Pre-existing Arrhythmias Research Articles

Effectiveness of β-blockers in improving 28-day mortality in septic shock: insights from subgroup analysis and retrospective observational study.

In recent years, septic shock remains a common fatal disease in the intensive care unit (ICU). After sufficient fluid resuscitation, some patients still experience tachycardia, which may lead to adverse effects on cardiac function. However, the use of β-blockers in the treatment of septic shock remains controversial. Thus, the purpose of this study is to evaluate the efficacy of β-blockers in the treatment of patients with septic shock and explore the most appropriate patient subgroups for this treatment. This retrospective observational study enrolled septic shock patients from the Medical Information Mart for Intensive Care (MIMIC)-IV and used propensity score matching (PSM) to balance some baseline differences between patients with and without β-blockers treatment. The primary outcome was the 28-day mortality. Length of stay (LOS) in the ICU and hospital, and the degree of support for organs such as circulatory, respiratory and renal systems were also assessed. Subgroup analysis and multivariate logistic regression were performed to determine the relationship between β-blockers therapy and 28-day mortality in different patient groups. A total of 4,860 septic shock patients were enrolled in this study and 619 pairs were finally matched after PSM. Our analysis revealed that β-blocker therapy was associated with a significant improvement in 28-day mortality (21.5% vs. 27.1%; P = 0.020) and led to a prolonged LOS in both the ICU and hospital. Subgroup analysis indicated that there was an interaction between cardiovascular diseases and β-blocker therapy in patients with septic shock. Patients with pre-existing heart disease or atrial arrhythmias were more likely to derive benefits from β-blocker treatment. We found β-blockers therapy was effective to improve 28-day mortality in patients with septic shock. Patients in the subgroup with cardiovascular diseases were more likely to benefit from β-blockers in mortality.

Pregnancy related complications in women with hypertrophic cardiomyopathy: a nationwide population-based cohort study

BackgroundThe impact of hypertrophic cardiomyopathy (HCM) on cardiovascular and obstetrical outcomes in pregnant women remains unclear, particularly in Asian populations. This study aimed to evaluate the maternal cardiovascular and obstetrical outcomes in Korean women with HCM.MethodsUsing data from the Korean National Health Insurance Service database, we identified women who gave birth via cesarean section or vaginal delivery after being diagnosed with HCM between 2006 and 2019. Maternal cardiovascular and obstetrical outcomes were assessed based on the trimester of pregnancy.ResultsThis study included 122 women and 158 pregnancies. No maternal deaths were noted; however, 21 cardiovascular events, such as hospital admission for cardiac problems, including heart failure and atrial fibrillation (AF), new-onset AF or ventricular tachycardia (VT) occurred in 14 pregnancies (8.8%). Cardiac events occurred throughout pregnancy with a higher occurrence in the third trimester. Cesarean sections were performed in 49.3% of the cases, and all cardiovascular outcomes occurring after delivery were observed in patients who had undergone cesarean sections. Seven cases involved preterm delivery, and two of these cases were accompanied by cardiac events, specifically AF. Pre-existing arrhythmia (AF: odds ratio (OR): 7.44, 95% confidence interval (CI): 2.61–21.21, P < 0.001; VT: OR: 31.61, 95% CI: 5.85–172.77, P < 0.001) was identified as a predictor for composite outcomes of cardiovascular events or preterm delivery.ConclusionsMost pregnant women with HCM were well-tolerated. However, cardiovascular complications could occur in some patients. Therefore, planned delivery may be necessary for selected patients, especially the women with pre-existing arrhythmias.

