Increased Risk of Atrial Fibrillation in the Early Period after Herpes Zoster Infection: a Nationwide Population-based Case-control Study

Combining fire needle plus cupping with famciclovir and gabapentin in the treatment of acute herpes zoster: a revised intervention approach

This study aimed to investigate the efficacy and safety of fire needle plus cupping (FC) combined with oral famciclovir and gabapentin for the treatment of acute-phase herpes zoster (AHZ). This study was conducted as a superiority, randomized controlled trial in which 84 patients with AHZ who met the diagnostic criteria were selected and randomly assigned to three groups on a 1:1 basis. Group A: received oral famciclovir with gabapentin treatment (FG); Group B: received fire needle plus cupping (FC) with FG. The primary outcome was the difference in patients' pain levels as assessed by the VAS scale. Secondary outcomes were changes in sign-symptom scores, incidence of adverse effects, and incidence of PHN. After one week of treatment, both groups showed decreased VAS scores and symptom-sign scores compared to baseline. However, the decrease in VAS scores was significantly higher in Group B compared to Group A (p < 0.0001). Similarly, the improvement in symptom-sign scores was significantly better in Group B (p < 0.0001). Group A experienced a higher rate of adverse reactions (21.95%) compared to Group B (4.76%), with a significant difference between the groups (p = 0.021). Furthermore, the incidence of PHN was significantly lower in Group B (4.76%) compared to Group A (29.27%) (p = 0.003). Fire needle therapy combined with medication demonstrated superior analgesic effects, improved symptom relief, and reduced adverse reactions and the incidence of PHN compared to medication alone in the treatment of AHZ. Importantly, the fire needle and cupping therapy should be considered an add-on therapy to standard drug treatment, rather than a standalone treatment. Additionally, due to the lack of a sham-treated control group, the placebo effect associated with invasive therapies such as fire needling and cupping. Future studies should include a sham control group to better isolate the true effects of the treatment. Clinical trial registration: This study was registered with the Chinese Clinical Trial Registry under the code ChiCTR1800015372 ( https://www.chictr.org.cn ). Registered on 28 March 2018. All experiments on the participants were following the Declaration of Helsinki.

Burden of Herpes Zoster in Individuals With Chronic Conditions in the Republic of Korea: A Nationwide Population-Based Database Study

Background

Chronic conditions (CCs) may increase the risk of herpes zoster (HZ) infection, leading to a greater healthcare burden in these individuals compared to those without CCs. It is therefore clinically important to quantify HZ disease burden in individuals with and without CCs, given the rapidly aging population in the Republic of Korea (ROK).

Methods

This retrospective cohort study examines the trends in incidence rates (IRs) and incidence rate ratios (IRRs) in individuals aged ≥18 years with CCs, using the National Health Insurance Service National Sample Cohort (NHIS-NSC) database from 2010 to 2019. These patients were stratified by age group, sex, HZ complications, and CCs. The annual average number of HZ patients, IRs, and IRRs were calculated for individuals with and without CCs.

Results

In total, 729 347 patients with HZ were eligible for the study. HZ IRs were highest in patients with diabetes, followed by chronic obstructive pulmonary disease, chronic kidney disease, asthma, and chronic liver disease, with HZ IRRs following a similar trend. Overall, HZ IRs generally increased with age, typically peaking at 60-64 or 65-69 years, and were similar for females and males. HZ IRs were highest among patients without complications, followed by HZ with other, cutaneous, ocular, and neurologic complications across all CCs. For each of the CCs, HZ IRs were consistently higher than those of the non-CC population regardless of sex.

Conclusions

The findings of this study reiterate the importance of HZ prevention for healthy aging, especially for CC populations at increased risk of HZ in the ROK.

Cardiac arrhythmias in viral infections

BACKGROUND

The current COVID-19 pandemic has led to many studies examining its arrhythmogenic effects. However, there are many other viruses that are capable of inducing arrhythmias that have not received as much attention. The objective of this study was to review common viruses and identify studies highlighting their arrhythmogenic effects.

METHODS AND RESULTS

In this review, we examined 15 viruses and the literature regarding their arrhythmogenic effects. The common mechanisms of action appear to be direct invasion of myocytes leading to immune mediated damage, infection of vascular endothelium, and alteration of cardiac ion channels.

