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Smunyahirun R, Wibowo S, Hao C. Accurate Ventricular Tachyarrhytmia Beats Detection on Low Sample Rate ECG Patch Signals Using 1D U-Net. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083620 DOI: 10.1109/embc40787.2023.10340592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ECG signals quality from mobile cardiac telemetry (MCT) wearable is much noisier than Holter or standard twelve leads ECG. Although, there are beats detection algorithms that has been shown to be accurate for MIT-BIH data, their performances degrade when applying to patches data and non sinus rhythms, especially when detecting ventricular beats on ventricular tachyarrhythmia. This paper presents a deep learning approach using convolutional neural network 1D U-net architecture as a core model, accompanied with miniature pre-processing and post-processing. The model consists of contracting path and expanding path. The contracting path is a sequence of multiple convolution layers and max pooling layers while the expanding path is a sequence of multiple convolution layers and up-convolution layers. There are internal connections between the contracting path and the expanding path to avoid gradient vanishing. The output of the model predicts beat probability map which can be converted to beat locations. Performance of the model on patch data gives 98.86% recall and 97.46% F1-score which is better than Pan-Tompkins by 2.48% and 0.33% respectively. For only ventricular beats, the recall is 95.21% which outperform Pan-Tompkins by 3.68%.
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Hu X, Fu S, Wang S. Hyperuricemia is associated with an increased prevalence of ventricular tachycardia and fibrillation in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:199. [PMID: 35473480 PMCID: PMC9044610 DOI: 10.1186/s12872-022-02635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Little is known about the association between hyperuricemia and ventricular tachycardia and fibrillation (VT/VF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods The data from a cohort of STEMI patients undergoing PPCI at our center from January 2013 to December 2018 were retrospectively analyzed. The endpoint of the study was the occurrence of VT/VF, including (1) non-sustained ventricular tachycardia (nsVT) on Holter monitoring; (2) sustained ventricular tachycardia (SVT)/VF on cardiac monitoring. Results Of the 634 patients included in the study, 147 (23.2%) of them had hyperuricemia. The occurrence of VT/VF after PPCI was significantly higher in patients with hyperuricemia (19.0 vs. 9.4%, p = 0.001) compared with those without hyperuricemia. Hyperuricemia was associated with a significantly higher risk of VF/VT (odds ratio (OR) 2.11; 95% CI 1.11–4.03; p = 0.024). The strength of this association remained statistically after adjustments for age, sex, history of hypertension, estimated glomerular filtration rate, hypersensitive C reactive protein, plasma natrium, peak troponin I, fasting glucose, B-type natriuretic peptides and VT/VF in PPCI (adjusted odds ratio 2.73; 95% CI 1.19–6.27; p = 0.018). Conclusions There is a significant association between hyperuricemia and increased prevalence of VT/VF in STEMI patients after PPCI, independently of multiple risk factors and potential confounders. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02635-4.
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Affiliation(s)
- Xianqing Hu
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China.
| | - Shenwen Fu
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China
| | - Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang Province, China
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OUP accepted manuscript. Cardiovasc Res 2022; 118:932-933. [DOI: 10.1093/cvr/cvac017] [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: 11/12/2022] Open
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Usefulness of echocardiography for predicting ventricular tachycardia detected by implantable loop recorder in syncope patients. Int J Cardiovasc Imaging 2021; 37:3157-3166. [PMID: 34050421 DOI: 10.1007/s10554-021-02295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
Ventricular tachycardia (VT) may lead to syncope and sudden cardiac death. Implantable loop recorders (ILR) are recommended in the clinical work-up of patients with unexplained syncope. Our aim was to evaluate if echocardiographic parameters assessed prior to ILR implantation in patients with unexplained syncope may aid in identifying individuals with an increased risk of VT. The present study included 288 ambulatory patients (mean age 58 ± 19 years, 51% women) with syncope (90%) and presyncope (10%) who had an ILR implanted in the diagnostic workup. All patients underwent an echocardiographic examination prior to device implantation (median 3 months [IQR 1 to 6 months]). We examined incident VT, defined as a first-time episode of VT (> 30 s) or non-sustained VT (< 30 s) detected by the ILR. During median follow-up of 2.9 years [IQR 1.3 to 3.5 years] of continuous rhythm monitoring, 36 patients (13%) were diagnosed with incident VT (n = 25 non-sustained VT, n = 11 sustained VT). In unadjusted Cox proportional hazards models, left ventricular (LV) mass index (HR: 1.04 per 1 g/m2 increase [1.00 to 1.08], P = 0.047), mean LV wall thickness (HR: 1.36 per 1 mm increase [1.08 to 1.71], P = 0.009), and global longitudinal strain (HR: 1.15 per 1% decrease [1.05 to 1.25], P = 0.002) were significantly associated with VT. After adjusting for age, sex, implantable loop recorder indication and known heart failure, the above-mentioned parameters remained significantly associated with incident VT. LV mass index, LV wall thickness, and GLS may aid in identifying patients with increased risk of incident VT among patients with syncope. Echocardiography may potentially help select patients who can benefit from ILR.
