Presence Of Arrhythmias Research Articles

Electrocardiograms from different types of exercise in Eventing horses with and without cardiac signs.

Exercising arrhythmias can be clinically irrelevant or associated with poor performance, collapse and sudden cardiac death. To test if readable exercising ECGs can be recorded by grooms or riders and to describe arrhythmias in ECGs from different types of exercise in Eventing horses and investigate associations with type of workout, the presence of previous cardiac signs and intensity of exercise. Cohort study. Single lead exercising ECGs were obtained by riders or grooms during training and competition from a convenience sample of horses in training for Eventing competitions. Arrhythmias were described, and associations between different arrhythmia categories and variables that described the horse and the workouts were sought. There were 1002 ECGs from 62 horses (median [range] 7 [2-97] ECGs/horse) evaluated and 737 workouts (73.6%) were >95% readable and included in the analysis. There were arrhythmias in 250 (33.9%) of the workouts, complex arrhythmias in 13 (1.8%) and the number of premature complexes was median (range) 0 (0-118). Peak heart rate and duration of exercise were associated with the number of premature complexes, the presence of arrhythmias and complex arrhythmias and were colinear with the type of exercise. Having previous signs of cardiac disease and the type of workout were associated with higher odds of having arrhythmias. Monitoring the rhythm of equine athletes with ECGs obtained by riders and transmitted to an online cloud was feasible. Arrhythmias were frequent, and complex arrhythmias were rare. The presence of cardiac signs, type of exercise and peak heart rate were associated with the presence of arrhythmias. None of the horses developed poor performance or collapse attributed to cardiac disease. The arrhythmias that should be concerning for equine veterinarians need further definition.

Incidence Rate of Post Coronary Artery Shunt Complications; Age Dependent!

Numerous complications, such as postoperative arrhythmia and stroke, have been observed following coronary artery bypass graft (CABG) surgery. This study sought to examine the impact of aging on the incidence of post-coronary artery shunt complications. Aging is a physiological process experienced by every living cell, beginning early in development. Age plays a crucial role in determining postoperative complications, including those related to CABG. A retrospective analysis was conducted on 290 patients who underwent CABG at the Mordovian Republic Hospital between 2017 and 2021. The sample was divided into two age-based groups: the first group comprised 126 patients (mean age range: 55.21-60.00), and the second group included 163 patients (mean age range: 66.11-80.00). Statistical analyses employed in this study encompassed descriptive statistics, Chi-square test, T-test, one-way ANOVA test, ROC analysis, and Pearson correlation using Statistica 12 software. Elderly patients in the second group demonstrated a higher incidence of post-CABG arrhythmia (p < 0.012528). Moreover, the second group experienced markedly longer ICU and total hospitalization days following CABG, with p-values of less than 0.000000 and 0.000072, respectively. Notably, elderly individuals in the second group faced an increased risk of developing psychosis after CABG surgery (p < 0.007379). Furthermore, psychosis was found to be significantly associated with longer ICU hospitalization (p < 0.000140). Postoperative stroke occurred more frequently among the elderly (second group) with a p-value of less than 0.037736. Consequently, postoperative stroke was associated with extended ICU hospitalization (p < 0.000747). The usage of internal thoracic arteries (ITAs) was lower among the elderly (second group), with a p-value of less than 0.016145. Regarding correlations, a direct association was observed between age and ICU days, total hospitalization days, and the number of complications, with correlation coefficients (r) of 0.189046, 0.141415, and 0.138565, respectively. Elderly individuals in the second group who undergo CABG face a greater risk of developing psychosis, arrhythmia, prolonged total and ICU hospitalization, and stroke. The presence of arrhythmia, which is commonly observed in patients aged 63 years and older, significantly affects total hospitalization days. The number of complications is influenced by age, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, ICU hospitalization, and total hospitalization duration.

A cross sectional study on prevalence of hypomagnesemia and hypokalemia in patients with STEMI and its relationship with occurrence of arrhythmias

Background: Cardiovascular disease is one of the leading causes of mortality, morbidity, and increased health-care cost. Magnesium and potassium has been implicated in the pathogenesis of acute myocardial infarction (AMI) and its complications. Magnesium ions and potassium ions are considered essential for the maintenance of functional integrity of myocardium. The serum magnesium and potassium concentration was found to have great significance in AMI. The present study was undertaken to evaluate the prognostic value of serum magnesium and potassium in AMI. Aim: This study aimed to assess the dynamic changes in serum magnesium and potassium levels in acute STEMI patients and evaluate whether these levels correlate with presence of arrhythmias. Materials and methods: A comprehensive analysis was conducted over 18 months on 100 patients with acute STEMI. ECG examination was done and blood sample was taken for evaluation of serum magnesium and serum potassium. Statistical analysis was performed to examine correlation with MI and arrhythmias. Results: In the present study 51-60 years of age were maximum, males were most commonly seen. Mean ±SD of serum magnesium in VPC was 1.900±.3232, sinus tachycardia was 1.850±.1195, maximum in RBBB was 2.200±.000 followed by RBBB/CHB was 2±0, and minimum in 1.288±.5621. Results were found to be significant when comparing type of arrhythmia with serum magnesium. Mean ±SD of serum potassium in VPC was 3.030±.9627, sinus tachycardia was 3.638±.4502, maximum in RBBB was 4.600±.000 and minimum VT/RBBB in 2.850±1.0344. Results were found to be significant. Conclusion: Patients of AMI with low serum magnesium and potassium levels are found to be more prone to develop arrhythmias as compared to those with normal serum magnesium and potassium levels. Hence, it can be concluded that measurement of serum magnesium and potassium level is of prognostic significance in AMI.

