Incidence Of Malignant Arrhythmias Research Articles

Incidence of intrahospitalary major cardiac events with the use of mechanic thromboaspiration versus only use of IIB/IIIA glucoprotein inhibitors on patients with acute ST elevation myocardial infarction

To identify the incidence of in-hospital major adverse cardiac events (MACE) with the use of mechanic thromboaspiration plus IIb/IIIa glycoprotein inhibitors versus only use of IIb/IIIa glycoprotein inhibitors on patients with acute ST elevation myocardial infarction. Retrospective, observational, cohort analytic study, on patients with acute ST elevation myocardial infarction that had angiography thrombus TIMI 5 grade, treated between October 2021 and December 2022. A total of 237 patients were included. In 113 patients thromboaspiration were used, 124 patients didn't used. 81.6% were men. In-hospital MACE occurred on 31.9% of patients with thromboaspiration use vs. 30.6% on patients with no use (RR: 1.05; IC95%: 0.61-1.93; p = 0.840). Incidence of malignant arrhythmias were of 8% with thromboaspiration use vs. 1.6% on patients with no use (RR: 5.27; IC95%: 1.11-24.97; p = 0.020). The use of thromboaspiration on concomitant treatment with IIb/IIIa glycoprotein inhibitors was similar with only IIb/IIIa glycoprotein inhibitors in reducing incidence of in-hospital MACE on patients with ST elevation acute myocardial infarction and high thrombus burden. The study has several limitations, so results should be taken with caution.

Traditional Chinese medicine injections with activating blood circulation, equivalent effect of anticoagulation or antiplatelet, for acute myocardial infarction: A protocol for the systematic review and meta-analysis of randomized clinical trials.

BackgroundIn spite of a growing number in the use of percutaneous coronary intervention (PCI) in China, the mortality of acute myocardial infarction (AMI) has not decreased. Traditional Chinese medicine injections for Activating Blood Circulation (TCMi-ABC), equivalent effect of anticoagulation or antiplatelet, are widely used in China; however, the improvement of fatality towards AMI is unclear. Therefore, we intend to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of TCMi-ABC in treatment with AMI.MethodsBased on the “National Medical Products Administration of China,” TCMi-ABC with AMI treatment indication will be selected, including Danhong injection, Sodium Tanshinone IIA Sulfonate injection, Danshen Chuanxiongqin injection, and Puerarin injection. Randomized controlled studies will be searched from as follows: PubMed, Embase, the CENTRAL in Cochrane Library, Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang Data Knowledge Service Platform. Two researchers will work independently on literature selection, data extraction, and quality assessment. The outcomes focus on the effects of TCMi-ABC on fatality of patients with AMI in hospitalization and in the long term, the incidence of malignant arrhythmia, left ventricular ejection fraction, and adverse events. RevMan 5.4.1 software was used for mate analysis.ResultsThis study will conduct a comprehensive literature search and provide a systematic synthesis of current published data to explore the efficacy and safety of TCMi-ABC for AMI.ConclusionThis study will provide high-quality evidence for treatment of AMI with TCMi-ABC in terms of efficacy and safety, which may help clinicians make a better complementary treatment schedule of patients with AMI.

Preventative effects of dapagliflozin on early ventricular dysfunction and remodeling in patients with acute anterior STEMI - The PREDOMINACE trial

