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Epifanio, Hindalis Ballesteros, Marcelo Katz, Melania Aparecida Borges, Alessandra da Graça Corrêa, Fátima Dumas Cintra, Rodrigo Leandro Grinberg, Ana Cristina Pinotti Pedro Ludovice, Bruno Pereira Valdigem, Nilton José Carneiro da Silva, and Guilherme Fenelon. "The use of external event monitoring (web-loop) in the elucidation of symptoms associated with arrhythmias in a general population." Einstein (São Paulo) 12, no. 3 (September 2014): 295–99. http://dx.doi.org/10.1590/s1679-45082014ao2939.
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Objective To correlate arrhythmic symptoms with the presence of significant arrhythmias through the external event monitoring (web-loop). Methods Between January and December 2011, the web-loop was connected to 112 patients (46% of them were women, mean age 52±21 years old). Specific arrhythmic symptoms were defined as palpitations, pre-syncope and syncope observed during the monitoring. Supraventricular tachycardia, atrial flutter or fibrillation, ventricular tachycardia, pauses greater than 2 seconds or advanced atrioventricular block were classified as significant arrhythmia. The association between symptoms and significant arrhythmias were analyzed. Results The web-loop recorded arrhythmic symptoms in 74 (66%) patients. Of these, in only 14 (19%) patients the association between symptoms and significant cardiac arrhythmia was detected. Moreover, significant arrhythmia was found in 11 (9.8%) asymptomatic patients. There was no association between presence of major symptoms and significant cardiac arrhythmia (OR=0.57, CI95%: 0.21-1.57; p=0.23). Conclusion We found no association between major symptoms and significant cardiac arrhythmia in patients submitted to event recorder monitoring. Event loop recorder was useful to elucidate cases of palpitations and syncope in symptomatic patients.
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Sridhar, Anuradha, Alessandro Giamberti, Sara Foresti, Riccardo Cappato, Carlos Rubio-Iglesias García, Nerea Delgado Cabrera, Angelo Micheletti, et al. "Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre." Cardiology in the Young 21, no. 6 (May 27, 2011): 665–69. http://dx.doi.org/10.1017/s1047951111000643.
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AbstractObjectivesClassical Atriopulmonary Fontan connections tend to fail in the long term due to progressive anastomotic site obstruction, right atrial enlargement, and refractory atrial arrhythmias. Conversion to total cavopulmonary connection with concomitant arrhythmia surgery is a promising treatment but optimal timing of the procedure remains controversial.MethodsBetween the years 2002 and 2009, 15 patients with a median age of 26.2 (12–43) years underwent Fontan conversion operation with concomitant arrhythmia surgery. All were symptomatic and 14 out of the 15 patients had refractory arrhythmias. The duration of pre-operative arrhythmia and the outcome of surgery were correlated to study the impact of delay in surgical intervention on post-operative survival and arrhythmia control.ResultsThere were two patients who died in the early post-operative period (13.3%). At the mid-term follow-up, 53 (20–86) months, late atrial arrhythmias had recurred in two of the 13 surviving patients (15.30%) and one patient developed late sinus node dysfunction. The need for anti-arrhythmic drugs decreased considerably from 93.5% to 15.3% on mid-term follow-up. There was no late death or need for cardiac transplantation. The duration of arrhythmia before surgery was prolonged for more than 10 years in patients who died as well as in those who had complications like late recurrence of arrhythmias, dependence on anti-arrhythmic medications, and worsening of ventricular dysfunction.ConclusionsFontan conversion is a well-established treatment option for salvaging the failing atriopulmonary connections. Concomitant arrhythmia surgery effectively resolves the refractory atrial arrhythmias and improves survival, but we need to optimise the timing of Fontan conversion to improve the long-term outcome.
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Akhmedov, V. A., M. A. Livzan, and O. V. Gaus. "COVID-19 and arrhythmias - is there a relationship?" South Russian Journal of Therapeutic Practice 3, no. 3 (September 1, 2022): 17–24. http://dx.doi.org/10.21886/2712-8156-2022-3-3-17-24.
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COVID-19 infection is associated with many different systemic complications. Among these, cardiovascular system complications are particularly important as these are associated with significant mortality. There are many different subgroups of cardiovascular complications, with arrhythmias being one of them. Arrhythmias are especially important as there are a substantial percentage of patients who have arrhythmia after a COVID-19 infection, and these patients are seen with an increased mortality rate. Arrhythmias in COVID-19 patients are associated with inflammation, electrolyte abnormalities, hypoxia, myocardial ischemia, cytokines, pro-arrhythmic or QT-prolonging medications, and underlying heart conditions such as severe congestive heart failure, inherited arrhythmia syndromes, or congenital heart conditions. In addition, arrhythmias and cardiac arrests are most prevalent in the critically ill intensive care unit COVID-19 patient population. This review of PubMed/MedLine articled presents an overview of the association between COVID-19 and arrhythmias by detailing possible pathophysiological mechanisms, existing knowledge of pro-arrhythmic factors, and results from studies in adult COVID-19 populations.
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Shashank, Shekhar Mishra, Kumar Neeraj, Sirvi Gajaram, Shekhar Sharma Chandra, Pratap Singh Hamendra, and Pandiya Harshda. "Computational Prediction of Pharmacokinetic, Bioactivity and Toxicity Parameters of Some Selected Anti arrhythmic Agents." Pharmaceutical and Chemical Journal 4, no. 5 (October 31, 2017): 143–46. https://doi.org/10.5281/zenodo.13853911.
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Many pharmacological agents are available for the treatment of cardiac arrhythmias. Arrhythmia may be classified on the basis of rate (bradycardia and tachycardia), mechanism (automaticity, re-entry, triggered) or duration (isolated premature beats; couplets). The treatment approach to arrhythmia depends firstly on whether or not the affected person is stable or unstable. This research investigation finds the various pharmacokinetic, bioactivity and toxicity parameters for some selected anti-arrhythmic agents for designing new agents.
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Ertugay, Serkan, Zehra Ünlü, Sedat Karaca, Yaprak Engin, Evrim Şimşek, and Mustafa Özbaran. "[MSB-11] Arrhythmia Course After Surgical Treatment of Mitral Annular Disjunction." Cardiovascular Surgery and Interventions 11, no. 100 (November 1, 2024): 17. https://doi.org/10.5606/e-cvsi.2024.msb-11.
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Objective: This study aimed to investigate the course of arrhythmia in patients with mitral annular disjunction (MAD) based on 24-h Holter electrocardiogram. Methods: In this retrospective study, 140 patients who underwent mitral valve surgery for type 2 dysfunction between ?? 2017 and May 2024 were reviewed. Forty-five patients with MAD were identified. A history of arrhythmia was identified in 30 (18 females, 12 males; mean age: 38.5±13.76 years) of these 45 patients. Results: The mean cardiopulmonary bypass time was 134.2 min, and the mean cross-clamp time was 99.1 min. One patient died due to low cardiac output. Control echocardiograms performed one month later showed no severe mitral regurgitation. The prevalence of supraventricular arrhythmia was 17.1% prior to surgery and 3.9% postoperatively. The prevalence of ventricular arrhythmia was 8.1% prior to surgery and 2.8% postoperatively. The relationship between MAD distance and the occurrence of arrhythmia was investigated. A notable correlation was observed between MAD exceeding 10 mm and a reduced prevalence of ventricular arrhythmia, with statistical significance (p<0.05). Conclusion: Mitral annular disjunction can lead to severe arrhythmic episodes and sudden death. In the presence of MAD over 10 mm, surgical treatment may reduce the incidence of ventricular arrhythmias. Surgical treatment of MAD decreased the incidence of arrhythmia; therefore, early operation may be considered in the presence of severe arrhythmic events, even if mitral regurgitation is not severe.
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Ertugay, Serkan, Zehra Ünlü, Sedat Karaca, Yaprak Engin, Evrim Şimşek, and Mustafa Özbaran. "[MSB-11] Arrhythmia Course After Surgical Treatment of Mitral Annular Disjunction." Turkish Journal of Thoracic and Cardiovascular Surgery 32, no. 4 (November 1, 2024): 28–29. https://doi.org/10.5606/tgkdc.dergisi.2024.msb-11.
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Objective: This study aimed to investigate the course of arrhythmia in patients with mitral annular disjunction (MAD) based on 24-h Holter electrocardiogram. Methods: In this retrospective study, 140 patients who underwent mitral valve surgery for type 2 dysfunction between ?? 2017 and May 2024 were reviewed. Forty-five patients with MAD were identified. A history of arrhythmia was identified in 30 (18 females, 12 males; mean age: 38.5±13.76 years) of these 45 patients. Results: The mean cardiopulmonary bypass time was 134.2 min, and the mean cross-clamp time was 99.1 min. One patient died due to low cardiac output. Control echocardiograms performed one month later showed no severe mitral regurgitation. The prevalence of supraventricular arrhythmia was 17.1% prior to surgery and 3.9% postoperatively. The prevalence of ventricular arrhythmia was 8.1% prior to surgery and 2.8% postoperatively. The relationship between MAD distance and the occurrence of arrhythmia was investigated. A notable correlation was observed between MAD exceeding 10 mm and a reduced prevalence of ventricular arrhythmia, with statistical significance (p<0.05). Conclusion: Mitral annular disjunction can lead to severe arrhythmic episodes and sudden death. In the presence of MAD over 10 mm, surgical treatment may reduce the incidence of ventricular arrhythmias. Surgical treatment of MAD decreased the incidence of arrhythmia; therefore, early operation may be considered in the presence of severe arrhythmic events, even if mitral regurgitation is not severe.
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Gasperetti, Alessio, Cynthia A. James, Liang Chen, Niklas Schenker, Michela Casella, Shinwan Kany, Shibu Mathew, et al. "Efficacy of Catheter Ablation for Atrial Arrhythmias in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy—A Multicenter Study." Journal of Clinical Medicine 10, no. 21 (October 26, 2021): 4962. http://dx.doi.org/10.3390/jcm10214962.
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Background: Atrial arrhythmias are present in up to 20% of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Catheter ablation (CA) is an effective treatment for atrial arrhythmias in the general population. Data regarding CA for atrial arrhythmias in ARVC are scarce. Objective: To assess the safety and efficacy of CA for atrial arrhythmias in patients with ARVC. Methods: In this international collaborative effort, all patients with a definite diagnosis of ARVC undergoing CA for atrial fibrillation (AF), focal atrial tachycardia (AT), or cavotricuspid isthmus (CTI)-dependent atrial flutter (AFl) were extracted from twelve ARVC registries. Demographic, periprocedural, and long-term arrhythmic outcome data were collected. Results: Thirty-seven patients were enrolled in the study (age 50.2 ± 16.6 years, male 84%, CHA2DS2VASc 1 (1,2), HAS-BLED 0 (0–2)). The arrhythmia leading to CA was AF in 23 (62%), focal left AT in 5 (14%), and CTI-dependent AFl in 9 (24%). Acute procedural success was achieved in all procedures but one (n = 1 focal left AT; 97% acute success). The median follow-up period was 27 (13–67) months, and 96%, 74%, and 61% of patients undergoing AF ablation were free from any atrial arrhythmia recurrence after a single procedure at 6 months, 12 months, and last follow-up, respectively. After focal AT ablation, freedom from atrial arrhythmia recurrence was 80%, 80%, and 60% at 6 months, 12 months, and last follow-up, respectively. All patients undergoing CTI ablation were free from atrial arrhythmia recurrences at 6 months, with 89% single-procedural arrhythmic freedom at last follow-up. One major complication (2.7%; PV stenosis requiring PV stenting) occurred. Conclusions: CA is safe and effective in managing atrial arrhythmias in patients with ARVC, with success rates comparable to the general population.
