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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [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] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), 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, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA 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 global data, 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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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: 1034] [Impact Index Per Article: 1034.0] [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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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: 2281] [Impact Index Per Article: 1140.5] [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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Atrial Arrhythmias in Patients with Severe COVID-19. Cardiol Res Pract 2021; 2021:8874450. [PMID: 33777449 PMCID: PMC7955658 DOI: 10.1155/2021/8874450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 12/15/2022] Open
Abstract
The number of confirmed COVID-19 cases has increased drastically; however, information regarding the impact of this disease on the occurrence of arrhythmias is scarce. The aim of this study was to determine the impact of COVID-19 on arrhythmia occurrence. This prospective study included patients with COVID-19 treated at the Leishenshan Temporary Hospital of Wuhan City, China, from February 24 to April 5, 2020. Demographic, comorbidity, and arrhythmias data were collected from patients with COVID-19 (n = 84) and compared with control data from patients with bacterial pneumonia (n = 84) infection. Furthermore, comparisons were made between patients with severe and nonsevere COVID-19 and between older and younger patients. Compared with patients with bacterial pneumonia, those with COVID-19 had higher total, mean, and minimum heart rates (all P < 0.01). Patients with severe COVID-19 (severe and critical type diseases) developed more atrial arrhythmias compared with those with nonsevere symptoms. Plasma creatine kinase isoenzyme (CKMB) levels (P=0.01) were higher in the severe group than in the nonsevere group, and there were more deaths in the severe group than in the nonsevere group (6 (15%) vs. 3 (2.30%); P=0.05). Premature atrial contractions (PAC) and nonsustained atrial tachycardia (NSAT) were significantly positively correlated with plasma CKMB levels but not with high-sensitive cardiac troponin I or myoglobin levels. Our data demonstrate that COVID-19 patients have higher total, mean, and minimum heart rates compared with those with bacterial pneumonia. Patients with severe or critical disease had more frequent atrial arrhythmias (including PAC and AF) and higher CKMB levels and mortality than those with nonsevere symptoms.
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Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B, Jędrzejczyk-Patej E, Mazurek M, Podolecki T, Sticherling C, Tfelt-Hansen J, Traykov V, Lip GYH, Fauchier L, Boriani G, Mansourati J, Blomström-Lundqvist C, Mairesse GH, Rubboli A, Deneke T, Dagres N, Steen T, Ahrens I, Kunadian V, Berti S. Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). Europace 2020; 21:1603-1604. [PMID: 31353412 DOI: 10.1093/europace/euz163] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022] Open
Abstract
Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.
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Affiliation(s)
- Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - 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
| | - Davide Capodanno
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Gheorghe-Andrei Dan
- "Carol Davila" University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Elia De Maria
- Ramazzini Hospital, Cardiology Unit, Carpi (Modena), Italy
| | | | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine., Tours, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Georges H Mairesse
- Department of Cardiology - Electrophysiology, Cliniques du Sud Luxembourg - Vivalia, Arlon, Belgium
| | - Andrea Rubboli
- Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Thomas Deneke
- Clinic for Electrophysiology, Rhoen-Clinic Campus Bad Neustadt, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Torkel Steen
- Department of Cardiology, Pacemaker- & ICD-Centre, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Ingo Ahrens
- Department of Cardiology & Intensive Care, Augustinerinnen Hospital, Cologne, Germany
| | - Vijay Kunadian
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Berti
- Department of Cardiology, Fondazione C.N.R. Reg. Toscana G. Monasterio, Heart Hospital, Massa, Italy
