In patients with bradycardia, DDDRP+MVP delays AF disease progression, with Reactive ATP efficacy being an independent predictor of permanent or persistent AF reduction.
Introduction and objectives In December 2019, SARS-CoV-2, was discovered as the agent of COVID-19 disease. Cardiac arrhythmias have been reported as frequent but their incidence is unknown. The aim of this research was to assess the real incidence of cardiac arrhythmias among COVID-19 patients admitted to Portuguese hospitals and to understand the underlying prognostic implications. Methods The Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) conducted a survey in Portuguese hospitals to assess the occurrence of arrhythmias in COVID-19 patients, their clinical characteristics, the use of experimental therapies and the impact on QT interval. Results Twenty hospitals participated, reporting 692 hospitalized patients. An arrhythmic episode occurred in 81 (11.7%) and 64 (79%) had detailed information on these episodes. New onset arrhythmias occurred in 41 (64%) patients, 45 (70.3%) male, median age 73.5 (61-80.3) years. There were 51 (79.7%) with associated comorbidities, mainly arterial hypertension (41, 64.1%). Of 53 patients (82.3%) on experimental therapy, 7 (10.9%) had an increased QTc interval. Regarding arrhythmias, two patients (3.1%) had ventricular tachycardia, 5 (7.8%) sinus bradycardia, 17 (26.6%) paroxysmal supraventricular tachycardia and 40 (62.5%) atrial fibrillation or flutter. At the time of reporting, there had been no deaths due to arrhythmic syndrome or related complications. Conclusions In a population of COVID-19 patients. The incidence of cardiac arrhythmias is high but not associated with increased cardiac mortality although it does though occur frequently in extremely ill patients and with multiple organ failure. Regardless of the use of experimental drugs, the incidence of ventricular arrhythmias is low and atrial fibrillation and other supraventricular arrhythmias are the most prevalent arrythmias.
Background Behçet’s syndrome is a multisystemic vasculitis of unknown aetiology. Cardiac involvement is rare, with described prevalence between 1% and 46%, with pericarditis, valvular insufficiency, intracardiac thrombosis, and eventually sinus of Valsalva aneurysms being the most common findings. Although previously reported, myocarditis is a very rare complication of Behçet’s syndrome. Case summary A 26-year-old man, smoker but otherwise healthy, was admitted to the emergency department with atypical chest pain, with no radiation, relation to efforts, position or deep inspiration, and dyspnoea, since the day before. His physical examination was unremarkable, including no fever, tachycardia, or pericardial friction rub. Electrocardiogram (ECG) revealed an early repolarization pattern, with no changes noted in subsequent exams. He had elevation of inflammatory parameters and an increased high-sensitivity troponin level of 3300 ng/L. Transthoracic echocardiography (TTE) was unremarkable. Coronary angiography showed no coronary stenosis. A presumed diagnosis of non-complicated viral myocarditis was established. The patient’s condition improved with acetylsalicylic acid as needed and colchicine and he was discharged after 3 days. Cardiac magnetic resonance was performed, showing late epicardial enhancement in the apical segment of the lateral wall, supporting the diagnosis of myocarditis. Four months later, the patient returned with recurrence of chest pain. Additionally, he also complained of fever, odynophagia, and otalgia since the previous week. Oropharyngeal examination revealed tonsillar pillars aphthosis. The ECG was similar to the previous and TTE was normal. Bloodwork revealed once again elevation of inflammatory parameters and elevation of troponin. Recurrent myocarditis was diagnosed. Treatment with ibuprofen, colchicine, and antibiotic therapy was started with no significant improvement. After a more thorough physical examination, an ulcerated scrotal lesion, a left buttock folliculitis, and an axillary hidradenitis were found, which, according to the patient, were recurrent in the last year. Accordingly, the diagnosis of Behçet’s syndrome with mucocutaneous and cardiac involvement was established. The patient was kept on colchicine and was also started on immunosuppressive therapy with corticosteroids and azathioprine, with resolution of the symptoms in the following day. A positron emission tomography (PET) was performed 2 days after discharge and showed a higher myocardial uptake in the left ventricular basal segments and both papillary muscles. Prednisolone tapering was started after 2 months, while maintaining azathioprine. At 1-year follow-up, the patient remained asymptomatic. A re-evaluation PET was performed, showing no images suggestive of metabolically active disease in the myocardium. Discussion This case highlights the importance of awareness of this rare but potentially serious entity and reinforces the significance of aetiology investigation in cases of recurrent myocarditis. It also shows the success of immunosuppressive therapy in a context where the optimal management is still considerably uncertain.
