Presence Of Atrial Fibrillation Research Articles

THE CONUNDRUM OF DRUG INTERACTIONS AND HOLTER MONITORING: LAMIN GENE MUTATION DISCOVERED BY A TORSADE DE POINTES EPISODE FOLLOWED BY OUT–OF–THE–HOSPITAL RESUSCITATION

Abstract The prolongation of the QTc interval on the electrocardiogram is known to be associated with an increased risk of developing life–threatening ventricular arrhythmias such as torsades de pointes (TdP). QTc values exceeding 500 ms can double or even triple the risk of TdP. Many drugs, including amiodarone and some SSRI antidepressants like paroxetine, can prolong the QTc interval. A 57–year–old patient experienced cardiac arrest during an overnight Holter recording prescribed to exclude brady–tachy syndrome in the presence of persistent atrial fibrillation. ECG ambulatory monitoring revealed significant bradycardia with the onset of idioventricular rhythm, followed by TdP triggered by premature ventricular contractions, subsequently degenerating into ventricular fibrillation. The patient was resuscitated by family members and later by emergency medical personnel using 3 DC shocks, leading to the restoration of spontaneous circulation. The patient was transferred to the cardiology intensive care unit where a coronary angiography showed normal results. Blood tests indicated low potassium levels (3.3 mEq/L), with a moderately reduced left ventricular ejection fraction at 45%. The patient was discharged after ICD implantation and during the diagnostic follow–up the genetic testings for long QT syndrome were negative, but showed a mutation of the LMNA lamin A/C gene. During the two months previous to hospital admission, the patient had complained of fatigue in the presence of atrial fibrillation with a low ventricular response. Nonetheless, she had been prescribed oral amiodarone to optimize the chances of successful electrical cardioversion, in combination with paroxetine that the patient was already taking at home. The combination of these two drugs and the patient‘s idiopathic bradycardia contributed to a marked prolongation of the QT interval, leading to TdP degenerated into ventricular fibrillation. This case, notable for the prolonged recording of ventricular fibrillation and subsequent resuscitation chest compressions during a Holter monitoring, suggests caution in the use of antiarrhythmic drugs unless strongly indicated in the presence of potentially ominous drug interactions. It is encouraging to note how the widespread adoption of cardiopulmonary resuscitation culture has enabled individuals who might not have otherwise received medical attention to be effectively resuscitated.

Cryoablation Catheter Used in the Surgical Treatment of Atrial Fibrillation May Treat Chest Tube Pain: Engin Technique.

Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.

Atrial fibrillation increases thrombogenicity of LVAD therapy.

This study investigates the hypothesis that presence of atrial fibrillation (AF) in LVAD patients increases thrombogenicity in the left ventricle (LV) and exacerbates stroke risk. Using an anatomical LV model implanted with an LVAD inflow cannula, we analyze thrombogenic risk and blood flow patterns in either AF or sinus rhythm (SR) using unsteady computational fluid dynamics (CFD). To analyze platelet activation and thrombogenesis in the LV, hundreds of thousands of platelets are individually tracked to quantify platelet residence time (RT) and shear stress accumulation history (SH). The irregular and chaotic mitral inflow associated with AF results in markedly different intraventricular flow patterns, with profoundly negative impact on blood flow-induced stimuli experienced by platelets as they traverse the LV. Twice as many platelets accumulated very high SH in the LVAD + AF case, resulting in a 36% increase in thrombogenic potential score, relative to the LVAD + SR case. This supports the hypothesis that AF results in unfavorable blood flow patterns in the LV adding to an increased stroke risk for LVAD + AF patients. Quantification of thrombogenic risk associated with AF for LVAD patients may help guide clinical decision-making on interventions to mitigate the increased risk of thromboembolic events.

Longitudinal NT-proBNP: Associations With Echocardiographic Changes and Outcomes in Heart Failure.

