Results Of Holter Monitoring Research Articles

Correlations between cardiac troponin I and nonsustained ventricular tachycardia in hypertrophic obstructive cardiomyopathy.

BackgroundNonsustained ventricular tachycardia (NSVT) is an independent risk factor for sudden cardiac death (SCD) in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, data concerning the correlations of cardiac biomarkers and NSVT in HOCM are rather limited.HypothesisOur study aimed to investigate the associations between the occurrence of NSVT and circulating biomarkers representing myocardial injury (cardiac troponin I, cTnI), cardiac function (N‐terminal pro‐brain natriuretic peptide, NT‐pro BNP), and inflammation (high‐sensitivity C‐reactive protein) in a large Chinese HOCM cohort.MethodsA total of 755 consecutive HOCM patients were recruited. Systematic cardiac evaluations and circulating biomarkers were examined routinely in all subjects under the clinically stable status. According to the results of 24‐hour Holter monitoring, patients were divided into the NSVT group (n = 138) and the nonventricular tachycardia (non‐VT) group (n = 617).ResultsCompared with the non‐VT group, circulating levels of both cTnI and NT‐pro BNP elevated significantly in patients with positive NSVT episodes (P < .001). Multivariable analyses demonstrated that cTnI was independently associated with the presence of NSVT (OR = 1.675, 95% CI: 1.406‐1.994, P < .001). Concentrations of cTnI increased progressively not only with the aggravation of ventricular arrhythmic events (P < .001), but also with the growing risk of SCD in HOCM patients (P < .001). Serum cTnI ≥ 0.0265 ng/mL indicated predictive value for the occurrence of NSVT in the HOCM cohort (area under the curve = 0.707, 95% CI: 0.660‐0.754, P < .001).ConclusionsElevated cTnI was an independent determinant of NSVT, and it seemed to be valuable for assessing the clinical status of ventricular arrhythmias and the risk of SCD in patients with HOCM.

Effect of 2 Different Dosages of Rosuvastatin on Prognosis of Acute Myocardial Infarction Patients with New-Onset Atrial Fibrillation in Jinan, China.

BackgroundAtrial fibrillation (AF) often occurs in patients with acute myocardial infarction (AMI). This study aimed to observe the influence of different dosages of rosuvastatin on the prognosis of AMI patients with AF.Material/MethodsWe performed an observational, retrospective cohort study in Jinan, China, in which 323 AMI patients were recruited. All patients were randomized to receive optimal medication treatment and 10 mg or 20 mg of rosuvastatin. Holter monitor results, serum lipid levels, and heart function were recorded. We used multivariate Cox and Kaplan-Meier analyses to assess the independent factors and differences in AF and ischemia events and safety of rosuvastatin administered at different dosages.ResultsTC, LDL-C, and TG at 1 and 12 months were significantly lower compared with those observed prior to treatment in both groups. The heart function of both groups was significantly improved after 12 months of treatment, especially in the 20 mg group. Multivariate Cox analysis showed that different dosages of rosuvastatin, age, smoking, drinking alcohol, and diabetes are independent factors related to the occurrence of AF and ischemic events. In addition, according to Kaplan-Meier analysis, no significant difference in adverse clinical events existed at different dosages of rosuvastatin.ConclusionsTreatment with rosuvastatin can reduce the serum lipid level and improve cardiac function. Different dosages of rosuvastatin, age, smoking, drinking alcohol, and diabetes are independent risk factors for AF and ischemia events. The results suggested it is safe to use 20 mg rosuvastatin in the 12 months after hospital admission.

Correlations between low thyroid function and incidence of atrial fibrillation in hypertrophic obstructive cardiomyopathy

BackgroundAtrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic obstructive cardiomyopathy (HOCM). Data regarding the correlations of thyroid dysfunction and the incidence of AF in HOCM are quite limited. This study aimed to reveal the correlations between different thyroid status and the corresponding incidence of AF in a large HOCM cohort. MethodsA total of 806 HOCM patients with complete information on thyroid function tests and comprehensive cardiac evaluations were recruited. The participants were divided into the AF group (n = 159) and non-AF group (n = 647) according to established medical history and results of Holter monitoring. The thyroid status of the study population and the corresponding incidence of AF were assessed and analyzed. ResultsHypothyroidism accounted for the greatest proportion of thyroid dysfunction in HOCM patients. The incidence of AF significantly increased in individuals with both overt (P = 0.022) and subclinical (P = 0.007) hypothyroidism. Compared with participants in the non-AF group, those with positive AF episodes presented with lower free triiodothyronine (FT3) (2.86 ± 0.52 pg/mL vs. 3.01 ± 0.42 pg/mL, P = 0.001), higher free thyroxine (FT4) (1.24 ± 0.25 ng/dL vs. 1.15 ± 0.16 ng/dL, P < 0.001), and remarkably increased levels of thyrotropin (TSH) (12.6% vs. 5.3%, P = 0.001). Multivariable analyses demonstrated that the concentrations of FT3 (odds ratio [OR] = 0.470, 95% confidence interval [CI]: 0.272–0.813, P = 0.007) and FT4 (OR = 17.992, 95% CI: 5.750–56.296, P < 0.001), as well as TSH levels above normal ranges (OR = 2.276, 95% CI: 1.113–4.652, P = 0.024) were independently associated with the occurrence of AF in the large HOCM cohort. ConclusionsThis study indicated a strong link between low thyroid function and the presence of AF in HOCM. Hypothyroidism (both overt and subclinical states) seems to be valuable for assessing the incidence of AF in patients with HOCM.

THE RELATIONSHIP BETWEEN PROLACTIN LEVELS AND THE RESULTS OF HOLTER MONITORING IN PATIENTS WITH STABLE ANGINA OF TENSION AND GASTROESOPHAGEAL REFLUX DISEASE

The aim: Determine the possible relationship between prolactin levels and the results of Holter monitoring in patients with stable angina of tension and gastroesophageal reflux disease (GERD). Materials and methods: The study included 118 patients with stable angina of tension of I-II functional class. Of these, 88 patients with stable angina of tension with comorbid GERD (A, B, C), who were included in the second group of the study and 30 patients with isolated stable angina of tension which formed the 1st group. All patients who were included in the study prior to treatment were evaluated for serum prolactin levels and Holter monitoring. Results: In patients with stable angina of tension and GERD, prolactin levels exceed the norm levels and are higher than the level of prolactin in the group with isolated stable angina (p<0,05), as well as the number of episodes of painful and painless myocardial ischemia and their duration (p<0,05). The presence of a comorbidity with GERD provokes an increase in the total duration of episodes of ischemia per day in patients with stable angina compared to those in patients with no GERD. A direct linear relationship was founded between prolactin serum levels and the number of episodes of pain in myocardial ischemia in patients with stable angina and GERD per day, and between the total duration of episodes of myocardial ischemia and prolactin levels. Conclusions: In patients with stable angina and GERD, in 70.4% of cases, the level of prolactin exceeds the norm in 2,6 times, and is higher than the level of prolactin in the isolated group of stable angina. For the comorbidity of stable angina and GERD, the number of episodes of painful, painless myocardial ischemia and their duration is more than once in the group of patients with stable angina without GERD (p<0.05).

Assessment of ventricular tachyarrhythmia in patients with hypertrophic cardiomyopathy with machine learning-based texture analysis of late gadolinium enhancement cardiac MRI

To assess the diagnostic value of machine learning-based texture feature analysis of late gadolinium enhancement images on cardiac magnetic resonance imaging (MRI) for assessing the presence of ventricular tachyarrhythmia (VT) in patients with hypertrophic cardiomyopathy. This retrospective study included 64 patients with hypertrophic cardiomyopathy who underwent cardiac MRI and 24-hour Holter monitoring within 1 year before cardiac MRI. There were 42 men and 22 women with a mean age of 48.13±13.06 (SD) years (range: 20-70 years). Quantitative textural features were extracted via manually placed regions of interest in areas with high and intermediate signal intensity on late gadolinium-chelate enhanced images. Feature selection and dimension reduction were performed. The diagnostic performances of machine learning classifiers including support vector machines, Naive Bayes, k-nearest-neighbors, and random forest for predicting the presence of VT were assessed using the results of 24-hour Holter monitoring as the reference test. All machine learning models were assessed with and without the application of the synthetic minority over-sampling technique (SMOTE). Of the 64 patients with hypertrophic cardiomyopathy, 21/64 (32.8%) had VT. Of eight machine learning models investigated, k-nearest-neighbors with SMOTE exhibited the best diagnostic accuracy for the presence or absence of VT. k-nearest-neighbors with SMOTE correctly identified 40/42 (95.2%) VT-positive patients and 40/43 (93.0%) VT-negative patients, yielding 95.2% sensitivity (95% CI: 82.5%-99.1%), 93.0% specificity (95% CI: 79.8%-98.1%) and 94.1% accuracy (95% CI: 88.8%-98%). Machine learning-based texture analysis of late gadolinium-chelate enhancement-positive areas is a promising tool for the classification of hypertrophic cardiomyopathy patients with and without VT.

