scholarly journals Feasibility of remote support for electrophysiological ablation procedures during CoVid-19 pandemics

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Muessigbrodt ◽  
F Demoniere ◽  
S Finoly ◽  
M Mommarche ◽  
J Inamo
Keyword(s):  
Atrial Flutter ◽  
Medical Training ◽  
Human Life ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Technical Support ◽  
Right Atrial ◽  
Global Challenge ◽  
Heart Rhythm Disorders ◽  
Technical Support Staff

Abstract   The COVID-19 pandemics is a global challenge with a huge impact on medicine, politics, economy, education, travel and many other aspects of human life. The treatment of heart rhythm disorders has also been affected by the disease itself and by restrictions in order to constrain the spread of the virus. Catheter ablations of cardiac arrhythmias are nowadays frequently guided by electro-anatomic mapping systems. Technical staff with medical training, or medical staff with technical training, is needed to assist the operator. Travel restrictions due to current COVID-19 pandemics have limited the in person availability for technical support staff. To overcome these limitations we explored the feasibility of remote support with an internet based communication platform. A total of 9 patients (87,5% male, mean age 66,6 years) with different arrhythmias (atrial fibrillation, left atrial flutter, typical right atrial flutter, left ventricular tachycardia), having undergone ablation procedures between October 2020 and February 2021, were included. Acute procedural success was obtained in 9 out of 9 procedures. No complications occurred. Our experience with remote support for electro-anatomic mapping for complex electrophysiological ablation procedures, show the feasibility and safety of this approach. It increases the availability of technical support at reduced costs and a reduced CO2 footprint. Remote support for electro-anatomic mapping may therefore facilitate continuous care for patients with arrhythmias during the COVID-19 pandemics. Due to its advantages beyond COVID-19 pandemics related problems, it will likely play a greater role in the future. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Feasibility of remote technical support for electrophysiological ablation procedures during the current CoVid-19 pandemic

2021 ◽  
Author(s):  
Andreas Müssigbrodt ◽  
Fabrice Demoniere ◽  
Rishika Banydeen ◽  
Steeve Finoly ◽  
Max Mommarche ◽  
...  
Keyword(s):  
Medical Training ◽  
Heart Rhythm ◽  
Technical Support ◽  
Viral Spread ◽  
Continuous Care ◽  
Heart Rhythm Disorders ◽  
Travel Restrictions ◽  
To Come ◽  
Technical Support Staff ◽  
Mapping Systems

Abstract The treatment of heart rhythm disorders has been significantly impacted by direct consequences of the current CoVid-19 pandemic, as well as by restrictions aimed towards constraining viral spread. Usually, catheter ablations of cardiac arrhythmias are guided by electro-anatomic mapping systems. Technical staff with medical training, or medical staff with technical training, is needed to assist the operator. Travel restrictions due to the current COVID-19 pandemic have limited the in-person availability of technical support staff. To overcome these limitations, we explored the feasibility of a trans-atlantic remote technical support for electro-anatomic mapping, with an internet based communication platform, for complex electrophysiological ablation procedures. Our first experience, based on nine ablation procedures of different arrythmias, highlights the feasibility of this approach. Remote support for electro-anatomic mapping might therefore facilitate continuous care for patients with arrhythmias during the COVID-19 pandemic, particularly in insular settings. Beyond COVID-19 related challenges, this approach will likely play a greater role in the cardiology field in years to come, due to its significant advantages.

scholarly journals Clinical and laboratory associations of liver fibrosis indexes in patients with decompensated Chronic Heart Failure II-IV Functional Classes

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 90-99
Author(s):  
S. K. Stolbova ◽  
N. A. Dragomiretskaya ◽  
I. G. Beliaev ◽  
V. I. Podzolkov
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Liver Fibrosis ◽  
Hepatic Fibrosis ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Heart Rhythm Disorders ◽  
High Liver