The relationship of serial NT-proBNP (N-terminal pro-B-type natriuretic peptide) measurements with changes in cardiac features and outcomes in heart failure (HF) remains incompletely understood. We determined whether common clinical covariates impact these relationships. In 2 nationwide observational populations with HF, the relationship of serial NT-proBNP measurements with serial echocardiographic parameters and outcomes was analyzed, further stratified by HF with reduced versus preserved left ventricular ejection fraction, inpatient versus outpatient enrollment, age, obesity, chronic kidney disease, atrial fibrillation, and attainment of ≥50% guideline-recommended doses of renin-angiotensin system inhibitors and β-blockers. Among 1911 patients (mean±SD age, 65.1±13.4 years; 26.6% women; 62% inpatient and 38% outpatient), NT-proBNP declined overall, with more rapid declines among inpatients, those with obesity, those with atrial fibrillation, and those attaining ≥50% guideline-recommended doses. Each doubling of NT-proBNP was associated with increases in left ventricular volume (by 6.1 mL), E/e' (transmitral to mitral annular early diastolic velocity ratio) (by 1.4 points), left atrial volume (by 3.6 mL), and reduced left ventricular ejection fraction (by -2.1%). The effect sizes of these associations were lower among patients with HF with preserved ejection fraction, atrial fibrillation, or advanced age (Pinteraction<0.001). A landmark analysis identified that an SD increase in NT-proBNP over 6 months was associated with a 27% increase in the risk of the composite event of HF hospitalization or all-cause death between 6 months and 2 years (adjusted hazard ratio, 1.27 [95% CI, 1.15-1.40]; P<0.001). The relationships between NT-proBNP and structural/functional remodeling differed by age, presence of atrial fibrillation, and HF phenotypes. The association of increased NT-proBNP with increased risk of adverse outcomes was consistent in all subgroups.

ANTIHYPERTENSIVE DRUGS IN CHRONIC HEART FAILURE IN THE CZECH REPUBLIC, FOCUSING ON BETA-BLOCKERS

Objective: Hypertension is a very common comorbidity in patients with heart failure. Beta-blockers (BB) are the first choice drug together with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) in patients with heart failure with reduced left ventricular ejection fraction (HFrEF), reducing morbidity and mortality. Design and method: Data were collected in the FARmacology and NeuroHumoral Activation Registry (FAR NHL). Patients with chronic heart failure with left ventricular ejection fraction (LVEF) &lt; 50% for at least one month were included. Results: 1,100 patients with a mean age of 65 years, 80.8% male, were included. The mean systolic blood pressure was 128.0 mm Hg, mean diastolic blood pressure was 80.0 mm Hg. Of all patients, 20% received low dose of beta-blocker (LD), 57% medium dose (MD) and 17% high dose (HD), 6.2% did not receive BB. The higher the blood pressure (LD 124/ 77; MD 129/ 80; HD 132/ 82 mm Hg; p &lt; 0.001), LV EF (LD 29.5; MD 30.5; HD 32.0%; p = 0.003), creatinine clearance (LD 78.7; MD 87.8; HD 91.1 ml/min; p = 0.001) or weight of the patients, the higher the BB dose they received (LD 83.2; MD 88.7; HD 93.5 kg; p &lt; 0.001). The lower the NT-proBNP, the higher the BB dose patients received (LD 767; MD 456; HD 314 pg/ml; p &lt; 0.001). The presence of atrial fibrillation (AF) did not affect the BB dose. Patients with AF were more likely to be treated with digoxin or a combination of digoxin and BB than patients without AF (p &lt; 0.001). Conclusions: According to FAR NHL registry, almost 94% of patients with HFrEF receive BB. A total of 17% of patients take the target dose of BB. If a patient has BB, he/she is treated with the recommended preparation in more than 99% of cases. The more severe the disease, as reflected by lower BP, creatinine clearance, LV EF, weight or higher NT-proBNP, the lower the dose of beta-blockers the patient receives and tolerates.

D-30 | Does the presence of Atrial fibrillation/ Flutter cause worse outcomes in the patient with cardiogenic shock after Impella placement: Nationwide inpatient sample analysis (2016- 2020)

D-30 | Does the presence of Atrial fibrillation/ Flutter cause worse outcomes in the patient with cardiogenic shock after Impella placement: Nationwide inpatient sample analysis (2016- 2020)

