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Young (<18 years of age) patients with Brugada syndrome (BrS) are often under-represented in BrS studies and their management, especially related to syncopal episodes, remains unclear. This study sought to describe the arrhythmia prevalence among young patients with BrS undergoing continuous rhythm monitoring by implantable loop recorder (ILR) and to assess the etiology behind syncope of undetermined origin. A total of 147 patients with BrS with ILR were enrolled in 12 international centers and divided into pediatric (age <12 years; n = 77, 52%) and adolescents (age 13-18 years; n = 70, 48%). Mean age was 11.3 years, 53 patients (36.1%) were female, and 31 (21.1%) had spontaneous type 1 electrocardiograms. Over a median follow-up of 3.6 years (Q1-Q3: 1.6-4.8 years), an arrhythmic event was recorded in 33 patients (22.4%), mainly of nonventricular origin: 15 atrial (10.2%) and 16 bradyarrhythmic events (10.9%). Ventricular arrhythmias occurred in 4 patients, all with spontaneous BrS, and were fever-related in one-half. Among all patients with recurrence of syncope during follow-up, true arrhythmic syncope was documented in 5 (17.8%), and it was due to bradyarrhythmias or atrial arrhythmias in 3 cases (60%). Continuous rhythm monitoring with ILRs in young patients with BrS detects a broad range of arrhythmias. Ventricular arrhythmias occur predominantly in patients with spontaneous type 1 electrocardiograms and during fever. Despite the young age, bradyarrhythmias and atrial arrhythmias are frequent and represent the cause of arrhythmic syncope in 60% of patients. Young patients with BrS with syncope of undetermined origin may benefit from ILR implant. [ABSTRACT FROM AUTHOR]

The aim of this guideline is to assist physicians in the management of patients with cardiovascular pathology and obstructive sleep-disordered breathing. The article consists data on diagnostic tactics for patients with possible sleep-breathing disorders, describes the basic principles of obstructive sleep apnea treatment, and substantiates the clinical significance of obstructive sleep apnea therapy initiating in the management of patients with cardiovascular diseases.

Background: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiac arrhythmias, which increases serious morbidity and mortality. Novel hypoglycemic drug sodium glucose cotransporter 2 (SGLT2) inhibitor has shown sufficient cardiovascular benefits in cardiovascular outcome trials. Objective: This systematic review and meta-analysis aimed to investigate the relationship between SGLT2 inhibitors and cardiac arrhythmias in patients with T2DM. Methods: We searched on PubMed and ClinicalTrials.gov for at least 24 weeks of randomized double-blind placebo-controlled trials involving T2DM subjects assigned to SGLT2 inhibitors or placebo as of May 5, 2023. Risk ratio (RR) with 95% confidence interval (CI) were used for binary variables. Primary outcomes included atrial arrhythmias, ventricular arrhythmias, bradyarrhythmias, cardiac arrest, and atrial fibrillation/atrial flutter. Secondary outcomes comprised atrial fibrillation, atrial flutter, ventricular fibrillation, ventricular tachycardia, atrioventricular block, and sinus node dysfunction. Results: We included 32 trials covering 60,594 T2DM patients (SGLT2 inhibitor 35,432; placebo 25,162; mean age 53.9 to 68.5 years). SGLT2 inhibitors significantly reduced the risk of atrial arrhythmias (RR 0.86; 95%CI 0.74–0.99; P = 0.04) or atrial fibrillation/flutter (RR 0.85; 95%CI 0.74–0.99; P = 0.03) compared to placebo; in subgroup analysis, SGLT2 inhibitors achieved a consistent effect with overall results in T2DM with high cardiovascular risk or follow-up > 1 year populations. There was no substantial evidence to suggest that SGLT2 inhibitors reduced the risk of ventricular arrhythmias (RR 0.94; 95%CI 0.71–1.26; P = 0.69) and cardiac arrest (RR 0.88; 95%CI 0.66–1.18; P = 0.39). A neutral effect of SGLT2 inhibitors on bradyarrhythmias was observed (RR 1.02; 95%CI 0.79–1.33; P = 0.85). SGLT2 inhibitors had no significant impact on all secondary outcomes compared to placebo, while it had borderline effect for atrial fibrillation. Conclusion: SGLT2 inhibitors were associated with a reduced risk of atrial arrhythmias in patients with T2DM. Our results support the use of SGLT2 inhibitors in T2DM with high cardiovascular risk populations. We also recommend the long-term use of SGLT2 inhibitors to achieve further benefits. [ABSTRACT FROM AUTHOR]

Bradyarrhythmias and conduction blocks are a common clinical finding and may be a physiologic reaction (for example in healthy, athletic persons) as well as a pathologic condition. Arbitrarily, bradyarrhythmias are defined as a heart rate below 60 beats per minute (bpm). These can be further categorized on the basis of the level of disturbances in the hierarchy of the normal cardiac conduction system. A total 100 consecutive high risk patients for having coronary artery disease requiring implantation of permanent pacemaker due to complete heart block or symptomatic sick sinus syndrome or conduction diseases were taken for study. This hospital based study was carried out to find the frequency of coronary artery disease in patients of chronic heart blocks who were candidates for permanent pacemaker implantation. 100 patients having chronic heart blocks who presented to emergency or OPD and admitted in cardiology ward of department of cardiology were taken for study. In all patients Coronary angiography was performed after PPM implantation who were at high risk for having coronary artery disease. In a population of 100 consecutive patients with newly implanted permanent pacemaker, who subsequently had coronary angiography due to high risk profile for coronary artery disease, the frequency of coronary involvement was 45% (total patients=100). Out of these 45 patients (N=45), 29 (64.44%) had obstructive coronary artery disease and 16 (35.56%) had non obstructive coronary artery disease. The most frequent symptom of this patient population is syncope/pre syncope (present in 100%) and angina and angina equivalent was present in 25% and 18% patients respectively. Since their main symptom at presentation is pre syncope/ syncope and their other cardiac symptoms are either ignored or not taken into consideration and their coronary artery disease remains undiagnosed, which can have detrimental effect on the morbidity and mortality. [ABSTRACT FROM AUTHOR]

The electrocardiogram (ECG) is an integral part of the diagnostic process for a wide variety of cardiac conditions. It consists of six limb and six precordial leads which record the electrical activity of the heart in the frontal and horizontal planes respectively. The standard ECG waves include the P wave which represents atrial depolarization, the QRS complex generated by depolarization of the ventricular myocardium and the T wave which reflects ventricular repolarization. According to the site of origin, cardiac arrhythmias can be classified as supraventricular or ventricular tachycardias. The most common supraventricular tachycardias are sinus tachycardia, atrial tachycardia, atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia, atrial flutter and atrial fibrillation. Ventricular tachycardias originate in the ventricles and can be potentially life-threatening. [ABSTRACT FROM AUTHOR]

In recent decades, there has been increased interest in obstructive sleep apnea (OSA), especially in patients with a combination of OSA and sleep bradyarrhythmias. Worldwide, the diagnosis of OSA is steadily increasing. Increasingly, clinicians have begun to use CPAP therapy to treat sleep-related bradyarrhythmias. But in world practice there are no unambiguous guidelines for the management of this group of patients.

