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Cottle B, Schriewer K, Tiwari S, Miller D, Kaza A, Hitchcock R, Sachse FB. 3D models of the cardiac conduction system in healthy neonatal human hearts. Cardiovasc Pathol 2024; 70:107626. [PMID: 38458505 PMCID: PMC11081815 DOI: 10.1016/j.carpath.2024.107626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024] Open
Abstract
Iatrogenic damage to the cardiac conduction system (CCS) remains a significant risk during congenital heart surgery. Current surgical best practice involves using superficial anatomical landmarks to locate and avoid damaging the CCS. Prior work indicates inherent variability in the anatomy of the CCS and supporting tissues. This study introduces high-resolution, 3D models of the CCS in normal pediatric human hearts to evaluate variability in the nodes and surrounding structures. Human pediatric hearts were obtained with an average donor age of 2.7 days. A pipeline was developed to excise, section, stain, and image atrioventricular (AVN) and sinus nodal (SN) tissue regions. A convolutional neural network was trained to enable precise multi-class segmentation of whole-slide images, which were subsequently used to generate high- resolution 3D tissue models. Nodal tissue region models were created. All models (10 AVN, 8 SN) contain tissue composition of neural tissue, vasculature, and nodal tissues at micrometer resolution. We describe novel nodal anatomical variations. We found that the depth of the His bundle in females was on average 304 μm shallower than those of male patients. These models provide surgeons with insight into the heterogeneity of the nodal regions and the intricate relationships between the CCS and surrounding structures.
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Affiliation(s)
- Brian Cottle
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Karl Schriewer
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Sarthak Tiwari
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Dylan Miller
- Intermountain Health, 5121 S Cottonwood St. Murray, UT 84107, USA
| | - Aditya Kaza
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Frank B Sachse
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA.
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Liegise A, Naro L. Effectiveness of late coronary angioplasty in restoring sinus rhythm in inferior wall myocardial infarction with complete AV block. Clin Case Rep 2024; 12:e8226. [PMID: 38681043 PMCID: PMC11052682 DOI: 10.1002/ccr3.8226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/05/2023] [Indexed: 05/01/2024] Open
Abstract
An elderly gentleman presenting late with inferior wall myocardial infarction and complete heart block underwent revascularization of an occluded proximal right coronary artery more than 4 days after the onset of symptoms and recovered sinus rhythm within 48 h of the procedure. There are no clear guidelines for time to percutaneous coronary intervention (PCI) in late-presenting myocardial infarction with complete atrioventricular blocks (CAVB), and studies looking at outcomes of primary PCI in this situation appear to be scarce. The case presented here is a good example of the relevance of late PCI.
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Affiliation(s)
- Avitso Liegise
- Department of CardiologyChristian Institute of Health Sciences and Research (CIHSR)DimapurNagalandIndia
| | - Lanu Naro
- Department of CardiologyChristian Institute of Health Sciences and Research (CIHSR)DimapurNagalandIndia
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3
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Ali ZS, Bhuiyan A, Vyas P, Miranda-Arboleda AF, Tse G, Bazoukis G, Burak C, Abuzeid W, Lee S, Gupta S, Meghdadi A, Baranchuk A. PR prolongation as a predictor of atrial fibrillation onset: A state-of-the-art review. Curr Probl Cardiol 2024; 49:102469. [PMID: 38369207 DOI: 10.1016/j.cpcardiol.2024.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
First-degree atrioventricular block (1-AVB), characterized by a PR interval exceeding 200 milliseconds, has traditionally been perceived as a benign cardiac condition. Recently, this perception has been challenged by investigations that indicate a potential association between PR prolongation and an elevated risk of atrial fibrillation (AF). To consolidate these findings, we performed a comprehensive review to assess the available evidence indicating a relationship between these two conditions. We searched MEDLINE and EMBASE databases as well as manually searched references of retrieved articles. We selected 18 cohort studies/meta-analyses involving general and special populations. Consistent findings across expansive cohort studies reveal that incremental increases in the PR interval may serve as an independent risk factor for AF. However, our analyses underscore the need for further research into the association between 1-AVB, defined by a specified PR interval cutoff, and the risk of AF.
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Affiliation(s)
- Zain S Ali
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Abdullah Bhuiyan
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Purav Vyas
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Cengiz Burak
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Wael Abuzeid
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Sharen Lee
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
| | - Shyla Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amin Meghdadi
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada.