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Poeppel, T. D., M. Reinhardt, E. G. Vester, M. Yong, J. Mau, B. E. Strauer, H. Vosberg, H. W. Müller, and B. J. Krause. "Myocardial perfusion/metabolism mismatch and ventricular arrhythmias in the chronic post infarction state." Nuklearmedizin 44, no. 03 (2005): 69–75. http://dx.doi.org/10.1055/s-0038-1625688.
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Summary Aim: Ventricular arrhythmias have been shown to originate in the myocardial peri-infarct region due to irregular heterotopic conduction. Hypoperfused but viable myocardium is often localised in those areas and may be involved in the pathogenesis of arrhythmias. We tested the hypothesis that these myocardial perfusion/metabolism mismatches (MM) are significantly associated with ventricular arrhythmias in the chronic post infarction state. Patients, methods: 47 post infarction patients were included in the study. 33 suffered from ventricular arrhythmia whereas 14 did not. All patients underwent 99mTc tetrofosmin SPECT and 18F-FDG PET. A region-of-interest(ROI)-analysis was used to assess viable myocardium based on predefined MM-criteria. Univariate analyses as well as a logistic regression model for the multivariate analysis were carried out. Results: 94% of the arrhythmic patients displayed at least one MM-segment as compared to 64% of the non-arrhythmic patients. MMsegments and arrhythmia showed a statistically significant relation (p = 0.018). The logistic regression model predicted the occurrence or absence of arrhythmia in 85% of all cases. Multivariate analysis gave consistent results, after adjusting for symptomatic chronic heart failure (CHF), aneurysms and age. Conclusion: Our results support the hypothesis that hypoperfused but viable myocardium represents an arrhythmogenic substrate and is a relevant risk factor for developing ventricular arrhythmias following myocardial infarction. Therefore, the detection of MM-segments allows the identification of patients with a higher risk for future cardiac events.
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CHIU, CHUANG-CHIEN, TONG-HONG LIN, and BEN-YI LIAU. "USING CORRELATION COEFFICIENT IN ECG WAVEFORM FOR ARRHYTHMIA DETECTION." Biomedical Engineering: Applications, Basis and Communications 17, no. 03 (June 25, 2005): 147–52. http://dx.doi.org/10.4015/s1016237205000238.
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Arrhythmia is one kind of diseases that gives rise to the death and possibly forms the immedicable danger. The most common cardiac arrhythmia is the ventricular premature beat. The main purpose of this study is to develop an efficient arrhythmia detection algorithm based on the morphology characteristics of arrhythmias using correlation coefficient in ECG signal. Subjects for experiments included normal subjects, patients with atrial premature contraction (APC), and patients with ventricular premature contraction (PVC). So and Chan's algorithm was used to find the locations of QRS complexes. When the QRS complexes were detected, the correlation coefficient and RR-interval were utilized to calculate the similarity of arrhythmias. The algorithm was tested using MIT-BIH arrhythmia database and every QRS complex was classified in the database. The total number of test data was 538, 9 and 24 for normal beats, APCs and PVCs, respectively. The results are presented in terms of, performance, positive predication and sensitivity. High overall performance (99.3%) for the classification of the different categories of arrhythmic beats was achieved. The positive prediction results of the system reach 99.44%, 100% and 95.35% for normal beats, APCs and PVCs, respectively. The sensitivity results of the system are 99.81%, 81.82% and 95.83% for normal beats, APCs and PVCs, respectively. Results revealed that the system is accurate and efficient to classify arrhythmias resulted from APC or PVC. The proposed arrhythmia detection algorithm is therefore helpful to the clinical diagnosis.
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van Bavel, Joanne J. A., Henriëtte D. M. Beekman, Agnieszka Smoczyńska, Marcel A. G. van der Heyden, and Marc A. Vos. "IKs Activator ML277 Mildly Affects Repolarization and Arrhythmic Outcome in the CAVB Dog Model." Biomedicines 11, no. 4 (April 11, 2023): 1147. http://dx.doi.org/10.3390/biomedicines11041147.
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Long QT syndrome type 1 with affected IKs is associated with a high risk for developing Torsade de Pointes (TdP) arrhythmias and eventually sudden cardiac death. Therefore, it is of high interest to explore drugs that target IKs as antiarrhythmics. We examined the antiarrhythmic effect of IKs channel activator ML277 in the chronic atrioventricular block (CAVB) dog model. TdP arrhythmia sensitivity was tested in anesthetized mongrel dogs (n = 7) with CAVB in series: (1) induction experiment at 4 ± 2 weeks CAVB: TdP arrhythmias were induced with our standardized protocol using dofetilide (0.025 mg/kg), and (2) prevention experiment at 10 ± 2 weeks CAVB: the antiarrhythmic effect of ML277 (0.6–1.0 mg/kg) was tested by infusion for 5 min preceding dofetilide. ML277: (1) temporarily prevented repolarization prolongation induced by dofetilide (QTc: 538 ± 65 ms at induction vs. 393 ± 18 ms at prevention, p < 0.05), (2) delayed the occurrence of the first arrhythmic event upon dofetilide (from 129 ± 28 s to 180 ± 51 s, p < 0.05), and (3) decreased the arrhythmic outcome with a significant reduction in the number of TdP arrhythmias, TdP score, arrhythmia score and total arrhythmic events (from 669 ± 132 to 401 ± 228, p < 0.05). IKs channel activation by ML277 temporarily suppressed QT interval prolongation, delayed the occurrence of the first arrhythmic event and reduced the arrhythmic outcome in the CAVB dog model.
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Baghel, Anita, Manoj Kumar, J. P. Soni, Mudit Agarwal, and Ravi Kumar. "Experience with Holter monitoring for evaluation of infant arrhythmia." International Journal of Contemporary Pediatrics 6, no. 3 (April 30, 2019): 1362. http://dx.doi.org/10.18203/2349-3291.ijcp20192044.
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Background: Arrhythmia is defined as abnormal heart rates. Sometimes they are intermittent and difficult to diagnose on routine ECG. Neonatologist and Pediatrician needs to rapidly establish accurate diagnosis and management for infants suspected to have arrhythmia. Hence Holter monitoring of the infants presenting with symptoms suggestive of arrhythmia is necessary as it provides a continuous record of heart’s electrical activity. The aim of this paper is to find out the role of continuous ambulatory electrocardiographic monitoring in daily clinical practice of Pediatrics.Methods: All infants including neonates, either inborn or brought to the paediatric emergency with risk factors, between January 2016 to January 2018, were included in this prospectively study. Evaluation including chest X-ray, standard 12-lead electrocardiography, 24 hours continuous ECG monitoring using Mortara holter, echocardiography, biochemical and haematological analysis.Results: A total of 73 babies were enrolled in present study. In this study arrhythmia was found in 29 (39.72%) new-borns. The most common arrhythmia observed was supraventricular tachycardia (SVT) (41.3%). Other arrhythmia observed were ventricular tachycardia (VT), AV block (34.4%), atria premature beats (3.4%) and ventricular premature beats (6.89%), tachy-bradyarrhythmia (3.4%) and junctional rhythm (3.4%). Of 29 arrhythmia patients four were diagnosed solely by Holter monitoring. None of the babies had long QT syndrome on Holter monitoring.Conclusions: Cardiac arrhythmias are important causes of infant morbidity, and mortality if undiagnosed and untreated. It is important for the neonatologist and paediatrician to be aware of these of arrhythmias and the various diagnostic modalities available for them. A Holter electrocardiogram may be of value in identification of these transient arrhythmic events.
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Gauvrit, Sébastien, Jaclyn Bossaer, Joyce Lee, and Michelle M. Collins. "Modeling Human Cardiac Arrhythmias: Insights from Zebrafish." Journal of Cardiovascular Development and Disease 9, no. 1 (January 5, 2022): 13. http://dx.doi.org/10.3390/jcdd9010013.
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Cardiac arrhythmia, or irregular heart rhythm, is associated with morbidity and mortality and is described as one of the most important future public health challenges. Therefore, developing new models of cardiac arrhythmia is critical for understanding disease mechanisms, determining genetic underpinnings, and developing new therapeutic strategies. In the last few decades, the zebrafish has emerged as an attractive model to reproduce in vivo human cardiac pathologies, including arrhythmias. Here, we highlight the contribution of zebrafish to the field and discuss the available cardiac arrhythmia models. Further, we outline techniques to assess potential heart rhythm defects in larval and adult zebrafish. As genetic tools in zebrafish continue to bloom, this model will be crucial for functional genomics studies and to develop personalized anti-arrhythmic therapies.
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Li, Jie, Bin Li, Hailiang Huang, Tao Han, and Yang Li. "Allocryptopine: A Review of Its Properties and Mechanism of Antiarrhythmic Effect." Current Protein & Peptide Science 20, no. 10 (September 20, 2019): 996–1003. http://dx.doi.org/10.2174/1389203720666190807123609.
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Abstract：Throughout the last decade, extensive efforts have been devoted to developing a percutaneous catheter ablation and implantable cardioverter-defibrillator technique for patients suffering from ventricular arrhythmia. Antiarrhythmic drug efficacy for preventing arrhythmias remains disappointing because of adverse cardiovascular effects. Allocryptopine is an isoquinoline alkaloid widely present in medicinal herbs. Studies have indicated that allocryptopine exhibits potential anti-arrhythmic actions in various animal models. The potential therapeutic benefit of allocryptopine in arrhythmia diseases is addressed in this study, focusing on multiple ion channel targets and reduced repolarization dispersion. The limitations of allocryptopine research are clear given a lack of parameters regarding toxicology and pharmacokinetics and clinical efficacy in patients with ventricular arrhythmias. Much remains to be revealed about the properties of allocryptopine.
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Drakopoulou, Maria, Heba Nashat, Aleksander Kempny, Rafael Alonso-Gonzalez, Lorna Swan, Stephen J. Wort, Laura C. Price, et al. "Arrhythmias in adult patients with congenital heart disease and pulmonary arterial hypertension." Heart 104, no. 23 (May 18, 2018): 1963–69. http://dx.doi.org/10.1136/heartjnl-2017-312881.
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ObjectivesApproximately 5%–10% of adults with congenital heart disease (CHD) develop pulmonary arterial hypertension (PAH), which affects life expectancy and quality of life. Arrhythmias are common among these patients, but their incidence and impact on outcome remains uncertain.MethodsAll adult patients with PAH associated with CHD (PAH-CHD) seen in a tertiary centre between 2007 and 2015 were followed for new-onset atrial or ventricular arrhythmia. Clinical variables associated with arrhythmia and their relation to mortality were assessed using Cox analysis.ResultsA total of 310 patients (mean age 34.9±12.3 years, 36.8% male) were enrolled. The majority had Eisenmenger syndrome (58.4%), 15.2% had a prior defect repair and a third had Down syndrome. At baseline, 14.2% had a prior history of arrhythmia, mostly supraventricular arrhythmia (86.4%). During a median follow-up of 6.1 years, 64 patients developed at least one new arrhythmic episode (incidence 3.47% per year), mostly supraventricular tachycardia or atrial fibrillation (78.1% of patients). Arrhythmia was associated with symptoms in 75.0% of cases. The type of PAH-CHD, markers of disease severity and prior arrhythmia were associated with arrhythmia during follow-up. Arrhythmia was a strong predictor of death, even after adjusting for demographic and clinical variables (HR 3.41, 95% CI 2.10 to 5.53, p<0.0001).ConclusionsArrhythmia is common in PAH-CHD and is associated with an adverse long-term outcome, even when managed in a specialist centre.
