BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psy...BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psychological distress com-pared with the general CHD population.This increased vulnerability has garn-ered growing clinical and research interest in the potential therapeutic benefits of structured psychological interventions for alleviating comorbid depressive and anxiety symptoms in this high-risk demographic.AIM To evaluate the efficacy of psychological care in reducing anxiety and depressive symptoms among older adult patients with CHD and comorbid arrhythmia.METHODS This retrospective analysis included 100 patients with CHD and arrhythmia admitted to the First Affiliated Hospital of Jinzhou Medical University from June 2024 to December 2024.Of these,49 patients in the control group received routine care,whereas 51 patients in the observation group received psychological care in addition to routine care.Therapeutic outcomes were compared between the two groups.Psychological distress was assessed before and after providing nursing care.A treatment compliance scale developed by the hospital was used to assess adherence.Complication rates were also compared.Quality of life was evaluated using the Short Form-36 Health Survey after providing nursing care.Patient satisfaction with nursing care was assessed using a self-designed questionnaire.RESULTS The observation group demonstrated a higher overall treatment effectiveness compared with the control group(P<0.05).After nursing care,both groups showed reduced scores on the Self-Rating Anxiety Scale and Self-Rating Depression Scale compared with baseline(P<0.05),with significantly greater improvements in the observation group(P<0.05).Treatment compliance was higher and complication rates were lower in the observation group(P<0.05).Additionally,the observation group demonstrated better quality of life after 1 month of care and higher satisfaction with nursing services(P<0.05).CONCLUSION Psychological care for patients with CHD and comorbid arrhythmia effectively enhanced therapeutic outcomes,reduced anxiety and depression,improved treatment compliance and quality of life,and lowered the risk of complications.These findings support the broader implementation of psychological care for patients with CHD in clinical practice.展开更多
Diagnosing cardiac diseases relies heavily on electrocardiogram(ECG)analysis,but detecting myocardial infarction-related arrhythmias remains challenging due to irregular heartbeats and signal variations.Despite advanc...Diagnosing cardiac diseases relies heavily on electrocardiogram(ECG)analysis,but detecting myocardial infarction-related arrhythmias remains challenging due to irregular heartbeats and signal variations.Despite advancements in machine learning,achieving both high accuracy and low computational cost for arrhythmia classification remains a critical issue.Computer-aided diagnosis systems can play a key role in early detection,reducing mortality rates associated with cardiac disorders.This study proposes a fully automated approach for ECG arrhythmia classification using deep learning and machine learning techniques to improve diagnostic accuracy while minimizing processing time.The methodology consists of three stages:1)preprocessing,where ECG signals undergo noise reduction and feature extraction;2)feature Identification,where deep convolutional neural network(CNN)blocks,combined with data augmentation and transfer learning,extract key parameters;3)classification,where a hybrid CNN-SVM model is employed for arrhythmia recognition.CNN-extracted features were fed into a binary support vector machine(SVM)classifier,and model performance was assessed using five-fold cross-validation.Experimental findings demonstrated that the CNN2 model achieved 85.52%accuracy,while the hybrid CNN2-SVM approach significantly improved accuracy to 97.33%,outperforming conventional methods.This model enhances classification efficiency while reducing computational complexity.The proposed approach bridges the gap between accuracy and processing speed in ECG arrhythmia classification,offering a promising solution for real-time clinical applications.Its superior performance compared to nonlinear classifiers highlights its potential for improving automated cardiac diagnosis.展开更多
Background:A greater prevalence of arrhythmias has been described in endurance athletes,but it remains unclear whether this risk persists after detraining.We aimed to evaluate the prevalence of arrhythmias and their r...Background:A greater prevalence of arrhythmias has been described in endurance athletes,but it remains unclear whether this risk persists after detraining.We aimed to evaluate the prevalence of arrhythmias and their relationship with cardiac remodeling in lifelong and retired master endurance athletes compared to non-athletic controls.Methods:We performed a cross-sectional analysis of observational studies that used echocardiography and cardiac magnetic resonance to detail cardiac structure and function,and Holter monitors to identify atrial and ventricular arrhythmias in 185 endurance athletes and 81 non-athletic controls aged≥40 years.Athletes were categorized as active lifelong(n=144)or retired(n=41)based on hours per week of high-intensity endurance exercise within 5 years of enrollment and validated by percentage of predicted maximal oxygen consumption(VO_(2max)).Athletes with overt cardiomyopathies,channelopathies,pre-excitation,and/or myocardial infarction were excluded.Results:Lifelong athletes(median age=55 years(interquartile range(IQR):46-62),79%male)were significantly fitter than retired athletes(median age=66 years(IQR:58-71),95%male)and controls(median age=53 years(IQR:48-60),96%male),respectively(predicted VO_(2max):131%±18%vs.99%±14%vs.98%±15%,p<0.001).Compared to controls,athletes in our cohort had a higher prevalence of atrial fibrillation((AF):32%vs.0%,p<0.001)and non-sustained ventricular tachycardia((NSVT):9%vs.1%,p=0.007).There was no difference in prevalence of any arrhythmia between lifelong and retired athletes.Lifelong athletes had larger ventricular volumes than retired athletes,who had ventricular volumes similar to controls(left ventricular end-diastolic volume indexed to body surface area(LVEDVi):101±20 m L/m^(2)vs.86±16 mL/m^(2)vs.94±18 mL/m^(2),p<0.001;right ventricular end-diastolic volume indexed to body surface area(RVEDVi):117±23 mL/m^(2)vs.101±19 mL/m^(2)vs.100±19 mL/m^(2),p<0.001).Athletes had more scar(40%vs.18%,p=0.002)and larger left atria(median volume=45m L/m^(2)(IQR:38-52)vs.31 mL/m^(2)(IQR:25-38),p<0.001)than controls,with no difference in atrial volumes and non-ischaemic scar between the athlete groups.Conclusion:Master endurance athletes have a higher prevalence of AF and NSVT than non-athletic controls.Whereas ventricular remodeling tends to reverse with detraining,the propensity to arrhythmias persists regardless of whether they are actively exercising or retired.展开更多
Arrhythmias stand out for having irregular cardiac rhythms,and the fast diagnosis of arrhythmias holds significant clinical importance due to its potential to mitigate adverse health outcomes.Despite the progress in t...Arrhythmias stand out for having irregular cardiac rhythms,and the fast diagnosis of arrhythmias holds significant clinical importance due to its potential to mitigate adverse health outcomes.Despite the progress in this field,existing research efforts have encountered limitations,necessitating innovative approaches to address diagnostic challenges effectively.The primary objective of this research is to propose an innovative classification methodology for distinguishing five distinct arrhythmia classes:atrial premature beat(A),normal(N),ventricular premature beat(V),right bundle branch block(R),and left bundle branch block(L).The proposed methodology involves constructing a hybrid model that incorporates an attention mechanism,utilizing electrocardiogram(ECG)data from an open-source repository.Additionally,we have incorporated an explainability feature into the model,allowing for the interpretation and explanation of its predictions.This model is designed to capitalize on the unique features of arrhythmic patterns and enhance classification metrics.Innovative techniques employed within the methodology are detailed to elucidate the rationale behind their selection and their anticipated contributions to improved model performance.Findings from this study underscore the superiority of the proposed classification model over existing methodologies.Quantitative analysis demonstrates its outstanding performance.The approach,outperforming existing methods,achieves high levels of accuracy(99.16%),specificity(99.79%),recall(99.20%),precision(99.20%),F1-measure(99.16%),and AUC(99.92%).This research advances medical diagnostics by integrating advanced machine-learning techniques to enhance arrhythmia detection.展开更多