Simple Summary: Our body's reaction to acute emotional stress differs, depending on several factors, which include a small molecule called endothelin. Excessive responses are important, as they can trigger (sometimes serious) heartbeat disturbances. To further investigate the role of endothelin in this process, we compared the reactions to laboratory-induced stress in two groups of rats, known to have diverse baseline levels of endothelin in the blood. We found distinct responses leading to slow heartbeat disturbances in the latter group. This feature resembles that observed in people with a tendency to faint after strong emotions, a common problem with many unknown aspects. Our study calls for further research on the effects of endothelin on fainting and irregular heartbeat after acute emotional stress. The ubiquitous peptide endothelin is currently under investigation as a modulatory factor of autonomic responses to acute emotional stress. Baseline plasma levels of endothelin alter blood pressure responses, but it remains unclear whether autonomic activity and arrhythmogenesis (i.e., brady- or tachyarrhythmias) are affected. We recorded sympathetic and vagal indices (derived from heart rate variability analysis), rhythm disturbances, voluntary motion, and systolic blood pressure after acute emotional stress in conscious rats with implanted telemetry devices. Two strains were compared, namely wild-type and ETB-deficient rats, the latter displaying elevated plasma endothelin. No differences in heart rate or blood pressure were evident, but sympathetic responses were blunted in ETB-deficient rats, contrasting prompt activation in wild-type rats. Vagal withdrawal was observed in both strains at the onset of stress, but vagal activity was subsequently restored in ETB-deficient rats, accompanied by low voluntary motion during recovery. Reflecting such distinct autonomic patterns, frequent premature ventricular contractions were recorded in wild-type rats, as opposed to sinus pauses in ETB-deficient rats. Thus, chronically elevated plasma endothelin levels blunt autonomic responses to acute emotional stress, resulting in vagal dominance and bradyarrhythmias. Our study provides further insights into the pathophysiology of stress-induced tachyarrhythmias and syncope. [ABSTRACT FROM AUTHOR]

Ticagrelor is currently considered a first-line choice in dual antiplatelet therapy (DAPT) following revascularization of acute coronary syndrome (ACS). However, its use is correlated with an increased incidence of two side effects, dyspnea and bradyarrhythmias, whose molecular mechanisms have not yet been defined with certainty and, consequently, neither of the therapeutic decisions they imply. We report the case of a patient with acute myocardial infarction treated with ticagrelor and aspirin as oral antithrombotic therapy after primary percutaneous coronary intervention (PCI), manifesting in a significant bradyarrhythmic episode that required a switch of antiplatelet therapy. Starting from this case report, this article aims to gather the currently available evidence regarding the molecular mechanisms underlying these side effects and propose possible decision-making algorithms regarding their management in clinical practice. [ABSTRACT FROM AUTHOR]

Fetal dysrhythmias are common abnormalities, which can be categorized into three types: rhythm irregularities, tachyarrhythmias, and bradyarrhythmias. Fetal arrhythmias, especially in high-risk pregnancies, require special monitoring and treatment. The aim of this study was to assess the stillbirth and early and late neonatal mortality rates for pregnancies complicated by fetal dysrhythmias from one single tertiary referral center from 2000 to 2022. Of the 1018 fetuses with congenital heart disease, 157 (15.42%) were evaluated in this analysis. Seventy-four (46.7%) fetuses had bradyarrhythmias, 51 (32.5%) tachyarrhythmias, and 32 (20.4%) had rhythm irregularities. Additional structural heart defects were detected in 40 (25.3%) fetuses and extracardiac anomalies in 29 (18.4%) fetuses. Thirteen (8.2%) families opted for termination of the pregnancy. Eleven (7.6%), out of 144 continued pregnancies ended in spontaneous intrauterine fetal death (IUFD). Neonatal death was observed in nine cases (5.7%), whereas three (1.9%) died within the first 7 days of life. Although most intrauterine fetal deaths occurred in pregnancies with fetal bradyarrhythmia, neonatal death was observed more often in fetuses with tachyarrhythmia (8.5%). The presence of extracardiac anomalies, congenital heart disease (CHD), and Ro-antibodies are predictive factors for the occurrence of IUFD. Rhythm irregularities without any other risk factor do not present higher risks of adverse perinatal outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the effects of Huangqi Guizhi Wuwu decoction on heart rate recovery from bradyarrhythmia, serum fatty acid binding protein levels and plasma Ang Ⅱ, Adropin and galectin (Gal) 3. METHODS: A total of 120 patients with bradyarrhythmias admitted into the hospital from Apr. 2020 to Apr. 2021 were extracted to be divided into the control group and the observation group via the random number table method, with 60 cases in each group. The control group was treated with routine treatment, while the observation group received Huangqi Guizhi Wuwu decoction based on the control group. The levels of Gal-3, vasoactive intestinal peptide (VIP), nitric oxide (NO) and Ang Ⅱ, Adropin, growth differentiation factor (GDF)-15, creatine kinase isoenzyme (CK-MB), heart-type fatty acid binding protein (H-FABP), endogenous nociceptin / orphanin FQ (N/ OFQ), left ventricular ejection fraction (LVEF), heart rate (HR), root mean square of the difference between successive NN intervals (RMSSD), every 5 min NN standard deviation of mean interval (SDANN) and total NN interval (SDNN) before and after treatment in two groups were detected. Clinical efficacy of two groups were compared. RESULTS: After treatment, the level of Ang Ⅱ of the observation group was lower than that of the control group, the levels of VIP, Adropin and NO were higher than those of the control group, the levels of Gal-3, GDF-15 was lower than that of the control group, the levels of H-FABP, CK-MB and N/ OFQ were lower than those of the control group, the levels of LVEF and HR were higher than those of the control group, the levels of RMSSD and SDANN were lower than those in the control group, the level of SDNN was higher than that of the control group, with statistically significant differences (P<0. 05). The total effective rate of the observation group was 96. 67% (58 / 60), higher than 83. 33% (50 / 60) of the control group, the difference was statistically significant (P < 0. 05). CONCLUSIONS: Huangqi Guizhi Wuwu decoction in the treatment of patients with bradyarrhythmias can improve vascular endothelial function, inhibit inflammation, reduce myocardial damage, improve heart rate, heart rate variability and cardiac function, and improve the clinical efficacy. [ABSTRACT FROM AUTHOR]