CONCLUSIONS

This review highlights the growing evidence that supports the involvement of other viral infections in the development of arrhythmia. Physicians should be aware of these potentially life-threatening effects when caring for patients with these viruses, some of which are very common. Additional studies are required to better understand the complex mechanism and risk factors of cardiac arrhythmias in patients suffered from viral infections to determine whether the processes can be reversed or even prevented.

Varicella zoster virus and cardiovascular diseases

Varicella zoster virus (VZV) is a Herpesviridae family double-stranded DNA virus that only affects humans. The first clinical manifestation appears to be varicella, typical of childhood. VZV, on the other hand, becomes latent in ganglion neurons throughout the neuroaxis after primary infection. The VZV reactivates and travels along peripheral nerve fibers in the elderly and immunocompromised individuals, resulting in Zoster. It can, however, spread centrally and infect cerebral and extracranial arteries, resulting in vasculopathy, which can lead to transient ischemic attacks, strokes, aneurysms, cavernous sinus thrombosis, giant cell arteritis, and granulomatous aortitis. Although the mechanisms of virus-induced pathological vascular remodeling are not fully understood, recent research indicates that inflammation and dysregulation of ligand-1 programmed death play a significant role. Few studies, on the other hand, have looked into the role of VZV in cardiovascular disease. As a result, the purpose of this review is to examine the relationship between VZV and cardiovascular disease, the efficacy of the vaccine as a protective mechanism, and the target population of heart disease patients who could benefit from vaccination.

The presence of cardiotropic viral genomes is not increased in atrial tissue of atrial fibrillation patients

Background

Infections with potentially cardiotropic viruses are associated with the development of atrial fibrillation (AF). However, whether direct viral infection of the atria is involved in the pathogenesis of AF is unclear. We have therefore analysed the presence of cardiotropic viral genomes in AF patients.

Methods

Samples of left atrial tissue were obtained from 50 AF patients (paroxysmal, n = 20; long-standing persistent/permanent, n = 30) during cardiac surgery and from autopsied control patients (n = 14). Herein, the presence of PVB19, EBV, CMV, HHV‑6, adenovirus and enterovirus genomes was determined by polymerase chain reaction. The densities of CD45+ and CD3+ cells and fibrosis in the atria were quantified by (immuno)histochemistry.

Results

Of the tested viruses only the PVB19 genome was detected in the atria of 10% of patients, paroxysmal AF (2 of 20) and long-standing persistent/permanent AF (3 of 30). Conversely, in 50% of controls (7 of 14) PVB19 genome was found. No significant association was found between PVB19 and CD45+ and CD3+ cells, or between the presence of PVB19 and fibrosis, in either control or AF patients.

Conclusion

The presence of viral genomes is not increased in the atria of AF patients. These results do not support an important role for viral infection of the atria in the pathogenesis of AF.

Supplementary Information

The online version of this article (10.1007/s12471-022-01660-4) contains supplementary material, which is available to authorized users.

Impact of Hemoglobin Levels and Their Dynamic Changes on the Risk of Atrial Fibrillation: A Nationwide Population-Based Study

Anemia is a risk factor for cardiovascular disease, but its impact on new-onset atrial fibrillation (AF) is unclear. In this study, we investigated the effect of hemoglobin (Hb) levels and their changes on the risk of AF development in the general population of Korea. We retrospectively analyzed a cohort from the Korean National Health Insurance Service database and identified 9,686,314 subjects (49.8% male) without a history of AF, aged ≥40 years, and with Hb levels available for both first (2009-2010) and second (2011-2012) health checkups. These subjects were followed up until 2017 to determine AF development. The presence of anemia (Hb level <13 g/dL in men and <12 g/dL in women) was a significant risk factor for AF development. However, Hb levels showed a U-shaped association with incident AF after adjustment for cardiovascular risk factors. AF incidence was lowest at Hb levels of 14-14.9 g/dL in men and 12-12.9 g/dL in women. Among individuals with Hb levels within normal ranges (13-15.9 g/dL in men and 12-14.9 g/dL in women), both decrease and increase in Hb levels at the second measurement outside the normal ranges showed an elevation of AF risk by 11% and 21% for men and 3% and 36% for women, respectively, compared with those who maintained normal Hb levels. In conclusion, low or high Hb levels are associated with an increased risk of incident AF. This study suggests that maintaining Hb levels within the normal ranges confers a low risk of AF development.

