Holter Electrocardiography Research Articles

0193 : Arrhythmogenic potential of hypertensive heart disease

Left ventricular hypertrophy (LVH) in hypertensive heart disease promots the occurrence of atrial and ventricular arrhythmias exposing the hemodynamic and embolic risk. The aim of our study was to evaluate the prevalence of cardiac arrhythmias in this population and to offer suitable support. This is a prospective, analytical study of 13 months including 186 hypertensive patients with and without LVH hypertensive. We placed these patients a 24-hour holter electrocardiography. We excluded all patients with other types of heart disease and those taking beta-blocker treatment and / or antiarrhythmic. The average age of our patients was 63 ± 6 years with female predominance. 59% of patients with LVH showed heart rhythm disorders versus 7% of patients without LVH. Ventricular premature beats occurred in 21.1% with LVH versus 4.1% without LVH, nonsustained ventricular tachycardia in 2.4% with LVH against 0,4% without LVH, the supraventricular extrasystoles occurred in 57.2% with LVH against 14.1%. ACFA and atrial tachycardia in 11.7% with LVH versus 1.3%. The variability of the heart rate was altered in 35,4% with LVH versus 6.8% without LVH. Arrhythmias represent the third face of hypertensive heart disease after coronary artery disease and heart failure. Holter ECG recording information on the three factors of atrial or ventricular arrhythmias: the trigger, the state of the autonomic nervous system and the search for silent ischemia. An early and effective management of hypertension is necessary to prevent the onset or regress left ventricular hypertrophy, determining factor in the genesis of these arrhythmias. The author hereby declares no conflict of interest

A Case of Type 1 Diabetes Whose Profile of Autonomic Nerve Activitiy During Nocturnal Hypoglycemia was Aalyzed by Continuous Glucose Monitoring and Holter Electrocardiography

A Case of Type 1 Diabetes Whose Profile of Autonomic Nerve Activitiy During Nocturnal Hypoglycemia was Aalyzed by Continuous Glucose Monitoring and Holter Electrocardiography

Computational Electrocardiography: Revisiting Holter ECG Monitoring

Since 1942, when Goldberger introduced the 12-lead electrocardiography (ECG), this diagnostic method has not been changed. After 70 years of technologic developments, we revisit Holter ECG from recording to understanding. A fundamental change is fore-seen towards "computational ECG" (CECG), where continuous monitoring is producing big data volumes that are impossible to be inspected conventionally but require efficient computational methods. We draw parallels between CECG and computational biology, in particular with respect to computed tomography, computed radiology, and computed photography. From that, we identify technology and methodology needed for CECG. Real-time transfer of raw data into meaningful parameters that are tracked over time will allow prediction of serious events, such as sudden cardiac death. Evolved from Holter's technology, portable smartphones with Bluetooth-connected textile-embedded sensors will capture noisy raw data (recording), process meaningful parameters over time (analysis), and transfer them to cloud services for sharing (handling), predicting serious events, and alarming (understanding). To make this happen, the following fields need more research: i) signal processing, ii) cycle decomposition; iii) cycle normalization, iv) cycle modeling, v) clinical parameter computation, vi) physiological modeling, and vii) event prediction. We shall start immediately developing methodology for CECG analysis and understanding.

Evaluation of Echocardiography and Holter Electrocardiography Findings in Patients with Mucopolysaccharidosis