The ubiquitous peptide endothelin is currently under investigation as a modulatory factor of autonomic responses to acute emotional stress. Baseline plasma levels of endothelin alter blood pressure responses, but it remains unclear whether autonomic activity and arrhythmogenesis (i.e., brady- or tachyarrhythmias) are affected. We recorded sympathetic and vagal indices (derived from heart rate variability analysis), rhythm disturbances, voluntary motion, and systolic blood pressure after acute emotional stress in conscious rats with implanted telemetry devices. Two strains were compared, namely wild-type and ETB-deficient rats, the latter displaying elevated plasma endothelin. No differences in heart rate or blood pressure were evident, but sympathetic responses were blunted in ETB-deficient rats, contrasting prompt activation in wild-type rats. Vagal withdrawal was observed in both strains at the onset of stress, but vagal activity was subsequently restored in ETB-deficient rats, accompanied by low voluntary motion during recovery. Reflecting such distinct autonomic patterns, frequent premature ventricular contractions were recorded in wild-type rats, as opposed to sinus pauses in ETB-deficient rats. Thus, chronically elevated plasma endothelin levels blunt autonomic responses to acute emotional stress, resulting in vagal dominance and bradyarrhythmias. Our study provides further insights into the pathophysiology of stress-induced tachyarrhythmias and syncope.

Aims: There is a paucity of epidemiological evidence on alcohol and the risk of bradyarrhythmias. We thus characterized associations of total and beverage-specific alcohol consumption with incident bradyarrhythmias using data from the UK Biobank.Methods and Results: Alcohol consumption reported at baseline was calculated as UK standard drinks (8 g alcohol)/week. Bradyarrhythmia events were defined as sinus node dysfunction (SND), high-level atrioventricular block (AVB), and permanent pacemaker implantations. Outcomes were assessed through hospitalization and death records, and dose-response associations were characterized using Cox regression models with correction for regression dilution bias. We studied 407 948 middle-aged individuals (52.4% female). Over a median follow-up time of 11.5 years, a total of 8 344 incident bradyarrhythmia events occurred. Increasing total alcohol consumption was not associated with an increased risk of bradyarrhythmias. Beer and cider intake were associated with increased bradyarrhythmia risk up to 12 drinks/week; however, no significant associations were observed with red wine, white wine, or spirit intake. When bradyarrhythmia outcomes were analysed separately, a negative curvilinear was observed for total alcohol consumption and risk of SND, but no clear association with AVB was observed.Conclusion: In this predominantly White British cohort, increasing total alcohol consumption was not associated with an increased risk of bradyarrhythmias. Associations appeared to vary according to the type of alcoholic beverage and between different types of bradyarrhythmias. Further epidemiological and experimental studies are required to clarify these findings. [ABSTRACT FROM AUTHOR]

In this article, we describe our first experiences implanting the AVEIR VR leadless pacemaker (Abbott) in Kazakhstani patients, a significant step in the development of this technology in Central Asia. This case series includes five male patients, with a range of symptoms (presyncope, dizziness and dyspnoea on exertion), ranging in age from 14 to 77 years; some individuals also had comorbidities, including atrioventricular block and AF. Indications for pacing were identified in each patient. The parameters of postimplantation stimulation and the results of initial observations were recorded. The procedure was quite successful and radiographic confirmation of the location of the leadless pacemaker was obtained. All patients demonstrated clinical improvement and satisfactory pacing parameters at early follow-up. The potential of the AVEIR leadless pacemaker to minimise lead insertion complications has been demonstrated, with no immediate complications observed in the patients in this study., Competing Interests: Disclosure: The authors have no conflicts of interest to declare. Ethics: The study was approved by the National Research Cardiac Surgery Center’s ethics committee. Consent: Informed consent was obtained from adult patients and from the child’s parents., (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)

Ticagrelor is currently considered a first-line choice in dual antiplatelet therapy (DAPT) following revascularization of acute coronary syndrome (ACS). However, its use is correlated with an increased incidence of two side effects, dyspnea and bradyarrhythmias, whose molecular mechanisms have not yet been defined with certainty and, consequently, neither of the therapeutic decisions they imply. We report the case of a patient with acute myocardial infarction treated with ticagrelor and aspirin as oral antithrombotic therapy after primary percutaneous coronary intervention (PCI), manifesting in a significant bradyarrhythmic episode that required a switch of antiplatelet therapy. Starting from this case report, this article aims to gather the currently available evidence regarding the molecular mechanisms underlying these side effects and propose possible decision-making algorithms regarding their management in clinical practice.

Several cardiovascular diseases and arrhythmogenic events have been associated with COVID-19 due to SARS-COV-2 infection, a topic of current global interest. Bradyarrhythmias are less frequent than other types of arrhythmia. We present a patient at 27 weeks of pregnancy, who on the fourth day of infection presented asymptomatic transient sinus pauses that did not require treatment (sinus bradycardia of 41 beats per minute, pauses of two seconds and junctional escape rhythm). She was diagnosed as possible atrial myopathy with third degree sinoatrial block, sinus arrest or atrial quiescence, primary sinoatrial node dysfunction due to myocarditis (edema and inflammation of the conduction system). She continued under followup, since after the infection was overcome arrhythmical events may recur. The second patient, 39 years old, presented bradyarrhythmia on the ninth day of infection, transient absence of P waves and junctional atrioventricular and idioventricular escape rhythms, as well as atrioventricular dissociation. No specific treatment was required. [ABSTRACT FROM AUTHOR]

This is a retrospective case series of two patients with laboratory-confirmed coronavirus 2 (SARS-CoV-2) infection, presented to the University of Arkansas for Medical Sciences in January 2021. Medical records of these patients were reviewed using the EPIC electronic health record system. Clinical, laboratory, and treatment data were reviewed against periods of bradycardia in each patient. Both of the patients presented with dizziness and presyncope related to sinus bradycardia in which they received treatment with 1 mg of IV atropine and theophylline 200 mg orally. We share these two cases of theophylline treatment in COVID-19 induced sinus bradycardia. The first patient was a 39-year-old female, with a past medical history of polycystic ovarian syndrome, who presented to the emergency department with lightheadedness and dizziness. Two weeks prior to her presentation, she was tested positive for COVID-19 infection that was treated with azithromycin, dexamethasone and aspirin. Upon presentation, her ECG showed sinus bradycardia at a rate of 48 bpm. The second patient, a 21-year-old female with no significant past medical history, presented with presyncope. Three weeks prior to her presentation, she tested positive for COVID-19 infection that was treated symptomatically at her home. Upon presentation, her ECG showed junctional rhythm at a heart rate of 51 bpm.

