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Kuntz MT, Eagle SS, Dalal A, Samouil MM, Staudt GE, Londergan BP. What an anesthesiologist should know about pediatric arrhythmias. Paediatr Anaesth 2024. [PMID: 39148245 DOI: 10.1111/pan.14980] [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: 06/04/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024]
Abstract
Identifying and treating pediatric arrhythmias is essential for pediatric anesthesiologists. Pediatric patients can present with narrow or wide complex tachycardias, though the former is more common. Patients with inherited channelopathies or cardiomyopathies are at increased risk. Since most pediatric patients present for anesthesia without a baseline electrocardiogram, the first identification of an arrhythmia may occur under general anesthesia. Supraventricular tachycardia, the most common pediatric tachyarrhythmia, represents a broad category of predominately narrow complex tachycardias. Stimulating events including intubation, vascular guidewire manipulation, and surgical stimulation can trigger episodes. Valsalva maneuvers are unreliable as treatment, making adenosine or other intravenous antiarrhythmics the preferred acute therapy. Reentrant tachycardias are the most common supraventricular tachycardia in pediatric patients, including atrioventricular reciprocating tachycardia (due to a distinct accessory pathway) and atrioventricular nodal reentrant tachycardia (due to an accessory pathway within the atrioventricular node). Patients with ventricular preexcitation, often referred to as Wolff-Parkinson-White syndrome, have a wide QRS with short PR interval, indicating antegrade conduction through the accessory pathway. These patients are at risk for sudden death if atrial fibrillation degenerates into ventricular fibrillation over a high-risk accessory pathway. Automatic tachycardias, such as atrial tachycardia and junctional ectopic tachycardia, are causes of supraventricular tachycardia in pediatric patients, the latter most typically noted after cardiac surgery. Patients with inherited arrhythmia syndromes, such as congenital long QT syndrome, are at risk of developing ventricular arrhythmias such as polymorphic ventricular tachycardia (Torsades de Pointes) which can be exacerbated by QT prolonging medications. Patients with catecholaminergic polymorphic ventricular tachycardia are at particular risk for developing bidirectional ventricular tachycardia or ventricular fibrillation during exogenous or endogenous catecholamine surges. Non-selective beta blockers are first line for most forms of long QT syndrome as well as catecholaminergic polymorphic ventricular tachycardia. Anesthesiologists should review the impact of medications on the QT interval and transmural dispersion of repolarization, to limit increasing the risk of Torsades de Pointes in patients with long QT syndrome. This review explores the key anesthetic considerations for these arrhythmias.
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Affiliation(s)
- Michael T Kuntz
- Department of Anesthesiology, Division of Pediatric Cardiac Anesthesiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Susan S Eagle
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aarti Dalal
- Department of Pediatrics, Division of Cardiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Marc M Samouil
- School of Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Genevieve E Staudt
- Associated Anesthesiology, PC, Iowa Methodist Medical Center, Des Moines, Iowa, USA
| | - Bevan P Londergan
- Department of Anesthesiology, Division of Pediatric Cardiac Anesthesiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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Sebastian SA, Sethi Y, Mathews AM, Santhosh T, Lorraine Co E, Padda I, Johal G. Cardiovascular complications during pregnancy: Advancing cardio-obstetrics. Dis Mon 2024:101780. [PMID: 38910052 DOI: 10.1016/j.disamonth.2024.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
As the incidence of cardiovascular diseases (CVDs) continues to rise among women of childbearing age, the pregnant population with pre-existing heart conditions presents a complex and heterogeneous profile. These women face varying degrees of risk concerning maternal cardiovascular, obstetric, and fetal complications. Effectively managing adverse cardiovascular events during pregnancy presents substantial clinical challenges. The uncertainties surrounding diagnostic and therapeutic approaches create a dynamic landscape with potential implications for maternal and fetal health. Cardio-obstetrics has become increasingly recognized as a vital multidisciplinary field necessitating a collaborative approach to managing cardiovascular conditions during pregnancy. In this review, we aim to provide a thorough and up-to-date examination of the existing evidence, offering a comprehensive overview of strategies and considerations in the management of cardiovascular complications during pregnancy. Special emphasis is placed on the safety assessment of diagnostic procedures and the exploration of treatment options designed to prioritize the well-being of the mother and fetus. We also explore the significance of a multidisciplinary cardio-obstetrics team in providing comprehensive care for women of childbearing age with or at risk for CVD.
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Affiliation(s)
- Sneha Annie Sebastian
- Department of Internal Medicine, Azeezia Medical College, Kollam, Kerala, India; Research Nexus, Philadelphia, United States.
| | - Yashendra Sethi
- Department of Internal Medicine, Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun, India
| | | | - Tony Santhosh
- Department of Internal Medicine, Dr. Somervell Memorial CSI Medical College, KUHS, Kerala, India
| | - Edzel Lorraine Co
- Research Nexus, Philadelphia, United States; Department of Internal Medicine, University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, USA
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Middelfart C, Tønnesen J, Zörner CR, Da Riis-Vestergaard L, Pham MHX, Pallisgaard JL, Ruwald MH, Rasmussen PV, Johannessen A, Hansen J, Worck R, Gislason G, Hansen ML. Two decades of SVT ablation in Denmark: a trend towards higher age, more comorbidity, and less prior use of antiarrhythmic and rate-limiting pharmacotherapy-a nationwide registry-based Danish study. J Interv Card Electrophysiol 2024; 67:837-846. [PMID: 38109025 PMCID: PMC11166800 DOI: 10.1007/s10840-023-01692-9] [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: 08/30/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Trends in patient selection and use of pharmacotherapy prior to catheter ablation (CA) for supraventricular tachycardia (SVT) are not well described. This study examined temporal trends in patients undergoing first-time CA for regular SVT, including atrioventricular nodal re-entry tachycardia (AVNRT), accessory pathways (APs), and ectopic atrial tachycardia (EAT) on a nationwide scale in Denmark in the period 2001-2018. METHODS AND RESULTS Using Danish Nationwide registers, 9959 patients treated with first-time CA for SVT between 2001 and 2018 were identified, of which 6023 (61%) received CA for AVNRT, 2829 (28%) for AP, and 1107 (11%) for EAT. Median age was 55, 42, and 55 in the AVNRT, APs, and EAT group, respectively. The number of patients receiving CA increased from 1195 between 2001 and 2003 to 1914 between 2016 and 2018. The percentage of patients with a CHA2DS2-VASc score ≥ 2 increased in all patient groups. The number of patients who underwent CA with no prior use of antiarrhythmic- or rate limiting medicine increased significantly, though prior use of beta-blockers increased for AVNRT patients. Use of verapamil decreased in all three SVT groups (P < 0.05). Use of amiodarone and class 1C antiarrhythmics remained low, with the highest usage among EAT patients. CONCLUSION Between 2001 and 2018, CA was increasingly performed in patients with SVT, primarily AVNRT- and EAT patients. The burden of comorbidities increased. Patients undergoing CA without prior antiarrhythmic- or rate-limiting drug therapy increased significantly. Use of beta-blockers increased and remained the most widely used drug.
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Affiliation(s)
- Charlotte Middelfart
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
| | - Jacob Tønnesen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Christopher R Zörner
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lise Da Riis-Vestergaard
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Maria Hang Xuan Pham
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Jannik Langtved Pallisgaard
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Martin H Ruwald
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Peter Vibe Rasmussen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Arne Johannessen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Jim Hansen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Rene Worck
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Copenhagen Cardiovascular Research Center, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hussen M, Woubshet K, Bacha S, Ketema W. Simple Criteria, Yet the Dearth Utilization-Antithrombotic Management Practice among Atrial Fibrillation Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia. Cardiol Res Pract 2024; 2024:6665787. [PMID: 38835499 PMCID: PMC11150045 DOI: 10.1155/2024/6665787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/05/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
Background Atrial fibrillation (AF) is associated with significant mortality and morbidity from stroke and thromboembolism. Despite the availability of effective oral anticoagulation medication, AF patients remain at a high risk of stroke if not treated properly. The purpose of this study was to evaluate antithrombotic therapy practices in patients with AF in the adult cardiac clinic at Hawassa University Comprehensive Specialized Hospital (HUCSH). Methods It was a retrospective document review study. Total charts of 119 patients who had follow-up at the adult cardiac clinic with a history of documented AF from January 1 to December 30, 2018, were included. Indicators for antithrombotic therapy based on the congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74, and sex category (female) (CHA2DS2-VASc) score were recorded. A p value of 0.05 was considered statistically significant. Data analysis was done using SPSS 23 software. Results In this study, about 55% of patients with AF were receiving the appropriate antithrombotic treatment. The patients were 48 ± 18.2 years old. Of these, 70% were women. The most frequent underlying cardiac etiology was chronic rheumatic valvular heart disease (50%), followed by cardiomyopathy (14%). In nonvalvular AF, the mean CHA2DS2VASc score was 4.0 ± 1.07. In valvular AF compared to nonvalvular AF, the need for appropriate antithrombotic therapy was substantially greater (p 0.0001). Only 8 (13.6%) of the warfarin-using patients had adequate anticoagulation. Conclusion The study's findings in regard to antithrombotic usage and maintenance of appropriate antithrombotics for stroke prevention in our patients revealed a discrepancy between recommendations and practice. Therefore, we demand that patients with AF who meet the criteria utilize antithrombotics properly to prevent stroke. Warfarin-taking patients' subpar optimum anticoagulation has to be addressed. Lastly, we advocate proper CHA2DS2-VASc score utilization for nonvalvular heart disease. A regular INR follow-up is also advised for patients who have started taking warfarin.
