D. Goncharik, V. Barsukevich, L. Plashchinskaya, Michail A. Zakhareuski
The article presents a description of a clinical case of a patient with structural myocardial pathology (postinfarction cardiosclerosis) with recurrent paroxysmal sustained monomorphic ventricular tachycardia (VT) refractory to the nominal recommended ICD (implantable cardioverter defibrillator) settings; as well as discusses the shortcomings of existing standard algorithms for antitachycardia pacing (ATP) of implantable cardioverter defibrillators and potential ways to increase its efficiency. The refractoriness of recurrent paroxysms of ventricular tachycardia to ATP therapy increases the risk of repeated ICD shocks. Despite the existence of universal recommendations for ICD programming and ATP therapy, there is a need in clinical practice for individualized ATP programming in patients refractory to nominal settings. Increasing the number of ATP series and changing algorithms enables to increase the efficiency of ATP up to 8089%. Refractoriness to standard ATP settings may be also overcome by using alternative ATP pacing algorithms (Ramp, Burst-plus, or Ramp-plus instead of Burst), changing the pacing interval, ATP sequence duration, pacing type, and even adding 12 extra stimuli, as well as using data from the previous intracardiac electrophysiological heart test. The presented clinical case of a patient with postinfarction cardiosclerosis and paroxysmal stable monomorphic VT (SM-VT) of several morphologies demonstrates that the arrhythmogenic substrate after myocardial infarction changes for a long time without new stenoses in large coronary arteries and without new episodes of acute coronary syndrome, as well as generates several different morphologies of VT from one scar (with different heart rates) and the effect on hemodynamics. The efficiency of early ATP pacing may differ for VT of various morphologies, which makes it reasonable to use alternative pacing algorithms (in addition to the standard Burst sequences recommended by the 2019 Consensus on ICD programming) and testing possible ATP algorithms during ablation of monomorphic VT, including during preventive VT ablation before ICD implantation.
{"title":"Antitachycardic Therapy of ICD in Patients with Multiple Morphologies of Monomorphous Ventricular Tachycardia Refractory to Therapy","authors":"D. Goncharik, V. Barsukevich, L. Plashchinskaya, Michail A. Zakhareuski","doi":"10.17816/cardar112248","DOIUrl":"https://doi.org/10.17816/cardar112248","url":null,"abstract":"The article presents a description of a clinical case of a patient with structural myocardial pathology (postinfarction cardiosclerosis) with recurrent paroxysmal sustained monomorphic ventricular tachycardia (VT) refractory to the nominal recommended ICD (implantable cardioverter defibrillator) settings; as well as discusses the shortcomings of existing standard algorithms for antitachycardia pacing (ATP) of implantable cardioverter defibrillators and potential ways to increase its efficiency. The refractoriness of recurrent paroxysms of ventricular tachycardia to ATP therapy increases the risk of repeated ICD shocks. \u0000Despite the existence of universal recommendations for ICD programming and ATP therapy, there is a need in clinical practice for individualized ATP programming in patients refractory to nominal settings. Increasing the number of ATP series and changing algorithms enables to increase the efficiency of ATP up to 8089%. Refractoriness to standard ATP settings may be also overcome by using alternative ATP pacing algorithms (Ramp, Burst-plus, or Ramp-plus instead of Burst), changing the pacing interval, ATP sequence duration, pacing type, and even adding 12 extra stimuli, as well as using data from the previous intracardiac electrophysiological heart test. \u0000The presented clinical case of a patient with postinfarction cardiosclerosis and paroxysmal stable monomorphic VT (SM-VT) of several morphologies demonstrates that the arrhythmogenic substrate after myocardial infarction changes for a long time without new stenoses in large coronary arteries and without new episodes of acute coronary syndrome, as well as generates several different morphologies of VT from one scar (with different heart rates) and the effect on hemodynamics. The efficiency of early ATP pacing may differ for VT of various morphologies, which makes it reasonable to use alternative pacing algorithms (in addition to the standard Burst sequences recommended by the 2019 Consensus on ICD programming) and testing possible ATP algorithms during ablation of monomorphic VT, including during preventive VT ablation before ICD implantation.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73696424","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}
