Presence Of Nonsustained Ventricular Tachycardia Research Articles

A Case of Cardiomyopathy Associated with CD36 Deficiency: Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis.

We herein report a patient with type I CD36 deficiency. The patient was initially suspected of having isolated cardiac sarcoidosis based on the presence of non-sustained ventricular tachycardia, delayed myocardial enhancement on magnetic resonance imaging (MRI), and diffuse accumulation of 18F-fluorodeoxyglucose (18F-FDG) on cardiac positron emission tomography (PET). Our findings suggest that the diagnosis of cardiomyopathy associated with CD36 deficiency is often missed, highlighting the importance of a differential diagnosis of isolated cardiac sarcoidosis.

Impact on clinical outcome of ventricular arrhythmias in patients undergoing transcatheter aortic valve implantation (TAVI)

Abstract Background Transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis has considerably grown in the latest years. There are limited data, however, about predictors of long-term prognosis in this population. Particularly, whether ventricular arrhythmic burden is associated with clinical outcome has poorly been investigated. Purpose The aim of our study was to investigate the association between ventricular arrhythmias and adverse clinical outcomes in patients undergoing TAVI. Methods We performed a 24-hour 3-channel ECG Holter monitoring (HM) in 267 consecutive patients who underwent TAVI for severe aortic stenosis at our Centre within 30 days from a successful procedure (average 10.2 days, range 2-30). For each patient we obtained the number of premature ventricular complexes (PVCs) and the presence of non-sustained ventricular tachycardia (NSVT, >3 PVCs with a rate >100 bpm). Frequent PVCs were defined as the presence of at least 30 PVCs per hour. We also collected clinical and echocardiographic findings for each patient. Assessment of clinical events at follow-up was performed by clinical visits or telephone interviews of patients or relatives (in case of fatal events). The primary endpoint of the study was the occurrence of cardiovascular events (CVE), a composite of cardiovascular death and resuscitation from cardiac arrest. All-cause-mortality was assessed as secondary endpoint. Survival Cox regression was applied to assess the univariate and multivariate association of clinical, echocardiographic and HM variables with endpoints. Results Clinical outcome could be obtained for 228 patients (85%), for an average follow-up of 3.5 years (range 1.0-8.6). Among these patients, frequent PVCs (≥30/hour) and episodes of NSVT at HM were found in 47 (20.6%) and 52 (22.4%) patients, respectively. CVE occurred in 26 patients (11.4%) and 63 patients died (27.6%). Frequent PVCs at HM were detected in 12 patients with (46.2%) and 35 patients without (17.3%) CVE (HR 2.29; 95% CI 1.03-5.09; p=0.04). One or more episodes of NSVT were detected in 9 patients with (34.6%) and 43 patients without (21.3%) CVE (HR 2.29; 95% CI 1.03-5.09; p=0.04), although it was not predictive of all-cause mortality (HR 1.18; 95% CI 0.48-2.77; p=0.52). Both the presence of PVCs>30/hour (HR 1.19; 95% CI 0.69-2.08; p=0.53) and NSVT (HR 0.93; 95% CI 0.52-1.65; p=0.22) were not significantly associated with all-cause mortality. Moreover, no clinical (age, gender, cardiovascular risk factors) and echocardiographic (aortic valve area, trans-aortic mean gradient, left ventricle mass and ejection fraction) variable showed significant association with both the primary and secondary outcome in our patients. Conclusions In our study the detection of frequent PVCs at HM after TAVI was a major predictor of CVE (cardiovascular death/cardiac arrest), suggesting that a 24-hour HM after TAVI can be helpful for risk stratification of these patients.

Prognostic role of atrial fibrillation in patients with non-compaction cardiomyopathy

Aim. To evaluate the prognostic role of atrial fibrillation (AF) as a predictor of adverse events and outcomes in a cohort of patients with non-compaction cardiomyopathy (NCCM).Material and methods. We examined 216 patients with NCCM (140 men and 76 women, median age, 39 (30; 50) years). In addition to traditional clinical methods, all patients underwent late gadolinium-enhanced cardiac magnetic resonance imaging (MRI). The endpoints of the study included progression of NYHA class III heart failure (HF) with the need for hospitalization, ventricular tachyarrhythmias, and thromboembolic events (TEEs).Results. There were 54 out of 216 (23,6%) patients with AF, of which 18 had paroxysmal AF, 16 — persistent AF, and 20 — permanent AF. During the follow-up period (median follow-up, 36 (6; 72) months), 98 out of 216 (45,4%) patients with NCCM had adverse events and outcomes as follows: 16 (7,4%) had ventricular tachyarrhythmias, of which 12 (5,6%) — sudden cardiac death with successful resuscitation and implantation of an implantable cardioverter-defibrillator; 62 (28,7%) patients had NYHA III-IV class HF progression; 20 (9,3%) patients had TEEs. The rate of adverse cardiac events was significantly higher in patients with AF (74,1% vs 35,8%, χ2=23,93, p<0,001) compared with patients without AF, including the incidence of TEEs (20,4% vs 5,6%, χ2=10,58, p=0,002) and HF progression to class III (46,3% vs 22,8%, χ2=10,9, p=0,002).Multivariate analysis showed that the following most significant predictors of HF progression risk: left ventricular ejection fraction (LVEF) <50% according to cardiac MRI (hazard ratio (HR), 95,8; 95% confidence interval (CI), 10,2 -898,6; p=0,0001), presence of AF (HR, 8,2; 95% CI, 2,2-31,3; p=0,0022) and left atrial volume index (LAVI) >43 ml/m2 (HR, 5,2; 95% CI, 2,1-12,8; p=0,0004); predictors of TEE risk were the presence of AF (HR, 6,5; 95% CI, 2,0-20,8; p=0,0020) and LAVI >43 ml/m2 (HR, 6,0; 95% CI, 1,8-19,7; p=0,036). No association of AF with ventricular tachyarrhythmias was found in the study cohort of patients with NCCM. Predictors of ventricular tachyarrhythmias were LVEF <50% (HR, 4,5; 95% CI, 2,950,4; p=0,0241) and the presence of non-sustained ventricular tachycardia (HR, 3,5; 95% CI, 1,3-9,3 p=0,0139).Conclusion. The present study shows that, along with the traditional predictor of adverse events in patients with NCCM (LVEF <50%), the identified additional predictors (AF and LAVI >43 ml/m2) can be used to identify patients at high risk of complicated NCCM for the timely prevention and treatment.