The course of the pulmonary embolism in patients with oncological diseases

The aim – to identify factors associated with in-hospital mortality among patients with acute pulmonary embolism (PE) and oncological diseases. Materials and methods. A retrospective analysis of 647 medical records of patients with acute PE treated at one center from January 1, 2018, to January 1, 2020, was conducted. Among them, 115 patients had verified oncological diseases. PE diagnosis in all patients was confirmed by computed tomography and/or autopsy results. Alongside laboratory studies, patients underwent ultrasound examination. Results and discussion. A comparative assessment of clinical and anamnestic parameters in patients with PE, depending on the presence of oncological diseases, was conducted. The analysis revealed that patients with PE associated with oncological process were on average 5 years older, with higher proportion of elderly patients, and less frequently had anamnestic episodes of venous thrombosis (13.9 % vs. 24.6 %), but predictably more often had additional risk factors, such as blood transfusions, central venous catheters, and laparoscopic interventions. According to the results of the multifactorial regression analysis, factors independently influencing the risk of in-hospital death in patients with acute PE and oncological diseases included decrease of blood pressure, saturation, an increase of the pulmonary artery pressure, leukocytosis and presence of atrial fibrillation. The ROC analysis results allowed determining threshold values of parametric indicators associated with the risk of death during the hospital period in a patient with PE and oncological diseases, i.e. blood pressure ≤ 105 mm Hg, SpO2 ≤ 87 %, pulmonary artery pressure &gt; 48 mm Hg, and leukocyte count &gt; 9.8  109/l. Conclusion. The risk factors of in-hospital death in patients with PE associated with oncological disease are atrial fibrillation, increased pulmonary artery pressure, leukocyte count, low blood pressure and saturation.

Exercise limitation in hypertrophic cardiomyopathy: combined stress echocardiography and cardiopulmonary exercise test.

The study aims to investigate exercise-limiting factors in hypertrophic cardiomyopathy (HCM) using combined stress echocardiography and cardiopulmonary exercise test. A symptom-limited ramp bicycle exercise test was performed in the semi-supine position on a tilting dedicated ergometer. Echocardiographic images were obtained concurrently with gas exchange measurements along predefined stages of exercise. Oxygen extraction was calculated using the Fick equation at each activity level. Thirty-six HCM patients (mean age 67±6years, 72% men, 18 obstructive HCM) were compared with age and sex-matched 29 controls. At rest, compared with controls, E/E' ratio (6.26±2.3 vs. 14±2.5, P<0.001) and systolic pulmonary artery pressures (SPAP) (22.6±3.4 vs. 34±6.2mmHg, P=0.023) were increased. Along with the stages of exercise (unloaded; anaerobic threshold; peak), diastolic function worsened (E/e' 8.9±2.6 vs. 13.8±3.6 P=0.011; 9.4±2.3 vs. 18.6±3.3 P=0.001; 8.7±1.9 vs. 21.5±4, P<0.001), SPAP increased (23±2.7 vs. 33±4.4, P=0.013; 26±3.2 vs. 40±2.9, P<0.001; 26±3.5 vs. 45±7mmHg, P<0.001), and oxygen consumption (6.6±1.7 vs. 6.8±1.6, P=0.86; 18.1±2.2 vs. 14.6±1.5, P=0.008; 20.3±3 vs. 15.1±2.1mL/kg/min, P=0.01) was reduced. Oxygen pulse was blunted (6.3±1.8 vs. 6.2±1.9, P=0.79; 10±2.1 vs. 8.8±1.6, P=0.063; 12.2±2 vs. 8.2±2.3mL/beat, P=0.002) due to an insufficient increase in both stroke volume (92.3±17 vs. 77.3±14.5 P=0.021; 101±19.1 vs. 87.3±15.7 P=0.06; 96.5±12.2 vs. 83.6±16.1mL, P=0.034) and oxygen extraction (0.07±0.03 vs. 0.07±0.02, P=0.47; 0.13±0.02 vs. 0.10±0.03, P=0.013; 0.13±0.03 vs. 0.11±0.03, P=0.03). Diastolic dysfunction, elevated SPAP, and the presence of atrial fibrillation were associated with reduced exercise capacity. Both central and peripheral cardiovascular limitations are involved in exercise intolerance in HCM. Diastolic dysfunction seems to be the main driver for this limitation.

Correlates of Plasma NT-proBNP/Cyclic GMP Ratio in Heart Failure With Preserved Ejection Fraction: An Analysis of the RELAX Trial.

