scholarly journals MIBG and imaging of cardiac adrenergic system: From heart failure to ventricular arrhythmias and atrial fibrillation, through cardiac asynchrony. What else?

2021 ◽  
Author(s):  
Claudio Marcassa
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Arrhythmias ◽  
Adrenergic System

New Onset Atrial Fibrillation Is a Risk Factor for Ventricular Arrhythmias in Heart Failure

2013 ◽  
Vol 19 (8) ◽  
pp. S24
Author(s):  
Ryan Aleong ◽  
William H. Sauer ◽  
Gordon Davis ◽  
Michael R. Bristow
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ventricular Arrhythmias ◽  
Onset Atrial Fibrillation ◽  
New Onset

Evaluation of the Incidence and Risk Factors Associated with Major Cardiovascular Events in Patients Receiving Acalabrutinib Therapy

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-30
Author(s):  
Leylah Azali ◽  
Lindsay Hazelden ◽  
Tracy Wiczer ◽  
Marilly Palettas ◽  
Rebekah Thomas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Research Funding ◽  
Ventricular Arrhythmias ◽  
Survival Outcomes ◽  
Btk Inhibitor ◽  
Never Smokers ◽  
Target Effects

Background Acalabrutinib is a highly selective second-generation Bruton's tyrosine kinase (BTK) inhibitor approved for the treatment of chronic lymphocytic leukemia (CLL) and mantle cell lymphoma. Ibrutinib, the first-generation nonselective BTK inhibitor, has been associated with cardiovascular (CV) complications including atrial fibrillation and ventricular arrhythmias, potentially related to off-target effects. In prior studies, the incidence of major adverse cardiovascular effects (MACE) with ibrutinib was 16.5-38%. With acalabrutinib being more selective, we postulate that less of these off-target effects would be seen. Although early experience with acalabrutinib suggests improved tolerability compared to ibrutinib, the long-term CV risks are unknown. Therefore, we sought to characterize the incidence, risk factors, and management of CV complications associated with acalabrutinib across long-term follow-up. Methods We performed a retrospective single-center cohort study of adult patients treated with acalabrutinib for a hematologic malignancy from January 2010 to August 2019. Patient demographics, CV and cancer variables, and CV complications were collected throughout the duration of acalabrutinib therapy. MACE was defined as cardiac arrhythmias (including atrial and ventricular arrhythmias), myocardial infarction, stroke, heart failure, and CV death. CV events, including arrhythmias, were graded according to the Common Terminology Criteria for Adverse Events (CTCAE), and adjudicated with an independent cardiologist. Descriptive statistics were used to summarize patient characteristics, using the mean ± standard deviation (SD) or median (interquartile range) for continuous variables and frequency counts with percentages for categorical variables. Time-to-event analysis methods were used to summarize MACE outcomes and evaluate associations with these outcomes. Results Overall, 290 patients treated with acalabrutinib were identified, majority had CLL (89%), and were male (72%) with a median age of 64 years. Seventy-seven (27%) patients were previously treated with ibrutinib. Sixty-seven percent of patients had a prior cardiac history, including 49% with baseline hypertension (HTN). MACE occurred in 18 patients (6%). Atrial fibrillation was the most common event occurring in 12 patients, followed by diastolic heart failure in 3 patients. There was one ventricular arrhythmic event (0.3%). Forty-four percent of patients temporarily held acalabrutinib during the MACE event, while 50% had no change to their acalabrutinib therapy. After the event, 6% of patients discontinued acalabrutinib and 11% of patients had dose reduced to 100mg daily. Age, gender, diabetes, kidney disease, and smoking status were found to be significantly associated with MACE. The odds of MACE were 1.8 times higher for every 7-year increase in age; when looking at just atrial fibrillation, the odds were 1.58 times higher for every 7-year increase in age. The effect of current smokers compared to never smokers was not significantly associated with MACE, however the odds of MACE were 3.4 higher in former smokers compared to never smokers. In comparison to ibrutinib (Dickerson, et al. Blood, 2019), the rate of MACE was lower- 66 vs 21 events per 1,000 person-years (P<0.05). Of the patients who developed MACE during acalabrutinib treatment, 7 (39%) died. Causes of death were related to infection, respiratory failure, or progression to hospice care. For survival outcomes, 79% of patients were expected to be alive at 3 years post acalabrutinib therapy, and 75% at 5 years. Among patients who experienced a MACE event, survival outcomes were worse (P = 0.046), with 71% of patients expected to be alive at 3 years compared to 50% at 5 years (Figure). Conclusion In summary, acalabrutinib was associated with a lower, but significant risk of MACE compared to ibrutinib. The occurrence of these cardiac events appears to associate with worse survival outcomes. Further research into the mechanism(s) of these events, their implications, and the optimal preventative strategies for adverse CV complications after BTK inhibitor initiation is needed. Figure 1 Disclosures Blachly: AbbVie, AstraZeneca, KITE Pharma: Consultancy. Rogers:Genentech: Research Funding; Acerta Pharma: Consultancy; Pharmacyclics: Consultancy; AstraZeneca: Consultancy, Other: Travel Funding; Janssen: Research Funding; AbbVie: Consultancy, Research Funding. Byrd:Kartos Therapeutics: Research Funding; Trillium: Research Funding; Vincera: Research Funding; Novartis: Research Funding; Acerta Pharma: Research Funding; Syndax: Research Funding; Leukemia and Lymphoma Society: Other; Janssen: Consultancy; Pharmacyclics LLC, an AbbVie Company, Gilead, TG Therapeutics, BeiGene: Research Funding; Pharmacyclics LLC, an AbbVie Company, Gilead, TG Therapeutics, Novartis, Janssen: Speakers Bureau; Pharmacyclics LLC, an AbbVie Company, Janssen, Novartis, Gilead, TG Therapeutics: Other. Woyach:AbbVie: Research Funding; Janssen: Consultancy, Research Funding; Karyopharm: Research Funding; Loxo: Research Funding; Morphosys: Research Funding; Pharmacyclics: Consultancy, Research Funding; Verastem: Research Funding.