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Mavrogeni S, Gargani L, Pepe A, Monti L, Markousis-Mavrogenis G, De Santis M, De Marchi D, Koutsogeorgopoulou L, Karabela G, Stavropoulos E, Katsifis G, Bratis K, Bellando-Randone S, Guiducci S, Bruni C, Moggi-Pignone A, Dimitroulas T, Kolovou G, Bournia VK, Sfikakis PP, Matucci-Cerinic M. Cardiac magnetic resonance predicts ventricular arrhythmias in scleroderma: the Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS). Rheumatology (Oxford) 2020; 59:1938-1948. [PMID: 31764972 PMCID: PMC7382593 DOI: 10.1093/rheumatology/kez494] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/28/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Cardiac rhythm disturbances constitute the most frequent cardiovascular cause of death in SSc. However, electrocardiographic findings are not a part of risk stratification in SSc. We aimed to translate 24 h Holter findings into a tangible risk prediction score using cardiovascular magnetic resonance. METHODS The Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS) was a prospective multicentre study including 150 consecutive SSc patients from eight European centres, assessed with 24 h Holter and cardiovascular magnetic resonance, including ventricular function, oedema (T2 ratio) and late gadolinium enhancement (%LGE). Laboratory/clinical parameters were included in multivariable corrections. A combined endpoint of sustained ventricular tachycardia requiring hospitalization and sudden cardiac death at a median (interquartile range) follow-up of 1 (1.0-1.4) year was generated. RESULTS Only T2 ratio and %LGE were significant predictors of ventricular rhythm disturbances, but not of supraventricular rhythm disturbances, after multivariable correction and adjustment for multiple comparisons. Using decision-tree analysis, we created the SAnCtUS score, a four-category scoring system based on T2 ratio and %LGE, for identifying SSc patients at high risk of experiencing ventricular rhythm disturbance at baseline. Increasing SAnCtUS scores were associated with a greater disease and arrhythmic burden. All cases of non-sustained ventricular tachycardia (n = 7) occurred in patients with the highest SAnCtUS score (=4). Having a score of 4 conveyed a higher risk of reaching the combined endpoint in multivariable Cox regression compared with scores 1/2/3 [hazard ratio (95% CI): 3.86 (1.14, 13.04), P = 0.029] independently of left ventricular ejection fraction and baseline ventricular tachycardia occurrence. CONCLUSION T2 ratio and %LGE had the greatest utility as independent predictors of rhythm disturbances in SSc patients.
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Affiliation(s)
- Sophie Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R, Pisa
| | - Lorenzo Monti
- Department of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Maria De Santis
- Department of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Daniele De Marchi
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R, Pisa
| | | | | | | | - Gikas Katsifis
- Department of Internal Medicine, Navy Hospital, Athens, Greece
| | | | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | | | - Genovefa Kolovou
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
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Ciuffo L, Bruña V, Martínez-Sellés M, de Vasconcellos HD, Tao S, Zghaib T, Nazarian S, Spragg DD, Marine J, Berger RD, Lima JAC, Calkins H, Bayés-de-Luna A, Ashikaga H. Association between interatrial block, left atrial fibrosis, and mechanical dyssynchrony: Electrocardiography-magnetic resonance imaging correlation. J Cardiovasc Electrophysiol 2020; 31:1719-1725. [PMID: 32510679 DOI: 10.1111/jce.14608] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Advanced interatrial block (IAB) on a 12-lead electrocardiogram (ECG) is a predictor of stroke, incident atrial fibrillation (AF), and AF recurrence after catheter ablation. The objective of this study was to determine which features of IAB structural remodeling is associated with left atrium (LA) magnetic resonance imaging structure and function. METHODS/RESULTS We included 152 consecutive patients (23% nonparoxysmal AF) who underwent preprocedural ECG and cardiac magnetic resonance (CMR) in sinus rhythm before catheter ablation of AF. IAB was defined as P-wave duration ≥120 ms, and was considered partial if P-wave was positive and advanced if P-wave had a biphasic morphology in inferior leads. From cine CMR and late gadolinium enhancement, we derived LA maximum and minimum volume indices, strain, LA fibrosis, and LA dyssynchrony. A total of 77 patients (50.7% paroxysmal) had normal P-wave, 52 (34.2%) partial IAB, and 23 (15.1%) advanced IAB. Patients with advanced IAB had significantly higher LA minimum volume index (25.7 vs 19.9 mL/m2 , P = .010), more LA fibrosis (21.9% vs 13.1%, P = .020), and lower LA maximum strain rate (0.99 vs 1.18, P = .007) than those without. Advanced IAB was independently associated with LA (minimum [P = .032] and fibrosis [P = .009]). P-wave duration was also independently associated with LA fibrosis (β = .33; P = .049) and LA mechanical dyssynchrony (β = 2.01; P = .007). CONCLUSION Advanced IAB is associated with larger LA volumes, lower emptying fraction, and more fibrosis. Longer P-wave duration is also associated with more LA fibrosis and higher LA mechanical dyssynchrony.
