Paroxysmal Supraventricular Tachycardia Research Articles

The advantage of the mini-electrode-equipped catheter for the radiofrequency ablation of paroxysmal supraventricular tachycardia.

Novel ablation catheters equipped with mini-electrodes (ME) offer high resolution mapping for target tissue. This study aimed to evaluate the mapping performance and efficacy of ME catheters in radiofrequency ablation (RFA) of paroxysmal supraventricular tachycardias (PSVTs). We prospectively enrolled 136 patients undergoing RFA of PSVT including 76 patients with atrioventricular nodal reentrant tachycardia (AVNRT) and 60 patients with atrioventricular reentrant tachycardia (AVRT) or Wolff-Parkinson-White (WPW) syndrome. Patients were randomized to the ME group (ablation using ME catheters) or the control group (ablation using conventional catheters). The number of ablation attempt and cumulative ablation time to ablation endpoints, which was defined as an emergence of junctional rhythm in AVNRT or accessory pathway (AP) block in AVRT/WPW syndromes were compared. During ablation procedures, discrete slow pathway or AP electrograms were found in 27 (39.7%) patients in the ME group and 13 (19.1%) patients in the control group. The primary study outcomes were significantly lower in the ME group (ablation attempt number: 2.0 [1-4] vs. 3.0 [2-7] in the ME and control group, p = .032; ablation time: 23.5 [5.0-111.5] vs. 64.5 [16.0-185.0] s, p = .013). According to the PSVT diagnosis, ablation time to junctional rhythm was significantly shorter in the ME group in AVNRT. In AVRT/WPW syndrome, both ablation attempt number and ablation time to AP block were nonsignificantly lower in the ME group. The novel ME catheter was advantageous for identifying pathway potentials and reducing initial ablation attempt number and ablation time to reach acute ablation endpoint for PSVTs(ClinicalTrials.gov number, NCT04215640).

<I>PRKAG2</I>-associated hypertrophic cardiomyopathy

Mutations in the PRKAG2 gene lead to hypertrophic cardiomyopathy in combination with Wolff—Parkinson—White syndrome. The cause of the development of heart damage is the deposition of glycogen in the myocardium and the conduction system of the heart with a violation of the metabolism of adenosine monophosphate-activated protein kinase. A feature of PRKAG2 hypertrophic cardiomyopathy is progressive conduction disturbances with the development of atrioventricular blockade and ventricular preexcitation syndrome with a high frequency of paroxysmal supraventricular tachycardia against the background of additional atrioventricular fenestrations (Wolff—Parkinson—White syndrome). Progressive heart failure, high frequency of sudden cardiac death at a young age are characteristic. The features of diagnosis and treatment are considered.

Deep-Learning-Based Detection of Paroxysmal Supraventricular Tachycardia Using Sinus-Rhythm Electrocardiograms.

Background: Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia associated with palpitation and a decline in quality of life. However, it is undetectable with sinus-rhythmic ECGs when patients are not in the symptomatic onset stage. Methods: In the current study, a convolution neural network (CNN) was trained with normal-sinus-rhythm standard 12-lead electrocardiographs (ECGs) of negative control patients and PSVT patients to identify patients with unrecognized PSVT. PSVT refers to atrioventricular nodal reentry tachycardia or atrioventricular reentry tachycardia based on a concealed accessory pathway as confirmed by electrophysiological procedure. Negative control group data were obtained from 5107 patients with at least one normal sinus-rhythmic ECG without any palpitation symptoms. All ECGs were randomly allocated to the training, validation and testing datasets in a 7:1:2 ratio. Model performance was evaluated on the testing dataset through F1 score, overall accuracy, area under the curve, sensitivity, specificity and precision. Results: We retrospectively enrolled 407 sinus-rhythm ECGs of PSVT procedural patients and 1794 ECGs of control patients. A total of 2201 ECGs were randomly divided into training (n = 1541), validation (n = 220) and testing (n = 440) datasets. In the testing dataset, the CNN algorithm showed an overall accuracy of 95.5%, sensitivity of 90.2%, specificity of 96.6% and precision of 86.0%. Conclusion: Our study reveals that a well-trained CNN algorithm may be a rapid, effective, inexpensive and reliable method to contribute to the detection of PSVT.