Incidence and Demographic Characteristics of Patients with Post Cardiac Surgery Arrhythmias: A Single Center Retrospective Study

Objectives Arrhythmias are a common complication following cardiac surgery, and can significantly affect patients’ outcomes. In some cases, post-operative arrhythmias may lead to hemodynamic instability, congestive heart failure, or even sudden cardiac death. Various types of cardiac surgery result in varying rates of post-operative arrhythmias, with more complex procedures causing higher rates. Risk factors for post-operative arrhythmias include advanced age, pre-existing cardiovascular disease, electrolyte imbalances, and the type of cardiac surgery. In this study, we aim to determine the incidence and demographic characteristics of patients who underwent cardiac surgery from November 15, 2020, till November 30, 2021, in a tertiary center in the Kingdom of Bahrain. Material and Methods All adult patients (18 years or older) who were booked for cardiac surgery during the study period were included. Patients with pre-existing documented arrhythmias were excluded from the study. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, and mortality. Descriptive statistics was used to analyze the data, including frequency distributions, means, and standard deviations. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, length of hospital stay, and mortality. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, length of hospital stay, and mortality. Results A total of 161 patients were enrolled in the study with a mean age of 56.75 ± 1.68 years. Among the total enrolled population, 68.32% were male and 31.68% were female. The majority of patients (61.49%) had undergone urgent surgery. Approximately, half (49.07%) of the patients had coronary artery bypass surgery. Premature ventricular complexes (PVC), atrial fibrillation (AF), junctional rhythm, heart block, and atrial flutter were reported in 30.43%, 29.19%, 11.18%, 9.31%, and 8.07% of patient populations respectively. Pleural effusion (50.31%) and bleeding (19.25%) were common post-surgery complications observed among the patients. The mean oxygen saturation (sO2) of the patients on the day of arrhythmia was 95.67 ± 2.05%. Epinephrine/norepinephrine (71.43%) was the most used inotropic agent used after cardiac surgery. Conclusion Cardiac surgery is associated with various arrhythmias. The two most common arrhythmias observed in patients after cardiac surgery are premature ventricular contractions and atrial fibrillation.

Cardiovascular Disease in Total Knee Arthroplasty: An Analysis of Hospital Outcomes, Complications, and Mortality.

Cardiovascular comorbidities have been identified as a significant risk factor for adverse outcomes following surgery. The purpose of this study was to investigate its prevalence and impact on postoperative outcomes, hospital metrics, and mortality in patients undergoing total knee arthroplasty (TKA). Our hypothesis was that patients with cardiovascular comorbidities would have worse outcomes, greater postoperative complication rates, and increased mortality compared to patients without cardiovascular disease. In this retrospective study, data from the National Inpatient Sample database from 2011 to 2020 were queried for patients who underwent TKA with preexisting cardiac comorbidities, including congestive heart failure (CHF), coronary artery disease (CAD), valvular dysfunction, and arrhythmia. Multivariate logistic regression analyses compared hospital metrics (length of stay, costs, and adverse discharge disposition), postoperative complications, and mortality rates while adjusting for demographic and clinical variables. All statistical analyses were performed using R studio 4.2.2 and Stata MP 17 and 18 with Python package. A total of 385,585 patients were identified. Those with preexisting CHF, CAD, valvular dysfunction, or arrhythmias were found to be older and at higher risk of adverse outcomes, including prolonged length of stay, increased hospital charges, and increased mortality (p < 0.001). Additionally, all preexisting cardiac diagnoses led to an increased risk of postoperative myocardial infarction, acute kidney injury (AKI), and need for transfusion (p < 0.001). The presence of valvular dysfunction, arrhythmia, or CHF was associated with an increased risk of thromboembolic events (p < 0.001). The presence of CAD and valvular dysfunction was associated with an increased risk of urologic infection (p < 0.001). This study demonstrated that CHF, CAD, valvular dysfunction, and arrhythmia are prevalent among TKA patients and associated with worse hospital metrics, higher risk of perioperative complications, and increased mortality. As our use of TKA rises, a lower threshold for preoperative cardiology referral in older individuals and early preoperative counseling/intervention in those with known cardiac disease may be necessary to reduce adverse outcomes.