Transient Brugada Like after Scorpion Sting: An Unexpected Connection

Introduction: Brugada syndrome was described in 1992 as a new clinical and electrocardiographic syndrome involving susceptibility to ventricular arrhythmias and sudden cardiac death in patients without obvious structural heart disease. Brugada phenocopy (BrP) is an evolving term for Brugada-like ECG patterns due to reversible causes. In this article, we will illustrate the case of a patient presenting with a transient Brugada pattern following a scorpion sting. Case Report: A 65-year-old woman with age and menopause as cardiovascular risk factors, but no notable medical history, presented to the emergency department with atypical chest pain five hours after a scorpion sting. She had no associated symptoms such as dyspnoea, syncope, or palpitations, nor a personal or family history of sudden death. On admission, she was conscious, hemodynamically stable, normotensive, and tachycardic, with no signs of heart failure. Her ECG showed a 2 mm elevation at the J point and an inverted T wave in V1 and V2, indicating a Brugada pattern. She was admitted to the ICU for close monitoring. An echocardiogram revealed normal left and right ventricular function. Lab tests showed negative troponins, a normal blood ionogram, and normal renal and hepatic function. The Brugada pattern resolved within a few hours, and the patient remained stable. Discussion and Conclusion: Our case highlights the importance of conducting a thorough medical history to rule out the presence of arrhythmia, syncope, or a family history of sudden cardiac death in similar situations. If the history raises concerns, cardiological follow-up is essential to investigate the possibility of Brugada syndrome. Performing a follow-up ECG at discharge is beneficial to confirm the reversibility of the findings. This distinction is crucial as it helps differentiate between Brugada syndrome and the Brugada pattern, the latter being a condition that may occur in patients with scorpion stings or other triggers.

POSSIBILITIES OF RADIOLOGICAL SCAN METHODS WITH POST-PROCESSING IMAGE RECONSTRUCTION IN THE ASSESSMENT OF ATHEROSCLEROTIC PLAQUES OF THE CAROTID ARTERIES

The aim. To establish the informativeness of the methods of computed tomography angiography, ultrasound diagnostics and magnetic resonance arteriography without contrast in patients with atherosclerosis of carotid arteries. Materials and methods. During July 2022 - July 2024, 82 male patients were examined on the basis of the Neurological Pathology Diagnostic Center of the KNP "Regional Clinical Hospital of the Ivano-Frankivsk Regional Council". Forty-six of them were included in the study group with clinical signs of atherosclerotic lesions of the carotid arteries. Thirty-six patients with asymptomatic course of the carotid arteries atherosclerosis were chosen as the control group. Patients of both groups were aged 51-79 years, and were homogeneous in terms of concomitant diseases, duration of smoking and lipidogram results. Exclusion criteria from both cohorts were: the presence of arrhythmia, radiation treatment of oncological processes in the projection of the head and neck, diagnosed Alzheimer's disease or Fara's disease, lack of written informed consent to participate in the study, impaired legal capacity of the person, when the written consent cannot be considered truly conscious. CTA was performed using a 160-slice computer tomograph Aquilion Prime Toshiba Scanner TSX-302A (Toshiba) with SUREPlaque software to analyze atherosclerotic plaques and vessels in the Carotid CTA fast scanning mode. MRI of the head and neck with non-contrast MR-arteriography was performed using a 1.5 Tesla Phillips Achieva device using blood flow imaging sequences: s3DI MC (three-dimensional time of flight MR-angiography). Ultrasound of the carotid arteries was performed using the Esaote MyLab9eXP device using B-mode, Doppler mapping and elastography. Atherosclerotic plaques were assessed according to the new imaging-based classification - Carotid Plaque-RADS from 2024. The results. According to the classification of Carotid Plaque-RADS, the following results were obtained according to visualization by ultrasound and CT methods: a combination of plaques of categories from Plaque-RADS 2 to Plaque-RADS 4, considering the types of each category, was detected in patients of both groups. There was no significant difference between the groups in the assessment of the structure of the atherosclerotic plaque (p=0.616). For the study group, the detection of the higher percentage of the stenotic lumen of the vessel was statistically different (median - 68.5% (interquartile range 9.75%)) compared to the control group (median - 60.0% (interquartile range 7.5%)) (p =0.048). A comparison of the degree of stenosis by ultrasound and CTA methods was carried out, where a direct correlation of very high strength according to the Chaddock scale was established (r=0.934 (confidence interval: 0.881 – 0.964), p˂0.001). Atherosclerotic lesions were characterized by indirect signs on MRI, namely: wall filling defects, which most likely correspond to plaques, increased bends of main arteries. Conclusions. Ultrasound diagnostics and reconstructive post-processing capabilities of computed tomography were practically equivalent in assessing the degree of stenosis with high correlation strength (r=0.934) and highly informative images of atherosclerotic masses of carotid arteries, while non-contrast magnetic resonance arteriography allowed to suspect atherosclerotic lesions as an area of ​​a filling defect without detailed tissue structures.