Introduction: Bradyarrhythmias are an established red flag for storage cardiac conditions including Anderson–Fabry disease (AFD). The prevalence of bradyarrhythmias requiring a pacemaker (PM) and their timing in AFD is unresolved. Methods: We evaluated the prevalence and predictors of PM requirement in a large AFD cohort, investigating the occurrence of bradyarrhythmias as initial versus late manifestation. We retrospectively evaluated 82 consecutive AFD patients referred to our multidisciplinary referral center from 1994 to 2020 with a median follow‐up of 6.9 years, identifying those requiring pacing. Univariable analysis was performed to identify cardiac features associated with PM implantation. Results: Five of 82 (6%) AFD patients required PM implantation (5/39, i.e., 13% of those with cardiac involvement), always in the context of advanced cardiomyopathy. In none, bradyarrhythmias were the presenting feature. Indications included sick sinus syndrome in three patients, advanced atrioventricular block in two patients. QRS prolongation during follow‐up strongly correlated with the onset of bradyarrhythmias. Conclusion: Severe bradyarrhythmias are relatively frequent in patients with AFD cardiomyopathy, but do not represent a mode of presentation, occurring late in the disease course and always in the context of advanced cardiac involvement. Monitoring QRS variations over time may help to identify patients requiring pacing. [ABSTRACT FROM AUTHOR]

Importance: Coronavirus disease 2019 is associated with a variety of arrhythmias. However, there are limited data regarding bradyarrhythmias and cardiac pauses in COVID-19. Objective: The objective was to characterize significant cardiac pauses in critically ill COVID-19 patients. Design: This was a case series of 26 consecutive patients with confirmed COVID-19 at an academic medical center in Shreveport, Louisiana. Setting: The study was conducted in the intensive care unit (ICU) and step-down ICU. Participants: Patients were either on mechanical ventilation or high-flow oxygen by nasal cannula. Main Outcomes and Measures: Demographic, clinical, laboratory, and medication data were analyzed. Continuous telemetry monitoring was utilized to record number, type, and duration of bradyarrhythmic events as well as their risk determinants. Results: The median age of the 26 patients was 49.5 years (range 33–78). Fifteen (57.7%) were men. Incidence of significant bradycardia and cardiac pauses, defined as an event, occurred in 11 (42.3%) patients. The median age of patients with an event was 57 years (range 33–66) and 5 (45.5%) were men. The average pause duration was 6.77 s with a range of 1.6–30 s. Five of 11 (45.5%) patients had high-grade atrioventricular (AV) nodal block. One patient required temporary pacemaker insertion for complete heart block and recurrent asystole arrests. A trend toward higher troponin I level in bradyarrhythmia patients was noted (mean troponin I was 2.72 ng/mL, [standard deviation] 4.48) compared to patients without event(s) (mean 0.42 ng/mL 0.52, P = 0.07). Conclusions and Relevance: Significant bradycardic events in critically ill patients with COVID-19 occurred in 42.3% of patients. This is the first case series of such events in COVID-19 patients. Increased awareness of these findings could affect management techniques and call for enhanced monitoring of such patients.

The article provides a scientific review based on the proceedings of the 2020 American Heart Association consensus on drugs that may cause arrhythmias on a risk-sensitive basis and a guidance on strategies for monitoring, prevention methods and therapeutic approaches.The risk factors for drug-induced arrhythmias are divided into modifiable and non-modifiable. Among the non-modifiable risk factors are congenital anomalies (changes in the conduction system, ion channel polymorphism) and heart diseases (cavity dilatation, myocardial ischemia). Among the modifiable risk factors are various electrolyte disorders (hypo/hyperkalemia, hypo/hypermagnesemia, hypocalcemia). Certain drugs can lead to electrolyte disorders, which require management with potassium and magnesium supplements. The drug-induced arrhythmias can be caused by conditions leading to altered drug pharmacokinetics and increased plasma concentrations and metabolites having proarrhythmogenic effects, as well as drug-drug interactions.Beta-blockers, non-dihydropyridine calcium channel blockers, other antiarrhythmic drugs, ivabradine, digoxin, anesthetics (bupivacaine, propofol) are the most common culprits in causing drug-induced bradyarrhythmias. The drug-induced atrial fibrillation frequently occurs in patients receiving antiarrhythmics, various sympathomimetics, psychotropic and antineoplastic drugs, anti-inflammatory (NSAIDs, corticosteroids) and immunotropic agents (interleukin-2, fingolimod). Various sympathomimetics and inotropic drugs, some antipsychotic drugs can produce drug-induced atrial and nodal tachyarrhythmias.The drug-induced ventricular tachycardia can be caused by antiarrhythmics, inotropics and various sympathomimetics, antipsychotic and antineoplastic drugs, as well as herbal drugs (aconite, ginkgo biloba). The list of drugs that cause a long QT syndrome includes antiarrhythmics, antimicrobial drugs (macrolides, fluoroquinolones, aminoquinolines, fluconazole), antipsychotics, antineoplastic drugs, antiemetics, etc. For a complete list of drugs that prolong a QT interval, see the CredibleMeds website (Arizona, USA). The drug-induced arrhythmia prevention strategies include rising awareness among doctors about risk factors and potentially dangerous drugs, sufficient monitoring of patients at risk of developing arrhythmias (ECG monitoring, electrolyte balance, kidney and liver function), maintenance of electrolyte balance, primarily potassium and magnesium. The therapeutic approach includes discontinuation of a causative drug; relief and maintenance therapy are carried out based on the modern international clinical guidelines for various forms of arrhythmias.