Phosphodiesterases degrade cyclic GMP (cGMP), the second messenger that mediates the cardioprotective effects of natriuretic peptides. High natriuretic peptide/cGMP ratio may reflect, in part, phosphodiesterase activity. Correlates of natriuretic peptide/cGMP in patients with heart failure with preserved ejection fraction are not well understood. Among patients with heart failure with preserved ejection fraction in the RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure With Preserved Ejection Fraction) trial, we examined (1) cross-sectional correlates of circulating NT-proBNP (N-terminal pro-B-type natriuretic peptide)/cGMP ratio, (2) whether selective phosphodiesterase-5 inhibition by sildenafil changed the ratio, and (3) whether the effect of sildenafil on 24-week outcomes varied by baseline ratio. In 212 subjects, NT-proBNP/cGMP ratio was calculated at randomization and 24 weeks. Correlates of the ratio and its change were examined in multivariable proportional odds models. Whether baseline ratio modified the sildenafil effect on outcomes was examined by interaction terms. Higher NT-proBNP/cGMP ratio was associated with greater left ventricular mass and troponin, the presence of atrial fibrillation, and lower estimated glomerular filtration rate and peak oxygen consumption. Compared with placebo, sildenafil did not alter the ratio from baseline to 24 weeks (P=0.17). The effect of sildenafil on 24-week change in peak oxygen consumption, left ventricular mass, or clinical composite outcome was not modified by baseline NT-proBNP/cGMP ratio (P-interaction >0.30 for all). Among patients with heart failure with preserved ejection fraction, higher NT-proBNP/cGMP ratio associated with an adverse cardiorenal phenotype, which was not improved by selective phosphodiesterase-5 inhibition. Other phosphodiesterases may be greater contributors than phosphodiesterase-5 to the adverse phenotype associated with a high natriuretic peptide/cGMP ratio in HFpEF. clinicaltrials.gov. Identifier: NCT00763867.

A three-dimensional left atrial motion estimation from retrospective gated computed tomography: application in heart failure patients with atrial fibrillation.

A reduced left atrial (LA) strain correlates with the presence of atrial fibrillation (AF). Conventional atrial strain analysis uses two-dimensional (2D) imaging, which is, however, limited by atrial foreshortening and an underestimation of through-plane motion. Retrospective gated computed tomography (RGCT) produces high-fidelity three-dimensional (3D) images of the cardiac anatomy throughout the cardiac cycle that can be used for estimating 3D mechanics. Its feasibility for LA strain measurement, however, is understudied. The aim of this study is to develop and apply a novel workflow to estimate 3D LA motion and calculate the strain from RGCT imaging. The utility of global and regional strains to separate heart failure in patients with reduced ejection fraction (HFrEF) with and without AF is investigated. A cohort of 30 HFrEF patients with (n = 9) and without (n = 21) AF underwent RGCT prior to cardiac resynchronisation therapy. The temporal sparse free form deformation image registration method was optimised for LA feature tracking in RGCT images and used to estimate 3D LA endocardial motion. The area and fibre reservoir strains were calculated over the LA body. Universal atrial coordinates and a human atrial fibre atlas enabled the regional strain calculation and the fibre strain calculation along the local myofibre orientation, respectively. It was found that global reservoir strains were significantly reduced in the HFrEF + AF group patients compared with the HFrEF-only group patients (area strain: 11.2 ± 4.8% vs. 25.3 ± 12.6%, P = 0.001; fibre strain: 4.5 ± 2.0% vs. 15.2 ± 8.8%, P = 0.001), with HFrEF + AF patients having a greater regional reservoir strain dyssynchrony. All regional reservoir strains were reduced in the HFrEF + AF patient group, in whom the inferior wall strains exhibited the most significant differences. The global reservoir fibre strain and LA volume + posterior wall reservoir fibre strain exceeded LA volume alone and 2D global longitudinal strain (GLS) for AF classification (area-under-the-curve: global reservoir fibre strain: 0.94 ± 0.02, LA volume + posterior wall reservoir fibre strain: 0.95 ± 0.02, LA volume: 0.89 ± 0.03, 2D GLS: 0.90 ± 0.03). RGCT enables 3D LA motion estimation and strain calculation that outperforms 2D strain metrics and LA enlargement for AF classification. Differences in regional LA strain could reflect regional myocardial properties such as atrial fibrosis burden.

