Predictors Of Arrhythmias Research Articles

Obstructive Sleep Apnea as a Predictor of Arrhythmias in 24-h ECG Holter Monitoring.

A relationship between obstructive sleep apnea (OSA) and abnormalities in 24-h electrocardiogram (ECG) Holter monitoring has not been sufficiently documented. The aim of this study was to analyze the relation between the occurrence and the severity of OSA and the parameters of ECG Holter monitoring in a group of patients with diagnosed OSA. Ninety-four patients with clinical suspicion of OSA were qualified for the study (mean age 53.7). All participants underwent a medical history, laboratory tests, 24-h ECG Holter monitoring, and single-night video-polysomnography (vPSG) using the American Academy of Sleep Medicine recommendations. A group of patients with diagnosed OSA was characterized by more frequent occurrence of supraventricular tachycardia (SVT) and ventricular arrhythmias (VPC). A statistically significant positive correlation was shown between the apnea-hypopnea index (AHI) and average heart rate, supraventricular arrhythmias (SVPC) pairs, SVT, and pauses >2.5 s. In regression analysis, higher AHI constituted an independent predicator for the increased number of pauses >2.5 s, SVT, and SVPC pairs in 24-h ECG Holter monitoring. In summary, patients with OSA are characterized by the increased number of abnormalities in 24-h ECG Holter monitoring.

Effect of chelation therapy on arrhythmogenic and basal ECG parameters of lead exposed workers

Lead exposure has etiological role on cardiovascular system diseases as hypertension, atherosclerosis, stroke, and arrhythmic events. In this study, we aimed to compare the basal and arrhythmogenic ECG parameters of lead exposed workers before and after chelation therapy and to evaluate the effect of acute change of blood lead levels on ECG. Fourty consecutive occupationally lead exposed workers were enrolled, demographic, blood, echocardiographic, and electrocardiographic data’s were analyzed before and after chelation therapy. Pmax, P min, P Wave Dispersion, and QT Dispersion values which are arrhythmia predictors were significantly lower after chelation therapy compared to values before chelation therapy. Lead exposed workers are under the risk of ventricular and atrial arrythmias and chelation treatment has a positive effect on these parameters.

Prevalence of cardiac arrhythmias in cannabis use disorder related hospitalizations in teenagers from 2003 to 2016 in the United States.

Cannabis is an increasingly common recreational substance used by teenagers. However, there is limited data probing association of cardiac arrhythmias with marijuana use in this population. We provide prevalence trends, disease burden and healthcare utilization of cardiac arrhythmias associated with cannabis use disorder (CUD) in hospitalized teenagers (13-20 years) using a large national administrative database in the United States from 2003-2016. We used partial least square regression analysis for assessing trends in prevalence of cardiac arrhythmias and multiple logistic regression to elucidate independent predictors of arrhythmias associated with CUD. Among all CUD related hospitalizations (n = 876, 431), 0.5% had arrhythmias. Prevalence trends of arrhythmias among CUD increased six-fold during the study period (P < 0.001). CUD was more prevalent in males and older teens (both P < 0.001). There was a significant risk for mortality when CUD was associated with arrhythmia (7.4% vs. 0.1%, P < 0.001). While mean length-of-stay (LOS) was shorter (4.4 vs. 5.4 days, P < 0.001) for patients with CUD, they incurred three times higher mean hospitalization charges when compared to CUD patients without arrhythmia ($45 959 vs. $18 986, P < 0.001). Both LOS and hospitalization charges showed an uptrend during the study period (P < 0.001). Congenital heart disease, congestive heart failure, hypertension, and obesity independently predicted arrhythmias in CUD while other substance abuse did not change the risk of arrhythmia in CUD. Arrhythmia burden is increasing among teenagers with CUD, and co-occurrence of arrhythmia and CUD worsens hospital outcomes.

