Search

Introduction: The impact of atrial arrhythmias on coronavirus disease 2019 (COVID‐19)‐associated outcomes are unclear. We sought to identify prevalence, risk factors and outcomes associated with atrial arrhythmias among patients hospitalized with COVID‐19. Methods: An observational cohort study of 1053 patients with severe acute respiratory syndrome coronavirus 2 infection admitted to a quaternary care hospital and a community hospital was conducted. Data from electrocardiographic and telemetry were collected to identify atrial fibrillation (AF) or atrial flutter/tachycardia (AFL). The association between atrial arrhythmias and 30‐day mortality was assessed with multivariable analysis. Results: Mean age of patients was 62 ± 17 years and 62% were men. Atrial arrhythmias were identified in 166 (15.8%) patients, with AF in 154 (14.6%) patients and AFL in 40 (3.8%) patients. Newly detected atrial arrhythmias occurred in 101 (9.6%) patients. Age, male sex, prior AF, renal disease, and hypoxia on presentation were independently associated with AF/AFL occurrence. Compared with patients without AF/AFL, patients with AF/AFL had significantly higher levels of troponin, B‐type natriuretic peptide, C‐reactive protein, ferritin and d‐dimer. Mortality was significantly higher among patients with AF/AFL (39.2%) compared to patients without (13.4%; p <.001). After adjustment for age and co‐morbidities, AF/AFL (adjusted odds ratio [OR]: 1.93; p =.007) and newly detected AF/AFL (adjusted OR: 2.87; p <.001) were independently associated with 30‐day mortality. Conclusion: Atrial arrhythmias are common among patients hospitalized with COVID‐19. The presence of AF/AFL tracked with markers of inflammation and cardiac injury. Atrial arrhythmias were independently associated with increased mortality. [ABSTRACT FROM AUTHOR]

Background Adenosine (ADO) can uncover dormant conduction following pulmonary vein (PV) isolation. We sought to identify the value of dormant conduction for predicting atrial fibrillation (AF) recurrence and chronic PV reconnection. Methods One hundred fifty-two patients (80 male; age 60 ± 11 years) undergoing PV isolation for AF were studied. After PV isolation, sites of ADO-induced PV reconnection were recorded and targeted with additional ablation. In patients undergoing repeat ablation for recurrent AF, chronic PV reconnection was assessed. Results Forty-five (30%) patients had ADO-induced PV reconnection following PV isolation. Dormant conduction was successfully eliminated with additional ablation in 41 (91%) of these patients. After follow-up of 598 ± 270 days, 60 (39%) patients had recurrent AF. Dormant PV conduction was not a significant predictor of AF recurrence (hazard ratio 1.51; 95% confidence interval: 0.89-2.56; P = 0.12) although three of four (75%) patients with residual dormant conduction following initial ablation developed recurrent AF. Twenty-six patients with recurrent AF underwent repeat ablation with 52 of 99 (53%) PVs found to have chronic reconnection. Nine of 11 (82%) PVs with dormant conduction and 43 of 88 (49%) PVs without dormant conduction at initial procedure had chronic reconnection at repeat ablation. Conclusions When additional ablation is performed to eliminate ADO-induced PV reconnection after PV isolation, dormant conduction is not a significant predictor of recurrent AF. Although PVs with dormant conduction at initial procedure may develop chronic reconnection, the majority of PVs that show conduction recovery at repeat ablation occur in nondormant PVs. [ABSTRACT FROM AUTHOR]

Recovery of AV Conduction After Valve Surgery Background Atrioventricular block (AVB) occurs commonly after valve surgery, and permanent pacemaker (PPM) implantation is often required. However, the rate and time course of spontaneous recovery of AV conduction in these patients is not known. The goal of this study was to define the rate and risk factors for late high-grade AVB in patients who have PPM implantation for this indication. Methods Serial PPM or defibrillator interrogation data as well as demographic and operative data were reviewed from consecutive patients who had device implantation for AVB following valve surgery. Predictors of late AVB were identified with multiple regression models, and recovery of AV conduction was determined with Kaplan-Meier analyses. Results Among 98 patients included in the analysis, 58% (57/98) had evidence of late high-grade AVB, with a mean follow-up of 3.6 years. Of the 57 patients with late AVB after PPM implantation, 44 (77%) displayed pacing dependency. In multivariate analyses, persistent AVB in the immediate postoperative period was the only variable associated with late AVB (odds ratio 5.3, 95% confidence interval [2.1, 13.5], P = 0.0006). Among patients who recovered AV conduction within 1 month of surgery, 26% developed AVB during extended follow-up. Conclusions Approximately 40% of patients who received a PPM for AVB after valve surgery displayed no evidence of high-grade AVB during serial device interrogations. However, simple baseline demographic, operative, and postoperative variables are not sufficiently robust for discriminating those patients with early postoperative AVB who will not need long-term pacing following valve surgery. [ABSTRACT FROM AUTHOR]

Acute exacerbations of heart failure (HF) are believed to trigger malignant ventricular arrhythmias, but the temporal association between fluid accumulation and ventricular arrhythmias has not been evaluated in an objective manner. We hypothesized that increased intrathoracic fluid accumulation in patients with HF, as measured by an index of intrathoracic impedance, is associated with an increased risk of ventricular arrhythmias. : We analyzed interrogations in a cohort of 96 patients with left ventricular dysfunction (EF ≤ 35%) with devices that monitor intrathoracic impedance (OptiVol fluid index). Treated episodes of ventricular tachycardia or fibrillation (VT/VF) were adjudicated and stratified according to predetermined fluid index thresholds (OptiVol indices of 15, 30, 45, 60 Ω-days). VT/VF episodes occurred in 16 patients (17%). VT/VF was more common on days when the fluid index was elevated using threshold values of 15, 30, and 45 Ω-days (P = 0.006, 0.04, 0.02, respectively). There were no differences in the percent of time above any threshold between patients with and without VT/VF. : In patients with HF who develop VT/VF, volume overload, as detected by an index incorporating changes in intrathoracic impedance, was temporally associated with malignant ventricular tachyarrhythmias. (J Cardiovasc Electrophysiol, Vol. 22, pp. 293-299, March 2011) [ABSTRACT FROM AUTHOR]