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Moiz A, Zolotarova T, Eisenberg MJ. Outpatient management of essential hypertension: a review based on the latest clinical guidelines. Ann Med 2024; 56:2338242. [PMID: 38604225 PMCID: PMC11011233 DOI: 10.1080/07853890.2024.2338242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Background: Essential hypertension, a prevalent cardiovascular condition, poses a significant health burden worldwide. Based on the latest American clinical guidelines, half of adults in the United States have hypertension. Of these, only about a half are treated and about a quarter are adequately controlled for hypertension. Given its impact on morbidity and mortality, ensuring effective management of high blood pressure is crucial to reduce associated risks and improve patient outcomes.Objective: This review aims to provide a comprehensive and up-to-date summary of the latest cardiology guidelines and evidence-based research on essential hypertension, with a focus on guiding outpatient clinical practice.Methods: The review evaluates both non-pharmacological approaches and pharmacological interventions to offer clinicians practical insights. Notably, it emphasizes the importance of individualized treatment plans tailored to patients' specific risk profiles and comorbidities.Results: By consolidating the latest advancements in hypertension management, this review provides clinicians with an up-to-date reference, offering a nuanced understanding of treatment goals and strategies.Conclusion: Through the incorporation of evidence-based recommendations, healthcare practitioners can optimize patient care, mitigate potential complications, and improve overall outcomes in essential hypertension.
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Affiliation(s)
- Areesha Moiz
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Tetiana Zolotarova
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Mark J. Eisenberg
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
- Department of Medicine and Health Sciences, McGill University, Montreal, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada
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2
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1239-e1311. [PMID: 38718139 DOI: 10.1161/cir.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victor A Ferrari
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
- SCMR representative
| | | | - Sadiya S Khan
- ACC/AHA Joint Committee on Performance Measures representative
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3
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García-Lara RA, Suleiman-Martos S, Dominguez-Vías G, Romero-Béjar JL, Garcia-Morales V, Gómez-Urquiza JL, Suleiman-Martos N. Impact effects of COVID-19 pandemic on chronic disease patients: A longitudinal prospective study. J Clin Nurs 2024; 33:2226-2236. [PMID: 38476057 DOI: 10.1111/jocn.17104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/11/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
AIMS To assess the effects of COVID-19 pandemic on clinical variables as part of the routine clinical monitoring of patients with chronic diseases in primary care. DESIGN A prospective longitudinal study was conducted in primary care centres of the Andalusian Health Service. METHODS Data were recorded before the pandemic (T1), during the declaration of the state of emergency (T2) and in the transition phase (T3). The Barthel index and the Short Portable Mental Status Questionnaire (SPMSQ) were used to analyse functional and cognitive changes at the three time points. HbA1c, systolic and diastolic blood pressure, heart rate, BMI and lipid levels were assessed as clinical variables. Descriptive statistics and non-parametric chi-square test were used for analysis. STROBE checklist was used for the preparation of this paper. RESULTS A total fo148 patients with chronic conditions were included in the analysis. Data analysis revealed in T2 only significant reductions in BMI, total levels of cholesterol and HDL during the onset of the pandemic. Barthel Index, SPMSQ, blood pressure and triglycerides and LDL levels worsened in T2, and the negative effects were maintained in T3. Compared to pre-pandemic values, HbA1c levels improved in T3, but HDL levels worsened. CONCLUSIONS COVID-19 has drastically disrupted several functional, cognitive and biological variables. These results may be useful in identifying clinical parameters that deserve closer attention in the case of a new health crisis. Further studies are needed to assess the potential impacts of each specific chronic condition. IMPACT Cognitive and functional status, blood pressure and triglycerides and LDL levels worsen in short term, maintaining the negative effects in medium-term.
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Affiliation(s)
- Rubén A García-Lara
- Íllora Health Center, Granada-Metropolitan Health District, Andalusian Health Service, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Spain
| | | | - Germán Dominguez-Vías
- Physiology Department, Ceuta Faculty of Health Sciences, University of Granada, Ceuta, Spain
| | | | - Victoria Garcia-Morales
- Biomedicine, Biotechnology and Public Health Department, Physiology Area, Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | | | - Nora Suleiman-Martos
- Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
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4
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Cheng RK, Kittleson MM, Beavers CJ, Birnie DH, Blankstein R, Bravo PE, Gilotra NA, Judson MA, Patton KK, Rose-Bovino L. Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1197-e1216. [PMID: 38634276 DOI: 10.1161/cir.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.
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5
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Nicmanis M, Holmes J, Oxlad M, Chur-Hansen A. Patient Information Needs and Decision-Making Before a Cardiac Implantable Electronic Device: A Qualitative Study Utilizing Social Media Data. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10024-6. [PMID: 38773048 DOI: 10.1007/s10880-024-10024-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 05/23/2024]
Abstract
The decision to receive a cardiac implantable electronic device (CIED) represents a challenging experience for patients. However, the majority of previous research has only considered retrospective accounts of patient experiences. This study aimed to use social media data to characterize the information sought by people anticipating or considering CIED implantation and factors that influence their decision-making experiences. A Python-based script was used to collect posts made to a community intended for discussions concerning CIEDs on the social media platform Reddit. Reflexive content analysis was used to analyze the collected data. From 799 posts collected, 101 made by 86 participants were analyzed. The reported median (range) age of participants was 34 (16-67), and most were anticipating or considering a pacemaker. Three overarching categories classified the data: "Use of social media to meet informational and other needs"; "Factors influencing acceptance of the need for implantation"; and "Specific concerns considered during decision-making." Participants anticipating or considering a CIED predominantly sought experiential information. Among asymptomatic participants, doubts were prevalent, with acceptance being an influential factor in decision-making. Healthcare professionals should recognize the informational and emotional needs of prospective CIED patients and tailor support mechanisms to better facilitate their decision-making.
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Affiliation(s)
- Mitchell Nicmanis
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Level 5, Hughes Building North Terrace Campus, Adelaide, SA, 5000, Australia.
| | - Joshua Holmes
- School of Computer and Mathematical Sciences, Faculty of Sciences, Engineering and Technology, The University of Adelaide, Adelaide, SA, Australia
| | - Melissa Oxlad
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Level 5, Hughes Building North Terrace Campus, Adelaide, SA, 5000, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Level 5, Hughes Building North Terrace Campus, Adelaide, SA, 5000, Australia
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6
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Zhang G, He S, Lin L, Gan P. Infection with COVID-19 Complicated by Sinus Arrest. Case Rep Infect Dis 2024; 2024:5361758. [PMID: 38784432 PMCID: PMC11115995 DOI: 10.1155/2024/5361758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
As a respiratory tract-transmitted disease, coronavirus disease 2019 (COVID-19) exerts a profound immune injury effect, leading not only to pulmonary impairment but also to cardiac complications. We present a case of a 79-year-old woman, who had previously contracted COVID-19 and subsequently developed sinus arrest (SA) following her second infection. The longest asystole time detected by Holter monitoring was 7.2 seconds. Although the patient met criteria for permanent pacemaker implantation, her family declined this intervention and conservative management was pursued instead. However, after a period of observation, the patient's SA resolved. The present case study describes a patient who experienced SA upon reinfection with COVID-19, which was not present during the initial infection. It emphasizes the impact of COVID-19 on cardiac health, particularly its potential to induce arrhythmias. In addition, it is worth noting that the arrhythmia induced by a COVID-19 infection may show reversibility, suggesting that a permanent pacemaker might not be the priority option if further pacing therapy is being considered.
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Affiliation(s)
- Guojun Zhang
- Department of Infectious Disease, The First People's Hospital of Fuyang Hangzhou, Fuyang District, Hangzhou, Zhejiang, China
| | - Shuai He
- Department of Hand and Foot Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai District, Taizhou, Zhejiang, China
| | - Lu Lin
- Department of Intensive Care Rehabilitation, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Luqiao District, Taizhou, Zhejiang, China
| | - Pengcheng Gan
- Department of Intensive Care Rehabilitation, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Luqiao District, Taizhou, Zhejiang, China
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7
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Ouchida S, Parratt K, Nikpour A, Fairbrother G. Syncope vs. Seizure: Ictal Bradycardia and Ictal Asystole. Case Rep Neurol Med 2024; 2024:1299282. [PMID: 38741705 PMCID: PMC11090674 DOI: 10.1155/2024/1299282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Background Ictal arrhythmia is a rare condition that causes arrhythmic manifestations induced by epileptic seizures, including asystole or bradycardia. Ictal asystole (IA) is a very rare condition found in patients undergoing video-encephalography (EEG) monitoring. It is often related to temporal lobe epilepsy and can cause syncope, which can lead to injury or even death. Case Presentation. Two patients with epilepsy showed symptoms of syncope. Both patients underwent 4-day ambulatory EEG tests and were diagnosed with IA. Following the tests, the patients were implanted with a permanent pacemaker, and one of them underwent a temporal lobectomy. As a result of these procedures, the patients experienced a reduction in episodes of symptomatic syncope. Conclusion Patients with ictal asystole and symptomatic ictal bradycardia are at increased risk of falls due to seizures. Although there are no specific guidelines for managing this condition, antiseizure medications, epilepsy surgery, and cardiac pacemaker implantation have been effective treatments.
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Affiliation(s)
- Sumika Ouchida
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kaitlyn Parratt
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- The University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Armin Nikpour
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- The University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Greg Fairbrother
- School of Health & Human Sciences, Southern Cross University, Sydney, NSW, Australia
- Patient and Family-Centred Care Research, Sydney Local Health District, Sydney, NSW, Australia
- School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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8
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Kouz K, Thiele R, Michard F, Saugel B. Haemodynamic monitoring during noncardiac surgery: past, present, and future. J Clin Monit Comput 2024:10.1007/s10877-024-01161-2. [PMID: 38687416 DOI: 10.1007/s10877-024-01161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
During surgery, various haemodynamic variables are monitored and optimised to maintain organ perfusion pressure and oxygen delivery - and to eventually improve outcomes. Important haemodynamic variables that provide an understanding of most pathophysiologic haemodynamic conditions during surgery include heart rate, arterial pressure, central venous pressure, pulse pressure variation/stroke volume variation, stroke volume, and cardiac output. A basic physiologic and pathophysiologic understanding of these haemodynamic variables and the corresponding monitoring methods is essential. We therefore revisit the pathophysiologic rationale for intraoperative monitoring of haemodynamic variables, describe the history, current use, and future technological developments of monitoring methods, and finally briefly summarise the evidence that haemodynamic management can improve patient-centred outcomes.