Prospective 1-year results of atrial fibrillation ablation using the pentaspline pulsed field ablation catheter: The initial French experience

BackgroundPulsed field ablation has recently emerged as an interesting non-thermal energy for atrial fibrillation ablation. At a time of rapid spread of this technology, there is still a lack of prospective real-life data. AimTo describe multicentre prospective safety and 1-year efficacy data in three of the first French centres to use pulsed field ablation. MethodsAll consecutive patients undergoing a first pulsed field ablation were included prospectively. The primary outcome was freedom from documented atrial arrhythmia. The safety endpoint was a composite of major adverse events. Univariate and multivariable analyses, including patient and procedural characteristics, were performed to identify factors predictive of recurrence. ResultsBetween May 2021 and June 2022, 311 patients were included (paroxysmal atrial fibrillation in 53%, persistent atrial fibrillation in 35% and long-standing persistent atrial fibrillation in 11%). Additional non-pulmonary vein pulsed field ablation applications were performed in 104/311 patients. One-year freedom from arrhythmia recurrence was 77.6% in the overall population and was significantly higher in patients with paroxysmal atrial fibrillation (88.4%) compared with patients with persistent atrial fibrillation (69.7%; P<0.001) and those with long-standing persistent atrial fibrillation (49.0%; P<0.001). The major complication rate was 2.6% (tamponade in four patients, stroke in two patients and coronary spasm in one patient). Besides the usual predictors of recurrences (left atrium size, CHA2DS2-VASc score, type of atrial fibrillation), the presence of atrial fibrillation at procedure start was independently associated with arrhythmia recurrence (hazard ratio: 2.04, 95% confidence interval: 1.10–3.77). ConclusionIn this prospective multicentre real-world study, pulsed field ablation for atrial fibrillation ablation seems to be associated with a good safety profile and rather favourable acute and 1-year success rates.

Transient ischemic attack in the vertebrobasilar vascular territory as a cause of isolated vertigo

Transient ischemic attack (TIA) in the vertebrobasilar vascular territory (VB) causes difficulties in diagnosis when it manifests only with vestibular symptoms. Issues relating to the differential diagnosis of TIA are discussed, awareness of which is necessary for the selection of informative methods of examination and the prescription of effective stroke prevention in patients with an episode of isolated dizziness. The likelihood of TIA as the cause of dizziness is increased by the patients' high cardiovascular risk, the presence of atrial fibrillation, severe instability during an attack, and head and/or neck pain. If a TIA in VB is suspected, it is advisable to perform a minimal instrumental examination, including computed tomography (CT) of the brain and CT angiography or diffusion-weighted magnetic resonance imaging (MRI) and MRI angiography. In case of doubt, additional information can be obtained by a perfusion CT or MRI as well as a post-contrast MRI. When interpreting the results of these methods of examination, their limitations in terms of application time and resolution should be taken into account.

Abstract TP254: The Incidence Rate and Risk Factors of In-Hospital Onset Stroke Among 83,990 Hospitalized Patients

Introduction: Clinical characteristics of patients with in-hospital onset stroke (IHOS) compared to those with out-of-hospital onset stroke are reported to be late detection of stroke onset, less use of rt-PA, presence of atrial fibrillation, and poor outcome. Among hospitalized patients, however, clinical characteristics of patients with IHOS has not been clear. The purpose of this study is to clarify the incidence rate of IHOS among hospitalized patients and to investigate the risk factors associated with IHOS. Methods: Patients consecutively admitted to the Nippon Medical School hospital between April 2018 and March 2023 were assessed. Patients under 18 years and discharged within 24 hours were excluded. Furthermore, patients admitted in Neurology and Neurosurgery also were excluded to remove in-hospital onset recurrent stroke from our study. First, we calculated the incidence rate of IHOS among hospitalized patients. Next, all patients were divided into two groups, Stroke group had IHOS and Control group did not, and investigated the risk factors associated with IHOS using multivariate analysis. Results: Of 98,225 patients hospitalized, 83,990 patients (median age was 69 [54-77] years and 55.3% were male) were enrolled into this study. The number of IHOS patients were 101. Thus, the incidence rate of IHOS was 0.12%. A half of them (n=49) had stroke onset within 1 week after admission. Stroke group had higher mortality (14.9% vs. 2.7%, p &lt; 0.01) and longer length of stay (36 days vs. 8 days, p &lt; 0.01) than Control group. Multivariate analysis demonstrated that risk factors associated with IHOS were old age (OR 1.03, p &lt; 0.01), hypertension (OR 1.57, p = 0.04), diabetes mellitus (OR 1.61, p = 0.03), atrial fibrillation (OR 2.43, p &lt; 0.01), emergency admission (OR 3.38, p &lt; 0.01) and low serum albumin level (OR 0.66, p = 0.03). Conclusions: Among 83,990 hospitalized patients, the incidence rate of IHOS was 0.12%. Risk factors associated with IHOS were old age, hypertension, diabetes mellitus, atrial fibrillation, emergency admission and low serum albumin level. Therefore, among hospitalized patients, cases with emergency admission and cerebrovascular risk factors including atrial fibrillation should be payed attention to prevent in-hospital onset stroke.

