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Kardiologia Polska 2023The benefit derived from implantable cardioverter-defibrillators (ICD) in subjects with non-ischemic systolic HF (NICM) is less well-established.
BACKGROUND
The benefit derived from implantable cardioverter-defibrillators (ICD) in subjects with non-ischemic systolic HF (NICM) is less well-established.
AIM
The study aimed to determine the incidence, predictors, and prognostic impact of ventricular arrhythmias in patients with ICD and NICM.
METHODS
The study sample included 377 consecutive patients with ICD or cardiac resynchronization cardioverter-defibrillators (CRT-D, 74% of patients) and NICM implanted and monitored remotely in a university hospital.
RESULTS
During the median (interquartile range [IQR]) follow-up of 1645 (960-2675) days, sustained ventricular arrhythmia occurred in 92 patients (24.4%). Of those, ventricular fibrillation (VF), ventricular tachycardia (VT), and both VT and VF occurred in 10 (10.9%), 72 (78.3%), and 10 (10.9%) patients, respectively. Patients with vs. those without ventricular arrhythmia differed concerning sex, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), post-inflammatory etiology, atrial fibrillation/flutter occurrence, and supraventricular arrhythmia (SVT) other than AF/AFL during follow-up. In multivariable Cox regression, LVEDD (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.003-1.09; P = 0.03), AF/AFL (HR, 1.86; 95% CI, 1.21-2.85; P = 0.004), and SVT (HR, 1.77; 95% CI, 1.10-2.87; P = 0.02) were independent predictors of sustained VT, while AF/AFL (HR, 1.65; 95% CI, 1.07-2.56; P = 0.02) was independent predictor of VF. All-cause mortality in patients with VT/VF was significantly higher than in subjects without sustained ventricular arrhythmias (35.9% vs. 22.4%; P = 0.01).
CONCLUSIONS
Ventricular arrhythmia occurred in every fourth patient with NICM and ICD during 4.5 years of observation and was associated with significantly worse prognosis than in subjects free of VT/VF. Higher LVEDD, atrial fibrillation/atrial flutter, and supraventricular tachycardia flag patients at risk of ventricular arrhythmia.
Topics: Humans; Atrial Fibrillation; Heart Failure, Systolic; Stroke Volume; Defibrillators, Implantable; Ventricular Function, Left; Tachycardia, Ventricular; Ventricular Fibrillation; Risk Factors; Follow-Up Studies; Heart Failure
PubMed: 37936556
DOI: 10.33963/v.kp.97000 -
Journal of Medicine and Life Sep 2022Left ventricular hypertrophy (LVH) caused by high blood pressure is linked to increased mortality and arrhythmia risk. This study aimed to evaluate arrhythmia in...
Left ventricular hypertrophy (LVH) caused by high blood pressure is linked to increased mortality and arrhythmia risk. This study aimed to evaluate arrhythmia in hypertensive patients due to left ventricular hypertrophy (LVH). A cross-sectional study was performed, assessing participants' blood pressure, echocardiography and electrocardiography, and Holter monitoring in certain cases. There were 300 hypertensive patients >18 years attending the cardiology unit of Baghdad medical city. The study was conducted between January-June 2022. The electrocardiograms at rest for 300 adults with hypertension were investigated. 130 (43.5%) were females, and 170 (56.5%) were males. The mean age of participants was 58 years. Forty-nine (16.3%) patients had arrhythmia. As compared to those without arrhythmia, participants with arrhythmia were older (62.3 . 56.1, p=0.03), had a greater prevalence of left ventricular hypertrophy (24.5% . 12.7%, p=0.026), and more prone to experience cardiac failure (32.7% . 8.5%, p<0.011). Atrial fibrillation was found in 6 (27.2%) female patients and 5 (18.5%) males. In addition, two (7.4%) male patients and one female patient (4.5%) had atrial flutter, and premature ventricular contractions (PVCs) were noted in 10 (37%) and 11 (50%) patients. Left ventricular mass index (LVMI) was 103 gm/m in female patients and 119.2 gm/m in males. Palpitation was present in 22 (44.9%) female patients and 27 (55.1%) males. The study revealed that hypertensives with LVH have an arrhythmia frequency of 16.3%. The most common arrhythmias were atrial fibrillation and premature ventricular complex.
