Annals of Noninvasive Electrocardiology最新文献

Background

Patients with heart failure with reduced ejection fraction (HFrEF) frequently experience electrical disturbances, such as ventricular or atrial fibrillation (AF). Sacubitril/Valsartan (SV) therapy has been linked to lower rates of mortality, ventricular tachycardia (VT), and ventricular fibrillation (VF), with decreased reliance on implantable cardioverter-defibrillator (ICD) therapy. However, studies on the antiarrhythmic effects of SV in patients with ICD or cardiac resynchronization therapy defibrillator (CRT-D) devices are limited. This study aimed to evaluate the impact of SV therapy on antiarrhythmic pacing, defibrillation shock occurrences, and the burden of ventricular arrhythmias in patients with HFrEF who have ICD or CRT-D devices.

Method

This study was conducted at a HF outpatient clinic involving patients with HFrEF treated with SV. Primary outcomes included the incidence of VT, VF, non-sustained VT (NsVT), supraventricular tachycardia (SVT), and related interventions such as antiarrhythmic pacing (ATP) and defibrillation shocks.

Result

A total of 181 HFrEF patients completed at least 12 months of follow-up, with a mean age of 63.39 ± 12 years; 36.5% were male, and 60.8% had an ICD. Device interrogation revealed a significant reduction in VF incidents (7 vs. 15, p = 0.025) and a decrease in the combined outcome of VT and VF (17 vs. 24, p = 0.047). The need for ICD interventions such as ATP and shocks also significantly decreased following the initiation of SV therapy (10 vs. 24, p = 0.012).

Conclusion

SV therapy significantly reduces the incidence of cardiac arrhythmias, particularly VT and VF, while decreasing the need for clinical interventions related to implanted devices.

Background

Patients undergoing cardiac resynchronization therapy with a defibrillator (CRT-D) often experience improvements in the left ventricular ejection fraction (LVEF). This study aimed to identify predictors of ventricular tachyarrhythmias (VTA) in patients with CRT-D devices and LVEF improvement beyond guideline recommendations for a defibrillator.

Methods

Patients randomized to the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy trial who improved their LVEF to > 35% at 12 months following CRT-D implant were included in this analysis (N = 651). Predictors of an appropriate implantable cardioverter defibrillator (ICD) Rx VTA were evaluated by Cox proportional hazards regression modeling.

Results

We identified three predictors of VTA among patients treated with CRT-D subsequent to LVEF improvement > 35%: Lower range improvement in LVEF 36%–40% versus improvement to > 40% (HR, 1.97; 95% CI, 1.21–3.20; p = 0.006); Baseline non-LBBB ECG morphology (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.23–3.04; p = 0.004); Occurrence of VTA during the first year post-CRT-D (HR, 4.91; 95% CI, 2.99–8.07; p < 0.001).

Conclusions

We identified a sub-group of patients with risk factors who remain at high risk of VTA despite improvement in LVEF following CRT implant. These patients require close monitoring despite improvement in LVEF beyond guideline recommendations for an ICD.

Background

Atrial septal defect (ASD) can lead to volume overload and related changes in P-wave parameters in surface electrocardiograms of these patients. In this study, we aimed to evaluate the effect of volume overload on P-wave parameters in patients with ASD.

Materials and Methods

This study is a retrospective cohort analysis. A total of 142 patients with secundum ASD who underwent percutaneous closure were evaluated. P-wave duration (Pmax) and P-wave dispersion (PWD) were measured on the surface ECG before and 1 h after the closure procedure. We evaluated P-wave parameters in terms of defect size, duration of the volume overload, and closure device sizes.

Results

Pmax and PWD were significantly decreased after the procedure compared with the values before the procedure (p < 0.001). Pmax values had a statistically significant correlation with ASD size (< 20 mm or ≥ 20 mm) both before and after the procedure. Pmax values were significantly higher in patients older than 30 years of age (119.6 ± 19.5 vs. 102.7 ± 17.1 ms, respectively; p = 0.039). A significantly positive correlation was found between pre- and post-procedural Pmax and defect sizes (r = 0.474, p = 0.019 and r = 0.4233, p = 0.04, respectively). However, no positive correlation between PWD and defect age and size was present.

Conclusion

Percutaneous closure of ASD is associated with an immediate decrease in both Pd and Pmax that seems to be related to the acute volume overload cessation in cardiac chambers.

Background

Digitalis glycosides are employed for rate control of atrial fibrillation and treatment of heart failure. Previous studies suggested potential harmful effects of digitalis therapy. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcomes in patients with systolic failure who were implanted with an ICD- or CRT-ICD system.

Methods and Results

The German Device Registry is a nationwide, prospective registry with a 1-year follow-up investigating 4384 patients receiving either ICD or CRT systems in 52 German centers. The present analysis focused on the presence of digitalis therapy in 3826 patients undergoing device implantation. Patients receiving digitalis therapy (n = 800) presented a more severely impaired left ventricular function, higher NYHA class, and an increased incidence of left bundle branch block. Consequently, the implantation of CRT systems was more common in this group. One-year mortality did not significantly differ between both groups (9.1% vs. 7.4%, p = 0.14). Similar results were obtained for the combined endpoint, including death, myocardial infarction, and stroke. ICD shock delivery (19.7% vs. 15.0%, p = 0.006) and device revision (11.4% vs. 7.5%, p < 0.004) were more common in digitalis-treated patients.

Conclusion

In this study in patients undergoing ICD or CRT implantation, an association of digitalis therapy with an increased risk of device revision was observed. Of note, mortality or severe cardiovascular events did not differ between both groups. Furthermore, an increased risk of ICD shock delivery was observed in digitalis-treated patients.

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.