Predictor Of Arrhythmias In Patients Research Articles

New risk predictor of arrhythmias in patients with congenital Long-QT Syndrome

Abstract Congenital long-QT syndrome (LQTS), is an inherited cardiac channelopathy characterized by delayed ventricular repolarization, which may lead to Torsade de pointes (TdP), that may degenerate into ventricular fibrillation. Determination of risk remains unrefined. It is well established that the repolarizing current Iks is increased during adrenergic stimulation, as occurs during exercise, thereby playing an important role in shortening the QT interval as an adaptation to increased heart rate. Accordingly, patients with LQTS, in particular those with LQT1 are at high arrhythmic risk during exercise. We hypothesized that changes in QTc during exercise stress test (EST) may be useful for risk stratification in LQTS. Furthermore, we hypothesized that as changes in IKs impact on repolarization reserve, the predictive capacity of the EST may extend to other LQTS genetic subtypes. Aim assessing the potential value of QT dynamics during EST to identify high risk patients in patients with LQT1 and LQTS2. Methods This study included genotype-positive LQT1 and LQT2 patients from the Netherlands, Italy and Germany. Symptomatic patients; patients whom experienced an arrhythmic syncope, sustained ventricular arrhythmia or (aborted) sudden cardiac death. Twelve-lead ECGs were digitally acquired during exercise testing. QT measurements were determined at specific time points. Statistical analyses were performed using R software. Logistic regression and cox proportional hazards models were used to calculate the predictive value and hazard ratio per ms increase in ΔQTc. Covariates included age, QTc, sex, beta-blocker use, center and genetic variant location. Results A total of 222 patients with LQT1 and 164 patients with LQT2 (Table 1), with a pathogenic or likely pathogenic variant in KCNQ1 or KCNH2, were included. In both LQTS1 and LQTS2 patients, the ΔQTc between rest and at 3-4 minutes recovery was the most relevant and significant EST predictor. For LQT1, the ΔQTc was significantly increased in symptomatic patients versus non-symptomatic ones (46 ms ± 35 vs 18 ms ± 36, p = < 0.001)(figure 1 panel A). Logistic regression model shows a predictive value (AUC) of 89.2% for ΔQTc. Survival analysis showed a hazard ratio of 1.02 with 95% CI of 1.01 – 1.03 for each ms ΔQTc increase. For LQTS 2 patients, the ΔQTc between rest and 3-4 minutes recovery was also increased in symptomatic patients versus non-symptomatoc ones (27 ms ± 40 vs 12 ms ± 40, p = 0.03). Logistic regression analysis; OR per ms: 1.02 (1.01 – 1.04 95%CI) AUC 78.3%. Survival analysis showed a hazard ratio of 1.02 (1.01 - 1.03 CI) for each ms ΔQTc increase. Conclusion The ΔQTc between rest and at 3-4 minutes recovery was significantly increased in symptomatic LQT1 and LQT2 patients compared to non-symptomatic patients, and is a promising risk marker to identify high risk patients, in both LQT1 and LQT2.Table 1

A Study on QT Dispersion before and after Thrombolysis in Acute Myocardial Infarction and its Prognostic Implications: A before and after Comparison Study.

Introduction: Acute myocardial infarction (AMI) stands as one of the most catastrophic occurrences in the progression of coronary artery disease. Measuring QT dispersion (QTd) is a fairly straightforward and noninvasive technique for predicting mortality in patients at high risk following a myocardial infarction (MI). Objective: To measure the QT, corrected QT interval (QTc), QTd, and corrected QT dispersion (QTcd) intervals before and after thrombolysis in patients with AMI and to determine prognostic implications of QTd in AMI. Materials and methods: This was a before and after comparison study conducted in the intensive care unit (ICU) of a tertiary care center in Central India. It was carried out in patients with AMI [ST-elevation myocardial infarction (STEMI)] who underwent thrombolysis in ICU. A total of 160 participants were enrolled over the time period of 24 months using the convenience sampling technique. Results: The most prevalent (68 patients) risk factor among MI patients was hypertension (HTN). QT parameters such as QT, QTd, and QTcd showed significant statistical variation of p-value < 0.0001 when compared at admission and after thrombolysis. No significant difference (p > 0.05) in QT parameters at admission (QTd, QTc, and QTcd) between anterior and inferior wall MI, except for QT interval (p = 0.0010). Among the 33 patients who experienced arrhythmia, ventricular tachycardia was the most prevalent arrhythmia in 22 patients (13.75%). There was a significant statistical correlation between the arrhythmic event and the outcome of the patient (p < 0.0001). Patients who died had higher QT parameter values at admission, and these remained on the higher side even after thrombolysis, whereas those who got discharged had lower QT parameter values at admission, and their values decreased after thrombolysis. Conclusion: Successful thrombolysis significantly decreases the QTd and thereby the arrhythmogenic potential, and thus can also be used as a reliable predictor of arrhythmia in patients of MI. How to cite this article: M A, Khandait H, Guralwar C, et al. A Study on QT Dispersion before and after Thrombolysis in Acute Myocardial Infarction and its Prognostic Implications: A before and after Comparison Study. J Assoc Physicians India 2023;71(10):14-18.