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Affiliation(s)
- Mubarak Hussen
- Department of Internal Medicine, College of Medicine and Health Sciences, School of Medicine, P.O. Box 1560, Hawassa, Ethiopia
- New York Internal Medicine Specialty Clinic, Hawassa, Ethiopia
| | - Kindie Woubshet
- Department of Internal Medicine, College of Medicine and Health Sciences, School of Medicine, P.O. Box 1560, Hawassa, Ethiopia
- Panacea Primary Hospital, Hawassa, Ethiopia
| | - Seifu Bacha
- Department of Internal Medicine, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Worku Ketema
- Department of Pediatrics, College of Medicine and Health Sciences, School of Medicine, P.O. Box 1560, Hawassa, Ethiopia
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Nartowicz SA, Ciepłucha A, Waśniewski M, Miechowicz I, Rajewska-Tabor J, Bartczak-Rutkowska A, Lesiak M, Pyda M, Trojnarska O. A Twenty-Year Follow-Up of Adults with Ebstein Anomaly with Special Focus on Supraventricular Arrhythmias, Supraventricular Arrhythmias and Effectiveness of Catheter Ablation in 20-Year Follow-Up of Adults with Ebstein Anomaly. J Clin Med 2024; 13:2039. [PMID: 38610805 PMCID: PMC11012800 DOI: 10.3390/jcm13072039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Ebstein anomaly (EA) is a rare congenital heart disease characterized by the apical displacement of the tricuspid leaflets, creating an enlarged functional right atrium. Supraventricular arrhythmias (SVA) are common, and catheter ablation remains challenging. SVA is considered a risk factor for sudden cardiac death in this population. Still, there are very few real-life data on the impact of SVA treated invasively or conservatively on a patient's prognosis. We aimed to analyze the incidence of SVA in adults with EA, evaluate the effectiveness of catheter ablation, and analyze the impact of SVA and catheter ablation on survival in this population. Methods and results: 71 pts (median age 53 years; range 24-84 years) with EA were evaluated retrospectively from 1988 to 2020. Forty patients (56.3%) had SVA, and eighteen of them (45.0%) required at least one catheter ablation (35 procedures in total). Indications for ablation were mostly intra-atrial reentrant tachycardia (IART) and atrioventricular reentrant tachycardia (AVRT) (14 pts [77.8% and 9 pts [50.0%], respectively. IART and AVRT coexisted in nine pts. One patient suffered from persistent atrial fibrillation. Procedural effectiveness was reported in 28 (80%) cases; over a longer follow-up (mean 12.6 ± 5.4 years), only eight (44.4%) patients were completely free from SVA after the first ablation. In total, 10 patients (14%) died due to cardiovascular events. There was no difference in survival between patients with or without SVA (p = 0.9) and between ablated and non-ablated EA individuals (p = 0.89). Conclusions: Supraventricular arrhythmia is frequent in adults with Ebstein anomaly. Patients often require more than one catheter ablation but eventually become free from arrhythmias. The imaging parameters assessed by echocardiography or cardiac magnetic resonance do not seem to be associated with ablation outcomes. The impact of supraventricular arrhythmia itself or treatment with radiofrequency ablation is questionable and should be thoroughly investigated in this population.
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Affiliation(s)
- Sonia Alicja Nartowicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Aleksandra Ciepłucha
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Michał Waśniewski
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Izabela Miechowicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
- Department of Computer Science and Statistics, Medical University of Poznan, 60-806 Poznań, Poland
| | - Justyna Rajewska-Tabor
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Agnieszka Bartczak-Rutkowska
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Małgorzata Pyda
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
| | - Olga Trojnarska
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.C.); (M.W.); (I.M.); (J.R.-T.); (M.L.); (M.P.); (O.T.)
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Vătășescu RG, Paja CS, Șuș I, Cainap S, Moisa ȘM, Cinteză EE. Wolf-Parkinson-White Syndrome: Diagnosis, Risk Assessment, and Therapy-An Update. Diagnostics (Basel) 2024; 14:296. [PMID: 38337810 PMCID: PMC10855590 DOI: 10.3390/diagnostics14030296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Wolf-Parkinson-White (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts of the world, affecting about 0.1-0.3% of the general population. Most patients with WPW syndrome have normal anatomy, but it may be associated with concomitant congenital heart disease or systemic diseases. Although many individuals are asymptomatic, during supraventricular arrhythmia episodes, they may experience severe symptoms, including syncope or even sudden cardiac death (mainly due to pre-excited atrial fibrillation over rapidly conducting AP). In addition to arrhythmia-related symptoms, for some specific locations of the APs with overt anterograde conduction, there might be a reduction in exercise capacity mediated by a reduction in LV systolic performance due to anomalous LV depolarization. Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias.
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Affiliation(s)
- Radu Gabriel Vătășescu
- Cardiology Department, Clinic Emergency Hospital, 014461 Bucharest, Romania;
- 4th Department—Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
| | | | - Ioana Șuș
- Emergency Institute for Cardiovascular Disease and Transplantation, 540136 Tirgu Mures, Romania;
| | - Simona Cainap
- 8th Department—“Mother and Child”, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400012 Cluj-Napoca, Romania;
- 2nd Pediatric Department, Clinical Children Hospital, 400177 Cluj-Napoca, Romania
| | - Ștefana María Moisa
- Department of Pediatrics, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Eliza Elena Cinteză
- 4th Department—Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Interventional Cardiology Compartment, Marie Sklodowska Curie Children Emergency Hospital, 077120 Bucharest, Romania
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Mone P, Guerra G, Verderosa S, Santulli G, Komici K. Effects of moderate caffeine intake in athletes. Eur J Intern Med 2024; 119:139-140. [PMID: 37775431 DOI: 10.1016/j.ejim.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Pasquale Mone
- University of Molise, Campobasso, Italy; Department of Medicine, Albert Einstein College of Medicine, New York, USA; Casa di Cura Privata "Montevergine", Mercogliano, Avellino, Italy.
| | - Germano Guerra
- University of Molise, Campobasso, Italy; International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
| | | | - Gaetano Santulli
- Department of Medicine, Albert Einstein College of Medicine, New York, USA; Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
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Marcus GM, Rosenthal DG, Nah G, Vittinghoff E, Fang C, Ogomori K, Joyce S, Yilmaz D, Yang V, Kessedjian T, Wilson E, Yang M, Chang K, Wall G, Olgin JE. Acute Effects of Coffee Consumption on Health among Ambulatory Adults. N Engl J Med 2023; 388:1092-1100. [PMID: 36947466 PMCID: PMC10167887 DOI: 10.1056/nejmoa2204737] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Coffee is one of the most commonly consumed beverages in the world, but the acute health effects of coffee consumption remain uncertain. METHODS We conducted a prospective, randomized, case-crossover trial to examine the effects of caffeinated coffee on cardiac ectopy and arrhythmias, daily step counts, sleep minutes, and serum glucose levels. A total of 100 adults were fitted with a continuously recording electrocardiogram device, a wrist-worn accelerometer, and a continuous glucose monitor. Participants downloaded a smartphone application to collect geolocation data. We used daily text messages, sent over a period of 14 days, to randomly instruct participants to consume caffeinated coffee or avoid caffeine. The primary outcome was the mean number of daily premature atrial contractions. Adherence to the randomization assignment was assessed with the use of real-time indicators recorded by the participants, daily surveys, reimbursements for date-stamped receipts for coffee purchases, and virtual monitoring (geofencing) of coffee-shop visits. RESULTS The mean (±SD) age of the participants was 39±13 years; 51% were women, and 51% were non-Hispanic White. Adherence to the random assignments was assessed to be high. The consumption of caffeinated coffee was associated with 58 daily premature atrial contractions as compared with 53 daily events on days when caffeine was avoided (rate ratio, 1.09; 95% confidence interval [CI], 0.98 to 1.20; P = 0.10). The consumption of caffeinated coffee as compared with no caffeine consumption was associated with 154 and 102 daily premature ventricular contractions, respectively (rate ratio, 1.51; 95% CI, 1.18 to 1.94); 10,646 and 9665 daily steps (mean difference, 1058; 95% CI, 441 to 1675); 397 and 432 minutes of nightly sleep (mean difference, 36; 95% CI, 25 to 47); and serum glucose levels of 95 mg per deciliter and 96 mg per deciliter (mean difference, -0.41; 95% CI, -5.42 to 4.60). CONCLUSIONS In this randomized trial, the consumption of caffeinated coffee did not result in significantly more daily premature atrial contractions than the avoidance of caffeine. (Funded by the University of California, San Francisco, and the National Institutes of Health; CRAVE ClinicalTrials.gov number, NCT03671759.).
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Affiliation(s)
- Gregory M Marcus
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - David G Rosenthal
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Gregory Nah
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Eric Vittinghoff
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Christina Fang
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Kelsey Ogomori
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Sean Joyce
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Defne Yilmaz
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Vivian Yang
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Tara Kessedjian
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Emily Wilson
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Michelle Yang
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Kathleen Chang
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Grace Wall
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
| | - Jeffrey E Olgin
- From the Division of Cardiology (G.M.M., G.N., E.W., M.Y., K.C., G.W., J.E.O.), the Department of Epidemiology and Biostatistics (E.V.), and the School of Medicine (K.O., S.J., V.Y.), University of California, San Francisco, San Francisco, the University of California, Irvine, School of Medicine, Irvine (C.F.); and the University of California, Berkeley, Berkeley (D.Y., T.J.)
