To assess the prevalence of short corrected QT (QTc) intervals and its impact on short QT syndrome (SQTS) diagnosis using different QT correction formulae.
Observational study. The prevalence of ...short QTc intervals was estimated using four different QT correction formulae in 14 662 young adults from the 'Sudden Cardiac Death Screening of Risk FactOrS' (SCD-SOS) cohort. Then, using data from this cohort and the pooled-cohort analysed by Gollob
, comprising 61 patients with SQTS, we assessed the impact of the different QTc correction formulae on SQTS probability and diagnosis based on the Expert Consensus recommendations (QTc ≤330 ms or QTc 330-360 ms+1 additional risk feature).
The prevalence of individuals with a QTc ≤330 and ≤320 ms in the SCD-SOS cohort was extremely low (≤0.07% and≤0.02%, respectively), and these were more frequently identified by the Framingham correction. The different QTc correction formulae led to a shift in SQTS probability in 5%-10% of individuals in both the SCD-SOS and Gollob cohort). Intermediate probability individuals were rare (<0.1%), and no high-SQTS probability individuals were identified in the SCD-SOS cohort. Based on Consensus criteria, instead of 12 (0.08%) individuals being diagnosed with SQTS using the
equation, a different number of individuals would meet diagnostic criteria with the other formulae: 11 (0.08%) using
, 9 (0.06%) with
and 16 (0.11%) using the
equation.
Prevalence of SQTS in the apparently healthy adult population is low. Applying different QTc correction formulae leads to significant reclassification of SQTS probability and their impact on predicting outcomes should be assessed.
The important increase in life expectancy of adult patients with congenital heart disease (ACHD) has generated new challenges, including arrhythmias that represent one of the main late complications. ...Reentrant atrial arrhythmias are by far the main mechanism encountered, and catheter ablation has been now presented as a first-line therapy in this patient population. The number of procedures is expected to continuously increase year after year. The heterogeneity and complexity of phenotypes encountered require these cases to be performed by highly experienced operators, in specialized centers with multidisciplinary competencies. A thorough knowledge and understanding of anatomic specificities, vascular access issues, and main circuits encountered according to underlying phenotype is essential. Acute success rates have significantly improved and are now excellent, but recurrences remain a common issue, with different mechanisms or circuits frequently encountered. Observational data have suggested the interest of systematically targeting all inducible atrial arrhythmias, whether previously documented or not, and a lot of hope and research is based on the prediction of arrhythmia substrate before arrhythmia development by imaging or electroanatomic mapping to deliver a prophylactic patient tailored ablation approach. In this review, we summarize those different points in the most common or distinctive defects to offer a didactic overview of atrial flutter catheter ablation in ACHD patients.
Recent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on ...outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome.
We used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale.
Between May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P < 0.001). Gender, age, and location of CA did not change over the years. Bystander CPR increased from 55% in 2011 to 73% in 2017 (P < 0.001) and patients with a no-flow time longer than 3 min decreased from 53 to 38% (P < 0.001). The use of TTM decreased from 55% in 2011 to 37% in 2017 (P < 0.001). Meanwhile, the rate of patients with good neurological recovery remained stable (19 to 23%, P = 0.76). After adjustment, year of CA occurrence was not associated with outcome.
We report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in "no flow" duration.
Public-Access Defibrillation in Japan Kitamura, Tetsuhisa; Kiyohara, Kosuke; Iwami, Taku
The New England journal of medicine,
02/2017, Letnik:
376, Številka:
7
Journal Article
Display omitted
Out-of-hospital sudden cardiac arrest (OHCA) is a major public health issue, with a survival rate at hospital discharge that remains below 10% in most cities, despite huge investments ...in this domain. Early basic life support (BLS) and early defibrillation using automated external defibrillators (AEDs) stand as key elements for improving OHCA survival rate. Nevertheless, the use of AEDs in OHCA remains low, for a variety of reasons, including the number, accessibility and ease of locating AEDs, as well as bystanders’ awareness of BLS manœuvres and of the need to use AEDs. Several measures have been proposed to improve the rate of AED use, including optimization of AED deployment strategies as well as the use of drones to bring the AEDs to the OHCA scene and of mobile applications to locate the nearest AED. If they are to be effective, these measures should be combined with large communication campaigns on OHCA, and wide-scale education of the public in BLS and AEDs, to reduce the burden of OHCA.
