scholarly journals First Vs Recurrent Syncope In Patients With Structural Heart Disease Or Bundle Branch Block

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Francisco Pascual ◽  
N Rivas Gandara ◽  
A Santos Ortega ◽  
J Perez Rodon ◽  
B Benito ◽  
...  
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Diagnostic Yield ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
First Episode ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Syncope Episode ◽  
Work Up

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Vall d"Hebron - Vall d"Hebron Institut de Recerca. CIBERCV BACKGROUND Patients with structural heart disease (SHD) or bundle branch block (BBB) are at high risk of having an arrhythmic syncope (AS).  In patients with recurrent syncope episodes (RSE)  complete work-up including electrophysiological study (EPS) and/or implantation of a loop recorder (ILR) is recommended, however patients with their first episode may also be at risk of an AS. AIM To determinate if the patients with SHD or BBB with a single syncope episode (SSE) are at high risk of having an AS and compare it with patients with recurrent episodes (RSE). METHODS Cohort study carried out in a tertiary hospital that is a reference centre for syncope. From January 2008 to August 2020 patients with SHD or BBB with syncope of unknown origin after the initial evaluation and without direct indication of an ICD were included. They were managed according the current ESC guidelines. RESULTS 417patients were included  (74 ±11 y. o; 39% female). Mean follow up was 2.5 ±1 y. 223 patients were diagnosed from an AS [113 (53%) in SSE group and 110 (54%) in RSE group, p = 0.9], 210 were due to bradyarrhythmia (AV block or sinus arrest). No differences in baseline characteristics where found comparing both groups, except that BBB was slightly more prevalent in patients with RSE (81% vs 90%, p = 0.01) (FIGURE- PANEL A). Risk of AS was 53% in patients with SE and 54% (p = 0.9). RSE were not associated with an increased risk of AS in univariate analyses (OR 1.01 IC95% 0.7-1.5) neither in the multivariate (FIGURE- PANEL B). EPS and ILR diagnostic yield was 45% / 32% respectively in SSE group and 44% / 33% in RSE group (p = 0.8) (FIGURE - PANEL C).  After appropriate treatment, recurrence syncope rate was 10% in SSE group and 9% in RSE group (p = 0.8). No significant differences in mortality rate were found. CONCLUSIONS Patients with SHD or BBB and single syncope episode are at a high risk of having AS, and similar to those with RSE. EPS and ILR offer a similar diagnostic yield in both groups. Complete syncope work-up must be recommended in these patients despite having had only a single episode. Abstract Figure

Abstract 2928: Sudden Arrhythmic Death Syndrome-Diagnostic Yield Of Combined Clinical & Genetic Screening In A British Specialist Clinic

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Pier D Lambiase ◽  
Juan C Kaski ◽  
Eileen Firman ◽  
Perry M Elliott ◽  
Akbar K Ahmed ◽  
...  
Keyword(s):  
Heart Disease ◽  
Genetic Testing ◽  
Screening Programme ◽  
Diagnostic Yield ◽  
Challenge Test ◽  
Structural Heart Disease ◽  
Clinical Screening ◽  
Arrhythmic Death ◽  
Sudden Arrhythmic Death Syndrome ◽  
Index Cases

Introduction: Sudden arrhythmic death syndrome (SADS) arises through disorders of ion channel function or structural heart disease. It accounts for over 400 deaths in the UK per annum. To date there has been no comprehensive analysis of the diagnostic yield and efficacy of a family screening approach in SADS index cases where the post mortem heart is structurally normal after expert pathological review. Methods: 118 SADS families where the SADS victim died between 1 and 35 years of age were evaluated in a systematic family screening programme between 2003–2006. All SADS index cases had a structurally normal heart after expert review of all available tissue. All studied relatives underwent resting, signal averaged ECG, 24h Holter, exercise ECG with V0 2 max, transthoracic echocardiography and an ajmaline challenge test after initial clinical screening. Systematic mutation analysis was performed on the known long QT (LQT)genes including SCN5A & ryanodine receptor/ARVC genes when clinically suspected. Results: The most common modes of death were rest in 28%, sleep in 25% and exercise in 18%. Clinical screening identified an inherited electrical cause of SADS in 41 of the 118 families (35%)-20 Brugada, 18 LQT Syndrome, 3 Catecholiminergic Polymorphic Ventricular Tachycardia (CPVT). Structural heart disease was identified in 5 ARVC & 2 DCM families. 26 ICDs have been implanted in affected family members-4 LQTS, 7 Brugada, 2 CPVT, 2 ARVC, 2 DCM and 9 on clinical grounds without a definitive diagnosis. The ECG (37%) and ajmaline challenge test (49%) had the highest diagnostic yield in families with a positive diagnosis. To date, genetic testing has increased the diagnostic yield by 5% (6/118 families-2 KCNQ1, 1 HERG, 2 SCN5A, 1 ARVC ), confirming a clinical diagnosis in 6.6%–3 KCNQ1, 3 SCN5A, 1 HERG, 1 KCNH2. Conclusions: Systematic clinical screening in relatives of SADS victims has a diagnostic yield of 35% increasing to 40% with genetic testing. Electrical causes of SADS predominate in these families. These findings demonstrate that a systematic clinical screening programme in SADS families is both achievable and effective. The full impact of gene testing (including RyR mutations) upon diagnostic yield is awaited.

Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease

Circulation ◽  
2021 ◽  
Vol 144 (16) ◽  
pp. 1323-1343
Author(s):  
Paolo Calabrò ◽  
Felice Gragnano ◽  
Giampaolo Niccoli ◽  
Rossella Marcucci ◽  
Marco Zimarino ◽  
...  
Keyword(s):  
Heart Disease ◽  
Antithrombotic Therapy ◽  
Structural Heart Disease ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Tricuspid Valve Repair ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
Valve Implantation ◽  
Transcatheter Interventions

Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.

Abstract P290: Stroke and Coronary Heart Disease - Predictive Power of Standard Risk Factors Until Old Age

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Wai Giang Kok ◽  
Lena M Bjorck ◽  
Masuma Novak ◽  
George Lappas ◽  
Annika Rosengren
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Old Age ◽  
Previous History ◽  
Cumulative Risk ◽  
Cumulative Effect ◽  
Risk Groups ◽  
Increased Risk ◽  
Score Model

Introduction and Aim: The SCORE model, based on age, sex, current smoking and systolic blood pressure, and serum cholesterol, was created to identify persons at increased risk for fatal cardiovascular disease (CVD) defined as death from coronary heart disease (CHD) or stroke within 10 years. We aimed to examine the short-term and long-term risk for CHD and stroke separately. Methods and Results: The Primary Prevention cohort study comprising 7174 men free from previous history of CHD, stroke and diabetes and aged 45 to 55 at baseline examination (1970–73) were followed up for 35 years. To estimate the cumulative effect of CHD and stroke, all participants were stratified into one of four risk groups defined by their burden of risk according to the SCORE factors. The 35 year relative risk (RR) for the men with the highest risk compared to those with the lowest was 3.38 (95 % CI 2.84–4.02) for CHD and 1.60 (95% CI 1.28–2.00) for stroke. When adjusted for competing risk the estimated 10 year cumulative risk for high risk individuals was 19.4% for CHD and 3.6% for stroke which increased substantially to 87% and 70% respectively after 35 years. Conclusions: The 10 year risk for CHD and stroke as calculated by the SCORE factors differs which indicates that the cumulative risk in middle age men based on the SCORE model can effectively be used to predict CHD but not stroke to the same extent. However, over an extended follow-up period until old age, the cumulative risk for stroke increased markedly such that high risk individuals developed a high cumulative risk for both CHD and stroke after 35 years.

P5353Pregnancy in congenital heart disease - risk stratificaton

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Pataki ◽  
M Szegedi ◽  
A Temesvari ◽  
L Ablonczy ◽  
P Andreka ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Premature Birth ◽  
Congenital Heart ◽  
Left Ventricular ◽  
High Risk Pregnancy ◽  
Cardiac Events ◽  
Risk Pregnancy ◽  
Increased Risk

