scholarly journals Unique clinical features and long term follow up of survivors of sudden cardiac death in an Asian multicenter study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pang-Shuo Huang ◽  
Jen-Fang Cheng ◽  
Wen-Chin Ko ◽  
Shu-Hsuan Chang ◽  
Tin-Tse Lin ◽  
...  

AbstractThere has been no long-term clinical follow-up data of survivors or victims of sudden cardiac death (SCD). The Taiwan multi-center sudden arrhythmia death syndrome follow-up and clinical study (TFS-SADS) is a collaborative multi-center study with median follow-up time 43 months. In this cohort, the clinical characteristics of these SADS patients were compared with those with ischemic heart disease (IHD). In this SCD cohort, around half (42%) were patients with IHD, which was different from Caucasian SCD cohorts. Among those with normal heart, most had Brugada syndrome (BrS). Compared to those with SADS, patients with IHD were older, more males and more comorbidities, more arrhythmic death, and lower left ventricular ejection fraction. In the long-term follow-up, patients with SADS had a better survival than those with IHD (p < 0.001). In the Cox regression analysis to identify the independent predictors of mortality, older age, lower LVEF, prior myocardial infarction and history of out-of-hospital cardiac arrest were associated with higher mortality and beta blocker use and idiopathic ventricular fibrillation or tachycardia (IVF/IVT) with a better survival during follow-up. History of prior MI was associated with more arrhythmic death. Several distinct features of SCD were found in the Asia–Pacific region, such as higher proportion of SADS, poorer prognosis of LQTS and better prognosis of IVF/IVT. Patients with SADS had a better survival than those with IHD. For those with SADS, patients with channelopathy had a better survival than those with cardiomyopathy.

Heart Rhythm ◽  
2012 ◽  
Vol 9 (9) ◽  
pp. 1579 ◽  
Author(s):  
Gust Bardy ◽  
Kerry Lee ◽  
Daniel Mark ◽  
Jeanne Poole ◽  
Daniel Fishbein ◽  
...  

1985 ◽  
Vol 110 (6) ◽  
pp. 1139-1145 ◽  
Author(s):  
Donald D. Tresch ◽  
Jule N. Wetherbee ◽  
Ronald Siegel ◽  
Paul J. Troup ◽  
Michael H. Keelan ◽  
...  

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Adriana Mallardi ◽  
Francesco Santoro ◽  
Alessandra Leopizzi ◽  
Enrica Vitale ◽  
Massimo Iacoviello ◽  
...  

Abstract Aims Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction, whose pathophysiological mechanisms are not completely known. There are evidence suggesting a possible link between neurological disease and TTS. Aim of the study was to evaluate incidence and prognostic value of cognitive neurological disorders among TTS patients. Methods and results 379 consecutive patients were enrolled in a prospective multicentre registry. History, clinical features, echocardiographic parameters, in-hospital complications and long-term Follow-up events of all patients were recorded. Cognitive neurological disorders included Alzheimer disease, old age dementia and cognitive impairment for other causes. Prevalence of cognitive neurological disorders among TTS patients was 5.5% (num = 21). Among this subset of patients 48% (num = 10) had Alzheimer syndrome, 24% (num = 5) old age dementia and 28% (num = 6) cognitive impairment for other causes. Compared to the control group, these patients were older (81 ± 5 vs. 71 ± 12, P = 0.01) and predominantly men (24% vs. 9%, P = 0.01). No differences in term of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found among the two groups. TTS patients with cognitive neurological disorders experienced higher rate of in-hospital complications (62% vs. 28%, P = 0.01), that were mainly driven by higher rate of pulmonary oedema (14% vs. 9%, P = 0.01), cardiogenic shock (29% vs. 8%, P = 0.01), death (24% vs. 4% P = 0.01), ischaemic stroke (10% vs. 4%, P = 0.01), and left ventricular thrombi (10% vs. 3%, P = 0.01). At long-term follow-up patients with cognitive neurological disorders when compared to those without, experienced higher rate of mayor cardiovascular events (48% vs. 16%, P = 0.01), cardiovascular re-hospitalization (14% vs. 10%, P = 0.01) and death (43% vs. 9%, P = 0.01). Conclusions TTS patients with cognitive neurological disorders had an increased risk of in and out of hospital mayor cardiac adverse events and mortality at short and long-term follow-up.


EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Alves Pinto ◽  
T Proenca ◽  
M Martins Carvalho ◽  
PD Grilo ◽  
CX Resende ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background  Sudden cardiac death (SCD) is an uncommon event in the absence of structural heart disease. However, ventricular fibrillation (VF) may occur in patients with unknown cardiac disease and a comprehensive work-up is needed to further improve diagnostic. Still, a significant and heterogenous group of patients remains labelled of Idiopathic VF and limited data is available regarding their natural history. Purpose The aim of this study was to evaluate the clinical outcomes of survivors of an aborted sudden cardiac death due to idiopathic VF or pulseless ventricular tachycardia (VT) and to assess possible predictors of recurrence. Methods  Patients who survived an idiopathic VF or pulseless VT between 2005 and 2019 referred to a cardiac defibrillator (ICD) implantation were included. Patients were followed for 1 to 15 years (median follow-up of 7 years). Clinical and device data were collected. Results A population of 29 patients, 59% male, with a median age of 50 years (age ranging from 18 to 76) at the time of the aborted SCD was studied. All patients implanted an ICD (69% single chamber, 24% dual chamber and 3% subcutaneous) at the index hospitalization. The initial rhythm was VF in 76% and pulseless VT in 24%. In relation to the context of the arrhythmic event, 48.3% occurred during daily life activities, 13.8% after an emotional stress, 6.9% during efforts and a similar percentage occurred either in rest or asleep. Of note, 12.5% of patients had previous history of syncope. Normal ECG was present in 83% of patients. Family history of SCD was present in 12% of the cases. As for the cardiovascular risk factors, 61.5% had hypertension, 19% dyslipidemia, 17% diabetes, 31% were smokers or previous smokers. Paroxysmal atrial fibrillation was present in 15% of patients. To exclude possible causes of VF, all patients were submitted to coronary angiogram and echocardiogram, 64% to genetic testing, 68% to cardiac magnetic resonance, 20% to electrophysiologic study, 12% to pharmacological provocative test and 4% were submitted to endomyocardial biopsy. At follow-up, an etiological diagnosis was established in 31% of patients: 3 events were attributed to coronary vasospasm, 3 to short coupled polymorphic VT, 1 patient had long QT syndrome, 1 had Brugada syndrome and in 1 patient an ANK2 mutation was identified. As for the clinical outcomes, 8% patients died (from non-arrhythmic causes), 31% patients received appropriate therapies and 19% had unappropriated shocks (of those 60% for sinus tachycardia and 40% for supraventricular tachycardia). Conclusion Etiologic diagnosis and prediction of recurrence of arrhythmic events in patients with idiopathic VF is challenging, even with a long-term follow-up and more sophisticated diagnostic evaluation.  Idiopathic VF is a rare but serious condition with recurrence in about one third of patients. Although not free of complications, ICD remains the gold standard of treatment.


Kardiologiia ◽  
2020 ◽  
Vol 60 (4) ◽  
pp. 77-85
Author(s):  
E. A. Shmidt ◽  
S. A. Berns ◽  
A. V. Ponasenko ◽  
A. V. Klimenkova ◽  
S. A. Tumanova ◽  
...  

Aim To study a relationship of several factors (clinical and genetical markers) with unfavorable outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in long-term follow-up.Material and methods This full-design, prospective study included 415 patients with NSTE-ACS. 266 patients were evaluated for the presence of multifocal atherosclerosis (MFA). Typing of polymorphic variants rs1041981 LTA, rs1800629 TNF, rs4986790, and rs498679 TLR4, and also rs3024491 and rs1800872 IL10 was performed. Follow-up period lasted for 67±4 months. By the end of this period, information about clinical outcomes for 396 patients became available.Results During the entire follow-up period, unfavorable outcomes were observed in 239 (57.5 %) patients with NSTE-ACS. The following clinical signs were associated with unfavorable outcomes: history of myocardial infarction, age >56 years, left ventricular ejection fraction (LV EF) ≤50 % and GRACE score ≥100, significant stenosis of brachiocephalic arteries, MFA, carriage of genotype А / А rs1041981 LTA (OR, 6.1; р=0.02) and allele А (OR, 1.9; р=0.01). According to results of a multifactorial analysis, the most significant predictors included LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.Conclusion Stratification of patients with NSTE-ACS into groups of high or low risk for having an unfavorable outcome within the next 6 years is possible using the prognostic model developed and presented in this study. The model includes the following signs: LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Weijian Huang ◽  
Lan Su ◽  
Songjie Wang ◽  
Shengjie Wu ◽  
Lei Xu ◽  
...  

Introduction: Left bundle branch pacing (LBBP) is a novel pacing method and has been proven to have low and stable pacing thresholds. However, data on large numbers of patients with long-term follow-up is still needed to evaluate its feasibility and safety. Hypothesis: To evaluate the feasibility and safety of LBBP in a large sample with long-term follow up. Methods: This study prospectively enrolled 632 consecutive patients with left bundle branch block, AV block or sick sinus syndrome with attempted LBBP from April 2017 to July 2019. Pacing parameters, ECG, echocardiographic measurements, complications were assessed at implant, and during follow-up of 1, 6, 12 and 24 months. Results: LBBP was successful in 618/632 (97.8%) patients according to the strict criteria for LBB capture. Mean follow-up time was 17.8±6.9 months. LBB capture threshold at implant was 0.65±0.27 [email protected] and 0.71±0.35 [email protected] at 2-year follow-up (n=166). Left ventricular ejection fraction were improved in QRS≥120ms and <120ms groups (60.62±14.22% vs. 63.95±11.29 %, p<0.001; 49.77±17.58 % vs. 58.58±12.79 %, p<0.001; respectively). The number of patients with moderate and sever tricuspid regurgitation decreased at 1-year (120 to 66;28 to 16; respectively). Permanent right bundle branch injury occurred in 55 (8.9%) patients. LBB capture threshold increased greater than 2 V in 6 patients, loss of capture in 2 patients, two lead dislodgements requiring operative revision within 1 month after implantation during 2-years follow-up. Conclusions: Feasibility and safety of LBBP were confirmed by this large sample size and long-term follow-up study. It is a reliable physiologic method for standards pacing indications.


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