Treatment Of Heart Rhythm Disorders Research Articles

Heart rate disorders in patients with Tako-tsubo syndrome

ObjectivesThis study sought to evaluate the incidence, prognosis and treatment of heart rhythm disorders (TdR) in Tako-tsubo syndrome (STT). BackgroundSTT is associated with TdR. The TdR prognostic value is not well characterized in STT yet. MethodsThe TdR of patients included in the National Registry of Tako-tsubo syndrome (XXX1), admitted between 2002 and 2018 and coming from 38 hospitals throughout the country, was analyzed. We analyzed any heart rhythm disorder in patients presented before admission, at admission and in long-term follow-up. ResultsAll types of TdR were described in 259 (23.5%) cases, from a cohort of 1,097 consecutive patients with STT. TdR was more associated with Diabetes Mellitus, smoking, hyperuricemia, sleep apnea, anemia with a worse LVEF on admission. The most frequent TdR was a new onset of atrial fibrillation (FA). During hospitalization, patients with TdR showed more complications such as shock on admission, major bleeding, acute renal failure, and combined infections. At follow-up, they presented higher mortality and more MACE, but with a non-significant correlation. ConclusionsThe incidence of TdR in patients with STT is not infrequent. STT, when associated with TdR, presents more complications and a worse prognosis both in hospital and in the long term.

Role of nursing in the implantation of the injectable holter

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): No Introduction The injectable Holter monitor is a useful tool in the evaluation of patients with recurrent syncope of unknown etiology and in patients with suspected embolic paroxysmal AF. This device monitors heart rhythm for 2-3 years. In our center, the implantation and follow-up of this type of patient is carried out exclusively by nursing, with three centers in Andalusia performing this type of procedure. The objective is to describe the injectable holter implant procedure prepared by nursing. Material and Method Through the bibliographic search in the CUIDEN and PubMed databases, a procedure for the implantation of an injectable Holter monitor by nursing has been developed. The types of Holter that are implanted in the Hemodynamics Unit, the implantation procedure, as well as the necessary material are described. When an injectable Holter monitor is implanted in a patient, a series of steps are followed, such as checking them the next day, conducting health education, as well as delivering the remote monitoring device. Results Since 2010, 266 devices have been implanted, with the nursing staff being fully responsible for both implanting and monitoring them. In the insertion procedure, the previous preparation of the patient, information, the necessary material for the implant, procedure and activation of the device by means of a programmer are highlighted. After the implant, monitoring and remote control are performed by the nursing staff for functional tests. Conclusions The complete approach to the implantation and follow-up of the injectable Holter monitor by nursing has allowed us to grow, helping closely in the diagnosis and treatment of heart rhythm disorders. The utility in the early detection of cardiac events in the injectable Holter monitor is a leap in the quality of life of patients, in the optimization of resources and in response time.

Trastornos del ritmo cardiaco en pacientes con síndrome de Tako-tsubo

ObjectivesThis study sought to evaluate the incidence, prognosis and treatment of heart rhythm disorders (HRD) in Tako-tsubo syndrome (TTS). BackgroundTTS is associated with HRD. The HRD prognostic value is not well characterized in TTS yet. MethodsThe HRD of patients included in the National Registry of Tako-tsubo syndrome, admitted between 2002 and 2018 and coming from 38 hospitals throughout the country, was analyzed. We analyzed any heart rhythm disorder in patients presented before admission, at admission and in long-term follow-up. ResultsAll types of HRD were described in 259 (23.5%) cases, from a cohort of 1,097 consecutive patients with TTS. HRD was more associated with diabetes mellitus, smoking, hyperuricemia, sleep apnea, anemia with a worse LVEF on admission. The most frequent HRD was a new onset of atrial fibrillation. During hospitalization, patients with HRD showed more complications such as shock on admission, major bleeding, acute renal failure, and combined infections. At follow-up, they presented higher mortality and more major adverse cardiac events, but with a non-significant correlation. ConclusionsThe incidence of HRD in patients with TTS is not infrequent. TTS, when associated with HRD, presents more complications and a worse prognosis both in hospital and in the long term.