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9
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1258] [Impact Index Per Article: 1258.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Cao Y, Liu X, Xue Z, Yin K, Ma J, Zhu W, Liu F, Luo J, Sun J. Association of Coffee Consumption With Atrial Fibrillation Risk: An Updated Dose–Response Meta-Analysis of Prospective Studies. Front Cardiovasc Med 2022; 9:894664. [PMID: 35872898 PMCID: PMC9299433 DOI: 10.3389/fcvm.2022.894664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several published studies have examined the association of coffee consumption with atrial fibrillation (AF) risk, but their findings are still controversial. Therefore, we performed a systematic review and dose–response meta-analysis of prospective studies to determine the relationship between coffee consumption and the risk of incident AF. Methods We systematically retrieved the PubMed and Embase databases until October 2021 for pertinent studies that reported the association of coffee consumption (caffeinated or decaffeinated coffee) with AF risk. A cubic spline random-effects model was used to fit the potential dose–response curve. The effect estimates were expressed as adjusted risk ratios (RRs) and 95% CIs. Results A total of 10 prospective studies (11 cohorts) involving 30,169 AF events and 723,825 participants were included. In the dose–response analysis, there was a linear inverse association between coffee intake and risk of AF although not statistically significant (Pnon–linearity = 0.25). Compared with participants with no coffee consumption, the RRs (95% CI) of AF risk estimated directly from the dose–response curve were 1.01 (0.98–1.03), 1.00 (0.97–1.04), 0.99 (0.92–1.02), 0.95 (0.89–1.01), 0.94 (0.87–1.01), 0.89 (0.79–1.02), and 0.87 (0.76–1.02) for 1–7 cups of coffee per day, respectively. One cup per day increased in coffee consumption was associated with a 2% reduced risk of AF (RR = 0.98, 95% CI: 0.97–1.00, P = 0.02). Conclusions Our evidence from this meta-analysis suggested that coffee consumption had a trend toward reducing the risk of AF in a dose–response manner. Further studies could be conducted to reinforce our findings.
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Affiliation(s)
- Yalin Cao
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhengbiao Xue
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Kang Yin
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Wengen Zhu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fuwei Liu
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
- *Correspondence: Fuwei Liu,
| | - Jun Luo
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
- Jun Luo,
| | - Junyi Sun
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Junyi Sun,
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11
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Bruce C, Saraf K, Rogers S, El-Omar M, Kirkwood G, Kelland NF, Shah D, Chalil S, Fullwood C, Wright M, Jamil-Copley S, Fox D, Abozguia K, Thachil J, McCollum C, Morris GM. Deep Vein Thrombosis is Common After Cardiac Ablation and Pre-Procedural D-Dimer Could Predict Risk. Heart Lung Circ 2022; 31:1015-1022. [PMID: 35301985 DOI: 10.1016/j.hlc.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cardiac catheter ablations are an established treatment for supraventricular tachycardia (SVT) involving prolonged cannulation of the common femoral vein with multiple catheters. This study aimed to identify the risk of deep vein thrombosis (DVT) by studying the frequency of this complication after catheter ablation. METHODS This was a prospective multi-centre cohort study of patients undergoing cardiac ablation for atrioventricular nodal re-entry tachycardia or right-sided accessory atrioventricular connection. Those taking anticoagulation or antiplatelet therapy prior to the procedure were excluded. Following the procedure, bilateral venous duplex ultrasonography from the popliteal vein to the inferior vena cava for DVT was undertaken at 24 hours and between 10 to 14 days. RESULTS Eighty (80) patients (mean age 47.6 yrs [SD 13.4] with 67% female) underwent cardiac ablation (median duration 70 mins). Seven (7) patients developed acute DVT in either the femoral or external iliac vein of the intervention leg, giving a frequency of 8.8% (95% CI 3.6-17.2%). No thrombus was seen in the contralateral leg (p=0.023). An elevated D-dimer prior to the procedure was significantly more frequent in patients developing DVT (42.9% vs 4.1%, p=0.0081; OR 17.0). No other patient or procedural characteristics significantly influenced the risk of DVT. CONCLUSION In patients without peri-procedural anticoagulation catheter ablation precipitated DVT in the catheterised femoral or iliac veins in 8.8% of patients. Peri-procedure prophylactic anticoagulation may be considered for all patients undergoing catheter ablation for SVT. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03877770.
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Affiliation(s)
- Charo Bruce
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karan Saraf
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences within the School of Medicine, University of Manchester, Manchester, UK
| | - Steven Rogers
- Independent Vascular Services Ltd, Manchester University NHS Foundation Trust, Manchester, UK
| | - Magdi El-Omar
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graeme Kirkwood
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Nicholas F Kelland
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Dinakshi Shah
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Shajil Chalil
- Clinical Cardiac Electrophysiologist at Marshall University Joan C. Edwards School of Medicine Huntington, WV, USA
| | - Catherine Fullwood
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Matthew Wright
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shahnaz Jamil-Copley
- Department of Cardiology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - David Fox
- North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Khalid Abozguia
- Clinical Cardiac Electrophysiologist at Marshall University Joan C. Edwards School of Medicine Huntington, WV, USA
| | - Jecko Thachil
- Department of Haematology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Charles McCollum
- North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK; Academic Surgery Unit, University of Manchester, Manchester, UK
| | - Gwilym M Morris
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences within the School of Medicine, University of Manchester, Manchester, UK.
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12
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2468] [Impact Index Per Article: 1234.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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13
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de Lima BA, da Silva ACG, Saffi MAL, Fröemming Junior C, Castilhos G, Kruse ML, de Lima GG, Leiria TLL. Clinical Characteristics of Patients with Tetralogy of Fallot who Underwent an Invasive Procedure for Arrhythmias. JOURNAL OF CARDIAC ARRHYTHMIAS 2021. [DOI: 10.24207/jca.v34i3.3452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that has an incidence of sudden cardiac death of 0.2% per year, being arrhythmias the main cause of its occurrence. Objective: To compare characteristics of TOF patients referred for electrophysiological study (EPS) against those that were not (No-EPS). Method: Retrospective cohort with 215 patients (57.2% men; age = 29 ± 4) with corrected TOF (median of three years, ranging from 0.33 to 51) that underwent EPS between 2009-2020. The primary outcome was composed of death, implantable cardiac defibrillator (ICD) requirement and hospitalization. Results: Pre-syncope (EPS = 4.7%, No-EPS = 0%; p = 0.004), syncope (EPS = 7.1%, No-EPS = 1.7%; p = 0.056) and palpitations (EPS = 31%, No-EPS = 5.8%; p < 0.001) were symptoms that justified electrophysiological investigation. ICD was implanted in 24% of EPS and 0.6% of No-EPS (p=0.001). Twenty-six percent of the EPS group presented non-sustained ventricular tachycardia, while 0% in No-EPS (p = 0.012). The EPS group had more atrial fibrillation or atrial Flutter (35.7% vs. 6.9%; p < 0.001). The EPS patients had a wider QRS duration than the no-EPS group (171.12 ± 29.52 ms vs. 147 ± 29.77 ms; p < 0.001). Also, 26.2% of EPS performed ablation to correct macroreentrant atrial tachycardias. The incidence of primary outcome (death + ICD requirement + hospitalization) was higher in patients in the EPS group compared to the No-EPS group (p = 0.001). However, the total of seven deaths occurred during the clinical follow-up, but without differences between the groups (EPS = 4.7% vs. No-EPS = 2.8%; p = 0.480). Conclusion: EPS group had a profile of greater risk, more complex heart disease, and a greater occurrence of the primary outcome when compared to the No-EPS group.
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14
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Kim EJ, Hoffmann TJ, Nah G, Vittinghoff E, Delling F, Marcus GM. Coffee Consumption and Incident Tachyarrhythmias: Reported Behavior, Mendelian Randomization, and Their Interactions. JAMA Intern Med 2021; 181:1185-1193. [PMID: 34279564 PMCID: PMC8290332 DOI: 10.1001/jamainternmed.2021.3616] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/23/2021] [Indexed: 12/27/2022]
Abstract
Importance The notion that caffeine increases the risk of cardiac arrhythmias is common. However, evidence that the consumption of caffeinated products increases the risk of arrhythmias remains poorly substantiated. Objective To assess the association between consumption of common caffeinated products and the risk of arrhythmias. Design, Setting, and Participants This prospective cohort study analyzed longitudinal data from the UK Biobank between January 1, 2006, and December 31, 2018. After exclusion criteria were applied, 386 258 individuals were available for analyses. Exposures Daily coffee intake and genetic polymorphisms that affect caffeine metabolism. Main Outcomes and Measures Any cardiac arrhythmia, including atrial fibrillation or flutter, supraventricular tachycardia, ventricular tachycardia, premature atrial complexes, and premature ventricular complexes. Results A total of 386 258 individuals (mean [SD] age, 56 [8] years; 52.3% female) were assessed. During a mean (SD) follow-up of 4.5 (3.1) years, 16 979 participants developed an incident arrhythmia. After adjustment for demographic characteristics, comorbid conditions, and lifestyle habits, each additional cup of habitual coffee consumed was associated with a 3% lower risk of incident arrhythmia (hazard ratio [HR], 0.97; 95% CI, 0.96-0.98; P < .001). In analyses of each arrhythmia alone, statistically significant associations exhibiting a similar magnitude were observed for atrial fibrillation and/or flutter (HR, 0.97; 95% CI, 0.96-0.98; P < .001) and supraventricular tachycardia (HR, 0.96; 95% CI, 0.94-0.99; P = .002). Two distinct interaction analyses, one using a caffeine metabolism-related polygenic score of 7 genetic polymorphisms and another restricted to CYP1A2 rs762551 alone, did not reveal any evidence of effect modification. A mendelian randomization study that used these same genetic variants revealed no significant association between underlying propensities to differing caffeine metabolism and the risk of incident arrhythmia. Conclusions and Relevance In this prospective cohort study, greater amounts of habitual coffee consumption were associated with a lower risk of arrhythmia, with no evidence that genetically mediated caffeine metabolism affected that association. Mendelian randomization failed to provide evidence that caffeine consumption was associated with arrhythmias.