Severity of obstructive sleep apnea is associated with the presence of frequent premature ventricular contractions

Abstract Funding Acknowledgements Type of funding sources: None. Background Obstructive Sleep Apnea (OSA) is a highly prevalent disorder in developed countries. It is well known that OSA is strongly associated with Atrial Fibrillation (AFib) and sinus pauses, but its impact on ventricular arrhythmias is less clear. Purpose The aim of this study was to evaluate the presence of rhythm disorders in 24h Holter in patients with OSA and their association with different grades of OSA severity. Methods We performed a retrospective single-center cohort study. The study included patients who underwent both a level 3 polysomnography and a 24h Holter test at our hospital center between 1 January 2015 and 31 December 2019 (n=464). We excluded patients without OSA, patients with OSA under current treatment with CPAP/APAP and those who only had 24h Holter test after starting CPAP/APAP. Patients were divided into 3 groups according to the OSA severity in the sleep study test: mild, moderate and severe. The Holter was analyzed for the presence of AFib, number of premature atrial contractions (PACs), presence of runs of PACs, number of premature ventricular contractions (PVCs), presence of non-sustained ventricular tachycardia (NSVT) and the presence of conduction disorders. Premature contractions were considered frequent when greater than 30 per hour. These results were compared in the three groups. Results This cohort included 233 patients: 89 classified into mild, 74 into moderate and 70 into severe OSA form. The baseline characteristics of patients are depicted in table 1. The overall median age was 67 (57-73) years and was similar between the groups. Male gender was more prevalent in the overall sample and statistically more prevalent in the severe OSA group (56.2% in mild vs 75.7% in severe OSA, p=0.08). Regarding cardiovascular risk factors, there was no difference between the groups except for obesity, with higher body mass indexes translating into more OSA severity (p=0.049). Results are shown in table 2. We observed that OSA severity and AFib are associated. AFib was more prevalent in the moderate and severe forms of OSA (13.5% in moderate and 18.6% in severe OSA vs. 6.7% in mild OSA; p=0.041). The prevalence of atrioventricular block and the prevalence of intraventricular block were higher in the moderate group of OSA (p=0.048; p=0.007). There was no association between OSA severity and the burden and complexity of PACs. On the contrary, we found a higher percentage of frequent PVCs in more severe forms of OSA (20.3 and 21.4% in moderate and severe group, p=0.031). Conclusion In the present study the severity of OSA was associated with a higher prevalence of AFIb and conductions disorders as expected. However, it was also associated with higher prevalence of frequent premature ventricular contractions but not with atrial premature contractions. Further studies are needed to confirm these findings and to study the benefit of level 3 polysomnography testing in patients with frequent PVCs.

PO-03-232 PROGNOSTIC IMPACT OF NON-SUSTAINED VENTRICULAR TACHYCARDIA IN WILD-TYPE TRANSTHYRETIN CARDIAC AMYLOIDOSIS

Non-sustained ventricular tachycardia (NSVT) detected on rhythm monitoring is common in AL amyloidosis, but data on its prevalence and prognostic impact in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) are sparse. To investigate the prevalence of NSVT detected during clinically-indicated ambulatory Holter monitoring and its association with incident sustained VT and ventricular fibrillation (VF) in ATTRwt-CA patients. A single-center retrospective cohort of ATTRwt-CA patients without known history of sustained VT/VF was included (2011-2022). The presence and characteristics of NSVT (≥3 beats) at the first Holter after the ATTRwt-CA diagnosis at our institution were documented. The endpoint was the first occurrence of sustained VT or VF recorded by an implantable cardioverter-defibrillator (ICD) or other methods (in patients without ICD), and it was comparatively assessed in patients with and without NSVT with Kaplan-Meier analysis. Multivariate Cox regression analyses using stepwise variable selection were also performed to identify predictors of incident VT/VF. A total of 219 patients with ATTRwt-CA were included (mean age 74.9 years; 95% males; mean LVEF 52%). Of them, 8 had an ICD at baseline while 14 underwent ICD implantation within a 6-month window from baseline. Mean Holter monitoring duration was 25.6 hours and 53% of patients had at least one NSVT run at index Holter monitor with mean total ventricular ectopy burden 3.8%. After mean follow up 35.2 months, 17 patients experienced the primary outcome. Patients with NSVT had a lower survival free of VT/VF compared to those without NSVT (log-rank p=0.01; figure). In multivariable analysis, the presence of NSVT (HR 3.95, 95% CI 1.10-14.0) and the number of NSVT runs (HR 1.003, 95% 1.00-1.01, per run) were significant predictors of future VT/VF. NSVT is highly prevalent among patients with ATTRwt-CA and confers an increased risk of incident sustained ventricular arrhythmias. This finding has implications in the risk stratification and decision-making for the prevention of sudden cardiac death in these patients.

