scholarly journals CLINICAL AND PROGNOSTIC VALUE OF EXTRASYSTOLIC ARRHYTHMIA IN PREGNANT WOMEN WITHOUT STRUCTURAL HEART DAMAGE

2020 ◽  
Author(s):  
O. Vinogradova ◽  
◽  
F. Rakhmatullov ◽  
M. Ostanin ◽  
D. Bocharnikov ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Sinus Node ◽  
Plasma Concentrations ◽  
Prognostic Significance ◽  
Atrioventricular Node ◽  
Cardiac Conduction ◽  
Hormonal Changes ◽  
Ventricular Extrasystole ◽  
Circulating Blood Volume ◽  
Heart Damage

Pregnancy is accompanied by physiological hemodynamic changes (an increase in circulating blood volume, stroke volume, cardiac output, heart rate), autonomic (an increase in plasma concentrations of catecholamines, an increase in the sensitivity of adrenergic receptors) and hormonal changes (an increase in the synthesis of estrogen, progesterone, prostaglandins, reninogen, angiotensin) ... All this can contribute to a change in the excitability, automatism and refractoriness of the myocardium, lead to the development and / or an increase in its electrophysiological inhomogeneity and, thus, provoke and / or aggravate the course of an already existing arrhythmia. This article will consider the relevance of the problem of the clinical and prognostic significance of extrasystolic arrhythmia in pregnant women without structural heart damage. The goal of increasing the efficiency of predicting the course of ventricular extrasystole without structural heart lesions in pregnant women at various periods of gestation in terms of thyroid and cardiovascular hormones will be proposed. The study of indicators of pregnancy hormones in pregnant women at different gestational periods with ventricular extrasystole without structural heart damage, the study of indicators of the sinus node, atrioventricular node and refractory periods of the cardiac conduction system in pregnant women is an urgent issue for research at the present time.

scholarly journals SEM, TEM, and IHC Analysis of the Sinus Node and Its Implications for the Cardiac Conduction System

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
D. Mandrioli ◽  
F. Ceci ◽  
T. Balbi ◽  
C. Ghimenton ◽  
G. Pierini
Keyword(s):  
Electron Microscopy ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Definite Description ◽  
Conduction System ◽  
Cardiac Conduction ◽  
Cardiac Conduction System ◽  
Ordered Structure ◽  
Healthy Individuals ◽  
Optical And Electron Microscopy

More than 100 years after the discovery of the sinus node (SN) by Keith and Flack, the function and structure of the SN have not been completely established yet. The anatomic architecture of the SN has often been described as devoid of an organized structure; the origin of the sinus impulse is still a matter of debate, and a definite description of the long postulated internodal specialized tract conducting the impulse from the SN to the atrioventricular node (AVN) is still missing. In our previously published study, we proposed a morphologically ordered structure for the SN. As a confirmation of what was presented then, we have added the results of additional observations regarding the structural particularities of the SN. We investigated the morphology of the sinus node in the human hearts of healthy individuals using histochemical, immunohistochemical, optical, and electron microscopy (SEM, TEM). Our results confirmed that the SN presents a previously unseen highly organized architecture.

Brugada syndrome in the paediatric population: a comprehensive approach to clinical manifestations, diagnosis, and management

2016 ◽  
Vol 26 (6) ◽  
pp. 1044-1055 ◽  
Author(s):  
M. Cecilia Gonzalez Corcia ◽  
Carlo de Asmundis ◽  
Gian-Battista Chierchia ◽  
Pedro Brugada
Keyword(s):  
Sudden Death ◽  
Brugada Syndrome ◽  
Sinus Node ◽  
Adult Population ◽  
Clinical Manifestations ◽  
Paediatric Population ◽  
Cardiac Conduction ◽  
Management Approach ◽  
Hormonal Changes ◽  
Increased Risk

