Prior statin use and the incidence of in-hospital arrhythmia in acute coronary syndrome: A systematic review and meta-analysis

Background: The benefit of prior statin use to reduce the incidence of arrhythmia in acute coronary syndrome (ACS) is still a matter of debate. Statins have multiple pleiotropic effects, which may reduce the incidence of in-hospital arrhythmia. A systematic review and meta-analysis were performed to evaluate prior statin use and the incidence of in-hospital arrhythmia in ACS. Methods: This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We performed a literature search through Pubmed, Proquest, EBSCOhost, and Clinicaltrial.gov. A random-effect model was used due to moderate heterogeneity. Quality assessment was performed using Newcastle Ottawa Scale. Sensitivity analysis was performed by using leave one or two out method. PROSPERO registration number: CRD42022336402. Results: Nine eligible studies consisting of 86,795 patients were included. A total of 22,130 (25.5%) patients were in statin use before the index ACS event. The prevalence of old myocardial infarction, heart failure, hypertension, diabetes mellitus, and chronic renal failure and concomitant treatment with aspirin, clopidogrel, and beta blocker was higher in the prior statin group compared to no previous statin. Overall, prior statin use was associated with a significantly lower incidence of in-hospital arrhythmia during ACS compared to no previous statin (OR 0.60; 95% CI 0.49e0.72; P < 0.00001; I2 ¼ 54%, Pheterogeneity ¼ 0.03). In subgroup analysis, previous statin use reduced the incidence of atrial fibrillation or atrial flutter (OR 0.64; 95% CI 0.43e0.95; P ¼ 0.03; I2 ¼ 73%, P-heterogeneity ¼ 0.01) and ventricular tachycardia or ventricular fibrillation (OR 0.57; 95% CI 0.49e0.65; P < 0.00001; I2 ¼ 8%, Pheterogeneity ¼ 0.35). Conclusions: Based on aggregate patient data, prior statin use may reduce the incidence of in-hospital arrhythmia during ACS, particularly atrial fibrillation or atrial flutter and ventricular tachycardia or ventricular fibrillation.

Ressonância Magnética Cardíaca como Ferramenta Diagnóstica Etiológica em Pacientes Recuperados de Morte Súbita Cardíaca ou Arritmias Ventriculares Instáveis / Cardiac Magnetic Resonance as an Etiological Diagnosis Tool in Recovered Sudden Cardiac Death or Unstable Ventricular Arrhythmia Patients

Resumo Fundamento A ressonância magnética cardíaca (RMC) tem relevância diagnóstica crescente em sobreviventes de morte súbita cardíaca (MSC) ou arritmia ventricular instável (AVI) em países desenvolvidos. Objetivo Procuramos avaliar retrospectivamente o papel adicional da RMC em um país em desenvolvimento com poucos recursos disponíveis e que pode direcionar um uso mais eficaz desses recursos. Métodos Foram incluídos sobreviventes de MSC ou AVI admitidos entre 2009 e 2019 em uma instituição acadêmica terciária após a realização de RMC. Dados demográficos, clínicos e laboratoriais foram coletados dos prontuários. Imagens e laudos de RMC foram analisados e o impacto disso no diagnóstico etiológico final foi afirmado. Realizou-se análise descritiva e definiu-se p<0,05 como significativo. Resultados Sessenta e quatro pacientes, 54,9±15,4 anos, sendo 42 (71,9%) do sexo masculino. A maioria dos eventos (81,3%) foi extra-hospitalar e a taquicardia ventricular foi o ritmo mais comum. Medicamentos cardiovasculares foram utilizados anteriormente por 55 pacientes, sendo os betabloqueadores os medicamentos mais utilizados (37,5%). O eletrocardiograma apresentava áreas elétricas inativas em 21,9% e todos apresentavam fibrose na RMC. A média da fração de ejeção do ventrículo esquerdo (FEVE) foi de 44±14%, com 60,9% ≤50% e apenas 29,7% ≤35%. Identificou-se realce tardio com gadolínio em 71,9%, com padrão transmural em 43,8%. A miocardiopatia chagásica foi a etiologia mais comum (28,1%), seguida da miocardiopatia isquêmica (17,2%). Entre 26 sem etiologia previamente identificada, foi possível definir com RMC (15 pacientes - 57%). Conclusão De acordo com estudos anteriores em países desenvolvidos, a RMC foi capaz de aumentar o diagnóstico etiológico e identificar o substrato arritmogênico, permitindo melhor atendimento em metade dos pacientes subdiagnosticados.

Abstract Background Cardiac magnetic resonance (CMR) has an increasing diagnostic relevance in survivors of sudden cardiac death (SCD) or unstable ventricular arrhythmia (UVA) in developed countries. Objective To evaluate retrospectively the additional role of CMR in a developing country where few resources are available, and should be used more effectively. Methods The study included SCD or UVA survivors admitted between 2009 and 2019 at a tertiary academic institution referred to CMR. Demographic, clinical, and laboratory data were collected from the medical records. CMR images and reports were reviewed and their impact on the final etiological diagnosis was determined. A descriptive analysis was performed and p<0.05 established as significant. Results Sixty-four patients, 54.9±15.4 years old, and 42 (71.9%) males. Most events (81.3%) were out of the hospital and ventricular tachycardia was the most common rhythm. Cardiovascular medications were previously used by 55 patients, and beta-blockers were the most used medications (37.5%). Electrocardiogram had electrical inactive areas in 21.9% and all of them had fibrosis at CMR. Mean left ventricular ejection fraction (LVEF) was 44±14%, with 60.9% ≤50% and only 29.7% ≤35%. Late gadolinium enhancement was identified in 71.9%, with a transmural pattern in 43.8%. Chagas cardiomyopathy was the most common etiology (28.1%), followed by ischemic cardiomyopathy (17.2%). Among 26 without a previously identified etiology, CMR could define it (15 patients - 57%). Conclusion In accordance with previous studies in developed countries, CMR was capable of increasing etiological diagnosis and identifying the arrhythmogenic substrate, allowing better care in half of the underdiagnosed patients.