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Affiliation(s)
- Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Robert Thiele
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | | | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
- Outcomes Research Consortium, Cleveland, OH, USA.
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9
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Kalsi J, Suffredini J, Pickett JK, Alam M, Kayani W, Jia X. Ischemic Evaluation and Revascularization in Patients Presenting With Advanced Atrioventricular Block Without Concomitant Acute Myocardial Infarction. Tex Heart Inst J 2024; 51:e238257. [PMID: 38665004 DOI: 10.14503/thij-23-8257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Jasmeet Kalsi
- Department of Medicine, Henry Ford Hospital, Detroit, Michigan
| | - John Suffredini
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - June K Pickett
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Waleed Kayani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Xiaoming Jia
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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10
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Xu Z, Chang Q, Liu R. Unusual Tachycardia in a Patient With Chest Pain and Bradycardia. JAMA Intern Med 2024; 184:437-438. [PMID: 38407870 DOI: 10.1001/jamainternmed.2023.7858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
This case report describes a patient in their 50s who presented with squeezing chest pain for 4 hours and an initial electrocardiogram showing acute inferior wall and right ventricular infarction with third-degree atrioventricular block.
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Affiliation(s)
- Zhaolong Xu
- Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Qinghua Chang
- Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Renguang Liu
- Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
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11
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Zhang Y, Liu T, Yan GX. Distinct electrocardiographic findings of a drug-drug interaction. BMJ 2024; 384:e077088. [PMID: 38548286 DOI: 10.1136/bmj-2023-077088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Yubin Zhang
- Department of Electrocardiogram, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gan-Xin Yan
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, PA, USA
- Fuwai Huazhong Hospital, Chinese Academy of Medical Sciences, Zhengzhou, Henan, China
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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12
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Ruberg FL, Maurer MS. Cardiac Amyloidosis Due to Transthyretin Protein: A Review. JAMA 2024; 331:778-791. [PMID: 38441582 DOI: 10.1001/jama.2024.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Importance Systemic amyloidosis from transthyretin (ATTR) protein is the most common type of amyloidosis that causes cardiomyopathy. Observations Transthyretin (TTR) protein transports thyroxine (thyroid hormone) and retinol (vitamin A) and is synthesized predominantly by the liver. When the TTR protein misfolds, it can form amyloid fibrils that deposit in the heart causing heart failure, heart conduction block, or arrhythmia such as atrial fibrillation. The biological processes by which amyloid fibrils form are incompletely understood but are associated with aging and, in some patients, affected by inherited variants in the TTR genetic sequence. ATTR amyloidosis results from misfolded TTR protein deposition. ATTR can occur in association with normal TTR genetic sequence (wild-type ATTR) or with abnormal TTR genetic sequence (variant ATTR). Wild-type ATTR primarily manifests as cardiomyopathy while ATTR due to a genetic variant manifests as cardiomyopathy and/or polyneuropathy. Approximately 50 000 to 150 000 people in the US have heart failure due to ATTR amyloidosis. Without treatment, heart failure due to ATTR amyloidosis is associated with a median survival of approximately 5 years. More than 130 different inherited genetic variants in TTR exist. The most common genetic variant is Val122Ile (pV142I), an allele with an origin in West African countries, that is present in 3.4% of African American individuals in the US or approximately 1.5 million persons. The diagnosis can be made using serum free light chain assay and immunofixation electrophoresis to exclude light chain amyloidosis combined with cardiac nuclear scintigraphy to detect radiotracer uptake in a pattern consistent with amyloidosis. Loop diuretics, such as furosemide, torsemide, and bumetanide, are the primary treatment for fluid overload and symptomatic relief of patients with ATTR heart failure. An ATTR-directed therapy that inhibited misfolding of the TTR protein (tafamidis, a protein stabilizer), compared with placebo, reduced mortality from 42.9% to 29.5%, reduced hospitalizations from 0.7/year to 0.48/year, and was most effective when administered early in disease course. Conclusions and Relevance ATTR amyloidosis causes cardiomyopathy in up to approximately 150 000 people in the US and tafamidis is the only currently approved therapy. Tafamidis slowed progression of ATTR amyloidosis and improved survival and prevented hospitalization, compared with placebo, in people with ATTR-associated cardiomyopathy.
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Affiliation(s)
- Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, Massachusetts
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Mathew S Maurer
- Cardiac Amyloidosis Program, Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, and NewYork-Presbyterian Hospital, New York
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Saugel B, Annecke T, Bein B, Flick M, Goepfert M, Gruenewald M, Habicher M, Jungwirth B, Koch T, Kouz K, Meidert AS, Pestel G, Renner J, Sakka SG, Sander M, Treskatsch S, Zitzmann A, Reuter DA. Intraoperative haemodynamic monitoring and management of adults having non-cardiac surgery: Guidelines of the German Society of Anaesthesiology and Intensive Care Medicine in collaboration with the German Association of the Scientific Medical Societies. J Clin Monit Comput 2024:10.1007/s10877-024-01132-7. [PMID: 38381359 DOI: 10.1007/s10877-024-01132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/22/2024]
Abstract
Haemodynamic monitoring and management are cornerstones of perioperative care. The goal of haemodynamic management is to maintain organ function by ensuring adequate perfusion pressure, blood flow, and oxygen delivery. We here present guidelines on "Intraoperative haemodynamic monitoring and management of adults having non-cardiac surgery" that were prepared by 18 experts on behalf of the German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin; DGAI).
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Outcomes Research Consortium, Cleveland, OH, USA.
| | - Thorsten Annecke
- Department of Anesthesiology and Intensive Care Medicine, Cologne Merheim Medical Center, Hospital of the University of Witten/Herdecke, Cologne, Germany
| | - Berthold Bein
- Department for Anaesthesiology, Asklepios Hospital Hamburg St. Georg, Hamburg, Germany
| | - Moritz Flick
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Goepfert
- Department of Anaesthesiology and Intensive Care Medicine, Alexianer St. Hedwigkliniken Berlin, Berlin, Germany
| | - Matthias Gruenewald
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Amalie Sieveking Krankenhaus, Hamburg, Germany
| | - Marit Habicher
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany
| | - Bettina Jungwirth
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany
| | - Tilo Koch
- Department of Anesthesiology and Intensive Care, Philipps-University Marburg, Marburg, Germany
| | - Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Agnes S Meidert
- Department of Anaesthesiology, University Hospital LMU Munich, Munich, Germany
| | - Gunther Pestel
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Jochen Renner
- Department of Anesthesiology and Intensive Care Medicine, Municipal Hospital Kiel, Kiel, Germany
| | - Samir G Sakka
- Department of Intensive Care Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, Academic Teaching Hospital of the Johannes Gutenberg University Mainz, Koblenz, Germany
| | - Michael Sander
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Amelie Zitzmann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Centre of Rostock, Rostock, Germany
| | - Daniel A Reuter
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Centre of Rostock, Rostock, Germany
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14
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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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15
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Petzl AM, Epstein AE, Guandalini GS. Less Obvious Than One Might Think: Why Is There Grouped Beating? Circulation 2024; 149:481-483. [PMID: 38315765 DOI: 10.1161/circulationaha.123.068252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Adrian M Petzl
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Andrew E Epstein
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Gustavo S Guandalini
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia
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16
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González-Matos CE, Rodríguez-Queralto O, Záraket F, Jiménez J, Casteigt B, Vallès E. Conduction System Stimulation to Avoid Left Ventricle Dysfunction. Circ Arrhythm Electrophysiol 2024; 17:e012473. [PMID: 38284238 DOI: 10.1161/circep.123.012473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Right ventricular apical pacing (RVAP) can produce left ventricle dysfunction. Conduction system pacing (CSP) has been used successfully to reverse left ventricle dysfunction in patients with left bundle branch block. To date, data about CSP prevention of left ventricle dysfunction in patients with preserved left ventricular ejection fraction (LVEF) are scarce and limited mostly to nonrandomized studies. Our aim is to demonstrate that CSP can preserve normal ventricular function compared with RVAP in the setting of a high burden of ventricular pacing. METHODS Consecutive patients with a high-degree atrioventricular block and preserved or mildly deteriorated LVEF (>40%) were included in this prospective, randomized, parallel, controlled study, comparing conventional RVAP versus CSP. RESULTS Seventy-five patients were randomized, with no differences between basal characteristics in both groups. The stimulated QRS duration was significantly longer in the RVAP group compared with the CSP group (160.4±18.1 versus 124.2±20.2 ms; p<0.01). Seventy patients were included in the intention-to-treat analyses. LVEF showed a significant decrease in the RVAP group at 6 months compared with the CSP group (mean difference, -5.8% [95% CI, -9.6% to -2%]; P<0.01). Left ventricular end-diastolic diameter showed an increase in the RVAP group compared with the CSP group (mean difference, 3.2 [95% CI, 0.1-6.2] mm; P=0.04). Heart failure-related admissions were higher in the RVAP group (22.6% versus 5.1%; P=0.03). CONCLUSIONS Conduction system stimulation prevents LVEF deterioration and heart failure-related admissions in patients with normal or mildly deteriorated LVEF requiring a high burden of ventricular pacing. These results are only short term and need to be confirmed by further larger studies. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT06026683.
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Affiliation(s)
- Carlos E González-Matos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain (C.E.G.-M., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Universitat Pompeu Fabra, Barcelona, Spain (C.E.G.-M., E.V.)
| | - Oriol Rodríguez-Queralto
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Fátima Záraket
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Jesús Jiménez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Benjamín Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain (C.E.G.-M., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Universitat Pompeu Fabra, Barcelona, Spain (C.E.G.-M., E.V.)
