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European Journal of Heart Failure Apr 2021
Topics: Anticoagulants; Fibrinolytic Agents; Heart Failure; Humans; Longitudinal Studies; Warfarin
PubMed: 33131202
DOI: 10.1002/ejhf.2045 -
The American Journal of Cardiology Jul 2020Heart failure with reduced ejection fraction (HFrEF) is associated with an increased risk of thrombotic events. We compared the safety and efficacy of different... (Meta-Analysis)
Meta-Analysis Review
Heart failure with reduced ejection fraction (HFrEF) is associated with an increased risk of thrombotic events. We compared the safety and efficacy of different antithrombotic strategies for HFrEF and sinus rhythm. PubMed and Embase were searched through January 2020 for studies comparing oral anticoagulants versus antiplatelet agents or placebo in HFrEF and sinus rhythm to include in this network meta-analysis. We identified 5 randomized controlled trials with a total of 9,390 patients randomized to low dose rivaroxaban, vitamin K antagonist (VKA), antiplatelets, or placebo. Low dose rivaroxaban and VKA did not show a significant decrease in stroke compared with placebo but were associated with an increased risk of major bleeding (risk ratio [RR] 6.86, 95% confidence interval [CI] 1.16 to 40.7; RR 8.62, 95% CI 1.52 to 48.9, respectively). When compared with antiplatelets, low dose rivaroxaban and VKA were associated with a significantly decreased risk of stroke (RR 0.67, 95% CI 0.47 to 0.96; RR 0.50, 95% CI 0.33 to 0.76, respectively), but with a significantly increased risk of major bleeding (RR 1.65, 95% CI 1.16 to 2.33; RR 2.07, 95% CI 1.51 to 2.84, respectively). There was no significant difference in these outcomes between low dose rivaroxaban versus VKA and antiplatelets versus placebo. There were no significant differences in all-cause mortality, myocardial infarction, or rehospitalization for heart failure among each treatment. In conclusion, in patient with HFrEF and sinus rhythm, use of oral anticoagulation with or without antiplatelet agents increases the risk of bleeding without substantial effects on the risk of ischemic stroke.
Topics: Fibrinolytic Agents; Heart Failure; Humans; Practice Guidelines as Topic; Stroke Volume; Thrombolytic Therapy; Thrombosis
PubMed: 32386959
DOI: 10.1016/j.amjcard.2020.04.007 -
Frontiers in Physiology 2020Circadian rhythms are involved in many physiological and pathological processes in different tissues, including the heart. Circadian rhythms play a critical role in... (Review)
Review
Circadian rhythms are involved in many physiological and pathological processes in different tissues, including the heart. Circadian rhythms play a critical role in adverse cardiac function with implications for heart failure and sudden cardiac death, highlighting a significant contribution of circadian mechanisms to normal sinus rhythm in health and disease. Cardiac arrhythmias are a leading cause of morbidity and mortality in patients with heart failure and likely cause ∼250,000 deaths annually in the United States alone; however, the molecular mechanisms are poorly understood. This suggests the need to improve our current understanding of the underlying molecular mechanisms that increase vulnerability to arrhythmias. Obesity and its associated pathologies, including diabetes, have emerged as dangerous disease conditions that predispose to adverse cardiac electrical remodeling leading to fatal arrhythmias. The increasing epidemic of obesity and diabetes suggests vulnerability to arrhythmias will remain high in patients. An important objective would be to identify novel and unappreciated cellular mechanisms or signaling pathways that modulate obesity and/or diabetes. In this review we discuss circadian rhythms control of metabolic and environmental cues, cardiac ion channels, and mechanisms that predispose to supraventricular and ventricular arrhythmias including hormonal signaling and the autonomic nervous system, and how understanding their functional interplay may help to inform the development and optimization of effective clinical and therapeutic interventions with implications for chronotherapy.
PubMed: 33519516
DOI: 10.3389/fphys.2020.611860 -
Heart Rhythm O2 Jun 2022Atypical left atrial flutter (AFL) may be macroreentrant or spatially localized. The relationship between the critical isthmus (CI) for localized reentry with sinus...
BACKGROUND
Atypical left atrial flutter (AFL) may be macroreentrant or spatially localized. The relationship between the critical isthmus (CI) for localized reentry with sinus rhythm (SR) conduction slowing has not been systematically examined.
