Abstract Background Studies of patients presenting for catheter ablation suggest that premature ventricular contractions (PVCs) are a modifiable risk factor for congestive heart failure (CHF). The ...relationship among PVC frequency, incident CHF, and mortality in the general population remains unknown. Objectives The goal of this study was to determine whether PVC frequency ascertained using a 24-h Holter monitor is a predictor of a decrease in the left ventricular ejection fraction (LVEF), incident CHF, and death in a population-based cohort. Methods We studied 1,139 Cardiovascular Health Study (CHS) participants who were randomly assigned to 24-h ambulatory electrocardiography (Holter) monitoring and who had a normal LVEF and no history of CHF. PVC frequency was quantified using Holter studies, and LVEF was measured from baseline and 5-year echocardiograms. Participants were followed for incident CHF and death. Results Those in the upper quartile versus the lowest quartile of PVC frequency had a multivariable-adjusted, 3-fold greater odds of a 5-year decrease in LVEF (odds ratio OR: 3.10; 95% confidence interval CI: 1.42 to 6.77; p = 0.005), a 48% increased risk of incident CHF (HR: 1.48; 95% CI: 1.08 to 2.04; p = 0.02), and a 31% increased risk of death (HR: 1.31; 95% CI: 1.06 to 1.63; p = 0.01) during a median follow-up of >13 years. Similar statistically significant results were observed for PVCs analyzed as a continuous variable. The specificity for the 15-year risk of CHF exceeded 90% when PVCs included at least 0.7% of ventricular beats. The population-level risk for incident CHF attributed to PVCs was 8.1% (95% CI: 1.2% to 14.9%). Conclusions In a population-based sample, a higher frequency of PVCs was associated with a decrease in LVEF, an increase in incident CHF, and increased mortality. Because of the capacity to prevent PVCs through medical or ablation therapy, PVCs may represent a modifiable risk factor for CHF and death.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Alcohol Abuse and Cardiac Disease Whitman, Isaac R., MD; Agarwal, Vratika, MD; Nah, Gregory, MA ...
Journal of the American College of Cardiology,
01/2017, Volume:
69, Issue:
1
Journal Article
Peer reviewed
Open access
Abstract Background Understanding the relationship between alcohol abuse, a common and theoretically modifiable condition, and the most common cause of death in the world, cardiovascular disease, may ...inform potential prevention strategies. Objectives The study sought to investigate the associations among alcohol abuse and atrial fibrillation (AF), myocardial infarction (MI), and congestive heart failure (CHF). Methods Using the Healthcare Cost and Utilization Project database, we performed a longitudinal analysis of California residents ≥21 years of age who received ambulatory surgery, emergency, or inpatient medical care in California between 2005 and 2009. We determined the risk of an alcohol abuse diagnosis on incident AF, MI, and CHF. Patient characteristics modifying the associations and population-attributable risks were determined. Results Among 14,727,591 patients, 268,084 (1.8%) had alcohol abuse. After multivariable adjustment, alcohol abuse was associated with an increased risk of incident AF (hazard ratio HR: 2.14; 95% confidence interval CI: 2.08 to 2.19; p < 0.0001), MI (HR: 1.45; 95% CI: 1.40 to 1.51; p < 0.0001), and CHF (HR: 2.34; 95% CI: 2.29 to 2.39; p < 0.0001). In interaction analyses, individuals without conventional risk factors for cardiovascular disease exhibited a disproportionately enhanced risk of each outcome. The population-attributable risk of alcohol abuse on each outcome was of similar magnitude to other well-recognized modifiable risk factors. Conclusions Alcohol abuse increased the risk of AF, MI, and CHF to a similar degree as other well-established risk factors. Those without traditional cardiovascular risk factors are disproportionately prone to these cardiac diseases in the setting of alcohol abuse. Thus, efforts to mitigate alcohol abuse might result in meaningful reductions of cardiovascular disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives The aim of this study was to compare single- versus dual-chamber implantable cardioverter-defibrillator (ICD) implantation and complication rates in a large, real-world population. ...Background The majority of patients enrolled in ICD efficacy trials received single-chamber devices. Although dual-chamber ICDs offer theoretical advantages over single-chamber defibrillators, the clinical superiority of dual-chamber models has not been conclusively proven, and