AbstractBrugada syndrome is an inherited arrhythmogenic disorder, characterised by coved-type ST-segment elevation in the right precordial leads, and is associated with increased risk of sudden death. It is genetically and clinically heterogeneous, presenting typically in the fourth or fifth decade of life. The prevalence of Brugada syndrome in the paediatric population is low compared with the adult population. Interestingly, over the last several years, there has been growing evidence in the literature of onset of the disease during childhood. Most of the paediatric cases reported in the literature consist of asymptomatic Brugada syndrome; however, some patients manifest the disease at different regions of the cardiac conduction system at a young age. Early expression of the disease can be affected by multiple factors, including genetic substrate, hormonal changes, and still unknown environmental exposures. The initial manifestation of Brugada syndrome in children can include sinus node dysfunction and atrial arrhythmias. Brugada syndrome can also manifest as ventricular arrhythmias leading to sudden death at an early age. In symptomatic children, performance of the ajmaline test by an experienced team can be safely used as a diagnostic tool to unmask latent Brugada syndrome. Defining indications for an implantable cardioverter defibrillator in children with the diagnosis of Brugada syndrome remains challenging. Given the rarity of the syndrome in children, most paediatric cardiologists will only rarely see a young patient with Brugada syndrome and there is still no universal consensus regarding the optimal management approach. Care should be individualised according to the specific clinical presentation, taking into account the family history, genetic data, and the family’s specific preferences.

scholarly journals Intraoperative localization of cardiac conduction tissue regions using real-time fibre-optic confocal microscopy: first in human trial

2020 ◽  
Vol 58 (2) ◽  
pp. 261-268 ◽  
Author(s):  
Aditya K Kaza ◽  
Abhijit Mondal ◽  
Breanna Piekarski ◽  
Frank B Sachse ◽  
Robert Hitchcock
Keyword(s):  
Confocal Microscopy ◽  
Adverse Events ◽  
Atrial Septal Defect ◽  
Heart Surgery ◽  
Septal Defect ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Cardiac Conduction ◽  
Fluorescein Sodium ◽  
Fibre Optic

Abstract OBJECTIVES The aim of this study was to evaluate the feasibility and safety of fibre-optic confocal microscopy (FCM) using fluorescein sodium dye for the intraoperative location of conduction tissue regions during paediatric heart surgery. METHODS The pilot study included 6 patients undergoing elective surgery for the closure of isolated secundum atrial septal defect aged 30 days to 21 years. FCM imaging was integrated within the normal intraoperative protocol for atrial septal defect repair. Fluorescein sodium dye was applied on the arrested heart. FCM images were acquired at the atrioventricular node region, sinus node region and right ventricle (RV). Total imaging time was limited to 3 min. Any adverse events related to the study were recorded and analysed. Subjects received standard postoperative care. Trained reviewers (n = 9) classified, de-identified and randomized FCM images (n = 60) recorded from the patients as presenting striated, reticulated or indistinguishable microstructures. The reliability of reviewer agreement was assessed using Fleiss’ kappa. RESULTS The FCM imaging instruments were integrated effectively into the cardiac surgery operating room. All adverse events found in the study were deemed expected and not related to FCM imaging. Reticulated myocardial microstructures were found during FCM imaging at atrioventricular node and sinus node regions, while striated microstructures were observed in RV. Reliability of agreement of reviewers classifying the FCM images was high (Fleiss’ kappa: 0.822). CONCLUSIONS FCM using fluorescein sodium dye was found to be safe for use during paediatric heart surgery. The study demonstrates the potential for FCM to be effective in identifying conduction tissue regions during congenital heart surgery. Clinical trial registration number NCT03189134.

Electrophysiologic Study of the Conduction System in Normal Children

PEDIATRICS ◽  
1977 ◽  
Vol 60 (6) ◽  
pp. 858-863
Author(s):  
Nigel K. Roberts ◽  
Paul C. Gillette
Keyword(s):  
Recovery Time ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Conduction System ◽  
Cardiac Conduction ◽  
Purkinje Fiber ◽  
Normal Children ◽  
Electrophysiologic Study ◽  
His Bundle ◽  
The Mean

Values for cardiac conduction intervals obtained from normal children are reported so that the data will be available for comparison with patients who are suspected of having abnormalities. Sinus node recovery time correlated linearly with the resting PP interval. The mean intra-atnal conduction was considerably shorter in children (< 25 msec) than in adults (42 msec). The atrioventricular node had similar electrophysiologic properties in the child and adult. With aging, the His bundle to Purkinje fiber time increased significantly (P < .01).