Expression and clinical significance of NRLP1 in patients with ST-segment elevation myocardial infarction combined with malignant ventricular arrhythmia.

To investigate the clinical effects of NRLP1 expression in patients with ST-segment elevation myocardial infarction (STEMI) combined with arrhythmia. We enrolled 231 patients with STEMI in the first hospital of Quanzhou affiliated to Fujian Medical University from January 2019 to December 2020 to the observational group and 230 healthy individuals as the control group. We divided patients with STEMI into a malignant ventricular arrhythmia (MVA) group (n=36) and non-MVA(NMVA) group (n=195) depending on whether the individuals had experienced an episode of MVA within 48 hours after PCI. We recorded general variables such as age, gender, history of smoking, hypertension, of diabetes, hyperlipidemia, left ventricular ejection fraction (LVEF), Gensini score, and mortality. Moreover, we determined NLRP1, IL-1β, TNF-α, high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-pro-BNP), cardiac troponin-1 (cTnI), and creatine kinase isoenzyme (CK-MB) in peripheral blood by ELISA. We found significant differences in LVEF, Gensini scores, smoking history, and mortality between the MVA and NMVA groups. The mean NLRP1 expression was highest in the MVA group, which was positively correlated with the levels of IL-1β, TNF-α, hs-CRP, NT-pro-BNP, cTnI and CK-MB. The expression of NLRP1 was associated with the smoking history, the LVEF value, the Gensini score, the MVA incidence and the mortality. Patients with higher NLRP1 expression levels had a higher MACE incidence and worse overall survivals within one year. The NLRP1 pathway is associated with the presence of arrhythmias after PCI treatments, and the NLRP1 expression level may be useful as a predictor of arrhythmia in patients with STEMI.

Is the magnesium phosphate ratio a predictor of arrhythmia in patients undergoing hemodialysis?

Aim: Sudden death due to coronary artery disease, heart failure, arrhythmia or hyperkalemia constitutes the majority of cardiovascular causes in patients with end-stage renal disease. Magnesium plays an important role in many processes that regulate cardiovascular functions such as endothelial function, regulation of vascular tone and myocardial excitability. In addition, hyperphosphatemia is very common in patients with end-stage renal disease and is associated with an increased risk of mortality in hemodialysis patients. Our aim in this study; to determine the role of Mg/PO4 ratio in predicting arrhythmia in patients with end-stage renal disease receiving hemodialysis.Material and Method: A total of 103 consecutive patients admitted to the cardiology outpatient clinic and receiving hemodialysis for chronic renal failure were included in the study. Between January 2018 and October 2022, patients monitored with 24-hour rhythm holter ECG were recruited. Patients were analyzed by dividing into 2 groups as those with arrhythmia detected in 24-hour rhythm Holter ECG (group 1: 51 patients) and those without (group 2: 52 patients). Result: The mean age of the patients in the study was significantly higher in group 1 compared to group 2 (66.96±10.27 and 62.21±10.50, p=0.02, respectively). When the 24-hour rhythm Holter ECGs of the patients were examined, the most common arrhythmia was ventricular extrasystole with a rate of 18.4% (n=19), and paroxysmal AF was the second with a rate of 9.7% (n=10). In the univariate regression analysis we performed for arrhythmia predictivity in patients receiving hemodialysis; age (OR: 1.046; 95%CI: 1.005-1.088, p=0.02), LVEF (OR: 0.941; 95%CI: 0.895-0.989, p=0.01), mid-severe MR (OR: 0.553; 95%CI: 0.215-1.424, p=0.22), Na (OR: 1.119; 95%CI: 0.967-1.294, p=0.13), Hemoglobin (OR: 0.872; 95%CI: 0.710-1.069, p=0.18), total cholesterol (OR: 1.006; 95%CI: 0.997-1.016, p=0.19), LDL (OR: 1.012; 95%CI: 0.998-1.026, p=0.10), Mg (OR: 0.117; 95%CI: 0.015- 0.941, p=0.04), PO4 (OR: 1.664; 95%CI: 1.093-2.532, p=0.01), Mg/PO4 ratio (OR: 0.002; 95%CI: 0.000-0.104, p=0.002) detected as arrhythmia predictors. In the multivariate regression analysis, independent predictors for the presence of arrhythmia were determined using 2 different models. In the model 1; age (OR: 0.993; 95%CI: 0.956 1.031, p=0.70), LVEF (OR: 0.955; 95%CI: 0.916-0.994, p=0.026), Mg (OR: 0.136; 95%CI: 0.014-1.308), p=0.08), PO4 (OR: 1.545; 95%CI: 0.989- 2.414, p=0.056) (Table 6). In the model 2; age (OR: 0.988; 95%CI: 0.951-1.026, p=52), LVEF (OR: 0.955; 95%CI: 0.917-0.995, p=0.029), Mg/PO4 ratio (OR: 0.002, 95%CI: 0.000-0.101 p=0.002) was detected independent predictors for the presence of arrhythmia. ROC analysis (Figure) showed that LVEF&amp;lt;54.5%, with 64% sensitivity and 53% specificity ([AUC]: 0.666, 95% CI: 0.560-0.772, p=0.004), Mg/PO4 ratio&amp;lt;0.45, with 64% sensitivity and 65% specificity ([AUC]: 0.674, 95% CI: 0.570-0.778, p=0.002), predicts arrhythmia in hemodialysis patients Conclusion: In our study, it was concluded that the Mg/P ratio, which can be calculated simply, is a predictor of arrhythmia in hemodialysis patients.

