Cardiovascular disease during the COVID-19 pandemic: Think ahead, protect hearts, reduce mortality

Coronavirus disease 2019 (COVID-19) is rapidly spreading globally. As of October 3, 2020, the number of confirmed cases has been nearly 34 million with more than 1 million fatalities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is accountable for COVID-19. Newly diagnosed and worsening cardiovascular disease are common complications in COVID-19 patients, including acute cardiac injury, hypertension, arrhythmia, myocardial infarction, heart failure and sudden cardiac arrest. The mechanisms contributing to cardiac disease burden include hypoxemia, inflammatory factor storm, dysfunctional angiotensin converting enzyme 2 (ACE2), and drug-induced cardiac toxicity.Notably, the macrophages expressing ACE2 as direct host cells of SARS-CoV-2 secrete chemokine and inflammatory cytokines, as well as a decrease in cellular immune responses to SARS-CoV-2 infection due to elevated exhaustion levels and dysfunctional diversity of T cells, that may be accountable for the “hyperinflammation and cytokine storm syndrome” and subsequently acute cardiac injury and deterioratingcardiovascular disease in COVID-19 patients. However, no targeted medication or vaccines for COVID-19 are yet available. The management of cardiovascular disease in patients with COVID-19 include general supportive treatment, circulatory support, other symptomatic treatment, psychological assistance as well as online consultation. Further work should be concentrated on better understanding the pathogenesis of COVID-19 and accelerating the development of drugs and vaccines to reduce the cardiac disease burden and promote the management of COVID-19 patients, especially those with a severe disease course and cardiovascular complications

Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia

AIMS: Little is known about patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM). Our aims were: (i) to describe electrocardiogram (ECG) characteristics of sinus rhythm (SR) and VT; (ii) to correlate SR with RBBB-VT ECGs; and (iii) to compare VT ECGs with electro-anatomic mapping (EAM) data. METHODS AND RESULTS: From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) sites of origin (SOOs) were estimated with a VT-axis-derived methodology and confirmed by EAM data when available.  Overall, 49 (70%) patients met definite Task Force Criteria. Low QRS voltage predominated in lateral leads (n = 37, 55%), but QRS fragmentation was more frequent in inferior leads (n = 15, 23%). T-wave inversion (TWI) was equally frequent in inferior (n = 28, 42%) and lateral (n = 27, 40%) leads. TWI in inferior leads was associated with reduced LV ejection fraction (LVEF; 46 ± 10 vs. 53 ± 8, P = 0.02). Regarding SOOs, the inferior wall harboured 31 (46%) SOOs, followed by the lateral wall (n = 17, 25%), the anterior wall (n = 15, 22%), and the septum (n = 4, 6%). EAM data were available for 16 patients and showed good concordance with the putative SOOs. In all patients with superior-axis RBBB-VT who underwent endo-epicardial VT activation mapping, VT originated from the LV. CONCLUSIONS: In patients with ACM and RBBB-VT, RBBB-VTs originated mainly from the inferior and lateral LV walls. SR depolarization and repolarization abnormalities were frequent and associated with underlying variants

Etude des caractéristiques des patients octogénaires porteurs d' un défibrillateur automatique implantable

Le défibrillateur automatique implantable (DAI) a fait la preuve de son efficacité pour la réduction de la mortalité chez les patients à risque de mort subite. La survenue de complications et le rapport bénéfice sur risque d un DAI chez les sujets âgés sont mal connus. L espérance de vie de la population s allonge et les patients octogénaires représentent une part importante des indications potentielles d un DAI. De juin 2001 à Juillet 2003, les données des patients implantés en France d un défibrillateur ont été consignées dans un registre prospectif (EVADEF). L objectif de ce travail est de comparer les caractéristiques et l évolution des patients octogénaires à ceux de moins de 80 ans. 80 patients octogénaires et 2301 patients < 80 ans ont été étudiés. 96,3% des patients 80 ans ont été inclus en prévention secondaire. Les octogénaires présentaient dans 78,8% des cas une cardiopathie ischémique (versus 58,9% parmi les patients < 80 ans (p<0 001)). La mortalité à 2 ans était de 26,2% parmi les octogénaires. 13,7% des octogénaires ont présenté des complications versus 13,6% pour les patients < 80 ans. La dysfonction VG à l inclusion était plus sévère chez les patients octogénaires décédés que chez les octogénaires survivants (p=0,017). Dans notre étude, l implantation d un défibrillateur après l âge de 80 ans en prévention secondaire n entraine pas plus de complications que dans une population plus jeune. La prise en compte de l état général du patient, sa FEVG ainsi que sa fonction rénale semblent être des paramètres indispensables pour la décision thérapeutique.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

My approach to ventricular tachycardia ablation in patient with arrhythmogenic right ventricular cardiomyopathy/dysplasia