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Hong, Bihong, Jianlin He, Qingqing Le, Kaikai Bai, Yongqiang Chen, and Wenwen Huang. "Combination Formulation of Tetrodotoxin and Lidocaine as a Potential Therapy for Severe Arrhythmias." Marine Drugs 17, no. 12 (December 5, 2019): 685. http://dx.doi.org/10.3390/md17120685.
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Severe arrhythmias—such as ventricular arrhythmias—can be fatal, but treatment options are limited. The effects of a combined formulation of tetrodotoxin (TTX) and lidocaine (LID) on severe arrhythmias were studied. Patch clamp recording data showed that the combination of LID and TTX had a stronger inhibitory effect on voltage-gated sodium channel 1.5 (Nav1.5) than that of either TTX or LID alone. LID + TTX formulations were prepared with optimal stability containing 1 μg of TTX, 5 mg of LID, 6 mg of mannitol, and 4 mg of dextran-40 and then freeze dried. This formulation significantly delayed the onset and shortened the duration of arrhythmia induced by aconitine in rats. Arrhythmia-originated death was avoided by the combined formulation, with a decrease in the mortality rate from 64% to 0%. The data also suggests that the anti-arrhythmic effect of the combination was greater than that of either TTX or LID alone. This paper offers new approaches to develop effective medications against arrhythmias.
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Thiruganasambandamoorthy, V., M. Sivilotti, M. A. Mukarram, C. Leafloor, K. Arcot, G. A. Wells, B. H. Rowe, A. Krahn, L. Huang, and M. Taljaard. "LO98: Optimal length of observation for emergency department patients with syncope: a time to event analysis." CJEM 19, S1 (May 2017): S62. http://dx.doi.org/10.1017/cem.2017.160.
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Introduction: Concern for occult serious conditions leads to variations in ED syncope management [hospitalization, duration of ED/inpatient monitoring including Syncope Observation Units (SOU) for prolonged monitoring]. We sought to develop evidence-based recommendations for duration of ED/post-ED ECG monitoring using the Canadian Syncope Risk Score (CSRS) by assessing the time to serious adverse event (SAE) occurrence. Methods: We enrolled adults with syncope at 6 EDs and collected demographics, time of syncope and ED arrival, CSRS predictors and time of SAE. We stratified patients as per the CSRS (low, medium and high risk as ≤0, 1-3 and ≥4 respectively). 30-day adjudicated SAEs included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism or serious hemorrhage. We categorized arrhythmias, interventions for arrhythmias and death from unknown cause as arrhythmic SAE and the rest as non-arrhythmic SAE. We performed Kaplan-Meier analysis using time of ED registration for primary and time of syncope for secondary analyses. Results: 5,372 patients (mean age 54.3 years, 54% females, and 13.7% hospitalized) were enrolled with 538 (10%) patients suffering SAE (0.3% died due to an unknown cause and 0.5% suffered ventricular arrhythmia). 64.8% of SAEs occurred within 6 hours of ED arrival. The probability for any SAE or arrhythmia was highest within 2-hours of ED arrival for low-risk patients (0.65% and 0.31%; dropped to 0.54% and 0.06% after 2-hours) and within 6-hours for the medium and high-risk patients (any SAE 6.9% and 17.4%; arrhythmia 6.5% and 18.9% respectively) which also dropped after 6-hours (any SAE 0.99% and 2.92%; arrhythmia 0.78% and 3.07% respectively). For any CSRS threshold, the risk of arrhythmia was highest within the first 15-days (for CSRS ≥2 patients 15.6% vs. 0.006%). ED monitoring for 2-hours (low-risk) and 6-hours (medium and high-risk) and using a CSRS ≥2 cut-off for outpatient 15-day ECG monitoring will lead to 52% increase in arrhythmia detection. The majority (82.2%) arrived to the ED within 2-hours (median time 1.1 hours) and secondary analysis yielded similar results. Conclusion: Our study found 2 and 6 hours of ED monitoring for low-risk and medium/high-risk CSRS patients respectively, with 15-day outpatient ECG monitoring for CSRS ≥2 patients will improve arrhythmia detection without the need for hospitalization or observation units.
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Rezwan, Refaya, Sharmin Zafar, Abu Asad Chowdhury, Shaila Kabir, Mohammad Shah Amran, and Mohammad Abdur Rashid. "Studies of Anti-arrhythmic and Hypercholesterolemic Activities of Ayurvedic Preparation Lauhasab in Rat Model." Dhaka University Journal of Pharmaceutical Sciences 16, no. 1 (July 30, 2017): 95–105. http://dx.doi.org/10.3329/dujps.v16i1.33387.
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Lauhasab, an Ayurvedic preparation, is widely used in anemia and cardiovascular diseases. Despite its claim as a cardio-tonic there is paucity of studies on pharmacological activities and toxicities. In this study, the anti-arrhythmic effect and impact on lipid profile were evaluated. Rats were pretreated with 0.28 and 2.8 ml/kg body weight of Lauhasab for 35 days and electrocardiographic tracings were recorded and analyzed to determine heart rate and occurrence of arrhythmia. Electrocardiogram recorded before digoxin administration showed significant decrease in mean heart rate along with longer duration of bradycardia than in digoxin control group after 35 days of chronic pretreatment with both doses of Lauhasab. In animal experiments, various arrhythmias were observed after intraperitoneal injection of digoxin. Lauhasab decreased the duration and delayed onset of time of various arrhythmias. It showed significant increase in cholesterol and triglyceride levels in a dose dependent manner. It can be concluded that Lauhasab possesses significant anti-arrhythmic activity against digoxin-induced arrhythmia. It also revealed hyperlipidemic effects.Dhaka Univ. J. Pharm. Sci. 16(1): 95-105, 2017 (June)
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Eftekhari, Helen. "Pharmacotherapy in arrhythmias: an overview of anti-arrhythmic drug therapy." British Journal of Cardiac Nursing 16, no. 4 (April 2, 2021): 1–9. http://dx.doi.org/10.12968/bjca.2021.0044.
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The article provides an overview of the principles in anti-arrhythmic drug prescribing. The cardiac action potential is explained, followed by general principles involved in treating arrhythmias and prescribing decisions. An overview of the five classifications of anti-arrhythmic drugs is given, with examples of the main drugs in the classification and principles to consider within each. Finally, anticoagulation is reviewed, being a cornerstone prescribing decision-making in the most common arrhythmia, atrial fibrillation.
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Bommer, Thea, Maria Knierim, Julia Unsöld, Dominic Riedl, Laura Stengel, Michael Paulus, Thomas Körtl, et al. "Simulation of cardiac arrhythmias in human induced pluripotent stem cell-derived cardiomyocytes." PLOS ONE 19, no. 9 (September 27, 2024): e0310463. http://dx.doi.org/10.1371/journal.pone.0310463.
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The effects and mechanisms of cardiac arrhythmias are still incompletely understood and an important subject of cardiovascular research. A major difficulty for investigating arrhythmias is the lack of appropriate human models. Here, we present a protocol for a translational simulation of different types of arrhythmias using human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) and electric cell culture pacing. The protocol comprises the handling of ventricular and atrial hiPSC-CM before and during in vitro arrhythmia simulation and possible arrhythmia simulation protocols mimicking clinical arrhythmias like atrial fibrillation. Isolated or confluent hiPSC-CM can be used for the simulation. In vitro arrhythmia simulation did not impair cell viability of hiPSC-CM and could reproduce arrhythmia associated phenotypes of patients. The use of hiPSC-CM enables patient-specific studies of arrhythmias, genetic interventions, or drug-screening. Thus, the in vitro arrhythmia simulation protocol may offer a versatile tool for translational studies on the mechanisms and treatment options of cardiac arrhythmias.
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Wang, Yan, Pei Tao, and Yu-Jie Wang. "Attenuated Structural Transformation of Indaconitine during Sand Frying Process and Anti-Arrhythmic Effects of Its Transformed Products." Evidence-Based Complementary and Alternative Medicine 2022 (February 17, 2022): 1–12. http://dx.doi.org/10.1155/2022/8606459.
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The transformation pathways of diterpenoid alkaloids have been clarified clearly in the boiling and steaming process, but remain to be determined in the sand frying process. The aims of the study were to investigate the transformation pathways of indaconitine in the sand frying process, as well as examine the cardiotoxicity and anti-arrhythmic activity of indaconitine and its transformed products. The transformed product was separated by column chromatography, and the structure was identified by 1H NMR, 13C NMR, and HR-ESI-MS. The cardiotoxicity of indaconitine and its transformed products was clarified by observing the electrocardiogram (ECG) changes at the same dose. Furthermore, the anti-arrhythmic activity of the transformed products was investigated using an aconitine-induced rat arrhythmia model. Consequently, Δ15(16)-16-demethoxyindaconitine, a new diterpenoid alkaloid, was isolated from processed indaconitine. Intravenous injection of 0.06 mg/kg indaconitine induced arrhythmias in SD rats, while Δ15(16)-16-demethoxyindaconitine did not exhibit arrhythmias at the same dose. In the anti-arrhythmic assay, mithaconitine, obtained in the previous research, together with Δ15(16)-16-demethoxyindaconitine, could dose-dependently delay the onset time of ventricular premature beat (VPB) and reduce the incidence of ventricular tachycardia (VT), combined with the increasing arrhythmia inhibition rate, exhibiting strong anti-arrhythmic activities. These results indicated that two or more pathways exist in the sand frying process, and the transformed products exhibited lower cardiotoxicity and strong anti-arrhythmic activities, which had the possibility of being developed into anti-arrhythmic drugs.
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Rasheed, A., M. D. Khan, A. K. Duke, M. Tofeig, A. Ng, P. Stafford, F. A. Bu'Lock, R. K. Firmin, and G. J. Peek. "Abstracts for the British Congenital Cardiac Association Annual Meeting: The Barbican, London, 24–25 November 2005: Poster Presentations: ECMO support for lifethreatening arrhythmia in infancy permits successful radiofrequency treatment." Cardiology in the Young 16, no. 3 (June 2006): 318–19. http://dx.doi.org/10.1017/s1047951106270239.
