Miocardiopatía hipertrófica en la edad pediátrica. Revisión a propósito de una serie de casos

Introducción: La miocardiopatía hipertrófica (MCH) constituye una enfermedad compleja y variable en cuanto a morfología, fisiopatología, pronóstico y sobrevida. Se caracteriza por una hipertrofia del ventrículo izquierdo, aunque en ocasiones puede ser biventricular o ventricular derecha aislada. En la edad pediátrica predominan las causas no sarcoméricas. La ecocardiografía es el método diagnóstico más utilizado para caracterizar la morfología y repercusión hemodinámica, sin embargo, la resonancia magnética cardíaca (RMC) es de elección por aportar mayores ventajas morfológicas y funcionales. Las pruebas genéticas son de gran importancia en la determinación del diagnóstico etiológico, manejo terapéutico y pronóstico. El tratamiento tiene como objetivo principal mejorar la capacidad funcional y aliviar los síntomas. Los betabloqueantes no vasodilatadores son considerados de primera líneay en algunos casos se puede recurrir a terapias avanzadas como disopiramida o terapia de reducción septal (TRS), uso del cardiodesfibrilador implantable (CDI), y en ocasiones se debe considerar trasplante cardiaco en pacientes con síntomas refractarios al tratamiento médico y en MCH del tipo obstructivo. Materiales y métodos: Estudio observacional, descriptivo, corte transversal. Resultados: Se estudiaron 12 pacientes, desde enero de 2020 a diciembre de 2022, con edades comprendidas desde 5 meses hasta 16 años, diagnosticados con MCH de presentación clínica variable y de distintas etiologías. Conclusión: La MCH de causas no sarcoméricas como los síndromes malformativos y errores innatos del metabolismo son las que tienen peor pronóstico y sobrevida. La finalidad de detectar precozmente la MCH es el inicio temprano de la terapia específica, para así retrasar el compromiso cardiovascular y mejorar la sobrevida.

Introduction: Hypertrophic cardiomyopathy (HCM) is a complex and variable disease in terms of morphology, pathophysiology, prognosis and survival. It is characterized by left ventricular hypertrophy, although it can sometimes be biventricular or isolated right ventricular. In the pediatric population, non-sarcomeric causes predominate. Echocardiography is the most widely used diagnostic method to characterize morphology and hemodynamic repercussions; however, cardiac magnetic resonance imaging (CMR) is preferred because it provides greater morphological and functional advantages. Genetic tests are of great importance in determining the etiological diagnosis, therapeutic management and prognosis. The main objective of the treatment is to improve functional capacity and alleviate symptoms. Non-vasodilator beta-blockers are considered first-line treatment and in some cases advanced therapies such as disopyramide or septal reduction therapy (SRT), use of implantable cardioverter-defibrillator (ICD) can be used; heart transplantation should be considered in patients with symptoms refractory to medical treatment and in HCM of the obstructive type. Materials and methods: This was an observational, descriptive, cross-sectional study. Results: 12 patients were studied, from January 2020 to December 2022, with ages ranging from 5 months to 16 years, diagnosed with HCM of variable clinical presentation and of different etiologies. Conclusion: HCM from non-sarcomeric causes such as malformation syndromes and inborn errors of metabolism have the worst prognosis and survival. The purpose of early detection of HCM is the early initiation of specific therapy, in order to delay cardiovascular compromise and improve survival.

Delta of Egypt Atrial Fibrillation Registry Phase Two

Background: Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia found in clinical practice. The assessed frequency of AF in adults is between 2% and 4%, with greater incidence and frequency rates in developed nations [1,2]. AF prevalence increases with advancing age, and with some cardiac and non-cardiac disorders, also it may exist in the absence of any conditions [2]. We aimed to determine case characteristics, practice patterns, management strategies and outcomes of atrial fibrillation in the delta area of Egypt. Methods: This registry-based cross-sectional study included 1000 atrial fibrillation patients (with any AF patterns) who were allowed to enter ER in cardiac centers and hospitals in middle Delta of Egypt from April 2020 to March 2021. Results: 267 patients (26.7%) were unstable. Heart failure, hypertension, and coronary disease were still prevalent comorbidities in our AF dataset, where hypertension accounts for over 50% of all AF cases. Rheumatic valvular heart disorder was a major underlying disease for the development of AF, still about 25.5% by echocardiography. Lone AF still high 20.6%. CHA2DS2VASc score ?2 is 83.5%. A high proportion of cases were treated with pharmaceuticals for rate control nearly 52.7% of the cases and nearly 30.3% of the cases were given pharmacological medications for the cardioversion to the sinus rhythm and a small proportion of the cases were given electrical cardioversion nearly 7%. Conclusions: Coronary disease, hypertension, and heart failure were still usual comorbidities in AF. Rheumatic valvular heart disease is still about 25.5% of the total registry. Amiodarone is the most prevalent antiarrhythmic medications (AAD) used. lone AF still high 20.6%. minimal use of novel oral anticoagulant (OAC).