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Affiliation(s)
- Luisa Ciuffo
- Division of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Vanesa Bruña
- Servicio de Cardiología, CIBERCV, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, CIBERCV, Hospital Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Ciencias Biomédicas, Universidad Europea, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | - Susumu Tao
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tarek Zghaib
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saman Nazarian
- Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David D Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald D Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antonio Bayés-de-Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Hiroshi Ashikaga
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Twenty-five year trends (1986-2011) in hospital incidence and case-fatality rates of ventricular tachycardia and ventricular fibrillation complicating acute myocardial infarction. Am Heart J 2019; 208:1-10. [PMID: 30471486 DOI: 10.1016/j.ahj.2018.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long-term trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of ventricular tachycardia (VT) and ventricular fibrillation (VF) among patients hospitalized with acute myocardial infarction (AMI) have not been recently examined. METHODS We used data from 11,825 patients hospitalized with AMI at all 11 medical centers in central Massachusetts on a biennial basis between 1986 and 2011. Multivariable adjusted logistic regression modeling was used to examine trends in hospital IRs and CFRs of VT and VF complicating AMI. RESULTS The median age of the study population was 71 years, 57.9% were men, and 94.7% were white. The hospital IRs declined from 14.3% in 1986/1988 to 10.5% in 2009/2011 for VT and from 8.2% to 1.7% for VF. The in-hospital CFRs declined from 27.7% to 6.9% for VT and from 49.6% to 36.0% for VF between 1986/1988 and 2009/2011, respectively. The IRs of both early (<48 hours) and late VT and VF declined over time, with greater declines in those of late VT and VF. The incidence rates of VT declined similarly for patients with either an ST-segment elevation myocardial infarction (STEMI) or non-STEMI, whereas they only declined in those with VF and a STEMI. CONCLUSIONS The hospital IRs and CHRs of VT and VF complicating AMI have declined over time, likely because of changes in acute monitoring and treatment practices. Despite these encouraging trends, efforts remain needed to identify patients at risk for these serious ventricular arrhythmias so that preventive and treatment strategies might be implemented as necessary.
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9
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Tran HV, Gore JM, Darling CE, Ash AS, Kiefe CI, Goldberg RJ. Hyperglycemia and risk of ventricular tachycardia among patients hospitalized with acute myocardial infarction. Cardiovasc Diabetol 2018; 17:136. [PMID: 30340589 PMCID: PMC6194566 DOI: 10.1186/s12933-018-0779-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/12/2018] [Indexed: 01/08/2023] Open
Abstract
Background Little is known about the association of hyperglycemia with the development of ventricular tachycardia (VT) in patients hospitalized with acute myocardial infarction (AMI) which we examined in the present study. The objectives of this community-wide observational study were to examine the relation between elevated serum glucose levels at the time of hospital admission for AMI and occurrence of VT, and time of occurrence of VT, during the patient’s acute hospitalization. Methods We used data from a population-based study of patients hospitalized with AMI at all central Massachusetts medical centers between 2001 and 2011. Hyperglycemia was defined as a serum glucose level ≥ 140 mg/dl at the time of hospital admission. The development of VT was identified from physicians notes and electrocardiographic findings by our trained team of data abstractors. Results The average age of the study population was 70 years, 58.0% were men, and 92.7% were non-Hispanic whites. The mean and median serum glucose levels at the time of hospital admission were 171.4 mg/dl and 143.0, respectively. Hyperglycemia was present in 51.9% of patients at the time of hospital admission; VT occurred in 652 patients (15.8%), and two-thirds of these episodes occurred during the first 48 h after hospital admission (early VT). After multivariable adjustment, patients with hyperglycemia were at increased risk for developing VT (adjusted OR = 1.48, 95% CI = 1.23–1.78). The presence of hyperglycemia was significantly associated with early (multivariable adjusted OR = 1.39, 95% CI = 1.11–1.73) but not with late VT. Similar associations were observed in patients with and without diabetes and in patients with and without ST-segment elevation AMI. Conclusions Efforts should be made to closely monitor and treat patients who develop hyperglycemia, especially early after hospital admission, to reduce their risk of VT.
