Risk Of Ventricular Tachycardia Research Articles

Dysrhythmic profile of inotropic therapy in patients with acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with acute coronary syndrome (ACS) may develop ventricular dysfunction and need to use drugs with a positive inotropic effect, during the acute phase. Despite the hemodynamic benefit of the use of these drugs, positive inotropic drugs may have several side effects, including ventricular tachycardia (VT)and atrial fibrillation (AF). AF can complicate the management of patients with ACS, since these patients need intense antiplatelet therapy, and in the case of AF, it may have to be associated with anticoagulant therapy, thereby increasing the bleeding risk. The clinical significance of AF during an acute event remains to be ascertained. Purpose This study aims to assess the frequency of occurrence of dysrhythmic complications with the use of positive inotropic drugs in patients hospitalized for ACS. Methods We performed a 6-year retrospective, observational, multicenter study. We included patients with ACS who used positive or not inotropic drugs during hospitalization, dividing the sample into two groups respectively (Group 1 and Group 2). Between the two groups we compared the occurrence of ventricular tachycardia and atrial fibrillation. In addition, we performed an analysis for the use of levosimendan. Results We analyzed a sample of 5860 patients. Of these, 70.3% were male. In Group 1 we included 377 patients and in Group 2 5329 patients. The occurrence of VT in Group 1 was higher than in Group 2 (15.5% vs 1.6%; p<0.001; OR: 11.472; 95% CI [8.212;16.027]). The rate of occurrence of AF in Group 1 was higher than in Group 2 (19.3% vs 5.1%; p<0.001; OR:4.413; 95% CI [3.388;5.749]). Regarding the use of levosimendan, 50 patients were analyzed. VT was more frequent with the use of this drug than without it (18.0% vs 2.5%; p<0.001; OR: 8.576 95% CI [4.092;17.976]). Atrial fibrillation was more frequent with levosimendan use than with no use (34.0% vs 6.0%; p>0.001; OR: 8.137; 95% CI [4.487;14.754]). Conclusion Arrhythmic complications were much more frequent in the group that used positive inotropic drugs, namely VT and AF. Levosimendan stands out, related to the increase in the occurrence of AF and the remaining inotropes with an increased risk of VT. These arrhythmic complications pose a challenge in the management of these patients, as in patients with ACS, the use of Levosimendan is associated with more episodes of AF, and might complicate the antithrombotic therapy strategy choice.

PO-05-193 PREVALENCE OF ARRHYTHMIAS AND CARDIAC CONDUCTION DISEASE IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICE

Left ventricular assist devices (LVADs) have been shown to increase the functional status and survival of patients with end -stage heart failure. There is limited data regarding the prevalence of arrhythmias and conduction disease in patients implanted with LVADs. Our objective was to determine the prevalence of arrhythmias and conduction disease in hospitalized patients with LVADs using the National Inpatient Sample (NIS) from 2016-2019. A retrospective study was done using the Nationwide Inpatient Sample from 2016-2019. 17,125 hospitalisations with LVADs were identified using ICD-10 codes. Multivariate logistic regression analysis was used to adjust for confounders and analyze the variables for the adjusted odds ratio. Among 17,125 hospitalizations, the average age was 55 years and 62% were male. Atrial fibrillation (AF) was the most prevalent (43%) atrial arrhythmia, followed by atrial flutter (AFL) (14%), and supraventricular tachycardia (SVT) (13%). Ventricular tachycardia (VT) was the most common ventricular arrhythmia (47%), and less than one percent of the cohort had reported episodes of ventricular fibrillation/flutter (< 1%). In terms of conduction disease, 10% had either first-degree (1AVB), <1% had second-degree AV block (2AVB), 10% had right (RBBB), and 3% had left bundle branch block (LBBB). When adjusted to patient demographics, comorbidities, and hospital characteristics, patients with LVADs had a higher risk of AF (aOR= 2.00, p<0.0001), AFL (aOR=3.5, p<0.0001), SVT (aOR=4.63, p<0.0001), VT (aOR=17.7, p<0.0001), and complete heart block (CHB) (aOR=2.6, p<0.0001). Patients with LVADs are more likely to develop atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, RBBB, and CHB. Atrial fibrillation was our cohort's most common arrhythmia, consistent with prior observational studies' trends.

Evaluation of a deep learning-enabled automated computational heart modelling workflow for personalized assessment of ventricular arrhythmias.