International audienceAbstract Aims Rate, incidence, risk factors, and optimal management of atrio-oesophageal fistula (AOF) after catheter ablation for atrial fibrillation (AF) remain obscure. Methods and results All French centres performing AF ablation were identified and surveys were sent concerning the number of procedures, eventual cases of AOF, and characteristics of such cases. Eighty-two of the 103 centres (80%) performing AF ablation in France were included, with a total of 129 286 AF ablations since 2006 (93% of the whole procedures in France). Thirty-three AOF were reported (reported rate 0.026% per procedure) with a stable reported annual incidence despite the increasing number of procedures. Sensitivity of computed tomography (CT) scan for AOF was 81%. Mortality was 60%, significantly lower in case of surgical corrective therapy (31 vs. 93%, P = 0.001). Conclusion The reported rate of AOF after AF ablation in this nationwide survey was 0.026%, with a stable reported annual incidence over time. A normal CT scan does not rule out the diagnosis and should be repeated in case of suspicion. Prognosis remains poor with a mortality of 60% and crucially dependant of immediate surgical correction. No clear protective strategy has been proven effective

Cardiovascular disease during the COVID-19 pandemic: Think ahead, protect hearts, reduce mortality

Coronavirus disease 2019 (COVID-19) is rapidly spreading globally. As of October 3, 2020, the number of confirmed cases has been nearly 34 million with more than 1 million fatalities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is accountable for COVID-19. Newly diagnosed and worsening cardiovascular disease are common complications in COVID-19 patients, including acute cardiac injury, hypertension, arrhythmia, myocardial infarction, heart failure and sudden cardiac arrest. The mechanisms contributing to cardiac disease burden include hypoxemia, inflammatory factor storm, dysfunctional angiotensin converting enzyme 2 (ACE2), and drug-induced cardiac toxicity. Notably, the macrophages expressing ACE2 as direct host cells of SARS-CoV-2 secrete chemokine and inflammatory cytokines, as well as a decrease in cellular immune responses to SARS-CoV-2 infection due to elevated exhaustion levels and dysfunctional diversity of T cells, that may be accountable for the "hyperinflammation and cytokine storm syndrome" and subsequently acute cardiac injury and deteriorating cardiovascular disease in COVID-19 patients. However, no targeted medication or vaccines for COVID-19 are yet available. The management of cardiovascular disease in patients with COVID-19 include general supportive treatment, circulatory support, other symptomatic treatment, psychological assistance as well as online consultation. Further work should be concentrated on better understanding the pathogenesis of COVID-19 and accelerating the development of drugs and vaccines to reduce the cardiac disease burden and promote the management of COVID-19 patients, especially those with a severe disease course and cardiovascular complications

Management of sustained arrhythmias for patients with cardiogenic shock in intensive cardiac care units

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Sexual Dimorphisms, Anti-Hormonal Therapy and Cardiac Arrhythmias

International audienceSignificant variations from the normal QT interval range of 350 to 450 milliseconds (ms) in men and 360 to 460 ms in women increase the risk for ventricular arrhythmias. This difference in the QT interval between men and women has led to the understanding of the influence of sex hormones on the role of gender-specific channelopathies and development of ventricular arrhythmias. The QT interval, which represents the duration of ventricular repolarization of the heart, can be affected by androgen levels, resulting in a sex-specific predilection for acquired and inherited channelopathies such as acquired long QT syndrome in women and Brugada syndrome and early repolarization syndrome in men. Manipulation of the homeostasis of these sex hormones as either hormonal therapy for certain cancers, recreational therapy or family planning and in transgender treatment has also been shown to affect QT interval duration and increase the risk for ventricular arrhythmias. In this review, we highlight the effects of endogenous and exogenous sex hormones in the physiological and pathological states on QTc variation and predisposition to gender-specific pro-arrhythmias

Traiter la fibrillation atriale dans l'insuffisance cardiaque

Le traitement des patients ayant à la fois fibrillation atriale et insuffisance cardiaque reste délicat. Dans l'absolu le maintien du rythme sinusal est souhaitable, mais la seule intervention pharmacologique qui permet de le faire en toute sécurité est l'amiodarone. Un essai de randomisation de stratégies, réduire ou ralentir, vient d'être réalisé chez les patients ayant les 2 pathologies, c'est l'essai AF-CHF qui a montré des résultats neutres, les deux stratégies, contrôle du rythme ou simple contrôle de la fréquence étant identiques en termes de mortalité. La dronédarone est une molécule innovante qui apporte de nouvelles possibilités dans le traitement de la fibrillation atriale mais elle est contre-indiquée en cas d'insuffisance cardiaque sévère. Une autre approche possible est celle des techniques non pharmacologiques. Le maintien du rythme sinusal peut être obtenu en cas d'ablation réussie par isolation des veines pulmonaires. L'autre possibilité est l'ablation du nœud auriculo-ventriculaire avec mise en place d'un stimulateur cardiaque, technique qu'il convient de réserver seulement à certains patients très sélectionnés