Ventricular Tachycardia/ventricular Fibrillation Research Articles

Association of device detected atrial and ventricular tachyarrhythmia with adverse events in patients with an implantable cardioverter-defibrillator.

Heart failure patients with a history of atrial fibrillation (AF) and ventricular tachycardia/ventricular fibrillation (VT/VF) are known to have worse outcomes. However, there are limited data on the temporal relationship between development of these arrhythmias and the risk of subsequent congestive heart failure (CHF) exacerbation and death. The study cohort comprised 5511 patients implanted with an implantable cardioverter-defibrillator (ICD) in landmark clinical trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, and RAID) who were in sinus rhythm at enrollment. Multivariate cox analysis was performed to evaluate the time-dependent association between development of in-trial device detected AF and VT/VF with subsequent CHF exacerbation and death. Multivariate analysis showed that AF occurrence and VT/VF occurrence were both associated with a similar magnitude of risk for subsequent CHF exacerbation (HR = 1.73 and 1.87 respectively, p < .001 for both). In contrast, only in-trial VT/VF was associated with a significant > two-fold increase in the risk of subsequent mortality (HR = 2.13, p < .001) whereas AF occurrence was not associated with a significant mortality increase after adjustment for in-trial VT/VF (HR = 1.36, p = .096). Our findings from a large cohort of ICD recipients enrolled in landmark clinical trials show that device detected AF and VT/VF can be used to identify patients with increased risk for CHF exacerbation and mortality. These findings suggest a need for early intervention in CHF patients who develop device-detected atrial and ventricular tachyarrhythmias.

Ventricular fibrillation/ventricular tachycardia within 72h of VA-ECMO: incidence, outcomes, risk factors, and management.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an important technique for the treatment of refractory cardiogenic shock and cardiac arrest; however, the early management of ventricular fibrillation/ventricular tachycardia (VF/VT), within 72h of VA-ECMO, and its effects on patient prognosis remain unclear. We retrospectively analysed patients at the First Affiliated Hospital of Nanjing Medical University who underwent VA-ECMO between January 2017 and March 2022. The patients were divided into two groups, VF/VT and nVF/VT, based on whether or not VF/VT occurred within 72h after the initiation of VA-ECMO. We utilized logistic regression analysis to evaluate the independent risk factors for VF/VT in patients undergoing VA-ECMO and to ascertain whether the onset of VF/VT affected 28day survival rate, length of intensive care unit stay, and/or other clinical prognostic factors. Subgroup analysis was performed for the VF/VT group to determine whether defibrillation affected prognosis. In the present study, 126 patients were included, 65.87% of whom were males (83/126), with a mean age of 46.89±16.23, a 28day survival rate of 57.14% (72/126), an incidence rate of VF/VT within 72h of VA-ECMO initiation of 27.78% (35/126), and 80% of whom (28/35) received extracorporeal cardiopulmonary resuscitation. The incidence of VF/VT resulting from cardiac arrest at an early stage was significantly higher than that of refractory cardiogenic shock (80% vs. 20%; P=0.022). The restricted cubic spline model revealed a U-shaped relationship between VF/VT incidence and initial heart rate (iHR), and multivariate logistic regression analysis showed that an iHR>120b.p.m. [odds ratio (OR) 6.117; 95% confidence interval (CI) 1.672-22.376; P=0.006] and hyperlactataemia (OR 1.125; 95% CI 1.016-1.246; P=0.023) within 1h of VA-ECMO initiation were independent risk factors for the occurrence of VF/VT. VF/VT was not found to be associated with the 28day survival of patients undergoing VA-ECMO support, nor did it affect other secondary endpoints. Defibrillation did not alter the overall prognosis in patients with VF/VT during VA-ECMO. An iHR>120b.p.m. and hyperlactataemia were independent risk factors for the occurrence of VF/VT within 72h of VA-ECMO initiation. The occurrence of VF/VT does not affect, nor does defibrillation in these patients improve the overall patient prognosis. ChiCTR1900026105.

Abstract 17309: Assessing the Effect of Corticosteroid Taper Rate and Repeat Pet Imaging on Cardiovascular Outcomes Among a Homogenously Treated Cohort of Patients With Suspected Cardiac Sarcoidosis