Syncope as a clinical presentation of cardiac lymphoma: a case report

Primary cardiac lymphoma, an extremely rare type of B-cell non-Hodgkin lymphoma, has an incidence of approximately 0.02-2% among malignant cardiac tumors. It is frequently associated with manifestations such as cardiac rhythm disturbances, refractory pericardial effusion and cardiac masses. Definitive diagnosis is achieved by biopsy, being essential to rule out hematogenous dissemination with PET-CT. The literature indicates a predominance of right chamber involvement and survival that varies significantly according to left ventricular involvement and the presence of arrhythmias. Therapeutic options are not well defined, but chemotherapy such as R-CHOP has shown efficacy, although the prognosis is generally poor due to complications such as disease progression, arrhythmias and sepsis. This case underscores the importance of considering cardiac lymphoma in patients with unexplained cardiac symptoms, highlighting the need for a multidisciplinary and specific diagnostic and therapeutic approach.

ECG findings are poor predictors for adverse events and cardiac death in Barth syndrome

BackgroundPatients with Barth syndrome (BTHS) can present with cardiomyopathy. BTHS subjects are at risk for cardiac adverse outcomes throughout life, including malignant arrhythmias and death. Electrocardiogram (ECG) parameters have never been assessed as a tool to predict adverse outcomes in individuals with BTHS. ObjectivesThe purpose of this study was to identify any ECG parameters, including QRS fragmentation, presence of arrhythmia, or abnormal intervals, that could predict adverse outcomes and cardiac death among the BTHS population. MethodsWe performed a retrospective case referent study on subjects with BTHS (n = 43) and compared them with our reference group, subjects with idiopathic dilated cardiomyopathy (DCM) from a single institution (n = 53) from 2007 to 2021. BTHS data was obtained from subjects attending the biennial Barth Syndrome Foundation International Scientific, Medical, and Family Conferences (BSFISMFC) from 2002 to 2018. ECG data from the first and last available ECGs prior to an adverse event or cardiac death was analyzed. Then, multivariable regression was performed to determine odd ratios between ECG characteristics and adverse events/cardiac death. ResultsNo ECG variables were statistically significant predictors of adverse events or cardiac death in the BTHS group. Last ECG QRS fragmentation trended to statistically significance (OR 13.3, p = 0.12) in predicting adverse events in the DCM group. ConclusionNo ECG parameters, including QRS fragmentation, presence of arrhythmia, or abnormal interval values, predict adverse events or cardiac death among BTHS patients. QRS fragmentation may be a predictor of adverse events in the DCM population.

Impact of Patient Age on Management of Hypothyroidism: A Survey of Physicians from Three Developing Regions

Abstract Background The thyroid-stimulating hormone (TSH) levels increase with age, and aiming for the same TSH target applicable in a younger population in older patients who are on replacement with thyroid hormones. Methods We assessed practice patterns regarding TSH goals and explored factors influencing physicians' decision-making when managing hypothyroidism. Multiple-choice questions in a case-based survey of a convenience sample of physicians practicing in relevant disciplines in three developing regions. Results Of the total 286, senior physicians represented 63% and mid-grades represented 27% of the respondents. Forty-one percent were endocrinologists, 19% were internists with endocrine interests, and 16% were family physicians. Over half (52%) practiced at a tertiary level and 42% had been in practice for over 20 years. Fifty percent of respondents had more than 20% of their patients over 65 years.Several attributes were factored into decision-making when managing hypothyroidism. Respondents took into account age (75%), preceded by the presence of cardiac arrhythmias (80%), pregnancy (79%), heart disease (78%), and patient symptoms (77%) when determining the treatment strategy. When presented with scenarios differing in patients' age, around 90% of physicians targeted a TSH ≤ 3.0 mIU/L in 30-year-old patients. Fifteen percent of respondents targeted a TSH of 1.6 to 3.0 mIU/L in octogenarians, but 78% targeted a TSH &gt; 3.1 to 5.0 mIU/L in this group. Regardless of sex, physician-reported TSH goal ranges (0.1–0.5, 0.6–1.5, 1.6–3.0, and 3.1–5.0 mIU/L) increased directly to patient age. Overall, respondents were less inclined to start treatment in 85-year-olds than in 70-year-old females with TSH of 6 mU/L (20% vs. 11%). Females with a TSH of 15 mU/L were more likely to get treated than those with a 6 mU/L TSH. Vital persons are more likely to be treated with thyroxine than vulnerable persons for the same TSH levels. Multivariate analysis showed that compared with endocrinologists, family physicians and other specialties were less likely to consider age in their clinical decisions, odds ratio (OR) 0.2 (95% confidence interval [CI] 0.1–0.7), p = 0.018, and OR 0.3 (95% CI 0.1–0.8), p = 0.013, respectively. Conclusion A consensus is needed on the role of patients' age in hypothyroidism management, the complexity of managing hypothyroidism in an older adult patient, and the variability in practice patterns among physicians. Addressing these challenges demands ongoing dialogue and collaboration among health care providers to improve patient care and outcomes in hypothyroidism management across different age groups.