Disease progression rate is a strong predictor of ventricular arrhythmias in patients with cardiac laminopathy in a prospective cohort study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Area Network on Cardiovascular Diseases (ERA-CVD) Background/Introduction: Cardiac laminopathy is a highly malignant and pro-arrhythmic familial dilated cardiomyopathy, caused by LMNA gene mutations. The optimal timing of primary preventive implantable cardioverter defibrillator (ICD) is a challenge in this patient population. Purpose We aimed to explore whether disease progression rate assessed by echocardiography can predict ventricular arrhythmias in LMNA genotype positive patients, and to describe the cardiac phenotype at time of first ventricular arrhythmia. Methods We prospectively included consecutively recruited LMNA genotype positive patients in a primary prevention cohort study. Patients underwent repeated clinical and echocardiographic examinations during long-term follow-up. Ventricular arrhythmia was defined as sustained ventricular tachycardia, appropriate therapy by ICD or aborted cardiac arrest. We used generalized estimating equation analyses to assess whether individual patient disease progression could predict first-time ventricular arrhythmia. Graphical illustration of disease progression rate was presented as linear prediction by patient age. Cardiac function and volumes at time of ventricular arrhythmia was assessed from echocardiograms acquired ±12 months of the arrhythmic event. Results We included 94 patients with no ventricular arrhythmia at baseline (age 38 ± 15 years, 32% probands, 53% female). Nineteen (20%) patients experienced ventricular arrhythmia during 4.6 (inter quartile range 2.1-7.3) years follow-up, at mean age 50 ± 11 years. We analysed 536 echocardiographic examinations. Individual patient disease progression were strong predictors of subsequent ventricular arrhythmia with OR 1.3 (95% CI 1.2-1.5) per 5% reduction in left ventricular ejection fraction (LVEF), OR 1.3 (95% CI 1.2-1.5) per 1% worsened left ventricular global longitudinal strain (LVGLS), and OR 1.2 (95% CI 1.1-1.3) per 5 ml/m2 increase in left ventricular end diastolic volume index (LVEDVi). Comparison of disease progression by LVEF between patients with and without ventricular arrhythmias is illustrated in Figure. At arrhythmic event, there was left ventricular structural- and functional pathology (LVEF 40 ± 12%, LVGLS -11.7 ± 4.3%, LVEDVi 83 ± 22 ml/m2), while right ventricular function was preserved in most patients (tricuspid annular plane systolic excursion 20 ± 7 mm). Conclusions First time ventricular arrhythmic event occurred in 20% of LMNA genotype positive patients during 4.6 years of follow up. Individual patient disease progression by structural and functional parameters were strong predictors of ventricular arrhythmias, indicating that the disease progression rate may have additional value to absolute measurements when considering primary preventive ICD implantation. Abstract Figure