Evaluation of the efficiency of combined pharmacotherapy with the use of trimetazidine with prolonged release in patients with stable angina in outpatient practice

To evaluate the effectiveness of complex pharmacotherapy with the inclusion in the treatment regimen of trimetazidine with a prolonged release in patients with stable angina. The pilot study included 22 patients aged 45-75 years with combined cardiovascular pathology. In addition to the received therapy, all patients were prescribed the original trimetazidine with a prolonged release at a dose of 80 mg/day (Preductal® OD, Servier, Russia). The observation period was 2 months. The survey included the double implementation of the following methods: the number of strokes per week, the frequency of use of short - acting nitrates per week, blood pressure, heart rate, echocardiography, daily ECG monitoring, assessment of the quality of life (questionnaire SF-36, questionnaire of patients with stable angina SAQ). When assessing the effect of ongoing pharmacotherapy on clinical and echoCG indicators in patients of the study group, significant positive dynamics was registered in the form of reducing the number of angina attacks and the number of short - acting nitrates used per week, a slight positive dynamics of EF on echoCG, episodes of pain and painless ischemia were eliminated according to the results of Holter monitoring), a significant positive dynamics of quality of life indicators was noted. Combined pharmacotherapy of patients with stable exertional angina with the inclusion of the trimetazidine with a prolonged release at a dose of 80 mg/day (Predductal® OD, Servier, Russia) has a significant positive pharmacodynamic effect in the form of an increase in the antianginal effect, improvement of Holter monitoring indicators and quality of patients life.

Results of Holter monitoring in patients with angina pectoris treated by combination of trimethazidine with fabomotisol in the area of former armed conflict

Aim. To assess the effectiveness of trimetazidine and fabomotisol adding to standard treatment in patients with stable angina in the area of former armed conflict in point of improving of Holter monitoring parameters.Material and methods. One hundred and twelve patients with stable angina of the II-III functional classes (FC) living in the area of former armed conflict were randomly divided into two groups. For 6 months 54 patients (control group) received standard treatment (isosorbide dinitrate 40 mg/day, metoprolole tartras 50-100 mg/day, acetylsalicylic acid 100 mg/day, simvastatin 40 mg/day). Fifty eight patients (study group) in addition to a standard treatment, took trimetazidine 70 mg/day and fabomotisol 30 mg/day. Initially and after 6 months they underwent Holter monitoring.Results. In patients of the control group the number of episodes of silent myocardial ischemia was statistically significantly reduced (p&lt;0,05). The duration of episodes of silent and manifest myocardial ischemia, ST segment depression &gt;1 mm, and the number of patients with supraventricular and ventricular extrasystoles decreased not statistically significant (p&gt;0,05). The number of episodes of manifest myocardial ischemia did not change. In the study group, the number of silent ischemia episodes, the duration of silent and manifest myocardial ischemia significantly decreased. ST segment depression and the frequency of ventricular extrasystoles were also decreased (p&lt;0,05). At the same time, the changes in number of supraventricular extrasystoles was not statistically significant (p&gt;0,05). Conclusion. Using a combination of trimetazidine with fabomotisol in comparison with standard treatment in patients with angina reduces the frequency of angina episodes, the duration of myocardial ischemia, ST segment depression, the frequency of supraventricular and ventricular extrasystoles.

Ambulatory Arrhythmia Detection with ZIO® XT Patch in Pediatric Patients: A Comparison of Devices.

Ambulatory electrocardiogram monitoring devices can be used for 24-72h to detect arrhythmias. A new device, the ZIO® XT Patch has cardiac monitoring capabilities that can be utilized for up to 14 days. The purpose of this study is to describe duration of ZIO use by age, and to compare its time to arrhythmia detection with the Holter monitor in a pediatric population. A single-center, retrospective review of patients < 18years of age who underwent clinical investigation with ZIO from October 2014 to February 2016was performed. An age-matched cohort was utilized to compare ZIO to Holter monitor results. Demographic and diagnostic data, time to first arrhythmia, and arrhythmia burden were analyzed. A total of 406 ZIO were prescribed; median age 12.7years and 50% male subjects. Median duration of ZIO monitoring significantly increased with age (p < 0.001). 499 Holter monitors were prescribed on a statistically different age group. Arrhythmia detection rates were similar between groups, 10% (n = 42) by ZIO and 9% (n = 45) by Holter (p = NS). The majority of arrhythmias (57%) detected by ZIO were after 24h (p < 0.0001). All arrhythmias detected by Holter monitor occurred within 24h (p < 0.0001), mean duration of wear was 24.1h, range 0.5-48h. The ZIO® XT Patch may be considered as an ambulatory ECG monitor to diagnose arrhythmia in pediatric patients of all ages. Increasing patient age resulted in increasing duration of ZIO monitoring. Majority of arrhythmias detected with ZIO were identified after 24h, which would have been missed by other short-term monitors.

