scholarly journals Role of atrial arrhythmia and ventricular response in atrial fibrillation induced atrial remodelling

2020 ◽  
Author(s):  
Jean-Baptiste Guichard ◽  
Feng Xiong ◽  
Xiao-Yan Qi ◽  
Nathalie L’Heureux ◽  
Roddy Hiram ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Atrial Arrhythmia ◽  
Ventricular Rate ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Arrhythmogenic Substrate ◽  
Atrial Remodelling ◽  
Ventricular Response

Abstract Aims No studies have assessed the specific contributions of atrial fibrillation (AF)-related atrial vs. associated ventricular arrhythmia to remodelling. This study assessed the roles of atrial arrhythmia vs. high ventricular rate in AF-associated remodelling. Methods and results Four primary dog-groups (12/group) were subjected to 3-week pacing: 600-b.p.m. atrial tachypacing maintaining AF [AF w/o- atrioventricular block (AVB)]; atrial tachypacing with atrioventricular-node ablation (AF+AVB) and ventricular-demand pacing (80 b.p.m.); 160-b.p.m. ventricular-tachypacing (V160) reproducing the response rate during AF; and sinus rhythm with AVB/ventricular-pacing at 80-b.p.m. (control group). At terminal study, left-atrial (LA) effective refractory period (ERP) was reduced equally in both AF groups (w/o-AVB and AF+AVB). AF-inducibility was increased strongly in AF groups (w/o-AVB and AF+AVB) and modestly in V160. AF duration was significantly increased in AF w/o-AVB but not in AF+AVB or V160. Conduction velocity was decreased in AF w/o-AVB, to a greater extent than in AF+AVB and V160. Atrial fibrous-tissue content was increased in AF w/o-AVB, AF+AVB and V160, with collagen-gene up-regulation only in AF w/o-AVB. Connexin43 gene expression was reduced only in AF w/o-AVB. An additional group of 240-b.p.m. ventricular tachypacing dogs (VTP240; to induce heart failure) was studied: vs. other tachypaced groups, VTP240 caused greater fibrosis, but no change in LA-ERP or AF-inducibility. VTP240 also increased AF duration, strongly decreased left ventricular ejection fraction, and was the only group with LA natriuretic-peptide activation. Conclusion The atrial tachyarrhythmia and rapid ventricular response during AF produce distinct atrial remodelling; both contribute to the arrhythmogenic substrate, providing new insights into AF-related remodelling and novel considerations for ventricular rate-control.

scholarly journals Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
E Marcusohn ◽  
O Kobo ◽  
M Postnikov ◽  
D Epstein ◽  
Y Agmon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Prosthetic Valves ◽  
Ventricular Response ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background  The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR). Aim  The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL). Methods  This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF >50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded. Results From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction. Conclusion In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

scholarly journals Cryoballoon Ablation for the Treatment of Atrial Fibrillation in Patients With Concomitant Heart Failure and Either Reduced or Preserved Left Ventricular Ejection Fraction: Results From the Cryo AF Global Registry

2021 ◽  
Author(s):  
Roberto Rordorf ◽  
Fernando Scazzuso ◽  
Kyoung Ryul Julian Chun ◽  
Surinder Kaur Khelae ◽  
Fred J. Kueffer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Atrial Arrhythmia ◽  
Left Ventricular Ejection ◽  
Cryoballoon Ablation ◽  
Ventricular Ejection Fraction ◽  
Global Registry