scholarly journals The role of epicardial adipose tissue and autonomic nervous system in pathophysiology of cardiac arrhythmias

2021 ◽  
Vol 25 (3) ◽  
pp. 27
Author(s):  
D. V. Losik ◽  
N. A. Nikitin ◽  
S. M. Minin ◽  
E. V. Fisher ◽  
I. L. Mikheenko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Nervous System ◽  
Adipose Tissue ◽  
Autonomic Nervous System ◽  
Cardiovascular Diseases ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Epicardial Adipose Tissue

<p>The role of epicardial adipose tissue (EAT) in the pathogenesis and prognosis of cardiovascular diseases has been actively discussed. This review provides information regarding the main mechanisms by which EAT influences the pathophysiology of rhythm disturbances, such as atrial fibrillation and ventricular arrhythmias, as well as their relationship with chronic heart failure. The pathogenesis of cardiac arrhythmias is exceedingly complex. As such, the mechanism by which EAT influences arrhythmias and heart failure can vary according to the anatomy and type of arrhythmia, one of which involves the autonomic nervous system (ANS). Some studies have shown a good treatment effects by targeting EAT in atrial fibrillation, whereas others have found that EAT volume can be used to predict the efficacy of radiofrequency ablation, a method for treating atrial fibrillation and ventricular arrhythmias. However, no standards have yet been established for the use of EAT visualisation. Fundamental, translational and clinical research are needed to study the role of EAT and ANS in the pathogenesis of cardiovascular diseases.</p><p>Received 15 March 2021. Revised 25 April 2021. Accepted 26 April 2021.</p><p><strong>Funding:</strong> The work is supported by a grant of the Russian Science Foundation (project No. 17-75-20118).</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: D.V. Losik, N.A. Nikitin, S.M. Minin, A.B. Romanov, A.M. Chernyavskiy<br />Drafting the article: D.V. Losik, I.L. Mikheenko, E.V. Fisher, N.A. Nikitin<br />Critical revision of the article: D.V. Losik, I.L. Mikheenko, E.V. Fisher, N.A. Nikitin<br />Final approval of the version to be published: D.V. Losik, N.A. Nikitin, S.M. Minin, E.V. Fisher, I.L. Mikheenko, A.M. Chernyavskiy, A.B. Romanov</p>

scholarly journals Future Perspectives in the Pharmacological Treatment of Atrial Fibrillation and Ventricular Arrhythmias in Heart Failure

2014 ◽  
Vol 21 (8) ◽  
pp. 1011-1029 ◽  
Author(s):  
Istvan Baczko ◽  
Istvan Lepran ◽  
Lorand Kiss ◽  
Danina Muntean ◽  
Peter Light
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Pharmacological Treatment ◽  
Ventricular Arrhythmias ◽  
Future Perspectives

scholarly journals Cardiac arrhythmias in COVID-19: Mechanisms, outcomes and the potential role of proarrhythmia

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
JL Merino ◽  
J Caro ◽  
JR Rey ◽  
S Castrejon ◽  
M Martinez-Cossiani
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Arrhythmias ◽  
Potential Role ◽  
Multivariable Analysis ◽  
Funding Sources ◽  
Kaplan Meier ◽  
Single Centre Study ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac arrhythmia seems to be a risk factor for mortality in coronavirus disease 2019 (COVID-19). However, the mechanisms, risk factors and outcomes of new arrhythmic events (NAEs) in this disease are unclear. Methods All patients with confirmed COVID-19 were retrospectively included in this single centre study. Patients who were alive and admitted &lt;30 days before the database lock were excluded. Results 3416 consecutive patients were reviewed and 1476 finally enrolled (65.9 ± 20.9 years, 57.3% male). 76 (5.1%) patients had NAEs. Most of them were new atrial fibrillation episodes (48 patients, 3.2%), mostly seen in patients with no previous arrhythmia (38 patients, 79.2%). Atrial flutter (AFL) accounted for 20% of all NAEs. Ventricular arrhythmias were seen in 9 (0.6%) patients. Multivariable analysis showed that prior AFL, heart failure, dyslipidaemia, lopinavir/ritonavir, and combined hydroxychloroquine and azithromycin were independently associated with NAEs. 66 (86.8%) patients with NAEs died. The Kaplan-Meier analysis showed a lower survival of patients with NAEs (P &lt; 0.001). Eight out of 9 (88.9%) and 41 out of 48 (85.4%) patients with ventricular arrhythmias and atrial fibrillation respectively died. Older age, male gender and NAEs were independently associated with death. NAEs and other outcomes, such as heart failure, thromboembolism, and bleeding independently predicted death. Conclusions NAEs are relatively uncommon in COVID-19 patients and mainly have an atrial mechanism. AFL is particularly frequent in this disease. The use of hydroxychloroquine, azithromycin and lopinavir/ritonavir, is associated with them, especially when used in combination. NAEs are independently and strongly associated with death. Abstract Figure.

Sign in / Sign up

Export Citation Format

Share Document