BackgroundSodium glucose cotransporter 2 inhibitors (SGLT-2i) are oral hypoglycemic drugs that can reduce the risk of deteriorating heart failure (HF) or cardiovascular death in patients with HF. Although some animal models have shown that SGLT-2i can effectively inhibit reperfusion injury after acute myocardial infarction (AMI), there is no clinical evidence to prove that SGLT-2i can also play a significant role in improving reperfusion injury in patients with AMI. Therefore, PREDOMINACE study enrolled patients with acute anterior large ST-segment elevation myocardial infarction, who are at high risk of developing HF in the future. The aim of this trial is to study the prevention effects of dapagliflozin on early ventricular dysfunction and remodeling in patients with acute anterior ST-segment elevation myocardial infarction (STEMI), and to explore the efficacy and safety of dapagliflozin in the treatment of patients with diabetes and without diabetes after acute anterior STEMI. MethodsWithin a multi-center, randomized, single-blind, controlled trial we will recruit patients with acute anterior STEMI from the Second Hospital of Tianjin Medical University and Tianjin Chest Hospital, who are randomly divided into intervention group or control group in a 1:1 ratio. The intervention group was given dapagliflozin (10 mg once daily) before primary percutaneous coronary intervention (PPCI) and 30 days after PPCI, while the control group is not given SGLT-2i. The primary endpoint is the impact of dapagliflozin on changes of NT-proBNP levels in 30 days of acute anterior STEMI. Secondary endpoints include changes in echocardiographic left ventricular remodeling parameters (LVESV, LVEDV, EF), and the changes of ECG (Q wave leads 30 days after PPCI/ST-segment elevation leads at baseline,ST-segment decline degree 24 h and 7 days after PPCI). Hospitalization rate due to HF or other causes, incidence of malignant arrhythmias, and all-cause mortality will be assessed as exploratory secondary endpoints. DiscussionThe PREDOMINACE trial will test dapagliflozin in patients with acute anterior STEMI, regardless of the presence or absence of diabetes. Therefore, the PREDOMINACE trial may support that the effects of SGLT-2i on improving cardiac remodeling, reducing cardiac pre and after load and improving cardiac metabolism are independent of its antidiabetic effects. Results will provide the clinical rationale for SGLT-2i to improve prognosis in patients with AMI.Trial registration: Chinese Clinical Trial Registry. Identifier: ChiCTR2100048157. Registered 23 September 2021.

Mechanical dispersion identifies patients with extensive electroanatomic abnormalities in Brugada syndrome

Abstract Background Brugada syndrome (BrS) was initially described as a pure electrical disorder caused by ion channel abnormalities in the absence of structural heart disease. However, imaging, autopsy and endomyocardial biopsy studies have increasingly demonstrated in patients with BrS the presence of myocardial structural alterations of the right ventricle (RV), particularly in the outflow tract. Indeed, electroanatomic mapping studies identified electroanatomic abnormalities of the RV outflow tract in both unipolar and bipolar maps with a significant correlation between the extension of low-voltage areas and the inducibility of arrhythmias at electrophysiological study or the incidence of malignant arrhythmias during the follow up. New echocardiographic parameters have been proposed to identify subtle myocardial alterations associated with arrhythmic events. Mechanical dispersion (MD) of the left ventricle (LV) has been identified as a prognostic marker in the arrhythmic risk stratification in various cardiac diseases including some cardiomyopathies. Purpose In this study we evaluated MD and global longitudinal strain (GLS) of RV and LV in patients with BrS to identify echocardiographic correlates of the abnormalities detected by electroanatomic mapping. Methods We performed 2D-Echocardiography with speckle tracking analysis of RV and LV in patients with BrS previously submitted to RV electroanatomic mapping. All studies were performed by investigators blind to clinical features and electrophysiological findings. Echocardiographic data were compared with electroanatomic mapping and electrophysiological study findings and with clinical data. Results We enrolled 18 patients (52±11 years, male 44%). Patients with a LV MD value ≥40 ms showed a pathological unipolar area with voltage <5.5 mV significantly more extended than patients with a LV MD value <40 ms (28.49±21.06 vs 10.47±8.22; p=0.03). Patients with LV MD ≥40 ms also showed a trend to greater extension of the unipolar area with voltage <4 mV (13.94±13.11 vs 4.94±3.12; p=0.07), a greater extension of the bipolar area with voltage <1.5 mV (6.24±5.22 vs 2.24±3.15; p=0.07) and higher inducibility at programmed ventricular stimulation (70% vs 37.5%, p=0.34). No correlation was observed between RV MD or GLS values and the extent of the low-voltage areas or with the presence of genetic mutations associated with BrS. Conclusions In patients with BrS a LV MD ≥40 ms is associated with a greater extension of low-voltage areas at unipolar mapping. Echocardiographic evaluation with MD analysis may represent a valuable non-invasive tool to identify electroanatomic alterations prompting further invasive studies including electronatomic mapping and electrophysiological study. Prospective studies on larger series may further clarify the potential role of MD and electroanatomic mapping in the prognostic stratification of patients with BrS. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Safety measures for COVID-19 do not compromise the outcomes of patients undergoing primary percutaneous coronary intervention: a single center retrospective study

