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Aim. To reveal the equivalence of nebivolol replacement with ivabradine in the prevention of endothelial dysfunction and cardiac electrical instability in patients with heart failure with reduced ejection fraction (HFrEF).Material and methods. In current observational study, 126 patients with HFrEF in the postinfarction period were randomized into two groups for six-month treatment: group 1 (n=62) — standard therapy (acetylsalicylic acid 0,1 g/day, clopidogrel 75 mg/day, veroshpiron 50 mg/day, nebivolol 5 mg/day, perindopril 5 mg/day and rosuvastatin 20 mg/day; group 2 (n=66) — the same therapy with nebivolol replacement with ivabradine 10 mg/day. Initially and after 6 months, 24-hour Holter monitoring was performed, heart rate variability was determined. We also investigated endothelial dysfunction using the photoplethysmographic technique with post-occlusive reactive hyperemia (PORH) test.Results. The heart rate, the number of episodes and the duration of symptomatic and silent myocardial ischemia, total myocardial ischemia were significantly decreased in both groups (p0,05). In both groups, after therapy, parameters of heart rate variability were improved with the parasympathetic predominance (p

Background: There are no data on the influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in 24-hour Holter monitoring in systemic lupus erythematosus (SLE). Methods: Consecutive 92 SLE and 51 healthy subjects were studied. The standard 12-lead electrocardiography (ECG), Holter monitoring with heart rate turbulence (HRT) and QT, Tp-e and Tp-e/QT ratio assessment (including corrected values) were performed. Subjects with conditions causing repolarization abnormalities or insufficient number of beats suitable for QT evaluation were excluded (17 SLE and 8 controls). Results: Finally, 75 SLE and 43 sex- and age-matched controls were included to the study. In SLE patients, the median disease severity score (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI)) was 3.0. The mean values of QTc, cTp-e and cTp-e/QTc were significantly higher in SLE patients than in controls. QTc ≥ 460 ms was observed in 18.7% of patients using standard ECG and in 58.7% using Holter monitoring. With Holter monitoring, patients with SLICC/ACR-DI >3.0 presented longer QTc than those with SLICC/ACR-DI ≤3.0 (418±15 vs. 409 ± 16, p = 0.04), while cTp-e and cTp-e/QTc values were similar. Patients with abnormal HRT presented longer cTp-e and higher cTp-e/QTc than those with normal HRT (92 ± 52 vs. 71 ± 16 ms, p = 0.04; 0.244 ± 0.126 vs. 0.187 ± 0.035, p = 0.03), while QTc values were similar. No differences in QT and Tp-e parameters were observed according to disease duration. Conclusion: In SLE patients, Holter monitoring revealed QTc prolongation more frequently than standard ECG. Longer QTc values were observed in patients with more advanced disease, while increased cTp-e and cTp-e/QTc were related to cardiac autonomic dysfunction expressed by abnormal HRT. [ABSTRACT FROM AUTHOR]

Background Long‐term cardiovascular risk in patients with intermediate pauses remains unclear. Whether asymptomatic patients with intermediate pauses have increased future cardiovascular events remains unknown. We hypothesize that intermediate pause is associated with increased cardiovascular risk and mortality. Methods and Results We retrospectively analyzed 5291 patients who have pauses of

Background: Definitive knowledge of the 24-hour cardiac autonomic activity in patients with allergic rhinitis (AR) is lacking. Thus, we aimed to evaluate heart rate variability (HRV), which is used to measure cardiac autonomic activity by 24-hour Holter monitoring in patients with AR., Methods: We enrolled 32 patients who visited our clinic and were diagnosed with AR. The control group was selected four-fold (n = 128) by matching (age, sex, hypertension, and diabetes) in the AR group from a Holter registry in the cardiology department. The HRV results, which were measured using 24-hour Holter monitoring, were compared between the AR and control groups., Results: All time-domain parameters of HRV revealed no differences between the groups. However, among the frequency domain parameters of HRV, the low-frequency to high-frequency ratio and low-frequency power in normalized units were significantly lower in the AR group. Conversely, high-frequency power in normalized units was significantly higher in the AR group. In the multiple regression analysis, AR was independently associated with sympathetic withdrawal (adjusted odds ratio = 3.393, P = 0.020) after adjusting for age, sex, hypertension, diabetes mellitus, and hyperlipidemia., Conclusions: The present findings suggest differences in cardiac autonomic activity which are related with sympathetic withdrawal in patients with AR compared with that in the normal population over 24 hours., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2023 The Korean Academy of Medical Sciences.)

