Arrhythmias and electrocardiographic changes in systolic heart failure

Abstract

Background:Heart failure is a common condition that that leads to hospitalization. It is associated with various atrial and ventricular arrhythmias.Aim:The aim of this study is to find common arrhythmias and electrocardiographic changes in hospitalized patients who have systolic heart failure.Materials and Methods:This is a retrospective study of medical records, and electrocardiograms (EKGs) of 157 patients admitted to our hospital who had systolic heart failure with ejection fraction (EF) <50% on echocardiogram. Based on EF, the patients were divided into two groups; one with EF ≤ 35% and the other with EF > 35%. Twelve-lead EKG of these patients was studied to identify common arrhythmia and demographic variables; laboratory results were compared to identify the differences.Results:A total of 157 patients with systolic heart failure, 63.7% had an EF ≤ 35%. Hypertension 82.8%, diabetes 49%, coronary artery disease 40.8%, chronic obstructive pulmonary disease or bronchial asthma 22.3%, and stroke 12.1% were common associated co-morbidities. On analysis of EKG, 28.6% had tachycardia, 21.9% had prolonged PR > 200 ms, 16.3% had wide QRS > 120 ms, 70.7% had prolonged corrected QT (QTc), and 42.2% had left axis deviation. The most common arrhythmias were sinus tachycardia and atrial fibrillation/flutter which were found in 14.6% and 13.4%, respectively. The left ventricular hypertrophy was a common abnormality found in 22.4% followed by ventricular premature contractions 18.4%, atrial premature contractions 9.5%, and left bundle branch block 6.1%. Patients with severe systolic heart failure had prolonged QRS (P = 0.02) and prolonged QTc (P = 0.01) as compared to the other group.Conclusions:Sinus tachycardia and atrial fibrillation/flutter were common arrhythmias in patients with systolic heart failure. Patients with severe systolic heart failure had statistically significant prolongation of the QRS duration and QTc interval.

Acquired long QT syndrome in chronic kidney disease patients

“…Drugs [21][22][23][24][25][26] The risk of drug-induced QTc interval prolongation varies by drug and presence of risk factors Comorbidities Cardiomyopathy; [18,19] Cardiomyopathy is a risk factor for QT prolongation. Congestive heart failure; [27,28] Patients with severe systolic HF had statistically significant prolongation of the QTc interval. The prevalence of LQTS was 63% in patients with HF against 4.4% in normal populations Left ventricular hypertrophy; [29,30] Myocardial hypertrophy induced by hypertension can result in 'reduced repolarization reserve', and thus a latent acquired LQTS Diabetes; [31,32] The LQTS shows high prevalence in diabetic patients and it could forecast cardiovascular and all-cause death Chronic kidney disease; [22,33,34] QT interval prolongation is prevalent in CKD and hemodialysis patients Liver failure; [20] Liver cirrhosis is a risk factor for QT prolongation.…”

“…The prevalence of LQTS in patients with heart failure is 60-70.2% [27,28]. Abnormalities of left ventricular function are common in people with CKD, and the incidence increases with the decline in kidney function [55].…”

Postnatal undernutrition in mice causes cardiac arrhythmogenesis which is exacerbated when pharmacologically stressed

“…The development of atrial flutter if gone untreated can potentially lead to an increased risk of atrial fibrillation and stroke due to the increased risk of blood clot formation in the atria. [55][56][57][58][59] It has been well documented in the literature that early life growth restriction increases the risk for stroke. 12 While the etiology of stroke risk from fetal origins may be independent of atrial fibrillation the fact that early life undernutrition also increases the risk of atrial flutter and fibrillation there is a further increase in the risk of stroke for individuals exposed to early life growth restriction.…”

A meta-analysis of ECG abnormalities (arrhythmias) in different types of heart failure

“…The 22 studies included countries in America (the U.S and Canada), Europe (the U.K., Netherlands, Denmark, and the Czech Republic), Asia (Japan, Pakistan, India), and Africa (sub-Saharan Africa, Nigeria, and Ghana). Together, the11 registries and 22 HF studies only evaluated a few types of HF, which included thyrotoxic HF [27][28][29][30][31], HFrEF [18,23,25,[32][33][34][36][37][38][39][40], ischemic [34,41], HFpEF [25,35], HFmEF [25], hypertensive [18,23,26,47,48], right HF [18], and systolic HF [42][43][44][45][46].…”

“…The bulk of the studies defined HF types based on structural and/or functional abnormalities. These studies mostly categorized HF by quantifying LVEF into HFrEF, HFpEF, HFmEF, and systolic HF [18,23,25,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Other studies categorized HF type based on the causative agent rather than functional changes but, in effect, relied on LVEF values to confirm HF diagnosis.…”