Ventricular Ectopic Activity Research Articles

Structure of cardiac rhythm disorders in patients with obesity and associated with it dyslipidemia as an arrhythmogenic factor

Obesity is a global public health problem in the twenty-first century. The most adverse it’s effects are associated with visceral type, with accumulation of epicardial fat, showing high metabolic activity, dysfunction and important role in the development of lipotoxic cardiomyopathy linked with significant morphological and functional myocardial changes, accompanying by high risk of heart rhythm disorders. The aim of the study: to identify structure (frequency and character) of cardiac arrhythmias in men of employable age with visceral obesity, to establish the relationship of arrhythmias with features of the blood lipid spectrum of these patients. Material and methods. 98 men with abdominal obesity and 46 overweight patients were examined. The control group consisted of 40 healthy patients with normal body weight. All the patients were undergone ECG monitoring, echocardiography and analysis of serum lipid levels. Results. The presence of obesity is statistically significantly associated with the risk of supraventricular couplets, frequent ventricular extrasystoles, sinus arrhythmia and atrial fibrillation. The increase in the severity of obesity was accompanied by a tendency to a greater frequency of arrhythmias: in obesity of I degree, the frequency of atrial fibrillation was 12.3%, II–III degree — 21.2%, p = 0.25; frequent ventricular extrasystoles with similar degrees of obesity — 13.8% and 21.1%, respectively. Atrial fibrillation was significantly more often detected against the background of lipid disorders, mainly with a decrease in HDLP. Conclusion. The main type of heart rhythm disturbance in patients with obesity are supraventricular arrhythmias, mainly atrial fibrillation, the frequency of which increases in proportion to the increase in the patient's body weight. Abdominal obesity leads to an increase in ventricular ectopic activity. Dyslipidemia is the one of risk factors for arrhythmias in these patients.

Difficulties in selecting antiarrhythmic therapy in a patient with left ventricular noncompaction and atrial septal defect: a case report

Introduction. Left ventricular noncompaction (LVNC) is a rare heterogeneous pathology characterized by a two-layered structure with a predominance of non-compact layer in the form of multiple trabeculations and pockets between them, communicating with the left ventricular cavity. One of the rare LVNC phenotypes is a combination with congenital heart defects, including atrial septal defect (ASD).Brief description. The article presents a case report describing the difficulties of selecting antiarrhythmic therapy in a patient with LVNC and ASD, complicated by arrhythmias due to heart failure. The diagnosis of LVNC was confirmed by the Petersen criterion using magnetic resonance imaging.Discussion. Cardiac arrhythmias in patients with LVNC and congenital heart defects, as a result of both anatomical and hemodynamic causes of electrical heart instability, constitute a danger of thromboembolism and sudden cardiac death, and also contribute to heart failure progression. The case is of interest due to the rare combination of LVNC and ASD, complicated by frequent episodes atrial fibrillation and premature ventricular contractions in the form of parasystoles, as well as difficulties in selecting antiarrhythmic therapy. Pulmonary vein cryoballoon ablation eliminated the source of atrial fibrillation. Ventricular ectopic activity was stopped using the anticonvulsant drug carbamazepine.

Long QT syndrome induced by elevated dose of Fluoxetine Cloridrate: case report

Introduction: Long QT syndrome is a clinical condition that affects cardiac repolarization with an increased risk for the development of severe ventricular arrhythmias. The acquired form can be induced by drugs, such as selective serotonin reuptake inhibitors. Case report: E.A.C.G., female, 83 years-old, previously diagnosed with major depressive disorder in use of Fluoxetine the 80mg/day, was admitted in the emergency department after a syncopal event. An important widening of the QT interval was noted on the occasion, with a corrected value of 580ms. A 24-hour Holter monitoring showed increased ectopic ventricular activity (18% of beats), prolonged QT interval (up to 630 ms), and high-complexity ectopic ventricular beats. Non-sustained ventricular tachycardia was also observed (1030 episodes). The prolonged QT interval was associated to an elevated dose of Fluoxetine. Discussion: We believe that the coexistence between a high dose of Fluoxetine and other risk factor such as female sex and increased age contributed to the development of the case presentation. Conclusion: The rising prevalence of depression in the geriatric population and the indiscriminate use of antidepressive agents such as selective serotonin reuptake inhibitors may contribute to an increase in potentially severe cardiovascular complications.

