UNASSIGNED: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a class of widely used hypoglycemic agents for the treatment of type 2 diabetes mellitus (T2DM). In addition to lowering blood glucose, SGLT2i protects the heart and kidney, significantly reduces cardiovascular events, and delays the progression of heart failure and chronic kidney disease. However, previous studies have not exhaustively discussed the association between SGLT2i and the risk of developing cardiac arrhythmias. The purpose of this study is to assess the association of SGLT2i with cardiac arrhythmias in patients with T2DM and without T2DM in cardiovascular outcome trials (CVOTs).
UNASSIGNED: We performed a meta-analysis and systematic review of CVOTs that compared SGLT2i with placebo. MEDLINE, Web of Science, The Cochrane Library and Embase were systematically searched from inception to December 2022. We included CVOTs reporting cardiovascular or renal outcomes with a follow-up duration of at least 6 months.
UNASSIGNED: A total of 12 CVOTs with 77,470 participants were included in this meta-analysis (42,016 SGLT2i vs 35,454 control), including patients with T2DM, heart failure (HF), or chronic kidney disease (CKD). Follow-up duration ranged from 9 months to 5.65 years. Medications included empagliflozin, canagliflozin, dapagliflozin and ertugliflozin. SGLT2i were associated with a lower risk of tachycardia (risk ratio (RR) 0.86; 95% confidence interval (CI) 0.79-0.95), supraventricular tachycardia (SVT; RR 0.84; 95% CI 0.75-0.94), atrial fibrillation (AF; RR 0.86; 95% CI 0.75-0.97) and atrial flutter (AFL; RR 0.75; 95% CI 0.57-0.99) in patients with T2DM, HF and CKD. SGLT2i could also reduce the risk of cardiac arrest in CKD patients (RR 0.50; 95% CI 0.26-0.95). Besides, SGLT2i therapy was not associated with a lower risk of ventricular arrhythmia and bradycardia.
UNASSIGNED: SGLT2i therapy is associated with significantly reduced the risk of tachycardia, SVT, AF, and AFL in patients with T2DM, HF, and CKD. In addition, SGLT2i could also reduce the risk of cardiac arrest in CKD patients. Further researches are needed to fully elucidate the antiarrhythmic mechanism of SGLT2i.

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BACKGROUND: Sophoridine (SR) has shown the potential to be an antiarrhythmic agent. However, SR\'s electrophysiological properties and druggability research are relatively inadequate, which limits the development of SR as an antiarrhythmic candidate.
OBJECTIVE: To facilitate the development process of SR as an antiarrhythmic candidate, we performed integrated studies on the electrophysiological properties of SR in vitro and ex vivo to gain more comprehensive insights into the multi-ion channel blocking effects of SR, which provided the foundation for the further drugability studies in antiarrhythmic and safety studies. Firstly, SR\'s electrophysiological properties and antiarrhythmic potentials were recorded and assessed at the cell and tissue levels by comprehensively integrating the patch clamp with the Electrical and Optical Mapping systems. Subsequently, the antiarrhythmic effects of SR were validated by aconitine and ouabain-induced arrhythmia in vivo. Finally, the safety of SR as an antiarrhythmic candidate compound was evaluated based on the guidelines of the Comprehensive in Vitro Proarrhythmia Assay (CiPA).
METHODS: The antiarrhythmic effect of SR was evaluated at the in vitro, ex vivo, and in vivo levels.
METHODS: Isolated primary cardiomyocytes and stable cell lines were prepared to explore the electrophysiologic properties of being a multiple ion-channel blocker in vitro by whole-cell patch clamp. Using electrical and optical mapping, the negative chronotropic effect of SR was determined in langendorff-perfused rat or guinea-pig hearts.The antiarrhythmic activity of SR was assessed by the ex vivo tachyarrhythmia models induced by left coronary artery ligation (LCAL) and isoproterenol (ISO). Canonical models of aconitine and ouabain-induced arrhythmia were used to verify the antiarrhythmic effects in vivo. Finally, the pro-arrhythmic risk of SR was detected in Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes (hSCCMs) using a Microelectrode array (MEA).
RESULTS: Single-cell patch assay validated the multiple ion-channel blockers of SR in transient outward current potassium currents (Ito), l-type calcium currents (ICa-l), and rapid activation delayed rectifier potassium currents (IKr). SR ex vivo depressed heart rates (HR) and ventricular conduction velocity (CV) and prolonged Q-T intervals in a concentration-dependent manner. Consistent with the changes in HRs, SR extended the active time of hearts and increased the action potential duration measured at 90% repolarization (APD90). SR could also significantly lengthen the onset time and curtail the duration of spontaneous ventricular tachycardia (VT) in the ex vivo arrhythmic model induced by LCAL. Meanwhile, SR could also significantly upregulate the programmed electrical stimulation (PES) frequency after the ISO challenge in forming electrical alternans and re-entrant excitation. Furthermore, SR exerted antiarrhythmic effects in the tachyarrhythmia models induced by aconitine and ouabain in vivo. Notably, the pro-arrhythmic risk of SR was shallow for a moderate inhibition of the human ether-à-go-go-related gene (hERG) channel. Moreover, SR prolonged field potential duration (FPDc) of hSCCMs in a concentration-dependent manner without early after depolarization (EAD) and arrhythmia occurrence.
CONCLUSIONS: Our results indicated that SR manifested as a multiple ion-channel blocker in the electrophysiological properties and exerts antiarrhythmic effects ex vivo and in vivo. Meanwhile, due to the low pro-arrhythmic risk in the hERG inhibition assay and the induction of EAD, SR has great potential as a leading candidate in the treatment of ventricular tachyarrhythmia.

