Rates of Cardiac Rhythm Abnormalities in Patients with CKD and Diabetes

Background and objectivesCardiac arrhythmias increase mortality and morbidity in CKD. We evaluated the rates of subclinical arrhythmias in a population with type 2 diabetes and patients with moderate to severe CKD who were not on dialysis.Design, setting, participants & measurementsThis is a prospective observational study, using continuous ambulatory cardiac monitors to determine the rate of atrial and ventricular arrhythmias, as well as conduction abnormalities in this group.ResultsA total of 38 patients (34% women), with mean eGFR of 38±13 ml/min per 1.73 m2, underwent ambulatory cardiac monitoring for 11.2±3.9 days. The overall mean rate of any cardiac arrhythmia was 88.8 (95% confidence interval [95% CI], 27.1 to 184.6) episodes per person-year (PY). A history of cardiovascular disease was associated with a higher rate of detected arrhythmia (rate ratio, 5.87; 95% CI, 1.37 to 25.21; P<0.001). The most common arrhythmia was atrial fibrillation, which was observed in two participants with known atrial fibrillation and was a new diagnosis in four patients (11%), none of whom experienced symptoms. Overall, atrial fibrillation episodes occurred at a rate of 37.6 (95% CI, 2.4 to 112.3) per PY. Conduction abnormalities were found in eight patients (21%), a rate of 26.5 (95% CI, 4.2 to 65.5) per PY. Rates of ventricular arrhythmias were low (14.5 per PY; 95% CI, 4.3 to 32.0) and driven by premature ventricular contractions.ConclusionsCardiac rhythm abnormalities are common in patients with diabetes with moderate to severe CKD not requiring dialysis. Rates of atrial fibrillation are high and episodes are asymptomatic. Future studies are needed to determine the role of screening and upstream therapy of cardiac arrhythmias in this group.

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POSSIBILITIES FOR PREDICTING OF CARDIAC ARRHYTHMIAS AND CONDUCTIVITY DISORDERS IN FORMER ATHLETES

Успехи геронтологии ◽

10.34922/ae.2020.33.1.018 ◽

2020 ◽

pp. 131-136

Author(s):

О. Б. Крысюк ◽

А. Г. Обрезан ◽

С. Ф. Задворьев ◽

А. А. Яковлев

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Prospective Studies ◽

Cardiac Arrhythmias ◽

Medical Records ◽

Cardiac Rhythm ◽

Prognostic Model ◽

Premature Ventricular Contractions ◽

Former Athletes ◽

The Relationship

Для выявления характера взаимосвязи спортивного анамнеза лиц, практиковавших в прошлом интенcивные физические нагрузки, и выявленных у них нарушений ритма сердца и внутрисердечной проводимости был проведен ретроспективный анализ медицинских документов 39 мужчинветеранов спорта (средний возраст - 61,6±11,3 года, средняя длительность постспортивного периода - 23,9±17,3 года, средний стаж соревновательной деятельности - 20,1±9,9 года), имеющих установленные сердечно-сосудистые заболевания. Проведено скрининговое обследование на предмет нарушений ритма и проводимости сердца, эхокардиографическое исследование. Выявлено, что распространенность устойчивых пароксизмов фибрилляции предсердий составила 42% в совокупной выборке, увеличиваясь с повышением уровня спортивной квалификации. Желудочковые нарушения ритма высокой градации выявлены у 14% обследованных. Лишь три параметра были достоверно связаны с риском нарушений ритма у ветеранов спорта: уровень спортивной квалификации, наличие генерализованного атеросклероза (антириск-фактор), возраст. Риск нарушений ритма у ветеранов спорта на 43% определяется указанными факторами. Был предложен алгоритм скрининга нарушений ритма у ветеранов спорта на основе клинических данных. Необходимы дальнейшие проспективные наблюдения для валидации алгоритма. In order to analyze the relationship between the athletic qualiﬁcation and syndrome of cardiac rhythm and conductivity disturbances in former athletes, a retrospective analysis of medical records of 39 male former athletes with cardiovascular complaints (mean age 61,6±11,3 years, mean duration of career in sports 23,9±17,3 years, mean duration of post-athletic period 20,1±9,9 years) was carried out. The patients were screened for cardiac arrhythmias and underwent echocardiography. The overall prevalence of sustained paroxysms of atrial ﬁbrillation was 42%, increasing with the athletic qualiﬁcation. Ryan grade 4 b -5 premature ventricular contractions were found in 14% of patients. 3 parameters were found to be the independent predictors of arrhythmias in former athletes, i. e. athletic qualiﬁcation, multifocal atherosclerosis (as an anti-risk factor), and age. The coefﬁcient of determinance for the created prognostic model reached 43%. Further prospective studies are needed to validate an algorithm.

