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Arrhythmia is the main cause of pregnancy-related hospitalizations. Potential risk of arrhythmias during pregnancy is associated with hypercoagulation and increased risk of thromboembolism. The aim. To increase patients’ safety and to improve maternal and perinatal outcomes by choosing the optimal medical strategy. Methods. We present the experience of multidisciplinary care for 54 pregnant and parturient women (32 with tachy-, 20 with bradyarrhythmia and 2 with ventricular asynchrony) who were admitted to the cardiac surgery facility from December 2013 to February 2022. Pacemakers were implanted in 15 cases of complete atrioventricular block radiofrequency ablation was performed in 12 cases. Results. There were no near misses and maternal losses in our group of patients. Two programmed perinatal losses were provided in patients with rhythm disorders and complex congenital heart defects. Type and place of delivery were chosen by the multidisciplinary team. There were nine childbirths at a specialized cardiac surgery clinic. There were no perinatal losses among patients who underwent rhythm interventions. In our group of patients, electrical cardioversion was performed in three cases, the pregnancies ended successfully with the birth of healthy newborns. Conclusions. Arrhythmias in all trimesters of pregnancy and the postpartum period are a common reason for seeking medical attention and hospitalization during pregnancy.Most of the arrhythmias are hemodynamically insignificant and don’t require hospitalization. Maternal risk stratification of major cardiac events during pregnancy, childbirth and the postpartum period is the cornerstone for choosing a strategy of medical care for pregnant women with arrhythmias. Patients with hemodynamic manifestations of tachy- and bradyarrhythmias, as well as patients with life-threatening types of rhythm disturbances are in the focus of attention of pregnancy heart team. Preconceptional management of patients with life threating arrhythmias is the best type of care in these patients. Pregnancy and delivery in high-risk class patients should be managed in an experienced center with on-site interventional electrophysiology techniques. Rhythm interventions have extremely limited indications and can be conducted when less invasive treatment strategy is unsuccessful.

Copyright of Herzschrittmachertherapie und Elektrophysiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: In children, a broad range of paroxysmal events, including syncope and arrhythmias, may mimic true epileptic seizures. When a definitive diagnosis could not be established, long-term video electroencephalogram monitoring (LTVEM) should be taken into consideration. Furthermore, epilepsy patients have a higher rate of cardiac comorbidities. The purpose of this study is to evaluate the rationale and results of the pediatric cardiology consultations in patients admitted to the LTVEM unit. Materials and Methods: We retrospectively analyzed the files of children who were admitted to LTVEM unit and consulted with the pediatric cardiology department between January 2006 and May 2014. The patients who had both echocardiography and 24-hour ambulatory electrocardiogram monitoring were included. Results: Among 70 children, 74.3% (n: 52) were classified as having epilepsy, 21.4%. (n: 15) with nonepileptic events, and 4.3% (n: 3) could not be classified. In epilepsy group, 21 children (40.4%) were consulted with pediatric cardiology due to rhythm disturbances detected during LTVEM, the remaining consultations (59.6%) were due to history of known cardiac diagnosis (arrhythmias n: 2, structural/congenital heart disease n: 5), tuberosclerosis (n: 6), drop attacks (n: 5), murmur (n: 5), and other reasons. The cardiac evaluation revealed previously undetected arrhythmia (n:3) and mitral valve prolapse (n:1) in four patients with epilepsy. In addition to the pre-existing long QT syndrome, one child experienced his typical attack, subsequently he was diagnosed as epilepsy. The remaining group consisted of 18 children, with syncope being the most common diagnosis for consultation (n: 10, 55.5%). Conclusion: Our study revealed that a subgroup of children with epilepsy had cardiovascular comorbidities. Additionally, epilepsy was confirmed in some patients who already had cardiac problems. Pediatricians should be aware of potential mimickers of epilepsy and note that epilepsy and cardiac problems may also co-exist. Correct diagnosis and appropriate treatment are crucial in this patient group. [ABSTRACT FROM AUTHOR]

Chagas Disease (CD) is highly prevalent among the indigenous populations in the Sierra Nevada de Santa Marta, Colombia. Villages examined show prevalence rates ranging from 43.6% up to 67.4%. In the present study, associated medical conditions were assessed with a particular focus on ECG alterations. CD diagnosis was based on a rapid test, two different ELISAs, and a specific and highly sensitive Chagas real-time PCR. In both CD positive and CD negative patients, relations of the status and medical (physical examination-based, questionnaire-based) and/or electrocardiogram-based findings were investigated. As expected, CD-associated symptoms and complaints were predominantly found in CD-positive patients. Interestingly, ECG-findings were found to show the potential of leading to early CD diagnosis because ECG alterations were already seen in early stagechanges of the disease. In conclusion, although the observed ECG changes are unspecific, they should be considered as an indicator for a CD screening and, in case of positive results, an associated early treatment of the disease.

Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder characterised by restrictive patterns of behaviour and alterations in social interaction and communication. Up to 80% of children with ASD exhibit sleep-wake cycle disturbances, emphasising the pressing need for novel approaches in the treatment of ASD-associated comorbidities. While sleep disturbances have been identified in ASD individuals, little has been done to assess the contribution of the circadian system to these findings. The objective of this study is to characterise circadian behaviour and clock-gene expression in a valproic acid (VPA)-induced animal model of autism to highlight perturbations potentially contributing to these disturbances. Male and female VPA-exposed offspring underwent circadian challenges, including baseline light-dark cycles, constant dark/light and light pulse protocols. Baseline analysis showed that VPA-exposed males, but not females, had a greater distribution of wheel-running behaviour across light-dark phases and a later activity offset (p < 0.0001), while controls showed greater activity confinement to the dark phase (p = 0.0256). Constant light analysis indicated an attenuated masking response and an increase in the number of days to reach arrhythmicity (p < 0.0001). A 1-h light pulse (150 lux) at CT 15 after 6 days of constant dark showed that both sexes exposed to VPA exhibited a lesser phase-shift when compared to controls (p = 0.0043). Immunohistochemical and western-blot assays reveal no alterations in retinal organisation or function. However, immunohistochemical assay of the SCN revealed altered expression of BMAL1 expression in VPA-exposed males (p = 0.0016), and in females (p = 0.0053). These findings suggest alterations within the core clockwork of the SCN and reduced photic-entrainment capacity, independent of retinal dysfunction. The results of this study shed light on the nature of circadian dysregulation in VPA-exposed animals and highlights the urgent need for novel perspectives in the treatment of ASD-associated comorbidities. [ABSTRACT FROM AUTHOR]

Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder characterised by restrictive patterns of behaviour and alterations in social interaction and communication. Up to 80% of children with ASD exhibit sleep-wake cycle disturbances, emphasising the pressing need for novel approaches in the treatment of ASD-associated comorbidities. While sleep disturbances have been identified in ASD individuals, little has been done to assess the contribution of the circadian system to these findings. The objective of this study is to characterise circadian behaviour and clock-gene expression in a valproic acid (VPA)-induced animal model of autism to highlight perturbations potentially contributing to these disturbances. Male and female VPA-exposed offspring underwent circadian challenges, including baseline light-dark cycles, constant dark/light and light pulse protocols. Baseline analysis showed that VPA-exposed males, but not females, had a greater distribution of wheel-running behaviour across light-dark phases and a later activity offset (p < 0.0001), while controls showed greater activity confinement to the dark phase (p = 0.0256). Constant light analysis indicated an attenuated masking response and an increase in the number of days to reach arrhythmicity (p < 0.0001). A 1-h light pulse (150 lux) at CT 15 after 6 days of constant dark showed that both sexes exposed to VPA exhibited a lesser phase-shift when compared to controls (p = 0.0043). Immunohistochemical and western-blot assays reveal no alterations in retinal organisation or function. However, immunohistochemical assay of the SCN revealed altered expression of BMAL1 expression in VPA-exposed males (p = 0.0016), and in females (p = 0.0053). These findings suggest alterations within the core clockwork of the SCN and reduced photic-entrainment capacity, independent of retinal dysfunction. The results of this study shed light on the nature of circadian dysregulation in VPA-exposed animals and highlights the urgent need for novel perspectives in the treatment of ASD-associated comorbidities.

