Arrhythmia Secondary to Cold Water Submersion during Helicopter Underwater Escape Training

2016 ◽  
Vol 31 (1) ◽  
pp. 108-110 ◽  
Author(s):  
Paven P. Kaur ◽  
Sarah E. Drummond ◽  
Jeremy Furyk
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cold Water ◽  
Escape Training ◽  
Publication Type ◽  
Normal Limits ◽  
History Of ◽  
Chest X Ray ◽  
Electrocardiogram Ecg ◽  
Irregular Pulse

AbstractA 32-year-old, fit and healthy, Caucasian male presented with a less than 24-hour history of palpitations with the onset following participation in helicopter underwater escape training (HUET). He reported no chest pain, shortness of breath, syncope, or pre-syncope symptoms. On examination, an irregularly irregular pulse was noted at a rate of 120 beats per minute with a blood pressure of 132/84. There was no evidence of congestive cardiac failure. The electrocardiogram (ECG) demonstrated atrial fibrillation at 97 beats per minute with a normal axis, normal QRS complexes, and a QTc of 399 ms. Bloods were all within normal limits and a chest x-ray showed no abnormality. The patient was loaded with amiodarone and reverted to sinus rhythm with a normal post-reversion ECG. Five years on, following further HUET, the patient presented with an identical presentation. His ECG showed fast atrial fibrillation at a rate of 115 beats per minute. On this occasion, he was sedated and Direct Current cardioverted with reversal to sinus rhythm after one shock. It was felt that the precipitating factor for this patient’s atrial fibrillation, in both cases, was HUET. The case discussed describes a previously fit and well subject who developed a sustained arrhythmia secondary to cold water submersion. Evidence suggests water submersion can provoke cardiac arrhythmias via the suggested theory of “autonomic conflict.” It has been proposed that a number of unexplained deaths related to water submersion may be secondary to arrhythmogenic syncope.KaurPP, DrummondSE, FurykJ. Arrhythmia secondary to cold water submersion during helicopter underwater escape training. Prehosp Disaster Med. 2016;31(1):108–110.

Amiodarone – induced pulmonary nodules mimiking metastatic lung disease – investigation by somatostatin radio peptide scaning

2005 ◽  
Vol 4 (2) ◽  
pp. 63-65
Author(s):  
Veronica Varney ◽  
◽  
Mary Warren ◽  
M Palmer ◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Nodules ◽  
Alcoholic Cardiomyopathy ◽  
X Ray ◽  
The Past ◽  
Previous Diagnosis ◽  
Metastatic Lung ◽  
Chest X Ray ◽  
200Mg Daily

A 61 year old former paramedic presented to A&E complaining of palpitations. He was found to be in atrial fibrillation, which reverted spontaneously to sinus rhythm. A chest x-ray taken at that time showed multiple pulmonary nodules consistent with metastatic malignancy (Figure 1). In the past he had been treated with amiodarone 200mg daily for 6 years following a previous diagnosis of atrial fibrillation, which had been attributed to alcoholic cardiomyopathy. He had discontinued the drug 8 months earlier, after selfdiagnosing hypotension and bradycardia. A previous chest X-ray, taken before starting amiodarone, was normal.

scholarly journals Beat-to-Beat P-Wave Analysis Outperforms Conventional P-Wave Indices in Identifying Patients with a History of Paroxysmal Atrial Fibrillation during Sinus Rhythm

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1694
Author(s):  
Dimitrios Tachmatzidis ◽  
Dimitrios Filos ◽  
Ioanna Chouvarda ◽  
Anastasios Tsarouchas ◽  
Dimitrios Mouselimis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
P Wave ◽  
P Value ◽  
Wave Analysis ◽  
P Waves ◽  
History Of

