MedWorm: Cardiac Arrhythmia

Tizanidine (Zanaflex): A Muscle Relaxant That May Prolong the QT Interval by Blocking IKr

Journal of Cardiovascular Pharmacology and Therapeutics — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion: Tizanidine prolongs the QT interval by blocking IKr. Patients could be at risk of cardiac proarrhythmia during impaired drug elimination, such as in case of CYP1A2 inhibition during drug interactions. (Source: Journal of Cardiovascular Pharmacology and Therapeutics)

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Evaluation of a direct access cardiac arrhythmia monitoring service.

Cardiology Journal — Mon, 06 Feb 2012 00:36:02 +0100

Conclusions: Direct access for cardiac arrhythmia monitoring seems to provide an effective mechanism for diverting inappropriate or non-essential referrals away from the cardiology clinic. (Cardiol J 2012; 19, 1: 70-75). PMID: 22298170 [PubMed - in process] (Source: Cardiology Journal)

Prinzmetal angina in the differential diagnosis of syncope.

Acute Cardiac Care — Wed, 01 Feb 2012 05:00:00 +0100

We present 2 patients with syncope where vasospastic angina and severe ventricular arrhythmias were found to be responsible for the syncopal episodes. PMID: 22296564 [PubMed - as supplied by publisher] (Source: Acute Cardiac Care)

QT interval variability in familial Mediterranean fever: a study in colchicine-responsive and colchicine-resistant patients

Clinical Rheumatology — Tue, 24 Jan 2012 07:54:07 +0100

In conclusion, patients with FMF who are continuously treated with colchicine and have not developed amyloidosis, regardless of their clinical response, have normal QT variability parameters, indicating normal repolarization dynamics and suggesting no increased risk of repolarization-associated cardiac arrhythmias. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s10067-011-1926-8Authors Udi Nussinovitch, Israel Naval Medical Institute, IDF Medical Corps, Haifa, Israel 31080Keren Kaminer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelMoshe Nussinovitch, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelBenjamin Volovitz, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelMerav Lidar, Sackler Faculty of Me...

Estimating the time scale and anatomical location of atrial fibrillation spontaneous termination in a biophysical model

Medical and Biological Engineering and Computing — Tue, 24 Jan 2012 07:19:28 +0100

This study contributes to the interpretation of previous clinical observations, and illustrates how computer modeling provides a complementary approach to study the mechanisms of cardiac arrhythmias. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s11517-011-0859-3Authors Laurent Uldry, Applied Signal Processing Group, Swiss Federal Institute of Technology, EPFL-STI-SCI-JMV, Bâtiment ELD, Station 11, 1015 Lausanne, SwitzerlandVincent Jacquemet, Department of Physiology, Université de Montréal, Montréal, CanadaNathalie Virag, Medtronic Europe, Tolochenaz, SwitzerlandLukas Kappenberger, University of Lausanne, Lausanne, SwitzerlandJean-Marc Vesin, Applied Signal Processing Group, Swiss Federal Institute of Technology, EPFL-STI-SCI-JMV, Bâtiment ELD, Sta...

Metabolic Syndrome Affects Midterm Outcome After Coronary Artery Bypass Grafting [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions The main finding of our study was the association between MetS and mortality both early and late after coronary artery bypass grafting. Thus, MetS should be recognized as an independent preoperative variable that can lead to the identification of high-risk patients and as a risk factor to correct with lifestyle modifications and pharmacologic therapy. (Source: The Annals of Thoracic Surgery)

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Drugs of abuse (amfetamines, BZP, cannabis, cocaine, GHB, LSD)

Medicine — Sat, 21 Jan 2012 13:58:54 +0100

Abstract: The features of amfetamine poisoning are related predominantly to stimulation of central and peripheral adrenergic receptors, and in severe cases, excitability, agitation, paranoid delusions, hallucinations with violent behaviour, hypertonia and hyperreflexia develop. Convulsions, rhabdomyolysis, hyperthermia, intracerebral haemorrhage and cardiac arrhythmias are less common. In addition, hyperthermia and hyponatraemia are features of severe MDMA toxicity.Benzylpiperazine (BZP) has stimulant and amfetamine-like properties. Those severely poisoned may develop seizures, collapse, hyperthermia, myoclonic jerks, extrapyramidal features and respiratory failure.Features of cannabis use include euphoria, distorted and heightened images, colours and sounds, altered tactile sensations, im...

[Review] Cardiovascular and neurological causes of sudden death after ischaemic stroke

Lancet Neurology — Sat, 21 Jan 2012 01:16:39 +0100

SummarySudden death is an important but widely under-recognised consequence of stroke. Acute stroke can disturb central autonomic control, resulting in myocardial injury, electrocardiographic abnormalities, cardiac arrhythmias, and ultimately sudden death. Experimental and clinical evidence suggests that autonomic imbalance is more frequent after infarcts involving the insular cortex, a crucial region for the control of sympathetic and parasympathetic autonomic functions. Cardiovascular comorbidities increase the risk of cardiac morbidity and mortality after stroke. (Source: Lancet Neurology)

Arrhythmogenic consequences of myofibroblast-myocyte coupling

Cardiovascular Research — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion Coupling of myocytes to myofibroblasts promotes EAD formation as a result of a mismatch in early vs. late repolarization reserve caused by the Ito-like component of the gap junction current. These cellular and ionic mechanisms may contribute to the pro-arrhythmic risk in fibrotic hearts. (Source: Cardiovascular Research)

Pitx2 confers left morphological, molecular, and functional identity to the sinus venosus myocardium

Cardiovascular Research — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion Pitx2 drives left/right patterning of the SV myocardium through multiple developmental steps. Overall, Pitx2 plays a crucial functional role by negatively modulating a nodal-type programme in the left SV myocardium. (Source: Cardiovascular Research)

Modeling Anesthetic Times. Predictors and Implications for Short Term Outcomes

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:42 +0100

Introduction: Little is known about predictors of anesthetic times, and the impact of anesthetic and operative times on patient outcomes. Methods: We documented operative case length (OCL) - defined as the time from incision to time of dressing placement -, and anesthetic time length (ATL) - defined as the sum of anesthetic induction time length (time from the patient's entrance in the operating room to the time of skin incision) and anesthetic recovery time length (time from dressing placement to time of patient's exit from the operating room), in 1771consecutive patients who underwent elective vascular surgical interventions. We recorded patient and procedure-related characteristics that might influence the anesthetic time length, including a variable for possible July-effect. Forward st...

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Silent heart irregularity also raises risk of stroke

Health Facts and Fears — Fri, 13 Jan 2012 05:00:00 +0100

Affecting over 2 million people in the U.S., atrial fibrillation (AF) is the most common cardiac arrhythmia (irregular heart beat) and can be associated with palpitations, chest pains, fainting, and congestive heart failure. (Source: Health Facts and Fears)

A new drug for heat stroke? Implications for malignant hyperthermia

ScienceDaily Headlines — Thu, 12 Jan 2012 21:24:24 +0100

Malignant hyperthermia (MH) is a life-threatening genetic muscle disorder, most commonly triggered in those at risk by certain types of drugs used during anesthesia. Heat stroke, on the other hand, most commonly occurs in individuals in response to physical exertion in hot/humid environments. While their common triggers may differ, the signs associated with MH and heat stroke are remarkably similar – uncontrolled muscle contractions, dangerous increases in body temperature, and muscle breakdown leading to the release of toxins in the blood which may cause cardiac arrhythmias and death. A new medication may be effective in preventing certain forms of heat stroke. (Source: ScienceDaily Headlines)

[Low-dose droperidol in children : Rescue therapy for persistent postoperative nausea and vomiting.]

Der Anaesthesist — Thu, 12 Jan 2012 05:00:00 +0100

CONCLUSIONS: Low-dose droperidol (10 µg/kgBW) was found to be effective as rescue medication in pediatric patients experiencing PONV despite various prophylactic antiemetic regimens. No neurological or cardiopulmonary side effects were recorded after this low dosage. PMID: 22234576 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)

A New Era of Antithrombotic Therapy in Patients With Atrial Fibrillation.

The American Journal of the Medical Sciences — Thu, 12 Jan 2012 05:00:00 +0100

This article will review 3 new antithrombotic medications that may potentially become the mainstay for treatment of patients with atrial fibrillation in the near future. PMID: 22245946 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)

Membrane dysfunction in Andersen‐Tawil syndrome assessed by velocity recovery cycles

Muscle and Nerve — Fri, 06 Jan 2012 05:00:00 +0100

This study was undertaken to determine whether sarcolemmal dysfunction could be identified with muscle velocity recovery cycles (MVRCs).Methods:Eleven genetically confirmed ATS patients and 20 normal controls were studied. MVRCs were recorded with 1, 2 and 5 conditioning stimuli and with single conditioning stimuli during intermittent repetitive stimulation at 20 Hz, in addition to the long exercise test.Results:ATS patients had longer relative refractory periods (P<0.0001) and less early supernormality, consistent with membrane depolarization. Patients had reduced enhancement of late supernormality with 5 conditioning stimuli (P<0.0001), and less latency reduction during repetitive stimulation (P<0.001). Patients were separated completely from controls by combining MVRC and repet...

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A systematic review and meta‐analysis of heart rate variability in epilepsy and antiepileptic drugs

Epilepsia — Thu, 05 Jan 2012 05:00:00 +0100

SummaryPurpose: Epilepsy is associated with near‐fatal and fatal arrhythmias, and sudden unexpected death in epilepsy (SUDEP) is partly related to cardiac events. Dysfunction of the autonomous nervous system causes arrhythmias and, although previous studies have investigated the effects of epilepsy on the autonomic control of the heart, the results are still mixed regarding whether imbalance of sympathetic, vagal, or both systems is present in epilepsy, and also the importance of anticonvulsant treatment on the autonomic system. Therefore, we aimed to investigate epilepsy and its treatment impact on heart rate variability (HRV), assessed by sympathetic and parasympathetic activity expressed as low‐frequency (LF) and high‐frequency (HF) power spectrum, respectively.Method: We pe...

Letter by Ravensbergen et al Regarding Article, "Long-Term Recording of Cardiac Arrhythmias With an Implantable Cardiac Monitor in Patients With Reduced Ejection Fraction After Acute Myocardial Infarction: The Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) Study".

Circulation — Tue, 03 Jan 2012 05:00:00 +0100

Letter by Ravensbergen et al Regarding Article, "Long-Term Recording of Cardiac Arrhythmias With an Implantable Cardiac Monitor in Patients With Reduced Ejection Fraction After Acute Myocardial Infarction: The Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) Study". Circulation. 2012 Jan 3;125(1):e239 Authors: Ravensbergen NJ, Verhagen HJ, De Melis M PMID: 22215899 [PubMed - in process] (Source: Circulation)

The Big Chill: Accidental Hypothermia

AJN — Sun, 01 Jan 2012 06:00:00 +0100

Overview: A potential cause of such emergent issues as cardiac arrhythmias, hypotension, and fluid and electrolyte shifts, accidental hypothermia can be deadly, is common among trauma patients, and is often difficult to recognize. The author discusses predisposing conditions, the classic presentation, and the effects on normal thermoregulatory processes; explains how to conduct a systems assessment of the hypothermic patient; and describes crucial management strategies. (Source: AJN)

Ondansetron (Zofran) Warning Strengthened

AJN — Sun, 01 Jan 2012 06:00:00 +0100

* The antiemetic ondansetron (Zofran) has undergone a label revision to emphasize the risk of cardiac arrhythmias such as QT-interval prolongation and torsade de pointes. * Patients with congenital long QT syndrome shouldn't receive ondansetron. * Cardiac monitoring should be conducted in patients taking ondansetron who have electrolyte imbalances, congestive heart failure, bradyarrythmias, or a history of taking other drugs that prolong the QT interval. (Source: AJN)

Effect of Pranayama (Breathing Exercise) on Arrhythmias in the Human Heart

Explore — Sun, 01 Jan 2012 05:00:00 +0100

Background: Cardiac arrhythmias, especially ventricular tachyarrhythmias are an important public health problem. QT dispersion (QTd), defined as the difference between maximal and minimal QT intervals, reflects the regional inhomogeneity of ventricular repolarization dispersion and may mark the presence of malignant ventricular arrhythmias. Purpose: To determine the effects of Pranayama (breathing exercise) on QTd in patients with arrhythmia. Patients: Fifteen patients with arrhythmia and ejection fractions (Source: Explore)

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A systematic review of validated methods for identifying ventricular arrhythmias using administrative and claims data

Pharmacoepidemiology and Drug Safety — Sun, 01 Jan 2012 05:00:00 +0100

ConclusionsThe use of ICD‐9 codes 427.x, alone or in combination with code 798.x, in the principal position is appropriate for the identification of ventricular arrhythmias in administrative and claims databases. Copyright © 2012 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)

Treating Cardiac Arrhythmias Detected With an Implantable Cardiac Monitor in Patients After an Acute Myocardial Infarction

Current Treatment Options in Cardiovascular Medicine — Mon, 26 Dec 2011 16:45:58 +0100

Opinion statement Using an implantable cardiac monitor (ICM) in patients with acute myocardial infarction (MI) allows continuous electrocardiogram monitoring and provides a much more detailed picture of the incidence of brady- and tachyarrhythmias than conventional follow-up. The CARISMA study was the first to use the ICM in post-MI patients with moderate to severe left ventricular systolic dysfunction. Atrial fibrillation (AF) events lasting longer than 30 s were associated with an almost threefold increase in the risk of major cardiac events. This confirms the current definition of clinically significant AF episodes, as patients with episodes of shorter duration were not at increased risk. The association of AF to progressive heart failure, reinfarction, and cardiova...

