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Chronotropic incompetency

Marco Herbsleb, Andy Schumann, Berend Malchow, Christian Puta, P Christian Schulze, Holger W Gabriel, Karl-Jürgen Bär
The elevated cardiovascular risk of patients with schizophrenia contributes to a reduced life expectancy of 15-20years. This study investigated whether cardiac autonomic dysfunction (CADF) in schizophrenia is related to chronotropic incompetence, an established cardiovascular risk marker. We investigated thirty-two patients suffering from paranoid schizophrenia and thirty-two control subjects matched for age, sex, body mass index and fat free mass. A cardiopulmonary exercise test (CPET) was performed to study heart rate responses to exercise as well as submaximal (ventilatory threshold 1, VT1 ) and maximal endurance capacities (peak oxygen consumption, VO2peak ; peak power output, Ppeak )...
March 8, 2018: Schizophrenia Research
Pietro Palmisano, Matteo Ziacchi, Mauro Biffi, Renato P Ricci, Maurizio Landolina, Massimo Zoni-Berisso, Eraldo Occhetta, Giampiero Maglia, Gianluca Botto, Luigi Padeletti, Giuseppe Boriani
: The purpose of this two-part consensus document is to provide specific suggestions (based on an extensive literature review) on appropriate pacemaker setting in relation to patients' clinical features. In part 2, criteria for pacemaker choice and programming in atrioventricular blocks and neurally mediate syncope are proposed. The atrioventricular blocks can be paroxysmal or persistent, isolated or associated with sinus node disease. Neurally mediated syncope can be related to carotid sinus syndrome or cardioinhibitory vasovagal syncope...
February 20, 2018: Journal of Cardiovascular Medicine
Matteo Ziacchi, Pietro Palmisano, Mauro Biffi, Renato P Ricci, Maurizio Landolina, Massimo Zoni-Berisso, Eraldo Occhetta, Giampiero Maglia, Gianluca Botto, Luigi Padeletti, Giuseppe Boriani
: Modern pacemakers have an increasing number of programable parameters and specific algorithms designed to optimize pacing therapy in relation to the individual characteristics of patients. When choosing the most appropriate pacemaker type and programing, the following variables must be taken into account: the type of bradyarrhythmia at the time of pacemaker implantation; the cardiac chamber requiring pacing, and the percentage of pacing actually needed to correct the rhythm disorder; the possible association of multiple rhythm disturbances and conduction diseases; the evolution of conduction disorders during follow-up...
April 2018: Journal of Cardiovascular Medicine
Hideyuki Hasebe
BACKGROUND Left bundle branch block (LBBB) is associated with atrial fibrillation (AF) and systolic heart failure, which can be treated with cardiac resynchronization therapy (CRT) that includes an implantable cardiac device (ICD). However, in some patients, LBBB may vary with heart rate, and during episodes of AF in LBBB, aberrant ventricular conduction, or wide QRS complex tachycardia (Ashman beats) can occur. This report is a case of LBBB treated with pharmacologic CRT, without the use of an ICD. CASE REPORT A 68-year-old man presented with persistent AF and systolic heart failure...
February 2, 2018: American Journal of Case Reports
Wojciech Gilewski, Jan Błażejewski, Danuta Karasek, Joanna Banach, Łukasz Wołowiec, Edyta Płońska-Gościniak, Tomasz Kukulski, Jarosław Kasprzak, Katarzyna Mizia-Stec, Ilona Kowalik, Piotr Gościniak, Władysław Sinkiewicz
BACKGROUND: According to current ESC Guidelines for the diagnosis and treatment of heart failure cardiac resynchronization therapy (CRT) is indicated in patients suffering from heart failure (HF) with reduced ejection fraction (EF) with significantly widened QRS complexes. Presence of vital myocardium proved by dobutamine stress echocardiography (DSE) is considered as a good prognostic factor for responsiveness to this treatment. Chronotropic incompetence is on the other hand known factor of unfavorable outcome in HF...
January 3, 2018: Kardiologia Polska
Faruk Kucukdurmaz, Gurkan Acar, Sefa Resim
INTRODUCTION: Erectile dysfunction (ED) and cardiovascular (CV) diseases share common risk factors and ED has been accepted as an early manifestation of CV disease. Exercise stress testing (EST) is used to evaluate CV functions in men with ED. Low exercise workload, a slower heart rate recovery (HRR) after exercise, and inability to increase heart rate during EST (chronotropic incompetence) are independent negative predictors of adverse CV outcomes. AIM: To assess the association among EST parameters, ED, and testosterone levels...
