Ventricular arrhythmias among patients with implantable cardioverter-defibrillator during the COVID-19 pandemic.

Background: Coronavirus Disease-2019 (COVID-19) has been associated with myocardial injury and higher risk of arrhythmic complications. However, no reports are available about the effect of the ongoing pandemic on arrhythmias in patients at risk. Objective: To describe the effect of COVID-19 pandemic on arrhythmic burden among high-risk patients. Methods: This is a cross-sectional study on the incidence of ventricular arrhythmia (VA) during the pandemic outbreak (study period), compared to the same timeframe in 2019 (reference period). Inclusion criteria were age (>18 years) and having an implantable cardiac defibrillator (ICD). Results: Among 455 patients enrolled (mean age 64.9 ± 15.7 years; 25.1% females and 39.6% with CRTD), in the study period, 45 (9.9%) patients experienced a total of 86 VA; 8 patients (1.7%) required antitachycardia-pacing (ATP) and 6 (1.3%) at least one shock. In the reference period, a total of 69 events occurred in 36 patients (7.9%). Six patients (1.3%) required ATP and three (0.7%) at least one shock. The number of patients that suffered from any arrhythmic events in the study period (9.9% vs 7.9%) did not significantly differ from the reference period (χ2 = 1.09, P = .29). The main predictor of VA during the COVID-19 pandemic was the previous history of any ICD therapy (OR = 3.84, P < .001). Conclusions: No evidence of an increase of arrhythmic burden was found during the COVID-19 pandemic among patients with an ICD.

Cardiac arrhythmias and In-hospital mortality amongst patients with takotsubo cardiomyopathy: A retrospective study in an Italian population.

BACKGROUND: Takotsubo cardiomyopathy (TTC) is an acute non-ischemic cardiomyopathy classically associated with an intense emotional or physiologic trigger. Data on the relationship between arrhythmias and mortality in TTC have been limited by small sample sizes. The aim of this study is to assess the impact of ventricular and atrial arrhythmias and advanced atrioventricular block on in-hospital mortality in a large inpatient population with TTC. METHODS: Data was obtained from the Italian National Healthcare System Databank from 2009 to 2016. Patients with TTC were identified using diagnosis codes and clinical characteristics were collected, with a primary outcome of mortality. Univariate and multivariate logistic regression analyses were used to identify significant predictors for mortality, and patients with TTC were further analyzed according to sex and age. RESULTS: There were 10,861 patients with TTC; 91.7% were women (9959) and the mean age was 70.7 +/- 11.9 years. The mortality rate was 2.2%; while 1.2% of patients had ventricular arrhythmias, 10.0% had atrial arrhythmias, and 1.3% had advanced atrioventricular block. Male sex, increased age and ventricular arrhythmias were predictors of mortality. In a sex-stratified analysis, ventricular arrhythmias and advanced age remained independent predictors for mortality in women. CONCLUSION: In this large retrospective analysis, male sex and the presence of ventricular arrhythmias are strong predictors of mortality in patients hospitalized with TTC.

Validation of criteria for selective his bundle and para-hisian permanent pacing.

BACKGROUND: His Bundle (HB) pacing is a valid alternative to right ventricular pacing for patients with preserved His-ventricle conduction who are candidates for permanent stimulation. Permanent pacing in the HB area enables Selective HB pacing (SHBP) or para-Hisian pacing (PHP) to be achieved. The aim of our study was to draw up a set of easy criteria to differentiate and validate the two kinds of stimulations according to the pacing output and the ECG/EKG signals. METHODS AND RESULTS: From February to July 2005, 17 patients eligible for a pacemaker (PM) procedure underwent implantation with the Medtronic SelectSecure lead (Medtronic, Minneapolis, MN, USA) screwed into the HB area.SHBP was defined when the intrinsic QRS was equal, in both duration and morphology, to the paced QRS, the His-Ventricular (H-V) interval was equal to Pace-Ventricular interval (Vp-V) and, at low output, only the HB was captured, while increasing the output resulted in both the HB and right ventricular (RV) being captured (widening of QRS at high output). Conversely, PHP was defined when the intrinsic QRS differed from the paced one, either in morphology or in duration and, at high output, both the RV and HB were captured (non-SHBP), while decreasing the output resulted in losing HB capture (widening of QRS at low output). According to these criteria, SHBP was achieved in 11 patients, while in the remaining 6, PHP was obtained. No adverse events were reported. CONCLUSIONS: The above criteria enabled SHBP and PHP to be validated easily and clearly. A longer follow-up will be needed in order to ascertain whether the clinical outcome of these two approaches differs.

Esophageal motor abnormalities in children with gastroesophageal reflux and peptic esophagitis.

Esophageal motility was studied in 26 children with gastroesophageal reflux. In 11 patients (group A), esophagitis was severe; in the remaining 15 (group B), either mild or no microscopic changes were found. Lower esophageal sphincter pressure and amplitude, as well as velocity and duration of esophageal pressure waves, were manometrically measured. All patients underwent a 12-week intensive antacid course. Manometric tracings, blindly read, were compared with those of 16 age-matched children with emesis without proven reflux (group C). Among the variables analyzed, amplitude of the motor waves was significantly lower in patients with severe esophagitis than in group B and C patients (P less than 0.01). Nonspecific motor defects (simultaneous, broad-based, double-peaked waves) were more commonly present in group A. At the end of therapy, symptoms had either disappeared or significantly improved. Endoscopic and histologic studies showed disappearance of the severe inflammatory changes. Manometry, repeated in patients with cured severe esophagitis, showed normalization of the amplitude and significant decrease of the nonspecific motility abnormalities. We conclude that severe gastroesophageal reflux disease in children causes esophageal motor dysfunction, resulting from esophageal inflammation. The occurrence of esophageal motility disorders only in patients with severe esophagitis and its disappearance after therapy may account for the favorable course of reflux disease in infancy.