Personalized, image-based computational heart modelling is a powerful technology that can be used to improve patient-specific arrhythmia risk stratification and ventricular tachycardia (VT) ablation targeting. However, most state-of-the-art methods still require manual interactions by expert users. The goal of this study is to evaluate the feasibility of an automated, deep learning-based workflow for reconstructing personalized computational electrophysiological heart models to guide patient-specific treatment of VT. Contrast-enhanced computed tomography (CE-CT) images with expert ventricular myocardium segmentations were acquired from 111 patients across five cohorts from three different institutions. A deep convolutional neural network (CNN) for segmenting left ventricular myocardium from CE-CT was developed, trained and evaluated. From both CNN-based and expert segmentations in a subset of patients, personalized electrophysiological heart models were reconstructed and rapid pacing was used to induce VTs. CNN-based and expert segmentations were more concordant in the middle myocardium than in the heart's base or apex. Wavefront propagation during pacing was similar between CNN-based and original heart models. Between most sets of heart models, VT inducibility was the same, the number of induced VTs was strongly correlated, and VT circuits co-localized. Our results demonstrate that personalized computational heart models reconstructed from deep learning-based segmentations even with a small training set size can predict similar VT inducibility and circuit locations as those from expertly-derived heart models. Hence, a user-independent, automated framework for simulating arrhythmias in personalized heart models could feasibly be used in clinical settings to aid VT risk stratification and guide VT ablation therapy. KEY POINTS: Personalized electrophysiological heart modelling can aid in patient-specific ventricular tachycardia (VT) risk stratification and VT ablation targeting. Current state-of-the-art, image-based heart models for VT prediction require expert-dependent, manual interactions that may not be accessible across clinical settings. In this study, we develop an automated, deep learning-based workflow for reconstructing personalized heart models capable of simulating arrhythmias and compare its predictions with that of expert-generated heart models. The number and location of VTs was similar between heart models generated from the deep learning-based workflow and expert-generated heart models. These results demonstrate the feasibility of using an automated computational heart modelling workflow to aid in VT therapeutics and has implications for generalizing personalized computational heart technology to a broad range of clinical centres.

Post-myocardial infarction treatment with resiniferatoxin modulates the expression of important genes involved in inflammation, plaque stability and angiogenesis.

Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the most frequent causes of death in the first 24 hours after myocardial infarction. Previous studies showed that depleting TRPV1 receptors with resiniferatoxin (RTX) led to a reduced risk of VT and VF post-myocardial infarction. Therefore, the question of resiniferatoxin as a cardioprotector against myocardial infarction (MI)-induced VT and VF was raised. The RNA sequence data from 3 groups of pigs, each having 4 animals (4 controls, 4 myocardial infarction - MI, and 4 RTX + MI) was analyzed through the lens of differentially expressed genes. The differential expression comparison was conducted in two ways: MI versus Control and RTX+MI versus MI. The results showed the downregulation of deleterious genes involved in inflammation and future plaque instability in the RTX group compared with the MI group. In the case of some of the genes, these findings were reinforced by obtaining the same trends in the MI versus Control group. All in all, we propose further investigation of RTX as a prophylactic method against cardiovascular complications of MI.

Risk of ventricular tachycardia and its outcomes in patients undergoing continuous renal replacement therapy due to acute kidney injury.

Despite efforts to treat critically ill patients who require continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI), their mortality risk remains high. This condition may be attributable to complications of CRRT, such as arrhythmias. Here, we addressed the occurrence of ventricular tachycardia (VT) during CRRT and its relationship with patient outcomes. This study retrospectively enrolled 2,397 patients who started CRRT due to AKI from 2010 to 2020 at Seoul National University Hospital in Korea. The occurrence of VT was evaluated from the initiation of CRRT until weaning from CRRT. The odds ratios (ORs) of mortality outcomes were measured using logistic regression models after adjustment for multiple variables. VT occurred in 150 patients (6.3%) after starting CRRT. Among them, 95 cases were defined as sustained VT (i.e., lasting ≥30 seconds), and the other 55 cases were defined as non-sustained VT (i.e., lasting &lt;30 seconds). The occurrence of sustained VT was associated with a higher mortality rate than a nonoccurrence (OR, 2.04 and 95% confidence interval [CI], 1.23-3.39 for the 30- day mortality; OR, 4.06 and 95% CI, 2.04-8.08 for the 90-day mortality). The mortality risk did not differ between patients with non-sustained VT and nonoccurrence. A history of myocardial infarction, vasopressor use, and certain trends of blood laboratory findings (such as acidosis and hyperkalemia) were associated with the subsequent risk of sustained VT. Sustained VT occurrence after starting CRRT is associated with increased patient mortality. The monitoring of electrolytes and acid-base status during CRRT is essential because of its relationship with the risk of VT.