Cardiac involvement as a consequence of LMNA mutations generally has a more aggressive natural history than other forms of non-ischemic dilated cardiomyopathy. A high index of suspicion and prompt referral for genetic testing are essential for appropriate therapeutic management.
Funding Acknowledgements Type of funding sources: None. Introduction Left ventricular systolic dysfunction (LVD) is a key concern in the context of cardio-oncology (CO). Usually, referral for suspected Cancer therapy-related cardiac dysfunction (CTRCD) is the main challenge, but heart failure with other more common causes, such as ischemic cardiomyopathy can also decompensate during cancer treatment or be diagnosed incidentally during cardiotoxicity echocardiographic (echo) surveillance. Multimodality imaging is essential in these patients in order to better establish aetiology and assure the most appropriate clinical management. Purpose evaluate clinical impact of multimodality imaging in the clinical management of CO patients. Methods retrospective study of a population followed in CO consultation. Statistical analysis of demographic, clinical, transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) data was made. Results we included 115 pts, mean age 66.3 ± 10.2 years, 67,8% female, with mean follow-up of 16.1 ± 12.8 months. About half (56.5%) had breast cancer, followed by gastrointestinal tract (16.5%) and haematological (8,7%) malignancies, with a significant proportion (32,2%) with advanced disease. Prevalence of cardiovascular risk factors was high (hypertension in 74.8%, dyslipidaemia in 47%, type 2 diabetes mellitus in 17.4%), but also coronary artery disease (18,3%) and atrial fibrillation (18.3%). All of them were treated with different types of chemotherapy and 53,9% of pts with radiotherapy. At baseline, 13% of pts had a left ventricular ejection fraction (LVEF) under 50% (LVD) assessed by TTE, which increased to 26,9% (n = 31) after oncological treatment initiation. Of these (n = 31), an ischemic aetiology was found in 32,3% and non-ischemic in 54,8%, which was significantly more frequent in patients with CTRCD (OR 2,7, p = 0,001). CMR was performed in 45,2%, mostly in CTRCD cases (p = 0,012, OR 8,4), which, apart from LVD, did not show any tissue changes in most patients (p = 0,026, OR 35). Only one patient with CTRCD (under treatment with trastuzumab and anthracyclines) had subepicardial late gadolinium enhancement, with wall motion abnormalities, suggesting a myocarditis-like mechanism for cardiotoxicity. Conclusion LVD has a major impact in patients" prognosis, particularly in CO context, where effective oncological treatments can be compromised due heart failure decompensation. Therefore, a thorough clinical evaluation should encompass etiological study in order to provide the most appropriate treatment strategies. Moreover, CTRCD can develop through different physiopathological mechanisms. Thus, multimodality imaging, particularly including CMR evaluation, can have a major role ensuring a good clinical outcome for these patients.
Cor triatriatum is a congenital atrial abnormality, which comprises a membrane that divides the atrium into two chambers. Symptoms can arise either due to the obstructive nature of this membrane or related to other associated anomalies, such as atrial septal defects or abnormal pulmonary venous return.The authors report the case of an adult male, in whom an incidental finding of cor triatriatum sinistrum was documented in association with mitral valve prolapse. However, both the late diagnosis and the association with mitral valve disease are uncommon.Multimodality imaging evaluation can prove very helpful in these cases to better define the anatomy of the left atrium and appropriately plan for intervention when indicated.
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