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Affiliation(s)
- Eun-jeong Kim
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Thomas J. Hoffmann
- Institute for Human Genetics, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Gregory Nah
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Francesca Delling
- Division of Cardiology, University of California, San Francisco, San Francisco
| | - Gregory M. Marcus
- Division of Cardiology, University of California, San Francisco, San Francisco
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15
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Qin C, He T, Li S. Successful risk stratification of a patient with ventricular preexcitation by improved transesophageal electrophysiological study. Ann Noninvasive Electrocardiol 2021; 26:e12882. [PMID: 34291526 PMCID: PMC8411780 DOI: 10.1111/anec.12882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 12/01/2022] Open
Abstract
The patient is a 19 years‐old man who often wakes up in dreams with palpitations and fatigue. The ECG shows: 1. Sinus rhythm; 2. Preexcitation syndrome. Transesophageal electrophysiological study (TEEPS) diagnosis:High‐risk accessory pathway. During radiofrequency catheter ablation, the patient suddenly developed atrial fibrillation and quickly converted to ventricular fibrillation. After defibrillation, ventricular fibrillation is transformed into sinus rhythm. Subsequently, the patient's high‐risk accessory pathway was successfully ablated. Studies have shown that about 25% of patients with WPW syndrome have a refractory period of less than 250 ms, which is one of the risk factors for the conversion of atrial fibrillation to ventricular fibrillation. Therefore, risk stratification is recommended for these symptomatic patients. From 1980 to 1990, there were literature reports on risk stratification of patients with preexcitation syndrome by TEEPS. But it has not become a routine examination of risk stratification in patients with preexcitation syndrome.The reason may be related to the hardware conditions and risk stratification methods used at that time. The TEEPS equipment currently used in our hospital can control the pacing voltage at about 12 mv on average. The voltage in this case report is 9 mv only. In addition, we successfully stratified the risk of patient with preexcitation syndrome without inducing atrial fibrillation. All the electrophysiological records of the patient during the examination were recorded simultaneously with the 12‐lead ECG and the esophageal lead ECG. These improvements makes TEEPS a simple, safe and reliable non‐invasive cardiac electrophysiological detection technology, which is worth popularizing in hospitals.
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Affiliation(s)
- Chao Qin
- Department of ECG Diagnosis, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tao He
- Department of ECG Diagnosis, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shuo Li
- Department of ECG Diagnosis, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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16
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Anzai T, Grandinetti A, Katz AR, Hurwitz EL, Wu YY, Masaki K. Cross-ethnic comparison of the association between central sleep apnea and atrial fibrillation/flutter: The Kuakini Honolulu-Asia Aging Study and the Osteoporotic Fractures in Men (Mr.OS) study. IJC HEART & VASCULATURE 2021; 35:100834. [PMID: 34258384 PMCID: PMC8256179 DOI: 10.1016/j.ijcha.2021.100834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022]
Abstract
Introduction Few studies indicated the impact of ethnicity on an association between central sleep apnea (CSA) and atrial fibrillation/flutter (AF) in older populations. We assessed possible ethnic differences in the association among elderly Japanese-American and White-American men. Methods We performed a cross-sectional analysis using two population studies of Japanese-American and White-American men. The Kuakini Honolulu-Asia Aging Study is a longitudinal cohort study of Japanese-American men living in Hawaii. Sleep data were collected between 1999 and 2000. The Osteoporotic Fractures in Men (Mr.OS) Sleep Study was conducted between 2003 and 2005 on the continental U.S. The majority of Mr.OS participants were White-American. We selected 79-90 year old males, who had overnight polysomnography from both studies. Total participants were 690 Japanese-American and 871 White-American men. The central apnea index (CAI) was the measure of the number of central apneas. CSA was defined by CAI>=5. Cheyne-Stokes breathing (CSB) was defined as a minimum consecutive 5-10 min period of a crescendo-decrescendo respiratory pattern associated with CSA. Results The prevalence of AF was 5.7% in Japanese-American men and 9.0% in White-American men. The prevalence of CSA and CSB in White-Americans were higher than in Japanese-Americans (11.5% vs 6.5% and 5.7% vs 3.3%, respectively). In multivariable-adjusted logistic regression models, CSA was associated with higher odds of AF, and the association was stronger in Japanese-Americans [Odds Ratio (OR) = 4.77, 95% confidence interval (CI): 1.95-11.67] than in White-Americans (OR = 2.09, 95 %CI: 1.09-4.01). CSB showed similar trends as CSA. Conclusions After adjustment, CSA and CSB were significantly associated with AF in both Japanese-American and White-American men.
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Affiliation(s)
- Tagayasu Anzai
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Andrew Grandinetti
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Alan R Katz
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Eric L Hurwitz
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Yan Yan Wu
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Kamal Masaki
- University of Hawai'i at Mānoa, Department of Geriatric Medicine, John A. Burns School of Medicine, 347 N Kuakini St, Honolulu, HI, USA.,Kuakini Medical Center, 347 N Kuakini St, Honolulu, HI, USA
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17
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Xu G, Chen Z, Lin H. Efficacy and safety of the application of extensive ablation in patients with atrioventricular re-entrant tachycardia (a retrospective study). Sci Rep 2021; 11:13423. [PMID: 34183741 PMCID: PMC8239005 DOI: 10.1038/s41598-021-92935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Radiofrequency catheter ablation (RFCA) has become the standard effective therapy for supraventricular tachycardia, but the reported success rates of ablation have differed across a large number of single-center studies. The main reason for tachycardia recurrence is accessory pathway (Ap)-mediated tachycardia, and the use of the RFCA strategy may be related to recurrence. This study compared the efficacy and safety of two different RFCA strategies for Ap-mediated tachycardia. We compared patients (group M) who underwent RFCA at multiple sites to patients (group S) who underwent RFCA at a single site during the index procedure for Ap-mediated tachycardia. The efficacy and safety were assessed in the two groups. Follow-up was conducted, and the main complications and the incidence of recurrence after RFCA procedures were recorded. Eight hundred eighty-two patients with 898 Aps were enrolled in group S, and 830 patients with 843 Aps were enrolled in group M. The cumulative number of recurrences (rates) in group M and group S at the 1st, 3rd, 6th, 12th, and 24th months after ablation were 4 (0.5%) and 17 (1.9%), p < 0.05; 5 (0.6%) and 27 (3.0%), p < 0.05; 6 (0.7%) and 34 (3.8%), p < 0.05; 6 (0.7%) and 43 (4.8%), p < 0.05; and 7 (0.8%) and 45 (5.0%), p < 0.05, respectively. Complications of chest pain, overactive vasovagal reaction, steam pop, and angina pectoris were rare in both groups. One patient in group M suffered from myocardial infarction before extensive ablation. No valve damage, cardiac tamponade, or other serious adverse events occurred in either group. The extensive ablation strategy reduced the recurrence rate and the need for subsequent ablation of the Ap without increasing the risk of complications.
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Affiliation(s)
- Guangze Xu
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China.