M. C. Matsiukevich, D. A. Bubeshka, V. Snezhitskiy
According to Russian epidemiological studies, the incidence of chronic heart failure (HF) in the general population is approximately 7%, increasing from 0.3% in the group aged 2029 years to 70% in patients aged 90 years [1]. In the general population, the incidence of atrial fibrillation (AF) ranges from 1% to 2%, which increases with age, that is, from 0.5% at the age of 4050 years to 5%15% at the age of 80 years [2]. HF and AF aggravate significantly each others course and mutually increase the risk of adverse outcomes [3, 4]. Moreover, the incidence of AF in patients with HF increases with increasing New York Heart Association (NYHA) grade; that is, among patients with HF of NYHA grade I, the incidence of AF is 5%, whereas among patients with HF NYHA grade IV, the AF incidence in 50% [5]. Chronic HF is a syndrome with complex pathophysiology, which is characterized by the activation of neurohumoral systems, namely, the reninangiotensinaldosterone system (RAAS), sympathetic nervous system (SNS), and insufficient activity of the natriuretic peptide (NUP) system. In the early stage of HF, i.e. asymptomatic dysfunction of the left ventricle, the activation of the SNS and RAAS plays a compensatory role aimed at maintaining cardiac output and circulatory homeostasis [6]. Moreover, the NUP system has a counter-regulatory function in relation to the RAAS and SNS, and with prolonged and excessive activation of the SNS and RAAS or with insufficient NUP system activity, imbalance occurs and HF progresses [7]. The brain natriuretic peptide (BNP) and biologically inactive N-terminal fragment of BNP (NT-proBNP) are the most studied and significant in clinical practice representatives of the NUP system. BNP and NT-proBNP are secreted by cardiomyocytes of the left ventricular (LV) myocardium in response to an increase in the mechanical load and stress of the LV myocardium. NT-proBNP is widely used as a test to rule out HF in patients with dyspnea. The NUP level also correlates with the severity and prognosis in patients with an established diagnosis of HF, and studies have reported that the NUP level acts as a criterion for treatment efficiency in patients with HF [8]. NT-proBNP is a biomarker not only for HF but also for several other conditions, such as acute coronary syndrome and myocardial infarction (MI), because it is associated with an increased risk of death from all causes, regardless of age, stable effort angina grade, myocardial infarction history, and LV ejection fraction (LVEF) [9]. NT-proBNP levels can be influenced by several additional factors such as age, obesity, or glomerular filtration rate. The prognostic value of NT-proBNP is relevant in comorbid patients with AF associated HF because AF can increase NT-proBNP levels independently [10]. Given that NUP secretion depends on intracardiac hemodynamics, the NT-proBNP levels may also depend on the approach to managing AF. Tachycardia is associated with high NT-proBNP levels [11]. The rhyth
{"title":"Prognostic value of N-terminal Brain Natriuretic Peptide (NT-proBNP) in Risk Assessment of Adverse Cardiovascular Events in Patients with Atrial Fibrillation and Heart Failure with Reduced Left Ventricular Systolic Function","authors":"M. C. Matsiukevich, D. A. Bubeshka, V. Snezhitskiy","doi":"10.17816/cardar111076","DOIUrl":"https://doi.org/10.17816/cardar111076","url":null,"abstract":"According to Russian epidemiological studies, the incidence of chronic heart failure (HF) in the general population is approximately 7%, increasing from 0.3% in the group aged 2029 years to 70% in patients aged 90 years [1]. In the general population, the incidence of atrial fibrillation (AF) ranges from 1% to 2%, which increases with age, that is, from 0.5% at the age of 4050 years to 5%15% at the age of 80 years [2]. HF and AF aggravate significantly each others course and mutually increase the risk of adverse outcomes [3, 4]. Moreover, the incidence of AF in patients with HF increases with increasing New York Heart Association (NYHA) grade; that is, among patients with HF of NYHA grade I, the incidence of AF is 5%, whereas among patients