395 ASSESSMENT OF VENTRICULAR ARRHYTHMIAS IN PATIENTS UNDERGOING TRANCATHETER AORTIC VALVE IMPLANTATION (TAVI): IMPACT ON CLINICAL OUTCOME

Abstract Background Transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis has considerably grown in the latest years. There are limited data, however, about predictors of long-term prognosis in this population. Particularly, whether arrhythmic burden is associated with clinical outcome has poorly been investigated. Methods We performed 24-hour 3-channel ECG Holter recording (HM) in 284 consecutive patients who underwent TAVI for severe aortic stenosis at our Center within 30 days from a successful procedure (average 10.2 days, range 2-30). For each patient we obtained the number of premature ventricular complexes (PVCs) and the presence of non-sustained ventricular tachycardia (NSVT, ≥3 PVCs with a rate ≥100 bpm). Assessment of clinical events at follow-up was performed by clinical visits or telephone interview of patients or relatives (in case of fatal events). The primary end-point of the study was a composite of cardiovascular death and resuscitation from cardiac arrest (CVE); total mortality was assessed as secondary end-point. Results Frequent PVCs (≥30/hour) and episodes of NSVT were found in 49 (20.2%) and 52 (21.4%) patients, respectively. Clinical outcome was obtained for 243 patients (85.6%). At an average follow-up of 3.5 year (range 1.0-8.6), CVE occurred in 25 patients (8.8%) and 64 died (22.5%). Frequent PVCs at HM were detected in 11/25 (44.0%) and 38/218 (17.4%) patients with and without CVE, respectively (p=0.006). Episodes of NSVT were detected in 9/25 (36.0%) and 43/218 (19.7%) patients with and without CVE, respectively (p=0.07). Furthermore, frequent PVCs were present in 18/64 (28.1%) and 31/179 (17.3%) patients dead and alive, respectively (p=0.07), whereas NSVT episodes were detected in 17/64 (26.6%) and 35/179 (19.6%) patients dead and alive, respectively (p=0.29). Frequent PVCs maintained independent association with CVE after correction for confounding variables at multivariable analysis (HR 2.63; 95 CI 1.05-6.62; p=0.04). Conclusions Our data indicate that assessment of ventricular arrhythmic burden after TAVI is helpful to identify patients at increased risk of cardiovascular death/cardiac arrest during medium follow-up.

Ventricular activation time as a marker for complex ventricular arrhythmias, sudden cardiac death and ICD implantation in hypertrophic cardiomyopathy

Abstract Background Identification of patients with hypertrophic cardiomyopathy (HCM) who are at high risk of sudden cardiac death (SCD) is essential, as life-threatening ventricular arrhythmias (VAs) can be effectively prevented with an implantable cardioverter defibrillator (ICD). Risk stratification using HCM Risk-SCD score is recommended in the 2014 ESC guidelines for the management of patients with HCM. However, the role of electrocardiogram (ECG) in risk stratification is less well established. Purpose We investigated the association between the ventricular activation time (VAT), an ECG marker of the duration of ventricular depolarization, with the HCM Risk-SCD score, the presence of complex VAs, the implantation of an ICD and ICD-therapy for VAs. Methods Patients with a history of HCM, documented by echocardiography, were studied. The 12-lead ECG and echocardiography were performed on the same day. On ECG, we evaluated the VAT in milliseconds, between the onset of the QRS complex to the peak of R wave on V5 or V6 precordial ECG leads. A careful personal and family history for unexplained syncope and SCD was obtained, respectively. The presence of non-sustained ventricular tachycardia (NSVT) and ICD therapy were assessed either with 48h ECG recording or ICD interrogation. HCM Risk-SCD score was calculated by the corresponding ESC online calculator. Statistical analysis was performed using the SPSS software. Results Thirty-three patients with HCM were included (mean age 51±12 years, 78.8% male). According to the HCM Risk-SCD score, HCM patients were divided into three groups: low-risk (<4, 45.5%), intermediate-risk (4 to <6, 24.2%) and high-risk (>6, 30.3%) for SCD. Approximately half of the HCM patients had episodes of NSVT (48.5%) and an ICD (48.5%). Ventricular activation time was significantly prolonged in high-risk group compared either with intermediate-risk (74±24.5 vs 48.7±16.4, p=0.006) or low-risk (74±24.5 vs 44.3±12.6, p<0.001). HCM patients with NSVT had a significantly prolonged VAT compared with those without NSVT (62.19±25.2 vs 47.06±15.3, p=0.022). Moreover, HCM patients with an ICD had a higher VAT than those without an ICD (62.1±25.2 vs 47±15.3, p=0.003). VAT was also significantly prolonged in the group with appropriate ICD therapy for VAs compared with that without ICD therapy (82.8±22.1 vs 52.2±16.4, p=0.007). Finally, there was a significant positive correlation between VAT and NSVT (r=0.352, p=0.044), history of syncope (r=0.604, p<0.001), HCM risk-SCD score (r=0.493, p=0.004), ICD implantation (r=0.508, p=0.003) and ICD therapy (r=0.648, p=0.007) for VAs while there was not a correlation with the family history of SCD. Conclusion Prolongation of VAT is associated with NSVT, HCM risk score for SCD, ICD implantation and ICD therapy for VAs in patients with HCM and it seems to be a novel, easy to measure, ECG marker for risk stratification. Funding Acknowledgement Type of funding sources: None.