Clinical Evidence of Oral Chinese Patent Medicines in Treatment of Cardiac Arrhythmia： A Scoping Review / 中国实验方剂学杂志

ObjectiveTo review the drug information and research progress on oral Chinese patent medicines in the treatment of cardiac arrhythmia to identify existing problems and provide references for follow-up research. MethodChinese patent medicines against cardiac arrhythmia were retrieved from the three major drug catalogues，Yaozh.com，and relevant guidelines with arrhythmia as the retrieval term. The instructions for included Chinese patent medicines were retrieved through Yaozh.com and specific information was extracted. The research articles on Chinese patent medicines included were retrieved from the five databases，and the information meeting the inclusion and exclusion criteria was extracted and displayed in the form of text description and graphs after statistical analysis. ResultSixty-five oral Chinese patent medicines were included in this study，with the main functions of activating the blood and resolving stasis. The average daily cost of medicines was 8.17 yuan，and there were 42 medicines with an average daily cost of less than 10 yuan，showing a moderate medicine cost. A total of 351 research articles on Chinese patent medicines were screened out，including 259 randomized controlled trials （RCTs），16 non-RCTs，eight non-controlled trials，62 systematic reviews，two guidelines，and two expert consensuses. Eighteen types of Chinese patent medicines were involved，whose clinical trials had been conducted in 28 provinces，cities，autonomous regions，and municipalities in China. Wenxin granules and Shensong Yangxin capsules were the top medicines under investigation，accounting for 75.21% of all research articles. Among the included studies，the most common comparison design was Chinese patent medicine combined with western medicine vs western medicine （64.25%）. The outcome evaluation was mainly based on clinical efficacy，symptom efficacy，arrhythmia efficacy，adverse reactions，and heart rate changes. ConclusionThe number of clinical studies of oral Chinese patent medicines against cardiac arrhythmia varies greatly，but traditional Chinese medicine （TCM） syndrome differentiation thinking is less considered in practical application. Due to unstandardized clinical research and low-quality literature，further advancement is required in the future.

Effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction

SUMMARY BACKGROUND/INTRODUCTION: Heart failure patients with reduced ejection fraction are at high risk for ventricular arrhythmias and sudden cardiac death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, provides heart rate reduction in sinus rhythm and angina control in chronic coronary syndromes. OBJECTIVE: The effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction patients has not been fully elucidated. The aim of this study was to investigate the effect of ivabradine use on life-threatening arrhythmias and long-term mortality in heart failure patients with reduced ejection fraction patients. METHODS: In this retrospective study, 1,639 patients with heart failure patients with reduced ejection fraction were included. Patients were divided into two groups: ivabradine users and nonusers. Patients presenting with ventricular tachycardia, the presence of ventricular extrasystole, and ventricular tachycardia in 24-h rhythm monitoring, appropriate implantable cardioverter-defibrillator shocks, and long-term mortality outcomes were evaluated according to ivabradine use. RESULTS: After adjustment for all possible variables, admission with ventricular tachycardia was three times higher in ivabradine nonusers (95% confidence interval 1.5-10.2). The presence of premature ventricular contractions and ventricular tachycardias in 24-h rhythm Holter monitoring was notably higher in ivabradine nonusers. According to the adjusted model for all variables, 4.1 times more appropriate implantable cardioverter-defibrillator shocks were observed in the ivabradine nonusers than the users (95%CI 1.8-9.6). Long-term mortality did not differ between these groups after adjustment for all covariates. CONCLUSION: The use of ivabradine reduced the appropriate implantable cardioverter-defibrillator discharge in heart failure patients with reduced ejection fraction patients. Ivabradine has potential in the treatment of ventricular arrhythmias in heart failure patients with reduced ejection fraction patients.