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First clinical experience with the wearable cardiac rhythm long-term monitoring cardioskin device

European Heart Journal ◽

10.1093/ehjci/ehaa946.3464 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Guedeney ◽

J Silvain ◽

F Hidden-Lucet ◽

C Maupain ◽

S Dinanian ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Cardiac Rhythm ◽

Cardiac Monitoring ◽

Funding Source ◽

Single Center ◽

Long Term Monitoring ◽

Monitoring Devices ◽

Term Monitoring

Abstract Background There are only limited options for long-term cardiac monitoring devices readily available in clinical practice for outpatients. Holter monitoring devices are limited by the uncomfort of wires and patches, the small number of leads for analysis, the quality of recordings or the monitoring duration while insertable cardiac monitors are costly and exposed to potential local complication. Purpose To describe a single center experience with a novel wearable device for cardiac rhythm monitoring. Methods The Cardioskin™ system is a patch-free, wire-free, wearable device with rechargeable batteries that provides a high quality 15-lead electrocardiogram monitoring over 1 month (Figure 1). Data are sent using a mobile application downloaded in the patient smartphone to a central Corelab where they can be interpreted by an expert and/or the prescribing physician. An alarm signal is readily available within the Cardioskin™ device, to allow patients to indicate the presence of symptoms. In this single center retrospective registry, we provide a first report of the use of this novel device in real world practice, with indication and duration of cardiac monitoring left at the physicans “discretion”. Results From January 2019 to December 2019, the Cardioskin™ system was prescribed in 60 patients for an overall median duration of 26.5 (14–32) days. The mean age of the patients was 45±12.2 years and 24 (40%) were male. Indications for cardiac monitoring were post-Stroke, palpitation, syncope and cardiomyopathy assessment in 56%, 30%, 7% and 7% of the cases, respectively. A sustained (>30 seconds) supraventricular tachycardia was detected in 4 cases, including one case of atrial fibrillation, two case of atrial tachycardia and on case of junctional tachycardia. Unsustained ventricular tachycardia and atrial fibrillation burst were detected in another 2 cases (Figure 1). There was no reported case of skin irritation by the Cardioskin™ system or abrupt interruption of the monitoring by the patients. Conclusion The Cardioskin™ system is a novel, discreet and comfortable cardiac rhythm wearable long-term monitoring device which can be used in clinical practice for broad diagnostic indications. Figure 1. Cardioskin system Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur

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Cardiac arrhythmias and conduction disturbances in the obstructive sleep apnea syndrome

In a good rythm ◽

10.5604/01.3001.0012.0392 ◽

2018 ◽

Vol 2 (47) ◽

pp. 10-15

Author(s):

Danuta Łoboda ◽

Karolina Simionescu ◽

Anna Szajerska-Kurasiewicz ◽

Dorota Lasyk ◽

Grzegorz Jarosiński ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cardiac Arrhythmias ◽

