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Objective:To investigate the efficacy of trimetazidine in the treatment of atrial arrhythmias in patients with ischemic cardiomyopathy and heart failure and analyze the effect of trimetazidine on cardiac function and atrial arrhythmias.Methods:A total of 79 patients with ischemic cardiomyopathy and heart failure who received treatment at the Second Hospital of Jiaxing from December 2018 to June 2020 were included in this study. These patients were randomly divided into an observation group ( n = 41) and a control group ( n = 38). Patients in the control group received conventional drugs, while those in the observation group received trimetazidine sustained-release tablets twice daily, each time taking 35 mg in addition to conventional drugs. The treatment lasted for 24 weeks. Before and after treatment, cardiac function indicators (left ventricular ejection fraction, B-type brain natriuretic peptide, 6-minute walking distance), cardiac color Doppler ultrasound indicators [ratio of early to late peak filling rate (E/A ratio)], left ventricular fractional shortening), electrocardiogram parameters (maximum P-wave duration, minimum P-wave duration, and P-wave dispersion), dynamic electrocardiogram parameters [number of single atrial premature beats, total number and duration of paroxysmal atrial tachycardia episodes, total number and duration of paroxysmal atrial flutter/fibrillation attacks, standard deviation of RR intervals, root mean square of successive differences between normal heartbeats, proportion of successive RR intervals that differ by more than 50 ms divided by the total number of NN intervals (PNN50), standard deviation of average NN intervals, high frequency and low frequency], as well as changes in high sensitivity C-reactive protein were analyzed in each group. Results:After treatment, left ventricular ejection fraction, B-type brain natriuretic peptide, 6-minute walking distance, maximum P-wave duration, P-wave dispersion, total number of atrial flutter/atrial fibrillation attacks, and duration of atrial flutter/atrial fibrillation in the observation group were (51.05 ± 7.68)%, (1 615.59 ± 1 129.78) ng/L, (350.02 ± 62.99) m, (99.73 ± 11.60) ms, (22.44 ± 12.03) ms, (0.22 ± 0.61), and (4.59 ± 12.30) minutes, respectively, which were significantly superior to (46.82 ± 7.34)%, (2 267.47 ± 1 539.03) ng/L, (294.16 ± 58.20) m, (111.71 ± 10.00) ms, (36.77 ± 15.07) ms, (0.76 ± 1.13), (15.66 ± 22.30) minutes in the control group, t = -2.95, 2.16, -4.08, 4.89, 4.68, 2.69, 2.76, all P < 0.01). Conclusion:Trimetazidine can effectively reduce atrial arrhythmias and improve the prognosis of patients with ischemic cardiomyopathy and heart failure, which warrants clinical promotion.
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Objective To investigate the efficacy of dronedarone combined with low dose metoprol-ol in the treatment of atrial tachycardia.Methods A total of 175 elderly patients with atrial tachy-cardia admitted in Northern Jiangsu People's Hospital during January 2020 to January 2022 were enrolled and then randomly divided into dronedarone group(n=57),metoprolol group(n=55)and combined group(dronedarone+metoprolol,n=48).The frequency,duration and symptom changes of arrhythmia were compared before and after treatment.Results After 3 and 6 months of administration,the total effective rate was significantly higher in the combination group than the dronedarone group and the metoprolol group(P＜0.05).The frequency of atrial fibrillation(AF)attacks[(2.31±1.78)/48 h vs(11.56±18.68)/48 h],AF duration[(4.86±6.73)h/48 h vs(10.92±9.61)h/48 h],atrial flutter(AFL)attacks[(2.33±1.53)/48 h vs(4.33±1.53)/48 h]and AFL duration[(5.15±4.87)h/48 h vs(21.54±20.08)h/48 h]in the combined group,and AFL duration[(2.75±1.94)h/48 h vs(10.29±8.04)h/48 h]in the dronedarone group were reduced after 6 months of treatment(P＜0.05).Conclusion In the treatment of atrial tachycardia,dronedarone combined with low dose metoprolol can not only obviously improve symptoms,but also significantly reduce the atrial premature and atrial tachycardia attacks,decrease the number and duration of AF and AFL attacks,and control heart rate effectively.