A NEW DIGITAL SOLUTION TO UNLOCK THE POTENTIAL OF SMART WEARABLES FOR REMOTE PATIENT CARDIAC MONITORING

BackgroundWearable devices have the potential to transform the traditional care pathway by enabling a much closer follow-up of patients' condition. However, they create an overwhelming amount of data not integrated in the clinical workflow. This prevents the technology from making its way into clinical practice on a large scale.NarrativeNinety patients were monitored using Cardiologs RPM, a solution that automatically collects and consolidates ECG and Photoplethysmography Heart Rate data (PPG-HR) from patient-owned smartwatches.From a workflow standpoint, data was centralized and triaged automatically, helping physicians to quickly access and review information of interest.From a clinical standpoint, the technology supported both the diagnosis and monitoring of patients as illustrated with these clinical cases:- A 25-year-old female was suffering from infrequent palpitations of unknown origin for years. Continuous PPG-HR data consolidated with ECGs recorded while she was symptomatic demonstrated supraventricular tachyarrhythmia. She got an ablation and has not experienced any palpitations since then.- A 60-year-old male with atrial flutter had recurrences detected on the ECGs he recorded with his smartwatch. Physicians were able to adjust the dosage of the anti-arrhythmic drug remotely rather than referring him to the emergency room because they were monitoring how he responded to the treatment.From the patient's point of view, they can use the device they own and are used to, in the comfort of their own home. They are reassured that their heart data is shared with their doctor.ConclusionCardiac data from the smartwatch showing paroxysmal supraventricular tachycardia. ECG (a) and heart rate plot consolidating ECG and PPG data acquired in the background (b).View Large Image Figure ViewerDownload Hi-res image Download (PPT) BackgroundWearable devices have the potential to transform the traditional care pathway by enabling a much closer follow-up of patients' condition. However, they create an overwhelming amount of data not integrated in the clinical workflow. This prevents the technology from making its way into clinical practice on a large scale. Wearable devices have the potential to transform the traditional care pathway by enabling a much closer follow-up of patients' condition. However, they create an overwhelming amount of data not integrated in the clinical workflow. This prevents the technology from making its way into clinical practice on a large scale. NarrativeNinety patients were monitored using Cardiologs RPM, a solution that automatically collects and consolidates ECG and Photoplethysmography Heart Rate data (PPG-HR) from patient-owned smartwatches.From a workflow standpoint, data was centralized and triaged automatically, helping physicians to quickly access and review information of interest.From a clinical standpoint, the technology supported both the diagnosis and monitoring of patients as illustrated with these clinical cases:- A 25-year-old female was suffering from infrequent palpitations of unknown origin for years. Continuous PPG-HR data consolidated with ECGs recorded while she was symptomatic demonstrated supraventricular tachyarrhythmia. She got an ablation and has not experienced any palpitations since then.- A 60-year-old male with atrial flutter had recurrences detected on the ECGs he recorded with his smartwatch. Physicians were able to adjust the dosage of the anti-arrhythmic drug remotely rather than referring him to the emergency room because they were monitoring how he responded to the treatment.From the patient's point of view, they can use the device they own and are used to, in the comfort of their own home. They are reassured that their heart data is shared with their doctor. Ninety patients were monitored using Cardiologs RPM, a solution that automatically collects and consolidates ECG and Photoplethysmography Heart Rate data (PPG-HR) from patient-owned smartwatches. From a workflow standpoint, data was centralized and triaged automatically, helping physicians to quickly access and review information of interest. From a clinical standpoint, the technology supported both the diagnosis and monitoring of patients as illustrated with these clinical cases: - A 25-year-old female was suffering from infrequent palpitations of unknown origin for years. Continuous PPG-HR data consolidated with ECGs recorded while she was symptomatic demonstrated supraventricular tachyarrhythmia. She got an ablation and has not experienced any palpitations since then. - A 60-year-old male with atrial flutter had recurrences detected on the ECGs he recorded with his smartwatch. Physicians were able to adjust the dosage of the anti-arrhythmic drug remotely rather than referring him to the emergency room because they were monitoring how he responded to the treatment. From the patient's point of view, they can use the device they own and are used to, in the comfort of their own home. They are reassured that their heart data is shared with their doctor. Conclusion

Delivering premature HIS complexe maneuver in differentiating between paroxysmal supraventicular tachycardias