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Affiliation(s)
- Hoang V Tran
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Department of Medicine, Bridgeport Hospital, Yale New Haven, CT, USA
| | - Joel M Gore
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Arlene S Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
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Catheter Ablation of Post-Infarct VT: Mechanisms, Strategies and Outcomes. Heart Lung Circ 2018; 28:76-83. [PMID: 30482686 DOI: 10.1016/j.hlc.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/29/2022]
Abstract
Ventricular arrhythmias are one of the leading causes of death in patients with a prior myocardial infarction. Implantable cardioverter-defibrillators (ICDs) are very effective in the prevention of sudden cardiac death but the risk of recurrence remains an issue since defibrillation does not alter the underlying substrate. Recurrent ICD shocks are distressing and are associated with an increase in mortality. Catheter ablation is an effective treatment for recurrent ventricular tachycardia in these patients, particularly when antiarrhythmic therapy produces side effects or is ineffective. This paper reviews the underlying mechanisms of VT in patients with a prior myocardial infarction, and the indications, strategies and outcomes of catheter ablation.
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Comprehensive arrhythmic surgery for sustained ventricular tachycardia revisited. J Cardiol Cases 2017; 15:122-124. [PMID: 30279757 DOI: 10.1016/j.jccase.2016.12.003] [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: 08/10/2016] [Revised: 11/21/2016] [Accepted: 12/08/2016] [Indexed: 11/21/2022] Open
Abstract
A 68-year-old woman with a history of old inferior myocardial infarction was admitted because of sustained ventricular tachycardia. Double vessel coronary disease was found with subtotal obstruction of the right coronary artery (#1) and severe stenosis of the left circumflex coronary artery (#13). Dilated left ventricle with a large ventricular aneurysm at the inferior wall and severely reduced systolic function were also present. A comprehensive surgical ablation using subendocardial resection and cryoablation was performed in combination with aneurysmectomy, left ventricular reconstruction, and coronary bypass grafting to the circumflex coronary artery. An implantable cardioverter-defibrillator was also implanted. She has remained well without recurrence of sustained ventricular tachycardia for one year. Although radiofrequency catheter ablation is nowadays considered a first-line therapy for patients with sustained ventricular tachycardia, surgical ablation remains a valuable option for selected patients, particularly for those requiring left ventricular aneurysmectomy and coronary artery bypass grafting, in order to gain a better long-term prognosis through total cure of ventricular tachycardia. <Learning objective: Although radiofrequency catheter ablation is nowadays considered a first-line therapy for patients with sustained ventricular tachycardia, surgical ablation remains a valuable option for selected patients, particularly for those requiring left ventricular aneurysmectomy and coronary artery bypass grafting, in order to gain a better long-term prognosis through total cure of ventricular tachycardia.>.