Aim To study clinical and laboratory associations of hepatic fibrosis indexes in patients with decompensated NYHA functional class II-IV chronic heart failure (CHF).Material and methods The study included 128 patients admitted to the cardiological or therapeutic department of the University Clinical Hospital #4 at the I. M. Sechenov First Moscow State Medical University (Sechenov University) with symptoms of CHF associated with ischemic heart disease (IHD) and/or arterial hypertension (AH). All patients had signs of liver disease (liver enlargement on physical examination ± diffuse changes in hepatic tissue according to ultrasound data). Mean age was 70.59±10.71 years. Along with general clinical examination, severity of hepatic fibrosis was evaluated by calculated indexes, FIB-4, APRI, MELD-XI, and BARD. All calculations were based on laboratory data obtained within the first two days of hospitalization for decompensated CHF, at the onset of active therapy with intravenous diuretics. Statistical analyses were performed with the R programming language (3.6.1).Results In patients with NYHA FC II–IV CHF, the FIB-4 index significantly increased with the increase in NYHA FC (р<0.05). Also, the high liver density by most fibrosis indexes correlated with the probability of LV EF decrease to <40 % (FIB-4: RR, 1.32 at 95 % CI from 0.53 to 3.28, р=0.079; MELD-XI: RR, 1.62 at 95 % CI from 1.19 to 2.20, р=0.004; BARD: median LV EF, 42.5 % vs. 56 %, р=0.019), and a tendency to heart rhythm disorders was observed (FIB-4: RR, 1.92 at 95 % CI from 0.75 to 4.90, р=0.218; BARD: RR, 1.09 at 95 % CI from 0.97 to 1.22, р=0.174; MELD-XI: RR, 1.34 at 95 % CI from 0.94 to 1.90, р=0.101). Increases in liver fibrosis indexes correlated with other multiorgan disorders in CHF patients evident as a decrease in platelet count (FIB-4: р<0.01; APRI: р=0.045) and a tendency to a decrease in hemoglobin (FIB-4: 127 g/l vs. 137 g/l, p=0.249; APRI: 127 g/l vs. 136 g/l, p=0.749). Patients with a high liver density more frequently had cardiorenal syndrome diagnosed by reduced glomerular filtration rate (GFR) estimated by CKD-EPI to less than 60 ml/min / 1.73 m2 (FIB-4: р<0.03; MELD-XI: p=0.0001; BARD: р=0.005). In comparing liver fibrosis indexes in subgroups of CHF patients with preserved and reduced left ventricular ejection fraction (LV EF), significant differences were found only for MELD-XI (12.08 vs. 9.32, р=0.001).Conclusions For all studied indexes, correlations were observed with LV EF, decreases in hemoglobin, and incidence of heart rhythm disorders. For the BARD, FIB-4, and MELD-XI indexes, high results of calculations correlated with the presence of other predictors for unfavorable prognosis and disease severity (LV EF, NYHA FC, presence of type 2 diabetes mellitus, chronic kidney disease, and lower GFR). Liver fibrosis indexes are a new and promising but understudied instrument for evaluation of prognosis in CHF patients, which requires further study to determine most appropriate prognostic formulas.

scholarly journals Sex-age features of the prevalence and structure of heart rhythm disorders in the patients with severe Covid-infection

2021 ◽  
Vol 27 (1) ◽  
pp. 41-49
Author(s):  
Y.M. Mostovoy ◽  
T.D. Danilevych
Keyword(s):  
Cardiac Arrhythmias ◽  
Sinus Tachycardia ◽  
Sinus Bradycardia ◽  
Statistical Processing ◽  
Major Complication ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Heart Rhythm Disorders ◽  
Age Features ◽  
The Right

There is growing evidence that arrhythmias are a major complication of COVID-19 infection. Inflammation of the myocardium, cytokine storm, hypoxia, changes of electrolyte levels, coronary vasospasm, microcloths may be factors that contribute to the development of arrhythmias and changes of the ECG. The aim of the study was to determine the sex and age characteristics of the prevalence and structure of cardiac arrhythmias in patients with severe COVID infection. In the study were examined 133 patients with severe COVID-19 infection, who were in the intensive care unit of the city clinical hospital №1 in Vinnytsia at the period from April to December 2020 and as a result of treatment with improved health were discharged from the hospital. Statistical processing of the obtained data was performed using the statistical software package SPSS 12.0 for Windows using parametric and non-parametric methods of statistical analysis. It was found that the most common comorbid pathologies of the patients with severe COVID-19 were – arterial hypertension 90 (67.7%), coronary heart disease 91 (68.4%), chronic heart failure 65 (48.9%), obesity 47 (35.3%) and diabetes mellitus 32 (24.1%). It was found that the prevalence of cardiac arrhythmias in patients with severe COVID-19 was 86 (64.7%) patients. Among all arrhythmias, tachyarrhythmias predominated – 68 (51.1%), in the structure of which sinus tachycardia was the most common in 45 (33.8%) and atrial fibrillation (AF) – in 19 (14.3%) patients, respectively. In turn, sinus tachycardia was significantly more common among women. The prevalence of bradyarrhythmias was 60 (45.1%), in the structure of which were dominated sinus bradycardia 16 (12%) and blockade of the right branch of the His bundle 30 (22.6%). Among men, there was a tendency to the predominance of complete left bundle branch block. The prevalence of ischemic changes and/or repolarization disorders according to the ECG was 119 (89.5%), in the structure of which were dominated the presence of inversion of the T wave 91 (68.4%) and depression of the ST segment 54 (40.6%). The mean age of the patients with ischemic ECG changes was significantly higher compared to patients without signs of repolarization disorders. Among men, there was a predominance of pancreatic hypertrophy and a tendency to predominance of left ventricular hypertrophy.