Preliminary study of stereotactic cardiac radioablation in radiotherapy of ventricular arrhythmia / 中华放射肿瘤学杂志

Objective:To introduce the stereotactic cardiac radioablation (SCRA) based on the stereotactic body radiotherapy (SBRT), and comprehensively evaluate the new approach by short-term effectiveness and safety.Methods:Patients with ventricular arrhythmia (VA) were evaluated and included in this clinical trial, who were immobilized by vacuum bag and performed simulation with 4-dimensional computed tomography (4DCT). In this study, the planning target volume (PTV) was set as the target to design a SBRT plan using volumetric modulated arc therapy (VMAT), which was evaluated by dose parameters such as R 50%, homogeneity index and conformity index, etc. The results of Holter and echocardiography were monitored during the follow-up and compared with the data before treatment. Results:Three subjects with ventricular tachycardia (VT) and one with premature ventricular contraction (PVC) received the same prescription of 25 Gy in a single fraction. The average volume of PTV was 71.4 cm 3(60.3-89.4 cm 3). The average time of beam delivery was 12.0 min (4.5-21.0 min). And the short-term follow-up lasted for an average of 18 weeks (14-25 weeks), which showed significant decrease in both VT and PVC load without complications. Conclusion:This study reports the implementation method of SCRA and proves its short-term effectiveness and safety, but the effects and standards of the key radiotherapy techniques still need to be explored.

Arritmia ventricular maligna asociada a un gossypiboma: reporte de un caso / Malignant ventricular arrhythmia associated to gossypiboma: clinical case report / Arritmia ventricular maligna vinculada a gossypiboma: reporte de um caso clínico

Un gossypiboma, oblitoma o textiloma se define como todo cuerpo extraño olvidado en el interior de un paciente durante una intervención quirúrgica. Representa una complicación posquirúrgica poco frecuente pero de consecuencias potencialmente graves. En general, se manifiesta con cuadros clínicos variables: una masa o pseudotumor, sangrados, fiebre, dolor, varios meses o años después de la cirugía original. También puede ser un hallazgo accidental. Describimos el caso clínico de una paciente con un gossypiboma vinculado a una cirugía cardíaca que se realizó 40 años antes al cuadro clínico actual, que se presenta con arritmia ventricular maligna.

A gossypiboma, oblitoma or textiloma is defined as a surgical object left in the interior of the body after surgery. It represents an uncommon but potentially life threatening post-surgery complication. Clinical manifestations are variable and depend on location, relations and size, from pseudo-tumoral masses, bleeding, fever, pain and other nonspecific presentations. The onset of symptoms is unpredictable, occurring from months or years after surgery. Patients may course asymptomatically and be diagnosed incidentally as an imaging finding. We describe a case of a patient with gossypiboma diagnosed 40 years after undergoing cardiac surgery, who presented with a malignant ventricular arrhythmia.

Um gossypiboma, oblitoma ou textiloma está definido como todo corpo estranho esquecido no interior de um paciente durante um procedimento cirúrgico, representando uma complicação pos cirúrgica pouco frequente, mas com consequências potencialmente graves. Geralmente, se manifesta com quadros clínicos variáveis: uma massa ou pseudotumor, sangramentos, febre, dor, varios meses ou anos após a cirurgia original ou ser um hachado acidental. Descrevemos o caso clínico de uma paciente com um gossypiboma vinculado a uma cirurgia cardíaca realizada 40 anos antes do quadro clínico atual, que se apresenta com arritmia ventricular maligna.

Relationship between fragmented QRS wave with ventricular arrhythmia's incidence situation and heart rate variability in patients with old myocardial infarction / 中国综合临床

