Rapid weather changes are associated with daily hospital visitors for atrial fibrillation accompanied by abnormal ECG repolarization: a case-crossover study

BACKGROUND

Atrial fibrillation (AF) is highly prevalent in the population, yet the factors contributing to AF events in susceptible individuals remain partially understood. The potential relationship between meteorological factors and AF, particularly with abnormal electrocardiograph (ECG) repolarization, has not been adequately studied. This case-crossover study aims to investigate the association between meteorological factors and daily hospital visits for AF with abnormal ECG repolarization in Shanghai, China.

METHODS

The study cohort comprised 10,325 patients with ECG-confirmed AF who sought treatment at Shanghai Sixth People's Hospital between 2015 and 2018. Meteorological and air pollutant concentration data were matched with the patient records. Using a case-crossover design, we analyzed the association between meteorological factors and the daily count of hospital visitors for AF with abnormal ECG repolarization at our AF center. Lag analysis models were applied to examine the temporal relationship between meteorological factors and AF events.

RESULTS

The analysis revealed statistically significant associations between AF occurrence and specific meteorological factors. AF events were significantly associated with average atmospheric pressure (lag 0 day, OR 0.9901, 95% CI 0.9825-0.9977, P < 0.05), average temperature (lag 1 day, OR 0.9890, 95% CI 0.9789-0.9992, P < 0.05), daily pressure range (lag 7 days, OR 1.0195, 95% CI 1.0079-1.0312, P < 0.01), and daily temperature range (lag 5 days, OR 1.0208, 95% CI 1.0087-1.0331, P < 0.01). Moreover, a significant correlation was observed between daily pressure range and daily temperature range with AF patients, particularly those with abnormal ECG repolarization, as evident in the case-crossover analysis.

CONCLUSION

This study highlights a significant correlation between meteorological factors and daily hospital visits for AF accompanied by abnormal ECG repolarization in Shanghai, China. In addition, AF patients with abnormal ECG repolarization were found to be more vulnerable to rapid daily changes in pressure and temperature compared to AF patients without such repolarization abnormalities.

Acute myocardial infarction occurring after hypertrophic obstructive cardiomyopathy with paroxysmal atrial fibrillation: a case report

Atheromatous plaque rupture and coronary artery stenosis/occlusion are leading causes of acute myocardial infarction (AMI). Other reasons for AMI are frequently overlooked. We report a rare case of AMI occurring after hypertrophic obstructive cardiomyopathy with paroxysmal atrial fibrillation. Although the patient showed multiple lead ST-T changes on an electrocardiogram and elevated circulating cardiac troponin I concentrations, no stenotic lesions were observed by repeated invasive coronary angiography examinations. Hypertrophic obstructive cardiomyopathy with paroxysmal atrial fibrillation was suspected as the primary cause of AMI. The patient received radiofrequency catheter ablation therapy and was free of atrial fibrillation and myocardial infarction 1 year postoperatively. The clinical management and outcome of the patient are also discussed.

Value of ST-T changes and heart rate variability in pulmonary heart disease during 24 h dynamic electrocardiography examination

PURPOSE

This study was designed to analyze the value of 24 h dynamic electrocardiography (DCG) examination in the diagnosis of pulmonary heart disease (PHD).

METHODS

Ninety cases of patients with PHD were included as the observation group, and 50 cases of healthy patients were enrolled as the healthy group. Both groups received DCG examination.

RESULTS

The proportion of ST depression and elevation as well as the magnitude and duration of ST depression differed significantly between the observation and healthy group (P < 0.05), and the magnitude of ST elevation in patients of the observation group with decompensated heart failure was greater than that of patients with compensated cardiac function and the healthy group (P < 0.05). The incidence rates of sinus bradycardia (SB), ventricular premature beats (VPB), paroxysmal ventricular tachycardia (PVT), and ventricular fibrillation (VF) in patients in the observation group with decompensated heart failure were higher than those of patients with compensated cardiac function and the healthy group (P < 0.05). The differences in standard deviation of the NN (R-R) intervals (SDNN) and standard deviation of average NN intervals (SDANN) between the three groups were significant, and the root mean square of successive RR intervals (RMSSD) of patients in the observation group with decompensated heart failure were lower than those of the healthy group (P < 0.05). The differences in deceleration capacity (DC), left ventricular ejection fraction (LVEF), and heart rate variability (HRV) between the three groups were significant (P < 0.05).

CONCLUSION

The results obtained by DCG examination can help clinical assessment of cardiac function in the decompensated or compensated stage, which can assist in judging the condition of PHD and guide clinical treatment.