Effect of Adaptive Servo-Ventilation on 1-Year Prognosis in Heart Failure Patients.

Circulation Journal — Fri, 23 Dec 2011 05:00:00 +0100

Conclusions: ASV prevents fatal cardiovascular events and improves survival in HF patients. PMID: 22199136 [PubMed - as supplied by publisher] (Source: Circulation Journal)

Skin biopsy–proven flecainide‐induced neuropathy

Muscle and Nerve — Fri, 23 Dec 2011 03:01:12 +0100

We report this unique case in that flecainide‐induced sensory neuropathy was confirmed with skin biopsy, and subsequent improvement of neuropathy was documented with assessment of intraepidermal nerve fiber density in a repeat nerve biopsy. Muscle Nerve 45: 144–146, 2011 (Source: Muscle and Nerve)

ZnT-1 protects HL-1 cells from simulated ischemia–reperfusion through activation of Ras–ERK signaling

Journal of Molecular Medicine — Thu, 22 Dec 2011 16:37:47 +0100

Abstract Activation of ERK signaling may promote cardioprotection from ischemia–reperfusion (I/R) injury. ZnT-1, a protein that confers resistance from zinc toxicity, was found to interact with Raf-1 kinase through its C-terminal domain, leading to downstream activation of ERK. In the present study, we evaluated the effects of ZnT-1 in cultured murine cardiomyocytes (HL-1 cells) that were exposed to simulated-I/R. Cellular injury was evaluated by lactate dehydrogenase (LDH) release and by staining for pro-apoptotic caspase activation. Overexpression of ZnT-1 markedly reduced LDH release and caspase activation following I/R. Knockdown of endogenous ZnT-1 augmented the I/R-induced release of LDH and increased caspase activation following I/R. Phospho-ERK levels were signif...

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ADRB1 Variants in Atrial Fibrillation: Small Steps and Giant Leaps Toward Personalized Therapy in Cardiovascular Disease⁎

Journal of the American College of Cardiology — Thu, 22 Dec 2011 02:25:47 +0100

Atrial fibrillation is the most common cardiac arrhythmia, affecting about 3 million adults in the United States and costing over 26 million dollars annually to treat (). As a common cause of symptoms and precipitant of decompensated heart failure, atrial fibrillation contributes greatly to cardiovascular morbidity and disability. Many of the symptoms and adverse outcomes associated with untreated atrial fibrillation may be attributed to the typically rapid ventricular rate, and therefore, a cornerstone of management is rate control. Rate control for atrial fibrillation can ameliorate symptoms and improve outcomes, and in prospective, randomized testing, shows no disadvantage compared with rhythm control (Atrial Fibrillation Follow-Up Investigation of Rhythm Management [AFFIRM]) (). Nevert...

Esophageal Electric Fields are Predictive of Atrial Defibrillation Thresholds

Pacing and Clinical Electrophysiology : PACE — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions: There was a strong negative relationship between EEF2s during 1‐J shocks and ADFTs for both AA and AP electrode placements. These preliminary results suggest that using EEF2s to predict patient‐specific electrode placements is feasible. (PACE 2011;1–6) (Source: Pacing and Clinical Electrophysiology : PACE)

Calmodulin kinase II and protein kinase C mediate the effect of increased intracellular calcium to augment late sodium current in rabbit ventricular myocytes.

Am J Physiol Cell Ph... — Wed, 21 Dec 2011 05:00:00 +0100

This study test the hypothesis that both Ca(2+)-calmodulin-dependent protein kinase II (CaMKII) and protein kinase C (PKC) mediate the effect of increased [Ca(2+)](i) to increase I(Na.L). Whole-cell and open cell-attached patch clamp techniques were used to record I(Na.L) in rabbit ventricular myocytes dialyzed with solutions containing various concentrations of [Ca(2+)](i). Dialysis of cells with [Ca(2+)](i) from 0.1 to 0.3, 0.6 and 1.0 μM increased I(Na.L) in a concentration-dependent manner from 0.221 ± 0.038 to 0.554 ± 0.045 pA/pF (n = 10, P < 0.01), and was associated with an increase in mean Na(+) channel open probability and prolongation of channel mean open-time (n = 7, P < 0.01). In the presence of 0.6 μM [Ca(2+)](i), KN-93 (10 μM) and bisindolylmaleimide (BIM, 2 μM) d...

Clinical Evaluation of Respiratory Motion Compensation for Anatomical Roadmap Guided Cardiac Electrophysiology Procedures

IEEE Transactions on Biomedical Engineering — Wed, 21 Dec 2011 00:24:56 +0100

We present a comprehensive comparison between the techniques in terms of robustness, as computed by tracking errors, and accuracy, as computed by TRE using two independent approaches. (Source: IEEE Transactions on Biomedical Engineering)

Verapamil as an antiarrhythmic in congestive heart failure: hopping from rabbit to human?

British Journal of Pharmacology — Tue, 20 Dec 2011 05:00:00 +0100

SummaryRepolarization dependent cardiac arrhythmias only arise in hearts facing multiple ‘challenges’ affecting its so‐called repolarization reserve. Congestive heart failure (CHF) is one such challenge frequently observed in humans and is accompanied by altered calcium handling within the contractile heart cell. This raises the question as to whether or not the well known calcium antagonist verapamil acts as an antiarrhythmic in this setting, as seen in arrhythmia models without CHF. According to the study of Milberg et al. in this issue of BJP the answer is yes. The results of this study, using a rabbit CHF model, raise important questions. First, given that the model combines CHF with a number of other interventions that predispose towards arrhythmia, will similar conclusions be r...

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FDA Alert : Multaq (Dronedarone) Increased Risk Of Death / Cardiovascular Problems

Health News from Medical News Today — Tue, 20 Dec 2011 00:00:00 +0100

The drug Multaq, from Sanofi-Aventis, is used to treat cardiac arrhythmias, however the FDA has issued a warning today stating that in further trials it has shown a serious risk of cardiovascular problems, including death. More specifically the FDA states that Multaq must now carry the warning : "Healthcare professionals should not prescribe Multaq to patients with Permanent Atrial Fibrillation who cannot or will not be converted into normal sinus rhythm (permanent AF), because Multaq doubles the rate of cardiovascular death, stroke, and heart failure in such patients... (Source: Health News from Medical News Today)

Snipping key nerves may help life-threatening heart rhythms

UCLA Newsroom: Health Sciences — Mon, 19 Dec 2011 21:00:00 +0100

What do sweaty palms and abnormal heart rhythms have in common? Both can be initiated by the nervous system during an adrenaline-driven "flight-or-fight" stress reaction, when the body senses danger. Hyperhidrosis, an abnormal flight-or-fight response of the sympathetic nervous system that causes excessively sweaty palms may also contribute to problems like dangerous irregular rhythms from the lower chambers of the heart, known as ventricular arrhythmias. UCLA cardiologists have now found that surgery to snip nerves associated with the sympathetic nervous system on both the left and right sides of the chest may be helpful in stopping dangerous, incessant ventricular arrhythmias — known as an "electrical storm" — when other treatment methods have failed....

Activation of epidermal growth factor receptor mediates reperfusion arrhythmias in anaesthetized rats

Cardiovascular Research — Mon, 19 Dec 2011 05:00:00 +0100

Conclusion These results demonstrate for the first time that EGFR plays an important role in the genesis of arrhythmias induced by reperfusion, which is likely mediated at least in part by enhancing tyrosine phosphorylation of cardiac Na+ and L-type Ca2+ channels. (Source: Cardiovascular Research)

The dangers of iron overload: Bring in the Iron Police

Journal of the American Academy of Nurse Practitioners — Mon, 19 Dec 2011 05:00:00 +0100

Conclusions: Transfusions of packed red blood cells save lives. There are many hematologic conditions for which packed red blood cell transfusions are required as a result of bone marrow suppression. However, extended exposure to red blood cell transfusions places the patient at an additional risk of iron overload. Iron overload is a real concern for patients who become transfusion dependent, with increased risks of liver cirrhosis and cardiac arrhythmias.Implications for practice: NPs in all areas of practice can increase awareness of the dangers of transfusional iron overload, and become familiar with the treatment options available. Additionally, NPs can institute a monitoring program based on the protocol suggested here within their own practices to prevent poor outcomes for patients w...

The Big Chill: Accidental Hypothermia.

The American Journal of Nursing — Mon, 19 Dec 2011 05:00:00 +0100

Authors: Davis RA Abstract How to identify and manage this life-threatening reaction to prolonged exposure. OVERVIEW: A potential cause of such emergent issues as cardiac arrhythmias, hypotension, and fluid and electrolyte shifts, accidental hypothermia can be deadly, is common among trauma patients, and is often difficult to recognize. The author discusses predisposing conditions, the classic presentation, and the effects on normal thermoregulatory processes; explains how to conduct a systems assessment of the hypothermic patient; and describes crucial management strategies. PMID: 22186703 [PubMed - as supplied by publisher] (Source: The American Journal of Nursing)

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CardioNet, Inc. Announces The Launch Of Its Next Generation MCOT Device

Medical Design Online News — Wed, 14 Dec 2011 14:00:00 +0100

CardioNet, Inc., a leading wireless medical technology company with a current focus on the diagnosis and monitoring of cardiac arrhythmias, today announced the launch of its next generation Mobile Cardiac Outpatient Telemetry device (Source: Medical Design Online News)

Disseminated mite infection with ocular involvement in a juvenile bald eagle (Haliaeetus leucocephalus)

Veterinary Ophthalmology — Tue, 13 Dec 2011 05:00:00 +0100

AbstractA bald eagle (Haliaeetus leucocephalus) was found unable to fly and was admitted to The Raptor Center (TRC). Major clinical signs were thin body condition and a cardiac arrhythmia. Ten days after admission to TRC, ophthalmic examination revealed multiple, distinct serpiginous lesions of chorioretinal atrophy in the ocular fundus of the right eye (OD). The bird was euthanized because of clinical deterioration and poor prognosis. Mites of an undetermined species were found histologically in the retina, episcleral tissues, lungs, and liver at the postmortem examination. Disseminated mite infection should be considered in the differential diagnosis of serpiginous chorioretinal lesions in bald eagles (H. leucocephalus). (Source: Veterinary Ophthalmology)

Rapid Estrogen Receptor-Mediated Mechanisms Determine the Sexually Dimorphic Sensitivity of Ventricular Myocytes to 17β-Estradiol and the Environmental Endocrine Disruptor Bisphenol A.

Endocrinology — Tue, 13 Dec 2011 05:00:00 +0100

Authors: Belcher SM, Chen Y, Yan S, Wang HS Abstract Previously we showed that 17β-estradiol (E(2)) and/or the xenoestrogen bisphenol A (BPA) alter ventricular myocyte Ca(2+) handing, resulting in increased cardiac arrhythmias in a female-specific manner. In the present study, the roles of estrogen receptors (ER) in mediating the rapid contractile and arrhythmogenic effects of estrogens were examined. Contractility was used as an index to assess the impact of E(2) or BPA on Ca(2+) handling in rodent ventricular myocytes. The concentration-response curve for the stimulatory effects of BPA and E(2) on female myocyte was inverted-U shaped. Detectable effects for each compound were observed at 10(-12) m, and the most efficacious concentrations for each were at 10(-9) m. Sensitivity to...