Objective:To explore the relationship between fragmented QRS complex and heart rate variability (HRV) and ventricular arrhythmia in patients with old myocardial infarction.Methods:From August 2018 to October 2019, 200 patients with old myocardial infarction were first treated in the Department of cardiac function examination of the First Affiliated Hospital of Hebei North University. The patients were divided into 99 cases of old myocardial infarction with fragmented QRS wave group and 101 cases of old myocardial infarction without fragmented QRS wave group according to the case bank data and conventional 12 lead ECG diagnosis in our hospital for the first time. Then, the 24-h ambulatory ECG reexamined within 1 year after discharge was retrospectively analyzed. The incidence of ventricular arrhythmia was compared between the two groups by χ 2 test. The difference of heart rate variability between the two groups was compared by rank sum test. Multiple logistic regression was used to analyze the value of different indexes of heart rate variability in the evaluation of fragmented QRS complex in old myocardial infarction. Drawing the receiver operating characteristic (ROC), and the area under the curve (AUC) was used to analyze the diagnostic accuracy of different indexes of heart rate variability in the broken QRS complex of old myocardial infarction. Results:According to the Lown classification of ventricular premature contraction, the number of positive ventricular arrhythmias in patients with Grade Ⅰ of ventricular premature contraction and Grade Ⅲ-Ⅴ of ventricular premature contraction in the old myocardial infarction fragmented QRS group was higher than that in the old myocardial infarction non fragmented QRS group (Grade Ⅰ of ventricular premature contraction: 54.5% (54/99)and 39.6%(40/101); χ 2=4.484, P<0.05;Grade Ⅲ-Ⅴ of ventricular premature contraction: 34.3% (34/99) and 9.9%(10/101); χ 2=17.406, P<0.05)). Ventricular premature contraction Grade 0 old myocardial infarction fragmented QRS group was lower than old myocardial infarction non fragmented QRS group (8.1% (8/99) and 48.5% (49/101); χ 2=37.995, P<0.05). The total number of positive cases of ventricular arrhythmia in the old myocardial infarction group with fragmented QRS wave was higher than that in the old myocardial infarction group without fragmented QRS wave (91.9% (91/99) and 51.5%(52/101); χ 2=57.146, P<0.05)). There was no significant difference in the number of positive ventricular arrhythmias between the old myocardial infarction fragmentation QRS group and the old myocardial infarction non fragmentation QRS group ( P>0.05). The standard deviation of NN intervals (SDNN) and the standard deviation of average NN intervals (SDANN) of HRV time domain indexes in the old myocardial infarction fragmented QRS group were higher than those in the old myocardial infarction non fragmented QRS Group (SDNN:143.00(122.00,166.00) vs. 110.00(95.00,130.50), Z=5.780, P<0.05; SDANN:112.00(100.00,136.00) vs. 96.00(76.00,118.50), Z=4.013, P<0.05). Multiple Logistics regression analysis results of HRV domain shows that HRV time domain SDNN and SDANN have diagnositic value in diagnosis fQRS after OMI(SDNN: OR=0.949, 95% CI:0.922-0.977, P<0.001; SDANN: OR=1.036, 95% CI:1.005-1.068, P=0.022). Area under ROC curve of HRV time domain SDNN and SDANN have particular diagnositic accuracy in diagnosis fQRS after OMI(SDNN: AUC 0.737, 95% CI 0.666-0.807, Sensitivity 0.818, Specificity 0.634; SDANN: AUC 0.664, 95% CI 0.587-0.741, Sensitivity 0.737, Specificity 0.673. 0.5<AUC<1). Conclusion:Fragmented QRS complex was positively correlated with the incidence and severity of ventricular arrhythmia in patients with old myocardial infarction, and positively correlated with time-domain indexes SDNN and SDANN of heart rate variability in patients with old myocardial infarction.

Analysis of radiofrequency catheter ablation of idiopathic ventricular arrhythmias in 328 pediatric patients in a single center within 5 years / 中华实用儿科临床杂志

Objective:To investigate clinical electrophysiological characteristics of idiopathic ventricular arrhythmias (VAs) and outcomes of radiofrequency catheter ablation (RFCA) in pediatric patients.Methods:A total of 328 consecutive pediatric patients with VAs and treated with RFCA in the First Hospital of Tsinghua University from January 2014 to December 2019 were recruited, involving 205 males and 123 females with the mean age of (7.8±3.9) years and the mean body weight of (32.8±17.7) kg.Their clinical electrophysiological characteristics, RFCA outcomes of different origins of VAs and complications were analyzed.Results:Among the 328 patients with the mean onset age of (5.4±4.1) years, 57.6% had frequent premature ventricular complex (PVC), 28.7% had paroxysmal ventricular tachycardia (VT) and 13.7% had incessant VT.A total of 38/328 cases (11.6%) VAs children were complicated with tachycardia-induced cardiomyopathy.Except for 13 cases of non-induced VAs, among 315 cases there were 152/328 cases (46.4%) originated from the ventricular outflow tract (including 46.1% of the origination of the right ventricular outflow tract septum, 27.6% of the origination of the left coronary cusp, 18.4% of the origination of the right coronary cusp, and 7.9% of the origination of the right ventricular outflow tract free wall), 55/328 cases (16.5%) originated from the tricuspid valve, 54/328 cases (17.4%) originated from the left posterior fascicle, 39/328 cases (11.9%) originated from the left posterior papillary muscle, 5/328 cases (1.5%) originated from multi-origin VAs, 3/328 cases (0.9%) originated from the left anterior fascicle, and 7/328 cases (2.1%) originated from other origins.Among 307/328 cases (93.6%) VAs patients receiving RFCA, 271/307 cases (88.3%) were instantly successful, 14/307 cases (4.6%) were effectively treated and 22/307 cases (7.2%) were invalid.During the follow-up time of 3 to 36 months, there were 42/271 cases (15.5%) recurrent cases.The mean radiation time and dose were (3.2±5.8) min, and (1.4±2.6) mGy, respectively.The mean dose-area product (DAP) was (384.2±42.6) mGy·cm 2.A total of 4/328 cases (1.2%) reported perioperative vascular complication.In 20 infant patients younger than 3 years, only 1 case was not induced during procedure of RFCA, and the remaining 19 cases were performed with RFCA, including 18/19 cases (94.7%) with an instant success and 4/18 (22.2%) recurrent cases during follow-up.There were 1/20 case (5.0%) had perioperative vascular complication caused by vascular puncture.No serious complications, such as myocardial perforation, cardiac tamponade and atrioventricular block were reported. Conclusions:The right ventricular outflow tract septum is the most common origin of the idiopathic VAs in pediatric patients.VAs originated from the ventricular outflow tract and tricuspid valve usually have an acceptable outcome following ablation.The recurrent rate is high following ablation in VAs cases originated from the left ventricular fascicle and posterior papillary muscle.RFCA is safe and effective for drug resistant or intolerant VAs in infants, but the surgical indications should be strictly mastered and operated by experienced pediatric electrophysiologists.The radiation dose of RFCA can be limited in a safe range under the guidance of the 3-dimensional mapping system.