Relaxin as a biological marker and therapeutic target in heart failure

An important task of modern cardiology is the search and study of new cardiovascular biological markers that can help in the early diagnosis of heart diseases, serve as a tool to assess the effectiveness of treatment, and act as a prognostic marker and risk stratification criterion. This literature review aimed to consider relaxin (RLN) as a new diagnostic and prognostic cardiovascular biological marker. RLN is a natural peptide hormone with a molecular weight of approximately 6000 daltons. RLN2 is the main circulating form of RLN in the blood. Although human RLN2 was originally discovered as a hormone mainly secreted by the corpus luteum of the ovary, it is also synthesized in various tissues in non-pregnant women and men and is considered one of the most pleiotropic hormones of the human body, which perform various activities beyond reproduction.
 The availability of serelaxin (a recombinant molecule identical to human RLN2) has made it possible to study the effects of RLN2 on the cardiovascular system, kidneys, liver, and brain and to evaluate it in several randomized placebo-controlled clinical trials. RLN2 exerts many cardioprotective effects on the heart and vessels and has been proposed as a therapeutic target for cardiovascular diseases such as heart failure, atrial fibrillation, coronary heart disease, myocardial infarction, and arterial hypertension. Through the activation of its cognate receptor and subsequent flow of several molecular signaling pathways in the cardiovascular system, RLN2 can induce vasodilation and angiogenesis, increase arterial compliance and cardiac output, reduce vascular resistance, exert antifibrotic effects through regulation and remodeling of extracellular matrix turnover, reduce inflammation and apoptosis, inhibit oxidative stress, induce chronotropic and inotropic effects, and inhibit ventricular and atrial ectopic activity.
 Further studies are needed to demonstrate the potential use of RLN as an additional laboratory tool for diagnosis, risk stratification, and prediction of cardiovascular events in patients with heart failure. The effects of relaxin on morbidity and mortality in patients with heart failure have yet to be evaluated in more detail.

Sleep-related breathing disorders in patients with heart failure with reduced and mildly reduced ejection fraction: main types and their dependence on heart failure etiology

Aim. To identify and study the nature of sleep-related breathing disorders (SBDs) in a cohort of hospitalized patients with heart failure (HF) with reduced and mildly reduced ejection fraction (EF), as well as to clarify the relationship between SBD type, etiology and severity of HF.Material and methods. The study included 117 patients with HF with reduced and mildly reduced ejection fraction hospitalized at the National Medical Research Center for Therapy and Preventive Medicine from 2019 to 2021. All patients underwent clinical and paraclinical examination, including cardiorespiratory sleep study. Patients were divided into three groups according to the type and severity of SBD: no or mild SBD, predominantly with obstructive sleep apnea (OSA) and predominantly with central sleep apnea (CSA). Severity of SBD and clinical data were compared between these groups.Results. A total of 5 patients (4,27%) did not have any SBDs, while 47 (40,17%) were diagnosed with CSA, and 65 (55,56%) — OSA of varying severity. The proportions of patients with moderate and severe CSA and OSA differed insignificantly and amounted to 35,9% (n=42) and 44,4% (n=52), respectively. There were following proportions of diseases related to HF: coronary artery disease (41,88%), nonischemic cardiomyopathy (26,5%), arrhythmogenic cardiomyopathy (15,38%) and other causes (16,24%) (hypertension, myocarditis, heart defects). We found that reduced EF <40%, end-diastolic volume >210 ml, and ventricular ectopy (>300 extrasystoles/day) were associated with CSA, and body mass index >30 kg/m2 was traditionally associated with OSA.Conclusion. More than half of HF patients with reduced and mildly reduced EF have SBDs. Decreased LVEF and ventricular ectopic activity are associated with CSA, while increased body mass index is associated with OSA. Consideration of SBD risk factors may improve patient phenotyping for individualized therapy.

A case of successful radiofrequency ablation of ectopic ventricular activity with para-Hisian origin by access from the right coronary sinus of Valsalva

A clinical case of successful radiofrequency ablation of ventricular tachycardia with para-Hisian localization of the substrate by access from the right coronary sinus of Valsalva is presented.

Pregnancy in women with hypertrophic cardiomyopathy: observational data from the tertiary referral center registry