December 20, 2017: Sexual Medicine
Jiankang Wu, Jianan Li, Andrew Seely, Yi Zhu, Sisi Huang, Xiaoqin Wang, Lei Zhao, Hongliang Wang, Herry Christophe
Chronotropic incompetence (CI) has been proven to be an important factor in the diagnosis and management of cardiovascular diseases. In this paper, we extend the existing CI parameters and propose chronotropic competence indices (CCI) to describe the exercise response of the cardiopulmonary system. A cardiac chronotropic competence Test (3CT), dedicated to CCI measurement using a wearable device, is also presented. Preliminary clinical trials are presented for the validation of 3CT measurement accuracy, and to show the potential of CCI in the prevention and rehabilitation of cardiovascular diseases...
October 25, 2017: Sensors
Mauro Biffi, Giulia Massaro, Andrea Candelora, Andrea Angeletti, Cinzia Valzania, Cristian Martignani, Diego Grassini, Igor Diemberger, Matteo Ziacchi
BACKGROUND: We compared clinical and technical outcome of CRT recipients treated either with a conventional 3‑leads (3L) CRTD or with the new 2‑leads (DX) CRTD that enables atrial signal detection by a floating dipole built on a pentafilar RV lead. METHODS: Echocardiography and cardiopulmonary exercise tests were repeated either before CRTD implantation and between 6 and 12 months follow up in consecutively implanted patients who had a resting heart rate>40bpm at maximum tolerated beta-blocker dosage...
December 15, 2017: International Journal of Cardiology
Rudolf K F Oliveira, Mariana Faria-Urbina, Bradley A Maron, Mario Santos, Aaron B Waxman, David M Systrom
Borderline resting mean pulmonary arterial pressure (mPAP) is associated with adverse outcomes and affects the exercise pulmonary vascular response. However, the pathophysiological mechanisms underlying exertional intolerance in borderline mPAP remain incompletely characterized. In the current study, we sought to evaluate the prevalence and functional impact of exercise pulmonary hypertension (ePH) across a spectrum of resting mPAP's in consecutive patients with contemporary resting right heart catheterization (RHC) and invasive cardiopulmonary exercise testing...
July 2017: Pulmonary Circulation
Amrish Deshmukh, Cevher Ozcan
Sinus node dysfunction with symptomatic bradycardia or chronotropic incompetence is generally an indication for pacemaker implantation. However, in patients with symptomatic sinus bradycardia, the identification and treatment of underlying pathologies may avoid the need for permanent pacemaker implantation. We present a case of carotid sinus syndrome and severe obstructive sleep apnea due to a massive multinodular goiter in a patient who presented with recurrent sinus pauses and syncope. The patient was managed without pacemaker implantation but instead with thyroidectomy resulting in decompression of the carotid sinus and airway and resolution of bradycardic episodes...
2017: Case Reports in Cardiology
Monika Smaś-Suska, Natalia Dłużniewska, Piotr Weryński, Jacek Pająk, Wojciech Płazak, Maria Olszowska, Piotr Podolec, Lidia Tomkiewicz-Pająk
BACKGROUND: Despite the low early mortality of Fontan procedures, Fontan patients are prone to various cardiac and extra-cardiac complications in the long term. This may influence patient perception of their health and outcome. The aim of the study was to assess the relationship of multi-organ complications and physical efficiency with self-reported health-related quality of life (QOL) in adult Fontan patients. METHODS: Quality of life was assessed with the Short Form-36 questionnaire...
July 11, 2017: Cardiology Journal
Johan Heiberg, Camilla Nyboe, Vibeke E Hjortdal
OBJECTIVES: Atrial and ventricular septal defects are commonly closed surgically with low rates of post-operative morbidity, and the long-term outcome has widely been described as benign. Nevertheless, there is an increasing understanding of late morbidity, and the possibility of postoperative chronotropic impairment is continuously questioned. Furthermore, potentially abnormal chronotropic responses may be associated with the recently demonstrated overrepresentation of late arrhythmias...
October 2017: Scandinavian Cardiovascular Journal: SCJ
Hong Shen, Jianrong Zhao, Xiaohong Zhou, Jingbo Li, Qing Wan, Jing Huang, Hui Li, Liqun Wu, Shungang Yang, Ping Wang
BACKGROUND: While exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients. This study explored the feasibility of using wearable devices to assess impaired chronotropic response in heart failure patients. METHODS: Forty patients with heart failure (left ventricular ejection fraction, LVEF: 44.6 ± 5.8; age: 54.4 ± 11.7) received ECG Holter and accelerometer to monitor heart rate (HR) and physical activities during symptom-limited treadmill exercise testing, 6-min hall walk (6MHW), and 24-h daily living...
May 25, 2017: BMC Cardiovascular Disorders
Rosalind F Cook, Carol T Bussey, Kimberley M Mellor, Patricia A Cragg, Regis R Lamberts
What is the central question of the study? The sympathetic system regulates heart rate via β-adrenoceptors; this is impaired during diabetes. However, the specific β-adrenoceptor subtype contributions in heart rate regulation in diabetes in vivo are unknown. What is the main finding and its importance? Telemetric recordings in conscious non-diabetic and type 2 diabetic rats demonstrated that the β1 -adrenoceptor subtype, and not the β2 -adrenoceptor, regulated the lower resting heart rate and increased β-adrenoceptor responsiveness in diabetes in vivo...