with HF NYHA grade IV, the AF incidence in 50% [5]. \u0000Chronic HF is a syndrome with complex pathophysiology, which is characterized by the activation of neurohumoral systems, namely, the reninangiotensinaldosterone system (RAAS), sympathetic nervous system (SNS), and insufficient activity of the natriuretic peptide (NUP) system. In the early stage of HF, i.e. asymptomatic dysfunction of the left ventricle, the activation of the SNS and RAAS plays a compensatory role aimed at maintaining cardiac output and circulatory homeostasis [6]. Moreover, the NUP system has a counter-regulatory function in relation to the RAAS and SNS, and with prolonged and excessive activation of the SNS and RAAS or with insufficient NUP system activity, imbalance occurs and HF progresses [7]. \u0000The brain natriuretic peptide (BNP) and biologically inactive N-terminal fragment of BNP (NT-proBNP) are the most studied and significant in clinical practice representatives of the NUP system. BNP and NT-proBNP are secreted by cardiomyocytes of the left ventricular (LV) myocardium in response to an increase in the mechanical load and stress of the LV myocardium. NT-proBNP is widely used as a test to rule out HF in patients with dyspnea. The NUP level also correlates with the severity and prognosis in patients with an established diagnosis of HF, and studies have reported that the NUP level acts as a criterion for treatment efficiency in patients with HF [8]. NT-proBNP is a biomarker not only for HF but also for several other conditions, such as acute coronary syndrome and myocardial infarction (MI), because it is associated with an increased risk of death from all causes, regardless of age, stable effort angina grade, myocardial infarction history, and LV ejection fraction (LVEF) [9]. \u0000NT-proBNP levels can be influenced by several additional factors such as age, obesity, or glomerular filtration rate. The prognostic value of NT-proBNP is relevant in comorbid patients with AF associated HF because AF can increase NT-proBNP levels independently [10]. Given that NUP secretion depends on intracardiac hemodynamics, the NT-proBNP levels may also depend on the approach to managing AF. Tachycardia is associated with high NT-proBNP levels [11]. \u0000The rhyth","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"156 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72617387","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}
A. Nechepurenko, N. Ilov, Dmitry A. Zorin, Eugeny I. Romantcov, O. V. Palnikova
AIM: This study aimed to conduct a comparative analysis of clinical, electrocardiographic, and echocardiographic factors in patients with chronic heart failure (CHF) with different hemodynamic responses to cardiac resynchronization (CRT) to assess the possibility of their use in predicting the positive effect of CRT. MATERIALS AND METHODS: The study included 136 patients with New York Heart Association grade 34 CHF with a left ventricular ejection fraction of 35%, QRS duration of 150 ms, QRS duration of 130149 ms, and QRS morphology of left bundle branch block (LBBB). For CHF treatment and primary prevention of sudden cardiac death, a cardioverter-defibrillator with CRT (CRT-D) function was implanted. The enrolled patients were followed up prospectively for 1 year to record the endpoint, namely, hemodynamic response to CRT, assessed by a decrease in the end-systolic volume of the left ventricle by 15%. RESULTS: During the 1-year follow-up, the primary endpoint was registered in 62 (46%) patients. With a one-way logistic regression, four indicators with the highest predictive potential (p 0.05) and associated with the occurrence of the studied endpoint were identified. Based on the results of the multivariate regression analysis, a prognostic model was developed, which included three factors with the highest levels of statistical significance, namely, a history of indications of a previous correction of valvular insufficiency, QRS duration, and LBBB criteria according to Strauss. The diagnostic efficiency of the model was 73% (sensitivity, 80%; specificity, 68%). The electrocardiographic parameters of the Strauss LBBB criteria and QRS duration were independent predictors of the studied endpoint. CONCLUSIONS: The developed multivariate prognostic model may be useful in the selection of patients with CHF reduced ejection fraction for implantation of devices with CRT function; the lack of external validation limits its application in practice.