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The majority of arrhythmias presenting in infancy cardiovert readily or rapidly respond to conventional medical therapy. A small number prove highly refractory to anti-arrhythmic medications. Myocardial performance may be severely compromised by the combination of fast heart rate and negatively inotropic drugs. Some babies die. We have recently supported 2 babies with refractory arrhythmias on ECMO, both to pursue drug therapy and eventually, to support the circulation during radiofrequency ablation, with very successful results. The first patient was a 2.5 kg neonate presenting with collapse secondary to atrial ectopic tachycardia with a rate of 300/minute. Myocardial function was severely impaired. The arrhythmia was adenosine resistant and after iv amiodarone loading had no effect, esmolol infusion was started. This produced profound hypotension and the arrhythmia rapidly recommenced after DC cardioversion. In the face of such severe haemodynamic disturbance, VA ECMO was instituted. Further anti-arrhythmics were tried on-circulatory support, but the arrhythmia was incessant despite multiple DC cardioversions. Therefore radiofrequency ablation of the atrial ectopic focus was attempted on ECMO support. This was achieved uneventfully and the myocardial function rapidly improved, with decannulation 24 hours later. Unfortunately the arrhythmia recurred 2 weeks later, but was successfully treated by further ablation without ECMO. The child remains well with normal development on no medication. An 11-month-old baby presented to the GP with acute onset of lethargy and poor feeding and a heart rate of 350 bpm was noted! This was a broad complex tachycardia with independent p wave activity (confirmed with adenosine); ie ventricular tachycardia. Although initially well tolerated, the tachycardia resisted DC “cardioversion” even up to 60 J. Progressive and severe myocardial dysfunction and hypotension ensued, exacerbated by any attempts at drug therapy. The patient was therefore placed on VA ECMO. Some slowing of the ventricular rhythm was achieved with amiodarone and flecainide. The patient was then decannulated but the rapid arrhythmia recurred and ECMO was reinstituted. Electro-physiological mapping was then undertaken on ECMO support. NAVEX mapping identified a right ventricular outflow tract focus. This was resistant to conventional RF energy but was eventually successfully ablated with a “Cool-tip” catheter. Myocardial function improved rapidly, the patient was decannulated after 48 hours observation and there has been no recurrence of the arrhythmia since discharge. Although viewed as a very invasive technique, VA ECMO support here has prevented two otherwise unavoidable deaths in babies with conditions readily treated by radio-frequency techniques in older children. Not only did ECMO permit institution of aggressive drug therapy but also safely supported catheter interventions in very small patients. ECMO support should be considered early for small patients with refractory arrhythmias, before irreversible neurological compromise ensues. It could also be used electively to permit radiofrequency ablation in children whose size causes concern for safe catheter manipulation.
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Deanfield, John E., Seamus Cullen, and Marc Gewillig. "Arrhythmias after surgery for complete transposition: Do they matter?" Cardiology in the Young 1, no. 1 (January 1991): 91–96. http://dx.doi.org/10.1017/s1047951100000147.
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SummaryConcern about long-term complications after intraatrial repair of complete transposition has been used as an argument in favor of “anatomic” repair by the arterial switch operation. Late arrhythmias, including loss of sinus rhythm and the development of supraventricular tachycardias, particularly atrial flutter, are widely reported after intraatrial repair. Despite modifications of technique, the electrophysiologic substrate for arrhythmia results from the extensive atrial surgery required. Arrhythmias occur, even in the “modern surgical era” after both Mustard and Senning operations, are progressive, and appear to be inevitable. The circulation after an intraatrial repair is more vulnerable to the effects of excessive tachycardia, and this may place the patient at risk from sudden cardiac death. Current attempts at individual stratification of risk are disappointing using even aggressive electrophysiologic approaches, and a combined assessment involving hemodynamics is likely to be necessary. The electrophysiologic and arrhythmic consequences of the arterial switch operation have been less extensively researched but, as might be expected, are quite different from those seen after intraatrial repair. The atrial activation sequence is relatively undisturbed, and sinus nodal dysfunction and supraventricular arrhythmia are uncommon. Ventricular extrasystoles are the arrhythmia most consistently found during the short follow-up currently available. In the longer term, myocardial ischemia, hemodynamic disturbances and autonomic imbalance may predispose to late arrhythmia. Current evidence would suggest that the lack of clinically significant arrhythmia and the restoration of the left ventricle to the systemic circulation are significant advantages of the arterial switch operation over intraatrial repair procedures.
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Manohar, Udutha, G. Rangha Vardhan, Mohammad Shireen, and T. Ramya. "AI driven ECG arrhythmia diagnosis." MATEC Web of Conferences 392 (2024): 01149. http://dx.doi.org/10.1051/matecconf/202439201149.
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The accurate and timely diagnosis of cardiac arrhythmias is crucial for effective patient management and improved health outcomes. However, the precise identification of arrhythmias in electrocardiogram (ECG) data often requires specialized medical expertise, leading to potential delays and errors in diagnosis. To address these challenges, this project introduces an AI-driven system for ECG arrhythmia diagnosis. Employing advanced deep learning techniques, the proposed system leverages a comprehensive dataset of annotated ECG recordings to train a robust model capable of detecting and classifying various types of arrhythmias. The model is designed to process raw ECG signals, extract relevant features, and generate clinically meaningful insights, enabling automated and rapid identification of arrhythmic patterns. Through a user-friendly interface, medical professionals can upload ECG data for real-time analysis, allowing for prompt decision-making and personalized patient care. Furthermore, the system offers interpretable results, highlighting key indicators and providing detailed explanations to aid clinicians in understanding the diagnostic outcomes.
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Kristanto, Harris, Budi Satrijo, Sasmojo Widito, and Ardian Rizal. "Reperfusion Arrhythmia in Acute Myocardial Infarction: Clinical Implication and Management." Heart Science Journal 3, no. 1 (January 1, 2022): 4–14. http://dx.doi.org/10.21776/ub.hsj.2022.003.01.2.
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Reperfusion is a critical component of myocardium survival in acute myocardial infarction to minimize infarct size and improve clinical prognosis. Reperfusion, on the other hand, may result in increased and accelerated myocardial injury, a condition known as reperfusion injury. Following reperfusion, several arrhythmias are observed, and it is called reperfusion arrhythmia. Reperfusion arrhythmia is one manifestation of reperfusion injury. Numerous modest studies have evaluated what reperfusion arrhythmias are defined. It is described as an arrhythmia that occurs immediately or within the first minutes after coronary blood flow is restored. Traditionally, Accelerated Idioventricular Rhythm (AIVR) has been seen as a reperfusion arrhythmia. However, reperfusion may reveal any arrhythmia (or none at all); conversely, AIVR may occur in the absence of reperfusion. Calcium excess within the cells is thought to be a significant factor in the development of reperfusion arrhythmias. This may affect the significant delay following depolarization and the regional heterogeneity of regional blood flow restoration inside the ischemic zone, resulting in reperfusion arrhythmia. In some studies, it was mentioned that these arrhythmias may be due to ongoing myocardial cell damage and ischemia. Arrhythmias associated with reperfusion require special attention since hemodynamics can deteriorate quickly. In this review, clinical significance and management of reperfusion arrhythmia, as well as its link with reperfusion injury will be discussed.
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Zylla, Maura M., Uta Merle, Johannes A. Vey, Grigorios Korosoglou, Eva Hofmann, Michael Müller, Felix Herth, et al. "Predictors and Prognostic Implications of Cardiac Arrhythmias in Patients Hospitalized for COVID-19." Journal of Clinical Medicine 10, no. 1 (January 2, 2021): 133. http://dx.doi.org/10.3390/jcm10010133.
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Background: Cardiac manifestation of COVID-19 has been reported during the COVID pandemic. The role of cardiac arrhythmias in COVID-19 is insufficiently understood. This study assesses the incidence of cardiac arrhythmias and their prognostic implications in hospitalized COVID-19-patients. Methods: A total of 166 patients from eight centers who were hospitalized for COVID-19 from 03/2020–06/2020 were included. Medical records were systematically analyzed for baseline characteristics, biomarkers, cardiac arrhythmias and clinical outcome parameters related to the index hospitalization. Predisposing risk factors for arrhythmias were identified. Furthermore, the influence of arrhythmia on the course of disease and related outcomes was assessed using univariate and multiple regression analyses. Results: Arrhythmias were detected in 20.5% of patients. Atrial fibrillation was the most common arrhythmia. Age and cardiovascular disease were predictors for new-onset arrhythmia. Arrhythmia was associated with a pronounced increase in cardiac biomarkers, prolonged hospitalization, and admission to intensive- or intermediate-care-units, mechanical ventilation and in-hospital mortality. In multiple regression analyses, incident arrhythmia was strongly associated with duration of hospitalization and mechanical ventilation. Cardiovascular disease was associated with increased mortality. Conclusions: Arrhythmia was the most common cardiac event in association with hospitalization for COVID-19. Older age and cardiovascular disease predisposed for arrhythmia during hospitalization. Whereas in-hospital mortality is affected by underlying cardiovascular conditions, arrhythmia during hospitalization for COVID-19 is independently associated with prolonged hospitalization and mechanical ventilation. Thus, incident arrhythmia may indicate a patient subgroup at risk for a severe course of disease.
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Liu, Yan, Hong-li Sun, Dan-lu Li, Li-yan Wang, Yang Gao, Yu-ping Wang, Zhi-min Du, Yan-jie Lu, and Bao-feng Yang. "Choline produces antiarrhythmic actions in animal models by cardiac M3 receptors: improvement of intracellular Ca2+ handling as a common mechanism." Canadian Journal of Physiology and Pharmacology 86, no. 12 (December 2008): 860–65. http://dx.doi.org/10.1139/y08-094.
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It is well known that choline has protective effects on ischemic arrhythmias. We designed the present study to evaluate the antiarrhythmic effects of choline and to detect its related mechanisms in aconitine-induced rat and ouabain-induced guinea pig models of arrhythmia. Laser scanning confocal microscopy and patch-clamp technique were utilized to study the action of choline on intracellular calcium concentration and L-type calcium current (ICa-L) of cardiac myocytes. M3 receptor antagonist 4-DAMP (4-diphenylacetoxy-N-methylpiperidine-methiodide) was applied preliminarily to evaluate the role of the M3 receptor. Choline significantly increased the survival time of arrhythmic rats and guinea pigs, delayed the onset of arrhythmias and ventricular tachycardia, and decreased the arrhythmia score. The overload of intracellular Ca2+ induced by aconitine or ouabain was reduced in isolated myocytes pretreated with choline. Choline reduced the increased density of ICa-L induced by aconitine or ouabain. Moreover, the beneficial effects of choline were reversed by 4-DAMP. Choline produced antiarrhythmic actions on arrhythmia models by stimulating the cardiac M3 receptor. The mechanism may be related to the improvement of Ca2+ handling.
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Kim, Esther D., Elsayed Z. Soliman, Josef Coresh, Kunihiro Matsushita, and Lin Yee Chen. "Two-Week Burden of Arrhythmias across CKD Severity in a Large Community-Based Cohort: The ARIC Study." Journal of the American Society of Nephrology 32, no. 3 (January 28, 2021): 629–38. http://dx.doi.org/10.1681/asn.2020030301.