Association of Premature Ventricular Contraction Burden on Serial Holter Monitoring With Arrhythmic Risk in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

A high burden of premature ventricular contractions (PVCs) at disease diagnosis has been associated with an overall higher risk of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC). Data regarding dynamic modification of PVC burden at follow-up with Holter monitoring and its impact on arrhythmic risk in ARVC are scarce. To describe changes in the PVC burden and to assess whether serial Holter monitoring is dynamically associated with sustained ventricular arrhythmias during follow-up in patients with ARVC. In this cohort study, patients with a definite ARVC diagnosis, available Holter monitoring results at disease diagnosis, and at least 2 additional results of Holter monitoring during follow-up were enrolled from 6 ARVC registries in North America and Europe. Data were collected from June 1 to September 15, 2021. The association between prespecified variables retrieved at each Holter monitoring follow-up (ie, overall PVC burden; presence of sudden PVC spikes, defined as absolute increase in PVC burden ≥5000 per 24 hours or a relative ≥75% increase, with an absolute increase of ≥1000 PVCs; presence of nonsustained ventricular tachycardia [NSVT]; and use of β-blockers and class III antiarrhythmic drugs) and sustained ventricular arrhythmias occurring within 12 months after that Holter examination was assessed using a mixed logistical model. In 169 enrolled patients with ARVC (mean [SD] age, 36.3 [15.0] years; 95 men [56.2%]), a total of 723 Holter examinations (median, 4 [IQR, 4-5] per patient) were performed during a median follow-up of 54 (IQR, 42-63) months and detected 75 PVC spikes and 67 sustained ventricular arrhythmias. The PVC burden decreased significantly from the first to the second Holter examination (mean, 2906 [95% CI, 1581-4231] PVCs per 24 hours; P < .001). A model including 24-hour PVC burden (odds ratio [OR] 1.50 [95% CI, 1.10-2.03]; P = .01), PVC spikes (OR, 6.20 [95 CI, 2.74-13.99]; P < .001), and NSVT (OR, 2.29 [95% CI, 1.10-4.51]; P = .03) at each follow-up Holter examination was associated with sustained ventricular arrhythmia occurrence in the following 12 months. These findings suggest that in patients with ARVC, changes in parameters derived from each Holter examination performed during follow-up are associated with the risk of sustained ventricular arrhythmias within 12 months of disease diagnosis.

Abstract 10746: Left Atrial Strain and the Risk of Arrhythmias on Extended Ambulatory Cardiac Monitoring: The Multi-Ethnic Study of Atherosclerosis

Introduction: Abnormalities in left atrial (LA) function can be identified before the development of overt LA structural changes. Little is known about the relationship between LA mechanics and the risk of subclinical atrial and ventricular arrhythmias. Methods: 1,441 participants of the Multi-Ethnic Study of Atherosclerosis completed speckle-tracking echocardiography and Zio Patch monitoring from 2016-2018 (mean age 73 years, 52% female); participants in atrial fibrillation (AF) during echocardiography or cardiac monitoring were excluded. Absolute values of LA reservoir, booster pump, and conduit strain were measured. We evaluated associations of LA strain measures with atrial arrhythmias (presence of monitor-detected AF, AF burden, frequency of premature atrial contractions [PACs], frequency of supraventricular tachycardia [SVT] runs) and with ventricular arrhythmias (frequency of premature ventricular contractions, presence of non-sustained ventricular tachycardia [NSVT], frequency of NSVT runs). Primary analyses adjusted for demographic variables, blood pressure, smoking, diabetes, and clinical cardiovascular disease (4%). Results: Cardiac monitoring (median 14 days) detected AF in 3%. Each standard deviation (5.4%) lower (worse) LA reservoir strain was associated with a 64% higher risk of monitor-detected AF (95% CI 16-137%), 33% higher PAC frequency (95% CI 22-46%), and 15% higher SVT frequency (95% CI 7-24%). Adjustment for kidney function, NT-proBNP, LA volume, and LV ejection fraction and global longitudinal strain had little impact on associations. Findings were similar for LA booster pump strain and null for LA conduit strain (Figure). Associations of LA reservoir and booster pump strain with ventricular arrhythmias were completely attenuated after adjustment for LV function. Conclusions: In a multi-ethnic community-based cohort, abnormal LA mechanics may be an important risk factor for subclinical atrial arrhythmias.

