Annals of Noninvasive Electrocardiology最新文献

Background

The relationship between oral anticoagulant (OAC) status after catheter ablation (CA) for atrial fibrillation (AF) and the risks of ischemic stroke or major bleeding events is still unknown.

Methods

This is a subanalysis of the RYOUMA registry, a prospective multicenter observational study of Japanese patients who underwent CA for AF in 2017–2018.

Results

Of the 2844 patients, the rate of DOAC continuation was 48.1%, 69.6%, and 80.9% in patients with a CHADS2 score of 0–1, 2, and 3–6, respectively. Among the patients taking DOACs with a CHADS2 score of 0–1 and 2, the incidence rates of major bleeding were significantly higher than those of ischemic stroke or systemic embolic events (SEEs) (1.3%/year [95% CI, 0.6–2.1] vs. 0.3%/year [95% CI, 0.0–0.7], p = 0.019; 1.8%/year [95% CI, 0.6–3.0] vs. 0.2%/year [95% CI, 0.0–0.6], p = 0.018, respectively). However, there was no difference between the incidence rates of major bleeding events and ischemic stroke or SEEs in patients taking DOACs with a CHADS2 score of 3–6 (1.6%/year [95% CI, 0.2–3.0] vs. 1.0%/year [95% CI, 0.0–2.1], p = 0.474).

Conclusions

In patients with a CHADS2 score of 2, those who continued taking DOACs had a higher incidence rate of major bleeding events compared to ischemic stroke/SEEs, similar to those with a CHADS2 score of 0–1. Conversely, in patients with a CHADS2 score of 3–6, the incidence rates of both ischemic stroke/SEEs and major bleeding were similarly high.

Trial Registration: The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry)

Background

Complete blockage of the culprit coronary artery is associated with 30% of NSTEMI (non-ST-segment elevation myocardial infarction) patients. The culprit vessel in the left circumflex artery (LCX) is more prevalent in this subset of individuals. These people's clinical features and ischemia alterations on electrocardiography (ECG) are unknown. The goals of this study were to examine clinical features and identify predicted ECG abnormalities in NSTEMI patients with complete blockage of the culprit LCX.

Methods

This study enrolled 5215 consecutive NSTEMI patients' data. A total of 180 people were diagnosed with acute total occlusion of the culprit artery (ATOCA). Based on the culprit vessel, the patients were classified into three groups:ATOCA in the LAD (n = 46), ATOCA in the RCA (n = 38) and ATOCA in the LCX (n = 96). Furthermore, basic clinical data, ECG alterations, and the occurrence of major adverse cardiac events (MACEs) were gathered and examined.

Results

In this single-center investigation, we discovered that ATOCA was more prevalent in patients with NSTEMI in the LCX group. Patients with culprit LCX were more prone to having multivessel coronary disease (p = 0.015), poorer LVEF (p = 0.040), and a lower revascularization success rate (p = 0.019) during hospitalization, although there were no significant differences in MACEs in short and long follow-up. STV5 + STV6 ≥ 2.5 mm (OR = 2.595, 95% CI: 1.297 ~ 5.192) and T-wave imbalance (defined as an upright T-wave in V1 with an amplitude larger than V6 (T1–T6 ≥ 1 mm) recorded from the P-R interval)(OR = 3.871, 95% CI: 1.820 ~ 8.231) were shown to be independent predictors of NSTEMI patients with acute complete blockage of the culprit LCX in multivariate regression analysis.

Conclusion

The LCX is the most prevalent culprit vessel with acute complete occlusion in NSTEMI patients, yet it has little effect on clinical outcomes. This subset of patients may be predicted by STV5 + STV6 ≥ 2.5 mm and T-wave imbalance.

Objectives

Direct current cardioversion (DCCV) is commonly used for atrial fibrillation, but there is uncertainty about whether active chest compression improves its effectiveness. This meta-analysis evaluates the impact of active compression on cardioversion outcomes.

Methods

A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and Cochrane Library till September 2024. Statistical analysis was performed using R software (version 4.3.1), applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). PROSPERO ID: CRD42024595499.

Results

Four RCTs with 737 patients were included. When compared to the no-compression approach, active compression during DCCV was not associated with any significant difference in cardioversion success (RR: 1.10; 95% CI [0.96, 1.25], p = 0.16), first shock success (RR: 1.62; 95% CI [0.94, 2.81], p = 0.08), number of shocks (MD: -0.32; 95% CI [−1.01, 0.36], p = 0.36), or crossover success (MD: 0.76; 95% CI [0.33, 1.77], p = 0.52). However, active compression was associated with a reduced successful shock energy (MD: -23.97 J; 95% CI [−26.84, −21.10], p < 0.01).

Conclusion

Active compression during DCCV does not significantly improve cardioversion success but may reduce the energy required for successful cardioversion, suggesting potential safety benefits. However, further studies are needed to determine its clinical relevance.

Background

Antiretroviral therapy (ART) has revolutionized the management of human immunodeficiency virus (HIV) infection by transforming it into a chronic but manageable condition. Despite its effectiveness in viral suppression and immune restoration, concerns remain regarding ART's potential impact on cardiovascular health, particularly on electrocardiographic (ECG) parameters.

Objective

This study investigated the effects of ART on ECG parameters in HIV-infected patients by analyzing pre- and post-therapy data.

