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Cardiac rhythm management

Lasse Skibsbye, Thomas Jespersen, Torsten Christ, Mary M Maleckar, Jonas van den Brink, Pasi Tavi, Jussi T Koivumäki
BACKGROUND: Refractoriness of cardiac cells limits maximum frequency of electrical activity and protects the heart from tonic contractions. Short refractory periods support major arrhythmogenic substrates and augmentation of refractoriness is therefore seen as a main mechanism of antiarrhythmic drugs. Cardiomyocyte excitability depends on availability of sodium channels, which involves both time- and voltage-dependent recovery from inactivation. This study therefore aims to characterise how sodium channel inactivation affects refractoriness in human atria...
October 20, 2016: Journal of Molecular and Cellular Cardiology
Peter A McCullough, Christopher T Chan, Eric D Weinhandl, John M Burkart, George L Bakris
The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, cardiomyopathy, and valvular heart disease, is higher in hemodialysis (HD) patients than in the US resident population. Cardiovascular disease is the leading cause of death in HD patients and the principal discharge diagnosis accompanying 1 in 4 hospital admissions. Furthermore, the rate of hospital admissions for either heart failure or fluid overload is persistently high despite widespread use of β-blockers and renin-angiotensin system inhibitors and attempts to manage fluid overload with ultrafiltration...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Abraham Speedie, Cinosh Mathew, Ramgopal S Shahi, Rajneesh Calton
INTRODUCTION: The development of implantable technology for cardiac rhythm management remains one of the seminal achievements of the second half of the 20th century. The development of artificial pacemakers for the electrical control of the cardiac rhythm has greatly enhanced the physician's ability to treat cardiac dysrhythmias. An ageing population and the extension of indications will in all probability result in an increasing number of cardiac device implantations. OBJECTIVE OF STUDY: To study mortality and morbidity in patients with permanent pacemaker implantation at a tertiary care hospital in North India...
September 2016: Journal of the Association of Physicians of India
Steven Swiryn, Michael V Orlov, David G Benditt, John P DiMarco, Donald M Lloyd-Jones, Edward Karst, Fujian Qu, Mara T Slawsky, Melanie Turkel, Albert L Waldo
BACKGROUND: The RATE Registry (Registry of Atrial Tachycardia and Atrial Fibrillation Episodes) is a prospective, outcomes-oriented registry designed to document the prevalence of atrial tachycardia and/or fibrillation (AT/AF) of any duration in patients with pacemakers and implantable cardioverter defibrillators (ICDs) and evaluate associations between rigorously adjudicated AT/AF and predefined clinical events, including stroke. The appropriate clinical response to brief episodes of AT/AF remains unclear...
October 18, 2016: Circulation
Giuseppe Ciconte, Massimo Saviano, Luigi Giannelli, Zarko Calovic, Mario Baldi, Cristiano Ciaccio, Amarild Cuko, Raffaele Vitale, Daniele Giacopelli, Manuel Conti, Felicia Lipartiti, Federica Giordano, Fabio Maresca, Mario Moscatiello, Gabriele Vicedomini, Vincenzo Santinelli, Carlo Pappone
AIMS: Continuous rhythm monitoring is valuable for adequate atrial fibrillation (AF) management in the clinical setting. Subcutaneous leadless implantable cardiac monitors (ICMs) yield an improved AF detection, overcoming the intrinsic limitations of the currently available external recording systems, thus resulting in a more accurate patient treatment. The study purpose was to assess the detection performance of a novel three-vector ICM device equipped with a dedicated AF algorithm. METHODS AND RESULTS: Sixty-six patients (86...
October 4, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
C Moini, B Sidia, D Poindron, L Fiorina, A Farge, W Amara, M El Issa
Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide technique in the field of treating aortic stenosis. One of the main side effects linked to the technique are mostly attached to rhythm disturbances, such as atrioventricular (AV) and intraventricular blocks. Consequently, a pacemaker implantation is often required. That implantation rate is estimated between 8 and 30%, depending on the valve chosen. Thanks to main meta analysis on the subject, it has been managed to isolate the following risks factors for AV block development: preoperative right bundle branch block (RBBB: the most powerful element), complete AV block during the procedure, male gender, a so-called porcelain aorta, the absence of previous valvular surgery, the aortic annulus size (i...