Phospholamban cardiomyopathy: aCanadian perspective on aunique population.

IntroductionPhospholamban cardiomyopathy is an inherited cardiomyopathy, characterised by a defect in regulation of the sarcoplasmic reticulum Ca2+ pump, often presenting with malignant arrhythmias and progressive cardiac dysfunction occurring at a young age.MethodsPhospholamban R14del mutation carriers and family members were identified from inherited arrhythmia clinics at 13 sites across Canada. Cardiac investigations, including electrocardiograms, Holter monitoring (premature ventricular complexes, PVCs), and imaging results were summarised.ResultsFifty patients (10 families) were identified (median age 30 years, range 3–71, 46% female). Mutation carriers were more likely to be older, have low-voltage QRS, T‑wave inversion, frequent PVCs, and cardiac dysfunction, compared to unaffected relatives. Increasing age, low-voltage QRS, T‑wave inversion, late potentials, and frequent PVCs were predictors of cardiac dysfunction (p < 0.05 for all). Older carriers (age ≥45 years) were more likely to have disease manifestations than were their younger counterparts, with disease onset occurring at an older age in Canadian patients and their Dutch counterparts.DiscussionAmong Canadian patients with phospholamban cardiomyopathy, clinical manifestations resembled those of their Dutch counterparts, with increasing age a major predictor of disease manifestation. Older mutation carriers were more likely to have electrical and structural abnormalities, and may represent variable expressivity, age-dependent penetrance, or genetic heterogeneity among Canadian patients.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-1247-0) contains supplementary material, which is available to authorized users.

К ВОПРОСУ АНАЛИЗА БАРОРЕФЛЕКСА В КЛИНИЧЕСКОЙ ПРАКТИКЕ ПРИ ЭССЕНЦИАЛЬНОЙ ГИПЕРТЕНЗИИ

Aim. The aim of this article is to study heart rate turbulence in healthy people and in patients with stages II and III of essential hypertension and to analyze possibilities of using the results obtained in clinical practice. Materials and methods. Weexamined 68 people (48.5 % female participants) aged 56.21 ± 1.06 years. We analyzed the results of 24-hour ECG Holter monitoring obtained with the help of Kardiotekhnica-04 computer appliance (INCART). Essential hypertension was diagnosed using a standard diagnostic scheme recommended by the Society of Cardiology of the Russian Federation guidelines (2013). This diagnosis was not confirmed in 6 participants. We registered stage II hypertension in 28 examinees with respect to disturbances of target organs. We diagnosed stage III hypertension in 34 patients taking into account such an associated linical condition as ischemic heart disease. The assessment of heart rate turbulence indices was performed within the standard procedure. Results. The results obtained show that in patients with essential hypertension there is a relative decrease in the parasympathetic activity of the vegetative nervous system and baroreflex sensitivity. As essential hypertension worsens, a decrease in the parasympathetic activity of the vegetative nervous system is becoming more pronounced. The comparative analysis of heart rate disturbance indices revealed a decrease in TO and TS as essential hypertension progresses, however these values remain within reference limits. Conclusion. We gave the examples of heart rate turbulence analysis with TO and TS pathological values. Heart rate turbulence is the method of assessment of the autonomous nervous system. It can be used for a complex assessment of essential hypertension in clinical conditions and during rehabilitation.

The Use of β-blockers in Patients with Ventricular Ectopic Heartbeat in the Early and Distant Postinfarction Period