Background: It is difficult to differentiate between paroxysmal supraventricular tachycardias in some circumstances. Delivering premature His complexes (PHC), a new maneuver, has been recently introduced. The study aimed to describe and evaluate initially the value of this maneuver.
 Methods: From 12/2021 to 05/2022, 30 patients who underwent electrophysiological studies were diagnosed with AVRT or AVNRT, and successful RF ablations. The PHC maneuver was performed when making differential diagnoses.
 Results: 12 AVRT cases and 18 AVNRT cases underwent the premature His complex maneuver. Delivering PHCs disturbed all AVRTs in both early PHCs (∆A1A2 = 21,33 ms) and late PHCs (∆A1A2 = 44,43ms). Late PHCs (∆PHC < 20ms) did not disturb the AVNRT circuit (∆A1A2 = 0ms). Early PHCs (∆PHC ≥ 20ms) with mean ∆PHC = 38,9ms would advance the next atrial potential of ∆A1A2 = 15,85ms, but it was significantly shorter than the atrial advancement of ∆A1A2 = 44,43ms in AVRT (p<0,05). In comparison with the prematurity of PHC, the advancement of the next atrial potential ∆A1A2 in AVRT was greater than or equal to it (∆A1A2-∆PHC ≥ 0ms, however in AVNRT was always shorter (∆A1A2-∆PHC ≤ -5ms). This maneuver had accurate results in all cases with a sensitivity and specificity of 100%.
 Conclusions: This initial evaluation suggested that this maneuver had highly accurate in differentiating AVNRT and AVRT. Premature His complexes will absolutely disturb the AVRT circuit. Delivering late PHCs could not disturb the AVNRT circuit, and early PHCs would advance the next atrial potential with an amount shorter than the prematurity of PHC. Further studies are necessary to determine the value of the maneuver in clinical practice.

Idiopathic Left Posterior Fascicular Ventricular Tachycardia in Children: A Case Report

AbstractThe incidence of idiopathic ventricular tachycardia is scarce; however, it is the most common type of ventricular tachycardia in previously normal children. Left posterior fascicular ventricular tachycardia is one of them, and many times it is mismanaged as paroxysmal supraventricular tachycardia. The characteristic features of this arrhythmia are a monomorphic tachycardia, right bundle branch block, and superior axis. This type of arrhythmia is highly sensitive to verapamil, even in infancy, but refractory to adenosine or amiodarone. As nonrecognition of this condition can be fatal, it should be identified early.

Diagnostic usefulness of implantable loop recorder in patients with unexplained syncope or palpitation

BackgroundIn a substantial proportion of patients with syncope, the exact cause is not identified because of the difficulty to document electrocardiograms correlated with the events during a syncope episode. Thus, an implantable loop recorder (ILR) was introduced for diagnosing hidden arrhythmia; however, its clinical use remains limited. Therefore, we conducted a retrospective analysis to assess the diagnostic value of the ILR in patients with unexplained syncope or palpitations.MethodsAll patients who had undergone ILR implantation from May 2016 to January 2020, were studied retrospectively. We analyzed their electrocardiogram stored in the device.ResultsAmong the 70 patients (mean age ± SD; 50.2 ± 20.3 years, 27 men) with unknown causes of syncope or palpitation, during two years follow-up, arrhythmia was detected in 26 patients (37.1%). Nineteen (73.1%) patients underwent permanent pacemaker implantation due to symptomatic bradycardia or atrioventricular block. All arrhythmias were detected within 6 days to 39 months after loop recorder implantation. Thirteen patients (50%) showed sick sinus syndrome (eight long pauses and five tachycardia-bradycardia syndromes). Eleven patients (42.3%) had paroxysmal atrioventricular block. Two patients who underwent permanent pacemaker implantation showed a positive tilt-table test. Three patients underwent radiofrequency catheter ablation for paroxysmal supraventricular tachycardia and atrial fibrillation. The mean duration for the detection of first sign (arrhythmia or palpitations) was 7.5 months, and the time from the detection of arrhythmia to ablation or device implantation was 3.4 months.ConclusionILR monitoring detected a substantial number of significant bradycardias in patients with unexplained syncope and palpitations, suggesting that it is an effective diagnostic method that can shorten the time required to identify the cause of arrhythmias.