Late gadolinium enhancement as a predictor of arrhythmias in patients with hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of arrhythmias and sudden cardiac death (SCD). The Late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR) has been associated with the occurrence of arrhythmic events. Purpose The aim was to analyze the association between LGE burden and location and arrhythmic events in HCM patients (P). Methods Retrospective analysis of P with HCM in a single tertiary center. Baseline clinical, echocardiographic and CMR characteristics were collected. On follow up arrhythmias (ventricular fibrillation (VF), sustained ventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation (AF) and atrial flutter (AFL)) were identified. LGE on CMR was compared between patients with and without arrhythmias. Results 61P (59% male) were included, with a mean age of 58 ± 2 years. The HCM risk-SCD score was 3.35 ± 0.28%. On echocardiography mean left ventricle ejection fraction was 62.16 ± 1.36% and maximum wall thickness 20.59 ± 0.596mm. 31.1% had systolic anterior movement of mitral valve and 26.7% had left ventricle outflow tract obstruction. LGE was present in 88.5% P with a median number of 5 ± 7 segments involved. Interventricular septum (IVS) was involved in 78.7% P, anterior wall in 57.4%, inferior wall in 54.1%, lateral wall in 52.5%, posterior wall in 9.8%, basal segments in 62.3%, median segments in 68.9% and apical segments in 63.9%. On follow up 3.3%P died, 45.8% had hospitalizations (22,2% because of an arrhythmia) and 75% had arrhythmias (1.6% VF, 6.6% SVT, 50% NSVT, 9.8% PSVT, 37.7% AF and 6.6% AFL). The number of segments with LGE correlated with arrhythmias (p = 0.05 for arrhythmias, p = 0.03 for SVT, p = 0.008 for NSVT and p = 0.042 for PSVT). A cut off of 5 segments involved was a good predictor of arrhythmias (p = 0.002), NSVT (p= 0.006), PSVT (p = 0.024) and AF (p = 0.0029). For SVT the best cut off was 9 (p = 0.003). Considering the LGE location, we found an association between the segments involved and the occurrence of different arrhythmias (table 1). Conclusion Supraventricular and ventricular Arrhythmias are frequent in patients with HCM, with the most frequents being NSVT and AF. The LGE burden (&amp;gt;5 segments) and location (median inferior IVS, median anterior IVS, median anterior wall, basal anterior IVS, apical anterior wall, median inferior wall, apical anterior wall and basal inferior IVS) were correlated with arrhythmic events. Abstract Figure.

Predictors of rhythm disorders following cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background. Identification of high-risk patients and predictors for cardiac arrhythmias allows the development of preventive measures that will improve the postoperative period and rehabilitation of patients following cardiac surgery. Purpose. To determine probable predictors of arrhythmias in patients following cardiac surgery in the early postoperative period (up to 7 days). Methods. 56 patients were examined, including 19 (33.9%) men (p = 0.02). The average age of the patients was 60.86 ± 8.87 years. Cardiac surgery was performed for coronary heart disease in 37 (66.1%) and valvular heart defects in 19 (33.9%) patients (p = 0.02). The average duration of the operations was 371.94 ± 102.04 minutes. In 25 (44.6%) cases, the operations were performed in conditions of bypass, the average duration of which did not differ from operations without bypass (389.44 vs. 355.47, p = 0.34). Assessment of arrhythmias was performed during the first 7 days after cardiac surgery. Results. 27 (48.2%) patients have developed arrhythmias within first 7 days, among them in 12 (63.2%) women and 15 (40.5%) men (p = 0.24). Predictors of arrhythmias in early postoperative period are: operation with bypass r = 0,332 [1,06-3,03], p = 0,01; the size of left atrium (LA)&amp;gt; 40 mm r =0,296 [1,01-3,31], p = 0,03; presence of coronary artery (CA) stenosis r = 0,139 [1,11-2,69], p = 0,04; atrial fibrillation (AF) in the history r = 0,607 [1,99-5,58], p = 0,001. AF dominates in the structure of arrhythmias – in 17 (30.4%) patients, among them – in 11 (64.7%) was paroxysmal, 6 (35.3%) patients - persistent form. The mean score of CHA2DS2VASc scale - 2.56 ± 0.89. The predictors of AF are: operation with bypass r = 0.451 [1.63-9.76], p= 0.0001; the size of the LA&amp;gt; 40 mm r = 0.303 [1.04-7.58], p = 0.02; left ventricle (LV) ejection fraction (EF) &amp;lt;40% r = -0.207 [1.23-1.82], p = 0.05; mitral regurgitation r = 0.314 [1.05-10.04], p = 0.02. Also registered ventricular ventricular prematute beats (VPB) – in 12 (21.4%) patients, among them VPB 1st Laun class - in 8 (66.7%), 2nd Laun class – in 2 (16.7%), 3rd Laun class – in 1 (8.3%), 4A Laun class – in 1 (8.3%) patient, respectively. Predictors of VPB are: chronic heart failure (CHF) 4 functional class (FC) r = 0.258 [2.94-8.48,], p = 0.05; CA stenosis r = 0,282 [1,04-40,54], p = 0,04; LV EF &amp;lt;50% r = -0.344 [1,3-9,42], p = 0,009, stroke in the anamnesis r = 0,262 [1,33-9,37], p = 0,05. Conclusions The prevalence of arrhythmias in the early postoperative period (up to 7 days) following cardiac surgery is 48.2%. The predictors of arrhythmias are: operation with bypass, the size of LA&amp;gt; 40 mm, presence of CA stenosis and any form of AF in the history. AF dominates in the structure of heart arrhythmias (30.4%). The predictors of AF are: operation with bypass, the size of the LA&amp;gt; 40 mm, LV EF &amp;lt;40%, mitral regurgitation according to echocardiography; predictors of VPB are: CHF 4 FC, CA stenosis, LV EF &amp;lt;50%, stroke in the history.