Topics: Adult; Humans; Male; Female; Middle Aged; Hypertrophy, Left Ventricular; Atrial Fibrillation; Cross-Sectional Studies; Iraq; Hypertension
PubMed: 36415521
DOI: 10.25122/jml-2022-0214 -
World Journal of Cardiology Jun 2020Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common...
BACKGROUND
Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common during cardiac catheterization, and there are risks of developing serious and potentially life-threatening arrhythmias, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and high-grade conduction disturbances such as complete heart block (CHB), requiring immediate interventions. However, there is lack of systematic overview of these conditions.
AIM
To systematically review existing literature and gain better understanding of the incidence of cardiac arrhythmias during cardiac catheterization, and their impact on outcomes, as well as potential approaches to minimize this risk.
METHODS
We applied a combination of terms potentially used in reports describing various cardiac arrhythmias during common cardiac catheterization procedures to systematically search PubMed, EMBASE and Cochrane databases, as well as references of full-length articles.
RESULTS
During right heart catheterization (RHC), the incidence of atrial arrhythmias (premature atrial complexes, atrial fibrillation and flutter) was low (< 1%); these arrhythmias were usually transient and self-limited. RHC associated with the development of a new RBBB at a rate of 0.1%-0.3% in individuals with normal conduction system but up to 6.3% in individuals with pre-existing left bundle branch block. These patients may require temporary pacing due to transient CHB. Isolated premature ventricular complexes or non-sustained VT are common during RHC (up to 20% of cases). Sustained ventricular arrhythmias (VT and/or VF) requiring either withdrawal of catheter or cardioversion occurred infrequently (1%-1.3%). During left heart catheterizations (LHC), the incidence of ventricular arrhythmias has declined significantly over the last few decades, from 1.1% historically to 0.1% currently. The overall reported rate of VT/VF in diagnostic LHC and coronary angiography is 0.8%. The risk of VT/VF was higher during percutaneous coronary interventions for stable coronary artery disease (1.1%) and even higher for patients with acute myocardial infarctions (4.1%-4.3%). Intravenous adenosine and papaverine bolus for fractional flow reserve measurement, as well as intracoronary imaging using optical coherence tomography have been reported to induce VF. Although uncommon, LHC and coronary angiography were also reported to induce conduction disturbances including CHB.
CONCLUSION
Cardiac arrhythmias are common and potentially serious complications of cardiac catheterization procedures, and it demands constant vigilance and readiness to intervene during procedures.
PubMed: 32774779
DOI: 10.4330/wjc.v12.i6.269 -
Journal of the American College of... Jun 1985Sudden death may occur in children with supraventricular arrhythmias. Sick sinus syndrome, particularly if associated with tachycardia, may result in sudden death in... (Review)
Review
Sudden death may occur in children with supraventricular arrhythmias. Sick sinus syndrome, particularly if associated with tachycardia, may result in sudden death in children who have had open heart surgery and rarely in children with a normal heart. Children with supraventricular tachycardia rarely die. Only those with junctional automatic tachycardia or Wolff-Parkinson-White syndrome have died. Patients with a short anterograde refractory period may be at risk of sudden death. Surgical division of the accessory connection can prevent sudden death. Digitalis may accelerate atrioventricular (AV) conduction in patients with Wolff-Parkinson-White syndrome and, thus, should be used only after testing in the electrophysiology laboratory. Sudden death due to complete AV block should be preventable using pacemakers. Neonates with a ventricular rate less than 55 beats/min or children with a rate less than 45 beats/min should receive pacemaker therapy because of the statistical probability of death or syncope. Ventricular ectopic beats, particularly if frequent or multiform, may be an indication for pacemaker insertion. Patients with surgical complete AV block that persists for more than 7 to 10 days should receive physiologic pacemakers for the prevention of sudden death and hemodynamic benefit.