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Menexi C, ElRefai M, Abouelasaad M, Chua AYT, Handa I, Newbery C, Hoskins N, Ullah W, Yue A, Roberts PR, Paisey J. Role of routine investigations post cardiac devices implants in detecting peri-procedural complications: A retrospective analysis from a tertiary UK center. Pacing Clin Electrophysiol 2024; 47:195-202. [PMID: 38214035 DOI: 10.1111/pace.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Peri-procedural complications associated with cardiac implantable electronic devices are not uncommon. European Society of Cardiology guidelines recommend device checks of all devices within 72 h of implant. European Heart Rhythm Association expert practical guide on Cardiac implantable electronic devices (CIEDs) recommend that a chest x-ray (CXR) should be performed within 24 h to rule out pneumothorax and document lead positions. First, the rate of peri-procedural complications associated with CIED implants at our center, as well as patient and/or procedural-related factors that are associated with higher rates of complications, is analyzed. Second, the yield of the guideline-recommended measures in the early detection of peri-procedural complications is examined. MATERIALS AND METHODS Consecutive de novo transvenous device implants at our center in 2019 were retrospectively analyzed. Patients' demographics, types and indications for device therapy, procedural reports, device checks, and CXRs were obtained from the hospital electronic records. RESULTS A total of 578 patients (Age 74 ± 16 years, 68% male) were included. All patients had routine post-procedure CXRs and device checks. There were 16 (2.8%) complications; 7 (1.2%) pneumothoraxes, 6 (1%) pericardial effusions, and 3 (0.5%) lead displacements. Procedure time correlated significantly with complications; in uncomplicated cases it was 99 ± 43 min versus 127 ± 50 min in procedures associated with complications (p = .02). CONCLUSIONS Routine post CIED implantation CXRs can detect early peri-procedural complications, while repeat post mobilization device checks has low yield of detection of complications. The only statistically significant predictor of peri-procedural complications is the duration of the procedure; longer procedures were associated with higher rates of complications.
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Affiliation(s)
- Christina Menexi
- Cardiology Department, Essex Cardiothoracic Center, Basildon, UK
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Mohamed ElRefai
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Mohamed Abouelasaad
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Anne Y T Chua
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Ishita Handa
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Clare Newbery
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Hoskins
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Waqas Ullah
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Arthur Yue
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Paul R Roberts
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
- School of Medicine, University of Southampton, Southampton, UK
| | - John Paisey
- Wessex Cardiothoracic Unit, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
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18
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Kainulainen S, Suni A, Lipponen JA, Kulkas A, Duce B, Korkalainen H, Nikkonen S, Sillanmäki S. Morbid obesity influences the nocturnal electrocardiogram wave and interval durations among suspected sleep apnea patients. Ann Noninvasive Electrocardiol 2024; 29:e13101. [PMID: 38031823 PMCID: PMC10770811 DOI: 10.1111/anec.13101] [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: 05/02/2023] [Revised: 08/20/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Obesity is a global issue with a major impact on cardiovascular health. This study explores how obesity influences nocturnal cardiac electrophysiology in suspected obstructive sleep apnea (OSA) patients. METHODS We randomly selected 12 patients from each of the five World Health Organization body mass index (BMI) classifications groups (ntotal = 60) while keeping the group's age and sex matched. We evaluated 1965 nocturnal electrocardiography (ECG) samples (10 s) using modified lead II recorded during normal saturation conditions. R-wave peaks were detected and confirmed using dedicated software, with the exclusion of ventricular extrasystoles and artifacts. The duration of waves and intervals was manually marked. The average electric potential graphs were computed for each segment. Thresholds for abnormal ECG waveforms were P-wave > 120 ms, PQ interval > 200 ms, QRS complex > 120 ms for, and QTc > 440 ms. RESULTS Obesity was significantly (p < .05) associated with prolonged conduction times. Compared to the normal weight (18.5 ≤ BMI < 25) group, the morbidly obese patients (BMI ≥ 40) had a significantly longer P-wave duration (101.7 vs. 117.2 ms), PQ interval (175.8 vs. 198.0 ms), QRS interval (89.9 vs. 97.7 ms), and QTc interval (402.8 vs. 421.2 ms). We further examined ECG waveform prolongations related to BMI. Compared to other patient groups, the morbidly obese patients had the highest number of ECG segments with PQ interval (44% of the ECG samples), QRS duration (14%), and QTc duration (20%) above the normal limits. CONCLUSIONS Morbid obesity predisposes patients to prolongation of cardiac conduction times. This might increase the risk of arrhythmias, stroke, and even sudden cardiac death.
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Affiliation(s)
- Samu Kainulainen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Aaron Suni
- The School of MedicineUniversity of Eastern FinlandKuopioFinland
| | - Jukka A. Lipponen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Emergency CareKuopio University HospitalKuopioFinland
| | - Antti Kulkas
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Clinical NeurophysiologySeinäjoki Central HospitalSeinäjokiFinland
| | - Brett Duce
- Sleep Disorders Centre, Department of Respiratory & Sleep MedicinePrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
- Institute for Health and Biomedical InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Henri Korkalainen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Sami Nikkonen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Saara Sillanmäki
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
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Ahmed KA, Ahmed J, Ahmed MH. Resolution of Marked Bradycardia Following Angioplasty. Cureus 2023; 15:e50412. [PMID: 38213360 PMCID: PMC10783991 DOI: 10.7759/cureus.50412] [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: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Bradycardia, a condition commonly managed conservatively and, subsequently, with pacemaker implantation presents a unique challenge when coexisting with coronary artery disease (CAD). This case report delves into an unusual scenario where bradycardia and its related symptoms resolved following coronary angioplasty. Our goal is to contribute valuable data to the argument for a comprehensive evaluation of bradycardic patients for underlying CAD prior to considering pacemaker implantation. This approach aims to prevent unnecessary pacemaker implantations and offers insights into the optimal management of patients presenting with both arrhythmia and CAD. The unusual resolution of bradycardia in this case underscores the importance of considering CAD as a possible underlying factor in bradycardic patients, prompting a reevaluation of conventional treatment protocols. By documenting this exceptional case, the authors advocate a more nuanced and individualized treatment strategy in the management of bradycardia, emphasizing the need to assess and address CAD as part of the diagnostic workup.
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20
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Xu X, He S, Liu Q, Liu R, Zhang L, Chen W, Yin Y, Lu T. Cardioneuroablation for successful treatment of symptomatic bradycardia in a 12-year-old child after a 6-month follow-up. Front Cardiovasc Med 2023; 10:1290482. [PMID: 38099231 PMCID: PMC10720979 DOI: 10.3389/fcvm.2023.1290482] [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] [Received: 09/07/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
Background Cardioneuroablation (CNA) is recognized as a promising therapeutic option for adults with severe symptomatic bradycardia caused by excessive vagal tone. However, no pediatric cases have been reported to date. Therefore, the aim of this study is to evaluate the feasibility and efficacy of CNA in children. Methods A 12-year-old male patient was hospitalized with symptoms of fatigue, palpitations, and syncope for more than 2 months, and was definitively diagnosed with functional sinoatrial node dysfunction by using a 12-lead electrocardiogram, 24-h Holter monitoring, loading dose of atropine test (0.04 mg/kg), and treadmill exercise test. Simultaneously, whole-exome sequencing was performed on the child and his core family members. After completing the preoperative examination and signing the informed consent form, the child underwent CNA therapy. Results First, the electroanatomic structures of both atria were mapped out by using the Carto 3 system, according to the protocol of purely anatomy-guided and local fractionated intracardiac electrogram-guided CNA methods. Then, the local fractionated intracardiac electrograms of each cardiac ganglionated plexus (GP), including the GP between the aortic root and the medial wall of the superior vena cava, the GP between the posterior wall of the coronary sinus ostium and the left atrium, the GP between the anterior antrum of the right superior pulmonary vein and the superior vena cava, the GP in the superolateral area around the root of the left superior pulmonary vein, the GP around the root of the right inferior pulmonary vein, and the GP around the root of the left inferior pulmonary vein, were used as targets for ablation at a power of 30 W with an ablation index of 350-400. At a 6-month follow-up, the child's heart rhythm saw a complete restoration to sinus rhythm and clinical symptoms disappeared. Conclusion The first application of CNA in a child with symptomatic sinus bradycardia was achieved with better clinical outcomes. CNA can be carried out cautiously in children under suitable indications.
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Affiliation(s)
- Xin Xu
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Shuang He
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qian Liu
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ruixi Liu
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lei Zhang
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Weijie Chen
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tiewei Lu
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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21
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Luviano A, Pandya A. Evolution of Value in American College of Cardiology/American Heart Association Clinical Practice Guidelines. Circ Cardiovasc Qual Outcomes 2023; 16:e010086. [PMID: 37920978 PMCID: PMC10842500 DOI: 10.1161/circoutcomes.123.010086] [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: 03/24/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND In January 2014, the American College of Cardiology/American Heart Association released a policy statement arguing for the inclusion of cost-effectiveness analysis (CEA) and value assessments in clinical practice guidelines. It is unclear whether subsequent guidelines changed how they incorporated such concepts. METHODS We analyzed guidelines of cardiovascular disease subconditions with a guideline released before and after 2014. We counted the words (total and per page) for 8 selected value- or CEA-related terms and compared counts and rates of terms per page in the guidelines before and after 2014. We counted the number of recommendations with at least 1 reference to a CEA or a CEA-related article to compare the ratios of such recommendations to all recommendations before and after 2014. We looked for the inclusion of the value assessment system recommended by the writing committee of the American College of Cardiology/American Heart Association policy statement of 2014. RESULTS We analyzed 20 guidelines of 10 different cardiovascular disease subconditions. Seven of the 10 cardiovascular disease subconditions had guidelines with a greater term per page rate after 2014 than before 2014. Across all 20 guidelines, the proportion of recommendations with at least 1 reference to a CEA changed from 0.44% to 1.99% (P<0.01). The proportion of recommendations with at least 1 reference to a CEA-related article changed from 1.02% to 3.34% (P<0.01). Only 3 guidelines used a value assessment system. CONCLUSIONS The proportion of recommendations with at least 1 reference to a CEA or CEA-related article was low before and after 2014 for most of the subconditions, however, with substantial variation in this finding across the guidelines included in our analysis. There is a need to organize existing CEA information better and produce more policy-relevant CEAs so guideline writers can more easily make recommendations that incentivize high-value care and caution against using low-value care.