| | - Zhikui Chen
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China
| | - Haiyan Lin
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China
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Costa G, D'Errigo P, Rosato S, Valvo R, Biancari F, Tamburino C, Cerza F, Cicala SD, Seccareccia F, Barbanti M. Long-term outcomes of self-expanding versus balloon-expandable transcatheter aortic valves: Insights from the OBSERVANT study. Catheter Cardiovasc Interv 2021; 98:1167-1176. [PMID: 33847447 DOI: 10.1002/ccd.29701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/19/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare clinical outcomes of balloon-expandable (BE) and self-expanding (SE) transcatheter aortic valves (TAVs) up to 5 years. BACKGROUND To date, no robust, comparative data of BE and SE TAVs at long-term are available. METHODS We considered a total of 1,440 patients enrolled in the multicenter OBSERVANT study and undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI) with either supra-annular SE (n = 830, 57.6%) and intra-annular BE (n = 610, 42.4%) valves. Clinical outcomes of the two groups were compared after adjustment using inverse probability of treatment weighting (IPTW) and confirmed by sensitivity analysis with propensity score matching. RESULTS Patients receiving SE valve showed a higher all-cause mortality at 5 years (Kaplan-Meier estimates 52.3% vs. 47.7%; Hazard ratio [HR] 1.18, 95% confidence interval [CI] 1.01-1.38, p = .04). Landmark analyses showed that there was a not statistically significant reversal of risk excess against the BE group starting from 3 years after TAVI (3-5 years HR 0.97, 95% CI 0.76-1.25, p = .86). Post-procedural, moderate/severe paravalvular regurgitation (PVR)(HR 1.46, 95% CI 1.14-1.87; p < .01) and acute kidney injury (AKI)(HR 3.89, 95% CI 2.47-6.38; p < .01) showed to be independent predictors of 5-year all-cause mortality in multivariable analysis. CONCLUSIONS Considering the intrinsic limitations of the OBSERVANT study, we found that patients undergoing TF-TAVI with a supra-annular SE valve had a higher all-cause mortality compared to those receiving an intra-annular BE valve at 5 years. A late catch up phenomenon of patients receiving the BE valve was observed beyond 3 years. Post-procedural moderate/severe PVR seems to play a crucial role in determining this finding. Comparative studies of new generation devices with longer follow-up are needed to evaluate the benefit of each specific TAV type.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Surgery, University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Francesco Cerza
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | | | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3090] [Impact Index Per Article: 1030.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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20
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Al Asmar M, Houssari M, Carlos El-Tallawi K, Feghali T, Refaat M, Khoury M, Abi-Saleh B. Safety of mapping in the sinus of valsalva region under intracardiac echocardiography guidance without angiography. Indian Pacing Electrophysiol J 2021; 21:141-144. [PMID: 33571656 PMCID: PMC8116810 DOI: 10.1016/j.ipej.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Radiofrequency ablation at the region of the sinus of Valsalva carries a risk to the ostia of the coronary arteries. Coronary angiography is usually utilized to document a safe distance for mapping and ablation. Objective To show that catheter ablation in the aortic root could be guided by phased-array intra cardiac echocardiography (ICE) and electro anatomic mapping without the need for coronary angiography. Methods We reviewed all patients referred to our lab that underwent mapping and/or ablation in the sinus of Valsalva region. Procedures were carried out by operators that are skilled in the use of ICE. The need for angiography was documented, also the rate of success along with the immediate and 30-day complications rate. Results Seventy patients (average age 48.7 ± 13.8 years; 64.3% males) were referred for ablation of ventricular and atrial arrhythmias. PVC constituted 95.7% of the cases. All patients underwent mapping and/or ablation at the sinus of Valsalva region without the need for coronary angiography to visualize the coronary ostia. Acute and effective ablation was achieved in 57 out of 70 (81.4%) patients partially effective ablation was achieved in 10 (14.3%) patients, and failure to ablate in the remaining 3 patients (4.3%). There was no occurrence of any adverse events, neither immediately or at day 30 after the procedure. Conclusion In the hands of experienced operators, mapping and radiofrequency ablation in the sinus of Valsalva can be safely and reliably performed using intracardiac echocardiography alone without the need for supplementary catheter coronary angiography.
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Affiliation(s)
- Mike Al Asmar
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Toufic Feghali
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan Refaat
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Maurice Khoury
- American University of Beirut Medical Center, Beirut, Lebanon
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21
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The Effect of Accessory Pathway Location on Cardiac Function in Adult Patients with Wolff-Parkinson-White Syndrome. Cardiol Res Pract 2021; 2021:8841736. [PMID: 33489357 PMCID: PMC7803398 DOI: 10.1155/2021/8841736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction The relationship between ventricular pre-excitation and left ventricular dysfunction has been described in the absence of sustained supraventricular tachycardia in a series of case reports. However, there have been no systematic studies about the effect of ventricular pre-excitation on cardiac function in adult patients with different accessory pathway locations. Methods and Results Patients were divided into four groups based on the type and location of their accessory pathway: septal, right free wall, left free wall, and concealed. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, electrocardiogram recordings, electrophysiological properties, and transthoracic echocardiographic data (septal-to-posterior wall motion delay (SPWMD) and interventricular mechanical delay (IVMD) indicating intraventricular and interventricular dyssynchrony) were compared before and after successful ablation. Before radiofrequency catheter ablation, left ventricular ejection fraction (LVEF) was significantly lower in patients with septal and right free wall accessory pathways. Within three months after radiofrequency catheter ablation, NT-proBNP levels decreased, left ventricular function improved, and intraventricular left ventricular dyssynchrony disappeared. There was a negative correlation between initial LVEF with initial QRS duration and initial SPWMD. Notably, SPWMD had a stronger correlation with LVEF than initial QRS duration. Conclusions Anterograde conduction with a septal or right free wall accessory pathway may cause left ventricular dyssynchrony and impair left ventricular function. Intraventricular left ventricular dyssynchrony seems to be responsible for the pathogenesis of left ventricular dysfunction. Radiofrequency catheter ablation results in decreased NT-proBNP levels, normalized QRS duration, mechanical resynchronization, and improved left ventricular function.
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22
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Woo SH, Trinh TN. P2 Receptors in Cardiac Myocyte Pathophysiology and Mechanotransduction. Int J Mol Sci 2020; 22:ijms22010251. [PMID: 33383710 PMCID: PMC7794727 DOI: 10.3390/ijms22010251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022] Open
Abstract
ATP is a major energy source in the mammalian cells, but it is an extracellular chemical messenger acting on P2 purinergic receptors. A line of evidence has shown that ATP is released from many different types of cells including neurons, endothelial cells, and muscle cells. In this review, we described the distribution of P2 receptor subtypes in the cardiac cells and their physiological and pathological roles in the heart. So far, the effects of external application of ATP or its analogues, and those of UTP on cardiac contractility and rhythm have been reported. In addition, specific genetic alterations and pharmacological agonists and antagonists have been adopted to discover specific roles of P2 receptor subtypes including P2X4-, P2X7-, P2Y2- and P2Y6-receptors in cardiac cells under physiological and pathological conditions. Accumulated data suggest that P2X4 receptors may play a beneficial role in cardiac muscle function, and that P2Y2- and P2Y6-receptors can induce cardiac fibrosis. Recent evidence further demonstrates P2Y1 receptor and P2X4 receptor as important mechanical signaling molecules to alter membrane potential and Ca2+ signaling in atrial myocytes and their uneven expression profile between right and left atrium.
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23
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Electrophysiological Characteristics and Outcomes of Radiofrequency Catheter Ablation of Atrial Flutter in Children with or Without Congenital Heart Disease. Pediatr Cardiol 2020; 41:1509-1514. [PMID: 32642798 DOI: 10.1007/s00246-020-02406-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
There are scarce studies on radiofrequency catheter ablation (RFCA) of atrial flutter (AFL) in the pediatric population. This study therefore aimed to investigate the clinical features and RFCA of AFL in children with or without congenital heart disease. Data from 72 consecutive children (44 males; mean age, 6.1 ± 3.8 [0.9-15.0] years; and mean weight, 23.6 ± 13.9 [8.1-72.0] kg) undergoing RFCA for AFL from 2009 to 2019 were retrospectively reviewed. Thirty-three patients had normal cardiac structure and 39 had congenital heart disease (CHD) of whom 29 had undergone surgical repair and developed AFL at a mean of 3.1 ± 2.5 years later. Fifty-nine patients (84%) presented with persistent AFL. Five patients (7%) had cardiac dysfunction with LVEF of 30-48%, which normalized after ablation. Overall, acute success rate of ablation was 99% and recurrence rate was 18% at 0.5-10 years of follow-up. No procedure-related complications were identified. All 33 patients with normal cardiac structure had cavotricuspid isthmus (CTI)-dependent AFL. Among patients who had undergone corrective surgery for CHD, 15 (52%) had CTI-dependent AFL, 4 (14%) had surgical incisional scar reentrant AFL and the remaining 10 (34%) had both CTI-dependent and scar reentrant AFL. Success rate (100% vs. 97%, P = 1.0000) and recurrence rate (21% vs. 16%, P = 0.7008) were similar between patients with and without CHD. Overall, sick sinus syndrome (SSS) was found in 42% (30/72) of patients with AFL, with an incidence of 39% (13/33) among patients with normal cardiac structure and 59% (17/29) among those who underwent surgery for congenital defects. Permanent pacemakers (PM) were implanted in 53% (16/30) of patients with SSS after ablation. RFCA therefore appeared efficacious and safe for treatment of pediatric AFL. The mechanisms underlying AFL after corrective surgery for CHD are complex, including CTI-dependent macro-reentrant, scar reentrant, or a combination of both. SSS is not rare among pediatric AFL cases, with approximately half of patients needing PM implantation.
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24
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Open-window mapping of accessory pathways utilizing high-density mapping. J Interv Card Electrophysiol 2020; 61:525-533. [DOI: 10.1007/s10840-020-00850-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
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25
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Comentarios a la guía ESC 2019 sobre taquicardia supraventricular. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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Arribas F, Brugada J, Brugada J, Almendral J, Arbelo E, Díaz Infante E, García-Cosío F, Lospitao S, Merino JL, Ormaetxe JM, Osca J, Tercedor L, Pedrote A, Andrés Lahuerta A, Barón G, Escobar C, Fiol M, Fortuny E, González Torrecilla E, Rodríguez Font E, Ruiz Granel R, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Sambola A, Vázquez R, Viana-Tejedor A, Ibáñez B, Alfonso F. Comments on the 2019 ESC guidelines on supraventricular tachycardia. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:445-451. [PMID: 32349912 DOI: 10.1016/j.rec.2019.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/18/2019] [Indexed: 06/11/2023]
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27
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Copeland H, Hayanga JA, Neyrinck A, MacDonald P, Dellgren G, Bertolotti A, Khuu T, Burrows F, Copeland JG, Gooch D, Hackmann A, Hormuth D, Kirk C, Linacre V, Lyster H, Marasco S, McGiffin D, Nair P, Rahmel A, Sasevich M, Schweiger M, Siddique A, Snyder TJ, Stansfield W, Tsui S, Orr Y, Uber P, Venkateswaran R, Kukreja J, Mulligan M. Donor heart and lung procurement: A consensus statement. J Heart Lung Transplant 2020; 39:501-517. [DOI: 10.1016/j.healun.2020.03.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/02/2023] Open
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Dufour M, Goujeau C. [Complete atrioventricular block revealed by an intermittent accessory pathway]. Ann Cardiol Angeiol (Paris) 2020; 69:151-154. [PMID: 32334778 DOI: 10.1016/j.ancard.2020.03.017] [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: 08/05/2019] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
We report the case of syncope in a 75-year-old man with known coronary artery disease following complete atrioventricular block, which became symptomatic with the loss of anterograde conduction properties of his left postero-septal accessory pathway. A double chamber pacemaker implantation was decided. There is no indication for radiofrequency ablation in the absence of reentry tachycardia and intermittent conduction. Cardiac pacing offers him an electrophysiologically interesting excitation profile with a quasi-synchronous right and left ventricular activation.
