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INTRODUCTION: Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death. OBJECTIVE: To assess whether OSA increases the risk of sudden death in the non-cardiac population. METHODS: This is a systematic review of the literature. The descriptors "sudden death" and "sleep apnea" and "tachyarrhythmias" and "sleep apnea" were searched in the PubMed/Medline and SciELO databases. RESULTS: Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death. CONCLUSION: There was a cause-effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population.

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BACKGROUND: Catheter ablation has become a widely accepted treatment for atrial fibrillation, but early recurrences remain a challenge, often attributed to inflammatory responses triggered during the procedure. This systematic review and meta-analysis aimed to evaluate the effectiveness of colchicine in preventing short-term AF recurrence post-ablation. METHOD: PubMed, Embase, and Cochrane Library were searched for studies comparing use of colchicine and placebo in patients after AF ablation. Outcomes included AF recurrence, GI side effects, and hospitalization. R program (version 4.3.2) was used for statistical analysis. Heterogeneity was assessed with I2 statistics. RESULTS: Five studies, including 1592 patients, were analyzed. Pooled results revealed no statistically significant decrease in AF recurrence (OR 0.74; 95% CI 0.48-1.12; p = 0.153) and pericarditis rates (OR 0.67; 95% CI 0.26-1.72; p = 0.403) with colchicine use. No significant difference in hospitalization rates was observed between colchicine and placebo groups (OR 1.00; 95% CI 0.63-1.59; p = 0.996). In addition, gastrointestinal side effects were notably higher in the colchicine group (OR 4.84; 95% CI 2.58-9.05; p < 0.001). CONCLUSION: Prophylactic use of colchicine after atrial ablation was not associated with a reduction in AF recurrence and pericarditis rates. In addition, there was no difference in the rate of all-cause hospitalization between the groups, and colchicine use was associated with gastrointestinal adverse events.

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BACKGROUND: There are multiple factors in both technique and substrate that lead to recurrence of atrial fibrillation after ablation. We sought to examine whether the degree of heart rate increase (HRI) caused by concurrent high-power-short-duration (HPSD) incidental parasympathetic denervation during AF ablation predicts long term success. Between December 2018 and December 2021, prospectively enrolled 214 patients who presented in sinus rhythm at AF ablation. Used 50 W of power and contact force (CF) of 5-15 g and 10-20 g at a flow rate of 40 mL/min on the anterior and posterior left atrial walls, respectively. RESULTS: Males were 143 (66.8%) and paroxysmal was 124 (57.9%) patients. Mean age 61.1 ± 12.3 years and follow-up time was 32.8 ± 13.2 months. Arrhythmia occurred after 90 days in 39 (18.2%) patients, 19 (48.7%) from the paroxysmal and 20 (51.3%) from the persistent AF patients. Recurrence group showed a lower HRI from a mean of 57 ± 7.7 to 64.4 ± 10.4 bpm (12.3%) while in success group HRI was from 53.8 ± 9.7 to 66.8 ± 11.6 bpm [(24.2%) p = 0.04]. We divided HRI in 3 percentiles of ≤ 8%, > 8 ≤ 37% and > 37%. A predictor of recurrence was identified in those in the first (< 8%, p = 0.006) and a predictor of success in the later (> 37%, p = 0.01) HRI percentile. CONCLUSION: Atrial fibrillation ablation with HPSD incidental cardiac parasympathetic denervation identified that patients with lower heart rate increase are prone to recurrence while those with higher heart rate increase had higher maintenance of sinus rhythm at a long-term follow-up.

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Tachycardia-induced cardiomyopathy is an entity characterized by reversible dysfunction of the left ventricle, which can be induced by different types of arrhythmia such as atrial fibrillation, atrial flutter, incessant supraventricular tachycardia and ventricular arrhythmia (more frequent causes). Correct identification of the causative arrhythmia and normalization of the heart rate (e.g through medical treatment, electrical cardioversion, ablation) can lead to recovery of left ventricular function. Tachycardia-induced cardiomyopathy should be suspected in patients with tachycardia and left ventricular dysfunction (heart failure setting), especially when there is no history of previous heart disease. Its usual phenotype is that of non-ischaemic/non-valvular dilated cardiomyopathy and it can occur in both children (main cause: permanent junctional reciprocating tachycardia) and adults (main cause: atrial fibrillation). With proper treatment, most cases recover within a few months, though there is a risk of relapse, especially when the causal arrhythmia reappears or its control is lost. This is a narrative review that comprehensively addresses the pathophysiology, clinical manifestations, and therapeutic management of tachycardia-induced cardiomyopathy. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.