Aim: to increase the effectiveness of patients after Q-, QS- myocardial infarction rehabilitation, based on the study of clinical, instrumental and biochemical changes in cases of cardiac arrhythmias, and development on this basis of new approaches to treatment. Materials and Methods. The clinical, instrumental and biochemical examinations were carried out for 70 patients who had Q-, QS-myocardial infarction (MI) with a ventricular ectopic heartbeat on the regenerative period since the acute coronary syndrome development in 1, 3, and 6 months. The features of the ventricular ectopic heartbeat course in patients with myocardial infarction against the backdrop of sotalol and carvedilol use and influence of applied treatment on the clinical and pathogenetical features of patients’ functional recovery in early and distant (prolonged) postinfarction period were analyzed. Results. Analyzing the dynamics of coronary artery disease clinical manifestations in patients with ventricular arrhythmia (VA) with myocardial infarction against the backdrop of sotalol and carvedilol treatment it has been noted a marked decrease in anginal chest pain manifestation, feeling of palpitations, disruption of the heart, shortness of breath, feeling of breath shortness, etc. in all groups of patients. The positive effect of therapy had been increasing since the 3 week during the 3-month long treatment. Results of heart rate Holter monitoring have shown a marked antiarrhythmic effect of metoprolol, carvedilol and sotalol. In particular, in all groups of patients the frequency of VA reduced by half, the percentage of high grade VA decreased namely pair and group arrhythmia, ventricular bigeminy. Assessment of hemodynamic parameters in the process of patients with ST treatment has represented the marked trend and a further significant increase in ejection fraction and other contractile dysfunction forms correction. This positive trend was the most relevant in the application of carvedilol, a slightly less in patients treated with metoprolol and sotalol. Conclusions. Sotalol in patients after ACS has an ability to reduce the ventricular ectopic heartbeat episodes number and prevents life-threatening arrhythmias, provides a permanent and controlled decrease of heart rate, corrects left ventricle (LV) contractility and processes of postinfarction remodeling of the heart. When using carvedilol it has been noticed a reduction of LV postinfarction remodeling processes, improvement of contractile function of myocardium, antianginal and antiarrhythmic effects, normalization of heart rate variability, reduction of myocardial ischemia, reduction in sudden cardiac death cases.

Adaptation of Radiology Software to Improve Cardiology Results Reporting.

Twenty-four hour ambulatory electrocardiograms ("Holter" monitors) are a key diagnostic test in cardiology. Commercial electronic medical record (EMR) tools have not been designed for pediatric Holter monitor reporting and paper-based methods are inefficient. Our tertiary pediatric hospital adapted a radiology EMR tool to a cardiology workflow in order to report Holter monitor results. A retrospective review was performed at 4 time points: prior to intervention, immediately post-intervention, at 6 months and at 12 months post-intervention. The primary outcome variable was time to reporting of Holter findings. Holter reports were reviewed on 527 studies (patient ages: 1 day to 42 years). The time between the date the patient returned the Holter monitor until the date the referring physician received a final report improved from 19.8 days to 1.5 days (p<0.001). This result was durable over the next 12 months of follow-up. Physician interpretation time improved from 2.1 days to 0.6 days (p=0.01). Transcriptionist time and result scanning time were eliminated (removing 1.9 days and 14 days from the workflow, respectively). EMR systems are not typically designed for pediatric cardiology, but existing systems can be adapted, yielding important gains for patient care. In specialties like pediatric cardiology, there is insufficient volume nationally to drive development of commercial systems. This study demonstrates the general principle that creative adaptation of EMR systems can improve result reporting in pediatric cardiology and likely in other cardiology practices.Citation: Webster G, Ward K, Deal BJ, Anderson JB, Tsao S. Adaptation of Radiology Software to Improve Cardiology Results Reporting. Appl Clin Inform 2017; 8: 936-944 https://doi.org/10.4338/ACI-2017-03-RA-0051.

Prolonged P-Wave and QT Dispersion in Children with Inflammatory Bowel Disease in Remission.

Objectives. Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory bowel diseases (IBD) with unclear underlying aetiologies. Severe cardiac arrhythmias have been emphasised in a few studies on adult IBD patients. This study aimed to investigate the alteration of the P-wave and QT interval dispersion parameters to assess the risk of atrial conduction and ventricular repolarisation abnormalities in pediatric IBD patients. Patients and Methods. Thirty-six IBD patients in remission (UC: 20, CD: 16) aged 3–18 years and 36 age- and sex-matched control patients were enrolled in the study. Twelve-lead electrocardiograms were used to determine durations of P-wave, QT, and corrected QT (QTc) interval dispersion. Transthoracic echocardiograms and 24-hour rhythm Holter recordings were obtained for both groups. Results. The P-wave dispersion, QT dispersion, and QTc interval dispersion (Pdisp, QTdisp, and QTcdisp) were significantly longer in the patient group. The mean values of Pminimum, Pmaximum, and QTcminimum were significantly different between the two groups. The echocardiography and Holter monitoring results were not significantly different between the groups. Furthermore, no differences in these parameters were detected between the CD and UC groups. Conclusion. Results suggest that paediatric IBD patients may carry potential risks for serious atrial and ventricular arrhythmias over time even during remission.

