Atrial fibrillation (AF) is the most common arrhythmia associated with the risk of morbidity and mortality in clinical patients. AF is considered as an arrhythmia type that develops and progresses through close connection with cardiac structural arrhythmogenic substrates. Since the introduction of catheter ablation-mediated electrical isolation of arrhythmogenic substrates, cardiac imaging indicates improved treatment outcome and prognosis with appropriate candidate selection, ablation catheter guidance, and post-ablation follow-up. Currently, cardiac computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging are essential in the case management of AF at both pre-and post-procedural stages of catheter ablation. In this review, we discuss the roles and technical considerations of CCT and CMR imaging in the management of patients with AF undergoing catheter ablation.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Case Management ; Catheter Ablation ; Catheters ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mortality ; Prognosis ; Treatment Outcome

BACKGROUND: Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. METHODS: We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. RESULTS: Compared with patients with STEMI (N = 16,315), those with NSTEMI (N = 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849-2.107). CONCLUSIONS: Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction. TRIAL REGISTRATION www.clinicaltrials.gov (No. NCT01874691).
Aged ; Arrhythmias, Cardiac ; pathology ; physiopathology ; China ; Electrocardiography ; methods ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; pathology ; physiopathology ; Odds Ratio ; Registries ; Risk Factors ; ST Elevation Myocardial Infarction ; pathology ; physiopathology

OBJECTIVES: To report our experiences in pregnant patients with pulmonary arterial hypertension (PAH) who were treated with targeted therapy. METHODS: From 2011 to 2017, women who decided to maintain pregnancies in our PAH clinic were included. Clinical data, management, and outcomes of the mothers and fetuses were reviewed. RESULTS: Nine women with PAH and 10 deliveries were reviewed. The median maternal age was 28 (26–32) years old. The functional status of each patient was New York Heart Association functional class II or III at first visit. Sildenafil was prescribed in advance in 9 cases of delivery. Multidiscipline team approach management and intensive care were performed during the peripartum period. There was no maternal or fetal mortality. Severe cardiac events occurred in 2 patients with Eisenmenger syndrome: cardiac arrest and uncontrolled arrhythmia. Non-cardiac events occurred in 3 cases: postpartum bleeding, urinary tract infection, and pneumonia. The median gestational period at delivery was about 34 (32–38) weeks. Three cases were emergent delivery because of unexpected preterm labor. Intrauterine growth restriction developed in 4 fetuses. CONCLUSIONS: Pregnancy could be maintained by the introduction of targeted therapy rather more safely than the previous era in the case of maintenance of pregnancy. Intensive care and a multidisciplinary team approach can possibly improve the outcomes of the pregnant women with PAH and their babies. However, pregnancy in patients with PAH is still strongly prohibited and it can be tried in expert center where there has sufficient multidisciplinary team approach in case of inevitability.
Arrhythmias, Cardiac ; Critical Care ; Eisenmenger Complex ; Female ; Fetal Mortality ; Fetus ; Heart ; Heart Arrest ; Hemorrhage ; Humans ; Hypertension ; Hypertension, Pulmonary ; Maternal Age ; Mothers ; Obstetric Labor, Premature ; Peripartum Period ; Pneumonia ; Postpartum Period ; Pregnancy ; Pregnant Women ; Sildenafil Citrate ; Urinary Tract Infections

Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities which may limit survival post-transplant. For these patients, left ventricular assist devices (LVADs) offer an alternative that can improve survival as well as exercise tolerance and quality of life. These devices have continued to improve as technology has improved with substantially improved durability of the devices and fewer post-implant complications. Pump thrombosis, stroke, gastrointestinal bleeding and arrhythmias post-implant have become less common with the newest devices, making destination therapy where ventricular assist device are implanted permanently in patients with advanced heart failure, a reality and an appropriate option for many patients. This may offer an opportunity for long term survival in many patients. As the first of the totally implantable devices are introduced and go to clinical trials, LVADs may be introduced that may truly be alternatives to cardiac transplantation in selected patients. Post-implant right ventricular failure remains a significant complication and better ways to identify patients at risk as well as to manage this complication must be developed.
Arrhythmias, Cardiac ; Cardiac Resynchronization Therapy ; Exercise Tolerance ; Health Care Costs ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Hemorrhage ; Humans ; Mortality ; Quality of Life ; Stroke ; Thrombosis ; Tissue Donors