Introduction: Serial positron emission tomography (PET) imaging is utilized to monitor disease activity and treatment response in patients with suspected cardiac sarcoidosis (CS). However, there is no data available on the cardiovascular outcomes associated with corticosteroid taper rates and timing of repeat PET imaging in patients with CS. Methods: We identified 70 patients with suspected CS (Age: 56.3 ± 9, 31% female, LVEF 45.6 ± 13.6, median follow-up time: 6.3 months [4-7.6]) who were treatment naïve and displayed inflammation on baseline FDG-PET, subsequently started on a moderate-dose of prednisone only (i.e., 30-40 mg/day), and had a diagnostic follow-up PET. Patients were divided into two groups based on median follow-up time between PET scans; early (&lt;6.3 months, n=35) or delayed (≥6.3 months, n=35) surveillance imaging. Corticosteroid taper was captured by measuring weekly changes in prednisone from treatment initiation to follow-up PET. Major adverse cardiovascular events (MACE) were defined as sustained ventricular tachycardia/ventricular fibrillation (VT/VF), heart failure (HF) admission, and death. Results: In this homogenously treated cohort, overall, we observed no significant difference in MACE between early vs delayed imaging groups (p=0.117, Figure 1A). Furthermore, there were no significant differences in corticosteroid taper rates between early and delayed groups (-0.927 ± 1.15 vs -0.618 ± 0.58, p=0.163). As such, we observed no difference in MACE associated with taper rate (p=0.647, Figure 1B). Conclusion: Patients with suspected CS undergoing repeat PET imaging had similar adverse cardiovascular outcomes despite variations in follow-up time and taper rates of prednisone. We suggest to adopt an early imaging strategy to allow for timely optimization of immunosuppression and clinical surveillance.

Alcohol ablation of the heart – Case report

Abstract&#x0D; Alcohol septal ablation (ASA) is a minimally invasive, non-surgical treatment for hypertrophic cardiomyopathy. This condition causes the heart tissue to thicken, restricting blood flow. Reduced blood flow causes symptoms such as shortness of breath and fatigue. Alcohol septal ablation restores normal blood flow by damaging and shrinking the thickened tissue. The procedure does not damage normal tissue. Providers perform this procedure on people who have HCM and, despite medication, have symptoms of shortness of breath and/or fatigue with exertion.1&#x0D; Alcohol ablation has been successfully used in the ablation of ventricular tachycardiaventricular fibrillation, and atrial fibrillation. 2&#x0D; Material and Methods&#x0D; The procedure is performed under the control of the Toshiba Infinix discoscope, in the coronary angiography program. Diascopy parameters are 86 kVp, 800 mA, fluoroscopy: 5 fr/sec, radiography 10 fr/sec, pulse width 12 bit, matrix size 1024x1024. The procedure was performed in the RAO 30° CRANIAL 30° projection, and with a magnification of 20 cm. Visipaque 320 contrast agent was used, which was injected via the MEDRAD Avanta automatic injector. Contrast injection parameters were flow rate 2 ml/s and volume 4 ml. A total of 120 ml of contrast agent was given. To confirm the results of AA, ultrasound contrast agent SONOVIEW was used. Monitoring of contrast flow through the myocardium was done with a SIEMENS ultrasound device.&#x0D; Case study&#x0D; The patient, 65 years old, is hospitalized at the Department of Interventional Cardiology for an invasive cardiac procedure under the diagnosis of hypertrophic obstructive cardiomyopathy. Echocardiography after the procedure: The left atrium is dilated and elongated. Mitral valve morphologically sclerotically changed, functionally mild to moderate MR 2+ (VC 4 min) Left ventricle of regular dimensions, concentrically hypertrophic walls. Type 3 SAM is being verified. Preserved left ventricular systolic function (EF 60%).&#x0D; Conclusion&#x0D; We present the case of an elderly patient with symptomatic obstructive hypertrophic cardiomyopathy. Despite the modification of drug therapy, significant obstructive pressure in the outflow tract of the left ventricle still persisted. After adequate preparation, septal alcohol ablation is performed with echo control of the procedure. Postprocedurally, the dynamics of cardioselective enzymes are monitored with ultrasound verified hypokinesis of the S2 irrigation area. Due to intermittent complete AV block, a permanent electrostimulator is implanted. At the&#x0D;

Clinical profiling and outcomes of viral myocarditis manifesting with ventricular arrhythmias.

Clinical features and risk stratification of patients with viral myocarditis (VM) complicated by ventricular arrhythmias (VA) are incompletely understood. We aim to describe arrhythmia patterns and outcomes in patients with VM and early-onset VA. We present a single-centre study, enrolling patients with VM proven by endomyocardial biopsy, and evidence of VA within 24 h of hospitalization. The incidence of major adverse events (MAE), including all-cause death, severe heart failure, advanced atrioventricular blocks, or major VA, was evaluated during a 24-month follow-up (FU) and compared with a matched group of virus-negative myocarditis. Of patients with VM (n = 74, mean age 47 ± 16 years, 66% males, and left ventricular ejection fraction 51 ± 13%), 20 (27%) presented with major VA [ventricular tachycardia/ventricular fibrillation (VT/VF)], and 32 (44%) had polymorphic VA. Patients with polymorphic VA more commonly had evidence of ongoing systemic infection (24/32 vs. 10/42, P = 0.004) and experienced greater occurrence of MAE at discharge (15/32 vs. 2/42, P < 0.001). However, the incidence of MAE during FU was higher in patients with monomorphic VA compared to those with polymorphic VA (17/42 vs. 2/28, P = 0.002). Patients with monomorphic VA displayed frequently signs of chronic cardiomyopathy and had outcomes comparable with virus-negative myocarditis (log rank P = 0.929). Presentation with VT/VF was independently associated with MAE [at discharge: hazard ratio (HR) 4.7, 95% confidence interval (CI) 1.6-14.0, P = 0.005; during FU: HR 6.3, 95% CI 2.3-17.6, P < 0.001]. In patients with VM, polymorphic VA point to ongoing systemic infection and early adverse outcomes, whereas monomorphic VA suggest chronic cardiomyopathy and greater incidence of MAE during FU. Presentation with VT/VF is independently associated with MAE.