Background Heart failure (HF) and atrial fibrillation (AF) often coexist; yet, outcomes of ablation in patients with AF and concomitant HF are limited. This analysis assessed outcomes of cryoablation in patients with AF and HF. Methods and Results The Cryo AF Global Registry is a prospective, multicenter registry of patients with AF who were treated with cryoballoon ablation according to routine practice at 56 sites in 26 countries. Patients with baseline New York Heart Association class I to III (HF cohort) were compared with patients without HF. Freedom from atrial arrhythmia recurrence ≥30 seconds, safety, and health care utilization over 12‐month follow‐up were analyzed. A total of 1303 patients (318 HF) were included. Patients with HF commonly had preserved left ventricular ejection fraction (81.6%), were more often women (45.6% versus 33.6%) with persistent AF (25.8% versus 14.3%), and had a larger left atrial diameter (4.4±0.9 versus 4.0±0.7 cm). Serious procedure‐related complications occurred in 4.1% of patients with HF and 2.6% of patients without HF ( P =0.188). Freedom from atrial arrhythmia recurrence was not different between cohorts with either paroxysmal AF (84.2% [95% CI, 78.6–88.4] versus 86.8% [95% CI, 84.2–89.0]) or persistent AF (69.6% [95% CI, 58.1–78.5] versus 71.8% [95% CI, 63.2–78.7]) ( P =0.319). After ablation, a reduction in AF‐related symptoms and antiarrhythmic drug use was observed in both cohorts (HF and no‐HF), and freedom from repeat ablation was not different between cohorts. Persistent AF and HF predicted a post‐ablation cardiovascular rehospitalization ( P =0.032 and P =0.001, respectively). Conclusions Cryoablation to treat patients with AF is similarly effective at 12 months in patients with and without HF. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02752737.

scholarly journals The evaluation of in-hospital prognosis of patient with myocardial infarction and atrial fibrillation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
M Solovyeva ◽  
S Boldueva
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Main Group ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Minor Bleeding ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients

Abstract Funding Acknowledgements Type of funding sources: None. Purpose  to assess the incidence of various forms of atrial fibrillation (AF) among the patients with MI, the prevalence of various types of myocardial infarction (MI) among the patients with AF, the features of the in-hospital prognosis among the patients with MI, and AF compared with those without AF. Materials and methods  1660 cases of patients with MI treated in 2013-18 - the main group (100 patients) were analyzed.  Results  AF occurred in 309 patients (18.6% of the total number of patients with MI). Preexisting AF was in 59.2% of patients. Patients with MI and AF were older than those without AF (mean age 75.2 ± 10.1 versus 64.6 ± 12.8, p <0.0001), among them there were more women (52.4% versus 35.5% in patients without AF, p <0.0001). Type 2 MI occurred 5 times more often among patients with MI and AF (p <0.0001). Further, 2 study groups were formed - the main (100 patients with type 1 MI and preexisting AF) and control (type 1 MI 200 patients without AF), adjusted for sex (58% of women in both groups), age (mean age 75.5 ± 8, 7 in the main group versus 75.2 ± 8.5 in the control group, p = 0.775). DM (45% versus 31.5%, p = 0.030), previous MI (40% versus 25.5%, p = 0.012) and stroke (21% vs. 11.5%, p = 0.037) were more common in the main group than in the control. Patients with MI and AF had lower GFR (56.8 ± 19.4 versus 61.7 ± 17.9 ml / min / 1.73 m2, p = 0.031), LDL (2.8 ± 0.9 versus 3.3 ± 1.0 mmol/L, p = 0.0002). Patients with AF had a lower left ventricular ejection fraction (55.2 ± 10.5 versus 59.8 ± 10.0 %, p = 0.0005). Significant mitral regurgitation was more common in the 1-st group (53.9% versus 30.3% in the control group, p = 0.0002). There were no significant differences in the incidence of acute heart failure (HF) (Killip 3-4) (20% versus 13%, p = 0.127). Patients in the 1-st and 2-nd groups did not differ in the number of affected coronary artery (p = 0.7327), the level of their damage (p = 0.1956), in the frequency of revascularization (p = 0.0686). Patients with MI and AF had worse in-hospital prognosis. Pulmonary embolism (PE) (9% in patients with AF versus 1% in patients without AF, p = 0.0011), minor bleeding (21% versus 9.5%, p = 0.0057), combined endpoint (stroke + PE + mortality) (19% versus 10.5%, p = 0.0415) were more common in the main group. At discharge, patients with AF had chronic HF III NYHA in 21.8% cases versus 5.5% in patients without AF, p = 0.0001. There were no significant differences in other endpoints (recurrent MI, stroke, major bleeding, and total mortality) between the groups during hospitalization. In-hospital mortality was 13% in the main versus 9.5% in the control group (p = 0.4276). Conclusion  AF occurs in 18.6% of patients with MI. Patients with AF and MI are older with the prevalence of females. Patients with type 1 MI and pre-existing AF is a group of high risk. PE, severe chronic HF, minor bleeding, and combined endpoint (stroke + PE + mortality) were significantly common among them.

