Lown Grade Research Articles

Noncomplex ventricular arrhythmia associated with greater freedom from recurrent ectopy at 1 year after mitral repair surgery

ObjectiveThe effect of mitral valve (MV) surgery on the natural history of ventricular arrhythmia (VA) in patients with arrhythmic MV prolapse remains unknown. We sought to evaluate the cumulative incidence of VA at 1 year after surgical mitral repair. MethodsA retrospective review of progressively captured data identified 204 consecutive patients who underwent elective MV repair for significant degenerative mitral regurgitation as a first-time cardiovascular intervention in a quaternary reference center between January 2018 and December 2020. A subset of 62 consecutive patients with diagnosed arrhythmic MV prolapse was further evaluated for recurrent VA after MV repair. ResultsThe median age was 62 years (range, 27-77 years) and 26 of 62 (41.9%) were female. The median time from initial mitral regurgitation/MV prolaspe diagnosis-to-referral was 13.8 years (interquartile range [IQR], 5.4-25) and from VA diagnosis-to-referral was 8 years (IQR, 3-10.6). Using the Lown-Wolf classification, complex VA (Lown grade ≥3) was identified in 36 of 62 patients (58%) at baseline, whereas 8 of 62 (13%) had a cardioverter/defibrillator implanted for primary (4/8) or secondary (4/8) prevention. Left ventricular myocardial scar was confirmed in 23 of 34 (68%) of patients scanned at baseline. The prevailing valve phenotype was bileaflet Barlow (59/62; 95.2%). All patients underwent surgical MV repair by the same team. Surgical repair was stabilized with an annuloplasty prosthesis (median size 36 mm [IQR, 34-38]). Concomitant procedures included tricuspid valve repair (51/62; 82.3%), cryo-maze ± left atrial appendage exclusion (14/62, 23%), and endocardial cryoablation of VA ectopy (4/62; 6.5%). The 30-day and 1-year freedom from recurrent VA were 98.4% and 75.9%, respectively. Absent VA after mitral repair was uniformly observed in patients with minor VA at baseline. Absent VA after mitral repair was uniformly observed in patients with minor VA preoperatively. Complex baseline VA was the strongest predictor of recurrent VA (hazard ratio, 10.8; 95% confidence interval, 1.4-84.2; P = .024), irrespective of myocardial fibrosis. ConclusionsIn a series of 62 consecutive patients operated electively for arrhythmic mitral prolapse, VA remained undetected in 75.9% of patients at 1 year. Freedom from recurrent VA was greater among patients without complex VA preoperatively, whereas baseline Lown grade ≥3 was the strongest independent risk factor for recurrent VA at 1 year. These findings attest to the importance of early recognition and prompt referral of patients with mitral prolapse and progressive VA to specialty interdisciplinary care.

Mitral annular disjunction and Pickelhaube sign in children with mitral valve prolapse: A prospective cohort study

BackgroundMitral annular disjunction (MAD) and the Pickelhaube sign are identified as risk factors for malignant ventricular arrhythmias (VAs) and sudden cardiac death in adults with mitral valve prolapse (MVP); their prevalence and consequences in children have never been studied. ObjectivesTo determine the proportion of MAD in children with MVP, and its potential link with VAs. MethodsA cohort of 49 consecutive children (mean age 12.8±3.0 years; 33 females) with MVP and comprehensive clinical arrhythmia (24-hour monitoring) and Doppler echocardiographic characterization, including pulsed-wave tissue Doppler (PWTD) of the lateral mitral annulus, was identified. The relationship between clinical and echocardiographic data and presence of VAs was studied. ResultsMAD was common (n=25; 51%). Only five patients had significant VAs (Lown grade>2) characterized by polymorphic premature ventricular contractions or couplets. MAD was not associated with VAs on 24-hour Holter monitoring, but an association was found between VAs and spiked high-velocity midsystolic signal>16cm/s on PWTD (Pickelhaube sign) (P=0.004), myxomatous mitral valve (P=0.004) and left ventricular dilatation (P=0.01). T-wave inversion in inferolateral leads on electrocardiogram was more frequent in patients with versus without the Pickelhaube sign (P=0.03). No difference was found between patients with or without MAD regarding sex, history of palpitation, severity of mitral regurgitation, aortic root diameter and incidence of connective tissue disorders. Myocardial fibrosis was detected in two of three patients who underwent a complementary cardiac magnetic resonance examination. ConclusionsMAD is common in children with MVP; its presence was not associated with significant VAs on 24-hour Holter monitoring, but the Pickelhaube sign and presence of myxomatous mitral valve may help to detect patients prone to significant VAs. Myocardial fibrosis can be detected by cardiac magnetic resonance in children with significant VAs.