Giris: Mukopolisakkaridozlar MPS glikozaminoglikanlarin GAG yikimini saglayan enzimlerin fonksiyonel eksikligi nedeniyle ortaya cikan kalitsal lizozomal depo hastaliklaridir. Kalp kapaklarinda kalinlasma, fonksiyon kaybi, iletim bozukluklari, koroner arter ve diger damarlarin tutulumu gorulebilir. Elektriksel acidan iletken olmayan GAG’larin iletim bozukluklarina yol actigi varsayilmaktadir. Kardiyak nedenli olumlerin bir kismindan ritim bozukluklari sorumlu tutulmaktadir. Bu calismada Holter elektrokardiyografi EKG ile hastalarin ritim durumunun arastirilmasi amaclandi.Gerec ve Yontem: Bu calismada 2010-2011 yillari arasinda mukopolisakkaridoz tanisi ile takip edilmekte olan 17 hasta ve 17 kontrol olgu alindi. Olgularin hepsine ekokardiyografik inceleme yapildi. Butun olgularda yuzey EKG ve 24 saatlik Holter EKG ile ritim durumu incelendi.Bulgular: MPS tanisi alan hastalarin sekizi tip VI, dordu tip II, biri tip I, ikiser hasta tip III ve tip IV tanisi almisti. Yas ortalamasi hasta grubunda 5,82±2,24 yil idi. Kapak tutulumu %82 oraninda saptandi. Mitral kapak %73 birinci sirada, aort kapagi %21 ikinci siradaydi. Hasta grubunda maksimum kalp hizi 161/dk, ortalama kalp hizi 108/dk, minimum kalp hizi 81/dk, kontrol grubunda ise sirasiyla 151/dk, 96/dk, 70/dk olarak bulundu. Hasta grubunun kalp hizlari kontrol grubunun kalp hizlarina gore yuksekti p< 0,05 . Hasta grubunda sol ventrikul diyastol sonu capi yuksek bulundu. Olgularda koroner iskemi veya aritmi saptanmadi.Sonuc: MPS’lerde kardiyak tutulum siktir. Bilindigi uzere en sik tutulan kapak mitral, ikinci sirada aort kapagidir. Bu calisma, bildigimiz kadariyla Holter EKG inceleme yapilan ilk calisma olmakla birlikte cocukluk yas grubunda, ozellikle erken donemde enzim yerine koyma tedavisi alan hastalarda aritminin onemli bir sorun olusturmadigini gostermektedir. Hasta grubunda ortalama kalp hizinin yuksek bulunmasi kapak yetmezligi nedeniyle olusan artmis volum yukune baglanmistir

Impact of markedly nasal septal deviation on 24-hour rhythm Holter findings

This study aims to investigate any impact of nasal septal deviations on cardiac arrhythmias and heart rates by performing 24-hour rhythm Holter analysis before and after septoplasty accompanied by Nasal Obstruction Symptom Evaluation (NOSE) scale. The study included 21 male patients (mean age 33 years; range 18 to 55 years) who underwent septoplasty between September 2013 and August 2014. Patients were performed 24-hour rhythm Holter electrocardiography analysis preoperatively and at postoperative third month. Supraventricular and ventricular extrasystoles were recorded pre- and postoperatively. Operation efficiency was measured with NOSE scale. Of the 21 patients, ventricular and supraventricular extrasystoles were observed in seven patients (33%) in the preoperative period. Mean age of patients with arrhythmia (mean age 51 years; range 18 to 55 years) was statistically significant higher compared to patients without arrhythmia (mean age 30 years; range 23 to 55 years) (p=0.012). Extrasystoles decreased in seven patients in the postoperative period. Average, minimum, and maximum heart rates did not change statistically significant in the postoperative period. The fact that septoplasty decreased arrhythmias indicates that nasal septum deviations may be associated with cardiac arrhythmias. Septoplasty had no effect on heart rates. Performing septoplasty in the early period may prevent future cardiac complications in indicated patients.

Abstract 14070: Combination of Clinical, Electrocardiographic and Echocardiographic Parameters Predict the Onset of Atrial Fibrillation

Bacground: The ability to identify risk markers for first atrial fibrillation (AF) is critical to the development of preventive strategies. Prior studies have demonstrated that advanced age, diabetes, hypertension, and cardiovascular disease increase the risk of developing AF. Echocardiographic left atrial (LA) size and diastolic dysfunction are also shown to predict the onset of AF. Furthermore, a recent study has revealed that the addition of premature atrial contraction (PAC) count to a validated AF risk algorithm provides superior AF risk discrimination. However, it remains unknown whether a combination of clinical, electrocardiographic, and echocardiographic parameters predict the onset of AF. In the present study, we evaluated the predictive value of the combined score including these parameters. Methods: We retrospectively studied 1,040 patients without AF in whom both echocardiography and 24-hour Holter electrocardiography were performed from May 2005 to December 2010 and could be followed thereafter. During the follow-up period of 70.0±29.1 months, we investigated the new onset of AF. Results: Of the 1,040 patients, 103 developed AF. Patients who developed AF were older than patients who did not. Total heart rate, PAC count, max RR interval, and frequency of sinus arrest quantified by 24-hour electrocardiography were associated with the new onset of AF. Left atrial diameter (LAD) determined by echocardiography was also associated with the development of AF. In multivariate Cox analyses, age, PAC count, max RR interval, and LAD were independently associated with the development of AF (multivariable-adjusted hazard ratios per SD: age 1.49, PAC count 1.16, max RR interval 1.21, and LAD 1.34). Furthermore, the predictive value of the combined score using these 4 parameters (hazard ratios per SD: 1.80) was higher than that of each parameter. Conclusion: The combined score using age, PAC count, max RR interval, and LAD could help to identify risk of the new onset of AF.