Cardiac arrhythmias in STEMI patients in ICU: study on occurrence in first 48h and correlation with age, sex, infarction site, and risk factors.

Acute myocardial infarction (AMI) is one of the leading causes of death in the developed world. The spread of the disease approaches three million people worldwide, with more than one million deaths in the United States annually. Myocardial ischemia and infarction can lead to electrophysiological and metabolic alterations that result in potentially fatal arrhythmias, some of which may be asymptomatic. About 90% of patients with AMI develop some form of arrhythmia during or immediately after the event, and in 25% of patients, these arrhythmias appear within the first 48h. The most common cause of death in patients with AMI in pre-hospitalization is ventricular tachycardia/ventricular fibrillation (VT/VF). A cross-sectional study targeting 150 patients with myocardial infarction attending tertiary hospital. According to certain acceptance and exclusion criteria. The sample consisted of 150 patients who suffered from heart infarction, the mean age of patients in the sample was 59.41 years with a standard deviation of 11.02 years and range of 28-90. Males constituted the largest portion of patients, with 112 males, that is 75%. The study identified that the anterior wall was the most frequent location for myocardial infarction among patients, with 64% of patients experiencing an infarction in this area. Additionally, ventricular fibrillation was the most commonly occurring arrhythmia, affecting 27% of myocardial infarction patients in the study. One of the most important recommendations of our study is the necessity of keeping the patient under observation for at least 48h after myocardial infarction within the hospital to monitor the ECG (Holter) in order to detect arrhythmias. Detection of arrhythmias in every patient with extensive anterior, lateral, or posterior myocardial infarction. And the need to know and take into account ventricular fibrillation and how to manage it in every patient with a heart infarction. And conducting future studies, including a larger number of patients, to study cardiac arrhythmias more precisely.

MP-453089-1 DIGOXIN AND RISK OF VENTRICULAR TACHYARRHYTHMIA AND DEATH IN ICD RECIPIENTS

Digoxin continues to be used in patients with heart failure with reduced ejection fraction (HFrEF), especially among those with atrial fibrillation (AF) with difficult to control ventricular response. However, some studies have shown digoxin use to be associated with adverse outcomes including increased mortality. There are limited data on whether digoxin use is associated with increased risk of ventricular tachycardia/ventricular fibrillation (VT/VF) in implantable cardioverter defibrillator (ICD) recipients. We sought to assess whether digoxin use would be associated with increased risk of VT/VF in patients with HFrEF who were implanted with a primary prevention ICD in landmark clinical trials. Our study cohort consisted of patients with an ICD or cardiac resynchronization therapy-defibrillator (CRT-D) who were enrolled in the four landmark MADIT trials. Propensity score for digoxin at baseline was developed using a wide variety of baseline clinical measures with a logistic regression model stepwise variable selection approach. All potential variables which met a significance level <0.10 were included in the propensity score model. Additionally, a multivariate proportional hazards regression model was developed for the endpoint of VT/VF. This multivariate model was used along with propensity score quintile stratification for the endpoints of VT/VF, death and VT/VF/death. At baseline, 1155 of 4499 patients were on digoxin (26%). Propensity score variables are shown in Table 1. From statistical models using both multivariate adjustment and propensity score quintile stratification, patients prescribed digoxin exhibited a statistically significant 28% increased risk of VT/VF [HR 1.28 (1.10-1.50); p=0.002; Figure 1A], 38% increased risk of the composite of VT/VF or death [HR 1.38 (1.21-1.58); p<0.0001; Figure 1B]; and a 64% increased risk of death [HR 1.64; (1.32-2.04); p<0.0001]. Our findings suggest that digoxin use is associated with a significant increased risk of ventricular tachyarrhythmic events and death among ICD recipients. This adds to the growing evidence that digoxin use is associated with adverse outcomes in certain groups of patients and suggest a need for reconsideration on use of digoxin in HFrEF patients with an ICD.