VEGETATIVE REGULATION OF CARDIAC FUNCTION IN DIFFUSE TOXIC GOITER ASSOCIATED WITH PATHOGENETIC THERAPY

Objective: to study the vegetative regulation of cardiac function by means of Holter monitoring in patients diagnosed with diffuse toxic goiter associated with therapy with tireostatics and beta adrenoblockers (рropranololum, bisoprolol). Material and methods . 82 patients diagnosed with a diffuse toxic goiter aged 18-60, out of them 24 men and 58 women participated in the study. The patients were divided into two groups: the first group (46 patients) took non-selective beta adrenoblocker Propranololum (Anaprilin), the second group (36 patients) took beta1-adrenoblocker Bisoprolol. The control group included 30 almost healthy volunteers. All the patients were performed Holter monitoring with the assessment of heart rate variability, their thyroid status was studied. Results. We have done the comparative analysis of the thyroid status in the groups of the patients with diffuse toxic goiter following different schemes of pathogenetic therapy. We have analyzed the data of Holter monitoring with the assessment of heart rate variability related to the intake of cardioselective and non-selective beta adrenoblockers. Conclusion . Patients with compensated thyrotoxicosis taking Bisoprolol at a dose of 5 mg/day and Thiamazolum of 15 mg/day have signs of vegetative imbalance in the form of dominance of sympathetic section of the vegetative nervous system. When the compensation of thyrotoxicosis is achieved in patients using the scheme of 40 mg/day of Anaprilin and 20mg/day of Thiamazolum, the vegetative regulation of cardiac function is characterized by vegetative balance. The correction of medicamentous therapy of vegetative imbalance is possible taking into account results of Holter monitoring.

Assessment Of Sinoatrial Node Function In Patients With Persistent And Long-Standing Persistent Forms Of Atrial Fibrillation After Maze III Procedure Combined With Mitral Valve operation.

Assessment of sinoatrial node function after Maze III procedure combined with a mitral valve operation. 100 patients were included in the research with persistent and long-standing persistent forms of atrial fibrillation (AF) and need of operative treatment concerning valve disease. The following preoperative preparation methods were executed to all patients: Electrocardiogram in 12 standard assignments;Two-dimensional echocardiographic with assessment of systolic and diastolic functions of the left ventricle, size of the left atrium and grade of valve disease;Transesophageal echocardiography for exclusion of blood clots in the left atrium and left atrial appendage;Coronary angiography for exclusion of coronary heart disease;Computer tomography for examination of cardiac chambers and anatomic characteristics of pulmonary veins. Electric cardioversion in X-ray operating room conditions was performed on all patients. After successful restoration of sinus rhythm, electrophysiological examination (EP) of heart was carried out. Then, on the first or second day after EP study, Maze III procedure combined with a mitral valve operation was performed. Following the results of Maze III procedure combined with correction of valve disease, disposal of AF was observed in 95% of patients. 46% of patients had stable sinus rhythm to the moment of discharge from the hospital. 24% of patients had atrial rhythm with the maximum heart rate of 80-110 bpm (according to results of 24-hour Holter monitoring). For 25% of patients, it was necessary to implant a pacemaker. According to results of EP study, 13% of these patients suffered from sick sinus syndrome before operation. For 9% of the remaining 12% of patients, the indications for pacemaker implantation were atrioventricular nodal rhythm with low heart rate and pauses more than 3 sec long. For 1% of patients the indication was second degree AV block (type 2) and second degree SA block (type 2); for 1% the indication was complete heart block, and for 1% it was atrial rhythm and pauses more than 3 sec long. 13% of patients with an atrial rhythm and normal heart rate developed typical atrial flutter (AFL) in the early postoperative period. For all of them the RF catheter ablation with linear ablation of the right atrial isthmus and creation of isthmus block was effective, and further recurrence of AFL was not observed. In the early postoperative period Maze III procedure combined with a mitral valve operation proved to be an effective surgical technique of treatment of persistent and long-standing persistent forms of AF. Only 12% of patients had dysfunction of sinus node work due to iatrogenesis.

Prevent Sudden Death in Carvajal Syndrome With Left Ventricular Hypertrabeculation/Noncompaction.

