyarrhythmia (Ata) on a 6-month follow-up. Results: We enrolled all 50 patients (34 male, 68%; mean age 55.14 ± 7.94 years) treated with PVI using CB-Adv. The mean duration of symptoms was 30.28 ± 13.48 months. PVI with CB-Adv was found to be curative in 49 patients (98%). Following the procedure, pericardial effusion was found in one patient (2%), whereas one patient (2%) had a retroperitoneal hematoma. On a six-month follow-up, only one patient (2%) had a recurrence of Ata, which was PAF. Conclusion: Our experience of PVI with CB-Adv has shown a high success rate of the procedure for rhythm control in patients who have PAF, which is resistant to antiarrhythmic drugs (AADs).

Heart rate fragmentation as a marker of altered activity of the autonomic nervous system activity : a novel predictor of atrial fibrillation occurrence in the general population

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Unrestricted grant for fellowship support - Abbott Medical Background The dysfunction of the autonomic nervous system (ANS) plays an important role in atrial fibrillation (AF). However, the meaning of high heart rate variability (HRV) in predicting AF is still under debate due to conflicting results in population-based studies. Short-term HRV is conceptually attributed to physiologic vagal tone modulation. But recent data suggest that a component of short-term HRV, called heart rate fragmentation, is related to ANS breakdown and not to the parasympathetic activity. Purpose – To assess the predictive capacity of novel short-term HRV-derived metrics regarding the occurrence of AF in the general population during long-term follow-up. Methods – A cohort study was designed to prospectively assess the predictive value of ANS activity level among general population regarding cardiovascular events and mortality. 1011 subjects aged 65 were enrolled in the study from September 2000 to December 2002. The study population had no history of AF and a low cardiovascular risk. A median follow-up of 17.8 years was managed. HRV data were acquired by 24-h Holter electrocardiogram (ECG) monitoring at baseline and assessed by frequency domain and time domain methods. Heart rate fragmentation using the percentage of inflection points (PIP) and alpha 1-index (using fractal evaluation of NN intervals) were then calculated. The study outcome was the development of AF during follow-up, defined as a standard 12-lead ECG recording or Holter recording with ≥ 30 s of AF. Results – AF was diagnosed in 123 patients during the 18-year follow-up, representing a cumulative incidence of 13.4%. Using multivariate analysis, the occurrence of AF was independently predicted by the male gender (HR=1.96, 95%CI:1.31-2.94, p&amp;lt;0.01), a higher percentage of NN intervals that differ by more than 50 ms from the previous interval (pnn50) (HR=2.01, 95%CI:1.27-3.18, p&amp;lt;0.01), an increased percentage of inflection points (HR=2.48, 95%CI:1.47-4.18,p&amp;lt;0.01), and a reduced alpha 1 index (HR=1.63, 95%CI:1.04-2.55, p&amp;lt;0.01). Given these results, a predictive score was built up based on the 4 independent predictors (Figure 1A). A predictive score of AF occurrence during the 18-year follow-up was assigned to every patient from 0 to 4. Compared to the group of patients with a score of 0 (Figure 1B), AF occurrence was progressively increased in patients with a score of 2 (n=390, HR=5.93, 95%CI:0.82-43.08, p=0.08), of 3 (n=175, HR=12.75., 95%CI:1.75-92.83, p=0.01), and of 4 (n=55, HR=22.31, 95%CI:2.98-167.23, p&amp;lt;0.01). Conclusion (Figure 2) – Different markers of short-term HRV predict independently the AF occurrence in the general population aged 65, including markers of ANS breakdown gathered in metrics of heart rate fragmentation, such as an increased PIP and a reduced alpha 1-index. A clinical predictive score based on these predictors is able de segregate a population at high risk of AF occurrence among the general population.