The Assessment of Ventricular Arrhythmia Indicators Based on Electrocardiography in Patients With Differentiated Thyroid Cancer Followed Up With Levothyroxine Suppression.

Levothyroxine suppression therapy (LST) can cause some unfavorable effects on the cardiovascular system in patients with differentiated thyroid cancer (DTC). The aim of this study was to evaluate ventricular arrhythmia predictors based on electrocardiography (ECG) in patients with DTC with LST. The ECG parameters including QT, corrected QT (QTc), Tp-e intervals, Tp-e/QT, and Tp-e/QTC ratios of 265 patients with DTC who met the inclusion criteria were compared with 100 controls. No difference was observed in the number of patients with DTC and controls with prolonged and borderline QTc interval (P = .273). Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly higher in patients (P = .002, P = .02, P = .003; respectively). Linear regression analysis suggested that male gender was a predictor of higher Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios (β = 4.322, R2 = 0.024, P = .042; β = 0.016, R2 = 0.048, P = .005; β = 0.015, R2 = 0.044, P = .006, respectively). A higher serum fT4 level was found to be associated with a higher Tp-e/QT ratio (β = 0.018, R2 = 0.089, P = .007). Ventricular arrhythmia indicators were found to be higher in patients with DTC with LST. Defining ventricular arrhythmia predictors through ECG, an easily accessible cardiac diagnostic tool, can be potentially useful in raising awareness of the possible cardiac harm of LST.

PERINATAL AND HEREDITARY RISK FACTORS OF HEART RATE AND CONDUCTION DISORDERS IN CHILDREN WITH GASTROESOPHAGEAL REFLUX

Objective: to improve the early diagnosis of cardiac arrhythmias and conduction disorders in children with gastroesophageal reflux by evaluating hereditary and perinatal risk factors for this pathology. Materials and Methods. The study involved 56 children aged 8 to 18 years, with an average age of 13.67 ± 2.67 years; 28 children with gastroesophageal reflux in combination with arrhythmias and cardiac conduction disorder comprised Group I (the main group), and 28 children with only gastroesophageal reflux without disorders of heart rhythm and conduction comprised Group II (the control group). Patients underwent clinical, anamnestic (with special attention paid to hereditary and perinatal history) and instrumental studies (electrocardiography, 24-hour Holter ECG monitoring, esophagogastroduodenoscopy). Results. Genetic burden of cardiovascular disease was found in 57.1% of mothers and 42.9% of fathers of patients in the main group, which was significantly higher than that in the control group: by 3.2 times (17.9%; p ≤ 0.001) and 2 times (in 21.4%; p ≤ 0.05), respectively. Apart from that, stratification of the parameter by the number of chronic diseases, namely ≤ 1 and ≥ 2, in both parents, showed that fewer (≤ 1) chronic diseases were characteristic of mothers and fathers of the control group children and were registered in 53.5% and 58,9% of them, respectively, while in the main group, the proportion of such parents was lower: by 5 times (10.7%; p ≤ 0.001) and 1.8 times (32.1%; p ≤ 0.05), respectively. It was found that gravida 1 para 1 and gravida 2 para 2 mothers were significantly more common among those of patients in the control group (85.8% and 62.5%, respectively; p ≤ 0.05), while gravida 3 para 3 and more was typical for mothers of patients in the main group and were observed in 37.5% of them, while in the control group, this value was 2.6 times lower (14.2%; p ≤ 0.05). As for the parity, the first childbirth was reported in 64.3% of mothers in the main group and in 28.6% of mothers (2.2 times less often) in the control group (p ≤ 0.05); while multipara mothers were characteristic of the control group children (71.4%), which was 2 times more often than in the main group (35.7%; p ≤ 0.05). The risk factors of arrhythmias and cardiac conduction disorder were threatened miscarriage and toxemia in the first half of pregnancy. Thus, threatened miscarriage was reported in 46.4% of mothers of the main group children and was observed 2.2 times less often (21.4%; p ≤ 0.05) in the control group; toxemia in the first half of pregnancy was diagnosed in 50% of mothers of children in the main group and 2 times less often (in 25%; p ≤ 0.05) – in the control group. Another predictor of the studied pathology was the physiological course of childbirth. Complicated childbirth was observed in 60.7% of mothers in the main group and 1.9 times less often (32.9%; p ≤ 0.05) – in the control group. Relatively low (up to 3000 g) birthweight and fetal macrosomia (≥ 4000 g) also acted as risk factors. The proportion of patients with a bodyweight of up to 3000 g was 32.1% in the main group, and 3 times less (10.7%; p ≤ 0.05) – in the control group. The bodyweight of ≥ 4000 g (large fetus) was a specific feature of patients in the main group, as it was reported exclusively among them (17.9%) and was not observed in the control group (0%, p ≤ 0.001). Conclusions. It was revealed that the maternal and paternal genetic burden of cardiovascular diseases and the number of chronic diseases in parents were statistically significant hereditary risk factors for the development of arrhythmias and conduction disorders in children. It was found that statistically significant perinatal predictors of arrhythmias and conduction disorders in children with GER included threatened miscarriage; toxemia; multigravida and multipara status; complicated delivery; relatively low (up to 3000 g) birthweight and fetal macrosomia (≥ 4000 g).