Comparative effectiveness and healthcare utilization for ambulatory cardiac monitoring strategies in Medicare beneficiaries

Objective data comparing the diagnostic performance of different ambulatory cardiac monitors (ACMs) are lacking. To assess variation in monitoring strategy, clinical outcomes and healthcare utilization in patients undergoing ambulatory monitoring without a pre-existing arrhythmia diagnosis. Using the full sample (100%) of Medicare claims data, we performed a retrospective cohort study of diagnostic-naïve patients who received first-time ACM in 2017 to 2018 and evaluated arrhythmia encounter diagnosis at 3-months, repeat ACM testing at 6 months, all-cause 90-day emergency department (ED) and inpatient utilization, and cost of different strategies: Holter; long-term continuous monitor (LTCM); non-continuous, event-based external ambulatory event monitor (AEM); and mobile cardiac telemetry (MCT). We secondarily performed a device-specific analysis by manufacturer, identified from unique claim modifier codes. ACMs were used in 287,789 patients (AEM = 10.3%; Holter = 53.8%; LTCM = 13.3%; MCT = 22.5%). Device-specific analysis showed that compared to Holter, AEM, MCT, or other LTCM manufacturers, a specific LTCM (ZioⓇ XT 14-day patch, iRhythm Technologies, San Francisco, CA) had the highest adjusted odds of diagnosis and lowest adjusted odds of ACM retesting. Findings were consistent for specific arrhythmia diagnoses of ventricular tachycardia, atrioventricular block, and paroxysmal atrial fibrillation. As a category, LTCM was associated with the lowest 1-year incremental health care expenditures (mean Δ$10,159), followed by Holter ($10,755), AEM ($11,462), and MCT ($12,532). There was large variation in diagnostic monitoring strategy. A specific LTCM was associated with the highest adjusted odds of a new arrhythmia diagnosis and lowest adjusted odds of repeat ACM testing. LTCM as a category had the lowest incremental acute care utilization. Different monitoring strategies may produce different results with respect to diagnosis and care.

The Prevalence of and Predisposing Factors for Late Atrial Arrhythmias after Transcatheter Closure of Secundum Atrial Septal Defects in Children.

A 24 h Holter study in children after transcatheter secundum ASD (ASD II) closure was conducted to detect the prevalence of defects and/or device-related late atrial arrhythmias (LAAs). ASD II closure with an Amplatzer septal occluder (ASO) is an established procedure. Little is known about LAAs after device implantation. The eligible participants were children who had undergone ASO implantation, with a follow-up of ≥5 years, as well as one pre- and at least one post-procedural Holter ECG. In total, 161 patients (mean age: 6.2 ± 4.3 years), with a mean follow-up of 12.9 ± 3.1 years (range 5-19), were included. A median of four Holter ECGs per patient were available. LAAs occurred before intervention in four patients (2.5%), and it was peri-interventional in four patients (2.5%), sustained in three patients (1.9%), and developed in three patients (1.9%). In patients with pre- and peri-interventional LAAs, the Qp/Qs ratio was higher (6.4 ± 3.9 vs. non-AA: 2.0 ± 1.1 (p = 0.002)) and the IAS/ASO ratio was lower (1.18 ± 0.27 vs. non-AA: 1.7 ± 0.4 (p < 0.001)). The patients with LAAs differed from those without LAAs in their Qp/Qs (6.8 ± 3.5 vs. 2.0 ± 1.3; p < 0.0001) and IAS/ASO ratios (1.14 ± 0.19 vs. 1.73 ± 0.45; p < 0.001). The patients with LAAs had a Qp/Qs ratio ≥2.94:1, and those who developed LAAs had an IAS/ASO ratio <1.15. LAAs occurred in 1.9% of patients and were sustained in another 1.9% of patients but persisted in those with large shunt defects and large occluders in relation to the atrial septal length. The predisposing factors for LAAs after ASD closure were a high Qp/Qs ratio, pre-existing atrial arrhythmias, and a low IAS/ASO ratio.

A contemporary evaluation of surgical aortic valve replacement outcomes and temporal trends.