Surgical Treatment of Atrial Fibrillation and Flutter in Patients with Atrial Septal Defects

The article analyzes the results of surgical treatment of atrial fibrillation or flutter in patients with an atrial septal defect (ASD). The aim. To increase the effectiveness of surgical treatment of concomitant atrial fibrillation (AF) / atrial flutter (AFL) in patients with ASD. Materials and methods. The study included 124 people, with a mean age of 38.3 ± 4.4 years. The patients were divided into 3 groups. Group 1 included patients with ASD and concomitant AF/AFL who underwent closure of the ASD and radiofrequency ablation, while group 2 included patients with ASD and concomitant AF/AFL who underwent only closure of the ASD. The third group included patients over 18 years old with ASD without obvious AF/AFL who underwent ASD closure. Results. It was established that severity of the perioperative period after ASD plasty is due to the duration of the operation and the need for radiofrequency fragmentation of the atria. It was found that performing radiofrequency fragmentation of the atria leads to an increase in the time of artificial blood circulation and the time of artificial lung ventilation. The criteria for forming the research groups were the presence of arrhythmia and surgical tactics used to eliminate ASD. It was established that the duration of ASD plasty was significantly longer in patients from the 1st group (271.0 ± 43.1 min) compared to the corresponding indicator in patients from the 2nd group (211.0 ± 29.4 min) and of the 3rd group (191.3 ± 28.0 min) (p = 0.001, χ2= 18.02). The time of artificial blood circulation was also significantly longer in the 1st group (80.2 ± 13.0 min), compared to the corresponding indicator in the 2nd (45.0 ± 8.4 min) and 3rd groups (47.4 ± 7.3 min), which is caused by performing radiofrequency fragmentation of the atria (p = 0.001, χ2= 17.52). Conclusions. It was established that complexity of the treatment of ASD is due to the duration and traumatic nature of the operation and the need for radiofrequency fragmentation of the atria. It was found that performing radiofrequency fragmentation of the atria leads to an increase in the time of use of artificial blood circulation and, accordingly, reliably extends the time of the patient’s stay on artificial lung ventilation. At the same time, radiofrequency atrial fragmentation provides high clinical efficacy in eliminating AF/AFL.

Arrhythmias among Older Adults Receiving Comprehensive Geriatric Care: Prevalence and Associated Factors.

Cardiovascular diseases and arrhythmias are medical conditions that increase with age and are associated with significant morbidities and mortality. The aim of the present study was to investigate the prevalence of arrhythmias and clinical associations in the collective of older adults receiving comprehensive geriatric care (CGC). Holter ECG monitoring (HECG) of older patients hospitalized for CGC was analyzed. The prevalence of arrhythmias and the associations between the presence of arrhythmias, patients' characteristics and the functional status regarding basic activities of daily living (assessed by the Barthel index (BI)), walking ability (assessed by the timed up and go test (TUG)), and balance and gait (assessed by the Tinetti balance and gait test (TBGT)) were examined. In the presented study, 626 patients were included (mean age: 83.9 ± 6.6 years, 67.7% were female). The most common arrhythmias detected in HECG were premature ventricular contractions (87.2%), premature atrial contractions (71.7%), and atrial fibrillation (22.7%). Atrial flutter was found in 1.0%, paroxysmal supraventricular tachycardia in 5.8%, non-sustained ventricular tachycardia in 12.5%, first-degree AV block in 0.8%, second-degree AV block type Mobitz I in 0.8%, second-degree AV block type Mobitz II in 0.3%, pause > 2.5 s any cause in 3.5%, and pause > 3 s any cause in 1.6% of the cases. Premature atrial contractions were associated with the female sex (74.8% vs. 65.3%, p = 0.018), whereas in male patients, the following arrhythmias were more common: premature ventricular contractions (91.6% vs. 85.1%, p = 0.029), ventricular bigeminus (8.4% vs. 3.8%, p = 0.021), and non-sustained ventricular tachycardia (17.3% vs. 10.1%, p = 0.014). Atrial fibrillation detected in HECG was more frequent in patients at high risk of falls, indicated by their TBGT score ≤ 18 (24.7% vs. 12.0%, p = 0.006), and premature ventricular contractions were more common in patients unable to walk (TUG score 5) compared to those with largely independent mobility (TUG score 1 or 2) (88.0% vs. 75.0%, p = 0.023). In a logistic regression analysis, atrial fibrillation detected in HECG was identified as a risk factor for a high risk of falls (odds ratio (OR): 2.35, 95% confidence interval (CI): 1.23-4.46). In our study, investigation of HECG of older adults hospitalized for CGC revealed that premature atrial contractions, premature ventricular contractions, and atrial fibrillation were the most common arrhythmias. Premature atrial contractions were found to be more frequent in female patients, while male patients were more prone to premature ventricular contractions. In the investigated population, atrial fibrillation emerged as a risk factor associated with a high risk of falls.