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Affiliation(s)
- Andrea Luviano
- Harvard University, Ph.D. Program in Health Policy, Cambridge, MA, USA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA. USA
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22
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Chattopadhyay RK, Thakur M, Wickramasinghe R, Hayes J, Chousou PA, Vassiliou VS, Pugh PJ. Exploring the Temporal Patterns of Right Ventricular Pacing Burden. J Innov Card Rhythm Manag 2023; 14:5605-5609. [PMID: 37927396 PMCID: PMC10621622 DOI: 10.19102/icrm.2023.14104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 11/07/2023] Open
Abstract
Elevated right ventricular pacing (RVP) burdens are associated with the development of pacing-induced cardiomyopathy. This association is alluded to in the recent European and American pacing guidelines where anticipated pacing burden forms part of the indications for conduction system pacing. Understanding the temporal pattern of RVP burden is important with respect to anticipating future burden and ensuring that the most appropriate pacing modality is selected for patients. To the best of our knowledge, this is the first study to assess how RVP burden changes over time in different pacing indications. A retrospective, single-center, observational study was performed. RVP burdens from pacing checks were extracted and plotted against 6-month time "bins." Graphical plots of RVP burdens for different pacing indications were produced. There was no significant change in the RVP burden across time, independent of the initial pacing indication. Individuals with sinus node disease (SND) and a P-R interval of >250 ms had increased RVP burden. Other than patients with SND and a P-R interval of <250 ms, individuals had pacing burdens higher than those proposed in both the European and American pacing guidelines for conduction system pacing.
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Affiliation(s)
- Rahul K. Chattopadhyay
- Department of Cardiology, Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Norwich Medical School University of East Anglia, Norwich, UK
| | - Mrinal Thakur
- Department of Cardiology, Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rucchira Wickramasinghe
- Department of Cardiology, Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Julie Hayes
- Department of Cardiology, Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Panagiota A. Chousou
- Department of Cardiology, Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Norwich Medical School University of East Anglia, Norwich, UK
| | - Vassilios S. Vassiliou
- Norwich Medical School University of East Anglia, Norwich, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Peter J. Pugh
- Department of Cardiology, Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Norwich Medical School University of East Anglia, Norwich, UK
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Fernandez Hazim C, Shaban M, Cordero D, Urena Neme AP, Rodriguez Guerra MA. Crochetage, the Forgotten Electrocardiographic Sign. Cureus 2023; 15:e46498. [PMID: 37927770 PMCID: PMC10624559 DOI: 10.7759/cureus.46498] [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: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Acquired complete heart block is a rare but severe arrhythmia caused by various factors such as infections, medications, and autoimmune conditions. Atrial septal defect (ASD) is a common congenital heart defect, with larger ASDs possibly causing symptoms such as fatigue, shortness of breath, and frequent respiratory infections. In some cases, high-grade atrioventricular block with ASD can occur; however, the exact incidence is not well established. We report a rare case of a 15-year-old male presenting with acute dizziness. Initial electrocardiogram (EKG) showed a complete heart block with a Crochetage sign. Patent foramen ovale (PFO) was confirmed by transthoracic and transesophageal echocardiograms. Closure of PFO and permanent pacemaker resulted in complete resolutions of symptoms and disappearance of Crochetage sign.
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Affiliation(s)
- Carol Fernandez Hazim
- Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Mohammed Shaban
- Internal Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, New York, USA
| | - Dessiree Cordero
- Internal Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mt. Sinai, New York, USA
| | - Ana P Urena Neme
- Cardiology, Medicina Cardiovascular Asociada, Santo Domingo, DOM
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Zheng N, Jiang L, Shen J, Zhong J. Guidance on left bundle branch pacing using continuous pacing technique and changes in lead V1 characteristics under real-time monitoring. Front Cardiovasc Med 2023; 10:1195509. [PMID: 37840950 PMCID: PMC10570442 DOI: 10.3389/fcvm.2023.1195509] [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] [Received: 03/28/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Background The changes in the morphology and characteristics of the V1 leads during left bundle branch capturing still need to be fully understood. Objective This study aims to provide some suggestions about the LBB capture process through the morphology and characteristics of the V1 lead. Method LBBP using the continuous pacing and morphology monitoring technique during screw-in using a revolving connector (John Jiang's connecting cable). The morphology and features of V1 leads are recorded by continuous monitoring technology. Results The most common morphology in the LVSP stage is QR, while in the NS-LBBP (low output) stage and the NS-LBBP (lower output) stage, it is rSR. In the S-LBBP stage, it is rsR. The predominant morphology is with r/R waves in S-LBBP, which includes variations like rSR, rsR, rSr, rsr, rR, rs, rS, and R type, making up 96.7% of the total. The r waves in lead V1 are associated with agitated myocardium conducted from the left bundle branch. Conclusion The initial r-wave in lead V1 may be a marker during the follow-up of patients with selective LBB capture.
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Affiliation(s)
| | - Longfu Jiang
- Department of Cardiovascular Medicine, Ningbo NO.2 Hospital, Ningbo, China
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Ju C, Xie X, Tang S, Cao S. Predictors of permanent pacemaker implantation in aortic valve diseases after TAVI with vitaFlow liberty system. Front Cardiovasc Med 2023; 10:1277528. [PMID: 37840951 PMCID: PMC10570722 DOI: 10.3389/fcvm.2023.1277528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Permanent pacemaker implantation (PPI) is a known complication in patients with aortic stenosis following transcatheter aortic valve implantation (TAVI). However, there is limited research on TAVI for pure aortic regurgitation (PAR), and more investigation is needed to determine the occurrence of postoperative cardiac conduction block and the need for PPI in this population. Therefore, this retrospective analysis aimed to evaluate the incidence of cardiac conduction block and the necessity of PPI after TAVI in patients with different types of aortic valve disease, including pure aortic stenosis (PAS), aortic stenosis with regurgitation (ASR), and PAR. Methods Clinical data of 100 patients who TAVI were analyzed retrospectively. The incidence of conduction block was assessed, and clinical factors were examined to predict the necessity of PPI. Results Cardiac conduction block was found to be a common complication following TAVI, particularly in patients with PAR. PAR was identified as an independent risk factor for requiring PPI. Additionally, first-degree atrioventricular block emerged as a sensitive predictor for PPI in patients with PAR. Discussion These findings provide valuable insights into the safety and effectiveness of TAVI, which can help enhance patient management and reduce complications.
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Affiliation(s)
- Changlin Ju
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Cardiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiangrong Xie
- Department of Cardiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shengxin Tang
- Department of Cardiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shiping Cao
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Shoura SJ, Teaima T, Sana MK, Abbasi A, Atluri R, Yilmaz M, Hammo H, Ali L, Kanitsoraphan C, Park DY, Alyousef T. Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database. World J Cardiol 2023; 15:448-461. [PMID: 37900263 PMCID: PMC10600784 DOI: 10.4330/wjc.v15.i9.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a worldwide health crisis since it first appeared. Numerous studies demonstrated the virus's predilection to cardiomyocytes; however, the effects that COVID-19 has on the cardiac conduction system still need to be fully understood. AIM To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks (BBB). METHODS The 2020 National Inpatient Sample (NIS) database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioventricular blocks (HDAVB) and right or left BBB utilizing ICD-10 codes. The patients with pre-existing pacemakers, suggestive of a prior diagnosis of HDAVB or BBB, were excluded from the study. The primary outcome was inpatient mortality. Secondary outcomes included total hospital charges (THC), the length of hospital stay (LOS), and other major cardiac outcomes detailed in the Results section. Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17. RESULTS A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database, of which 3210 (0.4%) and 17365 (1.6%) patients were newly diagnosed with HDAVB and BBB, respectively. We observed a significantly higher odds of in-hospital mortality, cardiac arrest, cardiogenic shock, sepsis, arrythmias, and acute kidney injury in the COVID-19 and HDAVB group. There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism. Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock than those without BBB. However, unlike HDAVB, COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB. CONCLUSION In conclusion, there is a significantly higher odds of inpatient mortality, cardiac arrest, cardiogenic shock, sepsis, acute kidney injury, supraventricular tachycardia, ventricular tachycardia, THC, and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB. Likewise, patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock as compared to those without BBB. Therefore, it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.
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Affiliation(s)
- Sami J Shoura
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Taha Teaima
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Muhammad Khawar Sana
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Ayesha Abbasi
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Ramtej Atluri
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Mahir Yilmaz
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Hasan Hammo
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Laith Ali
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
| | - Chanavuth Kanitsoraphan
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
| | - Dae Yong Park
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Tareq Alyousef
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States.
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Liu CM, Chen YC, Hu YF. Harnessing cell reprogramming for cardiac biological pacing. J Biomed Sci 2023; 30:74. [PMID: 37633890 PMCID: PMC10463311 DOI: 10.1186/s12929-023-00970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
Electrical impulses from cardiac pacemaker cardiomyocytes initiate cardiac contraction and blood pumping and maintain life. Abnormal electrical impulses bring patients with low heart rates to cardiac arrest. The current therapy is to implant electronic devices to generate backup electricity. However, complications inherent to electronic devices remain unbearable suffering. Therefore, cardiac biological pacing has been developed as a hardware-free alternative. The approaches to generating biological pacing have evolved recently using cell reprogramming technology to generate pacemaker cardiomyocytes in-vivo or in-vitro. Different from conventional methods by electrical re-engineering, reprogramming-based biological pacing recapitulates various phenotypes of de novo pacemaker cardiomyocytes and is more physiological, efficient, and easy for clinical implementation. This article reviews the present state of the art in reprogramming-based biological pacing. We begin with the rationale for this new approach and review its advances in creating a biological pacemaker to treat bradyarrhythmia.
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Affiliation(s)
- Chih-Min Liu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Biopharmaceutical Sciences, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
- Institute of Biopharmaceutical Sciences, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Moustafa AT, Tang ASL, Khan HR. Conduction system pacing on track to replace CRT? Review of current evidence and prospects of conduction system pacing. Front Cardiovasc Med 2023; 10:1220709. [PMID: 37649666 PMCID: PMC10463741 DOI: 10.3389/fcvm.2023.1220709] [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: 05/11/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Conduction system pacing (CSP) has been emerging over the last decade as a pacing option instead of conventional right ventricular (RV) pacing and biventricular (BiV) pacing. Numerous case reports, some observational studies and a few randomized control trials have looked at optimum pacing strategies for heart failure (HF) with left bundle branch block (LBBB) or cases where left ventricular (LV) dysfunction is anticipated due to chronic RV pacing (RVP). Evolution of pacing strategies from standard RVP to septal RVP, BiV pacing and now CSP have shown improving hemodynamic responses and possible ease of implantation of CSP systems. In this review article, we review the literature on the evolution of CSP and common scenarios where it might be beneficial.