P3 EXERTIONAL SYNCOPE AND VENTRICULAR ARRHYTHMIA IN A PATIENT WITH CARDIAC AMYLOIDOSIS

Abstract Systemic amyloidosis is a multisystem disorder caused by the misfolding, aggregation, and deposition of certain proteins in various organs and tissues. Cardiac involvement is common and worsens the prognosis. Atrial fibrillation is the most frequent arrhythmia in cardiac amiloidosis (CA), but many cases of ventricular arrhythmias (VA) and sudden cardiac death (SCD) have been described. We present a case of a 64–year–old man admitted following exertional syncope occurred after climbing a flight of stairs. His medical history included left gonarthrosis and surgery for right carpal tunnel syndrome one year before. Physical examination did not revealed signs of heart failure. A 12–lead electrocardiogram (ECG) showed a pseudoinfarction pattern with QS waves in V2 and V3 leads and low voltage in all limb leads. Routine blood tests revealed NT–pro–BNP 3436 pg/ml(n.v.0–125) and high–sensitive troponin T 67 pg/ml(n.v.&amp;lt; 58). A trans–thoracic echocardiogram showed left ventricle (LV) concentric thickening wall with granular and sparkling pat[1]tern, mild reduced ejection fraction, reduced global longitudinal strain with apical sparing, grade 3 diastolic disfunction, biatrial enlargement, mild mitral regurgitation, right ventricle free wall thickening (8 mm), mild reduced TAPSE, and mild pericardial effusion. Cardiac magnetic resonance (CMR) confirmed ventricular wall thickening with evidence at T1 mapping of interstitial infiltration more evident in the septum and inferior–lateral wall with apical savings. A total body 99mTc–HDP scintigraphy showed cardiac uptake with intensity similar to bone signal (Perugini Score 2) suggesting ATTR cardiac amyloidosis. Both kappa and lambda concentrations were normal. The genetic testing did not reveled mutations in the TTR gene. We concluded for a diagnosis of ATTR wild–type CA. The Holter ECG monitoring registered numerous ventricular ectopic beats and an episode of non–sustained ventricular tachycardia. A coronary angiography ruled out coronary artery disease. In consideration of the clinical–instrumental picture an ICD was implanted. Conclusions CA is still underdiagnosed. VA and SCD may further complicate the prognosis. Early diagnosis and adequate stratification of the arrhythmic risk are essential to ensure patients the best therapeutic strategies.

High-Burden Premature Atrial Contractions Predict New-Onset Atrial Fibrillation After Surgical Septal Myectomy

Although increased premature atrial contractions (PACs) reportedly predict atrial fibrillation (AF) in both general and specific (e.g., patients with stroke) populations, early postoperative AF (POAF) risk in patients with increased PAC burden who require cardiac surgery remains unclear. We examined the correlation between different preoperative PAC burdens and POAF in patients with obstructive hypertrophic cardiomyopathy (OHCM) who underwent surgical treatment. We analyzed 304 consecutively admitted patients with OHCM without previous AF who underwent isolated septal myectomy between January 2015 and December 2018. All patients underwent preoperative 24-hour Holter electrocardiogram monitoring. PACs were present in 259 patients (85.20%) and absent in 45 patients (14.80%). According to the cut-off PAC number of 100beats/24hours, there were 211 patients (69.41%) with low-burden PACs and 48 patients (15.79%) with high-burden PACs. AF after septal myectomy occurred in 73 patients, which consisted of 3/45 in the non-PAC group (6.67%), 47/211 in the low-PAC-burden group (22.27%), and 23/48 in the high PAC burden group (47.92%). POAF incidence was higher in both low- and high-burden patients than in patients without PAC (p <0.01). Multivariate logistic regression analyses demonstrated that high-burden PACs (p=0.02) and age (p <0.01) but not low-burden PACs (p=0.22) independently predicted POAF in patients with OHCM. The area under the receiver operating characteristic curve for preoperative PACs was 0.72 (95% confidence interval 0.66 to 0.79, p <0.01, sensitivity: 68.49%, specificity: 69.26%). In conclusion, POAF incidence was significantly higher in patients with preoperative high-burden PACs and can predict POAF in patients with OHCM.