Cardiac amyloidosis (CA) is an increasingly recognized cause of heart failure, characterized by extracellular deposition of insoluble protein fibrils leading to progressive myocardial dysfunction. The most common types of cardiac amyloidosis are immunoglobin light‐chain (AL) and transthyretin (ATTR). Conduction abnormalities are commonly encountered among patients with cardiac amyloidosis and are an important cause of morbidity and mortality. Abnormalities range from infra‐Hisian intraventricular conduction delay and bundle branch block to complete atrioventricular block. Pacemaker placement in CA patients follows established guidelines, similar to those for patients without CA, with generally good efficacy. The role and appropriate timing of pacemakers for primary prevention of brady‐arrhythmias in CA remains uncertain. While biventricular (BiV) pacing has been shown to improve clinical outcomes in patients with systolic heart failure without CA, there are few data examining the utility of BiV pacing in patients with CA. With the advent of effective treatments for AL and ATTR, appropriate application of pacing is important to support patients with CA and conduction disease through therapeutic trials. This systematic review summarizes the current literature examining the utility of pacing in CA. [ABSTRACT FROM AUTHOR]

Fetal dysrhythmias are common abnormalities, which can be categorized into three types: rhythm irregularities, tachyarrhythmias, and bradyarrhythmias. Fetal arrhythmias, especially in high-risk pregnancies, require special monitoring and treatment. The aim of this study was to assess the stillbirth and early and late neonatal mortality rates for pregnancies complicated by fetal dysrhythmias from one single tertiary referral center from 2000 to 2022. Of the 1018 fetuses with congenital heart disease, 157 (15.42%) were evaluated in this analysis. Seventy-four (46.7%) fetuses had bradyarrhythmias, 51 (32.5%) tachyarrhythmias, and 32 (20.4%) had rhythm irregularities. Additional structural heart defects were detected in 40 (25.3%) fetuses and extracardiac anomalies in 29 (18.4%) fetuses. Thirteen (8.2%) families opted for termination of the pregnancy. Eleven (7.6%), out of 144 continued pregnancies ended in spontaneous intrauterine fetal death (IUFD). Neonatal death was observed in nine cases (5.7%), whereas three (1.9%) died within the first 7 days of life. Although most intrauterine fetal deaths occurred in pregnancies with fetal bradyarrhythmia, neonatal death was observed more often in fetuses with tachyarrhythmia (8.5%). The presence of extracardiac anomalies, congenital heart disease (CHD), and Ro-antibodies are predictive factors for the occurrence of IUFD. Rhythm irregularities without any other risk factor do not present higher risks of adverse perinatal outcome.

Bullous pemphigoid is an autoimmune blistering disorder predominantly affecting the elderly, with rare systemic complications, including cardiac involvement. This case study presents a 46-year-old female with a history of arterial hypertension who developed complete heart block (CHB) associated with bullous pemphigoid. The patient initially presented with bilateral lower limb swelling and discoloration, later diagnosed as bullous pemphigoid following the appearance of characteristic skin lesions. Concurrently, she was found to have asymptomatic bradycardia, with an electrocardiogram confirming CHB. After ruling out other causes of heart block, a dual-chamber pacemaker was implanted, and the patient was treated with immunosuppressive therapy to control the autoimmune blistering disorder. This case highlights the rare but significant association between bullous pemphigoid and CHB, emphasizing the importance of multidisciplinary care and timely intervention in managing such complex cases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kakumani et al.)

Bleeding complications after pacemaker implantation pose risks, including infection and prolonged hospital stay. A case involving aortic intramural hematoma (IMH) arising from subclavian vein access during implantation and concomitant acute pulmonary embolism (PE) is presented. In the present case, IMH probably resulted from subclavian artery vasa vasorum trauma during vein puncture and guidewire advancement, leading to IMH and hemothorax. PE possibly stemmed from a prothrombotic state caused by the intervention and the IMH. Conservative management with serial CT scans was chosen due to hemodynamic stability and high surgical risk. IMH and PE resolution was confirmed at follow-up., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Del Monaco et al.)

Bradyarrhythmias, characterized by heart rates of <60 bpm due to conduction issues, carry risks of sudden cardiac death and falls. Pacemaker implantation is a standard treatment, but the interplay between bradyarrhythmias, coronary artery disease (CAD), and patient attributes requires further exploration. This study was a retrospective hospital record-based study that analyzed data from 699 patients who underwent pacemaker implantation for symptomatic bradyarrhythmias between February 2019 and February 2022. Clinical parameters, coronary angiography (CAG) findings, ejection fraction, and indications for pacemaker implantation were documented. The relationship between CAD severity, specific bradyarrhythmias, and ejection fraction was explored. Statistical analysis included chi-squared tests and t tests. The mean age of the study population (n = 699) was 66.75 years (male:female ratio, 70:30), with 77.2% having type 2 diabetes and 61.6% being hypertensive. The majority of patients had minor or non-obstructive CAD (61.8%), followed by normal CAG findings (25.75%) and obstructive CAD (12.45%). Complete heart block (CHB) was the primary indication for pacemaker implantation (55.2%), followed by sick sinus syndrome (22.3%). The results did not show any association between ejection fraction and CAG findings. Patients who presented with CHB had a higher incidence of obstructive CAD, indicating greater severity. This study sheds light on the intricate interplay between severe bradyarrhythmias, CAD, and patient characteristics. Our analysis revealed no statistical significance between obstructive CAD and the need for a permanent pacemaker. This makes us question our practice of maintaining a low threshold for coronary angiography during pacemaker implantation. The observed low yield and anticoagulation protocol reassure us of the choice to delay this diagnostic intervention. These insights can guide tailored management strategies, enhancing clinical care approaches for patients with severe bradyarrhythmias necessitating pacemaker implantation., Competing Interests: The authors report no conflicts of interest for the published content. No funding information was provided., (Copyright: © 2024 Innovations in Cardiac Rhythm Management.)