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Affiliation(s)
| | | | - Habib Rehman Khan
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Frick W, Chen Y, Zamora L, Osman O, Hussein A. Leadless pacemaker implantation in elderly patients with abandoned transvenous pacemakers with depleted batteries. J Arrhythm 2023; 39:638-640. [PMID: 37560280 PMCID: PMC10407190 DOI: 10.1002/joa3.12866] [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] [Received: 02/18/2023] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 08/11/2023] Open
Abstract
This spotlight article gives two clinical case examples for the implementation of a suggested safe and feasible strategy to implant leadless pacemakers instead of changing the generators of transvenous pacemakers with depleted batteries in elderly patients.
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Affiliation(s)
| | | | | | - Osama Osman
- St. Louis University HospitalSt. LouisMissouriUSA
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30
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Naraen A, Duvva D, Rao A. Heart Failure and Cardiac Device Therapy: A Review of Current National Institute of Health and Care Excellence and European Society of Cardiology Guidelines. Arrhythm Electrophysiol Rev 2023; 12:e21. [PMID: 37457437 PMCID: PMC10345955 DOI: 10.15420/aer.2022.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/21/2023] [Indexed: 07/18/2023] Open
Abstract
Guidelines help clinicians to deliver high-quality care with therapies based on up-to-date evidence. There has been significant progress in the management of heart failure with regards to both medication and cardiac device therapy. These advances have been incorporated into national and international guidelines with varying degrees of success. This article reviews current guidance from the National Institute of Health and Care Excellence in the UK and compares this with European Society of Cardiology guidelines, and evaluates how differences between them may impact on clinical practice.
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Affiliation(s)
- Akriti Naraen
- Cardiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dileep Duvva
- Cardiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Archana Rao
- Cardiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
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Frimodt-Møller EK, Vittinghoff E, Kaur G, Biering-Sørensen T, Soliman EZ, Marcus GM. Association Between Intensive vs Standard Blood Pressure Control and Incident Left Ventricular Conduction Disease: A Post Hoc Analysis of the SPRINT Randomized Clinical Trial. JAMA Cardiol 2023; 8:612-616. [PMID: 37133829 PMCID: PMC10157506 DOI: 10.1001/jamacardio.2023.0845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/28/2023] [Indexed: 05/04/2023]
Abstract
Importance Left ventricular conduction disease predicts heart failure and death, and the only strategies to mitigate its effects involve implantation of a permanent pacemaker. There are currently no proven preventive strategies for this common condition. Objective To determine the association between targeting intensive blood pressure (BP) control and the risk of developing left ventricular conduction disease. Design, Setting, and Participants This was a post hoc analysis of the 2-arm multicenter Systolic Blood Pressure Intervention Trial (SPRINT), which recruited participants from 102 sites in the US and Puerto Rico and was conducted from November 2010 until August 2015. Adults 50 years and older with hypertension and at least 1 other cardiovascular risk factor were included. Participants with baseline left ventricular conduction disease, ventricular pacing, or ventricular pre-excitation were excluded for the current analysis. Data were analyzed from November 2021 to November 2022. Intervention Participants were randomly assigned to a systolic BP target of less than 140 mm Hg (standard treatment group) or less than 120 mm Hg (intensive treatment group). Main Outcome The primary outcome was incident left ventricular conduction disease, including any fascicular or left bundle-branch block, assessed by serial electrocardiography. Incident right bundle-branch block was examined as a negative control. Results Among 3918 participants randomized to standard treatment and 3956 to intensive treatment (mean [SD] age, 67.6 [9.2] years; 2815 [36%] female) monitored for a median [IQR] 3.5 (0.02-5.2) years, 203 developed left ventricular conduction disease. Older age (hazard ratio per 10-year increase [HR], 1.42; 95% CI, 1.21-1.67; P < .001), male sex (HR, 2.31; 95% CI, 1.63-3.32; P < .001), and cardiovascular disease (HR, 1.46; 95% CI, 1.06-2.00; P = .02) were associated with a higher risk of left ventricular conduction disease. Assignment to intensive treatment was associated with a 26% lower risk of left ventricular conduction disease (HR, 0.74; 95% CI, 0.56-0.98; P = .04). These results persisted when incident ventricular pacing was included in the outcome and when considering all-cause death as a competing risk. In contrast, no association between randomization assignment and right bundle-branch block was observed (HR, 0.95; 95% CI, 0.71-1.27; P = .75). Conclusions and Relevance In this study, targeting intensive BP control was associated with lower risk of left ventricular conduction disease in a randomized clinical trial, suggesting that clinically relevant conduction disease may be preventable. Trial Registration ClinicalTrials.gov Identifier: NCT01206062.
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Affiliation(s)
- Emilie K. Frimodt-Møller
- Division of Cardiology, Department of Medicine, University of California San Francisco
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Eric Vittinghoff
- Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Gurbani Kaur
- Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elsayed Z. Soliman
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gregory M. Marcus
- Division of Cardiology, Department of Medicine, University of California San Francisco
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Manocha K, Kandola MS, Kalil R, Sciria C, Bassil G, Patel N, Lerman BB, Kim J, Abdelrahman M, Cheung JW. Reduction of left ventricular global longitudinal strain in patients with permanent pacemakers as a predictor of heart failure and mortality outcomes. Pacing Clin Electrophysiol 2023; 46:385-391. [PMID: 37087556 PMCID: PMC10288370 DOI: 10.1111/pace.14701] [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: 02/04/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Frequent right ventricular (RV) pacing is associated with cardiomyopathy. The impact of RV pacing on left ventricular (LV) global longitudinal strain (GLS) and clinical outcomes is unclear. METHODS We analyzed GLS via two-dimensional speckle tracking and LV ejection fraction (EF) on pre- and post-implantation transthoracic echocardiograms of patients undergoing dual chamber pacemaker implantation. We collected long-term data on strain, LVEF, and clinical outcomes. RESULTS One hundred and ten patients (mean age 76 ± 12 years; 59 [54%] female) were followed for mean 23 ± 17 months. Mean baseline LVEF was 58 ± 11% and mean GLS was -17 ± 4%. Twenty-four (22%) patients had an absolute decrease in LVEF > 10% and 43 (39%) patients had a relative reduction of GLS > 15%. Among patients with a reduction of GLS, a larger proportion of patients had RV pacing burden ≥20% (67% vs. 46%; p = .048). Compared to patients without GLS reduction, more patients with a reduction in GLS reached a composite endpoint of HF hospitalization, CRT upgrade or death (47% vs. 16%; p = .001). CONCLUSION Reduction in LV GLS was seen in nearly four in 10 patients undergoing pacemaker implantation and was significantly associated with increased RV pacing burden. LV GLS reduction was associated with increased risk of adverse outcomes. LV GLS may have utility in predicting outcomes among patients with RV pacing.
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Affiliation(s)
- Kevin Manocha
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Manjinder S Kandola
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Ramsey Kalil
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Christopher Sciria
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Guillaume Bassil
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Nishi Patel
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Jiwon Kim
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Mohamed Abdelrahman
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Jim W Cheung
- Department of Medicine, Division of Cardiology Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
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Ashraf A, Dumitrascu AG, Moran KM, Chirila RM, Smerina M. Acute Onset of Heart Failure and Renal Failure Due to Pacemaker Syndrome. Cureus 2023; 15:e37685. [PMID: 37206493 PMCID: PMC10190191 DOI: 10.7759/cureus.37685] [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: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Here, we report the outcome of an 87-year-old man with permanent non-valvular atrial fibrillation who initially presented with complete heart block and received a single right ventricle lead pacemaker programmed to ventricular demand pacing (VVIR). Over the next 10 months, the patient was readmitted to the hospital four times with recurrent edema, pleural effusions, and ascites. He was diagnosed with new onset systolic heart failure with mid-range (40-49%) ejection fraction and cardiorenal syndrome requiring dialysis. The underlying cause of his presentation was determined to be pacemaker syndrome mediated by new onset severe tricuspid regurgitation. He was treated with reimplantation of a pacemaker with His bundle pacing with subsequent improvement in his cardiac status and renal function. Implantation of dual-chamber pacing (DDDR) or His bundle pacing to achieve a narrow QRS complex over ventricular demand pacemaker is recommended whenever possible to reduce the incidence of pacemaker syndrome and improve patient outcomes.
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Dudoignon B, Denjoy I, Patout M, Matrot B, Gallego J, Bokov P, Delclaux C. Heart rate variability in congenital central hypoventilation syndrome: relationships with hypertension and sinus pauses. Pediatr Res 2023; 93:1003-1009. [PMID: 35882978 DOI: 10.1038/s41390-022-02215-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/06/2022] [Accepted: 07/09/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Autonomic nervous system (ANS) dysregulation has been described in congenital central hypoventilation syndrome (CCHS). The objectives were to describe heart rate variability (HRV) analyses in children suffering from CCHS both while awake and asleep and their relationships with both ambulatory blood pressure (BP) and ECG monitoring results. METHODS This retrospective study enrolled children with CCHS (n = 33, median age 8.4 years, 18 girls) who had BP and ECG monitored during the same 24 h. From the latter, HRV analyses were obtained during daytime and nighttime. RESULTS The prevalences of hypertension and sinus pauses were 33% (95% confidence interval [CI]: 18-52) and 18% (95% CI: 7-35), respectively. The decrease in systolic BP at night negatively correlated with an increase in very low frequency (VLF) and LF powers at night, and the longest RR interval positively correlated with daytime VLF and LF powers. Among the three groups of children (polyalanine repeat expansion mutation [PARM], moderate [20/25 and 20/26], severe [20/27 and 20/33], and non-PARMs), the prevalence of elevated BP or hypertension was different: in PARM subjects: 6/18 moderate, 7/9 severe versus 0/6 in non-PARM (p = 0.002). CONCLUSION Modifications of cardiac ANS are associated with systemic hypertension and the occurrence of sinus pauses in CCHS. IMPACT Children with congenital central hypoventilation syndrome (CCHS) exhibit an increased prevalence of hypertension and sinus pauses that are linked to cardiac autonomic nervous system dysfunction. Sinus pauses are the main manifestation of sinus nodal dysfunction in children with CCHS. The increased prevalence of hypertension, especially at nighttime, is a new finding in CCHS. Sinus nodal dysfunction can be due to the sole impairment of the cardiac autonomic nervous system. Ambulatory blood pressure and ECG monitoring are mandatory in patients with CCHS.