Association between Atrial Fibrillation, Myocardial Infarction, Heart Failure and Mortality in Patients with Nontuberculous Mycobacterial Infection: a nationwide population-based study

NTM infection demonstrates an increasing incidence and prevalence. We studied the impact of NTM in cardiovascular events. Using the Korean nationwide database, we included newly diagnosed 1,730 NTM patients between 2005 and 2008 and followed up for new-onset atrial fibrillation (AF), myocardial infarction (MI), heart failure (HF), ischemic stroke (IS), and death. Covariates-matched non-NTM subjects (1:5, n = 8,650) were selected and analyzed. Also, NTM infection was classified into indolent or progressive NTM for risk stratification. During 4.16 ± 1.15 years of the follow-up period, AF, MI, HF, IS, and death were newly diagnosed in 87, 125, 121, 162, and 468 patients. In multivariate analysis, NTM group showed an increased risk of AF (hazard ratio [HR] 2.307, 95% confidence interval [CI] 1.560-3.412) and all-cause death (HR 1.751, 95% CI 1.412-2.172) compared to non-NTM subjects, whereas no significant difference in MI (HR 0.868, 95% CI 0.461-1.634), HF (HR 1.259, 95% CI 0.896-2.016), and IS (HR 1.429, 95% CI 0.981-2.080). After stratification, 1,730 NTM patients were stratified into 1,375 (79.5%) indolent NTM group and 355 (20.5%) progressive NTM group. Progressive NTM showed an increased risk of AF and mortality than indolent NTM group. Screening for AF and IS prevention would be appropriate in these high-risk patients.

Increased risk of atrial fibrillation in patients with Behçet's disease: A nationwide population-based study

BACKGROUND

Chronic inflammation plays a role in the pathophysiology of atrial fibrillation (AF). However, there is a paucity of information about whether Behçet's disease (BD) is associated with an increased risk of AF. This population-based study aimed to determine the risk of AF in patients with BD.

METHODS

A total of 6636 newly diagnosed BD patients without a history of AF were included from the Korean National Health Insurance Service database between 2010 and 2014. Newly diagnosed non-valvular AF was identified using the claims data. An age- and sex-matched non-BD subjects were extracted at a ratio of 1:5 (n = 31,040). The incidence and risk of AF were compared between groups.

RESULTS

During a mean follow-up of 3.6 ± 1.5 years, AF was newly diagnosed in 173 patients (51 in the BD group, 122 in the control group). The incidence was 2.3 and 1.1 per 1000 person-years, respectively. After adjustment, the BD group showed a 1.8-fold higher risk of AF compared to the control group. Patients with BD aged ≤40 years had a higher risk of AF, while patients aged ≥65 years showed a similar risk. Men with BD had a 2.5-fold increased risk of AF, whereas women with BD did not. Severe BD had a higher risk for AF compared to non-severe BD and controls.

CONCLUSIONS

BD was associated with an increased risk of AF, particularly in men and young patients. Active surveillance and treatment are needed in BD patients and those with arrhythmic symptoms.

Herpes zoster and the risks of osteoporosis and fracture: a nationwide cohort study

This study aimed to investigate the association between herpes zoster (HZ) and the risks of osteoporosis and fracture. We conducted a nationwide retrospective cohort study using the National Health Insurance Research Database of Taiwan. The study enrolled 63,786 patients: 31,893 diagnosed with HZ between 2000 and 2012 were included in the HZ cohort, and 31,893 matched controls without HZ were included in the non-HZ cohort, with 1:1 exact matching for age, sex, and index year. Hazard ratios (HRs) were calculated for the risks of osteoporosis and fracture according to the HZ status using the Cox proportional hazards regression models. During a mean follow-up period of 6.0 years, 5597 and 4639 patients in the HZ and non-HZ cohorts, respectively, developed osteoporosis or fractures (incidence rate: 29.8 vs. 23.8 per 1000 person-years). HZ diagnosis was significantly associated with an elevated risk of developing osteoporosis or fracture (adjusted HR [aHR] = 1.20, p < 0.001). On analyses for each individual event, the HZ cohort had significantly increased risks for all events, including osteoporosis (aHR = 1.32, p < 0.001), hip fracture (aHR = 1.34, p < 0.001), vertebral fracture (aHR = 1.38, p < 0.001), and other fractures (aHR = 1.10, p < 0.001) compared with the non-HZ cohort. Patients with postherpetic neuralgia had especially higher risks of osteoporosis and fracture. Age- and sex-stratified analyses also revealed similar patterns. In conclusion, HZ was independently associated with an increased risk of osteoporosis and fracture. Further studies are required to investigate its underlying mechanisms.