1
|
Wu Y, Zhu X, Ning Z. Efficacy of statins combined with amiodarone in the treatment of atrial fibrillation: A meta-analysis. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221094426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Atrial fibrillation (AF) is a common arrhythmia in clinics with a high mortality rate. Recently, statins combined with amiodarone and amiodarone alone were used in the treatment of AF. This systematic review study aims to investigate the clinical efficacy and usefulness of statins combined with amiodarone and amiodarone alone in treating AF. Methods: Pubmed, Embase, Web of Science, Medline, Cochrane Library, and China National Knowledge Infrastructure were used to search for the relevant studies and full-text articles involved in evaluating statin-amiodarone versus amiodarone alone for AF. All included articles were quality assessed, and the data analysis was conducted with Review Manager 5.4. Results: Eight (8) relevant studies with 758 AF patients were included in this analysis. In the Meta-analysis, Statin-amiodarone treatment reduced AF recurrence (RR, 0.61; 95% CI, 0.50–0.75; p < 0.00001), C-reactive protein (CRP) level (MD, 0.96; 95%CI, 0.64–1.29, p < 0.00001) and Left atrial diameter (LAD) (MD, 0.81; 95%CI, 0.06–1.56; p = 0.03) compared with amiodarone alone for AF. However, no difference was observed for change of total cholesterol (TC) (MD, 1.32; 95%CI, −0.24–2.88; p = 0.10). Conclusion: Statin-amiodarone effectively reduced CRP level, LAD and reduced the recurrence of AF than amiodarone alone.
Collapse
Affiliation(s)
- Yingbiao Wu
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xi Zhu
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhongping Ning
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| |
Collapse
|
2
|
Carlson S, Nangrahary M, Ong JS. An immunosuppressed 37-year-old woman with right atrial necrotising myocarditis. BMJ Case Rep 2021; 14:14/4/e240895. [PMID: 33858895 PMCID: PMC8055118 DOI: 10.1136/bcr-2020-240895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 37-year-old immunocompromised woman was admitted with palpitations, fevers and myalgias. An echocardiogram demonstrated a mass in the right atrial walls and interatrial septum. Endovascular biopsy of the myocardium revealed neutrophilic necrotising myocarditis isolated to the right atrium. Multiple blood, urine and stool cultures were negative but a high anti-streptolysin O antibody titre was detected. The combination of these findings led to the working diagnosis of necrotising myocarditis. Without a positive culture, it was not possible to definitively state the cause of this condition. She was treated with intravenous antibiotics and continued to improve physically and biochemically on discharge.
Collapse
Affiliation(s)
- Sinead Carlson
- Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Mary Nangrahary
- Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jeremy Sl Ong
- Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| |
Collapse
|
3
|
Compagnucci P, Volpato G, Falanga U, Cipolletta L, Conti MA, Grifoni G, Ciliberti G, Stronati G, Fogante M, Bergonti M, Sommariva E, Guerra F, Giovagnoni A, Dello Russo A, Casella M. Myocardial Inflammation, Sports Practice, and Sudden Cardiac Death: 2021 Update. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:277. [PMID: 33802881 PMCID: PMC8002711 DOI: 10.3390/medicina57030277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
Myocardial inflammation is an important cause of cardiovascular morbidity and sudden cardiac death in athletes. The relationship between sports practice and myocardial inflammation is complex, and recent data from studies concerning cardiac magnetic resonance imaging and endomyocardial biopsy have substantially added to our understanding of the challenges encountered in the comprehensive care of athletes with myocarditis or inflammatory cardiomyopathy (ICM). In this review, we provide an overview of the current knowledge on the epidemiology, pathophysiology, diagnosis, and treatment of myocarditis, ICM, and myopericarditis/perimyocarditis in athletes, with a special emphasis on arrhythmias, patient-tailored therapies, and sports eligibility issues.
Collapse
Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Umberto Falanga
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Manuel Antonio Conti
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Gino Grifoni
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Marco Fogante
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60121 Ancona, Italy; (M.F.); (A.G.)
| | - Marco Bergonti
- Department of Clinical Sciences and Community Health, University of Milan, 20138 Milan, Italy;
| | - Elena Sommariva
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60121 Ancona, Italy; (M.F.); (A.G.)