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Dyhl‐Polk A, Schou M, Vistisen KK, Sillesen A, Serup‐Hansen E, Faber J, Klausen TW, Bojesen SE, Vaage‐Nilsen M, Nielsen DL. Myocardial Ischemia Induced by 5-Fluorouracil: A Prospective Electrocardiographic and Cardiac Biomarker Study. Oncologist 2021; 26:e403-e413. [PMID: 32959474 PMCID: PMC7930422 DOI: 10.1002/onco.13536] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/04/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cardiotoxicity induced by 5-fluorouracil (5-FU) is well known but poorly understood. In this study, we undertook ECG recording (Holter) and analyses of the biomarkers troponin and copeptin in patients receiving 5-FU to increase our understanding of the cardiotoxicity. SUBJECTS, MATERIALS, AND METHODS Patients with colorectal or anal cancer that received first-time treatment with 5-FU-based chemotherapy were prospectively included. Holter recording, clinical evaluation, 12-lead electrocardiogram, and assessment of plasma concentrations of troponin I and copeptin were performed before (control) and during 5-FU treatment (intervention). RESULTS A total of 108 patients were included, 82 with colorectal and 26 with anal cancer. The proportion of patients with myocardial ischemia on Holter recording was significantly higher during the first 5-FU infusion (14.1%) than before (3.7%; p = .001). The ischemic burden per day (p = .001), the number of ST depression episodes per day (p = .003), and the total duration of ischemic episodes per day (p = .003) were higher during the first 5-FU infusion than before, as was plasma copeptin (p < .001), whereas plasma troponin I was similar (p > 0.999). Six patients (5.6%) developed acute coronary syndromes and two (1.8%) developed symptomatic arrhythmias during 5-FU treatment. CONCLUSION 5-FU infusion is associated with an increase in the number of patients with myocardial ischemia on Holter recording. According to biomarker analyses, 5-FU is associated with an increase in copeptin, but rarely with increases in cardiac troponin I. However, 5%-6% of the patients developed acute coronary syndromes during treatment with 5-FU. IMPLICATIONS FOR PRACTICE Symptomatic 5-fluorouracil (5-FU) cardiotoxicity occurs in 0.6%-19% of patients treated with this drug, but a small electrocardiographic (Holter) study has revealed silent myocardial ischemia in asymptomatic patients, suggesting a more prevalent subclinical cardiac influence. This study demonstrated a significant increase in the number of patients with myocardial ischemia on Holter recording during 5-FU treatment and an increase in ischemic burden. Cardiac biomarker analyses suggested that 5-FU infusion results in endogenous stress (increased copeptin) but rarely induces myocyte injury (no change in troponin). These findings suggest a more prevalent cardiac influence from 5-FU and that Holter recording is an important tool in the evaluation of patients with suspected cardiotoxicity from 5-FU.