Comparison of the diagnostic value of a small, single channel, electrocardiogram monitoring patch with a standard 3-lead Holter system over 24 hours in dogs

Introduction/ObjectivesThe aim of this study was to compare a novel small event recorder device, the Carnation Ambulatory Monitor (CAM), with a standard Holter. AnimalsNineteen adult dogs. Material and methodsComparative and explorative study. The two devices were simultaneously applied for approximately 24 h. ResultsAnalysis time (P=0.013) and percentage of artefacts (P<0.001) were greater for the CAM (110 min [40–264]; and 9% [0–34], respectively) compared to a standard Holter (30 min [18–270]; and 0.3% [0–9], respectively). The total number of beats (P=0.017) and maximum (P=0.02) and mean (P=0.037) heart rates were lower for the CAM (113,806 ± 23,619 beats; 227 ± 35 bpm; and 88 ± 22 bpm, respectively) compared to the standard Holter (131,640 ± 40,037 beats; 260 ± 64 bpm; and 92 ± 26 bpm, respectively). The minimal heart rate (P=0.725), number of pauses (P=0.078), duration of the longest pause (P=0.087), number of ventricular ectopic complexes (P=0.55), ventricular couplets (P=0.186), ventricular triplets (P=0.203), ventricular tachycardia (P=0.05), Lown grade (P=0.233), presence or absence of ventricular bigeminy, trigeminy, supraventricular tachycardia, and atrial fibrillation (P=0.98) did not differ. The CAM missed some relevant events, like complex ventricular arrhythmias, and the Lown grade did not match in 5/19 dogs when comparing the devices. ConclusionsCardiac Ambulatory Monitor can be used to record ECG traces in dogs over a prolonged period, allowing to detect arrhythmias. Due to some clinically relevant limitations, including a higher percentage of artefacts, a longer reading time (which precludes quantitative counts of >300ventricular premature complexes), and underestimation of complex ventricular arrhythmias, the CAM appears not suitable for quantitative arrhythmia analysis in dogs.

Predictive value of serum HIF-1α and VEGF for arrhythmia in acute coronary syndrome patients.

Percutaneous coronary intervention (PCI) has been widely used in the alleviation of myocardial ischemia in patients with acute coronary syndrome (ACS). However, the incidence of reperfusion arrhythmia (RA) after PCI is high, which seriously affects the prognosis of ACS patients. Therefore, this study aimed to study the predictive value of serum HIF-1α and VEGF levels before PCI for RA in ACS patients post PCI. A total of 200 ACS patients who underwent PCI were selected and divided into those with RA after PCI (RA, n = 93) and those without RA after PCI (non-RA, n = 107) according to Lown grade. Spearman correlation analysis was applied for the relationship between serum hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) levels and Lown grade. Patients with RA after PCI tended to have higher levels of creatine kinase muscle and brain isoenzyme (CK-MB), serum HIF-1α and VEGF before surgery. Low left ventricular ejection fraction (LVEF), high CK-MB, high serum VEGF and HIF-1α were risk factors for RA in ACS patients within 24 h after PCI. Receiver operating characteristic (ROC) analysis revealed that serum HIF-1α and VEGF levels could predict RA in ACS patients after PCI, and the combined detection could increase the sensitivity of single HIF-1α detection and the specificity of single VEGF detection. Lown grade was positively correlated with the serum HIF-1α and VEGF concentrations. In conclusion, serum HIF-1α and VEGF levels before PCI are risk factors for the occurrence of RA in ACS patients after PCI, and have certain predictive values for the occurrence of RA in ACS patients after PCI.