Effects of atomoxetine on heart rhythm in children and adolescents

The aim of this study was to examine the effects of atomoxetine on heart rhythm using 12-lead electrocardiography (ECG) and 24 h Holter monitoring. Children and adolescents who were diagnosed with attention deficit-hyperactivity disorder according to DSM-IV-TR were referred to a pediatric cardiology clinic for cardiologic examination before and after 4 or 5 weeks of atomoxetine treatment. Cardiac examination, complete blood count, biochemistry, thyroid function tests, 12-lead ECG and 24 h Holter monitoring were performed routinely in all patients. Each subject underwent 24 h Holter ECG monitoring before atomoxetine was started and after 4 or 5 weeks of effective dose atomoxetine treatment. Forty-one patients were included in this prospective study. No statistically significant change was found in QT, QTc or QT interval dispersion or blood pressure before and after 4 or 5 weeks of atomoxetine treatment. There was a statistically significant increase in heart rate (both during the day and at night) and QRS duration, and a statistically significant decrease in P wave dispersion. Three patients had rhythm disturbances. All of these three patients were asymptomatic and none of these arrhythmias reached clinical significance. Atomoxetine did not cause significant changes in ECG or Holter variables. In two patients, who had undiagnosed subclinical extrasystoles, extra beats were increased after 4th week of treatment, but still remained clinically insignificant. Before and after atomoxetine treatment, listening to the heart sounds for a longer time, may help clinicians to notice an extra beat. If an extra beat is identified then 24 Holter monitoring is recommended.

Assessment of Microvolt T Wave Alternans in Children with Repaired Tetralogy of Fallot during 24‐Hour Holter Electrocardiography

We aimed to examine microvolt T wave alternans (MTWA) in 24-hour Holter electrocardiography (ECG) of children with repaired tetralogy of Fallot (TOF) to assess associations of MTWA with ventricular arrhythmias, ECG parameters, and echocardiographic findings. Holter ECG records and archive files of 56 repaired TOF patients (62.5% male) who were analyzed retrospectively. Subjects' ECG parameters and MTWA values were compared with age-sex-matched control group. T wave changes were analyzed by time-domain-modified moving average method from the three channels of 24-hour Holter ECG. Mean age was 123.4 ± 48.3 months. Median MTWA value was 55.5 μV in the control group, whereas 95.5 μV in patients group (P < 0.001). A significant weak positive correlation was found between the presence of ventricular extrasystoles and tricuspid regurgitation. There was no correlation between ECG parameters, echocardiographic findings, and MTWA. MTWA was increased in children with repaired TOF as reported before. To our knowledge, this is the first study analyzing MTWA with 24-hour Holter ECG in repaired TOF patients.

Detection of Atrial Fibrillation After Surgical Ablation: Conventional Versus Continuous Monitoring

Current guidelines recommend at least 24-hour Holter monitoring at 6-month intervals to evaluate the recurrence of atrial fibrillation (AF) after surgical ablation. In this prospective multicenter study, conventional intermittent methods of AF monitoring were compared with continuous monitoring using an implantable loop recorder (ILR). From August 2011 to January 2014, 47 patients receiving surgical treatment for AF at 2 institutions had an ILR placed at the time of operation. Each atrial tachyarrhythmia (ATA) of 2 minutes or more was saved. Patients transmitted ILR recordings bimonthly or after any symptomatic event. Up to 27 minutes of data was stored before files were overwritten. Patients also underwent electrocardiography (ECG) and 24-hour Holter monitoring at 3, 6, and 12 months. ILR compliance was defined as any transmission between 0 and 3 months, 3 and 6 months, or 6 and 12 months. Freedom from ATAs was calculated and compared. ILR compliance at 12 months was 93% compared with ECG and Holter monitoring compliance of 85% and 76%, respectively. ILR devices reported a total of 20,878 ATAs. Of these, 11% of episodes were available for review and 46% were confirmed as AF. Freedom from ATAs was no different between continuous and intermittent monitoring at 1 year. Symptomatic events accounted for 187 episodes; however, only 10% were confirmed as AF. ILR was equivalent at detecting ATAs when compared with Holter monitoring or ECG. However, the high rate of false-positive readings and the limited number of events available for review present barriers to broad implementation of this form of monitoring. Very few symptomatic events were AF on review.