PO-03-204 BURDEN OF ARRHYTHMIAS AND CLINICAL OUTCOMES IN PATIENTS HOSPITALIZED WITH ACUTE MYOCARDITIS ACCORDING TO LARGE DATASET

Acute myocarditis is known to cause diverse disorders of heart rhythm which can be difficult to diagnose and further investigate. Moreover, prevalence of arrhythmias and their clinical impact is not well studied in this population. This article aims to investigate the burden, basic characteristics, and clinical outcomes of the most prevalent arrhythmias arising in acute myocarditis (AM). We queried the National Inpatient Sample between 2017-2020 for adult patients who were hospitalized with AM. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, invasive mechanical ventilation, length of stay (LOS) and total hospital cost. Multivariable logistic, linear and Poisson regression analyses were used to estimate clinical outcomes. p-value < 0.05 was significant. There were 14,325 hospitalizations with AM, of which 2,784 (19.7%) had arrhythmia. Mean age was 45.3 yrs, 60.8% were Caucasian, 61.8% were male. The most prevalent arrhythmia was ventricular tachycardia (VT) 1,289 (8.9%), followed by paroxysmal atrial fibrillation (AFib) 604 (4.2%), 3rd degree AV block (AVB) 414 (2.8%), ventricular fibrillation 135 (0.9%), and permanent AFib 119 (0.8%). Subgroup with arrhythmia vs without arrhythmia had HTN 10.3% vs 16.8%; PH 10.3% vs 6.1%; HF 69.7% vs 37.9%; CKD 16.1% vs 9.2%; COPD 12.7% vs 7.6%, respectively. During hospitalization, these subgroups had following complication rates: ACS 27.2% vs 23.7%; AKI 41.3% vs 20.8%; stroke 4.3% vs 1.4%, respectively. Also, subgroup with arrhythmia was associated with higher ICD (7.5% vs 0.3%), PPM (2.7% vs 0.5%), and LVAD (7.9% vs 1.5%) insertion rate. Finally, subgroups with the most frequent arrhythmias (VT, AFib, 3rd degree AVB) demonstrated worse primary and secondary outcomes compared to non-arrhythmic patients (Table 1). Patients hospitalized with AM have significant burden of arrhythmia (almost 20%), mainly VT, AFib, and AVB. Arrhythmic population has prevalent PH, HF, CKD, and COPD. Hospital complications and requirements for device support are also higher in AM patients with arrhythmia resulting into worse mortality, clinical outcomes, and higher resource utilization. When managing patients with AM, early identification and treatment of heart rhythm disorders would improve results. Further research aiming on pathogenesis and long-term outcomes is needed.

Coping strategies and attitudes towards health in cardiac patients

Highlights. The importance of psychological assessment and psychological support in Cardiology Departments has been demonstrated. For the first time, predominant coping strategy in cardiac patients was revealed.Background. Why do patients with the same disease, disease course, prognosis and treatment have different outcomes? One hypothesis points to the influence of internal resources used in coping with the disease. A.B. Smulewicz in 1984 identified the association between the clinical symptoms and mental state of the patient.Aim. To determine characteristics of coping behavior and attitude toward health in cardiac patients from Surgical and Therapeutic Departments.Methods. 122 patients admitted to the State Autonomous Healthcare Institution “N.A. Semashko Republican Clinical Hospital” were included in the study. The 1st group consisted of in-patients from the Department of Surgical Treatment of Heart Rhythm Disorders and Electrical Cardiac Stimulation (61 patients); the 2nd group consisted of patients from the 1st Cardiology Department (61 patients). A questionnaire developed by R. Lazarus and S. Falkman in 1988 was used to determine coping strategies, and a questionnaire developed by R. A. Berezovskaya in 2005 was used to assess attitudes towards health.Results. Active coping strategy predominates in surgical patients, and distancing and avoidant strategies predominate in therapeutic patients. Correlation between characteristics of coping strategy and attitudes toward health was analyzed: active coping strategies are accompanied by high behavioral, cognitive, and emotional aspects. An inverse correlation is noted in distancing and avoidant coping strategies.Conclusion. Psychological comfort and correct attitude of patient to his/her disease is an important part of rehabilitation that highlights the significance of psychometric testing in cardiac patients.