Особенности нарушений сердечного ритма у пациентов с острым инфарктом миокарда с подъемом сегмента ST, перенесших COVID-19

Objective: to conduct a comparative assessment of the parameters of heart rhythm and conduction in patients with Covid-19 with acute ST-segment elevation myocardial infarction (STEMI) in the hospital and post-hospital treatment periods. Materials and methods. The study included 140 patients with STEMI, stratified into 2 groups: I - the main (52 people) patients with STEMI who had COVID-19 for 1.5-6 months before the development of acute coronary syndrome (ACS), II - the comparison group (88 people) with STEMI without COVID-19 in the anamnesis. All patients underwent percutaneous coronary intervention with stenting of a single infarct-related artery in the first 24 hours. Daily ECG monitoring was performed with an assessment of traditional heart rate and conduction parameters for 2-3 days, 9-11 days and after 6 months from the moment of the accident. Results. In the main group, in contrast to the control group, a shortening of the QT interval (7.7% vs. 0.0%), ventricular extrasystole (VES) of Lown grade IV A (25.0% vs. 7.9%) was more often recorded on 2-3 days. Supraventricular extrasystole (SVE; 92.0% vs. 65.4%), sinus arrhythmia (37.5% vs. 0.0%), supraventricular tachycardia (SVT; 7.9% vs. 0.0%) were more often recorded in group II on 2-3 days. During the hospital follow-up period, the retention of shortened QT (7.7% vs. 0.0%), predominance SVE (90.4% vs. 76.1%), sinus arrhythmia (48.1% vs. 29.5%), migration of the rhythm driver along the atria (15.3% vs. 0.0%), VES Lown grade IV A (9.6 % vs. 0.0%). In the control group, AV blockade of 1 deg. (15.9% vs. 3.8%), AV blockade of 2 deg. (4.5% vs. 0.0%), CA blockade (3.4% vs. 0.0%), QT prolongation (12.5% vs. 0.0%) were more often determined. By 6 months after STEMI, patients in the main group were more likely to have SVT (9.6% vs. 0.0%) and VES Lown grade IV A (7.6% vs. 0.0%). In the control group, AV blockade of 1 deg. (9.0% vs. 0.0%), CA blockade (3.4% vs. 0.0%) were registered. Conclusion. Patients with STEMI who had a history of COVID-19 and without COVID-19 had a multidirectional dynamics of heart rate and conduction parameters during the hospital and post-hospital follow-up periods. In patients who underwent COVID-19, there was a predominance of ventricular arrhythmias of high Lown gradations on 2-3 days of STEMI, an increase in supraventricular arrhythmias on days 9-11, an increase in supraventricular and ventricular arrhythmias of high Lown gradations and the absence of CA and AB disorders after 6 months. In the control group, there was a predominance of supraventricular and ventricular arrhythmias of low gradations according to Lown, a predominance of CA and AB conduction disorders on days 9-11 and 6 months after STEMI.

Abstract 15128: Are We Underestimating the Incidence of Significant Ventricular Ectopy in Pediatric Patients With Post-Covid Vaccine Myocarditis?

Background: The development of mRNA vaccines was essential in combatting the COVID-19 pandemic. Emergency use authorization for COVID-19 vaccine was granted to adolescents aged 12 and older in May 2021. Subsequently, an increase in myocarditis was observed related to the mRNA vaccine. Previous reports estimate a 5% incidence of ventricular arrhythmias in patients with vaccine-associated myocarditis. Hypothesis: The incidence of ventricular ectopy in patients with post-COVID vaccine myocarditis is higher than previously described. Methods: We analyzed data retrospectively for patients admitted to our cardiac center with clinically suspected myocarditis who received COVID-19 vaccine within 30-days prior to onset of symptoms and had no other clinical cause for myocarditis. We separated this cohort into 3 groups based on the presence of rhythm monitoring post discharge: normal monitor post discharge (Lown grade 0 or 1), abnormal monitor post discharge (Lown grade ≥ 2), and no monitor post discharge. Data are shown as mean ± standard deviation. Results: We included 16 patients with a mean age of 14.9 ± 3.1 years. 12 patients were discharged with ambulatory monitoring and 3 were categorized as abnormal (25%). Abnormal findings included non-sustained ventricular tachycardia, ventricular ectopy with bigeminy and trigeminy patterns, and sustained monomorphic ventricular tachycardia. 1 patient was readmitted for sustained ventricular tachycardia. Mean troponin levels were higher in the arrhythmia group (17.3 ±4) compared to the non-arrhythmia group (4.3 ±4.3). 2 of the 3 patients in the arrhythmia group had myocardial edema on cMRI. Only one patient had LGE. Conclusion: At our center, 25% of patients with post-COVID vaccine myocarditis experienced ventricular arrhythmias, and these patients had higher troponin levels during acute illness. Awareness of this increased rate of arrhythmia is necessary to safely monitor patients with post-COVID vaccine myocarditis.