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Background: Despite the growing number of studies using Lorenz (Poincaré) plots (LPs) for the analysis of heart rate variability (HRV), a possible correlation between the underlying ECG waveforms and the RR scatter plots has never been systematically studied. We report a comprehensive investigation of distinct Lorenz plot patterns (LPPs) encountered in the context of major cardiac tachyarrhythmias as assessed by 24-hour Holter monitoring and detail the mechanisms underlying the specific LPPs. Methods: The 24-hour ambulatory electrocardiograms (AECGs) of 2700 patients with atrial and/or ventricular tachyarrhythmias and the AECGs of 200 controls with pure sinus rhythm were analyzed using an Elatec arrhythmia analyzing system (Elamedical, Paris 1996). This system allows for the generation of two-dimensional LPs and the exploration of the underlying ECG waveforms. Each LPP obtained was categorized according to its shape and basic geometric parameters. In accordance with the most characteristic LPP feature, the LPPs were grouped into the following distinct classes: 1) comet shape; 2) torpedo shape; 3) H-Fan shape; 4) SZ-Fan shape; 5) double side lobe pattern type A ( DSLP-A); 6) double side lobe pattern type B ( DSL-B); 7) triple side lobe pattern type A ( TSLP-A); 8) triple side lobe pattern type B ( TSLP-B);9 island pattern type A (IP-A); 10) island pattern type B ( IP-B). Results: While a comet or a torpedo shape was associated with sinus rhythms, the other LPPs were specifically linked to the presence of cardiac tachyarrhythmias. Thus, a Fan shape was associated with atrial fibrillation or multifocal atrial tachycardia, whereas a DSLP indicated the presence of atrial premature beats, and a TSLP was highly specifically linked to frequent ventricular premature beats. An island pattern was exclusively associated with the presence of an atrial tachycardia or atrial flutter (sensitivity: 100%, specificity: 100%). Conclusion: Major tachyarrhythmias imprint specific patterns on two-dimensional Lorenz plots generated from 24-hour Holter recordings. Thus, the Lorenz plot method has the potential to significantly improve the accuracy of arrhythmia detection and differentiation, particularly with respect to supraventricular tachyarrhythmias. [ABSTRACT FROM AUTHOR]

Study Objectives: The association between daytime/nighttime heart rate variability (HRV) and the apnea-hypopnea index (AHI) remains unclear. We sought a relationship between AHI and the daytime-to-nighttime HRV ratio as measured by 24-hour Holter monitoring in patients with obstructive sleep apnea., Methods: We prospectively enrolled 66 patients who visited our sleep clinic complaining of habitual snoring or sleep apnea. All underwent 24-hour Holter monitoring (to measure HRV) combined with full-night polysomnography. Sixty-two met our enrollment criteria. We evaluated the associations between HRV frequency domains and the polysomnography indices. We also considered medical histories and anthropometric data., Results: The nighttime very-low-frequency (VLF), low-frequency (LF), and high-frequency HRVs were significantly higher than the daytime values. On correlation analysis, the day/night VLF ( r  = .550, P  < .001), LF ( r  = .556, P  < .001), and high-frequency ( r  = .303, P  = .017) HRVs were significantly related to the AHI. Of the day/night HRV ratios, the VLF ( P for trend = .003) and LF ( P for trend = .013) ratios decreased significantly by obstructive sleep apnea severity. Multivariable analysis showed that the day/night VLF (β = 16.387, P  < .001) and day/night LF (β = 25.248, P  < .001) were independently (and significantly) associated with the AHI., Conclusions: Twenty-four-hour Holter monitoring may usefully predict AHI. The day/night VLF and day/night LF ratios tended to decrease by obstructive sleep apnea severity and were independently associated with the AHI., Citation: Nam E-C, Chun KJ, Won JY, Kim J-W, Lee WH. The differences between daytime and nighttime heart rate variability may usefully predict the apnea-hypopnea index in patients with obstructive sleep apnea. J Clin Sleep Med . 2022;18(6):1557-1563., (© 2022 American Academy of Sleep Medicine.)