Resting heart rate correlates with major adverse cardiovascular and cerebrovascular events in patients with post-myocardial infarction ventricular aneurysms: a retrospective cohort study

To analyze the association of resting heart rate (RHR) with the prognosis of patients with post-infarction ventricular aneurysms. We retrospectively analyzed the clinical data of 227 patients with post-infarction ventricular aneurysms admitted to our hospital during 2017-2019. The endpoint event was the occurrence of any major adverse cardiovascular and cerebrovascular events (MACCEs) during the follow-up for 24 months. According to RHR measurements, the patients were divided into 3 groups with baseline RHR < 10%, 10%-90%, and >90%. The Cox proportional risk model and restricted cubic spline (RCS) model were used to analyze the effect of RHR on MACCEs. During the 24-month followup, 90 patients (39.6%) experienced MACCEs. The fully adjusted RCS curves showed a nonlinear "U" shaped correlation between RHR and the occurrence of MACCEs. In the fully adjusted model, the risk of MACCEs increased by 3.01-fold (Hazard ratio [HR]=4.01, 95% CI: 2.07-7.76, P < 0.001) in patients with RHR>90%, as compared with patients with RHR of 10%-90%. In patients with RHR in 1-9th percentile, 10th-90th percentile and 91st-100th percentile, the incidences of MACCEs were 39.1%, 36.6% and 66.7% (P=0.027), the incidences of ventricular tachycardia/ventricular fibrillation (VT/VF) were 17.4%, 2.7% and 4.8% (P=0.005), and the incidences of readmission for heart failure were 8.7%, 26.8% and 42.9% (P=0.036), respectively. Continuous monitoring and management of heart rate range may provide guidance for prognosis prediction in patients with post-infarction ventricular aneurysms.

Association of left atrial ejection fraction and cardiovascular outcomes in Asian patients with hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme Background The optimal method of risk stratification of hyp­ertrophic cardiomyopathy (HCM) patients, especially in the Asian population, is unknown. Left atrial ejection fraction (LAEF) is an emerging risk marker for cardiovascular outcomes. This study aimed to investigate whether LAEF was associated with cardiovascular outcomes in Asian patients with HCM. Methods This was a retrospective cohort study performed in a tertiary academic centre involving 291 consecutive patients diagnosed with HCM between 2010 and 2017. We collected the relevant clinical characteristics of these patients and retrospectively analysed the index transthoracic echocardiograms for novel left atrial indices including LAEF. We obtained the maximum (LAVmax) and minimum left atrial volumes (LAVmin) using the biplane method of disks in apical 4- and 2-chamber views. LAEF was derived by dividing the difference between LAVmax and LAVmin by LAVmax. We assessed the patients for outcomes of (1) heart failure requiring admission, and (2) a composite of adverse outcomes including all-cause mortality, ventricular tachycardia / ventricular fibrillation (VT/VF) events, appropriate device therapy if an implantable cardioverter defibrillator (ICD) was implanted, stroke and heart failure hospitalization. Results The patients had a mean age of 59.0 ± 16.7 years-old at diagnosis and had a male preponderance (71.2%). The most common comorbidities were hypertension, diabetes mellitus and ischemic heart disease. On univariable logistic regression analysis, maximum and minimum left atrial volume index (LAVI) as well as LAEF showed a significant association with heart failure and the predefined composite outcome. On Cox regression analysis adjusting for variables of age, sex, left ventricular ejection fraction (LVEF), left ventricular maximal wall thickness &amp;gt;30mm, significant left ventricular outflow tract (LVOT) gradient of &amp;gt; 30mmHg and more than moderate mitral regurgitation, maximum and minimum LAVI as well as LAEF retained an association with heart failure admission but only minimum LAVI and LAEF were associated with the composite outcome [(OR 0.019, 95% CI 0.02-0.230, p=0.002), (OR 0.226, 95% CI 0.053-0.960, p=0.044), (OR 1.030, 95% CI 1.016-1.045, p&amp;lt;0.001), and (OR 1.016, 95% CI 1.005-1.026, p=0.004) respectively]. Conclusion LAEF was an independently associated with congestive heart failure as well as a composite of adverse outcomes in Asian patients with HCM.

Abstract 277: Hyperoxemia Is Associated With Brain Death In Refractory Out-of-hospital Vt/vf Patients Treated With Extracorporeal Cardiopulmonary Resuscitation

Background: Brain death is a major cause of death among refractory ventricular tachycardia/ventricular fibrillation (VT/VF) out-of-hospital cardiac arrest (OHCA) who are treated with extracorporeal cardiopulmonary resuscitation (ECPR). Studies regarding the clinical consequences of hyperoxemia in this population are lacking. We aimed to determine whether hyperoxemia (PaO 2 &gt;300mmHg) is associated with brain death in patients treated with an established ECPR protocol. Methodology: This single-center retrospective study included consecutive patients presenting to the University of Minnesota between 2015-2021 with refractory VT/VF OHCA. All patients were treated with an ECPR protocol including VA-ECMO. All blood gases collected within the first 48 hours were reviewed and the highest and lowest values for PaO2, PaCO2, and lactate were recorded. The primary outcome was brain death. This was defined as a lack of brainstem reflexes on physical examination and herniation on CT imaging or lack of blood flow on a brain perfusion scan. Results: One-hundred and eighty-two patients met inclusion criteria and 141/182 (77.5%) had hyperoxemia. Presenting characteristics were comparable in both groups aside from higher initial PaCO 2 in patients who developed hyperoxemia ( Figure ). Brain death occurred in 42/141 (29.8%) of the hyperoxemia group vs 3/41 (7.3%) in the non-hyperoxemia group. After adjustment for age, CPR time, initial PaCO 2 and lactate, hyperoxemia was significantly associated with brain death (OR 5.2, 95% CI 1.4-19.0, p=0.014). The risk was independent of the number of hours spent with hyperoxemia ( Figure ). Overall survival was comparable between groups. Hypoxemia (PaO2 &lt;60mmHg) occurred in 76/182 (41.8%) and was not associated with survival or brain death. Conclusion: Among refractory VT/VF OHCA patients treated with ECPR, hyperoxemia after the cardiac arrest is associated with brain death independent of the number of hours spent with hyperoxemia.

