Christian Moreno Luize, Lucas Hollanda Oliveira, Ricardo Sobral de Carvalho, Marcel Fernando Silva Carvalho, Danusa Moreira Lago, Cristiano de Oliveira Dietrich, Alleh Nogueira, Claudio Cirenza
Single case report of a middle-aged patient with Kartagener’s syndrome who experienced recurrent paroxysmal supraventricular tachycardia. Despite optimized beta-blocker therapy, only cardioversion in emergency departments provided symptomatic relief. The unique electrocardiographic features of this condition and their significance in transaortic electrophysiological studies for diagnosis and treatment are highlighted.
{"title":"Atrioventricular Nodal Reentrant Tachycardia in Kartagener’s Syndrome","authors":"Christian Moreno Luize, Lucas Hollanda Oliveira, Ricardo Sobral de Carvalho, Marcel Fernando Silva Carvalho, Danusa Moreira Lago, Cristiano de Oliveira Dietrich, Alleh Nogueira, Claudio Cirenza","doi":"10.24207/jca.v38i1.3505","DOIUrl":"https://doi.org/10.24207/jca.v38i1.3505","url":null,"abstract":"Single case report of a middle-aged patient with Kartagener’s syndrome who experienced recurrent paroxysmal supraventricular tachycardia. Despite optimized beta-blocker therapy, only cardioversion in emergency departments provided symptomatic relief. The unique electrocardiographic features of this condition and their significance in transaortic electrophysiological studies for diagnosis and treatment are highlighted.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"17 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yona Gandye, Mervat Aboulmaaty, Amy Bonny, Mathew Sackett, K. Khanbhai, Pedro Pallangyo, H. Mayala, Mohamed Elalfy, Smitha Bhalia, M. Janabi
In Tanzania, despite the expansion of cardiovascular management through the expansion of health system infrastructure to combat cardiovascular diseases, radiofrequency ablation of cardiac arrhythmias remains a major challenge as the current management with catheter ablation is inaccessible to the majority. Several limitations for developing invasive arrhythmia care are identified: lack of manpower, healthcare resources, health systems challenges, high cost of consumables, healthcare financing challenges and limited antiarrhythmic medications. The proposed solutions to address the unmet are: inauguration of a domestic arrhythmia society with dedicated prioritized academic programs, advocacy for training in the cost-effective conventional approach to arrhythmia ablation, reducing irrational claim deduction from insurers and regulation of central medical store policy, calling the Ministry of Health to implement insurance accreditation of radiofrequency ablation in Tanzania, sensitize the government to offer motivation to candidates pursuing electrophysiology career, the government through the Ministry of Health and education to transform the current training infrastructure to meet current academic needs including radiofrequency ablation services, the creation of training partnerships within Africa to improve local electrophysiology expertise. Radiofrequency ablation using a conventional approach, which is cost-effective, can be adopted to ensure service availability in Tanzania and the Sub-Sahara region. A unique responsibility lies within the government and financers to reinforce the efforts to implement these recommendations and achieve the medical tourism policy in Tanzania.