May 22, 2017: Experimental Physiology
Marco Ambrosetti, Giuseppe Scardina, Giuseppe Favretto, Pier Luigi Temporelli, Pompilio Massimo Faggiano, Cesare Greco, Roberto Franco Pedretti
For patients with stable coronary artery disease (SCAD), either after hospitalization for acute cardiac events or in the chronic phase, comprehensive treatment programs should be devoted to: (i) reducing mortality and major adverse cardiovascular events, (ii) reducing the ischemic burden and related symptoms, and (iii) increasing exercise capacity and quality of life.Heart rate (HR) has demonstrated to have prognostic value and patients beyond the limit of 70 bpm display increased risk of all the above adverse outcomes, even after adjustment for parameters such as the extension of myocardial infarction and the presence of heart failure...
March 2017: Giornale Italiano di Cardiologia
Lidia Hategan, Beáta Csányi, Balázs Ördög, Kornél Kákonyi, Annamária Tringer, Orsolya Kiss, Andrea Orosz, László Sághy, István Nagy, Zoltán Hegedűs, László Rudas, Márta Széll, András Varró, Tamás Forster, Róbert Sepp
BACKGROUND: The most important molecular determinant of heart rate regulation in sino-atrial pacemaker cells includes hyperpolarization-activated, cyclic nucleotide-gated ion channels, the major isoform of which is encoded by the HCN4 gene. Mutations affecting the HCN4 gene are associated primarily with sick sinus syndrome. METHODS AND RESULTS: A novel c.1737+1 G>T 'splice-site' HCN4 mutation was identified in a large family with familial bradycardia which co-segregated with the disease providing a two-point LOD score of 4...
April 20, 2017: International Journal of Cardiology
Guilherme L Fialho, Arthur G Pagani, Roger Walz, Peter Wolf, Katia Lin
Autonomic dysfunction may account for sudden unexpected death in patients with epilepsy (PWE). On the other hand, low cardiovascular fitness, which may affect autonomic function, is a risk factor for sudden death and all-cause mortality in the general population. Little is known about autonomic variables and cardiovascular response to exercise in PWE. We submitted thirty consecutive PWE with no known cardiovascular diseases to maximal treadmill test, comparing them with matched controls. All individuals were submitted to clinical assessment, 12-lead electrocardiogram (ECG) and echocardiogram to exclude cardiovascular disease...
April 24, 2017: Epilepsy Research
Wesley T O'Neal, Waqas T Qureshi, Michael J Blaha, Zeina A Dardari, Jonathan K Ehrman, Clinton A Brawner, Elsayed Z Soliman, Mouaz H Al-Mallah
OBJECTIVES: To examine the association between chronotropic incompetence and incident atrial fibrillation (AF). BACKGROUND: Patients with inadequate heart rate response during exercise may have abnormalities in sinus node function or autonomic tone that predispose to the development of AF. METHODS: We examined the association between heart rate response and incident AF in 57,402 (mean age=54±13 years, 47% female, 64% white) patients free of baseline AF who underwent exercise-treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project...
November 2016: JACC. Clinical Electrophysiology
Sara Peterson, Jennifer A Su, Jacqueline R Szmuszkovicz, Robert Johnson, Barbara Sargent
Pediatric HTs account for 13% of all HTs with >60% of recipients surviving at least 10 years post-HT. The purpose of this systematic review is to synthesize the literature on exercise capacity of pediatric HT recipients to improve understanding of the mechanisms that may explain the decreased exercise capacity. Six databases were searched for studies that compared the exercise capacity of HT recipients ≤21 years old with a control group or normative data. Sixteen studies were included. Pediatric HT recipients, as compared to controls or normative data, exhibit significantly higher resting HR, and at peak exercise exhibit significantly decreased HR, VO2 , power, work, minute ventilation, and exercise duration...
August 2017: Pediatric Transplantation
Valentina Mantegazza, Anna Apostolo, Alfred Hager
Recently, the number of patients with congenital heart diseases reaching adulthood has been progressively increasing in developed countries, and new issues are emerging: the evaluation of their capacity to cope with physical activity and whether this knowledge can be used to optimize medical management. A symptom-limited cardiopulmonary exercise test has proven to be an essential tool, because it can objectively evaluate the functional cardiovascular capacity of these patients, identify the pathological mechanisms of the defect (circulatory failure, shunts, and/or pulmonary hypertension), and help prescribe an individualized rehabilitation program when needed...
July 2017: Annals of the American Thoracic Society
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