Impact Of Arrhythmias Research Articles

Arrhythmias in Critically Ill Surgical and Non-surgical Patients: A National Propensity-Matched Study.

Arrhythmias are common in critically ill patients, though the impact of arrhythmias on surgical patients is not well delineated. We aimed to characterize mortality following arrhythmias in critically ill patients. We performed a propensity-matched retrospective analysis of intensive care unit (ICU) patients from 2007 to 2017 in the Cerner Acute Physiology and Chronic Health Evaluation database. We compared outcomes between patients with and without arrhythmias and those with and without surgical indications for ICU admission. We also modeled predictors of arrhythmias in surgical patients. 467,951 patients were included; 97,958 (20.9%) were surgical patients. Arrhythmias occurred in 1.4% of the study cohorts. Predictors of arrhythmias in surgical patients included a history of cardiovascular disease (odds ratio [OR] 1.35, 95% confidence interval [CI95] 1.11-1.63), respiratory failure (OR 1.48, CI95 1.12-1.96), pneumonia (OR 3.17, CI95 1.98-5.10), higher bicarbonate level (OR 1.03, CI95 1.01-1.05), lower albumin level (OR 0.79, CI95 0.68-0.91), and vasopressor requirement (OR 27.2, CI95 22.0-33.7). After propensity matching, surgical patients with arrhythmias had a 42% mortality risk reduction compared to non-surgical patients (risk ratio [RR] 0.58, CI 95 0.43-0.79). Predicted probabilities of mortality for surgical patients were lower at all ages. Surgical patients with arrhythmias are at lower risk of mortality than non-surgical patients. In this propensity-matched analysis, predictors of arrhythmias in critically ill surgical patients included a history of cardiovascular disease, respiratory complications, increased bicarbonate levels, decreased albumin levels, and vasopressor requirement. These findings highlight the differential effect of arrhythmias on different cohorts of critically ill populations.

Prevalence and Impact of Arrhythmia on Outcomes in Restrictive Cardiomyopathy-A Report from the Beijing Municipal Health Commission Information Center (BMHCIC) Database.

Data on the outcomes of restrictive cardiomyopathy (RCM) are limited, when the condition is complicated with arrhythmia. This study was designed to investigate the prevalence of atrial fibrillation (AF), ventricular tachycardia (VT) and bradycardia (BC) and their impact on adverse outcomes (intra-cardiac thrombus, stroke and systematic embolism [SSE], heart failure and death) of RCM. The retrospective cohort study used data collected from the Beijing Municipal Health Commission Information Center (BMHCIC) database from 1 January 2010 to 31 December 2020. There were 745 (64.9%) patients with AF, 117 (10.2%) patients with VT and 311 (27.1%) patients with bradycardia. The presence of AF was associated with an increased risk of SSE (adjusted HR:1.37, 95%CI:1.02-1.83, p = 0.04) and heart failure (aHR:1.36, 95%CI:1.17-1.58, p < 0.001). VT was associated with an increased risk of intracardiac thrombus (aHR:2.34, 95%CI:1.36-4.01, p = 0.002) and death (aHR:2.07, 95%CI:1.19-3.59, p = 0.01). Bradycardia did not increase the adverse outcomes in RCM. The results remained consistent and steady when AF, VT and bradycardia were adjusted as competing factors. Cardiac arrhythmia are highly prevalent and associated with adverse outcomes in patients with RCM. AF and VT are more likely to be associated with intracardiac thrombosis, and the presence of AF increased the risk of SSE and HF. The presence of VT increased the risk of death.

Burden and Impact of Arrhythmias in Repaired Tetralogy of Fallot.

Arrhythmias are a leading cause of morbidity and mortality following repair of tetralogy of Fallot (TOF). This review will highlight current understanding of arrhythmia pathogenesis in this patient population and review novel therapeutic options. Risk factors for developing ventricular arrhythmias in repaired TOF have thus far been better defined than for atrial arrhythmias. Growing understanding of the pathophysiology of arrhythmias, development of risk stratification models, and novel techniques such as electrophysiologic ultrahigh-density mapping should help to better identify patients that benefit from advanced therapies such as ablation and implantable cardioverter defibrillators. Atrial and ventricular arrhythmias are common in TOF patients. Methods of risk stratification and therapeutic approaches are rapidly evolving, leading to ever improving clinical outcomes in this patient population.