Abstract 144: Impact Of Gender On Outcomes In The Extracorporeal Cardiopulmonary Resuscitation Population For Out-of-hospital Cardiac Arrest

Introduction: Extracorporeal Cardiopulmonary Resuscitation ( ECPR) is associated with improved neurologically favorable survival for refractory ventricular tachycardia/ventricular fibrillation (VT/VF) arrests. Women are known to have less coronary artery disease, and it is unknown if the lack of a reversible cause would be associated with worse outcomes after ECPR. Hypothesis: We hypothesize that female gender may be associated with worse outcomes after ECPR. Methods: Patients who presented for refractory VT/VF arrest between 2015 and 2021 were included. The primary outcomes included overall survival at 36 months and neurologically favorable survival on discharge (Cerebral Performance Categories scales of 1 or 2). Secondary outcomes included cardiopulmonary resuscitation (CPR) time, median lactate level on presentation, and bystander CPR. Results: Out of 357 patients who presented for out-of-hospital cardiac arrest, 68 patients (19%) were female. The median age for females was 57 years (IQR 57-52) and for males was 59 years (IQR 50-66). Women were more likely to receive ECPR and not to be excluded (5.9% of women were excluded vs. 14.9%, p=0.048) and were less likely to have obstructive coronary disease on coronary angiogram at presentation (39.5% vs. 62.9%, p=0.005). There was no difference in neurologically favorable survival based on gender (39.1% in women vs. 33.7%, p=0.42) nor 36 months survival (p= 0.58, figure). There was also no difference in median CPR time (62 minutes (IQR 51-76) in women vs. 59 minutes (IQR 45-70), p=0.16), median lactate levels (11.5 mmol/L (IQR 8-14.8) in women vs. 11.6 mmol/L (IQR 8.7-14.7), p=0.95), and in receiving bystander CPR (65.6% in women vs. 70.1%, p=0.49). Conclusion: There is no difference in neurologically favorable survival or overall survival based on gender in ECPR patients who had an out-of-hospital cardiac arrest, despite the difference in the prevalence of obstructive coronary artery disease on presentation.

Initial hospital length of stay and long-term survival of patients successfully resuscitated using extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest.

The long-term outcomes of patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory ventricular tachycardia/ventricular fibrillation (VT/VF) out-of-hospital cardiac arrest (OHCA) remain poorly defined. The purpose of this study was to describe the hospital length of stay and long-term survival of patients who were successfully rescued with ECPR after refractory VT/VF OHCA. In this retrospective cohort study, the length of index admission and long-term survival of patients treated with ECPR after OHCA at a single centre were evaluated. In a sensitivity analysis, survival of patients managed with left ventricular assist device (LVAD) implantation or heart transplantation during the same period was also evaluated. Between 1 January 2016 and 12 January 2020, 193 patients were transferred for ECPR considerations and 160 underwent peripheral veno-arterial extracorporeal membrane oxygenation cannulation. Of these, 54 (33.7%) survived the index admission. These survivors required a median 16 days of intensive care and 24 days total hospital stay. The median follow-up time of the survivors was 1216 (683, 1461) days. Of all, 79.6 and 72.2% were alive at 1 and 4 years, respectively. Most deaths within the first year occurred among the patients requiring discharge to a long-term acute care facility. Overall survival rates at 4 years were similar in the ECPR and LVAD cohorts (P = 0.30) but were significantly higher for transplant recipients (P < 0.001). This data suggest that the lengthy index hospitalization required to manage OHCA patients with ECPR is rewarded by excellent long-term clinical outcomes in an expert ECPR programme.

Incident heart failure, arrhythmias and cardiovascular outcomes with sodium-glucose cotransporter 2 (SGLT2) inhibitor use in patients with diabetes: Insights from a global federated electronic medical record database.