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
| |
Collapse
|
4
|
Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions. J Cardiovasc Transl Res 2020; 13:284-295. [PMID: 32270467 DOI: 10.1007/s12265-020-09996-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/24/2020] [Indexed: 12/26/2022]
Abstract
Myocarditis is as an important cause of sudden cardiac death (SCD) among athletes. The incidence of SCD ascribed to myocarditis did not change after the introduction of pre-participation screening in Italy, due to the transient nature of the disease and problems in the differential diagnosis with the athlete's heart. The arrhythmic burden and the underlying mechanisms differ between the acute and chronic setting, depending on the relative impact of acute inflammation versus post-inflammatory myocardial fibrosis. In the acute phase, ventricular arrhythmias vary from isolated ventricular ectopic beats to complex tachycardias that can lead to SCD. Atrioventricular blocks are typical of specific forms of myocarditis, and supraventricular arrhythmias may be observed in case of atrial inflammation. Athletes with acute myocarditis should be temporarily restricted from physical exercise, until complete recovery. However, ventricular tachycardia may also occur in the chronic phase in the context of post-inflammatory myocardial scar.
Collapse
|
5
|
Chen M. Scar homogenization in AF ablation: Evolution and practice. J Atr Fibrillation 2017; 10:1618. [PMID: 29250226 PMCID: PMC5673332 DOI: 10.4022/jafib.1618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/10/2022]
Abstract
Laboratory studies, histology studies, image studies and the clinical studies all prove the positive correlation between atrial fibrillation and atrial fibrosis from different perspectives. Atrial fibrosis, by separating myocardial cell coupling, diminishing conduction velocity and promoting anisotropic conduction, produce the substrate to sustain atrial fibrillation (AF). These fibrotic areas can be translated into signal abnormalities (low voltage and complex electrgram), and be depicted by electroanatomic high density map. Ablation targeting these areas after circumferential pulmonary vein produces isolation as the additional substrate modification strategy has proved its beneficial results. However, the unified methodology regarding the scar definition, the mapping rhythm (AF or sinus rhythm) and the modification endpoint is yet to be negotiated. Large-scale clinical trials, long-term follow-up results are needed to prove its contribution to the overall success rate of AF ablation.
Collapse
Affiliation(s)
- Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| |
Collapse
|
6
|
Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication. J Arrhythm 2016; 32:247-78. [PMID: 27588148 PMCID: PMC4996910 DOI: 10.1016/j.joa.2016.05.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hô pitaux de Paris, Pitié-Salpêtrière Hospital, Sorbonne University, INSERM UMR_S1166, Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundació n and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | | | | |
Collapse
|
7
|
Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace 2016; 18:1455-1490. [PMID: 27402624 DOI: 10.1093/europace/euw161] [Citation(s) in RCA: 429] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundación and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada .,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
8
|
EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm 2016; 14:e3-e40. [PMID: 27320515 DOI: 10.1016/j.hrthm.2016.05.028] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/21/2022]
|
9
|
Begieneman MPV, Emmens RW, Rijvers L, Kubat B, Paulus WJ, Vonk ABA, Rozendaal L, Biesbroek PS, Wouters D, Zeerleder S, van Ham M, Heymans S, van Rossum AC, Niessen HWM, Krijnen PAJ. Ventricular myocarditis coincides with atrial myocarditis in patients. Cardiovasc Pathol 2015; 25:141-8. [PMID: 26764148 DOI: 10.1016/j.carpath.2015.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/06/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is a common complication in myocarditis. Atrial inflammation has been suggested to play an important role in the pathophysiology of AF. However, little is known about the occurrence of atrial inflammation in myocarditis patients. Here, we analyzed inflammatory cell numbers in the atria of myocarditis patients without symptomatic AF. METHODS Cardiac tissue was obtained postmortem from lymphocytic myocarditis patients (n=6), catecholamine-induced myocarditis patients (n=5), and control patients without pathological evidence of heart disease (n=5). Tissue sections of left and right ventricle and left and right atrium were stained for myeloperoxidase (neutrophilic granulocytes), CD45 (lymphocytes), and CD68 (macrophages). These cells were subsequently quantified in atrial and ventricular myocardium and atrial adipose tissue. RESULTS In lymphocytic myocarditis patients, a significant increase was observed for lymphocytes in the left atrial adipose tissue. In catecholamine-induced myocarditis patients, significant increases were found in the atria for all three inflammatory cell types. Infiltrating inflammatory cell numbers in the atrial myocardium correlated positively with those in the ventricles, especially in catecholamine-induced myocarditis patients. CONCLUSIONS To a varying extent, atrial myocarditis occurs concurrently with ventricular myocarditis in patients diagnosed with myocarditis of different etiology. This provides a substrate that potentially predisposes myocarditis patients to the development of AF and subsequent complications such as sudden cardiac death and heart failure.