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Masuda M, Nakatani D, Hikoso S, Suna S, Usami M, Matsumoto S, Kitamura T, Minamiguchi H, Okuyama Y, Uematsu M, Yamada T, Iwakura K, Hamasaki T, Sakata Y, Sato H, Nanto S, Hori M, Komuro I, Sakata Y. Clinical Impact of Ventricular Tachycardia and/or Fibrillation During the Acute Phase of Acute Myocardial Infarction on In-Hospital and 5-Year Mortality Rates in the Percutaneous Coronary Intervention Era. Circ J 2016; 80:1539-47. [DOI: 10.1253/circj.cj-16-0183] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masaharu Masuda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
- Cardiovascular Center, Kansai Rosai Hospital
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Masaya Usami
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Sen Matsumoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tetsuhisa Kitamura
- Department of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Hitoshi Minamiguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yuji Okuyama
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | | | - Toshimitsu Hamasaki
- Office of Biostatistics and Data Management, National Cerebral and Cardiovascular Center
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroshi Sato
- School of Human Welfare Studies Health Care Center and Clinic Kwansei Gakuin
| | - Shinsuke Nanto
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine
| | - Masatsugu Hori
- Osaka Prefectural Hospital Organization, Osaka Medical Center for Cancer and Cardiovascular Disease
| | - Issei Komuro
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Bodi V, Monmeneu JV, Ortiz-Perez JT, Lopez-Lereu MP, Bonanad C, Husser O, Minana G, Gomez C, Nunez J, Forteza MJ, Hervas A, de Dios E, Moratal D, Bosch X, Chorro FJ. Prediction of Reverse Remodeling at Cardiac MR Imaging Soon after First ST-Segment-Elevation Myocardial Infarction: Results of a Large Prospective Registry. Radiology 2015; 278:54-63. [PMID: 26348232 DOI: 10.1148/radiol.2015142674] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To assess predictors of reverse remodeling by using cardiac magnetic resonance (MR) imaging soon after ST-segment-elevation myocardial infarction (STEMI). MATERIALS AND METHODS Written informed consent was obtained from all patients, and the study protocol was approved by the institutional committee on human research, ensuring that it conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Five hundred seven patients (mean age, 58 years; age range, 24-89 years) with a first STEMI were prospectively studied. Infarct size and microvascular obstruction (MVO) were quantified at late gadolinium-enhanced imaging. Reverse remodeling was defined as a decrease in left ventricular (LV) end-systolic volume index (LVESVI) of more than 10% from 1 week to 6 months after STEMI. For statistical analysis, a simple (from a clinical perspective) multiple regression model preanalyzing infarct size and MVO were applied via univariate receiver operating characteristic techniques. RESULTS Patients with reverse remodeling (n = 211, 42%) had a lesser extent (percentage of LV mass) of 1-week infarct size (mean ± standard deviation: 18% ± 13 vs 23% ± 14) and MVO (median, 0% vs 0%; interquartile range, 0%-1% vs 0%-4%) than those without reverse remodeling (n = 296, 58%) (P < .001 in pairwise comparisons). The independent predictors of reverse remodeling were infarct size (odds ratio, 0.98; 95% confidence interval [CI]: 0.97, 0.99; P = .04) and MVO (odds ratio, 0.92; 95% CI: 0.86, 0.99; P = .03). Once infarct size and MVO were dichotomized by using univariate receiver operating characteristic techniques, the only independent predictor of reverse remodeling was the presence of simultaneous nonextensive infarct-size MVO (infarct size < 30% of LV mass and MVO < 2.5% of LV mass) (odds ratio, 3.2; 95% CI: 1.8, 5.7; P < .001). CONCLUSION Assessment of infarct size and MVO with cardiac MR imaging soon after STEMI enables one to make a decision in the prediction of reverse remodeling.
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Affiliation(s)
- Vicente Bodi
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Jose V Monmeneu
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Jose T Ortiz-Perez
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Maria P Lopez-Lereu
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Clara Bonanad
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Oliver Husser
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Gemma Minana
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Cristina Gomez
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Julio Nunez
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Maria J Forteza
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Arantxa Hervas
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Elena de Dios
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - David Moratal
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Xavier Bosch
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
| | - Francisco J Chorro
- From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.)