Coronavirus disease 2019 (COVID-19) is a global pandemic impacting nearly 170 countries/regions and millions of patients worldwide. Patients with acute myocardial infarction (AMI) still need to be treated at percutaneous coronary intervention (PCI) centers with relevant safety measures. This retrospective study was conducted to assess the therapeutic outcomes of PCI performed under the safety measures and normal conditions. AMI patients undergoing PCI between January 24 to April 30, 2020 were performed under safety measures for COVID-19. Patients received pulmonary computed tomography (CT) and underwent PCI in negative pressure ICU. Cardiac catheterization laboratory (CCL) staff and physicians worked with level III personal protection. Demographic and clinical data, such as door-to-balloon (DTB) time, operation time, complications for patients in this period (COVID-19 group) and the same period in 2019 (2019 group) were retrieved and analyzed. COVID-19 and 2019 groups had 37 and 96 patients, respectively. There was no significant difference in age, gender, BMI and comorbidity between the two groups. DTB time and operation time were similar between the two groups (60.0 ± 12.39 vs 58.83 ± 12.85 min, p = 0.636; 61.46 ± 9.91 vs 62.55 ± 10.72 min, p = 0.592). Hospital stay time in COVID-19 group was significantly shorter (6.78 ± 2.14 vs 8.85 ± 2.64 days, p < 0.001). The incidences of malignant arrhythmia and Takotsubo Syndrome in COVID-19 group were higher than 2019 group significantly (16.22% vs 5.21%, p = 0.039; 10.81% vs 1.04% p = 0.008). During hospitalization and 3-month follow-up, the incidence of major adverse cardiovascular events and mortality in the two groups were statistically similar (35.13% vs 14.58%, p = 0.094; 16.22% vs 8.33%, p = 0.184). The risk of major adverse cardiac events (MACE) was associated with cardiogenic shock (OR, 11.53; 95% CI, 2.888–46.036; p = 0.001), malignant arrhythmias (OR, 7.176; 95% CI, 1.893–27.203; p = 0.004) and advanced age (≥ 75 years) (OR, 6.718; 95% CI, 1.738–25.964; p = 0.006). Cardiogenic shock (OR, 17.663; 95% CI, 5.5–56.762; p < 0.001) and malignant arrhythmias (OR, 4.659; 95% CI, 1.481–14.653; p = 0.008) were also associated with death of 3 months. Our analysis showed that safety measures undertaken in this hospital, including screening of COVID-19 infection and use of personal protection equipment for conducting PCI did not compromise the surgical outcome as compared with PCI under normal condition, although there were slight increases in incidence of malignant arrhythmia and Takotsubo Syndrome.

Abstract 15415: Trends and Predictors of Cardiogenic Shock and Mortality in Takotsubo Syndrome