{"title":"Evolution of Cardiac Arrythmia Management by Catheter Ablation in Tanzania","authors":"Yona Gandye, Mervat Aboulmaaty, Amy Bonny, Mathew Sackett, K. Khanbhai, Pedro Pallangyo, H. Mayala, Mohamed Elalfy, Smitha Bhalia, M. Janabi","doi":"10.24207/jca.v37i1.3475","DOIUrl":"https://doi.org/10.24207/jca.v37i1.3475","url":null,"abstract":"In Tanzania, despite the expansion of cardiovascular management through the expansion of health system infrastructure to combat cardiovascular diseases, radiofrequency ablation of cardiac arrhythmias remains a major challenge as the current management with catheter ablation is inaccessible to the majority. Several limitations for developing invasive arrhythmia care are identified: lack of manpower, healthcare resources, health systems challenges, high cost of consumables, healthcare financing challenges and limited antiarrhythmic medications. The proposed solutions to address the unmet are: inauguration of a domestic arrhythmia society with dedicated prioritized academic programs, advocacy for training in the cost-effective conventional approach to arrhythmia ablation, reducing irrational claim deduction from insurers and regulation of central medical store policy, calling the Ministry of Health to implement insurance accreditation of radiofrequency ablation in Tanzania, sensitize the government to offer motivation to candidates pursuing electrophysiology career, the government through the Ministry of Health and education to transform the current training infrastructure to meet current academic needs including radiofrequency ablation services, the creation of training partnerships within Africa to improve local electrophysiology expertise. Radiofrequency ablation using a conventional approach, which is cost-effective, can be adopted to ensure service availability in Tanzania and the Sub-Sahara region. A unique responsibility lies within the government and financers to reinforce the efforts to implement these recommendations and achieve the medical tourism policy in Tanzania.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"133 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Gabriela Ponte Farias, Arnóbio Dias da Ponte Filho, Marcela Albuquerque de Holanda, Arthur Holanda Dantas, Aston Alves de Freitas, Rodrigo Carvalho Paiva, Marcela Sobreira Kubrusly, Davi Sales Pereira Gondim, Pedro Barbosa Duarte Vidal, Fernanda Pimentel Arraes Maia, Luís Gustavo Bastos Pinho, Ana Gabriela Ponte Farias, Eduardo Arrais Rocha
Introduction: The elderly have several causes of syncope or pre-syncope. The importance of the Tilt Test (TT) has been questioned in this population. However, dysautonomic causes are common in these age groups, having an impact on morbidity and mortality. Objective: Compare the results of the TT between the age groups of the elderly (>=60 years) and the non-elderly. Methods: Crosssectional study carried out between 2016-2021. We used the Mann-Whitney and Chi-square tests, with a p-value < 5% considered significant. The protocols used were Westminster or Italian. Results: We analyzed 2364 tilt tests, 61.7% female, aged 51.1 (31-71) years. Positivity was 32.6%, 37.2% with sensitization (p < 0.0001). In the elderly group (EG), there were 958 tests (40.5%) and 1381 (58.4%) in the non-elderly (NEG). EG positivity was 270 (28.0%), lower than NEG with 524 (37.43%) (p < 0.01). Positivity with sensitization in EG was 195 (20.35%) x 403(29.18%) in NEG (p<0.001). In EG, 50 patients (5.22%) had a dysautonomic response and in NEG, there were 10 (0.72%) (p < 0.001). Complications were 4.2% EG x 2.6% NEG ( p= 0.03). Conclusion: The TT in the elderly showed a lower incidence of positivity in the passive and sensitization phases compared to the non-elderly. Vasovagal causes were the most frequent causes in the elderly, had a higher incidence of dysautonomic responses, fewer prodromes and a higher rate of complications, however without severity.