BACKGROUND Irregular heart rhythms are a primary manifestation of cardiovascular disease,considerably contributing to global morbidity and mortality rates.Moreover,patients with cardiac arrhythmias often experience a ...BACKGROUND Irregular heart rhythms are a primary manifestation of cardiovascular disease,considerably contributing to global morbidity and mortality rates.Moreover,patients with cardiac arrhythmias often experience a higher prevalence of sleep disorders,anxiety,and depression owing to various factors.AIM To investigate the epidemiological characteristics and psychological factors associated with arrhythmia in the elderly and to establish a theoretical foundation for its prevention and treatment in older adults.METHODS A retrospective analysis was performed on 169 elderly patients admitted to the Shangqiu First People’s Hospital from December 2022 to December 2023.All subjects underwent 24-hour electrocardiogram monitoring to record heart rate,heart rate variability,and 24-hour ambulatory electrocardiogram data.Additionally,patients’medical records were reviewed to gather information on their general condition,including age,gender,underlying diseases,and other relevant factors.Patients were divided into four groups based on their Hamilton Anxiety(HAMA)and Hamilton Depression Rating Scale(HAMD)scores:Group A(HAMA scores≥7),Group B(HAMD scores≥7),Group C(both HAMA and HAMD scores≥7),and Group D(HAMA and HAMD scores<7).Psychological factors such as depression,anxiety,sleep status,and quality of life were analyzed.Pearson correlation was used to examine the relationship between scores from the Pittsburgh Sleep Quality Index(PSQI),HAMA/HAMD scales,and the Short Form 36-item Health Survey(SF-36)with the presence of arrhythmia.RESULTS Among the 169 patients,87(51.5%)had concurrent arrhythmia.Atrial arrhythmias constituted the largest proportion at 34.8%(30 out of 87),followed by sinustachycardia at 24.1%(21 out of 87),and ventricular arrhythmias at 9.2%(8 out of 87).Factors such as advanced age,coronary heart disease,hypertension,smoking,exposure to secondhand smoke,and residing in rural areas significantly increased the risk of developing arrhythmia.There was a statistically significant difference between the two groups regarding PSQI,HAMA-14,HAMD-17,and SF-36 scores.Pearson correlation analysis revealed that PSQI,HAMA-14,and HAMD-17 scores were positively correlated with arrhythmia in the elderly,while the SF-36 score was negatively correlated.The anxiety,depression,and combined anxiety–depression groups exhibited significantly higher PSQI,HAMA-14,and HAMD-17 scores compared to the nonanxiety and non-depression group.CONCLUSION Arrhythmia among the elderly is primarily found in individuals with advanced age and existing health conditions.It is also linked to psychological factors such as depression,anxiety,reduced quality of life,and sleep disturbances.展开更多
Caffeine is a widely consumed stimulant known for its cardiovascular and metabolic effects.However,its impact on cardiovascular risk,including arrhythmias,in older adults remains underexplored.Emerging evidence highli...Caffeine is a widely consumed stimulant known for its cardiovascular and metabolic effects.However,its impact on cardiovascular risk,including arrhythmias,in older adults remains underexplored.Emerging evidence highlights sex-specific differences in caffeine metabolism,which may influence its role in cardiovascular health.This perspective examines the interaction between caffeine,hormonal changes,metabolic processes,and lifestyle factors,focusing on older women compared to men.Understanding these differences is essential for tailoring dietary and clinical recommendations to mitigate cardiovascular risks and promote healthy aging.展开更多
Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythm...Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythmia as the primary manifestation of cardiac metastasis of RCC with only two cases reported.[1,2]We add to the literature the third case,the diagnosis of which was only possible with cardiac magnetic resonance(CMR).展开更多
Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythm...Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia.The causes of AA are multifactorial.The review begins with a brief history of LT and AA.This review further describes the pathophysiology of the AA.The risk factors,incidence,recipient characteristics including intra-operative factors are elaborated on.Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT,the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia.The strategy of rate control vs rhythm control is discussed.The pros and cons of various drug regimen,need for direct current cardioversion and catheter ablation therapies are considered.Possible methods to prevent or reduce the incidence of AA after LT are considered.The impact of AA on the short-term and long-term outcomes following LT is discussed.展开更多
Arrhythmia is ubiquitous worldwide and cardiologists tend to provide solutions from the recent advancements in medicine.Detecting arrhythmia from ECG signals is considered a standard approach and hence,automating this...Arrhythmia is ubiquitous worldwide and cardiologists tend to provide solutions from the recent advancements in medicine.Detecting arrhythmia from ECG signals is considered a standard approach and hence,automating this process would aid the diagnosis by providing fast,costefficient,and accurate solutions at scale.This is executed by extracting the definite properties from the individual patterns collected from Electrocardiography(ECG)signals causing arrhythmia.In this era of applied intelligence,automated detection and diagnostic solutions are widely used for their spontaneous and robust solutions.In this research,our contributions are two-fold.Firstly,the Dual-Tree Complex Wavelet Transform(DT-CWT)method is implied to overhaul shift-invariance and aids signal reconstruction to extract significant features.Next,A neural attention mechanism is implied to capture temporal patterns from the extracted features of the ECG signal to discriminate distinct classes of arrhythmia and is trained end-to-end with the finest parameters.To ensure that the model’s generalizability,a set of five traintest variants are implied.The proposed model attains the highest accuracy of 98.5%for classifying 8 variants of arrhythmia on the MIT-BIH dataset.To test the resilience of the model,the unseen(test)samples are increased by 5x and the deviation in accuracy score and MSE was 0.12%and 0.1%respectively.Further,to assess the diagnostic model performance,AUC-ROC curves are plotted.At every test level,the proposed model is capable of generalizing new samples and leverages the advantage to develop a real-world application.As a note,this research is the first attempt to provide neural attention in arrhythmia classification using MIT-BIH ECG signals data with state-of-the-art performance.展开更多
With the help of computer-aided diagnostic systems,cardiovascular diseases can be identified timely manner to minimize the mortality rate of patients suffering from cardiac disease.However,the early diagnosis of cardi...With the help of computer-aided diagnostic systems,cardiovascular diseases can be identified timely manner to minimize the mortality rate of patients suffering from cardiac disease.However,the early diagnosis of cardiac arrhythmia is one of the most challenging tasks.The manual analysis of electrocardiogram(ECG)data with the help of the Holter monitor is challenging.Currently,the Convolutional Neural Network(CNN)is receiving considerable attention from researchers for automatically identifying ECG signals.This paper proposes a 9-layer-based CNN model to classify the ECG signals into five primary categories according to the American National Standards Institute(ANSI)standards and the Association for the Advancement of Medical Instruments(AAMI).The Massachusetts Institute of Technology-Beth Israel Hospital(MIT-BIH)arrhythmia dataset is used for the experiment.The proposed model outperformed the previous model in terms of accuracy and achieved a sensitivity of 99.0%and a positivity predictively 99.2%in the detection of a Ventricular Ectopic Beat(VEB).Moreover,it also gained a sensitivity of 99.0%and positivity predictively of 99.2%for the detection of a supraventricular ectopic beat(SVEB).The overall accuracy of the proposed model is 99.68%.展开更多
