Clinical Article : Association between Hypophosphatemia and Cardiac Arrhythmias in the Early Stage of Sepsis: Could Phosphorus Replacement Treatment Reduce the Incidence of Arrhythmias?

( Andrei Schwartz ),( Evgeni Brotfain ),( Leonid Koyfman ),( Ruslan Kutz ),( Shaun E. Gruenbaum ),( Moti Klein ),( Alexander Zlotnik ) 대한전해질학회 2014 Electrolytes & Blood Pressure Vol.12 No.1

It is well known that new-onset arrhythmias are common in septic patients. It is thought that hypophosphatemia in the early stages of sepsis may contribute to the development of new arrhythmias. In this study, we hypothesized that intravenous (IV) phosphorus replacement may reduce the incidence of arrhythmias in critically ill patients. 34 adult septic patients with hypophosphatemia admitted to the general intensive care unit were treated with IV phosphorus replacement per ICU protocol, and the incidence of new arrhythmias were compared with 16 patients from previously published data. IV phosphorus replacement was associated with a significantly reduced incidence of arrhythmias (38% vs. 63%, p=0.04). There were no differences in observed mortality between subgroups, which may be due to the small sample size. This study demonstrated that IV phosphorus replacement might be effective in reducing the incidence of new arrhythmias in septic patients.

부정맥의 약물요법

남기병 대한의사협회 2013 대한의사협회지 Vol.56 No.5

Management of cardiac arrhythmias involves antiarrhythmic drugs (AADs), catheter ablation,pacemakers, and implantable defibrillators. The effects of AADs are mediated by blocking various cardiac ion channels, mostly the cardiac sodium, calcium, or potassium channels. A simple classification of AADs based upon the target sites of drug action is useful for clinical application of AADs for common cardiac arrhythmias. Atrioventricular nodal blocking agents are useful for management of tachycardias with the atrioventricular node as a part of the reentrant circuit. Membrane active AADs are used for tachycardias occurring within the atrium or ventricle. Recent large randomized clinical trials have failed to show any beneficial effects of AADs for reducing cardiac mortality in patients with heart failure and at risk of sudden cardiac death or in patients with atrial fibrillation. In spite of these limitations, AAD medication remains an important initial or adjunctive therapy in the management of cardiac arrhythmias.

Urate-lowering therapy is associated with a reduced risk of arrhythmias: a systematic review and meta-analysis

( Palapun Waitayangkoon ),( Thiratest Leesutipornchai ),( Witina Techasatian ),( Noppawit Aiumtrakul ),( Manasawee Tanariyakul ),( Chinnawat Arayangkool ),( Tatchaya Kanthajan ),( Todd Nagamine ),( Ja 대한류마티스학회 2024 대한류마티스학회지 Vol.31 No.2

Objective: While urate-lowering therapy (ULT) is linked to increased cardioprotective benefits on primary prevention of cardiovascular events such myocardial infarction or heart failure, little is known regarding their effects on arrhythmia risk. The purpose of this study was to investigate the relationship between incident arrhythmias and ULT. Methods: We searched MEDLINE and Embase from inception to May 2023. Included studies were randomized controlled trials and cohort studies that compared the risk of cardiac arrhythmias among ULT users with non-ULT users. Results: A total of 12,420 patients from five studies were analyzed, comprising 7,359 subjects in the ULT group and 5,061 subjects in the non-ULT group. Our results showed that ULT users had significant reductions in the risk of arrhythmias (pooled relative risk [RR] 0.82, 95% confidence interval [CI]: 0.74~0.92, p<0.001, I²=0.0%) compared to non-ULT users. Subgroup analysis did not show that ULT users had a significant reduced risk of atrial fibrillation (pooled RR 0.76, 95% CI: 0.54~1.05, p=0.096 with I²=15.4%) compared to non-ULT users. Conclusion: ULT is associated with lower risk of overall arrhythmias. Further studies are warranted to confirm our findings.

소아 선천성 심장병 개심술 후 발생한 조기 부정맥

최희정,김여향,조준용,현명철,이상범,김규태,Choi, Hee-Joung,Kim, Yeo-Hyang,Cho, Joon-Yong,Hyun, Myung-Chul,Lee, Sang-Bum,Kim, Kyu-Tae 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.4