[Seminar] Sudden unexpected death in epilepsy

LANCET — Sat, 10 Dec 2011 05:00:00 +0100

SummarySudden unexpected death in epilepsy (SUDEP) refers to the sudden death of a seemingly healthy individual with epilepsy, usually occurring during, or immediately after, a tonic-clonic seizure. The frequency of SUDEP varies depending on the severity of the epilepsy, but overall the risk of sudden death is more than 20 times higher than that in the general population. Several different mechanisms probably exist, and most research has focused on seizure-related respiratory depression, cardiac arrhythmia, cerebral depression, and autonomic dysfunction. (Source: LANCET)

The association between insulin-like growth factor-I and cardiac repolarization.

Growth Hormone and IGF Research — Fri, 09 Dec 2011 05:00:00 +0100

CONCLUSION: The inverse association between IGF-I serum concentrations and QTc interval in our study is suggestive of a higher risk for cardiac arrhythmias and thus might provide additional evidence for increased cardiovascular mortality in subjects with low IGF-I secretion. PMID: 22154520 [PubMed - as supplied by publisher] (Source: Growth Hormone and IGF Research)

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Cardiac Arrhythmias and Mapping Techniques

Springer Medicine titles — Thu, 08 Dec 2011 12:08:35 +0100

(Source: Springer Medicine titles)

Disease modulation through the menstrual cycle.

Autoimmunity Reviews — Sat, 03 Dec 2011 05:00:00 +0100

Authors: Oertelt-Prigione S Abstract Sex and gender differences in disease prevalence, pathogenesis and modulation have been frequently reported. The menstrual cycle represents the opportunity to study the physiological effect of hormonal fluctuations in vivo on the immune function and chronic disease modulation. Reports on the effect of the cycle on immune cell numbers and activity fluctuations are scarce, but recent publications demonstrate an increasing interest in the subject. The menstrual cycle might affect immune cell numbers and modulate their activity throughout the 4-week cycle, as demonstrated in the case of regulatory T cells. The implications of these fluctuations are particularly relevant in the field of chronic diseases affecting women of reproductive age. In fact, b...

The Emerging Role of Cardiac Resynchronization Therapy in Milder Heart Failure: Are We Implanting Too Late for Response?

Current Heart Failure Reports — Thu, 01 Dec 2011 19:29:48 +0100

We present a review of the data supporting implantation of cardiac resynchronization devices in early stage heart failure. In addition, we present evidence that may suggest patients are often implanted too late for clinical benefit, potentially contributing to the relatively high nonresponder rate seen in randomized trials and clinical practice. Content Type Journal ArticleCategory Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)Pages 1-6DOI 10.1007/s11897-011-0075-3Authors Jason Bradfield, UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095-1679, USANoel G. Boyle, UCLA Cardiac Arrhythmia Center, Ronald Rea...

Decontamination and enhanced elimination in sustained‐release potassium chloride poisoning*

Emergency Medicine Australasia — Thu, 01 Dec 2011 05:00:00 +0100

AbstractPotassium chloride poisoning can be potentially life‐threatening, particularly in massive ingestions of sustained‐release preparations. Profound hyperkalaemia, developing over several hours, can lead to cardiac arrhythmias and death. This case series reports three episodes of sustained‐release potassium chloride poisoning in two individuals requiring whole bowel irrigation or haemodialysis. The first two episodes, in the same patient, illustrate the contrast between the successful use of decontamination versus the need for haemodialysis. The second case, in a child, illustrates the need for tertiary level paediatric expertise in managing this type of poisoning. Whole bowel irrigation with polyethylene glycol is a resource‐intensive procedure most beneficial when large numbe...

Clinical benefits and cost‐effectiveness of allogeneic red‐blood‐cell transfusion in severe symptomatic anaemia

Vox Sanguinis — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion ARBC transfusion in anaemic patients is clinically beneficial and cost‐effective. (Source: Vox Sanguinis)

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Dantrolene rescues arrhythmogenic RYR2 defect in a patient‐specific stem cell model of catecholaminergic polymorphic ventricular tachycardia

EMBO Molecular Medicine — Thu, 01 Dec 2011 05:00:00 +0100

AbstractCoordinated release of calcium (Ca2+) from the sarcoplasmic reticulum (SR) through cardiac ryanodine receptor (RYR2) channels is essential for cardiomyocyte function. In catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited disease characterized by stress‐induced ventricular arrhythmias in young patients with structurally normal hearts, autosomal dominant mutations in RYR2 or recessive mutations in calsequestrin lead to aberrant diastolic Ca2+ release from the SR causing arrhythmogenic delayed afterdepolarizations (DADs). Here, we report the generation of induced pluripotent stem cells (iPSCs) from a CPVT patient carrying a novel RYR2 S406L mutation. In patient iPSC‐derived cardiomyocytes, catecholaminergic stress led to elevated diastolic Ca2+ concentratio...

Almanac 2011: cardiac arrhythmias and pacing. The national society journals present selected research that has driven recent advances in clinical cardiology.

Turk Kardiyoloji Dernegi arsivi — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Liew R PMID: 22257814 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)

Life-threatening Cardiac Arrhythmia after a Single Dose of Nebulized Epinephrine in Pediatric Emergency Department

Journal of Tropical Pediatrics — Wed, 30 Nov 2011 05:00:00 +0100

We present a case of critical cardiac arrhythmia developed at the Pediatric Emergency Department in an otherwise healthy infant after receiving 3 mg of l-epinephrine (1:1000) nebulization over a 90 min period for a diagnosis of bronchiolitis. Unstable ventricular tachycardia was found after the nebulization therapy that required chemical cardioversion. Frequent premature ventricular contractions (PVCs) were found initially following the cardiac insult that was controlled with oral amiodarone, and disappeared during follow-up. Although epinephrine inhalation is generally safe, adverse life-threatening events could be unpredictable and may evolve even after a single dose of nebulized epinephrine. (Source: Journal of Tropical Pediatrics)

Cardiac Arrhythmias and Sudden Unexpected Death in Epilepsy (SUDEP)

Pacing and Clinical Electrophysiology : PACE — Tue, 29 Nov 2011 05:00:00 +0100

Sudden unexpected death in epilepsy (SUDEP) is a major clinical problem in epilepsy patients in the United States, especially those with chronic, uncontrolled epilepsy. Several pathophysiological events contributing to SUDEP include cardiac arrhythmias, respiratory dysfunction, and dysregulation of systemic or cerebral circulation. There is a significant body of literature suggesting the prominent role of cardiac arrhythmias in the pathogenesis of SUDEP. There is evidence to say that long‐standing epilepsy can cause physiological and anatomical autonomic instability resulting in life‐threatening arrhythmias. Tachyarrhythmias, bradyarrhythmias, and asystole are commonly seen during ictal, interictal, and postictal phase in epilepsy patients. It is unclear if these rhythm disturbances ne...

Hypomagnesaemia and targeted anti-epidermal growth factor receptor (EGFR) agents

Targeted Oncology — Wed, 23 Nov 2011 17:38:04 +0100

Abstract Currently, targeted anti-epidermal growth factor receptor (EGFR) agents have an important role in the treatment of various cancers. These drugs, particularly anti-EGFR monoclonal antibodies, may induce electrolyte disorders, such as hypomagnesaemia and hypocalcaemia. Early symptoms of magnesium deficiency can easily go unrecognized. However, hypomagnesaemia can in rare cases lead to serious clinical manifestations, including cardiac arrhythmias or convulsions. The elective tubular expression of renal EGF/EGFR explains the mechanism of this class-related drug side effect. Inhibition of the EGFR induces a mutated-like transient receptor potential cation channel, subfamily M, member 6 (TRPM6) syndrome, characterized by urinary magnesium and calcium wasting. The risk ...

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The prevalence and nature of cardiac arrhythmias in horses following general anaesthesia and surgery.

Acta Veterinaria Scandinavica — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions: This is the first study to report the prevalence of arrhythmias in horses during the post-operative period in a clinical setting. This study shows that arrhythmias are very common in horses following surgery. It showed no differences between those horses with or without gastrointestinal disease. Arrhythmias occurring in horses during the post-anaesthetic period require further investigation. (Source: Acta Veterinaria Scandinavica)

Particulate Matter Induces Cardiac Arrhythmias via Dysregulation of Carotid Body Sensitivity and Cardiac Sodium Channels.

Am J Respir Cell Mol... — Tue, 22 Nov 2011 05:00:00 +0100

Authors: Wang T, Lang GD, Moreno-Vinasco L, Huang Y, Goonewardena SN, Peng YJ, Svensson EC, Natarajan V, Lang RM, Linares JD, Breysse PN, Geyh AS, Samet JM, Lussier YA, Dudley S, Prabhakar NR, Garcia JG Abstract The mechanistic links between exposure to airborne particulate matter (PM) pollution and the associated increases in cardiovascular morbidity/mortality, particularly in people with congestive heart failure (CHF), have not yet been identified. To advance understanding of this important public health issue, genetically-engineered mice (CREBA133) exhibiting severe dilated cardiomyopathic changes, were exposed to ambient PM collected in Baltimore. CREBA133 mice which display aberrant cardiac physiology and anatomy reminiscent of human CHF displayed evidence of basal autonomic a...

The Reliability and Accuracy of a Noncontact Electrocardiograph System for Screening Purposes.

Anesthesia and Analgesia — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions:Heart rate was accurately measured, and some cardiac arrhythmias were correctly diagnosed using capacitive ECG electrodes. Capacitive electrodes embedded into an examination chair are a promising tool for preoperative screening. Improved artifact reduction algorithms are needed before capacitive electrodes will replace skin electrodes. PMID: 22104072 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

A “summertime differential diagnosis“ of elevated cardiac troponin

The American Journal of Emergency Medicine — Mon, 21 Nov 2011 05:00:00 +0100

In patients with chest pain, heart failure (HF), syncope, cardiac arrhythmias, and other, measurement of cardiac troponin (cTn) eases early recognition of high-risk patients. Recently, a high-sensitive troponin assay has shown to improve diagnosis of myocardial infarction or to identify patients at high risk of recurrent infarction and death . However, not infrequently, slightly elevated cTn is seen but without immediate clinical relevance. Elevated cTn is not exclusively specific for myocardial disease. (Source: The American Journal of Emergency Medicine)

Potassium Sparing Diuretics as Adjunct to Mannitol Therapy in Neurocritical Care Patients with Cerebral Edema: Effects on Potassium Homeostasis and Cardiac Arrhythmias

Neurocritical Care — Sat, 19 Nov 2011 06:50:45 +0100

Conclusion In patients receiving neurocritical care for cerebral edema, the adjunct of a potassium sparing diuretic (canrenone) to mannitol therapy reduces potassium urinary loss, prevents hypokalemia, and reduces the incidence of new cardiac arrhythmias. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s12028-011-9652-2Authors Federico Bilotta, Department of Anesthesiology, Critical Care and Pain Medicine, “Sapienza” University Rome, Italy, Viale Acherusio 16, 00199 Rome, ItalyFederico Giovannini, Department of Anesthesiology, Critical Care and Pain Medicine, “Sapienza” University Rome, Italy, Viale Acherusio 16, 00199 Rome, ItalyFlavia Aghilone, Department of Anesthesiology, Critical Care and Pain Medicine, “Sapienza” University...

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Is c-Src Tyrosine Kinase a New Target for Antiarrhythmic Drug Therapy?⁎

Journal of the American College of Cardiology — Wed, 16 Nov 2011 17:36:37 +0100

c-Src is the cellular homologue of the transforming gene of Rous sarcoma virus (). Discovery of this first human proto-oncogene won Bishop and Varmus the Nobel Prize in physiology and medicine in 1989. c-Src encodes plasma membrane-associated tyrosine kinase, which participates in cell growth and differentiation. It is an integral part of various signal transduction pathways (). Although c-Src has been extensively studied for its role in carcinogenesis, few have thought that it is important in the development of cardiac arrhythmia. Kieken et al. () found that an interaction between c-Src and zonula occludens-1 results in loss of scaffolding of connexin-43 (Cx43), leaving Cx43 free to diffuse in myocyte membranes from areas of high Cx43 content (the intercalated disk) to regions of lower Cx...