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Affiliation(s)
- Benjamin Dudoignon
- Université de Paris, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique Centre du Sommeil-CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, F-75019, Paris, France
| | - Isabelle Denjoy
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique, F-75019, Paris, France
| | - Maxime Patout
- Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S)-CRMR Hypoventilations centrales congénitales, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France
| | - Boris Matrot
- Université de Paris, INSERM NeuroDiderot, F-75019, Paris, France
| | - Jorge Gallego
- Université de Paris, INSERM NeuroDiderot, F-75019, Paris, France
| | - Plamen Bokov
- Université de Paris, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique Centre du Sommeil-CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, F-75019, Paris, France
| | - Christophe Delclaux
- Université de Paris, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique Centre du Sommeil-CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, F-75019, Paris, France.
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Knight AD, Medina-Morales K, Ozair S, Gomez S. Tachy-Brady Syndrome in a Schizophrenic Patient: A Case Report. Cureus 2023; 15:e35557. [PMID: 37007363 PMCID: PMC10063162 DOI: 10.7759/cureus.35557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
Tachy-brady syndrome is the result of sinus node dysfunction (SND), an electrocardiographic phenomenon caused by defective pacemaker functioning that leads to alternating arrhythmias. We present a case of a 73-year-old male with multiple mental health and medical comorbidities who was admitted to the inpatient floor for catatonia, paranoid delusions, refusal to eat, inability to cooperate with activities of daily life, and generalized weakness. Upon admission, a 12-lead electrocardiogram (ECG) showed an episode of atrial fibrillation with a ventricular rate of 64 beats per minute (bpm). During hospitalization, telemetry recorded a variety of arrhythmias such as ventricular bigeminy, atrial fibrillation, supraventricular tachycardia (SVT), multifocal atrial contractions, and sinus bradycardia. Each episode spontaneously reverted and the patient remained asymptomatic throughout these arrhythmic changes. These frequently fluctuating arrhythmias on resting ECG confirmed the diagnosis of tachycardia-bradycardia syndrome, also known as tachy-brady syndrome. Medical intervention, especially for cardiac arrhythmias, in patients with paranoid and catatonic schizophrenia can be challenging, as they might not share their symptoms. Additionally, certain psychotropic medications can also cause cardiac arrhythmias and must be carefully evaluated. The decision was made to start the patient on a beta-blocker and direct oral anticoagulation for reducing the risk of thromboembolic events. Due to an unsatisfactory response to drug therapy alone, the patient qualified as a candidate for definitive treatment with an implantable dual-chamber pacemaker. Our patient had a dual-chamber pacemaker implanted to prevent bradyarrhythmias and continued oral beta-blockers to prevent tachyarrhythmias.
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Diederichsen SZ, Xing LY, Frodi DM, Kongebro EK, Haugan KJ, Graff C, Højberg S, Krieger D, Brandes A, Køber L, Svendsen JH. Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care: Post Hoc Analysis of the LOOP Randomized Clinical Trial. JAMA Cardiol 2023; 8:326-334. [PMID: 36790817 PMCID: PMC9932940 DOI: 10.1001/jamacardio.2022.5526] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Importance There is increasing interest in heart rhythm monitoring and technologies to detect subclinical atrial fibrillation (AF), which may lead to incidental diagnosis of bradyarrhythmias. Objective To assess bradyarrhythmia prevalence and prognostic significance in persons screened for AF using implantable loop recorder (ILR) compared with unscreened persons. Design, Setting, and Participants This was a post hoc analysis of the Implantable Loop Recorder Detection of Atrial Fibrillation to Prevent Stroke (LOOP) randomized clinical trial, which took place in 4 sites in Denmark. Participants were 70 years or older without known AF but diagnosed with at least 1 of the following: hypertension, diabetes, heart failure, or prior stroke. Participants were recruited by letter invitation between January 31, 2014, and May 17, 2016. The median (IQR) follow-up period was 65 (59-70) months. Analysis took place between February and June 2022. Interventions ILR screening for AF with treatment of any bradyarrhythmia left to the discretion of the treating physician (ILR group) vs usual care (control group). Main Outcomes and Measures Adjudicated bradyarrhythmia episodes, pacemaker implantation, syncope, and sudden cardiovascular death. Results A total of 6004 participants were randomized (mean [SD] age, 75 [4.1] years; 2837 [47.3%] female; 5444 [90.7%] with hypertension; 1224 [20.4%] with prior syncope), 4503 to control and 1501 to ILR. Bradyarrhythmia was diagnosed in 172 participants (3.8%) in the control group vs 312 participants (20.8%) in the ILR group (hazard ratio [HR], 6.21 [95% CI, 5.15-7.48]; P < .001), and these were asymptomatic in 41 participants (23.8%) vs 249 participants (79.8%), respectively. The most common bradyarrhythmia was sinus node dysfunction followed by high-grade atrioventricular block. Risk factors for bradyarrhythmia included higher age, male sex, and prior syncope. A pacemaker was implanted in 132 participants (2.9%) vs 67 (4.5%) (HR, 1.53 [95% CI, 1.14-2.06]; P < .001), syncope occurred in 120 (2.7%) vs 33 (2.2%) (HR, 0.83 [95% CI, 0.56-1.22]; P = .34), and sudden cardiovascular death occurred in 49 (1.1%) vs 18 (1.2%) (HR, 1.11 [95% CI, 0.64-1.90]; P = .71) in the control and ILR groups, respectively. Bradyarrhythmias were associated with subsequent syncope, cardiovascular death, and all-cause death, with no interaction between bradyarrhythmia and randomization group. Conclusions and Relevance More than 1 in 5 persons older than 70 years with cardiovascular risk factors can be diagnosed with bradyarrhythmias when long-term continous monitoring for AF is applied. In this study, ILR screening led to a 6-fold increase in bradyarrhythmia diagnoses and a significant increase in pacemaker implantations compared with usual care but no change in the risk of syncope or sudden death.
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Affiliation(s)
- Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
| | - Lucas Yixi Xing
- Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
| | - Diana My Frodi
- Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
| | - Emilie Katrine Kongebro
- Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
| | - Ketil Jørgen Haugan
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Søren Højberg
- Department of Cardiology, Copenhagen University Hospital–Bispebjerg, Copenhagen, Denmark
| | - Derk Krieger
- Stroke Unit, Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark,Department of Internal Medicine–Cardiology, University Hospital of Southern Denmark–Esbjerg, Esbjerg, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Schoenfeld MH, Patton KK. Incidental Detection of Bradycardia by Implantable Loop Recorders-Unintended Consequences. JAMA Cardiol 2023; 8:312-313. [PMID: 36790795 DOI: 10.1001/jamacardio.2022.5541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
| | - Kristen K Patton
- University of Washington School of Medicine, Seattle.,Associate Editor, JAMA Cardiology
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King RB, Goel R. A Case of Right Bundle Branch Block With Changing Axis. JAMA Cardiol 2023; 8:202-203. [PMID: 36449301 DOI: 10.1001/jamacardio.2022.4283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
A man in his 80s presented with recurrent presyncope and bradycardia. An electrocardiogram showed atrial fibrillation with an irregular ventricular rate of around 60 beats per minute, right bundle branch block, and left posterior fascicular block. What would you do next?
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Affiliation(s)
- Robert B King
- Department of Medicine, University of Florida, Gainesville
| | - Ramil Goel
- Division of Cardiology, University of Florida, Gainesville.,Malcolm Randall VA Medical Center, Gainesville
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Alsowaida YS, Shehadeh F, Kalligeros M, Mylonakis E. Incidence and potential risk factors for remdesivir-associated bradycardia in hospitalized patients with COVID-19: A retrospective cohort study. Front Pharmacol 2023; 14:1106044. [PMID: 36817161 PMCID: PMC9930471 DOI: 10.3389/fphar.2023.1106044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Background: Remdesivir is widely used for the management of COVID-19 and several studies have reported bradycardia as a potential side effect associated with this agent. The aim of the present study was to evaluate the incidence rate, severity, and potential risk factors of remdesivir-associated bradycardia. Methods: We performed a retrospective cohort study among hospitalized adult patients with COVID-19 who were treated with remdesivir from March 2020 to October 2021. Our primary outcome of interest was the incidence rate and severity of bradycardia after remdesivir administration. We defined mild bradycardia as a heart rate of 51-59 beats per minute, moderate bradycardia as a heart rate of 41-50 beats per minute, and severe bradycardia as a heart rate of ≤40 beats per minute. We also performed univariable and multivariable regression analyses to determine potential bradycardia risk factors. Baseline characteristics were reported as means with standard deviations or medians with interquartile ranges (IQRs). All the statistical tests are shown as odds ratios (ORs) with 95% confidence intervals (CIs). Results: In total, 1,635 patients were included in this study. The median age with IQR was 68 (57-79) years and 51.7% of the patients were male. In total, 606 (37.1%) patients developed bradycardia. Among them, 437 patients (26.7%) developed mild bradycardia, 158 patients (9.7%) moderate bradycardia, while 11 patients (0.7%) experienced severe bradycardia. In our adjusted multivariate logistic regression, the odds of bradycardia development after remdesivir administration were higher among patients with age ≥65 years (OR 1.76, 95% CI: 1.04-2.99, p = 0.04), those with hypertension (OR 1.37, 95% CI: 1.07-1.75, p = 0.01), and obesity (OR 1.32, 95% CI: 1.02-1.68, p = 0.03). Conclusion: More than 1 out of 3 patients (37%) who received remdesivir for COVID-19 developed bradycardia with the majority of these patients developing mild or moderate bradycardia that is usually a benign manifestation not needing treatment in most cases. Age ≥65 years, hypertension, and obesity were potential risk factors for remdesivir-associated bradycardia among hospitalized COVID-19 patients. Clinicians should be aware of this adverse event and consider close clinical monitoring for patients at high risk for this adverse event.