Introduction: There is limited data on trends, predictors and outcomes of cardiogenic shock (CS) and mortality among patients admitted with takotsubo syndrome (TTS). We aim to study these parameters from the national inpatient sample. Methods: We analyzed the National Inpatient Sample (NIS) database from September 2006 to December 2017 to assess the trends and predictors of cardiogenic shock and mortality among patients with TTS. Results: A total of total of 265,423 patients with takotsubo syndrome (TTS) were included in our study, of whom 14703 (5.5%) were diagnosed with cardiogenic shock (CS). TTS Patients with CS were more likely to be younger (67, Interquartile range [IQR] 57-75 vs 68, 58-78), males (20.9% vs 13.8%, P &lt;0.01), with key ethnicities being Asian and Hispanic. TTS patients with CS were also more likely to have multiple medical comorbidities at baseline including congestive heart failure (65.7% vs 40.9%, P &lt;0.01), chronic lung disease (31.1% vs 29.2%, P &lt;0.01) diabetes with chronic complications (7.4% vs 5.6%, P &lt;0.01) and chronic kidney disease (13.2% vs 11.1% P &lt;0.01). TTS patients with CS had a higher incidence of malignant arrhythmias including ventricular tachycardia or ventricular fibrillation (15.0% vs 4.6%, P &lt;0.01) and non-shockable cardiac arrests (12.2% vs 2.3%, P &lt;0.01). In-hospital mortality among patients with TTS-CS was fivefold higher compared to those without CS (22.9% vs 4%, P &lt;0.01). During our study period we also noted a significant increase in trends of cardiogenic shock and mortality among patients with TTS. Conclusions: In hospital mortality among TTS patients with CS was approximately five-fold higher compared to those without CS (22.9% vs 4.0%, P &lt;0.01).Future research should be directed towards management strategies to improve outcomes in patients with TTS.

Myocardial injury in severe and critical coronavirus disease 2019 patients.

To investigate the effect of myocardial injury on the prognosis of patients with severe or critical coronavirus disease 2019 (COVID-19). Between February 10, 2020 and March 31, 2020, data of severe and critical COVID-19 patients were collected and retrospectively analyzed. Admission data included age, heart rates, mean arterial pressure, and myocardial injury markers including creatine kinase isoenzyme-MB (CK-MB), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and interleukin-6. The endpoints included mortality, the incidence of malignant arrhythmia, and mechanical ventilation time. Univariate regression analysis, multivariate linear regression analysis, and binary logistic analysis were performed to develop the risk predictors in myocardial injury to the prognosis of severe and critical COVID-19 patients. Seventy-four COVID-19 patients were included (mean age of 67.2 ± 14.6 years, male of 66.2%), including 42 severe and 32 critical cases. The mortality was 62.2% (n = 46). CK-MB (odds ratio = 5.895, p < .001, 95% confidence interval: 3.097-8.692) and interleukin-6 (odds ratio = 0.379; p = .005; 95% confidence interval: 1.051-1.769) were independent risk factors of increased mechanical ventilation time; myoglobin (odds ratio = 7.710; p = .045; 95% confidence interval: 1.051-56.571) were the independent predictor of incidence of malignant arrhythmia; age (odds ratio = 1.077; p = .009; 95% confidence interval: 1.019-1.139), myoglobin (odds ratio = 9.480; p = .032; 95% confidence interval: 1.211-78.188), and NT-proBNP (odds ratio = 4.852; p = .047; 95% confidence interval: 0.956-24.627) were the independent predictors of mortality. In severe and critical COVID-19 patients, the obvious myocardial injury was observed. Increases of CK-MB, myoglobin, NT-proBNP, interleukin-6, and age were independently associated with poor prognosis including increased ventilation duration, the incidence of malignant arrhythmia, and mortality.

Effect of Triple Combination Therapy With Lopinavir-Ritonavir, Azithromycin, and Hydroxychloroquine on QT Interval and Arrhythmic Risk in Hospitalized COVID-19 Patients.