A canine model of ischemic ventricular tachyarrhythmias was established in open-chest dogs subjected to programmed electrical stimulation (PES) for 5￣8 days after acute myocardial infarction. The electrophysiologic e...A canine model of ischemic ventricular tachyarrhythmias was established in open-chest dogs subjected to programmed electrical stimulation (PES) for 5￣8 days after acute myocardial infarction. The electrophysiologic effects of sophoridine (Sop) and procainamide (PA) were observed in this canine model. With routine methods of PES, ventricular tachycardia (VT) and ventricular fibrilation (VF) could be reproducibly initiated in this model. Both drugs distinctly lengthened the QTc interval ( P <0.01) and the effective refractory period (ERP) in normal and ischemic ventricular myocardium ( P <0.01), decreased the dispersion of ERP in ischemic myocardium and the dispersion of ERP in left ventricle (P <0.05), and increased the diastolic excitability threshold of normal and ischemic ventricular myocardium remarkably ( P <0.01). Both drugs effectively prevented the PES-induced VT or VF and ischemia-induced VF ( P <0.05). The results indicated that this canine model is a good and reliable one, sophoridine and procainamide may be effective in preventing the onset of reentrant ventricular tachyarrhythmias after myocardial ischemic damage.展开更多
Fetal arrhythmias reach up around 10%of the total third-level perinatal cardiology references.Sustained bradycardia is defined as a baseline fetal heart rate(FHR)of less than 110 bpm sustained for at least 10 min.The ...Fetal arrhythmias reach up around 10%of the total third-level perinatal cardiology references.Sustained bradycardia is defined as a baseline fetal heart rate(FHR)of less than 110 bpm sustained for at least 10 min.The overall incidence of malignant fetal bradyarrhythmias,such as complete atrioventricular block(AVB)and channellopathies,is relatively rare,1:5000 pregnancies,but represents a serious emergency for the gynecologist,neonatologists,and pediatric cardiologists.Fetal complete AVB is strongly associated with maternal connective tissue disease,but it can be also associated with congenital heart disease and usually with a poorer prognosis with high risk of fetal hydrops and abortion.Currently,the treatment of severe fetal bradyarrhythmias is principally pharmacological and aims to increase the FHR,besides an early resolution of underlying causes,when possible,and a promptly management of fetal heart failure.Intrauterine electrostimulation nowadays is an experimental pioneering method,reserved for limited selected cases.展开更多
Prophylactic effect of magnesium sulfate on reperfusion arrhythmias was studiedusing a left anterior descending coronary artery occlusion followed by reperfusion in theisolated rat heart.In the first studies,we have o...Prophylactic effect of magnesium sulfate on reperfusion arrhythmias was studiedusing a left anterior descending coronary artery occlusion followed by reperfusion in theisolated rat heart.In the first studies,we have observed a bell-shaped relationship be-tween the incidence of reperfusion-induced ventricular fibrillation（VF）and the durationof preceding ischemia.With 5,10,15,20 and 25 min of ischemia,10,70,60,50 and 20per cent of the hearts exhibited irreversible VF,respectively.In the second studies（10 minischemia）,perfusate magnesium sulfate was increased to 3.6,4.8 and 6.0 mmol/L 1 min be-fore coronary ligation,VF fell in a dose-dependent manner from its control total inci-dence of 100%（1.2mmol/L MgSO<sub>4</sub>）to 82%,73% and 18%（P【0.01）,respectively.Heartrate was also reduced in a dose-dependent manner,falling from its control value of326±11 to 227±22 beats/min with the highest concentration of magnesium sulfate.Asperfusate magnesium sulfate was increased to 6.0 mmol/L just before reperfusion,no an-ti-arrhythmic effects were observed.With an anti-arrhythmic concentration of magnesiumsulfate（6.0 mmol/L,increased 1 min before ligation）,calcium concentration was increasedby 1.5 mmol/L at the same time,under these conditions the anti-arrhythmic effect of mag-nesium sulfate was lost and its negative chronotropic effect was also partially abolished.We conclude that magnesium sulfate has a certain prophylactic effect againstreperfusion induced arrhythmias and this could be due to a direct or indirect calci-um-antagonist action.展开更多
Objective:Sudden cardiac death(SCD)and malignant ventricular arrhythmia(VA)are increasingly recognized as important issues for people living with a Fontan circulation,but data are lacking.We sought to characterize the...Objective:Sudden cardiac death(SCD)and malignant ventricular arrhythmia(VA)are increasingly recognized as important issues for people living with a Fontan circulation,but data are lacking.We sought to characterize the cohort who had sudden cardiac death,most likely related to VA and/or documented VA in the Australia and New Zealand Fontan Registry including risk factors and clinical outcomes.Methods:A retrospective cohort study was performed.Inclusion criteria were documented non-sustained ventricular tachycardia,sustained ventricular tachycardia,ventricular fibrillation,resuscitated cardiac arrest or SCD>30 days post-Fontan completion.Results:Of 1611 patients,20(1.2%)had VA;14(1.0%)had VA without SCD and 6(<1%)had SCD(6%of all deaths recorded in Registry;5 of those had documented VA at the time of arrest and 1 was presumed to be VA-associated).The median age at first VA was 20.5(14–32)years,10(50%)were females,and the median age at Fontan operation was 8(4–17)years.On univariable analysis,hypoplastic left heart syndrome(p=0.03)and older age Fontan operation(p<0.001)were associated with VA.Earlier Fontan era(p<0.003),atriopulmonary Fontan(p<0.001),pre-Fontan atrioventricular valve repair(p=0.013)pre-or post-Fontan atrial arrhythmia(p=0.010)were associated with SCD.Patients with VA had a 3 times higher risk of death or heart transplant(HR 3.27(1.19,8.98),p=0.02).Conclusions:A proportion of people living with a Fontan circulation have malignant VA.Routine VA screening in this cohort is essential.More data are needed to aid risk stratification.展开更多
Objective:To observe the effects antiarrhythmic peptide 10(AAPIO) aon acute ventricular arrhythmia and the phosphorylation state of ischemic myocardium conncxin.Methods:Acute total ischemia and partial ischemia models...Objective:To observe the effects antiarrhythmic peptide 10(AAPIO) aon acute ventricular arrhythmia and the phosphorylation state of ischemic myocardium conncxin.Methods:Acute total ischemia and partial ischemia models were established by ceasing perfusion and ligating the left anterior descending coronary artery in SD rats.The effects of AAP10(1 mg/L) on the incidence rate of ischemia-induced ventricular arrhythmia were observed.The ischemic myocardium was sampled to detect total-Cx43 and NP-Cx43 by immunofluorcsecnt staining and western blotting,the total-Cx43 expression was detected through image analysis system by semi-quantitative analysis.Results:AAP10 could significantly decrease the incidence of ischemia-induced ventricular tachycardia and ventricular fibrillation.During ischemic stage,total ischemia(TI) and AAP10 total ischemia(ATI) groups were compared with partial ischemia(Pi) and AAP10 partial ischemia(API) groups.The rates of incidence for arrhythmia in the ATI and API groups(10%and 0%) were lower than those in the TI and PI groups(60%and 45%).The difference between the two groups was statistically significant(P=0.019,P=0.020).The semi-quantitative analysis results of the ischemic myocardium showed that the total-Cx43 protein expression distribution areas for TI.ATI,PI and API groups were significantly decreased compared with the control group.On the other hand,the NP-Cx43 distribution areas of TI,ATI,PI and API groups were significantly increased compared with the control group(P>0.05).AAP10 could increase the total-Cx43 expression in the ischemic area and decrease the NP-Cx43 expression.Western blot results were consistent with the results of immunofluorescence staining.Conclusions:AAP10 can significantly decrease the rate of incidence of acute ischemia-induced ventricular tachycardia and ventricular fibrillation.Acute ischemic ventricular arrhythmias may have a relationship with the decreased phosphorylation of Cx43 induced by ischemia.AAP10 may stimulate the phosphorylation of Cx43 by increasing the totai-Cx43 expression and decreasing the NP-Cx43 expression in the ischemic area,so as to decrease ventricular arrhythmia.展开更多