Effects of Dexmedetomidine on Ventricular Arrhythmia in Myocardial Hypertrophy Model Rabbits and CaMK Ⅱ Expression in Cardiac Tissue / 中国药房

OBJECTIVE：To study th e effects of dexmedetomidine on ventricular arrhythmia in myocardial hypertrophy model rabbits and the expression of calcium ion /calmodulin-dependent protein kinase Ⅱ（CaMKⅡ）in myocardial tissue of rabbits. METHODS： The rabbits were randomly divided into sham operation group ， model group ， dexmedetomidine low-dose ， medium-dose and high-dose groups （10，25，50 μ g/kg），CaMK Ⅱ inhibitor KN- 93 group （10 mg/kg），high-dose of dexmedetomidine+KN-93 group（50 μg/kg+10 mg/kg），with 10 rabbits in each group. Except for the sham operation group ，other groups received abdominal aortic coarctation to induce myocardial hypertrophy model. After surgery ，administration groups were given relevant dose of dexmedetomidine or/and intraperitoneal injection of KN- 93；sham operation group and model group were given constant volume of normal saline intravenously ，once every other day ，for consecutive 8 weeks. After last medication ， programmed stimulation was used to induce ventricular arrhythmia. The induction rate of early posterior depolarization （EAD）and tip torsion type ventricular tachycardia （Tdp）were recorded. Left ventricular ejection fraction （LVEF）and left ventricular shortener fraction（FS）were measured. QT interval ，transventricular wall repolarization dispersion （TDR）and transmembrane 90％ action potential duration （APD90）of endocardial and epicardial cardiomyocytes in wedge-shaped myocardium were recorded. The ratio of heart weight to body weight （HW/BW）and the thickness of left ventricular wall （LVT）were measured and calculated. The cross-sectional area of cardiomyocytes ，mRNA expression of ANP and BNP as well as protein expression of CaMK Ⅱ and p-CaMK Ⅱ in myocardial tissue was measured. RESULTS ：Compared with sham operation group ，the induction rate of EAD and Tdp ，HW/BM， LVT，mRNA expression of ANP and BNP and protein relative expression of CaMK Ⅱ and p-CaMK Ⅱ in cardiac tissue were all increased significantly ，while LVEF and FS were decreased significantly ；QT interval ，APD90 of endocardial and epicardial cardiomyocytes were all prolonged significantly ；TDR was increased significantly ，while cross-sectional area of cardiomyocytes was increased significantly in model group （P＜0.05）. Compared with model group ，induction rate of EAD and Tdp ，HW/BW （except for dexmedetomidine low-dose group ），LVT（except for dexmedetomidine low-dose group ），mRNA relative expression of ANP（except for dexmedetomidine low-dose group ）and BNP （except for dexmedetomidine low-dose group ）as well as protein relative expression of CaMK Ⅱ and p-CaMK Ⅱ were all decreased significantly in administration groups ；the levels of LVEF （except for dexmedetomidine low-dose group ） and FS （except for dexmedetomidine low-dose group ） were all increased significantly； QT interval ，APD90 of endocardial and epicardial cardiomyocytes were shortened significantly ； TDR and cross-sectional area of cardiomyocytes （except for dexmedetomidine low-dose group ）were decreased significantly （P＜0.05）；the improvement effects of dexmedetomidine high-dose group were significantly better than those of dexmedetomidine low-dose and medium-dose groups （P＜0.05）. Compared with dexmedetomidine high-dose group and KN- 93 group，the improvement of above indexes were all more significant in high-dose of dexmedetomidine+KN- 93 group（P＜0.05）. CONCLUSIONS ：Dexmedetomidine can reduce the induction rate of ventricular arrhythmia and improve myocardial hypertrophy in myocardial hypertrophy model rabbits，the mechanism of which may be associated with down-regulation of CaMK Ⅱ expression.

A Experience of Surgical Treatment for Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy with Apical Ventricular Aneurysm / 日本心臓血管外科学会雑誌

Mid-ventricular obstructive hypertrophic cardiomyopathy is rare and often complicated by apical ventricular aneurysm, which can cause life-threatening ventricular arrhythmias. A 76-year-old male patient came to our hospital because of an electrocardiogram abnormality (giant T-wave inversion). Transthoracic echocardiography showed myocardial hypertrophy at the level of the papillary muscles, apical thinning, and aneurysm formation. The patient was diagnosed with mid-ventricular obstructive hypertrophic cardiomyopathy with apical ventricular aneurysm. During follow-up, the patient developed exertional dyspnea, and nonsustained ventricular tachycardia was noted on Holter monitoring. Therefore, we opted for surgical treatment. The patient was placed on cardiopulmonary bypass and treated with apical aneurysmectomy, followed by myectomy with a trans-apical approach. Postoperative echocardiography showed an increased left ventricular end-diastolic volume. The patient no longer had difficulty breathing and did not develop postoperative ventricular arrythmia. He has been uneventful six months after surgery. We considered surgical treatment was effective in treating arrhythmias and heart failure.