OBJECTIVE
To examine the correlation between CI sites for localized AFL (L-AFL) and deceleration zones (DZ) identified by isochronal late activation mapping (ILAM) during baseline rhythm.
METHODS
Patients with localized AFL who underwent high-density activation mapping of both SR and AFL were retrospectively analyzed. L-AFL was defined as reentry restricted to 2 wall segments of the left atrium. CI was defined by activation mapping and sites of successful termination during ablation. DZ, defined as >3 isochrones within 1 cm radius during baseline rhythm, were correlated to the locations of the CI.
RESULTS
Thirty-one consecutive patients that underwent detailed sinus rhythm and AFL high-density activation maps were analyzed at 3 centers. A mean 4060 ± 3275 and 6209 ± 8656 points were collected in ILAM and AFL activation maps, respectively. At least 1 DZ (1.7 ± 0.77) was identified in all patients. ILAM showed 3.27 ± 0.52 isochrones per DZ (168 ± 32 ms), and co-localized to CI sites at a distance of 6.7 ± 3 mm. A total of 34% ± 14% of the AFL cycle length was contained within 0.5 cm of the DZ.
CONCLUSIONS
In patients with L-AFL, CI co-localized with DZ during baseline rhythm, suggesting that DZ mapping during SR may yield candidate targets for ablation as an adjunct to pulmonary vein isolation to prevent a subtype of AFL.
PubMed: 35734295
DOI: 10.1016/j.hroo.2022.03.003 -
European Heart Journal Nov 2019
Topics: Anticoagulants; Coronary Artery Disease; Heart Failure; Humans; Ischemic Attack, Transient; Rivaroxaban; Stroke
PubMed: 31369067
DOI: 10.1093/eurheartj/ehz523 -
Arrhythmia & Electrophysiology Review Nov 2020AF and heart failure (HF) commonly coexist. Left atrial ablation is an effective treatment to maintain sinus rhythm (SR) in patients with AF. Recent evidence suggests... (Review)
Review
AF and heart failure (HF) commonly coexist. Left atrial ablation is an effective treatment to maintain sinus rhythm (SR) in patients with AF. Recent evidence suggests that the use of ablation for AF in patients with HF is associated with an improved left ventricular ejection fraction and lower death and HF hospitalisation rates. We performed a systematic search of world literature to analyse the association in more detail and to assess the utility of AF ablation as a non-pharmacological tool in the treatment of patients with concomitant HF.
PubMed: 33240512
DOI: 10.15420/aer.2020.23 -
Blood Pressure Monitoring Aug 2024We investigated the accuracy of the OMRON HEM-7361T automated oscillometric blood pressure (BP) monitor in the differentiation between atrial fibrillation and sinus... (Clinical Trial)
Clinical Trial
OBJECTIVE
We investigated the accuracy of the OMRON HEM-7361T automated oscillometric blood pressure (BP) monitor in the differentiation between atrial fibrillation and sinus rhythm.
METHODS
An approximately equal number of patients with persistent atrial fibrillation and individuals with sinus rhythm were recruited from outpatients and inpatients of Ruijin Hospital, Shanghai, China. BP was measured three times consecutively with a 30-s interval with the OMRON HEM-7361T automatic electronic BP monitor for atrial fibrillation detection. A hand-held single lead electrocardiogram device was used for simultaneous electrocardiogram recordings.
RESULTS
The device accurately identified atrial fibrillation in 100 (99.0%) of the 101 patients, with only 1 patient incorrectly classified as non-atrial fibrillation. The device correctly identified 99 (95.2%) of the 104 participants with sinus rhythm as non-atrial fibrillation, with five participants incorrectly classified as atrial fibrillation. The device had a positive predictive value of 95.2%, negative predictive value of 99.0%, and overall accuracy of 97.1%. Among the six misclassified participants, one with atrial fibrillation had a heart rate of 65 beats/min, and four of the five participants with sinus rhythm had cardiac arrhythmias (atrial or ventricular premature beat in one participants, sinus tachycardia in one participant, and both arrhythmias in one participant).