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A 26-year-old pregnant woman with 29 weeks of gestational age reported two months of cough, dyspnea, orthopnea, and palpitations. Chest tomography revealed a 10x12cm solid mass in the right lung. Echocardiography showed that the tumor compromised the right atrium and ventricle, and was diagnosed by transcutaneous biopsy as Primary Mediastinal B-Cell Lymphoma (PMCBL). The patient presented 2:1 atrial flutter, sinus bradycardia, and ectopic atrial bradycardia. Due to the rapid poor evolution, it was decided to terminate the pregnancy by cesarean section and start chemotherapy, after which the cardiovascular complications resolved. PCML is a very rare lymphoma that can affect pregnant women in any trimester, its symptoms are related to its rapid growth and compromise of the heart, causing various cardiovascular manifestations (heart failure, pericardial effusion, cardiac arrhythmias). PCMLC is characteristically chemosensitive and has a good prognosis.

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Aims: This paper evaluates the feasibility of piloting the collaborative clinical simulation (CCS) model and its assessment instruments applicability for measuring interpersonal, collaborative, and clinical competencies in cardiologic emergency scenarios for medical students. The CCS model is a structured learning model for the acquisition and assessment of clinical competencies through small groups working collaboratively to design and perform in simulated environments supported by technology. Methods: Fifty-five students were allocated in five sessions (one weekly session) conducted with the CCS model within the course Cardiovascular Diseases. The applied practice aimed at the diagnosis and treatment of tachyarrhythmias in a simulated emergency department. In addition to the theoretical classes four weeks before the simulation sessions, students were sent a study guide that summarized the Guide to the European Society of Cardiology. For each simulation session, one clinical simulation instructor, one cardiologist teacher, and the principal investigator participated. Students were divided into three groups (3-5 students) for each-session. They designed, performed, role-played, and debriefed three different diagnoses. Three instruments to assess each group's performance were applied: peer assessment used by groups, performance assessment, created and applied by the cardiologist teacher, and individual satisfaction questionnaire for students. Results: The applicability of the CCS model was satisfactory for both students and teachers. The assessment instruments' internal reliability was good, as was internal consistency with a Cronbach Alpha of 0.7, 0.4, and 0.8 for each section (Interpersonal, Clinical, and Collaborative competencies, respectively). The performance group's evaluation was 0.8 for the two competencies assessed (Tachyarrhythmia and Electrical Cardioversion) and 0.8 for the satisfaction questionnaire's reliability. Conclusions: The CCS model for teaching emergency tachyarrhythmias to medical students was applicable and well accepted. The internal reliability of the assessment instruments was considered satisfactory by measuring satisfaction and performance in the exploratory study.

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OBJECTIVE: Current estimates of the incidence of tachyarrhythmias in infants rely on clinical documentation and may not reflect the true rate in the general population. Our aim was to describe the epidemiology of tachyarrhythmia detected in a large cohort of infants using direct-to-consumer heart rate (HR) monitoring. STUDY DESIGN: Data were collected from Owlet Smart Sock devices used in infants in the US with birthdates between February 2017 and February 2019. We queried the HR data for episodes of tachyarrhythmia (HR of ≥240 bpm for >60 seconds). RESULTS: The study included 100 949 infants (50.8% male) monitored for more than 200 million total hours. We identified 5070 episodes of tachyarrhythmia in 2508 infants. The cumulative incidence of tachyarrhythmia in our cohort was 2.5% over the first year of life. The median age at the time of the first episode of tachyarrhythmia was 36 days (range, 1-358 days). Tachyarrhythmia was more common in infants with congenital heart disease (4.0% vs 2.4%; P = .015) and in females (2.7% vs 2.0%; P < .001). The median length of an episode was 7.3 minutes (range, 60 seconds to 5.4 hours) and the probability of an episode lasting longer than 45 minutes was 16.8% (95% CI, 15.4%-18.3%). CONCLUSIONS: We found the cumulative incidence of tachyarrhythmia among infants using direct-to-consumer HR monitors to be higher than previously reported in studies relying on clinical diagnosis. This finding may represent previously undetected subclinical disease in young infants, the significance of which remains uncertain. Clinicians should be prepared to discuss these events with parents.

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Conduction delay in the right ventricular outflow tract as manifested in the electrocardiogram constitutes a high-risk predictor of ventricular arrhythmias in patients with Brugada syndrome. We present a case with a right QRS axis between -90° and ±180°. This feature has never been reported in the context of Brugada syndrome. (Level of Difficulty: Advanced.).