Evaluation of cardiac-electrophysiological balance according to National Institutes of Health Stroke Scale score at admission and discharge in acute ischemic stroke patients: A pilot study

SUMMARY OBJECTIVE: The main objectives of this investigation were to determine whether there were any relationships between corrected cardiac-electrophysiological balance value and National Institutes of Health Stroke Scale scores at admission and discharge in patients with acute ischemic stroke and to assess whether cardiac-electrophysiological balance value was an independent predictor of high National Institutes of Health Stroke Scale scores (National Institutes of Health Stroke Scale score ≥5). METHODS: In this retrospective and observational study, 231 consecutive adult patients with acute ischemic stroke were evaluated. The cardiac-electrophysiological balance value was obtained by dividing the corrected QT interval by the QRS duration measured from surface electrocardiography. An experienced neurologist used the National Institutes of Health Stroke Scale score to determine the severity of the stroke at the time of admission and before discharge from the neurology care unit. The participants in the study were categorized into two groups: those with minor acute ischemic stroke (National Institutes of Health Stroke Scale score=1-4) and those with moderate-to-severe acute ischemic stroke (National Institutes of Health Stroke Scale scores ≥5). RESULTS: Acute ischemic stroke patients with National Institutes of Health Stroke Scale score ≥5 had higher heart rate, QT, corrected QT interval, T-peak to T-end corrected QT interval, cardiac-electrophysiological balance, and cardiac-electrophysiological balance values compared with those with an National Institutes of Health Stroke Scale score of 1-4. The cardiac-electrophysiological balance value was shown to be independently related to National Institutes of Health Stroke Scale scores ≥5 (OR 1.102, 95%CI 1.036-1.172, p<0.001). There was a moderate correlation between cardiac-electrophysiological balance and National Institutes of Health Stroke Scale scores at admission (r=0.333, p<0.001) and discharge (r=0.329, p<0.001). CONCLUSIONS: The findings of this study demonstrated that the cardiac-electrophysiological balance value was related to National Institutes of Health Stroke Scale scores at admission and discharge. Furthermore, an elevated cardiac-electrophysiological balance value was found to be an independent predictor of National Institutes of Health Stroke Scale score ≥5.

ICD indication in hypertrophic cardiomyopathy: which algorithm to use?

SUMMARY OBJECTIVE: This study aimed to evaluate the agreement in the indication of implantable cardioverter-defibrillators in patients with Hypertrophic cardiomyopathy, as per the 2014 European Society of Cardiology and 2020 American Heart Association recommendations, and evaluate fragmented QRS as a predictor of cardiovascular outcome. METHODS: Retrospective cohort with 81 patients was evaluated between 2019 and 2021. Patients with hypertrophic cardiomyopathy ≥16 years old were included. Exclusion criteria include secondary myocardiopathy and follow-up <1 year. Kappa coefficient was used to determine the agreement. Survival and incidence curves were determined by Kaplan-Meier method. A p<0.05 was considered significant. RESULTS: The fragmented QRS was identified in 44.4% of patients. There were no differences between patients with and without fragmented QRS regarding clinical parameters, echocardiography, fibrosis, and sudden cardiac death risk. During follow-up of 4.8±3.4 years, there was no sudden cardiac death, but 20.6% patients with implantable cardioverter-defibrillator had at least one appropriate shock. Three of the seven appropriate shocks occurred in European Society of Cardiology low- to moderate-risk patients. Three shocks occurred in moderate-risk patients and four in American Heart Association high-risk patients. Overall recommendations agreement was 64% with a kappa of 0.270 (p=0.007). C-statistic showed no differences regarding the incidence of appropriate shock (p=0.644). CONCLUSION: sudden cardiac death risk stratification algorithms present discrepancies in implantable cardioverter-defibrillator indication, both with low accuracy.

Intervenções de enfermagem no cuidado aos pacientes portadores de arritmias cardíacas / Intervenciones de enfermería en el cuidado de pacientes con arritmia cardíaca / Nursing interventions in the care of patients with heart arrhythmia

Objetivo: as arritmias cardíacas acometem mais de 20 milhões de brasileiros, desse modo, o presente estudo objetiva realizar um levantamento sobre as intervenções de enfermagem diante de um quadro de arritmia em ambiente hospitalar. Método: trata-se de revisão integrativa de literatura de caráter descritivo, realizada entre janeiro e fevereiro de 2022. Por meio de buscas na biblioteca virtual de saúde BVS (Lilacs, Medline, BDEnf, IBECs, PAHO) e Scielo BDenf de artigos publicados nos últimos 5 anos. Resultados: os enfermeiros têm aptidão para identificar anormalidades no ritmo cardíaco. A compreensão das complicações pós-operatórias contribui para a elaboração de um plano de cuidado mais eficaz. As intervenções de enfermagem devem ser pautadas no monitoramento da arritmia, bem como orientação sobre o uso dos antiarrítmicos e esclarecimento de dúvidas sobre a doença. Conclusão: é imprescindível a atuação do enfermeiro na assistência a pacientes com arritmias cardíacas, o qual necessitam monitorar os sinais vitais para determinar o efeito hemodinâmico de tal problema cardíaco, manter uma atitude tranquilizadora e compartilhar informações sobre a patologia e seu tratamento.(AU)