Given the ageing population and uptake of transcatheter approaches for treating aortic stenosis (AS), a renewed evaluation of outcomes after surgical aortic valve replacement (SAVR) is warranted. With guidelines recommending age-based indications for surgical and transcatheter approaches, this study critically evaluates outcomes in age-based subgroups, with the aim to refine management of AS in the elderly, where there is often no clear consensus. Six hundred and thirteen consecutive patients who underwent SAVR in an Australian tertiary cardiac centre between 1 June 2014 and 13 January 2022 were retrospectively analysed. Of these, 70.31% were <75 years (Group 1) and 29.69% were ≥75 years (Group 2). Groups were compared with respect to early and long-term outcomes. Logistic regression, Kaplan-Meier survival estimates and Cox proportional hazards regression were performed for all patients and an AS-specific sub-group. Patients aged ≥75 years were more likely to be female and have hypercholesterolemia, hypertension, and pre-existing arrhythmia (P < 0.001). Group 1 experienced a higher incidence of renal failure compared with Group 2, in the overall cohort and AS-specific subgroup (P = 0.02). The incidence of stroke was similar between groups, in the overall cohort (P = 0.22) and the AS-specific subgroup (P = 0.32). Age ≥ 75 was not found to be an independent predictor of 30-day, 1-year or 5-year mortality. Temporal trends revealed low consistently low complication rates. Elderly patients should not be denied surgery based on age, despite guideline-driven age-based recommendations.

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care.

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care.

Ventricular arrhythmias following balloon-expandable transcatheter pulmonary valve replacement in the native right ventricular outflow tract.

Ventricular arrhythmia incidence in children and adolescents undergoing transcatheter pulmonary valve replacement (TPVR) within the native right ventricular outflow tract (nRVOT) is unknown. We sought to describe the incidence, severity, and duration of ventricular arrhythmias and identify associated risk factors in this population. This was a retrospective cohort study of 78 patients <21 years of age who underwent TPVR within the nRVOT. Patients were excluded for pre-existing ventricular arrhythmia or antiarrhythmic use. Study variables includedsurgical history, valve replacement indication, valve type/size, and ventricular arrhythmia. Univariable logistic regression models were used to evaluate factors associated with ventricular arrhythmias, followed by subset analyses. Nonsustained ventricular arrhythmia occurred in 26/78 patients (33.3%). The median age at the procedure was 10.3 years (interquartle range [IQR]: 6.5, 12.8). Compared with other nRVOT types, surgical repair with transannular patch was protective against ventricular arrhythmia incidence: odds ratio (OR): 0.35 (95% confidence interval [CI], 0.13-0.95). Patient weight, valve type/size, number of prestents, and degree of stent extension into the RVOT were not associated with ventricular arrhythmia occurrence. Beta blocker was started in 16/26 (61.5%) patients with ventricular arrhythmia. One additional patient was lost to follow-up. The median beta blocker duration was 46 days (IQR 42, 102). Beta blocker was discontinued in 10 patients by 8-week follow-up and in the remaining four by 9 months. Though common after balloon-expandable TPVR within the nRVOT, ventricular arrhythmias were benign and transient. Antiarrhythmic medications were successfully discontinued in the majority at 6- to 8-week follow-up, and in all patients by 20 months.

Adverse reactions to antiarrhythmic drugs

There are various types of adverse reactions to antiarrhythmic drugs (AADs). Proarrhythmia, which refers to an exacerbation of the preexisting arrhythmia or occurrence of a new arrhythmia, may occur under the therapeutic concentration of an AAD. Bradyarrhythmia is the most common type of proarrhythmia due to AADs, and prior myocardial infarction and old age are known risk factors. Atrial flutter with 1:1 atrioventricular conduction usually occurs during rhythm control of atrial fibrillation with class IC AADs. QT prolongation due to AADs, mainly class III AADs, elevates the risk of torsade de pointes by triggered activity due to early afterdepolarization. The addition of clinical factors that promote QT prolongation, such as hypokalemia, hypomagnesemia, female sex, and bradycardia, increases the risk of developing torsade de pointes. Proarrhythmic monomorphic ventricular tachycardia usually occurs as a result of slow conduction and disparity of refractoriness due to class IC AADs. In patients with preexisting left ventricular systolic dysfunction or structural heart disease, the risk of hypotension or cardiogenic shock caused by negative inotropic effects due to AADs should be considered. To prevent these major adverse reactions to AADs, we need to understand the electrophysiologic properties of AADs in detail. Furthermore, the risk of proarrhythmia could be heightened by interplay with clinical factors, such as electrolyte unbalances, heart rate, and hepatic/renal or myocardial dysfunction. Sufficient awareness about drug-drug interactions, which may affect the metabolism of AADs, will improve patient safety during the management of arrhythmia.