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Toprak K, Kaplangoray M, Özen K, Koyuncu İ, Taşcanov MB, Altıparmak İH, Biçer A, Demirbağ R. Disruption of the endothelial glycocalyx layer is associated with idiopathic complete atrioventricular block in the elderly population: An observational pilot study. J Investig Med 2024; 72:233-241. [PMID: 38102740 DOI: 10.1177/10815589231222239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Idiopathic atrioventricular block (iCAVB) is the most common reason for the need for a permanent pacemaker in the elderly population. The fibrotic process that occurs in the conduction system of the heart with aging is the main pathogenesis in the development of iCAVB. However, the processes that trigger the development of iCAVB in the elderly population have not been fully elucidated. In this study, we aimed to reveal the possible relationship between the endothelial glycocalyx (EG) layer and idiopathic complete atrioventricular block. A group of 68 consecutive patients who developed iCAVB and a group of 68 healthy subjects matched for age, sex, and cardiovascular risk factors were included in the study. The groups were compared for clinical, laboratory, and levels of Syndecan-1 (SDC1), an EG layer marker. In the study, SDC1 levels were found to be significantly higher in the iCAVB group compared to the control group (23.7 ± 7.5 vs 16.7 ± 5.2; p = 0.009). In multivariable regression analysis, SDC1 was determined as an independent potential predictor for iCAVB (OR: 1.200; 95% CI: 1.119-1.287; p < 0.001). In the receiver operating characteristic curve analysis, SDC1 predicted iCAVB with 74% sensitivity and 72% specificity at the best cut-off value of 18.5 ng/mL (area under the curve: 0.777; confidence interval: 0.698-0.856; p < 0.001). Disruption of the endothelial glycolic layer may be one of the main triggering factors for the process leading to iCAVB.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Mustafa Kaplangoray
- Department of Cardiology, Faculty of Medicine, Şeyh Edebali University, Bilecik, Turkey
| | - Kaya Özen
- Department of Cardiology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - İsmail Koyuncu
- Department of Clinical Biochemistry, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | | | - Asuman Biçer
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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5
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Zhao M, Gao J, Chen S, Yao S, Wang M, Wang C, Zhang S, Feng Z, Tian L, Li Y, Liu Y, Wu S, Xue H. Association Between New-Onset Type 2 Diabetes and Cardiac Conduction Diseases: A Prospective Cohort Study. J Am Heart Assoc 2023; 12:e032237. [PMID: 38063148 PMCID: PMC10863756 DOI: 10.1161/jaha.123.032237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/31/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Cardiac conduction diseases can lead to life-threatening outcomes. However, the evidence on risk factors for conduction disease that is needed to underpin prevention strategies is limited. The present study aimed to determine the association between type 2 diabetes and cardiac conduction diseases. METHODS AND RESULTS This study included 101 080 participants free of prevalent diabetes and cardiac conduction diseases at baseline from the Kailuan Study. All participants were monitored biennially until December 31, 2020. During follow-up, 14 397 participants were diagnosed as having type 2 diabetes. For each case subject, 1 control subject was randomly selected, matched for age (±1 year) and sex. The final analysis comprised 10 744 case-control pairs. Cox regression models with age as the underlying time scale were used. During a median follow-up of 5.46 years, 571 incident events occurred, including 164 atrioventricular blocks, 414 bundle-branch blocks (BBBs), 274 right BBBs, and 210 left BBBs. After adjustment for potential confounders, participants with type 2 diabetes diagnosed had greater relative risks for most outcomes relative to controls, with hazard ratios of 1.42 (95% CI, 1.18-1.67) for conduction diseases, 1.40 (95% CI, 1.00-1.96) for atrioventricular blocks, 1.43 (95% CI, 1.16-1.75) for BBBs, and 1.69 (95% CI, 1.15-2.49) for left BBBs. In contrast, no association between diabetes and right BBB was observed. CONCLUSIONS In this study, participants with type 2 diabetes are at an increased risk of cardiac conduction disease but not associated with the development of right BBB.
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Affiliation(s)
- Maoxiang Zhao
- Department of Cardiology, The First Medical CenterChinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation ArmyBeijingChina
| | - Jingli Gao
- Department of Intensive Care UnitKailuan General HospitalTangshanChina
| | - Shuohua Chen
- Department of CardiologyKailuan HospitalTangshanChina
| | - Siyu Yao
- Department of CardiologyThe Sixth Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation ArmyBeijingChina
| | - Miao Wang
- School of MedicineNankai UniversityTianjinChina
| | - Chi Wang
- Department of CardiologyThe Sixth Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation ArmyBeijingChina
| | - Sijin Zhang
- School of MedicineNankai UniversityTianjinChina