The consequence of biomarkers of myocardial fibrosis in the prediction of arrhythmias in patients with hypertension in combination with coronary heart disease (literature review)

The main morphological structural lesion substrate is myocardial fibrosis. The processes of fibrosis in a certain way are associated with the severity of a variety of cardiac arrhythmias. Myocardial fibrosis may be manifested by prolongation of the QRS complex, frequent ventricular arrhythmias and ventricular tachycardia on the electrocardiogram. Echocardiography is the main tool used to assess the structure and function of the heart, it reveals an increase in the left ventricle, and decrease in ejection fraction and diastolic dysfunction of the left ventricle and an increase in filling pressure. Biological markers are quantitatively defined biological parameters that, as indicators, determine the norm, pathology and result of medecinal correction of the disease (definition of experts from the Biomarkers Definitions Working Group, USA). Changes of biomarkers can be controlled to determine the individual risk of cardiovascular diseases development and measures to normalize them. Among the main causes of fibrosis activation, hyperactivation of the renin-angiotensin-aldosterone system and, as a consequence, the excessive formation of angiotensinogen and aldosterone are considered; increased levels of galectin-3, which contributes to the migration of macrophages, proliferation of fibroblasts and collagen synthesis in cardiomyocytes. Recently, much attention is paid to the study of biochemical markers such as aldosterone, galectin-3 and transforming growth factor- beta-1.Thus, these markers were determined in hypertension, metabolic syndrome, congestive heart failure, hypertrophic cardiomyopathy, myocardial infarction, atrial fibrillation. However, to date studies considering association between frequent ventricular premature beats, as a marker of electrical instability and plasma levels of biomarkers of fibrosis, such as aldosterone, galectin-3and transforming growth factor beta-1, in patients with essential hypertension without / or in combination with coronary heart disease are absent. Based on the aforesaid material,, further thorough study of this problem is promising.

Incidence and predictors of arrhythmias in patients with systemic sclerosis and no overt cardiac disease