Pregnancy Outcomes in Women with Arrhythmias following Surgical Repair of Cardiac Defects.

The goal of this study was to investigate whether preexisting cardiac arrhythmias are associated with adverse obstetrical outcomes in women with a history of open cardiac surgery. This was a retrospective cohort study of women with a history of open cardiac surgery who delivered at MedStar Washington Hospital Center (Washington, DC) from January 2007 through December 2018. Women with the isolated percutaneous cardiac surgical repair were excluded. Maternal and neonatal outcomes were compared between patients with preexisting cardiac arrhythmias and patients without preexisting cardiac arrhythmias. Maternal outcomes studied were intensive care unit admission, postpartum blood loss greater than 1,000 mL, congestive heart failure development, preeclampsia with severe features, postpartum readmission, postpartum cardiac events, and postpartum length of stay >5 days. Neonatal outcomes investigated were low birth weight <2,500 g, Apgar's scores <7 at 5 minutes, and neonatal intensive care unit admission. Multivariate logistic regression model was used to calculate the adjusted odds ratio (aOR) and 95% confidence intervals. The outcomes for 69 deliveries from 56 women with a history of open cardiac surgery were examined. Thirty-three women (48%) had arrhythmias after cardiac surgery with fourteen (20%) requiring implantable cardioverted defibrillators. Two women (6%) with preexisting arrhythmias after cardiac surgery developed postpartum volume overload requiring readmission (p = 0.06). After controlling for age, gestational age at delivery, and BMI, preeclampsia with severe features (p = 0.02) and low birth weight neonates (p = 0.02, aOR = 2.26 [0.56-9.03]) remained statistically more like to occur in patients with preexisting cardiac arrhythmias than in patients without preexisting arrhythmias. Women with a history of open cardiac surgery and preexisting cardiac arrhythmias prior to pregnancy are more likely to develop preeclampsia with severe features and have low birth weight neonates compared with women with a history of open cardiac surgery without preexisting cardiac arrhythmias. · Preexisting arrhythmias after cardiac surgery was associated with a risk of preeclampsia.. · Neonates of women with preexisting cardiac arrhythmias are more likely to be low birth weight.. · Forty-seven percent of women with open cardiac surgery developed subsequent arrhythmias..

626 CARDIOVASCULAR DISEASE PHENOTYPES IN PREGNANCY: GESTATION, PERIPARTUM, AND LONG-TERM OUTCOMES

Abstract Background Maternal cardiovascular physiology is affected by changes that may be impaired in women with cardiovascular disease. Management of these pregnancies is challenging, as prevalence of late childbearing and of women with congenital heart disease achieving pregnancy is increasing. Objective This single-center prospective study sought to evaluate the effects of maternal cardiovascular disease (CVD) on pregnancy outcome and, after birth, on maternal and fetal morbidity and mortality. Methods 140 patients with cardiovascular disease prior to pregnancy (congenital or acquired) or cardiovascular disease developed during pregnancy were enrolled at our tertiary referral hospital between 2011 and 2021. Baseline data included cardiovascular risk factors, cardiological therapy, mWHO class in pregnancy, 12-lead EKG, and transthoracic echocardiography. Birth-related data included gestational age at delivery; neonatal weight, Apgar score at 1 and 5 minutes from birth; admission to neonatal ICU. A medium-to-long term follow-up of these patients was carried out by telemedicine. The primary endpoint was pregnancy outcome in terms of live births, week of delivery and fetal growth. Secondary endpoints included neonatal complications, maternal adverse cardiovascular events (death from cardiovascular causes, sustained arrhythmia, acute heart failure, postpartum cardiac surgery) and adverse obstetric events (spontaneous abortion, fetal loss, intrauterine death, neonatal death, SGA, prematurity, frequency of caesarean sections). Results Six cohorts were identified: adult congenital heart disease (ACHD); arrhythmias; valvular heart disease (VHD); ischemic CVD; cardiomyopathies and myopericarditis (CM/MYO); aortic disease. Heart disease prior to pregnancy was the most common setting (88%), mainly including ACHD (54%), followed by VHD (15%) and arrhythmias (11%). The pregnancy-onset cardiovascular diseases (12%) were predominantly CM/MYO (53%), mainly peripartum dilated cardiomyopathy, followed by arrhythmias (35%). Intermediate and high-risk classes (mWHO II-III, III and IV) were observed in 94 patients (67%). There were no maternal deaths; acute heart failure occurred in 6% of patients with no significant difference between groups. Sustained arrhythmias were found in 7% of the total cases, with a significantly higher prevalence in the cohort with preexisting arrhythmia (p &amp;lt;0.05). Cardiac surgery was performed in 4% of the patients, all in the ACHD cohort. Live births were 135 (94%); fetal deaths were 5 (one spontaneous abortion, 3 fetal losses and one neonatal death). Caesarean section was performed in 74% of patients. The mean gestational age at birth was low in all groups (36.6 ± 4.6 weeks), as well as the neonatal weight in grams (2676.9 ± 698.3) and the percentile of neonatal weight (37.8 ± 25.2). Reduced LVEF was significantly associated with low neonatal weight in the mWHO risk class IV patients (p = 0.04). At a mean follow-up of 26 months, cardiac surgery was significantly higher in the group of aortic disease (50% in diseases of the aorta, 8% in the ACHD group, 7% in the CM/MYO group, no events in other groups; p = 0.007), despite the small sample under investigation. Conclusions We provide insights of how, by strict and timely follow-up and a multidisciplinary approach implemented before pregnancy and throughout gestation, good outcomes can be achieved in pregnancies with congenital or acquired cardiovascular disease, despite the high prevalence of intermediate and high-risk patients.