Heart Rate Turbulence Analysis in Subclinical Hypothroidism Heart Rate Turbulence in Hypothyroidism.

Heart rate turbulence (HRT) is a baroreflex-mediated biphasic reaction of heart rate in response to premature ventricular beats. Abnormal HRT identifies patients with autonomic dysfunction or impaired baroreflex sensitivity. The aim of the present study was to demonstrate the effect of subclinical hypothyroidism (SCH) on cardiac autonomic function using HRT parameters. The study sample consisted of 25 patients (10 men, 15 women with a mean age of 39.7 ± 15.5 years) who were diagnosed with SCH and 35 euthyroid patients (13 males, 22 females with a mean age 38.4 ± 11.7 years). All patients underwent 24 h ambulatory electrocardiography monitorization. The study calculated two HRT parameters, turbulence slope (TS) and turbulence onset (TO), and these HRT parameters were compared between the groups to examine the relationship between HRT and thyroid-stimulating hormone (TSH) levels. The characteristics of SCH patients and control cases were similar with regard to age, sex except for TSH levels. Serum TSH levels were significantly higher in SCH patients than in the controls (7.3 ± 1.8 μIU/ml vs. 2.4 ± 1.0 μIU/ml, p < 0.001). TO was significantly higher in SCH patients compared with controls (-1.51 ± 0.5 vs. -2.2 ± 1.0, p = 0.002). SCH patients had lower TS values than controls (7.6 ± 2.4 vs. 10.8 ± 3.4, p < 0.001). TO was positively correlated with serum TSH levels (r = 0.276, p = 0.033). There was also a negative correlation between TS and serum TSH levels (r = -0.437, p < 0.001). The results of our study indicated that cardiac autonomic function is impaired in patients with SCH. Heart rate; Holter electrocardiography; Hypothyroidism.

Multiscale Entropy of the Heart Rate Variability for the Prediction of an Ischemic Stroke in Patients with Permanent Atrial Fibrillation.

BackgroundAtrial fibrillation (AF) is a significant risk factor for ischemic strokes, and making a robust risk stratification scheme would be important. Few studies have examined whether nonlinear dynamics of the heart rate could predict ischemic strokes in AF. We examined whether a novel complexity measurement of the heart rate variability called multiscale entropy (MSE) was a useful risk stratification measure of ischemic strokes in patients with permanent AF.Methods and ResultsWe examined 173 consecutive patients (age 69±11 years) with permanent AF who underwent 24-hour Holter electrocardiography from April 2005 to December 2006. We assessed several frequency ranges of the MSE and CHA2DS2-VASc score (1 point for congestive heart failure, hypertension, diabetes, vascular disease, an age 65 to 74 years, and a female sex and 2 points for an age≥75 years and a stroke or transient ischemic attack). We found 22 (13%) incident ischemic strokes during a mean follow up of 3.8-years. The average value of the MSE in the very-low frequency subrange (90–300 s, MeanEnVLF2) was significantly higher in patients who developed ischemic strokes than in those who did not (0.68±0.15 vs. 0.60±0.14, P<0.01). There was no significant difference in the C-statistic between the CHA2DS2-VASc score and MeanEnVLF2 (0.56; 95% confidence interval, 0.43–0.69 vs. 0.66; 95% confidence interval, 0.53–0.79). After an adjustment for the age, CHA2DS2-VASc score, and antithrombotic agent, a Cox hazard regression model revealed that the MeanEnVLF2 was an independent predictor of an ischemic stroke (hazard ratio per 1-SD increment, 1.80; 95% confidence interval, 1.17–2.07, P<0.01).ConclusionThe MeanEnVLF2 in 24-hour Holter electrocardiography is a useful risk stratification measure of ischemic strokes during the long-term follow-up in patients with permanent AF.