Clinical Indications and Arrhythmic Patterns of 24-h Holter Electrocardiography among Cardiovascular Disease Patients

Background: This study aimed to evaluate the clinical indications and arrhythmic patterns in cardiovascular disease patients who were referred for Holter electrocardiography (ECG) in Dr. Soetomo General Hospital, Surabaya, Indonesia. Methods: A retrospective cross-sectional study was held at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Patient's data, including Holter ECG, was obtained from the local Holter Registry between July 2019 and December 2019. Results: A total of 89 patients were included in this study. The mean age was 50.1 ± 16.0 years old, and 48 patients (53.9%) were females. The most common indication was palpitation (39.3%) followed by the history of arrhythmia (14.6%), shortness of breath (13.5%), and chest pain (12.4%). Ventricular ectopic (VE) and supraventricular ectopic (SVE) were the most common arrhythmia in 70.8% and 12.4% of subjects, respectively. About 20.2% of patients had frequent VE, and Lown's Grade 4 was the most prevalent VE accounting for 45.9% of patients among all VE events. A total of 5.6% of patients had episodes of atrial fibrillation. Frequent SVE was found in 4.5% of patients, whereas 5.6% had supraventricular tachycardia. About 3.4% of patients had abnormal atrioventricular conduction, and 4.5% had chronotropic incompetence. Conclusions: Palpitation of unknown etiology was the most common clinical indication for Holter ECG among our patients. The most prevalent arrhythmias were VEs and SVEs, with Lown's Grade 4 being the most prevalent VEs. Holter ECG in patients with that indication was reasonably high diagnostic yield in detecting arrhythmia.

Relationship between premature ventricular contractions and serum TNF-α, IL-6 level in patients

Objective: To investigate the relationship between premature ventricular contractions and serum TNF-α, IL-6 level. Methods: From December 2020 to April 2021, 35 patients with premature ventricular contractions of coronary heart disease with deficiency of both qi and Yin in our hospital were selected as the observation group, and 41 healthy people in the same period were selected as the control group. Serum samples were collected from the observation group and the control group, The expression levels of TNF-α, IL-6 in serum were detected by ELISA; Objective to evaluate the relationship between lown classification of ventricular premature beat and TCM symptom score of patients with coronary heart disease of Qi and yin deficiency type; The relationship were measured between serum TNF-α, IL-6 level and lown grade of ventricular premature beat in the observation group. Results: Compared with the control group, the levels of serum TNF-α, IL-6 in the observation group were significantly higher; With the improvement of lown classification of ventricular premature beat, TCM symptom score and the levels of serum TNF-α, IL-6 are increased step by step. Conclusion: The relationship between premature ventricular contractions and serum TNF-α, IL-6 in patients with coronary heart disease of Qi Yin deficiency type may provide some theoretical value for clinical treatment.

Immunosuppression and outcomes of myocarditis patients presenting with ventricular arrhythmias

Abstract Background Effects of immunosuppressive therapy (IST) on ventricular arrhythmias (VA) have not been reported in immune-mediated biopsy-proven myocarditis patients. Furthermore, myocarditis arrhythmic risk is still unpredictable. The aim of our study was to evaluate effectiveness of IST on VA in myocarditis patients, and stratify their arrhythmic risk, using clinical and diagnostic features, including serum organ-specific anti-heart (AHA) and antiintercalated-disk autoantibodies (AIDA). Methods From a cohort of 498 consecutive patients, we enrolled 255 cases with biopsy-proven virus-negative myocarditis and evidence of VA (VF, VT, NSVT, and Lown's grade ≥2 PVC) at index hospitalization. Serum AHA and AIDA were detected by a standardised indirect immunofluorescence technique. Whenever accepted and non-contraindicated, IST was started. Controls (IST-) were chosen after 1:1 matching to IST+ cases by age, gender, ethnicity, left ventricular ejection fraction, VA type, and treatment. Prospective follow-up (FU), occurred at defined timepoints. Results 58 matched patient couples (42±13 y, 67% males, 50% IST+) were analyzed in the main study cohort. Overall, 28 (24%) had VT, and 62 (53%) were discharged with ICD. IST duration was 12±1 months. No patients died and no serious complications from IST occurred. By 24-month FU, major VA occurred in 6 IST+ vs. 10 IST- patients (p=0.420), with no cases of VT following IST termination. As compared to IST- ones, IST+ patients showed a significant reduction in NSVT and PVC burden, as well as an improvement in clinical, laboratory and imaging findings (all p&amp;lt;0.05). Major VA onset and positive AIDA status were independently associated with major VA at FU (HR 14.2, 95% CI 2.9–68.7, and 8.0, 95% CI 2.6–25.2, respectively, both p&amp;lt;0.001). Furthermore, in the whole study population (N=255), IST played as an independent protective factor from major VA (HR 0.3, 95% CI 0.2–0.7, p=0.005) at 38±21 months FU. Conclusions In immune-mediated virus-negative myocarditis patients presenting with VA, IST is feasible and effective on NSVT and PVC burden, as well as on structural, laboratory and imaging endpoints. Short-term effects are limited on major VA, which were independently associated with major arrhythmic onset and positive AIDA, in keeping with the proposed etiopathogenetic involvement of autoimmunity in virus-negative myocarditis. Funding Acknowledgement Type of funding source: None