| | - Zekun Feng
- Department of CardiologyThe Sixth Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation ArmyBeijingChina
| | - Lu Tian
- School of MedicineNankai UniversityTianjinChina
| | - Yanjie Li
- School of MedicineNankai UniversityTianjinChina
| | - Yang Liu
- Department of Epidemiology and Biostatistics, School of Public HealthChina Medical UniversityShenyangLiaoningChina
| | - Shouling Wu
- Department of CardiologyKailuan HospitalTangshanChina
| | - Hao Xue
- Department of CardiologyThe Sixth Medical Center, Chinese People’s Liberation Army Hospital, Medical School of Chinese People’s Liberation ArmyBeijingChina
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Noubiap JJ, Middeldorp ME. Prevention of cardiac conduction disease: a long way to go. Eur Heart J 2023; 44:1067-1069. [PMID: 36632727 DOI: 10.1093/eurheartj/ehac752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia
- Smidt Heart Institute, Cedar-Sinai Medical Centre, Los Angeles, CA, USA
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Toprak K, Kaplangoray M, Palice A, İnanır M, Memioğlu T, Kök Z, Altıparmak İH, Toprak İH, Biçer A, Demirbağ R. Increased whole blood viscosity is associated with primary idiopathic complete atrioventricular block and poor clinical outcomes in these patients. Clin Hemorheol Microcirc 2023; 84:141-151. [PMID: 36683503 DOI: 10.3233/ch-221596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Complete atrioventricular block is most commonly caused by age-related degeneration and fibrosis in the cardiac conduction system and is called primary idiopathic complete atrioventricular (iCAVB). Although many factors affect this situation, which increases with age in the cardiac conduction system, the relationship between whole blood viscosity (WBV) and iCAVB has not been clarified until now. In this study, we aim to reveal the relationship between iCAVB and WBV. METHODS AND RESULTS 141 patients with dual-chamber permanent pacemaker implanted for iCAVB and 140 age- and sex-matched subjects were included in this study. The WBV values of the study groups were compared in both high shear rate (HSR) and low shear rate (LSR). Both WBV at HSR and WBV at LSR were significantly higher in the iCAVB group compared to the control group (16.11 [15.14-16.89] vs 14.40 [13.62-15.58]; 39.82 [17.43-55.23] vs 1.38 [-13.14-26.73]; p < 0.001, respectively). The patient population was followed up for an median of 38 months for all-cause mortality. Higher mortality rates were found in higher WBV at HSR and WBV at LSR (p < 0.001,for both). CONCLUSIONS In this study, WBV was found to be an independent predictor for iCAVB, and in these patients WBV was associated with poor clinical outcomes.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | - Ali Palice
- Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
| | - Mehmet İnanır
- Abant Izzet Baysal University, Medical Faculty, Cardiology Department, Bolu, Turkey
| | - Tolga Memioğlu
- Abant Izzet Baysal University, Medical Faculty, Cardiology Department, Bolu, Turkey
| | - Zafer Kök
- Izzet Baysal Training and Research Hospital, Bolu, Turkey
| | | | - İbrahim Halil Toprak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Asuman Biçer
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Negru AG, Vintilă AM, Crișan S, Ana Luca S, Ivănică AE, Mihăicuță Ș, Cismaru G, Popescu F, Iovanovici DC, Luca CT. The Risk of Sudden Death Associated with Symptomatic and Asymptomatic Ventricular Pre-excitation in Athletes. ROMANIAN JOURNAL OF CARDIOLOGY 2022; 32:85-92. [DOI: 10.2478/rjc-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Abstract
Sudden death (SD) in athletes is a potential avoidable dramatic scenario. When done regularly, cardiological evaluation increases the chances of diagnosing ventricular pre-excitation. Consequently, the following question arises: what is the real incidence of SD risk in athletes with Wolff-Parkinson-White (WPW) syndrome/pattern? This study included 84 consecutive patients diagnosed with WPW and was designed as a retrospective analysis of data acquired between 2011 and 2021 to answer this question. The patients were evaluated using a 12-lead electrocardiogram (ECG), echocardiography, stress test, and electrophysiological study (EPS). The SD risk linked to WPW was defined as ≥ 1 of the following: the anterograde effective refractory period (AERP) of the accessory pathway (AP) ≤ 250 ms, atrial fibrillation (AF) with the shortest RR pre-excited interval ≤ 250 ms, syncope during AF or atrioventricular reentry tachycardia. The athletes with WPW pattern (n=25) or syndrome (n=59) at risk of SD were identified and treated with radiofrequency ablation (RFA). The mean age was 19.83 (10–29) years; 66.6% were men. Seventeen athletes (n=17; 20.23%) were found with SD risk: 15 (n=15; 17.85%) in the WPW syndrome group and 2 (n=2; 2.38%) in the WPW pattern group. During the EPS, n=4 developed syncope: 1 during antidromic tachycardia and 3 during pre-excited AF. RFA was curative in 96.42% of cases. The EPS is mandatory to identify athletes with short AERP APs linked to an increased risk of SD. RFA is the intervention that settles the patients into a risk-free area, allowing resumption of sports shortly afterward.