Safety and Efficacy of an Ultrashort-Acting ?1-Blocker on Left Ventricular Dysfunction

2012 ◽  
Vol 15 (4) ◽  
pp. 189 ◽  
Author(s):  
Nobuhisa Ito ◽  
Tadashi Tashiro ◽  
Noritsugu Morishige ◽  
Masaru Nishimi ◽  
Yoshio Hayashida ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Multiple Logistic Regression Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Safety And Efficacy ◽  
Landiolol Hydrochloride

Landiolol hydrochloride, an ultrashort-acting ?1-selective blocker, is a highly regulated drug. This study evaluated the safety and efficacy of this drug for cases of coronary artery bypass grafting (CABG) with left ventricular dysfunction. Between September 2006 and August 2009, 32 patients with a left ventricular ejection fraction of <40% underwent CABG. Two groups of patients, a group administered landiolol hydrochloride and a control group not administered this drug, were compared. The administration of landiolol hydrochloride was initiated at 1 ?g/kg per minute (?) after cardiopulmonary bypass in on-pump cases and after completion of all the distal anastomoses in off-pump cases. We observed no significant differences between the groups with respect to preoperative patient background or incidences of complications, except for postoperative atrial fibrillation. The heart rate decreased significantly 30 minutes after landiolol hydrochloride administration, but no change was observed in arterial pressure. No change was observed in other parameters; the hemodynamics were stable. The occurrence of atrial fibrillation during the intensive care unit stay (during landiolol hydrochloride administration) was significantly lower in the administration group. The difference remained significant after multiple logistic regression analysis; landiolol hydrochloride was the sole inhibitory factor.

Effect of Diltiazem Hydrochloride on Cardiac Function and Prognosis in Patients with Atrial Fibrillation–Mediated Cardiomyopathy

2021 ◽  
Author(s):  
yongrong liu ◽  
Dan Wang
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Diltiazem Hydrochloride ◽  
Ventricular Ejection Fraction ◽  
Experimental Group

Abstract BackgroundIn previous studies, faster heart rates in patients with atrial fibrillation combined with heart failure have been associated with poor long-term patient prognosis. However, the classical pharmacological regimen of beta-blockers has not reduced mortality in patients with atrial fibrillation combined with heart failure. Therefore, in patients with atrial fibrillation combined with heart failure with an ejection fraction >40%, we further screened patients with a diagnosis of atrial fibrillation cardiomyopathy and compared the combination of diltiazem with standard anti-heart failure drug therapy.Objective:To observe the effect of diltiazem hydrochloride on cardiac function and prognosis in patients with Atrial Fibrillation–Mediated Cardiomyopathy.Methods: A total of 186 patients diagnosed with atrial fibrillation–mediated cardiomyopathy who were admitted to the First Affiliated Hospital of Zhengzhou University from August 2018 to June 2020 were randomly divided into two groups: 93 cases in the experimental group and 93 cases in the control group, both groups were given standardized pharmacological treatment for heart failure (diuretics, digoxin, β-blockers, perindopril), and the experimental group was given diltiazem 30 mg on the basis of standardized treatment, 3 times a day. The patients were followed up for 30 days to observe the target heart rate <110 beats/min, left ventricular ejection fraction, proBNP, the rate of decrease in activity tolerance during the treatment period, and readmission rate within 30 days.Results:After the addition of diltiazem, the attainment rate of target heart rate was significantly higher in the experimental group than in the control group (p<0.05) . The improvement of left ventricular ejection fraction and proBNP was more significant in the experimental group than in the control group (p<0.05). The incidence of decreased activity tolerance during the follow-up period was higher in the experimental group than in the control group, but the difference was not statistically significant (p>0.05). The readmission rate for heart failure within 30 days was significantly lower in the experimental group than in the control group (p < 0.05).Conclusion：Diltiazem hydrochloride is effective in improving cardiac function and prognosis in patients with atrial fibrillation–mediated cardiomyopathy, and is a safe and effective method.

scholarly journals In-hospital prognosis in patients with myocardial infarction and atrial fibrillation