{"title":"Factors Associated with a Positive Hemodynamic Response to Cardiac Resynchronization Therapy","authors":"A. Nechepurenko, N. Ilov, Dmitry A. Zorin, Eugeny I. Romantcov, O. V. Palnikova","doi":"10.17816/cardar112154","DOIUrl":"https://doi.org/10.17816/cardar112154","url":null,"abstract":"AIM: This study aimed to conduct a comparative analysis of clinical, electrocardiographic, and echocardiographic factors in patients with chronic heart failure (CHF) with different hemodynamic responses to cardiac resynchronization (CRT) to assess the possibility of their use in predicting the positive effect of CRT. \u0000MATERIALS AND METHODS: The study included 136 patients with New York Heart Association grade 34 CHF with a left ventricular ejection fraction of 35%, QRS duration of 150 ms, QRS duration of 130149 ms, and QRS morphology of left bundle branch block (LBBB). For CHF treatment and primary prevention of sudden cardiac death, a cardioverter-defibrillator with CRT (CRT-D) function was implanted. The enrolled patients were followed up prospectively for 1 year to record the endpoint, namely, hemodynamic response to CRT, assessed by a decrease in the end-systolic volume of the left ventricle by 15%. \u0000RESULTS: During the 1-year follow-up, the primary endpoint was registered in 62 (46%) patients. With a one-way logistic regression, four indicators with the highest predictive potential (p 0.05) and associated with the occurrence of the studied endpoint were identified. Based on the results of the multivariate regression analysis, a prognostic model was developed, which included three factors with the highest levels of statistical significance, namely, a history of indications of a previous correction of valvular insufficiency, QRS duration, and LBBB criteria according to Strauss. The diagnostic efficiency of the model was 73% (sensitivity, 80%; specificity, 68%). The electrocardiographic parameters of the Strauss LBBB criteria and QRS duration were independent predictors of the studied endpoint. \u0000CONCLUSIONS: The developed multivariate prognostic model may be useful in the selection of patients with CHF reduced ejection fraction for implantation of devices with CRT function; the lack of external validation limits its application in practice.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76938834","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}
Tatiana N. Novikova, Vladimir I. Novikov, Sergey A. Sayganov, Vladislava A. Shcherbakova
The review presents new indications to help with diagnosis and treatment of ventricular arrhythmia (VA) in patients with various etiologies of rhythm disturbances, including patients with coronary artery disease, cardiomyopathies, channelopathies, inflammatory heart disease, neuromuscular disease, and congenital heart defects. Algorithms for diagnostic evaluation at first presentation with VAs in patients without known cardiac disease are given.
{"title":"2022 Esc Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: What is New?","authors":"Tatiana N. Novikova, Vladimir I. Novikov, Sergey A. Sayganov, Vladislava A. Shcherbakova","doi":"10.17816/cardar110961","DOIUrl":"https://doi.org/10.17816/cardar110961","url":null,"abstract":"The review presents new indications to help with diagnosis and treatment of ventricular arrhythmia (VA) in patients with various etiologies of rhythm disturbances, including patients with coronary artery disease, cardiomyopathies, channelopathies, inflammatory heart disease, neuromuscular disease, and congenital heart defects. Algorithms for diagnostic evaluation at first presentation with VAs in patients without known cardiac disease are given.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89266646","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}
{"title":"Editorial note","authors":"Sergey A. Sayganov","doi":"10.17816/cardar81184","DOIUrl":"https://doi.org/10.17816/cardar81184","url":null,"abstract":"","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83564808","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}
Born on 1 December 1922 in the small Ukrainian town of Zvenigorodka, Cherkasy region; died on 11 Juni 2002 in Saint Petersburg. In 1947, M.S. Kushakovky graduated from the Military Medical Academy with merits, and his name was among the first to be put on Academy's marble plaque of honor after the war. At the beginning of 1951, M.S. Kushakovky defended his PhD. thesis on the topic Hemodynamic disorders and the condition of the precapillary bed in advanced stages of hypertension (on the issue of adaptive mechanisms). In September 1960 he received the academic title of Associate Professor. At the department, he was in charge of the clinical department, conducted practical classes with students of the 3rd and 6th years of the Military Medical Academy, lectured for military doctors of advanced courses on various sections of internal diseases, functional diagnostics of diseases of the heart and blood vessels. In 1965, the doctoral dissertation was successfully defended. In total, he published 17 monographs (including reprints) and more than 220 articles. Max Solomonovich was a member of the editorial boards of the journals Arterial Hypertension and Bulletin of Arrhythmology. For a long time, Max Solomonovich was a board member of the therapeutic and cardiological societies of Leningrad and St. Petersburg. Prof. M.S. Kushakovsky was a scientific advisor for 30 PhD students. In 2001, he was awarded the title of "Honorary Doctor" of the St. Petersburg Medical Academy of Postgraduate Education, as well as the title of "Honorary Cardiologist of Russia". In 2003, the Department of Cardiology of St. Petersburg Medical Academy of Postgraduate Education was named after him. Since 2011, after the merger of St. Petersburg Medical Academy of Postgraduate Education and Leningrad Sanitary and Hygienic Medical Institute, the combined Department of Hospital Therapy and Cardiology has born his name.