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Temporal Evolution and Implications of Ventricular Arrhythmias Associated With Acute Myocardial Infarction. Cardiol Rev 2013; 21:289-94. [DOI: 10.1097/crd.0b013e3182a46fc6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ruwald ACH, Bloch Thomsen PE, Gang U, Jørgensen RM, Huikuri HV, Jons C. New-onset atrial fibrillation predicts malignant arrhythmias in post-myocardial infarction patients--a Cardiac Arrhythmias and RIsk Stratification after acute Myocardial infarction (CARISMA) substudy. Am Heart J 2013; 166:855-63.e3. [PMID: 24176441 DOI: 10.1016/j.ahj.2013.08.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/17/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND After myocardial infarction (MI) the risk of sudden cardiac death due to arrhythmias is substantial. OBJECTIVE The purpose of this study was to investigate if new-onset atrial fibrillation (AF) is associated with development of potential malignant brady- and tachyarrhythmias after an acute MI. METHODS The study included 277 post-MI patients from the CARISMA study with left ventricular ejection fraction ≤ 40%, New York Heart Association class I, II, or III and no history of AF. All patients were implanted with an implantable cardiac monitor within 4 to 27 days after an acute MI and followed every 3 months for 2 years. Time-dependent association between new-onset AF > 30 s and the development of bradyarrhythmias and/or ventricular tachyarrhythmias were investigated using Cox proportional hazard regressions. RESULTS New-onset AF was associated with an increased risk of bradyarrhythmias when adjusting for male gender and baseline age, left ventricular ejection fraction and QRS width (HR = 2.8 [1.3-5.8], P = .006). Similarly, new-onset AF predicted ventricular tachyarrhythmias when adjusting for New York Heart Association class ≥ II and baseline QRS width (HR = 2.3 [1.2-4.4], P = .019). After dividing ventricular tachyarrhythmias into subgroups of non-sustained ventricular tachycardia (VT), sustained VT and ventricular fibrillation (VF), new-onset AF was significantly associated with an increased risk of non-sustained- and sustained VT but not VF (non-sustained VT: HR = 3.5 [1.7-7.2], P < .001, sustained VT: HR = 4.2 [1.1-15.7], P = .035, VF: HR = 1.1 [0.2-5.8], P = .877). CONCLUSION In patients surviving a MI with reduced left ventricular systolic function, new-onset AF is associated with a significantly increased risk of developing ventricular brady- and tachyarrhythmias.
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Affiliation(s)
- Anne-Christine Huth Ruwald
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark; University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY.
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Mirza M, Strunets A, Shen WK, Jahangir A. Mechanisms of arrhythmias and conduction disorders in older adults. Clin Geriatr Med 2013; 28:555-73. [PMID: 23101571 DOI: 10.1016/j.cger.2012.08.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aging is associated with an increased prevalence of cardiac arrhythmias, which contribute to higher morbidity and mortality in the elderly. The frequency of cardiac arrhythmias, particularly atrial fibrillation and ventricular tachyarrhythmia, is projected to increase as the population ages, greatly impacting health care resource utilization. Several clinical factors associated with the risk of arrhythmias have been identified in the population, yet the molecular bases for the increased predisposition to arrhythmogenesis in the elderly are not fully understood. This review highlights the epidemiology of cardiac dysrhythmias, changes in cardiac structure and function associated with aging, and the basis for arrhythmogenesis in the elderly.
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Affiliation(s)
- Mahek Mirza
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora University of Wisconsin Medical Group, Aurora Health Care, 3033 South 27th Street, Milwaukee, WI 53215, USA
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Timmer JR, Breet N, Svilaas T, Haaksma J, Van Gelder IC, Zijlstra F. Predictors of ventricular tachyarrhythmia in high-risk myocardial infarction patients treated with primary coronary intervention. Neth Heart J 2011; 18:122-8. [PMID: 20390062 DOI: 10.1007/bf03091750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background. We investigated the association between clinical characteristics, angiographic data and ventricular arrhythmia in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI)Methods. In patients with STEMI (n=225), a Holter analysis was performed the first 12 hours after primary PCI.Results. A total of 151 (66%) patients had >/=1 episode of ventricular tachycardia (VT). Age <70 years (RR 4.9, 95% CI 1.8 to 12.7), TIMI 0-1 pre-PCI (RR 2.6, 95% CI 1.1 to 6.1) and peak CK (RR 3.5, 95% CI 1.9 to 5.8) were independent predictors of VT. One-year mortality was 7%, no association between mortality and presence of early VT was found.Conclusion. Ventricular tachycardia is common in the first 12 hours after primary PCI for STEMI. Independent predictors of VT are younger age, TIMI 0-1 flow prior to PCI and larger infarct size. The presence of early VT was not significantly associated with one-year mortality. (Neth Heart J 2010;18:122-8.).