Abstract Introduction The number of cases of hypertrophic cardiomyopathy (HCM) in pregnancy increases every year. In most cases the course of pregnancy is favorable, however in certain high–risk scenarios there is an increased risk of complications (e.g., increased ventricular ectopic activity, heart failure exacerbation). Management heavily relies on the severity of the outflow tract obstruction, extent of left ventricular hypertrophy and sudden cardiac death (SCD) risk stratification. Purpose The main objective of this study is to assess risk factors and complications during pregnancy, childbirth and the postpartum period in women with HCM. Methods In this retrospective study we included 60 pregnant women with HCM who were admitted to the tertiary referral center between October 2010 and December 2019 with a mean age of 29.1±5.19 years. ECHO was performed in all patients. Results Twenty patients (33%) have obstructive HCM (HOCM), 31 patients (51,6%) were nulliparous, 20 patients (33%) had no clinical symptoms prior to pregnancy. Since the third trimester of pregnancy we observed the onset or exacerbation of heart failure in 26 (43.3%) cases, half of these patients presented with NYHA class III–IV. SCD risk was 3.64% (2.66 –5.84) in the third trimester. Six patients (9.23%) were required ICD implantation. Caesarean section (CS) delivery was performed in 38 patients (63.3%). However, the CS proportion has decreased from 80% to 51% in the last 5 years. Despite frequent complications during pregnancy and the postpartum period, no maternal mortality has been reported. The newborns' weight in HOCM cases was significantly lower than in patients without LVOT obstruction. Conclusion Despite the favorable course of pregnancy in HCM patients, the third trimester of pregnancy was often accompanied by the onset and progression of heart failure, as well as an increase in the proportion of patients with ventricular arrhythmias. In patients with HOCM, a decrease in the weight of newborns was revealed. Funding Acknowledgement Type of funding sources: None. Characteristics of women with HCP

Impact of Anti-Hepatitis C Therapy on Cardiac rhythm

Abstract Background The use of direct-acting antiviral (DAA) has raised some concerns about the possibilities of cardiac toxicity after US Food and Drug Administration (FDA) issued a safety announcement of serious slowing of the heart rate when Amiodarone was used with hepatitis C treatment . Aim The aim of the present study was to assess the impact of Anti-Hepatitis C Therapy on cardiac rhythm using 24 hours Holter monitoring. Methods The current study was conducted on fifty consecutive adult patients with chronic hepatitis C infection eligible for DAA therapy supplied in the outpatient clinic of Ain shams University Virology Center .Patients have received Sofosbuvir 400 mg and Daclatasvir 60 mg / day for 12 weeks. All patients underwent 24 hour Holter monitoring before and after the completion of therapy. Both recordings were compared as regards: heart rate, minimum and maximum heart rate, the presence and frequency of ectopic atrial or ventricular activity. The measurement of QRS intervals such PR, corrected QT intervals in msec. Results The pre and post analysis of the Holter recording was done with comparing different baseline and post therapy parameters, The pre and post therapy mean average heart rates were 79.44±10.14 bpm vs.79.96±8.77 bpm respectively (p = 0.534) which are non-significant changes. There is also non-significant change was observed in mean maximum and mean minimum heart rate 129.08±20.07 bpm 128.98±16.89 bpm (p = 0.964), 55.88±9.20 bpm 56.66±9.45 bpm (p = 0.457) respectively. And as regard corrected QT duration and PR interval duration, the mean pre-therapy PR interval was 154.00 ± 25.95 ms as compared to the mean post-medication PR interval duration 151.40 ± 23.82 ms (p = 0.124) and The mean premedication Corrected QT duration was 397.34 ± 29.38ms vs. post therapy 395.04 ± 30.23ms ( p = 0.403) Which showing a non-significant change of both intervals. And as regard the median pre-therapy and post medication PACs and PVCs numbers and the median pre-therapy and post medication attacks of tachycardia and bradycardia, they showed non-significant changes with P-value > 0.05 . Conclusions Novel DAAs are safe to use as regards its effect on cardiac rhythm

B-AB01-04 INTERACTION BETWEEN ISCHEMIA AND SYMPATHETIC ACTIVITY ON CARDIAC ELECTROPHYSIOLOGY AND ARRHYTHMIA IN THE INNERVATED LANGENDORFF-PERFUSED MOUSE HEART

Sympathetic activation of the heart plays a key role in the modulation of cardiac electrophysiology and arrhythmogenesis. It is generally believed that sympathetic activation is proarrhythmic in the setting of cardiac ischemia. However, few studies have looked at the dynamic effects of physiological sympathetic nerve activation on cardiac electrophysiological activities during ischemia. To investigate the effects of sympathetic activation in the innervated Langendorff-perfused mouse heart subjected to acute ischemia. The heart and posterior thoracic cavity from mice (C57Bl6, N=4) were dissected and perfused through the descending aorta for dual optical mapping of transmembrane potential (Vm) and intracellular Ca2+ to study the effects of sympathetic nerve stimulation (SNS). SNS, achieved through spinal cord stimulation at T1-T3, was performed before, during and immediately after 5 min of low-flow ischemia (10% of pre-ischemic flow rate). Early afterdepolarizations (EADs) and ventricular tachycardia (VT) occurred in all 4 animals within 5 min of ischemia and immediately upon reperfusion. Both SNS and ventricular pacing, during either ischemia or reperfusion, completely abolished EADs and VT induced by global low-flow ischemia and reperfusion (Fig). In the isolated innervated mouse heart, we showed that sympathetic stimulation protects against ischemia-induced cardiac arrhythmias potentially by over-driving ventricular ectopic activity.