Objective: To explore the effect and mechanism of angiotensin II receptor blockers-Irbesartan on occurrence of ventricular arrhythmias in rats with myocardial ischemia. Methods: Rats with embryonic cardiomyocytes-H9c2...Objective: To explore the effect and mechanism of angiotensin II receptor blockers-Irbesartan on occurrence of ventricular arrhythmias in rats with myocardial ischemia. Methods: Rats with embryonic cardiomyocytes-H9c2 were randomly divided into control group. ischemia group. Irbesartan group and Irbesartan+ischemia group. The cell viability of rats in each group was tested using MTT. Real-time PCR was employed to detect the expression of connexin43 (Cx43) mRNA and western blot to detect the expression of Cx43 and phosphorylated Cx43. SD rats were randomly divided into the sham-operation group (SO). myocardial infarction group (MI). Irbesartan group and MI+ Irbesartan group, with 10 rats in each group. HE staining was employed to observe the change in the pathomorpholouy of left ventricular tissue and TUNEL method to analyze the cell apoptosis in the tissue. The immunofluorescence was adopted to observe the expression and distribution of Cx43 in the left ventricular myocardium and study the change in the expression of Cx43 in the cardiac muscular tissue at mRNA and protein level. Results: The intervention of lrbesartan in the condition of ischemia indicated the significant decrease in the number of necrotic cells. The expression of Cx43 was significantly decreased under the culture of ischemia (P<0.05), but in the presence of Irbesartan, the expression of Cx43 was increased compared with the ischemia group (p<0.01). The results of WB assay showed the similar trend of change at mRNA level. There was the significant difference in the score of ventricular arerythmia between MI group and SO group (P<0.01). The incidence of ventricular tachycardia or ventricular fibrillation was significantly increased compared with the one in SO group (P<0.05). There was the significant difference in the overall score between MI+Irbesartan group and MI group (P<0.05). The expression of Cx43 in the cardiac muscular tissue in MI group was significantly decreased (P<0.01(US) SO group). But the expression of Cx43 was increased after the treatment with Irbesartan. Conclusions: Irbesartan can inhibit the injury of H9c2 cardiomyocytes and the decreased expression of Cx43 that are induced by the ischemic myocardial infarction. Irbesartan can also improve the reconstruction of Cx43 in rats with ischemic myocardium to inhibit the myocardial infarction-induced arrhythmias.展开更多
This work is aimed at exploring the clinical efficacy of continuous positive airway pressuie(CPAP)in treatment of patients with arrhythmias combined with obstructive sleep apnea(OSA).Through evaluating serum native th...This work is aimed at exploring the clinical efficacy of continuous positive airway pressuie(CPAP)in treatment of patients with arrhythmias combined with obstructive sleep apnea(OSA).Through evaluating serum native thiol,malonaldehyde(MDA)and nicotinamide adenine dinucleotide phosphate oxidase(NADPH oxidase)in these patients and describing the effects on oxidative parameters of CPAP therapy for 3 months,we confirmed the impact of oxidative stress on arrhythmias.A total of 64 patients with OSA combined with arrhythmias were collected from April 2014 to April 2017 with full clinical information.Patients were divided into two groups(paired experiment design):32 patients in group A(control group),who received unchanged anti-arrhythmia treatment and 32 patients in group B,who were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP.OSA related parameters were compared between the two groups after 3-month therapy.And the levels of parameters of oxidative stress in patients were measured before and after CPAP therapy.After 3 months of CPAP therapy,compared with the control group,the percentage of sage N3(NREM 3)and stage R(REM)in total sleep time was significantly increased,while apnea-hypopnea index(AHI)and the Epworth Sleepiness Scale(ESS)score were evidently decreased.Meanwhile,the lowest oxygen saturation(LSpCh)was also elevated after CPAP treatment for 3 months.The CPAP therapy significantly prevented the occurrence of arrhythmias(P<0.05).Both the MDA level and NADPH oxidase levels were significantly lower in the group B than in the group A(P<0.05).But serum native thiol was improved by CPAP treatment(P<0.05).In conclusion,proper use of CPAP therapy provides significant benefits for the treatment of arrhythmia in patients with OSA.展开更多
BACKGROUND Mushroom exposure is a global health issue.The manifestations of mushroom poisoning (MP) may vary.Some species have been reported as rhabdomyolytic,hallucinogenic,or gastrointestinal poisons.Critical or eve...BACKGROUND Mushroom exposure is a global health issue.The manifestations of mushroom poisoning (MP) may vary.Some species have been reported as rhabdomyolytic,hallucinogenic,or gastrointestinal poisons.Critical or even fatal MPs are mostly attributable to Amanita phalloides,with the development of severe liver or renal failure.Myocardial injury and even cases mimicking ST-segment elevation myocardial infarction (STEMI) have been previously reported,while cardiac arrhythmia or cardiac arrest is not commonly seen.CASE SUMMARY We report a 68-year-old woman with MP who suffered from delirium,seizure,long QT syndrome on electrocardiogram (ECG),severe cardiac arrhythmias of multiple origins,and cardiac arrest.She was intubated and put on blood perfusion.Her kidney and liver functions were intact;creatine kinase-MB was mildly elevated,and then fell within normal range during her hospital stay.We sent the mushrooms she left for translation elongation factor subunit 1α,ribosomal RNA gene sequence,and internal transcribed spacer sequence analyses.There were four kinds of mushrooms identified,two of which were found to be toxic.CONCLUSION This is the first time that we found cardiac toxicity caused by Panaeolus subbalteatus and Conocybe lactea,which were believed to be toxic to the liver,kidney,and brain.We suggest that intensive monitoring and ECG follow-up are essential to diagnose prolonged QT interval and different forms of tachycardia in MP patients,even without the development of severe liver or renal failure.The mechanisms need to be further investigated and clarified based on animal experiments and molecular signal pathways.展开更多
Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The hea...Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The heart is one of the most adversely affected organs in patients with liver cirrhosis. For example, arrhythmias and electrocardiographic changes are observed in patients with liver cirrhosis. The risk for arrhythmia is influenced by factors such as cirrhotic cardiomyopathy, cardiac ion channel remodeling, electrolyte imbalances,impaired autonomic function, hepatorenal syndrome, metabolic abnormalities, advanced age, inflammatory syndrome, stressful events, impaired drug metabolism and comorbidities. Close monitoring of cirrhotic patients is needed for arrhythmias, particularly when QT intervalprolonging drugs are given, or if electrolyte imbalances or hepatorenal syndrome appear. Arrhythmia risk may persist after liver transplantation due to possible QT interval prolongation, persistence of the parasympathetic impairment, post-transplant reperfusion and chronic immunosuppression, as well as consideration of the fact that the transplant itself is a stressful event for the cardiovascular system. The aims of the present article were to provide a review of the most important data regarding the epidemiology, pathophysiology, and biomarkers of arrhythmia risk in patients with liver cirrhosis, to elucidate the association with long-term outcome, and to propose future research directions.展开更多
Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute C...Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140. Methods A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140. Results Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1%± 6.9% vs. 61.5%± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively;the positive predictive value was 20% and the negative predictive value was 99%. Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.展开更多
文摘BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psychological distress com-pared with the general CHD population.This increased vulnerability has garn-ered growing clinical and research interest in the potential therapeutic benefits of structured psychological interventions for alleviating comorbid depressive and anxiety symptoms in this high-risk demographic.AIM To evaluate the efficacy of psychological care in reducing anxiety and depressive symptoms among older adult patients with CHD and comorbid arrhythmia.METHODS This retrospective analysis included 100 patients with CHD and arrhythmia admitted to the First Affiliated Hospital of Jinzhou Medical University from June 2024 to December 2024.Of these,49 patients in the control group received routine care,whereas 51 patients in the observation group received psychological care in addition to routine care.Therapeutic outcomes were compared between the two groups.Psychological distress was assessed before and after providing nursing care.A treatment compliance scale developed by the hospital was used to assess adherence.Complication rates were also compared.Quality of life was evaluated using the Short Form-36 Health Survey after providing nursing care.Patient satisfaction with nursing care was assessed using a self-designed questionnaire.RESULTS The observation group demonstrated a higher overall treatment effectiveness compared with the control group(P<0.05).After nursing care,both groups showed reduced scores on the Self-Rating Anxiety Scale and Self-Rating Depression Scale compared with baseline(P<0.05),with significantly greater improvements in the observation group(P<0.05).Treatment compliance was higher and complication rates were lower in the observation group(P<0.05).Additionally,the observation group demonstrated better quality of life after 1 month of care and higher satisfaction with nursing services(P<0.05).CONCLUSION Psychological care for patients with CHD and comorbid arrhythmia effectively enhanced therapeutic outcomes,reduced anxiety and depression,improved treatment compliance and quality of life,and lowered the risk of complications.These findings support the broader implementation of psychological care for patients with CHD in clinical practice.
文摘Diagnosing cardiac diseases relies heavily on electrocardiogram(ECG)analysis,but detecting myocardial infarction-related arrhythmias remains challenging due to irregular heartbeats and signal variations.Despite advancements in machine learning,achieving both high accuracy and low computational cost for arrhythmia classification remains a critical issue.Computer-aided diagnosis systems can play a key role in early detection,reducing mortality rates associated with cardiac disorders.This study proposes a fully automated approach for ECG arrhythmia classification using deep learning and machine learning techniques to improve diagnostic accuracy while minimizing processing time.The methodology consists of three stages:1)preprocessing,where ECG signals undergo noise reduction and feature extraction;2)feature Identification,where deep convolutional neural network(CNN)blocks,combined with data augmentation and transfer learning,extract key parameters;3)classification,where a hybrid CNN-SVM model is employed for arrhythmia recognition.CNN-extracted features were fed into a binary support vector machine(SVM)classifier,and model performance was assessed using five-fold cross-validation.Experimental findings demonstrated that the CNN2 model achieved 85.52%accuracy,while the hybrid CNN2-SVM approach significantly improved accuracy to 97.33%,outperforming conventional methods.This model enhances classification efficiency while reducing computational complexity.The proposed approach bridges the gap between accuracy and processing speed in ECG arrhythmia classification,offering a promising solution for real-time clinical applications.Its superior performance compared to nonlinear classifiers highlights its potential for improving automated cardiac diagnosis.
基金funded by the National Health and Medical Research Council of Australia(Grant No.APP1130353)supported by a Royal Australian College of Physicians Research Entry Scholarship(Grant No.2023RES00039)+4 种基金The National Health and Medical Research Council Postgraduate Scholarship(Grant No.2031119)a Heart Foundation PhD Scholarship(Grant No.107659)supported through an Australian Government Research Training Program Scholarshipsupported as a postdoctoral clinical researcher by the Fund for Scientific Research Flanderssupported by a National Health and Medical Research Council of Australia Investigator Grant(Grant No.APP 2027105)。
文摘Background:A greater prevalence of arrhythmias has been described in endurance athletes,but it remains unclear whether this risk persists after detraining.We aimed to evaluate the prevalence of arrhythmias and their relationship with cardiac remodeling in lifelong and retired master endurance athletes compared to non-athletic controls.Methods:We performed a cross-sectional analysis of observational studies that used echocardiography and cardiac magnetic resonance to detail cardiac structure and function,and Holter monitors to identify atrial and ventricular arrhythmias in 185 endurance athletes and 81 non-athletic controls aged≥40 years.Athletes were categorized as active lifelong(n=144)or retired(n=41)based on hours per week of high-intensity endurance exercise within 5 years of enrollment and validated by percentage of predicted maximal oxygen consumption(VO_(2max)).Athletes with overt cardiomyopathies,channelopathies,pre-excitation,and/or myocardial infarction were excluded.Results:Lifelong athletes(median age=55 years(interquartile range(IQR):46-62),79%male)were significantly fitter than retired athletes(median age=66 years(IQR:58-71),95%male)and controls(median age=53 years(IQR:48-60),96%male),respectively(predicted VO_(2max):131%±18%vs.99%±14%vs.98%±15%,p<0.001).Compared to controls,athletes in our cohort had a higher prevalence of atrial fibrillation((AF):32%vs.0%,p<0.001)and non-sustained ventricular tachycardia((NSVT):9%vs.1%,p=0.007).There was no difference in prevalence of any arrhythmia between lifelong and retired athletes.Lifelong athletes had larger ventricular volumes than retired athletes,who had ventricular volumes similar to controls(left ventricular end-diastolic volume indexed to body surface area(LVEDVi):101±20 m L/m^(2)vs.86±16 mL/m^(2)vs.94±18 mL/m^(2),p<0.001;right ventricular end-diastolic volume indexed to body surface area(RVEDVi):117±23 mL/m^(2)vs.101±19 mL/m^(2)vs.100±19 mL/m^(2),p<0.001).Athletes had more scar(40%vs.18%,p=0.002)and larger left atria(median volume=45m L/m^(2)(IQR:38-52)vs.31 mL/m^(2)(IQR:25-38),p<0.001)than controls,with no difference in atrial volumes and non-ischaemic scar between the athlete groups.Conclusion:Master endurance athletes have a higher prevalence of AF and NSVT than non-athletic controls.Whereas ventricular remodeling tends to reverse with detraining,the propensity to arrhythmias persists regardless of whether they are actively exercising or retired.
基金supported by the National Natural Science Foundation of China under Grant No.62271127the Medico-Engineering Cooperation Funds from University of Electronic Science and Technology of China and the West China Hospital of Sichuan University under Grants No.ZYGX2022YGRH011 and No.HXDZ22005+1 种基金the Natural Science Foundation of Sichuan,China under Grant No.23NSFSC0627Sichuan Provincial Key Laboratory Fund for Ultra Sound Cardioelectrophysiology and Biomechanics,China under Grant No.2023KFKT01.