Methods

A total of 83 HIV-positive patients were enrolled and evaluated for ECG parameters before and 3 months after ART initiation. Key parameters, including QRS duration, QT duration corrected by the Bazett formula (QTc interval), QRS-T angle, morphology in inferior leads, voltage in lead 1, and P-wave duration (MVP) score, were manually assessed. Statistical analyses compared pre- and post-ART values.

Results

No statistically significant changes were observed in ECG parameters post-ART. For example, QRS duration remained stable (pre-ART: 89.08 ± 12.01 ms; post-ART: 88.94 ± 10.00 ms, p = 0.849), as did QTc interval (pre-ART: 403.51 ± 22.22 ms; post-ART: 404.84 ± 14.91 ms, p = 0.563) and MVP ECG score (pre-ART: 3.02 ± 0.95; post-ART: 2.98 ± 0.87, p = 0.882). The QRS-T angle also showed no significant difference (p = 0.675).

Conclusion

ART does not appear to significantly affect ECG parameters in HIV-infected patients, supporting its favorable cardiac safety profile. These findings highlight the importance of regular ECG monitoring to ensure cardiovascular safety in patients undergoing ART.

Objective

Investigate the distribution of triggers in paroxysmal atrial fibrillation (PAF) patients and assess the efficacy of circumferential pulmonary vein isolationI (CPVI) combined with non-pulmonary veins (PV) trigger ablation over 1 year.

Methods

This prospective study included 130 PAF patients undergoing initial catheter ablation. A standardized protocol was applied before CPVI, followed by ablation targeting non-PV triggers. Ablation success was marked by the inability to induce atrial fibrillation (AF) or related arrhythmias. Patients underwent Holter monitoring at intervals post-surgery, culminating in a 7-day exam at 12 months.

Results

Atrial fibrillation (AF) was induced in 88 patients (67.0%), with 94 foci identified. The left pulmonary vein was a common source, but the superior vena cava emerged as the most prevalent non-PV site. The 1-year success rate was 86.0%, with no significant differences in success rates among trigger types. However, non-PV triggers were linked to lower recurrence rates post-surgery (HR 0.27, 95% CI 0.08–0.96, p = 0.04).

Conclusion

The study found that the combination of drug stimulation and high-frequency atrial stimulation before CPVI significantly boosted AF induction rates and revealed a high incidence of non-PV triggers. Effective intraoperative induction and accurate identification of non-PV triggers, particularly in the superior vein cava (SVC), contributed to a substantial reduction in postoperative recurrence rates. This approach suggests a potential strategy for improving outcomes in PAF treatment.

Background

Frailty predisposes individuals to morbidity and mortality. Increasing numbers of elderly and comorbid individuals are undergoing primary prevention implantable cardioverter defibrillator (ICD) device placement. Little is known about the association of frailty with post-device implantation outcomes.

Methods

We conducted a single-center, prospective cohort study of 71 patients who underwent primary prevention ICD insertion and who had their baseline frailty status assessed using the Fried index. Participants were followed for a median period of 7.8 years.

Results

The mean age (± SD) was 70.6 ± 4.5 years. 12 (17%) patients met the criteria for frailty. 23 (33%) patients received cardiac resynchronization therapy. Frailty was associated with a significantly higher incidence of mortality (HR [95% CI]; 3.9 [1.2–12.1]), ED visits (2.7 [1.1–6.7]), and hospitalizations (2.8 [1.1–7.6]). Within the non-frail cohort, there was no association between Fried frailty scores and adverse outcomes. None of the frail patients received appropriate shock therapy.

Conclusion

Among primary prevention ICD recipients, frailty is associated with worse mortality and morbidity. Clinicians should consider frailty when discussing risks and benefits with this patient population.

Background

Brugada syndrome (BrS) is associated with an electrocardiogram (ECG), but the causal relationship remains unclear. This study aimed to assess the bidirectional causal relationship between ECG parameters and BrS using Mendelian randomization (MR) analysis.

Methods

A bidirectional MR analysis using data from the OpenGWAS database. Six ECG parameters, including PR interval, PP interval, ST duration, QRS duration, T wave duration, and QT interval, were included in the forward MR analysis with BrS as the outcome. In the reverse MR analysis, BrS was the exposure and the aforementioned ECG parameters were the outcomes. The inverse-variance weighted (IVW) method was the primary analytical approach, complemented by four other methods to account for potential pleiotropy. Sensitivity analyses were performed using Cochran's Q test, MR-Egger intercept, and leave-one-out analysis to evaluate heterogeneity and pleiotropy.

Results

In the forward MR, genetically predicted ST duration (OR = 1.3478, 95% CI: 1.0611–1.7118, p = 0.014) and QRS duration (OR = 0.9582, 95% CI: 0.9208–0.9972, p = 0.036) showed significant associations with BrS. The reverse MR indicated that BrS was significantly associated with PR interval, QRS duration, P wave duration, and QT interval (all p < 0.05). Sensitivity analyses confirmed the robustness of the results in both forward and reverse MR analyses. However, there were significant horizontal pleiotropy and heterogeneity in reverse MR analysis.

Conclusions

This MR study supported a causal effect of ECG parameters, including ST duration and QRS duration, on BrS development.