IntroductionNo data are provided about the effect of triple combination therapy with Lopinavir/Ritonavir (LPN/RTN), hydroxychloroquine (HQ) and azithromycin (AZT) on corrected QT (QTc) interval and arrhythmic risk, in COVID-19 patients. This study aims to describe the incidence of extreme QTc interval prolongation among COVID-19 patients on this experimental treatment and to identify the clinical features associated with extreme QTc prolongation.Materials and MethodsData of 87 COVID-19 patients, treated with triple combination including LPN/RTN, HQ and AZT, were analyzed. QT interval was obtained by the tangent method and corrected for heart rate using Bazett’s formula. Extreme QTc interval prolongation was considered an absolute QTc interval ≥ 500 ms or an increase in QTc intervals of 60 ms or greater (ΔQTc ≥ 60 ms) compared with baseline.ResultsHypertension (66.7%) and diabetes (25.3%) were the most prevalent cardiovascular comorbidities. Twenty patients (23%) showed extreme QTc interval prolongation; no clinical, electrocardiographic or pharmacological characteristics have been associated to extreme QTc prolongation, except the history of ischemic stroke (P= 0,007). One torsade de pointes (TdP) in patient with QTc extreme prolongation (QTc: 560 ms) after 5 days of therapy was recorded.ConclusionsWe observed a high incidence of extreme QTc interval prolongation among COVID-19 patients on triple combination therapy. Since the incidence of malignant arrhythmias seems to be not negligible, a careful electrocardiographic monitoring would be advisable.

Antiarrhythmic effects of ginsenoside Rg2 on calcium chloride–induced arrhythmias without oral toxicity

BackgroundMalignant arrhythmias require drug therapy. However, most of the currently available antiarrhythmic drugs have significant side effects. Ginsenoside Rg2 exhibits excellent cardioprotective effects and appears to be a promising candidate for cardiovascular drug development. So far, the oral toxicity and antiarrhythmic effects of Rg2 have not been evaluated. MethodsAcute oral toxicity of Rg2 was assessed by the Limit Test method in mice. Subchronic oral toxicity was determined by repeated dose 28-day toxicity study in rats. Antiarrhythmic activities of Rg2 were evaluated in calcium chloride–induced arrhythmic rats. Antiarrhythmic mechanism of Rg2 was investigated in arrhythmic rats and H9c2 cardiomyocytes. ResultsThe results of toxicity studies indicated that Rg2 exhibited no single-dose (10 g/kg) acute oral toxicity. And 28-day repeated dose treatment with Rg2 (1.75, 3.5 and 5 g/kg/d) demonstrated minimal, if any, subchronic toxicity. Serum biochemical examination showed that total cholesterol in the high-dose cohort was dramatically decreased, whereas prothrombin time was increased at Day 28, suggesting that Rg2 might regulate lipid metabolism and have a potential anticoagulant effect. Moreover, pretreatment with Rg2 showed antiarrhythmic effects on the rat model of calcium chloride induced arrhythmia, in terms of the reduced duration time, mortality, and incidence of malignant arrhythmias. The antiarrhythmic mechanism of Rg2 might be the inhibition of calcium influx through L-type calcium channels by suppressing the phosphorylation of Ca2+/calmodulin-dependent protein kinase II. ConclusionOur findings support the development of Rg2 as a promising antiarrhythmic drug with fewer side effects for clinical use.

QT Dispersion Changes after Transcatheter Aortic Valve Implantation in Patients with Aortic Stenosis.

ObjectiveThe aim of this study was to evaluate the QT dispersion and echocardiographic parameters in patients before and after transcatheter aortic valve implantation (TAVI).MethodsOne hundred and fifty-two patients with severe aortic valve stenosis (AS) were included in our study. Ninety five patients who underwent aortic valve replacement with TAVI were included in the TAVI group and 57 patients, who refused TAVI, were included in the medical treatment group. The QT interval and echocardiographic parameters of all patients were assessed before and after the procedure (first and sixth months and first year). The QT intervals were taken from the onset of the QRS to the end of the T wave.ResultsAll patients had severe AS. The average mean aortic valve gradient was 46.1±12. Left ventricular internal diastolic diameter (LVIDD) and interventricular septum diastolic thickness (IVSDT) did not change significantly after TAVI (P>0.05). QT dispersion, corrected QT dispersion, and mean aortic valve gradient changed significantly six months after TAVI (P<0.05). Compared to the medical treatment group, QT dispersion and corrected QT dispersion were significantly decreased at the sixth month in the TAVI group. The incidence of malignant arrhythmias was smaller in the TAVI group than in the medical treatment group. The mortality rate was lower at the first-year follow-up in the TAVI group than in the medical treatment group.ConclusionIncreased QT dispersion is associated with severe symptomatic AS. After TAVI, QT dispersion reduces.

