Exercise-induced ventricular arrhythmias: analysis of predictive factors in a population with sleep disorders

Cintra, Fátima Dumas; Makdisse, Márcia; Oliveira, Wercules; Rizzi, Camila F.; Luiz, Francisco Otávio de Oliveira; Tufik, Sérgio; Paola, Ângelo Amato Vincenzo de; Poyares, Dalva

doi:10.1590/s1679-45082010ao1469

Cited by 2 publications

(2 citation statements)

References 28 publications

(23 reference statements)

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“…For instance, some respiratory diseases that involve chronic, transitory, or intermittent hypoxia induce the process of fibrosis in cardiac tissue, and increase the occurrence of cardiac arrhythmias. Studies in patients with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and with cystic fibrosis (CF) have shown that low oxygen saturation during exercise may predispose them to cardiac ventricular arrhythmias (Cheong et al, 1990 ; Ruf and Hebestreit, 2009 ; Cintra et al, 2010 ). Cardiac arrhythmia has been also reported in patients with sleep apnea syndrome (SAS) (Guilleminault et al, 1983 ).…”

Section: Introductionmentioning

confidence: 99%

Killing Many Birds With Two Stones: Hypoxia and Fibrosis Can Generate Ectopic Beats in a Human Ventricular Model

2018

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During cardiac diseases many types of anatomical and functional remodeling of cardiac tissue can occur. In this work, we focus on two conditions: hypoxia and fibrosis, which are part of complex pathological modifications that take place in many cardiac diseases (hypertrophic cardiomyopathy, hypertensive heart disease, and recurrent myocardial infarction) and respiratory diseases (obstructive pulmonary disease, obstructive sleep apnea, and cystic fibrosis). Using computational models of cardiac electrophysiology, we evaluate if the interplay between hypoxia and fibrosis is sufficient to trigger cardiac arrhythmia. We study the mechanisms behind the generation of ectopic beats, an arrhythmic trigger also known as premature ventricular contractions (PVCs), in regions with high hypoxia and fibrosis. First, we modify an electrophysiological model of myocytes of the human left ventricle to include the effects of hypoxia. Second, diffuse fibrosis is modeled by randomly replacing cardiac myocytes by non-excitable and non-conducting cells. The Monte Carlo method is used to evaluate the probability of a region to generate ectopic beats with respect to different levels of hypoxia and fibrosis. In addition, we evaluate the minimum size of three-dimensional slabs needed to sustain reentries for different stimulation protocols. The observed mechanism behind the initiation of ectopic beats is unidirectional block, giving rise to sustained micro-reentries inside the region with diffuse fibrosis and hypoxia. In summary, our results suggest that hypoxia and fibrosis are sufficient for the creation of a focal region in the heart that generates PVCs.

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Section: Introductionmentioning

confidence: 99%

Killing Many Birds With Two Stones: Hypoxia and Fibrosis Can Generate Ectopic Beats in a Human Ventricular Model

2018

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“…Some experimental studies have identified the potential association between desaturations and the occurrence of ventricular arrhythmias. However, the underlying mechanism was still unclear [ 28 ]. Patients with respiratory failure were found to be at higher risk of LTA.…”

Section: Discussionmentioning

confidence: 99%

Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention

Wongthida

Lumkul

Patumanond

et al. 2022

IJERPH

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ST-elevated acute coronary syndrome (STEACS) is a serious condition requiring timely treatment. Reperfusion with primary percutaneous coronary intervention (pPCI) is recommended and preferred over fibrinolysis. Despite its efficacy, lethal complications, such as life-threatening arrhythmia (LTA), are common in post-PCI patients. Although various risk assessment tools were developed, only a few focus on LTA prediction. This study aimed to develop a risk score to predict LTA events after pPCI. A risk score was developed using a retrospective cohort of consecutive patients with STEACS who underwent pPCI at Chiangrai Prachanukroh Hospital from January 2012 to December 2016. LTA is defined as the occurrence of malignant arrhythmia that requires advanced cardiovascular life support (ACLS) within 72 h after pPCI. Logistic regression was used for model derivation. Among 273 patients, 43 (15.8%) developed LTA events. Seven independent predictors were identified: female sex, hemoglobin <12 gm/dL, pre-and intra- procedural events (i.e., respiratory failure and pulseless arrest), IABP insertion, intervention duration >60 min, and desaturation after pPCI. The LTA score showed an AuROC of 0.93 (95%CI 0.90, 0.97). The score was categorized into three risk categories: low (<2.5), moderate (2.5–4), and high risk (>4) for LTA events. The LTA score demonstrated high predictive performance and potential clinical utility for predicting LTA events after pPCI.

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Exercise-induced ventricular arrhythmias: analysis of predictive factors in a population with sleep disorders

Cited by 2 publications

References 28 publications

Killing Many Birds With Two Stones: Hypoxia and Fibrosis Can Generate Ectopic Beats in a Human Ventricular Model

Killing Many Birds With Two Stones: Hypoxia and Fibrosis Can Generate Ectopic Beats in a Human Ventricular Model

Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention

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