The objective of this retrospective study was to describe the indications, complications, and long-term outcomes in a group of cats that received an epicardial pacing (EP) system. Twenty client-owned cats. Medical records were reviewed for signalment, presenting complaint, primary electrocardiogram (ECG) diagnosis, presence of structural heart disease, presence of congestive heart failure (CHF), presence of major or minor complications, and survival time. The majority of cats were presented for syncope (n = 11), and the most common ECG diagnosis was advanced second-degree atrioventricular block (n = 9). Fifteen cats (15/20, 75%) had one or more major or minor complications. One cat died in the perioperative period as a result of a major complication. None of the variables evaluated were associated with a statistically significant increase in the occurrence of major or minor complications. The most common major complication was loss of ventricular capture (seven instances in six cats), which was successfully treated in all cases by increasing pacemaker output or replacing both the lead and the pulse generator. The most common minor complications were arrhythmias (n = 7) and sensing issues (n = 8). The overall median survival time (MST) was 948 days. No statistical difference in survival time was identified between cats that experienced a major complication and those that did not. Although complications were common in this feline population after EP, major and minor complications were successfully treated. [ABSTRACT FROM AUTHOR]

We report a case of unusual and unexplained cardiac death in an 18-years old female patient with congenital neurosensorial deafness. The fatal event was characterized by an initial syncopal episode, associated with a wide QRS tachycardia (around 110 bpm) but stable hemodynamic conditions. The patient, however, subsequently developed severe hypotension and progressive bradyarrhythmias until asystole and lack of cardiac response to resuscitation maneuvers and ventricular pacing. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate differences in cardiac manifestations of patients affected by laminopathy, according to the presence or absence of neuromuscular involvement at presentation. Methods We prospectively analyzed 40 consecutive patients with a diagnosis of laminopathy followed at a single centre between 1998 and 2017. Additionally, reports of clinical evaluations and tests prior to referral at our centre were retrospectively evaluated. Results Clinical onset was cardiac in 26 cases and neuromuscular in 14. Patients with neuromuscular presentation experienced first symptoms earlier in life (11 vs 39 years; p

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation.

This is a retrospective case series of two patients with laboratory-confirmed coronavirus 2 (SARS-CoV-2) infection, presented to the University of Arkansas for Medical Sciences in January 2021. Medical records of these patients were reviewed using the EPIC electronic health record system. Clinical, laboratory, and treatment data were reviewed against periods of bradycardia in each patient. Both of the patients presented with dizziness and presyncope related to sinus bradycardia in which they received treatment with 1 mg of IV atropine and theophylline 200 mg orally. We share these two cases of theophylline treatment in COVID-19 induced sinus bradycardia. The first patient was a 39-year-old female, with a past medical history of polycystic ovarian syndrome, who presented to the emergency department with lightheadedness and dizziness. Two weeks prior to her presentation, she was tested positive for COVID-19 infection that was treated with azithromycin, dexamethasone and aspirin. Upon presentation, her ECG showed sinus bradycardia at a rate of 48 bpm. The second patient, a 21-year-old female with no significant past medical history, presented with presyncope. Three weeks prior to her presentation, she tested positive for COVID-19 infection that was treated symptomatically at her home. Upon presentation, her ECG showed junctional rhythm at a heart rate of 51 bpm. [ABSTRACT FROM AUTHOR]

Aims: We determined the incidence and type of arrhythmias at 2-year follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR).Methods and Results: Multicentre prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR (SAPIEN XT/3: 53; CoreValve/Evolut R: 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted before hospital discharge and patients had continuous monitoring for up to 2 years. Arrhythmic events were adjudicated in a central core lab. 1836 new arrhythmic events (tachyarrhythmias: 1655 and bradyarrhythmias: 181) occurred at 2 years. Of these, 283 (15%) occurred beyond 1 year (tachyarrhythmias 212, bradyarrhythmias 71) in 33 (36%) patients, without differences between valve type. Most late (>1 year) arrhythmic events were asymptomatic (94%) and led to a treatment change in 17 (19%) patients. A total of 71 late bradyarrhythmias [high-degree atrioventricular block (HAVB): 3, severe bradycardia: 68] were detected in 17 (21%) patients. At 2 years, 18 (17%) patients had received a permanent pacemaker (PPM) or implantable cardiac-defibrillator. PPM implantation due to HAVB predominated in the early phase post-TAVR, with only 1 HAVB event requiring PPM implantation after 1 year.Conclusion: Patients with new-onset LBBB post-TAVR exhibited a very high burden of arrhythmic events within the 2 years post-procedure. While new tachyarrhythmic events were homogeneously distributed over time, the vast majority of new HAVB episodes leading to PPM implantation occurred early after the procedure. These results should help to guide the management of this challenging group of patients. (clinicaltrials.gov: NCT02153307). [ABSTRACT FROM AUTHOR]

Background: P2Y12 inhibitors have differing associations of bradyarrhythmias. Ticagrelor has been shown to increase adenosine plasma concentrations leading to increases in bradyarrhythmias. While clopidogrel and prasugrel have not been shown to have any association with bradyarrhythmias., Objective: The objective of this study was to determine heart rates after ticagrelor initiation compared to clopidogrel/prasugrel in inferior ST Elevation Myocardial Infarction (STEMI) patients., Methods: This was a retrospective, multicenter study conducted at 3 primary percutaneous coronary intervention (PCI) centers between January 1, 2017 and September 30, 2022. Adult patients were included if they were diagnosed with an inferior STEMI to the right coronary artery (RCA) and treated with PCI followed by an oral P2Y12 inhibitor. The primary outcome was heart rate at 48 hours or discharge, whichever first, after administration of ticagrelor compared to clopidogrel/prasugrel., Results: This study reviewed 331 patients, 172 in the ticagrelor group and 159 in the clopidogrel/prasugrel group. There were no statistical differences between groups regarding the primary outcome, with a median heart rate of 76 beats per minute (bpm) [67-85] in the ticagrelor group versus 73 bpm [66-84] in the clopidogrel/prasugrel group ( P = 0.238). No differences were observed between groups regarding any secondary outcomes., Conclusion and Relevance: There were similar heart rates between ticagrelor and clopidogrel/prasugrel. There were also similarities in the ability to tolerate beta-blocker therapy after initiation of a P2Y12 inhibitor. The results of this study suggest that in inferior STEMIs when using ticagrelor as the P2Y12 inhibitor, there are not increased clinical manifestations of bradycardia., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The adverse effects of ventricular dyssynchrony induced by right ventricular (RV) pacing has led to alternative pacing strategies, such as biventricular, His bundle (HBP), LV septal (LVSP) and left bundle branch pacing (LBBP). Given the overlap, LVSP and LBBP are also collectively referred to as left bundle branch area pacing (LBBAP). Although among these alternative pacing sites HBP is theoretically the ideal strategy as it maintains a physiological ventricular activation, its application requires more skills and is associated with the most complications. LBBAP, where the ventricular pacing lead is advanced through the interventricular septum to its left side, creates ventricular activation that is only slightly more dyssynchronous. Preliminary studies have shown that LBBAP is feasible, safe and encounters less limitations than HBP. Further studies are needed to differentiate between LVSP and LBBP with regard to acute functional and long-term clinical outcome. [ABSTRACT FROM AUTHOR]

