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Clinical Cardiology Jan 2024While ivabradine has demonstrated benefits in heart rate control and prognosis for chronic heart failure patients, its application in acute decompensated heart failure...
BACKGROUND
While ivabradine has demonstrated benefits in heart rate control and prognosis for chronic heart failure patients, its application in acute decompensated heart failure remains underexplored.
HYPOTHESIS
For patients with acute decompensated heart failure with reduced ejection fraction (HFrEF) who are intolerant to β-blockers or unable to further titrate their dosage, the use of ivabradine is hypothesized to be effective and safe is improving outcomes.
METHODS
This retrospective, multicenter database analysis included patients with hospitalized decompensated heart failure with a left ventricular ejection fraction of ≤40% from June 1, 2015 to December 31, 2020. The exclusion criteria were a baseline heart rate of <70 bpm, previous use of ivabradine, mortality during admission, existing atrial fibrillation, or atrial flutter. The primary outcome was the composite of cardiovascular death and hospitalization for heart failure.
RESULTS
Of the 4163 HFrEF patients analyzed, 684 (16.4%) were administered ivabradine during their index admission. After matching, there were 617 patients in either group. The results indicated that ivabradine use was not significantly associated with the risk of the primary composite outcome (hazard ratio: 1.10; 95% confidence interval: 0.94-1.29). Similarly, the risk of secondary outcomes and adverse renal events did not significantly differ between the ivabradine and non-ivabradine cohorts (all p > .05).
CONCLUSION
For hospitalized acute decompensated heart failure patients who are intolerant to β-blockers or cannot further titrate them, ivabradine offers a consistent therapeutic effect. No significant disparities were noted between the ivabradine and non-ivabradine groups in heart failure hospitalization and cardiovascular death.
Topics: Humans; Heart Failure; Ivabradine; Retrospective Studies; Stroke Volume; Ventricular Function, Left
PubMed: 38269634
DOI: 10.1002/clc.24206 -
Physiological Measurement Feb 2024Cardiac arrhythmias are a leading cause of mortality worldwide. Wearable devices based on photoplethysmography give the opportunity to screen large populations, hence...
Cardiac arrhythmias are a leading cause of mortality worldwide. Wearable devices based on photoplethysmography give the opportunity to screen large populations, hence allowing for an earlier detection of pathological rhythms that might reduce the risks of complications and medical costs. While most of beat detection algorithms have been evaluated on normal sinus rhythm or atrial fibrillation recordings, the performance of these algorithms in patients with other cardiac arrhythmias, such as ventricular tachycardia or bigeminy, remain unknown to date. Theopen-source framework, developed by Charlton and colleagues, evaluates the performance of the beat detectors named,andamong others. We applied theframework on two newly acquired datasets, one containing seven different types of cardiac arrhythmia in hospital settings, and another dataset including two cardiac arrhythmias in ambulatory settings. In a clinical setting, thebeat detector performed best on atrial fibrillation (with a medianscore of 94.4%), atrial flutter (95.2%), atrial tachycardia (87.0%), sinus rhythm (97.7%), ventricular tachycardia (83.9%) and was ranked 2nd for bigeminy (75.7%) behinddetector (76.1%). In an ambulatory setting, thebeat detector performed best on normal sinus rhythm (94.6%), and thedetector on atrial fibrillation (91.6%) and bigeminy (80.0%). Overall, the PPG beat detectors,andconsistently achieved higher performances than other detectors. However, the detection of beats from wrist-PPG signals is compromised in presence of bigeminy or ventricular tachycardia.
Topics: Humans; Heart Rate; Atrial Fibrillation; Photoplethysmography; Benchmarking; Tachycardia, Ventricular; Algorithms; Electrocardiography
PubMed: 38266291
DOI: 10.1088/1361-6579/ad2216 -
European Heart Journal. Case Reports Jan 2024Deviations from usual coronary artery anatomy are well documented. The left circumflex artery (LCx) arising from the pulmonary artery is an example of one such deviation...