scholarly journals Fabry’s disease in cardiological aspect

2020 ◽  
pp. 22-27
Author(s):  
L. D. Khidirova ◽  
A. Kh. Magomedova ◽  
A. A. Vasilenko ◽  
V. S. Dudchenko
Keyword(s):  
Subsequent Development ◽  
Heart Rhythm ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Fabry’S Disease ◽  
Fabry's Disease ◽  
Enzyme Replacement ◽  
Heart Rhythm Disorders ◽  
Lysosomal Accumulation ◽  
Gla Gene

Hereditary genetic X-linked disease Fabry’s disease belongs to the group of lysosomal accumulation diseases and is caused by mutations in the GLA gene and is characterized by a decrease in functional activity or complete absence of the enzyme α-galactosidase A. This pathology belongs to the group of orphan diseases. Mutation of the GLA gene leads to the formation of defective forms of the enzyme α-galactosidase A, which contributes to the violation of the catabolism of glycosphingolipids, their further accumulation in the lysosomes of various cell cultures, and the development of lysosomal cell dysfunction. The prevalence of Fabry disease is about 1 in 117,000 live-born boys. According to screening studies in newborns, this figure can be about 1 in 3,100 and affects to the same extent representatives of all ethnic groups. Fabri’s disease has become actively studied in Russia, but more than 5,000 people (according to estimates) remain undiagnosed. In the first place among the causes of death in Fabry’s disease is heart disease, in particular left ventricular hypertrophy with the subsequent development of diastolic dysfunction and heart failure. Heart rhythm disorders are often observed. Early diagnosis of Fabri disease will lead to the appointment of genotype-specific enzyme replacement therapy and reduce the risk of cardiovascular complications.

scholarly journals Cardiac Stimulation in the Third Millennium: Where Do We Head from Here?

Hearts ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 15-35
Author(s):  
Mauro Biffi ◽  
Alberto Spadotto ◽  
Giuseppe Pio Piemontese ◽  
Sebastiano Toniolo ◽  
Lorenzo Bartoli ◽  
...  
Keyword(s):  
Heart Diseases ◽  
Heart Rhythm ◽  
Cardiac Pacing ◽  
Right Atrial ◽  
Cardiac Stimulation ◽  
Life Saving ◽  
Heart Rhythm Disorders ◽  
Structural Heart Diseases ◽  
Right Atrial Appendage ◽  
The Right

Over the years, pacemakers have evolved from a life-saving tool to prevent asystole to a device to treat heart rhythm disorders and heart failure, aiming at improving both cardiac function and clinical outcomes. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases. This has led to awareness of the concealed risks of customary cardiac pacing that can inadvertently cause atrioventricular and inter-/intra-ventricular dyssynchrony, and has promoted the development of new pacing modalities and the use of stimulation sites different from the right atrial appendage and the right ventricular apex. The perspective of truly physiologic pacing is the leading concept of the continued research in the past 30 years, which has made cardiac stimulation procedure more sophisticated and challenging. In this article, we analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing.

scholarly journals The role of thyrostatic agents in the treatment of chronic heart failure patients with comorbid coronary artery disease and thyrotoxicosis