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Abstract Background: Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system, while the most common extrapulmonary complication of COVID-19 is cardiovascular involvement. Objective: To identify the frequency of electrocardiographic changes and cardiac arrhythmias in patients hospitalized with COVID-19 infection. Methods: This was a cross-sectional study, including patients aged >18 years with diagnosis of severe acute respiratory syndrome coronavirus 2 infection in a high-complexity hospital in Santiago de Cali, Colombia, from March to September 2020. A descriptive analysis with an analytical component and multiple logistic regression analysis were performed; all estimates were established with a 95% confidence level (CI) and a 5% significance level. Results: This study included 183 individuals; of whom 160 were considered for electrocardiographic analysis, 63% of which evidenced significant findings, the most frequent being sinus tachycardia (29.4%). The frequency of myocardial injury was 21.9% and was more common among non-survivors than among survivors (41.7% vs. 12.2%, p < 0.001). Myocardial injury was also significantly more common in patients who presented electrocardiographic findings than those who did not (26.5% vs. 12.1%, p = 0.032) and in those who required intensive care admission (31.8% vs 10.5%, p < 0.001). The strongest mortality-associated factor was the need for mechanical ventilation — odds ratio (OR), 9.14; 95% confidence interval, 3.4-24.5. Conclusions: Electrocardiographic findings in patients with COVID 19 are frequent, including newly diagnosed arrhythmias, justifying the use of cost-effective tools for the initial approach and follow-up of this affected population. Worse outcomes depend on factors such as invasive mechanical ventilation, comorbidities, age, and superinfection.
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Objective To explore the regulatory effect of miR-26b-5p on PI3K/PIP3 signaling path-way and its effect on L-type calcium channel of atrial cardiomyocytes in rats with ischemic ar-rhythmia.Methods A total of 72 SD rats were randomly divided into sham operation group,mod-el group,LY294002 group,negative control group,overexpression group and combination group,with 12 rats in each group.In 24 h after corresponding intervention,rat model of ischemic arrhyth-mia was established in the other groups except the sham operation group(only thoracotomy but without ligation).During the modeling process,arrhythmia indexes were detected in each group,and Curtis-Walker scoring was used for arrhythmia score.Fluorescence quantitative PCR was em-ployed to detect the expression of miR-26b-5p in atrial myocardiocytes,whole-cell patch-clamp technique was used to record the ICa-L of atrial myocardiocytes,and Western blotting was applied to measure the expression of CACNA1C,calmodulin and PI3K/PIP3 pathway related proteins.Re-sults Compared with the model group,the number of left ventricular preventricular contrac-tions,duration of ventricular tachycardia,duration of ventricular fibrillation,arrhythmia score,ab-solute value of ICa-L peak density of atrial myocardiocytes,and expression levels of CACNA1C and calmodulin were significantly increased,and the levels of miR-26b-5p,p-PI3K,PIP3 and p-Akt were obviously decreased in the LY294002 group(P＜0.05).While the overexpression group had decreased number of left ventricular preventricular contractions,shorter duration of ventricular tachycardia,shorter duration of ventricular fibrillation,lower arrhythmia score,reduced absolute value of ICa-L peak density,and lower expression levels of CACNA1C and calmodulin,and in-creased levels of miR-26b-5p,p-PI3K,PIP3 and p-Akt than the model group(P＜0.05).The number of left ventricular preventricular contractions,duration of ventricular tachycardia,dura-tion of ventricular fibrillation,arrhythmia score,absolute value of ICa-L peak density and expres-sion levels of CACNA1C and calmodulin were significantly increased,and the expression of p-PI3K,PIP3 and p-Akt were obviously decreased(0.82±0.08 vs 1.09±0.11,0.91±0.09 vs 1.17± 0.11,0.94±0.09 vs 1.20±0.12,P＜0.05)in the combination group than the overexpression group.Conclusion Overexpression of miR-26b-5p may block the L-type calcium channel in atrial myocardiocytes in ischemic arrhythmia rats by activating PI3K/PIP3 related signaling pathway,and thus improve the performance of arrhythmia in rats.