A high number of ‘natural’ mitochondrial DNA polymorphisms in a symptomatic Brugada syndrome type 1 patient

Brugada syndrome (BrS) is a rare genetic arrhythmic disorder with a complex model of transmission. At least 20 different genes have been identified as BrS-causal or susceptibility genes. Of these, SCN5A is the most frequently mutated. Coregulation of different mutations or genetic variants, including mitochondrial DNA (mtDNA), may contribute to the clinical phenotype of the disease. In the present study, we analysed the mitochondrial genome of a symptomatic BrS type 1 patient to investigate a possible mitochondrial involvement recently found in the arrhytmogenic diseases. No pathogenic mutation was identified; however, a high number of singlenucleotide polymorphisms were found (n=21) and some of them were already been reported in molecular autopsy case for sudden death. The results reported here further support our hypothesis on the potential role of mtDNA polymorphisms in mitochondrial dysfunction, which may represent a risk factor for arrhythmogenic disease.

Parada cardíaca súbita por arritmia ventricular en pacientes con infarto agudo de miocardio / Sudden cardiac arrest due to ventricular arrhythmia in patients with acute myocardial infarction

RESUMEN Introducción: La muerte súbita cardíaca no ha disminuido de igual manera que la mortalidad por enfermedad coronaria, por la elevada incidencia de las paradas cardíacas súbitas (PCS). Objetivos: Determinar factores predictivos de PCS por arritmia ventricular en pacientes con infarto agudo de miocardio. Método: Se realizó un estudio analítico en el Servicio de Cardiología de Las Tunas entre 2011 y 2017. La población de estudio estuvo conformada por los 917 pacientes ingresados con infarto agudo de miocardio. Los 90 pacientes con PCS en arritmia ventricular constituyeron el «grupo de casos¼; el resto fue el «grupo control¼. Se utilizó estadística descriptiva y un modelo de regresión logística múltiple, y se calculó el índice de probabilidad (odds ratio [OR]), con un 95% de confiabilidad para determinar los factores predictivos. Resultados: En los pacientes del grupo de casos predominó el sexo masculino (73%), el infarto biventricular (24,7%), la fracción de eyección ventricular izquierda (FEVI) <35% (18,9%) y los fallecidos (41,1%) en relación al grupo control. Al 10,0% se le administró betabloqueadores en la primera asistencia médica. El shock cardiogénico (OR=15,3), la FEVI <35% (OR=8,51), la creatina quinasa > 1200 UI (OR=2,77), la obesidad (OR=3,16), el hábito de fumar (OR=2,28), el supra/infradesnivel del ST en el electrocardiograma >15 mm (OR=2,23) y el infarto anterior (OR=2,39) se asociaron a la PCS en arritmia ventricular. Conclusiones: El shock cardiogénico, la FEVI <35%, la creatina quinasa >1200 UI, la obesidad, el hábito de fumar, el supra/infradesnivel del ST en el electrocardiograma >15 mm y el infarto anterior fueron factores predictivos de PCS en arritmia ventricular.

ABSTRACT Introduction: Sudden cardiac death has not decreased in the same way as mortality due to coronary heart disease, because of the high incidence of sudden cardiac arrest (SCA). Objectives: To determine predictive factors of SCA due to ventricular arrhythmia in patients with acute myocardial infarction. Method: An analytical study was carried out in the Cardiology Department of Las Tunas between 2011 and 2017. The population of study was 917 patients admitted with acute myocardial infarction. All 90 patients with SCA in ventricular arrhythmia represented the "case group"; the rest were the "control group". Descriptive statistics were used, as well as a multiple logistic regression model; the odds ratios (OR) was calculated, with 95% reliability to determine the predictive factors. Results: In the patients of the case group predominated: male sex (73%), biventricular infarction (24.7%), left ventricular ejection fraction (LVEF) <35% (18.9%) and deceased (41.1%); all these results compared to the control group. A 10.0% was given beta-blockers on their first medical assistance. Cardiogenic shock (OR 15.3), LVEF <35% (OR 8.51), creatine kinase >1200 IU (OR 2.77), obesity (OR 3.16), smoking (OR 2.28), ST-segment elevation/depression on the electrocardiogram >15 mm (OR 2.23) and anterior wall infarction (OR 2.39) were associated with SCA due to ventricular arrhythmia. Conclusions: Cardiogenic shock, LVEF <35%, creatine kinase > 1200 IU, obesity, smoking, ST-segment elevation/depression on the electrocardiogram >15 mm and anterior wall infarction were predictive factors of SCA due to ventricular arrhythmia.

Bloqueo atrioventricular completo, taquicardia ventricular y muerte súbita en una paciente gestante a término / Complete atrioventricular block, ventricular tachycardia and sudden death in a pregnant woman at term

Resumen Se presenta un caso clínico de una mujer gestante que presentó bloqueo atrioventricular completo en labor de parto, bradicardia severa, intervalo QT prolongado secundario, torsión de puntas y paro cardiorrespiratorio, del cual fue recuperada. Se discuten los mecanismos potenciales que pueden desencadenar este escenario.