文摘Arrhythmias stand out for having irregular cardiac rhythms,and the fast diagnosis of arrhythmias holds significant clinical importance due to its potential to mitigate adverse health outcomes.Despite the progress in this field,existing research efforts have encountered limitations,necessitating innovative approaches to address diagnostic challenges effectively.The primary objective of this research is to propose an innovative classification methodology for distinguishing five distinct arrhythmia classes:atrial premature beat(A),normal(N),ventricular premature beat(V),right bundle branch block(R),and left bundle branch block(L).The proposed methodology involves constructing a hybrid model that incorporates an attention mechanism,utilizing electrocardiogram(ECG)data from an open-source repository.Additionally,we have incorporated an explainability feature into the model,allowing for the interpretation and explanation of its predictions.This model is designed to capitalize on the unique features of arrhythmic patterns and enhance classification metrics.Innovative techniques employed within the methodology are detailed to elucidate the rationale behind their selection and their anticipated contributions to improved model performance.Findings from this study underscore the superiority of the proposed classification model over existing methodologies.Quantitative analysis demonstrates its outstanding performance.The approach,outperforming existing methods,achieves high levels of accuracy(99.16%),specificity(99.79%),recall(99.20%),precision(99.20%),F1-measure(99.16%),and AUC(99.92%).This research advances medical diagnostics by integrating advanced machine-learning techniques to enhance arrhythmia detection.
文摘BACKGROUND Irregular heart rhythms are a primary manifestation of cardiovascular disease,considerably contributing to global morbidity and mortality rates.Moreover,patients with cardiac arrhythmias often experience a higher prevalence of sleep disorders,anxiety,and depression owing to various factors.AIM To investigate the epidemiological characteristics and psychological factors associated with arrhythmia in the elderly and to establish a theoretical foundation for its prevention and treatment in older adults.METHODS A retrospective analysis was performed on 169 elderly patients admitted to the Shangqiu First People’s Hospital from December 2022 to December 2023.All subjects underwent 24-hour electrocardiogram monitoring to record heart rate,heart rate variability,and 24-hour ambulatory electrocardiogram data.Additionally,patients’medical records were reviewed to gather information on their general condition,including age,gender,underlying diseases,and other relevant factors.Patients were divided into four groups based on their Hamilton Anxiety(HAMA)and Hamilton Depression Rating Scale(HAMD)scores:Group A(HAMA scores≥7),Group B(HAMD scores≥7),Group C(both HAMA and HAMD scores≥7),and Group D(HAMA and HAMD scores<7).Psychological factors such as depression,anxiety,sleep status,and quality of life were analyzed.Pearson correlation was used to examine the relationship between scores from the Pittsburgh Sleep Quality Index(PSQI),HAMA/HAMD scales,and the Short Form 36-item Health Survey(SF-36)with the presence of arrhythmia.RESULTS Among the 169 patients,87(51.5%)had concurrent arrhythmia.Atrial arrhythmias constituted the largest proportion at 34.8%(30 out of 87),followed by sinustachycardia at 24.1%(21 out of 87),and ventricular arrhythmias at 9.2%(8 out of 87).Factors such as advanced age,coronary heart disease,hypertension,smoking,exposure to secondhand smoke,and residing in rural areas significantly increased the risk of developing arrhythmia.There was a statistically significant difference between the two groups regarding PSQI,HAMA-14,HAMD-17,and SF-36 scores.Pearson correlation analysis revealed that PSQI,HAMA-14,and HAMD-17 scores were positively correlated with arrhythmia in the elderly,while the SF-36 score was negatively correlated.The anxiety,depression,and combined anxiety–depression groups exhibited significantly higher PSQI,HAMA-14,and HAMD-17 scores compared to the nonanxiety and non-depression group.CONCLUSION Arrhythmia among the elderly is primarily found in individuals with advanced age and existing health conditions.It is also linked to psychological factors such as depression,anxiety,reduced quality of life,and sleep disturbances.
文摘Caffeine is a widely consumed stimulant known for its cardiovascular and metabolic effects.However,its impact on cardiovascular risk,including arrhythmias,in older adults remains underexplored.Emerging evidence highlights sex-specific differences in caffeine metabolism,which may influence its role in cardiovascular health.This perspective examines the interaction between caffeine,hormonal changes,metabolic processes,and lifestyle factors,focusing on older women compared to men.Understanding these differences is essential for tailoring dietary and clinical recommendations to mitigate cardiovascular risks and promote healthy aging.
文摘Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythmia as the primary manifestation of cardiac metastasis of RCC with only two cases reported.[1,2]We add to the literature the third case,the diagnosis of which was only possible with cardiac magnetic resonance(CMR).
文摘Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia.The causes of AA are multifactorial.The review begins with a brief history of LT and AA.This review further describes the pathophysiology of the AA.The risk factors,incidence,recipient characteristics including intra-operative factors are elaborated on.Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT,the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia.The strategy of rate control vs rhythm control is discussed.The pros and cons of various drug regimen,need for direct current cardioversion and catheter ablation therapies are considered.Possible methods to prevent or reduce the incidence of AA after LT are considered.The impact of AA on the short-term and long-term outcomes following LT is discussed.
基金This research was partially supported by JNTU Hyderabad,India under Grant proceeding number:JNTUH/TEQIP-III/CRS/2019/CSE/08.The authors are grateful for the support provided by the TEQIP-III team.
文摘Arrhythmia is ubiquitous worldwide and cardiologists tend to provide solutions from the recent advancements in medicine.Detecting arrhythmia from ECG signals is considered a standard approach and hence,automating this process would aid the diagnosis by providing fast,costefficient,and accurate solutions at scale.This is executed by extracting the definite properties from the individual patterns collected from Electrocardiography(ECG)signals causing arrhythmia.In this era of applied intelligence,automated detection and diagnostic solutions are widely used for their spontaneous and robust solutions.In this research,our contributions are two-fold.Firstly,the Dual-Tree Complex Wavelet Transform(DT-CWT)method is implied to overhaul shift-invariance and aids signal reconstruction to extract significant features.Next,A neural attention mechanism is implied to capture temporal patterns from the extracted features of the ECG signal to discriminate distinct classes of arrhythmia and is trained end-to-end with the finest parameters.To ensure that the model’s generalizability,a set of five traintest variants are implied.The proposed model attains the highest accuracy of 98.5%for classifying 8 variants of arrhythmia on the MIT-BIH dataset.To test the resilience of the model,the unseen(test)samples are increased by 5x and the deviation in accuracy score and MSE was 0.12%and 0.1%respectively.Further,to assess the diagnostic model performance,AUC-ROC curves are plotted.At every test level,the proposed model is capable of generalizing new samples and leverages the advantage to develop a real-world application.As a note,this research is the first attempt to provide neural attention in arrhythmia classification using MIT-BIH ECG signals data with state-of-the-art performance.
基金supported by Faculty of Computing and Informatics,University Malaysia Sabah,Jalan UMS,Kota Kinabalu Sabah 88400,Malaysia.