Rhythm disturbances are life-threatening cardiovascular diseases, accounting for many deaths annually worldwide. Abnormal electrical activity might arise in a structurally normal heart in response to specific triggers or as a consequence of cardiac tissue alterations, in both cases with catastrophic consequences on heart global functioning. Preclinical modeling by recapitulating human pathophysiology of rhythm disturbances is fundamental to increase the comprehension of these diseases and propose effective strategies for their prevention, diagnosis, and clinical management. In silico, in vivo, and in vitro models found variable application to dissect many congenital and acquired rhythm disturbances. In the copious list of rhythm disturbances, diseases of the conduction system, as sick sinus syndrome, Brugada syndrome, and atrial fibrillation, have found extensive preclinical modeling. In addition, the electrical remodeling as a result of other cardiovascular diseases has also been investigated in models of hypertrophic cardiomyopathy, cardiac fibrosis, as well as arrhythmias induced by other non-cardiac pathologies, stress, and drug cardiotoxicity. This review aims to offer a critical overview on the effective ability of in silico bioinformatic tools, in vivo animal studies, in vitro models to provide insights on human heart rhythm pathophysiology in case of sick sinus syndrome, Brugada syndrome, and atrial fibrillation and advance their safe and successful translation into the cardiology arena.

Chagas Disease (CD) is highly prevalent among the indigenous populations in the Sierra Nevada de Santa Marta, Colombia. Villages examined show prevalence rates ranging from 43.6% up to 67.4%. In the present study, associated medical conditions were assessed with a particular focus on ECG alterations. CD diagnosis was based on a rapid test, two different ELISAs, and a specific and highly sensitive Chagas real-time PCR. In both CD positive and CD negative patients, relations of the status and medical (physical examination-based, questionnaire-based) and/or electrocardiogram-based findings were investigated. As expected, CD-associated symptoms and complaints were predominantly found in CD-positive patients. Interestingly, ECG-findings were found to show the potential of leading to early CD diagnosis because ECG alterations were already seen in early stagechanges of the disease. In conclusion, although the observed ECG changes are unspecific, they should be considered as an indicator for a CD screening and, in case of positive results, an associated early treatment of the disease.

Background: The incidence of atrial fibrillation (AF) is increased by an average of approximately 2.5-fold in recreational and elite athletes, depending on the intensity of exercise. It is, however, difficult to determine the exact duration or intensity of exercise that increases the risk of AF. The pathophysiological mechanisms of AF in athletes are a combination of pulmonary vein ectopy as a trigger, myocardial changes such as fibrosis and remodeling processes, and modulators such as changes in the autonomic nervous system. However, gastroesophageal reflux also seems to play an important role., Material and Methods: The classic AF diagnosis is performed by means of 12-lead or Holter ECG; arrhythmia recordings via chest belts and pulse watches are not sufficient for the differentiation of the arrhythmia. However, wearables with the capability of ECG recording can also be used for AF screening. The first AF documentation in an athlete should be followed by cessation of physical exercise and initiation of detailed cardiac diagnostics. Thereafter, evaluation of oral anticoagulation is important. Long-term antiarrhythmic therapies are usually not tolerated or desired by athletes. Thus, valuable therapeutic options are either a "pill in the pocket" therapy with antiarrhythmic drugs or catheter ablation., (© 2022. The Author(s).)

Rhythm disturbances are life-threatening cardiovascular diseases, accounting for many deaths annually worldwide. Abnormal electrical activity might arise in a structurally normal heart in response to specific triggers or as a consequence of cardiac tissue alterations, in both cases with catastrophic consequences on heart global functioning. Preclinical modeling by recapitulating human pathophysiology of rhythm disturbances is fundamental to increase the comprehension of these diseases and propose effective strategies for their prevention, diagnosis, and clinical management. In silico, in vivo, and in vitro models found variable application to dissect many congenital and acquired rhythm disturbances. In the copious list of rhythm disturbances, diseases of the conduction system, as sick sinus syndrome, Brugada syndrome, and atrial fibrillation, have found extensive preclinical modeling. In addition, the electrical remodeling as a result of other cardiovascular diseases has also been investigated in models of hypertrophic cardiomyopathy, cardiac fibrosis, as well as arrhythmias induced by other non-cardiac pathologies, stress, and drug cardiotoxicity. This review aims to offer a critical overview on the effective ability of in silico bioinformatic tools, in vivo animal studies, in vitro models to provide insights on human heart rhythm pathophysiology in case of sick sinus syndrome, Brugada syndrome, and atrial fibrillation and advance their safe and successful translation into the cardiology arena. [ABSTRACT FROM AUTHOR]