September 29, 2016: Annales de Cardiologie et D'angéiologie
W Amara, S Naccache, C Akret, S Cheggour, S M'Zoughi, G Galuscan, A Dompnier
INTRODUCTION: Management of antiplatelet therapy at the time of device implantation remains controversial. This study aimed to assess the risk of bleeding complications in patients receiving ticagrelor at the time of cardiac device surgery. METHODS: We performed a multicentre (n=4), retrospective study from January 2015 to January 2016. The survey included all patients (pts) treated with ticagrelor before undergoing pacemaker, implantable cardioverter-defibrillator (ICD) implantation or generator replacement...
September 29, 2016: Annales de Cardiologie et D'angéiologie
Adrian D Elliott, Rajiv Mahajan, Dennis H Lau, Prashanthan Sanders
Exercise training has considerable health benefits. However, recent research has demonstrated a greater risk of atrial arrhythmias in endurance athletes. The mechanisms promoting atrial fibrillation in athletes are unclear but there seems to be a central role for atrial remodeling, accompanied by autonomic alterations and inflammation. Animal studies have provided unique insights, yet prospective human data are lacking. Treatment options seem to yield similar efficacy to that seen in a nonathletic population and may be justified as an early rhythm control strategy...
November 2016: Cardiology Clinics
Christopher C Cheung, Andrew D Krahn
Implantable loop recorders (ILRs) have become an important pillar in the diagnostic work-up of patients with unexplained syncope. The modern ILR is minimally-invasive and provides an extended-duration of monitoring with high diagnostic yield. These insertable cardiac monitors (ICMs) enable prolonged monitoring that extends the opportunity for symptom-rhythm correlation from days-weeks to years, with associated incremental diagnostic yield. Over the years, observational studies and randomized trials have supported a unique role for ILRs in the assessment of recurrent or high-risk unexplained syncope...
October 3, 2016: Expert Review of Medical Devices
Christian Steinberg, Zachary W M Laksman, Andrew D Krahn
Sudden cardiac death (SCD) is still among the leading causes of death in women and men, accounting for over 50% of all fatal cardiovascular events in the United States. Two arrhythmia mechanisms of SCD can be distinguished as follows: shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia) and non-shockable rhythms including asystole or pulseless electrical activity. The overall prognosis of cardiac arrest due to shockable rhythms is significantly better. While the majority of SCDs is attributed to coronary artery disease or other structural heart disease, no obvious cause can be identified in 5% of all events, and those events are labeled as sudden unexplained deaths (SUD)...
November 2016: Trends in Cardiovascular Medicine
Veerapong Vattanavanit, Rungsun Bhurayanontachai
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of intensive care unit admission, which results in high hospital mortality. Targeted temperature management (TTM) was introduced several years ago and is considered to improve neurological and mortality outcomes. This management process was implemented in our hospital in 2012, which was expected to improve the standard of care in OHCA patients. PURPOSE: We aimed to report the clinical and mortality outcomes after TTM was introduced to our hospital in 2012...
2016: Open Access Emergency Medicine: OAEM
Julianna Jung
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm...
October 2016: Emergency Medicine Practice
Nichole Bosson, Amy H Kaji, Andrea Fang, Joseph L Thomas, William J French, David Shavelle, James T Niemann
BACKGROUND: The purpose of this study was to evaluate sex differences in out-of-hospital cardiac arrest (OHCA) characteristics, interventions, and outcomes. METHODS AND RESULTS: This is a retrospective analysis from a regionalized cardiac arrest system. Data on patients treated for OHCA are reported to a single registry, from which all adult patients were identified from 2011 through 2014. Characteristics, treatment, and outcomes were evaluated with stratification by sex...
September 2016: Journal of the American Heart Association
Alessio Galli, Francesco Ambrosini, Federico Lombardi
Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages...