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BackgroundCKD is associated with sudden cardiac death and atrial fibrillation (AF). However, other types of arrhythmia and different measures of the burden of arrhythmias, such as presence and frequency, have not been well characterized in CKD.MethodsTo quantify the burden of arrhythmias across CKD severity in 2257 community-dwelling adults aged 71–94 years, we examined associations of major arrhythmias with CKD measures (eGFR and albuminuria) among individuals in the Atherosclerosis Risk in Communities study. Participants underwent 2 weeks of noninvasive, single-lead electrocardiogram monitoring. We examined types of arrhythmia burden: presence and frequency of arrhythmias and percent time in arrhythmias.ResultsOf major arrhythmias, there was a higher prevalence of AF and nonsustained ventricular tachycardia among those with more severe CKD, followed by long pause (>30 seconds) and atrioventricular block. Nonsustained ventricular tachycardia was the most frequent major arrhythmia (with 4.2 episodes per person-month). Most participants had ventricular ectopy, supraventricular tachycardia, and supraventricular ectopy. Albuminuria consistently associated with higher AF prevalence and percent time in AF, and higher prevalence of nonsustained ventricular tachycardia. When other types of arrhythmic burden were examined, lower eGFR was associated with a lower frequency of atrioventricular block. Although CKD measures were not strongly associated with minor arrhythmias, higher albuminuria was associated with a higher frequency of ventricular ectopy.ConclusionsCKD, especially as measured by albuminuria, is associated with a higher burden of AF and nonsustained ventricular tachycardia. Additionally, eGFR is associated with less frequent atrioventricular block, whereas albuminuria is associated with more frequent ventricular ectopy. Use of a novel, 2-week monitoring approach demonstrated a broader range of arrhythmias associated with CKD than previously reported.
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Guarracini, Fabrizio, Massimo Tritto, Antonio Di Monaco, Marco Valerio Mariani, Alessio Gasperetti, Paolo Compagnucci, Daniele Muser, et al. "Stereotactic Arrhythmia Radioablation Treatment of Ventricular Tachycardia: Current Technology and Evolving Indications." Journal of Cardiovascular Development and Disease 10, no. 4 (April 17, 2023): 172. http://dx.doi.org/10.3390/jcdd10040172.
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Ventricular tachycardia in patients with structural heart disease is a significant cause of morbidity and mortality. According to current guidelines, cardioverter defibrillator implantation, antiarrhythmic drugs, and catheter ablation are established therapies in the management of ventricular arrhythmias but their efficacy is limited in some cases. Sustained ventricular tachycardia can be terminated by cardioverter-defibrillator therapies although shocks in particular have been demonstrated to increase mortality and worsen patients’ quality of life. Antiarrhythmic drugs have important side effects and relatively low efficacy, while catheter ablation, even if it is actually an established treatment, is an invasive procedure with intrinsic procedural risks and is frequently affected by patients’ hemodynamic instability. Stereotactic arrhythmia radioablation for ventricular arrhythmias was developed as bail-out therapy in patients unresponsive to traditional treatments. Radiotherapy has been mainly applied in the oncological field, but new current perspectives have developed in the field of ventricular arrhythmias. Stereotactic arrhythmia radioablation provides an alternative non-invasive and painless therapeutic strategy for the treatment of previously detected cardiac arrhythmic substrate by three-dimensional intracardiac mapping or different tools. Since preliminary experiences have been reported, several retrospective studies, registries, and case reports have been published in the literature. Although, for now, stereotactic arrhythmia radioablation is considered an alternative palliative treatment for patients with refractory ventricular tachycardia and no other therapeutic options, this research field is currently extremely promising.
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Pereira, Helder, Steven Niederer, and Christopher A. Rinaldi. "Electrocardiographic imaging for cardiac arrhythmias and resynchronization therapy." EP Europace 22, no. 10 (August 5, 2020): 1447–62. http://dx.doi.org/10.1093/europace/euaa165.
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Abstract Use of the 12-lead electrocardiogram (ECG) is fundamental for the assessment of heart disease, including arrhythmias, but cannot always reveal the underlying mechanism or the location of the arrhythmia origin. Electrocardiographic imaging (ECGi) is a non-invasive multi-lead ECG-type imaging tool that enhances conventional 12-lead ECG. Although it is an established technology, its continuous development has been shown to assist in arrhythmic activation mapping and provide insights into the mechanism of cardiac resynchronization therapy (CRT). This review addresses the validity, reliability, and overall feasibility of ECGi for use in a diverse range of arrhythmias. A systematic search limited to full-text human studies published in peer-reviewed journals was performed through Medline via PubMed, using various combinations of three key concepts: ECGi, arrhythmia, and CRT. A total of 456 studies were screened through titles and abstracts. Ultimately, 42 studies were included for literature review. Evidence to date suggests that ECGi can be used to provide diagnostic insights regarding the mechanistic basis of arrhythmias and the location of arrhythmia origin. Furthermore, ECGi can yield valuable information to guide therapeutic decision-making, including during CRT. Several studies have used ECGi as a diagnostic tool for atrial and ventricular arrhythmias. More recently, studies have tested the value of this technique in predicting outcomes of CRT. As a non-invasive method for assessing cardiovascular disease, particularly arrhythmias, ECGi represents a significant advancement over standard procedures in contemporary cardiology. Its full potential has yet to be fully explored.
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Andelova, Katarina, Barbara Szeiffova Bacova, Matus Sykora, Peter Hlivak, Miroslav Barancik, and Narcis Tribulova. "Mechanisms Underlying Antiarrhythmic Properties of Cardioprotective Agents Impacting Inflammation and Oxidative Stress." International Journal of Molecular Sciences 23, no. 3 (January 26, 2022): 1416. http://dx.doi.org/10.3390/ijms23031416.
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The prevention of cardiac life-threatening ventricular fibrillation and stroke-provoking atrial fibrillation remains a serious global clinical issue, with ongoing need for novel approaches. Numerous experimental and clinical studies suggest that oxidative stress and inflammation are deleterious to cardiovascular health, and can increase heart susceptibility to arrhythmias. It is quite interesting, however, that various cardio-protective compounds with antiarrhythmic properties are potent anti-oxidative and anti-inflammatory agents. These most likely target the pro-arrhythmia primary mechanisms. This review and literature-based analysis presents a realistic view of antiarrhythmic efficacy and the molecular mechanisms of current pharmaceuticals in clinical use. These include the sodium-glucose cotransporter-2 inhibitors used in diabetes treatment, statins in dyslipidemia and naturally protective omega-3 fatty acids. This approach supports the hypothesis that prevention or attenuation of oxidative and inflammatory stress can abolish pro-arrhythmic factors and the development of an arrhythmia substrate. This could prove a powerful tool of reducing cardiac arrhythmia burden.
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Perna, Francesco, Alessandro Telesca, Roberto Scacciavillani, Maria Lucia Narducci, Gianluigi Bencardino, Gaetano Pinnacchio, Francesco Raffaele Spera, Rocco Sabarese, Gianluca Comerci, and Gemma Pelargonio. "Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease." Journal of Cardiovascular Development and Disease 10, no. 4 (April 13, 2023): 168. http://dx.doi.org/10.3390/jcdd10040168.
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Background. Adults with congenital heart disease (ACHD) are often affected by cardiac arrhythmias requiring catheter ablation. Catheter ablation in this setting represents the treatment of choice but is flawed by frequent recurrencies. Predictors of arrhythmia relapse have been identified, but the role of cardiac fibrosis in this setting has not been investigated. The aim of this study was to determine the role of the extension of cardiac fibrosis, detected by electroanatomical mapping, in predicting arrhythmia recurrencies after ablation in ACHD. Materials and Methods. Consecutive patients with congenital heart disease and atrial or ventricular arrhythmias undergoing catheter ablation were enrolled. An electroanatomical bipolar voltage map was performed during sinus rhythm in each patient and bipolar scar was assessed according to the current literature data. During follow-up, arrhythmia recurrences were recorded. The relationship between the extent of myocardial fibrosis and arrhythmia recurrence was assessed. Results. Twenty patients underwent successful catheter ablation of atrial (14) or ventricular (6) arrhythmias, with no inducible arrhythmia at the end of the procedure. During a median follow-up period of 207 weeks (IQR 80 weeks), eight patients (40%; five atrial and three ventricular arrhythmias) had arrhythmia recurrence. Of the five patients undergoing a second ablation, four showed a new reentrant circuit, while one patient had a conduction gap across a previous ablation line. The extension of the bipolar scar area (HR 1.049, CI 1.011–1.089, p = 0.011) and the presence of a bipolar scar area >20 cm2 (HR 6.101, CI 1.147–32.442, p = 0.034) were identified as predictors of arrhythmia relapse. Conclusion. The extension of the bipolar scar area and the presence of a bipolar scar area >20 cm2 can predict arrhythmia relapse in ACHD undergoing catheter ablation of atrial and ventricular arrhythmias. Recurrent arrhythmias are often caused by circuits other than those previously ablated.
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Eftekhari, Helen. "Pharmacotherapy in arrhythmias: an overview of anti-arrhythmic drug therapy." Journal of Prescribing Practice 2, no. 11 (November 2, 2020): 582–88. http://dx.doi.org/10.12968/jprp.2020.2.11.582.
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The article aims to give an overview of the principles in anti-arrhythmic drug prescribing. Practitioners assessing cardiac patients are highly likely to review anti-arrhythmic drug therapies and need an understanding of the principles of therapy. The cardiac action potential is explained, followed by general principles involved in treating arrhythmias and prescribing decisions. An overview of the five classifications of anti-arrhythmic drugs is given, with examples of the main drugs in the classification and principles to consider within each. Finally anticoagulation is reviewed being a cornerstone prescribing decision in the most common arrhythmia, atrial fibrillation.
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Soniwala, Mujtaba, Saadia Sherazi, Susan Schleede, Scott McNitt, Tina Faugh, Jeremiah Moore, Justin Foster, et al. "Arrhythmia Burden in Patients with Indolent Lymphoma." Blood 136, Supplement 1 (November 5, 2020): 6–7. http://dx.doi.org/10.1182/blood-2020-140053.