Parameters associated with ventricular arrhythmias in mitral valve prolapse with significant regurgitation

ObjectiveMitral valve prolapse (MVP) has been associated with ventricular arrhythmias (VA), but little is known about VA in patients with significant primary mitral regurgitation (MR). Our aim was to describe...

Immunosuppressive Therapy and Risk Stratification of Patients With Myocarditis Presenting With Ventricular Arrhythmias

This study sought to investigate the effects of immunosuppression on arrhythmic myocarditis. The effects of immunosuppressive therapy (IST) on ventricular arrhythmia (VA) have not been reported in patients with immune-mediated biopsy-proven myocarditis. Furthermore, myocarditis arrhythmic risk is still unpredictable. We enrolled 255 patients with biopsy-proven virus-negative myocarditis and VA (major: ventricular fibrillation, ventricular tachycardia; minor: nonsustained ventricular tachycardia, Lown grade≥2 premature ventral complexes) at presentation. Serum cardiac autoantibodies (antiheart antibodies, anti-intercalated disk autoantibodies [AIDA]) were detected by a standardized indirect immunofluorescence technique. Whenever accepted and noncontraindicated, IST was started. Control individuals (IST-) were chosen after 1:1 matching to IST+ patients by age, sex, ethnicity, left ventricular ejection fraction, VA type, and treatment. A total of 58 matched patient couples (age 42 ± 13 years; 67% male) were analyzed in the main study cohort. IST duration was 12 ± 1months. By the 24-month prospective follow-up, major VA occurred in 6 IST+ versus 10 IST- patients (p=0.42), with no episodes following IST termination. As compared to IST- patients, IST+ patients showed a significant reduction in minor VA burden, as well as improvement in clinical, laboratory, and imaging findings (all p<0.05). Major VA onset and positive AIDA status were independently associated with major VA at follow-up (hazard ratio [HR]: 14.2; 95% confidence interval [CI]: 2.9 to 68.7 and HR: 8.0; 95%CI: 2.6 to 25.2, respectively; both p<0.001). Furthermore, in the whole study population (N=255), IST was independently associated with protection from major VA (HR: 0.3; 95%CI: 0.2 to 0.7; p=0.01) at 38 ± 21months of follow-up. In patients with immune-mediated virus-negative myocarditis presenting with VA, IST is associated with positive effects on minor VA and nonarrhythmic endpoints. Short-term effects are limited on major VA, which were independently associated with major VA onset and positive AIDA.

Peculiarities of data of 24-hour ECG monitoring and heart rate variability in patients with hypertension associated with chronic obstructive pulmonary disease