UNASSIGNED: Although cardiac disorder-related adverse events (AEs) have been reported in patients treated with aryl hydrocarbon receptor (AHR) agonists, their safety profiles remain unknown. Here, we identified significant cardiac disorders associated with AHR agonists and further evaluated their relevance.
UNASSIGNED: Database queries were performed using OpenVigil 2.1 and AEs voluntarily submitted to Food and Drug Administration Adverse Event Reporting System (FAERS) between 2004 and 2020 were included. This study based on the Medical Dictionary for Regulatory Activities and the standardized MedDRA Queries to define the preferred terms, and we used reporting odd ratio to detect signals.
UNASSIGNED: In the FAERS database, 14,078 cardiac disorder-related AEs were identified in patients receiving AHR agonists. Among all AHR agonists, the number of cardiac disorder-related PTs with positive signals for AHR agonists was 93. Peripheral swelling (n = 1572) and atrial fibrillation (n = 1277) were the most reported cardiac disorder-related AEs among AHR agonists in disproportionately reported PTs. Moreover, several AHR agonists were highly associated with tachyarrhythmia.
UNASSIGNED: By mining the FAERS database, we provided more information on the association between AHR agonist use and cardiac disorder-related AEs.

OBJECTIVE: We aimed to investigate the clinical effect of predictive nursing combined with amiodarone on the treatment of tachyarrhythmia in patients with coronary heart disease (CHD).
METHODS: The clinical data of 101 patients with CHD and tachyarrhythmia in our hospital were collected retrospectively and divided into two groups according to different intervention methods. Patients in group A (n=50) were treated with Propafenone, while patients in group B (n=51) were treated with Amiodarone. Meanwhile, patients in both groups were given predictive nursing. The therapeutic effect, cardiac function indexes, electrocardiogram (ECG) monitoring results, ventricular rate, chest pain recurrence, adverse reactions, the conversion rate of atrial fibrillation and re-infarction rate were compared between two groups before and after treatment.
RESULTS: The total effective rate of group B was 94.21%, which was higher than 62.00% of group A (P<0.05). Compared with group A, group B had lower left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) and higher left ventricular ejection fraction (LVEF) after treatment (P<0.05). Group B also showed shorter QRS duration, longer PR interval and lower ventricular rate after treatment (P<0.05). The re-infarction rate and incidence of adverse reactions in group B was 3.92% and 5.88%, respectively, which was lower than 22.00% and 24.00% in group A, respectively (P<0.05).
CONCLUSIONS: Predictive nursing combined with amiodarone has ideal clinical therapeutic effects on the treatment of tachyarrhythmia in patients with CHD. It can effectively improve cardiac function, increase the conversion rate of atrial fibrillation, and it can reduce re-infarction rate, recurrence rate of chest pain as well as incidence of adverse reactions.