Predictors of heart rhythm disorders in the patients with severe COVID-infection

Annotation. The severe course of COVID-19 infection often leads to complications of cardiovascular system. Among them, heart rhythm disorders are one of the main ones requiring careful examination and improvement of management of the patients with COVID-19 infection. The purpose of the work was to establish the probable predictors of cardiac rhythm disorders of the patients with severe COVID infection. In the study were examined 133 patients with severe COVID-19 infection, who were in the intensive care unit of the city clinical hospital №1 in Vinnytsia for 9 months 2020 and as a result of treatment with improved health were discharged from the hospital. Statistical processing of the obtained data was performed using the statistical software package SPSS 12.0 for Windows using parametric and non-parametric methods of statistical analysis. It was found that the prevalence of heart rhythm disorders in patients with severe COVID-19 is 86 (64.7%) patients. The predictors of arrhythmias were: the presence of stroke in anamnesis; acute thrombophlebitis during a hospital treatment; the term of being in the intensive care unit and the overall term of hospitalization. Among all rhythm disorders, tachyarrhythmias were in – 68 (51.1%), sinus tachycardia 45 (33.8%) and atrial fibrillation 19 (14.3%) were dominated in the structure of tachyarrhythmia. There were no significant predictors of tachyarrhythmias. The prevalence of bradyarrhythmias is 60 (45.1%), sinus bradycardia (12%) and the right branch of His bundle block – 30 (22.6%) were prevalent in the structure of bradyarrhythmias. Predictors of the bradyarrhythmias were: the presence of ischemic heart disease (IHD) in anamnesis; acute thrombophlebitis in anamnesis; diseases of the gastrointestinal tract; stroke while staying in a hospital; post-infarction cardiosclerosis; combination of arterial hypertension and IHD; the term of staying in the hospital and in the intensive care unit. Also, ECG predictors of bradyarrhythmia were: depression of the ST segment; pathological Q wave; hypertrophy of the left ventricle; hypertrophy of the right ventricle; extension of QT interval. The prevalence of violations of repolarization according to ECG were in 119 (89.5%) patients, among them the presence of inversion of T wave in 91 (68.4%) and depression of the ST segment – in 54 (40.6%) patients respectively. The predictors of which are: reducing of glomerular filtration rate &lt;60 ml/min/1.73 m2; the duration of hospitalization; the old age of the patients.

Burden of arrhythmia in hospitalized HIV patients.