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Affiliation(s)
- M Dufour
- Cardiologie médicale et interventionnelle, clinique Saint-Augustin, 14, avenue d'Arès, 33200 Bordeaux, France.
| | - C Goujeau
- Service rythmologie, centre hospitalier de Saintonge, 11, boulevard Ambroise-Pare, 17100 Saintes, France
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29
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4832] [Impact Index Per Article: 1208.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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30
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5324] [Impact Index Per Article: 1064.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Management of paroxysmal atrial flutter that occurred in an outpatient prior to dental surgery: a case report. BMC Oral Health 2019; 19:271. [PMID: 31801491 PMCID: PMC6894332 DOI: 10.1186/s12903-019-0963-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/19/2019] [Indexed: 12/05/2022] Open
Abstract
Background It is essential to accomplish the appropriate emergency care particularly in patients undergoing stressful dento-oral surgical procedures. Atrial flutter may be induced by sympathetic hypertonia due to excessive mental and physical stress. There is no report regarding dental care in patients with atrial flutter. Herein, we describe a rare case of the antiarrhythmic management in an outpatient who presented with an electrocardiographic finding of paroxysmal atrial flutter before the initiation of the dento-oral surgical procedure. Case presentation A 60-year-old male patient was scheduled for a dental extraction. He had a history of angina pectoris, diabetes mellitus, and paroxysmal atrial fibrillation with medication. The preoperative electrocardiogram (ECG) revealed left ventricular hypertrophy and ST-T segment abnormality. Immediately before the dental extraction, II-lead ECG revealed atrial flutter; however, he complained of few subjective symptoms, such as precordial discomfort or palpitation. Observing the vital signs, ECG findings, and the general condition of the patient, low dose diltiazem was immediately administered by continuous infusion in order to control the heart rate and prevent atrial flutter-induced supraventricular tachyarrhythmia. Special attention was paid to prevent any critical cardiovascular condition under a preparation of intravenous disopyramide and verapamil and a defibrillator. The intravenous administration of diltiazem progressively restored the sinus rhythm after converting atrial flutter into atrial fibrillation, resulting in the prevention of tachycardia, and then was found to be appropriate as a prophylactic therapy of tachyarrhythmia. Conclusions The present case suggests that it is possible to successfully manage some of such patients using our method during dento-oral surgery which is likely to be associated with mental and physical stress. Therefore, it is essential to accomplish an initial emergency care in parallel to the differential diagnosis of unforeseen serious medical conditions or paroxysmal arrhythmia such as atrial flutter.
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32
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jais P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Eur Heart J 2019; 39:1442-1445. [PMID: 27856499 DOI: 10.1093/eurheartj/ehw455] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/12/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jais
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Madaffari A, Krisai P, Spies F, Knecht S, Schaer B, Kojic D, Kühne M, Sticherling C, Osswald S. Ablation of typical atrial flutter guided by the paced PR interval on the surface electrocardiogram: a proof of concept study. Europace 2019; 21:1750-1754. [PMID: 31384937 DOI: 10.1093/europace/euz208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/09/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS We aimed to assess the novel concept of using the paced PR interval (PRI) on the surface electrocardiogram (ECG) to prove trans-isthmus block after cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl). METHODS AND RESULTS Consecutive patients with AFl underwent linear radiofrequency ablation of the inferior CTI (6 o'clock). After AFl termination and/or presumed completion of the CTI line, CTI block was proven by atrial pacing by the ablation catheter medial (5 o'clock) and lateral to the line (7 and 9 o'clock). Corresponding PRIs were measured on the surface ECG. CTI block was assumed, if a sudden increase in the PRI was observed by moving the pacing site from 5 to 7 o'clock, and if the latter was longer than at 9 o'clock. Afterwards, bidirectional CTI block was confirmed by differential pacing. Thirty-one patients (mean age 67 ± 16 years, 81% male) underwent CTI ablation, and 18/31 (58%) were in AFl at the time of ablation (cycle length 249 ± 31 ms). Successful CTI block as defined by the PRI method was achieved in 31/31 (100%), and the mean PRIs during pacing at 5, 7, and 9 o'clock were 203 ± 56 ms, 329 ± 70 ms, and 296 ± 66 ms, respectively. Cavotricuspid isthmus block was confirmed in all patients (100%) by coronary sinus pacing with a reversal of the local activation sequence lateral to the isthmus line. CONCLUSION The method of PRI analysis on the surface ECG to guide CTI ablation is easy to apply and highly accurate in confirming CTI block. This simple technique enables the novel concept of CTI ablation and proof of block with a single catheter.
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Affiliation(s)
- Antonio Madaffari
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Florian Spies
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Dejan Kojic
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Morka A, Śledź J, Deutsch K, Ludwik B, Zagrodzka M, Szydłowski L, Stec S. Feasibility and performance of catheter ablation with zero-fluoroscopy approach for regular supraventricular tachycardia in patients with structural and/or congenital heart disease. Medicine (Baltimore) 2019; 98:e17333. [PMID: 31593082 PMCID: PMC6799864 DOI: 10.1097/md.0000000000017333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patients with structural heart disease (SHD) are more difficult to ablate than those with a structurally healthy heart. The reason may be technical problems. We compared periprocedural data in unselected patients (including SHD group) recruited for zero-fluoroscopy catheter ablation (ZF-CA) of supraventricular arrhythmias (SVTs).Consecutive adult patients with atrioventricular nodal reentry tachycardia (AVNRT), accessory pathways (AP), atrial flutter (AFL), and atrial tachycardia (AT) were recruited. A 3-dimensional electroanatomical mapping system (Ensite Velocity, NavX, St Jude Medical, Lake Bluff, Illinois) was used to create electroanatomical maps and navigate catheters. Fluoroscopy was used on the decision of the first operator after 5 minutes of unresolved problems.Of the 1280 patients ablated with the intention to be treated with ZF approach, 174 (13.6%) patients with SHD (age: 58.2 ± 13.6; AVNRT: 23.9%; AP: 8.5%; AFL: 61.4%; and AT: 6.2%) were recruited. These patients were compared with the 1106 patients with nonstructural heart disease (NSHD) (age: 51.4 ± 16.4; AVNRT: 58.0%; AP: 17.6%; AFL: 20.7%; and AT: 3.7% P ≤ .001). Procedural time (49.9 ± 24.6 vs 49.1 ± 23.9 minutes, P = .55) and number of applications were similar between groups (P = 0.08). The rate of conversion from ZF-CA to fluoroscopy was slightly higher in SHD as compared to NSHD (13.2% vs 7.8%, P = .02) while the total time of fluoroscopy and radiation doses were comparable in the group of SHD and NSHD (P = .55; P = .48).ZF-CA is feasible and safe in majority of patients with SHD and should be incorporated into a standard approach for SHD; however, the procedure requires sufficient experience.
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Affiliation(s)
- Aleksandra Morka
- Department of Pediatric Cardiosurgery and Cardiosurgical Intensive Care University Children's Hospital in Kraków, Jagiellonian University Medical College, Faculty of Health Sciences, Kraków
| | | | | | - Bartosz Ludwik
- Research and Development Centre in Wroclaw, Department of Cardiology, Regional Specialist Hospital, Wrocław, Poland
| | | | - Lesław Szydłowski
- Medical University of Silesia, Katowice, Poland. Department of Pediatric Cardiology
| | - Sebastian Stec
- El-Medica, EP-Network, Kielce
- MediNice Research and Development Centre, Rzeszów, Poland
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Bragança B, Nogueira-Marques S, Ferreirinha F, Fontes-Sousa AP, Correia-de-Sá P. The Ionotropic P2X4 Receptor has Unique Properties in the Heart by Mediating the Negative Chronotropic Effect of ATP While Increasing the Ventricular Inotropy. Front Pharmacol 2019; 10:1103. [PMID: 31611793 PMCID: PMC6769074 DOI: 10.3389/fphar.2019.01103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/28/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Mounting evidence indicate that reducing the sinoatrial node (SAN) activity may be a useful therapeutic strategy to control of heart failure. Purines, like ATP and its metabolite adenosine, consistently reduce the SAN spontaneous activity leading to negative cardiac chronotropy, with variable effects on the force of myocardial contraction (inotropy). Apart from adenosine A1 receptors, the human SAN expresses high levels of ATP-sensitive ionotropic P2X4 receptors (P2X4R), yet their cardiac role is unexplored. Methods: Here, we investigated the activity of P2 purinoceptors on isolated spontaneously beating atria (chronotropy) and on 2 Hz-paced right ventricular (RV, inotropy) strips from Wistar rats. Results: ATP (pEC 50 = 4.05) and its stable analogue ATPγS (pEC 50 = 4.69) concentration-dependently reduced atrial chronotropy. Inhibition of ATP breakdown into adenosine by NTPDases with POM-1 failed to modify ATP-induced negative chronotropy. The effect of ATP on atrial rate was attenuated by a broad-spectrum P2 antagonist, PPADS, as well as by 5-BDBD, which selectively blocks the P2X4R subtype; however, no effect was observed upon blocking the A1 receptor with DPCPX. The P2X4R positive allosteric modulator, ivermectin, increased the negative chronotropic response of ATP. Likewise, CTP, a P2X agonist that does not generate adenosine, replicated the P2X4R-mediated negative chronotropism of ATP. Inhibition of the Na+/Ca2+ exchanger (NCX) with KB-R7943 and ORM-10103, but not blockage of the HCN channel with ZD7288, mimicked the effect of the P2X4R blocker, 5-BDBD. In paced RV strips, ATP caused a mild negative inotropic effect, which magnitude was 2 to 3-fold increased by 5-BDBD and KB-R7943. Immunofluorescence confocal microscopy studies confirm that cardiomyocytes of the rat SAN and RV co-express P2X4R and NCX1 proteins. Conclusions: Data suggest that activation of ATP-sensitive P2X4R slows down heart rate by reducing the SAN activity while increasing the magnitude of ventricular contractions. The mechanism underlying the dual effect of ATP in the heart may involve inhibition of intracellular Ca2+-extrusion by bolstering NCX function in the reverse mode. Thus, targeting the P2X4R activation may create novel well-tolerated heart-rate lowering drugs with potential benefits in patients with deteriorated ventricular function.