Atrial fibrillation (AF) is rarely found in newborns and infants. It is usually associated with some underlying diseases and presents as tachyarrhythmia. Here, we describe a case of AF in a preterm neonate. Paroxysmal AF and multifocal atrial tachycardia had been observed in the postnatal dynamic electrocardiogram. Further investigations revealed patent foramen ovale, pulmonary disease, heart failure and potential viral myocarditis. After receiving antiarrhythmic therapy and supportive treatment, the neonate underwent successful cardioversion and showed favorable outcomes without any recurrence.

OBJECTIVE: Tongguan Capsule, a traditional Chinese medicine, is safe to use and is efficient in treating ischemic heart diseases. The present study aimed to investigate whether Tongguan capsule derived-herb (TGD) can mitigate left ventricular remodeling and dysfunction in post myocardial infarction (MI) rats as well as reduce arrhythmias.
METHODS: MI was induced by a ligation of the left anterior descending coronary artery. TGD was administered to the post-MI rats over a period of 4 weeks. TGD treatment significantly attenuated tachyarrhythmia inducibility and cardiac dysfunction in post-MI heart. Echocardiogram showed that TGD significantly reduced the development of ventricular remodeling. Histological study revealed that TGD significantly reduced myocardial interstitial collagen deposition, myocyte area and α-smooth muscle actin (α-SMA) expression, and increased connexin 43 expression in the infarcted border zone (IBZ). Western blotting results revealed that TGD treatment significantly down-regulated the protein expression levels of type I and III collagen, α-SMA, and up-regulated connexin 43. RT-qPCR results showed that TGD decreased the levels of ANP and BNP.
CONCLUSIONS: These findings provided strong evidences that TGD intervention ameliorated interstitial fibrosis, myocyte hypertrophy and gap junction expression in the IBZ, attenuated left ventricular remodeling and dysfunction, and reduced vulnerability to tachyarrhythmia. TGD inhibited IBZ remodeling by its inhibition effect on myofibroblasts differentiation.

Double ventricular response in dual atrioventricular (AV) nodal pathways can result in nonreentrant supraventricular tachycardia. Since this condition was first described in 1979, around 20 cases have been reported. Here, we present the case of a patient with a confirmed diagnosis of double ventricular response in dual AV nodal pathways resembling an interpolated premature beat who underwent successful radiofrequency ablation of the slow pathway.

BACKGROUND: The risk-benefit ratio of radiofrequency catheter ablation (RFCA) in infants and toddlers remains controversial. Experience with RFCA in these patients is limited. This work is intended to describe the efficacy and safety of RFCA in children under 3 years of age with tachycardia complicated by drug resistance, drug intolerance, or tachycardia-induced cardiomyopathy.
METHODS: We retrospectively reviewed data from 123 consecutive children under 3 years of age (mean, 2.3 ± 0.8 years; weight, 13.6 ± 2.8 kg) with tachycardia complicated by drug resistance, drug intolerance, or tachycardia-induced cardiomyopathy; the children underwent an electrophysiology study between 1994 and 2014 at our center. Fifteen children had congenital heart disease, and 27 children were under 1 year of age. Among the 109 children who underwent RFCA, acute success rate (no inducible arrhythmia before procedure completion), 2-year rate of symptomatic tachyarrhythmia recurrence, and complication rate were assessed.
RESULTS: Among the 123 children studied, 76.4% had atrioventricular reentrant tachycardia, 5.7% had atrioventricular nodal reentrant tachycardia, 2.4% had focal atrial tachycardia, 6.5% had atrial flutter, and 4.1% had idiopathic left ventricular tachycardia. For RFCA, the acute success rate was 94.5%, and the 2-year recurrence rate was 6.8%, without any major complications.
CONCLUSIONS: RFCA appears to be an effective and safe therapeutic option in selected small children with tachycardia resistant to conventional medical management, tachycardia complicated by drug intolerance, or tachycardia-induced cardiomyopathy.

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