Incidence and predictors of major perioperative adverse cardiac and cerebrovascular events in non-cardiac surgery

British Journal of Anaesthesia — Wed, 16 Nov 2011 05:00:00 +0100

Conclusions The risk score based on seven objective and easily assessed factors can accurately predict MACCE occurrence after non-cardiac surgery in a population at intermediate-to-high surgery-specific risk. (Source: British Journal of Anaesthesia)

Atrial fibrillation pathophysiology: implications for management.

Circulation — Tue, 15 Nov 2011 05:00:00 +0100

This article reviews the basic pathophysiology of AF over a broad range of levels, touching on the tissue mechanisms that maintain the arrhythmia, the relationship between clinical presentation and basic mechanisms, ion channel and transporter abnormalities that lead to ectopic impulse formation, basic models and tissue determinants of reentry, ion channel determinants of reentry, the nature and roles of electric and structural remodeling, autonomic neural components, anatomic factors, interactions between atrial and ventricular functional consequences of AF, and the basic determinants of atrial thromboembolism. We then review the potential implications of the basic pathophysiology of the arrhythmia for its management. We first discuss consequences for improved rhythm control pharmacothera...

Novel Insights into the Pathomechanisms of Skeletal Muscle Channelopathies

Current Neurology and Neuroscience Reports — Mon, 14 Nov 2011 16:52:51 +0100

Abstract The nondystrophic myotonias and primary periodic paralyses are an important group of genetic muscle diseases characterized by dysfunction of ion channels that regulate membrane excitability. Clinical manifestations vary and include myotonia, hyperkalemic and hypokalemic periodic paralysis, progressive myopathy, and cardiac arrhythmias. The severity of myotonia ranges from severe neonatal presentation causing respiratory compromise through to mild later-onset disease. It remains unclear why the frequency of attacks of paralysis varies greatly or why many patients develop a severe permanent fixed myopathy. Recent detailed characterizations of human genetic mutations in voltage-gated muscle sodium (gene: SCN4A), chloride (gene: CLCN1), calcium (gene: CACNA1S), and inw...

Coffee, caffeine, and risk of hospitalization for arrhythmias. - Klatsky AL, Hasan AS, Armstrong MA, Udaltsova N, Morton C.

SafetyLit: All (Unduplicated) — Sun, 13 Nov 2011 23:51:22 +0100

Context: Population study data about relations of coffee drinking to arrhythmia are sparse.Objective: To study relations of coffee drinking to risk of cardiac arrhythmia in 130,054 persons with previous data about coffee habits.Design and Outcome Measure: ... (Source: SafetyLit: All (Unduplicated))

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Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty

Annals of the Rheumatic Diseases — Wed, 02 Nov 2011 04:00:00 +0100

Conclusion Older age, higher comorbidity, higher ASA class and previous history of cardiac/thromboembolic disease were associated with an increased risk. (Source: Annals of the Rheumatic Diseases)

Glomerular hemophagocytic macrophages in a patient with proteinuria and clinical and laboratory features of hemophagocytic lymphohistiocytosis (HLH).

International Journal of Hematology — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Cao L, Wallace WD, Eshaghian S, Linhares Y, Marder VJ Abstract Hemophagocytic lymphohistiocytosis (HLH) is a heterogeneous disorder characterized by excessive activation and proliferation of nonmalignant histiocytes, which are commonly found in bone marrow, lymph nodes, spleen and liver in affected patients. Here, we report the presence of glomerular macrophages, including one showing erythrophagocytosis, on renal biopsy in a 25-year-old patient with clinical presentation and laboratory changes consistent with HLH. The clinical course was marked by persistent fever for 2 months, pleural and pericardial effusion, splenomegaly, lymphadenopathy, pancytopenia, cardiac arrhythmias, multiple organ dysfunction, and proteinuria, with demise after a 2-month hospitalization. Positi...

Oral presentation

Pacing and Clinical Electrophysiology : PACE — Tue, 01 Nov 2011 04:00:00 +0100

Conclusion: i.v. niferidile in doses up to 30 mkg/kg seems to be very effective (up to 88%) and safe for sinus rhythm restoration in patients with persistent AF and AFL.O002ELECTROPHYSIOLOGIC AND ANTIARRHYTHMIC EFFECTS OF NEW CLASS III AGENT NIFERIDILE IN PATIENTS WITH PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIASMironov NYu; Golitsyn SP; Sokolov SF; Yuricheva YuA; Maikov EB; Shlevkov NB; Rosetstraukh LV; Chazov EI  Russian cardiology research complexBackground: According to preclinical studies Niferidile (Nf) is a novel potassium channel blocker that inhibits transient outward and delayed rectifier currents and increases effective refractory periods (ERP) more in atria, less in ventricles. High affinity of Nf to atrial myocardium predispose to high efficacy in patients with supraventricular ...

Poster presentations

Pacing and Clinical Electrophysiology : PACE — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions: In our study statin therapy is associated with a lower incidence of non‐sustained ventricular tachycardias in patients with coronary artery disease and ICDs but does not influence overall mortality and appropriate or inappropriate intervention of the device.P002QUINIDINE: AN “ENDANGERED SPECIES” DRUG APPROPRIATE FOR MANAGEMENT OF ELECTRICAL STORM IN BRUGADA SYNDROMETheofilogiannakos EK; Paraskevaidis S; Kamperidis V; Chatzizisis Y; Tsilonis K; Dakos G; Vassilikos V; Styliadis IH 1st Cardiology Department, AHEPA Hospital, Aristotle University Medical School, ThessalonThe clinical manifestation of Brugada Syndrome (BS) varies from asymptomatic form to electrical storm and sudden cardiac death. We report two cases of BS that were presented with electrical storm. A 38‐year...

Ionic and Cellular Mechanisms Underlying the Development of Acquired Brugada Syndrome in Patients Treated with Antidepressants

Journal of Cardiovascular Electrophysiology — Fri, 28 Oct 2011 04:00:00 +0100

Conclusions:Our data suggest that amitriptyline‐induced inhibition of INa unmasks the Brugada ECG phenotype and facilitates development of an arrhythmogenic substrate only in the setting of a genetic predisposition by creating repolarization heterogeneities that give rise to phase 2 reentry and VT.(J Cardiovasc Electrophysiol, Vol. pp. 1‐10) (Source: Journal of Cardiovascular Electrophysiology)

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Scientists Discover New Pathway Critical To Heart Arrhythmia

Health News from Medical News Today — Thu, 27 Oct 2011 08:00:00 +0100

University of Maryland School of Medicine researchers have uncovered a previously unknown molecular pathway that is critical to understanding cardiac arrhythmia and other heart muscle problems. Understanding the basic science of heart and muscle function could open the door to new treatments. The study, published recently in the journal Cell, examined the electrical impulses that coordinate contraction in heart and skeletal muscles, controlling heart rate, for example... (Source: Health News from Medical News Today)

Increased repolarization heterogeneity and ventricular instability in patients with end-stage renal disease with an increased risk for death

Journal of Electrocardiology — Wed, 26 Oct 2011 08:41:35 +0100

The objective of this study is to test the hypothesis that electrocardiographic (ECG) parameters measuring ventricular instability and repolarization heterogeneity could correlate with cardiac death when monitored during or after hemodialysis session (HS). (Source: Journal of Electrocardiology)

Estimated lower limit of the reference value of QT interval in healthy young Japanese men using the bootstrap method

Journal of Electrocardiology — Wed, 26 Oct 2011 08:41:35 +0100

Recently, a short QT interval (QT) has been thought to be a risk factor of the fatal cardiac arrhythmia as well as a prolonged QT. To avoid unexpected sudden death caused by such arrhythmia that occurred during the phase 1 clinical trials for new drugs, it is important to set beforehand the lower limit of the QT reference value and exclude the inadequate candidates for the trials. However, there was no criterion to reasonably exclude individuals with the short QT from the candidates. The purpose of this study is to set the lower limit of QT reference value in rest electrocardiograms (ECGs) in healthy young Japanese men. (Source: Journal of Electrocardiology)

Familial Atrial Fibrillation Mutation KCNQ1-S140G Exhibits Enhanced Sensitivity to Block by the IKs Selective Inhibitor HMR-1556

Heart Rhythm — Wed, 26 Oct 2011 08:34:18 +0100

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. The contribution of genetic factors to AF susceptibility has been emphasized by the discovery of mutations that enhance outward potassium current, predicted to shorten atrial action potential duration and predispose to re-entrant arrhythmia mechanisms. Understanding the genetic basis for familial AF can inspire new ideas regarding treatment of this common arrhythmia. We hypothesized that potassium channel mutations predisposing to AF may have distinct pharmacological properties from wild-type channels. We tested this hypothesis by investigating the effects of HMR-1556, an IKs selective inhibitor, on a gain-of-function familial AF associated mutation, KCNQ1-S140G. (Source: Heart Rhythm)

Dominant-Negative Suppression of Nav1.5 Channel by N-Terminal SCN5A Mutations in Brugada Syndrome

Heart Rhythm — Wed, 26 Oct 2011 08:34:18 +0100

Background: Brugada syndrome (BrS) is an autosomal inherited cardiac arrhythmia characterized by ST-segment elevation in the right precordial leads of the ECG, and an increased risk of syncope and sudden death. Mutations in the SCN5A gene encoding the cardiac sodium channel Nav1.5 account for 20 to 30% of BrS cases. Here, we aimed to characterize two SCN5A mutations in the N-terminal cytoplasmic region, of which the function is still unknown: R104W that we recently identified in a BrS patient and R121W, both affecting evolutionarily conserved residues. (Source: Heart Rhythm)

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UM School of Medicine finds new pathway critical to heart arrhythmia

EurekAlert! - Medicine and Health — Wed, 26 Oct 2011 04:00:00 +0100

(University of Maryland Medical Center) University of Maryland School of Medicine researchers have uncovered a previously unknown molecular pathway that is critical to understanding cardiac arrhythmia and other heart muscle problems. Understanding the basic science of heart and muscle function could open the door to new treatments. The study in Cell examined the electrical impulses that coordinate contraction in heart and skeletal muscles, controlling heart rate. These impulses are key to health conditions like paralysis, muscle relaxation and heart arrhythmia. (Source: EurekAlert! - Medicine and Health)

Benefits and risks of oral anticoagulation for stroke prevention in nonvalvular atrial fibrillation

Thrombosis Research — Mon, 24 Oct 2011 04:00:00 +0100

Abstract: Nonvalvular atrial fibrillation is the most common clinically significant cardiac arrhythmia in the United States. It increases both the risk for and the severity of strokes and is associated with substantial morbidity, mortality, decreased quality of life, and related health care costs. Guidelines recommend anticoagulation therapy for the majority of patients with atrial fibrillation. Clinical trials have established that vitamin K antagonists are effective for stroke prevention for patients with atrial fibrillation for whom anticoagulation is recommended. However, vitamin K antagonists remain underutilized for a variety of reasons, including drug, physician, and patient factors. While vitamin K antagonists considerably reduce the risk of stroke, the absolute risk reduction vari...

