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Xu B, Zhang X, Qian W, Zhou R, Chen T, Ma Y, Chen H. Evaluation of the associations of pulmonary vein vertical diameter, cardiothoracic ratio, and atrial fibrillation combined hiatal hernia. Medicine (Baltimore) 2024; 103:e39583. [PMID: 39287230 PMCID: PMC11404944 DOI: 10.1097/md.0000000000039583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 07/11/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
Recent studies have suggested that there may be a relationship between hiatal hernia (HH) and atrial fibrillation (AF), but the specific mechanism is unclear. The aim of this study was to explore the clinical characteristics associated with HH and AF and to identify the potential relationship between the 2 diseases. The study comprised 180 patients with HH, of which 54 had AF. Every patient had chest computed tomography to quantify the cardiothoracic ratio, HH volume, thoracic cavity volume, and diameters of the pulmonary veins. The clinical data of all patients was acquired through an electronic medical record system. Patients who experienced AF had a noticeably smaller total pulmonary vein vertical diameter (TPVVD) and a higher cardiothoracic ratio compared to those who only had HH. Logistic multivariate regression study demonstrated a significant association between TPVVD, cardiothoracic ratio, and AF in individuals with HH. This study established a correlation between TPVVD, cardiothoracic ratio, and HH in conjunction with AF. Patient with HH who had a thinner TPVVD and a bigger cardiothoracic ratio were found to have a greater likelihood of suffering from AF.
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Affiliation(s)
- Bowen Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
- Medical Department of Qingdao University, Qingdao, Shandong Province, China
| | - Xueshan Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
- Medical School, Soochow University, Suzhou, Jiangsu Province, China
| | - Wei Qian
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Ran Zhou
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Tao Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Yanfeng Ma
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Hongping Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
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2
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Khalid S, Albaba I, Neu K. Hypocalcemia: A Little Known Cause of Supraventricular Tachyarrhythmia. Cureus 2023; 15:e38456. [PMID: 37273362 PMCID: PMC10234768 DOI: 10.7759/cureus.38456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/06/2023] Open
Abstract
Calcium is an essential electrolyte in impulse generation and contraction of cardiac muscle. Hypocalcemia can occur in cases of parathyroid hormone deficiency, primarily due to inadvertent removal of the parathyroid gland during thyroidectomy, however most cases are idiopathic. We present a case of an adult male who developed sustained narrow complex tachycardia due to hypocalcemia in the setting of untreated idiopathic hypoparathyroidism.
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Affiliation(s)
- Sualeha Khalid
- Internal Medicine, Stratton VA Medical Center, Albany, USA
| | - Isam Albaba
- Internal Medicine, Stratton VA Medical Center, Albany, USA
| | - Kristofer Neu
- Internal Medicine, Stratton VA Medical Center, Albany, USA
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3
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Bagliani G, De Ponti R, Leonelli FM, Casella M, Gaggiotti G, Volpato G, Compagnucci P, Russo AD. The History of Atrial Flutter Electrophysiology, from Entrainment to Ablation: A 100-Year Experience in the Precision Electrocardiology. Card Electrophysiol Clin 2022; 14:357-373. [PMID: 36153119 DOI: 10.1016/j.ccep.2022.05.001] [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: 11/15/2022]
Abstract
Atrial flutter (AFL) is a regular supraventricular reentrant tachycardia generating a continuous fluttering of the baseline electrocardiography (ECG) at a rate of 250 to 300 beats per minute. AFL is classified based on the involvement of the cavo-tricuspid isthmus in the circuit. The "isthmic" (or type 1) AFL develops entirely in the right atrium; this circuit is commonly activated in a counter-clockwise direction, generating the common sawtooth ECG morphology in the inferior leads (slow descendent-fast ascendent). AFL can be nonisthmus dependent (type 2), often presenting with faster atrial rate and most commonly a left atrial location.
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Affiliation(s)
- Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy.