Electrochemotherapy of colorectal liver metastases--an observational study of its effects on the electrocardiogram.

BackgroundElectrochemotherapy (ECT) is a combined treatment in which high voltage electroporation (EP) pulses are used to facilitate the uptake of a chemotherapeutic drug into tumor cells, thus increasing antitumor effectiveness of the drug. The effect of ECT of deep-seated tumors located close to the heart on functioning of the heart has not been previously investigated. In this study, we investigate the effects of intra-abdominal ECT of colorectal liver metastases on functioning of the heart during the early post-operative care period.MethodsFor ECT high voltage EP pulses with amplitudes of up to 3000 V and 30 A were delivered in synchronization with electrical activity of the heart. Holter electrocardiographic (ECG) signals were obtained from 10 patients with colorectal liver metastases treated with ECT. ECG was recorded during the periods of 24 hours before and after the surgical procedure involving ECT. Four-hour long night-time ECG segments from both periods exhibiting the highest level of signal stationarity were analyzed and compared. Changes in several ECG and heart rate variability (HRV) parameters were evaluated.ResultsNo major heart rhythm changes (i.e., induction of extrasystoles, ventricular tachycardia or fibrillation) or pathological morphological changes (i.e., ST segment changes) indicating myocardial ischemia were found. However, we found several minor statistically significant but clinically irrelevant changes in HRV parameters after ECT procedures: a decrease in median values of the mean NN interval, a decrease in the low-frequency and in the normalized low-frequency component, and an increase in the normalized high-frequency component.ConclusionsOnly minor effects of intra-abdominal ECT treatment on functioning of the heart were found. They were expressed as statistically significant but clinically irrelevant changes in heart rate and long-term HRV parameters and were as such not life-threatening to the patients. The nature of these changes is such that they can be attributed to the known effects of the drugs given to the patients in the post-operative care. Further investigation is still warranted to unambiguously resolve whether ECT with high voltage EP pulses applied in immediate vicinity of the heart is responsible for the observed effects.

Acupuncture-induced changes of vagal function in patients with depression: A preliminary sham-controlled study with press needles

To study the biological effects of acupuncture on depression, we hypothesized that acupuncture will exert its antidepressant effect through a bottom-up neuromodulation of the autonomic dysfunction in depression. The participants received press needle (PN) acupuncture for 72 h continuously in a sham-controlled design. Psychological assessments and Holter electrocardiography were performed before and after PN acupuncture. We evaluated their autonomic functions through the heart rate variability (HRV). As a result, following PN acupuncture participants showed significant improvement in the Beck's Depression Inventory scores (P = 0.031), systolic/diastolic blood pressures (P = 0.002/P = 0.011), and coefficient of variation of the R–R interval (P < 0.0001), compared to sham PN. The present findings showed PN acupuncture induced alterations in vagal function, blood pressure, and Beck's Depression Inventory scores. It was suggested that vagal stabilization effect by acupuncture may be associated with the therapeutic mechanism in depression.

Heart rate variability and arrhythmic patterns of 24-hour Holter electrocardiography among Nigerians with cardiovascular diseases.

BackgroundFacilities for Holter electrocardiography (ECG) monitoring in many Nigerian hospitals are limited. There are few published works in Nigeria on the use of 24-hour Holter ECG in cardiac arrhythmic evaluation of patients with cardiovascular diseases.ObjectiveTo study the clinical indications, arrhythmic pattern, and heart rate variability (HRV) among subjects referred for 24-hour Holter ECG at our Cardiac Care Unit.MethodsThree-hundred and ten patients (134 males and 176 females) were studied consecutively over a 48-month period using Schiller type (MT-101) Holter ECG machine.ResultsOut of the 310 patients reviewed, 134 were males (43.2%) and 176 were females (56.8%). The commonest indication for Holter ECG was palpitation followed by syncope in 71 (23%) and 49 (15.8%) of subjects, respectively. Premature ventricular complex and premature atrial complex were the commonest types of arrhythmia in 51.5% and 15% subjects, respectively. Ventricular arrhythmia was more prevalent in dilated cardiomyopathy patients (85.7%). The HRV of subjects with palpitation, stroke, and diabetes mellitus with autonomic neuropathy, using standard deviation of normal to normal intervals average (milliseconds), were 107.32±49.61, 79.15±49.15, and 66.50±15.54, respectively. The HRV, using standard deviation of averages of normal to normal intervals average (milliseconds), of patients with palpitation, stroke, and diabetes mellitus with autonomic neuropathy were 77.39±62.34, 57.82±37.05, and 55.50±12.71, respectively.ConclusionPalpitation and syncope were the commonest indications for Holter ECG among our subjects. The commonest arrhythmic patterns were premature ventricular complex and premature atrial complex, with ventricular arrhythmia being more prevalent in dilated cardiomyopathy. There was a reduction in HRV in patients with stroke and diabetic autonomic neuropathy.