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No presente trabalho relata-se o caso de um cão, macho, cocker spaniel americano de onze anos com histórico de dispneia aguda e intolerância ao exercício. O exame eletrocardiográfico evidenciou a presença de arritmias ventriculares, e, por meio do exame ecocardiográfico o paciente foi diagnosticado com cardiomiopatia dilatada e insuficiência cardíaca congestiva. Realizou-se o tratamento, com melhora dos sinais congestivos e das arritmias. Arritmias ventriculares são difíceis de se controlar em pacientes tratados somente para a doença cardíaca de base, sema administração de antiarrítmicos. O paciente atingiu uma sobrevida de quinze meses evidenciando a necessidade de se realizar diagnóstico e tratamento precoces, a fim de se obter uma melhora na expectativa de vida de pacientes cardiopatas.

We report a case of a dog, male, eleven year old, american cocker spaniel with a history of acute dyspnea and exercise intolerance. The electrocardiography examination revealed the presence of ventricular arrhytmias, and, through echocardiographic examination, the patient was diagnosed with dilated cardiomyopathy and congestive heart failure. Treatment was performed, with improvement in congestive signs and arrhytmias. Ventricular arrhytmias are difficult to control in patients treated only for underlying heart disease, without the administration of antiarrythmics. The patient survived for fifteen months, emphasizing the need for early diagnosis and treatment, in order to obtain an improvement in life expectancy of patients with heart disease.

El presente trabajo relata el caso de un perro Cocker spaniel americano macho, de once años con histórico de disnea aguda e intolerancia al ejercicio físico. El electrocardiograma mostró arritmias ventriculares y la ecocardiografia evidenció la presencia de una cardiomiopatía dilatada yinsuficiencia cardíaca mayor. La enfermedad fue tratada y el paciente mostró mejoría del cuadro congestivo y de las arritmias. Las arritmias ventriculares son difíciles de controlar en pacientes tratados solo por enfermedad cardíaca subyacente, sin la necessidad de administrar medicamentos antiarrítmicos. El animal tuvo una supervivencia de quince meses. Los resultados muestran la importancia de realizar un diagnóstico y un tratamiento precoces, con objetivo de mejorar la expectativa de vida de pacientes con cardiopatías.

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No presente trabalho relata-se o caso de um cão, macho, cocker spaniel americano de onze anos com histórico de dispneia aguda e intolerância ao exercício. O exame eletrocardiográfico evidenciou a presença de arritmias ventriculares, e, por meio do exame ecocardiográfico o paciente foi diagnosticado com cardiomiopatia dilatada e insuficiência cardíaca congestiva. Realizou-se o tratamento, com melhora dos sinais congestivos e das arritmias. Arritmias ventriculares são difíceis de se controlar em pacientes tratados somente para a doença cardíaca de base, sema administração de antiarrítmicos. O paciente atingiu uma sobrevida de quinze meses evidenciando a necessidade de se realizar diagnóstico e tratamento precoces, a fim de se obter uma melhora na expectativa de vida de pacientes cardiopatas.(AU)

We report a case of a dog, male, eleven year old, american cocker spaniel with a history of acute dyspnea and exercise intolerance. The electrocardiography examination revealed the presence of ventricular arrhytmias, and, through echocardiographic examination, the patient was diagnosed with dilated cardiomyopathy and congestive heart failure. Treatment was performed, with improvement in congestive signs and arrhytmias. Ventricular arrhytmias are difficult to control in patients treated only for underlying heart disease, without the administration of antiarrythmics. The patient survived for fifteen months, emphasizing the need for early diagnosis and treatment, in order to obtain an improvement in life expectancy of patients with heart disease.(AU)

El presente trabajo relata el caso de un perro Cocker spaniel americano macho, de once años con histórico de disnea aguda e intolerancia al ejercicio físico. El electrocardiograma mostró arritmias ventriculares y la ecocardiografia evidenció la presencia de una cardiomiopatía dilatada yinsuficiencia cardíaca mayor. La enfermedad fue tratada y el paciente mostró mejoría del cuadro congestivo y de las arritmias. Las arritmias ventriculares son difíciles de controlar en pacientes tratados solo por enfermedad cardíaca subyacente, sin la necessidad de administrar medicamentos antiarrítmicos. El animal tuvo una supervivencia de quince meses. Los resultados muestran la importancia de realizar un diagnóstico y un tratamiento precoces, con objetivo de mejorar la expectativa de vida de pacientes con cardiopatías.(AU)

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