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Affiliation(s)
- Yazed Saleh Alsowaida
- Division of Infectious Diseases, Department of Medicine, The Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI, United States,Department of Clinical Pharmacy, College of Pharmacy, Hail University, Hail, Saudi Arabia,*Correspondence: Yazed Saleh Alsowaida, ; Eleftherios Mylonakis,
| | - Fadi Shehadeh
- Division of Infectious Diseases, Department of Medicine, The Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI, United States,School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Markos Kalligeros
- Division of Infectious Diseases, Department of Medicine, The Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI, United States
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Department of Medicine, The Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI, United States,*Correspondence: Yazed Saleh Alsowaida, ; Eleftherios Mylonakis,
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Senart AM, LeClair LA. Cardiovascular and Adverse Effects of Glucagon for the Management of Suspected Beta Blocker Toxicity: a Case Series. J Med Toxicol 2023; 19:9-15. [PMID: 36479689 PMCID: PMC9813284 DOI: 10.1007/s13181-022-00919-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although glucagon use in beta blocker toxicity has been recommended for many years, evidence for its safety and efficacy in humans is limited. This study aims to determine the magnitude of effect of glucagon on heart rate (HR) and systolic blood pressure (SBP) in patients with suspected beta blocker toxicity and describe potential adverse effects of the medication. METHODS We conducted a retrospective, multi-center case series of patients greater than 12 years of age who received glucagon for suspected beta blocker toxicity. The primary outcome was the mean difference in HR from immediately pre- to 20-minutes post-glucagon administration. Secondary outcomes included the median difference in SBP, and occurrence of nausea, vomiting, and hyperglycemia. RESULTS A total of 107 patients met inclusion criteria accounting for 144 glucagon orders. The mean difference in HR from pre- to post-glucagon administration was 4 bpm ± 10.6 (95% CI [2.25-5.76], p < 0.001). The median difference (IQR) in SBP was 4.5 (- 6 to 16) mmHg (p = 0.004). Similar increases were observed when patients receiving concomitant vasopressors were excluded. A total of nine glucagon administrations (6.3%) were associated with nausea and 14 (9.7%) with vomiting; however, 52 doses (36.1%) were administered concomitantly with antiemetic medications. Fifteen administrations (10.4%) were associated with hyperglycemia. CONCLUSION Glucagon administration was associated with a statistically significant increase in HR, but a small absolute difference of uncertain clinical significance. A similar observation was noted for SBP. Few patients experienced adverse events.
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Affiliation(s)
- Alicia M Senart
- Department of Pharmacy, Greater Baltimore Medical Center, 6701 N. Charles St., MD, 21204, Towson, USA
| | - Lorrie A LeClair
- Department of Pharmacy, Inova Fairfax Medical Campus, 3300 Gallows Rd., VA, 22042, Falls Church, USA.
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Tang S, Lu J, Xu C, Wei L, Mei S, Chen R, Meng QT. Feasibility and Safety of Remazolam versus Propofol When Inserting Laryngeal Masks Without Muscle Relaxants During Hysteroscopy. Drug Des Devel Ther 2023; 17:1313-1322. [PMID: 37152102 PMCID: PMC10162397 DOI: 10.2147/dddt.s408584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/16/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose This study aimed to evaluate the efficacy and safety of remazolam compared with propofol in patients who underwent laryngeal mask airway (LMA) insertion without the use of muscle relaxant agents during hysteroscopic surgery. Patients and Methods A total of 72 patients undergoing hysteroscopy with LMA insertion were assigned to two groups. The patients in the remazolam group received 0.3 μg/kg sufentanil, 0.3 mg/kg remazolam and 1.2 mg/kg remifentanil, whereas the patients in the propofol group received 0.3 μg/kg sufentanil, 2.0 mg/kg propofol and 1.2 mg/kg remifentanil for insertion of the LMA. The primary endpoint was the summed score of the insertion conditions. The secondary endpoints included hemodynamics, the duration of induction, the duration of insertion, tidal volume, plateau pressure and adverse events. Results No difference was identified between the propofol group and remazolam group in the median summed score [18.0 (18.0, 18.0), 18.0 (17.0, 18.0), respectively, P > 0.05]. The induction duration was significantly longer (P < 0.05) in the remazolam group than propofol group. The cost of dopamine (P < 0.05) was significantly lower in the remazolam group compared with the patients in the propofol group, while the plateau pressure (P < 0.05) and the incidence of transient mild laryngospasm (P < 0.05) were significantly higher in the remazolam group. No differences were identified between the two groups in terms of heart rate, tidal volume, injection pain or hiccups (P > 0.05). Conclusion Remazolam provided similar insertion conditions and better hemodynamic stability than propofol during LMA insertion without the use of muscle relaxant agents. However, a higher incidence of transient mild laryngospasm was found in the remazolam group, which should be considered.
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Affiliation(s)
- Shan Tang
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Jingxiao Lu
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Cheng Xu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Lu Wei
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Shenglan Mei
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Rong Chen
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Qing-Tao Meng
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Correspondence: Qing-Tao Meng, Tel +8615178857650, Email
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Muacevic A, Adler JR, Birlas A, Pham S. Bedside Carotid Sinus Massage for Syncope Evaluation With Bifascicular Block and First-Degree Atrioventricular Block. Cureus 2023; 15:e33925. [PMID: 36819364 PMCID: PMC9937085 DOI: 10.7759/cureus.33925] [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: 01/18/2023] [Indexed: 01/19/2023] Open
Abstract
Symptomatic bifascicular block (BFB) with a reversible high-grade atrioventricular block (AVB) is an overlooked cause of syncope with differing diagnostic and therapeutic approaches. We present a case of a 79-year-old gentleman with multiple episodes of cardiac syncope. Initial electrocardiogram revealed a left bundle branch block and first-degree AVB worsened by bedside carotid sinus massage (CSM) obviating the need for electrophysiologic (EP) studies or continuous electrocardiographic monitoring for further evaluation. This case highlights the importance of CSM as a useful clinical tool in addition to EP studies and internal loop recorder (ILR) placement for assessment and appropriateness of permanent pacemaker (PPM) implantation. It also sheds light on the differing management protocols between EP studies and ILR evaluation versus empiric PPM implantation for patients with cardiac syncope secondary to BFB and AVB.
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Chubb H, Mah D, Dubin AM, Moore J. Conduction system pacing in pediatric and congenital heart disease. Front Physiol 2023; 14:1154629. [PMID: 37035676 PMCID: PMC10080025 DOI: 10.3389/fphys.2023.1154629] [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] [Received: 01/30/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Conduction system pacing (CSP) has evolved rapidly to become the pacing method of choice for many adults with structurally normal hearts. Studies in this population have repeatedly demonstrated superior hemodynamics and outcomes compared to conventional pacing with the recruitment of the native conduction system. Children and patients with congenital heart disease (CHD) are also likely to benefit from CSP but were excluded from original trials. However, very recent studies have begun to demonstrate the feasibility and efficacy of CSP in these patients, with growing evidence that some outcomes may be superior in comparison to conventional pacing techniques. Concerns regarding the technical challenges and long-term lead parameters of His Bundle Pacing (HBP) have been overcome to many extents with the development of Left Bundle Branch Area Pacing (LBBAP), and both techniques are likely to play an important role in pediatric and CHD pacing in the future. This review aims to assimilate the latest developments in CSP and its application in children and CHD patients.
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Affiliation(s)
- Henry Chubb
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
- *Correspondence: Henry Chubb,
| | - Douglas Mah
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Anne M. Dubin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Jeremy Moore
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, United States
- Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, CA, United States
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Wang N, Zhu T, Li Y, Cheng G, Chen Y, Fu Y, Chen X, Liu X. His-Purkinje system pacing reduced tricuspid regurgitation in patients with persistent atrial fibrillation after left-sided valve surgery. Front Cardiovasc Med 2023; 10:1049482. [PMID: 36960469 PMCID: PMC10027705 DOI: 10.3389/fcvm.2023.1049482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/15/2023] [Indexed: 03/09/2023] Open
Abstract
Background & objective Tricuspid regurgitation after left-sided valve surgery was a common and difficult problem. Atrial fibrillation was considered to be an important etiology of tricuspid regurgitation. His-Purkinje system pacing (HPSP) was a physiological pacing method, which could prevent and treat heart failure and might reduce tricuspid regurgitation. Our study aimed to investigate the effect of HPSP on tricuspid regurgitation in patients with persistent atrial fibrillation after left-sided valve surgery. Methods This study was a retrospective study. The 3-year patient review focused on those who underwent permanent cardiac pacemaker implantation of HPSP after mitral valve and/or aortic valve replacement from Jan 1st, 2019 to Jan 1st, 2022. HPSP included His bundle pacing (HBP) or left bundle branch pacing (LBBP). Clinical data collected included electrocardiogram, pacing parameters, ultrasonic cardiogram parameters and chest x-ray at implantation and 3-month follow up. Univariate and multivariate linear regression analysis of tricuspid regurgitation velocity were performed. Results A total of 44 patients was retrospectively reviewed. Eight patients who had undergone implantation of HPSP after left-sided heart valve replacement were enrolled in the study. All patients had persistent atrial fibrillation. Three of them received HBP and five underwent LBBP. At 3-month follow-up, the tricuspid regurgitation grade was significantly lower than that before implantation (P = 0.007). The tricuspid regurgitation velocity significantly decreased (317 ± 74 cm/s vs. 261 ± 52 cm/s, P = 0.022) and tricuspid valve pressure gradient (PG) reduced (42 ± 21 mmHg vs. 28 ± 10 mmHg, P = 0.040). The cardiothoracic ratio of patients was significantly lower than that before implantation (0.61 ± 0.08 vs. 0.64 ± 0.09, P = 0.017). The NYHA classification of patients also improved (P = 0.013). In multivariate liner regression analysis, the pacing ratio (β = 0.736, P = 0.037) was an independent determinant of tricuspid regurgitation velocity variation. Conclusion HPSP might reduce tricuspid regurgitation and improve cardiac function in patients with persistent atrial fibrillation after left-sided valve surgery.