文摘With the help of computer-aided diagnostic systems,cardiovascular diseases can be identified timely manner to minimize the mortality rate of patients suffering from cardiac disease.However,the early diagnosis of cardiac arrhythmia is one of the most challenging tasks.The manual analysis of electrocardiogram(ECG)data with the help of the Holter monitor is challenging.Currently,the Convolutional Neural Network(CNN)is receiving considerable attention from researchers for automatically identifying ECG signals.This paper proposes a 9-layer-based CNN model to classify the ECG signals into five primary categories according to the American National Standards Institute(ANSI)standards and the Association for the Advancement of Medical Instruments(AAMI).The Massachusetts Institute of Technology-Beth Israel Hospital(MIT-BIH)arrhythmia dataset is used for the experiment.The proposed model outperformed the previous model in terms of accuracy and achieved a sensitivity of 99.0%and a positivity predictively 99.2%in the detection of a Ventricular Ectopic Beat(VEB).Moreover,it also gained a sensitivity of 99.0%and positivity predictively of 99.2%for the detection of a supraventricular ectopic beat(SVEB).The overall accuracy of the proposed model is 99.68%.
文摘A canine model of ischemic ventricular tachyarrhythmias was established in open-chest dogs subjected to programmed electrical stimulation (PES) for 5￣8 days after acute myocardial infarction. The electrophysiologic effects of sophoridine (Sop) and procainamide (PA) were observed in this canine model. With routine methods of PES, ventricular tachycardia (VT) and ventricular fibrilation (VF) could be reproducibly initiated in this model. Both drugs distinctly lengthened the QTc interval ( P <0.01) and the effective refractory period (ERP) in normal and ischemic ventricular myocardium ( P <0.01), decreased the dispersion of ERP in ischemic myocardium and the dispersion of ERP in left ventricle (P <0.05), and increased the diastolic excitability threshold of normal and ischemic ventricular myocardium remarkably ( P <0.01). Both drugs effectively prevented the PES-induced VT or VF and ischemia-induced VF ( P <0.05). The results indicated that this canine model is a good and reliable one, sophoridine and procainamide may be effective in preventing the onset of reentrant ventricular tachyarrhythmias after myocardial ischemic damage.
文摘Fetal arrhythmias reach up around 10%of the total third-level perinatal cardiology references.Sustained bradycardia is defined as a baseline fetal heart rate(FHR)of less than 110 bpm sustained for at least 10 min.The overall incidence of malignant fetal bradyarrhythmias,such as complete atrioventricular block(AVB)and channellopathies,is relatively rare,1:5000 pregnancies,but represents a serious emergency for the gynecologist,neonatologists,and pediatric cardiologists.Fetal complete AVB is strongly associated with maternal connective tissue disease,but it can be also associated with congenital heart disease and usually with a poorer prognosis with high risk of fetal hydrops and abortion.Currently,the treatment of severe fetal bradyarrhythmias is principally pharmacological and aims to increase the FHR,besides an early resolution of underlying causes,when possible,and a promptly management of fetal heart failure.Intrauterine electrostimulation nowadays is an experimental pioneering method,reserved for limited selected cases.
文摘Prophylactic effect of magnesium sulfate on reperfusion arrhythmias was studiedusing a left anterior descending coronary artery occlusion followed by reperfusion in theisolated rat heart.In the first studies,we have observed a bell-shaped relationship be-tween the incidence of reperfusion-induced ventricular fibrillation（VF）and the durationof preceding ischemia.With 5,10,15,20 and 25 min of ischemia,10,70,60,50 and 20per cent of the hearts exhibited irreversible VF,respectively.In the second studies（10 minischemia）,perfusate magnesium sulfate was increased to 3.6,4.8 and 6.0 mmol/L 1 min be-fore coronary ligation,VF fell in a dose-dependent manner from its control total inci-dence of 100%（1.2mmol/L MgSO<sub>4</sub>）to 82%,73% and 18%（P【0.01）,respectively.Heartrate was also reduced in a dose-dependent manner,falling from its control value of326±11 to 227±22 beats/min with the highest concentration of magnesium sulfate.Asperfusate magnesium sulfate was increased to 6.0 mmol/L just before reperfusion,no an-ti-arrhythmic effects were observed.With an anti-arrhythmic concentration of magnesiumsulfate（6.0 mmol/L,increased 1 min before ligation）,calcium concentration was increasedby 1.5 mmol/L at the same time,under these conditions the anti-arrhythmic effect of mag-nesium sulfate was lost and its negative chronotropic effect was also partially abolished.We conclude that magnesium sulfate has a certain prophylactic effect againstreperfusion induced arrhythmias and this could be due to a direct or indirect calci-um-antagonist action.
文摘Objective:Sudden cardiac death(SCD)and malignant ventricular arrhythmia(VA)are increasingly recognized as important issues for people living with a Fontan circulation,but data are lacking.We sought to characterize the cohort who had sudden cardiac death,most likely related to VA and/or documented VA in the Australia and New Zealand Fontan Registry including risk factors and clinical outcomes.Methods:A retrospective cohort study was performed.Inclusion criteria were documented non-sustained ventricular tachycardia,sustained ventricular tachycardia,ventricular fibrillation,resuscitated cardiac arrest or SCD>30 days post-Fontan completion.Results:Of 1611 patients,20(1.2%)had VA;14(1.0%)had VA without SCD and 6(<1%)had SCD(6%of all deaths recorded in Registry;5 of those had documented VA at the time of arrest and 1 was presumed to be VA-associated).The median age at first VA was 20.5(14–32)years,10(50%)were females,and the median age at Fontan operation was 8(4–17)years.On univariable analysis,hypoplastic left heart syndrome(p=0.03)and older age Fontan operation(p<0.001)were associated with VA.Earlier Fontan era(p<0.003),atriopulmonary Fontan(p<0.001),pre-Fontan atrioventricular valve repair(p=0.013)pre-or post-Fontan atrial arrhythmia(p=0.010)were associated with SCD.Patients with VA had a 3 times higher risk of death or heart transplant(HR 3.27(1.19,8.98),p=0.02).Conclusions:A proportion of people living with a Fontan circulation have malignant VA.Routine VA screening in this cohort is essential.More data are needed to aid risk stratification.
基金supported by the National Natural Science Foundation of China(No:81300150)
文摘Objective:To observe the effects antiarrhythmic peptide 10(AAPIO) aon acute ventricular arrhythmia and the phosphorylation state of ischemic myocardium conncxin.Methods:Acute total ischemia and partial ischemia models were established by ceasing perfusion and ligating the left anterior descending coronary artery in SD rats.The effects of AAP10(1 mg/L) on the incidence rate of ischemia-induced ventricular arrhythmia were observed.The ischemic myocardium was sampled to detect total-Cx43 and NP-Cx43 by immunofluorcsecnt staining and western blotting,the total-Cx43 expression was detected through image analysis system by semi-quantitative analysis.Results:AAP10 could significantly decrease the incidence of ischemia-induced ventricular tachycardia and ventricular fibrillation.During ischemic stage,total ischemia(TI) and AAP10 total ischemia(ATI) groups were compared with partial ischemia(Pi) and AAP10 partial ischemia(API) groups.The rates of incidence for arrhythmia in the ATI and API groups(10%and 0%) were lower than those in the TI and PI groups(60%and 45%).The difference between the two groups was statistically significant(P=0.019,P=0.020).The semi-quantitative analysis results of the ischemic myocardium showed that the total-Cx43 protein expression distribution areas for TI.ATI,PI and API groups were significantly decreased compared with the control group.On the other hand,the NP-Cx43 distribution areas of TI,ATI,PI and API groups were significantly increased compared with the control group(P>0.05).AAP10 could increase the total-Cx43 expression in the ischemic area and decrease the NP-Cx43 expression.Western blot results were consistent with the results of immunofluorescence staining.Conclusions:AAP10 can significantly decrease the rate of incidence of acute ischemia-induced ventricular tachycardia and ventricular fibrillation.Acute ischemic ventricular arrhythmias may have a relationship with the decreased phosphorylation of Cx43 induced by ischemia.AAP10 may stimulate the phosphorylation of Cx43 by increasing the totai-Cx43 expression and decreasing the NP-Cx43 expression in the ischemic area,so as to decrease ventricular arrhythmia.
