Two undesired conditions resulting from T-Wave oversensing in two patients with hypertrophic cardiomyopathy: Inappropriate ICD shocks and pacemaker dysfunction

Introduction: T-wave oversensing (TWOS) is generally seen in patients with hypertrophic cardiomyopathy (HCM) and is a rare cause of inappropriate implantable cardioverter defibrillator (ICD) shocks. TWOS rarely causes pacemaker dysfunction. Case Presentation: In this paper, we present two patients with hypertrophic cardiomyopathy (HCM). One patient had several in- appropriate ICD shocks, and the other experienced pacemaker dysfunction due to TWOS. ICD interrogation revealed that TWOS occurred only during high heart rates in the first patient. Attempts to fix TWOS, including a higher beta blocker dose, electrophysi- ology study, and ICD re-programming, were unsuccessful. Conclusions: We replaced the previously implanted ICD generator (Medtronic Maximo II DR) with a new one that has a specific diagnostic algorithm to prevent TWOS (Medtronic Protector). After replacement, the patient did not have any inappropriate shocks due to TWOS. The second patient had bradycardic pacemaker rhythm due to TWOS. Although we reposed, the ventricular lead did not stabilize with an adequate threshold, and thus we decided to replace the lead with a new one. The pacemaker dysfunction disappeared after the lead replacement. Patients with HCM must be observed carefully for these undesired conditions

Evans syndrome with non-ST segment elevation myocardial infarction complicated by hemopericardium

Evans syndrome (ES) is a rare hematological disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and/or neutropenia, all of which may be seen simultaneously or subsequently. Thrombotic events in ES are uncommon. Furthermore, non-ST segment-elevation myocardial infarction (NSTEMI) during ES is a very rare condition. Here, we describe a case of a 69-year-old female patient presenting with NSTEMI and ES. Revascularization via percutaneous coronary intervention (PCI) was scheduled and performed. Hemopericardium and cardiac tamponade occurred 5 h after PCI, and urgent pericardiocentesis was performed. Follow-up was uneventful, and the patient was safely discharged. Early recognition and appropriate management of NSTEMI is crucial to prevent morbidity and mortality. Coexistence of NSTEMI and ES, which is associated with increased bleeding risk, is a challenging scenario and these patients should be closely monitored in order to achieve early recognition and treatment of complications

Biomarkery uszkodzenia miokardium po przezcewnikowej ablacji prądem o wysokiej częstotliwości i krioablacji balonowej z powodu migotania przedsionków oraz ich wpływ na nawrót migotania