Abstract Introduction Maternal congenital heart disease is a leading cause of peripartum maternal mortality, which is also associated with increased risk of fetal morbidity and mortality. We aimed to provide risk stratification for congenital heart disease patients using the recently introduced CARPREG (Cardiac Disease in Pregnancy) II score at our Institute. Patients and methods We enrolled 191 pregnant women with congenital heart disease (mean age at pregnancy 29.2±5,7 years). We recorded all foetal (premature birth, abortion, congenital heart abnormalities) and maternal (postpartum heart failure, stroke, hypertension) events in 276 pregnancies. High-risk pregnancy was defined as a CARPREG II score of 4≤. Results High-risk pregnancy was detected in 14.1%. We found fetal and maternal events in 13.8% and 14.5% of all pregnancies, respectively, which both were more prevalent in the high-risk group (p<0.001). No maternal death occurred, whereas premature birth and abortion was detected in 7.6 and 2.9%, respectively, both complications were more frequent in the high-risk patient population as compared to the lower risk patients (30.8 vs. 7.2%, p<0.001). In univariate analysis, CARPREG II of 4≤ was significantly associated with fetal (p<0.001, OR: 4.2) and maternal (p<0.001, OR: 5.3) events. Risk factors of the CARPREG II were further analyzed using multivariate logistic regression analysis: prior cardiac events or arrhythmias (p=0.027) and cyanosis (p=0.026) were independent predictors of fetal complications. Left ventricular outflow tract obstruction (p<0.001), cardiac interventions (p=0.024) and prior cardiac events or arrhythmias (p=0.001) demonstrated significant association with maternal events. Conclusion The CARPREG II could help in the identification of high-risk pregnancies and thus aids the selection of patients for strict monitoring and special therapies. In line with previous studies we detected higher rates of fetal and maternal events among patients with CARPREG II of 4≤ score.

Cardiovascular outcomes of pregnancy in Turner syndrome

Heart ◽  
2020 ◽  
Vol 107 (1) ◽  
pp. 61-66
Author(s):  
Jasmine Grewal ◽  
Anne Marie Valente ◽  
Alexander C Egbe ◽  
Fred M Wu ◽  
Eric V Krieger ◽  
...  
Keyword(s):  
Heart Disease ◽  
Aortic Dissection ◽  
Pregnant Women ◽  
Turner Syndrome ◽  
Structural Heart Disease ◽  
Risk Category ◽  
Hypertensive Disorder ◽  
Time Period ◽  
Increased Risk ◽  
American Society

ObjectivesWomen with Turner syndrome (TS) are frequently counselled against pregnancy due to lack of data and unclear aortic dissection risk. However, with advances in fertility therapy, more women with TS are contemplating pregnancy. This study compared rates of adverse cardiovascular (CV) outcomes among: (1) pregnant and non-pregnant women with TS and (2) pregnant women with TS with/without structural heart disease.MethodsRetrospective analysis of pregnant and age-matched non-pregnant controls with TS (2005–2017) across 10 CV centres was done. Data were collected at initial evaluation in pregnancy and outcomes were assessed to 6 months postpartum. Adverse CV events were defined as CV death, aortic dissection/rupture and/or aortic intervention. Non-pregnant age-matched controls were followed over the same time period.ResultsSixty-eight pregnancies were included (60 women, mean age 33 years, 48% primigravid, 49% fertility therapy, 80% structurally normal heart, 25% XO karyotype). Based on American Society of Reproductive Medicine criteria, 10 pregnancies occurred in women stratified to high-risk category. There were no CV events in the pregnant women or in the non-pregnant women with TS. Obstetric events complicated 12 (18%) pregnancies with 9 (13%) attributed to hypertensive disorder of pregnancy. Fetal events included small for gestational age neonates (18%), preterm delivery (15%) and fetal death (3%).ConclusionsThis study helps to refine the approach to pregnancy in women with TS. Among women with TS without structural heart disease, pregnancy does not impose an increased risk of CV outcomes. Among women with TS with structural heart disease, the risk of pregnancy is not as prohibitive as previously described but does require ongoing evaluation.

scholarly journals LO03: Application and usefulness of outpatient cardiac testing among emergency department patients with syncope

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S28
Author(s):  
O. Cook ◽  
M.A. Mukarram ◽  
S. Kim ◽  
K. Arcot ◽  
M. Taljaard ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Disease ◽  
High Risk ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Structural Heart Disease ◽  
Serious Adverse Events ◽  
High Risk Patients ◽  
Risk Patients ◽  
Cardiac Testing