Retrospective analyses of factors influencing arrhythmias and the impact of arrhythmias on inpatient outcomes among hospitalized patients with hemochromatosis

BackgroundThough hemochromatosis is described as an infiltrative cardiomyopathy that can result in arrhythmias, studies are lacking on the impact of arrhythmias in this population. We examined the prevalence, factors influencing arrhythmias, and impact of arrhythmias on inpatient outcomes among hospitalized patients with hemochromatosis. MethodsRetrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS) collected between 2016 and 2018. Descriptive analyses were done to assess the prevalence of arrhythmias in patients with hemochromatosis. Univariate and multivariable logistic and linear regression models were used to examine the factors associated with arrhythmias and hospital-associated outcomes among patients with hemochromatosis. Results11.7% of hemochromatosis patients were diagnosed with arrhythmias. Compared to hemochromatosis patients less than 40 years old, those between 40 and 59 years had 2.3 times higher odds (Adjusted Odds Ratio (AOR): 2.35; 95% Confidence Interval (CI): 1.81–3.05) of having arrhythmias relative to no arrhythmias while patients aged 60 and above had 5 times higher odds (AOR: 4.96; 95% CI: 3.74–6.58) of arrhythmias. Compared to male patients, females were significantly less likely to be diagnosed with arrhythmias. Hispanics were 36% (AOR: 0.64; 95% CI: 0.47–0.86) less likely to have arrhythmias when compared to their non-Hispanic white counterparts. Other factors associated with arrhythmias were income, insurance type, and patient disposition. Furthermore, arrhythmias were related to higher hospital mortality, longer hospital stays, and total hospital charges. ConclusionOur findings accentuate the need for close monitoring and early detection of arrhythmias in patients with hemochromatosis to improve their health outcomes. Patients need to be continually educated on their medical diagnoses and the need for treatment adherence, while hospitalist physicians need to ensure good continuity of care between the hospital and primary care setting to drive hospital costs down while keeping patients healthy.

Impact of Arrhythmia in Hospital Mortality in Acute Ischemic Stroke Patients: A Retrospective Cohort Study in Northern Mexico

BackgroundAtrial fibrillation has been associated with higher morbidity and mortality rates in acute ischemic stroke patients (AIS). However, there is scarce information regarding the clinical outcomes and strokes’ characteristics among AIS patients with other type of arrhythmias. ObjectiveOur study aims to analyze the hospital mortality rate, stroke characteristics, and clinical and demographical data of patients with any post-stroke arrhythmia. MethodsRetrospective cohort study of AIS patients with 24h-Holter monitoring during hospital admission recruited between 2015-2020, outcomes were measured using the modified Rankin scale. Results597 patients (61.13±13.61 years; 352 men) were included. Arrhythmias were diagnosed in 33 (5.5%), with atrial fibrillation as the most common finding (82%). Age was related to a higher rate of arrhythmia (P = 0.014). A larger prevalence of cardioembolic strokes (69.7% vs 16.6%, P < 0.05) and AIS in the middle cerebral artery's vascular territory (78.8% vs 58.7%, P < 0.05) were found amongst patients with an arrhythmia. No significant association was found between NIHSS at admission with neither incidence of arrhythmia nor mortality. Within the arrhythmia group, three in-hospital deaths were reported: one AF, one ventricular arrhythmia and one second-degree atrioventricular block. In a logistic regression analysis, patients with any kind of arrhythmia had a higher mortality rate (9.1% vs 1.2%, P = 0.011; OR 6.766, 95% CI 1.552 – 29.500). ConclusionArrhythmia detection after an AIS was associated with increased in-hospital mortality. Risk factors related to arrhythmia detection were a higher mean age, cardioembolic strokes and AIS affecting the middle cerebral artery.