목 적 : 선천성 심장병의 개심술 직후에 발생하는 부정맥은 술 후 조기 사망의 주된 원인의 하나인데, 이는 심폐 우회술 및 심근보호법의 발달, 술 후 집중치료와 적절한 약물 치료로 감소시킬 수 있다. 이에 이번 연구에서는 선천성 심장병의 개심술 후 조기에 발생한 부정맥의 빈도와 종류, 그 위험 인자들을 조사하여 보았다. 방 법: 2002년 1월부터 2008년 12월까지 선천성 심장병으로 경북대학교병원에서 개심술을 시행받은 561명의 환자를 대상으로 하였다. 이들의 의무기록지를 후향적으로 조사하여 진단명, 수술방법, 수술 후 부정맥이 발생한 시기와 기간, 부정맥의 종류와 치료방법, 부정맥으로 동반된 합병증 및 사망률, 부정맥 발생 당시 혈액 전해질 수치 등을 분석하였다. 결 과 : 소아 개심술 후 조기 부정맥의 빈도는 7.3% (42/578 개심술)로 남아 23명, 여아 18명이었으며, 개심술을 시행 받은 나이는 평균 $8.7{\pm}19.8$개월, 몸무게는 평균 $5.8{\pm}4.0kg$이었다. 발생한 부정맥 종류는 방실 접합부 이소성 빈맥이 17례로 가장 많았고, 다음으로 가속 심실고유 율동이 13례였으며, 또한 대혈관 전위에 대한 동맥 전환술에서 가장 많은 빈도의 부정맥을 보였다(36.4%). 대부분의 부정맥은 치료에 반응이 좋았다. 개심술 후 조기 부정맥의 위험 인자로는 수술 당시 작은 몸무게, 어린 나이, 긴 인공 심폐기 시간과 긴 대동맥 차단 시간이었다($P$<0.05). 부정맥이 발생한 환자에서 그렇지 않은 환자에 비해 인공호흡기 사용시간과 집중치료실 입원기간이 의미있게 길었으나($P$<0.05), 사망률에서는 의미있는 차이가 없었다. 결 론 : 선천성 심장병의 개심술 후 발생하는 조기 부정맥은 주의깊은 감시와 적극적인 치료로 치명적인 결과를 줄일 수 있다. 최근 개심술의 나이가 낮아짐에 따라 술 후 조기 부정맥에 대한 더욱 세심한 관리가 필요할 것으로 생각된다. Purpose : Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. Methods : From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. Results : Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times ($P$<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer ($P$<0.05), the mortality rate was not significantly different among the 2 groups. Conclusion : Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.

부정맥의 뜸 치료 효과에 대한 체계적 문헌고찰

이보라,황주영,권정남 대한한의학회 2019 대한한의학회지 Vol.40 No.3

Objectives: The purpose of this study was to assess the effects of moxibustion treatment for Cardiac arrhythmia through a systematic review. Methods: Electronic database including Cochrane library, Pubmed, China National Knowledge Infrastructure, Embase, DBpia, and Korean studies Information Service System were searched by combining the keywords such as “arrhythmias”, “cardiac arrhythmias”, “心律失常”, “moxibustion” and “艾灸”. Through the searching, 5 randomized controlled trials(RCTs) were included except animal testing and cellular experiment etc. The quality of each RCTs was assessed using the Cochrane risk of bias tool. Results: We included 5RCTs involving 468 participants. Two RCTs compared moxibustion versus conventional treatment, another RCT compared moxibustion plus acupuncture versus conventional treatment, another RCT compared moxibustion plus herbal medicine verus conventional treatment, the other RCT compared moxibustion plus herbal medicine and ointment versus conventional treatment. These studies were evaluated by the efficacy rate of treatments. Studies measured outcomes in efficacy, heart rate, electrocardiogram and symptoms. Each of 5 trials statistically showed a significant differences in efficacy rate. One study reported about side effects and another study reported about complications. The overall risk of bias was unclear in 5 studies. Conclusions: The evidence suggests that moxibustion treatment may help to reduce cardiac arrhythmia, however, it is limited, low-certainty and we cannot rule out benefits or risks with this treatment. High-quality studies that report adverse effects are needed.

노인환자에서의 돔페리돈과 부정맥 및 돌연심장사 위험: 환자-교차연구

양보람 忠南大學校 醫藥品開發硏究所 2021 藥學論文集 Vol.36 No.-

Domperidone, a dopamine antagonist, is used for increasing gastrointestinal motility since the 70s. However, issues of domperidone related cardiac side effects were raised. To investigate the association of domperidone use and arrhythmia/sudden cardiac death in the elderly using case-crossover (CCO) design. We perform a CCO study using the National Health Insurance ServiceSenior cohort (2002~2013). The event was defined as first hospitalization with primary diagnose of arrhythmia (ICD-10 code: I47-I49) or cardiac arrest (I46) during 2003-2013. Exposures to domperidone were assessed during the 14 days prior to the date of event. We set four control periods with same lengths as the hazard periods, and we selected 120 days as washout period. Odds ratios (ORs) with 95% confidence intervals (CIs) were esti- mated by conditional logistic regression.Of 4,436 patient of events, 934 patients were prescribed domperidone in during 1-year before the event date. In CCO study, the adjusted OR for arrhythmia or sudden cardiac death was 1.42 (95% CI 1.13-1.77), and when applying 90, 60 days of washout periods, the OR was 1.20 (95% CI 0.96-1.51), 1.01 (95% CI 0.85-1.34). The association of increased risk of arrhythmia or sudden cardiac death and domperidone use in elderly patients that showed in CCO design.