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Affiliation(s)
- Bruno Bragança
- Laboratório de Farmacologia e Neurobiologia, Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal.,Hospital Pedro Hispano, ULS Matosinhos, Matosinhos, Portugal
| | - Sílvia Nogueira-Marques
- Laboratório de Farmacologia e Neurobiologia, Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Fátima Ferreirinha
- Laboratório de Farmacologia e Neurobiologia, Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Ana Patrícia Fontes-Sousa
- Laboratório de Farmacologia e Neurobiologia, Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Paulo Correia-de-Sá
- Laboratório de Farmacologia e Neurobiologia, Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
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Kasia C, Henry C, Santucci P. A case of electrolyte disturbances leading to flecainide toxicity at normal serum levels and pacemaker malfunction. HeartRhythm Case Rep 2019; 5:448-451. [PMID: 31934538 PMCID: PMC6951303 DOI: 10.1016/j.hrcr.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Christopher Kasia
- Department of Internal Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Christopher Henry
- Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Peter Santucci
- Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
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Suffredini JM, Rutland J, Akpunonu P, Baum R, Catanzaro J, Elayi CS. Flecainide Toxicity Resulting in Pacemaker Latency and Intermittent Failure to Capture. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1279-1283. [PMID: 31467262 PMCID: PMC6735620 DOI: 10.12659/ajcr.916370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patient: Female, 91 Final Diagnosis: Flecainide toxicity Symptoms: Bradycardia Medication: Flecainide Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- John M Suffredini
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Joshua Rutland
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Peter Akpunonu
- Department of Emergency Medicine, University of Kentucky, Lexington, KY, USA
| | - Regan Baum
- Department of Emergency Medicine, University of Kentucky, Lexington, KY, USA
| | - John Catanzaro
- Division of Cardiology, University of Florida - Jacksonville, Jacksonville, FL, USA
| | - Claude S Elayi
- Division of Cardiology, University of Florida - Jacksonville, Jacksonville, FL, USA
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A multicenter randomized controlled trial of a modified Valsalva maneuver for cardioversion of supraventricular tachycardias. Am J Emerg Med 2019; 38:1077-1081. [PMID: 31422858 DOI: 10.1016/j.ajem.2019.158371] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/20/2019] [Accepted: 07/25/2019] [Indexed: 12/15/2022] Open
Abstract
CLINICAL QUESTION Valsalva maneuver is a recognized treatment for supraventricular tachycardia, but in clinical setting it has a low chance to achieve successful cardioversion. Studies suggested that the postural modification of valsalva maneuver may improve the rate of cardioversion. We further modified the maneuver and conduct a multicenter randomized controlled trial to test its efficacy. RESEARCH IN CONTEXT Appelboam A, Reuben A, Mann C, et al. Postural modification of the standard Valsalva maneuver for emergency treatment for supraventricular tachycardias (REVERT): a randomized controlled trial. Lancet 2015; 386 (10005):1747-53 [1]. Allison Michaud, PhD, Eddy Lang. Leg lift Valsalva maneuver for treatment of supraventricular tachycardias. CJEM 2017; 19(3):235-237 [2]. OBJECTIVE To verify the efficacy of the modified Valsalva maneuver in SVT in Chinese population and simplify the operation process further.
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Hu J, Yu J, Chen Q, Hu J, Huang Q, Xia Z, Xia Z, Ju Z, Yuan P, Fan S, Xiong Q, Zhu B, Huang L, You C, Bao H, Wu Y, Cheng X, Li J, Marian AJ, Hong K. Efficacy of Nifekalant in Patients With Wolff-Parkinson-White Syndrome and Atrial Fibrillation: Electrophysiological and Clinical Findings. J Am Heart Assoc 2019; 8:e012511. [PMID: 31234695 PMCID: PMC6662361 DOI: 10.1161/jaha.119.012511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The efficacy of nifekalant in preexcited atrial fibrillation (AF) has not been assessed. Methods and Results The study populations consisted of patients with sustained preexcited AF (n=51), paroxysmal supraventricular tachycardia (n=201), and persistent AF (n=87). Effects of intravenous infusion of nifekalant were assessed on electrophysiological and clinical parameters. Nifekalant prolonged the shortest preexcited R‐R, the average preexcited R‐R, and the average R‐R intervals from 290±35 to 333±44 ms, 353±49 to 443±64 ms, and 356±53 to 467±75 ms, respectively, in patients with preexcited AF (all P<0.001). Nifekalant also decreased the percentage of preexcited QRS complexes, heart rate, and increased systolic pressure (all P<0.001). Nifekalant terminated AF in 33 of 51 patients (65%). Similar effects were also observed in a subgroup of 12 patients with preexcited AF and impaired left ventricular function. In patients with paroxysmal supraventricular tachycardia, nifekalant significantly prolonged the effective refractory period, the block cycle length of the antegrade accessory pathway, and the atrial effective refractory period (all P<0.001). Nifekalant had no effect on the effective refractory period of the antegrade atrioventricular node. Finally, in patients with persistent AF without an accessory pathway, nifekalant did not significantly decrease the ventricular rate of AF. One patient developed Torsades de Pointes. No other adverse effects were observed. Conclusions Nifekalant prolongs the effective refractory period of the antegrade accessory pathway and atrium without blocking antegrade conduction through the atrioventricular node, leading to slowing and/or to termination of preexcited AF. Thus, nifekalant might be an effective and a relatively safe drug in patients with preexcited AF.
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Affiliation(s)
- Jinzhu Hu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Jianhua Yu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Qi Chen
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Jianxin Hu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Qianghui Huang
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zhen Xia
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zirong Xia
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zhenzhen Ju
- 3 Post-Anesthetic Care Unit The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Ping Yuan
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Siyang Fan
- 4 Clinical EP Laboratory and Arrhythmia Service Center of Fuwai Heart Hospital Beijing China
| | - Qinmei Xiong
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Bo Zhu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Lin Huang
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Chunjiao You
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Huihui Bao
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Yanqing Wu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Xiaoshu Cheng
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Juxiang Li
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Ali J Marian
- 5 Center for Cardiovascular Genetics Brown Foundation Institute of Molecular Medicine The University of Texas Health Science Center Houston TX
| | - Kui Hong
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China.,2 Jiangxi Key Laboratory of Molecular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
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Georgiopoulos G, Tsiachris D, Kordalis A, Kontogiannis C, Spartalis M, Pietri P, Magkas N, Stefanadis C. Pharmacotherapeutic strategies for atrial fibrillation in pregnancy. Expert Opin Pharmacother 2019; 20:1625-1636. [PMID: 31136204 DOI: 10.1080/14656566.2019.1621290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Georgios Georgiopoulos
- Department of Cardiology, Athens Medical Center, Athens, Greece
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Christos Kontogiannis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Nikolaos Magkas
- 1stDepartment of Cardiology, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Khiabani AJ, Greenberg JW, Hansalia VH, Schuessler RB, Melby SJ, Damiano RJ. Late Outcomes of Surgical Ablation for Inappropriate Sinus Tachycardia. Ann Thorac Surg 2019; 108:1162-1168. [PMID: 31077661 DOI: 10.1016/j.athoracsur.2019.03.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 02/09/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inappropriate sinus tachycardia (IST) is a rare clinical disorder characterized by an elevated resting heart rate and an exaggerated rate response to exercise or autonomic stress. Pharmacologic therapy and catheter ablation are considered first-line treatments for IST but can yield suboptimal relief of symptoms. The results of surgical ablation at our center were reviewed for patients with refractory IST. METHODS Between 1987 and 2018, 18 patients underwent surgical sinoatrial (SA) node isolation for treatment-refractory IST. All 18 patients had previously failed pharmacologic therapy, and 15 patients had failed catheter ablation of the SA node. RESULTS Ten patients underwent a median sternotomy, and 8 patients underwent a minimally invasive right thoracotomy. The SA node was isolated with the use of surgical incisions, cryoablation, or bipolar radiofrequency ablations. Sinus tachycardia was eliminated in 100% of patients in the immediate postoperative period. Long-term follow-up data were available for 17 patients, with a mean follow-up of 11.4 ± 7.9 years. At last follow-up, 100% of patients were free from recurrent symptomatic IST. More than 80% of patients were completely asymptomatic, whereas 3 patients reported occasional palpitations. Four patients were on β-blockers, and 5 patients required subsequent pacemaker implantation. All 8 patients who underwent minimally invasive isolation were in normal sinus rhythm at last follow-up, and only 1 patient complained of palpitations. CONCLUSIONS Surgical isolation of the SA node is a feasible treatment for IST refractory to pharmacologic therapy and catheter ablation. A minimally invasive surgical approach offers a less morbid alternative to traditional median sternotomy.