Introduction: 2.6% of emergency department (ED) syncope patients will have underlying cardiac serious conditions (e.g. arrhythmia, serious structural heart disease) identified within 30-days of disposition. If those at risk are discharged home, outpatient cardiac testing can detect underlying arrhythmias and structural heart disease, and thereby improve patient safety. We describe the frequency of outpatient referrals for cardiac testing and the proportion of cardiac serious adverse events (SAE) among high risk and non-high (low and medium) risk ED syncope patients, as defined by the Canadian Syncope Risk Score (CSRS). Methods: We conducted a multicenter prospective cohort study to enroll adult syncope patients across five large tertiary care EDs. We collected demographics, medical history, disposition, CSRS value, outpatient referrals and testing results (holter, echocardiography), and cardiac SAE. Adjudicated 30-day SAE included death due to unknown cause, myocardial infarction, arrhythmia, and structural heart disease. We used descriptive analysis. Results: Of 4,064 enrolled patients, a total of 955 patients (23%) received an outpatient referral (mean age 57.7 years, 52.1% female). Of the 299 patients (7%) hospitalized, 154 received outpatient cardiac testing after discharge. Among the 3,765 patients discharged home from the ED, 40% of the non-high risk patients (305/756) and 56% of the high risk patients (25/45) received outpatient cardiac testing. Of all patients who received outpatient cardiac testing, 4 patients (0.8%) had serious cardiac conditions identified and all were arrhythmias. Among those with no cardiac testing, 5 patients (0.9%) suffered cardiac SAE (80% arrhythmias) outside the hospital. Of the 20 (44%) high risk patients who did not receive outpatient cardiac testing, 2 (10%) patients suffered arrhythmias outside the hospital. While among the 451 non-high risk patients, only 0.8% suffered arrhythmia outside the hospital. Conclusion: Outpatient cardiac testing among ED syncope patients is largely underutilized, especially among high risk patients. Better guidelines for outpatient cardiac testing are needed, as current practice is highly variable and mismatched with patient risk.

scholarly journals Diagnostic Workflow in Competitive Athletes with Ventricular Arrhythmias and Suspected Concealed Cardiomyopathies

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 182
Author(s):  
Maria Lucia Narducci ◽  
Michela Cammarano ◽  
Valeria Novelli ◽  
Antonio Bisignani ◽  
Chiara Pavone ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Arrhythmias ◽  
Young Patients ◽  
Structural Heart Disease ◽  
Competitive Athletes ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Apparently Healthy

The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed cardiomyopathies. This study shows the various diagnostic levels and tools to help identify which athletes need deeper investigation in order to unmask possible underlying heart disease.

scholarly journals An unusual presentation of atrioventricular nodal reentrant tachycardia

2021 ◽  
Vol 6 (1) ◽  
pp. 014-018
Author(s):  
Ghitun Florina-Adriana ◽  
Ailoaei Stefan ◽  
Ursu Dan ◽  
Chistol Raluca ◽  
Tinica Grigore ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Heart Disease ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
Unusual Presentation ◽  
Ventricular Rate ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Ecg Monitoring ◽  
Reentrant Tachycardia ◽  
Holter Ecg

Introduction: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent supraventricular tachycardia, commonly manifesting as autolimited paroxysmal episodes of rapid regular palpitations that exceed 150 beats per minute (bpm), dizziness and pounding neck sensation. Case presentation: We present a case of a male patient, 70 years old, with ischemic heart disease and slow-fast AVNRT treated with radiofrequency catheter ablation (RFCA) in March 2019, with regular 6-months follow-ups. He was readmitted in our department in November 2020 for rest dyspnea and incessant fluttering sensation in the neck, without palpitations. The event electrocardiogram (ECG) was initially interpreted by general cardiologist as accelerated junctional rhythm, 75 bpm. Due to the persistence of symptoms and ECG findings, a differential diagnosis between reentry and focal automaticity was imposed. The response to vagal maneuvers and Holter ECG monitoring characteristics provided valuable information. We suspected recurrent slow ventricular rate typical AVNRT, which was confirmed by electrophysiological study and we successfully performed the RFCA of the slow intranodal pathway. Conclusion: AV nodal reentry tachycardia may have an unusual presentation, occurring in elder male patients with structural heart disease. Antiarrhythmic drugs can promote reentry in this kind of patients. In cases of slow ventricular rate, vagal maneuvers and Holter ECG monitoring can help with the differential diagnosis. The arrhythmia can be successfully treated with RFCA with special caution regarding the risk of AV block.

Sign in / Sign up

Export Citation Format

Share Document