{"title":"What are the characteristics and results of Tilt Tests in the elderly?","authors":"Ana Gabriela Ponte Farias, Arnóbio Dias da Ponte Filho, Marcela Albuquerque de Holanda, Arthur Holanda Dantas, Aston Alves de Freitas, Rodrigo Carvalho Paiva, Marcela Sobreira Kubrusly, Davi Sales Pereira Gondim, Pedro Barbosa Duarte Vidal, Fernanda Pimentel Arraes Maia, Luís Gustavo Bastos Pinho, Ana Gabriela Ponte Farias, Eduardo Arrais Rocha","doi":"10.24207/jca.v38i.3491","DOIUrl":"https://doi.org/10.24207/jca.v38i.3491","url":null,"abstract":"Introduction: The elderly have several causes of syncope or pre-syncope. The importance of the Tilt Test (TT) has been questioned in this population. However, dysautonomic causes are common in these age groups, having an impact on morbidity and mortality. Objective: Compare the results of the TT between the age groups of the elderly (>=60 years) and the non-elderly. Methods: Crosssectional study carried out between 2016-2021. We used the Mann-Whitney and Chi-square tests, with a p-value < 5% considered significant. The protocols used were Westminster or Italian. Results: We analyzed 2364 tilt tests, 61.7% female, aged 51.1 (31-71) years. Positivity was 32.6%, 37.2% with sensitization (p < 0.0001). In the elderly group (EG), there were 958 tests (40.5%) and 1381 (58.4%) in the non-elderly (NEG). EG positivity was 270 (28.0%), lower than NEG with 524 (37.43%) (p < 0.01). Positivity with sensitization in EG was 195 (20.35%) x 403(29.18%) in NEG (p<0.001). In EG, 50 patients (5.22%) had a dysautonomic response and in NEG, there were 10 (0.72%) (p < 0.001). Complications were 4.2% EG x 2.6% NEG ( p= 0.03). Conclusion: The TT in the elderly showed a lower incidence of positivity in the passive and sensitization phases compared to the non-elderly. Vasovagal causes were the most frequent causes in the elderly, had a higher incidence of dysautonomic responses, fewer prodromes and a higher rate of complications, however without severity.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141009206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eduardo Arrais Rocha, Bruna Sobreira Kubrusly, Aléssia Alencar Araripe Gurgel, Luís Gustavo Bastos Pinho, Ana Gardenia Liberato Ponte Farias, Vitor Olímpio Coimbra, Pedro Sales Gondim, Maria Camila Timbó Rocha, Maria Eduarda Quidute Arrais Rocha, Francisca Tatiana Moreira Pereira, Vera Marques, Roberto Lima Farias, Eduardo Arrais Rocha
The tilt table test (TT) provides relevant information about individual susceptibility to neuro-mediated hypotension and bradycardia. Its importance has been questioned. In this work, we analyze the results and safety of TT in the investigation of syncope, presyncope or postural dizziness. Cross-sectional study, with TT exams performed by specialists in cardiac arrhythmias, in the period 2016-2021, in a syncope unit. Analyzes were performed using the Mann-Whitney test, multiple logistic regression, with a significant p value <0.05. The protocols used were Westminster or Italian protocol. There were 2364 TT performed, 61.7% female, aged 51.1 (31-71) years. The positivity rate was 32.6%, 37.2% with pharmacological sensitization (p< 0.01). For the investigation of syncope, positivity was 34.2% (477) x 30.65% (285) for other symptoms (p<0.001), while evaluating syncope and presyncope together the difference was 37.55% (623) x 20.9% (139) for other symptoms (p<0.001). Positivity was higher in males (p<0.01; OR=1.40(1.16-1.69)), in sensitized tests (p<0.01;2.01(1.64-2, 38)), in patients with early orthostatic hypotension (OH) with symptoms (p <0.01; 9.68(4.13-27.44)). The complication rate was 3.29%, but without severity. The TT remains an important and safe methodology in clinical practice for the investigation of patients with suspected neurally mediated syndromes.