Objective: cardiac arrhythmias affect more than 20 million Brazilians, thus, the present study aims to carry out a survey on nursing interventions in the face of arrhythmia in a hospital environment. Method: Method: this is an integrative literature review of a descriptive nature, carried out between January and February 2022. Through searches in the virtual health library VHL (Lilacs, Medline, BDEnf, IBECs, PAHO) and Scielo. Results: nurses are able to identify heart rhythm abnormalities. Understanding postoperative complications contributes to the development of a more effective care plan. Nursing interventions should be guided by the monitoring of arrhythmia, as well as guidance on the use of antiarrhythmics and clarification of doubts about the disease. Conclusion: it is essential for nurses to assist patients with cardiac arrhythmias, who need to monitor vital signs to determine the hemodynamic effect of such a heart problem, maintain a reassuring attitude and share information about the pathology and its treatment.(AU)

Objetivo: las arritmias cardíacas afectan a más de 20 millones de brasileños, por lo tanto, el presente estudio tiene como objetivo realizar una encuesta sobre las intervenciones de enfermería frente a la arritmia en un ambiente hospitalario. Método: se trata de una revisión integrativa de la literatura de carácter descriptivo, realizada entre enero y febrero de 2022. Mediante búsquedas en la biblioteca virtual en salud BVS (Lilacs, Medline, BDEnf, IBECs, PAHO) y Scielo. Resultados: los enfermeros logran identificar alteraciones del ritmo cardíaco. Comprender las complicaciones posoperatorias contribuye al desarrollo de un plan de atención más eficaz. Las intervenciones de enfermería deben estar guiadas por el seguimiento de la arritmia, así como orientación sobre el uso de antiarrítmicos y aclaración de dudas sobre la enfermedad. Conclusión: es fundamental que los enfermeros ayuden a los pacientes con arritmias cardíacas, que necesitan monitorear los signos vitales para determinar el efecto hemodinámico de tal problema cardíaco, mantener una actitud tranquilizadora y compartir información sobre la patología y su tratamiento.(AU)

Leocádia e sua passagem pelos infernos / Leocádia and her journey through hell / Leocádia y su paso por los infiernos

Narrativa que percorre o conjunto de atendimentos clínicos vividos por uma dupla, médica e paciente, no Ambulatório de Arritmia durante o processo de tratamento de uma jovem, sem cardiopatia estrutural, com arritmia ventricular complexa, muito sintomática, sem resposta ao tratamento convencional. Utilizou-se abordagem médica ampliada, não convencional, em que o perfil psicoemocional da paciente foi levado em consideração. Por meio de um método cartográfico, buscou-se delinear os percursos trilhados, ressaltando-se os afetos vividos, os impasses, superações e paradas, enquanto vincos de intensidade que marcaram diversos acontecimentos. A paciente obteve reversão das arritmias e dos sintomas após três anos e meio de tratamento e segue sem arritmia após seis anos e meio. Com isso, acreditamos poder colaborar, de forma construtiva, com o questionamento de diversos aspectos das relações clínicas contemporâneas, das dimensões afetivas do adoecer e de processos implicados na construção da saúde. (AU)

arrative depicting the clinical care journey experienced by a doctor and her patient-a young woman with symptomatic ventricular tachycardia, with no structural heart disease, with no response to conventional treatment-at the Arrhythmia Outpatient Clinic. The non-conventional expanded medical approach-where the patient's psychoemotional profile is taken into consideration - was adopted. Through a cartographic method, we aim to trace the paths taken, highlighting feelings, deadlocks, achievements, and stoppage moments as lines of intensity marking several events. The patient reversed her arrhythmia and symptoms after three and a half years of treatment, and remains so after six and a half years. Therefore, we believe we can constructively cooperate with the discussions of several aspects of contemporary clinical relations, affective dimensions of becoming ill, and processes implied in the development of health. (AU)

