Abstract 16223: Cardiac Arrhythmias in Hospitalized Patients With COVID-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jae Hyung Cho ◽  
Ali Namazi ◽  
Richard Shelton ◽  
Archana Ramireddy ◽  
Ashkan Ehdaie ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Interleukin 6 ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Sinus Tachycardia ◽  
Sustained Ventricular Tachycardia ◽  
Rhythm Disorder ◽  
Baseline Characteristics

Introduction: Arrhythmias have been reported frequent in COVID-19 patients, but the incidence and nature have not been well characterized. Hypothesis: Atrial and ventricular arrhythmias are common complications of patients with COVID-19. Methods: Patients admitted with COVID-19 and monitored by telemetry were prospectively enrolled in the study. Baseline characteristics, hospital course, treatment and complications were collected from the patients’ medical records. Telemetry was monitored to detect the incidence of cardiac arrhythmias. The incidence and types of cardiac arrhythmias were analyzed and compared between survivors and non-survivors. Results: Among 143 patients admitted with telemetry monitoring, overall in-hospital mortality was 23.1% (33/143 patients) during the period of observation (mean follow up 19.9 ± 13.7 days). Survivors were younger (68.1 ± 17.2 vs. 77.6 ± 15.9 years old, p=0.006), had higher body mass index (28.1 ± 8.3 vs. 24.3 ± 6.2, p=0.019), were less tachycardic on initial presentation (heart rate 90.6 ± 19.4 vs. 99.8 ± 23.7 bpm, p=0.026) and had lower troponin (peak troponin 0.03 vs. 0.14 ng/ml. p=0.006) and interleukin-6 levels (peak interleukin-6 32 vs. 264 pg/ml, p=0.001). Sinus tachycardia, the most common arrhythmia (occurring in 39.9% [57/143] of patients), occurred more frequently in non-survivors (57.6% vs. 34.5% in survivors, p=0.018). Premature ventricular complexes occurred in 28.7% (41/143), and non-sustained ventricular tachycardia in 15.4% (22/143) of patients, with no difference between survivors and non-survivors. Sustained ventricular tachycardia and ventricular fibrillation were rare (seen only in 1.4% and 0.7% of patients, respectively). Conclusions: In this prospective observational study of hospitalized and monitored patients with COVID-19, sinus tachycardia was the most common rhythm disorder, and its presence was associated with higher mortality. Sustained ventricular tachycardia or ventricular fibrillation were infrequent, contradicting previous reports that malignant ventricular arrhythmias are commonly seen in patients hospitalized with COVID-19.

scholarly journals Cardiac arrhythmias in hospitalized patients with COVID-19: A prospective observational study in the western United States

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244533
Author(s):  
Jae Hyung Cho ◽  
Ali Namazi ◽  
Richard Shelton ◽  
Archana Ramireddy ◽  
Ashkan Ehdaie ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Interleukin 6 ◽  
Cardiac Arrhythmias ◽  
Sustained Ventricular Tachycardia ◽  
C Reactive Protein ◽  
Related Factors ◽  
Reactive Protein ◽  
Baseline Characteristics ◽  
Overall Mortality