RR interval analysis based on a newly developed PC program as a predictor of interventions in implantable cardioverter-defibrillator patients.

Prediction of sudden cardiac death remains a significant challenge. There is some evidence that ventricular ectopic activity could be regarded as a predictive marker. We carried out an analysis to explore whether premature ventricular complexes (PVCs) are a risk factor in implantable cardioverter-defibrillator (ICD) interventions. The study method was a RR interval series analysis (n = 184) of arrhythmic events and controls from the ICD. Study group consisted of patients with a mean age of 55 ±27 years; 74% of them were male, 85% were secondary prevention patients, 62% had coronary artery disease (CAD), 15% hypertropic cardiomyopathy (HCM), 15% dilated cardiomyopathy (DCM), and 8% diseases of other etiology. The mean follow-up time was 64 months (range: 3-126 months). The study population was divide into patients with at least 1 appropriate intervention ventricular tachycardia/ventricular fibrillation (VT/VF) (group A, n = 101) and controls without interventions (group B, n = 83). The number of PVC/4000 RR cycles, the shortest coupling intervals between a PVC and preceding R as well as the number of PVCs of very short (180-220 ms), short (220-280 ms) and different cycle lengths (CL) as well as the incidence of short-long-short (SLS) sequences were compared. The number of PVCs/4000 RR cycles was significantly higher in group A (263 ±32 compared to 43 ±17, p < 0.0001). The mean shortest PVC CL was significantly shorter in group A (320 ±13 compared to 400 ±38, p = 0.029). The number of PVCs with a very short CL was 1 ±0.4 compared to 0.1 ±0.1 (p = 0.028). The number of PVCs with a short CL was 5 ±1.2 compared to 0.6 ±0.4 (p = 0.0007) in groups A and B, respectively. The incidence of SLS sequences was significantly higher in group A than in group B (67 (94% of patients) and 4 (33% of patients) respectively (p < 0.0001)). Significant differences were found in the characteristics of PVCs and SLS sequences between patients with appropriate ICD interventions and controls. A newly developed basic computer program called PCRR was applied for RR interval analysis. This simple method could be a predictor of PVC burden and life-threatening arrhythmias in different populations.

Дифференцированный подход к оценке желудочковой эктопической активности: показания к назначению пролонгированной формы лаппаконитина гидробромида

Дифференцированный подход к оценке желудочковой эктопической активности: показания к назначению пролонгированной формы лаппаконитина гидробромида

Bilateral impact of cardiorenal relationships in the nephrotic syndrome.

To study and analyze the cardiorenal relationships in nephrotic syndrome, taking into account sex differences. A total of 272 patients with nephrotic syndrome (NS) aged 16 to 65 years were examined. All patients underwent general clinical examination, electro-and echocardiography, assessment of peripheral and biochemical blood counts. NS was determined with daily proteinuria of more than 3.5 g/1.73 m2 per day, hypoalbuminemia (albumin less than 30 g/l) and hyperlipidemia (total cholesterol more than 5.1 mmol/l). The duration of the National Assembly ranged from 3 months or more. Depending on the gender, the total sample (n=272) was divided into two subgroups: the 1st subgroup - patients with female NS (n=88), the 2nd subgroup - males with NS (n=184). The mean systolic, diastolic, pulse and mean arterial pressure (BP) were significantly higher in male NS patients (p<0.05). Supraventricular and ventricular ectopic activity was significantly more common in males. In the subgroup of women with NA, sinus tachycardia was significantly more frequently detected, a slowing down of the impulse conduction along the bundle of His, a violation of the processes of repolarization of the LV (p<0.05). The final systolic and diastolic sizes of the left ventricle (LV), the thickness of the interventricular septum and the posterior wall of the left ventricle, the diameter of the aorta, the longitudinal size of the left atrium and the right ventricle were significantly larger in the group of males with NA. Significantly lower concentrations of hemoglobin, hematocrit, erythrocyte counts were observed in the subgroup of females with NS compared with men (p<0.05). In the cohort of men with HC, there was a significant decrease in the content of total serum protein (44.8±11.0 g/l versus 49.2±11.2 g/l; p=0.003) as compared with females. In the male subgroup of HC, serum creatinine concentration [97 (81;143) mmol/l versus 86 (68;123) mmol/l; p=0.005] and the degree of daily protein excretion [6,490 (4,865;9,661) g versus 5,585 (4,168;7,625) g; p=0.034] with urine were significantly higher compared with the female subgroup (Table 2). At the same time, in the cohort of men with HC, there was a significant decrease in the calculated GFR [62.3 (46.2; 114.9) ml/min versus 87.0 (67.7;127.5) ml/min; p=0.002]. In case of NS in females, factors of deterioration of cardiorenal interrelations are anemia, sinus tachycardia, slowing down of impulse conduction along the bundle of His. Whereas in the NA subgroup of men, negative factors of cardiorenal interrelations are hypoproteinemia, increased systolic, diastolic, pulse and mean blood pressure, creatinine concentration and daily proteinuria, which was accompanied by a decrease in glomerular filtration rate and an increase in the linear dimensions of the heart.