Abstract 10109: High Prevalence and Significant Impact of Arrhythmias on Healthcare Resource Utilization in Hospitalizations of Patients with Prior (corrected) Congenital Heart/Circulatory Disease

Introduction: Even after surgical correction, adults with a previously corrected Congenital Heart Disease (CHD) may remain at a significantly elevated risk of arrhythmias. However, there is not much known about the prevalence, comorbidity burden, and impact of arrhythmia in these patients. Methods: Using the National Inpatient Sample (2015 Oct-2017), adult admissions with previously corrected CHD were identified. The primary outcome was the prevalence of arrhythmia and secondary outcomes included comorbidities and outcomes between the arrhythmic vs. non-arrhythmic cohort. Results: Of 19,395 admissions with previously corrected CHD, 7675 (39.6%) patients experienced arrhythmias [median age 55 (39-68) years, male 51.7%, white 75%] (Table 1). The arrhythmic cohort often consisted of relatively older, male, white patients and had higher rates of hypertension (56.4% vs. 41%), hyperlipidemia (33.1% vs. 23%), diabetes (9% vs. 6.5%), renal failure (14% vs. 7.8%), and congestive heart failure (17.6% vs. 9.2%) compared to the non-arrhythmic cohort. The arrhythmic cohort had a higher frequency of patients with at least one CVD risk factor (75.5% vs. 65.4%). All-cause mortality was non-significantly higher in the cohort with arrhythmia (1.6% vs. 1.3%). Furthermore, the arrhythmic cohort was less often routinely discharged and had more frequent transfers/home healthcare requirements, prolonged hospital stay, and higher hospital charges. Conclusions: Nearly 40% of admissions among patients with a prior history of surgically corrected CHD experienced arrhythmias which were associated with a considerably higher comorbidity burden and healthcare resource utilization with non-significantly higher all-cause mortality.

Post-operative arrhythmias in patients with hypoplastic left heart syndrome and anatomic variants: incidence, type, and course.

Arrhythmias are common in the post-operative course of patients with hypoplastic left heart syndrome. We sought to determine the types, incidence, risk factors, and impact of arrhythmias in patients with HLHS and anatomic variants. We performed a retrospective chart review of 120 consecutive patients with HLHS and anatomical variants, who had single-ventricle palliation at our institution from January, 2006 to December, 2016. A total of thirty-one patients (26%) had 37 episodes of arrhythmias over a median follow-up period of 3.5 years. Of the 37 episodes, 12 (32.4%) were ectopic atrial tachycardia, 9 (24.3%) were paroxysmal supraventricular tachycardia, 4 (10.8%) were junctional ectopic tachycardia, 5 (13.6%) were sinus node dysfunction, 3 (8.1%) were heart block, 2 (5.4%) were atrial flutter, and 2 (5.4%) were ventricular tachycardia. Twenty-four (65%) of the arrhythmias occurred at post-stage 1 surgery. Most (64.8%) of the arrhythmias were resolved. Arrhythmias that occurred at post-stage 1 surgery were more likely to resolve compared to post-stages 2 or 3 (p = 0.006). No anatomical, surgical, or clinical variables were associated with arrhythmia except for age (OR per unit decrease in age at stage 1 palliation: 1.12 (95% CI 1.003, 1.250); p = 0.0439). Arrhythmias were not associated with length of hospital stay or mortality. Arrhythmias are common in patients with HLHS and anatomic variants, with EAT and PSVT being the most common types. Arrhythmias were associated with younger age at surgery, but did not affect mortality or length of hospital stay.

Burden and impact of arrhythmias in asthma-related hospitalizations: Insight from the national inpatient sample.

BackgroundThis study aimed to analyze the burden and impact of cardiac arrhythmias in adult patients hospitalized with asthma exacerbation using the nationwide inpatient database.MethodsWe used the National Inpatient Sample (NIS) database (2010‐2014) to identify arrhythmias in asthma‐related hospitalization and its impact on inpatient mortality, hospital length of stay (LOS), and hospitalization charges. We also used multivariable analysis to identify predictors of in‐hospital arrhythmia and mortality.ResultsWe identified 12,988,129 patients hospitalized with primary diagnosis of asthma; among them, 2,014,459(16%) patients had cardiac arrhythmia. The most frequent arrhythmia identified is atrial fibrillation (AFib) (8.95%). The AFib and non‐AFib arrhythmia group had higher mortality (3.40% & 2.22% vs 0.74%), mean length of stay (LOS) (5.9 & 5.4 vs 4.2 days), and hospital charges ($53,172 & $51,105 vs $34,585) as compared to the non‐arrhythmia group (P < .005). Predictors of arrhythmia in asthma‐related hospitalization were history of PCI or CABG, valvular heart disease, congestive heart failure (CHF), and acute respiratory failure. Predictors of higher mortality in arrhythmia group were acute respiratory failure, sepsis, and acute myocardial infarction.ConclusionsAround 16% of adult patients hospitalized with asthma exacerbation experience arrythmia (mostly AFib 8.95%). The presence of arrhythmias was associated with higher in‐hospital mortality, LOS, and hospital charges in hospitalized asthmatics.