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Affiliation(s)
- Alina Gabriela Negru
- Department of Cardiology , University of Medicine and Pharmacy “Victor Babeş” Timișoara , Eftimie Murgu Sq. no. 2 , Timișoara , Romania
- Institute of Cardiovascular Diseases , Gh. Adam 13 A , , Timișoara , Romania
| | - Ana-Maria Vintilă
- Internal Medicine and Cardiology Department, Colțea Clinical Hospital , Bucharest , Romania
- Internal Medicine Department , Carol Davila University of Medicine and Pharmacy , Bucharest , Romania
| | - Simina Crișan
- Department of Cardiology , University of Medicine and Pharmacy “Victor Babeş” Timișoara , Eftimie Murgu Sq. no. 2 , Timișoara , Romania
- Institute of Cardiovascular Diseases , Gh. Adam 13 A , , Timișoara , Romania
| | - Silvia Ana Luca
- University of Medicine and Pharmacy “Victor Babeş” Timișoara , student
| | - Adrian Emil Ivănică
- Zollernalb Klinikum Albstadt – Friedrichstr. 39 , Albstadt , Ebingen , Germany
| | - Ștefan Mihăicuță
- Department of Pulmonology , University of Medicine and Pharmacy Timișoara , Timișoara , Romania
| | - Gabriel Cismaru
- “Iuliu Hatieganu” University of Medicine and Pharmacy , 5th Department of Internal Medicine, Cardiology-Rehabilitation , Cluj-Napoca , Romania
| | - Florina Popescu
- Discipline of Occupational Health , “Victor Babeş” University of Medicine and Pharmacy Timișoara , Romania
| | - Diana-Carina Iovanovici
- Doctoral School of Biological and Biomedical Sciences , University of Oradea , Oradea , Romania , PhD student
| | - Constantin Tudor Luca
- Department of Cardiology , University of Medicine and Pharmacy “Victor Babeş” Timișoara , Eftimie Murgu Sq. no. 2 , Timișoara , Romania
- Institute of Cardiovascular Diseases , Gh. Adam 13 A , , Timișoara , Romania
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Seki A, Fishbein MC. Age-related cardiovascular changes and diseases. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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10
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Verheule S, Schotten U. Electrophysiological Consequences of Cardiac Fibrosis. Cells 2021; 10:cells10113220. [PMID: 34831442 PMCID: PMC8625398 DOI: 10.3390/cells10113220] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/27/2022] Open
Abstract
For both the atria and ventricles, fibrosis is generally recognized as one of the key determinants of conduction disturbances. By definition, fibrosis refers to an increased amount of fibrous tissue. However, fibrosis is not a singular entity. Various forms can be distinguished, that differ in distribution: replacement fibrosis, endomysial and perimysial fibrosis, and perivascular, endocardial, and epicardial fibrosis. These different forms typically result from diverging pathophysiological mechanisms and can have different consequences for conduction. The impact of fibrosis on propagation depends on exactly how the patterns of electrical connections between myocytes are altered. We will therefore first consider the normal patterns of electrical connections and their regional diversity as determinants of propagation. Subsequently, we will summarize current knowledge on how different forms of fibrosis lead to a loss of electrical connectivity in order to explain their effects on propagation and mechanisms of arrhythmogenesis, including ectopy, reentry, and alternans. Finally, we will discuss a histological quantification of fibrosis. Because of the different forms of fibrosis and their diverging effects on electrical propagation, the total amount of fibrosis is a poor indicator for the effect on conduction. Ideally, an assessment of cardiac fibrosis should exclude fibrous tissue that does not affect conduction and differentiate between the various types that do; in this article, we highlight practical solutions for histological analysis that meet these requirements.
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11
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High-grade atrioventricular block in acute coronary syndrome: Portuguese experience. J Electrocardiol 2021; 68:130-134. [PMID: 34419648 DOI: 10.1016/j.jelectrocard.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The high-grade atrioventricular block (HAVB) occurrence in acute coronary syndrome (ACS) is a potentially life-threatening complication, that demands a rapid and efficient response regarding reperfusion time and rhythm stabilization. This study aimed to analyse the rate, clinical features, therapeutic approach, complications, in-hospital mortality and follow-up of HAVB in the setting of ACS. METHODS Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry, including 32157 patients admitted for ACS between 1/10/2010-3/05/2020, classified according to the presence or absence of HAVB during the hospitalization for ACS. Comparison between the two groups was performed. Logistic regression was accomplished to assess predictors of HAVB in ACS patients. RESULTS Patients with HAVB were older, and had higher rates of females, history of stroke and neoplasia. HAVB patients presented more frequently ST-segment elevation myocardial infarction, syncope as a major symptom, higher Killip-Kimball class and multivessel disease. Furthermore, HAVB patients had more major adverse cardiac events during the hospitalization for ACS, namely heart failure complication, cardiogenic shock complication, new-onset of atrial fibrillation, ACS mechanical complication, sustained ventricular tachycardia, cardiac arrest, stroke complication and in-hospital death. Logistic regression revealed that female gender, age ≥ 75 years old, heart rate < 60 and Killip-Kimball class > I were predictors of HAVB in ACS patients. Also, HAVB patients presented higher rates of all-causes of death at 1-year follow-up (p = 0.011). CONCLUSIONS Using real-life data, patients with HAVB in the setting of ACS had a worse prognosis during hospitalization and in the short-term follow-up period.