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
M Solovyeva ◽  
S Boldueva ◽  
E Bykova
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Main Group ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Minor Bleeding ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The number of patients with myocardial infarction (MI) and atrial fibrillation (AF) is increasing every year. Purpose to assess the incidence of AF among the patients with MI, the features of the in-hospital prognosis among the patients with MI and AF compared with MI without AF. Methods The patients with type 1 MI and preexisting AF have been selected from all MI patients MI admitted in 2013-18. They have formed the main group (100 patients). The control group (200 patients with type 1 MI without AF), has been created by "pair selection" method. Patients in the groups did not differ in gender, age, MI date and had not severe comorbidities. Results 1660 patients with MI were analyzed. AF occurred in 309 patients (18.6% of patients with MI). Preexisting AF was in 59.2%. Patients with MI and AF were older than MI without AF (mean age 75.2 ± 10.1 versus 64.6 ± 12.8, p &lt;0.0001) with women’s prevalence (52.4% versus 35.5%, p &lt;0.0001). Type 1 MI predominates among all patients. Type 2 MI occurred 5 times more often among main group (p &lt;0.0001). 2 groups were adjusted for sex (58% of women in both groups), age (mean age 75.5 ± 8, 7 in the main versus 75.2 ± 8.5 in the control group, p = 0.775). Diabetes (45% versus 31.5%, p = 0.030), previous MI (40% versus 25.5%, p = 0.012) and stroke (21% versus 11.5%, p = 0.037) were more common in the main than in the control. Patients with MI and AF had lower GFR (56.8 ± 19.4 versus 61.7 ± 17.9 ml/min/1.73 m2, p = 0.031), LDL (2.8 ± 0.9 versus 3.3 ± 1.0 mmol/L, p = 0.0002). Patients with AF had a lower left ventricular ejection fraction (55.2 ± 10.5 versus 59.8 ± 10.0 %, p = 0.0005). Significant mitral regurgitation was more common in the main group (53.9% versus 30.3% in the control group, p = 0.0002). There were no differences in the incidence of acute heart failure (HF) Killip’s 3-4 (20% versus 13%, p = 0.127). Patients did not differ in the number of affected coronary artery (p = 0.7327), the level of stenosis (p = 0.1956), in the frequency of revascularization (p = 0.0686). Patients with MI and AF had worse in-hospital prognosis. Pulmonary embolism (PE) (9% in main versus 1% in control group, p = 0.0011), minor bleeding (21% versus 9.5%, p = 0.0057), combined endpoint (stroke + PE + mortality) (19% versus 10.5%, p = 0.0415) were more common in the main group. At discharge, patients with AF had HF III NYHA in 21.8% cases versus 5.5% in patients without AF, p = 0.0001. There were no significant differences in other in-hospital endpoints (recurrent myocardial infarction, stroke, major bleeding, and mortality) between the groups. In-hospital mortality was 13% in the main versus 9.5% in the control group (p = 0.4276). Conclusion AF occurs in 18.6% of patients with MI. Patients with AF and MI are older with female prevalence. Type 1 MI predominates. Patients with type 1 MI and pre-existing AF is a group of high risk because of more severe HF, PE, minor bleeding and combined endpoint (stroke + PE + mortality)

Prognostic role of results of dynamic capnography in integral assessment of parameters of respiratory system in 6-minute walk test in patients with chronic heart failure

2020 ◽  
Vol 28 (3) ◽  
pp. 290-299
Author(s):  
Kira A. Ageeva ◽  
Evgenii V. Filippov
Keyword(s):  
Respiratory System ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Walk Test ◽  
Ventricular Ejection Fraction ◽  
6Mwt Distance ◽  
6 Minute Walk Test ◽  
Minute Walk