The Prevalence and Impact of Arrhythmias in Hospitalized Patients with Sickle Cell Disorders: A Large Database Analysis

Introduction: Sickle cell disorders (SCD) is associated with progressive dysfunction of vital organs, including the cardiovascular system. While the development of pulmonary hypertension and left ventricular dysfunction have been previously studied, the burden of arrhythmias in SCD patients remains largely unknown. Thus, we aim to describe and analyze the prevalence and impact of arrhythmias in hospitalized adult patients with SCD and their impact in patient-oriented outcomes. Methods: We identified incident arrhythmias in patients with SCD in the National Inpatient Sample (NIS) database in 2 years (2016-2017), using ICD-10 codes. We compared major patient characteristics, outcomes, and economic impact between groups of SCD patients with and without documented arrhythmias. A logistic regression model was used to control for age, sex, race, admission type, hospital characteristics, and relevant comorbidities. To increase statistical robustness, propensity-score matching for age, sex, income, and comorbidities was used to match 1144 SCD patients with arrhythmia and 1144 patients without. Results: Among inpatients with SCD in the database, 5,930 of 174,450 patients with SCD had documented arrhythmias (3.4%). The arrhythmia group consisted mostly of patients' sickle cell disease (5,650; 95%), while 245 had sickle cell trait, and 35 were classified as having other sickle cell disorders. Individuals in the arrhythmia group were significantly older (mean age 41.3, SD 14.1) than those with no arrhythmia (mean age 31.5, SD 10.3). Further, arrhythmia group had higher prevalence of hypertension (44.2% vs 19.1%, p&amp;lt;0.001), congestive heart failure (25.8% vs 4.1%, p&amp;lt;0.001), chronic kidney disease (24.0% vs 5.6%, p&amp;lt;0.001), valvular heart disease (9.3% vs 1.5%, p&amp;lt;0.001), myocardial infarction (4.1% vs 1.25%, p&amp;lt;0.001), type 2 diabetes mellitus (3.5% vs 1.7%, p&amp;lt;0.001), and pulmonary hypertension (3.5% vs 1.2%, p&amp;lt;0.001). When looking at major outcomes, after adjusting for confounders, arrhythmias were positively associated with all cause in-hospital mortality with an adjusted OR of 53.6 (95% CI 44.3, 65.1). After propensity-matching (Table 1), the arrhythmia group had a higher rate of all-cause in-hospital mortality (6.12% vs 0.35%, p&amp;lt;0.001), higher median length of stay (6.8 days vs 5.8 days, p&amp;lt;0.001), and mean total hospital charges ($13,441 vs $10,255, p&amp;lt;0.001). There was no statistically significant difference in the rate of stroke between both groups. Conclusions: The presence of arrhythmias in patients with SCD was associated with markedly increased all cause in-hospital mortality, even after adjusting for confounders via logistic regression and propensity-score matching analyses. Despite a relatively low overall prevalence of 3.4% among this large inpatient cohort, this data suggests that arrhythmias may confer an important excess disease burden in SCD patients, including higher mortality. Intuitively, arrythmias confer higher mortality in patients with chronic disorders and multiple cardiovascular risks, whether this is specific to SCD deserves further study. Also, studies are needed to better understand the occurrence particularly in relation to active vaso-occlusive crisis and to evaluate whether SCD individuals with arrhythmias could potentially benefit from more intensive monitoring and/or better cardiovascular disease control. Disclosures No relevant conflicts of interest to declare.

Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16-year nationwide study from 1999 to 2014.