To investigate the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors on the risk of incident heart failure and adverse cardiovascular outcomes. All patients with diabetes who were registered between January 2018 and December 2019 were identified from a federated electronic medical record database (TriNetX) and followed up for 2 years. A 1:1 propensity-score matching (PSM) analysis was performed to balance the SGLT2 inhibitor and non-SGLT2 inhibitor cohorts. The primary outcome was incident heart failure. Secondary outcomes included all-cause mortality, cardiac arrest, ventricular tachycardia/ventricular fibrillation (VT/VF), incident atrial fibrillation (AF), ischaemic stroke/transient ischaemic attack (TIA), composite of arterial and venous thrombotic events, and composite of incident VT/VF and cardiac arrest. A total of 131 189and 2 692 985 patients were treated with and without SGLT2 inhibitors, respectively. After PSM, 131 188 patients remained in each group. The risk of incident heart failure was significantly lower in the SGLT2 inhibitor cohort compared to the non-SGLT2 inhibitor cohort (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.68-0.73). SGLT2 inhibitor use was also associated with a significantly lower risk of all-cause mortality (HR 0.61, 95% CI 0.58-0.64), cardiac arrest (HR 0.70, 95% CI 0.63-0.78), incident AF (HR 0.81, 95% CI 0.76-0.84), ischaemic stroke/TIA (HR 0.90, 95% CI 0.88-0.93), composite of arterial and venous thrombotic events (HR 0.90, 95% CI 0.88-0.92), and composite of incident VT/VF and cardiac arrest (HR 0.76, 95% CI 0.71-0.81). There were no significant differences for VT/VF (HR 0.94, 95% CI 0.88-1.00). Use of SGLT2 inhibitors was associated with a significant reduction in the risk of incident heart failure and adverse cardiovascular outcomes but not ventricular arrhythmias.

Clinical Characteristics, Genetic Findings and Arrhythmic Outcomes of Patients with Catecholaminergic Polymorphic Ventricular Tachycardia from China: A Systematic Review

Introduction: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac ion channelopathy. The present study aims to examine the clinical characteristics, genetic basis, and arrhythmic outcomes of CPVT patients from China to elucidate the difference between CPVT patients in Asia and Western countries. Methods: PubMed and Embase were systematically searched for case reports or series reporting on CPVT patients from China until 19 February 2022 using the keyword: “Catecholaminergic Polymorphic Ventricular Tachycardia” or “CPVT”, with the location limited to: “China” or “Hong Kong” or “Macau” in Embase, with no language or publication-type restriction. Articles that did not state a definite diagnosis of CPVT and articles with duplicate cases found in larger cohorts were excluded. All the included publications in this review were critically appraised based on the Joanna Briggs Institute Critical Appraisal Checklist. Clinical characteristics, genetic findings, and the primary outcome of spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF) were analyzed. Results: A total of 58 unique cases from 15 studies (median presentation age: 8 (5.0–11.8) years old) were included. All patients, except one, presented at or before 19 years of age. There were 56 patients (96.6%) who were initially symptomatic. Premature ventricular complexes (PVCs) were present in 44 out of 51 patients (86.3%) and VT in 52 out of 58 patients (89.7%). Genetic tests were performed on 54 patients (93.1%) with a yield of 87%. RyR2, CASQ2, TERCL, and SCN10A mutations were found in 35 (71.4%), 12 (24.5%), 1 (0.02%) patient, and 1 patient (0.02%), respectively. There were 54 patients who were treated with beta-blockers, 8 received flecainide, 5 received amiodarone, 2 received verapamil and 2 received propafenone. Sympathectomy (n = 10), implantable cardioverter-defibrillator implantation (n = 8) and ablation (n = 1) were performed. On follow-up, 13 patients developed VT/VF. Conclusion: This was the first systematic review of CPVT patients from China. Most patients had symptoms on initial presentation, with syncope as the presenting complaint. RyR2 mutation accounts for more than half of the CPVT cases, followed by CASQ2, TERCL and SCN10A mutations.

Epidemiology of Cardiopulmonary Arrest and Outcome of Resuscitation in PICU Across China: A Prospective Multicenter Cohort Study.

ObjectiveTo investigate the epidemiology and the effectiveness of resuscitation from cardiopulmonary arrest (CPA) among critically ill children and adolescents during pediatric intensive care unit (PICU) stay across China.MethodsA prospective multicenter study was conducted in 11 PICUs in tertiary hospitals. Consecutively hospitalized critically ill children, from 29-day old to 18-year old, who had suffered from CPA and required cardiopulmonary resuscitation (CPR) in the PICU were enrolled (December 2017–October 2018). Data were collected and analyzed using the “in-hospital Utstein style.” Neurological outcome was assessed with the Pediatric Cerebral Performance Category (PCPC) scale among children who had survived. Factors associated with the return of spontaneous circulation (ROSC) and survival at discharge were evaluated using multivariate logistic regression.ResultsAmong 11,599 admissions to PICU, 372 children (3.2%) had CPA during their stay; 281 (75.5%) received CPR, and 91 (24.5%) did not (due to an order of “Do Not Resuscitate” requested by their guardians). Cardiopulmonary disease was the most common reason for CPA (28.1% respiratory and 19.6% circulatory). The most frequent initial dysrhythmia was bradycardia (79%). In total, 170 (60.3%) of the total children had an ROSC, 91 had (37.4%) survived till hospital discharge, 28 (11.5%) had survived 6 months, and 19 (7.8%) had survived for 1 year after discharge. Among the 91 children who were viable at discharge, 47.2% (43/91) received a good PCPC score (1–3). The regression analysis results revealed that the duration of CPR and the dose of epinephrine were significantly associated with ROSC, while the duration of CPR, number of CPR attempts, ventricular tachycardia/ventricular fibrillation (VT/VF), and the dose of epinephrine were significantly associated with survival at discharge.ConclusionThe prevalence of CPA in critically ill children and adolescents is relatively high in China. The duration of CPR and the dose of epinephrine are associated with ROSC. The long-term prognosis of children who had survived after CPR needs further improvement.