{"title":"Max Solomonovich Kushakovsky. Life and work","authors":"Y. Grishkin","doi":"10.17816/cardar116602","DOIUrl":"https://doi.org/10.17816/cardar116602","url":null,"abstract":"Born on 1 December 1922 in the small Ukrainian town of Zvenigorodka, Cherkasy region; died on 11 Juni 2002 in Saint Petersburg. \u0000In 1947, M.S. Kushakovky graduated from the Military Medical Academy with merits, and his name was among the first to be put on Academy's marble plaque of honor after the war. At the beginning of 1951, M.S. Kushakovky defended his PhD. thesis on the topic Hemodynamic disorders and the condition of the precapillary bed in advanced stages of hypertension (on the issue of adaptive mechanisms). In September 1960 he received the academic title of Associate Professor. At the department, he was in charge of the clinical department, conducted practical classes with students of the 3rd and 6th years of the Military Medical Academy, lectured for military doctors of advanced courses on various sections of internal diseases, functional diagnostics of diseases of the heart and blood vessels. In 1965, the doctoral dissertation was successfully defended. In total, he published 17 monographs (including reprints) and more than 220 articles. Max Solomonovich was a member of the editorial boards of the journals Arterial Hypertension and Bulletin of Arrhythmology. For a long time, Max Solomonovich was a board member of the therapeutic and cardiological societies of Leningrad and St. Petersburg. Prof. M.S. Kushakovsky was a scientific advisor for 30 PhD students. In 2001, he was awarded the title of \"Honorary Doctor\" of the St. Petersburg Medical Academy of Postgraduate Education, as well as the title of \"Honorary Cardiologist of Russia\". \u0000In 2003, the Department of Cardiology of St. Petersburg Medical Academy of Postgraduate Education was named after him. Since 2011, after the merger of St. Petersburg Medical Academy of Postgraduate Education and Leningrad Sanitary and Hygienic Medical Institute, the combined Department of Hospital Therapy and Cardiology has born his name.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87058164","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}
Embolic myocardial infarction (EMI) is more common than gets to be diagnosed. EMI is often associated with atrial fibrillation (AF). The incidence of this pathology, prognosis and treatment tactics remain unclear. AIM: To assess the incidence of EMI among patients with myocardial infarction (MI), genesis of coronary embolism (CE), initial characteristics, treatment and prognosis in group of patients with EMI. MATERIALS AND METHODS: The group of patients with EMI was selected among 1989 patients with MI admitted to the cardiology department of the North-Western State Medical University named after I.I. Mechnikov between 2013 to December 2019. The CE verification criteria were the SUITA criteria. Statistical data processing was carried out using the SAS program. RESULTS: 16 cases of EMI were registered (0.8% of all MI and 4.3% of patients with MI and AF). 68.7% (95% CI = 41.5%88.9%) of patients with EMI had AF. All patients with EMI and AF did not have adequate anticoagulant therapy before admission. Among patients with EMI, men predominated, they were younger, had fewer comorbidities than patients with MI and without AF. 13 of 16 patients with EMI were prescribed anticoagulants. During hospitalization, the composite endpoint (pulmonary embolism + stroke + cardiovascular death) was recorded in 25% (95% CI = 7.3%52.2%), in the long-term period in 30% of cases (95 % CI = 6.765.2). All these patients had AF. EMI in patients with AF was associated with the development of severe chronic heart failure (CHF) by the time of discharge and with decompensation of CHF in the long-term period. CONCLUSIONS: EMI often occur in group of patients with AF, always in the absence of adequate anticoagulant therapy. Patients with EMI and AF have a worse prognosis due to recurrent thromboembolic events. Keywords: anticoagulants; atrial fibrillation; coronary embolism; embolic myocardial infarction; prognosis; thrombaspiration.