BackgroundThe improved life expectancy observed in patients living with human immunodeficiency virus (HIV) infection has made age‐related cardiovascular complications, including arrhythmias, a growing health concern.HypothesisWe describe the temporal trends in frequency of various arrhythmias and assess impact of arrhythmias on hospitalized HIV patients using the Nationwide Inpatient Sample (NIS).MethodsData on HIV‐related hospitalizations from 2005 to 2014 were obtained from the NIS database using International Classification of Diseases, 9th Revision (ICD‐9) codes. Data was further subclassified into hospitalizations with associated arrhythmias and those without. Baseline demographics and comorbidities were determined. Outcomes including in‐hospital mortality, cost of care, and length of stay were extracted. SAS 9.4 (SAS Institute Inc., Cary, NC) was utilized for analysis. A multivariable analysis was performed to identify predictors of arrhythmias among hospitalized HIV patients.ResultsAmong 2 370 751 HIV‐related hospitalizations identified, the overall frequency of any arrhythmia was 3.01%. Atrial fibrillation (AF) was the most frequent arrhythmia (2110 per 100 000). The overall frequency of arrhythmias increased over time by 108%, primarily due to a 132% increase in AF. Arrhythmias are more frequent among older males, lowest income quartile, and nonelective admissions. Patients with arrhythmias had a higher in‐hospital mortality rate (9.6%). In‐hospital mortality among patients with arrhythmias decreased over time by 43.8%. The cost of care and length of stay associated with arrhythmia‐related hospitalizations were mostly unchanged.ConclusionsArrhythmias are associated with significant morbidity and mortality in hospitalized HIV patients. AF is the most frequent arrhythmia in hospitalized HIV patients.

Burden and impact of arrhythmias in asthma-related hospitalizations: Insight from the national inpatient sample.

BackgroundThis study aimed to analyze the burden and impact of cardiac arrhythmias in adult patients hospitalized with asthma exacerbation using the nationwide inpatient database.MethodsWe used the National Inpatient Sample (NIS) database (2010‐2014) to identify arrhythmias in asthma‐related hospitalization and its impact on inpatient mortality, hospital length of stay (LOS), and hospitalization charges. We also used multivariable analysis to identify predictors of in‐hospital arrhythmia and mortality.ResultsWe identified 12,988,129 patients hospitalized with primary diagnosis of asthma; among them, 2,014,459(16%) patients had cardiac arrhythmia. The most frequent arrhythmia identified is atrial fibrillation (AFib) (8.95%). The AFib and non‐AFib arrhythmia group had higher mortality (3.40% & 2.22% vs 0.74%), mean length of stay (LOS) (5.9 & 5.4 vs 4.2 days), and hospital charges ($53,172 & $51,105 vs $34,585) as compared to the non‐arrhythmia group (P < .005). Predictors of arrhythmia in asthma‐related hospitalization were history of PCI or CABG, valvular heart disease, congestive heart failure (CHF), and acute respiratory failure. Predictors of higher mortality in arrhythmia group were acute respiratory failure, sepsis, and acute myocardial infarction.ConclusionsAround 16% of adult patients hospitalized with asthma exacerbation experience arrythmia (mostly AFib 8.95%). The presence of arrhythmias was associated with higher in‐hospital mortality, LOS, and hospital charges in hospitalized asthmatics.

Electrocardiographic Evaluation of the Ventricular Arrhythmia Risk in Patients Diagnosed With Schizophrenia.