Collapse
Affiliation(s)
- Mark P V Begieneman
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands; ICaR-VU, VU University Medical Center, Amsterdam, the Netherlands; Dutch Forensic Institute, The Hague, the Netherlands
| | - Reindert W Emmens
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands; ICaR-VU, VU University Medical Center, Amsterdam, the Netherlands; Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands.
| | - Liza Rijvers
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Bela Kubat
- Dutch Forensic Institute, The Hague, the Netherlands
| | - Walter J Paulus
- ICaR-VU, VU University Medical Center, Amsterdam, the Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Alexander B A Vonk
- Department of Cardiac Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Lawrence Rozendaal
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands; ICaR-VU, VU University Medical Center, Amsterdam, the Netherlands
| | - P Stefan Biesbroek
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Diana Wouters
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
| | - Sacha Zeerleder
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands; Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | - Marieke van Ham
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
| | - Stephane Heymans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert C van Rossum
- ICaR-VU, VU University Medical Center, Amsterdam, the Netherlands; Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Hans W M Niessen
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands; ICaR-VU, VU University Medical Center, Amsterdam, the Netherlands; Department of Cardiac Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul A J Krijnen
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands; ICaR-VU, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
10
|
[A rest or arrest--asystolic episodes of 7 seconds in a 22-year-old athlete]. Internist (Berl) 2011; 53:218-22. [PMID: 22002765 DOI: 10.1007/s00108-011-2948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A 22-year-old athlete with nocturnal asymptomatic episodes of transient sinus arrest/sinoatrial block up to 7.3 s and recurrent inappropriate sinus tachycardias which had been incidentally found during Holter electrocardiography diagnostics is presented. In spite of extensive diagnostic work-up including invasive procedures like coronary angiography and electrophysiological study, no causal etiology was found. Based on the normal findings and the lack of symptoms, we decided not to implant a permanent pacemaker. After 14 months, the patient is still asymptomatic. Howerver, the 24-h Holter electrocardiography shows unchanged frequency of nocturnal transient sinus arrest episodes.
Collapse
|
11
|
Chimenti C, Russo MA, Carpi A, Frustaci A. Histological substrate of human atrial fibrillation. Biomed Pharmacother 2010; 64:177-83. [PMID: 20006465 DOI: 10.1016/j.biopha.2009.09.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022] Open
Abstract
Histologic and ultrastructural examination of atrial tissue regarding the main entities responsible of human atrial fibrillation, is reported. The pathologic changes deriving from various disorders, like degenerative, inflammatory, ischemic diseases as well as from cardiac aging and hormonal imbalance are analysed. Structural changes associated with lone atrial fibrillation and investigated by atrial biopsy are also described, as being able to provide useful information on the disease's etiology, prognosis and treatment.