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Affiliation(s)
- Anne Dyhl‐Polk
- Departments of Oncology, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
- Faculty of Health and Medical Sciences, University of CopenhagenCopenhagenDenmark
| | - Morten Schou
- Departments of Cardiology, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
- Faculty of Health and Medical Sciences, University of CopenhagenCopenhagenDenmark
| | - Kirsten K. Vistisen
- Departments of Oncology, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
| | - Anne‐Sophie Sillesen
- Departments of Cardiology, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
| | - Eva Serup‐Hansen
- Departments of Oncology, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
| | - Jens Faber
- Departments of Medicine, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
- Faculty of Health and Medical Sciences, University of CopenhagenCopenhagenDenmark
| | - Tobias W. Klausen
- Departments of Hematology, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
| | - Stig E. Bojesen
- Departments of Clinical Biochemistry, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
- Faculty of Health and Medical Sciences, University of CopenhagenCopenhagenDenmark
| | - Merete Vaage‐Nilsen
- Departments of Cardiology, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
| | - Dorte L. Nielsen
- Departments of Oncology, Herlev‐Gentofte Hospital, University of CopenhagenHerlevDenmark
- Faculty of Health and Medical Sciences, University of CopenhagenCopenhagenDenmark
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López-Patiño HG, Niño-Pulido CD, Vásquez-Trespalacios EM, Aristizábal-Aristizábal JM, Duque-Ramírez M. Disfunción diastólica y relación con arritmias: un vínculo más allá de la fibrilación auricular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Impact of Safety Warning on Domperidone Prescribing for Geriatric Patients in South Korea: Analysis of National Insurance Claim Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162985. [PMID: 31434200 PMCID: PMC6719182 DOI: 10.3390/ijerph16162985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
Domperidone is a dopamine antagonist used for the symptomatic management of nausea and vomiting. Many countries banned or add a black box warning due to an increased risk of serious adverse cardiac effects. In 2014, the Korea Ministry of Food and Drug Safety also released a safety warning to carefully consider adverse cardiac effects when prescribing domperidone. Therefore, we conducted this study to analyze the impact of the safety warning on domperidone prescribing. This study included patients 65 years or older who used national health insurance services in the years 2011 and 2016, using the national patient sample dataset in South Korea. We analyzed the characteristics of domperidone prescribing and compared on pre- and post-safety warning. Prescribing frequency of domperidone was significantly reduced from 603,962 cases in 2011 to 24,623 cases in 2016. In 2011, 53,272 (8.8%) prescriptions were for greater than 30 mg/day, whereas only 200 (0.8%) prescriptions were in 2016. The number of patients with one or more comorbidities and electrocardiogram monitoring showed positive changes after the safety warning. In conclusion, after the 2014 safety letter was issued, domperidone was more safely prescribed in various aspects in elderly patients, including frequency of prescribing, maximum daily dose, and duration of continuous prescription.
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Pedrotty DM, Kuzmenko V, Karabulut E, Sugrue AM, Livia C, Vaidya VR, McLeod CJ, Asirvatham SJ, Gatenholm P, Kapa S. Three-Dimensional Printed Biopatches With Conductive Ink Facilitate Cardiac Conduction When Applied to Disrupted Myocardium. Circ Arrhythm Electrophysiol 2019; 12:e006920. [DOI: 10.1161/circep.118.006920] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Dawn M. Pedrotty
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia (D.M.P.)
| | - Volodymyr Kuzmenko
- Department of Microtechnology (V.K.), Nanoscience and Wallenberg Wood Science Center, Chalmers University, Gothenburg, Sweden
| | - Erdem Karabulut
- Department of Chemistry and Chemical Engineering (E.K., P.G.), Nanoscience and Wallenberg Wood Science Center, Chalmers University, Gothenburg, Sweden
| | - Alan M. Sugrue
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Christopher Livia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Vaibhav R. Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Christopher J. McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Samuel J. Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Paul Gatenholm
- Department of Chemistry and Chemical Engineering (E.K., P.G.), Nanoscience and Wallenberg Wood Science Center, Chalmers University, Gothenburg, Sweden
- CELLHEAL, Blacksburg, VA (P.G.)
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
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Sudan R, Yaqoob I, Aslam K, Bhat IA, Beig JR, Alai S, Rather H, Rather F. Profile of patients presenting with sustained ventricular tachycardia in a tertiary care center. Indian Heart J 2018; 70:699-703. [PMID: 30392509 PMCID: PMC6204442 DOI: 10.1016/j.ihj.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/11/2017] [Accepted: 10/27/2017] [Indexed: 11/28/2022] Open
Abstract
Background and aim Ventricular tachycardia (VT) represents the most frequent cause of sudden cardiac death. Information on clinical characteristics, acute management and outcome of patients with sustained VT is limited in our part of world. The aim of this study was to analyze the demography, hemodynamics, ECG features, underlying disease, mode of termination and outcome of patients presenting with VT. Methods This single center cohort study represents total of 107 patients of VT enrolled over 45 months. Results Mean age was 45 years and 59 of the patients were males. Thirty three of these patients were hemodynamically unstable (31%) and 74 were stable (69%) Coronary artery disease was the most common etiological factor accounting for 39% of patients followed by non-ischemic cardiomyopathy. Determinants of hemodynamic instability were VT in course of acute myocardial infarction (8 out of fourteen) and polymorphic pattern of VT (13 out of 26). Spontaneous termination of VT occurred in seven patients, antiarrythmic drugs terminated VT in 53 of 67 patients and in remaining 45 patients VT was terminated with direct current (DC) cardioversion. Total of twenty three patients died during the hospital stay. Factors that contributed to mortality were old age, hemodynamic instability and low ejection fraction. Conclusion Ischemic heart disease remains the leading cause of VT. Hemodynamically unstable VT occurs more frequently in acute myocardial infarction and polymorphic VT. Most effective method of VT termination is DC cardioversion. Old age, hemodynamic instability and ejection fraction contribute to overall mortality in VT.