The purpose of this study was to examine electrocardiographic ventricular arrhythmia predictors in patients with schizophrenia by comparing with healthy controls. The study included 100 patients with schizophrenia and 100 healthy controls. Electrocardiography (ECG) was performed on all participants in resting position. T-wave peak to end (Tp-e), QT ranges, P-wave dispersion (Pd), and R-R range were measured. Then, the Schizophrenia Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS) were applied to the schizophrenia group. The PANSS positive symptom subscale was calculated as 10.41 (SD = 2.27), the negative symptom subscale was calculated as 14.44 (SD = 5.42), and the overall functionality level was calculated as 27.04 (SD = 5.43). The mean CDSS score was determined to be 3.74 (SD = 2.15). No differences were detected in the heart rate measurements of the patient and control groups in ECG results (P = .427). The minimum QT interval and minimum Tp-e wave times were found to be low in the patient group (P < .001 for both intervals). Corrected QTc dispersion, Pd, Tp-e dispersion, and QT dispersion were found to be higher in the patient group than in healthy controls (P < .001 for all intervals). Based on our results, it is possible to speculate that patients with schizophrenia are at a risk of developing cardiac arrhythmia and cardiac dysfunction if they do not receive treatment. For this reason, clinicians should pay attention to cardiac transmission problems when organizing the treatment of patients. Further studies should be conducted to determine cardiac problems in patients with schizophrenia.

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

Possibilities in the Prediction of Cardiac Arrhythmias and Conductivity Disorders in Former Athletes

In order to analyze the relationship between the athletic qualification and syndrome of cardiac rhythm and conductivity disturbances in former athletes, a retrospective analysis of medical records of 39 male former athletes with cardiovascular complaints (mean age 61,6±11,3 years, mean duration of career in sports 23,9±17,3 years, mean duration of post-athletic period 20,1±9,9 years) was carried out. The patients were screened for cardiac arrhythmias and underwent echocardiography. The overall prevalence of sustained paroxysms of atrial fibrillation was 42%, increasing with the athletic qualification. Ryan grade 4b-5 premature ventricular contractions were found in 14% of patients. 3 parameters were found to be the independent predictors of arrhythmias in former athletes, i. e. athletic qualification, multifocal atherosclerosis (as an anti-risk factor), and age. The coefficient of determinance for the created prognostic model reached 43%. Further prospective studies are needed to validate an algorithm.

Left ventricular strain and fibrosis in adults with repaired tetralogy of Fallot: A case-control study

BackgroundLeft ventricular (LV) systolic dysfunction and myocardial fibrosis have prognostic implications in repaired tetralogy of Fallot (rTOF), but their relationship with myocardial strain is not well understood. We evaluated systolic strain and fibrosis (extracellular volume fraction, ECV) of the left ventricle (LV) using feature tracking with magnetic resonance and determine their association with each other and clinical outcome. MethodAdults with rTOF and age-matched controls underwent CMR to measure LV-ECV. Feature-tracking was used to quantify radial, circumferential, and longitudinal strain in both 2 and 3 dimensions. Clinical events (death, arrhythmia and heart-failure hospitalization) were obtained through chart review. Associations between strain, ECV and clinical events were explored. Results48 rTOF subjects (age 40.5 ± 14.3, 42% female) and 20 healthy controls were included. Both LV 2D and 3D global circumferential strain (GCS) and global longitudinal strain (GLS) were lower in rTOF subjects (p ≤0.01 for all). There was no association between strain and LV-ECV. Strain parameters correlated with ventricular volumes and function. After a median follow-up of 8.5 years (range 1–10.9 years) there were 5 deaths, 6 hospitalizations and 9 new arrhythmias. By multivariate Cox-regression, GLS was an independent predictor of both hospitalization and death, whereas LV-ECV was an independent predictor of arrhythmia. ConclusionWhile both LV strain abnormalities and fibrosis are present in rTOF, they are associated with different types of clinical outcome, and not to each other. The findings suggest that these measures reflect different long-term adverse adaptations to abnormal hemodynamics.

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.

Arrhythmias and sudden cardiac death in post-cardiac transplant patients.