Evaluation of plasma free amino acid and carnitine levels in patients with cesarean scar pregnancy

2020 ◽  
Vol 23 ◽  
Author(s):  
Omer Tammo ◽  
Hacer Uyanikoglu ◽  
İsmail Koyuncu
Keyword(s):  
Amino Acid ◽  
Pregnant Women ◽  
Free Amino Acid ◽  
Free Amino ◽  
Plasma Concentrations ◽  
Myometrial Invasion ◽  
Controlled Study ◽  
Control Group ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar

Aim and Objective: This study aimed to explore the plasma free amino acid (FAA) and carnitine levels in pregnant women with cesarean scar pregnancy (CSP), and to compare them with those of healthy pregnant women. Materials and Methods: This prospective and randomized controlled study was conducted in patients admitted to Harran University Medical Faculty Hospital Obstetrics Clinic between January 2018 and January 2019. A total of 60 patients were included in the study, and the patients were divided into two groups: CSP group (n = 30) and healthy pregnant group as the control group (n = 30). The blood samples were taken from the participants between 7 - 12 weeks of gestation. Twentyseven carnitines and their esters and 14 FAAs were analysed by liquid chromatography – mass spectrometry (LC-MS/MS). Results: The mean plasma concentrations of some carnitines, including C2, C5, C5-OH, C5-DC, C6, C8-1, C12, C14, C14- 1, C14-2, C16, C16-1, C18, and C18-1 were significantly higher in CSP group than in the control group. However, other carnitines, including C0, C3, C4, C4-DC, C5-1, C6-DC, C8, C8-DC, C10, C10-1, C18-1-OH, and C18-2 were similar in both groups. The plasma levels of some FAAs, including Methyl Glutaryl, Leu, Met, Phe, Arg, Orn, and Glu values were significantly higher in CSP group than in the control group. However, there was no statistically significance in other FAA levels, including Val, Asa, Tyr, Asp, Ala, Cit, and Gly between the two groups. Additionally, Pearson’s correlation analysis showed that there were significantly positive correlations between many FAA and carnitine values. Conclusion: Since several plasma carnitine and FAA levels were higher in CSP group than in the control group, we think that scar pregnancy increases metabolic need for myometrial invasion. Also, we think that these results may be useful in clinical practice for CSP diagnosis.

scholarly journals Sertraline concentrations in pregnant women are steady and the drug transfer to their infants is low

2021 ◽  
Author(s):  
E. Heinonen ◽  
M. Blennow ◽  
M. Blomdahl-Wetterholm ◽  
M. Hovstadius ◽  
J. Nasiell ◽  
...  
Keyword(s):  
Cord Blood ◽  
Pregnant Women ◽  
Plasma Concentrations ◽  
Relative Difference ◽  
Interindividual Variation ◽  
Therapeutic Drug ◽  
Cytochrome P450 Enzyme ◽  
Second Trimester ◽  
P450 Enzyme ◽  
Placental Passage

Abstract Purpose Sertraline, a selective serotonin reuptake inhibitor (SSRI), is one of the most commonly used antidepressant during pregnancy. Plasma sertraline concentrations vary markedly between individuals, partly explained by variability in hepatic drug metabolizing cytochrome P450-enzyme activity. Our purpose was to study the variability in the plasma concentrations in pregnant women and the passage to their infants. Method Pregnant women with moderate untreated depression were recruited in 2016–2019 in Stockholm Region and randomized to treatment with sertraline or placebo. All received Internet-based cognitive behavior therapy as non-medical treatment. Sertraline plasma concentrations were measured around pregnancy weeks 21 and 30, at delivery, 1-month postpartum, in cord blood and at 48 h of age in the infant. The clinical course of the infants was followed. Results Nine mothers and 7 infants were included in the analysis. Median dose-adjusted sertraline concentration in second trimester was 0.15(ng/mL) /(mg/day), in third trimester and at delivery 0.19 and 1-month postpartum 0.25, with a 67% relative difference between second trimester and postpartum. The interindividual variation was 10-fold. Median concentrations in the infants were 33% and 25% of their mothers’, measured in cord blood, and infant plasma, respectively. Only mild and transient adverse effects were seen on the infants. Conclusion Placental passage of sertraline to the infant is low. However, the interindividual variation in maternal concentrations during pregnancy is huge, why therapeutic drug monitoring might assist in finding the poor metabolizers at risk for adversity and increase the safety of the treatment. Trial registration The trial was registered at clinicaltrials.gov July 9, 2014 with TRN: NCT02185547.