Abstract Background Cardiac involvement in SSc is frequent, mostly subclinical and represents a negative prognostic factor. Speckle tracking derived measurement global longitudinal strain (GLS) has been able to identify primary heart involvement in patients with SSc and no overt cardiac disease. SSc-related cardiomyopathy, defined as a condition affecting the heart primarily and globally, has been proven to progress over time and seems to be correlated to cardiac arrhythmias. Nonetheless, cardiac arrhythmias represent 6% of the overall causes of death in SSc patients. Purpose The aim of our study was to assess the incidence of cardiac arrhythmias in SSc patients with no overt cardiac disease and to identify potential predictors. Methods Prospective longitudinal study enrolling all consecutive patients with a diagnosis of SSc and no overt cardiac disease or pulmonary hypertension. Echocardiographic parameters and GLS were obtained at baseline and at each follow up. Presence of atrial fibrillation (AF), atrial tachycardia (AT), ventricular ectopic beats &amp;gt;1000/24 h (VEB), supraventricular ectopic beats (SVEB), bundle branch block (BBB) and atrioventricular block (AVB) was assessed through clinical history, ECG and 24-Holter monitoring over time. Results Among 67 consecutive patients with SSc, 11 (16.7%) had at least one episode of AF or AT. Moreover, respectively 12 (17.9%) and 16 (23.9%) had a significant amount of SVEB and VEB at Holter monitoring. Conduction defects were common, with 4 (4.6%) of all patients with grade I AVB, 1 (1.5%) with grade II AVB and 1 (1.5%) with complete heart block. Complete right BBB was seen in 6 (6.9%) of patients. Four patients (4.6%) experienced a sudden cardiac death during follow-up (median 20 months, 1st-3rd quartile 12–24 months). Years from SSc diagnosis (RR 1.10; 95% CI 1.02–1.23; p=0.047) and indexed right atrial volume (iRAV; RR 1.22; 95% CI 1.07–1.39; p=0.004), but not indexed left atrial volume were independently correlated with the diagnosis of AF/AT. The same two variables were independently correlated with any degree of AV block (years from SSc diagnosis: RR 1.11; 95% CI 1.01–1.23; p=0.004; iRAV: RR 1.14; 95% CI 1.02–1.27; p=0.019). Due to the low sample size, we were unable to detect any clinical predictors of sudden cardiac death in our population, however those who died experienced a larger worsening in left ventricle GLS values (4.0±1.6 vs. 0.9±0.4, p=0.056). Conclusions Supraventricular arrhythmias and conduction defects are common in patients with SSc. Time from diagnosis and right atrial volumes are able to predict the incidence of such conditions, supporting the hypothesis that a long-lasting disease and the anatomical remodelling of the right atrium could contribute to the developing of tachy- and bradyarrhythmias in this population. Funding Acknowledgement Type of funding source: None

Subclinical cardiac structural and electrical abnormalities in fibromyalgia syndrome

Background/aim In the literature, there is a paucity of data about the effects of fibromyalgia syndrome (FMS) on myocardial function and electrophysiological properties of atrium and ventricles. In this study, we investigated cardiac functions and noninvasive predictors of arrhythmias in patients with FMS.Materials and methods The study included 43 female patients diagnosed with FMS and 30 age- and sex-matched healthy subjects. The presence of fragmented QRS (fQRS) morphology, P dispersion, QT dispersion, inter- and intraatrial electromechanical delay was evaluated in the groups with 12-lead ECG and standard and tissue Doppler echocardiography.Results Among electrocardiographic parameters, P dispersion, QT dispersion, and the ratio of presence of fQRS morphology were found to be significantly higher in the study group as compared to the control group. In lateral and septal, the ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em) was significantly higher in the study group. Additionally, intra- and interatrial electromechanical delay was found significantly prolonged in the study group. Conclusion FMS is found to be associated with significant cardiac electrical alterations that may indicate the increased risk of atrial and ventricular arrhythmias in this group of patients.

P575Usefulness of late gadolinium enhancement cardiac magnetic resonance to predict appropriate therapies in implantable cardioverter defibrillator patients in primary prevention

Abstract Funding Acknowledgements No funding acknowledgements OnBehalf VT and sudden cardiac death Background The scar and the amount of border zone measured by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has been proposed as an independent predictor of ventricular arrhythmias in patients with ischemic and non-ischemic cardiomyopathy. However, at the present time, the guidelines are based only on the ejection fraction to recommend an implantable cardioverter defibrillator (ICD) in primary prevention, and only a minority of these patients receive appropriate therapies. So, prevention needs to be improved. Purpose To identify predictors of appropriate therapies in patients with a primary prevention ICD using cardiac magnetic resonance imaging and a dedicated software (ADAS-3D) to characterize the scar. Methods All consecutive patients who underwent a LGE-MR prior to ICD implantation in primary prevention were prospectively included. Clinical and cardiac imaging characteristics were collected. The myocardium was segmented with ADAS-3D software in 10 layers (from endocardium to epicardium). The scar, border zone, core and conducting channels were automatically measured in grams by the software. Results Since 2008 to 2017, 206 patients were included. Mean age was 67 +/- 28 years, 80% men, mean ejection fraction 26%+/-9, 52% with ischemic cardiomyopathy and 48% non-ischemic. The primary endpoint was appropriate therapies and/or sudden cardiac death (SCD). Median follow-up was 46,33 months. 46 patients (22%) reached the primary endpoint. Greater scar mass (36,05 grams vs 21,5 grams; HR 1.04; 95% CI (1.03-1-05), p &amp;lt;0.001), core mass (9,8 grams vs 5,6 grams; HR 1.06; 95% CI (1.04-1-09), p &amp;lt;0.001), border zone mass (26,2 grams vs 15,9 grams; HR 1.05; 95% CI (1.04-1-09), p &amp;lt;0.001) and channel mass (3,0 grams vs 1,6 grams; HR 1.15 95% CI (1.06-1.25), p &amp;lt;0.001) were associated with appropriate therapies and SCD. A border zone mass &amp;gt;5.3 grams was independently associated with the primary endpoint (HR: 4.77; 95% CI (1.15-19.73), p = 0.03). Conclusions The amount of border zone, core and channel mass measured by LGE-MR and ADAS software are independent predictors of appropriate therapies and SCD in patients with ICD in primary prevention. Abstract Figure. Scar characterization