Assessing the arrhythmogenic risk of engineered heart tissue patches through in silico application on infarcted ventricle models

BackgroundPost myocardial infarction (MI) ventricles contain fibrotic tissue and may have disrupted electrical properties, both of which predispose to an increased risk of life-threatening arrhythmias. Application of epicardial patches obtained from human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) are a potential long-term therapy to treat heart failure resulting from post MI remodelling. However, whether the introduction of these patches is anti- or pro-arrhythmic has not been studied. MethodsWe studied arrhythmic risk using in silico engineered heart tissue (EHT) patch engraftment on human post-MI ventricular models. Two patient models were studied, including one with a large dense scar and one with an apparent channel of preserved viability bordered on both sides by scar. In each heart model a virtual EHT patch was introduced as a layer of viable tissue overlying the scarred area, with hiPSC-CMs electrophysiological properties. The incidence of re-entrant and sustained activation in simulations with and without EHT patches was assessed and the arrhythmia inducibility compared in the context of different EHT patch properties (conduction velocity (CV) and action potential duration (APD)). The impact of the EHT patch on the likelihood of focal ectopic impulse propagation was estimated by assessing the minimum stimulus strength and duration required to generate a propagating impulse in the scar border zone (BZ) with and without patch. ResultsWe uncovered two main mechanisms by which ventricular tachycardia (VT) risk could be either augmented or attenuated by the interaction of the patch with the tissue. In the case of isthmus-related VT, our simulations predict that EHT patches can prevent the induction of VT when the, generally longer, hiPSC-CMs APD is reduced towards more physiological values. In the case of large dense scar, we found that, an EHT patch with CV similar to the host myocardium does not promote VT, while EHT patches with lower CV increase the risk of VT, by promoting both non-sustained and sustained re-entry. Finally, our simulations indicate that electrically coupled EHT patches reduce the likelihood of propagation of focal ectopic impulses. ConclusionsThe introduction of EHT patches as a treatment for heart failure has the potential to augment or attenuate the risk of ventricular arrhythmias, and variations in the anatomic configuration of the substrate, the functional properties of the BZ and the electrophysiologic properties of the patch itself will determine the overall impact. Planning for delivery of this therapy will need to consider the possible impact on arrhythmia.

Abstract 13311: Risk of Ventricular Tachycardia and Sudden Cardiac Arrest Associated With Drugs Known to Cause Torsades De Pointes in Patients With Heart Failure With Preserved Ejection Fraction

Introduction: Heart failure (HF) with reduced ejection fraction (HFrEF) is a risk factor for drug-induced proarrhythmia. It is unknown whether patients with HF with preserved ejection fraction (HFpEF) are also at increased risk. Hypothesis: The risk of drug-associated ventricular tachycardia (VT) and sudden cardiac arrest (SCA) is increased in patients with HFpEF. Methods: Using Medicare enrollment in fee-for-service medical and pharmacy benefits (2014 to 2016) and ICD-9/10 codes, we identified patients taking drugs known to cause torsades de pointes (TdP drugs; www.crediblemeds.org) and non-TdP drug users among three groups: HFrEF (n=31,422), HFpEF (n=40,012), and no HF (n=633,558). Multinomial propensity score-matching was performed to minimize baseline differences in covariates (patient demographics, comorbidities, health care utilization and drug history). Cochran-Mantel-Haenszel statistics and standardized differences were used to compare baseline characteristics. A generalized Cox proportional hazards model was used to estimate hazard ratios (HRs) and test the association of VT and SCA among TdP drug users with HFpEF, HFrEF, and no HF. Results: Of 23,910 TdP drug users with HFrEF, VT and SCA occurred in 4,263 (17.8%) and 493 (2.1%) patients, respectively. In comparison, among 31,359 TdP drug users with HFpEF, VT and SCA occurred in 1,570 (5.0%) and 340 (1.1%) patients. VT and SCA occurred in 3,154 (0.8%) and 528 (0.1%) of 384,824 TdP drug users without HF. The overall risk of both VT and SCA was increased in patients with HFrEF and in those with HFpEF (Table). The risk of VT associated with TdP drugs was increased across the overall population. Use of TdP drugs significantly increased the risk of VT and SCA in patients with HFrEF, but not in patients with HFpEF. Conclusions: The risk of VT and SCA associated with drugs known to cause TdP was increased in patients with HFrEF but not in those with HFpEF.