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Jong-Ming Pang B, Green MS. Epidemiology of ventricular tachyarrhythmia : Any changes in the past decades? Herzschrittmacherther Elektrophysiol 2017; 28:143-148. [PMID: 28484840 DOI: 10.1007/s00399-017-0503-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 06/07/2023]
Abstract
Ventricular tachyarrhythmias include potentially lethal episodes of sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) as well as hemodynamically tolerated ventricular ectopic activity. Sustained VT or VF may develop in the setting of acute myocardial infarction or as clinical sequelae of advanced cardiomyopathy. The incidence of these serious arrhythmias is estimated from retrospective and observational studies and registries of sudden cardiac arrest and sudden cardiac death. Over the past few decades, there has been a gradual decline in the incidence of life-threatening ventricular tachyarrhythmias which has been largely driven by upstream treatments for and prevention of coronary artery disease and its sequelae. In addition primary prevention implantable cardioverter-defibrillators (ICDs) have improved survival in patients at risk for malignant ventricular arrhythmias and sudden cardiac death. Improved understanding, and improved diagnostic and imaging methods have elucidated many of the previously classified "idiopathic" ventricular arrhythmias as inherited arrhythmic syndromes and occult cardiomyopathies. In addition, improved sensitivity and duration of ECG monitoring has allowed increased detection of ventricular ectopic activity.
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MESH Headings
- Aged
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electrocardiography
- Electrocardiography, Ambulatory
- Europe
- Humans
- Incidence
- Middle Aged
- Risk Factors
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/therapy
- United States
- Ventricular Fibrillation/diagnosis
- Ventricular Fibrillation/epidemiology
- Ventricular Fibrillation/etiology
- Ventricular Fibrillation/therapy
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Affiliation(s)
| | - Martin Stephen Green
- H-1285, University of Ottawa Heart Institute, 40 Ruskin Street, K1Y 4W7, Ottawa, ON, Canada.
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Singh JA, Cleveland J. Allopurinol and the risk of ventricular arrhythmias in the elderly: a study using US Medicare data. BMC Med 2017; 15:59. [PMID: 28327188 PMCID: PMC5361697 DOI: 10.1186/s12916-017-0816-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/10/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There are no published human studies investigating whether the use of allopurinol, the most commonly used medication for the treatment of hyperuricemia in gout, the most common type of inflammatory arthritis in adults, has any beneficial effects on ventricular electrophysiology. The objective of our study was to assess whether allopurinol use is associated with a reduction in the risk of ventricular arrhythmias (VA). METHODS We used the 5% random sample of Medicare beneficiaries from 2006-2012 to examine new allopurinol use and the risk of incident VA. Multivariable Cox regression analyses were adjusted for demographics (age, race, sex), comorbidity, cardiac medications, and conditions associated with VA. We calculated hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Of the 28,755 episodes of new allopurinol use, 2538 were associated with incident VA (8.8%). Among patients with incident VA, 54% were male, 78% were White, 75% had gout as the underlying diagnosis, and the mean Charlson-Romano comorbidity score was 4.8. The crude incidence of VA per 1,000,000 person-days declined as the duration of allopurinol use increased: 1-180 days, 151; 181 days to 2 years, 105; and > 2 years, 85. In multivariable-adjusted analyses, compared to non-use, allopurinol use was associated with lower HR of VA of 0.82 (95% CI, 0.76-0.90). Compared to allopurinol non-use, longer allopurinol use durations were significantly associated with lower multivariable-adjusted HR for VA: 1-180 days, 0.96 (95% CI, 0.85-1.08); 181 days to 2 years, 0.76 (95% CI, 0.68-0.85); and > 2 years, 0.72 (95% CI, 0.60-0.87). Multiple sensitivity analyses adjusting for cardiac conditions, anti-arrhythmic drugs and alternate definitions confirmed our findings with minimal/no attenuation of estimates. CONCLUSION Allopurinol use and use duration of more than 6 months were independently associated with a lower risk of VA. Future studies need to assess the pathophysiology of this potential benefit.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. .,University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
| | - John Cleveland
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA
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Mirza M, Strunets A, Shen WK, Jahangir A. Mechanisms of arrhythmias and conduction disorders in older adults. Clin Geriatr Med 2013; 28:555-73. [PMID: 23101571 DOI: 10.1016/j.cger.2012.08.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aging is associated with an increased prevalence of cardiac arrhythmias, which contribute to higher morbidity and mortality in the elderly. The frequency of cardiac arrhythmias, particularly atrial fibrillation and ventricular tachyarrhythmia, is projected to increase as the population ages, greatly impacting health care resource utilization. Several clinical factors associated with the risk of arrhythmias have been identified in the population, yet the molecular bases for the increased predisposition to arrhythmogenesis in the elderly are not fully understood. This review highlights the epidemiology of cardiac dysrhythmias, changes in cardiac structure and function associated with aging, and the basis for arrhythmogenesis in the elderly.
