Cardioversion differences among first detected episode, paroxysmal, and persistent atrial fibrillation patients in the RHYTHM AF registry in Poland

Background: The aim of the publication is to show differences among patients with the first detected episode of atrial fibrillation (AF), paroxysmal, and persistent AF patients, for whom cardioversion was planned in the hospital setting in Poland. Methods: We present an analysis of the Polish cohort of the multicenter, multinational RHYTHM-AF registry. Consecutive patients in the hospital setting, aged ≥ 18 years, with documented AF at the time of enrollment, and for whom cardioversion of AF is one of the planned therapeutic options were recruited. Follow-up data was collected 60 days after enrollment. Results: Five-hundred-and-one patients were recruited, 483 with a defined AF type: 88 — first detected, 191 paroxysmal, and 204 persistent AF. CHA2DS2VASc scores were not significantly different between the groups, while treatment with vitamin K antagonists (VKA) was significantly lower in paroxysmal AF group than in persistent AF patients. Primary electrical cardioversion was most commonly performed in patients with persistent AF (90.4%), while primary pharmacological cardioversion — in the first detected AF (80.0%) and paroxysmal AF patients (76.7%). During 2 months of follow-up, the rate of rehospitalization and complications was comparable among the groups. Conclusions: Despite their comparable CHA2DS2VASc scores, patients with persistent AF were more frequently treated with VKA antagonists than other groups. Recurrence of AF within 2 months after restoring sinus rhythm was present in about 25% of the patients, and the rate of complications was not different among the three groups.

Strategie oceny przedoperacyjnej i redukcji ryzyka u chorych obciążonych kardiologicznie poddawanych procedurom zabiegowym w świetle nowych wytycznych Europejskiego Towarzystwa Kardiologicznego

In this article we summarise recent European Society of Cardiology guidelines on perioperative evaluation and management of patients undergoing invasive non-cardiac procedures. Close attention is paid to pharmacological methods of risk reduction including beta-blockers, statins, aspirin and angiotensin converting enzyme inhibitors. Simple, stepwise and evidence-based algorithm for patient evaluation is presented. We discuss the need for excessive diagnostic tests and coronary revascularisation before the procedure. Time frame for stopping dual antiplatelet therapy following percutaneous coronary interventions, methods of glycaemic control and bridging protocol for patients on oral anticoagulants are also provided. We emphasise the importance of prompt implementation of the above guidelines as the number of surgical procedures being performed in high risk patients (including the elderly) constantly rises. Kardiol Pol 2010; 68, 6: 702-70

Cardioversion of Atrial Fibrillation (RHYTHM-AF) International Registry in Poland

Background: A key procedure of the rhythm control strategy in atrial fibrillation (AF) is cardioversion to normal sinus rhythm. The aim of the present study was to provide a review of treatment patterns for the cardioversion of patients with AF in a hospital setting in Poland and document the success rate of various cardioversion procedures.Methods: We herein present the results from Poland of a prospective observational study to characterize patients with recent onset episodes of AF for whom cardioversion is one of the planned therapeutic options — the RHYTHM-AF registry. Consecutive patients in the hospital setting, age > 18 years, with documented AF at the time of enrollment, excluding those with atrial flutter and those treated with vernakalant, were recruited. No treatment was recommended nor discouraged.Results: Five hundred and one patients were recruited (mean age 64.2 ± 12.1), with 294 (58.7%) patients finally undergoing cardioversion. Primary electrical cardioversion (ECV) was successful in 131 (88.5%) patients. Primary pharmacological cardioversion (PCV) was successful in 110 (75.3%) patients. Amiodarone and propafenone were most commonly used (52.1% and 24.7%, respectively). Fourteen complications and adverse events were recorded (no stroke was observed).Conclusions: Conversion to sinus rhythm was attempted in < 60% of the patients with AF admitted to the hospital with an intention to terminate arrhythmia. ECV was successful in ~90% of the patients, while PCV in ~75% of the patients (amiodarone and propafenone were most commonly used). The rate of complications was low (2.8%).