栓塞性心肌梗死(EMI)比诊断更为常见。EMI常与心房颤动(AF)相关。这种病理的发生率、预后和治疗策略尚不清楚。目的:评价心肌梗死(MI)患者的EMI发生率、冠状动脉栓塞(CE)的发生、EMI患者的初始特征、治疗和预后。材料与方法:从2013年至2019年12月以I.I. Mechnikov命名的西北州立医科大学心内科收治的1989例心肌梗死患者中选择EMI患者。CE验证标准为SUITA标准。统计数据处理采用SAS程序进行。结果:共登记了16例EMI(占所有MI的0.8%，占MI合并AF的4.3%)。68.7% (95% CI = 41.5% - 88.9%)的EMI患者患有房颤。所有EMI和房颤患者在入院前均未接受充分的抗凝治疗。在EMI患者中，男性占主导地位，他们年轻，合并症比心肌梗死和无房颤的患者少。16例EMI患者中有13例使用抗凝剂。在住院期间，复合终点(肺栓塞+卒中+心血管死亡)记录为25% (95% CI = 7.3%52.2%)，在长期期间记录为30% (95% CI = 6.765.2)。所有这些患者都有房颤。房颤患者的EMI与出院时严重慢性心力衰竭(CHF)的发展以及长期的CHF代偿有关。结论:EMI常发生在房颤患者中，且总是在没有适当抗凝治疗的情况下发生。由于复发性血栓栓塞事件，EMI和AF患者预后较差。关键词:抗凝血剂;心房颤动;冠状动脉栓塞;栓塞性心肌梗死;预后;thrombaspiration。
{"title":"Incidence of Coronary Embolism in Group of Patients with Atrial Fibrillation and Myocardial Infarction","authors":"M. V. Soloveva, S. Boldueva","doi":"10.17816/cardar111979","DOIUrl":"https://doi.org/10.17816/cardar111979","url":null,"abstract":"Embolic myocardial infarction (EMI) is more common than gets to be diagnosed. EMI is often associated with atrial fibrillation (AF). The incidence of this pathology, prognosis and treatment tactics remain unclear. \u0000AIM: To assess the incidence of EMI among patients with myocardial infarction (MI), genesis of coronary embolism (CE), initial characteristics, treatment and prognosis in group of patients with EMI. \u0000MATERIALS AND METHODS: The group of patients with EMI was selected among 1989 patients with MI admitted to the cardiology department of the North-Western State Medical University named after I.I. Mechnikov between 2013 to December 2019. The CE verification criteria were the SUITA criteria. Statistical data processing was carried out using the SAS program. \u0000RESULTS: 16 cases of EMI were registered (0.8% of all MI and 4.3% of patients with MI and AF). 68.7% (95% CI = 41.5%88.9%) of patients with EMI had AF. All patients with EMI and AF did not have adequate anticoagulant therapy before admission. Among patients with EMI, men predominated, they were younger, had fewer comorbidities than patients with MI and without AF. 13 of 16 patients with EMI were prescribed anticoagulants. During hospitalization, the composite endpoint (pulmonary embolism + stroke + cardiovascular death) was recorded in 25% (95% CI = 7.3%52.2%), in the long-term period in 30% of cases (95 % CI = 6.765.2). All these patients had AF. EMI in patients with AF was associated with the development of severe chronic heart failure (CHF) by the time of discharge and with decompensation of CHF in the long-term period. \u0000CONCLUSIONS: EMI often occur in group of patients with AF, always in the absence of adequate anticoagulant therapy. Patients with EMI and AF have a worse prognosis due to recurrent thromboembolic events. \u0000Keywords: anticoagulants; atrial fibrillation; coronary embolism; embolic myocardial infarction; prognosis; thrombaspiration.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81575324","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}
Differential diagnosis of wide QRS complex arrhythmias is one of the most challenging tasks in routine practice arrhythmology. The analysis of the wide QRS complex morphology has been introduced due to the complex problem of detecting atrial waves on ECG. A slow conduction index based on the ratio of the initial and terminal QRS amplitudes is one of the solutions to evaluate conduction velocity based on the surface ECG due to a significant variability of QRS morphology and real complexity of its detailed assessment. However, one of the significant limitations of this algorithm is a need to search for the RS wide complex type and randomly select an ECG lead with this morphology which can finally create a contradictory result. AIM: To evaluate a possibility of using the slow conduction index for differential diagnosis of wide QRS complex arrhythmias with left bundle branch (LBBB) morphology in any of 12-leads ECG followed by evaluation of the obtained diagnostic accuracy values. MATERIALS AND METHODS: The study included 280 single premature wide QRS complexes with LBBB morphology recorded during holter ECG monitoring in randomly selected 28 patients. Atrial extrasystoles were recorded in 14 patients and ventricular extrasystoles were captured during sinus rhythm in other 14 patients. A ROC analysis was used for the qualitative and quantitative assessment of a slow conduction index diagnostic values based on sensitivity (Sn), specificity (Sp) and accuracy (Acc). RESULTS: The highest values of Sn and Sp were obtained for a slow conduction index in the leads aVL, V2, aVF, V5 and III, and the lowest for the leads I, V3 and V6 based on the calculated area (AUC) under the ROC curves (p 0.001 for all leads). CONCLUSION: The study presented the fundamental possibility of using a slow conduction index in any of 12-lead ECG for the differential diagnosis of wide QRS complex arrhythmias with LBBB morphology.