Background: Myocardial injury induced by catheter ablation (CA) for atrial fibrillation (AF) leads to elevated biomarker levels. Aim: This prospective study examined levels of myocardial injury biomarkers (creatinine kinase [CK], myocardial bound for CK [CK-MB], and troponin I [TnI]) and their impact on AF recurrence following two different ablation strategies, namely: cryoballoon ablation (CBA) and radiofrequency ablation (RFA). We also aimed to evaluate the relationship between AF recurrence after CA and other clinical, echocardiographic and procedural parameters. Methods: We enrolled 98 patients with AF, 21% of whom had persistent AF and 79% had paroxysmal AF. 58% of patients underwent CBA, and 42% underwent RFA. CK, CK-MB, and TnI levels were measured before and 6 h after the procedure. Patients had follow-up visits three, six, and nine months after the index procedure. Biomarker levels were compared between the patients with and without AF recurrence. Results: Post-ablation CK (postCK), post-ablation CK-MB (postCKMB), and post-ablation TnI (postTnI) levels were significantly high in the CBA and RFA groups (p < 0.001 for all). TnI elevation (DTnI) was correlated with age (p = 0.033) and median temperature reached during ablation (p < 0.005) in the CBA group, while it was correlated with application time in the RFA group (p < 0.001). Multivariate analysis in the CBA group revealed age and left atrium diameter as positive independent predictors (p = 0.029 and p = 0.046), and DTnI as a negative independent predictor for AF recurrence (p = 0.001). Elevated cardiac biomarkers were not associated with AF recurrence in the RFA group (p > 0.05). Conclusions: The levels of all cardiac biomarkers were elevated after CBA and RFA. Elevated TnI levels after CBA were independent negative predictors of AF recurrence. Measurement of TnI levels after CBA may be useful for the prediction of better clinical outcome.Wstęp: Uszkodzenie miokardium w wyniku ablacji przezcewnikowej (CA) z powodu migotania przedsionków (AF) wiąże się z podwyższonymi stężeniami biomarkerów. Cel: W tym prospektywnym badaniu zmierzono stężenia biomarkerów uszkodzenia miokardium (kinaza kreatynowa [CK]), izoenzym sercowy kinazy kreatynowej [CK-MB], troponina I [TnI]) oraz oceniono ich wpływ na nawrót AF po zabiegu ablacji wykonanym jedną z dwóch metod: krioablacji balonowej (CBA) i ablacji prądem o wysokiej częstotliwości (RFA). Autorzy zamierzali również ocenić zależność między nawrotem AF po CA a innymi parametrami klinicznymi, echokardiograficznymi i związanymi z metodą zabiegową. Metody: Do badania włączono 98 chorych z AF, spośród których u 21% rozpoznano przetrwałe AF, a u 79% — napadowe AF. U 58% chorych wykonano CBA, a u 42% osób — RFA. Stężenia CK, CK-MB i TnI zmierzono przed zabiegiem i 6 godzin po zabiegu. Wizyty kontrolne odbyły się 3, 6 i 9 miesięcy po ablacji. Porównano stężenia biomarkerów u pacjentów z nawrotem AF i bez nawrotu. Wyniki: Zmierzone po ablacji stężenia CK (postCK), CK-MB (postCKMB) i TnI (postTnI) były istotnie wyższe w grupach CBA i RFA (p < 0,001 dla wszystkich porównań). Zwiększenie stężenia TnI (DTnI) w grupie CBA korelowało z wiekiem (p = 0,033) i medianą temperatury osiągniętej w czasie ablacji (p < 0,005), natomiast w grupie RFA korelowało z czasem aplikacji (p < 0,001). Analiza wieloczynnikowa danych pacjentów z grupy CBA wykazała, że wiek i średnica lewego przedsionka były niezależnymi czynnikami predykcyjnymi dodatnimi (p = 0,029 i p = 0,046), a DTnI — niezależnym czynnikiem predykcyjnym ujemnym nawrotu AF (p = 0,001). Podwyższone stężenia biomarkerów sercowych nie wiązały się z nawrotem AF w grupie RFA (p > 0,05). Wnioski: Po CBA i RFA stężenia wszystkich biomarkerów sercowych były podwyższone. Zwiększone stężenia TnI po CBA stanowiły niezależny czynnik prognostyczny ujemny nawrotu AF. Pomiary stężeń TnI po CBA mogą być użyteczne w prognozowaniu lepszego efektu klinicznego

Demographics of patients with heart failure who were over 80 years old and were admitted to the cardiology clinics in Turkey

WOS: 000468584300005PubMed ID: 30930455Objective: Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. Methods: The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: >= 50%). Results: A total of 1098 patients (male, 47.5%; mean age, 83.5 +/- 3.1 years) aged 80 years and 4596 patients (male, 50.2 %; mean age, 71.1 +/- 4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were >= 80 years and 27.1% for patients 65-79 years old. For patients aged >= 80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p= 80 years with HFrEF (p<0.01). Conclusion: HF is common in elderly Turkish population, and its frequency increases significantly with age. Females, diabetics, and hypertensives are more likely to have HFpEF, whereas CAD patients are more likely to have HFrEF.Turkish Society of CardiologyThis study was supported by Turkish Society of Cardiology

Demographics of patients with heart failure who were over 80 years old and were admitted to the cardiology clinics in Turkey

Objective: Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. Methods: The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: >= 50\%). Results: A total of 1098 patients (male, 47.5\%; mean age, 83.5 +/- 3.1 years) aged 80 years and 4596 patients (male, 50.2 \%; mean age, 71.1 +/- 4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8\% for patients who were >= 80 years and 27.1\% for patients 65-79 years old. For patients aged >= 80 years with HF, the prevalence rate was 67\% for hypertension (HT), 25.6\% for diabetes mellitus (DM), 54.3\% for coronary artery disease (CAD), and 42.3\% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p<0.01), whereas CAD had a higher prevalence in the HFrEF group (p=0.02). Among patients aged 65-79 years, 43.9\% (548) had HFpEF, and 56.1\% (700) had HFrEF. In this group of patients aged 65-79 years with HFrEF, the prevalence of DM was significantly higher than in patients aged >= 80 years with HFrEF (p<0.01). Conclusion: HF is common in elderly Turkish population, and its frequency increases significantly with age. Females, diabetics, and hypertensives are more likely to have HFpEF, whereas CAD patients are more likely to have HFrEF