Narrativa que trascurre por el conjunto de atenciones clínicas vividas por dos personas, una médica y una paciente, en el Ambulatorio de Arritmia, durante el proceso de tratamiento de una joven, sin cardiopatía estructural, con arritmia ventricular compleja, muy sintomática, sin respuesta al tratamiento convencional. Se utilizó el abordaje médico ampliado, no convencional, en el que el perfil psicoemocional de la paciente se llevó en consideración. Por medio de un método cartográfico, se buscó delinear los recorridos seguidos, subrayándose los afectos vividos, los callejones sin salida, las superaciones y las paradas, como marcas de intensidad que señalaron diversos acontecimientos. La paciente tuvo reversión de las arritmias y de los síntomas después de tres años y medio de tratamiento y continúa sin arritmia pasados seis años y medio. De esa forma, creemos que podemos colaborar, de forma constructiva, con el cuestionamiento de diversos aspectos de las relaciones clínicas contemporáneas, de las dimensiones afectivas del enfermarse y de procesos implicados en la construcción de la salud. (AU)

A clinical study of arrhythmias associated with acute coronary syndrome: a hospital based study of a high risk and previously undocumented population

Background: ACS represents a global epidemic. Arrhythmia in ACS is common. Careful investigation may lead to further improvement of prognosis. Retrospectively analyzed the year- round data of our center. Study was undertaken to analyze the incidence, frequency and type of arrhythmias in ACS. This is to aid timely intervention and to modify the outcome. Identification of the type of arrhythmia is of therapeutic and prognostic importance.Methods: This cross sectional analytical study was conducted in the Department of Cardiology, Apollo Hospitals Dhaka, from January 2019 to January 2020 with ACS patients. Enrolled consecutively and data analyzed.Results: There were 500 patients enrolled considering inclusion and exclusion criteria. Sample was subdivided into 3 groups on the type of ACS. Group-I with UA, Group-II with NSTE - ACS and Group-III with STE - ACS. Different types of arrhythmia noted. Types of arrhythmia were correlated with type of ACS. 500 patients included. Mean age 55.53±12.70, 71.6% male and 28.4% female. 60.4% hypertensive, 46.2% diabetic, 20.2% positive family history of CAD, 32.2% current smoker, 56.4% dyslipidaemic and 9.6% asthmatic. 31.2% UA, 39.2% NSTE-ACS and 29.6% STE-ACS. Type of arrhythmias noted. 22% sinus tachycardia, 20.2% sinus bradycardia, 9% atrial fibrillation, 5.2% ventricular ectopic, 4.8% supra ventricular ectopic, 2.8% bundle branch block, 2.2% atrio-ventricular block, 1% broad complex tachycardia, 0.4% narrow complex tachycardia, 0.2% sinus node dysfunction and 32.2% without any arrhythmia. Significant incidences of arrhythmia detected - respectively 29.8%, 39.2% and 31%, p<0.001.Conclusions: In conclusion, arrhythmias in ACS are common. More attention should be paid to improve their treatment and prognosis.

Resultado del tratamiento en pacientes sometidos a ablación percutánea por arritmias supraventriculares en la ciudad de Cuenca, periodo abril 2013- julio 2018 / Treatment outcome of percutaneous ablation in patients with supraventricular arrhythmias in Cuenca, April 2013- July 2018

INTRODUCCIÓN: Las taquicardias supraventriculares son comunes en la práctica clínica, a pesar de tener buen pronóstico, puede afectar significativamente la calidad de vida de los pacientes. El tratamiento médico no da como resultado la ausencia total de la arritmia, por lo que la terapia por ablación se ha convertido en el tratamiento de elección en muchos de los casos por su alto índice de éxito brindando una solución definitiva. El objetivo de este estudio es determinar la frecuencia de presentación de las principales taquicardias supraventriculares, distribuidas por edad y sexo, la frecuencia de éxito de la ablación percutánea y los factores relacionados con el mismo y la frecuencia de las complicaciones presentadas. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo transversal y de correlación, que incluyó 156 con diagnóstico de taquicardia supraventricular y ablacionados en los cinco centros hospitalarios en donde se realizó el procedimiento, basándonos en los registros clínicos de los mismos. RESULTADOS: De los 156 pacientes, 51.9% fueron mujeres y 48.1% hombres, con edades comprendidas entre los 10 y 80 años de edad. Las arritmias reportadas fueron taquicardia de reentrada nodal, taquicardia reentrante auriculoventricular y flutter auricular, de estas la más frecuente fue la taquicardia por reentrada auriculoventricular. El éxito global del tratamiento fue del 93.5%, sin reportar complicaciones, los factores relacionados estudiados no presentaron asociación estadísticamente significativa. CONCLUSIÓN: El tratamiento por ablación tuvo un alto porcentaje de éxito y una tasa nula de complicaciones, esto es un indicador tanto de eficacia como seguridad de este procedimiento.(au)