ОСТРЫЙ КОРОНАРНЫЙ СИНДРОМ И КОРОНАВИРУСНАЯ ИНФЕКЦИЯ: ПЕРЕСЕЧЕНИЕ ДВУХ ПАНДЕМИЙ

Вackground Acute coronary events (ACEs) in combination with SARS-COV 2 infection have their own distinctive features that determine the dynamics of the disease and differences in therapy. Since at present there are no generally recognized algorithms for the management of such patients, there is a need to search for approaches to determine the risk of adverse outcomes of this disease phenotype. Aim of the study. To study the peculiarities of clinical course and to build a prognostic model of lethal outcomes risk in patients with ACS combined with SARS-COV 2 infection at the hospital stage Characteristics of patients and methods of research. The study included 225 patients admitted to a regional vascular center with a diagnosis of ACS who had a verified diagnosis of SARS-Cov 2 infection. Initially, 120 general clinical, biochemical and instrumental parameters were evaluated. Results and Conclusion. A predictive model was constructed with the identification of eight variables most influencing outcomes: age, the presence of atrial fibrillation (except for the first time detected in ACS), severe and extremely severe course of SARS-COV 2 infection, AKI, CKD, ferritin, albumin and glycemia in blood serum on admission. Conclusion. The proposed author's approach for assessing the risk of death in acute coronary syndrome in combination with SARS-CoV 2 has good predictive accuracy and is easy to use.

Mitral Annulus Calcium Score in Patients With Calcific Mitral Stenosis Undergoing Invasive Hemodynamic Assessment.

Aortic valve calcium score is associated with hemodynamic severity of aortic stenosis. Whether this association is present in calcific mitral stenosis remains unknown. This study was a retrospective analysis of consecutive patients with mitral stenosis secondary to mitral annular calcification (MAC) undergoing transseptal catheterization. All patients underwent invasive mitral valve assessment via direct left atrial and left ventricular pressure measurement. Computed tomography within 1 year of cardiac catheterization and with adequate visualization of the mitral annulus was included. MAC calcium score quantification by Agatston method was obtained offline using dedicated software (Aquarius, TeraRecon, V.4). Median patient age was 66.9±11.2 years, 47% of patients were women, 50% had coronary artery disease, 40% had atrial fibrillation, 47% had prior cardiac surgery, and 33% had prior chest radiation. Median diastolic mitral valve gradient was 9.4±3.4 mm Hg on echocardiography and 8.5±4 mm Hg invasively. Invasive median mitral valve area using the Gorlin formula was 1.87±0.9 cm2. Median MAC calcium score for the cohort was 7280±7937 Hounsfield units. MAC calcium score correlated with the presence of atrial fibrillation (P=0.02) but was not associated with other comorbidities. There was no correlation between MAC calcium score and mitral valve area (r=0.07; P=0.6) or mitral valve gradient (r=-0.03; P=0.8). MAC calcium score did not correlate with invasively measured mitral valve gradient and mitral valve area in patients with MAC-related mitral stenosis, suggesting that calcium score should not be used as a surrogate for invasive hemodynamic parameters.

Clinical significance of aortic spontaneous echo contrast in patients with nonvalvular atrial fibrillation.