BACKGROUND
Deviations from usual coronary artery anatomy are well documented. The left circumflex artery (LCx) arising from the pulmonary artery is an example of one such deviation which is rarely seen. We present the case of a 26-year-old male with this coronary artery distribution presenting with an episode of ventricular flutter with late gadolinium enhancement and pluri-morphological ventricular arrhythmias.
CASE SUMMARY
A 26-year-old male with a history of cardiac surgery presented to his local hospital with an episode of symptomatic broad-complex tachycardia (BCT). It failed to revert to sinus rhythm following intravenous beta-blockers and amiodarone and required external cardioversion. Subsequently, the patient developed a aspiration pneumonia requiring ICU admission, after which he was transferred to our institute for ongoing cardiac management. Cardiac computed tomography CTA and coronary angiography revealed that the LCx was found to originate from the pulmonary artery. He underwent insertion of a subcutaneous pacemaker and was subsequently discharged. Despite the potential for steal syndrome of viable coronary territories. Multidisciplinary team discussion determined him to be fit for conservative management and not for surgical correction of his anomalous coronary artery anatomy.
DISCUSSION
Aberrant coronary artery anatomy can lead to diverse outcomes for patients in terms of both morbidity and mortality. The need for surgery in these situations varies on a case-by-case basis and little research exists to guide decision-making for healthcare professionals. As such there is a need for further study both to guide treatment and to ensure high-quality outcomes for patients with this condition.
PubMed: 38249112
DOI: 10.1093/ehjcr/ytad641 -
Clinics and Practice Jan 2024Cardiovascular diseases and arrhythmias are medical conditions that increase with age and are associated with significant morbidities and mortality. The aim of the...
BACKGROUND
Cardiovascular diseases and arrhythmias are medical conditions that increase with age and are associated with significant morbidities and mortality. The aim of the present study was to investigate the prevalence of arrhythmias and clinical associations in the collective of older adults receiving comprehensive geriatric care (CGC).
METHODS
Holter ECG monitoring (HECG) of older patients hospitalized for CGC was analyzed. The prevalence of arrhythmias and the associations between the presence of arrhythmias, patients' characteristics and the functional status regarding basic activities of daily living (assessed by the Barthel index (BI)), walking ability (assessed by the timed up and go test (TUG)), and balance and gait (assessed by the Tinetti balance and gait test (TBGT)) were examined.
RESULTS
In the presented study, 626 patients were included (mean age: 83.9 ± 6.6 years, 67.7% were female). The most common arrhythmias detected in HECG were premature ventricular contractions (87.2%), premature atrial contractions (71.7%), and atrial fibrillation (22.7%). Atrial flutter was found in 1.0%, paroxysmal supraventricular tachycardia in 5.8%, non-sustained ventricular tachycardia in 12.5%, first-degree AV block in 0.8%, second-degree AV block type Mobitz I in 0.8%, second-degree AV block type Mobitz II in 0.3%, pause > 2.5 s any cause in 3.5%, and pause > 3 s any cause in 1.6% of the cases. Premature atrial contractions were associated with the female sex (74.8% vs. 65.3%, = 0.018), whereas in male patients, the following arrhythmias were more common: premature ventricular contractions (91.6% vs. 85.1%, = 0.029), ventricular bigeminus (8.4% vs. 3.8%, = 0.021), and non-sustained ventricular tachycardia (17.3% vs. 10.1%, = 0.014). Atrial fibrillation detected in HECG was more frequent in patients at high risk of falls, indicated by their TBGT score ≤ 18 (24.7% vs. 12.0%, = 0.006), and premature ventricular contractions were more common in patients unable to walk (TUG score 5) compared to those with largely independent mobility (TUG score 1 or 2) (88.0% vs. 75.0%, = 0.023). In a logistic regression analysis, atrial fibrillation detected in HECG was identified as a risk factor for a high risk of falls (odds ratio (OR): 2.35, 95% confidence interval (CI): 1.23-4.46).