Abstract 14294: Patients With Chronic Kidney Disease Have a Lower Odds of Ventricular Tachycardia Than General Population

Introduction: Monomorphic ventricular tachycardia (VT) often results from scar formation secondary to chronic ischemia or myocardial infarction. Microvascular disease is a known risk factor for myocardial dysfunction as it can lead to focal scar formation and thus increase the risk for VT. Chronic kidney disease (CKD) is characterized by microvascular dysfunction on the basis of animal studies through metabolic, endocrine, and immune pathways and therefore was suspected to be a risk factor for developing VT. Methods: We conducted a retrospective cohort study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2019 database to investigate hospitalizations for patients aged 18 years old or older with VT based on stage of CKD. Comorbidities were identified through their international classification of diseases, 10th revision (ICD-10 codes) recorded in the discharge record for each hospitalization. Records having cocaine or other stimulants were excluded. An alpha (p) value less than 0.05 was considered statistically significant. Results: A total of 456,925 patients were identified based on the inclusion and exclusion criteria above. The number of patients that had VT with and without CKD was 163,760 (3%) and 293,165 (1%), respectively. However, after an adjusted analysis was performed we discovered that the odds ratio of VT in patients with CKD was 0.735 (95% CI 0.720-0.751). Conclusions: In our retrospective cohort study, patients with CKD were found to have a lower risk of developing VT. This is suspected to be due to electrolyte derangements, such as hyperkalemia and hypermagnesemia, commonly seen in these patients and thus creating a cardioprotective electrolyte balance.

Abstract 12600: Mitral Annular Disjunction: How Accurate Are We? A Cardiovascular MRI Study Defining Risk

Background: Mitral Annular Disjunction (MAD) refers to embryologic fibrous separation between mitral annular ring and basal left ventricular myocardium. Since its original description, the role of MAD in arrhythmic mitral valve prolapse (MVP) has been subject of active research. In this study we sought to assess prognostic and imaging characteristics of MVP patients with and without underlying MAD. Methods: Patients with posterior or bi-leaflet MVP were retrospectively identified via a review of all patients referred to our cardiac magnetic resonance (CMR) imaging laboratory from January 2015 to May 2022. MVP patients were further stratified by underlying MAD status. CMR characteristics including late gadolinium enhancement (LGE) distribution, clinical characteristics, and data on mitral valve intervention were determined. Results: A total of 100 MVP patients undergoing CMR imaging (52 MVP patients with posterior MAD) were retrospectively identified with female comprising 55% of the cohort. MVP patients with MAD were more likely to have an abnormal basal inferolateral/ papillary muscles LGE (51% vs 21%, p&lt;0.01). Posterior MAD longitudinal disjunction gap in ‘mm’ was a predictor of ventricular tachycardia (VT) [1.23, p=0.03)]. Similarly, posterior MAD as a binary variable was predictor of VT (11, p&lt;0.01), ventricular arrhythmia (composite of VT, and non-sustained VT) (2.4, p=0.03), and major adverse cardiac events (MACE) (composite of VT, syncope, and mitral valve intervention) (2.5, p=0.03). Using ROC curve analysis, a disjunction gap of &gt; 4 mm was predictive of VT (AUC-0.71, p&lt;0.01), and incorporation of LGE in ROC model further improved AUC to 0.78 confirmed via Akaike information criterion (p&lt;0.05), see Figure. Conclusion: Abnormal LGE involving basal inferolateral myocardium and papillary muscles may provide substrate for arrythmia in MVP patients. Further, for the first time, a MAD threshold of &gt; 4 mm is demonstrated to stratify the VT risk.

Risks of Ventricular Tachyarrhythmia and Mortality in Patients with Amyloidosis - A Long-Term Cohort Study.

The presence of ventricular tachycardia (VT) is associated with higher mortality. The annual incidence of VT after a diagnosis of amyloidosis and the associated cardiovascular (CV) outcomes have not been well assessed in a large cohort. A total of 12,139 amyloidosis patients were identified from the Taiwan National Health Insurance Research Database. Non-amyloidosis group was matched 1:1 for age, gender, hypertension, and diabetes mellitus (DM) to the amyloidosis group using a propensity score. Analysis of the risk of CV outcomes was conducted. We also analyzed the incidence of cardiac amyloidosis (CA). The incidence rates of amyloidosis and CA were 6.54 and 0.61 per 100,000 person-years, respectively. Multivariable analysis revealed that the risk of VT was higher in both the amyloidosis [hazard ratio (HR): 7.90; 95% confidence interval (CI): 4.49-13.9] and CA (HR: 153.3, 95% CI: 54.3-432.7) groups. In the amyloidosis group, the risk of heart failure (HF)-related hospitalization, CV death, and all-cause death was also higher. Amyloidosis was associated with a higher CV mortality rate following VT (HR: 1.50; 95% CI: 1.07-2.12). The onset of a new VT event in patients with amyloidosis was associated with HF, DM, chronic liver disease, and anti-arrhythmic drug use. In this nationwide cohort study, the incidence rates of amyloidosis and CA were 6.54 and 0.61 per 100,000 person-years, respectively. The long-term risks of VT and CV mortality were higher in the patients with amyloidosis and CA. The patients with amyloidosis had a poorer prognosis following VT events, highlighting the importance of continuous monitoring in these patients.

