Background
Early detection of cardiac involvement in patients with sarcoidosis is important but currently unresolved. The aim of this study was to elucidate the utility of frequency domain microvolt ...T‐wave alternans (TWA), signal‐averaged ECG (SAECG), and heart rate turbulence (HRT) using 24‐hour Holter ECG for detecting cardiac involvement in patients with pulmonary sarcoidosis.
Methods
This study consisted of consecutive 40 pulmonary sarcoidosis patients (11 males, 62 ± 13 years) who underwent 24‐hour Holter monitoring with and without cardiac involvement. All patients underwent frequency domain TWA, SAECG, and HRT using 24‐hour Holter monitoring. Patients with atrial fibrillation pacing or wide QRS electrocardiogram were excluded.
Results
After 14 patients were excluded, a total of 26 patients (six males, 59 ± 14 years) were evaluated. Seven patients had cardiac involvement (cardiac sarcoidosis CS group). On the Holter SAECG, duration of low‐amplitude signals <40 μV in the terminal filtered QRS complex (LAS40) was significantly higher, and root mean square voltage of the terminal 40 ms of the filtered QRS complex (RMS40) was significantly lower in the CS group compared with the non‐CS group (LAS40: 61.4 ± 35.9 vs 37.6 ± 9.2 ms; P = .018, RMS40: 11.4 ± 10.3 vs 23.6 ± 13.2 ms; P = .023). Prevalence of positive late potential (LP) was also significantly higher in the CS group than that in the non‐CS group (85.7% vs 31.5%; P = .026). The sensitivity, specificity, positive, and negative predictive values of LP for identifying patients with cardiac involvement were 85.7%, 68.4%, 50.0%, and 92.8%, respectively.
Conclusion
Holter SAECG may be useful for detecting cardiac involvement in patients with pulmonary sarcoidosis.
Holter‐based signal‐averaged ECG showed high prevalence of positive late potentials (LP) in cardiac sarcoidosis (CS) patients.
Purpose
Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). Although coronary artery spasms (CAS) during or after ablation procedures have been described as a rare ...complication in some case reports, the incidence and characteristics of this complication have not been fully elucidated. The present observational study aimed to clarify the CAS in a large number of patients experiencing AF ablation.
Methods
A total of 2913 consecutive patients (male: 78%, mean 66 ± 10 years) who underwent catheter ablation of AF were enrolled.
Results
Nine patients (0.31%, mean 66 ± 10 years, 7 males) had transient ST-T elevation (STE). Eight out of the 9 patients had STE in the inferior leads. STE occurred after the transseptal puncture in 7 patients, after the sheath was pulled out of the left atrium in 1, and 2 h after the ablation procedure in 1. Six patients had definite angiographic CAS without any sign of an air embolization on the emergent coronary angiography. In the3 other patients, the STE improved either directly after an infusion of nitroglycerin or spontaneously before the CAG. The patients with CAS had a higher frequency of a smoking habit (89% vs. 53%;
P
= .04), smaller left atrial diameter (36 ± 6 vs. 40 ± 7;
P
= .07), and lower CHADS
2
score (0.6 ± 0.5 vs. 1.3 ± 1.1;
P
= .004) than those without.
Conclusions
Although the incidence was rare (0.31%), CAS should be kept in mind as a potentially life-threatening complication throughout an AF ablation procedure especially performed under conscious sedation.
There is increasing evidence that a proportion of patients with cardiac sarcoidosis (CS) have atrial arrhythmias (AA). Although 18F-fluorodeoxy-glucose (FDG) uptake in the ventricle on positron ...emission tomography/computed tomography (PET/CT) is well studied, FDG uptake in the atrium has not been elucidated in detail.
To evaluate FDG uptake in the atrium and its relationship with AA in patients with CS.
We retrospectively investigated 62 CS patients. All patients underwent echocardiography and PET/CT. Serum angiotensin converting enzyme (ACE) and soluble IL-2 receptor (sIL-2R) levels, plasma N-terminal pro–brain natriuretic peptide (NT-proBNP) concentrations were also evaluated. ECG, Holter monitoring and device interrogations were used to detect AA.