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Objective:To summarize the arrhythmic characteristics, clinical course, and prognosis of chaotic atrial tachycardia (CAT) in neonates.Methods:The researchers retrospectively analyzed and described the clinical data obtained from 30 neonates diagnosed with CAT and treated at the Maternal and Child Health Hospital of Hubei Province from January 2019 to August 2022. Prenatal and postnatal data were collected to analyze the electrocardiogram characteristics, clinical manifestations, treatment, and prognosis of CAT. Statistical analysis was performed using Mann-Whitney U and Chi-square (or Fisher's exact) tests. Results:(1) Among the 30 newborns with CAT, 19 were male infants (63%). The diagnosis age [ M(min-max)] was 11 days (1-28 days). Among them, 20 (67%) were born with full term, six (20%) had low birth weight, and 15 (50%) had abnormal cardiac structures. (2) The incidence of postnatal complex arrhythmias (coexisting with atrial fibrillation, flutter, supraventricular tachycardia, etc.) in fetuses with abnormalities, including fetal arrhythmias and fetal distress, was higher than those without abnormalities (9/14 vs 3/16, Fisher's exact, P=0.024). The median maximum atrial rate in incessant-type CAT patients (8 cases) was higher than that of paroxysmal-type CAT patients (22 cases) [400 bpm (300-700 bpm) vs 300 bpm (200-460 bpm), Z=－2.41, P=0.02]. There was no statistically significant difference in the maximum ventricular rate between the two groups [250 bpm (190-350 bpm) vs 270 bpm (180-350 bpm), Z=－0.26, P=0.800]. There were 19 cases (63%) complicated with diseases that seriously affected the respiratory or circulatory system, or infectious diseases. (3) Antiarrhythmic drugs were used in 23 cases (77%), including six cases treated with one drug, 12 cases with two drugs, and five cases with more than two drugs, mainly propafenone (20 cases, 67%). Seven cases (23%) with no complex arrhythmia turned to normal rhythm spontaneously without using antiarrhythmic drugs. Among all cases, 16 (53%) achieved clinical cures after complete cardioversion during hospitalization, while 14 cases (47%) were not cured. (4) The children who were cured during hospitalization were followed up for 1.5 months (2 weeks to 8 months) after discharge, and no recurrence was observed, indicating good growth and development. Untreated patients were followed up for 1.9 years (3.5 months to 4.4 years), of which seven cases completely recovered within six months, and the other seven cases continued to recur. However, no adverse outcomes, such as death, occurred. Conclusions:The overall prognosis of neonatal CAT is favorable. A history of fetal arrhythmia and intrauterine distress may increase the risk of CAT. Active drug treatment should be considered for children of CAT with complex arrhythmia.
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Objective:To investigate risk factors of arrhythmia in elderly patients with early lung cancer after thoracoscopic pulmonary resection to construct a prediction model.Methods:Two hundreds and twenty elderly patients with early lung cancer after thoracoscopic pulmonary resection were retrospectively chosen in the period from January 2017 to January 2023 in Guang'an People's Hospital of Sichuan Province. The occurrence of arrhythmia was calculated, and the clinical data of patients with arrhythmia and those without arrhythmia were compared. Logistic regression was employeed to analyze the independent influencing factors of arrhythmia in elderly patients with early lung cancer after thoracoscopic pneumonectomy. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of regression model on arrhythmia after thoracoscopic pneumonectomy in elderly patients with early lung cancer.Results:Forty-one of 220 (18.64%) elderly patients with early lung cancer treated by thoracoscopic pneumonectomy had arrhythmia. There were statistically significant differences between patients with arrhythmia and patients without arrhythmia in age ( χ2=17.76, P<0.001), combined with essential hypertension ( χ2=21.06, P<0.001), forced expiratory volume in one second as a percentage of predicted value (FEV 1%) ( χ2=17.88, P<0.001), left atrium anterior-and-posterior diameter ( χ2=37.82, P<0.001), operation type ( χ2=27.09, P<0.001) and postoperative constipation ( χ2=18.25, P<0.001). The results of multivariate analysis showed that age>75 years old ( OR=22.17, 95% CI: 3.78-130.11, P=0.001), combined with essential hypertension ( OR=26.55, 95% CI: 3.99-176.95, P=0.001), FEV 1%≤70% ( OR=6.20, 95% CI: 1.37-28.11, P=0.018), left atrium anterior-and-posterior diameter>40 mm ( OR=10.84, 95% CI: 2.24-52.45, P=0.003), thoracoscopic lobectomy ( OR=7.07, 95% CI: 1.62-30.80, P=0.009), and postoperative constipation ( OR=79.97, 95% CI: 11.87-538.83, P<0.001) were all independent risk factors for arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer. A prediction model was established for statistically significant indicators in multivariate analysis, ln ( P/1- P) =-7.89+3.10×age+3.28×combined with essential hypertension+1.82×FEV 1%+2.38×left atrium anterior-and-posterior diameter+1.96×operation type+4.38×postoperative constipation ( P was the prediction probability of P value in regression model). ROC curve analysis showed that the area under the curve (AUC) of predict arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer were 0.64, 0.71, 0.68, 0.74, 0.76, 0.87 and 0.98, respectively. The Yoden index was 27.29%, 42.28%, 34.92%, 47.42%, 73.63%, 50.97% and 91.97%, respectively. Conclusion:Age>75 years old, combined with essential hypertension, FEV 1%≤70%, left atrium anterior-and-posterior diameter>40 mm, thoracoscopic lobectomy and postoperative constipation are all independent risk factors for arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer. Nomogram model based on the above risk factors has high efficacy in predicting arrhythmia occurance after thoracoscopic pulmonary resection.