BACKGROUND: Supraventricular tachycardia is commonly diagnosed in clinical practice, despite having a good prognosis, it can significantly affect the patient's life quality. Pharmacological treatment does not result in the total absence of the arrhythmia, which is why ablation therapy has become the treatment of choice, due to its high success rate, and for offering a definitive solution. The aim of this study was to determine the frequency of each supraventricular tachycardia type, according to age and sex, the rate of success of percutaneous ablation and its related factors, and the frequency of complications due to the procedure. METHODS: A cross-sectional, descriptive, correlational study was conducted, including 156 patients diagnosed with supraventricular tachycardia and ablated, from five hospitals where the procedure was performed, based on their clinical records. RESULTS: From the 156 patients in this study, 51.9% were women and 48.1% men, the age ranged between 10 and 80 years. The most commonly reported arrhythmias were nodal reentrant tachycardia, atrioventricular reentrant tachycardia and atrial flutter, being the atrioventricular reentrant tachycardia the most frequent of all. The global success rate was 93.5%, no complications were reported, and none of the studied factors had significant statistical association with the success rate. CONCLUSION: Ablation treatment had a high success rate, with cero complications in this study, demonstrating the efficacy and safety of the procedure.(au)

Effect of Renal Denervation on Suppression of PVC and QT Prolongation in a Porcine Model of Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Antiarrhythmic effect of renal denervation (RDN) after acute myocardial infarction (AMI) remains unclear. The goal of this study was to evaluate the effect of RDN on ventricular arrhythmia (VA) after AMI in a porcine model.METHODS: Twenty pigs were randomly divided into 2 groups based on RDN (RDN, n=10; Sham, n=10). After implanting a loop recorder, AMI was induced by occlusion of the middle left anterior descending coronary artery. Catheter-based RDN was performed for each renal artery immediately after creating AMI. Sham procedure used the same method, but a radiofrequency current was not delivered. Electrocardiography was monitored for 1 hour to observe VA. One week later, the animals were euthanized and the loop recorder data were analyzed.RESULTS: Ventricular fibrillation event rate and the interval from AMI creation to first VA in acute phase were not different between the 2 groups. However, the incidence of premature ventricular complex (PVC) was lower in the RDN than in the Sham. Additionally, RDN inhibited prolongation of the corrected QT (QTc) interval after AMI. The frequency of non-sustained or sustained ventricular tachycardia, arrhythmic death was lower in the RDN group in the early period.CONCLUSIONS: RDN reduced the incidence of PVC, inhibited prolongation of the QTc interval, and reduced VA in the early period following an AMI. These results suggest that RDN might be a therapeutic option in patients with electrical instability after AMI.

Cardiomyopathy in Patients with Myasthenia Gravis Crisis

Myasthenia gravis (MG) crisis is a life-threatening condition characterized by respiratory failure requiring intubation and mechanical ventilation. Cardiac problem in patients with MG crisis is a rare condition, presenting as cardiomyopathy, arrhythmia, heart failure and sudden death. We report two cases that developed arrhythmia and stress-induced cardiomyopathy during MG crisis episodes.

Reporte de caso: bloqueo del ganglio estrellado para manejo de la tormenta eléctrica / Case report: stellate ganglion blockade for electric storm management

The electric storm is an emergency whose handling is very demanding. Our case report describes a patient with multiple episodes of ventricular tachycardia, refractory to conventional therapy (antiarrhythmics, beta blockers and sedoanalgesia) where the sympathetic activity of the heart seems to play a crucial role. We decided to try as additional therapeutic strategy, the performing of a transient and bilateral blockade of the stellate ganglion under ultrasound guidance, this procedure was carried out at the patient's bed, without complications during the same. The sympathetic modulation allowed us to optimize conventional antiarrhythmic therapy, thus reducing the appearance of malignant arrhythmias.

La tormenta eléctrica es una emergencia cuyo manejo es muy exigente. Nuestro reporte de caso describe a un paciente con múltiples episodios de taquicardia ventricular refractarios a terapia convencional (antiarrítmicos, betabloqueadores y sedoanalgesia) donde la actividad simpática del corazón parece jugar un rol crucial. Decidimos plantear como estrategia terapéutica adicional la realización de un bloqueo transitorio y bilateral del ganglio estrellado bajo guía ecográfica, este procedimiento se realizó en la cama del paciente, sin complicaciones durante el mismo. La modulación simpática nos permitió optimizar la terapia antiarrítmica convencional, logrando así reducir la aparición de arritmias malignas.