Early identification of patients at risk for paroxysmal atrial fibrillation (PAF) is essential to attain optimal treatment and a favorable prognosis. We compared the performance of a beat-to-beat (B2B) P-wave analysis with that of standard P-wave indices (SPWIs) in identifying patients prone to PAF. To this end, 12-lead ECG and 10 min vectorcardiogram (VCG) recordings were obtained from 33 consecutive, antiarrhythmic therapy naïve patients, with a short history of low burden PAF, and from 56 age- and sex-matched individuals with no AF history. For both groups, SPWIs were calculated, while the VCG recordings were analyzed on a B2B basis, and the P-waves were classified to a primary or secondary morphology. Wavelet transform was used to further analyze P-wave signals of main morphology. Univariate analysis revealed that none of the SPWIs performed acceptably in PAF detection, while five B2B features reached an AUC above 0.7. Moreover, multivariate logistic regression analysis was used to develop two classifiers—one based on B2B analysis derived features and one using only SPWIs. The B2B classifier was found to be superior to SPWIs classifier; B2B AUC: 0.849 (0.754–0.917) vs. SPWIs AUC: 0.721 (0.613–0.813), p value: 0.041. Therefore, in the studied population, the proposed B2B P-wave analysis outperforms SPWIs in detecting patients with PAF while in sinus rhythm. This can be used in further clinical trials regarding the prognosis of such patients.

scholarly journals Anaesthetic Management of Pheochromocytoma with Atrial Fibrillation - A Case Report

2020 ◽  
Vol 7 (48) ◽  
pp. 2885-2887
Author(s):  
Anjali Chandrasekharan ◽  
Thasreefa Vettuvanthodi ◽  
Priya Jayasree ◽  
Suvarna Kaniyil ◽  
Nanda Lakshmi Anitha
Keyword(s):  
Atrial Fibrillation ◽  
Bladder Carcinoma ◽  
Lateral Wall ◽  
Anaesthetic Management ◽  
Ventricular Rate ◽  
Vanillylmandelic Acid ◽  
Normal Limits ◽  
Left Lateral Wall ◽  
History Of ◽  
Enhanced Computed Tomography

An elderly female aged 65 years weighing 69 Kgs presented to the Pre-Anaesthetic Clinic (PAC) for transurethral resection of bladder carcinoma. As part of the evaluation of bladder carcinoma, Contrast Enhanced Computed Tomography (CECT) abdomen done showed a left adrenal lesion. She was a known case of hypertension since the last 10 years and was on telmisartan tablets 40 mg once daily (OD) since then. She had a history of palpitations 3 years back, which when evaluated was diagnosed as atrial fibrillation. She was started on metoprolol tablets 25 mg OD and warfarin 2 mg OD. In view of her history and positive findings on CECT abdomen, it was decided in the PAC to screen her for pheochromocytoma. There was no definite history of classic triad of headache, palpitation and sweating. No history of headache, weight loss, fatigue, syncopal attacks, hypo / hyperthyroidism were reported. Physical examination showed Heart Rate (HR) of 96 beats per minute (bpm), irregular in rhythm, Respiratory Rate (RR) of 16 breaths per minute and Blood Pressures (BP) of 146 / 98 mmHg and 140 / 90 mmHg in the supine and sitting positions respectively. Biochemical test results showed 24-hour urine metanephrine 0.452 mg / l which is 1.45 mg / 24 hrs. (normally < 1 mg / 24 hrs.) and urine vanillylmandelic acid 8.1 mg / gm creatinine (2 – 7 mg / gm). Electrocardiography (ECG) showed right bundle branch block and AF (Atrial Fibrillation) with controlled ventricular rate. Echocardiography showed mild aortic stenosis, aortic regurgitation and ejection fraction of 68 % with no evidence of clots / thrombus. In terms of clinical imaging, the CECT showed a well-defined lesion in the left adrenal measuring 19 x 12 mm with a relative washout of 21 % and a faint subtle hyperdense lesion in the base of left lateral wall of the urinary bladder measuring approximately 20 x 19 mm. Other blood investigations like Hb, haematocrit, urea, creatinine and blood sugars were within normal limits.

scholarly journals An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

2018 ◽  
Vol 7 (2.24) ◽  
pp. 453
Author(s):  
S. Sathish ◽  
K Mohanasundaram
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
Normal Limits ◽  
Normal Sinus ◽  
P Wave Duration ◽  
Standard Lead ◽  
Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology.  Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.  