Abstract A clinical case of a pregnant woman who presented with complete atrioventricular block in labor, severe bradycardia, secondary prolonged QT interval, Torsades de pointes and aborted cardiorespiratory arrest is presented. Potential mechanisms that can trigger this scenario are discussed.

Taquicardia ventricular como manifestación de sarcoidosis cardíaca. Reporte de un caso / Ventricular tachycardia as a manifestation of cardiac sarcoidosis. Case report

La sarcoidosis es una enfermedad inflamatoria crónica que posee una amplia variabilidad de presentaciones clínicas. El compromiso cardíaco de esta patología oscila en el orden del 5%, pudiendo variar desde anormalidades en la conducción hasta la falla cardíaca. Existe poco conocimiento sobre los beneficios de su tratamiento y no hay datos que evalúen la reducción de la mortalidad a largo plazo, por lo que genera este tipo de pacientes un gran desafío para el profesional. A continuación presentamos el caso de un masculino de 37 años con taquicardia ventricular como debut cardiológico de una sarcoidosis.

Methotrexate induced ventricular arrhythmia as a medication error: a case report

Methotrexate (MTX) is the most widely used drug in clinical practice for long term treatment of connective tissue disorders. As this drug has narrow therapeutic index, if it goes unmonitored can lead to life threatening complications. Herein we are describing the case of a patient who presented with ventricular arrhythmia, due to failure to execute MTX therapy in the prescribed frequency and took daily dose of MTX which was meant to be taken as a weekly dose pointing to failure of patient education or patient comprehension regarding MTX and finally succumbed due to cardiogenic shock. We concluded this causality as probable/likely category according to WHO-UMC causality categories.

Arritmias y muerte súbita en la falla cardíaca: estratificación eléctrica de grupos de riesgo / Arrhythmias and sudden death in heart failure: electrical stratification of risk groups

RESUMEN Se presenta una panorámica de la falla cardíaca ligada a las arritmias y a la muerte súbita, que pueden coexistir, agravarse, o ser causa o consecuencia una de otra. Se discuten los signos eléctricos premonitorios que permiten estratificar riesgo en pacientes con eventos previos, con posible acercamiento a la realidad, y en quienes no los han presentado (la mayoría, los no protegidos), y resulta muy difícil o imposible establecer un pronóstico. Estos signos son numerosos, esquivos, de baja especificidad y sensibilidad, ninguno es absoluto ni despreciable, para interpretarlos se requiere una visión integral. Se discuten las extrasístoles ventriculares como predictoras y desencadenantes de arritmias, de muerte súbita y de miocardiopatía, y la utilidad de los procedimientos ablativos frente a los medicamentosos. Los signos eléctricos son buenos para identificar grandes grupos de riesgo pero no lo son tanto para, dentro del gran grupo de bajo riesgo (la mayoría), identificar los individuos de alto riesgo.

ABSTRACT In this research is presented an overview of heart failure related to arrhythmias and sudden death, which can coexist, worsen, or be cause or consequence of one another. Here are discussed the premonitory electrical signs that allow to stratify risk in patients with previous events, with a possible approach to reality, and in those who have not presented them (most of them, the unprotected ones) and where a prognosis is very difficult, or impossible, to be established. These signs are numerous, elusive, with low specificity and sensitivity, none is absolute or negligible, in order to interpret them, a comprehensive vision is required. Premature ventricular contractions are discussed as predictors and triggers of arrhythmias, sudden death and cardiomyopathy, as well as the usefulness of ablative procedures versus medications. Electrical signs are good for identifying large risk groups but not for identifying high risk individuals inside the large low risk group (the majority).

Experimental study on Yiqifumai mixture in treatment of arrhythmia induced by isoproterenol / 中国中西医结合急救杂志