Dear Editor, With interest we read the article by Mohammadpour Ahranjani et al. about a nine-year-old girl with heart failure due to systolic dysfunction and left ventricular hypertrabeculation/noncompaction (LVHT) in whom the association with skin abnormalities led to the diagnosis of Caravajal syndrome (CS) (1). We have the following questions and concerns: mutations in the desmoplakin genes have been identified in some patients with CS. However, there are also CS-cases in whom no mutations of the desmoplakin gene have been found thus indicating genetic heterogeneity (2). It would be interesting to know if genetic studies were carried out in the presented patient. In the case report we miss information about the family history of the patient. It is only indicated that two cousins suffered also from skin lesions and it remains unclear if they were investigated by a cardiologist and dermatologist. Since CS seems to be autosomal recessively inherited it would be of interest if the patient’s parents were consanguineous and if other family members showed any cardiac, skin or hair anomalies. CS may also be inherited as an autosomal dominant disease. In these cases, dental anomalies have been found (2-6). Thus, information about dental anomalies in the presented patient or in her family would be of interest. Regarding the patient’s history, we would like to know if there were any other health problems during pregnancy or early childhood except the skin problems and about her intellectual development. It is mentioned that she was diagnosed with anemia at age 8 years, but the type of anemia and the therapy are not indicated. CS is characterized by woolly hair. We miss the description of the patient’s hair. CS manifests frequently with arrhythmias, even leading to sudden death (4-6). Thus, it would be of interest to get information about any electrocardiographic abnormalities and whether she had a history of syncope, vertigo or spells suggesting arrhythmia which are reported to precede sudden death (7). If carried out, results of 24-hour Holter monitoring and bicycle stress testing are of interest. Implantation of a defibrillator (ICD) is reported in patients with CS and we miss information if this was considered in the presented patient (3, 6). Application of a wearable defibrillator (live vest) could be an alternative to protect her from sudden death and to defer placement of an ICD, or implantation of a loop recorder to more effectively assess the risk of ventricular arrhythmias and sudden death and to support the indication for an ICD. The patient suffered from systolic dysfunction of the left ventricle. It would be of interest if the right ventricle did also show any abnormalities. CS associated with LVHT has been reported in only 3 cases (2, 5, 8). The location of LVHT within the left ventricle should be described more precisely and how it was differentiated from thrombi, papillary muscles, or aberrant bands. Since the presented echocardiograms date from the year 2012, recent follow-up data could be useful. It would be interesting to know if LVHT changed in size and degree, if left ventricular function improved and left ventricular diameter decreased after successful heart failure therapy. Since LVHT is frequently associated with neuromuscular disorders it would be of interest to know if the patient was investigated neurologically and if she had a family history of a neuromuscular disorder (9). In the end of the discussion, the authors state that “we need much more time for the follow-up, cannot conclude clearly about the prognosis...” (1). Although CS as well as LVHT are rare disorders, there are sufficient data which indicate that both diagnoses in children and young adults are associated with a high risk for sudden death (10). Thus, careful follow-up and protection from sudden death seem mandatory in the presented patient.

Intermediate-Term Results After Extracardiac Conduit Fontan Palliation in Children and Young Adults with Single Ventricle Physiology-A Single-center Experience.

The Fontan operation and its modifications are currently the standard palliation in patients with single ventricle physiology. The advantages of extracardiac conduit Fontan operation (ECF) have previously been described. We evaluated the outcome of patients who underwent ECF operation at our center since the year 2000 to assess morbidity, mortality and New York Heart Association (NYHA) functional class in the current era. Medical records of 97 patients who underwent ECF operation from November 2000 till October 2013 were reviewed to determine the diagnosis, age at surgery, surgical technique, postoperative complications, NYHA class at last follow-up, echocardiographic parameters, and most recent Holter monitor results. The median age at surgery was 3.4years with 4 total deaths until last follow-up (hospital mortality was 1%, and mortality after hospital discharge was 3%). Seventy-eight of the 97 patients (80%) underwent fenestrated Fontan surgery. Median duration of follow-up was 3.9years (IQR 0.2-12.2years). At the latest follow-up, 62 patients (67%) were determined to be in NYHA class I, 25 patients (27%) in NYHA class II, and 6 (6%) patients in NYHA class III, and the median oxygen saturation was 92% (IQR 86-96). There were 15 patients with history of preoperative arrhythmias and 6 of them required pacemaker placement at the time of surgery. One patient developed ectopic atrial tachycardia, and 1 patient had clinical thromboembolism on follow-up. Systolic function of the single ventricle by transthoracic echocardiogram at the latest follow-up was described as normal in 77 patients (83%), fair in 15 patients (16%), and poor in 1 patient (1%). The results of our study show that patients who undergo extracardiac conduit Fontan operation in the modern era may have significantly less morbidity and mortality when compared to earlier years.