CONCLUSION
In our study, investigation of HECG of older adults hospitalized for CGC revealed that premature atrial contractions, premature ventricular contractions, and atrial fibrillation were the most common arrhythmias. Premature atrial contractions were found to be more frequent in female patients, while male patients were more prone to premature ventricular contractions. In the investigated population, atrial fibrillation emerged as a risk factor associated with a high risk of falls.
PubMed: 38248435
DOI: 10.3390/clinpract14010011 -
Journal of Cardiovascular... Mar 2024Patients with congenital heart disease are at increased risk for requiring cardiac pacing during their lifetime.
Different leadless pacemakers working in harmony (Aveir in the atrium/Micra AV2 in the ventricle) in a patient with dextrocardia and double outlet right ventricle after high-risk infected device extraction.
INTRODUCTION
Patients with congenital heart disease are at increased risk for requiring cardiac pacing during their lifetime.
METHODS
We present the first described case of using two leadless pacing systems manufactured by separate companies implanted within the same patient to provide atrial and ventricular pacing due to complex congenital anatomy.
RESULTS
A 27-year-old male with dextrocardia with double outlet right ventricle, subaortic ventricular septal defect, and pulmonary stenosis status-post pulmonary valve replacement complicated by ventricular pacing dependence and subsequent atrial pacing dependence after atriotomy-based atypical flutter ablation developed recurrent mediastinitis and pocket infection with erosion despite prolonged antibiotic treatment. Due to atrial and ventricular pacing dependence, a comprehensive congenital care team concluded the need for lead extraction and replacement of pacemaker via leadless peacemaking device. Laser-lead extraction and temporary atrial pacemaker placement was performed. Afterward, a transesophageal echocardiogram guided implantation of both a Micra AV 2 (Medtronic) leadless pacemaker in the interventricular septum within the right ventricle and an Aveir (Abbott) leadless pacemaker in the superior base of the right atrial appendage was performed with successful pacing. Although there is no communication between these devices, atrial-mechanical ventricular pacing was reliable with good implant thresholds, impedances and sensing from both devices.
CONCLUSION
Our case demonstrates the feasibility of using dual leadless pacing modalities to simultaneously pace someone at complex, prohibitive risk for temporary permanent or permanent pacemaker devices.
Topics: Male; Humans; Adult; Cardiac Pacing, Artificial; Heart Ventricles; Double Outlet Right Ventricle; Treatment Outcome; Pacemaker, Artificial; Dextrocardia; Equipment Design
PubMed: 38213071
DOI: 10.1111/jce.16173 -
JACC. Clinical Electrophysiology Mar 2024
Topics: Humans; Atrial Flutter; Atrioventricular Block; Verapamil; Tachycardia, Ventricular
PubMed: 38206262
DOI: 10.1016/j.jacep.2023.11.011 -
JACC. CardioOncology Dec 2023Hematopoietic stem cell transplantation (HSCT) is associated with various cardiovascular (CV) complications.
BACKGROUND
Hematopoietic stem cell transplantation (HSCT) is associated with various cardiovascular (CV) complications.
OBJECTIVES
We sought to characterize the incidence and risk factors for short-term and long-term CV events in a contemporary cohort of adult HSCT recipients.
METHODS
We conducted a multicenter observational study of adult patients who underwent autologous or allogeneic HSCT between 2008 and 2019. Data on demographics, clinical characteristics, conditioning regimen, and CV outcomes were collected through chart review. CV outcomes were a composite of CV death, myocardial infarction, heart failure, atrial fibrillation/flutter, stroke, and sustained ventricular tachycardia and were classified as short-term (≤100 days post-HSCT) or long-term (>100 days post-HSCT).
RESULTS
In 3,354 patients (mean age 55 years; 40.9% female; 30.1% Black) followed for a median time of 2.3 years (Q1-Q3: 1.0-5.4 years), the 100-day and 5-year cumulative incidences of CV events were 4.1% and 13.9%, respectively. Atrial fibrillation/flutter was the most common short- and long-term CV event, with a 100-day incidence of 2.6% and a 5-year incidence of 6.8% followed by heart failure (1.1% at 100 days and 5.4% at 5 years). Allogeneic recipients had a higher incidence of long-term CV events compared to autologous recipients (5-year incidence 16.4% vs 12.1%; 0.002). Baseline CV comorbidities were associated with a higher risk of long-term CV events.