Theleadless pacemaker (LLPM) therapy has been developed in recent years to overcome the transvenous lead and device pocket‐related complications. The LLPMs now available are self‐contained right ventricular pacemakers and are limited to single‐chamber ventricular pacing modality. This literature review deals with the current status of LLPM technology and current areas of clinical applicability. The safety and efficacy outcomes published from randomized clinical trials and real world registries are analyzed and compared with historical conventional transvenous pacemaker data. Furthermore, new pacing modalities and future perspectives to broaden the clinical use and cover most of pacing indications are discussed. Due to the overall safe and effective profile in the short term and intermediate term, also in fragile patients, the LLPM use is constantly growing in daily clinical practice. Actually, it can be considered a landmark innovation, through which a new era of cardiac pacing has begun. [ABSTRACT FROM AUTHOR]

The results of prospective studies, meta-analyzes and systematic reviews on the associations of obstructive sleep apnea (OSA) with various cardiovascular diseases (CVD) were analyzed. Currently, the mechanisms related to high prevalence of breathing-related sleep disorders among population of economically developed countries are clear, and an increase in the number of OSA patients has been shown. The relationship between OSA and CVD has been widely confirmed in large cohort studies. The first review part discusses the relationship of hypertension (HTN) and various heart arrhythmias (atrial fibrillation (AF), bradyarrhythmias, premature ventricular contraction, sudden death during sleep) with breathing-related sleep disorders. These groups of cardiovascular disorders currently show the most proven relationship with sleep apnea. In addition to cross-sectional studies indicating the high prevalence of OSA in patients with HTN and AF, some observational studies indicate an increase in the number of patients with HTN and paroxysmal AF with history of untreated sleep apnea. An analysis of the current issues of OSA phenotypes (in particular, REM-related OSA in hypertensive patients) as the most unfavorable cardiovascular factors is carried out.

Introduction: Myocardial infarction is defined as a clinical or pathologic event caused by myocardial ischemia in which there is evidence of myocardial injury or necrosis. The diagnosis of myocardial infarction is established by typical symptoms, cardiac biomarkers, electrocardiographic changes, or imaging evidence of new regional wall motion abnormality or new loss of viable myocardium. Arrhythmias are well-recognised complications of Acute Myocardial Infarction (AMI) and are important risk factors for mortality in both men and women, across a wide age range. Aim: To analyse the incidence of arrhythmias in acute myocardial infarction with respect to the type, age, gender distribution, location and extension of AMI and to interpret effect of arrhythmias on mortality and morbidity in patents in the first 48 hours of AMI. Materials and Methods: This observational study included 120 patients admitted within one hour of chest pain in Cardiac care unit at Sri Ramachandra Institute of Higher Education and Research Chennai, Tamil Nadu, India from February 2017 to April 2018 after fulfilling the inclusion criteria. Diagnosis of AMI with arrhythmia was made on clinical features, electrocardiography, cardiac biomarkers and echocardiogram. For statistical analysis of data, Statistical Package for Social Sciences (SPSS 16.0 version) was used. Results: In this study of 120 patients, 74 (61.7%) were males and 46 (38.3%) were females (post-menopause) and highest incidence of arrhythmia was noted in the age group of 61-70 years (32.5%). A total of 71 patients (59.2%) presented with chest pain (p

Introduction: Bradyarrhythmias are a common clinical finding yet can be life-threatening in certain situations. Accordingly, diagnosis and prompt intervention remain the cornerstone of effective management of bradyarrhythmia. The study compares the two methods by assessing improvement in knowledge acquisition using pretest, posttest, and satisfaction survey with the teaching pedagogy. Materials and Methods: A randomized control trial of simulation-based teaching compared with case-based discussion was conducted among Postgraduate Diploma in Emergency Medical Services students. The students anonymously filled out pretest, posttest, and a satisfaction questionnaire composed of six statements in three domains (quality of instruction, debriefing, and overall satisfaction). The statements were rated using a 10-point scale. Test results were compared using t-test for equality of means of independent samples. Results and Discussion: All 40 students selected completed all the steps of the study. Knowledge improvement from pretest to posttest was observed in both teaching methods derived using paired sample t-test (P < 0.05). However, no significant difference was observed while comparing improvement scores of posttest versus pretest between both the groups. Mean satisfaction score of simulation group was significantly higher at 8.40 compared to case-based group which was at 7.87. Satisfaction survey showed marked significance (P = 0.03) for simulation-based teaching. Conclusion: As a single intervention, simulation-based teaching is superior to case-based discussion in terms of student satisfaction but remains similarly effective in terms of knowledge acquisition.

Aims: The primary aim of the VIP‐HF study was to examine the incidence of sustained ventricular tachyarrhythmias (VTs) in heart failure (HF) with mid‐range (HFmrEF) or preserved ejection fraction (HFpEF). Secondary aims were to examine the incidence of non‐sustained VTs, bradyarrhythmias, HF hospitalizations and mortality. Methods and results: This was an investigator‐initiated, prospective, multicentre, observational study of patients with HF and left ventricular ejection fraction (LVEF) >40%. Patients underwent extensive phenotyping, after which an implantable loop recorder was implanted. We enrolled 113 of the planned 250 patients [mean age 73 ± 8 years, 51% women, New York Heart Association class II/III 54%/46%, median N‐terminal pro B‐type natriuretic peptide 1367 (710–2452) pg/mL and mean LVEF 54 ± 6%; 75% had LVEF >50%]. Eighteen percent had non‐sustained VTs and 37% had atrial fibrillation on Holter monitoring. During a median follow‐up of 657 (219–748) days, the primary endpoint of sustained VT was observed in one patient. The incidence of the primary endpoint was 0.6 (95% confidence interval 0.2–3.5) per 100 person‐years. The incidence of the secondary endpoint of non‐sustained VT was 11.5 (7.1–18.7) per 100 person‐years. Five patients developed bradyarrhythmias [3.2 (1.4–7.5) per 100 person‐years], three were implanted with a pacemaker. In total, 23 patients (20%) were hospitalized for HF [16.3 (10.9–24.4) per 100 person‐years]. Fourteen patients (12%) died [8.7 (5.2–14.7) per 100 person‐years]; 10 due to cardiovascular causes, and four sudden deaths, one with implantable loop recorder‐confirmed bradyarrhythmias as terminal event, three others undetermined. Conclusion: Despite the lower than expected number of included patients, the incidence of sustained VTs in HFmrEF/HFpEF was low. Clinically relevant bradyarrhythmias were more often observed than expected. [ABSTRACT FROM AUTHOR]