{"title":"The Tilt Test in the Assessment of Syncope and Pre-syncope. Effective and safe? Analysis of a Series of 2364 Patients over 6 Years","authors":"Eduardo Arrais Rocha, Bruna Sobreira Kubrusly, Aléssia Alencar Araripe Gurgel, Luís Gustavo Bastos Pinho, Ana Gardenia Liberato Ponte Farias, Vitor Olímpio Coimbra, Pedro Sales Gondim, Maria Camila Timbó Rocha, Maria Eduarda Quidute Arrais Rocha, Francisca Tatiana Moreira Pereira, Vera Marques, Roberto Lima Farias, Eduardo Arrais Rocha","doi":"10.24207/jca.v37i1.3490","DOIUrl":"https://doi.org/10.24207/jca.v37i1.3490","url":null,"abstract":"The tilt table test (TT) provides relevant information about individual susceptibility to neuro-mediated hypotension and bradycardia. Its importance has been questioned. In this work, we analyze the results and safety of TT in the investigation of syncope, presyncope or postural dizziness. Cross-sectional study, with TT exams performed by specialists in cardiac arrhythmias, in the period 2016-2021, in a syncope unit. Analyzes were performed using the Mann-Whitney test, multiple logistic regression, with a significant p value <0.05. The protocols used were Westminster or Italian protocol. There were 2364 TT performed, 61.7% female, aged 51.1 (31-71) years. The positivity rate was 32.6%, 37.2% with pharmacological sensitization (p< 0.01). For the investigation of syncope, positivity was 34.2% (477) x 30.65% (285) for other symptoms (p<0.001), while evaluating syncope and presyncope together the difference was 37.55% (623) x 20.9% (139) for other symptoms (p<0.001). Positivity was higher in males (p<0.01; OR=1.40(1.16-1.69)), in sensitized tests (p<0.01;2.01(1.64-2, 38)), in patients with early orthostatic hypotension (OH) with symptoms (p <0.01; 9.68(4.13-27.44)). The complication rate was 3.29%, but without severity. The TT remains an important and safe methodology in clinical practice for the investigation of patients with suspected neurally mediated syndromes.\u0000 ","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"10 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140430425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Lima, Francisco Flavio Costa Filho, Randy Lieberman, Preeti Ramappa
A man with history of Heart Failure with preserved Ejection Fraction (HFpEF), Atrioventricular (AV) node ablation followed by biventricular pacemaker placement was hospitalized for dyspnea. During invasive hemodynamic assessment patient had brief episode of asystole due to lead displacement. Right catheterization should be cautiously performed in patients with intracardiac devices, when done safety protocols should be followed.
{"title":"Lead Dislodgement Post Invasive Hemodynamic Assessment after Atrioventricular Node Ablation and Biventricular Pacemaker","authors":"N. Lima, Francisco Flavio Costa Filho, Randy Lieberman, Preeti Ramappa","doi":"10.24207/jca.v36i1.3495","DOIUrl":"https://doi.org/10.24207/jca.v36i1.3495","url":null,"abstract":"A man with history of Heart Failure with preserved Ejection Fraction (HFpEF), Atrioventricular (AV) node ablation followed by biventricular pacemaker placement was hospitalized for dyspnea. During invasive hemodynamic assessment patient had brief episode of asystole due to lead displacement. Right catheterization should be cautiously performed in patients with intracardiac devices, when done safety protocols should be followed.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"45 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139011863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vitaly V. Lyashenko, Andrey V. Ivanchenko, Angelika S. Postol, Sardor N. Azizov, Alexander B. Vygovsky, Yuri A. Schneider
BACKGROUND: Thoracoscopic version of the MAZE operation alone or in combination with catheter ablation (hybrid approach) has become widespread in the treatment of atrial fibrillation (AFib). However, recurrences of arrhythmias after such operations, in particular recurrence of AFib, remain unresolved problem.
AIM: The aim of this study was to establish the structure of arrhythmia recurrence in patients with long-standing persistent AFib after primary epicardial ablation using the Dallas lesion set technique, as well as determining the optimal RFA strategy for recurrence.
METHODS: 138 catheter ablation procedures for 100 patients, who applied with recurrence of various atrial arrhythmias after thoracoscopic MAZE. 34 patients had 2 or more RFA (31 pts 2, 2 pts 3, 1 pts 4).
RESULTS: After Dallas lesion set thoracoscopic ablation in the structure of recurrences dominated: 1 AFib recurence; 2 incisional left atrial flutter. After the operation, a potential arrhythmogenic substrate remains, which must be fully eliminated by RFA (in addition to ablation the main cause of recurrence). This minimally necessary intervention implies: control and reisolation of the pulmonary veins; control and reisolation of the posterior wall; septal line from the mitral valve to the right superior pulmonary vein with Y-shaped branch to the left superior pulmonary vein; cava-tricuspid isthmus-blockade. This will eliminate and prevent in the future potentially possible incisional arrhythmias in fragmentary scars after thoracoscopic MAZE procedure. The return of AFib represents the most difficult group of patients. Restoration of sinus rhythm in recurrent AFib after epicardial ablation is possible, but may require extensive ablations in both atriums, as a result of repeated procedures, until all potential arrhythmia mechanisms, present in a particular patient, are eliminated.