L’arrêt cardiorespiratoire (ACR) extrahospitalier constitue un véritable problème de santé publique, avec un taux de survie qui reste inférieur à 10 % dans la plupart des pays, malgré de considérables investissements dans ce domaine. La réanimation précoce et une défibrillation précoce grâce à l’usage des défibrillateurs automatiques externes (DAE) ont été identifiées comme des éléments clés pour améliorer la survie des ACR. Pourtant, le taux d’utilisation des DAEs dans les ACR reste faible. Plusieurs limites empêchent une plus ample utilisation des DAE, dont leur nombre, leur accessibilité et la facilité de leur localisation, ainsi que l’éducation des témoins aux gestes qui sauvent et à la nécessité d’utiliser un DAE. Plusieurs pistes ont été testées pour améliorer ces différents paramètres, incluant une optimisation du déploiement des DAEs, ainsi que l’utilisation de drones permettant de ramener les DAEs sur le site d’ACR et d’applications permettant de localiser le DAE le plus proche. Ces mesures doivent systématiquement être associées à de vastes campagnes de communication sur la mort subite et à une éducation du grand public aux manœuvres de réanimation et à l’intérêt de l’utilisation des DAEs.
Atrial fibrillation (AF) catheter ablation is performed in patients receiving direct oral anticoagulants (DOACs) with intra-procedural unfractionated heparin (UFH) administration to achieve activated ...clotting time (ACT) at 300 s, as for vitamin K antagonist (VKA). We determined whether ACT monitoring might be transposed from VKA to DOAC-treated patients. Blood was taken from 124 patients receiving uninterrupted dabigatran, rivaroxaban, apixaban, or VKA or being untreated. DOAC concentration or INR (VKA) were measured. ACT was determined at baseline, and after spiking with UFH doses equivalent to 1000, 2500, 5000 and 10000 IU
. At baseline, anticoagulants prolonged ACT differently, ACT was longer with dabigatran and shorter with apixaban despite similar concentrations. ACT strongly correlated with INR and dabigatran concentration, but not with apixaban or rivaroxaban concentrations. Moreover, UFH effects on ACT prolongation depended on the anticoagulant: dose-response curves in samples with VKA and dabigatran were parallel whereas ACT prolongation in response to UFH was significantly smaller with rivaroxaban and especially apixaban. Therefore, UFH to achieve ACT at 300 s might be transposed from VKA to uninterrupted dabigatran-treated patients but not to patients receiving FXa-inhibitors, especially apixaban. Targeting 300 s might expose to UFH overdosing and bleeding, questioning the current anticoagulation strategy.
Background Little data are available in women presenting with ventricular fibrillation (VF) in the setting of acute myocardial infarction (AMI). We assessed frequency, predictors of VF, and outcomes, ...with a special focus on women compared with men. Methods and Results Data were analyzed from the FAST‐MI (French Registry of Acute ST‐Elevation or Non‐ST‐Elevation Myocardial Infarction) program, which prospectively included 14 406 patients admitted to French cardiac intensive care units ≤48 hours from AMI onset between 1995 and 2015 (mean age, 66±14 years; 72% men; mean left ventricular ejection fraction, 52±12%; 59% with ST‐segment–elevation myocardial infarction). A total of 359 patients developed VF during AMI, including 81 women (2.0% of 4091 women) and 278 men (2.7% of 10 315 men, P =0.02). ST‐segment–elevation myocardial infarction (odds ratio OR, 2.29 95% CI, 1.75–2.99; P <0.001) was independently associated with the onset of VF during AMI. In contrast, female sex (OR, 0.73 95% CI, 0.56–0.95; P =0.02), hypertension (OR, 0.75 95% CI, 0.60–0.94; P =0.01), and prior myocardial infarction (OR, 0.69 95% CI, 0.50–0.96; P =0.03) were protective factors. Women were less likely to have cardiac intervention than men (percutaneous coronary intervention during hospitalization 48.1% versus 66.9%, respectively; P =0.04) with a higher 1‐year mortality in women compared with men (50.6% versus 37.4%, respectively; P =0.03), including increased in‐hospital mortality (42.0% versus 32.7%, respectively; P =0.12). After adjustment, female sex was no longer associated with a worse 1‐year mortality (adjusted hazard ratio, 1.10 95% CI, 0.75–1.61; P =0.63). Conclusions Women have lower risk of developing VF during AMI compared with men. However, they are less likely to receive cardiac interventions than men, possibly contributing to missed opportunities of improved outcomes.
Incidence of ventricular arrhythmias per week compared with the number of new coronavirus disease 2019 (COVID-19) cases per week in France (blue line) and the daily percentage of COVID-19 information ...on 24-hour television information channels per week (red line). TV: television; VF: ventricular fibrillation; VT: ventricular tachycardia. ▪
The coronavirus disease 2019 (COVID-19) has been a fast-growing worldwide pandemic.