Orthotopic heart transplantation (OHT) significantly improves morbidity and mortality in patients with end-stage heart disease. Despite advances in surgical technique, immunosuppressive therapies, and patient monitoring, long-term risk of arrhythmias and sudden cardiac death (SCD) in the denervated heart remains unchanged. SCD is responsible for approximately 10% of all posttransplant deaths with a pooled incidence rate of 1.30 per 100 person years and is strongly associated with cardiac allograft vasculopathy (CAV). Risk factors for SCD and CAV include higher donor age, younger recipient age, and reduced left ventricular ejection fraction. Little is known about the time course between CAV and SCD. Although some registry data establish ventricular fibrillation as a documented terminal rhythm, the arrhythmia may not be the mechanism of SCD. In this review, we identify risk factors and general independent predictors of arrhythmia and SCD and discuss the utility of implantable cardiac defibrillators in post-cardiac transplant patients.

PROGNOSIS OF INDIVIDUAL RISK OF HEART RHYTHM DISTURBANCES AND CONDUCTIVITY IN NEWBORNS IN THE EARLY NEONATAL PERIOD

Background. Neonatal arrhythmias, for the most part, have a good prognosis for recovery. However, they can also have an adverse course and lead to the development of life-threatening conditions. Therefore, it is important to search for earlier markers of myocardial lesion, diagnostic criteria and predictors of arrhythmias. Purpose. Improvement of diagnosis and prediction of the risk of cardiac arrhythmias and conduction in newborns in the early neonatal period by identifying factors that play a role in the prediction of neonatal arrhythmias. Subjects &amp; Methods. The study involved 76 newborns. Group 1 included 57 infants with arrhythmias according to Holter monitoring, Group 2 included 19 infants without arrhythmias. The study implied a comparison of history data, laboratory and instrumental findings, levels of troponin I and copeptin. To predict the development of neonatal arrhythmias, logistic regression analysis was performed. The quality of the model was tested using the Percent Concordant (PC). Quality Score was evaluated by R2 Nigelkerke. Model adequacy was estimated using the Hosmer-Lemeshow test. Results. The study showed that the factors that can influence the development of arrhythmias in the early neonatal period are the level of umbilical cord blood, the levels of troponin I, copeptin, GGT, assessment of Apgar scale in the 1st and 5th minutes, asphyxia at birth, indices of wave R amplitude in V3 and V5 of chest leads, ST segment deviation from the isoline according to standard surface ECG, QTc levels and mean daily maximum, minimum heart rate according to Holter monitoring. Conclusions. Predictors of neonatal arrhythmias development are indicators of laboratory-instrumental parameters of cardiovascular system status, troponin I level above 0.29 ng/ml and copeptin level above 0.1 ng/ml.

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.

Long-term outcomes after catheter-ablation of atrioventricular nodal reentrant tachycardia: A ten-year follow-up

Background/Aim. Atrioventricular nodal (AV) reentry tachycardia (AVNRT) is the most common form of supraventricular tachycardia. Treatment of choice is a catheter-ablation of the slow pathway of the AV node. The aim of the study was to present the outcomes of this procedure after ten years of follow-up. Methods. The catheter- ablation procedure was performed in 92 patients (30 men and 62 women, mean age 52.0 ? 13.3 years, range 19 to 76 years) with confirmed AVNRT during the electrophysiological examination, from 2007 to 2009. Out of these, 64 patients were followed-up for ten years by inviting them to clinical examinations regularly. The occurrence of AV block, arrhythmia and the use of antyarrhythmic drugs were the main outcomes of the ten-year follow-up. Multivariate logistic regression was applied to identify significant predictors of arrhythmia after a follow-up period. Results. The primary success of intervention was achieved in 91 (98.9%) patients. Third-degree AV block was registered in 1 (1.1%) patient after the intervention, which required the implantation of a pacemaker. After ten years of follow-up, AVNRT relapses were not registered. A total of 7 out of 64 (10.9%) patients died during the follow-up period, mostly due to non-cardiac causes. After ten years of follow-up, firstdegree AV block was registered in six (10.5%) patients, whereas other arrhythmias were observed in 17 (29.8%) patients such as atrial fibrillation or flutter, atrial premature beats and sinus tachycardia. The number of antiarrhythmic drugs were reduced from 2.1 ? 1.2 at baseline to 0.5 ? 0.6 during follow-up, mostly beta-blockers, propafenone and amiodarone, and 33 (57.9%) patients were no longer using anti-arrhythmic therapy. Logistic regression identified participant?s age above 55 years at baseline and re-intervention performed after the initial catheter-ablation as significant predictors of arrhythmia after a 10-year follow-up, independent from gender and arterial hypertension at baseline. Conclusion. The catheter-ablation of AVNRT represents a successful and safe procedure, from the perspective of tenyear follow-up.