Impact of the caFFR-Guided Functional SYNTAX Score on Ventricular Tachycardia/Fibrillation Development in Patients With Acute Myocardial Infarction.

AimsTo explore the relationship between the severity of coronary artery disease (CAD) and the occurrence of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with acute myocardial infarction (AMI).MethodsWe retrospectively enrolled 705 patients with AMI, who were hospitalized and underwent percutaneous coronary intervention (PCI), in Nanfang Hospital from July 2017 to July 2020. Logistic regression analysis and backward stepwise approach were taken to select the correlation factors. The left and the receiver operating characteristic curves (ROC) analysis were plotted to observe the discriminative power of the SYNTAX score (SS)/caFFR-guided functional SS (FSScaFFR) on the incident VT/VF.ResultsAbout 58 (8.2%) patients experienced life-threatening VT/VF. The FSScaFFR (OR: 1.155; 95% CI: 1.047 to 1.273; p = 0.004) was an independent predictor of VT/VF after AMI. The ROC analysis showed that the discriminative power of FSScaFFR on the incident VT/VF was significantly better than SS (0.759 vs.0.695, p < 0.0001). Patients with VT/VF were categorized into 2 groups according to the interval between the onset of AMI and the VT/VF. The logistic regression analysis revealed that FSScaFFR was a significant independent correlation of early- and late-VT/VF.ConclusionThe incident VT/VF in patients with AMI is closely associated with the severity of CAD evaluated by SS and FSScaFFR. Compared to SS, FSScaFFR has a higher correlation with VT/VF, and FSScaFFR was demonstrated to be an independent correlation factor of incident VT/VF after AMI.

N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification of Heart Failure Patients With Implantable Cardioverter-Defibrillator.

BackgroundThe prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure (HF) is well-established. However, whether it could facilitate the risk stratification of HF patients with implantable cardioverter-defibrillator (ICD) is still unclear.ObjectiveTo determine the associations between baseline NT-proBNP and outcomes of all-cause mortality and first appropriate shock due to sustained ventricular tachycardia/ventricular fibrillation (VT/VF) in ICD recipients.Methods and resultsN-terminal pro-B-type natriuretic peptide was measured before ICD implant in 500 patients (mean age 60.2 ± 12.0 years; 415 (83.0%) men; 231 (46.2%) Non-ischemic dilated cardiomyopathy (DCM); 136 (27.2%) primary prevention). The median NT-proBNP was 854.3 pg/ml (interquartile range [IQR]: 402.0 to 1,817.8 pg/ml). We categorized NT-proBNP levels into quartiles and used a restricted cubic spline to evaluate its nonlinear association with outcomes. The incidence rates of mortality and first appropriate shock were 5.6 and 9.1%, respectively. After adjusting for confounding factors, multivariable Cox regression showed a rise in NT-proBNP was associated with an increased risk of all-cause mortality. Compared with the lowest quartile, the hazard ratios (HRs) with 95% CI across increasing quartiles were 1.77 (0.71, 4.43), 3.98 (1.71, 9.25), and 5.90 (2.43, 14.30) for NT-proBNP (p for trend < 0.001). A restricted cubic spline demonstrated a similar pattern with an inflection point found at 3,231.4 pg/ml, beyond which the increase in NT-proBNP was not associated with increased mortality (p for nonlinearity < 0.001). Fine-Gray regression was used to evaluate the association between NT-proBNP and first appropriate shock accounting for the competing risk of death. In the unadjusted, partial, and fully adjusted analysis, however, no significant association could be found regardless of NT-proBNP as a categorical variable or log-transformed continuous variable (all p > 0.05). No nonlinearity was found, either (p = 0.666). Interactions between NT-proBNP and predefined factors were not found (all p > 0.1).ConclusionIn HF patients with ICD, the rise in NT-proBNP is independently associated with increased mortality until it reaches the inflection point. However, its association with the first appropriate shock was not found. Patients with higher NT-proBNP levels might derive less benefit from ICD implant.

A wearable cardioverter defibrillator with a low false alarm rate.