BACKGROUND/AIMS: Refeeding syndrome (RFS) is a fatal clinical complication that can occur as a result of fluid and electrolyte shifts during early nutritional rehabilitation for malnourished patients. This study was conducted to determine the clinical implications of RFS in patients with acute pancreatitis (AP). METHODS: Between 2006 and 2016, AP patients with very early mortality were retrospectively enrolled from three university hospitals. RESULTS: Among 3,206 patients with AP, 44 patients died within 3 days after diagnosis. The median age was 52.5 years (range, 27 to 92 years), male-to-female ratio was 3:1, and median duration from admission to death was 33 hours (range, 5 to 72 hours). The etiology of AP was alcohol abuse in 32 patients, gallstones in five patients, and hypertriglyceridemia in two patients. Ranson score, bedside index for severity of AP, and acute physiology and chronic health evaluation-II were valuable for predicting very early mortality (median, [range]; 5 [1 to 8], 3 [0 to 5], and 19 [4 to 45]). RFS was diagnosed in nine patients who died of septic shock (n=5), cardiogenic shock (n=2), or cardiac arrhythmia (n=2). In addition, patients with RFS had significant hypophosphatemia compared to non-RFS patients (2.6 mg/dL [1.3 to 5.1] vs 5.8 mg/dL [0.8 to 15.5]; p=0.001). The early AP-related mortality rate within 3 days was approximately 1.4%, and RFS occurred in 20.5% of these patients following sudden nutritional support. CONCLUSIONS: The findings of current study emphasize that clinicians should be aware of the possibility of RFS in malnourished AP patients with electrolyte imbalances.
Alcoholism ; Arrhythmias, Cardiac ; Diagnosis ; Gallstones ; Hospitals, University ; Humans ; Hypertriglyceridemia ; Hypophosphatemia ; Mortality ; Nutritional Support ; Pancreatitis ; Physiology ; Prognosis ; Refeeding Syndrome ; Rehabilitation ; Retrospective Studies ; Shock, Cardiogenic ; Shock, Septic

Acute myocarditis is clinically rare in children, but poses a significant risk for morbidity and mortality. Children with myocarditis show a wide variety of clinical manifestations ranging from subclinical myocarditis to heart failure, hemodynamic compromise, arrhythmia, and even sudden death. Salmonella species are associated with clinical presentations including gastroenteritis, enteric fever, bacteremia, and extra-intestinal focal infections. Non-typhoidal Salmonella infections usually cause self-limiting gastroenteritis, but are rarely associated with myocarditis. In this report, we present a case of myocarditis associated with Salmonella serogroup B gastroenteritis in a previously healthy 15-year-old boy.
Adolescent ; Arrhythmias, Cardiac ; Bacteremia ; Child ; Death, Sudden ; Focal Infection ; Gastroenteritis ; Heart Failure ; Hemodynamics ; Humans ; Magnetic Resonance Imaging ; Male ; Mortality ; Myocarditis ; Salmonella Infections ; Salmonella ; Serogroup ; Typhoid Fever

Enteroviral infections are common in neonates. One important infection pathway is vertical transmission from an infected mother to her neonate. Here, we report the early detection and successful treatment of a vertically transmitted fulminant enteroviral infection associated with myocarditis and hepatitis. The patient had a sudden onset of high fever on the fourth day of life and developed severe, rapidly progressing symptoms of disseminated intravascular coagulopathy (DIC), hepatitis, and myocarditis accompanied by tachyarrhythmia. As it was the peak season for enteroviral infections and both the mother and the patient's 36-month-old sibling had a high fever around the time of delivery, we suspected an enteroviral infection. Thus, we initiated prompt evaluation of enteroviral infection, as well as close observation and intensive care of the neonate. We strongly recommend evaluation for the possibility of vertical enterovirus infection in neonates when the mother is suspected of having a viral infection (e.g., high fever and negative results from bacterial infectious studies) around the time of delivery and when the neonate shows some early symptoms of infectious diseases such as thrombocytopenia, DIC, hepatitis, and myocarditis. Early detection of enteroviral infections and prompt implementation of proper treatment are key to reduce the risk of complications and mortality associated with enteroviral infections in neonates.
Arrhythmias, Cardiac ; Child, Preschool ; Communicable Diseases ; Critical Care ; Dacarbazine ; Enterovirus ; Enterovirus Infections ; Fever ; Hepatitis ; Humans ; Infant, Newborn ; Mortality ; Mothers ; Myocarditis ; Seasons ; Siblings ; Tachycardia ; Thrombocytopenia