Sleep Apnea Syndrome ◽

The Body ◽

Apnea Hypopnea Index ◽

Premature Ventricular Contractions ◽

Mortality And Morbidity ◽

Conduction Disturbances ◽

Obstructive Sleep

Cardiac arrhythmias during sleep are reported in almost half of the population suffering from obstructive sleep apnea (OSA). The most common are bradyarrhythmias and atrial fibrillation whereas premature ventricular contractions and nonsustained ventricular tachycardia are less frequent. The risk of arrhythmia is proportional to the body mass index (BMI), number of respiratory events per hour of sleep described with apnea/hypopnea index (AHI) and the level of oxygen desaturation during these episodes. Continuous positive airway pressure (CPAP) treatment in OSA reduces the incidence of cardiac arrhythmias therefore reduce mortality and morbidity from cardiovascular disease.

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Holter Monitoring and Loop Recorders: From Research to Clinical Practice

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2016.17.2 ◽

2016 ◽

Vol 5 (2) ◽

pp. 136 ◽

Cited By ~ 28

Author(s):

Alessio Galli ◽

Francesco Ambrosini ◽

Federico Lombardi ◽

◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Arrhythmias ◽

Cardiac Rhythm ◽

Cryptogenic Stroke ◽

Heart Rhythm ◽

Holter Monitoring ◽

Cardioverter Defibrillator ◽

Proven Efficacy ◽

Prolonged Monitoring ◽

Monitoring Technologies

Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages. This review discusses the advances in this area of arrhythmology and how Holter monitors have improved the clinical management of patients with suspected cardiac rhythm diseases.

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Cardiac Rhythm and Conduction Disturbances

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0029 ◽

2019 ◽

pp. 197-206

Author(s):

Yahaira Ortiz Gonzalez ◽

Fred Kusumoto

Keyword(s):

Atrial Fibrillation ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Cardiac Arrhythmias ◽

Cardiac Rhythm ◽

Hemodynamic Instability ◽

Conduction Disturbances ◽

Ventricular Tachycardias

Patients in the intensive care unit (ICU) are exposed to several physiologic stressors that may trigger cardiac arrhythmias and lead to hemodynamic instability. Prompt recognition and initiation of appropriate therapies for arrhythmias is important because critically ill patients with arrhythmias (compared to patients without arrhythmias) have longer hospitalizations and higher mortality (30.8% vs 21.2%). Arrhythmias are classified as tachyarrhythmias or bradyarrhythmias. The most common sustained arrhythmias are supraventricular; atrial fibrillation is the most prevalent. Among the ventricular arrhythmias, up to 50% are monomorphic ventricular tachycardias.

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Atrial fibrillation and Ventricular Tachyarrhythmias: Advancements for better outcomes

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x20666201001143907 ◽

2020 ◽

Vol 20 ◽

Author(s):

Alireza Gheini ◽

Afsoun Pourya ◽

Ali Pooria

Keyword(s):

Atrial Fibrillation ◽

Cardiac Arrhythmias ◽

Ventricular Arrhythmias ◽

Medical Condition ◽

Pharmacological Therapy ◽

Medical Attention ◽

Cardiac Diseases ◽

Cardioverter Defibrillator ◽

Rhythm Disorder ◽

Atrial Fibrillation And Flutter

: Cardiac arrhythmias are associated with several cardiac diseases and are prevalent in people with or without structural and valvular abnormalities. Ventricular arrhythmias (VA) can be life threating and its onset requires immediate medical attention. Similarly, atrial fibrillation and flutter lead to stroke, heart failure and even death. Optimal treatment of VA is very variable and depends on the medical condition associated with the rhythm disorder (which includes reversible causes such as myocardial ischemia or pro-arrhythmic drugs). While an implanted cardioverter defibrillator is often indicated in secondary prevention of VA. This review highlights newest advancements in these techniques and management of ventricular and atrial tachyarrhythmias, along with pharmacological therapy.