Objective To evaluate the effect of Yiqifumai mixture on ventricular arrhythmia induced by isoproterenol. Methods Forty spontaneous hypertensive rats (SHR) were randomly divided into a control group and a Chinese medicine (TCM) group with 20 rats in each group. The control group was given distilled water 3.48 mL·kg-1·d-1, and the TCM group was given Yiqifumai mixture (composition: Codonopsis pilosula, Rhizoma coptidis, Pinellia ternate, Euonymus alatus, Rhizome of chuanxiong, Salvia miltiorrhiza, Radix paeoniae rubra, Radix paeonia alba, Licorice, Zizyphus jujuba, Polygala tenuifolia) 3.48 mL·kg-1·d-1, both groups were administered continuously for 7 days. Arrhythmia was induced by subcutaneous injection of isoproterenol 100 mg/kg into the neck 1 hour after the last administration in both groups. ECG telemetry was carried out for 2 hours to record whether single premature ventricular contraction (SP), paired premature ventricular contraction (PP) and ventricular tachycardia (VT) occurred in the control group and the TCM group, and the incidences, numbers and times of their occurrences were registered. Results There were no statistical significant differences in SP incidence (SPR), PP incidence (PPR), VT incidence (VTR) between the control group and TCM group at 1 hour and 2 hours [1 hour SPR was 90% (18/20) vs. 80% (16/20), PPR was 65% (13/20) vs. 65% (13/20), VTR was 45% (9/20) vs. 40% (8/20); 2 hours SPR was 100% (20/20) vs. 100% (20/20), PPR was 75% (15/20) vs. 75% (15/20), VTR was 65% (13/20) vs. 60% (12/20); all P > 0.05]. After 1 hour of ECG telemetry, the number of SP in the TCM group was significantly lower than that in the control group [numbers: 10.00 (4.00, 11.00) vs. 16.00 (8.50, 42.50), P < 0.05]; after 2 hours of ECG telemetry, the numbers of SP, PP and VT in the TCM group were significantly lower than those in the control group [SP (numbers), 27.00 (15.50, 38.00) vs. 37.50 (24.00, 74.50), PP (numbers), 5.00 (3.00, 8.00) vs 7.00 (5.00, 11.00), VT (numbers), 2.50 (1.25, 4.00) vs. 7.00 (4.50, 11.00), all P <0.05]. After 1 hour and 2 hours of ECG telemetry, the occurrence times of SP, PP and VT were slightly longer than those in cintrol group, but there were no significant differences between the two groups [1 hour: SP (minutes) was 4.35 (3.65, 9.90) vs. 3.66 (1.12, 9.52), PP (minutes) was 35.56 (26.78, 46.42) vs. 23.39 (11.74, 43.42), VT (minutes) was 22.31 (6.25, 30.02) vs. 14.27 (8.79, 31.38); 2 hours: SP (minutes) was 7.06 (3.65,12.29) vs. 4.09 (1.38, 14.11), PP (minutes) was 46.40 (33.88, 71.39) vs. 33.81(14.54, 46.20), VT (minutes) was 75.49 (59.37, 96.63) vs. 60.55 (24.65, 86.48), all P > 0.05]. Conclusion Yiqifumai mixture has the effect of anti-arrhythmia induced by isoproterenol and its effect in longer term use is more significant.

Clinical significance of detecting transmural dispersion of repolarization in patients with hypertrophic cardiomyopathy / 中国医师进修杂志

Objective To explore the changes and clinical significance of transmural dispersion of repolarization (TDR) in patients with hypertrophic cardiomyopathy (HCM). Methods Seventy-two patients with HCM (observation group) and 72 healthy subjects (control group) in Shengjing Hospital of China Medical University were selected from January 2015 to October 2017. The 12-lead conventional electrocardiogram was performed on enrolled personnel in 2 groups to measure T-peak T-end (TpTe), correct the QT interval (QTc), QT interval dispersion (QTd) and TpTe/QTc. The observation group underwent 24 h dynamic electrocardiography. The patients were divided into ventricular arrhythmia subgroup and non- ventricular arrhythmia subgroup according to the results of 24 h dynamic electrocardiography, and the TpTe, QTc, QTd and TpTe/QTc were compared. Results The TpTe, QTc, QTd and TpTe/QTc in observation groups were significantly higher than those in control group:(112.5 ± 11.2) ms vs. (105.6 ± 9.2) ms, (396.5 ± 13.5) ms vs. (385.3 ± 12.5) ms, (36.5 ± 6.4) ms vs. (32.4 ± 5.4) ms and 0.289 ± 0.016 vs. 0.262 ± 0.015, and there were statistical differences (P＜0.05). In observation group, the 24 h dynamic electrocardiogram result showed that 47 patients had ventricular arrhythmia (ventricular arrhythmia subgroup) and 25 patients had not ventricular arrhythmia (non-ventricular arrhythmia subgroup). The TpTe, QTc, QTd and TpTe/QTc in ventricular arrhythmia subgroup were significantly higher than those in non-ventricular arrhythmia subgroup: (114.4 ± 14.5) ms vs. (110.3 ± 12.2) ms, (402.5 ± 15.2) ms vs. (392.0 ± 12.1) ms, (37.5 ± 6.2) ms vs. (35.4 ± 6.5) ms and 0.292 ± 0.016 vs. 0.285 ± 0.015, and there were statistical differences (P＜0.05). Conclusions The values of TpTe, QTc, QTd and TpTe/QTc reflect the increase of transmural dispersion of repolarization in patients with HCM, and have a certain predictive effect on ventricular arrhythmia.

Management of ventricular arrhythmias in pregnancy / 中国实用妇科与产科杂志

Ventricular arrhythmias in pregnancy is a common disease of cardiovascular disease during pregnancy which can cause adverse outcomes in severe state,such as maternal heart failure,sudden death,fetal hypoxia,premature delivery and stillbirth.The management of ventricular arrhythmias requires multidisciplinary participation,including obstetrics,cardiology,anesthesiology and neonatology.This article discusses how to manage the ventricular arrhythmias from the following aspects:pre-pregnancy counseling and assessment,treatments,managements during pregnancy and managements of delivery in order to reduce the occurrence of maternal and fetal complications,and emphasizes the significance of multidisciplinary collaborative management to the prognosis of disease.