Abstract 14676: Landmark-based Functional Computed Tomography Reveals Diminished Left Atrial Appendage Contraction During Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan H Chung ◽  
Gordon Ho ◽  
Andrew Schluchter ◽  
Francisco Contijoch ◽  
Jonathan C Hsu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Ct Scan ◽  
Blood Volume ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
History Of

Introduction: The formation of thrombus in the left atrial appendage (LAA) and risk for systemic embolization may result in part from stasis and poor blood volume emptying during atrial fibrillation (AF). Functional 4-dimensional computed tomography (4DCT) is a promising technique to measure LAA ejection fraction and blood volume emptying. Hypothesis: We hypothesize that the LAA ejection fraction measured by 4DCT is decreased during AF compared to sinus rhythm. Methods: 256-slice 4DCT scans obtained in patients for coronary artery imaging or pre-procedurally for AF, VT or SVT ablation procedures were analyzed retrospectively. In each patient, LAA volumes were measured at multiple phases during one cardiac cycle using segmentation software (ITK-SNAP and Osirix MD). LAA ejection fraction was calculated as the difference between minimum and maximum volumes and was analyzed using Wilcoxon rank sum. Results: Out of 54 patients, 37 patients were in sinus rhythm and 17 patients were in AF. Between NSR vs. AF, mean age was 69.1±12.8 vs 73.2±11.5 years (p=0.13), 28% vs 36% female (p=0.54), LVEF was 58±11% vs 60±9% (p=0.95), and echo-derived left atrial volume index was 29.5±6.1 ml/m2 vs 41.7±12.8 ml/m2 (p=0.06). Patients who were in sinus rhythm during their CT scan had a higher LAA ejection fraction than those who were in AF (58±13% vs. 29±9%, p<0.0001). For patients who were in AF during their CT scan, there was no difference in LAA ejection fraction between patients with a history of paroxysmal AF compared to patients with a history of persistent AF (30±10% vs. 28±10%, p=0.75). Conclusions: Analysis of the LAA volumes using functional cardiac CT is a feasible method to quantify blood volume emptying from the LAA. Patients in AF were observed to have significantly decreased LAA ejection fraction and blood volume emptying compared to patients in sinus rhythm. Further studies are needed to determine whether this technique may improve personalized risk stratification for stroke.

scholarly journals The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure

2019 ◽  
Vol 109 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Bernadet T. Santema ◽  
Michelle M. Y. Chan ◽  
Jasper Tromp ◽  
Martin Dokter ◽  
Haye H. van der Wal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Plasma Levels ◽  
Validation Cohort ◽  
Post Hoc Analysis ◽  
Patients With Heart Failure ◽  
History Of ◽  
Post Hoc ◽  
Multivariable Adjustment

Abstract Background In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR). Methods In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738). Results Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th–75th percentile 1897–6486] versus 1788 [682–3870], adjusted p < 0.001, versus 2231 pg/mL [902–5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062–5253] versus 2545 [1686–4337], adjusted p = 0.36, versus 2294 [1471–3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort. Conclusion These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF. Graphic abstract

P4784Efficacy and safety of dronedarone by duration of atrial fibrillation history: a post-hoc analysis of the ATHENA trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Blomstrom-Lundqvist ◽  
N Marrouche ◽  
S Connolly ◽  
V Corp Dit Genti ◽  
M Wieloch ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
New York ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
Efficacy And Safety ◽  
History Of ◽  
Summary Relative Risk ◽  
Post Hoc ◽  
Symptom Recurrence