Effects of Nursing Intervention on the Psychology and Quality of Life of Patients with Paroxysmal Supraventricular Tachycardia Radiofrequency Ablation

Effects of Nursing Intervention on the Psychology and Quality of Life of Patients with Paroxysmal Supraventricular Tachycardia Radiofrequency Ablation

Rationale for and design of a multicenter, placebo-controlled, phase 3 study to assess efficacy and safety of intranasal etripamil for the conversion of paroxysmal supraventricular tachycardia

Presently, acute pharmacological termination of paroxysmal supraventricular tachycardia (PSVT) unresponsive to patient-initiated vagal maneuvers requires in-hospital intervention. Etripamil, a fast-acting, nondihydropyridine, L-type calcium channel blocker, is formulated as an intranasal spray to rapidly terminate atrioventricular (AV) nodal-dependent PSVT in a medically unsupervised setting. The NODE-301 study did not meet its prespecified primary end point of PSVT conversion over 5 hours following a single dose of etripamil 70 mg. However, analysis at earlier time points demonstrated etripamil treatment effect during the first 30 minutes, consistent with its expected rapid onset and short duration of action. This led to the design of the RAPID study, which includes a new dosing regimen (up to 2 etripamil 70 mg doses separated by 10 minutes) to increase the exposure and pharmacodynamic effect of etripamil. The primary objective of RAPID (NCT03464019) is to determine if etripamil self-administered by patients is superior to placebo in terminating PSVT in an at-home setting. The secondary objective is to evaluate the safety of etripamil when self-administered by patients without medical supervision. Additional efficacy end points include the proportion of patients requiring additional medical intervention in an emergency department to terminate PSVT and patient-reported outcomes. After successfully completing a test dose to assess the safety of 2 70 mg doses of etripamil during sinus rhythm, approximately 500 patients will be randomized 1:1 to etripamil or placebo to accrue 180 positively adjudicated AV nodal-dependent PSVT events for treatment with the study drug. Etripamil may offer a new alternative to the current in-hospital treatment modality, providing for safe and effective at-home termination of PSVT.

Searching for novel antagonists of adenosine A1 receptors among azolo[1,5-a]pyrimidine nitro derivatives

Introduction: Ligands of adenosine A1Rs are potential candidates for the development of drugs for the treatment of paroxysmal supraventricular tachycardia, angina pectoris, hypertriglyceridemia, type 2 diabetes mellitus, neuropathic pain, and heart failure. At the same time, there is a deficiency of drugs that can regulate the functions of A1 receptors. A number of A1-antagonists are at the various stages of clinical trials; other drugs are not very selective or are characterized by an insufficient breadth of their therapeutic action. Therefore, the search for new medicinal compounds for the prevention and treatment of A1-depended diseases among nitro derivatives of tetrazolo[1,5-a]pyrimidine and 1,2,4-triazolo[1,5-a]pyrimidine is of scientific interest.
 Materials and methods: The search for active compounds was carried out by in silico and in vitro methods. At the first stage, a computer forecast of A1-antagonistic activity was carried out using the Microcosm BioS software. At the second stage, the prediction results were verified in vitro in a model of isolated mouse atria.
 Results and discussion: Based on the results of the prediction by the method of maximum similarity to standards, the most active compounds III, VIII, and XVII were selected. After testing the prediction results by the isolated atria method, the compound VIII was characterized by A1-blocking effect in vitro at a concentration of 10 μmol/L.
 Conclusion: The most promising compound with A1-blocking effect in vitro was identified; it is a derivative of tetrazolo[1,5-a]pyrimidine under the code of VIII. It is of interest for us for further in-depth study of its pharmacological properties.