Calidad de vida relacionada con la salud en pacientes con arritmia ventricular una medición con el ASTA, en dos momentos / Health-related quality of life in patients with ventricular arrhythmia a measurement with the ASTA, at two moments

Objetivo: Establecer una comparación en las mediciones de calidad de vida relacionada con la salud y carga de los síntomas con el ASTA en pacientes con arritmia ventricular, antes y después de implante de cardiodesfibrilador. Método: observacional analítico, con diseño de serie de casos y de abordaje cuantitativo. Participaron 83 pacientes, con diagnóstico de arritmia ventricular de dos instituciones de la ciudad de Bucaramanga, con dos mediciones, antes y después de implante de cardiodesfibrilador. Instrumento: Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA), versión validada al español. Análisis: se utilizó estadística descriptiva y para determinar el cambio en los puntajes de las mediciones iniciales y finales, se utilizó, la prueba pareada de T Student. Resultados: los pacientes con arritmia ventricular que recibieron implante de cardiodesfibrilador, son en su mayoría hombres con una media de edad de 60,97 años, de estratos socioeconómicos bajos, ocupación hogar y labores agrícolas, el puntaje en la escala de calidad de vida inicial fue de 10.97 y de 9.52 para la medición final post-implante, con un valor de p: 0.001, para la comparación entre los dos puntajes, lo que muestra una diferencia estadísticamente significativa. Conclusión: la evaluación de la calidad de vida del paciente con arritmia ventricular medida por un instrumento especifico, muestra una afectación de la calidad de vida, con una leve mejoría en la medición a un mes posterior al implante del cardiodesfibrilador y visualiza la importancia de intervenciones de Enfermería en etapas tempranas del pre-implante en diferentes aspectos.

Objective: To establish a comparison in health-related quality of life measurements and symptoms burden with ASTA in patients with ventricular arrhythmia, before and after implantation of a cardiodefibrillator. Method: observational analytical, with case series design, with a quantitative approach. A total of 83 patients participated, with a diagnosis of ventricular arrhythmia from two institutions in the city of Bucaramanga, with two measurements, before and after implantation of a cardiodefibrillator. Instrument, Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA), version validated in Spanish. Analysis: descriptive statistics were used and, to determine the change in the scores of the initial and final measurements, the paired test of T -Student was used. Results: patients with ventricular arrhythmia, and who received a cardio-defibrillator implant, are mostly men, with a mean age of 60.97 years, from low socioeconomic strata, household occupation and agricultural work, the score in the quality scale of initial life was of 10.97 and of 9.52 for the final measurement after implant, with a value of p: 0.001, for the comparison between the two scores, which shows a statistically significant difference. Conclusion: the evaluation of the quality of life of the patient with ventricular arrhythmia, measured by a specific instrument, shows an affectation of the quality of life, with a slight improvement in the measurement one month after the implantation of the cardiodefibrillator. And the importance of nursing interventions in the early stages of pre-implantation in different aspects is visualized.

Protective Effects of Duloxetine on Arrhythmia in Rats with Myocardial Ischemia Reperfusion Injury / 医学研究杂志

Objective To explore the protective effects of duloxetine on ventricular arrhythmia in rats with ischemia reperfusion injury.Methods Thirty Sprague Dawley (SD) rats were randomly divided into 3 groups:Sham group,ischemia reperfusion group (IR group),duloxetine-treated group (Dulo group).The rats in IR group were subjected to 30min-ischemia of left anterior descending artery ligation followed by 120min of reperfusion,while intraperitoneal injection of duloxetine 40mg/kg were give prior ischemia in Dulo group,and the remaining experiment protocols were same as IR group.The left anterior descending artery of rats in sham group was exposed without being clamped.Two biopotential leads ECG monitor was used to record the arrhythmia in each group,and ECG parameters were analyzed by LabChart 8 software.Triphenyltetrazolium chloride (TTC) was used for determination of infarct area.The protein expressions of Akt,extracellular regulated protein kinases (Erk),caspase-3,superoxide dismutase (SOD) 1,SOD2 and Connexin 43 (Cx 43) were measured by western blot analysis.Results As compared to IR group,the incidences of both ventricular extrasystoles and tachycardia were decreased during ischemic period (P ＜0.05),and the incidence of ventricular tachycardia was decreased with no significant changes in ventricular extrasystoles during reperfusion period in Dulo group (P ＜ 0.05).Duloxetine decreased the prolonged QTc and infraeted area during IR injury (P ＜ 0.05).Duloxetine inhibited the phosphorylation of Akt and Erk,and downregulated the protein expressions of cleaved caspase-3,cytochrome C,while upregulated SOD1,SOD2 and Cx 43 protein expression during I/R injury (P ＜ 0.05).Conclusion Duloxetine decreases the phosphorylation of Akt and Erk,inhibits oxidative stress and apoptosis,exerts anti-arrhythmogenic effects and decreases the occurrence of ventricular arrhythmia and infracted area induced by myocardial IR.

The progress of interrelationship between chronic obstructive pulmonary disease and sudden cardiac death / 天津医药

Both chronic obstructive pulmonary disease (COPD) and sudden cardiac death (SCD) are major health burdens.In conclusion,cumulating evidence associates COPD with an increased risk of SCD.First,it is found that asystole and pulseless electric activity(PEA)are more common than ventricular tachycardia/ventricular fibrillation(VT/VF)in deaths associated with COPD in studying interrelationship between COPD and ventricul ararrhythmias and cardiac arrest. The underlying mechanism explaining this association requires further investigation.Second,it is found that COPD is associated with a prolonged and shortened QT interval in studying the role of ECG markers between SCD and COPD.Finally,studies of the potential impact of respiratory treatment on the occurrence of SCD showed conflicting results.Accurate prediction of SCD in the general population is still a challenge. The risk assessment of SCD might be guided by studying the link between COPD and SCD.