CONCLUSIONS
The incidence of short-term CV events in HSCT recipients is relatively low. Long-term events were more common among allogeneic recipients and those with pre-existing CV comorbidities.
PubMed: 38205002
DOI: 10.1016/j.jaccao.2023.07.007 -
Journal of Clinical Medicine Dec 2023Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare, inherited heart rhythm disorder that is caused by variants in genes responsible for cardiac...
BACKGROUND
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare, inherited heart rhythm disorder that is caused by variants in genes responsible for cardiac calcium homeostasis. The aim of this study was to analyze different genotype-specific clinical manifestations of this disease.
METHODS AND RESULTS
We analyzed five CPVT cases from our institution in the context of specific patient characteristics and genotype-phenotype correlations. In this cohort, three of the index patients were male. The median age at diagnosis was 11 (11-30) years, and median age at disease onset was 12 (12-33) years. Four index patients suffered from syncope, while one female index patient suffered from out-of-hospital cardiac arrest. Two index patients experienced concomitant atrial flutter and atrial fibrillation. Three patients received an implantable cardioverter defibrillator and one patient received an event recorder. All index patients had causative genetic variants in the -gene.
CONCLUSIONS
This study presents various phenotypic presentations of patients with CPVT harboring different pathogenic variants in the gene, some of which have not previously been described in published studies. Syncope was the most prevalent symptom on admission. Adjustment of beta-blocker therapy may be necessary due to side effects. Moreover, our work further highlights the common occurrence of atrial tachyarrhythmias in these patients.
PubMed: 38202054
DOI: 10.3390/jcm13010047 -
European Heart Journal Feb 2024A rising number of countries allow physicians to treat chronic pain with medical cannabis. However, recreational cannabis use has been linked with cardiovascular side...
BACKGROUND AND AIMS
A rising number of countries allow physicians to treat chronic pain with medical cannabis. However, recreational cannabis use has been linked with cardiovascular side effects, necessitating investigations concerning the safety of prescribed medical cannabis.
METHODS
Using nationwide Danish registers, patients with chronic pain initiating first-time treatment with medical cannabis during 2018-21 were identified and matched 1:5 to corresponding control patients on age, sex, chronic pain diagnosis, and concomitant use of other pain medication. The absolute risks of first-time arrhythmia (atrial fibrillation/flutter, conduction disorders, paroxysmal tachycardias, and ventricular arrhythmias) and acute coronary syndrome were reported comparing medical cannabis use with no use.
RESULTS
Among 1.88 million patients with chronic pain (46% musculoskeletal, 11% cancer, 13% neurological, and 30% unspecified pain), 5391 patients claimed a prescription of medical cannabis [63.2% women, median age: 59 (inter-quartile range 48-70) years] and were compared with 26 941 control patients of equal sex- and age composition. Arrhythmia was observed in 42 and 107 individuals, respectively, within 180 days. Medical cannabis use was associated with an elevated risk of new-onset arrhythmia {180-day absolute risk: 0.8% [95% confidence interval (CI) 0.6%-1.1%]} compared with no use [180-day absolute risk: 0.4% (95% CI 0.3%-0.5%)]: a risk ratio of 2.07 (95% CI 1.34-2.80) and a 1-year risk ratio of 1.36 (95% CI 1.00-1.73). No significant association was found for acute coronary syndrome [180-day risk ratio: 1.20 (95% CI 0.35-2.04)].
CONCLUSIONS
In patients with chronic pain, the use of prescribed medical cannabis was associated with an elevated risk of new-onset arrhythmia compared with no use-most pronounced in the 180 days following the initiation of treatment.
Topics: Humans; Female; Middle Aged; Aged; Male; Cannabis; Medical Marijuana; Chronic Pain; Acute Coronary Syndrome; Atrial Fibrillation; Denmark
PubMed: 38200679
DOI: 10.1093/eurheartj/ehad834