BackgroundPatients with cardiac amyloidosis (CA) have increased mortality, which can be explained in part by an increased risk of arrhythmias. The burden of arrhythmias in CA, their predictors, and impact on in‐hospital outcomes remains unclear. The role of implantable cardioverter‐defibrillators (ICD) in this population is also uncertain.MethodsWe queried the National Inpatient Sample (NIS) using ICD‐9‐CM codes 277.39 and 425.7 to identify CA. Twelve common arrhythmias were extracted using appropriate, validated ICD‐9‐CM codes. ICD implantation was identified using procedure ICD‐9 codes 37.94 to 37.98, 00.51 and 00.54.ResultsThere were a total of 145,920 CA hospitalizations between 1999 and 2014 in the United States and 56,199 (38.5%) of them were associated with arrhythmias. The prevalence of arrhythmias remained relatively constant from 41.5% in 1999 to 40.2% in 2014. The most common arrhythmia was atrial fibrillation (25.4%). In‐patient mortality was significantly higher in CA patients with arrhythmias (10.4% vs 6.5%, P < .001). ICD implantation was performed in 1,381 (0.94%) patients with CA and analysis revealed an incremental trend in implantation over the study period (0.48% in 1999 to 0.65% in 2014). In‐hospital mortality was significantly lower in patients who underwent ICD implantation (3.7% vs 8%; P = .0078). CA patients with arrhythmias also had an increased cost of hospitalization and length of stay ($65,046 ± 1,079 vs $53,322 ± 687 and 8.3 ± 0.1 vs 7.4 ± 0.1 days, respectively; P < .0001).ConclusionCardiac arrhythmias are common in patients with CA and are associated with worse in‐hospital outcomes, increased length of stay, and cost of hospitalization.

Impact of atrial arrhythmia on survival in adults with tetralogy of Fallot

Atrial arrhythmia is a late complication after tetralogy of Fallot (TOF) repair, but arrhythmia outcomes data are limited. The purpose of the study was to describe atrial arrhythmia presentations, outcomes of antiarrhythmic therapy, and impact of arrhythmia on transplant-free survival. We reviewed the MACHD (Mayo Adult Congenital Heart Disease) Registry and identified 113 patients (age 49 ± 13 years) with documented arrhythmia, and 302 patients without history of arrhythmia, 1990-2017. We classified arrhythmias into atrial fibrillation and atrial flutter/tachycardia based on the rhythm on the first abnormal electrocardiogram. At the time of first documented arrhythmia, 58(51%) had atrial fibrillation while 55(49%) had atrial flutter/tachycardia. Of the 113 patients, 14(12%) received rhythm control with class I/III antiarrhythmic drugs (AAD), 79(70%) had direct current cardioversion, 9(8%) received rate control with class II/IV AAD, and 11(10%) received only anticoagulation. Successful cardioversion occurred in 100(89%) patients, and arrhythmia recurrence rate was 16 per 100 patient-years. The multivariate risk factors for death and/or heart transplant were atrial fibrillation (HR 1.94, CI 1.10-3.15, P = .031) and older age (HR 1.63, CI 1.12-2.43, P = .019) per 5 year increment. Atrial fibrillation, but not atrial flutter, was associated with reduced survival in our repaired TOF cohort. Further studies are required to determine if more aggressive antiarrhythmic therapy will improve survival in patients with atrial fibrillation.

Clinical impact of newly developed atrial fibrillation complicated with longstanding ventricular fibrillation during left ventricular assist device support: A case report

BackgroundContinuous-flow left ventricular assist devices (LVADs) improve survival and morbidity in patients with stage D heart failure. Management of LVADs for longer durations is necessary in some clinical settings, and a better understanding of the hemodynamics of patients using LVADs is warranted. Arrhythmia, including atrial (AA) and ventricular (VAs) arrhythmias, is a modifying factor of hemodynamics that is highly prevalent among patients with LVADs. However, the clinical impact of arrhythmias in various clinical settings in patients with LVAD, in which the hemodynamic load is likely to present as worsening of right heart failure, remains to be completely elucidated.Case presentationWe describe the case of a patient under sustained ventricular fibrillation for extraordinarily long duration who was stabilized using LVAD support and in whom newly developed atrial fibrillation led to a significant worsening of right heart failure while using an LVAD.ConclusionThis case demonstrates the substantial clinical impact of AAs in the management of right heart failure using an LVAD.