A systematic review and meta-analysis comparing radiofrequency catheter ablation with medical therapy for ventricular tachycardia in patients with ischemic and non-ischemic cardiomyopathies.

In patients with cardiomyopathy, radiofrequency catheter ablation (CA) for ventricular tachycardia (VT) is an adjunctive and alternative treatment option to long-term anti-arrhythmic drug therapy. We sought to compare CA with medical therapy for the management of VT in patients with ischemic and non-ischemic cardiomyopathies. MEDLINE, Cochrane, and ClinicalTrials.gov databases were evaluated for relevant studies. Eleven studies with 2126 adult patients were included (711 in CA, 1415 in medical therapy). In the randomized controlled trial (RCT) analysis, CA reduced risk of recurrent VT (risk ratio (RR) 0.79 [95% CI 0.67 to 0.93], p = 0.005), ICD shocks (RR 0.64 [95% CI 0.45 to 0.89] p = 0.008), and cardiac hospitalizations (RR 0.76 [95% CI 0.63 to 0.92] p = 0.005). There was no difference in all-cause mortality (RR 0.94, p = 0.71). In combined RCT and observational study analysis, there was a trend for reduction in all-cause mortality (RR 0.75 [95% CI 0.55 to 1.02] p = 0.07). In subgroup analysis of studies with mean left ventricular ejection fraction (LVEF) < 35%, CA demonstrated reduction in mortality (RR 0.71, p = 0.004), ICD shocks (RR 0.63, p = 0.03), VT recurrence (RR 0.76, p = 0.004), and cardiac hospitalizations (RR 0.75, p = 0.02). The subgroup of early CA prior to ICD shocks demonstrated reduction in ICD shocks (RR 0.57, p < 0.001) and VT recurrence (RR 0.74, p = 0.01). CA for VT demonstrated a lower risk of VT recurrence, ICD shocks, and hospitalization in comparison to medical therapy. The subgroups of early CA and LVEF < 35% demonstrated better outcomes.

Atrial fibrillation is associated with an increased risk of ventricular arrhythmias and sudden death in patients with pacemakers and implantable cardioverter defibrillators (ICDs)

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) has been linked to an increase in the risk of ventricular arrhythmias. Purpose We aimed to investigate whether AF is associated with an increased risk of ventricular tachycardia (VT), ventricular fibrillation (VF) and sudden death (SD) in patients with cardiac implantable electronic devices (CIEDs). Methods All patients hospitalised in France between 2011 and 2020 with a history of pacemakers (PPMs) and implantable cardioverter defibrillator (ICD) were identified from the French National database. Patients with a prior history of VT, VF and SD were excluded. Results A total of 701,195 patients were identified. Of these, 581,781 (90.1%) patients had PPMs and 63,726 (9.9%) had ICDs. In the PPM group, 248046 (42.6%) had AF and 333735 (57.4%) had no AF. After multivariable analysis, predictors for VT, VF and SD included sex, diabetes, heart failure, history of pulmonary oedema, valve disease, dilated cardiomyopathy, coronary artery disease (CAD), AF, vascular disease, intracranial bleeding, smoking, dyslipidaemia, alcohol related disorders, lung disease, chronic kidney disease (CKD), thyroid disorders, inflammatory diseases, anaemia, poor nutrition, cognitive impairment, previous cancer and frailty. The incidence of VT, VF and SD was higher in patients with AF (1.47%/year) compared to those without AF (0.94%/year), with the risk significantly elevated in the former group, hazard ratio (HR) 1.554 (confidence interval (CI) 1.508-1.601). After adjustment for confounders (Figure 1), AF was still associated with a significantly increased risk of VT, VF and SD, HR 1.236 (CI 1.198-1.276) in patients with PPMs. This was further demonstrated through a 1:1 propensity score matched (PSM) analysis (n=200977 in each group) where the risk of incident outcomes was significantly higher in PPM patients with AF, HR 1.230 (1.187-1.274), compared to those without AF. In the ICD group, 20965 (32.9%) had AF and 42761 (67.1%) had no history of AF. Predictors of VT, VF and SD after multivariable analysis included age, sex, diabetes mellitus, heart failure, valve disease, CAD, previous percutaneous coronary intervention, vascular disease, AF, CKD, liver disease and frailty. Incidence of VT, VF and SD was higher in ICD patients with AF (5.30%/ year) compared to those without AF (4.21%/year), with a significantly higher risk, HR 1.261 (CI 1.204-1.320). After adjustment for confounders, this elevated risk was still significant HR 1.167 (1.111-1.226) (Figure 1). 1:1 PSM analysis (n=18349 in each group) demonstrated this further with a significantly elevated risk in ICD patients with AF, compared to ICD patients without AF, HR 1.134 (CI 1.071-1.200). Conclusion Our findings suggest that patients with PPM and ICD with concurrent AF are at a higher risk of VT, VF and sudden death compared to patients with PPM and ICD who do not have AF.