P4682Left ventricular noncompaction in adults: complications, their predictors and outcomes

Abstract Background Left ventricular noncompaction (LVNC) is characterized by high frequency of heart failure, arrhythmias, thromboembolism and ischemia. Purpose To estimate frequency, predictors, outcomes of adverse events in patients with LVNC. Methods 120 patients with LVNC were included (male, 58.3%); mean age, 45.9±15.0 years. To diagnose LVNC EchoCG (n=120), CT (n=85), MRI (n=55) were performed. The mean LV EF was 39.0±13.9%, LV EDV 155.5±65.0ml, LV EDD 6,03±0.8cm, LA volume 96.3±38.4ml. The median follow-up was 15 [4.0; 41.0] months. We also performed NGS sequencing, followed by Sanger sequencing. Results Pathological mutations in genes MYH7, MyBPC3, LAMP2, DES, DSP, TTN were found in 10% of patients. The main clinical manifestations were chronic heart failure NYHA II-III (66.7% of patients), ventricular arrhythmias (PVCs&gt;500/day in 46.7%, sustained/unsustained VT in 49.2%), AF 30.8% (paroxysmal, n=18; persistent, n=11; permanent, n=9), ischemia (angina pectoris in 20%, myocardial necrosis in 13.3%), intracardiac thrombosis without anticoagulants (19.2%), embolism (6.7%), AV block degree II-III (11.7%), bundle branch blocks (37.5%), sinus node dysfunction (10%). VT frequency was associated with lower LV EF (34.6±13.4 v 42.8±13.1 p=0.001), higher NYHA functional class (class 2.5 [2.0; 3.0] v class 2 [0.75; 3.0], p&lt;0,01), low voltage ECG (20.3% v 5.2% p&lt;0,05), poor R-wave progression (42.4% v 20.7% p&lt;0,01), QRS duration (110ms [100; 140] v 100ms [90; 110], p=0,001), myocarditis presence (66.1% v 37.9% p&lt;0.01) and higher mortality (22% v 6.9% p&lt;0.05). AF correlated with the size of LA (AUC 0.712), and RA (AUC 0.716), p&lt;0.001. Pacemakers were implanted in 7 cases, ICD in n=25 (20.8%), CRTD in n=9 (7.5%). Appropriate ICD shocks were recorded in 26.5%. In two patients without ICD sudden cardiac death occurred. Radiofrequency ablation was performed in 5 cases, in 3 of them without effect. Patients with thromboembolic events (renal, pulmonary, myocardial infarction, stroke) had significantly lower LV EF (31.8%±11.4 v 41.0±13.9%, p&lt;0.005), higher NYHA functional class (class 3 [1.75; 3.0] v class 2 [1.0; 3.0], p&lt;0.05), greater LV EDD (6.34±0.83 v 5.9±0.81, p&lt;0.05), E/A ratio (2.15±0.8 v 1.5±0.84 p&lt;0.01), lower VTI (10.19±2.9 v 12.8±3.6 p&lt;0.05). The main MI mechanisms were embolism, thrombosis, myocarditis, inadequate myocardium perfusion. Six patients (5%) underwent heart transplantation. The mortality rate was 14.2% (17 patients) due to myocardial infarction, arrhythmias, heart failure. Conclusion Thromboembolic events, arrhythmias and ischemia are typical adverse events of LVNC. Non-sustained/sustained ventricular tachycardia, myocardial infarction is significantly associated with increased mortality. LV dilation, systolic and diastolic dysfunction increases the frequency of thromboembolism in these patients. Low voltage ECG, poor R-wave progression, QRS duration and myocarditis should considered predictors for arrhythmias in LVNC patients.