Collapse
Affiliation(s)
- Cristina Chimenti
- Cardiovascular and Respiratory Sciences Department, La Sapienza University, viale del Policlinico 155, Rome, Italy
| | | | | | | |
Collapse
|
12
|
Inclusion of electric disturbance type cardiomyopathy in the classification of cardiomyopathy: A current review. J Cardiol 2008; 51:81-8. [DOI: 10.1016/j.jjcc.2008.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 02/13/2008] [Indexed: 11/23/2022]
|
13
|
Woolley R, Blundell R, Else R, Corcoran B, Devine C, French A. Atrial myocarditis as a cause of sinus arrest in a dog. J Small Anim Pract 2007; 48:455-7. [PMID: 17425699 DOI: 10.1111/j.1748-5827.2006.00256.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 10-year-old male cairn terrier cross was presented with a history of myxomatous mitral valve disease diagnosed six months previously and with a four-week history of intermittent collapse. On 24 hour electrocardiograph (Holter) analysis, periods of no discernable electrical cardiac activity, which coincided with three collapsing episodes, were identified. Unfortunately, on re-presentation for removal of the Holter monitor, the dog collapsed and died. A post-mortem examination was conducted, and histology of the right and left atrium showed evidence of myocarditis. This is the first reported case, to our knowledge, of collapse because of electrical asystole in a dog with atrial myocarditis.
Collapse
Affiliation(s)
- R Woolley
- Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Hospital for Small Animals, Easter Bush, Roslin, Midlothian EH25 9RG, UK
| | | | | | | | | | | |
Collapse
|
14
|
Krieg A, Scharhag J, Kindermann W, Urhausen A. Cardiac tissue Doppler imaging in sports medicine. Sports Med 2007; 37:15-30. [PMID: 17190533 DOI: 10.2165/00007256-200737010-00002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The differentiation of training-induced cardiac adaptations from pathological conditions is a key issue in sports cardiology. As morphological features do not allow for a clear delineation of early stages of relevant pathologies, the echocardiographic evaluation of left ventricular function is the technique of first choice in this regard. Tissue Doppler imaging (TDI) is a relatively recent method for the assessment of cardiac function that provides direct, local measurements of myocardial velocities throughout the cardiac cycle. Although it has shown a superior sensitivity in the detection of ventricular dysfunction in clinical and experimental studies, its application in sports medicine is still rare. Besides technical factors, this may be due to a lack in consensus on the characteristics of ventricular function in relevant conditions. For more than two decades there has been an ongoing debate on the existence of a supernormal left ventricular function in athlete's heart. While results from traditional echocardiography are conflicting, TDI studies established an improved diastolic function in endurance-trained athletes with athlete's heart compared with controls.The influence of anabolic steroids on cardiac function also has been investigated by standard echocardiographic techniques with inconsistent results. The only TDI study dealing with this topic demonstrated a significantly impaired diastolic function in bodybuilders with long-term abuse of anabolic steroids compared with strength-trained athletes without abuse of anabolic steroids and controls, respectively.Hypertrophic cardiomyopathy is the most frequent cause of sudden death in young athletes. However, in its early stages, it is difficult to distinguish from athlete's heart. By means of TDI, ventricular dysfunction in hypertrophic cardiomyopathy can be disclosed even before the development of left ventricular hypertrophy. Also, a differentiation of left ventricular hypertrophy due to hypertrophic cardiomyopathy or systemic hypertension is possible by TDI. Besides the evaluation of different forms of left ventricular hypertrophy, the diagnosis of myocarditis is also of particular importance in athletes. Today, it still requires myocardial biopsy. The analysis of focal disturbances in myocardial velocities might be a promising non-invasive method; however, systematic validation studies are lacking. An important future issue for the implementation of TDI into routine examination will be the standardisation of procedures and the establishment of significant reference values for the above-mentioned conditions. Innovative TDI parameters also merit further investigation.