they may increase complications. Methods The National Cardiovascular Data Registry ICD Registry was used to examine the association between baseline characteristics and device selection in 104,049 patients receiving single- and dual-chamber ICDs between January 1, 2006, and December 31, 2007. A longitudinal cohort design was then used to determine in-hospital complication rates. Results Dual-chamber devices were implanted in 64,489 patients (62%). Adverse events were more frequent with dual-chamber than with single-chamber device implantation (3.17% vs. 2.11%, p < 0.001), as was the rate of in-hospital mortality (0.40% vs. 0.23%, p < 0.001). After adjusting for demographics, medical comorbidities, diagnostic test data, and ICD indication, the odds of any complication (odds ratio: 1.40; 95% confidence interval: 1.28 to 1.52; p < 0.001) and in-hospital mortality (odds ratio: 1.45; 95% confidence interval: 1.20 to 1.74; p < 0.001) were increased with dual-chamber versus single-chamber ICD implantation. Conclusions In this large, multicenter cohort of patients, dual-chamber ICD use was common. Dual-chamber device implantation was associated with increases in periprocedural complications and in-hospital mortality compared with single-chamber defibrillator selection.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Ventricular premature complexes (VPCs) may represent a reversible cause of heart failure (HF); however, the type of patients most prone remains unknown. This study leverages a large ...population-based database to examine interactions that might prove clinically useful in risk stratifying patients with VPCs. We used the California Healthcare Cost and Utilization Project to identify patients with VPCs and incident systolic HF from January 1, 2005, to December 31, 2009. We calculated hazard ratios for predictors of incident systolic HF using multivariable Cox proportional hazard models. Interactions with known risk factors were studied. Of 16.8 million patients experiencing 48.1 million hospitalizations, 35,817 (0.2%) had a VPC diagnosis, and 198,818 (1.2%) developed systolic HF. Incidence of systolic HF was 62.8 per 1000 patient-years (95% CI 61.2-64.4) in those with and 6.1 per 1000 patient-years (95% CI 6.1-6.2) in those without VPCs (p<0.001). After adjusting for potential confounders, VPCs were associated with a nearly two-fold risk of systolic HF (HR 1.8, 95% CI 1.8-1.9, p<0.001). Interaction analyses revealed a stronger relation between VPCs and HF among those with fewer cardiovascular risk factors. A VPC diagnosis in younger patients (<65 years) without coronary artery disease, hypertension, diabetes or atrial fibrillation exhibited a six-fold increased risk of systolic HF (HR 6.5, 95% CI 5.5-7.7, p<0.001). In conclusion, these results suggest that a diagnosis of VPCs independently predicts incident systolic HF. This effect is most pronounced in younger patients without comorbidities, suggesting that VPCs may be an important cause of “idiopathic” HF.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abnormal atrial repolarization is important in the development of atrial fibrillation (AF), but no direct measurement is available in clinical medicine.
To determine whether the QT interval, a marker ...of ventricular repolarization, could be used to predict incident AF.
We examined a prolonged QT interval corrected by using the Framingham formula (QT(Fram)) as a predictor of incident AF in the Atherosclerosis Risk in Communities (ARIC) study. The Cardiovascular Health Study (CHS) and Health, Aging, and Body Composition (ABC) study were used for validation. Secondary predictors included QT duration as a continuous variable, a short QT interval, and QT intervals corrected by using other formulas.
Among 14,538 ARIC study participants, a prolonged QT(Fram) predicted a roughly 2-fold increased risk of AF (hazard ratio HR 2.05; 95% confidence interval CI 1.42-2.96; P < .001). No substantive attenuation was observed after adjustment for age, race, sex, study center, body mass index, hypertension, diabetes, coronary disease, and heart failure. The findings were validated in Cardiovascular Health Study and Health, Aging, and Body Composition study and were similar across various QT correction methods. Also in the ARIC study, each 10-ms increase in QT(Fram) was associated with an increased unadjusted (HR 1.14; 95% CI 1.10-1.17; P < .001) and adjusted (HR 1.11; 95% CI 1.07-1.14; P < .001) risk of AF. Findings regarding a short QT interval were inconsistent across cohorts.
A prolonged QT interval is associated with an increased risk of incident AF.