SLEEP AND CARDIAC TACHYARRHYTHMIA: RESULTS FROM THE CROSS-SECTIONAL SLEEP HEART HEALTH STUDY

Despite the well-known relationship between sleep disorders and general cardiovascular risk, few studies have examined sleep quality and quantity at pre-clinical levels in patients with cardiac arrhythmias (CA). Patients with CA are at an elevated risk of stroke, sudden cardiac death, disability, and reduced quality of life. In this study, we sought to elucidate the sleep-related predictors of arrhythmia using both subjective and objective measures of sleep. Baseline, comorbidity, electrocardiogram, and polysomnography data from the Sleep Heart Health Study (age 44-90 y) was available for secondary analysis. ECG data was used to identify participants with cardiac arrhythmias during polysomnography. Exposure variables used included blood oxygen saturation, sleep stages, and tertiles of sleep quality and quantity. Unadjusted and adjusted logistic regression was used to quantify the association between sleep and non-sleep related factors and arrhythmia. Of the 5,804 original SHHS sample, a total of 3,453 participants with complete variables of interest were included in the final analysis (mean age: 68.1 ± 10.6 Years, 54% male, 499 with arrhythmia (Atrial Tachyarrhythmia and Conduction Abnormalities), and 2,954 Controls). At the bivariate level, underweight (BMI < 18.5) (OR: 2.86, 95% CI: 1.1 – 7.2, P < 0.0001), sleep time < 6 hours (OR: 2.58, 1.5-4.3, P < 0.0001), % time in REM sleep ( < 17.6; OR: 1.53, 1.2-1.0, P < 0.0001), sleep efficiency ( < 81; OR: 1.9, 1.5-2.3) and regular afternoon naps (OR:1.8, 1.3-2.4, P < 0.0001) were significantly associated with CA. Once adjusted for age and sex, only % time in REM sleep and minimum oxygen saturation during REM (OR: 0.97, 0.96-0.98, P=0.006, and; OR: 0.97, 0.96-0.98, P=0.001, respectively) were significantly associated with CA. Preliminary analyses suggest differences in sleep stages and oxygen saturation as potential targets for future work in the prevention and early management of CA. Further study is necessary to understand the nature of these relationships using longitudinal data with adjustment for traditional CA markers.

Predictors, burden and impact of cardiac arrhythmias among patients hospitalized with end-stage liver disease

BackgroundCirrhotic cardiomyopathy, hyperammonemia, and hepatorenal syndrome predispose to cardiac arrhythmias in End-stage liver disease (ESLD). ObjectivesAmong ESLD hospitalizations, we evaluate the distribution and predictors of arrhythmias and their impact on hospitalization outcomes. MethodsWe selected ESLD records from the Nationwide Inpatient Sample (2007–2014), identified concomitant arrhythmias (tachyarrhythmias and bradyarrhythmias), and their demographic and comorbid characteristics, and estimated the effect of arrhythmia on outcomes (SAS 9.4). ResultsOf 57,119 ESLD hospitalizations, 6,615 had arrhythmias with higher odds with increasing age, males, jaundice, hepatorenal syndrome, alcohol use, and cardiopulmonary disorders. The most common arrhythmias were atrial fibrillation, cardiac arrest/asystole, and ventricular tachycardia. After propensity-matching (arrhythmia: no-arrhythmia, 6,609:6,609), arrhythmias were associated with 200% higher mortality, 1.7-days longer stay, $32,880 higher cost, and higher rates of shock, respiratory and kidney failures. ConclusionsDue to worse outcomes with arrhythmias, there is a need for better screening and follow-up of ESLD patients for dysrhythmias.