A Retrospective Cohort Evaluation of Left Ventricular Remodeling, Perioperative Complications and Outcome in Medium and Large Size Dogs with Patent Ductus Arteriosus after Percutaneous Closure.

This retrospective cohort study included one hundred fifty-seven medium and large-size dogs with the aim of evaluating the effect of signalment and echocardiographic features on complications, outcomes and left ventricular modifications before and after patent ductus arteriosus (PDA) closure. The patients were divided in two groups based on the heart remodeling after closure: Group A included dogs that had a reduction in the end-systolic volume index (ESVI) after closure compared to the ESVI measured before; Group B included dogs without a reduction in ESVI after closure. Body weight, minimal ductal diameter (MDD) of PDA, end-diastolic volume index and presence of arrhythmias at presentation were significantly higher in Group B compared to Group A. The shortening fraction and ejection fraction after closure were reduced in both groups, but in Group B there was a major reduction, and the mean values indicated a possible systolic dysfunction. Complications during the procedure and death due to cardiac reasons were greater in Group B compared to Group A. In conclusion, a higher body weight, a larger MDD, a more severe heart enlargement or arrhythmias at presentation increased the risk of developing a worsening structural and functional condition after ductal closure, and this can be associated with perioperative complications and cardiac death.

Adult congenital heart disease in women: demographics and outcomes in mexico. gender differences?

Abstract Background Due to advances in cardiovascular medicine in recent decades, adult congenital heart disease (ACHD) is becoming a growing field in cardiology. Differences in clinical presentation, treatment, and outcomes of ACHD between men and women have not been well studied in Latin America and Mexico. Purpose To characterize gender differences in clinical presentation, treatment, and mortality of ACHD in Mexico. Methods From January 2006 to December 2020, 3503 patients with ACHD were studied at a cardiology national reference center in Mexico. SPSS V. 23 software was used for statistical analysis. Results Women comprised 56% of the study population, in which a higher percentage of pulmonary hypertension and Eisenmenger syndrome was observed, (10.9% men vs. 17.7% women; 1.5% men vs. 3.3% women, p &amp;lt;0.01). Women had a higher score in AHA´s physiological classification (State C, 27.9% men vs. 35.3% women, p &amp;lt;0.01). Men had a higher rate of severity/anatomic complexity (13.3% men vs. 11.7% women, p &amp;lt;0.01), a higher rate of LVEF &amp;lt;40%, (8.0% men vs. 23.8% women, p &amp;lt;0.01), and underwent total repair surgery more often (61.3% men vs. 57% women, p &amp;lt;0.01). No statistical difference was observed in functional class, presence of arrhythmias, or mortality (patient´s current status). Figure 1. Conclusions We found gender differences in ACHD in Mexico: women were more likely to have pulmonary hypertension, which may reflect the already known gender predilection of PH; additionally, women had a higher AHA's physiological score; despite this, women underwent complete surgery less frequently. Although men had higher anatomic complexity and a lower LVEF, there was no statistical difference in functional class or mortality.Figure 1