Abstract Background Atrial fibrillation (AF) is known to progress over time and the effectiveness of antiarrhythmic therapy may vary based on the duration of a patient's AF history. Outcomes with dronedarone (DRO) based on duration of AF/atrial flutter (AFL) history have not been previously characterized. Purpose To evaluate the efficacy and safety of DRO by time since first known AF/AFL episode in patients studied in the ATHENA trial. Methods 2859 (61.8%) patients from ATHENA with documented first known AF/AFL episode (of 4628 total patients randomized) were included in the analysis. Among these patients, first AF/AFL episode was reported at <3 months (shorter history), 3 to <24 months (intermediate), and ≥24 months (longer) in 1296 (45.3%), 845 (29.6%) and 718 (25.1%) patients, respectively. AF/AFL recurrence was evaluated in patients in sinus rhythm at baseline by ECG during study visits or symptom recurrence. Results Demographics (age, sex) were similar across all groups. Patients with longer AF/AFL history tended to have higher prevalence of coronary heart disease and structural heart disease; and were more likely to have AF/AFL (by 12-lead ECG) at baseline (30%) compared to 26% and 16% for intermediate and shorter history groups. Patients with a longer AF history likely had a prior ablation for AF/AFL (7%) vs patients with an intermediate (2%) or shorter AF/AFL history (1%), and more likely required cardioversion during the study (24%) vs intermediate (17%) and shorter history groups (11%). Outcomes and efficacy are reported in Table 1. Rates of treatment-emergent adverse events (TEAEs), serious TEAEs, permanent drug discontinuations, and deaths were similar across all AF/AFL groups. Table 1. Outcomes and efficacy summary Relative Risk, dronedarone (DRO) vs placebo (PBO)1 (95% CI)1,2 AF/AFL <3 months AF/AFL 3 to <24 months AF/AFL ≥24 months PBO (n=626) DRO (n=670) PBO (n=429) DRO (n=416) PBO (n=363) DRO (n=355) First CV hospitalization3 or death (any cause) 0.79 (0.65, 0.96) 0.72 (0.56, 0.92) 0.84 (0.66, 1.07) First CV hospitalization 0.78 (0.64, 0.96) 0.70 (0.55, 0.91) 0.82 (0.63, 1.05) Death (any cause) 0.82 (0.54, 1.24) 0.85 (0.43, 1.68) 1.13 (0.61, 2.10) First AF/AFL recurrence4 0.80 (0.65, 0.97) 0.67 (0.53, 0.84) 0.81 (0.65, 1.02) 1Cox regression model. 2On study period, all randomized patients. 3Main reason was AF/other supraventricular rhythm disorders. 4On selected patients in sinus rhythm at baseline (AF/AFL <3 months: PBO n=514, DRO n=529; 3 to <24 months: PBO n=288, DRO n=312; ≥24 months: PBO n=252, DRO n=250). CV = Cardiovascular. Conclusions Nearly half the patients in ATHENA had a shorter history (<3 months) of AF/AFL prior to randomization. Patients with a longer history of AF/AFL had a greater burden of AF/AFL based on baseline rhythm status, ablation history, and cardioversions required post randomization. Despite these differences, clinical outcomes, efficacy, and safety of DRO appeared to be generally consistent irrespective of duration of AF/AFL history. Acknowledgement/Funding Sanofi, New York, New York, United States of America

scholarly journals Thyroid Storm Treated With Nonconventional Therapy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A962-A962
Author(s):  
Caroline Tashdjian ◽  
Paul Shiu ◽  
Tarandeep Kaur
Keyword(s):  
Atrial Fibrillation ◽  
Critically Ill ◽  
Liver Enzymes ◽  
Normal Liver ◽  
Ventricular Rate ◽  
Thyroid Storm ◽  
Free T4 ◽  
History Of ◽  
Chest X Ray ◽  
Iodine Treatment