One ominous case of focal atrial tachycardia in pregnancy, two victims and a successful outcome: a case report

BackgroundPregnancy is associated with both new-onset and exacerbation of pre-existing arrhythmias, particularly supraventricular tachycardia, with increased maternal and fetal risks and with added concerns on the safety of the available drug therapy and catheter ablation techniques.These are often withheld, with worse outcomes, and lead to challenging decisions in the approach to pregnant women with refractory supraventricular arrhythmias.Case presentationWe present a case of a 28-year-old 37-weeks pregnant woman with symptomatic, almost incessant, atrial tachycardia causing tachycardia-induced cardiomyopathy, refractory to medical therapy, that evolved in acute cardiac failure and needed emergency cesarian delivery. The patient was afterward submitted to catheter ablation therapy, with an electrical isolation of the ectopic foci on the lower left pulmonary vein with radiofrequency and total suppression of the arrhythmia. The patient and infant were discharged clinically well and during follow-up the patient was asymptomatic, without recurrence of tachycardia and with complete recovery of left ventricle function.ConclusionsThis case highlights the challenges in the treatment of this special population with a stepwise medical approach that proved ineffective and clinical deterioration requiring termination of pregnancy and catheter ablation in the postpartum period, with a successful maternal and fetal outcome.

A worsened prognosis for patients after a stroke with newly diagnosed atrial fibrillation compared to having a preexisting arrhythmia.

IntroductionAtrial fibrillation (AF) is a major cause of the ischemic stroke. Patients with undiagnosed AF lack the stroke prevention provided by oral anticoagulants. The aim of this study was to compare the in-hospital mortality rate between ischemic stroke patients diagnosed with AF de novo against ischemic stroke patients diagnosed with AF prior to hospitalization for stroke.Material and methodsWe identified patients admitted to the Neurology Center during the years 2013-2014 with acute ischemic stroke and AF. We analyzed in-hospital outcomes in patients with newly diagnosed AF and those with known AF. The study endpoint was death during hospitalization.ResultsThe study included 2,000 patients with acute ischemic stroke out of which 579 patients (29%) were diagnosed with AF. AF was newly diagnosed in 123 patients (21.2%) (new-AF group), while 456 patients (78.8%) had a history of AF (previous-AF group). Mean National Institutes of Health Stroke Scale (NIHSS) score at admission was 7.2 points in the new-AF group and 3.7 in previous-AF group (P&lt;0.001). In-hospital death was more common in new-AF group (13 patients, 10.6%) than in previous-AF group (16 patients, 3.5%) (P=0.003). In multivariate analysis, the NIHSS score at admission in new-AF group was associated with higher mortality, while in previous-AF group, the NIHSS score at admission and multiple ischemic foci were risk factors of in-hospital mortality.ConclusionsNewly diagnosed AF in ischemic stroke patients significantly worsens prognosis compared to patients previously diagnosed with AF. Early detection of latent AF and subsequent use of anticoagulation is important in preventing severe stroke.