Background: Various experimental and clinical observations suggest changes in sympathetic and vagal neural regulatory mechanisms play a critical role in altering cardiac electrical properties and favor the occurence of arrhythmic events. There is limited information about the influences of the autonomic tone on the development of episodes of paroxismal atrial fibrillation in patients with no evidence of organic heart disease. The aim of this study was to investigate changes in sympatho-vagal balance 5 minutes before the onset of atrial fibrillation. Methods: We evaluated 28 patients with no history of heart disease who were not undergoing pharmacological treatment and who had at least one episode of paroxysmal atrial fibrillation recorded during an 24-hour ECG Holter monitoring. We analyzed values of frequency domain heart rate variability parameters 5 minutes before the onset of atrial fibrillation (prefa period) compared to an equivalent period at least 1 hour after from atrial fibrillation (random period). Results: Thirty-six episodes of atrial fibrillation were recorded and our results showed we had two types of episodes. Eighteen were classified as Type A. in which we had an increase of low frequency (LF) (79.15 ± 10.76 in comparison with 62.64 ± 19.55) (P = 0.004) and a decrease of high frequency (HF) (20.82 ± 10.74 in comparison with 37.64 ± 20.20) (P = 0.004) consistent with an increase of sympathetic tone; and 18 were classified as Type B in which there was a decrease of LF (62.82 ± 15.38 in comparison with 85.97 ± 8.48) (P < 0.001), and an increase of HF (36.79 ± 14.72 compared with 14.01 ± 8.48) (P < 0.001), consistent with an increase of parasympatetic tone. Conclusion: We observed abrupt changes in sympatovagal balance in the last 5 minutes preceeding an episode of atrial fibrillation. This can be related to a double behavior in the neurogenic drive: in Type A episodes there is an increa... [ABSTRACT FROM AUTHOR]

Previous studies have reported that hypothyroidism can lead to sick sinus syndrome (SSS) or other rhythm disturbances. Variants in the alpha subunit of the cardiac sodium channel (SCN5A) are known to be among the genetic causes of SSS. We encountered an adolescent patient with SSS and hypothyroidism who also harbored an SCN5A variant. The patient was a 13-year-old girl who was referred to our hospital because of bradycardia identified during a school electrocardiography screening. Clinical examination revealed severe hypothyroidism due to Hashimoto thyroiditis and SSS. After levothyroxine supplementation, her symptoms of hypothyroidism improved; however, the SSS did not. Genetic testing revealed a heterozygous variant (c.1066 G>A, p.Asp356Asn) in SCN5A. This is the first report of the coexistence of SSS due to an SCN5A variant and severe hypothyroidism in an adolescent patient. While patients with SCN5A variants exhibit phenotypic heterogeneity due to the presence of various modifiers, the presence of severe hypothyroidism may affect the development of SSS. This case highlights the importance of genetic analysis, including testing for SCN5A variants, in patients with hypothyroidism complicated by SSS or cardiac conduction disorders.

Cardiovascular complications of the COVID-19 comprise cardiac arrhythmias, including sinus bradycardia (SB)., Case Reports: The authors present clinical data of 19 hospitalized patients (12 males), aged 20-73 years, with marked (less than 45/min during daily hours) self-limiting SB. None of them had SB at admission or earlier, none had used cardiovascular medications potentially decreasing the heart rate. Pulmonary involvement was severe in 4, moderate in 13 and mild in 2 patients; 14 needed oxygen therapy (4 using high flow oxygen equipment), none required treatment in the intensive care unit. All patients were given low molecular weight heparin in a prophylactic dose, 13 intravenous ceftriaxone, 12 dexamethasone, 8 convalescent plasma. Before SB appearance, 12 patients were treated with remdesivir (3 patients did not receive a full planned dose) and 2 with tocilizumab. SB appeared suddenly on day 5-14 from the onset of the disease, with a minimal heart rate of 32-44/min and in 3 cases it was mildly symptomatic; 2 of those received ad-hoc atropine, one orciprenaline. Interleukin-6 (Il-6) and C-reactive protein (CRP) concentrations at SB onset were significantly lower than at admission (9.3 vs 70.0 pg/ml and 16.8 vs 98.5 mg/l, respectively). Cardiac troponin I was slightly elevated in 2 patients. ECG morphology abnormalities (transient negative T waves or ST depression) were found in 4 males. All subjects had normal left ventricular ejection fraction; in 5 echocardiography revealed small pericardial effusion; in 10 patients, longitudinal strain was also studied: reginal abnormalities were found in all of them, particularly in basal segments. SB lasted 3-11 days and was reversible in all patients; none required temporary stimulation. The COVID-19 course was favorable in all patients; they were stable at discharge. During 4-12 months of posthospital observation, including clinical features, control ECG and 24-hour Holter monitoring, none of the patients was qualified for pacemaker implantation., (© 2021 MEDPRESS.)