Background: In many genetic and acquired non-ischaemic cardiomyopathies (NICM) there have been frequent reports of involvement of the interventricular septum (IVS) by late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR). However, no studies have investigated the relationship between septal LGE and arrhythmias in different NICM subtypes.Methods: This study enrolled 103 patients with septal LGE at baseline CMR and different NICM: hypertrophic (n=29) or lamin A/C gene (LMNA)-associated (n=23) cardiomyopathy, and acute (n=30) or previous (n=21) myocarditis. During follow-up, the occurrences of malignant ventricular arrhythmias (MVA) and major bradyarrhythmias (BA) were evaluated.Results: At 4.9±0.7 years of follow-up, the occurrence of MVA and major BA in genetic vs acquired NICM were 10 of 52 vs 12 of 51, and 10 of 52 vs 4 of 51, respectively (both p=n.s.). However, MVA occurred more frequently in LMNA-NICM (eight of 23 vs two of 29 hypertrophic, p=0.015) and in previous myocarditis (nine of 21 vs three of 30 acute, p=0.016), while major BAs were particularly common in LMNA-NICM patients only (nine of 23 vs one of 29 hypertrophic, p=0.003). Different patterns of septal LGE were consistently retrospectively identified at baseline CMR: junctional and limited to the base in 79.3% of uneventful hypertrophic NICM; extended and focally transmural in LMNA-NICM with follow-up arrhythmias (both p<0.05); transitory in patients with acute myocarditis, who, differently from the post-myocarditis ones, showed follow-up arrhythmias only in the presence of unmodified LGE at follow-up CMR (five of 13, p=0.009).Conclusion: Septal LGE was significantly associated with MVA at the 5-year follow-up in LMNA-NICM or previous myocarditis, and with major BA in LMNA-NICM only. These differences correlated with heterogeneous patterns of IVS LGE in different NICM. [ABSTRACT FROM AUTHOR]

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Introduction: Myocardial infarction is defined as a clinical or pathologic event caused by myocardial ischemia in which there is evidence of myocardial injury or necrosis. The diagnosis of myocardial infarction is established by typical symptoms, cardiac biomarkers, electrocardiographic changes, or imaging evidence of new regional wall motion abnormality or new loss of viable myocardium. Arrhythmias are well-recognised complications of Acute Myocardial Infarction (AMI) and are important risk factors for mortality in both men and women, across a wide age range. Aim: To analyse the incidence of arrhythmias in acute myocardial infarction with respect to the type, age, gender distribution, location and extension of AMI and to interpret effect of arrhythmias on mortality and morbidity in patents in the first 48 hours of AMI. Materials and Methods: This observational study included 120 patients admitted within one hour of chest pain in Cardiac care unit at Sri Ramachandra Institute of Higher Education and Research Chennai, Tamil Nadu, India from February 2017 to April 2018 after fulfilling the inclusion criteria. Diagnosis of AMI with arrhythmia was made on clinical features, electrocardiography, cardiac biomarkers and echocardiogram. For statistical analysis of data, Statistical Package for Social Sciences (SPSS 16.0 version) was used. Results: In this study of 120 patients, 74 (61.7%) were males and 46 (38.3%) were females (post-menopause) and highest incidence of arrhythmia was noted in the age group of 61-70 years (32.5%). A total of 71 patients (59.2%) presented with chest pain (p<0.001) and 59.2% had type 2 diabetes. Anterior Wall Myocardial Infarction (AWMI) was observed in 29.16%, followed by Inferoposterior Wall Myocardial Infarction (IPWMI) which was observed in 21.6%. A total of 40.8% had arrhythmias within first hour of hospitalisation. In this study, ventricular premature complex was the most common arrhythmia, observed in 29.2%, followed by sinus tachycardia (20%). Tachyarrhythmias were more frequently observed in anterior infarction whereas bradyarrhythmias were more frequently observed in inferior infarction. 30.8% of patients had ejection fraction of <40%. Overall, mortality was 10% {5.8% in AWMI and 1.7% in IPWMI}. Cardiac biomarkers and left ventricular function were good predictors of extent of infarction (p<0.001). Ten deaths were due to arrhythmias and two secondarily to cardiogenic shock. Conclusion: In this study, it was observed that incidence of myocardial infarction increases with age and was noted more in males than females and in females it was noted more in postmenopausal group. Most common type of arrhythmias observed were ventricular premature complexes and sinus tachycardia and significant number of patients had arrhythmias during the first hour of hospitalisation. Overall, mortality rate was 10% and cardiac biomarkers and left ventricular function are good predictors of infarct size. [ABSTRACT FROM AUTHOR]

Aims Physical activity reduces cardiovascular disease burden and mortality, although its relationship with cardiac arrhythmias is less certain. The aim of this study was to assess the association between self-reported physical activity and atrial fibrillation (AF), ventricular arrhythmias and bradyarrhythmias, across the UK Biobank cohort. Methods and results We included 402 406 individuals (52.5% female), aged 40–69 years, with over 2.8 million person-years of follow-up who underwent self-reported physical activity assessment computed in metabolic equivalent-minutes per week (MET-min/wk) at baseline, detailed physical assessment and medical history evaluation. Arrhythmia episodes were diagnosed through hospital admissions and death reports. Incident AF risk was lower amongst physically active participants, with a more pronounced reduction amongst female participants [hazard ratio (HR) for 1500 vs. 0 MET-min/wk: 0.85, 95% confidence interval (CI) 0.74–0.98] than males (HR for 1500 vs. 0 MET-min/wk: 0.90, 95% CI 0.82–1.0). Similarly, we observed a significantly lower risk of ventricular arrhythmias amongst physically active participants (HR for 1500 MET-min/wk 0.78, 95% CI 0.64–0.96) that remained relatively stable over a broad range of physical activity levels between 0 and 2500 MET-min/wk. A lower AF risk amongst female participants who engaged in moderate levels of vigorous physical activity was observed (up to 2500 MET-min/wk). Vigorous physical activity was also associated with reduced ventricular arrhythmia risk. Total or vigorous physical activity was not associated with bradyarrhythmias. Conclusion The risk of AF and ventricular arrhythmias is lower amongst physically active individuals. These findings provide observational support that physical activity is associated with reduced risk of atrial and ventricular arrhythmias. Open in new tab Download slide Open in new tab Download slide [ABSTRACT FROM AUTHOR]