Atrial fibrillation is associated with an increased risk of ventricular arrhythmias and sudden death in the general population

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) has been linked to an increase in the risk of ventricular arrhythmias. Purpose We aimed to investigate whether AF is associated with an increased risk of ventricular tachycardia (VT), ventricular fibrillation (VF) and sudden death (SD). Methods Hospitalised patients from 2013 with and without AF were identified from the French National database and included if they had at least 5 years of follow-up. Results Over a median follow-up period of 5.4 years (interquartile range (IQR) 5.0-5.8 years), a total of 3345638 patients were identified. Of these, 312226 had AF and 3033412 did not have AF. After multivariable analysis, the predictors significantly associated with VT, VF and SD included age, sex, hypertension, diabetes mellitus, heart failure, history of pulmonary oedema, valve disease, dilated cardiomyopathy, coronary artery disease, vascular disease, AF, smoking, dyslipidaemia, obesity, alcohol related diagnoses, chronic kidney disease, lung disease, liver disease, inflammatory diseases, anaemia, previous cancer, poor nutrition, cognitive impairment, and frailty. The incidence of VT, VF and SD was higher in those with AF compared to those without AF (2.23%/year vs. 0.56%/year). AF was associated with a higher risk of incident outcomes compared to no AF, hazard ratio (HR) 3.657 (confidence interval (CI) 3.604-3.711). After adjustments were made for confounders (Figure 1), this increased risk was still significant HR 1.167 (CI 1.111-1.226). A 1:1 propensity score matched analysis was also performed (n=289,332 in each group), demonstrating the significantly increased risk of ventricular arrhythmias and SD in patients with AF compared to those without AF, HR 1.339 (CI 1.313-1.366). Conclusion The findings from our study AF indicate that AF is associated with an increased risk of VT, VF and sudden death in the general population.

PO-714-03 CLINICAL CHARACTERISTICS, MANAGEMENT, AND OUTCOMES IN A REAL-WORLD COHORT OF ADULT PATIENTS WITH SCAR-RELATED VENTRICULAR TACHYCARDIA

Ventricular tachycardia (VT) is a potentially fatal cardiac rhythm disturbance. VT patients with cardiomyopathies (CM) have the highest risk of sudden cardiac death and recurrent VT, but there are major knowledge gaps regarding patient characteristics, prognosis, and other data to guide clinical management.

Ventricular Tachycardia Burden and Mortality: Association or Causality?

Ventricular tachycardia (VT) is a potentially fatal cardiac rhythm disorder. Implantable cardioverter defibrillators (ICDs) are the primary management strategy for VT and have been shown to reduce the incidence of death but, ICDs do not reduce VT recurrences. Further, mounting evidence indicates that high VT burden, defined as the cumulative number of recurrent VTs or ICD shocks, is associated with an elevated risk of death; however, it is unclear if high VT burden is a cause of death or a marker of severe heart disease. Proposed mechanisms for a causal pathway suggest that multiple VT episodes or potential deleterious effects from ICDs might alter the myocardium of the ventricles to induce worsening heart disease, which might translate to an increased risk of mortality. In this review, we present the evidence to support association and causation hypotheses for the relationship between VT burden and risk of mortality and indicate potential gaps in evidence. Overall, there is insufficient evidence to prove causal hypotheses for the relationship between VT burden and mortality. Consistent definitions for VT burden, randomized controlled trials that assess the relationship between VT burden and mortality, and observational studies that capture VT burden are warranted to investigate if a potential causal relationship exists.