Risk factors of self-terminating and perpetuating ventricular tachyarrhythmias in post-infarction patients with moderately depressed left ventricular function, a CARISMA sub-analysis

Europace — Fri, 21 Oct 2011 04:00:00 +0100

Conclusion Self-terminating ventricular tachyarrhythmia and pVT have differences in electrophysiological substrate and arrhythmia modifiers in post-AMI patients with moderate left ventricular dysfunction. (Source: Europace)

A New Optrode Design for Intramural Optical Recordings

IEEE Transactions on Biomedical Engineering — Fri, 21 Oct 2011 03:39:33 +0100

Intramural measurements of V$_m$ and Ca$_i^{2+}$ are important in the studies of cardiac arrhythmias and defibrillation. We developed a new design of an “optrode” (bundle of optical fibers) for use in intramural cardiac mapping. The optrodes are made from seven optical fibers with the fiber ends polished at 45$^{circ}$ angle and coated with mirror surfaces. The optrodes are enclosed in smooth epoxy resin cast, which protects mirror surfaces from damage and ensures constant optrode diameter along its length. The optrodes are strong enough to be easily inserted into heart muscle, can be reused multiple times, and they may reduce artifacts in the measurements of the effects of defibrillation shocks on V$_m$. (Source: IEEE Transactions on Biomedical Engineering)

Systemic venous anatomy in congenital heart disease: implications for electrophysiologic testing and catheter ablation

Journal of Interventional Cardiac Electrophysiology — Thu, 20 Oct 2011 15:53:19 +0100

Conclusions Systemic venous anomalies occur frequently in the congenital heart disease population and may complicate electrophysiologic testing and catheter ablation. Pre-procedural imaging may assist in facilitating a successful procedure. Content Type Journal ArticlePages 1-7DOI 10.1007/s10840-011-9624-7Authors Rachael Louise Cordina, Royal Prince Alfred Hospital, Sydney, AustraliaDavid S. Celermajer, Royal Prince Alfred Hospital, Sydney, AustraliaMark A. McGuire, Royal Prince Alfred Hospital, Sydney, Australia Journal Journal of Interventional Cardiac ElectrophysiologyOnline ISSN 1572-8595Print ISSN 1383-875X (Source: Journal of Interventional Cardiac Electrophysiology)

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TRPM4 inhibitor 9‐phenanthrol abolishes arrhythmias induced by hypoxia and reoxygenation in mouse ventricle

British Journal of Pharmacology — Thu, 20 Oct 2011 04:00:00 +0100

Conclusions and implications: Hypoxia and reoxygenation‐induced EADs could be generated in the mouse heart model. 9‐phenanthrol was shown to abolish EADs, which strongly suggests an involvement of TRPM4 in the generation of EAD. This identifies non‐selective cation channels inhibitors as new pharmacological candidates in the treatment of arrhythmias. (Source: British Journal of Pharmacology)

Electrocardiographic Signals and Swarm-Based Support Vector Machine for Hypoglycemia Detection.

Annals of Biomedical Engineering — Thu, 20 Oct 2011 04:00:00 +0100

This article introduces electrocardiographic (ECG) parameters for artificially induced hypoglycemia detection. In addition, a hybrid technique of swarm-based support vector machine (SVM) is introduced for hypoglycemia detection using the ECG parameters as inputs. In this technique, a particle swarm optimization (PSO) is proposed to optimize the SVM to detect hypoglycemia. In an experiment using medical data of patients with Type 1 diabetes, the introduced ECG parameters show significant contributions to the performance of the hypoglycemia detection and the proposed detection technique performs well in terms of sensitivity and specificity. PMID: 22012087 [PubMed - as supplied by publisher] (Source: Annals of Biomedical Engineering)

Patterns, predictors and preventability of adverse drug reactions in the coronary care unit of a tertiary care hospital

European Journal of Clinical Pharmacology — Tue, 18 Oct 2011 16:00:13 +0100

Conclusion A high frequency of ADR occurrence was identified, with many of the ADRs being potentially preventable. Patients with renal dysfunction or cardiac arrhythmias and those receiving polypharmacy were at an increased risk for developing an ADR in the CCU. Content Type Journal ArticleCategory Pharmacoepidemiology and PrescriptionPages 1-7DOI 10.1007/s00228-011-1138-9Authors Padmini Devi, Department of Pharmacology, St. John’s Medical College, Koramangala, Bangalore, Karnataka 560034, IndiaDeepak Y. Kamath, Department of Pharmacology, St. John’s Medical College, Koramangala, Bangalore, Karnataka 560034, IndiaNaveen Anthony, Department of Pharmacology, St. John’s Medical College, Koramangala, Bangalore, Karnataka 560034, IndiaSushma Santosh, Department of ...

Ionic mechanisms underlying cardiac toxicity of the organochloride solvent trichloromethane.

Toxicology — Mon, 17 Oct 2011 04:00:00 +0100

Authors: Zhou Y, Wu HJ, Zhang YH, Sun HY, Wong TM, Li GR Abstract Trichloromethane (chloroform) is widely used for industrial chemical synthesis and also as an organic solvent in laboratories or ingredient of pesticides of pesticides. Sudden death resulted from cardiac arrhythmias has been reported in clinic with acute trichloromethane intoxication. The present study was designed to investigate ionic mechanisms underlying arrhythmogenic effect (cardiac toxicity) of trichloromethane in isolated rat hearts and ventricular myocytes and HEK 293 cells stably expressing human Nav1.5, HCN2, or hERG channel using conventional electrophysiological approaches. It was found that trichloromethane (5mM) induced bradycardia and atrial-ventricular conduction blockade or ventricular fibrillation, ...

Cardiac Genetic Investigation of Young Sudden Unexplained Death and Resuscitated Out of Hospital Cardiac Arrest

Heart, Lung and Circulation — Mon, 17 Oct 2011 04:00:00 +0100

Nearly 30% of young sudden deaths have negative autopsies and these sudden unexplained deaths (SUDs) are presumed to be due to heritable cardiac arrhythmias attributed to cardiac ion channel disorders. Comprehensive cardiac and genetic testing of families of SUD is helpful in the detection of inherited cardiac genetic conditions. It frequently provides a clue to the cause of death in SUD victims and allows early diagnosis and opportunities to prevent SUD in other family members.Out of Hospital Cardiac Arrest (OHCA) victims and their families also require similar assessment, although the role of genetic testing in this group should be reserved to patients where a clinical diagnosis is established. A team approach with multidisciplinary specialised clinics and increased access to genetic ana...

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The Use of SU-8 Topographically Guided Microelectrode Array in Measuring Extracellular Field Potential Propagation.

Annals of Biomedical Engineering — Sat, 15 Oct 2011 04:00:00 +0100

Connexin 43 gene therapy prevents persistent atrial fibrillation in a porcine model

Cardiovascular Research — Fri, 14 Oct 2011 04:00:00 +0100

Conclusion Our results highlight the contribution of Cx43 to the pathophysiology of AF and demonstrate the viability of gene therapy for prevention of atrial arrhythmias. (Source: Cardiovascular Research)

AQP4 knockout mice manifest abnormal expressions of calcium handling proteins possibly due to exacerbating pro-inflammatory factors in the heart.

Biochemical Pharmacology — Fri, 14 Oct 2011 04:00:00 +0100

Authors: Cheng YS, Tang YQ, Dai DZ, Dai Y Abstract We tested the hypothesis that aquaporin-4 (AQP4) knockout (KO) mice might exhibit abnormal Ca(2+) modulating proteins resulting from the exacerbation of pro-inflammatory factors in the heart. Downregulation of FKBP12.6, SERCA2a, and CASQ2 and calcium leak in diastole have been recognized as endpoints for assessing cardiac failure and arrhythmias. The AQP4 KO mice and wild-type (WT) mice were randomly divided into 3 groups, such as control, isoproterenol (ISO, β-receptor agonist) injected (1mg/kg, sc, 5d), and treated with aminoguanidine (AMG, 100mg/kg, po, a selective inhibitor of the iNOS) during the last 3d. RT-PCR, western blot and calcium transient measurements were conducted. The results demonstrated that the cardiac weight i...

Takotsubo syndrome (TKS): A possible mechanism of sudden unexplained death in epilepsy (SUDEP)

Seizure: European Journal of Epilepsy — Thu, 13 Oct 2011 04:00:00 +0100

We report a case of Takotsubo syndrome after epilepsy, and review the literature. We identified 59 cases of Takotsubo syndrome after focal or generalised epilepsy. As in Takotsubo syndrome in general, the patients were mostly female (84%), with a mean age of 63 years, and the evolution was generally favourable. There was one death and one stroke, and 4 cases were of relapsing Takotsubo after a new seizure. Takotsubo syndrome may induce cardiac arrhythmias. A near-SUDEP (sudden unexplained death in epilepsy) was reported in one patient. Animal models of SUDEP have shown similar cardiac lesions to those seen in Takotsubo syndrome, and strengthen the hypothesis of a link between these conditions. Takotsubo syndrome after epilepsy may be relatively common; we suggest measurement of serum tropo...

Temporal Transcriptome Changes Induced by MDV in Marek's Disease-Resistant and -Susceptible Inbred Chickens

BMC Genomics - Latest articles — Wed, 12 Oct 2011 04:00:00 +0100

Conclusions: By testing temporal transcriptome changes using three representative chicken lines with different resistance to MD, we identified 163 candidate genes for MD-resistance and 175 candidate genes for MD-susceptibility over the three time points. Genes included in our resistance or susceptibility genes lists that are also involved in more than 5 biofunctions, such as CD8alpha, IL8, USP18, and CTLA4, are considered to be important genes involved in MD-resistance or -susceptibility. We were also able to identify several biofunctions related with immune response that we believe play an important role in MD-resistance. (Source: BMC Genomics - Latest articles)

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Utilization of Hyperbaric Oxygen Therapy and Induced Hypothermia After Hydrogen Sulfide Exposure.

Respiratory Care — Wed, 12 Oct 2011 04:00:00 +0100

We report the case of a patient presenting with cardiac arrest secondary to hydrogen sulfide exposure treated with both hyperbaric oxygen therapy and therapeutic hypothermia to achieve full neurologic recovery. PMID: 22004989 [PubMed - as supplied by publisher] (Source: Respiratory Care)

Almanac 2011: cardiac arrhythmias and pacing. The national society journals present selected research that has driven recent advances in clinical cardiology

Heart — Thu, 06 Oct 2011 04:00:00 +0100

Atrial fibrillationClinical trials In the past 2 years, a number of landmark clinical trials have been published which further our understanding and clinical management of patients with atrial fibrillation (AF). Two of the major goals in the treatment of this condition include reducing progression or recurrence of the arrhythmia and decreasing the risk of cardiovascular events, thereby improving quality of life and decreasing morbidity. Following on from a large body of evidence from preclinical studies, small clinical trials and meta-analyses suggesting that blockade of the renin–angiotensin system has beneficial effects on the pathophysiology of AF,1 two large multicentre, placebo-controlled, randomised trials were conducted to determine the effects of angiotensin II receptor ...

New treatment options for atrial fibrillation: towards patient tailored therapy

Heart — Thu, 06 Oct 2011 04:00:00 +0100

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Currently more than six million people in Europe are affected by AF and this number is expected to increase twofold during the next 30–50 years, partly due to the ageing population.1 AF is not a benign disease as it is responsible for an increased risk of death, stroke, and heart failure, reduced exercise capacity and left ventricular dysfunction, and an impaired quality of life. It is therefore important to develop safe treatment strategies for AF in order to improve outcome and to promote healthy ageing. Treatment of AF, however, is not straightforward due to the progressive nature of the arrhythmia, the wide range of associated diseases, and differences in presentation between patients. The complexity of the &lsq...

Value of Real-Time Transesophageal 3-Dimensional Echocardiography in Guiding Ablation of Isthmus-Dependent Atrial Flutter and Pulmonary Vein Isolation.

Circulation Journal — Thu, 06 Oct 2011 04:00:00 +0100

Authors: Faletra FF, Regoli F, Acena M, Auricchio A Abstract In the past decade, both the range of indications and the efficacy and safety of interventional electrophysiology has improved considerably. This progress is attributed to both the accumulating experience of electrophysiologists and the advances in technological tools facilitating the diagnosis and treatment of cardiac arrhythmias. Real-time 3-dimensional transesophageal echocardiography (RT 3D TEE) has emerged as a new imaging tool in the clinical arena. Its ability to image in "real time" cardiac structures "en face" and the almost entire length of intracardiac catheters has made this technique a promising imaging tool to guide percutaneous catheter-based procedures. More recently it has been used in monitoring ablation...

Characterisation of electrophysiological conduction in cardiomyocyte co-cultures using co-occurrence analysis.

Computer Methods in Biomechanics and Biomedical Engineering — Tue, 04 Oct 2011 04:00:00 +0100

Authors: Chen MQ, Wong J, Kuhl E, Giovangrandi L, Kovacs GT Abstract Cardiac arrhythmias are disturbances of the electrical conduction pattern in the heart with severe clinical implications. The damage of existing cells or the transplantation of foreign cells may disturb functional conduction pathways and may increase the risk of arrhythmias. Although these conduction disturbances are easily accessible with the human eye, there is no algorithmic method to extract quantitative features that quickly portray the conduction pattern. Here, we show that co-occurrence analysis, a well-established method for feature recognition in texture analysis, provides insightful quantitative information about the uniformity and the homogeneity of an excitation wave. As a first proof-of-principle, we ...