Feasibility of remote technical support for electrophysiological ablation procedures during the current COVID-19 pandemic.

AimsThe treatment of heart rhythm disorders has been significantly impacted by direct consequences of the current COVID-19 pandemic, as well as by restrictions aimed towards constraining viral spread.Methods and resultsUsually, catheter ablations of cardiac arrhythmias are guided by electro-anatomic mapping (EAM) systems. Technical staff with medical training, or medical staff with technical training, are needed to assist the operator. Travel restrictions due to the current COVID-19 pandemic have limited the in-person availability of technical support staff. To overcome these limitations, we explored the feasibility of a trans-atlantic remote technical support for EAM, with an internet-based communication platform, for complex electrophysiological ablation procedures.ConclusionOur first experience, based on nine ablation procedures of different arrhythmias, highlights the feasibility of this approach. Remote support for EAM might therefore facilitate continuous care for patients with arrhythmias during the COVID-19 pandemic, particularly in insular settings. Beyond COVID-19-related challenges, this approach will likely play a greater role in the cardiology field in years to come, due to its significant advantages.

Feasibility of remote support for electrophysiological ablation procedures during CoVid-19 pandemics

Abstract The COVID-19 pandemics is a global challenge with a huge impact on medicine, politics, economy, education, travel and many other aspects of human life. The treatment of heart rhythm disorders has also been affected by the disease itself and by restrictions in order to constrain the spread of the virus. Catheter ablations of cardiac arrhythmias are nowadays frequently guided by electro-anatomic mapping systems. Technical staff with medical training, or medical staff with technical training, is needed to assist the operator. Travel restrictions due to current COVID-19 pandemics have limited the in person availability for technical support staff. To overcome these limitations we explored the feasibility of remote support with an internet based communication platform. A total of 9 patients (87,5% male, mean age 66,6 years) with different arrhythmias (atrial fibrillation, left atrial flutter, typical right atrial flutter, left ventricular tachycardia), having undergone ablation procedures between October 2020 and February 2021, were included. Acute procedural success was obtained in 9 out of 9 procedures. No complications occurred. Our experience with remote support for electro-anatomic mapping for complex electrophysiological ablation procedures, show the feasibility and safety of this approach. It increases the availability of technical support at reduced costs and a reduced CO2 footprint. Remote support for electro-anatomic mapping may therefore facilitate continuous care for patients with arrhythmias during the COVID-19 pandemics. Due to its advantages beyond COVID-19 pandemics related problems, it will likely play a greater role in the future. Funding Acknowledgement Type of funding sources: None.

Alexander Nikolaevich BAKULEV - Soviet surgeon-scientist, the founder of cardiovascular surgery in the USSR (to the 130th of birthday)