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12
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Turan T, Kara F, Kul S, Sayın MR, Sahin S, Varol MO, Akyuz AR, Bayraktar A, Çırakoğlu ÖF, Korkmaz L. The Association Between Cardio-Ankle Vascular Index and Primary Idiopathic Complete Atrioventricular Block in an Elderly Population. Angiology 2021; 73:120-124. [PMID: 34235950 DOI: 10.1177/00033197211028780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The most common cause of complete atrioventricular block (CAVB) is age-related fibrotic degeneration and is referred to as primary idiopathic complete atrioventricular block (iCAVB). This study aims to investigate the relationship between iCAVB and arterial stiffness using the cardio-ankle vascular index (CAVI).In this study, of 205 CAVB patients, 41 patients with iCAVB implanted with a dual-chamber permanent pacemaker and 40 age- and gender-matched controls were studied. Arterial stiffness was assessed by a VaSera VS-1000 CAVI instrument. The CAVI values of patients with iCAVB were significantly higher compared with the controls (9.63 ± 1.42 vs 8.57 ± 1.12, P < .001). Idiopathic complete atrioventricular block frequency was higher among patients with abnormal CAVI values than those with borderline and normal CAVI (P = .04). In multivariate analysis, only CAVI was an independent predictor of iCAVB after adjusting for other relevant factors (odds ratio, 2.575; 95% CI [1.390-4.770]; P = .003). The present study demonstrated that CAVI, as a marker of arterial stiffness, was increased among elderly patients with iCAVB. Thus, we provide a possible additional mechanism linking easily measured CAVI with iCAVB.
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Affiliation(s)
- Turhan Turan
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Faruk Kara
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Selim Kul
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Muhammet Rasit Sayın
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Sinan Sahin
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Mustafa Oğuz Varol
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Ali Riza Akyuz
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Ali Bayraktar
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Ömer Faruk Çırakoğlu
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Levent Korkmaz
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
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Kawamura Y, Yokoyama H, Kitayama K, Miura N, Hamadate M, Nagawa D, Nozaka M, Nakata M, Nishizaki F, Hanada K, Yokota T, Yamada M, Higuma T, Tomita H. Clinical impact of complete atrioventricular block in patients with ST-segment elevation myocardial infarction. Clin Cardiol 2020; 44:91-99. [PMID: 33179796 PMCID: PMC7803372 DOI: 10.1002/clc.23510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/11/2022] Open
Abstract
Complete atrioventricular block (CAVB) is a common complication of ST-segment elevation myocardial infarction (STEMI). Although STEMI patients complicated with CAVB had a higher mortality in the thrombolytic era, little is known about the impact of CAVB on STEMI patients who underwent primary percutaneous coronary intervention (PCI). The study aimed at evaluating the clinical impact of CAVB on STEMI patients in the primary PCI era. We consecutively enrolled 1295 STEMI patients undergoing primary PCI within 24 hours from onset. Patients were divided into two groups according to the infarct location: anterior STEMI (n = 640) and nonanterior STEMI (n = 655). The outcomes were all-cause death and major adverse cardiocerebrovascular events (MACCE) with a median follow-up period of 3.8 (1.7-6.6) years. Eighty-one patients (6.3%) developed CAVB. The incidence of CAVB was lower in anterior STEMI patients than in nonanterior STEMI (1.7% vs 10.7%, p < .05). Anterior STEMI patients with CAVB had a higher incidence of all-cause deaths (82% vs 20%, p < .05) and MACCE (82% vs 25%, p < .05) than those without CAVB. Although higher incidence of all-cause deaths was found more in nonanterior STEMI patients with CAVB compared with those without CAVB (30% vs 18%, p < .05), there was no significant difference in the incidence of MACCE (24% vs 19%). Multivariate analysis showed that CAVB was an independent predictor for all-cause mortality and MACCE in anterior STEMI patients, but not in nonanterior STEMI. CAVB is rare in anterior STEMI patients, but remains a poor prognostic complication even in the primary PCI era.
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Affiliation(s)
- Yosuke Kawamura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazutaka Kitayama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naotake Miura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Misato Hamadate
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daiki Nagawa
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masashi Nozaka
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masamichi Nakata
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Fumie Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenji Hanada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takashi Yokota
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masahiro Yamada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takumi Higuma
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Xue Y, Shen J, Liu G, Zhou Q, Zhou W, Luo S. Predictors, incidence, and prognostic significance of PR interval prolongation in patients with ST-segment elevation myocardial infarction. Coron Artery Dis 2020; 31:606-612. [DOI: 10.1097/mca.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Matrix metalloproteinase 1 1 G/2 G gene polymorphism is associated with acquired atrioventricular block via linking a higher serum protein level. Sci Rep 2020; 10:9900. [PMID: 32555355 PMCID: PMC7303204 DOI: 10.1038/s41598-020-66896-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022] Open
Abstract
Limited studies are available regarding the pathophysiological mechanism of acquired atrioventricular block (AVB). Matrix metalloproteinases (MMPs) and angiotensin-converting enzyme (ACE) have been implicated in the pathogenesis of arrhythmia. However, the relationship between these molecules and acquired AVB is still unclear. One hundred and two patients with documented acquired AVB and 100 controls were studied. Gene polymorphisms of the MMP1 and ACE encoding genes were screened by the gene sequencing method or polymerase chain reaction-fragment length polymorphism assay, followed by an association study. The frequencies of the MMP1 −1607 2G2G genotype and MMP1 −1607 2 G allele were significantly higher in the AVB group than that in the controls (OR = 1.933, P = 0.027 and OR = 1.684, P = 0.012, respectively). Consistently, the level of serum MMP1 was significantly greater in acquired AVB patients than that in controls (6568.9 ± 5748.6 pg/ml vs. 4730.5 ± 3377.1 pg/ml, P = 0.019). In addition, the MMP1 2G2G genotype showed a higher MMP-1 serum level than the other genotypes (1G1G/1G2G) (7048.1 ± 5683.0 pg/ml vs. 5072.4 ± 4267.6 pg/ml, P = 0.042). MMP1 1 G/2 G gene polymorphism may contribute to determining the disease susceptibility of acquired AVB by linking the MMP serum protein level.