Influence of ST2 level on the development of acute arrhythmias in NSTEMI

Abstract Funding Acknowledgements Type of funding sources: None. Purpose To determine the structure and relationship of cardiac arrhythmias in NSTEMI patients based on plasma ST2 level. Methods We studied 90 patients with NSTEMI aged from 35 to 79 years (mean 60.7 ± 0.8, median - 61, interquartile range 54 and 69). Plasma ST2 level was determined and analyzed in the NSTEMI patients group, the gradations of the ST2 level and the correlation with cardiac arrhythmias. All of the research corresponds to the principles of the Declaration of Helsinki of the World Medical Association. Results. Using the variation statistics method, the ST2 level gradations group were selected. Thus, the relatively low (RL) corresponded to less than 25, and the relatively high (RH) level of ST2 to more than 75 persons in the group, respectively. For patients in the main group, these levels were &amp;lt;26 and&amp;gt; 56 ng / ml, respectively. Instead, the relatively moderate (or intermediate) ST2 level (RM) for these patients was 26-56 ng / ml. It has been determined that the most frequent rhythm disturbances were observed in the RM and RH risk groups, and more often in the RM risk group, probably due to a larger number of observations (Tab. 1). At that time, the total duration of ventricular tachycardia (VT) episodes, regardless of the number of patients, was at RH risk group. The same was observed with episodes of ST-depression. Conclusions. Despite the number of observations, the risk of VT and ST-depression is significantly higher in patients at RH risk group. This should be taken into account when predicting the risk of complications in patients with NSTEMI. Abstract Figure. Tab. 1

Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction.

To non-invasively characterize, by means of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR), scar differences, and potential variables associated with ventricular tachycardia (VT) occurrence in chronic post-myocardial infarction (MI) patients. A case-control study was designed through retrospective LGE-CMR data analysis of chronic post-MI patients (i) consecutively referred for VT substrate ablation after a first VT episode (n = 66) and (ii) from a control group (n = 84) with no arrhythmia evidence. The myocardium was characterized differentiating core, border zone (BZ), and BZ channels (BZCs) using the ADAS 3D post-processing imaging platform. Clinical and scar characteristics, including a novel parameter, the BZC mass, were compared between both groups. One hundred and fifty post-MI patients were included. Four multivariable Cox proportional hazards regression models were created for total scar mass, BZ mass, core mass, and BZC mass, adjusting them by age, sex, and left ventricular ejection fraction (LVEF). A cut-off of 5.15 g of BZC mass identified the cases with 92.4% sensitivity and 86.9% specificity [area under the ROC curve (AUC) 0.93 (0.89-0.97); P < 0.001], with a significant increase in the AUC compared to other scar parameters (P < 0.001 for all pairwise comparisons). Adding BZC mass to LVEF allowed to reclassify 33.3% of the cases and 39.3% of the controls [net reclassification improvement = 0.73 (0.71-0.74)]. The mass of BZC is the strongest independent variable associated with the occurrence of sustained monomorphic ventricular tachycardia in post-MI patients after adjustment for age, sex, and LVEF. Border zone channel mass measurement could permit a more accurate VT risk stratification than LVEF in chronic post-MI patients.

Abstract 14400: Prevalence of Arrhythmias and Conduction Disease in Patients Hospitalised With Cardiac Amyloidosis

Introduction: Cardiac Amyloidosis (CA) is an infiltrative cardiomyopathy that results in deposition of misfolded amyloid fibrils into the myocardium, and is thought to disrupt the conduction system. As there is limited data regarding the prevalence of arrhythmias and conduction disease in patients with cardiac amyloidosis, we sought to determine their prevalence in patients hospitalized with CA using the National Inpatient Sample (NIS) from 2017. Methods: A retrospective study was done using the Nationwide Inpatient Sample from 2017. 18,380 patients with cardiac amyloidosis were identified using ICD-10 codes. Multivariate logistic regression analysis was used to adjust for confounders and analyze the variables for the adjusted odds ratio. Results: Among 18,380 total patients, the average age was 74 and 56% were male. Atrial fibrillation (AF) was the most prevalent (34%) atrial arrhythmia followed by atrial flutter (AFL) (5.2%) and supraventricular tachycardia (SVT) (3.0%). Ventricular tachycardia (VT) was the most common ventricular arrhythmia (4.9%) and less than one percent of the cohort had reported episodes of ventricular fibrillation/flutter (&lt; 1%). In terms of conduction disease, 3.5% had either first-degree (1AVB) or second-degree AV block (2AVB), and 3.2% had either right (RBBB) or left bundle branch block(LBBB). When adjusted to patient demographics, comorbidities, and hospital characteristics, patients with CA had higher risk of AF (aOR= 1.69, p&lt;0.0001), AFL (aOR=2.3, p&lt;0.0001), SVT (aOR=1.78, p&lt;0.0001), VT (aOR=2.3, p&lt;0.0001), ICD (aOR=1.5, p &lt;0.0001), RBBB (aOR=1.32, p=0.048), 1AVB (aOR=1.82, p&lt;0.0001), and 2AVB (aOR=2.24, p&lt;0.0001) as compared to those without. Conclusions: Patients with cardiac amyloidosis are more likely to develop atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, RBBB, 1AVB, and 2AVB. Atrial fibrillation was the most common arrhythmia found in our cohort, and this is consistent with trends seen in prior observational studies.