Mortality and incidence of malignant arrhythmias in patients with dilated cardiomyopathy and implantable cardioverter defibrillator in primary and secondary prevention

Mortality and incidence of malignant arrhythmias in patients with dilated cardiomyopathy and implantable cardioverter defibrillator in primary and secondary prevention

Primary prevention with statin and incidence of malignant arrhythmia among acute coronary syndrome patients

Primary prevention with statin and incidence of malignant arrhythmia among acute coronary syndrome patients

Effects of Hyperglycemia on the In-hospital and Long-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction

Objective: A large amount of acute ST-segment elevation myocardial infarction (STEMI) patients have stress hyperglycemia on admission, which is associated with poor in-hospital and long-term prognosis. This research aimed to find the effects of hyperglycemia on in-hospital mortality, adverse cardiovascular events and long-term prognosis in patients with STEMI.Method: We conducted a prospective cohort study on 456 STEMI patients from January 2015 to December 2016 in Zhongda hospital affiliated to Southeast University. We recorded the baseline data, then used propensity matching (a ratio of 1:2) to balance the confounding variables and rule out the bias, according to the definition of stress hyperglycemia, admission random blood glucose >11.1 mmol/L, we divided patients into two groups: hyperglycemia group (71 cases) and non-hyperglycemia group (142 cases). We recorded and compared the baseline data, past history, auxiliary examination index, medication usage, coronary angiography data, and inhospital outcome between two groups. One-year follow-up main adverse cardiovascular and cerebrovascular events (MACCE) were recorded by telephone and clinic, we use X2 test to research the relationship between hyperglycemia and in-hospital outcome, we use ROC curve to assess the predictive value of hyperglycemia for in-hospital death both in diabetic and non-diabetic patients. Kaplan-Meier curve and Cox regression are used to evaluate the predictive value of stress hyperglycemia for the long-term prognosis.Result: Stress hyperglycemia occurred in 86 patients (18.9%), of whom 65 had diabetes history. There were 10 patients (14.1%) died in hospital in hyperglycemia group, 6 for malignant arrhythmia, 3 for cardiogenic shock and 1 for cardiac rupture. In the non-hyperglycemia group, the in-hospital mortality is 3.5% (P=0.028). The incidence of malignant arrhythmia and cardiogenic shock were higher in hyperglycemia group than control group (P=0.023, P=0.030). The ROC curve of admission random blood glucose predicting in-hospital deaths for non-diabetic patients and diabetic patients showed the area under curve and 95% CI were 0.627, 0.438 ~ 0.837; 0.786, 0.586 ~ 0.913 respectively. The incidence of one-year follow-up MACCE was about 41.7% in hyperglycemia group, and the incidence in the control group was 27.8% (P=0.018). Gender, age, diabetes, hypertension, previous myocardial infarction, hyperglycemia, left ventricular ejection fraction were included in Cox regression model of one-year followup MACCE in STEMI patients. Stress hyperglycemia was an independent risk factor for one-year follow-up MACCE in STEMI patients (OR=4.398, 95% CI=2.869 ~ 7.483, P<0.001).Conclusion: Hyperglycemia is a predictive factor for in-hospital death in STEMI patients, and it has good predictive value for the long-term prognosis.