#3160 IMPACT OF HEART FUNCTION ON ELDERLY INCIDENT HEMODIALYSIS PATIENTS

Abstract Background and Aims Cardiovascular disease (CVD) is the most common cause of death in patients on hemodialysis (HD). Indeed, left ventricular (LV) dysfunction, symptomatic congestive heart failure and arrhythmia are independent predictors of poor survival and hospitalization in these patients. Among the patients who initiated HD, the proportions of the elderly patients aged &amp;gt;65 years are increasing worldwide. According to the Korean Renal Data System, the percentage of incident HD patients aged&amp;gt;65 years increased from 11% in 1990 to 53% in 2022. In addition, the prevalence of CVD increases with age. Therefore following these trends, investigating the impact of heart function on prognosis in elderly patients on HD is important for predicting prognosis and making appropriate treatment plans. This study aims to investigate the all-cause mortality in elderly incident HD patients according to heart function and presence of arrhythmia. Method 1,002 incident HD patients aged &amp;gt;70 years were recruited from a retrospective cohort of the Korean Society of Geriatric Nephrology. The primary outcome is all-cause mortality (6 months, overall) according to the LV function and presence of arrhythmia. To analyze, patients were divided into 6 groups according to the LV function (LV ejection fraction [LVEF]≥50%, 40≤LVEF&amp;lt;50%, LVEF&amp;lt;40%) and the presence of arrhythmia. The secondary outcome is all-cause mortality (6 months, overall) according to the LV function or presence of arrhythmia. To analyze, patients were divided into 3 groups according to the LV function and separately divided into 2 groups according to the presence of arrhythmia. Cox regression univariate and multivariate analyses was used. Results 1,002 patients were divided into 6 groups (LVEF≥50% without arrhythmia [N = 707, 70.6%], 40≤LVEF&amp;lt;50% without arrhythmia [N = 71, 7.1%], LVEF&amp;lt;40% without arrhythmia [N = 66, 6.6%], LVEF≥50% with arrhythmia [N = 124, 12.4%], 40≤LVEF&amp;lt;50% with arrhythmia [N = 15, 1.5%], LVEF&amp;lt;40% with arrhythmia [N = 19, 1.8%]). There were no differences of 6-month all-cause mortality among the groups. Compared with LVEF≥50% without arrhythmia group, 40≤LVEF&amp;lt;50% without arrhythmia (hazard ratio [HR], 1.59; 95% confidence interval [95% CI], 1.21-2.09; P = 0.001), LVEF≥50% with arrhythmia (HR, 1.39; 95% CI, 1.12-1.74, P = 0.003) and LVEF&amp;lt;40% with arrhythmia groups (HR, 1.95; 95% CI, 1.19-3.17, P = 0.007) showed higher all-cause mortality of overall period. According to the LVEF groups, there were no differences of 6-month all-cause mortality among the groups. Compared with LVEF≥50% group, 40≤LVEF&amp;lt;50% group showed higher all-cause mortality of overall period (HR, 1.51; 95% CI, 1.18-1.94, P = 0.001). According to the arrhythmia groups, there were no differences of 6-month all-cause mortality between the groups. The presence of arrhythmia was associated with higher all-cause mortality of overall period (HR, 1.39; 95% CI, 1.15-1.69, P = 0.001). Conclusion Decreased heart function and presence of arrhythmia have negative impact on all-cause mortality of overall period, but not on 6-month all-cause mortality in elderly patients on incident HD. Therefore, evaluation of the heart function and detection of arrhythmia in elderly patients who start HD and providing the appropriate treatment to these patients would be helpful for improving the prognosis.

Anti-arrhythmia potential of honey-processed licorice in zebrafish model: Antioxidant, histopathological and tissue distribution

Ethnopharmacological relevanceHoney-processed licorice (HPL) is the roasted product of licorice. It is recorded in the “Shang Han Lun” that licorice has better protection on heart after honey-processed. However, researches regarding its protective effect on the heart and the distribution of HPL in vivo are still limited. Aim of the studyTo evaluate the cardio-protection of HPL and explore the law of ten main components distribution in vivo under physiological and pathological conditions for an attempt to clarify the pharmacological substance basis of HPL in treating arrhythmia. Materials and methodsThe adult zebrafish arrhythmia model was established by doxorubicin (DOX). Electrocardiogram (ECG) was used to detect the heart rate changes of zebrafish. SOD and MDA assays were used to evaluate oxidative stress levels in the myocardium. HE staining was used to observe the morphological change of myocardial tissues after HPL treatment. The UPLC-MS/MS was adapted to detect the content of ten main components of HPL in heart, liver, intestine, and brain under normal and heart injury conditions. ResultsHeart rate of zebrafish was decreased, the SOD activity was attenuated and MDA content was increased in myocardium after administration of DOX. Moreover, tissue vacuolation and inflammatory infiltration were detected in zebrafish myocardium induced by DOX. HPL could ameliorate heart injury and bradycardia induced by DOX to a certain extent by increasing SOD activity and reducing MDA content. In addition, the study of tissue distribution revealed that the content of liquiritin, isoliquiritin, and isoliquiritigenin in the heart was higher in the presence of arrhythmias than those in the normal condition. Under pathological conditions, the heart highly exposed to these three components could elicit anti-arrhythmic effects by regulating immunity and oxidation. ConclusionThese findings indicate that the HPL is protective against heart injury induced by DOX, and its effect is associated with the alleviation of oxidative stress and tissue injury. And the cardioprotective effect of HPL under pathological conditions may be related to the high distribution of liquiritin, isoliquiritin, and isoliquiritigenin in heart tissue. This study provides an experimental basis for the cardioprotective effects and tissue distribution of HPL.

Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society.

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021-2022 in relation to Polish health care conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include: drugs blocking the renin-angiotensin-aldosterone system (preferably angiotensin receptor antagonist/neprilisin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect - options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers - carvedilol and nebivolol), mineralocorticoid receptor antagonist and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness of the above-mentioned has been confirmed in numerous prospective, randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent, additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or presence of arrhythmia. The manuscript emphasizes cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction. We propose practical guidelines for the use of medicines, the profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation or antiplatelet and anticoagulant therapy were also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF were discussed.

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.

PO-03-222 CURRENT TRENDS AND OUTCOMES OF SUDDEN CARDIAC ARREST IN YOUNG ADULTS IN THE USA: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE

Sudden cardiac arrest (SCA) is a rare but devastating event in young adults. There is a lack of population studies that evaluate the current trends and outcomes of SCA in young adults. We sought to estimate current trends in incidence, risk factors and mortality rates for out-of-hospital SCA in young adults (18 – 35 years) using the national in-patient sample of the USA. The demographic data of all young adults (18 – 35 years) admitted to hospitals in the US from 2016 to 2020 was analysed using the National Inpatient Sample database. We further identified primary admissions for sudden cardiac arrest using the ICD 10 code (I46). We analyzed the trend in the incidence and mortality of SCA during the study period using the marginal effect of years. Subsequently, we compared the sociodemographic and comorbid factors of patients with out-of-hospital SCA with other young adults admitted to the hospital. Multivariate logistic regression was then used to determine the sociodemographic and comorbid factors independently associated with SCA in our population. There were approximately 3,610 cases of out of hospital cardiac arrest in the study period, with an incidence rate of 1:10000 young adult admissions. The mean age at admission was (28.3 ± 0.4 years). We noted a 16.7% increase in SCA cases from 2016 to 2020 (660 to 770 cases). Similarly, there was a 21% increase in the mortality between 2016 and 2020 (474 to 574 deaths), with a mean mortality rate of 69.7% throughout the study period. The main factors associated with increased odds of SCA in young people were the presence of arrhythmias. Other significant risk factors were male sex, a history of stroke, electrolyte abnormalities, renal failure on hemodialysis, hypertrophic cardiomyopathy, congenital heart disease, and cocaine use disorder. There is an increase in the incidence of sudden cardiac arrest in young adults, with the main risk factors being male sex, history of stroke, hypertrophic cardiomyopathy, congenital heart disease, presence of arrhythmias and cocaine use disorder. Identifying young adults with high-risk characteristics as described above and implementing risk factor modification with aggressive surveillance can reduce the incidence of SCA and the risk of death in young adults.Tabled 1Sociodemographic and comorbid factors associated with Sudden Cardiac Arrest in Young AdultsVARIABLESOdds ratioLower limit of CIUpper limit of CIP-valueAGE1.000.981.020.373RACE (Reference, Whites)BlacksHispanicsAsians-1.070.621.25-0.850.450.78-1.360.842.01-0.5530.002*0.628Female0.410.330.51<0.001*Smoking0.760.571.030.077Dyslipidemia0.430.240.770.004*History of myocardial infarction0.730.182.960.663COPD1.270.572.840.558Stroke5.462.999.97<0.001*Hypertension0.750.561.010.057Hypothyroidism1.330.842.080.225Obesity0.920.691.240.593Arrhythmia27.5221.435.3<0.001*Electrolyte Derangement13.410.517.1<0.001*ESRD on Hemodialysis2.401.463.940.001*Oxygen Dependence1.170.363.790.792Hypertrophic cardiomyopathy7.893.0420.45<0.001*Cocaine Use Disorder1.761.202.570.004*Congenital heart disease2.941.725.03<0.001*∗Statistically significant findings, COPD - chronic obstructive pulmonary disease, CI - Confidence interval Open table in a new tab

Arrhythmias in Williams Syndrome

Williams syndrome (WS) is a congenital, multisystem disorder in which 80% of patients have cardiovascular abnormalities. Sudden cardiac death occurs 25 to 100 times more often in WS than in the general population, and cardiac repolarization is abnormal in WS. We sought to determine the prevalence of primary arrhythmias in patients with WS and whether QTc prolongation impacts arrhythmia risk. We retrospectively reviewed all patients with WS with ambulatory electrocardiogram (ECG) monitoring at our institution between October 2017 and January 2022. The primary outcome was the presence of arrhythmia. Predictors pre-determined for analysis included premature ventricular and atrial complex burden (%), degree of QTc change with varying heart rates, intervals and rhythm on 12-lead ECG, age, gender, symptomatology, and clinical and surgical history. A total of 74 patients (55% female, median age 8years (3, 13) underwent 108 ambulatory monitors. Arrhythmias were present in 9 patients (12%). Within this group of 9 patients, 18/24 serial monitors were abnormal, and 3/9 patients (33%) had >1 arrhythmia type. Older age (p=0.002) and symptoms (syncope, p=0.005) were associated with arrhythmias. Arrhythmia was not associated with the degree of structural heart disease. Atrial tachycardia was the most identified arrhythmia (n=6; 67% of patients with arrhythmias and 8% of the total cohort). The QTc abnormally increased with higher heart rates in all groups. There was a higher number of premature ventricular and atrial complexes per hour in patients with arrhythmias. In conclusion, atrial arrhythmias were the most common arrhythmia in patients with WS and routine ambulatory ECG and intermittent rhythm monitoring are indicated in WS, particularly given the high risk of sudden cardiac death in WS.