scholarly journals Perfluoroalkyl substances and lipid profile in exposed pregnant women in the Veneto Region, Italy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
T Dalla Zuanna ◽  
G Barbieri ◽  
G Pitter ◽  
M Zare Jeddi ◽  
F Daprà ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Lipid Profile ◽  
Plasma Concentrations ◽  
Density Lipoprotein ◽  
Additive Models ◽  
Lipoprotein Cholesterol ◽  
Perfluoroalkyl Substances ◽  
Surveillance Program ◽  
Veneto Region ◽  
Exposed Population

Abstract Background Perfluoroalkyl substances (PFASs) are persistent and widespread environmental pollutants. Residents of a large area of the Veneto Region (North-Eastern Italy) were exposed to high concentrations of PFASs through drinking water from the late-1970s to 2013. PFASs have been consistently associated with raised serum lipids, but only few studies have been conducted among pregnant women, and none has stratified analyses by trimesters of gestation. Our main objective was to evaluate the association between perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) levels and lipid profiles in high-exposed pregnant women. Methods A cross-sectional analysis was conducted in 319 pregnant women (age 14-48 years) recruited in the Regional health surveillance program. Serum PFASs were measured by HPLC-MS/MS. Non-fasting serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured by enzymatic assays in automated analysers, and low-density lipoprotein cholesterol (LDL-C) was calculated. The associations between ln-transformed PFASs (and categorized into quartiles) and lipids were assessed using generalized additive models. Analyses were adjusted for potential confounders and stratified according to pregnancy trimester. Results In the first trimester, plasma concentrations of both PFOA and PFOS were positively associated with TC. However in the third trimester PFOA levels were instead inversely significantly associated with TC and LDL-C levels. Overall, both PFOA and PFOS were positively associated with HDL-C, and PFOA negatively with LDL-C. Conclusions In a small highly exposed population of pregnant women, the associations between PFASs concentrations and lipid profile were modified by trimester of gestation. Patterns late in pregnancy were different to the positive associations with LDL-C generally found. Differential transfer and bioaccumulation of lipids and PFAS in the placenta across gestation might explain our findings. Key messages This study provides evidence of different patterns of PFAS associations with lipids in pregnant women across the trimesters of gestation. The different patterns of association from general population studies sheds light on the role of fetal nutrition during pregnancy affecting both lipids and PFAS in serum.

scholarly journals Radioimmunoassay of plasma ouabain in healthy and pregnant individuals

2000 ◽  
Vol 165 (3) ◽  
pp. 669-677 ◽  
Author(s):  
O Vakkuri ◽  
SS Arnason ◽  
A Pouta ◽  
O Vuolteenaho ◽  
J Leppaluoto
Keyword(s):  
Pregnant Women ◽  
Human Plasma ◽  
High Performance ◽  
Chemical Nature ◽  
Solid Phase ◽  
Plasma Concentrations ◽  
First Trimester ◽  
Plasma Samples ◽  
Third Trimester ◽  
Endogenous Substances

Ouabain was recently isolated from human plasma, bovine hypothalamus and bovine adrenal in attempts to identify endogenous substances inhibiting the cell membrane sodium pump. A number of radioimmunoassays have been developed in order to study the clinical significance of ouabain. The results have been controversial with regard to the presence and chemical nature of plasma ouabain-like immunoreactivity. We have now measured ouabain in healthy and pregnant individuals using solid-phase extraction of plasma samples followed by a new radioimmunoassay with the extraordinary sensitivity of at least 2 fmol/tube (5 pmol/l). Plasma extracts, a previously isolated human plasma ouabain-like compound and bovine hypothalamic inhibitory factor displaced the tracer in parallel and eluted identically with ouabain in high-performance liquid chromatography. Plasma ouabain immunoreactivity was found to be much lower than reported previously: 12.6+/-1.3 pmol/l in healthy men (mean+/-s.e., n=20) and 9.4+/-0.7 pmol/l in women (n=14). In pregnant women (n=28) plasma ouabain concentration was 16.3+/-4.0 pmol/l during the first trimester, 18.8+/-4.3 pmol/l during the second trimester and 24.3+/-4.0 pmol/l during the third trimester (all P<0.01 compared with non-pregnant women). Plasma ouabain 3-5 days after the delivery was 13.6+/-1.1 pmol/l (n=10, P<0.05-0.01 compared with second and third trimesters). The pregnancy-related changes in the plasma concentrations of ouabain resembled those of cortisol. Therefore cortisol was measured from the same plasma samples and a significant positive correlation was found (r=0.512, P=0.006). The similar profiles of plasma ouabain and cortisol during pregnancy and their rapid decreases postpartum are consistent with the adrenal cortical origin of ouabain and also show that the secretions of these hormones are possibly under the control of same factors.