Investigation of short-term prognosis of fragmented QRS complexes in patients with acute myocardial infarction in two groups that received invasive and fibrinolytic therapy

BackgroundStudies have shown that the primary causes of death in patients with acute coronary syndrome are arrhythmias and heart failure. The aim of this study is to evaluate the short-term prognosis of fragmented QRS (f-QRS) in patients with acute myocardial infarction (MI). MethodsThis study was a prospective and longitudinal analytic study performed on all patients with acute MI admitted to Rasht Heshmat Hospital Emergency during 2018–2019. Serial Electrocardiography (ECG) was performed in the emergency room after patient admission and was repeated 24 h after percutaneous coronary intervention and fibrinolytic therapy, as well as at the time of patient discharge. Short-term prognosis of f-QRS in patients was evaluated by a cardiologist within admission, 40 days after hospitalization and three months later again. ResultsIn this study, 453 patients with MI were evaluated in two treatment methods of fibrinolytic and invasive with and without f-QRS. Based on the data of this study, the four study groups had no statistically significant difference in arrhythmia (p = 0.196). In addition, the effect of study groups on left ventricular ejection fraction index was not statistically significant (p = 0.597). The probability of adverse outcomes occurrence was not statistically significant among the four groups (p = 0.07). ConclusionThe final results of this study showed that there was no significant difference between the four study groups and arrhythmia status. Therefore, f-QRS was not introduced as an independent predictor of arrhythmia in patients with acute MI.

4090Maximum standardized uptake value of pericardial fat for prediction of ventricular arrhythmias in patients with cardiac sarcoidosis

Abstract Background Cardiac sarcoidosis is a cause of epicarditis and sustained life-threatening ventricular arrhythmias. These arrhythmias occasionally arise from epicardial. Positron emission tomogramphy-comututed tomography (PET-CT) is useful for diagnosis with sarcoidosis. However, the usefulness for prediction of ventricular arrhythmias in patients with cardiac sarcoidosis is unknown. Objective We hypothesized that the evaluation of pericardial fat inflammation could identify high-risk sarcoidosis patients for ventricular arrhythmias. Methods We enrolled 20 consecutive patients with cardiac sarcoidosis performed PET-CT between August 2016 and December 2018. In each case, we measured the maximum standardized uptake value (SUVmax) of pericardial fat around the left atrium, both ventricules, atrioventricular groove, and left main coronary. Results Seven patients experienced ventricular tachycardia (VT) or ventricular fibrillation (VF). VT/VF patients had significantly more complete right bundle branch block (P=0.035), larger left atrial dimension (P=0.021), larger left ventricular end-diastolic dimension (P=0.005), lower ejection fraction (P=0.007), and higher E/e' (P=0.004). SUVmax of pericardial fat in the roof of left atrium (LA) and left ventricular (LV) with VT/VF patients were significantly higher than non-VT/VF patients (LA: 1.63 vs 1.32, P=0.0311; LV: 1.84 vs 1.26, P=0.045). The cut-off values of SUVmax derived from the ROC curve in the roof of LA and LV are 1.47 and 1.59 respectively. The Kaplan Meire estimator showed that high SUVmax patients in the roof of LA had significantly more detection of NSVT. Conclusions Our results suggest the relationship between SUVmax and VT/VF occurrence in patients with cardiac sarcoidosis. The evaluateon of SUVmax may be useful for VT/VF risk stratification.