IMPACT OF ATRIAL ARRHYTHMIA ON SURVIVAL IN ADULTS WITH TETRALOGY OF FALLOT

Atrial arrhythmia is a late complication after tetralogy of Fallot (TOF) repair, but arrhythmia outcomes data are limited. The purpose of the study was to describe atrial arrhythmia presentations, outcomes of antiarrhythmic therapy, and impact of arrhythmia on transplant-free survival. We reviewed

The burden and impact of arrhythmia in chronic obstructive pulmonary disease: Insights from the National Inpatient Sample

BackgroundWe aimed to analyze the burden and predictors of arrhythmias and in-hospital mortality in chronic obstructive pulmonary disease (COPD)-related hospitalizations using the nationwide cohort. MethodsWe queried the National Inpatient Sample (NIS) (2010–2014) databases to identify adult COPD hospitalizations with arrhythmia. Categorical and continuous variables were compared using Chi-square and Student's t-test/ANOVA. Predictors of any arrhythmia including AF and in-hospital mortality were evaluated by multivariable analyses. ResultsOut of 21,596,342 COPD hospitalizations, 6,480,799 (30%) revealed co-existent arrhythmias including 4,767,401 AF-arrhythmias (22.1%) and 1,713,398 non AF-arrhythmias (7.9%). The AF or non-AF arrhythmia cohort consisted mostly of older (mean age~ 75.8 & 69.1 vs. 67.5 years) white male (53.3% & 51.9% vs. 46.9%) patients compared to those without arrhythmias (p < 0.001). The all-cause mortality (5.7% & 5.2 vs. 2.9%), mean length of stay (LOS) (6.4 & 6.5 vs. 5.3 days), and hospital charges ($52,699.49 & $58,102.39 vs. $41,208.02) were higher with AF and non AF-arrhythmia compared to the non-arrhythmia group (p < 0.001). Comorbidities such as cardiomyopathy (OR 2.11), cardiogenic shock (OR 1.88), valvular diseases (OR 1.60), congestive heart failure (OR 1.48) and pulmonary circulation disorders (OR 1.25) predicted in-hospital arrhythmias. Invasive mechanical ventilation (OR 6.41), cardiogenic shock (OR 5.95), cerebrovascular disease (OR 3.95), septicemia (OR 2.30) and acute myocardial infarction (OR 2.24) predicted higher mortality (p < 0.001) in the COPD-arrhythmia cohort. ConclusionsAbout 30% of COPD hospitalizations revealed co-existent arrhythmias (AF 22.1%). All-cause mortality, LOS and hospital charges were significantly higher with arrhythmias. We observed racial and sex-based disparities for arrhythmias and related mortality.

Treatment for ventricular arrhythmias in the absence of structural heart disease: from guidelines to clinical practice

To determine criteria for choosing management tactics in patients with ventricular arrhythmias (VA) in the absence of structural heart disease from the point of view of physicians and patients in clinical practice and to compare the immediate results of antiarrhythmic drug therapy (ADT) and radiofrequency ablation (RFA) with the trends in arrhythmic syndrome in the non-treatment group. Examinations were made in 90 patients (23 men and 67 women) (mean age, 44 (31; 57) years) with VA in the absence of structural heart disease. Preference was given to RFA (n = 32 (36%)), ADT (n = 37 (41%)), and follow-up tactics (n = 21 (23%)). At baseline and 1 month, Holter ECG monitoring was done; quality of life (QOL) was assessed; and anxiety and depression levels were detected using the SF-36 and HADS questionnaires. In addition, 71 physicians were surveyed about their preferences to the treatment of VA in individuals without structural heart disease. In the total group of patients, VA was unambiguously accompanied by the symptoms only in 47%. The signs of anxiety and depression were identified in 41 and 14% of cases, respectively. The efficiency of RFA was comparable to that of ADT (p > 0.1): a positive antiarrhythmic effect was observed in 71.9% of the patients in the RFA group and in 67.6% in the ADT group. During one month, 38.1% of the patients in the follow-up group showed a spontaneous substantial reduction in the number of ventricular premature beats (VPBs) or disappearance of unstable ventricular tachycardia (UVT), which met the criteria for a positive effect. At baseline, the QOL indicators on a social functioning scale in the RFA group were worse than those in the ADT group. At the same time, most QOL indicators in the patients who have chosen a wait-and-see tactic were significantly higher than those in the RFA and ADT subgroups. The patients treated with ethacyzin in the ADT group more frequently achieved a positive effect. In the interviewed physicians' opinion, the choice of a tactic depended on the impact of arrhythmia on health status (68%), the number of VPBs per day (61%), and the presence of UVT (56%). RFA or ADT was most often recommended when there were 10,000-15,000 or more VPBs per day ((49 and 35% of the respondents, respectively). 46.5% of the respondents stated that β-blockers were the drug of choice for idiopathic frequent VPBs. Only 30% of the respondents considered it appropriate to restrict to a follow-up in the presence of asymptomatic VPBs. Patient management in clinical practice generally complies with the current guidelines; however, much importance is attached to the severity of arrhythmia (the number of VPBs per day, the presence of UVT) in addition to the presence of symptoms. In the opinion of most physicians, the initiation of treatment is justified when there are 10,000-15,000 and more per day. QOL assessment may be promising in choosing the optimal management tactics for these patients. Treatment should not be initiated immediately in patients with a high level of QOL, especially in those with arrhythmia lasting less than 12 months, by taking into account that there can be a spontaneous improvement in 38% of cases within the next month. The immediate results of ADT and RFA are comparable in patients with VA in the absence of structural heart disease. The Class IC antiarrhythmic drug ethacyzin is the most effective agent that ensures positive changes in arrhythmic syndrome in 66.7% of cases with the rate of side effects being in 17.8%.

Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network

ObjectivesThe study objective was to determine the predictors of new-onset arrhythmia among infants with single-ventricle anomalies during the post-Norwood hospitalization and the association of those arrhythmias with postoperative outcomes (ventilator time and length of stay) and interstage mortality. MethodsAfter excluding patients with preoperative arrhythmias, we used data from the Pediatric Heart Network Single Ventricle Reconstruction Trial to identify risk factors for tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia) and atrioventricular block (second or third degree) among 544 eligible patients. We then determined the association of arrhythmia with outcomes during the post-Norwood hospitalization and interstage period, adjusting for identified risk factors and previously published factors. ResultsTachyarrhythmias were noted in 20% of subjects, and atrioventricular block was noted in 4% of subjects. Potentially significant risk factors for tachyarrhythmia included the presence of modified Blalock–Taussig shunt (P = .08) and age at Norwood (P = .07, with risk decreasing each day at age 8-20 days); the only significant risk factor for atrioventricular block was undergoing a concomitant procedure at the time of the Norwood (P = .001), with the greatest risk being in those undergoing a tricuspid valve procedure. Both tachyarrhythmias and atrioventricular block were associated with longer ventilation time and length of stay (P < .001 for all analyses). Tachyarrhythmias were not associated with interstage mortality; atrioventricular block was associated with mortality among those without a pacemaker in the unadjusted analysis (hazard ratio, 2.3; P = .02), but not after adding covariates. ConclusionsTachyarrhythmias are common after the Norwood procedure, but atrioventricular block may portend a greater risk for interstage mortality.

176-57: Impact of Detected Arrhythmias on further Therapy Decision in Patients with Wearable Cardioverter Defibrillators

Background: Patients (pts) with reduced left ventricular function often suffer from fatal cardiac arrhythmias. Cardioverter Defibrillator implantation (ICD) is recommended after risk stratification and/ or a period of optimized pharmacological and/ or coronary interventional treatment. Wearable cardioverter defibrillator (WCD) have been invented to bridge this period, providing both, cardiac rhythm monitoring and defibrillation therapy delivery. As there are only few data about further therapy decision in WCD pts, we present a single centre experience. Methods: 84 pts (64 male, 64 ± 14 years) with reduced left ventricular function (EF 33.5 ± 12.9 %) received a WCD (LifeVest®, ZOLL, Pittsburgh, PA, USA). 46 pts suffered from dilative cardiomyopathy or non-ischemic cardiomyopathy, 21 pts from ischemic heart disease post coronary intervention or from CABG operation (n = 3), 6 pts from acute myocarditis, 4 pts from ICD explantation, and 4 from other reasons. Results: Pts wore WCD 48.5 ± 32.6 days and 20.3 ± 3.8 hours per day. During that time, 2065 events were registered, ranging from 1 to 222 events per pt. 1592 events were automatically detected, 366 events were manually activated and 99 were due to initiating the system. Out of the automatically detected events, 1586 were tachycardia and 6 were bradycardia or asystole. The latter was in all patients due to disconnected systems. Out of the manually detected events, only 8 arrhythmias were “true”, i.e. sustained VT (n = 2), non-sustained VT (n = 2), bradycardia (n = 1), and atrial fibrillation (n = 3). In 3 pts. arrhythmia detection led to an adequate and successful shock delivery. Non of these patients showed VT/VF before or after this event. All data were transferred automatically by the device remote system. After WCD therapy, 33 pts (39.3%) received an ICD due to persistence of left ventricular EF reduction and/or persistence of high degree of ventricular ectopy. In 51 pts (60.7%), an ICD implantation could be avoided. Conclusion: Among patients with reduced left ventricular function and high risk of ventricular arrhythmia, the use of WCD was feasible and showed a high acceptance rate. In these pts, WCD allowed a high detection rate and shock application, if necessary. As decision for ICD implantation was based on arrhythmias detected by WCD only in few patients, the impact of arrhythmias on ICD implantation seems to be low in these patients.

