Pseudo-polymorphic Ventricular Tachycardia in a 12-lead Holter Recording

AbstractWe present an image of pseudo-polymorphic ventricular tachycardia recording on a 12-lead surface ECG Holter. Although at first glance the appearance of the recording resembled polymorphic ventricular tachycardia, careful investigation revealed normal electrocardiographic findings

Irregular ventricular tachycardia underdetected by implantable cardioverter defibrillator device

A case of sustained monomorphic ventricular tachycardia underdetected by a single chamber implantable cardioverter defibrillator because of RR interval irregularity is presented. The programmed stability criterion is responsible for the underdetection. Special attention must be paid when it comes to programming this detection parameter. (Cardiol J 2008; 15: 281-283

Proarrhythmic Effect of Implantable Defibrillator Function

Proarrhythmia usually refers to the worsening of an arrhythmia from an antiarrhythmic medication. However, implantable cardioverter defibrillator (ICD) devices can also be proarrhythmic as is shown in the case herein presented

Proarrhythmic Effect of ICD Function

The implantable cardioverter ??? defibrillator (ICD) is a device that treats ventricular tachyarrhythmias (VT), when they appear in a sustained form. The device???s programming can deliver the following therapies: 1) antitachycardia pacing (ATP), 2) cardioversion and 3) defibrillation. Today???s devices also have the capability of every mode of cardiac pacing, i.e. atrial, ventricular, atrio-ventricular and biventricular pacing.It is well known that the antiarrhythmic drug therapy can exhibit proarrhythmic effects. Likewise, the antiarrhythmic apparatus can possibly aggravate an existing VT or cause the appearance of a new arrhythmia, attempting to convert the clinical tachyarrhythmia. A case of proarrhythmic effect related to the therapeutic sequences delivered by an ICD, is delineated in the following continuous recording of an arrhythmic event,as it was stored in the Holter function of the device

Implantable Loop Recorder and Syncope-Rhythm Correlation

A case of syncope-rhythm correlation is presented in a patient with a history of unexplained loss of consciousness and an implantable loop recorder. A permanent pacemaker was implanted due to the bradycardia event revealed by the recorder device and the patient remained asymptomatic in the follow up period

The Relation of Migraine Headaches and Interatrial Shunts

Foramen ovale plays a very important role in fetal circulation by bypassing the lungs and diverting circulation from the right to the left heart. With birth it is usually sealed; however, probe patent or incompletely sealed foramen ovale remains in approximately 25% of adults. Patent foramen ovale (PFO) acquires significance in various congenital heart diseases or other particular settings leading to a right to left shunt, and thus to paradoxical embolism. PFO has been associated with transient ischemic attacks or cryptogenic strokes and also a host of other problems, including migraine. The recognition of an association between migraine syndrome with aura and PFO appears to have come ???full circle??? over the past two decades. Epidemiologic studies have suggested a notably increased PFO prevalence in persons suffering from migraine.The prevalence of migraine headache is higher in cryptogenic stroke patients with PFO than in the general population. Studies have suggested that closure of the PFO may reduce migrainous symptoms. The relation between this association and the recognition of migraine as a risk factor for ischemic stroke in the young is unclear, though right to left passage of circulating factors has been postulated in both syndromes. Despite case series and uncontrolled studies documenting beneficial effects of PFO closure in patients with migraine, particularly those also afflicted by cryptogenic stroke, the recommendation for PFO closure in patients with migraine alone will need to await the results of ongoing randomized trials

Addressing the clinical unmet needs in primary Sjögren's Syndrome through the sharing, harmonization and federated analysis of 21 European cohorts

For many decades, the clinical unmet needs of primary Sjögren's Syndrome (pSS) have been left unresolved due to the rareness of the disease and the complexity of the underlying pathogenic mechanisms, including the pSS-associated lymphomagenesis process. Here, we present the HarmonicSS cloud-computing exemplar which offers beyond the state-of-the-art data analytics services to address the pSS clinical unmet needs, including the development of lymphoma classification models and the identification of biomarkers for lymphomagenesis. The users of the platform have been able to successfully interlink, curate, and harmonize 21 regional, national, and international European cohorts of 7,551 pSS patients with respect to the ethical and legal issues for data sharing. Federated AI algorithms were trained across the harmonized databases, with reduced execution time complexity, yielding robust lymphoma classification models with 85% accuracy, 81.25% sensitivity, 85.4% specificity along with 5 biomarkers for lymphoma development. To our knowledge, this is the first GDPR compliant platform that provides federated AI services to address the pSS clinical unmet needs. © 2022 The Author(s

Expert consensus document: A 'diamond' approach to personalized treatment of angina.

In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for traditional first-choice drugs. Considering some drugs, but not others, to be first choice is, therefore, difficult. Moreover, double or triple therapy is often needed to control angina. Patients with angina can have several comorbidities, and symptoms can result from various underlying pathophysiologies. Some agents, in addition to having antianginal effects, have properties that could be useful depending on the comorbidities present and the mechanisms of angina, but the guidelines do not provide recommendations on the optimal combinations of drugs. In this Consensus Statement, we propose an individualized approach to angina treatment, which takes into consideration the patient, their comorbidities, and the underlying mechanism of disease

Lipoprotein‐Associated Phospholipase A2 Activity Is a Marker of Risk But Not a Useful Target for Treatment in Patients With Stable Coronary Heart Disease

Background: We evaluated lipoprotein‐associated phospholipase A2 (Lp‐PLA2) activity in patients with stable coronary heart disease before and during treatment with darapladib, a selective Lp‐PLA2 inhibitor, in relation to outcomes and the effects of darapladib in the STABILITY trial. Methods and Results: Plasma Lp‐PLA2 activity was determined at baseline (n=14 500); at 1 month (n=13 709); serially (n=100) at 3, 6, and 18 months; and at the end of treatment. Adjusted Cox regression models evaluated associations between Lp‐PLA2 activity levels and outcomes. At baseline, the median Lp‐PLA2 level was 172.4 μmol/min per liter (interquartile range 143.1–204.2 μmol/min per liter). Comparing the highest and lowest Lp‐PLA2 quartile groups, the hazard ratios were 1.50 (95% CI 1.23–1.82) for the primary composite end point (cardiovascular death, myocardial infarction, or stroke), 1.95 (95% CI 1.29–2.93) for hospitalization for heart failure, 1.42 (1.07–1.89) for cardiovascular death, and 1.37 (1.03–1.81) for myocardial infarction after adjustment for baseline characteristics, standard laboratory variables, and other prognostic biomarkers. Treatment with darapladib led to a ≈65% persistent reduction in median Lp‐PLA2 activity. There were no associations between on‐treatment Lp‐PLA2 activity or changes of Lp‐PLA2 activity and outcomes, and there were no significant interactions between baseline and on‐treatment Lp‐PLA2 activity or changes in Lp‐PLA2 activity levels and the effects of darapladib on outcomes. Conclusions: Although high Lp‐PLA2 activity was associated with increased risk of cardiovascular events, pharmacological lowering of Lp‐PLA2 activity by ≈65% did not significantly reduce cardiovascular events in patients with stable coronary heart disease, regardless of the baseline level or the magnitude of change of Lp‐PLA2 activity

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)

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