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Objective:To investigate the predictive value of dynamic electrocardiography (ECG) for myocardial ischemia and arrhythmia in patients with coronary heart disease.Methods:A total of 87 patients with coronary heart disease who received treatment in Wenling Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were included in this study. These patients were divided into a conventional ECG group (group A, n = 40) and a dynamic ECG group (group B, n = 47) according to different examination methods. The detection rate of myocardial ischemia in the two groups was determined. The diagnostic efficacy of routine ECG and dynamic ECG for myocardial ischemia was analyzed according to the results of coronary angiography. The detection rate of arrhythmia was determined in each group. Patient satisfaction was compared between the two groups. Results:There was no significant difference in the total detection rate of myocardial ischemia between the two groups ( P = 0.154). The detection rate of asymptomatic myocardial ischemia in group B [25% (25/47)] was significantly higher than that in group A [10% (10/40), χ2 = 5.24, P = 0.020). According to the results of coronary angiography, the detection rates of myocardial ischemia in group A and group B were 68% (27/40) and 87% (41/47), respectively. The sensitivity, specificity, and accuracy of group B in diagnosing myocardial ischemia were 80% (33/41), [67% (4/6), and 74% (35/47), respectively, all of which were significantly higher than 74% (20/27), [46% (6/13), 68% (27/40) in group A ( χ2 = 8.03, 5.89, 5.03, P = 0.003, 0.012, 0.005). The detection rates of premature ventricular contraction in bi-triplet rhythm, frequent paired premature atrial contraction in bi-triplet rhythm, right bundle-branch block, atrioventricular block, supraventricular tachycardia in group B were significantly higher compared with group A ( χ2 = 10.78, P = 0.001). According to the results of coronary angiography, the detection rates of arrhythmia in groups A and B were 65% (26/40) and 79% (37/47), respectively. The sensitivity, specificity, and accuracy of diagnosing arrhythmia in coronary heart disease in group B were 86% (32/37), 40% (4/10), and 81% (38/47), respectively. The sensitivity and accuracy of diagnosing arrhythmia in coronary heart disease in group B were significantly higher than those in group A [58% (15/26), 55% (22/40), χ2 = 7.30, 4.90, P = 0.005, 0.010). Patient satisfaction in group B [87% (41/47)] was significantly higher than that in group A [65% (26/40), χ2 = 6.24, P = 0.044]. Conclusion:Compared with conventional ECG detection, dynamic ECG has substantially higher detection and diagnosis rates of myocardial ischemia and arrhythmia, as well as a higher patient satisfaction rate, in patients with coronary heart disease, in particular in those with asymptomatic myocardial ischemia.
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Objective:To analyze the 24-hour dynamic electrocardiographic changes in middle-aged and older adult patients with cardiovascular disease, providing effective guidance for clinical targeted intervention.Methods:The clinical data of 232 middle-aged and older adult patients who received treatment in Shanxi Coal Central Hospital from April 2019 to April 2021 were retrospectively analyzed. Among these patients, 166 patients with cardiovascular disease aged ≥ 60 years were included in the observation group, and 157 patients with cardiovascular disease aged < 60 years were included in the control group. The 24-hour dynamic electrocardiographic changes were compared between the two groups.Results:The detection rates of atrial arrhythmias, ventricular arrhythmias, sinus arrhythmias, complex ventricular arrhythmias, and complex atrial arrhythmias in the observation group were 96.99%, 88.55%, 28.31%, 39.76%, and 52.41% respectively, which were significantly higher than 50.32%, 50.96%, 8.28%, 9.55%, 8.92% in the control group ( χ2 = 19.21, 28.75, 23.45, 6.90, 8.06, all P < 0.001). The time of myocardial ischemia attack in the observation group [(1.5 ± 0.5) minutes] was significantly shorter than that in the control group [(2.5 ± 0.5) minutes, t = 23.09, P < 0.001)]. The time of myocardial ischemia attack in the observation group was mostly from 0:00 a.m. to 8:00 a.m. Conclusion:Patients aged ≥ 60 years are more likely to develop cardiovascular disease. The risk of cardiovascular diseases increase with increasing age. In particular at 0:00 a.m. to 8:00 a.m., 24-hour dynamic electrocardiographic changes should be monitored to further understand the actual situation of patients and guide clinical effective prevention and treatment of myocardial ischemia.