Topics: Adolescent; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Atrioventricular Node; Cardiac Pacing, Artificial; Cardiac Surgical Procedures; Child; Death, Sudden; Digitalis Glycosides; Electrocardiography; Heart Atria; Heart Block; Humans; Infant; Male; Sick Sinus Syndrome; Tachycardia; Wolff-Parkinson-White Syndrome
PubMed: 3889104
DOI: 10.1016/s0735-1097(85)80541-6 -
The American Journal of Case Reports May 2021BACKGROUND Tachycardia from atrial fibrillation or flutter can lead to left ventricular systolic dysfunction. Some patients deteriorate quickly, and there is an acute...
BACKGROUND Tachycardia from atrial fibrillation or flutter can lead to left ventricular systolic dysfunction. Some patients deteriorate quickly, and there is an acute drop in their left ventricular systolic function; however, they tend to normalize rapidly after treatment of the underlying arrhythmia. The aim of publishing the present case is to maintain awareness that tachycardia is one of the etiologies of acute systolic heart failure, which is potentially reversible by treatment when recognized. CASE REPORT An 88-year-old woman with a history of hypertension and diabetes presented to the emergency department with shortness of breath and new-onset atrial fibrillation. The physical examination revealed jugular vein distention, an irregular heart rate of approximately 140 beats/min, bilateral basal lung crackles, and no murmurs. One week before this presentation, she underwent electrocardiography, which showed she was in sinus rhythm, and transthoracic echocardiography, which indicated an ejection fraction of 65%. After hospital admission, she was started on beta-blockers for heart rate control and diuretics for heart failure management. As her symptoms persisted, she underwent a transesophageal echocardiography-guided cardioversion, where her ejection fraction was 30%. A repeat transthoracic echocardiography 3 days after the cardioversion indicated the ejection fraction had normalized to 60%. She was followed up every month in the Outpatient Cardiology Clinic and has remained asymptomatic for 1 year to date. CONCLUSIONS Although most literature describes tachycardia-induced cardiomyopathy as a chronic process, it can be acute. Patients benefit from rhythm control, and with early diagnosis and appropriate management, the prognosis is good.
Topics: Aged, 80 and over; Atrial Fibrillation; Cardiomyopathies; Female; Heart Failure; Humans; Tachycardia; Ventricular Function, Left
PubMed: 33970894
DOI: 10.12659/AJCR.930732 -
Medicina (Kaunas, Lithuania) 2004Despite the appearance in clinical practice of modern treatment modes as thrombolysis and percutaneous coronary intervention, in-hospital mortality from acute myocardial... (Comparative Study)
Comparative Study Review
Despite the appearance in clinical practice of modern treatment modes as thrombolysis and percutaneous coronary intervention, in-hospital mortality from acute myocardial infarction remains an important problem. In this paper we review recently published data concerning risk stratification in the acute phase of myocardial infarction, different factors affecting the prognosis, their dynamics in the course of the disease, and inter-factor relations. We emphasize the prognostic value of three factors: heart rate variability, left ventricular dysfunction and arrhythmias. Changes in heart rate variability are discussed in association to location of myocardial infarction, patency of infarct-related artery, the chosen treatment mode and its timing. Left ventricular diastolic function and right ventricular function are shown to be predictors of morbidity and mortality after myocardial infarction besides left ventricular systolic function. We also present the latest data concerning the prognostic implication of arrhythmias, their relation to left ventricular function and autonomic nervous system balance. Atrial fibrillation and atrial flutter appear to be important factors in predicting mortality after myocardial infarction, especially in the elderly, as well as ventricular arrhythmias - sustained ventricular tachycardia and ventricular fibrillation.
Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Diastole; Electrocardiography; Heart Rate; Hospital Mortality; Humans; Myocardial Infarction; Prognosis; Risk Assessment; Risk Factors; Systole; Tachycardia, Ventricular; Time Factors; Ventricular Dysfunction, Left; Ventricular Fibrillation; Ventricular Function, Left; Ventricular Function, Right
PubMed: 15007270
DOI: No ID Found -
North American Journal of Medical... Apr 2016Heart failure is a common condition that that leads to hospitalization. It is associated with various atrial and ventricular arrhythmias.
BACKGROUND
Heart failure is a common condition that that leads to hospitalization. It is associated with various atrial and ventricular arrhythmias.
AIM
The aim of this study is to find common arrhythmias and electrocardiographic changes in hospitalized patients who have systolic heart failure.
MATERIALS AND METHODS
This is a retrospective study of medical records, and electrocardiograms (EKGs) of 157 patients admitted to our hospital who had systolic heart failure with ejection fraction (EF) <50% on echocardiogram. Based on EF, the patients were divided into two groups; one with EF ≤ 35% and the other with EF > 35%. Twelve-lead EKG of these patients was studied to identify common arrhythmia and demographic variables; laboratory results were compared to identify the differences.
RESULTS
A total of 157 patients with systolic heart failure, 63.7% had an EF ≤ 35%. Hypertension 82.8%, diabetes 49%, coronary artery disease 40.8%, chronic obstructive pulmonary disease or bronchial asthma 22.3%, and stroke 12.1% were common associated co-morbidities. On analysis of EKG, 28.6% had tachycardia, 21.9% had prolonged PR > 200 ms, 16.3% had wide QRS > 120 ms, 70.7% had prolonged corrected QT (QTc), and 42.2% had left axis deviation. The most common arrhythmias were sinus tachycardia and atrial fibrillation/flutter which were found in 14.6% and 13.4%, respectively. The left ventricular hypertrophy was a common abnormality found in 22.4% followed by ventricular premature contractions 18.4%, atrial premature contractions 9.5%, and left bundle branch block 6.1%. Patients with severe systolic heart failure had prolonged QRS (P = 0.02) and prolonged QTc (P = 0.01) as compared to the other group.
CONCLUSIONS
Sinus tachycardia and atrial fibrillation/flutter were common arrhythmias in patients with systolic heart failure. Patients with severe systolic heart failure had statistically significant prolongation of the QRS duration and QTc interval.
PubMed: 27213140
DOI: 10.4103/1947-2714.179931 -
The American Journal of Medicine Dec 2010Due to the growing awareness of exercise-related arrhythmias and improved sensitivity of diagnostic modalities, physicians are increasingly faced with choices that may... (Review)
Review
Due to the growing awareness of exercise-related arrhythmias and improved sensitivity of diagnostic modalities, physicians are increasingly faced with choices that may have life-changing impact for the athlete. This article surveys recent research and expert opinion addressing benign and pathogenic cardiac changes underlying arrhythmias in athletes.
Topics: Arrhythmias, Cardiac; Arrhythmogenic Right Ventricular Dysplasia; Athletes; Atrial Fibrillation; Atrial Flutter; Brugada Syndrome; Cardiomegaly; Catecholamines; Commotio Cordis; Coronary Vessel Anomalies; Death, Sudden, Cardiac; Heart; Humans; Long QT Syndrome; Myocardium; Ventricular Fibrillation; Ventricular Premature Complexes; Wolff-Parkinson-White Syndrome
PubMed: 20870195
DOI: 10.1016/j.amjmed.2010.05.008 -
Heart Failure Reviews Jul 2023Atrial fibrillation (AF) and atrial flutter (AFL) are associated with adverse outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We... (Review)
Review
Association between sodium-glucose cotransporter-2 inhibitors and incident atrial fibrillation/atrial flutter in heart failure patients with reduced ejection fraction: a meta-analysis of randomized controlled trials.