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA; University of South Florida, FL 4202 East Fowler Avenue, Tampa, FL 33620, USA
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
| | - Gemma Gaggiotti
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
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4
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Electrocardiographic Approach to Atrial Flutter: Classifications and Differential Diagnosis. Card Electrophysiol Clin 2022; 14:385-399. [PMID: 36153121 DOI: 10.1016/j.ccep.2022.05.007] [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: 11/20/2022]
Abstract
Atrial flutter (AFL) is a macro-reentrant arrhythmia characterized, in a 12 lead ECG, by the continuous oscillation of the isoelectric line in at least one lead. In the typical form of AFL, the oscillation is most obvious in the inferior leads, due to a macro-reentrant circuit localized in the right atrium, with the cavo-tricuspid isthmus as a critical zone.: This circuit can be activated in a counterclockwise or clockwise direction generating in II, III, and aVF leads, respectively, a slow descending/fast ascending F wave pattern (common form of typical AFL) or a balanced ascending/descending waveform (uncommon form of typical AFL). Atypical AFLs (scar-related) do not include the CTI in the circuit and show an extremely variable circuit location and ECG morphology.
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Palacio LC, Pachajoa DC, Durango-Giraldo G, Zapata-Hernandez C, Ugarte JP, Saiz J, Buitrago-Sierra R, Tobón C. Atrial proarrhythmic effect of lead as one of the PM10 metal components of air pollution. An in-silico study. PLoS One 2021; 16:e0258313. [PMID: 34637464 PMCID: PMC8509962 DOI: 10.1371/journal.pone.0258313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Particulate matter (PM) is considered the most severe environmental pollution problem due to its serious effects on human health associated with an increased risk of cardiovascular morbidity and mortality. In this work, a physicochemical characterization of PM10 from the city of Medellin was developed. The results evince that lead (Pb) is one of the most abundant elements since it is present in all analyzed samples. Therefore, Pb was chosen to perform an in-silico study to assess its effects on atrial arrhythmias generation. For this purpose, we developed a model representing the Pb2+ blocking effect on the L-type calcium channel. This formulation was incorporated in a human atrial cell mathematical model and in 2D and 3D models of human atria. The simulations showed a proarrhythmic effect at high Pb2+ concentrations, through shortening of action potential duration inducing the generation of reentrant activity and atrial flutter. The results contribute to the knowledge about the cardiac physiopathological processes, triggered by lead as one of the main PM10 metal components of air pollution, that yields the generation of arrhythmias.
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Affiliation(s)
| | | | | | | | - Juan P. Ugarte
- GIMSC, Universidad de San Buenaventura, Medellín, Colombia
| | - Javier Saiz
- CIB, Universitat Politècnica de València, Valencia, Spain
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Sheehan NK, Tjostheim SS. ECG of the Month. J Am Vet Med Assoc 2021; 257:273-276. [PMID: 32657656 DOI: 10.2460/javma.257.3.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kugamoorthy P, Spears DA. Management of tachyarrhythmias in pregnancy - A review. Obstet Med 2020; 13:159-173. [PMID: 33343692 PMCID: PMC7726166 DOI: 10.1177/1753495x20913448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/16/2020] [Indexed: 11/16/2022] Open
Abstract
The most common arrhythmias detected during pregnancy include sinus tachycardia, sinus bradycardia, and sinus arrhythmia, identified in 0.1% of pregnancies. Isolated premature atrial or ventricular arrhythmias are observed in 0.03% of pregnancies. Arrhythmias may become more frequent during pregnancy or may manifest for the first time.
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Affiliation(s)
| | - Danna A Spears
- University Health Network – Toronto General Hospital, Toronto, Canada
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Leonelli FM, De Ponti R, Bagliani G. Electrocardiographic Approach to Complex Arrhythmias: P, QRS, and Their Relationships. Card Electrophysiol Clin 2019; 11:239-260. [PMID: 31084849 DOI: 10.1016/j.ccep.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
When faced with an electrocardiographic recoding of a complex arrhythmia, we often use inflexible algorithms or try to recall patterns already seen, which is often insufficient to explain the mechanisms of difficult bradycardias and tachycardias. We propose an approach to these situations where, starting from basic observations, the behavior of the different components of the arrhythmia is reconstructed using logical deductions. The extensive use of laddergrams faithfully illustrates how analysis of timing of each visible event, P and QRS, clarifies their relationship and dictates the behavior of electrocardiographic silent cardiac structures (sinus node and atrioventricular node).