Electrical properties of the myocardium in patients with arterial hypertension combined with subclinical hypothyroidism

Late atrial and ventricular potentials are non-invasive electrocardiographic criteria for presence of high arrhythmic readiness and risk of life-threatening arrhythmias. The electrical properties of the myocardium in patients with stage II arterial hypertension (AH) combined with subclinical hypothyroidism have not been studied previously.Aim. To study the changes of electrical properties of the atrial and ventricular myocardium in patients with AH combined with subclinical hypothyroidism.Materials and methods. The criteria for inclusion in the study were the presence of stage II AH without thyroid gland pathology and combined with subclinical hypothyroidism (SH) (for patients of the main group). Depending on the level of thyroid-stimulating hormone (TSH), the AH patients were divided into 2 groups – with normal (0.4–4.0 mU/ml) and moderately elevated level of TSH (4.0–15.6 mU/l, with normal levels of thyroid hormones).The group of patients with AH without SH included 92 patients (women – 81.52 % (75), men – 18.48 % (17)); the group of patients with AH with concomitant SH included 30 patients (women – 86.7% (26), men – 13.3 % (4)). All patients underwent 24-h BP monitoring and ECG (combined ECG and BP monitor “Kardiotechnica-04-AD-3”,St. Petersburg,Russia). A 40 Hz cutoff filter was used recording in the X, Y, Z orthogonal leads. Data were processed with the help of a program Statistica 6.0. Data were presented as the median and inter-quartile range of Me (25 %; 75 %).Results. In AH patients without concomitant subclinical hypothyroidism, unlike in relatively healthy patients, late atrial potential predominance was seen (63 % vs. 84 %; P = 0.0419) with a 16.4 times (P = 0.018) increase in the number of premature atrial contractions. Also, in patients with AH without concomitant subclinical hypothyroidism late ventricular potentials (LVPs) occurred 5.7 times more often (6 % vs. 34 %, P = 0.0302) and were associated with a significant (P = 0.004) increase in the number of premature ventricular contractions per day in this category of patients.In SH patients with a concomitant subclinical hypothyroidism, unlike in relatively healthy individuals, atrial ectopic activity was significantly more predominant (LAP was found in 87 %; versus 63 %, P = 0.0498), which was accompanied by a logical 27.2 times (P = 0.038) increase in the number of premature atrial contractions and ventricular ectopic activity. Changes in the electrical properties of the ventricles were accompanied by an increase in the percentage of detected LVPs (77 % versus 6 %, P = 0.0001), which was associated with a significant (P = 0.001) increase in the number of premature ventricular contractions per day in this category of patients (441.53 ± 1414.97 versus 0.00 ±0.00 inalmost healthy subjects, P = 0.001).AH patients with and without concomitant SH did not differ from each other in terms of indexes characterizing late atrial potentials. There was also no statistically significant difference in the number of premature atrial contractions (P = 0.527), paired premature atrial contractions (P = 0.449), salvos of atrial premature contractions (P = 0.314). However, in AH patients with concomitant SH there was a significant increase in the ectopic activity of the ventricles – LVPs were found in 77 % vs. 33 % in individuals without SH (P = 0.0001), changes in the electrical properties of ventricles in AH patients with concomitant SH were also associated with an increase in the number of premature ventricular contractions by 6.69 times (from 42.56 ± 36.96 to 441.53 ± 1414.97, P = 0.026) compared with the same index in patients with AH without concomitant SH, indicating the negative effect of SH on the electrical properties of the ventricles.Conclusions. In patients with stage II arterial hypertension in comparison to relatively healthy subjects, indicators that characterize the late potentials of the atria and ventricles are significantly changed, which is accompanied by an increase in the number of supraventricular and ventricular rhythm disorders. Subclinical hypothyroidism causes an additional pro-arrhythmic effect on the ventricular myocardium in arterial hypertension.