Arrhythmias in children with congenital heart defects.

Objective: To find out the prevalence of different types of arrhythmias in children with congenital heart defects (CHDs) presenting at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material &amp; Methods: A total of 120 children of both genders aged 1 day to 16 years and presenting to study setting with confirmed CHDs were evaluated. At the time of enrollment, demographical information and disease history were noted. Necessary laboratory investigations like complete blood count and serum electrolytes were analyzed while standard electrocardiography (ECG) was performed. Prevalence of different types of arrhythmias was noted. Results: In a total of 120 children with CHDs, 64 (53.3%) were boys. Mean age was be 2.7±2.1. Most common electrolyte abnormalities were noted to be hyponatremia and hypermagnesemia found in 39 (32.5%) and 26 (21.7%) children respectively. There were 31 (25.8%) children who were diagnosed to have arrhythmias. Out of these 31 children, first degree A-V block was the most common types of arrhythmias observed in 24 (77.4%) cases while ectopic A-V rhythm were found in 3 (9.7%). Conclusion: The findings of this research revealed that arrhythmias are quite common among children having CHDs. There is a need to routine assessment for the possible presence of arrhythmias among children presenting with CHDs.

214 THE IMPACT OF ARRHYTHMIA ON PROGNOSIS IN HOSPITALIZED COVID-19 PATIENTS. A CARDIAC TELEMETRIC MONITORING STUDY

Abstract Background Cardiovascular abnormalities have been largely reported in patients with COVID-19. Among these, myocardial injury and rhythm disorders represent one of the most important complications in patients affected by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Moreover, a poorer prognosis has been documented in COVID-19 patients when complicated by arrhythmias, independently by age and sex. Objectives The aims of the present study were to identify some of non-cardiac and cardiac comorbidities and some myocardial electrical features (including QT dispersion) associated with arrhythmia in hospitalized COVID-19 patients. Moreover, another objective was to contribute in analyzing the impact of arrhythmias on outcome in this setting of patients. Methods At admission, each patient underwent cardiac telemetry monitoring through entire hospitalization period. In all the subjects, laboratory analyses, standard 12-lead electrocardiogram (both at admission and on discharge), and lung imaging examination (by means of both ultrasound scans and computed tomography) were performed. Patients exhibiting arrhythmia during in-hospital period were divided into three groups: i, with brady-arrhythmias; ii, with tachy-arrhythmias; and, iii, with tachy- and brady-arrhythmias. Results Two-hundred patients completed the study (males, 123; mean age, 70.1 years); of these, 80 patients (40%) exhibited rhythm disorders on cardiac telemetry. Patients with arrhythmia resulted to be older (p&amp;lt;0.0001) than patients without arrhythmia. Moreover, patients with arrhythmia showed: i, greater number of comorbidities (p&amp;lt;0.0001); ii, higher values of creatinine (p=0.007), B-type natriuretic peptide (p&amp;lt;0.0001), troponin (p&amp;lt;0.0001), c-reactive protein (p=0.01), ferritin (p=0.001), d-dimer (p&amp;lt;0.0001), and procalcitonin (p=0.0008); iii, QT interval (p=0.002), QTc interval (p=0.04), and QTc dispersion (p=0.01); and, iiii, lower values of sodium (p=0.03), magnesium (p=0.04), glomerular filtration rate (p&amp;lt;0.0001), and hemoglobin (p=0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. Multivariate analysis showed that age (OR=1.14 [95% CI: 1.07-1.22]; p=0.0004), coronary artery disease (OR=12.7 [95% CI: 2.38-68.01]; p=0.005), and circulating troponin (OR=1.05 [95% CI: 1.003-1.10]; p=0.04) represented risk factors independently associated with arrhythmia. By analyzing all-cause in-hospital mortality, it resulted a ∼forty-fold higher among patients with arrhythmia (OR=39.66 [95% CI: 5.20-302.51]; p=0.0004) when compared to patients without rhythm disorders. Conclusion In the present study, arrhythmias have been to be associated with ageing, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and abnormalities in myocardial electrical impulse propagation in patients affected by SARS-CoV-2 infection. In alignment with previous reports, the presence of arrhythmia seems to be associated with a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetric monitoring should be encouraged in COVID wards.