Sudden Death and Ventricular Arrhythmias in Heart Failure With Preserved Ejection Fraction

Jae Hyung Cho 대한심장학회 2022 Korean Circulation Journal Vol.52 No.4

Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure (HF) cases. The prevalence of HFpEF is increasing due to an aging population with hypertension, diabetes mellitus, and obesity. HFpEF remains a challenging clinical entity due to a lack of effective treatment options. Traditional HF medications have not been shown to reduce mortality of patients with HFpEF, and an implantable cardioverter-defibrillator is not indicated due to normal ejection fraction. Sudden death is the most common mode of death in patients with HFpEF; however, the underlying mechanisms of sudden death are not fully elucidated. Although ventricular arrhythmias are responsible for the majority of sudden deaths in general, their contribution to sudden deaths in HFpEF patients is likely less significant. The mechanisms of ventricular arrhythmias in HFpEF are 1) reduced conduction velocity due to ventricular hypertrophy, 2) delayed repolarization due to potassium current down-regulation, 3) calcium leakage due to altered excitation-contraction coupling, and 4) increased ventricular fibrosis caused by systemic inflammation. Hypertension and subsequent ventricular hypertrophy reduce the conduction velocity in HFpEF hearts via heterogeneous distribution of connexin 43. Delayed repolarization caused by potassium current down-regulation in HFpEF hearts provides a window for early afterdepolarization to trigger ventricular arrhythmias. Altered excitation-contraction coupling in HFpEF can cause calcium to leak and trigger delayed afterdepolarization. Increased systemic inflammation and subsequent ventricular fibrosis provide substrates for re-entry. Further research is warranted to investigate the detailed mechanisms of ventricular arrhythmias in HFpEF.

Real-Time Automated Cardiac Health Monitoring by Combination of Active Learning and Adaptive Feature Selection

( Mohamed Ezzeldin A. Bashir ),( Ho Sun Shon ),( Dong Gyu Lee ),( Hyeongsoo Kim ),( Keun Ho Ryu ) 한국인터넷정보학회 2013 KSII Transactions on Internet and Information Syst Vol.7 No.1

Electrocardiograms (ECGs) are widely used by clinicians to identify the functional status of the heart. Thus, there is considerable interest in automated systems for real-time monitoring of arrhythmia. However, intra- and inter-patient variability as well as the computational limits of real-time monitoring poses significant challenges for practical implementations. The former requires that the classification model be adjusted continuously, and the latter requires a reduction in the number and types of ECG features, and thus, the computational burden, necessary to classify different arrhythmias. We propose the use of adaptive learning to automatically train the classifier on up-to-date ECG data, and employ adaptive feature selection to define unique feature subsets pertinent to different types of arrhythmia. Experimental results show that this hybrid technique outperforms conventional approaches and is therefore a promising new intelligent diagnostic tool.

Acupuncture treatment for cardiac arrhythmias: A systematic review of randomized controlled trials

Kim, Tae-Hun,Choi, Tae Yong,Lee, Myeong Soo,Ernst, Edzard Elsevier 2011 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.149 No.2

Hypokalemia as a risk factor for prolonged QT interval and arrhythmia in inherited salt-losing tubulopathy

Kang Seong Ryeong,Ahn Yo Han,Kang Hee Gyung,Choi Naye 대한소아신장학회 2023 Childhood kidney diseases Vol.27 No.2

Purpose: To analyze electrocardiograms (ECGs) of patients with a salt-losing tubulopathy (SLT) and to determine the frequency and risk factors for long QT and arrhythmia. Methods: A total of 203 patients aged <19 years with SLT, specifically Bartter syndrome and Gitelman syndrome, who had a 12-lead ECG were included in this retrospective study. We analyzed the presence of an arrhythmia or prolonged corrected QT (QTc) on ECGs obtained for these patients. Demographic and laboratory data were compared between patients with abnormal and normal ECG findings. Results: Out of the 203 SLT patients, 38 (18.7%) underwent electrocardiography and 10 (40.0%) of 25 patients with inherited SLT had abnormal ECG findings, including prolonged QTc and arrhythmias. The abnormal ECG group had significantly lower serum potassium levels than the normal group (median [interquartile range]: 2.50 mmol/L [2.20–2.83] vs. 2.90 mmol/L [2.70–3.30], P=0.036), whereas other serum chemistry values did not show significant differences. The cutoff level for a significant difference in QTc interval was serum potassium level <2.50 mmol/L. One cardiac event occurred in a 13-year-old boy, who developed paroxysmal supraventricular tachycardia and underwent cardiac ablation. No sudden cardiac deaths occurred in this cohort. Conclusions: The incidence of ECG abnormalities in patients with inherited SLT was 40.0%, whereas the ECG screening rate was relatively low (18.7%). Therefore, we recommend ECG screening in patients with inherited SLT, especially in those with serum potassium level <2.50 mmol/L.