P312The acute impact of a high altitude ultra-trail race on the ECG

Abstract Background Ultra-endurance competitions are becoming increasingly popular but the consequences of ultra-endurance sports activity on the heart rhythm is still a debated issue. Some authors demonstrated that athletes engaging in ultra-endurance sports show a transient rise in cardiac biomarkers and right ventricular dysfunction after a competition, suggesting the possibility of an adverse arrhythmic remodeling and an increased risk of sudden cardiac death. The aim of our study was to evaluate the effects on heart rhythm of an ultraendurance high-altitude race. Methods The study was performed during the 2018 North Face® Lavaredo Ultra Trail mountain run. We recorded the ECG with the FDA-approved MyDiagnostick device. Recordings were performed at baseline the day before the run and immediately after the run in the available athletes. The ECG was analyzed for heart rate, QRS duration, QT interval duration corrected according to the Bazett formula and presence of at least one beat of presumed ventricular origin (PVB). Results A total of 545 athletes (83% males, mean age: 40±9 years), 241 running the 120 Km race and 304 running the 50 Km race, were included in the study. At baseline, athletes showed a mean heart rate of 64±14 bpm and a mean QRS duration of 92±18 ms. Three (0.5%) showed at least one PVB. Analysis of QTc interval duration showed a mean value of 412±25 ms. After the race, athletes showed a higher heart rate (91±13 bpm, p&amp;lt;0.001), a similar QRS duration (94±16 ms, p=0.32) and a longer QTc interval duration (447±25 ms, p&amp;lt;0.001), as compared to baseline data. The number of athletes showing at least 1 PVB significantly increased to 18 (3.3%, p=0.004) as compared to pre-race evaluation. Athletes engaged in the 120 Km run showed a slightly longer post-run QTc interval (450±24 versus 444±25 ms, p=0.009) while the post-run QRS duration was similar between the two groups. The presence of PVBs after the race was not correlated with the duration of QTc interval. Conclusions In this study we found an increased number of PVBs and a prolonged QTc duration after an ultra-endurance competition. Increased ventricular ectopic activity and QT prolongation recorded shortly after an intense and prolonged exercise could contribute to the increased risk of arrhythmias occurring after the finish line.

Abstract 17313: Myocardial Remodeling in Atrial Fibrillation is Not Associated With Supraventricular or Ventricular Ectopic Activity: Results From a Cardiac Imaging Study

Background: Myocardial remodeling in atrial fibrillation (AF) is a continuum of structural, hemodynamic, and electrophysical changes that often coexist in a complex pathophysiological interplay. Purpose: The aim of this study was to evaluate whether cardiac magnetic resonance imaging (CMR) derived myocardial strain, by tracking subtle alterations in myocardial function, was associated with premature atrial (PAC) and ventricular (PVC) complexes, detected by 7-day Holter-monitoring. Methods: A total of 95 patients (mean age 63±8.5 years, 52% male) with a history of paroxysmal (51%) or persistent AF (49%) underwent CMR and 7-day Holter-monitoring during sinus rhythm. Left atrial measures, including volume, ejection fraction, peak systolic longitudinal, radial and circumferential strain were assessed using cine CMR feature tracking by commercially available software (Circle, Calgary, Canada). Holter-monitoring was used to determine heart rate and rhythm, including the presence of PACs and PVCs. The associations between strain variables and Holter-variables were examined using multivariable linear regression, adjusted for age, sex, and AF type. Results: Left atrial end-diastolic volume was significantly increased, particularly in patients with persistent AF, when compared with healthy controls (persistent AF 132±32 ml vs. healthy 77±14 ml). Similarly, left atrial ejection fraction was significantly reduced in persistent AF as compared with normal reference values (48±10 ml vs. 54±10 ml). There were no significant associations between CMR strain parameters and average PACs per hour, average PVCs per hour, average PACs per sinus beats per hour or average PVCs per sinus beats per hour. These associations remained unaltered after adjusting for age, sex, and AF type. Finally, no significant interactions with AF type were found. Conclusions: Despite significant myocardial remodeling in left atrium shown by increased end-diastolic volume and decreased left atrial ejection fraction, there was no correlation with increased ectopic activity as assessed by 7-day ambulatory Holter monitoring. Image

RESULTS OF NON-INVASIVE ACTIVATION MAPPING OF THE HEART IN “IDIOPATHIC” VENTRICULAR ARRHYTHMIAS IN COMPARISON WITH STRUCTURAL CHARACTERISTICS OF MYOCARDIUM BY MAGNETIC RESONANCE IMAGING