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AJN: What is appropriate end-of-life care for ICD patients?

Cardiovascular Business News — Mon, 03 Oct 2011 13:41:18 +0100

Implantable cardioverter-defibrillators (ICDs) are standard treatment for patients at risk for life-threatening cardiac arrhythmias, but what happens when these patients are delivered high-energy, painful electric shocks, particularly during end of life? While device deactivation is an option, no standard protocols are in place to address this issue. Policies must be developed to help guide providers on best practices during end of life care, according to a research published in this month's American Journal of Nursing. (Source: Cardiovascular Business News)

Novel GATA4 mutations in lone atrial fibrillation.

International Journal of Molecular Medicine — Mon, 03 Oct 2011 12:31:28 +0100

In this study, the entire coding sequence and splice junctions of GATA4, which encodes a zinc-finger transcription factor essential for cardiogenesis, were sequenced in 160 unrelated patients with lone AF. A total of 200 unrelated ethnically matched healthy individuals were used as controls. The available relatives of the patient carrying an identified mutation were genotyped. The functional characteristics of the mutant GATA4 were analyzed using a luciferase reporter assay system. As a result, two novel heterozygous GATA4 mutations of p.G16C and p.H28D, were identified in 2 unrelated families with AF, respectively, which co-segregated with AF in each family with complete penetrance. Functional analysis demonstrated that the mutations o...

Treatment of cocaine overdose with lipid emulsion

Anaesthesia — Mon, 03 Oct 2011 04:00:00 +0100

We describe the management and recovery of a 28‐year‐old man following a history of overdose by nasal inhalation of cocaine. The patient was presented in a comatose state suffering from seizures and marked cardiovascularly instability. Intravenous lipid emulsion was administered following initial resuscitation and tracheal intubation, as a means of treating persistent cardiac arrhythmias and profound hypotension. Following lipid emulsion therapy, the patient’s life‐threatening cardiovascular parameters rapidly improved and he recovered well without any side effects, thus being discharged within 2 days.You can respond to this article at http://www.anaesthesiacorrespondence.com (Source: Anaesthesia)

Rate vs. rhythm control in patients with atrial fibrillation — An updated meta-analysis of 10 randomized controlled trials

International Journal of Cardiology — Mon, 03 Oct 2011 04:00:00 +0100

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting more than 2million adults in the United States . Rate control and rhythm control, both combined with anticoagulation therapy, are two fundamental strategies to treat AF. A series of randomized controlled trials (RCTs) were performed to compare the two strategies, but which one is better still has been the focus of controversy . Therefore, we systematically performed an updated meta-analysis to compare rate and rhythm control strategy in terms of all cause mortality and worsening heart failure. (Source: International Journal of Cardiology)

Original Research: Deactivation of ICDs at the End of Life: A Systematic Review of Clinical Practices and Provider and Patient Attitudes

AJN — Sat, 01 Oct 2011 05:00:00 +0100

Conclusions: Both patients and providers need better knowledge of ICD functions and options at the end of life in order to foster more timely discussion of device deactivation. More research is needed, in particular regarding patient attitudes toward ICD deactivation. Formal ICD deactivation policies should be developed to guide providers. A comprehensive and interdisciplinary approach to deactivation discussions should be considered. Keywords: cardiac arrhythmia, cardiac implantable electronic device, deactivation, defibrillation, end-of-life care, heart failure, hospice care, implantable cardioverter-defibrillator, palliative care, ventricular tachyarrhythmia (Source: AJN)

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A critical review and meta-analysis of the association between overt hyperthyroidism and mortality.

European Journal of Endocrinology — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion In patients diagnosed with hyperthyroidism, mortality is increased by ∼20%. Future studies need to address the cause of hyperthyroidism, impact of type of therapy, time dependency, as well as the potential influence of confounding or genetic susceptibility before the question of causality can be answered. PMID: 21724839 [PubMed - in process] (Source: European Journal of Endocrinology)

Outcomes registry for better informed treatment of atrial fibrillation: Rationale and design of ORBIT-AF

American Heart Journal — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion: The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation will provide insights into “real-world” treatment including rate and rhythm control, stroke prevention, transitions to new therapies, and clinical and patient-centered outcomes among patients with AF in community practice settings (ClinicalTrials.gov NCT01165710). (Source: American Heart Journal)

[Acute mesenteric ischemia].

Der Chirurg — Sat, 01 Oct 2011 04:00:00 +0100

Authors: Ritz JP, Buhr HJ Abstract Acute mesenteric ischemia (AMI) is a rare cause of acute abdomen. Coupled with a high patient age, non-specific clinical symptoms and a significant co-morbidity the disease is still associated with a significant mortality of 60-85%. With a combination of preexisting cardiac arrhythmia and sudden abdominal pain AMI should always first be ruled out. Contrast-enhanced computed tomography (CT) scanning has replaced angiography as the first diagnostic step, largely because both intravascular and intra-abdominal pathologies can be diagnosed. In the case of an acute abdomen or lack of immediate access to diagnostic tools, rapid surgical exploration should be preferred. Surgical therapy includes embolectomy and resection of ischemic bowel segments. There ...

Dysrhythmias to Go

JEMS: Journal of Emergency Medical Services — Sat, 01 Oct 2011 04:00:00 +0100

Learning to read ECGs takes time and practice. You need to learn the basics, then read as many rhythm strips as you can get your hands on. During paramedic school, when you're completing your cardiac care unit clinical rotation, you need a handy reference to compare all the odd patient ECGs they give you with established criteria. The Pocket R-CAT (rapid cardiac arrhythmia tool) from EKG Concepts is a 12-panel, double-sided, laminated tool that folds out to reveal 41 six-second ECG strips, with the identifying criteria listed below them. So when you can't tell the PVC from the PJC, you simply need to pull out the Pocket R-CAT and compare the known with the unknown. (Source: JEMS: Journal of Emergency Medical Services)

Atrioventricular conduction abnormality and hyperchloremic metabolic acidosis in toluene sniffing.

J Formos Med Assoc — Sat, 01 Oct 2011 04:00:00 +0100

We report a 38-year-old man who suffered from general muscular weakness of all extremities after toluene sniffing, which was complicated with hypokalemic paralysis, atrioventricular conduction abnormality, and normal anion gap hyperchloremic metabolic acidosis. Renal function, serum potassium and acid-base status normalized within 3 days after aggressive potassium chloride and intravenous fluid replacement. Electrocardiography showed regression of first-degree atrioventricular block. Exposure to toluene can lead to cardiac arrhythmias and sudden sniffing death syndrome. Tachyarrhythmia is the classical manifestation of toluene cardiotoxicity. Atrioventricular conduction abnormalities have been rarely mentioned in the literature. Knowledge of the toxicology and medical complications associa...

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Atrial fibrillation and primary stroke prevention.

Nursing Standard — Sat, 01 Oct 2011 04:00:00 +0100

Authors: Bloe C Abstract Atrial fibrillation (AF) is a common cardiac arrhythmia that significantly increases the risk of ischaemic (embolic) stroke. The primary aim of this article is to help healthcare practitioners understand the link between AF and stroke and to assist them in assessing and managing high-risk patients. The association between a cardiac arrhythmia and a disabling cerebral event is not always understood fully. However, all healthcare professionals are in a position to identify patients with AF. PMID: 22046927 [PubMed - in process] (Source: Nursing Standard)

Cardiac arrhythmias and pacing.

Archivos de Cardiologia de Mexico — Sat, 01 Oct 2011 04:00:00 +0100

Authors: Liew R PMID: 22188895 [PubMed - as supplied by publisher] (Source: Archivos de Cardiologia de Mexico)

[On the first studies of electrophysiology].

Archivos de Cardiologia de Mexico — Sat, 01 Oct 2011 04:00:00 +0100

Authors: de Micheli A Abstract A historical outline of the evolution of electrophysiology from the eighteenth century is shortly presented. Topics concerning the so called animal electricity starting from the observations on descharges of Torpedo fish until Bolognese Galvani's researches on the frogs are exposed. The points of view of their oppositionists also are examined. These ones, leaded by the physicist Alessandro Volta, professor in the University of Pavia, believed that electricity detected by galvanists was not inherent to animal but was due to the action of the metallic conductors present in the circuit: contact electricity. Only towards the middle of the nineteenth century the physicist Carlo Matteucci attained to demonstrate the existente of the real animal electricity ...

Poststernotomy Pain: A Clinical Review

Journal of Cardiothoracic and Vascular Anesthesia — Thu, 29 Sep 2011 04:00:00 +0100

POORLY CONTROLLED PAIN is associated with sympathetic nervous system activation and an increased hormonal stress response. This response may contribute to multiple adverse postoperative events, including myocardial ischemia, cardiac arrhythmias, hypercoagulability, pulmonary complications, and increased rates of delirium and wound infection. In a systematic review of trials that examined postoperative pain and patient outcomes, better pain control was associated with lower rates of cardiovascular complications, pneumonia, and postoperative hypercoagulability. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Investigation into data fraud results in heart researcher's dismissal

BMJ Online First — Tue, 27 Sep 2011 04:00:00 +0100

Five published articles on the genetic causes of cardiac arrhythmia are being retracted after the dismissal of a Montreal Heart Institute researcher who falsified data in his work. The institute... (Source: BMJ Online First)

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Unexpected Double Lethal Oleander Poisoning. - Papi L, Luciani AB, Forni D, Giusiani M.

SafetyLit: All (Unduplicated) — Mon, 26 Sep 2011 16:58:41 +0100

Nerium oleander is a very popular urban ornamental plant in Europe, but it is also extremely dangerous because it contains several types of glycosides, accidental ingestion of which can cause cardiac arrhythmias and even deaths.The rarity of such cases mak... (Source: SafetyLit: All (Unduplicated))

The cost of illness of atrial fibrillation: a systematic review of the recent literature

Europace — Mon, 26 Sep 2011 04:00:00 +0100

Atrial fibrillation (AF) is the most common cardiac arrhythmia, its prevalence increasing markedly with age. Atrial fibrillation is strongly associated with increased risk of morbidity, including stroke and thromboembolism. There is growing awareness of the economic burden of AF due to ageing populations and constrained public finances. A systematic review was performed (1990–2009). Cost studies for AF or atrial flutter were included; acute-onset and post-operative AF were excluded. Total, direct, and indirect costs were extracted. Of 875 records retrieved, 37 studies were included. The cost of managing individual AF patients is high. Direct-cost estimates ranged from $2000 to 14 200 per patient-year in the USA and from 450 to 3000 in Europe. This is comparable with other chronic con...

Should T-wave alternans magnitude be corrected with T-wave amplitude in the ultra-short-term prediction of life-threatening cardiac arrhythmias?

Europace — Mon, 26 Sep 2011 04:00:00 +0100

(Source: Europace)

San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review.

cmaj — Mon, 26 Sep 2011 04:00:00 +0100

Authors: Saccilotto RT, Nickel CH, Bucher HC, Steyerberg EW, Bingisser R, Koller MT Abstract BACKGROUND:The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It has been valid ated across various populations and settings. We undertook a systematic review of its accuracy in predicting short-term serious outcomes. METHODS:We identified studies by means of systematic searches in seven electronic databases from inception to January 2011. We extracted study data in duplicate and used a bivariate random-effects model to assess the predictive accuracy and test characteristics. RESULTS:We included 12 studies with a total of 5316 patients, of whom 596 (11%) experienced a serious o...