The cardiac conduction system in Hurler syndrome: pathological features and clinical implications

1992 ◽  
Vol 2 (2) ◽  
pp. 196-199
Author(s):  
Louis Tsun-cheung Chow ◽  
Wing-Hing Chow
Keyword(s):  
Sinus Node ◽  
Fibrous Tissue ◽  
Conduction System ◽  
Cardiac Conduction ◽  
Cardiac Conduction System ◽  
Clinical Implications ◽  
Hurler Syndrome ◽  
Pathological Features ◽  
Hydropic Degeneration ◽  
Dense Fibrous Tissue

SummaryWe studied the cardiac conduction system in a case of Hurler syndrome. There was dense fibrosis of the supporting matrix of the sinus node and accumulation of mucopolysaccharide in the nodal cells. The bundle branches showed prominent hydropic degeneration, being encased and punctuated by dense fibrous tissue. These changes in the conduction system may predispose to the development of arrhythmias, accounting for the sudden deaths in Hurler syndrome.

Abstract MP083: Autonomic Imbalance at the Level of Atrioventricular Node, but Not at the Level of Sinus Node, is Associated With Sudden Cardiac Death: The Atherosclerosis Risk in Community Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Srini V Mukundan ◽  
Muammar M Kabir ◽  
Jason Thomas ◽  
Golriz Sedaghat ◽  
Jonathan W Waks ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Cox Regression ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Av Node ◽  
Atherosclerosis Risk In Communities ◽  
Autonomic Imbalance ◽  
Summary Effect ◽  
Atherosclerosis Risk

Introduction: Autonomic imbalance, quantified by decreased heart rate variability (HRV), is associated with increased cardiovascular mortality. It is unknown if autonomic influences on sinus and atrioventricular (AV) nodes are equally important for the risk of sudden cardiac death (SCD). Hypothesis: Autonomic influences on sinus and AV node are equally strongly associated with increased SCD, non-sudden cardiac death (non-SCD), and non-cardiac death. Methods: Baseline visit 10-second ECGs (n=14,250) of the Atherosclerosis Risk in Communities (ARIC) cohort were analyzed. Normalized variance of P-onset to P-onset intervals (PPVN) and QRS-onset to QRS-onset intervals (QQVN) was calculated to assess autonomic influence on sinus and AV node respectively. Normalized variance of Rpeak - Rpeak intervals was determined as HRV measure. Values were log-transformed to normalize distribution. SCD served as primary outcome. Secondary outcomes were non-SCD and non-cardiac death. Three Cox regression models were constructed for dichotomized at 20 th percentile predictor variables. Results: Over median follow-up of 24.4 years, there were 497 SCDs (incidence 1.66 [95%CI 1.52-1.82], 742 non-SCDs (incidence 2.48 [95%CI 2.31-2.67], and 3,753 non-cardiac deaths (incidence 12.6 [95%CI 12.1-13.0]) per 1,000 person-years. In paired analysis, LogPPVN was significantly larger than LogQQVN (-7.28±1.06 vs. -7.72±1.24; P<0.0001). There was no difference between LogQQVN and Log RRVN (-7.72±1.24 vs -7.72±1.23; P=0.364). After full adjustment, LogRRVN and LogQQVN were significantly associated with non-SCD and SCD. Association with non-SCD was stronger. LogPPVN was independently associated with non-SCD but not SCD. No value was associated with non-cardiac death. Conclusion: Autonomic imbalance at the AV node, with likely summary effect at the bundle of His, is associated with SCD and non-SCD. Autonomic imbalance at the SA node is associated with non-SCD only. Autonomic input to SA and AV node should be further studied.

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