Aim.To compare the results of non-invasive activational mapping in patients with “idiopathic” ventricular arrhythmias (IVA) with the data on myocardial structure obtained by late enhancement magnetic resonance tomography (MRI).Material and methods.Twenty eight IVA patients, mean age 37 y. o. [26; 45], with ventricular arrhythmias of the heart (VA) of 2nd or higher grade by Lown, and 5 healthy volunteers (HV), mean age 29 [29; 30], underwent surface epiand endocardial non-invasive mapping (SEENIM) of the heart with the system for noninvasive electrophysiological investigation of the heart “Amicard 01C” with the analysis of duration of the activation-recovery interval (ARI) of the ventricles, and high resolution MRI (voxel 1,25x1,25x2,5mm) with delayed contrasting.Results.The number of VA in IVA group was 20196 [11479; 29834] for 24 hours. In 11 patients there were episodes of non-sustained ventricular tachycardia (VT). By SEENIM, predominating morphological type of ventricular ectopic activity in 22 patients sourced from the right ventricle myocardium (RV), of those in 20 from outflow tract of the LV (OTLV). There was significantly prolonged ARI in OTLV patients with IVA comparing to HV (p&lt;0,05). In IVA and non-sustained ventricular tachycardia patients, by contrast MRI of the heart, in LV myocardium there were small foci of contrast retention found. There was no correlation of the areas of contrast retention and topography of VA sources.Conclusion.In most of IVA patients the source of VA was outflowing tract of the RV. The revealed prolongation of the ARI of this area in IVA patients can be an important factor of IVA onset. Small foci of LV fibrosis, found in late enhancement MRI of the heart and episodes of so called idiopathic VT, might be the earliest presentation of the “tachycardiopathy” at the step of pathology development when there are no signs of LV dilation.

To the question of electrophysiological remodeling role in the genesis of ventricular ectopy in patients with postinfarction cardiosclerosis

Aim. To study the character and intensity of relationship between left ventricular dilatation, severity of electrophysiological myocardium remodeling and ectopic ventricular activity in patients with postinfarction cardiosclerosis.&#x0D; Methods. 46 patients with postinfarction cardiosclerosis were examined (males, average age 57.9 years). All patients underwent echocardiography with detection of end diastolic volume of left ventricle and its ejection fraction, Holter monitoring with determining signal-averaged electrocardiogram and severity of ventricular ectopic activity with calculation of ventricular ectopic activity index. Based on the ejection fraction the patients were divided into two groups. Group 1 included 17 patients with ejection fraction ≥45%, and group 2 - 29 patients with ejection fraction &lt;45%.&#x0D; Results. Left ventricle ejection fraction in patients from group 2 was lower, and parameters of signal-averaged electrocardiogram were worse than in patients from group 1. Ventricular ectopic activity index in patients from group 2 was 5 times higher than the average index in group 1. According to correlation analysis in the combined group, signal-averaged electrocardiogram parameters more tightly correlated with end diastolic volume than with ventricular ectopic activity index. The latter more tightly correlated with end diastolic volume (r=0.67, p &lt;0.001), than with signal-averaged electrocardiogram parameters. After calculating partial correlation coefficient and excluding the effect of end diastolic volume, correlation coefficients of ventricular ectopic activity index and signal-averaged electrocardiogram parameters became insignificant. The received data put in question the view that electrophysiological remodeling is an independent cause of severity increase of ventricular arrhythmias. More probable is that electrophysiological remodeling and ventricular ectopic activity are related pathogenetically, and correlation between them is determined by the fact that both depend on left ventricle end diastolic volume.&#x0D; Conclusion. Relation between electrophysiological myocardium remodeling and ectopic ventricular activity in patients with postinfarction cardiosclerosis may depend on severity of left ventricular dilatation.

Mitral valve prolapse: an underestimated cause of sudden cardiac death-a current review of the literature.