Alexander Bakulev was born in the village Nebankovskaya Vyatka province. He studied first at the parish school, and then at the Vyatka theological Seminary. In 1911 he entered the medical faculty of Saratov University. In 1918, he passed the exams for a doctor's degree ahead of schedule and remained in the hospital surgery clinic of the University. In 1926 A. N. Bakulev entered the residency at the Department of surgery of the 2nd Moscow medical Institute. In 1928 he successfully defended his thesis and was sent for a one-year internship in Germany. For the first time in the domestic practice, he proposed the introduction of radiopaque substances in the brain tissue, a method of ureteral transplantation, improved methods of x-ray examination of vessels, kidneys and ureters, developed methods of plastic esophagus (1935), surgery on the biliary tract, methods of surgical treatment of peptic ulcer, for the first time in the world surgically eliminated the fixation of the heart muscle to the heart bag with pericarditis, developed new methods of treatment of brain abscesses. A. N. Bakulev is considered a pioneer of intubation anesthesia in the USSR, the founder of thoracic and radical pulmonary surgery. He performed a successful lobectomy for chronic abscess (1938) and lung actinomycosis (1939). In 1943 A. N. Bakulev became head of the Department. During the great Patriotic war A. N. Bakulev - front, and then chief surgeon of the evacuation hospitals of Moscow, head of the surgical Department of the hospital medical and sanitary Department of the Kremlin. He successfully removed a lung from a patient with chronic suppurative process (1945), for the first time carried out a successful operation in nezaradene known to inhibit the Bayou (1948), have developed a method comissurotomy. In 1949, A. N. Bakulev was awarded the Stalin prize (1949). He was the first to impose an anastomosis between the superior Vena cava and pulmonary artery, performed surgery for aneurysm of the thoracic aorta, created a technology of heart operations in hypothermia, for the first time in the world he began to operate on children suffering from congenital heart defects. In 1955 on the initiative of A. N. Bakuleva was established Institute of thoracic surgery (now the Institute of cardiovascular surgery. A. N. Bakuleva), the first Director of which he became. Among his developments can be noted the method of electrocardio-stimulation, intended for the treatment of heart rhythm disorders, a method of plasty of coronary vessels in acute myocardial infarction. In the mid-fifties A. N. Bakulev lays the foundations of shunting operations on the vessels of the heart. In 1957 he was awarded the Lenin prize. In 1959 A. N. Bakulev performed a successful operation for valvular stenosis of the pulmonary artery. In 1958, the scientist was elected a full member of the USSR Academy of Sciences. From 1953 to 1960 President of the USSR Academy of Sciences. A. N. Bakulev was awarded three orders of Lenin, the order of the red banner of Labor and the red Star, was awarded the highest international award of surgeons the award "Golden scalpel". On March 31, 1967, Alexander Bakulev died suddenly from cardiac arrest and was buried at Novodevichy cemetery. In memory of Alexander Nikolaevich in 2005, a documentary film "the Key to the heart" was shot in front of the Institute of cardiovascular surgery named after A. N. Bakulev monument to the scientist, and the building a plaque.

Beta-blocker Use in Moderate and Severe Chronic Obstructive Pulmonary Disease.

Introduction:The most appropriate choice of pharmacological treatment of heart rhythm disorders occurring in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidity is often a topic of debate between pulmonologists and cardiologists in clinical practice, although numerous studies and clinical trials have demonstrated evidence to support the use of selective beta-blockers (BBs) in these patients.Aim:To examine the difference in the number of exacerbations in patients treated with a combination of verapamil and digoxin or BB alone in patients with different COPD stages.Patients and methods:The study included 68 patients (n = 68) diagnosed with COPD who were followed-up during a 12-month period, and the number of exacerbations were analyzed. The patients were divided into two groups according to the stage of COPD: GOLD II (moderate), and GOLD III (severe), and in each group a subdivision was established in relation to the use of either a combination of verapamil and digoxin or the use of BBs alone in pharmacological treatment. The inclusion criteria for patients were defined as following: a) established diagnosis of COPD according to present or deteriorated relevant clinical symptoms and signs, b) the ejection fraction (EF) of a left ventricle (LV) >35%, and c) spirometric cut-points classified as GOLD II (FEV1 / FVC <0.7, FEV1 predicted 50-80%), or GOLD III (FEV1/FVC <0.7, FEV1 predicted 30-50%) stage of the COPD. The exclusion criteria were EF of LV <35% and a lethal outcome during a follow-up period (2 patients were encountered). Exacerbation was defined as functional deterioration of the COPD symptoms verified by spirometric functional testing, frequency of hospitalizations according to GOLD stage assignment or verified clinical symptoms deterioration.Results:Regardless the pharmacological treatment, there is a statistically significant increase in the number of COPD exacerbations, in a 12-month period follow-up, in the GOLD III group (severe) compared to the GOLD II group (moderate). In the group of patients taking verapamil and digoxin, a two-tailed t-test was used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.01, and 2. In the group of patients taking BBs, a two-tailed t-test was also used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.003). Within the COPD GOLD II stage group, there appears to be no statistically significant difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 24) and the patients taking BBs alone (n = 15), although, in patients taking BBs alone, there appears to be a trend towards a decrease in the exacerbations compared to the number of exacerbations in patients taking verapamil and digoxin (p = 0.007). Within the COPD GOLD III stage group, there is no difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 20), and the patients taking BBs alone (n = 9), as analyzed by a two-tailed t-test, p = 0.577.Conclusion:Use of selective BBs in the treatment of cardiovascular comorbidity in patients with COPD represents a far better choice of pharmacological approach in the treatment of patients diagnosed with COPD GOLD II (moderate) stage.