August 2016: Arrhythmia & Electrophysiology Review
Mindy Vroomen, Laurent Pison
PURPOSE: Hybrid ablation for AF is performed in a growing number of centers. Due to absence of guidelines, operative approaches and perioperative care differ per center. In this review, an overview of findings from published studies on hybrid ablations is given, and related topics are discussed (e.g., one- and two-stage approaches, lesion sets, and patient management). METHODS: A systematic literature search was performed in the PubMed and Embase databases. All identified articles were screened and checked for eligibility by the two authors...
September 9, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Monica Maselli, Valter Giantin, Alessandro Franchin, Francesca Attanasio, Alessandra Tramontano, Pietro De Toni, Valentina Pengo, Domenico Corrado, Enzo Manzato
INTRODUCTION: Little is known about the effects of atrial fibrillation (AF) on blood pressure (BP) levels in hypertensive patients. Some studies suggest a role for rhythm control in managing such patients' BP, but the improvement observed in cardiac performance after restoring sinus rhythm (SR) may coincide with an increase in BP. The aim of this study was to apply ambulatory BP monitoring to analyze BP changes in hypertensive patients after electrical cardioversion for persistent AF...
September 7, 2016: Blood Pressure Monitoring
Patrick Lugenbiel, Patrick A Schweizer, Hugo A Katus, Dierk Thomas
The clinical management of heart rhythm disorders still constitutes a major challenge. The development of alternatives to current approaches is of significant interest in order to establish more effective therapies that increase quality of life and reduce symptoms and hospitalizations. Over the past two decades the mechanistic understanding of pathophysiological pathways underlying cardiac arrhythmias has advanced profoundly, opening up novel avenues for mechanism-based therapeutic approaches. In particular, gene therapy offers greater selectivity than small molecule-based or interventional treatment...
September 2, 2016: European Journal of Pharmacology
Joerg C Schefold, Nora Fritschi, Gerhard Fusch, Aldin Bahonjic, Wolfram Doehner, Stephan von Haehling, Rene Pschowski, Christian Storm, Tim Schroeder
BACKGROUND/AIMS: Temperature control improves neurological prognosis in comatose cardiac arrest (CA) survivors. Previous reports demonstrate that most affected patients show signs of significant systemic inflammation. In an effort to better characterize potential temperature-related effects on key inflammatory pathways, we investigate the course of Tryptophan (Trp) levels, Tryptophan catabolites (including kynurenines) and indoleamine-2,3-dioxygenase (IDO)-activity in post CA patients...
October 2016: Resuscitation
Jan Hovdenes, Kjetil Røysland, Niklas Nielsen, Jesper Kjaergaard, Michael Wanscher, Christian Hassager, Jørn Wetterslev, Tobias Cronberg, David Erlinge, Hans Friberg, Yvan Gasche, Janneke Horn, Michael Kuiper, Tommaso Pellis, Pascal Stammet, Matthew P Wise, Anders Åneman, Jan Frederik Bugge
AIM: To investigate the association of temperature on arrival to hospital after out-of-hospital-cardiac arrest (OHCA) with the primary outcome of mortality, in the targeted temperature management (TTM) trial. METHODS: The TTM trial randomized 939 patients to TTM at 33 or 36°C for 24h. Patients were categorized according to their recorded body temperature on arrival and also categorized to groups of patients being actively cooled or passively rewarmed. RESULTS: OHCA patients having a temperature ≤34...
October 2016: Resuscitation
Stephen A Bernard, Karen Smith, Judith Finn, Cindy Hein, Hugh Grantham, Janet E Bray, Conor Deasy, Michael Stephenson, Teresa A Williams, Lahn D Straney, Deon Brink, Richard Larsen, Chris Cotton, Peter Cameron
BACKGROUND: Patients successfully resuscitated by paramedics from out-of-hospital cardiac arrest often have severe neurologic injury. Laboratory and observational clinical reports have suggested that induction of therapeutic hypothermia during cardiopulmonary resuscitation (CPR) may improve neurologic outcomes. One technique for induction of mild therapeutic hypothermia during CPR is a rapid infusion of large-volume cold crystalloid fluid. METHODS: In this multicenter, randomized, controlled trial we assigned adults with out-of-hospital cardiac arrest undergoing CPR to either a rapid intravenous infusion of up to 2 L of cold saline or standard care...
September 13, 2016: Circulation
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