Abstract 13743: Prevalence of Cardiac Rhythm Disturbances in Heart Failure Patients With and Without Cardiac Amyloidosis: A National Inpatient Sample Analysis

Background: Cardiac amyloidosis (CA) is well-known to affect electrocardiographic findings. However, the impact of CA on the prevalence of cardiac arrhythmias, particularly in heart failure (HF) patients, is unknown. Our aim was to assess the prevalence of arrhythmias in HF patients with and without CA. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2017. About 5,074,059 patients who had acute, acute on chronic and chronic HF as primary or secondary diagnosis were identified and stratified based on the presence or absence of CA using ICD-10 codes. Both univariate regression and literature review were used to determine the covariates. Multivariate logistic regression analysis was used to adjust for confounders and analyze the variables. Results: Out of the 5,074,059 hospitalized patients with a primary and secondary diagnosis of HF, 7,980 individuals had CA. HF patients with CA had a higher prevalence of Atrial Fibrillation (AF) (52.6% vs 39.3%), Atrial Flutter (AFL) (9.4% vs 3.89%), Ventricular tachycardia (VT) (9.6% vs 4%), Supraventricular tachycardia (SVT) (3.9% vs 2.1%), right bundle branch block (RBBB) (2.9% vs 1.6%), 1st degree AV block (1AVB) (3.07% vs 1%), 2nd degree AV block (2AVB) (1.4% vs 0.4%), and 3rd degree AV block (3AVB) (1.25% vs 0.7%) than without. When adjusted to patient demographics, comorbidities, and hospital characteristics, HF patients with CA had higher risk of AF (aOR= 1.67, p&lt;0.0001), AFL (aOR=2.9, p&lt;0.0001), VT (aOR=2.08, p&lt;0.0001), SVT (aOR=1.63, p&lt;0.0001), RBBB (aOR=1.62, p=0.002), 1AVB (aOR=2.27, p&lt;0.0001), and 2AVB (aOR=2.86, p&lt;0.0001) compared to those without. However, there was no significant difference in the prevalence of Ventricular Fibrillation (VF) (aOR=0.92, p=0.82) in the same population. Conclusion: HF patients with CA are 67%, 190%, 108%, 63%, 62%, 127%, and 186% more likely to develop AF, AFL, VT, SVT, RBBB, 1AVB, and 2AVB respectively, than those without. However, HF patients with CA did not have a significant difference in the prevalence of VF, 3AVB, and LBBB. CA is an infiltrative disease process that is known to cause cardiac conduction disturbances. Limitations include the underdiagnosis of CA in our society as well as the non-specificity of ICD codes for CA.

The effect of anesthesia depth on radiofrequency catheter ablation of ventricular tachycardia: a retrospective study

BackgroundRadiofrequency catheter ablation (RFCA) as a safe and effective method has been widely used in ventricular tachycardia (VT) patients, and with which anesthesiologists frequently manage their perioperative care. The aim of this study was to investigate the effects of different anesthetic depths on perioperative RFCA and recurrence in patients who with intractable VT and could not tolerate an awake procedure.MethodsWe reviewed electronic medical records of patients with VT who underwent RFCA by general anesthesia from January 2014 to March 2019. According to intraoperative VT induction, they were divided into two groups: non-inducible group (group N) and inducible group (group I). We constructed several multivariable regression models, in which covariates included patient characteristics, comorbidities, protopathy and bispectral index (BIS) value.ResultsOne hundred one patients were analyzed. Twenty-nine patients (28.7%) experienced VT no induction, and 26 patients (25.7%) relapsed within 1 year. Compared with group I, the proportion of patients with arrhythmogenic right ventricular cardiomyopathy in group N were higher (P < 0.05), and the recurrence rate of VT was significantly higher (51.7% vs 15.3%) (P < 0.05). The BIS value in group N was significantly lower (P < 0.01), in addition, the BIS < 40 was associated with elevated odds of VT no induction compared with a BIS > 50 (odds ratio, 6.92; 95% confidence interval, 1.47–32.56; P = 0.01). VT no induction was an independent predictor of recurrence after RFCA (odds ratio, 5.01; 95% confidence interval, 1.88–13.83; P < 0.01).ConclusionLower BIS value during VT induction in RFCA operation was associated with high risk of VT no induction, which affects postoperative outcomes. We proposed that appropriate depth of anesthesia should be maintained during the process of VT induction.