Mitral valve prolapse (MVP) is a common valve abnormality in general population. Despite the general belief of a benign disorder, several articles since the 1980s report sudden cardiac death (SCD) in MVP patients, with a substantial percentage of asymptomatic young individuals. The problem is to detect those patients at increased risk and implement methods that are suitable to prevent cardiac arrest. This review investigates the correlation between MVP and SCD, the understanding of the pathophysiology, the strategies for detecting those at risk and treatment options. A complete literature survey was performed using PubMed database search to gather available information regarding MVP and SCD. A total of 33 studies met selection criteria for inclusion in the review. MVP is an underrated cause of arrhythmic SCD. The subset of patients with malignant MVP who may be at greater risk for SCD is characterized by young women with bileaflet MVP, biphasic or inverted T waves in the inferior leads, and frequent complex ventricular ectopic activity with documented ventricular bigeminy or ventricular tachycardia (VT) and premature ventricular contractions (PVCs) configurations of outflow tract alternating with fascicular origin or papillary muscle. MVP is a common condition in the general population and is often encountered in asymptomatic individuals. The existing literature continues to generate significant controversy regarding the association of MVP with ventricular arrhythmias and SCD. Early echocardiography and cardiac magnetic resonance (CMR) are essential, as is a greater understanding of the potential electrophysiological processes of primary arrhythmogenesis and the evaluation of the genetic substrate.

Epidemiology of ventricular tachyarrhythmia : Any changes in the past decades?

Ventricular tachyarrhythmias include potentially lethal episodes of sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) as well as hemodynamically tolerated ventricular ectopic activity. Sustained VT or VF may develop in the setting of acute myocardial infarction or as clinical sequelae of advanced cardiomyopathy. The incidence of these serious arrhythmias is estimated from retrospective and observational studies and registries of sudden cardiac arrest and sudden cardiac death. Over the past few decades, there has been agradual decline in the incidence of life-threatening ventricular tachyarrhythmias which has been largely driven by upstream treatments for and prevention of coronary artery disease and its sequelae. In addition primary prevention implantable cardioverter-defibrillators (ICDs) have improved survival in patients at risk for malignant ventricular arrhythmias and sudden cardiac death. Improved understanding, and improved diagnostic and imaging methods have elucidated many of the previously classified "idiopathic" ventricular arrhythmias as inherited arrhythmic syndromes and occult cardiomyopathies. In addition, improved sensitivity and duration of ECG monitoring has allowed increased detection of ventricular ectopic activity.

Late ventricular potentials in chronic heart failure patients with preserved ejection fraction

Rationale : More than half of patients with chronic heart failure have a preserved left ventricular ejection fraction. It has been found that sudden cardiac death is more frequent in this patient category. A reliable and easily available marker is needed that would predict the death outcome with a high probability. The use of the late ventricular potentials for this purpose could be reasonable. Aim : To assess the prevalence of the late ventricular potential and their association with the structural and functional parameters of the myocardium in patients with early stages of chronic heart failure with preserved ejection fraction. Materials and methods : We examined 77 patients with chronic heart failure (grade I to IIА, functional class I to III) with preserved ejection fraction (> 50%), aged 47 to 77 years (mean ± SD, 59.7 ± 7.8 years). Echocardiography (SonoScape 8000 and Vivid 3) at М-, В- and Doppler modes was performed in all patients. Ventricular ectopic activity and late ventricular potentials were registered during 24- hour ECG monitoring (Cardiotekhnika, INKART, St. Petersburg). Results : Late ventricular potentials were found in 13% (10 of 77) of patients. The following correlations were found in patients with concentric hypertrophy (n = 53): between the duration of the filtered QRS (TotORSF) and the left ventricular end diastolic diameter (r = 0.27, p = 0.049), TotORSF and the interventricular septum thickness (r = 0.28, p = 0.04), TotORSF and the left ventricular myocardial mass (r = 0.35, p = 0.01), mean square magnitude of fluctuations within the last 40 ms of ORS (RMS40) and the left ventricular end diastolic diameter (r = -0.42, p < 0.01), RMS40 and the left ventricular end-systolic diameter (r = -0.37, p < 0.01). In the patients with eccentric hypertrophy (n = 14), the following correlations were found: between RMS40 and the left ventricular myocardial mass index (r = -0.77, p < 0.01), between duration of the low amplitude signal (< 40 μV) at the end of QRS (LAS40) and the left ventricular myocardial mass index (r = 0.76, p < 0.01), as well as between LAS40 and RMS40 with the end diastolic diameter of the left ventricle adjusted to the body surface area (r = 0.76, p < 0.01 and r = -0.83, p < 0.01, respectively). The patients with a pseudo normal type of diastolic dysfunction (n = 27) showed an association between their NT-proBNP levels and TotORSF (r = 0.56, p < 0.01). Conclusion : The prevalence of late ventricular potentials among patients with early stage chronic heart failure and preserved left ventricular ejection fraction is not high. The parameters of electrophysiological myocardial instability in patients with concentric hypertrophy are mostly influenced by the size of heart chambers, whereas in those with the eccentric one, by the myocardial mass and volume parameters. The risk of sudden cardiac death is higher in patients with a pseudo normal type of diastolic dysfunction.