Conventional Acupuncture for Cardiac Arrhythmia: A Systematic Review of Randomized Controlled Trials / 中国结合医学杂志

<p><b>OBJECTIVE</b>To exam the effect and safety of conventional acupuncture (CA) on cardiac arrhythmia.</p><p><b>METHODS</b>Nine medical databases were searched until February 2016 for randomized controlled trials. Heterogeneity was measured by Cochran Q test. Meta-analysis was conducted if I was less than 85% and the characteristics of included trials were similar.</p><p><b>RESULTS</b>Nine qualified studies involving 638 patients were included. Only 1 study had definitely low risk of bias, while 7 trials were rated as unclear and 1 as high. Meta-analysis of CA alone did not have a significant benefit on response rate compared to amiodarone in patients with atrial fibrillation (Af) and atrial flutter (AF) [relative risk (RR): 1.09; 95% confidence interval (CI): 0.79-1.49; P=0.61; I=61%, P=0.11]. However, 1 study with higher methodological quality detected a lower recurrence rate of Af in CA alone as compared with sham acupuncture plus no treatment, and benefits on ventricular rate and time of conversion to normal sinus rhythm were found in CA alone group by 1 study, as well as the response rate in CA plus deslanoside group by another study. Meta-analysis of CA plus anti-arrhythmia drug (AAD) was associated with a significant benefit on the response rate when compared with AAD alone in ventricular premature beat (VPB) patients (RR, 1.19, 95% CI: 1.05-1.34; P=0.005; I=13%, P=0.32), and an improvement in quality-of-life score (QOLS) of VPB also showed in 1 individual study. Besides, a lower heart rate was detected in the CA alone group by 1 individual study when compared with no treatment in sinus tachycardia patients (MD-21.84 [-27.21,-16.47]) and lower adverse events of CA alone were reported than amiodarone.</p><p><b>CONCLUSIONS</b>CA may be a useful and safe alternative or additive approach to AADs for cardiac arrhythmia, especially in VPB and Af patients, which mainly based on a pooled estimate and result from 1 study with higher methodological quality. However, we could not reach a robust conclusion due to low quality of overall evidence.</p>

Inhibitory effect of monoclonal antibody NCX-2D2 on isoproterenol-induced arrhythmias in adult rat hearts / 中国药理学通报

Aim To investigate the effects of mono-clonal antibody NCX-2D2 on isoproterenol-induced ar-rhythmias in rat hearts, and to explore the electrophys-iological mechanism. Methods Using isoproterenol to establish in vitro and in vivo arrhythmic rat models to observe the effect of NCX-2D2 antibody on ventricular arrhythmias in rats. The whole-cell patch clamp tech-nique was used to investigate the effects of NCX-2D2 antibody on INa/Ca, ICa-Lat voltage-clamp mode and on DADs at current-clamp mode in single rat ventricular myocytes. Results 10 mg·L-1NCX-2D2 antibody significantly inhibited cardiac arrhythmias induced by ISO in vitro ( P<0.01) . 80 μg·kg-1NCX-2D2 anti-body markedly inhibit the occurrence of arrhythmias in ISO-induced anesthetized rats in vivo ( P <0.01 ) . 5 mg·L-1NCX-2D2 antibody partially inhibited the in-crease of INa/Ca(P<0.01) and the increase of ICa-L(P<0.01 ) , and could effectively inhibit ISO-induced DADs in rat ventricular myocytes ( P <0.05 ) . Con-clusions The sodium-calcium exchanger monoclonal antibody NCX-2D2 significantly inhibits isoproterenol-induced ventricular arrhythmias in rats. The mecha-nism against ventricular arrhythmias is mainly due to its inhibition of cardiomyocyte sodium-calcium exchanger and L-type calcium channel and marked suppression of DADs in rat ventricular myocytes.

The roles of Epac in ventricularar rhythmogenesis and chronic heart failure / 医学研究生学报

Epac acts as a guanine nucleotide exchange factor for the Raslike small G-proteins Rap1 and Rap2,which activates independently classical effector of cAMP,protein kinase A. Many studies have demonstrated that Epac modulates various cAMP-de-pendent cardiovascular functions,such as calcium handling and ion channel remodeling,which are involved in the development of ar-rhythmias and heart failure. The novel cAMP sensor may represent an attractive therapeutic target for the treatment of several cardiovas-cular disorders,including cardiac arrhythmias and heart failure,because themodulation of Epac function is expected to enable morespe-cific regulation of particular cAMP-mediated signals than therapies targeting β-AR and Acs.