Impact of cardiac arrhythmia on velocity quantification by ECG gated phase contrast MRI

Background Blood flow quantification using ECG gated phase contrast (PC) MRI has proven to be a useful clinical tool for the evaluation of cardiovascular pathologies such aortic valve disease or cardiac shunts. However, data are acquired in an ECG synchronized manner over multiple heart beats and the impact of cardiac arrhythmia, which can frequently be encountered in patients with atrial fibrillation (AF), on flow parameters is unclear. To assess the impact of arrhythmia and thus RR interval variability on ECG-gated PC MRI acquisitions we have performed a simulation study to systematically investigate the impact of beat-to-beat variations on ECG gated multi-beat flow imaging with MRI using real time invivo TEE data in 5 AF patients with known arrhythmia.

Driving and arrhythmia: a review of scientific basis for international guidelines

In patients with arrhythmias, the most feared complication while driving is of driver incapacity resulting in a road traffic accident. Patients with implantable cardioverter-defibrillators (ICDs) may suffer incapacity as a result of device therapy itself. The aim of this review article was to examine the types of arrhythmia that occur while driving, the impact of arrhythmia on driving as well as evidence to support that driving itself can precipitate arrhythmias. We will also review the postulated mechanisms by which driving can precipitate arrhythmias. Finally, we will compare guidelines from the USA, Europe, and UK in fitness to drive in patients with arrhythmias and ICDs.

Assessment of the Influence of Atrial Fibrillation on Gated SPECT Perfusion Data by Comparison with Simultaneously Acquired Nongated SPECT Data

The impact of arrhythmias on the evaluation of perfusion data from myocardial gated SPECT has been assessed by comparing arrhythmic patients with nonarrhythmic patients or by simulating rhythm disturbances. Whether gating-related artifacts may have a clinically relevant influence on the evaluation of perfusion in atrial fibrillation (AF) patients is still uncertain. Recently, collection of nongated and gated datasets during the same SPECT acquisition has become possible. The aim of this study was to examine the difference in myocardial perfusion between simultaneously acquired gated and nongated SPECT data in AF patients. In 44 consecutive AF patients who underwent myocardial perfusion SPECT for standard clinical indications, both a gated and a nongated study were simultaneously acquired. Perfusion was estimated in a masked manner on a 20-segment model using an established scoring scheme. Agreement was good between the gated and nongated perfusion scores on a segment basis; the agreement for resting scores was the highest, with those for stress and difference scores being lower (Spearman rho = 0.82, 0.74, and 0.55, respectively). On a patient basis, a similar trend was seen in summed resting scores (rho = 0.911), summed stress scores (rho = 0.779), and summed difference scores (rho = 0.596). When summed stress and summed difference data were grouped by severity class (normal, mild abnormality, moderate abnormality, and severe abnormality), agreement decreased from rho = 0.818, kappa = 0.639, for summed stress score to rho = 0.549, kappa = 0.367, for summed difference score. The severity class of inducible ischemia changed in 17 patients (39%) if a (summed) gated image was used instead of a standard nongated perfusion image. AF may have a clinically relevant impact on summed gated perfusion images, compared with images simultaneously obtained without gating in the same patients. Therefore, acquisition of a nongated SPECT study is mandatory for accurate assessment of myocardial perfusion in AF patients.