Risk for neonatal hypoglycaemia and bradycardia after beta-blocker use during pregnancy or lactation: a systematic review and meta-analysis protocol

IntroductionBeta-blockers are often used during pregnancy to treat diseases such as pre-existing hypertension, arrhythmias or pregnancy-related hypertension. Since beta-blockers are able to cross the placenta and can pass into breast...

Closing the Integration Gap: A Pilot for Incorporating Foundational Sciences, DEI-Decision Making, Empathy, and Communication for Congestive Heart Failure and Arrhythmia Management by Pharmacy Students.

Pharmacists must integrate foundational sciences with pharmacy practice for providing optimal patient care. Pharmacy students need to be trained to provide culturally competent, linguistically accessible, and empathetic care while integrating foundational science principles. However, such holistic integration is challenging to achieve and assess. To bridge this gap, we implemented and assessed an “integrated cardiovascular simulation” (ICS) module for P2 students, employing case-based and team-based learning. ICS focused on congestive heart failure with preexisting arrhythmia and incorporated patient counseling relating to diversity factors such as cultural competency, linguistic challenges, and the impact of population diversity on cardiac diseases. Students learned the SBAR communication technique (situation, background, assessment, and recommendation) and recommended therapy while elaborating on drug MOA and adverse effects. ICS was assessed through pre-and post-session quizzes and perception data immediately after the activity, and after two years, when students progressed to the cardiovascular APPE block. Student performance improved on a post-test (80.2%) compared to the pre-test (66.9%), p < 0.01 paired student t-test, with an increase in symptom and arrhythmia pattern recognition (41.2% and 36.7%, respectively). ICS was effective for teaching (1) arrhythmia pathophysiology (85%), (2) EKG interpretation (89%), (3) drug adverse effects (93%), (4) DEI-clinical decision making (92%), and (5) communication skills (85%).

Atrial fibrillation and coronavirus infection

Funding AcknowledgementsType of funding sources: Public Institution(s). Main funding source(s): NSC M.D Strazhesko Institute of CardiologyCoronavirus infection (CI) needs to be specified in terms of the impact on the development of first-onset arrhythmia episodes and the worsening of the course of pre-existing arrhythmias and conduction disturbances.The aim of our study was to examine the features of the most common and potentially dangerous arrhythmia - atrial fibrillation (AF) in patients with COVID-19 infection (CI).Research methods in this fragment of work the estimation of clinical and anamnestic characteristics of patients (pts) and a course of a disease is resulted.ResultsWe studied 29 pts, including 9 men and 20 women, aged 65.7 + 1.8 years, who 3.8 + 0.6 months ago underwent CI, and were admitted to our clinic with a diagnosis of atrial fibrillation ( AF): 18 pts with paroxysmal, 8 pts with persistent and three people with permanent forms of this arrhythmia. Of these, 18 (62.1%) had AF before COVID-19 (study group 1), and 11 (37.9%) pts had this arrhythmia after CI (study group 2). In pts of the 1st group after CI there was an increased duration of AF paroxysm in all 15 pts with paroxysmal and persistent forms of AF from 1.9 + 0.4 to 59.1 + 2.0 days (p (0.001). In favor of the latter is the fact that in these patients the frequency of arrhythmia paroxysms increased from 2.5 + 0.4 times a year to 53.6 + 1.9 during the same time (up to almost once a week) (p <0.001). In addition, all three pts with persistent AF had a transition from "normosystolic" form of this arrhythmia to "tachysystolic" (100%, p <0,05). Pts of the 1st group more often had coronary heart disease (77.8% vs. 72.7%, p <0.05), a history of myocardial infarction 5.6% vs. 0%, p <0.05), stroke (11.1% vs. 0%, p <0.05), diabetes mellitus (22.2% vs. 0%, p <0.05). Pts in group 1 were older than patients in group 2 (67.7 + 1.9 years versus 63.9 + 2.4 years) (p <0.001). AF in group 1 first appeared on average 6.1 + 0.6 years before the survey, which is significantly greater than the difference in human age of 3.8 +1.9 years (p <0.001) between pts of the 1st and 2nd groups. That is, AF in pts of the 2nd group of CI dishonestly accelerated its development. Finally, the 1st group of women there were 61.1%, which is more than men, which was 38.9% 1.6 times, and in the 2nd group the number of women increased significantly ( and amounted to 81.8% to 18.2% of men), and the ratio of women to men increased to 4.5 - almost three times more than in the group of pts with AF to CI (p <0.001).ConclusionsCoronavirus infection significantly worsens the course of all forms of atrial fibrillation. COVID-19 increases the likelihood of newly registered atrial fibrillation in pts without significant comorbid and age-related "load". The probability of atrial fibrillation after coronavirus infection in women is higher than in men.