Collapse
Affiliation(s)
- Anne Krieg
- Institute of Sports and Preventive Medicine, University of Saarland, Saarbruecken, Germany.
| | | | | | | |
Collapse
|
15
|
Abstract
Viruses are the most common cause of myocarditis in economically advanced countries. Enteroviruses and adenoviruses are the most common etiologic agents. Viral myocarditis is a triphasic process. Phase 1 is the period of active viral replication in the myocardium during which the symptoms of myocardial damage range from none to cardiogenic shock. If the disease process continues, it enters phase 2, which is characterized by autoimmunity triggered by viral and myocardial proteins. Heart failure often appears for the first time in phase 2. Phase 3, dilated cardiomyopathy, is the end result in some patients. Diagnostic procedures and treatment should be tailored to the phase of disease. Viral myocarditis is a significant cause of dilated cardiomyopathy, as proved by the frequent presence of viral genomic material in the myocardium, and by improvement in ventricular function by immunomodulatory therapy. Myocarditis of any etiology usually presents with heart failure, but the second most common presentation is ventricular arrhythmia. As a result, myocarditis is one of the most common causes of sudden death in young people and others without preexisting structural heart disease. Myocarditis can be definitively diagnosed by endomyocardial biopsy. However, it is clear that existing criteria for the histologic diagnosis need to be refined, and that a variety of molecular markers in the myocardium and the circulation can be used to establish the diagnosis. Treatment of myocarditis has been generally disappointing. Accurate staging of the disease will undoubtedly improve treatment in the future. It is clear that immunosuppression and immunomodulation are effective in some patients, especially during phase 2, but may not be as useful in phases 1 and 3. Since myocarditis is often selflimited, bridging and recovery therapy with circulatory assistance may be effective. Prevention by immunization or receptor blocking strategies is under development. Giant cell myocarditis is an unusually fulminant form of the disease that progresses rapidly to heart failure or sudden death. Rapid onset of disease in young people, especially those with other autoimmune manifestations, accompanied by heart failure or ventricular arrhythmias, suggests giant cell myocarditis. Peripartum cardiomyopathy in economically developed countries is usually the result of myocarditis.
Collapse
Affiliation(s)
- James T. Willerson
- The University of Texas Health Science Center in Houston, Houston, ,Texas Heart Institute, Houston, TX USA
| | - Hein J. J. Wellens
- Department of Cardiology, University of Maastricht, Masstricht, The Netherlands
| | - Jay N. Cohn
- Rasmussen Center for Cardiovascular Disease Prevention Cardiovascular Division, University of Minnesota, Minneapolis, MN USA
| | - David R. Holmes
- Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
| |
Collapse
|
16
|
Chimenti C, Pieroni M, Frustaci A. Myocarditis: when to suspect and how to diagnose it in athletes. J Cardiovasc Med (Hagerstown) 2006; 7:301-6. [PMID: 16645406 DOI: 10.2459/01.jcm.0000219325.50622.93] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Myocarditis should be suspected in athletes with unexplained cardiac arrhythmias and dysfunction, especially if preceded by a flu-like syndrome. An early diagnosis is desirable in order to avoid the risk of fatal consequences, since physical activity can enhance the inflammatory process. Although several diagnostic tools can be useful for the diagnosis of myocarditis, endomyocardial biopsy is still the gold standard. Athletes with myocarditis should be withdrawn from all competitive sports for at least 6 months and resume training when ventricular function and cardiac dimensions return to normal and the clinically relevant arrhythmias disappear. In the presence of life-threatening arrhythmias or rapidly progressive cardiac dysfunction an antiviral or an immunosuppressive treatment should be considered depending on whether a viral agent is present or absent, respectively, in the myocardium.