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Abstract P036: Little Evidence Of Association Between Kidney Function And Subclinical Arrhythmias Measured By Extended Ambulatory Cardiac Monitoring: The Multi-Ethnic Study Of Atherosclerosis (MESA)

Circulation ◽

10.1161/circ.143.suppl_1.p036 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Kerri L Wiggins ◽

James S Floyd ◽

Nisha Bansal ◽

Bryan Kestenbaum ◽

Susan R Heckbert

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

Ventricular Arrhythmias ◽

Large Population ◽

Cardiac Monitoring ◽

Premature Ventricular Contractions ◽

Ethnic Study ◽

Wide Range ◽

History Of

Introduction: Chronic kidney disease (CKD) patients are at high risk for atrial fibrillation (AF) and ventricular arrhythmias. Arrhythmias are often asymptomatic and not detected clinically, so the true prevalence among CKD patients is unknown. Extended ambulatory cardiac monitoring is a sensitive and unbiased method for detecting arrhythmias. Hypothesis: We assessed the hypothesis that impaired kidney function is associated with atrial and ventricular arrhythmias as measured by extended ambulatory cardiac monitoring. Methods: In the Multi-Ethnic Study of Atherosclerosis (MESA), kidney function was assessed at the 2016-2018 study visit: estimated glomerular filtration rate (eGFR) using the 2009 Chronic Kidney Disease Epidemiology Collaboration creatinine equation and urinary albumin-creatinine ratio (UACR). UACR was log 2 transformed for analysis. At the same visit, extended ambulatory cardiac monitoring was conducted for up to two 14-day periods per participant using the Zio Patch XT (iRhythm Technologies, Inc., San Francisco, CA). Device information was consolidated for participants with 2 devices, and 7 arrhythmia outcomes were studied: presence of monitor-detected AF (>30 seconds), presence of subclinical AF (in those with no history of clinically detected AF), frequency of premature atrial contractions, frequency of runs of ≥ 4 beats of supraventricular tachycardia (SVT), frequency of premature ventricular contractions, presence of runs of ≥ 4 beats of ventricular tachycardia (VT), and frequency of runs of VT. Continuous outcome variables were natural log transformed. Analyses used logistic regression for binary outcomes and linear regression for continuous outcomes, adjusted for demographic and clinical risk factors. Results: A total of 1459 participants had eGFR measures and 1369 had UACR measures; 178 had a history of clinically detected AF. Mean (standard deviation (SD)) age was 74 (8) years; with 52% women. Median (interquartile range) kidney function measures were eGFR 77 (62, 88) ml/min/1.73 m 2 and UACR 6 (3, 18) mg/g, and total monitoring duration was 14 (14, 26) days. AF was detected in 7%, all but one participant had supraventricular ectopy, and 99% had ventricular ectopy. A doubling of UACR was associated with increased odds of monitor-detected AF (odds ratio 1.18; 95% confidence interval (CI): 1.06-1.32) while eGFR was not significantly associated. Neither eGFR nor UACR was associated with subclinical AF or with ventricular arrhythmias. The analysis of eGFR and frequency of runs of SVT yielded results opposite of the expected direction: a 10 ml/min/1.73 m 2 greater eGFR was associated with a 7% greater frequency of SVT (95% CI: 1%-12%). Conclusion: In summary, in a large population of older individuals across a wide range of kidney function, we found little evidence that impaired kidney function was associated with increased monitor-detected arrhythmias.

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Recognition and Management of Cardiac Arrhythmias: Part I. General Principles and Supraventricular Tachyarrhythmias

Journal of Intensive Care Medicine ◽

10.1177/088506669801300102 ◽

1998 ◽

Vol 13 (1) ◽

pp. 15-31

Author(s):

Simon Chakko ◽

Raul Mitrani

Keyword(s):