Arrhythmias have been reported frequently in COVID-19 patients, but the incidence and nature have not been well characterized. Patients admitted with COVID-19 and monitored by telemetry were prospectively enrolled in the study. Baseline characteristics, hospital course, treatment and complications were collected from the patients’ medical records. Telemetry was monitored to detect the incidence of cardiac arrhythmias. The incidence and types of cardiac arrhythmias were analyzed and compared between survivors and non-survivors. Among 143 patients admitted with telemetry monitoring, overall in-hospital mortality was 25.2% (36/143 patients) during the period of observation (mean follow-up 23.7 days). Survivors were less tachycardic on initial presentation (heart rate 90.6 ± 19.6 vs. 99.3 ± 23.1 bpm, p = 0.030) and had lower troponin (peak troponin 0.03 vs. 0.18 ng/ml. p = 0.004), C-reactive protein (peak C-reactive protein 97 vs. 181 mg/dl, p = 0.029), and interleukin-6 levels (peak interleukin-6 30 vs. 246 pg/ml, p = 0.003). Sinus tachycardia, the most common arrhythmia (detected in 39.9% [57/143] of patients), occurred more frequently in non-survivors (58.3% vs. 33.6% in survivors, p = 0.009). Premature ventricular complexes occurred in 28.7% (41/143), and non-sustained ventricular tachycardia in 15.4% (22/143) of patients, with no difference between survivors and non-survivors. Sustained ventricular tachycardia and ventricular fibrillation were not frequent (seen only in 1.4% and 0.7% of patients, respectively). Contrary to reports from other regions, overall mortality was higher and ventricular arrhythmias were infrequent in this hospitalized and monitored COVID-19 population. Either disease or management-related factors could explain this divergence of clinical outcomes, and should be urgently investigated.

Recognition and Management of Cardiac Arrhythmias: Part II. Ventricular Arrhythmias and Bradyarrhythmias

1998 ◽  
Vol 13 (2) ◽  
pp. 68-77
Author(s):  
Simon Chakko ◽  
Raul Mitrani
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Qrs Complex ◽  
Implantable Defibrillators

This review discusses the treatment of ventricular arrhythmias and bradyarrhythmias. Recent studies addressing the management of nonsustained ventricular arrhythmias in patients with congestive heart failure and those recovering from myocardial infarction are discussed. Determination of the origin of wide QRS complex tachycardia is usually possible at the bedside and the diagnostic criteria are provided. Therapy to prevent recurrent ventricular tachycardia or ventricular fibrillation is difficult and controversial. A widely accepted approach based on electrophysiologic testing and implantable defibrillators appears to be the most effective. Recognition and management of common bradyarrhythmias including the indications for pacemakers are discussed.

Relationship between myocardial amiodarone concentration and antiarrhythmic effect in dogs with myocardial infarction and electrically induced ventricular arrhythmias

1991 ◽  
Vol 69 (6) ◽  
pp. 812-817 ◽  
Author(s):  
Hoshiar Abdollah ◽  
F. James Brennan ◽  
Sandra Jimmo ◽  
James F. Brien
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Ventricular Arrhythmias ◽  
Dose Group ◽  
Low Dose ◽  
Antiarrhythmic Effect ◽  
Baseline Data ◽  
Sustained Ventricular Tachycardia ◽  
Control Group ◽  
High Dose

The relationship between the antiarrhythmic effect of amiodarone and its myocardial concentration was studied in dogs with 1-week-old myocardial infarction and reproducibly inducible sustained ventricular tachycardia or ventricular fibrillation. Three groups of animals (n = 10/group) received amiodarone, 40 mg∙kg−1∙day−1 (low-dose amiodarone), amiodarone 60 mg∙kg−1∙day−1 (high-dose amiodarone), or no amiodarone (control group). After 1 week of treatment, programmed electrical stimulation was repeated, and plasma and myocardial amiodarone and desethylamiodarone concentrations were measured. In the control group, sustained ventricular tachycardia or ventricular fibrillation was induced in six dogs (p = NS) when compared with baseline data. In the low-dose amiodarone group, sustained ventricular tachycardia or ventricular fibrillation was induced only in two dogs after 1 week of treatment (p < 0.01 vs. baseline data). Sustained ventricular tachycardia or ventricular fibrillation was induced in seven dogs after treatment with high-dose amiodarone (p = NS vs. baseline data). Plasma amiodarone concentration in the low-dose amiodarone group (2.54 ± 1.9 μg/mL) was significantly less (p < 0.01) than that in the high-dose amiodarone group (4.64 ± 1.66 μg/mL). Similarly, the plasma desethylamiodarone in the low-dose amiodarone group (0.32 ± 0.16 μg/mL) was significantly less (p < 0.001) than that in the high-amiodarone dose group (0.56 ± 0.23 μg/mL). The myocardial amiodarone concentration in the low-dose amiodarone group (49.7 ± 23.1 μg/g) was significantly lower (p < 0.001) than that in the high-dose group (98.4 ± 32.1 μg/g). There was no significant difference in the myocardial desethylamiodarone concentrations between the two treatment groups (25.1 ± 12.2 μg/g in the low-dose amiodarione group vs. 37.4 ± 16.4 μg/g in the high-dose amiodarone group). These data show that the high-dose amiodarone regimen, which produced high myocardial amiodarone concentration, didn't suppress sustained ventricular arrhythmias.Key words: amiodarone, ventricular arrhythmias, plasma and myocardial drug concentrations.

