- The incidence, predictors and outcomes of QTc prolongation in critically ill patients. [Journal Article]J Crit Care 2019; 54:244-249JC
- CONCLUSIONS: A QTc ≥500 ms likely represents a marker of illness severity modulated by several risk factors, and carries no independent association with clinically-significant ventricular tachyarrhythmias. Thus, cessation of QT-prolonging medications to prevent arrhythmias may lack clinical benefit.
- N-octanoyl dopamine is superior to dopamine in protecting graft contractile function when administered to the heart transplant recipients from brain-dead donors. [Journal Article]Pharmacol Res 2019; :104503PR
- The major source of heart transplantation comes from brain-dead (BD) donors. However, brain death and myocardial ischemia/reperfusion injury during transplantation may lead to cardiac dysfunction and hemodynamic instability. A previous work demonstrated that pre-treatment of BD donors with dopamine improved the graft survival of heart allograft in recipient after transplantation. However, low-dos…
The major source of heart transplantation comes from brain-dead (BD) donors. However, brain death and myocardial ischemia/reperfusion injury during transplantation may lead to cardiac dysfunction and hemodynamic instability. A previous work demonstrated that pre-treatment of BD donors with dopamine improved the graft survival of heart allograft in recipient after transplantation. However, low-dose dopamine treatment might result in tachycardia and hypertension. Our previous experimental study showed that pre-treatment of BD donor rats with the dopamine derivate N-octanoyl dopamine (NOD), devoid of any hemodynamic effects, improved graft function after transplantation. Herein, we hypothesized that NOD confers superior myocardial protection and improves graft function than dopamine, when administered to the heart transplant recipients from BD donors. Male Lewis donor rats were either subjected to sham-operation or brain death via a subdurally placed balloon followed by 5.5 h monitoring. Then, the hearts were explanted and heterotopically transplanted into Lewis recipient rats. Shortly before the onset of reperfusion, continuous intravenous infusion of either NOD (14.7 μg/kg/min, BD + NOD group, n = 9), dopamine (10 μg/kg/min, BD + Dopamine group, n = 8) or physiological saline vehicle (sham, n = 9 and BD group, n = 9) were administered to the recipient rats. In vivo left-ventricular (LV) graft function was evaluated after 1.5 h reperfusion. Additionally, immunohistochemical detection of 4-hydroxy-2-nonenal (HNE, an indicator of oxidative stress) and nitrotyrosine (a nitro-oxidative stress marker), was performed. After heart transplantation, systolic and diastolic functions were significantly decreased in the BD group compared to sham. Treatment with NOD but not dopamine, resulted in better LV graft systolic functional recovery (LV systolic pressure BD + NOD 90 ± 8 vs BD + Dopamine 66 ± 5 vs BD 65 ± 4 mmHg; maximum rate of rise of LV pressure dP/dtmax BD + NOD 2686 ± 225 vs BD + Dopamine 2243 ± 70 vs BD 1999 ± 147 mmHg/s, at an intraventricular volume of 140 µl, p < 0.05) and myocardial work compared to BD group. The re-beating time (time to restoration of heartbeat) was significantly shorter in BD + NOD group than that of BD hearts (32 ± 4 s vs. 48 ± 6 s, p < 0.05), Dopamine treatment had no impact on all of these parameters. Furthermore, NOD as well as dopamine decreased HNE and nitrotyrosine immunoreactivity to the same level. NOD is superior to dopamine in terms of protecting LV graft contractile function when administered to the heart transplant recipients from BD donors.
- Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation. [Journal Article]Am J Case Rep 2019; 20:1536-1539AJ
- CONCLUSIONS: The incidence of ventricular ectopics after PVI ablation has been previously described, but a sustained monomorphic ventricular storm has not been reported before with RF ablation. We attribute the pathophysiology to an increase in myocardial excitability and/or ventricular autonomic modulation. This is a very rare phenomenon, but any subtle imaging abnormality before planning RF-PVI should be taken into consideration.
- Filamin C variants are associated with a distinctive clinical and immunohistochemical arrhythmogenic cardiomyopathy phenotype. [Journal Article]Int J Cardiol 2019IJ
- CONCLUSIONS: ACM associated with FLNC variants presents with a distinctive phenotype characterized by Holter arrhythmia and LGE on CMRI with unremarkable ECG and echocardiographic findings. Clinical presentation in asymptomatic mutation carriers at risk of sudden death may include abnormalities which are currently non-diagnostic for ARVC. At the molecular level, the pathogenic mechanism related to FLNC appears different to classic forms of ARVC caused by desmosomal mutations.