Imaging-Based Simulations for Predicting Sudden Death and Guiding Ventricular Tachycardia Ablation.

Simulation-driven engineering has put rockets in space, airplanes in the sky, and self-driving cars on the road. Computational approaches have also contributed to advancements in clinical medicine and human health.1–3 In the arena of cardiac care, the recent emphasis on personalized medicine has provided a significant impetus for the development of predictive approaches combining imaging and computational modeling that can be applied to the diagnosis and treatment of heart rhythm disorders. A major advance in this direction is the creation and translation into clinical practice of novel imaging- and simulation-based strategies for predicting an individual’s risk of sudden cardiac death (SCD) and for the noninvasive planning of optimal personalized antiarrhythmia therapies. Clinical decisions about the stratification of patients for SCD risk resulting from arrhythmia and for determining the optimal targets for antiarrhythmia ablation therapies could greatly benefit from such targeted developments because current approaches, although life saving, remain suboptimal, often increase the burden on the healthcare system, and could lead to increased patient morbidity. SCD resulting from ventricular arrhythmias is a leading cause of death in the industrialized world, particularly among patients with prior myocardial infarction (MI).4 For patients at high risk of SCD, mortality is reduced by the prophylactic insertion of implantable cardioverter defibrillators (ICDs).5 To determine the level of SCD risk, clinical cardiology practice still relies on the one-size- fits-all metric of left ventricular ejection fraction (LVEF) <35% to identify high-risk patients. Mechanistically, in hearts with structural disease, arrhythmia results from the heterogeneously distributed remodeled tissue, which can promote the initiation and maintenance of electric instability. Global LVEF poorly reflects these mechanistic factors and, hence, its use to determine the level of SCD risk and stratify patients for ICD implantation results in a low rate of appropriate ICD device therapy, only 5% per …

Heart Rythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety.

ABBREVIATIONS CIED = cardiovascular implantable electronic device; CT=computed tomography; EP=electrophysiology; FDA= U.S. Food and Drug Administration; ICD=implantable cardioverterdefibrillator; MRI = magnetic resonance imaging; QA = quality assurance; QI = quality improvement; RF = radiofrequency; VT = ventricular tachycardia (Heart Rhythm 2014;11:e9–e51)

Augmented Reality for Improving Catheterization in Magnetic Resonance Imaging-Guided Cardiac Electrophysiology Therapy1

Augmented Reality for Improving Catheterization in Magnetic Resonance Imaging-Guided Cardiac Electrophysiology Therapy1

New Multipoint Pacing Technology for Heart Failure Patients

Tim Betts speaks to Caroline Telfer, Assistant Commissioning Editor. Tim Betts is currently a consultant cardiologist and electrophysiologist at the Oxford Heart Centre, John Radcliffe Hospital (Oxford, UK). Dr Betts gained his MB ChB from Birmingham Medical School (Birmingham, UK) in 1991, and his MD on the relationship between atrial anatomy and electrophysiology was awarded by Southampton University (UK) in June 2003. Dr Betts' special interests include diagnosis, investigation and treatment of heart rhythm disorders, including blackouts, palpitations and risk assessment for sudden cardiac death. He performs diagnostic electrophysiology and catheter ablation. He also specializes in cardiac devices including pacemakers, defibrillators and cardiac resynchronization therapy (biventricular pacing).