CONCLUSIONS: Catheter ablation remains the only method of effective treatment of recurrences after thoracoscopic MAZE procedure. The complexity and multicomponent nature of long-standing AFib causes the frequent need for repeated procedures, especially in cases of recurrence of atrial fibrillation.
{"title":"Recurrence of Arrhythmias after Thoracoscopic MAZE procedure","authors":"Vitaly V. Lyashenko, Andrey V. Ivanchenko, Angelika S. Postol, Sardor N. Azizov, Alexander B. Vygovsky, Yuri A. Schneider","doi":"10.17816/cardar492331","DOIUrl":"https://doi.org/10.17816/cardar492331","url":null,"abstract":"BACKGROUND: Thoracoscopic version of the MAZE operation alone or in combination with catheter ablation (hybrid approach) has become widespread in the treatment of atrial fibrillation (AFib). However, recurrences of arrhythmias after such operations, in particular recurrence of AFib, remain unresolved problem.
 AIM: The aim of this study was to establish the structure of arrhythmia recurrence in patients with long-standing persistent AFib after primary epicardial ablation using the Dallas lesion set technique, as well as determining the optimal RFA strategy for recurrence.
 METHODS: 138 catheter ablation procedures for 100 patients, who applied with recurrence of various atrial arrhythmias after thoracoscopic MAZE. 34 patients had 2 or more RFA (31 pts 2, 2 pts 3, 1 pts 4).
 RESULTS: After Dallas lesion set thoracoscopic ablation in the structure of recurrences dominated: 1 AFib recurence; 2 incisional left atrial flutter. After the operation, a potential arrhythmogenic substrate remains, which must be fully eliminated by RFA (in addition to ablation the main cause of recurrence). This minimally necessary intervention implies: control and reisolation of the pulmonary veins; control and reisolation of the posterior wall; septal line from the mitral valve to the right superior pulmonary vein with Y-shaped branch to the left superior pulmonary vein; cava-tricuspid isthmus-blockade. This will eliminate and prevent in the future potentially possible incisional arrhythmias in fragmentary scars after thoracoscopic MAZE procedure. The return of AFib represents the most difficult group of patients. Restoration of sinus rhythm in recurrent AFib after epicardial ablation is possible, but may require extensive ablations in both atriums, as a result of repeated procedures, until all potential arrhythmia mechanisms, present in a particular patient, are eliminated.
 CONCLUSIONS: Catheter ablation remains the only method of effective treatment of recurrences after thoracoscopic MAZE procedure. The complexity and multicomponent nature of long-standing AFib causes the frequent need for repeated procedures, especially in cases of recurrence of atrial fibrillation.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135734859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalia V. Bakulina, Michail R. Scherbakov, Lyudmila I. Anikonova
Atrial fibrillation (AF) is the most commonly diagnosed cardiac arrhythmia in adults, the frequency of which increases in patients with chronic kidney disease (CKD). The substrate for the development of AF is atrial cardiomyopathy, which includes structural, electrophysiological and molecular remodeling of the atria. AF, in turn, can initiate and accelerate the progression of CKD. Such a bidirectional relationship causes a frequent combination of these two conditions, leading to both a prothrombotic state and an increased risk of bleeding. In patients with CKD, the pharmacokinetics of drugs used in AF are changing, what limits their use in CKD S4/S5. If previously patients with CKD S4-5 were excluded from randomized clinical trials (RCTs) on treatment strategies for AF, a number of such studies on their management have been published to date. The purpose of the article is to review existing ideas about the features of the pathogenesis of AF in CKD and strategies of recent years for the treatment of AF with advanced stages of CKD.