- Automated detection of shockable and non-shockable arrhythmia using novel wavelet-based ECG features. [Journal Article]Comput Biol Med 2019; 115:103446CB
- Malignant arrhythmia can lead to sudden cardiac death (SCD). Shockable arrhythmia can be terminated with device electrical shock therapies. Ventricular-tachycardia (VT) and ventricular fibrillation (VF) are responsive to electrical anti-tachycardia pacing therapy and defibrillation which help to restore normal electrical and mechanical function of the heart. In contrast, non-shockable arrhythmia …
Malignant arrhythmia can lead to sudden cardiac death (SCD). Shockable arrhythmia can be terminated with device electrical shock therapies. Ventricular-tachycardia (VT) and ventricular fibrillation (VF) are responsive to electrical anti-tachycardia pacing therapy and defibrillation which help to restore normal electrical and mechanical function of the heart. In contrast, non-shockable arrhythmia like asystole and bradycardia are not responsive to electric shock therapy. Distinguishing between shockable and non-shockable arrhythmia is an important diagnostic challenge that has practical clinical relevance. It is difficult to accurately differentiate between these two types of arrhythmia by manual inspection of electrocardiogram (ECG) segments within the short time duration before triggering the device for electrical therapy. Automated defibrillators are equipped with automatic shockable arrhythmia detection algorithms based on ECG morphological features, which may possess variable diagnostic performance depending on machine models. In our work, we have designed a robust system using wavelet decomposition filter banks for extraction of features from the ECG signal and then classifying the features. We believe this method will improve the accuracy of discriminating between shockable and non-shockable arrhythmia compared with existing conventional algorithms. We used a novel three channel orthogonal wavelet filter bank, which extracted features from ECG epochs of duration 2 s to distinguish between shockable and non-shockable arrhythmia. The fuzzy, Renyi and sample entropies are extracted from the various wavelet coefficients and fed to support vector machine (SVM) classifier for automated classification. We have obtained an accuracy of 98.9%, sensitivity and specificity of 99.08% and 97.11.9%, respectively, using 10-fold cross validation. The area under the receiver operating characteristic has been found to be 0.99 with F1-score of 0.994. The system developed is more accurate than the existing algorithms. Hence, the proposed system can be employed in automated defibrillators inside and outside hospitals for emergency revival of patients suffering from SCD. These automated defibrillators can also be implanted inside the human body for automatic detection of potentially fatal shockable arrhythmia and to deliver an appropriate electric shock to the heart.
- Pericardial access via wire-guided puncture without contrast: The feasibility and safety of a modified approach. [Journal Article]
- CONCLUSIONS: Wire-guided pericardial puncture exhibits better safety and similar success rates to contrast-guided technique with a trend towards less complications. This article is protected by copyright. All rights reserved.
- Effects of Focal Impulse and Rotor Modulation-Guided Ablation on Atrial Arrhythmia Termination and Inducibility: Impact on Outcomes after Treatment of Persistent Atrial Fibrillation. [Journal Article]
- CONCLUSIONS: A FIRM-guided approach was not associated with a significant difference in freedom from AF when compared to conventional ablation. Termination of AF with ablation was not associated with increased freedom from AF. While AF termination using substrate-based ablation may have mechanistic implications for understanding AF rotor physiology, its impact on clinical outcomes remains unclear. This article is protected by copyright. All rights reserved.
- Analysis of Temporal Trends and Variation in the Use of Defibrillation Testing in Contemporary Practice. [Journal Article]JAMA Netw Open 2019; 2(10):e1913553JN
- CONCLUSIONS: Defibrillation testing at the time of ICD placement in the United States may have declined over time; however, institutional variation in its use appears to be marked and increased. This variability in the reduced use of defibrillation testing could reflect differences in individual or institutional cultures of practice.
- Stellate Ganglion Block and Cardiac Sympathetic Denervation in Patients with Inappropriate Sinus Tachycardia. [Journal Article]
- CONCLUSIONS: SG blockade modestly reduces resting HR but has no significant effect on HR during exercise. Permanent CSD may have a modest role on alleviating symptoms in selected patients with IST. This article is protected by copyright. All rights reserved.
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