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Affiliation(s)
- J R Timmer
- Department of Cardiology, Thorax Center, University Medical Center Groningen, Groningen; currently: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
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Alaiti MA, Ishikawa M, Costa MA. Bone marrow and circulating stem/progenitor cells for regenerative cardiovascular therapy. Transl Res 2010; 156:112-29. [PMID: 20801408 DOI: 10.1016/j.trsl.2010.06.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/23/2010] [Accepted: 06/23/2010] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease is the leading cause of death and disability in the Western world. In addition to the advancement of current therapeutic approaches to reduce the associated morbidity and mortality, regenerative medicine and cell-based therapy have been areas of continuous investigation. Circulating and bone-marrow-derived stem or endothelial progenitor cells are an attractive source for regenerative therapy in the cardiovascular field. In this review, we highlight the advantages and limitations of this approach with a focus on key observations from animal studies and clinical trials.
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Affiliation(s)
- Mohamad Amer Alaiti
- Division of Cardiovascular Medicine, Harrington-McLaughlin Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH 44106-5038, USA.
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Osmancik PP, Stros P, Herman D. In‐hospital arrhythmias in patients with acute myocardial infarction—the relation to the reperfusion strategy and their prognostic impact. ACTA ACUST UNITED AC 2009; 10:15-25. [DOI: 10.1080/17482940701474478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haqqani HM, Kalman JM, Roberts-Thomson KC, Balasubramaniam RN, Rosso R, Snowdon RL, Sparks PB, Vohra JK, Morton JB. Fundamental Differences in Electrophysiologic and Electroanatomic Substrate Between Ischemic Cardiomyopathy Patients With and Without Clinical Ventricular Tachycardia. J Am Coll Cardiol 2009; 54:166-73. [DOI: 10.1016/j.jacc.2009.04.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 03/30/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
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Zareba KM, Shenkman HJ, Bisognano JD. Predictive Value of Admission Electrocardiography in Patients With Heart Failure. ACTA ACUST UNITED AC 2008; 14:173-9. [DOI: 10.1111/j.1751-7133.2008.07528.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bartunek J, Vanderheyden M, Wijns W, Timmermans F, Vandekerkhove B, Villa A, Sánchez PL, Arnold R, San Román JA, Heyndrickx G, Fernandez-Aviles F. Bone-marrow-derived cells for cardiac stem cell therapy: safe or still under scrutiny? ACTA ACUST UNITED AC 2007; 4 Suppl 1:S100-5. [PMID: 17230205 DOI: 10.1038/ncpcardio0744] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 11/01/2006] [Indexed: 01/14/2023]
Abstract
Cardiac stem cell therapy with bone-marrow-derived stem cells is a promising approach to facilitate myocardial regeneration after acute myocardial infarction or in congestive heart failure. The clinical data currently available seem to indicate that this approach is safe and is not associated with an increase in the number of adverse clinical events; nevertheless, the level of safety confidence is limited because of the small number of patients who have been treated and the absence of long-term clinical follow-up data. In order to establish the clinical safety of cardiac stem cell therapy, it will be necessary to collect additional data from both previous and ongoing clinical trials in subsets of patients relative to their background risk. Several conceptual safety concerns should also be addressed. These concerns relate to a number of operational mechanisms and include biological effects on differentiation, remote homing of transplanted stem cells, progression of atherosclerosis, and arrhythmias. The proactive scrutiny of these phenomena could eventually facilitate the translation of the promise of cardiac regeneration into a safe and effective therapy.
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Affiliation(s)
- Jozef Bartunek
- Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, 9 300 Aalst, Belgium.