We found a high frequency of co-occurrence of arterial hypertension and chronic obstructive pulmonary disease (COPD) in the therapeutic practice of 130 patients. Objective . To investigate daily ECG monitoring results and heart rate variability (HRV) in patients with a combination of hypertension and COPD. Material and Methods. A total of 130 patients with arterial hypertension were examined. The main group ( n = 90) consisted of comorbid patients with arterial hypertension suffering of COPD, mean age of 61.3 ± 1.0 years. The comparison group ( n = 40) comprised hypertensive patients without COPD, with a mean age of 59.1 ± 1.5 years. All patients received 24-hour ECG monitoring with HRV assessment. Results. Analysis of heart rhythm abnormalities and cardiac conduction disorders allowed to detect the following arrhythmias in patients with hypertension in the presence of COPD: paired supraventricular extrasystoles, runs of supraventricular tachycardia, paroxysmal atrial fibrillation, Lown grade I ventricular extrasystoles, and paired ventricular extrasystoles. The right bundle-branch block was the most frequent conduction disorder observed in patients with COPD. Temporal analysis of HRV showed that the basic daily-average parameters responsible for the overall tone of the autonomic nervous system (SDNN, SDNNi, and SDANN) and the indicators reflecting the effects of parasympathetic regulation on the heart activity (RMSSD, pNN50, and HRVTI) were attenuated in comorbid patients. Conclusion. This study showed that patients with arterial hypertension associated with COPD were more prone to the occurrence of potentially dangerous arrhythmias. Heart rate variability in such patients was characterized by a decrease in the tone of the parasympathetic division of the autonomic nervous system and the predominance of sympathetic effects on cardiac activity.

P919Ventricular arrhythmias in patients with mitral valve prolapse and severe mitral regurgitation

Abstract Background Mitral valve prolapse (MVP) is known to be associated with ventricular arrhythmias (VA), from symptomatic premature ventricular contractions (PVCs) to malignant ventricular tachycardia (VT) and sudden cardiac death (SCD). Previous studies identified risk factors for VA in these patients such as young woman, bileaflet prolapse and inverted T-waves, but they included only specific cohort of patients who experienced SCD or who had only trivial or mild mitral regurgitation (MR). The prevalence of VA and their potential risk factors in a population of MVP patients with severe MR are unknown. Purpose The aim of our study was to describe the prevalence of VA in patients who underwent mitral valve surgery for moderate to severe MR due to MVP and to identify clinical, electrocardiographic and echocardiographic parameters associated with VA. Methods 797 patients (65±12 years, 65% male) who underwent surgery for MVP were included from 2000 until 2018. The presence of VA was defined as symptomatic and frequent PVCs (Lown grade ≥2), non-sustained ventricular tachycardia (nsVT), VT or ventricular fibrillation (VF) documented before surgery and without an ischemic cause. The echocardiogram and electrocardiogram (ECG) prior to operation were used for the specific analysis. ECGs were checked for rhythm, conduction times, QRS morphology and inferior T-wave inversion. The origin of the PVCs was derived from a 12-lead ECG when available and divided in 5 groups; mitral annulus, papillary muscle (PM), left ventricle (LV, including outflow tract), right ventricle (including outflow tract) and other. By echocardiography, several parameters such as LV thickness and volumes, LV ejection fraction (EF), global longitudinal strain (GLS) and MR grade were obtained. Results A total of 99 (12%) patients showed VA; 70% (69/99) of the patients had symptomatic PVCs, 36% (36/99) had nsVT, 12% (12/99) VT and 3% (3/99) VF. 21 patients had more than one type of VA, of which the combination PVCs and nsVT was the most common (19/99, 19%). In addition, 6 patients experienced an out of hospital cardiac arrest of a non-ischemic cause. When comparing the clinical characteristics (Table), patients with VA were significantly younger (and with better renal function), more frequently diagnosed with Barlow's disease and experienced more palpitations as compared to patients without VA. The ECG analysis showed that patients with VA more often had inferior T-wave inversions and that the PVCs predominantly originated from the PM whereas in patients without VA the PVCs originated from different regions. Echocardiography showed that patients with VA had a thinner posterior wall, reduced LV EF and worse GLS; more severe MR was not associated with VA. Conclusion In MVP patients with moderate to severe MR undergoing surgery, Barlow's disease, inferior T-wave inversions, thinner posterior wall and LV systolic dysfunction are associated with the presence and development of VA.

Ambient fine particulate matter (PM2.5) exposure is associated with idiopathic ventricular premature complexes burden: A cohort study with consecutive Holter recordings.

