European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment.

AIMS: To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS: We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION: We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.

Short- and long-term effects of propafenone in ventricular arrhythmias.

The effectiveness of short- (15 days) and long- (12 months) term propafenone treatment was assessed in 53 patients presenting with more than 30 premature ventricular complexes per hour as detected by 24-hour ambulatory Holter monitoring. Thirty-nine patients had no apparent concomitant heart disease while 14 had chronic coronary artery disease. The effects of propafenone were analysed by ambulatory Holter monitoring after 15 days and at 3, 6 and 12 months. The initial dose was 150 mg four times daily and was increased up to 300 mg four times daily when necessary. Favourable short-term effects were obtained in 39 patients (73.6%). After 12 months, 17 patients (32.1%) were still on propafenone treatment with good results. Treatment was discontinued on account of low compliance in 28.3%. This was because treatment was ineffective even at high doses in 15.2%, because of severe side effects in 13.2%, because of proarrhythmic effects in 5.6% and for other causes in 5.6%.

Holter monitoring and provocative maneuvers in assessment of unipolar demand pacemaker myopotential inhibition.

Myopotential inhibition was produced by a combination of different provocative maneuvers in 423 (77%) out of 550 consecutive unipolar pacemaker patients. The most useful maneuvers were the hand-to-shoulder press (90% positivity) and the hand-to-hand press (60% positivity). Three groups of 20 patients were then submitted to 24 hours of Holter monitoring. Group A during the provocative maneuvers had shown myopotential inhibition and symptoms of cerebral ischemia. In group B symptomless myopotential inhibition had been induced. Group C had no myopotential inhibition nor symptoms during the tests. Abnormal pacemaker pauses related to myopotential inhibition were recorded during Holter monitoring in 90% of group A and in 80% of group B patients, but only group A patients showed symptoms. Thus in patients who are able to practice provocative isometric maneuvers and who can be selected according to their response, Holter monitoring seems to offer few advantages in discovering myopotential inhibition and related symptoms.

[Spontaneous changes of ventricular ectopic beats in ischemic patients and subjects without other signs of cardiopathy]. / Variabilità spontanea dei battiti ectopici ventricolari in pazienti ischemici ed in soggetti senzi altri segni di cardiopatia.

Spontaneous variability of premature ventricular complexes was evaluated by 72 hour continuous ambulatory electrocardiographic monitoring in 38 patients. Nineteen patients had coronary artery disease and 19 subjects had no documented signs of cardiac disease. Using multifactorial analysis of variance we determined the minimal percent reduction of premature ventricular complexes frequency that could not be ascribed to spontaneous variability alone in both single subject and in groups of 10 and 19 individuals and analyzed the difference between the two groups of ischemic and healthy patients. Our results show that in each subject with or without coronary artery disease the minimal reduction of premature ventricular complexes is similar: 71% and 72% respectively. On the other hand when the two groups were compared the percentage of reduction was 49% in healthy subjects and 40% in patients with coronary artery disease. Spontaneous variability of premature ventricular complexes decreases as the period of monitoring lengthens; however the improvement obtained with longer electrocardiographic monitoring doesn't justify the prolongation of the examination beyond 24 hours.

[Amiodarone in paroxysmal supra-ventricular tachycardias associated with sinus bradycardia]. / L'amiodarone dans les tachycardies supra-ventriculaires paroxystiques associées à une bradycardie sinusale.

The efficacy of amiodarone in the prevention of atrial tachycardia is well recognised. However, there remains some controversy over its use in patients with a basal sinus bradycardia because of the risk of further depression of sinus node function. We studied the effects of acute and chronic amiodarone therapy in 13 patients with paroxysmal supraventricular tachycardia and intercritical sinus bradycardias of between 40 and 50/min. All patients underwent electrophysiological investigation under basal conditions and after 5 mg/kg IV amiodarone. Five patients were excluded from chronic oral amiodarone therapy after IV amiodarone for the following reasons : sinus bradycardia of less than 30/min; sinus node recovery times greater than 2 s; 2nd or 3rd degree sino-atrial block. The other 8 patients were administered oral amiodarone on a long term basis. They were followed up clinically with dynamic ECGs every three months over a period of 1 to 3 years. All symptoms regressed in 6 patients. In one patient, the daily attacks of palpitations decreased to one a week. One patient did not improve. No cases of sino-atrial standstill were observed, although the sinus rate remained unchanged. The results of our study show that amiodarone may be administered for long periods in patients with sinus bradycardia and attacks of paroxysmal supraventricular tachycardia if the dynamic ECG during the waking hours shows a heart rate of no less than 40/min, and if electrophysiological investigations do not show significant depression of sinus node function after acute intravenous administration of the drug.