Resting Sinus Heart Rate and First Degree AV block: Modifiable Risk Predictors or Epiphenomena?

Simple and cost-effective tools that identify patients at increased risk for adverse cardiovascular events are actively sought. High resting sinus heart rate and first degree AV block are easily recognized and commonly encountered findings in a cardiology practice. A growing body of epidemiological and clinical evidence has been shown them to be independent predictors of all-cause and cardiovascular mortality, both in the general population and in patients with structural heart disease. This paper reviews the important role of heart rate and first degree AV block in predicting cardiovascular outcomes, examines the pathophysiological mechanisms underlying this increased risk, and discusses the effectiveness of available therapies to favorably modify these risk factors

Advances in the management of atrial fibrillation in congestive heart failure

Atrial fibrillation, a common problem in patients with heart failure, is associated with increased mortality and morbidity. Pharmacological as well as invasive management and the endpoints of such management are complex. Recent randomized trials indicate that a rate-control strategy, along with anticoagulation treatment with warfarin, when appropriate, has a similar outcome in terms of mortality and morbidity as rhythm control, and could, therefore, be considered as the primary management strategy for atrial fibrillation in patients with heart failure

INFLUENCE OF LIPOPROTEIN LIPIDS AND APOLIPOPROTEIN E GENE POLYMORPHISMS ON COAGULATION FACTOR VIII CHANGES WITH SIX MONTHS OF AEROBIC EXERCISE TRAINING

Title of Thesis : INFLUENCE OF LIPOPROTEIN LIPIDS AND APOLIPOPROTEIN E GENE POLYMORPHISMS ON COAGULATION FACTOR VIII CHANGES WITH SIX MONTHS OF AEROBIC EXERCISE TRAINING. Rakesh Gopinathannair, Master of Arts, 2004. Thesis directed by: Professor James M. Hagberg, Ph.D., Dept. of Kinesiology Elevated plasma factor VIII antigen (FVIII:Ag) level is an independent risk factor for coronary artery disease. Aerobic training improves cardiovascular risk and improvement in coagulation profile might be a potential contributory mechanism. Available evidence suggests that plasma lipoprotein-lipid levels and lipid-related genotypes might have a regulatory effect on plasma FVIII:Ag levels. We assessed the effects of APO E gene polymorphisms and plasma lipoprotein-lipid changes on plasma FVIII:Ag changes with 6 mo of standardized aerobic training in 44 sedentary, 50-75 year old men and women with different APO E genotypes. Plasma FVIII:Ag levels, lipoprotein-lipid levels, VO2 max, and intra-abdominal fat (CTIA) were estimated before and after 6 mo of training . Plasma FVIII:Ag levels showed an increase of 3.5% (152.5±6.7% to 156.0±6.1%, P=0.290) with exercise training. FVIII:Ag levels were positively correlated to CTIA at baseline (r= 0.30) and after training (r=0.37). There was no significant association between FVIII:Ag levels and APO E genotype, before and after covarying for training-induced changes in plasma lipoprotein-lipids. In conclusion, the effect of regular aerobic exercise training on plasma FVIII:Ag levels appears small and clinically insignificant when compared to the clear and beneficial effects on lipoprotein-lipid profile and body composition. Truncal obesity may be a significant factor modulating baseline plasma FVIII:Ag levels and their response to training

Cardiac resynchronization therapy in continuous flow left ventricular assist device recipients: A systematic review and meta-analysis from ELECTRAM investigators

Introduction: Whether cardiac resynchronization therapy (CRT) continues to augment left ventricular remodeling in patients with the continuous-flow left ventricular assist device (cf-LVAD) remains unclear. Methods: We performed a systematic review and meta-analysis of all clinical studies examining the role of continued CRT in end-stage heart failure patients with cf-LVAD reporting all-cause mortality, ventricular arrhythmias, and ICD shocks. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data. Results: Eight studies (7 retrospective and 1 randomized) with a total of 1,208 unique patients met inclusion criteria. There was no difference in all-cause mortality (RR 1.08, 95% CI 0.86-1.35, p = 0.51, I2=0%), all-cause hospitalization (RR 1.01, 95% CI 0.76-1.34, p = 0.95, I2=11%), ventricular arrhythmias (RR 1.08, 95% CI 0.83-1.39, p = 0.58, I2 =50%) and ICD shocks (RR 0.87, 95% CI 0.57-1.33, p = 0.52, I2 =65%) comparing CRT versus non-CRT. Subgroup analysis demonstrated significant reduction in ventricular arrhythmias (RR 0.76, 95% CI 0.64-0.90, p = 0.001) and ICD shocks (RR 0.65, 95% CI 0.44-0.97, p = 0.04) in CRT on group versus CRT off group. Conclusion: CRT was not associated with a reduction in all-cause mortality or increased risk of ventricular arrhythmias and ICD shocks compared to non-CRT in cf-LVAD patients. It remains to be determined which subgroup of cf-LVAD patients benefit from CRT.The findings of our study are intriguing, and therefore,larger studies in a randomized prospective manner should be undertaken to address this specifically

Status of Early-Career Academic Cardiology, A Global Perspective

Early career academic cardiologists, whom many believe are an important component of the future of cardiovascular care, face a myriad of challenges. The Early Career Section Academic Working Group of the American College of Cardiology (ACC) along with senior leadership support, assessed the progress of this cohort from 2013–2016 with a global perspective. Data consisted of accessing National Heart Lung and Blood Institute (NHLBI) public information, American Heart Association and international organizations providing data, and a membership-wide survey. Although NHBLI increased funding of career development grants, only a small number of early career ACC members have benefited as funding of the entire cohort has decreased. Personal motivation, institutional support, and collaborators continued to be positive influential factors. Surprisingly, mentoring ceased to correlate positively with obtaining external grants. Totality of findings suggests that the status of early career academic cardiologists remain challenging; therefore, we recommend a set of attainable solutions

Left Ventricular Dysfunction Caused by Unrecognized Surgical AV block in a Patient with a Manifest Right Free Wall Accessory Pathway

A 24-year-old male with Wolff-Parkinson-White syndrome developed systolic cardiomyopathy and severe heart failure following membranous ventricular septal defect repair and tricuspid valve replacement. Following successful catheter ablation of a right anterolateral accessory pathway (AP), complete AV block with junctional escape rhythm was noted. Patient subsequently underwent implantation of a biventricular ICD. Heart failure symptoms significantly improved soon after and left ventricular systolic function normalized 3 months post-procedure. In this case, surgically acquired AV block likely explains development of postoperative cardiomyopathy by facilitating ventricular activation solely via the AP and thereby increasing the degree of ventricular dyssynchrony

Fractionation mapping software to map ganglionated plexus sites during sinus rhythm

Ablation of ganglionated plexuses (GPs) is a relatively new technique in patients with vasovagal syncope. Due to individual variation of GP settlement, reproducible GP detection methods are needed to during electrophysiologic study. In the present case, fractionation mapping software of Ensite system was tested to detect localization of GPs and first compared with previously validated fractionated electrograms based strategy