Niewydolność serca u chorych na cukrzycę

Badania epidemiologiczne wskazują na fakt częstego współwystępowania niewydolności serca (HF, heart failure) u chorych na cukrzycą typu 2 (DM, diabetes mellitus). Ponadto HF jest niezależnym czynnikiem ryzyka zwiększonej częstości ujawniania się DM. Obecność DM u chorego z niewydolnością serca w niekorzystny sposób wpływa na przeżywalność odległą. Mimo wielu danych wskazujących na ścisłe związki między DM a HF, nie udało się dotychczas jednoznacznie wyjaśnić ich patomechanizmu. Rozpoznawanie niewydolności serca u chorych z DM wiąże się z licznymi problemami z uwagi na niecharakterystyczne objawy podmiotowe i przedmiotowe. Z tego względu kluczowym dla potwierdzenia rozpoznania HF jest wykonanie badań: elektrokardiograficznego, radiologicznego klatki piersiowej i echokardiograficznego z użyciem doplera oraz oznaczenie stężenia mózgowego peptydu natriuretycznego. Stosując leki przeciwcukrzycowe, należy pamiętać o ich potencjalnych działaniach niepożądanych u chorych z HF. Zasady leczenia niefarmakologicznego i farmakologicznego nie różnią się od stosowanych u chorych z HF bez cukrzycy typu 2. Chcąc osiągnąć sukces w leczeniu HF współistniejącej z DM, trzeba zwrócić uwagę na modyfikację czynników ryzyka, ocenić równowagę płynową w ustroju i poprawić aktywność fizyczną, a także unikać wybranych grup leków nasilających HF. W zależności od stanu nasilenia niewydolności, należy stosować w różnych kombinacjach leki moczopędne, inhibitory konwertazy angiotensyny, blokery receptora angiotensynowego, ß-blokery III generacji, spironolakton. Pacjenci z HF i współistniejącą cukrzycą typu 2 mogą skorzystać również z leczenia rewaskularyzacyjnego: przezskórnej rewaskularyzacji i pomostowania aortalno-wieńcowego. Obecność żywotnego myocardium determinuje kwalifikację i wyniki przeprowadzonego zabiegu rewaskularyzacyjnego. Jeżeli na wstępie oceni się, że chory nie będzie kandydatem do zabiegu rewaskularyzacyjnego, należy odstąpić od koronarografii i oceny żywotności i skupić się na potencjalizacji leczenia, zarówno nie- jak i farmakologicznego, z rozważeniem wskazań do leczenia z użyciem kardiowertera-defibrylatora (ICD) i/lub terapii resynchronizującej (CRT) albo rozważyć wskazania do transplantacji serca

The year in cardiology 2018: heart failure

No abstract available

Effects of vildagliptin on ventricular function in patients with type 2 diabetes mellitus and heart failure: a randomized placebo-controlled trial

Objectives: This study sought to examine the safety of the dipeptidyl peptidase-4 inhibitor, vildagliptin, in patients with heart failure and reduced ejection fraction. Background: Many patients with type 2 diabetes mellitus have heart failure and it is important to know about the safety of new treatments for diabetes in these individuals. Methods: Patients 18 to 85 years of age with type 2 diabetes and heart failure (New York Heart Association functional class I to III and left ventricular ejection fraction [LVEF] <0.40) were randomized to 52 weeks treatment with vildagliptin 50 mg twice daily (50 mg once daily if treated with a sulfonylurea) or matching placebo. The primary endpoint was between-treatment change from baseline in echocardiographic LVEF using a noninferiority margin of −3.5%. Results: A total of 254 patients were randomly assigned to vildagliptin (n = 128) or placebo (n = 126). Baseline LVEF was 30.6 ± 6.8% in the vildagliptin group and 29.6 ± 7.7% in the placebo group. The adjusted mean change in LVEF was 4.95 ± 1.25% in vildagliptin treated patients and 4.33 ± 1.23% in placebo treated patients, a difference of 0.62 (95% confidence interval [CI]: −2.21 to 3.44; p = 0.667). This difference met the predefined noninferiority margin of −3.5%. Left ventricular end-diastolic and end-systolic volumes increased more in the vildagliptin group by 17.1 ml (95% CI: 4.6 to 29.5 ml; p = 0.007) and 9.4 ml (95% CI: −0.49 to 19.4 ml; p = 0.062), respectively. Decrease in hemoglobin A1c from baseline to 16 weeks, the main secondary endpoint, was greater in the vildagliptin group: −0.62% (95% CI: −0.93 to −0.30%; p < 0.001; −6.8 mmol/mol; 95% CI: −10.2 to −3.3 mmol/mol). Conclusions: Compared with placebo, vildagliptin had no major effect on LVEF but did lead to an increase in left ventricular volumes, the cause and clinical significance of which is unknown. More evidence is needed regarding the safety of dipeptidyl peptidase-4 inhibitors in patients with heart failure and left ventricular systolic dysfunction. (Effect of Vildagliptin on Left Ventricular Function in Patients With Type 2 Diabetes and Congestive Heart Failure; NCT00894868