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Introduction Indolent Non-Hodgkin lymphomas (NHL) comprise a heterogeneous group of diseases including marginal zone lymphoma (MZL), lymphoplasmacytic lymphoma (LPL), small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL), and follicular lymphoma (FL). These compose a heterogenous group of disorders that frequently measures survival in years due to the long natural history of these diseases. Frequency and morbidity of cardiac arrhythmias in patients with indolent lymphoma is unknown, but recent observations note that arrhythmias are an increasing problem. Due to advances in treatment for indolent NHL with emergence of novel therapeutics, combined with an aging population and a long natural history, understanding of arrhythmia burden in indolent lymphoma is an area of research with important implications for patients undergoing active treatment as well as for long term lymphoma survivors. Methods Adult patients 18 years or older with indolent NHL treated at the University of Rochester Wilmot Cancer Institute between 2013-2019 were included in the Cardio-Oncology Lymphoid Malignancies Database and analyzed. The primary objective of this study was to define the rate of arrhythmic events and sudden cardiac death in patients with indolent lymphoma during treatment. Cardiac arrhythmias including ventricular arrhythmias (VT/VF), atrial arrhythmias (atrial fibrillation (afib), flutter, SVT and atrial tachycardia), and bradyarrhythmias were identified using ICD-10 codes. Kaplan-Meier survival analysis was used to assess cumulative probability of arrhythmia. Results There were nine hundred and eighteen patients who were diagnosed with indolent lymphoma. Diagnoses included: CLL, N=414; FL, N=284; MZL, N=144; LPL, N=76. Median age was 64, and 43% were female. There were 383 (42%) patients who received treatment. Treatments were classified as chemotherapy, targeted therapy, monoclonal antibodies/immunotherapy, and combination therapy. There were no significant differences in baseline characteristics between treated and never treated patients. At the time of diagnosis, 277 patients (30%) had hypertension, 101 (11%) had prior history of arrhythmia. During median follow up of 24 months, 168 patients (18%) developed a new or recurrent arrhythmia based on ICD-10 codes documented in the electronic medical record. Sixty-three out of one hundred sixty-eight patients had both prior history of and recurrence of arrhythmia, while one hundred five had a new diagnosis of arrhythmia. Afib was the most common arrhythmia, noted in 81 patients (9%). At 6 months from diagnosis, cumulative probability of developing any arrhythmia was 8% (Figure 1). Of all arrhythmias, 89/168 (53%) occurred in SLL/CLL, 35/168 (21%) in FL, 17/168 (10%) in LPL, 27/168 (16%) in MZL. Arrhythmias on treatment occurred in 4/95 patients receiving chemotherapy alone (4.2%), 12/95 patients receiving monoclonal antibodies/immunotherapy (12.6%), and 28/95 patients receiving targeted therapy (29.4%). Most arrhythmias (51/95; 53.6%) occurred in patients receiving combination therapy (chemoimmunotherapy or targeted/immunotherapy). Overall, there were 80 (9%) deaths. Ten deaths were related to cardiovascular diseases; of which 8/10 (80%) were from sudden cardiac death. Conclusions This real-world cohort demonstrates that patients with indolent lymphoma could have an increased risk of cardiac arrhythmias that is increased by treatment. Afib was the most common arrhythmia identified in this study and appears increased compared to the incidence in the general age matched population (1-1.8 per 100 person-years). Surprisingly, of 80 deaths, 8 (10%) were attributed to sudden cardiac death. This data set contributes important information that can help identify patients at increased risk of cardiovascular morbidity and mortality that can impact treatment. Prospective monitoring in these patients may better define the incidence and associated risks of arrhythmias. Future directions will focus on risk factors for arrhythmias and developing an approach to prevent and treat arrhythmias in this patient population. Updated results will be presented at the meeting. Disclosures Zent: Acerta / Astra Zeneca: Research Funding; TG Therapeutics, Inc: Research Funding; Mentrik Biotech: Research Funding. Barr:Janssen: Consultancy; Abbvie/Pharmacyclics: Consultancy, Research Funding; Verastem: Consultancy; Celgene: Consultancy; Seattle Genetics: Consultancy; TG therapeutics: Consultancy, Research Funding; Morphosys: Consultancy; Gilead: Consultancy; AstraZeneca: Consultancy, Research Funding; Merck: Consultancy; Genentech: Consultancy. Reagan:Kite, a Gilead Company: Consultancy; Seattle Genetics: Research Funding; Curis: Consultancy. Friedberg:Seattle Genetics: Research Funding; Roche: Other: Travel expenses; Bayer: Consultancy; Astellas: Consultancy; Acerta Pharma - A member of the AstraZeneca Group, Bayer HealthCare Pharmaceuticals.: Other; Kite Pharmaceuticals: Research Funding; Portola Pharmaceuticals: Consultancy.
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Kwon, Soonil, So-Ryoung Lee, Eue-Keun Choi, Hyo-Jeong Ahn, Hee-Seok Song, Young-Shin Lee, and Seil Oh. "Validation of Adhesive Single-Lead ECG Device Compared with Holter Monitoring among Non-Atrial Fibrillation Patients." Sensors 21, no. 9 (April 30, 2021): 3122. http://dx.doi.org/10.3390/s21093122.
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There are few reports on head-to-head comparisons of electrocardiogram (ECG) monitoring between adhesive single-lead and Holter devices for arrhythmias other than atrial fibrillation (AF). This study aimed to compare 24 h ECG monitoring between the two devices in patients with general arrhythmia. Twenty-nine non-AF patients with a workup of pre-diagnosed arrhythmias or suspicious arrhythmic episodes were evaluated. Each participant wore both devices simultaneously, and the cardiac rhythm was monitored for 24 h. Selective ECG parameters were compared between the two devices. Two cardiologists independently compared the diagnoses of each device. The two most frequent monitoring indications were workup of premature atrial contractions (41.4%) and suspicious arrhythmia-related symptoms (37.9%). The single-lead device had a higher noise burden than the Holter device (0.04 ± 0.05% vs. 0.01 ± 0.01%, p = 0.024). The number of total QRS complexes, ventricular ectopic beats, and supraventricular ectopic beats showed an excellent degree of agreement between the two devices (intraclass correlation coefficients = 0.991, 1.000, and 0.987, respectively). In addition, the minimum/average/maximum heart rates showed an excellent degree of agreement. The two cardiologists made coherent diagnoses for all 29 participants using both monitoring methods. In conclusion, the single-lead adhesive device could be an acceptable alternative for ambulatory ECG monitoring in patients with general arrhythmia.
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von Sanden, Felix, Svetlana Ptushkina, Julia Hock, Celina Fritz, Jürgen Hörer, Gabriele Hessling, Peter Ewert, Alfred Hager, and Cordula M. Wolf. "Peak Oxygen Uptake on Cardiopulmonary Exercise Test Is a Predictor for Severe Arrhythmic Events during Three-Year Follow-Up in Patients with Complex Congenital Heart Disease." Journal of Cardiovascular Development and Disease 9, no. 7 (July 4, 2022): 215. http://dx.doi.org/10.3390/jcdd9070215.
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Patients with congenital heart disease (CHD) are at increased risk for severe arrhythmia and sudden cardiac death (SCD). Although implantable cardioverter defibrillators (ICD) effectively prevent SCD, risk stratification for primary prophylaxis in patients with CHD remains challenging. Patients with complex CHD undergoing CPET were included in this single-center study. Univariable and backwards stepwise multivariable logistic regression models were used to identify variables associated with the endpoint of severe arrhythmic event during three years of follow-up. Cut-off values were established with receiver operating characteristic (ROC) curve analysis. Survival analysis was conducted via Kaplan–Meier plots. Severe Arrhythmia was documented in 97 of 1194 patients (8.1%/3 years). Independent risk factors for severe arrhythmia during follow-up were old age and a low peak oxygen uptake (V.O2peak) on multivariable analysis. Patients with more advanced age and with V.O2peak values of less than 24.9 mL/min/kg were at significantly increased risk for the occurrence of severe arrhythmias during follow-up. The combined analysis of both risk factors yielded an additional benefit for risk assessment. Age at CPET and V.O2peak predict the risk for severe arrhythmic events and should be considered for risk stratification of SCD in patients with complex CHD.
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Zhu, Yujie, Isaac Shamblin, Efrain Rodriguez, Grace E. Salzer, Lita Araysi, Katherine A. Margolies, Ganesh V. Halade, et al. "Progressive cardiac arrhythmias and ECG abnormalities in the Huntington’s disease BACHD mouse model." Human Molecular Genetics 29, no. 3 (December 9, 2019): 369–81. http://dx.doi.org/10.1093/hmg/ddz295.
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Abstract Huntington’s disease (HD) is a dominantly inherited neurodegenerative disease. There is accumulating evidence that HD patients have increased prevalence of conduction abnormalities and compromised sinoatrial node function which could lead to increased risk for arrhythmia. We used mutant Huntingtin (mHTT) expressing bacterial artificial chromosome Huntington’s disease mice to determine if they exhibit electrocardiogram (ECG) abnormalities involving cardiac conduction that are known to increase risk of sudden arrhythmic death in humans. We obtained surface ECGs and analyzed arrhythmia susceptibility; we observed prolonged QRS duration, increases in PVCs as well as PACs. Abnormal histological and structural changes that could lead to cardiac conduction system dysfunction were seen. Finally, we observed decreases in desmosomal proteins, plakophilin-2 and desmoglein-2, which have been reported to cause cardiac arrhythmias and reduced conduction. Our study indicates that mHTT could cause progressive cardiac conduction system pathology that could increase the susceptibility to arrhythmias and sudden cardiac death in HD patients.
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Graham, George M. "Evaluation of Fetal Arrhythmias." Donald School Journal of Ultrasound in Obstetrics and Gynecology 4, no. 1 (2010): 51–57. http://dx.doi.org/10.5005/jp-journals-10009-1129.
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Abstract Fetal arrhythmias are not uncommon. The diagnosis of a fetal arrhythmia is challenging and normally requires referral for a detailed fetal echocardiogram. The first step in the ultrasound evaluation should be distinguishing whether the arrhythmia is an irregular rhythm, a bradycardia, or a tachycardia. This can be done by evaluating the arrhythmia using simultaneous atrial and ventricular M-mode or pulsed Doppler. Although the majority of fetal arrhythmias are self-limited and benign, some are potentially life-threatening for the fetus and for these cases a multidisciplinary approach to treatment may be required. Learning Objectives Know the different types of fetal arrhythmias Understand how fetal arrhythmias are diagnosed Know which fetal arrhythmias require treatment
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Abdelhafid, ERRABIH, EDDER Aymane, NSIRI Benayad, SADIQ Abdelalim, EL YOUSFI ALAOUI My Hachem, OULAD HAJ THAM Rachid, and BENAJI Brahim. "ECG Arrhythmia Classification Using Convolutional Neural Network." International Journal of Emerging Technology and Advanced Engineering 12, no. 7 (July 9, 2022): 186–95. http://dx.doi.org/10.46338/ijetae0722_19.
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This study provides a thorough analysis of earlier DL techniques used to classify the ECG data. The large variability among individual patients and the high expense of labeling clinical ECG records are the main hurdles in automatically detecting arrhythmia by electrocardiogram (ECG). The classification of electrocardiogram (ECG) arrhythmias using a novel and more effective technique is presented in this research. A high-performance electrocardiogram (ECG)-based arrhythmic beats classification system is described in this research to develop a plan with an autonomous feature learning strategy and an effective optimization mechanism, based on the ECG heartbeat classification approach. We propose a method based on efficient 12-layer, the MIT-BIH Arrhythmia dataset's five micro-classes of heartbeat types and using the wavelet denoising technique. Compared to state-of-the-art approaches, the newly presented strategy enables considerable accuracy increase with quicker online retraining and less professional involvement.
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Deal, Barbara J., Constantine Mavroudis, Jeffrey Phillip Jacobs, Melanie Gevitz, and Carl Lewis Backer. "Arrhythmic complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease." Cardiology in the Young 18, S2 (December 2008): 202–5. http://dx.doi.org/10.1017/s104795110800293x.
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AbstractA detailed hierarchal nomenclature of arrhythmias is offered with definition of its applications to diagnosis and complications. The conceptual and organizational approach to discussion of arrhythmias employs the following sequence: location – mechanism – aetiology – duration. The classification of arrhythmias is heuristically divided into an anatomical hierarchy: atrial, junctional, ventricular, or atrioventricular. Mechanisms are most simplistically classified as either reentrant, such as macro-reentrant atrial tachycardia, previously described as atrial flutter, or focal, such as automatic or micro-reentrant tachycardia, for example, junctional ectopic tachycardia. The aetiology of arrhythmias can be either iatrogenic, such as postsurgical, or non-iatrogenic, such as genetic or congenital, and in many cases is multi-factorial. Assigning an aetiology to an arrhythmia is distinct from understanding the mechanism of the arrhythmia, yet assignment of a possible aetiology of an arrhythmia may have important therapeutic implications in certain clinical settings. For example, postoperative atrial arrhythmias in patients after cardiac transplantation may be harbingers of rejection or consequent to remediable imbalances of electrolytes. The duration, frequency of, and time to occurrence of arrhythmia are temporal measures that further refine arrhythmia definition, and may offer insight into ascription of aetiology. Finally, arrhythmias do not occur in a void, but interact with other organ systems. Arrhythmias not only can result from perturbations of other organ systems, such as renal failure, but can produce dysfunction in other organ systems due to haemodynamic compromise or embolic phenomena.