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Affiliation(s)
- Ning Wang
- Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Tianyu Zhu
- Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Yan Li
- Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Guanliang Cheng
- Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Yu Chen
- Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Yuwei Fu
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Xuezhi Chen
- Department of Cardiology, Peking University International Hospital, Beijing, China
- Correspondence: Xuezhi Chen
| | - Xiaohui Liu
- Department of Cardiology, Peking University International Hospital, Beijing, China
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Chen Z, Zhou X, Ma X, Chen K. Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart. Front Physiol 2022; 13:1045740. [PMID: 36589433 PMCID: PMC9798297 DOI: 10.3389/fphys.2022.1045740] [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] [Received: 09/16/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a leading health burden around the world. Although pharmacological development has dramatically advanced medication therapy in the field, hemodynamic disorders or mechanical desynchrony deteriorated by intra or interventricular conduction abnormalities remains a critical target beyond the scope of pharmacotherapy. In the past 2 decades, nonpharmacologic treatment for heart failure, such as cardiac resynchronization therapy (CRT) via biventricular pacing (BVP), has been playing an important role in improving the prognosis of heart failure. However, the response rate of BVP-CRT is variable, leaving one-third of patients not benefiting from the therapy as expected. Considering the non-physiological activation pattern of BVP-CRT, more efforts have been made to optimize resynchronization. The most extensively investigated approach is by stimulating the native conduction system, e.g., His-Purkinje conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). These emerging CRT approaches provide an alternative to traditional BVP-CRT, with multiple proof-of-concept studies indicating the safety and efficacy of its utilization in dyssynchronous heart failure. In this review, we summarize the mechanisms of dyssynchronous HF mediated by conduction disturbance, the rationale and acute effect of CSP for CRT, the recent advancement in clinical research, and possible future directions of CSP.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Keping Chen,
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Muacevic A, Adler JR, Agrawal H, Arko SB. A Case Report on BRASH (Bradycardia, Renal Failure, Atrioventricular Blockade, Shock, and Hyperkalaemia) Syndrome: A Challenging Diagnosis. Cureus 2022; 14:e32704. [PMID: 36686086 PMCID: PMC9848718 DOI: 10.7759/cureus.32704] [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: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
A relatively new yet critical phenomenon of bradycardia, renal failure, atrioventricular (AV) blockade, shock, and hyperkalemia (BRASH) syndrome is hypothesized to happen in patients who take atrioventricular nodal blocking (AVNB) agents and have underlying renal insufficiency. In our case, a 67-year-old female with an extensive medical history presented to the emergency room with chief complaints of decreased appetite, nausea, vomiting, fatigue, and left-sided atypical chest pain for the past two weeks. The patient was taking losartan potassium 50 mg daily in addition to carvedilol 6.25 mg twice daily for her hypertension (HTN) and heart failure with reduced ejection fraction (HFrEF) with the addition of bumetanide 0.5 mg, which was added three weeks prior. On presentation, the patient had sinus bradycardia and hypotension along with the laboratory finding of acute kidney injury (AKI) in the setting of chronic kidney disease (CKD) and hyperkalemia. Cardiology and nephrology were consulted emergently; her clinical scenario raised suspicion of the BRASH syndrome. The patient was admitted to the intensive care unit (ICU), and all antihypertensive medications, including beta-blockers, were stopped. Intravenous (IV) fluid resuscitation and medical management of hyperkalemia were initiated, along with BiPAP for respiratory distress. She responded significantly, and her vitals remained stable. She was successfully discharged home with a cardiology and nephrology follow-up. We highlight the case to emphasize the consideration of BRASH in a patient on multiple cardiac medications who presented with deranged electrolytes and organ failure, and decompensated heart failure (HF) should not be fixed on as the principal diagnosis.
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Parsova KE, Hayiroglu MI, Pay L, Cinier G, Gurkan K. Long-term follow-up of patients with drug-related atrioventricular block without a need of permanent pacemaker during index hospitalization. Egypt Heart J 2022; 74:56. [PMID: 35913636 PMCID: PMC9343480 DOI: 10.1186/s43044-022-00297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Most of the patients hospitalized due to drug-related atrioventricular (AV) block do not require permanent pacemaker implantation (PPI) since AV block regresses following cessation of the responsible drug. However, AV block requiring PPI may relapse in long-term follow-up. In this study, we retrospectively evaluated the factors predicting the need for a PPI in the long-term follow-up in patients admitted to our hospital with drug-related AV block but did not require PPI in index hospitalization. Results We evaluated 177 patients who had been hospitalized with drug-related AV block between January 2012 and July 2020 and who had not required PPI during hospital follow-up. The patients were divided into two groups according to whether PPI was performed or not. The independent predictors of long-term PPI were evaluated and the effect of glomerular filtration rate (GFR) of the patients during the index hospitalization on the long-term outcome was compared. A GFR above 60 ml/min is an independent significant risk factor in predicting long-term permanent pacemaker implantation in drug-related AV blocks. It is found that the need for PPI was 2.64 times higher without adjusted and 1.9 times higher with adjusted for all covariates in patients with GFR above 60 ml/min during hospitalization compared to those with GFR below 30 ml/min. Conclusions GFR may be considered as an indicator of the PPI need in patients with drug-related atrioventricular AV block.
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Predictors of high-degree atrioventricular block in patients with new-onset left bundle branch block following transcatheter aortic valve replacement. J Interv Card Electrophysiol 2022; 65:765-772. [PMID: 36056221 DOI: 10.1007/s10840-022-01361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The development of new left bundle branch block (LBBB) is frequently seen post TAVR and is a known risk factor for progression to high degree AV block. The timing and likelihood of progression into complete heart block is variable and can develop after hospital discharge. We sought to determine predictors for the development of high degree AV block in patients who developed LBBB following TAVR. METHODS All patients between 2014 and 2019 underwent electrophysiology study after developing LBBB post TAVR. Data on these patients including baseline characteristics, echo parameters, EKG variables, HV interval, and the need for subsequent pacemaker implantation were extracted. A prolonged HV interval was defined as ≥ 65 ms. Clinically significant conduction abnormality was defined as development of high-degree AV block or clinically significant complete heart block. RESULTS Thirty-four patients were included in our study of which 10 (29.4%) developed clinically significant heart block, while 24 (70.6%) did not. The mean HV interval for patients with clinically significant heart block was 70.1 ms vs 57.8 ms for those who did not (p = 0.022). Pre-existing first-degree heart block prior to TAVR (p = 0.026), history of AFib (p = 0.05) in addition to STS score (p = 0.037) were predictors of development of high-degree AV block in our patient population. CONCLUSIONS In patients who develop LBBB following TAVR, HV interval, pre-existing first-degree heart block, and STS score predict progression to high-degree AV block. Performance of a routine electrophysiology study should be considered for high-risk patients who develop LBBB following TAVR.
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Cui Y, Liao Y, Zhang Q, Yan H, Liu P, Wang Y, Sun Y, Xu W, Liu X, Du J, Jin H. Spectrum of underlying diseases in syncope and treatment of neurally-mediated syncope in children and adolescents over the past 30 years: A single center study. Front Cardiovasc Med 2022; 9:1017505. [DOI: 10.3389/fcvm.2022.1017505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
BackgroundSyncope is the primary cause of transient loss of consciousness, which causes severe physical and mental burdens to children and adolescents.ObjectiveThe study was designed to analyze the spectrum of underlying diseases of syncope and treatment options for neurally-mediated syncope (NMS) in Chinese children and adolescents.MethodsMedical records including history, physical examination, blood biochemistry, standing test, head-up tilt (HUTT), sitting-up test, electroencephalogram (EEG), electrocardiogram (ECG), and echocardiography were retrospectively studied in children and adolescents admitted to the National Pediatric Syncope Center, Department of Pediatrics, Peking University First Hospital between 1992 and 2021. All the data were collected from the Beijing Kaihua Medical Management System (Kaihua, Beijing, China). Children who met the syncope diagnostic criteria were enrolled in the study. The spectrum of the underlying diseases of syncope in children and adolescents and the treatment options of NMS were analyzed.ResultsA total of 1,947 children and adolescents with syncope were admitted, including 869 males (44.63%) and 1,078 females (55.37%) aged 1–18 years, with an average age of 11.1 ± 3.1 years. The number of children and adolescents with syncope displayed a gradually increasing trend between 1992 and 2021 except after 2020. NMS proportion increased, and the proportion of unexplained syncope decreased (χ2 = 128.839, P < 0.01). The treatment options of NMS mainly included autonomic nervous function exercise (549, 34.46%), oral rehydration salt (ORS; 445, 27.94%), metoprolol (219, 13.75%), midodrine (120, 7.53%), ORS plus metoprolol (139, 8.73%), ORS plus midodrine (120, 7.53%), and pacemakers (1, 0.06%). Patients with vasovagal syncope (VVS) coexisting with postural orthostatic tachycardia syndrome (POTS) were more likely to take pharmacological treatments than those with VVS or POTS only (χ2 = 41.696, P < 0.01).ConclusionThe number of children with syncope displayed an increasing trend before 2020, and the proportion of unexplained syncope decreased. Autonomic nervous function exercise was the most common treatment for children and adolescents with NMS. Children with VVS coexisting with POTS were more likely to receive pharmacological treatments than those with either.
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Muacevic A, Adler JR. Congenital Aneurysm of the Muscular Interventricular Septum Associated With Bifascicular Block. Cureus 2022; 14:e29994. [PMID: 36238417 PMCID: PMC9548025 DOI: 10.7759/cureus.29994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
Isolated congenital aneurysm of the muscular interventricular septum is rare. We present a patient with congenital aneurysm of the basal muscular ventricular septum, who also develops conduction abnormalities with first-degree heart block, right bundle branch block, and left posterior fascicular block. The case details the natural history of the aneurysm over a 10-year period follow-up during which the patient remained asymptomatic with evidence of regression of the aneurysm. Given the aneurysm's location close to the proximal right bundle and left posterior fascicle, we believe that the cause for the aneurysm also injured both fascicles resulting in bifascicular block. The diagnosis of bifascicular block was confirmed using the electrocardiogram-derived vectorcardiography loops. These conduction abnormalities have remained stable. The case illustrates the utility of vectorcardiography in diagnosing bundle branch conduction defects. The case also illustrates the importance of anatomical considerations when encountering congenital heart defects.
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