Effects of propofol on ventricular repolarization and incidence of malignant arrhythmias in adults

BackgroundPropofol is commonly used for procedural sedation in interventional electrophysiology. However, ventricular arrhythmias under Propofol have been reported. Our aim was to investigate ventricular repolarization and incidence of ventricular arrhythmias under Propofol infusion in adults with cardiac arrhythmias. MethodsQRS, QTcB (Bazett), QTcFri (Fridericia), JTc, measurement of T peak to Tend time (Tp-e) at baseline and under Propofol infusion was performed in 235 patients. Screening for unexpected ventricular arrhythmias was performed in 1165 patients undergoing EP procedures under Propofol. ResultsA significant prolongation of Tp-e under Propofol infusion (79.7±17.3 vs. 86.4±22.5ms, p<0.001) and of QTcFri (429.3±35.8 vs. 435.5±36.5, p=0.033) was detected. No significant change of the QTcB interval, JTc interval or QRS duration was observed. One case (0.09%) of ventricular fibrillation during rapid ventricular pacing under Propofol occurred. ConclusionAlthough transmural dispersion of ventricular repolarisation is increased under Propofol, incidence of malignant ventricular arrhythmias is low. For evaluation of QT interval under Propofol, Fridericia's correction formula should be used rather than Bazett's formula.

The incidence of malignant arrhythmia and death outcomes in patients with ischemic and nonischemic dilated cardiomyopathy with implantable cardioverter defibrillator - results of a single center

The incidence of malignant arrhythmia and death outcomes in patients with ischemic and nonischemic dilated cardiomyopathy with implantable cardioverter defibrillator - results of a single center

Coronary artery disease : Interventional and operative therapeutic options after cardiac arrest

Coronary artery disease (CAD) represents acommon structural cause for developing cardiac arrest in older patients, whereas in young adults cardiac arrest is more often caused by cardiomyopathies and cardiac channelopathies. Astructural heart disease is known in almost 50% of patients prior to cardiac arrest. The present review outlines current interventional and operative therapeutic options for patients surviving cardiac arrest. The focus is on associations between epidemiological data on the incidence of malignant arrhythmias causing cardiac arrest depending on the presence or absence of CAD. Furthermore, the potential benefits of an early coronary revascularization as well as of aprompt complete coronary revascularization compared to the individual treatment of the so-called culprit lesion only are described. Finally, the advantages of invasive therapies for patients surviving cardiac arrest, such as targeted temperature management and mechanical cardiac assist devices, are elucidated. Cardiac assist devices comprise the use of the intra-aortic balloon pump (IABP) and devices for extracorporeal life support (ECLS) for peripheral and central support of the right and left heart chambers.

Etiology and clinical analysis of dilated cardiomyopathy in children

Objective To determine the etiology and clinical characteristics of children with dilated cardiomyopathy.Methods 112 children with DCM from January 2002 to December 2011 were studied.The age,cause and the clinical manifestations were analyzed.According to the children with heart function,they were divided into four groups,the incidence and type of arrhythmia were compared.Results In 112 cases of DCM in children,＜ 1 year old diagnosed 52 cases (46.42％),107 cases (95.53％) with heart failure,25 cases (22.32％) with chear causes,96 cases(85.71％) children with a variety of arrhythmias.According to cardiac function in Ⅰ,Ⅱ and Ⅲ and Ⅳ level,they were divided into four groups.The incidence of one kind of arrhythrnia were 20.00％,31.25％,36.17％ and 42.85％.The incidence with two or more kinds of arrhythmia was 0,18.75％,38.29％ and 50.00％ respectively.The incidence of malignant arrhythmia was 0,12.50％,40.42％and 67.85％ in different groups.There was significant differences among the groups of Ⅱ and Ⅲ and Ⅳ level (P ＜ 0 05).Conclusion Children with dilated cardiomyopathy disease younger than I year old had the highest incidence.The major causes were myocarditis,hereditary and congenital metabolic diseases.The incidence of arrhythmia in DCM were high and diverse,often exist for a variety of arrhythmia,and arrhythmia have closely relation with heart function.The embolism in children with DCM was very rare. Key words: Dilated cardiomyopathy; Etiology; Arrhythmia; Children

E0423 The research about the short-time effects of preinfraction angina in patients complicated with acute myocardial infraction and treated by primary percutaneous coronary intervention

ObjectiveTo evaluate the short-time effects, angiographic characteristics, and the clinical outcome of preinfarction angina in patients with first acute myocardial infarction (AMI) after emergency primary percutaneous coronary intervention (PCI). And...