{"title":"Atrial fibrillation in patients with chronic kidney disease: features of pathogenesis and treatment","authors":"Natalia V. Bakulina, Michail R. Scherbakov, Lyudmila I. Anikonova","doi":"10.17816/cardar430414","DOIUrl":"https://doi.org/10.17816/cardar430414","url":null,"abstract":"Atrial fibrillation (AF) is the most commonly diagnosed cardiac arrhythmia in adults, the frequency of which increases in patients with chronic kidney disease (CKD). The substrate for the development of AF is atrial cardiomyopathy, which includes structural, electrophysiological and molecular remodeling of the atria. AF, in turn, can initiate and accelerate the progression of CKD. Such a bidirectional relationship causes a frequent combination of these two conditions, leading to both a prothrombotic state and an increased risk of bleeding. In patients with CKD, the pharmacokinetics of drugs used in AF are changing, what limits their use in CKD S4/S5. If previously patients with CKD S4-5 were excluded from randomized clinical trials (RCTs) on treatment strategies for AF, a number of such studies on their management have been published to date. The purpose of the article is to review existing ideas about the features of the pathogenesis of AF in CKD and strategies of recent years for the treatment of AF with advanced stages of CKD.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135733777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tatyana I. Makeeva, Elizaveta V. Zbyshevskaya, Mark V. Mayer, Faiz A. Talibov, Sergey A. Saiganov
BACKGROUND: Over the past 3 years, the prevalence of atrial fibrillation (AF) has increased significantly worldwide, which was associated with the pandemic caused by SARS-CoV-2. It is accompanied by an increase in the cases of ischemic stroke, myocardial infarction, and development of heart failure due to acute myocardial injury. Given the high lethality of SARS-CoV-2 infection (COVID-19), studying the characteristics of new-onset AF is essential.
AIM: The study aims at determining the predictors of new-onset AF in patients with COVID-19 pneumonia and at analyzing the clinical and pathophysiological characteristics of acute myocardial injury.
MATERIALS AND METHODS: In 36 patients aged 4482 years (average 68.0) with COVID-19 pneumonia, AF paroxysms were recorded for the first time. All of them underwent computed tomography of the chest, electrocardiography, and echocardiography. The left ventricular ejection fraction was calculated using the Simpson method. Oxygen saturation was determined as blood oxygen saturation. Clinical blood tests were performed, C-reactive protein (CRP), ferritin, D-dimer, fibrinogen, and troponin I levels were measured.
RESULTS: Along with the well-known predictors of AF development (arterial hypertension, coronary heart disease, left ventricular myocardial hypertrophy, and left atrial dilatation), with COVID-19 pneumonia, new-onset AF paroxysms were recorded in patients of the middle, elderly, and late-life age. In 44.4% of patients with AF, cardiomegaly occurred with dilatation of both atria and ventricles. With decreased left ventricular ejection fraction, the incidence of AF paroxysms reached 61.5%. With preserved ejection fraction, AF paroxysms occurred much less frequently (27%). In patients with AF, the extent of lung damage is on average 62.5% (2080%) with oxygen support saturation of 93% (7697%). Serum troponin I levels of 2000 ng/L indicated acute myocardial injury. CRP and blood ferritin values confirmed the presence of a pronounced inflammatory component in myocardial injury. High concentrations of blood fibrinogen and D-dimer, reaching 16,301 ng/mL, were associated with a tendency to hypercoagulation in patients with AF and COVID-19 pneumonia.
CONCLUSIONS: COVID-19 has a direct damaging effect on the myocardium and probably persists for a long time, which may induce AF in patients with acute pneumonia.