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Affiliation(s)
- Ali J Khiabani
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Jason W Greenberg
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Vivek H Hansalia
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Richard B Schuessler
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Spencer J Melby
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washinton University School of Medicine in St Louis, St Louis, Missouri.
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Atrioventricular node reentrant tachycardia: Remote magnetic navigation ablation versus manual ablation - impact on operator fluoroscopy time. Rev Port Cardiol 2019; 38:187-192. [PMID: 30979530 DOI: 10.1016/j.repc.2018.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/24/2018] [Accepted: 07/18/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND AIMS Remote magnetic navigation systems have demonstrated benefits in the ablation of difficult substrates. Their role in the ablation of atrioventricular nodal reentrant tachycardia (AVNRT), however, has only been studied in small patient series. The aim of this study was to compare the results of AVNRT ablation using magnetic navigation, in a center where every procedure is performed with this system, with manual ablation. METHODS We selected 139 consecutive patients undergoing AVNRT ablation with magnetic navigation by a single operator between January 2009 and June 2016 and compared them to a group of 101 consecutive patients undergoing manual ablation in the same period by the same operator in another hospital. The methodology was the same in both groups. Success rates, complications, procedure time, radiofrequency time, total and operator fluoroscopy time, and recurrence rates were compared. RESULTS There were no differences in success and complication rates. Procedure and total fluoroscopy times were not significantly different, but operator fluoroscopy time was significantly shorter with the magnetic navigation system (2.4±1.5 min vs. 7.2±4 min; p<0.001). The recurrence rate was higher in the manual group, although without statistical significance. CONCLUSIONS The ablation of AVNRT with magnetic navigation is feasible using the same methodology as for manual ablation. Success and complication rates were similar. Operator fluoroscopy time was significantly less with the magnetic navigation system.
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Nauchi M, Sakai T, Sugisaki Y, Ito Y. Revelation of early repolarization by eliminating accessory pathway in manifest Wolff-Parkinson-White syndrome: A case report. J Arrhythm 2019; 35:300-302. [PMID: 31007798 PMCID: PMC6457479 DOI: 10.1002/joa3.12166] [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: 10/14/2018] [Revised: 12/19/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
A 23-year-old male with manifest Wolff-Parkinson-White syndrome presented with a first occurrence of ventricular fibrillation (VF). Initially, we anticipated the occurrence of atrial fibrillation, causing rapid antegrade conduction over the accessory pathway and, thus, resulting in hemodynamic deterioration. Electrophysiological study revealed that the atrioventricular accessory pathway was located at the mid-septum. After eliminating the pathway, a J-point elevation was revealed in the inferior and lateral leads. In addition, program ventricular stimulation induced VF, and the administration of isoproterenol suppressed VF. In our case, VF occurrence can be attributed to early repolarization syndrome and ventricular preexcitation-modified J-point elevation.
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Affiliation(s)
- Masahiro Nauchi
- Saiseikai Yokohamashi Tobu HospitalYokohama‐City, KanagawaJapan
| | - Tsuyoshi Sakai
- Saiseikai Yokohamashi Tobu HospitalYokohama‐City, KanagawaJapan
| | - Yuuta Sugisaki
- Saiseikai Yokohamashi Tobu HospitalYokohama‐City, KanagawaJapan
| | - Yoshiaki Ito
- Saiseikai Yokohamashi Tobu HospitalYokohama‐City, KanagawaJapan
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Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, Deharo JC, Svendsen JH, Heidbüchel H, Isa R, Kalman JM, Lane DA, Louw R, Lip GYH, Maury P, Potpara T, Sacher F, Sanders P, Varma N, Fauchier L, Haugaa K, Schwartz P, Sarkozy A, Sharma S, Kongsgård E, Svensson A, Lenarczyk R, Volterrani M, Turakhia M, Obel IWP, Abello M, Swampillai J, Kalarus Z, Kudaiberdieva G, Traykov VB, Dagres N, Boveda S, Vernooy K, Kalarus Z, Kudaiberdieva G, Mairesse GH, Kutyifa V, Deneke T, Hastrup Svendsen J, Traykov VB, Wilde A, Heinzel FR. Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). Europace 2019; 21:844–845. [DOI: 10.1093/europace/euz046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractAsymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.
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Affiliation(s)
- David O Arnar
- Department of Medicine, Landspitali - The National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hugh Calkins
- Department of Arrhythmia Services, Johns Hopkins Medical Institutions Baltimore, MD, USA
| | - Ashley Chin
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andrew Coats
- Department of Cardiology, University of Warwick, Warwickshire, UK
| | - Jean-Claude Deharo
- Department of Rhythmology, Hôpital Universitaire La Timone, Marseille, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Heidbüchel
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Ruan Louw
- Department Cardiology (Electrophysiology), Mediclinic Midstream Hospital, Centurion, South Africa
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Tatjana Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Frederic Sacher
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Laurent Fauchier
- Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Kristina Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | - Erik Kongsgård
- Department of Cardiology, OUS-Rikshospitalet, Oslo, Norway
| | - Anneli Svensson
- Department of Cardiology, University Hospital of Linkoping, Sweden
| | | | | | - Mintu Turakhia
- Stanford University, Cardiac Arrhythmia & Electrophysiology Service, Stanford, USA
| | | | | | - Janice Swampillai
- Electrophysiologist & Cardiologist, Waikato Hospital, University of Auckland, New Zealand
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze
| | | | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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Parreira L, Marinheiro R, Carmo P, Cavaco D, Reis-Santos K, Amador P, Teixeira T, Soares AS, Costa F, Adragao P. Atrioventricular node reentrant tachycardia: Remote magnetic navigation ablation versus manual ablation – impact on operator fluoroscopy time. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Boxhammer E, Goette A, Hammwöhner M, Lüker J, Patscheke M, Pavaci H, Pizzulli L, Razhniova A, Reek D, Schimpf R, Steven D, Wörmann J, Wolpert C, Zrenner B. [Rhythmogenic syncopes and survived sudden cardiac death]. Herzschrittmacherther Elektrophysiol 2019; 30:72-88. [PMID: 30847550 DOI: 10.1007/s00399-019-0614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Elke Boxhammer
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland
| | - Andreas Goette
- Arbeitsgruppe Molekulare Elektrophysiologie, Institut für Klinische Chemie und Pathobiochemie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland.
| | - Matthias Hammwöhner
- Arbeitsgruppe Molekulare Elektrophysiologie, Institut für Klinische Chemie und Pathobiochemie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland
| | - Jakob Lüker
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland
| | - Markus Patscheke
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland
| | - Herribert Pavaci
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland
| | - L Pizzulli
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland
| | - Alina Razhniova
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland
| | - David Reek
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland.
| | - Rainer Schimpf
- Kardiologische Praxisklinik Ludwigshafen, Standort Neustadt, Schütt 2, 64733, Neustadt a.d. Weinstraße, Deutschland.
| | - Daniel Steven
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland.
| | - Jonas Wörmann
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland
| | - Christian Wolpert
- 2. Medizinische Klinik, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland.
| | - Bernhard Zrenner
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland.
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47
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An irregular narrow complex tachycardia: atrial fibrillation or something else? Neth Heart J 2018; 27:112-113. [PMID: 30552570 PMCID: PMC6352620 DOI: 10.1007/s12471-018-1217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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48
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Pison L. Transseptal or retrograde approach for transcatheter ablation of left sided accessory pathways: Do all roads lead to Rome? Int J Cardiol 2018; 272:213-214. [PMID: 30072149 DOI: 10.1016/j.ijcard.2018.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Affiliation(s)
- L Pison
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
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49
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Oebel S, Hindricks G. [Management of syncope in clinical practice : What has changed according to the new ESC guidelines 2018?]. Herz 2018; 43:701-709. [PMID: 30341445 DOI: 10.1007/s00059-018-4757-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Syncope is a common problem in clinical practice, which affects approximately 1% of patients admitted to European emergency departments. The clinical practice guidelines for the diagnosis and management of syncope published by the European Society of Cardiology (ESC) are based on the newest scientific data in the field and have provided clinical cardiologists with a structured therapeutic approach for affected patients over many years. The previous ESC guidelines on syncope were published in 2009 and are compared to the most recent edition, which was published in 2018. This review summarizes the most important innovations with respect to the diagnostic principles and treatment of syncope. The initial assessment of the patient and the risk stratification in the emergency department are the focus of the review. Another important topic that is adequately covered in the current guidelines is the rising significance of implantable loop recorders for the evaluation of unexplained syncope and the assessment of potential indications for a definitive treatment with a pacemaker or implantable cardioverter defibrillator (ICD). Additional changes involve the evidence level with respect to the use of other diagnostic (ECG monitoring, tilt testing) and therapeutic measures (indications for pacemaker implantation, catheter ablation of tachycardiac rhythm disorders).
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Affiliation(s)
- S Oebel
- Abteilung für Rhythmologie, HELIOS Herzzentrum Leipzig, Strümpellstraße 39, 04289, Leipzig, Deutschland
| | - G Hindricks
- Abteilung für Rhythmologie, HELIOS Herzzentrum Leipzig, Strümpellstraße 39, 04289, Leipzig, Deutschland.
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50
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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