PP.32.04

Objective: To assess Holter electrocardiography monitoring datain patients with pulmonary arterial hypertension (PAH) Design and method: In this study we included 59 PAH pts experiencing angina-like symptoms with excluded ischemic heart disease. Among them 28 pts (25 f/3m) aged 36,86 ± 11,5yrs had IPAH, 18 pts (14 f/4m) aged 44 ± 17, 47 yrs -PAH associated with congenital heart disease (PAH-CHD) and 13 pts (12 f/1m) aged 46,32 ± 15,71yrs- PAH associated with systemic scleroderma (SS). Patients were comparable in WHO functional class (II-III). All patients underwent electrocardiography(ECG), Holter ECG monitoring Results: In IPAH group mean/maximal(max)/minimal heart rates (HR)were 73,45 ± 10,02 per min, 123,14 ± 18,41 per min and 55,25 ± 8,39 per min respectively. In PAH-CHD group HRmean was 77,05 ± 8,64 per min, HRmax was 127,32 ± 15,76 per min and HRmin were 55,72 ± 6,73 per min. In PAH-SS group HRmean was 76 ± 13,04per min, HRmax was 124,6 ± 9,66 per min and HRmin were 55,2 ± 12,95 per min respectively. In IPAH group we observed ST depression by Holter ECG monitoring in 9 patients (32,1%), in PAH-CHD group – 3 pts (16,6%), in PAH-SS group 1 pt (7,7%). In PAH-CHD group the frequency of arrhythmia was maximal as compared with other groups (1228,56 ± 2824,48 ventricular extrasystoles (Ex) and 1113,64 ± 2827,37 supraventricular Ex. In comparison in the group of IPAH113,53 ± 301,21 ventricular Ex and 142 ± 212,82 supraventricular Ex. In the group of PAH-SS was396 ± 738,55ventricular Ex and 659,4 ± 1341,53 supraventricular Ex Conclusions: Finding ischemic changes on Holter ECG monitoring in PAH pts with angina-like symptoms require further examination by adding of visualization methods and stress test

Ventricular tachycardias in patients with pulmonary hypertension: an underestimated prevalence? A prospective clinical study.

Sudden cardiac death (SCD) accounts for approximately 30 % in patients with pulmonary arterial hypertension (PAH). The exact circumference for SCD in this patient population is still unclear. Malignant cardiac arrhythmias are reported to be rarely present. There are no systematic data concerning long-term electrocardiographic (ECG) recording in patients with PAH. We sought to investigate the rate of potentially relevant arrhythmias in patients with pulmonary hypertension (PH). Consecutive patients without diagnosis of known cardiac arrhythmias followed in our outpatient clinic for PH were enrolled in the study. All patients underwent a 72-h Holter ECG. Clinical data, 6-min walk distance, laboratory values, and echocardiography were collected/performed. Ninety-two consecutive patients (New York Heart Association class (NYHA) III/IV: 65.2 %/5.4 %, PH Group 1: 35.9 %, Group 3: 10.9 %, Group 4: 28.3 %, Group 5: 2.2 %) were investigated. Relevant arrhythmias were newly detected in 17 patients: non-sustained ventricular tachycardia (n = 12), intermittent second-degree heart block (n = 1), intermittent third-degree heart block (n= 3), and atrial flutter (n = 1). Echocardiographic systolic pulmonary pressure and diameter of the right heart were elevated in patients with relevant arrhythmias. Right heart catheterization revealed higher pulmonary vascular resistance (672 vs. 542 dyn · s · cm(-5), p = 0.247) and lower cardiac index (2.46 vs. 2.82 l/min/m(2), p = 0.184). Ventricular tachycardias occur more often in PH patients than previously reported. However, the prognostic relevance of non-sustained ventricular tachycardias in this cohort remains unclear. As a large number of PH patients die from SCD, closer monitoring, e.g., using implantable event recorders, might be useful to identify patients at high risk.