Collapse
Affiliation(s)
- Cristina Chimenti
- Department of Heart and Great Vessels Attilio Reale, La Sapienza University, Rome, Italy
| | | | | |
Collapse
|
17
|
Nakamura Y, Nakamura K, Fukushima-Kusano K, Ohta K, Matsubara H, Hamuro T, Yutani C, Ohe T. Tissue factor expression in atrial endothelia associated with nonvalvular atrial fibrillation: possible involvement in intracardiac thrombogenesis. Thromb Res 2004; 111:137-42. [PMID: 14678810 DOI: 10.1016/s0049-3848(03)00405-5] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Tissue factor plays a key role in the extrinsic coagulation pathway and is induced by inflammatory cytokines. Atrial myocarditis has been detected recently in some patients with lone atrial fibrillation. Virchow's triad of low blood flow, hypercoagulability, and endothelial dysfunction, enhances thrombus formation. The present study was designed to elucidate the role of endothelial dysfunction in thrombogenesis associated with nonvalvular atrial fibrillation. MATERIAL AND METHODS We investigated tissue factor expression in the endothelia of left atrial appendages obtained from seven patients with nonvalvular atrial fibrillation and cardiogenic thromboembolism. Tissues were divided into 7-13 sections and compared with control specimens from four patients who died of noncardiac events. Expression of tissue factor, von Willebrand factor and tissue factor pathway inhibitor was evaluated by immunohistochemistry. RESULTS Histopathologically, inflammatory cells infiltrated the endocardium and all seven patients showed features of persistent myocarditis. Activated T cells [15.3+/-9.4 cells/high power field (HPF, mean+/-S.D.) vs. control 2.2+/-4.4/HPF (P=0.0294)] and a few macrophages [5.1+/-8.4 cells/HPF vs. control 2.4+/-3.5 cells/HPF (P=NS)] infiltrated the endocardium. Tissue factor was overexpressed in the endothelia particularly in tissues containing inflammatory cells and denuded matrix of the endocardium, compared with the control group. Von Willebrand factor, but not tissue factor pathway inhibitor, was also overexpressed in these tissues. CONCLUSION Tissue factor expression induced by local inflammation is involved in the pathogenesis of thrombosis in patients with nonvalvular atrial fibrillation.
Collapse
Affiliation(s)
- Yoichi Nakamura
- Department of Cardiovascular Medicine, Matsuyama Shimin Hospital, 2-6-5, Ohte-machi, Ehime, 790-0067, Matsuyama, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 1997; 96:1180-4. [PMID: 9286947 DOI: 10.1161/01.cir.96.4.1180] [Citation(s) in RCA: 971] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lone atrial fibrillation (LAF) is a common clinical syndrome, but its origin remains unknown. METHODS AND RESULTS We performed endomyocardial biopsies of the right atrial septum (2 to 3 per patient; mean, 2.8) and of the two ventricles (6 per patient) in 12 patients (10 men, 2 women; mean age, 32 years) with paroxysmal LAF refractory to conventional antiarrhythmic treatment. As controls, we used endomyocardial biopsies (3 to 5 per patient; mean, 4.4) from the right atrial septum of 11 patients with Wolff-Parkinson-White syndrome (WPW) undergoing resection of the abnormal AV pathway. The weight of the biopsies ranged from 2.8 to 4.5 mg. Biopsy samples were processed for histology and electron microscopy and were read by a pathologist blinded to clinical data. All patients underwent two-dimensional Doppler echocardiography; cardiac catheterization; coronary angiography; and hormonal, virologic, and electrophysiological studies. All tests and WPW biopsies were normal, but all LAF atrial biopsy specimens (average, 2.8 per patient) showed abnormalities (P<.0001). The type of abnormalities varied: Two patients had a severe hypertrophy with vacuolar degeneration of the atrial myocytes and ultrastructural evidence of fibrillolysis occupying >50% of the areas assessed morphometrically (P=.50), 8 had lymphomononuclear infiltrates with necrosis of the adjacent myocytes (5 with fibrosis and 3 without; P<.003), and 2 had only nonspecific patchy fibrosis (P=.50). Biventricular biopsies were abnormal in only 3 patients and showed inflammatory infiltrates similar to those found in atrial biopsies. CONCLUSIONS Abnormal atrial histology was uniformly found in multiple biopsy specimens in all patients with LAF. It was compatible with a diagnosis of myocarditis in 66% of patients (active in 25%) and of noninflammatory localized cardiomyopathy in 17% and was represented by patchy fibrosis in 17%. The cause of the pathological changes, which were found only in atrial septal biopsies but not in biventricular biopsies, in 75% of patients remains unknown.
Collapse
Affiliation(s)
- A Frustaci
- Istituto di Cardiologia, Università Cattolica del S. Cuore, and the Dipartimento di Medicina Sperimentale e Patologia, Rome, Italy
| | | | | | | | | | | |
Collapse
|