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Harkness, Weston, Paula Watts, Michael Kopstein, Oliwier Dziadkowiec, Gregory Hicks, and Dmitriy Scherbak. "Correcting Hypokalemia in Hospitalized Patients Does Not Decrease Risk of Cardiac Arrhythmias." Advances in Medicine 2019 (September 24, 2019): 1–4. http://dx.doi.org/10.1155/2019/4919707.
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Background. It is currently standard practice to correct hypokalemia for the purpose of preventing cardiac arrhythmias in all hospitalized patients. However, the efficacy of this intervention has never been previously studied. Objective. The objective of our study was to evaluate whether patients without acute coronary syndrome or history of arrhythmias were at increased risk of clinically significant cardiac arrhythmias if their potassium level was not corrected to ≥3.5 mEq/L. Design. A retrospective case control study. Setting. A community hospital. Participants. We enrolled selected patients who had episodes of hypokalemia during their hospital stay and were monitored on telemetry. Patients were split into groups based on success of replacing serum potassium to ≥3.5 mEq/L after 24 hours. Measurements. The primary outcome was the development of an arrhythmia. Arrhythmias included supraventricular tachycardia, atrial fibrillation, atrial flutter, Mobitz type II second-degree or third-degree AV block, ventricular tachycardia, or ventricular fibrillation. A one-tailed Fisher’s exact test and logistic regression were used for analysis. Results. A total of 1338 hypokalemic patient days were recorded. Out of these days, 22 arrhythmia events (1.6% of patient days) were observed, 8 in the uncorrected group (1% patient days) and 14 in the corrected group (2.6% patient days). We found no statistically significant relationship between successfully correcting potassium to ≥3.5 mEq/L and number of arrhythmic events (p=0.037, OR = 2.38 (95% CI: 0.99, 6.03)). Logistic regression revealed that correction of potassium does not seem to be significantly related to arrhythmias (β = 0.869, p=0.0517). Conclusions. In the acute care setting, we found that patients with hypokalemia whose potassium level did not correct to ≥3.5 mEq/L were not at increased odds of having an arrhythmia. This study suggests that the common practice of checking and replacing potassium is likely inconsequential.
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Wagner, Michael, Mirna S. Sadek, Nataliya Dybkova, Fleur E. Mason, Johann Klehr, Rebecca Firneburg, Eleder Cachorro, et al. "Cellular Mechanisms of the Anti-Arrhythmic Effect of Cardiac PDE2 Overexpression." International Journal of Molecular Sciences 22, no. 9 (May 1, 2021): 4816. http://dx.doi.org/10.3390/ijms22094816.
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Background: Phosphodiesterases (PDE) critically regulate myocardial cAMP and cGMP levels. PDE2 is stimulated by cGMP to hydrolyze cAMP, mediating a negative crosstalk between both pathways. PDE2 upregulation in heart failure contributes to desensitization to β-adrenergic overstimulation. After isoprenaline (ISO) injections, PDE2 overexpressing mice (PDE2 OE) were protected against ventricular arrhythmia. Here, we investigate the mechanisms underlying the effects of PDE2 OE on susceptibility to arrhythmias. Methods: Cellular arrhythmia, ion currents, and Ca2+-sparks were assessed in ventricular cardiomyocytes from PDE2 OE and WT littermates. Results: Under basal conditions, action potential (AP) morphology were similar in PDE2 OE and WT. ISO stimulation significantly increased the incidence of afterdepolarizations and spontaneous APs in WT, which was markedly reduced in PDE2 OE. The ISO-induced increase in ICaL seen in WT was prevented in PDE2 OE. Moreover, the ISO-induced, Epac- and CaMKII-dependent increase in INaL and Ca2+-spark frequency was blunted in PDE2 OE, while the effect of direct Epac activation was similar in both groups. Finally, PDE2 inhibition facilitated arrhythmic events in ex vivo perfused WT hearts after reperfusion injury. Conclusion: Higher PDE2 abundance protects against ISO-induced cardiac arrhythmia by preventing the Epac- and CaMKII-mediated increases of cellular triggers. Thus, activating myocardial PDE2 may represent a novel intracellular anti-arrhythmic therapeutic strategy in HF.
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Gausz, Flora Diana, Kom Nangob Manuela Lena, Paul Emmanuel Gedeon, Marton Miklos, Attila Benak, Gabor Bencsik, Attila Makai, et al. "Arrhythmia Detection in Atrioventricular, Single-Lead, Floating Atrial Dipole ICD Systems Compared with Conventional Single- and Dual-Chamber Defibrillators." Journal of Cardiovascular Development and Disease 11, no. 12 (December 1, 2024): 386. https://doi.org/10.3390/jcdd11120386.
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Background: An atrioventricular defibrillator system with a floating atrial dipole (VDD ICD) can provide atrial sensing by a single lead. Our aim was to compare the arrhythmia detection efficacy of VDD ICDs with conventional single- (VVI) and dual-chamber (DDD) defibrillators. Methods: Data from consecutive patients undergoing ICD implantation were retrospectively analyzed. The primary endpoint was the incidence of device-detected, new-onset atrial arrhythmias, while secondary endpoints were sensing parameters, complication rates, incidence of appropriate/inappropriate ICD therapy, arrhythmic/heart failure-related hospitalizations, and all-cause mortality. Results: A total of 256 patients (mean age 64 ± 12 years, male 75%, primary prophylaxis 28%, mean follow-up 3.7 ± 2.4 years) were included (VVI: 93, VDD: 94, DDD: 69). Atrial arrhythmia episodes were detected more frequently by VDD systems compared to VVI ICDs (aHR 7.087; 95% CI 2.371–21.183; p < 0.001), and at a rate similar to that of DDD ICDs (aHR 1.781; 95% CI 0.737–4.301; p = 0.200). The rate of inappropriate shocks was not different among the three ICD systems. Conclusion: VDD devices revealed an advantage in atrial arrhythmia detection compared to VVI ICDs and were non-inferior to DDD systems. Their main indication may be closer monitoring in high-risk patients with atrial arrhythmias to help therapy optimization and not the improvement of tachycardia discrimination.
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Xu, Gang, Guangxin Xing, Juanjuan Jiang, Jian Jiang, and Yongsheng Ke. "Arrhythmia Detection Using Gated Recurrent Unit Network with ECG Signals." Journal of Medical Imaging and Health Informatics 10, no. 3 (March 1, 2020): 750–57. http://dx.doi.org/10.1166/jmihi.2020.2928.
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Background: Arrhythmia is a kind of heart disorder characterized by irregular heartbeats which can be detected with Electrocardiographic (ECG) signals. Accurate and early detection along with differentiation of arrhythmias is of great importance in a clinical setting. However, visual analysis of ECG signal is a challenging and timeconsuming work. We have developed an automatic arrhythmia detection model with deep learning framework to expedite the diagnosis of arrhythmia with a high degree of accuracy. Methods: We proposed a novel automatic arrhythmia detection model utilizing a combination of 1D convolutional neural network (1D-CNN) and Gated Recurrent Unit (GRU) network for the diagnosis of five different arrhythmia on ECG signals taken from the MITBIT arrhythmia physio bank database. Results: The proposed system showed a high classification performance in handling variable length ECG signal data, achieving an accuracy rate of 99.45%, sensitivity of 98.35% and specificity of 99.21% and a F1-Score of 98.95% using a five-fold cross validation strategy. Conclusions: Combining 1D-CNN and GRU networks yielded a higher degree of accuracy compared with other deep learning networks. Our proposed arrhythmia detection method may be a powerful tool to aid clinicians in accurately detecting common arrhythmias on routine ECG screening.
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Leren, Ida Skrinde, Jørg Saberniak, Eman Majid, Trine F. Haland, Thor Edvardsen, and Kristina H. Haugaa. "Abstract 9815: Nadolol Seems to Be Superior to Selective Beta Blockers in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia: Is a Smaller Arrhythmic Window Part of the Explanation?" Circulation 132, suppl_3 (November 10, 2015). http://dx.doi.org/10.1161/circ.132.suppl_3.9815.
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Introduction: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inheritable arrhythmogenic disease, and typically presents as syncope or sudden cardiac death during exercise. Beta blockers are first choice therapy but little is known about antiarrhythmic effects of different beta blockers in CPVT. Nadolol has shown superior antiarrhythmic effect in other cardiomyopathies. Hypothesis: We hypothesized that nadolol is superior to selective beta blockers in arrhythmia protection in CPVT patients. Methods: We included 34 CPVT patients (age 34±19 yrs, 44% female, 88% RYR2 mutation positive). We serially performed 2 bicycle exercise tests in each patient; 1)>6 weeks on maximum tolerated dose of selective beta blockers. 2)>6 weeks on maximum tolerated dose of nadolol. We recorded resting and maximum heart rate (HR), HR at first arrhythmia and the most severe arrhythmia occurring. Arrhythmic window was defined as the difference between maximum HR and HR at first arrhythmia. Severity of arrhythmias was scored as arrhythmic score: no arrhythmias (0point), single ventricular extra systoles (1point), bigemini (2points), couplets (3points) and nonsustained VT (4points). Results: Resting HR was similar on nadolol and selective beta blockers (54±10bpm vs. 56±14bpm, p=0.50), while maximum heart rate was lower on nadolol (122±21bpm vs. 139±24bpm, p<0.01). First arrhythmias occurred at similar HR at both exercise tests (113±21bpm vs. 113±19bpm, p=1.0). Consequently, arrhythmic window was smaller during nadolol treatment (17±10bpm vs. 32±26bpm, p=0.03) (Figure) and also the arrhythmic score was lower than on selective beta blockers (1.1±1.2 vs. 2.4±0.9, p<0.01). Conclusion: Arrhythmic score was lower on nadolol compared to selective beta blockers. Also, arrhythmic window, representing the span of heart rates where arrhythmias may occur and progress in severity, was smaller. This suggests that nadolol should be the beta blocker of choice in CPVT patients.
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Dammeyer, Kristen L., Kara S. Motonaga, Henry Chubb, Elizabeth L. Profita, and Seth A. Hollander. "Early Post‐Operative Versus Late Arrhythmias After Heart Transplant at a Pediatric Center: Incidence, Management, and Outcomes." Pediatric Transplantation 29, no. 5 (June 4, 2025). https://doi.org/10.1111/petr.70094.