Effects of Antiarrhythmic Drugs on Antiepileptic Drug Action-A Critical Review of Experimental Findings.

Severe cardiac arrhythmias developing in the course of seizures increase the risk of SUDEP (sudden unexpected death in epilepsy). Hence, epilepsy patients with pre-existing arrhythmias should receive appropriate pharmacotherapy. Concomitant treatment with antiarrhythmic and antiseizure medications creates, however, the possibility of drug–drug interactions. This is due, among other reasons, to a similar mechanism of action. Both groups of drugs inhibit the conduction of electrical impulses in excitable tissues. The aim of this review was the analysis of such interactions in animal seizure models, including the maximal electroshock (MES) test in mice, a widely accepted screening test for antiepileptic drugs.

Cardiac Arrhythmias and Covid-19

Cardiovascular manifestations of COVID-19 include cardiac rhythm disturbances, whose mechanisms, incidence, and most common types are not well established in this population. Intense inflammatory response and metabolic activity contribute to recurrence of pre-existing arrhythmias, and other arrhythmias can occur due to myocardial injury, acute coronary insufficiency, and electrolyte disturbances. Brady- and tachyarrhythmias, as well as conduction disorders have been described. QT interval prolongation and fatal ventricular arrhythmias ( Torsades de Pointes ) may result from the pathological process or [...]

Impact of preeclampsia on ventricular repolarization indices

BackgroundBecause of cardiac hypertrophy and electrophysiological alterations associated with preeclampsia, worsening of preexisting arrhythmias or occurrence of de novo arrhythmias are common in patients with preeclampsia. Tp-e/QT and Tpe/QTc ratios are accepted as reliable indexes for predicting ventricular arrhythmias. In this study, we examined the impact of preeclampsia on ventricular repolarization indices in patients with preeclampsia by using the QT, QTc and Tp-e interval, Tp-e/QTratio, and Tp-e/QTc ratio. MethodsWe analyzed electrocardiographic recordings of sixty pregnant women with preeclampsia and thirty age-matched healthy pregnant women. Women presenting with preeclampsia were divided into 2 groups and classified as early (gestational age < 34 weeks at clinical onset) or late (≥34 weeks) onset preeclampsia. Ventricular repolarization indices were evaluated. ResultsThe QT and Tp-e intervals were found to be longer in patients with earlyonset preeclampsia compared to patients with late-onset preeclampsia and helthy pregnants (377.6 ± 23 ms vs 374.3 ± 15 ms, 362 ± 15 ms & 82.6 ± 9.4 ms vs 74.0 ± 10.6 ms, 68.6 ± 10 ms). In adition, Tp-e/QT and Tp-e/QTc ratio were significantly higher in this patient population compared to others (0.21 ± 0.02 vs 0.19 ± 0.02, 0.18 ± 0.02 & 0.19 ± 0.02 vs 0.16 ± 0.02, 0.15 ± 0,02, p < 0.05 respectively). ConclusionOur data showed that preeclampsia has unfavorable effects on electrocardiographic indices of ventricular repolarization compared to healthy pregnant women. This effect is more prominent in patients with early-onset preeclampsia.