{"title":"New-onset atrial fibrillation in patients with SARS-CoV-2 pneumonia as a manifestation of acute myocardial injury","authors":"Tatyana I. Makeeva, Elizaveta V. Zbyshevskaya, Mark V. Mayer, Faiz A. Talibov, Sergey A. Saiganov","doi":"10.17816/cardar321501","DOIUrl":"https://doi.org/10.17816/cardar321501","url":null,"abstract":"BACKGROUND: Over the past 3 years, the prevalence of atrial fibrillation (AF) has increased significantly worldwide, which was associated with the pandemic caused by SARS-CoV-2. It is accompanied by an increase in the cases of ischemic stroke, myocardial infarction, and development of heart failure due to acute myocardial injury. Given the high lethality of SARS-CoV-2 infection (COVID-19), studying the characteristics of new-onset AF is essential.
 AIM: The study aims at determining the predictors of new-onset AF in patients with COVID-19 pneumonia and at analyzing the clinical and pathophysiological characteristics of acute myocardial injury.
 MATERIALS AND METHODS: In 36 patients aged 4482 years (average 68.0) with COVID-19 pneumonia, AF paroxysms were recorded for the first time. All of them underwent computed tomography of the chest, electrocardiography, and echocardiography. The left ventricular ejection fraction was calculated using the Simpson method. Oxygen saturation was determined as blood oxygen saturation. Clinical blood tests were performed, C-reactive protein (CRP), ferritin, D-dimer, fibrinogen, and troponin I levels were measured.
 RESULTS: Along with the well-known predictors of AF development (arterial hypertension, coronary heart disease, left ventricular myocardial hypertrophy, and left atrial dilatation), with COVID-19 pneumonia, new-onset AF paroxysms were recorded in patients of the middle, elderly, and late-life age. In 44.4% of patients with AF, cardiomegaly occurred with dilatation of both atria and ventricles. With decreased left ventricular ejection fraction, the incidence of AF paroxysms reached 61.5%. With preserved ejection fraction, AF paroxysms occurred much less frequently (27%). In patients with AF, the extent of lung damage is on average 62.5% (2080%) with oxygen support saturation of 93% (7697%). Serum troponin I levels of 2000 ng/L indicated acute myocardial injury. CRP and blood ferritin values confirmed the presence of a pronounced inflammatory component in myocardial injury. High concentrations of blood fibrinogen and D-dimer, reaching 16,301 ng/mL, were associated with a tendency to hypercoagulation in patients with AF and COVID-19 pneumonia.
 CONCLUSIONS: COVID-19 has a direct damaging effect on the myocardium and probably persists for a long time, which may induce AF in patients with acute pneumonia.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135733775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalya V. Bakulina, Sergey V. Tikhonov, Anna G. Apresyan, Inna G. Ilyashevich
The review article presents dates about the physiology and pathophysiology of the hemostasis system, discusses the features of the use of oral anticoagulants in clinical practice. Oral anticoagulants are drugs characterized by predictable pharmacokinetics and pharmacodynamics, a favorable efficacy and safety profile. The article considers the main clinical and pharmacological characteristics of apixaban, rivaroxaban and dabigatran (bioavailability, metabolism, excretion); factors that increase the risk of gastrointestinal bleeding associated with anticoagulant therapy; drug interactions; the possibility of gastroprotection in patients taking oral anticoagulants. In real clinical practice, the reason for not prescribing or unreasonably reducing the dose of oral anticoagulants is the fear of bleeding. In this case, the risks of bleeding, as a rule, are overestimated. Knowledge of bleeding risk factors, prognostic scales and management of risk factors is an approach that can improve the safety of anticoagulant therapy. In clinical practice, the choice of the ideal oral anticoagulants, in addition to taking into account the risk of bleeding, should be based on a comprehensive assessment, including an assessment of the patient's age, risk of stroke and coronary events, renal function, and predicted compliance.