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Affiliation(s)
- Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University South Florida, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
| | | | - Giuseppe Bagliani
- Foligno General Hospital, Cardiology Department, Arrhythmology Unit, Foligno, Italy; Cardiovascular Diseases Department, University of Perugia, Perugia, Italy
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Bagliani G, De Ponti R, Leonelli FM. Precision Electrocardiology: A Rational Approach for Simple and Complex Arrhythmias. Card Electrophysiol Clin 2019; 11:175-187. [PMID: 31084845 DOI: 10.1016/j.ccep.2019.01.003] [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: 11/29/2022]
Abstract
Electrocardiography (ECG) in all its forms, from 12-lead ECG to long-term monitoring, is considered, an old and increasingly irrelevant test in this high technology era. This article reviews the clinical utility of this tool and argues that the obsolescence is due to an increasing inability to read electrocardiographic tracings. The usual interpretative pitfalls are discussed and a logical approach is proposed with illustrative examples. Finally, the concept of precision ECG is presented and its meaning reviewed.
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Affiliation(s)
- Giuseppe Bagliani
- Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Foligno, Italy; Cardiovascular Diseases Department, University of Perugia, Perugia, Italy.
| | - Roberto De Ponti
- Cardiology Department, University of Insubria, Varese 21100, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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Thomas D, Christ T, Fabritz L, Goette A, Hammwöhner M, Heijman J, Kockskämper J, Linz D, Odening KE, Schweizer PA, Wakili R, Voigt N. German Cardiac Society Working Group on Cellular Electrophysiology state-of-the-art paper: impact of molecular mechanisms on clinical arrhythmia management. Clin Res Cardiol 2018; 108:577-599. [PMID: 30306295 DOI: 10.1007/s00392-018-1377-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/24/2018] [Indexed: 12/19/2022]
Abstract
Cardiac arrhythmias remain a common challenge and are associated with significant morbidity and mortality. Effective and safe rhythm control strategies are a primary, yet unmet need in everyday clinical practice. Despite significant pharmacological and technological advances, including catheter ablation and device-based therapies, the development of more effective alternatives is of significant interest to increase quality of life and to reduce symptom burden, hospitalizations and mortality. The mechanistic understanding of pathophysiological pathways underlying cardiac arrhythmias has advanced profoundly, opening up novel avenues for mechanism-based therapeutic approaches. Current management of arrhythmias, however, is primarily guided by clinical and demographic characteristics of patient groups as opposed to individual, patient-specific mechanisms and pheno-/genotyping. With this state-of-the-art paper, the Working Group on Cellular Electrophysiology of the German Cardiac Society aims to close the gap between advanced molecular understanding and clinical decision-making in cardiac electrophysiology. The significance of cellular electrophysiological findings for clinical arrhythmia management constitutes the main focus of this document. Clinically relevant knowledge of pathophysiological pathways of arrhythmias and cellular mechanisms of antiarrhythmic interventions are summarized. Furthermore, the specific molecular background for the initiation and perpetuation of atrial and ventricular arrhythmias and mechanism-based strategies for therapeutic interventions are highlighted. Current "hot topics" in atrial fibrillation are critically appraised. Finally, the establishment and support of cellular and translational electrophysiology programs in clinical rhythmology departments is called for to improve basic-science-guided patient management.
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Affiliation(s)
- Dierk Thomas
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,HCR (Heidelberg Center for Heart Rhythm Disorders), Heidelberg, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.
| | - Torsten Christ
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, UHB NHS Trust, Birmingham, UK.,Department of Cardiovascular Medicine, Division of Rhythmology, University Hospital Münster, Münster, Germany
| | - Andreas Goette
- St. Vincenz-Hospital, Paderborn, Germany.,Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Matthias Hammwöhner
- St. Vincenz-Hospital, Paderborn, Germany.,Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Jordi Heijman
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jens Kockskämper
- Biochemical and Pharmacological Center (BPC) Marburg, Institute of Pharmacology and Clinical Pharmacy, University of Marburg, Marburg, Germany
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.,Experimental Electrophysiology, University Hospital of Saarland, Homburg, Saar, Germany
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute for Experimental Cardiovascular Medicine, Heart Center University of Freiburg, Freiburg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.,Heidelberg Research Center for Molecular Medicine (HRCMM), Heidelberg, Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, Medical Faculty, West German Heart Center, University Hospital Essen, Essen, Germany
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
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