Metabolic stress, reactive oxygen species, and arrhythmia

Journal of Molecular and Cellular Cardiology — Mon, 26 Sep 2011 04:00:00 +0100

This article is part of a Special Issue entitled “Local Signaling in Myocytes”.Highlights: ► Cardiomyopathies are associated with metabolic stress, oxidative stress, and arrhythmic risk. ► Oxidative stress alters ion channels, Ca2+ handling, and gap junctions, possibly explaining the arrhythmic risk. ► Anti-oxidants may be useful anti-arrhythmic drugs. ► Highlights ROS mediate arrhythmogenesis through the alteration of ion homeostasis and structural remodeling. (Source: Journal of Molecular and Cellular Cardiology)

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Incomplete occlusion of the LAA with the PLAATO device is not associated with increased risk of stroke

Journal of Interventional Cardiac Electrophysiology — Fri, 23 Sep 2011 15:51:08 +0100

Conclusions The main finding of our analysis suggests that in long-term follow-up, residual flow after LAA occlusion with the PLAATO device, as documented by cardiac CT, is ubiquitous but is not associated with an increased risk of stroke. Content Type Journal ArticlePages 1-7DOI 10.1007/s10840-011-9613-xAuthors Juan F. Viles-Gonzalez, Cardiac Arrhythmia Service, Mount Sinai Heart, Mount Sinai School of Medicine, New York, NY, USAVivek Y. Reddy, Cardiac Arrhythmia Service, Mount Sinai Heart, Mount Sinai School of Medicine, New York, NY, USAJan Petru, Cardiology Department, Homolka Hospital, Prague, Czech RepublicTomas Mraz, Cardiology Department, Homolka Hospital, Prague, Czech RepublicZuzana Grossova, Cardiology Department, Homolka Hospital, Prague, Czech RepublicSt...

Incomplete occlusion of the left atrial appendage with the percutaneous left atrial appendage transcatheter occlusion device is not associated with increased risk of stroke

Journal of Interventional Cardiac Electrophysiology — Fri, 23 Sep 2011 15:51:08 +0100

NT-proBNP, but not ANP and C-reactive protein, is predictive of paroxysmal atrial fibrillation in patients undergoing pulmonary vein isolation

Journal of Interventional Cardiac Electrophysiology — Thu, 22 Sep 2011 06:01:18 +0100

Conclusions Elevated NT-proBNP level at baseline, but not ANP and hs-CRP, is a sensitive biomarker for early predicting AF recurrence in patients with PAF. Content Type Journal ArticlePages 1-8DOI 10.1007/s10840-011-9606-9Authors Jinqi Fan, Department of Cardiology, Chongqing Cardiac Arrhythmia Therapeutic Service Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 ChinaHua Cao, Department of Cardiology, Chongqing Cardiac Arrhythmia Therapeutic Service Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 ChinaLi Su, Department of Cardiology, Chongqing Cardiac Arrhythmia Therapeutic Service Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010 ChinaZhiyu Ling...

Is Clonidine an Adequate Alternative to Epinephrine as a Vasoconstrictor in Patients With Hypertension?

Journal of Oral and Maxillofacial Surgery — Thu, 22 Sep 2011 04:00:00 +0100

Conclusions: Clonidine could be a useful and safe alternative to epinephrine for intraoral block anesthesia with lidocaine in patients with hypertension and American Society of Anesthesiologists class II. (Source: Journal of Oral and Maxillofacial Surgery)

The “missing” link in atrial fibrillation heritability

Journal of Electrocardiology — Mon, 19 Sep 2011 04:00:00 +0100

Abstract: Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, represents a major health burden to individuals and health care system within the Western world. The lifetime risk for the development of AF at age 40 years has been estimated to be approximately 1 in 4. Atrial fibrillation is associated with substantial morbidity and a 2-fold increased risk of mortality. Given its increasing prevalence with age, coupled with the aging population, the number of Americans affected with AF is expected to increase from approximately 2.3 million in the year 2000 to nearly 16 million by 2050. This AF epidemic is further complicated by the lack of highly effective therapies. One reason for the lack of effective therapies for AF stems from incomplete understanding of the complex pat...

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Gender differences in trend of hospital management for atrial fibrillation: A nationwide population-based analysis

International Journal of Cardiology — Mon, 19 Sep 2011 04:00:00 +0100

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice and it induces cardiac dysfunction and strokes . Gender differences were shown to play important roles in the pathogenesis of AF . The prevalence of AF was significantly higher in men than in women . Women AF patients are usually older than men, with a lower AF incidence rate, and more frequent recurrence . Previous studies also identified that AF women had more co-morbidities, had lower quality of life, a higher risk of strokes, and received more conservative treatments . However, most epidemiological analyses investigated AF in Western communities. It is not clear whether gender differences also exist in the medical management for AF in Asia. The National Health Insurance (NHI) has provided medi...

Microvolt T-Wave Alternans: Physiological Basis, Methods of Measurement, and Clinical Utility—Consensus Guideline by International Society for Holter and Noninvasive Electrocardiology

Journal of the American College of Cardiology — Sat, 17 Sep 2011 22:21:00 +0100

This consensus guideline was prepared on behalf of the International Society for Holter and Noninvasive Electrocardiology and is cosponsored by the Japanese Circulation Society, the Computers in Cardiology Working Group on e-Cardiology of the European Society of Cardiology, and the European Cardiac Arrhythmia Society. It discusses the electrocardiographic phenomenon of T-wave alternans (TWA) (i.e., a beat-to-beat alternation in the morphology and amplitude of the ST- segment or T-wave). This statement focuses on its physiological basis and measurement technologies and its clinical utility in stratifying risk for life-threatening ventricular arrhythmias. Signal processing techniques including the frequency-domain Spectral Method and the time-domain Modified Moving Average method have demons...

Infliximab does not affect postoperative complication rates in Crohn's patients undergoing abdominal surgery

Inflammatory Bowel Diseases — Fri, 16 Sep 2011 04:00:00 +0100

Conclusions:Infliximab does not affect postoperative complication rates, suggesting no need to alter surgical management in these patients. (Inflamm Bowel Dis 2011;) (Source: Inflammatory Bowel Diseases)

How is acute hypocalcaemia treated in adults?

NeLM - Medicines Q and A — Thu, 15 Sep 2011 04:00:00 +0100

Source: Leeds Medicines Information Centre Area: Evidence > Medicines Q & A There is no national guidance on the treatment of hypocalcaemia, and practice varies widely between hospital Trusts. The guidance in this document reflects practice at Leeds Teaching Hospitals NHS Trust. The cause of the hypocalcaemia should be established and if possible, steps taken to correct it before calcium is administered. Mild, asymptomatic hypocalcaemia is usually treated with oral calcium replacement at a dose of 10 to 50 mmol calcium daily for simple deficiency states and adjusted to the patient's individual requirements. In severe acute hypocalcaemia or hypocalcaemic tetany, 2.2 to 4.5 mmol calcium is administered as a slow intravenous injection over 5 to 10 mi...

Original Research: Deactivation of ICDs at the End of Life: A Systematic Review of Clinical Practices and Provider and Patient Attitudes.

The American Journal of Nursing — Thu, 15 Sep 2011 04:00:00 +0100

CONCLUSIONS: Both patients and providers need better knowledge of ICD functions and options at the end of life in order to foster more timely discussion of device deactivation. More research is needed, in particular regarding patient attitudes toward ICD deactivation. Formal ICD deactivation policies should be developed to guide providers. A comprehensive and interdisciplinary approach to deactivation discussions should be considered. PMID: 21926561 [PubMed - as supplied by publisher] (Source: The American Journal of Nursing)

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Deletion of the metabolic transcriptional coactivator PGC1{beta} induces cardiac arrhythmia

Cardiovascular Research — Wed, 14 Sep 2011 04:00:00 +0100

Conclusion PGC1β–/– hearts showed a lysophospholipid-induced cardiac lipotoxicity and impaired bioenergetics accompanied by an ion channel remodelling and altered Ca2+ homeostasis, converging to produce a ventricular arrhythmic phenotype particularly during adrenergic stress. This could contribute to the increased cardiac mortality associated with both metabolic and cardiac disease attributable to lysophospholipid accumulation. (Source: Cardiovascular Research)

Thyroxine monotherapy without amiodarone enhances atrial fibrillation recurrences in amiodarone-induced hypothyroidism

International Journal of Cardiology — Mon, 12 Sep 2011 04:00:00 +0100

Atrial fibrillation (AF) is the most sustained cardiac arrhythmia requiring medical care. Amiodarone is a di-iodinated benzofuran derivative widely used for preventing the recurrences of AF . Although amiodarone is the most effective agent in rhythm control of AF , the adverse effects of amiodarone frequently result in treatment discontinuations. Hypothyroidism caused by the iodine in amiodarone is one of the most frequent and important adverse effects. The incidence of amiodarone-induced hypothyroidism varies from 1 to 32% . The report of amiodarone-induced hypothyroidism in Asia is about 10 to 20% . However, the optimal treatment for amiodarone-induced hypothyroidism remains unclear. (Source: International Journal of Cardiology)

Seizure‐related cardiac repolarization abnormalities are associated with ictal hypoxemia

Epilepsia — Sun, 11 Sep 2011 04:00:00 +0100

SummaryPurpose: Cardiac arrhythmias and respiratory disturbances have been proposed as likely causes for sudden unexpected death in epilepsy. Oxygen desaturation occurs in one‐third of patients with localization‐related epilepsy (LRE) undergoing inpatient video–electroencephalography (EEG) telemetry (VET) as part of their presurgical workup. Ictal‐related oxygen desaturation is accompanied by hypercapnia. Both abnormal lengthening and shortening of the corrected QT interval (QTc) on electrocardiography (ECG) have been reported with seizures. QTc abnormalities are associated with increased risk of sudden cardiac death. We hypothesized that there may be an association between ictal hypoxemia and cardiac repolarization abnormalities.Methods: VET data from patients with refractor...

ROS and RNS Signaling in Heart Disorders: Could Antioxidant Treatment Be Successful?

Diagnostic and Therapeutic Endoscopy — Sat, 10 Sep 2011 22:28:57 +0100

There is not too much success in the antioxidant treatment of heart deceases in humans. However a new approach is now developed that suggests that depending on their structures and concentrations antioxidants can exhibit much more complicated functions in many pathological disorders. It is now well established that physiological free radicals superoxide and nitric oxide together with their derivatives hydrogen peroxide and peroxynitrite (all are named reactive oxygen species (ROS) and reactive nitrogen species (RNS)) play a more important role in heart diseases through their signaling functions. Correspondingly this work is dedicated to the consideration of damaging signaling by ROS and RNS in various heart and vascular disorders: heart failure (congestive heart failure or CHF), left ventr...

Teaching the pharmacology of antiarrhythmic drugs.

American Journal of Pharmaceutical Education — Sat, 10 Sep 2011 04:00:00 +0100

Conclusion. Students learned about cardiac arrhythmias through a high-quality, interdisciplinary series of classes presented by faculty members with extensive experience related to the pharmacology and pharmacotherapy of cardiac arrhythmias. PMID: 21969725 [PubMed - in process] (Source: American Journal of Pharmaceutical Education)

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Genetic suppression of atrial fibrillation using a dominant-negative ether-a-go-go–related gene mutant

Heart Rhythm — Fri, 09 Sep 2011 04:00:00 +0100

Conclusion: Inhibition of ERG function using atrial AdCERG-G627S gene transfer suppresses or delays the onset of persistent AF by prolongation of atrial refractoriness in a porcine model. Targeted gene therapy represents an alternative to pharmacological or ablative treatment of AF. (Source: Heart Rhythm)

Advances in the enantioseparation of β‐blocker drugs by capillary electromigration techniques

Electrophoresis — Thu, 08 Sep 2011 04:00:00 +0100

Abstractβ‐Blocker drugs or β‐adrenergic blocking agents are an important class of drugs, prescribed with great frequency. They are used for various diseases, particularly for the treatment of cardiac arrhythmias, cardioprotection after myocardial infarction (heart attack), and hypertension. Almost all β‐blocker drugs possess one or more stereogenic centers; however; only some of them are administered as single enantiomers. Since both enantiomers can differ in their pharmacological and toxicological properties, enantioselective analytical methods are required not only for pharmacodynamic and pharmacokinetic studies but also for quality control of pharmaceutical preparations with the determination of enantiomeric purity. In addition to the chromatographic tools, in recent years, cap...

Human Epicardial Fat: what is new and what is missing?

Clinical and Experimental Pharmacology and Physiology — Tue, 06 Sep 2011 04:00:00 +0100

Authors: Sacks HS, Fain JN Abstract 1. Putative physiological functions of human epicardial adipose tissue [EAT] include lipid storage for the energy needs of the myocardium; thermoregulation whereby brown fat components of EAT generate heat by non-shivering thermogenesis in response to core cooling; neuroprotection of the cardiac autonomic ganglia and nerves; and regulation of vasomotion and luminal size of the coronary arteries. Under pathophysiological circumstances, EAT may play an adverse paracrine role in cardiac arrhythmias and in lipotoxic cardiomyopathy but of major current interest is its hypothetical role as an immunological organ contributing to inflammation around coronary artery disease [CAD]. 2. The amount of EAT measured either by echocardiographic thickness over th...