Abstract Atrial fibrillation (AF) is likely secondary to multiple different pathophysiological mechanisms that are increasingly, but incompletely understood. Motivated by the hypothesis that 3 ...previously described electrocardiographic (ECG) predictors of AF identify distinct AF mechanisms, we sought to determine if these ECG findings independently predict incident disease. Among Cardiovascular Health Study participants without prevalent AF, we determined whether left anterior fascicular block (LAFB), a prolonged QTC , and atrial premature complexes (APCs) each predicted AF after adjusting for each other. We then calculated the attributable risk in the exposed for each ECG marker. LAFB and QTC intervals were assessed on baseline 12-lead ECG (n=4,696). APC count was determined using 24-hour Holter recordings obtained in a random subsample (n=1,234). After adjusting for potential confounders and each ECG marker, LAFB (hazard ratio HR. 2.1, 95% confidence interval CI. 1.1-3.9, p=0.023), a prolonged QTC (HR 2.5, 95% CI 1.4-4.3, p=0.002), and every doubling of APC count (HR 1.2, 95% CI 1.1-1.3, p<0.001) each remained independently predictive of incident AF. The attributable risk of AF in the exposed was 35% (95% CI 13-52%) for LAFB, 25% (95% CI 0.6-44%) for a prolonged QTC , and 34% (95% CI 26-42%) for APCs. In conclusion, in a community-based cohort, 3 previously established ECG-derived AF predictors were each independently associated with incident AF, suggesting they may represent distinct mechanisms underlying the disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Background Renin angiotensin system (RAS) inhibition via ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) may reduce the risk of developing atrial fibrillation (AF) in ...certain populations, but the evidence is conflicting. Recent genome wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with AF, potentially identifying clinically relevant subtypes of the disease. We sought to investigate the impact of carrier status of 9 AF-associated SNPs on the efficacy of RAS inhibition for the primary prevention of AF. Methods We performed SNP-RAS inhibitor interaction testing with unadjusted and adjusted Cox proportional hazards models using a discovery (Cardiovascular Health Study CHS) and a replication (Atherosclerosis Risk in Communities ARIC) cohort. Additive genetic models were employed for the SNP analyses and two-tailed p-values < 0.05 were considered statistically significant Results Among 2796 CHS participants. none of the 9 a priori identified candidate SNPs exhibited a significant SNP-drug interaction. Two of the 9 SNPs, rs2106261 (16q22) and rs6666258 (1q21), revealed interaction relationships that neared statistical significance (with point estimates in the same direction for ACEi only and ARB only analyses), but neither association could be replicated among 8604 participants in ARIC. Conclusions Our study failed to identify AF-associated SNP genetic sub-types of AF that derive increased benefit from upstream RAS inhibition for AF prevention. Future studies should continue to investigate the impact of genotype on the response to AF treatment strategies in an effort to develop personalized approaches to therapy and prevention.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Ventricular arrhythmias (VAs) originating from the aortic root are common. Coronary angiography is typically recommended before catheter ablation to document proximity of the ablation catheter to the ...coronary ostia.
To investigate how often catheter ablation in the aortic root could be guided by phased-array intracardiac echocardiography (ICE) and electroanatomic mapping without requiring aortography or coronary angiography.
We reviewed consecutive patients referred for aortic root VAs to operators experienced in the use of ICE at a single center. An ICE catheter and a 3.5-mm irrigated ablation catheter were used in all cases, and the need for angiography before ablation was documented. Acute success and acute and 30-day complications were noted.
Thirty-five patients (age 58 ± 13 years; 74% men) were referred for the ablation of VAs; 32 of 35 (91%) underwent ablation using ICE and 3-dimensional mapping without the need for coronary angiography. Successful acute ablation was achieved in 29 of 35 (83%) patients. In all cases, the catheter tip was directly visualized with ICE >1 cm from the coronary ostia. The site of origin of the earliest VA was the left cusp (17 of 35 49%), right cusp (9 of 35 26%), right-left cusp junction (8 of 35 23%), or right-noncoronary cusp junction (1 of 35 3%). There were no cases of coronary injury, embolic stroke, aortic root perforation, worsening of aortic regurgitation, or death acutely or at 30 days.
Radiofrequency ablation of VAs originating from the aortic root may be safely performed using ICE and electroanatomic mapping in the majority of cases without the need for coronary angiography.
Gradually Understanding Sudden Cardiac Death Stecker, Eric C., MD, MPH; Dewland, Thomas A., MD
Journal of the American College of Cardiology,
05/2016, Volume:
67, Issue:
18
Journal Article
Peer reviewed
Open access
...the finding that death during exercise was independently associated with left ventricular fibrosis and ARVC/D amplifies concern about the safety of exercise among these patients and adds to the ...uncertainty regarding exercise recommendations for any patient with fibrosis detected on cardiac magnetic resonance. The inability to identify a mechanism of death despite exhaustive autopsy efforts in many of the included cases reminds us that our clinical examination and imaging studies have substantial limitations for SCD prediction and that other information, including detailed patient and family history, may provide important insights into SCD risk.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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