Genetic treatment of heart rhythm disorders—where do we stand?

C d a i p p Groundbreaking discoveries on genetic loci that underlie arrhythmia syndromes, which commenced in the early 1990s, have immensely increased our understanding of these syndromes. These discoveries also rigorously changed daily clinical practice for cardiologists who were faced with the enquiries of presymptomatic family members of symptomatic individuals who were known with an arrhythmia syndrome. Now it has become possible to screen the genome for the risk of arrhythmias or even sudden death and, understandingly, this took a flight. Still, the holy grail of genetic discoveries in disease is in its therapeutic applicability and that promise is indeed coming our way. For example, in Duchenne muscular dystrophy, the increasing knowledge of the diseased locus has recently led to therapeutic gene therapy in a relatively small number of patients in whom the diseased exon was selectively bypassed. For rrhythmia syndromes, we are still in a preclinical phase, ut efforts to find curative options by means of genetic herapy are growing. Currently, genetic therapy for atrial brillation and bradycardia/conduction disease seems to dominate the field, but ventricular arrhythmias in ischemic conditions are also thoroughly investigated (for a recent review, see, eg, Boink and Rosen). The first in-human studies into the use of gene therapy in heart failure are even underway. In this issue of HeartRhythm, Soucek and colleagues from Heidelberg, Germany, presnt to us their preclinical work on genetic therapy for atrial brillation. Delay of atrial repolarization is considered one pproach to genetic therapy for atrial fibrillation, as coninuing propagation or reentry of fibrillation waves can be mpeded by prolonging the atrial effective refractory period ERP). The main currents responsible for the atrial ERP are outward potassium currents: IKr, IKur, IKs, and IK1. In their tudy, Soucek et al focused on suppressing the IKr current y means of introducing an engineered gene that encodes an Kr-suppressing (dominant-negative) protein into the atria of pigs with the use of an adenovirus vector. Their aim was to

Guidance for the Heart Rhythm Society Pertaining to Interactions with Industry

The mission of the Heart Rhythm Society (HRS) is to improve the care of patients by promoting research, education, resources for patients and their families, and optimal healthcare policies and standards. HRS sets professional standards for treatment of heart rhythm disorders and disseminates these standards to its members.

Rationale and design of the Duke Electrophysiology Genetic and Genomic Studies (EPGEN) biorepository

Disturbances in cardiac rhythm can lead to significant morbidity and mortality. Many arrhythmias are known to have a heritable component, but the degree to which genetic variation contributes to disease risk and morbidity is poorly understood. The EPGEN is a prospective single-center repository that archives DNA, RNA, and protein samples obtained at the time of an electrophysiologic evaluation or intervention. To identify genes and molecular variants that are associated with risk for arrhythmic phenotypes, EPGEN uses unbiased genomic screening; candidate gene analysis; and both unbiased and targeted transcript, protein, and metabolite profiling. To date, EPGEN has successfully enrolled >1,500 subjects. The median age of the study population is 62.9 years; 35% of the subjects are female and 21% are black. To this point, the study population has been composed of patients who had undergone defibrillator (implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator) implantation (45%), electrophysiology studies or ablation procedures (35%), and pacemaker implantation or other procedures (20%). The cohort has a high prevalence of comorbidities, including diabetes (33%), hypertension (73%), chronic kidney disease (26%), and peripheral vascular disease (13%). We have established a biorepository and clinical database composed of patients with electrophysiologic diseases. EPGEN will seek to (1) improve risk stratification, (2) elucidate mechanisms of arrhythmogenesis, and (3) identify novel pharmacologic targets for the treatment of heart rhythm disorders.

Heart Rhythm Treatment Services (Hearts): An Interdisciplinary Approach to the Treatment of Heart Rhythm Disorders

Heart Rhythm Treatment Services (Hearts): An Interdisciplinary Approach to the Treatment of Heart Rhythm Disorders