A CLINICAL CASE OF ACUTE ALLERGIC MYOCARDITIS SIMULATING MYOCARDIAL INFARCTION

Objective: to describe a clinical case of evolving acute eosinophilic myocarditis simulating coronary heart disease. Subjects and methods. Patient B. aged 62 years was admitted to Intensive Care Unit Fifteen, N.I. Pirogov First Moscow City Clinical Hospital, by being transferred from Thailand with a referral diagnosis of acute myocardial infarction made on November 1, 2012, with complaints of pressing and aching heart pains. At a Phuket hospital, his electrocardiogram recorded atrial fibrillation; indirect cardiac massage, electric pulse therapy, and mechanical ventilation were performed. After being admitted to the N.I. Pirogov First Moscow City Clinical Hospital, the patient underwent examination: estimation of laboratory indicators over time, electrocardiography (ECG), echocardiography, Holter ECG monitoring, and myocardial scintigraphy. Results. The patient had a history of an allergic reaction as urticaria to the ingestion of fish products. His examination showed practically all diagnostic criteria for allergic myocarditis: hypereosinophilia (the admission level of eosinophils was 9% with their further normalization); the characteristic clinical presentation of myocarditis (pressing retrosternal pain); elevated levels of cardiac specific enzymes (creatinine phosphokinase-MB, lactate dehydrogenase, troponin T); ECG changes – myocardial hypokinesis in the acute period, followed by its pattern normalization. of the pattern. Myocardial scintigraphy (by taking into account the fact that the patient had had a new allergic reaction episode, the investigators decided not to perform coronary angiography) revealed decreased radiopharmaceutical accumulation in the lower left ventricular wall in the right coronary arterial bed; perfusion remained in the other myocardial walls. Conclusion. This clinical case reflects the specific features of the course of and difficulties in the diagnosis of acute allergic myocarditis that, in most cases, has no specific clinical manifestations and may mimic different diseases.

HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices.

DavidSlotwiner,MD, FHRS, FACC(Chair),Niraj Varma,MD,PhD, FRCP(Co-chair), JosephG.Akar,MD,PhD, George Annas, JD, MPH, Marianne Beardsall, MN/NP, CCDS, FHRS, Richard I. Fogel, MD, FHRS, Nestor O. Galizio, MD, Taya V. Glotzer, MD, FHRS, FACC, Robin A. Leahy, RN, BSN, CCDS, FHRS, Charles J. Love, MD, CCDS, FHRS, FACC, FAHA, Rhondalyn C. McLean, MD, Suneet Mittal, MD, FHRS, Loredana Morichelli, RN, MSN, Kristen K. Patton, MD, Merritt H. Raitt, MD, FHRS, Renato Pietro Ricci, MD, John Rickard, MD, MPH, Mark H. Schoenfeld, MD, CCDS, FHRS, FACC, FAHA, Gerald A. Serwer, MD, FHRS, FACC, Julie Shea, MS, RNCS, FHRS, CCDS, Paul Varosy, MD, FHRS, FACC, FAHA, Atul Verma, MD, FHRS, FRCPC, Cheuk-Man Yu, MD, FACC, FRCP, FRACP From the Hofstra School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York, Cleveland Clinic, Cleveland, Ohio, Yale University School of Medicine, New Haven, Connecticut, Boston University School of Public Health, Boston, Massachusetts, Southlake Regional Health Centre, Newmarket, Ontario, Canada, St. Vincent Medical Group, Indianapolis, Indiana, Favaloro Foundation University Hospital, Buenos Aires, Argentina, Hackensack University Medical Center, Hackensack, New Jersey, Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina, New York University Langone Medical Center, New York City, New York, University of Pennsylvania Health System, Philadelphia, Pennsylvania, The Arrhythmia Institute at Valley Hospital, New York, New York, Department of Cardiovascular Diseases, San Filippo Neri Hospital, Rome, Italy, University of Washington, Seattle, Washington, VA Portland Health Care System, Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon, Johns Hopkins University, Baltimore, Maryland, Yale University School of Medicine, Yale-New Haven Hospital Saint Raphael Campus, New Haven, Connecticut, University of Michigan Congenital Heart Center, University of Michigan Health Center, Ann Arbor, Michigan, Brigham and Women’s Hospital, Boston, Massachusetts, Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver, Colorado, and Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.