Aim. To study the prognostic value of the results of dynamic capnography in the complex assessment of parameters of the respiratory system in 6-minute walk test in patients with chronic heart failure (CHF). Materials and Methods. 73 Patients were examined: the group of study included 48 patients with IIA or IIB stage CHF (mean age 57.94.6 years, 23 men), the control group included 25 practically healthy volunteers (mean age 47.63.5 years, 9 men). The patients were conducted complex determination of parameters of the respiratory system: clinical scaling before and after 6-minute walk test (6MWT), instrumental examinations including spirometry, capnography and pulse oximetry before, during and after physical activity. The analysis of survival was conducted on the basis of the dynamic follow-up of patients within 5 years (60 months). Results. In the analysis of parameters of dyspnea at rest, all the parameters were higher in the group of patients with CHF (р0.05). The distance walked by the patients with CHF in 6 minutes was 488.2390.84 m, which was significantly less than in the control group (815.6053.89 m, р=0.009). Dyspnea as the cause of stoppage/slowing down of walking in 6MWT, was also more often recorded in patients with CHF (93.83.0% and 48.05.1%, р=0.049). Besides, in 6MWT the patients noted: weakness in legs (50.15.0% in the group of CHF and 40.05.0% in the control group, р=0.014), palpitation (29.04.6% and 20.04.1%, respectively, р=0.004). Worsening of dyspnea parameters in 6MWT was more evident in patients with CHF than in the control group (р0.01). In the CHF group, hypocapnic type of ventilation was revealed in 6MWT, analysis of РЕТСО2 trend graphs revealed a wave-like increase in the parameters, the so called periodic breathing (PB). CO2 trend was recorded in CHF group in 58.31.0% of cases (the difference with the control group with р=0.046), the trend of heart rate in 18.80.3% of cases (р=0.027). Cox proportional hazards regression analysis of mortality in patients with CHF showed a prognostic significance of a complex model comprising the following parameters of a patient: body mass index (р=0.005), left ventricular end-diastolic dimension (р=0.034), left ventricular end-systolic dimension (р=0.002), left ventricular ejection fraction (р=0.041), 6MWT distance (р=0.004), desaturation (р=0.009), and the presence of signs of PB during 6MWT (р=0.005). Model coefficients were statistically significant at р0.0001. Conclusions. Dynamic capnography and pulse oximetry allow to identify signs of PB in patients with CHF during 6MWT which may deepen a complex assessment of parameters of the cardio-respiratory system in patients with CHF in order to determine tolerance to physical exercise as well as the effectiveness of the conducted treatment. Complex assessment of survival of patients with CHF showed prognostic significance of the following parameters of a patient: body mass index, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, 6MWT distance, desaturation, PB during 6MWT.

STUDY THE CHANGES IN MORPHOLOGY AND LEFT VENTRICULAR FUNCTION IN OVERWEIGHT-OBESE CHILDREN 5-15 YEARS OLD WHO VISITED CHILDREN'S HOSPITAL IN CAN THO

2011 ◽  
pp. 36-42
Author(s):  
Hung Viet Bui ◽  
Thi Cu Nguyen
Keyword(s):  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Obese Children ◽  
Ventricular Ejection Fraction ◽  
Children's Hospital ◽  
Number Of Patients ◽  
Children’S Hospital

Objective: In Vietnam, obesity is increasing particularly in many large cities. Adult cardiovascular diseases are often derived from cardiovascular disorders during the children period. The implementation of early measures to prevent atherosclerosis, such as weight control, better lipid control will reduce the cardiovascular complications, such as hypertension (HTA), coronary heart diseases and some other diseases. Materials and Methods: Overweight - obese children from 5 to 15 years old who visited the Children's Hospital in Can Tho from May 2009 to May 2010. Total number of patients were chosen as 50 children. Method: Descriptive cross-sectional. Children in the study underwent Doppler ultrasound exam to evaluate cardiac morphology and cardiac function. Results: There were increases in left ventricular systolic diameter, left ventricular diastolic diameter, LV mass in overweight-obese children in the study compared with controls at all ages (p <0.05 ). Left ventricular ejection fraction in overweight-obese children in the study was lower than the control group at all ages (p> 0.05). The average rate of left ventricular shortening of overweight-obese children in the study was 34.8 ± 4.5(%). There was no difference in the rate of shortening of the left ventricle in overweight-obese children in the study compared with controls (p>0.05). There was no relationship between variation in morphology and left ventricular function with the degree of overweight-obesity in this study. Conclusion: The study showed that disturbances in morphology and left ventricular function in overweight-obese children but did not find a strong association with the disorder degree of overweight-obesity.

scholarly journals Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001716
Author(s):  
Luke Byrne ◽  
Roisin Gardiner ◽  
Patrick Devitt ◽  
Caleb Powell ◽  
Richard Armstrong ◽  
...  
Keyword(s):  
Public Health ◽  
Public Perception ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
St Elevation ◽  
The Impact ◽  
Transfer Times

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

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