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Santilli RA, Giacomazzi F, Porteiro Vázquez DM, Perego M. Indications for permanent pacing in dogs and cats. J Vet Cardiol 2019; 22:20-39. [PMID: 30709617 PMCID: PMC7185536 DOI: 10.1016/j.jvc.2018.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/25/2022]
Abstract
Pacemaker implantation is considered as a standard procedure for treatment of symptomatic bradycardia in both dogs and cats. Advanced second-degree and third-degree atrioventricular blocks, sick sinus syndrome, persistent atrial standstill, and vasovagal syncope are the most common rhythm disturbances that require pacing to either alleviate clinical signs or prolong survival. Most pacemakers are implanted transvenously, using endocardial leads, but rarely epicardial leads may be necessary. To decide whether a patient is a candidate for pacing, as well as which pacing modality should be used, the clinician must have a clear understanding of the etiology, the pathophysiology, and the natural history of the most common bradyarrhythmias, as well as what result can be achieved by pacing patients with different rhythm disturbances. The goal of this review was, therefore, to describe the indications for pacing by evaluating the available evidence in both human and veterinary medicine. We described the etiology of bradyarrhythmias, clinical signs and electrocardiographic abnormalities, and the choice of pacing modality, taking into account how different choices may have different physiological consequences to selected patients. It is expected that this review will assist veterinarians in recognizing arrhythmias that may require permanent pacing and the risk-benefit of each pacing modality and its impact on outcome.
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Affiliation(s)
- R A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy; Department of Clinical Sciences, Cornell University, Ithaca, NY, USA.
| | - F Giacomazzi
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | | | - M Perego
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
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Clinical and electrophysiological characteristics of patients with paroxysmal intra-His block with narrow QRS complexes. Heart Rhythm 2018; 15:1372-1377. [DOI: 10.1016/j.hrthm.2018.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Indexed: 11/22/2022]
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Worsening atrioventricular conduction after hospital discharge in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the HORIZONS-AMI trial. Coron Artery Dis 2018. [PMID: 28644212 DOI: 10.1097/mca.0000000000000525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The chronic effects of ST-segment elevation myocardial infarction (STEMI) on the atrioventricular conduction (AVC) system have not been elucidated. This study aimed to evaluate the incidence, predictors, and outcomes of worsened AVC post-STEMI in patients treated with a primary percutaneous coronary intervention (PCI). PATIENTS AND METHODS The current analysis included patients from the HORIZONS-AMI trial who underwent primary PCI and had available ECGs. Patients with high-grade atrioventricular block or pacemaker implant at baseline were excluded. RESULTS Analysis of ECGs excluding the acute hospitalization period indicated worsened AVC in 131 patients (worsened AVC group) and stable AVC in 2833 patients (stable AVC group). Patients with worsened AVC were older, had a higher frequency of hypertension, diabetes, renal insufficiency, previous coronary artery bypass grafting, and predominant left anterior descending culprit lesions. Predictors of worsened AVC included age, hypertension, and previous history of coronary artery disease. Worsened AVC was associated with an increased rate of all-cause death and major adverse cardiac events (death, myocardial infarction, ischemic target vessel revascularization, and stroke) as well as death or reinfarction at 3 years. On multivariable analysis, worsened AVC remained an independent predictor of all-cause death (hazard ratio: 2.005, confidence interval: 1.051-3.827, P=0.0348) and major adverse cardiac events (hazard ratio 1.542, confidence interval: 1.059-2.244, P=0.0238). CONCLUSION Progression of AVC system disease in patients with STEMI treated with primary PCI is uncommon, occurs primarily in the setting of anterior myocardial infarction, and portends a high risk for death and major adverse cardiac events.