{"title":"Differential Diagnostics of Wide QRS Complex Arrhythmias with Left Bundle Branch Block Morphology Using Slow Conduction Index","authors":"M. Chmelevsky, M. Budanova, T. Treshkur","doi":"10.17816/cardar112593","DOIUrl":"https://doi.org/10.17816/cardar112593","url":null,"abstract":"Differential diagnosis of wide QRS complex arrhythmias is one of the most challenging tasks in routine practice arrhythmology. The analysis of the wide QRS complex morphology has been introduced due to the complex problem of detecting atrial waves on ECG. A slow conduction index based on the ratio of the initial and terminal QRS amplitudes is one of the solutions to evaluate conduction velocity based on the surface ECG due to a significant variability of QRS morphology and real complexity of its detailed assessment. However, one of the significant limitations of this algorithm is a need to search for the RS wide complex type and randomly select an ECG lead with this morphology which can finally create a contradictory result. \u0000AIM: To evaluate a possibility of using the slow conduction index for differential diagnosis of wide QRS complex arrhythmias with left bundle branch (LBBB) morphology in any of 12-leads ECG followed by evaluation of the obtained diagnostic accuracy values. \u0000MATERIALS AND METHODS: The study included 280 single premature wide QRS complexes with LBBB morphology recorded during holter ECG monitoring in randomly selected 28 patients. Atrial extrasystoles were recorded in 14 patients and ventricular extrasystoles were captured during sinus rhythm in other 14 patients. A ROC analysis was used for the qualitative and quantitative assessment of a slow conduction index diagnostic values based on sensitivity (Sn), specificity (Sp) and accuracy (Acc). \u0000RESULTS: The highest values of Sn and Sp were obtained for a slow conduction index in the leads aVL, V2, aVF, V5 and III, and the lowest for the leads I, V3 and V6 based on the calculated area (AUC) under the ROC curves (p 0.001 for all leads). \u0000CONCLUSION: The study presented the fundamental possibility of using a slow conduction index in any of 12-lead ECG for the differential diagnosis of wide QRS complex arrhythmias with LBBB morphology.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"123 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73457819","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}
C. Agudo, V. C. Urda, J. T. Ramos, D. J. Sánchez, D. V. Urrea, E. Jaén, C. Trung, V. M. Palomero, S. M. Santos, I. Lozano
Up to now, few factors have been identified to predict successful pulmonary vein isolation, none of which with high predictive values. The objective of our study was to compare different predictive factors of atrial fibrillation recurrence after pulmonary vein isolation,including new parameters of the right atrium (area and index volume). We retrospectively analysed data from 66 patients and included echocardiogram parameters performed within 18 months prior to the ablation procedure. We excluded patients with left ventricular dysfunction (defined as a left ventricular ejection fraction < 50%); previous diagnostic of cardiomyopathy; severe valvular heart disease; severe pulmonary hypertension; or those with poor image quality in the echocardiogram. We considered atrial fibrillation recurrence to be the presence of atrial fibrillation of 30 seconds or longer demonstrated by a standard electrocardiogram or in a 24-hour Holter electrocardiogram within a year after the ablation procedure. We found that the right atrium area (odds ratio = 1.52; 95% confidence interval 0.95–2.43, P = 0.08) and a previous pulmonary vein isolation procedure (odds ratio = 0.21; 95% confidence interval 0.04–1.01, P = 0.05) were nearly statistically significant predictors of successful atrial fibrillation ablation at one year. Although our study was limited because of a low number of patients and because it is a retrospective analysis, we found that a higher right atrial area may be related to the late recurrence of atrial fibrillation. This tendency may be useful in predicting patient outcomes.