Left ventricular non-compaction cardiomyopathy: additional predictors of life-threatening events for selecting patients for cardioverter-defibrillator implantation

Abstract Funding Acknowledgements Type of funding sources: None. The aim of the study is to determine predictors of life-threatening arrhythmic events in order to identify high-risk patients requiring ICD/CRT-D implantation. Methods. The study included 155 patients with left ventricular non-compaction cardiomyopathy (NCСM), 59 (38.1%) women, 96 (61.9%) men, and a median age of 39 (28; 51) years. In addition to the standard examination, cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) was performed. The median follow-up was 36 months (6; 152). Endpoints of the study included life-threatening arrhythmic events (sustained VT/VF) requiring device implantation (ICD/CRT-D). Results. The most frequent types of arrhythmia were ventricular premature beats (VPB) &amp;gt;500 per day – in 64 (41.3%) pts, nonsustained ventricular tachycardia (VT) was observed in 54 (34.8%) pts, sustained VT – in 15 (9.7%) pts and permanent atrial fibrillation (AF) with episodes of nonsustained VT – in 34 (21.9%) pts. Syncope was recorded in 17 (11%) pts. Symptoms of NYHA FC III CHF were found in 28 (18.1%) pts. According to EchoCG data, the median LV ejection fraction (LVEF) was 44% (34; 54). According to LGE-CMR, 72 (46.8%) pts showed areas of myocardial fibrosis; the median volume of myocardial fibrosis was 13.2% (0.6; 58.5). During the follow-up period, life-threatening arrhythmic events (sustained VT/VF) developed in 15 pts, among which ICD – 8 and CRT-D – 7 were implanted as part of the secondary prevention of sudden cardiac death (SCD). The 3-year event-free survival rate was 88 ± 14%. In multivariate analysis, independent factors associated with the risk of life-threatening events requiring ICD/CRT-D implantation are the following characteristics: the presence of syncope (HR 12.5; 95% CI 3.9–39.7, p &amp;lt; 0.001), the presence of nonsustained VT (HR 11.8; 95% CI 1.5–95.1, p &amp;lt; 0.021) and the percentage of fibrosis volume ≥30% (HR 3.23; 95% CI 1.01–10.4, p &amp;lt; 0.048). Risk groups of life-threatening events were stratified based on multi-factor analysis. The three-year event-free survival rate of the high-risk group was 77.8 ± 5.8%, the low-risk group had no adverse events during the entire follow-up period, and the three-year event-free survival rate was 100%. Conclusion. The developed model of risk stratification of life-threatening events allows identifying high-risk patients for timely preventive measures.

Antiarrhythmic effect of 9-week hybrid cardiac telerehabilitation - subanalysis of the TELEREHabilitation in Heart Failure patients - TELEREH-HF randomized clinical trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Centre for Research and Development, Warsaw, Poland. Background. Cardiac rehabilitation is a component of heart failure (HF) management but its effect on ventricular arrhythmias is not well recognized. Purpose. We analyzed the antiarrhythmic effect of a 9-week hybrid cardiac telerehabilitation (HCTR) and its influence on long term cardiovascular mortality in HF patients taken from the TELEREH-HF trial. Methods. We evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥10 beats/hour (PVCs ≥10) with 24-hour ECG monitoring at the baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%). Results. Among 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR, similarly among 165 patients randomized to UC who had nsVT 34.5% did not show them after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR (Δ peak oxygen consumption [pVO2] in cardiopulmonary exercise test &amp;gt;2.0 ml/kg/min) did not affect occurrence of arrhythmias. The multivariable analysis of the entire population did not identify HCTR as an independent factor determining improvement in terms of nsVT or PVCs &amp;gt;10. However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2 years follow-up (Logrank p = 0.0009) (Figure). Conclusions. Significant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs ≥10. An antiarrhythmic effect after the 9-week HCTR affected long term cardiovascular mortality in HF patients. Abstract Figure

Antiarrhythmic effect of 9-week hybrid comprehensive telerehabilitation and its influence on cardiovascular mortality in long-term follow-up - subanalysis of the TELEREHabilitation in Heart Failure Patients randomized clinical trial.

IntroductionCardiac rehabilitation is a component of heart failure (HF) management, but its effect on ventricular arrhythmias is not well understood. We analyzed the antiarrhythmic effect of a 9-week hybrid comprehensive telerehabilitation (HCTR) program and its influence on long-term cardiovascular mortality in HF patients taken from the TELEREHabilitation in Heart Failure Patients (TELEREH-HF) trial.Material and methodsWe evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥ 10 beats/hour (PVCs ≥ 10) in 24-hour ECG monitoring at baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%). Functional response for HCTR was assessed by changes – delta (Δ) – in peak oxygen consumption (pVO2) as a result of comparing pVO2 from the beginning and the end of the program.ResultsAmong 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR. Similarly, among 165 patients randomized to UC who had nsVT 34.5% did not show it after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥ 10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR in ΔpVO2 > 2.0 ml/kg/min did not affect occurrence of arrhythmias. Multivariable analysis did not identify HCTR as an independent factor determining improvement of nsVT or PVCs ≥ 10. However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2-year follow-up (p < 0.001).ConclusionsSignificant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs ≥ 10. An antiarrhythmic effect after the 9-week HCTR affected long-term cardiovascular mortality in HF patients.