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Guías de Práctica Clínica del ACC/AHA/ESC 2006 sobre el manejo de pacientes con arritmias ventriculares y la prevención de la muerte cardiaca súbita.Versión resumida. Rev Esp Cardiol 2006. [DOI: 10.1157/13096582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247-346. [PMID: 16949478 DOI: 10.1016/j.jacc.2006.07.010] [Citation(s) in RCA: 863] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death—Executive Summary. Circulation 2006. [DOI: 10.1161/circulationaha.106.178104] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Myerburg RJ, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Moss AJ, Priori SG, Antman EM, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death—Executive Summary. J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e385-484. [PMID: 16935995 DOI: 10.1161/circulationaha.106.178233] [Citation(s) in RCA: 807] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Petrina M, Goodman SG, Eagle KA. The 12-lead electrocardiogram as a predictive tool of mortality after acute myocardial infarction: current status in an era of revascularization and reperfusion. Am Heart J 2006; 152:11-8. [PMID: 16824827 DOI: 10.1016/j.ahj.2005.11.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 11/11/2005] [Indexed: 12/22/2022]
Abstract
Many recently published studies established the admission electrocardiogram as an excellent source of prognostic information in patients presenting with acute myocardial infarction. Using our search criteria, we identified a large number of articles but selected only the most relevant in each category. The best predictors of increased short-term mortality are ventricular tachycardia (odds ratio [OR] 6.1, 95% CI 4.6-8.3), ST-segment deviations (OR 5.1, 95% CI 4.6-8.3), high-degree atrioventricular block (OR 5.1, 95% CI 2.1-11.9), and long QRS duration (OR 4.2, 95% CI 1.8-10.4). For increased long-term mortality, the best predictors were ST-segment depression (OR 5.7, 95% CI 2.8-11.6), ST-segment elevation (OR 3.3, 95% CI 2.1-5.1), and left bundle-branch block (OR 2.8, 95% CI 1.8-4.3). In addition, our review discusses electrocardiographic markers of poor outcome that were not independent risk factors on multivariate analysis, conflicting findings, and knowledge gaps that can help plan future research efforts.
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Affiliation(s)
- Mircea Petrina
- University of Michigan Medical Center, Ann Arbor, MI, USA.
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Henkel DM, Witt BJ, Gersh BJ, Jacobsen SJ, Weston SA, Meverden RA, Roger VL. Ventricular arrhythmias after acute myocardial infarction: a 20-year community study. Am Heart J 2006; 151:806-12. [PMID: 16569539 DOI: 10.1016/j.ahj.2005.05.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Accepted: 05/12/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although myocardial infarction (MI) severity is declining, the occurrence of ventricular arrhythmia (VA) after MI and its effect on outcome is unknown. This study was undertaken to examine the frequency and timing of VA and the effect of VA on mortality after MI. METHODS Myocardial infarctions recorded between 1979 and 1998 were validated. Baseline characteristics, occurrence of VA, and survival were determined. Ventricular arrhythmias were categorized as primary ventricular fibrillation (VF), nonprimary VF, and ventricular tachycardia (VT). Logistic regression was used to analyze associations between VA and baseline characteristics. Temporal trends were assessed with the Mantel-Haenszel chi2. Survival was analyzed with the Kaplan-Meier method. Proportional hazards regression was used to examine the association between death and occurrence of VA. RESULTS Among 2317 persons with incident MI, 7.5% experienced VA (3.6% nonprimary VF, 2.1% primary VF, 1.8% VT). Ventricular arrhythmia-associated factors were younger age, female sex, higher Killip class, ST elevation, and atrial fibrillation. Ventricular arrhythmias were associated with increased risk of death at 30 days. CONCLUSION Ventricular arrhythmias after MI are relatively common, particularly among persons with more severe MI and no prior history of coronary disease. Over time, the incidence of VF declined, whereas VT did not change. Ventricular arrhythmia after MI was associated with a 6-fold increase in morality. Thus, identification of high-risk MI survivors and prevention of VA could markedly improve outcomes. Further studies are needed to determine the cause of the shift in distribution of VA subtype.
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Abstract
Cardiac arrhythmias routinely manifest during or following an acute coronary syndrome (ACS). Although the incidence of arrhythmia is directly related to the type of ACS the patient is experiencing, the clinician needs to be cautious with all patients in these categories. As an example, nearly 90% of patients who experience acute myocardial infarction (AMI) develop some cardiac rhythm abnormality and 25% have a cardiac conduction disturbance within 24 hours of infarct onset. In this patient population, the incidence of serious arrhythmias, such as ventricular fibrillation (4.5%) ,is greatest in the first hour of an AMI and declines rapidly thereafter. This article addresses the identification and treatment of arrhythmias and conduction disturbances that complicate the course of patients who have ACS, particularly AMI and thrombolysis. Emphasis is placed on mechanisms and therapeutic strategies.
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Affiliation(s)
- Andrew D Perron
- Department of Emergency Medicine, Maine Medical Center, Portland, 04102, USA.
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