IntroductionA wearable cardioverter defibrillator (WCD) is indicated in appropriate patients to reduce the risk for sudden cardiac death. Challenges for patients wearing a WCD have been frequent false shock alarms primarily due to electrocardiogram noise and wear discomfort. The objective of this study was to test a contemporary WCD designed for reduced false shock alarms and improved comfort.MethodsOne hundred and thirty patients with left ventricular ejection fraction ≤40% and an active implantable cardioverter defibrillator (ICD) were fitted with the ASSURE WCD (Kestra Medical Technologies) and followed for 30 days. WCD detection was enabled and shock alarm markers recorded, but shocks and shock alarms were disabled. All WCD episodes and ICD ventricular tachycardia/ventricular fibrillation (VT/VF) episodes were adjudicated. The primary endpoint was the false‐positive shock alarm rate with a performance goal of 1 every 3.4 days (0.29 per patient‐day).ResultsOf 163 WCD episodes, 4 were VT/VF and 159 non‐VT/VF (121 rhythms with noise, 32 uncertain with noise, 6 atrial flutter without noise). Only three false‐positive shock alarm markers were recorded; one false‐positive shock alarm every 1333 patient‐days (0.00075 per patient‐day, 95% confidence interval: 0.00015–0.00361; p < .001). No ICD recorded VT/VF episodes meeting WCD detection criteria (≥170 bpm for ≥20 s) were missed by the WCD during 3501 patient‐days of use. Median wear was 31.0 days (interquartile range [IQR] 2.0) and median daily use 23.0 h (IQR 1.7). Adverse events were mostly mild: skin irritation (19.4%) and musculoskeletal discomfort (8.5%).ConclusionThe ASSURE WCD demonstrated a low false‐positive shock alarm rate, low patient‐reported discomfort, and no serious adverse events.

Rotors anchored by refractory islands drive torsades de pointes in an experimental model of electrical storm.

Electrical storm (ES) is a life-threatening emergency in patients at high risk of ventricular tachycardia/ventricular fibrillation (VF), but the pathophysiology and molecular basis are poorly understood. The purpose of this study was to explore the electrophysiological substrate for experimental ES. A model was created by inducing chronic complete atrioventricular block in defibrillator-implanted rabbits, which recapitulates QT prolongation, torsades des pointes (TdP), and VF episodes. Optical mapping revealed island-like regions with action potential duration (APD) prolongation in the left ventricle, leading to increased spatial APD dispersion, in rabbits with ES (defined as ≥3 VF episodes/24 h). The maximum APD and its dispersion correlated with the total number of VF episodes invivo. TdP was initiated by an ectopic beat that failed to enter the island and formed a reentrant wave and perpetuated by rotors whose centers swirled in the periphery of the island. Epinephrine exacerbated the island by prolonging APD and enhancing APD dispersion, which was less evident after late Na+ current blockade with 10 μM ranolazine. Nonsustained ventricular tachycardia in a non-ES rabbit heart with homogeneous APD prolongation resulted from multiple foci with an electrocardiographic morphology different from TdP driven by drifting rotors in ES rabbit hearts. The neuronal Na+-channel subunit NaV1.8 was upregulated in ES rabbit left ventricular tissues and expressed within the myocardium corresponding to the island location in optically mapped ES rabbit hearts. The NaV1.8 blocker A-803467 (10 mg/kg, intravenously) attenuated QT prolongation and suppressed epinephrine-evoked TdP. A tissue island with enhanced refractoriness contributes to the generation of drifting rotors that underlies ES in this model. NaV1.8-mediated late Na+ current merits further investigation as a contributor to the substrate for ES.

Clinical characteristics, outcomes, and genetic findings of patients with catecholaminergic polymorphic ventricular tachycardia in Hong Kong: A systematic review

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare cardiac ion channelopathy. This was the first systematic review of published works on the clinical characteristics, outcomes, and genetic findings of patients with CPVT from Hong Kong. PubMed and Embase were searched electronically from their inception until February 2022. The Joanna Briggs Institute Critical Appraisal Checklist was used to critically appraise included studies. Studies written in English describing at least one patient with CPVT were included. Studies describing overlapping CPVT patients from previous reports were excluded. Two studies describing 17 patients with CPVT were included. All included studies were rated of acceptable quality. The largest case series evaluated 16 CPVT patients with a mean presentation age of 11 ± 4 years. Of these, 15 patients (93.8%) were symptomatic at initial presentation. Ten patients presented with both premature ventricular complexes (PVCs) and ventricular tachycardia/ventricular fibrillation (VT/VF), whereas one had PVCs without VT/VF. Among the 14 patients (87.5%) who underwent genetic testing, eight (57.1%) tested positive for the ryanodine receptor 2 (RyR2) gene. Over a mean follow-up duration of 116 ± 36 months, six patients (37.5%) had incident VT/VF. In a 5-year review of autopsy data retrieved from public mortuaries for 289 sudden cardiac death patients, one CPVT patient (0.03%) was identified. All patients with CPVT in Hong Kong presented at or below 19 years old, of whom a majority were initially symptomatic or had incident VT/VF events. Novel genetic variants in the RyR2 gene not reported beyond our locality were identified.