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Arrhythmias are usually asymptomatic and paroxysma.l Conventional 24h Holter electrocardiogram usually cannot discover all arrhythmia events,so long-term Holter electrocardiogram came into being.Main types of long-term Holter ECG recorders include wearable patch devices and implantable electrocardiogram recorders.Long-term Holter electrocardiogram has been applied to early screening of asymptomatic arrhythmia,etiological screening of cryptogenic ischemic stroke and etiological diagnosis of patients with unexplained syncope etc.The present article makes a review on research progress of long-term Holter electrocardiogram in clinical application in recent years.
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Resumo Fundamento A fibrilação atrial (FA) acomete cerca de 2% a 4% da população mundial. Nos pacientes internados em unidades de terapia intensiva, esta incidência pode chegar em até 23% naqueles com choque séptico. O impacto da FA nos pacientes sépticos se reflete em piores desfechos clínicos e o reconhecimento dos fatores desencadeantes pode ser alvo para estratégias de tratamento e prevenção futuras. Objetivos Verificar a relação entre desenvolvimento de FA e mortalidade nos pacientes acima de 80 anos incluídos no protocolo sepse e identificar fatores de risco que contribuam para o desenvolvimento de FA nesta população. Métodos Estudo observacional retrospectivo, com revisão de prontuários eletrônicos e inclusão de 895 pacientes com 80 anos ou mais, incluídos no protocolo sepse de um hospital privado de alta complexidade em São Paulo/SP, no período de janeiro de 2018 a dezembro de 2020. Todos os testes foram realizados com nível de significância de 5%. Resultados A incidência de FA na amostra foi de 13%. Após análise multivariada por regressão logística múltipla, foi possível demonstrar associação de mortalidade na população estudada, com o escore SOFA ( odds ratio [OR] 1,21 [1,09 - 1,35]), valores mais altos de proteína C-reativa (OR 1,04 [1,01 - 1,06]), necessidade de droga vasoativa (OR 2,4 [1,38 - 4,18]), uso de ventilação mecânica (OR 3,49 [1,82 - 6,71]) e principalmente FA (OR 3,7 [2,16 - 6,31). Conclusões No paciente grande idoso (80 anos ou mais) com sepse, o desenvolvimento de FA se mostrou como fator de risco independente para mortalidade intra-hospitalar.
Abstract Background Atrial fibrillation (AF) affects about 2% to 4% of the world population, and in patients hospitalized in intensive care units, this incidence can reach up to 23% in those with septic shock. The impact of AF in patients with sepsis is reflected in worse clinical outcomes, and the identification of the triggering factors can be a target for future prevention and treatment strategies. Objectives To verify the relationship between the development of AF and mortality in patients over 80 years of age included in the sepsis protocol and to identify the risk factors that contribute to the development of AF in this population. Methods Retrospective observational study, with a review of electronic medical records and inclusion of 895 patients aged 80 years or older, included in the sepsis protocol of a high-complexity private hospital in São Paulo, SP, from January 2018 to December 2020. All tests were performed with a significance level of 5%. Results The incidence of AF in the sample was 13%. After multivariate analysis, using multiple logistic regression, it was possible to demonstrate an association of mortality, in the studied population, with the SOFA score (odds ratio [OR] 1.21 [1.09 - 1.35]), higher values of C-reactive protein (OR 1.04 [1.01 - 1.06]), need for vasoactive drugs (OR 2.4 [1.38 - 4.18]), use of mechanical ventilation (OR 3.49 [1.82 - 6.71]), and mainly AF (OR 3.7 [2.16 - 6.31]) Conclusion In very elderly patients (80 years of age and older) with sepsis, the development of AF was shown to be an independent risk factor for in-hospital mortality.
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A angina vasoespástica é uma causa incomum de parada cardíaca e arritmias ventriculares. No entanto, os sobreviventes dessas complicações têm um risco aumentado de recorrência, apesar da função ventricular normal e do tratamento médico otimizado. Descrevemos o caso de uma ex-tabagista de 50 anos que teve parada cardiorrespiratória secundária a vasoespasmo coronariano grave.
Vasospastic angina is an uncommon cause of cardiac arrest and ventricular arrhythmias. However, survivors of these complications are at an increased risk of recurrence, despite normal ventricular function and optimized medical therapy. We describe a case of a 50-year-old former smoker who developed cardiorespiratory arrest secondary to severe coronary vasospasm.