Subclinical myocardial dysfunction and cardiac autonomic dysregulation are closely associated in obese children and adolescents: the potential role of insulin resistance.

BackgroundThe prevalence of obesity is increasing among children/adolescents. Subtle cardiovascular abnormalities, responsible for a higher mortality later in life, have been reported in obese children/adolescents. The aims of the study were to evaluate cardiovascular autonomic regulation, by means of spectrum analysis of R-R interval variability, and myocardial function, by means of standard and tissue Doppler echocardiography, in a group of non-hypertensive asymptomatic obese children and adolescents; furthermore, the influence of insulin resistance was tested.Subjects and MethodsR-R interval variability was analyzed during both the 70° head-up tilt and 24-hour electrocardiographic holter monitoring. Spectrum analysis of R-R interval variability provided the indices of sympathetic (low frequency [LFRR]) and vagal (high frequency [HFRR]) modulation of the sinoatrial node. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to classify obese children/adolescents (n=72) as insulin resistant (n=37) and non-insulin resistant (n=35).ResultsIn obese subjects: a) left ventricular mass was significantly (p<0.05) increased, whereas both the e/a ratio and the e'/a' ratio were decreased; b) at rest, HFRR was lower, and the LFRR/HFRR ratio was higher; c) during tilting, magnitude of tilt-induced inhibition of HFRR was lower; d) during 24-hour electrocardiographic holter monitoring, LFRR and the LFRR/HFRR ratio were higher, whereas HFRR was lower; e) HOMA-IR inversely correlated with both the e'/a' ratio (r=-0.655; p<0.001) and the tilt-induced LFRR/HFRR ratio (r=-0.933; p<0.001); and, f) the e'/a' ratio correlated with the tilt-induced LFRR/HFRR ratio (r=0.501; p<0.001). Moreover, HFRR at rest, magnitude of tilt-induced HFRR reduction, and the e'/a' ratio in insulin resistant obese children/adolescents were markedly lower when compared with the remaining subjects.ConclusionsSubclinical abnormalities of myocardial function and of cardiac autonomic regulation were closely associated in obese children/adolescents and both correlated with the degree of insulin resistance.

Dobutamine Stress Echocardiography in the Diagnosis of Asymptomatic Ischemic Heart Disease in Patients With Chronic Kidney Disease—Review of Literature and Single-Center Experience

BackgroundCoronary artery disease (CAD) may be present in kidney transplant (KT) candidates without the presence of CAD clinical symptoms. This study joins an ongoing discussion about appropriate noninvasive diagnostic approaches for ischemic heart disease (IHD) assessment and patient selection for revascularization procedures. The aim of this study was to evaluate the role of dobutamine stress echocardiography (DSE) in IHD diagnosis in initially asymptomatic maintenance hemodialysis (HD) patients. MethodsForty HD patients aged 52.4 ± 2.0 years, were studied for 2.5 years. At inclusion, they were free of both symptoms and history of IHD. Standard electrocardiography (ECG), chest X-ray, standard echocardiography, DSE, 24-hour Holter ECG, and Doppler ultrasonography (carotids and lower extremities) were performed. Results were analyzed according to a predefined diagnostic algorithm. ResultsDSE yielded negative results in all patients. Left ventricular (LV) ejection fraction ≤60%, LV hypertrophy, and Holter ECG silent ischemia features were noticed in 15%, 70%, and 10% of patients, respectively. Atherosclerotic lesions in lower extremities and carotid arteries were present in 50% and 37.5% of patients, respectively. During the follow-up, 9/40 patients died, including 6 cardiovascular (CV) deaths: 2 with intermediate and 4 with high CV risk according to the proposed algorithm. ConclusionsIn asymptomatic KT candidates, not only DSE, but also other noninvasive tests (eg, echocardiography and Doppler ultrasonography of the carotid and peripheral arteries) along with a detailed profile of the remaining CV risk factors should be performed and analyzed. Defined composition of risk factors and particular changes in noninvasive tests may be an indication for coronary angiography.