2020 ◽  
Vol 49 ◽  
Author(s):  
E. V. Pashchenko ◽  
A. I. Chesnikova ◽  
V. P. Terentyev ◽  
V. I. Kudinov ◽  
M. S. Lankina ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Combination Therapy ◽  
Clinical Symptoms ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Heart Rhythm Disorders ◽  
Diastolic Left Ventricular Function ◽  
Artery Disease

Background: Thyroid dysfunction exerts a  pronounced effect on the cardiovascular system, and, if comorbid with an existing cardiovascular disorder, may lead to a significant deterioration in the outcome, thus obviating the need for timely diagnosis and therapy optimization.Aim: To evaluate the effect of combination therapy, including thyrostatics, on the clinical symptoms of chronic heart failure (CHF), heart rate variability, NT-proBNP concentration, and structural and functional parameters of the left heart in patients with comorbid coronary artery disease (CAD) and thyrotoxicosis.Materials and methods: This open-label comparative study included 77 patients aged 45–65 years. The study group consisted of 36  patients with thyrotoxicosis, CAD and CHF II–III functional class, whereas the comparison group consisted of 41 patients with thyrotoxicosis without cardiovascular diseases. The patients were assessed clinically at baseline and after 6 months of therapy with addition of a thyrostatic, with tolerance to physical activity, measurements of NT-proBNP levels, 24-hour Holter monitoring, and echocardiography.Results: At 6 months of the combination therapy including a  thyrostatic, with stable drug-induced euthyroidism, the patients in the group 1 showed an increase in the distance of a 6-minute walking test (p<0.001) and a decrease in CHF clinical symptoms. The incidence of heart rhythm disorders decreased (supraventricular extra systoles from 31% to 16%, ventricular extra systoles from 21% to 4%, atrial fibrillation from 32% to 23%; p<0.05), with a positive trend for spectral and temporal parameters of heart rate variability. The NT-proBNP level in patients with CAD, CHF and thyrotoxicosis decreased by 42.9% (p=0.001). During euthyrosis, echocardiography in the patients with ischemic CHF and concomitant thyrotoxicosis showed a significant increase in stroke volume (p=0.03), stroke ejection index (p=0.04), left ventricular ejection fraction (p=0.01), a decrease in the value of myocardial stress (p=0.02), and transmitral blood flow parameters (E/A, p<0.05). This indicates an improvement in systolic and diastolic left ventricular function after normalization of thyroid function.Conclusion: The inclusion of thyreostatics to the combination therapy and the achievement of euthyrosis have contributed to increased tolerance to physical activity, reduction of sympathetic activity level of the autonomic nervous system and frequency of heart rhythm disorders, reduced the NT-proBNP levels, improved systolic and diastolic left ventricular function in patients with ischemic CHF and concomitant thyrotoxicosis.

scholarly journals Comparison of clockwise and counterclockwise right atrial flutter using high-resolution mapping

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Yvorel ◽  
A Da Costa ◽  
C Lerebours ◽  
J B Guichard ◽  
G Viallon ◽  
...  
Keyword(s):  
High Resolution ◽  
Atrial Flutter ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Lateral Side ◽  
Ventricular Ejection Fraction ◽  
Ridge Line ◽  
Mapping System ◽  
Significant Difference

Abstract Background To the best of our knowledge, few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) using the high-resolution Rhythmia mapping system. Objectives. Accordingly, our prospective cohort study, sought to compare CW and CCW CTI-dependent AFL in preselected pure right AFL patients (pts) using the ultra-high-definition (ultra-HD) Rhythmia mapping system. The study also aimed to mathematically develop a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities. Methods and results Between October 2019 and July 2020, 33 patients were recruited. The mean age was 71±13 years old. No difference was found concerning clinical variables between CCW AFL and CW AFL or regarding left ventricular ejection fraction (LVEF) (55.5±10 vs. 56.6±12; p=0.76). The AFL cycle length was very similar (248±20 vs. 252±28 ms; p=0.6). The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p=0.7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. (4/10 [40%]); p=0.9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. (6/10 [60%]) (p=.9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p=0.2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28±10cm/s; n=8),and the velocities were similarly altered between both groups (26±10 [4/22] vs. 29.8±11cm/s [4/11]; p=0.6). We created mathematical, three-dimensional RA reconstruction-velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit-conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL. The only differences between CW and CCW AFL concerned activation patterns. Conclusions The ultra-HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Emery-Dreifuss muscular dystrophy presenting as a heart rhythm disorders in children