BACKGROUND AND OBJECTIVES: Multifocal atrial tachycardia (MAT), in general, has a favorable outcome. However, there are insufficient data regarding MAT in a pediatric population. This study sought to determine the clinical course of MAT and identify potential prognostic factors. METHODS: The medical records of MAT patients from 1997–2015 were reviewed. The arrhythmia control rate and factors for unfavorable outcomes were assessed and compared to those in the literature. RESULTS: Of the 33 included patients (19 boys and 14 girls), 27 were infants less than 1 year of age. The median age at diagnosis was 1.7 months (range, 0 day to 14 years). Fourteen (42%) patients had structural heart disease. Eight (24%) patients had lung disease and 6 (18%) had a syndromic diagnosis belonging to RASopathy. Two patients developed polymorphic ventricular tachycardia, in whom genetic analysis confirmed the presence of the RyR2 mutation several years later. MAT was controlled in 26 patients (84%) within 3.9 months (median; range, 16 days–18.4 years) using an average of 2.4 medications. There were 3 cases of cardiopulmonary mortality. The arrhythmia control rate was higher in the infant group (85%) than in the non-infant group (67%), although this trend was not statistically significant. There was a significantly lower rate of unfavorable outcomes in the idiopathic infant group (n=11) than in the other groups (p=0.008). Considering the findings of previous studies, the mortality rate was significantly higher in patients with structural heart disease than in patients without (21% vs. 5%, p=0.01). CONCLUSIONS: MAT usually affects infants and has a favorable prognosis, particularly in the idiopathic infant group. However, in the presence of other comorbidities, MAT may have a variable clinical course.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrial Flutter ; Comorbidity ; Diagnosis ; Heart Diseases ; Humans ; Infant ; Lung Diseases ; Medical Records ; Mortality ; Prognosis ; Ryanodine Receptor Calcium Release Channel ; Tachycardia ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

Ventricular arrhythmias (VA) are a major cause of sudden cardiac death (SCD) in patients with known heart disease. Risk assessment and effective prevention of SCD are key issues in these patients. Implantable cardioverter defibrillator (ICD) insertion effectively treats sustained VA and reduces mortality in patients at high risk of SCD. Appropriate anti-arrhythmic drugs and catheter ablation reduce the VA burden and the occurrence of ICD shocks. In this guideline, authors have described the general examination and medical treatment of patients with VA. Medications and catheter ablation are also used as acute phase therapy for sustained VA.
Arrhythmias, Cardiac ; Catheter Ablation ; Catheters ; Death, Sudden, Cardiac ; Defibrillators ; Heart Diseases ; Humans ; Mortality ; Risk Assessment ; Shock

PURPOSE: Whereas continuous renal replacement therapy (CRRT) has been utilized during liver transplantation (LT), there was a lack of evidence to support this practice. We investigated the adverse events at the perioperative periods in recipients of LT who received preoperative CRRT without intraoperative CRRT. METHODS: We retrospectively reviewed medical records of adult patients (age ≥ 18 years) who received LT between December 2009 and May 2015. Perioperative data were collected from the recipients, who received preoperative CRRT until immediately before LT, because of refractory renal dysfunction. RESULTS: Of 706 recipients, 42 recipients received preoperative CRRT. The mean (standard deviation) Model for end-stage liver disease score were 49.6 (13.4). Twenty-six point two percent (26.2%) of recipients experienced the serum potassium > 4.5 mEq/L before reperfusion and treated with regular insulin. Thirty-eight point one percent (38.1%) of recipients were managed with sodium bicarbonate because of acidosis (base excess <−10 mEq/L throughout LT). All patients finished their operations without medically uncontrolled complications such as severe hyperkalemia (serum potassium > 5.5 mEq/L), refractory acidosis, or critical arrhythmias. Mortality was 19% at 30 day and 33.3% at 1 year. CONCLUSION: Although intraoperative CRRT was not used in recipients with severe preoperative renal dysfunction, LT was safely performed. Our experience raises a question about the need for intraoperative CRRT.
Acidosis ; Adult ; Arrhythmias, Cardiac ; Humans ; Hyperkalemia ; Insulin ; Liver Diseases ; Liver Transplantation ; Liver* ; Medical Records ; Mortality ; Perioperative Period ; Potassium ; Renal Replacement Therapy ; Reperfusion ; Retrospective Studies ; Sodium Bicarbonate ; Transplant Recipients*