Little is known about spontaneous echo contrast (SEC) in the descending aorta (DASEC), occurring with or without SEC in the left atrium (LASEC), in the presence of atrial fibrillation (AF). We examined the clinical significance of DASEC, including its relationship with LASEC, in patients with nonvalvular AF. Among 176 patients, 41 (23%) had DASEC and 51 (29%) had LASEC. The patients were divided into four groups based on the presence/absence of LASEC and DASEC, as Group A: no SEC (n=107); Group B: only LASEC (n=28); Group C: only DASEC (n=18); and Group D: both types of SEC (n=23). Clinical and echocardiographic parameters were compared between groups, and the possible determinants of DASEC were evaluated. Age, sex, and CHA2 DS2 -VASc score were similar in the four groups. Group D was more likely to have an increased LA diameter, decreased left ventricular ejection fraction (LVEF), and low LA appendage velocity compared to Group A. Group C had a smaller LA diameter and a higher appendage velocity than Group B. Multivariate logistic regression analysis, with age ≥75 years, female sex, LASEC, LVEF<50%, and presence of DA plaques included as covariates, showed that LASEC (OR 4.22, 95% CI 1.92-9.26, p<.001) and LVEF<50% (OR 2.70, 95% CI 1.12-6.52, p=.027) were significant determinants of DASEC. The prevalence of DASEC increased with increasing LASEC severity in order of none (13%), mild (28%), and dense (50%) (p<.001). In nonvalvular AF patients, DASEC is common, and it partly originates from LASEC, particularly in the presence of LV systolic dysfunction.

Catheter Ablation of Paroxysmal and Persistent Atrial Fibrillation in Patients with Secondary Atrial Septal Defect. Evaluation of the Results and Impact on the Quality of Life

Introduction. The presence of atrial fibrillation (AF) in patients with secondary atrial septal defect (ASD) has significant impact on their quality of life (QoL) and reduces life expectancy. Current guidelines recommend catheter ablation (CA) for patients with AF in case of medical treatment failure, however, its use in patients with AF and ASD is still poorly studied.&#x0D; The aim. To study the efficacy and safety of CA and its impact on the QoL in patients with AF and secondary ASD.&#x0D; Materials and methods. In 2003-2023, 1408 patients with secondary ASD were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Of these, 54 patients who had AF and underwent the CA procedure were included in group 1 of our study. There were 36 (66.7%) men and 18 (33.3%) women aged 24-76 years (mean age 61.4 ± 9.8 years). Four (9.3%) patients had persistent AF and 50 (90.7%) patients had paroxysmal AF. Fifty-six patients with paroxysmal or persistent AF and with the comparable age, duration of symptoms and associated pathology but without ASD were examined as group 2. The type and results of surgical interventions were analyzed according to surgical reports. The results of the treatment and QoL were assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire during the follow-up period 1, 2 and 3 months after the procedure.&#x0D; Results. Pulmonary vein isolation was performed in all 54 (100%) patients of the group 1, as well as cavotricuspid isthmus ablation in 26 (48.2%) cases, cavotricuspid isthmus ablation and left atrial linear ablation in 2 (3.6%) cases. Type, length and complication of the procedure were comparable to those in the group 2. Fourty-four (81.5%) patients with ASD were free from AF 3 months after procedure, and their results did not differ from those obtained in the group 2 (p &gt; 0.05). Average QoL indicators according to AFEQT significantly improved in both groups of patients who underwent CA. The differences in post-treatment QoL between patients of both groups were insignificant (p &gt; 0.05).&#x0D; Conclusions. CA was found to be safe and beneficial in patients with AF and secondary ASD. The rate of procedural complications and cure rate in patients with AF and secondary ASD (81.5%) were compatible to those in patients without ASD (80.5%). AF has negative effect on the main indicators of the patient’s life. In patients with secondary AF with ASD who underwent CA, a significant improvement in AF symptoms and QoL according to the AFEQT questionnaire (total score 56.1 ± 2.7 before the procedure vs. 78.7 ± 4.0 at follow-up) was noted.

The Prognostic Significance of Atrial Fibrillation and Left Atrium Size in Patients with Aortic Stenosis.

Aim Aortic stenosis increases left atrial (LA) pressure and may lead to its remodeling. This can cause supraventricular arrhythmia. The aim of this study was to determine if the size of the LA and the presence of atrial fibrillation are related to the prognosis of patients with aortic stenosis.Material and methods Clinical evaluation and standard transthoracic echocardiographic studies were performed in 397 patients with moderate to severe aortic stenosis.Results In all patients, LA dimension above the median (≥43 mm) was associated with a significantly higher risk of death [HR 1.79 (CL 1.06-3.03)] and a LA volume above the median of 80 ml was associated with a significantly higher risk of death [HR 2.44 (CI 1.12-5.33)]. The presence of atrial fibrillation was significantly associated with a higher risk of death (p &lt;0.0001). The presence of atrial fibrillation [HR 1.69 (CI 1.02-2.86)], lower left ventricular ejection fraction [HR 1.23 (CI 1.04-1.45)], higher NYHA heart failure class [HR 4.15 (CI 1.40-13.20)] and renal failure [HR 2.10 (CI 1.31-3.56)] were independent risk factors of death in patients in aortic stenosis.Conclusion The size and volume of the LA and the occurrence of atrial fibrillation are important risk factors for death in patients with aortic stenosis. The presence of renal dysfunction, low left ventricular ejection fraction, high NYHA functional class and atrial fibrillation are independent risk factors of poor prognosis in patients with aortic stenosis.