Atrial fibrillation (AF) and atrial flutter (AFL) are associated with adverse outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We investigated the effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on the incidence of AF and/or AFL in HFrEF patients. PubMed and ClinicalTrials.gov were systematically searched until March 2022 for randomized controlled trials (RCTs) that enrolled patients with HFrEF. A total of six RCTs with 9467 patients were included (N = 4731 in the SGLT2i arms; N = 4736 in the placebo arms). Compared to placebo, SGLT2i treatment was associated with a significant reduction in the risk of AF [relative risk (RR) 0.62, 95% confidence interval CI 0.44-0.86; P = 0.005] and AF/AFL (RR 0.64, 95% CI 0.47-0.87; P = 0.004). Subgroup analysis showed that empagliflozin use resulted in a significant reduction in the risk of AF (RR 0.55, 95% CI 0.34-0.89; P = 0.01) and AF/AFL (RR 0.50, 95% CI 0.32-0.77; P = 0.002). By contrast, dapagliflozin use was not associated with a significant reduction in the risk of AF (RR 0.69, 95% CI 0.43-1.11; P = 0.12) or AF/AFL (RR 0.82, 95% CI 0.53-1.27; P = 0.38). Additionally, a "shorter" duration (< 1.5 years) of treatment with SGLT2i remained associated with a reduction in the risk of AF (< 1.5 years; RR 0.58, 95% CI 0.36-0.91; P = 0.02) and AF/AFL (< 1.5 years; RR 0.52, 95% CI 0.34-0.80; P = 0.003). In conclusion, SGLT2i therapy was associated with a significant reduction in the risk of AF and AF/AFL in patients with HFrEF. These results reinforce the value of using SGLT2i in this setting.
Topics: Humans; Atrial Fibrillation; Atrial Flutter; Treatment Outcome; Randomized Controlled Trials as Topic; Heart Failure; Ventricular Dysfunction, Left; Glucose; Sodium
PubMed: 36282460
DOI: 10.1007/s10741-022-10281-3 -
JACC. Clinical Electrophysiology May 2021The study's goal was to compare the efficacy and safety of dofetilide (DOF) versus amiodarone (AMIO) in patients with atrial fibrillation (AF).
OBJECTIVES
The study's goal was to compare the efficacy and safety of dofetilide (DOF) versus amiodarone (AMIO) in patients with atrial fibrillation (AF).
BACKGROUND
Comparative efficacy of DOF versus AMIO in patients with AF has not been well established. In addition, proarrhythmia has been a concern with DOF therapy.
METHODS
Rhythm control was attempted by using DOF in 657 consecutive patients (mean age 72 ± 9 years; 35% women) with AF (n = 528) or atrial flutter and AF (n = 129) between January 2014 and December 2018.
RESULTS
DOF was successfully initiated in 573 (87%) of 657 patients, including 510 (89%) with persistent AF and 63 (11%) with paroxysmal AF. During a mean follow-up of 19 ± 7 months, sinus rhythm was maintained in 361 (63%) of the 573 DOF-treated patients. At 12 months, patients on DOF had a similar likelihood of experiencing recurrent atrial arrhythmias compared with the 2,476 consecutive patients treated with AMIO for rhythm control during the study period (37% vs. 39%; p = 0.56). The efficacy of DOF and AMIO was also similar in specific subgroups of patients, including patients >75 years of age, with a low left ventricular ejection fraction, obesity, renal insufficiency, and prior catheter ablation for AF. Among patients with atypical atrial flutter, likelihood of recurrent atrial flutter was similar between the DOF (43 of 108 [40%]) and AMIO (211 of 555 [38%]; p = 0.69) groups.
CONCLUSIONS
When properly initiated and monitored, DOF has efficacy comparable to that of amiodarone for rhythm control in patients with AF.
Topics: Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Female; Humans; Male; Middle Aged; Phenethylamines; Stroke Volume; Sulfonamides; Ventricular Function, Left
PubMed: 33812835
DOI: 10.1016/j.jacep.2020.11.027