Zero- and minimal fluoroscopic approaches during ablation of supraventricular tachycardias: A systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablations for cardiac arrhythmias are conventionally performed under fluoroscopic guidance. Using three dimensional electroanatomical mapping systems to guide these procedures, zero/minimal fluoroscopy (Z/MF) approaches became available. Purpose Our aim was to conduct a meta-analysis comparing these two different methods for the treatment of paroxysmal supraventricular tachycardias (SVT). Methods Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of conventional, fluoroscopy-guided vs. Z/MF approaches in patients undergoing EP procedures for SVTs. The random-effects model was used to derive mean difference (MD) and risk ratios (RR) with 95÷ confidence interval (CI). Results 24 studies involving 9,074 patients met our inclusion criteria. There were no differences between the groups in acute success (RR=1.00, 95÷ CI, 0.99–1.01; p=0.97) and long-term success rate (RR: 1.01, 95÷ CI, 1.00–1.03; p=0.13). Compared to the conventional method, Z/MF ablation significantly reduced fluoroscopic time (MD: -10.95 min (95÷ CI, -18.43 to -3.46 min; p<0.01)) and ablation time (MD: -25.23 s (95÷ CI: -42.04 to -8.43 s; p<0.01)). Procedure time (MD: 3.06 min (95÷ CI: -0.97 to 7.08; p=0.14)) and number of ablation applications (MD: 0.13 (95÷ CI: -0.86 to 1.11; p=0.80)) were not different between the groups. Complication rate was 1.59% in the entire study population and did not differ among the groups (RR: 0.68, 95÷ CI: 0.45–1.05; p=0.08). Conclusions Z/MF approach for the catheter ablation of SVTs is a feasible method that reduces radiation exposure and ablation time but does not compromise the acute and long-term success, or complication rates.

P105 A MARBLE IN THE HEART: A MYSTERIOUS MITRAL MASS

Abstract A 70–year–old woman came to our observation for acute heart failure during atrial fibrillation with high ventricular response. In the medical history she presented a previous radiofrequency ablation of paroxysmal supraventricular tachycardia, a previous episode of atrial fibrillation treated with electrical cardioversion, two hospitalizations for transient ischemic attack (TIA), the last two months before hospitalization . The patient had always refused the introduction of oral anticoagulant therapy. The transthoracic echocardiogram showed a rounded formation, with regular margins, of 20x19 mm, isoechoic and poorly mobile, adhered to the atrial side of the annulus and the posterior mitral flap, confirmed by the transesophageal echocardiogram (Fig 1,2,3). The formation did not result in mitral obstruction or significant mitral regurgitation. The left atrium appeared markedly dilated, with moderate spontaneous echo inside. In the left appendage there was no thrombus, and there were no other relevant findings. Markers of inflammation and serial blood cultures taken during hospitalization were negative, so bacterial endocarditis appeared unlikely. Mixoma or fibroelastoma appeared to be the most likely diagnosis. In consideration of the high risk of embolization and to clarify the diagnosis, the patient underwent cardiac surgery with exeresis of the formation (Fig 4–5), subsequent quadrangular resection of the posterior mitral flap, sliding and mitral annuloplasty. Macroscopically, the mass appeared brownish–red, with a smooth surface, solid and compact consistency. The histological analysis showed red blood cells and platelets mixed with vessels and granulation tissue; the wall of the mass was made up of connective tissue. Based on the findings, the differential diagnosis was between a blood cyst or a native mitral valve thrombosis. Blood cysts are generally congenital and disappear spontaneously in childhood, rarely occurring in adults. They are fluid or semi–fluid formations, and ultrasonographically they appear as masses with anechoic or hypoechoic content, surrounded by a thin wall. Thrombosis on native mitral valve is also an infrequent event, but described in literature, particularly in the presence of hypercoagulative states, mitral stenosis, atrial fibrillation. Based on the characteristics of the mass, we believe that the most likely hypothesis is that of a rare case of thrombosis on a native mitral valve.