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ABSTRACTBackgroundArrhythmias in pediatric heart transplant patients have historically raised concerns for acute rejection, often prompting invasive evaluation and empiric treatment. Despite this, the association of post‐transplant arrhythmias with adverse outcomes remains understudied.MethodsThis is a retrospective single center review of pediatric patients who underwent heart transplant between 01/2014 and 12/2022. Arrhythmias were classified as early (</= 14 days post‐transplant) or late (> 14 days post‐transplant) and as atrial, ventricular, or bradyarrhythmias. Adverse outcomes including death, re‐transplantation, acute cellular rejection, acute antibody‐mediated rejection, and cardiac allograft vasculopathy were compared by chi‐squared or Fisher Exact test for those with and without arrhythmias.ResultsAmong 184 patients, 116 (63%) had at least 1 arrhythmia (284 total arrhythmia episodes). Overall, 99 (35%) arrhythmia episodes occurred in the early post‐operative period and 137 (48%) arrhythmia episodes were ventricular. Anti‐arrhythmic therapy was started for 69 (24%) arrhythmia events. There were 42 biopsies prompted by arrhythmia, yielding a new diagnosis of acute cellular rejection in 2 (5%) patients and antibody mediated rejection in 1 (2%) patient. No biopsies prompted by arrhythmia in the early post‐transplant period were positive for rejection. Compared to those without arrhythmia, patients with at least one arrhythmia episode were not at increased risk of cardiac allograft vasculopathy, any post‐transplant rejection, retransplantation, or death (p = 0.26–0.78).ConclusionsPost‐transplant arrhythmias occur commonly in pediatric heart transplant patients but are not clearly associated with rejection or adverse outcomes. Further study in larger patient populations is necessary to better understand the significance of post‐transplant arrhythmias.
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Senarath, Sachintha, Pavitra Nanayakkara, Anna L. Beale, Monique Watts, David M. Kaye, and Shane Nanayakkara. "Diagnosis and management of arrhythmias in pregnancy." EP Europace, December 14, 2021. http://dx.doi.org/10.1093/europace/euab297.
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Abstract Arrhythmias are the most common cardiac complications occurring in pregnancy. Although the majority of palpitations in pregnancy may be explained by atrial or ventricular premature complexes, the full spectrum of arrhythmias can occur. In this article, we establish a systematic approach to the evaluation and management of arrhythmias in pregnancy. Haemodynamically unstable arrhythmias warrant urgent cardioversion. For mild cases of benign arrhythmia, treatment is usually not needed. Symptomatic but haemodynamically stable arrhythmic patients should first undergo a thorough evaluation to establish the type of arrhythmia and the presence or absence of structural heart disease. This will ultimately determine the necessity for treatment given the potential risks of anti-arrhythmic pharmacotherapy in pregnancy. We will discuss the main catalogue of anti-arrhythmic medications, which have some established evidence of safety in pregnancy. Based on our appraisal, we provide a treatment algorithm for the tachyarrhythmic pregnant patient.
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Smoczyńska, Agnieszka, Vera Loen, David J. Sprenkeler, Anton E. Tuinenburg, Henk J. Ritsema van Eck, Marek Malik, Georg Schmidt, Mathias Meine, and Marc A. Vos. "Short‐Term Variability of the QT Interval Can be Used for the Prediction of Imminent Ventricular Arrhythmias in Patients With Primary Prophylactic Implantable Cardioverter Defibrillators." Journal of the American Heart Association 9, no. 23 (December 2020). http://dx.doi.org/10.1161/jaha.120.018133.
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Background Short‐term variability of the QT interval (STV QT ) has been proposed as a novel electrophysiological marker for the prediction of imminent ventricular arrhythmias in animal models. Our aim is to study whether STV QT can predict imminent ventricular arrhythmias in patients. Methods and Results In 2331 patients with primary prophylactic implantable cardioverter defibrillators, 24‐hour ECG Holter recordings were obtained as part of the EU‐CERT‐ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter Defibrillators) study. ECG Holter recordings showing ventricular arrhythmias of >4 consecutive complexes were selected for the arrhythmic groups (n=170), whereas a control group was randomly selected from the remaining Holter recordings (n=37). STV QT was determined from 31 beats with fiducial segment averaging and calculated as , where D n represents the QT interval. STV QT was determined before the ventricular arrhythmia or 8:00 am in the control group and between 1:30 and 4:30 am as baseline. STV QT at baseline was 0.84±0.47 ms and increased to 1.18±0.74 ms ( P <0.05) before the ventricular arrhythmia, whereas the STV QT in the control group remained unchanged. The arrhythmic patients were divided into three groups based on the severity of the arrhythmia: (1) nonsustained ventricular arrhythmia (n=32), (2) nonsustained ventricular tachycardia (n=134), (3) sustained ventricular tachycardia (n=4). STV QT increased before nonsustained ventricular arrhythmia, nonsustained ventricular tachycardia, and sustained ventricular tachycardia from 0.80±0.43 ms to 1.18±0.78 ms ( P <0.05), from 0.90±0.49 ms to 1.14±0.70 ms ( P <0.05), and from 1.05±0.22 ms to 2.33±1.25 ms ( P <0.05). This rise in STV QT was significantly higher in sustained ventricular tachycardia compared with nonsustained ventricular arrhythmia (+1.28±1.05 ms versus +0.24±0.57 ms [ P <0.05]) and compared with nonsustained ventricular arrhythmia (+0.34±0.87 ms [ P <0.05]). Conclusions STV QT increases before imminent ventricular arrhythmias in patients, and the extent of the increase is associated with the severity of the ventricular arrhythmia.
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Zalavadia, Dipen, Srija Shanker, Ashish Nepal, Bushra Fatima, Tanvi Singla, Aamer R. Mohammad, Deepu Joseph, Sonali Sachdeva, and Rupak Desai. "Abstract 10109: High Prevalence and Significant Impact of Arrhythmias on Healthcare Resource Utilization in Hospitalizations of Patients with Prior (corrected) Congenital Heart/Circulatory Disease." Circulation 144, Suppl_1 (November 16, 2021). http://dx.doi.org/10.1161/circ.144.suppl_1.10109.
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Introduction: Even after surgical correction, adults with a previously corrected Congenital Heart Disease (CHD) may remain at a significantly elevated risk of arrhythmias. However, there is not much known about the prevalence, comorbidity burden, and impact of arrhythmia in these patients. Methods: Using the National Inpatient Sample (2015 Oct-2017), adult admissions with previously corrected CHD were identified. The primary outcome was the prevalence of arrhythmia and secondary outcomes included comorbidities and outcomes between the arrhythmic vs. non-arrhythmic cohort. Results: Of 19,395 admissions with previously corrected CHD, 7675 (39.6%) patients experienced arrhythmias [median age 55 (39-68) years, male 51.7%, white 75%] (Table 1). The arrhythmic cohort often consisted of relatively older, male, white patients and had higher rates of hypertension (56.4% vs. 41%), hyperlipidemia (33.1% vs. 23%), diabetes (9% vs. 6.5%), renal failure (14% vs. 7.8%), and congestive heart failure (17.6% vs. 9.2%) compared to the non-arrhythmic cohort. The arrhythmic cohort had a higher frequency of patients with at least one CVD risk factor (75.5% vs. 65.4%). All-cause mortality was non-significantly higher in the cohort with arrhythmia (1.6% vs. 1.3%). Furthermore, the arrhythmic cohort was less often routinely discharged and had more frequent transfers/home healthcare requirements, prolonged hospital stay, and higher hospital charges. Conclusions: Nearly 40% of admissions among patients with a prior history of surgically corrected CHD experienced arrhythmias which were associated with a considerably higher comorbidity burden and healthcare resource utilization with non-significantly higher all-cause mortality.
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Sherazi, Saadia, Susan Schleede, Scott McNitt, Carla Casulo, Jeremiah E. Moore, Eugene Storozynsky, Arpan Patel, et al. "Arrhythmogenic Cardiotoxicity Associated With Contemporary Treatments of Lymphoproliferative Disorders." Journal of the American Heart Association, March 9, 2023. http://dx.doi.org/10.1161/jaha.122.025786.
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Background There are limited data on risk of arrhythmias among patients with lymphoproliferative disorders. We designed this study to determine the risk of atrial and ventricular arrhythmia during treatment of lymphoma in a real‐world setting. Methods and Results The study population comprised 2064 patients included in the University of Rochester Medical Center Lymphoma Database from January 2013 to August 2019. Cardiac arrhythmias—atrial fibrillation/flutter, supraventricular tachycardia, ventricular arrhythmia, and bradyarrhythmia—were identified using International Classification of Diseases, Tenth Revision ( ICD‐10 ) codes. Multivariate Cox regression analysis was used to assess the risk of arrhythmic events with treatments categorized as Bruton tyrosine kinase inhibitor (BTKi), mainly ibrutinib/non‐BTKi treatment versus no treatment. Median age was 64 (54–72) years, and 42% were women. The overall rate of any arrhythmia at 5 years following the initiation of BTKi was (61%) compared with (18%) without treatment. Atrial fibrillation/flutter was the most common type of arrhythmia accounting for 41%. Multivariate analysis showed that BTKi treatment was associated with a 4.3‐fold ( P <0.001) increased risk for arrhythmic event ( P <0.001) compared with no treatment, whereas non‐BTKi treatment was associated with a 2‐fold ( P <0.001) risk increase. Among subgroups, patients without a history of prior arrhythmia exhibited a pronounced increase in the risk for the development of arrhythmogenic cardiotoxicity (3.2‐fold; P <0.001). Conclusions Our study identifies a high burden of arrhythmic events after initiation of treatment, which is most pronounced among patients treated with the BTKi ibrutinib. Patients undergoing treatments for lymphoma may benefit from prospective focused cardiovascular monitoring prior, during, and after treatment regardless of arrhythmia history.
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Yinadsawaphan, Thanaboon, Mustafa Suppah, Srekar N. Ravi, JUAN FARINA, Robert L. Scott, and Dan Sorajja. "Abstract 14098: Epidemiology and Clinical Outcomes of Cardiac Arrhythmias in Pulmonary Arterial Hypertension." Circulation 148, Suppl_1 (November 7, 2023). http://dx.doi.org/10.1161/circ.148.suppl_1.14098.
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Background: There is limited evidence regarding the impact of cardiac arrhythmias in patients with pulmonary arterial hypertension (PAH). We aim to comprehensively investigate the epidemiology and clinical outcomes of cardiac arrhythmias in patients with PAH. Methods: In a retrospective cohort study including 512 PAH patients from 2001-2021 at 3 Mayo Clinic sites, PAH patients were identified via echocardiogram, pulmonary function tests, and right heart catheterization. Demographic data at PAH diagnosis and clinical outcomes over a 10-year period were collected. The PAH patients were categorized into three groups based on arrhythmic onset: 1) patients with arrhythmia prior to PAH diagnosis, 2) patients diagnosed with arrhythmia during 10-year PAH follow-up, and 3) patients without arrhythmia during 10-year PAH follow-up. Survival outcomes were analyzed using multivariable Cox proportional hazards regression, adjusted with the REVEAL 2.0 score. Results: Among 512 PAH patients (mean age 56.1 years, 81.8% female), the prevalence of cardiac arrhythmias at PAH diagnosis was 10.5%. The cumulative incidences of new-onset arrhythmias at 1, 5, and 10 years were 6.6%, 18.4%, and 29.2%, respectively. Patients with arrhythmia diagnosed before and after PAH diagnosis showed significantly higher all-cause mortality rates with adjusted HR of 2.06 [95% CI 1.36-3.12] and 1.57 [95% CI 1.17-2.20] respectively (Figure 1). Similarly in both arrhythmic groups, there was a shorter median time to the first all-cause hospitalization (9.5 and 15.9 months vs. 21.2 months) and a higher number of all-cause hospitalizations (0.38 and 0.64 times per year vs. 0.10 times per year) compared to the non-arrhythmic group. Conclusions: Cardiac arrhythmias can develop in nearly one-third of PAH patients within 10 years of PAH diagnosis and independently contribute to increased mortality and hospitalization frequency.