Of the studied population, 25 patients (40.3%) had AA, of which 2 patients had atrial tachycardia (AT) and 23 patients had atrial fibrillation (AF). Eighteen patients with AA had atrial FDG uptake on PET/CT, whereas 14 patients without AA had atrial FDG uptake (72.0% vs 37.8%, P = 0.017). Multivariate analysis revealed a significant association between AA and age (odds ratio OR: 1.15; 95% confidence interval CI: 1.01–1.31, P = 0.040), atrial FDG uptake (odds ratio OR: 7.23; 95% confidence interval CI: 1.91–27.36, P = 0.004), and left atrial diameter (OR: 1.08; 95% CI: 1.01–1.16, P = 0.027). Meanwhile, gender, serum ACE and BNP levels, and left ventricular ejection fraction were not associated with AA.
Atrial FDG uptake was common in patients with CS and strongly associated with AA.
•We found a high prevalence of atrial FDG uptake in patients with Cardiac Sarcoidosis.•A significant association between atrial arrhythmias and age, atrial FDG uptake, and left atrial diameter was demonstrated.•Gender, ACE and NT-proBNP levels, and LVEF were not associated with atrial arrhythmias.
COVID‐19 is a global catastrophe with markedly reduced health and economy of human civilization. Heart rhythm disorder has also been impacted by this disease. This statement is the universal criteria ...for EP procedures in the new era, which we will face during COVID‐19 pandemic. We described the methods of triage based on the severity of disease, the regional state of pandemic and supply of medical resources. This guidance will be the universal criteria for EP procedures in the new era, which we will face during and after the COVID‐19 pandemic.
This statement of Japanese Heart Rhythm society was published to address the issues faced by electrophysiologists and to provide standard indications for the regulation and advancement of EP procedures for health care professionals during and after the COVID‐19 pandemic. We described the methods of triage based on the severity of disease, the regional state of pandemic and supply of medical resources. This guidance will be the universal criteria for EP procedures in the new era, which we will face during and after the COVID‐19 pandemic
•Ethe effect of sodium–glucose cotransporter 2 inhibitors on fluid balance and improvement of heart failure.•Enrolled patients had an acute myocardial infarction and type 2 diabetes ...mellitus.•Bioelectrical impedance analysis was used to measure extracellular water and intracellular water.•An sodium–glucose cotransporter 2 inhibitor may decrease body weight and attenuate the change in extracellular water and intracellular water.•Results indicate that sodium–glucose cotransporter 2 inhibitors are an effective treatment for heart failure.
The development of heart failure is associated with fluid balance, including that of extracellular water (ECW) and intracellular water (ICW). This study determined whether sodium–glucose cotransporter 2 inhibitors affect fluid balance and improve heart failure in patients after acute myocardial infarction.
EMBODY was a prospective, randomized, double-blinded, placebo-controlled trial of Japanese patients with acute myocardial infarction and type 2 diabetes. Overall, 55 patients who underwent bioelectrical impedance analysis were randomized to receive once daily 10 mg empagliflozin or placebo 2 weeks after acute myocardial infarction onset. We investigated the time course of body fluid balance measured using the bioelectrical impedance analysis device, InBody. The primary end points were changes in body fluid balance from weeks 0 to 24. Changes between baseline and week 24 in the empagliflozin and placebo groups were –0.21 L (P = .127) and +0.40 L (P = .001) in ECW (P = .001) and –0.23 L (P = .264) and +0.74 L (P < .001) in ICW (P < .001), respectively. In a stratified analysis, the rise in ECW and ICW was significantly attenuated in the empagliflozin group in contrast to the placebo group in participants with a body mass index of 25 or higher but not in those with a body mass index of less than 25.
Early sodium–glucose cotransporter 2 inhibitor administration may attenuate changes in ECW and ICW.
Aims
Although the reno‐protective effects of sodium–glucose cotransporter 2 inhibitors are known in patients with heart failure or type 2 diabetes mellitus (T2DM), this effect has not been confirmed ...in patients with acute myocardial infarction (AMI).