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Affiliation(s)
- Mahek Mirza
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora University of Wisconsin Medical Group, Aurora Health Care, 3033 South 27th Street, Milwaukee, WI 53215, USA
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Hatch F, Lancaster MK, Jones SA. Aging is a primary risk factor for cardiac arrhythmias: disruption of intracellular Ca2+ regulation as a key suspect. Expert Rev Cardiovasc Ther 2012; 9:1059-67. [PMID: 21878050 DOI: 10.1586/erc.11.112] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aging is an inevitable time-dependent progression associated with a functional decline of the cardiovascular system even in 'healthy' individuals. Age positively correlates with an increasing risk of cardiac problems including arrhythmias. Not only the prevalence but also the severity of arrhythmias escalates with age. The reasons for this are multifactorial but dysregulation of intracellular calcium within the heart is likely to play a key role in initiating and perpetuating these life-threatening events. We now know that several aspects of cardiac calcium regulation significantly change with advancing age - changes that could produce electrical instability. Further development of knowledge of the mechanisms underlying these changes will allow us to reduce what currently is an inevitable increase in the incidence of arrhythmias in the elderly.
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Affiliation(s)
- Fiona Hatch
- Biological Sciences and HYMS, University of Hull, Kingston-Upon-Hull, UK
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Abstract
Underlying causes of ventricular tachycardia (VT) or complex ventricular arrhythmias (VA) should be treated if possible. Antiarrhythmic drugs should not be administered to treat asymptomatic individuals with complex VA and no heart disease. Beta-blockers are the only antiarrhythmic drugs that have been documented to reduce mortality in patients with VT or complex VA. Radiofrequency catheter ablation of VT has been beneficial in treating selected patients with arrhythmogenic foci of monomorphic VT. The automatic implantable cardioverter-defibrillator (AICD) is the most effective treatment for patients with life-threatening VT or ventricular fibrillation. Patients with AICDs should be treated with biventricular pacing, not with dual-chamber rate-responsive pacing at a rate of 70/min. Patients with AICDs should also be treated with beta-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin blockers.
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Guías de Práctica Clínica del ACC/AHA/ESC 2006 sobre el manejo de pacientes con arritmias ventriculares y la prevención de la muerte cardiaca súbita.Versión resumida. Rev Esp Cardiol 2006. [DOI: 10.1157/13096582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247-346. [PMID: 16949478 DOI: 10.1016/j.jacc.2006.07.010] [Citation(s) in RCA: 867] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death—Executive Summary. Circulation 2006. [DOI: 10.1161/circulationaha.106.178104] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Myerburg RJ, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Moss AJ, Priori SG, Antman EM, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death—Executive Summary. J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e385-484. [PMID: 16935995 DOI: 10.1161/circulationaha.106.178233] [Citation(s) in RCA: 807] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Already the major cause of mortality in the United States, cardio-vascular emergencies will become increasingly prevalent in the future as the geriatric population doubles. This article discusses five cardiovascular emergencies: acute coronary syndrome, congestive heart failure, dysrythmias, aortic dissection, and ruptured abdominal aortic aneurysm. The discussion focuses on the differences in presentation, management, and outcomes that characterize each disease amongst the elderly. As a rule, the elderly have significantly worse outcomes than younger patients.
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Affiliation(s)
- Rohit Gupta
- Department of Emergency Medicine, Advocate Christ Medical Center, 4440 West 95(th) Street, Oak Lawn, IL 60453, USA.
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