CONCLUSION
The OMRON HEM-7361T BP monitor is accurate in the differentiation between atrial fibrillation and sinus rhythm. Whether the device is sufficiently accurate in the differentiation between atrial fibrillation and other cardiac arrhythmias remains under investigation.
Topics: Humans; Atrial Fibrillation; Female; Male; Middle Aged; Aged; Electrocardiography; Blood Pressure Monitors; Arrhythmia, Sinus; Blood Pressure; Adult; Blood Pressure Determination; Aged, 80 and over
PubMed: 38774977
DOI: 10.1097/MBP.0000000000000706 -
Heart Rhythm Apr 2024Sinus rhythm activation time is useful to assess infarct border zone substrate.
BACKGROUND
Sinus rhythm activation time is useful to assess infarct border zone substrate.
OBJECTIVE
We sought to further investigate sinus activation in ventricular tachycardia (VT).
METHODS
Canine postinfarction data were analyzed retrospectively. In each experiment, an infarct was created in the left ventricular wall by left anterior descending coronary artery ligation. At 3 to 5 days after ligation, 196-312 bipolar electrograms were recorded from the anterior left ventricular epicardium overlapping the infarct border zone. Sustained monomorphic VT was induced by premature electrical stimulation in 50 experiments and was noninducible in 43 experiments. Acquired sinus rhythm and VT electrograms were marked for electrical activation time, and activation maps of representative sinus rhythm and VT cycles were constructed. The sinus rhythm activation signature was defined as the cumulative number of multielectrode recording sites that had activated per time epoch, and its derivative was used to predict VT inducibility and to define the sinus rhythm slow/late activation sequence.
RESULTS
Plotting mean activation signature derivative, a best cutoff value was useful to separate experiments with reentrant VT inducibility (sensitivity, 42/50) vs noninducibility (specificity, 39/43), with an accuracy of 81 of 93. For the 50 experiments with inducible VT, recording sites overlying a segment of isochrone encompassing the sinus rhythm slow/late activation sequence spanned the VT isthmus location in 32 cases (64%), partially spanned it in 15 cases (30%), but did not span it in 3 cases (6%).
CONCLUSION
The sinus rhythm activation signature derivative is assistive to differentiate substrate supporting reentrant VT inducibility vs noninducibility and to identify slow/late activation for targeting isthmus location.
PubMed: 38677360
DOI: 10.1016/j.hrthm.2024.04.082 -
Journal of Echocardiography Jun 2020The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. The morphology of the LAA correlates with stroke in patients with atrial...
BACKGROUND
The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. The morphology of the LAA correlates with stroke in patients with atrial fibrillation. In this study, we evaluated the correlation between LAA morphology and cardiac function by transthoracic echocardiography in patients with sinus rhythm.
METHODS AND RESULTS
We studied 55 patients (36 men, 70 ± 11 years) who underwent cardiac computed tomography and transthoracic echocardiography. The following 4 different morphologies were used to categorize LAA by computed tomography: chicken wing (CW), windsock, cactus, and cauliflower. These morphologies were also classified into CW and non-CW (nonCW) types. There were no significant differences in the left ventricular ejection fraction (63% vs 62%), left atrial (LA) volume (22.2 vs 25.5 ml/m), and LAA volume (4.3 vs 4.7 ml/m) between nonCW and CW. Patients with nonCW showed a lower A' velocity (8.0 vs 9.3 cm/s, p < 0.01), worse global longitudinal strain (- 17.2 vs - 20.2%, p < 0.01), lower tissue mitral annular displacement (9.7 vs 11.1 mm, p = 0.01), and lower LAS strain (22.6 vs 34.5%, p < 0.01) by speckle tracking echocardiography than did those with CW. Multiple logistic analysis showed that nonCW LAA morphology was closely associated with lower LAS strain. Furthermore, a change in volume of the LAA during the cardiac cycle was lower in nonCW than in CW.
CONCLUSIONS
These findings suggest that impaired LA and LAA functions are related to changes of the LAA in patients with sinus rhythm.
Topics: Aged; Atrial Appendage; Atrial Fibrillation; Atrial Function; Echocardiography; Female; Heart Rate; Humans; Male; Multidetector Computed Tomography; Reproducibility of Results; Stroke
PubMed: 31950356
DOI: 10.1007/s12574-020-00462-0