Methods and results
The prospective, multicentre, randomized, double‐blind, placebo‐controlled EMBODY trial investigated patients with AMI and T2DM in Japan. The eligible patients included adults aged 20 years or older, diagnosed with AMI and T2DM, and who could be discharged within 2–12 weeks after the onset of AMI. One hundred and five patients were randomized (1:1) to receive once daily 10 mg empagliflozin or placebo within 2 weeks of AMI onset. In this sub‐analysis, we investigated the time course of renal functional parameters such as serum creatinine levels and estimated glomerular filtration rate (eGFR) from baseline to Weeks 4, 12, and 24. Ninety‐six patients (64 ± 11 years, 78 male) were included in the full analysis (n = 46 and 50 in the empagliflozin and placebo groups, respectively). We used serum creatinine and eGFR as indicators of renal function. In the placebo group, eGFR decreased from 66.14 mL/min/1.73 m2 at baseline to 62.77 mL/min/1.73 m2 by Week 24 (P = 0.023) but remained unchanged in the empagliflozin group (from 64.60 to 64.36 mL/min/1.73 m2, P = 0.843). In the latter group, uric acid improved from 5.8 mg/dL at baseline to 4.9 mg/dL at Week 24 (P < 0.001). In the earlier analysis of 56 patients with eGFR ≥ 60 mL/min/1.73 m2, the eGFR decreased and the serum creatinine increased from baseline to 24 weeks in the placebo group, significantly different to the empagliflozin group (−6.61 vs. +0.22 mL/min/1.73 m2, P = 0.008 and +0.063 vs. −0.001 mg/dL, P = 0.030, respectively). The changes in serum creatinine and eGFR from baseline to Week 24 were significantly correlated with those in uric acid in the placebo group (r = 0.664, P < 0.001 and r = −0.675, P < 0.001, respectively) but not in the empagliflozin group.
Conclusions
Empagliflozin prevented the kidney functional decline in patients with AMI and T2DM, especially those with baseline eGFR ≥ 60 mL/min/1.73 m2. Early administration of sodium–glucose cotransporter 2 inhibitors in these patients is considered desirable for renal protection.
Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). The present study aimed to investigate the incidence and prognostic impact of newly detected ...AF after cardiac implantable electronic device (CIED) implantation with HCM patients. Fifty-six patients (33 men, age 57 ± 17 years) with HCM who underwent CIED implantations with no previous history of AF at the time of implantation (ICD
n
= 46, Pacemaker
n
= 10) were retrospectively enrolled. During 5.7 ± 3.6 years of follow-up, AF was newly detected in 20 (36%) of 56 patients after the CIED implantation (AF group) and the rest of the patients had no newly detected AF (non-AF group). The presence of mitral regurgitation (HR 8.49; 95% CI 2.29–30.6
P
< 0.01) and concomitant NYHA II–IV (HR 3.37; 95% CI 1.30–8.86
P
= 0.01) were the independent predictors of newly detected AF. During the follow-up, all patients in the AF group started anticoagulation mean 21 days after detection of AF, and none had a stroke during the follow-up period. The rate of appropriate ICD therapy (log-rank
P
= 0.95), inappropriate ICD therapy (log-rank
P
= 0.78), and all-cause death (log-rank
P
= 0.23) were similar between the two groups. However, the incidence of hospitalizations due to heart failure was higher in the AF group (55% vs. 6% log-rank
P
< 0.01). In conclusion, the incidence of newly detected AF after CIED implantations in HCM patients was high. The newly detected AF was associated with worsening heart failure and careful follow-up is recommended.
Early detection of cardiac involvement in sarcoidosis is difficult but essential to achieve optimal treatment. Signal-averaged electrocardiography (SAECG) can detect subtle cardiac electrical ...abnormalities termed late potentials (LPs) and would be useful for the early diagnosis of cardiac involvement.
This study aims to investigate the prognostic significance of LP in patients with pulmonary sarcoidosis.
We prospectively studied 74 patients with pulmonary sarcoidosis without overt electrocardiographic abnormalities. All participants underwent SAECG, cardiac echocardiography, and 24-hour ambulatory Holter monitoring. Serum angiotensin-converting enzyme and B-type natriuretic peptide levels were also evaluated. We followed these patients for the evaluation of incidence of cardiac events including cardiac death, arrhythmias, and heart failure requiring hospital admission.
Of the studied population, 29 patients (39.2%) had detectable LP. During a mean follow-up period of 9.8 years, 8 patients with LPs had cardiovascular events, including development of complete atrioventricular block (n = 4), ventricular tachycardia (n = 2), and heart failure (n = 2). Meanwhile, only 1 of 45 patients without LP developed cardiac event (heart failure). Multivariate analyses revealed that LPs were associated with an increased risk of developing cardiac events (hazard ratio 9.66; 95% confidence interval 1.20-78.01; P = .033) whereas age, sex, serum angiotensin-converting enzyme and B-type natriuretic peptide levels, number of premature ventricular contractions on 24-hour Holter monitoring, and echocardiographic parameters were not associated with subsequent cardiac events.
SAECG might possibly be useful for the early detection of cardiac sarcoidosis and, if independently validated, could eventually be considered as a screening test for further risk stratification.
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