Myocardial extracellular space expansion is related to burden of premature ventricular contractions in patients with hypertrophic cardiomyopathy without non-sustained ventricular tachycardia

Abstract Funding Acknowledgements Type of funding sources: None. Background Current guidelines suggest the presence of non-sustained ventricular tachycardia (NSVT) as a risk factor of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, high burden of premature ventricular contraction (PVC) may reflect myocardial fibrosis although the absence of NSVT. Purpose We investigated the association between PVC burden and myocardial extracellular space expansion in HCM patients without NSVT. Methods Of the 212 patients prospectively enrolled to the HCM registry of genetics, 84 patients were evaluated with both cardiac magnetic resonance and 24hr holter. Among them, 71 patients (58 males, mean age: 71 ± 13 years) have not been diagnosed with NSVT. Results Patients with NSVT (n = 13) showed more impaired LA functional indices and higher myocardial fibrosis burden compared with patients without NSVT (n = 71). Among patients who have not been diagnosed with NSVT, patients with late gadolinium enhancement (LGE, n = 46) had a higher total beats (109 ± 332 vs. 7 ± 13 beats per a day, p = 0.003) and burden (0.114 ± 0.225 vs. 0.008 ± 0.014 %, p = 0.003) of PVC during 24-hour compared with patients without LGE (n = 25). %LGE was correlated with total beats of PVC (r = 0.358, p = 0.002) and PVC burden (r = 0.377, p = 0.001). ECV also correlated with total beats of PVC (r = 0.387, p = 0.001) and PVC burden (r = 0.401, p = 0.001). The optimal cutoff value for PVC number was 45 (37.0% of sensitivity and 100% of specificity) with 0.733 of the area under the ROC curve (p &amp;lt; 0.001). Pathogenic or likely pathogenic sarcomere mutation was higher in NSVT group than no NSVT group (p &amp;lt; 0.05), and had a higher tendency in higher PVC burden group (0.05 &amp;lt; p &amp;lt; 0.1) than lower PVC burden group. Conclusions Total beats and burden of PVC are significantly related to increase in myocardial fibrosis in HCM patients without NSVT. Abstract Figure. Mechanism of ventricular arrhythmia

Correlations between cardiac troponin I and nonsustained ventricular tachycardia in hypertrophic obstructive cardiomyopathy.

BackgroundNonsustained ventricular tachycardia (NSVT) is an independent risk factor for sudden cardiac death (SCD) in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, data concerning the correlations of cardiac biomarkers and NSVT in HOCM are rather limited.HypothesisOur study aimed to investigate the associations between the occurrence of NSVT and circulating biomarkers representing myocardial injury (cardiac troponin I, cTnI), cardiac function (N‐terminal pro‐brain natriuretic peptide, NT‐pro BNP), and inflammation (high‐sensitivity C‐reactive protein) in a large Chinese HOCM cohort.MethodsA total of 755 consecutive HOCM patients were recruited. Systematic cardiac evaluations and circulating biomarkers were examined routinely in all subjects under the clinically stable status. According to the results of 24‐hour Holter monitoring, patients were divided into the NSVT group (n = 138) and the nonventricular tachycardia (non‐VT) group (n = 617).ResultsCompared with the non‐VT group, circulating levels of both cTnI and NT‐pro BNP elevated significantly in patients with positive NSVT episodes (P < .001). Multivariable analyses demonstrated that cTnI was independently associated with the presence of NSVT (OR = 1.675, 95% CI: 1.406‐1.994, P < .001). Concentrations of cTnI increased progressively not only with the aggravation of ventricular arrhythmic events (P < .001), but also with the growing risk of SCD in HOCM patients (P < .001). Serum cTnI ≥ 0.0265 ng/mL indicated predictive value for the occurrence of NSVT in the HOCM cohort (area under the curve = 0.707, 95% CI: 0.660‐0.754, P < .001).ConclusionsElevated cTnI was an independent determinant of NSVT, and it seemed to be valuable for assessing the clinical status of ventricular arrhythmias and the risk of SCD in patients with HOCM.

Combined right and left ventricular mechanical dispersion enhance the arrhythmic risk stratification in hypertrophic cardiomyopathy

BackgroundVentricular arrhythmias are the most frequent cause of sudden cardiac death in individuals with hypertrophic cardiomyopathy (HCM). In the present study we investigated if combined left ventricular (LV) and right ventricular (RV) mechanical dispersion (MD) are correlated with ventricular arrhythmias. We aimed also to analyze if MD enhances the arrhythmic risk stratification in HCM. MethodsThe cohort included 47 subjects with HCM and 36 healthy individuals. All the studied population underwent clinical, 24-h electrocardiographic (ECG) monitoring for detection and description of non-sustained ventricular tachycardia (NSVT) in terms of number of events, maximal rate and length and comprehensive transthoracic echocardiography, including strain rate imaging. MD was calculated as standard deviation of time from the peak of R wave on ECG to maximum LV or RV shortening in 17 LV and 3 RV segments. ResultsHCM subjects with NSVT on ECG monitoring had increased LVMD (81±18ms vs 42±8ms) and RVMD (52±26 vs 25±23ms) compared with the HCM group without NSVT or compared with the healthy controls. On receiver operating characteristic curves the cut-off values associated with optimal specificity and sensitivity were 62ms for LVMD and 39ms for RVMD. LVMD (OR=1.86, 95% CI 1–1.06, p=0.01) and RVMD (OR=1.04, 95% CI 1.01–1.07, p=0.003) were the only independent variables that correlated with longer and faster NSVT and furthermore improved the risk stratification of NSVTs. ConclusionsIn a cohort of subjects with HCM, LVMD and RVMD correlates with the presence of NSVT on ECG monitoring. Combined LVMD and RVMD may improve the risk stratification of HCM with NSVT.

