Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Recurrencia , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Fibrilación Atrial/cirugía , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Humanos , Ablación por Catéter/efectos adversos , Resultado del Tratamiento , Potenciales de Acción , Frecuencia Cardíaca/efectos de los fármacos , Factores de Riesgo , Factores de TiempoRESUMEN
Detailed heart rate (HR) response patterns during exercise in patients with heart failure (HF) and sinus rhythm remain uncertain. We screened consecutive patients with HF who underwent cardiopulmonary exercise tests at a large academic center from November 2013 to July 2023. HR response during exercise was statistically classified using logistic differential equation models. A total of 99 patients were included. Of them, 75 patients were assigned to "sigmoidal pattern" and the other 24 to "exponential pattern." Patients with the sigmoidal pattern were older and exhibited higher plasma B-type natriuretic peptide levels. Increases in HR and oxygen consumption (VÌo2)/kg up to the anaerobic threshold level were not different between both patterns. However, beyond the threshold, the sigmoidal pattern group showed no further increase in HR and significantly lower VÌo2/kg than their counterparts (interactions for P < 0.001). HR response during exercise in patients with heart failure and sinus rhythm was categorized into two unique groups: sigmoidal and exponential patterns. More detailed clarification of the sigmoidal pattern, potentially indicating sinus node dysfunction, should offer new clinical insights for chronotropic incompetence.NEW & NOTEWORTHY Heart rate response patterns can be classified into two groups among patients with chronic heart failure reaching maximal exertion: sigmoidal and exponential.
Asunto(s)
Prueba de Esfuerzo , Insuficiencia Cardíaca , Frecuencia Cardíaca , Consumo de Oxígeno , Humanos , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/metabolismo , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad Crónica , Ejercicio Físico/fisiología , Tolerancia al Ejercicio , Umbral Anaerobio , Péptido Natriurético Encefálico/sangreAsunto(s)
Fibrilación Atrial , Ablación por Catéter , Criocirugía , Embolia Intracraneal , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Criocirugía/efectos adversos , Ablación por Catéter/efectos adversos , Estudios Prospectivos , Incidencia , Embolia Intracraneal/etiología , Embolia Intracraneal/epidemiología , Resultado del Tratamiento , Masculino , Femenino , Factores de Riesgo , Persona de Mediana Edad , Anciano , Factores de TiempoAsunto(s)
Potenciales de Acción , Fibrilación Atrial , Ablación por Catéter , Frecuencia Cardíaca , Venas Pulmonares , Fibrilación Atrial/cirugía , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Venas Pulmonares/cirugía , Venas Pulmonares/fisiopatología , Humanos , Resultado del Tratamiento , Masculino , Técnicas Electrofisiológicas Cardíacas , Recurrencia , Factores de Tiempo , Persona de Mediana Edad , Femenino , AncianoAsunto(s)
Fibrilación Atrial , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Pronóstico , Factores de Riesgo , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Fibrilación Atrial/diagnóstico , Medición de Riesgo/métodosRESUMEN
BACKGROUND: Epicardial unipolar mapping has not been thoroughly investigated in Brugada syndrome (BrS). OBJECTIVES: This study aims to examine the characteristics of epicardial unipolar potentials in BrS and investigate the differences from overt cardiomyopathy. METHODS: Epicardial mapping was performed in 8 patients with BrS and 6 patients with cardiomyopathy. We investigated the J-wave amplitudes using unipolar recordings at delayed potential (DP) sites via bipolar recordings. The repolarization time (RT) at and around the DP recording sites was measured, and maximum dispersion of the RT divided by the distance was defined as the RT dispersion index. RESULTS: Epicardial mapping at baseline revealed significantly higher J-wave amplitude with bipolar DP in patients with BrS than in patients with cardiomyopathy. J-wave amplitude ≥0.42 mV had 99.1% sensitivity and 100% specificity for diagnosing BrS. The RT dispersion index was significantly higher in patients with BrS than in patients with cardiomyopathy at baseline. In all patients with BrS, coved-type unipolar electrograms without negative T waves (short RT) appeared close to coved-type electrograms with negative T waves (long RT) at the DP recording sites after pilsicainide administration. Thus, a steep RT dispersion was observed in this region, and ventricular arrhythmias emerged from this shorter RT area in all 3 patients with BrS in whom ventricular arrhythmias were induced. CONCLUSIONS: Bipolar DP-related prominent unipolar J waves and steep repolarization gradients may be more specific for characterizing BrS than for overt cardiomyopathy. Ventricular arrhythmias in BrS are associated with a steep repolarization gradient, indicating phase 2 re-entry as a possible cause.