10 Years of Intracoronary and Intramyocardial Bone Marrow Stem Cell Therapy of the Heart: From the Methodological Origin to Clinical Practice

Journal of the American College of Cardiology — Sat, 03 Sep 2011 13:27:50 +0100

Intracoronary and intramyocardial stem cell therapy aim at the repair of compromised myocardium thereby—as a causal treatment—preventing ventricular remodeling and improving overall performance. Since the first-in-human use of bone marrow stem cells (BMCs) after acute myocardial infarction in 2001, a large number of clinical studies have demonstrated their clinical benefit: BMC therapy can be performed with usual cardiac catheterization techniques in the conscious patient as well as also easily during cardiosurgical interventions. New York Heart Association severity degree of patients as well as physical activity improve in addition to (“on top” of) all other therapeutic regimens. Stem cell therapy also represents an ultimate approach in advanced cardiac failure. For acute myocardi...

Dangerous Arrhythmia Analyzed In A Heartbeat

Health News from Medical News Today — Fri, 02 Sep 2011 08:00:00 +0100

Just one second, one heartbeat. That's what is needed for a new, noninvasive functional imaging technology to record data for locating the source in the heart of a dangerous cardiac arrhythmia called ventricular tachycardia (VT). VT is an abnormal, fast beating of the heart, which, if ignored, can lead to ventricular fibrillation, which causes some 400,000 cases of sudden death yearly in the United States alone. The technique, developed by a Washington University in St. Louis scientist, is called Electrocardiographic Imaging (ECGI)... (Source: Health News from Medical News Today)

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Virtual Ventricle: Computer Predicts Dangers of Arrhythmia Drugs Better than Animal Testing

Scientific American Topic - Medical Technology — Thu, 01 Sep 2011 19:00:00 +0100

Drugs useful in the long-term management of cardiac arrhythmia, which occurs when electrical impulses in the heart become irregular and put patients at risk of sudden death, have eluded researchers for decades. Despite best efforts, most of the medications developed to calm abnormally fast heartbeats, a type of arrhythmia known as tachyarrhythmia , have faltered. Several clinical trials, including the seminal 1986 Cardiac Arrhythmia Suppression Trial (CAST) , even showed that the use of certain drugs designed to correct tachyarrhythmia--encainide and flecainide , in particular--actually increased the risk of death . [More] (Source: Scientific American Topic - Medical Technology)

Dabigatran Versus Warfarin

The Journal for Nurse Practitioners — Thu, 01 Sep 2011 04:00:00 +0100

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting about 1% of patients younger than 60 and about 8% of patients older than 80. AF causes significant morbidity and mortality, impairing cardiac function and increasing the risk of embolic stroke. Without anticoagulation, patients with AF have a risk of stroke of about 4.5% per year. (Source: The Journal for Nurse Practitioners)

The Role of Magnesium in Hypertension and Cardiovascular Disease

The Journal of Clinical Hypertension — Thu, 01 Sep 2011 04:00:00 +0100

J Clin Hypertens (Greenwich).Magnesium intake of 500 mg/d to 1000 mg/d may reduce blood pressure (BP) as much as 5.6/2.8 mm Hg. However, clinical studies have a wide range of BP reduction, with some showing no change in BP. The combination of increased intake of magnesium and potassium coupled with reduced sodium intake is more effective in reducing BP than single mineral intake and is often as effective as one antihypertensive drug in treating hypertension. Reducing intracellular sodium and calcium while increasing intracellular magnesium and potassium improves BP response. Magnesium also increases the effectiveness of all antihypertensive drug classes. It remains to be conclusively proven that cardiovascular disease such as coronary heart disease, ischemic stroke, and cardiac arr...

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Implantable loop recorders in myotonic dystrophy 1

International Journal of Cardiology — Wed, 31 Aug 2011 04:00:00 +0100

Myotonic dystrophy 1 (MD1) is an autosomal dominant disorder that is regarded as the most common muscular dystrophy in adults . MD1-patients are at high risk for atrioventricular conduction defects, supraventricular and ventricular arrhythmias and sudden death . Implantable cardioverters/defibrillators (ICD) and antibradycardic pacemakers (PM) are effective to prevent fatal outcomes of arrhythmias, but have also side effects . The proper selection of patients is crucial. Implantable loop recorders (ILR) have been developed to look for cardiac arrhythmias in patients with suspected arrhythmogenic syncope or at risk for sudden cardiac death (SCD). ILR in MD1 have been reported twice . Aim of the study was to present experiences with ILR in 6 MD1-patients. (Source: International Journal of Ca...

Atrial-selective inhibition of sodium-channel current by Wenxin Keli is effective in suppressing atrial fibrillation

Heart Rhythm — Wed, 31 Aug 2011 04:00:00 +0100

Conclusion: Wenxin Keli produces atrial-selective depression of INa-dependent parameters in canine isolated coronary-perfused preparations via a unique mechanism and is effective in suppressing AF and preventing its induction, with minimal effects on the ventricular electrophysiology. (Source: Heart Rhythm)

A mathematical model of action potentials of mouse sinoatrial node cells with molecular bases

AJP: Heart and Circulatory Physiology — Mon, 29 Aug 2011 23:00:00 +0100

Genetically modified mice are popular experimental models for studying the molecular bases and mechanisms of cardiac arrhythmia. A postgenome challenge is to classify the functional roles of genes in cardiac function. To unveil the functional role of various genetic isoforms of ion channels in generating cardiac pacemaking action potentials (APs), a mathematical model for spontaneous APs of mouse sinoatrial node (SAN) cells was developed. The model takes into account the biophysical properties of membrane ionic currents and intracellular mechanisms contributing to spontaneous mouse SAN APs. The model was validated by its ability to reproduce the physiological exceptionally short APs and high pacing rates of mouse SAN cells. The functional roles of individual membrane currents were evaluate...

A novel radiofrequency ablation catheter using contact force sensing: Toccata study

Heart Rhythm — Mon, 29 Aug 2011 04:00:00 +0100

Conclusions: Catheter ablation using real-time CF technology is safe for the treatment of SVT and AF. High CFs may occur during catheter manipulation and not just during ablation, suggesting that measuring CF may provide additional useful information to the operator for safe catheter manipulation. In the future, CF-sensing catheters may also increase the effectiveness of RF ablations by allowing better control of the RF lesion size. (Source: Heart Rhythm)

Patient-related Risk Factors for Postoperative Mortality and Periprosthetic Joint Infection in Medicare Patients Undergoing TKA.

Clinical Orthopaedics and Related Research — Fri, 26 Aug 2011 23:00:00 +0100

CONCLUSIONS: We believe this information important when counseling elderly patients regarding the risks of mortality and PJI after TKA and risk-adjusting publicly reported TKA patient outcomes. LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID: 21874391 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

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Taser stun guns and their use in the UK

Guardian Unlimited Science — Wed, 24 Aug 2011 17:57:32 +0100

English and Welsh police have used Tasers since 2008 despite reports indicating a risk to those with pre-existing conditionsTaser is a brand name for a type of electrical stun gun that is licensed, in the UK, for exclusive use by police and military personnel. Police can use one of two Taser weapons in England and Wales: the M26 and the X26.The commonly used version looks like a handgun and uses compressed nitrogen canisters to project a pair of darts towards a suspect. When these are embedded in a person, the Taser delivers a 50,000v electric shock through wires connecting the darts to the handheld device.The 19 pulses of electricity per second stimulate nerves that control muscles and are designed not to affect the heart. The shocks make a person's muscles rigid, dropping them to the gro...

FDA Warns Against High-Dose Citalopram

MedPage Today Psychiatry — Wed, 24 Aug 2011 16:12:14 +0100

(MedPage Today) -- Citing increased risk of cardiac arrhythmias and a lack of therapeutic benefit associated with high doses of the SSRI citalopram hydrobromide (Celexa), the FDA has reduced the recommended maximum to 40 mg/day. (Source: MedPage Today Psychiatry)

Ictal electrocardiographic changes in children presenting with seizures

Pediatrics International — Tue, 23 Aug 2011 23:00:00 +0100

Conclusion: Tachycardia is the main finding in seizures in children. Ictal bradycardia and cardiac arrhythmias are very rare despite being more frequent in adults with seizures. (Source: Pediatrics International)

Widening spectrum of the J-wave syndromes

Journal of Electrocardiology — Mon, 22 Aug 2011 04:00:00 +0100

For decades, early repolarization characterized by elevation of the junction between the end of the QRS complex and the beginning of the ST segment (the J point) has been considered to be a normal electrocardiographic (ECG) variant. The presence of a prominent J wave, however, especially in the inferior leads, is increasingly recognized as a marker of risk for malignant cardiac arrhythmias and cardiac death. The electrophysiologic mechanism and clinical significance of J-point elevation are hotly debated. The prevailing and almost uncontested theory is that J-point elevation is a genetic and purely electrophysiologic abnormality characterized by early repolarization of certain segments of the myocardium, giving rise to prominent voltage gradients between the endocardium and the epicardium ...

Defects in Ankyrin-Based Membrane Protein Targeting Pathways Underlie Atrial Fibrillation.

Circulation — Sun, 21 Aug 2011 23:00:00 +0100

Conclusions- These findings support that reduced ankyrin-B expression or mutations in ANK2 are associated with AF. Additionally, our data demonstrate a novel pathway for ankyrin-B-dependent regulation of Ca(v)1.3 channel membrane targeting and regulation in atrial myocytes. PMID: 21859974 [PubMed - as supplied by publisher] (Source: Circulation)

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Metabolic Emergencies in the Child With Acute Leukemia

Clinical Pediatric Emergency Medicine — Sat, 20 Aug 2011 16:10:53 +0100

Acute leukemia is the most common malignancy in children. Children with acute lymphoblastic leukemia and acute myeloid leukemia are frequently diagnosed, evaluated, and treated in emergency departments. Children with acute leukemia may develop multiple life-threatening electrolyte abnormalities, either at the time of diagnosis or after initiation of therapy. Children with acute lymphoblastic leukemia or hyperleukocytosis are at high risk for developing tumor lysis syndrome, which includes hyperuricemia, hyperkalemia, hyperphosphatemia, or hypocalcemia. Clinical complications of tumor lysis syndrome include renal insufficiency or acute renal failure, seizures, altered mental status or coma, cardiac arrhythmias, and sudden death. Rarely, children with acute leukemia will present with hyperca...

Sleep apnea, cardiac arrhythmias, and sudden death.

Texas Heart Institute Journal — Sat, 20 Aug 2011 10:44:06 +0100

Authors: Ludka O, Konecny T, Somers V PMID: 21841855 [PubMed - in process] (Source: Texas Heart Institute Journal)

Use of an Implantable Loop Recorder in the Investigation of Arrhythmias in Adult Captive Chimpanzees (Pan troglodytes).

Comparative Medicine — Fri, 19 Aug 2011 17:48:03 +0100

Authors: Lammey ML, Jackson R, Ely JJ, Lee DR, Sleeper MM Abstract Cardiovascular disease in general, and cardiac arrhythmias specifically, is common in great apes. However, the clinical significance of arrhythmias detected on short-duration electrocardiograms is often unclear. Here we describe the use of an implantable loop recorder to evaluate cardiac rhythms in 4 unanesthetized adult chimpanzees (Pan troglodytes), 1 with a history of possible syncope and 3 with the diagnosis of multiform ventricular ectopy (ventricular premature complexes) and cardiomyopathy. The clinical significance of ventricular ectopy was defined further by using the implantable loop recorder. Arrhythmia was ruled out as a cause of collapse in the chimpanzee that presented with possible syncope because the ...

Bi-stable wave propagation and early afterdepolarization–mediated cardiac arrhythmias

Heart Rhythm — Thu, 18 Aug 2011 04:00:00 +0100

Conclusion: Under EAD-prone conditions, both INa-mediated conduction and ICa,L-mediated conduction can occur in the same tissue. These novel wave dynamics may be responsible for certain EAD-mediated arrhythmias, such as torsades de pointes and polymorphic ventricular tachycardia. (Source: Heart Rhythm)