We aimed to investigate the incidence of cardiac arrhythmias among a large French cohort of implantable cardioverter defibrillator recipients over the first 5 months of 2020.
Five thousand nine hundred and fifty-four implantable cardioverter defibrillator recipients were followed by remote monitoring during the COVID-19 period (from 01 January to 31 May 2020). Data were obtained from automated remote follow-up of implantable cardioverter defibrillators utilizing the Implicity® platform. For all patients, the type of arrhythmia (atrial fibrillation, ventricular tachycardia or ventricular fibrillation), the number of ventricular arrhythmia episodes and the type of implantable cardioverter defibrillator-delivered therapy were recorded.
A total of 472 (7.9%) patients presented 4917 ventricular arrhythmia events. An increase in ventricular arrhythmia incidence was observed after the first COVID-19 case in France, and especially during weeks #10 and #11, at the time of major governmental measures, with an increase in the incidence of antitachycardia pacing delivered therapy. During the 11 weeks before the lockdown order, the curve of the percentage of live-stream television coverage of COVID-19 information matched the ventricular arrhythmia incidence. During the lockdown, the incidence of ventricular arrhythmia decreased significantly compared with baseline (0.05±0.7 vs. 0.09±1.2 episodes per patient per week, respectively; P<0.001). Importantly, no correlation was observed between ventricular arrhythmia incidence and the curve of COVID-19 incidence. No changes were observed regarding atrial fibrillation/atrial tachycardia episodes over time.
An increase in ventricular arrhythmia incidence was observed in the 2 weeks before the lockdown order, at the time of major governmental measures. Ventricular arrhythmia incidence decreased dramatically during the lockdown.
Le COVID-19 est une épidémie mondiale de croissance rapide.
Nous avons étudié l’incidence des arythmies cardiaques dans une cohorte française de patients implantés de défibrillateur automatique implantable (DAI) pendant les cinq premiers mois de 2020.
Cinq milles neuf cent cinquante quatre patients implantés d’un DAI suivis en télé cardiologie ont été analysés pendant la première partie de l’épidémie de COVID-19 (du 1er janvier au 31 mai 2020). Les données ont été automatiquement extraites en utilisant la plate-forme de télé-cardiologie Implicty. Pour l’ensemble des patients, le type d’arythmie (fibrillation atriale, tachycardie ventriculaire ou fibrillation ventriculaire), le nombre d’épisodes d’arythmie ventriculaire, et le type de thérapie délivrée par le DAI ont été recueillis.
Au total, 472 (7,9 %) patients ont présenté 4917 épisodes d’arythmie ventriculaire. Une augmentation de l’incidence des arythmies ventriculaires a été observée après le premier cas de COVID-19 en France et particulièrement pendant les semaines 10 et 11, au moment des principales mesures gouvernementales. Une élévation de l’incidence de stimulation antitachycardique délivrée par le DAI a également été observée pendant cette période. Pendant la semaine numéro 11, avant le début du confinement, on met en évidence une corrélation entre le pourcentage d’information dédié au COVID-19 sur les chaînes d’information télévisée et l’incidence des arythmies ventriculaires. Pendant le confinement, l’incidence des arythmies ventriculaires a diminué de façon significative comparée à la période avant confinement (0,05±0,7 vs 0,09±1,2 épisodes par patient par semaine, p<0,001). Aucune corrélation n’est observée entre l’incidence des arythmies ventriculaires et l’incidence de nombre de cas de COVID-19. Aucun changement n’a été observé concernant l’incidence des arythmies supraventriculaires pendant cette période.
Une augmentation de l’incidence des arythmies ventriculaires est observée dans les deux semaines avant le confinement, au moment des principales mesures gouvernementales. Pendant le confinement, l’incidence des arythmies ventriculaires a significativement diminué.
Major advances in pediatric cardiology in recent decades, especially surgical techniques, have resulted in an increasing number of patients with congenital heart disease (CHD) surviving to adulthood. ...This has generated new challenges, particularly with regards to the late onset of complex arrhythmias. Abnormal anatomy, surgical scarring, chronic hypoxemia, hemodynamic compromise, neuro-hormonal abnormalities, and genetic factors can all contribute to creating a unique substrate for arrhythmia development. This review attempts to synthesize the current state of knowledge spanning the spectrum from underlying mechanisms of arrhythmias in patients with congenital heart disease to current ablative strategies. We discuss existing knowledge gaps and highlight important areas for future research.
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