基金supported by Research Topic of Department of Health of Jiangxi Province(No.20131074)Natural Science Fund of Jiangxi Province(No:20122BAB205028)
文摘Objective: To explore the effect and mechanism of angiotensin II receptor blockers-Irbesartan on occurrence of ventricular arrhythmias in rats with myocardial ischemia. Methods: Rats with embryonic cardiomyocytes-H9c2 were randomly divided into control group. ischemia group. Irbesartan group and Irbesartan+ischemia group. The cell viability of rats in each group was tested using MTT. Real-time PCR was employed to detect the expression of connexin43 (Cx43) mRNA and western blot to detect the expression of Cx43 and phosphorylated Cx43. SD rats were randomly divided into the sham-operation group (SO). myocardial infarction group (MI). Irbesartan group and MI+ Irbesartan group, with 10 rats in each group. HE staining was employed to observe the change in the pathomorpholouy of left ventricular tissue and TUNEL method to analyze the cell apoptosis in the tissue. The immunofluorescence was adopted to observe the expression and distribution of Cx43 in the left ventricular myocardium and study the change in the expression of Cx43 in the cardiac muscular tissue at mRNA and protein level. Results: The intervention of lrbesartan in the condition of ischemia indicated the significant decrease in the number of necrotic cells. The expression of Cx43 was significantly decreased under the culture of ischemia (P<0.05), but in the presence of Irbesartan, the expression of Cx43 was increased compared with the ischemia group (p<0.01). The results of WB assay showed the similar trend of change at mRNA level. There was the significant difference in the score of ventricular arerythmia between MI group and SO group (P<0.01). The incidence of ventricular tachycardia or ventricular fibrillation was significantly increased compared with the one in SO group (P<0.05). There was the significant difference in the overall score between MI+Irbesartan group and MI group (P<0.05). The expression of Cx43 in the cardiac muscular tissue in MI group was significantly decreased (P<0.01(US) SO group). But the expression of Cx43 was increased after the treatment with Irbesartan. Conclusions: Irbesartan can inhibit the injury of H9c2 cardiomyocytes and the decreased expression of Cx43 that are induced by the ischemic myocardial infarction. Irbesartan can also improve the reconstruction of Cx43 in rats with ischemic myocardium to inhibit the myocardial infarction-induced arrhythmias.
文摘This work is aimed at exploring the clinical efficacy of continuous positive airway pressuie(CPAP)in treatment of patients with arrhythmias combined with obstructive sleep apnea(OSA).Through evaluating serum native thiol,malonaldehyde(MDA)and nicotinamide adenine dinucleotide phosphate oxidase(NADPH oxidase)in these patients and describing the effects on oxidative parameters of CPAP therapy for 3 months,we confirmed the impact of oxidative stress on arrhythmias.A total of 64 patients with OSA combined with arrhythmias were collected from April 2014 to April 2017 with full clinical information.Patients were divided into two groups(paired experiment design):32 patients in group A(control group),who received unchanged anti-arrhythmia treatment and 32 patients in group B,who were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP.OSA related parameters were compared between the two groups after 3-month therapy.And the levels of parameters of oxidative stress in patients were measured before and after CPAP therapy.After 3 months of CPAP therapy,compared with the control group,the percentage of sage N3(NREM 3)and stage R(REM)in total sleep time was significantly increased,while apnea-hypopnea index(AHI)and the Epworth Sleepiness Scale(ESS)score were evidently decreased.Meanwhile,the lowest oxygen saturation(LSpCh)was also elevated after CPAP treatment for 3 months.The CPAP therapy significantly prevented the occurrence of arrhythmias(P<0.05).Both the MDA level and NADPH oxidase levels were significantly lower in the group B than in the group A(P<0.05).But serum native thiol was improved by CPAP treatment(P<0.05).In conclusion,proper use of CPAP therapy provides significant benefits for the treatment of arrhythmia in patients with OSA.
文摘BACKGROUND Mushroom exposure is a global health issue.The manifestations of mushroom poisoning (MP) may vary.Some species have been reported as rhabdomyolytic,hallucinogenic,or gastrointestinal poisons.Critical or even fatal MPs are mostly attributable to Amanita phalloides,with the development of severe liver or renal failure.Myocardial injury and even cases mimicking ST-segment elevation myocardial infarction (STEMI) have been previously reported,while cardiac arrhythmia or cardiac arrest is not commonly seen.CASE SUMMARY We report a 68-year-old woman with MP who suffered from delirium,seizure,long QT syndrome on electrocardiogram (ECG),severe cardiac arrhythmias of multiple origins,and cardiac arrest.She was intubated and put on blood perfusion.Her kidney and liver functions were intact;creatine kinase-MB was mildly elevated,and then fell within normal range during her hospital stay.We sent the mushrooms she left for translation elongation factor subunit 1α,ribosomal RNA gene sequence,and internal transcribed spacer sequence analyses.There were four kinds of mushrooms identified,two of which were found to be toxic.CONCLUSION This is the first time that we found cardiac toxicity caused by Panaeolus subbalteatus and Conocybe lactea,which were believed to be toxic to the liver,kidney,and brain.We suggest that intensive monitoring and ECG follow-up are essential to diagnose prolonged QT interval and different forms of tachycardia in MP patients,even without the development of severe liver or renal failure.The mechanisms need to be further investigated and clarified based on animal experiments and molecular signal pathways.
文摘Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The heart is one of the most adversely affected organs in patients with liver cirrhosis. For example, arrhythmias and electrocardiographic changes are observed in patients with liver cirrhosis. The risk for arrhythmia is influenced by factors such as cirrhotic cardiomyopathy, cardiac ion channel remodeling, electrolyte imbalances,impaired autonomic function, hepatorenal syndrome, metabolic abnormalities, advanced age, inflammatory syndrome, stressful events, impaired drug metabolism and comorbidities. Close monitoring of cirrhotic patients is needed for arrhythmias, particularly when QT intervalprolonging drugs are given, or if electrolyte imbalances or hepatorenal syndrome appear. Arrhythmia risk may persist after liver transplantation due to possible QT interval prolongation, persistence of the parasympathetic impairment, post-transplant reperfusion and chronic immunosuppression, as well as consideration of the fact that the transplant itself is a stressful event for the cardiovascular system. The aims of the present article were to provide a review of the most important data regarding the epidemiology, pathophysiology, and biomarkers of arrhythmia risk in patients with liver cirrhosis, to elucidate the association with long-term outcome, and to propose future research directions.
基金supported by the Capital Health Research and Development of Special Foundation (2018-1-2061)
文摘Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140. Methods A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140. Results Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1%± 6.9% vs. 61.5%± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively;the positive predictive value was 20% and the negative predictive value was 99%. Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.