Abstract W P182: Left Atrial Volume as a Clinical Predictor for Atrial Fibrillation Detection in Cryptogenic Stroke: A Retrospective Analysis

Background: Detection of paroxysmal atrial fibrillation (PAF) after cryptogenic stroke has a major impact on secondary stroke prevention. Identifying clinical predictors to obtain a higher detection rate is necessary. There is an unclear association between left atrial enlargement (LAE) and PAF. Our goal was to determine the yield of 30-day Holter monitoring in patients with left atrial enlargement following acute ischemic stroke. Methods: We retrospectively identified patients with acute ischemic stroke from November 2012 to June 2014 who had an echocardiogram done and a 30-day holter monitor on discharge. Demographics, medical history, clinical/laboratory data, echocardiographic features and holter monitor detected events were collected. Moderate to severe LAE was defined as left atrial volume index (LAVI) &gt;35 cc/m2 on trans-thoracic echocardiogram. Patients were divided into two groups based on LAVI &gt;35 cc/m2; thirty day holter monitoring results were retrieved in each group. Along with paroxysmal atrial fibrillation, detection of other supraventricular arrhythmias associated with subsequent development of PAF (i.e., supraventricular tachycardia (SVT) and atrial ectopy) was compared between the groups. Categorical variables were analyzed with Fischer’s exact test and continuous variables using independent sample T-test. Results: 136 patients met our inclusion criteria, of which 76 (55.9%) completed 30 days of monitoring. Moderate to severe LAE was identified in 30 of 76 patients (39.5%). PAF was detected in 4 patients (5.3%). However, PAF was more likely in patients with LAE (13.3% vs 0%, p= 0.21). Detection of any PAF, SVT and atrial ectopy was more likely in patients with LAE (30% vs 6.5%, p= 0.009). Demographics, medical history, clinical and laboratory variables did not differ between patients with and without LAE. Conclusions: In our cohort, the presence of LAE increased the yield of PAF on 30-day holter monitoring. Supraventricular arrhythmias historically associated with subsequent development of atrial fibrillation were more likely in ischemic stroke patients with LAE.

Characteristics of risk factors in young and middle-aged patients with first hemispheric ischemic stroke

To compare risk factors of the first hemispheric ischemic stroke in young, middle and old age groups. One hundred and thirteen patients with first hemispheric ischemic stroke confirmed by CT/MRI were examined. The patients were divided into 2 groups: young and middle-aged (51 patients, 24 women, 27 men, mean age 49.8±5.2) and advanced-aged (62 patients, 30 women, 32 men, mean age 76.4±7.5). The frequency and duration of the following risk factors for ischemic stroke, including arterial hypertension, ischemic heart disease and arrhythmias, diabetes, smoking, family history of myocardial infarction and/or stroke, body mass index, acute emotional stress before the onset of the disease, were compared. Results of echocardiography, Holter and blood pressure monitoring, total cholesterol, low and high-density lipoproteins, triglycerides and blood glucose were analyzed. In young and middle-aged patients, an increased variability of blood pressure, acute emotional stress before the onset of stroke, a family history of cardiovascular and/or cerebrovascular disease, a decreased level of high-density lipoproteins, silent myocardial ischemia on Holter monitoring, mitral and tricuspid valve prolapse, minor abnormalities of the heart were more frequent than in the advanced age group. There are age-related differences in the spectrum and frequency of risk factors in patients with first hemispheric ischemic stroke. This fact should be taken into account in stroke prevention programs in various age groups.

Rupture of Nonstenotic Carotid Plaque as a Cause of Ischemic Stroke Evidenced by Multimodality Imaging

A 34-year-old woman was admitted for sudden onset of left-sided hemiparesis. Diffusion-weighted magnetic resonance imaging (MRI) 12 hours after symptom onset was positive, with hypersignal in the territory of the right middle cerebral artery consistent with acute cerebral infarction. Magnetic resonance angiography confirmed occlusion of the right middle cerebral artery and found a 30% stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria) of the origin of the right internal carotid artery. Carotid ultrasound (Figure, A–D) evidenced the presence of a noncalcified plaque of the right carotid causing a stenosis of the origin of the internal carotid artery evaluated at 40% (North American Symptomatic Carotid Endarterectomy Trial criteria). Results of electrocardiography, Holter monitoring, transthoracic and transesophageal echocardiography, and laboratory investigations were all normal. Figure. A–D , Carotid ultrasound of the right carotid showed the presence of a noncalcified plaque with gray-scale 2-dimensional imaging (white arrow; A , longitudinal view; C , axial view) that caused a …