Kryterii prohnozuvannia kardiovaskuliarnykh podii u khvorykh iz khvorobamy sertsia za rezultatamy kholterivskoho monitoruvannia elektrokardiohramy (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. This review is devoted to the current state of knowledge regarding the clinical value of Holter electrocardiogram monitoring to identify predictors of predicting future adverse cardiovascular events. The aim of the study. Based on the study of modern sources and the results of own research, analyze scientific studies on the criteria for predicting cardiovascular events with Holter electrocardiogram monitoring in patients with heart disease. Materials and methods. 52 sources of literature and the results of own research were analyzed, in which the role of Holter electrocardiogram monitoring in predicting adverse cardiovascular events was highlighted. Results. The analysis of the literature and the results of our own research prove that the indisputable advantage of Holter electrocardiogram monitoring is the detection of prognostic and unfavorable indicators of the risk of sudden cardiac death, which, of course, is extremely important in modern society. Conclusions. The high informativeness of Holter electrocardiogram monitoring for predicting future adverse cardiovascular events has been proven and the criteria for their prediction have been clarified.

Heart rate variability is associated with disease severity and portal hypertension in cirrhosis.

Autonomic nervous system activity in cirrhotic portal hypertension is linked to hyperdynamic circulation. Heart rate variability (HRV) is a validated noninvasive method to assess the sympathovagal balance. To investigate the correlation between HRV parameters and degree of portal hypertension, we studied a cohort of patients with cirrhosis accounting for etiology and treatments. In this cross-sectional, observational cohort study, 157 outpatients of both sex with nonalcoholic cirrhosis were assessed by upper gastrointestinal endoscopy to search for esophagogastric varices. Twenty-four-hour electrocardiogram Holter monitoring with 3 HRV parameters measurement [SD of the NN intervals, root mean square successive difference of NN intervals, and SD of the averages of NN intervals (SDANN)] according to time-domain analysis were performed in all patients. Sixteen patients with large esophagogastric varices underwent measurements of the HVPG and assessment of HRV parameters at baseline and after 45 days on carvedilol. The liver dysfunction, expressed by Child-Pugh class or MELD score, was directly related to root mean square successive difference of NN intervals and inversely related to SDANN. Presence of ascites was inversely related to SDANN and to SD of the NN intervals. Treatment with carvedilol had an inverse relation with SDANN. Presence and size of esophagogastric varices had an inverse relation to SDANN and SD of the NN intervals. Upon multivariate analysis the associations between SDANN and Child-Pugh class, size of varices and ascites were confirmed. In the subgroup of 16 patients undergoing HVPG measurement, pressure gradient was unrelated to heart rate and HRV parameters. Time-domain HRV parameters in patients with cirrhosis, confirm the autonomic nervous system alteration, and their correlation to the degree of portal hypertension suggesting a role of the ANS in hepatic decompensation.

The role of growth differentiation factor-15 in assessing the prognosis of patients after uncomplicated myocardial infarction

Aim To study the role of growth differentiation factor 15 (GDF-15) in the long-term prognosis for patients after uncomplicated myocardial infarction (MI).Material and methods This study included 118 MI patients aged &lt;70 years with and without ST-segment elevation on electrocardiogram (ECG). All patients underwent an examination that included ECG, echocardiography, Holter ECG monitoring, routine laboratory tests, and tests for plasma N-terminal pro-brain natriuretic peptide (NT-proBNT) and GDF-15. GDF-15 was measured by ELISA. The dynamics of patients was evaluated by interviews at 1, 3, 6, and 12 months. The endpoints were cardiovascular death and hospitalization for recurrent MI and/or unstable angina.Results Median concentration of GDF-15 in MI patients was 2.07 (1.55; 2.73) ng/ml. No significant dependence was found between GDF-15 concentration and age and gender, MI localization, smoking, body weight index, total cholesterol, and low-density lipoprotein cholesterol. During 12-month follow-up, 22.8 % of patients were hospitalized for unstable angina or recurrent MI. In 89.6 % of all cases of recurrent events, GDF-15 was ≥2.07 ng/ml. For patients with GDF-15 in the upper quartile, the time dependence of recurrent MI was logarithmic. High concentrations of NT-proBNP in MI patients were also associated with increased risk of cardiovascular death and recurrent cardiovascular events [RR, 3.3 (95 % CI, 1.87-5.96), р=0.046].Conclusion A combination of GDF-15 and NT-proBNP at high concentrations significantly reflects an adverse prognosis for patients with uncomplicated MI within 12 months [RR, 5.4 (95 % CI, 3.4-8.5), р=0.004].