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Oxford EM, Giacomazzi FB, Moïse NS, Santilli RA. Clinical and electrocardiographic presentations of transient trifascicular block in three cats. J Vet Cardiol 2018; 20:204-212. [DOI: 10.1016/j.jvc.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
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A novel predictor of adverse outcomes after ST-elevation myocardial infarction: deterioration of atrioventricular conduction. Coron Artery Dis 2017; 28:541-542. [PMID: 28708660 DOI: 10.1097/mca.0000000000000536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Kwok CS, Rashid M, Beynon R, Barker D, Patwala A, Morley-Davies A, Satchithananda D, Nolan J, Myint PK, Buchan I, Loke YK, Mamas MA. Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis. Heart 2016; 102:672-80. [DOI: 10.1136/heartjnl-2015-308956] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/08/2016] [Indexed: 11/04/2022] Open
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22
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Seki A, Fishbein M. Age-related Cardiovascular Changes and Diseases. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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23
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Mainigi SK, Chebrolu LHB, Romero-Corral A, Mehta V, Machado RR, Konecny T, Pressman GS. Prediction of Significant Conduction Disease through Noninvasive Assessment of Cardiac Calcification. Echocardiography 2012; 29:1017-21. [DOI: 10.1111/j.1540-8175.2012.01752.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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24
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Gang UJO, Hvelplund A, Pedersen S, Iversen A, Jons C, Abildstrom SZ, Haarbo J, Jensen JS, Thomsen PEB. High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary percutaneous coronary intervention. Europace 2012; 14:1639-45. [DOI: 10.1093/europace/eus161] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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25
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Clinical significance of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction--a Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) substudy. Am Heart J 2011; 162:542-7. [PMID: 21884874 DOI: 10.1016/j.ahj.2011.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 06/05/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND High-degree atrioventricular block (HAVB) is a frequent complication in the acute stages of a myocardial infarction associated with an increased rate of mortality. However, the incidence and clinical significance of HAVB in late convalescent phases of an AMI is largely unknown. The aim of this study was to assess the incidence and prognostic value of late HAVB documented by continuous electrocardiogram (ECG) monitoring in post-AMI patients with reduced left ventricular function. METHODS The study included 286 patients from the CARISMA study with AMI and left ventricular ejection fraction of 40% or less. An insertable loop recorder was implanted 5 to 21 days after AMI for incessant arrhythmia surveillance. Furthermore, ECG documentation was supplemented by a 24-hour Holter monitoring conducted at week 6 post-AMI. The clinical significance of HAVB occurring more than 21 days after AMI was examined with respect to development of major heart failure events and major ventricular tachyarrhythmic events. RESULTS During a median follow-up of 1.9 years (interquartile range 0.9-2.0), late HAVB was documented in 30 patients. The risk of major heart failure events (hazard ratio [HR] 4.08 [1.38-12.09], P = .01) and major ventricular tachyarrhythmic events (HR = 5.41 [1.88-15.58], P = .002) were significantly increased in patients who developed late HAVB. CONCLUSION High-degree atrioventricular block documented by continuous ECG monitoring occurring more than 3 weeks after AMI is a frequent complication in post-AMI patients with left ventricular dysfunction. Furthermore, HAVB is associated with ominous prognostic implications of both potentially lethal arrhythmias and heart failure.
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26
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Cohle SD. Histopathology of the Cardiac Conduction System in the Investigation of Sudden Unexpected Death. Acad Forensic Pathol 2011. [DOI: 10.23907/2011.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
When a gross and microscopic autopsy, drug screen, and past medical history fail to yield a cause of death, the forensic pathologist may opt to study the cardiac conduction system. This paper describes the excision of the SA (sinoatrial) node and AV(atrioventricular) node-containing areas of the heart and the microscopic appearance of normal SA and AV nodes, His bundle and bundle branches. Conduction system findings that have been reported to be significant include fibromuscular hyperplasia (often mislabeled dysplasia) of the SA and AV nodes arteries, persistent fetal dispersion of the AV node and His bundle, accessory pathways, ganglionitis and neuritis near the SA node, fibrosis and fatty infiltration of the conducting tissue, AV node tumor, left-sided His bundle, and AV node fibrosis. In an otherwise normal autopsy, AV node tumors, severe fibromuscular hyperplasia of the AV node artery and AV node fibrosis are sufficient to cause death. Other findings, particularly Mahaim tracks, are competent causes of death if they correlate with premortem electrocardiographic findings. Conduction system examination, although a low-yield procedure, is a worthwhile endeavor. Care must be taken to not overestimate the significance of the findings.
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27
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Saga A, Karibe A, Otomo J, Iwabuchi K, Takahashi T, Kanno H, Kikuchi J, Keitoku M, Shinozaki T, Shimokawa H. Lamin A/C gene mutations in familial cardiomyopathy with advanced atrioventricular block and arrhythmia. TOHOKU J EXP MED 2009; 218:309-16. [PMID: 19638735 DOI: 10.1620/tjem.218.309] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lamin A and C proteins, encoded by the lamin A/C gene (LMNA), are inner nuclear membrane proteins predominantly expressed in terminally differentiated cells. Mutations in LMNA can cause various forms of cardiomyopathy with arrhythmia in an autosomal dominant manner. We collected and evaluated the clinical characteristics of unclassified familial cardiomyopathy with advanced AV block and sporadic cases with advanced AV block. Mutation in LMNA was directly screened using the cycle sequencing method in 5 probands of the familial cardiomyopathy and 60 sporadic cases with advanced AV block. In four of the five familial cases (80%), we identified four distinct mutations: two protein-truncation mutations, R225X and 815_818delinsCCAGAC, and two missense mutations, Y259H and R166P. No sporadic cases carried LMNA mutation. Left ventricular end-diastolic diameter (LVEDD) was slightly enlarged in LMNA mutant carriers (123.5 +/- 9.5%) as well as in non-carriers (125.1 +/- 13.3%), while left ventricular fractional shortening (LVFS) was preserved in LMNA mutant carriers (32.3 +/- 4.8%) and non-carriers (37.6 +/- 6.8%). In LMNA mutation carriers, the average age at onset of advanced AV block is significantly lower than that in non-carriers (43.7 +/- 9.5 vs. 65.3 +/- 13 yr., p < 0.01). Ventricular tachycardia, sudden death, and poor prognosis were observed in LMNA mutation carriers. LMNA mutation could cause familial cardiomyopathy with insignificant LV remodeling, early-age onset of advanced AV block, and lethal ventricular arrhythmia. Screening of LMNA mutation might be beneficial for risk stratification and clinical management of this type of unclassified familial cardiomyopathy.