Cardiotoxicidad por quimioterapia en el Instituto Nacional de Enfermedades Neoplásicas 2012-2016 / Chemotherapy-induced cardiotoxicity at the Instituto Nacional de Enfermedades Neoplásicas 2012-2016

Objetivo: Reportar la frecuencia de los efectos adversos a nivel cardiaco (cardiotoxicidad) producida por la quimioterapia en los pacientes del Instituto Nacional de Enfermedades Neoplásicas en el período 2012-2016. Materiales y métodos: El estudio realizado fue de tipo no experimental, descriptivo y retrospectivo. La población estudiada fueron los pacientes atendidos en el Servicio de Cardiología por presentar durante la quimioterapia molestias cardiovasculares. Resultados: Se realizaron 985 evaluaciones por sintomatología cardiaca de pacientes en tratamiento antineoplásico. Entre los efectos adversos a nivel del corazón de la terapia oncológica, las arritmias cardiacas fueron las más frecuentes (41,2%), en segundo lugar estuvieron los episodios de angina de pecho con un 18,7% y la insuficiencia cardiaca tuvo una frecuencia del 4,9%. La bradicardia sinusal ha sido la arritmia más usual (55,9%), seguida por la taquicardia sinusal sintomática (17,7%) y, en tercer lugar, la fibrilación auricular (12,0%). Conclusiones: La arritmia cardiaca fue el efecto adverso más frecuente del tratamiento oncológico, siendo la bradicardia sinusal asintomática la de mayor prevalencia

objective: To report the frequency of cardiac adverse effects (cardiotoxicity) induced by chemotherapy in patients of the Instituto Nacional de Enfermedades Neoplásicas during the period 2012-2016. Materials and methods: The study had a non-experimental, descriptive and retrospective design. The study population consisted of patients treated at the Cardiology Service due to cardiovascular discomfort during chemotherapy. Results: Nine hundred eighty-five (985) evaluations were performed because of cardiac symptoms in patients undergoing antineoplastic treatment. Among the oncological treatment-related cardiovascular adverse effects, cardiac arrhythmias were the most frequent ones (41.2%), episodes of angina pectoris were in the second place with 18.7%, and heart failure had a frequency of 4.9%. The most frequent arrhythmia was sinus bradycardia (55.9%), followed by symptomatic sinus tachycardia (17.7%) and, in the third place, atrial fibrillation (12.0%). Conclusions: Cardiac arrhythmia was the most frequent adverse effect induced by oncological treatment, with asymptomatic sinus bradycardia being the most prevalent one

Clinical and Etiological Profile of Patients with Atrial Fibrillation (AF): Analysis and implications

Background and Objectives: Atrial fibrillation (AF) is a frequently encountered cardiac arrhythmia which may be either symptomatic or asymptomatic. So, this study was conducted to know clinical presentation and to find out possible clinical and etiological profile of patients with AF.Material and Methods: This cross sectional study was conducted at Osh Regional Integrated Clinical Hospital, Osh Territorial City Clinical Hospital, The Kyrgyz Republic in collaboration with Janaki Medical College Teaching Hospital, Janakpurdham, Nepal. Sixty consecutive patients with AF were taken. Presenting complaints, past history, personal history was recorded. A thorough clinical examination was done, electrocardiogram, chest X-Ray posterio-anterior view, echocardiogram, thyroid function test and relevant test were done and analyzed.Results: Forty percent of the patients complained palpitation. Systemic thrombo-embolism was found in 15% of the patients. Other presenting complaints were cough, chest pain, shortness of breath, dizziness, swelling of the legs, tremors. Eighteen percent of patients presented with features of congestive cardiac failure and 30% of the patients gave history of rheumatic heart disease, 16.6% and 11.6% hypertension and ischemic heart disease respectively. Etiology-wise, rheumatic heart disease was the most common (46.6%) followed by hypertension (21.6%), ischemic heart disease (11.6%), dilated cardiomyopathy (6.6%), hyperthyroidism (5%), pneumonia (5%).Conclusion: Rheumatic heart disease, especially mitral stenosis is the most common cause of AF in this study. Systemic hypertension was next common etiology of AF, followed by ischaemic heart disease, dilated cardiomyopathy, thyroid disease. Heart failure, Systemic thromboembolism, decreased exercise tolerance are a major determinants for development of significant morbidity and mortality.