scholarly journals Impact of Sacubitril/Valsartan on the Long-Term Incidence of Ventricular Arrhythmias in Chronic Heart Failure Patients

2019 ◽  
Vol 8 (10) ◽  
pp. 1582 ◽  
Author(s):  
Ibrahim El-Battrawy ◽  
Christina Pilsinger ◽  
Volker Liebe ◽  
Siegfried Lang ◽  
Jürgen Kuschyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Ejection Fraction ◽  
Ventricular Arrhythmias ◽  
Left Ventricular Ejection ◽  
Before And After ◽  
Term Data

Background: Sacubitril/valsartan decreased the risk of sudden cardiac death (SCD) in patients suffering from heart failure with reduced ejection fraction (HFrEF). However, long-term data are sparse. Objective: The aim of the present study was to compare the incidence of life-threatening arrhythmias consisting of ventricular tachycardia and/or ventricular fibrillation before and after initiation of sacubitril/valsartan treatment. Methods: Out of 12,000 patients with HFrEF from 2016–2018, 148 patients were newly prescribed sacubitril/valsartan, but the long-term data of only 127 patients were available and included in this study. Results: Patients with an average age of 66.8 ± 12.1 had a median left ventricular ejection fraction (LVEF) of 25% (interquartile range (IQR) 5.00–45.00) and 30% (IQR 10.00–55.00, p < 0.0005) before and after sacubitril/valsartan treatment, respectively. Systolic blood pressure decreased from 127.93 ± 22.01 to 118.36 ± 20.55 mmHg (p = 0.0035) at 6 months of follow-up. However, in 59 patients with a long-term outcome of 12 months, ventricular arrhythmias persistently increased (ventricular fibrillation from 27.6 to 29.3%, ventricular tachycardia (VT) from 12% to 13.8%, and nonsustained VT from 26.6 to 33.3%). Conclusions: Sacubitril/valsartan does not reduce the risk of ventricular tachyarrhythmias in chronic HFrEF patients over 12 months of follow-up.

Abstract 17238: Taper With Caution: A Case Report of Treatment Response of a Patient With Cardiac Sarcoidosis to Tapering of Steroid Therapy and Initiation of Methotrexate

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
GAURANGA MAHALWAR ◽  
HANAD BASHIR ◽  
Jeffery Courson ◽  
Anas Alameh
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Antiarrhythmic Drugs ◽  
Cardiac Sarcoidosis ◽  
Sustained Ventricular Tachycardia ◽  
Myocardial Inflammation ◽  
Prednisone Dose ◽  
Pacemaker Placement ◽  
Immunosuppression Therapy