Epidemiological evidence has shown an association between ambient fine particulate matter (PM2.5) exposure and cardiovascular mortality. Increased ventricular premature complex (VPC) burden can cause left ventricular dilatation and dysfunction. We aimed to investigate the relationship between acute PM2.5 exposure and VPC burden in patients without structural heart disease. We reviewed 26 820 patients who underwent 24-hour Holter electrocardiogram (ECG) recordings between 1 Jan 2013 and 1 Dec 2016. We enrolled patients with significant idiopathic (structurally normal heart) VPC burden defined as ≥30 VPCs/h (Lown grade 2) who had at least two Holter ECG recordings. The VPC burden between the studies on high and low PM2.5 exposure dates was compared in 24 and 12 hours time periods. Sixty-seven patients (31 men, 56.49 ± 18.35 years) were enrolled. Patients were exposed to 25.63 ± 11.47 and 14.66 ± 7.51 μg/m 3 of PM2.5 during the high and low study dates, respectively. The overall VPC counts (10,490.69 ± 10,681.63/day) and burden (10.22% ± 10.17%) were significantly higher on the days with higher PM2.5 exposure compared with low PM2.5 exposure dates (8293.31 ± 9009.09; P = 0.014% and 9.14% ± 12.73%, P = 0.012, respectively). Compared with low PM2.5 exposure dates, the VPC burden on high exposure dates was significantly higher from 9 am to 9 pm(5.85% ± 6.41% vs 4.84% ± 6.97%; P = 0.025) but not at nocturnal periods. Our study demonstrated a significantly higher VPC burden on high PM2.5 exposure date. The burden was increased in the daytime but not at nighttime. This result suggests that daytime PM2.5 exposure may be associated with ventricular arrhythmia burden in the healthy population.

Clinical Application of the Heart Rate Deceleration Capacity Test to Predict Epirubicin-induced Cardiotoxicity.

Objective:To investigate the clinical value of heart rate deceleration capacity (DC) in predicting the risk of epirubicin-induced cardiotoxicity.Methods:The CK-MB and cTnI levels and DC values of 86 patients were examined before chemotherapy and again after 2 and 4 cycles of chemotherapy. Patients were divided into low-risk group (LRG) (40 cases), medium-risk group (26 cases), and high-risk group (HRG) (20 cases) based on the calculated DC values.Results:After 4 cycles of chemotherapy, HRG showed a significantly greater increase in serum CK-MB (17.1 ± 4.9 vs. 14.6 ± 3.7) and cTnI (1.28 ± 0.38 vs. 1.0 ± 0.29) concentrations over the prechemotherapy levels when compared with LRG. After 2 and 4 cycles of chemotherapy, HRG exhibited a significantly greater increase in mean heart rate (2 cycles: 79.6 ± 6.0 vs. 77.6 ± 6.7; 4 cycles: 88.2 ± 10.2 vs. 82.4 ± 6.2) and the supraventricular (2 cycles: 68.9 ± 19.3 vs. 57.2 ± 17.6; 4 cycles: 131.1 ± 29.5 vs. 91.7 ± 16.5) and ventricular arrhythmia counts (2 cycles: 179.0 ± 20.5 vs. 162.3 ± 16.3; 4 cycles: 228.6 ± 44.8 vs. 187.4 ± 22.6) over the prechemotherapy values compared with LRG. When the supraventricular and ventricular arrhythmia counts measured after 4 cycles of chemotherapy were compared with those obtained before chemotherapy, HRG (131.1 ± 29.5 and 228.6 ± 44.8, respectively) showed the largest differences, followed by medium-risk group (107.4 ± 31.9 and 202.0 ± 29.8, respectively) and then LRG (91.7 ± 16.5 and 187.4 ± 22.6, respectively) (P < 0.01). After 4 cycles of chemotherapy, the incidence rates of ventricular arrhythmia greater than Lown's grade 3 (30% vs. 2.5%), QTc (20% vs. 0) elongation, and ST-T (40% vs. 5%) changes in HRG were significantly higher than those observed in LRG (P < 0.05).Conclusions:DC test was shown to be an effective predictor of the risk of epirubicin-induced cardiotoxicity.