532Quantitative late gadolinium enhancement for the prediction of ventricular arrhythmias in patients with hypertrophic cardiomyopathy

532Quantitative late gadolinium enhancement for the prediction of ventricular arrhythmias in patients with hypertrophic cardiomyopathy

Ventricular electrical delay as a predictor of arrhythmias in patients with cardiac resynchronization implantable cardioverter defibrillator

Background. Left ventricular (LV) remodeling and clinical response to cardiac resynchronization therapy (CRT) is inversely related to electrical dyssynchrony, measured as LV lead electrical delay (QLV). Presence of atrial or ventricular arrhythmia is correlated with worsening heart failure and LV remodeling. Objective. We sought to assess the association of QLV with arrhythmic events in CRT recipients. Methods. We identified patients implanted with a CRT device at our center. QLV interval was measured and corrected for baseline QRS (cQLV). We performed multivariable Logistic regression to assess the effect of cQLV on the occurrence of atrial/ventricular arrhythmic events. Results. Sixty-nine patients were included in analyses. The cQLV was significantly shorter in patients with atria tachycardia/supraventricular tachycardia (AT/SVT) events compared to patients without AT/SVT events (43.4 ± 22% vs. 60.3 ± 26.7%, p = .006). In contrast, no significant difference in cQLV was observed between patients with and without ventricular tachycardia/fibrillation (VT/VF) events (46.2 ± 25.4% vs. 56 ± 25.7%, p = .13). cQLV was significantly shorter in patients with new onset AT/SVT events compared to those without (38.3 ± 22.2% vs. 55.7 ± 25.7%, p = .028). In contrast, no significant difference in cQLV was observed between patients with and without new onset VT/VF events (44.2 ± 25.2% vs. 56.3 ± 25.5%, p = .069). Following adjusted analyses, cQLV was a significant predictor of AT/SVT, but not for VT/VF. Conclusion. cQLV is a simple measure that can identify a vulnerable cohort of CRT patients at increased risk for atrial tachyarrhythmias, and hence can predict reverse remodeling and clinical response to CRT treatment.

P1636Incidence and predictors of atrial arrhythmias in patients with a dual chamber implantable cardioverter-defibrillator followed by remote monitoring

P1636Incidence and predictors of atrial arrhythmias in patients with a dual chamber implantable cardioverter-defibrillator followed by remote monitoring

Clinical Application of the QRS-T Angle for the Prediction of Ventricular Arrhythmias in Patients with the Fontan Palliation

Fontan palliation patients are at risk for ventricular arrhythmias post-operatively. This study aimed to evaluate whether differences in the spatial QRS-T angle can reliably predict ventricular arrhythmias in patients who had undergone Fontan palliation. A total of 117 patients who had theFontan palliation and post-Fontan catheterization were included. Ventricular arrhythmias were identified in nine patients. Measurements of ECG parameters including QRS vector magnitude, QRS duration, corrected QT interval, and spatial peaks QRS-T angles were performed, and compared between those with and without ventricular arrhythmias. The only ECG parameter to distinguish those with versus those without VA was the SPQRS-T angle (p<0.001), which at a cut-off value of 102.9° gave sensitivity, specificity, positive and negative predictive values of 100.0, 57.0, 17.6 and 100.0%, respectively. Only the spatial peaks QRS-T angle differentiated those with and without ventricular arrhythmia development with a univariate HR 1.237 (95% CI 1.021-1.500) and a multivariate HR of 1.032 (1.009-1.056) when catheter measured parameters were taken into account. In Fontan patients, the spatial peaks QRS-T angle is a significant independent predictor of ventricular arrhythmias. Clinical usefulness of this parameter remains to be seen and should be tested prospectively.

136-45: Chronic total occlusion in an infarct related artery: a new predictor of ventricular arrhythmias in patients with ICD

136-45: Chronic total occlusion in an infarct related artery: a new predictor of ventricular arrhythmias in patients with ICD

216-61: Echocardiographic predictors of ventricular arrhythmias in patients with left ventricular assist device: a large single-center study

216-61: Echocardiographic predictors of ventricular arrhythmias in patients with left ventricular assist device: a large single-center study

Cardiac magnetic resonance imaging predictors of atrial arrhythmias in patients with repaired tetralogy of Fallot

Cardiac magnetic resonance imaging predictors of atrial arrhythmias in patients with repaired tetralogy of Fallot