Genotype-Related Clinical Characteristics and Myocardial Fibrosis and Their Association with Prognosis in Hypertrophic Cardiomyopathy

Background: The spectrum of genetic variants and their clinical significance of Hypertrophic cardiomyopathy (HCM) have been poorly studied in Asian patients. The objectives of this study were to assess the spectrum of genetic variants and genotype–phenotype relationships within a Korean HCM population. Methods: Eighty-nine consecutive unrelated HCM patients were included. All patients underwent genotypic analysis for 23 HCM-associated genes. Clinical parameters including echocardiographic and cardiac magnetic resonance (CMR) parameters were evaluated. A composite of major adverse cardiac and cerebrovascular events was assessed. Results: Genetic variants were detected in 55 of 89 subjects. Pathogenic variants or likely pathogenic variants were identified in 27 of HCM patients in MYBPC3, TNNI3, MYH7, and MYL7. Variants of uncertain significance were identified in 28 patients. There were significant differences in the presence of non-sustained ventricular tachycardia (p = 0.030) and myocardial fibrosis on CMR (p = 0.029) in the detected compared to the not-detected groups. Event-free survival was superior in the not-detected group (p = 0.006). Conclusion: Genetic variants in patients with HCM are relatively common and are associated with adverse clinical events and myocardial fibrosis on CMR. Genotypic analysis may add important information to clinical variables in the assessment of long-term risk for HCM patients.

675Non-sustained ventricular tachycardia in nonischemic dilated cardiomyopathy: results from a nonischemic cardiomyopathy study

Abstract Background The underlying substrates and mechanisms of non-sustained ventricular tachycardia (NSVT) in nonischemic dilated cardiomyopathy (DCM) are unclear and may be different than those of sustained VT. Purpose To characterize NSVT in DCM and analyze its association with late gadolinium enhancement (LGE) on CMR, inducibility of sustained VT during EP study, and ventricular arrhythmias during follow-up. Methods In the prospective Leiden Nonischemic Cardiomyopathy Study (ClinicalTrials.gov Identifier: NCT01940081) patients with DCM underwent a comprehensive evaluation. For the present study, 24h-Holters were assessed for the presence of NSVT (defined as ≥3 consecutive beats arising below the atrioventricular node with a rate ≥120 bpm and lasting &amp;lt;30 s) and its features (number of episodes, rate, rate variability &amp;gt;10%, duration, coupling interval and morphology). CMRs were assessed for the presence of LGE and EP studies for inducibility of sustained monomorphic VT. Patients were followed and ICDs were programmed with therapy &amp;gt;188-200 bpm or adjusted to clinically documented VT. Results Of all 148 patients, 95 underwent a 24-hour Holter at the Leiden University Medical Center and were included in the present study (age 59 ± 13 years, 76% male, history of sustained VT in 26 [27%], out-of-hospital cardiac arrest in 7 [9%]). NSVT was observed during Holter in 52 patients (55%) and was typically short (median 4 beats, IQR 3-5 beats), relatively slow (median 144 bpm, IQR 134-156 bpm), irregular (median 67%, IQR 43-100% of all episodes per patient) and monomorphic (median 87%, IQR 12-100%). NSVT was not associated with LGE on CMR (p = 0.49) or VT inducibility during EP study (p = 0.96), nor were its features (all p &amp;gt; 0.05). During 4.0 ± 1.7 years follow-up, sustained VT occurred in 25 patients (26%), polymorphic VT/VF in 8 (8%), and any sustained ventricular arrhythmia in 30 (32%). NSVT was associated with a higher rate of sustained VT during follow-up (HR 5.45, p = 0.002) and any sustained ventricular arrhythmia (HR 4.17, p = 0.002), but not with polymorphic VT/VF (p = 0.69). Similarly, inducibility of sustained VT during EP study was also associated with sustained VT during follow-up (HR 5.78, p &amp;lt; 0.001) and any sustained ventricular arrhythmia (HR 4.88, p &amp;lt; 0.001), but not with polymorphic VT/VF (p = 0.13). The findings remained similar when only primary prevention patients were included. In multivariate analysis, NSVT on Holter and inducibility of sustained VT during EP study both remained independently associated with sustained VT and any sustained ventricular arrhythmia during follow-up (all p ≤ 0.001), but not with polymorphic VT/VF. Conclusion In DCM, NSVT on Holter and inducible sustained VT during EP study are not directly interrelated, but both predict the occurrence of sustained VT during follow-up. These data suggest that non-sustained and sustained VT may have different underlying mechanisms and provide complementary information in DCM. Abstract Figure. Sustained VT during follow-up

Associations between Cardiac Magnetic Resonance T1 Mapping Parameters and Ventricular Arrhythmia in Patients with Chagas Disease.