CLINICAL ASPECTS OF MYOCARDIAL ELECTRICAL INSTABILITY IN CHRONIC IHD

The aim of the study was to assess associations between myocardial electrical instability estimates (heart rhythm turbulence, T- wave microvolt alternation, QT dispersion) and structural and functional changes in heart in the settings of IHD with ventricular premature beats. Eighty two subjects with exertional angina (NYHA FC II-III) and Lown Grade 3-5 class ventricular arrhythmia were examined. Controls included 28 pts. with chronic IHD with no arrhythmias. Heart rhythm turbulence, T- wave alternation and QT dispersion were defined based on 12-lead ECG data with record duration of 5 minutes using Intecard-7 apparatus. All patients underwent common clinical examination, 60-lead electrocardiogram (ECTG-60), ECG daily monitoring test (SMECG) (Cardian, Belarus), bicycle ergometric test, short ECG recording vagal sympathetic balance was estimated (using Briz Program Package and SMECG). IHF subjects who had Lown Grade III-V class ventricular arrhythmia had a higher frequency of heart rhythm turbulence disturbance, higher T microvolt alternation estimates and QT dispersion. Close relationship between myocardial electrical instability parameters (heart rhythm turbulence, T microvolt alternation and QT dispersion) and myocardial ischemic signs, LVEF, and heart rhythm variability in chronic IHD have been identified.

Predicting utility of exercise tests based on history/holter in patients with premature ventricular contractions.

Premature ventricular contractions (PVCs) are considered benign in patients with structurally normal hearts, particularly if they suppress with exercise. Catecholaminergic polymorphic ventricular tachycardia (CPVT) requires exercise testing to unmask the malignant phenotype. We studied risk factors and Holter monitor variables to help predict the necessity of exercise testing in patients with PVCs. We retrospectively reviewed 81 patients with PVCs that suppressed at peak exercise and structurally normal hearts referred to the exercise laboratory in 2011. We reviewed 11 patients from 2003 to 2012 whose PVCs were augmented at peak exercise (mean age 13±4years; 52% male, 180 exercise studies). We recorded clinical risk factors and comorbidities (family history of arrhythmia or sudden unexpected death [SUD], presence of syncope) and Holter testing parameters. Family history of VT or SUD (P=0.011) and presence of VT on Holter (P=0.011) were significant in predicting failure of PVCs to suppress at peak heart rate on exercise testing. Syncope was not statistically significant in predicting suppression (P=0.18); however, CPVT was diagnosed in four patients with syncope during exercise. Quantity of PVCs, Lown grade, couplets on Holter, monomorphism, and PVC elimination at peak heart rate on Holter were not predictors of PVC suppression on exercise testing. Patients with syncope during exercise, family history of arrhythmia or SUD, or a Holter monitor showing VT warrant exercise testing to assess for CPVT.

Ventricular Arrhythmia Suppression by Magnesium Treatment after Coronary Artery Bypass Surgery.

Ventricular arrhythmias occur frequently shortly after coronary artery bypass grafting (CABG), and their occurrence coincides with the postoperative decline in serum magnesium (Mg) levels. To examine if this decline causes ventricular arrhythmias and if their appearance could be reduced by intravenous Mg administration, 140 consecutive CABG patients were randomized to receive 70 mmol of Mg sulphate (N = 69) or placebo (N = 71) over two days. Serum Mg concentration fell to 0.77 mmol/l in the control group but rose to 1.09 mmol/l in the Mg group (p < 0.001). On 48 h Holter, the number of ventricular premature complexes (VPC) on the third postoperative day was reduced in the Mg group (4 +/- 5 vs 12 +/- 21 VPCs/h; p < 0.05) and the incidence of complex ventricular arrhythmias (Lown grade 2-5) was significantly diminished (19% vs 41% of the patients; p < 0.05). In multivariate analysis, high risk ventricular arrhythmias (repetitive polymorphic ventricular complexes, couplets, R-on-T complexes or operative tachycardia) were independently predicted by high number of bypassed vessels (p = 0.01), poor NYHA functional class (p = 0.06), preoperative diuretic use (p = 0.07), and low postoperative Mg levels (p = 0.08). In conclusion, correction of the postoperative decline in serum Mg concentration decreases the occurrence of early VPCs and complex ventricular arrhythmias. Patients with extensive underlying coronary artery disease and prior diuretic therapy appear to benefit greatest from Mg treatment.http://link.springer-ny.com/link/service/journals/00547/bibs/8n3p165.html

CSPE Young Investigator Award Session

CSPE Young Investigator Award Session

E0249 Prognostic value of premature ventricular contraction originating from different location for patients with chronic heart failure

BackgroundSeveral studies have suggested that ventricular arrhythmias detected by ambulatory ECG (AECG) may identify patients with chronic heart failure (CHF) at high risk for cardiovascular death. However, few studies aim...