Stymulacja nerwu przeponowego w leczeniu centralnego bezdechu sennego u chorych z niewydolnością serca

Central sleep apnea (CSA) is characterised by a cessation of airflow in the respiratory airways during sleep due to fluctuationsin respiratory drive accompanied by a cessation of respiratory muscle activity. Patients with CSA often havea Cheyne-Stokes respiration. CSA occurs in patients with various diseases including patients with heart failure (HF).It can lead to many unfavourable phenomena associated with sympathetic nervous system activation and increasedmortality. Continuous positive airway pressure and other methods are used in the treatment of CSA. Recently, a newmethod has been developed that features stimulation of the phrenic nerve. This leads to contractions of the diaphragmand to regulation of the breathing pattern. The following paper presents the current state of knowledge on stimulation ofthe phrenic nerve, and its impact on respiratory parameters, physical performance and quality of life in patients with HF.Centralnym bezdechem sennym (CSA) nazywane jest zatrzymanie przepływu powietrza przez drogi oddechowe w czasie snu wywołane upośledzeniem funkcji ośrodkowego napędu oddechowego, któremu towarzyszy zatrzymanie ruchów oddechowych klatki piersiowej i brzucha. U pacjentów z CSA często stwierdza się tor oddechowy typu Cheyne’a-Stokesa. Centralny bezdech senny występuje u pacjentów z różnymi chorobami, między innymi u osób z niewydolnością serca (HF). Może on prowadzić do wielu niekorzystnych zjawisk związanych ze wzmożonym napięciem współczulnego układu nerwowego, a także zwiększać ryzyko zgonu. W leczeniu stosuje się różne metody, między innymi terapię wykorzystującą stałe dodatnie ciśnienie w drogach oddechowych. Ostatnio pojawiła się nowa metoda oparta na stymulacji nerwu przeponowego wpływająca na skurcz przepony i regulująca tor oddechowy. W pracy przedstawiono aktualny stan wiedzy dotyczący stymulacji nerwu przeponowego, jej wpływu na parametry oddechowe, wydolność fizyczną i jakość życia u chorych z HF

Clinical profile and management of outpatients with non-ischemic and non-hypertensive systolic heart failure: Analysis of the Polish DATA-HELP registry

Background: Although coronary artery disease and arterial hypertension are the most common etiologies underlying heart failure (HF), there are still many patients present with non-ischemic and non-hypertensive HF whose management remains very challenging. In this research study the clinical profile and applied treatment of patients with HF without coronary artery disease or hypertension versus patients with known etiology of HF (ischemic/hypertensive) were compared. Methods: Clinical data about 5563 patients with stable systolic HF were obtained from prospective multicenter DATA-HELP registry performed between October and December 2009 in ambulatory clinics in Poland, in which 500 cardiologists and 290 general practitioners participated. Results: Heart failure of non-ischemic and non-hypertensive etiology which affected 10% of all patients and was particularly frequent in younger patients, both in women: < 50 years old 42%; 50–65 years old 12%; > 65 years old 7%; and men: < 50 years old 47%; 50–65 years old 10%; > 65 years old 5%; p < 0.0001. Patients with non-ischemic and non-hypertensive HF were characterized by younger age, fewer co-morbidities, shorter duration of HF and, surprisingly, more advanced HF. Patients in this group were less likely to have received life-prolonging treatment in HF recommended by European Society of Cardiology (ESC) and more often required symptomatic management. Similarly, they were more likely to have implanted CRT-D and ICD. Conclusions: Heart failure of non-ischemic and non-hypertensive origin affects particularly young patients. These patients, despite suffering from more advanced HF are not optimally managed according to ESC guidelines