Cardiac Arrhythmias ◽

Ventricular Arrhythmias ◽

Antiarrhythmic Drugs ◽

Supraventricular Arrhythmias ◽

Implantable Defibrillators ◽

Premature Ventricular Contractions ◽

New Techniques ◽

Supraventricular Tachyarrhythmias ◽

Treatment Of Arrhythmias ◽

Supraventricular Tachycardias

Management of cardiac arrhythmias has undergone major changes in the last few years. In the first part of this review, general principles of arrhythmia diagnosis are discussed. New techniques such as event recording and signal-averaged electrocardiography have a significant role in the clinical management of arrhythmias. Many new antiarrhythmic drugs are now available. Suppression of premature ventricular contractions to prevent malignant ventricular arrhythmias has been demonstrated to be an ineffective strategy. Implantable defibrillators and radio frequency ablation have revolutionized the treatment of arrhythmias. Differentiation of various supraventricular tachycardias has become very important since some these arrhythmias may be cured by radiofrequency ablation. Diagnosis and treatment of common supraventricular arrhythmias are discussed.

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Frequency of cardiac arrhythmias in older adults: findings from the subclinical atrial fibrillation and risk of ischemic stroke (SAFARIS) study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0356 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Mannina ◽

Z Jin ◽

K Matsumoto ◽

K Ito ◽

A Biviano ◽

...

Keyword(s):

Atrial Fibrillation ◽

Older Adults ◽

Ischemic Stroke ◽

Ethnic Differences ◽

Cardiac Rhythm ◽

Cryptogenic Stroke ◽

Cardiac Monitoring ◽

Funding Source ◽

National Budget ◽

Public Grant

Abstract Background Prolonged monitoring of cardiac rhythm has been used in patients with symptomatic arrhythmias and to assess for atrial fibrillation (AF) after cryptogenic stroke, but not in the general population and especially in older adults. Purpose To evaluate the frequency of arrhythmias in a community-based cohort of older adults through 14-days continuous cardiac monitoring using a patch-based device. Methods Cardiac rhythm was analyzed in 533 participants free of AF and congestive heart failure (CHF) from the tri-ethnic (white, black, Hispanic) Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study. AF, supraventricular tachycardia (SVT, defined as 4 beats or more), premature atrial (PACs) and ventricular (PVCs) contractions, ventricular tachycardia (VT, defined as 4 beats or more), sinus pauses (SP) and atrio-ventricular blocks (AVB) were analyzed. Gender, age and race-ethnic differences were examined. Results Mean age was 77.2±6.8 years (198 men, 335 women). Recording duration was over 10 days in 91%, and over 13 days in 84%. AF was present in 10 participants (1.9%), atrial flutter in 1 (0.2%). Other arrhythmias are reported in the Table. SP (1.9%) and high-degree AVB (Mobitz II: 0.6%; 3rd degree: 0.9%) were rare. No significant race-ethnic differences were observed. Conclusion In older adults without history of stroke or CHF, prolonged rhythm monitoring revealed moderate frequency of AF, but higher than expected frequencies of AF-predisposing conditions such as SVT and frequent PACs. VT episodes were relatively frequent, whereas SP and AVB were less frequent than commonly believed. Most arrhythmias were more frequent in the oldest; ventricular arrhythmias were more common in men than in women. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): NINDS R01 NS083874

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Ibrutinib associated cardiovascular events in a patient wearing an implanted loop recorder

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2021.044 ◽

2021 ◽

Vol 13 (1) ◽

pp. e2021044

Author(s):

Daniel Rivera ◽

Koichi Takahashi ◽

Jean-Benard Durand ◽

Alessandra Ferrajoli

Keyword(s):

Atrial Fibrillation ◽

Chronic Lymphocytic Leukemia ◽

Cardiac Arrhythmias ◽

Cardiovascular Events ◽

Ventricular Arrhythmias ◽

Effective Therapy ◽

Lymphocytic Leukemia ◽

Loop Recorder

Ibrutinib is a well-tolerated and effective therapy used for the treatment of chronic lymphocytic leukemia (CLL). Its use has been associated with cardiovascular events such as atrial fibrillation (Afib), hypertension, and ventricular arrhythmias. Implanted loop recorders are a useful tool in guiding the management of patients with cardiac arrhythmias.

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