{"title":"The Right Atrial Area as a New Factor to Predict Successful Pulmonary Vein Isolation: an Emergent Predictor Variable","authors":"C. Agudo, V. C. Urda, J. T. Ramos, D. J. Sánchez, D. V. Urrea, E. Jaén, C. Trung, V. M. Palomero, S. M. Santos, I. Lozano","doi":"10.24207/jca.v35i1.3466","DOIUrl":"https://doi.org/10.24207/jca.v35i1.3466","url":null,"abstract":"Up to now, few factors have been identified to predict successful pulmonary vein isolation, none of which with high predictive values. The objective of our study was to compare different predictive factors of atrial fibrillation recurrence after pulmonary vein isolation,including new parameters of the right atrium (area and index volume). We retrospectively analysed data from 66 patients and included echocardiogram parameters performed within 18 months prior to the ablation procedure. We excluded patients with left ventricular dysfunction (defined as a left ventricular ejection fraction < 50%); previous diagnostic of cardiomyopathy; severe valvular heart disease; severe pulmonary hypertension; or those with poor image quality in the echocardiogram. We considered atrial fibrillation recurrence to be the presence of atrial fibrillation of 30 seconds or longer demonstrated by a standard electrocardiogram or in a 24-hour Holter electrocardiogram within a year after the ablation procedure. We found that the right atrium area (odds ratio = 1.52; 95% confidence interval 0.95–2.43, P = 0.08) and a previous pulmonary vein isolation procedure (odds ratio = 0.21; 95% confidence interval 0.04–1.01, P = 0.05) were nearly statistically significant predictors of successful atrial fibrillation ablation at one year. Although our study was limited because of a low number of patients and because it is a retrospective analysis, we found that a higher right atrial area may be related to the late recurrence of atrial fibrillation. This tendency may be useful in predicting patient outcomes.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44425323","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}
Interleukins (IL) are a group of cytokines with complex immunomodulatory functions, whereas atrial fibrillation (AF) is the most common cardiac arrhythmia. This review article highlights the role of major IL in the pathogenesis of AF. IL-1 had elevated levels in permanent and persistent AF patients as compared to paroxysmal AF. A study had shown a straightforward connection between the development of postoperative atrial fibrillation and IL-2 sera levels shortly after cardiopulmonary bypass graft for the first time. IL-4 has been involved in anti-inflammatory response and played no role in the contribution of AF. The elevated level of IL-6 rapidly induces atrial electrical remodeling by downregulating cardiac connexins. This change could be significantly increased the risk of AF and related complications during active inflammatory processes. Moreover, a study has shown higher IL-8 levels in permanent AF patients as compared with paroxysmal AF patients. An association was found between IL-10 gene -592A/C polymorphism and AF in Han Chinese. Recombinant human IL-11 therapy shortened atrial refractoriness and also created favorable conditions for AF by an indirect mechanism involving volume expression, stretching of atrial myocardial tissue and sodium retention. An elevated IL-12 expression was observed in the left atrial tissues of AF patients. IL-17 signaling pathway has played a significant role, and some genes could be used as potential therapeutic targets for AF. An association between the risk of AF with single nucleotide polymorphism of IL-18 and also resulted in the increased left atrial diameter and decreased left ventricular ejection fraction in AF subjects as compared to control. IL-27 genetic variants had increased the occurrence of AF. AF patients had elevated levels of IL-37 that were closely linked with AF subgroups.
{"title":"Major Interleukins: Role in the Pathogenesis of Atrial Fibrillation","authors":"Saira Rafaqat, Sana Rafaqat, Simon Rafaqat","doi":"10.24207/jca.v35i1.3470","DOIUrl":"https://doi.org/10.24207/jca.v35i1.3470","url":null,"abstract":"Interleukins (IL) are a group of cytokines with complex immunomodulatory functions, whereas atrial fibrillation (AF) is the most common cardiac arrhythmia. This review article highlights the role of major IL in the pathogenesis of AF. IL-1 had elevated levels in permanent and persistent AF patients as compared to paroxysmal AF. A study had shown a straightforward connection between the development of postoperative atrial fibrillation and IL-2 sera levels shortly after cardiopulmonary bypass graft for the first time. IL-4 has been involved in anti-inflammatory response and played no role in the contribution of AF. The elevated level of IL-6 rapidly induces atrial electrical remodeling by downregulating cardiac connexins. This change could be significantly increased the risk of AF and related complications during active inflammatory processes. Moreover, a study has shown higher IL-8 levels in permanent AF patients as compared with paroxysmal AF patients. An association was found between IL-10 gene -592A/C polymorphism and AF in Han Chinese. Recombinant human IL-11 therapy shortened atrial refractoriness and also created favorable conditions for AF by an indirect mechanism involving volume expression, stretching of atrial myocardial tissue and sodium retention. An elevated IL-12 expression was observed in the left atrial tissues of AF patients. IL-17 signaling pathway has played a significant role, and some genes could be used as potential therapeutic targets for AF. An association between the risk of AF with single nucleotide polymorphism of IL-18 and also resulted in the increased left atrial diameter and decreased left ventricular ejection fraction in AF subjects as compared to control. IL-27 genetic variants had increased the occurrence of AF. AF patients had elevated levels of IL-37 that were closely linked with AF subgroups.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42701141","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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