C20 IMPACT OF TELEMEDICINE SERVICES DURING THE COVID–19 PANDEMIC

Abstract During the Italian national lockdown (11/3 to 4/5/2020), the COVID–19 epidemic caused a shift of hospital resources towards the management of the COVID+ patient; hospitals saw a progressive drop of admissions for acute myocardial infarction and arrhythmias. In order to verify the role of Telemedicine in this context, we compared 6104 ECGs recorded by 5000 pharmacies, with the 17280 ECGs of the same period of 2019, evaluated and stored in the telemedicine platform of Health Telematic Network (HTN), in collaboration with the Department of Cardiology of the University of Brescia, Federfarma and Istituto Superiore di Sanità. Chest pain was the reason for examination in 298 patients (4.88%) vs 402 (2.33%) in 2019 (+109.86%). Of these, 118 were in Lombardy, (39.50% of the total), 36 in the province of Brescia (30.50%) and 28 in the province of Bergamo (23.73%). 8 ECGs showed a STEMI picture, (2.68%), compared with 7 STEMIs (1.74%) detected in 2019 (+ 54.17%). All of these patients were referred urgently to the emergency department. We detected Atrial Fibrillation in 344 patients (5.64%), vs 393 (2.27%) in 2019, (+ 40.25%); 32 cases of Atrial Flutter (0.52%), vs 25 (0.14%) detected in 2019 (+ 26.92%). Finally, we found paroxysmal supraventricular tachycardia in 8 cases (0.13%), vs 6 cases (0.03%) detected in 2019(+ 23.07%). During the lockdown period, 384 patients (6.29%) were referred to the emergency department for symptomatic tachyarrhythmia, vs 424 patients (3.47%) in 2019(+ 55.16%). In Lombardy, 194 cases of tachyarrhythmia were reported in territorial pharmacies (about 50.52% of the total in Italy), 93 in the Brescia area (47.94%), 50 in the Bergamo area (25.77%). Conclusions: a high number of patients with cardiovascular symptoms preferred to refer to territorial pharmacies during the COVID–19 blast. Telemedicine allowed patients with STEMI to access hospitals quickly, avoiding a serious diagnostic delay; a significant proportion of accesses to local pharmacies for chest pain occurred in the region most affected by the COVID–19 outbreak; the service also allowed to refer to the hospital only patients with clinically relevant tachyarrhythmias, avoiding delay of care and inappropriate accesses. This underlines how the telemedicine network provided by pharmacies can become an important resoruce for the citizen, supporting the services of the Italian National Health System.

PO-641-08 VERY LOW EFFICACY OF VAGAL MANEUVERS IN TERMINATING PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA: RESULTS FROM THE NODE-301 STUDY

There are currently no acute drug therapies for paroxysmal supraventricular tachycardia (PSVT) approved for self-administration outside a medically supervised setting. Vagal maneuvers (VMs) are often recommended to individuals with PSVT as a first-line treatment for sustained episodes. Etripamil is a fast-acting, intranasally administered non-dihydropyridine, L-type calcium channel blocker in development to treat atrioventricular nodal-dependent PSVT. NODE-301 (NCT03464019) was a randomized, placebo-controlled, multicenter, phase 3 study evaluating self-administration of 70 mg etripamil nasal spray for acute termination of PSVT episodes in patients aged ≥18 years.

PO-681-07 COMPLICATIONS AND OUTCOMES OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA ABLATIONS AT A LARGE CANADIAN CARDIAC CENTER

Paroxysmal supraventricular tachycardia (PSVT) carries a significant burden on patients. PSVT treatment with catheter ablation is both practical and cost-effective. Contemporary real-world data on intra-operative complications and long-term outcomes to help with shared decision making is critical.

CE-542-03 CANNON A WAVE VALIDATION AS A DIAGNOSTIC TOOL IN PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIAS

Atrioventricular nodal re-entrant tachycardia (AVNRTs) and orthodromic reciprocating tachycardias (ORTs) are major mechanisms of paroxysmal supraventricular tachycardias. Cannon A waves, rapid and regular pulsations with bulging of the internal jugular veins, is traditionally associated with AVNRTs.

Supraventricular Tachycardia Ablation and Its Effects on Anxiety Medications.

Background: Patients with true paroxysmal supraventricular tachycardia (PSVT) are frequently misdiagnosed with panic or anxiety disorders due to similar symptoms of palpitations, light-headedness, dyspnea, or chest discomfort. Unrecognized PSVT can lead to unnecessary management with anxiety medications. Treatment of PSVT with catheter ablation may lead to a reduction in anxiety medications. Methods: A total of 175 patients underwent successful PSVT ablation between January 1, 2010 and December 31, 2020. We examined symptoms at presentation, psychiatric medications prior to PSVT ablation, comorbidities, and psychiatric medications at three months post-ablation. Results: Fifteen percent of patients who underwent successful PSVT ablation were being treated with psychiatric medications and included in the final study population. The most common symptoms were palpitations (80.77%), followed by dizziness (42.31%), and shortness of breath (34.62%). The average number of medications prior to ablation was 1.42 and decreased to 1.08 at three months post-ablation (p = 0.04). The average number of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other anxiolytics also decreased but was not statistically significant.Conclusion: In patients with anxiety and PSVT, catheter ablation reduced the average number of psychiatric medications.