CHARACTERISTICS OF COGNITIVE FUNCTIONS DURING THE RECOVERY PERIOD AFTER ISCHEMIC STROKES IN PATIENTS WITH IMPAIRED CARDIAC RHYTHM AND CONDUCTION

Introduction. Disturbances of cardiac rhythm and conduction are risk factors for cognitive impairments.&#x0D; Aim: to determine peculiarities of the cognitive status in patients with impaired heart rhythm and conduction during the recovery period after ischemic non-lacunar strokes.&#x0D; Material and methods. This study included 52 patients with atrial fibrillation, 18 patients with atrioventricular block 2-3 degrees, and 24 patients with sinus rhythm who had an ischemic non-lacunar stroke during the last 6 months. Cognitive status was measured using the MMSE, MoCA, ADAS-cog scales, the Clock Drawing Test, the “5 Words” test, and the frontal assessment battery.&#x0D; Results. According to the MoCA scale, patients with atrial fibrillation and atrioventricular block were significantly more often diagnosed with post-stroke cognitive impairments (71.2% and 77.8%, respectively) compared with patients having sinus rhythm (37.5%). Among patients with cognitive impairments by the MoCA scale, the presence of atrial fibrillation was associated with a significant decrease in MoCA scale scores, compared with sinus rhythm (18.0 (17.0-22.0) versus 22.0 (18.0-23.0)). In patients with sinus rhythm, the clock-drawing test had higher scores (8.0 (7.0-9.0)) compared to cases with atrial fibrillation (7.0 (5.8-8.0)). Patients with sinus rhythm had higher values of the frontal assessment battery (15.0 (14.0-15.0)) compared to atrial fibrillation (13.0 (12.0-14.0)) and atrioventricular blocks (14.0 (13.0- 15.0)).&#x0D; Conclusions. During the first 6 months after schemic non-lacunar strokes, patients with impaired heart rhythm and conduction demonstrated a significant prevalence of cognitive impairments by the MoCA scale and significantly worse scores of cognitive tests for executive functions.

The Effect of Laterality in Modified Radical Neck Dissection on the Risk of Intraoperative Bradycardia: A Retrospective Cohort Study.

Background Intraoperative bradycardia is a hardly studied complication of modified radical neck dissection (MRND). Methods Using convenient sampling, we retrospectively studied a cohort (n = 159) of patients who underwent MRND at Papanikolaou General Hospital, Thessaloniki, Greece between 2019 and 2020 to investigate whether MRND laterality (bilateral vs. unilateral) affects the occurrence of intraoperative bradycardia (a pulse rate lower than 50 bpm). Results Roughly two-thirds of the patients underwent unilateral MRND, and the rest underwent bilateral MRND. Bradycardia was observed in 25.8% of the cohort. We used logistic regression and investigated several potential confounding factors. Unilateral MRND was associated with a lower risk of intraoperative bradycardia compared to bilateral MRND in the simple regression model (relative risk (RR): 0.555, 95% confidence interval (CI): 0.331-0.932, p = 0.027). MRND laterality was not significantly associated with intraoperative bradycardia (p = 0.082) in the multiple regression model, whereas an American Society of Anesthesiologists physical status (ASA-PS) score of 3 vs. 4 (adjusted odds ratio (aOR) = 0.125, 95% CI: 0.0340-0.457, p = 0.002), the presence of atrial fibrillation (aOR = 11.4, 95% CI: 4.10-31.8, p < 0.001) and induction of anesthesia with dexmedetomidine (aOR = 4.57, 95% CI: 1.34-15.6, p = 0.015) were significantly associated with intraoperative bradycardia. Conclusions MRND laterality was close to statistical significance. Bigger sample sizes may provide more definitive information since the effect of MRND laterality on intraoperative bradycardia remains unclear. Our findings can inform clinical practice so that clinicians know when to expect bradycardia and are better prepared to manage it.