Chronic Chagas disease can progress to myocardial involvement with intense fibrosis, which may predispose patients to sudden cardiac death through ventricular arrhythmia. The associations of myocardial fibrosis detected by cardiac magnetic resonance (CMR) parameters with non-sustained ventricular tachycardia (NSVT) were evaluated. This cross-sectional study included patients in early stages of Chagas disease (n = 47) and a control group (n = 15). Patients underwent cardiac evaluation, including CMR examination. Myocardial fibrosis assessment by CMR with measurement of late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) was performed. There was an increase in myocardial fibrosis CMR parameters and ventricular arrhythmias among different stages of Chagas disease, combined with a decrease in the left ventricular ejection fraction (LVEF) by CMR and also in the right ventricular systolic function by S' wave on tissue Doppler. Fibrosis mass and ECV were associated with the Rassi score, ventricular extrasystole, and E/e' ratio in a logistic regression model adjusted for age and gender. The ECV maintained an association with the presence of NSVT, even after adjustments for fibrosis mass and LVEF assessed by CMR. The receiver-operating characteristic area under the curve for global ECV (0.85; 95% CI: 0.71-0.99) and NSVT was greater than that for fibrosis mass (0.75; 95% CI: 0.54-0.96), although this difference was not statistically significant. Extracellular volume could be an early marker of increased risk of ventricular arrhythmia in Chagas disease, presenting an independent association with NSVT in the initial stages of chronic Chagas cardiomyopathy, even after adjustment for fibrosis mass and LVEF.

Cardiac troponin I is associated with non-sustained ventricular tachycardia in patients with hypertrophic obstructive cardiomyopathy.

As highly sensitive and specific markers of myocardial damage, cardiac troponins were demonstrated to correlate with clinical parameters of patients with hypertrophic cardiomyopathy. However, the relationship between cardiac troponins and presence of non-sustained ventricular tachycardia (NSVT) in hypertrophic cardiomyopathy remains unclear. The aim of our study was to explore the association between serum cardiac troponin I (cTNI) and presence of NSVT in patients with hypertrophic obstructive cardiomyopathy (HOCM). A total of 309 HOCM patients were enrolled in our study. All participants underwent clinical evaluations, including collections of medical history, blood tests, 24-h Holter monitoring, echocardiography, and cardiac magnetic resonance imaging. There were 53 (17.2%) patients with NSVT and 256 patients without it. Compared to patients without NSVT, serum cTNI (P < 0.001) and plasma NT-proBNP (P = 0.042) were significantly higher in patients with NSVT. Moreover, cTNI and NT-proBNP were positively correlated with left atrial diameter, maximum wall thickness (MWT), left ventricular volume index and left ventricular mass index. In multivariable logistic analysis, log cTNI [odds ratio (OR) = 2.408, 95% confidence interval (CI) 1.108-5.325, P = 0.027], left ventricular end-diastole diameter (OR = 0.922, 95%CI 0.856-0.994, P = 0.034), MWT (OR = 1.131, 95%CI 1.035-1.235, P = 0.006) and left ventricular end-systole volume index (OR = 1.060, 95%CI 1.025-1.096, P = 0.001) were independent determinants of NSVT occurrence after adjustment for potential cofounders. Serum cTNI level was elevated in patients with NSVT. And it was independently associated with NSVT in patients with HOCM. Our results suggest that it may be more reasonable for HOCM patients with elevated serum cTNI to extend the time of Holter monitoring.

Prevalence and clinical significance of cardiovascular magnetic resonance adenosine stress-induced myocardial perfusion defect in hypertrophic cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) is thought to be associated with microvascular dysfunction. Adenosine stress-perfusion cardiovascular magnetic resonance imaging (CMR) is a sensitive method for assessing microvascular perfusion abnormalities. We evaluated the prevalence and clinical characteristics of HCM patients with adenosine-induced perfusion defects on CMR.MethodsAmong 189 consecutive patients with HCM who underwent adenosine-stress perfusion CMR, 115 patients who had clinical, echocardiography, 24-h Holter monitoring and treadmill exercise test data were analyzed. We calculated myocardial perfusion ratio index from the intensity-over-time curve to quantify perfusion defects. The presence and extent of the stress-induced perfusion defect were compared with clinical characteristics, presence and extent of late gadolinium enhancement (LGE), left ventricular (LV) mass index and volume, presence of non-sustained ventricular tachycardia (NSVT) and results of treadmill exercise test.ResultsThe mean age of enrolled patients was 51.8 ± 11.3 years. Most patients were asymptomatic except 25 subjects presented with New York Heart Association Class II dyspnea and 16 patients with atypical non-exertional chest discomfort. LGE was present in 103 (89.6%) subjects. Adenosine stress-induced perfusion defects were present in 48 (42%) subjects. None of the perfusion defects corresponded with a single or multiple coronary artery territories, showing a multiple patchy pattern in 24 (50.0%), a concentric subendocardial pattern in 20 subjects (41.7%), and as a single blot-like defect in the remaining 4 (8.3%). A perfusion defect was associated with NSVT, LV apical aneurysm, higher LV mass index, and higher LGE volume on univariate analysis. Multivariate analysis revealed female gender (P = 0.008), presence of apical aneurysm and NSVT (P = 0.036 and 0.047, respectively), and LV mass index (P = 0.022) to be independently associated with adenosine stress-induced perfusion defects.ConclusionsIn patients with HCM, adenosine-stress perfusion defects on CMR are present in more than 40% of subjects. This perfusion defect is associated with NSVT, higher LV mass index, and apical aneurysms. The prognostic value of this finding needs further elucidation.