{"title":"Features of the use of oral anticoagulants in clinical practice: focus on gastrointestinal complications","authors":"Natalya V. Bakulina, Sergey V. Tikhonov, Anna G. Apresyan, Inna G. Ilyashevich","doi":"10.17816/cardar321821","DOIUrl":"https://doi.org/10.17816/cardar321821","url":null,"abstract":"The review article presents dates about the physiology and pathophysiology of the hemostasis system, discusses the features of the use of oral anticoagulants in clinical practice. Oral anticoagulants are drugs characterized by predictable pharmacokinetics and pharmacodynamics, a favorable efficacy and safety profile. The article considers the main clinical and pharmacological characteristics of apixaban, rivaroxaban and dabigatran (bioavailability, metabolism, excretion); factors that increase the risk of gastrointestinal bleeding associated with anticoagulant therapy; drug interactions; the possibility of gastroprotection in patients taking oral anticoagulants. In real clinical practice, the reason for not prescribing or unreasonably reducing the dose of oral anticoagulants is the fear of bleeding. In this case, the risks of bleeding, as a rule, are overestimated. Knowledge of bleeding risk factors, prognostic scales and management of risk factors is an approach that can improve the safety of anticoagulant therapy. In clinical practice, the choice of the ideal oral anticoagulants, in addition to taking into account the risk of bleeding, should be based on a comprehensive assessment, including an assessment of the patient's age, risk of stroke and coronary events, renal function, and predicted compliance.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135733785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kidney diseases and atrial fibrillation often occur together. Renal impairment increases the risk of developing incident atrial fibrillation (AF) and is linked to it in a bidirectional manner, making it a prothrombotic and pro-hemorrhagic condition. In Japanese patients with nonvalvular AF, lower creatinine clearance values were associated with thromboembolism, all-cause death, and cardiovascular death, but not with major haemorrhage. Older individuals with elevated serum levels of cystatin C had a significantly higher prevalence of AF. Moderate to severe chronic kidney disease individuals with increased levels of fibroblast growth factor-23 were independently associated with prevalent and incident AF. A higher baseline glomerular filtration rate was associated with an increased risk of AF. Elevated levels of insulin-like growth factor binding protein-7 were also observed in AF patients, while reduced circulating tissue inhibitor of metalloproteinase 2 levels were also associated with an increased risk of AF. Patients with AF had higher levels of non-esterified fatty acids and liver type fatty acid binding protein. Interleukin-18 levels in blood plasma were also found to be higher in AF patients. Furthermore, higher baseline urea/blood urea nitrogen levels were significantly associated with the incidence of AF in women and kidney disease in both men and women.
{"title":"Association Between Biomarkers of Kidney Disorders and Atrial Fibrillation: A Literature Review","authors":"Saira Rafaqat, Sana Rafaqat, Saima Sharif","doi":"10.24207/jca.v36i1.3488","DOIUrl":"https://doi.org/10.24207/jca.v36i1.3488","url":null,"abstract":"Kidney diseases and atrial fibrillation often occur together. Renal impairment increases the risk of developing incident atrial fibrillation (AF) and is linked to it in a bidirectional manner, making it a prothrombotic and pro-hemorrhagic condition. In Japanese patients with nonvalvular AF, lower creatinine clearance values were associated with thromboembolism, all-cause death, and cardiovascular death, but not with major haemorrhage. Older individuals with elevated serum levels of cystatin C had a significantly higher prevalence of AF. Moderate to severe chronic kidney disease individuals with increased levels of fibroblast growth factor-23 were independently associated with prevalent and incident AF. A higher baseline glomerular filtration rate was associated with an increased risk of AF. Elevated levels of insulin-like growth factor binding protein-7 were also observed in AF patients, while reduced circulating tissue inhibitor of metalloproteinase 2 levels were also associated with an increased risk of AF. Patients with AF had higher levels of non-esterified fatty acids and liver type fatty acid binding protein. Interleukin-18 levels in blood plasma were also found to be higher in AF patients. Furthermore, higher baseline urea/blood urea nitrogen levels were significantly associated with the incidence of AF in women and kidney disease in both men and women.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48144215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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