Abstract Background: Thyroid storm is a rare sequela of thyrotoxicosis with mortality rate of 10-30%. Management of thyroid storm is heavily dependent on thionamides. Cholestyramine and potassium iodide (SSKI) are used as adjunctive therapy and not as the sole treatment for storm. We present a case of thyroid storm treated with cholestyramine and SSKI. Clinical Case: A 45 year old male with past medical history of atrial fibrillation, congestive heart failure, hypertension, substance abuse and grave’s disease presented to the emergency department (ED) for diarrhea. During the course of ED, patient went into atrial fibrillation with rapid ventricular rate. Chest X-ray showed pulmonary edema. Labs were: TSH &lt;0.0025 mIU/L (0.35-4.94 mIU/L) and free T4 3.52 ng/dl (0.7-1.40 ng/dl). Patient was noncompliant with methimazole. Upon admit, ACLS was initiated due to hypoxia and transferred to ICU for ventilator and pressor support. Wartofsky score was 60, suggestive of thyroid storm. Management included methimazole 20mg every 4hours, hydrocortisone 100mg every 8 hours, cholestyramine 4mg every 6 hours, and SSKI 250mg every 6 hours for thyrotoxicosis and amiodarone infusion for afib. Despite normal liver enzymes on admit, day 3 AST increased to 2740 U/L (5-34) and ALT 2684 U/L (0-55). Methimazole was stopped due to potential hepatotoxicity. Day 3 free T4 remained high at 4.16 ng/dl and patient remained critically ill. Plasmapheresis was offered as methimazole was stopped and patient was hemodynamically unstable to undergo surgery. However, family declined this intervention; SSKI and cholestyramine were continued. Free T4 was monitored over the course of treatment; by day 5 free T4 trended down to 1.93 ng/dl. SSKI was eventually stopped on day 8 of treatment as free T4 had normalized and cholestyramine reduced to 4mg twice daily. By day 15, free T4 was 0.8 ng/dl, so cholestyramine was stopped. Due to clinical improvement, patient was weaned off the ventilator and pressor support along with hydrocortisone. Liver enzymes normalized by Day 17. Patient was restarted on methimazole 5mg daily before discharge. Discussion: Thyroid storm is associated with varying degree of liver dysfunction, which can pose a challenge to treatment. In our case, acute fulminant liver failure was multifactorial in the setting of shock, thyroid storm and potential drug toxicity. Thus, thionamides were contraindicated. Radioactive iodine treatment was contraindicated due to use of amiodarone. Plasmapheresis and emergent thyroidectomy could not be done. Thus, nonconventional therapy was used and patient responded well to treatment. This case emphasizes the use of cholestyramine along with SSKI as an effective treatment in patients who are critically ill the setting of a thyroid storm, especially when thionamides are contraindicated and other avenues of treatment are limited.

P566Activated amyloid-beta pathways in patients with atrial fibrillation and heart failure, a pathway analysis in BIOSTAT

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
V A Artola Arita ◽  
B T Santeman ◽  
I E Sama ◽  
M Kloosterman ◽  
I Van Gelder ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Pathway Analysis ◽  
Amyloid Beta ◽  
Plasma Proteins ◽  
Horizon 2020 ◽  
History Of ◽  
Pathway Analyses