Cardiac arrhythmias in patients with bronchial asthma

Introduction. According to modern data, bronchial asthma (BA) is an independent risk factor for the development of cardiac arrhythmias (CA), and the use of long-acting β2-agonists (LABA) in basic therapy may further increase the risks of CA.Aim. To study the structure and risk factors of cardiac arrhythmias in patients with bronchial asthma. Materials and methods. A retrospective study included 181 patients aged 69.4 ± 0.8 years, hospitalized for asthma, with the presence a CA in medical documentation.Results. Among BA patients with CA, supraventricular CA were found in 71.3% (129) patients, ventricular CA in 16.6% (30), combined CA in 12.2% (22). In 52.5% (95) patients, supraventricular extrasystole was detected, in 35.9% (65) – atrial fibrillation, in 28.7% (52) – ventricular extrasystole, in 1.1% (2) – paroxysmal supraventricular tachycardia, in 0.6% (1) – paroxysmal ventricular tachycardia. It was found that supraventricular CA was significantly more frequent among women (χ2 = 5.974, p = 0.05). The severity of BA and the level of control are not related to the type of observed CA (χ2 = 0.755, p = 0.685 and χ2 = 3.003, p = 0.557, respectively).Discussion. The use of a combination of ICS and LABA in basic BA therapy versus the use of ICS alone does not have a significant effect on the frequency and structure of cardiac arrhythmias (χ2 = 1.172, p = 0.556).Conclusion. In hospitalized BA patients, supraventricular cardiac arrhythmias are most often detected, among which supraventricular extrasystole and atrial fibrillation take the main place.

Circulating microRNA‑423 attenuates the phosphorylation of calcium handling proteins in atrial fibrillation.

MicroRNAs (miRNAs) are small non-coding RNAs that control patterns of gene expression by inducing the degradation of mRNAs. In addition, miRNAs are known to serve an important role in the pathogenesis of atrial fibrillation (AF). In general, AF is diagnosed using electrocardiography. However, the present study investigated whether specific miRNAs derived from microarray analysis of human urine could regulate AF through the inhibition of calcium handling protein phosphorylation in an AF model. Microarray analysis of the transcriptome in the human urine of patients with paroxysmal supraventricular tachycardia and AF revealed that 7 differentially expressed miRNAs were significantly downregulated (miR-3613, 6763, 423, 3162, 1180, 6511, 3197) in patients with AF. In addition, quantitative PCR results demonstrated that collagen I, collagen III, fibronectin and TGF-β, which are fibrosis-related genes, were upregulated in patients with AF. Furthermore, fibrosis-related genes were upregulated in angiotensin II-induced atrial myocytes, which demonstrated that these genes may be targets of miR-423. In the AF cell model transfected with miR-423, the expression of calcium handling proteins, including phosphorylated calmodulin-dependent protein kinase II, was reduced. The transfection of miR-423 attenuated damage to cardiac cells caused by calcium handling proteins. The findings highlight the importance of calcium handling protein phosphorylation changes in fibrosis-induced AF and support miR-423 detection in human urine as a potential novel approach of AF diagnosis.

Verapamil: prevention and treatment of cardio-renal syndromes in diabetic hypertensive patients?

Patients with diabetes mellitus (DM) often present other chronic comorbidities including arterial hypertension (AH), chronic kidney disease (CKD), ischemic heart disease (IHD) and heart failure with preserved ejection fraction (HFpEF). The frequent association of the latter conditions is considered part of the spectrum of cardio-renal syndromes (CRS), a group of disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. Verapamil is a non-dihydropyridine calcium channel blocker (CCB) widely used in the treatment of hypertension, chronic stable angina, secondary prevention of reinfarction, paroxysmal supra-ventricular tachycardia and for rate control in atrial fibrillation/flutter. In addition to its antihypertensive and anti-ischemic actions verapamil exerts favorable effects also on glycemic control, proteinuric diabetic nephropathy, left ventricular diastolic dysfunction and sympathetic nervous system overactivity which may potentially benefit patients with DM and CRS. In this narrative review, we summarize the current evidence on the potential role of verapamil in the prevention and treatment of CRS in diabetic hypertensive patients.