Recent insights pertaining to sarcolemmal phospholipid alterations underlying arrhythmogenesis in the ischemic heart.

Myocardial ischemia in vivo is associated with dramatic electrophysiologic alterations that occur within minutes of cessation of coronary flow and are rapidly reversible with reperfusion. This suggests that subtle and reversible biochemical alterations within or near the sarcolemma may contribute to the electrophysiologic derangements. Our studies have concentrated on two amphipathic metabolites, long-chain acylcarnitines and lysophosphatidylcholine (LPC), which have been shown to increase rapidly in ischemic tissue in vivo and to elicit electrophysiologic derangements in normoxic tissue in vitro. Incorporation of these amphiphiles into the sarcolemma at concentrations of 1 to 2 mole%, elicits profound electrophysiologic derangements analogous to those observed in ischemic myocardium in vivo. The pathophysiological effects of the accumulation of these amphiphiles are thought to be mediated by alterations in the biophysical properties of the sarcolemmal membrane, although there is a possibility of a direct effect upon ion channels. Inhibition of carnitine acyltransferase I (CAT-I) in the ischemic cat heart was found to prevent the increase in long-chain acylcarnitines and LPC and to significantly reduce the incidence of malignant arrhythmias including ventricular tachycardia and fibrillation. This review focuses on the electrophysiologic derangements that are observed during early ischemia and presents data supporting the concept that accumulation of these amphiphiles within the sarcolemma contributes to these changes. The potential contribution of these amphiphiles to the increases in extracellular potassium and intracellular calcium are examined. Finally, recent data pertaining to the accumulation of long-chain acylcarnitines on cell-to-cell uncoupling are presented. In addition to the events reviewed here, there are many other alterations that occur during early myocardial ischemia, but the results from multiple studies over the past two decades indicate that the accumulation of these amphiphiles contributes importantly to arrhythmogenesis and that development of specific inhibitors of CAT-I or phospholipase A2 may be a promising therapeutic strategy to attenuate the incidence of lethal arrhythmias associated with ischemic heart disease in man.

Prevention of life-threatening arrhythmias by pharmacologic stimulation of the muscarinic receptors with oxotremorine

The potential antiarrhythmic efficacy of pharmacologic parasympathetic activation is still controversial. This study assessed the antiarrhythmic effect of saline solution ( n = 9) and of the muscarinic agonist oxotremorine (1.5 μg/kg administered intravenously) ( n = 17) in a feline animal model in which malignant arrhythmias were reproducibly elicited by the combination of acute myocardial ischemia and left stellate ganglion stimulation. Although saline solution had no effect, oxotremorine significantly decreased heart rate, blood pressure, the incidence of ventricular fibrillation from 47% to 0% ( p = 0.004), and the incidence of malignant arrhythmias (either ventricular tachycardia or ventricular fibrillation) from 88% to 12% ( p < 0.001). When reduction in heart rate was prevented by means of atrial pacing ( n = 15), the incidence of malignant arrhythmias was still significantly reduced from 87% to 27% ( p = 0.001). Arrhythmias were also graded as follows: 0 = no premature ventricular contractions; 1 = 1 to 10 premature ventricular contractions; 2 = 11 to 50 premature ventricular contractions; 3 = ventricular tachycardia; 4 = ventricular fibrillation. Arrhythmia severity was 3.29 ± 0.16 (SEM) in the control trials and was reduced to 0.76 ± 0.26 ( p < 0.001) by oxotremorine and to 1.53 ± 0.34 by oxotremorine and pacing ( p = 0.002). Therefore a muscarinic agonist can significantly reduce malignant arrhythmias during acute myocardial ischemia and may represent a novel approach to the prevention of sudden cardiac death.