Introduction: We present a case of a patient with systemic sarcoidosis with cardiac involvement who presented with palpitations and was noted to be in non-sustained ventricular tachycardia (NSVT) after being tapered down the prednisone dose and being started on methotrexate. Clinical Course: 49-year-old female presented with symptoms of palpitations for 10 day prior to presentation with associated lightheadedness. Her past medical history included cardiac sarcoidosis, atrial tachycardia and complete heart block with a pacemaker placement. Upon checking her remote pacemaker interrogation during the current admission she was found to have recurrent episodes of non-sustained ventricular tachycardia. Patient was diagnosed with sarcoidosis 4 months prior to presentation and was started on 50 mg of prednisone which was tapered down to 30 mg 2 months prior to patient’s presentation due to weight gain along with initiation of methotrexate therapy .Patient was started on amiodarone 200 mg daily with a loading dose of 400 TID while admitted. Her prednisone was increased temporarily and weekly methotrexate was continued. The patient was found to have resolution of symptoms and did not have recurrence of arrhythmia on telemetry. She was upgraded to ICD placement during the same admission and was discharged with follow up. Conclusions: Ventricular tachycardia (VT) resulting from myocardial inflammation is the most common arrhythmia in cardiac sarcoidosis (CS), found in up to 23% of the patients. Antiarrhythmic drugs such as amiodarone are standard treatment for VT in patients with CS. However, corticosteroid therapy has shown to be beneficial for ventricular arrhythmias (VA) as demonstrated in some studies while even worsening ventricular arrhythmias in minority of the patients. In our patient, the tapering of the prednisone dose despite introduction of methotrexate resulted in the recurrence of ventricular tachycardia which eventually resolved with the re-administration of the original dose of prednisone. This indicates that more definitive immunosuppression therapy guidelines are required for patients with CS.

1175Structural progression increases the risk of ventricular arrhythmias in patients with arrhythmogenic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Chivulescu ◽  
Ø.H Lie ◽  
H Skulstad ◽  
B A Popescu ◽  
R O Jurcut ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Arrhythmogenic Cardiomyopathy ◽  
Cardioverter Defibrillator ◽  
Structural Progression ◽  
Life Threatening ◽  
Arrhythmic Event ◽  
History Of ◽  
Structural Disease

Abstract Background Arrhythmogenic cardiomyopathy (AC) is an inheritable cardiomyopathy with incomplete penetrance, variable phenotype severity and poorly described disease progression. It is characterized by high risk of life-threatening ventricular arrhythmias and sudden cardiac death in young individuals. Risk stratification and selection of patients presenting without history of life-threatening arrhythmic events for cardioverter-defibrillator implantation in primary prevention remains challenging. Purpose We aimed to assess the impact of disease progression on arrhythmic outcomes in AC patients. Methods We included consecutive AC probands and mutation-positive family members with at least one complete follow-up evaluation. Echocardiographic and electrical parameters were defined according to the 2010 Revised Task Force criteria at inclusion and at last follow-up. Structural progression was defined as development of new echocardiographic diagnostic criteria. Electrical progression was defined as the development of new diagnostic depolarization, repolarization and/or premature ventricular complex count criteria during follow-up. Non-sustained ventricular tachycardia or ventricular tachycardia occurring during follow-up defined incident ventricular arrhythmic events. Results We included a total of 144 patients (48% female, 47% probands, 40±16 years old). At inclusion, 54 patients (37%) had a history of arrhythmic events, 30 patients (21%) had overt structural disease and 114 (79%) had no or minor structural disease. During 7.0 (IQR: 4.5 to 9.4) years of follow-up, 49 patients (43%) with no or minor structural disease at inclusion developed new structural criteria being defined as progressors. Among 80 participants with no or minor structural disease and no arrhythmic history at inclusion, a first arrhythmic event occurred in 14 (17%). The incidence of arrhythmic events was higher in progressors (11/27, 41%) than in non-progressors (3/53, 6%) (p<0.001) (Figure). Structural progression was associated with higher risk of first arrhythmic events during follow-up when adjusted for sex, age at inclusion and follow-up duration, independent of electrical progression (7.6, 95% CI [1.5, 37.2], P=0.01). Incident arrhythmic events distribution Conclusion Almost half of patients without overt structural cardiac disease at genetic diagnosis develop new structural criteria during 7 years follow-up and 17% experienced their first ventricular arrhythmic event. Structural progression was independently associated with ventricular arrhythmic events during follow-up. These findings highlight the increased risk of arrhythmias when structural abnormalities are detected. Their finding may initiate the evaluation for primary prevention cardioverter-defibrillator implantation.

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