Abstract Funding Acknowledgements European Commission [FP7-242209-BIOSTAT-CHF], European Union’s Horizon 2020 under the Marie Skłodowska-Curie grant agreement No 754425 Background. Atrial fibrillation (AF) and heart failure (HF) are two growing epidemics that frequently co-exist, share clinical risk factors, and predispose to each other. There is limited understanding of the underlying pathophysiology of the combination of both conditions. Purpose. To perform pathway analyses of circulating plasma proteins and evaluate whether patients with both HF and AF have different activated pathways compared to those with HF without AF. Methods. We performed pathway overrepresentation analyses of differentially expressed plasma proteins in HF, with reduced (HFrEF) and preserved (HFpEF) ejection fraction, with AF versus sinus rhythm on ECG at enrolment in BIOSTAT-CHF, using 92 cardiovascular biomarkers. Pathway analyses were performed based on existing knowledge using Gene Ontology, REACTOME, and KEGG, to study underlying activated biological pathways. Resulting pathways were corrected by Bonferroni method. Results. We studied 2,839 patients with HF irrespective of their ejection fraction of whom 1,116 (39%) had AF and 1,723 (61%) were in sinus rhythm. HF patients with AF were older (76 ± 10 vs. 70 ± 12, p &lt; 0.001), were less women (28% vs. 34%, p &lt; 0.001), had history of stroke (16% vs. 10%, p &lt; 0.001), renal disease (39% vs. 31%, p &lt; 0.001) and less history of coronary artery disease (40% vs. 53%, p &lt; 0.001). There were no significant differences in patients with hypertension (62% vs. 60 %, p = 0.22), diabetes (32% vs. 31%, p = 0.51) and COPD (18% vs. 16%, p = 0.20). A total of 1,661 (59%) had HFrEF and 432 (15%) had HFpEF. Pathway overrepresentation analyses revealed three amyloid-related pathways statically significant in  total HF group, and in HFrEF and HFpEF respectively, with AF compared with those in sinus rhythm: amyloid-beta formation (p &lt; 4.0E-4, p &lt; 7.4E-6), amyloid-beta metabolic process (p &lt; 1.0E-3, p &lt; 1.9E-5), and amyloid precursor protein catabolic process (p &lt; 9.1E-4, p &lt; 1.6E-5). The key proteins related to these processes were spondin-1 (SPON-1), insulin-like growth factor binding protein 1 (IGFBP-1) and 7 (IGFBP-7). After adjusting for sex and age and correcting for multiple testing with fall discovery rate (FDR), SPON-1 (FDR &lt; 6.3E-6), IGFBP-1 (FDR &lt; 6.6E-3) and IGFBP-7 (FDR &lt; 2.5E-9) remained statically significant in HFrEF patients with AF vs. sinus rhythm; whereas only SPON-1 (FDR &lt; 7.3 E-3) and IGFBP-7 (FDR &lt; 1.9E-3) remained in HFpEF patients with AF vs. sinus rhythm. Conclusion. Pathway analyses revealed activation of amyloid-beta pathways in HF patients with AF versus sinus rhythm with SPON-1, IGFBP-1 and IGFBP-7 overrepresented proteins. Amyloid-beta pathways may play a role in the pathophysiology of the combination of HF and AF, which needs to be replicated and validated in additional cohorts.  Figure. Pathway analysis of activated proteins in patients with HF, HFrEF (A) and HFpEF (B) and AF versus sinus rhythm. Proteins are represented as dots and pathways as circumferences. Abstract Figure. Pathway overrepresentation analysis

Atrial fibrillation following low voltage electrical injury

2021 ◽  
Vol 14 (1) ◽  
pp. e239306
Author(s):  
Shrestha Ghosh ◽  
Atanu Chandra ◽  
Sourav Sen ◽  
Sukanta Dutta
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Involvement ◽  
Low Voltage ◽  
Ventricular Rate ◽  
Prior History ◽  
Electrical Injury ◽  
Bundle Branch Block ◽  
History Of ◽  
Premature Beats ◽  
Irregular Pulse

Electrical injuries can have myriad presentations, including significant cardiac involvement. Arrhythmias are the most frequently experienced cardiac affliction, of which sinus tachycardia or bradycardia, ventricular fibrillation, atrial or ventricular premature beats and bundle branch block are most commonly reported. A 50-year-old man, with no prior history of cardiac disease, presented with palpitations following low voltage electrical injury. On examination, he was tachycardic with an irregularly irregular pulse. An ECG confirmed atrial fibrillation with rapid ventricular rate. Chemical cardioversion was attempted successfully, following which the patient reverted to sinus rhythm. Atrial fibrillation following electrical injury has been rarely described in the literature, and is rarer so without associated high voltage electrical exposure or pre-existing cardiac ailment.

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