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T S Kovalchuk ◽  
E V Yakovleva ◽  
S G Fetisova ◽  
T L Vershinina ◽  
T M Pervunina ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Skeletal Muscle ◽  
Muscular Dystrophy ◽  
Atrial Flutter ◽  
Sinus Node ◽  
Heart Rhythm ◽  
Sinus Node Dysfunction ◽  
Supraventricular Arrhythmias ◽  
Heart Rhythm Disorders ◽  
The Mean

Abstract Introduction Emery-Dreifuss muscular dystrophy (EDMD) is an inherited muscle dystrophy often accompanied by cardiac abnormalities in the form of supraventricular arrhythmias, conduction defects, sinus node dysfunction. Cardiac phenotype typically arises years after skeletal muscle presentations, though, can be severe and life-threatening. The disease usually manifests during the third decade of life with elbow joint contractions and progressive muscle weakness and atrophy. Objective To present our clinical experience of diagnosis and treatment of arrhythmias in children with Emery-Dreifuss muscular dystrophy Materials and methods We enrolled 5 patients with different forms of EDMD (X-linked and autosomal dominant) linked to the mutations in EMD and LMNA genes, presented with early onset of cardiac abnormalities and no leading skeletal muscle phenotype. The predominant forms of cardiac pathology were atrial flutter, atrial fibrillation and conduction disturbances that progress over time. Clinical examination included physical examination, 12-lead electrocardiography, Holter ECG monitoring (HM), transthoracic echocardiography, neurological examination and biochemical and hormone tests. Also we performed CMR, electrophysiological study (EPS), treadmill test of some patients. One patient underwent an endomyocardial biopsy to exclude inflammatory heart disease. Target sequencing was performed using a panel of 108 or 172 genes Results We observed five patients with EDMD and cardiac debut during first-second decades of life: 3 with 1st subtype (variants in EMD gene) and 2 with 2nd subtype (variants in LMNA gene). All patients were males. The mean age of cardiac manifestation was 13,2±3,11 (from 9 to 16 y.o.). The mean follow-up period was 7,4±2,6 years. All patients presented with sinus node dysfunction and four out of five with AV conduction abnormalities. The leading arrhythmic phenotypes included various types of supraventricular arrhythmias: multifocal atrial tachycardia (AT) (n=4), premature atrial captures (PACs) (n=4), atrial flutter, (AF) (n=3), atrial fibrillation (AFib) (n=3) and AV nodal recurrent tachycardia (AVRNT). Heart rhythm disorders were the first manifestation in all three patients with 1st EDMD subtype. Radiofrequency ablation was performed in 2 patients, one of them received permanent pacemaker implantation. Conclusions In conclusion, while being the rare cases, heart rhythm disorders can represent the first and for a long time, the only clinical symptom of EDMD even in the pediatric group of patients. Therefore, thorough laboratory and neurological screening along with genetic studies, are of importance in each pediatric patient presenting with complex heart rhythm disorders of primary supraventricular origin to exclude EDMD or other neuromuscular disorders. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The Clinical Value of no-Reflow Phenomenon in the Routing Operation of The Regional Vascular Center

Kardiologiia ◽  
2020 ◽  
Vol 60 (4) ◽  
pp. 146-150
Author(s):  
E. V. Konstantinova ◽  
M. D. Muksinova ◽  
M. Yu. Gilyarov ◽  
A. E. Udovichenko ◽  
E. V. Kuzmina ◽  
...  
Keyword(s):  
Heart Rhythm ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Clinical Value ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Heart Rhythm Disorders ◽  
Diagnostic Characteristics ◽  
No Reflow Phenomenon

Coronary no-reflow phenomenon (CNR) is a complication of primary percutaneous coronary intervention (PCI). According to different reports, CNR occurs in 10 to 60 % of cases. Despite the long history of studying this phenomenon many issues remain unsolved. This article presents a clinical case of electrocardiographically confirmed ST-segment elevation myocardial infarction. In this case, the CNR phenomenon occurred during PCI and was associated with heart rhythm disorders, left ventricular (LV) cavity dilatation with a decrease in LV contractility, and formation of intracavitary thrombus. The patient asked for medical care late, which could influence the development of CNR. This case demonstrates the clinical significance, diagnostic characteristics, and successful drug correction of the no-reflow phenomenon.

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