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Affiliation(s)
- Akiko Saga
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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29
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Gulino SP. Examination of the cardiac conduction system: forensic application in cases of sudden cardiac death. Am J Forensic Med Pathol 2003; 24:227-38. [PMID: 12960658 DOI: 10.1097/01.paf.0000083453.43318.74] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Forensic pathologists may occasionally encounter cases of apparent sudden cardiac death without gross cardiac abnormality. In some of these cases, evaluation of the cardiac conduction system may reveal pathologic lesions which may act as the substrates for ventricular tachyarrhythmias and sudden death. Sample case studies are used to illustrate the suggested criteria and techniques for examination, and commonly-encountered pathologic lesions and normal variants are discussed.
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Affiliation(s)
- Sam P Gulino
- Hillsborough County Medical Examiner Department, 401 S. Morgan Street, Tampa, FL 33602, USA.
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30
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Birnbaum Y, Sclarovsky S, Herz I, Zlotikamien B, Chetrit A, Olmer L, Barbash GI. Admission clinical and electrocardiographic characteristics predicting in-hospital development of high-degree atrioventricular block in inferior wall acute myocardial infarction. Am J Cardiol 1997; 80:1134-8. [PMID: 9359538 DOI: 10.1016/s0002-9149(97)00628-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study assessed the ability of simple clinical and electrocardiographic variables routinely obtained on admission to identify patients who are at high risk of developing high-degree atrioventricular (AV) block during hospitalization in 1,336 patients with inferior wall acute myocardial infarction (AMI). Patients were classified into 2 initial electrocardiographic patterns based on the J-point to R-wave amplitude ratio: pattern 1: those with J point/R wave <0.5 and pattern 2: patients with J point/R wave > or =0.5 in > or =2 leads of the inferior leads II, III, and aVF. High-degree AV block was found in 6.7% of patients (41 of 615) with pattern 1 versus 11.8% of the patients (85 of 721) with pattern 2 on admission electrocardiogram (p = 0.0008). Multivariate logistic regression analysis revealed that the only variables found to be independently associated with high-degree AV block were female gender (odds ratio [OR] 1.48; 95% confidence interval [CI] 0.98 to 2.23; p = 0.06); Killip class on admission > or =2 (OR 2.24; CI 1.43 to 3.51; p = 0.0004); initial electrocardiographic pattern 2 versus pattern 1 (OR 1.82; CI 1.22 to 2.21; p = 0.003); and absence of abnormal Q waves on admission (OR yes vs no 0.68; CI 0.44 to 1.05; p = 0.08). A simple electrocardiographic sign (J point/R wave > or =0.5 in > or =2 leads) is a reliable predictor of the development of advanced AV block among patients receiving thrombolytic therapy for inferior wall AMI.
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Affiliation(s)
- Y Birnbaum
- Beilinson Medical Center, Petah-Tiqva, Israel
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31
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Stumpp JW, Schneider J, Bär W. Drowning of a girl with anomaly of the bundle of His and the right bundle branch. Am J Forensic Med Pathol 1997; 18:208-10. [PMID: 9185945 DOI: 10.1097/00000433-199706000-00022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report an unusual case of a 17-year-old girl who died in an filled bathtub. There were at least two attacks of unconsciousness in her premortem history. In April 1994, electrocardiography had shown an incomplete right bundle branch block. At autopsy, unspecific signs of drowning and hypoplasia of the terminal part of the atrioventricular bundle of His and the right bundle branch within the cardiac conduction system were found. There were no other obvious autopsy findings related to the sudden death of this girl. In addition, toxicologic examination for illegal drugs and alcohol was completely negative. We conclude that this might be a rare case of death because of acute decompensation of a partial hypoplastic cardiac conduction system with loss of consciousness and consequent drowning in the bathtub. This case illustrates the value of an extensive pathologic examination of the cardiac conduction system in unexpected death of young people.
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Affiliation(s)
- J W Stumpp
- Institute of Legal Medicine, University of Zürich, Switzerland
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