Beta-blocker effect on ST-segment: a prespecified analysis of the EARLY-BAMI randomised trial

Objective

The effect of early intravenous (IV) beta-blockers (BBs) administration in patients undergoing primary percutaneous coronary intervention (pPCI) on ST-segment deviation is unknown. We undertook a prespecified secondary analysis of the Early Beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction (EARLY-BAMI) trial to investigate the effect of early IV BB on ST-segment deviation.

Methods

The EARLY-BAMI trial randomised patients with ST-elevation myocardial infarction (STEMI) to IV metoprolol (2×5 mg bolus) or matched placebo before pPCI. The prespecified outcome, evaluated by an independent core laboratory blinded to study treatment, was the residual ST-segment deviation 1 hour after pPCI (ie, the percentage of patients with >3 mm cumulative ST deviation at 1 hour after pPCI).

Results

An ECG for the evaluation of residual ST-segment deviation 1 hour after pPCI was available in 442 out of 683 randomised patients. The BB group had a lower heart rate after pPCI compared with placebo (71.2±13.2 vs 74.3±13.6, p=0.016); however, no differences were noted in the percentages of patients with >3 mm cumulative ST deviation at 1 hour after pPCI (58.6% vs 54.1%, p=0.38, in BB vs placebo, respectively) neither a significant difference was found for the percentages of patients in each of the four prespecified groups (normalised ST-segment; 1–3 mm; 4–6 mm;>6 mm residual ST-deviation).

Conclusions

In patients with STEMI, who were being transported for primary PCI, early IV BB administration did not significantly affect ST-segment deviation after pPCI compared with placebo. The neutral result of early IV BB administration on an early marker of pharmacological effect is consistent with the absence of subsequent improvement of clinical outcomes.

Electrocardiogram analysis of patients with different types of COVID-19

Background

Severe acute respiratory syndrome coronavirus 2 causes acute myocardial damage and arrhythmia in coronavirus disease 2019 (COVID‐19) patients. Studying the changes of electrocardiogram is of great significance for the diagnosis of patients with COVID‐19.

Methods

A retrospective analysis method was adopted to compare the electrocardiogram changes between COVID‐19 critically severe and severe patients. Univariate and multivariate logistic regression were used to analyze the correlation of the levels of serum indexes and past medical history with ST‐T changes and atrial fibrillation. And the correlation of ECG parameters with in‐hospital death and ventilator use were investigated by using the same methods.

Results

The incidence of male, stroke, elevated cardiac troponin I (cTnI), N‐terminal of the prohormone brain natriuretic peptide (NT‐proBNP), d‐dimer, high‐sensitivity C‐reactive protein (hs‐CRP), hyperkalemia, and hypocalcemia in the critically ill patients was higher than that in severe patients. There were differences in ST‐T changes, sinus tachycardia, atrial fibrillation, and atrial tachycardia between the two groups. Multivariate logistic regression analysis showed that elevated cTnI and NT‐proBNP were the independent risk factors of ST‐T changes. Elevated NT‐proBNP and age were the independent risk factors of atrial fibrillation. Sinus tachycardia and atrial fibrillation were the independent risk factors of in‐hospital death and ventilator use.

Conclusion

ST‐T changes, sinus tachycardia, and atrial fibrillation are with great significance in the diagnosis of the severity, myocardia injury, and cardiac insufficiency of COVID‐19 patients. Sinus tachycardia and atrial fibrillation could be used as independent variables predicting in‐hospital death and ventilator use.

QT interval prolongation in patients with acute ischemic stroke: a report in northwest China

Aims

QT interval prolongation is common in patients with stroke and increases the risk of malignant arrhythmia and sudden death. Our aim was to analyze differences in the QT interval and electrocardiogram abnormalities between acute ischemic stroke patients and controls.

Methods

We retrospectively collected data from 273 patients with acute ischemic stroke from the neurological intensive care unit and 495 controls from other departments. A standard 12-lead electrocardiogram was recorded within 24 hours of hospitalization. Clinical information, the QT interval corrected for heart rate (QTc), and the incidence of electrocardiogram abnormalities were compared between groups.

Results

There was no difference in age, sex, or the prevalence of hypertension or diabetes mellitus between the acute ischemic stroke group and controls. Acute ischemic stroke patients showed a significantly longer QTc and a higher incidence of both sinus bradycardia and ST-T changes compared with controls. We also showed that the changes in electrocardiogram results observed in acute ischemic stroke might be transient.

Conclusion

Acute ischemic stroke patients may have a longer QT interval and a higher incidence of electrocardiogram abnormalities. In clinical practice, careful attention should be paid to acute ischemic stroke patients to prevent malignant arrhythmia.